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i
ST CROIX CO
@ A#A U
PLANNING ZONING
August 28, 2006
Mark Colman
s 1174 Rolling Hills Trail
Hudson, WI 54016
RE: Remodeling/addition to existing house, Town of St. Joseph
I 7i Code AdministraticOil Parcel # 030-1018-10-001 (5.29.19.76-B)
715-386-4680
Dear Mr. Colman:
Land Information
Planning
You have requested the Zoning Office review your remodeling project for compliance
715-3386 86-4674
with the state sanitary code (COMM 83). When remodeling or adding onto a dwelling
Real Prope ty' you are required to examine whether or not the planned modifications involve an
715-3 677 increase in design wastewater flows to the existing Private On-site Wastewater
Re Treatment System (POWTS).
cling
-386-4675 According to your stated description, the project involves finishing one additional
bedroom over the garage. The original septic system was designed and installed
based on wastewater flow for four (4) bedrooms (600 gallons/day) with a maximum
occupancy of eight (8) persons. This project will not result in an increase of the design
wastewater flow. A replacement dispersal area was installed in 1997 that used a 3-
bedroom sizing for the new trenches and added an effluent filter to improve
wastewater quality. A valve was installed that allows alternating drainfields to extend
the useful life of the septic system.
The original system was installed in 1978 by Don Schmitt using a 1200 gallon capacity
septic tank and was inspected by zoning staff at the time of installation. The system
was found to be code compliant at that time. Inspection report, as-built, and sanitary
permit documents are on file in the zoning department archives.
To prolong the life of the POWTS, remember to have the septic tank pumped at least
r;
once every three years or when the tank becomes 1/3 full of sludge and scum.
Other efforts to extend the lifespan of the system include water conservation
measures such as repair or replace leaking plumbing fixtures, reducing shower time,
running the dish washer only when it's full, avoid using a garbage disposal, using a
wash machine with a suds saver feature, etc. The projected lifespan of your POWTS
is dependent upon proper maintenance of the system.
If this POWTS should fail at any time in the future, the system will be need to be
inspected by a licensed plumber or POWTS maintainer to determine if it must be
replaced according to state code requirements in effect at that time.
57. CROIX COUNTY GOVERNMENT CENTER
1 101 CARMICHAEL ROAD, HUDSON, W1 54016 715-386-4686 FAX
PZO)CO. SAINT-CROIX. WL US W W W .CO. SAI NT-C ROIX. W I . U S
The pro osed remodeling project must comply with all applicable building codes. Please
contact the wilding Inspector for the town of St. Joseph to obtain a building permit.
Should yo have any questions, please contact this office.
Sincer
Pamela Quinn
Zoning Specialist
10
Cc- Dwight Farnham, Deputy Zoning Administrator
Sanitary permit file
Kr~:
?Y
v
ST. CRO1X COUNTY GOVERNMENT CENTER
1 101 CARMICHAEL ROAD, HUDSON, W1 54016 715386-4686 FAX
PZ@CO.SA/NT-CROIX.WI. US WWW.CO.SAINT-CROIX.WI.US
AS BUILT SANITARY SYSTEM REPORT
WNER TOWNSHIP SEC. T N, R W
'•0. ADDR SS , ST. CROIX COUNTY, WISCONSIN.
'UBDIVISION LOT LOT SIZE
PLAN VIEW
-Distances & dimensions to meet requirements of H62.20
SHOW EVERYTHING,WITHIN 100 FEET OF SYSTEM
J
PTIC TANK(S) MFGR. r_f' CONCRETE STEEL
N0. of rings on cover Depth " DRY WELL
'ENCHES NO. of width length area
'D no. of lines~3 width 1r length y~> area
depth to top of pipe.
GREGATE
. -RK RATE --r AREA REQUIRED AREA AS BUILT
::°.sciaimer: The inspection of this system by St. Croix County does not imply complete
'mpliance with State Administrative Codes. There are other areas that it is not possible
inspect at this point of construction. St. Croix County assumes no liability for
-stem operation. However, if failure is noted the County will make every a fort to
:.termine cause of failure.
:EASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYST
--INSPECTOR
DATED
PLUMBER ON JOB
LICENSE NUMBER
3' a/
L c
REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM
Sanitary Pe,%mit-&S=
State Septic 7
NAME C) Township St. C&oix County
Location.5'~'~ o~L%, Section TYN,R2W
SEPTIC TANK
Size gattonz. Numbers os Compahtmentz
Distance Fie m: Wet 12% ok greaten d dap ~
Buitd.i.ngZ!_it. Wettands
Highwaten it.
DISPOSAL SYSTEM
Distance Fnom: Wet ~ it. 12% an gneaten A2ape 6t.
/ Building it. Wettands - Ft.
l
Highwaten 6t.
FIELD DIMENSIONS:
Width o6 theneh it. Depth o5 rock below tite /Z in.
Length o6 each tine it. Depth aj rock oven tite 2- in.
Numbers , a 6 tines ~ Depth o6 tite b eZow grade in.
Totat tength o6 tines it. Sto pe o6 tneneh ~ in pen 100 it.
Distance between t i,ned 4' ,t. Depth to bedrock it.
Totat absonbtion aneg92-29 6t2 Depth to gnoundwaten --tt.
Requi,%ed area it 2
PIT DIMENSIONS:
Number o6 pigs navet anaund pits ye.a no
Outside diameters t. Depth beZow intet it.
Totat abso&b on a ea bt 2
a
Area neq n it2 rn
INSPECTED BY Ci l TITLE
APPROVED CDATE 710
REJECTED , DATE_ 197
_
T
State and County State Permit # -7 v~. 6 8
PLB67 Permit Application County Permit #
for Private Domestic Sewage Systems County
*DENOTES STATE APPROVAL REQUIRED
Date Approval Received from State if Required State Plan I.D. #
A. OWNER OF PROPERTY Mailing Address: eve,
~Ri~Xtct .r10
B. LOCATION: -51a.)'/4 Section , T N, Ra (or) o # City _
Subdivision Name, nearest road, lake or landmark Blk# Village
Township 574
C. TYPE OF OCCUPANCY: Commercial *Industrial _*Other (specify) *Variance
Single family C Duplex No. of Bedrooms No. of Persons
D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder YES-,NO # of Bathrooms
Automatic Washer YES NO Other (specify)
E. SEPTIC TANK CAPACITY 12®0 Total gallons No. of tanks
*Holding tank capacity Total gallons No. of tanks
New Installation ?Addition Replacement _ Prefab Concrete X
*Poured in Place Steel Other (specify)
F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) _vZ_ 2)___ 3) Total Absorb Area sq. ft.
New A Addition Replacement *Fill System (2, t,
Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches
Seepage Bed: Length Width Depth" Tile Depth No. of Lines 3
Seepage Pit: Inside diame r Li uid apt h Tile Size 00,11111
Percent slope of land Distance from critical slope -740
I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20,
Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared
by the Ce ied Soil T ter
NAME... # i and other information
obtained from owner/
Plumber's Signature MP/MPRSW# Phone A . -;AC 3
Plumber's Address
PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with
H62.20, including well).
Sc+a~e,
goo C
r r ° ` ♦ E,~dvA,
let
ao h
EH 115
WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES
' DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH
P.O. BOX 309
MADISON, WISCONSIN 53701
R PORT ON SOIL BORINGS AND PERCOLATION TESTS P.
LOCATIONSection 4N, P/T40(or)(Pownship or Municipality ~-j'
x
Lot No. , Block No. j 1 ~ _A1M A -County ubdvsi n Name
1*044,51,
Owner's Name: 401LOW"
Mailing Address: 6.rt~
TYPE OF OCCUPANCY: Residence 2S~- No. of Bedrooms Other
EFFLUENT DISPOSAL SYSTEM: NEW ADDITION
~y REPLACEMENT
DATES OBSERVATIONS MADE: SOIL BORINGS del-PERCOLATION TES~TSS/ IV'"v44_17e
SOILMAPSHEET J Q SOIL TYPE IV29 l
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE
NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN
BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3
P 2,
P_ L101 lzel ell-I
P-j o2k p2 2_13
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST yc~ (DEPTH TO BEDROCK IF OBSERVED)
B- -3 ~6n 'q~~r G u 6 t~ "s 7J'04
ti s-
K N
6~ 12 -Y:S
PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.)
Indicate on the plan the location and square et of suitable areas. Inn_dicate nu~ r f square feet of absorption area
o _4 0.00 C& Indicate scale
needed for building type and occupancy.
11
or distances. Give horizontal and vertical referen poin ndi to slope. r,_ •r.
i
133
rf
2
/S p A \
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tN
S4
1
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SrEA1 /,v _574 z
RECEIVED
STC - 104 JUN 2 ? 199
AS BUILT SANITARY SYSTEM REPORT - ST CAOIX NJ
0OWTY
d ~rl 4/-SJ~' /J IPflGU~ 0":1GE
OWNER 3Q6 Z0NIN3
d .
117~1 lPo!/'v6- ///S ~ 2
ADDRESS
//UIP.SSO AJ 0/S . Sy 6
fl
SUBDIVISION / CSM# 34413 LOT #
SECTION S T Lf N-R l W, Town of S~ ~b
ST. CROIX COUNTY, WISCONSIN
b 2.d - m/
- b b
PLAN VIEW
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
tioTES 1?t -IA.; 6 - /7 C T
4)h S PC) n-
0-0
go b
s yS . 4v4-s /,v S~ 4,14 , f S
'q" 7. Z E4S 7-
S&P f7
S'c~ . ~-o o 1, f /c~ 7" S~ j o/a~
0,45
S~ INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this form.
Provide 2 dimensions to center of septic tank manhole cover.
s r ,
13a /0/-1-c
BENCHMARK: S ~O w~ ~~2 O = -,0 D ' 0 r
ALTERNATE BM:
IC TANK / / FO ION
13,2 I i elN,-
Manufacturer: to/`e-SE-12- Liquid Capacity:
Setback from: Well 80, House Other
Pump: Manufacturer Model# Size
Float seperation Gallons/cycle:
Alarm Location
SOIL ABSORPTION SYSTEM
Width: S f Length 1 S Number of trenches Z
z5-fb'f./~'w
Distance & Direction to nearest prop. line:
Setback from: well? too House 106 Other
ELEVATIONS
Building Sewer ST Inlet: N/j~ ST outlet:
PC inlet y~ PC bottom Pump Off
Header/Manifold Bottom of system
Existing Grade Final grade
DATE OF INSTALLATION:
PLUMBER ON JOB: Rof3ERT uLQ~ G
LICENSE NUMBER: m PI` S 33 d-~
INSPECTOR: ln~11
3/93:jt
IVN19ldO
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02
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41
IAL
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM '
Safety and Buildings Division County ST. CROIX
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) SanitaruPur~jtlVn.:
Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)]. 6 33 tifs dG
13KUWN ~dellAN Q& LISA Town of: State Plan ID No.:
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Thl&-:1018-10-000
/60 CD
TANK INFORMATION ELEVATION DATA A9700198
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic l C ww b Benchmark
Dosi n
Aeration Bld Sewer
9 Y'lc~ ~t CG
Holdin St/Ht Inlet
TANK SETBACK INFORMATION St/fit Outlet c ~P,d ,G,o 9~ "ap TANKTO P/L WELL BLDG. ventto ROAD Dt Inlet
Air Intake
Septic 7 ?S6~ /4 NA Dt Bottom
Dosing NA HeadeN-PdFar . 6:02
Aeration NA Dist. Pipe 97/ors S
Holding Bot. System 75 g9,Y7~
.62
PUMP/ SIPHON INFORMATION Final Grade
Manufact Demand 1-5 9/ O?
Model Number GPM
TDH Lift riction Ft 7 g3,5ead 0
rrl c4 Loss F' C n ,
For main Length Dia. Dist. To Well " - r~j!$ ('may (off
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS f' 7n- DIMENSIONS
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHI acturer:
SETBACK
INFORMATION TypeO ~S?,~~'. , CHANJWR Mo e
System: it O NIT
DISTRIBUTION SYSTEM
Header/ - Distribution Pipe(s) x Hole Size x Intake
i
Length Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mo r At-Grade Syste
Depth Over Depth Over epth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges/Y Topsoil ❑ Yes C] No ❑ Yes E]
No
COMMENTS: (Include code discrepancies, persons present, etc.)
s
LOCATION: ST. JOSEPH 5.29.19.76B,NW,NE 1174 ROLLING HILLS TRAIL LOT 1
(A I f • ~ ,c _ rYf^•~. 0a +
d J vC Y) {R..s .r C^1 /
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD-6710 (R.3/97) Date Inspector's Signature Cert. No.
f
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
J1__
Safety and Buildings Division
will . SANITARY PERMIT APPLICATION Bureau Buildingwatersystems
201 E. Waashington Ave.
In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969
Madison, WI 53707-7969
• Attach complete plans (to the county copy only) for the system, on paper not less County sTl ceol* x
than 8 112 x 11 inches in size.
• See reverse side for instructions for completing this application State Sanitary Permit Number
626? 3 6;L
The information you provide may be used by other government agency programs ❑ Check it revision to previous application
[Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number
1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION
Property Owner Npme Property Lo tion G
77 L/=S + 43 /►~l ,v AIX1114 1/4, S T Z ! , N, R /fE (orXD
Property Owner's Mal ing Address Lot Number Block Number
7 A-a!/iAs 11415. 1 i_ - 0SA1
City, State Zip Code Phone Number Subdivision Nam or CSM Number ,per
~.S Gc>/. S(161 6o (7-6 3<Q • at4 3 -,/823/
v0 2" ' f • s~S
II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ Cityy Nearest Road
3 ❑ Village $7'
❑ Public or 2 Family Dwelling - No. of bedrooms wn of
III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s)
01 O -l//2 -
1 ❑ Apartment/ Condo 02.0 - //f _ 00
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1. ❑ New 2. R-R'2placement 3_ ❑ Replacement of 4_ ❑ Reconnection of 5- ❑ Repair of an
System System Tank OnlyExisting System _________Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one) a SyST '7~O ~v/ (~j4/vim
Non-Pressurized Distribution Pressurized Distribution Fc~ ernm ntalp"244 Other
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 [9-5-eepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit Z 7--xpe/.) 44.0s e 5 , 43 ❑ Vault Privy
14 ❑ System-In-Fill ~f
VI. ABSORPTION SYSTEM INFORMATION: 006.0 2..•
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/ ay/sq. ft.) (Min./inch) 7 e Elevation
yJr S`12? ~s O Q° Feet Feet
VII. TANK Capacity
in
gallons Total # of Prefab. Site Fiber- Plastic Exper.
INFORMATION Gallons Tanks Manufacturer's Name Concrete con- steel glass App.
New Existing strutted
Tanks Tanks
Septic Tank or Holding Tank ! CW ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumber'sSign ture: (No St ps) W/MPRSW No.: Business Phone Number:
20a 7- 33,07 7~,5 356 ever
Plumber's Address (Street, City, State, Zip Code):
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary PerLnit Fee (Includes Groundwater Date Issue Iss i g Agent Signature (No Stamps)
)(Approved Surcharge Fee)
El Owner Given Initial
Adverse Determination Z& I X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
SBD-6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Ruildings Divr_ion, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped bya licensed pumper whenever
necessary, usually every2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7-
VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and
holding tanks for this system. Check experimental. approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County /-Department Use Only.
ComphMe plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump per curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that I shave inspected the septic tank presently
serving the 1399 ✓ residence locat.:d dt:
N 1/4, A16 1/4, Sec. 7 , T N, R W, Town of
S ~ZPL Upon inspection, I certify that I have found the
tank and baffles to be in good condition, and it appears to be
functioning properly. 9 /A
Last time serviced
Did flow back occur from absorption system? YesyNo (if no, skip
next line)
Approximate volume or length of time: 5 bD gallons minutes
Capacity: /Qvro yl~
Construction: Prefab Concrete Steel Other
Manufacurer (if known) : &71&-rex ~f
Age of Tank (if known): lf-7
(Signature) (Name) Please Print
33 a
(Title) (License Number)
(Date)
Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes)
or Licensed Disposer (NR 113 Wisconsin Administrative Code)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Plumber (applying for sanitary permit) Certification:
In accepting the above statement regarding existing septic tank
condition, I certify that the tank to the best of my knowledge will
conform to the requirements of ILHR-83, Wis. Adm. Code (except for
inspection opening over outlet baffl
Name UIT "Whzf'?4 Signature ----ttP/MFRS
5/88
Wisconsin Department of Industry, SOIL AND SITE EVALUATION
Labor and Human Relations Page-./ of 3
Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis.
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
Include, but not limited to: vertical and horizontal reference point (BM), direction and 4A6 X
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # 0 2 0 2
0 2- 0
APPLICANT INFORMATION - Please print all information. Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner f~ Property Location
Govt. Lot 411V 1/4 N~ 1/4.S • T-Z ,N,R /9 E (0 W
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM#
/,~y RV4t1,V~ 3x z3/ 'ea/ 2 . s8s-
City State Zip Code Phone Number ❑ City ❑ Village Q Town Nearest Road
)396 Sr.
❑ New Construction Use: 2 esidenflal / Number of bedrooms 3 Addition to existing building
[Replacement ❑ Public or commercial - Describe:
Code derived daily flow 7 0 gpd Recommended design loading rate 7 bed, gpde trench, gpd/112
Absorption area required bed, 0 -trench, ft 23 Maximum design loading rate • bed, g;d ::2~trench, gpd/ft2
Recommended infiltration surface elevation(s) sue- ~CI, ft (as referred to site plan benchmark)
Additional designtsitte considerations
Parent material / 1'*e'4L Flood plain elevation, if applicable -it
S = Suitable for system Conve tional Moouu In Ground Pressure ;70 de System Fill Holding Tank
U = Unsuitable for system Qs❑ U 0 5❑ U Sun ❑ U U EfrS ❑ S
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure GPD/f12
In. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench
/ i0 loY,e -T/V' L XS Cs gf- '5':
z -2.3 /VY yl6e Ls ale ~s i~ ' • 8
Ground •95 ,-57 S GAS' .
elev. TO V4 L~9 4 49 et
Depth to
limiting
factor
Remarks:
Boring #
2 7-13 io I SG / he :.5
3 3 - ),o T-9
Ground - S a ` • 7 '
Alev.
Depth to
limiting
f ctor
7 in. Remarks:
CST Name (Please Print) Signature Telephone No.
1
,ewer" Z~~~~ r ' 7,5.38 - 8183"
9013
Address ` Q Date CST Number
Associates J f Cs 7--4f -2- 4/ 82-
SOIL DESCRIPTION REPORT Z j
PROPERTY OWNER Page of
PARCEL I.D.ii
Boring # Horizon Depth Dominant Color Mottles Structure 2
Texture Consistence Boundary Roots
In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
/ 0:7 is - Z. 2-fAw, ds es 3-F
a -1 o .Y:•S
Ground 3 _ /O _ G/ ~ijly •O
elev.
• tt: elk
o
Depth to
limiting ;
facto In.
Remarks:
Boring #
Ground
elev.
ff.
Depth to
limiting
factor
In.
Remarks:
Horizon Depth Dominant Color Mottles fe Structure Consistence Boundary Roots D/ft2
In. Munsell Ou. Sz. Cont. Gr. Sz. Sh. Bed , Trench
Boring #
Ground
elev.
ff.
Depth to
limiting
factor
In. Remarks: ,
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
In. Remarks:
SBDW-8330 (R. 08/95)
W N ~ ~ n y
61 ~ ~ R ~ O
r
H /
C \ Z cr
O c~ ~ Y 1 1 1 Q 1
o
w
FE
~d
I
f1~
N ~
CIA
1
~ ~ / 1 t~-t 1
O O ` t+ , 1 1
°t
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-1 G
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Fresh Air Inlets And Observation Pipe
Approved vent cap
Minimum 12".Above j
Final Grade
'A
30 " Above Pipe _ 4" Cast Iron
-to Final Grade Vent 'Pipe'
Synihefic Covering
Min. 2" Aggregate
Over Pipe
Distribution Tee
Pipe 0 0 0 0 0 ,
ri
Aggregate 0 Perfbroled Pipe Below
Beneath Pipe 0 Coupling Terminating At
S yST, Bottom Of System
d ~
Tpg~) 6~v Fresh Air Inlets And Observation Pipe
~cJ ( + Approved Vent Cap
Minimum 12" Above
Final Grade ~j,viSff•~L~ 1.f34~~'
2-
30 " Above Pioe - 4" Cast Iron
8 T C - 100
This application form is to be completed in full and signed by the
owner(s) of the property being developed. Any inadequacies will
only result in delays of the permit issuance. Should this
development be intended for resale by owner/contractor, (spec
house), then a second form should be retained and completed when
the property is sold and submitted to this office with the
appropriate deed recording.
Owner of property
Location of property /VAI 1/4 /V6 1/4, Section ,T---1-7 N-R_Zf W
Township J~~• Mailing address
Address of site
Subdivision name ~ZM 3` O ~-3 Vd~ poiLot no.
Other homes on property? Yes No
Previous owner of property
Total size of property f4 Cq
Total size of parcel f
Date parcel was created ~`t 7 8
Are all corners and lot lines identifiable? Yes No
Is this property being developed for (spec house)? Yes No
Volume .100 and Page Number 4 ov / as recorded with the Register
of Deeds.
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE
NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a
certified survey, if available, would be helpful so as to avoid
delays of the reviewing process. If the deed description
references to a Certified Survey Map, the Certified Survey Map
shall also be required.
PROPERTY OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the
best of my (our) knowledge that I (we) am (are) the owner(s) of the
property described in this information form, by virtue of a
warranty deed recorded in the office of the County Register of
Deeds as Document No. $j lee.) , and that,I (we) presently
own the proposed site for the sewage disposal system or I (we)
obtained an easement, to run the above described property, for the
construction of said system, and the same has been duly recorded in
the office of the County Register of Deeds as Document No.
Signa ure of Applicant Co-Applican
5 1c;~_q-7
Date of Signature to of Signature
71.
S T C - 105
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER ~~N LAS lake llJA'i
ADDRESS Z/7~ FIRE NUMBE Z
CITY/STATE_#U,PS0A) /S ZIp STdI
PROPERTY LOCkTION ! A) 1/4, NG 1/4 , SECTION J , T.?/ M-RSV
TOWN OF_ 54. 'h St. Croix County, '
SUBDIVISION_.GSM 3Ngi3/ !~dl~z 14~. 5V;, LOT NUMBER
Improper use and maintenance of your septic system could
result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three
years or sooner, if needed by a licensed septic tank pumper. What
you put into the system can affect the function of the septic tank
as a treatment stage in the waste disposal system.
'St. Croix County residents may be eligible to receive a grant
for a maximum of 60t of the cost of replacement of a failing
system, which was in operation prior to July 1, 1978. St. Croix
County accepted this program in August of 1980, with the
requirement that owners of all new systems agree to keep their
system properly maintained.
The property owner agrees to submit to St. Croix Zoning a
certification form, signed by the owner and by a mater plumber,
journeyman plumber, restricted plumber or a licensed pumper
verifying that (1) the on-site wastewater disposal system is in
proper operating condition and (2) after inspection and pumping (if
necessary), the septic tank is less than 1/3 full of sludge and
scum.
I/Ile, the undersigned have read the above requirements and
agree to maintain the private sewage disposal system in accordance
with the standards set forth, herein, as set by the Wisconsin DNR.
Certification stating that your septic has been maintained must be
completed and returned to the St. Croix Co. Zoning officer within
30 days of the three year expiration dat .
SIGNED.
DATE* St. Croix co. Zoning office
911 4th St.
Hudson, WI 54016