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Home My WebLink About006-1045-40-000State of Wisconsin WISCONSIN FUND -PRIVATE SEWAGE SYSTEM Safety and Department of REPLACEMENT OR REHABILITATION PROGRAM Buildings Commerce Division OWNER'S APPLICATION Instructions For Property Owners: TO BE COMPLETED 8Y COMMERCE You may apply for a grant award for up to three y , of op-t>~ve received a determination of failure and after ou have o ~ isan`~r etf it ~ Application Number Date Received y y p n . . a. Complete Part A of this form, attach eviden f\\,,~,~ur annuu~~I income explained in section #7, and send those items to the en {. 19Rlis d belovih ' ~ ~ .. ; ~~. r. Elt~E~ , ' :1 _. , ~ ST CR~x ~~ ~ , COUNTY i PART A. TO BE COMPLETED BY TI.1~~!~~i~`~YFbIWINI~f t~~ Owner Name' Sobia ** ~ ,~ , itiona Owner Social Security No." ~1~ \ Address ~ U Attach documentation of additional owners if needed. t~ .. City, State Zip Code Telephone Number (include area code) ""Note: Your Social Security Number may be used to verify your 'Grant awards will be issued in the name and address of this owner. income and status of child support or maintenance payments. 1. W as th e failing private sewage system serving the principal residence or small commercial establishment constructed prior to July 1, 1978? r ~ / ~ L~ Yes ^ No his 2. T application is for (complete both if appiigble): ~ ~ ,~ ,~ tom' Prinapal Residence Do you occupy this residence at least 51 °k of the year: LI~JYes ^ No ^ Small Commercial Establishment Do you orxupy this small commeraal establishment at least 51 % of the year: ^ Yes ^ No Small Commercial Establishment Name: D cri lion of Small Commercial Establishment (farm, restaurant, etc.): ,,-,~ 3. Was the private sewage system replaced as part of a real estate transaction or change of ownership? ^ Yes Lfd No If es, lain: 4. As the owner, are you a licensed plumber or contracxor engaged in the business of installing private sewage systems? ^ Yes No 5. Will a portion of this system be funded by another source? ^ Yes No If es, ex lain: 6. How did you hear about the Wisconsin Fund-Private Sewage System Replacement or Rehabilitation Program? 1 t~~0e~ ~~- ~c~' ~ o~ ~ -~-0 r ~S ~ ~~~~ ~ ; . t -~ ~ 7. Evidence of income. A ch a copy of your federal income tax return for the year of or prior o the enforcement order or determination of failure if you are applying as a principal residence. If you are applying as a all commercial establishment, submit a copy of your federal profit and loss forms for the year of or prior to the order or determination of failure. If you were married and filed separate forms, you must also include your spouse's return for the same year. You must include evidence of income for each owner (and for each owner's spouse) listed above. Evidence of income will be kept on file at the governmental unit and is subject to verification by the Department of Revenue and by the Department of Commerce. If you or any owner listed above were a art ear resident or did not file an income tax return, contact our governmental unit for further instructions. 8. Property Owner's Certlfication. I certify that, tD the best of my knowledge and belief, the information 1 have provided on this form and all attachments are true and correct. ignatu Date Signed Co-Ovmer's Signature Date Signed . .____ '~-~ -zo Personal infonnation you pYovide may bevsed for se~dary purposes [Privacy Law, s. 15.04(1)(m)). SBD-9163 (R. 1/2000) PART B. TO BE COMPLETED BY THE GOVERNMENTAL UNIT 1. VERIFICATION OF OWNERSHIP Does the owner(s) name(s) as listed on the document used to verify ownership agree with the name(s) of the applicant(s) on Part A of this application? ^ Yes ^ No What document was used i cume r ~a 36~ to verify ownership? Page Number If the applicant answered yes to question 3 on Part A of this ap lication, did the applicant own the property when the order/verification of failure was issued or the s stem installed and incur the cost of replacement? ^ Yes ^ No 2. Is this application for a replacement structure? ^ Yes ^ No If es, have all requirements outlined in Comm 87.20 4), Wis. Adm. Code, been met? ~ Yes ^ No 3. Is a public sewer available to this property? ^ Yes / No 4. Has a previous rant been awarded for this grope under this program? ^ Yes ^ No ~ p / 5. Principal Residence evidence of income. Please indicate applicable annual income: $_~ I ~"f Federal income tax form ~ b ,Line 33 ,Year ~~°~ Affidavit of ,Year Other form used ,Line ,Year Small Commercial Establishment evidence of income. Please indicate applicable annual gross income: $ Profit 8~ loss form used: ,Line ,Year 6. Date of Order or r Age of the ~ ~~ ~ Determination of Failure: o S z6va ex+sting failed system: ` 6V~•+' , Seoaratin Distance from the bottom of the existin failed s stem to a limiting factor: 7. Private sewage system failure caused by discharge of sewage to (check all that apply): Surface water or groundwater ............................................................................................................... ^ Category 1 A zone of saturation ............................................................................................................................ ^ A drain .tile or zone of bedrock .............................................................................................................. ^ Category 2 The surface of the ground .......................................................................:............................................. ^ Category 3 Back-up of sewage into the structure served ........................:.............................................................. ^ . 8. Replacement System Type: ^ Conventional ^ In-ground Pressure ^ At-grade ®Mound ^ Holding Tank ^ Experimental System ^ Monitoring ^ Other, explain Uniform Sanitary Permit Number 3~~ a ~ ~ Date Issued ~ ~ ~~ ~ d ~ (~ I 3~~ ~1~ Date Approved roval Number Plan A _ ~ pp Experiment Approval Number Date Approved 9. Eli ible ~ or Ineligible ^ Reason ineligible: 10. Governmental Unit Representative's Certfication. I certify that I have reviewed and verified all information provided on this form and attachments and that the are true and correct to the best of m knowledge and belief. Signature of Authorized Governmental Unit Representative Title Date Signed • l ec~nn~~ci 6L.. Z -29 -Z~ • State of Wisconsin .PRIVATE SEWAGE SYSTEM REPLACEMENT Safety and Department of OR REHABILITATION GRANT PROGRAM Buildings Commence Division GRANT WORKSHEET Owner's Name: Governmental Unit: ~ '' ART 1. GRANT FUND G TABLES A. Site evaluation and soil testin Grant amount $250. $ ~~~ B. Installation of a replacement or additional septic tank. Minimum Gallons Required Grant Amount 750 ....................................................................................................................$500 975 ............................................................................................................ .........550 1,200 ............................................................................................................. ........650 1,425 ............................................................................................................. ........725 1,650 ............................................................................................................. ........750 1.875 ............................................................................................................. ........875 ~~~ ': 2,100 or more ................................................................................................ ........950 $ C. Installation of a pump chamber and lift pump or siphon: Number of Bedrooms G rant Amount 1 or2 ............ ..............................................................................................$1,100 3 or 4 ........................................................................................................... ......1,200 .. ~ ~ ~ 5 or more ..................................................................................................... .....1,250 $ D. Installation of anon-pressurized or In-ground pressure soil absorption area. 1. The following table shall be used for systems sized according to percolation tests. Grant amounts determined by number of bedrooms. Percolation Rate Design Loading When Properly Rate in Gallons Filed with County Per Square 1 2 3 4 5 Each Addl Before 7-2-94 Foot Per Day Bedroom: Minutes Per Inch 0 tD less than 10 0.7 or more $ 800 $1,100 $1,225 $1,400 $1,725 $150 10 to less than 30 0.60 th 0.69 900 1.175 1,400 1,800 1,900 250 30 to less than 45 0.50 to 0.59 1,050 1,450 1,650 1,950 1,975 300 45 to less than 60 0.49 or less 1,150 1,900 2,200 2,250 2,275 300 -' E. Installation of an at-grade or mound soil absorption area. Grant amounts determined by number of bedrooms. Type of Design 1 2 ~ 4 5 Each Addl Bedroom: At-Grade $900 $1,300 $1,475 $1,825 $1,950 $250 High Groundwater Mound 2,250 2,325 2 55 3,400 3,775 250 High Bedrock Mound 2,350 2,950 3,000 3,400 3,525 275 Slowly Permeable Mound 2,900 3,100 3,250 3,400 3,650 300 Mound with less than - 24" of suitable soil or greater than 12% slo 3,050 3,400 3,475 3,550 4,500 375 ,. $ a2 ~ S S O . F. InstaNation of a holding tank. ,. Addl Number of Bedrooms; ~ '(, 2 of 3 ;- 4 5 6 7 8 Bedrooms Grant Amount: $2,250 2,925 3,100 4,000 4,200 4,750 $225 $ 6. Iristaltllion of a Replacement Exterior Grease Interceptor by Gallon Capacity. Gallons: Up to 1,249 1,250-1,499 1,500-1,749 1,750-1,999 2,000 or more '6cantAmoun~~ $550 $650 $750 $800 - $900 $ . :r Personal ~ntorpamon you provroe may de uses for seoonaary purposes irnvacy ~.aw, s. ~ a.u~o-~i 1cm1J• SBD-9167 (R. 1/99) PART 1 GRANT FUNDING TABLES continued H. Installation of an Experimental System. Amount Requested For Installation: The Department on a case-by-case basis reviews installations of experimental systems. If you are requesting funding for an experimental system not covered by the grant funding tables, $ please submit a copy of the plan approval letter and experiment approval letter with corresponding identification numbers signifying that the experiment has been accepted by the Amount Requested Department of Commerce. For Monitoring: Ust the total cost of the experimental system and monitoring that is being requested separately at the ri ht. Copies of aid invoices must be submitted with this re uest. $ '" 1. Installations not Covered by the Grant Funding Tables. The Department on acase-by-case basis reviews installations not covered by the Grant Funding Tables. If you are requesting funding for an installation not covered by the grant funding tables or listed in Sections A H, please explain your request here, attach a copy~of the ' paid invoice, and request 60°~ of the cost of the installation at the right. TOTAL PART 1. `~ ~~b•. $ PART 2, GRANT AMOUNT CALCULATIONS A. Enter the total from Part 1. $ ~D' B. is the applicant a licensed plumber or contractor who installs private sewage systems? If yes, enter 2/3 of the amount from section A or $4,667, whichever amount is less. C. Enter the smaller amount listed in sections A or B. ff this application is for a small commercial establishment and the annual gross income of the business that owns the small commercial establishment is less than $362,500, this is the total grant award. Carry this amount forward to section F. If this application is for a principal residence and the annual family income of the owner(s) is less than $32,001, this is the total grant award. Carry this amount forward to section F. If this application is for a principal residence and the annual family income of the owner(s) is greater than $32,000, goes to section D. / I ,/ ` ~ 0 If this a lication is for an a rimental s stem, ca this amount forward to section F. $ T 7 D. Enter 30% of the amount by which the applicant's annual family income exceeds $32,000. Annual Family Income Subtract - $32,000 p~ $ ~ ~ b ~ ~ Subtotal X .30 = ~ E. Subtract line D from line C. This is the maximum grant amount for this applicant. Carry this amount forward to section F. (The amount in section E must be at least $100 to be eligible for any grant award. If the amount calculated is less than $100, enter $0.00 in section F. ~ $ F. Total rant award requested for this a licant. $ i ai~~-.' a,i~~.. ~,ti ~~ 1~ ~~~ ;~~~ ~rxexnrr~---- -- r~r~i •.,. ,. ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 Fax (715) 386-4686 NOTICE OF VIOLATION May 5, 2000 MARY ANN RADIGAN 2264 205TH AVE. DEER PARK, WI 54007 RE: Failing septic system at 2264 205th Ave. Town of Cylon - St. Croix County, WI Computer # 006-1045-40-000 Parcel # 21.31.16.312B Dear Mrs. Radigan: As required by the ST. CROIX COUNTY ZONING ORDINANCE, notice is hereby given that you are in violation of § 254.59(2) Wisconsin Statutes, COMM 83.32(1) Wisconsin Administrative Code, and Article 15.04 of the St. Croix County Zoning Ordinance. This system has failed under the defmition in § 145.245(4)(b) Wisconsin Statutes (Category I). This violation was first noted on 5/5/00. The violation noted is septic effluent failing to a saturated soil horizon. An on-site inspection on 5/5/00 did reveal the septic effluent discharging to the zone of saturation. If fines and or forfeitures become necessary to bring about the abatement of this violation, they will be assessed as of 5/5/00 in accordance with Chapter 145.12(4) Wisconsin Statutes. THE FAILING SANITARY SYSTEM ON THIS PROPERTY POSES IMMEDIATE HEALTH CONCERNS AND NEEDS PROMPT ATTENTION. REQUIRED ACTION: You have already contracted with a certified soil tester to have a soil evaluation conducted. The soil evaluation will determine the type of septic system needed and it's location. You will need to contract with a licensed plumber, who will design the septc system and obtain a sanitary permit through this office. The septic system must be installed no later than December 1, 2000. If you have any questions or concerns that I can address for you in this matter, please feel free to contact me. I look forward to working together to resolve this matter. Sin erely, vin Grabau Zoning Technician cc: file ~~isconsin Department of Commerce Safety and Buiklings Division SANITARY PERMIT-PPLICA~ON z01 W. Washington Avenue P O Box 7302 In accord with Comm $3'OS,,Wis. Adm. Code ` _~`, Madison, WI 53707-7302 ~-, • Attach complete plans (to the county copy only) for the`sYs#@m,R~Fe~,hot lest _ 'county than 8 vz x 11 inches in size. h _ ': _ ~ ,.~ • See reverse side for instructions for completing this a pTidation,, . ; , +~ ~a~d .~ ~~ t.Q ~~ ~~ ~~t~te anitary Permit Number :~~ 3~o zZZ . x _. Personal information you provide may be toed for secondary purposes ~~ 1, ST K-S( ;` ~ Check if revision to previous application (Privacy Law, s. 15.04 (t) (m)]. ~~y ~ dF~ ~a tate Plan I.D. Number I. PP I ATI N INF RMATI N -PLEA E PRINT AL 1 •F ~ AATI ~ ~ ~' ~ . 31 t ~"~- PropertyOwner me ~ ~ / f__ ~ o ion t t/a,S T ,N,FtY~ E(o Property Owner's aili Ad ress Lot Number Block Number Ci ate 1 ^~ ' ~ Ip C e ~~ Phone Number Subdivision Name or CSM Number .~ / / / / C. O ILD NG: (check one) ^ State Owned o Its/ o~ ollwn o Nearest Road1 ~~ 2d / Public 1 or 2 Famil Dwellin - No. of bedrooms f / J p III. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) , o ~ - ~ °~' ''~° -ooo 1 ^ Apartment /Condo 0 0~- c ov 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 online B, if applicable) A) 1. ^ New 2, t~f Replacement 3. ^ Replacement of 4. ^ Reconnection of 5. ^ Repair of an ______S~stem ________S~rstem _____________ TankOnl~r_ __ ExistinQSystem ________ Exlstln~S~stem B) ^ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ^ Seepage Bed 21Mound 30 ^ Specify Type 41 ^ Holding Tan~C 12 ^ Seepage Trenc 22 ^ In-Ground Pressure / ( 42 ^ Pit Privy 13 ^ Seepage Pit ~ ~ 43 ^ Vault Privy ill ~ ~~ / 14^System-In-F R • VI. ABSORPTION STEM INFORMATION. ,9210 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. 7. Final Grade ' on ~~ Required (sq. ft.) Proposed (sgft.) (Gals/day/sq. ft.) (Min./inch) ~~-~- Elev ~ ~ -s ' ' . ~ ,7 ~ ~ , v2 ~ 'r Feet Feet VII. TANK INFORMATION Ca aclt jn allOns Total # Of r Manufacturer s Name Prefab. Site steel Fiber- Plastic Exper. i i Gallons Tanks concrete glass App New Ex st n st uded T nks Tanks Septic Tank or Holding Tank ~ ~ Q e ^ ^ ^ ^ ^ lift Pump Tank /Siphon Chamber ~ ~. ~J ^ ^ ^ ^ ^ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. PI bet's Name: (P iM) Plu "s Signature: No Sta ) MP/MPRSW No.: Z Business Phone Number6 `~ ~ ~ O ) ~J !~ 7 .~O ~~~ Plu er's Address (Street, City, State, Zip Cod ~ i e w ~h•, ' ~ , r .~ ~ Y ~ IX. CO TY /DEPARTMENT USE ONLY ^ Disapproved Sani ry Permit Fee pndudes Groundwater ate slue Issuing Agent Signature (No Stamps) i ~]A roved ~ `' pp ^ Owner Given Initial ~~ ~ Surcharge tee) _5.. ,2~ I ~ Adverse Determination L X. C D~TIONS~PROVAL REA NS FOR DISAPP^ROVAL: ~t a-S ~ C6c~5r SBD-6398 (R. 4/99) ~-• DISTRIBUTION: Original to County, One copy To: Safety a Buildings Division, Owner, Plumber isconsin Department of Commerce Safety and Buildings 1340 E GREEN BAY ST STE 300 SHAWANO WI 54166 TDD #: (608) 264-8777 www.commerce.state.wi.us Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary May 30, 2000 CUST ID No.220527 BYRON BIRD JR 896 68TH AVE AMERY WI 54001 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/30/2002 SITE: Site ID: 193077, MARY ANN RADIGAN ST CROIX County, Town of CYLON; 205TH AVE W 1/2, NE1/4, S21, T31N, R16W ATTN: POWTS INSPECTOR ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 FOR: Description: MOUND SYSTEM FOR MARY ANN RADIGAN Object Type: POWT System Regulated Object ID No.: 665884 Identification Numbers Transaction ID No. 319177 Site ID No. 193077 Please refer to both identification numbers, above, in all cones ondence with the a enc . The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. CAUTION: Wis. Stats. 145.135(2)(b) indicates that the approval of a sanitary permit is based on regulations in force on the date of approval. The effective date of COMM 83 revisions is expected to be July 1, 2000. Thus depending on the type of system and your design, this plan approval may not be eligible for sanitary permit approval if submitted to the issuing agency on or after July 1, 2000. Note: There is a potential for a lawsuit that may delay the effective date of the code so this status may or may not change. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, '1~ KEI A WILKINSON , POWTS PLAN REVIEWER Integrated Services (715) 524-3630, FAX: (715) 524-3633 , M-F 7 AM - 3:45 PM KW ILKINSON@COMMERCE.STATE. WI.US DATE RECEIVED 05/24/2000 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 BALANCE DUE $ 0.00 WiSMART code: 7633 cc: MARY ANN RADIGAN PLOT PLAN PROJECT Marv Ann Radiaan ADDRESS 2264 205th Ave Deer Park Wi 54007 SW 1/4 NE i/4S 21 ° /T 31 N/R 16 W TOWN Cylon COUNTY ST.CROIX - - c 5/19/00 3 MPRS Byron Bird Jr." 220527 ~ , DATE BEDROOM CONVENTIONAL y IN-GROUN RESSURE NVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 800 HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 375 BED SIZE 8' X 47' BENCHMARK V.R.P. Base of Siding ^ BOREHOLE O WELL •H.R.P. Same as Benchmark SYSTEM ELEVATION g2.1 Scale ~ 1 /4" = 10' N 0 D m Old System is to be pumped and buried DT DW g- 3 $~-~- ^ _ 4% Slope Existing 3 Bedroom HOUSe ASSUME ELEVATION 100' Well 0 I I~B.M. Weeks ST Septic and Dose tanks are to be properly bedded and provided with approved warning labels, Dose tank is to have a lockdown cover B-2 F• nn. ^ Mo"''Y`~ 1320' Property Line :r-~ System is to be installed along the 91.1 Contour Line O.W.T.S. F ~ ~, Area 25' Below . Conditionally ~ System is to remain ~~ ~ ~O Y ~ D undisturbed DEPARTMENT OF COMMERCE DIVISION OF SAFETY AND BUILDINGS 200' ~ ~ L SEE CORRESPONDENCE -~- 3 ~q 1~7 /* Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may tie used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ^ City ^ Village T n of: Radigan, Mary Ann Cylon~ownship CST BMElev.:- Insp. BM Elev.: BM Description: tm .c~' av .~' S _ ~~M~2 TAIUIC tlUFARMATIAN FI FVATION DAT TYPE MANUFACTURER CAPACITY Septic ,,~ ~ ~ Dosing ~ e~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Air Intake ROAD Septic yso r >$p r (~ ~ NA Dosing >SO~ ~118~ sir ~ S-6r NA Aeration NA Holding PUMP /SIPHON INFORMATION Manufacturer ~y Model Number 5 TDH Lift r~.3 Fri<iion o 1z Dem(~and 3~' GPM TDH ~,,,~'~'Ft Forcemain I Length 3s ~ I Dia. ~ " I Dist. To Well ~- f ~ $ SIDIL ABSORPTION SYSTEM County St. Croix Sanitary~~~~2 0.: State Plan ID No.: _~ t q l ~-~- Parcel Tax No.: 006-1045-40-000 STATION BS HI FS ELEV. Benchmark ofl• ` Ofl- d Alt. BM N/~ Bldg. Sewer •'-~3p 2Z' • St/Ht Inlet ,~38 QS.lZ~ St/ Ht Outlet S(o3 9 •84 ~ Dt Inlet ~.0~/ q (. ~ r Dt Bottom (2.35' $s•1'~-~ Header / Ma ~ r ~ `+~ Q3. lZ ~ Dist. Pipe ~ ~~ qZ,~/~ Bot. System ~'~ 92 12 r Final Grade S~,w.~r St cover q.o 9,~•SZ r .~ BE .f~ Width ~ ~ Lengt ~ ( N No.O Inside Dia. Liquid Depth IMNI N ~ DIMEN I N SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING n r: SETBACK INFORMATION TypeO /J ' . ~ L ~ C '~ ' ~ 08 `~ CHA NIT Mo a Num System: ~V(s~^~+~t 30t O ' ' Il1~TRIR11T1C1111 SYSTEM ~~{- fe~,$Q~1 1 Header / Mani old Z K r Distribution Pipe(s) p ~ , ~ ~ x Hole Size " r x Hole Spacing 3( " Vent To Air Intake ~-' Dia. Length ~ Spacing Length ~ Dia. /~ 0 SOIL COVER x Pressure Svstems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No •~ ^ Yes ^ No nt~nn COMMENTS' ~Includ code di crenancpPr~~~s p Q;~n# ems) lr"uG~rr"1' rr 1 • ~ ~ r' ~ ~~ L~»~ •~ ~~ Location: 22 205t~i Street,l~u-OarK:, Sy-6u7_ t~W 1//4 NI~; 1/4 21 T31N R16W) - 21.31.16.312B ~D ~~ ~ 1.) Alt BM Description = ~/i4~h"'`*°"` °t•`-s'~-~ ~r' ~r `~$ • ~ ?` ~ ~a8 ~ ~~ 2.) Bldg sewer length = ~-7j0 -amount of cover = ~ 2~ ~ ~ C1~+~^~ • ` 3.) contour = f 1 •`f~ a.4' l{'r = /eb • S~Z,. ~ a ~,~) Pfan revi~equired. Yes j~ No g(~ 2f as Us other si a fQ~` itional in r~ t_t,gn. ~ ~` 6 5 IVi, t.rl ~'`~ ate ~spector's5ignature Cert. NO. ~ SB -6710 (R.3/97) ~ God- ) o. ~, ~ `y,r~ j • 1 ~ TN:~ :iY +,•.C giir.AYL:. !7R ~.' '!i.'.'i~ G D4 . STaTi'. Ba12 Or Yri~~CO4Si*t FORM ~ i3~d,; ,__.T_ _ .. _ ' oocu*•tEr+; No ~ ' , ~~ ~i.te7 Lg..,~ai;*,ii Sf ~~':i7 ~ i ,n4 I~ . .~ __ - -- - - „ . ~~ ~ t ......_. ._....... ..... ................. J ~ C2 K irtC y > •-- - Da' ~ ., f ~.,~ --- _ _. ' -- K .......... . li A - --- - ....... - .... Nizry..AY~r k3dig~!'t ..... .-.-. - ;j ~ 11 :3 ~ .. i~ ~~ s~ar„Sr .... ...... ... .. ~. _ _ .... .. .......... ...... .... .... ... ..,. .. o _. vS..wb ,... ~ ' ~~ ~' ~; ' '! ' s.:~... of 3~ ,..~~,rs: ~ O i q_tI.RY .i Att~t't3e' !~11~~1v E G~1~',ylick C ' ~ ' . l-?~;',~Y:IICK, S. t+ & i LiJDL'IG;;i 1L3;. ~~'i O~ I'1•~rl t?iwlt'..at Qt.irlCt.'_T' ^ -t C j~ Usca_~la, WI Sa~~) - - _: j L Section 21, Towrz.w?~ti~ 31 Ir'r~xth, Ra::s:~.: (~ ~ 2v%di ; ' , , 16> G. ~;st , F:SCCr;~T the F~r.::~t 6~:i feet ttl<~~cPC~.f' ~~~ Tax P..rcel ?von ... ~ - -- -- . tr,e r.:~r 330 Petit of the ~c~ut•.1w'`= c,~Q~ic~rte21~31-16 y~ r;^} ~ (S; , , , ti..._ P''Jr +•.._~3;~t ~1?l~.l~tBL :it claim deed is givc:z }~.z° ;~zant to the par ~; q~ ' T`'; ties Firc~~_rlga of 199~1, ted D.>ce,n'a~= d . . F:1~t, Cr_,~,~luaior~:~ of Law aa'1~:i ~t?ci~jl~t~rlt of Di.vc~rce St. C-'LCti.X ~l~ttit 1~I ?C ' a Ca3 CUtiTlty ClZCliit , , l ~c ~:: I;:Ott R, 1'.•,::~'~'~"~ tC1~=: ~.G?'lr7i"d~:'i ~~~ . '` . - .._. ~.-.~i 1105;, ~.-~E=•-1 ^. r;; i:+'_Ctj- ,; 7h~, .......... ............ . D~~uai;3.~ex . ..... _ . _... _ . , 1s.9~ 1 7 C~1 _ _. dsy .,t ... _. .(: ESL) - -... ._ _... ~,,,. 1 ___ . _ . 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'. r + p, is 's ( . . _ ~ J F ~ ~' r (' t i t f i i .- ~ t~_ ~n i. _iTT.ITf rl. vt. . ~i .~, ~+~u i. (: ~ 'r. t..1 $:,1R~ Sty (`Cs'.. -.... F•r _~Tl It h.__. .y.) dY-~£+. ..-... __ .... ..... .... . .... ..... _. , .....__ ~.~ , ,. 'I i _ _.[ _ . _ _ .i i 1 r ,,, ~! BT:17 i- i 2 Rat I'!'^'~~.iY F iq I Y.'. s..- 1.. . .. ,. ~ v /* . aViscon^~rl Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: ^ City ^ Village ^ T n of: Radigan, Mary Ann Cylon Township CST BM Elev.:- ~ Insp. BM Elev.: " BM Description: ~2 ~ ItTO .~ a-a .~ . = CST~M S~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ ~ ~0 Dosing ~ ~~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Air Intake ROAD Septic >s'o r >gp r (~ ~ NA Dosing >SO` °'lls' S"~r ~. Jr-6r NA Aeration NA Holding PUMP /SIPHON INFORMATION Manufacturer De~nd ~p\ Model Number S ~ 3~' GPM TDH Lift r~.3 Lriction p yy System TDH ~,.~'~'Ft Forcemai n Length s r Dia. z ~~ Dist. To weu ~- ~ ~ 8 SOIL ABSORPTION SYSTEM VELEVATION DATA County St. Croix Sanitarx~~222 0.: State Pljjan ID No.: Parcel Tax No.: 006-1045-~0-000 STATION BS HI FS ELEV. Benchmark oa, r ofl, d Alt. BM ~y/~ Bldg. Sewer '~-~3p , 22r St/Ht Inlet i~38 QS.IZ~ St/Ht outlet S~3 9 •84~ Dt Inlet 9~oy ql.~g' Dt Bottom (2. 3S' $~.17-~ Header / Ma ~ r ~ `~° g3, IZ' Dist. Pipe 77 7- ~~ crZ,~~r Bot. System •~ 92r IZ ~ Final Grade ~ *.s St cover Q.o ~~.~ r BE ~itE~tllFt" width ~ ~ Lengt ~ ( N ~ ~~~ No. O Inside Dia. Liquid Depth IMEN 1 N DIMEN I N SETBACK SYSTEM TO P/ L BLDG WELL LAKE 1 STREAM LEACHING n r: INFORMATION TypeO n ^~' N( r 3D • L '~^ r 'S~' ~ ~~ `_~ CRAM NIT Mo a Num System: ,~ -F O DISTRIBUTION SYSTEM ~* +'~c-~-~. Header / MMani old ~ th 5 Di L 2 Distribution Pipe(s) ~ ~ ~t ~ acin L th ~s Dia ~ S L x Hole Sµ e ~1 x Hole Spacing 3( Vent To Air Intake '~'- eng a. g , p eng . ~ p SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched . Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include codediscrenancl pPr~~r)sp n ~ lnspecnon~i:~i~3~~~~~,~u~~~,~~,~T~. Location: 2264 205th Street l~wlrovK: ~ 5~}-~l_ 1~ W 1~4~~ 1/4 21 T31N R1.6W) - 21.31.16.3128 ~~ ~ 1.) Alt BM Description = N/A hw~#' °" ~'°'''.x-~ ~,~,,~'"."' ~ ~~ `ti`g ~ _ T` ~ ~ ~ 8 ~ ~~ 2.) Bldg sewer length = ti.z~p~ ~ -amount of cover = ' 2c.~`" ~ C~++~^~ • ` 3.) contour = C~.'f~ af" ~ = 1~ . S-Z. ~ QI ~~,~) Plan revi~equired. Yes y No ® 2f ~ ~ ~ l ~6 Us~ot,~er si a fob` itional in o, ~~_t4n. Nl ti'l 't'~ ~_ _ ate C~spector'sSignature Cert. No. ~ S -6710 (R.3/97) ~ Gem- K~,ILIA7~ p,, p1„ ~~~, ~ ~~ ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Y ,* I r ' Safety and Buildings Division ,- - SANITARY PERMIT ~PPLiCAT~.QN 201 W. Washington Avenue ~~scons~n ,~ , P O Box 7302 Department of Commerce In accord with Comm f~3.05, Wis: Adm. Code '~ Madison, WI 53707-7302 ~, • Attach complete plans (to the county copy only) for thg system, ~Ii~tot less 'r ~~ 'county than 8 vi x 11 inches in size. - _ ~ ,~ • See reverse side for instructions for completing this a[~pTidation ~ 1 `~~~~ ~ ~~t~te anitary Permit Number ~ ~ Personal information you provide may be used for secondary purposes ~ '~, S~ µT( ~ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. CfF~ '~ F tate Plan LD. Number .~ ~t~IIATI ~ ~ I. APPLI ATI N INFORMATI N -PLEASE PRINT AL I ~ = 3! l ~'~- Property Owner me r ~ - t ~ ~ t/a, 5 T , N, IzY~' E (o W ~ Property Owner's Maili Ad ress Lot Number Block Number Cit tate ~1/^~ i^ / ~ Ip Code '~~00 Phone Number Subdivision Name or CSM Number ., / 11. TYP F B IL NG: (check one) ^ State Owned ~ !t~ u/ own o ~~ Nearest Road 2v ~ ~~ Public 1 or 2 Famil Dwellin - No. of bedrooms f / p 3 ~ III. BUILDIN USE: (If building type is public, check all that apply) Parcel Tax Number(s) . D ~ - l ~~ .~~~ -o®o ... 1 ^ Apartment /Condo o `~~-' °'J '~ 2 ^ Assembly Hall 6 ^ Medical Facility/ Nursing Home 10 ^ Outdoor Recreational Facility j 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) ,q) 1 _ ^ New 2. t~1' Replacement 3. ^ Replacement of 4. ^ Reconnection of 5. ^ Repair of an ______System _____~__System_____________TankOnly______________ Existing System ________ Existing System B) ^ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ^ Seepage Bed 21~Mound 30 ^ Specify Type 41 ^ Holding Tank 12 ^ Seepage Trenc 22 ^ In-Ground Pressure / ( 42 ^ Pit Privy 13 ^ Seepage Pit ~ ~ 43 ^ Vault Privy ~ ~~ / 14 I Fill ~ R . ^System- n- VI. ABSORPTION STEM INFORMATION. ;82.10 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. 7. Final Grade L~ ~ Required (sq. ft.) Proposed (sq~ft.) (Gals/day/sq. ft.) (Min./inch) ~-~- Elev 'on ~ -y ( ~ ,7 ~ ~ ~ ~ ~ ' ~ - ' Feet Feet VII. TANK INFORMATION Ca acct in altos g Total # of Manufacturer s Name Prefab. Site con- l Fiber- Plastic Exper- N E i i Gallons Tanks Concrete stee glass App ew x n st strutted Tanks Tanks Septic Tank or Holding Tank ~ 1 ~ e ^ ^ ^ ^ ^ Lift Pump Tank/Siphon Chamber ® ~. ^ ^ ^ ^ ^ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached pitans. PI tier's Name: (P 1nt) -~--- ~ Ptu 's Signature: No Spa ) MP/MPRSW No.: Z Business Phone Number: ' ~6 ~~ d J ~ ! = 7 So ,~,~6~ Plu er's Address (Street, City, State, Zip Cod f c,~ ~C r- am (/ % ~ J / ~ - ' to IX. CO TY /DEPARTMENT USE ONLY ^ Disapproved Sani ry Permit Fee (Includes Groundwater ate slue Issuing Agent Signature (No Stamps) Approved ^ Owner Given Initial Surcharge Fee) ~S ~ Z~ ~S ` Adverse Determination ~ ~ X7COj11 ONS~PROVAL REA N SFOR DI ~~~ AL: ~~ ~ SBD-6396 (R. 4199) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ' ~ ~', 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe 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. OrSSite sewage systems must be properly maintained. The septic tank(s) rrlust be purt'~ped by a'litensed pumpeP whenever necessary, usually every 2 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, 608-266-3151. -- To be complete and accurate this sanitary permit application must include: I. 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. Complete plans and specifications not smaller than 8 1/2 x 1 1 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 performance 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 1 15 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. isconsin Department of Commerce Safety and Buildings 1340 E GREEN BAY ST STE 300 SHAWANO WI 54166 TDD #: (608) 264-8777 www. com merce. state. wi. us Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary May 30, 2000 CUST ID No.220527 BYRON BIRD JR 896 68TH AVE AMERY WI 54001 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05130/2002 ATTN: POWTS INSPECTOR ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: Site ID: 193077, MARY ANN RADIGAN ST CROIX County, Town of CYLON; 205TH AVE W1/2, NE1/4, S21, T31N, R16W FOR: Description: MOUND SYSTEM FOR MARY ANN RADIGAN Object Type: POWT System Regulated Object ID No.: 665884 Identificatio ers Transaction ID No 19177 Site ID No. 193077 Please refer to both identification numbers, above, in all corres ondence with the a enc . The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CGNDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is resonsible for compliance with all code requirements. CAUTION: Wis. Stats. 145.135(2)(b) indicates that the approval of a sanitary permit is based on regulations in force on the date of approval. The effective date of COMM 83 revisions is expected to be July 1, 2000. Thus depending on the type of system and your design, this plan approval may not be eligible for sanitary permit approval if submitted to the issuing agency on or after July 1, 2000. Note: There is a potential for a lawsuit that may delay the effective date of the code so this status may or may not change. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, KEI A WILKINSON , POWTS PLAN REVIEWER Integrated Services (715) 524-3630, FAX: (715) 524-3633 , M-F 7 AM - 3:45 PM KWILKINSON@COMMERCE.STATE. WLUS DATE RECEIVED 05/24/2000 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 BALANCE DUE $ 0.00 WiSMART code: cc: MARY ANN RADIGAN ~ ~ ~scons~n Department of Commerce ATTN.• POWTSlNSPECTOR May 30, 2000 CUST ID No.220527 BYRON BIRD JR 896 68TH AVE AMERY WI 54001 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/30/2002 SITE: Site ID: 193077, MARY ANN RADIGAN ST CROIX County, Town of CYLON; 205TH AVE W1/2, NE1/4, S21, T31N, R16W FOR: Description: MOUND SYSTEM FOR MARY ANN RADIGAN Object Type: POWT System Regulated Object ID No.: 665884 ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Safety and Buildings 1340 E GREEN BAY ST STE 300 SHAWANO WI 54166 TDD #: (608) 264-8777 www. commerce state.wi . u s Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary Identification Numbers Transaction ID No. 319177 Site ID No. 193077 Please refer to both identification numbers, above, in all corres ondence with the a enc . The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. CAUTION: Wis. Stats. 145.135(2)(b) indicates that the approval of a sanitary permit is based on regulations in force on the date of approval. The effective date of COMM 83 revisions is expected to be July 1, 2000. Thus depending on the type of system and your design, this plan approval may not be eligible for sanitary permit approval if submitted to the issuing agency on or after July 1, 2000. Note: There is a otp ential for a lawsuit that may delay the effective date of the code so this status may or may not change. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, KEI A WILKINSON , POWTS PLAN REVIEWER Integrated Services (715) 524-3630, FAX: (715) 524-3633 , M-F 7 AM - 3:45 PM K W ILKINSON@COMMERCE. STATE. W LUS DATE RECEIVED 05/24/2000 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 BALANCE DUE $ 0.00 WiSMART code: 7633 cc: MARY ANN RADIGAN PROJECT Marv Ann Radiaan SW 1 / 4 NE 1 /4 S 21 /T 31 N/R 16 W TOWN CylOn COUNTY ST. CROIX e MPRS Byron Bird Jr: 22$27 ~/ ~ DATE5/19/00 BEDROOM 3 CONVENTIONAL IN-GROUN RESSURE NVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE i 000 gallons LIFT TANK SIZE DOSE TANK SIZE 800 HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 375 BED SIZE 8' X 47' BENCHMARK V.R.P. Base of Siding ASSUME ELEVATION 100' ^ BOREHOLEU WELL sH,R,p, Same as Benchmark SYSTEM ELEVATION g2 1 N 0 v, D m Existing 3 Bedroom HOUSe Well 0 B.M. Weeks ST Septic and Dose tanks are to be properly bedded and provided with approved warning labels, Dose tank is to have a lockdown cover DT DW S-3 ~ ~~ ~- ^ ~"~ 4% Slope 1320' Property Line <y PLOT PLAN ADDRESS 2264 205th Ave Deer Park Wi 54007 Scale ~ 1 /4" = 10' Old System is to be pumped and buried B-2 ~ Mpu"hCX System is to be installed along the 91.1 Contour Line R.O.W.T.S. ~ ~. Area 25' Below Conditionally ~ System is to remain ~ ~ ~~~ undisturbed DEPARTMENT OF COMMERCE ILDINGS U ND B DI`lISION OF SAFETY A 2 0 0' `1 ~~ ~ ( ~ 1it~.a - SEE CORRESPONDENCE 3l~ 1~7 Qesigner Ho ~~dJ~' Date ~"/~'- 62~ 4" Observation Pipe Perforated Below Filter Fabric /AS7M C-33 5 o n d ® "Topsoil ----~ ~'. Slope ~t Bed Of t~~- 2'2 Qrr~in Rock Non-Woven Filter Fabric DisiriDution p;p~ ._.._ IQ G ~~ - r Force Moin ~~FipweO From Pump toyer Cross Section Of A Mound System Usino A Bed For The Absor Lion Areo A ~ Ft. r------ ,-~ -,-- s Ft. 1 Ft.~ ~ ~ FL. L ~_ Ft. K3/ ~Fi. ~D 1 ~~ t: , $ ' G -L h ~'~ L .. J ~ E 40bservotion pipe j-- -- --.-- -- - -. -- _..-_ - - __....._~ " A ~.______.._______------------------------_-_-- ~ - f W in l~ ;~ -- ___----------- ---------------•-•___ 1 Force Moin „~_ ~ '~-.--~-._.._.. ---- From Pump e ~ Distribution Bed Of %t~- 2 %Z j Pipe Drain Rock 4' ~bt-lrvOtion Pipe Permanent Marker Pipe ar Rods P{on View pl Mound Ucir~ A Bed For Tne Abaor lion Areo P^c~ o~ _-___ En e i.aealad 0~ l3oilon+, rt ERuoi~r Spocea FlR9T Na.c. t1axT ro Gonnsr„}~cr ~a:~ Na. -- - - Ji5lribttljQA Pjpa ti.py0v1 ~ _ Ft. R :~ F'E. .._~ '~~,.,~,_,_.. I nCh4 s ~ ~ Y ~~-.~ .,... Inches Signed: --~~ - , '~' - No}e Diameter ! f Inch License Number: pC~O 5 2 `) Latera} '/ { z~ Inch es: Date: S-/ --dU Scale = 1 /4" = 10' m...~nm.,. - ._._._ - ~- ----- YLU1~ PLAN PRdJECT Marv Ann Radiaan ADDRESS 2264 205th Ave Deer Park Wi 54007 SW 1 / 4 NE i /4 S 21 /T 31 N/R 16 W TOWN Cylon COUNTY ST. CROIX r` MPRS Byron Bird Jr. 2.2,OS27 ~ DATE5/19/00 BEDROOM 3 CONVENTIONAL IN-GROUN PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 800 HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 375 BED SIZE 8' X 47' BENCHMARK V.R.P. Base of Siding ASSUME ELEVATION 100' ^ BOREHOLE O WELL '"H.R.P. Same as Benchmark SYSTEM ELEVATION g2.1 N O ~s D m Existing 3 Bedroom House Menifald Inches . Farce Maim _._.___ Inches ~ of holes/pipe Invert: ~levdtion f ~'z-~.. c Laterals 4a~ ~ Ft. Well 0 sr I I\B.M. Weeks ST Old System is to be pumped and buried Septic and Dose tanks are to be properly bedded and provided with approved warning labels, Dose tank is to have a lockdown cover DT DW 1320' Property Line B-2 -3 ~ ~B ='T ~ System is to be installed along the 91.1 Contour Line B- ~ Area 25' Below 4% ~- Slope System is to remain undisturbed 200' Perforolad Pipt 4etdil Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of'Safety and Buildings Page of _ Bureau of Integrated services in accordance with Comm 83.09, Wis. Adm. Code 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 ~~. ~/ /~O ~ j~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION -Please print all information. R viewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). - _S _ Property Owner r ~' ~ Property Location Govt. Lot ~ j~ 1/4~~~1/4,S ~ f T 3~ ,N,R ` E ( W Property Owner' ai mg A ress Lot # Block# Subd. Name or CSM# Ci State Zip Code Phone Number ~ fi ' - z ^ City ^ Villa (.Town Nearest Road r -e~ r` ~~ 7 ~7/S~~ a ~ c. ~ d q New Construction Use: Residential /Number of bedrooms ~_ Addition to existing building replacement ^ Public or commercial -Describe: Code derived daily flow ~.~~ gpd Recommended design loading rate ~' bed, gpd/ft2 _ J trench, gpd/ft2 Absorption area required bed, ft2 `3 ~.~ trench, ft2 Maxi um design loading rate bed, gpd/ft2.~_~trench, gpd/ft2 Recommended infiltration surface elevation(s) S ~~~~• ~ ft (as referred to site plan benchmark) i Additional design/site considerations a~ `~ • ~ _ c Parent material i Flood plain elevation, if applicable ~ ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ^ S ~U ~S ^ U ^ S ,®U ^ S ~ U ^ S ~. U ^ S ~'U Boring # Ground ele . s ~~~~. Depth to limiting factor in. Boring # Ground elev. ~~. Depth to limiting C(lll r1FCrRIPTIAN RFP~RT Horizon Depth Dominant Color Mottles Structure i B d R t GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Cons stence oun ary oo s Bed , T r en c h ~s ( ` ~ ~ -~~ d /j~ / ~s ~~ -.5 ~- /~iZ d ~ ~ // d~ ~~ _ ~..~ . Remarks: ~~ v2 Q -G ~ ~ .~. ~." G c o .Q' / ~ '"'.. `,.. , ^~ ~ , w'' ~i last ^~ a C~.. JT ~.!"'~~A n. Remarks: ^'"` ST Nam lease Print) ~ /- ' /_ Signature , -, , N~~ s. =K~, ~ Telephone No. Addre ~ `' -. Date CST Number PROPERTY OWNER ~ "' ~ ~ ~ SOIL DESCRIPTION REPORT PARCEL I.D.# Boring # Ground elev. Depth to limiting fact r in. Boring # Ground ele . Depth to limiting factor in. Boring # Ground elev. ft. Depth to limiting factor in. Boring # Ground elev. ft. Depth to limiting factor in Page ~ of _._' Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. ry Bed ~ Trench ~/ .~. r B G ors ~ Remarks: Remarks: L~'~'~4G ~! 1!/rb~v`~l/ ~=min °`/`t .,iyi c~7 ~ /, ~ ~ ~S~-s7'~~ Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/tt2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench Remarks: Remarks: SBD-8330 (R.9/98) ;, ' ~ Soil Test Plot Plan Project Name MaryAnn Radigan Byron ird Jr. Address 2264 205th ave. DeerPark Wi. 54007 CST #220527 Lot --- Subdivision --- Date 5/4/Od sw 1 /4 ne 1 /4S 21 T 31 N/R~ 6 W TownshipCylon Boring Q Well PL Property Line COUnty ST. CROIX ,BM or VRP Assume Elevation 100 ft.base of sideing System Elevation g~,1 H.R.P. ne corner of house Alternate B.M. ~ ~~„~ ~~ ~ f /~~~ ~ 1 f~ ~~ i, a• ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address ~~~ ~ ~d ~i~/f ~c~, Property Address (Verification required from Planning Department for new construction) City/State 6~~`'~~/1 ~~ '~ Parcel Identification Number G o~ ~0 4%s'=~0 LEGAL DESCRIPTION Properly Location .ice'/a„~~ '/a, Sec. v~, T~N-R~W, Town of G~~~J Subdivision ~--- ,Lot # --- Certified Survey Map # ~- .Volume '~ ,Page # Warranty Deed # . 5~~~~s ,Volume ,~~, Page # Spec house ^ yes ~ no Lot lines identifiable [~Cyes ^ no SYSTEM MAINTENANCE 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 pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property ow~fer agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. ~~ll DO S GNA OF APPLI DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. ~ ~ ~// SIGNA~ OF APP ICAN' DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ~ Vi4 ~i ~..e. iGti.~. ~W:} -rf '.~:L ~i '::AY F.:: )?R F'_:: .'!a~i ~ D4'.. I ~•~ ~.~~r •J~:R Y ~U'r. U'~"I E-iJ t nib. 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