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HomeMy WebLinkAbout020-1051-10-000 ~ iI c °o I - O Ern h t3 a 4' ~ C O O M N . 1 r x yy~ .V 0 GL o y ~ C C cv c0 U I ~ N I O = y I ~ ro -°o m o~ LL O C O 7 cA C u O Q 'O N 3 0 Z y - O Z r d d III a m FN- tW o_ I O Z d c w o N - 01 z ~t c (n ~ m N z c E -o v m N O CL m • ► 2 <n = o 1 o c Q O .~zCO z U') o N 4) = c N O O L 'O _ V N c0 06 :3 C. 2 H d w O p _ min a _n N ~ aD O o_ C7 o d• 0 0 0 z ° •N m >aaa N 0 U) z 0) a) a r to ~ V jl _o ~ ~ } 10~ W M l1y O O w E N O COQ O.. N O < cu N 7 w U) U) O O O N H C 9 c CD r- Cl) ) p d C C O O O " O 0 6j ~ C y C G O '7 co O ~n 5 4r O o u r- W Z -0o n a a) CD E Z d N 'a . N O L O y O c6 7 U O N= ! U O Z y H (n v~ m a III/ cz y #t g. IL • RS O. d ,V d C N L C C Y W A 0 m m o V Jansky, Leroy From: Kevin Grabau [KevinG c@CO.Saint-Croix.WI.US] Sent: Thursday, January 16, 2003 10:50 AM To: Leroy Jansky (E-mail) Subject: Christ Center church Leroy, You wanted me to email you some info for this church. Address: 815 Larsen Lane, Hudson Original plumber: Herman Glotfelty Installing plumber: Gary Zappa/Mark Stahnke permit issued: 6/30/92 State approval: June 2, 1992 approval # S92-01498 reviewer: James Quinlan Town: Hudson legal: SE/SW 20.29.19 State approval for 2,250gpd. Permit issued for 1,500 gpd. state approval shows a 1,000g grease interceptor; not installed or on application approval. State approval indicated a bed that was 18'x 80', and it WAS installed as a 18'x 182', and as such the drainfield is sized as state plan, and the tanks are sized as state plan approval. SO, this may be our ace in the hole, and looks that it may be OK. I will also check out the kitchen status at the church, and dig around in their heads as far as future plans, etc. Do I really need anything else if it was installed to state plan sizing? Thanks, p.s. no matter what Roman says, I like your stories! Kevin Grabau St. Croix County Zoning Department 1101 Carmichael Rd Hudson, WI 54016 715.386.4680 keving@co.saint-croix.wi.us 1 s FORM - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNEq~/5L-Z~ZAr FE3 ~4 aF OWNSHIP DS v1'/ SECTION_ 20 T_E9 N-R_W ADDRESS_ ST. CROIX COUNTY, WISCONSIN _~fG/DSoN C~c% ~Yol ~ SUBDIVISION AJA LOT_ LOT SIZE AJ,4 PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM • four ~~P.~En ~o Mee A vo'-=-fi-? JeA)T 7 S • t o~ ' ~SG~ SHPT/C ~ ~Ct t I L•.>iFT~ ~cJy,'/D/ficTE/J' ~9L~'~<c D " Sc N ~/O ~oNN~GTiiCJG ` O /V V TF = ~inTI~C~T J~rF< aQ c✓cAJT 6F~ ~~.r;pr - ' 1 I° j o.u A,Ow AT glo r u IN ICATE NORTH ARROW . BENCHMARK: Elevation and description: _ / "<u.v 9,0 Ar 5- w r4ti4,r Alternate benchmark- • VA L,LcV r /ov_ ow" SEPTIC TANK: Manufacturer:_4~~ir'se•P Liquid Cap. ,gX 1 E/k ff ~i 5 03 ' rs; Rings used:. Manhole cover elev: _53 Final grade elev: s.ao• Tank inlet elev.: i_ ' Tank outlet elev.: 9 /3' No. of feet from nearest road:Front , Side Rear Ft. 0:~'' From nearest prop. line:Front Side , Rear Ft. No. of feet from: Well Building:_: (S' (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE t PUMP CHAMBER Manufacturer: • - Liquid-Capacity: Pump Model: Pump/Siphon Manufact.: --------Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.:__pump off elev.: ----,Gallons/cycle: Alarm: Man.: Switch Type: -Location Distance from nearest prop* line: Front._,_, Side, Rear_Ft. Distance from: Well Building SOIL ABSORPTION SYSTEM Bed :~%~✓_Trench s -Seepage pit: Width: /e' Length S Number of Lines: ?-Area Built ~ ~6 Exist. Grade Elev. 951 -,Proposed Final Grade Elev. Fill depth to top of pipe: ~601 No. feet from nearest prop. line.Front_, Side-, Rear No. feet from well: /yv' No, feet from building HOLDING TANK Manufacturers • Capacity: No. of rings uasds___Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front_, Side No. feet from: Well Rear Ft. building nearest road Alarm Manufacturer: INSPECTOR: DATE: i r PLUMBER ON JOB: - LICENSE NUMBER: 6/90:cj b i ~ ~rtr> t~i 0.29.19.1 __W'5 ;ATIr ~EWA`T(jfSffrEM E County: Labor ang Human,Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) sanitary Permit No.: GENERAL INFORMATION 171 47R Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.: CHRIST CEN ASSEMBLY GOD KE THUDSO CST BM Elev.: Insp. BM Elev.: BM Descripti)n: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A9200243 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic X 53d ) Benchmark 6 Dosing Aeration Bldg. Sewer Holding St/ Ht Inlet q n7s/ TANK SETBACK INFORMATION St/ Ht Outlet 4 4 q l`~b TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet Ar I 7 b ' G S ~ > G NA Dt Bottom Septic &0 ~ 17o' Dosing NA Header / Man. 13,36 6 Rq Aeration NA Dist. Pipe 13 31 o1d.~1 Holding Bot. System 1 a' q0, /w la PUMP/ SIPHON INFORMATION Final Grade ' ~ Cr( 356-5 Demand 0&jz, -vol) q . qq, 5 S 3 Manufacturer ~ Model Number GPM ' jILf TDH Lift Friction System TDH Ft oss mead Forcemain Length Dia. Dist. To weu SOIL ABSORPTION SYSTEM BED/TRENCH width/ Length• No. Of Trenches PIT No. Of Pits In Liquid Depth DIMENSIONS ~ / Y~ DIMEN I N LEACHI Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM INFORMATION Type O 7;3. ZD/ CHA ER Mode Number: System: 0-1-A A OR NIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing 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 ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 1, 4 Y73 IVI Plan revision required? ('Yes 1 No Use other side for additional information. WWW SBD-6710(R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH r SANITARY PERMIT NUMBER: ` = I - SANITARY PERMIT APPLICATION 7 0ILHR COUNTY In accord with ILHR 83.05, Wis. Adm. Code 51 CR©1 v T STATE SANITARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ / , 8% x 11 inches in size. Check i revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. s 9 a -0 y 9g P P RTY OWNE PROPERTY LOCATION 5,E %a VJ1/4, S vR0 T Q4?, N, R 19 or W PROPERTY OWNER'S MAILING ADD ESS LOT # BLOCK # &is l-ARSE L- 0r- CITY, STATE ZIP CODE PHONE NUMBER Q SUBDIVISION NAME OR CSM NUMBER Roo S4 o 1,(- -7 /J & 51-7o NEAREST ROAD Nay VU 11. TYPE OF BUILDING: (Check one) El State Owned ❑ CITY u05a ACO L,A Public ❑ 1 or 2 Fam. Dwelling-~# of bedrooms - PAR NUM III. BUILDING USE: (If building type is public, check all that apply) 0 oZ ~ ~ ~ ~ - ( Q 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Horne 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 in line A. Check line B if applicable) A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4.E] Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ® Seepage Bed 21 ❑ Mound 300 Specify Type 41 ❑ Holding Tank 120 Seepage Trench 220 In-Ground 420 Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 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/day/sq. ft.) (Min./inch) ELEVATION 16001 p~ e _ o. Feet 9 3 . ~D Feet VII. TANK CAPACITY Site in allons Total #of Prefab. Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Cori- Steel glass Plastic App Tanks Tanks structed CflIA, Septic Tank or Holding Tank i O 3OD0 2 h1E 0 9,1 t t h C L_ 1.~ Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sew a system shown on the attached plans. Plumber's Name (Print): Plumber's SignatuAZ~ MP PRSW No.: Business Phone Number: 0~"rmm 6ZOAC& Plumber's Address (Street, City, S e, Zip Code): w r %i ~ r5~~ IX. OUNTY/DEPARTM NT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater a e slue I ISuln ~~4pproved ❑ Owner Given Initial Surcharge Fee) ll Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) 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 may be renewed before the expiration date, and at the 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 by a licensed pumper 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 & 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. 11. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. Ill. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in 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 in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete fer all septic, pump/siphon and holding tanks for this system. Check experimental approval only `t 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 81/2 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 los:r,; 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 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, ground- water contamination investigations and establishment of standards.' SBD-6398 (R.11/88) S 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 0, h R/S r C,iAJ I -r-- 2 19-55Fly? 8L `y Ot~ 6D00 Location of property Jt 1/4 StJl/4, Section Do, Tc;~5N-RLW Township ~4 U S O ~II Mailing address ~ ~llEN LA IJ F-_ f-~v.nS I Address of site CmA)gf, or yU o-,a :S'RCC35 LFWE E. Subdivision name/V 0 nJ Ez Lot no. A) 6 nl,F Other homes on property? II yes X No Previous owner of property _,On R R 15 t SO S~ p•Re ! S Total size of parcel Rcer-S Date parcel was created _?~~oRE 19 00 Are all corners and lot lines identifiable? _ C Yes No Is this property being developed for (spec house)? Yes X No Volume ©nand Page Number 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 & 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. Z46'4622 , 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 County Register of deeds as Document No. S gnature of applicant Co-applicant Date of Signature Date of Signature i ~ k x 00 r r i . i S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ChkjST CIE:WtoZ p .55ENM 3Lk-1 ©F: ~QD ADDRESS- (.o2nJFr OF Uy ,fi -T,9&4a -M A;6 FIRE NUMBER CITY/STATE _ H U PS cy~ j(5 ZIP "'40 l C PROPERTY LOCATION : _dE 1/4,5(J1/4, SECTION T_2aN-R_ 19 J* TOWN OF k o Q_e-,C)Iv , St. Croix County, SUBDIVISION_ N OD E , LOT NUMBER pJo~JE . 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 60% 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/We, 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 date. SIGNED: ( 3Q - DATE: St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS 'IN"JUSTfiY, DIVISION LABOR-AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN H.ELATIONS \ / MADISON, W1 53707 • (ILHR 83.09(1) & Chapter 145):, LOCATION: SECTION: TOWNSHIP/MVI=PALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: sE 1/ 6") 1/ io /T2f N/Ri9 E (o W /fvDsa v I _I COUNTY: OWNER'S /BUYER'S NAME: rM-Al LING ADDRESS: cw 'Peo kCur Bo Yom 3 b'oo' 9y27 5-f- o~oi7( rf7iQ/S1~CENTE,( ASSc+tB(.y o-FG•oc) N.o.I~vx yy 3 o wl S • 54o/ 6 USE _ DATES OBSERVATIONS MADE N0. BEDRMS : COMMERCIAL DESCRIPTION: ^ PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: ❑'Re' ce Cl~v?tGl~ ~t of 4New ❑Replace3O- IC~~! roy • 30 1 a / Q /Od 7~b 200 - l v l . o r a ^ , < 7 - c 5 ~ouDiT~o uS Jj °P hf e74y S'uv,uy /.Z ,c-,~osr RATING: S= Site suitable for system U= Site unsuitable for system ONVENTI NAL: MOUND: IN-GROUND PRESSURE: SY§YEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) r 1 os au as au as ❑u as au as au Cr7uUevTiOJh - r,~FN s ~K(ESSiUE SLOPES > fZ , R, 'P►20t3oK 7C)►S i6o i row If Percolation Tests are NOT required DESIGN RATE: Floany portion of the tested area is in the unders. ILHR 83.09(5)(bCLodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS 57C5 S9 (7N,y u j~ - Cda BORING TOTAL TOBSERVE-D H TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH FW. ELEVAST. I SHE TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) g-1 9 JL D > y' 0 33 ' 8u-Sy. S/ rS. t x.14 ' [.i -Ra . S/~ . P3' ae . eov,Pk 7-.fo uER cS _e B-2 j• J Iv7.7~- j 7 c- 33' GG ' T-,t.v S/ b;S' T~v ~1. 5 e s • ,l ,S// .33 TAN S ~ B-3 1 e. y~ " > ?3 T; B- 0 r z s Z ` 9 0 /6 S1 r, S. , 1,K3 - Teti 5-'/ G. 0 'Teti Ls~ Y c s 3 . B-S 9.S' f5. 30' g-Cv ~70' f0-7Z' 2~ c~p /,0' BIY. d,~y.s; rs.~ Z.o o,~ - 3.c 5,e . e,' 5,/ w GD.,rr ° 15 . o R- riots O ,ef t S IUo/D 4e4Eh of y s5 7L,1 Rh CD . PERCOLATION TESTS lu UE C.5 TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD t PERIOD2 PES100 -1 PER INCH P. ► , 0 ' 95.3' Z P. 2 0 r Z Y P- P P- e C 'Cl 471v-.15 2-~ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical, elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. u P I7 E2 T IIIi N C(, = 7/, 30 ' til/ l~D~ Tf F.t9G(~ s 0 ' SYSTEM ELEVATION /0L, T~Gti~~ 50 11, i ROVEO~ ite AP P 2St S T H tic 0 nventional ~P or a co A , G-- ST ~E S t ~PF Sc ,e Fa p SET 14Cbc- ~ O K FU u~~ L_ I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME print): TESTS WERE COMPLETED ON: hiOMESITE SEPTIC PLUMBING CO. zI ,e G . 3 I ^ 15 e ADDRESS: r ROBEPiTUDSON T CERTIFICATION NUMBER: PHONE NUMBER(optionaq: 12 2- NO. 3307 M.P.R.S. Z 3 ?Ie S MIP)N. INSTALLER & DESIGNER LIC. NO. 00663 CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. 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'0 V) 0 o Y x Q c c ~ c p m H a, c D O a > o Lu O ti`+ y ~ C C a c N 9. Cl- c 1- C~ ;L -0 0 0 ro _j _j E N c E E` o O d E V J ~L Q V) l0 N V V J TZ O ,1 17 t V p J O J l ~0 0 (D + A ~ N ~ 0 0 lo a d > o _W 11 Z a s o v O' o L Ln N U 7 p c 1 Z Z 0U \ O 4r Q V, kn o- a v x A V) ~ z o~ o~ 3 o m T a o :3 V? N C: 01 o° W E D o ; J O- s EW C-i 1-0 in N ~c •o N c - s Y' L a 2 o c i M 1 C) o E -C, Q) :3 C-6 G~ ? lll ~ t0 LL , R o cr N~ Z m o C c C O N C_ rn O Q d~ N T Of NO O1 t mW L Aft (r \ As-o O~ O C - (Ilk I `J C p •3J > 7 O O L `~J = Q O J vmi La V V ~ SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL Office of Division Codes and Application 201 East Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 DON NASH Owner: CHRIST CENTER C/O DON NASH 815 LARSEN LN 815 LARSEN LN HUDSON WI 54016 HUDSON WI 54016 ! RE: Plan Number: S92-01498 Date Approved: June 2, 1992 Gallons Per Day: 2,250 Date Received: June 2, 1992 Project Name: CHRIST CENTER Location: SE,SW,20,29,19E Town of HUDSON County: ST CROIX The plumbing plans and specifications for this project have been reviewed for compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50-64 of the Wisconsin Administrative code. This approval is for the following components only: - NEW CONVENTIONAL Inquiries concerning this approval may be made by calling (608) 266-3937. SBD 6423 i8. oU611 J SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations DON NASH Page 2 II Sin rely, AMES QUINLAN Section of Private Sewage Division of Safety and Buildings PPP012/0009n/ 4 cc: CHRIST CENTER -Private Sewage Consultant County UW-SSWMP Plumbing Consultant Owner Plumber Environmental Health SBD 64231R.01/911 l ZAPPA BROTHERS EXCAVATING INC. 715 SIXTH STREET NORTH HUDSON, WI 54016 PH. 715-386-2850 This document is to state Zappa Brothers, Inc. does assume responsibility for the design of the on-site sewage system located at the Christ Center Assembly of God Church located in the State of Wisconsin, County of St. Croix, Township of Hudson, 810 Northview Drive. at lo 4'~ 2 Gary P Z~Notary Sc omMaster P 1 umber Public (MPRS 3300) State of Wisconsin Mr. Clarence Goltfelty agrees to above statement. ;Jjz" Date: Cl rence Goltfel X ZAPPA BROTHERS EXCAVATING INC. 715 SIXTH STREET NORTH HUDSON, WI 54016 PH. 715-386-2850 This document is to state Zappa Brothers, Inc. does assume responsibility for the design of the on-site sewage system located at the Christ Center Assembly of God Church located in the State of Wisconsin, County of St. Croix, Township of Hudson, 810 Northview Drive. at Gary P /J Sc omZ Master Plumber Notary Public (MPRS 3300) State of Wisconsin Mr. Clarence Goltfelty agrees to above statement. Date: QT C1 rence Goltfel / Y1