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HomeMy WebLinkAbout026-1077-20-000 o m O d O n N ~4 O O C .Q C N T N co i 00 C U 0 N co O CL m .x I N O c N y ~ C 0 -0 m U. E o) a c O O Un Q U r~ I 3 M v z N .r O Z a co (0 w N p Z E Q X r :.9 n d Z ~ O C O L O O dI O N O •N ~ s ~ N c O `o r N © Z Z O 00 o m N Ln N > L O N O -0 d a E Q O O Vl to !n t U Z > E F- F- I- " O O O Z N Cl) 7 O N fn J U 7 0) 0) N } r ~ N O N CN L O N O j a o Q Z Q C o ~2 O c N C O 3 O 'O c E O O ~p p - U N p O O_ O O H FO N c N CL 0 0 z: O r02 c c N p r L' O E c^ N N ch U N p H O N O E U • Lw O N E O O N Zi O ~ cwt \ r~'+ - d N £ a ` a • :C ~ d .V d w C 0 a 0 0 0 T~CATI N: 26. g0 '~8 RICHMOND SEVATE S` WA SW U G"E MY VGisconsin epartmentoflndus~ ry, ftRIEM County: 'Cabor and Human Relations INSPECTION REPORT Safety and Buildings Division ' (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 17147-3 Permit Holder's Name: ❑ City ❑ Village [Town of: State Plan ID No.: LSON DONALD RICHMOND Parcel Tax No.: CST BM Elev.: Insp. BM Elev.: BM Description: d TANK INFORMATION ELEVATION DATA A9200239 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Cod- >'O Benchmark 3,$b~ /Ga,GC~~ Dosing ~iCJ{l~ , /3 ~r1, 1,GG /C)5/. $a 61 q Bldg. Sewer Holding St/f Inlet TANK SETBACK INFORMATION St/ IV Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake 16, 01(~ 9110. Septic/' NA Dt Bottom ~,~~,~g3.GS 3 Z+ r /DD, g~ Dosing 72' >7Sl NA fte.r/Man. A n NA Dist. Pipe Holding Bot. System L ZlJ~ FtA .0, PUMP /INFORMATION i' Final Grade ManufacturerDemand ~zw~~~ X10 140~ Model Number ~d GPM TDH Lift Friction System TDH 10,$1Ft Loss Head Forcemain Length 70/ Dia. - Dist.ToWell dp SOIL ABSORPTION SYSTEM BED/TRENCH width Length / No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 1S Y7 DIME LEACHI Manufacturer: - SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION System: (j ti~lC S, ~F9 CHAMBER Mo e System: 7 OR UNIT DISTRIBUTION SYSTEM ~.•D ^ Weirder/Manifold r~ Distribution Pipe(s) ~ x Hole Size ~ ~ x Hole Spacing VentllTo Ai~lntake c,j Length/ Dia. Length Dia. / ~T Spacing `f ~!(.CJ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over 1 Depth Over 7r It xx Depth Of xx Seeded /-bedd'e'd- xx Mulched Bed/ T,refteh Center j Bed / Yvei=dLEdges 12 Topsoil c~ es ❑ No 9-Y9r--0 No COMMENTS: (I lude code discrepancies, persons present, etc.) ' t 11' X'cty t.ta/cr~? .Lx r+ e i% Z--; ~ r J. 9 J L(?3"1i ~Yt l_L . f:1 «-f C7! v ~~jt~J2 f `tom (Z f~ L'~ t L~ A ~ nn ` P ~f, "i ~ ~`"~o-" ~ ~y,~ fib'' L-~ .~G'• z c~~7 r, [S l 4 r < /-I!' Ll 1. Plan revision required? ❑ Yes EJNbo Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: s sn DILHR SANITARY PERMIT APPLICATION LJ In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITA Y PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 17 / (4 7 3 8% x 11 inches in size. ❑ Check if 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. ^Q PROPERTY OWNER PROPERTY LOCATION Sj,: '/a GJ'/a, S T -9d, N, R E (or PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # Z / 17 eejir'~c_ 4/r, 4A ad ac. P..a &X T CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME R CSM NUMBER II. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned ❑ VILLAGE : 13o v L ❑ Public 91 or 2 Fam. Dwellings of bedrooms PARCEL TAX NUMBER(S) 111. BUILDING USE: (If building type is public, check all that apply) a 1 ❑ Apt/Condo 2 ❑ Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify s IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. [A New 2. ❑ Replacement 3. ❑ Replacement of 4.E] Reconnection of 5. ❑ 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 9 Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 130 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) /do. 34 ELEVATION Z_/S'D 19y 191Y3 l S Feet 1' G6 Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xistin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed -,A I Septic Tank or Holdin Tank Lift Pump Tank/Si hon Chamber l VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system show on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) P PRSW No.: Business Phone Number: 3 31a? ~ Plumber's Address (Street, City, State, Zip Code): ~_5 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No Stamps) VApproved ❑ Owner Given in surcharge Fee) itial 4/F _ 0 AW ~~Wj Adverse De rmination A402"t W-1 IN. X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/86) 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 t:y 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. 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 in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending o i system type. Vl. 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. lumber 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 muss: sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% 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 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) A.L.H.R. 83.08(2) PROJECT INDEX SHEET _ J Owner : v l i t ? Do -j -Co ZGG Address: 1117 ST. C,Po/ A, iGtiTS f~vGSo-v Gvis. i Site Location: „?.C) AGE': Z4, T~v,v, ;f'/J'rv Tocc~ti o~ /c'~c~,~,►o.v~ Project Description: 577" C.,e0I'X c~ ' t 5 ~ w. / w: rte) .2 tJ ~~RJ~ U.t1L~ 1'S 1K .S (6`ij&D i S92-01810 Page 1. PLOT PLAN VIEWS Page 2. MOUND CROSS SECTION & SYSTEM PLAN VIEWS - Page 3. PIPE LATERAL LAYOUI j AN& Page 4. DOSING CHAMBFR CRO. SECTION \ 41.:~ Page 5. PUMP PERFROMAf ASP, r fl SUN 1 Ci 07 Ica 00, 0 f PLUMBER: DATE: SITE EVALUATER/ DESIGMER SIGNATURE SvyyESrD ~S/o . /SOP"' ° a ~ 1 a /o y.5"a N~ fv ~ /000 r4,47-1'c a T y ,t- di~ewESTf•P~v ~a N M I I I I ( i ---=--°-~~•o ~ 96'-0 o SCALE : = 30 2h 3 I I 7,(NUiSTUR~t D So~L ~I Vh-Tia,,5S 'o So/L 776'S'TepS' 132- 9 ?3- loa, o 7, 3 A, Prior To P1oTring Installer will carefuh shift or orient mound position ~ toe and area under bed agaregare) so growid 3~ 1 L elevations across slope are as uniform as possible. Suggested elevations (staked on site with lathe markera) are shoTm herein 0~3€ ' and on pg. 2. ~~11 5 892-01810 t SE Lo T" f I,, Q 2 O A c~c-5 J 4 .10 ~ wE~ T ) ywy. ~s OA Ott- Page 2 Of 14)146~;p r o~ Zf T&kll-- 14 O. 60 Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand H-_ _ja SYSTEM Topsoil E/~►'hreo'd c - 11 D 100-30 3 ' b 4% Slope Bed Of i*- 2 (Force Main Plowed su9~E5TED Movup Z1v.1'4ell Layer y930 f Aggregate h TC~E G~%vE /E vhTiD.v D Ft. Cross Section Of A Mound System Using E Ft. E SEWAGE SYSTE-M A Bed For The Absorption Area F o Ft. ONS1T G Ft. n vv' A Ft. H / S Ft. Signed Ft. Li m ° rka l tvt. K /D Ft. 1_ r t,p1t L ~e 7 F 't. F 0 A .4, pEPD.FIT~Q A~ Ft. J Set CEition T 13 Ft. CpRFtES of W Z SEE Force Main y Ft. L O T71K bservation Pipe--------------- I-rA ~o °I W -----7:Bed ~I Distribution Bed Of 2~- 2 2'. Pipe Aggregate Observation Pipe Permanent Markers S92-01810 Plan View Of Mound Using A Bed For The Absorption Area s~7z, g 10, g, If page 3 0f S • 0/ t~ O /VM E' U c FoR c~ //}C /4.s r kle- Perforated Pipe Detail kv R/'Gti r hoe VA t; v.,tE tVA 0411 A-)~ / End Viow PeCf Uf OleO End Cop) e PVC Pipe Holds Located On Soltorn, \ \\R Are Equally Spaced Q PVC C Manifold Pipe ,tom \ DNtrlbatlon I Pipe Hold Should Be j Next To End ' Mgn~lfuiD ,''%y / Distribution Pipe t_oyuul P / Ft. R i X Inches Inches Hole Diameter Inch Signed: Lateral Inch(es) License Number: Manifold Z Inches Date: Force Main Inches # o•f holes/pipe /z 0 Invert Elevation of Laterals /00, 8 Ft. ~/'S 7- 0((113 v7104) 7E/'I / 14.0 VAt, C) ' ~O ~I'ST~/~SUT/Q.J L7/j GLi ~~~~E n~~l~E~ /U•f'~1U0~ Zd t r RED A~~A : _ VA 2 -01810 i R ~ i j ~r 1 PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS Pf} E I OF S VENT CAP 1 4"C.I. VENT PIPE WEATHER PKOOF APPROVED LOCKING MANHOLE COVER l✓/(~j~(,cllv(~~~I~E~ Z5' FROM DOOR. JUNCTION BOX WINDOW OR FRESH 12"MIU. AIR INTAKE %vrlT~p"t/ GRADE I 'i°MIIJ. i. y/1AV ' I CONDUIT-- 3 96~~ PROVIDE I - INLET AIRTIGHT SEAL { -T / I I (I APPROVED JOINTS APPROVED JOINT A INy~~r I III W/C.I. PIPE w/C.T. PIPE n ~0I.A I III EXTEUDING 3' iXTENDING 3' t0~ I II ALARM ONTO SOLID SOIL ONTO SOLID SOIL 9 9a " 10 oN + I N6 C: ELEV. FT 1 POFf N 13 i RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL .j f I SPECiFICAT10QS } SEPTIC E DOSE ip[vEST ,PJ f~~~rlST_ ~uGt~UMBER OF 3 PGR DAB TANKS MANUFACTURER: M N DOSES: ~ 7-5-0 GALLONS DOSE VOLUME /J!Q ! ! TAAIK ,IZE : Cll GALL-ONS CCT'" INCLUDIIJG BAGKFLOW ALARM MANUFACTURER: MODEL NUMBER: -D' V, L CAPACITIES: A= lG INCHES OR 3 GALLONS ~J~,pLyR~/ f/U R T- _ B L INCHES OR `3o GALLONS SWITCH TYPE: 70,,!~ me--,(-o C . 9 S INCHES OR BS GALLONS j I PUMP MANUFACTURER: MODEL NUMBER: 9T 'F0t~t12L ?-7 D= INCHES OR ZJ~y GALLONS i SWITCH TYPE: MOTE: PUMP AMD ALARM ARE TO BE ! 3D GPM INSTALLED ON SEPARATE CIRCUITS MINIMUM DISCHARGE RATE S^a~ v J I VERTICAL DIFFERENCE 6ETWEEN PUMP OFF AND DISTRIOUTION PIPE.. /"O FEET Ajk 2.5 FEET EACt,- olr r -I- MINIMUM NETWORK SUPPLY PRESSURE . r 5O FEET OF FORCE MAIN X /"s F/0 FLFKICTIOAI FAC70R.. '7 FEET ~d • 7-S 10' 3 FEET TOTAL D'JWAMIC HEApD = INTERNAL. DIMEIJS►ONSitOANK: LENGTH ;WIDTH ;LIQUID DEPTH S~ PGE S AT ° ~T 9 2 01810 r of 5 ~~1 1 L ° , S E t i V ffEADI 115- 34 A ACITY" 32 105 - - 30 V10-0 CURE 95 28 90 26 85 EFFLUENT 24 so - MODEL and O 75 MODEL 189 DEWATER/NG = x2 70 165 U 20 ~ 85" Q Z 18 60 55 J H 16 50 MODEL 0 14 163 1 MODEL 45 I tae 12 40- 35 10 MODEL 30 -MODEL -137,139: 185 SE1GE an/d~ 6 x5 DEW fTEf? 5 20 MODEL 15 MODEL 161 3 s U) 2 \Sr r. MODEL 5 53, 55, 1r 57, 59 0 GALLONS 10 20 30 40 60 80 70 80 90 100 110 24 LITERS 0 80 160 240 75 320 400 7' FLOW PER MINUTE 20 z ~ MODEL 285 W 5!i e(~. 1,4 MODEL I r Z t, 284 2 12 71 40 - JUN 121" a MODEL 36 283 O 70 MODEL I OF ,,jj1 .'s a a 284 p ER SYS. TEi; MODEL a 4~ 2 2 16 I 1Q MODEL - - 1TELLE,~' 0. 2 8 7. 268 u I 3280 014 Mmeis Lane i GALLONS 10 ?0 30 40 50 60 70 80. 90 100 110 120 130 140 i5P 160 170 180 180 P.O. Box 16347 1 ~p Louisville, Kentucky 40216 LITERS 0 Y 160 240• " 320 400 480 560 - 640 720 (502) 778'2731 ' FLOW PER MINUTE S 9 2 -01810 6197" CeSt Iron Series \ MEAD CAPACITY UNITS/MIN ~Jf • Automatic or Non-Automatic. Feel Meters Gal. Ltrs. t'y • ' H.P., 1 Ph., 115V or 230V. 5 1.52 57 216 • Non-clogging vortex impeller I, design. 10 3.05 51 193 15 4.57 43 163 tI • Passes '12" solids (sphere)- 20 6.10 27 104 • 1'ir" NPT discharge. Lock valve: 24.5• • Float opercted submersible (Nema 6) mech- anical switch. 226 + Automatic reset thermal overload protection. U~ listed 97 SC-2Series 2225 • Stainless steel screws, guard, handle and arm and wr~sr seal assembly. • Watertight neoprene °Q" ring between motor and pump housing. Approval d5 Assoc, Approval v N97, non-automatic, available packaged with a piggyback mercury avedaule float switch. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS 1(VD~ISTRY,' DIVISION LABOR P.O. BOX HUMAN NDATIONS PERCOLATION TESTS 115) MADISON WI 7969 REL (H63.09(1) & Chapter 145.045) LOCATION: SECT-ION: TOWNSHIP/NIUMIE}P]IMY: I OT NO.: BLK. NO.: SUBDIVISION NAME: SE ~4 SI / 26 /j 30N/R 18" Richmond in/a n/a n/a COUNTY: Zia UYER'S NAME: MAI NG ADDRESS: St. Croix Don Olson 1117 St. Croix Heights, Iludon, Ili. 54016 USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMER 1_AU_DESCRIPTION: PROFILE TS: tesidence 3 n/a [!New ❑Replace 5-4-92 5-6-92 FP 4 RATING: S= Site suitable for system U= Site unsuitable for system UNV€-Nfii~ MOC1N'D: '-GROUND-PiESSUT1€TS9~f~ -1® ros OLDING TANK: RECOMMENDED SYSTEM:(optlonal) D S ®U HSDiT ❑ S MU I 2U mound It Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.1-163.0915)(b), indicate: n/a_ Floodplain, indicate Floodplaln elevation: n/a decimal' PROFILE DESCRIPTIONS page 44 JeC2 BORING TOTAL H R U U A-TER-INCHE CHARACTER OF SOIL WITH THICKNESS, C 0 T RE, AND DEPTH NUMBER DEPTH 00 ELEVATION QBSERV D JIGHEST TO BEDROCK IF OBSERVED (SEE ABSRV. ON BACK. B_ 1 5.41 99.95 none 2,91 3, 10yr3/3, , S11, 5yr4/6, l.s., 2.50, 7.5yr4/4, not. l.s. B 2 5.33 99.95 none 2.33 .75, 10yr3/3, 1., .75, 7.5yr4/4, ail,, .83,- 7.5 r s.l. 3.00 10 r3/3 & 5 4/6 mot. l.s. - 97.95 .83, 10yr3/3, 1., 1.50, 10yr , ail., 1.00 B- 3 5.33 none 3.33 •5yr4/4, s.l., 2.00, 7.5yr5/6, mot. l.s. B- B B- decimal' PERCOLATION TESTS IESf DEPTH WATER IN HOLE TEST I IME DROP IN WAi ER LEVEL-INCHES ATE I UTES NUMBER AFTER SWELLING INTERVAL-MIN. PE NC _XJQM p. 1 2.00 none 30 4 3 3 10 13 P. none -3 z V. -3- 7Z. W P. none 4 P_ P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the horl- 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. SYSTEM ELEVATION 100.50 1 6-1 r3 I oe/ JILA 1, 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: Gary L. Steel 5-6-92 MBEfl: PHONE NUMBERIoptional): g CER'T FI " 5~~A~T7: A 1554 200th. Ave., New Richiliond, Ili. 54017 12 5- 6-6200 ST SIGN DISTRIBUTION: Original and one Cnpy to Local Amhority, Property Owner and Soil Tester. r Dit HR SBCI (3395 1!1. 02187) UVFII 4 I S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER C~ 4-s ADDRESS Q L- XL - FIRE NUMBER CITY/STATE zip l PROPERTY LOCATION : 114,6W 1/4, SECTION Z~O, T_)N-R W TOWN OF tip0tqC2 , St. Croix County, SUBDIVISION IV IA- 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 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" e. SI ED• DATE:. 9 St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 I i I 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 Location of property ~r--1/4 Sw 1/4, Section ;?,G, T-0N-R VR W Township Mailing address ~ SAS ~ Address of site Subdivision name- Lot no. Other homes on property? yes No Previous owner of property Total size of parcelG Date parcel was created Are all corners and lot lines identifiable? Yes No Is this operty being developed for (spec house)? Yes 'Z_No Volume ~ and Page Number~V~. " 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 . 04~ t) /,7 , 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. Signature of plicant Co-applicant Date of Signature Date of Signature -TRW -.y4Fa 7 t ,is~ t ~ J v kT a terry' _ ~ ~~3'' i t, ♦N..... M.Mi~i~MNM/1. 1 N N. ..~.:,:..M.,..r,,,...~...„.,,... .LaN..:~ 1} e A. R1R1.. I~f 7~~' {~!f f `L ST. CROIX COUNTY WISCONSIN ZONING OFFICE dv ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, WI 54016 (715) 386-4680 June 10, 1992 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To whom it may concern: An onsite investigation of the Don Olson property, located in the SE 1/4 of the SW 1/4 of Sec. 26, T30N-R18W, Town of Richmond, St. Croix County has been conducted. This onsite revealed suitable soils at a depth of 28". This site does require 12" of sand fill beneath the mound for new construction. Should you have any questions, please feel free to contact this office. in erely, James K. Thompson Assistant Zoning Administrator cj