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HomeMy WebLinkAbout030-1031-50-000 - _0 0 -01 0 M C ti Qr O ; O i a~ :2 c r~.. 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CROIX COUNTY WISCONSIN PLANNING & ZONING OFFICE M M W M r~ur COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson WI 54016-7710 (715) 386-4680 FAX (715) 386-4686 August 3, 2005 &AA"n~ Jeffrey Roberts Z 1085 Nelson Farm Road Hudson, WI 54016 RE: Addition to existing structure, Town of St. Joseph, St. Croix County Parcel # 030-1031-50-000 (8.29.19.111E) Dear Mr. Roberts: You have requested the Zoning Office review your remodeling project for compliance with the state sanitary code (COMM 83). When remodeling or adding onto a dwelling you are required to examine whether or not the planned modifications involve an increase in design wastewater flows to the existing Private On-site Wastewater Treatment System (POWTS). According to your statement, the project involves an addition for a bedroom and making 2 existing bedrooms into a single larger room. The number of occupants will remain unchanged. The septic system was designed and installed based on wastewater flow for five (5) bedrooms (750 gallons/day) with a maximum occupancy of ten (10) persons. This project will not result in an increase of the design wastewater flow. The replacement system was installed in 1992 by Jim Boumeester and was inspected by zoning staff at the time of installation. The system was found to be code compliant at that time. Inspection report, as-built, and sanitary permit documents are on file with the zoning department. Our records also indicate that the tank was pumped in 2003. To prolong the life of the POWTS, remember to have the septic tank pumped at least once every three years ~A or when the tank becomes 1/3 full of sludge and scum. The-,effluent Other efforts to extend the lifespan of the system include water conservation measures such as repair or replace leaking plumbing fixtures, reducing shower time, running the dish washer only when it's full, avoid using a garbage disposal, using a wash machine with a suds saver feature, etc. The projected lifespan of your POWTS is dependent upon proper maintenance of the system. If this POWTS should fail at any time in the future, the system will be need to be inspected by a licensed plumber or POWTS maintainer to determine if it must be replaced according to state code requirements in effect at that time. The proposed remodeling project must comply with all applicable building codes. Please contact the Building Inspector for the town of St. Joseph to obtain a building permit. Should you have any questions, please contact this office. Sincerel Pamela Quinn Zoning Specialist Cc: I)wight Farnham, Deputy Zoning Administrator file Parcel 030-1031-50-000 08/02/2005 11:44 AM PAGE IOF 1 Alt. Parcel 08.29.19.111 E 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * ROBERTS, JEFFREY S & SUSAN JEFFREY S & SUSAN ROBERTS 1085 NELSON FARM RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1085 NELSON FARM RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 8 T29N R19W PARCEL IN N 1/2 NE 1/4 Block/Condo Bldg: SHOWN AS #5 ON SURVEY & DESC IN 570/167 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 08-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/07/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.240 183,200 211,500 394,700 NO Totals for 2005: General Property 5.240 183,200 211,500 394,700 Woodland 0.000 0 0 Totals for 2004: General Property 5.240 183,200 211,500 394,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 312 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 030-1031-50-000 05/06/2005 09:51 AM PAGE 1 OF 1 All. Parcel M 08.29.19,.111E 030 - TOWN OF SAINT JOSEPH Current n - ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): = Current Owner JEFFREYS & SUSAN ROBERTS ROBERTS, JEFFREY S & SUSAN 1085 NELSON FARM RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 1085 NELSON FARM RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 8 T29N R19W PARCEL IN N 1/2 NE 1/4 Block/Condo Bldg: SHOWN AS #5 ON SURVEY & DESC IN 570/167 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 08-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/07/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.240 183,200 211,500 394,700 NO Totals for 2005: General Property 5.240 183,200 211,500 394,700 Woodland 0.000 0 0 Totals for 2004: General Property 5.240 183,200 211,500 394,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 312 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ov- r f AS BUILT SANITARY SYSTEM REPORT j O.R DRESS T4WNSHI h SEC. _ T , R~W o , ST. CROIX OUN Y, WISCONSIN. _3DIVISION LOT LOT SIZE PLAN VIEW -Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~ ( <5 1 117 ?TIC TANK(S)___ MFGR. CONCRETE TEEL NO. of rings on cover a Depth DRY WELL 7INCHES NO. of width length area D no. of lines _-Z_ width~a , length area- de h to top f pipe-"?_6 ' 3REGATE J2 =K RATE 5 AREA REQUIRED AREA AS BUILT sclaimer; The inspection of this system by St. Croix County does not imply complete pliance with State Administrative Codes. There are other areas that it is not possible inspect at this point of construction. St. Croix County assumes no liability for --tem operation. However, if failure is noted the County will make every effort to ':ermine cause of failure. BASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYST 'INSPECTOR D.TFD a2d , /~97~ f~ PLUMBER ON JOB LICENSE NUMBER S I i z - REPIRT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM San.itany Penm.it State Septic NAME. 1'own6hi p St. Cnoix County Location Section _ SEPTIC TANK Size ./j9 0 Q gatton6. Number ob Compantmentz- D.iatance Fnom: Wetl 0 it. 12% on greaten ztope /Q~)7'c"6t Bu.itd.ing it. Wettand.6 DISPOSAL SYSTEM fitighwaten D.iztance Fnom: Well D it. 12% on greaten Mope it. Bu.itd.ing it. Wet.lands Ft. H ighwaten FIELD DIMENSIONS: Width o6 trench_ it. Depth of rock below t.ite / ?.i.in. Length o6 each lino IWAW it. Depth ob rock oven t.ite Z- .in. Numbers, o6 .Lines 07X Depth ob tite below grade yz .in. Totat .length o j tines it. Sto pe o6 trench i in pen 100 it. Di-6Lance between tines lp St. Depth to b edno ck /Vfy fit. Total ab.6 onbt.ion aneaG4t2 Depth to gnoundwaten it. Requited area 6t2 Type o4 Coven: Paper on Straw PIT DIMENSIONS: Number o6 pit. 6" around pits ye.6 no Out ide diam e ~t_ Depth below inlet it. 2 Total ab.6 o t.ion area it z A Area nequined ~t2 rn INSPECTED B TITLE APPRO TED , DATE Z~ Z 19 7 REJECTED DATE 197. r ~ ~ EH 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH L ti P.O. BOX 309 MADISON, WISCONSIN 53701 A~~~/~'~ REPORT ON SOIL BORINGS AND PERCOLATION TEST LOCATION: _ ''/4, Section _S_ T27-N, R /2 E (or) W, Township or Municipality - Lot Lot No. , Block No. SAC e ~le- County .s r7l' Owner's Name: Subdivision Name Mailing Address: . ~o y C Jj] yh ~r S ,G / M/~ TYPE OF OCCUPANCY: Residence C~ No. of Bedrooms 3 Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS 3- 2.2 PERCOLATION TESTS SOIL MAP SHEET SOIL TYPE Z21~ 6 PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P_' 3 ,.See, o le_ ~4 fg, f 3 6 P-) i / P 3 3b , . SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) B ^7 PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square fget o uitablea; Indicate numberp~square feet of abs on area needed for building type and occupancy. /ice .,,,x, /I C 49TtAfEat tale or distances. Give horizontal and vertical reference points. Indicate slope. i N 1 e ~ ~ ~ r1 D T1 r' ~v 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 location of test holes are correct to the best of my knowledge and belief. Name (print) 141 A/V g- AT Z Certification No. Z / 3 Address ~Y I Ale- Name of installer if known X l CST Signature COPY A -LOCAL AUTHORITY State and County State Permit P L B # 6.7 ~ ~.Permit Application County Per # for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: 7ffr B. LOCATION: b(1 F Section T,U N, R_Z7'E (or) W Lot# 3' City Subdivision Name, nearest road, lake or landmark Blk# Village Township p e S' h e- 17-1- C. TYPE OF OCCUPANCY: *Commercial *Industrial *Other (specify) Variance Single family L/- Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY 4D-a, Total gallons No. of tanks 4 : HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel L/ Fiberglass Other (specify) New Installation i / Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New L-~- Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width epth Tile depth (top) No. of Trenches Seepage Bed: !j Length 52 Width /2 i Dep Tile depth (top)-20~ No. of Lines 2- Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land- C- - % Distance from critical slope WATER SUPPLY: Private CR Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil Tester, NAME _ d / C, `j a L C.S.T. # j 7 /3-and other information obtained from (owner/builder). Plumber's Signature , nIP/MPRSW# -5 Phone - ~yyy Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. A0 w . , E f E 3 E 1 „P v , D y 3 a_ . Do Not Write in Spac Bel R COUNTY AND STATE DEPARTMENT US OIV~t Y Date of Application - FFees Paid: State /n ~L1Coun Date - 1 Permit Issued/Rejectsd (date) Issuing Agent Name; Inspection Yes. No State Valid# Date Rec' 1. county (wh.ite copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4, plumber (canary copy) Revised Date 7/1/78 AS BUILT SANITARY SYSTEM REPORT OWNER T j rO Etc RtS . TOWNSHIP l O SQ P~ SECTION-&_T 1 N-R_L9 W ADDRESS F{ Xrn R ST. CROIX COUNTY, WISCONSIN SUBDIVISION_ Y v LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 1004 GARAyt o d g y o i .v r Iv INDICATE NORTH ARROW BENCHMARK:Elevation and description: Alternate benchmark 1~ SEPTIC TANK: Manufacturer: nn n~ IZA ~00 AI LiquidbCap~p~ wPs 'I 'Ov~yX1~ Rings used:J-Manhole cover elev: J106inal grade elev• / 1' s- 0 (.4 Tank inlet elev.:NeW W flank outlet elev.: Mtk) No. of feet from nearest road : Front Side Rear Ft. CM 9 6 0 f ! From nearest,prop. line:Front Side ~ , Rear Ft. No. of feet from: Well- SCE' Building: S~ (Include this information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE it i PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manu€act.: 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 ao y. zr I-krw~n gs lO "7 - . - IUv G~ SOIL ABSORPTION SYSTEM 1 1 as ~ N p 91. 3 U- Y S" . 3 9 Bed: Trench: Seepage Pit: Width: S - Length 100 Number of Lines: Area Built-j-000 Exist. Grade Elev. 5919,5 Proposed Final Grade Elev. Fill depth to top of pipe: t4l' No. feet from nearest prop. line:Front Side X Rear Ft D)' No. feet from well: ~ 3 No. feet from building HOLDING TANK Manufacturer: Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. line:Front , Side , Rear Ft. No. feet from: Well building , nearest road Alarm Manufacturer: Q INSPECTOR: DATE: 1 PLUMBER ON JOB: LICENSE NUMBER: TO 6/90:cj i t `Wi3c i LfAertm Tt of I'c~us ry, 8-29.19 RIVATE' SE1~►ACiE SYSTEMFARM RD • county: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division ST. CROIX I (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 175658 Permit Holder's Name: ❑ City ❑ Village EkTown of: State Plan ID No.: OBERTS JEFFREY S & SUSAN ST. JOSEPH CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: IZ~ /1 ~ vd , ,_~O /Z 030-1031-50--000 TANK INFORMATION ELEVATION DATA A9200315 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dead ' Aeration Bldg. Sewer Holding St/ 41't Inlet TANK SETBACK INFORMATION St/ H,( Outlet Vent TANK TO P / L WELL BLDG. Airl to ntake ROAD Dt Inlet Septic 2! NA Dt Bottom Dosi~ NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System ' PUMP/ SIPHON INFORMATION Final Grad 2 S S~ Man Demand Model Number GPM TDH Lift Friction Sys TDH Ft Forcemain Length Dia. Fi Dist. To SOIL ABSORPTION SYSTEM BED /TRENCH Width Length i No. Of Trenches o. Of Pits Inside Dia. Liquid Depth DIMENSIONS 1U~ Z DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufacturer: SETBACK f Q,0-n7.7 CHAMBER Moe r: INFORMATION TypeO System: kl[eYdIPL Z0 OR UNIT DISTRIBUTION SYSTEM Header /4A&Mtf644_ it Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length i Dia. Length -_-q~ Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over 2 Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center _53 Bed /Trench Edges ' 7- Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) C4 U , Plan revision required? ❑ Yes D;1410, Use other side for additional information. C 1021 9z , SBD-6710 (R 05/91) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: DILH 2 SANITARY PERMIT APPLICATION , H In accord with ILHR 83.05, Wis. Adm. Code CouNTI 5 I , 0)`C STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than / _ 0 8% x 11 inches in size. ❑Cn k r sion o Zus application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY P OPERTY LOCATION ~1~ 4j, T N, R E (or) W PROPERTY (O~WN~R'S M r~ILINGARDRESS LOT # BLOCK ~e~Nsao ~)A CI STATE ZIP CODE PHOy~ BER SUBDIVISION NA r ORHV NUMBER I7V unscl~ disc ~ 0~ 1~ 5~- c e TA i II. TYPE OF BUILDING: (Check one) ❑ State Owned ❑ VILLLLAGE : S NEARS T ROAD -gyp Q S`o/.1QtClr~ 1~ =W QF: ❑ Public 1 or 2 Fam. Dwelling-# of bedrooms R EL x NUMB ( ) III. BUILDING USE: (If building type is public, check all that apply) (V-:?o - /0 3 / - Q 1 ❑ Apt/Condo 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 ❑ Mobife 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 4.0 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 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 12. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE r7s 0 REQUIRPp sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min inch) ~t EV~TIION 9 09 1 1• Y Feet -J~ meet VII. TANK CAPACITY Site in gallons Total #of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holdin Tank 00e S Lift Pump Tank/Si hon Chamber El . El I F-1 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name tint): Plumber's Signatur e: (No Stamps) MP/MPRSW No.: Business Phone Number: _ g(,w Plu V e a dress (Street, city, S te, zip code). IN P ki V k, bIO~ S IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved SIm ary Permit Fee (Includes Groundwater Date issued Issuin Approved Surcharge Fee) 9 gent Si nature ( mps) ❑ Owner Given Initial 681.1 Adverse Determin ion 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, maintairied. 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. It. 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 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 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 fik 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% 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) so-H tebt 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) STC-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 .TE~~p.Ey-y S' AlyvI7 Sus 4p . Location of property *l/4 AJE 1/4 , Section , T a 9 N-R /`S'' W Township q- ~O<S~oii Mailing address /dcfs Al'(51,561v 6Aeyn /!'vO f~Ue~,Sov W / St/0 ~ ~ Address of site .5L- Subdivision name 5'01Ej L - Lot no. Other homes on property? _yes --No Previous owner of property Total size of parcel 67666-lq Date parcel was created 3 - / Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes,, No Volume J.b and Page Number /6-7 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. U3-1031-6Z) , and that I (we) r own the proposed site for the sewage disposal system or I e(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. a Si of applicant - ~nt Co-applicant Date of Signature Date of Signature Reed. fOr ' cloy of, r WT UM TO County, as Parcel #S located ; }of Section 8, Si. Joseph, St. Croix Tax K NO. at the North Quarter c°rufst' t ` 1313.25 feet Aloes the Vast 1S~IS of Qtr of said Section 8; thence North. 37' trh sew` Northwest Ottarter of the Northeast qua!'tet : *10* kbe mast line of said Northwest Quartet, `t-- t thence South 890 37' 50" West 642.0 "T-," aLnq~the Easterly right-of-+way lone of a,. ; .TT mot; thence South 00 22' 10" Fast 2%,'19 f wtl to" South 00 39' 10" West 30.01 foot alo" R- t Witi etast Cntarts-r to the point of beltionfup. p aeE specified in Affidavit Establishinx' t# of Deeds for St. eoix Co., Wis., in Vol-. 497,,E rigt,we covenants. y &V of 19 _a. Yr - Katherine L. HaakaGA01k ACKNOWLEDGM.E14T s;. j)r of STATE OF -iYiBCG>K~- MWeir" ~ Ra M se County. Personally came before me, this - _ - the above named . - ~ ~Ota K~ ~ , r , me known to be the person- ~ who exactttM1,111r, ;.•itng instrument and acknowledged the Sams. kmariedged. Both u tic,lary My Commission is permanent. (If not, stOW d4R; Y-s~sv ~ Cdr- SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER J- r0OW S AWO VvV97V e- 46Cze?":5 ADDRESS: &)X5 A46zS0N jr~- 40 AtoSor✓ FIRE NO : /O607 LOCATION: AIAI 1/4, IVE 1/4, SEC. r' T~9 N-R / Y W, TOWN OF: 9- J0.JC °i,F ST. CROIX COUNTY-14-fl- SUBDIVISION: SCA77_1ZE LOT NO. S 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 to help with the cost of the 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 the St. Croix County Zoning 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 (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification from will be sent approximately 30 days prior to three year expiration. 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 form must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED:/ I. DATE : a ~ ~2 St. Croix County Zoning Office 911 4th St. Hudson, WI 54016 x . 0 V) m O o o tTv. C Q S J 1 r; U1 N CD 3 (3 rt° o to N v O O b V) A A z OI 3 y T (X./Ct N A D b Q.3 v =v V CL -D J ; X I- 3~ v ~ ~ L /r QQ 3 l`~ o o'er, o N p P rt Q - c L ::j G { c co (4 0 "n cl -0 o V N r N Lv, 0 j' D to r+ tc) 3 ~ !D ' V •O M ? N S/ Q 1 _ o Z o 'v 'r► n r N X wWL C C (D O f ~Q ° Arai O 0 IA (V o r 11 ao G GI C) C7 z ~ v L/2 . + o e S - I L4 0 O 3 v v r ~ C) (,1r O P 3 0 CL 7. 914 ~It a ~b ~ CA 3 -D mr CL t-0 to 40 3 (4 0 .-D ` v = Gl OD A~ D O N c, o cn. N r oo ° b r sc 0 r b L N ~ A O O K A c Q m v m ` C_ -<I 6 ~ A 0 a LA 0 'o 0 CA c1D cn N- w 0 d o~ ~L O it n Y'C = N m CLI o D o C-% 4r 'D ~ C 7 0. RO ` o CAW b <ko_. Q Al O o 'o I~ o to i n - O N O v v ~ -A J 00 d~ 00 to ~ ~ < lip r I 0 Q O 0 i N M ro w< 3 Q W V,~.G o o r~t tsp. O b A A f~, N O ? V) m ~ V' D d a3 J fli (b 3 v m LA L X N I'1 J tlJ s J C7 ~ O ~ tJ G ~ cD r+ 31, , v' x r( 3 cn vii C 6.0 m :3 1) ft CL _ r. N- c N Z 0 O co N IV 0 c .O x .9 M n v+ Z vJ b co D N -4 9D i r C) 0 a) tQ ( ( O Z ^ 7 ID V 0 In T ' j O N r) -D o H fD p o L s ° < b ti_ (A h o r" 7 ° ro C) 0 r O N~ z . ~ 70 ri v _ n 0 O ° 0 -0 3 non b r A d x r~-f T C N 6) O LA =r cx to m m l r r J^ ° to ro o m (D ' (Cj b O m (J> > a `M° A~ O ' v c, m D 00 ~ o :3 N S~ N F rD LU f/1 N d' rl V O m O .0 C ~ 7 N L4 N CL O A lQ A T N ° o U) ODD A 3 Od -(D (D v+ SL C b. Q b I-o C'^ O D I" 7 G eD m DAi O V O 7r O,. r+ U) 7 r 00 90 v OO ~%Dc A rn_ ~Q w ~o lNoLO N n p O G oQ r a" o LA N p~ ( 00 v, U' N~ 0 O D = o 0 C c ro r In a p M. w m --I o v, r 3 3 r+ COP O O b m A Z or 7 CL IV CL:3 N w _ O W ril re C p _ N 3 O W IJ 6' s 1 r JW dm v m W L X Q : N N l r J t=i ~ m ti J r O d~ C/ 3 (D cto N ~ ~ L ~ h 77•• ~ N• c 0 r+ Li 2. -3 d- O 0 c NOS x0 .4 V D N N -4 n ~ rT I 1 r 13 0 /U o I U) ~M v ~N c o N u 0- 2. T L ~ G O CA 0 I f X y (D (D (/j LA to c o ' C r b N G o~ .fir 0 0 (D Q 6 c m (A c/1 cA rr c 0 a7 t/1 ~Ip rl `K ~C N O O N ~ 14 3 r+ N b b b N G C U1 VI :3 _-y to n► ID _ m a D O p ro N IA Oh N N p C r ~ N 0 N d Q T ~ A cn b s 'D ;~p o La (D v~+ d b- Q b zfi v Y'CA O H r m aN d0o, v ° U) zw v.m 3 fT rD 00 x SN LP 'o ~tOC ry Q1-- tD Q T W r ~ I O v to N 0 D 0© 0 a( o 0 CP LA LP :3 0 TI ~ ~ ~ 10 F~ 3 ~'a F ~ I v Q? * J Z S I 10 A r c. J N 07 m _ ~I E-i ~ I O a a o h ~ r ~1 4 Qf-' 1 U~ a CJ 'VI C c bo ~ R Q.L. 67 PLOT A Nc:1`0SS SECT I0 ICI P I ~1 L C, -r i YM NAME ~J~ 6u~.~~ ~r< " L 0 CAT 10 LICE N IS E :ff- 3 - `L.~.. I) A P. L .O -1- ""'PA _P ~.rw, -10a' o c~~ c r~'~~ SI~~ x~ 1,000 AI _t r N ~!S (A to 1 W) Ali a XF) span S.(~ Lsysf~ £RESH AI1: INLIsTS"11ND OBSERVA'PIpN PI.BE CROSS SECTION .Approved Vent Cap Minimum 12" Above 3 r; GKbWk Final rrade ~~~*oat~► l 4" Cast Iron To Final Grade! Vent Pipe Marsh lay Or Synthetic Covering Min. 2" Aggreg'.11 Over Pipe \V Distribut-io~~ ~i Tee Pipe J~ Aggregate Pel orated Pipe Delow ~Iso r~~ ta^ i)e~~eath Pipe 'e Cour).i.ng Terminating P lie c- V~ Bottom of System SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL Western Regional Office 2226 Rose Street LaCrosse, Wisconsin 54603 WEGERER SOIL TESTING & DESIGN Owner: JEFF ROBERTS PO BOX 74 1085 NELSON FARM RD RIVER FALLS WI 54022 HUDSON WI 54016 RE: Plan Number: S92-40298 Date Approved: May 19, 1992 Gallons Per Day: Date Received: May 13, 1992 Project Name: ROBERTS, JEFF - RESIDENCE Location: NW,NE,8,29,19W Town of ST JOSEPH 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: - REPLACEMENT PETITION NOTE: Conditionally Approved. The condition is that plans for the soil a 9 system be submitted to St. Croix County for review and approval rb O Inquiries concerning this approval may be made by calling (608) 78 8. r ~r Z S130 6725 , R. 01/91) SAFETY & BUILDINGS DIVISION lot 201 E. Washington Avenue P.O. Bog 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations May 18, 1992 JEFF ROBERTS 1085 NELSON FARM ROAD HUDSON WI 54016 Petition No. S92-40298-P Dear Mr. Roberts: Re: Jeff Roberts - Residence Private Sewage System NW,NE,8,29,19W Town of St. Joseph, St. Croix County, WI Your petition for a variance to sections ILHR 83.10 (1) and 83.13 (6)(a), Wisconsin Administrative Code, has been reviewed. The petition has been conditionally approved. The conditions are as follows: Plans for the soil absorption system shall be submitted to St. Croix County for review and approval. The rules being petitioned require that a soil absorption system be located not less than 10 feet from an uninhabitable slab-constructed building and the top of the distribution piping shall be no more than 42 inches below the final grade. The variances requested were to allow an existing soil absorption system to remain in place 2 feet from an existing garage and to install a replacement soil absorption system with the top of the distribution piping approximately 53 inches below final grade. All of the data and statements submitted on behalf of the petitioner were considered. This variance is specific to the subject petition and cannot be used for any additional modifications. Sincerely, Richard Meyer, Archit ct Director, Office of Division Codes and Application (608) 266-3080 RM:GS:1741WPP1 cc: Leroy Jansky, Private Sewage Consultant - District 6, Chippewa Falls Thomas Nelson, Zoning Administrator - St. Croix County sBD 6928A. 01MO  i I o3L-z s Owner's name San. Permit No. H63.05 PLOT PLAN 92-4029 Show: 0 Location of building served A Dosing chamber Q Septic tank Vertical/horizontal reference point of Building sewer Q System elevation is Q y .S `1' Effluent system Q Well NA Replacement system area Q Property lines w/in 50• of system Q Distribution boxes F--I Scale = ~ti= alol , or dimensioned t1 - Pump and. controls : Fm- Mfr. & Model No. Vertical Lift Size Force Main Friction Loss T. D. H. Vol. Dist. Pipe Gal..per Min. Gal, per Cycle Place check mark in appropriate box, indicating item is shown on plot plan,below: B - eL-I0p:p ON h ~tzkGE ~C~sI~NG se"c ~R ~CIU h►aDO1atD hs 1~ez eaww S So' of 4~ FXtgltniG PtPI \St,S GAt_ Wth3~ CdvC. / S t_= p ~ e }tc~Jk ~ a ~ ~ wt~-a~ co~Ctt..clt. e/ ot~lltlt3v\ioN $OX S 9D2~ ~~wa/ aL Rr'~1CC-►~cE o v~ / ¢ h / j. ,0 fltg9~ PJ CZe4t_ h Lt-.IF?a r c\te s \oo' t V E1~tT S 6' vi vES M C VAJ Q&eTIt S' o= - - - O1g'~tl~Z1l11J BOX \~l0 P•1 tt.49 a . ~sd®®~~®0®iQ0100~9 P~'p2 a C®Iy®®® 96- Z ~ ®w 'CIl-~S~" l~(2pp~,`(Y LI/VL o ARTHUR L. WEGL'RER ELLSWORTH, • Wrs. i 40 l ~ ♦•,~i~~ ~S I G 14 ~o N • s E qz S92 -40298 Nu SCh 2'/ r 54 cI vLc*jr PIPES Ll PVC PeRFORATE!a Q)Pe 6 w/PCPP2ov~ D~S'SRIt3v~o~J Tam - - T Z~li S' c-( A V C 1 1~ Sdu tmwRu- a,P(S i G~~ S S S ~c-n o N rvo sch~l LJ''CJ V&Qr (~/P GV1`fT1 ~~PRvv tD CAP /~T LL'I}ST 1-zwAaovc Fuu1sN~D GRAbG EXIST)" G - A!vD Fr A-^ . so~~- t ` AcPPA.lJVG~b S~t1.1`Zl}~T1~ PI2.FORp1'ED'PtpE sn-ss ~t~l ~1V~ j•~!` COUClZJ/UCo oil 9 N OF ~o soT1'am or-O-m o` v1~JCAJA pnCM S7RAw E-L. 9~[.S. ~c . 4~i•S' 7*tAE6AT- A " BEIAuv DlS"TR113U~0~ A) PB top v.;s. Q OF A GGl2C GhTE Nz~ PIE k) , GI; S--t,2-22 ` ' • , X11 ,2 ' SAFETY & BUILDINGS DIVISION 05 EAVEO~ ^ 00 MAY, L iiat isconsin D tmelit ot4ndust abor and Human Relations ZONINGp _ FFICE 9 Rose Str:~ Er,;1 IGN owner: JEFF ROBEEPTE NEL S: -a:RM RD F:T`vER FALLS 0,T 0~ HUDSON WT 54016 RE: Plan Number: 392-40298 Gate ,~.ppr May 19, 1392 Ta' GI Is r Gate Rec. : av. May 1 3 - ! 92 Fr.sect "ame: P 43ER JEFF - RESIDENCE Locatic.n. E, 8,2 9,19,.q CT W;1E,?H, r. p'•aisbin? Ts specifications for to?s project rta've __z_n 1 ev lewed f Jr ;sapl;ante wit;, avp?icable code requirements. This app-o%;:;_, _s based on Chapter -5, 'Wisconsin S`l`ates and the Wisconsin. Administrative Code. The plans are *am es 'corioTt'.ona approved'. This approval is con n 9 e n upon compliance with ny wtipul 3r -,,n own on the plans. All items that are -Ioted must be corrected. ^.i1 permits required by the city, village, township or count- =hall be obtained urior to construction. The licensed plumber responsible for t^is installation shall keep one set of plans with the department's approva sr-3 p at the ~cnstruction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will et.pire 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: - REPLACEMENT PETITION NOTE: Conditionally Approved. The condition is that plans for the soil absorption system be submitted to St. Croix County for review and approval. i Inquiries concerning this approval may be made by calling (608) 785-9348. SBD 9197,a. 011YU - SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations '4EGEIDU R SOIL TESTING ex ~~;'E iGN Page Sincerely, r M Sectior) o. Private Se,~age Division of. Safety :.r u~'~ ,ays cc. JEE= ROBERTS Pr.va,re Sewa-;a ^onsultant SOD Hag-a. u1N11 - - - - - - - - I SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations May 18, 1992 JEFF ROBERTS 1085 NELSON FARM ROAD HUDSON WI 54016 Petition No. S92-40298-P Dear Mr. Roberts: Re: Jeff Roberts - Residence Private Sewage System NW,NE,8,29,19W Town of St, Joseph, St. Croix County, WI Your petition for a variance to sections ILHR 83.10 (1) and 83.13 (6)(a), Wisconsin Administrative Code, has been reviewed. The petition has been conditionally approved. The conditions are as follows: Plans for the soil absorption system shall be submitted to St. Croix County for review and approval. The rules being petitioned require that a soil absorption system be located not less than 10 feet from an uninhabitable slab-constructed building and the top of the distribution piping shall be no more than 42 inches below the final grade. The variances requested were to allow an existing soil absorption system to remain in place 2 feet from an existing garage and to install a replacement soil absorption system with the top of the distribution piping. approximately 53 inches below final grade. All of the data and statements submitted on behalf of the petitioner were considered. This variance is specific to the subject petition and cannot be used for any additional modifications. Sincerely, Richard MeYer Archittt Director, Office of Division Codes and Application (608) 266-3080 RM:GS:1741WPP1 cc: Leroy Jansky, Private Sewage Consultant - District 6, Chippewa Falls Thomas Nelson, Zoning Administrator - St. Croix County SBD 09281R.011911 i s SAFETY & BUILDINGS DIVISION A 201 E. Washington Avenue P.O. Box 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations May 18, 1992 PETITION FOR VARIANCE: Sections ILHR 83.10 (1) and 83.13 (6)(a), Wis. Adm. Code. PETITION NUMBER: S92-40298-P PETITIONER: JEFF ROBERTS 1085 NELSON FARM ROAD HUDSON WI 54016 BUILDING OR PROJECT: Residence/Onsite Sewage System NW,NE,8,29,19W Town of St. Joseph, St. Croix County, WI CODE REQUIREMENT: A soil absorption system be located not less than 10 feet from an uninhabitable stab-constructed building and the top of the distribution piping shall be no more than 42 inches below the final grade. VARIANCE REQUESTED: The petitioner requests to allow an existing soil absorption system to remain in place 2 feet from an existing garage and to install a replacement soil absorption system with the top of the distribution piping approximately 53 inches below final grade. PETITIONER'S STATEMENTS: 1. Due to the elevation of the existing septic tank and building sewer, the distribution pipes will be 47 inches to 53 inches below grade. 2. The existing drain field is about 2 feet from the existing garage. 3. A trench type system will be installed with a distribution box placed between the septic tank and the existing drain field in order to utilize it in the future. The nature of the soil, being $ 9 sandy loam and sand/gravel has a low bulk density and will not hold water. This fact and the trench design should pose no concern with ';0 possible crushing of the distribution pipes. The N _ well is located 80 feet from the existing drain field and about 140 feet from the proposed o o trenches. All other setback requirements are met except (2) above. E Z seo seae a. o~ro~ _ I SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Bog 7969 Madison, Wisconsin 53707 State of Wisconsin Department of Industry, Labor and Human Relations 4. It is requested that the existing drain field may remain in place for future use. It has been in place for 12 to 13 years with no apparent adverse effects. Its failure at this time is likely due to overloading. There are eight people in this family and the drain field has only 624 square feet of absorption area. COMMENTS: 1. No mottling is present, therefore groundwater will not be a problem. 2. In reviewing the petition, it was noted that request was similar to other petitions accepted by this department. 3. Based on the precedence established by the previous petitions, this petition for variance is being processed as permitted by Wisconsin Statute, Section 101.02 (6)(g). RECO14MENDATION: Conditional Approval. The conditions are as follows: Plans for the soil absorption system shall be submitted to St. Croix County for review and approval. Prepared by: Gerard M. Swim DEPARTMENT ACTION: Signature: Date. Richard eyes- Director Office of Division Codes and Application SBD 0928 (R. 91/91