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014-1013-10-000
v 0 d � 0 CO) 0 is G A M W 70 at c :: 0 I \ 1 II eTo v p I z p o n o o CD 3 co N O 0 O O N O I �. < < d CD ro O CO a c o 0 0 O m i p w „� OD rn °' CD o I 3 c0 o g 0 l o o (D c w a o W o 0) rn 3 CD w m In Z r D W a W I �n y y a m o I': C..� O CL :r o o s N 3 Q W` O O O C O "' Q O C (n „' • W W p N N I 7 T T -0 ^J 0 0 0 0 0 to fA U) c I a 3 N cn cn D 1 3 > ? v v m °— I r�T N C d I CD m y I OZ 0 Y D D I ' O O > S o 0 CD o m ? CD I c c I W rn _ I Z ? A 0 O in N Z e 0 I z w rn m I a e0 o a ;0 o cn cn 3 y X ? D N L N O. o z D v y' c o ° 'c o» m a fD CD G ?. �.� N 3 f• —n 7 aa 3 7 n O > m �� y °' 3 0 =o o z a 2 0 o z a W � En D, ro> > m� o 0 7 m •' c av�''o °am �] mgm m S o m c.� � w oo� Q . �£ns -y m3.° ° f,�N aC l. a CD CD 0) u , 5 ( a v, — CD CD m CD oog=,o Z�c �, w m tnur C,c S �33 O 'pp) Oman � "c r- � o' CD 'O a > > a a ;c O :, p N. � -°' �• O CD O • y � N f° o C a o m c I v d o N a n 3 � � o m �f H v a 0 m v m 3 m 3� y� cD ti c 3 - c � o CD I ox yo— I o 0.5 , Z� N 7 f0 a g� y I ~ 'm (D c ° o O c ° I °° � ~ , isconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT s GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID N (fl j 5 65 Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. /v . A Permit Holder's Name: City Village X Township Parcel Tax N . Severson, Wayne Forest Township Q/ ., CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 06.31.15.89B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) 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 / E Yes U No D Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /& )03 Inspection #2: Location: Hodson, - WI 54016 (NE 1/4 SE 1/4�6 R1 5W) NA Lot �id — Parcel No: 06.31.15.89B 1.) Alt BM Description = Z-3�J �O ST. 2.) Bldg sewer length L ¢,t /,, �- �j,{,vp . LSD" 7 - amount of cover 3.) Contour Plan revision Required? de for additional in Yes 1 No — - T - - — - - - - -- -- formation. i Use other SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. / / �/. � ���/ .I I = / / /�. L1y� � i ,.. �" . �, .i'! � � � �� l .� / � �� r� l ��,, : �� .� �, /•�� � - ,� �- � ,� i���`/ ��� ® ®� D Z y rr . 0 m 0 O m O n X r rV � Q L O cn < 1 m 0. 0 0 m 0 2 r 2 O � o n OQ m -� O n D 0i r c n Gm z o m 00 m C m Cn Z Z -i m Fn 03 v C W -n (n c Cn n0 C/) c < CD N n 5-1 z o O ZZ m Z ( - '� ;o ' �� m� m a o 3� E Q � � d _ � v l O m 3 , o 3-i co ° C �N W ° a m °,`° o m v, oo I� _ I U1 ° � N N m 01 � O � q� m C �� ado _ aIE co 0 r o W n d n •Z N o o v n $ N ° D o m d ° - �-- ° c vc3m 3� m°' rcD c E ; .zed in c� com �? om g' H mw to 3 3 3° c� 0 0 m z m m� �� �7 0 01 m °: m O n d o�w m U `c cn? O a ° o c M< Z Du z c m m° a ny m m c z p W y d m CL W � D D m C1 m N ° � y �► . O OZ O D ? �• m c ,n z z z m id m d � o 0 0 County Sanitary Permit — Application ST. CROIX COUNTY WISCONSIN In accord with 15.04 St. Croix County Sanitary Ordinance ZONING OFFICE Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER [Privacy Law. S. 15.04(1)(m)) 1101 Carmichael Road Hudson, WI 54016 -7710 (715)386 -4680 Fax (715)386-4686 Attach complete plans for the system on paper not less than 8-112 x 11 inches in size. County Sanitary Permit # ❑ Check if revision to previous application 1. Application Information - Please Print all Information location: roperty Owner Name r Y f AUG 1/4 1/4, Sec No Property s Mailing Address T 3 N, R or Lot Number Block Number Y1 �; �- ity, State Zip Code Phone Nume Subdivision Name or CSM Number V aIP 3 -- - II Type of Building: (check one) O✓ity ❑Village Town P1 or 2 Family Dwelling - No. of Bedrooms: of n : ❑ Public/Commercial (describe use): ❑ State -owned Nearest Road 1t II. Type of Permit: (Check only one box on line A. Check box on line B if applicable) Parcel Tax Number(s) 1 Repair 2 3.❑Non- plumbing . Q Rejuvenation O� �` - , 5� 9 Sanitation Permit Number Date Issued [3 State Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ❑ Non- pressurized In- ground W - Mound ❑ Sand Filter ❑ Constructed Wetland Q Pressurized In -ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line At-grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other - Dispersal/Treatment Area Information: 1 • Design Flow (gpd) 2. Dispersal Area 3. Dispersal Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Gals. /day /sq.ft.) (Minfinch) Elevation Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks I Tanks t !1 /moo ee ❑ ❑ ❑ ❑ "' � �� Q� ❑ ❑ ❑ Q I. Responsibility Statement 1, the undersigned, assume responsibility for repair/ reconnenction /rejuvenation/installation of non - plumbing for the POWTS shown on the attached plans. A icense is not required for terralift repair or the installation of non - plumbing sanitation system. s Name (print) Plum r ignatu (no (IO)MPRS No. Business Phone Number jostamps) f Plumber's ddress tr et, City ate, Zip �J°�e C// 11. County Use Only Disapproved Sanitary Permit Fee Date Issued ssuin gent Signat Approved Owner Given Initial Adverse '� S _,� C Determination IX Conditions of Approval /Reasons for Disapproval: INDUS T TR Y Gk= REFORM ON SOIL BORINGS GS y� N SAFETY &BUILDING' INDUSY, �® "'� J 1� 6'( ��1 e� /`1 DIVISIOi LABOR REL ATIONS PE PERCOLATION ION `�"ESTS (115) MADISON WI 5 37 HUMAN u, REL ATIONS , (H63.090) & Chapter 145.045) I LO ATC tON ISECTIOfV: TOWNSHI °tr'{��f Y: LOT NO BLK. NO.: SU6D dISION N, ME: '/4 G /T�� /R /; car)( r E.s I COUf TY OWNEH'S/tR'S NAME: MAILING Z ESS: �� - -- 9� �-- - -- - D ATES O BS ERVAT IONS MADE t #td9;.: COMMERCIALDESCRIPTION: - — - -- PROFILE DESCRIPTIONS. `: ER�L, l ION TESTS: �Residance New ❑Replace _ RATING: S= Site sui table for sy stem U= Site unsuitable for syst -- -- ' - ON - VENTIONAL MOUND IlV- GROGND:PRFSSURE: SYSTEM -IN -FILL HOLDING TANLK:R OMM ENDED SYSTEM:(opnon:rl) EIS �u os FIs 1U _ IDS u ❑s 2u I If Percolation Tests are NOT required DESIGN HATE: If ,r� portion of the tested area is in the �/ y (under s.H63.09(5)(b), indicate: y / V Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL �. ELEVATION DEPTH TO GROUNDWATER INChIES CHARACTER OF SOIL WI H THICKNESS, COLOR, TEXTURE, AND DEPTH iNUMBER DEfR:f F+AI, OBS EST. HIGHEST TO BEDROC IF OBSERVED (SEE ABBRV. ON BACK. r /7 �. s. s- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP I WAT ER LEVEL- INCHES RATE MINUTES NUMBER .9 -rn AFTER SW IN TERVAL -M IN. PERIOD i PERIOD ? PEHTiiC� PER !N &O -- 5 . U -- „� -- a A o r, F- vu 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 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. SYSTEM ELEVATION Z I-5. //et 0 I��1nArK�r lov, �� t � ( r -- 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 hest of my knowledge and belief. NAME ( TESTS WERE COMPLETED OfJ: _ ADDRESS. CERTIFICATION NUMBER: 1'HU lE NLJM8ERlnp6ona0: �/ // /,/ i i Wit'----- - CISTRIBU T ION: Original and one copy to Local Authority, Property Owner ano Soil Tester. 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CROIX COUNTY, WISCONSIN OLD TXSCR01 REAL ESTATE TOWN OF FOREST COMPUTER NUMBER 014-1013-10-000 Parcel Number 6.31.15.89B `1" ,gp ad Claimed 1 Date Re- certified / / Relate Number: OWNER NAME: First WAYNE A & ANITA R Last SEVERSON CO -OWNER Mailing Address 2336 265TH ST City CLEAR LAKE State WI Zip 54005 - Type Vol Page Doc # Rec.Date Type Vol Page Doc # Rec.Date HISTORY QC 1342/ 265 583480 07/23/1998 630/ 14 07/23/1997 PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name- Type SD Apartment Post Office C 2336 265TH ST School District: 1127 - CLEAR LAKE \ 13, to Special District: (1) 1700 - (2) - (3) - V W ITC Plat Coda.: Last Changed on: 08/12/1998 Book Number: 1 SECTIOf- 6 TOWN 31N RANGE 15W '/4160 1 /440 Map Number: 00 - Sales Area: Parcel Control 0 TAXABLE Number of Units: ZONING: Permit Number: Type: Bank Numbers F4 -P v, F5 -Next, F6- Legal, F7- Value, F8- History, F10 -Exit, F12 -More T3 IL IN[ I IIIK IL 51 C) 0 0 (0 r*--_ 0 N N Polk/St. Croix Road • 2389 N C N N rl N v I 2359 2348 • 6 Sev'ers� 2336 63 • rm o n 2338 2329 Lake v N in N IT N N N N co • M • O N (O N N n N Fil Q 2293 • • r N r ti � f- N I-- N N N H 7 8 2245 E A 2235 0 WO' 0 3vn tw o CD 3 o CD r \ ft 1 3 !? 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Co y CD (D 0 Co CD OD O O a, x� U) -0 � 3 3 cn v� .t � (D N y (D O n o O cr Q CD ��; w dy A (D y a N S O O N fo 3 •0 7 5. (p CD 'O O C CD z n �v O m 0. o x s3 y o c �ooaQ� m��D > >�o=r o a � a n=mNnnor .0 m c r UO a c m A 1 y o o b r° CD CD in 0 0 0 ., 4 ° a ° ?. . X D:II.H.R. ; { Leroy Jansky O.W.S.Wisconsin Department� of.Industry, PLB -1 INSPECTION REPORT 13 E. Spruce Street : Labor & Human Relations Chippewa Falls, WI 547 Safety & Buildings Division (71'5) 723 -8786 Bureau of Plumbing Name of remises a e an o. N . 3yV _ s'r County S anitary ermtt 31 SVj Rot , master um er ame csT ess 6 - SrE - ,� J ourneyman Plumber ress G O wner Addres s .� -3 cs . S Z 6 $S WA .. Air Fes. Z. - Uti.. w • �� - E ST "1. IF V1 r ' SECR A T ` /iry � v f�fT �UY(� 0 BS, w/�T - 2 t ►J KIT �t D Vii Discus With ign ure ( )See Attached. DILHR SBD 6192(R .11/83) Signature of is � as pec LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL E'TATE TOWN OF FOREST CO 'U MP ER NUMBER 014 - 1012 -95 -000 Parcel Number 6.31.15.89A O'.';' DER NAME: First RAY H & JUDITH N Last SMITH P': PER TY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment 2338 265TH ST S_ TION 6 TOWN 31N RANGE 15W 1 /4160 '/440 Lne Description Line Description TOTAL ACREAGE 22.500 PLAT LOT BLK 01 SEC 6 T31N R15W PT OF NE SW 15 02 COM N1/4 COR SEC 6 TH S 02 16 03 D ^G W 3090.33' TH S 83 DEG 17 0e1 � ;' 33.18' TO WTLY R/W LN TWN 18 F '& POB; TH S 01 DEG W 904. 19 4 ALG R/W LN TH N 89 DEG 20 V\ 1044.78' TO MEANDER LN 21 HARMON LK. TH N 34 DEG W 22 323.05' ALG MEANDER LN, TH N 23 0 51 DEG E 332.95' TH N 0 DEG 24 1 1 05.88' TH N 83 DEG E 25 12 x.20' TO POB 26 13 27 1 28 F1 F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL EFTATE TOWN OF FOREST C0MPU'7_ NUMBER 014 - 1013 -10 -000 Parcel Number 6.31.15.89B OWN:rF' NAME: First WAYNE A & ANITA R Last SEVERSON PROP` : FY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment 2336 265TH ST SECTIC'J 6 TOWN 31N RANGE 15W %160 '/.40 Line__ Description Line Description TO FA -ACREAGE 17.500 PLAT LOT BLK 01 S` -C 6 T31N R15W NE SW, THE 15 G2 N 1/4 -SW1 /4 EXC P89AAS DESC 16 03 1 630/14 17 18 G` 19 C 20 Ci 21 08 22 23 24 1 25 12 26 13 27 1 28 F1 -G ;r F - 4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER �T�J� = CO�T OWNSHIP ,a -��� SEC. T 3/ N -R /-5 W ADDRESS ff; .&,2,K 13� ST. CROIX COUNTY, WISCONSIN l�/� LOT /�'� i �G' SUBDIVISION LOT SIZE r J PLAN VIEW Distances and dimensions to meet requirements of ILHR 83 Ff�` SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM T—L: Z) r '' v E 0 C� �O 13 " No, iaoo � Gm 1 Septic pump 'rayl r o 2 r �t P P f y Vol //'' 14 • V� W 8� INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference oint: S�� J p /lX� -O � Proposed slope at site: SEPTIC TANK: Manufacturer: 4 g : 2ty Liquid Capacity: "eyeg q Number of rings used: -5�" Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side Rear, O /000 feet From nearest property line Front, 0 Side ,® Rear, 0 ,2� feet //of a✓^.'�� of fi,n� ° %rlsfa Number of feet from: well 50f , building: 15 � (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: 1,a. Liquid Capacity: �dd Sq Pump Model: 4J wTsl 7 Pump /Siphon Manufacturer: G'4uld IT Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: 135 Alarm Manufacturer: ' k - 1 0 00 Alarm Switch Type: zn r a ar i Number of feet from nearest property line: Front, 0 Side, Rear, Q Ft. ^ Number of feet from well: Number of feet from building: 3,2 (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: ei / Width: �f / Len$th: lv_7 / Number of Lines: Area Built: S�ZO Fill depth to top of pipe: LJos of 0 ,1 O&l/-- ✓' �a sirs.' /j ,� � y Number of feet from nearest p , Kea r, Number of feet from well: -S 50� Number of feet from building: S� (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: ameter: Liquid depth: Bottom f /sepage pi elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: ont, ide, O Rear, 0Ft. Number of feet from a 1: Number of feet from bu ld ng: Number of feet from near t d: Alarm Manufacturer: Inspector: Dated: jZJ Plumber on job: License Number: 3/84:mj DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR &HUMAN RELATIONS P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 53707 BUREAU OF PLUMBING t ❑CONVENTIONAL 'ALTERNATIVE State Plan I.D. Number: El Holding Tank E] 505 In- Ground Pressure XX Mound of assi 716 NAME OF PERMIT HOLDER: / x$ ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Wayne Seve&60n R. R. 5, Box 132, Hud6on, W1 54016 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN EF. PT. ELEV.: CST REF. PT. ELEV.: NE SW, Section 6, T31N- R15G1, Town of Fotmt Name of Plumber: MP /MPRSW No.: County: Sanitary Permit Number: Date B. Hud6on 6629 St. cuix 74957 SEPTIC TANK /HOLDING TANK: EBEDOING URER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑NO ❑YES ONO VENT DIA.: VENT MATL.: HIGH WATER NUBER ;ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALA �EE,7, LINE: AIR INLET: ❑NO ❑YES ONO NE AREST DOSING CHAMBER: MANUFACTURER. BEDDING: LIQUID CAPACITY. PUMP MODEL. PUMP /SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER ❑YES ❑NO PROVIDED: PROVIE DD: GALLONS PER CYC C DYES ONO [- ONO LE: PUMP AND (CONTROLS OPERATIONAL �� pROPERTV WELL BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN LINE, AIR wLET PUMP ON AND OFF)TR DYES ONO IEAEtIREf SOIL ABSORPTION SYSTEM. Check the Soil moisture at the depth Of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORGE the soil is dry enough to continue.) MAIN, CONVENTIONAL SYSTEM: °WIDTH: LENGTH DISTR. PIPE SPACING COVER OF . INSIDE DIA.: ��� TRENCHES: #PITS LIQUID I�• MATERIAL: }�'° DEPTH: GRAVEL DEPTH FILL DEPTH DISTR_ PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR', +PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPE &. ABOVE COVER ELEV. INLET ELEV END. PIPES: LINE . AIR INLET: Nrc�eRsT; MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- OYES 0 N meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS: OBSERVATION WELLS ❑YES ONO ❑YES NO DEPTH OVER THE DEPTH OVER TRENCH /BED DEPTH OF TOPSOIL. SODDED. SEEDED: MULCHED: CENTER. EDGES ❑NO DYES ❑NO OYES FIND PRESSURIZED DISTRIBUTION SYSTEM: E WIDTH. LENGTH: KO-OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: �i TRENCHES MANIFOLD PUMP : ",� 8 MAN IFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING. 'ELEV.. ELEV.: DIA.. ELEV.: PIPES: DIA.: T A HOLE SIZE HOLE SPACING. DRILLED CORRECTLY COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: L 1:1 YES ONO ❑YES ONO COMMENTS, PERMANENT MARKERS: OBSERVATION WELLS: PROPERTY WELL: BUILDING: LINE: ❑YES ❑NO DYES NO Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE: TITLE: DILHR SBD 6710 (R. 01/82) v p = n m m N c _ (A N =r C C N 3 O N (D a (D pr t o A A (D m 0.7 a co .� o c O w w y `` w o n 'a =r CD ' 'o a CD CD O In (D N (D • - ► (p 0.00 w 00 ( M CD o f (D O '� m w w co =a - o (u M M C M(DwA i r .• --�.�� A3a o °m v �? �: o O 3 k `< CL cc w A ' N v * � 7 N (D p. p�ipp O a -� IA et 7 O O Ja N c A A D (D y C p_ D C 1 = O (D n w C w o: aQM w C O y m O ?� p� v, C � v o Z y D s 0 (D s �( 3�y�Na a D N 0 A M M ,. =r O Qu ?wo >> a a(c a c (Dc = c av (Dv z 4 M (A (D y (D (a fA n ° 8! p (A p . — m mc n o w c e ° c °'► _. aw O m 3. pl N (D CL (D (p z OL C �� O . O' -w -< c w 3 W fA m0 C �CO C ) (D O A a a c ° (° w c -gym c cD F a_3 O v p o 3 CL (D Ul d O ( n to • APPLICATION FOR SANITARY PERMIT L &�� OUNTY / °E�gP^'te"T°F lP�-B 67) UNIFORM SANITARY PERMIT # . N' 1 0USTr .�M.4P,C�ORGMIJrrKifIRELATKir1S / � / - Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8' /2x 11 inches in size. — See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS 5 ROX12Z PROP LOFCATION 1/4 a&) /4. S X, . T31. N. R (or) TOWN OF: ° [ LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, LAKE OR LANDMARK STATE PLAN I.D. NUMBER AIX TYPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedroums: ❑ Public (Specify): THIS PERMIT IS FOR A: New System ❑ Tank Replacement ❑ Repair Replacement Soil Absorption System ❑ Revision ❑ Privy (I Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed ❑ Seepage Trench C] Seepage Pit ❑ Holding Tank System -In -Fill ❑ In- Ground Pressure ❑ Vault'Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Per t issued An Existing System That Has Been Inspected And 1& rn liant As Far oil fonditions. Total *of of Site Steel Fiberglass Plastic Gallo Tanks on Constructed Septic Tank Capacity Lift Pump Tank /Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: W Mound ❑ In- Ground Pressure Total *of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity O� X Lift Pump /Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): Private ❑Joint ❑Public 1, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): / Signatur MP /MPRSW No.: Phone Number: Plumber's Address; Name of Designer: COUNTY /DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved El Owner Given Initial Approved I Adverse Determination Reason for Disapproval: Alternate course(s) of Action Available: DILHR -SBD -6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber u t � t,30. N C. Yj S y f 5' .L C t'p 1 1 P1 1 J�" l J Fb r e 5 400 +'1 S� 2 0 -F 0.Cfc T a�c.t.� t.)r 1`l ©u n c l ��nc oil Lr. S t s o cg xr SeverSo�n 0 d� �L Q ♦ � o q 'C &st ?i c P ro P-tc-}y Iri t - no SC-4(c p On S� +e �n5 Q ;� � on CotlaVC b � L.e.a.y 3��sky • Tort Ne1Se s y s, S3 Pcwposev S; lc �,r r+lo�nej M � `� ht3 � � Lr► t t. A T b 4 Tc, o` LT4r�).t oor 31 al 'z _ 100.00 PLUMING O's Ar CEIVEp A 1414 SEP p 8 1 985 t��F�IRIMEAi;i� LI INDUS S&gp AND t3ulH�ltt ON of PLUA4BING ,� _ BUREAU APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequagies will only result in delays of the permit Issuance. Should this development be intended for resale by owner /contractpr,( "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 &/e,�'SO� Location of Property k 1 %. Section T 3/ N - R W Township ✓ e S' Mailing Address Subdivision Name AA Lot Number Previous Owner of Property Total Size of Parcel Date Parcel was Created Are all corners and lot lines identifiable? �� Yes No Is this property being developed for resale (spec house) ? Yes No Volume 5;-76 and Page Number /d as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING i. Warranty Deed - 2. Land Contract 3.- Other recordings filed with the Register of Deeds Office 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 the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (We) eeAfii6y that a.tt atatementa on thiA 6o4m aAe t.ue to the beat o6 my (oun) knvwtedge that i (we) am (ane) the ovineA e6 the pl.opefttu de cA bed in .thiA .in6oAmation 6oAm, by viAtue o6 a wannanty deed necoa.ded in the 066.ice o the County RegiAteA o6 Vee,4 ab Document No. � 11_-o 7 ; and that 1 (we) pnea entty own the p,,%opoaed 6 to b on the aewag� diApoa�eyatem (on 1 (we) have obtained an easement, to ruin with the above dearn.Lbed pupen.ty, boa the con,mucti.on o6 said dyetem, and the dame has been duty teeon.ded in the 066.iee o6 the County RegiAteA o6 Veeda, ae Document No. 1. SIGN RE OF OWNER SIGNATURE OF CO -OWNER (IF APPLICABLE) DATE SIGkED DATE SIGNED r-+ z cn H 9 r ST C'- 105 a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z d J a OWNER /BUYER z" Vne -� r✓ �'�5�� ROUTE /BOX NUMBER IQf 7O l✓?� Fire Number CITY/STATE /����/Sc� l�i Z I P PROPERTY LOCATION: A44�7 Sly !4, Section T .3/ N, R /_'5 W, Town of � �-S-/ St . Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists 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 treat- ment 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 systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to H three year expiration. 0 E z I /WE, the undersigned, have read the above requirements and agree (n to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart - 'b ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED a IA464,�_ DATE ad 9 $S St. Croix County Zoning Office P.O. Box 98- Hammond, WI 54015 715- 796 -2239 or 715- 425 -8363 Sign, date and return to above address. D I L H R Safety and Buildings Division PLAN APPROVAL Bureau of Plumbing P.O Box 7 %9 ' ❑ General Plumbing Plans Madison, Wl 53707 Private Sewage Plans Telephone: (608)266 -3815 moll i , J -e �yl p t _ Project Name Project Location - Street No. or Legal Description t C Count El City ❑Village own of: J o -5-7- � 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. ❑ FOR GENERAL PLUMBING PLANS: 3a 3b 3c 3d 3e 3f 3g This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. FOR PRIVATE SEWAGE PLANS: (1) (2) (3b) (4a) (4b) (6) (7) This approval will expire two years from the date approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Bureau of Plumbing has reviewed these plans for plumbing and /or private sewage code requirements only. All other system reviews must be submitted to the Bureau of Buildings and Structures. Comments: By: James Sargent Bureau Director If Questions Plans Approved By: Date Approved: Contact y � ve,may ® P cc: Private Sewage Consultant E Plumbing Consultant F-1 Environmental Health /County 11 Local PI 11 Facilities Need Analysis Section ❑ UW -SSWMP ❑ Plumber ❑ Department of Agriculture DILHR.SBD -6099 (R. 01/85) ❑ Owner ❑ Other f 4 F X Co r a wl 1 i I' ).3y �g5 E f , f E � _ C2) S D Z� Go , I � '�� � �► r�� n , X1.9 3 ► ' � N Yy S L-) / Se_c tP X15 t) Fbresf a 0 t 0.Cfc" Parc w1 1`t 6e 1 to y V o n e-c"z f- c'1 W, n 7 Q f oQ q�'� joo ' N 5'ev�rSon 0 c r Q No %° 1 1 C" C- a I \ ' T - 5or q I�iPe in ,mod .�1�`0 G .� la^ r no Sc4tc 9 On sl +Q 'le 1 Q'tc�ton CendVCicob,l; ?- a Dr°i.D �-�Lav 3aMSk ° - roM Nekso CS 5k"-\s # ' n sy .9 t C rvr� g,� t �ua �o p+ T Ss, lei � �75 e.nce 505711 100. PLUMBING C,,,,d 4al4 EQE IVED APPROVE RELATIONS SEP U 3 198 DEPARTMENT1), FIONDOFTSAFETYB AND 6U1 utt= PLUINgING ' BUREAU L-2 SEE CORRESP NDENCE 40 - Z'cZ ee Page f Of Straw, Marsh Hay, Or Synthetic Covering 1 I Distribution Pipe Medium Sand Topsoil G F 3 E D X Slops Bad Of 2 ? C Force Main Plowed Aggregate From Pump La • D � APPRO r:N;i tiUMAtGRt� 'VDVe ction Of A Mound S E ('� �JE!•ARTMEi!T IF INDUSTRY, lAE'�OR S ystem Using 11ViS10 ,OF SAFETY AND EUIL ' For The Absorption Area F 7' G r Signe�E CO ES DNDENCE ,/ o A q Ft. B 3 Ft. License Number: • IZ ft- Ft. Date: - 7, 4 t*' Ft. K (:b Ft. L a, -) Ft. Force Main - Q* Ft. L (3 Observation Pipe �-- - - -- K f — A fie. , 0 �. W I •� � Dislribulio ' n Bed i Of '2 — 2 ? Pipe ' Aggregate Observation Pipe Permanent Markers SEP U 3 1 985 Plan View Of Mound Using A'r For The Absorption I�yriq� ING BUREAT! .� Page z Of Perforated Pipe Detall End View Perforulsd End Cop i/ PVC Pip• a.. a, G Holes Locoted On bottom, Are Equally Spaced PVC Farts Main From Pump P� Oil l nbu l ion - Pips Last Hold Should be Nut To End Cop Distribution Pipe Layout P 3 0 R S NA x 9 � Y Signed: .�[_/CZ,< Nole Diameter Inch License Number: Lateral L Inch(es) _ -_ ���� Manifold " �f�" Inches Date; — .�� Force Main Z Inches 8505716 r / Oand A pp '� �tECE1VED 4'_I'TIONS S n�, PN� HIMAN EP ,ES- r��rarFNr n.: ,ter, i ,,,o 8 3 1985 S n Cr OF ;�rE(Y AND P LUMBING off LcF - BU RESP PUMP CH AMbLK C K055 SCCTIOH Akj[) `PECIf•ICAiIU�I'� VC WT CAP '1 "C.1. VLIUT PIPE ' WCAIHC PKOOF APPKOVE tCJ T U .0 KING 4b' FkGM UC4CJK, Jtiwc FlO1J box � MANHOLL COVkK F/tMOOW OK VRLSH 12 "M 111. r f�t1K IAITAKf E�O ki 2 A-J l/f pC GRADL — I COtJDU1T — - � ° • • 11 ei 1 1 din :: L. 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NN■uueoNererrU / ■re■ /uuounururre 1 1 uuuNn■rrN■r■•■ror3 ■ ■r NUrN■ NUU■ uuuuNNNUUUUUN■ uNNUnur rrNNrrrrr ■ ■rrrrinnuuOUNn■ ■uuue■■rr■u■■uU■.■o■ra u■unu■eer■•rNO■■.rr•■NO: 1 UN■■ Nrer \■nurooN■euuNNru■\ur■uvuoaar 1 I 1 1 I P • � 1 . I DOCUMENT NO. '. h STATE BAR OF WISCONSIN —FORM 2 AYA 0 UOL 6 GE 1 `FAanANTT DEW 30 PA 371107 T_ sp,cE RESERVED FOR RECORDING D Ray H Smith REGISTERS OFFICE .................................... .................... ................... ................................... ST. CROIX CO., WIS. . -- ° ........................... .•----------......------................ . ................................ Recd. for Record this 28th conveys and warrants to ... ......... Wayne -. Severson............................. day of A.D. 19 ...................... .......................... ................... . ...... - ...... ................. at 4:00 P , MF ... .... ........ ................... .° ----- - - ° --- --- •--...... --• Mohr g ............ ... .. ............. ---- - --------- _--_ ............ — ............................ ....................... .. _. _ ..................... ...... RETURN To ........................................................ --- ........ ..... .. ----- .,. 1.............................. the following described real estate in ....... S t : Cr O1X __ County, State of Wisconsin: Northeast quarter of the Southwest quarter (NEk -SWk) Key No . ........................ and the East 341.2 feet of the South 825.0 feet of t ... Northwest quarter of the Southwest quarter (NWk -SWk), Section 6 -31 -15 EXCEPT a part of the NE'k of SWt of Section 6, Township 31 North, Range 15 West, Town of Forest, County of St. Croix, State of Wisconsin, and more particularly des- cribed as follows: Commencing at the North k corner of said Section 6; thence S02D03 11 W 3090.33 feet; thence S83 "W 33.18 feet to the Westerly right of way line of a town road and the point of beginning; thence S01 °40'45 "W 904.46 feet along said right of way line; thence N89 ° 58'50 "W 1044.78 feet to a meander line of Harmon's Lake; thence N34 °05'51 "W 333.05 feet along said meander line; thence, leaving said meander line, N51P52'22 "E 332.95 feet; thence NOO "E 305.88 feet; thence N83P18'16 "E 999.20 feet to the point of beginning. The grantor reserves to himself and his heirs, successors, assigns and legal representatives an easement for ingress and egress on and over that part of the existing present, permanent roadway on the above described real estate, and further reserves the right to dedicate said roadway easement to the public. This transfer is a deed of partition of the parcel acquired by the parties unde; a deed dated July 13, 1978, and recorded July 14, 1978, in Volume 577 of 1jp ds at Page 410. - This --- --. 1 nO.t.....__ homestead property. F inf XkKxotk # � � � Exception to warranties: Subject to municipal and zoning ordinances and I� recorded easements and restrictions of record, if any. Dates this .... .... 23 rd day of .------------- aY.---- - - -.._ 19 1.... .......................... --- °------ °-- °(SEAL) .... ........... ................ ................ -............ (SEAL) Ray .............. . Smith ................. .................... ( SEAL) --------- .---------------------------------------------------------- (SEAL) AUTHENTICATION Signatures authenticated this ...Dr-d- --- day of s7mammax --- - - - - -- -- .- - d%xJ@k Bert D. Petersen -- .--- °--.._ ...... .......... se7lxxei9cxaDxx-------•----------•----- TITLE: MEMBER STATE BAR OF WISCONSIN (If not. ........ - authorized by 706.06, Wis. State.) ------- -------------- ........ - ---------------------------- .._...------.....-- _. _ ................._._...._.____....... ....__._..__._.._------ __...... THIS INSTRUMENT WAS DRAFTED BY �� X9WC Bert D. Petersen, Attornev at Law ...... _ .. .._.-- I ............ ......._.... °- ._......... Clear Lake Wisconsin 54005 .............................. .......................... ................ _- ,.- ......I ..... ... •..! ..................... .I..........,.......,.......... (Signatures may be authenticated or acknowledged. Both NDUD xMilICx----_- -_-- --- ----'--- '-- ......--.0UH MA. are not necessary.) tdRYOMMkIWW&XKM34IfA91Cx . - -'. _ ---- _ _.. _...i]mx......) •Namea of Persona signing In any aapaelty ahould be typad or Srinld below their Flgnat— WARRANTY DBRD STATE BAR OF WISCONSIN Wisconsin Lead Blank Co. Ina. FORM No. 2 -1977 Milwaukee, wia. (dobl4fia) VOL 630 PAGE 11 /Nf�� OF+ �LECT•2 /C POI�t/E.2 Ef7SEiYJ�NT LOCfl /N TJVF_ SG✓ /�P Ca�SEC T /O 6, TL�wNS..io 3//�./Oe7 --/. t�i✓`E sWEST �+.a/ OF F ZaECST GIX /N7'j Glc STC.E�p,{ � 57 - ,c Gjc WSCO•/S,1/ .2EST'2 /CTS BLAN,E�ET Er9.�L - E- -/2.50' MEAT' 4c_'CORG+EU ice/ ILL. G/O \ /2.50' PS,ZS S•2B, ST C COU/✓Ty� OC1n/.6 �S.ha44b�/ .2EG/S7.2 O.� OEt OS. ss✓�RSO,v e' ES /t/EQ BU.c?Q II: /��N071'Q: 7YIE GJWN�,QS SHALL '^ I O � �� LUQ1.YEf2 w26'STQ /C r TivE P UNOER v.¢O[./ ELG'CT.B /C Q" I / 5Q 77 /O'FEET .4T aCTL /,vL 50 LOC�T/O,\/ o� -r./E a�•e co / I h \ / �y• L/n/E. \\ ,�\ •_ / ^/P FOUND I 0 �� P�2oPC2 \ I . AIL ✓E•2 .PJCS//T' CI�IN.OY \ \ v N ti I(�O Er9 SER /ENTR7•@ c.0i.�'LR. \�. 8J•2/EO \ I `J G.?Q[JN,O BCLi G /NC9 csrt/r� BeiJee V , .; \ m 1 I I Gr L1r -EO -S ✓367 P360 f ST. CROIX COUNTY WISCONSIN -f, ZONING OFFICE S ui7`�� i ° 796 -2239 (HAMMOND) T' r.' 425 -8363 (RIVER FALLS) - HAMMOND, WI 54015 August 28, 1985 Division of Safety and Building Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir: An onsite investigation for the Wayne Severson property located in the NEh of the SW14 of Section 6, T31N -R15W, Town of Forest, St. Croix County, revealed suitable soils at a depth of 36 inches, below which seasonable high ground water was noted. This site should be suitable for a mound system. Should you have any questions, please feel free to contact this office. Sincerely, --� z- Thomas C. Nelson Assistant Zoning Administrator mj WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS s DIVISION OF SAFETY 6 BUILDINGS, BUREAU OF PLUMBING P.O. BOX 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. Croix Location NE 1/4, sw 1/4, Sec. 6 , T 31 N, R 15 W Town JX Forest Street Address Lot No. Block __•______. Subdivision Landowner's Name: Wayne Severson The application for this site is for: 0 new construction use. ❑ replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: (..1 to have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota numVers ssuea klone of the applications needing a quota number. The quota number assigned to this application is 59 - 18 - 6 . ❑ for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. D for an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. (._]for an application on file prior to February 1, 1980. (Ifor a lot that meets the criteria for a conventional private sewage system. If this is a REPLACEMENT SYSTEM USE, the alternative private sewage system is replacing: ❑ a failing conventional soil absorption system. EJ a holding tank that was installed and in use prior to February 1, 1980. ❑ a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the Jot meets the criteria for a conventional private sewage system, check here. I certify that the above information is true and accurate to the best of my knowledge. Name Thomas C. Nelson $ j re (County Official) Title Assistant Zoning Administrator Date August 28, 1985 DILHR -SBD -6158 (R 12/82) STATE OF WISCONSIN - DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS - BUREAU OF PLUMBING .` P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Township /3KANGWP9MW- NE k I SW 34 S 6 IT 31 N/R 15 JVWW Forest St. Croix Street Address: Subdivision: County: Landowners Name: Mailing Address: Wayne Severson 117 5th Avenue, Clear Lake, WI 54005 I (Me), the undersigned, hereby make application for an alternative system on the above - described premises. I recognize that the above premises are not suited for a conventional private sewage system. If approval is granted, I agree to have the system installed in conformance with the Bureau's approval of plans and specifications. I further understand that an alternative system is more complex in nature than a conventional private sewage system and as such will require detailed inspection during construction and monitoring after the system is put into use. I agree to permit both county officials charged with administering county sanitary ordinances and Bureau employes or other authorized persons to have access to the above described premises at any reasonable time for the purpose of inspection the construction of or monitoring of the system. I further agree to either personally or by my agent contact the proper county official to arrange the time and date to begin construction of the system. I understand that this application does not permit me (the applicant) or my agent (the contractor) to begin installation. If the system is approved, the Bureau will send the applicant a letter of approval which authorizes construction of the alternative system after all necessary permits have been obtained. I agree to give notice to any subsequent buyer that an application for an alternative system has been made and if installed, that the premises are served by an alternative system and further agree to give the buyer a copy of this application. The Bureau accepts this application subject to this understanding and subject to all the conditions and obligations set out in this application. Signature of Applicant Date STATE OF WISCONSIN Subscribed and sworn to before me SS. COUNTY OF This day of 19 Notary Public, State of Wisconsin DILHR -SBD -6413 (N. 05/81) My Commission Expires: Plb. 1 -A Wisconsin Department of Industry, Labor & Human Relations D.I.L.H.R. 7 Safety & Buildings Division Leroy Jansky O.W.S. Bureau of Plumbing 13 E. Spruce Street Chippewa Falls, WI 54729 (715) 723 -8786 PRIVATE SEWAGE SYSTEM INVEST TION Name of Premises NE :S Pu 6� 31 1 K/ - IoRE.ST Sr . C Location Township County Master Plumber /Soil Tester Address Owner hA'rmoNz iT/+ IWAYNE Sl;Vyk Address 11 S AVE d4,6A -k L+)<F-, kxr- S1C0[7_', Sanitary Permit # Plan I.D. No. Type of Inspection -SO I �s/ rE Persons Present at Site Type of Building: ❑Public Single Family er- Baplax BRIEF, FACTUAL COMMENTS AND SKETCH: qqL 44 I ! i 1 `7 . 1 41 - -- - ' i fib LAM 1 p OWT : 3 — I ' 100. -�9 j _ - rZ- L _a., Lg ` : 1 - - - - I I i r z !- I _ f f - _ �� 8 I 1 R -a Ito ❑ SEE ATTACHED DISCUSSED WITH PLUMBER /CST SIGNATURE DATE OF INSPECTION -7 ` 2 S' Signa s of Inspect Inspector Local Inspector Plumber or Responsible Part DILHR -SBD -6799 (N. 6/82) Plb. 1 4 °1iRa Wisconsin Department of Industry, Labor & Human Relations D.I.L.H.R. Safety & Buildings Division Leroy Jansky O. W.S Bureau of Plumbing 13 E. Spruce Street Chippewa Falls, WI 54729 (715) 723 - 8786 PRIVATE SEWAGE SYSTEM INVESTIGATION REPORT Name of Premises /VET s w 6 r 31 . /S►✓ -FORE ST `S C I X Location Township County Master Plumber /Soil Tester Address Owner nAYMOnra _'�Pi I >r-f+ /WAYNE Address 117 S AVE d4,&= & LnI4- E . i.;L S COOS Sanitary Permit # Plan I.D. No. Type of Inspection SOIL /S/TE Persons Present at Site � A ` Q y Eb AA'0'� D f�o /�. PA-tt �s1)n1 ��.. veP . Type of Building: El Public Single Family ef- Buy{wr BRIEF, FACTUAL COMMENTS AND SKETCH: / 4 a acs �T v , ILL- 17- 1 0 — ' hT� _ i � _� � ✓ I 0T3 , - -- - - - I I t - r3 Ida 9 ! + iT- I T I i / / f e , . �P :k .'LU2�2 u _ '4" Piz Tv tiS SEE ATTACHED DISCUSSED WITH PLUMBER /CST SIGNATURE DATE OF INSPECTION 2 _ - . 2 5 ` Signa a of Inspect Inspector Local Inspector Plumber or Responsible Part DILHR -SBD -6799 (N. 5/82) Sate Of W,>ESCOnSIn ` De - of Andustry, Labor and Human Relations SAFETY &BUILDINGS DIVISION kwift of In memo$ 111 T t vay" S ol v ow i Rayn"d ism am" s I Nom. r�oart i Sstitts aril 1 , 1 elm lFuld "tow" St.. ** t Wit. in fiat ! +estlgstur No eowbctaY 1w t" pwpM of 1eatte% if Io la, a !tlla Ow a am soli 4086MUM systmo Soil l" ors aMS3tit ort IS a of 649MM +owart tMock ao TM fWile +1100 soi� alai le"Us" W* lrrw to tkis . It u we first tees ' iifto"Pt soil arNditios per arts t%4 as bewifty bebmw efts tors 6rnation as'ists. l*s Naetit half M the p it ia�t glatisl efll ww M wt ha! of silt. Ibis till is �► +�ral1 It arm M frrr+o loot s�rili s ' M_M#osi+call7 to aw art Sw '`aMO 'fit ifttw* peftuft of at "" a ;anti w to a 'of IN*" saw a later of till is aritrorotta�e+ai. 'llMt till` a tae ttll► as an wMM is a Swtbwl3 olirratis1 ibis arms is O art 31Y w Illy Satwattas r tape till is only to Awt 36 IMMin 10 #fire WWIYUW sue. Vii% this his is 3oitw a"" soil absepvtift . 'taws me" siOs MM tdM0f16d* Us irCttiaas with *U" "M M* "A rut at► AO" 0 %a snow Ss id"Oftw by T•1 It awl 3, ilwa w" 0 sm MUs A E arr! +C. -1 1 UP taltiwt soil pwi It 40wiptuft frwr am* amt are so fellefto T•-1 "s *► *at ir#0s boom (Wlit 3/2) silt oa ► 441 ftft ys lledsh ar (IOTA 4 /4) wittlt milt IMIM lW6 ft l# I~ (18M s ilt l aw. (70 / silt i WAO 274WO Dint br4 (7.M 4/4) t DILHRSBD -6423 (N. 04/81) x ,r State o f Wisconsin ` Department of Industry, Labor .and Human Relations SNOrsoa & Rejewd Su} SAFETY & BUILDINGS DIVISION A"wt 160 54*a4' ary m (7.SfR 513) said with few aoriw distinct sh +wti levers pom " iteddisb (SYR 413) +fit so* lei! till. Rst s"""l or Pwiedic s4watisa at 54•0 T•2 Slkdlw ;l• T•1 with rwttlt" at 4t'. T•3 _ W Dsrk IM40 lrretrs (IOU 3/2) silt loam. 544 Jai Y011WIA bras (MU 4'4) gritty silt lsr. W-14 tart "row *Vt 6/3) st It 1*481. M-1!i ltt►rtrs s►i ! ►silt lets, 046 �t 1�e+rws (7 4fJ4 awl sartd. 36 Tt)Wsh lrre (MR VQ Maven sssd with Vr is 1/V dwk roridisit ($V% 314) doss* sarM irwsds r ap&ft wft Gomm* "dim 41 sir l IWOM (7„ $VR ) Md 119 ft lry misb ice' ( ) irtt Uti d "Maul w p #c s&*"tU* at 36*. T-A, a 4101111 C "me r lrof'tlss we slit idatical to T-2 with mil. er Pw iedte sa wStisa frow 36-4r. C Setl Scisrrtist Seib tt Of Privda (M) 3P lr Ewe CCS LIN"atr junky* hriraft 5etwgo It4st - District i, pttppotn falls i w C. fir, riot AdrrieistrIetw - St. Croix Cewty IOU ire P"Isw t � DILHR -SBD -6423 (N. 04/81) State of Wisconsin ` Depart dustr Labor and Human-R °- SAFETY & BUILDINGS DIVISION feet l7 l �' V of Clamping 01 E. Vashiegton A"mw P.O. Box 7m ftdison, MI 53707 I My" S*Vsr m i Rayne" Soitlt Route S. Box 132 !ludson, MI "016 Clear Messrs. Seim rt T8102 I Sawn boas asked to rogmW to the letter you swot to Senator Jars Nrsdwf and r tatiro Oanid poulsstn coocaraiog your property is the Teri of forest, St. Croix C,oe mU illscensin. I bare net aid rovismed this Issea with Ropressatative fans*, said contacted our district staff and MeWiAs e oa ty staff regarding yew site poblsm6 It -a►ers that you bave had difficulty In securing a wit for a private so*W System for this p&M01. You also Indicate that s~al ter- sheens ban ban comdocted at yew property and you have not boon adequately Infeme of the outcome of tweed S sites. Enclosed please flsd a copy of a site iniestigation pe rforeeed by Loray am*# on April 10, l9RS. ter. Jansky would hm sent You copies of the ir6t if lit had address. Mr. Jaosby also IsfOrees ate that since t" es-611 t regmted by the soil taster and co my persommel be assumed m Wiel be I nformed by yew licensed soil tester of Ow results of the oar -iltm and his sail tasting* B oM of this )otter I see &*In$ Wy Stool, soil tester for th site to file with you diet of bis soil test report and conclusions regarding site suitability of thaso properties. Since ter. Steel has not filed thane reports I can only conclude there Is see addit soil testing that he arify X to do on the parcel.. i weld hope I thot you and Mr. Steel can reso lve the problam Involving filing of report on thi s ite. You indicate that you feel the site to be smi table for a private ustes, and f or indicate )eat sail tests conducted is 1977 and IM by a licasaii soil tester reveals suitable sites. Yews provieaes $011 testa Mr. Robert ft fail, is no longer licensed as a soil tester is this state. This department undertook licaeese rewoication action in a complaint filed in July of IM and that license revocation action I r told has am boa completed. As suest, the state was aware of problems with Mr. Meson's soil testing and took stop to room his from eur licom cater. DILHRSBD -6423 (N. 04/81) State Of Wisconsin ` Department of Industry, Labor and Human. Relations sa & RS SAFETY &BUILDINGS DIVISION YN"d Soft t *� > 17, 11,3 That, home'* does "t ht y with tM; prolae at yew Sift. in 090ol-� th is site wift Mir. JMMW and Mr. s filsorr of the St. { mIx ftw%y ZW " office I fiat #hank t#arre has wt bean, disad emeat ba tremor #* covoky a" ow district sta" ralpard " yw sit**% srtito llitr. the April 10 llsh, so -oft for lastatwce, "w" I" observed at a very shalI" depth on aalh at #fie parcel It does riot appow that tha bo"Ings that woro (ao - atrt bola we su table for privaft saw syAgose W. 4410ft in kolas, More w lbat Is discums #at this site w1th *r* Stwl and Pp. Melts It rat felt that swet Portia of the am adp#tt be farm to be sr ltarble far a floor type_ mod "1141101 to sor" boo of the pr rties. This can, onlp bed t f 1 11 attalr cartinttip weft tostirrp to try ad kvwft a saita�llt te ao As bran Wi ante frool Mr. ovosws M"ito repo 0 M tanks are prath#biw for as~ bvet #art in, St. I1.04x "oft'' M its des an w is bat s ,flak MUM fw Irat. A"Id M desire, iattalnttatiaa in tltt late of hoWIMIll ta" is St. Croix Couft t far ** ftlsain, ar lift *#door Mr. Moraid tar bor In We St. &* *oft zoaft ar"m It is oar bw* *4 on air" cam a 10 located prtid,, be sea red a c+ar urrwtd 1p! � It is fwtMr ape . Mw have be" old a patltioa far aAlria�ioat n be web be filad far the site so Oat a OMM could 6* so an ova with las fhm 26 larchos of seltatblat "Ilo #trtttitiew for vart are sely !twitsit far wristiar strsst s that hew preotowlr had soil ar werptioa systars„ As seth, lint site my aft be 011916 10 far, a potition for rariatn,cs sl so priveft spotatt hn aim on that Porml, we mart thae ft" an orris of sol =1* U tho got far a aowrn,A tit, Sy$tM* If yoo M" rm Mt& soil MnM M0 111*14. Ift Trish to gatut ilia ,ears IN of aea s is arr swim At awl Tasted si t" so* ats s at � tim far ertparriono—sl at tka pnroblon Ulik your sits I maid s tp to wt Clrtsoilr with ,per soles wit tostw er plafte r to U7 and lecatie a salta ble site for a clostar -mood systare. If yu an ,rot wake ��rMrlt#r th t s Provided Aw Prowls" soil tasters th" #mine ogees ri ask far Witte Side tale wake at�flMe to be si if ,#rwr a�rpa ar epee a� lint pprf of Mr* ftftil# as YW 'ilrttarr OMM %# irrdi E I tiara +d s neatatr # t JIM r con 04" f 1 I dat"Ift whether � MGM" A" he ar F'U&IVW 1 DILHR -SBD -6423 (N. 04/81) State of Wisconsin ` Department of Industry, Labor and Human ,Relations om 5sverson ftymand solo SAFETY & BUILDINGS DIVISION June 17 IM Would like to Indicate that my investigation of the matter does net shm aye disagreement bet won W. ltelsoa or Mr. JanskY in Moards to the suitability of this site. I t that yer were not adaMtely Informed of the reseits of the on oss4" c= either by the count or our staff. It Is_ ai parties ccerned gill Provide this ioroation to you vitals h"" a ram ts' o siwrt prrivd of time.. If wE can be of further assistance is this enter nleasrr contact Mr. Jansky coacersin this site's suitabiliy Si iy rid free Icksoa r Sell Scientist _Mti9M cat Jarees Marsdoet, State Senator ikvid Pulsau, State Aepr+esentatIva e *m i le SuMr, a"I" Administrator • St. Croix County 6trf Steel, Snip Toster Larey J**skYs Private SO N'41111 CAMMIttfit - M strict is Chippewa fhiis DILHRSBD -6423 (N. 04/81) Wisconsin Department of Industry, PL.B =1 - INSPECTION REPORT . Labor & Human Relations _ Safety & Buildings Division Name of remises Bureau of Plumbing a e an o: ry _ oun y S anitary ermi t f T P Ix as er Pl Fi rm ame dress ourneyman Plumb er Address owner ress ` C 1 r 1 t Q i 1 V - 1 r� �..__._. ' ! . QM 0 'i _,.._._ _ ____`_' `.�� 1 + +' __' .� rJ � `-� - -- Pt �. c i� ��. � ,. �.. �:,. , u a, r.' � r�•a r ; f t_ V , , r . .- .. +. % f a ...e'7"J .... ;-^�' r • � ---.- -.. ...- �.....,.__.. .. .. � .,.. —...� _..,. .. .....,. `?+*�..��.. - —� .... —. /-},- -ISCUSSed with igna ure ( )See Attached. DILHR - SBD - 6192 (R• Signature o Is Plumbing up. n -site Va s a pecia I is ate Q Wisconsin of industry, tabor and Human Relations.. 8� SAFETY & BUILDINGS DIVISION asi y 17 . i l�5 Jo J . �Fc� �\9 Of I1061" �� ,2' ��F j � 2�1 fast M�i►lalp�et o V * �� l — P.A. 11111" A �Fi S obotsm, ia !my C� Nr. Von 16 m i + W. fty no Swith Aowt ft"lloon vi "016 ptetition �r-A -� Dew Mr.: sue► Md intro ft"M Puts salt T OW� w VI ve, hoe rWwW yew re*mt for a petition for vw44MCe. e +ef th lattw is to istim yes "at 40 30" yea see, Pw1ww de this fil th addit i+dfie'eeat#aet to g►l atee aid '. t"Y Jew petulan staff will ram desial of th is petition. a nal y sis of jow data and coaclfrsims for petition dwisi am to IGI111 d . t• the swwwy >rsrts"at encused with this lstter. If low "old Ilke, to st#wt, additlawl iftfMINktion Is response to Our Conclusions I* will expedite continuation of the pet racier ad notifir yow of the final dtecist . If so a IUM&I iaffwMation is received withis tre f oft fvWM the daft of this letter tine petition will be fierra4ed to the division awalstrator with the F Scoo mill diction for denial. Sfrai,fs M. l td, CPSS Sa il Sicift0st Sactioa of Ptrtv&te seep s t181+r Eaclssdre c y ic Pri+ ate C *svltaat • District d. Ck ip a Fal v )**" C. 9~0 Zoning AdolaistrStOr . St. CMIX faua DILHR -SBD -6423 (N. 04/81) s r , PETITION FOR VARIANCE: Section ILHR 83.23 (1) (c), Wis. Adm. Code. PETITION NUMBER: 85- 03501 -P PETITIONER: Mr. Wayne A. Severson & Mr. Ray H. Smith Route 5, Box 132 Hudson, WI 54016 BUILDING OR PROJECT: Residence /Private Sewage System NE,SE,6,3,5W Town of Forrest, St. Croix County, WI CODE REQUIREMENT: There shall be at least 24 inches of unsaturated natural soil over high groundwater as indicated by soil mottling or direct observation of water. VARIANCE REQUESTED: To construct a mound on a site having nine inches to soil mottling and 21 inches to observed water. PETITIONER'S STATEMENTS: 1. Groundwater is estimated at nine inches as determined by mottling to effect the site has been monitored for four years by basement excavation within 15 feet of the B3 boring. 2. At no time was groundwater observed to be y present in the excavation. 3. The property was purchased in 1977 based on a report of a soil tester that was suitable. The _ parcel was then divided in half by Mr. Smith and Mr. Severson. In 1980 Mr. Smith had electricity brought in, basement dug and an $8,000 garage constructed. 4. In 1984 I sold my home in preparation for building on the site and acted in good faith and now cannot get permission to proceed. I now have a total investment of over $30,000. 5. At no time have we tried to circumvent the existing laws and we have always followed regulatory procedures. COMMENTS: 1. This is new construction as it has been determined that there is only a garage on the site that has been partioned and has some furniture in one part of it. There are no known sewage facilities. 2. Evidence or information obtained from the county indicates that a sanitary permit was never issued for this property. The town may have issued a building permit for the garage without a sanitary permit thus making the building permit invalid. 3. The soil conditions have been verified by the district private sewage consultant as being at eight or nine inches to soil mottling and observed water at 20 and 21 inches. This was also observed by the county personnel. 4. We have not in the past issued a variance for new construction for a site having less than 24 inches to soil mottling and /or observed water. 4 RECOMMENDATION: Denial. This petition was denild because a variance may not be used for a new construction site having less than 24 inches of suitable soil above high groundwater. Prepared by: A, Date: Edmund M. Drozd, CPSS Soil Scientist Section of Private Sewage Endorsed by: Date: James Sargent Director DEPARTMENT ACTION: Signature: Date: Ed McClain Division Administrator SBD 6678 (R. 08/83) (Plb 100a) (Wis Stats. S. 145.02) Detach And Return Upper STA (W - W U MNSIN acHR fDIV 19F SAFETY & SURA Portion Of This Form With euil±tncuMe�I Any Return Correspondence �, :o w i>It " rc AVE , 8 � FC DATE: 0624/85 F PROJECT: :Y . j 0 of tj�' I9M3 Severson, Layne & Sm ith,'` "ltil) . 6 NE, SF, 6, 3, 540 z Tn Forrest Wayne Severson & Ray Smith St. Croix: W1, x { Route 5, Box 132 Hudson, W1 54016 PLAN ID. # � DETACH HERE`A31 p c . PROJECT NAM Spvprcnn WsivnQ +1, RBE.S. PLAN ID. . 'n — = {" rs d This 19 -to acknowledge. receipt of your plains and specificaljons.for the abo 3 Preliminary review indicates the required fee is $ j P Y Received Plan accepted for review. ❑ Underpayment ment – Please submit additional feew Plans vA be tad' , nee Plans being returned. Overpayment –Refund forthcoming. ; ❑Additional information required. SEE BELOW, ❑ No fee has been remitted. Plans will be held in_abeyarlee ` L: Plan Submission ❑ Soil boring and f percol8tioatest 4 ,'� ❑ Additional information shall be submitted in duplicate unless by Certified Saul Tester 1 specifically noted.- ❑ Petition For Modification r ❑ Plans not clear, legible or permanent. notarized. (1 copy) r te " ❑ Al} information shall be signed, dated and sealed or ' g ❑ Complete data relatwe�td "ag#icipa stamped in accord with Section ILHR 83.08 (2). (a) Wisconsin ❑ Deed restriction -r r , Administrative Code. equ:3 ' El enclosed. ❑ Condominium declaration.j T campy) ❑ Plot plan showing location of land parcel (distance from € i nearest road intersection, etc.), lot size and all distances from IV. Holding Tanks N i private Sewage system to buildings, lot lines, well; water- El Holding tank profile showing vent, manhole; ate; course, - swimming pools, water service piping, - all weather ser- and manufacturer if state a vice ,o approved. Compi ad, etc. Show benchmark permanent elevation. e #e construction details if site constructed. 11: - Pressure Distribution Systems (Mound or In round Pressure) El Holding tank agreement signed by owner'and local g unit of government�(sample enclosed). ❑" Application for Use of an Alternative System signed by owner ❑ Reason for installing holding. #from ❑ and notarized. (1 copy) county or soil boring and percolation tat 11111 � on onsite r 1 co g G Y 4 ( copy) ❑ Design calculations. 115 completed by CST, showing thate ;#e►i) e Count ❑ Soil boring and percolation test data on 115 completed by cannot be installed on the land parcel Certified Soil Tester. (1 copy) ❑ Affidavit for all- weather service roatt (ems y ❑ Cross section of system. ❑ Pipe lateral layout. ❑ Plan view of system. G V. Dosing Information ❑ Verification to Exception Status Form by county. (1 copy) ❑ Calculations for total dynamic head and gallons IH. pumped per cycle. Private Sewage Systems ❑ Size, length and depth of force main. Ground slope with 2' contours in entire area of soil absorption ❑ Detail and model of pump or automatic siphon, including system extending 25' minimum on all sides. size, pump curves, drawdown, and average flow rate ((FPM). Location of area suitable for replacement system _ provide soil ❑ Cross section of dosing tank showing pumps) or siphon {s). data. ❑ Construction details of septic, holding or dose tank if site VI: Systems in Fill (Fill must be placed prior to plan submission.) El constructed, or tank manufacturer if state approved. ❑ Total area filled (fill to extend20'.beyond edit Construction details ind cross section of soil absorption P of trench before side system. ❑ Depth and We of f1N ❑ Co of si repbrt by COPY gnedgnsite couniy� 6 7 tSCIIYt$tli ���P �PYt�P �' �►y �� � o I � May 15, 1985 Mr. Thomas C. Nelson, Assistant Administrator St. Croix County Zoning and Civil Defense Off. Box 227, 1030 Davis Street Hammond, Wisconsin 54015 Dear Mr. Nelson, I was recently contacted by Mr. Ray.Smith of Clear Lake, and Mr. Wayne Severson of Hudson, regarding soil !tests conducted on their behalf at homesites in the Town of Forest, St. Croix County. My office discussed the matter with Harold Barber, County Administrator and his advice to Messrs. Smith and Severson that they proceed with an application for a mound system on the site has been conveyed to them. I would appreciate your immediate attention to any applications they may make, either for a conventional or a mound private sewage system. In addition, Mr. Severson indicated that he has not received the results of the most soil tests conducted on his property. If you have access to this information, Mr. Severson would appreciate a copy of these materials. If I can be of further assistance in this matter, I would be happy to meet with you and Mr. Severson or Mr. Smith to discuss the matter futher. Please feel _free to call on me for further information or assistance in this matter. i cerely, OE J ES E. HARSDORF T nth Senate District isconsin State Senate cc Wayne Severson JEH : j cm 7882 Andisan, Pisransin 53707 - 7882 ume 715 425 -2138 Office 608 267 -9693 N f view S ley -- - -- i }D al ------ - - - - -- Ja /v �. 3 f � r f; ti I r ii SBD 6678 (R. 08183) (P#b 100a) (Wis Slats. S. 145.02) STIA11VIIIIIISCOMMO&HR . Detach And Return Upper � *jjU portion Of This orm''I th su l of P..0 . M I- WOSHMTON AVE. Any R eturn Correspondence. P.O. 90i CO DATE: PROJECT: 09/03/85 sever on, Wa - Residesice o o�9� 3a(b) k NE,Sit,6,31 Ta Forest Boldt's Pluming' , St. CroixNI . L 820 Main Street B1 dw i n, WI 542 L LAN ID. #. 85 -05716 — DETACH HERS — — k� � PROJECT NAME Severson, Wayne.- a Residence PLAN ID. # $5- 0,6716 r This is to acknowledge receipt of -your plans and specifications for fhe above=l f?reiimirtary review indicates the required fee is $ Fee Received fs $ Plan accepted for review. ❑ Underpayment Please submit additional fee. Plant Plans being returned. ❑ Overp - Refund forthcoming, ri ' ❑: Additional information required. SETT BELOW. ❑ No'fee has been remitted. **A be - ttek# rn• at t= � } . ,_ T w` t. Plan Submission ❑ 'Soi# r 3 boring and percolatiarr ❑ Additional information shall be submitted in duplicate, unless by Certified Soil Tee*.. ti, cx pfr) _ `• y specrfiCally noted. ❑ .Peti iGn For Modiflbi lonsigned 4ty 41 �, ❑ Plans not clear, legible or permanent. notarized. (1 copy) ❑ Ali information submitted shall be signed, :dated and sear. or - '❑"Complete data relawo.tol ex Bad t W. s p "low tamped: in accord with Section ILHR 8308 (2) (a) V%Ipconsin ❑ Deed retbit tion•require& ( ;00 Administrative Cade. ❑Affidavit enclosed. ❑ Condominium declaration. (1 copy}, ❑ Plot plan showing lotion -of land parcel (distance from M nearest road intersection, etc.), lot size and all distances from IV.' Holding Tanks& - private ,sewage_ system ,to buildings, lot lines,. well, water ❑ Holding ank r g P ehawing vent; course, swimming pools, water service piping, aft weather set and manufacturer if ataite approved � r vice road, etc. Show benchmark with permanent elevation. construction details 8 site constructed [] Holding tank agreement signed by ow* IL Pressure Distribution° Systems (Mound or Inground Pressure) unit of government (sample enclosed). ' El. Application for Use of an Alterriative System signed by owner ❑ Reason for installing holding tank.5tatemerl# from and notarized. (1 copy) county or soil boring and percolation test data on , ❑ County onsite required. (1 copy) ❑Design calculations. 115 completed by CST, showing that a soil, ibq pn sum Soil boring and percolation test data on its completed by cannot be installed on the Certified Soil Tester. (1 co ) ❑ Affidavit for all- we$tfter service road c � ❑ cross section of system. ( Pipe lateral layout. ' ❑ Plan view of system. V. Dosing Ihformation ❑ Verification fo Exception Status Formby county. (1 copy) ❑ Calculati "for, otal dynamic head awlaaons� r pumped It) Private Sewage Systems ©" Size, length and depth of force main. Groundslope with 2' contours in entire area of soil absorption ❑ Detail and model of pump or automatic siphon, irwjuwng' -.. system extending 25' minimum on all sides. size, pump curves, drawdown, and average #law raE4: ;_ , ❑ Location of area suitable for replacement system - provide soil ❑ Cross section of dosing tank showing purrs) or sit{ w V data. ❑ Construction details of septic, holding or dose tank if site VI. Systems in f=ill (Fill must be ,placed prior to plan eu con structed, or tank manufacturer if state approved. ❑ Total area filled (fill to extend 2q' bext4edge ❑ Construction• details: cross section of soo 7 absorption of trench before sW n system. ❑ Depth and type of;fiN. r. ❑ Copy of signed onsite rapOrt-byWw*or dooict OWN j U D' L H R Safety and Buildings Division PLAN APPROVAL B ureau of Plumbing P.O Box 7 %9 ❑ General Plumbing Plans Madison, WI 53707 Private Sewage Plans Telephone: (608)266 -3815 E �..�. " .�. _ �._w.. ...�....._"...._ _.....,..W.. . ,�— �.m.e..- ___..._..,. ®.m......m. --° I ..tom..,. Project Name Project Location - Street No. or Legal Description County ❑ City ❑ Village YTown of:f , l y 0 ' The plumbing plans and specifications for this project have been reviewed for compliance 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. ❑ FOR GENERAL PLUMBING PLANS: 3a 3b 3c 3d 3e 3f 3g This approval will expire two years from the date approved below. If construction has not commenced before the expiration date, new plan approval must be obtained. f FOR PRIVATE SEWAGE PLANS: (1) (2) (3a�) (3b) (4a) (4b) (6) (7) yj This approval will expire two years from the date approved below or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Bureau of Plumbing has reviewed these plans for plumbing and /or private sewage code requirements only. All other system reviews must be submitted to the Bureau of Buildings and Structures. Comments: By: James Sargent Bureau Director If Questions Plans Approved By: > Date Approved: Contact cc: EJ' Private Sewage Consultant ❑ Plumbing Consultant ❑ Environmental Health Cf County ❑ Local PI ❑ Facilities Need Analysis Section ❑ UW -SSWMP ❑ Plumber ❑ Department of Agriculture DILHR -SBD -6099 (R. 01/85) ❑ Owner ❑ Other l..)0.y � �VtrS S L-) S e_ c (0 2 0-t 0.0 i s P o. r C c..I w c ou n cI V-eN n 9 o t aS c c�� n� S 5'ev�rSon r �O r �p��`Q 2 6eAveo •� `O ,p 1 '1 I 10 q , ' ce--,t 91p i n a ^a Pro y '�r1 L �t tt np SC41C 9 �n 11 11 � dt1 $t�2 Tn5 vcAl Or1 Coc►aVCTCO ��� Q,a \7roZU o � LeLcuay 3ar,sky Toot Nt\s,n g3 1u0,19 (,S 25' �N POSQ.D S� �t For � 3 v' 1�csIdth Qn TUP J \ LTaf a�� ��JJT S� al � aT 00, °o Page Of _ Straw, Marsh Hay, Or Synthetic Covering1 1 Medium Sand Distribution Pipe Topsoil G -J F 3 E D % Slope 1 Bed Of !� 2 2 Force Main _ Plowed Aggregate From Pump Layer • D 1 Cross Section Of A Mound System Using E ' 7 For The Absorption Area F G Signed: A Ft, H 1. B (03 Ft. License Number: I 12 Ft. Date: J i 2 Ft. K I:b Ft. L d, > Ft. Force Main W Ft. L F Observation Pipe B K A L.. W .I Distribution � " Bed Of '2 2 2 Pipe I Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A lr "`• For The Absorption Area Page ._ Of _ Perforated Pipe Deloll 0 End View Perloraled End Cop A PVC Pipe ae� Moles Located On Balloon, Are Equally Spaced \� P �! PVC Force Main \ From Pump L istribulion t Pipe Losl Mob Should Be Neal To End Cop Distribution Pipe Layout P J I R 11 S J1 X Signed: Hole Diameter /4 Inch Lateral i.L Inch(es) License Ntanber: Manifold U"'f Inches Date: Force Main Inches ' 39 / 1 00 �r 4 1 ✓ 1p Page Of _ Perforated Pipe Detail 0 End View End Co ) POrforalecl p PVC Pipe Moles Located On sollonn, Are Equally Spaced i PVC Force Main From Pump P C C ~ Distribution Pipe Lail Mole Should as Neal To End Cap Distribution Pipe Layout P I r' R S X. '6 Signed: Hole Diameter i �_ Inch License Number: Lateral ( Inches) Manifold ��- inches Date: Force Main 2 Inches _ - e . �' J t J i / State of Wisconsin Department of Industry, Labor and Human Relations August 15 , 1985 ` SAFETY & BUILDINGS DIVISION " Bureau of Plumbing 201 E. Washington Avenue �J P.O. Box 7969 Madison, WI 53707 Wayne Severson & Raymond Smith Route 5, Box 132 Hudson, WI 54016. Dear Messrs. Severson & Smith: ' Re: July 25, 1985 DILHR Field Investigation NE,SW,26,31,15W Town of Forest, St. Croix county, WI The subject investigation was conducted for the purpose of locating, if possible, a site for a new soil absorption system. Soil profiles were evaluated in eight baekhoe constructed trenches. The profile description and locations are included in this letter. It was determined that two very different soil conditions occur on this property and that an abrupt boundary between the two conditions exists. The north half of the property has dense glacial till underlying about one foot of silt. This till is very impermeable and therefore the soils seasonally or periodically saturate to near the surface. The southern portion of the property has a medium sand underlying the silt cap to a depth of about 54 inches where a layer of till is encountered. The till apparently decreases as one moves in a southerly direction. This area seasonally or periodically saturates where till is present but only to about 36 inches in the overlying sand. Therefore, this area is suitable for mound soil absorption system. Two mound sites were identified. The locations with elevations are shown`on an attached sheet. One area is identified by bore holes T -1, 2 and 3. The second area by bore holes A, B and C. Representative soil profile descriptions for each area are as follows. 0 -4 Very dark grayish brown (IOYR 3/2) si lt loam. 4 -11" Dark yellowish brown (IOYR 4/4) gritty silt loam. 11 -16" Pale brown (IOYR 6/3) gritty silt loam. 16 - 27 11 Strong brown (7.5YR 4/6) gritty silt loam. 27 -54 Dark brown (7.5YR 4/4) medium sand. DI'LHR-SSD•6423 iN. 04/81) Y aI i Mate of Wisconsin Department of Industry, Labor and Human Relations Wayne Severson & Raymond Smith SAFETY & BUILDINGS DIVISION August 15, 1985 Page 2 54 -64" Brown (7.5YR 5/4) sand with few medium distinct strong brown (7.5YR 5/8) mottles. 64 Reddish brown (5YR 413) dense sandy loam till. Estimated seasonal or periodic saturation at 54 ". T -2 Similar to T -1 with mottling at 42 ". T -3 0 -5 Dark grayish brown (10YR 3/21 silt loam. 5 -10 Dark yellowish brown 0 0YR 4/4) gritty silt loam. 10 -14" Pale brown (10YR 6/3) gritty silt loam. 14 -19" Strong brown (7.5YR 4/6) gritty silt loam. 19 -36" Dark brown (7-5YR 4/4) medium sand. 36 -53" Yellowish brown (10YR 5/6) medium sand with 1/2" to 1/8" dark reddish brown (5YR 3/4) dense sand bands 2 11 apart with common, medium distinct strong brown (7.5YR 5/8) and light brownish gray (10YR 6/2) mottles. Estimated seasonal or periodic saturation at 36 ". T -A, B and C 'These three profiles are almost identical to T -2 with seasonal or periodic saturation from 36 -42 "0 Sincerely, Edmund M. Drozd, CPSS Soil Scientist Section of Private Sewage (608) 267 -9803 EMD :1529v Enc. cc: Leroy Jansky, Private Sewage Consultant - District 6, Chippewa Falls Harold C. Barber, Zoning Administrator - St. Croix County Representative Paulson DILHR -$BD -6423 (N104/81) IM IM P i Wisconsin Department of Industry r Labor $Human Relations - R Safety & Buildings Division Leroy J ansky O. W .S. Bureau of Plumbing 13 E. Spruce Street Chippewa Falls, WI 54728 (715) 723 -8786 PRIVATE SEWAGE SYSTEM INVESTIGATION REPORT Name of Premises t y Sby 6 . 3t� l5ty� ±2RE5717 l). Location Township County Master Plumber /Soil Tester Address " Owner hAYMoNz�, f r r �W,44'(N Address /17 A y - `/9 to Ln a j0_ Sanitary Permit # Plan I.D. No. Type of Inspection _%O S. ASuE Persons Present at Site - , bL_ _Se U y Ea C%ZQ'Ib , 961 Type of Building: ❑ Public 1d Single Family er- 8ulalex- BRIEF, FACTUAL COMMENTS AND SKETCH: T j�-:+d !!y't i 1 �r j 1 l i _ l ,,� •- 11 r "( i L� J .. _ � . _ �EVr1T40 m T �1- { iT i �T` - a /i•�2 •C.e sc�sia - - - t � /Jl+a� -4 -4 %t� �.1•�� � _ - T - s9 I Esc► -- A , _ % 7 SEE ATTACHED DISCUSSED WITH PLUMBER /CST SIGNATURE DATE OF INSPECTION . Sign a cf Inspect Inspector Local Inspector Plumber or Responsible Part '0111 MIR "go �f R Wisconsin Department of Industry, PLB-1 INSPECTION REPORT Labor & Human Relations Safety & Buildings Division Bureau of Plumbing ame of remises Date an. Ev. N O.- i Street cit c ount y Sanitary Per A M aster Pl umb er & f N ame Address our eyman Pl Add ress - s n r G i ress E jj • t L3 k I f 4 r . L} ' i `/ 4 UiscUssed with igna ure )See Attached. DILHR- SBD- 6192(R.11/83) Signature of is . Plumbing Sup. on-Site W aste specialis DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS DIVISION INDUSTRY, LABOR AND PERCOLATION TESTS (115 MADISON WI 53707 HUMAN RELATIC (1-163.090) & Chapter 145.045) LOCI ,/ C _/ SECTIO :BLK. NO T3 N /If /for►W TOWNSH r�Y OT / O L .: SUBDIVISION NAME: 71 � OW ER'S 'S NAME: MAILIN DD ESS: /'T USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMME R DESCRIPTION: PR FI DESCRIPTIONS: PERCOLATION TESTS: 09 esidence 5 54New DReplace // y I � ^ -- RATING: S= Site suitable for system U- Site unsuitable for system ONVENTI NAL: MOUND: IN- GROUND - PRESSURE: SYSTEM- IN- FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) DS E DS DS U DS DS I®U If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. H63.09(5) (b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS E BORING TOTAL DEPTH TO GR UNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPFH4N. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 8" ?s 193 .& � �3 LL � B- /,>3� X5/1 �S; , Iy,�, / o?i iG S• d/I . / B - Z to �U o2 00 / �% /. / �Y �r n oS i �t'1►1. M�•�, p� J,l�s B- 3 S8 30 o ,eydJU B- B- B- �, r PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER AFTERSWELLING INTERVAL -MIN. PERIOD 1 PER1002 P R PER INCH P_ t ° — O P P _ P 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 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. SYSTEM ELEVATION JW JN { i i f t I f J V sc- o� Q_. j k 1 f i f F j k L 5 t 1 1 3 L_ _I __i_ 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: V F �,49 ISO 5 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): - z <5- r . � CST SIGN /f e< ZAtle IT. OS one copy to Local Authority, Property Owner and Soil Tester. .. —OVER— f .b b ?.,�,� . /J�e f �'..�. �w� �� s�� rho• / w,114 r LA Lin is -,C i3 i (c 781. 1. l�jpr,/l10�.�j� � y'i.��S, �Ba.�� /� Gii -�°,s. � c � a A5. bz Ts voi s a• +� ri a I A o gq ti p ,1 p I i 6- 3. SUPPORTING ARGUMENTS We (Wayne Severson & Ray Smith) are requesting permission from the county of St. Croix and the state of Wisconsin to build a cluster mound system based on 21 inches of suitable soil over observed groundwater. Recent 1985 soil tests show minor mottling at 9" which apparently requires a Petition for Modification and is outside the present guidelines for approval. We believe our request should be considered on the basis of our'good faith reliance on the original reports of the Wisconsin licensed soil tester. The supporting arguments are these: 1. The property was purchased in 1977 based on the report of a Certified Soil Tester (CST) that the land was suitable for a conventional gravity system. A private road was constructed at a cost of about $5000. The 45 acre parcel was then divided in half by Mr. Smith and myself. 2. In 1980, Mr. Smith had the site retested by the same CST with similar results. On this basis, electricity was brought in,a basement dug and an $8000 garage constructed. 3. In 1984, I sold my home in preparation for building on my site. We have acted in good faith up to this point but are now unable to get permission to proceded. Our total investment, which begin in 1977 now totals over $30,000. 5. The argument is made by the County that the previous CST is incompetent. We do not believe that we should be penalized because the State licensed an incompetent soil tester especially since he still has his license! 6. At no time have we tried to circumvent existing laws and we have always followed regulatory procedures. Petition for Modification of an WISCONSIN DEPARTMENT OF OFFICE USE ONLY Administrative Rule INDUSTRY, LABOR AND HUMAN RELATIONS Petition No. PRIVATE SEWAGE DIVISION OF SAFETY & BUILDINGS P.O. BOX 7969, MADISON, WI 53707 ID - No. Name of Owner Building Occupancy or Use Agent, Architect or Engineering Firm or Ljaa n tl• A Sr,, S g erson (�ESIp Ne,E Master Plumber Company Tenant Name, if any Street & No. Building Location, Street & No. Street & No. Kt. 5 Box 132 City State & Zip City County City State & Zip Iludson dIlis. 51 016 S • CRO1 X Phone Plan Numbers (If Known) Phone 336- 6 Type of Petition Set Backs (Soil Absorption Experimental and Fee $ ❑ and Septic Systems) ❑ Loading Rates ❑ Site Evaluations LEGAL DESCRIPTION Section 6 ' T 3 N, R 5 �', E (or) W, Township Von' o S Subdivision Name County at • Jroix WISCONSIN ADMINISTRATIVE RULE BEING PETITIONED '� C - 1. Rule l �1 r 1P�'� of the Wisconsin Administrative code cannot be entirely satisfied due to the following reasons: Ground level estimated at 9 as dete_rnined by niottlin�;. ---------------------------------------------------=----- (CST ;;2298) ----------------------------------------------------------- ----------------------------------------------------------- -----------------'------------------------------------------ 2. In lieu of complying exactly with the rule, the following alternative is proposed as a means of providing an equivalent degree of safety or health:' in efi'ect, the site h. been - moni for foul° years by a basement e,ceavation within 15t of B -3. i lt no time has ;round -water - Veen ob co TD -i ���x�avatt - ox� --------------- - - - - -- We request aj),)roval for a cluster (�) mound 9 stem b3.Se O.ii t ul -, ,(5 - MI ff iMTUM - 01M - G 7 cr1- t U 77 'i3t12Ttr TwT p - Cede - ri- ,Thm - d - c?urirr,_- - i - .arrcir l9 - - - - - ----------------------------------------------------------- ----------------------------------------------------------- 3. Supporting arguments (For site evaluations, include Form 115 — "Report on Soil Boring and Percolation Tests ") See at -mant . ----------------------------------------------------------- ----------------------------------------------------------- ----------------------------------------------------------- DILHR BD-6689 (R.12/81) (OVER) DETAILED PLAN OR DRAWING COUNTY PERSONNEL AUTHORIZATION Rule (� �" � � - 2 ' �' � << Ling petitioned On -site inspection condu date) S $ S indicate the infonm r_ recorded on this request form is accurate and correct to the best of my knowledge and belief. t7� '� \ S c �.w � wit '"� ' " I _Lai C. VERIFICATION BY OWNER — PETITION VS VALID ONLY IF NOTARIZED. FOR INFORMATION CONTACT THE DEPARTMENT AT (608) 266 -3815 being duly sworn, says he is petitioner herein, thus he has read the foregoing petition and that the same is true, as he verily believes. y Subscribed and sworn to me this da y of 19 County, Wisconsin. Signature of owner, Notary Public My commission expires: OFFICE USE ONLY DEPARTMENT ACTION SITE EVALUATIONS SET -BACK OR EXPERIMENTAL Date Received Amount Paid Receipt No. Date Received Amount Paid Receipt No. Department Action Department Action ADMINISTRATOR Date BUREAU DIRECTOR OR DESIGNEE te _ - ---_.. ` WAYNE OR ANITA SEVER-SON ROUTE BUILDING BOX 13 ACCOUNT 15,' 6.8141 1003 HUDSON, WI 54016 / PAY TO THE ORDER OF Bank M.F.O.LC• HUDSON, WISCONSIN 54018 MEM x:09 0 2 y 71: 10 844u' 100 We are not submitting a plan for approval at this time because we first need tentative approval of.the Petition for Modification based on 21" of suitable soil before we are committed to spend $300 -500 for plans from a designer. Approval for a system based on 9 ", even if granted, would not be acceptable to us. S/S Wisconsin Department of Industry, s ' Labor & Human Relations - � l Safety & Buildings Division .Jy Jansky O.W .S. L Z, Bureau of Plumbing r3 E. Spruce Street �) Chippewa Falls, WI 54729 (715) 723 - 8786 PRIVATE SEWAGE SYSTEM INVESTIGATION REPORT Name of Premises N>= 5 f+y. 6 , 31 . l S►✓ -IaRE S-T- S r. C Pp 1 X Location Township County Master Plumber /Soil Tester Address Owner j?A rm0wa / r/+ LUAYNE St 0BJ ' .. s Address [L7 t; AVA d4&_' 4tP L_+A/ =_ r k_x yam[. ll Sanitary Permit # Plan I.D. No. Type of Inspection -SOILS �siTE Persons Present at Sit; AI LI�.r,Ljl I ED A�?O•zb • Rep. PA., LSvn1 Type of Building: ❑ Public Single Family of Duplex BRIEF, FACTUAL COMMENTS AND SKETCH: `•' -�"� `""'"" -, �cK•� 1,4�• -0� /1�.!1�. ,.�ill��y'►� u,.f'�. _ l � Y '� -; f� I j� / I I• o f f ( )F i C$T .516 &�. i I �y s" . LP AT '� Cie— w E v Ta C Z 4 - i r -z — 3 _I uo � �9 z-1 m I - -- - — _ : T - � I 'R CL 4U j I _ C ! V>E Su S + ❑ SEE ATTACHED DISCUSSED WITH PLUMBER /CST SIGNATURE DATE OF INSPECTION - 7 - 25 - Biiy Signayf of Inspect Inspector Local Inspector Plumber or Responsible Part DILHR -SBD -6799 (N. 5/82)