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HomeMy WebLinkAbout030-2019-70-000 o in m 4 c 0 I a o I h N I � I I f4 N U C _ LL m LL c a 0 Q) <1 w M v Q) Z E N Z = C z d N N 3 " d m � �- ZI: 0 o z v ° v z - � � w mzd R' m z H r v i y - I N C O = C c it C O c U Z m Z) Z i+ LD y C r {p E N N d co O. W r LO O y N d O O O t[') G G m N ��ww o 0 0 0 Z ° �+J _a Na a a a Z5 a O N o 0 CO J U > m _rn - 0 � } o N f co o 'a o Q E2 E N E M m CL LO M �+ p N N 2 C ° W E .- O p Ci oN -o Oi a°� co N c Y v n� m o m . o) O o o M 7 CO N Z o M M C d •- it) �1 O O UJ ICI J s- O z C a `1v E ' _1 A U a 2 1 O U) v r Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SZ. JOB SEC. _t T 29 N-R 20 W ADDRESS J(o5 S, Q©. aZ. ST. CROIX COUNTY, WISCONSIN SUBDIVISION f3rNEr.-, LOT _rk: 4 LOT SIZE ? ? PLAN VIEW Distances and dimensions to meet requirements of I•ZHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM tPu,�,R2S�Ca X WEl1. �OG�AZL,r� QiM�SG-� �UU.SE 46)5 ►, - 5 -o 3o- w2-o pzn� INDICATE NORT ARROW BENCHMARK: Describe the vertical reference point used 1 =Rt'N �1 �1 e'E CAN tu7N9x Elevation of vertical reference point: ICO-00 Proposed slope at site: 8 00 SEPTIC TANK: Manufacturer: V 2.ssea_ Liquid Capacity: JOCX) GqAyt)r�j Number of rings used: 1, Tank manhole cover elevation: Tank Inlet Elevation: $,b2.. Tank Outlet Elevation: Number of feet from nearest Road: Front,©Side ,O Rear, O QTR lLV-p" feet From nearest property line : Front,OSide,ORear,0 �IEtR �C��-p� feet Number of feet from: well NOWEtL , building: 140 1' `fir (Include this information of the above plot plan) ( 2 reference dimensions to septic tank) i • i � PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevations Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,O Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: X Trench: Width: 12'0 u Length: 01-0" Number of Lines: Z Area Built: Fill depth to top of pipe: 22'' " Number of feet from nearest property line: Front, O Side, Rear,O F 0 t . x -ld Number of feet from well: UVe✓L- IOL),-0���„� Number of feet from building: 31�- tO u (Include distances on plot plan). SEEPAGE PIT . i Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit 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 . x Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: i� Inspector: Dated: /� 3 Plumber on job: License Number: /W P R S W a2 /3 9 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY&BUILDING LABOR&HUMAN RELATIONS DIVISION P.Q.BOX7Q6g ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES&APPLICATION MADISON,WI 53707 State Plan I.D.Number: NA,,N(Uj,S1,T29N-R20W [XN CONVENTIONAL ❑ ALTERATIVE (If assigned) I -4- U4 S Joseph ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound 5 iT 7,ADDRESS OF PERMIT HOLDER: INSPEC117 .^ Q� y Mitt am 6 Jeanine LaUon B. Co. Road B-2 Apt. 120 L��t2e Cap da MN 551107 D ��.3C� BENCH MARK(Permanent reference point)DESCRIBE IF DIFFERENT FROM PLAN: REF.PT.ELEV.: CST REF.PT.ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Paul R. Cudd 2739 St. Ctoix 119382 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLETrELLEV.: I TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER / C.b / ► /► Ro PROVIDED:YES ❑NO PROVIDED:❑YES 9 NO BEDDING: VENT DIA.: VE T MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO F ESH t t ALARM: FEET FROM r �„�Q / AIR INLET: YES ❑NO 4 �`L ❑YES ❑NO NEAREST—­111I C.I./ Lcx I /�6 DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: [__1 YES ON ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WE 4ILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF ❑YES E]NO NEAREST­111110- SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER M IAL D ARKING: or excavation. (If soil can be rolled into a wire,construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: SO H NO.OF DISTR.PIPE SPACING: COVER INSIDE DIA.: #PITS: LIQUID TRENCHES: A f I MATERIAL: PIT DEPTH: DIMENSIONS b GRAVEL DEPTH FILL DEPTH DISTR.PIPE DISTR.PIPE DISTR.PIPE MATERIAL: NO.DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BE OW PIPES: ABr^O�VE COVER: EL V.INLET: EI-EV.E PIP L EM: ,1 tt d ,1 Q 7 X02 NEARESTO—� W/ T• ' Al %t MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑YES ❑NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑YES [::]NO E]YES ❑NO DEPTH OVER TRENCH/BED I DEPTH OVER TRENCH/BED S TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: DEPTH ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR.PIPE MANIFOLD MATERIAL: NO.DISTR. I DISTR.PIPE DISTRIBUTION PIPE MATERIAL&MARKING: ELEVATION AND ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLESPACING: DRILLED CORRECTLY: COVERMATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑YES ❑NO ❑YES ❑NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: 0 ❑YES ❑NO ❑YES ❑NO NEAREST-� 1 0 S Sketch System on Retain in county file for audit. Reverse Side. SIGNA URE: TS BD-6710(R.06/88) LU A SANITARY PERMIT APPLICATION couY CJ ZT:I- ILHR In accord with ILHR 83.05,Wis.Adm.Code T STATE SANITARY PERMIT# /Ma —Attach complete plans(to the county copy only)for the system,on paper not less than STATE PLAN I.D.NUMBER 8%x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION—PLEASE PRINT ALL INFORMATION. FOR VARIANCE El YES f) NO PROPERTY OWNER j .G M PROPERTY LOCATION � NW '/a NW %, S 1 T 29, N, R 20 fM(gEj*W PROPERTY OWNER'S MAILING ADDRESS 1 657 1' t:). Uct &R LOT NUMBER BLOCK NUMBER SUBDIVISION NAME ---' St.-T' (Ttr Pines CITY,STATE L, CODE PONE NUMBER CITY NEAREST RO D,LAKE OR LANDMARK IF—] VILLAGE : St. Joseph STx 15 II:TYPE OF BUILDING OR USE SERVED: [WX­ , Oa —010 1 Y— 7 — Number of Bedrooms if 1 or 2 Family 3 OR ❑ Public(Specify): III. PURPOSE OF APPLICATION: (Check only one in#1. Check##2,3 or 4,if applicable) 1. a. a New b.❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e.❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner/building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in##1 and only one in##2) 1. a. ®Conventional b. ❑Alternative C. ❑ Experimental 2. Holding .❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP a �System- b. ❑ Hod g c y y In Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ® seepage Bed b. ❑Seepage Trench c. ❑See a e Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5.SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED(Square Feet): PROPOSED(Square Feet): Class 11 945 96o 96-5 Feet ®Private ❑Joint ❑ Public CAPACITY VI. TANK Site in allons Total ##of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank L 000 1000 1 Wieser Conc. Lift Pump Tank/Siphon Chamber. ❑ ❑ ❑ 1 ❑ ❑ I El VII. RESPONSIBILITY STATEMENT I,the undersigned,assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name(Print): PI rs Signatur (No ps) P/MPRSW No.: Business Phone Number: Paul R. Cudd MPRSW2739 715 425-2049 Plumber's Address(Street,City,State,Zip Co e: Name of Designer: Rt. 5 , Box 364, River Falls , WI 540 2 Art Wegerer ( 576) Vlll. SOIL TEST INFORMATION Certified Soil Tester(CST)Name CST# James L. Swanson 55-2152 CST's ADDRESS(Street,City,State,Zip Code) Phone Number: 123 E . Elm St. , River Falls , WI 54022 715 425-7631 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater Date Issuing Agent Signature(No Stamps) �4,Approved ❑ Owner Given Initial �� rc rge Fe�e�\ Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: pL try C�(�tjJ.,e� SBD-6398(formerly Plb-67)(R.03/86) DISTRIBUTION: Original to County,One Copy To:Bureau of Plumbing,Owner,Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT' r APPLICATION ti r TO THE APPLICANT: 1. This 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. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms,_etc.), depth of system, or type of system; 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. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: Property owner's name and mailing address. Provide the legal description where the system is to be installed; I!. Type of building or use served: If public is checked, ;ndicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1-6; VI. Tank information: Fill in the capacity of every new and/or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift/siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County/Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8Yz 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; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. ---------------------------------------------------------------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the �! result of over 2 years of steady negotiation and public debate. The groundwater bill Grounter included the creation of surcharges (tees) for a number of regulated practices which Wisco trl'$ can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried reaSure is used in your building is returned t the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. The :;conies collected through these sjrcharges are credited to the groundwater fund adminis- tere_! by the Department of Natural R--sources. These funds are used for monitoring ground- T water groundwater contamination in.estigations and establishment of standards GroundwatE,! it's worth protecting. F,GD-5398(R 03%86) 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 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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1�1I ILlM A J �A uyG ,o Owner of Property .6 Location of Property 14 34, Section , T 21 N-R ZO W Township Mailing Address Ad N. 551 l Address of Site L-(3T 4 4-T CJ2A L.X, &Jf,S "j!!5? Subdivision Name 4:Vr Lot Number Previous Owner of Property �t,1�12�, a NLB.SOi� "12 Acr Total Size of parcel R 'S Date Parcel was Created 0&T 12.411" Are all corners and lot lines identifiable? X Yes No Is this property being developed for resale (spec house) ? Yes No Volume " 00)and Page Number as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number, volume and page number, and the $eal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTy OWNER CERTIFICATION 1 (We) ceAti6y that att .6tatement6 on this botcm cute tAue to the best o6 my (ouA) knowledge; that I (we) am (are) the owner(.$ ) o6 the pttopetr ty dens cA bed in this in4oAmati.on bonm, by vi tue o4 a wauanty deed Ae Aded in the 066ice ob the County Reg.usteA o6 Deeds as Document No. 4 A 7 a)U ; and that I (We) ptesentty own the proposed 4ite 6oA the sewage du6po,6 �sa� syAtem (ot I (we) have obtained an easement, to nun with the above de�schibed pAopeAty, 6oA the cons uction ob .said zybtem, and the 6ame ha,6 been duty tcecmded in the 046ice o6 the County RegisteA o6 Deeda, ass Document No. SIGNATURE OF OWNER 1GNATURE OF CO-OWNER (IF APPLICABLE) L T DATE SIGNED DATE SIGNED cbwl" *6000 . � ........... . .................................... .»---.-................_... . ��ic�oa�ai�--��aa3ii�::�:•fariioii�:�i �I f. .....�:. . .......................---. .... .............................................. IM.........................................................oer mY Oeeeh ,AW a wlrlio « «_.. . 1I11►±Serteliwrs dweeMi nd aloft ie St. Croix "a* w ......... ................... .. r i ft*at Wbueft: dt°QOe�srsMSt Lot "1" of Section 1, Township 29 20 Best described as follows: Lot 6 of Pseml : " OWN my Hap f iled October 12, 1983 in Vol. "5". YI'PII and SITW= TO those essgents, 8 etloms oamtdlesd In DeclarstIon Of Protective e -31. 1953 and saeocded Nmber 1, 1963 is ~` o. ;74-260, Doc. No. 346929 in the office of the ON &SMIN f0c St. Croix County, and TOGETHS: WITH private a as aI on said Certified Survey tiap and easements -rlMess is col. "654", Pago SS and "655". Page 62. to as aMe■sst for walkway purposes over the West 5 feet of said Lot 1►, s . !o°Sivsm is fwlfillmeat of au unrecorded land contract executed brtrasa_:, {Dios parties on October 17. 1966.' i ink to-got �g aY asd pport�"Um dweafta : �s+• �� . :r and a rr,re IMb b«�. ie fate aiapa aad itve aad tdoar of .».._......:,°•. ! • aaeoleaaoaa aaD�t. covessnts and restrictions of record and any liens or ewuabramtsn F"-'046"d bY set or default of grantees - and we"mates and drdwd do mom ri .......................... .It......... day of . ........-... June ........... M ..................................._.................................(SEAL) ,.,,,,.... • .............................................................. CHARLES MASON --•-�u'i#ra a ...................»...............................................(SEAL) -.... { ,......_.............. ............................. ' ................ AUT=»tTZOATZO>t •os><ownsaaUsrT .. �� R4A... ..............«... STAT! OF WISCONSIN ; .......... P*290aDS coma bat on sis-t►b ».«----------"�►dt �-�-- ............».. ..................... ............. 1sw.... the 0111011W spi_........ ... ----------•------------«««w.« VsR>NkF ...r.__..»..._«.-..w._.w..�_.. STATE RU OF WISCONL{IN--•--.... ..................... «w..... .._....«---....».._...._. ....a��1M.�•Afi.Shfs.)..................... te nto kaowa te bo t4 ponoa...................wtio arwUd l6f fora0{09 betroaooat and admowb be the aaara. itaa teIUMMINr was tstArrac sr { .C�Ri .I tAX................................... �' - .. ..........._... t. Carl � �.. ... .548i6... ....... Nolan Pubne we ova a e,,, ' wP) mard ter aetsawia ad.Both Y, Caemiado: ii �r•...a£(tt wilt aiiile ' � date: . -......_... .........-.t,. loop"at"am 4404 IN w-sow sawli M t,ow or,eiN.t bd..doir 1 Stock No. 26273 CERTIFIED SURVEY MAP :-CATED IN GOVERNMENT LOT 1 , SECTIONI, T29N, R20W, TO1:'.N OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN - NORTTI LraE �F_ �E�filbN 1 S89°47'49"E -o�I� PRIVATE ROAD EASEMENT i7 CORNER 768. 00 °i NE CORNER, :CTION 1 POINT OFnC�' 69251 9"E ROADWAY SECTION 1 29N, R20W BEGINNING �66 25'r EASEMENT T29N , R20W w o Co APPROVED _ ^ r! ^ O t O r",. � z � N ^ OCT 121983 O � 6 `O C�O1X COUr4iY U -- -( D COMr.EMENS yf PARr$ tLAH-ANC) Z A.4 o Zci;rro C01A.W11ee Q • w ° -N < - - - - 176'5 _ 6 1 O;; N 61 Q t.l 1-0 A r es } . � _il a.79 F1,{ w ° �i IBF . moo,• h - - 21 LOT 3 : - -- _ ho 3. 97 Acres} i= °- ),y . - 173, 061 .Sq Ft_ . + 4. A res+ 0 71 ICY °1 205, ' A, 1 N Ln co 0 \ A X8''0 1 - ..- o - _ i - ,� ^' o•_ .- - T F p TO LL► J Of Of o \ } 1 � , - 11J O _, ._. \O 200. 00' - -.- o 'w --J \ N 88 050'50"W _ o O, : aI Uc - - - w o ZI _ � w o � 0 Z l - � rn ^ rn J �o o rn SCALE IN FEET S. LINE N � T�T ' GOVT LOT 1 Z 300. 12' w — _ 1 - N87°1248"W ---- 0 150' 300' _LO_T 1 C. .S .M. (N 86052153"W) % _VO_L. 3, PG. A6 GOV'T LOT 2, SECTION 1 phis ir,struinent drafted by James T . S% anson. l 4 • A yq. - -- H x H 9 STC - 105 r 9 H SEPTIC TANK MAINTENANCE AGREEMENT c St . Croix County x d a OWNER/BUYER �16li Ui2S00 M ROUTE/BOX NUMBER tar L L q _ - A Fire Number CITY/STATE . 1-5$60 7/�S�l� 7j ( /X V6• ZIP 51.0 14 PROPERTY LOCATION : P(A) 14, J(j '&4, Section l T 7-9 N, R ZD W, Town of Sr 1Q �N St . Croix County, Subdivision fINI& 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 ptit 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 three year expiration. Ho I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x M 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. 7 SIGNED �L DATE 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 . r 6 R Y, ` -` �. 't ► v 1 i u.�f..ris_ f`•.1 t,j 1 111 .�� 1 i1 WV D I V I S I O N RANC' PERCOLATION TESTS (115) MADISON WI 53707 P.O. BOX 7969 ft RELATIONS cn"T LOT 1 (H63.090) & Chapter 145.045) LOCA1 ION SECTION. TOWNSHIPIMUNICIPALITY LOT NO.:BLK.NO.: SUBDIVISION NAME: Nr I�s*1�4 1 /T29 N/RzAmWi St. Joseph 4 - -- COUNTY OWNER'S BUYER'S NAME: MAILING ADDRESS St. Croix John F, Carol Landry 595 Mallalieu Rd. Hudson, Wi. 54016 USE _ _ DATES OBSERVATIONS MADE NO.BEDRMS.: COMMER L DESCRIPTIO PROFILE UESERI€ l0 S: Pl�Z A ON TESIS: Residence J �N/A LjaNew CJReplace 11/3/82 N/A RATING:S=Site suitable for system U=Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUNaPRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM:(optional) U S ❑U ®S ❑U ®S ❑U ❑S 0u ❑S ®U I Conventional Bed 12'x801 If Percolation Tests are NOT required DESIGN RATE: --__--- --T -- — 4 If any portion of the tested area is in the under s,H63.09(5)Ibl,indicate: NSA. CLASS I I Flondplain, indicate Floodplam elevation: NIA PROFILE DESCRIPTIONS I BORING TOTAL DEPTHTOGRQU NDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED ' I HES TO BEDROCK IF OBSERVED (SEE ABBRV.ON BACK.) --- — - B- 1 66 97.8 None > 66 18, Bn sl; 48, s & gr with cob. B. 2 1 .10S 101.0 None > 105 24, Bn sl; 81 , s F, gr. B. 3 85 99.5 None 7 85 21, Bn sl; 64, s & gr. B_4 60 98.4 None > 60 18, Bn sl; 42, s $ gr. B- 5 80 100.0 None > 80 21, Bn sl; 59, s $ gr. PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERT PE RI OD 2 PER INCH P- 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. 96.5 ORIGINAL SYSTEM ELEVATION 95. 5 ALTERNATE - - NE' CORNER I IOT 4 'l7.S SCALE: 1"=40' I TN 0 O 6Z os6, LEGEND BENCH MARK • I" IRON PIPE d2'k80� �'� TOP OF PIPE BORING NDMBER F, IOCATION ON EASTLINE OF B-10 LOT 4 ELEV. 100.00 B� 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 any knowledge and belief. NAME (print TESTS WERE COMPLETED ON: James T. Swanson November 4, 1982 ADDRESS: CERTIFICATION NUMBER: PHONE NL:MBER(npun :�l) 55-2152 715 4Z5-7631 __ 123 E. Elm Street, River Falls, Wi. 54022_— _ _ _ ___——�___�-5 - - -- CS" SIC ATURE: Job No. 82-1394 . J — - ' �O-wne`r 's name an. Permit o. H63.05 PLOT PLAN Show: . Location of building served tiA Dosing chamber �✓ Septic tank © Vertical/horizontal reference point Building sewer System elevation is ctb•S� FV-71 Effluent system Q Well Replacement system area Q Property lines w/in 50' of system Distribution boxes Scale = 1�=�{O�, or dimensioned A ' Pump and controls: 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: t L UT y ____---- 1 _ \Aov SC IL y'of u'nvC S iv LUOO Gf��- t�cEs� c,o+je. st!..P-nl `Tt`cxhe 5 L4c or- N6Pv c b �I v By the granting or approving of the above plan, or upon the event of a subsequent permit being issued,St.CroixCounty and theSt.Croix County Zoning Administrator, does riot assume or hold itself liable for any defects in plans or specifications, plan om-4ssion, examination oversight, construction, or any damage that may result in or a in tallat•on �- 141119le S t4),�4 ate x CROSS SECTIOU OF A BED SYSTEM Frech Air Welc And Obcervallon Pipe nom---Apvo,ed Vent Cop ,m 12'Above Flnol Grode 4' Cost Iron 20-42' Above Pipe _Vent Pipe To Final Grade Morsh Hay Or Synthetic Covering win 2' Aggregote Over Pipe Dictrlbulion —?se Pipe 0 0 0 0 0 L' Aggregate d Pertoroted Pipe below beneotn Pipe � —Cooplinq lsrminotinq At bottom Of Syilem i SOIL FILL 2" OF AGGREGATE 015TRI5UT10Q PIPC-1 XPPROVED 5y:IWTHLTIC COV:R r !'1ATERlAL OR V OF 5TR,&,W OR MARSH KA`i %G 0 F%t-2tY= AGGREGATE >LL�V. OF 96•� FEET; �,,. � �°..�.�-'�\� �.�r. DISTRIBUTIOW PIPE TO bC AT LEAST 3 IUCHES BELOW ORIGIUAL GRADE AWE) AT LEA5T1-0 10CHES BUT AJO MORC THAW 42. IUCHES BELOW FWAL GRADC mmumum OLP-I 11 OF EXCAVATIOu FROM ORIGIUAL GRADE WILL BE ' Z IAIGHES MINIMUM DEPTH OF EXCAVATIOU FROM ORIGIUAL GRADE WILL 15C Z3 INCHES 51GUCO: LIGC►JSC UUMBE R:IYPe—S w c,2 �73 y C AT C