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010-1020-50-050
St. Croix County Planning and Zoning Thursday, January 26, 2006 at9:31:46a~r Page 1 of I Detail Sanitary Information Computer 010.1020-50.050 Sub/Piat: NA Section: 9 ~R~,; T30N R16W Parcel 09.30.16.124A Lot: 1 Municipality: Emerald, Town of CSM: Vol. 13 Pg. 3644 114114: NE 114 NW 114 - - Owner: Hagen Marvin 2339 170th Ave. Emerald, WI 54013 permit; Replacement State Permit: 88423 Issued: 1013011986 POWTS Dispersal: Mound Bedrooms: 4 WI Fund: County Permit: 0 Installed: 04/1711987 POWTS Detail: NA POWTS Pretreatment: NA Notes Additional Notes Money Owed Issuerllnscector As Built Plumber Other Requirements Steel, Gary L. Gary installed a new 800 gal. Weeks septic after $0.00 Mary Jenkins Yes existing 1000 gal. Powers septic tank to new 800 Tom Nelson Signed Off: No gal. Weeks pump chamber to 9x 56' mound cell. Permit paperwork mistakenly used NE/NE 1/4 of Sec. 9 to describe this parcel, but Hagen's deed described E 112 of NW 114 Maintenance Scheduled Pump Q@ItEqaMft~ 1 st Notification 2nd Notification 3rd Notification 411712006 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4/D - !D b-ocd I I HAGEN, MARV a,, E NE Section 9 FtT,r- 8339 /7d -Avg T N-R16W. /a Emerald, WI 54012 Town of Emera d jo, San, Permit#88423 10-30-86 G. Steel Mound, Re laceme t 'jf~llld 11-1747 . Parcel 010-1020-50-050 01/26/2006 09:22 AM PAGE 1 OF 1 Alt. Parcel 09.30.16.124A 010 - TOWN OF EMERALD Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner MARVIN D & MARILYN HAGEN O - HAGEN, MARVIN D & MARILYN 2339 170TH AVE EMERALD WI 54013 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 39.120 Plat: 3644-CSM 13/3644 SEC 9 T30N R16W PT NE NW & PT SW NW Block/Condo Bldg: LOT 1 BEING LOT 1 CSM 13/3644 EXC PT TO CSM 16/4319 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 09-30N-16W NE NW Notes: Parcel History: Date Doc # Vol/Page Type 06/26/2002 682641 16/4319 CSM 05/24/2002 680017 1898/235 EZ-1 2005 SUMMARY Bill Fair Market Value: Assessed with: 80039 Use Value Assessment Valuations: Last Changed: 10/19/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 15,000 146,400 161,400 NO COMMERCIAL G2 1.000 5,000 14,800 19,800 NO AGRICULTURAL G4 32.120 4,300 0 4,300 NO PRODUCTIVE FORST LANDS G6 4.000 6,400 0 6,400 NO Totals for 2005: General Property 39.120 30,700 161,200 191,900 Woodland 0.000 0 0 Totals for 2004: General Property 39.120 30,700 161,200 191,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 12/04/1998 Batch 551 Specials: User Special Code Category Amount 010-GARBAGE SPECIAL ASSESSMENT 30.00 Special Assessments Special Charges Delinquent Charges Total 30.00 0.00 0.00 Parcel 0 -1020-10-000 01/26/2006 09:22 AM Alt. Parcel 9.30.16.120 PAGE 1 OF 1 Current X 010 -TOWN OF EMERALD CROIX COUNTY, Date Historical Date Map # Sales Area Application # Permit # Permit Type' WISCONSIN 00 0 Tax Address: TO O = Current Owner, C = Current Co-Owner LINDA C WOZNIAK NIAK, LINDA C 2385 170TH AVE EMERALD WI 54013 Districts: SC = School SP = Special 7ck/C ress(es): Primary Type Dist # Description AVE SC 2198 GLENWOOD CITY SP 1700 WITC WITCowl Legal Description: Acres: 40OT AVAILABLE SEC 9 T30N R16 40A NE NE Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 09-30N-16W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 995/585 QC 07/23/1997 9321551 2005 SUMMARY Bill Fair Market Value: Assessed with: 80035 Use Value Assessment Valuations: Last Changed: 10/19/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 15,000 115,700 130,700 NO AGRICULTURAL G4 20.000 3,000 0 3,000 NO UNDEVELOPED G5 7.000 8,400 0 8,400 NO PRODUCTIVE FORST LANDS G6 11.000 29,700 0 29,700 NO Totals for 2005: General Property 40.000 56,100 115,700 171,800 Woodland 0.000 0 0 Totals for 2004: General Property 40.000 56,100 115,700 171,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 115 Specials: User Special Code Category Amount 010-GARBAGE SPECIAL ASSESSMENT 30.00 Total Special Assessments Special Charges Delinquent Charges 30.00 0.00 U ® EMERALD (q? ON~ T30N.-R.16 W 47 S O SEE PAGE 5911 I PAGE 6p ~i /Ye Berson • ~ Low a ~e • S SEE ti O f Er e%z /,/2! %/Cn lTarn~s 6✓C oe~~if: ~{l \C s0 ~ s.se// E: y C a e111x C von L/ Webs>ez if+rx y Pat .c' z i a a z i K'/L LOW b ZEh F ln r°adde •HP dG'l~5'00 ~Tose/oh g a a l •z `"((a~~1 zb7 On D 7s / Eric,Eson Lorr¢irre a?-B Kern etfi 0 ~J 4 3 R :kbo. 6 _4 ,g Cji//en _ cSa/ on ~o Q /`1¢~aref Meath s N 3,9/ s b F w 279 6 s • m Bz . 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Box 73 ` Via,r (715) 265-4966 Woodville, Wisconsin Y 4•H Route 1, Box 253 (715) 698-2001 a family affair Glenwood City, Wisconsin 54013 Registered Polled Herefords Breeding Stock For Sale Springfield Section 17 Form-STC- 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP _eyn~& !e SEC. ` T C>N-R G W 7 ADDRESS ST. CROIX COUNTY, WISCONSIN i CkriA SUBDIVISION 0 S,~ LOT - LOT SIZE 9a PLAN VIEW Distances and dimensions to meet requirements of I1HR 83 SHOW THING WIT N 100 FEET OF SYSTEM f- 80 ' AP, ~t r INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used p~f h= Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: Liquid Capacity: l 000 2Kq, ~ x S1 g Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: T~ Number of feet from nearest- Road.: Front,0 Side,O Rear, O feet -From nearest-property line .-Front aside 10Rear,0 feet Number of feet from: well building: P/ (Include this information of t #e above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER c Manufacturer: C K s Liquid Capacity: pump Model: d Pump/Siphon Manufacturer: ~~5 Pump Size . 9 s 6-5 Bottom of tank elevation: 13 Elevation of inlet: 47 Gallons per cycle: Pump off switch elevation: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, Side, O Rear, i Number of feet from well: 7 6 Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: v Trench: Widtht: Length: Number of Lines: .3 Area $uilt:5~ t Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side ,0 Rear,0Ft.o+ Number of feet from well: Number of feet from building: (Include distances on plot plan). ; SEEPAGE PIT Size: Num of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has eithe drop box O or distribution box O been used on any of the above soil absorb on sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number rings used: Elevation of bottom of tank: El ation of inlet: umber 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: Inspector: Dated: Plumber on job License Number:, 3/84:mj DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS INSPECTION REPORT FOR SAFETY & BUILDINGS P.O. BOX 7969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 53707 BUREAU OF PLUMBING ❑CONVENTIONAL UALTERNATIVE State Plan I.D. Number: E-1 Holding Tank El In-Ground Pressure XKRMound (If assigned( 8607599 4/-/)- NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Marv Hagen Rt. 1, Emerald, WI 54012 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: NE NE, Section 9, T30N-R16W, Town of Emerald Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number. Gar Steel 3254 St. Croix 88423 SEPTIC TANK/HOLDING TANK: MANUFACTURER: / LIQUID CAP CITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LA L LOCKING COVER Tp/f~.+/~r_✓•• 7 3 J 7~ PR_OV~D ED: PROVIDED: BEDDING: F--+ r ES ❑NO ❑YES NO VENT DIA.: VENT MATL.: HIGH A NUMB R OF ROAD: PROPERTY WELL: BUI G: V NTT FRE H ALgRM. FEET FROM LINE ❑YES NO AIR INLEZ ❑YES NO NEAREST / / !!U DOSING CHAMBER: MANUFACT11gER: BEDDING: LIOUID~gPACITV: PUMP MODE L: NMANU CTURER: jvQ7 /V`^!~/V^) 37 r7~va4t WARNYINGES LABEL LOCKING COVER PROVIDED: PROO,V~°ED: YES NO ❑NO L]YES ❑NO GALLONS PER CYC E: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PR OPE RTV WELL aUILOING V NT TO FRESH PUMP (DIFFER ON (DIFFERENCE AND OFF) BETWEEN ~ O Y FEET FROM LIN^ A INLET - SOIL ABSORPTION SYSTEM . C ES ❑ NO NEAREST eck the soil moisture at t ad Pth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: BED/ TRENCH WIDTH: LENGTH: ii! OF DISTR. PIPE SPACING COV INSIDE DIA TRENCHES: MATERIAL: *PITS LIQUID DIMENSIONS PIT EPTH GRAVEL P H FILL DEPTH DISTR. PIPE DISTR. PIPE ISTR. PIPE MA E IAL: NO. DISTR. BELOW PIPES: ABOVE COVER: ELEV. INLET. ELEV. END: NUMBER OF PROPERTY WELL: BUILDINT TO F RESH PIPES: FEET FROM LINE. AIR INLET NEAREST -s 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- Y YES ❑NO meets the criteria for medium sand. TIONS MEASURED. IL OVER TEXTURE ^ PERMANENT MARKERS /r,X/fV OBSERVATION WELLS DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED YES ❑ NO YES ❑NO CENTER: EDGES: DEPTH OF TOPSOIL. SODDED. SEEDED MULCHED. ` r S NO YES ❑NO YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: ❑ YE FBE RENCHLEN THNO.OF LATERAL;CING GRAVEL DEPH ELOW PIPF. FILL DEPTH ABOVE CNSIONS TECHES: VER IFOD IFOLD DISTR. PIPE MANIFOLD MA ERIAL: NODISTRDISTR. PI E DISTRIBUTION PIPE MATERIAL & MARKING TION AND ELEV.: r3 ELEV.: DIA. ELEV. 1 PIPES. DIA.: DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL. VERTICAL LIFT CORRESPONDS TO APPROVED 3 ( PLANS. COMMENTS: PERMANENT MARK Rs: YES 1-1 jUBbt:HVATION OWELLS: EYES ❑NO NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: YES ❑NO YES ❑No NEAREST i Sketch System on Reverse Side. Retain in county file for audit. SIGNATURE: TI LE: DILHR SBD 6710 (R. 01/82) ~~~.F„~~ SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code ~7= STAlEaANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than dA 8% X 11 inches in size. STA PLAN I.D. NUMBER -See reverse side for instructions for completing this application. &6 s 559 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PETITION PROQERTYYO N R FOR VARIANCE BYES ❑ NO 'f r~l Tl~~ PROPERTf~LOCA ION G~ PROPS TY QV~INER'S MAILING ADDRESS S / T ~0, N' R ~Or) W Ir/ I LOT,N\I E BLOCI~fV ~ER SUBDIVISIQN AME CIT 1/ 3C.T..A„TE ZIP CODE PHONE NUMBER~ C~IITJY ~►`J /0 TO J S VILLAGE : NEARES AKE OR LANDMARK n41Uj/1qH.1 (A 5 'Z II. TYPE OF BUILDING OR USE SERVED: /Oaj`T";20 Number of Bedrooms if 1 or 2 Family OR ❑ Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in ##1. Check 2,3 or 4, if applicable) 1. a. E1 New b. `Replacement c. ❑ Replacement of d. ❑ Reconnection of e. 1:1 Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit 3. ❑ An Existing System has been inspected and soil conditions meet minimum equerIssued ements. 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. DkAIternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e.XMound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. Xsee a e 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): d Cp ~o o VI. TANK CAPACITY Feet Private ❑ Joint ❑ Public INFORMATION in allons Total of Prefab. Site New xistin Gallons Tanks Manufacturer's Name Con- SteelglFiberss App, - plastic App. Tanks Tanks Concrete structed a Septic Tank or Holding Tank / f Q(~ Z S Lift Pum Tank/Si hon Chamber VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for instal ion of the private sewage system shown on the attached plans. Plumber's Name (Print): ~ Plum r' gnature: ( St ps P/MPRSW No.: Business Phone Number: P 's Ad ess (Street, City, Stat Zip E -mss s Z i~4i & Zkyw Name of Designer: VIII. SOIL TEST INFORMATION Certifie Tester (CST) Name CST # CST' DDRESS (Stre ,City, State, ~1p Code) J I Phone Number: a2AOdi Ilk OUNTY/DEPARTMENT USE ONLY f ❑ Disapproved S ary Permit Fee Groundwater r pproved F1 Owner Given Initial Sur arge Fee ate ? Iss Ling Agent Signature (No Sta S) Adverse Determination O v ~s ~Ja~d X. COMMENTS/REASONS FOR DISAPPROVAL: 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 APPLICATION 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 Stafe of,Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description where the system is to be installed; 11. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 3 sea 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; application is disapproved. X. Comment area for use by county or resaon given when app Complete plans and specifications not smaller than 8'/z 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 Grdundwator Wisconsin's included the creation of surcharges (fees) for a number of regulated practices which buriedreasure can effect groundwater. The surcharge took effect on July 1, 1984. Ail of the water that is used in your building is returned to the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund sdriinis- tered by the Department of Natural Resources. These funds are used for monitoring gioun0- fa water, groundwater contamination investigations and establishment of standards Gro Inc w ate. its worth protecting. '.BD-6398 (RMI36) 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/contractgr.,("Spec house"), then a second form should be retained and completed when the property is sold-and-submitted-to this-office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property Location of Property 3b Section , T ?_D N - R l .CAW Township I Mailing Address Subdivision Name Lot Number f+ Previous Owner of Property Total Size of Parcel Date Parcel was Created 5 r / S _ '7 z~ Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume and age umber , ^ r~ ded with t egister of Deeds C UDE WITH THIS APPLIC ION ONE~OF ~ . 7 IN THE FLOWING. 1. 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 r I (We) een tt.6 y that a.tt a.tatementa on #h i-6 6onm are tkue to the beat o6 my ( our ) knowledge; that I (we) am (are) the ownerla) o6 the propehty deaehi.bed in .thin in6onmati.on 6onm, by v Atue o6 a warranty deed Aeeonded in the 066ice o6 the County Re9i4ten o6 Deeda as Document No. / &AA 742 ; and that I (we) pneaen,Zy awn the pnopoaed aete ban the aewa e obtained an eaa emen t, to nun with the above Rea c4 ibed opextm ( an 1 (we) have con6t4uction o6 aaid aya.tem, and the name has been duty ecoAded6in the 066ice o6 the County Reg.ca.ten o6 Deeda, as Document No. A. 'y *SIGNNAARE OF OWNER SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED } /~Joc~-gal Sys rr~ Y4 !U G' % S, 'f 30 .v . 2 /6 ~J F m~,~ w l d l-o w a s Wl p . 80 ~4 w~Fs ~Z rE-~i T~j O r7 /T~rrr/~s ~j d4 SVS lld 0Y7 . . Le , an ow 15.- 361 0 -ly 86 IIJF5 L pi pew #Z .5' ~ rnr t hoc P. a61~~, ~tCE1~E MBIN~ B~REa~ 4 .,d g4e DIL!-~R PRIVATE SEWAGE SYSTEMS DSTATE OF wiscumsom UILMN IMION OF SAFETY & BUILDINGS BUREAU OF PLUMBING PLAN APPROVAL APPLICATION M E. washloVen Avenue. Rm 141 P.O. s" MR, Madison, WI 53707 d faoa.usans .STRUCTIONS: Piease fill in all applicable data and submit this form with plans. Plans will not be reviewed until all fees are received. The back side of this form describes required plan information. Plumbini codes can be purcgased from the Department of Administration. Document Sales, 202 South Thornton Ave., P.O. Box 7840, Madison, Wisconsin 53707, Telephone (808) 2664358. 1. PROJECT INFORMATION (Type or print clearly) Revision To Plan Number. Name of S emitting Party (Plans returned to same) Project Name Street a No. or Rur Route Proj Locationeet a No. or Legal Description i9e e r • /-!3 0,C) 12 City or Village State Zip city I Counq Village OF: lt~ 7 Town E7 en S _ -QA I, q-,0 1 elephone No. (Inuude area eodej 6' Designer Telephone No. (Include area code) Owners Name Telephone No. (include area code) Street a No. q. CS Street a No. v E ^°~es ~ ( City or village State 4 I Zip City or illage tats Zip An-lo 2. APPLICATION FOR: ew Mound System (3a) Groundwater Mon itorinig (7) Conventional System - Public Building (1) Replacement Mound (4a) Holding Tank (2) PI-Replacement Pressurized System (4b) System in Fill (1) Petition For Varitrice (6) ❑ New Pressurized System (3b) System in Flood Fringe (1) . Other Alternatives (5) FEE COMPUTATIONS (Include exlstlng tanks) 4. FEE SUBMITTED FOR OFFICE USE MAKE ALL CHECKS PAYABLE TO DILHR 3a. 750 - 1,500 gallon septic tank 40_ 50,00 4a. 3b. 1,501- 2.500 gallon septic tank MOO - 60,00 4b. 6,15,00 3c. 2.501- 5,000 gallon septic tank - 80,00 4C. 3d. 5,001- 9,000 gallon septic tank -100.00 4d. 3e. 9,001 gallon septic tank -150,00 4e. ' 311. Over 15,000 gallon septic tank -250.00 Q. 39. 500- 1,000 gallon dose chamber - 30,00 4g. %301 Cr 3h. 1.001- 2,000 gallon dose chamber - 50.00 4h. 31. 2,001- 4,000 gallon dose chamber - 70.00 41. 31. 4,001- 8,000 gallon dose chamber - 90,00 41. 3k. 8,001- 12.000 gallon dose chamber -110.00 4k. 31. Over 12,000 gallon dose chamber -150.00 41. 3m. 500- 5.000 gallon holding tank - 30.00 4m. 3n. 5,001-10,000 gallon holding tank - 55,00 4n. 3o. Over 10,000 gallon holding tank -100,00 4o, v Cit ,SI 3p. Revisions - 20.00 4p. C 3q. Groundwater Monitoring Per Lot - 32.00 4q. (other than a proposed subdivision) Subtotal 40.00 3r. Priority plan review: walk through 4r, vMB~N lax Submittal of plans in person. -r by appointment, with double fee 3s. Petition for variance Setback - 25.00 4a. Site evaluation _ 50.00 Total Fee jk2;jW / O M NOTE: Pon pwerml to wls. Adze. Cods. Cit peer hid. M 7RRr1.AYAQ 00 e/a!t IItN tie etdgeet w aUnlee aARtlsNr PETITION FOR VARIANCE WISCONSIN DEPARTMENT OF OFFICE USE ONLY OF A RULE IN THE INDUSTRY, LABOR AND HUMAN RELATIONS Petition No. WISCONSIN ADMINISTRATIVE CODE DIVISION OF SAFETY So BUILDINGS P.O. BOX 7969, MADISON, WI.53707 - uttt r Nerve of Owner Building Dec nay or Use , rahitect or Engiing Fir neer Codips" Tenant N if any t 6 No. Street 8 Building Location. Street No. 68 ro- S state a, ip :fix 8 &tYono City coone / Z Plan Numbsr(s / r Z 4 Z 5 •Z~ S~ / d / 6- IF KNOWN N~++s of Conaat Perron 1. Rule~~ `3 • 30) 0 of the Wisconsin Adminstrative code cannot be entirely satisfied because: -14i V! -k2h Az Top .90 - _Yr! ! . _-g ~ ~ ~ FC 2. In lieu of complying exactly with the rule, the following alternative is proposed as a means of providing an equivalent degree of safety: Lie 551 -4.'j4&4eJ"n 3. Supporting arguments are: =ttii 4- P- J~-V-OA'fw- 4-1~ - - - - - - - - - we-60-ps VERIFICATION BY OWNER - PETITION IS VALID ONLY IF NOTARIZED For Fee Information See ILHR 69.15 or Contact The Department at (608)-267-7843 NOTE: Petitioner must be building owner. Tenants, agents, designers, contractors, attorneys, etc. may not sign petition unless a Power of Attorney is submitted with the Petition. Max-lm D. Hagen being duly sworn, I state as petiti N (NAME of PETITIONER Please type/print) ,I~e the foregoing petition, that I believe it to be true and I have significant ownership rights in the subject building. • OFFICE USE ONLY V 4re of 0*1) r Date Received Amount Paid Receipt No. Subscribed and sworn to nw his Bete: A lavtst 2-80 86 St Q=ix _ County, Wisconsin. r Department Action My art' F O. HEE ,}r.►K Office of The Secretary Dats rosin explores. d W Am Aw. )VW STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION or SAFETY & BUILDINGS - BUREAU OF PLUMBING . P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: 'Towns hIpAW 1~y.LE~: NE's NE S 9 T 30 N/R 16 W Emerald Street Address: St. Croix Subdivision: County: Landowners Name: Mailing Address: Marvin Hagen Rt. 1, Emerald, WI 54012 I (We), 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 sewage private system. I I agree to have the system installed In onformancewithptheaBureau'snapproval of plans and specifications. pr 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 se. I agree to permit both county officials charged with adminiatering county nitary ordinances and Bureau employes or other authorized persons to have cress to the,above described premises at any reasonable time for the purpose i f inspection the construction of or monitoring of the system. I further agree either personally or by my agent contact the proper county official to rrange 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 thast~'or an alternative system has been made and if installed, that the pre~fidis are served by an alternative system and further agree to give the buyer a copy of this application. RECEIVED The Bureau accepts this application subject to this understanding ~ aubj*0 to all the conditions and obligations set out in this application. PLUMBING BUREAU a8 Signature of pplican ate STATE OF WISCONSIN Subscribed and sworn to before one r, " SS. i COUNTY OF_JL.QZ2iX This 28th day of A 145 No a y u 1 c, of Wisconsin- - DILHR-S$D-6413 (N. 05/81) ' V.~.! My mmiasion Expires: ~1' ~ «M►o~ Wiec~n ST. CROIX COUNTY 4 WISCONSIN ZONM OFFICE r 798-2239 (HAMMOND) 425-8383 (RIVER FALLS) HAMMOND, VA 64016 August 18, 1986 Division of Safety and Building Bureau of Plumbing P. 0. Box 7969 Madison, WI 53787 Dear Sir: An on site investigation for the Marvin Hagen property, located at the NE1/4 of the NE1/4 of Section 9, T38N-R16W, Town of Emerald, St. Croix County, revealed suitable soils at a depth of 1.58 feet, below which seasonable high ground water was noted. i This site should be suitable for a mound system. Should you have any questions, please feel free to contact this office. Sincerely, 0'. Thomas C. F /may Nelson Assistant Zoning Administrator ~ TCN/mj RECEIVED c=P PLUMBING BUREAU WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY b BUILDINGS, BUREAU OF PLUMBING P.O. BOX 79699 MADISON, WISCONSIN 53707 Verification of Exception Status for anrAlternative Private Sewage System In the County of St. Croix Location NE 1/49 NE - 1/4, Sec. 9 9 Tj_N, R__LL_.#jfiVd W Town ~ ea l W Emerald Street Address Lot No. Block , Subdivision Landowner's Name: Marvin Hagen The application for this site is for: O new construction use. replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: Ll 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 nWers7 ssueU7o you.) 1. lone of the-applications needing a quota number. The quota number assigned to this application is 0 for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. Elfor 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. L for an application on file prior to February 1, 1980. ~0 7 9 Ufor 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: RECEIV&Q (Aa failing conventional soil absorption system. ~L C la holding tank that was installed and in use prior to February 1, 1980. P v 0a privy that was installed and in use prior to February 1, 19800 PLUMBING f3URE If this is a REPLACEMENT SYSTEM USE and the Jot meets the criteria for a conventional private sewage system, check here. 0 I certify that the above information'is true and accurate to the best of my knowledge. 00, Name Thomas C. Nelson Si oun y Official Title -Assistant Zoning Administrator Date August 18. 1986 OILHR-5804158 (R 12/82) DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDING: INDUSTRY, P.O. BOX 7981 DI V ISIOhLABOR AND PERCOLATION TE TS (115) MADISON, WI 63701 HUMAN RELATIONS (H63.090) b Chapter 14 045) LOC / NCR Aor) w W S P/ TY: OT NO.49LK : N0.:jSUSOIVJStON ME: m2 C.,*c it id 1L DATES OBSERVATIONS MADE MResidana ONew CAeplaa RATING: On Site suitable for system U- Site unsuitable for system 3U a S camme: YSTE 1""' 70 - 1 TANK: RECOMMENDED SYSTEM-(optional) CIS U F Percolation Tests are NOT required 1 N R T If any portion of the tested area is in the nder s.H63.09(5)(b), 14o te. iFloodplain, indicate FI oodplain elevation: PROFILE DESCRIPTIONS BORING TEXTURE. law. ormpywy IL AN DEPTH NUMBER ELEVATION AT - I K IF OBSERVED SEE ABBRV, ON BACK s ~D9o 3 a o P 761 & Z So 00 a .eels & ~t~CE1VED e- r PERCOLATION TESTS PtUMBING BUREAU NUMBER NC11f AFTE SW LLIN INTERVAL-MIN. PER INCH P. Y -8 2 P- P P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate sale or distance the hori- wntol and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borin ,tlfe dir~m g rosnt of land slope. SYSTEM ELEVATION -w-~ to -A 0 11'0 t , crl f° t J t ..,r _.i . i 10 J f Q P 1, the undersigned, hereby certify that the soil tests reported on this form wan merle 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 we correct to the best of my knowledge and belief. NAME (print)* TESTS WERE COMPLETED N: ADORE Q CERTIFICATION NUMBER: PHONE NUMBER optional : a CSTSIGN . DISTRIWTION: Original and one copy to Local Authority, Property Owner and Soil Tester. t"iLHR490- m (R. 02102) - OVER - • ~ e~'`y ~ 1 N5 P'EC'T ~ o Co'~E Ca MPt~\1\~C~ r ~r►~C fllSls~'~pl• ` IiSeoogAl. U.S 40 G L ~MB~NG p 1100, MA PA,t4N~ ► Y; ~ pNA ~p1 Soo bA 1, ,~N~ OF SAF AAA w► PG° ~ ~ _ c:tyc:, -tor di vmoA its -Sir- It P PE 9.9 0 boo L04 51 z L 80 Ae * # % ~ 11 8.1 14 ------3 03' ~ , to 4rnm•a ~t 1 RECEIVED PLUMBING BUREAU OPTIONAL WORKSHEET L MOUND SYSTEM 11. IN•GROUNO PRESSURE SYSTEMtendmwd- 1. Wuwwawr Load. Teal DAY Flow Il on fd• ~ 10. Fop MAIN: We a. ILUR 83.15 (3) (c) mhowtsm Deslot Raft• ~s Ada. CsM amd PROVIDE A DETAILED Dloaew • LIST Of SIZING~ON FLAN:. ~ ,Sb 11. Tpgll Dymaak NOW: 7. God! to L101ft Facwr • - h. Swtk Need • ?.f S Lift 4. Distance 000S .00111 CAantbw le frkRloss Loan • S Ok+telYstNoir>l • fL TO" • z. S S. Ele'sUM DINWOM a.ewM 70 1!. Fwp Seloalon: hasp and Dknlbudas Straw • 11L will disc I ae Lit vat dvo L , AbwPdam Ana SWsst: oo a►it .L+Z~.h. aal axle Ma/. Cie 1[ Asua RepMN N. tL PwmP nodd +W Sled w Us* Lem* (N) • tL ~I J =a Sol of Trow* Width (A) • ft 13. Dew Volume: TWA soom t ic) • h. 10 Times Veld V0IW" et i t. meow INtwls S Dkerlbudoss Lksea■ sw DapeA.(p) • R Daffy Wadewaw vokin e FIN Opp* OewigleFe (E) • tL X000 N 34 hrs. • i NN or TEA DiNA (f) • h: Nackflsw • i Car and Too"N Dopth (G) • .40 gy h MMlmwmm Dew • i Cap And TePwN Dyd: (II) ■ IL 14: Dow Chaaben L Mound LuOu Vekmne ` i cow a" (K) ToW noww one* (L) • IL IIL CONVENTIONAL PRIVATE SEWAGE SYSTEM „ - 0. MewW WkW r' 1. Wn"wow Lead. TWO Dd1v flow • . USRoPa twraieelom Faeear ■ • me s. I7~tIt 83.15 (3) (o) Nis. Uptlo/e Width 11) • h. Ada. Cede we PROVIDE DETAI d Dewndele Caned F=W • LIST Of SIZING ON FLANS. , . DewMle►e WideA (1) • . ,h. 2. RNWnd Seek TS1k CIPAft • i Total Mound WWdi (W) • h • 3. ►waladee Raw • w 10. &W Arm 4. Absorod m Ana SAdmet iftow"M cam* of. Peter to Table Z is n= 83 Hawn! SAN • ad./N.h./ut► wd PROVIDE A DETAILS OF Bud Ana Rpuhed ■ N. h. SIZING ON PLANS. `LL213 N• h RukedAn -pug AnAnhift• • ' , eM g h i 1 It Standard Tames ham Chapw ILM 3 P Lenith "h &W-lased, Indicate Table • `width • for de Dkwftden Nnwok, Use Numbers S•14 In Secdem 11. Num:bw et T • Trench h IL IN•GROUNDPRESSURE•;YSTEM• S. D Isis no 1. Depds to Lbd t Faew • La ` h Laoddepe'• N bw of Lawak • .~.r.~ ' 3. lweeladed Raw • ~607 tercel SPadn • • ..>M 4. ►tepon A Syswmr Ithwolon • ft ' Distama fnim SidewaN 1e ►4a ■ M f. WtWawr LAIPAD1 S 1135p (e) , 1i S. ~ Sriwm: ENwden ~ M Ada. Cede amdPROVIDE A DETAILED SYSTEM4N-FILL LIST OF SIZING ON'►LANS. FIN In AN lame from: SeedN 111 _~11 It o"I fpekTook CaPadty ■ 00 tai. 515TH rje 0O40 SA L Abserrdoo Mw Skko V. SEPTIC TANK Pereekdom Rata • o m m qm 1. Capacity Ana Rooked • sq. h. 3. Ma Wutun" Syswa Lemt* ■ ~ ft 3. Show Site Cemdmewd Tank Dowps on Plan Syswa width ■ d~ ft. 7. Ohplbudm Min SkhW VI. DOSING TANK Hole Star • in. 1. Capadty • . AV IINtSPodmll h. Matwfacswon LAS" Lo will • II. ►urop Mamura iurw: Lawral.Siae • kt 4. =811=j. I.awal Simclmsl ~ p. S. Did~ Goa SWMA am Fyw t►t w Rases. N. DWribulloorle DkdmW Rant T. Show SUM CenequeW.To* DeuNsem.M m Nuabw of Im" M 1 low Per lope • VII. 1 Wt.U1NG.1 ANK'' Ir., Mawom S~ •_1~,.. Capadly ` Type (maw «emd) - G .SURE AV 7t ,Matwtacs Tank Oatailaem Mara oteim.w • B lie: 3. • Si WSW ALL INFORMATION ON PLUS- $90061 (0.+am Strew. Marsh Nay,, dr Synthetic Coverins Distribution Pipe Medium Send e TOP*" p E % Slope Bed Of = 2 Force iMein plowed Aggregate IoW D ~ Ft. E L - Ft. Cross Section Of A Mound System Using F Ft. A Bed For The Absorption Area 6 Ft. A Ft. N Signed, Ft. B S4 Ft. License Number : • 3A K /..R Ft. L An Ft. Date: J~• /D ' j :16 Ft. I Ft. 860 7599 WL Ft. L 77- Observation Pipe-~ K -7 -7 F INK nl . c ,;e' r r - 2 Lp Bed 01 Aggregate bservation Pipe Permanent Markers S E P .2 a 1986 Plan View,Of Mound Using A Bed For The Absorption AN"Ne MOON. Ptffofetod Pipe Detail `tg V+.n! EM 6y pWfa~~~o PVC Pipe f41M 4oNIM N Mtn d w tame aPS~ • A f d moo 8 6 0 7 5 9 9 ua MM. Mould Go oand C" w s.r o ?"kwon P" 1.aNeVt p X 3& Inches Y AVOL finches $tgrAd: WO oil Inch Latorel Inch(a) License Idnlli ffig"O 2z Manifold. Inches Oa to : D ' c Force Nis 1 n " Z _ Inches p~~M81Na 0 of holes/p1pa-0. fh F atL°''~~ rt Elevation of La ~F ~o 4trslt t. In 1` "56.k I V' V J w"VED 7~ R,N , S E P 2 31986 PLUMB" 39CTM PAG1: CF PUMP CHAMBER CROSS SECTIOM AUD SPECIFICATIONS VEMT CAP y"C.Z. VEIJT PIPC WCATNCK PROOF APPROVCD LOCKING JUUCTION BOX MANHOLE COVER ASS FROM DOOR. It"MIU. u~ h~~,n~rg ~.wbE( WIWDOw OR FR:CSM I AIR IUTAKC. GRADE ( y"MIN. IB" hIIU. CONDUIT-- s PROVIDE I - IMLE:T AIRTIGHT UAL i i I I 1:y . ~ J/ 7 APPROVED JauT A APPROY&D 6M w/c.%. PIPE I I I w/C.r. PIPE EXTCUDIN6 3' II ALARM EXT uDImG OUTO SOLID $011. B i' ONTO SOLID oo P%r a- . 45 9 1.9 C Q a ~P LLCM fT PUMP 0 NG BUREAU cONCRcTE B `F PUSCR EXIT PERAIVED OAJLV' IF TAUK MAUUFAC~ LI~~ PAPPROVAL, FQ ~ SEPTIC # _ S PE C I F I'GAT`I OAl3 00ic ER OF DOTES: PER OA11' yAUKS #%"UFACTURCR. 6! TANK SIZC:.6 LLOW$ DOSE VOLUME 1 MMJYFACTURCR: INCLUDING, GACKFLOW: C20/0 GALLO A0091. UUMtlCR: CAPACITIES: A ■ MICNU OR O SWITCH T1r1!E: ~'1 1~ a ■ IMCWCS oR PUMP MAMUIMACTURCR: 6~ Motii c IUtims OR ap 440 GALLO MODEL UuMecR: Z Do A' INCNis OR"wr~ OALLO OWITc11 TIJPE: MOTE: PUTAP AND ALARM ARE TO BE * 1 49, go go MIEIIMUM DI=CHAR" RATE GPM INSTALLED OW bEPARATE CIRCUITs VERTICAL DIFFEREMCE BETWCCN PUMP OFF AUO DISTRISUTIOU P1PC.. 7 FEET + MINIKUM NETWORK SUPPLU PRESSURE t= FILET Z 2 2 9` ~ + -O SECT OF EORCC MAIM x 4&_f o KFlKIeT1Ou WT0R...11.- FEET TOTAL Oy1JAMlt. HEAD : L117- FEET IUTCRUAL DIMIL ONS OF TANKS LEM&TH ;WIDTH ..;LIQUID OEFTM 3 ..r • . Jm ~ ~~SL moo. >;uau ENS,e I►><JnsElt. a►'TE. P Submersible erforman ce Effluent Curves Pumps 00 MODEL 3885 SIZE'/ Solid so o ro ~o s till% a PuVA P Q0 0 ,o 'o k o0 0o TO w 00 100 110, 120 GPM [qGOULDS PUMPS, INC sau rw~ raw ~aAC ow ~toa ~ ISO MODEL 3885 SIZE W Solid ~o .o , ~a o0 ~o N --T ~o. a0 ~o - . a 0 0 .0 V w 90 .40 00 so 70 so 0o too I" =am o oo IBM" t H z N H a STC - 105 r r a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z Cl _I a OWNER/BUYER 1~1 r ~T 14-5c~~ M ROUTE/BOX NUMBER ►ry► 9-,,44d, b (A) Fire Number .CITY/STATE &v, C.". rl- Id tn9 ZIP PROPERTY LOCATION: NFi- it, G It, Section T-3o N, R -W, Town of 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 pdt 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. H I/WE, the undersigned, have read the above requirements and agree to to maintain the private sewage disposal system in accordance with x 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 4 A44VVjP,,A DATE J~O 6'6 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. s to of Wisconsin \ Department of Industry, Labor and Human Relations p. a " € 7 SAFETY & BUILDINGS DIVISION of 'Phrllirr, C.'y Fes' Vast irctcr Avenue 80, Fe x(. 19 Q I e' r. t:r°v r Crcral , 1'I F eti ti cr i G, Ec :tr !,r. daCcn 1 Fe: 1,'Gcvvir 1`apen - FEE?Si c..erce Private SEya4eE: Sysct(+- 'Tcwr* of Fi-rar al (l , St. C rm! C ourty, 1v I t Sect41or., 14 sconsiP St+,tutc5, , r(, Viscursir, Ar,'rir istra.tivc food, 01nv, Uv cs rpcr to rctitior tic ('rrixtrtEll..t for P. vFriance to, ti,°c irstaliatticr% "t(:'r r riv t'-: su%(£' t( rc i ;cc, nr (xisting private 5f')t'ace sy ter at t sit,- 4; Ack is rot ir"` full c(('xIiwnce vith 1-Jic sitirr s to I)e.a rdS ir> the e? er . i n i,: t re t i vc rule. !i' C S; A':,-tC.F: f esi(.n 6'Y`C3i`()SF`c stiouie protect tfh .-Ttcr of t:i e Sf'e?tE' i'ra, CC:ra.T,.,irii e"tic . 1i t'hiS syster). k ecorrres a f: i i t,Ca StCI ckr CC r tar i r at(s ti:( uc trrr of Vf,e Stiate, t°iA S variance Shell he The pet.iticr fer a v arimi.ce r questc( to s. 11Li ' C: .c.': ! r,f fl:( Vis. Adyl. C oft v4-.s (.cr-si('r rc ' rr Cctot,er 4., 1!('(;. ae F' rp.. *i Cor'sd ti oral l y &.PT rrv('(". T Y3c ccne.It.i cr f>(i nc ti at i l t!'( cv.rt of fa.fl vre, tfwe 'round sys tcrr i:( vji W z fIII (i r , t pr" cr oi t,cr ' C;i'i -I C is f,,~,Stem. The rule rE (yV F rC';r that r"cur('' s~ s lw h avr- is r i I^ir'E_r; c ~ "t 9 r;Ci'` r. f e;r. i ta.~ ~Fa Tk. variance rL:Clrestr'(` w:a,,; to irstoi1 C tf'r1aCCr,,C-nf. r,!Cune systvu on a Sitc r i tk. i s i t)c, c`s of si,i tf-0 1( r att r l so- All ct tP-.c d& t+.:: * t,'( S t U a:.s'(?E r'tC sul r.~I tte, f°rI ('f i,c ( rc-ti t'i crier vcrf CCr's i(ercc. P"As ver' eo u is q'('cific t( t.:.t_; v„~ ~;((t pctitic>ra arc Cannot h us(! 'r:cr` c.ny b(`c",itiCr' rat r C4 7 fi(e=;t"i(riS. ' t ie V. FetcP wcr°?, Active 0 iefi" ^C ti cr. Ci` Pritfe~t:C_' SEvccC. JHP:PFP:4Ca2t .e4*e, t 4t. fitPt ) trira, 4i? e a Felix Stu'l , P t u't. f er DILHR-SBD-6423 (N. 04/81) ST. CROIX COUNTY WISCONSIN ' ZONING OFFICE x ' 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 August 18, 1986 Division of Safety and Building Bureau of Plumbing P. 0. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Marvin Hagen property, located at the NE1/4 of the NE1/4 of Section 9, T30N-R16W, Town of Emerald, St. Croix County, revealed suitable soils at a depth of 1.50 feet, 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, Si q Thomas C. / Nelson Assistant Zoning Administrator TCN/mj 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 RX: NEk4 NE ;4 S 9 T 30 N/R 16 XR(W)W Emerald St. Croix Street Address: Subdivision: County: Landowners Name: Mailing Address: Marvin Hagen Rt. 1, Emerald, WI 54012 I (We), 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: WISCONSIN DEPARTMENT OF INDUSTRY, LABOR AND HUMAN RELATIONS DIVISION OF SAFETY & BUILDINGS, BUREAU OF PLUMBING P.O. BOX 79699 MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. Croix Location NE 1/4, NE 1/4, Sec. 9 T 3o N, R 16 xkxj2 ; W Town 0ffJ* P5Nf4 t Emerald Street Address Lot No. Block Subdivision Landowner's Name: Marvin Hagen The application for this site is for: ❑ new construction use. replacement system use. If this is NEW CONSTRUCTION USE, the alternative private sewage system is: 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 n_5mTers-issueTfo you.) l one of the applications needing a quota number. The quota number assigned to this application is - - for one additional homesite on a farm to be occupied by 'a parent, child, grandchild, sibling, niece, nephew, or first cousin. F.1for 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. 1J for an application on file prior to February 1, 1980. L]for 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: [4a failing conventional soil absorption system. U 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 .0 I certify that the above information is true and accurate to the best of my knowledge. Name Thomas C. Nelson Si re (County Official) Title Assistant Zoning Administrator Date August 18. 1986 DILHR-SBD-6158 (R 12/82)