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HomeMy WebLinkAbout020-1164-20-000 St. Croix County Zoning Monday, December 13, 2004 x14:31:16 PM Detail Sanitary Information Page 1 of I Computer 020-1164-20-M SubfPlat: Edgewood Estates Section: 7 Parcel 07.29.19.967 Lot: 37,38&39 TNIRNG: T29N R19W Municipality: Hudson Township CSM: 1/4114: SW 1/4 NW 1/4 Owner: Houman, Tom 322 Edgewood Drive Hudson, WI 54016 State Permit: 88408 Issued: 10/17/1986 POWTS Dispersal: Non-Pressurized In-ground Permit: New County Permit: 0 Installed: 11/25/1986 POWTS Detail: Bed (seepage) Bedrooms: 3 WI Fund: POWTS Pretreatment: Unknown Notes Inspector As Built Plumber Other Requirements Additional Notes Money Owed Tom Nelson Yes Zappa, Gary $0.00 Signed Off: Yes Maintenance Scheduled Pumo Date Pumped 1st Notification 2nd Notification 3rd Notification 6/25/2005 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Parcel 020-1164-20-000 12/13/2004 04:26 PM PAGE 1 OF 1 Alt. Parcel 07.29.19.967-969 020 - TOWN OF HUDSON Current 0 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner JEFFREY S ROSENOW ROSENOW, JEFFREY S 322 EDGEWOOD DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 322 EDGEWOOD DR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.016 Plat: 1929-EDGEWOOD ESTATES SEC 7 T29N R19W EDGEWOOD ESTATES LOTS Block/Condo Bldg: LOT 37 37, 38, & 39 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 12/14/1998 593684 1386/462 WD 07/23/1997 756/521 07/23/1997 723/353 2004 SUMMARY Bill Fair Market Value: Assessed with: 49032 219,000 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.016 32,300 137,100 169,400 NO Totals for 2004: General Property 1.016 32,300 137,100 169,400 Woodland 0.000 0 0 Totals for 2003: General Property 1.016 32,300 137,100 169,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 129 Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSMENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 Fo rm - S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SEC. T N-R19-W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT 3~-.~- ?9 LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~Ro/~~RTY ~ ~tiE ~g S6' sy G 3~ , /~fSloEticE L,i~c~ n ~RvPos~0 AAE L2)vE~Ay 5©urN ` AeL)PCjrry 4 JAje INDICATE NORTH ROW BENCHMARK: Describe the vertical reference point used /':ze- j ) '0JJpE Elevation of vertical reference point: ,CEO' Proposed slope at site: SEPTIC TANK: Manufacturer: G jjE_,5 ~ Liquid Capacity: /(>DO a,,Eg Number of rings used: Tank manhole~'cover elevation: Tank Inlet Elevation: , 9Y Tank Outlet Elevation: 99. V:5" Number of feet from nearest Road: Front,O Side, Rear, 0 ` feet From nearest property line Front ,O Side, Rear, O~ feet Number of feet from: well 1 building: /3' T" (Include this information of the above plot plan)( 2 reference dimensions to septic tank) a' RF.F. RRVF.RRF. gTnR s t .j PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: IS, Q O ~ Trench Number of Lines: 3 Area Built 11 4. ' Length: Width: IT Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side,(?Irear,0 Pt. Number of feet from well: Number of feet from building: (Include distances on plot plan). SEEPAGE PIT Size: 46mber 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 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: Inspector: Dated: 4~.CS~O Plumber on job: License Number : 8 ~ 3/84:mj DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR LABOR & HUMAN RELATIONS SAFETY & BUILDINGS P.O. BOX 1969 PRIVATE SEWAGE SYSTEMS DIVISION MADISON, WI 53707 BUREAU OF PLUMBING MCONVENTIONAL ❑ALTERNATIVE is Plan J.D. Number: ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound )Ir assigned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION D T Thomas Houman 730 9th St., Hudson, WI 54016 ` ~,j''f BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELF, V.: SW NW9 Section 7, T29N-R19W, Twn. of Hudson, Lots 37-38-39,Edg. Est Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Gary Zappa 3300 St. Croix 88408 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQU9 CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LAB LOCKING COVER 99-$G qq 5.y P OVI D PROVIDED BEDDING: VENT YES ❑NO DYES VENT MA L.: HIGH WA NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT O FRESH C ALARM FEET FROM Q LINE AIR INLET DYES NO DYES NO NEAREST v 2 (is 7 /j/ DOSING CH ER: MANUFACTUR R: BEDDING. LIQUID CAPACITY: PUMP MODEL. PUMP/SIPHON MANUFACTURER: ' WARNING LABEL LOCKING COVER DYES ❑NO PROVIDED: PROVIDED: GALLONS PER CYCLE. PUMP AND CONTROLSO ERATIONAL: ❑ YES ❑ NO ❑ YES D NO (DIFFERENCE BETWEEN NUMBER OF PROPERTY WELL BUILDING V N To RE FEET FROM LINE AIR INLET: PUMP ON AND OFF) DYES ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I L- 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: NO.OF DISTR. PIPE SPACING: OV R NSIOE DIA ft PITS LIQUID DIMENSIONS I ~j SIG TREN^HES: M TERIAL: PIT DEPTH f GRAVE L H ILL DEPTH DISTR. PIPE DISTR. PIPE ISTR. PIPE MA ERIAL: NO. D R. PIPES: BOVE COVER: ELEV INLET. ELEV. END NUMBER OF BELOW PROPERTY WELL: BUILDING: V NT TO FRESH . r (y S• , ~g,98 7 $r 2'~ I~ S PIPES. FEET FROM LINE.~G T AIR INLET 1 NEAREST SVC 2 $ t 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- DYES ONO meets the criteria for medium sand. TIONS MEASURED. IL C VER TEXTURE: 11EHMANIN T MARKERS: OBSERVATION WELLS DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DYES 1:1 NO ❑ YES ❑ NO CENTER. DEPTH OF TOPSOIL: SODDED. SEEDE MULCHED EDGES: DYES ONO YES DNO DYES ONO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH: WO. -OF LATERAL SPACING GRAVEL DEPT L PIPE FILL DEPTH ABOVE COVER DIMENSIONS TRENCHES: MANIFOLD PUM MANIFOLD DISTR. PIPE MANIFOLD T IAL CIS DIST . PIPE DISTRIBUTION PIPE MATERIAL $ MARKING ELEVATION AND ELEV. ELEV.: CIA,: ELEV. PES DIA. DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING: DRILLED CORRECTLY OVER MAT R L. VERTICAL LIFT CORRESPONDS TO APPROVED PLANS: COMMENTS: DYES ❑NO DYES ❑NO ERMANENT MARKERS: OBSERVA ON WELLS: UMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: DYES ❑NO DYES ONO NEAREST Sketch System on Reverse Side. t ' in county file for audit. SIGN TI LE: A DI LHR SBD 6710 (R. 01 /82) J -///JL ~ILHR SANITARY PERMIT APPLICATION COUNTY 0✓J~ ~~••„Y ~R In accord with ILHR 83.05, Wis. Adm. Code 071 STATE SAA►NIITTA/RY PERM # -Attach complete plans (to the county copy only) for the system, on paper not less than P _j 8% X 11 inches in size. STATE PLAN I.D. NUMBER -See reverse side for instructions for completing this application. 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PETITION FOR VARIANCE ❑ YES ❑ NO PROPERTY OWNER PROPERTY LOCATION TtiG+~iJ'~ C• yC~.~s/~i Gy /j~(j(J,y,~,~ SW % ,vdJ,~4, S T Z N, R ~p E (or W PROPERTY O ~F~ W MAI G ADDRESS LOT NUMBER BLQCK NUMBER SUBDIVISION NA 770 , 37: 3P- 3t v,6,oruA" D T CITY, STATE ZIP CODE PHONE NUMBER CITY N AREST ROAD, v J0-! A/S sG Go7l VILLAGE: TOWN II. TYPE OF BUILDING OR USE SERVED: (Ja0 - &C-0 ~ /-v?C- 00 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.;~ New b. E1 Replacement c. ❑ Replacement of d- El 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. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In-Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. X See a e Bed b. ❑ See a e Trench c. ❑ Seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Miles per inch): QUIR E~ (Square Feet): 60 S (Sgare Feet): G~,l Feet Private ❑Joint El Public VI. TANK CAPACITY in allons Total # of Site INFORMATION Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. New xistin Gallons Tanks Concrete Tanks Tanks structed glass App. Septic Tank or Holdin Tank Y, Lift Pum Tank/Si hon Chamber I A/ ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/M~ PRA No.: Business Phone Number: Plumber's Address (Street, City, State, Codek Name of Designer: 25 ti04 ~D~d 53;00 VIII. SOIL TEST INFORMATION Certified Soil Tester (C T) Name ~4 ~V~ 70 6i4V f o - csr # 3 CST's AjDDRESS (S ee.t, City, State, Zip Code) T 3c~ S~ . /VQ ' ,,J 0Il Pho ~Numb~~ IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved S1,1111:13 Permit Fee Groundwater Date Issuing Agent Signature (No Stamps) Approved ❑ Owner Given Initial /O char a Fee Adverse Determination X. COMMENTS/REASONS FOR DISAPPROVAL: BD-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 w 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: 1. Property owner's name and mailing address. Provide the legal description where the system is to be installed; Il. Type of building or use served: If public is checked, indicate 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 8'/2 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 ball Ground ater - included the creation of surcharges (fees) for a number of regulated practices which Wisco in's buried reasure can effect groundwater. The surcharge took effect on July 1, 1984. All of the water tha is used in your building is returned to the groundwater through your soil absorpt'F)n ~l system or the disposal site used by your holding tank pumper. U The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitork-ig ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, - it's worth protecting. SBD-6398 (R.03/86) `"Ii',) STRYNT OF REPORT SOIL. BORINGS AND SAFETY & BUILDINGS I'~J;aUSTF?Y' DIVISION LABOR AND PERCOLATION TESTS 1115 P.O. BOX 7069 HUMAN ULATIONS MADISON, WI 53707 (1463.090) & Chapter 145.045) ILtlCA1 IOnJ: SECTI N: OW UNICIPALITY: lOT ]BILK NO. SUBOIVISII©N NAME: 'V+1 V4Nt4/I TZ9 N/R/b f o c p°,or; 4? 38 L. Irt(r r .tt COUNTY: W BUYEIR'S NAME: MAILING ADDRESS: S"P t(llx f Exc+4tE/lTtNb 836 57. C06 of r ; J1( I-(ta pS r ~,i` jC11(~ )SE DATES OBSERVATIONS MADE NO. B D MS : OM T DESCRIPTI-0-N-F) PROFILE DESCFTIPTIOffg7.MCOLATION S S: Residence UNK New ❑Replace ~ULy I,14 S ULy So ► t.s $aRS K - AaC 4 9 SO►« - ,'S$ JEw " 1AT1NG: S- Site suitable for system U- Site unsuitable for system 'OMEN : MOUND: -TI- N U I -FILL OLOiNG TANK: RECOMMENDED SYSTEM: loptiona ZS EIU S 1 S ❑U -1 [is oU ~S ~U If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.0915)(b), indicate: L 14'St T iFloodplain, indicate Floodplain elevation: / y A haft. Pr. PROFILE DESCRIPTIONS ;2tORIN TOTAL UUMBER DEPtHW. ELEVATION P R UNDWATER•IH IZUR AfiACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH N B ERV D TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B Sy s' qg,3 t tea E > ss o-ac- Rem L *6*. 0AA-1 Ro+QRK as. ,F 6* B Z 7-V 97.14 t46#46 > TZ, o-o-4'tt,4L t41t 4am ge$4 ccfG+k e- 3 7,7 99.4 Nomir ?7,7 ~ aoss' BR..Lt6~ o•g-7.7 Ru*te% c%46R B- 4 7,S /or v4 Nw4c ~ 7. S ~ d-2-o, Lr &it% S, L COL4Ge Gam ZO-4 4 R LS tGlt 4.0-r' B' 1B.0, a-t.3ir8RNS4 Calk t611k Cows 1.3-3.0 RdS*G 34-to 5t6R B- ' PERCOLATION TESTS EST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER QlAlMltS AFTERSWELLiNG iNT RVAL-MIN. t PER INCH P t , f, 'C I P- 2 4' blame > P- J. 7' ` < -Nalux P- P- P- - LO PLAN: Show locations of percolation tests, it borings and the dimensions of suitable soil recs. Indicate scale or distances, Describe what are th hori- rnta and vertical elevation reference points and sh their location on the plot plan. Show the urface elevation at all borings and the direction and rcent f la slope, NoTd ►Y fiEM ->~LEVA7I~N 48.0: -ro~If_ 11,4 1~Rr,N6 did sa c_ i FOP p 11 .r. 1`6 - T►Q14 N' 0 r V ! . • j ~ I A A r e 4 Z, I s t atr i elt4m I }.-.Aq-4 . f t _ e~ c o. a l_ k „ J.- 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 !ministrative Code, and that the dots recorded and the location of the tests are correct to the best of my knowledge and belief. ' 1ME print : TESTS WERE COMPLETED ON: W00Y JOHAISOn► duty /9fr~ )DR CERTIF CATION NUMBER: PHONE NUMBER (optional): 3 F t F'1" ~~t ~i 6 11{O~RT1V G l4 u , T40) 'ST SIGMA RE: STRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. LHR-SS"395 (R. 02/82) - OVER - , iNSTRUCTIONS FOR COMPLETING FORM 115 SBD - 63955 rr>t;lpl(?tai anr.I accurate soil test, your report must include: 1. Coiaapltrte lixlal description; 2. Tlw use (Ak)1) utat.r aoarty im(lii;ato whither this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or, rt t,ltacemeni writema; 15 1,0,, of 1, 1ho -mn .t)1i,t y ratim l N)es. A SITE iS SUITABLE FOR A HOLDING TANK ONLY IF ALI_ cat 111:1; Y`,tl i /!i1: HULI t)OUI BASED ON SOIL CONDITIONS; 6. PLl t:;F m.. 0. '0)1o' viatvals "114)6o licre for writinq profile descriptions and completing thep{ot plan; t. MAK! 1 F GIRI I' dimliam accrrratoly locating Your test locations, Drawing to scale is pretprred. A tif. IIkrI; 'W:, .Ir Itt rt !111 m'A"I if S. M•,t r sr yciin h v." l,mi,,rk 1,1111 ,,et t,cal elevation reference point are clearly shown, and are permanent, 9. t:: t<nl l ii, all at,lo r,1,i late boxi-s is to (Lites, names, addresses, flood plain data, percolation test exemp- L~,ut, 10, li ac, in , i,,i;n, ;.urt, n•, 1111c) d Itlaua, elevation) dots not apply, place N.A. in the,appiolniate box. !I. Su;!i 1111, Imi'l land ryas' yom isatr "nl address and your certification number; 12. Mal'(' le(libie c q%i'>s .31)c9 distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE " 1-0k,/ J At ! Lf01M Y 41117 LI IN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS soil S4;11iaeat4ts amcl feX111105 Other Symbols ,i Stoi-ie laver 10") BR - Bedrock cob - Cobble (3 - 10") SS - Sandstone qr Gravel (under 3") LS Limestone s - Sand HGW - High Groundwater C" 011il.,c Sand Pcrc Percolation Rate ow': Y ,`"14-?film Sand W Well F ime sand Bldr Building IL'i;,rrly Sand - Greater Than I.();aitI l Less Than °1 I..a raa Bn Blown sii .`.rill Loans BI Black ,:i ;ail,. Gy - Gray rl ;:lay I oam y Yellow .ci :7a-Ay Clay Loam R Red ,id Sdi.y Clay Lr>am, mot - Mottles SC Sanely Clay w/ - with siC Silly Clay fff - few, fine, faint c ("lay cc common, coarse p! Peat mm - Many, medium rYi Muck d - distinct p prominent HWL High water level, Six ctin~rra:;l sail te,xtllr+'s surface water fol hgkiid waste disposal BM - Bench Mark VRP Vertical Reference Point TO THE 01NNER This soil ti*t report is the first stop in securing a sanitary permit. The county or the Deparvnent•may request veWic..au:;14 o> dais !>w; test in the fii=td plior to permit issuance. A complete sr,t of plans for the piivati~ '4"Wldni'' /i'-r- .'"d ,a 1,01rn,t eapplicat~,,)n niust I'ae s1.iI"Ir1'1i11(,,,l to Ow appiopriat:e Ihcial andio,rty 1?-i ortier tr, (,t"i'1 f twit 'l t;E~')fltdii?!',d arid posted fluor: to the st,arl. (,)7 amy ra~ilSlr'U,"a!t)il. • H z N ' H • a STC - 105 r r a SEPTIC TANK MAINTENANCE AGREEMENT ►y-. St. Croix County z d a OWNER/BUYER 7`A,0M,9_5- (~Al Z r V,4A1 M ca ROUTS/BOX NUMBER~~ap rioj7d Fire Number .CITY/STATE /~~SD~[/. ZIPSLo/~ PROPERTY LOCATION:~h, 'All'i-3t, Section , T_j9 N. R_Lj_W. Town of Alll SW , St. Croix County, Subdivision ejjj,0,9tY 61 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. y 0 I/WE, the undersigned, have read the above requirements and agree z z to maintain the private sewage disposal system in accordance with x ,the standards set forth, herein, as set by the Wisconsin Depart- v ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Offipe within 30 days of the three year expiration date. SIGNED 7L,..- DATE_ 1D - ~3 -P 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. 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. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property ThomA- <(7-4. e jl2 ,e /y A. Al f a iZ Location of ~P/roperty ' 34, Section , T_N-RW Township /1IMS I Al Flailing Address '136 9~ Address of Site .4_U~nn~' ~G'AT Subdivision Name F~GIO%///~lId ~sTATG4 Lot Number Previous Owner of Property _ 2z&/// V- lqoL/gzll Total Size of Parcel Ldp X /fin 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 7 and Page Number fll as recorded with the Register of Deeds.. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warrant Deed which includes a Document number, volume and page number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION I (We) cent 6y that aty btatemenu on this 6onm are true to the best o6 my (our) knowyedge; that I (we) am (are) the owner (b) o6 the pnopenty deb cA ibed in this .in6o ma ti,on 6o4m, by vi tue o6 a wa4 an ty deed neconded in the 0 S 6ice o6 the County Reg-isten o6 Deeds aa. Document No. 41,e 464 and that I (We) pnea enty own the pnopobed b.tte bon the bewage diapoba,~.sybfe-m (on I (we) have obtained an eaaement, to nun with the above d6chibed pnopenty, bon the conatnucti.on o6 baid ,system, and the same ha6 een duty neconded in the 046ice o6 the County Reg.iateA o6 Deeds, aA Voeument No.~ g) , r' I . O aaaoov..~~~ =aaa J W10 (/,.vw SIGNATURE O1 OWNER SIGNATURE 0060-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED :a r 607` 7 Lo f 3 Y 0-/- 7 ; . V 19 , I SC.9/~ ~ ~K' ~30 ~ well ~ one Ile v A /,POP y • y _ _ as 1E X Sail 7,0,r, t B ,Pcf Pr 3 'r / of r VC~ Pf?r ~E SAG 100th 0 v Fresh Air Inlets And Observation Pipe _ i - Approved Vent Cap Minimum 12" Above Final G r a d e' ~i~0~/D S't17~i~✓/f~E`~? MoM IPA or „ Y 4" Cast Iron y ,AlRov.e Pipe - , Vent ripe <o Final Grade Synthetic Covering - Min; 2" Aggregate OL..e pe Distribution Tee Pipe 0 0 0 0 , ,t Aggregate o Perforated Pipe BeiRw Beneath Pipe o Coupling Terminating At Bottom P1 System