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032-2075-60-000
a l O O d o d 0 N C _ C w > > 3 ftlZ y m M (D 2) m o 00 0 0 ° j a O P. N 3 3 m z L N O CD O N ►e"{ `Al CD ID Cn CD =r \ N CL N 7C N O O in 0 -4 O W= N n m p V O O W N N O O p I .r O W lV © CD D O a CD D CD C N W (D O C a a = a v c CD .p _ -1 (D or, oo 3 O ` C) r-j O 0 c r. CO) 00 00 (n 0 r 3 3 -0 z 000 C0 3 o CA 0 m CD .31co w ~r vvv~ N G) CD 90 r w y ! O w rM r 3 o r rxC a o y r r tzl z co CL 1-d c, z z (D O D D o rt co H O O a H. 00 E CD oo _ 41 H W F- 3 p CD ,yH ~ p ~ A ` A rt A z O N ` I o (D G7 Cl) C" M A a Q Q a o z N o 3 N A z l 00" N 0 CD cy\ ~°zy ~~Q ~e N O D h 1, CD n a_ In 3 =r (D c En 0 ;Z. z CL cn (D (D H y` (D G7 y' a m fi N rt F- 0) ~ I v v a. oC :3 CD A Gj .3 a N a I 7 N O O 3 I ~ M O N aC b O ~ ~ W Parcel 032-2075-60-000 01/26/2006 02:36 PM PAGE 1 OF 2 Alt. Parcel 14.30.20.787D 032 - TOWN OF SOMERSET Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner DAVID R & ELAINE M SINN O - SINN, DAVID R & ELAINE M 163 ANDERSEN SC'T CP RD HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 0.580 Plat: N/A-NOT AVAILABLE SEC 14 T30N R20W PT GI-4 W 242' OF E 550' Block/Condo Bldg: LYING NLY OF A LN COM ON E LN GI-4 & CL SCOUT RD, TH S 621 FT TO POB TH W 550' & Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) ENDING & SLY OF A LN COM ON E LN GL 4 & 14-30N-20W CL RD TH S 441' TO POB; TH W 550' AND TERMINATING Notes: Parcel History: Date Doc # Vol/Page Type 06/17/2003 726237 2279/79 WD 06/17/2003 726236 2279/77 WD 1-06/11712003 726235 2970175 QC 03/13/2001 640280 1600/93 LC more... 2005 SUMMARY Bill Fair Market Value: Assessed with: 78124 11,600 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.580 9,300 0 9,300 NO Totals for 2005: General Property 0.580 9,300 0 9,300 Woodland 0.000 0 0 Totals for 2004: General Property 0.580 9,300 0 9,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Total Special Assessments Special Charges Delinquent Charges 0.00 0.00 0.00 i Parcel 032-2075-60-000 01/26/2006 02:36 PM PAGE 2OF2 Parcel History: cont. 03/13/2001 640279 1600/92 QC 0 5 3 n d c 8 3 A- •hl. ID (D m 3 3 ;w ° sm O m n o ~ co m C/) - oA° N• m CD C, SD CD ~ n 3 w CL CD C1i CD O N O O = N O V ~O N N o. j p co =1 x N O k - -4 N r'T 3 CO O O O n = N n m O v° O co cn 3 O j g L O m m w l C D m a CD t0 N N Q (D (.0 O W tD O O. (D C:) 0 I a - °'I 11 CL goo; CD N Go 00 n (n o c o o o a 0 _0 m 3 vi ai tin m y - lo- p O - y m m ~ ~ ~o 9o O w N N A O O_ w °w ` N \v A O o Z Z O N D D o o CD j 0 0' 0 a !H • m 7 ,O x lV'+ CD I c cn CD ~ N Z CD to ;o o A z 5' I G W O O W A M (D K Z CL 3 r O - o N o r' o N Z A A I a T m ~ I Z 7 o a co rn I m m I ~ 0 `D o I b CD n ~ m a I ~ m a I 3 ti o I ~ O ti ~ro ti fn a 0 a I C) L Parcel 032-2076-20-000 01/26/2006 02:42 PM PAGE 1 OF 2 Alt. Parcel 14.30.20.787J 032 - TOWN OF SOMERSET 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 DAVID R & ELAINE M SINN O - SINN, DAVID R & ELAINE M 163 ANDERSEN SC'T CP RD HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 163 ANDERSEN SCOUT RD SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 1.420 Plat: N/A-NOT AVAILABLE SEC 14 T30N R20W PT GI-4 W 242' OF E 550' Block/Condo Bldg: OF GL 4 LYING SLY OF R/W SCOUT CAMP RD & NORTH OF LN COM CL RD & E LN GI-4; S Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 44170 POB W 550'& THERE ENDING 14-30N-20W Notes: Parcel History: Date Doc # Vol/Page Type 06/17/2003 726237 2279/79 WD 06/17/2003 726236 2279/77 WD 06/17/2003 726235 2279/75 QC 03/13/2001 640280 1600/93 LC more 2005 SUMMARY Bill Fair Market Value: Assessed with: 78130 209,200 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.420 22,700 145,700 168,400 NO Totals for 2005: General Property 1.420 22,700 145,700 168,400 Woodland 0.000 0 0 Totals for 2004: General Property 1.420 22,700 145,700 168,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 145 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 r Parcel 032-2076-20-000 01/26/2006 02:42 PM PAGE 2OF2 Parcel History: cont. 03/13/2001 640279 1600/92 QC 747/326 727/414 r. Form-STC- 104 AS BUIL4 SANITARY SYSTEM REPORT OWNER a Y1Pm~l~f}~ V TOWNSHIP -,!s~0s,"Oh SEC. J T 90_N-Ra0 W ADDRESS ST. CROIX COUNTY, WISCONSIN A CD : I SUBDIVISION A> LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•IHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~~ll c a►' VT t ~i 4 ,m cc INDICATE NORTH ARROW Ji BENCHMARK: Describe the vertical reference point used S. U-) ht~~ S Elevation of vertical reference point: )801 Proposed slope at site: O -2- SEPTIC TANK: Manufacturer: W u°_ _s Liquid Capacity: ( 511 1 Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: J~~ S O'- Tank Outlet Elevation: Number of feet from nearest Road: Front, Side,0 Rear, O (Q ~j feet From nearest property line Front,O Side, Rear, O (p feet Number of feet from: well building: ` C (Include this information of the above plot plan)( 2 reference dimensions to septic tank) RF.F. RRURRgR gTnV PUMP CHAMBER Manufacturer: Liquid Capacity: g©© S-99'~ ' Pump Model: W 831/ 4- Pump/Siphon manufacturer: ( o p Pump Size il' i6 Bottom of tank elevation: / Elevation of inlet:S ~7 ~ z Z Pump off switch elevation: a Gallons per cycle: Alarm Manufacturer: 41q-yl Alarm Switch Type: Number of feet from nearest property line: Front, Q Side, aRear,0 Ft._~,Z. Number of feet from well: c7 C9 14- Number of feet from building: 1 3 f (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: 4 Trench: Width: Lenth: (p Number of Lines: Area Built: -~-Cq O Fill depth to top of pipe: Number of feet from nearest property line: Front, O Side, O Rear, Vt. Number of feet from well: So 4 Number of feet from building: ~s (Include distances on plot plan). SEEPAGE PIT Size: Num of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area B t: Has e' er 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 rin used: Elevation of bottom of tank: Elevatio of inlet: Num r 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, INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 796,9 BUREAU OF PLUMBING MADISON, WI 53707 ❑CONVENTIONAL MALTERNATIVE State Plan I.D. Number: Holding Tank El In-Ground Pressure TN Mound (If assigned) NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPE TION DATE: Thomas Hyde Rt. 1, St. Joseph, WI 54082 ~g BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. SW NE, Section 14, T30N-R20W, Town of St. Joseph Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Gary Steel 3254 St. Croix 88410 SEPTIC TANK/HOLDING TANK: MANUFACTURER: ILIQUIO CAPACITY: TANK INLET ELEV TANK OUTLET EV.: WARNING LABEL LOCKING COVER G~/ q r PROVIDED: PROVDED GJ / v / OYES ❑NO DYES ONO BEDDING: VENT DIA.: VENT MATE.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH (f ALARM: FEET FR LINE. AIR INLET DYES MNO l C DYES LONO NEARESTM X~O 9 lps 7 r ~y~ DOSING CHAMBER: MANUFACTURER . =INGS LIQUID CAPACITY: PUMP MODEL. PUMP/SIPHON MANUF CTURER. WARNING LABEL LOCKING COVER PROVIDED: PROVIDED 'Wry O Soo ()31 1 L l? QTYES ❑NO DYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONA L: NUMBER OF PROPERTY WELL BUILDING. JVENT LE FR ESH (DIFFERENCE BETWEEN FEET FROM LI"% ~ AIR jj~r' PUMP ON AND OFF) 1~c .G LJYES ❑NO NEAREST CO f Y ;GI f SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE / 0 / the soil is dry enough to continue.) MAIN `Y CONVENTIONAL SYSTEM: BED/TRENCH WIDTH LENGTH NF JDISTR. PIPE SPACING COVER FINSIDI DIA uPITS LIQUID TRENCHES. MATERIAL: PIT DEPTH. DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY =WELL G: VENT TO FRESH BELOW PIPES. ABOVE COVER. ELEV. INLET ELEV. END: PIPES FEET FROM L : LINE: AIR INLET. NEAREST------p. 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- ,ffi~ttYES ONO meets the criteria for medium sand. TIONS MEASURED. LtJ SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WELLS 19YES ❑NO LJYES ❑NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTH OF TOPSOIL SODDED. SEEDED MULCHED. CENTER: / EDGES / r DYES C~YNO QYES ❑NO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH (TO. OF LATERAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER 9 S6 TRENCHES DIMENSIONS - MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATE AC's MARKING ELEVATION AND~~ E .~(t D1 eL~b PIPES / DIA DISTRIBUTION 7" (O OC INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED I~ PLANS YES ❑NO ES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELL S: NUMBER OF PROPERTY WELL Bul~ FEET FROM LIN~~ / YES ❑NO YL6JYES ❑ NO NEAREST T Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE:y TITLE. DILHRSBD6710(R.01/82)~~'~°~ s°.,. DILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code ST S NITAR P IT # -Attach complete plans (to the county copy only) for the system, on not less than /D paper STATE PLAN I.D. NUMBER 8% x 11 inches in size. -See reverse side for instructions for completing this application. 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PETITION FOR VARIANCE ❑ YES XNO mr)~3065 YOWNER PROPERTY LOCATION i3 %4M %4, S T30, N, Rc2O A (or) W PROPERTY, OWNER'S MAILING ADDRE LOT NU BER BLOCK U BER SUBDIVI 10 NAME 704 ILIA !jaSj:Ejj E ZIP CODE PHONE NUMBER CITY EST ROAD, LAKE R LANDMARK i S O VILLAGE II. TYPE OF BUILDING OR USE SERVED- 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. &ew b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. E1 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. Iternative c. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e7tg-Vound f. ❑ IGP 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: (Min tes~pper inch): REQUIRED (Square Feet): PROPOSED (Square Feet): ,m cno .5Qci, zoo Feet ,Private ❑ Joint ❑ Public VI. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holding Tank Z00 112 46 ff-S ❑ ❑ ❑ ❑ ❑ Lift Pump Tank/Si hon Chamber ❑ ❑ ❑ ❑ ❑ -Le VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for install ion of the private sewage system shown on the attached plans. Pl~er's Name (Print): Plumber'3~~ r e: (Nops f;FMPRSW No.: Business Phone Number: 1.5)0 i46-6em PI ber's A ress (Street, ity, State, Zip Name of Designer: L-Ank V L SOIL TEST INFORMATION 5Cd Soil Tester (C T) N e CST # DDR SS (Stre , City, State, Zip Code) Phone Number: X04P r fh AUNTY/DEPARTMENT USE ONLY X ❑ Disapproved Sanitary Permit Fee Groundwater r5ate Issuing Agent Signature (No Stamp) Approved ❑ Owner Given Initial y~ r-cyharge Fee Adverse Determination ~ Or1S 62Q 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 R41FOR14ATION & 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 approyedby the permit issuing authority. Anew 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) lo 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 c~;: cerning yoor private sewage syste;: contact' your local code administrator Or the State of Wisconsin, Bureau of Plumbing, 608-266-3815. To be complete and accurate this sanitary permit app;icaf:ion must include. 1. Property owner's name and mailing address. Providc the legal description where the system is to be installed; 11. Type of building or use served: K public s cra eked, 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; 111. 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'/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 nego nation and public debate. The groundwater bill Groun&--ate- - included the creation of surcharges (lees) for a number of regulated practices which Wiscorkin's can effect groundwater. The surcharge took effect on July 1, 1984 All of the water that buried Treasure is used in your building is returned to the groundwater through your soil absorption system or the disposal site used oy your holding tank pumper. The monies collected through; these surcharges are c-edited to the groundwater fund adm'!nis tered by the :department of Natural F, ;so_ rces. These funds are used for monitoring o our g water, g:rwuedwater contaminatic-, it ,estigations and establishment of standards. GAround%,,a. o it's worth protecting. 5BD-6398 (8.03/86) NC 40/ 8rop382I RECEIVED JUL 1986 .,il'~j, aelit• toff InAust)r~y,gL~abor $ s~ AAA ~iro s ~.5~ . wv ~ ~"t7YJ~J~- ED A)&z4) /Joel STATE OF WISCONSIN DILHR ®ILHR > PRIVATE SEWAGE SYSTEMS BUREAU"OFPLe1NQ ~u1LD1"Q8 0000.... " 201 E. Washinaton Aveme Rm 141 PLAN APPROVAL APPLICATION P.O. Box 71169, Madison. WI 58707 eoe-zeaaeta INSTRUCTIONS: Please fill In all applicable dots and submit this form with plans. Plans will not be reviewed until all fees are received. The back side of this Win describes required plan information. Plumbing codes can be purchased from the Departm6nt of'Adminlstntion, Document Sales, 202 South Thornton Ave., Madison, Wisconsin 53703, Telephone (608) 266-3358. • INFORMATION PROJECT (Type print y Revision To Pion Number: ^ n 13 Name of bmitting Pony, ((Plena rltturr to sarne) Project Name Street "o or R Rg-RIOU Project Location - S d P N. or Local Dascriptbn • ~ I City or Villaaa State Zip Cis C 7 S rr~. r ty ❑ County ; u' • Village ❑ OF., c (l Town V s Telephone No, (include am code) 66/0 - 127.,Z2 Designer Telephone No. (include we$ code) Ow : elephons too. (Inclu& areo cocM) Street 6 No. Street i No. t~ City or Village Stote Zip City or VI lope S Zip 2. APPLICATION FOR: C% New Mound System (3a) 'droundwatet'Monitoring m Conventional System - Public Building (1) ❑ Replacement Mound (48) ; 4v,• G] Nolding Tank (2) w: Y ❑ Ftepdacament Pressurized Systerrl (4b). ❑ System in FIN (1► 3 0 Petition For Modification (9) ❑ New Pressurized System {3b) ❑ System in Flood Fringe (1) Other A{ternatiws (5) 3• FEE COMPUTATIONS (include existing tanks) 4. FEE SUBMITTED FOR OFFICE USE MAKE ALL CHECKS PAYABLE TO DILHR 3a. 750 • 1,500 gallon septic tank 50.00 4a. +'~OI OI>' 3b. 1,501 - 7,500 gallon septic tank;; - 60.00 4b. 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 -15,000 gallon septic tank -160.00 4e. 3f. Over 15,000 gallon septic tank -250.00 4f. ; 39. 500, r ~ 1 A00,9Wlon dose chamber - 30.00 49. U• e~ CE~ILFLL, A. 1,001 - 2,000 gallon dose chamber - 50.00 4h. JUC O 31. 2,W ji; - 4,000 gallon dose chamber - 70.00 4i. 3j. 4,001: 6,000,gallon.dose chamber - 90.00 4j. p: 3k. 8,001 - 12,000 gallon dose chamber -110.00 4k. UN1L.f/~1C 31. Over 12, 000 gallon dose chamber -160.00 41: J 3m. 100 5,000 vapor holding tank - 30.00 4M. LIVE 3n. 5,001 •10.000 gallon holding tank - 55.00 ; An. 3o. Over 10,000 gallon holding tank - 100.00 4o. 3p. Ret►i:ions 4~t 4 tu'.tk' 1. - 20.00 ~ fop. -f.Indoso, Labe i+•=--~- 3q. Groundwater Monitoring Per Lot - 32.00 4q itirziluor~~;i (other than a proposed subdivision) Subtotal - ~ ' O ~'''!i" - 3r. Priority plan review: walk through) 4r. Submittal of plans in person, "iaA1D by appointment, with double fee 3s. Petition for Variance 155~~ Setback - 25.00 4s. Site evaluation - 50.00 Total Fee Nos: Fen purwont to W4. Adm. Corti, Chapter Ind. M 01LIfR.SSD#7A$ (R« 03m) maw it* t.1Yla to ~ -OVER 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: TownshipXlXKXX4X1XVffi SW 34NN S 14 T 30 N/R 20 E(or)W Someu et St. Cnoix Street Address: Subdivision: County: Landowners Name: Mailing Address: Thomas Hyde Rt. 1, St. Jose h, W1 54082 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. 3 6 0 3 8 2 1 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. ~ 2 7~b RECEIVED ignature of Applica at STATE OF WISCONSIN "'0 J86 Subscribed and sworn to before me ss. JUl 0 7 COUNTY OF&1&1 PLUMBING EUREAU This-7 day of 19 ~Y A. sGGO No" PIS Notary Public, State of Wiscon p DILHR-SBD-6413 (N. 05481) My Commission Expires: -,p ST. CROIX COUNTY WISCONSIN a ZONING OFFICE 'r 798-2239 (HAMMOND) a. 425-8383 (RIVER FALLS) HAMMOND, WI 54015 June 26, 1986 Divizion o¢ Satiety and Building $3603821 Bureau o6 Ptumb.i.ng P. 0. Box 7969 Madizon, Wl 53707 Dean SiA: An on.6-c to inveatigation bon the Thomas Hyde pnopen ty, toeated at the SUN o6 the NE14 of Section 14, T30N-R20W, Town of Someuet, St. Cno.i.x County,neveated eu.c table .6oitA at a depth o6 3.75 tit., beeow which 4ea6ona.bte high ground water wa6 noted. This 4-i:te .6houtd be 6u,ctabte bon a mound .6y6tem. Should you have any quati.on6, ptea6e 6eet Jnee to contact thin o66 ice, eJc~P,ey'► Thomas C. Net zon A.64i6tant Zoning Adm.i.ni6tnaton TCN/mi RcCEWED ,1111 0 7',236 PLUMBI~~1~, ~ U,~~Av 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 an Alternative Private Sewage System In the County of St. Cnoix Location 4W 1/4, _ 1/4, Sec. 14 , T 30 N, R 20 XRX ,aka; W Town )OIK)"VOWPOMb;e( Someuet Street Address Lot No. Block , Subdivision Landowner's Name: Thomas Hude The application for this site is for: Onew construction use. B603821 0 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 num ers-'issueT o you.) lone of the applications needing a quota number. The quota number assigned to this application is 59 - 08 _7 . ❑ for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. E-.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. for an application on file prior to February 1, 1980. LIfor 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: RECEIVED Ela failing conventional soil absorption- system. ~986 ❑a holding tank that was installed and in use prior to FebruarjPLI' 149~UREH ~ ❑ 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 .El I certify that the above information is true and accurate to the best of my knowledge. Name Thomas C. Net6on Si re (County Official) Title A,44izt Ant Zog4M AdmLn tAatoh. Date June 26, 1986 DILHR-SOO.6158 (R 12/82) )US TRY, OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS ►USTRY, DIVISION 30R AND P.O. BOX 7969 MA RELATIONS PERCOLATION TESTS (115 (H63.090) & Chapter 145.045) MADISON, WI 53707 ( jTOWWS-HIP/L4WWtTFXMY. ILOT NO. M NO.: SUBDIV) 1 NAME: N1 4 E Y 4-1"3o N/R .wi (or) w t) .4...p. ljJt S IA)Jd 1.4 A2 ` DATES 013SERVATIONS MADE PTION] Residence KNew ❑Replace / 'ING: S= Site suitable for system U- Site unsuitable for system 0903 JVtc MOUND: 1,11 IN S -F LL OLDING TANK: RECOM ENDED SYSTEM:(optionatt ~J OY ❑J ❑S Q Im- avolation Tests are NOT required DESIG NE: If any portion of the tested area is in the er s.H63.09(51(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS e. R3 2gE 06 LING tTOTAL P R AT R•INCHE A ATE SOIL WI THI KNESS, COLOR, TEXTURE, AND DEPTH 16ER ELEVATION RV H TO BEDR CK IF OBSERVED SEE ABSRV. ON BACK I 4 N P, s ow 3 'Z Sri. ~a 49i'- z 10 f- !~P o?- 7$ 47,7,53 ~&I M o PERCOLATION TESTS MT DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES ABER AFTER SWELLING INTERVAL-MIN. PER INCH 20 F%\Iv N y 7 30 -JVO 2 3o Y 7/16 '7/ P ----Ion -tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- $hnw the surface elevation at all borings and the direction and percent v~ ~-ICO y~ NN( e 4~ 1 0 :5 goo 14 Ij v J ~ * C lJl I . 8 nr Jill a a ~-llti~j 11{-~i Y j~ Y OPTIONAL WORKSHEET 1. . MOUNQ SYSTEM 11. IN-GROUND PRESSURE SYSTEM- Continued-1. Wastewater Load, Total Dally Flows Sdd.LC.L. gal. 10. Fora Main: Use S. ILHR 83.15 (3) (c) Minimum Dodnii Rate • BMn• Adm. Code and PROVIDE A DETAILED Diamew • M. LIST OF SIZING ON PLANS. 75 11. Total Dynamic Head: 2. Depth to Limiting Factor ■ fL System Head ■ 2,~ h. 2.50 3. Landsiope ■ x Vertical Lilt ■ 33 ft, i;_3- 4. Distance from Doss Chamber to Friction Leis ■ ft.. '0% Distribution System • „(.(,L fL TON • fL Iu.4 S. Elevation Difference Between 12. Pump Selection: Pump and Distribution System • .~L`~ ft Pump will dledsarp at Mast 6 ~O'hl? also 6. Absorption Area Sizing: at --*7// 44 fL total dynamk head. Area Required ■ _.►.i~:L fL pump modern m~uuu/aetura►: o ~d Bed or Trench Length (B) ■ Js (a fL \.1 Bed or Trench Width (A) ■ 9 fL 13. Dote Volume: Trench Spacing (C) • IL 10 Times Void Volume of , 7. Mound Haight: Distribution Lbws ■ Fill Depth (D) Dally Wastewater Volume G. . PL Fill Depth Downslope (E) • fL . 10oses M 24 hrs. a ■ 54 Bed or Trench Depth (F) ■ fL $ 64 Backflow ■ a'.'0:L0'PA ga. Cap and Topsoil Depth (G) ■ ft. O 3 Minimum Dose a~0 tile. Cap and Topsoil Depth (H) • h.R6 14. Dose Chamber. g. Mound Length: '.J Volume ■ ~~f~j~ W. End Slope (K) • ft. Total Mound Length (L) ■ fL 111. CONVENTIONAL PRIVATE SEWAGE SYSTEM 9. Mound Width: y7 1. Wastewater Lead. Total Daily flow • Upslope Correction Factor ■ Use 0. ILHR 83.15 (3)(c), Wi s . Upslope width (1) • ft. Adm. Ce& and PROVIDE DETAILED Downslops Correction Factor ■ ~ LIST OF SIZING ON PLANS. Downslope Width (1) ■ ~v~ ■ fL 2. Required Septic Tank Capacity • gal. Total Mound Width (W) ■ .asLZ.,~ fL 3. Percolation Rate ■ 01n61111. 10. Basal Area: 4. Absorption Area Sizing: Infiltrative Capacity of Refer to Table 2 in ch. LHR 83 Natural Soil ■ Y pi,104.ftiday and PROVIDE A DETAILED TOP Basal Area Required ■ sq. ft SIZING ON PLANS. Basal Area Available ■ sq. fL Required Area • 194. fl. 1. It Standard Tables from Chapter ILHR 83 Length ■ fL are Mused, Indicate Table # width . a ft. 12. for the Distribution Network. Use Numbers S•14 M Section 11. Ep Number of Tre to • JI. IN-GROUND PRESSURE SYSTEM 7S Trench Spacl f. Distribution m: 1. Depth to Limiting Factor ■ ft. ";J") Lateral ength ■ ~ IL 2. Landibpe • • xislo u r of Laterals ■ 3. Percolation Rate • f./in. v O F N oral Spacing ■ 'K 4. Proposed System Elevation ■ ft. ~~h istanes from Sidswall to Pipe • In. S. Wastewater Load, Total Daily flow: ~ gal. \:)030111 1,VM System Elevation ■ fL Use s. ILHR 83.15 (3) (c) , Was. Adm. Code and PROVIDE A DETAILED IV. YSTEM-IN-FILL LIST OF SIZING ON'PLANS. Fill in All Items from Section 111 Required Septic Tank Capacity ■ 1 z~ pl. i. Absorption Area Siting: V. SEPTIC TANK Percolation Rate ■ min./in. 1. Capacity ■ W G P,*).5 ®^P ~ ~ . Area Required ■ sq. ft. 2. Manufacturer. System Length ■ ft. 3. Show Site Constructed Tank Details on Plan System Width • ft, 7. Distribution Pipe Sizing: ~ A VI. DOSING TANK Hole Sloe • / In. 1. Capacity • gal. Hole Spacing ■ ft. 2. Manufacturer*. 0191d Lateral Longlh • ft. 3. Pump Manufacturer: Lafcral Wn • 2 In. 4. Pump memlel: I.a1eral tip*0111 A. S. Operatins Head■ ft. Ukfance from shbwall401 Pipe Its. b. Flow Rafe ■ germ, x. Dibfribulfon Pipe Dkdt&W Rail: 7, Show Site Constructed Tank Details on Plans Number of Iirrles Per pipe 1 low Per pine Z~Z xpm. VII. IIUI.INNG TANK q; ManifaW SUInx: d 1. Capacity ■ pl, Type (center or aril) T 2. Manufacturen Length ■ ft. 3. rutted Tank Details on Plans Diameter ■ UL -SHOW ALL INFORMATION ON ►LANS- DILHR SRD7N (R.03te21 Page _ Of _ Straw, Marsh Hay, Or .Synthetic Covering Distribution Pipe Medium Sand N ~ Topsoil F 3 D .k . ape d 0f•. Force Main Plowed x- v~ ~'4E Aggre to Layer ;t 8603821 D A Ft. = Cross Section Of A Mound System Using E .Z~ Ft. A Bed For The Absorption Area F ~7 Ft. G ,oo Ft. A Ft. Hi.L Ft. Signed: B -5'(o .Ft. License Number: tea= K Ft. Date: G - Q L 74o Ft. RFCENE© Alternate Position J Ft. i~Bb of I Ft. ~U Force Main W eg 2 Ft. pj_0M ' Observation Pipe-, B K A I•---------------------- - W ~o ----------------------+I Force Main Distribution Bed Of 2 Pipe 2 z I Aggregate Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area . VLUM8jt4a Page Of _ 6 1E, ov ,0N ,T10S s li i GS Y r` I_F~Si, A !S F TY~'~l ~ppRTIJ~ ,I01 0V SA pp~lpE CE Perforated P~~p?e Detoi E COpRE ~n End View Per/aolea End Cop PVC Pipe d~s`~►t: Holes Located On Bottom, S Are Equally Spaced P PVC Fore* Me' 00 P PVC's Manifold Pipe Distribution Alternate Position Of Pipe Force Main Last Hole Should Nest To End End Cep Distribution Pipe Layout P Ft. S. X &4- Inchon y -3 (-_Inches Signed 1~--4 (2-- Hole Diameter Inch Lateral nZ"T Inch(es) License Number: ~jp . tty 3a S~_ Manifold .3 Inches Date: Force Main Inches # of holes/pipe Z'Y 5 O Invert Elevation of Laterals/29/ Ft. RECEIVED IUL07'N6 pal iVL11nG C?UREAU PAft LF • PUMP CHAMBER CROSS SECTION ANO SPECIF'ICATIOUS VEUT CAP Y"C.Z. VENT PIPC ~►c-rN`. ~l .l~l ~°'6"~``~ WEATHER PROOF APPROVED LOCKIM& Z5' FROM 00011. JUNCTIOIJ BOX MANHOLE COVER/ WINDOW OR FRESH IL'MIU. I ~Idl AIR INTAKE GRADE I _T_ I Y" MIIJ. Ie• rrla., ' COAIDUIT 1 MULCT PROVIDE tIRTI&NT $CAL 'kit APPROVED JOIAt'i' APPROVED JOINTS W/C.I. PIPE W/C.I. PIPE EXTENJDIW6 3' I I ALARM EXTENOIUb 3' ONTO SOLID SOIL s 1~`~4pN~ GZ $ nj't OAITO SOLID SOIL R~ E n o f 1 LLEV.92 PUMP orr ' D RE E! ED L CONCRETE BLOCK 1111_17'i'0)86 PLUMBING APPROVALREAU RISER EXIT PERMIWCD OIJLS IF TAUK MANUFACTURCR HAS SUCH SEPTIC _SPEGIFI'CATIOKIS OOSE• TAB K MAIJUFACTURER: IJUMSER OF DOSES: PER DAV TAWK SIZE: ALLOAIS DOSE VOLUME 41 et' IMCLUDINfi OACKFLOW: :22'Z' b f.ALLONS LAR MAIJUFACTURER; MODEL IJUMPiER: ~ CAPACITIES: A s 45- INCHES OR GALL0143 SWITCH TYPE: r \ 13 s5.INCNtS OR 2 "LLOUS PUMP MAIJUFAGTURCR: u G•1QIIJLNt3 OR 22 2- GALLONS MODEL NUMBER.. ~j uw T* 00 -Ll~m INCHES OR 227 GALLOUG SWITCH TWPt: &y^ IJOTE PURP AMD ALARM ARt TO BE MINIMUMI DISCHARGE RATE-,4Q1¢ 6IM INSTALLED OLI SEPARATE CIRCUITS QQ33 VERTICAL DIFFEREMCC BETWEEN PUMP OFF AND 0I3TRIbUT10N PIPE..tj,, FELT + MIAIIMUM NETWORK SUPPLY PRESSURE . 2-5 FLET 22 ♦ _ rEET Or FORCE MAIN X MFRICTIOU lwym.._0=15 FEET - TOTAL DVIJAMIC. HEAD : 1O q FEET IuT6R1JAL DIMC IONS OF TAIJK: belle =;WIDTH .;LIQUID DEPTH -e4La'o Q.~ to 31611a9Os L E NUMdER:.~.,~.3 DATE: ' 60 Performance Submersible Effluent Curves Pumps METERS FEET - go- 25 w MODEL 85 wE1sH 70 20 WE10H 60 1 WE07H 15 50 '40 10 30 $ /.r 2Q 5 Pu~P 0 0 0 10 20 30 40 50 80 70 80 90 100 110 120 GPM t 0 10 20 30 IWIh CAPACITY CeGOULDS PUMPS, INC .s" METERS FEET 120 MODEL 3885 35- 110 WERISHH SIZE 3/4" Solids 30 100 EjVVED 90 0 7 ,986 25- so jNG GUREAU 20 0 so WEOSHH 15 50 40 10- 30 1 -T 20 5 10 0 0 - -f+ ffF 0 10 20 30 40 50 80 70 80 90 100 110 120 GPM 1 , , 0 10 20 30IWIh CAPACITY 91M 0+0" Pumps, kw. EftWw Ady. ION State of Wisconsin ` Department of Industry, Labor and Human Relations PRIVATE t.4l~ll.ya PI-6N APPROVAL SAFETY & BUILDINGS DIVISION f.?. 69 M•;$t '.1 0; t W t_li r s t. i't / -r { {~P:... 4rJ .i f..~fil 21Ea 0: I <.3 t3 NOIxIH ,jIPOK, 0Ki,V f- fit,,}•iv('(i 1,i NEW iAj A. Q1 I C. }'Drz 1r+ ~')t , I'ieive been Y,~V IE;C't x~ Psi)" i P't~ti? (,7 i+ l mTll 1'' 74,4 j;) 1 k~ l 1 4 f t r n j iC t X- yy S 4. Vi'ir7Pl:d (7 C_ e wit 44 1, tfI!,) fir ,tbj .E i.i a<"~!)rcty.-4 d. {s bbl ..J~ ..(lt`31)(. f`•Fr" ( (ItIsJ'i 1 1tut "inn ~lI ! III LVe' i a i;Fm l,.ilt r. yCi ill f - , S rI (b t r (Il s'! P d ri 1r j rvt Ii} kl r uflip I Irli e w1, 1"h bo c'+,ys~•r t .;1 it I R p,,~ o)I I, r'(@L~U I 'v.1 t; i Cie' t t>4!t""i *r S{I 1 b CkP1t 133 t.Fi^i }rdY:I.f,?t t.i) t.S-Irw:tJ Pi4 'I 1t'en SiLd u s.th4,?` 7 .IP:)I k'. for H.11..> insr,,tP P<tE;Itlri r. th :Pia d(-,; iar Ao(r 4,11 '3Iamp 61t the _n)(:)I i_ir pF+.,. .•3 ratr•7fii{i ori- {t's7- ,tP,rlfrt t'Cd.. will, oxpir "v•=7r E,•'~I'" I i i`}il (he t3<,i,~? <slppl"i vc? I Ckl I Yr t Vi t ~l 5, N.- P0rift Is r.r)3i ii ~ fl'.L~ . 11, W1, ! I i the (Iay UI( ,rdl,- j. l l sbtro. i x y f.t. i ~I ['IArt 'tli s,a"t I Iil :d)ir.z (xPri t th do P.rJ.tAo,3 JY P,3r'iN ti;sa tf l ~ ti;[ I rs ;eo-sit' (l;`tur. a<aa~. P ~(_~r ~;T .la1tE i 3, (i~ hs..tP ilt'i+S~,kPI. L.17}c 1 S r vi iy rife ?'u~ rk ~1,1 : ~.•7f~:I r -i:ri ,+ir, i. -r•` 6. t.1 xr i ,k,' 4 e`f IS7.tr tdifil111°.T,3 ~f3'?- > ca j:,};:Y ~t r I ..?r' hP'e~, r'(:a.~ , .uS i t"Pf's r :+#ll~) ll'its?rrl:.> ~?Y16;tf ;y be U Vw 6911 \."P ~.i.< Cat, br' ~i?t,irl~ y U ` aWP"P? strlrtsirxt e li i>,~ ~ t., ilt ~rrJr'Iktl` yam}? .P (,I,C4hf'1°~ I_ rb!i z i"1l~It_.fr P.: P'iC'd. ~ ~k'7 DILHR-S8D-6423 (N. 04/87) State of Wisconsin ` Dopartment,of"Indu'stry,`Labor and Human Relations SAFETY & BUILDINGS DIVISION p t i c Plc: ro 7 8 (P ~y R b t3~ E , .r. i DILHR-SBD-6423 (N. 04/81) ,mot` ST. CROIX COUNTY r WISCONSIN ZONING OFFICE i ,w< 796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 June 26, 1986 Divizion ob Satiety and Building Buheau ob Ptumbing P. 0. Box 7969 Mad,~6on, Wl 53707 Dean Sit: An on z to .i.nvatigati,on bon the Thomas Hyde pnopeAty, .located at the SGl% ob the NB% ob Section 14, T30N-R20W, Town ob Somemet, St. Cuix County,neveated .6u tabte soils at a depth ob 3.75 tit., beeow which seazonabte high ground water w" noted. TW .site .ahoutd be .su.i tabZe bon a mound system. Should you have any que~stione, peease 6ee.2 bnee to contact this o b b.ice . S ' enet y, jr o. 9~"' J Thomas C. Nelson A,ss.iustant Zoning Adm,inist&a.ton TCN/m1 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 KXX0XXUyX Sw 14 N s 14 T 30 N/R 20 E(or)W SameAzet St. cuix Street Address: Subdivision: County: Landowners Name: Mailing Address: Thcmcu Hyde Rt. 1, St. Jozeph, W1 54082 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 7969, MADISON, WISCONSIN 53707 Verification of Exception Status for an Alternative Private Sewage System In the County of St. CAoix Location _ 1/4, NF 1/4, Sec. 14 T 3_N, R 20 XRY_t,NKj W Town )gix*X#Kbq#m0s gds Samelu5et Street Address Lot No. Block , Subdivision Landowner's Name: Thom" Hyde 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 num ers-i-ssued- 15-you . ) ]one of the applications needing a quota number. The quota number assigned to this application is 59 - 08 - 7 . for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. for an individual lot for which a sanitary permit was issued but was later ruled unsuitable due to new or changed soil criteria established by the department. I.J for an application on file prior to February 1, 1980. (_]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: Ula 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 lot 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 Thom" C. Netzon County Official Si ure Title Ass.6,utant Zoning Adminizt .atot Date June 26, 1986 DILHR-SBD-6158 (R 12/82) DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N WI 539069 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIP/ 7I Y: LOT NO.:BLK. NO.: SUBDIV ION NAME: 1/ F1/ T3o N/R.?o1 (or) W v-m COU T W ER' UYER'S NAME• MAILING DDRESS: Ltd- ~ ~ \ USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMER L DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: u~ysesidence ,/f New ❑ Replace RATING: S= Site suitable for system U= Site unsuitable for system V +C (O CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHO❑LDING TANK: RECOM E~ ED SYSTEM: (optional) If Percolation Tests are NOT required DESIGI~j JATE: If an .Jl~/) any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: ' / PROFILE DESCRIPTIONS 3-3 BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEP+H4H, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) ,3 13 1. 1. a 13,n 3 >s~ 99 > 1 , J l 9%; . a oo B-'~ 7-1 963 kb/) u B- 3 a+ PERCOLATION TESTS 5Slmal ~ TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER- AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD2 PERIOD PER INCH P_ ;Z -all / s g P- z z 40 1U 0 3 7/6 7/A -3 'V 7 3 P- 3 J00 ye -7 P-_ P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION /4d9 i i N 42" 1 06 . - - - 51 ! i 14 SCdd 3 3 JS a 1 a I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (grin TESTS WEER~E COMPLETED ON: ADDRESS:(~• CERTIFICATION NUMBER: PHONE NUMBER (optional): 7 CST SIGN U I DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. I DILHR-SBD-6395 (R. 02/82) - OVER - s INSTRL CT-)NS FOR COMPL.ETIN-"7OR 115 - D - 6395 . To be jil test, your report i de. 1. 2, indicate whethr- ; Or Carr +}ect; 3 arras or corgi 4 ei , 6. MIMG TANK ONLY IF ALL 0 LEA 6. PLEA' 'is shy plot plan; 7 1 ac preferred. A 8. nermanent; 9. _ ;st exernp- 10 I 1 i the appropriate box; 12 A I FILED WITH THE L 1 -..OMPLE. ,y f ABBREVIATIONS FOR CER TESTERS :tares A ~sE rr CC pa _ Mm- rn d fv. Mi "oint r TC1 li ,m t€t _ g)errnit must be ('gained and poste ° .1 ~ 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 ,FMS Location of Property 5 Cj k k),&-k, Section, T N - R -a~: W Township S (.N~ f:eS t_~ Mailing Address r -t- Address of Site Subdivision Namer Lot Number v l Previous Owner of Property Total Size of Parcel L Date Parcel was Created 2 -8 (o Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes -No Volume and Page Number ~a ~ 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 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) eetti6y that aU statements on th.i,s 6otm arse true to the best o6 my (out) knowledge; that I (we) am (ate) the owner (s) o6 the ptoperr ty des ell ibed in this .in6otmati.on 6orun, by virtue ob a waauanty dee¢ tecotded in the 064ice ob the .County Regi6tet ob Deed6 as Document No. ~ 5 ; and that I (We) pte~sen-t2y own the proposed site bot the sewage dLspo.a system (ot I (we) have obtained an easement, to tun with the above dedciribed ptoperrty, 4ot the construction o6 said .system, and the same has been duty tecotded in the 046.ice o6 the County Regiztet og Deeds, as Document No. SIGNATURE OF OWNE$,.,, SIGNATURE OF CO-OWNER (IF APPLICABLE) DAT SIGNED DATE SIGNED ' H • z H a STC - 105 r r a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z ry a OWNER/BUYER !:64=a4on-s M ROUTE/BOX NUMBER Fire Number .CITY/STATE ZIP PROPERTY LOCATION:p5W, _ Section l~ T~N, R ICJ W, Town of @NS re St. Croix County, Subdivision Lot numb q(Ij 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 pit 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 0 V. I/WE, the undersigned, have read the above requirements and agree z 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 DAT E 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. ST. CROIX COUNTY WISCONSIN ZONING OFFICE ) n.• 425 SSIBS S) 54016 3,? - y6s° ~t (~c~sd~--~ ~ GTI SS/c1/!o May 12, 1988 Division of Safety and Buildings Bureau of Plumbing P. O. Box 7969 Madison, WI 53707 Dear Sir: An on site investigation for the Dr. and Mrs. Hamid Khan property located in the SW 1/4 of the NW 1/4 of Section 27, T30N-R20W, town of St. Joseph, revealed suitable soils at a depth of 2.0 feet, below which high groundwater was noted. This site should be suitable for a mound system. Should you have any questions regarding this subject, please feel free to contact this office. Sincerely, C?_ ti!n r~ ~ ~ c) cY,a' Thomas C. Nelson Zoning Administrator rc ' Y