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HomeMy WebLinkAbout038-1082-20-000 0 r 0) ty ' ' O 3 A. c~ CD (D 13 K M c p T m sk ' A 3 c A c 3 A z o w c-N) C) C'3~ Z n At p 01 N O w w O w• to 71~ o a ro Z L N cD ?C ! o r7 CD CD 00 CD 2) H N a N N O N O n 7 (D < A N O w e fD N n d W O ,zr G 5 H coo °g ° C) C N N N ` CD (D U) C D = CD a o m N a 5r V - co D 3 Cl. r. oV o o V CD o CD (n z mm3 p rCA Co 00 I rn rn ~ co o a_ M h• - 0 000 y c co) N ; a, VvvU' C CD K ~ v Q, O w rt ~yy-+ m - y O lV F- I =r 00 r- 0 N) CD z r. N I-d 0 z H Q H E rr !~D a_ p z D K C o ° !V U1 co CD W jw CD lV N W to a, c t-~ ~ to I w m p rat °'1 3 N O p Z (DD O ' , I o, A O 7 7 tJ z 010 w M m o rn v a j z c 3 ~ ~ ~o 3 m w N < rn 0 w m a 00 (n :4 N' c a rY n :3 m c P) rt CL r; ~O P" I CCD a o a H d ! cD in r. N Fl -4 m p, y a I v ~ zi I 0 a 3 Q lv CCD a O N O ~ o a X w CD D4 N O O ~ a y CD L y c Form- S T C - 104 AS BUILT SANITARY SYSTEM REPORT OWNER ~GdP J4- ^/c.' TOWNSHIP _<,74-.- fJro.-je 'v SEC. 2a T N-R_~k W ADDRESS 4P3 Gu...b,a.• L4~.d cr ST. CROIX COUNTY, WISCONSIN LOT LOT SIZE PLAN VIEW ist~ d m-,nsions to meet requirements of IIHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ~Qec~rao~ L,paw Q INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used o c,'J Elevation of vertical reference point: /ODD Proposed slope at site: SEPTIC TANK: Manufacturer: /-~~S4t. Liquid Capacity: 91- Number of rings used: Tank manhole cover elevation: ' Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,0 Side,O Rear, O feet From nearest property line Front,O Side,O Rear, O feet Number of feet from: well - 4<building: ra (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE L PUMP CHAMBER Manufacturer: Liquid Capacity: `?s-G pump Model: Z 6 7 Pump/Siphon Manufacturer: C_ C e r Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: 16 O Alarm Manufacturer: ST 67(1 Alarm Switch Type: ~o Number of feet from nearest property line: Front, Q Side, O Rear, 0 Ft. Number of feet from well: 9 S Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length: Number of Lines: Area Built: Fill depth to top of pipe: 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). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box Q 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: 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 7969 BUREAU 0 PLUMBING MADISON, WI 63707 ❑CONVENTIONAL UALTERNATIVE State Plan l.D. Number; Of assigned) Holding Tank ❑ In-Ground Pressure1 Mound 86-03909 NAME OF PERMIT HOLDER: JADDRESS OF PERMIT HOLDER, INSPECTION DATE, David Janski 1182 Cumberland St., St. Paul, MN 55112 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT, ELEV.: CST REF. PT. ELEV. NE NE Section 20, T31N-R18W, Town of Star Prairie Name of Plumber: IMP;RSW Na. County Sanitary Permit Number: Michael Wilson 88 St. Croix 83789 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID C &C TANK INLET ELEV.. TANK OUTLET ELEV.. WARNING LABEL LOCKING COVER I 7 PROVIDED: PROVIDED: '2 / RYES ❑NO ❑YES NO BEDDING: VENT DIA.. VENT MA71 JHIOI-(WATER NUMB OF - ROAD. JPROPERTY 1111-L. BUILDING. IVENTTOFRESH n ALARM FEET FROM ~J LINE C AIR INLET . ❑YES NO \ ❑YES NO NEAREST o J l(? DOSING CHAMBER: MANUFACTUR ER. J BEDDING. LIOUIC)Pn PUMP MODEL PUMP; SIPHONM N FM:TUHEH WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: L ' ❑YES O ik-1 ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CON T ROLS OPERATIONAL rNBER OF WELL' ING VENT TO FRESH (DIFFERENCE BETWEEN AIRInLerL _0 1, EET F R OM PROPERTY BUI LD~ PUMP ON AND OFF) YES ❑NOEAREST-> SOIL ABSORPTION SYSTEM. Check the soilmoisture att edepthofplowing r_ I DIAMFTEH MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE CIO the soil is dry enough to continue.) L MAIN f~ CONVENTIONAL SYSTEM: BED/TRENCH wlorH JLENGTH No of DISTH PIPE sPnr,ING covEEV PIT NsIUF I~In =Plrs ILIQUID TRENCHES MATERIAL' DEPTH: DIMENSIONS GHAVEL DEPTH FILL DEPTH DISTH PIPF DISTH PIPE DISTR PIPE MATERIAL NO DISTH NUMBER OF PROPERTY WELL BUILDING. VENT TO FRESH BELOW PIPES ABOVE COVER ELEV. INLFf ELEV.ENU PIPES FEET FROM LINE AIR INLET. NEAREST-_ i► MOUND SYSTEM: T 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- ES ❑ NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER rE TURE PEHMANf NT MARKERS oBSEHHVATION WELLS _ YES ❑N0 L{V1TES ❑NO DEPTH OVER TRENCH BED F~~ ED DEPTH OF TOPSOIL ISOUOFO SMULCHED CENTFR1 S ❑YES [YN O ❑NO ES ❑NO PRESS URIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH LENGTH NO OF LA TEHAL SPACING GRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER DIMENSIONS TRENCHES /0 1 MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATEHIAL NO DISTH ID ISTH. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVATION AND E E ELE DIA PIPES / DIA C (C DISTRIBUTION /6 INFORMATION HOLE SIZE HOL SPACING DRILLED CORHECTt V COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED J/ -3Z" YES ❑NO _5__ _ PLANS 19YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF .PROPERTY WELL: BUILDING: FEET FROM ~r YES ❑ NO ES ❑NO NEAREST- L,:1,`! ASketch System on Retain in county file for audit. Reverse Side.DILHR SBD 6710 (R. 01/82) [NATURE ullsconsln APPLICATION FOR SANITARY PERMIT ~ DILHR COUNTY (PLB 67) OEPRRTTEI"IT OF - UNIFORM SANITARY PERMIT # - InDUSTRM, LRBOR 6 HumRn RELRTIOnS 17 g y Attach complete plans in accord with s. H 63.05, Wis. Adm. Code for the system, on paper not less than 8'/2x 11 inches in size. -See reverse side for instructions for completing this application. PLEASE PRINT PROPERTY OWNER MAILING ADDRESS g~ Cum 46 0,., r sr, sI PROPERTY LOCATION CITY: VILLAGE: ET", 1/4 ~I/4, Ta I , N, R E (or)b S ra. /era LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST-LAKE OR LANDMARK STATE PLAN NJ# # h VQO W TYPE OF BUILDING OR USE SERVED Q -/ue +2 O?V-0(m .54 1 or 2 Family Number of Bedrooms: c~ ❑ Public (Specify): w 4g Q THIS PERMIT IS FOR A: .F>-!4- New System ❑ Tank Replacement ❑ Repair ❑ Replacement Soil Absorption System ❑ Revision ❑ Privy ❑ Alternate System ❑ Reconnection ❑ Petition for Modification IF THIS IS A CONVENTIONAL SYSTEM COMPLETE THIS BLOCK. ❑ Seepage Bed ❑ Seepage Trench ❑ Seepage Pit ❑ Holding Tank ❑ System-In-Fill ❑ In-Ground Pressure ❑ Vault Privy ❑ Pit Privy ❑ Existing, For Which A Previous Permit Is On File, Permit # issued ❑ An Existing System That Has Been Inspected And Is Compliant As Far As Soil Conditions. Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: IF THIS IS AN ALTERNATIVE SYSTEM COMPLETE THIS BLOCK: Mound ❑ In-Ground Pressure Total #of Prefab. Site Steel Fiberglass Plastic Gallons Tanks Concrete Constructed Septic Tank Capacity ap ✓ Lift Pump/Siphon Chamber 7.50 Manufacturer: L✓;c r' o.. er 7-e PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 5-3 jOO sp o ® Private ❑ Joint ❑ Public I, the undersigned, hereby assume responsibility for installation of the private sewage system shown on the attached plans. Name of Plumber (Print): Signature: /MPRSW No.: phone Number: i Li t I C: l.v ra 3P8' (7~S`)-2GP-.?S'.~'~ Plumber's Address: Name of Designer: 17 IQi.y r L✓ ' o / w/~f COUNTY/DEPARTMENT USE ONLY Sig ture of Issuin Ag Fee: Date: fY ❑ Disapproved I~d l a El Owner Given Initial Approved Adverse Determination Reaso Af_or_ysaiiA~ro. Alternate course(s) of Action Available: DILHR-SBD-6398 (R. 5/82) DISTRIBUTION: Original to County, One Copy To; Bureau of Plumbing, Owner, Plumber INSTRUCTIONS FOR COMPLETING THIS PERMIT APPLICATION, PLB 67 - SBD 6398 To be complete and accurate the permit application must include: 1. Property owner's name and complete legal description, please circle the appropriate municipal government unit, (whether this is in a city, village or town); 2. Indicate specifically what type of use is served, if public is checked indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.); 3. Complete the block for conventional or alternate system depending on system type, check all appropriate boxes or blanks. 4. Indicate the design percolation rate listed on the 115 soil test report, the number of square feet required by code and the number of square feet to be installed; 5. Complete the section on water supply; 6. PRINT the name of the master plumber or master plumber restricted who will install the system, circle the appropriate license classi- fication, place your license number in the space provided and sign the permit in the signature block; 7. Please place the plumbers business phone number in the blank provided, if there is a problem or question this will speed review of the permit; 8. Change of ownership or plumber requires a Sanitary Permit Transfer Form (67-T) to be submitted to the county prior to installation. Failure to comply will void the sanitary permit. 9. This permit may be renewed, and at the time of renewal any new criteria in the Wis. Adm. Code will be applicable. 10. A new permit will be needed if there is a change in, estimated wastewater flow, (number of bedrooms, etc.), location of the system, depth of the system, type of system. 11. All revisions to this permit must be approved by the permit issuing authority. 12. A complete plan including a plot plan, drawn to scale or with complete dimensions. 13. Horizontal and vertical elevation reference points that are permanent and clearly shown. 14. Piping detail including pipe size, separating distances, distances between beds if appropriate, tank locations, effluent line from tank(s) to system, building sewer and vent observation pipe(s). 15. The permit issuing agent may require a cross section drawing of the effluent disposal system. TO THE OWNER: This is valid for two years. Changes in your building plans or locations may require you to obtain a new permit. Private sewage systems must be properly maintained. Have a licensed pumper clean your septic tank whenever necessary usually every 2 to 3 years. If you have questions concerning your system, contact your local code administrator or the Bureau of Plumbing, DILHR, State of Wisconsin. DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, G DIVISION LABOR AND PERCOLATION TESTS (115) MADISON WI 53707 P.O. BOX 76 HUMAN RELATIONS (H63.090) & Chapter 145.045) LOCATION: SECTION: /MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME: '/a ~'/a o /Ts N/R wE ( ► S TC, e P r', 'C- I N N I" w ~4 COUNTY: BUYER'S NAME: MAILING ADDRESS: ST, C"O.'A _C d 5, r. L7c.~ ST Pa USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: PER OLAT ON TESTS: ResidenceVew ❑Replace 6 RATING: S= Site suitable for system U= Site unsuitable for system ONVEN I1UNAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ❑S 0U ®S ❑U ' ❑S ©U ❑S 9U ❑S ©U rho [under Percolation Tests are NOT required SIGN RATE: If any portion of the tested area is in the s.H63.09(5) (b), indicate: Floodplain, indicate Floodplain elevation: f IJ/ F PR~Q a DESCRIPTIONS ee BORING TOTAL ELEVATION D PTH TO GROUNDWATER-ITQe#ES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH W. OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B o7,S~ SS, F! /1Jon-e 67'CC Zed c1, .~+oT aT Q' B- ,Z 13' -.9S-,33 h~on 1 S' a C St ' ' S L G SL ; 2-T5 SC 0e 1, r„oT 47- B- ' ~i3,7S hJDh2 ,g3'aL SL ' SS3' S 1. Sl B- B- B- of P 11 4.1 L) Peer PERCOLATION TESTS TEST DEPTH, WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IRTGhfEB AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD PERIOD PER INCH P 09, #VO 30 /,/1& 57 9 / 6 S P- 1. rv0 30 1 30 P- 16-7 WO 30 7/S i3 /6 -3/9 90 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 Nig i 1 o.,. Ty 1Po4 d C_ i 1 o l9v "a 1~ G y, Ln Lti z E I ore- l ,Ir ' i ( t F E mm r, IoT i r as III 4 .d , ' _c1 E 3 1 P LO p ( F r f I i L T L'ae i J ~Ll it - S 1, the undersigned, hereby certify that the soil tests reporte n this form were made ine in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and C&Fi 0 tests are co c to the best of my knowledge and belief. NAME (print : TE ERE COMPLETED ON: 'Ali ADDRESS: p !i Q CERTI ATION NUMBER: PHONE NUMBER (optional): Fl ~bJp-~r~~ ee►► CST ATURE: DISTRIBUTION: Original and one copy to Local Aut II d wner and Soil Taster: DILHR-SBD-6395 (R.02/82) -OVER - I -TRU TIONS FO_ `ARM 115 - S BD - 6395 Accurate sail te. „ G, P 5j /yy . 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Y4'.:{ _a ♦ e,..._x A,.,. s (4 t-..._ ,L. ~.a. .a 1.. . x..54 t M , i ' ~ 1_.~:. 1-9 i.b-'. t.~ . ~x ..,_..L t. .:_...t 1.~*.i.,. ~ ~ i r 3 , . _ . a:, . is i.. ; 1 1.. z S _ L - } ' r e. L.K...-~. f. 4 s E. . i " , ♦ Y....... _ 1. L ..u:... i?- Lt^a c.;.,_ _L'_ _ , r1.3._ L•. 1.-. _ ?.C ..°a.:. t ' - - i ~ e. , ,.i„ _ w... of :..~k_;f~, L -L kj 7' 614-ter,r:i'i1' Z.f' _ to it ~j toC3d.1., ~asl.L' ti. nii uo con cno~ °ni nn io~t IORKSHEET - MOUND SYSTEM DESIGN PROBLEM: . Design a mound system for a . a ve s kc - - - ' The site characteristics are: . Depth to groundwater or bedrock a -in. % Landslope Percolation rate min./in. Distance from dose Athamber to distribution system ft. Elevation difference between pump and distribution system _ 6 ft. Step 1. WASTEWATER LOAD (?acl oo gal. Step 2. SIZE THE ABSORPTION AREA A) Area required = i,a 6co . -oo sq. ft. B) Bed or treneh length (B) = So ft. C) Bed or treneh width (A) _ ft. D)_ Trench spacing (C) Wastewater load : .24 gal/ft2/day B = ft. # trenches Step 3. MOUND HEIGHT A) Fill depth (D) ft. B) Fill depth (E) D + % slope (A) _ ft. C) Bed or toeucb depth (F) _ ?s ft. D) Cap and topsoil depth (G) ft. E) Cap and topsoil depth (H) _ ' ft. Step 4. MOUND LENGTH A) End slope (K) _ (D + El + F + H x3 = /o ft. B) Total mound length (L) = B + 2(K) go ft. Step 5. MOUND WIDTH A1) Upslope correction factor A2) Upslope width (J) _ (D + F + G)(3)(factor) _ ft. B1) Downslope correction factor = 6 B2) Downslope width (I) _ (E + F + G)(3)(factor) ft. Cl) Total mound width (W) for bed = J + A + I ft. C2) Total mound width (W) for trenches ■ • J + ~ + (no. trenches -1)(c) + A + I = ` ft. Step 6. BASAL AREA A) Infiltrative capacity of natural soil = gal./ft2/day B) Basal area required = wastewater flows natural soil infiltrative capacity . T /j sq. ft. C1) Basal area available for bed for sloping sites = B x (A + I) _ io r° sq. ft. C2) Basal area available for trench for sloping sites ■ B W i J + AA sq. ft. C3) Basal area available for trench or bed for level- sites = B x W = 114_ sq. ft. s •S o o „ Step 7. DISTRIBUTION SYSTEM r 7A) SIZE DISTRIBUTION SYSTEM 1) Hole size in. 2) Hole spacing = 3d in. 3) Distribution pipe length = # Xr-e-r 4) Distribution pipe diameter in. 5) Spacing between distribution pipes = -3_ in. 6) Distance from sidewall to distribution pipe .2,y in. 16) DISTRIBUTION PIPE DISCHARGE RATE 3s ft. C-p 1) Number of holes per pipe _ _,L0 2) Flow per pipe ~7 GPM 1C) SIZE MANIFOLD 1) Manifold is ,_,x central/ end 2) Manifold length = 6_ ft. 3) Number of distribution lines = 4) Manifold diameter in. 7D) SIZE FORCE MAIN 1) Minimum dosing rate GPM 2) Force main diameter = in. 3) Friction loss z i, lo )I. •~s~ ft. .00, -;I" 1, to 1E) TOTAL DYNAMIC HEAD 1) Vertical lift 6 ft. 2) Friction loss = 17 ft. 3) System head 215 ft. = RECEIVED ft. 4) Total dynamic head = ~UL 9 1986 g.ft. j IRS "1..1 r 4 J o O ' f M 7F) PUMP SELECTION 1) Pump selected will discharge GPM at 8.6` ft. total dynamic head. 2) Pump model and manufacturer r 7G) DOSE VOLUME ~ti.rxb : I~1~ 1) 10 times void volume of distribution lines = 4a2,7 gal./cycle 1W) n,ayt Ok /o Z. 6e-a? X- io : 60,a , I 2) Daily wastewater volume . 4 doses/24 hrs. iso gal./cycle (.00 s `1 3) Minimum dose volume = J yLgal./cycle lGH 19' : :2, 4 6 A y L + ISv 7H) DOSE CHAMBER 1) Minimum capacity required gal. use Sa, ti4 Pose 'SSGT g ,t J y Z, vY 5 c( dea of spG C e 6 SS. ?y gaff. l7. Sr6 gGt per i'N 7SO gat at Os w,.+ T» t eT , z w ~0 QJ , i E >0 vc ' 0 C O v C' co aD d 00 ° o o r L= cor»-t o c c p O 0 i v) 0 c V m V N E O c O w C i> O 0= c: C.0 L O N ~ ~ ] p ~ (D 0 -0 o (0-0 - N 3 o-0 W 0 3 6.0 vEc c O N 4) rn 'a V NN ate) o 4)0C rot ~ 0. r_' E o W y30 v $i) - U) IL U) 3 v) o t N ~ 1JJ O L p t cu c N Z- 3' r- o Q a~ Z c ~ P- ca N ~ .c co ` Q c c c Z cn - N 0 a°) c m vi 0 t 3 ca c •0 " O v c.C cp O 3 0 0 0 co e rn 7 CD v 0 cv- a v 00 C 0 0 O O (n co p 3 cZ ~cz.E C L = u'D0 E 0 00 E O c c t w o co o m o " ma b Q) C +L cis C to (n a) L N a co _ 0 O Y a) N 3 O _ Qom) C a) - 00 Ca i 00-0 113 ~7 C 0 0 0 d O Y 0 a c0 L fd cC ` =3 0-0 w cc~t C C- E-o o N O i i N 0) (D C C O N O 0 i OEcNvpiaiw~ ►L-~m° a = w c Form - S T C 100 Owner of Property 7s.415/o Location of Property /M5- Section_ aC TAN R W Township-- S i AR A191- Mailing Address A)0,~~ J~7 -jltl5 Subdivision Name _ Lot Number Previous Owner of Property Lll/~~jZLD Cl~n,~c sonl Total Size of Parcel Zo.so Date Parcel yras Created 3Z, Are all corners identifiable? Yes No Include with this a2plication-one of the following: V. Certified Survey Map ✓.Deed .Land Contract, or .Other hegal Document which describes the property PROPERTY OWNER CERTIFICATION I I (We) certify that all statements on this form are true to the best of my (our) knowledge; that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the Office of the County Register of Deeds as Document and that I (we) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, to run with the above described property, for the construction of said system, and the same has been duly recorded in the Office of the County Register of Deeds, as Document No. SIGNATURE OF DWNE SI ATU OF C WNER (IF APPLICABLE) Y PATE SIGNED DATE SIGNED H r ST C- 105 r y H SEPTIC TANK MAINTENANCE' AGREEMENT o St. Croix County z d H OWNER/BUYER Z~VIDD. d- T OD~/ / J~. ~~IN51 ! ROUTE/BOX NUMBER C/N i ___._1 lre Number CITY / STATE t1' PROPERTY LOCATION:N'E_4, 1NLC, 4, Section-ZQ__-, I_ 31-N, R_1y.._W, Town of /9/Z p~~~ 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 _s_e_L)tic tank puujper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix County residents m~ 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 septictank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to ti three year expiration. o I/WE, the undersigned, have read the above requirements and agree Ln to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- b rnent of Natural Resources. Certification norm must be completed and returned to the St. Croix County Zoning Office wi hit 30 days of the three year expiration date. SIGNED_ St. Croix C:,unty Zonj.ng Office P.O. lox 98 Hammon d, WI 54015 715-711-6-2239 or 715-425-8363 Sign, date and return to above address. ST. CROIX COUNTY s~a.. WISCONSIN 4M,,e ZONING OFFICE 'N796-2239 (HAMMOND) 425-8363 (RIVER FALLS) HAMMOND, WI 54015 June 25, 1986 Division ob Satiety and Buitdi.ng BuAeau ob P.E?umbing P. 0. Box 7969 Madison, WI 53707 Dea,t Sit: An on Site ,inve6ti.gat on bon the Dave Janski pnopeAty, .located at the NB% ob the NB% ob Section 20, T31N-R18W, Town ob StoA PnaiAi.e, St. Croix County , wa6 conducted on June 24, 1986. The investiga- tion neveated suitable soils at a depth ob 2.0 beet, below which seazonabte high ground watetc was noted. TW site shou,l'd be suitabte bon a mound system. Sh.outd you have any questi,ont6, ptease beet bnee to contact this obbtice. 'ety, CJ Thom" C. Nebon Assi,6tant Zoning AdminiztAaton m1 STATE OF WISCONSIN-DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS DIVISION OF SAFETY P.O. BOX 7969 - MADISON, WI, 53707 APPLICATION FOR THE USE OF AN ALTERNATIVE SYSTEM Location: Townshipy"SUi "UfXX NE 14 NE !4 S 20 T 31 N/R 18 X# XM W Sto PhaiAie St. Cnatix Subdivision: County: Street Address: Landowners Name: Mailing Address: Dave Janshi. 1183 Cumbe&and Sheet, St. Paut, MN 55117 I (We), the undersigned, hereby make application for an alternative system on the above-described premises. I recognize that the above premises are notI suited for a conventional private sewage system. If approval _ 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. Croix Location NE 1/4, NE 1/4, Sec. 20 T 31 N, R 18 $XtOkJ W Town AW*X ifc 010dfttjK Stan PtaiA, a Street Address Lot No. Block Subdivision Landowner's Name: Dave Janski 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: ~.1 to have one of the first five approvals guaranteed for this year. This is number - - of those applications. (Use one of the first five quota num ers ssuea to you.) None of the applications needing a quota number. The quota number assigned to this application is 59 - 06 - 7 ❑ for one additional homesite on a farm to be occupied by a parent, child, grandchild, sibling, niece, nephew, or first cousin. F]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. .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: ❑ a failing conventional soil absorption system. a holding tank that was installed and in use prior to February 1, 1980. ❑ a privy that was installed and in use prior to February 1, 1980. If this is a REPLACEMENT SYSTEM USE and the Jot meets the criteria for a conventional private sewage system, check here I certify that the above information is true and accurate to the best of my knowledge. Name Thomas C. Neap n Si gfirllf ure County Official Title A Sista.nt Zoning A&n&tistAatah Date June 25, 1986 DILHR-SBD-6158 (R 12/82)