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HomeMy WebLinkAbout020-1135-80-000 t o(aOj 3- o d ~1 r° M e~ i y m Vi (f) p N O O? C O N ~FM. O ~l 3 co O A y (D Z C1 N O a l 7 W 0 r*) 7 o v I cn N Q j O cn -4 O O O " O CD 0 a) ? Cil 3 CD x o CD C H N W 0 C!] N W d uNi CD U? m m a s N CD ~ I c') CD ~ ((D U-1 (D ty: a W ° rt ID F, rrt r CD O o j ~\i H. oo -(D r C N O co D O O D N i n o c v C-4 N a cn a Q 4- rt n 1 a co rb x z p O 0 o 2 ~l - aQ z 'a , v, co) C/1 v E I~ vv v cn f y m .0 CD X W rn D I r y 0 .d+ H N O1 t 3 r. I N d ~ ~ a ; I a Lj z a r o N Z D W a z a Oo 7 LTI N rt lf~.. O CCD N !i1 N I , CD l0 Pd CD C CND F v Q F' z~ (D n -I CO) n z =5 A Z A rt o v, c c n F O 0 a A 3 x 0 H. N =i Z N O m o eWo co (D x a 3 A Cf) 0 y z 0 CD W i O Q c O CL < (a 0 N S C z a m o CD N N =ft ~ a• S m y X N ` i ~ ' N b N O O to ii w V o O k-j CD OAp O~ EA O . W O ~ rZa ti CC 06/29/2005 10:22 AM Parcel 020-1135-80-000 PAGE 1 OF 1 Alt. Parcel 20.29.19.668 020 - TOWN OF HUDSON ST. CROIX COUNTY, WISCONSIN Current I X_; Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * WARD, WILLIAM E & JEAN M WILLIAM E & JEAN M WARD 431 VALLEY VIEW RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 431 VALLEYVIEW RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.230 Plat: 2624-WILLOW RIDGE 2ND ADD SEC 20 T29N R19W WILLOW RIDGE 2ND ADD Block/Condo Bldg: LOT 59 LOT 59 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 20-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 03/29/1999 600183 1414/077 WD 07/23/1997 711/362 2005 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/26/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.230 30,000 237,200 267,200 NO Totals for 2005: General Property 1.230 30,000 237,200 267,2000 Woodland 0.000 0 Totals for 2004: General Property 1.230 30,000 237,200 267,2000 Woodland 0.000 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 518 Specials: User Special Code Category Amount Special Assessments Special Charges 00 Delinquent Charges 00 Total 0.00 Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT 0WNER SAC UIN~YJ ~ TOWNSHIP t C 5~U SEC. o)6 T'~N-R---~-~ ~d ADDRESS ~ -Q_ ST. CROIX COUNTY, WISCONSIN • SUBDIVISION U ~J~lOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•LH-R 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Q3~ f~ksa Qe JAI. 3 ve~ zoo m R 103 I i INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Op Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: 1A~~~ S Liquid Capacity: 0o0 5p,] Number of rings used: Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,O Side,a Rear, O 10~ _ feet From nearest property line Front,OSide,~Rear, 0 1 feet 1, Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE I :aagwnN asuaoTq :qop uo aagwnTd :paauQ :aoaoadsul :aaanaou3nuvN wauTV :puoa isaauau woa3 aaa3 3o aagwnN :2uTPTTnq woa3 aaa3 3o aagwnN :TTOM woa3 aaa3 3o aagwnN 'a3 0 `auag 0,;DPTS O `auoag :auTT 41aadoad isaauau woa3 aaa3 3o aagwnN :aaTuT 30 uoTaunaTR :-4uua 3o woaaoq 3o uoTaunaTg :pasn sSUTa 3o aagwnN ~CaTosduO : aaanaou3nuuyl XNVI 9NIQ IOH •(auo ~joag0) Lswaals uoTagaosqu TTos anoqu aga 3o Auu uo pasn uaaq O xoq uoTangTaasTp ao 0 xoq doap u jagITa SUH :aTTnq uaaV :uoTaunaTa aTd aSudaas 3o woaaog :gadap pTnbTZ :aaaawuTQ :saTd 3o aagwnN :azTS lid a9vaaas •(uuTd aoTd uo saouuasTp apnToul) 1 / :2?uTPTTnq woa3 aaa3 3o aagwnN :TTaM woa3 aaa3 3o aagwnN c~ I'd O`auag 0`apTS 'auoa3 :auTT Aaaadoad asaauau woz3 aaa3 3o aagwnN :adTd 3o doa oa gadap TTTd 1~ ~q :aT-Fng uaay :sauTZ 3o aagwnN :g3puaq •gaPTM :gouaaJ 1 :Pau WaISU NOIJciIIOSHV 'IIOS •(uuTd aoTd uo SaouuasTp apnToul) :duTpTTnq woa3 aaa3 3o aagwnN :TTam woa3 aaa3 3o aagwnN 'aa ( `auag 0 'aPTS 0`311013 :auTT Aaaadoad asaasau woa3 aaa3 3o aagwnN :adAj, goITMS waETV :aaanaou3nuuyl wauTV :aTDAD aad suoTTEO :uoTaunaTa goaTMS 33o dwnd :uoTaunaTa xuua 3o woaaog :aaTuT 30 uoTaunaTH azTS dwnd :aaanaou3nuvW uogdTS/dwnd :TapoN dwnd : XITosduO pTnbTq : aaanaou3nuvN APPLICATION FOR SANITARY PERMIT S il' C - 100 xr, 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 p issuance. Should this development'be intended for.resale by owner/contractgr,("spec .house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - Owner of Property 1.u_P~11~i41-LT 1 ~~R ytt,~ Location of Property Nw ~4 NIA) , Section s T 7. N - R W F G~ Township, 1~~►J~ Mailing Address ~ 1/!7 ~v wi S4 ol~ `j Subdivision Name U1 l_l.ow ~l D(or=' 2^~►~`~ 1°'T~ t4 Lot Number S Previous Owner of Property ~2.N0(L-T-m~ / 1 raYU1~ ~2 i~4Y Total Size of Parcel ? i jt ~~x • Date Parcel was Created MA-Y ZN~ jg55 --4'00 r m r, Are all corners and lot lines identifiable? Yes No Is this property being developed for resale (spec house) ? Yes No Volume and Page Number as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract i 3. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays ,~...,t.~.: ' of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERTIFICATION T (we) ce i6y Mat a.Q.P 6tatement6 on .thia 604111 WLe true to the but 06 my (oun) hnowZedge; .ghat I (we) am (ane,) the otjrjm(s) o6 the p&openty d"C&iibed in thiA .in6o/mati,on16o4m, by vi tue o6 a wannanty deed iceco/cded in the 066.ice 06 the County Regiz ten. o 6 Deeds a6 Do current No . __4z-U) D 1 and that I (we ) pneeentxy oun the pkopobed e.i to 6on. the au•uage c c,epoa ay.6tem (on I (we) have obtained an eaaement, to &un with the above descAi.bed ptopeA ty, bon the corVStAuetior, o6 aaid 6y.6tem, and the aa►ne has been duty aecmded in the 066.iee • o6 .the Coundy Regi-6-teA o6 Deeds, as Docwnent No. 4-01-701 ) S NATURE or. OW ER SIGNAT RE F CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUST>Rlj, DIVISION LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969 HUMAN~RELATIO`NS DISON, W1 53707 (H63.09(1) & Chapter 145.045) LOCATION: SECTION: TOWNSHIPM tff tetP*+r4Y: OT NO . NO.: 5WM N Nw 1/ 'i/ 20 /T29N/R /9E (or •HuDSaN), COLIN Y: ar'NEWS BUYER'S NAME: M (LING ADDRESS: s ACR c o 2 2 USE DATES VATIONS MA NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFIL ~LSPTION -QkAZF O ATION TESTS: Residence N New ❑Replace }q~~ r, /J P 1~ ~5' l~1 RATING: S= Site suitable for system U= Site unsuitable for system scS 13 viE' e CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) ©s ou El S E111 : a s au OS CA! EIS 0714PV, X_fX If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: CGy¢ S S -L- Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS iN CiN(m-R_ F-71- . BORING TOTAL ELEVATION DEPTH TO GROUNDWATER2 CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) r B-~ 0 , .SI /.s' N. St, ils a. , S S ~N vF,p e S ~r G.P. B- y 9 0' /06 ?za- > 9 O ' 67- QN. S~ 7.7S - j~N a Y ~•S. ,J ' AD, 6A . . o,* M 1 H, ' B- (-3 S~ /OS. 21- > 67 ,w vE.P CS . G.e . FB_ W >5? S •670 SA . s 1.33 ' IFa/ , G.S N vER C 5 Q-Mr~ 6i ?e , i B- ~p f l/0. 7~ 7t,- > /0 S • . fz' Ak as. S 7D -);fvSC5 G.e 6- 0 IDS. lD Y17 / . /7 ,7- s r t 047t7-eD 74,4j-G s, <7- . AUoip 4*'4 If /3&- SeAw#Vy PERCOLATION TESTS ..M70^tT~~ //I~ 60600,D 4Wtt Sd " TEST DEPTH WATER IN HOLE TEST TIME/ DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER IN.' AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P_ 3. ~to- I-, co ,e /~e s f iN v P_ 2- < 10A74- j ,,9 IAJ S r P- MiiuvTk3 A-T 77g5-s7- P_ t 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 ~a TT0~L ~xc ~t~tr'O'~ c ~D 3 .v 3 E a l is test site APP0O EQ 6f conv ntlon ~ at se~t~s~st~~. 3 E 3 E r 117 _ . 3 r M 4,0 3 E ~o I I 1 E r I rl~l 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 (print): TESTS WERE COMPLETED ON: HOMESITE SEPTIC PLUMBING CO. ADDRESS: mi. 3 0 NEIL HUDSON, WIS. 54016 CERTIFICATION N MBER: jPHQ. E NUMBER (optional): ROBERT ULBRICHT J S - O L` f J WAN. INSTALLER & DESIGNER LIC. NO. 00663 CST SIGNATURE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. ~DILHR-SBD-6395 (R. 02/82) OVER - L INSTRUCTIONS FOR COMPLETING FORM 115 - S BD - 6395 To be a complete anti accurate soil test, your report mast include: 1, Complete legal rte on; 2. The use sectic i° ly i(--ate w;heth.er this is a residence or commercial project; 3. MAXIMUM num ,r ; or commercial use planned; 4. Is this a new or rt 5= Complete the r`s, A SITP eq 11TABLE FnR ni_DINC TANK ONLY IF ALL OTHER SYST-1 C JT BAS J IL CON 6. PLEASE use ` n here for v~ s and completing the l plan; 7. A r ,atir Irving to scale is A own, and ar es to da nes, rcolatiol ti rp t: 10 c plain, )riate box; irrent a_. r i Aute i T C! LED WITH THE L ' T'iI i 3t} DAY, l _ "EVIATIONS FOR CERTIFIED SOIL TESTER and Textures 1(0-) _ „j *s - dwater Rate Y i^t i Yn . H v s ` 1• re to i RIB. . 67 PLOT Ar~f I0 SS ` EC:Ti~?f~.l 'PROJECT ' L U M f~ f-- N A M. EJ-hc.[\] A M E ~ r L-0C AT I 0 i.llu L I C ; E N S_E 1) A T E P. L 0 -'1- k/1 A_P. __j d e. RA 3 'bedKow~ N V E v«.t R~ .0' Nvr~~e 90 x ev I o 16('00 i f. i 4- 1 06 14 AI~Rnq a N OAK L404 H4 FRESH AIR I NILETS AND OBSERVATION~PIVE CP.O3f> SECTION Approved Vent Cap Minimum 12" Above Q7S -Final Gracje___.__ _ r.._._ F~ N~ i grer~~e , MAX NI 4" Cast Iron Above Pipe ~ Vent Pipe To Final Gradc----_.. Marsh Hay Or Synthetic Covers ilg Min. ,2" Aggr!(j, Ile Over Pipe D:istribution~ Tee Pipe F 14 Aggregate Perforated Pipe Below Beneath Pipe Coupling Terminating At _ Bot. t:om of System mom i DEPARTVENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS T=ABOR &'HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969• BUREAU OF PLUMBING MADISON, WI 53707 yyI~ ~EONVENTIONAL ❑ALTERNATIVE State Plan l,D.Number: ❑ Holding Tank ❑ In-Ground Pressure [:1 Mound (if assigned) NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER INSP CTION DATE Jack Rubendall 3M Center-225-45-08, St. Paul, MN BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.. NW NW, Section 20, T29N-R19W, Town of Hudson, Lot#59,Willow Ridge II Name of Plumber. JMPIMPRSW No.. Cn~nty San~,.,y Permit Number: Richard Hopkins 1059 St. Croix 74989 SEPTIC TANK/HOLDING TANK: MANUFACTURER. LIQUID CAPACITY. TANK INLET ELEV.. ITAN OUTLETELEV WARNING LABEL LOCKING COVER / PROVIDED: PROVIDED: (AV t c la-0 /`j..~>:" 7LJ DYES ONO DYES ENO BEDDING. VENT DIA.: VENT Tt HIGH WATER NUMBER OF ROAD. PROPERTY Ti_1BUILDING ~VENTTO FRESH FEET FROM LINE AIR INLETDYES S ONO NEAREST DOSING CHAMBER: MANUFACTURER BEDDING: LIQUID CAPACITY PUMP MODEL JPUMP;SIPHON MANUI AC11111111 WARNING LABEL LOCKING COVER PROVIDED. PROVIDED. DYES NO YES ENO DYES ENO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL E OF PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN EE OM NE AIR INLET PUMP ON AND OFF) DYES ENO NE EST_ SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing V OIAMF TER MATE HIAE AND MAHKINa 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: WIDTH LENGTH NO. OF DISTH PIPE SPACINI, COV EH INSIRE DIA =117S LIQUID BED/TRENCH TRENCHES n n HIAL PIT DEPTH DIMENSIONS GRAVEL DEP[H FILL DEPTVH UISTH PIPE DISTH PIPE DISTR. PIPE. MATERIAL NO DIS H NUMBER OF PROPERTY WELL. BUILDING VENT TO FRESH BELOW PIPES ABOVE COER EI Ev. INLf I ELEV END PIPES FEET FROM LINE AIR INLET NEAREST U G~ +.t u~ 4 +1ir I _ I~~ ) 1 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 NO meets the criteria for medium sand. TIONS MEASURED. E SOIL COVER TEXTURE PFHMANI NT MARKS HS 1111111 H VA T 11111 WELLS EYES ENO DYES ENO DEPTH OVER TRENCH BED DEPTH OVER TRENCH HEU OFPTH OF TOPSOIL SOUDTD SEEDED MULCHED CENTER EDGES DYES. ENO DYES ENO DYES ENO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO. OF LATERAL SPACING IGRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVER BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MNO UISTH D ISTRPIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEVELEVDIAELEVPIPES DIAELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORHECI LY ERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS EYES ENO DYES ENO COMMENTS: PERMANENT MARKERS: JOBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: FEET FROM LINE: YES ENO DYES ENO NEAREST L\ e)v `r Sketch System on Retain in county file for audit. Reverse Side. SIGNATURE. TITLE. DILHR SBD 6710 (R. 01/82) ~5~°neln APPLICATION FOR SANITARY PERMIT i ' 1ea'0//'rr.OUNTY 1 L H R (PLB 67) UNIFORM SANITARY PERMIT # ~ OEPRRTTEI"IT OF IfIOUSTRY, LRBOR 6 HUMRn RELRTIons '7,1-/ 9 ~f h V{ -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 O JRC MAILING ADDRESS 1 Q)S^VS_0 St PAu NINA. PROPERTY LOCATION CITY: Nt~1/4 ~~~W7/4, s :~Q T N, R E (or W Hujs LOT UMBER BLOCK gNUMBER SUBDI( SION N O~Aj~ NE REST ROAD LAKE OR NDMARK STATE PLAN I.D. NUMBER 'S 'i / ► l 00 IQ e I Ass TYPE OF BUILDING OR USE SERVED CJ~.. fa 1 or 2 Family Number of Bedrooms: ~u 1 I Public (Specify): CONU wr-r-el THIS PERMIT IS FOR A: X 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. -9 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 Concr to Constructed Septic Tank Capacity 10OQ Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: Q'i 0, K-5 TN c 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 Lift Pump/Siphon Chamber Manufacturer: PERCOLATION RATE ABSORPTION AREA ABSORPTION AREA WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): 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): Sign e: 1/MPRSW No.: Phone Number: Plum s Address: 4 • Na of Designey,`- / ~ t COUNTY/DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ji ❑ Disapproved 4- Approved ❑ Owner Given Initial Adverse Determination Reason for Disapprove : . 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 r 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. 1 a ANZ ~i3 i;! t ~ ~ '_~'1 ~ ~ p~ r~rss~- ss~✓ a,.nx i,t',, 8?a y t Zz h ` t! ~i 1 i ~ In 3 I, j. o Yi3 S ~ I>+ N \ . O A- A ""Y asrznva~q H t U) t 1' S T C - 105 r H S1?PTIC `1'ANh MA1NTLNANCE A(;1M,_'MLNT St. Croix County ` d OWNER/BUYER V"j iYiw~'~ m ROUTE/BOX NUMBER I,) Fire Number CITY/STATE VDSON WIS- ----ZIP 5401 to 1`R011ERTY LOCATION: 'a, '-4, Section 7i(J T IMM, R_t~L_W, Town of- _ St. Croix County, Subdivision W it'Lola I-Im Lot number 7111P Ikn) rnON 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 LumLe_r. What you put into the system can affect the function of the sL•,)tic tank as a treat- ment stake 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. J I The pruperty owner agrees to submit to St. Croix County Zoning; a certification form, signed by the owner and by a muster 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 I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with x H the-standards set forth, herein, as set by the Wisconsin Depart- a went 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. SICNE DATE St. Ctloix County Zoning Office P.O. Fox 98 Hammond, WI 54015 715 - 7 c 6-2239 or 715-425-8363 Sign, date and return to above address I° v y ~ m N c y N A'1 ~ O O c~ ;'(p A A ,(D< OO ~ N (D a ~ 3 c o o o m p O (D •0 O (D (D p :A, to 'a C 7 N N (D ~ N N y ~ D 0a000 w 0 (~C t 7 N N (D M aD _ wwm (~DCD VOi < R r.. e CD r M O A O M (D 'COO O (D W ? cc O N O CC _ A O M C~ 7 S N ~ ~ ~ ~ !11 Al _ C =r Ch m w N o -A o CL o O N W A ((3 C A N Q CD 0 c= -0, i3 0 m n ° M O : Q. w a- m S ca ~m o ~n o o Ov w o N C vo,-~N ~D~N Z f Aw N A 3 aN o m m ?a 1 C~~ Q~N`°0= a v N a m y ?ate c 3~O (n 0 ww3 CD C ffl C= 0O.= (D mm m - (D -N emu-; n ~ 0a w0~vm = 00 c o WO _ 5i(o a w (D -4 0 w dOf (ccc.c~ CL N o fl1 w O w (D = O N N O c <(o =(D N jY^ 0 G CD -4 0 0 "N 0M 00 I ao O(o a c " N CD a 0 0 ° 3 0 CD 0 - 3 Q. m N 0 s CD Q w ° - 0 o