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HomeMy WebLinkAbout030-1069-10-001 ST CR01x cOUNTY 16#oAl - PLANNING & ZONING June 22, 2006 Greg Howard 3403.W. 28th Street Minneapolis, MN 55146-4302 RE: Remodeling/addition to existing house, Town of St. Joseph Code Adminrstratior Parcel # 030-1069-10-001 (26.30.19.251 F) 715-386-4680 Dear Mr. Howard: Land Information Planning k' 715-386-4674 You have requested the Zoning Office review your remodeling project for compliance with the state sanitary code (COMM 83). When remodeling or adding onto a dwelling Real Prop - you are required to examine whether or not the planned modifications involve an 715-386=4677 increase in design wastewater flows to the existing Private On-site Wastewater Rec Treatment System (POWTS). ycling 715-386-4675 According to house plans submitted, the project involves finishing one additional bedroom within the existing 2-bedroom structure. The septic system was designed and installed based on wastewater flow for three (3) bedrooms (450 gallons/day) with a maximum occupancy of six (6) persons. This project will not result in an increase of the design wastewater flow. The original system was installed in 1984 by Cal Powers and was inspected by zoning staff at the time of installation. The system was found to be code compliant at that time. Inspection report, as-built, and sanitary permit documents are on file in the zoning department archives. The property has been occupied for seasonal use until now. To prolong the life of the POWTS, remember to have the septic tank pumped at least once every three years or when the tank becomes 1/3 full of sludge and scum. _ Other efforts to extend the lifespan of the system include water conservation measures such as repair or replace leaking plumbing fixtures, reducing shower time, running the dish washer only when it's full, avoid using a garbage disposal, using a wash machine with a suds saver feature, etc. The projected lifespan of your POWTS j' is dependent upon proper maintenance of the system. ~frk s If this POWTS should fail at any time in the future, the system will be need to be inspected by a licensed plumber or POWTS maintainer to determine if it must be replaced according to state code requirements in effect at that time. ST. CROIx COUNTY GOVERNMENT CENTER 1 10 1 CARMIOHAEL ROAD, HUDSON, W1 54016 715-386-4686 FAx PZ6:)CO5Ah%TC 12 U3 `A/WW CO.SAINT_CP,OG.V,d].U5 The proposed remodeling project must comply with all applicable building codes. Please contact4he Building Inspector for the town of St. Joseph to obtain a building permit. ,pve any questions, please contact this office. Should ydbb'h Sincerely, Pame a Quinn Zoning Specialist Cc: Dwight Farnham, Deputy Zoning Administrator Sanitary permit file ST. CROIX COUNTY GOVERNMENT CENTER 1 101 CARMICHAEL ROAD, HUDSON, WI 54016 715-386-4686 FAX PZC)CC.SAINT-CROIX, INi.US WWW.CO_SAINT-CROIX. WLUS G "\'Cr (-iE DECK GARAG L1_ HOUSE DECK t CEN' V DRIV 75' SETBACK FROM SEPTIC O.H.W.M. j VENTS V - o c Q - 0,2 n fn Q 3 T n o d f c d o CD 0 CD Q 5 0 I, z p A= C/) N) pW cC l~l v 3 O O i(D n N Q N p w 'p N v Q N ~ p .~y T 0 G) to T t~ ~cn N 1= o m 6 p (o ( N w (D ° CD OEn d -p W ~ 0 ~p -A CD C) N d = ~~1 Z -P O C1 O Cl CD co 00 a N p a a ~ 'on r! c v j z 0 0 O " S O O I_D fn fn Ln o N z rf r- f I~ rn - D I Nl A n IMP N N ~ - cD ~1 _ ~ ((may v (D OD O a v o D D j O oo - I -I -1 Z C c co w rn ~ ~ 7~ m z N n o q`' ~ c' o h o ZCD Z N C) f i (O N N Z -I N ( m Co 0) o ,4k Q t z 0 3 41 o m CD N Z A CD W F c. Fn i p C C 7 N ! d c 0 CD o 0 ~I s o A o b ~p iC ^ VV lj~ 6 D V T~ J Form - S T C - 104 AS BUILT SANITARY SYSTEM REPO_R_T OWNER C j-- -e TOWNSHIP SEC. - c T ( N RJZ-W ADDRESS P s ST. CROIX COUNTY, WISCONSIN SUBDIVISION LOT LOT S 7.E PLAN VIEW Distances and dimensions to meet requirements of H 63 SHOW EVERYTHING WITHIN 100 F1;F"' OF SYSTEM Q 1 r e I I DICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used Elevation of vertical reference point: 1 b 0j ~ Proposed slope at site: 1 '1 SEPTIC TANK: Manufacturer: G u, 1ri/? Liquid Capacity: C2-L Number of rings used: / Tank manhole cover elevation: c~ 7 Tank Inlet Elevation: ~r Tank Outlet Elevation: 7 Number of feet from nearest Road: Front, @Side,o Rear, O J(f~3 feet From nearest property line Front, (2) Side,0 Rear, O )p feet Number of feet from: well r~ building: (Include this information of the above plot plan)( 2 reference dimensions to septic trunk) PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: pump/Siphon Manufacturer: _ Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, 0 Ft, Number of feet from well: - Number of feet from building: - (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: ss ~J Len the - Number of Lines: Area Built: Width: g Fill depth to top of piper Number of feet from nearest property line: Front, Side, O Rear, O Ft. ~Iy Number of feet from well: Number of feet from building: 13 (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 O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: ry L I l Plumber on job: Jr- Dated: 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 OF PLUMBING MADISON, WI 53707 ACONVENTIONAL ❑ALTERNATIVE State Plan ID Number (If assigned) ❑ Holding Tank ❑ In-Ground Pressure ❑ Mound L NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Gneg Howi R. R. 2, Hud6on, W1 O._/D Xy M; 30 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN. REF. PT. ELEV.: CST REF. PT. ELEV.. NE SE, Section 26, T30N-R19W. Lot#2,Ted Ong Sub., Town o6 St. Ji Name of Plumber. MP/MPRSW Na. Coumy Sanitary Perm, Number. Ca Power 54945 St. CtLoix 54945 SEPTIC TANK/ OLDING TANK: JMANUFACTURER.. LIQT CAPACITY: TANK INLET ELE V.. TANK OUTLET ELEV.. WARNING LABEL LOC N COVER PQOVXED f YES ❑NO ES ❑NO BEDDING: VENT DIA.. VENT A(L HIGH WATE NUMBE OF ROAD: Pq OPERTY WELLBUILDINGVENT TO FRESH ALARM FEET FROM LInEAIR ❑YES ❑NO ❑ S NO NEAREST rl -1 s° DOSING CHAMBER: MANUFACTURER. BEDDING. LIQUID CAPACITY PUMP MODEL PUMP/SIPHON MANUFACTURER WARNING LABEL LOCKING COVER PROVIDED. PROVIDED: ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL NUMBER OPROPERTY JWELL BUILDING VENT rE FR (DIFFERENCE BETWEEN FEET FROLINE I AIR INLET PUMP ON AND OFF) ❑ YES ❑ NO NEAREST FRESH SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I LNG1H JDIAMETER MATERIAL AND MARKING, or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH. LENGTH NO. OF DISTR. PIPE SPACING C,p+YFR INSIDE DIA UPITS LIQUID BED/TRENCH TRENCHES MA ERIAL DEPTH. DIMENSIONS I GRAVEL DFPTH FILL DEPTH JDISTR. PIPE DISTR PIPE DISTR. PIPE ATERIAL. NO. DI R NUMBER OF PROPERTY WELL. BUILDING'. VENT TO FRESH BELOW PIPE ABOVE OVER EL~ VK iN T ELE V.`E~ND. ^ II PIPES FEET FROM ,LINE. AIgT_/ NEAREST I l( 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- ❑YES ❑NO meets the criteria for medium sand. TIONS MEASURED. SOIL COVER TEXTURE PERMANENT MARKERS. OBSERVATION WELLS ❑YES ❑NO ❑YES ❑NO DEPTH OVER TRENCH BED IDEPTH UOVER THENCH;BED DEPTH OF TOPSOIL SODDED SEEDED 111111-CHID CFNTER EDGES ❑YES ❑NO ❑YES ❑NO ❑YES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH LENGTH NO. OF LATERAL SPACING. JGRAVEL DEPTH BELOW PIPE FILL DEPTH ABOVE COVEH BED/TRENCH TRENCHES DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE JMANIFOLD MATERIAL: NO. DISTR. ID~ITRPIPE DISTRIBUTION PIPE MATEHIAL & MARKING ELEVELEVCIAELEVPIPESDA.. ELEVATION AND DISTRIBUI ION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ❑YES ❑NO ❑YES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS. NUMBER OF : FEET FROM ~LRNOEP ❑YES ❑NO ❑YES ❑NO NEAREST f> C" ~•`~5 c'j 4 Sketch System on Retain in county file for audit. Reverse Side. -SIGNATURE TITLE DI LHR SBD 6710 (R. 01/82) Wisconsin APPLICATION FOR SANITARY PERMIT , ,DILHR COUNT (PLB 67) 0~ oERRRTmEnT of In OUSTRV, LRBOR 6 H, m,n 1ELRT1015 UNIFORM SANITARY PERMIT -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 OWN MAf,LING ADDRE S t 1 PROPERTY LOCATION CFFY: L7 1/4~.;' 1/4, S T'i IV, R (or) W TOWN oF: LOT NUMBER BLOCK NUMBER SUBDIVISION NAME NEAREST ROAD, AKE OR LANDMARK __[STATE PLAN I.D. NUMBER YPE OF BUILDING OR USE SERVED 1 or 2 Family Number of Bedrooms. Public (Specify): THIS PERMIT IS FOR A: LJ 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 Gallons Tanks Concrete Constructed Steel Fiberglass Plastic Septic Tank Capacity Lift Pump Tank/Siphon Chamber Holding Tank capacity Manufacturer: l r - 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 ofjthe-priv to sewage system shown on the attached plans. N 1/ ame of Plumber (Privtfi: f Signa t MP/MPRSW No.: Phone Number: _ J Plumber.'g.Address: j Name of Designer ZL Z COUNTY/ DEPARTMENT USE ONLY Signature of Issuing Agent: Fee: Date: ❑ Disapproved [_X ❑ Owner Given Initial o/lr~y v .a LJ Approved Adverse Determination Reason for Disapproval: 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. APPI-(CATION FOR SANITARY PERMIT S T C - 100 This application form is to be completed in full rend 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 GrG~(-gy-q ~.4tt9ay-C11 'zJ-©c"VV^e- & Location of Property _14, Section 2( T 30 N - R Iq W Township joss k - Mai_Iing Address ~p gj$ _v r 1 Subdivision Name Lot Number ~~fQfU/~y Zt" Previous Owner of Property -AeQ&p- Q~-~e~ ~dTyYS 'T'otal Size of Parcel 3. dl acv-e5 I)ate Parcel was Created. ~q;S3 Are rill corners and lot 1i-nes identi-liable? Yes No Is thi.s property being developed {or resale (spec house) ? Yes No vo lLITT) e and Page Number 13 2;4 as recorded with the Register of Deeds INCLUDE WITIJ THIS APPLICATION ONE OF T11F FOUOWING: 1. Warranty Deed Land Contract 3. Other recordings filed with the Register of. Deeds Office fn addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process, ?f the deed description references t.o a Certified Survey Map, the the. Certified Survey Map shall also be required. PROPFRTV OWNER CFRTIFTCATION I (We.) eeA-t4-()y that a -Z Atatement,~ on tows ~on.m vte tIcueto the beAt o~ my (ouA) I.nowTedge; that T (we.) am (aAe) the owners (b) o~) the pupe,rty daan bed in .th'i'6 ( I n{onmation AoAm, by viAtue o~ a wvA-anty de_e_d AecoAded in the NOgee 00 ,the. County Regi,6ten oo Dee.d,5 cus Document No. 9 (3C70 ; and that 1 (we.) p,> Me.nUy own the, pnopo6ed bite. ion the 6wage d'.bpoSct.2 6y~te.m (on I (we-) have eb-ta,~ne-d an eaA me.nt, to nun With t_h.e. above. de~cA.~be.d pnopent_y, KoA the. con,5tntact,~on of Aaid AyAtem, and the Game hay been duty neconde,d -cn the OAOice cif .the County Re-_giAten o{ Deeds, a,5 Doeumevtt No. ) . SIG F OF OWNER SI ATURF. OF CO-OWNER (IF APPLICABLE) 7- 7- ga~-2--- DATF SIGNED DATE SIGNI?D V o 1- • 5 , ~u. g c 13 `-j 1 v cr. 3 g o y z 5 CERTIFIED SURVEY MAP T LOCATED IN PART OF GOVERNMENT LOT 2, SECTION 26, T30N, R19W , TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN. SECTION 26 T30N-R19W E 1/4 COR N LEGEND N89°43'57"W 4' 87.76' • 1" IRON PIPE, FOUND 3 COUNTY SECTION CORNER MONUMENT, FOUND 0 1" IRON PIPE WEIGHING pa ls~ 1.68 LBS./LIN. FT. , SET. 0 v NOTE: ALL BEARINGS ARE 1 REFERENCED TO THE EAST LINE OF THE SE 1/4 OF SECTION 26 ASSUMED TO BEAR N00°15'03"E. S89°58'40"E m~ 66-oo . L\)' APPROVED 4% W E DEC 19$3 co 0 I 3 S o z I rn rL o I 0 s~.: o1x colUNTY o F o kc, CO.'dPd`t.`i_:r~;y~ P!•.i;!:~ V.?:rY.ii i a W S C A L E AND ZOM-NO cc.+, ;`,Irre_ to ° 0 in w 01 I a o ww• loo, So' o' loo' LOT 2 o o zw I a o (r?'. 41o' 135,557 SQ. FT. a rr(Do , 3.11 ACRES OWNER 16,01 I EXISTING BLDG. I RR THEDOREBOX OR6F AND SONS h NEW RICHMOND, W1. 54017 27' w I I 9° 9' 14° O ~ ' r 20' 40.68' o to ,W 10) S14°22'08"W m V J I r- N pp I !~A SS 52.00' S 89° 58' 40" E 0 Q ( z LAKE `°W w 3 0 383.26' Tro I: 3 ❑ EXISTING COO ° w CABINS tD Q I tD ~i 'v co z 0 AUEN C.~ cr I ~ v> ;YHA: $-1AJ7 '~Y 1 CABIN LOT I I - LL I K., ,„IS•186, 026 SQ. FT. PTO THE MEANDER 01j^ < •.'••~c 4.27 ACRES LINE) co in I z k - O) n O F O ' y C I ~'~r~t v~ M M I J a,a` 179 , 365 S0. FT. I (C / 4.12 ACRES EXCLUDING RD. R/W I r v v) QOUTHOUSE ( w l9 l 8 = 64 53'- 23" I y> O R 28.14' ' „~O BUNKHOUSE L ' 3228.14' C = 327. 95' °~y2 CB= S86°-32'-105"W a1~,rO2 SOUTH LINE GOVERNMENT LOT 2 5 N89°-58'-52' I S 83°-05-29 w 84. 59 S89°58'40"E 191.55' 28.38' S 890 58'40" E 439.99' 23.42 66.00' 33.5'- 631.54' N 89°--58' 40"W! ENT CORNR TOW R0A_D GOVEERRNMNM SE ENT ~ _ LOT 2 SURVEYORS CERTIFICATE: I, Allen C. Nyhagen, a registered Land Surveyor, hereby certify that by the direction of Theodore Orf; owner of said land, I have surveyed described and mapped the land parcel which is represented by this Certified Survey Map; that the exterior boundary of the land parcel surveyed and mapped is described as follows: A parcel of land located in part of Gov't Lot 2 of Section 26, T 30 No R 19 W, Town of St. Joseph, St. Croix County, Wisconsin, further described as follows: Commencing.at the E 1/4 corner of said Section 26; thence S 000-16'-03" W along the East line of the SE 1/4 of said Section 26, 1298.53 feet to the SE. corner of said Gov't Lot 2; thence N 89°-58'-40" W ( Rec. as I-lest ) along the South line of said Gov't Lot 2, 660.00 feet to the point of beginning of this description; thence N 000-16'-03" E ( Rec. as North ) parallel with the East line of the SE 1/4 of said Section 26, 951.00 feet; thence N 890-43'-57" W, 87.76 feet to a point located on the easterly shore of Bass Lake and is the beginning of the meander line along the lake; thence S 211-01'-36" W, 112.44 feet; thence S 350-16'-49" W, 238.52 feet; thence S 351-07'-37" W, 198.33 feet; thence S 09°-59'-14" E, 40.68 feet; thence S 140-221-08" W, 280.75 feet; thence S 47°-29'-30of I "I' 262.32 feet to the end of said meander line; thence S 89°-58'-40" E ( Rec as East ) along the South line of Gov't Lot 2, 631.54 feet to the point of beginning ............including all lands lying between the meander line herein described and the easterly shore of Bass Lake, vhich lies between true extensions of the northerly and southerly boundary lines of the parcel herein described. Above described parcel is subject to an easement for Town Road purposes along the South line as shown on this map. Togather with a 66 foot road easement for ingress and egress from Lot 2 to the Town Road, to be granted by the adjoining property oi•rner, further described as follows: An easement located in part of Gov't Lot 2 of Section 26, T 30 N, R 19 W Town of St. Joseph, St. Croix County, Wisconsin,further described as follows: Commencing at the E 1/4 corner of said Section 26; thence S 001-16'-03" W along the East line of the SE 1/4 of said Section 26, 1298.53 feet to the SE. 'corner of said Gov't Lot 2; thence N 890-58'-40" W along the South line of said Gov't Lot 2, 660.00 feet to the point of beginning of this easement description; thence N 000-16'-03" E parallel with the East line of the SE 1/4 of said Section 26, 819.60 feet; thence S 89°-58'-40" E, 66.00 feet; thence S 000-16'-03" W, 796.17 feet; thence N 890-58'-40" ti'l along the South line of Gov't Lot 2, 66.00 feet to the point of beginning. that this Certified Survey Map is a correct representation of the exterior boundary surveyed and described; that I have fully complied with the current provisions of Chapter 236.34 Wisconsin Revised Statues in surveying and mapping same: ~ Y . ALLEN C. h NYHAGEN s-i 407 J HUDSON, / wis. tJ.` 'Fee, t D T u~~• ~I J ?ca s `L u V~ y • r ST C- 105 r y ti SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County c7 y OWNER/BUYER ROUTE/BOX NUMBER Fire Number 200 CITY/STATE '4AOS7~ -ZIP - PROPERTY LOCATION: ~4, Z, Section 2-(o T 30 N, W, Town of L7 St. Croix County, Subdivision_~a Lot number Z l; I 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 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 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. o I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- 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 ^rv Zoning Office SANITARY PERMIT ILHR Coun 2 GROUNDWATER SURCHARGE NIOU'YT6IV, LAW)"GMUfTIPlflfW1LAT%3rM Sanitary Permit No. y 9 S On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more com- monly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that is used in your building is returned to the groundwater through your soil absorption system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting.. p Ground ater Signs a of Issuing Ag nt: Ground ter Fee: Date: Wisco $in's buried tr+~aur~t DILHR SBD-7289 (N. 05/84) ° •r. s- y f LPL . PAGE OF a 1 ~•;I J_ r c) S S Z Q 1 U '-'1 O y S rt l Freeh Air Inlstc~Annd Obcervallon Pipe i---~"'--- Approved Vent Cop Minimum 12" Above Final Grade 2U- 42" Above Pipe _ 4" Cast Iron To Final Grade Vent Pipe Mash Hay Or Synthetic Covering Min 2" Aggregale Ovu Pipe i Dlerrlbutlon pipe 0 0 0 0 0 Tee - 6" Aggregale Beneath Pipe 0 Perforated Pipe Belo, o Covlpling Terminating At Bottom Of System I ~~tJ•.~ tort SOIL FILL DISTKIBUTIOI.I PIPE APPROVED S4W- HETIC COVER Oo 2u 0Fg6GRE GATE -MATEIiII~I 9" OF STRAW OR /AARSU HAj 'dam r (a OFAGGREGATE o8~ KIEV. oF;~FEF.T-.-- DISTRIF~UTI(DM PIPE TO BE AT LEAST< IIUCHE5 BELOW ORIGI"AL GRADE AML AT LEAST20 IIJCHES BUT KIO MORE THAK. 1-12 IMCHES BELOW FINAL GRADE t MAXIMUM DkPTH OF F-XcAVATI,00 FKom 0K1&*JAL (RAIDS WILL BE - 1'2 WCHES ,M1141MUM ®EP" of FACAVATIOM FKOJIR 0RI4I1JAL GRApf- WILL eE INCHES SIGUED: LICEUSE IJUMBER: DATE: tto i w a i f fi= , i / TG - - lh - DEPARTrMENTOF' REPORT ON SOIL BORINGS FE,, & BUILDINGS IN.DUS'TRY, DIVISION LP,(JR AND PERCOLATION TESTS (115 loy~9,~// O. BOX 7969 HUMAN RELATIONS (H63.09(1) & Chapter 145.045) •~~uf'MA0 ON, WI 53707 LO ATION: SECTION: TOWNSHIPfP&HHI8IP }:WY: LOTNO.:B IF'N SU DIVISIOr N7s, E: 1/ L / /T3tN/Rj71 lor) W S ~ e ; COUNTY: S/BUYER'S NAME: MAI IN ADD ESS: L r P . I e 2 A/ 1~, rep, S~ USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFLLE D€SCf~IPTIONS: PERCOLATION EST Residence XNew ❑Replace e L~ RATING: S= Site suitable for system U= Site unsuitable for system rk~gTff~~ OUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILL HOLDING TANK: RECOMMENDED SYSTEM: (optional) Ks u s ❑u ❑ s ~.u El S Xu IfPercolation Tests are NOT required DESIGN R E: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: A5 _r Floodplain, indicate Floodplain elevation: - B PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH40Q, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B s71 7 G _ c 131- 5` B (r r _ p l , B- , SMv Pop -0,6.? 1-5' B- /!t PERCOLATION TESTS S TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVELaWd*"tES RATE MINUTES NUMBER 14+01111S AFTERSWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERIOD 3 PER INCH P- a, L P- fir? / P- , i1 P- 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 t All, ke- All `=d r/ ti S . e y0A F A. V V _ H A ~ 0 : d ~ E E - i I, the undersigned, he by 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 TESTS WERE COMPLETED ON: ADDR S , I , CERTIFICATION NUMBER: PHONE NUMBER (op tional): °7j Xetu _/i') CZ k" 4 21 4/ Ul I~ ~fd I;7 CST I NAT RE: t DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) - OVER - l • i x s »~.a m.aR % i.> $ a e d w)"" o t i S"k.'r a3 F"D", To Ifn eY and "WIC:Si"WO 2. The use .~ec,,. .r£ist 008; IV If C-fl 3, ',AX HtIUM, {~Lffl;ber Cif E:7i"Ca t)t_78,`lS Or C..:_)(-HM1 l-Cli'l 1!'k' fi:ddl-31' 4, E tiEis 3 n t o, ,t;13?aceni t,P system; unz, lete t, , },Rini, [)ox+a. SITE i T z a „ _ 1 _ nA B E_!'. diaLlrw€, acF'f.-',u~~;y l€,r;a11i'1f} }€7:.~" s r }tFU,.~~a>t`YS. D Clv£Cty t "l is t, s£.d"l rC.Jr C F.~ . b i r d the ~ot -n ao,-l j "W') B 1 , . er h a, se Sams, Pert; Pe} icoli e x SO; o r.._ zii. F -,3 03V L-oam 'y Sia3'~FI ° SJI C,ia t rL; €J C: I