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GENERALINFORMNTION
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
(ATTACH TO PERMIT)
Ow b 51. Croix
SAN-201E-288
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TANK SETBACK
INFORMATION
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St. Croix County SEP
10 2019 1088125
Non Sa/nilafion Adovi[
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RED FEE boost
CQPVAEE zuo
HdsM is the owner ofthe following parcel oflaM locnsed in St
raoas.I
Crov Cowty, Wiscwsin, recorded iv Volume= Page=
Doclunrnt Number9�St Croix Cowry Regieterof Dsds OfFce;
,v�,p,y„s,m
AI> loflwdlocatedinp oftl 5k)`hofIe SWy, of Smoot, T RD
//0,T�-29 N—R /(oW, Town ofs IQ ,St. Croix 9°
County, Wisconsin, being duly descujb as follawg(iwlude lot no. Wf
and subdivision/CSM or detailed legal description): a62—/°35-7n-c66
yiD Ar c' rot Ixwe.monrvn.eervml
I. Amwvtrurnuvontislolwillb medwaMbitabledwellmg. Cccutsumcoxid mucrvrc WOOD avaultpmy for
disposal ofhuman wavu, which was authorized by a non -plumbing svNation pomitin compliencewiN Scotism Q.A.
g and 123a2 ofJ, coumy sanituy, oMinance.
2. The wvene of the vault stall be cOposM In avnrdarce with NR 113, Was, Adm. Gtln
3. This agreement shall be binding on the owner, their M1e1m, assipum, uWlor Wd,,vact purchwe
I also ac410w1edge FOR l will disclose tis inlwmalion to my parries interested in purehzsing lain property m Nefuture.
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ST CRc Community Development
Y Government Center
1101 Carmichael Road 1 Hudson WI 54016
15r tlfhvo Telephone: 715-386-46801 Fax 715-386-C6B6
www.sccwi.gov
RE: Non -Plumbing Sanitation, privy
A sanitary privy can be Installed provided there is no interior plumbing W a structure, but only
with an approved County Sanitary Permit, a recorM.N non -plumbing sanitation affidavit and
supplying a plot plan showing all setbacks are met.
Please be advised of the following requirements:
1. A Soll and Site Evaluation W be completed W a Certified Soil Tester in the state of
tjrr�moment
A copy of the recorded Warranty Deed is required at time of application submittal. If you
do not have a copy available, you can obtain a copy from the a. Croix County Register of
Deeds at a minimal fee. This office is located across the hall from the Community
lopment Deparbnent office.
A Non -Plumbing Sanitation affidavit is required to be remanded with the R. Croix County
Register of Deeds; a $30 recording fee will be required. Staff will be abe to help you fill
out the form. Please contact the main office at (715) 3864680 to schedule an
appointment with a staff person to complete this affidavit when you drop off the
application.
4..�sA��si't'e''' plan must be included with the application with the following setbacks:
c."-ed must be 50 feet from a privy.
♦ e"Pdvy must be 25 feet from a dwelling, 25 feet from a lot line and 25 feet from any
slope 20% or greater.
0Ivy must be 75 feet from the Ordinary High Walter Mark of a stream, lake or river.
ohs must be 200 gallons or greater and a State of Wisconsin approved product. — soro9 I.
,{y Privy openings shall be screened and all doors self -closing.
It
Vent for the vault must extend at least one foot about the roof and be at least 3 inches In
diameter.
B. Owner must call for an inspection, 24 hours prior to requested inspection time.
Due to the amount of sanitary permits submitted to this Department every day, staff cannot
guarantee that a permit will be approved the same day is submitied. Please plan for
approximately one (1) week W receive your approval. Upon approval of the sanitary permit,
then you will be able to pursue approval with the Town for a building permit for a structure
intended for habitable purposes Each Town contracts with a Building Inspector, it may he
easiest to contact the Town Chair W get this Information. A driveway permit may also be
required if there Is not an existing residential access, please contact the Town Chair regarding
this as well.
The Town Chair lorN /xX and he can be mooted at 000-00 0000,.
Ilk CROIX COUNTYNo. STC 1111IINF U I I
N I IIIV
SANITARYPER11✓ IT «<JI
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AI[ QHIZED ISSUING omcwY HAIL pV11-7
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CC)pY VISIBLE FROM NGC ROAD
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