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HomeMy WebLinkAbout026-1137-01-000 r Wiscons.?!"Jep;,rtment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Bui;ding Division INSPECTION REPORT 1 ( C "• � ( Sanitary Permit No: 395221 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village x Township Parcel Tax No: P.C. Collova Builders, Inc. I Richmond Township 026- 1137 -01 -000 CST BM Elev: Insp. BM Elev: BM Description: fK TANK INFORMATION ELEVA N DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic !!0 Benchmark LO Dosing CAJ ' 44— 44 0 Alt. BM .41 Aeration Bldg. Sewer �dq Holding St/Ht Inlet 60 � TANK SETBACK INFORMATION St/Ht Outlet �3� 1 40 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet r Dt Bottom Dosing t Header /Man. qb -3� Aeration Dist. Pipe 7,p CUP • 4 01 5 . / Holding Bot. System Q Z z 4 Final Grade PUMP /SIPHON INFORMATION 3 •l Manufacturer Demand St Cover G PM �t joo,9s/ Model Number TDH Lift Fr oss System Head T UH Ft Forcemain Le th Dia. o well SOIL ABSORPTION SYSTEM BED/TRENCH Width N Length No. Of Trenches PIT DIMENSIONS No. Of Pits De th DIMENSIONS 1 4 �r 7 � SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEA IN Ma ctyrgr: INFORMATION Ty stem: CHA ER R !� Yp e Y IJ UNI Model Num DISTRIBUTION SYSTEM _ � Bader /Manifod• Distribution x Hole Size x Hole Spacing Vent to Air Intake q / Pipe(s) ' Length Dia "/ Length ( r Dia _ Spacing ' V I -1 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of 1 xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil [a] Yes [M:] No [] Yes COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / i Location: 1498 112th Street New ichmond, WI 54017 (NW 1/4 NW 1/421 T30NN R_18 /W_) Golfview.Ay� , � No: 21.30.18.927 1.) Alt BM Description =�,f10 Gt k �% A)a �` 2.) Bldg sewer length = l , • �� (q,� f7►/K, / �sR - amount of cover =f,. Lo Aj 0 t.AkAd w Plan revision Required? [inj Yes ❑ No �� ZZ •' Use other side for additional information. BD - 6710 Date Inse s Signature ^S� (R.3/97) Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 lViscons Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce (privacy Law, s. 15.04(1 Xm)] (Submit completed form to county if not state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 1 i inches in size, Caen Cr6 r State Sunit Perm Number ❑ Check if revision to previous application State Plan I. 9. I. Application - Please Print all I formation Locatio Property Ow�nerName /� & Property Location I . c C-. ri[J ce.i +C.� .l �= .�....., Ldi14n g1 T3` ,N, K J (o W Property Ownces Mailing Address 1, 7 Lot Number Block Number city, state Zip Code P :`� ber Subdivision ame or M Number II. ype of Building: (check one) -( ° ❑City 1 or 2 Family Dwelling - No. of Bedrooms: r ..- �_ ❑ Village � � ' ' 9' "` ❑ bliclCommercial (describe use):_ n of ❑ State -Owned Nearest Road Pa rce ax Alum s) IIl. Type of P mit: (allijk only one box on line A. Check box on line B if applicable) A) 1. w 2. ❑ Replacement 3. 0 Replacement of 4. 5. 6. EJ Addition to System System Tank Only Existing System B) _ ermitNumber Datei su A Sanitary Permit was pre viously issued Z( I'V. Type of POWT System: (Check all that apply) on- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland zed In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: / � ?Ae-, riilcn..,. � V. Die ersal/Treatment Area Information: R — ,r f g-, 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Una& Ll Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing erete structed Tanks Tanks ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for ins ation of TS shown on the attached plans. um s Name (print) P umber cure (no S ): /MFRS No. J f j Business Phone Number Plumber's Address (Street, City, State, Zip (� �p )94,e000U&J'jqr IX. County/Department Use Only Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued ing Agent Signature (No stamps) Approved ❑Owner Given Initial Adverse Surcharge Fee) 00 0 // - / O( Determination NO X of Approval /Reasons for Disapproval: 1 O 7 et- � o w ;4 A � *AAO !x 6--C', sl;n -630 r R 071001 f � �� -- 1 K + hl: ; �:w .� PLOT PLAN PROJECT P.C. Collova Builders Inc. A JODRESs 705 Countv Rd E Hudson Wi 54016 NW 1/4 NW 1 /4s 21 /T 30 / 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/7/01 BEDROOM 3 CONVENTIONAL X)OC IN -GRO RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22 IL BENCHMARK V.R.P. Top of 1" iron Pipe ASSUME ELEVATION ioo° Filter Zabel A -100 ❑ BOREHOLE O WELL +H.R,P, Same as Benchmark B.M. #1 County Road G SYSTEM ELEVATION 96.0 Vent > 12" Sidewinder High ' Capacity Leaching Plans Designed Using ap of Cover C g Conventional Powts Manual Version 2.0 g 16" 6 Lon 34„ Grade at System Elevation 0 , B -3 40' ❑ � � 2 -3' X 69' Cells 4 0� with >3' Spacing Vents 160' I 80' B -1 B -2 25' CIO S -S 20' Pro 3 >, Bedroom House 0 1 B.M. #2 I PLOT PLAN PROJECT P.C. Collova Builders Inc. 4DREss 705 Countv Rd E Hudson Wi 54016 NW 1/4 NW 1/4s 21 /T 3�,L / 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10 /7/01 BEDROOM 3 CONVENTIONAL )00C IN -GRO RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22 BENCHMARK V.R.P. Top of 1 " iron Pipe ASSUME ELEVATION 100° Filter Zabel A -100 ❑ BOREHOLE O WELL IH.R.P. Same as Benchmark B.M. #1 SYSTEM ELEVATION 96.0 County Road G 2L — Sidewinder High Capacity Leaching Plans Designed Using Chamber Conventional Powts Manual Version 2.0 3 4 Grade at System Elevation 0, 40 B -3 ❑ � � 2 -3' X 69' Cells 40 00 with >3' Spacing Vents 160' 80' B -1 B -2 25' S I Cq 2 0' Pro 3 >, Bedroom House 0 B.M. #2 R Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County cw Attach cotnpteta sda plan on paper not less than 8 1/2 x 11 inches in size. Plan must r 1 - include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.U. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner /� Property Location x/ �l) tn. 4 � ��� ,� Govt. Lot ��1I4�1 /A / T N R (J E (or)�YY� Property Owner's Mailin ddress Lox # Block # Subd, Name or CSM # c ity State ZW ne Number ❑ City E] Village Town Nearest Road -5YOl rGene Construction Use: Residential / Number of bedrooms _ _ Code derived design flow rate _ GPD ral placement f PubHc or com erciai - Describe: t material G,c/ Flood Plain elevation if applicable comments ;—�� and recommendations: � /,5 / ,��.✓ `� Z044e� © Boring # Boring /� it Ground surface elev / �[,,,__, ft. Depth to limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'E11#2 2 `M'' S , -r 4 F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots . GPD1ft In. Munsell Qu. Sz. Cont. Color Gr. Sz, Sh. *Eff#1 •Eff#2 " Effluent #1 = BOD > 30 220 mg /L and TSS >"o mg/L ` Effluent #2 = BOD 30 mg/L and TSS < 30 mg/L CST N (Please P ) gna re CST Number S � �, G.� Address Date Evaluation Conducted Telephone Number MD -9330 ra07/001 PLOPL N PROJECT P.C. Collova Builders Inc. A D s 705 Countv Rd E Hudson Wi 54016 NW 1/4 NW 1/4s 21 /T 30 N/R/�/ W TO # N Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/7/01 BEDROOM 3 CONVENTIONAL XXX IN- GROUND P SURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22 IL BENCHMARK V.R.P. Top of 1" iron Pipe ASSUME ELEVATION 100 Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P Same as Benchmark B.M. #1 Prope Line SYSTEM ELEVATION 96.0 Vent > 12" Sidewinder High of Cover Capacity Leaching Plans Designed Using Chamber Conventional Powts Manual Version 2.0 6' Long 16" Grade at System Elevation .54 �, v►�' _ ! 0 , B -3 40' 2 -3 X 69' Cells 40 B -4 with >3' Spacing Vents 160' ft 80' B -1 B -2 25' S � N 20' Pro 3 Bedroom House 0 B.M. #2 Wscort ,Department of Commerce SOIL EVALUATION REPORT Page l of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must S4 • r Ul include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and loca " ance to nearest road. Please print all i ed by Date Personal information you provide may be used for nd purposes rivacY Law ,a: 04 (1) (m)). 1 4 Property Owner ,,1 _ d e CEIV Pro Location R tv ar S GW t 1/4 1/4 S ( T_ N R( E (or)® Property Owner's Mailing Address MAY I Lot #.; Block # Subd. Name or i�.0. 6ox 10 (0 "� ST CFOX -j:: Gol��iew Acres State Zip Code ` N ❑ Village [Town Nearest Road MN*4GOFFtCE d:.+ �J' , 1 4 4 a -6 y �., Ch Mona ® New Construction Use: ® Residential/ Number Code derived design flow rate 415 (0 1 ) C ) GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material NA- c- 511 Flood Plain elevation if applicable AW ft General comments 5YS4e vv\ e I e u• 9G • 0 v and recommendations: At,}. e(ev. `l'�v • od F-1 I Boring Boring # 99 v ® Pit Ground surface elev. ft Depth to limiting factor. 1210 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. i *Eff#1 *Eff#2 0 -(4 /D Z — 5; GS I vy .8 Z �V --310 /b r•y /y s;i Zo-w bk rryG- cs g 3 :;t ,D r 41 tP / . Z Boring # E] Boring F ® Pit Ground surface elev. 10 0. 0 ft Depth to limiting facto in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Lure Consistence Boundary Roots GPDAf in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 'Eff#2 i 0 -12. / 3/Z s;/ 2n c- <' 1 VC . s • 8 2 iZ -3z /U r y Iy 5 11 2 rreb k m cs 3 /d yA - MS Os m 1 — _ /. Z. * _ ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 BOD < 30 mg/L and TSS < mg/L CST Name (Please Prim) ature CST Number Acdom Sch ker �. 2533c� Address Date Evaluation Conducted Telephone Number 2.u3 Somerse W l 5JAOT -5 S— 8 -0 C 15) Zy -1 -AI00$ I Property Owner N e Son Parcel ID # Page 2 of 3 F31 Boring # Boring ❑ O X Ground surface elev. q9. ft. Depth to limiting factor in. ❑ pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stnxture Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 I -� 2 ry� c s 14 5 $ 0 -14 3 - 2 37- -)6 10 y� m S 1 1 . 2 ❑ Boring # ❑ Boring E] Pit Ground surface elev. ft Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 F1 Boring Boring # Boring ❑ Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Lure Consistence Boundary Roots GPDtfF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg(L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777. sBn -W30 OL07ro0) PAGE - -�_OF_ NAME A] LOW1 ( LEGAL DESCRIPTIONN w ' /4A)w' /a,SLf T ,N If, E (or)(V SCALE: 1 "= BM I ELEVATION /acs . BM 1 DESCRIPTION e. -e + BM 2 ELEVATION G 7 76 1 BM 2 DESCRIPTION 424 al / ` .I eoA�'�� SYSTEM ELEVATION '76 -00 ALTERNATE ELEVATION ?'6.06 CONTOUR ELEVATION Zz S/ o�oe t3 -3 ■ ■ P r; ,{,A. ■ g -1 � /y 5ha '1 �V 1� SIGNATURE DATE .S /G T i O D � b d w m r $ u 41b LLr mr m 86 s C/ ) i S O y O GG� G q Y m _ CCC O p Y O i N � � g ' LU W rn ci u a IL I I I � � V ��rg pmt o z LL W Elf CA I m ` gar m � Z w O [] i > ® O." tL W z "` _ CL m � f- J 0 V M U) z Z J N z �C 52 m o ® LL W �/ go MEMO Cl) z �r Q r Q z I 0 M z C/) w 0 W i2 w FM ui _ LL � W 0 w Z p a. LL UJ m0 . i W Z 4 z w ❑ - IL m " j0WZ _ �9 Td Wd8S:20 TOOE L, '6no TTSS 6VS STZ : ON 3NOHd ON? `RMS HnO7000 0 d W06A Ale gri? Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. 1 4sconsin See reverse side for instructions for completing this application PO Box 7302 Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce (Submit completed form to county if not [Privacy Law, s. 15.04(1)(m)] state owned.) Attach complete plans (to the county copy only) for the s Qn paper not less than 8 -1/2 x 11 inches in size. County r ' _ State Sanitary Permit Number 101 c� i re Qn to pfev ous application State Plan I. D. Number I. Application Information - Please Print all Informatio /' 1 Location: Property Owner Name y� r � /! > Property Location t.. . N"A W114, S /T 30N, R� o W Property Owner's Mailing Address s t {, r r ��}�' Lot Number Block Number City, Siate Zip Code G P Subdivision Name or CSM Number 4, ac", tl� S 't: ) -971 II. Type of Building: (check one) \ 1 1 c; ❑ City X - 1 or 2 Family Dwelling - No. of Bedrooms: ❑ Village ❑ Public /Commercial (describe use):_ ;'Town of L 7 -=L�� ❑ State -Owned — /© � C-2- z x V o.- > Nearest Road III. Type of Permit: (Ch only one box on line A. Check box o n line B if applicable) A) 1. IANew 2. ❑ Replacement 3. ❑ Replacement of 4. 5' / - - Addition to "S ystem System Tank Only �, E sting System $) Permit Number e ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) j� Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland �a Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Informa 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /daylsq. :) (Min. /inch) Elevation yIo 377 /, d y� � go VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks -- a ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigne assume resp onsibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) Plumber's n e o Ms PRS No. Business Phone Number Plumber's Address (Street, City, State, ip Code) Yo IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Is ' A ent Signature (No stamps) Approved ❑ Owner Given Initial Adverse Surcharge Fee) 21 � b \ Determination ?i2� 0 (� 8 X. Conditions of Approval /Reasons for Disapproval: I Q� Li i5 3up �, To w•ct v `f �a � I 1 ' 1 1 SBD -6398 (R. 07/00) Cj L150 6-PP BA 3 = 9q.76 � 7- T 1 �1 i 23 1po wu.(�5 �, �--� - w • . , W I C tk 6D 1•tR. ��� 'FIT �I ao as J Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number ZZ Number of Bedrooms 3 Design Flow - Peak (gpd) `/SO Estimated Flow - Average (gpd) Septic Tank Capacity (gal) 60 o 0 Soil Absorption Component Size (ft Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Zmponent Design Flow - Peak (gpd) CO Q Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 Absorption Component Management Plan for a Septic Soil Tank and Plantings of deep-rooted trees and shrubs direc�iy over or within ten feet of the component Went should be the c om p onent may obstruct wastewater avoided since root intrusion into flow. S ova N nn C7 5) 1 SI' CROIX COUNTY SP_I'TIC 'TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer _ �, � . t b 110VA 8 (11 tt S �_ AJ < I — Mailing Address - 7Q 00. P C— / lv�su.v LV L Property Address �� g 11�2 /1 (Verification required from Planning Department for new construc(ion) City /Slate _ NEC° R ��(-I/ t&/,/ . Parcel Identification Number tu,T- LEGAL DESCRIPTION Property Location A14 Y, _44, Sec. , T I& N - R /Q W, Town of f1 tCHMo jj_ Subdivision V d t�1 t,y C � S Lot 11 -�— Certified Survey Map it Volume P age It Warranty Deed It C� , Volume Page # d Spec house ❑ yes )'_no Lot lines idcnlifiableX yes ❑ no SYSTEM ]WAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. 'Ilse property owner agrees to submit to St. Croix Zoning Department a certification roll,,, signed by file owner and by a rr jouracynran plumber, restricted plumber or a licensed pumper verifying that (1) the oil-site wastewater disposal system is in proper operating condition and/or (2) after hrspcetion and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwc, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as act by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification n stating that your septic system has been ,ah,laincd must be completed and returned to lire St. Croix County Zoning Office within 30 days of the three year expiration date. 4 SINA � T ; UURE Or APPLICANT DATE OWNER CERTIFICATIO I (we) certify that all stalen,enls oil this torn arc lnre to (lie bcsl of my (our) knowledge. I (we) Bill (arc) the ownci(s) of ;1ZGNAT1U;1. escribed above, by virtue of a warranty decd recorded in Regislcr of Deeds Office. Or APPLICANT DATE * * * * ** Any informatioi, that is n►is- represented n,ay result in the sanitary pem,it being revoked by the Zoning Department. * * * * ** ** Include `vilh tilts applicallon: a stamped wairanly dccd fiom the Regislcr of Deeds office a copy of the certified survey map if reference is made in the warranty dccd 08/08/01 WED 08:01 FAX 715 386 4687 REGISTER OF DEEDS 0 001 ST/!'CE BAR OP "L'1 1 .% 2-1999 KATHLEEN H. WALSH WARRANTY Y REGISTER OF DEEDS Ducumant biumbtr 9T. C1?ITx CO., loll This Deed, made between Hillva lo,Devslopv' ent L6 ,d, s RECEIVE4 FOR REM - 0 ota Limite Liability Pse 08 -07 2041 9:30 Min F� .. .. ..— _.., . LIA MTY DEED Grantor, and F. C. f Collvver Buil Inc., 8 Mrrt Co ' ora tion, . 1 rp _ MT COPY FEE: — CORY FEE. —_ -... TRIOISM FEE: 780 30 _- REC101116 M 10.00 . pAGESr 1 Grantee. Grwitor, for a valuable consideration, conveys to Grantee the following described real estate in St. C County, State of Wisconsin (if more space is needed, please attach addendum): Reccrding Arta Nmne and Refum Address Lots P ew ' 3, 6, 7, 29, 30, 31, 32 an 33, EAV1D J. ESTREEN Golf V Acres, Town of Richmond, St. Croix County, Wisconsin. 304 L OCUST WI 54 016 T T. HUDSON, Pt 026 - 10 12.50 _ Parcel identification Number (PN) This is not hotnestead property. N) (is not) Irxceptions to watmties: Easements, restrictions and rights-of-way of record, If any. Dated this _ r' 9 day of Jane 2001 Milvale Development Limited • Bye R ichard Nalson AUTRENTICATION ACKNOWLEDGMENT Signatures) _ STATE Of WISCDN6IN } • } ss. " St Croi County } authenticatcd (his day of _ •._. Personally came before me this ',-o " day of June 2001 the above named Yilifvale velopme Limited, a lYGnnutrts Limited Liabili �. Partn is � "�bJ o ' s. Krishna lend Richard Nels .._ ... TITLE.- MEMBER STATE BAR OF WISCONSIN � rson(s) who c x to ccuted the f0ro90irtg (If not, iri gad the same, authorised blf § 746,06, Wis.,Stvts.) : THIS fNSTRUMF.NT WAS DRAFTED BY Attorne Kr 1b istina Og land _ _ N Hudso isconsin M "� anent, (If not, state expiration date; .. . (Signatures may be authenticated or acknowicdgcd. Both are not accessary.) — • — Names orpersons signing in any oqaclty must be typed or printed below their signature. IrlwMat9m prokofflo .8 compwy, Fon du Let N 8x21 WARRANTY DEED STATE BAN OF WISCONSIN NORM No. 2.1999 Nf',IY TR HIGHWAY 0'» ' "E 1066.0 1309. 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