HomeMy WebLinkAbout026-1071-40-000 41sconsin Department of C erce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Divisio
INSPECTION REPORT Sanitary Permit No:
399683 0
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. Richmond Township 026- 1071 -40 -000
CST BM Elev: Insp. BM Elev: BM Description:
orb /� /,�,,r_ Lx ,��'n sr
c�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark /
Dosing Alt. BM
i z�r f 2. 3 C-
Bldg. Sewer
Aeration
411 -,
Holding Ht Inlet 4 i'
C'
,
St/Ht utlet we. e. (1-
TANK SETBACK INFORMATION Shot n %Jt ,� 0lJkf ��
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inl
Septic �% i r > Dt Bo
t ET /L n? c�
Dosing Hader /Man.
C C v e iq_ j --
Aeration Dist. Pipe L_ ' 6
Holding Bot. System to 5 X1 3
s __ i
de f
PUMP /SIPHON INFORMATION Final "1,' �- Y, yy 6
Manufacturer Demand St over
5
Model Number
TDH Lift Frictio ss System Head T H Ft
Forcemain L th Dia.
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSI No. Of Pits Inside Dia. Liquid Depth / I DIMENSIONS - ::5, T / , 1� _
SETBACK SYSTEM TO / / P/L JBLDG IWELL LAKE /STREAM LEACHING Manufactu
INFORMATION HAMB R -1-n } 'f�f R -fa ✓ r V >lrt
Type Of System: t UNIT Model Number:
-/079
DISTRIBUTION SYSTE v ` { _ (tOmct v �� �'!,� f �� �5 �'/m!a�?, -s >�i11-C1
Header /Manifold j-,e", Distribute x Hole Si e x Hole Spacing Vent to Air Intake
Length Dia / Length Dia Spacing t!Y
_ SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over — ooP , h < e-_-7 F Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bedrrrench Center Bed/Trench Edges Topsoil Yes No Yes No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / /�'rrloobk L Inspection #2:
Location: 1419 143rd Street New Richmond, WI 54017 (SE 1/4 SW 1/4 24 T30N R1 8W) Eve4ed Ov Lot 17 Parcel No: 24.30.18.947
1.) Alt BM Description e -k
2.) Bldg sewer length = %/
- amount of cover =�
Plan revision Required? _] Yes No
Use other side for additional information.
/
/ Date ( w� Ins 'sS+gEiature Cert. No.
SBD -6710 (R.3/97)
`t-
Y V
S
FIN
NFL
S rtI �e'l / '4 S '
e ldings Division County —
201 W. Washington P.O. Box 7162 A
�seonsin Ma r o ii,3m , WI 53707 - 7162 Site Address
Department of Commerce S
Sanitary Permit Ap lication Sanitary Pernntt Number
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide fR v ` 3
Check if Revision
"
may be used for secondary purposes Privacy Law, s15. 1 m
I. Application Information - Please Print All Information State Plan I.D. Number
Property Owner's Name Parcel Number
Property Owner's Mailing Address Property Location
Ll ^.
City, State Zip Code AP P Lot Nyt�tber Block Number
1 R OI , COUNTY Subdivision Name CSM Number
f. 1/ i Z NING OFFICE
II. Type of Building (check all that apply) ❑City
r 2 Family Dwelling - Number of Bedrooms , []Village
❑ Public /commercial - Describe Use nship
❑ State Owned l I Nearest Roaa
z R 3.7S ' 1
M. Type of Permit: Check only one box on line A (numbering scheme for internal use). Complete line B if applicable)
A
New 2 ❑Replacement System 3 C1 Replacement of 6 C1 Addition to For County use
stem Tank Only Existing stem
B. I 1KCheck if Sanitary Permit Previously Issued Permit Number Date Issued
Z Zpp Z
M of Permit: (Check all that apply)(numbering scheme is for internal use)
on - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland
22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line
45 ❑ At -Grade 46 ❑ Aerobic Treatment 1Vnit 49 ❑ R sting 30 ❑Other
V. Dispersal/Treatment Area Information: 0. - Sot
Design Flow (gpd) Dispersal Area Dispersal Area Soil A icalion Percolatio Rate stem Elevation Final Grade
Required Proposed te( /Days/Sq.Ft.) (Min. ) Elevation /
C — q �S) 'D 0 o I f VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanks Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank
Dosing Chamber
VII. Responsibility Statement- I, the undersigned responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber' i MP/MPRS Number Business Phone Number t
! ! n /�J_ /
Plumber's Address (Street, City, State, Z' e)
VIII. County /De artment Use Onl
Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps)
Surcharge Fee)
❑ Owner Given Initial Adverse
Dete � 'on 5� • �' 3 Z�
IX. Conditions of 4proi easons for Disapproval
Attach complete plans (to the County only) for the system on paper not less than 8112 x 11 inches is she
SBD -6398 (R. 05101)
LOT PLAN
PROJECT P.C. Collova Builders Inc. ' ADDRESS 705 ctv Rd E Hudson Wi 54016
SE 1/4 SW 1 /4S 24 /Tj R 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 2269 DATE 3 /31/02 BEDROOM 3
CONVENTIONAL )00( IN- OUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE •9 ABSORPTION AREA 514 # of chambers 30
IL BENCHMARK V.R.P. Top of Power Box ASSUME ELEVATION 100° Filter Zabel A -100
❑ BOREHOLE (DWELL •H.R.P. Same as Benchmark
SYSTEM ELEVATION 94.4'
Alt. BM Top of Telephone Box @ 100.1' Plans Designed Using
Conventional Powts
*
B.M. 143rd St. Manual Version 2.0
Tested area has
15' B- 1 %Slope 2 -3' X 94' Cells with >3' Spacing
Vents
5 '
0 '
&3 -3
100 Vent
L�11 > 12" Sidewinder High
Pro 3 ?6'Lonjg Capacity Leaching
Bedroom Chamber
B -1 40 House "
Vents 3499 Grade at System Elevation
Not enough slope to
establish contour lines
4PLOT PLAN
PROJECT P.C. Collova Builders Inc. ADDRESS 705 ctv Rd E Hudson Wi 54016
SE - 1/4 SW 1/4s 24 /T. % iR 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226909 DATE 3/31/02 BEDROOM 3
CONVENTIONAL XXX IN- OUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE .9 514 30
N E LOAD RATE ABSORPTION AREA # of chambers
BENCHMARK V.R.P. Top of Power Box ASSUME ELEVATION loo' Filter Zabel A -100
❑ BOREHOLE O WELL 'H.R.P. Same as Benchmark
SYSTEM ELEVATION 94.4'
Alt. BM Top of Telephone Box @ 100.1' Plans Designed Using
Conventional Powts
4� 143rd St. Manual Version 2.0
Tested area has
ope 2 -3' X 94' Cells with >3' Spacing
Vents
0'
-3
100 Vent
ST A5ng Sidewinder High
1 Pro 3 Capacity Leaching
Bedroom Chamber
B -1 40' House 6"
Vents 34„ Grade at System E levation
i
a�
a�
0
Not enough slope to
establish contour lines
2
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code /1
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
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)).
' :L� I , S Zoi)
Property Owner n Property Location
• 1 14 . L p //D �� F l a & , Govt. Lot , j e 1/4 �I /4 S � T - N R E (or W
Property Owne(s Mailing Address Lot # Block # Subd. Name or CSM#
G C. p t
City State Zip Code Phone Number ❑ City ❑ ViNage wn Nearest Roaq
4,z" L.; U ) I /y - s , c S4 -
' New Construction User' Residential /Number of bedrooms Code derived design flow rate y GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material _ dvftdrr.Q�� Flood Plain elevation if applicable
General comments �[ f
and recommendations: r l
Y'�� �1t7
F T] Boring # E] Boring
El 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/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
a -412- �� S S �.
z �. s �
�o
Boring # ❑ Boring f
® &Pit Ground surface elev. � 1 /ft. Depth to limiting factor ! in.
� /�;" 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 I `Eff#2
0 -1 r l -3 / 5 1'Il L' �- a .3 -�
2, i57-3o 0 0 tt .3
88
Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 _< 150 g/L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L
CST Narp (Please Print) ature CST Number
+✓ 66
Address Date Evaluation Conducted Telephone Number
6Lq,5
SBD -8330 (R07 /00)
Property Owner Parcel ID # Page of
F-31 Boring # Boring
pit Ground surface el j _r ft. Depth to limiting factor 1 in.
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 'E
S 1 1 /1 0 1.1
Z z -3 G
` ct . z
F-1 Boring # [] Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
FS7W 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 'Eff#2
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 GPD/ft
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 = BOO, < 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.
SBD -8330 (R.07 /00)
Y
: Soil Test Plot Plan
Project Name P.C. Collova Builders Inc. Shaun B'
Address 705 cty rd E
Hudson Wi 54016 CSTM #226900
Lot 17 Subdivision Evergreen Date 3/31/02
SE 1 /4 S W 1 /4S 24 T 30 N /1318 W Township Richmond
M Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Power Box
System Elevation 94.4 *HRPSame as Benchmark
Alt. BM Top of Telephone Box @ 100.1'
M.
B.M. 143rd St.
Tested area has
15' <1% Slope
- 0'
5'
0'
3
100
Pro 3
Bedroom
40' House
B -1
a�
c
a
0
Not enough slope to
establish contour lines
Safety and Buildings Division County r
N visconsin 201 W. Washington Ave., P.O. Box 7162 �` Madison, WI 53707 - 7162 Site Address
Department of Commerce
Sanitary Permit Application sanitary Permit N
391(093
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide Check if Revision
may be used for secondary purposes Privacy Law, s15A4(1)(m)
I. Application Information - Please Print All Information State Plan I.D. Number
Property Owner's Name Parcel Number
Property Owner's Mailing Address - Property Location
/ � -k ;S
City, State Zip Code Phone Number Lot Number Block Number
Subdivision Name CSM Nu ber
T ype of Building (Check all that apply.) ❑City
or 2 Family Dwelling - Number of Bedrooms _� ❑ Village
❑ Public/Commercial - Describe Use hi
❑ State Owned
Nearest Road
Z 3 h 6S• �S_ ► cQ9�s c� l�
III. Type o Permit: (Check only one box on line A. Numbering is for internal use.) Womplete line B, if applicable.)
A. ew 3 O Replacement of 6 ❑ Addition to
stem 2 ❑ Replacement System Tank Only Existin System For County use
B ' ❑Check if Sanitary Permit Previously Issued Permit Number Date Issued
IV - [OD POWT System: (Check all that apply. Numbering is for internal use.) - 1E
on - Pressurized In- Ground 210 Mound 47 O Sand Filter 50 O Constructed Wetland
22 ❑ Pressurized In- Ground 41 Holding Tank 48 ❑ Single Pass 51 O Drip Line
45 ❑ At -Grade 46 OAerobic Treatment Unit 49 ❑ Recirculating 30 OOther
V. Dis rsal/Treatment Area Information:
Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade
Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min. /Inch) Elevation
-2 -7;? . 1�?
3-, 11-3 &�,/, -1
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanks Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank
Dosing lumber
VII. Responsibility Statement- I, the undersign a responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumbe�Am e MP IMPRS Number Business Phone Number
l / j U �/� �' %� — �� j
Plumber's Address (Street, City, State, Zip od
VII . Column /De artment Use Onl
Disapproved Date Issued Issu' g Agent Si a (No Stamps)
Approved O Owner Given Initial Adverse Sanitary Permit Fee (includes Groundwater
Determination I Surcharge Fee) C" i- V
IX. Conditions of Approv f Di p roval
SitKl2 ►v Sirs►++ kSt+aC v��T t�t4� .X9.ac""� , N,a O . 2
-k- W2Lk- SA n_Q ao �, N� 9ct $IZ/
�•�9utieA vw,.a�lc��iKa � �eceutuA
Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size
PLOT PLAN
PROJECT P .E. Collova Builders Inc. ADDRESS 705 ctv rd E Hudson Wi 54016
SE 1/4 SW 1/4 24 /T 30 /R 18 W TOWN Richmond COUNTY ST. CROIX
�
MPRS Shaun Bird 226900 DATE 1/23/02 BEDROOM 3
CONVENTIONAL )= IN -GRO PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFO TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22
BENCHMARK V.R.P. Top of 1.5 pvc ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL ;H. R. P. Same as Benchmark
Vent SYSTEM ELEVATION 96.3
> 12" Sidewinder High
of Cover Capacity Leaching Plans Designed Using
Conventional Powts
Manual Version 2.0
6' Long 16 B.M. #2
.5 499 Grade at System Elevation B.M. #2
245' Property Line 5'
B- L
2
2 -3' X 69' Cells Vents
with >3' Spacing B-4
35'
Pro 3
'0 Bedroom 35'
House
25'
AMIN .11
T
30 , B -2 Vents50 B -5 a
COO"�
291' Property Line
PLOT PLAN
PROJECT P.E. CoIlov Builders Inc. ADDRESS 705 ctv rd E Hudson Wi 54016
SE 1/4 SW 1/4S 24 /T 30 /R 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 r DATE 1/23/02 BEDROOM 3
CONVENTIONAL XXX IN -GRO PRESSURE 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 1.5 pvc ASSUME ELEVATION loo Filter Zabel A -100
❑ BOREHOLE O WELL IH Same as Benchmark
Vent SYSTEM ELEVATION 96.3
> 12" Sidewinder High
of Cover Capacity Leaching Plans Designed Using
Chamber Conventional Powts
Manual Version 2.0
6' Long 6" B.M. #2
34 ' Grade at System Elevation B.M. #
245 Prop Line 5'
gL
20
2 -3' X 69' Cells Vents
wi >3' Spacing B -4
35'
0'
Cn 2 ` Pro 3
Bedroom 35'
House
25'
T , ,
30 B-2 Vents50 B -5
a�
a
0
0
29 1' Property Line
' 4visc64in Department of commerce SOIL AND SITE EVALUATION
Division of Safety. and Buildings Page of
Bureau bf Integrated Services in accordance with Comm 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
Include, but not limited to: vertical and horizontal reference po BM direction and
percent slope, scale or dimensions, north arrow, and location- and-di$tance to nearest road. Parcel I. D. #
APPLICANT INFORMATION - Plead pr/nt all formation:, �.� Z 'awed by Date
Personal information you provide may be used for $ pu "asj Prtya Law, s. (m)).
Property Owner ( `Property Location
�a� Col a , '
Govt. Lot SF 1/4� 1 /4,SZ �f T C,N,R E(or)0l
Property Owners Mailing Address _ -� C?.r Lot # Block# Subd. Name or CSM#
'_T C ` ar��oc4. �V��
City State Zip Code . 'Phone ' umber City Village Town Nearest Road
dson ono ' �, �; ...� .. - ���� h10 el CP 1 a�s c au
New Construction Use: residential / Number of bedrooms 3� Addition to existing building
Replacement L ]Public or commercial - Describe:
Code derived daily flow G o gpd _ Recommended design loading rate ' bed, gpd/f1 �O trench, gpd/ft
Absorption area required _ bed, ft 2 S / trench, 2 ft 2 �" Maximum design loading rate bed, gpd/ft trench, gpd/ft
Recommended infiltration surface elevation(s) G `1 / ✓ ft (as referred to site plan benchmark)
Additional design /site considerations
Parent material O Q5 Flood plain elevation, if applicable 4K/ ft
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U = Unsuitable for system [ ❑ U [54:8 ❑ U [�PS ❑ U I E � r"t ❑ U ❑ S [R'U ❑ S
SOIL DESCRIPTION REPORT
Boring Horizon Depth Dominant Color Mottles Structure GPD /ft
9 Texture Consistence Boundary Roots
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
I p -►$ J Z --- S� ( 1 rr 'i3k GS I v-C S Lj
2 'Ji I Z rn-,b i m - �i c.
Ground 7 IU r y l � L�j m� T1 )rl C S J -�
elev.
/6p ft.
Depth to
limiting . 3a
factor
7 in.
Remarks:
Boring # ` &-n b f 31 Z 1 fff.Ibk T4 CS
Z 2 i�a r yl� Z rrr m CS .s
g
yp 9 i !� r q �� — L5 I r C S 4
Ground
to Z5 to ft.
Depth to
lim it i ng
L in. Remarks:
CST Name (Please Print) Signature _ Telephone No.
Adam Sch 7t,5) Zq 7-'-16O�
Address a e CST Number
21/3 &� S4. Somerse -14 -00 253309
i
SOIL DESCRIPTION REPORT .
PROPERTY OWNER Page � of 3 '
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Structure 2
Texture Consistence Boundary Roots
in, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
a 3' I b I vir 31 Z — S� ( 2 n z mfr c_ 1 14 .5 :
Z
18-3, 14 1417 i 2 rnab k cs - S
Ground qf� rYl p
elev.
Depth to
limiting
factor
Remarks:
Boring #
l b r 7 mfr i V-�
r
S rr S
LS 1 (Y q cs
Ground
elev.
� I.8 ft.
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
) i(] 1 ,fA q s' ( 2fY79bk Y T � i CIS
Ground ;
elev.
/ 0b.QS ft.
Depth to
limiting ;
factor
('f - ' n ' Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
SBD -8330 (R.9/98)
PAGE__]�_OF�
NAME C LOT# 11 LEGAL DESCRIPTIONS '/6w'/4,S&T ,N,R(9 E (or)(�b
SCALE: F'= OO`
BM 1 ELEVATION ' 0
BM 1 DESCRIPTIO Q, �L q,,)QC ]Atk uj/F
BM 2 ELEVATION /Z. 0 5 - Z �
BM 2 DESCRIPTION 45pp o� /z ' oc, I,ct �'� lti (af h CC
/ 2 1
SYSTEM ELEVATION
ALTERNATE ELEVATION
CONTOUR ELEVATION
0
U
�64
I
I_
SIGNATURE
DATE ���
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the fiker.
3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of
the cells.
4. Owner agrees to limit groases, garbage, and water conditioner discharge into the system.
5. The owner agrees to save this plan.
6. Do not plant trees nor park nor drive over system.
7. Watershed is to be diverted away from system.
8. Discharge into system is not exceed those required as per Comm. 83
Contingency Plan
1. If system fails, determirm) cause of failure, use alternate area and install new system or
install system at a lower elevation.
2. Replace any other failing components as needed.
Plumber: Shaun Bird 715.246 -4516
Shaun Bird #226900
sT CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSIiIP CERTIFICATION FORM
Owner /Buyer t U OVA 6 1� 6 S - AJ <.
Mailing Address — 70J Lu
Property Address
(Verification required from Planning Dcpartmcnt for new construction)
City /StatC D4Z Q,jUh,��, - Parcel Identification Number
LEGAL DESCRIPTION
Property Location�f ', ' /,, Sec. ZK , T 3 N -R W, Town of \CJt WYtaYIIJ�_
Subdivision 1 Lot If
Certified Survey Alap it , Volume Page If
Warranty Decd If Gya335 7 Volume 1 Page It a
Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no
SYSTEM MAINTENANCE
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.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the ou -site wastewater disposal system
is in proper operating condition and/or (2) after imspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
sct forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days o e three year ex iration date.
TTJRE Or A GNA AP L CANT ATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (wc) am (are) the owncr(s) of
the pro ty described a ve, by virtue of a warranty decd recorded in Register of Deeds Office.
� Pq SIGNATURE OF APPLICANT / DATE
* * * * ** Any information that is nnis- represented may result in the sanitary permit being revoked by the Zoning Department.
*" Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty decd
FROM P C COLLOUA BL DRS • INC PHONE r NO 15.549 5911 Jul. 21 2001 01 54PM P i j:
.n ri.
Ui.'05r00 TUE L3:33 FAX 716 M 4687 <UGISTIM OF DEEDS wool
vs: 15VT=242 /D
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FOUND 1' STEEL MONUMENT
N 1/4 CORNER SECTION 24
TEMPORARY CUL -DE -SAC Fil Z t f 1 %/
EASEMENTS (REMOV E UPON � NORTHERLY EXTENSION OF ROAD) NORTH LINE SEt /4 -SW1 /4 1300.25' N89'40'38 "W
333&4' 314.31* 292.00
.3 � 66 00 222.00'
LOT 20 ti LOT 1 942.25' -- LOT 10 I i �j
44796 50. FT. �n I I I �; I 1 I LOT 9
bi 1.03 ACRES f 44719 SO. FT. a 48764 S0. FT, 1 ;�, �'�', ,e j 46764 S0. FT. $ } Q U
2 S 1.03 ACRES 1.12 ACRES I l 1.12 ACRES - T r _ t
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OT 21 �'' 74 g I JOINT Ca
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/ \ 48004 50. Fi. LOT 11 I I LOT 8 / ( , __ � a ; 1
/ \ 1.10 ACRES R 4380 SO. FT' 8' I 4 800 SO. FT. $ ``� _
1.01 ACRES I SCI IS 01 ACRES R
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\ I 32'4a1v 24229 S89140'WE 222. $ I *T40 30 222.00
LOT 22 \ 2 ® / LOT 17 I I R
4 4 18 ACRES \1 2 124 / 44308 Sq. Fi. $ LOT 12 RI t 1 r $ I LOT 7 g
1.02 ACRES 43800 S0. FT. _ S 4 800 SO. FT.
R I i I S 1.01 ACRES i I it I .01 ACRES
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trto Set 292.00'
1 SaP40'38t 291.e0' I Sar40'38t 292. I 40'3et 292.00'
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LOT 23 I 74 4 4'_
I 3F 3F I LOT 16 LOT 13 gi , I8 I LOT 6
44 195 SO. FT. I 43746 SO. FT. g L I 8
1.01 ACRES v _ I 1.04 ACRES Si 43800 SO. R' 43800 SO. FT. R I w
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11 O0 84098 S0. FT. 56583 SO. FT.
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LOT 26 N
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\'� u5.te' ONUMENT ELEVATION
990.2 (ASSUMED)
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: 1
! 4 /Q / wale. Eevulian 603.00' S89'48'34 "E SOUTH LINE SEl /4 -SW1 /4
/ 04/19/96
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