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HomeMy WebLinkAbout026-1141-01-000 ,nsiri Departmlit of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix y and Building ivision INSPECTION REPORT Sanitary Permit No: 420688 =NERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: ,rsonal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. ermit Holder's Name: City Village X Township Parcel Tax No: P.C Collova Builders, Inc. I Richmond Township 026- 1141 -01 -000 CST BM Eiev: Insp. BM Elev: IBM Description: 11 � SectioNTown /Range/Map No: PVC _ 491;7 / 33.30.18.1005 TANK INFORMATION ELEVATION DAT TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic /DO 0 Benchmark Dosing b Alt. BM Aeration — - Bldg. Sewer�� Holding St/Ht Inlet - O TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 25 f 1 , Dt Bottom 1 Dosing oc /' ea er /Man. Aeration ist. Pipe n I p�Uq� Holding Bot. System 1 D. y 13.1 (oS Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM 3, Model Number TDH Lift ion Loss System Head TD Ft Fo ain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Widt 3 ' Length y No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P /LS BLDG WELL L , E/ TREA LEAC Manuf rer: INFORMATION Ty Of System: CHAMBER O 8% to _ \ s o r Model Number: DISTRIBUTION SYSTEM / / (, tv,yJ M Header /Manifold Distributions / x Hole Size x Hole Spaci� Vent o Air Intake � r Dia It Pipe(s) 1 �""( / 4 '7 7 �� _/ A 0 1 1-ength 1_ Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only d Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center L q Bed/Trench Edges Topsoil Yes (� No Yes % No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 15 - 1 03 Inspection #2: Location: 1218 116th St New Richmond, WI 54017 (SW 1/4 SE 1/4 33 T30N R18W) Duck Pond Escape Lot 1 Parcel No: 33.30.18.1005 1.) Alt BM Description 2.) Bldg sewer length = ,� ' , ,4.k/ /,t�>�, p�(,d - amount of cover = ; 4 / Use other side for additionalinformatio� Plan revision Required? (y f% c Date Insepctor's ignature Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 Co Vi s nsin Madison, Wl 53707 - 7162 Sanitary Permit Number (to be filled i n by Co.) Depart of Commerce (608) 266 -3151 &r Sanitary Permit Application state Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal ' o /") may be used for secondary purposes Privacy Law s1 0 = E D Project Address (if erent than mailing address) I. Application Information - Please Print Au Information APR 1 4 2003 4 /l!o � S T Pr� - Owner's Na me Parcel / Lot y Block y 5T. CROIX COUNTY / e C m o 0 C<, ZONING OFFICE Property Owner's M ailing Address Property Location j i3 04 V F 7 SCJ 'A, sic �A,Setxion 3 -3 City, State Zip Code Phone Number .sy�. T � (tarcle H. Type of Building (check all that apply) N; R W 3 �!�� Subdivision Name CSM Number or 2 Family Dwelling - Number of Bedrooms t'- 4 e ❑ Public /Commercial - Describe Use a F - — e ❑ State Owned - Describe Use ❑City_❑Villa eX90.hip of`X III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A, w System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal it Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner U /_ p� �l -3 IV. Type of POWTS System: (Check all that a 1) oal< J 8 )Xlv - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Fi lter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ aung -Sand Filter r ❑ Recirculating Synthetic Media Fitter g Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain V. Dis rsaUTreatment Area Informati n: Design Flow (gpd) / Design Soil Application Rate(gpisfZ Dispersal Area Required (sf) Dispersal Area Proposedlsf) System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab site Seel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersign , e responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber' Lure MPIMPRS Number Business Phone Number Plumber's Addre ss (Street, City, State,vpew VIII. /De enf Use Onl ermit Fee (inc Sanitary P tides Groundwater Dat Issued inApproved 11 Disapproved S Fee / /� ❑Owner Given Reason for Denial J U ' 7 / ` S d IX. ConditLons of Approval/Reasons for Disapproval 6 -4- CX A- t vw 5� �6 dc t Attueh ctm plans (to the County only) for the system on paper not less than 81f1 x 11 inches in size SBD -6398 (R. 01/03) . 1 AN d S PLOT PLAN PROJE P.C. Collova Bldrs. Inc S P.O. Box 489 Somerset Wi 54025 SW 1/4 SE 1 /4S 33 /T 30 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 4/11/03 BEDROOM 3 CONVENTIONAL M IN- GROUND PIWSSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambe 30 BENCHMARK V.R.P. Top of 2 " PVC Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL 'H. R. P Same as Benchmark 487' Property Line SYSTEM ELEVATION 93.0/92.8 6' Below Grade Vent 202' P.L >6 „ Standard Biodiffuser of Cover Leaching Chamber with 31.1 ft2 of Area 6' Long 11 " 34" Grade at System Elevation Plans Designed Using Conventional Powts Manual Version 2.0 Setback from pond was measured from highest observed water elevation 20' Pro 3 S Bedroom �,�� y House GAG , o 0 20 , 2 -3' X 94' Cells with >3' Spacing Pond ` 1% SLope 0' 50' 25' B -3 not enough slope to establish Vents 1 contours Vents B -2 B -1 5 ' � 5 _ 1 from drainage easement 15' 515' Property Line B. l stagy CA Hinos Hi�JON .11,92.00 N ;26 ,9L 69l ,99 ZOZ SO 06Z� o / O rt O D V rn D� -- OC D > Z o O Z D A 0) Q C O C cp Z r ° �� N , 0 K:oo r N a � i m I No ID MM Z m 1 00 C) s 4 D Tl N Crl V) F m 110TH S o z 0 n n � i 00 :j Z C O O 0,I K Z Z f \ �4'" `5 Ir y NO O N z �Crl = LA N I D (n rn z 6 D L� z v rn I ten - m : LA •, ?.. J � g6 O cD � W r ry U' _ £ L' 6 30 / O cn cn 0 ,92.00 s D D� 0 ,', ,L��2i,LSC 3a3 HS.9t1 ° o o Q 99 t6 " o ,.Oti,92.00 Z O 0 0 o ,,, m C v mKM O hp w mr ° CC N c lu N fTl 11) o W in > m XC m s/ �I `{ rn m 084 0 /��' / Oo O Z o z m➢ ?3• cb v a z LO Ao\1 , Ln / ti o - S 03 W 33204' - 9 5 123.45' q / �O r 08 Z9 / • $ / � � 9 1,g� q L �M..l£.Z CO r cn V) �ti I n I c 0000 I �"� 0 �I � c 5 Z ab- O I N O C D CpN 00 M to RECEIVED APR 1 5 2003 wisoonsin Depm*nw t of Cananerce 0I4 T,MN R PORT Page / of Division of saw and Builaw v c in accordenoev CarriY Attach complete S y s Plan on paper not less than 8112 x 11 Inches in sue. Plan must include, but not llndted to verbs d and horoxt;at reference point 0". dkedton and Parcel LD. / U percent Aope, scale ordknerrsions. north amow. and locoon and dance to nearest road 0 ` r PIM" print au informatfan. Date (f Persarat Mton when Yau Provide m9 be used for seeon"Y PKPMM thWSY taw. s 15.04 t (m)b � U3 Pn7� �1Br proPery IApUOn 1 S T ,//��N R E( jf ' )1 l4 C/ c (� • `-'D /to fJ t '�..A ` GOER. Lot � K/ l4✓ ,.W l,. at Bloc k# IC # Kane ME P(t8 1 L.� CS IM e m wL (✓ Town Nearest Road � state, 40 Cade Phone Ntrruber ❑ �Y '�l (� /►GttY�� �-�• S �i Boa erv" C"Struclion Residential / Number of bedrooms - Code derived design flow rate GPD ❑ Replacenwt ❑ PLMc commercial - Describe: Parent maladai 15 u , f Flood Plain elevation if big — - _— - -- ft. / / _ _ �jecommendgdons: -S , s k✓ e.� •� /� � /`� / Ob i r J ❑ 8aft Eg Pit Ground s�0e Nev �it Depth b factor in. Sol Rate Horton Depth Dominant Color Redox Desaiprion Tex4ae Sbucture Canso Boundary Rook GPDW in, Liunsell / fro. Sz. Cont. Color Gr. Sz. SK *M1 *E1192 I 0 ° 6 o ,2 z / o f d,,-- I ' J r Z 01 Baft ptt Ground surface eltv. n Depth to *Wft factor iru. Sol Application Rate Haim Depth DomkwtC010f Redox Desai &m Taxtue Stmckae Carrsislanae Boundary Rods GPDW h Mtffmd pLL Sz, Can. Color or. Sz. Sh. 'EM" *EM2 S7 r d i, EtAuent #1= tjaD > 30 < M nV& and Tss `30 - Effluent = BM ,: S 30 mgl� and TS5 <_ 30 rrtglL csrNr.r�er ` Please RIA ACV — "A-1 / r Dare Evaluadon Conducted Telephone Number adaress Lge-o / — Property Owner Parcel ID # page Z of F3 Boring # ❑ Borft ,a pit Ground surface elev. 4 ' 2 R. Depth to rm" %caor in. Sod icatian Rye Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDJff° in. Munsell Qu. Sz Cont. Color Gr. Sz Sh. 'Etf#1 'Eff#2 p d7 F-1 Boring # p Borin ❑ Pit Ground surface elev. ft. Depth to knVft factor in. Applicat Raga Sol Horizon Depth Dominant Color Redox Description Texture Shuctu a Consistence Boundary Roots GPDNf; lo. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. •Eff#1 '092 Boft # ❑ Boring F ❑ pit Gtourxi srface elev. ft Depth to Fmiting factor in SoN Application Rate Hodam Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDNf 'rrr. Munsell Qu. Sz Cont Color Gr. Sz Sh. 'Eff#1 '002 • Effluent #1 = BOD, > M < 220 rrg& and TSS >30 < 150 mglL ` Effuent #2 = BM, 130 mg& and TSS < 30 mglL 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. seauw(RAM) r AN d System PLOT PLAN PROJE P.C. Collova Bldrs. Inc. S P.O. Box 489 Somerset Wi 54025 SW 1/4 SE 1/4s 33 /T 30 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 4/11/03 BEDROOM 3 CONVENTIONAL M IN- GROUND P SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambe 30 ,BENCHMARK V.R.P. Top Of 2" PVC Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P Same as Benchmark 487' Property Line SYSTEM ELEVATION 93.0/92.8 6' Below Grade Vent 202' P.L >6 » Standard Biodiffuser of Cover Leaching Chamber with 31.1 ft2 of Area 6' Long 11 34" Grade at System Elevation Plans Designed Using Conventional Powts Manual Version 2.0 Setback from pond was measured from highest observed water elevation 20' Pro 3 S Bedroom a 0 House 60' 20' <��u 0 2 -3' X 94' Cells with >3' Spacing rt Pond 1% SLope 0' 50' 25' B -3 95' not enough slope to establish Vents 1 contours q15' ents B-2 -1 � 5 — ' from drainage easement M 515' Property Line %sty c�—`� C�S.r�a•4.? Safety and Buildings Division County • AN 201 W. Washington Ave., P.O. Box 7082 �CO��,� Madison, WI 53707 - 7082 Sanitary Permit Number (16 be filled in by Co.) Department of Commerce (608) 261 -6546 Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide /v may be used for secondary purposes Privacy Law, s 15.04(1)(m) Project Address (i�% en ling address) 1. Application Information - Please Print All Information 11q / & RECEIVED 33.3 / F / s- Pro Owner's Name P cel ��., .SG t %., Section # Block # FER U01 Pr Owner's Mailing Address P perty Location T `� ST. CROIX COUNTY ' _ City, State Zip Code LAJ `� 5g0a (circe II. ype of Building (check all that a 1 /I T, N; E or 2 Family Dwelling - Number of Bedrooms Subdivision Name �CSM Number ❑ Public /Commercial - Describe Use �" ? O " / 13 `'/ t Q ,A5_ ❑ State Owned - Describe Use ;z 3 y 61 /,;7 ❑City _ ❑Villag wnship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. System Replacement System System ep y ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that apply) TA-L_ g�� 1 — 3) �E✓ X 'Non - Pressurized In -Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand filter Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching hamber ❑ Drip Line g p ❑Gravel -less Pipe ❑Other (explain) Z, V. Dispersal/Treat ent Area Information: l Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (so Dispersal Area Proposed (sf) System E1e ti n S pS -? VI. Tank Info Capacity in Total Number Manufacturer Prefab Site fStecl Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank x, + to Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersi ed, s me responsibility for installation of the POWTS shown on the attached plans. Plumber's ame (Print) Plumb Si re MP/MPRS Number Business Phone Num J Plumber's Address (Streit, City, State, Zip r J 2�� 2 I. oun JDe artmen se ri Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued I rng Ag t Signature amps) Surcharge Fee) s db // ❑ Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval dl� Co>7.� -dim 3 (o "-- �cx>'- -' � 3 y •, a ,� �- 1.. 9'3.92- - A ach co plet s (to the County only) for the system o ape not less t an 81/2 x I I inches in size t vZe J2, 'a-v . , ke- , Q-aA CAZ RA V4 d4. sV-rvOP- QiSEA . SBD -6398 (R. 081026) P 1q,3 —/, I !� P LOT T' PROJECT P.C. Collova Bldrs. Inc. '.O Box 489 Somerset Wi 54025 SW 1/4 SE 1/4s 33 /T 30 ; V Richmond COUNTY ST. CROIX r 2/10/03 BEDROOM 3 MPRS Shaun Bird 226900 - DATE CONVENTIONAL )= IN- GROUND P ESSURR, \ 'f'IONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallor s ; ANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RA "1'i: ., ;,)RPTION AREA 933 # of chamber 30 BENCHMARK V.R.P. Top of 2" PVC Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Sam 487' Property Line vATION 98.7/98.5 Vent 202' P.L >6 „ Standar(? of Cover Leachi; Plans Designed Using with 31. Conventional Powts Manual Version 2.0 6' Long 11" Grade �i! lv : ,ion 34" 25' 0 0 25' -1 0% SLope ! ' 50' 30' B.M. #2 Vents r- 2 -3' X 94' Cells with >3' Spacing 15' B -3 515' Property Line B.M. #1 NHI Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County � r ; Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan mutt include, but not limited to: vertical and horizontal r t (BM), direction and Parcel I.D. / percent slope, scale or dimensions, north arr aR ii �q tance to nearest road. �2(p — /� f LIZ / Re ' ed by Date Please prin rimph n. Personal information you provide may be u Te��§eco fq (Priva s.15.04(l) (m)). �3 Property Owner / roperty Location S 70 Y - Vt. Lot jtj 114 SF 114 S 33 T .30 N R /$ E (or)(9 Property Owner's Mailing Address GOO('- of # Block # Subd. Name or CSM# C ip{f } — ' Nrr �= J D uck Pon Esc City State Zip Codk -,, Y ❑ City ❑ Village ff aTown Nearest Road ( ,% }i Kic1�M0 C [�b New Construction Use: ® Residential / Number of bedrooms 3 _ y Code derived design flow rate 4�S��G Q O GPD ❑ Replacement ❑ Public or commercial - Describe: Flood Plain elevation if applicable Parent material -b' I General comments s y,5�e � . .e v • 9l`f 3 and recommendations: 5 5� /�iPp�oS em fl-T cy? G QIo�,J �GI_ e (c V • y 3 $ . 6 u S • -�-c.� � r�.de ua�•� � . S - 5pd�� z " Boring # Boring ® pit Ground surface elev. /�.SO ft. Depth to limiting factor �O in. F 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 o -(z 2 i 2k �s (� . 5 Z 1- t r 14 � S i 2,r,r,�,b r � 5 "� • �' Boring # (] Boring _ © pit Ground surface elev. /O Oft. 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 I 6 -12 ID y r Z S, Z �' CS V It) Z -2g ► l s, I c — 3 * Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg /L * Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST N me (Please Print) Signature CST Number a•�rt �,S" 3 3 a 9 Address Date Evaluation Conducted Telephone Number i3 0 ��C-7 4 C*s 6 - �� 75= zv� -youS � T , s� Property Owner c n k v Parcel ID # Page of E Boring # ❑ Boring / ❑ pit Ground surface elev. 160 • 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. i *Ef1#1 *Eff#2 1 / Z — si< < Ivy - �5 g 2 12--4 2- (6 k s — S 7- g 3 yl m5 Os I - - i.2 F -1 Boring # F] F] ❑ 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 F] Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Armlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIN in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F 1 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30:5 150 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. SBD -8330 (W07/00) PAGE -�__OF_ 7S_ NAME Co I (0 tPc%, LOT# ( LEGAL DESCRIPTION•Sw SE' /a S3 aJ30 N R IS E (or) �V SCALE: BM I ELEVATION 100- y BM I DESCRIPTION -- I Z' BM 2 ELEVATION 9 9. 0 s ec. 3 BM 2 DESCRIPTION 4c- SYSTEM ELEVATION �T •� G _ 4-- _ X ALTERNATE ELEVATION 9j-,40 I CONTOUR ELEVATION Ian cJ . 9� ■ t3' l �2 r ■ u. w. G • g6 eA S I G NATURE AZ- %'G-- DATE 60 r D uCK P p �tI D PAGE OFD NAME C0 «0 V'0. LOT# LEGAL DESCRIPTIONScy '� +SE'�� S3 N R 19E (or) SCALE: P �!O BM I ELEVATION ( • U BM I DESCRIPTION -6 i L'_p e BM 2 ELEVATION 9 9• (O e G• 3 BM 2 DESCRIPTION •}oe o f Z" J� P SYSTEM ELEVATION LI q . -T o k- - X ALTERNATE ELEVATION o I CONTOUR ELEVATION O S to A 2 y am '97 qU z 3UlLDA�BLE r?A L is oQ k �Z ■ ■ 6 .3 r N. W. L • q(,H eA �J a 4 71,,ep, 4-v SIGNATURE � - JG- G- DATE le ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer P. C. Collova Builders, Inc. Mailing Address P O Box 489 Somerset, WI 54025 UJA Property Address , R (Verification required from Planning Department for new co truction) City/State LSA,J) 1C hn)nld W � Parcel Identification Number 02 CO -11q1-01-060 33 3a i�. 160 LEGAL DESCRIPTION Property LocationS� %,, %, Sec, T--30N -R ( W Town of Subdivision Lot # Certified Survey Map # Volume �� , Page # Warranty Deed # VA 3 l 3°, Volume . Page # Spec house ❑ yesno Lot lines identifiabl J ❑ 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 masterplumber, joumeymanplumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection 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 set 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 da three y e . tion date. / /o/ 0 3 IGNA OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the described a ve, by virtue of a warranty deed recorded in Register of Deeds Office. GNA OF APPLICANT llQl �3 D * * * * ** Any information that is mis- 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 deed Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Eff luent 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 filter. 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 greases, 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, determine 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 St. Croix County Zoning 715 - 386 -4680 Pumper Tom Mondor 715- 246 -5148 Shaun Bird #226900 F'KCM P C CDL.LDUR BLDRSc 1 H PH(3NE N0. : 715 549 591 Nov. 16 2001 0S .:cRM P1 ^ IWE3 Alt UFWISCUNSIN FORM I.1"ll K 71 E 1319{ WARRANTY DEED REGISTER OF DEEPS oast r I S ( . CRV IX Co., W1 This Dead, smde Setwrett Kcrtncth L . Drown nad NZ111cen B. AGUI.yu FM R= l3cown, Ilusbrad and Wile 04• -041 9:45 AN mmTT c-a Gtasaor.Ond P. C Collora Builders. Inc. uai.iiUT Fe ft CODS FA=: ,;;p ;(R FEE: US. m 4ECC$111 F?Lc 10.09 • r. ,..._.,..., pocegar.. t l Gtutttt. Grantor, rot a valuable eonsiden loo, oorvcys and wurnnts to !, Grantee Ule following dacritcd Pal estato in 51. C: oiz L J G ���� u � sc�� County, Sale of Wisconsin: 2ew.tIrr A ma r Vero, sod ItMnra Addreaa David 1. E.ctracn That part of SS 114 SIN 114 and SW I/A SP. 1/4 Sc-.. 3 "ri 0 �' -215 ;�' dasaibeti 304 Lr_nst St. as follows: Lou 1, 2 and 1 of Camitiod Sur"y Mm reccrded in Vol. I, of ;luctton, `SrT ;aGtb Corurtea SUTNSy Mapi:, page JG48 3S fix. No- 56 %501. +�ryry IL Croix CamcV, Wlfcalum UZri•IUY6•c0•C'tJU. U:E-t VY(s•olrZUt:. 0:& 1 C9640•oco wrest luomneattma Nunea i1't: t) i nis 'a not holmu:d ptvDeny. (da+ (is not) i Excepticns to war:rnies: 2x:zting highwnm ch3emcnts A rig:vs of vnv of eca:d. Dmi:4 thic 1 day of 21LQr1l 2701 . Kenneth L. 3rowit KaW= B. Brown Jt LTH WTICA TI ON ACXP10 W LLD(- -M Z? (T STA -E Of Wisconsin ) n. Slgaasute(t) St. Croix County. ) Per:onaily waa bei re me this 1) r day of Ittkenikated this _ day of APrtI 1 2001 the above .—C enatth L. Brown and KALkle6a B. Bruira yjnx OF WISCONS ?f fo.'vld ie be the persom(t) cobs cFecut.d tram :�reSeina tt and aeksxtwteoac the same. is, . WA3 UItAY THU Hy Att �, J. rztretn 304 LocmdUSl:: HYdsm WI 54016 Nnary Pun &e, a of A ti (Sigtttturtlo-W bt .tbendcfiW er aeknowi.dted, Sail ere aot My Comni -+on Is pennar»n� no a exQtcauon au: tle'tLSSlfp � ') Name of Manias sittal tt is aey c=wky shmid be typed a minted 1,4 a their dpnRrr STArc SAX or Wtg=sto - AAAAMTY tits Yatae nom • rm RtrCRNATION 1'WrH3"WAL3 COMPANY WWO OV LAC. 44 NO- US -20" ,, LOCATION MAP PRELIM 1 N� t'��y��SG�N�I�� (NOT TO SCALE) i SECTION 33, T30N, R18W, � s � A• K DUCK N LOCATED IN PART OF THE SOUTHEAST 1/4 - SOUTHWEST 1/4 OF THE SOUTHEAST 1/4 0 TOWN OF RICHMOND, ST. CROIX COUNTY, WI av i� ` �lz SECT LOCATM SURVEY MAP RECORDED IN VOLUME 13 PAC N Z d�d ryes ,.� ` -, 'E"v°R""r -DE- I I NOR EwsTHM r EXTE N UN� AN ,o O J ����/�, 33 — naRR„ba ExTEnn O O T30N, RiBW,•fOkIMR�� \ �� I I I 1 - \ 0 CA SURVEYORS MONUMENT � � � � Z�NG: AG �ES.I I / I ' S 69'52'11 E 2635 to A I 602.00' Z Ift 1- _ - - --� — ,-- -- _ _ — — OT 1 I b I I t I -` Ft. f' z3o AC / ,u 1,410 A<S n ✓b/� /[5�// ' / 1325 M / 2pl / , \ Nd .ioSkn/ � LOT / / o� I 35s Fe. LOT 2/ 95 IC 7� ` 22�Aa 93'5011 WFt. ILL 1111M) ft rL y M 110397 Sq(Ft. / KL Aram � � \ , — / / /� i , COT 8 \ I LOT 9\ : Y4754 5q. Ft. 1, I 962.1 S L Ft. 1 Lis r'_ P ai t7 n rs p73� n �u. 13s t L, r 1 I L 2\51 r a > AL n -- - - -- -- s,1,o - - - -- f - - - - -- -= Thad == - �- sOUTNt /4CORNER SECTION 33- - - -- -- OW BY: - - - -I --------------------- T70N, RIM FOUND 3' COUNTY DEDICATED TO THE PUBLIC SOUTH LINE OF THE SURVEYORS MONUMENT BY: I W� CREENFIELD 1 WONAa_ �REENFIELD ( LOT 1 C.S.M. 1 ZONING: AG -RES. OWNED B` UNPEATTED LANDS I PA13217 LOIiN dc SUBDIVISION PARAMETERS ZONING = AG RESIDENTIAL MINIMUM PERFORMANCE STANDARDS: APPROVING Al TOYM OF NUMBER OF LOTS= 25 TOTAL PLAT BOUNDARY= 59.74 AC. ROW) ST CROIX LENGTH OF ROAD= 2900' t TOTAL PLAT BOUNDARY= 55.95 AC. ( INC. (EXC. ROW) MINIMUM 'LOT SIZE= 1.5 AC. O WNER MINIMUM PERFORMANCE STANDARDS: AVERAGE LOT SIZE = 2.05 AC. FRONT SETBACK = 1,00' ROADWAY REQUIRMENTS: PAT COLLOVA SIDE SETBACK - 25 COMBINED MINIMUM PAVED WIDTH = 22' P.C. COLLOVA BLDRS., INC. H REAR SETBACK = 25 MINIMUM OVERAL ROADWAY WIDTH = 26' 705 CTY. RD. E: HUDSON. WI W FRONT SETB ACK MEASURED FROM R —O —W MINIMUM CUL —DE —SAC PAVED RADIIUS = 4 9 y HORIZONTAI cru F. AS PER GRAPHIC 002 IPP 05 -08-01 REVISED PER COUNTY SURVEYORS OFFICE At ZONING OFFICE 145 Mai, s RELEASED FOR REVIEW i tlox rxc: 001 .IPP 03 -22-01 ood�lll. so 100 too REY. NAME: DATE: REVISION DESCRIPTION: now 71: