HomeMy WebLinkAbout026-1141-03-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St
Safety and juilding Division
'= INSPECTION REPORT Sanitary Permit N .
430401 "" 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID
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- 1141 -03 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
10 01D I I ao, 0 t i' Z CQ, POs P' 33.30.18.1007
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark UM) 100
Dosing Alt. BM 1
I v'� Adcu 1 ®.70 100,_75
Aeration Bldg. Sewer
�.8 bC*ynq i al A tc i7o qq - 7
Holding F St/Ht Inlet , 9,5 9 (P
1 11W ; S
St/Ht Outlet
TANK SETBACK INFORMATION S. . 2-
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic ; J . u't 27 / Dt Bottom A �
Dosing I Header /Man. P G R.O q Z, 4b
.--y -- - 41 1 , 9- 2.
Aeration , 1 u , +K q.5 ?Z, I
Holding �- _ Bot. System
_ yt O 4 ql.`v -
Final Grade
PUMP /SIPHON INFORMATION ma.
Manufacturer , •- ~ nd St Cover
GPM
Model Number
TDH L Loss System Head TDH t
Force m Length Dia. ist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches 3 PIT DIMENSIONS N ide Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer:
r �
INFORMATION CHAMBER OR . /
Type Of System: • / / t 1 �, UNIT
Model Number:
DISTRIBUTION SYSTEM
Header /Manifol Distribution x Hole Size Ix Hole Spacing Vent to Air Intake
j/
Length / q Pipe(s
Di Length Dia
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over w _,-,, _.. Depth Over xx Depth of 1xx Seeded /Sodded 1xx Mulched
Bed/Trench er To soil
e _ o L_1 No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 11 / 0 /_Q E). In
µpm
Location: 1208 117th S treet New Richmond, WI 54017 (SW 1/4 SE 1/4 33 T30N R1 8W) Duck Pond Escape Lot 3 Parcel No: 33.30.18.1007
1.) Alt BM Description = 6 p tom S,Q�2 w// �/D 3
2.) Bldg sewer length=
- amount of cover = kit
-- — -- -
Plan revision Required? Yes No F
Use other side for additional information. I I LO _! Q C� "ZLf.QG — —j
SBD -6710 (R.3/97) p Q, Date 1 Ins epctor's Signature Cen No
\Jof I ° F��'"'� J
Safety and Buildings Division county f
� rp � �
201 W. Washington Ave., P.O. Box 7082 c�
FI VI ������ Madison, WI 53707 — 7082 Sanitary Permit Number (to be filled in E Lvl�
(608) 261 -6546
Department of Commerce State Plan LD. Nuttlbe�
Sanitary Permit Application. provide
In accord with Comm 83.21, Wis. Adm Code, personal information you p
may be used for secondary purposes Privacy Law, s15.04(lxm) may Address (if different than mailing address)
I. Application Information — Please Prin formation
parcel # # Block #
Property Own ' Nagle
Property Location •
property Owner's Mailing Address } _--'
�• y.,, %., Section
City, State Zip Code Pho" �fi? ' r f I-' C circle e
C C Tc t/ N, ) E l
s LV)
Type of Building (check all that apply) `2 �� �,lt�` Su ision N SM Number
Z Family Dwelling — Number of Bedrooms '
❑ PubficXomnercia) — Describe Use
❑City ❑Villa owaship of
C1 State Owned — Describe Use 1 I L ^1'rN
IIL
A. El of Permit: (Check only one box on line A. Complete line B if applicable)
New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
last Previous Permit Number and Date Issued
B. ❑ Permit Renewal t Revision ❑Change of Permit Transfer to New
3t� 1 3b �J3
Before Expiration Plumber Owner o /
IV. T of POWTS stem: Check all that a I vi
on Pressurized in- Ground ❑ Mound >- 24 in. of suitable soil C1 Mound < 24 in of suitable soil ❑ At -Grade single Pass Sand Filter ❑
❑ Aerobic Treatment Unit ❑ R atiagsl?er
Constructed Weiland ❑ Pressurized In round ❑ Holding Tank ❑ Peat Filter 1
Recirculating Synthetic Media Filter . g her 13D' ' e Clem I I Pipe ❑ ex-p / s' ek
V. Dis ersal/Trestment Area Inf rmation:
i Flow (gpd) Design Soil pli O dsf) Dispersal Area Required (st) Dis Area Pr ed (sf)
Total Number manufacturer Capacity in Prefab Site Steel rber P astic
VI. Tank Info '1l /� Concrete Constructed Glass
Gallons Gallons of Units
New Existing
Tanks Tanks
Septic or Holding Talc
Acrobat Treatment Unit
Dosing Chamber
VIL Responsibility Statement — 1, the unde ed, assume reapor►afbility for installation of the POWTS shown on the attached plans
MP/MPRS Number Busi� J� hone Nu
Plu>t}ber's Name (Print) Plum Signature � i / 7
S
Plumber's Address (Street, City, tale, Zip e) j
le
VIII nun 'Depart t Use Only e signature Sanitary Permit F (includes Gqotmdwater Date (SSUed, ass ' g A g S� (N ) `
Approved ❑ Disapproved Surcharge Fee) ( J} !Z /0
Q�
Owner Given Reason for Denial V
IX. Conditions of Approval/Reasons for Disapproval O'n
YSTEM OWNER: 3
1 Septic tank, effluent filter al �1� lUt�
Pao dispersal cell must all be serviced / maintained
as per management pla provided by plumber S" L
2. All setback requirements mus a madn arn � �'�"`
as per applicable code /ordinances.
Attack complete plans (to the County rely) for the system on paper than 81/2 s Il inches to size
t
SBD -6398 (R. 08/02) J9�
_ 3ok 3
Soil Test and S PLOT PLAN
PROJECT P.C. Collova Bldrs. Inc. DRESS P.O. Box 489 Somerset Wi 54025
SW 1/4 SE 1/4s 33 /T 30 19 OWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 10/1 0/03 BEDROOM 3
CONVENTIONAL XXX IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK S ZE
HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1212 # of chambe 39
BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION loo' Filter Zabel A -100
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
SYSTEM ELEVATION 90.9/90.8/90.7 5.5' below Grade
269' Property Line
Tested area does not have
enough slope to establish >
contours a.
' 3 -3' X 83' Cells with >3' Spacing o
�O
B -2 80' B -1
B.M. * Vents ents
Pro 3 Bedroom
40' 30' d House.
50' , 30'
Alt. B.M. B -3
is to of survey��t i
iron @ 96.1 30 15
�-_
Plans Designed Using
Conventional Powts
Vent Manual Version 2.0
382'
>6 „ Standard Biodiffuser property
of Cover Leaching Chamber Line
with 31.1 ft2 of Area
6' Long 11
4 Grade at System Elevation
3of 3
Soil Test and System PLOT PLAN
PROJECT P.C. Collova Bldrs. Inc. DRESS P.O. Box 489 Somerset Wi 54025
SW i/4 SE 1/4S 33 /T 30 19 TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 10/10/03 BEDROOM 3
CONVENTIONAL XXX IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK S ZE
HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1212 # of chamber 39
BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
SYSTEM ELEVATION 90.9/90.8/90.7 5.5' below grade
Od 269' Property Line
Tested area does not have
enough slope to establish
contours
3 -3' X 83' Cells with >3' Spacing o
O M
B -2 80' B -1
B.M. * Vents ents
Pro 3 Bedroom
40' 30' House
50' 30'
Alt. B.M. T
B -3
is to of survey
iron @ 96.1' 30' 15'
Plans Designed Using
Conventional Powts
Vent Manual Version 2.0
382'
>6„ Standard Biodiffuser Property
of Cover Leaching Chamber Line.
with 31.1 ft2 of Area
6' Long 11 "
Grade at System Elevation
34"
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page l of
Division of Safety and Buildings
in accordance with Comm 85, 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 point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. OZ �O /�y�' D 3 G7
Please print all information. eviewed b Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). !d 17
Property Owner / Property Locatio
II Govt. LotS 1145��1 /4 S 3 R E (o W
Prope Owners Mailing Address Lot # Block # Subd. Na or CSfvl#
City State Zip Code Phone Number ❑ city ❑ Village J.T con Nearest Road
S ( ) c-k I J isl
New Construction Use: Residential / Number of bedrooms - Code derived design flow rate !Y D GPD
❑ Replacement ❑ Public commercial - Describe: __—
Parent material l/ Flood Plain elevation if e
General reco S V ee and recommendations: 5 t s ct'("L &Ae S �y e r A I'd
Boring # Boring % 0 (� in �2 3� �► D/ �zA ✓
Fj 'a Pit Ground surface elev. ft. Depth to limiting factor _ . — 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
IV 14 �Jllv
o. 70 d
Borirlg # ❑ Boring
a �p Pit Ground surface elev. ft. Depth to limiting factor &2 In.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
a- l 9 5 1 L- S e ," - s
�' l -SD O s ---
3 /F s n✓/ 14 Al) J
_ _ <
• Effluent #1 =SOD > 30 < 220 mglt and TSS >30 < 1 Effluent #2 - BOD < 30 mglt and TSS 30 mgfl.
CST Name (Please Print) - - re CST Number
Bird Plumbing, Inc. Shaun Bird gnatu 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 5401, ' 13 715 - 246 -4516
jP ' MProperty :Owne, _ Parcel ID # Page of
# B
g
❑ oring
Pit Ground surface elev ' ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ft?
in, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'EN#2
312 aAA .r s
-
3
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 GPDfff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
F Boring # E] Boring
1:1 Pit Ground surface elev. ft. Depth to limiting factor in.
Soil ication 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
Effluent #1 = BOD. > 30 5 220 mglL and TSS >30 < 150 mgll_ ' Effluent #2 = BOD, < 30 mgA_ and TSS < 30 mg1L
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 (8.6/00)
Safety and Buildings Division County
An 201 W. Washington Ave., P.O. Box 7082
Madison, W / r D J
lViscons I 53707 - 7082 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce (608) 261546 D ypi
Sanitary Permit Application State Plan I.D. Number
`e
In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide
may be used for secondary purposes Privacy Law, s 15.04(1 xm) Project Address (if different than mailing address)
I. App .
Ilcation Information - Please Print All Information Q
PP �
RECEIVED
Property ? Name _ Parcel # _ Lot # Block #
3
Properly Owner's Mailing A Property Location
/7
� /s' Section
City, State Zip Code Pho =
2/1 d a �/T —
14 �� (circl ne
. N; E r W
Type of Building (check all that apply) oa S
1 or 2 Family Dwelling - Number of Bedrooms bt Af S division a he , CSM Number
❑ PublidCotnmercial - Describe Use
❑ State Owned - Describe use 9 3 3 K S ty_ ❑villa�ownship o
III. Type of Permit: (Check only one box on lin 'Complete line B if applica ) p 2tP - 0 3-
A System ❑ Replacement SystemTreatmenUHokting Tank R p lacement Only ❑ Other Modifigti sting
.0 \ 1 1. o ff - In - A J
�Ij
li• ❑ Permit Renewal ❑ Permit Revision ❑ ge of ❑ P�imit Transfer tom vto Permit an hs
Before Expiration Plum Ov h-
IV. of POWTS System: Check all that apply)
f
�rft - Pressurized In -Ground ❑ Mound > 24 in. of suitable soil Mound -124 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In and ❑ Holding Tank Ppat Filter El Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Finer hing Chamber Drip Li ❑ vel -less Pipe er n) �Q
V. DispersaliTreatment Area Information:
Design Flow Design Soi7ication Rate(gpdsf) rspe equired (sf) Dis Area Propos (sf) System Ele lion
Ali , � � " 3 . �5 A7.
VI. Tank Info Capacity in Total Number ufactim Prefab Site S Fiber Plastic
Gallons Gallons of Units ' Concrete Constructed Glass
New Exkting
Talcs Tanks
Septic or Holding Tank
Aerobic Treatmem Una
Dosing Chamber
VII. Responsibility Statement- , the undersi a ass a responsibility for Installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumb griattfie . MPIMPRS Number Business Phone Number
umber's Address (Street, City, State, Zip e)
Coun /De artment Use Onl
Approved ❑ Disapproved Sanitary Permit F (includes Groundwater Date Issued Iss i Agent Signature Stamps)
Surcharge Fee)
❑ Owner Given Reason for Denial ' r
IX. Conditions of Approval/Reasons for Disapproval
SYSTEM OWNER:
1 Septic tank, effluent filter and ia�nM t� I sr ti4�t`_
dispersal cell must all be serviced / maintained 5«`( r �trw�. LJ U a �°`
as per management plan provided by plumber. Y o..�Qi1
2. All setback requirements must be maintainedr�,ln. ,� S
as per applicable code /ordinances.
Attach complete plans (to the County only) for the system on t less tha /2 1 t lathes size
SBD -6398 (R. 08/02)
PLOT PLAN
PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025
SW 1/4 SE 1 /4S 33 /T N/ 19 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 AV DATE 9 BEDROOM 3
CONVENTIONAL XXX IN -GRO D PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1212 # of chambers 39
IL BENCHMARK V.R.P. Top of 2" Pipe ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL - H. R. P Same as Benchmark
SYSTEM ELEVATION 97.3/97.4/97.5 2' below grade
.M. #1
269' Property Line
OA.�Lk B- 40' 0'
ents M. #2
� _I 2% Slope
50'
B -1 60 a
a B -2°
o
9� Vents Vents
of
3 -3' X 83' Cells with >3' Spacing 30'
Please note:
T further testing will
be do
30'
382' ov
Property C Pro 3 Bedroom
Line
House
Vent
>6 ,, Standard Biodiffuse Plans Designed Using
of Cover I-caching Chamber Conventional Powts
with 31.1 ft2 of Area Manual Version 2.0
6' Long
11"
3 Grade at System Elevation
PLOT PLAN
PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025
SW 1/4 SE 1 /4s 33 /T N/ 19 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 9 BEDROOM 3
CONVENTIONAL XXX IN -GRO D PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1212 # of chambers 39
BENCHMARK V.R.P. Top of 2" Pipe ASSUME ELEVATION 100 Filter Zabel A -100
❑ BOREHOLE O WELL *H. R. P Same as Benchmark
SYSTEM ELEVATION 97.3/97.4/97.5 2' below qrade
.M. #1
269' Property Line
B- 40'
°Io Slope ents M. #2
� 2
a�
50'
B -1 60
B -2
a� o
O M
9� Vents Vents
of
3 -3' X 83' Cells with >3' Spacing 30'
Please note:
. further testing will
be do
30'
382'
Property Pro 3 Bedroom
Line
House
Vent
>6„ Standard Biodiffuser Plans Designed Using
of Cover Leaching Chamber Conventional Powts
with 31.1 ft2 of Area Manual Version 2.0
6' Long 11 "
" Grade at System Elevation
34
Wisconsin` Department of Commerce SOIL EVALUATION REPORT Page ( of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County �(. �l•-Oi
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan mutt JJ
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 infQpWq R iewed by Date t
Personal information you provide may be used fors apnrt>'oses rif$ s. 15.04 (1) (m)). �3 p
Property Owner [ perry Location �h
al: // �`G Lot 1/4 SE1/4 S T (or)V�v
CoII a va P ' .� - S cJ 3 3 3 p N R le E
Property Owners Mailing Address i Block # Subd. Name or CSM#
'u`' �'; x4}t�1 Ouc k �r� scc.,
�oS'
City State Zip Code "Phone Nun0 N ity ❑ Village Town Nearest Road
(� New Construction Use: ® Residential / Nurribep ob 40 rfbpklls-A— e Code derived design flow rate y.�� G d GPD
❑ Replacement ❑ Public or commercial
Parent material ! Flood Plain elevation if applicable
General comments SYS {gym k V 40W
and recommendations: e% V . �/7 3 o
F T] Boring # Boring
❑
❑� pit Ground surface elev. g • W ft. Depth to limiting factor %.00 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /if?
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. " Eff#1 'Eff#2
0 -115 Io r31Z. sit 2 rn�i C- 1'V! .5
' / - , s - 56 IO r N 2mGbk m C- — 5
3 15,6 Z ✓r l< m
❑ Boring . V6
Pl- Boring #
® pit Ground surface elev. 99. S � ft. Depth to Limiting factor (0'S 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
0 -Is 10. 3 z - ;Ii/ I 2 C- / Vf- 5
Z � / `— Std m fr'
`I I Q (`I I L 5
.�If bZ-
* 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 Name (Please Print Signature CST Number
i� t�cc er Z - 5 3 3 a �/
Address Date Evaluation Conducted Telephone Number
Z/ 2 S � e�� w/ syozs -zz -mil 7rs- 2 lylfwk
Property Owner Co/% V Parcel ID # Page Z of 3
a Boring # F1 Boring
[ pit Ground surface elev. 29. 3L) ft. Depth to limiting factor �o -S 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
1 O- 2 Si I z mcbk 1n- c v
I Z - `b l 414 S / 2 rncb k, rvn-6— ss - S
3 4v -lob l � Sc I 2m5 bj<
F-1 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
F-1 F] Boring Boring # Ground surface elev. ft. Depth to limiting factor in.
1:1 pit 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
' 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.
SBD -8330 (R.07 /00)
PAGE 3 OF_
NAME ('n( (pyc LOW LEGAL DESCRIPTIONSw' / <5�' / <,S - I o N,R ) �E (or) �V
SCALE:
BM 1 ELEVATION �(�' >• O
BM I DESCRIPTION d Z
BM 2 ELEVATION
BM 2 DESCRIPTION e o t Z vc - �f
SYSTEM ELEVATION t6�-oo Low c r
ALTERNATE ELEVATION ? 3 6 x
1
CONTOUR ELEVATION I.0 LOD-00
Ciw� l
�— D ro►; ry a � C a S e w•e. •� + �%
�3 w1 Z
• ' L.v �
O
skp�
0
q Q,o
v �
0 ,z
sN
c
(o �.o
SIGN URE
DATE S
Maintenance
and Contingency Plan for a Septic System
Maintenanc Plan
1. Septic k 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 installs in
order to extend the maintenance interval of the filter the inspections pipes at the ends of
3. Once every 3 years, cells are to be inspected via
the cells.
es arbage, and water conditioner discharge into the system.
4. owner agre es to limit greas , 9
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.
Y
8. Discharge
into system is not exceed those required as per Comm. 83
Contingency Plan
1. If sy stem 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
St. Croix County Zoning 715- 386 -4680
Pumper Tom Mondor 715- 246 -5148
Shaun Bird #226900
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, W154025
Property Address l ao U
(Verification required from Planning Department for new construction) C-�
City/State tVO4-4 1�'"yVIG A G.Y Parcel Identification Number
LEGAL DESCRIPTION
Property Locationc %,, S& %,, Sec, T 3O N -R. Town of
Subdivision I 1 `S Lot #
Certified Survey Map # C2y - / Volume ` , Page #
Warranty Deed # _ � AA I �& Volume Page # (0
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
masterplumber, journeyman plumber, restricted plumber 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.
I/we, 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
V e your sep em has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
tion date.
P. C. COLLC" -QERS, INC. 9 AZ / G3
SIGNATURE OF APPLICANT Q
—
DATE
SOMERSl =7 ; rb..:; I:�9NStN 54025
OWNER CERTIFICATION
(w) citify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the rty cribed above, by virtue of warranty deed recorded in Register of Deeds Office.
SiGNATUIE OF APPLICANT C IALR P.O. F DATE
4
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.******
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** 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
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WARRANTY DZED REGJGTV OF DE»I35
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,:,rroSoil FEE: 828.
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Grantor, for a vaiuzoi: Qonstderstloa, roryt ve and wvmtlts to
Gantea Uu folla+rin; oexriha ral cgtato in 51 C: ois
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as follows: :au 1, 2 and ? efCani:ied Sur—? i•t..o teecrded in `col. 1; of Lw dtoo.'.V! ;4C16
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N 00'3641" E 983.86' - — — —
NORTH -SOUTH 1/4 LINE OF SECTION 33