HomeMy WebLinkAbout026-1141-04-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
` (ATTACH TO PERMIT) 429944 0
GENERAL INFORMATION State Plan ID No: t
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 -04 -000
CST BM Elev: Insp. BM Elev: BM Descri tion: Section/Town /Range /Map No:
/00.6 It X - O tM 1 T o Z N 33.30.18.1008
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark � � 2 • � Z'� Cab • U
Dosing r - Alt. BM jr r G VeA_ 1-15
Aeration }� Bldg. Sewer
�.Z
Holding St/Ht Inlet
J '1
TANK SETBACK INFORMATION St/Ht Outlet • 7 9 �O- (o
TANK TO /L WELL BLDG. Vent t Air Intake ROAD Dt In l@L��
Septic Dt Bottom /
Dosing Header /Man.
Aeration Dist. Pipe ' 3 D
.'3
Holding Bot. System I 2 a
Final Grade
PUMP /SIPHON INFORMATION kv N4 -3. (,,
Manufacturer Demand St Cover III _ GPM- 3-1
Model Numb e ,2 r �'S.Qr -F - 4
TDH Lift n ' n Loss System Head TDH t
Forcemain Length Dia. f ist Well
SOIL ABSORPTION SYSTEM (+ = 3
BED/TRENCH Width r Length No. Of Trenches IT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L tj JBLDG WELL LAKE /STREAM LEACHIN Manuf turer: 11
INFORMATION Ty p Of System: CHAMBER O b t? 1
^ S � I / UNIT Model Number.
DISTRIBUTION SYSTEM ` V"J
Header /Manif Id Distribution �-� r x Hole x Hole Spacing Vent to Air Intake it
Len th Dia
9
LE Pipe(s �— D a acin
k / Sp ci g y / /
Len th —
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only n d G ' L
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched s
Bed/Trench Center Bed /Trench Edges Topsoil
Yes No ['] Yes i� No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: 5 1 23 Q 3 Inspection #2:
Location: 1206 117th Street New Richmond, WI 54017 (SW 1/4 SE 1/4 33 T30N R1 8W) Duck Pond E ct 4 Parcel No: 33.30.18.1008
1.) Alt BM Description = ST' ���'� h�llti► —�
2.) Bldg sewer length = Zy
- amount of cover = 2 P I Required? 1
Use other for additional in Yes /No
formation.
SBD -6710 (R.3/97) Date Insepctor's Si nature Cert. No.
r
I SI om
Safety and Buildings Division County t
Vi
2,01 W. Washington Ave., P.O. Box 7162 �' rO )
sconsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce (608) 266 -3151 4-ZI Cl f q
Sanitary Permit Application state Plan I.D. Number
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide
may be used for secondary purposes Privacy Law, s15.04(IXm) Project Address (if different than mailing address)
I. Application Information - Please Print All Information
q ECEIV
Property Owner's Na me Parcel # t # Block k
o ll MAY 0 7
Property Owner's M ailing Address Property Location
S ROIX COUNTY �5 , /--- 'A fl/w u,Section
City, State Zip Code Phone u
S!` �
✓ T�N; R (%t )
e+�W
H. Type of Building (check all that apply)
Subdivision Name CSM Number
or 2 Family Dwelling - Number of Bedroo
❑ public/Commercial - Describe Use
❑ State Owned - Describe Use W 3 3'x 9 3. �S' S - ❑City_❑Village,;Rtownship of
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A ' dew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
/ \ ❑Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued
B. ❑ Permit Renewal rmit Revision
Before Expiration Plumber Owner
IV. Type of POWTS System: (Check all that appl `
on - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter
❑ Constructed Weiland ❑ Pressurized In -Grmnd ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter
i
❑ Recirculating Synthetic Media Filter Ching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. D' rsaUTreatment Area Information:
Design Flow (gpd) Design Soil A lication Rate(gpdsf) Disperseequired (sf) D:isper Area Proposed (sf) System Elevation
,. /
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tanks
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- I, the unde responsibility for installation of the POWTS shown on the attached plans.
Plumber's Na the (Print) Plumber' ture MP /MPRS Number Business Phone Number
k v IZZ d yon
Plumber's Addre ss (Street, City, State, e) )� DI
C9� ,, � /
VIII. Count /De artment Use Onl
Sanitary Permit Fee (includes Groundwater Date Issu;J Usum Agent Signature o Stamps)
(� Approved ❑Disapproved Surcharge Fee) S� do I �
❑ Owner Given Reason for Denial `
IX. Conditions of � S S 4 Approval/Reasons for Disapproval 1
` Z - , _ tell `�� t 6-h l'
c19 -U . M, a s&-`T
O-L )i'll-M,
.ems Y
pc'� \ l�t 6'ttiS Attach cogplete planA (to the Co un ty only) r S � n PaPG' tt less than $1,(2 11 inches in size _
SBD -6398 (R. 01 /03) a �` J TI •IL11` T/
430" est and System PLOT PLAN 3
PROJECT P.C. Collova Bldrs. Inc. P.O. Box 489 Somerset Wi 54025
SE 1/4 NW 1/4s 7 -/ W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 5/5/03 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 .5 ABSORPTION AREA 933 # of chambers 30
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 92.1' 6 below grade
Alternate benchmark is top of power box @ 103.9'
operty Line
Tested area has <1% Slope, thus no contours
B - �S ( B.M. #1
Vents 30 , V is 60' B
0 '
' 30'
45' B -1 T
2 -3' X 94' Cells with >3 spacing ,a
Town Road
Vent Pro 3
Bedroo
>69' Standard Biodiffuser House
of Cover Leaching Chamber
with 31.1 ft2 of Area
6' Long 11 "
Grade at System Elevation 1
34"
Plans Designed Using
Conventional Powts
Manual Version 2.0
459' Property Line
So' est and System PLOT PLAN 3
PROJECT P.C. Collova Bldrs. Inc. D P.O. Box 489 Somerset Wi 54025
SE 1/4 NW 1 / 4 S 7 /T 30 / 16 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 5/5/03 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 .5 ABSORPTION AREA 933 # of chambers 30
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 92.1'6' below grade
Alternate benchmark is top of power box @ 103.
operty Line
Tested area has <1% Slope, thus no contours
B -3 B.M. #1
Vents Vents 60 B.M. Alt.
3 0'
0 '
10' 30'
45 45 B 1 T
2 -3' X 94' Cells with >3' spacing 15'
Town Road
Vent Pro 3
Bedroom
>6 » Standard Biodiffuser House
of Cover Leaching Chamber
with 31.1 ft2 of Area
6' Long 11 "
3419 Grade at System Elevation
Plans Designed Using
Conventional Powts
Manual Version 2.0
459' Property Line
Wisoonsin Department of Commerce SOIL EVALUATION REPORT Page of 3
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.
Please print all information. R 'ewes by Date
Personal inforrnation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). (I)
Property Owner RECEIVED Pro e rty location
L4t2 Go . Lot 1 /4 /4 S T N R �j E (o�V
Property rs Mailing Address Lot Block # Subd. Name CSM#
` o e), y MAY 0 7 2003 " �c-7
city State 7jp Code Pho%e�Ny, X COUNTY ❑ City C] Village Town Nearest bad
L '9, J J �G ONING OFFICE J.
New Construction UseBesidential / Number of bedrooms –3 Code derived design flow rate SCy GPD
❑ Replacement I •,� ❑ Public r commercial - Describe:
Parent material 0 K�'�l �J Flood Plain elevation if applicable n/ / A ft.
General mm n data �2 and recommendations: _S �,� � `
G
0 Borin # ° �
Pit Ground surface elev. 1 ft. Depth to limiting factor 13 �D 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. 'Eff#1 •Eff#2
92.10
851 l2
®Boring # Q Boring U C
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
— L
6v '_ S n? /
�Z o�
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) – – Sig natu CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
715- 246 -4516
1008 192nd Ave, New Richmond, WI 54017 J� —��
Property Owner _ Parcel ID # Page Z-- of 3
Ong It Boring n q
Pit Ground surface elev. ` 0 7 ft. Depth to limiting factor in. Soil lication 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
_ ,rte /✓l /�/� a'// • ,S �
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 GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
F-1 Boring # ❑ Boring
❑ 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 < 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 (8000)
• k
C
�V MA 201 W. Washington Ave., P.O. Box 7162 V '
l sconsin Madison, WI 53707 - 7162 Sanitary Permit Num (to be filled in by Co.)
Department of Commerce (608) 266-3151 q2 I 1
Sanitary Permit Application State Plan I.D. N cr
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide
may be used for secondary purposes Privacy Law, sl5.04(1Xm) Project A (if different than mailing address)
I. Application Information - Please Print All information G / I :� J6
Par
I Lot # Block #
Property Owner's Na me
Re" �� /
R tea-
Location
Property Owner's M ailing Address perry
d 7 lf, %,Section 3 �
City, State Zip Code Phone Number
�Z, /' (circl
S da' T t/ N; R)E r W
II. Type of Building (check all that apply) �( S ^^ /"""��
Subdivision Name CSM
or 2 Family ling - Number of Bedrooms
❑ Public/Commercial - cribe Use Q
❑City_❑VillagqoKTrewnship of a
❑ State Owned - Describe Us
III. Type of Permit: (Check only x on line A. Complete line B if appli e)
A. New System ❑ Replacement ❑ Treatment/Holding Tank ment Only ❑ Other Modification to Existing Sy
vious Permit Num D ued
B. El Permit Renewal ❑ Permit Revision hange of El Pe Transfer to New '
Before Expiration Owne
IV. Type of POWTS S e (Check all that a 1 )
n -Pressurized hi- Ground ❑ Mound > 24 in. of suitable soil < 24 in. suitable soil ❑ At Grade Pass S il
P q
❑ Constructed Wetland ❑ Pressurized In- Ground 11 Holding Tank ilter Aerobic ui a8 S
❑ Recirculating Synthetic Media Filter ❑Leaching Chamber ❑ Dri L' vel-less Pi
V. Dispersal/Treatment Area Information: sal Area pro Sy rem o
Desi Flow (gpd) Design Soil licafion RateW&f) Dispersal Required (sf)
VI. Tank _nfo Capacity in Total Number Manufacturer Prefab ite S F' 1
Gallons Gallons of Units rete Constructed G
New Existing J
Tanks Tanks
Sentic or Holding Tank
C / ;9ume usability for installation of the POWTS shown on the attached p
ure MP/MPRS Number Business Phone Num
J 2- 769 0® ) - L�6 — '�,s 1
t i ce` 01
tary Permit Fee (includes Groundwater Date Issued Agent Signa (No Stamps)
hange Fee 212—.5�� I � � � y �
/ °` 1
ft \, � 5 1 2 ff
S� mpkttph-
( oil for the on per not than 8112 x 1 inches in size
SBD8� gnaw, W t -C, 7. �(5�'^^ -
R. 01/03)
• �r
,>
1 /
vo
7
PLOT PLAN
PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025
SE 1/4 NW 1/4S 7 /T N W TOWN Emerald COUNTY ST. CROIX
4/30/03 BEDROOM 3
MPRS Shaun Bird 226900 DATE
CONVENTIONAL XXX IN -GR / D PRESSURE CONVENTIONAL LIFT HOLDING TAN
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE T K SIZE
HOLDING TANK SIZE LOAD RATE •4 ABSORPTION AREA 1212 # of ch bers 39
BENCHMARK V.R.P. Top of 2" Pipe ASSUME ELEVATION 100' ilter Zabel A -100
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
SYSTEM ELEVATION 92.5/92.0 .5 1"' Below Grade
Vent
>6„ Standard Biodiffuser Plans De ed Using
of Cover Leaching Chamber Conven nal Pow C✓
with 31.1 ft2 of Area Manu ersio .0
6' Lon 11 "
3 4 Grade at System Elevation 4 ��, fQ
note: this soil test is only
suitab lat approval and
issuing a s permit, further Town Road
testing will be Pro 3
B -1 Bedroom
House
c Vents
30' S'
B -2
0 , 3 -3' X 82' Cells with >3' S
1 30'
0
B -3
300'
Vents
B.M. #1
0' B.M. #2 o •
3
320'
459' Property Line
,�a ''��
t'
.:;� � �►
,.. �, ,
�,`a; ,.
.�
.�'�.
PLOT PLAN
PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025
SE 1/4 NW 1/4s 7 IT N 16 W TOWN Emerald COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE4 /30/03 BEDROOM 3
CONVENTIONAL XXX IN -GR 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 /100, Filt4er bers 39
BENCHMARK V.R.P. Top of 2" Pipe ASSUME ELEVATION Zabel A -100
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
ent SYSTEM ELEVATION 92.5/92 1 9 , 1.5 r"' Below Grade
V
>6" Leaching Biodiffuser Plans D gned Using
Leaching Chamber Conve onal Powt c�✓
of Cover with 31.1 ft2 of Area Man Versio .0�
6' Long 11 " `
34" Gr at System Elevation , �Q
Please note: t oil testis only
suitable for plat a oval and
issuing a sanitary pe further Town Road
testing will be done o3
> B -1 edroom
House
o Vents
30' 5'
T
B -2 50' 3-3'X 82' Cells with >3' ing
130'
B -3
300'
Vents
B.M. #1
30' B.M. #2 4 •
320'
459' Property Line
i
rD
f�
xf
x
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page i of 3
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 J Cr a ; V
include, but not limited to: vertical and horizontal reference point (BM), direction and P rcel I. .
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all inform 1 . v ed by Date
Personal information you provide may be used for secon s u L c�l/dw 15.04 (1) (m)). 0 2CD1
Property Owner C rty Location
?Q4 ,j � �t,E1V�0 dovf t S4! 1/4 $� 1/4 S33 T 3a N d � E (or)CO
Property Owner's Mailing Address Lot #, T ,4 Block # Subd. Name or CSM#
- lo ts WA 2 6 200 ` Po
City State Eip Code _ dpe Numbe§T C i4 ❑ Village R Town Nearest Road
ty^r C mil L
Uas6 I 1 (�1 `�
1
[ja New Construction Use: 151 Residential / Number of be s 3- Code derived design flow rate yea /G4 d GPD
❑ Replacement ❑ Public or commercial - D6S`sri --
Parent material A// Flood Plain elevation if applicable
General comments S t V - QO. 3 4
and recommendations: Lt e %C V o G 5 Y S ` Ix __^ I L I_ o
a �Q Q V ,U •� t� C-e� _ 62
F I Boring #
Boring �
I I Q pit Ground surface elev. C / Z . ZO ft. Depth to limiting factor 1 O 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 � -IZ l(:� yr3 I Z i/ C5 (v- S
2 IZ -4 t i0 rylti
3 ` 1 0 � r `11ic C ZP I , S 'Ak 5L 2 rn 5 bk ry' � s _ 5 `?
4 lc 5L Zm )D K rn
Boring
a Boring # � g
® pit Ground surface elev. Si 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
CI ( IZ 50 2 r» (-5 1 v S
Z 3 - Y 8 l y `f S/ 2 rnabk
3 r qko
* 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) Si nature CST Number
dda
Address Date Evaluation Conducted Telephone Number
7rs -zy;Z -y2r
Property Owner Co / / , o / Parcel ID # Page 2. of
F R1 Boring # ❑ Boring _
Pit Ground surface elev. 9 3-lo 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 I *Eff#2
lO 31Z — Sid Z C ►vC .5 .8
Z !'i - 1 4 — S'' ern k fn-�- s - 5
3 s O -15 10 r `fAv C 2 P - 1 m
❑ 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 GPDM
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2
❑Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ 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 *Effn
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.
SB"330 (R.07 /00)
fl f
PAGE 3 OF
NAME C o o u LOT# 4 LEGAL DESCRIPTION Sw ' /,S�'/a S33 T3a , N,R ($ E (or)
SCALE: I "= YD
BM I ELEVATION X00 d
BM l DESCRIPTION l6e6� Z ' �vc Q p
BM 2 ELEVATION 9 Y •o 7?- S e c, 33
BM 2 DESCRIPTION fopT Z " fJyc j O,'Dc
SYSTEM ELEVATION 90.3 0 t +
ALTERNATE ELEVATION
I
CONTOUR ELEVATION 'M- S . 93• so
5�
(a
<-
o
a , 3
SIG TUBE DATE
IX17
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 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
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
Property Address ,� '54 "''
(Verification required from Planning Department for new construction)
City/State NeW 'Ri4XIMawj W-E - Parcel Identification Number
LEGAL DESCRIPTION
Property Location S In) %,, S C %,, Sec. 0>. T ON -R If W, Town of ` cim"
Subdivision Lot #
v ' Q� G�JC.OI TP
Certified Survey Map # Volume , Page # 3 V10
Warranty Deed # ( I T S Y ? D Volume . Page #
Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result is 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 is 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, journeymaaplumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system
is is 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 Departure of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
t yo septic s t a intained must be completed and returned to the St. Croix County Zoning Office within 30
e e n
OF APPLI ANT i DATE
OWNER CEATIFICATION
I (we) certify that 11 tatemen n this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
p cr{bed a v warranty deed recorded is Register of Deeds Office.
GNATURE OF APPLIC DATE
* * * * ** 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
rKCM P C COL1.aVA HLDftr, INC FHCNE NO. i i5 =-►- _� trt lb cl:1l�l • -,crn 1 ri
SrA18 BAR UFWj3CUNMf4pURM
K �-� S{
WARRANTY DEED RESISTER QF DE
St. CR.nix CD., WI
ooe+t
Thij pen(, made hetsaeoa Kenneth L 13 own and KsiLian B. M b-M FM X=
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N 00'36'41" E 983.86'
NORTH— SOUTH 1/4 LINE OF SECTION 33
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