HomeMy WebLinkAbout026-1141-05-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
• INSPECTION REPORT sanitary Permit No: 405004 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. I Richmond Township 026- 1141 -05 -000
CST BM Elev: ! Insp. BM Ele : BM Description:
TANK INFORMATION U ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmarks /
�; 1 3 Fsa 1r,3 Ias.
Dosing Alt. BM
Aeration Bldg. Sewer S-1 �S�
Holding St/Ht Inlet a go
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic y , f t , I Dt Bottom
Dosing Header /Man.
Aeration e `
Holding Bot. Systekd s� A
Final Grade �oa�
PUMP /SIPHON INFORMATION I
Manufacturer Demand St Cover wy►.e
Model Numbe
TDH Lift tion Loss System Head TDH Ft
For ain Length Dia. Dist. to
SOIL
BSORPTION SYSTEM 3
%RMW RENCH Pidth Length No. Of Trenchet DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIM 3 1. 2,5 3
SETBACK SYSTEM TO P/L Manuf L G WELL LAKE /STREAM LEACHING yrpr: L - %1
INFORMATION CHAMBER OR five
Type Of System: r r ( UNIT Model N n
cevv N . 7 w�ptwt
DISTRIBUTI N SYSTEM
Hea dMan'If91 w Distribution x Hole Size x Hole Spacing Vent to Air Intake
�ss Pipes) I
Le efD ia� Length Dia Spacing
S OVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil Fw] Yes [] No Yes ❑ No
COMMENTS: (include code discrepencies, persons present, etc.) Inspection #9 ^ �v� O' _2 =7 _ Inspection #2:
Location: 1207 117th Ave New Richmond, WI 54017 (SE 1/4 SE 1/4 33 TION R18W) Duck P T scape Lot 5 Parcel No:
1.) Alt BM Description = A)IIA. i4) A 1 tv. # S
2.) Bldg sewer length IMF .0 t.+i� r ff `j
�r t 93.1D
amount of cover = ) $ 4 to J - D
3> K A -100 E ri lW�' /o bo 93.20
Plan revision Required? Yes No I
Use other side for additional information. _ - - --
Date Insepctor's Signature Cert. No.
SBD -6710 (R.3/97)
1
Safety and Buildings Division COQ'
` 201 W. Washington Ave., P.O. Box 7162 J L A
FVVi SconSin Madison, WI 53707 - 7162 Site Address
Department of Commerce Permit Number
Sanitary Permit Applic E p p y
In accord with Comm
83.21 Wis. Adm. Code, personal inf rnati Check if Revision
may be used for secondary purposes Privacy Law, 15.04(l m Stan Plan I.D. Number
I. Application Information - Please Print All Information MAY 0 7 2002
Property Owner's sine ST. C 1 0" COUNTY Parcel Number 3=�
C D ZONING OFFICE s�
property Location
Property Owner's , Mailing 2 Address
`, `
City, State Zip Code Phone Number Lot ber Block
L Numb
Su 'vision N CSM Number
II. Type of Building (check all that apply) ❑City
2 Family Dwelling - Number of Bedrooms
7 17'-- � / �� -h_,�. ❑Village
❑ Public/Commercial - Describe Use /` _r o nship / ('
❑ State Owned L / Nearest Ro}dd
M. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable)
A 2 �[]R Sy stem 3 11 Replacement of 6 11 Addition to For County use
stem Tank Onl Permit Number Date Issued
Exis ' stem
B. ❑ Check if Sanitary Permit Previously Issued
IV. of Permit: (Check all that apply)(numbering scheme is for internal use)
Non - Pressurized In Ground 21❑ Mound 47 [1 Sand Filter Constructed Wetland
22 11 Pressurized In- Ground 41 El Holding Tank 48 ❑Single Pass 51 Drip Line
45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑Other
V. D' tment Area Information:
Design Flow (gpd) Dispersal Area j Dispersal Area Soil Application Eleva n
Percolation Rau System Elevation Final Grade
Required V proposed Rate( Gals ./Days /Sq.Ft.) (Min./Inch)
VI. Tank Info CaIracity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanks Concrete Constructed Glass
New ExistWS
Twiks Talcs
Septic or Holding Tank
Dosing Chamber
VII. Responsibility State t- II, the undersigned responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber' cure MP/MPRS Number Business Phone N r
Plumber's s (street, City. state. e)
V. -olint /De attment Use Only ent Si o Stamps)
Sanitary Permit Fee (includes Groundwater Date Issued g»a
Approved ❑Disapproved Surcharge Fee)
❑ Owner Given Initial Adverse (G
Determination
IX Conditions of Approval/Reasons for pisapproval
_m.)"I 44,421(1 rD11- r
Attach complete plans (to the County only) for the system on paper not leas than 8112 x 11 inches rn size
can -A (R OS /Oi)
PLOT PLAN
/MPR P.C. Colbva Bldrs. Inc. AD ESS P.O. Box 489 Somerset Wi 54025
11/ SE 1/4s 33 /T 30 N W N Richmond COUNTY ST. CROIX
aun Bird 226900 DATE4 /9/02 BEDROOM 3
CONVENTIONAL XXX IN-GROUND PR ESSURE 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 Foundation ;/ ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
SYSTEM ELEVATION 93.2
Alt. BM Top of Basement Floor @ 96.0 per y�
1
Plans Designed Usin
Conventional Powts Culdesac
Manual Version 2.0
Vent
>6 » Standard Infiltrator - — -- Property Line
i —
Leaching Chamber 1 Pro
of Cover with 31.1 ft2 of Area
12" ~
Long ' 34 „ Grade at System Eleva n Bedroom Alt r
House A .0
5�
B. 50'
0
Z_ 2 0'
3 -3' 80' Cells with >3' Spac' g� ST
B -1 10'
B-2
20 0
Vents
45' '65 45'
Site does not have Vents
enough slope to
establish contours 0% Slope 100'
C ry _ R k oa d E
PLOT PLAN
PROJECT P.C. Collova Bldrs. Inc. AD ESS P.O. Box 489 Somerset WI 54025
SW 1/4 SE 1/4s 33 /T 30 N W N Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 4/9/02 BEDROOM 3
CONVENTIONAL XXX IN- GROUND 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 Foundation ;/- ASSUME ELEVATION 100° Filter Zabel A -100
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
SYSTEM ELEVATION 93.2
Alt. BM Top of Basement Floor @ 96.0
Plans Designed Usin
Conventional Powts Culdesac
Manual Version 2.0
Vent
> 6» Standard Infiltrator
Leaching Chamber Property Line
of Cover with 31.1 ft2 of Area
6' Long 12" Pro 3
34" Grade at System Eleva ' n Bedroom
House Alt
* .M.
B.M. 50'
20'
20'
-3' 80 Cells with >3' Spacing] ST
0'
B -1 10'
B -2
20 0'
Vents
45' 45'
Site does not have Vents
enough slope to
establish contours 0% Slope 100'
Cty Road E
Wisconsin Department of commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings s .
in accordance with Comm 85, Wis. Adm. Code
County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
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. J ' � I- �Vie w by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Own e Property Location
C s �
- 0 �� "> G , �• Govt. Lot S 4-./ 1/4 5�F 1/4 S3 3T N R E ( ) W
Property Own is Mailing Address Lot # Block # I Subd. Name or CSM#
City State Zip Code Phone Number ❑ City Village -Town Nearest Rdfid
New Construction Use. Residential / Number of bedrooms Code derived design flow rate '�'�,' (� GPD
❑ Replacement ❑ P lic or co al - Describe:
Parent material Flood Plain elevation if applicable /✓//7 ft.
General cornmer6s
and recommendations:
Boring # ❑Boring � /
v7 ft. Depth to limiting factor � in.
❑ A Pit Ground surface ele
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
-17 57
® Boring # Boring
pit Ground surface elev. Depth to limiting facto/—e&L in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2
S— f %i .� i
t✓✓ �S .
' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 1 0 mg/ • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Nam (Please Print)_ Si ture l Number
G�
Address t E aluation Conducted Telephone Number
SBD -8330 (R07 /00)
I
Property Owner Parcel ID # Page Z of Z
® 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 GPDfft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. �+ *Eff#1 *Eff#2
2 - a
F-1 Boring # E] 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
F-1 ❑ 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 /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 = 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)
Soil Test Plot Plan
Project Name P.C. Collova Builders Shaun B' —�
Address P.O. Box 489
Somerset Wi 54025 #226900
Lot 5 Subdivision Duck Pond Date 5/6/02
SW 1/4 SE 1/43 33 T 30 N /R W Township Richmond
Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Foundation
93.2 *
System Elevation HRP Same as Benchmark
Y
0
Alt. BM Top of Basement Floor @ 96.0
Culdesac
Property Line
Pro 3
Bedroom Alt
House
.M.
` B.M. 50'
20'
0 '
B -1
B -2
20' 0
45' 45'
Site does not have
enough slope to
establish contours 0% Slope 100'
Cty Road E
I
Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162 0 /
N *iscoiisin Madison, W1
d 0110
53707 - 7162 V Si C
De artment of Commerce
'
Sanitary Permit Application Sanitary Permit Number
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision� S0
ma be used for secondary purposes Privacy Law, s15.04(1 m
I. Application Information - Please Print All Information State Plan I.D. Number
Property Owner's Name Parcel Number .
?
Property is Mailing Addres I Property Location � . - ' J
Sf 14;S T�>T ✓�N,R
City, State Zip Cade Ph NurC G` E' Lot r Block Number
c-" Sub vision Name CSM Number
APR 10 200
H. Type of Building (check all that apply) rr � ' _ ST. CROIX COUNT ❑Ci
or 2 Family Dwelling - Number of Bedrooms �A"'� OFFICE . He
❑ Public/Commercial - Describe Use wnship
❑ State Owned 1 ( Barest Road
3o C3 3 X 6z sa In
III. Type of Permit: (Check Wy one box on line A (nuifibering scheme for internal use). Complete line B if applicable)
A. 1 2 11 Replacement System 3 ❑ Replacement oq Existing 6 ❑ Addition to For County use
stem Tank Only S stem
B • ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued /Q
IV. Type of Permit: (Check all that apply) (numbering scheme is for internal use)
44Aon - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland
22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 43 ❑ Single Pass 51 ❑ Drip Line -
45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other �� se ; '
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation IN e
Required Proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) 10,3,2-1 f evat
spa 2 16 S.
Z
VI. Tank Info Capacity in Total Number Manufacturer Prefab Sik Steel Fiber Plastic
Gallons Gallons of Tanks Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank
Dosing Chamber
VII. Responsibility Statement- Ii, the undersignW M ane responsibaity for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber'sA01111ure MP/MPRS Number Business Phone Number
Plumber's Address (Street, City, State, e)
� l Y2- �P�tc//�� �' �� �i
VIII. Coun /De artment Use Onl
Sanitary Permit Fee (includes Groundwater D Issued jssu ent igna ps)
Approved ❑ Disapproved Surcharge T 6 - j
❑ Owner Given Initial Adverse 2zS /1
Determination
IX. Conditions of a pprov al/P ea Di
sons fo sapproval
Attach eomplete plans (to the r4unty only) for the system on paper not lees than 81/2 x 111nches la size
SBD -6398 (R. 05101)
X P PLO PROJECT P.C. Collova Bldrs. Inc. .O. Box 489 Somerset Wi 54025
SW 1/4 SE 1/4s 33 /T 30 TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 4/9/02 BEDROOM 3
CONVENTIONAL XXX IN -G N RESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 930 # of chambers 30
IL 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 -- - - -- - -_
Vent SYSTEM ELEVATION 103.2/102.2/101.2
Standard Infiltrator
>6" Leaching Chamber Plans Designed Usin g
of Cover with 31.1ft ^2 of area Conventional Powts
Manual Version 2.0
6' Long 16"
3 4" Grade at Syste Elevation
80'
B.M. #2
3 -3' X 63' Cells with >3' Spacing
0'
B.M. #1
AL
469' Property Line 09 %
40' B -3 40' Slope 40'
Vents Vents
X07 - 2
20'
B -2
T
10'
Pro 3 0
0
Bedroom �
2 . House
�i 305'
51 1' Property Line
PLO P AN
PROJECT P.C. Collova Bldrs. Inc. AN
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 /9/02 BEDROOM 3
CONVENTIONAL XXX IN -G N RESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 930 # of chambers 30
BENCHMARK V.R.P. T f 2 PV Pi
Op 0 C pe ASSUME ELEVATION 100'
Filter Zabel A -100
❑ BOREHOLE O WELL •H.R.P. Same as Benchmark --- -- - --
Vent SYSTEM ELEVATION 103.2/102.2/101.2
Standard Infiltrator
>6" Leaching Chamber Plans Designed Using
of Cover with 31.lft 2 of area Conventional Powts
Manual Version 2.0
6' Long 16"
34" Grade at Syste Elevation
80'
B.M. #2
3 -3' X 63' Cells with >3' Spacing
0 '
B.M. #1
AL
469' Property Line 01 %
40' B -3 40' Slope 40' 'l
Vents J - Vents
20'
B -2
T
10'
Pro 3 ¢
2 Bedroom
House
305'
51 1' Property Line
Wisconsin Department ofCommerce SOIL EVALUATION REPORT Page of�_
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan mutt Clio r
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 p rint all in Reviewed by Date
Personal information you provide may be used for seco Tarqy� rrvacy Law : 15.04 (1) (m)).
Property Owner / � Location
1 DAIOv -�� Goan. of �G�f 1/4S E 1/4 S ,33 T 30 N R /g E (or
Property Owner's Mailing Address - Lot# Block # Subd. Name or CSM#
2. q —
City State Zip Code ' NumbeEi G Y ❑ Village ®,Town Nearest Road
v I(� (11) N `°" r'ch C mil L
® New Construction Use: ® Residential I Number of bed(ooms ` Code derived design flow rate 'v-s01, 4 r GPD
❑ Replacement // ❑ Public or commercial - Describes.--- -
Parent material � Flood Plain elevation if applicable "e ft.
General comments fv Y S {� � a!� v • P 143•/O 40W C4—
and recommendations: !,/] (_ e 7' 10 2 ,26 � � � � /ar•Q a
Boring #
Boring
fVl VU Pit Ground surface elev. /6 '3- ft. Depth to limiting factor �0 8 in.
Soil Applicatio n 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
D 16 Y r 31z — I 2 me b k m c. S I V-C S �'
Z 10- ) ► 0 4 L c4 2m rm4r
3 _
�(o (erg �b (�f ��o LS I rn 5 my • 1 �
(Dfz
�s.z Gf�2 �z� e
F-2-1 Boring # t � Boring
I '1` Pit Ground surface elev. 10S ft. Depth to limiting factor 2 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
�_ S I 3 z 5 i/ 2mabk (y, �r C S I 'J
2 - 20 �t sL Zwi5b m
3 - (oZ 4I to L 5 t r, s m V �f — _
uZ.2
f
* 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 j CST Number
Address Date Evaluation Conducted Telephone Number
Z//3 - 00 ' S� -�of �S-�,� 4/l S az
I I
Property Owner Co//o v Parcel ID# Page . of 3
3 Boring# El Boring /b
I. /O 3 pit Ground surface elev. ft. Depth to limiting factor g 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 p— It /0yr3/Z — 511 2mG-bk m-C' CS I v_c . 5 8
Z f/- z /Ovr-411{ - S 2 rn5 bk m cS - 5
54- 2.rr>5b/... 0. A. 5 -?
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/ff
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 1 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 =BODS>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOLO,<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.
$BD-8330(R 07/00)
♦ M.
PAGE ;3 OF 3
NAME Co I J o u LOT# 5 LEGAL DESCRIPTIONSW 1/4SE'/4,S 33T36,N,R (g E(or)OD
SCALE: 1"= 1110
BM 1 ELEVATION /00 •0
BM I DESCRIPTION 71a(>a Z " p✓c p;p a /
BM 2 ELEVATION el q.O S E'C • 33
l BM 2 DESCRIPTION -h: P o Z ' P,p -
SYSTEM ELEVATION fop 103. 1 Lower /oz.g _ —
ALTERNATE ELEVATION 61, (Q .1O Lower`)01•4 v x
CONTOUR ELEVATION (03.o, /oS.0
c` c,a+
te
,SQc Sk„
eav
e3 ■ 4I, /U3.0
II 3-I
3-Z
SIGNATURE DATE 6 • z S—oi
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
. _ - 7/j-- 3e6
Shaun Bird #226900
FROM : P C COL.LOVA BURS, INC PHLTIE NO. : 715 549 5911 Feb. 01 2001 07:33W P1
S7' CROIX COUN'ry
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer _ R r 5
Mailing Addre P- 0' G0 X " L189 5;o1Y1. E1_ _s ET u,1_/ 7 7
Property Address 0 4-1) S+'
`�-- ( Verification required from Planning Deparument for new construction) 1
City/State Ne'j) c.� W� d W Parcel Idetatiftcatiost Number
U GAL DESCRIPTION
Property Location , SL. '/,, SCC� T
't /, -R _&V, Town of T% -'
Subdivision Lot if .
Certified Survcy Man 11 2 Vela:.•* c �, ?age r
Warranty Deed # �7q Volume . Page #
Spec house Q yes ❑ no Lot a-- identifiable ❑ ytw ❑ no
SYSTEM MAINTENANCE
Improper use and maiwen mce of your septic system could result in its premature failure to handle wastes. Proper Maiateaaacc
consists of pumping out the septic teak every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic wik as a treatsaent stage in the waste disposal system -
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by thz owner and by a
macwphsmber, joumeymanphsasber, restrietcd plumber or a licensed pumper verifying ttsat (1) the on -site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if accessary), the septic tank is less than 1/3 full of sludge.
I/we, the uadtasigaed 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 Deputment of Natural Resources, State of Wisconsin. Certification
stating that your septic ryatem has been maintained must be completed and returned to the St, Croix County Zoning Office within 30
days of m three year tio date,
S GNATURE OF APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the hest of ray (aur) knowledge. I (we) ant (are) die ownet(s) of
the p described abo y virtue of a warranty deed recorded in Register of Deeds Office. Z _
SIGNATURE OF APPLICANT DATE
ar +t
Any information that Is mis-represented may result in die sanitary permit being revoked by the Zoning Department. • "'•'
•r Include with this appllealtant a stamped warcanty dccd from the Register of Deeds otllce
a copy of the certified survey map if reference is made in the warranty dccd
FROM P C COLLOVA BLDRS, INC PHONE NO. : 715 549 5911 Nov. 16 2001 09 :32AM P1
S I A I G H AV, OF W ISCONSIN FURM 1- 1948 16 A- I - 3
• WARRANTY DEED KNHL.E'EN N. WkSli
REM
STER OF DEEPS
ocanleux Numbfr St. ; kvlx Co., WI
1'hls Deed, atnde hctwcen Kenneth L. Brolrn nrd N athleen B. kEC6 ;VEA FOR pip
Brewle, llusbrad rnd Wife — r TT
04 -18 - 2001 9:45 AM
MAHTY DEE1
Grantor, and P. C Ccllovn BulldCT4, 12 EXERT 1
UNI' tlpt FEE.
COPY FEE.
,VAWFER FEE: 828.00
_..._...........,....._ _. _ -- RECMUM FECt 10.00
Granttt.
Oranter, for a valuable Consideration, conveys and warrants to
Grantee Ih4 following dcacribcd roll cstoto in St. Croix _ � ( I QAf f-
Cou nty, Stak of Wisoormim y
ItecordiricAms
Nme end Item Addren
'Chat part or so I /4 SW 114 and SW 114 SE 114 Soo. 33- T30N -RISW doscribdd avid I. i9t St. n
s, F91 lows: Lacs 1, 2 and 3 of CorliRod Survey Map reeorded In Vol, 13 of I udtotr, WI 54016
Certifted Survey Maps, Page 3698 ss Doe, Rio. 607591.
$t. Croix County, Wisconaill ")
- I09 .U2G - 1 OSi UC.
026.1096.70000
FamclIM oatlonNural>tai1RN}
This is not holnestcad property,
(Irk (is not)
E1mePtlorls to w2rrarlties: Existing highway$, easements & tights of way of.tiecrd.
Doled thir 4 day of April $061
. Kenneth C„ Brown�r�
Katkima B. Brown
AUTA Ei1TDCATION ACKNOW LEDGM ENT
STATE Or Wisconsln 1
tit>P1itYn(►} $r. Crol:t
County. j
Personally cams before me this day or
autkemtkated this day of April , 2001 the &Wvc rwnled
enaeth �,, ralv,t and Katkleen B. Drtrwa
TITLE: v Art O r WISCONSIN to now" !e he the croons w6a a,.eul.d the fo
.':' P O regotrg
C ! etu sod dekrrowleda the ssmr.
Dr4ur). is. Stals.j
`iWAS D&AFTL'U BY
AIt I _ _ avid J. Estreen
304 Liu Y on, WI 54016 Natuy Public, State of "
(S 111utur/D'w1,sy. be tauthemleaw or seknowlsdgad, Both art Sot My Cornmimon Is pen u n . no's o explr om s
1 14 mes Of retrone slanka id my capacity ADvId be IYPrd or prink Wm theIr olgmmms
WARRANTV Oak& STATC BAN or WISCONSIN
yt11aN N0.1. N,a
INFORMATION I'RUNNd]IONALa COMPANY aOMt) W LAC, WI rooila.]e)1
N01103S 30 31NI� i,/ l Hint
,99' 96 3 ,. Liv,9E.00 N
SGN`d 03iiVd dNn 4 9C'N6
ZL 659
IC C/I � I N o
Z C n I cD O
-< Z m I \ " Dc
O ;u I sr n -
m o �.
D 00_,
t c 0
Icn rrl W 00
CA I° I ; , O \
• I o
D�
M�M r �N I W 1
L J IDIOIO I N I I I 1
0o I
WI I N Qo
J cn I i q
J
M ..ZO ,10.90
� I � a, w
�d 1
42 ,
I I o�lo� I = I
I ° 5 4" fl w Ww I m o' /
o
o O
o
of / I O
O JI
r W I 0 ,
J
6 0 00
CA 0 "N�,
` O I l0$
c 87'
I N I U�
r /
Ln
N O
00 I I I II r
z O
OD
— S 0" 4 b4" W
� 1 I —
�1