HomeMy WebLinkAbout026-1141-06-000 WisconsimDepartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Divis m
t = INSPECTION REPORT Sanitary Permit No:
420648
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 Town
026- 1141 -06 -000
CST BM Elev: Insp. BM Elev: BM Descri
Apo �a ld0. a
TANK INFORMATION ELEVATION DA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic — Q� Benchmark 2 d2.
Dosing D0 Alt. BM s7` It D C ` DO
Aeration Bldg. Sewer o
y 3 �0-
Holding S Ht Inlet
� a s R7.7
TANK SETBACK INFORMATION t Outlet S Z 7•
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet !_
Septic Dt B ttom
Dosing Header /Man. q �
Aeration Dist. Pipe t 04.i
Holding Bot. Soystigm 1 Gi • 2 '
d
PUMP /SIPHON INFORMATION Final Grade 'S 1•1 3a
Manufacturer Demand St Cover
IG �o _Pv
Model Num r
TDH Lift >4rriction Loss System Head TDH Ft
Force ain Length
SOIL ABSORPTION SYSTEM
BED/TRENCH Width r Len th� / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING anufa rr Jl r
INFORMATION Typ Of System: MBER O (6 U
�" / UNIT Model Number:
DISTRIBUTION SYSTEM J f ltd
Ing
Header /Manifold Distribution 1. x Hole Size x Hole Spacing Ve to Air Intake
� Pipe(s) 1 /
Length Die Length Dia {f . Wa.acing J �� I
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only .� vI� Dltisyl
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center L /,(fi Bed/Trench Ed es To soil
7 g p r � Yes r � No � Yes :L7
COMMENTS: (Include iscrepencies, persons present, etc.) Inspection #1: Y // r 3 Inspection #2:
Location: 1211 117th Ave New Richmond, WI 54017 (SW 1/4 SE 1/4 33 T30N R18W) Duck Pond Esc, a Lot 6 Parcel No: 33.30.18.1010
1.) Alt BM Description
2.) Bldg sewer length = 2 i /_ i,�_ /
- amount of cover = � `�'��'""� ` ,JGt,�{,QyytO�y�
Z, S Sy Q,Gu yr
�r
Plan revision Required? ] Yes o L CO
Use other side for additional information. Si D 3 2 — 1 ��l
SBD -6710 (R.3/97) Date Insepctor's Signa re Cert. No.
Soi Test and System PLOT PLAN
PROJECT P.C. Collova Bldrs. Inc ADDRE S P.O. Box 487 Somerset Wi 54025
SW 1/4 SE 1/4S 33 /T 30 /R W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 4/5/03 BEDROOM 3
CONVENTIONAL )00( 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 .5 ABSORPTION AREA 933 # of chambers 30
IL BENCHMARK V.R.P. Bottom of Siding ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL •H.R.P. Same as Benchmark
SYSTEM ELEVATION 93.6/92.2
121 st Ave
Plans Designed Using
g
Conventional Powts
Manual Version 2.0
Property Line
2 -3' X 94' Cells with
" >3' spacing Vents
B -2
COPY
5' Pro 3
Bedroom
10% B.M. House
Slope 15'
-3
0 , Vent
40'
>6 „ Standard Biodiffuser
, T f Cover Leaching Chamber
5
with 31.1 ft2 of Area
a 50'
11"
B- 15 6 Long Grade at System Elevation
o n 3 4„
Drainage
easement 175' Please note:
Drainage easement
must be verified and
staked before
system can
be installed!
Oh.
\ 19
DEDICATED TO
5 00'41
42
13 S 87'16'38" W 12
X75--
N - L T '7
— 87'16'38" , 17 � �
16 50 75'
-
`��i, //9580 Sq. Ft.
- , 1.83 Ac. LOT 8 I
, I� l
N 1 N
94754 Sq. Ft. S I 95
/ 2.18 Ac.
✓� / 0 o; b O N
6
Sq
.51 Ac.
dl
s s SF� u 411 w
4 .74' -
121.48' F 79 7B' — 262.26' — — — —
- - - -- 1 ? � �- ---- - - - - -- i 7g.
-" -- 1.8 95 6' - 9B.
8 DEDICATED TO THE PUBLIC COUNTY ROAD E SOUTH LINE
3 N 89
1, C. `
IN
217
74
` ,
ou s TILITY
COUNTY SECTION CORNER MONUMENT G S `
/
q — — — — 12 UTILITY EASEMENT NO POLE OR BURIED
c �( WOULD DISTURB ANY .
R. A. RECORDED AS STREET LINE, THE DIS
��- OF SECTION 236.32 0'
T HWE = HIGH WATER ELEVATIONS SET FORTH ARE FOR
HAVING A RIGHT TO S
FOUND 1 1/4" IRON PIPE
r
. Safety and Braidings Division COUBLY 7 l
201 W. Washington Ave., P.O. Boa 7162
N VIsconsin Madison, WI 53707 - 7162 Sire Address
De artment of Commerce ,12 11 / 7
Sanitary Permit App ' Pew Number
In accord wi& Coamn 83.21, wis. Adm. code. personal forma n yd4 D r TQ 0 &o 4 �
my be used for LA , sl5. i m Dd' CCheck ¢Revue
L Application information — Please Print AD Information APR G 8 2 00 3 stale Plau LD. Number A///4
P roperw ST. CROIX C0UN7Y Pa�lNomi�es
ZONING OFFICE OZ( /l W — D(v - 0Dd z1
Property Owner's Address Pmperty Location
1 ! WS 'A• 933 T N, IV ,ff
City. state Zip Code Phone Number Lot N Block Number //D l0
Name CSM Number
>i. Type of Building (heck an that apply)
16 or 2 Family Dwelling — Number of Bedrooms
0 Public/Commercial — Describe Use G'
0 State Owned c ) T /L�/.!G( -lES w //S z
n-7
_ �� Nearest Road
Iii. Type of Permit: (Cho& ally one boa on line A (n sr� for internal use). Complete line B if applicable)
A. 2 0 Replacement Sytsem 3 0 Replacement of 6 0 Addition to For County we ystem
stem Tank S p' 1
B. 0 Cheek if Sanitary Permit Prneviously Issued Permit Number Date/ Z cd Q 3
IV. Type of Perm ih (Check all that apply)(numbering scheme is for internal me)
44 pressurized In-Ground 210 Mound 47 0 Sand Falser 50 0 Constructed w ed da and (- I
22 0 Pressurized h Ground 410 Holding Tank 48 0 single Pass 510 Drip
45 0 At -Grade 46 0 Aerobic Treatment Unit 49 0 Recii+calatmg 30 0
V. Area Informsdon:
Design Plow (gpd) Dispersal Area Dispersal Ana '/ Application Percolation Rase Find Grade
Required / Proposed Rate(Gals.iDays1Sq.FL) (WmJlnch) �� IDevanon
VL Tank Info Capacity in Total Number Manufacturer Prefab ate Sled Falter Plastic
Gallons Gallons of Tanks Concrete Constructed Glass
New
Tads Tanks
Scpdcor BoUift Yank
t lbw
VII. Responsibility Statement 4 the . ----- -s DAN— fa installation of the POWTS shown an Sue attached plans.
Plumbers aam (Pdwl Phmtber's S' M Ph
PAAM Number Business one Number
S�
nunbees Address (Sweet. City. State. Zip ) y P oq 3
v Mille Coup me Use Only
Approval 0 INsapl ed Sanitary Permit Fee (includes Groundwater Due Issued o Stamps)
sarcharse Fat
0 Owner Given bunial Adverse )* • �� " l 1 lj l
Determination 1
IIc, Condition of App Approval/Reasons; for nisappcoval
i CA a.,
Alta& convide ph- (su Se Conoly calf) far me a,ateao an paps not leas thm asn: u taxies in doe
SBD -6398 (R.. 05/01)
430/R Test and System PLOT PLAN
PROJECT P.C. Collova Bldrs. Inc ADDRE S P.O. Box 487 Somerset Wi 54025
SW 1/4 S E 1/4s 33 / W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 4/5/03 BEDROOM 3
CONVENTIONAL XXX IN-GRqXD 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. Bottom of Siding ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
SYSTEM ELEVATION 93.6/92.2
121st Ave
Plans Designed Using
Conventional Powts
Manual Version 2.0
Property Line
2 -3' X 94' Cells with
>3' spacing Vents
B -2
45' Pro 3
B edroom
10% B.M. House
Slope 15'
B -3
Vent
40' 30'
>6 „ Standard Biodiffuser
Leaching Chamber
t 50' 5 T of Cover with 31.1 ft2 of Area
a
0 11"
� 6 Long
B -1 34 „ Grade at System Elevation
r, Vents - -�
Drainage
easement Please note:
175' Drainage easement
must be verified and
staked before
system can
be installed!
4301R_ Test and System PLOT PLAN
PROJECT P.C. Coliova Bldrs. Inc ADDRE s P.O. Box 487 Somerset Wi 54025
SW 1/4 SE 1/4s 33 /W TOWN Richmond COUNTY ST.CROIX
MPRS Shaun Bird 226900 DATE 4/5/03 3
BEDROOM
CONVENTIONAL XXX IN -GR D PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC, TANK SIZE 1 000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # o f c hambers 30
c h a
I , BENCHMARK V.R.P. Bottom of Siding ASSUME ELEVATION 100 Filter Zabel A -100
BOREHOLE O WELL 'H. R. P. Same as Benchmark
SYSTEM ELEVATION 93.6/92.2
&
1 1 st ve
Plans Designed Using
Conventional Powts
Manual Version 2.0
'A
�C c
Property Line
S I
2 -3' X 94' Cells ith kil
>3' spacing Ven
i
B2
45' Pro 3� t
B edroom
10% B.M. House
Slope 5'
-3
0 , Vent
40'
>6„ Standard Biodiffuser
Leaching Chamber
lr� 1670 o Cover with 3 1. 1 ft2 of Area
a
° 11"
� �
B- 15 6 Long Grade at System Elevation
34 „
r� Vents —
Drainage
easement 1 Please note:
Drainage easement
y must be verified and
k , staked before
r system can
I' be installed!
► 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 81/2 x 11 inches in size. Plan must x
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 eviewed by Date
q
Personal information you provide may be used for secondary purposes (Privacy taw. s. 15.04 (1) (m)). l 0 3
Property // f Property Locatio
. eV110 ` Govt. Lot
L-5 1/4��1/4 S 3T 3 v N E ( W
Property is Mailing Address Lq# I Block # S Name CSM#
0 , V j 6 Cs C
City State Zip Code Phone Number ❑ City ❑ Villa a AffT Nearest
ew Construction Us dential / Number of bedrooms Code derived design flow rate .J GPD
❑ Replacement ❑ Public or com ercial - Describe:
Parent material ��ci�. Flood Plain elevation if applicable / fl. comments
G
and ons:s
Boring #
Boring
a A Pit Ground surface elev. I ft. Depth to limiting facto in.
Soil Appimbon Rate
Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
p.-1 �L ----- �'s '
7- — V . O t 4 �a
A- 1,4 l - Z
®
Ong # Boring
Pit Ground surface ele� ft. Depth to limiting facto in. Appl ication Rate
Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPDM
in .. Munsell Qu. Sz. Cont. Colo Cq. Sz. Sh. /J •Eff#1 *E
7"
• Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < mg/L ' Effluent #2 = BCD ,:5 30 mg& and TSS < 30 mg1L
CST Name (Please Print) Signature C$T Number
Address Date Evaluation Conducted Telephone Number
Property Owner Parcel ID # Page 2 of 3
9 Ong # ❑ Boring
it Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Ef1#2
/ >
F-1 Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
Boring # O Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Applicatim 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 1220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/- 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.
SOD -9330 (FLU00)
Safety and Buildings Division County
N i se 20 1 . Washington Ave.. P.O. Box 7162 e nsin Madison. WI 53707 - 7162 Site Address
Department of Commerce I a l / I ( ,
Sanitary Permit Application Permit Number
In accord with Comm 8321, Vrm Adm. Code, Personal ;of
may be used for Law. :15. 1 m I V E: D ¢
L Application Inform_ adon - Please Print All Infotmatioua Plan I.D. Number /
Property Owners Number D Z f0 6 - 6, 0 -C
�O I LO v f.
T. c�lx counlT
�M Mane Address �O �v 70 - SvtgD
mac, rI GOFFIC- 7 Location 02b
�L: S ? j T N. ld t`a
city. State Zip Code Phone Number Lot Number Block Number
Subdivision Name CSM Number
- Ad 1 c
IL T7tm of Building (check all that apply) - OCky 2 Family Dwelling - Number of Bedrooms
O PttbliclCommercial - Describe Use ❑Village
O State Owned nn Neatest Road
4, �
gZ
III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). B If aPP�le
A.
Rat System 3 ❑
1 1
2 ❑ R.I... of 6 O Addition to For Cou» ty we
Tank Only Existing System
B. O Check if Sanitary Permit Previously Issued Permit Number Date Issued
IV- of Permit: (Check all that appiy)(ntwnbering scheme is for interne! use S-fd.
3lad�
Pmssurized In- Ground 210 Mound 47 ❑ Sand Filter 50 O Constructed W 44
O Pressemtized In Castel 410 Holding Tank 48 0 Single Pass 51 ❑
45 0 A1-Grade 46 0 Aerobic Treatment Unit 49 ❑ Recirculatmg 30 0 / , S /5
V. Area Inftmation:
Design. Flow (V 1XVersal Area Dispersal Area Soil Application Percolation Rate System F�
R ,/ Proposed ' y Rate(Gals.Mays/Sq.FL) (Mi tAnch) f � Mevatioa I
N
CCU X00 133 - S �� S "� 6
VL Tank Info Capacity in Total Number Manufacturer Site
New
r ,i
Steel Fmluer pie
Gallons Gallons of Tanks Conch Constructed Glass
Talks Talcs
Septic or Holdi� Tauk _
DosWS C m berr
VII. Responsibility Statement- L the assume responsibility for installation of the Pow" shown on the attached plans.
?heeler's Name 3 Plumber MP/l1�RS Number Business Phone Number
9 Oa
4umber s Address (Street, City, State )
/De ent Use
Approved O Disapproved SwntRiY Permit Fee (includes Groundwater Date Issued 5W Signature (N Stamps)
Sarcha Fee
O
[ )
Owner Given Initial Adverse ZZ j/ l
Deenninadon
% Conditions of Approvai/Ressaw fpr Disapproval
!, ��aU� u�c.Q.��c�� -c cLe__ �.�.•)mvnoti./ � ��-`y� p�i�, -h-� � �JLtJ7s / �lan • '�`,�� �
sysr.�,�,, �a.P�, ,
l Cs .fie a lam= _ u�
Attach Bo eye for the s�steea on sot legs am zi 11 in sine
�vrt d S CQ rt v u�/ a " Z3 Z
' X398 (R. 05101 y3 -/
�u. q
.e q11- s� .
VADDRESS AN
PROJECT P.C. Collova Bldrs. Inc P.O. Box 487 Somerset Wi 54025
SW 1/4 SE 1/4s 33 /T 30 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 1/10/03 BEDROOM 3
CONVENTIONAL XXX IN -GROU 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 sH.R.P. Same as Benchmark
SYSTEM ELEVATION 95.0/95.5/ 1.5' Below Grade
121st Ave
SC J O - C � ,
�
` 1 1 100' 60re o-
2-3' X 94' lls with A' Spac ng J4,s
OX 70
f
�J6rr ; Y v►o S ope
S 5 sh�w,'J B -1 0' 0' B -2 Vent
Ilk
� n 3 3 , M. #2
V
- f
20' V .M. #1
rte' 10' N6 8
s�
30' T B -3 > t5�
o 3 Bedroo
H ouse 41 .L.
3
IV f W J6
0 i
vent
>6 „ Standard B diffuser Q
Leaching Ch be Plans Designed Using
of Cover with 31.1 ft2 o a Conventional Powts
Manual Version 2.0
6' Long 1111
4 „ Grade at System vation
r
P T PLAN
PROJF,CT P.C. Col lova Bldrs. Inc ADDRESS P.O. Box 487 Somerset Wi 54025
SW 1/4 SE 1/4s 33 /T 30 1 18 W TOWN Richmond COUNTY ST. CROIX
r
MPRS Shaun Bird 226900 DATE 1/10/03 BEDROOM 3
CONVENTIONAL X IN -GROU )= 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 (D WELL *H. R. P. Same as Benchmark
AL SYSTEM ELEVATION 95.0/95.5/ 1.5' Below Grade
121st Ave
f Z ScA-
f I �
100'
2-3'X 94' lls with >3' Spac ng
t f Err ; V 0� S ope ^ ��
,S S � J B -1 0' 01 B -2 Vents
n� , cwy �
tN fi o n 11 6 ° r� n ;y 3 ` � ; M. #2
4, dv lr� -gym, -t Vents B
20' M. #1 y
10' tc) OP
B -3 US 1
30 T
0 3 Bedroom 'x
House 41 L.
��
$� 3 .47 r
0 x
Vent
>6 „ Standard Bi diffuser
of Cover Leaching Cha ber Plans Designed Using
with 31.1 ft2 o Conventional Powts
Manual Version 2.0
6' Long ill,
3 4" Grade at System vation
PAGE 3 OF
NAME of /ova LOW (o LEGAL DESCRIPTIO
NSw' /.st' /, S T o N R 1 E or
SCALE: 1 "�
BM 1 ELEVATION . y
BM 1 DESCRIPTION & �� o .
BM 2 ELEVATION N 9'9.30
BM 2 DESCRIPTION c a✓ Sec . 3
SYSTEM ELEVATION
ALTERNATE ELEVATION qG. 4 3a — '+
CONTOUR ELEVATION Z.00, 9S.
� pro oSc ' d
h ' c
q
7 .
b Ise
BS ��,1l��•�'�`
- l+vCe%
83
V tAt� j
s 41A410 }a
p � 5 .., � �- � 4 B Z � � *.
{t.k,s S0
rj, .�,{� D� •�'�.listGk Bhp `� - c..'f" C
SIGNATURE
DATE -ZS =C7/
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County C
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 reference point (BM), direction and Parcel I.
percent slope, scale or dimensions, north arrow, and to nd distance to nearest road. Q� �p . _ j096 - ° — °' �D � 0
Please print all " (7 eview by Date
Personal information you provide may be used f ary pu oses (PriJa�j,LB s. 15.04 (1) (m)). J
Property Owner operty Location
P al W1 -G vt. Lot ,S'W 1/4� 114 S 33T_ N R 1 ff E (or)®
Property Owner's Mailing Address vi , x # Block # Subd. Name or CSM#
- 7 5 C d C cwt nd s Ca pt
City State Zip Cod C . J hone Nu � City ❑ Village E1 Town Nearest Road
L,01 rya - C //
0 New Construction Use: [ja Residential / Num r0odi ` —� Code derived design flow rate e - 1 - 5 - d lj, tJQ GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material L Flood Plain elevation if applicable
General comments s �! 7- e w\ C / b v. P 6 /-a we q -/ • y �� ✓ �Sh,�/�Oi <
and recommendations: 1 4 1 - 4 - e t
Mkv S�Zs4t-kn 24
Boring _ l/
Borin # -4"P Y e(e-✓_
g ® pit Ground surface elev. g,5 . '7D ft. Depth to limiting factor 55 ^ in. S
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. 'Eft#1 - Eff#2
I O— ,3 5'i t 2.mc bk r CS l 5
2 9- r tJ, l�} s ►1 2 c►bk (m�r
3 -55 1p y 1p S 2 m 5b k rn c S j 7
4 ip�r� 3 C - 1 5 ry 13 ScJ Zrnsbk M -(�
Ci e, qt. 3
F2-1 Boring # 1 Boring
0 Pit Ground surface elev. 96.56 ft. Depth to limiting factor LUU in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /f?
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 - Eff#2
I 0 - 12 j 5' I 2 m c- 5 1 v-� 5 .8
2 tZ -1 yI :S 2 � . 5 •$
3 % - too t Liko — 5t_ 2 mSbk mom' .5
9 D - / _36 " S s a ,-j-- _f ac4
' 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
Lim er (r —1 Zs �3 Oct
Address Date Evaluation Conducted Telephone Number
ZIl3 o 1 S-Q 1. s o z z z -c
I
I ,
Property Owner Caro Ve, Parcel ID # Page ? of 3
F Boring # ❑ Boring
® pit Ground surface elev. 99. $6 ft. Depth to limiting factor �_ in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fg
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
0 -1 tD 3 3 5i I 2rrrabk r ]Pr C I v y . 5 8
y14 5i ( 2 m c.bk ► - n f-r c
3 4s- 10 ( -41(P SL 2 rn5bk rnf('
F1 Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil ApElication Rate
Horizon Depth Dominant Color Redox Description Texture [ Gr. tructure Consistence Boundary Roots GPD /fF
in. Munsell Qu. Sz. Cont. Color Sz. Sh. *Eff#1 *Eff#2
I
❑ Boring # Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil ADDlication 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 (W07/00)
l
� J
PAGE 3 OF
NAME LOT# (o LEGAL DESCRIPTIONSw' /�'/4 53+ Tao ,N,R 19 E (or)(2)
SCALE: 1 "=
BM I ELEVATION y
BM 1 DESCRIPTION 7b P o 4�L " Or/c f j0e
BM 2 ELEVATION
SeG• 3
BM 2 DESCRIPTION p a Z 1
SYSTEM ELEVATION 6p 4'y. q D Gre c r 9N. y O _ + _
ALTERNATE ELEVATION t � SD Lvw 1 ? 6 36
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CONTOUR ELEVATION 9Y.0
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SIGNATURE �� il� /� -- - -- DATE
r
f
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
C ontingency Plan
1. if system fails, determine cause of failure, use altemate 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 - 4� PC .
(Verification required from Planning Department for new construction) --) .
n - � &0 -660 (o0 - ate
City/State k)QA.0 1 1 1C.Q(�VV�tird GA � ^ Parcel Identification Number OZ
70
LEGAL DESCRIPTION
Property Locatior.3_-(&) /,, F /,, Sec. T 3
� 5 � ' � �N -R Town of Cal
Subdivision . Lot #
Certified Survey Map # �OO�'S°l ( , Volume Page #
Warranty Deed # (- 1 Volume 2 v Page # 0
Spec hous ❑ es ❑ no Lot lines identifiable ❑ yes ❑ no
SYSTEM KAINTENANCE
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, journeymanplumber, 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
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
�daya�of the three year expiration date.
SIGNATURE OF APPLICANT ` D�
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 perty described above by virtue of a warranty deed recorded in Register of Deeds Office.
6W
SIGNATURE OF APPLICANT /DAT
* * * * ** An information that is mis -re ed
Y resent m ay y result in the sanitary permit being revoked by the Zoning Department. * * * * **
** Include with this application: a stamped warranty deed from the Register of Deeds oMCC
a copy of the certified survey map if reference is made in the warranty deed
-ROM P C COLLOUA BURS, INC PHONE NO. : 715 549 5911 Nov. 16 8001 OS: MAM P1
;rAIEDAitVWIECUNSINFURN2 -1948 K�L E i
WARRANTY DEED REGdSTEA OF DEEDS
t7ocs r
St. CR ^IX cu., W1
This Dad, made hetvreea Kenneth L. Brown and I£atllleen B. AFZ.Y d FOR liEr"M
Brown, IIuslread and Wire — 04 -;8 20^1 9:45 PM
mom WED
Grarstor, and P. G Callora Butidara. Inc. —+_�— MVr I
CRU.COPY FEE:
MY Vic:
:«G1lSFf7 FEE: U&N
— REC efYG F'M 10.09
➢o{,�ga,.. t
Cnntse.
(Zrantrrr, for s valuable consideration, corveys and w:vranu to ^ C
Grantee U)o fol{avrin; dcacrihcd r-al catctc in St. C: aix �f Gl(() n xi C3 S QA L .
Couua►, State of `N'uwnsin: }
Ieee R Am:
r VA.,, end Itdvm AJdrea
David 1. F -Aran
ThOt port of SE Ili SW IA sad Sw 1/4 SE 1/4 Sec. 334 )ON' 71SW �615=bed 304 L=ast St.
as follows: u 1, 2 and 3 of Cartitiod Su i�1. taccrdeJ in col. I: 0£ ;ludson. `•h11 1 '4G t6
Certified S
4t coil Ccunre, Wlrcon:bt uZU•ICVS ao+xV. n:r vYtw�ztly. {
0�6•1C96- 70-0co
rwmf waWacatic. Number WIM)
i nis �� �t I)elneaJ:d
not)
i
Execpticm 10 w1mrities: Hxsting hignwlyl' r se^:cn1; A ri3ats of msy of rcc::d.
i
Ctucd this f i y" Qay of .1nra
. Kenneth L 3rowit
e Kathtcca B. Bro"M
A UTA U TICA TI ON ACX)r0 W LLD
57A'7 OF Wisconsin )
s:.
Stgnatvreth) St. Croix County.)
9ersoeaily came 6e:vre me this _ l�� 4,-r
het6eatkated this day of Aprd , 2001 the above rained
K enneth L. Browa and KAtukea B. Bruwa
. TiTLE: , , 4J/1R Of W ISC6N5 ?t toy / /yy'' nrn a, fe be the rerhon(7) wbo — eeuted the foreVi-is
Q ' I ela 20d 3eknowleage the tams.
CGuTi. W s. Suss_)
. rW DILAY rav NY 7
Aft e avid J. . streen
304 LoeaJp y Iludaoas. WI 54016 Mum INnue, st2te of w1sconeta
(Slgntturel+aiy be xtduadestee or aeknewied Sed. 30th ere -lot "My Caatmi on Is pennanar nal. slate txpauauoe au:
aectsssry.) ,)
• Nun" of MMj risaieR Is SNP eaoseity ,amid be typed a prided Well tw, dtneAws
tTATe SAI Or e18=11311
wApUNTY ees,N nfef, dw I - ms
WORS1AT10H V=r11370NAL3 COMPANY e7/lp 99 I.AC. M WDASS•SOD,
r
Sanitary Check List
Lot
Legal po'00 -�Q E5Cc
Date l— ID —b
Septic Agreement Signed
Copy of Deed
�^ Soil Test
Blue Print Copy
Check for $225
4
L)kAIN 1.77 0 \ 1.77 AC. 1 2
O 7
10
IL
,5 \ s
LO T 2 , A l -46 N \
\ ��
s` �• s
s7 \ \ X 8 8
b�o ° >� 93501 Sq.Ft. 90:
` - 2.15 Ac.
A7 6
DEDICATED TO 11 2 \ \ \ \ 19
— \ \ THE PUBLIC / i 18
I I 13 S 87'1638" W@ (5,
50.75'_ /
—117TH N 8.16' 58 E 1 L T 7
16 50.7 _
/19 4 580 Sq. Ft. / /
1.83 Ac. LOT 8
z / :J 94754 Sq. F
o 2.18 Ac.
° ° °� LOT �"6 °�
109173 Sq. Ft.
2.51 Ac.
a. Ft.
- - - -- � \s• � z
F
s 6
co
24
-- — — — — — — — — —
�— 121. -- 3S ?� - - - -- — �— 262.26'
1.8 95.07' 58.78 —
— — — — — — — — — — — — -
56" W 632.58 DEDICATED TO THE PUBLIC COUNTY ROAD E
- — — — — — — — — — — — — — — — — — — — -
LOT 1, C.S.M. dl
VO 11
PA GE 3 217
LEGEND 81, c rG!`( of
" or of °'sods U T I
'.ATIONS COUNTY SECTION CORNER MONUMENT
— — — — 12' UTILITY EASEMENT
NO POLE
R. A. RECORDED AS WOULD [
STREET
HWE = HIGH WATER ELEVATIONS OF SEC'
J. 4.172 LBS. /FT. SET FOP
i n� n nr HAVING