HomeMy WebLinkAbout026-1144-08-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
• 429957 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- 1144 -08 -000
CST BM Elev: Insp. BM Elev: BM Descrip on: Section/Town /Range /Map No:
00 - 0 l l1 Q•o/�?� 33.30.18.1012
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic U � � Benchm�rk
Dosi
ng LA !l Alt. B 5 3` / � D . _7tv
Aeration - Bldg. Sewer
Holding St/Ht Inlet 3 o3�f i C,
t14 4 Ot b
TANK SETBACK INFORMATION St/H Outlet Q,
TANK TO P/L W QL L / BLDG. Vent to Air Intake ROAD Dt Inlet
•Z �
Septic , ZS � � ' � — Dt Bottom
Dosing t/1^ Headgr /Man.
�l s �Z. 6 T - 7. Z
Aeration gist. Pip 0 7
Holding Bot. System
-�f L
Final Grade
d
PUMP /SIPHON INFORMATION too
Manufacturer Demand St Cover
�. GPM g. — 3 2
Model Nu 111er
TDH Lift ction Loss System Head TDH Ft
rcemain Length Dist. to Well
SOIL ABSORPTION SYSTEM T 4- 4- 43 G 're _ 3
BEDITRENCH Width Length No. Of TrenchesPI DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ( 3
SETBACK SYSTEM TO BLDG WELL LAKE /STREAM ACHIN Manu�aehLer:� .�
INFORMATION Ty Of System: ` ` I I / HA UNIT O Model Number: r
DISTRIBUTION SYSTEM 6 _�PAal—
H Distribution x Hole Size x Hole Spacing 1 >1 it Intake
N
Pipe(s) 'r /� [� �
L Length Dia Spacing_
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over X Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center 44 g p • S ' �" Bed /Trench Edges Topsoil
Yes No El Yes [] No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: J /3/ Inspection #2:
23
Location: 1165 121st Avenue New Richmond, WI 54017 (SW 1/4 S =1/433 0N R18W) Duck P nb d Escape Lot 8 Parcel No: 33.30.18.1012
1.) Alt BM Description = �'` CAVU al � VJ �� ( ' ' " ia'`�'�- 71 �y(jyti
2.) Bldg sewer length =
- amount of cover = 0
Plan revision Required. Yes
Use other side for additional Information.
SBD -6710 (R.3/97) Ll% L1�1/�1,
Date Insepctor's nature Cert. No.
11
Safety and Buildings Division County
` m 0 201 W. Washington Ave., P.O. Box 7082
Madison, WI 53707 — 7082 Sanitary Permit Nt mb7to filled in by Co.)
sconsin (608) 261 -6546 (-/
Department of Commer
•
Sanitary Permit Application State Plan I.D. Number
In accord with Comm 93.2 1, Wis. Adm. Code, personal information you provide
may be used for secondary purposes Privacy Law, a15.04(1Xm) Project Address (if different than mailing address)
I. Application Information — Please Print All Informatio RECEIVED sf _
Property 's Name Parcel # Lot 4 Block #
2 5 2003 - 0
Propaty 's ail g Property Location
2
ST. CROIX COUNTY �) '
City, State Zip Code �.1 /�L y+ -•, Section _
(circle one)
T�(L N; R�E or W
EL Type of Building (check all that apply) ,
44 Subdivision Name
1 or 2 Family Dwelling — Number of Bedrooms _-? _
❑ Publir/Cotmnaoial — Describe Use
❑ State Owned — Describe Use 311etVCkeT ❑City ❑v a 0ownship of
IIL Type of Permit: (Check only one box on line A. Complete line B If applicable) 4.
A.
New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision Change of ❑ Permit Transfer to New list Previous Permit Number and Date Issued
Before Expiration Plumbs Owner "'7 �/_
G (l/
IV. Type of POWTS System: Check all that appl
V Non — Pressurized in -Ground ❑ Mound a 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized )n- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravewess Pi ❑ Other (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil Application RatOgpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
a •
VL Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tanks Tanks
Septic at Bolding Tank
Aerobic Tmatmem U nit
Dosing Chamber
VII. Responsibility Statement - 1, the undersigned, ss me responsibility for installation of the POWTS shown on the attached plans.
PI ame (Pritill Plumber Si - t MP/MPRS Number Business Phone Number
PI ber's Address (Street, City , S Zip
VI oun /D epartrnidt Use Onl
Approved 1 ❑ Disapproved Sanitary Permit Fee includes Groundwater Issuing Ag Si s) t
Surcharge Fee) y�
❑ Owner Given Reason for Denial h U
IX. Conditions of Approval/Reasons for Disapproval
Attach complete plans (to the County ly) he system on paper no&az than 81/2 1 11 inches in size
SBD -6398 (R. 08/02)
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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix
Safety and 1301c Division
INSPECTION REPORT Sani ry Permit No:
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. Richmond Township 026- 1144 -08 -00
CST BM Elev: Insp. BM Elev: BM Description:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer
Holding St/Ht Inlet
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
Dosing Header /Man.
Aeration Dist. Pipe
Holding Bot. System
Final Grade
PUMP /SIPHON INFORMATION
Manufacturer Demand St Cover
GPM
Model Number
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System: UNIT Model Number:
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s)
Length Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Edges Bed/Trench Center Bed/Trench Ed I Topsoil g � Yes U No [1j] Yes
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: ! / Inspection #2:
Location: 1165 121st Avenue New Richmond, WI 54017 (SW 1/4 SE 1/4 33 T30N RI 8W) Duck Pond Escape Lot 8 Parcel No: 33.30.18.1012
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
Plan - - revis -
Use otherside for additional In —
Required Yes No
l formation. _ —_ --
SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No.
and
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ' of 2
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner . C - �O Septic Tank Capacity I 0o a l ❑ NA
Permit ff 29 Q � Septic Tank Manufacturer S ❑ NA
DESIGN PARAMETERS I Effluent Filter Manufacturer ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model A— 0 D ❑ NA
Number of Public Facility Units _NA Pump Tank Capacity al NA
Estimated flow (average) 360 al /day Pump Tank Manufacturer NA
Design flow (peak), (Estimated x 1.5) �� gal /day Pump Manufacturer NA
Soil ion ate 6 al /day /ft2 Pump Model ❑
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit NA
e (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Tot al Suspended Solids (TSS) :5150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD 530 mg /L In- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) :_30 mg /L '/�` QI ❑ At- ra e NA ❑ Mound
5
Fecal Coliform (geometric mean) ° /100m1 ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
* Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
❑ month(s) (Maximum 3 years) ❑ NA
Inspect condition of tank(s) At least once every: Z ear(s)
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: 3 ❑ month(s) (Maximum 3 years) ❑ NA
2 - �year(s)
❑ month(s) ❑ NA
Clean effluent filter tj M 4 5 p At least once every: (- 2 year(s)
Inspect pump, pump controls &alarm At least once every: ❑ month(s) ❑ NA ❑ yearls)
Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s)
Other: ❑ month(s) ❑ NA
At least once every: ❑ year(s)
Other: ❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
Page Z of 2
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or: must be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
T he
alua ' a o ing an
be ' e ai e . ?R0 44115 Mb VOR— AI&J a6J57R(JC –A p
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name N IJ �( Name
Phone - 7 ( 5 _ '� – – 3 / C Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name
Phone Phone "7 /S— 3�(�_ (0 (D
This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d) &(f) and 83.540), (2) & (3), Wisconsin Administrative Code.
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 GS &S 1-
(Verification required from Planning Departme t for new construction)
City/State aAjA m,& Parcel Identification Number r)z6 - 1( ° �' c oo C • 1 0 1z)
LEGAL DESCRIPTION
Property Locatior ; '' /,, %,, Sec. j 3 , T -R W, Town of 1 11C. b�i1�
Subdivision ESC' Lot # _.
Certified Survey Map # Volume , Page # 3 (Qq
Warranty Deed # Volume . Page #
Spec house ❑ yesXno 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.
Inc property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
masterplumber, journeymanplumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of a ear exp 'on date.
SIGNATURE OF APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the described abo , by virtue of a warranty deed recorded in Register of Deeds Office.
- 9' IGNATURA OF APPLICANT 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
i
Safety wA Bwldmgs Dwtsion
201 W. WasbbiapM Ave., P.O. Box 7162 �`�, / �� ✓
Aff
De artment of Commerce
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SaoiLzry Pank Number
Sanitary Permit Application
way. �. e7ode.
you WwAde o Check if Ravi m
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be State pyn . Number
Please Prw AD Infaematim
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property owner's Name
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Location
property o m es MdTwg Adder
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Pexmlt Previously Issued Permit
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—prewmizad in. xw and 210 Mound Sand Fibber SO ❑ Comuuc od waland en 0 41 ❑ Holft Tank 48 Pass
510 Drip Line
30 O Omer ,5
45 0 et -cRda 46 O Aerobic Treatment 4 om �
V. AVWe Percolation Rafe Syaam Elevation Final Grade
Ana Area Dispersal Etevatiat
Required Des�►Fla�rt� Proposed xate(Gals.maya�l � '�lH
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std - ;. Phone Number
VII- MP/MPRS Number
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VIII. ire saner � . Fee eind�es Gtoomdaater Date lasaed (No sta�a)
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PLOT PLAN
PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Bo x 489 Somerset Wi 54025
SW 1/4 SE 1/4s 33 /T N/R 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 10/2/02 BEDROOM 3
CONVENTIONAL XXX IN- ND 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 0 of Steel Fence Post ASSUME ELEVATION loo' Filter Zabel A -100
❑ BOREHOLE (DWELL *H. R. P. Same as Benchmark ^�
SYSTEM ELEVATION 97.0/96.0/95.2
Alt. BM Top of Power Box @ 98.7'
Plans Designed Using
Conventional Powts
Vent Manual Version 2.0
>6 » Standard Infiltrator
a of Cover Leaching Chamber
with 31.1 ft2 of Area
i a
6' Long 12"
34" Grade at System Elevation
I
Pro 3
Bedroom
House
30'
T
35 '
B-
Vents 35 30'
10' Vents
B -1 BBB,
�/— 5%
80' Slope
3 -3' X 80' Cells with >3' Spacing
Alt.
B.M.
B.M.
121st. Ave
PLOT PLAN
PROJECT . P.C. Collova B ldrs. Inc. ADDRESS P.O. Bo x 489 Somerset Wi 54025
SW 1/4 SE 1/4S 33 /T N/R 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 1 0/2/02 BEDROOM 3
CONVENTIONAL XXX IN- ND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1 000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE •4 ABSORPTION AREA 1212 # of chambers 39
,BENCHMARK Y.R o . p of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
SYSTEM ELEVATION 97.0/96.0/95.2
Alt. BM .^ Top of Power Box @ 98.7'
Plans Designed Using
Conventional Powts
Vent Manual Version 2.0
> 6" Standard Infiltrator
of Cover Leaching Chamber
with 31.1 ft2 of Area
0 6' Long
12"
34 Grade at System Elevation
Pro 3
Bedroom
House
30' 10 1
T
B-
1 - 35'
Vents 35 30'
10 Vents
B -1 B-2
/- 5%
80' Slope
3 -3' X 80' Cells with >3' Spacing
Alt.
B.M.
�k
B.M.
121st. Ave
4
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Ca, ,a. Sm dwy -e�rz
Ta�4ire
Hodmon O.Pde CAL SL or. SL Sh
in.
60
, fi g =Spp <3pmgLwd1rSS_ <
CST #1 s gpp > 30 <7�D �eefd 150 eeglL C5t Number
P — e z z 69 N
d"cisci
•
f �
M=x mmm
fFA WA
�■■����mm
�,- � ,�� u�:�. t anu.,� «- �. :�i �. ,✓ rrrt; urn «- a . ..a :�� i gun �� a .�� � ��t y rv. �r rt ::« «:.�:
Soil Test Plot Plan
Project Name P.C. Collova Bldrs. Inc. Shaun B'
Address P.O. Box 489
Somerset Wi 54025 #226900
Lot 8 Subdivision Duck Pond Date 10/2/02
SW 1/4 SE 1/4S 33 T 30 N/R 18 W Township Richmond
Boring ()Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post
System Elevation 97.0/96.0/95.2 *HRpSame as Benchmark
Alt. BM Top of Power Box @ 98.7'
a�
a
a
0
Pro 3
Bedroom
House
75'
B -3 35'
102'
101' 35'
tAlt 75'
-1 B -2 100'
5%
8 Slope
121 st. Ave
PAGE__a_OF_'S
NAME LOT# LEGAL DESCRIPTION.Sw 1 /45#'/4 S3!,T3p,N R JJSE (o
SCALE: 1 "= y�
BM 1 ELEVATION < O
BM 1 DESCRIPTION a 2- P
BM 2 ELEVATION q `{. Q U Sec. 3
BM 2 DESCRIPTION _ J&
P �-
SYSTEM ELEVATION /m O
ALTERNATE ELEVATION i c/ /9-
X I
CONTOUR ELEVATION 106 .2- 0
Q ds c�
►Qc�vw,{
Lo 4-
c�KaPt-
eleJ• Ioa.
a4
■ UO.0
� -3
SIGNATURE
— DATE zs '
� n - - -- - -
k
Wisconsin D, partmentof Commerce SOIL. EVALUATION REPORT Page I of
Divigion 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
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 a tt _� i . ,,
Reviewed by Date
Personal information you provide may be use o dary p rposes (Privaey,� w, s. 15.04 (1) (m)).
Property Owner RL ;� e Property . Location to
ovt. Lot : S W 1/4,5 F 1/4 S 3 3 T S a N R 1 E (or)
Property Owner's Mailing Address eji 6 2001 of # Block #, Subd. Name or CSM# —
C ^t'ox j �U T
City State Zip Cow Phone PF ,�\ ❑City ❑ Village [Town Nearest Road
��} . t i J evv ► � _
® New Construction Use: 0 Residential / Nu1t�r of, "0 `7� Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material I. , �' Flood Plain elevation if applicable
General comments $Y C f rwf C-lev, loo 7
and recommendations: CtM f r 2/e V. (oo•Zo
1 - 1
Boring
Boring # �/
[� pit Ground surface elev. / 0 ft. Depth to limiting factor J� 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 0 -IZ 14 8
2 I Z Ip 1 5f 'Zn-c,bk -C/^
5c
F2-] Boring # Boring
® pit Ground surface elev. IW- 36 ft. Depth to limiting factor &-Q_ in, Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fl?
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2
- 31z- Sfl 5 8
Z- t► -2 cp �,rl�f —� Si I 2, �'r �� — . s 8
Z 10 � `t1 SL 2
' - 1 5 CZP j s1- 2 ,G
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
&r%t S c� vYfa .-a i �_—. Zs33G9
Address Date Evaluation Conducted Telephone Number
'i
4
Property Owner collo\g=, Parcel ID # Page of 3
F�] Boring # ❑ Boring U
[ pit Ground surface elev. 1W .0o ft. Depth to limiting factor _ in.
Soil 8pplication 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
6--t 10 31 2 -- S 2. �'r c- S ( v � 5 Z
2 Z -40 1 3 S f d Zrn bk C
10AC 2- _ 5
z4 r51q C2P 14 5L 2-rn
❑ Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil lication 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
r-71
F - 1 F] Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
13 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:s 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.
SB0.8330 (R.07 /00)
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Eff luent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of
the cells.
4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
5. The owner agrees to save this plan.
6. Do not plant trees nor park nor drive over system.
7. Watershed is to be diverted away from system.
8. Discharge into system is not exceed those required as per Comm. 83
Contingency Plan
1. If system fails, determine cause of failure, use alternate area and install new system or
install system at a lower elevation.
2. Replace any other failing components as needed.
Plumber: Shaun Bird 715 - 246 -4516
St. Croix County Zoning 715 - 386 -4680
Pumper Tom Mondor 715 - 246 -5148
Shaun Bird #226900\
FROM P C ca i cVA BL Rs, INC FHCNE NO. : 715 549 5911 Nov. 16 2,001 09:.:cAM P1
• ITAIr BAKU WISCUNSiN WxM2• 1948 KATHLE -- N : 3IS
WARRANTY DEED REGISTER OF DEEDS
Doer r e St. CR ^IX CD., WI
This Deed, made between Kenneth L. Br nnti KatLl(211 B. A7X-Y U FOR MM
Brown, lloshoad end Wtfe —� ~ 0�- :8-2MI 9 :43 i44
Ui%diiWTT �>i
-- EREVT I
Grantor, and P. C. Callors Builders. Inc. CSI -CM M!
COPY M.
':&WM FEE- 1128,
— ••- RECM' J FLLI IO.N1
Qnnlpe. r
Grantor, for a valuable conaideratlan, eorveys and w;trrnnts to I �s C�� `�•!
Gcatllee Ula following 6=ribcd rat cstato in SL C: pia ifG,
Counh, %k of Wisconsin: 2ece -I�e nrra
r V.n.c :nd Itetun Add".
David 1. FAMen
'(,rot port of SS 114 SW 114 and SW 1/4 SF, 1/4 See. deraibed 302, Lo^_ast St.
as rollowrt Lots 1, 2 and 1 of CdMiilod Survey I�t Q reccRied is Vol, 1 of iluclton..'!1 1
Cartiflea Sltry7y )Maps, pogo 1699 is 7x. NA. 607501. ' d
4t Croix Ccmrv, Wlacoltau, oZG-I�Y6 axw. U:trlv9a ut�ztlt.
0ab•IC96. 70.000
r.resf luaw neation Nalat>cr i1't:n
i nu � not helne:t::d Ptopeny.
(iu+ (ia rat)
Exeelrtiom to rummies: Sx:sting hinhwap <, a semcnis e3 rpts of way of rec-tti.
Dawd lhi: < l" Cab of .hEni
I - e
. Kenneth L 3romt
t KAthleca B. Brown
?tIiTA WTICATT ON A(:1U40 W LLD(-
STA -% Of Wisconsin )
) a.
Stgnature{t) St. Croix County. )
Pcr:oraily Came berme me thin _ *or
athentkaled p+ia _ lay of Apr.! X001 _ the above tamed
caneth L. Brown and Knthkan B. Brtnra
11?LE: !r,.16 t OF W IECONSIN tp etfo ya to be the Person(!) wbp ezee rtad the f�rogoin s
q ' I Merl[ 20d =knowledge the 13mc. II
gGav Wia. suta_)
7 :.
.WAS DRAY TEL) AV 7I
Aft d„ avid .1...streen
304 Lm! l9;; U1114110116 )VI 54016 Nntary Public, Size of Wkeouain
($IgnaltlralYary ba aadtatdatet er ee e,w„ri.dsad 3dth rte met Mr Catrani.sion b perm>rta1� t =0047 exQrrauuo due:
neassaeY � ,)
'Nom" of vetoes altirleat id a" capacity aiwald be IYOcd a Prinrad t.Idw ti=lt .le -a—a '
rTATC BAR Or mItCAHSM
MApUMTY Data Yf161 n. r •Ina
1MfORNATION I•M:PISO3M1NAL2 COMIAteY T7t1n DV t.AC,'yr "o
r
04 cv
\ 1.77 Ac. z
\ 1 LOT 23 "'o s °,
Af
90394 Sq. Ft. , —
> 4 et• 2.08 Ac
/ ~ 2js 6
_ r
\ Z
25.25; W
/ S 00'46'17" W ` S c a n N /
42.47'
� \
V �
L T 7
1 /9580 Sq. Ft. cr
/ o `
1.83 Ac. LOT 8 I T 9 9D �� \
/ / � I LO
; J 94754 Sq. Ft. I 95551 Sq. Ft. O o
` a 2.18 Ac. y� _ 2.19 Ac. �, t
0 ' / !] / ��
> A
/ N O
r 6 / 2
rn
3173 Sq. Ft. \ t f ^ti ' ` c
2.51 Ac. 3 o A 900
o I hry / rn
T
s 'ro.
\ q� / ^ �;
262.26' _ 2 41.0 6 ' - _ ` ' %�h' - 17
-- 95.07' — 58.78' �— -------- - - - - -- %7$4$ 116.99 S5 1D7.7T'
TED TO THE PUBLIC COUNTY ROAD E SOUTH LINE OF T SE 1/4 O F SECT
N 89'43'55" W 2638.57' R.A. 26
UNPLATTED LANDS
UTILITY EASEMENTS:
Y SECTION CORNER MONUMENT
LITY EASEMENT
NO POLE OR BURIED CABLES ARE TO BE PLACED SUC
;DED AS WOULD. DISTURB ANY SURVEY STAKE, OR OBSTRUCT
STREET LINE, THE DISTURBANCE OF A SURVEY STAKE
4ATER ELEVATIONS OF SECTION 236.32 OF WISCONSIN STATE STATUES. U
SET FORTH ARE FOR THE USE OF PUBLIC BODIES ANC
-- WA \ /INlr A Rl('WT T() CF'P \/P TNP" APFA