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Home My WebLink About026-1141-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430112 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 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 33.30.18.1014 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 Bed/Trench Center Bed /Trench Edges Topsoil Yes [ No ] Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: Location: 1175 121st Ave New Richmond, WI 54017 (SE 1/4 SE 1/4 33 T30N R18W) Duck Pond Escape Lot 10 Parcel No: 33.30.18.1014 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? El Yes Use other side for additional information. No E LI � 1 SBD -6710 (R.3/97) Date Insepctor's Signature I Cart. No. Natety ann Buuaings utvtslon t-Ue 1 Ly 201 W. Washington Ave., P.O. Box 7162 . e, , *isconsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce r (608) 266 - 3151 30// 2 State Plan I.D. Number Sanitary Permit Application In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(1)(m ) Project Address (if different than mailing address) REGEIVED I. Application Information - Please Print All Information Property Owner's Na me �S E p 0 9 2003 Parcel # �# Block # F C. C n/ r� ._— Property Owner' I�ingAddress ZONING OFFICE Property Location ! 0 1 /4, 1 k,Sectton City, State �7 Phone Number circle 7 ). II. a of Building (check all that apply) N; R�E o v �`YP g - or 2 Family Dwelling - Number of Bedrooms 2� Subdivision N e CSM Number u Public /Com nercial - Describe Use v ❑ State Owned - Describe Use ❑City FIVillage ownship of , III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A s ❑ Replacement System g p y g y ❑ Treatmenv'Holdin Tank Re O Other Modification to Existin S B. ❑ Permit Renewal Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that apply) 'on - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wedand ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal /Treatment Area Information: /3e Design Flow (gpd) Design Soil Ap ication Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 9Z 4d7 7 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel iber Pl s lc Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment unit Dosing Chamber VII. Responsibility Statement 1 , the undersigne a responsibility for installation of the POWTS shown on the attached plans. Plu b s Na me (Print) Plumber's re MP /MPRS Number / Business Phone Number J / Plumber's Addre ss (Street, City, State, e) V artment Use Only Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Dat Issued Issuing Agent Signature (No Stamps) Surcharge Fee# El Owner Given Reason for Denial �j O d ) j I A. Conditions of Approval /Reasons for Disapproval yyoc U i Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) Soil Test and S PLOT PLAN PRQJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 SE 1/4 SE 1 /4S 33 / N/R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATER / 30/03 BEDROOM 3 CONVENTIONAL IN- UND PRESSURE CONVENTIONAL LIFT XXX 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. Bottom of Siding ASSUME ELEVATION 100° Filter Zabel A -100 ❑ BOREHOLE O WELL - H Same as Benchmark 121st. Ave SYSTEM ELEVATION 98.2/97.7/97.2/96.7 Vent >6 „ Standard Biodiffuser of Cover Leaching Chamber with 31.1 ft2 of Area 220 6' Long 11" 34" Grade at System Elevation a, Plans Designed Using Pro 3 Well Conventional Powts Bedroom Manual Version 2.0 House B. M. 40' 30' 52' 3 -3' X 63' Cells and 1 3' X 56' Cell with >3' 3 B spacing 85' 35' 9% Slope o Huffcutt Combo Tank B- o� 10' 35' 8 V ents 30' Cty Rd E Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code n County � t , 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. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property ,Q.wner Property Location el 0. D ` LICA- Govt. Lot 1/4 1/4 S T N R E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or NW IL;2 222.z City State Zip Code Phone Number ❑ City ❑ Village own Nearest Road New Construction Use: esidential / Number of bedrooms 3 Code derived design flow rate - 7�- _ GPD ❑ Replacement ❑ Public or commercial - Describe: __— Parent material Flood Plain elevation if applicable /✓) ft. General comments and recommendations: s�l� /�✓ ) � ?7 7 l J -3 K 77-j # J' a Bori n9 Ground surface elev 41. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAY in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 Zen Boring # Boring Pit Ground surface ele - � Depth to limiting fador/�? 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 X 7 7 .� 7 Effluent #1 = BOD > 30 < 220 mg& and TSS >30 < 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) S' re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address ate aluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ��'�v3 715 - 246 -4516 i Property Owner _ Parcel ID # Page of aBoring # Q Boring 1 Pit Ground surface elev. �� ft. Depth to Limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Lplicafion 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 'EH#2 Boring # C] Boring F 11 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 i Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 1150 mg/L ' Effluent #2 = BOD, < 30 mg/1. 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 (8.6/00) CT ION JN ADD SQECIi ICATIONS SEPTIC TAN!( � FUMP CliAMBEIR CROSS S£C , �t Cl BOX PPROV ED > � 5 `RflM DOOR WITH C'ONDU TIT MAN140LE COV EIR / PADLOCK & FRESH AIR INTAKE - wARNING LABEL FINISHED G RADE ---- � MIN. �s � at.s'!• 2af S. ¢� u Lf Is" IN• *, . S INLET s ', GAS- a MATER T_TG =4T SEALS TIGHT ,4"WVEO A SEAL JOINTS WITH FILTEf• -- "'s•"' ALI"i APPRQY£D PIPE s _ , ON 3 Omm APPROVEJ) --{-- _ S(3t FD SOI PIPE 3` C ' OFF a,(TO SOLID , LFT . -i-- SOIL pump '.F_ £L£1� - � BEDDING UND�R Tl3i�l{ 3'= AFPRQV sD CGNC. PAD Al � u 0 S'CCIFICATIC3T35 ' I�J��,"� S F ER DAY: SEPTIC f DOSE i�UMBER DOSES TANK -- ---- -- TANK MANUFACTURER: DOSE O I�+iCi.{�DZI+�G GAL- PT Z C GAL. r LoWBAC TANK SIZES: S£ �� L . ,C J, b GAL. t�� DOSE CAPACITIES A -- �0 GAL. AIA I MANUFAC B = �_ INCHES = -- - MO DEL NU14SER: C = ? INCHES � 1 C) s GAL SW ITCH TYPE:- 4 ., , ZO PUM P MANUFACTU � c,AL MODEL NUMBE : I 23 s,tAC SkITC`i APE: £ ALARM WIFT_iv'G .4S P£sZ FEET F'M pUMp IRED C G= REAL DIS_HARGE F££ ---`-� DISTRIW'JTTO" `QIt�£ - - — i PUMP O: F AND _ - FEET VESTICAL DIFFERENCE B£ Id TirIE pRESSURi - FRICT23 FACTOR - FEET + MINIMUM NET3rIG1RI� SUPPLY �Ti 1GfI ET- T FR I3`I IC MEAD } T f OR. CEFIAZN DIAMETER � �' � -1 FEE �--- w T'— =�� T �'Nt1�u if ' +�Lr ii��Til . NT� DA E' v ��tt Li��Yy�� Si IGNED- - :fQ.7 HEAD/CAPACITY CURVE EFFLUENT and DEWATERING WARNING: Model 18514185 should not be subjected to less than 30 feet TDH. TOTAL DYNAMIC HEADICAPACITY PER MINUTE d' SLSS W t7 1151411! 164 1 w4i is 119/.111 191 lL j 44 so 137431 "W4140 163;4163 ERIE 17 FT ' : Ptb� Gil. ILK:: G&L Gal. Uri. Gal. in Gal. �:Lb-k Gal; . Gil. Gal.: Gil. . LIM: Got. WILF1. Gal. IK". Gal. L&S.. Cal. Ltm Gal. 21 104, 43 163 72 :273 53 isd 14 756 106 461 43 1 51 22V 144 �40 151 $ 4 3 :278 il 10 `�!IA: 13.2 23 jjr:i. 34 121 N TS 100 42 60 112 45 iS If 11 ::n 45 70; 64 :ij4j*� 115 J71: 60 2 5 220 :11 135— 22 140 &w 43 :: 24 25 13 16 IA 13 12 316 It 133 .,50 43 40 T3—o 63 :jSS; 74 210 128 44A.' A2 51 �As �i: 121 .:A" 127 ASI.::. as 53 241 701; ]�i� u 30 is 209, r! 363; f : Aj 1 48 70� Iqs ..317. 1 ...1 90 .�34f 100 C�' is So LU 21 33 . 38 —125 43 14 : lot. 71 26I - 777 32 U.. as ".179::,: 30 1 14 10 3 70 2 120--- 70 2 7 21 lot xi 4 45 SA 64 AS 1711 36-- 191 to .44,311 as alr 115— 1 30 30 :, 114: : 1 10 34 i!lzod mm 120 :::"A 34 105 130 77 32 - Lod Vil r 7 1 Isir 2Y is 46 56' e6 Ir 100 30 95: 28-- go— ,5 4186 Sal a., 24— 80 — ' 75— 222— 70— 2 65 — 18___6_O_ 16 4163 189, 4189 55— N 0 l'— 16— 50— 14 45 N 1 2 140, 35-- 4140 4188 10__ 30— 185, 137, 4185 8 5— 139 6 _20 15— 4-- 10— 2 Ila 43 48 5355 95 161, 57:5.9 41611 1 0- 1 1 1 1 1 1 10 201 30 401 50 60 70 So go 100 1110 120 jf� 140 150 160 U.S. GALLONS t— LITERS 8 160 2�� 400 4k 5k 640 0 FLOW PER MINUTE 009922 No te : For Head capacity on Model 112, industrial coiumn•explosion pr000f pump, see FMO219- Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430112 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 -10 -000 CST BM Elev: Insp. BM Elev: FBMDes riptio : - Section/Town /Range /Map No: 7 33.30.18.1014 TANK INFOR ATION ELEVAT O ATA TYPE MANUFACTURER CAPACITY ST ON BS HI FS ELEV. Septic B hmark Dosing Alt. BM Aeration Bldg. Sewer -7 -5- 9 7-4 Holding St/Ht Inlet / St/Ht Outlet s ' e TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic �/ ' 1 VV �I f D Boo tntn._ 1 Dosing K t t << �� Header /Man. C Aeration -�t� O Holding 7Bot. System ' 9 Final Grade PUMP /SIPHON INFORMATION; Manufacturer Demand St Cover /t GPM 5A `/ Model Number fl 6 AD Z 4s. - 7. .� 7DH Lif , J Friction Los System Head � H Ft 2 Y n� / Forcemain Length Dia. 1/ Dist. to Well p a .� •� SOIL ABSORPTION SYSTEM Mtoo K!,h ,I1 6t,Y BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 (03 SETBACK SYSTEM TO lY P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution d x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Ltj V L r Length Dia Length Dia 1^ 5pacing�_ SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over I Depth Over ) xx Depth of xx Seeded /Sodded T Mulched Bed/Trench Center Bed/Trench Edges Topsoil f� Yes Fj No Yes COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:z /AY—/_Q3 Inspection #2: / / Location: 1175 121st Ave New Richmond, WI 540177 (SE 1/4 SE 1/4 T30N R18W) Duck Pond Escape Lot 10 Parcel No: 33.30.18.1014 1.) Alt BM Description • L0AY �✓J' 1 `�ti �Q r tllaaY ✓_-/ � � 2.) Bldg sewer length = $0 1 44 1 ( `Q .� dead - amount of cover = M CN V v v` Plan revision Required? Yes F- No Use other side for additiona�irmation. Cert. No. SBD -6710 (R.3/97) 1 Date I ynaiure Safety and Buildings Division County 2Q1 W. Washington Ave., P.O. Box 7162 �� / �X Madison, WI 53707 - 7162 Sanitary Permit 1 (to be filled in by Co.) isconSjn (608) 266 -3151 aJ Department of Commerce State Plan .D. N Sanitar um e Permit A lication Sanitary pP � In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (i different than mailing address) / I s 121dTr I. Application Information - Please Print All Information Property ner's Na Parcel # Lot # Block # Z Proper wner's M ailing Address ation 0 � �(/ ✓ i� �/4 ' /4,Section City, State Zip Code Phone Number JE j `:4 T ►► N; E II. Type of Building (check all that apply) k. tvigion N me CSM Number 1 or 2 Family Dwelling - Number of Bedrooms — ❑ Public /Commercial - Describe Use / - _ _ - w sC ❑ State Owned - Describe Use 3 �tY/� tL/ 13 _ itiYi ❑City_ JVillag�ownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of El Permit Transfer to New Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that apply) ,/' ❑ 'f�Li�ton - Pressurized In- Ground [I Mound > 24 in. of suitable soil ❑Mound < 24 in, of suitable soil ❑ At -Grade Single Pass Sand Filter round ❑ Holding Tank El Peat Filter El Aerobic Treatment Unit ❑ Recirculating Sand Filter Pressurized g 0_ Constructed Wetland ❑ s L1 Recirculating Synthetic Media Filter Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Otper (explain) i V. Dispersal/Treatment Area Information: c J r9�J Desi low (gpd) Design Soil A lication Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (s System Elevation � v Jas /a /1 9d o .4,7 7 A VI. Tank Info Capacity in Total Number sM/annuffaactuurrrer Prefab Site Seel Concrete Constructed Glaass ss Plastic Gallons Gallons of Units i A - /(z New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I , the undersi assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber' i gnature MPIMPRS Number Business Phone Number Plumber's Addre ss (Street, City, State, p ode) � ? VII . Count /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued uing Age n Signature S ps) pproved ❑Disapproved Surcharge Fee) �1 O ✓u / ❑ Owner Given Reason for Denial IX. Conditions of Approval /Reasons for Disap - 7,5 I sZ on for th em r n ss an x 1 inches mi e la s the Co y) y Attach co lete y . P P ( i PLOT PLAN PROJECT P.C. Collova Bldrs. Inc. RESS .O. Box 489 Somerset Wi 54025 SE '1/4 SE 1 /4s 33 /T 30 N/ 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6 BEDROOM 3 CONVENTIONAL XX)C IN- GROUND PR SURE CONVENTIONAL LIFT HOLDING TANK I MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1212 # of chamber 39 BENCHMARK V.R.P. Top of 2" Pipe SHIT &Vatj ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P Same as Benchmark 121St. Ave SYSTEM ELEVATION 90.5/90.6/90.7 5.5' below grade Vent ALong Standard B odiffus i er Pro 3 Leaching Chamber Bedroom with 31.1 ft2 of Area House 1 " Grade at Sy stem Elevation 20' a 34" Plans Designed Using T O Conventional Powts Manual Version 2.0 30' � o Vents a 60 B- B -2 � 3 -3'X 83' ells with >3' Spacing 55' -1 B- ad Vents 90' B.M. #2 20 M.#1 Cty Rd E PLOT PLAN PROJECT P.C. Collova Bldrs. Inc. RESS .O. Box 489 Somerset Wi 54025 SE 1/4 SE 1 /4S 33 /T 30 N/ 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/18/03 BEDROOM 3 CONVENTIONAL XXX IN- GROUND PR SURE 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 chamber 39 IL BENCHMARK V.R.P. Top of 2" Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL - H Same as Benchmark 121st. Ave SYSTEM ELEVATION 90.5/90.6/90.7 5.5' below grade Vent >6 » Standard Biodiffuser Pro 3 of Cover Leaching Chamber Bedroom with 31.1 ft2 of Area House � 6' Long 11 " a 34" Grade at System Elevation 20' o Plans Designed Using T 0 Conventional Powts Manual Version 2.0 30'' � o Vents '^ B B -2 60' 3 -3'X 83' Cells with >3' Spacing 55' -1 B- Vents 90' B.M. #2 20' B.M. #1 Cty Rd E Wisconsin Department of Commerce '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 8 112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and i Parcel I.D. / �/ �� _ /vim jyU percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 7 �(O V V l eviewe by Please print all information. Date te I Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner property Locati L i z /� 4� ..4�• Govt. s 1I 1Id S 1T AN R E (O W Property Owners ailing Address Lot # Block # I Sut>d. Name or CSM# r CAA state P Cade Phone mum t>er City [� Village was Nearest Road ! J ew Construction Us esidertial f Number of bedrooms - -.�__ Code derived design flow rate S� GPD ❑ Replacement Ei Public or m. e cial - r'be: -- __ - - - -- __ - -- i ° Parent materiel Flood Plain elevabor, If applicable �/I - - -- - - -- ft- 4 I /f General co mments S ��ifi�� '' 6�� D� •� 0 9(/J and recommendations: s �!w �l�i ✓c�-u�.SD � � Grp G�/��(, l s Boring G Pit Ground surface slay. b' fi. Depth to limifJrw3 tactar � in Sol! lication Rats Horizon Depth y Dominant Color Redox Description Texture Structure c Consistence Boundary Roots CPD/ff 9 "Eft# , 1 I •Ef#f2 i 8 in. RAunsell a Go, Sz. ant. Color � Cs . Sz. S". E C G a a @ I j� # �j Boring D pit Ground surfaces slay. ft. Depth to limiting factor in Soil Application Rate Horizon Depth Dominant Color Redox D Texture Structure Consistence Boundary Roots GPDtf9? in. Munsell tau. Sz. olor g Gr. Sz. Sh. i s °Eff#1 "Eff#2 I I I i 1 I 4 I E � I 1 a i 1 I Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mglL • Effluent #2 = BOD 0 m9n and TSS < 30 rr►g/L CST Name (Please flint) Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date = valuation Conducted Telephone Number i 715- 246 -4516 1008 192nd Ave, New Richmond, WI 54017 I Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ' of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County C r - Q I 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. Q�(o / �11 ( 7 1— ! O � percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print — I R sewed y Date Personal information you provide may be u dYOr nda purpose Law, s. 15.04 (1) (m)). Property Owner ` i;1 � GFt Property Location P CLT a 1/0 =' W Govt, Lot S L' 1/4 S E 1/4 S _3 T a d N R E (or) W Property Owner's Mailing Address � ) Lot # Block # Subd. Name or M# `7D _ f ` l L= --fi t° c X 10 � cl C c City State Zip ode: Phon �E El City ❑ Village own Nearest Road al n wl Dl. �.. ,,,,x, 3 ° - C4 C- [W New Construction Use: [59 Residential/ Code derived design flow rate y so /G 0 6 GPD ❑ Replacement 1 ❑ Public or commercial - Describe: t Parent material I �. I/ Flood Plain elevation if applicable /i/ ft. General comments SY94 r►A C' ft v. 9 3. $ and recommendations: ✓) L�• e e V Boring # Boring 1 5g Pit Ground surface elev. 9 (0 -SO ft. Depth to limiting factor ZD in. Soil Applicatio n 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 o - ka Ip 3 3 5d 2mq.bk mfr C Z �D -Zy 1 3)2- ~ St 1 2 rr%n.bk m -Fr- c 5 - S 3 Zq -ya 10 r �} - c� 2►, -�sbk -fir c s �t u0 - 10 y C Z- 5 Ico 5� Zmsb I< ►m �'' c 5 `� 5 - 7D 1 bv r it (p — S 2 mabl< n , ) W - S Z Boring # Ej Boring IR pit Ground surface elev. 9 (p. O O 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 I 0 -(Z I v 1 3 I Z 5 i I 2 ir)G6 (-r 1 v l' S 9 2 1 Z - 1q 4 Si c-- 2 n-g m-�'r C-5 3 Z4 -y5 r`A — Ins O SCA mfr c- 5 C4 4S - to • — �4. 3rr, * 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 Prin " S �► ature CST Number Address Date Evaluation Conducted Telephone Number i Property Owner Parcel ID # Page 2 of 3 r 3] Boring # F1 Boring G� � Pit Ground surface elev. ! e 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 I *Eff#2 o -22 r r3) Z '5d Zmabk B 2- Z 2 - t 10,/V-9)3 —' c 3 -4?2 lb. y — LS /ms rnV -rr- cs -7 /.2 4 2 -&0 — SL Z r n Sbk m F - 9 F—I 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 /fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 F—I Boring # n 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 GPDAf 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) r W PAGE 3 OF NAME C o I IoJ a LOT# /o LEGAL DESCRIPTIONSQ 1 /45E'/4 S 37,T3 N R I S E(or) SCALE: I "= yo I BM I ELEVATION /00-0 BM I DESCRIPTION - be BM 2 ELEVATION 9 BM 2 DESCRIPTION ,• pvc. f� D� e SYSTEM ELEVATION q 3 . SG �. ALTERNATE ELEVATION 93.6' 0 0 &Q OUR ELEVATION iV'o S I* P - e - �K i no SI Pe GaS� A X c # E I a SIG DATE � `0- 0 m i 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 (Verification required from Planning Department for new construction) 1 City/State N eQ� j-) m z-c\j Parcel Identification Number 0 06 , LEGAL DESCRIPTION - Properly Location - %,, r /., Sec, /oil N -R , T �W, Town of RiC,IniMo Subdivision Lot # y Certified Survey Map # — (0 0 ° c5 �� Volume Page # � Warranty Deed # Volume _ . Page # Spec house 9 ❑ no Lot lines identifiable Zyes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature-failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner- and by a masterplumber, journeyman plumber, restrictedplumber or a licensedpumper 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. Itwe, 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 9 yo s ' ystem has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 iration date. //e/ SIGMA OF APPLICANT P. C. COLLOVA BUILDERS INC. DATE (715) 247 -2742 P.O. Box 489 OWNER CERT ATION SOMERSET WISCONSIN 54025 I we) c ra t all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the des ve, by virtue of a warranty deed recorded in Register of Deeds Office. P. C. COLLOVA BUILDERS, INC. 6 1 1 4, 03 SIGMA F AP I:ICANT (715) 247 -2742 DATE P.O. Box 48g9� « * « « ** Any information that is mis- represented ma}i� Qte %� perlg mg revoked by the Zoning Department. r � ** 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 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 rKCM P C CGLLOVA BLDRE, INC FHCT+E NO. - �c..• le sJel er ctro'l ri � -- SrA1E9A1tGg NsSCUtMt MKMS-t942 KA H LE_E3i 1 311�L5ti WARlL1NTY DEED RMSTEA OF DE EDS NwnW 5(. CRPTX CD., WI uoe+t Trip Deed, made 5etseectt Kcaac L Brown anti ICathitxn B. k6C5i4d F�{ ipRb Bto�e Ilaseead and Mire �— 0{ -! a- 0^I 1:15 AM mom X Gtaatow sad P. C Co114" Badde 3. Inc. MU.C®T > cit Upy ME! exit afa FEE: 823. 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