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HomeMy WebLinkAbout026-1141-11-000 F in Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix y nd Building Division INSPECTION REPORT Sanitary Permit No: 420765 & Vj 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 -11 -000 CST BM Elev: Insp. BM Elev: BM Description: Sectionrrown /Range /Map No: bD • D 1 1 cro • o' o dA*- r, 1 33.30.18.1015 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchma Ita0.0 Dosing Alt. BM Aeration Bldg. Se I Holding St/Ht Inlet . V 9 -op TANK SETBACK INFORMATION SUHt Outlet 1.7-0 `13 .9 0, TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ' � ' _ Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Q-0 ' G :os w. .0 a 9Z • Zo' Holding Bot. System �,SO /•SID' an S • }E1 Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover ' 90 19• i Model Num / TDH Lift Fri Loss System Head DH Ft Forcemain ength Dia. ell SOIL ABSORPTION SYSTEM RE CH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits In Dia. Liquid Depth DIME 9 SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Man facturer: INFORMATION CHAMBER OR ton 1 F ca S�eS Type Of System: �J• S + 7-1 :R i UNIT Model Number: l I •Q �� DISTRIBUTION SYSTEM ( I> f(L. ;s �Q ot.. Eas4 g:da a lot Header /main jto�i� Distribution x Hole Size x Hole Spacing Vent to Air Intake �`' ti Pipe(s) Length Dia Length Dia Spacin Z 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 J Yes ] No L] Yes Fj1 No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: 1�3 Inspection #2: - 7 1 Location: 1177 121st Ave New Richmond, WI 54017 (SE 1/4 SE 1/4 33 T30N R18W) Duck Pond Escape Lot 11 Parcel No: 33.30.18.1015 1.) Alt BM Description = tl,a. ST, 2.) Bldg sewer length = M' �� • �' - amount of cover = Plan revision Required? Yes No - Use other side for additional information. 3 - _ —_ J _L SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. I Soil Test and System PLOT PLAN PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 SE 1/4 SE 1/4S 33 /T 30 N/R 18 W T N Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 4/11/03 BEDROOM 3 CONVENTIONAL XXX IN- GROUND PRESSUR 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 Foundation ASSUME ELEVATION loo° Filter Zabel A -100 ❑ BOREHOLE O WELL IH.R.P. Same as Benchmark SYSTEM ELEVATION 92.1/91.9 5.5' Below Grade 121 st Ave Vent >6» Standard Biodiffuser 70 ' of Cover Leaching Chamber with 31.1 ft2 of Area 2% ents B _ 6' Long 11 " Slope 5' 34" Grade at System Elevation 2 -3' X 94' Plans Designed Using Cells with >3'' Conventional Powts Spacing B -3 r Manual Version 2.0 20'`� 5' t� Pro 3 Bedroom 20' M. 35' House 110' 5 10' B -1 25' T Vents 297' 150' Property Line r S it est System PLOT PLAN 343 PROJECT P.C. Collova Bldrs. Inc. DR S P.O. Box 489 Somerset Wi 54025 SE 1/4 SE 1/4s 33 /T 30 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE4 /11/03 BEDROOM 3 CONVENTIONAL XXX IN -GROUN RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallonnsLIFi' TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RAT 5 ABSORPTION ARE 933 # of chambers 30 ✓ BENCHMARK V.R.P. Top of Foundation ASSUME ELEVATION 100 Filter Zabel A -100,/ ❑ BOREHOLE O WELL IH.R.P. Same as Benchmark �- SYSTEM ELEVATION 92.1/91.9 5.5' Below Grade 121 st Ave Vent >6 » Standard Biodiffuser 70, of Cover Leaching Chamber with 31.1 ft2 of Area 2% ents 'Long 11 B_ 6 " Slope 5' 34" Grade at System Elevation 2 -3' X 94' Plans Designed Using Cells with >3' Conventional Powts Spacing B -3 Manual Version 2.0 20' 9 5' Pro 3 Bedroom 20' M. 35' House G�C`S vu� -47 .S S4 y _ Vents 5 10' -1 25' T a� 0 150' Property Line 201 W. Washington Ave., P.O. Box 7162 N VIsconsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled imby Co.) Department of Commerce (608) 266 -3151 QO .(,�GC Sanitary Permit Application State Plan I.D. Nu" In accord with Comm 83.21, Wis. Adm. Code, personal info n / ,v/ may be used for secondary purposes Privacy w, sl� Project Address (it different than malting address) I. Application Information - Please Print All Information APR 1 4 2003 /ad r Property Owner's N me Parcel / Lot f Block # ST. CROtX COUNTY �/ZZ431NG0FFICE Property Owner's M aililuring r Address Property Location City, State S Zip Code / Phone Number H. Type of Building (check all that apply) � ?� N; or W or 2 Family Dwelling - Number of Bedrooms —3v- G��2� Subflivls'on N CSM Number ❑ Public/Commercial - Describe Use ❑ State Owned - Describe Use .V 64 4"4MA J (/H `� ��}C 9�' ❑City _❑Villaaship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) ,Z( — //It/ - / 06 A. System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Permit Revision Before Expiration Plumber Owner 7 Z b 7�p5 _ O IV. Type of POWTS System: (Check all that a ly) is on - Pressurized IwGround ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized round ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter c . Cham ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis rsal/Treatment Area Infor tion. S � S Des' Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dis rsal Area Proposed (sf) ys VI. Tank Info Capacity in Total Number A=we Prefab S'te Steel Aber Plastic Gallons Gallons of Units 1, Concrete Cons Glass New Existing / Tanks Tanks Septic or Holding Tank �I Aerobic Treatment Unit C/ Dosing Chamber VII. Responsibility Statement- I, the undersigned, a responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si M6&re MP /MFRS Number Business Phone Num Plumber's Addre ss (Street, City, State, Z' " ) A)41, - VIII ottn /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date )lsstied LWUing A nt Signature } Surcharge Fee) ❑ Owner Given Reason for Denial I /X /. 1 Conditions of Approval/Reasons for Disapproval W 7� Q.fvtiT- 2�i/t�d/ D ► ` �d t�c�s l� S s�/� "l Attach complete plans (to the County only) for the system on paper' not Iess than 8112 x 11 inches in size SBD -6398 (R. 01/03) 343 1. S it est System PLOT PLAN PROJECT P.C. Collova Bldrs. Inc. DR s P.O. Box 489 Somerset Wi 54025 SE 1/4 SE 1/4s 33 /T 30 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 4/11/03 BEDROOM 3 CONVENTIONAL X04( IN -GROUN RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons 7 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RAT .5 ABSORPTION ARE 933 # of chambers 30 ✓ IL 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 92.1/91.9 5.5' Below Grade 121 st Ave Vent >6 » Standard Biodiffuser 70' of Cover Leaching Chamber with 31.1 ft2 of Area 2% ents B _ 6' L 11 Slope Long 5' 34 Grade at System Elevation 2-3'X 94' Plans Designed Using Cells with >3' Conventional Powts Spacing B -3 Manual Version 2.0 20' 95' ytJ VA qa.w Pro 3 Bedroom j aa, q1 35' -cam . 35' House -41 3ys� 5 Vents B -1 25' a t a 0 150' Property Line Wisconsin Depardnent of Commerce SOIL Page I of Division of Safety and Buildings in accordance with Comm , Wis. Ado. Code � p � Caxuty j+ � r o i es 1C. Attach complete site plan on paper not less than 81/2 x 11 inch size. " Include, but not limited to: vertical and horizontal reference point ), direction and 5 20 I.D. percent slope, scale or dimensions, north arrow, and location and tarrdSelfo� � _ t c:ONN Please print all information. ZONING OFFICE Re Date Penonel IMortnetion you provide mey be used for secmxlwy purposes (Priv Law, s. 15.04 (f) (m)). PropertyOwner /� Property Location P r` C. C: V /I.p uC— E WAA , Govt. Lot 5 r 1/4, 1/4 S 3T 3 ®N R E Propeq0mWsMw1ingAdftss Lot # Block # I SAd. Name CSW s ff*8L A, 4j X lte City State Zip Code Phone Number ❑ City ❑ Village bjTown Nearest Road (D I I S Oa ( ) �i �� /.5�• Construction Residential / Number of bedrooms Code derived design flaw rate 4 f GPD ❑ Replacement ❑ Public commercial - Describe: �}-- Parent material Flood Plain elevation if applicable N ! /� -- ft. General commerts and recdxrimendations: S Y 5 Utlout S ar z,�•- S 5 R e (4w F fl i[5 Pit Ground surface elev. r f ft. Depth to limiting factor Soo Applicadw Rate Horimn Depth Dominant Color Redox Description Te)tre Structure Consistence Boundary Roots GPM In. Mutsell Qu. Sz. Cont Color Gr. Sz. Sh. '011#1 •Eff#2 3 All to # Boring �' ® Pit Ground surface elev. /� fL Depth to "Ong factor in Solt Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Mu sell Qu. Sz. Court. Color Gr. Sz. Sh. *M1 'Eff#2 Z S 01 � � ' .� � /¢ •mil � Z • Effluent #1 = SOD > 30 220 rtglL and TSS >30 1150 ' Effluent #2 = SOD 130 mglL and TSS < 30 mglL ( CST N�umber 20-6) *% v Address Date Evaluation C wKkxted Telephone Number Lott! Property Owner Parcel ID # Page 2 F31 B oring 9 Q Boring # Pit Ground surface elev. l ! ft. Depth to kn�e9 factor 1,20 in. Sol A Rate Horizon Depth Dominant Color Redox Description Texture Stnch" Consistence Boundary Roots GPDW in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. `E1#1 •EB#2 C';r 12 10,1qA „+..��. / o2" ❑ Boring # Boring ❑ Pit Ground surface elev. ft. Depth to Nmitmg factor in. Soo Application Rabe Horizon Depth Dominant Color Redox Description Texture Struct Consistence Boundary Roots GPDAfz In. Munsell Qu. Sz Cont. Color Gr. Sz Sh. 'Eff#1 'Efl#2 ❑ # ❑ Boring ❑ Ground surface elev. ft. Depth m limiting favor in. Pit Sol Application Rate HrAtnon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff° in. Munsell Qu. Sz Cord. Color Gr. Sz. Sh. 'EM 'Eff#2 I * Effluent AM = BOD > 30 I= ffV& and TSS >30 150 rng& ` Effluent #2 = BOD < 30 mg& and TSS < 30 mg1L 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. SW-090 (R. M) Safety and Bin7dings Division Cowdy w 201 W. Washington Ave., P.O. Box 7082 jf , ` ` �S'/ Madison, WI 53707 — 7082 Slmiwy Pamir Number (to be GW in by Cm) Department of Commerce (609)261-6M6 D ter S Sanitary Permit Ap . Stare Plm L . ..Number In accord with Comm 33.21, Wis. Adm. Code, b e it N may ba used for secondary P Privacy , :l m� D Projxt Addms (ifdiifaeot than uw'Iiog addmis) L Application on — Phase Print All Isdarnm APR 0 12003 1// / Z / r0 � o e-- A) Property Owaer's Namme / S Pared # tot # Bloc O 4 • �O �s`d/ l ZONIN OFFICE COUNTY i.a S Property owner's Mailing Adtess Prop`, 2 . L of led �y State 1 Z . 2f^ y,, ✓� y S Sxtim / 3 Zap Code Phan Number � J � II. of Building (check all that aWy) 1er2 Family Dwelting—Numberof B Brooms N� CSMNambw ❑ �— Describe Use 3 ❑State Owned — Describe Use 3 I x � ❑L�ty! ❑Vi>bgs�owashipof III. Type of Permit: (Check only one box an fine A. Complete fine B if appiiande) ✓ ( / �— _ A- system ❑ itguo went Systan ❑ Trastmmviioidiag Tack Replacement only ❑ Odra won to SYMM B. ❑ Permit Rawwal ❑ Permit Revision ❑ Chaoga of ❑ Permit Transfer to New List Ptevious Permit Numbs and Date issued BeOm ibspirstiai Plumber Owner 1V Inpe of POW15 Chwk all that Non —Pmou iced ht-C ind ❑ Mound> 24 ia. ofsuirablc sail ❑ Mamd -c M err of saitsbk soil ❑ m-ewa& ❑ single Pass saad Piker ❑ C 0usitucad Wdlmd ❑ Praarmimd lo ❑ Hokhog Took ❑ Pad FUW ❑ Aerobic Ttptment Ihut ❑ 1tairculstin g Sand }7ker 0 xecitnolatin • Maths Fika ❑ e ❑ Gravel - Pipe ❑ other (eaplain V. tment Area tiara• t o ws Design Flow (gpd) Design Soil Application • Disperstd A� Required ( Disper:d area (� system � / ✓ , o� VL Tank Info Opacity in Total Number Manafsaura Prefab site ost6d Plastic Gallats Gahbas of Utrits/ -i�a Cotacrete Coated (Kass New aka T� Ta Sep& wHo ft Tm* Aerobic TreaaaM Unit Dwia9C3rambcr VII. bility Statement I, the respon for installation of the POWTS sbwm on the attached plats. Plumbees (Print) Phrmba's MP/MPRS Number Basiaess Pbare Number l P •sAa cs . lity. stamk stn It use Only ❑ wed sanitary Permit Fes rwjudes Cmamdwua mite s; start�a) Fa) ❑ Owner Given Raasoo for Douai Conditions of Approval/Reasons for proval L t a � ` �_p6as ( b the C o a b ) f i r oa paper aat� it is sin SBD -6398 (R. 08/02) I PLOT P N PROJECT P.C. Collova Bldrs. Inc. AD ss P.O. Box 489 Somerset Wi 54025 SE 1/4 SE 1 /4S 33 /T 30 N/R TOW Richmond COUNTY ST. CROIX 3/31/03 BEDROOM 3 MPRS Shaun Bird 226900 DATE CONVENTIONAL X= IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK E HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1212 # of chambe 39 ,BENCHMARK V.R.P. Top of 2" Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 94.4/94.2/94.0 1' below grade Please note: further testing may be done on this site 121 st Ave Vent Plans Designed Using Conventional Powts ALong Standard Biodiffuser Manual Version 2.0 Leaching Chamber " with 31.1 ft2 of Area 34" Grade at System Elevation \ ope B -3 50' Pro 3 3 -3' X 83' Cells with >3' ing Vents Bedroom 0 House Vents B -2 10' T 15 B -1 >5' from property Line 80' B.M. #2 30' B.M. #1 150' Property Line PLOT P N PROJECT P.C. Collova Bldrs. Inc. ADI� ss P.O. Box 489 Somerset Wi 54025 SE 1/4 SE 1/4s 33 /T 30 N/R TOW Richmond COUNTY ST. CROIX j' MPRS Shaun Bird 226900 f DATE3/31/03 BEDROOM 3 CONVENTIONAL XXX IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK E HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1212 # of chambe s 39 BENCHMARK V.R.P. Top of 2" Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark SYSTEM ELEVATION 94.4/94.2/94.0 1' below qrade Please note: further testing may be done on this site 121 st Ave Vent Plans Designed Using Conventional Powts >6 » Standard Biodiffuser Manual Version 2.0 of Cover Leaching Chamber with 31.1 ft2 of Area 6' Long 11 " Grade at System Elevation 34" 2% a Slope ° B -3 50' Pro 3 3 -3' X 83' Cells with >3' Spa ing Vents Bedroom 30' House Vents B -2 10' T 15 B -1 >5' from property Line 80' B.M. #2 30' B.M. #1 150' Prop Line ` Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safe and Buildings s 9 in accordance with Comm 85, Wis. Adm. Code County C I,.O 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 B ), direction and Parcel I.D. �� U percent slope, scale or dimensions, north arrow, and to n i e to nearest road. 020- 111111 - 9p� Z / , R sewed y Date Please print all Z in` `` Personal information you provide may be used for sry purp ses (Ir.Vhacy Law � (1) (m)). G�✓ / Z U Property Owner , 4 P Location P Coll v� �', a4 r Go S E 1 /4SE 1/4 S 3 T �� N R 18 E 1 1- 1 1, Property Owner's Mailing Address Lot Block # Subd. Name or CSM# - 105 C 2�1'';; C sY CROIx C ck City State Zip Code Rhone NurpWINGOFFICE ty ❑ Village [A-Town 11 Nearest Road I rJ�I ( L Q G G- [A New Construction Use: FXb Residential . Number of bedro - 7 Code derived design flow rate VS /G�a GPD ❑ Replacement Public or commercial - Describe: Parent material Flood Plain elevation if applicable if/ /yT ft. General comments S y ,G �C V • � S 6 and recommendations: F I Boring Boring # ® Pit Ground surface elev. 95 • ft. Depth to limiting factor - 12. — 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 I Si 2mc�bk 5 l v� • 5 g Z �0 - 30 V4 SL Z m rr c — 5 3 5L- Zms k Boring # Boring pit Ground surface elev. 9 5 • y ® Depth to limiting factor Lo 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 to r 3 SO z fn�r C5 IV S 2 I p_ 5 2) Z (LIILD — 5L Z 5)3 - 5 * 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) Sigpature CST Number O"A — Address Date Evaluation Conducted Telephone Number f - 1 Property Owner Parcel ID # Page of Boring # F1 Boring _ F3 © pit Ground surface elev. 9 So ft. Depth to limiting factor y 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. i *Eff#1 *Eff#2 I v -IZ Id X312. sit 2 C.S Ivy 5 $ 2 NZ-50 3 Io r sW v f s a 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/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. F ❑ 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 I Effluent #1 = BOD > 30 < 220 mg/L and TSS >30:5 150 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.07 100) I OF PAGE_ NAME C l IoUa LOT# t) LEGAL DESCRIPTION S' '/4,56'/a S,3ST N R1 E (or) d SCALE: F'= yd BM i ELEVATION /00 BM I DESCRIPTION P a Z' D pe BM 2 ELEVATION 7 S ec . 3- BM 2 DESCRIPTION js p of Z " l0 do O; Dt I SYSTEM ELEVATION Cf 3. S o ALTERNATE ELEVATION q3. O CONTOUR ELEVATION q Sa , 9 S . SD S � -3 O � s ■ Q�, maw SIGNATURE DATE BmZ {I. c l y E I Maintenance and Contingency Plan for a Septic System -4q) 0 7� S 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. I 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 �- (Verification required from Planning Department for new construction) City/State �� 1(�_ C��' arcel Identification Number 026 LEGAL DESCRIPTION Property Location %,, S %,, Sec. T30 N -R W, Town of E, " . Subdivision Lot # Certified Survey Map # 620 Volume l . Page # . Warranty Deed # _ CQ Qt , > c �C'1 Volume . Page # Spec house 0/yes ❑ no 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. The 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 ve ' that the on -site wastewater sal Per �g 1 () drspo 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 days of-theifirce year expiration date. -L� 1/12- 3 i 31 1 C) 3 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 p described above, by virtue of a warranty deed recorded in Register of Deeds Office. M GN — ATNE OF APPLICANT 3 l.3 l 3 DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** f ** 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 ROM : c P C CCLLCUR BLURS, INC FHCHE N0. : 715 5 49 5911 Nw :,, . 16 2001 OS: w PL iTAIL•7ARGFW:St:UN5 KATH LEEN 1 l{ WARRANTY DEED REGISTER OF DE EDS RUMW ST. CR ^IX CB., ldI Uoce This o"d, amde yetvmli Kenneth L. Brown and Kathleen B. ACZ-M FM FECM Broewn,111:36nad and Wire - -`� 04•;8-29^1 9:43 AK YAR1 WTY DW Graator, attd P. C Callovs guilders. lac. CRI.CaPT FEE! MY eg_t ,;AWFEi FEE. &23.00 — RECC4aI1G FM 10.M Cahn. c Grantor, For +valuable corsideratioo, eorveys and wvmtsts to O u Grantee U)e following dexrihcd r.:l cstote in SG C: aiz County, Stale of `Nuraroin: ze=tIre Agra r 4- and ttaar,a Addrea David 1. Evtratsn Z•hal yrrt of SS 114 S 114 and Sul I/A SE 1 /4 Sao. 3'r ^�0 �' -T15 � described 304 Lr_ast St. as follows: Lou 1, 2 and! of Camitiod Surrey 11-1,T rwccrded in Vol. 1, of ;ludton,'.ui 1 4016 Certified Survey ?Raps, page 3698 u 7x. New 5(1 .591. _ U� :C� It. Croix CCMCV, Witconabt uz6•tl v6 au{K:v. rare tvvtwUzuc- 026- IC96.70.000 P+riz! lu,aldaeuton Nuniva 01N) i nis �A not holneaa :d Propen7. a notl OZ,�GfGf s Exacpticra to wir n ies; 'ax!,zing "irawiy!, e:vemcnt R ripts of may of racord. t Doted this day of ACr;l l ?01 . Kenneth L. Elm" 4 Kathicaa B. Brown A UTH UTICA TI ON AM41O W LED STATE OF Wlscensin ) ) ss. Slgnarurdl) St. Croix County. ) Persaraily eaete 6efrrre me this Ij 4,.f 1et6erttkated thin day of April 2001 the above ,aaaed anneth I,. Brown rand Kutilesn B. Brown _ 4 i . TITLE: y J^H O£ WISCONSIN to/ a n1CAx1 to be the peaoa(r) w b0 axee9led the Foregoing and aetnewteatic the lama. � OGUU, WIa. 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N C) ,°/ -� 9 9.4, i 00 O cn ' ~"3 F\ 1 z I N ti�� rj S. gyp' 1 ?� I N C14 /� q bZ`6 LS I I — 3 6 L.CLO 0 S _ _ — 1 NIOf J f � N I °° r I II z 'f N O I 00 1� I o y I I o O / co / Q 0232'+3= W— �-- • o / / / 10 — — -485.55' N 1 p / .�_ 0 0 1WO o 1 - 3 v / Pam Q uinn From: Jane Hansen Sent: Thursday, April 03, 2003 8:27 AM To: Steven Fisher; Jennifer Emmerich Cc: Kevin Grabau; Pam Quinn Subject: Duckpond 11 Last night, 4/2/03 1 drove past Duckpond 11 on a hunch: Yes, there is 1/2 a basement dug on Duckpond 11. No septic, but at least 1/2 the basement is dug, and a heater is hooked up to it. The septic permit was issued 4/2/03 (3:00 p.m.) and no copies sent to the building inspector, plumber or builder (PC Collova /Sh Bird), so there is most likely not a building permit either. Jane 1 I