HomeMy WebLinkAbout026-1141-14-000 ST. CROIX COUNTY
WISCONSIN
ti
ZONING OFFICE
N 11 p M ■ - M1 \A■ ST. CROIX COUNTY GOVERNMENT CENTER
Imm -- __ 97- 110 1 Carmichael Road
Hudson, WI 54016 -7710
(715) 386 -4680 FAX (715) 386 -4686
Thursday, August 22, 2002
P.C. Collova Builders, Inc.
1191 121st Avenue
New Richmond, WI 54017
Regarding septic inspection for P.C. Collova Builders, Inc..
Location of Property in St. Croix County:
I
Municipality: Richmond Township
Subdivision or Plat: Duck Pond Escape
Certified Survey Map:
Lot: 14
Address: 1191 121st Avenue
Dear Applicant:
A septic inspection of the above reference property was conducted on June 05,2002.
This property is located in the SW 1/4 SE 1/4 of Section 33, T30N R18W, Duck Pond Escape (Lot 14),
Richmond Township, St. Croix County, Wisconsin. At the time of the inspection, this septic system was
found to be code compliant for a 3 bedroom home.
If you have any questions regarding this, please contact our office at 715.386.4680.
Sincerely,
evin Grabau
Zoning Staff
cc: file
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
, INSPECTION REPORT Sanitary Permit No: 405075 0
(ATTACH TO PERMIT)
GENERAL INFORMATION 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 -14 -000
CST BM Elev: Insp. BM Elev: BM Description:
(&0 ' Z) 1 Sw kou a
I
TANK INFORMATION U ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Be chmark :W-
too -O
Dosing Alt.
_ tx�
Aeration Bldg. Sewer
Holding St/Ht Inlet -� St/Ht Outlet 77
17 � fi r
TANK SETBACK INFORMATION `F -r°� ��•Sa
TANK TO P/L WELL BLDG. Eto ke ROAD Dt Inlet
Septic Dt Bottom
Dosing Header /Man.
Aeration Dist. Pipe S�2
Holding Bot. System yr�
Final Grade
PUMP /SIPHON INFORMATION
Manufacturer Demand St Cover
� GPM Z-
Model ber
TDH Lift Fric ' oss System Head TDH Ft
Forcemain ngth Dia. ist. to Well
SOIL ABSORPTION SYSTEM r� -
8FPIi1fR'rNCHJ Width Length No. Of Trench s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIM •3 ZS /
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manuf tyr r:
INFORMATION CHAMBER OR �'V►.`
Type Of System: UNIT Model Number:
1 V -
1O S
DISTRIBUTION SYSTEM
Header /Manifold `( Distribution Ix Hole Size Ix Hole Spacing Vent to Air Intake
Length Dia Lengt Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over
Depth Yes [] No LEI Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil — i
[� � Yes �, No
COM NTS D / Ins L i - -+-
w n (In�c� cod di crep�nciesperso s preset, etc.) Inspection Inspection #2:
#4 t7u p
�ocation: 1191 121st Avenue New c Richmond, WI 54017 (SW /1 1 1/4 33 T30N R18W) Duck Pond Escape Lot 14 P r I No: 33.30.18
1.) Alt BM Description = U W-, IMu te'w '
2.) Bldg sewer length =
t
- amount of cover = s toil I � �� -6 PW $ ZD v �' � • 3 S � �
Use other l s de for addition 1 i Y s No ` �
'r� .
n G �!
�t Wti+9 I
SBD - 6710 (R.3/97) Date Insepctor's Signature ert. No.
` / n
Safety and Buildings Division Cry
201 W. Washington Ave., P.O. Box 7162
Visconsin Madison, Wl 53707 - 7162 Site Address 1,2 /,51 . &
Department of Commerce Sanitary Permit Number / I V
Sanitary Permit Application �,�
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide iJd'C►ieck if Revision
may be used for secondary purposes Privacy Law, State Plan ID Number
I. Application Information - Please Print All Information I . D . /, A
Property Owner's Name Parcel Number
oil
SAY 3 1 2002 33. 30. 1. /D/ 9
Property Owner's Mailing Address S1. C R O I X GO U N T Y Property Location
(1R IfJfa OFFICE 5i; S�✓ XN, Ld
6 1 13 X - bey Block Number
City, State Zip Code Phone Number
Subdivision Name CSM Number
II. Type of Building (check all that apply) n ✓ ❑City
2 Family Dwelling - Number of Bedrooms ❑Village
❑ Public/Commercial - Describe Use o P
11 state Owned j 3 �x y / / — 1 3 Nearest Road
III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable)
A For County use
ew 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to
stem I Tank Only Existing stem
B. ❑ Check if Sanitary Permit Previously Issued
Permit Number Date Issued
IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) T�7w� 1
zt Pressurized In -Ground 210 Mound 47 11 Sand Filter 50 ❑ Constructed Wetland
m%. In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line
45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other
V. Dispe rsalPTreatment Area Information:
Design Floc (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade
propo� te(Gals./Days/Sq.Ft.) (Min./Inch) 9 � 7 evadon
e-
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanks Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank
Dosing Chamber
VII. Responsibility Statement- I, the undersignefi responsibil ty for installation of the POWTS shown on the attached plans.
1 plum be rMP/MPRS Number Bss Phone Nuns r
Plumber's Name (Print) � usine
J l
Phmilrer's Address (Street, City, S te. e) /
VIII. County/Department Use Only em Si lure o Stamp
e (includes Groundwater Date Issu mg s)
Sanitary Permit Feed Sna
Approved 0 Disapproved Surce Fee)
❑ Owner Given Initial Adverse 5j� ev 3 Q
Determination JJ VV
IX. Conditions of Approval/Reasons for Disapproval
�b�uc�/r�/ �- h�ow �C ru-� Gt,� � �n�-�c -fie -� -sa � � L s —> �„ �,�, � S 3a �a►
Selz I nEa wtil�►z-
MA, nl7zgmv
Attach compiete plans (to the Counts only) for the "em on paper not less than 81/2 x 11 inches In size
( By
QRn -A';4R (R 05/01)
kk
Safety 04 Buildings Division Ca
201 W. Washington Ave., P.O. Box 7162 ✓J
is�onsin 53707 - 7162 Site / Address
1 /
D ment of Commerce sanitary Permit Number
Sanitary Permit Application ,�
in accord with Comm 83.21. Wis. Adm. Code. Personal information you Prov'de Check tf Revision
may be used for
rpo Privacy Law, IR
State Plan I.D. Number
I. Application Information - Please Print All Information
Parcel Number
Property Owner's Name MAY 3 1 2002 33 - 8 . /D/
C Property Lmnon
Property Owner's Mailing Address S
T. CRO IX
d' Sox- ZONING OFFICE: s 33 �N, >"
City, State Zip Code Phone Number Lgt r Block Number
Subdivisions CSM Number
II. Type of Btu'lding (check aII �apily) n✓ ❑City
r 2 Family Dwelling - Number of Bedrooms ❑Village
0 lic/Commercial - Describe Use Road Owned 3 3'x y/ / , i'3 N earest
III, Type of Permit; (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable)
Of 6 ❑ Addition fn For County use
A
ew 2 ❑ System 3 ❑ Replaocm�t
Tank Od Date Issued
B. ❑ Check if Sanitary Permit Previously Issued Permit Number
IV. Type of Permit: (Check all that apply)(mnnbering scheme is for internal use) n
- ding
20 tssurized In- Ground
-Pressurized hi- Ground 21❑ Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland
41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line
45 ❑ AL - Grade 46 ❑Aerobic Treatment Unit 49
❑ Recirculating
30 ❑ other
V. DispersaMeatm eat Area Information: percolation Rate System Elevation Final Grade
Area Dispersal Area Soil Application
Design 47 Flow 7W Q T D � iwqp � ,er � sdl Gals./Days/Sq.Ft.) (Min./inch) �� f- ovation
Z 9�
/
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons
Gallons of
Tanks
Concrete Constructed Glass
� New Exiadni
Tanks Talcs
Septic or Holding Talc
Doting (umber
VII. Responsibility Statement- I, the tend responsibility for installation of the POWTS shown on the attached plans.
Plumber' WIM[PRS Number Business Phone N r
Plumber's Name (Print)
Plumber's Address (Street. City. S te, e) /
VI Count artment Use Oil
II. eat Si tore o Stamps)
Sanitary Permit Fee (includes Groundwater Date Issued
❑ Disapproved a Fee)
❑ Owner Given Initial Adverse � If 3 Q
Determination
IX. Conditions of Approval/Reasons for Disapproval so LS' '"�' y > ...5
aim x ii Incim m au
not teat than
GPM tar the tntem oa paper � `
P e Attach oornt� tit 00 the Camp � ^ , m . , r .-,o � _ �IIG
� B
cRr���4R M 0.5/01) y
` Soil Test and System PLOT PLAN
PkGJECT P.C. Collova Builders Inc. ADDRESS 705 Countv Rd E Hudson Wi 54016
a
SE 1/4 St 1 /4s 33 /T 3 N/R 18 W TOWN Richmond COUNTY ST. CROIX
/ 5/31 /02 BEDROOM 3
MPRS Shaun Bird 226900 l DATE
CONVENTIONAL I - OUND PRESSURE CONVENTIONAL LIFT XXX HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .4 i/ABSORPTION AREA 1212 # of chambe s 39
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 96.5/96.3/96.1
Vent -
Standard Infiltrator \ Plans Designed Using
>6„ g Leachin Chamber , Manual Version 2.0
Conventional Powts
of Cover
with 31.1 ft2 of Area '
6 Long 12"
349f Grade at System Elevation
Pro 3 Bedroom
House
* 20'
Q B. B -3 30'
10'
15'
3 -3' X 80' Cells with >3' Spacing
BY
Vents
80'
-1
Vents
2%
B-2 Slope
10'
150' Property Line
i _
of
Wisconsin Department of Commerce SOIL EVALUATION REPORT pPage l 2i
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
CountXS4 D l �
Attach complete site plan on paper not less than 81/2 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. 3-3
Please print all information. /, R eview by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s 15.14 (1) (m)). 3
Property Owner ) Property Location l
r C D l l D �, Govt. Lot 3� 1/4 ,5� S 3- 3 a N I� E( W
P s Mailing Address Lot # Block # Subd. Name or CSM#
Cif ,3
State , Zip ode Phone Number ❑ City ❑ Village JR] Town Nearest Ro
) I
Construction Use-j2DResidential / Number of bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Public or mmercial - Describe:
Parent material d Flood Plain elevation if applicable cable ft '
and recom
xt
a Boring # ❑ Boring
a 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
YO-6
® Boring # ❑ Boring
pit Ground surface eX ft. Depth to limiting factoj /f � 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
2 O
(�(-
' Effluent #1 = BOD > 30 < 220 mg/L and TSS > mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST me (Reese Print) Signature � � CST Number
Qv a J 1 (/v
Address Date Evaluation Conducted Telephone Number
Property Owner _ Parcel ID # Page of
F31 Boring # ❑ Boring
19 - Vit 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
a Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
C] Boring a Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit
Soil Application Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff #1 'Eff#2
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 -3330 (R.6/00)
..xN
Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave.
See reverse side for instructions for completing this application 15 Box 7302
Madison, W I 5 Personal information you provide may be used for secondary purposes 3707 -7302
Viseonsisi
Department of Commerce [privacy Law, s. 15.04(lxm)j (Submit completed form to county if not
state owned)
Attach complete plans (to the county copy only) for the system, on paper not less than 8-1/2 x i 1 inches in size.
County State Sanitary P h Number ❑ heck if revision to previous application State Plan I. D. Number
y � i� S
L Application Information - Please Print all Information P roration: �•
RECEIVED Propert Location
��� Own«�Iame � l zi
J I-✓1/4 SF1 /4, S> T R or W
Property Owner's Mailing Address MA Y p 2 Lot Number Block umber
q 9 9 2002 Iq 3 • /o /
City, State Zip Code O Subdivision Name or CSM Number
ZONING NTY
C.t�l
i s c7 �— ( OFFICE fist.. r` FA d
II. ��,Iz of Building: (check one) „ ❑ City
;6r2 Family Dwe lling - No. of Bedrooms � Village
�� Town of
❑ u/Cotnmercial (describe use):_
❑ State -Owned
T l26NC/YES 3 I X 3.7 J am- l S / 30 Nearest Road
III. Type of ermit: (Check only one box on line A. Check box on line B if applicable) a to _ 5// - /'f - G14 d
A) 1. 2. 0 Replacement 3. Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only Existing System
B) Perm :t Num r Date Issued
❑ A Sanitary Permit was previously issued
Type of POWT System: (Check all that appl ay , t'l 5 A - YAP4 3 1 • I
n pressurized In ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V. Dispersal/Treatment Area Information:
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Ele}'ation 7. Final Grade
fired Pro Rate (GalsJday /sq. ft) (Min. /inch) ✓ Elevation ✓_
VII. Tank Capacity in Total # of Manufacturer Prefab Site S I Fiber- PI 'c
Information Gallons Gallons Tanks Con- Con- glass
New Existing 2a� / crete structed
Tanks Tanks
0 13 0 13
❑ ❑ ❑ ❑ ❑
VIIL Responsibility Statement
1, the undersigned, assume responsibility for 46 of the POWTS shown on the attached plans.
Plumber s�Name (print) Plumber' i (no stamps): W#,VRS No. Business Phone Nurnber
umbers Address (Street, city, state, Zi )
IX County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Usuing nt S' o stamps)
[� ; Approved 13 Owner Given Initial Adverse Surcharge Fee) r€� `�/li,
Determination
X. Conditions of Approval /Reasons for Disapproval: _/V nt v,.. A it's /
dc,uz - P (��� � 1 /6 n✓fap h2�. mop ofc�a�m,�y�—
quZA- 12 /.
I
PLOT PLAN
PROJECT P.C. Collova`Builders Inc. DDRESS P.O. Box 489 Somerset Wi 54025
SW 1/4 SE 1/4S 33 /T 30 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 5/2/02 BEDROOM 3
CONVENTIONAL X04C I - UND 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 chamber 30
IL 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 ELEVATI 96.7/97.0 1' below grade w`e'd J�
121st. Ave
12 6o
Vent ~
Standard Infiltrator
of Cover Leaching Chamber Plans Designed Using
0 with 31.1 ft2 of Area Conventional Powts
12" Manual Version 2.0 cl"
6 Long 34„ Grade at System Elevation ends / 8
,` B �
dlr � ,� V 2 -3' X 94' Cells with >3' Spacing
CP 1�1b I
J
B -3�
5%
80
p Q
7-3 >° Slope
> of fill over ystem to make current 1 17•S - `7 ��,
code, system is to be installed 1' Below
grade Vents;tB.M./*2
B -1
�
s y 1151rz 0 o
I/� , fie ^ / , -�= (2 << (o �Cau�✓oue� 3o 5 jS4& .M. #1
Pro 3
Bedroom
House
214' Property Line
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3
Division of Safety and Buildings '
in accordance with Comm 85, Wis. Adm. Code Q
County J �- , Ciro)
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. /19 / /02 / ST
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all informati rr 1 Re " e by YL2Lt� �Y
Personal information you provide may be used for second u o(' a`y [ 5.04 (1) (m)). Z
Property Owner I, x, A Location
rr,P t, G' t 114 1!4 S T N R g E (or
pa� Cb //b v� Ic> S� S E
Property Owner's Mailing Address Lot' ; ,j Block # Subd. Name or SM#
City State Zip Code a Numbe�,, ,jjg7,tX E}',�y ❑ Village [kTown Nearest Road
ud rn k� s�tol rte) - C4
[R New Construction Use: [ta Residential I Numt �r of bedro,DMD a �> Code derived design flow rate 11sol6o GPD
❑ Replacement Public or commercial - Descrb
Parent material r / P w Flood Plain elevation if applicable
General comments S Y e V • '•�
and recommendations: el e v • 6 1p 98 •� LOu' �r �/ 36
'� �v vv ewe✓ ov e r s ysr►1 --? `�� 6 �OZ e>� rc�P�aN`'�
0, S�SeI u
Boring # Boring
❑
I ® pit Ground surface elev. W Pe 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. *Ef1#1 I *Eff#2
I 0-1 ID 1 2rnob r CS IV . 5 g'
/Z• 2N i I 2 C
3 - Z4 - sb ID �l
S t, S — S
(-4 •sa I rfq CZP v I — — - .
�, a !i 6 0
13 .z`� rid a
a Boring # Boring /
pit Ground surface elev, . q� ft.
El pit 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
t O -iZ- t0 Z- si I Zf -ab r,n- 1 C l vS� �-✓ 8
Z• IZ - 10, j 19 5 i k n-,Cy - c 5 r 8✓
3 Za -too to r 41 — SL 2,, bk — s 5
�•8
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) Si t CST Number
a Sc vvt CA k -� S330
Address Date Evaluation Conducted Telephone Number
z 11 f �� �� s� w l• Sy6 z S ip 'Z �- o ( 7rS - -4 4 1 7- 4 CC) 9'
* 1
Property Owner ( C J Q Parcel ID # Page 2. of 3
3 Boring # F1 Boring
a pit Ground surface elev. �1�. 7 ft. Depth to limiting factor �� in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistencee Boundary Roots GPD /fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
I - o -1 ►v
r 2 �r C_ Ivy 5 $
Z
A 0 3 2 - 10 r l 5L L ,rr -fr
z'
F-1 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 /ft?
in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. *Eff#1 *Eff#2
F-1 El Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
1:1 pit
Soil Armlication 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 5 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 (k07 /00)
PAGE 3 OF .3
NAME 00 l LO ua LOT# / 4 ( LEGAL DESCRIPTION 5 C '�4SE'�4 ,N R I TE (or)
SCALE:
BM 1 ELEVATION /00 d
BM I DESCRIPTION koou; Z'' Q.OP
BM 2 ELEVATION $ eC• 3-3
BM 2 DESCRIPTION
SYSTEM ELEVATION ��i •:�0 _ }
ALTERNATE ELEVATION f $•Sa Gouser 97 3 6
CONTOUR ELEVATION--f 5 4� so
x
v
r
si � S
r F
. ! r
g"
r
r
' r
r ,
r ,
r
SIGNATURE DA
9 rAZ 8M1
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT I
AND
OWNERSIiIP CERTIFICATION FORM
Owner /Buyer (� H oVA 6 U tl S A N
/�
Mailing Address �• L.J • 1.X7 ]� �LU� � �•1 -- ��t�� J
Property Address /
(Verification required from Planning Dcpartment for new construction) t/
City /Sttat I I
e C,NM,Mn& W Parcel Identification Number
0z- i09�
LEGAL DESCRIPTION 6 - �[�`16 - 7 p - 00 C--
Property Location q \ LO ec. TI -RW, Town of L rk\M=d_— / 1 / S'
Subdivision CX C Lot It
Ccrtifieti Survey iliap ;t L (y� 7 �11 Volume 3 Page « 3 �1
`Varrauty Decd It (0_ VI q Volumc Patgc 4 1 ,
Spec House ❑ yes ❑ no Lot lines iticutifiauic `- yes ❑ no
S I STEM MAINTENANCE
Improper use and maintcnance of your septic system could result in its premature failure to Handle wastes. Droner 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 a,rces to submit to St. Croix Zoning Dcpartment a ccrtiticaGon form, signed by the owner and by a
=stcr plumber, journeyman plumber, restricted pi=bcr or a licensed pumncr verifying that (1) the ou -site wastewatcrdisposal 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 sewagc 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
statin your septic systein has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
day opfic thrc car expiration date.
SIGNATURE- Or APPLICANT DATI:
OWNER CERTIFICATION
I (we) certify that statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owncr(s) of
the r cscribed ab , by virtue of a warranty deed recorded in Register of Deeds Office.
SIGNATURE- OF APPL; ANT DATE;
* * * * ** Any information that is ntis- represented may result in tite sanitary permit being revoked by the Zoning Department.
*• Include with this application: a stamped warranty dccd from the Register of Deeds office
a copy of the certified survey map if reference is made in tine warranty decd
r
yoso - - 7 S
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years. f tf O -
��� �f 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
71 j- --3,cP.6 8a
Y
Shaun Bird #226900
FROM P C COLLOVA BURS, INC PHONE NO. : 715 549 5911 Nov. 16 2061 9 P1
.11'A 7 C DAR OF W {SCUNSIN FORM 2. 1948 0&-4- - - - 4 139
WARRANTY DEED KWHI.XEN 11. WALSli
REGISTER OF REEDS
vaitnt r I ST. moix CO., ldI
This 0nd, made between Kenneth L. Drown a Xatllks2n B. RMItk) FOR =M
Drown,11usbead and Wire - -` .,M
04 9:45 AN
MANTY OEE4
Grantor, and P. C. C0119 Builders, Inc, W EWIVT t
umf -cm FEE:
FEET
'.pa min FEE: 925,00
RE MI`l0 FCCt 10.00
Grantee.
Grantor, for a valuable consideration, corvtys and warrants to
Grantee the following dmribcd resl cstoto in St. Croix t)( cAp o m e s (ZAf �-
County, Stale OM I000in:
Recordln Ares
name and 1tmure Addmae
hat Part of SO 114 SW 114 and SW 114 SE 114 Soo, 33- T391` -? ISIN described 304 s�.
'C
as rollowa: L ou 1 2 and 3 of Cwtitied Su y" M. a recorded In Vol, 1 3 o Hudson, WT S4016
C or dGod Survey laps, page 3 698 as D(m Na. 6 67 S
SL Croix Cotu7ty, Wisconsit UI Jo
026 •IU9G•aU- 00V.U2trlUYfruO -2UC.
026•IC96.70.000
rata! Nawfiaaion Nunlia (rt4)
This la not holnestead property.
(W (is rat)
F.accptioas to waI' Mies: Existing highways, easements R rights away or record.
Dalad thin w day of April 100)
• . Kenneth L. Brown
Katblooa B. grown
AUT11WTICATION ACKNOwl>: cmEmr
STATE OF Wisconsin
Slgnalura(s1 St. Cry12 )m.
Couny.)
Personally coma Wore me this day of
atl'nmikeati this day of April 2001 the above mnwd
Kenneth 1- grown and Katishen B. Brown
J.
TITL R Or WISCONSIN to mown to be the perso u(s) who axeeated the foregoing
I em and acknowteaae the same. Wit. Slats.)
WAS DRAY rRV AY
A4 • aYid J. Lstreen
304 54016 Notary PdhBC, Sate of Wiscomfit
(Siaaatur NAir im aothendeaW or aeknowi.daad, Both are n et Mr CQMmission Is pen ,a, no s e explra We a
nexssary.I ,)
Nsmp of ptom mw ft it am Gawky ,hoeid be IYOW or printed Wm dulr dgnearas
eeAFdIANTY 0,620 STATIC aAs OT VIaCANSIN
epILL1 Me. 7 • IF,e
INFORMATION rR1JPH4"P1AL3 COMPANY sown Oe t.AC. ee 803d39•7021
S ,��4Q6`f 191.60' — _ -- - -- — 233.72 - - --
1 � 01 ' 3 � 5 9 ?� \ \O N 89'35'53 W 425.32
Sp 3 1 23 — 121st AVENUE
� 24 r�
S 89'35'53" E 425.32
- -- ---- - - - - -- - -- 189.87'-- -
47.60' 187.85 c-
12�
OT Z
078 Sq. Ft. i , O T 13� - - - - - - - - � -
1.70 Ac. L LOT 14 15 LO T 16
� LOT �
66649 Sq. Ft. 4 65568 Sq. Ft. I 68637 Sq. Ft. 66635 ISq. Ft.
I 1.53 Ac. 1.51 Ac. w 1.57 Ac. 1.53 I Ac.
c o o
153.90' 153.36' 207.03 181.18'
113.14' ' - - -_ -- -- - - --
2.80' n — cn
LA
w
SOUTHEAST CORNER, SECTION
T30N, R18W. SET P.K. NAIL F
COUNTY TIES
•
N0 TE. i� r
-
ALL BEARINGS ARE REFERENCED TO THE " SOUTH LI NE OF THE SOU THEAST 1 / 4 OF SE CTION 33,
T30N, R1 8W, RECORDED AS N 89'43'55" W.
60UN A Y VI Y' MURhHY LAND SURVEYING.
..
lQ N S: T 8 CONSTRUCTED IN PROXIMITY WITH DRAINAGE EASEMENTS SHALL HAVE A
DOW WELL ELEVA T ION NO T LESS THAN TWO FEET ABOVE THE HIGH WATEF
DRAFTED BY: JASON THOMAS SHEET 1
Vv