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Home My WebLink About026-1141-24-000 ;consin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix ety and Building Division INSPECTION REPORT sanitary Permit No: 405184 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. Coliova Builders, Inc. I Richmond Township 026- 1141 -24 -000 CST BM Eiev: Insp. BM Elev: BM Description: TANK INFORMATION EL VATION DAT TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / / q� _ / _ /O f . Benchmark / JOB V / Dosing Alt. BM� `c vy Aeration Bldg. Sew 2.S p p � Holding SVHt Inlet ! 4 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/ WELL BLDG. to Air Intake ROAD Dt Inlet Septic - 6 M to / / Dt Bottom Dosing r Header /Man. c� Aeration Dist. Pipe-ro." rn G• Holding Bot. Syste - 7 Final Grade PUMP /SIPHON INFORMATION R , , Manufacturer and St Cover f, GP Wn& G 0 "X O. Model Numb TDH Lift on Lo tiss System Head TDH t Forcemain Length I t. S. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width y Length , No. Of Trenches PIT DIME S No. Of Inside Di Liquid De DIMENSIONS ^ I SETBACK SYSTEM TO P/L W BLDG IWELL LAKE /STREAM LEACHING Manufacture Tr IN CHAMBER O Ty Of System: UNIT Model Number ll r V -e ,,4i,Sx Z �f DISTRIBUTION SYSTEM c bs�t Header /Manifol DistributionP Dia S � i �' L . x Hole Size x Hole Spacing Vent to it Intake �/ Pipe(s) 0 K r � ` l ngth Dia Length pacing 6� 1C� SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Coe P .S a(oS2Y +° Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil . / Yes No i Yes �I No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1162 121st Avenue New Richmond, WI 54017 (SW 1/4 SE 1/4 33 T30N R18W) Duck Pond Escape Lot 24 Parcel No: 33.30.18.1028 1.) Alt BM Description a dam. 2.) Bldg sewer length _p cl - amount of cover - / � Fd vie J� 2 Sys k�^ C� • 7�` 0 Z Plan revision Required? ' Yes o _ _ -- -.- Q . Use other side for additional reformation. ; L Date Insepctors Si at Cert. No. SBD -6710 (R.3/97) 0 W �D1 i e� �ty but am j3uuu~ 201 W. Washingwn Ave., P.O. Box 7162 Madison. WI 53707 - 7162 Site Address Department of Commerce 7 - Z -� Z- �5 �'�a. Sani S T. Sanitary Permit Application @/ ;fRev Numbe ` fad /g� In accord wide Comm 83.21, Wis Adm. Code pe . , nnforma Ron you prov be used i uw I. Application Inforwatloa - Please Print All Informati Stan Plan I.D. r 0Z A Prop" Owner's N J �5 2002 Parcel Number property Owners Mauling Address F . CROIX COUNTY Location ZONING OFFICE < S 3�' , �� E City. State sp de Phone Number Block Number Subdi ' ion N � CSM Number II. Type of Btu'Iding all that apply) ✓ a - 2 Family Dwelling - Number of Bedrooms C0 _ 0 Public/CommercW - DescnU Use 0 State Owned Ts(,� f Q l� Nearest Road JIL Type of (Check on* l use). Complete line B if applicable) A 2 ❑ Repl>ament System 3 0 Replacement of 6 0 Addition to For Coaoi{y use 1 stem T ank Only B. ❑ Cheek if Sanitary Permit Previously Issued Permit Number Date Issued IV. of Permit: (Check an that apply)(numbering scheme is for Internal use) V( U4 �/ I'Kt A 3 L N Pressurized In- Ground 210 Mound 47 0 Sand Fdter 50 0 Constructed w 22 0 Pressurized k4round 410 Holding Tank 48 0 Side Pass 510 Drip lane 45 0 At -Grade 46 0 Aerobic Treatment unit 49 ❑ PteckcalatiNg 30 0 Other l V. Area Infoamation: Flow (gpd) rsal Ares Dispersal Area Application Percolation Rate Final > Grade Required Proposed Rate(Ga1s./Days/Sq FL) (Min.�� .3 f � Elevation �� ar VI. Tank info Capacity in Total Number Manufacuuer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks COWAVIC Constructed Glass New Existing Tanis Tads septic or Holding Tank - �� Dosing gmmber n_ the resvonsgay for instaMon of the POW" shown on the attached plans. � ST. CROIX COUNTY WISCONSIN ZONING OFFICE e ■ a s ■ u ■ n ■ — M�.ar ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road SAN. Hudson, WI 54016 -7710 (715) 386 -4680 FAX (715) 386 -4686 Thursday, October 24, 2002 P.C. Collova Builders, Inc. 1162 121st Avenue New Richmond, WI 54017 Regarding septic inspection for P.C. Collova Builders, Inc.. Location of Property in St. Croix County: Municipality: Richmond Township Subdivision or Plat: Duck Pond Escape Certified Survey Map: Lot: 24 Address: 1162 121st Avenue Dear Applicant: A septic inspection of the above reference property was conducted on August 09,2002. This property is located in the SW 1/4 SE 114 of Section 33, T30N R18W, Duck Pond Escape (Lot 24), 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. 07/18/02 Revision, If you have any questions regarding this, please contact our office at 715.386.4680. Sincerely, Pam Quinn Zoning Staff cc: file ' A Soil d System PLOT PLAN PROJECT P.C. Collova Bldrs Inc. R Ss P.O. Box 489 Somerset Wi 54025 SW 1/4 SE 1 /4S 33 /T 30 / W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE7 BEDROOM 3 CONVENTIONAL XXX IN-GWCKPRESSURE 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 chambe s 30 BENCHMARK V.R.P. Top of Power Box ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark / cM j6'Long ent SYSTEM ELEVATION 93.1/92.8/92.5 v a� 0 -4 Standard Infiltrator Plans Designed Using Leaching Chamber Conventional Powts 0 " with 31.1 ft2 of Area Manual Version 2.0 34" Grade a t System Elevation System Elevation set @ 5' Below Grade 2% 3 -3' X 82' Cells with >3' Spacing Slope Vents 30' B-3 40' ST 5 , Pro 3 Bedroom 40 House -1 Vents 20' 0 B -2 60' M 121 st. Ave ti Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of v Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County � Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must f r 15 include, but not limited to: vertical and horizontal reference point (BM), direction and Pairel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. o / - --?- V —6 Please print all information. Re " wed y Date p Personal infonnaton you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). -7/1 Q Y Property Owner Property Location _ 2 r C— Govt. Lot�1,J 1/4 1/4 S 3 3 0 N R) E (o W Property Owner's Maili ng Addre Lo # Block # Subd Name or SM# O 1 -- City State r Zip Code Phone Number ❑ City ❑ Village own Nearest Road AR�New Construction use. '`Residential / Number of bedrooms _�_ Code derived design flow rate 'TQ GPD ❑ Replacement /��❑ Public comm; ' escribe: Parent material Flood Plain elevation if applicable v� General comments and recommend ations � c S7 .SC� M Boring # 4 Boring it Ground surface elev. ft. Depth to limiting factor /� c/ in. IIII� --- �--- 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 D �3/ ----- z � ----- s 3 s �-- - qq- ® Boring # ❑ Boring pit Ground surface elev. �X j /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 ,, �� ' S ZI < > < — < 'Effluent #1 - BOD > 30 220 mg/L and TSS 30 150 mg/ ' Effluent #2 - BOD < _ 30 mg /L and TSS 30 mg/L CST N me (Please Print S' CST Number 2a ter✓ Z5.0' l 2 � L 9 G+ Address p y Date Evaluation Conducted Telephone Number SB 8330 (R07 /00) J Property Owner Y 1CLt /Z. Parcel ID # Page Of Z� F3-1 Boring # ❑ Boring Pit Ground Surface elev. ! ft. Depth to limiting facto 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 1 '7 F 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 ❑ Boring # ❑ pit Boring ❑ 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 ' 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) F Safety.and BuildinSs Division CO " W. Washington Ave., P.O. Box 7162 2ol W NVft4cons�n Madison, WI 53707 - 7162 Site Aildnas / . `1v� . Department of Commerce S Permit Ntmtber Sanitary Permit Application In accord wilt Comm 83.21, Wis. Adm. Code, personal information you Provide ❑ Check if Revision f ma V be used for Privacy LAW, sl5. 1 m Sate Plan I.D.�N ber I. Application Information - pease Print All Information ✓ Property is Name Pare l Number Property Location 33 • D / Property Owner's Mailing Address j2�� ;S T &N, R E tJ Lot Block Number ,r City, State Zip Code Phone Number Subdnvis' Name M Number II. Type of Hooding (check all that apply) �/�1P1v ❑City 2 Family Dwelling - Number of Bedrooms ;[]Vlftlage ❑ Public/Commercial - Describe Use (I State Owned o? = 3 g� Nearest Road ✓fZO M. Type of ermit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) EDRephcemellt System 3 ❑Replacement of 6 ❑ Addition to For County use sty Tank stem B. ❑ Check if Previously Issued Permit Number Date Issued iN. Type f Permit: (Check all that apply)(numbering scheme is for internal use) � p n 3/• I 44Pressutized br Ground 21❑ Mound 47 ❑ Sand Filter 50 11 Constructed wetland 3 4D C 22 ❑ pressurized In- Ground 41 ❑ Holding Tank 48 ❑Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑Other -- V. anent Area Information: Percolation Rate System Elevation Final Grade Design Flow WO Dispersal Area Dispersal Area Soil Application Elevatiion / /3 3 Required V / Proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks C Constructed Glass New FXisdnY Tanks Tanks Septic or Holding Tank Dosing Chamber VII. R nsibility State t- I, the tmdersign , e responsibIlky for installation of the POWTS shown on the attached plans. Pl r' Name (Print) Number. Mft"RS Number Business Phone Number Plumber's Address (Street, City, State, e) VIII. unt /De artment Use Onl Date Issued tug nt Signature j Stamps) Sanitary Permit Fee (includes Groundwater Approved ❑ Disapproved Surcbarge ) O %y. ❑ Owner Given Initial Adverse a� Determination IX. Conditions of Approval/Reasons fof � Disapproval d 5 S Yrti �{,y/ILQd f2� DD sha�2o�1 � ' �� n � y ours /i ,,. �,�,� at ido• �� ,�,r� �u ran 6� r�wwr d jo aj - Sy AV TM L I V Attach eamptete plans (to me camty oofr) for system on pops' sa les. man s tl tnch« m dze /vJf1 /AfT �R �3 vu�D�- 7b PRQVrQ cRn -A1oR !R 05 1011 PLOT PLAN PROJECT P:C.*Collova Bldrs Inc. ND DRf SS P.O. Box 489 Somerset Wi 54025 SW '1/4 SE 1/4s 33 /T 30 N 8 ` W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE6 /17/02 BEDROOM 3 CONVENTIONAL )00( IN -GROUN PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE, HOLDING TANK SIZE LOAD RAT 5 ABSORPTION AREA 933 # of chambers 30 ✓/ BENCHMARK V.R.P. Top of 2" Pipe ASSUME ELEVATION 100' Filter Zabel A -100 V ❑ BOREHOLE O WELL - H.R.P Same as Benchmark SYSTEM ELEVATIO 100.41100.0 Vent a� ans esi z Pl gned Using ►� > 6" Standard Infiltrator Conventional Powts of Cover Leaching Chamber Manual Version 2.0 Q, with 31.1 ft2 of Area 6' Long 12' 497 Grade at System Elevation 4% Slope B -2 Please note: Site is to be retested and a revision is to be B.M. #2 B -1 Vents filed 30' 7 ' 15' B.M. #1 Ve 20' 80' -3 T 10' 110 Pro 3 Bedroom ` i House 2 -3' X 94' Cells with >3' Spacings/ 121 st. Ave "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 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, ,AW6caEi0ii piad..distance to nearest road. LOT of _ ` A iewe by bate Please print infl rrt iffl6n: -,, Personal information you provide may be used forsk: ndag puvOmes Pm a� , s. 15.04 (1) (m)). (C� Property Owner 1vt perty Location a c u� ..+ r , y+ Lot SGl/ 1 /4.!55 1/4 S T 3 Q N R E (or)(W Property Owners Mailing Address - t# Block # Subd. Name or CSM# ST CFiW f I - �; i City State Zip Code PhoQp®FFICE C] City C1 Village ® Town Nearest Road kJ/ a , 7� )SYy Q 4 G (� New Construction Use: rd Residential / Number o ms 3 — y Code derived design flow rate '/rW :5 GPD ❑ Replacement Public or commercial - Describe: Parent material �i' / Flood Plain elevation if applicable ft. General comments s �.,-� .20(t (j, {v/ /00-9 Gowc r 160• y 0 and recommendations: ,n ( I-e V� Boring # F -(] Boring ®. pit Ground surface elev. 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 6 --( ld 3 Z 5;1 Zmahlk� Fr C V c 5 3 3 ,Y -S�, ID `tA. L 2w , sb end— 7. Boring # ❑ Boring Pit Ground surface elev. Aw . Depth to limiting facto 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 O' lQ /Z 5i l 2 k r c 5 1 ' �c 5 $ 2 - � (C) /`f 5 i Z k i n 7 yr m4- * 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 Address Date Evaluation Conducted Telephone Number z //3 O f kc atL�� GrJ/ S7'az_s` Co / -z-2_7 -G 7/57 Property Owner 06) `rte Parcel ID # Page Z of -3 5 Boring # El Boring ^' L ® 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 I 'Eff#2 /2 I r3 z 5; i �►-� - B 3 im -SN 1v <-I S y- 0 ID rJ H 62 P - 7, S r V Ap SL- Zff6b Boring # 11 Boring ❑ ' /Yt2Q yn fir, • �' /¢ « /r�; S�Gd ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Apelication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 ❑Boring Boring # Ground surface elev. ft. Depth to limiting factor in. El Pit Soil ADrAication 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 < 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) PAGE_ NAME LOT #Z LEGAL DESCRIPTIONSW',5E`/` S33T2o_N_R 155E (orl� SCALE: BM I ELEVATION /00.0 BM I DESCRIPTION 4o Lt P BM 2 ELEVATION /& ' S y S 3 BM 2 DESCRIPTION 45 0 o C z A'12 e I SYSTEM ELEVATION {may p 10p• 80 L o w c � /(l0 . W 0 4 „ x ALTERNATE ELEVATION -19 loo . o 1 CONTOUR ELEVATION /OQ - /01. St) A t- P -C- ymo sk �• � c k }h sV.atlow ck-c A' 0 o Sd •c. DATE � SIGNATURE Q '� X1 County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN In accord with 15.04 St. Croix County Sanitary Ordinance ZONING OFFICE c o Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER [Privacy Law. S. 15.04(1)(m)] 1101 Carmichael Road Hudson, WI 54016 -7710 (715)386 -4680 Fax(715)386 -4686 Attach complete plans for the system on paper not less than 8-1/2 x 11 inches in size. County Sanitary Permit # ❑ Check if revision to previous application 1. Application Information - Please Print all Information Location: Property Owner Name cC.J 114.5,6 114, Sec C < C IT N, R E (o 4 w Property Owner's ilingg Address I VED Lot Number Block Number 0 r City, State Zip Code Pho Nu m 2002 Subdivision Nam or CSM Number S� 7 0 z b' ST. CROIX 11 T of Building: (check one) G OFFICE amity ❑villag wn of r 2 Family Dwelling - No. of Bedrooms: ❑ Public/Commercial (describe use): ❑ State -owned Nearest Road 11. Type of Permit: (Check only one box on line A. Check box on line B if applicable) Parcel Tax Number(s) A 2. ❑ Reconnection 3. ❑Non- plumbing ❑Rejuvenation Sanitation B) Permit Number Date Issued ❑ State Sanitary Permit was previously issued 1V. Type of POWT System: (Check all that apply) xr"Non-pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line 11 At-grade 11 Aerobic Treatment Unit ❑ Recirculating � 1he V. Dispersal/Treatment Area Information: ( 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade XSC Required Pro osed (Gals. /day /s (Min. /inch) �� Elevation 10, I. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ II. Responsibility Statement I, the undersigned, assume responsibility for repair / reconnenction /rejuvenation/installation of non - plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installati of - plumbing sanitation system. PIu r Name (print) Plumber s S' no sta ps): MP /MPRS No. Business Phone Nu er J IA Plumber Ad dress (Str9e�City, Stat Zi e) Ill. County Use Only L!%� Disapproved Sanitary Permit Fee Date Issued Issuing Agent Signature (No stamps) ❑ Approved Owner Given Initial Adverse Determination IX. Conditions of Approval /Reasons for Disapproval: I�adntenance ow Continpw Plan for a Sepik System M�rnt+enantte Pierrt p�;g every 3 Year �A'/I , Septic Tank is to be pumped __-� Please rrotie: a ia�rfiker is being irrs�tlaci in Errt fitter iss to be c once a Y vo orderto extend the mainbNN noe interval ofthe fitter. - f the erg of 3. Once every 3 yews, cells ate to be irq)ecwd via the ink � pipes the tels. 4. Owner agrees fib ltrrit greases, gad ge, and water conditioner dkx*goW into the system- s. The owner agrees to save this plan. 6. Do not pianttrees nor park nor drift over systerrL 7. Wadershed is to be diWOrted away from system- $. ffat tge into system is not oweed those regAred as per Comm 83 Contingency Plan 1. t# si mm tads6 detem*e cam of figure, use alemeAD area► and instal new system or instal system at a der 810vat n. 2 Repbm any other far'ing mmpments. as needed. Plumber. Shaun Bird 715 - 246 -4516 8o Shaun Bird #226900 S'r CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWN CERTIFICATION FORM Owner /Buyer I I oVA 6 1 J <-- Mailing Address Y 0• �v( Property Address - (Vcri(ication required from Planning Dcpartment for new construction) City /State 1 )gag �WkM u0 ii P arcel Identifi LEGAL DESCRIPTION Property Location 3u� ;;, �_',!,, Sec. , T 3()N -R W, Town of t 11�►'`I( \ CX� Subdivision , Na C3`6\A CSC- Lot If 0 Cl . i ertiGed Survey Nlap it 42 �� ( Volume I Paec fl Warranty Deed It 62U313 g V011lnle . Paec ,'. 3�q� Spec house [I yes ❑ no Lot lilies icientitiabie yes :] no SYS'T'EM MAINTENANCE Improper use and maintcaancc of your septic system could result in its premature failure to liandle wastes. Proper maintenance consists of pumping out the septic tank every tluec years or sooner, if needed by a liccascd 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 Dcpaitincnt a certification form, signed by the owner and by a master plumber, joumeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site was tewa ter disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), We septic tauk 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 fire standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, Slate of Wisconsin. Certification stating that your septic system has beca maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. F 80 s // / a - z— SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all staicincats on this form are true to the best of my (our) knowledge. I (wc) am (arc) the owncr(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. _ e U4 &A & 6 11 1 O� j o SIGNATURE OF APPLICANT I DATE « «ss «s 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 snap if reference is made in the warranty decd FROM P C COLLOVA -EILDRS, INC PHONE NO. : 715 549 5911 Nov. 16 2001 09 :32AM P1 5 T A T C 'JAR UP W ISCUNSI N KJKM 2. 1998 f„ iA - 3-:33'0 WARRANTY DEED REGISTER OF DE A5 r ST. .RVTX CO., W1 This Deed, made hetacen K e nn eth L. Brown a Xubleen B. k 1 Fill > 8 Brown,11mbsad acid Wift C 04 -18 -20^1 9:45 Ail _ t�tftMMT - Omstor, attd t'. G Coilovs Builders, Inc. I LBii.CODT Pc - E! COPY ME: 14"FER FEE: 826.90 REC0001 FEE: 10.09 Games. Gnntor, for a valuable consideratioa, conveys and wuntus to i Grantee the following daeribcd noel cstote in St. Croix �j (J ( �, n rJ 8 S QA f county, State of Wisconsin; 'teewdiric Ams Mme end itNun Add"= That pert of SE( 114 SW 114 and SW 114 SE 114 Scc. 33- T3Or -RISIN descrit:ed 3304 St. ai follows: Lola 1, 2 ind 3 of Ca tined Survey Map reeonJed in Vol. 13 of Fludton, WT 34016 urvey ?Aepc, Paie3(98 s"ETSOe. NO. 607591. — r 41. CIOIX County, W19COaaltt 0 G•IU96•oU-0W. U2 &lVY6- oll -2UU. 026.1C96-W-000 rvred J4cW omion Nunba (1't r) This Is not holmtcsd property. ( (is not) Exceptions 10 warranties: Existing highways, easements A rights of way of record. Dolcd thi day of Apr1i 1091 • . Kenneth L. Brower KAthwen B. grown AL'TAF.,NTiCAVON ACKNOWLEDGMENT STATE OF Wisconsin ) Slenatwe(t) ) sv 3l. Croix founey. ) Personally cane be Pore me We Ij r day of wtheetkated this _ day of April , 2001 _ the above named csaeth I,. J1.1'Otea acid ISat>+1seg B. Brnwa e J r It,; &3XI;j OF WISCONSIN to so wn to be sha pe neon () v wbo mceeMSed the I eat and acknowledge the same. Wis. Stats_) WAS OKAY r8U NY Aft Ltd J. Lstreen 304 I 54016 Nntuy Nshse, Sues of wheonslq (SIVUtUmlmay be Wtheadakd or aekrowirtaed. Both are aot Mr Commisston is perm ne s e UporTnl�a e. Ittxessaty.) ,) 'Name of t1erJ0a1 didea is aer rapeeity si+oeld be typed or prided tMda,e tlulr daneewe wANMNTY seas tTATa aAa Or olt VAnia ►t,au Me. 7 • If,e INFORMATION MVI'83eIOMAL3 COMPANY sOMp Do LAC. w 1e04511-VOt WW Y ". p � Y 80' RADIUS TEMPORARY U N PL ATTED L CUL -DE -SAC EASEMENT (TO — - BE REMOVED UPON S 89'52'17 E 2635. / NORTHERLY EXTENSION OF ROAD) __ 2048.98 325.31' o - ' i 184.27 2 I— — — — — — — — — o� r l r DRAINAGE EASEMENT 21.58' _ °' LOT 24 S 8425 53' W I I i H WE = 970.00' v \2 115.5 Do S, N , ��lf a •� laJ . _ 79 9.6 69 9 419, 6 F N I N /N �_ ?/ Q o LOT 25 1 S 8 I 64 92 2 _ E / 0 0 L0 9 N s� 83817 Sq. Ft. � � z \ 1.92 Ac. I �s��,� DRAINAGE W I 9132 _ 146. 72'_ 70.80' ��` I 2. S 89'02'19" E 217.52 TN 76886 Sq. Ft. � N I ° Fti \ \ 77 Ac. z s � ' °\ I 1 LOT 230�� -��s °� s 90394 Sq. Ft. 4� \ 4 s4. 2.08 Ac s A `, 38. Q e IAzIst 6 — - _ _ 5 6$ 9$ 9 9 N 98 . TED TO t t 2 �/ \ \ 19 JBLI C / � � 18 25.25; S 00'46' W N 12 / 42.47' ys E 17 L � /19580 Sq. Ft. l 1.83 Ac. LOT 8 LOT 9 1 i \ 94754 Sq. Ft. 95 2519 SAc. F , sr ��• / � 2.18 Ac. �' LOT 6 � ,/ 109173 Sq. Ft. _ 2.51 Ac. \ \� r� ry / N \s 2 - - -- -- -J — — C �'