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HomeMy WebLinkAbout030-2122-10-000 .;onsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix .fety and Building Division * INSPECTION REPORT Sanitary Permit No: 399687 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 St. Joseph Township CST BM Elev: t Insp. BM Elev: I BM Description: TANK INFORMATION ELEvRrION DAT TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet �2S •oS I � I TANK TBACK INFORMATION St/Ht Outlet 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 7 �• 3a . . PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover •�� •ZS GPM Model Nu m TDH Lift Fr' s System Head DH Ft ( • Forcemai Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM1,,..s �30> BED /TRENCH Width Length r No Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS `Zy —p �� SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manuf cturer INFORMATION CHAMBER OR Type Of System: 1 / UNIT Model Number: tl DISTRIBUTION SYSTEM Hide 1(V9 'f u Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s 1 .� Q t Lengt Dia_ Length Dia ing 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: Du,' D+11 / 02AX nspection #2: Location: 691West Shore Drive So erset, WI X4025 (NE 1/4 SE 114 23 T30N R19W) Bass Lake Meadows Parcel No: 23.30.19. 1.) Alt BM Description = l eQ �VV►�ti • 5 6,0% 2.) Bldg sewer length – , / 3 0 a - amount of cover = V OL - 1 11CO �•t (-Y 3) t.�a9Qwotk cro+^fiwtr`clkd2 .�ls� h. 42 �.� �� • �. 3� I t Required? i ��J Yes No -`� Use otheS for additional in Llrtiu Ste• s ns41,* ore Cent SBD - 6710 (83/97) y "� t",R_ No. i .� f I. � �. e Soil Test and System PLOT PLAN PROJECT P.C. Collova Builders Inc. s P.O. Box 489 Somerset Wi 54025 NE 1/4 SE 1 /4S 23 /T 30 19 W TOWN St. Joseph COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/26/02 BEDROOM 3 CONVENTIONAL XXX IN- GROUND SSURE 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 IL BENCHMARK V.R.P Top of Nail in Tree ASSU ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE (DWELL *H.R.P. Same as Benchmark Vent SYSTEM ELEVATION 92.5 ,12" Sidewinder High Alternate Benchmark is Top of Footing @ 99.9' of Cover Capacity Leaching Chamber 6' Long 16" a� 34" Grade at System Elevation B -2 3-3'X 63' Cells with 3' Spacing � 100' Vents Plans Designed Using Conventional Powts Manual Version 2.0 2% B -3 Pro 3 Bedroom Slope House 5' 15' T Vents 30' 15' 30' Alt. B.M. B.M. 1 10` 5 B -1 50' Not enough slope to establish contours �-S West Shore Drive Safety and Buildings Division County ' 201 W. Washington Ave., P.O. Box 7162 `sconsin Madison, WI 53707 - 7162 Site Address Det�artment of Commerce U ( GUQ s-f - SFI64,e_ �n V�— Sanitary Permit Application P rmet Number /n In accord with Comm 83.21. Wn. Adm. Code, personal info ye» -pcevide_ k if Revision may be used r Privacy Law, sl 1 ` °v 1 I. Application Information - Please Print All Information tate Plan I.D. Number Prpryty Owner's Name ) u � Parcel Number r V Z) C o G� 036 - a i' D -- o 7rope Owner A = Property Location if : S0 T N, R =B City, State / ' Zip Code Phone Number Lo Number „Alock Number Subdivision Name CSM umber II. Type of Building (check all that apply) nn � t `�V- []city r 2 Family Dwelling - Number of Bedrooms 0yolage ❑ Public/Commercial - Describe Use � ownship r ❑ State Owned N earest Road fly III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. ew 2 ❑ Replacement System 3 ❑Replacement of 6 ❑ Addition t For County use see Tank stem B. Check if Sanitary Permit Previously Issued Permit Number Date Issped l CO l 30 Z O - Z, Kc, IV. of Permit. (Check all that apply)(numbering scheme is for internal use) - Pressurized hi-Ground 210 Moue 47 ❑ Sand Filter 50 ❑ Constructed Wetland ❑ Pressurized hr -Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Lin 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. tment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade _- Required - Proposed � Rate(Gals./Days/SgJ (Min.Mch) � ElAvatio� VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tan1m Septic or Hokling Tank Dosing Cbamber / �{ VII. Responsibility Statement- I, the tmderidgtie responsibility for installation of the POWTS shown on the attached plans. Plumber'; Name (Print) Plumbers MP/MPRS Number Business Phone N u m ber Plumber's Address (Street, City, Sta d e) VIII. un /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date ed Signa o Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse ,S7-0 I r1 � Determination . Conditions of ApprovaMeasonc for Disapproval ph- ) for thaafatem paper not less than Ella 441 lathes >o size SBD -6398 (R. 05101) Soil T and System PLOT PLAN PROJECT P.C. Collova Builders'lnc. RESS P.O. Box 489 Somerset Wi 54025 NE 1/4 SE 1 /4S 23 /T :3:0 R W TOWN St. Joseph COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/26/02 BEDROOM 3 CONVENTIONAL XXX IN -GROU RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallo LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RA E .5 ABSORPTION AREA 933 # of chambers 30 BENCHMARK V.R.P. Top of Nail in Tree ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark Vent SYSTEM ELEVATION 92.5 >12" Sidewinder High Alternate Benchmark is Top of Footing @ 99.9' of Cover Capacity Leaching Chamber 6' Long 16 a� 34" Grade at System Elevation B -2 Vents 3 -3' X 63' Cells with 3 Spacing 100' Plans Designed Using Conventional Powts Manual Version 2.0 2% B -3 Pro 3 Bedroom Slope '70' "Alit. ouse 5' T Vents 15, � 30 B. M. B. M. * 1 10 5 B -1 50' Not enough slope to establish contours It West Shore Drive Wisconsin Department SOIL EVALUATION REPORT Pa ge /I of P 9 _I___ 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, and location and distance to nearest road. ��C/ Please print all information. W viewed b Date Persone i information vide may be used for seconds es ( Pri v acy Law, s. 15.04 1 . ,� cro y second c acr c l m c» Y d Property Owner L /� Property Locatio F . , (jo /f Slc Govt. Lot jj G 1/4 11 1/4 S 2.3 20 N R E (oQ Property Owner's Mail' A d Lot # Block # Subd. Name or CSM# � Y ✓ { r- . city State Zip Code Phone Number ❑ city ❑ Village T Nearest d F LNew Construction Use: sidentiai / Number of bedrooms _f?_ Code derived design flow rate GPD ❑ Replacement ❑ Put#c or commercial - Describe: Parent material Flood Plain elevation if applicable Q� a eneral corrvnentsons. Sy / f./L)q 6v--, Z , So— a:t r7 ! 1 -t , r 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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 # Boring / ® pit Ground surface elev. ft. Depth to limiting factor 1 3 !O in. Soil Appl ication 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 #2 - B < 3o and TSS < 30 - T E OD Effluent #1 BOD 30 and SS 30 mglL _ mglL _ rrgJL CST (Please ) Signature �7 ,� 2 Address Date Evaluation Conducted Telephone Number Property Owner Parcel ID # 03 - o! / � � Page ;3� of ® Boring # Boring I it Ground surface elev. 3 ft. Depth to limiting factor / in. r *Eftt#1 od A pp l ication Rate Horimn Depth Dominant Col Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#2 , 2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Stnxxure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. F Sal ANPOication 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 mgll. and TSS >30 < 150 mglL Effluent #2 BOD 130 mglL and TSS < 30 mglL 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 QLWO0) cQ C l cft Safety and Buildings Division County f . 201 W. Washington Ave., P.O. Box 7162 N visiconsin Madison, WI 53707 - 7162 Site Address Department of Commerce -* (09 / Sanitary Permit Applic g: Sanitary Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal i a n you pt�lde � � T may be used for second purposes Privacy La 1)(t� C ^�!\ �� Check if Revision I. Application Information - Please Print All Information mate Plan I.D. Number Property Owner's Nam I Number Property Owner's Mailing Address 3 r `' Prope tion /2 V J /«� �� �k ��-A; S y T74' N, E City, State Zip Code Ph on Lot Number Block Number i ` Subdivision Name CSM N her e Z8; II, Type of Building (Check all thit apply.) []City Family Dwelling - Number of Bedrooms 3 ❑ illage O Public /Commercial - Describe Use ❑ State Owned ht vs � Nearest Road 2 3 t x bps• �s` �i C, III. Type of Permit: (Check only one box on line A. Numbering is for internal use.) (Complete line B, if applicable.) A ' 2 O Replacement System 3 O Replacement of 6 i Addition to For County use System Tank Only Existing System B ' O Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of POWT System: (Check all that apply. Numbering is for internal use.) tt — r- - 44 - Pressurized In- Ground 210 Mound 47 O Sand Filter 50 O Constructed Wetland 22 O Pressurized In- Ground 41 Holding Tank 48 ❑ Single Pass 51 Drip Line 45 ❑ At -Grade 46 13 Aerobic Treatment Unit 49 ❑ Recirculating 30 OOther V. Dispersal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Ukil Apifficition Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) '(Min. /Inch) Elevation z VI. Tank Info Capacity in Total Number M ac r Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing T Tanks Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the undersigned ass a responsibility for installation of the POWTS shown on the attached plans. Plumber' Name (Print) Plum�se MP /MPRS / Number Busiss Phone Number Plumber's Address (Street, City, State, Z' ode) xv VIII. Coln epartment Use Onl ❑ Disapproved Sanitary Permit F e (includes Gro water D Issued Issu' g Agent Si tune (No Stamps) Approved Owner Given Initial Adverse Surcharge Fee) �s Determination IX. Conditions of A ro al/Reasons for Disapproval (_ f 11 2-3. 0 m "aw-\ t>l Attach complete plans (to the Coimty only) for the system on paper not less than 81/2 x 11 inches in she Safety and Buildings Division County r . N V " isconsirn 201 W. Washington Ave., P.O. Box 7162 Madison, WI 53707 - 7162 Site Address Department of Commerce �p9 / (,, �rtbp -E �,b K. Sanitary Permit Number Sanitary Permit Appl4 In accord with Comm 83.21, Wis. Adm. Code, personal' n you PAIde Check if Revision may be used for second purposes Privac La t� I. Application Information - Please Print All Information rate Plan I.D. Number Property Owner's Nam , 1 Number �> 'ax P ll Property Owner's Mailing Address n ,3 Prope lion 12 f ��A;S� T/� N, E City, State Zip Code Pho Lot Number Block Number Subdivision Name : CSM N her Ak II Type of Building (Check all thfit apply.) mot: P� S °A �s ❑ City Family Dwelling - Number of Bedrooms 3 ❑ lage ❑ Public/Commercial - Describe Use ❑ State Owned hi yr t x Nearest Road 2 3 bps• �s ' L �(,�� �,- III. Type of Permit: (Check only one box on line A. Numbering is for internal use.) (Complete line B, if applicable.) A. - 3 ❑ Replacement of 6 ❑ Addition to System 2 ❑ Replacement System .Tank Onl Existing System For County use B ' ❑Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of POIAT System: (Check all that apply. Numbering is for internal use.) - — faD . Pressurized In- Ground 21 ❑ Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 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. Dispersal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Wkil Ap nation Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals./Days /Sq.Ft.) (Min./Inch) Elevation .3Z 71� VI. Tank In Capacity in Total Number M ac i Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing T Tanks Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the undersigned res ponsibility for installation of th e POWI'S shown on the attached plans. Plumber' Name (Print) P MP /MPRS Nu mber Burgos Phone Number Plumber's Address (Street, City, State, Z' ode) VIII. County /De partment Use Onl Disapproved Date Issued Issu' g Agent Si cure (No Stamps) Approved 1 0 1 Owner Given Initial Adverse Sanitary Permit Fie (includes Groh water Determination Surcharge Fee) �� � , t IX. Conditions of A pproV al/Rea sons for Disapproval vv t W. L . ,W s 4 1 2-3.0 1 d,4 G Attach complete plans (to the Co lin only) for the system on paper not teas than 8112 x 11 inches in size 4.' PLAN PROJECT P.C. Collova Builders Inc DDRESs 705 dv rd E Hudson Wi 54016 NE 1/4 SE 1 /4s 23 /T 19 W TOWN St. Joseph COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 1/24/02 BEDROOM 3 CONVENTIONAL X04( IN -GROUN J RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22 IL BENCHMARK V.R.P. Top of Nail in Elm Tree ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL - H.R.P. Same as Benchmark J nt SYSTEM ELEVATION 90.70 Sidewinder High Ca aci Leachin Plans Designed Using Chamber g Conventional Powts Manual Version 2.0 34" Grade at System Elevation West Shore Drive a� 0' Q B.M. #1 100' c� 10 Pro 3 25' Bedroom House 10 , Vents T B- 2 -3' X 69' cells with >3' 20' 1 spacing 20' 1% Slope V,1 Vents 20' � � l -1, l AAt 1 � a M V7 PL T PLAN PROJECT P.C. Collova Builders Inc. /! DDRESS 705 ctv rd E Hudson Wi 54016 NE 1/4 SE 1/4s 23 /T 30 / 19 W TOWN St. Joseph COUNTY ST. CROIX 1/24/02 3 MPRS Shaun Bird 226900 DATE BEDROOM CONVENTIONAL X)OC IN -GROUN RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22 -` , BENCHMARK V.R.P. Top of Nail in Elm Tree ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL .H.R.P. Same as Benchmark Vent SYSTEM ELEVATION 90.70 > 12" Sidewinder High of Cover Capacity Leaching Plans Designed Using Chamber Conventional Powts Manual Version 2.0 6' Long 16" 1 Grade at System Elevation West Shore Drive AL a� 0 ' 1~ Q., C e, 0 00' M �n to ' Pro 3 25' Bedroom House 10 Vents T B -3 2 -3' X 69' cells with >3' 20' 1 spacing 20' n ?, 1% Slope �X B-1, vt � Vents 20' a M r Vftconsin Department of commerce • SOIL EVALUATION REPORT Page I of 3 Division of Safety and Bindings in accordance with Comm 85, Mfg. Adm. Code , County 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 Parod I.D. percent slope, scale or dirnensions, north arrow, and location and distance to nearest road. Please print aif Information. by Date Personal Udorroabon you Provide may be used for Law, s. 15.04 (1) (m)). ` Owner ' r Properly Location Property , T W �I v '. 7 Lot GJ 114.S 1/4 S T N R E (or) is Property Owner's Mailing Address r rr L i Block # Subd. N��e orC:SAAt/ dos ' 1J,Q City State zip - -, Phone S ' City ❑ Village ® Town Nearest Road I lj es� 5 [� New Construction use: 5a Residential of beckoorW Code derived design flow rate y.M<6 a O GPD p Replacement ❑ Public or - r Parent material Zd/ Flood Plain elevation if applicable ,(��/X! ft General comments .� ( - e QO • ? v and recommendations: ' Boring # F1 Boririg Pit Ground surfaceelev. I Depth to limi ft fact 1 or r D0 in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPON in. Munsell Qu. Sz. Copt Color Gr. Sz. Sh. - Eff#1 'Eff#2 - Z —' S' I I ffiabk cs v.- . . 3 2 r1 -32 i y q s. 2 c S 3 Jes a.6 Boring # ❑ Boring G � Z e v. • 00 ft D epth to i factor in. Ground surface le ©Pit �s2 � �'+� (1S � Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD� in. Munseii Qu. Sz. Cont Color Gr. Sz. Sh. -01101 -01#2 1 2 --- 5' c Z v.0 . 2 Z �' < C S r S o . ' EfBuent #1 = BOD > 30 < 220 mg& and rSS >30 150 mg/L - Effluent #2 = BOD <_ 30 mg/L and TSS < 30 mg/L CST Name (Please Print) 19r►ature CST Number Address Date Evaluation Conducted Telephone Number S CJ 7 S 57 SC .e',L Property Owner (� U (�d V Parcel ID # Pap —Z— of F31 Boring ° Bor Pit Ground surfac:eelev. S1.Qd ft. Depth to limiting factor 1i 3 in. Soil Application Rabe Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tf in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. "Eff#1 *Eff#2 0-14 2 5. rn-Fr t • 2 3 2 14-4 Xnrnbk r 4 - i C ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. r*011#1 il ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff/x2 Boring # ° Swing ❑ Pit Ground surface elev. ft. Depth to lirnitirg factor in. Soil lic�tion Ram Horizon Depth DominantColor Redox Dssaiption Texture Structure Corrsistence Boundary Roots DIN in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#'1 Ef#2 Effluent #1 BOD > 30 < 220 mg/L and TSS >30 150 mg1L ' Ef xmt #2 = SOD, <_ 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 60 9-264 -8777. SOD -9330 (R.m/oo) I r PAGE__I_OF_ NAME C a I I pV o, LOT# I LEGAL DESCRIPTION 1 /a - s Z3T30 ,N,R 19 E (or) ( SCALE: 1 '= yU 1 BM 1 ELEVATION O BM 1 DESCRIPTION yla,' I ,, A S'�e I w� t. -y r /oc„ ) N BM 2 ELEVATION 00. _ Z3 BM 2 DESCRIPTION n u (; e w W/ Fla SYSTEM ELEVATION "1(� . 7 0 ALTERNATE ELEVATION w• SO CONTOUR ELEVATION 9g4UO3 qS. oo l O 1 i3 L 0 3A Q 0` V � 4 v / DATE SK NATURE %� 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 6 j Shaun Bird #226900 i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer I I o VA 6 1 A (t S_ N <. Mailing Address BUJ �v . L /�vll Property Address c o g / (Verification required from Planning Department for new construction) City /State / parcel Identification Number LEGAL DESCRIPTION Property Location /Q ' /,, �7 C� '/,, Sec4: , T fl -R W, Town of Subdivision ��� S Lot It Certified Survey Alap it , Volume e -- Page It l �7 Warranty Deed # �6 Volumc/ ! Page it Spec House 11 y E Lot lints icicutifiabL yes ❑ no SYSTM 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da a the gear piration date. NATURE OF APPLICANT DATE OWNER CEATIFICATION I (we) cert' y that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owncr(s) of the aorty dcsc ed a ve, by virtue of a warranty decd recorded in Register of Deeds Office. SIGNATU OF APPLICANT DATE •'•��• Any information that is mis- represented may result in the sanitary permit being revoked by tine Zoning Department. •* Include with this applicallon: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty decd 7oi.1574PA-z 528 STATV BAR OF WISCONSIN FORM 7 - 1998 636669 TRUSTEE'S DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number ST. CROIX CO., WI "j RECEIVED FOR RECORD HELEN E. VAN S .YKE 01 -11 -2001 11:30 AN -- TRUSTEES DEED _ as Trustee of EXEMPT N HFT F_ N g- VAN sr vxE REVOCABLE TRUST CREATED BY REVOCABLE P CERT COPY FEE: T RUST AGR DATED FEBRUARY 21, 1994 COPY FEE: - TRANSFER FEE: 1275.00 _ RECORDING FEE: 10.00 for a valuable consideration conveys without warranty to PAGES: 1 P.C. COLLOVA BUILDERS, INC. I —" Recording nU Area Grantee '- the following described real estate in ST. CROIX County N V4LN 6 0CUST turn Address OD & CARI, S.C. Sta:e of Wisconsin: 2 STREET, BOX 125 PART OF GOVERNMENT 7 OF SECTION 23, TOWNSHIP 30 NORTH,; H, WI 54016 RANGE 19 WEST AN LOT 1 STEVENS AND SHIRLEY'S PLAT IN THE,. TOWN OF ST. JOSEP , CROIX COUNTY WISCONSIN DESCRIBED 0 /�, 7;7 Si AS FOLLOWS: LOT 3 OF CERTIFIED SURVEY MAP FILED JULY 24, 1978 IN VOL. 3, PAGE 644, DOC. NO. 350360. `430= 1049 -70 -002 - 030- 1060 -10 "! PART OF NEB OF SE's OF SECTION 22-AND PART OF GOVERNMENT LOT 7 OF SECTION 23, ALL IN TOWNSHIP 30 NORTH, RANGE 19 Parcel identification Number (PIN) WEST, ST. CROIX COUNTY, WISCONSIN DESCRIBED AS FOLLOWS: LOT 4 OF CERTIFIED SURVEY MAP FILED JULY 24, 1978 IN VOL. 3, PAGE 644, DOC. NO. 350360. PART OF NEk OF SEk OF SECTION 22, TOWNSHIP 30 NORTH, RANGE 19 WEST, DESCRIBED AS FOLLOWS: COMMENCING AT THE SOUTHEAST CORNER OF SAID SECTION 22; THENCE N00 ° 32'43 "W ALONG THE EAST LINE OF SECTION 22, 1313.35 FEET TO A POINT THAT IS 16.5 FEET NORTH OF THE SOUTHEAST CORNER OF THE NEB OF THE SE OF SAID SECTION 22; THENCE N89 ° 47'00 "W, 16.5 FEET NORTH AND PARALLEL;" TO THE SOUTH LINE OF THE NEZ OF THE SEZ OF SECTION 22, 309.00 FEET TO THE POINT OF BEGINNING OF THIS DESCRIPTION; THENCE CONTINUING N89 ° 47'00 "W, 202.78 FEET TO THE SOUTHEASTI CORNER OF CERTIFIED SURVEY MAP AS RECORDED IN VOL. 2, PAGE 595; THENCE N00 0 32'43 "W ALONG THE EAST LINE OF SAID CERTIFIED SURVEY MAP 539.09 FEET TO THE SOUTHERLY RIGHT OF WAY' LINE OF A TOWN ROAD KNO14N AS SUNSET RIDGE; THENCE S89 ° 18'52 "E ALONG SAID SOUTHERLY TOWN ROAD RIGHT OF WAY, 202.81 FEET; THENCE S00 ° 32'43 "E, 537.44 FEET TO THE POINT OF BEGINNING. Dated this Q day of JANUARY 2007 - - -- - (SEAL) Z �yv � (SEAL) HELEN E. VAN SLYKE Trustee Trustee AUTHENTICATION ACKNOWLEDGMENT Signature(s) HELEN E. VAN ST IKF State of Wisconsin, ss. County. JANUARY 2001 Personally came before me this day of authenticated this � d ay of , the above named R. C4n fiTLE: MEMBER STATE BAR OF WISCONSIN to (If not, me known to be the person who executed the foregoing authorized by §706.06, Wis. Stats.) instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY HRYWOOn & ART, S.c 204 LOCUST STREET, BOX 121 HUDSON W I 54016 Notary Public. State of Wisconsin _ My commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not ) necessary) ' Names of persons +,grog in any cap-(v must oe t or printed below (heir si8n,Iw.,. STATE EAR OF WISCONSIN Wt,00n5in 1-e9ai Blank Co. M. TRUSTEE'S DEED FORM No. 7 - 1998 Milwaukee, Wts. SOO 534.65' W a Z I w � I _ i o 3f i W �-- w I LL w �I S00°52'35'E 535.00' I � I �I w >i I w I •� 0� ! 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