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HomeMy WebLinkAbout030-2098-50-000 Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count . INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanita o.: Personal information you provice may be used for secondary purposes [Privacy Law ?x.15.04 (1)(m)]. IRjSttWidd0Rp4e: ❑ City ❑ g shp State Plan ID No.: CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel /00 O TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic L A J S 4�0 B c Fork /Q , "G �O 6 02, 3 Bldg. Sewer Holdi St/ Ht Inlet # Q 6. 36 TANK SETBACK INFORMATION St/ Ht Outlet :�'/ TANK TO P/ L WELL BLDG. Ai Intake ROAD Inlet # A // �� • 3 Septic > 2-S ' `{ 2 t NA > L� Z 3' NA Header /Man. ' '5 <Z) �y 0 _ Dist. Pipe O Holdin Bot. System �' Q3 O UMP / SIPHON INFORMATION �a c z. s" acturer Demand - Model Number GPM f #ft� s 03 -0q /0 S TDH Lift Friction stem DH Ft -lZ eoo el Z- Q, Fore ain I Length Dia_ Dist. To SOIL A PTION SYSTEM e. oj BED /jtFCE Width _ Len th No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM NS 3 s Z DIMENSION SYSTEM TO P / L BLDG WELL LAKE / STREAM LEAC Ma of tiger- SETBACK t F ATI N T e O r um er: INFORM O yp / > O � System. 2U _ Z� S DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length S Dia. 4 14: Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil InS ectio # / L3/N In pea ti l 'MM NTS' nc a c� e n u e , No e Ws e e r t o �I pr � 5 1/4 SE 1/4 28 T ON R19W) - 283019809 Birch ocatlon: 5� '���n venue, , Point -Lot 5 Cov ��� 3. o .- 5 ���� 1.) Alt BM Description = �' d "�`n" 4 AJW � �Sc�v� �ia- P��QS vc( - // = S i N � �rU C9t Id sewer length `1 N� 2. B C ��� r 9 9 c -amount of cover= >yZ ekj' 3 ') 2 ' �eTWe�w 4" S �() z 4 5 Gveve pck, .n r`k sfcad y) " well 4 wIt f/ 6y / G exec R or V4 eosa�e'a . s. Plan revision require. K Yes ❑ No Use other side for additional information. /� SBD -6710 (R.3 /97) Date Inspector's nature L uk i�� t '7,)#Ne J Soa 4,/ r%t/lcS e Y /Cf/r Src�� ''�� - .. ��\ / w �° � � __ !C � _ _. ._ _ r h � OU. • a �k � \ O ��/ I I anitary Permit AppHeatioa Wely & Buildings Divisim In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. see reverse side for :nstruations for coMploting this application PO Itwt 7302 Deoartrneer � qp fia ,� Personal information you provide may be used for pus Madhsatt, WI 13707-7302 (MV110y Law, S. 13.04(1 (Submit com leted Porn: to MM 12 � P ty rfnot ete A" owned.) or a not -1 x I I a ea re Mi. stm t vv umbw C3 Ch eale I . . # t W Iatormetiun tio�o ale 5 LOUR GO l4 r1l1. T g �l &W ` _'° �' Nww B one r C # I a - area or M ing No sae f 1 or 2 Pamily " Dwell - , o Bedrooms 1 O Puidic�Conune�reiel (deocrlbe tree);_ ..— ._____ o vuiap >94 0wo of 0 Sate•Owned �/' Nearost Road Q L ype e rm t: on one box on line A. ec x on linC B Ica e T M - -so Z A . aoetrtant o f 9 Tank Only s ' A Partnit was t ous issued 3 --- 0 Non : (Cheek all that apply) � � ❑ Mound l] Prateurlted�groUad 0 Sand Filter © Conse WAW Wetland O Atgrade 0 Molding Tank O Single Pass O Dri Line O Aerobic Treatment Unit Cl ❑ R,eci rculatirtg O Other: ratitmeat Ares Int rsattaa: 3 a a w Required ego at ystem v ✓ Proposed Rue (Cislslday /sq. ft.) (MwiQQh) / 7 m o e of Man toter Q � � Irtibeauttba Cialions Gallons Tanks C con. g glue Tanks Tanks Crete strutted oo � S . eo6 t t,t etsun:e bill far lnshil Idoa o p4WTS shown on th9--attach ed plans. s w jjj a -� V neu b0 y 1/ °7 � wc,Q �J' J JIL ovity partmewt only � Mproved O lni" Adverse Su"hwae ree) .. o es , Asa s � // t P was it DFU pp / 1f►,'s rGV(`Si oa. I,vaS c�a`�n,,6��X SBD -6348 (R. 07/00) ` PLOT PLAN PROJECT James Ristow ADDRESS 8451 87th St. S Cottaae Grove Mn 55016 SW i/4 SE 1/4s 28 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE5/30/01 BEDROOM 5 CONVENTIONAL XXX IN-4 O ND PRE SSSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE ABSORPTION AREA 653 # of chambers 38 BENCHMARK V.R.P. To p of�P'�' 4 e1� c - -- i ASSUME ELEVATION 100 Filter Zabel A -100 ❑ BOREHOLE (D WELL *H.R.P. Same as Benchmark 12 � SYSTEM ELEVATION 93.4/93.8 Alt. BM Top of 2" Pipe @ 100.3 ° RECEN N 1 5 2001 W 626' Property Line J U N d, zowW+G6 250' C) Plans Designed Using / 9 Conventional Powts 50' Manual Version 2.0 Vents * -1 2 -3' X 120' Cells 10 40' with >3' spacing 60' Garage 9% Slope B -3 2 30 Ad 10' Road 60' Pro 5 Bedroom 10' B- Vents House Vent > 12" Sidewinder High of Cover Capacity Leaching Chamber 6' Long 16 11 421' Property Line " Grade a 34 t System n Wisc onsin Department of Commerce R ECEIVED SOIL EVALUATION REPORT t Page Divisiomof Safety and Buildings w in accordance with Comm 85, Wis. Adm. Code County n Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must L r CFM include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel 1. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ZONE Please print all information. Re kewed b ate Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location J o Govt. Lots 1/4 1/4 T� N R�� E (ooV Property Owner's Mailing dress Low Block # Subd. Name or CSM# - �, iD City State Zip Code Phone Number ❑ City ❑ Village Town Nearest R I New Construction Use Residential/ Number of bedrooms Code derived design flow rate DSO GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material e Flood Plain elevation if applicable ft. General comments ✓ T S �J�� S/ /� 2� and recommendations: / %--�. O F 1-1 Boring # E] Boring ILy pit Ground surface elev & k_ ft. Depth to limiting factor Z J E 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 �) �4 Z, ,r a� y' 3. yS b Boring # Boring v Pit Ground surface ele . _� 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 �q 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 C YAC FI O:: . `� (Please Print) gn ture CST Number , o�D Address /f Date Evaluation Conducted Telephone Number SBD -8330 (R07 /00) Property Owner Parcel ID # Page of 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 /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. El Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz 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) Soil Test Plot Plan Project Name James Ristow Sha d 1 , Address 8451 87th St. S Cottage Grove Mn 55016 STM #226900 Lot 5 Subdivision Birch Point Date 5/29/01 SW 1/4 SE 1/4S 2 8 T 30 N /13 9 W Township St. Joseph F1 Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of e System Elevation 93.8/93.4 *HRPSmae as Benchmark Alt. BM Top of 2" Pipe @ 100.3 626' Property Line 250' 50' *R B- 10' 6 Y Garage 9% Slope 5' -3 25 10' Road 6' Pro 5 - Bedroom 4 10 4, House 97' 98' 99' 421 Property Line Sanitary Permit Application S '& 57ild Division In accord with Comm 83.21, Wis. Ad=,—Cgde 281 W. Washington Ave. ,'��a� n See reverse side for instructions for c, " eting thta a 'on PO Box 7302 Department of Commerce Persona! information you provide ma u� for secoddary Rtwc�poses Madison, WI 53707-7302 [Privacy Law 1 xm) (Submit compleuW form to county if not . state owned.) +� Attar c letep s to tine county a syst net less 8-1/2x 11 inc es in Count I erne. teen w umber k ffmsv s to prey tlus qnM teen IN Ucatioa nformation • lake t aU Information } Propelly an►e Location: s p j +v PMWty MEN ! s /� 114, 7 �U,N, IC Lot � BIOCK N um tm Zip �. Subdivision Natne or or aS: (check one ) — s pr s 0 City 1 or 2 Family Dwelling - No. of Bedrooms ❑ PublicJCortltnWdel (describe use) :_ of 0 state - owned � �aS 4 ^ n Nearest Roams -� ' k G 7.57D � s arse ax a I. of rmit: (Check one box on me A. Check box on line B if i ble) , 3d lq.L 'S — A) ent ' s s ystem eplatxrreent of ° Tank Only s' 326c m ° J111) Exi sting System t um r ssue 0 A sari Permit was reviousl issued Of stem: (Check all that apply) A ---ICD -press uized In- and Q Sand Filter D Constructed Wetland C7 heaaurized In- grounder D Holding Tank D Single Pass ❑ Con Line AL•stade O Aerobic Treatment Unit ❑ Recirculating D Other: V• rsa matment Arai Information: 1310persal Aits 3. Dispersal 4. = on . Percotauon 6 S ystarn E ev 7. Required used Rate (GdsJday /sq. ft.) (Mindinch) Elev n VII. Tank Capacity in Total 0 of Manu urer Prefab Site lfee iben PloAc Information Gallons Gallons Tanks Con- Con- slaw ew crete structed Tanks Tanks X b� � © o v ❑ L-1 0 0 VIII. RsoponolbUlty Statement the uodasi , assume ibili for i lation of tit OWTS shown on the attached lans, s Raw )rt�� V um s naturo no 90 ness s ,stile, e UL Cottaty partMeow use only JlMV an►tsey taut ee no uses afar s t )KApproved O Owner Given Initial Advertise S-a Poc) dD s [ Determination z s 2 . JC. _ Con d bone o A naroval Memo for Dbagproval: p � C., cr S S� �e✓ o- �- Dec ,�w. t'rS is S -4,A- ye= Lseetc .- s,,,,�.c ,s,,��,�i�D -j26�� SBD-6399 (R. 07 /00) PLOT PLAN PROJECT James Ristow ADDRESS 8451 87th St. S Cottaae Grove Mn 55016 SW 1/4 SE 1/4s 28 /T 30 w wN St. Joseph COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5/13/01 BEDROOM 5 CONVENTIONAL M IN -GRO PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1600 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE ABSORPTION AREA 688 # of chambers 40 IL BENCHMARK V.R.P. To p of SE Lot Stake ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL - H. R. P. Same as Benchmark SYSTEM ELEVATION 95.5 Plans Designed Using Conventional Powts 626' Property Line Manual Version 2.0 4 -3' X 63' Cells with >3' Spacing B -2 B- 60' 0' 3% Slope ' 41 5 Bedroom 4;& House 105' ILI .1 00 B -1 20 2 10 , ST 51 Vent 8' >12" Sidewinder High of Cover Capacity Leaching Chamber 6' Long 16 „ 34" Grade at System Elevation 421' Property Line PLOT PLAN PROJECT James Ristow ADDRESS 8451 87th St. S Cottaoe Grove Mn 55016 SW 1/4 SE 1/4s 28 /T 30 W WN St. Joseph COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5/13/01 BEDROOM 5 CONVENTIONAL XXX IN-GRO16 CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1600 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE ABSORPTION AREA 688 # of chambers 40 BENCHMARK V.R.P. To p of SE Lot Stake ASSUME ELEVATION 100° Filter Zabel A -100 ❑ BOREHOLE O WELL sH . R . P. Same as Benchmark SYSTEM ELEVATION 95.5 Plans Designed Using Conventional Powts 626' Property Line Manual Version 2.0 4 -3' X 63' Cells with >3' Spacing B -2 ) B- 60' 0' 3% Slope ' 41 5 Bedroom House B.-- 105' B -1 20 2 10 , ST 5, 8 jtL Sidewinder High Capacity Leaching Chamber Grade at System Elevation 421' Property Line j tscc r ns epartment of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 uabur and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not les asi�8 i Fi��in size. Plan must include, but St. Croix not limited to vertical and horizontal refer a Int (BM), direction end ,% of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location `$ istan e�to st road' : `',, pending , ... APPLICANT INFORMATION -PL A PRINT iWSVRMAiii .N IEWED BY DATE zw Z( PROPERTY OWNER: i , , ` "" �' PROPERTY LOCATION ` '- i'; GOVT. LOT SW 1/4 SE 1/4,S28 T 30 N,R 19 or Dennis Erickson � -, � W ) PROPERTY OWNERS MAILING ADDRESS ` .% A LOT # BLOCK # I SUBD. NAME OR CSM # 143 St. croix Trl. 5 na Birch Point CITY, STATE ZIP COD ❑CITY ❑VILLAGE GOWN NEAREST ROAD Lakeland, MN. 55043 11 St. Joseph 60th. St. [ New Construction Use [x] Residential / Number of bedrooms 3 ( ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd/ft trench, gpd/ft Absorption area required 643 bed, 112 563 trench, ft Maximum design loading rate • 7 bed, gpd/11 trench, gpolft Recommended infiltration surface elevation(s) 95.85 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na It S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for system I ® S ❑ U ®S ❑ U E S O U ®S ❑ U E] S QkU ❑ S iau SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color MOtlies Texture Structure ConsistencelBourxivy Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tfertdl 1' => 1 0 -9 10yr3 /3 none 1 2msbk mfr cs 2f .5 .6 S 2 9 30 10 fsbk mfr w if .2 .3 r4 4 none s i 1 Y g Ground 3 1 30-33 7.5yr4/4 none is DSg mfr gw na .7 .8 ? 88v 8.5 W. 4 33 -82 7.5yr4/6 none cos Dsg ml na na .7 .8 .} Depth to limiting factor +82" Remarks: Boring # ::< >.•:v;<::.t 1 0 -10 10yr3/3 none 2msbk mfr cs 2f .5: .6 S °Y 2 10- 2110yr5/4 none sit Ifsbk mfr gw if .2� .3 Z ;�' 3 21 -29 7.5yr4/4 none is Dsg mfr gw na .7 .8P Ground 9 2 5ft 4 1 29-8010yr4/4 none cos s ml na na .7 .8 Depth to limiting factor +80" Remarks: CST Name: — Please Print Gary L. Steel Phone- 715-246-6200 Address: 1554 0th A Wi . 54017 9- 4-95 Signature: Date: CST Number: PROPERTYOWNER Dennis Erickson SOIL DESCRIPTION REPORT Pag 2 61 3 PARCELL pending ' D.# ` Boring # Horizon Depth Dominant Color Mottles (Texture Structure Consistence Barbary I Roots GPD /ft in. Munsell Cu. Sz. Cont Color Gr. Sz. Sh. Bed iTwch 3 1 0 -10 10yr3 /3 none 1 12rnsbk mfr cs 2f .5 6 7 2 10- 3410yr5/4 none sil lfsbk mfr gw if y�-,6 Ground 3 34 -37 7.5 yr4/4 none is osg mfr gw na .7 .8 elev. 9 4 37 -9010 r4 4 none .7 .8 + Depth to 6o N limiting factor qS TO Remarks: Boring # 1 0 -12 10 r3/3 n e 1 2msbk mfr cs 2f .5 .6 S -mot at " 2 12- 3410yr4/4 7.5 r5/8 sil if r mfr gw if .2.3 • Ground 3 4 -40 7.5 r4 4 none is oscr mfr Qw na .7 .8 � - elev 4 0 -84 10 r4/4 none cos osq ml na na .7` .8 .� 9 Depth to limiting factor 2.6 02.6 +84" Remarks: Boring # 1 -9 10yr3 /3 none 1 2msbk mfr cs 2f .5 .6 S� 5 2 -19 10yr4 /4 none sil 2fp1 mfr gw if na .3 " 3 19 -33 10yr5 /4 none sil lfsbk mfr gw if 1 2!.3 ,2 Ground elev. 4 33 -84 7.5yr4/6 none cos osg ml na na .7'.8 99.7 Depth to limiting factor +84" Remarks: Boring # Ground elev. ft. Depth to limiting factor F- Remarks: SBD- 8330(8.05/92) II - i STEEL'S SOIL SERVICE Gary L. Steel Dennis Erickson- 1554 200th Ave. CSTM2298 SW4SE4 S28- T30N -R19W New Richmond, WI 54017 MPRSW 3254 town of St. Joseph (715) 246 -6200 lot #5 -Birch Point N - top of SE lot stake C el. 100 A pfi P I r� � �p7 2- Gary L. Steel 9 -4 -95 f - 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 r'0 include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Re ad by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Z( ?W Property Owner Property Location �j Govt. Lots 1/4 L 114 S o� T� N R j E( W Property Owner's Mailing Address Lot # I Block # Subd. Name r CSM# 85`s� 5 S City State Zip Code Phone Number ❑ City C3 Village Town N ?rest R d 0 . New Construction Use.j;(Residential / Number of bedrooms _ Code derived design flow rate _ 7 S U GPD ❑ Replacement ❑ Public or commercial -Describe: -- Parent material Flood Plain elevation if applicable ti ft. General comments and recommendations: G ' JD F-b] Boring # ❑Boring QJ �) Pit Ground surface elev! O 2S 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 4<,7 14 n Boring # ❑ Boring L-J ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 1W mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg1L CST (Please Print) 'nature Address /J Date Evaluation Conducted Telephone Number ��� ���wtO �� -c- r <-�c� j tf4 ►1 5��3°-t>J Property Owner Parcel ID # Page of 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 I GPD/ff 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. Soil Appli cabon 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 F ❑ 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. M unsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 Effluent #1 = BOD > 30 < 720 mg/L and TSS >30 < 150 mgft. * 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 (8.6/00) 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 0 �` - Shaun Bird #2 6900 ST CROEK COUNTY SEPTIC TANK MAIN AGREEMENT m l 0 -184 a r s �P- OWNERSHIP CERTIFICATION FORM �1 Owner/Buyer t Mailing Address g /`� // M(:;�::, Property A dder► S'1 a f-- (Verification required Sore Planting Departownt fbr now construction) City/State Parcel Identification Number ;�U � CJ � � 0 LEG D�CRTPTTON Property Locatioa , — y., %+, See S . T JA N - R W, Town a J vS Subdivision —_ 1& 1- )064'c'-zz , Lot # Certified Survey Map # Volume . Page # Warranty Deed # - Vole, � Page # Spec house ❑ yno Lot Tines ideatifiable�*JIPLo AXIM Improper use aria mabb= nceafyour septic system could result in its premature failure to handle wastes. Proper maintenance consists of pining ofd flue septic tnk every duce years or sooner, if needed by a lioensod pumper. What you put tale the system can affect the Samoa 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 P plambw. restrictedplumber or a licensed pumper verifying that (I) the on4ite waatcwaterdisposal system is is Pry oPamthg condition and/or (2) after inspection. and pumping (if necessary), the septic tank is less flaw 1/3 fall of sludge. [/we. the uadetsigaed have read the above r pdr+en=ts and agree to maintain the private sewage disposal system with the standards set forth, herela, as set by the Departtt mt of Cmmerce sad the Deparraneat of Natural Resources, Stato of Wisconsin, Ce d&Atioa that ft�& YOM has been atainttt#ned must be completed and returned to the St. Croix County Zoning Office within 30 d j. fire tyeawcpiratlon date. Sl ATURE OF APPLICANT DATE OWNER CR1'f�IC_,,�ATION I (we) Certify that all statements aft this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of th perry d above, by virtue of a warranty deed recorded in Register of Deeds Office. Sl ATURE O APPLICANT ATTE` =L=- DATE s• * ** Any information drat is mis- represented may result in the sanitary permit being revoked by the Zoning Dop smTAL , •• Include with this application. a stamped warawy do" from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed � J • 1621 211 a Y01.. ►'AGE. STATE BAR OF WISCONSIN FORNf 2 - 14'99' W ALSH 4 WARRANTY DEED KATHLEEN H. DEEDS Document Number ST. CROI OF DEEDS ST. CR!lIX CO., 4!I This Deed, made between _P hillip G. Leith and Kat hleen J. Lei th, RECEIVED FOR RECORD husban a wife, — 04 -19 -2001 9:30 AN YARRANTY DEED Grantor, and James T . Ristow an Mary T Glieden — EXEMPT N - .. CERT COPY FEE: COPY FFF: - _ TRANSFER FEE: 179.70 RECORDING FEE: 10.00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Lot 5, Birch Point in the'rown of St. Joseph, St. Croix County, Wisconsin. Nwn a and Return Address I 76 030- 2098 -50 -000 Parcel Identification Number (PIN) This is not homestead property. (is) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this 1(0 40 day of April 2001 + - - + Philli 9 () + K Been J. Leith AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) _ _- ) ss. -- County ) authenticated this__day of _ — —� Personally came before me this _ day of April _2 the above named —" Phillip 6. Leith an Kathleen J. Leith, h usband and wife, TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, ANotar ent and acknowledged the same. authorized by § 706.06, Wis. Stats.) TIIIS INSTRUMENT WAS DRAFTED BY i /fitly ' f i �/ •f f= i << Public, State of LV+seensin /)7, n ts , .•r" / {'r /st> , Cz�� �s�C�— My Commission is permanent. (if not state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) + Names of persons signing in any capacity must be typed or printed below their signature. A42MI, i o a �/�/� u Lac, W1 A oW r l a b55 -2021 WARRANTY DEED STATE BAR OF WISCONSIN oW FORM No. 2 - 1999 NOTARY /lXIC•��A 1'Curs"s' N � Jan. 31, 20CS Y 8 W o O 10 N N Z LOT 4 8.96 ACRES 390,133 SO. FT. I �sl �I 01 LU 1 I— 1 � � I t0 A Oo �I ti i F 0 -1 N u -� n 0� v� 3 ` �P M ° 9' 3.64 ACRES to L_ 158,783 SO. FT. �x 1 7 • S7 c 2 0 1 I 50' 1 `\\ cl I �i CSI \ a� U-1 1 I w l rj LOT 6 1 iR 3.14 ACRES g 136,782 80. FT. S89 *OW58 "E 265.18' o o M N O NT FOUND N M AT i Ev 246.33' 3.65 LBS. -S pAONUMENTED WEIGHING 1.68 BE RT I r i cd E AS SHOWN) `J 8, INpAMS At1K PARALLEL I