The URL can be used to link to this page

Home My WebLink About032-2159-10-000 r _ Wisconsin Departmt.r of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building D.dsian INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 430117 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. Permit Holder's Name: City Village X Township Parcel Tax No P.C. Collova Builders, Inc. I Somerset Township 032 - 2159 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No 12.31.19.1369 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM o � ' - v•B Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet C> TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic O � � Dt Bottom Dosing T Header /Man. Aeration a /- Holding Bot. yste Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover / c GPM gj 7 , Model Num TDH ift Friction Loss Syst ead TDH Ft GC �•✓J ��• illy- Forcem Len th ia. Dist. to Well SOIL ABSORPTION SYSTEM �f , a (9 . 7-5 - 1,Y ' . 3 BED/TRENCH Widtth / Length / No. Of Trenches PIT DIMENSIONS NZ. Of Pits Inside Dia. Liquid Depth DIMENSIONS ( i / � ` ( SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: _ UNIT Model Number: ai > /Ob 5b � DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole x H acing n o take / if Pipe(s) Length Dial Length Dia 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 >36 I� Bed/Trench Edges Topsoil �. -, Yes :', No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: 1 /_19 3 Inspectio #2: / Location: 730 220th Ave Somerset, WI 54025 (SE 1/4 SW 1/4 12 T31N /) R19W) Wild Turkey Retreat Lot 1 Parcel No: 12.31.19.1369 1.) Alt BM Description = 3) ��CZ/OI C/ /O dt( O�IpLrnrS 2.) Bldg sewer length = (� - amount of cover >L( y C43yw Plan — - - V1J n Use other de for additional m Yes No / Re quired? ( /Y/n formati �_ _ _ -- - _ '.'_� iL 1 _ J .I. SBD -6710 (R.3/97) Date \> Insepct s Signature Cert. No. Iq Safety and Buildings Division uu "�� 201 W. Washington Ave., P.O. Box 7162 v r ) Y isconsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) (608) 266 -3151 �j fl 14 . Department of Commerce Sanitary Permit Application State plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide Project Address (if different than mailing address) may be used for secondary purposes Privacy Law, slS.04(1)(m) ] I. Application Information - Please Print All Information 2,, Parcel # Lot # Block # Property Ow Na me Na me CV I lb Property Owner's M ailing Address Property Location 4 �) , n 4� vi. t� [A,,Section r City, State Zip Code Phone Number circl ` 5L(V � T � � N; R Eo W II. Type of Building (check all that apply) 1 Subdivision N amp CSM Number � —Ior 2 Family Dwelling - Number of Bedrooms u Public /Conunercia) — Describe Use ! :.! State Owned - Describe Use Z X - � ❑City ❑Village ownship o III. Typ of iYer heck only one box on line A. Complete line B if applicable) A. . 11 Re 1 nt S stem ❑ Treatment/Ho lding Tank Replacement Only Other Modification to Existing Svstem B. ❑ Per mit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Plumber Owner Type of POWT c all that apply) A � on - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ pressurized I Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter I hing Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal /Treatment Area Info ation: D 'gn j Flo ow w (gpd) Design Soil Application Rate(gpdsf) Dispersal Are equired (sf) Dispersal Area (sf) S stem El at] n lJ �J S.] , VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Sep[ic or Holding Tank 1A eili" Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersi assume responsibility for installation of the POWTS shown on the attached plans. Plu er's Na me (Pr Plumber' gnature MP /MPRS Number Business Phone Nu per i ZZ , , Plumber's Addre s�4 Street. City, State, odYy'1/�� VIII. County/Department Use Only Approved ❑ Disapproved Sanitary Permit Fee cludes Groundwater Date Issued iss in gen;Signature (A Stamps) Surcharge Fee) a � ❑Owner Given Reason for Denial F__�_ IX. Conditions of Approval /Reasons for Disapproval ' At ch com lete plans the County only) for the system on not less than 81/2 11 ipches ' size - A-Q �'0t" Sly o t t ` SBD -6398 R. 01/03 (� PLOT PLAN PROJECT P.C. Collova Bldrs. Inc. , ADDRESS P.O. Box 489 Somerset Wi 54025 SE 1/4 SW 1/4S 12 /T 3 ii 1 W TOWN Somerset COUNTY ST. CROIX MFRS Shaun Bird 226900 DATE 7/28/03 BEDROOM 4 CONVENTIONAL XXX IN -GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 870 # of chambers 28 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 ELEVATION 95.5/94.5' Alt. BM Top of 2" Pipe @ 95.0' 285' Prop Line Plans Designed Using Conventional Powts Manual Version 2.0 a Pro 3 Bedroom 00 House tn 2 Vents T B -3 45' B -1 30' * B.M. 30 10' Alt- 3 M. 2 -3' X 88' Cells with pacin nts 16% B-2 Slope 200' Vent ALong Standard Biodiffuser Leaching Lea g � with 31.1 ft2 of Area k 1 " 34" G rade at System Elevation 220th Ave PLOT PLAN PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 SE 1/4 SW 1/4S 12 /T 3 1 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 7/28/03 BEDROOM 4 CONVENTIONAL XXX IN -GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 870 # of chambers 28 BENCHMARK V.R.P. Top of 2" Pipe ASSUME ELEVATION loo' Filter Zabel A -100 ❑ BOREHOLE O WELL "H. R. P. Same as Benchmark SYSTEM ELEVATION 95.5/94.5' Alt. BM Top of 2" Pipe @ 95.0' 285' Property Line Plans Designed Using Conventional Powts Manual Version 2.0 a � Pro 3 Bedroom tn House �r 20' Vents T B -3 45' B -1 30' * B.M. 30 10' Alt 3 M. 2 -3' X 88' Cells with >3' Spacing Vents 16% B Slope 200' Vent >6 " Standard Biodiffuser of Cover Leaching Chamber with 31.1 ft2 of Area 6' Long 11" 34" Grade at System Elevation 220th Ave Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: - 430117 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. Somerset Township 032- 2159 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: CST BM Elev: Insp. BM Elev: 7 12.31.19.1369 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK 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 Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. 7 uid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only F th Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched (Trench Center Bed/Trench Edges Topsoil Yes [,j No [J Yes I No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 730 220th Ave Somerset, WI 54025 (SE 1/4 SW 1/4 12 T31 RI 9W) Wild Turkey Retreat Lot 1 Parcel No: 12.31.19.1369 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Use other de for additional information. No � _J Re quired? ��_] SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No. V Safety and Buildings Division County r 201 W. Washington Ave., P.O. Box 7162 51- P rA SConsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 -3151 43ol 11 State Plan . N}unher Sanitary Permit Applica iox In accord with Comm 83.21, Wis. Adm. Code, personal info tion you 0 6 h•$' may be used for secondary purposes Privacy Law, 5.04(1)(m) rProjec,,ddress (if different than mailing address) 1. Application Information - Please Print All Information 200 70 � C� Property Owner's Na a Parcel /f t .- Block # Property Owner's M ailing Address Property Location 2 City, State V , " Code Phone Number e- �' =-- '' A,Section ') S t o� � (circ o H. Type of Building (check all that apply) ` T N; R E 1 W �or 2 Family Dwelling — Number of Bedroo n,� l � v Subdivisi n Name CSM Number (] Public /Commercial — Describe Use - ❑ State Owned - Describe Use (:;2 1 IG 4qG �' k�� ❑City_❑Village)!5;@w ip of f / III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. w S stem ❑ Replacement System ❑ Treatment/Holding Tank Replaceme my I ❑ Other Modification toli[isting Sy B. ❑ Permit Renewal Permit Revision 11 Change of El Permit Tr fe w ious Per 1 u Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (C all that apply) ! _Non - Pressurized In- Ground El Mou 24 in. of suitable soil F1 Moun 24 in. of s s yro-1, e ❑ Single Pass Sand Filter ❑ Constructed Wetland El Pressurized In -Gr ding Tank El Filter El Aerobic nit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filte eachin mbe El Drip L' ❑ Gravel -less Pipe xplain) V. Dispersal/Treatment Area Infor ation. Design Flow (gpd) Design Soil Application Rate( f) Lspersal ArffRequired (sf) Dispersal Area Proposed ( System Elevati sc� 3 VI. Tank _nfo Capacity in Total NumberManufacturer Prefab Site St el ' Fiber s lilasil l c Gallons Gallons of Units Concrete Constructed New Existing A-1,0 Tanks Tanks Septic or Holding Tank tx� LA )VI )<, . t r � Ak ) Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- 1, the undersi ed, a responsibility for installation of the TS own a attached plans. Plumber's Na me (Print) Plumbe i re MP /MPRS Number Business Phone Number & J 6 1 Plumber's Addre ss (Street, City, State, Zi e) l VIII. ou - t /De artment se Onl l Approved ❑ Disapproved Sanitary Permit Fe ❑ � C. e (includes Groundwater Da Issued sluing g ents S - gna o Stamps) Surcharge Fee) ��/O G� al� Owner Given Reason for Denial Cone3itionsApproval for Disapproval t v lJ1 �(t ltf� °�• l�/!�. ��E' /S.ssuf'' 103 YM13-1 t _ / Attach coEpplete plans (W the C unty only) for the system on er not lesj than 81/2 x 11 inches in size SBD -639 (R. 01/03) 1 w �': "� +� �' -�,. �� e � �� a �,� � P �� 4 , ��i� ' � y� t. w.� ` �` .. ,� �� "� ;�� .m °` ...� ', ., PL PLAN PROJECT P.C. Collova Bldrs. Inc. DI RE S P.O. Box 489 Somerset Wi 54025 SE 1/4 SW 1 /4S 12 /T 31 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/18/03 BEDROOM 3 CONVENTIONAL ) IN- GROUND P SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambe 22 BENCHMARK V.R.P. Top of 2" Pipe ASSUME ELEVATION 100 Filter Zabel A -100 ❑ BOREHOLE O WELL 'H. R. P. Same as Benchmark SYSTEM ELEVATION 95.5/94.5' Alt. BM Top of 2" Pipe @ 95.0' 285' Prop Line Plans Designed Using Conventional Powts Manual Version 2.0 a 0 a c Pro 3 v; Bedroom °O House �t 20' Vents T B - 3 45' B -1 30' * B.M. 30 2 -3' X 69' Cells with >3' Spacing 3 10' Alt Vents S 00' Vent >6 „ Standard Biodiffuser • , of Cover Leaching Chamber with 31.1 ft2 of Area 6 Long 11 „ y 4" Grade at System Elevation i 220th Ave �► `�'�` �.„ � � .•,� ,+ 4 V � �' ,. '4�'e �; f PL PLAN PROJECT P.C. Collova Bldrs. Inc. DDRE s P.O. Box 489 Somerset Wi 54025 SE 1/4 SW 1/4S 12 /T 31 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/18/03 BEDROOM 3 CONVENTIONAL XXX IN- GROUND P SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chamber 22 BENCHMARK V.R.P. Top of 2" Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL •H.R.P. Same as Benchmark SYSTEM ELEVATION 95.5/94.5' Alt. BM Top of 2" Pipe @ 95.0' 285' Property Line Plans Designed Using Conventional Powts Manual Version 2.0 4 a 0 Pro 3 Bedroom House Vents B- 45' B -1 30' * B.M. 30 2 -3' X 69' Cells with >3' Spacing 10' Alt. M. Vents -2 6% 200 ALong Standard Biodiffuser Leaching Chamber 00 with 31.1 ft2 of Area 1 " 34" Grade at System E ation 220th Ave i I i I I i I i� �.� ��,� w �� '� � � �: �' ,� :,: �„ 11 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page -�— of Di4on of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must include. but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. „ 6 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Q tj 'O (� Please print all information. Personal iofmniatiori You provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 8 7 -z Property Ow/ / +ner Property Location C 14 6 D rl0 0 0 c"., C Z",- GovL Lot j4 1/4114 S! G T ✓�' N R E( W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# r v, 15 9 J; eg rX, k City State Zip Code Phone Number O City ❑ Village Town Nearest Road 5 Q. f"0 )S -12-9177 I -S 0 ZGbti [Rr New Construction Used Residential / Number of bedrooms _ _ Code derived design flow rate GPD ❑ Replacernent ❑ Public or commercial - Describe: Parent material G`� i a�, �, �� Flood Plain elevation if applicable ft General comments c #� _ and recommendations: �} JUN 1 1 2002 c �/ O IS(' ✓ Cki Boring # ❑Boring � /'� �. ZONING OFFICE 1,� ® (it Ground surface elev.,/,6 /' ft Depth to limiting factor / in. Sat Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munseli yj Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 j- 7 �4113odng # 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 Z "V ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgy Effluent #2 = 113013, : < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) S' CST Number Address Date Evaluation Conducted Telephone Number Z- U- L Property Owner Parcel ID # Page of factor in. 0 # ❑ Boring Depth to - Pit Ground surface elev. Limiting Soil Application Rate Horizon Depth Dominant Color Redox Descrip" Texture structure Consistence Boundary Roots GPD/ftz In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eft#{ 1 '01#2 �r `l F-I Boring # ❑ Boring ❑ p� Ground surface elev. ff. Depth to lirniting factor Soil Application Rate Ftotizon Depth Dominant Color Redox Description Texture Structure consistence Boundary Roots GPDW 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 F-EMI Application Rate Horizon Depth Dominant Color Redox Description Teochue Structure consistence Boundary Roots GPDW in. Munselt Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#2 ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L 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 60 9 - 3151 or TTY 608 264 - 8777. ssn-ssso te-mroo) r . Soil Test Plot Plan 3 Project Name P.C. Collova Bldrs. Inc Shaun Address P.O. Box 489 Somerset Wi 54025 M #226900 Lot 1 Subdivision Wild Turkey Date 6/7/02 SE 1/4 SW 1/4S 12 T 31 N /13 W Township Somerset Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 2" Pipe System Elevation 95.5/94.5 *HRpSame as Benchmark Alt. BM Top of 2" Pipe @ 95.0' 285' Property Line a� a ..a a 00 B- 45' B -1 ,B. M. 10' Alt 35' M. 100' 16% 98 B-2 Slope 200' 96' 220th Ave Soil 'rest Plot Plan ,sect Name P.C. Collova Bldrs. Inc Shaun .ddress P.O. Box 489 Somerset Wi 54025 "X� #226900 Lot 1 Subdivision Wild Turkey Date 6/7/02 SE 1/4 SW 1/4S 12 T 31 NiR 9 W Township Somerset Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 2" Pipe System Elevation 95.5/94.5 *HRpSame as Benchmark Alt. BM Top of 2" Pipe @ 95.0' 285' Property Line � a 00 in B- 45' B -1 *B.M. 10' ` lt. 35' M. 100' 6% 98' B -2 Slo 96' 220th Ave I i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM i Owner/Buyer P. C. Collova Builders, Inc. Mailing Address P O Box 489 Somerset, WI 54025 Property Address 736 .� . (Verification required from Planning Department for new construction) City/State ML Parcel Identification Number 03 2" ,, 2 /S /0 — Cx ?ZD LEGAL DESCRIPTION Property Location A V., Sec. �, 1 N -R _aW, Town of 5OI'Y\O.4 �e " Subdivision Lot # Certified Survey Map # Volume Page # Warranty Deed # (jo �` �J G / Volume Page # Spec house 0 yes ❑ no Lot lines identifiable ❑ no Y SYSTEM MAINTENANCE Impmper use and maintenanceof your septic system could result in its premature.failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeymanplumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal 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 gree 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 Wfihas been maintained must be completed and returned to the St. Croix County Zoning Office within 30 e year expiration date. P. C. COLLOWA BUILDERS, INC. (715) 247 -2742 _ SIGNATURE OF APPLICANT P.O. Box 489 DATE SOMERSET, WISCONSIN 54025 OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of desc 'bed above, by virtue of a w�gacaidrd �.Ber6 Df Office, (711M5)�1247-- 2JJ117CC42 c C� - P.O. Box 489 6 ll b / C13 § IGNAAME OF APPLICANT SOMERSET, WISCONSIN 54025 DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** r " ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed 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 St. Croix County Zoning 715 - 386 -4680 Pumper Tom Mondor 715- 246 -5148 Shaun Bird #226900 I ' 3WO St. Croix County Check List For Septic, Mound and At -grade Systems Subdivision and Lot #1 W," Soil Test Copy of Deed ---- Septic Tank maintanance agreement Blue Print Copy Septic System permit $225 (to St. Croix County Zoning) Change to $250 after July . 1 st Mound and At -grade permit Department of Commerce for $175 St. Croix County Zoning for $325 Change to $350 after July 1 St j•d 496 :20 ED Be RQW FROM P C COLLOVR DLDRS, INC PHONE N0. : 715 247 2747 Oct.. 28 2002 02 :14PM P1 v ("Y p '� Iq 61 G k' V 18 8 S r 2 7 9 Mty Rp $TMf MU Dr *14ccr+." Maw a IM DoerWrtilwl0r WA.AA*NTVD92D O A S • 6v. , 113 This GraA m.deimtw mn Shaaa Llia.sQri Eltaa. tr>;i !<pg l NLeU� Yloa,DOM. oimo ea Fail ,,g xi.a, r , _ sl- 0e -ai912 i11a* AN _ wane MD 4raetGE, pMl �F CCknva 8 alld�rg i�a a 1► osad tMpt t ,� Uwe go Crawsdr, for a vatwb4e <artWvldsa *Rnmo tip Oroatow ups f9flowl tdMe,9brdmisobitl CaunD ' 91110 ar wiwmte (F RIG» IP"s it awar pwun mut io ftftw � cw"' , WOODS R. 2 Lse ar O■E■nr AAdx►s ��La4 e32.10".0•o40kM%l0dd•7pg04 _ ParW iftff0criw we wiMMi tYt shnni &bEalDd9MN fi► Ic, ar. l8, rostrlec[ eneaEadrtSht r•PSw,>,Y eltward,Efany. Ddgd prig �"� d0y twi Monk 9D04 ! AU'tX9MTtC4'Tl0K ACKNOWLEOGt L47 34MIM tp) i111111w M" C lam ,. 'a b4hN iY STATE OF WMCONSih auEh0n00at ffifs pene,uJlYwsabaMw roe 1 *ta_ dry or TXf L l M950 S' A rt MPL4P WISCONSIN tv k si» varrw*i01 (tCnet, iamvm mr wd W.6*WIWwd We mme. rainfimma ' Tfi1161 'rUtTRiSt.tGNi'WAODR.1rTC4iY .. .,,.,,. - .,. d ?4&MW?YYIk. Sweat W iNgkWn henN - - - -- _ MY Camadaaan awmianeK, of nm auri upkatwn d", Ism iead OW aM� m 801h era ax awwxy,l •Nigh swvsAJam* WW twtrsrdm phwttn*Ar07prt L — - - - Melon lrm4"p wp9rgwm.'� � WAAAAdTY DCta "AITLtiARfJlwUMON wj FO�It Ala i. H/Y M HWE = y'L° 6 34.89' N w�� s sso.o' �,�� NI - a LOT 4 —' N \ 5 / 130712 S.F. � � s 3.00 Ac. / �,► io 0 i o �PS�`- 4F I'p9 9p, C.B. 1.65 Ac. "� ° 6 S•\F` LBO = 962.00' / / / / I 20 3.00' \ / 142.44 � '� ^ 25 09' I �`S84 � � -- — 0) E 5 80.47' O / bo M P\a°`'� LOT 3 10 8.52' I ° oR , N I I N Z 130721 S.F. a' N i ,4 "s�• 3.00 Ac. A ►o co L4 `OJ AO•• C.B. 1.26 Ac. �I \LBO = 962.00' O S 89'38'08" E HWE o - I L - - - -- 571 960.0' E TA. I I � I 285.18 93.24' 110.55' 33' 33` I 6' — — — — — — — — 286.65' TOP OF 3/4" IRON I I \ RER00 BENCHMARK I � te a. �cA. I LOT 1 \��. t , (\ I Z 130855 S.F LOT 2 ��,�� o I "6'ss� S 3.00 Ac. I �P� I`"� o I -L s 130743 S.F. I �o I ° � c o \a P OD 0 3.0 0 A c. v I o I -rrI p C.B. 2.91 Ac. a I I W N (1: 0) I N 89'37'0 C.B. 1.35 Ac. - ° o W b� I 137.2; - LBO = 962.00' , r^ N SW CORNER W o a� tk � / L I o SECTION 12 0 0 566 48 p� ' 1 I ROUND 3" - g /lp ALIMINUM I MONUMENT 285.21' 281.27' --- - - - - -- 139.32' - — — - - - - -- - - - - -- 66. 0' �! - -- ►"; - 220TH A VE N UE S 89 '18 7 53" E 1340.67' uj _89'18'53' rr M N 89'18'53" W 1340.69' 1340.x --- -_ -- - -- ___ UNPLATTED LANDS