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032-2160-20-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 556339 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used'for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Bank of New York Mellon Somerset, Town of 032-2160-20-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 99. ~}5 f Go 12.31.19.1380 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 2.3 O 16 1.7 99. '/s Alt. BM 4A] Ze -15 igo Aeration Bldg. Sewer 1 ►li 6V-i /L Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic i . Dt Bottom ~5o 42 Zs > Z9 Dosing Header/Man. (o3 -15-12- Aeration Dist. Pipe Co75 75 Holding Bot. System -775 qs,_ PUMP/SIPHON INFORMATION Final Grade -30 q8 • 75 Manufacturer Demand St Cover l 9. ys GPM Z•3cD Model tuber va 1,)e, i., ZL y 5 5 3 TDH ift Friction Loss Systerp TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width I Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO V P/L BLDG CW"E~cLLLL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of System: CHAMBER OR g~ ~,;7 UNIT Model Number. / /v5 DISTRIBUTION SYSTEM 50,,4, 32 Header/Manifl , i Distribution x Hole Size x Hole Spacing Vent o Air take LA/ 9 Pipe(s) e Length (0 Dia Length Dia Spacings'' ti SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over / Depth Over Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ 75 Bed/Trench Edges Topsoil Yes L] No Yes [E No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 2244 74th Street Somerset, WI 5/4025 (NW SW 1/4 12 T31 N R1 9W) Wild Turkey Retreat Lot 12 Parcel No: 12.31.19.1380 1.) Alt BM Description 2.) Bldg sewer length = t v - amount of cover = 4 _ Plan revision Required? Yes No Use other side for additional information. G o Date Insepctor' ignatur Cert. No. SBD-6710 (R.3/97) County r Safety and Buildings Division St. Croix # 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, WI 53707-7162 ALA 55 L33 Sanitary Permit A 1~ State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of thi$or to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms t ate•oWMUMWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04 1)(m , Slats. 2244 74a' Street, Somerset, WI 54025 1. Application Information - P ase Print All Information Property Owner's Name 1 Parcel # oe- Bank of New York Mellon 032-2160-20-000 Property Owner's Mailing Address 0.;r Property Location 14525 SW Milikan Way, Suite 200 - Govt. Lot City, State Zip Code I ~i ~.1"F! -t" P Number NE SW Section _12 (circle on Beaverton, OR 97005 T 31 N; R 19 E oUW II. Type of Building (check all that apply) Lot # ❑ 1 or 2 Family Dwelling - Number of Bedrooms 3 Subdivision Name 12 f Block # Wild Turkey Retreat ❑ Public/Commercial - Describe Use ❑ City of Na ❑ State Owned - Describe Use CSM Number ❑ Village of C14-joer5 W~L Na gown of Somerset III. Type of Permit: (Check !21i one box on line A. Complete line B if applicable) A' ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. El Permit Renewal El Permit Revision ❑ Change of mit Transfer to New List Previous Permit Number and Date Issued Plumber ❑ Per f Before Expiration Owner 6 3 2 Z D© 5 Type of POWTS System/Component/Device: Check all that a 1 on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Compone lain) ❑ Pretreatment Device (explain) 5;4. d'i1 V. Dis ersaVrreat ent Area Informati : 32 I filtrator "Q-4 Plus" standard chambers, 4 endca s, diversion v* e, existing Zabel A100 a uent rlter Design Flow (gpdJ Design Soil Application 0/ Di ersal a Required (sf) D'spers Area Proposqd 9& (sf) System Elevation 450.00 Gpd 0.70 Gpd/Sq. Ft. J 66 sq. ft. 6 6 Sq. Ft. 94.00' VI. Tank Info Capacitym Total # of Manufacturer Y Gallons Gallons Units 2 o cAa v Ui New Tanks Existing Tanks a U on y w C7 a Septic or Holding Tank 1,000 1,000 1 Huffcut X Dosing Chamber VII. Responsibility Statement- I, the un ersigned, as me responsibility for . allation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumbe s Signa MP/MPRS Number Business Phone Number James K. Thompson - MPRS 30021 (715) 248-7767 Plumber's Address (Street, City, State, Zip Code) 340 Paulson Lake Lane, Osceola, W1 54020 VIII. Coun /De artment Use Only Approved isapp Permit Fee DP;e nt Signat $7~5 °b 4/,,, ft~n Reason Denial IX. CondiLi~Hiji~iQj WNMeasous for Disapproval (~1. $eptic tank, effluent filter and 3) 3w 1 t"► off' O A, dispersal cell must all be servfces / maintained as per management plan provided by plumber. 1t '6S~et~. G 3 2. Alt se6ack requirements must be maintained 6 r 1~ rr~ ' n 1 t IN per aWicable code / ordinances. D J ~O tom- ~t7 - r~ d f' • Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in s' SBD-6398 (R. 11/I1) ♦ Ex.~ ~ ~~e ele.~` 2z spy • ~ornersG~,~~ S~~Z~ T• So.,,t~s~~, S~.~rokG;oo/. ba,~q 3.iz.4cr'es Eit'iS~i/!//gyI~APiD~a.~. Nk{~-~•~-~ ~isiden~ ~ ~oo)crL~C ScPfy Jl- L di~ersu.( O ~ o qv 9ic~•(•~ Ce Q 1 eda,~J'~.n3 S"y- ,0 y` 3O i ~ P. J. C~ EX~'s tin g it = ys'd9s~3' io[o~ \ p~bpo~ed, well d ~odv~c~ raFi,bw6vr, 49 04LI of l k 1Yta/ = ~o"~Zarr) OIC' ~^r ~ r ~~opose.o~ dsPvsai eYer. ~7~ ~ f~/~• err(. = roy~fsta£e. Tk~O tJL°nG~i o 5 4 f 3 !!(s~i' ctat 6-an K/?XNy ~l41e CO!!r-- /usb4f -,Zs/Aer ae e itµ 11a E~ : (I Cof %ne S I.re I "rdx. W, v. ce, V Conventional POWTS Index & Tilte Sheet Project Name: Bank of New York Mellon 3 bedroom Replacement Conventional POWTS Owners Name: Bank of New York Mellon Owner's adress: 14525 SW Milikan Way, Suite 200, Beaverton, OR 97005 Site address: 2244 74th Street, Somerset, WI 54025 Project Location: Subdivision: Lot 12, Plat of Wild Turkey Retreat Legal Description: NE1/4 SWv4, Sec. 12, T.3 IN., R. 19W., Town of Somerset, St. Croix Co., WI. Parcel ID 032-2160-20-000 Page 1 Index and Title Sheet Page 2 Site Plan Page 3 Dispersal Cell Sizing Calcualtions Page 4 System Cross Section Page 5 System Management Plan Page 6 Certification for Utilization of existing septic tank Page 7 Septic Tank Maintenance Agreement Page 8 Parcel map Page 9 Deed Attachments: Soil Evaluaiton Report Mater PI er Restricted Service: James K. Thompson, Dept. of Comm. Credential #30021 .2 5 Signature: b--- Date: Page 1 of 9 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N.01/01) ♦ Ex.3~,`~ ~r+~e/e ale.` &.,2, o ;U yy 73~ So~nerSl.~,~~ Syo,ZS 0 ~oL` cJ;ld T~~~y~ fief /IEyf Shy 5e~ T. 3/~l,,P/9~ T , gL.Soa, ~ls~E, S clr~,k G; u~ ~e% X032- ;U 60 - AO -ems hang 3.1.2-acres EXiS~ii1(~I~GP/Qh(oc/tu-6 ~'ss,denCC a 3 C. taut/tt. ~Q Ge/!. 7eaa (et~ E~+re4S ~O• ~ E,YjSEfn S!'A•S T.'.K. ~%k, a~3`r6p'J;;~ItIU4-✓e Sao si~d~ ,c 9ti-4tc elcoh-A4, u 9foy' CX,'s~i~g d I _ ~ds'd9sl~" well ~ ` ~ H'lar = ~o'~orY~ O~' ♦r d spcrsa/ (i¢I. ` \ ~17~ ,S! Togo f S4° c P,-Oposc..a( ?)o W &-e,4c.la s 416 3 VG14 / +C ~o„ ~ry,Ycn ~-le Covu: LAY/(. T,~I66o+~ .,¢.q., s std. /err. 99. ~s' 101us ►bNts/0 e-&Vfy-~. but F~/Era Eivt Su r,~~a oe C Note: c 1I Cof /,'yes are el;artil Gee!/. ~-EreQE BANK OF NEW YORK MELLON DISPERSAL CELL SIZING CALCULATIONS 1. (3 bedrooms)(100 gallons estimated flow)(1.5 design factor) = 450.00 Gpd design flow 2. Infiltrative capacity of native soil = 0.7 gpd/sq. ft. 3. Absorption area required: 642.86 sq. ft. 4. Absorption area as proposed: 660.40 sq_ ft. (32 chambers total) Infiltrator "Quick 4 Plus" = 20.00 sq.ft. EISA per chamber, Infiltrator "Quick 4 Plus" end cap = 5.10 sq.ft. EISA 642.86 sq. ft. - (4 endcaps)(5.10) = 622.46 sq. ft. 622.46 sq. 1/20.00 = 31.13 chambers required Number of trenches: 2 @ 16 chambers per trench Trench width: 2.83' Trench length: 66.00' Trench spacing: 9.00' on center Total system area w/ 6' trench spacing: 12.00'x 65.00' Pg. 3 of 9 Soil Absorption System Cross Section ft Final Grade 4" Schedule 40 PVC Vent Pipe With Vent Cap 0 ft Leaching Chamber ft System Elevation z• s ft (n.D ft Soil Absorption System Plan View ft ft Leaching Trench ~ft Vent Or Observation Pie 1 p Chambers THE WE F 4" Dia. Trench 2] Header Leaching Chamber Specifications /~Y Q'~ /~~uS S~~cf Manufacturer And Model EISA Rating 2-0,0 sq ft per chamber Soil Application Rate 4,70 gpd/sq ft ~SUI~ gpd Design Flow 0.7 Soil Application Rate 10.0 EISA = 32 Chambers 2 rows of chambers each. i Page Al of Conventional Septic System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10705-P (N.01/01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank Septic tank servicing mechanics comply with SPS 383.54(1)(e). Septic tank to be located within 150' of service pad, with bottom of tank to be 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1 /3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October-March) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Effluent flow shall be alternated between dispersal cells on a two-year schedule by use of diversion valve. Effluent to be diverted from new dispersal cell to old cell at 4 year anniversary of new system installation. Old cell to be utilized for a 6 month period. Afterwards, effluent dispersal to be alternated between cells on a two year/6 month rotating schedule. Contineency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715) 248-7767 or the St Croix County Zoning Department at (715) 386-4680. Pg. 5 of 9 i ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) ~Z5/5/77 a~. 50'X4e'-545,1~ eJ/. SFeozS located at: 6 '/4, Sel) 1/4, Section Town 31 N, Range /f W, Town of 56ircrSc.~ , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service Did flow back occur from absorption system? Yes No 4---- (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: Construction: Prefab Concrete Steel Other Manufacturer (if known): ficensed o ank (if known): ? yes - Ste, J/ mit nu ber (if known) 5/G33G2 aMi 1-7 P tuber Signa re) (Print Name) (Title) (License NumberMPRS 7, Pdl,2 (Date) Form to be completed by licensed plumber (Dept of Commerce Chapter 5 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 9/2008 500 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/ler On Mailing Address 5cJ ✓erwn Df Property Address ;Z.2 Vy 7`f 9a-6 .50rn4-5zZ D/ Sf~O.ZS (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number 6 32- 2160 -,0-eW LEGAL DESCRIPTION Property Location ! '/4 , .5k) '/4 , Sec. /Z, T _J/_N RAW, Town of Subdivision Plat: (.C>//ol T l 6-Q,q6 Lot # /02 Certified Survey Map # ~a Volume , Page # .c Warranty Deed # (before 2007)Volume , Page # Spec house Cl4es "O Lot lines identifiable eyes SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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. I/we, 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 Planning & Zoning Department within 30 days of the three year expiration date. 1/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 the property described above, by virtue of a arranty deed recorded in Register of Deeds Office. Number of bedrooms n n A~ _ , 'tKIGNAIURE OF APPLICANT(S) DAT ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 09/07) SHERIFF'S DEED ON FORECLOSURE 955574 08 CV 505 BETH PABST Document Number TITLE OF DOCUMENT REGISTER OF DEEDS ST. CROIX CO., WI WHEREAS, pursuant to a judgment of foreclosure and sale rendered in the RECEIVED FOR RECORD Circuit Court of St. Croix, Wisconsin, in an action between, THE BANK OF 05/03/2012 08:27 AM NEW YORK COMPANY N.A., AS SUCCESSOR TRUSTEE TO JPMORGAN EXEMPT # 14 CHASE BANK, NATIONAL ASSOCIATION AS ORIGINAL TRUSTEE FOR REC FEE: 30.00 THE MLMI SURF TRUST SERIES 2005-CB4 C/O WILSHIRE CREDIT CORPORATION, plaintiff and Mark James Stock and Terra Stock, defendant(s), PAGES: 2 and after due advertisement, the mortgaged premises hereinafter described was sold on March 20, 2012 to the plaintiff, THE BANK OF NEW YORK MELLON **The above recording information FKA THE BANK OF NEW YORK, AS SUCCESSOR TRUSTEE TO verifies that this document has JPMORGAN CHASE BANK, N.A., AS TRUSTEE FOR THE HOLDERS OF been electronically recorded THE MLMI SURF TRUST, MORTGAGE LOAN ASSET BACKED & returned to the submitter CERTIFICATES, SERIES 2005-BC4, for the sum of 137,250.00. Record this document with the Register of Deeds AND WHEREAS, the said purchaser, plaintiff, THE BANK OF NEW Name and Return Address YORK MELLON FKA THE BANK OF NEW YORK, AS SUCCESSOR Blommer Peterman S.C. TRUSTEE TO JPMORGAN CHASE BANK, N.A., AS TRUSTEE FOR THE 165 Bishops Way, Suite 100 HOLDERS OF THE MLMI SURF TRUST, MORTGAGE LOAN ASSET Brookfield, WI 53005 BACKED CERTIFICATES, SERIES 2005-BC4, is now entitled to a conveyance according to law, NOW THEREFORE, the undersigned conveys to THE BANK OF NEW YORK MELLON FKA THE BANK OF NEW YORK, AS SUCCESSOR TRUSTEE TO JPMORGAN CHASE BANK, N.A., AS 032-2160-20-000 TRUSTEE FOR THE HOLDERS OF THE MLMI SURF TRUST, MORTGAGE LOAN ASSET BACKED CERTIFICATES, SERIES 2005-BC4, the tract of land Parcel Identification Number (PIN) in St. Croix County, Wisconsin as described below. Veriff %of A S is St. Croix, County Date: 4R 0`7(/.h,v STATE OF WISCONSIN St. Croix COUNTY On before me came Sheriff John A Shilts known to be the individual and officer described in said document and ho executed the above conveyance and acknowledged that he executed the same for such sheriff, for the uses and purposes therein set forth. Print Name: Notary Public, State of Wisconsin S►r$ Public ,1 ~'1 ~a1 My commission expires: d- W i 0f tiVis~onsin This instrument was drafted by Scott D Nabke 165 Bishops Way, Suite 100 Brookfield, WI 53005 LEGAL DESCRIPTION See Attached Legal Description 1 of 2 PJ . 90'z/o p °vj M y ti O C C N N N c 00 ~ X03 ,N a m O f64) L 0 E L 0 ON LQ0 0) N Z cr- O7 a N 30 E N I N N a N .0 > ~ 'O O ZO O v .a C O =.a 0 7 l6 3 ° = T - m Q 2 w w 0 Cl) Z y _ 3 rn „ 0 lq VIII O O w O N ~ N Z (L m U) N Cl) H Z 4 0 Z j c y v ~ ~ o w d 'z g N a~ci N (A H r D. E ~w N v a~WjJ N 0 ~ O O O O Q Z co z N y T CL m N y N L m U) 3 E H F-- FN- U) o o o a m ~N R a~ a a a IL (D o N t o o to J U O O V N_ _N O } 0 0 Z~ O O O 04 Q L O N N N O Q LO O '0 E Lo (O j O C m a to f~ d w N Q n (n (o v O p ° y c Al p 'o c O O~ O co V = 'O C1 E - 00 O_ N_ ° M H m M C V a 0 0 0 r N> d C -O N N N CS .2 E! (D V O w O N c m c = N r to N V M d (D o c a~ n ~ M 0 U O N N% v CD a v p z w Y g (n Q y ~ xti III = E V €d 4) CL L: a~ r`~i +r E ` 'c c 9z L) IL 0 U) 0 ST, CROIX COUNTY SEPTIC TANK M,ANWENANCE ACd PP.-MENT AND OW NPERSHIP [ rXIVICATION FORM f>~+n~,'E3d,rr•crr M wiling Adi#lri Propech, Adders t .~F,~~. try rexltred f>K to Ptwa & Tawwr"t t?t artytrrtat fut s*wltttltcti00' ) Cif + tatir P*=l Identificetim Numbet LEGAL D Property L ocauon _ Sec. , T Town of Subdivision Plat: . LW C*rdfkd Survey Map tM Volume Pie 0 wanwly Deed (before 21107)Vof urne , Peer Spec bw u, VCA no tit tu'aac ►Kt ittiaktile trtx il! SYSTEM! MAINTEN NCL AIM,QY1+'"'IY1FR C£RTIMA110N I tt~e staid of !rssa r aPtac "stia cKWO snrsaA. in ids ptcadiatwc hJ,1ffe bDbMdke %Vfts k}rrv a +*ga;ACWA^ OXWiA* Of PLMpt* a+n>fe tine MpKx IWA e+, rtaN duc vicat'K Lx w* , if ncaWbct. by a lw crmd pea qm, tiT► hw }vu p4A inW Ow sF1+mim can All;ect 1hw ru cibm (it the wvw tsttl)r as a "wtrwrx stake to ides wWo 4b.lq mW WMOM ChM M tl>tirs at spmi£red in f C 8) 52(l i aiid in Ch■txter 12 . wt trill', Cokm Smtt r c"trdsprrattce Ttte ply ow w agreft try ss;bmai to 5a icio t co m v Pkmrw ac za Njwrtment a caurk3fft,un Lunn, vgwd by ttte krwu a era! Mw a mu pkmi -r, pca#rw* tats plunow. jrAtrwted phnnhm iu a Lccrwd pump a •►+ctrfvan# tyre; I i the owsise wastewaW dijxeii stVm is w ;ptz W i4wmwrgi trim ttr,rwt w (2 i at'dar wapectke aW pmping t.tf woomary x the WPM tmkk as< tmrs thm If3 ftdl od'scludpe INx. dw bffvr tend tlrc above rm"aerrems arrt atpft ft, msaataawn & pri+ate 4ewW dupnml ~wsseesn with date standards ser f4th, harcm, ax set by etc 1 - ot coffifficice UA ita l l au of ` 4tuml 3trsax me s. Swe of wM ansin CaUfkauunt stating t'hm s sv9trtn hrs boar tgaiutta wd mwr.-t he cco mpleed wd rrtransal tw dw S1 C rotx 0xv iv FLttto r* At ,t'.+'attt>;g; I)cpatrttri as + ikNn 'Q).to •a nrihr awes 3e expiraimm dncc l4w oI ' that till Aawp~ an tiff{ firm aver wr in the hem err ni rhnr k w)wicL*c L` wr atnrwc ttw owncri si of tha popam dewnbW 4W-v, by k'irhm of a v►Art#Idtt4' &W recmdw m R &vAe wt 13eod. t 0kc Number of beydtr*ema 11 i A APPLICANT(Sp DATE 'Any [atarmsdswras that is smarm waa reach in the wftiarti, po7nit hang rmokrti Wy the Plowmig & lane DepwhTAtM • Irtc kwe with s. Speak ww a fecrrrclol wwrrwft deed timw fire Rcp4a 4V I I vib c 1'i'hcr mbd a r4vy of flee ixmfW survvN map tf 1V k1w= ix merle m the wattarats dowd. (REV. 7) w bl S WILD TUR LOCATED IN THE NE 1/4 OF THE SW 1, LEGEND TOWNSHIP 31 NORTH. RANGE 19 WEST, tVED PR DRIVEWAY DRAINAGE EASEMENT NOTE• - BIN G SETBACKS COUNTY SECTION MONUMENT NO O~ OR RESIDENT SHALL DO ANYTHING WHICH WOULD IN'TERFER! WATER DRAINAGE AND ITS ~ A FOUN 3/4' RON REROD _ _ (FOINND AS NOTED) OPERATION OF THE THIS I S BUT IIS NOT~TO BUILDING UPON, OBSTRI NCLUDE f 2 4 LU42 12' UTILITY EASEMENT EXCAVATING OR PLANIMG IN ANY POND EASEMENT% WATER DRAINAGE 'T SET 3 ' BY 18' ICON REROD WATER CULVERTS. BERMS OR GRASS SEEDINGS. ST. Ct~OiX COUNT WEIGH G 1.50 POUNDS PER DRAINAGE EASEMENTS ZONING I OFFICE~I FOOT AT ALL OTHER C9. 021742 4 n ~ S BINLDABLE GENERAL NOTICE STATEMENT CA L" As CONTIGUOUS BUILDABLE EACH PARCEL SHOWN ON THIS MAP (PLAT) IS SUBJECT TO, STATE, Ca ■ SET 1 1/4' BY 14' IRON PIN BOUNDARY RULES AND REGULATIONS (LE. WETLANDS. MIMMINI LOT SRE, ACCESS WEIGHING 4.172 POUNDS PER PURCHASING OR DEVELOPING ANY PARCEL OF LANG, CONTACT 1FE ST. LINEAR FOOT HIE - HIGH WATER ELEVATIONS AND THE APPROPRIATE TOWN BOARD FOR ADVI IE_ Soo NORTH-SOUTH LINE 1/4 SECTION LINE 2E 21 29!12- - - _L904 t - _33509' 2Xtt 1 r- 2,7.25' r- b ILL E-1 ll@~ t- 0 co 1 b I • .glaea I X ~Q o ri -3 / E., O I NI I i..~/ g m NQIb i ~I i ®lr' s,~17 d bb to 0 _ Ol►OOI lir0y ZL>r 3 .LL. N ~y>, \ ` N / ' mzw fit A. L: H ` /k -#sb i all ;7i s 6 E- 41 vil 1 40 1 A~ r Ic1 .tt r 3 t S 000 E ♦ ° 1 • , f _ M1L1 M: r, 1 - 0x40' , O , 11A 11 110 -ftw -z - 1 0 1 11\ Is t - ly 1w I Lon* 'c L 'D 13 LL®"w,e' ~I~ d12i i I Do® a ,r+ s EQ-- N q 9o 6S ~~\i ` ~ 't"~ ; t--1 e~i N Q „ S) Vj Q F 1 {ki-'4 i 100' I 3 E"' M 0 I ,831 E-i ^ 7 I 1 i I ~I i I I GD t,, yjry I w 3! I _ Awi I L - - I I 3 JZiCZO N - - - - ~9~ib 2fA92 xt.or ixW 8 I 1 1 - - - - N 00'0491P w 67592' 4rj - I a = ! Jill ~ i 1 lid Ey fi I I F N* Lo Is ~M I s 'i 1 - - - - - - - - -451.90' - - - - J 24 S IJNR.ATIED LAIRS NEST LINE OF THE E 1/2 OF THE SW 1/4 N 001K'04 4ti Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No. 463362 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, Town of 032-2160-20-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No (3-1 CST 12.31.19.1380 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic J„„^ Benchmark / 102- Fie- n Alt. M ! n 55 Aeration Bldg. Sewer 4 Z5 (T7 `75 Holding St/Ht Inlet 5 .GS `l (o • 5 TANK SETBACK INFORMATION St/Ht Outlet 1 S $ % ' Z TANK TO P/L WELL BLDG. EVentto Intake ROAD Dt Inlet Jr0 Septic Z~ Dt Bottom Dosing Header/Man. 5 6,100 95• Z Aeration Dist. Pipe (c+•to `T$ to•$ L Holding Bot. System T • 4744.5 7-7 yy.3 PUMP/SIPHON IN TION Final Grade 3.4 iv ' Manufactur De and St Cover M Z S~ Model umber TDH Lift Friction Loss Head TDH ' Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenc ise~ PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ~1 INFORMATION CHAMBER OR I ) Model Number 64--Z Type O l .0 V~ System: -36' 1 ~ > UNIT DISTRIBUTION SYSTEM # ea j ZZ roj-,A Header/Manifold Mistr(itbution x Hole Size ix Hole Spacing Vent to Air Inta ) Length Dia Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only a..L Depth Over . Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center I • 2 Bed/Trench Edges \ Topsoit~ Yes No Yes No COMMENTS: (Include Jcode discrepencies, persons present, etc.) Inspection #1: S 1~105 Inspection #2: Location: 2244 74th Stre t omerset, WI 540 5 W 1/4 SW 1/4 12 T31N R1 9W) Wild Turkey Retreat Lot 12 Parcel No: 12.31.19.1380 1.) Alt BM Description 2.) Bldg sewer length = Z~ (ion C~ -amount of cover ~:0 ~~y7 Plan revision Required? Yes No ()Cr - (o Use other side for additional information. _ J Date Insepctor's ignat Cert. No SBD-6710 (R.3/97) Safety and Buildings Division County NvM1iffallmonsirn W. Washington Ave., P.O. Box 7162 AFW Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) (60 3,3 t /0 t0 2 Department of Commerce Sanitary Permit AP lica ion 1 QED Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, perso info ation y pp provide may be used for secondary purposes Privacy, w, s .04(1))Q R .8 oject Address (if different than mailing address) 1. Application Information -Please Print All Information T, CRO/ # ~ q jCT~~•1 zo X ~oUN?T I Property Own s Name /CE Parcel # Lot # Block # s jZ C. 1y V~ . Property Own Mailing Address Property tion P. o 14 Section City, State Zip ode Phone Number I cite one) VV `-~~0 T~ N; R E r W I . Type of Building (check all that apply) S Subdivision or 2 Family Dwelling - Number of Bedrooms Name CSM Number /WT(,, Q Public/Commercial -Describe Use Vv. Q State Owned -Describe Use ❑Cily ❑Village wn f III. Type f Permit: (Check only one box on line A. Complete line B i applicable) p 32. 2- o - zp -M 3 A' El Replacement S System [I ystem y Treatment/Holding Tank Replacement Only El Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that a I) is VxAjvg essurized In-Ground ❑ Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil ❑ At-Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In-Grou ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculatin Sand Filter ❑ Recirculating Synthetic Media Filter ac mg amber ❑ Drip Line ❑ Gravel-less Pipe ❑ Other (explain) ,t l~ w V. Dispersal/Treatment Area In rmation: Design Flow (gpd) Design Soi Application Rate(gpdsf) Dispersal Ar Required (sf) Dispersal Area Proposed (sf) yytem Elevapon VI. Tank Info Capacity in Total Number Manufacturer ~l l Prefab Site S Fiber Plastic Gallons Gallons of Units t - Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statem t- I, the undersign me responsibility for installation of the POWTS shown on the attached plans. Plumber'e (Print) Plumber's ure MP/MP s~RS N her - Business ~P-h^one N r ~ - Plumber's Address (Street, City, State Zi e) / ` wl ~`f ~C 7 VIII. Cotm!j1Dep;`rtmcnt Use Only X Approved ❑ Disa Sanitary Permit Fee includes Groundwater Date Issued Issuing A t Signature o ps) Surcharge Fee) El Owner n Reason r Denial 3) V IX. Conditions o pprova 1 , 3) A to SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced l maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 it 11 inches in size SBD-6398 (R. 01/03) P PLAN PROJECT P.C. Collova Bldrs. Inc. DRESS P.O. Box 489 Somerset Wi 54025 NW 1./4 SW 1/4S 12 /T 31 /R 1 W TOWN Somerset COUNTY ST. CROIX 3/25/05 BEDROOM 3 MPRS Shaun Bird 226900 DATE CONVENTIONAL XXX IN-GRO PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE DING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 NCHMARK V.R.P. Top of 2" pipe = DM I ASSUME ELEVATION 100' Filter ZabelA-100 D BOREHOLE O WELL *H.R.P. Same as Benchmark Alt. BM Top of 2" Pipe C 100.7' SYSTEM ELEVATION 966.11//9966..33 4.5' below qrade Well is to meet all Plans Designed Using setbacks required by Conventional Powts WDNR Manual Version 2.0 Vent >6" Standard Biodiffuser of Cover Leaching Chamber with 31.1 ft2 of Area 11" 6' Long 3 4" Grade at System Elevation Pro 3 Bedroom House fit' B.M. Please note: original benchmarks may be 15' destroyed, durin B.M. ert P Y Line g construction of home and new benchmark will be 30' 75' established 74th St. ad by original CST! 5% Slope 2-3' X 69' Cells with >3' Spacing B-1 10' B-2 Vents 25' 35' Q B-3 70, 466' Property Line PROJECT P.C. Collova Bldrs. Inc. DDRESS P.O. Box 489 Somerset Wi 54025 J31/R PLAN NW 1/4 SW 1/4S 12 /T 1 W TOWN Somerset COUNTY ST. CROIX BEDROOM MPRS Shaun Bird 226900 DATE 3/25/05 3 CONVENTIONAL )00( IN-GRO PRESSURE 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 chambers 22 NCHMARK V.R.P. Top of 2" pipe = ( ASSUME ELEVATION no, Filter Zabel A-100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Alt. BM Top of 2" Pipe @ 100.7' SYSTEM ELEVATION 96.11196.3 4.5' below qrade Well is to meet all Plans Designed Using setbacks required by Conventional Powts WDNR Manual Version 2.0 Vent >6" Standard Biodiffuser of Cover Leaching Chamber with 31.1 ft2 of Area 6' Long 11 " 34" Grade at System Elevation Pro 3 Bedroom Alt House B.M. Please note: original 15' benchmarks may be B M perty Line destroyed, during construction of home and new benchmark will be 30' 75' established 74th St. R :)ad by original CST! S 5% Slope 20' 2-3' X 69' Cells with >3' Spacing B-1 10' B-2 Vents 25' 35' B-3 70' ]Lii - 466' Property Line 1 t c SOIL EVALUATION REPORT Page of Division of safety and Buildings es. ws. Adm. Code not rase tier accordance wan Corm sme man must Cams Aaadr complete site plan on paper incNde. but not limited to: wx6cal and horizontal reference posit M). direction and panel to. percent slo^ scale or dimension. north arrow. and location arm distance to nearest road. ; C)-52 - Z ((v0 - 2D -oao i! 1380 Please print all inforrrtadon. I by Date Posond wdbmu eon you provide msy bs used ror s@-Way pwposes t *-7L-.6- 15-04(1)(-)).' propery l©catior~ XX Govt k# t 1/4 S 1' T N R E( W L d/ w F properly Oar's Melling Address Block # Subd. 777. qty State zip Code Phone Number city O usage own rt Owed Road New coron Use: Residential / Number of bedrooms code derived design flow rate GPD O Replacernert O Public - Describe: • ~r 1~%1.Y Flood plain elevation if applicable ~J.sz ft parent..: General comments ~ l lions: S~ 5~'ti, /•P dcx,~ , s and Baft # Boring Rate Ground surface elev. R Depth to iaitirg factor G r1M1 l Application Hotimn Depth Dominant Color Redooc Desualplim Texture Sbuciue Consistence Boundary Roots GPM in. Mu sell Qu. Sz. Cont. Color Gr. SZ. Sh ' 011 2 2- 141 A "I- a 02 8 eoring a ~ pit Ground surface /&,-~L • Depth to Iiaddn9 favor n. Soo Applica*n Rate Horizon Depth Dominant Color Redorc Description Texture Structure Considenoe Boundary Roots GPOW in. Munsd Qu Sz. Cont. Color 2s• S• W '~#1 'Eff#2 rfi• ' jr ' `lb •lo ~ a Effluent #1 = BOD > 30:s 220 mg& and TSS >30 < • m%myt #2 = BAD 130 mg& and TSS < 30 nglL CST Number v/Lzzzu '-7 ✓ Telephone MxMw Address ~ Evaluation Carrduded ~8 2 12 / S/~i ~7 Property Owner Parcel ID # Page of # ❑ e°"ng ® Boring pit Ground surface elev. 02 . )R Depth to Nrrl *V tailor /Yz in. Sol Application Rate Homon Depth Dominant Color Redox Description Texture Structure Consistence Botxtdwy Roots GPOIle in. Munsel Ou. S7_ Cant. Color Gr. S7_ Sh. -12011 •Eff#2 s IV z GG S BorkV F-1 # ° Borkv ❑ Pit Crowd surface elev. R Depth So Grtr6ng factor in. Soll Applicetion Ram Horizon Depth Dominant Color Redox Description Texture Strucdxe Consistence Boundary Roots GPM in Munsel Qu. Sz. Cart. Color Gr. Sz. Sh. 'E1 'EM F-1 Boring # ° BorkV ❑ Pit Ground surface elev. R Depth to limift factor in. Sol Application Rate Hermon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDIfF in. Maisel Ou. Sz. Coat Color Gr. Sz. Sh. •1211#1 TOM Effluent #1 = BODS > 30:E 220 mglL and TSS >30 < 150 mglL • Enkxm t #2 = BODS < 30 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. aeosuotrreoo~ Soil Test Plot Plan Project Name P.C. Collova Bldrs. Inc Shaun Bird Address P.O. Box 489 Somerset Wi 54025 CS 226900 Lot 12 Subdivision Wild Turkey Retreat Date 9/6/02 E 1 /2 S W 1/4S 12 T 31 N/R19 W Township Somerset R Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 2" Pipe System Elevation 96.5/96.1 *HRpSame as Benchmark Alt. BM Top of 2" Pipe @ 100.7' Please Note: Tested area may not be suitable for desired building area. Check system location before excavating. Also, survey was not completed at time of test. Set backs from lot lines may change. Alt* a~ a 5 a B.M. c 75 o M E~ 50 L Slope B-1 100' 10' 35' 35' B- 102' 25' 101' B-3~ 70' 466' Property Line e i S WILD TURI LOCATED IN THE NE 1/4 OF THE SW 1/4 LEGEND TOWNSHIP 31 NORTH, RANGE 19 WEST, TC ~j _ " 1 V GD PR SED DRIVEWAY y,~~p DRAINAGE EASEMENT NOTE' L pL- ~i ` ~ LOCA DNS - - BUI G SETBACKS COUNTY SECTION MONUMENT NO OWNER OR RESIDENT SHALL DO ANYTHING WHICH WOULD INTERFERE W (FOUND AS NOTED) OPERATION OF THE APPROVED COMPREHENSIVE WATER DRAINAGE AND SO. S q ~O2FOUN 3/4' IRON REROD PLAT. THIS INCLUDES BUT IS NOT LIMITED TO BUILDING UPON. OBSTRUCT 12' UTILITY EASEMENT EXCAVATING OR PLANTING IN ANY POND EASEMENTS. WATER DRAINAGE DI 'T SET 3 4' BY 78' IRON REROD WATER CULVERTS, BERMS OR GRASS SEEDINGS. WEIGHI G 1.50 POUNDS PER DRAINAGE EASEMENTS ST. CROIy, COUNTI c& 1zt>~ Ft ZONIidG OFFICE LINEAR FOOT AT ALL OTHER a.& 2.79 CONTIGUOUS BUILDABLE GENERAL NOTICE STATEMENT' NERS AREAS CONTIGUOUS BUILDABLE EACH PARCEL SHOWN ON THIS MAP (PLAT) IS SUBJECT TO STATE, COUN1 ■ SET 1 1/4' BY 18' IRON PIN BOUNDARY RULES AND REGULATIONS (I.E. WETLANDS, MINIMUM LOT SIZE, ACCESS TO WEIGHING 4.172 POUNDS PER PURCHASING OR DEVELOPING ANY PARCEL OF LAND, CONTACT THE ST. CF LINEAR FOOT HWE HIGH WATER ELEVATIONS AND THE APPROPRIATE TOWN BOARD FOR ADVICE S OOro6 NORTH-SOUTH LINE 1/4 SECTION LINE 2850 - 2617. 29812' r - - 296.04 - - ` 247.2880.56' 4 335.69' _ 236.11 •A I o vi x IN E- 0c) 14 vr,, I 0 I° Q •~oz~ rn K I < LL; F I Qd Y L_ ° I 8 = 0) 0 b~ J I - ~`tlb rn (D O °D`i+~ I I I ®j + _ _ y Q 2l tr) o 2 x n4l'1r W w _ 9'96z - - - - - ' 173.56_ _ Zei~ n tm.sa-~ •s;~;~ g j ZLi M .LZ.9Z.00 S .Y~\ w„S 4 _ z m aVOQI mam. ~LZL1' 3 -L&SLOO N N i' / ~ \ ` ` ~ S ;nn - - - 4y 219.85' z gig_ 252.68' c/~~~ n K /241 sv! w b cm w r.: ~t1 ddh ~p "',1 •'`V, I it) ( T M ` {S x01 E .9o•cs . _ _zf'szs ~a , an ~ ~ ~ r 1 I$ ~1\$ S 000.1 ' n I Q Q _ ' 'ncLCO N dd co /4!;i V1 m = h r 456.82 - 1x.91' 1 I 1 r M .OO,ZSyO g , as u(- ~y ~e I I I I \ sas. o lei ' I i rYa ; 1: b I LW 100' ~•/.p Y, tg , d (p f I $ 3 -c(.es~ ~rcye N~ ~ - I I ~3 DD ,,,tn ~ ` y g I;n y~ x m''I I~ I ®i Q p1{ W S n rnl I ad co g. nl 16991 ; Lik°rr~I1I Of 11 N In E LL; lZ LL: V-i Q gg U) U 1j 100. I O 90,6Y .Q..~ 1 M^ W$ $ ~Q : s ° Mr+j ~i~ 34.0 I E- C, 0 E- I I M ~f " a I W 3t I I - _ - .oz'tio9 A~~r I ~ O L - I I t~ i 3 - - 3\ s 219.92' - - - - 241.09' 459. 1x.11' _;f I L' .Lf.9GZ0 N I yrB=ei - - - - I rn z I N 00'04'13' W 878.92' u- S' r l I N UST I vi E-4 f~ 15 In° Is I a~ bj`cy I IN\ I 0 CO E-4 ~2 C4 Is 880.71------I I I I 481.90' ----JI 240.: b UNPLATTED LANDS WEST LINE OF THE E 1/2 OF THE SW 1/4 x ~ n N 00'04'04' 2854.74! Maintenance and Contingency Plan for a Septic System Maintenance Plan ed once every 3 years. 1. Septic Tank is to be pump 2. Effluent fitter 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. ins ections pipes at the ends of 3. Once every 3 years, cells are to be inspected via the p the cells. limit greases, garbage, and water conditioner discharge into the system. 4. Owner agrees to 9 5. The owner agrees to save this pi an. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. d as per Comm. 83 8. Discharge into system is not exceed those require p C Plan I stem fails, determine cause of failure, use zsrnate of and install new Option #1. Y n tested replacement area. II system at a lower elevation, by removing chambers, removing biomat, Option #2. Insta and install new system. No adequate area is suitable for replacement area, and system elevation Option#3 cannont be lowered. Install holding tank as last resort. 3. Replace any other falling 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 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer CC) „ QqG 1 Mailing Address WK `-l ;~9r UC I Property Address q J c~ O (Verification required from Pl ning Department for new construction.) I __T City/States mmU , Parcel Identification Number cyc O O~Z - Z~l~o - Zo-ooO~~) LEGAL DESCRIPTION Property Location l lJ/4 , , Sec. 19- , T'3) NR I 1W, Town of Subdivision Lot ~J Certified Survey Map # 1 , Volume Page # Warranty Deed # S __l , Volume 0 o , Page # a 9 Spec house U yes U no Lot lines identifiableA yes U no SYSTEM 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 County 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 Z2ent within 30 days of the three year expiration date. a A- cd~" P, C. COLLOVA BUILDERS, INC. 05 SIGNATURE OF APPLICANT (715) 247-2742 DATE P.O. Box 489 SOMERSET, WISCONSIN 54025 OWNER CERTIFICATION I/we certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the p p des ibed ~ove, b vi of a warranty deed recordAd tRe6U&J.is DERS, INC. (715) 247-2742 ~ j /d t / o _5 P.O. Box 489 - - - SIGNATURE OF APPLICANT SOMERSET, WISCONSIN 54025 DATE Any information that is misrepresented 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 and a copy of the certified survey map if reference is made in the warranty deed. FROM P C COLLOVP BLDRS, INC PHONE NO. : 71S 247 2747 Oct. 28 2002 02:14PM P1 lY/iO/UL Aw ll.uf liS 11:1 JDU auol P.CV4dL6A ur ijbl-Ws yyuus 8r~reruu or a BrSN~a~iwa. w7 7M Dfi D OOtearal NY~1Y~ wA,A~ =20 Tlia nesNi, Wads astsrosn Slaaaaa DioasQaiss~Calis Qulsn. ~ititi8 Fpg Ketl~fj~llfaa,Dads aisl aad Fo~tjesaa. pl-ikt-aYi,T ila= An _ _ YAlif7r iEFD 419®tat', ettd P ..t atlws Bmtdarl, iae»a h$sc Cac,~arlmf,, gEMT arssla~ ~A~1 F~g• tirsa+,ae, !pr a ws1u16k oxaadesdon, ioawyn b Qsaoear as i ft+tloMiafdrati6od nW,t ~stats is fits Crnfs Caisnb'. Suds sf Wii mlo ftrmon %FSes a t~seded ;(sate w%b0 ukbWw4: bt,'4 gi'$"14 Of SoWan 1; , Twt0*~f: S) intaje )9 WM SL CMiaa 1 lteowdlai AYW wfl:y. 1A'Wmsb. I Mang ar Cam Md"a P. U i3ar,. t~4/ cs2.to>d.aa•uno~a~~±aa+~~aaoa ?r.'fi1 iltrit.4Tctii0a Ntarber JYS ' 7*!e ~t - nos,tir®a oa~etr. 1 Oil (rrnN) 1! EAa0Stl4A/iD'*aM1'4Pt'ia~ n°Srxra+lt~ro3:~~tilC'9.Y.CrlilfttO•Pf,wayulnanrA,ifeny D4W vhit 44Y of NWeh 11104 r~ • ioa Ae+M Qr~ nom- ~ r.. AUTilEK7tGATStN~ AC1CN:ryI.~DGh'lE~7 aSEaalutt(s; wMni Dhaa CaMat Cotln~alia itdla dua15O STATE CF W-MUSfT ) ~ ' Ccwt. authantfaat 'h4s gfOYi'f MrrNr. lyeroanulfYrtmslWn,«emetkh_ _ do, or { srtt>3:1Nt)1 M vA r: MiLof wiscom.-4 (if tmt., ros knows to h• tM a.rwifs> ~+iw s*~ ihr ~mwpY:aa i isavu .rn.T sod sekn,vwWdWed Ac woo. j aaWaritsd !y ~ 7P3.Gi. ~+1~et.1 Zli7F1lJRTAifHtGNSWAif?0.A.►"S"a.Di'Y _ I ifnadia and NaweyP"Ik' At6fWftr]alin My CeaabMan is yermanM, (if n% upkma- 4ata. mpom swim tWntatl:ad w sbwuisdiai sodi tilt ZV4 --_4 , • Nt 1 Cf I innu ii im YaF1at ,gw is wad Q 7•vaad bow ft-s mn b,0aan1M►'• KR Ijporm % Oa+d6 0, WAARANTV MM SSATZ"xaPVUCVWUN FOW 4.i-1000 gl-U6-44- E 1339-17' NORTH LINE OF THE SW 1 /4 0922' 66.00' ,3p E S X009. I - 437.09' - ~I r N 1 O I N 23', s'o, ° E LOT 14 86.72'I t~s~ 130823 S. f 3.00 A 607.26' I 0 0) 10) 0 80' RADIUS TEMPORARY t h ' I I CUL-D -SAC EASEMENT (TO C.B. 2.89 Ac. 21294 91.07'00 ) BE REMOVED UPON 304.01' I;' V V NORTH RLY EXTENSION OF w s 1 ROAD S 45'11'24- E m ~ I S E 89'11'11" 40 127.39' I I L _ LOT 1'~''I 12 N N ` j„~ Ln N w - - 136020 S. F. N I w N 100' 439.91' HWE = 60 I` w 970.0' 3.12 Ac. rncol , LOT 15 ' C.B. 1.35 Ac. I ' I w 130775 S.F. S 8741.00" W I 0 v, 143.50 ' I NPGF, ~S mss. 3.00 Ac. '1Jl L - I r HWE =Sp \ E` C.B. 2.29 Ac. BO 972.00' N 970.0' LBO _ 972.00' 6 S 88'49'52,. 1~ 461. 85' /57.75' z 211.36 i ' 77719274 ° 3t,1?'.. 10 ' LOT 16 0"~o O" (p S S . b'\ - W 3 130690 S.F.o 1115°3ss 81 O~ 3.00 Ac. 2 HWE HWE co 970.0 ` \ 11 Boa/o~ /~N 6 970.0 w u~ S 86. O ' to ~a 420 i o 08'47 1 / v+ rd SS 4, C.B. 0.78 Ac. a`182.52' o~ LBO = 972.00' k ; \ \ \ N 88'59'56" E HWE 38.99' 482.54 3? li~7.8' \ 836 N ` LO T 17 Wisconsin Department of Commerce ~4LY N EPORT Page of Division of Safety and Buildings in accordance ' h Comm 85, Wis. Adm. Code ~~{{~~((~~~~jj County Attach complete site plan on paper not less than 8 1/2 x 1 inc iz% Aarffftll~t include, but not limited to: vertical and horizontal referen point M direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and to ion and~i~~ toad. Please print all info rmat n. S ZomIN~ ()FFIOE Revie d by Date Personal information you provide may be used for secondary pu rivacy Law, s. 15.04 (1) (m)). Property Owner J Property Location r / , 0, C t2 C Govt. Lot~/~ 1/g~ 1/4 S ~p T N R E ( W Property is Mailing Address Lot # Block # Subd. Name or CSM# 01C> 0'9, qD State . Zip Code Phone Number ❑ City ❑ village Town Nearest Road ~v ✓ -o ) ~S' ' / New Construction Use: sidential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or mercial - Describe: Parent material Flood Plain elevation if applicable General comments and recommendations: / st Boxing # Boring jg-pit Ground surface elev. ft. Depth to limiting factor _,&~in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 3/ 5 r 17-- /Id o~3k~ In o 36 -1 a 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 GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 • Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) - _ CST Number Bird Plumbing, Inc. Shaun Bird 4c~Si re 226900 Address Dat E aluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 -J~~ 715-246-4516 Property Owner Parcel ID # Page of a 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 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 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 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil -Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODE > 30 < 220 mg/L and TSS >30 < 150 mg/_ ' Effluent #2 = BOD, < 30 mg/_ 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 (RAMO) T PLAN PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 NW 1/4 SW 1/4S 12 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5/20/05 BEDROOM 3 CONVENTIONAL XXX IN-GROU PRESSURE 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 chambers 22 BENCHMARK V.R.P. Bottom of Siding ASSUME ELEVATION 1009 Filter Zabel A-100 ❑ BOREHOLE O WELL IH.R.P. Same as Benchmark Alt. BM Top of 2" Pipe @ 100.7' SYSTEM ELEVATION 94.1/94.3 4.5' below qrade Well is to meet all Plans Designed Using setbacks required by Conventional Powts WDNR Manual Version 2.0 Vent ALo Standard Biodiffuser Leaching Chamber with 31.1 ft2 of Area " 34" Grade at S ystem Elevation Pro 3 Bedroom House B. M. 25' perty Line S 5 B-4 74th St. ad ope 20' 20' 2-3' X 69' Cells with >3' Spacing B-1 10' 35' B-2 35, Vents 25' 35' B-3 70' 466' Property Line ii