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HomeMy WebLinkAbout032-1034-40-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety end Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 420610 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: P.C. Collova Builders, Inc. I Somerset Township 03 3--o�) 6 " Z O —a > CST BM Elev: Insp. BM Elev: T Description: Section/Town/Range/Map No: CST BM Elev: Insp. BM Elev: 12.31.19. TANK INFORMATION ELEVATION DAT /39a TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. S e anal Grade PUMP /SIPHON INFORMATION Manufacturer Demand St C GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. I Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid 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 I 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 Bed/Trench Edges To Yes E No Yes [ No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: Somerset, WI 54025 (SW 1/4 SW 1/4 12 T31 N R1 9W) Wild Turkey Retreat Lot 22 Parcel No: 12.31.19. 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Ilan revision Required? I ; j Yes No LT se other side for additional information. _ D -6710 (R.3/97) Date Insepctor's Signature Cert. No. I Safely/ Slid Buildnlgs DWidon Y ) 201 W. Wasbiagton Ave., P.O. Boa 7162 5 V M % WI 53 707 — 7162 Site Ad j De artment of Commerce ZZ N Sanitary Permit Applicatio RECEIVE � 2U In accord with Comm 83.21, Wit. Adm. Code, personal ioformaWEL provde k if Revision my be used pri Law. s15. i L Application Information - Please Print All Information LD. N r pmpertyOwneesName� ZONINGOFFI ��l a r� of 0� - / 0 3 - o property Owner's Mailing Address �Q� �'S T N.1 city, Stain Zip Cade 7PhDneNumber I.gt N - Block Number _ Subdivision N CSM Number S L AJ) bz Type of Building (check all that apply) OCityy Rio f 4- ea.T 1 or 2 Family Dwelling - Number of Ovillage 0 pnbliclComme dd - Describe Use ,, / 5 0 State Owned ��' �/ ! l (i�l�'v E� - �� N Z 2 D III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete One B if applicable) A- 2 0 Replacement System 3 0 Replacement of 6 0 Addition to For County use Tank sty B. 0 Click if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) oa prossuimd m4round 210 Mound 47 0 Sand Filter 50 0 Consuneoed Wedand Zt O Pr�rited In- Ground 410 Holding Tank 48 0 Single Pass 510 Drip Line 45 0 At -Grade 46 0 Aerobic Treatment Unit 49 ❑ 30 0 Other V. Area Information: Design plow (Std) real Area Dispersal Area Soil Application Percolation Rate Syste=m Elevation Final Grade ReWited Proposed Rate(Gals./DayslSq p 4 (MmJ1ocb) Elevation o (D 4 � � /-) - -- Y �, Z VL Tank Info Capacity in Total Number Manufactmer Prefab Site Sted Fiber Plastic Gallons Gam of Tanks Concrete Construed Glass New Endue Taub ?woks Septic or Holdiu;l'ank _ Dosing Chamber VII. Responsibility Statement 11 the assume respan:36Dity for Installation of the POWTS shown on the attached plans. � �a Name Signa Phimber's Address (street, Cky, ) e� N IDe ent Use O nly Approved 0 Disapproved S Permit Fee (includes Graudwaoer Dace Issued S�� �° Ste) Surcharge Fee) ❑ Owner Given Lnitial Adverse , 7i 0 Deocrmination 1K. Conditions of Approval/Reasons for Disapproval A sys dick -4 dA . tLe Comt7 od7l.far ttx on paper rot ices dton z ll is sloe Soil Test and System PLOT PLAN PROJECT P.C. Collova Bldrs. APDA P.O. Box 489 Somerset Wi 54025 E 1/4 SW 1/4S 12 /T 31 ASURECONVENTIONAL WN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 12/6/02 BEDROOM 3 CONVENTIONAL )00( IN-GROUND 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. Top of Steel Fence Post ���r�, OSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 90.7 Not enough slope to * establish contours M. 120 , 558 Property Line 1% Slope B -1 qh� 70' B -2 Vents / �` 2 -3' X 69' Cells with >3' Spacing Vents 10' B -3 35' T 15' 15' I� Pro 3 Bedroom House a� a 0 j M N Plans Designed Using Conventional Powts Manual Version 2.0 Please Note: Tested area Vent may not be suitable for desired building area. >6 „ Standard Biodiffuser Check system location Leaching Chamber before excavating. Also, ?6'Lonjg with 3 1. 1 ft2 of Area survey was not completed at time of test. Set backs 1 from l ot lines may Grade at System Elevation change. 34" Pro Town Road Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of_�`� Division of Safety and Buildings i in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 inchen in siz �� �s 9 , / include, but not limited to: vertical and horizontal reference point ( M), die n Pa I.D. percent slope, scale or dimensions, north arrow, and location and istance to nearest road. Please print all information. J AN 0 2?001 Revi by Date Personal information you provide may be used for secondary purposes (Pr vacy Law. s. 15.04 (1) (m)). 2 3 Property OwD er ON (,f1/4 S , R E( W Props Owner's Mailing Add ss # Block # Subd. Narne or M# State . Zip Code Phone Number kty ❑ Village Town Nearest Road New Construction Use�Residential / Number of bedrooms _ Code derived design flow rate GPD ❑ Replacement //❑ Public / �r commercial - Describe: Parent material t� � r ��td-Y.�. . Flood Plain elevation if applicable �h r,�- ft. and recommendations ��''"� 5�°+sg�) , � ��ev ��• �S— (�- •.G��r�r�- cam. J�/� -��a © Boring # Boring L Pit Ground surface elev ft. Depth to limiting factor in. Soft 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 2 Boring # Boring ® Pit Ground surface eley ft. Depth to limiting fact in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 '042 Z' 177 .S Os All T1Z Effluent #!Z BOD > 30 1220 mg/L and TSS >30 < ' Effluent #2 = BOD < 30 mg& and TSS 130 nVL me Pleasapw Address , Date Evaluation Conducted Telephone Num - - /-� Vz r- Property Owner Parcel ID # Page of a Boring # ❑ Boring Pit Ground surface eley/- ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtYf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 F cq- Boring # ° Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Boring # ° Boring Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Sal Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDtrf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 • : > < Effluent #1 BOD > 30 < 220 mglL and TSS 30 _ 150 mglL Effluent #2 - BOD 130 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -8330 ("M) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 420610 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: a Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. r ` Permit Holder's Name: City Village X Township Parcel Tax No: P.C. Collova Builders, Inc. _ Somerset Township N A r y I 62 CST BM Elev: Insp. BM Elev: BM Description '61 1 Idd 1 U 1 I l i ne"V— TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic A0 Benchmark ' IS Les 6 Dosing Alt. BM Aeration ov Bldg. Sewer Holding St1Ht Inlet 15 TANK SETBACK INFORMATION St/Ht Outlet Z TANK TO P/L v WELL BLDG. Vent to Air Intake ROAD Dt Inlet / � T Septic \ � �� Dt Bottom / J C Dosing Head ! ih /e b Aeration Disk. Pipe r � Holding Bot. System r . t I , g9 / PUMP /SIPHON INFORMATION Final Grade 3 5 • �b Manufacturer Demand St Cover ( L GPM Model Number TDH Lift F n Loss System Head TDH Ft Forcemain Length Dist. to well SOIL ABSORPTION SYSTEM Gn C am_ BEDITRENCH Width I Len / gth No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ' SETBACK SYSTEM TO P/L '- JBLDG WELL LAKE/STREAM LEACHING Man facturer. INFORMATION CHAMBER OR a yC�l Typ Of System: t '> �� �-- UNIT Model Number: DISTRIBUTION SYSTEM J � . � v absnr ✓• Header /Manifold IDistribution f x Hole Size x Hole Spacing IVent to Air Intake f Pipe(s) I, r,, l �� Length Dia I Length Dia J►S{5�cit�g � SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only r Y Depth Over / Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bedlrrench Center / _ �' Bed/Trench Edges Topsoil vJ [� Yes ❑ No [] Yes ❑ No T COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / 17- 2 - 1 / d Z Inspection #2: ! ! r- Location: Somerset, WI 54025 (SW 1/4 SW 1/4 12 T31,jNR19W)) Wild Turkey Retreat Lot 22 JL"� Parcel No: 12.31.19. 1.) Alt BM Description = ST �v�l✓� r 'R """�- �� �J �' "� X�I �`f) 2.) Bldg sewer length x� (Jh _J2 a S! � � /�- � a ,c+'S - of k404 � � (',' + 4o 15� )(f h �� �-�- � d 50- ,s - '� - amount of cover �t8 �� Plan revision Required? Yes ❑ No , Use other side for additional information. � 03 1 __ -_ —_ _ G�- '�r/lti�- _� f SBD -6710 (R.3/97) Date insepctor's Signatu Cert. No. Safety and Buildings Division Cry C j I N * I 241 W. Washington Ave- P.O. Box 7162 scons�n Madison. WI 53707 - 7162 She Address , De artment of Commerce /t-- 7 -07- J e` Sanitary Permit Application s"ita`'' Neer 42-0( in accord with Comm 83.21. Wis. Aim. Code, personal information you provide ❑ Check if Revision may be used for Privacy Law, s1S. 1 m L Application Information - Please Print All Information State Plan I.D. Number Property Owner's Name Pared N C , Cv� )d �b Properr Owner ' a Mailing Address i'roPery �li -544. S /d T 31 N. R City. State N Code umber O � l� Number Block Number p 9 14 Subdi,risioa ame csM Number II fP - ' 0 W ' bU ' r CommemW Te of Building (check aII that apply) °"� S� - G N"NG O y - 2 Family Dwelling - Number of Bedrooms L��o "w� 2 - Describe Use 0 State Owned 2 3 ' ,k 6& , T'S-- h s '� ZZ IM of Permit: (Check a* one box on line A (numbui ng scheme for internal use). Complete Hue B if applicable) AL ew 2 0 Replacement System 1 30R.0aceinentf 1 60Additiont, For Coin use System Tank B. 0 Check if S wituy Penton Previously Issued Permit Number Date Issued M. Tnx of Permit (Check all that apply)(nnmbeting scheme is for internal use) 2t ssurized - Pressurized h Ground 210 Maud 47 0 Sam FdWr SO 0 Cousbuctea Worland In4ramd 410 Holding Tank 48 0 Single Pass 510 Drip Line 45 0 At -Graft 46 0 Aerobic Treatment vnu 49 0 Rc=cukftg 30 0 Other V. Area Information: Design Flow (ad) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Foal tirade Proposed Raoe(Gala / Days /Sq.Ft.) (Min•/Inch) Elevation 3 6 0 9 '/' 7/j /),O I s VL Tank We Capacily in Total Number Manufacwrer Prefab site Sail Fbex Plash Gallons Gallons of Tanis Concrete Constructed Glata New Eshtlna Tanks Tads kpdc or Holes Tank Doft Chamber VII. Responsibility Statement- 1, the >mdersigned, for installation of the POWI'S shown on the attached Plumber's Name (Print) Plumber's S' / ItsP/11�RS Number Business Phone Number 2 Z � �� �.s �- / Plumber's Address (Street, City. state, d V-tw gAzL JW)" 2 Approved 0 Disapproved Satutax Permit Fee (includes Groundwater Date Issued Signawre (No Stamps) Surcharge ) 1 0 Owner Given h» fm Adverse �7 I Detetnbination LL-� !' 3 - 1 �' DL Conditions of rav""sons foT Dim ` �t ill rs?�e w�a be w„a� a � •�e, the cnaer ooh) for the sptem ore srpes tot less trio i>f/2: u hbchss to size SBD -6398 (R. 05101) PLO AN PROJECT P.C. Collova Bldrs. A ESS P.O ox 489 Somerset Wi 54025 E '1/4 SW 1/4S 12 /T 31 N/ W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE12 /6/02 BEDROOM 3 CONVENTIONAL X0C IN- GROUND PR SURE 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 IL BENCHMARK V.R.P. To Surve Ir '/ P Y ft I ASSUME ELEVATION 100 Filter Zabel A -100 BOREHOLE O WELL •H.R.P. Same as Benchmark SYSTEM ELEVATION 94.7/94.6 It. BM : Top of Lath h @a 1 03.0 ' B.M. 558 Property Line t. .M. 0 2 0 , B -1` Vents 2 -3' X 69' Cells with >3' Spacing 30' 5' ? 3% (Is 70 B -3 Slope Pro 3 .S Bedroom a House ` 50 ' ST 30' B -2 t Vents N Plans Designed Using Conventional Powts Manual Version 2.0 Please Note: Tested area Vent may not be suitable for desired building area. >6„ Standard Biodiffuser Check system location Leaching Chamber before excavating. Also, of Cover with 3 1. 1 ft2 of Area survey was not completed at time of test. Set backs 6' Long 11 from lot lines may 34" Grade at System Elevation change. Pro Town Road PLO AN PROJECT P.C. Collova Bldrs. A 1 1 ESS P.O ox 489 Somerset Wi 54025 E i/4 SW 1 /4S 12 /T 31 N/ W TOWN Somerset COUNTY ST. CROIX 12/6/02 3 MPRS Shaun Bird 226900 j DATE BEDROOM CONVENTIONAL XXX IN- GROUND PR SURE 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 IL BENCHMARK V.R.P. To of Survey Iro 5 Nk ( '� =4P ASSUME ELEVATION 100 Filter Zabel A -100 ❑ BOREHOLE (DWELL •H.R.P. Same as Benchmark SYSTEM ELEVATION 94.7/94.6 It. BM =Top of Lath @ 1 03.0 ' B.M. 5 58' Property Line Alt. .M. 0 2 0 , B -lt Vents 2 -3' X 69' Cells with >3' Spacing 30' 35' '7 3% 70' B -3 Slope Pro 3 Bedroom a House a, ` 50' ST 30' B -2 l; IIJ _j o Vents M N Plans Designed Using Conventional Powts Manual Version 2.0 Please Note: Tested area Vent may not be suitable for desired building area. Standard Biodiffuser Check system location A6'Long before excavating. Also, Leaching Chamber survey was not completed with 31.1 ft2 of Area at time of test. Set backs from lot lines may Grade at System Elevation change. 34" Pro Town Road Wisconsin Department of Commerce SOIL EVALUATION REPORT Page-A— of Z Division of Safety and Buildings in accordance with Comm 85. Wis. Adm. Code Attach complete site plan on paper not less than 81/2 x 11 Indus in size. Plan must include, but not limited to: vertical and horizontal reference ' '(BM), direction and Parcel I.D. percent slope, scale or dimensions. north arrow, and location distance to nearest road. 1 Please print all Information. R 1 Date Personal infarnobon you provide maybe used for secondary purposes (ltirivacy Law. s. 15.04 (m)). Property /1 Property Location /7 T; L- . Govt l at_ . 1/4 S 42 T 3 N R E ( W Property 9eTes Mailing Address Lot # Block# Subd. CSM# CNy State Zip Code Phone Number ❑ City ❑ Village Town Oarest Road New C.anhidw Use: Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public 1- Describe: —r -- - _ - - - --- Parent material / S� Flood Plain elevation if a R applicable /y /.t2 art comments /� �f t'�r ✓ Pi! Pi tJ� r 1 �7 �y _ Borhg # Boring a pn Ground surface elev -22-Z ft. Depth to irrift factory in. Sod Applicabon Rate Haiaott Depth Damhlant Redox Desaiptlon Texture Structure Consistence Boundary Roots GPDRP in. Munsed Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I •Eff#2 2- 7 5'2 Bodw # 0 Boring 7 El Pit Ground surface elew Depth to rimiting factor _��� in. a �I Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN Irl. Munsed Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 i • — — <_ < 30 mglL E ffluent #1 - BOD > 30 < 220 mglL and TSS < ngA. Effluent #2 - BOD 30 mglL and TSS _ /� (Please Print) - - Signature / CST Number I f ;F h d0 Address Date Evaluation Conducted Telephone Number l Property owner Parcel ID Al Page of ® Bwi% # ❑ Boring Pit Ground surface elev /� ft. Depth to lirn&V factor i .G—t? in. Sob Application Rate Horizon Dominant Redox Texture Stru ct re Consistence Bounds Roots Dots GPD/ff in. Munsed Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F Bo� # C] Boring ❑ Pit Ground surface elev. ft. Depth to frnMV factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Sfnxture Consistence Boundary Roots GPDM in. Munsell Ou. Sz. Cora Color Gr. Sz. Sh. 'Eff#1 'Eff#2 BorlrV ° C1 Pit Ground surface elev. ft. Depth to limiting factor in. F # Sod Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fP in. Munsed Ou. Sz. Cont. Color Gr. Sz. Sh. 'Ef1#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mg& ' Effluent #2 = BOD < 30 nxyl. 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. seo4330(PL6=) i L � Soil Test Plot Plan Project Name P.C. Collova Bldrs. Inc Sha ird Address P.O. Box 489 Somerset Wi 54025 _ STM #226900 Lot 22 Subdivision Wild Turkey Retreat Date 9/6/02 E 1/2 S W 1/4S 12 T 31 N /R W Township Somerset M Boring ()Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 94.7/94.6 *HRpSame as Benchmark Alt. BM Top of Lath @ 103.0' B.M. 558' Property Line Alt. .M. 0' B -1 20' 30' 35' 3% 70' B -3 Slope a a� o B -2 r 99 100' o �- M N 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. Pro Town Road r enc Plan for a Septic System Maintenance and Contingency Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. larger filter is being installed in 2. Effluent filter is to be cleaned once a year. Please note: a 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 altemate 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\ ST CROIX COUNTY I ' SEPTIC TANK MAINTENANCE AGREEMENT AND I OWNERSHIP CERTIFICATION FORM Owner/Buyer P. C. Collova Builders, Inc. Mailing Address P O Box 4 merset, WI 54025 Property Address (V ri ation required om Planning Department for new construction) Ci /State �—� h' a a�- Parcel Identification Number LEGAL DESCRIPTION Property Locatiort� %,, 0 A Sec. . T a) N -R W, Town of Subdivision c t Lot # Certified Survey Ma Volume . Page # Warranty Deed V1 4 �p �Q Volume P ge # Spec house yes ❑ no Lot lines identifiable yes ❑ 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 Zoning Department a certification form, signed by the owner and by a masterplumber, joumeymauplumber, restrictedplumber 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. I/we, the undersigned have read the above uirements and agree req gre to maintain the rivate sewage disposal system with the standards P g set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 d year expiration date. APPLI ANT DATE OWNER CERTIFICATION the 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 " rty scribed above b virtue of a warranty e Y ty d ed recorded in Register of Deeds Office. t-§ 1GNktURh OF APPLICANT 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 FROM P C COLLOVA BLDRS, INC PHONE NO. ; 715 247 2747 Opt. 2e 2002 02:14PM P1 10 /CO /UL Aun tl.ur Nu. I.L l 03 Auel "V11IL ur 1 j"" „ „_ _ tyyluuA. p 67 �1 y BTAY'0 "k Ctr tnKOt W* 10CAW 2 • WW4� T 194L C' W fl6�S oetrrta Mwbar j A,ARAXTV DRZ'b L 1� ice. V3 TIl+ DM1i ma 1 1 atwwe Ago so& Llimgri g, C QuIrN It 10 tif6 no I wwm K l�QtlleavDadk aiamacdFO�Q 84. — 111ag AN Grant9r, 0114 P Cegtna B YItd OT�S Iaa a l o Cw oral m, Dole OPMUL Creuera, 'br a vrVwhk <ar>itCfebon, amhoys 4a Gram. cv PoflowGtg dueri6ad epl etd✓sb .n Ol. CaeEt Counp, fj Sw 2f Wboattsln tw ee v spats it mwhcL;Inm easah> 7' 151,"4 gt'3Wl/A of 54won ! 1. TakMM; r l Nwtb : ,Uclp 19 VOL 9c Cater ( luyad4.t Am ( / 1 Ri • . d 6� cwr, MO M01 . !Vasa w U&M Add,ess Punt IdarUl,WM tXl :16 AM) I c2f70>:dMNiO',VlfM19D0A7e n' tae' c+ fa, ro3 :f�Ci1C!16 %".^.rlr1i51r•Jfway r�ltanrl, �!'°rq+_ Do>Ad t},ie � �4ay xf Mareh 90tl7 � t aer ! AL'THtN7lGAT11?ti ACXNc'W41SDLML. lwmurKa; tam" 2ha,L&*!a STATE OF w15:ANSIN i n a s1a� yet fer .: l,�q�0�DrrJ n s a_od 4tb�. ' m' au[hm�lu� Ctis GDy Cf Mr ._., — , 1700 peromwlly ev„rs 1+ -rbfv me +hk day or TTlLS MEbID 11g'S"?'f.l�.1RfJPWISCONS:N a,a�I.a9"ttybiiho,Jos (lirot, iettvm.era and *rA Q.kmdwtdLhC41000. ,tftrom K riman eed —_ —_ —__ - -_ T1amyA1Wk.3tateefWi9NLll� � My Castobswn is peMantrn4 ftf nol, smsa axpunrw daa. . I BiN�e my be awwab. -ei m Hedr Vitt RX nroerm.l •Nt 3rT ll0SaM101aial CWig*AYKm�YDada ri,Ld 4lGawASirsysshes. ��s+�rWRa4.,rnyvGwcas "�+ '�.'°'� su es r i7to! WulCwrouv oaoream wtatlt,wal;r celro ><arttar,.s.ttav �l r YRETREAT AL BEARINGS ARE REFERENCED TO THE SOUTH LINE OF THE SOUTHWEST 1/4 OF SECTION 12, T31N, R19W, RECORDED AS FHE SE 1/4 OF THE SW 1/4 OF SECTION 12, S89'1 8'53"E. SOMERSET, ST. CROIX COUNTY WISCONSIN. ALL BUILDINGS TO BE CONSTRUCTED IN PROXIMITY WITH DRAINAGE EASEMENTS SHALL HAVE A FINISHED FLOOR OR WINDOW WELL ELEVATION LOCATION MAP ELEVATION N TWLESS THAN TWO FEET ABOVE THE HIGH WATER CHANGE THE (nor TO SCALE) 385' FROM SE CORNER OF PROJECT TO NEXT DRIVEWAY EASTERLY. ON PLAN FOR THIS SECTION 12, T31N, R19W. - ERING, FILLING, OR FRONT SETBACK = 100', SIDE SETBACK = 12.5', REAR SETBACK = 25'. WATER RUNWAYS, k w UTILITY EASEMENTS < NO POLE OR BURIED CABLES ARE TO BE PLACED SUCH THAT THE scA f: 1' - too € INSTALLATION WOULD DISTURB ANY SURVEY STAKE. OR OBSTRUCT TOWNSHIP LAWS, !S VISION ALONG ANY LOT LINE OR STREET LINE, THE DISTURBANCE OF ETC.) BEFORE 6 So loo Zoo A SURVEY STAKE BY ANYONE IS A VIOLATION OF SECTION 236.32 LINTY ZONING OFFICE WISCONSIN STATE STATUES. UTILITY EASEMENTS AS HEREIN SET R LOCATION FORTH ARE FOR THE USE OF PUBLIC BODIES AND PRIVATE/PUBLIC UTILITIES HAVING A RIGHT TO SERVE THE AREA. UNPLAITEO LANDS ATNE ( I UNPLD LANDS "'— —' — — M n 209.72' _ 20 — _ _ 22 &02' — — — — — — _ — —52' — — — I 33.00I I II 1 1 I I � v i Q� igg l 1 1 I I E-+ t o 1 >7 3 0 00 I I I rn I I 1 1 I I — S 00*W " E -- i 0 I I _ cD ¢ - - -- $ W 1 I Cn U 1 1 r— 556.62' — -- i 1 O 0 O t"') d J 'o�i n 1 LL, I I Ira is S4 I i Ey � o g N 1 W� "' Q� W I I co V) I I m m0 ed aIII - 00 B N s I I rn I I 1 - 4 "' c7 a I li o Ey N t0 NI I [--t N I MI 10 Lo M � 0 � to M�d I t Ni I 1.4 Lo I — — — — S 00'08'08" E _, — — 55&72' ; d I W g 1 ' 3 E ,n o w = `� N sq I es PI ' oz AQ7 71 N 1 �1•i _ 3 "�%DLSt p �'�� _.zr p8 - � I ° � IN � 146.48 _ - y`9yee � / 461.22' S ry a w —ii 5 N 8076 oo' E S\ I I 166.34 I I I I �L` Q m` I 161 1 Lo ' Q I I Lri Q c`7 vi Q e _ E .., t O '� I I `E E -. In 8 W I I E•+ N O I Ey N O F R 0 W) q`As� O �� �° �Q r- 0" .I ,.a f 1 Im O � I lbi to O6 d O,.j t - - I I ra o I? r'? 00 . 04'13 - E -- ��'[ Zy 5 y..%V 23 E� m o1 r"f pq� .GQgq� ► , B 1 71 'p , P 1 1 — — — — 459.66. — i o 1 � , b In .60 [['[s �1 �"' t o o a 1 N i •q % � /y j� sa[sl �.el.alro N 1 0 a0 O _ 3 .N.L? to N L o -- -- 1 33. ' 218.89' 221.77' L 254.19' — 45&07' I 31 1875.03' — — — h 190 &03' I p o� ORAr1ED Or tt06 awAw SHEET 1 OF 2 =