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HomeMy WebLinkAbout032-2185-30-000 consin Department of Commerce PRIVATE SEWAGE SYSTEM County: S C roix f4 ard; Building Division INSPECTION REPORT Sanitary Permit No: �� GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 479334 J ' 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, Town of CST BM Elev: Insp. BM Elev: BM Description: t � Sectionfrown /Range /Map No: Q) 12.31.19. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ) A660 B Fo � n � 0. Am, � /0rs / �: Z /�T Alt. BM � `t.-60 Z . 1 �•� Aeration Bldg. Sewer / W, Z u• Z Holding St/Ht Inlet 7.1 93. 3 TANK SETBACK INFORMATION St/Ht outlet 17 , -4 5 91.95 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 16Z �f _ `A 33 0 -33 Dt Bottom Dosing Header /Man. Aeration Dist. Pipe • Z q Z • 2- �- R Holding Bot. System Q e7 e /O 1-1 d PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover y 2 GPM ` Z . I 71r J Model N ber Z 9/. Z TDH Lift Friction Loss System Head TDH Ft Forcemain Length 7­ ist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length , No. Of Trenches 1 1 _ (� PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS (_ S( •Z ed � � SETBACK SYSTEM TO v u P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR n I t s ty5s- Type Of 65 1\ Syst I y y w UNIT Model Number � (�v, I v Q" o. w DISTRIBUTION SYSTEM /I ec. ZZ 4'a Header /Manifold Fistribution x Hole Size x Hole Spacing Vent to Pfjr Ina Pipe(s) �[ Length Dia 7 ength \ Dia ` Spacing er 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 46 • � Bed/Trench Edges Topsoil Yes [•_? No Yes [] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:_/ j / a 15 In Parcel No: 12.31.19. spection #2: Location: 702 224th Avenue Somerset, WI 54025 (NW 1/4 SW 1/4 12 T31 R1 9W) Wild urkey Retrea t II Lot 30 1.) Alt BM Description = �� G ° ` ? �'� G Wa�v�S L6 C.1 s 0 2.) Bldg sewer length = 33 - amount of cover = $ /I Plan revision Required? � _Yes [ No �� - - � -1 -- � - - -` — -- - -- Use other side for add itiona information. _ . _. ! � 1 651 - -- - - - -- - Date Insepctor's ignatur Cert. No. SBD -6710 (R.3/97) , .: S e B i jsion tnity 1 201 W. ` 1,��O�Si�� Madiso o ib �Permit Number (to be fille m b (608 151 Department of Commerce lan I.D. umber Sanitary Permit Application In accord with Comm 83.21, Wis. Adm. Code, personal info tion ymi p�oy��e may be used for secondary purposes Privacy Law, s I 1 40N /N O`FfiOiV / 1 P ject Address if different than mailing address) I. Application Information - Please Print All Information , e ;� z ZZ Property Owner'7Ne Parcel # Lot # Block # 0/ / Property Location Property Owner's Mailing Address t 1 - 3" Y a, Section City, Stale ki� Phone Number / � r a one) T3 N; E rW II. pe of Building (check all that apply) 4A O(�: Subdivisio N e CSM mily Dwelling —Number of Bedrooms 1� r ❑ Public/Commercial — Describe Use El State Owned — Describe Use G I ❑City_ ❑Village ip III. Type ermit: (Check only one box online A. Complete line B if applicable) e ystem El Replacement System ❑ Treatment/Holding Tank Replacement Only L1 Other Modification to Existing System List Previous Permi and Date Issued B. ❑Permit Renewal Revision ❑Change of Permit Transfer to New � 7 Before Expiration �� Plumber Owner IV a of POWTS System: Check all that a l .3,%-- Non - ssuri In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ L tructed Wetland ❑ Pressurized In -Gr d ❑ Holding Tank El Peat Filter ❑ Aerobic Treatment Unit El Recirculating Sand Filter rculating Synthetic Media Filter Leac El Drip Line El Gravel -less Pipe El Other (explain) V. Dis ersal/Treatment Are forma ion: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal AreaRequired (st) Dispersal Are Proposed (sf) System Elevation 0 ,41 g VI. Tank Info Capacity in —Total Manufacturer Prefab Site eel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Q Tanks Tanks Septic or Holding Tani: 1 Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersig ssume responsibility for installation of the POW TS shown on the attached plans. Phone Plumber' ature MP/MPRS Number Business ne N tuber P� pr's Name (Print) � o _ / � f � J� a Plumber's Address (Street, Ci �� ,Zip L v111.CpuuLyjD e artment Use Onl Sanitary Permit Fee (includes Groundwater Date sued Issuing t Signature Stain pproved ❑ D' pproved Surcharge Fee) ❑ er ' en Reason or (� (J�J Q tt/ v✓ Ili:. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: /"e�`-J irk 1. Septic thrik, effluent filter and dispersal cell must all be services / malntalned as per management plan provided by plumber. 2. AN 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/Z x 11 inches in size SBD -6398 (R. 01/03) i Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County �) + Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must r 1 include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. P Please print all information. Reviewed Date / �y< Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). �� ,J Property Owner Property Location 1 j2 ` ) / 0 Govt. Lot 1 /4 j JI /4 S -T N R E (o W Property ga r's Mailing Address Lot # Block # Subd. Name or CSM# 7: 0 x- v� 0 City State J Zip Code Phone Number ❑ C I� e Town rest Rqa ew Construction U - esidential / Number of bedrooms Code derived design now rate GPD ❑ Replacement � ❑ Public or col meraai - Describe: Parent material � "X7 Flood Plain elevation if applicable - - -- ft. General continents and recommendations: 7--%1", 2-/ 1 9/,0 F Boring # Boring / t Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 © Boring # �Boring 7`�it 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 a--/V 10y'-UL T , J Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Narne (Please Print) Sig a CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 5401 fl � 715 - 246 -4516 ' ^ C Property Owner _ Parcel ID # Page of Boring # Boring Ground surface elev. V 2, / !, v ft. Depth to limiting factor � in. wit 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 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 F-1 Boring # Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgA. • 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.6330 (RAW) Property Owner _ Parcel ID # Page of Boring # Boring Ground surface elev. ` !, 0 ft. Depth to limiting factor -� in. RGPDAf ced ate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#2 fo F -1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 a Boring # ❑ Boring Ground surface elev. ft. Depth to limiting factor in. C1 Pit Sal Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg& • 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. SOD4330 (8.6/00) r y ' j31 Test and System PLOT PLAN PROJECT P.C. Collova Bldrs. IncADD ESS P.O. Box 489 Somerset Wi 54025 NW' 1/4 SW 1/4S 12 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 8/11/05 BEDROOM 3 CONVENTIONAL XXX 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 IL BENCHMARK V.R.P. Top of lookout foundation ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark SYSTEM ELEVATION 9591.2/91.0 Alternate Benchmark Top of 1/2" pipe @ 100.0' Plans Designed Using Conventional Powts 362' property line Manual Version 2.0 Scale is 1" = 40' Well is to meet all unless otherwise setbacks required by WDNR noted B- Vents 150' -3 70' 35' B.M. Pro 3 70' ST 40' Bedroom 15' 20' House - 10' 2 -3' X 69' Cells with >3' Spacing Property Vent Line ALo Standard Biodiffuser Leaching Chamber with 3 1. 1 ft2 of Area " 3 4" Grade at System Elevation Safety and Buildings Division r r 201 W. Washington Ave., P.O. Box 7I62 i Permit Nom (Lo be PH ed In by Co.) consin 66 Z 111 State I.D. Number De artment of Commerce lan permit Applie 3M 21 Sanitary A vide . $different than rnai address) In accord with Comm 83.21, Wis Adm . . Code, personal inform o? },y 4 Proj Address Law, sl5. ,(,�:'� ' ' P may be used for secondary Purposes Privacy , 70 oZ o14 #t)z I. Application Information - Please Print All Information arcel # t/# Block # Property O Name C � a Property fi pro Owner s Mailing Ad � ,�� �`^'� /., Section �_ t r3 Zip Code Phone Number / circl K. State / '3 T N, � E W City, � � d -5 a I l S CSM Number sio r�T EL of Building (check ail that ply) V/ or 2 Family Dwelling - Number of B ins ---- - -- - e (� o tp ❑ Public/Commercial - Descnbe Use �D - ❑City ❑Vil f4l ❑ State Owned - """'be Use Complete Iine B if applica III, Type of Permit: (Check only one box on Ii A zr,ent only Other Modification to Existing System ❑ Replacement System TreatrnentlHoldingIank R A. System List Previous Permit Number and Date Issued El C ge of ❑ it Transfer to New B. ❑Permit Renewal ❑ Permit Revision Plumb e er Before Expiration Z Z Z � ` '� ❑ Single Pass Sand Filter IV. ❑ T of Powrs S stem: (Cheek all that a l and < 24 in. of suitable soil ❑ At �e Saud Filter ❑ Mound ? 24 in. of suitable soil bic Treatrnent Unit ❑ Recirculating Sa on Pressurized In-Ground t Filter [] Aero In- Ground ❑ Holding Tan e k Gravel -less Pip C3 o (explain) Constructed Wetland ❑Pressurized g ❑ Dri i nc El chin Chamber Proposed (sf) System evation Recirculating SYnd -dt c- Media Filter ed (� Dispersal A opo , forma 'on: D ersal Area S V. Dis ersa gpd) m g $oil,k plication Rate(gPdsfl LT/ Design P 1 ow (gpd) Prfab Site Fiber Plastic Glass p Mani rer e rl 1 Concrete Constructed Capacity in Total N r � _ I � (}PlJ VI, Tank Info Gallons Gallons of ni W New F-asting Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber for installation of the PO S shown on the B ernieN onsibili Statement 1, the unde gne ume responsibility � her / J VII. Resp tY PI r' Pl Name (Print) , iue City, State, _ Plumb dress (S ; re�et, tY, e) Pl °`J-' V Issuing t Sign (No Stamps) tiridwatci- Date Issued Use On es Gro eat Us clod VIII. Coin We rum g ar ,; mry Permit Fee - Approved ❑ Di Surcharge Fee} tDV J 11 on r Denial Uv A. Conditions ppro SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / meintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. sln X ll inchcsin size the system on paper not Attach complete plans (to the County only) for less than SBD -6398 (R.. 01/03) OT PLAN PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 NW 174 SW 1 /4S 12 /T 31 /R 1 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 7/19/05 3 DATE BEDROOM CONVENTIONAL )00( IN -GROU P ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE K SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of ambers 22 ,BENCHMARK V. P. . Top of 1 /2" pipe ASSUME ELEVATION Filter Zabel A -100 D BOREHOLE O LL * H. R. P. Same as Benchmark 5 SYSTEM ELEVATION 95.1 .0 Alternate Benchmark of 1/2" pipe @ 100.0' Plans Desi ed Using Conventi al Powts 362' property line Manual ersion 2.0 Sc eisF =40' y�,�1.Li to meet all u ess otherwise setbacks WDNR required by Oted 100' Pro 3 30 ' 30 ' 3B' - Bedroom House 10' AIt.B. Vent B -3 >6" Standa Biodiffuser 0' of Cover Leach' g Chamber 2 -3' X 69' Cells with 1 ft2 of Area with >3' Spacing 11" 6' Long Vents 34" ade at System Elevation 0% )Slope B -2 Please note: Lot lines were not adequately staked at the time of testing. Installer must verify all lot 389' lines and setbacks before installation! Property Line G t�'P y OT PLAN PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 J31 NW 1'i4 SW 1 /4S 12 /!N/R 1 W TOWN Somerset COUNTY ST. CROIX 7/19/05 BEDROOM 3 MPRS Shaun Bird 226900 DATE CONVENTIONAL XXX IN -GROU P ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE T SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of mbers 22 ELEVATION o Filter Zabel A -100 BENCHMARK V.R.P. Top of 1/2" pipe ASSUME EL ' ❑ BOREHOLE O WELL «H. R. P. Same as Benchmark SYSTEM ELEVATION 9 .1 /95.0 Alternate Benchma Top of 1/2" pipe @ 100.0' Plans D igned Using Cony tional Powts 362' propert 'ne Ma ydal Version 2.0 cale is 1" = 40' & 5 - -dL i s to meet all unless otherwise setbacks required by WDNR noted 100' T T �Alt& F Pro 30' 30' B room use 10 45' Vent B -3 >6„ Standard Biodiffuser 90 of Cover Leaching Chamber 2 -3' X 69' Cells with 31.1 ft2 of Area with >3' Spacing 6' Lon 11 " g 3 4" Grade at System Elevation Vents 0% Slop B -2 Please note: Lot lines were not adequately staked at the time of 389' testing. Installer must verify all lot ' Property lines and setbacks before installation. Line Wisconsin Department of Comm ,OIL EVALUATION REPORT Page of Division of Safety and Buildings in ecccordance with Comm M . Code County Attach complete site plan on pap`e7 not ejtj,ri8112 x 11 inch #s i use include, but not limited to: vertical and horizon6l'id ference point (Bn Pan�i I.D. percent slope, scale or dimensions, north arrow, and location and dr r Please print all information. Re wed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). I P Property Location rY O Govt. lot 1 /4J ��tJ 1!4 S T l N R E (o W Prope er' Mailing Address Lot t # Block # Subd. Na � or � CS �� }J i D (.� -� . I K c /�L�/ /- city State Zip Code Phone Number ❑ City [I Village Nearest Roa New Construction Us � Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or co me - Describe: 9 --- - - - - -- - Parent material " -� - - - / Flood Plain elevation if applicable ��� -4 ft. General mmen oornm ati and recommendations: ��s5 /-� � �# Boring F - J] Pit Ground surface elev. � ft. Depth to limiting factor l! Z- in. Soil A Rate Horizon Depth Dominant Color Redox Description Texture Structure consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Etf#2 fir 0 ---- I, ,ti. l Yn r� r -E 15 ® Boring # Boring Alp it Ground surface elev. /Ob< Z ft. Depth to limiting factor -, in. Sod Applicedw Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 O fo 3 / m� Z I z 3y S-1 . G 3 A l ' il 1 cc 6z.Y 9� ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 ' Effluent #2 = BOD 5 30 mg/L and TSS < 30 7 CST Name (Please Print) re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 715- 246 -4516 Property Owner Parcel ID # Page of a Boring # Boring Pit Ground surface elev. 1' � I ft. Depth to limiting factor �• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 S a a 1 F-1 Boring # Boring �n ❑ ❑ Pit Ground surface elev. ft. Depth to limiting factor Soil 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 '042 Boring # Boring F ❑ Pit Ground surface elev. ft. Depth to limiting factor in. ication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/M in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eif#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, <_ 30 mg/L and TSS _< 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD4330 (86/001 K Soil Test Plot Plan . Project N ame P.C. Collova Blyds. Inc. Shaun Address P.O. Box 489 Somerset Wi 54025 CS #226900 Lot 3 Subdivision Wild Turkey Retreat II Date 11 /18/04 N W 1/4 SW 1/4S 12 T 31 N /14 W Township Somerset ❑ Boring Q Well PL Property Line County ST. CROIX f 1 /2 T Assume Elevation 100 ft. op o pipe BM or VRP �� System Elevation 95.0/95.1 *HRP Same asBenchmark 00 Alternate Benchmark Top of 1/2" pipe @ 100.0' 362' pro line Scale is 1" = 40' unless otherwise 100' noted B -1 Please note: Lot lines were not 3 adequately staked at the time of 10' testing. Installer must verify all lot lines and setbacks before installation! ;2 1" 45' /�' B -3 0 ' 0% Slope B -2 389' Property Line B.M. TOP OF 3/4' 60 RADIUS 4 r IRON PIN ELEVATION TEMPORARY 987.24 CUL -DE -SAC EASEMENT. TO BE 1 IN 1/4 CORNER OF SECTION 12, REMOVED uaoN 1 FOUND 3" ALUMINUM MONUMENT NORTH LINE OF THE NORTHWEST 7/4 OF THE SOUTHWEST i/4 EX OF — — S 89'06'44" E 1339.17 ROADWAY f / 361.86' ./ 360.26 � � 66.0 � 551.05' / / - 722.12'- I / / I � S25 7'07 "W 91. <7' LOT 30 70 E'SE EN of N BD' RADIUS V/ 9ax.0o' LOT 28 TEM PDRARV 1 1362 S0. 1 I L BO . 9114.00' ..00' CUL CUL -DE -SAC W C / / / I I 131058 S0. FT. ° EASEMENT, TO BE v REMOVED UPON ° / 3.00 AC. vlesTERLY U" 1 LOT 29 - % `� ^� / E %TENSION OF ROADWAY N 131754 SO. FT. / �' U / / a 3.02 AC. / /\ / �Cp/ J N 89'21'04" W 599.04' 279.20' 379.84' S67'33'00 'c! 86.54' TO ASEME Of O ' / \ Lj / B. M. TOP 3/4 EU ' m EASEMENt \ IRON PIN EIEVATON � -S 895758 W - - - - _ y 998.04' J / J• / I m 193.98' - 79 5 32.. s� 6 T3 ' z 4T cs ti� / / o AVENUE \ \� : ^ry o- /� // LOT 27 U� LOT 25 \-N 89'57'58" E -= -�-��_ C6 \ / h� ary�ry 134502 SO. FT. '°- w� 131068 SO. FT. p 3.08 AC. � 3.00 AC. .° C� B.M. TOP S /a' EL J. ? IRON PIN ELEVATION Z .-- -- --'- 2 / � � I p 997.77' Z Z Z O 1 F I \ / 83 20'23" VJ 535.03' l t--j o N ° LOT 31 U10. 992aa' m F m a '- 137273 SO. FT. ? s I I \ LOT 26 / o O O N w 3.15 AC. I �NZ I I \ 131230 SO. FT, / / y o -, \ o ID = W 0 I -N 89'33'57" W B.M. P TOP OF 3 /a' 57 N 1 \ \ 3.01 AC. / - - - .p z rn $ RON IN ELEVATION / 2_. 'y \ / J ' i 108.33' O 1� N N 947.90' A \ D \ \ \ / / C 171 Z g - --�'-� 108.90' o - S 89'3357 E C, 6 I . S 01 1 s ` LOT 32 O' 140495 SO. FT. \ / z / 3.22 AC. o \ — — Z N N LOT 35 LOT 36 N o_ 130965 SO. FT. 130921 S0. FT. J LOT 33 H w, 3.00 AC. J 3.00 AC. 130918 SO. FT. w LOT 34 3.00 AC. m po 130834 SO. FT. m 2 O 3.00 AC. 428.08' 455. 220.69' 236.06' z N 89'06'44" IN 1339,95' 0 a w UNPLATTED LANDS \� -� ' \ 1 cw rnoniro nc crrnnu .� , Y Maintenance and Contingency Plan for a Septic System Maintenance Plan 3 ears 1. Septic Tank is to be pumped once every years. r is bung installed in 2. Efflue ntfilter is to be cleaned once a year. Please note: a larger filter order to extend the maintenance interval of the filter: actions pipes at the ends of 3. Once every 3 years, cells are to be inspected via t he inspections the cells. ' reases, garbage, and water conditioner discharge into the system. 4.Owner agrees to limit g 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. 8. Disc h r e into system is not exceed those required as per Comm. 83 y Plan ?Option # . system falls, d etermine cause of failure, use a Ornate ae and install new m in tested replacement area. removin biomat, Option #2. Install system at a lower elevation, by removing chambers, 9 and install new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. 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 -5 Shaun Bird #226900 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer e r Cn to y gy l yj am , - Eri c Mailing Address p(-) �X �0 q , So cn P,f-�3 e, 4 - Property Address '70� ola �t ' Roe �Cl mP �� �� c�� O a � (Verification required from Planning Departme t for new construction.) City /Stat Wel_34, U Parcel Identification Number LEGAL DESCRIPTION Property Location MA) ' /4 , ' /4 , Sec. , T (I N RAW, Town of Subdivision � ui l d_ - T - U( �)b j RC &Q— , Lot # 3 0 Certified Survey Map # ' / Volume Page # Warranty Deed # j 5 q3�f Volume 2 -VT Page # 0L` 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 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. 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. Cprtification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning T ent ithin 30 ys of the t ree year expiration date. P. C. COLLOVA BUILDERS, INC. 22 (715) 247-2742 /�cJ / SIGNATURE OF APPLICANT P.O. Box 489 DATE SOMERSET, WISCONSIN 54025 OW NER CERTIFICATI :des L=edabnq� y that all statements on this form are true to the best of my /our knowledge. I /we am /are the owner(s) of the p ope by v'riue f warranty deed recorded in Re i e f s i pERS, INC• P. C. ��C715 2 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. .v. U 2 4 8 7 P 0 9 6 - 7 s121 "E30Z4 1 J it DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982' WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO.. MI RECEIVED FOR RECORD This Deed made between -_ E-I a1. T1Q_._ M_..._Quirxn ;------------ - -- - -- 01/07/2004 11:15AN s- I ngle- _perso -- -- - -- ... -- - - - - - - - --- WARRANTY DEED _. .. -- Grantor, EXEMPT # -- -- and .. P._.. C�.._ Csal �Q37c1__ F3. uildQxs-,--- Iz1C ....- ...a..MxA_x1esSZta.__... REC FEE: 13.00 Co =para.t nIn--- --- ---- ------- -- -- - -- - --- -------------------------------------------- TRANS FEE: 1200.00 COPY FEE: j C FEE: -- --- - - -- ------ - - - - -- ----- - ---- ------------------ -- -- ----- ----- --- ------ -- --..__ , Grantee, PAGES: 2 Witnesseth That the said Grantor, for a valuable consideration_. -._ I _y t - _ e... - - ...._... _ i- ---- - -- --• RETURN TO I� conve . ys to Grantee the . . follo . wing deacrlbed real estate in _- St - .--- CrO.ix_. _ ._._ -. County, State of Wisconsin: A"Q3 _1 1 3 Z-6 Legal description attached Tax Parcel No: --------- i I I a i I I i{ This ------- iS --- riot ------- homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And---------- ------ --- --- - --- •----- - - - - -- - --- - - - -- ....................... ... ................ ......•. - --- ----- ---- - -- -.._....- - --- - ------ -- ---- +{ warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except i � I and will warrant and defend the same. Dated this ... ----- - - 6th ----------- - --- - - - --- - - -- day of ....... January.. 2004 ... ...................... (SEAL) r_ - ^ - - - - - - -.. ` - -Ela n..... .......4uinn ..... ............- .... .... __(SEAL) - ------ -- --- - --- --- -- --- --- -- ..... ...... -- w I i AtrTHENTICATION ACKNOWLEDGMENT r, Signature(s) ____ .___ ..............._ . --- ---- -- ------------------- STATE OF WISCONSIN -•------- --- -$.ti..- --�`i�oa.ac.... County. authenticated this _. - da - FM.C._t_.- Turner 19 ...... Personally came before me this �2�k1 --------- day of u011C - -- sa-nuarlr, ___200.4 ------------ XX------- the above named '------------------------ -------- State_.Qf _ Wisconsin Eiane_..M..._Quan.. .a _.�_ns_].e--- Rer,soP -- TITLE: MEMBER STATE BAR OF WISCONSIN --•- - - --- - ---•-- - -- --- ---- ------- --- - - --- -•-- ---- -- - -- -... (If not, ----------------------------------------------------- - authorized by § 706.06, Wis. Stats.) - - - ----- -.. to a own b e persoerso n ..____._____ who executed the fore i a d s wle the same. THIS INSTRUMENT WAS DRAFTED BY David M. Newberg, PO Box 206 -- -- - - --- -• - -- --- •-- --• --• -- -• --- •-- -- • --- -- - - - - -- - - - -- -r -- -- �.A±!r`o S_t.i11 w_. tar. r___ Mh1__ 55QBL2--------------------------------- Notary Publi -------- ------------------ County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (Tf not, state expiration are not necessary.) date: -• - �� -�-•-- --- -------------------- •.... _., 29-- ---- - •Namss of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF W ISCONSIN Wi.ao in Local Biaak Co. Inc. FORM No. 1 — 1982 klil.vs ,kee. Wis. U 2487P 097 Part of NW % of the SW '/4 of Section 12, Township 31 North, Range 19 West, St. Croix County, Wisconsin described as follows: Beginning at t e West' /, corner of said Section 12; thence S89 "E along the North line of id SW A 1339.17 feet to an iron pin; thence S00 0 04'04 "E along the East line of he W '/z of said SW %., 1301.28 feet to an iron pin; thence N89 0 06'44' W 1339.95 eet to an iron pin on the West line of the SW % of Section 12; thence N00 °02'02 along said West line 1301.27 feet to the point of beginning. " ` LLJ LLJ 0) Q z f- LL- •9 z N 15 LLJ LL. J J N or Q \ \ p d Of c � F- Z N O 0 vj J O 00 / �� mLr rn / A, ) F- ,98'88 3 «SS SZ.ZO N �'/ v j � N ry ,W 'o Nw i CV ' ;z Z� O 0 co z � I I �:D I I w p z 0 o w wD ,� I �Ln m - 00 rn Ln LL] U, � `� � a � 0 , . _ \ / � �� U I � Z Lo / 370.59' 66 00' -� ry m N O z I 0 00 z O ����? >-Z o �z WEST Q I Z J 0 r O W W �� I <Do >WZ PI) t2 O �mo -jcw2V)F-Q I� ODC)Q 00 C) LJ Or 3: W O' V) O w Z U O ►= �- to