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HomeMy WebLinkAbout032-2148-50-000 O N Q 3 G 3 ... 0 m v < c ° co = 3 N CD ": 7 = CD `r` W C CD N r 7 CL _ `A\ O C_ N @ O ' N C1 z @ N r• !b "'S O C O d (D Z -I N O O C .Tr co C (� N O p >v CO O :E O ,••r (�I � to � CO co ,III O � m v D a CD 0 A N G 3 Cl O O C O O S 3 C � - rn ? cn i Z cn w cu I O N N a CD O O cn CD O m O y O C a c 3 o a O O O N Mn� a� v_ O V n a .3 . U to °i m x °.: 3 a , O G � cn _ 0 =r C w y Co N C ' Of A C CD !r .r d I N 3 a Q. z f `\ `" II 0 0 D O o C) O C/) O CD Cj N • 7J W CA @ 0 1 C7 N C N CD W CD 3 C1 O A N M R CL 0 00 m C t z Q 3 0. O r: � A z A CD A 0 cn D N n C O d o = CD j O C N C m 3 z a 5' - 5 m CD d N I N N CD m 3 `- N CL fD O N N C m a N I CD O' G CD I N O N O O V A O pp CD pp ro O 69 O CD a Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division ' INSPECTION REPORT Sanitary Permit No: - 488131 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: Landucci, Nathan I Somerset, Town of 032 - 2148 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: Sectionl7own /Range /Map No: e 6-CST Rw: a 15.31.19.1296 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ate. / Benchmark l 9 /b ) 9 Alt. BM Z, 3 6 C". (p� F, I Aeration Bldg. Sewer Holding St /Ht In qo i7 - TANK SETBACK INFORMATION S t/Ht Outlet 57. Z:9 '7(,. TANK TO P/L WELL BLDG. Vent o it Intake net ep AJ b C4L.. Ic i o om (0n rs Ae; Vs 36 hod — Header/Man. (� 4 9 - 5 , S3 S CJ w^„' � n �►s1 i era Ion Dist. P ipe s `''g i s S 3 'l.tb H olding bot. Systern ?. 4Qi 4'q . S 1 . r(C , 93 ' 7 F inal Grade . PUMP /SIPHON INFORMATION Z,Li( ( ci5 53 v M anufacturer Demand st cover GPM um er lum ric Ion LOSS syst mea orcemain Leng Mr-Lif I DIMENSIONS (�6 Z. t ren _� _� CHAMBER OR mm�n INFORMATION �, lJ54� (� UNIT Go a ' sy (PlS 7 75 A! 4S N ( 3�O �,7—e , . \ [ WILW 44 Pipe(s) Length 7 Dia Length Dia--Sl_ Spacing e SOIL (;UVhK x Pressure Systems Only xx Mound Or At -Grade Systems Only Bed /Trench Center � !� Bed/Trench Edges Topsoil Yes E No "Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 2108 54th Street Somerset, WI 5402 (SE 1/4 SW 1/4 15 T 1N R19W) Oak Haven Lot 25 - / J Parcel No: 15.31.19.1296 1.) Alt BM Description= W� 2.) Bldg sewer length = 3c1 - amount of cover = Plan Reqred? Use other revis de for additional in rmation. No l �5 � �.� _ I / .f ✓ I Bate -� rtW -�- SBD -6710 (R.3197) r - afety and Buildin i� County 20 W. C0 �Pl3ZlP� C l���Ons�>� i n, /1' i7�(T7/ -' - 7162 Sanitary Permit Number (to be filled in by Co.) 08) 266 - 3151 ­r? Department of Commerce fate Plan Y.D. Num Sanitary Permit Al 1i In accord with Comm 83.21, Wis. Adm. Code, person info n 19C COU1`1N ber may be used for secondary purposes Privacy s .04(1 ) oject Address (if different than mailing address) I. Application Information — Please Print All Information Property Owner's Name , Parcel # Lot # Block # Property Owner's Mailing Address /1 Property Location /J 2 / e / r / Sr.l✓ ' /,, Section / /C"ty, S Zip Code Phone Number / / C� Subdivision 5 / rc ne) G ` T L_ N; or W II. ype of Building (check all that apply) A. 4.3 5 �o►nn -� e on N CSM Number or 2 Family Dwelling - Number of Bedrooms Public/Commercial - Describe Use State Owned - Describe Use ❑City_ ❑ ❑ Z- t6� X1.16 c.� ❑vil of 111. Type f Permit- (Check only one box on line A. Complete line B if applicable) 6 1 5 A ' New System ❑Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System List Previous Permit Number and Date Issued B. ❑ Permit Renew ermit Revision ❑ Change of ❑ Permit Transfer to New - Before Expiration Plumber Owner IV. T yne of Co cted Wetlan d ❑ Pressurized In- Ground ❑ Holding Tank POWTS System: Check all that apply) essurized In- Ground 11 Mound > 24 in. of suitable soil [I Mound < 24 in. of suitable soil ❑ At -Grade ❑Single Pass Sand Filter El El Peat Filter El Aerobic Treatment Unit El Recirculating Sand Filter Recirculating Synthetic Media Filter eaching Chamber ❑ Drip Line [] G Pipe ❑ Other (explain) v V. Dis ersal/Treatment Area ormati in: Des' Flow ( d) Design Soil Application Rate(gpdsf) Disper al Area ired (s is nal ea Propos (sf) System Elevation I 2L VI. T Total Number Manufacturer Prefab Site Fiber Plastic Tank Info Capacity in Gallons Gallons of Units Concrete Constructed Glass New Existing Tapks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VIT. Responsibility Statement- the undersigned a responsibility for installation of the POWTS shown on the attached plans. Plum is Name (Print Plumber's a MP/MPRS Number Business Phone Numb r lum is Addre treet, City, State, Zip' VIII. oun /De artment use Onl Sanitary Permit Fee (includes Groundwater Dateissugd Issuing t Signet (N pproved ❑ Surcharge Fee) ❑ O er en Reason 1 IX. Conditions of Approval/Reasons for Disapproval �` �> � t SYSTEM OWNER: JV 1. Septic tank, effluent finer and dispersal cell must all be Services / mefntlilinlild as per management plan provided by plumber. 2 AM sdback requirements must be maintained as per applicable code / ofdnarX06. Attach complete plans (to the County only) for the system on paper not less than 8112 x 11 inches in size SBD -6398 (R. 01/03) Soil Test and System PLOT PLAN PROJECT Nathan Landucci DD SS 2871 Leaion Ave N Lake Elmo Mn 55042 SE 1/4 SW 1 /4S 15 /T 31 N/ W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/6/06 BEDROOM 4 CONVENTIONAL XXX IN- GROUND S R CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SI 255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 900 # of chambers 36 IL BENCHMARK V.R.P. Top of ST Cover ASSUME ELEVATION 100' Filter BEST ❑ BOREHOLE WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 93.9/94.2 525' Property Line 300' 0% Slope 40' B -2 B -1 90' 30' Vents 25' 45' 30' B.M. 2 -3' X 90' Cells with >3' Spacing 35' Pro 4 Bedroom House Plans Designed Using Conventional Powts Well is to meet all Manual Version 2.0 setbacks required by WDNR jL ARC 36 Standard 174' Property Line Biodiffuser Leaching Chamber with 25.0 ft "2 of Area 3 5 Grade at System Elevation Wisconsin Department of Commerce SOIL EVALUATION Page of Division of Safety and Buildings in accordance with Comm 85, Fee ounty J C f� IL Attach complete site plan on paper not less than 8 1/2 x 11 inches in si lan must � include, but not limited to: vertical and horizontal reference point (BM), ion an ) D' percent slope, scale or dimensions, north arrow, and location and dista o rt a Please print all information Reviewed y , Date you vide may be used for seconds u (1) (m)). �oiX CC UNTY Personal information Y Pro Y secondary purposes (Privacy w, s. 15.04 �J S Property Owner rope ovation jj ) � Govt. Lot C 1 /4 J(,t A S l5 N R E (o w Property Owner's Mailing Address Lot # Block # Subd. Na or t ` L k) • o - City StateoF Zip Code Phone Number ❑ City [I Village own Nearest Road I 5-s&( ) o ew Construction Us esidential /Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Publicf commercial - Describe: __— Parent material Flood Plain elevation if applicable General continents and recornmendation System Type System Elevation r 1-1 Boring # C] Boring O Pit Ground surface ele ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture St Consistence Boundary Roots GPD/f? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I - Eff#2 f C `�' �°' Win- /' � S' ,.✓ i r a Boring # ❑ Boring Z", A -Pit Ground surface elor 99 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 L s" �- t AA- . Effluent#I=BOD , >30 ! 220ffigILandTSS>30 < 150mgA- ffluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Nance (Please Print) Signa CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Cond cted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 �-�� ® 715- 246 -4516 Property Owner _ Parcel ID # / Page of ® Bo, # Boring i J it Ground surface ele . ft. Depth to limiting factor / in. E*Eff#1 Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PDIif° in. Munsell Qu. Sz. Cont. Color G r. Sz. Sh. )M 'Eff#2 1 ,3 a 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 GPDlfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 E] Ground # Ground surface elev. ft. Depth to limiting factor in. Cl Pit Soil ication Rate Horizon ')epth 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 mg1L and TSS >30 < 150 mgA. ' Effluent #2 = BOD < 30 mg& and TSS < 30 mg1L 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 (RAM) Property Owner _ Parcel ID # / Page of ® Boring # Boring � ✓/ it Ground surface ele . ft. Depth to limiting factor / in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 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 GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil ication Rate Horizon - *pth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDAf in. Munsell Qu. Sz. Cont. Colo Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 rtg/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. SOD-8330 (R.6100) Safety and ing ivis n County AV 201 W. Washin O. 71 �frji Isconsin on, WI 5 D an Permit Number (to be filled in by Co.) Lf Department of Commerce (60 n Sanitary Permit Applicati n n pp pp s Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal informatio you p9�Lid1 2006 may be used for secondary purposes Privacy Law, sl5.04( )(m) 4Proj d dress (if different than mailing address) El T. CROIX COUNT , r I. Application Information - Please Print All Information 2 ©g 5 S+ Property Owner's Name 2 / Par- J A Lot # Block # 5e S -- /\j c cI, t� cx v., I'L C, (C, ) — Property- Owner's MaiN Address t6perly tion - A ; � . 1 /. L /, Section City, S Zip Code Phone Number r � � / OW �a� �.= X 'j , 1 r Y� T N R E h II. Type of Building (check all Ilk, apply) / L� v� d � S � Subdivision Name CSM Number or 2 Family Dwelling -Number of ms S _ � Oblic/Commercial - Describe Use 4 , ❑ State Owned - Describe Use ❑City ❑villag ownship of.�� III. Type of Permit: (Check only one box on a A. Complete line B if appli able) 2, ­,Q = f ' '50 A. New System ❑ Replacement System Treatment/Ilolding T eplacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ C e of Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber wner IV. g a ofPOWTS S stem: Check all that appl on - Pressurized In- Ground El ❑ Mound > 24 in. of suitable soil , d < 24 in. of suitable soil ❑ At -Grade El Single Pass Sand Filter - 11 Constructed Wetland ❑ Pressurized In- and ❑ Holding Tank Peat er ❑ Aerobic Treatment Unit ❑ Recirculating SanoXilter ❑ � r Recirculating Synthetic Media Filter ching Chamber ❑ Line ❑ G vel-less Pipe ❑ Other (explain) V. Dispersal/Treat ent Area ormation: Design low (gpd) Design Soil Application Rate(gpdsf) D -, ersal Area Required ( Dii a] Area Proposed (sf) System on VI. Tank Info Capacity in Total Nu er Manufacturer Prefab Site Y eel Fiber Plastic Gallons Gallons of nits Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank z. Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the unde.i...404 responsibility for installation of the POWTS sho on the attached plans. Plumber's Name (Print) Plumb ure MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip `C / VIII. County/Department Use Only Approved [] Di ved Sanitary Permit Fee �ncludes Groundwater Date Issued Issuing ignature o Stamps) Surcharge Fee) El Reaso nial IX. Conditions Approva r SYSTEM ER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 1 2. All setback requirements must b 4 e maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) • $DPRESURE LOT PLAN PROJECT Nathan Landucci ADDRESS 2871 Leaion Ave N Lake Elmo Mn 55042 SE 1/4 SW 1 /4S 15 N/ 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE /14/06 BEDROOM 4 CONVENTIONAL XXX IN -GS CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE K SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of ambers 28 BENCHMAR V.R.P. Top of Survey Iron ASSUME ELEVATION 1 I Filter Zabel A -100 ❑ BOREHOLE WELL * H. R. P. Same as Benchmark B.M.* 525' Pr erty Line SYSTEM ELEVATION 101. 00.2 3.5' below qrade Designed Using ell is to meet all 7' Plans Desi g g setbacks required by B -1 Conventional Powts' WDNR 50' anual Version 2.0 x Vents ' Vent 2 -3' X 88' Cells �� 8 with >3' spacing > 619 Standard Biodiffuser Leaching Chamber Lt. of Covef with 31.1 ft2 of Area . M. _:%- 11" % _ song �� Grade at System Elevation 8 34 r� 10% Slope r 8' ' 40 ST 50' B -2 30 1, A l Pro 4 Bedroom House 174' Property Line (;OP • j/TN/P OT PLAN PROJECT Nathan Landucci ADDRESS 2871 Leaion Ave N Lake Elmo Mn 55042 SE 1/4 SW 1 /4S 15 19 W TOWN Somerset COUNTY ST. CROIX 4/14/06 4 MPRS Shaun Bird 226900 DATE BEDROOM CONVENTIONAL XXX IN -GRO D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TA NK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of / tubers 28 BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 1 dy Filter Zabel A -100 ❑/ BOREHOLE O WELL * H. R. P. Same as Benchmark 0 B.M.* 52 roperty Line SYSTEM ELEVATION 101. 100.2 3.5 below grade ell is to meet all 7' Plans Designed Using setbacks required by 50 B= Conventional Powts WDNR ' Manual Version 2.0 Vents 2 -3' X 88' Cells ent 8 with >3' spacing >6 „ Standard Biodiffuser Leaching Chamber Lt. COV with 3 1. 1 ft2 of Area .M. 11" BJ 6 on Grade at System Elevation 8 ' 3 10% Slope 8' 40' 30' ST O'y t 50' B -2 Pro 4 Bedroom House 174' Property Line 4 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1— of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must C roix 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. pend ing 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)). J 6 Property Owner Property Location Geral J. S mith Govt. Lot SE 1/4 SW 1/4 S 15 T 31 N R 19 )Mor) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 11160 190th. Ave. 25 na Oak Haven City State Zip Code Phone Number ❑ City ❑ Village JkTown Nearest Road Elk River MN 1553301(612)441-8888 Somerset I 210th. Ave. [ New Construction Use: U Residential / Number of bedrooms 4 Code derived design flow rate ' 1 " GPD ❑Replacement El Public or commercial - Describe: �� Parent material nu twa Gh Flood Plain elevation if appli DID A. � n na ft. General comments - and recommendations: trenches @ el. 100.60 spaced to code 3.50' below gr ` �;�,•, F Boring ��FN Boring # 10450 1 [� pit Ground surface elev. ft. Depth to limiting factor +9 i . Nv Soit4plication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bou Ro GPD /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 `Eff#2 __ 2 Mgr mvfr qw 1 f '. 5 .9 o(. o F�2 # Boring Boring pit Ground surface elev. 104. ft Depth to limiting factor +90 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 1 0 -8 10yr4/ none sl 2m r mvfr gw if 0 .9 none is osq ml qw na .7 1.2 7 1 2 31 2-/7- 5 . 2.. ` Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ` EfWent #2 = BOD <30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Gar L. Steel 02298 Address a va ation Cond cted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 6 -3 -2001 715- 246 -6200 f Property Owner Gera 1 d .T qm i th Parcel ID# pending Page 2 of 3 ❑ 3 Boring # ❑ Boring 100. +90 ® 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 " 1 0 -10 10 r4 3 2 10 -30 7.5 r4 4 none is Osq ml CfW na .7 1.2 3 30 -90 7.5 r4 6 none ms Oscr ml na na 7 1 2 F-1 Boring # ❑Boring — ❑ Pit Ground surface elev. k. 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 # Ground surface elev. ft. Depth to limiting factor in. El Pit =Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BOD > 30:S 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.6/00) r ' STEEL'S SOIL SERVICE Gary L. Steel Gerald J. Smith 1554 200th Ave. CSTM2298 SE4SW S15- T31N -R19W New Richmond, WI 54017 MPRSW -3254 town of Somerset (715) 246 -6200 lot #25 -Oak Haven This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. r1 " =40' G to'R of NW lot st4e @ el. 1 00.00 ' K top of 1" pv ipe @ el. 99 .60' �y jt AOL `,J D 1 Gary L. Steel 6 -3 -2001 I Maintenance and Contingency Plan for a Septic S stem Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 C Mmg ncy Plan Option #1 system fails, determine cause of failure, use alternate area and install new em in tested replacement area. Option #2. Install system at a lower elevation, by removing chambers, removing biomat, 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 -5148 i Shaun Bird #226900 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND / OWNERSHIP CERTIFICATION FORM Owner/Buyer & h u ►n. (, Mailing Address 0 �- ���.�• /� �n u /ryt� (� Property Address d (Verification required from P anning & Zoning Department for new construction.) City /State Parcel Identification Number ` 129w LEGAL DESCRIPTION ell Property Location o0 '/4 S '/ , Sec. , T � N R,& W, Town of ,Lot # Subdivisi Certified Survey Map # , Volume "- , Page # _ '----- — Warranty Deed # �2 Z ,Volume , Page # Spec house 'Cep no Lot lines identifiable ye no 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. 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 Planning & Zoning Department within 30 days of the three year expiration date. 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms IL 4vZ� SIGNATURE OF APPLICANT(S) DATE ** *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. 08/05 ' . 822445 State Bar of Wisconsin Form 2 -2003 KATHLEEN H. WALSH REGISTER OF DEEDS WARRANTY DEED ST. CROIX Co., WI Document Number Document Name RECEIVED FOR RECORD THIS DEED, made between Patrice Polta aWa Patrice M. Polta ( "Grantor," whether 04/10/2006 10: 45AM one or more), and Nathan L. Landucci ( "Grantee," whether one or more). WARRANTY DEED Grantor, for a valua le consideration, conveys and warrants to Grantee the following EXEMPT #F described real estate, together with the rents, profits, fixtures and other appurtenant REC FEE: 11.00 interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is needed, TRANS FEE: 137.70 please attach addendum): COPY FEE: CC FEE: PAGES: 1 Lot 25, ak Haven, Town of Somerset, St. Croix County, Wisconsin. -------------- — Recording Area Exceptions to warranties: All easements and restrictions of record. Name and Return Address Nathan Landucci 2871 L.-_- _I i or) /-I!-- r ) Lake Elmo, MN 55042 32- 21485 -0000 Parcel Identification Number (PIN) �� �,✓ This is not homestead property. Dated: April 2006 (SEAL) Z-,�� (SEAL) * * Patrice M. Polta (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF Wisconsin ) ) ss. authenticated on Polk COUNTY Personally came before me on, April 2006 * the above -named Patrice M. Polta TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) J sAN D. 4 nt and acknowled ed a sam r ' THIS INSTRUMENT DRAFTED BY: NOTARY Su n D. L ee Louis J. Andrew. Jr. * —' _ Public, State of Wisconsin Andrew Law Offices, SC t j, PUBLIC mrnis sion (is permanent) (expires:) (Signatures may be 9 61(ti Ldged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY N O THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ®2003 STATE BAR OF WISCONSIN FORM NO. 7,2003 *Type name below signatures. INFO - PRO"' LegM Forms • (800)655.2021 • infoprdorms.com tofl N / � 3.00 ACRES - - -- I ,�`►� / M/N. FFE=8853 ; N I $' N8915'22 "W I 1 .'33.00; 626.33' I LO • I ( I z O LOT 23 OD I I ^ O0 130, SO. FT. =u'+ ..v OD • N 3.00 ACRES o MIN. F7£ =908.0 N89'15'22 "W HM[ 626.33' ° ORA4VAQE EA.SEMEN) LOT 24 X WE -A ai 130 681 SO.. FT. 0 J. ACRES 3 . WN. F'FE=906.0 • l N � O• f� A' N8915'22 "W 525.37' , e°'� B LC 130,718 130 3. 00 AC o l •� MIN. Fn ............. / / / .......... 0 Z Z P E M a ®© o a M O - O j Crl ? � ---------- - - - - -- —� 33' I - - - - -•� — H1K g - — 413.75' N89 7 "W 404.16' • • MA X ,__ _______ 210TH AVENUE � NN N89 . 02'17"W 1324.18 T - - ----------------------- -- - - R/GH7' OFwAY -- '------------------ � I I N89'02'1 7 "W 2648.36' 1 I UNPLATTED LANDS i I I