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HomeMy WebLinkAbout038-1194-60-000 Wisr ansin Department of Commerce County: PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: R 383826 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. Star Prairie Township 038 - 1194 -60 -000 CST BM Elev: Insp. BM Elev: BM Description: , L aID AI TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark S onb 1 .45 - l c m• 0 Dosing Alt. BM •O 1 Aeration Bldg. Sewer Holding St/Ht Inlet �• r 9y o TANK SETBACK INFORMATION St/Ht Outlet 7 7 3•so , 7 7 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic S S- � , O t 3 � __ _—� Dt Bottom Dosing Header /Man. g • (o^O 93- �s Aeration Dist. Pipe c Holding Bot. System 7 Final Grade PUMP /SIPHON INFORMATION Manuf turer Demand St Cover 2 (ps t Model ber TDH Lift Friction Loss System Head TDH Ft Force n Length 1 26 11 ABSORPTION SYSTEM �,J,� _ 3 • � I BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS -31 (3) SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Man act ��(( INFORMATION CHAMBER OR I XL.> %NALP Type Of System: UNIT Mod I Number: It � • `� �d �b2 ` •` DISTRIBUTI N SYSTEM Header/Mar ifo Distribution o 1 e x Hole Spacing Vent to Air Intake kt Pipe(s) ) �� Length Dia 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 Topsoil Yes r No Yes y' No COMMENTS (Include code discrepencies, persons present, etc.) Inspection L,- Inspection Location: 1333 220th Avenue New Richmond, WI 54017 (NE 1/4 NW 1/4 13 T31N R18W) Pine Acres Lot 16 Parcel No: 13.31,18.1011 1.) Alt BM Description = 2.) Bldg sewer length s 4, > _ - amount of cover l 9! •� Tr 43As �/ Z.qS� g, ao `c.� . 9�• Plan revision Required? jo Yes Mi No U r idefor dditional inf rm J_ -- - -� _!' - - -`' t I sepcto�s Si nature j, Cert . No. S (R.3/97) a � ' c� ��� � �4 ,, J PLAN PROJECT P.C. Collova Builders Inc. PL( A ' D ES P.O. Box 489 Somerset Wi 54025 NE 1/4 NW 1/4S 13 /T 31 / W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE2 /15/02 BEDROOM 3 CONVENTIONAL XXX IN- GRIOUN RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 375 # of chambers 22 IL BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark R ECEIVED * SYSTEM ELEVATION 91.6/91 4 B.M. APES 12me Alt. 30' 5' , Vents M. ZON 5 9 Designed using Conventional Manual version 2.0 3% - 3 2 -3' X 44' Cells and 1 -3' Slope X 50' Cell with >3' Spacing ents B -1 30 40 T 30' 97 9 98' Pro 3 Bedroom House Gti/IM�� I 4, (A/ I _ Wisconsin Department of Commerce PRIVATE SEWAGE SEWAGE unt , �arety and Buildings Division t. Croix • INSPECTION REPORT 7� A-� y 'GENERAL INFORMATION (ATTACH TO PERMIT) az"�� Sanita 83826N� Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ❑ City ❑ Village ❑ wn of: State Plan ID No.: P.C. Collova Builders, Star Prairie Township CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: 038 - 1194000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV- Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. AirI to ntake ROAD Dt Inlet Air I Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand St cover Model Number GPM TDH Lift Friction System TDH Ft L oss Forcemai n Length Dia. H Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth D IMENSIONS DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manu a ct urer: SETBACK CHAMBER INFORMATION Type O Mod Number: System: OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipes) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only _T Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed / Trench Center Bed /Trench Edges Topsoil []Yes ❑ No ❑Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: / / Inspection #2: Location° Q'1 '?j 2.20th Avenue, New Richmond, WI 54017 (NE 1/4 NW 1/4 13 T3 1N R1 8W) - 1331181012 Pine Acres -Lot N O 1.) Alt BM Description= 2.) Bldg sewer length= - amount of cover = Plan revision required? ❑ Yes ❑ No Use other side for additional information. I F_ LLLIJ SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. l Safety and Buildings Division County ® 201 W. Washington Ave., P.O. Box 7162 �sconsin Madison, WI 53707 - 7162 ite Address Department of Commerce 3,�,7 Z'2 Q y ,t� Sanitary Permit Application Sanitary Permit Number 6 In accord with Comm 83.21, Wis. Adm. Code, personal information you provide 3 8'3 x'2. Check if Revision may be used for secondary purposes Privacy Law, s15.04(1)(m) I. Application Information - Please Print All Information State Plan I.D. Number Property Ow Name Parcel Number (3 • 3 I. ( 101 I T' �� U'0 C. - mil' 038 - 04 -60 - eafl Property Owner's Mailing Address Property Location City, State Zip Code Phone Num r' Lot Block Number 11 Vre CSM Number YO H. Type of Building (Check all that apply.) > - Family Dwelling - Number of Bedrooms y;? C f`Oear 'llage y O Public /Commercial - Describe Use O State Owned w ��eiFl(3 III. Type of Permit: (Check only one box on line A. Numbering is for internal » §e.)( t e B. if applicable.) A. ew 3 O Replacement of 6 ❑ Addition to System 2 13 Replacement System Tank Only I Existing System For County use B ' heck if Sanitary Permit Previously Issued Permit Number Y 3 b Date Issued J � 2 00 a IV. Toe of POWT System: (Check all that apply. Numbering is for internal use.) on - Pressurized In- Ground 210 Mound 47 O Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 OAerobic Treatment Unit 49 ❑ Recirculating 30 OOther V. Dispersal/Tr ent Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate S tern Elev lion Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min. /Inch) 6�(+� Elevation r 7 Id � VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the undersigned, Wume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' i re MP /MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zi ) / VIII. County/Department Use Onl Disapproved Date Issued Agent Signature tamps Approved O Owner Given Initial Adverse Sanitary Permit Fee (includes Gr�ndwater d Issuing A S g ( �) Det Surcharge Fee) IX. Conditions o Approv Reasons for Disapproval , 5t eti► ran m �� / `` �t e+ti. -- Attach complete plans (td the C ty only) for the system on paprr not less than 81/2 xL11 inches in size PLOT PLAN PROJECT P.C. Collova E3uilders Inc. AIYb ss P.O. Box 489 Somerset Wi 54025 NE 4/4 NW 1/4S 13 /T 31 N /,� W TOWN Star Prairie COUNTY ST. CROIX r � MPRS Shaun Bird 226900 DATE /15/02 BEDROOM 3 CONVENTIONAL XXX IN- GROUND P SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 375 # of chambers 22 BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL H. R. P. Same as Benchmark * SYSTEM ELEVATION 91.6/91.4 B.M. Pro pe rty Line V Alt. 30' 5 M. 5' I - Vents 5 Designed using Conventional Manual version 2.0 3% -3 Slope 2 -3' X 69' Cells with >3 Spacing ents Q B- 30' 40 T �. 30' 97' 98' ,4r 03 edroom House i PLOT PLAN PROJECT P.C. C r ollova Builders Inc. A ss P.O. Box 489 Somerset Wi 54025 NE 1/4 NW 1/4S 13 /T 31 N/I W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE2 /15/02 BEDROOM 3 CONVENTIONAL )= IN- GROUND P SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 375 # of chambers 22 BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100° Filter Zabel A -100 ❑ BOREHOLE O WELL - H. R. P. Same as Benchmark SYSTEM ELEVATION 91.6/91.4 B.M. Property Line AlM 0' 9 . 5 5' Vents 59 Designed using Conventional Manual version 2.0 3% -3 Slope 2 -3' X 69' Cells with >3' Spacing ents Q B -1 40 T 30' 97 ' 98' Pro 3 Bedroom House • , WiscoxinDepartment,ofCommerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Coun �^ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must tyI r 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. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ` Prop e Owner Property Location � �� � I Govt. Lot � 1/4 1/4 S T N R/ E or) Property Owner's Mailing Address L t# Block # Subd. Name or CSM# f x 9' '/X' "V e4a'e City State Zip Code Phone Number ❑ City ❑ Village .Town Nearest Road (.v) S�OZ ( ) S Q f� u �vi,� Z' 'e'�A � w Construction Us esidential / Number of bedrooms Code derived design flow rate 7e) GPD ❑ Replacement ❑ Public or cpmmerciai -Describe: Parent material � u��4 —�J Flood Plain elevation if applicable ry ),*9' ft. General comments and recommendations: ' b 6e, 0 F11 Boring # ❑ Boring /� pit Ground surface elev. , (/ ft. Depth to limiting factor 1 2- 9 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots cots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Z l y s y 9--- , a, 3 -3 A4 Z' y S e5L � 1 i o� 15:1 Boring # ❑ Boring pit Ground surface elev. ft. Depth to limiting factor / 2 - 7 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 * Effluent #1 = BOD 20 m an _ 150 m * Effluent = 30 m /L and TSS 30 m s > 30 < 2 � L d TSS >30 < � L E #2 BOD s_ < < 9 _ 9/ L CST Name (Please Prints Mgnature CST Number Address Date Evaluation Conducted Telephone Number SBD -8330 (R07 /00) Property Owner Parcel ID # Page of © Pit Boring # ❑ Boring 2 Ja Ground surface elev. ?/j ft. Depth to limiting factor_ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 . �3 •L` oil •Z 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 /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Ef1#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 /ft 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/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.07 100) Soil Test Plot Plan Project Name P.C. Collova Builders Inc. Shaun Bird'' Address P.O. Box 489 Somerset Wi 54025 CST #226900 Lot 16 Subdivision Pine Acres Date 2/15/02 NE 1/4 NW IMS 13 T 31 N /R18 W Township Star Prairie M Boring 0 Well PL Property Line County S T. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post System Elevation 91.6/91.4 *HRpSame as Benchmark Alt, BM Top of Survey Iron @ 96.7' B.M. Property Line Alt 30' S M. 5 �- -2 5 ' 3% -3 Slope 5 ' 1 N 40' 97' 98' Pro 3 Bedroom House Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Eff luent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715 - 246 -4516 3 Shaun Bird #226900 ;r 3 7Z� Sanitary Permit Application Safety &Buildings Divi ton / In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington ` See reverse side for instructions for completing this application PO Box 7 isconsin Personal information you provide may y purposes be used for secondar ur Madison, WI 53707 -7 Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county it state own Attach complete plans (to the county copy only) for the s ste ,gn paper not less than 8 -1/2 x I I inches in size. Count) T o State Sanitary Permit Number ❑ Check keYMon to,pre`Vicws application State Plan I. D. Number 7APplication Information - Please Print all Information ,' Location: Property Owner Name P Property Location r t464 Property r ��,N, R E or Property Owner's Mailing Address Lot Numb 0 ck Numb City, State Zip Code Php •r ` . � S division I1 Type of Building: (check one) �. ❑ Ciry ( 1 or 2 Family Dwelling — No. of Bedrooms eA , w ❑ Village O Public /Commercial (describe use): Gown of O State -owned I I !6 III Type of Permit: (C ck only one box on line A. Check box on line B if applicable) Nearest Road map . G A) I. KNew System ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s) System Tank Or Existing S stem 0. B) Permit Number Dole.i9sw d I Q ❑ A Sanitary Permit was rev' I issued IV. Type of POWT System: (Check a at apply) X,Non pressurized In ground ❑ Mound ❑,Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank 0 Single Pass ❑ Drip Line ❑ At -grade , r ❑ Aerobic Treatment Unit O Recirculating ❑ Other: x 6g" V Dispersal/Treatment Area Information: ✓ Q 1. Design Flow (gpd) 2. DispersalArea 3. Disperse Area 4. Soil Application 5. ercolation R 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation 3 ?5 577 VI Tank Capacity in Total k of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks 5 00o ❑ ❑ ❑ 1\ N11 ❑ a ❑ ❑ ❑ VII Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) Plum s Sign urE (n MP /MPRS No. T Phone Number n A �►0 35 t Plumber's Address (Street, City, State, Zip Code) 2 VIII County/Department Use Only r ❑ Disapproved Sanitary Permit Fee cludes rou dwater vIeDaICTssued Iss ing Agent Signature (No stamps) ;iZ Approved ❑ Owner Given Initial dverse Sur rge Fee) Determination T�' IX. Conditions of Approval /Re 94ons for Disapproval: " I f , ^ S �°� is cC. 3 — � ttocs�ce_, rv�,3"�iV nn tKQ.. lOak Val O t uG C�+►�xJ1wR.•,�"St��- C �� . t C�nS � � �l,�,.s SBD -6398 (R. 07/00) lVl� , 3-0 r O { x 124 1 . 3. 7 �-, 0a IzAk ftseonsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings. in accord with Comm 85.05, Wis. Adm. Code Attach complete site plan on paper not less than 8'h x 11 inches in size.. Plan must Coun �- include, but not limited to: vertical and horizontal refere or t ection and percent slope, scale or dimemsions, north arrow, a IOp ti hd tan44p nearest road. Parcel I. D.# s...: _ APPLICANT INFORMATION - Plea info pint /l i+�$o'rmatht% Pendm Personal information you provide may be used for pu (FT", aw, s. S:64 \1)). R v iewed B Date :'� ) (m � � -ti -Zeno Property Owner Probe Location �� Lakes & Hills Development _ G0 �� 11 NW 1/4,3 1 T 31 N,R 18 Property ner's Mailing Address# Subd. Name or CSM# � "Q ry -- Pine Ac re s Aj lty St to Zip Code Phone�rumtb r City — Pilla Town Nearest Road 4 r f� fd,c � J //� � s/4 c\ ��K � .7 "e, - - I 220 TH. Ave Z New Construction Use: Z Residential / Nurr;6�yedrooms 3 (Addition to existing building ---------- ❑ Replacement [] Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd/ft .8 trench, gpolfts Absorption area required 643 bed, fF 562 trench, T Maximum design loading rate .7 bed, gpd/ft .8 tr ench, gpd/ft Recommended infiltration surface elevation(s) 93.7 ft (as referred to site plan benchmark) Additional design / site considerations Parent material- - - - - -- Flood plain elevation, if applicable - - - - -- ft S= Suitable for system Conventional Mound In - Ground Pressure AT - Grade System in Fill Holding Tank U= Unsuitable for system MS ❑ U 2 S❑ u N S❑ U � S❑ U ❑ S M U I ❑ S Z u SOIL DESCRIPTION REPORT H Depth ( Dominant Color Mottles Structure I Consistence Boundary Roots GPD/ ft2 Boring# Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. -- Bed Trench 1 1 0 -9 10YR3 /3 ------------ - - - - -- 1 Imsbk mvfr as if .4 .5 2 9-20 10YR4 /4 -------- - - - - -- 1 Imsbk mvfr as 1vf 4 .5 Ground elev 3 20 -44 7.5Y ------------ - - - - -- cs I osg ml gw - - -- .7 .8 97.6 ft. 4 44 -89 10YR4/6 ----------- - - - - -- s j os g ml - - -- - - -- 7 8 _ -- - -- -- -- -- -- 1 _ _ Depth to — - - -- -- - - - - -- —_ - -- I - -- limiting cd R3 - - - -- - factor >8911 8 orz s Remarks: 2 1 0 -9 10YR3 /3 ------------ - - - - -- I Imsbk mvfr as if .4 .5 2 9 -19 10YR4 /4 --- --------- - - - - -- 1 Imsbk mvfr gw 1vf .4 .5 Ground 3 19 -49 7.5YR4/4 ------------------ cs osg ml gw - - -- 7 8 elev — - - - - - -- - -- 98.1 ft. 4 49 -93 10YR4 /6 ------------ - - - - -- s osg ml - - -- ---- 7 .8 Depth to limiting factor >93 J Remarks: - - - - -- - - -- - -- CST Name (Please Print) Signature: Telephone No. Jac que Hawkins Address Date CST Number Ref # / / 3 — o h v Ccr c' /Vi ' 9S 4/8/00 a ass PROPERTY OWNER: Lakes & Hills Development SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D.# Pending__ Depth Dominant Color Motdes Structure C GP Dr Horizon in Munsell Qu. Sz. Corn Color Texture Gr. Sz. Sh. onsistence Boundary Rooks Bed :Trench 1 0 -10 10YR /3 -- --------- - - - - -- I lms bk mvfr as if .4 .5 2 10 -19 10YR4 /4 ----------- - - - - -- I lmsbk mvfr gw lvf .4 .5 Ground 3 19 -52 7.5YR4/4 ------------ - - - - -- cs osg m1 gw - - -- .7 .8 elev -- _ - -_ 98.2 ft. 4 52 -93 10YR4 /6 ------------------ s osg ml - - -- 7 .8 Depth to limiting -- - - -- - -- -- - - — -- factor f p >93" Remarks: 4 1 0 -10 10 YR3 /3 ------------ - - - - -- 1 l msbk mvfr as if 4 .5 2 10 -20 10YR4 /4 ------------ - - - - -- 1 l msbk mvfr g w I l of 4 .5 Ground 3 20 -56 7.5 iR4 /4 - -- - -- cs osg ml gw - - -- 7 8 elev 97.8 f t, 4 56 -90 10YR4/6 ------------ - - - - -- s osg ml - - -- - - -- .7 .8 Depth to limiting -- - - -� - - - -- - factor >9 0 1, - - - - Remarks: 5 l 0 -11 10YR3 /3 ------- - - - - -- 1 Imsbk mvfr as if .4 .5 2 11 -19 l 0YR4 /4 ------------ - - - - -- 1 1 msbk mvfr gw 1 of .4 .5 Ground- - - -- - - - - -- -------- - - - - -- -- - - - - -- - - - — - elev 3 19 -50 7.5YR4/4 ------------ - - - - -- cs osg ml gw - - -- .7 .8 97.6 ft. 4 50 -88 10YR4 /6 - - - - - -- s o sg m - - -- - - -- 7 .8 Depth to limiting — - - - -- - - - -- - - - -- - -- — - factor >88" Remarks: Ground — elev ft. Depth to limiting - -- - — — — - - -- - - -- - -._ -- -- -- - -- -- - factor Remarks: _-- __.__ -- -- - - - - -- / "lN 'fS 1 d J L 4_ 6 K- e-- ffi) irSN J a z ifd A7 / d a v A) 71/ �� �• � I a i I � I- Q N✓ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND nn OWNERSHIP CERTIFICATION FORM Owner /Buyer �, l b � � oVA B IL S _w L. Mailing Address — 706 00. E //W 5 a v (, U L Property Address 1 33 3 Ae IMF ( Vcrification required from Planning Department for new construction) City /State /Ufbt.l i (CA A "J Parcel Identification Number LEGAL DESCRIPTION Property Location s y, %,, Sec. 3 , T 3 I N -RISW, Town of Subdivision P! t!0 C- kF S Lot Certified Survey Map # Volume _ , Page It Warranty Deed # _ 4:�' 3 (:�' Volume Page # Spec house yes ❑ no Lot lines identifiable X ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewatcrdisposal 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 Office within 30 da re ar expire ' n date. z v SIGNATURE ' Or-APPLICANT / DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) k nowledgd. I (we) am (are) the ownet(s) of the scribed above by virtue of a warranty deed recorded in Register of Deeds Office. 4- Z/ O GNATURE Or APPLICANT DATE * * * * ** Any information that is mis represented 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 8 copy of the c.ettificd survey map if reference is made in the warranty deed RIVER V LLEY rBSTRACT Fax.715 -381 -5053 Apr 2 2001 10,27 P.02 1� IT. ROIX RIMMED FOR wzn NXU14RNTN06 QUITCLAIMD21b 03-m -WI Wo AM �Gulf_MAIM 1w 0 GERT Y Mi InY 1 PUBIS FE F: 10.9 quit s )aimdto ,f',0jltztuBuiltlers Inc 1114 foDowit� dawnt�dd rMl aaaN to fit. CrNix _ �, a Stu, of Wiaotrvi� Lot 16. Pine Ades, St. Cfoi t County, Wiur a,Win• RETURN TQ P.C. Collova 13uodw, Inc, 703 Gbauq Road B. Hadsva, WI 54016 Tax Ptm) No. _ 039-1194,60-000 This is not hatnaateW property. Dated _ day of Fithpaw, 1001. u) Ctmsaucdva, Inc. A eadiau Aekawlaftment 91yz+AWA*d) _ STATE OF MINNBSQTA ) )SS COUNTY OF WAS�db�ntl authautiuted &s — day of , Peraoaal� wne br&ve ncC Ails G t �day o � ZO !dteabxsnauted .y�pi461�schmitl. tha a ri�a RrG r,bF. Name: Title: Mgmtter, Sous bar of Wacanain - — TEIS D4MVMEr4T WAS DRAFTED BY: to I= known b pcapq(i) who eatxuted ilia k+regtlinY At •<eui ps0.;yta14q. PA. + kttowlodgc tlta S41 t0 Otea Ayemu! NoctYt S191wxur. MN 550E2 (65 1) 439.2951 Public County, MLut EA! My o 4 4 anion is parrtanent. M oot stale cxpiratiou dace:____,_ 9ignattttcs may he authautinitud of ac3snouvledget4 ! KgXNMILMW .,.., uY�vrtw,tt+oaawPalbtataou aw.w. � � Lj of of a Qi 04 U) UI >I 01 �I C91 • JI 3 Z � • CL --West line of I of Lot 1, C.S.M. 9/2494. S06S3' = I i • � „ 335.69 S00 53 17 W 33' 1 ; 470.24 1 328.00 109.24 � 12 X 1 6 6' ( — 43724- 70,634 a � 14 � 1.62 ac 0o I g g 65,600 sq.ft. g Z I g 1.51 acres 1 3 67,544 sq.ft. 0) I 1.55 acres d' 328.00' Cc 00 N00'53'1 7"E 15 I 0 �s I cb Z I 76,424 sq. ft. N o I / w , 1.75 acres W > 18 o 0 I I 70, 766 sq. ft. o 328.00' N00 71E 1.62 acres $ I tn 0 �Ip L Z E I eft% g 16 g _�