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HomeMy WebLinkAbout038-1221-19-000 �unc -ell <c� County. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430649 0 0 (ATTACH TO PERMIT) CNERAL INFORMATION State Plan ID No: 4 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 Star Prairie Township 038 - 1221 -19 -000 CST BM Elev: Insp. BM Elev: BM Description: _ Section/Town /Range /Map No: 32.31.18.1219 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding S t Inlet 9� S 7 �•D TANK SETBACK INFORMATION S Ht Outlet ' 3 yy2 TANK TO /L — V FIL BLDG. Vent to take ROAD Dt Inlet Septic / � / C� Dt Bottom Dosing ^ V H eader /M an. z R3• Aeration Dist. Pipe 2 Holding Bot. S1 L —7 Final Grade 7 PUMP /SIPHON INFORMATION Yd �•� L l 1 Manufacturer Demand St Cover q GPM Model Nu r TDH Lift Fric i ss System Head TDH t Forcemain ength Dia. Dist. to \ SOIL ABSORPTION SYSTEM 2 Z BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS I / _ a f y �r SETBACK SYSTEM TO UJ L P/L BLDG WELL LAKE /STREAM LEACHING anufactur INFORMATION CHAMBER OR Typ Of System: � � � -,/� UNIT Mo el Number: •C' �Q 25 " > 10 Q J DISTRIBUTION SYSTEM fv- Header /Manifold Distribution x Hole Size x Hole Spacing lVent to Air Intake 1 N Pipe( s) j , !e / 4 1 �� ) —7 Length Length lY `"! Dia Spacing� /5 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 No j Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 4 / Inspection #2: Location: 1895 90th Street Star .n Prairie, WI 54026 (NW 1/4 NW 1/4 31 T31 N R1 8W) Prairie Pond Breaks L 19 Parcel No: 32.31.18.1219 // 1.) Alt BM Description = _:v v 2.) Bldg sewer length - amount of cover Plan Use other for in Yes /No D) Inst na re ` Ce formation. SBD -6710 (R.3/97) No Safety and Buildings Division County l t # 201 W. Washington Ave., P.O. Box 7082 � �__ MadiWl 53707 7082 Sanitary Permit Number (to be filled - in by Co.) sX6 60 4.6546 pepartment of Commerce - state Plan LD. Number li " Sanitary Permit App ation I ---- -� nal ' fotmatLqgj, u Provide i ' In scwrd w i t h Comm 83.Z t, Ws. Adm. Code, Pero 1 °� y Project Addres (if different than mailing address) may be used for secondary purposes I. Applicati on Information — Please Print All Information Parcel # Lot t? Bioek-At —, Property Owner's Na Location Property Owner's Mailing Address I AlEh, Section ' ip Code Phone Number City, State 3 r � �(circl rte T N; E U. Type of Building (check all that apply) Subdivision Name CS uatber 2 Family Dwelling — Nurabcr of Bedrooms p Vr' ❑ publidComtnercial — Describe Use ❑City CVillage� 0 tp of ` [� State Owned — Descn'be Use _ d / Z Z IIL Type o Permit: (Cheek only one box oa Line A. Complete line B if applicable) '+• New System C] Replacement System C] Treatment/Holdiag Tank Replacement Only ❑ Other Modification to Existing System I at Previous permit Number and D er Data Issued C3 Change of ❑ Permit Transfer to New ` O B. Permit Renewal etmit Revision Plumber Owner LY I Before Expiration IV. T of POVM S stem: Check Al that a 1 on _pressurized la -Ground ❑Mound _> 2A in. of suitable soil ❑Mound <24 in. of suitable soil ❑ At.Orade ❑Single Peas Sand Filter Cl Constructed Wetland ❑Pressurized In G and [] Haldiag Tank ❑ Peat Filter 13 Aerobic Treatment Unit ❑Recirculating Sand Filter bet ❑Drip Line ❑Gravel -less Pipe ❑Other (explain) Racirculatia Synthetic Media Filter his S Elevation V. Dis enalrfreatment Are nformatioa: Dispersal Area Required (sf) Dispe3sal �{� °p°Sed (sf) Design flow (gpd) Design Soil A plicati on Rate(gpdsf)� 6 t � ✓ ( / 9 J 7e p Site Steel Fiber Plastic VL Tank Info Capacity is Total Number /// Manufacturer Concrete Constructed Glass Gallons Gallons of Units ?few iag Tanks Tanks septic or Ho {ding Tank Aerobic Treatment Unit Dosing (:hamber WTS sAawa oa the attached fans. VII. Responsibility Staterneet- 1, the undersigns ume reapoasibility for iastallatfon of the PO E:�inecs Phone Plumber's re MPlMPRS Number ( Pl v u � mber� Namc (Print) �j Z b I plumber's Address (Str�actt, City, State, Zip C VIII. Court /D tRmeat Use Oal Fee (; Judes Grouadwatcr Date issued W g Agent Signatu (No Stamps) Sanitary Permit 'Approved ❑ Disapproved Surcharge Fce) . - b 200 Q owner Given Reason for Denial � � � I � IX. Conditions pprov i a� SYSTEM OWNER: .}.o CA { 1 Septic tank, effluent filter and r �2a dtit �_ ` dispersal cell must all be serviced 1 maintained t 1 , © as per management plan provided by plumber. � `tom B 2. All setback requirements must be maintained (�A as per applicable code /ordinances, ' m to the County only} for toe system ea paper sot less the t z 11 belies a size Anocil complete Pl& SBD -6398 (R. 08142) f Soil Te t and S stem PLOT PLAN V 3 u Y PROJECT P.C. Collova Bldrs. Inc. VAI SS RE P.O. Box 489 Somerset Wi 54025 6i. 1 / 4 NE 1 / 4S 31 /T 18 vy TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 / DATE 3 /31 /04 BEDROOM 3 CONVENTIONAL XXX IN -GROUN RESSURE 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 kk BENCHMARK V.R.P. Top ofl=oundation = ASSUME ELEVATION 100° Filter Zabel A -100 ❑BOREHOLE S WELL *H.R.P. SameasBenchmark SYSTEM ELEVATION 93.2/93.3 4' below qrade @ B -1 B-3 AL 396' Property Line _ 35' ❑ I 5' 15' See original soil test alternate are 70' -v B -1 2 -3' X 69' 30' Cells with >3' Spacing 5' 1% Slope not Plans Designed Using enough slope to Conventional Powts establish contours 25 B.M. Manual Version 2.0 122 Pro 3 Bedroom House 90th St. 537' Vent >6 Standard Biodiffuser C;0,?' of Cover Leaching Chamber with 3 1. 1 ft2 of Area 6' Long 1 1 " Grade at System Elevation 34" Soil Te t and System PLOT PLAN V U PROJECT P.C. Collova Bldrs. Inc. A RESS P.O. Box 489 Somerset Wi 54025 S(I' 1/4 NE 1 /4s 31 /T 31 / 18 vy TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE3131 f04 BEDROOM 3 CONVENTIONAL )00( IN -GROU� '' RESSURE 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 kk BENCHMARK V.R.P. Top ofFoundation _ ASSUME ELEVATION 100 Filter Zabel A -100 ❑ BOREHOLE WELL *H. R. P. Same as Benchmark O SYSTEM ELEVATION 93.2/93.3 4' below qrade @ B -1 396' Property Line B-2 35 ❑ 5' 15' See original soil test altern a rea 70' -- B-1 2 -3' X 69' 30 Cells with >3' Spacing 51 1% Slope not Plans Designed Using enough slope to Conventional Powts establish contours 25' B.M. Manual Version 2.0 122 Pro 3 Bedroom House 90th St. 537' Vent A Standard Biodiffuser Leaching Chamber with 31.1 ft2 of Area 1 " Grade at System Elevation 34" j Wisconsin Department of Commerce SOIL EVALUATION REPORT Page —L of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code f , County r^ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must 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. Re 'wed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ' p Property Owner /1 /J Property Location ( D �ipi✓cx !( Govt. Lot 114 /4 S 3l - T 3 I N R Z9 E (or� Props Omer 's Mailing Address lot # Block # S 0d. Name or CSM# i X rr City State zip ode Phone Number ❑ City El Village own Nearest Road New Construction Use Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: - -- Parent material �LCL� C Flood Plain elevation if applicable General Ms �- t J � 3, and recommendations: r r I J •3 �Qe� �3 - 2 Fn Boring # Boring P-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/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ® Boring # O Boring , Pit Ground surface elev. �� + Depth to limiting factor /� in. Z*E ff#1 Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots D/ff in. Munsell r Qu. Sz. Cont. Color Gr. Sz. Sh. ff#2 D l3 z- r p p s 1 IA Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation g onducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 2 -- �-�,� 715 - 246 -4516 I 2 Property Owner _ Parcel ID # Page of F31 Boring # ❑ Boring (� t , U l p � pit Ground surface elev. /�� ft. Depth to limiting factor �� in. 7°'l A;Ro1otsGPD/ff Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#2 p -3 )U 31 L 1. F Boring # a 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 a Boring # Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon DeP th Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mglt- ' 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.W00) Wisconsin Departmer,4of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430649 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)l. Permit Holder's Name: City Village X Township Parcel Tax No: P.C. Collova Builders, Inc. I Star Prairie Townshi CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: CST BM Elev: Insp. BM Elev: 7 31.18. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet SUHt 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. System PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist, to Well SOIL ABSORPTION SYSTEM BEDITRENCH 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 Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx SeededlSodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No 1 COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 1 Inspection #2: / / Location: 1895 90th Street Star Prairie, WI 54026 (SE 1/4 NE 1/4 31 T31 N R1 8W) Prairie Pond Breaks Lot 19 Parcel No: 31.31.18. 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? i Yes?; No Use other side for additional information SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No. f County ' Safety and Buildings D ivi ion � X 201 W Washington Ave., P.O. Box 7082 Madison, WI 53707 - 7082 nary Permm N O umber (toLL r be p sued is by co.) fsconsi�n (608 CEIVE ? r T 1 S to Plan LD. Number Department of Commerce Sanitary ermi t A�]pilCatl i n P p�qv� e 1 2 2004 in accord with Comm 83.2 1, Wis. Adm. Code, perso infon n You Law, s15. I)(m) J H 1 `t Pt 'ect Address (if different than mailing address) may be used for secondary purposes PrivaeY pq tJ_ ZONING OFFICE �`J��' I. Application Tnformatioa - Please Print All Information ZON Parcel t Block M Property Owners /J��� �� )) (/ Property s Mailing Address Section U i C 1�P X %., Zp ode Phone Number City, State rcle gale J t7r, T N; R U. Type of Building (check all that apply) O� 5 ' SubdivisionThame, i CSM N umber Number of Bedroom � G ' "' or 2 Family Dwelling - -, ❑publiaiCotntnercial - DescrftUse Z 3 x � _- ❑City CVm ownshipo ❑ State Owned - Descr Use lIL Type of permit: (Cheek only one box on line A- Complete line B if applicable) Q o Modification to Existing System A. w System ❑ Replacement System Q T Tank Replacement Onl y e ❑ List Previous Permit Number and Date Issued [:1 Change of Permit Transfer to New B. ❑ Permit Renewal ❑ Permit Revision plumber Owner Before Expiration TV. T e o S tem: f PO Check aU that a 1 on- Pressurized In -Ground [)Mound _ 24 in. of suitable soil Mound < 24 in. of suitable soil Q At Grade Drculatin p ass San Filter T� ent Unit ❑ Peat Filter ❑ Aerobic Treatm �S'�z`z�z`�r Consaucted Wetland [] Pressurized inGroun d Q Holding [] O er (explai Synthetic Media Filter his Cbamb [D Drip Line ❑ Gnvel -less Pipe Recirculatia Synth 6D V. Dis ersa (pd) lrrreatm Area Information: Dispersal � Proposed (sf) System FJ oa� Design Flow iga So' Application Rate(gpdsf) Dispersal Area equired 00 D / 6 Site tee! Fiber Plastic J� Maattfacttuer Prefab VL Tank Info Capacity in Total Number Concrete Constructed Glass (flow Gallons of Units New Existing Tanks r anks Septic or Holding Tank Aerobic Tretumeot Uah posing (�amher VII. Responsibility Statemen - I, the undersigned. as responsibility for installation of the pOWTS shown on the attached Pone Number Plumbers Si MP/MP RS Number Pltmber's Name (Print) ' 0 Z_ 6 ✓ y Plumber's Address (Street, Ci , State, Zip VIII. Cozen /D evartment use Onl Sanitary Permit Fec (includes Groundwater Date issued iss 'ng ent Signatur (N tamps %Approved ❑ Disapproved Surcharge Fee) ❑ Owner Given Reason for Denial IX. Conditions of ApprovaVRessons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained f� as per management plan provided by plumber. 0.-"` 2. All setback requirements must be maintained — ��,); �a 9 as per applicable code /ordinances. �� t Attach tosrpk� pla as ( to the County only) for the system oa paper sot 101 s than D" z 11 laetus la size SBD -6398 (1 08102) OT PLAN PROJECT P.C. Colbva Bldrs. Inc. ADD R Ss P.O. Box 489 Somerset Wi 54025 SE 1/4 NE 1/4s 31 /T 31 /R 1 W TOWN Star Prairie COUNTY ST. CROIX ;i MPRS Shaun Bird 226900 DATE 1/8/04 BEDROOM 3 CONVENTIONAL )00( IN- GROUND(P ESSURE 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 2 BENCH K V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filte bel A -100 ❑ BOREHOLE WELL Same as Benchmark / O WE SYSTE I*H.R.P. LEVATION 89.3/89.2 4' bo grade Alt. BM Top of ste fence post @ 100.0' L PI 'Designed Using Alt * Chventional Powts 206' g M anual Von 2.0 Vent 10' >6 „ Standard Biodiffuser of Cover aching Chamber 4 3 1. 1 ft2 of Area 6 Long - 70' jo 3 4" Gr at System Eleva - en Vents 2 T 30' 30' 35' 1% Slope not 122' Pro 3 B-3 enough slope to Bedroom stablish contours House 16 90th St. 7 ' Vin Depertmerd Of commerce SOIL EVALUATION REPORT Page of oivisiarr �Saf�yarrd Bu�dirrgs in a000rdance wkh Ad Qde X95 Attach cornplele sfe pim on paper not loss than 81/2 x 11 k�ches in alas. P(an rrarst ` C ro i kwkrft but not Imiled tm we *W and hodzmM reference paint M". dkecbon and Parcel t D. p=et* slope. scWie ordmensions, north amm. and locdton and dts wm to r road. Please print a# intorrnatfon. by Date pomw r kdomntioo you provkb WAy be wee for aewrWWY twP=e (P�y LOW- s. 1504 ( ( ")• a . I LoCOM P ti �, LD /Ol/Y�i / �• GavR.l�ot L 1k�y tM S a T N R / E( W Pity OMws 9 A Bloc* # Syhd. Mane or CSM# CRY Or the awe P! s zip cow Phone Number ocky 11 VMS" JaTown NWmd Road New Constroclion Use;UB deal / N umber of bedrooms _-3 _ Code derived desW flow rate GPD 0 PAPMM=t 0 Pubic or ownmerdal - Describe: _. Parer* mdedal �1.L �''� �g..S 1 � Flood Plate elevation N appicebie Vic/ 11* n Genaaloarrrrerrls s 16 "Cron s ?. 3 5 $ , - 7 and reawrenerrdallorar &l' M B# pit Graard surface etev. �/ .�R Depth b g factor Sol Aookdbn Rate Hw1wn Depth Domkwt Cokw Redm Descrkftn Texkwo Structure Corrsistenoe Bor xk" Rods GPOW in. Mussel (hr. SL Ca*. Color Gr. Si. Sh. `Et 1 'EffM2 ' S All /V)A z .4/ s$ 0BM" Brxltp # Pit Grorard asUce else. ✓ tt Depth to WW" factor -- ir Sol AAvkodon Rate Ho&w Depth Darrrinar* Redox Descdpbon Texture Situdure CorrsiSUerrce BOWtdary Roots � K WkmoA tau. Sz Car*. t,olor Or. S& Sh. *EWl 'Et1fa ( to r--v L S ► S� N $ � • EMUMlt #1= BM > 30 < 220 mgL and TSS >30 _515' ' Mwit 02 at SOD 1 30 mg& and 30 mglL CST 049050 P" CST Adder - ' _ Date Evak a*m CorA cted Telephone Number Ply owner Parcel ID # Page of a 13,43ft# ❑ 7 - 1-di Qg Pit Ground sixtiew elev. Depth ID iti Sad Appkaftn Rate f mtwnn Depth Dor *md Color Redox DescrIpOOn Texture Strvrs,ue Consistence B=Wwy Roots GPDff bn Munsell IOU . Sz Cora. Color Gr. Sz. Sh. *EW I I EW 2 .,, M C S 'L M . w A , s S n 7 J, z e' a # ❑ � ❑ Pit Ground wrface efay. IL Depth tD In Aft tactrx in► Sad Application Rats Harimn Depth DomirmtCalar Redox Desctipfim Texttre Skwwre Carulaten ce Boundery Roots WON IM Munsd flu. Sz Cont. Color Gr. SL Sh. 'Efi#1 D e«ft # a pit surface elev. iz Depth b &IKM factor in Sall ApOicallm Rate ti Depth Dotr>inarn Cdw RedoxDesatpticn. Tendure sbucaue consistence Botundary Roots irL Murnsed qo. Sz. coat. Cdor Gr. Sz Sh. 'F.iffi I • E &mt #1= DOD, > 301220 engL and TSS >30 c 150 mWL - Et>iusttt #2 - S0D 30 mglt. and TSS <_ 30 uiWL The Department of Cotnrttetre is an egwl opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, Please contact the deprttmwt at 608- 266 -3151 or TTY 608 -264 -8777. seo+sw%A" I Soil Test Plot Plan Project Name P.C.Collova Mrs. Inc. Shaun B' Address P.O. Box 489 Somerset Wi 54025 CSfM #226900 Lot 1 9 Subdivision Prairie Pond Breaks Date 4 /9/03 E 1/2 NE 1/43 31 T 31 N /11 W Township Star Prairie N W 1/4 W 32 M Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 10 ft. Top of Survey Iron System Elevation 89.3/88.7 *HRPSame as Benchmark O BM � T op of steel fence post @ 100 Q' 206' 100' Alt. * B.M. 396' 1' i 40' B -1 70' _2 �� 30' 35' 1% Slope not 122' e nough slope to stablish contours 537' Pro Town Road ZZ l� Maintenance and Contingency Plan for a Septic System 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 cy Plan Option #1. system fails, determine cause of failure, use alternate area and install new 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° Shaun Bird #226900 d ST CROIX COUNTY A l SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer P. C. Collova Builders, Inc Mailing Address P O Box 489 Somerset, WI 54025 Property Address (Verification required from Planning Department for new construction) City /State New Richmond WI Parcel Identification Number LEGAL DESCRIPTION Property Location SE '' /,, NE '' /,, Sec. 3V T 31 N -R 18 W, Town of Subdivision Prairie Pond Breaks Lot # �. Certified Survey Map # Volume . Page # 695417 2021 27 Warranty Deed # 695419 . Volume 2021 Page # 29 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, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 I o the three a expiration date. S GN OF APPLICANT C . COLLOVA BUILDERS, INC. / G / 0 y (715) 247 -2742 DATE P.O. Box 489 OWNER CERTIFICATION SOMERSET, WISCONSIN 54025 . 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 roperty desc ' above, by virtue of a warranty deed recorded in Register of Deeds Office. P, C• COLLOVA BUILDERS INC. (715) 247 -2742 11610%4 ' SIGNAMRIJ OF APPLICANT SOMERSET, WISCONSIN 54025 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 a copy of the certified survey map if reference is made in the warranty deed U 2021 P 027 STATE BAR OF WISCONSIN FORM 2 - 1999 E5-4 1 - 7. KATHLEEN H. WALSH WARRANTY DEED Document Number REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Douglas A. Strohbeen and Eileen RECEIVED FOR RECORD Strohbeen, husband and wife, 10 -23 -2002 11:00 AM WARRANTY DEED Grantor, and P. C. Collova Builders, Inc. EXEMPT # REC FEE: 11.00 TRANS FEE: 1260.00 COPY FEE: Grantee. CERT COPY FEE: Grantor, for a valuable consideration, conveys to Grantee the PAGES; 1 following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Part of the NE1 /4 of NE1 /4 and part of SE 1/4 of NE 1/4 of Section 31, Name and Return Address Township 31 North, Range 18 West, St. Croix County, Wisconsin, described as follows: Lot 1 of Certified Survey Map filed September 17, 1993, in Vol. 9, Page 2686, Doc. No. 505678, St. Croix County, Wisconsin. 038 - 1125 -10 -100 & 038 - 1127 -70 -000 Parcel Identification Number (PIN) This is homestead property. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. (is) NXOq Dated this — Zg � � ay of September , 2002 + Douglas A. Strohbeen ' + Eileen Strohbeen AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. St. Croix County ) authenticated this day of Personally came before me this &W j oy of V' (,':',•, September 2002 the above named { j Douglas A. Strohbeen and Eileen Strohbeen, husband and wife, TITLE: MEMBER STATE BAR OF I (If not, to me known to be the rson(s) who executed the foregoing authorized by § 706.06, Wis. Stats. OF CC�. -• =�' . instru nd a ged the same. tf-,., WIS - - THIS INSTRUMENT WAS DRAFT63)iY^' • �lj ' Attorney Kristine Ogland Notary Public, State of Wisconsin Hudson, WI 54016 ommission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary • Names of persons signing in any capacity must be typed or printed below their sigidture. Information professionals company. Fond du Lac. v1 STATE BAR OF WISCONSIN aoo�ss -2021 WARRANTY DEED FORM No. 2 - 1999 U 2021P 029 STATE BAR OF WISCONSIN FORM 2- 1999 6 9 5 4 1 9 KATHLEEN H YALSH WARRANTY DEED Document Number REGISTER OF DEEDS ST. CROIX CO., YI This Deed, made between Cecil Brighton and Cleo Brighton, RECEIVED FOR RECORD husband and wife, 10 - 23 -2002 11 :00 Atl OWNTY DEED Grantor, and P. C. Collova Builders, Inc. EXEMPT # TRANS 720000 COPY F CERT COPY FEE: Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area NW 1/4 of NW I/4 of Section 32, Township 31 North, Range 18 West, St. Name and Return Address Croix County, Wisconsin. 038- 1131 -60 Parcel Identification Number (PIN) This is not homestead property. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. CK) (is not) Dated this day of Septem ber , 2002 • Cecil Brighton V ` LCIeoghton AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ;' �`'J y St. Croix County ss. authenticated this day of r p s Personalty came before me this -A!X day of September 2002 the above named Cecil Brighton and Cleo Brighton, husband and wife, ` t y� OF V1IS���`� TITLE: MEMBER STATE BAR OF WISCONSIN... (If not, to me kn to be a on(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instru d led ed the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristine Ogland Notary Public, State of Wisconsin Hudson, WI 54016 AA- - - -------- - n is permanent (If not, state expir ion da (Signatures may be authenticated or acknowledged. Both are not necessary.) ) Names of persons signing in an c m ust 1; g y p ty t be typed or printed below their si Lure. trdarmatian Pmtenianefe Camp". 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