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HomeMy WebLinkAbout040-1050-70-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)). 383992 Permit Holder's Name: ❑ City []Village Town of: State Plan ID No.: Peskar, Tracy Troy Township b = Trams• I6. 4 � CST BM Elev.: r Insp. BM Elev.: I BM Description: Parcel Tax No.: (� S 040- 1050 -70 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark • 3 9 • 7 - . O Dosing Cy I Alt. BM Aeration Bldg. Sewer Holding . St / Ht Inlet TANK SETBACK INFORMA St/ Ht Outlet 2, .Z r TANKTO P/L WELL BLDG. Air I to ntake ROAD Dt Inlet Air Septic S-a I " y -, o r — 9 / NA Dt Bottom b.$O k�Z To Dosing S I ? 5-0 / " 6 (o r NA Header/Man. 3 95 Zo Aeration NA Dist. Pipe 4S. 20 Holding Bot. System A ,,,,�_ SD I e - PUMP/ SIPHON INFORMATION Final Grad � ( 12 4' t Manufacturer C— Demand St Cover ,o '5o ,S odl b p e Number # , (o T IN. GPM 5� TDH Lift \,L.,50 Frictlor I System TDH r..q f Ft LOSS oki3q � Forcemain Length GO ' H Dia. z ' Dist. To Well SOIL ABSORPTION SYSTEM $ BED/TRENCH width O I Lem thh I N o. Of renches PI EN 1 No.O its ide Dia. Liquid Dep D IMENSI O NS SETBACK SYSTEM TO P / L BLDWELL LAKE / STREAM CHAMB L G Manu acturer: INFORMATION Type Of ��I 1 —Itsod ( 30/ .�—_ O UNIT o e Num r: System: DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe / « x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length V Dia. � Spacing � 3Z SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only 4 S, c/•c. L/. -L / Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No []Ye ❑ No COMMENTS: (Include code discrepancies, persons present, etc lyspection #1: 04 / c"ho 1 Inspection #2: --/ -- Location: 814 Coulee Trail, Hudson, WI 54016 (W 1/2 NW1 /4 12 T28N R19W) - 122819185E -Lot 1 1.) Alt BM Description = r 2.) Bldg sewer length = q.o u - amount of cover = 18 Coe Plan revision required? ❑ Yes O NO Use other side for additional information. SBD -6710 (R.3197) Date Inspectors Signature Cert No. � S >" i Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 N V A scons in Personal information rov ou provide m be used for second Madison, Wl 53707 -7302 Department of Commerce Y Y secon purposes [Privacy Law, s. 15.04 (1)(m)1 (Submit completed form to county if not state owned.) Attach comp ete plans (to the county copy only) for t4m 'not less than 8 -1/2 x 11 inches in size. Cnun� State Sanitary Permit Number tevision to previous a iication State Plan I. D. Number I. Application Information - Please Print all Information '�° ;' = Location: Property Owner Rame / Property Location rte, x •' .J /4 Ai./4,s /ZT0g,RI co�� z Property s Mailing Add s k i X Lot Number B1ncJc timber City, rata / Zip Code ne Number Su {vision Name or CSM Number 3 3 14 u .ck� -G� b rjv IL Type of Building: (check one) ?� ❑ Village ga 1 or 2 Family Dwelling - No. of Bedrooms : Town of ❑ ublic /Commcrcial (describe use):_ ❑ State -Owned r 07 Neare Road � b / Y D i AT— n - 6 i Z u P arcel Tax Num III. pe of Permit: (Check only one box od line A. Check box on line B if applicable) 1g g S A) 1. O New 2. 'Xi-Replacement 3. 0 Replacement of 4. S. 6. A dition to System System Tank Only Existing System $) 13 Permit Number Issu A Sanitary Permit was previous! issued IV. Type of POWT System: (Check all that apply) ❑ Non - pressurized In -ground ❑ Mound la Sand Filter ❑ Constructed Wetland ,CUt essurized In- ground C3 Holding Tank ❑ Single Pass 0 Drip Line At-grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: 1. Design Flow ( 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elov O o S� VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks 04a-1 ❑ a o 0 VIII. Responsibility Statement 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. umbee Name (print) Plumber's Signature (no stamps): MP/MPRS No. usiness Number m er Plum is Address (Street, City, State, Zip ode) O l "7 �, • c..'I'D ` SC� IX. County/Department Use Only D Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued sau ng Agent Signature o stamps) Approved O Owner Given Initial Adverse Surcharge Fee) d o Determination 325. M (( 2061 X. Conditions of Approval /Reasons for Disapproval: tXRov.a04 /w�bti`W[�- t �/ ►n�ya,�„ �� �2- GI+M.u.F.�i[.��• - �cis -� c Sy 4e" C�vc,.a -t a.,- I cun_�2oA rn mmm PL T LAN JECT' Tracv Peskar AD� RESs 814 Coulee Trail Hudson Wi 54016 SW 1/4 NW 1/4S 12 /T 28 At R, 9 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE4 /14/01 BEDROOM 3 CONVENTIONAL AT -GRA XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE 800 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none IL BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 10o Filter Sim -Tec in line ❑ BOREHOLE O WELL sH.R.P. Same as Benchmark SYSTEM ELEVATION 95.0 Plans Designed Using At -Grade Manual f . 6 . Version 1.0 and SSWMP Publication "t J 9.6 Design of Pressure Distribution Property Line Networks for ST -SAS (01/81) _a ' OFC LL � 2 50' ErYAruD auER PC Alt.4B.M B M System is to be installed N CENCF along the 95' Contour Line . � 4 B_1_ 9 6' iberglass B-2 g 5 affles, 1000 94' allon tank, DT 93' Existing 3 eiser B - 3 Bedroom ` 15% 92, House Slope Area 15' Below g - � System is to remain �3f , Failed System undisturbed Current Homeowner does CD not qualify for Wisconsin Vent Tank is to be properly Funding bedded and provided with a lockdown cover with a approved warning label CA) 0 0 0 Scale = 1/4 = 10' r m Coulee Rd/County Rd. U . E Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8777 ,sconsin www.wisconsin.gov .wis c ons .wisonsin.gov Department of Commerce Scott McCallum, Governor Brenda J. Blanchard, Secretary May 01, 2001 CUST ID No.226900 A777V: POWTS Inspector ZONING OFFICE SHAUN R BIRD ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/01/2003 Identification Numbers Transaction ID No. 639099 Site ED No. 628864 SITE: Please refer to both identification numbers, Ctl.,l SITE ID: 628864, TRACY PESKAR above, in all correspondence with the agency. „- ,.: ST CROIX COUNTY TOWN OF TROY; 814 COULEE TRAIL, HUDSON 5 4016 4 SW1 /4, NW1 /4, S12, T28N, RI 9W P�RrR'Ef FOR: REPLACEMENT AT GRADE SYSTEM, 450 GPD - or Al OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 789651 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes SEE CCkR and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for complianc e with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "At Grade Component Manual, SBD- 10570 -P (R.6/99)" and SSWMP Publication 9.6, Design Of Pressurized Distribution Networks For Septic Tank- Soil Absorption Systems. • In the event this holding tank malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitorin g duties as described the Holding Tank Component Manual are complied with. A copy of this information must be given to the owner upon completion of the project. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The maintenance plan for this system must be given to the owner of the POWTS. Site Specific Conditions: • The orientation of the at grade system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the at grade per At grade Component Manual. • Surface water drainage shall be diverted away from the system area. • The existing septic tank must be inspected for structural soundness, size and baffles and must be brought into conformance with the requirements of COMM 83, Wis. Adm. Code. If it does not conform a state approved tank must be installed. i SHAUN R BIRD Page 2 511101 • The septic tank shall be serviced at least when the combined sludge and scum volume equals 1/3 of the tank volume per COMM 83.54(3)(b). • The maintenance plan must be expanded to include a maintenance schedule for the pump chamber (i.e. servicing [pumping] and inspection of tank and wiring, etc.) Amend your plan and provide this information to the owner. • The management plan / users manual must contain the maintenance of the soil absorption cell (i.e. what activities may or may not take place on and around the mound system, including traffic, plantings, etc). Amend your plan and provide this information to the owner. • Bed tank(s) per COMM 83.45(5). A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 04/19/2001 i FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 PATRICIA L SHA ORF BALANCE DUE $ 0.00 POWTS PLAN REVIEWER, INTEGRATED SERVICES (715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM PSHANDORF @COMMERCE.STATE.WI.US WiSMART code: 7633 cc: TRACY PESKAR PL T AN PROJECT Tracv Peskar A� REss 814 Coulee Trail Hudson Wi 54016 SW 1/4 NW 1 /4S 12 /T 28 N ft,{ 9 W TOWN Troy COUNTY ST. CROIX 4/14/01 BEDROOM 3 MPRS Shaun Bird 226900 DATE CONVENTIONAL AT -GRA XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE 800 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none IL BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Sim -Tec in line ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark SYSTEM ELEVATION 95.0 Plans Designed Using At -Grade Manual Version 1.0 and SSWMP Publication / i3O1p,�l�� 9.6 Design of Pressure Distribution -1 Property Line Networks for ST -SAS (01/81) 250' ETY4NpeUER Alt. B.M System is to be installed p�NDENC� � along the 95' Contour Line, C� o B-1 9 6 Fiberglass g _ 2 95' baffles, 1000 94' gallon tank, DT 93' Existing 3 Weiser Bedroom ST 15% 92' House Slope Area 15' Below System is to remain Failed System undisturbed Current Homeowner does CD not qualify for Wisconsin Vent Tank is to be properly Funding bedded and provided with a lockdown cover with a approved warning label w 0 0 v 0 m Scale = 1 /4" = 10' r CD Coulee Rd/County Rd. U f • . v L 5' 8 PYC FORLR.N111iM ... - ,,,,._"'"""'-,-- „� +' .•� T LA 0.N — L r r ••�•�w •rim ..•ww� r� wr .•wwir �...� ���� err �rsr E A I L DisrAi4�uT3eW �.AtLRAL -� J f SrA 8, L a E b 09%ZAVATt§ WCLL I 1/6 1 /68 A = �t. - - 1 /2B Ft. --CELL aF /L �/t AGC�R�lia1'� h�PRoVtp SYNTHEnL Fabric ` Distribution Lateral STA811.'!; ,b Observation---..,, We l f �2 mv Soil Cover '2t' • I � r ' a 5 r �e V�f ED L AYCR A fa S Lof: Plan Vi V "a Cr s Sactiar► of Wisconsin wt -grads Un3.t wttl% s Sing,l• / �s r ti to on • Sloping Site S ti & �.t a ^r u rt L ,._. L % C E P-J S F- �� K 29 y /S OI Pag Of Distribution Pipe Detail For Lateral Network r uaw . up (CLIERt4ov r PVC Force Main PVC Distribution Pi Pe P * Lest Bole Should Be Next To ru►RN• up ... P jo- Ft. Hole Diameter � a Inch x --.. Inch Lateral Diameter `� Inch(es) Y °'.L...._.. Inches Force Main Diameter ° Inches # Of No /Pipe Invert Elevation Of Laterals � Ft. signed: License Number: Date. EMS CROWS 5EC?IG�., Ah.lf S ° E 41r �rAT10A,5 �.. WCATHCRPR00r _ r ( APPROVED LOCAIMCO. Z5 rg0'h DOM ' _IuNCr)ou 80x �MAwkOLC COVER 'Olwa0w Ox 6 Pt C l OKA OIL a +R �Ai�Axt # i I i I AJ L 1< Y P R o V t C g � •• •"• •••r r // Ait[TiG►iT Stil: �� � I I c *APPROVED I Oki Q? JOINTS WITH I I� LLCk FT APPROVED PIPE h 3' ONTO ounl: _..� Corr 0 SOLID SOIL G OfuC RCTG aiaGx ' RifCR CXtT P3rKl "TrCO OWI.!d If TAWK MAitufACt RCR HAS SwCM APP /lOVAII. M AU ti El uk 0o c �2r2r�� ti1LiNt8ER Of D05Cx, add PER CAN TAI►IK $IZL : GrAl.lO►JCi DOSE YOLi,JAit ALAKl1 nA►II�FACT�RtR: -S ,at. 'WCUU0104C. RAGA /t.OW,, �AL�oas MOOCL wumsclt CAPACITICS1 ASP`, .J I#iGItES OR s w1TGq Til't: - �!��`7' ?�rC' G OR y BAI.I.oNs mAmurAc- ruottR:.. G�C......r C ■ `� +yC►tti Otit 6A660>r>< 0 iKC #45 OR OAi.LOW sw17C►i T>tfPt: ATV PUAP AUD ALARM ARi TO at MINIMUM 9)16G14A#kGC XATC CP INSTA66CO 0&j SEP^gATC 9I0tCIS VCIlT14At. DIFlC1lRIJCt ttTWtiil PU" OFF A140 Oil'1'RIIlU'rj0,.1 pt ►�., _ Lip Mt+Jihum Wc TWORK SUPPI.'S PREti LIKE ......... f FEET OP arQRCt MAIN X f• FACTGII...-- .,L,.... FECT `MTAL. MAMIC. HIAb Fttr 1 IyTTRAJA L AIM [ kJ TAAJK,l� L.E1JGYk W10T1i .G..�.�,�,,,, O£PTH 5 En g in eering D eta il s / t j Performance Data 3� Pum Cl�a+ract�rrists C Zo KW mww o TT 1lf1 1 20 1 30 GPM 30 60 70 i its AL if 74" N•od 040) 10 14 t� �1 Z8 4i ao Ss bmft 1F i 11Vtr. m 3 .7 1 y A GPM (us am) To bo so 40 30 90 10 0 dNi N e4ue _ 4 _ X _ .0 1a a L Dimensional Data 7 64Y4" (1683') 1. Al &git11l:m in k (Mdrh for t> }/or ( Illhrnalionol ). McIftdals� of Cown wU _w � ' } 2• /8 f� ions ma 3 71" ale wancc 3. Not ff or rucma p"m 2" NPT III1106S �, i 4, Dimmions oW ***IS ara MOW !wi Flue cwbwvyAm 0 S. VYe reserve the r' i b mdse wow S l Ieiis � ----�— revs m to our and their Law 111MILIN JANLIK— � w�Noul ae0a. cxeava ie°s�'i r cso ay c ? 14 hy«ram Pumps, As gland, Ohio All Rio k Ream IF y HYDROMATIC `� � ��,�. Au +For z�'owl Di striewlw• . ,�� 470 o 1860 SW W "W Ad M* 0044M 44M ilh 419 -XI- 44 rwt 419-20-4067 YMtk SING www#sw("",C m "ZOO 00410 l• Alt AL Qtf>ry AAAP Rlpfgiff•P�i \ Artr m Orr w * ,A �s 0 iMm /Atrr rtntrory iitr �' ✓Vtd Qist � � i +� �YIOt 1 .r.4.,�'."I Maintenance and Contingency Plan for a At -Grade System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Dose Chamber is to be pumped at the same time as the septic tank. 3. 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. 4. Once every 3 years the At -Grade is to be inspected via the inspections pipes in the at- grade. The laterals are to be inspected via the cleanouts. 5. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 6. Pump and electrical components are to be checked at the time of the pumping. 7. Owner agrees to leave the area 15' below at -grade undisturbed. 8. The owner agrees to save this plan. 9. Trees, shrubs, and other similiar vegitation are not be planted on system. Contingency Plan 1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if needed, then bypass pump float and try pump with out float. If this works, float is bad, replace float. If pump still does not work, check power at the pump with a electrical device such as a hair dryer. If no power, check breaker inside house and call a electrician. If there is power, then pump is bad and needs to be replaced by a plumber. 2. If At -Grade fails, determine cause of failure, test another area or remove pipe and sewer rock, retill soil, install new mound system. 3. Replace any other failing components as needed. Important Phone Numbers Plumber: Shaun Bird 715 - 246 -4516 Pumper: Kolve's Septic Service 715 - 425 -8191 St. Croix County Zoning: 715 - 386 -4680 Shaun Bird #226900 4/14/01 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code ' O I Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County 5 4 C include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel LDQ / � percent slope, scale or dimensions, north arrow, and location and distance to nearest road. `7 Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).,� 'JJ�"' `^�— 1 Property Owner Property Location �l Govt. Lot SU_�) 114/�tj S/ 2 T 2 gN R/? E (o W Property Owner's Mailing Add s� � L Block # Subd. Name or CSM# vv / y //a 6 City State Zip Code Phone Number ❑ City ❑ Village PS Town VNearest Road H (A )'Ij ❑ New Construction use: 0 Residential / Number of bedrooms Code derived design flow rate s d GPD K iReplacement ❑ Publico�m ercial - Describe: Parent material Flood Plain elevation if applicable /`" General comments omments and recommendations: ,— cl J ST CROiX F-1 I �VIfVG OFFPCa= Boring # ❑ Boring r Pit Ground surface elev. ft. Depth to limiting factor in. /'�! i r Applic . ' n Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots Dff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Effff'#2 J ✓Ins 0 W 3 ,P Pq 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 /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff #1 *Eff#2 1 31 7,, Y 1 4 /2? c J - if 3 --- I * 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) / gn ure- �� Nufn��� Address Date Evaluation Conducted Telephone Number SBD -8330 (R07/00) Property Owner Parcel ID # Page of © Boring # E] Boring Pit Ground surface elev. 7 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 � 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 F-1 Boring # F1 Boring Pit Boring 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 /00) ` Soil Test Plot 7 PIa Pr oject Name Tracy Peskar d Address 814 Coulee Trail Hudson Wi 54016 TM #226900 Lot 1 Subdivision --- ---- Date 4/12/01 S W 1/4 N W 1/4S 1 2 T 28 N /R W Township Troy Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Stee Fence Post with Orange Ribbon System Elevation 94.5 *HRP Same as Benchmark Alt. BM Base of Siding Property Line Scale = 1/4" = 1O' 250' Alt. B.M. B.M 0 B - 1 96' B -2 95' 94' Existing 3 B - 3 93' Bedroom ST 15% 92' House Slope Failed System Current Homeowner does not qualify for Wisconsin Vent Funding 0 0 0 CD r CD Coulee Rd/Count Rd. U ST CRODC COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ' f 2 EzLq-- .' Mailing Address 1 �. L t SV d I l Property Address (Verification required from Planning Department for now construction) city/State Parcel Identification Number 12 Pmperty Locatio> r /4, �r /4, Sec. J�L T2ZN -R -jW, Town of - TI - 0 Subdivision , Lot # Certified Survey Map # _ S �� 3 7 . Volume T . Page #,.._ Warranty Deed # _ ��� � � � Volume Pag # 4/T $ _.. Spec house ❑ yes ono Lot lines identifiable yea ❑ no SYEM MAMMA= Improper use and matntenaneeof yoaar septic system could result in its premature failure. to bmune wastes. Proper maintenance consists of pumping oat doe septic task every &M yearn or sooner, if needed by a licensed pumper. What you put into the system can affect the f3metioa of the septic taisk 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 master Plumber, jotrraeYman plumbed; restricnedplumber or a licensed pumper verifying that (1) the on-she wastowaterdfsposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic teak Is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal systow with the standards set forth, herein, as act by 60 Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that yeas septle system has been maintained must be compleW and returned to the St. Croix County Zoning Offlco within 30 days the three year lion date. STONAMME MAPPLICANT DATE OWNERRT�F.I A 'ION I (we) Car* that all statements o this form are true to the best of my (our) knowledge. I (we) also (are) the owner(s) of the property described shave, by virtue of a warranty deed recorded in Register of Deeds Office. IMIATIr5 APPLICANT DATE •• « *�" Any information that is mis- repcaaeated may result is rho sanitary permit being revoked by the Zoning Dap9►ctsmat, •'•• «s «« Include with this application: a stamped warranty deed from the Register of Dcods office a copy of the certified survey map if reference is made in the warranty deed a S , ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the % races I ,S X - residence located at: Section T e ( N, R W, Town of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: Did flow back occur from absorption system? Yes No (If no, skip next line) Approximate volume or length of time: gallons minutes t2apacity: Construction: Prefab Concrete X Steel Other Manufacturer: (If known): W Age of Tank (If known a e- CA- T (Sig u e) (Name) Please print (Title) (License Number) /t �l Date Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR 83, W's Adm. Code (except for inspection opening over outlet baffle). M oo Name �vN. 15) aU ) �Z� Signature/ MP /MPRS_,c;_ ~ WA"RANTY DEED STATE BAR OF WISCONSIN FORhI 2 1282 Ub PAX REGIVER'S OFFICE IT. CROIX I "Al j,=r ....................... | ' ............ ..................................................... ......................................... ... � ~-'------`------`-`-----''--'---------`----'.---. ..... .... .......................................................... ...................................... .... ^ .- ' .................................................. .............................................. ..... . -------__-'_-'---_-_----..--'.-.------------ the following described real estate In ----'--'J�t°-xr.11x ............. County, State or Wisconsin: Tax Parcel No: .............................. � Part of the NW 1/4 of the SW 1/4 and the SW 1/4 of the NW 1/4 of Section 12, T280 819VV, Town of Troy, 8t. Croix County, Wi0000a10 described as: Lot l Certified Survey Map dated September 33" 1981 ^ revised November 9, 1981 and recorded November g^ 1981 in the Office of the Register of Deeds for St. Croix County, Wisconsin in Vol. 4 of C.8.M. ° page 11.26 as Document 0u. 374349. , .. r�� � "~� . , ^ ^ � ^ ' This ......... 1 §............... homestead property. (is) (is not) Exception to wmr,*nW**: easements, restrictions and rights-of-way of ' ' ^ record, If any. ' ^ Dated this ................ I........................ day of .................. Mazxcb-' ' '--' ' - ...... .»m'-8�� ' 'n ' ! _ ----------'���m�� -------' . --- '-----'--(SEAL) 4'. 'J |' °_'��o�-0e2.&xn...................................... ° -. ---' -. --' ' - -. ' --- /rnA,-1 , 3 V ~ FILED NOV 91981 374349 JIMN 0 #°` CD CERTIFIED SURVEY MAP O $ DONALD MONSON I 6 Part of the Northwest 1/4 of the Southwest 1 and the Southwest 1 of the Northwest 1 of Section 12, Township 28 North, Range 19 West, Town of Troy, St. Croix County, Wisconsin. • Indicates 1 iron pipe found o Indicates 1" x 24" iron pipe weighing 1.13 lbs. /lin. ft. set W z O S 6 6 2,091, _j M 0 3 W I Ate W 5 O b SF? x ai o o • • ��, I-. Q W N WI /4 COR SEC. 12 1 0 � O ff'• EW 1/4 LINE F ; 0► T28N,R19W, F ° (PK NAIL FOUND c' E 1/4 COR. SEC. 12, W �? T28N,R19W, m=* (COUNTY SURVEYOR'S MONUMENT) am b 195 N O S z F►2 � � a S88 1 GARAGE 09 '' W W m 400.92 F m N J n ?s$ a , a o 0 3 LOT 1 = 4.814 ACRES SCALE 1" =100' NET= 4.290 ACRES S84 2 1'39 16 1E 8 io0 209,684 SQ.FT. W (\i NET -z 186,859 SQ. FT. DWELLING N . ZO\.3 22 �6 1 C ' z ,, O �O 9 z a -b ` e ©� o — 17 2. 2 a' - - -0_ \ � 89 53'1 M 173.01' - 0) APPROVED N NOV 09 1981 � 51.5 Q ST, -zOIX COUNTY 6 COMPREH_" SIW PARKS PLANNING s T CURVE N '90 40 CURVE CHORD ARC CHORD BEARING I - ANGLE RADIUS A 527.98538.33' N71 "W 39 790.00' C - D 511.84' 520.34' N 72.3449" W 36 30" 823.00' State f Wisconsin) sconsin _ County of Pierce) I, James L. Murphy, Registered Land Surveyor, do hereby certify that by direction of the Owner, Donald Monson, I have surveyed and divided the lands shown hereon in accordance with official records, Chapter 236 of Wisconsin Statutes and the Ordinances of St. Croix Coun d that i the above map and description are a true and correct representation thereo ������� /j llo S C O /V Dated: 23 September 1981 '� IF .:' JAMES L. Revised: 9 November 1981 _ ? MURPHY Vol. 4 Page 1126 9 �= S• 1 0 4 Certified Survey Maps James L. Murphy RIVER F St. Croix County, Wisconsin Registered Land Surveyor i:��'�i%.,.. WIS, '' (DESCRIPTION ON REVERSE) ' %,,,F� LAND ����11 I q J 11111111110