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HomeMy WebLinkAbout042-1057-20-300 in Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix d Building Division INSPECTION REPORT Sanitary Permit No: 488223 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal info ?nation you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit•'iolder's Name: City Village X Township Parcel Tax No: Brady, Greg Warren, Town of 042- 1057 -20 -300 CST BM Elev: Insp. BM Elev: BM Descri Lion: Q — Section/Town /Range /Map No: P rC / lZe — 14-a` 20.29.18.319A30 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark / 2 r wv� II I Dosing , i Alt. BM Aeration Bldg. Sewer 36 5 y7 Holding opaOV4 St/Ht Inlet TANK SETBACK INFORMATION pry` St/Ht Outlet • 7 SS TANK TO P/l WELL BLDG. Vent to Air Intake ROAD Dt Inlet 3 / Dt Bottom Septic � 7 Dosing I u( Header /Man 9 r Aeration Dist. Pipe 9.z Holding Bot. System ,2 Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover r ,� GPM r{,� fit. Model Number N1 TDH Lift Friction Lo Sys te ead TDH Ft t Forcemain Len Dia. Dist. to Well 1> SOIL A ORPTION SYSTEM k z $r �Z `7 BED /TRENCH Width �) Len No. Of Trench PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth ED /TR IONS �)� �� SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEAC ING Manufactur r INFORMATION CHAMBER OR Ty Of System: /O 7a/ /� / UNIT Model Number: DISTRIBUTE N SYSTEM Head /Manifold Distribution keoG' — Hole Size x Hole Spacing Vent Air Intake / Pipe(s) (r --- � 0 Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over ��Q Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center /Lr�� — Bed /Trench Edges Topsoil Yes No Yes No i COMMENTS: (Include code discrepe ci s, persons present, etc.) Inspection #1: 7 - 7 7 Inspection #2: Location: 812 106th Street Roberts, WI 54023 (SW 1/4 SE 1/4 20 29N R1 8W) NA Lot 3 tV Parcel No: 20.29.18.319A30 1.) Alt BM Description 4aJe- ( - 2.) Bldg sewer length = q3, V - amount of cover = } 3 r _ y // L /. Plan revision Required? Yes o Use other side for additional informatio - - -- -- - Date Insepctors Signature Cert. No. SBD -6710 (R.3/97) I � L Co7T1ir3erCC.WI . goV Safety antgBuild s Division County 201 W. Washin ton O. Box 7162 /\ i Q co n c n Madison, WI 07 -7 62 San itary Permit Ntunber (to be filled in by Co.) Depart meVof Co $ �f ZZ Sanitary Permit Application State ransaction,Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appr iate g nml n /' �j unit is required prior to obtaining a sanitary permit. Note: Application fo a Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information y proviR econda p urposes in accordance with the Privacy Law, s. 15.04 ( 1)(m ), Stats. 1. Application Information - Please Print All lafprmation Property 0 er's Name JUN 2 7 Z00 Parcel # C� rea V ozlz -1657 ZO - 31no Property Owner's mg Address / ,/' L fST.CROIXCOUNly2 Property Location / 7/1 _ b �t _2 / `! J e 1, Are Govt. Lot c� City, State Zip Code Phone Number y. /., Section O _!SV rcle on �/ J T R�EprEW ) 11. Type of Building (check all that apply) Lot # L/ 2 Family Dwelling Number of Bedroom Subdivision Name o(': '' Block ❑ Public/Commercial - Describe Use I �� - ❑City of CSM Number ❑ Village of ❑State Owned - � Use 2- ti6 C a GJ G .� Qrl� Town of ZeAQ 1 Ill. Type of Permit (Check. only one box on line A. Complete line B if applicable) A. ew System y ❑Replacement System !, ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System (explain) C1 Permit Renewal Revision List Previous Permit Number and Date Issued B. ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner �( IV. a of POWTS S stem/Com onent/Device: Check all that appl n- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. ofsuitable soil ❑ Mound < 24 in. of suitable soil G�• `� ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) 6 V. Dis persal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required 4(s I Dispersal roposed (sf) Systi0fin Elevatio L1 6_1 :3 VI. Tank Info Capacity in Total # o 'Manufacturer u Gallons Gallons Units a w U y New Tanks Existing TapkS U iii rn Septic or Holding Tank Z s Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assum es nsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' ure MP /MPRS Number Business Phone Number Wu. `G Plumber's Address (Street, City, State, Zip Co e 0"—en"4 a, Vill. Count /De artment Use Onl Approved ❑ � ed Permit Fee Date I sued Issuing ent Sign e ❑ caner en Reas for Denial IX. CondiWN1 s1y�1(Reasons for Disapproval 3 S 1. `", S , e��pt ti ic tank, effluent filter and J dispersal cell must all be services / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained tac to complete plans for the system and submit to the County only on paper not less than S in x I1 inches in sue SBD -6398 (R. 01/07) Valid thru 01/09 l �3 �f. M S it Test and.System PLOT PLAN PROJECT Grea 8radv ADDRESS 2243 Tilsen Ave St. Paul Mn 55119 SW 114 SE 1 /4S 20 /T 29 /R 18 W TOWN Warren , cOunrry ST. CAOIX T MPRS Shaun Bird 226900 6/20/07 3 DATE BEDROOM CONVENTIONAL )OCK IN- GROUND t SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of 3/4 pipe ASSUME ELEVATI0N 100' Filter BEST Fil ter � Q BOREHOLE WELL •H.R.P. Same as Benchmark SYSTEM ELEVATION 96.3/95 5' 7 4 below qrade Town Road Well is to meet all setbacks required by Vent WDNR >6" QuiC 4 S ndard -W Plans Designed Using of Cover Leaching hamber Conventional Powts with 20.0 ft2 of Area Manual Version 2.0 4' Long 1211 5.8ft ^2 /pair of end caps 4 Grade at System Filevation Property Line s P Pro 4 Bedroom �n\ l House 25' 0 2 2 -3'X 68' e s >3' Spacing ST o Slope 101' 40' B -3 20' 30' r 99' 90' B -1 _ Property Line B -2 B. M. * 5 z•7 / U�' 100' d L' egg: ll LO OZ d IL Property Owner _ Parcel ID # Page of a Boring # ❑ Boring o r. 3 Ground surface elev. ft. Depth to limiting f �� a or 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 z-- Ir ll 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 I •Eff#2 F-1 Boring # E] ❑ Pit Boring Ground surface elev. ft. Depth to limiting factor in. F soiiApplicafion 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 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 (8.6/00) Property Owner _ Parcel ID # Page of a Boring # ❑ Boring f tJ it Ground surface elev. ft. Depth to limiting factor f– "-- 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 A-/) - ? lr a D 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 GPDAf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 F-1 Boring # ❑Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil NTlication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDlff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 I •Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mglL ` Effluent #2 = BOD < 30 ffKA and TSS < 30 mglL 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 (8.6/00) 429/R st and System PLOT PLAN PROJECT Grea Bradv DRESS 2243 Tilsen Ave St. Paul Mn 55119 SW 1 / 4 S E 1 /4 s 20 8 W TOWN Warren COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/20/07 BEDROOM 4 CONVENTIONAL XXX IN -GROU 1 � 1 / / RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK S,Iz1,V 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL - H.R.P. Same as Benchmark SYSTEM ELEVATION 96.3/95.7 4.5' below qrade Town Road Well is to meet all Vent setbacks required by WDNR >6" Quick4 Standard -W of Cover Leaching Chamber Plans Designed Using with 20.0 ft2 of Area Conventional Powts 5.8ft ^2 /pair of end caps Manual Version 2.0 4' Long 12" 34" Grade at System Elevation Property Line Pro 4 Bedroom House 25' 0' 2 -3'X 90' Cells with >3' Spacing ST 6% Slope 101' 40' B -3 20' 30' 99' B -2 90' B -1 5 Property Line B.M.* 100' Safety and Buildings Division County e 201 W. Washin ve., P.O. Box 7162 C ✓ p ~ Madison, 537 —7162 Sanitary Permit Number (to be filled in wnsw by Co.) 608 1 Department of Commerce ( ) ZZ3 der Sanitary Permit A licatio San ry PP � Z (e, +. Comm 83.21 Wis. Adm. Code, In accord with erso P may be used for secondary purposes Privacy Law, s IV Project Address (if different than mailing address) I. Application Information - Please Print All Informs a s _ O Property Owner's Name Parcel # Block # �7 ST. CROIX COUNTY Property Loca Property Owner's Mail' Address / 2 — � / ., �' /., Section City, State Zip Code Phone Number / Am�, r (� s/ N; II. Tyne of Building (check all that aa apply) pk q,.S OrAoeA ` Yp ��'`'' Subdivision Name CSM Number r 2 Family Dwelling -Number of Bedrooms ❑ Public/Commercial - Describe q q ❑ State Owned — Describe Use 1.J o f / � 9 G ❑City_❑wlag ownship III. Type of ermit: (Check only one b on line A. Complete line B if applica A' System ❑ Replacement Sys ❑ Treatment/Holding Tank lacement Only ❑ Other Modification to Existing System r B. El Permit Renewal ❑ Permit Revision Change of ermit Transfer to New List Previous Permit Number and Date Issued Before Expiration - 7 ber wner ` Z I i 1 � IV. Tyne of POWTS System: Check all that a I — Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In -Gr and ❑ Holding Tank Peat Filter ❑ Aerobic Treatment Unit ❑ R ulating Sand Filter -❑ ❑ Other (explain) Recirculating Synthetic Media Filte g Chamber ❑ p Line ❑ Grave! -less Pipe V. Dis ersal/Treatment A a Information: Area Pro osed Dispersal s System El ation Desr Flow (gpd) Design Soil Application Rat sf) Ispersal Area Re red (sf) Dis P ( ✓- Prefab Site St Fiber Plastic V1. Tank Info Capacity in Total ber Manufa er Concrete Constructed Glass Gallons Gallons Units New Existing Tanks Tanks Septic or Holding Tank (L Aerobic Tteatmem Unit Dosing Chamber VII. Responsibility Statement- T, the and assume responsibility for installation of the POWTS s wn on the attached plans. Plum s Name (Print) PI 1 MP/MFRS Number Business Phone Num r Plumber's Address (Street, City, State, L e) �/*� Z Y / V11" ounty /De artment Use Onl Sanitary Permit Fee (includes Groundwater Dat Issu Issuin gent Signat pproved 11 prove Surcharge Fee) 4 1 x r • 00 : IZ n/ _ El n Reason o 1 (� lJ �(' TX. Conditions of Approval/Reasons for Disapproval SYS TEM OWNER: 1. Septic tank, 0kott liitsr and dispersal call must aN b, SWAM .L,mwnmk m as per mans"nW t plan provided by per• 2 AM setback reWW me t must be mabtt kod as per gViceW code / ordkwwm. Attach complete plans (to the County only) for the syslem on paper not less than 8112 x 11 inehes In size SBD -6398 (R. 01/03) l i I I brf i 9fil eb C !et!�.a:'i `•CR! !+n : ?til*t i': •. :'y� ;i:i�4Z 6A j I OT PLAN PROJECT Grea Bradv ADDRESS 2243 Tilsen Ave St. Paul Mn 55119 SW 1/4 SE 1 /4S 20 /T /R 18 W TOWN Warren COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/7/06 BEDROOM 3 CONVENTIONAL XX IN -G D R SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 675 # of chambers Z IL BENCHMARK V.R.P. Top of nail in Fence Post ASSUME ELEVATION 100' Filte BEST Filter ❑ BOREHOLE O WELL * H. R. P Same as Benchmark SYSTEM ELEVATION 93.0/92.6/9 4; below grade Well is to meet all setbacks req 'red by Vent WDNR Tow >6 „ Standard Biodiffuser Road of Cover Leaching Chamber Plans Designed Using with 25.0 ft2 of Area Conventional Powts 1 Manual Version 2.0 1� 5' Long 3 4" Grade at System Elevation Pro 3 Bedroom House Pi se note: fu testing will be done t nstall system in ore suitable location 4 ' ST 50' 3 -3' X 46' cells with >3' Spacing 40' B -3 4 ' B -2 Property Line Vents 10' 85' OT PLAN PROJECT Grea Brad ADDRESS 2243 Tilsen Ave St. Paul Mn 55119 SW 1/4 SE 1/4s 20 /T /R 18 W TOWN Warren COUNTY ST. CROIX 7 6/7/06 3 MPRS Shaun Bird 226900 / DATE BEDROOM CONVENTIONAL XX IN -G PRIESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 675 # of chambers Z ,BENCHMARK V.R.P. Top of nail in Fence Post ASSUME ELEVATIOZ100'Le ❑ BOREHOLE WELL *H.R.P. SameasBenchmark SYSTEM ELEVATION 93.0/92.ow q Well is to meet all setbacks requir by Vent WDNR Tow >6 „ A Standard Biodiffuser Road of Cover Leaching Chamber Plans Designed Using with 25.0 ft2 of Area Conventional Powts Manual Version 2.0 5' Long 34 Grade at System Elevation " Pro 3 Bedroom House Ple a note: further testing ill be done to stall system in a more su ble location 4 ST 50' 3 -3' X 46' cells with >3' Spacing 40' B -3 .n 40' 0 ' B -2 Property Line Vents 10' 85' Wiswnsin Department of Commerce SOIL EVALUATION REPORT Page of ` Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County � 0 t Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, bat 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. t�`1 2 — /( 9 5 ` �Q — t Please print all information. R view Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location , 3) qA 3d Govt. Lot S W 1/45 F 1/4 S T Z N R( E (or) Property Owners Mailing Address Lot # Block # Subd. Name r CS � &� d vv 3 City Slate Zip Code Phone Number ❑ City ❑ Village [2 'fown Near st Road So✓� (/f � (iS`) 3�G -S9'� �- � r <-e ✓� �o a� rsl �c� ( New Construction use: I2 Residential ! Number of bedrooms ^ `� C de Wd desig flo y /l4 C) GPD ❑ Replacement ❑ Public or commercial - Describe: . Parent material 6) U Gt !a S Gj Flogd Ptain elevation if ap'Itli ble General comments and recommendations: — �S y G�tlrrGOFFtc 1 Boring # ❑Boring ®pit Ground surface elev. Depth to Ilmitin 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 I b - 1 3 Z 5' 2 3 Zo-ti ro r 4 L 5 1 ms m V-C' - 2 `f Q 2, , r i( a Boring # ❑ Boring ® pit Ground surface elev. .t. Depth to limiting factor � Z �f 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 0 -1 4 10 312 S 2 I�� .5 S Z i`l - 3b 5 • I 2 rcyPr s . 5 8 't -124 10 r yl m h, _ . 1. / Ito * 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 Nam (Please Print) ignature CST Number ZS Address Date Evaluation Conducted Telephone Number Property Owner Parcel ID # ( Page of 3 a Boring Boring # ❑ S 2 © Pit Ground surface elev. 9 �' ft. Depth to limiting factor 1 in. Soil Ap plication 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 to 3i' Sr( Zr,� L. 4r c5 �vC S • 2 - r - Ib Y4 s(I 2 �s - 5 8 3 30 4 (L� `I � 4 L 5 ( n v - �y- I z1 t (`t to m S O 2 < ' f, `S" Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Effluent #1 = SOD, > 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 (W07/00) i Property Owner PG' 4° ' 1 Parcel ID # /O / Page Z of 3 F Boring # ❑ Boring rrll © Pit Ground surface elev. 9 S - 0 9t. Depth to limiting factor Z in. l 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 I 0 -1( � vC S 2 - /- jbvc Y4 S I 2 I_5 ( ms "m v-Cr c S — 1 I .2 - q - - I z$ `t to m S O ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor )n . - ' go — ilApplication 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 I *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/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *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) - Y PAGE 3 OF 3 NAME -L�t 7� LOT# 3 LEGAL DESCRIPTION S F ' Z4,S Zd T Z ,N,R, g E(odlp SCALE: 1 "= yG BM 1 ELEVATION 160 BM 1 DESCRIPTION n a ' ^ 16 Ac ✓ C, P° S BM 2 ELEVATION 100 • a BM 2 DESCRIPTION <,, ( 0" Ob 6 le Q ox el d i r S eG . Z O SYSTEM ELEVATION 9 2, 6 y ` ALTERNATE ELEVATION '7 -- CONTOUR ELEVATION °" x � l I l 5 ; 10 C �h r ;b Sox Q FIL F S A Z 5er SIGNATURE /�� DATE mil 0 - °� 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 Plan Op7em 1. 1 ystem fails, determine cause of failure, use alternate area and install new sys n teste d 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 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner Buyer l r / Address 'S / Mailing / Property Address / (Verification required rom Planning & Zoning Department for new construction.) City /State Parcel Identification Number 0 y� / 7 ` 2- 0 LEGAL DESCRIPTION _ Property Locatio� 1 /a j� '/a , Sec. � 0 T � N R W, To wn of .`— g L # � Subdivision Certified Survey Map # � J j 1 , Volum�� Page # � Warranty Deed # :21 y , Volume 2 �i , Page ## Spec house yes Do Lot lines identifiable Ono 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. Uwe certify that all statements on this form are true to the best of my /our knowledge. Itwe am/are the owner(s) of the pr described y v' of a warranty deed recorded in Register of Deeds Office. NA 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) 40' -0" 2' -6" O O ° oa ° oo - om 6'-0' C%o — 5 -9Y y - 20" FLO m I . TR SS A j o Ir •r Zp j 00o z 1 4 O 2 I yo' o x 5'- 20 f1.0 • J. I �O $Gzi n O _ f 40 20" DEER o m I' FLOORTRUSS I J , I 24" O.C. I . fz 2 1 r f O r a - t O j � m j. 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WALSH STATE BAR OF WISCONSIN FORM 2 - 1999 REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROIX Co., WI RECEIVED FOR RECORD This Deed, made between Steven M. Dalton, 04/28/2003 09:30AN WARRANTY DEED EXEIPT # Grantor, and Gregory P. Brady and Maureen O'Donnell,as joint, REC. FEE: 11.00 tenants TRANS FEE: 156.00 COPY FEE: CC FEE: PAGES: 1 Grantee. 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 Name and WjWfflhW Of LAND That part of SW' /<SE' /, Sec. 20 and NW' /.NE' /. Sec. 29- 129N -R18W ATTOR AT LAW described as follows: Lot 3 of Certified Survey Map recorded in Volume 17 P.O. BOX 359 of Certified Survey Maps, page 4444, as Document No. 705988. St. Croix HUDSON, WI 54016 County, Wisconsin. 042- 1057 -20 -000 Parcel Identification Number (PIN) This is not homestead property. 0() (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this 2 day of April , 2003 * * Steven M. Dalton AUTHENTICATION ACKNOWLEDGMENT Signature(s) Steven M. Dalton, STATE OF WISCONSIN ) ss. �µ County ) Gatic0 ¢ l 11 ,� ay of April 2003 Personally came before me this day of `•'' April , 2003 the above named Steven M. Dalton, Kriytin9'O On , TI';E: MEMBiINATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. ag r § 706.06, Wis. Stats.) 'THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogiand Notary Public, State of Wisconsin Hudson, W1 5401 My Commission 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 signature. Inrorm oon Professiwi comWw. FwW du LK WI WARRANTY DEED STATE BAR OF WISCONSIN eoo$ssaozr FORM No. 2 -1999 Parcel #: 042 - 1057 -20 -300 06/12/2006 09:26 AM PAGE I OF 1 Alt. Parcel M 20.29.18.319A -30 042 - TOWN OF WARREN Current Lk ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: O = Current Owner C = Current Co -Owner Owner(s): , O - BRADY, GREGORY P GREGORY P BRADY C - O'DONNELL MAUREEN O'DONNELL MAUREEN 2243 TILSEN AVE ST PAUL MN 55119 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 812 106TH ST SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 2.000 Plat: 4444 -CSM 17 -4444 042/03 SEC 20 T29N R18W PT SW SE BEING CSM Block/Condo Bldg: LOT 03 17 -4444 LOT 3 (2.000AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 20- 29N -18W SW SE Notes: Parcel History: Date Doc # Vol /Page Type 04/28/2003 718974 2220/245 WD 01/15/2003 705988 17/4444 CSM 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/20/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 37,500 0 37,500 NO Totals for 2006: General Property 2.000 37,500 0 37,500 Woodland 0.000 0 0 Totals for 2005: General Property 2.000 37,500 0 37,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 r { ST. r�l ?`.�IY CC:l.l�ttY : Tut r� l�s C.nrnr,i`( ^q;, VOL 17 PAGE 4444 KATALM H. WAR-- - JAN • � .�11 REGISTER OF DEEDS ST. CROIX Go., WI RECEIVED FOR RECORD 01/15/2003 04:00PH I' EtGp;':9cCl V'+liillli Rio clI'y ,I •i-- - - - - -- REC FEE: 17.00 I i� �r.�l (1,Pr ��s,l:ttnw �l �.ItsM f �' pw Q BEARINGS ARE REFERENCED TO THE 03 COPY FEE: > r; -,VIII m 77 PAGES: 4 r SOUTH LINE OF THE SE1 /4 OF SECTION 1 y m 20, ASSUMED TO BEAR 589'10'58 " m c cf) cf) Z c d m1 m mq co ' ° G 5 d ®. 0 1: I 9 oZ� � � Z� ®IT1 d m z I /� 'g� gy p. (1) N -n v n j m I / \ �N - Zn Q) o° I / 2s �� ��r m w SOY Z I m u, 01_ W 0 c) m m 1 1 Q� S NQ � �Z 1 1� i �� 10 1 to o Z I �j I II cS If O 1 0 I OO m N IQI^ id .i�J I— � I i� Z �� C®f1 _4>� ii1IN� W IOI�U ' Ilj moo jU�u r - y • .� O 1 1� Q M �7 I I C) O 1 �p 1 C j Q v I i ° v rn •0) Np. •`' g ��.Z � 1 1 1 1 (S01 °41'54 "M ~I\ T,-O P °- ZZ c 1 0 1 0 o CAp Z6� �y'CY►m 1 � ,� i� ° I sel,se 319.18 1 69 I. p Z �p9„a'® 1� z tt i� ua IC , .99 S020240"W g �Z +�� C) , 1 ° i �I� w mS02 °02'40 "W 3 81 . 99' zo fJ"' 0� � i 1� o o �w a? 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