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HomeMy WebLinkAbout040-1239-20-000 Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM C ounty: INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryP rmitNo: Personal information you provice may be used for secondary purposes [Privacy La s.15.04 (1)(m)J. 06 PermitFi gl N @I El Citv,.,C]_Vil age Town of: State Plan ID No.: CST BYMUEEleev.: i[ " RICK BM Elev.: BM Description: p Parcel T N r o.: f � r/ 0— X239 - O -IIDO Ida A 1 111 , 10 Al Q a 264 TANK INFORMATION - I ELEVATION DATA ' N o TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic evet 106 Benchmark 3_ p o 0 Dosing 459 r A ' S; 3L tion Bldg. Sewer , Z Holdin Ht Inlet . 9 TANK SETBACK INFORMATION St utlet TANKTO P/L WELL BLDG. Ventto ROAD �te Air Intake Septic T�d r NA Dt Bottom , 0� Dosing ��bf 7Z NA Header /Man. Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer S Demand / o , 00 _& P. Model Number p 540 ( GPM TDH Lift Friction Syetem TDH Ft Forcemain Length (d t Dia. 1 2 f Dist. To Well SOIL ABSO PTION SYSTEM BED EN H Width Len ( No. Of T enches PIT No. Of Pits Inside Dia. Liquid Depth DIM r N 1 DIMENSION SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK I CHAMBER ^ /V Model Number: INFORMATION Type O System: l �r j l (V - - OR UNIT DISTRIBUTION SYSTEM Header /Manifold J Distribution Pipe(s) r x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length � L Dia. Spacing _J_ H - V ' I j SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded ISodded xx Mulched Bed/ Trench Center Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATIO TROY 21 28 19.1210,SE,SE 578 COUNTRY OAKS rAW Z b Lve l t J P sa.,,W re V �� a� �a-- wok 4, Lod if Zxin.oQ f S sa�ara � ,/ � 10.4 5 5 65 0 � kJ mo« w Plan revision requi.�ed? ❑ Yes No Use other side for additional inform tion. - Zi Z Z d ,J SBD -6710 (R.3/97) Dat Inspect s Signature Cert. No. Safety and Buildings Division �. 201 W. Washin SANITARY PERMIT APPLICATION ton Avenue g ►scons►n In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less Count than 8112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary P ermit Number Personal information you provide may be used for secondary purposes ❑ Check ewslort v s application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION 2 Property,Ow r Nam Property Location 5F va E r 1 /4, S T 0, N, R X(orko IM Owner's Mailing Aless Lot Number Block Number 7 J7` .5 , o, City Stat q e /G (7 Zip Code Phone Number Subdivision Na or CSM Numb r /SS G� I. TYPE OF BUILDING: (check one) ❑ State Owned It Nearest Road Public ❑ Village 1 or 2 Famil Dwellin - No. of bedrooms Town OF 44 III BUILDING SE: (If building type is public, check all that apply) Parcel TaxNumber(s) / •%- 19-12 �1 10 1 171 Apartment/ Condo 0 L /O — / L , : r " 5-© ✓ 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. "New 2 E] Replacement 3. E] Replacementof 4_ [] Reconnection of 5. ❑ itepair of an System System _____ ________TankOnly_____._________ Existing System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21f Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vauht Privy 14 ❑ System -In -Fill VI. AB SYSTEM INFORMATION: 1. Gal ons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev 7. Final Grade Required (s ft.) Pro ed s ft.) (Gals/da /s ft.) (Min. /inch) Elevation 4 �� ; y G Feet — Feet VII. TANK Capacit gallo s Total # of Prefab. Site Fiber- Exper INFORMATION Gons - all Tanks Manufacturers Name Concrete con steel glass Plastic App New Existing strutted Tanks Tanks eptic Tan 4r ank `QpC9 j 0 0 - ❑ ❑ ❑ Lift Pump Tan iph er — �� ❑ ❑ ❑ ❑ ESP NSIBILITY STATEMENT 1, the undersigned, assume responsibility for install tion of the onsite sewage system shown on the attached plans. Plu s m : (Pr t) lumber' nat : (N M MPRSW No.: Business Phone Number: lr aa o� f 7 Plum Address (S reet, City tate, ode): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate I ssued Issuing t S' nature (No Stamps) Surcharge Fee) Approved F1 Owner Given Initial L;I Zlf ,/A Adverse Determination / `/ X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION; Original to County. One copy To: Safety & Buildings Division, Owner, plumber PLOT PLAN ' - Page Z of � • Scal 1 "= 50'' BM -- -- -- - - -- - -- - W T L I YjkZ _ � ? oo NoT cA��?rtcT � I T Li.-t (6. S 3 gDRwl J IIne �, suc� e3Tft rJ� I ��' I 10�bF �1 i O pi opUC, ai r co,�m,wZ e� , a`�•S � 13oYtuw� oc hcU U t'L 48S i L O'r 1. l W t�_ ,� 17 n O � C5 q NOTES 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( Z required) 3. Install 4" observation pipes with approved caps. ( Z required) 4. Septic tank to be WjO L650 gallon capacity manufactured by 'l--A, � D 1�j �TTNz( ��z� ry c, 5. Bench Mark LLPU, too.b' o� I" czvt "L 6. Divert surface water around mound to prevent ponding at the uphill side. Page S Of �o i Approved Synthetic Covering FlsTNt c 33 Distribution Pipe Medium Sand . Topsoil H —1 F Elev*. � 8 • S _ 3 E p b % Slope Force Main Plowed Trench of k" - 2 12" From Pump Layer Aggregate Undisturbed D �.O Ft. Soil E 1,08 Ft. Cross Section Of A Mound System Using F 0.$ Ft. I Trench For The Absorption Area G N • a Ft. A �_ Ft. H I- S Ft. B 0 14 Ft. I \-- Ft. Linear Loading Rate = q- GPD /LN FT J Ft. Design Loading Rate= p.3 GPD /SQ FT K \O Ft. L 1\4 Ft. W Z4 Ft. L J Force g K Mai_ W � opP ost`tE Distribution Trench Of Pipe Aggregate I Permanent 1 Observation Markers Pipes (Anchor securely) Mound Using I Trench For Absorption Area ! Safety and Buildings • 1340 E GREEN BAY ST STE 300 SHAWANO WI 54166 TDD #: (608) 264 -8777 iscons n www.commerce.state.wi.us Department Of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary June 01, 1999 CUST ID No.267341 ATTIC POWTS INSPECTOR WEGERER SOIL TESTING & DESIGN ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES• 06 /01/2001 Identification Numbers r 4 Transaction ID No. 229000 i ( r t t 1,. Site ID No. 173463 SITE: ` 1 , ' Please refer to both identification numbers, Site ]D: 173463 - ? a �, ' bove, in all correspondence with the agency. ST CROIX County, Town of TRO POUl,�SATE SE1 /4, SE1 /4, S21, T18N, R19W Ggr RICHARD LA CASSE COUNTRY S LANE FOR: Description: MOUND SYSTEM FOR RIC -GASSE Object Type: POWT System Regulated Object ID No.: 471674 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. 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. 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 05/25/1999 i FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 KE TH A 'WILKINSON, POWTS PLAN REVIEWER BALANCE DUE $ 0.00 Integrated Services (715) 524 -3630, FAX: (715) 524-3633, M -F 7 AM - 3:45 PM KWILKINSON @COMMERCE.STATE.WLUS WiSMART code: 7633 o -- Page l of 6 a MOUND SYSTEM FOR A 3 BEDROOM RESIDENCE 4q � LP*ATED IN THE SE 1/4 OF THE Se 1/4 OF SECTION Z ,T It N; , R W, TOWN OF COUNTY , WISCONSIN . LoY 9 or- cAu QT ClftlLs sr . INDEX PAGE 1 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 FLAN VIEW4CROSS SECTION ; bf M ouN A PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER LiU SELT I or1 P nc a Shx—S. PA GE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR C�t Lomb LY\ Cgsse ��soty, DUI Sao 16 PREPARED BY WEGE[ZEF;Z SO I L TEST I P4 CS AND. ICES I GN SE=FZV I P.O. BOX 74 421 K. KAIK ST. A"UP RIM FALLS. NI 54022 WEGER p L Cott dit ionally 715 - 422.-0165 W° �' S W P s APPROVED . � DEPARTMENT OF COMMERCE y E I G1 VISION OF SAFETY #ND BUILDINGS �j�h,BhiN EE CORRESPONDENCE - --7 O 0 0 JOB NO. Pag Of Perforated Pipe Defoil 0 End View Cop Perforated End Co Jo``o�o PVC Pipe Install permanent-marker at end of each lateral Holes Locoted On Bottom. Are Equally Spored Q End Cop * PVC Force Main Distnoution Pipe Lost Hole Should Be Next To End Cop Distribution Pipe Layout P Ft. X 31 Inches Y 3'7 Inches Hole Diameter Jry Inch Lateral 1 Inch(es) Force Main Z Inches # of holes /pipe 1 S Invert Elevation of Laterals G Ft. Place lst hole W c '� from tee with succeeding holes at 3- I ,I intervals. Last hole to be next to the end cap. Combination Septic; Tank and PUMP CHAMBER CROSS SECTfON AA1D SPECIFICATIOM ' PAGE S OF VE►JT CAP WEATHER PROOF JUIJCTIOLI 80X . 4'C.I. VEAIT PIPE 'APPROVED LOCKING lO' FROM DOOR, MAWHOLE COYER wIV - ,iIMD0W OR FRESH AIK I1JTAKE coNpu\ tj 6 M I I � IB "MI►!. _ lh y�ll.�shl'�hoN PIPt PROVIDE I "— INLE T AIRTIGHT SEAL I I II v 3gFPL�S I A II APPROVED JO11JT5 APPROVED JOIIJT I II W /C.I PIPE0Kp'C W C.I. PIPEOR Tank construction / I II ALARM shall comply with ILHD 133.15 and 33.20 f3 I 1 I I ofJ C I I LLEV. FT. PUMP - - -j OFF D C0kul KLTE Z DO BLOCK APPScov RISER EXIT PERMITTED OWI-tl IF TAIJK MANUFACTURER HAS SUCH APPROVAL JLDDIN46 SPEGIFICATIOI.lS SEPTIC f 005E I p�Lr�flS UUMISER OF DOSES: 3' S PE.R DAy T/+U�C MAAIUFACTURCR: TANK :,IZC : 1. UU ��D GAL.LOUS DOSE VOLUME t S IMCLUDING 6ACKFI.OW S� GALLONS ALARIA MAUUFACTURER: = 1� 3Db I' V..) A L O [ UM ER' O` � CAPACITIES' A IUCHCS OR G L OUS M D L AI B SWITCH TYPE: B= 2 ' IIJCHES`OR G�LLOIJS (JUMP MANUFACTURER: So UI- DS C- 9 ILK HE$ OR S � GALLOWS MODEL UUMBER: 3 $ 1 S D- INCHES OR 1$ 3 CALLOUS SWITCH TYPE: I`1 f2L MOTE: PUMP AM ALARM ARC TO bE b MI DISCHARGE RATE �''�� GPM INSTALLED OW SEP C{RCUITS VERTICAL DIFFEKEUCE DETWEELJ PUMP OFF AUD- 13I5TRIBUTIOU PIPE.. '' S FEET + jAiul MCTWORK SUPPLY PRESSURE .. 2-52 FEET + FEET O F FORCE MAIM X Z`'� FYortFRICT10" FACTOR -- 3 FEET TOTAL OyWAMIC HEAD = FEET Pump chamber DIAMETER IIJTERAIAL. DIMLWSIOWJ OF TAUK: LEKIGTH ;WIDTH .;LIQUID DEPTH BOTTOM AREA — - 231= - GAL /INCH AS PER MANUFACTURER - GAL /INCH r . POYAV Goulds Submersible Effluent Pump EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas- • Homes components. Available for automatic and tic cover with integral handle Motor: and float switch attachment • Farms manual operation. Automatic • Heavy duty sump • EPO4 Single phase: 0.4 HP, models include Mechanical points. • 115 or 230 V, 60 Hz, 1550 ■ Power Cable: Severe duty Water transfer RPM, built in overload with Float Switch assembled and • Dewatering preset at the factory. rated oil and water resistant. automatic reset. ■ Bearings: Upper and lower SPECIFICATIONS • EP05 Single phase: 0.5 HP, FEATURES heavy duty ball bearing 115 V, 60 Hz, 1550 RPM, construction. Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo- * Solids handling capability: automatic reset. plastic Semi -open design 1 /4 " maximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. 5- Canadian standards association • Total heads: up to 24 feet. with three prong grounding m EP05 Impeller: Thermo- • Discharge size: 1 1 /2" NPT. plug. Optional 20 foot (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in " F" or "AC ".) rotary/ceramic- stationary, three prong grounding plug improved performance. BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 - -- - - ------ - -------- -- - • Capable of running dry without damage to s 30 _P.-=• --5GPM components. i ,_ -___ Pump: EP05 8 F • Solids handling Capability: 0 25 3 /4" maximum. w - — - __ -- • Capacities: up to 60 GPM. X s 20 • Total heads: up to 31 feet. • Discharge size: 1 1 /2" NPT. Z 5 -- - - - -- - — -- - -- — - - -- - • Mechanical seal: Carbon- 0 15 rotary/ceramic- stationary, a BUNA -N elastomers. o - - -- -- - - - - - -- - _ -- -_ -- -- -- -- -- - ePOS • Temperature: 3 10 104 °F (40 °C) continuous 140OF(60°C)intermittent. 2 -_- - - -- - -- i 5 1 I I . 0 00 10 20 30 40 50 GPM i 0 2 4 6 8 10 12 m'/h CAPACITY t Wisconsin Department of Industry SOIL AND SITE EVALUATION Labor and Human Relations r age of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis.' Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and ST'� K•; i � percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.f3 f APPLICANT INFORMATION - Please print all information. Review i ROix Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). - FIDE 4 Property Owner Property Location L 4W R6_10 C9!5_ W MUR y l P�RT'u��� Govt. Lot SE 1/4 ✓�F 1/4,S ,N,R (9 E (or )(0 Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# A, 9302 goo T'h Ate. f loo•'rVc/ — Covur,Py 0 City State Zip Code Phone Number Nearest Road R + tit fA l15 !.0 1. Sg (•11 ) tl-.c -9032 El cit El village D J own (ovaTA LrJ New Construction Use: Residential / Number of bedrooms � �� Addition to existing building N/� No T ❑ Replacement El Public or commercial - Describe: �(/�� V ,V O j P� (may y� y D Le� yso - Code derived daily flow Co OD gpd Recommended design loading rate bed, gpd/fl 3 trench, gpd/(t Absorption area required N/A bed, (t — trench, ft N 3 r7 — _ Maximum design loading rate ,bed, gpd/fl • trench, gpd/It Recommended Infiltration surfrics elevation(s) ' 3 ft (as referred to site _pl an benchmark) Additional design /site co ations RCQ d T/p �'j e' T E 'H o u-'-J D S yS T �'• Parent material B2 � Dwe �S �T�i1(r4' S' "�T s�o'WEa"j Flood plain elevation, if applicable N ft S = Suitable for system Conventional Mound In- Ground Pressur AT -Grade System in Fill Holding Tank U = Unsuitable for system El 2'u O El u ❑ S 1:1 ❑ S 0-6 ❑ S p'u SOIL DESCRIPTION REPORT Boring # FrIzonDepth Dominant Color Mottles Structure ry GPD /f1 In. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Bounds Roots Bed , Trench -il io 3/3 / �`sh� „„ fe C s / T ; • 3 Ground 3 _ 3 � 0 3� � 2 4* d fi 5 - elev. Depth to — a limiting factor � In. , ys $, Remarks: 04) 4 f 1 A ��'l /P ,S mil° /'GTip.y S 1 3 Boring # I - 5" i�Y 3/1- J s,/ /�s�,� vF,Q s 1 A /vf G Around i6 I S cL D- 414 .�I :AJ elev. 7 ft. Depth to limiting ; fact r in. Remarks: 1 &A Re S Tit° cTio,vS % .2 J 0 CST Name (Please Print) ROBERT— L Signature elephone No. R R I c !� 7- 75 306 - X35 Address Date CST Number 1111h 1 -S - csry 2y8 Z Privato Sowage Consultants 685 O'Nell Rd. Hudson, Wis. 54016 Y PROPERTY OWNER // _ 4004 17W SOIL DESCRIPTION REPORT Page Z of PARCEL I.D.# h0 T l y elAt Boring # L-3 Depth Dominant Color Mottles Structure 2 In. Munsell Qu. Sz. Cont. Color Texture Consistence Boundary Roots f Gr. Sz. Sh. Bed , Trench . /3 /o Y 3/3 s17 / fS f>,t elev Ground 13 . l i° ye 3 /y 5 �► f eS ! F 27-y 10 ,E' , s s S /u Depth to limiting factor 2_'_in. ; Remarks: Boring # Ground elev. ft. Depth to limiting factor In. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # , Ground elev. ft. Depth to — limiting factor in. Remarks: Boring # Ground elev. tt. ' Depth to limiting factor In. Remarks: SBDW -8330 (R. 08/95) -- I .. 1 �M• �ovvp : To� of 33 S /'' � ,}T o v Lo T CO /PN �l2. F /EU� =' /Oa• C� � V D +0 39 v,vi qp,y Ca.v fav,P a N t y�. PO' DoT 5 � 0 v DoT so , Lo 3�1o' L-O g 3 O • _ 134e4, Ts FS �Sa"CS 7 - ,&D l Af 13 9 7. 70 . B3 P�, 3 of y ULBRICHT & ASSOCIATES CO. '655 O'Neil Road - Hudson, WI 54016 Reg. Designers of Engineering Systems 715- 386 -8185 Private Sewage Consultants SPECIAL NOTES TO THE BUYERS/ BUILDERS, REGARDING SEPTIC SYSTEMS AND SOIL TESTING ON LOTS #8 THROUGH 20 IN COUNTRY OAKS. All of the lots evaluated will require mound type septic systems. With only a few exceptions, the soils across the 1st Addition to Country Oaks had very fine weak textured silt loam in the upper 12 of topsoil (a soil loading rate of .3 GPD /ft2). These low soil loading rates will require larger trench type mound systems by design codes. Trenches can be no wider than 48 ". It is suggested, to the installer, if a 4 bedrm. home is proposed, some test areas provided may not be lonig enough for a single 4 trench, in which case a wider mound utilizing two tenches 4 63 may be more suitable. CAUTION: since all of the soil test sites are very heavily wooded, extra careful planning and site preparation is required. Great care will need to be taken in removing trees and brush without disturbing the fine delicate silt loam topsoil. If the site is carelessly disturbed, the Zoning Dept. will reject the site and require costly new testing and designing! Do not allow anyone to drive across or compact or distuyb the topsoil. Consult with the Zoning Dept. Inspectore, a qualified plumber, or designer for advice on how to properly prepare the site for mound system construction. The owners /developers have provided a complete approved soil test area, registered with the zoning office as required by subdivision ordinances. It is difficult to imagine today where a future buyer prefers to build upon a lot. Common sense is used to select a site at this point. If the buyer intends to utilize the test area, careful planning between the oxner and septic plumber (or designer) is very important. Careful planning with qualified designers/ installers is critical. THe final actual size and shape and location of the septic system is dependent on the size and type of home proposed. Test areas large enough for a 3 -4 bedroom home has been provided, but a larger home may require new or additional soil testing. The septic system can not be shifted outside of the recorded test area. pg. 4 of 4. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Q w v � °rte 5-Jr Mailing Address '" .3 C1 6 f d Z e Property Address - (Verification requited from Planni g Department for new construction) City/State Parcel Identification Number Q -/a 39 -afl LEGAL DESCRIPTION yo Property Location /, Sec. 2 f _ 1 -+- ' --- N -R-±j—W, Town of Subdivision , Lot # -� A 1fS Certified Survey Map # L Volume Page # Warranty peed # to o "e) J 6 Volume LW Page # Spec house ❑ yes l(no Lot lines identifiable U Y es ❑ no SYSTEM 1►'hAINTENANCE 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 b a licensed pumper. Y p p What yo put into the an affect Y p system can function of the septic tank as a treatment stage in the waste disposal system. Y 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 wastewaterdisposal 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 days of the three year expiration date. K SIG ATURE OF PLICANT DATE 01IER CERTIFICATION I (we) certify that all statements on this forms are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the porty d c 'b d above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNA OF APPLICANT — 4 DATE * * * * ** Any information that is mis- represented may suit in the sanitary permit being revoked b the Zon Department y g - *.* 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 4� - K 24?Wlfl KAT S r i WISCU40 t0im z - "n 6T. I TW J�k-4,, Ckwaor, And 103 46 Gamw. in a "haw cotWder4km� coovys and ww=aft wGrat ft W*vWS &smi�ed reW estme In Cnk Cmq, State ofWkeongn IL Pro" RKOF&ft AM Marne &W Reern Addrm EAVT' j. ESTREE, 304 LOUXT 5r. HOadsixI4. WI 54018 -26 SWIM ftrcel Idesdticallos NuNAW (PDQ IU ILNG—t bm-md raparty- JAK 9. Fbw Adalmucouary Osh M TWA of Troy, SL C.--Ex Couay, Wbcomin. � & EKcqxkxu to wmantia: Easemcnts, ramicti= and rishts-of-way of rwmd, if any. DWd fts r'day of ApriL 1999. MA& Phu, a/Va Milan Him sis"Mo AOTMEWMATION - AC sivmofum(s) bid" Hau, Aws MAM HM SrATE OF WISCO114SIN this of Aail, Pcmnak- came befem m ft _�_*W &e Aow named so me kmwn to bc�-thc pers*s) L mcuwl the forcongInstrun,est and aCknowledIC the SAID". TMX: MDAUR STATE RAR OF WISCONSIN Of mlv pxhorized by 1 706.06, Wis. Stats.) L TM RWRW"NT WAS DRAFMD BY Nowy Public, State of WWxmwin m CNnm is permamt. (Ir not, statc wipirimian dric: Attormy KrWm Ogbnd H86614 W1 5016 (Sigmamm may be witheroawl or adimewIM&W. Both am not necessary.) Ali& p ool, 'Numotp—arm 00% in sM capacity shmidbe tyrdcf priard below their sigoAturri WAMAMY 6- SrAlm 3AR OF w"MmIqv I - 0" CC-P44Y FONDOULACM WOFUVA *k tO N EYSlt�+. /1ICATEO ROAD LY /NG NORTH �I - OE - SAC is TO BE LEFTo EXTEND THE ROAD TO SERVE THE /r /S OEENED NECESSARY O T ADJOIN /NG PROPERTY E fON O OF THE ROAD WILL /M B �ONG 4 C. ON L S/ T FOR THE COST OF COSTT RUGT TO THE DEVELOPER WHO BENEFITS FROM SA /D ROAD EX TENS /ON. NEITHER THE TOWN Of TROY OR ADJOINING LANDOWNERS WIL BE LIABLE FOR ANY CONSTRUCTION COSTS. N 1 390. T 66. 74 — ---- -- _. _ l � 1 1 TION 9TE: WATER RUNOFF DOES ENTER LOT /0 AND DISPERSE ACROSS 1 ON T /O TO THE SOUTHEAST. CARE MUST BE TAKEN DURING CONSTRUCTION ► cD 1 )T /ONO TO DIVER WATER ON TO or IN A MANNER THAT W 100 11 ,^ 1 DVERSELY EFFECT EX /STING OR FUTUR IMPROVEMENTS, �O _ 6 6 N 1 i ,h 2. 462 ,ACRES 1 4 p 107,237 SO. F . a M r� 70 , 1 W , � � N ti 01� � N r 38 m N800/8,3' � v • 1 0 ° 5 3 � 2.040 ACRES 88, 867 SO. FT, N11 /0 • N — 0 1 M 1 / o N 1 38C"38 OT� Bo o /8 / 1 / i !DING 6 ~ O ING 2. 666 ACRES 6, 146 SO. FT. / ' 0 I co , ° / 200 —? THESE PORTIONS OF TEMPORARY 1 CU - DE -SAC TO BE AU TO MA TI CALLYz 4� q9- ���/ p 1% �,�