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HomeMy WebLinkAbout018-1096-27-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and '.iilding Division Sanitary Permit No: INSPECTION REPORT 499240 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan I ' D 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 Ulterts Family Trust I Hammond, Town of 018 - 1096 -27 -000 CST BM Elev: ( Insp. BM Elev: BM Description.. . Section/Town /Range /Map No: �• C0.0 0 4 09.29.17.802 TANK INFORMATION ELEVATION DATA TYPE w /.UF TUR R /f CAPACITY STATION BS HI FS ELEV. Septic (�- Benchmark 3, 30 Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet / • Sz SUHt Outlet (0 3v h TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD IDt Inlet Septic r t 2 0 � U/ i �-° Dt Bottom Dosing 7 Header /Man. Aeration Dist. Pipe • S'a O Holding Bot. System O � Final Grade PUMP /SIPHON INFORMATION • 6� Manufactur r Demand St Cover r Gt•� GPM , ,� j` 2- • D � Model Numb TDH Lift Nicgon Loss System Head DH Ft Forcemain IL gth Dist. towel SOIL RPTION SYSTEM( TRENC idth f Length No. Of Trenches PIT DIMENSIONS No, Of Pits Inside Dia. 77� pth DIME NS 3 1 I SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of �S UNIT � V Model Nu c Ao DISTRIBUTQN SYSTEM Header /Manif Distribution Ix Hole Size x Hole Spacing Vent to Air Intake 11 pipe(s) S + Length Dia Le is Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed /Trench Edges Topsoil Yes No Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: 17t • � t Inspection #2: "' T — ) ` Location: 1737 109th Avenue Unknown (NE 1/4 NW 1/4 9 T29N R17W) Pheasant Ridge Lot 27 Parcel No: 09.29.17.802 1.) Alt BM Description = j• i . ��^' Cd 2.) Bldg sewer length = gZ - 6 amount of cover= I f 2 f Sou C -• . Plan revision Required? Yes �' No -- �/ - - — T 5l . ._ Use other side for additional informat(On. / Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) r Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 VV W1 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) n (608) 266 -3151 // '? l Z Department of Commerce State Plain I.D.Number Sanitary Permit Application / �� ✓ ✓ )) Y /- In accord with Comm 83.21. Wis. AdnL code, personal information you pr vide Amass (if different than mailing address) may be used for secondary purposes Privacy Law, s I5.04(1)(m) T. Application Information - Please Print All Informatio 1 / Parcel # Lot B\# ' Property wrier 's Name �, n RECEIV Property Location Property owner's MailMg Address OF 3 1 2006 �/ � y� ., section City, S Zip Code P e COUNTY 62- ✓/� C�`� / c� DO r�� N; R E r W e Type of Building (check all that apply) rob v-. ` ` f 5 Subdivision Name CSM Number or 2 Family Dwelling - Number of Bedrooms °O ❑ public/Commercial -Describe Use -6JA "' ��' Ptak S , � �C ❑city ❑villa wnship of ❑ State Owned - Describe Use 2 rk ITT. Type of Permit: (Check only one box on line A. Complete line B if applicable) Q l $ - /0 9 Z A. w System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New Before Expiration Plumber Owner TV. T e of POVVTS System: Check all that apply) on - Eressurized In- Grou [I Mound ? 24 m• of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At Grade ❑Single Pass Sand Filter ❑ CorrstruetedWetland ❑Pressurized In-Ground 13 Holding Tank 11 Peat Filter ❑ Aerobic Treatment Unit. ❑ g Sand Filter ❑ Recirculating Synthetic Media Filter hing Chamber ❑Drip Line ❑Gravel -less Pipe ❑ Other (explain) V. Dis ersat/Treatmeat A 5 Sy Elevati n DsiFlow (gpd) Design Soil Applicati� Rate(gpds0 Dispersal Ar�Xequ:ired Drs Pe /rsal Area Propos VT. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fber Plastic Gallons Gallons of Units Concrete Constructed Glass New Ddsting �/ 8 Tanks Tanks v Septic or Holding Tank Aerobic Treatment Unit hosing Chamber VH. Responsibility Statement - Y, the undersign me responsibility for installation of the POWTS shown on the attached plans. Plumber' i MP11v1PRS Number Business Phone Number Plumber's Address (Street, City, State, Zi 2 VIII. Conn /De a T' Use Onl Sanitary Permit Fee (includes Groundwater Date su Issu' Agent Si , o pproved ❑ D' ppro Surcharge Fee) ❑ 0 even ial TR. Conditions of Approval)Rcasons for Disapproval 3) �d SYSTEM OWNER: V 1. Septic tank, effluent filter and / dispersal cell must all be setvlces / maintai� & e t p- (.moo, t ip— C� as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code l ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 % 11 inches In size SBD -6398 (R. 01/03) I P PLAN PROJECT Ulferts Familv Trust DDRESS 1011 170th St. Hammond Wi 54015 NE 1/4 NW 1 /4S 9 /T 29 R 17 W TOWN Hammond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/31/06 BEDROOM 2 CONVENTIONAL X>(X IN- GROUND P SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 800 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 750 # of chambers 30 ,BENCHMARK V.R.P. Top of Wood Stake ASSUME ELEVATION 100 Filter BEST Filter ❑BOREHOLE O WELL *H.R.P. SameasBenchmark SYSTEM ELEVATION 95.5/95.0 4' below qrade Alternate Benchmark Top of 1/2 pipe @ 97.0 97t Ave hA Well is to meet all Vent Scale is 1" = 40' setbacks required by >6" ARC 36 Biodiffuser unless otherwise WDNR Leaching Chamber of Cover noted with 25.0 ft2 of Area Pro 2 5' Long 11 " Plans Designed Using Bedroom 3611 Grade at System Ele ation Conventional Powts House Manual Version 2.0 30' ST Property Line 50' B -2 8% Slope ents 5' B -1 2 -3' X 75' Cells with >3' spacing 10' �uc�¢ * B.M. 80' Atl.B.r B -3 100' Golf Course Easement (suitable for septic system) Propertv Lin C P IV P PLAN PROJECT Ulferts FamilvT DDRESS 1011 170th St. Hammond Wi 54015 NE 1/4 NW 1 /4S 9 /T 29 R 17 W TOWN Hammond COUNTY ST. CROIX M MPRS Shaun Bird 226900 DATE 10/31/06 BEDROO 2 CONVENTIONAL XXX IN- GROUND P SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 800 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 750 # of chambers 30 hk BENCHMARK V.R.P. Top of Wood Stake ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark SYSTEM ELEVATION 95.5/95.0 4' below qrade Alternate Benchmark Top of 1/2" pipe @ 97.0' 97th Ave Vent Well is to meet all Scale is 1" = 40' setbacks required by >6" ARC 36 Biodiffuser unless otherwise WDNR Leaching Chamber of Cover noted with 25.0 ft2 of Area Pro 2 5' Long 11 " Plans Designed Using Bed- oom 3611 Grade at System Ele ation Conventional Powts House Manual Version 2.0 30' ST Property Line 50' B -2 8% Slope ents 5 ' B -1 2 -3' X 75' Cells with >3' spacing 10' B.M. 80' -310' Atl.B.n B 100' Golf Course Easement (suitable for septic system) Provertv Lin ` I . 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IECT� a Norld tt'• DEO ICA TO 1NE PUBLIC td tt•• su. t.' rm•ly er NOO'10'tt'W — /t — — STREET I - -�- — ' rae ivtt•r ....... r w ` Wisconsin Departmentof Com SOIL EVALUATION REPORT Page of Division of Safety and Buildings !� in accordance with Comm 85, Wis. Adm. Code /I ( /^� Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must Count" 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. Revie by Date Personal information you provide may be used for nd i w, s. 15 04 (1) (m)). 4 0 Property Owner Pro erty Location Go .Lot /l /, —z 1/4y )/4 S Tel- N R E (or Property Owner's Mailing Address Lot Block # Sut!Mne or CSM# State Zip Code Phone Number ❑ flY C] Villa ge Town Ne Ro adf 14-2 j s e Apt New Construction Us sidentiai / Number of bedrooms Code derived design flow rat t -t GPD ❑ Replacement ❑ Public %commercial - Describe: Parent material Flood Plain elevation if applicable � ' - ft. General rrrneMs and reoornnwmendation/s: e^ / System Type L d !1 /J /u� System Elevation J ' F-/1 Boring # Boring pit Ground surface elev. � ft. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2 Z U -e 3 Boring # ❑ Boring �jq / Pit Ground surface elev. / l • D 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 'Eff #2 Effluent #1 = BOD > 30 220 mg/L and TSS >30 1 150 ' 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 Conducte Telephone Number 1008 192nd Ave, New Richmond, WI 54017 � 715- 246 -4516 Property Owner _ Parcel ID # Page of Boring # ❑� Boring / w\pit Ground surface elev. i° 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 F] 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 GPDtff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 a ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil lication Rate Horizon 7epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDtfF 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 altemate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. seD -8330 pe.6roo> Soil Test Plot Pla Projlact Name Ron Bonte Sh A d Address 1011 170th St. �/� Hammond Wi 54015 #226900 Lot 27 Subdivision Pheasant Ridge Date 10/13/06 NE 1/4 N W 1/4S 9 T 29 N /R W Township Hammond ❑ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Wood Stake System Elevation 95.5/95.0 *HRpSame as Benchmark Alternate Benchmark Top of 1/2" pipe @ 97 .0' 97th Ave Please note: The soils found in the 3rd Scale is 1 » = 40' horizon were layered with alternating colors patterns as described. There was unless otherwise no bands present and the soil texture noted was the same. The soils were not cemented and were loosely in place. Leroy Jansky has done on sites on lot Property Line 25 and 26 and found the soils were suitable for a conventional septic system. This soil type is the same. B -2 8% Slope 35' B -1 99.5' 10' M. 80' B -3 1 At1.B.M. 96.5' 100' Golf Course Easement (suitable for septic system) Property L' Vts=sln•Dwartment of Commerce SOIL EVALUATION REPORT Page ) of Divkon of Safety and Buildings In accordance with Comm 85, Wis. Adm. Code • Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must County Crdj 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. Ql f - /QF( a 00 v Please print all information. by Date l � Persoriat inicrmation you provide may be used rive t avr, s. 15.04 (1) (m)). At� 3/ 1 i rT Property Owne Property Location Govt. Lot I\ E- 1/4 Ntti,1/4 S 9 T N R V? E (orD Property Owner's Mailing Address JUN 1 O 200 Lot # I Block # Subd. Name or CSM# Z-1 QKI, city 1 State Zip Cod Pliffn6lMWWOUNTY ❑City _ ❑ V�Ilage Town Nearest Road l� 1 IJ FF ' 9-New Construction Use: 0- Residential / Number of bedrooms �- Code derived design flow rate 5 0 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material y Flood Plain elevation if applicable A ft. General comments Sy� {ew 1% V - / �', ZO and recommendations: C n / . U ef e U, 9 )7 - 6 0 ���Z4.�1�GIG�C y�tlrnw� Gzu,�Ga` Boring # I ❑a Boring 1� pit Ground surface elev. ft Depth to limiting facto in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft In. Munsell Qu. Sz. C ont. Color Gr. S z. Sh. 'Eff#1 'Eff#2 C- — �E • tP 3 28- _3(. h. CS ^7 1, 2, 4 — I L4 r - Z Boring # ❑ Boring Q /� 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. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 C5 V 1Z_ 2 )0 , , `i 5 d 2 rrAr c -- . 4, WIN IN I I 3 _ 9 IDI ro g, Jwl at Effluent 41 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' E4 jent #2 = ROD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Address / Date Evaluation Conducted Telephone Number � �o ���.�.�. - 5-G�J r. ✓/ - ts�''o�s G - s - 0 2 ��s -zy� -yao Property Owner Parcel ID # Page of © Boring # ❑ Boring pit Ground surface elev. - 9� ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDh1 in. Munsell Qu. Sz Cont Color Gr. Sz Sh. 'Eff#1 'Ef1#2 o - r - 3�2 — 4 31 .. 2- m oOL rnPr C- 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 GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 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 GPDfft 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 (807/00) i r - PAGEaOF NAME n �� 1 OT# d-7 LEGAL DESCRIPTION C - X t Z ,o T L 9 ,N,R, I I E(or SCALE: I"= yO BM 1 ELEVATION 00 - 0 BM 1 DESCRIPTION L o o BM 2 ELEVATION q 3, BM 2 DESCRIPTION �o -� "Luc- � P e � sec SYSTEM ELEVATION Z 6 SYSTEM TYPE CONTOUR ELEVATION q - 7 , 7 3 6 0 ,t r m d� o� c s/ c 0 o X13 SIGNATURE DATE 6 - q z SAFETY AND BUILDINGS DIVISION Field Operations Bureau 13 East Spruce Street INSPECTION REPORT Chippewa Falls, WI 54729 isconsin www.commerce.state.wi.us Department of Commerce Scott Mccallun%Governor Philip Edw. Albert Secretary Date of Inspection: July 18, 2002 Plumber Name and Address: Project Name: Pheasant Ridge Use: New - Residential Legal Description: NE, NW, 9,29,17W Lot Number: Lots 25 -26 Subdivision: Pheasant Ridge Certified Soil Tester Name and Address: Municipality: Town of Hammond Henry Grote CST 222774 County: St. Croix E 4366 353` Ave Plan Transaction Number: Menomonie WI 5475LRECEIVED Sanitary Permit Number: Owner Name and Address: Ron Bonte Wastewater Flow: 450 -600 gpd 1011 170u' St 02 Persons Present: Jon Sonnets g Hammond, WI 54015 Rod Eslinger TY E This onsite investigation was conducted because of conflicting soil and site evaluation reports by Henry Grote and Adam Schumaker. CST Schumaker felt that the contrasting soil colors of the substratum might be indicative of seasonal soil saturation. Two soil pits were reviewed (one on lot 25 and one on lot 26) and it is my opinion that the bands a streaks of contrasting color are depositional in nature and not pedogenic redoximorphic features. The colors were likely deposited by water from different sources and thus there are different colors. Co volute bedding often overlies horizontal bedding as was observed in the soil pit on Lot 25. The high chroma streaks noted in the horizontal bedded sands are like due to uneven weathering of minerals in the sand rather than contemporary redox feature formation. Recommendations for these lots include keeping the dispersal areas as shallow as possible and not to load the fine sand over 0.4 gpd/ft^2. Sizing example: 3 bedroom home 1125 ft ^2 or about 37 chambers 4 bedroom home 1500 ft ^2 or about 49 chambers If there are any questions regarding this report, please feel free to contact me. Le y G. J sky, last ater Speci Ljansky@ mmerce.state.wi.us E- it 715/726 -2549 Fax 715/726 -2544 Voice cc: 0 —ounty ❑ Plumber ❑ CST ❑ Owner ❑ Other ;�� Department of commerce SOIL EVALUATION REPORT Page 1 of 3 •• Divisim ct Safe and Buildings In accordance with Comm 85, Yrs. Adm. Code A Attach complete site plan on paper not less than 81/2 x 11 inches In size. Plan must include. but not limited to: vertical and horizontal reference point County C (BM), direction and Parcel I.D. p percent slope. scale or dimensions. north arrow, and location_ and distance to nearest road. el /0 f& — Please pdn all 1 R Dat 3 / I Personal Infcrmet m r«� p ma be for secondary E trnvmy . & M04 (1) (m)l. 7 Property Location prope JUN (� 2002 Govt. lot N n E 1/4 rvW114 S ! T Z 9 N R E(a� Property Owners Mailing Address T. CROIX COUNTY" Lot # Block # Subd. Name or CSM# - J Lvi -1c . ZONING OFFICE 2- g \ 0 c 1 State Zip Code Phone Number ❑ City _ ❑ village aTown N oad 117-(o . 16 tom—' New Construction use: i} Residential / Number of bedrooms - 4 _ Code derived design flow rate 4 4 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material -�i 11 Fl Plain elevation if applicable AJ ft. General comments j�S /'� �/C (/; / ! G � ` fA4 &ft0ANU44 . LOT 7— and recommendations: U AA 4 .�0 �•evs , � i M ❑ Boring Boring # Pit Ground surface elev. C • R Depth to Grniting factor Z g�g in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMF In. Munsell Qu. Sz. Cont Color Gr. Sz. Sti. *Etf#1 *01112 o -12. I Z SN I IYl*i C5 A4 8 2 t2 -3b �o r I 5 cl k M4- C 5 ink C- $ 2 7.S m ld 3 P r F # D 1� Pit Ground surface elev. _ ft- Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure 4Consist Boundary Roots GPDW in. Munseli Qu. Sz. Cont. Color - Gr. Sz. Sh. •Etf#1 'Eff#2 1 0-13 2. 5' C 5 $ 2 I t© — ' i Z G5 — 3 � to mS D m I c 7 l- �- Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L re CST Number CST Name (Please Print) Address C'r' Date Evaluation Conducted Telephone Number .�mersc / OZ57 ! _ 0 Z (7i 5)2Y7-q IV r 00 ! r I ! SdT 4¢ 32" 260. p c Q ! ti w I -�� w OZ _s£ON_ r ' 881 ' '.3 Z r °£OS ... '�. Nit S\ r • S y 0 l may\ V � I \ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer` Mailing Address Il a. Property Address ` (Verification required from Planni g & Zoning Department for new construction.) City /State Parcel Identification Number LEGAL DESCRIPTION Property Location / '/a �� 1 /4 , Sec. �, T 0 N RZJW, Town of Subdivision Wit, - �, , Lot # d 7 Certified Survey Map # , Volume , Page # 1 Warrant Deed # S 5 e3 , Volume / , Page # O Spec house yes no Lot lines identifiable G no 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. I/we certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the operty described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF 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) Maintenance and Contingency Plan for a Septic System Maintenance Plan n 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 ncy Plan Option #1. system fails, determine cause of failure, use alternate area and install new cyst min tested replacement area. Option #2. Install system at a lower elevation, by removing chambers, removing biomat, and install new system. O tion#3. No adequate area is suitable for replacement area, and system elevation p q p 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 a n�, -,•'a �. �.n..�,`*.. caoi� -.. �, -' -..: -„ ..Ar... . , .ate.• 'r. ° -'� - x 'a. '� t 1 r :, . 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'' + ; N m•'"�+� \ :^ , t _ - ` q ty yE� y} ��#� y{� may\ - \ .{�;' \ 1-1 , N4 , , ". ! �11,�, �, , il ,�w` yy� � � y y It, ,.. , \T \ $S ,. \ . \ € .11 11 ': �` �' ` I ',�,\� �� � ;, � , ,,,-� �. , .��', , -' , � , .,'�Z ,-, 11 if - 71�1; 1, ��N.I-,' �V4 ". . i ". .1 , ..�\ `\ :` \ \ \ \ , \ ��' � :"` �a? ,�,1,,6,{{S \, — f , `Rx �ItC 1. \\ � \ \ ` 1. \, `: , 1. \ t �,�,:,�,i'_-;.,%:;�I, uw S— 0 fl, ` \`\ �! " �!Itl,�".�, , '. , � � ,. I �':�.:, ", " : - `. �: , g. \ \. \\ ♦ \♦ \ \ \� a '; .. \,. \ \ \ \ . ,\: 11 \ \ \ : , 11,1, 1. 11, � , I - .,. 'k—t . \ \ \ % ,,` , \. \ \ \; \ ,. f LOT 2 S,,• / 2. 10 ACRES S: 91,582 SO. FT. 0.' s� ��� 0021 ,/ �� , ' ®•. L 0 A � mw 10" ' LFE 1064' Ck • A te'. LOT 3 LOT 29 00, 1.50 ACRES °l' • 65,409 SO. FT. ��' �'• ,� 9 1.57 ACRES �`�,, �'►�• 68,524 S0. FT. ! 6' fp�i �p� ,� � •• HK 1062' �., tn1♦ Z,i' tij• / JI �$ LFE 1064' w 1 81 : ' `�O pG TOP OF 1 • I JI �• 0 0 . o p �� � 2 / O , / P 1 PE 1 061.'3 tih c' .� �` .' pQ` 1 ck Dc �` �p ' �� ,'® � � � `` • , ,LOS. � Q �► LOT 28 0; lb ' ,' 1.54 ACRES i SSA O•g �, a ` ' � 67,027 S0. FT. 9 � ', J° • 'j 'Si o ,, pg� Qy4• L OT 27 &o. 1.53 ACRES ' 66,861 S0. FT. UTIL EASEMENT: / 6`• NO POLE OR BURIED CABLES ARE TO BE PLAI THAT THE INSTALLATION WOULD DISTURB AN' STAKE, OR OBSTRUCT VISION ALONG ANY LO' O STREET LINE. ti LOT 26 THE DISTURBANCE OF A SURVEY STAKE BY At 11s 04 ACRES `� /�, VI OLATION OF SECTION 236.32 OF W I SCONS 387 SO. FT. UT 1 L I TY EASEMENTS AS HERE IN SET FORTH USE OF PUBLIC BODIES AND PRIVATE UTILV �Al ` THE RIGHT TO SERVE THE AREA. o = SET 2. 375 0. D. X 30 • IRON P I PE WE 1 GI Co� LOS. PER LINEAR FOOT. ' N OTE: SET t O.D. X 24 IRON PIPE WE I GI ti ��• L BS. PER LINEAR FOOT AT ALL OTHER LOT UTILITY EASEMENT (TYP. ) ....... .... K � DWAY SETBAC