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HomeMy WebLinkAbout018-2003-18-000/~ /1 l~il ~ltN -' Safety and $uildings Division Counry~~( ~/ / ! ~~~ ~ ' P.O. Box 7162 Washington Ave 201 W ~~~0~~~~ ., . Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) rce f C (608) 266-3151 omme Department o State P1anI. .Number Sanitary Permit Application rovide ou tion f l i p y orma n In accord with Comm 83.21, Wis. Adm. Code, persona may be used for secondary purposes Privacy Law, s15.04(1)(m) pro ect Address (if different than mailing address) J ~ ,~, ~ v ~ ~ I. Application Information -Please Print All Info ation - r~ q 9'~ %-~ ~ . ! Property Owner's Na me ~ ~ t~ ~~ Lo[ # Block # Parcel # Property Owner's M ailing Address `' ' ~ ~ -! . ! ~ i ~i i , W Property Location i ~~ r ~ ~ J ~ on /a,Sect ~/o, City, State ~ Zip Code ^~ ~( Phone Number ~~~ ~~ (ctrcl one) N; R E o W II. Type of Building (check all that apply) ~ Subdivision Name CSM Number or 2 Family Dwelling -Number of Bedrooms /7 - ~ D~ ~` p C- ^ Publia`Commercial -Describe Use _ __ _- ~ ^Ciry ^Villag~wnship of - ~ ^ State Owned -Describe Use III. Type of Permit: (Check only one box on line A. Complete line B if applicable) '`~' w System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ O[her Modification to Existing System B. ^ Permit Ren al rmit Revision ^ Change of ^ Permit Transfer to New Owner be Pl List Previous Permit Number and D Issued ~ y` ~Z~R~ ~ /~y~ /~ 2 '+[" "( a r um Before Expir 1V. Type of POWTS System: (Check all that apply) ^ Single Pass Sand Filter ~va-Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade Fil ^ Aerobic ^ Constructed Wetland ^ Pressurized In-G ound ^ Holding Tank ^ Peat Filter ter _, Treatment Unit ^ Recirculating Sand v/ ue~/~ i Recirculating Synthetic Media Filter Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (ex lain P ) V. Dis ersal/Treatment Area nformation: Desig FI w (gpd) Design Soil~ation Rate(gpdsf) Dispe 1 Area Required (sf) Dispe ~ea Proposed (sf) ~em Elevation yl y 7 /~ i ~~ v L ./ Fib l i Ca acit in Total Number Manufacturer VI. Tank Info P Y er c as[ Prefab Site :eel Concrete Constructed Glass Gallons Gallons of Uniu New Existing "fanlcs Taril:s Septic or Holding Tank t ~ t%~ :4erobic Treatmen[ Unit Dosine Chamber VII. Responsibility Statement- I, the tutdersigne some responsibility for installation of the POWTS shown on the attached plans. Business Phone Number ~ MP/MPRS ,'Number Plume me (Print} Plumber's attire ~ ~~~ .~.~- ~// i 7 G Plumber's Addre ss (Street, City, State, Zip ode) ~ / ~~ D ~ ~ ~ ,J ! VIII. Count /De artment Use Onlv Sattitary Permit Fee (includes Groundwater Date Issued Iss ~ng ent Signa o Stamps) Approved ^ Disapproved Surcharge Fee) ~ ~ '~ ^ Owner Given Reason for Dezrial IX. Conditions of Approval/Reasons for Disapproval ,, ~.p..,_~ YSIk'J ~X1~xal a~Qq . Q . u a ~ Clt~11Cy ~~"C l aD3 Attach complete plans (to the County only) for the system on paper not less than Slit x 11 inches in size Soil T s and System PLOT PLAN PROJECT P.C. Collova Bldrs. Inc. A ESS P.O. Box 489 Somerset Wi 54025 ~ 1 / 4 NE i /4 S 18 /T 29 N/R 7 TOWN Hammond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE5/9/03 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESS E CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 30 ,BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 101.0/100.8/100.6 5' below grade Alt. BM Top of 2" Pipe @ 100.0' Pro3 ~ --~~ ~ ~ ` t ~~~"" Bedroom ~ ~~ ~~ House 80' 10' 70' B-3 30' 30' Vents 540' 10' Property Vents Line 80~ B-2 B-1 4% Slope 220' 3-3' X 63' Cell s with >3' Spacing Plans Designed Using Conventional Powts Manual Version 2.0 Vent > 6„ Standard Biodiffuser of Cover Leaching Chamber with 31.1 ft2 of Area Alt. 6' Long 11" M Grade at System Elevation ~ A ~~ ~soonsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings m accoraa~ce wnn ~.omm ao, vvis. ram. wue r Countys [ Plan must er not less than 8 1/2 x 11 inches in size Attach com lete site lan on a . 1 7 . p p p p indude, 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. ewed by Date Personal iMortnation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). is Property ~ / C -~ Property Location N R E W J • ~ ~/ ~ (o Govt. Lot 1 /4 1 /4 S T Props Owner's Ma~~ddress / / Lo~ Block # Name or CSM# S . ~ 7 ~ ~~ 1 'p Code Phone Number City S tate ^ City ^ V'illage Town Nearest Road ~ ,/ ~~~ , New Construction Use' esidential /Number of bedrooms .~ Code derived design flow rate ~~r0 GPD ^ Replacement ~~ ~"~~^ Public or co erdal -Describe: __.____- __-._ __- Parent material G,~,~~i.~~ Flood Plain elevation if applicable ~/1/ I~ ------ ft. General corrxrleMs % and recommendations:~~ ~ / ~L+~ J~~ y7~,. ~Q~ a /iy~ ~ /~- Kt..~ ` L/ ~~ # p Boring ...5- I ~ pit Ground surface elev. ~ ''eft. Depth to limiting fador D in. Soil ligtion Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 ~- ~ S ® ~~ # .~ Bonng Pit Ground surface ele~~`'' ' -S ft. Depth to limiting fador ~• Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 ~ ~__ // - • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 1 mg/L `Effluent #2 = BOD < :iU mg/L and i ~ < :St) nxyL CST Name {Please Print) lure CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date valuation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 5401 ~~~ ~~~ 715-246-4516 ~3 Property Owner _ Parcel ID # ~ Page of . Boring # ^ Boring ~ Pit Ground surface elev. ~~. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 y ^ Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIfP 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 ication Rate Horizon Depth Dominant Color Redox Description- Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Eff#1 •Eff#2 'Effluent #1 = BODE > 30 < 220 mg/L and TSS >30 < 150 mglL 'Effluent #2 = BODs < 30 mglL 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. sao-s3ao ~e.~oor Wisconsin Department of Commerce 1 PRIVATE SEWAGE SYSTEM Safety and Building Division ' ' - INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township P.C. Collova Builders, Inc. Hammond Townshi CST BM Elev: / Insp. BM Elev: ` BM Description: > ~ 1 ~~ ~ •o ~ •a ~~ Z = CST TANK INFORMATION ELEVATION DATA c°unty. St. Croix Sanitary Permit No: 429977 0 State Plan ID No: ~~"'~ Parcel Tax No: ~_~ Section/Town/Range/Map No: 18.29.17. STATION BS HI FS ELEV. Benchmark , ~ ~•y "[o ( ~ O 1 Alt. BM $ w Bldg. Sewer ~ ('.~ ~ ~ / St/Ht Inlet ~ ~o ~ZO / o •ZO St/Ht Outlet ~ (o•Sa o .90' Dt Inlet Dt Bottom Header/Man. ~p.~ 02.Zo Dist. Pipe Bot. System r n_ _ I Final Grade ~.p St Cover '' 2 • ~ J TYPE MANUFACTURER CAPACITY Septic t, tG.r~ Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~~ -.,. ~ ~ } ~_ Dosing ~~ Aeration Holding PUMPYSIPHON INFORMATION Manufacturer Demand PM Model Nu er TDH Lift Friction Loss System Head TD Ft Force in Length Dia. Dist. to well SOIL„~BS,pRPTION SYSTEM RENC Width ~ Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSI S '~ ~~ ~ ~ 3 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Ma a cture . ~ INFORMATION CHAMBER OR ~ FF~ E' Type Of System: • t~'~1T , } ~ ~ ~ f~ ~'~+ _ UNIT ' Model Number: ~ X11 DISTRIBUTION SYSTEM Header/Manifol Distribution x Hole Size le S in Vent to Air Intake u ~ Pipe(s) Lengt Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~ Yes [~ No L Yes [] No COM~VIEfI~S: `(~lude c ~~C e~pencies, persons present, etc.) Inspection # 3 Inspection #2: / L~oca~tion~:Q~•156L~9 97th Ave Hamm `nd, WI 54015 (NE 1/4 NE 1/4 18 T29N R17W) Crick Bottom verl 8.29.17. 1.) Alt BM Description =~~~~ Cn~~ , ~fI ~ , ~ J v ~~---,..._ 2.) Bldg sewer length = .w $5 ~' ~ b 10~ •o -amount of cover = t[2 /; • G; (~ IOO ~` ~a` ~?j { IaD•Iro~ ) ''~~ t Plan revision Required? N ~' ~s~-~`~ ~ ~ ~i Use other side for additional rmati } 1__ 3 ~_ _ _ _ D to Insepctor's Signature Cert. No. SBD-6710 (R.3/97) a Q ~ rf~^wS ~af`~. ~s ~ Safety and Buildings Division County ~~ ~ ~ ' ~ ~ 201 W. Washington Ave., P.O. Box 7162 / /~ ISCO/ISI%I Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266-3151 L~.~ 9 ~ Sanitary Permit Applicatio State Plan I.D. Number ~C In accord with Comm 83.21, Wis. Adm. Code, personal informatio you pr-obifdeC~/ c may be used for secondary purposes Privacy Law, s15. )(m) VED Prod t Address {if different than mai li ng address) { I. Application Information -Please Print All Information 2 7~~ ~ ~ 2 LI 3 vr; . S 6 7 Property Owner's Na, m~ // / ,, L - ~ /X // ~~ ~D O ONI NG O o C Y ce L~oJt # Block # - l `l / E CL L/l~l ~ Jim--' O Property Owner's M a il ing Address petty Location / ' ~ ' v ~ ~~x' ~~ tk ~y Section ~~ City, State r Zip Code Phone Number , , ~ ~/ ~ (ctrc ne w ~ E ~~ N II. Type of Building (check all that apply) i r ; w. ~ ~ ~ S Subdivision Name CS umber D S , or 2 Family Dwelling -Number of Bedrooms ` ~ ° ^ Public/Commercial -Describe Use - ~( / ~ ~ i ^ State Owned -Describe Use 2 3. ~ Q..~- c~S ^City_^villag Township of a III. Type of Perm heck only one box on line A. Complete line B if 'cable) A. ew System .Replacement System ^ Treatment/Holding T Replacement O O Modification t Exist B. ^ Permit Renewal ^ Per evision Previousrmi m ate Issu ^ Change of Permit Transf to N Before Expiration Plumber Owner IV. Type of POWTS System: (Check at apply) -It7p n -Pressurized In-Ground ^ Mound > . of suitable soil Mound < 24 in. of suitable so e ^ and Filter ^ Constructed Wetland ^ Pressurized In-Ground Holding ^ Peat Filter ^ Aerobic Tre nit ^ it g Sand Filter ^ Recirculating Synthetic Media Filter eaching Ch r Drip Line ^ Gravel-less Pipe ^ O r (expl ' V. Dis rsallTreatm t Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) rsal Area Required (sf) Dis rsal Area Pro (sf) ystem Elevation ~ ~3 3 ~ d3 ~ ~ , VI. Tank =nfo Capacity in Total N r Manufacturer Prefab Si See Fiber Plastic Gallons Gallons o nits Concrete Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Urut Dosing Chamber VII. Responsibility Statement- I, the unde some responsibility for installation of the WTS shown on the a ached plans. Plumber's Na me (Print) ~ Plum t lure umber MP/MPRS~N Business Phone Number r ~ ~~ j ~ V ~~ ...~ ..fi Plumber's Addre ss (Street, City, State, ~ e) i ~ ~/ VIII. County/De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issu' g Agent Signatur (No Stamps) ^ Owner Given Reason for Denial Surchazge Fee) Z2-S ~~ - IX. C onditions of Approval/Reasons for Disapproval ~ ~ ~ ~~ ) ,~ / ~~ ~ -eOuL ~' f'1fp ~~l / ~//~IVNy~.Q~ y I / ~J ''''"''(~ ~ ~`' ,~~J" a _ , tt R ~ f~ J~ com lete plans (7<o the omty only) for We Jy em on paJ~r not les$'tbad 81/2 x 11 inches in sue SRl~-f 39R (R . (11!(1 - 'r.-2' ~dJ . Wiscor>sin Departrnent of Commerce SOIL EVALUATION REPORT Page ' of Division of Safety and Btaldrtrgs in aoootdanoe with Comm 85, Wis. Adm. Code `, C ~ ~ t ~ tl Attach complete site plan on paper n~ less than 81/2 x 11 inches include, but not ~mffed to: vertical and horizontal reference point ( and location and north arrow scale or dimensions t l size. ), dire-lion ' V C stance to nearest road. P I.D. , , ope, percen s Please prynt aJ! information. MAY 0 1 20 R ~ _ Date Personal information You P ~Y be used for secondary Poses t ~ l.aw, s. 15.04 (1) tmlt- I propertYOwner I OFFI E ~ T N R E( W O! ~ ~..- ~ 1/4 S property Owner Mailing Address ~ ~y ~ State Zq~ Cade Phone Nun~er Lot # Block # s~ .Name or CSMp C"r~G ^ Ctly ~ VrUage Tovm Nearest Road (i{~l New Cor>stnrction tJse: esidentiai / Wtrrnber of bedrooms Code derived design Clow rate ~ Q GPD Parent material ~ .~ Flood Plain elevation ff applicable ~ ~ ~' ~ rnrrrertdatiars: ~~ .~/T`~~ ~ j~ d ~t~(R~-/~~~ / ~~~ </ J(rw. ~. --- '-~ 3 ~9 # ~n9 Depth to Gnuting factor ~. ~~ ft ' R urface elev 1 m ~ . . a Pit s tlot~on p~ pominar-t Redox Description Texture Stnx3ttre Consistence Boundary Raots P 'EtTfJ1 DVft `Eff#2 at. Mtmsed Qu. Sz. CoM. Cobr Gr. Sz. Sh. ~y/ 2 S ; ~ _._---. , • I o3.3 D~ © # U ~ Ground surface elev,/ ~ ' ft- Dew m ~g ~~ ~L-~=- in. S~ Rate Pit ti i D Texture Stnx~ure Consistence BourxJary Roots GP DIfP Fioraon Depth ~t. Dominant MtmseB on escr p Redox t1u. Sz Cortt. Color Gr. Sz. Sh. 'Eft#1 'Etf#2 ~3.2/~.Z • Effluent fr~'f - BOD > 30 < Z20 mgtf-and TSS >30 < 150 ' Etl~erd #2 - gpp < 30 mglL and T~SS{_<~`30~mglt. p~\ W' IwIW r'w~ 4 / rq ///~ Date Evaluation,/Carduded Tay//,l Ntarrbar /_ ~s r~ . 1f A A /s ~_~J _ // / iJ, ~[.//5/ 7 ~,~ ~`l',J'!i -l~f•-a L "'~~~ ~u !4a 25 / Y ~t/ t ' o ~--) ~ Property Owner _ n B~# ^~~9 Parcel ID # /l5~ ~~ Page z~ 3 f ~ 1 ~ pit Ground s~iaoe elev. ~ R D~fh to iimidng factor i v ~ m. th Dominant Redox Descxiptron Texttae Stnx~rae Cor~istertce Boundary Roots rimn De H Sai Race GPDlf~ o p in. Murueq Qu. Sz Cont. Color Gr. Sz Sh. `Faf#1 `Eff#2 l,~ O oj~~ ------ S .~ ~ - ~ -~ /" ~r• z 9~-Z # ^ ^ Pit Ground surface elev. ft. Depth b n9 factor in. Sod Rate Horizart Depth Ddninartt Redox Desert Texttre SUudure Consistence Boundary Roots GPDffE kt. Murtsetl Qu. Sz. Cont. Color Gr. Sz Sh. `Eff#1 `Eff#2 o f ^ ^ Pit Ground staface NeV. it. Depth ~ factor in. soa Rabe Horimn th De Dorrtirtartt Redact Destxiptiort Texture Stnrchae Catst~ertce Boundary Roots GP DIrf p in. Mur~eB . flu. Sz Cord. Color Gr. Sz Sh. •~ ~~ ` Etfluertt #1 = BODs > 30 <220 mglL and TSS >30 < t50 mgA ` Ettkrerd #2 = BOOS _< 30 mgll. 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 608-2648777. fir, .:~ n r ~ ~ '~ . ~ ~ Soil Test Plot Plan Project Name P.C. Collova Bldrs. Inc. Shau Address P.O. Box 487 P• ~ ~~ 3 Somerset Wi 54025 S #226900 Lot 18 Subdivision Crick Bolton Date ~ 2/4/02 1 /4 N E 1 /4S ~ 8 T 29 N/R17 W Township Hammond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. =Top of Survey Iron= g„~-~ I System Elevation ~ 02.9' *HRpSame as Benchmark Alt. BM Top of 2" Pipe @ 100.0' ' PLOT PLAN PROJECT P.C. Colbva Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 i/4 NE i/4S 18 /T 29 /R 17 W TOWN Hammond COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE5/9/03 BEDROOM 3 CONVENTIONAL XXX IN-GROUN PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 30 ,BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 103.3/103.1' 4' below grade Alt. BM Top of 2" Pipe t7a 100.0' 30 Pro 3 Bedroom House 30' i /~ 50' - • ents Qi S~ 540' Property Line ,Vents 3 7% Slope 250' f --Plans Desi~ Manual // - ' 4' lls >3' S acin 2 3 X 9 Ce with p g /~ -' .d Using POWtS on 2.0 Vent >6" of Cover ~~ Biodiffuser with 31.1 ~f Area Alt. \ L6' Long, jl l " $.M. \ ~ ~ ~~ ~\ Grade at System Elevation PLOT PLAN PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 i / 4 NE i /4 S 18 /T 29 !R 17 W TOWN Hammond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE5/9/03 BEDROOM 3 CONVENTIONAL )00C IN-GROUN ~ PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933. # of chambers 30 ,BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 103.3/103.1' 4' below grade Alt. BM Top of 2" Pipe @ 100.0' Pro 3 Bedroom House 30' / ~ T / ? / l~'- / 30' • • ~ 50' - ~ Q - Vents i- ~~ Vents 35' 540' B / / Property , Line 0 ~ 0 ~ 80, 2-3 Cells with >3' Spacing B-1 '` 7% ~ Slope ,~ 250' ~ ~ - ' 'W s Designed Using Conventional Powts Manual Version 2.0 Vent >6„ Standard Biodiffuser f ver Leaching Chamber with 31.1 ft2 of Area Alt 6' Long 11 " M ~ A „ Grade at System Elevation 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 Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. 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 OwnerBuyer P• C. Collova Builders, Inc. Mailing Address Property Address 5 54025 Qom`` ,..rwa„ ~(~ ~`-~ ~ ~ ~,;,~ -~5 ~_~aP ~ / r fit" 1/~ . 1'~Co~-IG~irot: ~' C ~4 t ~ ~,~.~ r~., .' (Verification required from Planning Department for new construction) City/State /~L~_t~~Parcel Identification Number LEGAL DESCRIPTION Properly Location %,, Subdivision 1 Certified Survey Map # '/,, Sec. G b . T o~9 N-R~W, Town of ~~%t-~"'`~1 t1 ~ . ~1 I.ot # l ~ . Volume .Page # Warranty Deed # ~ d ~ 0~ '~G p~ Volume ~ 1 c~ Page # Spec house ^ yes ^ no Lot lines identifiable ^ yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could nesnlt is its prematurafailure to handle wastes. Proper maintenance consists of pumping out the septic task every three years or sooner, ff needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner. and by a masterplumber, journeymanplumber, restrictedplumber 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. ~o~~ ~~~ ~ ~ S l ~1 6 SIGNATURE OF APPLICANT DATE 3 OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of t~e,pro rty described above, by virtu f a wa deed recorded in Register of Deeds Office. ~Ljj ~ ~ ~r~ I .Sr / `~ / a3 SIGNATURE OF APPLICANT DATE ****** Any information that is mis-represented may result in the sanitary pemut being revoked by the Zoning Department. ***""* r~ ** 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 decd U 1950P 5281 ~---. STATE 8AR OF WISCONSIN FORM 1 -1998 WARRANTY DEED wsband and wife .Grantor, and P. C. C11ikwa Builders. inc. . ~;n Grantor, for a valuable consideration corneys to Grantee the follrnn desrxibed real estate In St CroLY _ County State of VHisconsin (the "Property'): 687242 KATNLEts9i R. YALSH REGISTER OR DBEDS ST. CROIX CO." YI RECEIVED FOR RECORD 08-16-2002 9:00 AM EIl7PT t#i ~ REC FEE: 13.00 7RARS FEE: 1155.00 COPY FEE: CERT COPY FEES PAGES: 2 P)C/CaNova Butldars,lne. -xIT~,~,mondh ~V1w5401b O)8-1039-20-•000 / 018-1039- 018 1039 80 000 PareN tdentlRcatbn Numt>ar (PIN) Thla Is not homestead OroPartY• (Is) (Ia not) See Exhibit A attached hereto Together with all appurtenant rights, title and Interests. none Grantor warrants that the title io the Properties good, indefeasible fn simple fee and free and clear of encumbrances except Dated this 1~ day of August. ~• (SEAL) (SEAL) hn J. ton arolyn G. alton (SEAL) (SEAL) ,, •- fly IO~~C ACKNOWLEDGMENT -;~atEOFwist Signature(s) State of Wisconsin, ."~~~nv C~~" • ZIfVn authenticated thb NO ~i{,~.._' - gTATE TITLE: MEMBER STATE BAR 4F WISCONSIN (H not, authorized by §706.08, Wis. Stets) St. Cmlx County } ss. t~ Peroonally came before me this 1~ day of AuausL ~2 the abave med 1 nd W Notary Public. State(of Wisconsin THIS INSTRUMENT WAS DRAFTED BY My commtesian is pe anent. (If not, state e>~Iretbn date: Cddweli Banker Bumet Vy ) 1301 Coulee Road Hudson, W 154016 2-32aTo (Signatures maybe authenticated or acknowledged. Both are not necessary.) WARRANTY GEED STATE 8AR OF WISCONSIN FORM No.1-1998 W lsconsln Legal Blank Co, Inc. Mihvaukee, Wls. ~~~e~ ~~ DUE~~K t o~ ~ .:.; -. ,•. .. ~ 11 i~.9S0P 52.9 ~: .w..wr."wi/wC/r'iG4Si'WY ^!~: , .. ~ ~ ~.:~. ~': ,; ` ' ` .t arr...s.~ylrYtWid.$ t'Ex'YL~Yydpl4l'~IFb~ICfl~f~fOC~`~,j ~2~MW A part of the NE ~/. of the NE % and In part of the NW '/. of the NE Y, end In part of the SW~`'/. of the NE '/. of Section 18, Township 29 North, Range 17 West, Town of NammonQ St. Croix County, Wisconsin and more part(culady described as: Beginning at the Northeast comer of said Section 18; thence S89.33'31"W 372:Ot feet along the North line of the NE'/. of said Sectlpn 18; thence S89'33'31"VU along the North line of the NE '/. of said Section 18 775.94 test; thence S00°52'23"E 250.00 feet; thence S89'33'31"W 966.24 fse~ thence S00.52'23"E 42p,00 feet; thence S89'33'31"W 528.00 feat; thence S00.52'23'E along the North~outh Quarter Sectloh tine of said Sedlon i8 1311,77 feet; thence N89'33'39°E 626,33 feet; thence N00°31'25"W 930.23 feet: thence N89°33'24"E 692J8 feeb thence N00'S2'23"W ~g the East 11ne of the SW % 9-f the NE '/. 330.31 feet; thence N89°33'24`E along the South tine of the NE Y. of the NE '/• 949.09 fast; thence N00°52'24•W 1321.19 feet to the Point of Segfnning. 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