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HomeMy WebLinkAbout018-2003-25-000Wiswnsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL !NFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township P.C. COllova Builders, I Hammond Townshi 3ST BM Elev: Ins~Bly E~ Description: ' ~ s ~ IAiIGM-~S SANK INFOR ATION LEVATION DATA TYPE MANUFACTURER CAPACITY Septic ~~~~ t ~ _ _ /~ ~a Dosing `~'~M0,0 ~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ' ZS ~ ~` f ~ _ Dosing i Aeration Holding PUM~1SIPHON INFORMATION ~0 r h Manufacturer Demand E ~ J-~ G ' ~ . Model Number ~ / `" ~ ~ ~ C . Lift +O Friction L~~ System Head ~ TDH'~ Forcemain Le~gth ~ ia. •, Dist. to Well ~\ Z ~[0 f SOIL ABSORPTION SYSTEM( lClrl~.,....I~K .LL.,~o..rrll's,. county: St. Croix Sanitary Permit No: 429942 0 State Plan ID No: Parcel Tax No: ~- Sectionlrown/Range/Map No: STATION BS HI FS ELEV. Benchmark ~.~g 3 •~b ~ ' ~ ,1 9~ ~ Alt. B / , y v Bldg. Sewer b~(~ - . /O St/Ht Inlet p,r'' . ~0 3.0 0 SUHt Outlet Dt Inlet DtBottom //, Q,,, ~q•~/ ( Header/Man. 5~1° ~ , ~/ Dist. Pipe ti ~~ 1 - "[ Bot. System ~ 3p O -3 , ~ Final Grade 3•Sd ~~ . 3 St Cover BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ~ 03•~~ !! ~~ 1 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Man cturer: INFORMATION CHAMBER OR ~~LF F~~e~ Type Of System: ~ >, ~ -. -~'~ -- UNIT Model Number: -~ I J, ~o • 105 - -o a I UI, I KI13U I -S~iV ~.Y~L? 1 tM / t,.7p.{v S„ _ / p /L 1 s 4,A.tri~ `K 't''p Q'~'"• 1~/ ~..1 Header/Mani u Distribution x Hole Size x Hole Spacing Vent to Air Intake Lengt Dia Pip s) Lengt Dia g ~ ~ ~ Od SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Svstems Onlv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BediTrench Center Bed/Trench Edges Topsoil / f~ Yes ~] No [f Yes ~ No COMMENTS' (Include code discrepenci rsons present, etc.) Inspection #1~/~3 Location: 976 158th S r et Hammond WI 54015 (NE 1/~ 1/4 1 T29N R17W) Crick Bottom Overlook Lot 25 1.) Alt BM Description = ~~`"'~~ ~ s'~'^9 r 2.) Bldg sewer length = ~-- ?O ~ `~\ ~~ ~ o p of coy: r = 'Z~ _ ~ ~ ~"~ ~ ~~-~Q~@to . Plan revision Required? ~ ~ ~~~ ~~ ~, ~ Use other side for additions ation. ,____~__ '~_____; i _ _ __ __ - ______ SBD-6710 (R.3/97) ate ~ Insepctor's O Inspection #2: 7'--->`~- Parc No: Z~' '~ ~ $ ~ m iD _ ~"b __ / ~I _ _~ ~ -_~ Cert. No. 0 0 ~~ -~ DATE ~ J~~~"~ `'' RECEIVED FROM _ LJ/Z~L li'i Address _ FOR `l _~~ < `l L ~ ~'~ RECEIPT eisez .:, - ACCOUNT HOW PAID BEGINNING CASH BALANCE AMOUNT PAID CHECK BALANCE MONEY DUE ORDER DOLLARS l _ .-, BY ®2001 REDIFORM 51657N{~ PL T PLAN , PROJECT' P.C. Collova Bldrs. Inc DDRESS P.O. Box 489 Somerset Wi -54025 ' i / a NE 1 / 4 S 18 /T 29 17 w TowN Hammond couN'rY ST. CROIX MPRS Shaun Bird 226900 DATE/8/03 BEDROOM 3 CONVENTIONAL IN-GROUND ESSURE CONVENTIONAL LIFT )000'HOLDING TANK J MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE 630 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 93.6/93.5 Alt. BM Ton of 2" Pine Cad 100.0' -Plans Designed Using Conventional Powts Manual Version 2.0 Pro 3 Bedroom House 30' Huffcutt Combo f ~~~ qo C ~~~ ,Vent y Vents ~`` SO 3% Slope B-3 2-3' x 94' Cells with >3' Spacing >6„ Standard Biodiffuser of Cover Leaching Chamber with 31.1 ft2 of Area 11" 6' Long „ , „ Grade at System Elevation 50 ~# 412' Property Line B-2 100 y~,-- _ Vent B _ 25' 30' Alt. ~.M. ' SEPTIC TANK ~ FUMP CfiAMBER CROSS SECTION AND SPECIFICATIONS wEAtHERPROOf u" Ci VENT PIPE 1Z" MIN. ABOVE GRADE ~ .1uNCTION BOX > 45' FROM D04R. 4JINDOW 4R WITH CONDUIT FRESH AIR INTAKE FIt~YSHCD -^G~RADE _ pbjEiLVwtK+~ s" v. 18" IN. y~ C.Z. ~;, ry!E ' ~ s INLET f `. GAS- ~ WATER 'FIGHT SEALS , "~" TIGHT ~ `~ A SEAL ' ; F{tTER ~_ ~ ALM APPROVED 8 - ' ON PIPE 3' ~- ~ ~ Wn'O SOLID C t + OFF SOIL pUMP OFF ELEV • .---- ~T" D APPROVED MANHOLE COvER W f PADLOCK ~ WARNING LABEL - -4" MIN. ~S~ MtiM• JOINTS Wltri APPROYE4 PIPE 3' ONTO SOLID SOIL 3~* APPROVED BEDDING UNDER TANK CO CRETE PAD ~j SPECIFICATIONS I !' j (~k ~ ~ SEPTIC f DOSE ~~ NUMBER DOSES P£R DAY : ,_,_------ TANK MANUFACTURERS ~ -"~ DOSE VOLUME INCLUDING 5EP'IIC L c~ GAL , F LOWSAC K : ~_~~... GAL TANK SIZES ~ DOSB ~~ ~L" ft ~' ~,~SGAL• r - {~~~ ,~ CAPACITIES: A = ~~' ~ INCHES = ALARM MA1~t,1FACT13RER: `~~~~ ~ ~'-' S = ~? _ INCHES = ~ '~ GAL' MODEL NUMBER: i SWITCH 'T`YPE: ` ` _ .~ INCHES = 7' S GAL. C -~ FACT{fRER: -~ _ 1~,,,~ ~; PUMP MANU ,~ :J D ~ INCITES - ~~~" MODEL NUMBER: ~ ~~~~~ ;.;,,c-°~ _ 16.23 wAC SWITCH TYPE: ~ ~ RATE v~_ GPM ~ PUMP E ALARM WIRITtG AS PER ILHR REQUIRED DISCIiARGE , VERTICAL DIFFERENCE BETWEEN PUMP£OFF AND .DISTRIBUTION PTOR. ~ • + MINIMUM N£TWOFORCEMAIN XR`_~FTl100 FTOTAL;DYNAMICAHEAD ~_ + ~ FEET T INTERNAL DIilEN5IQN5 OF PU!•IP TANK: LENGfiH LIQi3ID ` ~---- `----1---^"' `~ FEET ,,~ FEET FEET ~~~FEET DIAMETER _..~- DA'" E LfCENS£ NIIM$~R= SIGNED: 1188 `' • ~ HEADICAPACITY CURVE EFFLUENT and DEWATERING WARNING: Model 18514185 should not be subjected to-less than 30 feet TDH. ' TOTAL DYNAMIC HEADICAPACITY PER MINUTE ~ s7-ss i w ~ SERIES 17 31~Sf 91 7J7.1]9 11011110 1/11H 11 71YH 17 ~ 11SNtfS 17LH1! 1eu/+lf 11L/111 11fwt1f 111 ~ <L R, 'M. CN. iDil WI. Ltrt:. GN. Ltrf CN. ,Llr/. GII. ;;Ltrf' GN..:LOf. WI. Ltrf> WI . LLt G16 'ltrf. G+I ~:Lhf. Cli LI+>L' C11. LRt.I~ G+I, LOS.J WI . ~ltr7i i. S f 51 tt ! {2^' II 10f U 783 T1 I71 f1 132 >J IJ36'~ 706 101 99 ]71 N ,'774 51 870 ISS 517. ISS Stl > 1S ''470:( 14 . . ' 10 JD6 173 50"' 17 17' x :119 S1 3I1 79 J00 f0 '; x1 1D0 771 61 I71 17 771 SI 310 1W f6/; 171 RS .! 1702 42 1 ' 1S !. t 9 t! it /S 170 M / 11 1/ 11 lu a0 7]7 a0 71 SI 1711 111 1J7 113 /J 1 p 1 3 ' SI3 1.0 570 IS 111 M 5.11 2f 1.- 7 11: 13 if 76 .116 7J :: I71 11 7J0 Sf 21) f0 : 11T :. SI 130 111 .. . 40 7s 7JI 1 7a a ::u 7/ Ilo n I1! n III sl 121> 1a '.++ u7 so7' 1s ne 1 3 ' I `120 f0 x6 !t IID 111 W 127 tEt ,I 13 17p 70 .;9.11 U 701 97 2/{ 53 tSOi S 10 >:ffiif JO :.111 10:111 /1 <.t7I SS s2B1 JS 717. SI 320 70! dlf7 111 :Ui 1! .171.'6 38 1 2 SO 1524 11 w J] HIS St 'tsl Sl 21f SI z1e' f0 s'xl 100 J11 /S 170 W -'f129 13 S1 17 :.tli 7t Vila SI '210: 71 '.209 i IS 31 /! Y71I. 12 70 ' r 71 Jo 9i1 1o u sl u1 s1 ' +17 7o Iss a vl' 36 to fx 71 a u' /s rnz n 109 x to>: a vp 191 . ' ' M '2TA7 71 iSt S 1 77 d/0 t3 t)0 11 ' 11 61« S1 79: ': /0 111r 100 <.:M/1 . . ' 7 11? i 1 7a' Jo 1u' 34 nl :uoo 110 :o '~ uo ';n+ ~ 10 11 105 +lo ~~ 32 t«f v.n.: 1+.r Ir +us m n• /s ss er s} w-t 1r f+• 1 1r ur 100 30 95 :1 28 90 186, -~- s. 1 .. 26 4186 85 165, `~" 24 80 4165 75 a 22 Q 1aJ 70 x v 20 ~ 65 0 60 1 18 4 63 189, --~ 4189 0 55 ~ 16 50 14 45 4 12 0 188 140, , • 4140 4188 35 10 30 185, 8 137, 4185 25 139 20 6 15 4 10 . 2 5 43 q g 98 161, 57,59 4161 0 s1,5. GALLONS 10 2 0 30 40 50 60 70 80 90 100 110 120 0 140 150 160 ~ERS g0 160 240 320 400 480 560 640 0 FLOW PER MINUTE ooovzz Note: For Head Capacity on Model 112, industrial column-explosion prooof pump, see FM0219. • ~ .._~_~ ~_.. --._-___a_ . 201 W. Washington Ave., P.O. Box 7162' ~ ~ = iscons~n Madison, WI 53707 - 7162 Sanitary Permit Number (tn be filled in by Co.) Department of Commerce (~8) 266-3151 Z Z,,. Sanitary Permit AppliCat' -- -----_._-.. __._,- State Pian LD. Number personal informs Wis, Adm. Code In accord wilt Comm 83.21 'on yot~it~'" ~ ~p~ ~~° ~.) ' " ~ , , may be used for secondary purposes Privacy Law, s15. lxm) _ address) jest Address (if different ST y~~ ~.~ . I. Application Information -Please Print All Information r=t e'` Ci >; L. ~~ [. Q Property 0 r;s a me ' C j ~ mm # t /! Block I' a ~ .~ ~ ' e v~- l - ~ J -_ . .. ~ Property Owner's M ailing Address Pro ~ Location ~ ' v ti ~~ ~ St,'k,Section ~ City, State Zip Code Phone Number __ ~. ,.~) ~~ ~ cl one) _ , ", a.-nl~i~ 1 W~- ~ N; R E W e of BtWtlin (check all that aPP1Y) ~ tlL~ II C . g . Typ ~ ~ or 2 Family Dwelling -Number of Bedrooms Subdivision Name CSM Number ^ PubliclCommercial -Describe Use ~r / ~~ ~ `-~ ^ State Owned -Describe Use - _ ^City_^Villa wnship of III. Type of Permit: (Check only one bog on line A. Complete line B if applicable) A. System ^ Replacement System ^ TreatmenUHotfling Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permii Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS S stem: (Check all that a 1 ) Non Pressurized In-Grourtd ^ Mould > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constrocted Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other e ) V. Dis al/Treatment Area Information: ~• ~ Design Flow (gpd) Design Soii Application Rate(gpdsfl D~rsal Area Required (sfl Dis Proposed s System Elevatign ~ 6 ' 3 ~ ~ ~ , ~ . . O D - 5 VI. Tank =nfo Capacity in Total Number y~c~rer Prefab Site S Fiber Plastic Gallons Gallom of Units ~ ~(//~~~G~"_ „ ' ~ Coticreoe Consuttcted Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, tli! uudersi a responsibility for installation of the POWTS shown on the attached plans. Plumber's a me (Print) ~ ~~ Plumber' i "gnature ~~~ MP/MPRS Nujmber ~/ ~~ ~" ~ Business Phone Number ~~ Jam' ~ ~ J i c.~c (/ ~ Plumber's Addre ss (Street, City, State> od/e)~ ~ n r / ~~~/~L~ /~7~C~ ~ ~ ~~ l Corm / ent Use t?nl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater , Surcharge Fee) ~ ~ n Da Issued mg A ent Signs o tamps)` ^ Owner Given Reason for Denial ~ " ~ `ill ~ D~ 1X. Conditions of Approval/Reasons for Disapproval ~tct,QdArt. /'1'tUSrl"N6~',~iitc~t.ei~~i m^-~G~h-~^a.,~ d~uht~:~ Ce~.l~~.u:c~d~.= ~crlt,~- ~ ,S~,s.~,-, ! ~•t:~-G~d~t~ ~tiu.Q,~~r~/~t,~-c-~-- ~~z~u~5,2~,1->D (,~ ~~~ L Attach eom plans ( Cowty )tor the ttm on pa sot Itss than 81/2 x 11 inches io sloe SBD°~~{R. Ol /03) ~"'~'„'i'`~ ~G~'i~-~-~" ~' Z~`~'~° ~.1~~"'+~'~ >.5~0 ~~ ~ sys~ Wi$oonsirt f~pattrr-ent of Commerce Division of safety and Btili~rtgs SOIL EVALUATION REPORT pays ~ of " in accerdanoe wim c:omm ts5, wis. nam. ~:oae County t -j_ 'D ~ ~ Attach cwmple~ site plan on paper not less than 81/2 x 11 inch in s¢ v E include. but not amited to: vertical and horizontal reference Point ( north amaiv, and location and scale or dimensions rcent slo e M), di istance to nearest road. I.D. d i ~~ , p , pe Please print all information. MAY 0 1 2 0 0 Date ~ Personal information I~ Pry ~Y be used for secorMary Proposes ( Law. s. 15.04 (1) (m)). U p~1yp~ ) / S .R,~f~Y/ FFI 1/4 S ~ T N R E( W ©~~ o ! / ~ Property Owner' MailingAddress # bck # Nam or CSfuNF r~. ~y ~ State ~ Code Number ^ City ^ ViUage Tovm Nearest Road (,tII ( ) New Cor~h'udion Use: 'al / Ntunber of bedrooms Code derived design flow rate S 0 C>PO ^ ~ ^ ~ or ' 1-Describe: - Pats~ fnedeiial r' ~ Flood Plain elevation if applicable I`~ / ~ R :.~ ~ ~f~~ e l2 ~~~~3~93 ~ ~ah~ ~~~- ~ 3~~~~or~l ~ C,•. c'1~. ..«... ~ v, ~~n, ~d,..~~,L1 ~/~.>a' s --~ .~'L/~c~tJ' X31_ / - ~rr~M -..- - - - - --- - y c~ 7~~ ~8 # ~ ~Orirtg ~~ ~ 1 Pit Ground surfaae elev. ~.=- ft. Depth m factor in. ~ Rate T t Stntcltxe Consistence Boundary Roots G tfotizort Depth fn. i DarNitartt Mtxtsei ~ Redox Description Qu. Sz. Cont Cobr ex uue Gr. Sz. Sh. ~1 ~~ ~P~ ~ icy ~~ lev~~ ft t 'F d ti R # ~ ~. . ace e a sts e So Pit Grotm tiat i D Texture Structure Car>sister>ce Boundary Roots Gt r Fforaon pepth in. Dominant Mtn estx p Redox Qu. Sz Corn. Color Gr. Sz. Sh. 'Eifl/1 'EB#2 ~ -~ .0 3.Z ~ ~~ ~m v m-~'r LS ~~ r~ 2 3v s - c L s t'Yl~ w I , Z , 3 b N -- S ~ a -~ ~r ~~ q n °- ,- f~ ' Effluent #1 = BOD > 30 < 220 mgll and TSS >30 < 1 F_flluertt #2 = BOD _< 30 mgll and TSS <_ 30 mgJL CST Ntxrtrer ( Prird) ~ ~ Date EvaNiation Condtx~ed Telephone Ntirtber n Address J /, ~/ / 7 rn f // /~ _ ~ /' ~.n. _ !J _ _ ~/J3 ~~~/ 7 ~~ X7'.97/ l~f~a ~6-~.r/ ~U~o i z ~ - - Property Owner ~~~~~ Paroel 1D # Page of # ^ ~Ptt Ground surface elev. ~ ft. Depth >~ firnifin9 factor ~ Soi Rate tiatizorr th De Dorrrirwrt Redox Description Texture Structure Corrsist~rce Boundary Rotes GP DIIfF p in. Mtrnse0 Qu. Si. Coat. Color Gr. Sz Sh. "Eif#'I •Eff#2 l ~ Z 10 3j ~ L a m r m~'' C S a m ~ , ~' 2 -3v ~ y -- 4 s ~ ,~ : Z , ~ 3 -~ ~~ s ~ a rrf r ~'-rL n /~ n G ~' ^# ^ ~ ^ Pit Ground surFace env. R Depth to ~rniting factor in. ~ Rate horizon Depth Dorr~rt Redox Desaipfion Texture Struchrre Consistence Boundary Roots GPI` in. Mtrtse~ Qu. Sz Cord. Corr Gr. Sz Sh. 'E/f#'t 'Eff#2 ~~ # ^ 8otrng ^ Pit Ground surface elev. ft. Depth fo fsr~g faGtw in. Soi Rate Horizon Depth Dominant Redact Oescription. Texture Structure Consistence Barmdary Roots GPD/(i; in. 11Atx>saM Qu. Sz Cord. Cotor Gr. Sz Sh. `~~ •Efflf2 F_tikrent #1 = BODE > 30 < 220 mglL and TSS >30 _< 150 mgA. • Effluent #2 =BODE _< 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 nevi material in as attemate fomnat, please contact the department at 608-266-3151 or TTY 608-2648777. ~. Project •Name Soil Test Plot Plan P.C. Collova Bldrs. Inc. Shaun~Bird Address P.O. Box 487 ~,` Somerset Wi 54025 Lot ~Z ~ Subdivision Crick Bolton Dat CSTM #' e 12/4/02 1 /4 N E 1 /4S 18 T 29 N/R17 W Township Hammond Boring Q Well PL Property Line BM or VRP Assume Elevation 100 ft. County ST. CROIX Top of Survey Iron System Elevation 96.5/96.3 *HRpSame as Benchmark apt RM Tnn „f ~~~ p;,,P n i nn n' Z. vrc-H~tN~~ r~~r~ ~,v ~ ~r ' YL 1 LAN PROJECT 'P.C. Cdllova Bldrs. Inc A RES .O. Box 489 Somerset Wi 54025 1 / 4' NE 1 / 4 S 18 /T 29 7 W TOWN Hammond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE4/20/03 BEDROOM 3 CONVENTIONAL XXX IN-GROUND SSURE 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 sg,R,p, Same as Benchmark SYSTEM ELEVATION 93.6/93.5 Alt. BM Top of 2" Pipe ~ 100.0' Pro 3 Bedroom House ,~ ~`1 (+~ Vent _ ~S~ iNl >6„ Standard Biodi ~ of Cover Leaching Chamber with 31.1 ft2 of Area 11" 6' Lona ~~ ~ with > flans Designed Using Conventional Powts Manual Version 2.0 30 50' B-3 ' 50 412' Property B-2 100 3% Slope ents~ 25' ~~ 30' B.M. 1 a.1 ~ .{„ ~~i v~a.9j fL ~2~v~-w`a'y-~" PROJECT 'P.C. Collova Bldrs. Inc A RES P.O. Box 489 Somerset Wi 54025 i/4~ NE i/4S 18 /T 29 7 W TOWN Hammond COUN 4/20/03 MPRS Shaun Bird 226900 DATE CONVENTIONAL X~ IN-GROUND SSURE CONVENTIONAL LIFT HOLDIN MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE D HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of ,BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' ^ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 93.6/93.5 Alt. BM Top of 2" Pipe @ 100.0' TY ST. CROIX 3 BEDROOM G TANK OSE TANK SIZE chambers 30 Filter Zabel A-100 Plans Designed Using Conventional Powts Manual Version 2.0 Vent >6" of Cover 111„ 6' Long at System Elev Vents y f 3 -3' x 94' Cells ith >3' Spacing ~ 50 412' Property Line B-2 3% Slope 100 ne ~B- 25' ~~ 30' .M. B.M. Pro 3 Bedroom House 30 Standard Biodiffuser Leaching Chamber with 31.1 ft2 of Area ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer P• C. Collova Builders, Inc. P O Box 489 Somerset, WI 54025 Mailing Address Property Address _ ~~~~ ~ 5 ~ ~ ~``f ~I~.r2.~ (Verification required from Planning Department for new City/State ~~03~tSZ ~~ Parcel Identification Number ~.e.,1dv__v:~/ LEGAL DESCRIPTION Property Location %,, %., Sec. ~ T~~ N-R ~~ W, Town of 6~~ . Subdivision ~ ~ C ~~~~~~~ ~`t~P ~1~~ ~ Lot # ~~ . . Certified Survey Map # Volume ,Page # Warranty Deed # ~ ~ 7 Z ~{ ~~ Volume S~ Page # s Z ~ Spec house [1~' yes ^ no Lot lines identifiable 0 yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result is 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner. and by a masterplumber, journeymaaplumber, restricted plumber or a licensedpumper verifying that (1) the oa-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 bees maintained must be completed and returned to the St. Cmix County Zoning Office within 30 da of the three year e a date. ~ ~ ~ 27-~ SIGNATURE OF APPLICANT DATE 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 e roperty described ve, by virtue of a warranty deed recorded in Register of Deeds Office. /~ / ~ SIGNATURE OF AP LICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ~~ ** 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 Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. ~~f29 R ~fZ 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 _ __.-.. ~ _ _ ~ ~ ~~ ~ LOT 29 70229 S.F. ~ ~~ S 89'33'31 W 2 ~/8 ~'~ ~ 119 46 Q ~.~ \ 1.61 Ac. N 89'33'31" E ,~ ~ ~ ~ /~ ' ~pjr, 1 s 119.46 ~ p ~• \ ~ ~ ~ / --. ~ ~e ~ LOT 24 ~ ~ , p \ ' \ s~ 69518 S.F. ~ ~ s \ ~ '~ O Q. ~ 1.60 Ac. Q ~ D \ `? h LOT 22 ~" ~' ~~, \ ~~ LOT 23 ~,~ ~b 93180 S.F. ~o ~ 68872 S.F\ s~, ~o~y~~. ~ 2.14 Ac. \ ~'`~ \ '`~ ~ ~ 1.58 Ac. ~,~ o• o \O , ~ ~'~ /~o> ~6, ~ ~~~`~' ry~/rye ~P 2 s \ o ~SS~+ ~11~ `o N \ O ~~~~ /LOT 25 LOT 26 ~ ~~ ~ \ /1 .~ ~ 121064 S.F. iv 84789 S.F. \ °~ o`' "' ~ `~ 1.95 Ac. ~~ ~`' ~ ~, 2.78 Ac. N s. \ 1 G, ~., a~ \~/ ~ \ / o . L80= 1018' o o ~ ~ \ / ~la / N \ h~ HWE=1014' ZI \ /' 46 5' L \ .~ ~_ 8 2 ~ \ 122.7x' 127.04' 366.., \l 218.45' LOT 20 D SOUTH LINE OF THE NE 1 /4-NE 1 ~4 S 89'33'24" W 949.09' ~ D R.A. = N 89'54'47" E 89098 S.F. r 2.05 Ac. Z ~~ -- LBO = 1007' p O W C01' oo ~~ = o N ~ LOT 1 CERTIFIED SURVEY MAP VOLUME 337.75 ~ = r V V ;~; O~ ~s7.16. ~ r~ w x ~t~~y ~4'',~;,-.fig; ~t ~°`".~`. e: -9j~ -' ~ ~ ~C4t1k ~ ~CF o ~ ~ • I HWE 1004' A Z m 166.70' ., - - z U 1950P 5281 .----. STATE BAR OF W ISCONSIN FORM 1 -1998 I WARRANTY DEED ` Document Number 1 Thts Deed, made between John J. Dalton and Carolyn G. Dalton. Husband and wife ,Grantor, and P. C. Collova Builders. Inc. .Grantee. Grantor, for a valuable consideration conveys to Grantee the tollowing iescrit>ed real estate in St. Croi County State of ~M1/isconsln (the "Property"): 667242 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO., NI RECEIVED FOR RECORD 08-16-2002 9:00 AM E7IUAR~ GEED REC FEE: 13.00 TRANS FEfi: 1155.00 COPY FEE: CERT COPY FEE: PAGES: 2 t~f P' C/Codova Bulldero. Inc. x/dn~h Avenue mood , 4v1 54015 j'~'~~"9slO y o) e-1039-2a~ooo / ois-;< 018 1039 t~0 000 Parcelldentlflcedon Number(PiN) Thls Is not homestead propeAy. (Is) (IS not) Sea ExhtbR A attached hereto Together with ail appurtenant rights, UUe and Interests. none Grantor warrants that the UUe to the Properties good, Indefeasible in simple fee and free and clear of encumbrances except Dated this 15th day of euoust• 202. (SEAL) 'Y+~~~ hn J. Iton (SEAL) A 1.~~.ICi -, ~A7E OF ~SCO~ Signature(s) i':6P~r "" ~ -IN:~ authenticated mis NO ~C' ~i.A~EWSH~F-' " TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stets) THIS INSTRUMENT WAS DRAFTED BY Cddweii Banker Bumet 1301 Coulee Road Hudson, WI 54016 2-32470 (Signatures maybe authent>cated or acknowledged. Both are not necessary.) • -,e...e. ,.~ neea,.,,e .lnnlnn In env rs,nar.Nv must l,e tvoed (SEAL) • arolyn G. alton (SEAL) ACKNOWLEDGMENT State of Wisconsin, } ss. St. Croix County Personally came before me this 1 tSh day of August ~ the above amed . O nd rot t b nd WI . VJ w~k~ Notary Public, State of Wisconsin My commission b pe manent. (If not, state expiration date: ~y .) ei2lC~ go~ c~t1~12 L GO K I o~ `2 STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc. WARRANTY GEED FORM No. i -1898 Milwaukee, Wis. .~ ~, i . ~ - ~~...1950P 5''2.9., - f -az't`s1'~"*~'.-v~rli~vi; ~ssa ::.s:rc~ ;~~sn~:w:: A part of the NE Y. of the NE /and In part of the NW '/. of the NE Y, and in part of the SVY:'/. of , the NE Y. of Section 18, Township 29 North, Range 17 Weat, Town of Hammond, St, ~Crofx County, Wisconsin and more particularly described as: Beglgning at the Northeast comer of said Section 18; thence S89.33'31"W 372;01 feet along the North line of the N)~'/~ of said Secryprt 18~ thence S89'33'31"W along the North line of the NE % of said Section 18 775.94 fast; thence S00°52'23"E 250.00 feet; thence S89'33'31"VV 966.24 fs thence S89°33'31°VII 528.00 feet; thence S00°52'23`E slo ~ thence S00°52'23"E 4~p,0Q .feet; of said Section 18 1311.77 feet; thence N89°33'39"E ~ the North-South Quarter Sectioh line feet: thence N89°33'24"E 692.76 feet; thence N00'S2'23~~33 feet; thence N00°31'25'°W 330.23 NE '/. 330.31 feet; thence N89°33'24"E along the South line o mthe NEEj at'i~a NF ~ 949 ~g the thence N00°52'24"W 1321.19 feet to the Point of Beginning, feet; i i L .. t...~..,_. .,. ...... .' ~. ~ L ...... ...~ .......... ...v.....w.. ~...,.C._,. t ~ . ~ n " ~, ~; j 4' i : ; ~ y; .~). i',. 4h ` ., _ - ~'4 ..};i. ' ~, ~ ~ ,~.. li'. (~' jZl CK ~~vM 6 ttf vt c_c;vk 2 o P ~.