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HomeMy WebLinkAbout026-1153-06-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 430625 0 PERMIT) GENERAL INFORMATION (ATTACH TO . � State Plan ID No: 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 Parcel Tax No: Country Living Builders Richmond Township D?lo —1153 - o r CST BM Elev: ( j Insp. , BM8ev: BM Description: Section/Town /Range /Map No: dv •O b�•O r reu t6.+S g ( 1 19.30.18. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. .t( Septic v '1 Benchmark Dosing Alt. BM r Aeration Bldg. Sewer + ,.0 •3 aL Holding St/Ht Inlet f/S / -?q -5 TANK SETBACK INFORMATION St/Ht outlet q• �S TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. D • 30 ► Aeration Dist. Pipe �, o $' 3 • Z� Holding Bot. System L 0.0 2. , gyp CY i Final Grade - PUMP /SIPHON INFORMATION q• QS Manufacturer Demand St Cover / GPM �p✓'� q . (90 Model Number �� 1Q �` nsL.s t 0 . 30 .30 drp. v TDH Lift Friction Loss System Head TDH Ft LV 13.30 1.39 OC Forcemain Length f Dia. Dist. to Well 1. rf �t Io •6!7 SOIL SORPTION SYSTEM �„�,� °" RENC Width r Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM Q SETBACK SYSTEM TO P/L JBLDG IWELL I LAKE /STREAM LEACHING Ma ufacture INFORMATION CHAMBER OR Loa Type Of System: 4671' t ` UNIT Model Number t .v DISTRIBUTION §YSTEM Header /Manifol Distribution x Hole Size x Hole Spacing Vent to Air Intake It Pipe(s) Length Dia Length is Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil g p` Yes 1 ,j No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: I ection #2: t' / i Parcel No: `19.30. Location: 1492 94th Street New Richmond, WI 5,4,0s17 (NW 1/4 19 T30N R18W) Glen View Lot 6 Pa 1.) Alt BM Description = l �',",`p`"p� 5, ( �a�.QO�+r� �1 5.31> t' ($ .0� :� 2.) Bldg sewer length = '�'" L.t_ .aM O • cC Z te e- �j - amount of co er = Plan revision Required? Use other side for addition In ormation. SBD -8710 (R.3/97) Date Insepctor's Signature Cert. No 1151 A { ^ I Safety and Buildings Division County 201 W. W" I. P Awe.; P.O. Box 70$2 Saarrary Permit Number (to be filled in by CO.) Madison, WI 53707 — 7082 O —_ _--- -� (608) 261-6546 1P2 State Plan LD. N 08 girtment of Commerce Sanitary Permit APP info Project Address( ifd Iii ereat Ulan tnailiogrddress) la accord with Comm 83.21, Wis. Adm. Cade, Paso w, a15.04(i may be used for 6=0LSdary purposes Information -4 14 2 . I. Application Information — Please Print All In o parcel # # Black # sName q'] OFF F ICA Property � -'" property Location Property Owner's Mailing _ /.,/ � '�ti Section zi cod Phone Numb (tint one) City, Late --7 Jo N; E r Vv' �A i ) �1.! S w oa NaMID CSM Ni1IDbG jj. .fpe Of B alsams (check all that aPP1Y) d i ���! or 2 Family Dwelling - Number of H4drOPI �ownship 10 ❑ public lCort asercisl — Dtsc D Use ❑City �`• Village of be Use ❑ State Owned — Dearn p Uc ble) (Chock only one box on line A. Complete line B if a p Other Modification to Existics System TtrstmentlH lIL Type ermit: oldiag Tank UPlaument only RePiscement SYstem ❑ A• New Systara List Previous Perarit Number and Date Issued � Cllattge of 11 Permit Tnasfet to New .�� g, ❑ Permit Renewal it Ac- ision plumber Owner Ob2� ir — - 2 Befm Expiration Filter 0 e Z4 in, of suitable soil ❑ At -Crude 0 Single Pass Sand ❑ rv,'[ of PO $ ft Cheek all em: that a 1 table soil ❑Mound rculsting Sand Filter 24 in. Of sui eat Unit ❑'' - p murized in- Ground ❑ mound > - G Hogg T � post Filter (] Aerobic Tresrm ❑ Pressurized to touad ❑ Other lain . ( .> Constructed Walsnd ❑ Drip Line ❑ Gravel -less Pipe Chamber S heat F]Mdn Retirwisda S etic Med'u Filter Dispersal Arts proposed (sf) C D+sPas'1 Ares R (sf) ` V. Din enel/Trsatm gn Boil Appl o n Ratew dsf) Fiber Plastic Delli ow (Bpd) p Site Glass a Num ber � Masiufiesurer erica � Constructed Tnal z o ' p "`_' Q `C� 4ti. Tank Info Capacity in o Gallons (1a31ons of Uni W N Fsiaiag 1 Tanks TuLks kp& or Ho Wing Tads Aeroblo Trtatment Unh ! posing Clamor P4 W vra S5 s4o on the F us plan naponatbfUty for iasmustion Of the E s assume I asiness ness Phone Number VU. Rea onslbiUty Statement 1. the undenta MP/M1� m , C bc Narae (Print) P ' S"wre l Plumber's Address (Street, G . State, Zip Permit Foe includes Groundwater Date issued Is uin Agent Signs o Stamps) VIII. Colin artmeat Use Onl � Sanitary �Approved Q Disapproved Surcharge Fee) r' " ❑ at+mer Given Reason `or DenialP p rovsl rovWReasons for ID1ss 1 IX. conditions of App ° _ .^a°` - lip Q . o � SYSTEM OWNER: I 1 Septic tank, effluent filter and , S dispersal cell must all be serviced /maintained ( �`4► (� Ch?� i as per management plan provided by plumber. nl 2. All setback l'C ui code/ordinances must be maintained �C as per app es not t05 t"A $1n: tl tactics [a siY Attaeh;tomplote 011's (to the County only) for the system so paper O N) Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code 1� County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must 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. a ewed by Date Personal information you provide may be,,sed,for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ` ' Property Qwner I Y F ( Ikj ;=I- Property Location Govt. Lot 1/ d4 S T N E r) W Property o � ff 'ers Maili Address Lot # Block # Subd. Name or M# 2004 city to Zip ode Phone , r ❑ City ❑ jVillaa own Nearest Road Construction Us . Residential I Number of bedrooms Code derived design flow rate GPD ❑ Replacement . _❑ or commercial - Describe: - -- Parent material �/ � 1_� -4 J Flood Plain elevation if applicable ft. General comments n and recommendations: S / d ✓ Cs . Q , I Boring Boring # 9J � . v 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/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring # Boring 0 pit Ground surface elev. l ft. Depth to limiting factor, in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 715 - 246 -4516 Property Owner _ Parcel ID # Page of Boring # ❑ Boring 7 pit Ground surface elev. I < ft. Depth to limiting factor in. 4L*Eff Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. #1 'Eff#2 — t7 �� ✓ J -� ,� uJ 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 F-1 Boring # ❑ Boring El pit Ground surface elev. ft. Depth to limiting factor in. Soil Appl ication 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 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. SB0.8330 (8.6/00) Soil Test and System PLOT PLAN PROJECT Country Livina Bldrs. ADDRESS 92 172nd Ave New Richmond Wi 54017 V . 1/4 NW 1/4S 19 /T 3 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 12/16/03 BEDROOM 4 CONVENTIONAL IN -GRO PRESSURE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE 805 gallons DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 870 # of chambers 28 BENCHMARK V.R.P. Top of Steel Fence Post ^ BM41 ASSUME ELEVATION 100 Filter ZabelA -100 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark SYSTEM ELEVATION 90.7/90.9 5' below grade 6 A !.:B::M Top of Survey Iron @ 96.4 fB.M7 292' Property Line B.M. Plans Designed Using Al Conventional Powts F1 B_2 Manual Version 2.0 —. 2 - 3' x gs' cells 45' with >3' Spacing Scale is 1" = 40' unless otherwise noted 5% Slope 110' 5 ' Pro 4 40' 15 , B -1 50 ' House \0' Well perty Line 50' T Vent perty Line >6 „ Standard Biodiffuser of Cover Leaching Chamber with 31.1 ft2 of Area 6' Long 11 " Grade at System Elevation 34" REMIT HEAD CAPACrry CURVE EFFLUENT M D MI am 11112 WEBB �m ®mmm�mi ®m�m�m ®m�� ®��o�m�m� ®� ■►■■ ■I ®emmmm ®m�m�mmm ®m ®� ®��m� ®m ® ® ® � ■\ ■■ ■lam ■ ■������omm ®mm� ® ® ■ ■°©� ®0 ®®IRE mmsm�m�m�m�m�m0 ®gym ® ®�m EE03 =am mm���m ® ■\ ■ ■ I Mil mmmmmm1111®� ®� NMI MIMM \ ■\ \I�Ii■� ■ ■ ■� ■■ ■� ■ ■ ■ ■ ■� ■�� ■�i��■ ■gym NMI ME ■■\ ■111 ■ \ ■ ■ ■■■ ■■■■ nEngm■ .::.. M ON I less than 30 feet TI)H. \Vol Il ■ ■\ \ \ ■ ■ mom NOTE: For Head Capacity on Model 112, Industrial ■ ■ ■■■ column-explosion proof pump, see FMO219. ■ \\ 11 *2 ! ■ ■■ \ \ ■ ■ ■ ■■■ ■1011ft ■■ \ \ \■■ ■ ■■■ ■ \1►�11■ E \■ ■ ■■■ NNE ■ ■i'. ■ ■( ■ ■ ONE ■ ■■■ M HEAD CAPACITY CURVE SEWAGE ------ - - - - -- .. ■■��■■■■■■�m�o ®o ®o ®�omomo ®omm�omo ®�B000mommmmm® ®mmmo ��■■ �� ■■■■� om.mmmomomo o ® mmmmm ©momomo _ mm■mmmmmmmmom©mmmmmomm ®mm MUM Io ���■■■■■■■■■■ son OMEN ■ ■■ .. _ . OMEN . .... .....:............. .:........ ... . :.. ::. syrh� GMA TIAN �YChiT LAP � u rt a 1►fNC WtATt{tJlP1�ODf of V4*VC V 4041 � sr�vt":p� s►oti ° ;MA�is�pLL gave "Aw OR etas AM INI'MIC GRADC gnu" dL cowau :r ` tROv�Gi f s t ft *APPROVED i JQins 44TH t: �.�.. A~ PIPE 3 ONTO O SOLID SOIL G�Rt itiOG14 Rtlett. LILIT ACRAIWM 0"6 N TWA AAAA ACTUASS reds aw" Wft srEa<ss •��e�� 7 ear Goats: TM�itl �1ii bAL�.Q1dR COiC VOLUAC i AAtMi�ACTK�fA: �° r tftc,LYltitrf4 iACKEbh.r `� �.�rr iA f#N MOOtL Wmall1 :.,t,, ,�,: .,�... b ! 1t+iC�+tis. ON OA�W" swrTCM Tr/i: ` ,� AU rQ PUMP AWR ALA M AILS VO K l�t1rt1lKYlq OtfClilrl >;ATi °� G ►�! "Too,&CD am s<iM1N�iT[ CiA4WTi VIVICAL 6111849m i ImArl gagm PUPM 4st AND Owitw:lu+ piPC.. z a ilfr't' t Af ul AWIA U C TitORK WMV I SS KC . • ......... r . -� f•!T . � M ET or ragtag rwar x M ss meswu .�►�+�+�...: .. rse3 6T"klA6 BACiJE"t Of '+k' "WIDTH i i.tQUIC Q�.`�'!M r......�,.. + Safety and Buildings Division M l 201 W. Washington Ave., P.O. Box 70 Madison, W1 Sanitary Penrtit Number (to be filled in by Co.) 8 V&consin► 30(o2-5— Department of Commerce state e lan 1.D. Number Sanitary Permit App 'canon 003 personal f° u JFAd� Wis. Adm. Code, pett o sl S.) Project Address (if different than mailing address) in accord with Comm 83.2 1, may be used for secondary PurPoses Privacy la UNT 1 I. Application Information — Please Print All Information S ZON111G �FFI ' c el # �� Z / -P ar c el ' Lod # property Owner's Name / 6 Lc. a t ti f pro ation C Property Owner's Mailing dress I - v., section ( ip ode Phone Number City, State �/ J _ / /�� trcle/e)� 1 7 �j T N; R Eo /w / II Type of Building (eh II that apply) S vision Nome �./ CSM Number or 2 Family Dwelling — N of Hodrootas _ ❑ PublictCotnmetcial Describe Us 2 IZ ❑City ❑villagc)!�TDwnship o ❑ State Owned — Describe Use 2 > - IIL Type of Permit: (Check only one on ne A. Complete line B if applicable) A. w system ❑ Replacement S ❑ Treatment(Holding Tank Replacem y ❑ Other Modification to fisting System T List previous Permit Numb d Date Issued B. ❑permit Renewal 11 Permit Change of 01 permit fer to New Petrel[ Revision Owner Before Expiration lumber IV .,Type of POWTS S to Check all that a 1 At -Grade ❑ Sin d Filter on— pressuhzed ln-Grouad El Mound > 24 in. of suitabl it ❑ Mound < in. of le ant Unit erircula d Fitter ❑ ro' Constructed Wetland 11 Pressurizred In ones ®Holding T peat F' ❑ ❑Other (ex 1 to S A. Recirculating Synthetic Media Filter hing Chamber [3 D Line Oravel - 1 Pipe P V. Dis ersaVTreatment Area In ormation: Required (sf) Dispersal e —f Sy em tion Dis rsa l Ar Pro lLf! © ' Deli Flow (gpd) Design Soil Application Rate(gpdsf) P Man»faeturer f Site Fi Plastic VL Tank Info Pacity is Total Number Coro Glass Gallons Gallons of Units New Existing Tanks Tanks Septic or Holding Tank Actable Treatment Unit Dosing Chamber the plauL VII. Responsibility Statement- I, the undersigne me responsibillty for installation the POWTS shown on Business Phone Number Plumber's N e (Print) Plumber's re MP/MPRS N r = L D Plumber's Address (Street, City, State, Zip C VIII. County /Department Use Onl s ng Agent Signatur (No Stamps) Sanitary Pertait Fee (includes Groundwater D Issued ls Approved C1 Disapproved Surcharge Fee) 2 5 0 \ C] Owner Given Reason j Denial IX. Conditions of Approval/Resson or Disapproval OWL— SYSTEM OWNER: 1 Septic tank, effluen ter and dispersal cell mus I be serviced / maintained n C � as per manage t plan provided by plumber. �f� 2. All setback req ements must be maintained as per applic a code /ordinances lR s l l lathes la $ize Attack complete pia as to the wt nty only) rot the system oa paper not less than 8 SBD -6398 (R. 08102) .� ,� � � ±► ,�Ad. ar a ,,fit �* `.,� 4 P . 1 w � � '` •r !" i "� 'fit PLOT PLAN PROJECT Country Livina Bldrs. ADDRESS 923 172nd Ave New Richmond Wi 54017 1/4 NW 1/4S 19 /T 3 N/R 18 W TOWN Richmond COUNTY ST. CROIX 12/16/03 4 MPRS Shaun Bird 226900 DATE BEDROOM CONVENTIONAL XXX IN -GR NW PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 870 # of chambers 28 BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATIO 98.0/96.5 5' below qrade Alt. BM Top of Survey Iron @ 96.4' Plans Designed Using Conventional Powts 292' Property Line Manual Version 2.0 Please note: survey was not Vent completed at time of testing, setbacks from lot lines may >6 „ Standard Biodiffuser change. Installer must verify Leaching Chamber all lot li d setbacks of Cover with 31.1 ft2 of Area before install a 6' Long 11 " Vents Grade at System Elevation 3 4 ' B -1 Scale is I" = 40' unless otherwise 109 40' noted r B -3 - ' X 88' Cells with >3' Spacing Vents 40' 20% pe B. Alt. B= .M. 50' T o Pro 4 Bedroom 30' House 1 ,� �� �� ,�. d;. ♦ t t` 7i ,� < v ia v a?c �� �; d: ' w I Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Div%ion of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A Count' Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. P Pe P D rcent slo e, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. evi by Date Personal information you provide may be used ipreeconderypvrposes-secondary - s 115.04 (1) (m)). I Z 316 Property Owner Property Location Govt. Lot OR 0A S l / T N R E (o 6WD Owners Mailing Address . _. .. i L # Block # S ubd. Name tx M# Props L�.r '— C� L�.✓!/ ��6't/ City tale Zip Code P one Number - city ❑ Village To Nearest Road r New Construction User Residential / Number of bedrooms � Code derived design flow rate GPD o Replacement ❑ Public or commercial - Describe: _ -- Parent material Flood Plain elevation if applicable /V//" _ ft• General m and recommendations: `,.S y �✓ t� �{'� i/�JC �' ff• �� ! j / Or Boring M Boring # gn Pit Ground surface elev. 10 - 3 ft. Depth to limiting facto 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 -31, ® Boring # Q, Boring JC pit Ground surface elev f � ft. Depth to limiting factor ln• 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 r Effluent #1 = BOD > 30 1 220 mg/L and TSS >30 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 —� 715 - 246 -4516 i Property Owner _ Parcel ID # Page of [37 Boring # ❑ Boring 9 Pit Ground surface elev. � ft. Depth to limiting factor 13 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIT in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - 'Eff#1 'Eff#2 1 0 ' I ILA r z L m,Fr a� ° I �•o r a 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 GPD/fF 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 GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgll. ` 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. SBD4330 (8.6(00) • Soil Test Plot Plan Project Name Lakes and Hill Development Shaun Address P.O. Box 10598 White Bear Lake Mn 55110 CSW #226900 Lot 6 Subdivision Glen View Date /18/03 1 /4 N W 1 /4S 1 9 T 30 N /R W Township Richmond Boring 0 Well PL Property Line County ST. CROIX IL BM or VRP Assume Elevation 1 f t. Top of Steel Fence Post — g 1 System Elevation 98.0/96.5 *HRpSame as Benchmark Alt. BM _ Top of Survey Iron @ 96.4' Scale is 1" = 40' unless otherwise 292' Property Line noted Please note: survey was not completed at time of testing, Please Note: Tested area setbacks from lot lines may may not be suitable for change. Installer must verify all lot lines and setbacks desired building area. Check system location before installation. 104 before excavating. 102' 100' 0 B -1 4 98' 10' 00 0 20% Slope B. 30' Alt .M. 1 a� a t~ a� 0 Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 ncy Plan Option # . If system fails, determine cause of failure, use alternate area and install new min tested replacement area. Op#2. Install system at a lower elevation, by removing chambers, removing biomat, and install new system. Op� 3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715 - 246 -4516 St. Croix County Zoning 715- 386 -4680 Pumper Tom Mondor 715- 246 -5148 Shaun Bird #226900 ST CROIX COUNTY SEPTIC - TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM i ► h,1 ` O �p 1 Mailing Address ► D e 2 Proper Address (Verification required from Planning Department for new construction City/state Parcel Identification Number LEGAL DESCRIPTION i Property Sec. 0 N -R Town of erty Location 1 /,,�� 1 /� P Lot # �• Subdivision v ��✓� , � Certified Survey Map # Volume . Page # (f Warranty Deed # ! Volume °2 C � Page # Spec ho es ❑ no Lot lines identifiablxyes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance out the se tic tank every three years or sooner, if needed by a licensed pumper. What you put into the system consists of pumping P can affect the function of the septic tank as a treatment stage in the waste disposal system. Croix Zoning submit to St. ing Department a certification form, signed by the owner and by a The property owner agrees to su rest plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system masterplumber, journeymanp lumber, septic the s tic tank is less than 1/3 full of sludge. is in proper operating condition and/or (2) after inspection and pumping (if necessary), Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards rtiion set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsofi 30 s that your septic system has been maintained must be completed and returned to the St. Croix County Zoning the year expiration date. /�,,/ DATE _ i�� g ) VGN IM OF APPLICANT 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 ZSIGNA perty desc 'bed above, by virtue of a warranty deed recorded in Register of Deeds Office. � ��� DATE OF APPLICANT Any information that is mis- representedmay result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Inelude 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 % 2 4 7 1 P 5 0 8 74675 i STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH WARRANTY WEED REGISTER OF DEEDS Document Number ST. CROI K CO.. WI RECEIVED FOR RECORD This Deed, made between Hillvale Development Limited Liability 12! 10 / 2003 12 : 30P1t Partnership Grantor, and Country Livin¢ Builders, Inc., WARRANTY DEED Grantee. EXEMPT Grantor, for a valuable consideration, conveys and warrants to Grantee REC FEE: 11.00 the following described real estate in St. Croix County, State of Wisconsin TRANS FEE: 127.50 space is needed, please attach addendum): COPY FEE: Lot 6, at of Glen View in the Town of Richmond, St. Croix County, CC FEE: PAGES: 1 nsin. Recording Area Name and Return Address 030-1056- 30-000 030-1055- 90-000.030-1055 -95- 000, 030-1056 -20 -0 00, Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. 7 Dated this day of December ' 2003 * * Hillvale Development Limited iability Partnership s * AUTHENTICATION CKNOWLEDGMENT Signature(s) STAT OF ) ) ss. urne County ) authenticated this NQ;er publie , estate o f Wisco came before me this day of nsin December thea bove named H illval e Develop Limited Li P by TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument Aid acknowledged gicsame. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristine Ogland Hudson, WI 54016 Nota Public, to of My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) Z- ) * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, WI STATE BAR OF WISCONSIN 800- 655.2021 WARRANTY DEED FORM No. 2 -1999 Ot UNPLATTED LANDS ------- - - - - -- 2759.9 --------------- w �.._.._ 54" E --------- - - - - -- 1591.33' -- - v, _.- .— • - - -- -- 545.45 � to S88 05'26 "W ' O w zy BRA w4a — o 5' 229.39 33' 8 J \� EASE%NT 23.03' _ z 33' i � � � � O 42.W' $ c �OtW�,y° �g N88'22'S9 I C 0D —P N p I _ X64_64 _ H.W.L. - 921.50 --, Io �I mo DRAINAGE \ \tea m T cn _ EASEMENT i45.i3' \ \ ,• 10 5 ti N88'22'59 "E l \ \\� I I v a DRAINAGE w �► s,� II EASEMENT w c^ \ °� I I 84,589 S.F. O . W.L • = 932.00 \ �`'• / I I 1 (1.94 ACRES) 85,897 S.F. '�o� ��� j I I \ I I ` L.B.O. EL. 930.00 0 88.83' 22 +. »' z (1.97 ACRES) ,o. ` \ I E L.B.O. EL. 934.00 \ H \ I PD J ok Nl H.1t!I.L. - \ 3s s. 5. 4� r ° N874 33 I �� \ 6 8E 47'33 "E X00•°0 \ \� \ (2.0 N82' u \ 291.64 L -"•- 1 9 \ Q� \ JOIN EASEMENT 91,51 6 c '� 05 F. \ , (2.10 4N (1.82 ACRES) �� / sy L.B.O. EL. �• L.B.O. EL. = 923.00 - 9 4F 9 . iQ 9 4 J 58.4 i * 0 . y '' N 91,764 S.F. w w (2.11 ACRES) / N90'00'00_W *4 y ` l N L.B.O. EL. _ 927.00 'l i�� � 68.25' co ,. �, � � : „�j •. / �� \ : ?• 96,668 S.F. / (2.22 ACRES) \ \'i 470.8 DRAINAGE L.B.O. EL. = 923.00 71.82' \ 180.76' EASEMENT • S�� DRAINAGE c $ EASEMENT !W $� \ \� H.W.L. 920.35 w j 4� 27 °°