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HomeMy WebLinkAbout026-1137-07-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: t 405045 0 GENERAL INFORMATION (ATTACH TO PERMIT) 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: P.C. Collova Builders, Inc. I Richmond Township 026- 1137 -07 -000 CST BM Elev: ! Insp. BM Elev: BM Description: 160 tM l 1JoUN _ l TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. eptic Uto Benchmark S 1 5 Dosing Alt. BM Aeration Bldg. Sewer j� 97 2 Holding St/Ht Inlet y g S St/Ht Outlet 6 TANK SETBACK INFORMATION L TANK TO P/L WELL BLDG. Vaalo Air Intake ROAD Dt Inlet Septic fi W � � �.� r t Ib Dt Bottom Dosing 1 Header /Man. n L Aeration Dist. Pipe -7, 2 Holding Bot. System L PUMP /SIPHON INFORMATION Final Grade Manufacturer De M and St Cover 2 160 c Model Number TDH Lift Friction Loss Syst ad H Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 7 r / G :1, r�2 �— SETBACK SYSTEM TO (GG P/L JBLDG IWELL LAKE /STREAM EACH[ Mani f ctur r: INFORMATION Type Of System: XCb S3 P ik UNIT OR Model Numb : /) DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake 1 i Pipe(s) Length 10 Dia Length (P C6 1 � Dia Spacing b - SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth rench Edges Topsoil Over xx Depth of xx Seeded /Sodded 1 xx Mulched Bed/Trench Center Bed/T Yes No [ Yes [� No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ::1 1,0 / ut Inspection #2: Location: 1495 111th St New Richmond, WI 54017 (NW 1/4 NW 114 21 T30N R1 8W) Golf View Acres Lot 7 Parcel No: 21.30.18.963 � �jeb�y, S hi�� !O „I �rn 1.) Alt BM Description = f °1 • t,11 vv+ 4_A4 Vc-1,4) V^ "' i1 L7 (D*j , e�, ;, u�''f + ✓f S� ) 2.) Bldg sewer length = lip - amount of cover 1) 7 t4t 6 kt o.VA A( 1M-6 wa Use other de for additional i formatio�5. ___��' v -- --- - - - - —� W No R Date nsepct is Signature SBD -6710 (R.3/97) 201 W. Washington Ave , P.O. Box 7162 . N resin Madison, WI 53707 - 7162 Site Address Department of Commerce 36.E ell # 1'495 ( . Sanitary Permit Application Sanitary Permit Number In accord with Coamn 83.21, Wis. Adm. Code, personal nal infonmatioa you provide ❑Check if Revision ma be used for Privacy Law, s15. L Application Information - Please Print All Information KEGEIVED Plan I.D. Number Property Owner's Name APR 2 5 1 Number 21.30. ( 3 ?- (. CV//VL)<ti lr& .� 2002 0z/v- ,13;- -oa -� Property ms's Mfg Address perty Location ST. CROIX COUNTY ? ©yt ZONING OFFICE, ; S ZI T ,7D N, R City, State Zip Code Phone Number Lot N ber Block Number S Subdivision Name CSM Number H. Type of Building (check all that apply) as tP4" s a+ ►rzS. ❑City 2 Family Dwelling - Number of Bedrooms - - ❑Vt7lage ❑ Public/Commercial - Describe Use 4 6 . wnshi p ❑ State Owned Nearest Road III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. 2 System ❑ Replace ment 3 ❑ Replacement of 6 ❑ Addition to For County use stem Tank Only Existing System B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use)* A - foo .Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Presarrized h Ground 41 ❑ Holding Tank 48 ❑ SingIe Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. D' t Area Information: Design Flow (gpd) Dispersal Area Dispersal Am N Soil Application Percolation Rate System Elevation Final Grade Required (6S qd Rate(Gals./Days/Sq.F-L) (Min./Inch) � Elevation VL Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Sepue or Holding Tank _ Dosing Ctnmber VII. Responsibility Statement - I, the undersigned, ility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Phnnber's S' MP/MPRS Number B7 / 7 z7// z 6 Plumber's Address (Street, City, State Cdder me arrment use Onl g Approved ❑ Disapproved &nibiry Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) co ❑Owner Given Initial, Adverse � Determination A Z 3 202 IX. Conditions of Approv"easons for Disapproval j: 6/_ t t�AOti C! C7'� v Attach complde plans (to the Counq only) for the system an paper not less than SM x U Inches In size SBD -6398 (R. 05101) I 201 W. Washington Ave.. P.O. Box 7162 �� X Vh � iconsin Meson, WI 53707 — 7162 Sine Address Department of Commerce # 1 g95 ( . Sani tar yJ Permit A Sanitary Pe r N um b er r In accord with Comm 83.21. Wis. Adm. Code, persona wmnation you provide 10 sv qJ may be used for Law, a15. ❑ Check if Revision L Application Information - Please Print All information Owner's Nam IVED Pla I.D Number Property Number 2 - (.30.1 3 C C I l ( n _ APR 2 5 2002 Property Owner's Mailing Address ST. CROIX COUNTY Location Ok ZONING OFFICE LA ; S T JQ N, R City, State Zip Code Phone Number Lot N Block Number S Subdivision Name CSM Number II, 3hn of Building (check all that apply) as r s "" °w"� S. ocu3' 2 Family Dwelling - Number of Bedrooms > ❑villap ❑ Pablic/Commercial - Describe Use - ❑ State Owned Nearesi Road 2 3 � L8 • � � �oers S� III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete Bne B if applicable) A. 2 ❑ Replacement System 3 ❑ For County use Replacement ; ❑ Addition to Tank B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) A-- too . Pressurized 1n -Ground 210 Mound 47 ❑ Sand Fi ter 50 ❑ Constructed Wed W 22 ❑ Pressurized BWruund 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Odor V. Area Information. Design Flow (gpd) Dispersal Area PDi Soul Application Percolation Rate System Elevation Final Grade Required 6� q0 Rate(Gals./Days/Sq.FL) (Min./Inch) �� Elevation VL Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Eiiuiog Tanks Tanks Septic or Holding Teak - bD Dosing Chamber VII. Responsibility Statement- I, the undersigned, for msta>>atlon of the POWTS shown on the attached plans. Name (Print) Plumber's S' MP/l IM Number Business N cu /.�` 2 Z O� �� , 7/; K Plumber's Address (Street, City, State 2 ;&'e 1 VIlL /De partment Use Only L-1 1A Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) to ❑Owner Given Initial Adverse �{ � Determination `� 2�� � J 3 2 W2- EL Conditions of ApprovaUReasons for Disapproval Attach complete plans (to the Canty a*) for the system an papa ant kss am stn z u tW*W In sin SBD -6398 (R. 05101) 430/ PLAN PROJECT P.C. Collova Bldrs. Inc DRESS P.O. Box 489 Somerset Wi 54025 NW 1/4 NW 1/4s 21 / 8 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 4 BEDROOM 3 CONVENTIONAL )00C IN- GROUND ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 688 # of chambers 22 BENCHMARK V.R.P. Top of 1" Iron ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL •H.R.P. Same as Benchmark SYSTEM ELEVATION 95.8 Vent .� Standard Infiltrator Plans Designed Using >6 Leaching Chamber Conventional Powts of Cover with 31.1 ft2 of Area Manual Version 2.0 6' Long 12" Grade at System Elevation 34 " 3 B se 10' T C 30' -- Vents 111th St. Culdesac 2 -3' X 69' Cells with >3' Spacing 2 13-3 80' 0' a 20' a 40' ° 1 Vents Property Line B - _ 70' -- M.#1 B.M. #2 135' P RDRESS PLAN PROJECT P.C. Collova Bldrs. Inc P.O. Box 489 Somerset Wi 54025 NW 1/4 NW 1/4s 21 /T 30 8 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 4/25/02 BEDROOM 3 CONVENTIONAL XXX IN- GROUND U ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 688 # of chambers 22 BENCHMARK V.R.P. Top of 1" Iron ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL •H.R.P. Same as Benchmark SYSTEM ELEVATION 95.8 Vent >6„ Standard Infiltrator Plans Designed Using of Cover Leaching Chamber Conventional Powts with 31.1 ft2 of Area Manual Version 2.0 6' Long 12" 34" Grade at System Elevation Pro 3 Bedroom House �Z �kK 10' `- T 30' Vents 111th St. Culdesac 2 -3' X 69' Cells with >3' Spacing -3 80' 0' 20'' 1 Vents 0 B - Property Line 1 70' B.M. #2 135' VKisconsin Department of Commerce SOIL EVALUATION REPORT Page of-5- EYN*n of Surety and Buildings in accordance with Comm 85, Wis. Adm. Code County S4 C Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must . rol include, but not limited ited 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. Reviewed by Date Please print all i Personal information you provide may be used for Q1�tit+._ J•� Property Owner cy� : PrdRerty Location � Rtchard e s GovV. of NW 114.4 1 /4 S Z / T 30 N R / 8 E (or)g Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# /�� S ":' I' ?. `� Gol�� ►ew Acres l 5 —Zt � d (0 - Phone N � ❑ ❑ Village [� by Town Nearest Road i t t.(a5l) ch m ® New Construction Use: ® Residential / Nurni c d b6oft Code derived design flow rate 4 5 D (O no GPD ❑Replacement ❑ Public or commercial - y �-�) Flood Plain elevation if applicable 1('14— R Parent material -- 5 P General comments S Y SX 4 i, , ✓ / v �T (9 3 and recommendations: �¢L„/, �(eJ• Q�• a Boring # ❑ Boring ® Pit Ground surface elev. q9 $ d ft Depth to limiting factor i 1 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Con Boundary Roots GPD/fF sistence in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'EfW I a -iZ t �3 5i I Z C5 ( VC 5 8 1 k k 5 s- 2 1Z- O 5� ''' 3 � - 1 r � •-- m5 � I ____ -- • - 7 � - Z `IS � F-z] Boring # ❑Boring ® Pit Ground surface elev. 130 ft Depth to Uniting factor in. Soil Applica tion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. i *Eff#1 'Eff#2 O - 1 Z - lb 3 Si ) 2mab m c a l v C s S Z 1 z -3 l0 1 4 s. 2n-o' 0 C r . 3 34,-1 10 L1 rrnS D S vrl I - 7 / Z �F8 � ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Z533cR Address Date Evaluation Conducted Telephone Number 2113 86� S cxnerse 1 X11 5'- 025 S" - O �- ( -1 15)29- 1 -4J60S !F Property Owner N e ISon Parcel ID # Page 2 of 31 [-3] Boring # Boring Q pit Ground surface elev. gq• y d ft Depth to uniting factor in. Soil plication Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 S; I L rr r C s I v S 8 Z /D- I 4 4 Si I rn -Cr c-5 � y F-1 Boring # ❑ Boning ❑ 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 # ❑ 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 GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 *Eff42 Effluent #1 = BOD > 30 < 220 mWL and TSS >30 < 150 mg& ' Effluent #2 = BOD < 30 mg1L and TSS < 30 mg1L 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 -030 OL07 /00) PAGE 3 OF NAME I J e l So /\ LOT# ? LEGAL DESCRIPTION Nit! '/4 Aiw' /a,S ?-I Ta N,R 18' E (ori SCALE: 1 "= e BM I ELEVATION /QG •O _ X BM I DESCRIPTION " ei �, � — + BM 2 ELEVATION q 9. 7 �( I Sec Z BM 2 DESCRIPTION -Fo a ( "S ea r\ Pi' P e SYSTEM ELEVATION GJ C� • O ALTERNATE ELEVATION CONTOUR ELEVATION h o 51 o P--- ►�a 51aPe Q -Z ■ T � e � v -- X C ■ B -� SIGNATURE ��� �_ DATE /G - / 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 attemate 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 7/ . 6 ,Slq 51 - 71j -- 3J2,6 Shaun Bird #226900 FROM P C COLLOUA BURS, INC PHONE NO. : 715 549 5911 Feb. 01 2001 07 :33AM P1 ST CROix CO UN'T'Y SEPTIC TANK MAINTENANCE AGREEMENT AND + OWNERSHIP CERTIFICATION FORM D Owner/Buyer _ F , `, (b { IAVA A Mailing Address P101 6 ©X ' 489 5041U - S ET U4 S �Zr Property Address (Verification required from Planning Department for new construction) / City/State Parccl Identification Number y �— '< 7 — S-0 LEGAL DESCRIPTION Property Location NW - 1 14, N hl %, Sic. _ 21 — r 3 D N -RI W, Town of k C ycn(�- Subdivision �`��) �it� �C�l /� . Lot If Certltied Survey I122n 11 votumc ?age r _ - 3 Wsrranty Deed f# . Volume Pogo # �l Spec Igo l no Lot tiu_ identifiablc�s C3 ge no SYSTEM MAINTTENANCC ✓✓ Impmperuse and maiateawccof your seYdic system couldm=lt in its premature failure to Lendlc wastcs. rropermaintcnaace co nsists of pumping out the septic tank every thrse years or sacner, if needed by a li=oscd pamper. what you put into the system can aged the function of the septic tank as a treatment stage in tha waste disposal system The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by th;: owner. and by a warm plumb -m joameytuanphimbef, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdiolmal system is in proper operating condition and/or (2) after inspection and pumping (if accessary), the septic tank is less than 1/3 full of sludge. I/we, the u admigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set f herein, as set by the Department of Commerce and the Depi tmcnt of Natural Resources, State of Wisconsin- Certification t your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office witltin 30 f the ca! exp tion data, i IGNATURE OF APPLICANT DATE OWNER TION (we) ee:tdVthat all sta tements on this form are true to the best of m (cur) knowledge. I (w ant (are) the owner of the described ove, by virtue of a warranty dccd recorded in Register of Deeds Office, d GNATURE OF APPLICANT DATE "� + ++ Any information that is mis- represented army result in the sanitary permit being revoked by the Zoning Department • " "• Include with this applleatlan: a stamped warranty deed from the Register of Deeds otrlce a -apy of the cartitied survey map if reference is made in the warranty decd V 6531 ?O STATE BAR OF LbNSIN 2 - 1999 KATHLEEN H. WALSH Document Number WARRANTY 1 EtD REGISTEk OF DEEDS ST. CROIX CO., WI This Deed, made between Hillvale Development Limite a RECEIVED FOR RECORD Minnesota Lim ited Liability Partnership, — 48 -07 -2001 9:30 AM WARRANTY DEED Grantor, and P. C. Collova Builders, Inc., a Minnesota Corporation, EXEMPT I CERT COPY FEE: COPY FEE: TRANSFER FEE: 780.60 RECORDING FEE: 10.00 Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix __ County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Lots 1, 2, 3, 6, 7, 29, 30, 31, 32 and 33, Name and Return Address Golfview Acres, 2 of Richmond, St. Croix DAVID J. ESTREEN County, Wisconsin. 304 LOCUST ST. HUDSON, WI 540169 5 P t 026 - 1012 -50 Parcel Identification Number (PIN) This is not homestead property. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. QE) (is not) Dated this » _day of June 2001 Hillvale Development Limited -- - -- -- —_ • By: Richard Nel AUTHENTICATION ACKNOWLEDGMENT Signature(s) _ STATE OF WISCONSIN ) ) ss. St, Croix County ) authenticated this _day ol'_ -- fir Personally came before me this 2 day of June_ 2001 the above named + K ristina Ogland Hil lvale velop Limited, a M innes ota Limited Liabil — Partne 's p by R Nelson, T TITLE: MEMBER STATE BAR OF WISCONSIN '• _ (Ifnot, _ to rson(s) who executed the foregoing authorized by § 706.06, Wis. Slats.) in r ged the same. THIS INSTRUMENT WAS DRAFTED BY — Attorney K ristina O glan d • — ----- -• - - -- — Hu dson, Wl 5401 - - -- Not isconsin - -- -- — -- MyZ4q fi anent. (If not, state expiration dale: (Signatures may be authenticated or acknowledged. Both are not necessary.) - �� • Nfq • Names of persons signing in any capacity must be typed or printed below their signature. toformaeon Prvres —nals compaor. Fond du tae, W WARRANTY DEED STATE BAR OF WISCONSIN eoo�ss - zort FORM No. 2 - 1999 -C I j w I O co I ( X41 "W —868.06' — w y I I �{ • CrC;X ° I 217.22 217.00 217.00' 1 427.34' 440.72' W N I �� CO f i 7 r 5 I � •- 87,137 sq.ft. 1 I 87,938 sq.ft. Z 2.00 acres I i 2.02 acres I 'y A w -- 100 - -, S �9 1 co N � ) Ito �8 2 i w j p Z I 87,580 sq.ft. C 7 __ V 2.01 acres 89,782 sq.ft. __ acres N .C3 1, C ^) — — A) NOC 1 C C�3� — SC —50 50' 6-4 I 9 -- T 10o I I r- � 90,218 sq.ft. - --- " " ^-_- 1 (o I 2.07 acres _ - - - - -- 87,231 sq.ft. 2.00 acres 10 0 I N i 100,724 sq.ft. � r o sp 2.31 acres h I W O N AA ' \\ S03 "E . 1 0) .W 329.45 \ CO LP h 1 z � N West line of the NW 1/4 of Sec. 21 X21— . —._._. — ._.— ._. —. —.— R1 8W -- — 6 f,�e . _ . \� ^ �\ N00 ° 54' 45 "W 1251. \ �.y East line of the \ ! G ^, ��- cry_ _ • ?�, B' o NE 1 A of Sec. 20