HomeMy WebLinkAbout026-1137-09-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 420337 0
GENERAL INFORMATION 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. Richmond Township 026- 1137 -09 -000
CST BM Elev: Insp. BM Elev: BM Description:
� � / LPG � CO > • l.,r T . • /✓�
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic � y J A 1 � � � Benchmark � ?S /O ,� � � • 6
Dosing Alt. B
7 to
Aeration Bldg. Sewer / a
Holding St/Ht inlet [G � 6 ?
TANK SETBACK INFORMATION St/Ht Outlet J
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD I Dt Inlet
NO F Sse d
Septic �� / / / O Dt Bottom
Dosing Head rMan.
Aeration Dist. Pipe p O 9 r
Holding Bot. System E
DI •3
Final Grade
PUMP/SIPHON INFORMATION
Manufacturer Ilemand St Cover
GP 2 •� ,
Model Number
T Li Friction Loss System Head TDH Ft
Forcemain Leng Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length f No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 / � �
SETBACK SYSTEM TO [�/ P/ BLDG WELL LAKE /STREAM LEACHING Man= t r. / • l L _Q Y
INFORMATION Ty f System: a 7 b 7 - / (CHA UNET OR Model Number: Y1 /7 r'
s j I` � ' r�
�N 40 DISTRIBUTION SYSTEM y ,�, yL Inc✓
Header /Manifold Distrib io 7 ole Size x Hole Spacing Vent to Air Intak .�C/'
y y Pipes) k I �l'1 / l �— �� C A4_ Length Dia Length Dia Spacing (� J
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 I No Yes ]N,
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: /0 / 0 2- �� Inspection #2:
Location: 1496 111th Street New Richmond, WI 54017 (NW 1/4 NW 1/4 21 T30N R18W) Golf View Acres Lot 9 Parcel No: 21.30.118..965
1.) Alt BM Description = p,P 4 �• G Ua- /� � . S' � ® crsL Gx�,� �; �+ sC(/ILCIS ¢
2.) Bldg sewer length =110/
- amount of cover =
Plan revision Required? Yes
Use other side for additional information. /O
SBD -6710 (R.3/97) Date Insepctor's ignature Cert. No.
r
Safety and Buildings Division COWILY r ' ,
201 W. Washington Ave., P.O. Box 7162 2' - r►
11 *ia�oiisin Madison, WI 53707 — 7162 Sim Address
Department of Commerce , c t(o in
Sanitary Permit Application Sanitary � - " 1
In accord with Comm 83.21. Wis. Adm. Code, personal information you provide �! -
❑ Check if Revision
may be used for Law, sl5. 1 m
I. Application Information — Please Prbrt All Information State Plan I.D. Number
Property Owner's Name y Parcel Number
• e rbs
Property Owner 'a Maili Add ress RECEIVED L °ta n °°
T l4; S T3:)N.RA E
l City, State Zip Code Pb Nuft 1 4 2 00 2 timber Block Number
1 Lot rev
vision Name CSM Number
ST. CROIX COUNTY/
,.� J/! 2 fi "�` ( J *� `�-/ •- ZONING OFFICE t) ovz
of Building (check all that apply) OCicy
n r 2 Family Dwelling - Number of Bedrooms [IV
0 PubiidCommercial - Describe Use
0 State Owned Nearest
III. Type of Permit: (Check only one boot on line A (mnnbering scheme for internal rise). Complete line B II applicable)
A. 1 New 2 11 Replacxa►ent System 3 ❑ Replacement ; 6 0 Addison to
For County use
Tank steer
B. ❑Check if Sarritacy Permit Previously Issued PermitNumbe - Date Issued
W. of Permit: (Check all that apply)(n>mibering scheme is for internal use)�C —(�
44 on Pressurized In- Ground 210 Mound 47 0 Sand Filter 50 0 Constructed Wetland
22 0 Pressurized In- Ground 410 Holding Tank 48 0 Single Pan 510 Drip Line
45 0 At - Grade 46 0 Aerobic Treatment unit 49 0 Recirculating 30 0 Other
V. Area information:
Design Flow (gpd) Disperser Area Dispersal Area Soil Application Percolation Rate System Elevation Final Glade
Requited Proposed Rate( Gals. / Days /Sq.Ft.) (Min./Inch) Elevation
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanks Concrete Constructed Glass
New Exkft
Teaks Tanks
Septic or Hdktine Tank _ fl
Doing Cibmber
VII. RftVondbflky Statement- I, the , assumue r ty for installation of the POWTS shown on the attached plans.
is Name (Print) Plmber's tore MP/MPRS Number Business Phone N uMbFr
�; 2Z- � �U
Plumber's Address (Street, City, State, Zip
16) O'X 'UU-J) 0
VIII. County I nly
Sanitar Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stands)
,Approved ❑Disapproved
Surdn"t Pa)
0 Owner Given Iaitiai Adverse Z2 ��_
Detetmoinetion
I%. Conditions of Appro for pprovad
� s�s�
� - moaWd 4D W4j-+ mob
rMcw 40 = A ` f- , C. S
Attach compide phms 0a the Coody only) for the system laWpaper rid des than SW x Upodaes to she
SAD -6398 (R_ 05 /01)
P OT PLAN
PROJECT P.C. Collova Bldrs. Inc A DRESS P.O. Box 489 Somerset Wi 54025
NW 1/4 NW 1 /4s 21 /T 30 / 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE8/14/02 BEDROOM 3
CONVENTIONAL XXX IN -GRO PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE •7 ABSORPTION AREA 684 # of chambers 22
BENCHMARK V.R.P. Top of 1.5" Pipe ASSUME ELEVATION 100 Filter Zabel A -100
❑ BOREHOLE (DWELL •H.R.P. Same as Benchmark
B.M. 2
SYSTEM ELEVATION ��•d
Property Line
Property Line
Vent 50'
>6 » Standard Infiltrator
of Cover Leaching Chamber M.#1
with 31.1 ft2 of Area
_ 6' Long
12" 20
Grade at System Elevation 0
34"
lans Designed Using
nventional Powts Vents 1.4
M ual Version 2.0 0% Slope
0'
B -3
40'
2 -3' x 69' Cells with >3' Spacing
40'
0' 20'
T
B -2
o 3 Bedroom Vents
H use
Couldesac
{
P OT PLAN
PROJECT P.C. Coll Bldrs. Inc A DRESS P.O. Box 489 Somerset Wi 54025
NW 1/4 NW 1 /4S 21 /T 30 / 18 W,TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 8/14/02 BEDROOM 3
CONVENTIONAL XXX IN -GRO PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22
IL BENCHMARK V.R.P. Top of 1.5" Pipe ASSUME ELEVATION 100 Filter Zabel A -100
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
T/i.M2
SYSTEM ELEVATION Property Line
Property Line Vent >6 „ Standard Infiltrator
of Cover Leaching Chamber
with 31.1 ft2 of Area
6' Long 12 20'
34" Grade at System Elevation 0
Plans Designed Using
Conventional Powts Vents a
Manual Version 2.0
0% Slope B -1
0'
r
B -3
40'
2 -3' x 69' Cells with >3' Spaci
40'
0' 20'
T
B -2
Pro 3 Bedroom Vents
House
Couldesac
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code County
C
S-�
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must
. rol
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and loca8on and distance to nearest road.
Reviewed by Date
Please print all i►xj�rh"�on• L
Personal information you provide may he used for s.o ri pu Law, s_ 15 4 (1)
w nr ;..
Property Owner _ ,. ,.. i :._ 0 Prope#y Location
pl&ard e s p, ;
G 41W 1 /4,41W 114 S z/ T ? N R E (or)29
Property Owner's Mailing Address Name or CSMtt
ST GF Oq
i� "o . Cox !0(0 �� N o ►���e� Acres
city gate Zip Nu . 4G [Town Nearest Road
t (toil) 7 ! . -� 1. /// Z` 5�/
® New Construction Use: ® Residential/ Number of bedio'o'rrtt;" - Code derived design flow rate 4 5D Co00 GPD
❑ Replacement ❑ Public or commercial - Describe:
Flood Plain elevation if applicable ft
Parent material 0 v - hA3 a s
General comments s y •--j -e v • 4G • 3 0
and recommendations: , C(-e U.
F1 Boring
F - 1 Boring # q9: 8 a ft Depth to limiting factor I I in.
® pit Ground surface elev. P 9 -- — Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2
l 0 - I Z IU 3 Z 5it k c Ivy 5 8
Z I2- z l 4 s;l 2
3 32 -113 t i'�) rrS i ( "
° ►to .c7
F 2-1 Boring # Boring
® Pit Ground surface elev. 9V G 6 ft Depth to limiting factor (� Co in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg
in. Munsetl Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2
I
0 -12 - IU 312 5• I r l-(- C5 IV 5
Z IZ -34 in q Iq s, 2 i;- S -
(014r46 Z
' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = B013 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature CST Number
Ardour Schu ker — C - 2533cA
Address Date Evaluation Conducted Telephone Number
21t3 80'* S� • Somersc �.► I 5�-io2� ..S 9' -O/
Property Owner N e 150x, Parcel ID # Page 2 of 3
F 3] Boring # ❑ Boring
Pit Ground surface elev. I sd ft Depth to limiting factor 5 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 I 'Eff#2
l 0 -1z 10 Z SO l C5 l vc 5 8
2► 2- 2 f S i d r��r c — . 5
S`f c io
❑ 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 # 1:1 Pit F1 Boring
Ground surface elev. ft Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Stnx:ture Consistence Boundary Roots GPDM
in. Munsell Qu. Sz Cont Color Gr. Sz. Sh. "Eff#1 'Eff#2
• Effluent #1 = BOD > 30 < 220 rng/L and TSS >30 < 150 mg/L ` 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 -8330 (R.07/00)
Y
PAGE 3 OF3
NA ME AI e ISo^ LOT# 9 LEGAL DESCRIPTION W ' /*W /. S Z T3o N,R fA E
,- 1 "= �
X �
BM 1 ELEVATION /00 - U
BM 1 DESCRIPTION
BM 2 ELEVATION /OD • U S C G Z
BM 2 DESCRIPTION 92
SYSTEM ELEVATION 9G • 3 O
ALTERNATE ELEVATION 9l0 " 3 C)
CONTOUR ELEVATION •Vo S /cam
B w1 Z
,Va Slo()e
13-(
f
■ k-
Q �
■
a - Z
5 4.
SIGNATURE DATE
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
OWNERSIiIP CERTIFICATION FORM
Owner /Buyer �. (U oVA S — 5- - N L
Mailing Address J, 0.
Property Address 1 '
(Verification rc ,Hired from Planning Department for new construction) PAO
City /State WTV Parcel Identification Number
LEGAL DESCRIPTION
Property Location !;, Sec. T W, Town of
Subdivision
Lcrtifled Surrey flap ;r - VOil1I11C Pap-,
`Varrauty De,d ft' 4 nIC
Snee hour es_C 110 Lot inc:: 1, 1 .c :lt :1("
SYSTEM MAINTENANCE
Improper use and ma. intcaancc of your septic systcm could result in its premature lallurc to IlarluIC -.vastcs. :Cf7Cr IIlalIItenallcc
consists of pumping out the septic tank every three years or sooner, if uccded by a liccascd pumper. what you put into the system
can affect the function of the scptic tank as a treatment stage in the wrstc disposal systcm.
T"hc property owner agrees to submit to St. Croix Zoning Dcpaiuncat a certification form, signed by the owner and by a
master plumber, journeyman piumbcr, restricted plumber or a licensed pumncr verifying that (1) the ou -site :vastewatcrdisposal systcm
is in proper operating condition and/or (2) after iusnectioa and pumping (if necessary), the scptic tank is less than 1/3 full of sludge.
Uwe, the undersigned have read the above rcquiremcuts and agree to maintain tic private svxagc disposal system with tic standards
sct forth, herein, as set by the Deparuncat of Commerce and the Departmcat of Natural Resources, Slate of Wisconsin. Certification
stating that your septic system has beep maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of ^year expiration tc.
<'l ZivZ
SiGNATLTRL OP AI'PLICAr1T DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) .mowicdgc. I (wc) ani (are) the ovrnct(s) of
the escribed abo e, by virtue of a warranty decd recorded in Register of Dceds Officc.
/ 11 z
IGNA RI: OF APPLICANT DATE
ss.sss A n y information that is niis- represented may result in the sanitary permit being revoked by the Zoning Department.
" Include ivith this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survc Y map if reference is made in the warranty decd
i
U 1871P 022 \3
- STATE BAR OF WISCONSIN FORM 11 - 1982 6 7 6 0 1
LAND CONTRACT KATHLEEN H. WAALSH
Individual and Corporate REGISTER OF DEEDS
(TO BE USED FOR ALL TRANSACTIONS WHERE OVER ST. CROIX Co., NI
$25,000 IS FINANCED AND IN OTHER NON - CONSUMER RECEIVED FOR RECORD
Document Number ACT TRANSACTIONS)
04 -11 -2002 9:35 AN
CONTRACT, by and between Hillvale Development Li mited, a LAND CONIRACT
Minnesota L imited Liabi Partnership, - EXI?WT #
- - -- - - -- REC FEE: 13.00
TRANS FEE: 499.20
—_ —... - — - )- — —
( "Vendor ", whether one or more and P. C. C ollova Builders, Inc COPY FEE: _ CERT COPY FEE:
— — -- - -- -- — PAGES: 2
Recording Area
( "Purchaser ", whether one or more). Vendor sells and agrees to convey to Name and Return Address
Purchaser, upon the prompt and full performance of this contract by Purchaser,
the following property, together with the rents, profits, fixtures and other KRISTINA OGLAND
appurtenant interests (all called the "Property "), in St. Croix ATTORNEY AT LAW
County, State of Wisconsin: -- — P.O. BOX 359
HUDSON, WI 54013
Pt026 -1060- 80,026 -1063- 95,026 - 1064 -10
an 026. 1060 -10 -
(Parcel Identification Number)
Lots 'C. l 1, 25, 27, and 34, Golfview Acres, St. Croix County, Wisconsin.
This is not homestead property.
N) (is not)
Purchaser agrees to purchase the Property and to pay to Vendor at place Ve ndor dire cts
the sum of $ 16 6,400.00 in the following anner. (a) $ 5,10
g — - - -- at the execution of this Contract; and (b) the balance of $ 161,300.00 . —together with interest from date-
hereof on the balance outstanding from time to time at the rate of S e e Below _% percent per annurn
until paid in full, as follows: Vendor shall release the above lots upon payment as follows: Lot 8 for $27,900,00; Lot 9 for $27,900.00;
Lot 11 for 526,900.00; Lot 25 for $26,900.00; Lot 27 for 29,900.00 and Lot 34 for $26,900.00. Interest shall not accrue until 6 months
after the closing of this Contract. The down payment on this Contract shall be a credit to the last lot released.
Provided, however, the entire outstanding balance shall be paid in full on or before the 1 0th _ day of
April _ _ 2003 (the maturity date).
Following any default in payment, interest shall accrue at the rate of % per annual on the entire amount
in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the enti
principal balance).
Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici-
pated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor,
Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of
taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest
unless otherwise required by law.
Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any
amount may be prepaid without premium or fee upon principal at any time after d of closing _ , XXXXXKMK
In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long
as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated
as unpaid principal) is less than the armor that said indebtedness would have been had the monthly payments been
made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds
of insurance or condemnation, the condemned premises being thereafter excluded herefrom.
Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser
for examination except First mortgage to Builders Mortgage Company, LLC
Purchaser agrees to pay the cost of future title evidence. if title evidence is in the form of an abstract, it shall
be retained by Vendor until the full purchase price is paid.
Purchaser shall be entitled to take possession of the Property on day of clo sing. XXXX
• Cross out one.
LAND CONTRACT - Individual and State Bar of Wisconsin
Corporate Form No. 11 - 1982
Information Professionals Company, Fond du lac. WI 900- 555 -2021
_ BPIs I o
i 217.22 217.00' 217.00'
440.72' 427
I
W
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4! o 5
1 i 7 1—
z
I 00 87,137
pr i I I 87,938 sq.ft. 2.00 a
1 2.02 acres
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� � -- 100' - -� ��.
uj
W i N
ft
pr 1 oho i ^ 1 2 \
Y � O Z T - 87,580 sq.ft. �\ I 2.01 acres /C� — — \ 89,782 sq.
3 1, CZ j / \ 06 ' , 2.06 acre
o>
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v, I C3
(j `� I N2 2 .w % .1 C9\ CI O i� — — Cl
ch
o —50 50' 1 64 — — -
� -- T 1oo' M
90,218 sq.ft. - -- -
z I M 2.07 acres —
0
r y
?. N ry
87,231 sq
' 2.00 acn
100,724 sq.ft.
N �O-o 2`SOA 2.31 acres h
w L 0 st•
o rn
S03
1� 329.45'
OD
z �° � N West line of the ___\
comer ''ojj S �o NW 1/4 of Sec. 21
Mon21 _ — .— .— . —. —._ —. — .— .— .— . —. —.— — — — — —
IN. R18W �— 6 ° °0 ' ° ��h `o �� N00 °54'45 "W 1
���o � N �� - - -- East line of 1
\ y
NE 1/4 of Sec
f
10 I N
r N 95,555 sq.ft.
w w
zCq 3 0 \ �` .b O ,r� o 'gyp. 2.19 acres
f