HomeMy WebLinkAbout026-1137-29-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix
Safety and Building division INSPECTION REPORT Sanitary Permit No: 420368 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 -29 -000
CST BM Elev: Insp. BM Elev: BM Descri i n:
TANK INFORMATION ELEVATI N DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmar
Dosing Alt. BM �jbp p D
A -160 4 60VE
Aeration Bldg. ewer
Holding St/Ht Inlet
St/Ht Outlet
TANK SETBACK INFORMATION °/ 7. /
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic C7 ('�, �/ / 4 Dt Bottom
U to ,p
Dosing Head r/M
Aeration Dis Pipe
OP a-A h
Holding Bot. gystem I M / r0
Final Grade
PUMP /SIPHON INFORMATION 3• Z
Manufacturer _ Demand St Covy� � , � ,� , � / •
Model Number
TDH L' Fri oss System Head TDH Ft
Forcemain Length
SOIL ABSORPTION SYSTEM
BEDITRENCH Width t Len th / No. Of Trenches PIT DIM IONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P /1_5�j BLDG LAKE /STREA LEACHING M ur ✓
INFORMATION CHAMBER OR h ! T4-
Type f System: 3e Y� , odel N O / 2
71G0_►"_C�t.F� 1 N �J
DISTRIBUTION SYSTEM �� !l &X u.
Header /Manifold Distribution /n Q x Hole Size x Hole Ve it Intake
lr
Pipe(s) f(/ 1 / yfl 10_
Length Dia Length Dia Spacing — _5_1
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only c� f•rfiM
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched .�tidS
Bed/Trench Center B Edges Topsoil ® Yes Fm No ❑ Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:/b / / 0 l 2 — Inspection #2:
Location: 1472 111th Street New Richmond, WI 54017 (SW 11/4 NW 1/4 21 T30N R1 8W) Golf View Acres Lot 29 Parcel No: 21.30.18.985
1.) Alt BM Description _ 0 04�¢�
2.) Bldg sewer length = 60 ,
- amount of cover =, t , //,
7 ,
Plan revision Required? ® Yes�qSinitu w�r'LYa —
_ -11 r �
Use other side for additional information. _ --
I U " � 6 41nse pct orr's SBD -6710 (R.3/97) Date Cert. No.
201 W. WMWBgfon Ave., P.O. Box 7162
con��in .� �� -7162 _` �`,�`
Department of Commerce —S •D Z �/ S
Sanitary Permitt Application —N �
Sa
In
.d .i& Gomm 8321. Wrs. Ad= Code. penuml Wermalian ym PAW O Check if Revision
be used far I.aw s15. i
L Appti�aa Infers - PIOM Print AN Infarmaflon stale Plan LD. Number
Pwcd Number
Property owner's Name
Address
property owners Msili,ffi Property Loadon N�R s 'T ) L1 � JI , 0)'A • S T
zip CO&
cit sow RE I V 2 ivisiae Name CSM Number
JIL T pe of BuDding (dkwk aR dud ap*) der
2 Fam8y DwCMM - Numbs' of Bedtoems � I
O PdadC:ommercid - Describe Use - --___
Nearest Bond
❑ Some Owned
2) 3 ' x 6 -lh' f ca NM B Kabie)
III. Type of Permit: (Chad[ only am box an EM A (UMbUft seheme for am)- compieft
A. O Repiaammc of 6 O Addition �Wto B us Comfy Hse
zOS� 3
13m1e Only Date Issued
B. O ale* if Saairary permit[ Previm* Issued Pezmit Number
E
IV. of pftwfif: (Check aII fled appW(nambering scheme is for » -k. _Z•,h t4 - rvfl
IeWsround 210 bound 47 0 sand Fier 5o 0 Gonsttomd wetland
x
22 0 Primed I m a crn d 410 Holding Tank 48 0 Sk& Pass 510 Drip Line
45 0 At -Grade - T1t
rade 46 O A TreOn * 49 D 30 ❑ odrer
V. tArea Information: Bate px„si Final tirade
> Flow (� Dispersal Area Dispersal Area So�1 AppUadon Bkvatioa
g proposed Ruse Gds OAnJhdi)
Prelab s
TOW Site teel Fiber Plastic
VL Task Info min C of Tacks Bites Coacwte CoOvsed Blass
New
Tads Tads
Septie er Heidiai - m-0
Daft
VII. � � � �aHation of the POfaV18 gown m the attached phsss.
I Plane Number
7 s Name (leis[) plOmber'
Pluffix s Address (Sweet. city. So.
L_Z ill l
VIII. use Date Issued iss=W AReat sig�re (N Sops)
10 O App<o � �) (memdes C3roaedwater
❑ owaer Gri babd Adverse A o � 2 S �/ ( IM
M Con MMS of jCppM -.Mea for D val
A�t�• a» tr�c�• a ►�v�u���mr�aact�er.ays=ub.a��,�
PLOT P N
PROJECT P.C. Collova Bidrs. Inc ADD SS P. .Box
489 Somerset Wi 54025
SW 1/4 NW 1/ 21 /T 30 N/ W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 8/26/02 BEDROOM 3
CONVENTIONAL XXX IN-GROUND 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 1,>u �'' ( ASSUME ELEVATION 00 ) Filter Zabel A -100
❑ BOREHOLE O WELL - H.R.P. Same as Benchmark
$ 0- '2_ Yp I SYSTEM ELEVATION 95.0/95.1
'I `t . a/ 111th Culdesac
Plans Designed Using
Conventional Powts
Manual Version 2.0 Vent
>6 " Standard Infiltrator
of Cover Leaching Chamber
with 31.1 ft2 of Area
Long 12"
/ Grade at System Elevation
34"
361' Property Lin
,V �- a
�° b0 Pro 3
m
Ho e
1
B.M. #1
1
�S ST
30 30' _
B -1 75' -2
Ve ents ;�
14
65' 30'
B -3 35'
B.M. #2 2 -3' X 69' Cells with >3' Spacing
120' 416' Property Line
r
PLOT P N
PROJECT P.C. Collova Bldrs. Inc ADD Ss P. . Box 489 Somerset Wi 54025
SW 1/4 NW 1/4s 21 /T 30 N/ ,1� W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE8 / 26/02 BEDROOM 3
CONVENTIONAL XXX IN- GROUND ifsSURE 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 t„U, (ASSUME ELEVATION 100 Filter Zabel A -100
❑ BOREHOLE O WELL *H.R Same as Benchmark '
Ci n�� ' —
S YSTEM ELEVATION 95.0/95.1
111th Culdesac
Plans Designe
Conventional Powts
Manual Version 2.0 Vent
>6" Standard Infiltrator
of Cover Leaching Chamber
with 31.1 ft2 of Area
6' Long 12"
34" Grade at System Elevation
361' Property Line
Pro 3
Bedroom
House
25'
ST
30' 30'
B -1 1, 75' _2
f
100 Vents Vents
65' 30'
B�3
B.M. #2 2 -3' X 69' Cells with >3' Spacing
120' !^ 416' Pro rt Line
Vftconsin Department of commerce SOIL EVALUATION REPORT Page l of.
Db4sion o vafety and Buildings
• in accordance with Comm 85, Wis. Adm. Code County
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must S4 • C r Ul
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and n-" distance to nearest road.
Please pdnt a1#1 "
1 �:_` R by Date
Personal information you provide may be used putpus�A (privacy Law, 's. 15.04 (1) (m)).
Property Owner r y l Property Location x �7
P t d GO Lot 1/4 w 1/4 S ( T • 3 0 N R( E (or)(
Property Owner's Mailing Address - .�/7 1 Lot Block #
C� Stthd. Name or CSM#
P.0 Co Ib �r c'�!x 9 C- rott =��e� AcreS
Zip city C] Village (Town Nearest Road
State `� , , m .
® New Construction use: [5g Residential/ Number bfl[adms- Code derived design flow rate 4 5 0 / co on GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material G u� o- � >n Flood Plain elevation if applicable �it� 7 �- ft
General comments 5�y S4 v✓) t (-e ✓
and recommendations:
❑ Boring
F-1 Boring # 9g• d ft De i
Depth to limiting factor 112. n.
® Pit Ground surface elev. P Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roj-Eff#1 GPD/fF
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *EM2,
I v -IZ 1b. 1?— — 5; 1 Z mfr" c Iv "r 5
Z IZ
3 3g -11 ' rn 5 C�s m 1 — — I • Z
Boring # E] Boring
® Pit Ground surface elev. q?' (0 0 ft. Depth to limiting factor I (O 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. fHt1 *Eff#2
0 -12 10 Z 5 I 2 m'r I v y
Z I Z - !>81 1p. -i 5t<- 2-rn sb k rY1k S
vs w, I l . Z
3 :32 to , yl `-- �,) --
Ss, 2 q( v
* 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) re CST Number
Ado.rn Sch k er � � 2533tR
Address Date Evaluation Conducted Telephone Number
21t3 80r` �,. Son,er -� �.I 5' -IO2� s =�-C�/ C�15)2`1l -tid0$
Property Owner N e l50r1 Parcel ID # Page 2 of 3
a Boring # ❑ Boring
Pit Ground surface elev. QQ, y4 ft. Depth to limiting factor U 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
I
0 -12 Io IZ S I ZMS m- i7 CS v� 5 8
z I -,2 `t 1 q ►),sbk rnPy c s
3 zta 1O 4 — s Os en
Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiling factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Mun Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2
❑ Boring # Ground surface elev. ft Depth to limiting factor in.
El Pit 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 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- 2648777.
SBD -5330 OLO O)
I
PAGE 3 OF_j_
NAME k LOT# Z 4 LEGAL DESCRIPTION&y T,- ,U N,R / g E (or) (9
SCALE:
BM LEVATION /40 .0
BM I DESCRIPTION Ip p a l L N +Ovc �, :p -e
<LB LEVATION q 9 O O
Sec• L�
BM 2 DESCRIPTION -for o-f (" ie oel p.' e
SYSTEM ELEVATION 7,5 S O
ALTERNATE ELEVATION SO
CONTOUR ELEVATION A g. S/o ff°_
4-o4-
p-e.
Li
ef
B .y S/o
Z
M Z
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
n OWNERSIIIP CERTIFICATION FORM
Owner /Buyer oVA - :�:-w <--
Mailing Address lJ• �� �)C �t'�('����.. S
Property Address �� �`"' c l - t
(Verification required from Planning Dcpartment for new construction)
City /State &)&)j a rlt►n a�,& (/J7 Parcel Identification Number
LEGAL DESCRIPTION
Property Locatiot� tJ '' /,, '/4, Sec. T 4-� N -R W, Town of
Subdivision CA Q,0 Lot 1r .
Certified Survey Map it Volume Page 11
Warrauty Deed # O Volume Page 11
Spec lio�es El no Lot lines identifiable ❑ no
SYSTEM rvfAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to liandle 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 Dcpartment a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the ou -site wastewater disposal 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.
I/we, 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.
SIGNATU& OF APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form arc true to the best of my (our) lnrowledge. I (we) am (are) the ownct(s) of
the roperty described b ve, by virtue of a warranty decd recorded in Register of Deeds Office.
T')6'6'a'
SIGNATURB O PPI'ICANT DATE
Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.
*' Include with (his applicatlon: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey rnap if reference is made in the warranty decd
i
V im
STATE BAR OF CONSIN 2-1999
653170
Document
WARRANTY 1fE�D KATHLEEN H. WALSH
Number REGISTER OF DEEDS
ST. CROIX Co., WI
This Deed, made between Hillvale Development Limite a RECEIVED FOR RECORD
Min nesota Lim ited Liability Partnership,
08 -2001 9:30 AN
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
Name and Ret urn Address
Golfview z o f Richmortd3 D J. ESTREEN
County, Wisconsin. 304 LOCUST ST.
HUDSON, W1 5401�6
P t 026 - 1012 -50
Parcel Identification Number (PIN)
This _ not homestead property.
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. QE) (is not)
Dated this 8f ~ day of June 2001 _
Hillvale Development Limited
s -- —_ _ • By: Richard Nel
AUTHENTICATION ACKNOWLEDGMENT
Signaturc(s) STATE OF WISCONSIN )
) ss.
St Croix County )
authenticated this — day of _ _ _ t
-- Personally came before me this 9t day of
June 2001 the above named
s Kristine O land Hi llvale velop Limited, a Minnesota Limited Liabil
- - -� - -- - - - -- Partne ''s by R Nelson, —
TITLE: MEMBER STATE BAR OF WISCONSIN •. _
(irnot, _ to t rson(s) who executed the foregoing
authorized by § 706.06, Wis. Slats.) to r ged the same.
THIS INSTRUMENT WAS DRAFTED BY
Attorney K ristina Ogland --
H WI 5401 — Not isconsin
— — — MY ��, 6 aneint. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) _ ��tNS$ _ — — _ _ )
" Names orpersons signing in any capacity must be typed or printed below their signature. n o mafw Prctesslonats compov. Fong d� Lac, v1n
WARRANTY DEED STATE BAR OF WISCONSIN e00-655-2021
FORM No. 2 - 1999
i F-
CIO
\0?� 2 2�51�
5.59 ,G�� ` N � ioo
C3 / cr HOT^
29 = ,� ww -
1 65,713 sq.ft.
g
e3 2 \ 1.51 acres ;.� a suR
515 _ \ / oo o Cn
C2 , �
0
a
w
27
Z 87,154 sq.ft.
73,355 sq.ft. -.1 w 2.00 acres
LO 1.68 acres Todd M. Hendershott, RLS
,-, �.\ Registered Wisc nsin Land
i Dated this day of
M S0 "E 220. — — S00 ° 54_03 "E 239.43_
0 958 1 . 25YR ``�> DRAINAGE EASEMENT - -� West line of the E.
NW 1/4 of Sec. 21
^'
958.3 100YR �=-'� ,. l
250.40' I 270.90' - _ _N00 °54 45 W _ \ 62
_ NDO °54'45"A' 521.30' East line of the -- �� South I
N00°26'02 "W (rec.)
��' NE 1/4 of Sec. 20 NE 1/4
3 �- SW corner of NE 1 /
3 UNPLATTED LANDS 20 T30N, R18W. Per
M to � -------------- - - - - -- Doc.#605017 VOL.13,
nt M LEGEND 3665.(1 "iron pipe)
QO 0 87,154 sq.ft. Denotes Total Lot Area East - West 1/4 line of
2.00.acres W 1/4 comer Sec. 20 T301
(rec.) Denotes recorded bearings C.S.M. Doc.#605017 VOL.13,
Set
Vertical Datum is U.S.G.S. 1929 Adjustment
All Other Lot Corners Are Monumented With PREPARED BY.
1" X 24" Iron Pipe Weighing 1.68 Ibs /ft.
Distances are computed to the Nearest
3sement 0.001' and measured to the nearest 0.01' IA
Angles are computed to the Nearest 00 ".5
e and measured to the nearest 00°00'05"
dd M. Hendershott Sh