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HomeMy WebLinkAbout026-1137-32-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix I Safety and Building Division INSPECTION REPORT sanitary Permit No: 404911 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 -32 -000 CST BM Elev: LIZ) � Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION _ BS HI FS ELEV. Septic � /-� Benchmark Dosing IN -/ (J Alt. BM�vEa '� s C►Y � �• � I0l q Aeration f Bldg. Sewer q 4 Holding St/Ht Inlet �.3 16.z5' St/Ht Outlet T n p S G, TANK SETBACK INFORMATION �j d TANK TO P /Ll WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / / �/ / Dt Bottom S /M Header an. gS Dosing � Aeration D' t. Pipe N+ Holding Bot S tem 3 Final r e PUMP /SIPHON INFORMATION 3.3 Manufacturer Demand St Cover Model Numb TDH Lift ction Loss System Head TDH Ft i Forcemain ength i �,si.Well i SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS t �J SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM EACHING Manufacturers /_ INFORMATION OT HAMBER 0 .�h Td r Type System: ` i !' f t UNIT Model Number: S X DISTRIBUTION SYSTEM Header /Manifold IDistribution x Hole Size x Hole Spacing V Air In ake I/ Pipe(s) Length Dia Length Dia W pacing ✓• SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only C1 �! Depth Over �/ Depth Over xx Depth of j xx Seeded /Sodded / xx Mulched Bed/Trench Center G � Bed/Trench Edges Topsoil / Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / 2 / 02 Inspection #2: / / Location: 1477 111th St New Richmond, 'WII, 54017 (SW 1/4 NW 1/4 2,1 T30N R1 8W) Golf View Acres Lot 32 P : 2211.330 1.) Alt BM Description = 2.) Bldg sewer length - � `� Wrn,� -- 7i la Yb -�CJ/N • --� - amount of cover - � S V s ry C wfl , Plan revision Required? Yes �', No 2 0 low C� Use other side for additional information. _ _ e Date Inspctor's Signature Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County t 201 W. Washington Ave., P.O. Box 7162 `) N visconsin Madison, WI 53707 - 7162 Site Address Department of Commerce a Zak f 07--Z-6 4 pt fl Sanitary Permit Application Sanitary Permit Number In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide __ Check i 9// may be used for secondary purposes Privacy Law, s15.04(1) 2L I. Application Information - Please Print All Information State Plan I.D. N umbe r Property Owner's Name Parcel Number / j cZb_ Property Owner's Mailing Address Property Location h b 3T i9rltr �' U . /� x " - S4 /U �k; S T N, R $ City, State Zip Code Bh NlE Lqt Number Block Number �. r' Subdivision Name CSM Number a s � b { f M = X01 HVXype of Building (Check all that apply.) V 4S pae S O City 2 Family Dwelling - Number of Bedrooms S O Village O Public /Commercial - Describe Use nship i O State Owned ^^ nn Nearest Road III. Type of Permit: (Check only one box on line A. Numbering is for internal e. )Tcomplete line B, if applicable.) A• 3 O Replacement of 6 O Addition to 2 O Replacement System For County use Sys tem Tank Only Existing System B' OCheck if Sanitary Permit Previously Issued Permit Number Date Issued ops 11 IV. of POWT System: (Check all that apply. Numbering is for internal use.) p i— toD , C.r Pressurized In- Ground 2113 Mound 47 O Sand Filter 50 ❑ Constructed Wetland 22 O Pressurized In- Ground 41 Holding Tank 48 O Single Pass 51 Drip Line 45 ❑ At -Grade 46 DAerobic Treatment U 't 49 El R 30 OOther V. Dis rsal/Treatment Area Information: Q Design Flow (gpd) Dispersal Area Dispersal Area Soil A p ication Percolation Rate Systan Elevation Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min. /Inch)s. d Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank d Dosing Chamber VII. Responsibility Statement- I, the undersigned, afflume responsibility for installation of the POWTS shown on the attached plans. Pl Name (Print) Plumber's i r MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, ) J l ey- VIII. County epartment Use Onl O Disapproved Sanitary Permit Fee cludes Groundr Date Issued Issu' Agent Signature (No Stamps) pproved Owner Given Initial Adverse Surcharge Fee) !L L 5 � Determination IX. Conditions of Approval/Reaso for Disap royal , (� c,.o Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size PLO LAN PROJECT P.C: Collova Builders Inc. RESS P.O. Box 489 Somerset Wi 54025 SW 1/4 NW 1/4 21 /T 30 18 TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 2/12/02 BEDROOM 3 CONVENTIONAL XX)C IN-GROOK CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22 BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATIO 100' Filter Zabel A -100 [:]BOREHOLE O WELL «H.R.P. Same as Benchmark Vent SYSTEM ELEVATION 95.0 > 12" Sidewinder High Capacity Leaching Plans Designed Using of Cover Chamber g Conve Powts Manual Version 2.0 6' Long 16" 34" Grade at System Elevation 415' Property Line B.M. #1 111th St Pro 3 Bedroom - R ouse 30' o „n o 1 T 0% Slope 2 -3' X 69' B -3 Cells with >3' 30' Spacing Vents Vents �✓� 40' 30' B -2 45' 45' B -1 10' 38 1' Property Line B.M. #2 PLO LAN PROJECT P.C. Collova Builders Inc. RESS P.O. Box 489 Somerset Wi 54025 SW 1/4 NW 1/4s 21 /T 30 18 TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 J - DATE2 /12/02 BEDROOM 3 CONVENTIONAL XXX IN -GRO RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22 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 95.0 > Sidewinder High Capacity Leaching Plans Designed Using Chamber Conventional Powts Manual Version 2.0 Grade at System Elevation 34 415' Property Line B.M. #1 111th St. Pro 3 Bedroom House 30' o 0 T 0% Slope 2 -3' X 69' B -3 Cells with >3' 30' Vents Spacing Vents 40' 30' B -2 45' 45' B -1 10, 381 Property Line B.M. #2 Wisconsin Department of Commerce SOIL EVALUATION REPORT page l of Division of; afety and Buildings in accordance with Comm 85, Wis. Adm. Code County Cr Attach complete site plan on paper not less than 8 1 I inch" ^ `h►spze. Plan must �4 • `UI t limited to: vertical and horizonta rtie * point ( include, but no 'on and Paroal I.D. percent slope, scale or dimensions, north a lmj n and distance nearest road. .{ Rqviewed b Date Please pint =1cn Personal information you provide may be used ndary purposes (P6004 Law.• l_95 04 (1) (m)). . , 1� —ice Property Owner rly Location P t d e SO ' � 1 Lot S, 1/4 �( CO /4 S Z ( T 3G N R l E (ora Property Owner's Mailing Address '.'�aG OF��E , Lo Block # Sid. Name or CSM# �. 2 Glgl(�view Acres CAY State Zip Code P±beG r ❑ city ❑ Village [Town Nearest Road f ( ((v51)`t l& h ® New Construction Use: ® Residential / Number of bedrooms 3 _ y — Code derived design flow rate 1 45o /1060 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material j5 c ) -4 � G S 2 Flood Plain elevation if applicable �// General comments S S f vyt t (-e U• q 6 ZO and recommendations: 0 z-4- .c (2 v ' Q G • Z d Boring # ❑ Boring a 9 D ft Depth to limiting factor / 3 pit Ground surface elev. � P g .--•L— in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/1F in. Munsell Qu. Sz. Cant Color Gr. Sz. Sh. *Eff#1 *Effir2 I 6 -14 l0 r 5; I 2 rna& m�' � vr - Z /y -4 zvr4l - I Z b WyG- e- - s Boring # E] Boring t ® Pit Ground surface elev. ZO 3"o ft Depth to limiting facto 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. *Efr#1 'Eff#2 6-It Id 3 Si I Z m-�Jr c- Z /y -39 lbjrq s,'l bk i 3 * 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 Arcdoxn Schu ker� �^ 2533CA Address Date Evaluation Conducted Telephone Number 2�i3 8��' -' ^ �l• . Somerse -� �I I 5'-�02� S'-- - o � C Ig)1� �- '-1�0� Property Owner N e l5o n Parcel ID # Page 2 of 3 F31 Boring # ❑ wing rKj Pit Ground surface elev. 99 0 ft Depth to limiting factor �_ in. Soi Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfff in. Munsefl Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 Z k c S V� s S 3 33 –I 17 y b 0 S m t — .7 Z . e q 8D f . d k 4 -7 F-1 Boring # ❑9 F1 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. Munsefl 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 Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsefl 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. SBD4330 (R07ro0) I PAGE_�!L_OF_ NAME e I So ,r\ LOW 3 Z LEGAL DESCRIPTION Sw ' /4Auw` /<,S z T 3 o N R t S E (or V l SCALE: I y d BM 1 ELEVATION /DO - 0 t BM 1 DESCRIPTION 400 n � I " t_eoft 02 BM 2 ELEVATION c 9 Z 3 I e C I BM 2 DESCRIPTION SYSTEM ELEVATION 5 b • 2 D ALTERNATE ELEVATION 1 76p • Z a CONTOUR ELEVATION h o S Io P M� ✓1 4 S!o P e- s ' d -3 ■ 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 inter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 y ears, cells are to be inspected via the inspeceo is 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 raquired 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 3 Shaun Bird #226900 G ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND (� / OWNERSHIP CERTIFICATION FORM Owner/Buyer I� • �.. l:0 1 10 VA 6 U 1 ? j £d1 f .�/•J C— Mailing Address P ©= gOx 4 Z X -,:�1- Property Address / (Verification required from Planning Department for new construction) City /State Parcel Identification Number LEGAL DESCRIPTION Property Location � %,, ,L ✓� y,, Sec. �� , T, N -R-Z�W, Town of Subdivision _ (;' , 17(� V l y 0 C f Lot It 3 . Certified Survey Map # Volume . Page # Warranty Deed # _ b Volume 5 Page # / Spec houseAyes O no Lot lines identifiable yes O no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in 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, journeyman plumber, restricted plumber or a licensedpumperverifying that (1) the on -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 been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days ie a year p' n date. ' Z / %Z / O Z S03RATURE 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 the pr6p`e escribed abov by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.****** ** Include witlr 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 OA ;08/01 WED 08;01 FAX 715 580 4687 REGISTER OF DEEDS 01001 f STAT E BAR OF C JNSf : 2 -1999 1 -710 I:AT14LEEh1 H. WALS11 DucumentNumlar WARR��lT ,'�D REGISTER OF DEEDS t.; ; a ; ,: ,.. ST. CRnTx Co., WI :; r' ?: This Decd, made benvezn litllvu Devaloj�w Li RECEIVED FOR RECORD - id, s Min nesota Limited L labilityPart n ership, '� ��' ••'° 48 -07 -2001 9:30 AN ' r UARRMTY DEED EXEINT i Grantor, and P. C. CDllova Buil Ine a M Corporm EERT COPY FEE: — COPT FEEL TRANSFER FEE 780.60 - =-- RECORDINO FEE: 10.00 Grantee. Grantor, for a valuablt consideratlon, conveys to Grantee the following described real estate In St. C County, Stato of Wisconsin (if tno space is needed, please attach addendum); Reccrding Arcn Name and Return Address Lots 1, 2, 3 6, 7r 29, 30, 31, 3 and 33, Gol£viev Acres, Town of Richmond, St. Croix DAVID J. ESTREEN County, Wisconsin. 304 LOCUST ST HUDSON, W1 54016 Pt 026 - 10 12.50 _ Parcel Identificalian Number (PIN) This Is not hoinestead property. - IN) (is not) Exceptions to warranties: Easaments, rostric:iona and rights -of -way of record, If any. Dutud this _ a is day of June 2001 lt Development Limited AUTHENTICATION 4CKNOWLEDGMENT Signatures) — STATE OF WISCONSIN ) ) ss. St. Croi County ) authenticated (his day of , • r Personttlly ctme before ma this `� � day of June _, 2001 the 3bovc named Tilllvale ^ elo me at Limited, a H innesott Li mite d Liability s Kri stin/ Oglarr —__ Partnr s �b llichrrrd Nelso - .X , . - TITI..F: MEMBER STATE BAR OF WISCONSIN to i !(S�rson(s) who cxacutcd tl:c forueuing (If not, ins gad the same. authvrixed by 706.06, WIS..Shda.) r' ^ra TIIIS INSTRUNWNT WAS DRAFTED BY • i. .z.`t Attarnc Kristina Og larrd Nit ` isconsin — kiuds� WI 4016 My 'ip 1riN ancnL (if not, stttto expiration date; , ''ti,1 . , • (Signotures mar be authenticatcd or ncknuwlcdgcd. Both are not necessary.) _ ) *.Nam of person;; signing In any aupacity must be typed or printed below their signature. worm.n:a+arafaniona.a Comm+. Feed du Lac tM STATE BAIL OF WISCONSIN eCO•asa2o�n WARRANTY DEED FORM No. 2 .1090 7�A:r -� °..._,... •, _.... _ I ' N00 °41'43 "W hey 209.00' 209.00 I 383.00' a� �' 130.78' 302.95 I - 173100' 210.00' N to o i 3> � 3 68,536 sq .ft. CV , 1.57 acres ,h U O� �h I K, °* �0. 3 32 0 � 3 : cp n ^5 b o 87,091 sq.ft. 0 1 .ft. 2.00 acres 87 0 s 5 q ao N 2.00 acres - -- -- 0) v 00 34 N N \ 87,178 sq.ft. 2.00 acres CD 5g'ii \ C \ — 259.00' — — — — — — — 210.00' — — — 116.92' — - - C32 5 3 � � V00 041'43 "W 585.92 11 1 TH S T • S S00 0 41 43 E 585.92 _ _ _ C 5.59 C24 — — 26 - - - -- 373.91'-- - - - - -- - - -' 212.01' - -- C2 0 0 -- - - - - - - - -- - - - -- M ---- - - - - -- to � c w 27 z 87,15 87,121 sq.ft. N ,,� 2 V 73,355 sq.ft. � 2.00 2.00 acres 75,674 sq.ft. - M 1.68 acres 1.74 acres o ° - w � 00 r` z i N00 041'43 "W — 500°58'35 "E 220. — — S00 00 373.91' rn z o H.W.E. I o o ` 2 4 N o 958.1 25YR 87,172 sq.ft. 958.3 100YR 2.00 acres 34.361 210.39' ! 250.40' - • — • — - — - — • — — N00 "W 244.74' �`� NOO ° 54'45' W - -- MATCH LINE - v N oo°26'0 2 "w (rec.) � SEE SHEET 2 OF 3 \ ti LEGEND: °� M LEGEND: Denotes County Surveyor's ap o 87,154 sq.ft. Aluminum Monument (unless ,' V' 2.00.acres Denotes T noted)