HomeMy WebLinkAbout026-1135-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
420574 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. Richmond Townshi 026- 1135 - 10-000
CST BM Elev: Insp. BM Elev: BM Descn tion:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchm k
Dosing ,/ � Alt. BM
Aeration �{ i Bldg. Sewer
o jgw•l� r" w is 91" L
Holding / = St/HtInlet
St/Ht Outlet
TA K SETBACK INFORMATION �S
TANK TO P L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
o
_ M Ah2f
Septic Dt Bottom
Dosing He d /Man. 9S 3
Aeration 6'�
Holding
rBbof.System A
( p,
Final Grade , (�
PUMP /SIPHON INFORMATION $ ,
Manufacturer Demand St Cover R.
GPM Z• Ob•
Model Number b
TDH Lift Fri ' Loss System Head TDH Ft
Forcemain Length Dia. Dist. to e
SOIL ABSORPTION SYSTEM U L y
BED/TRENCH Width �� L Len th No. Of Trench PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS T
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREA LEACHIN M ufacturer:
INFORMATION Ty Of System: CHAMBER R
--./ K n n 7 n/ Model Number:
DISTRIBUTION SYSTEM �}C ' ,
Header /Manifold Distribution / r x Hole Size x Hole Spacing Vent to Air Intake
1 h Pipe(s) /.�� kr
Length Dia Length llJ Dia *&ng l
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only y `
Depth Over Center Bed/Trerch Edges Topsoil Depth Over xx Depth of xx Seeded /Sodded xx Mulched
❑Yes ❑ No Yes [] No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / a Z Inspection #2:
Location: 1426 144th Street New Richmond, WI 54017 (SE 1/4 SW 1��/4��2,4,T,-�30N R1 8W) Ever / g een verlook Lot 10 Parcel No: 24.30.18.940 /
1.) Alt BM Description = 'C ovG� C i"�"n d �j C,[tQ,rytAa,'S /A
2.) Bldg sewer length = ( y D7 A'0 ry,
amount of cover 610 .US h r f �/ / Z Q �yy+Gt' p0�i7 pfGha r
Plan revision Required? [* Yes [
Use other side for additional information. L /i _�'✓y �_�__.
SBD -6710 (R.3/97) Date Cert. No.
Insepctor's Sign ure
iI
PLOT PLAN
PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025
SE 1/4 SW 1 /4S 24 /T 30 R 8 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 1 1/11/02 BEDROOM 3
CONVENTIONAL XXX IN -GROU ESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 30
BENCHMARK V.R.P. Top of 1.5" Pipe ASSUME ELEVATION loo' Filter Zabel A -100
❑ BOREHOLE O WELL +H. R. P. Same as Benchmark
Vent
SYSTEM ELEVATION 95.5' 4' Below qrade
>6 „ Standard Biodiffuser
o over f C Leaching Chamber Plans Designed Usi g
with 3 1. 1 ft2 of Area Conventional Powt RECEIVED
11 " Manual Version 2.
6' Long p
B. #1 34" Grade at System Elevation EC 1 j ? 002
B.M. #2 292 , S Property Line Z T p CR o1X Co
10' 10' FiCE
30'
B -1
25, 2 B -5
45'
Vents 100'
B -4 25' 30'
I T
100' Pro 3
Bedroom
House
B -2 -3
' Vents :a
b �
O
3 -3' X 63' Cells with >3' Spacing
P g �
I
I
292' Property Line
PL LAN
PROJECT P.C. Collova Bldrs. Inc. D RE .O. Box 489 Somerset Wi 54025
SE '1/4 SW 1/4s 24 /T 30 / 1 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 1 1/11/02 BEDROOM 3
CONVENTIONAL M IN -GROUN RESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 30
IL BENCHMARK V.R.P. Top of 1.5" Pipe — , l Sut/�af ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL - H. R. P. Same as Benchmark
ALong t
SYSTEM ELEVATION 95.5' 4' Below grade
Standard Biodiffuser
Leaching Chamber Plans Designed Using
with 31.1 ft2 of Area Conventional Powts
Manual Version 2.0
B. . 34" Grade at System Elevation
B.M. #2 292' Property Line
10' 10'
30
B -1 25' 2 Vents B_5 b �
45'
i
100'
B -4
1 OF
Bedroom
/ House
7�� I 25' 30'
B -2 B -3 J nve L
Vent -- f
94' Cells with >3' Spacing a
f 292' Property Line
Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162
1* 66onsin Madison, WI 53707 - 7162 Site Address
Department of Commerce /- Z2_. --0 Z 3 o3 # 142f-
Sanitary Permit Application Sanitar Permit Number
Wi
In accord with Comm 83.21, s. Adm. Code, personal information you provide Tzc S -+4
may be used for secondary purposes Privacy Law, sl5. 1 m 0 Check if Revision
I. Application Information - Please Print All Information State Plan I.D. Number
Property Owner's Name n }, 8 w. e F. " Parcel Number
/ fl �c l 02nD 113s -10 -&<W
Property Owner's /') Address Property Location !]/�
i t/ i �?� V 1f� 4; Sa C T E
City, State Zip Code Rbrnp.Nn0b& -) i [ r Lot Number Block umber
y C'
C ) CE
O� pion Name CSM N ber
II. of Building check all that a 1 OL S •�
I � PP S � OCity
2 Family Dwelling - Number of Bedroo
OV' e �
0 Public/Commercial - Describe Use
o s • P
0 State Owned 30 Nearest Road
3 X 93 �i f
III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable)
A' 1 2 0 Replacement System 3 0 Replacement of 6 0 Addition to For County use
stem Tank stem
B. 0 Check if Sanitary Permit Previously Issued Permit Number Date Issued
IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) Q_ 14--M .
44 Pressurized In- Ground 210 Mound 47 0 Sand Filter 50 0 Constructed Wetland
,210 Pressurized In-Gmu d 410 Holding Tank 48 0 Single Pass 510 Drip Lin
45 0 At -Grade 46 0 Aerobic Treatment Unit 49 0 Recirculating 30 0 Other
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate 6 System Elevation Final Grade
Required Proposed Rate( Gals. / Days /Sq.Ft.) (Min./Inch) Elevation
933�
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel itiher Plastic
Gallons Gallons of Tanks Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank _
Dosing Chamber
VII. Responsibility Statemen I, the undersign responsibility for installation of the POWTS shown on the attached plans.
Plum'(Print) Plumber' r MP/1vtPRS Number Bus ne� Phone Ntyp� her
/
Plumber's Address (Street, City, State, e)
VIII. /De artment Use Onl
1P Approved 0 Disapproved Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps)
0 Owner Given Initial Adverse ZS r / �2(!O Z
�—
Determination
IX. Cond�ti Qf Approval/R easo for>s�proval
Attach osmpkte plain tto the Comrq only) for the system on paper uol teas than SW x 11 lathes in size
D-6398 (R. 05101)
PL LAN
PROJECT P.C. Collova Bldrs. Inc. D RE O. Box 489 Somerset Wi 54025
SE 1/4 SW 1/4s 24 /T 30 ! 1 W TOWN Richmond COUNTY ST. CROIX
_7 MPRS Shaun Bird 226900 DATE 11/11l02 BEDROOM 3
CONVENTIONAL XXX IN -GROUN V RESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 30
IL BENCHMARK V.R.P. Top of 1.5" Pipe ASSUME ELEVATION too Filter Zabel A -100
❑ BOREHOLE O WELL - H.R.P. Same as Benchmark
ALong t
SYSTEM ELEVATION 95.5' 4' Below grade
Standard Biodiffuser
Leaching Chamber Plans Designed Using
with 31.1 ft2 of Area Conventional Powts
Manual Version 2. 0
B. #1 34" Grade at System Elevation
B.M. #2 292' Property Line
10' 10'
30'
B -1
25 2 Vents B -5
IL
45'
100'
B -4
100' Pro 3
Bedroom
House
25 30'
T
B -2 B -3
0
Vents
a �
0 2 -3' X 94' Cells with >3' Spacing a
0
�o
292 Property Line
" Wisconsin Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page of
Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and CrQ►
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Pa r c el I.D. #
APPLICANT INFORMATION - Please pri a�i� vi wed by Date
Personal information you provide may be used for secon ry��i5ses (Pd cy Law, t. 15, (1) (m)). I f j21 0 Z
Property Owner t Pro erty Location
,_ P C r/ J� -_� GovtttLot 5 1/4 S W 1 /4,S Z T 30,N,R f� E (or Ao!
Property Owner's Mailing Address ; Lot # i Block# Subd. Name or CSM#
I SJ t
_ver ree-) ver"
city tate Zip Code Phone Nuir" Nearest Road
ty P ' City E] Village Town
140 ' p l c� l UI Lo i '1 � J`t I `.� 1. dcse� f ov lC r -
RA New Construction Use: [14Residential / Numb? rooms Addition to existing building
Replacement ❑ Public or commercial - Describe: �^
Code derived daily flow (D 0 G gpd Recommended design loading rate J bed, gpd/fl �_trench, gpd/ft
Absorption area required 40 bed, ft o 0 trench, ft Maximum design loading rate • 5 bed, gpd/ft 60 trench, gpd1ft
Recommended infiltration surface elevation(s) q� 7U ft (as referred to site plan benchmark)
Additional design /site considerations 9� - y
Parent material /--) o 4::W a S " I Flood plain elevation, if applicable i��t9 ft
S = Suitable for system Conventional Mound In- Ground Pressure I AT -Grade System in Fill Holding Tank
U = Unsuitable for system [$S ❑ U S ❑ U Vq- ❑ U (�PS ❑ U ❑ s F U ❑ S
SOIL DESCRIPTION REPORT NtjOWL-AA4i
Boring Horizon Depth Dominant Color Mottles Structure GP
g Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
t L Si f( l vp 5 •S
Ground .�j �� y (� L. 1rn
elev.
r
Depth to
limiting a f
factor
in. •
Remarks:
Boring # ,
0-1 31z �' Z m�,- �, u S .s
x..
19 914
Ground
--
�•
Depth to
limiting
r
fact
_$$.-in. Remarks:
CST Name (Please Print) gnature Telephone No.
M
u mfx k ec Address Date CST Number
i
a � t
SOIL DESCRIPTION REPORT
PROPERTY OWNER / Page — 4 - of
PARCEL I.D.# /10 T /
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GeDM2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
g 3 r31 s. Zwioa r C
UNA Z. t� rL( — s,, 2 S
Ground SL 2mobk M� i LS •�
elev.
Depth to
1 /
limiting I ci t
f actor (
O in. I/J co �•
Remarks:
Boring #
-: 3 5 Z c�
Ground
elev.
Depth to
limiting
f or
�in.
Remarks:
Horizon Depth Dominant Color Mottles Structure GPD
Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring # 1Y)�f C
e
.. t r 1
;.
Ground
elev.
ft.
Depth to B
limiting
� fa for
tn • Remarks:
Boring #
Ground
elev.
Depth to
limiting
factor
in. Remarks:
SBD -8330 (R.9/98)
PAGE__,S_OF_
NAME O ucA LOT# 16 LEGAL DESCRIPTION ,5 !; ' /4 S«i' /4,S x kT 3a,N,R 18" E (or)(i)
/
SCALE: 1 "= l� D s
BM 1 ELEVATION U
BM 1 DESCRIPTION - kye6.E (? PvG W//at
2 ELEVATION q 6 1 r J
BM 2 DESCRIPTION f0_ 1 L pycP,'V-F- Wj I4f k `
SYSTEM ELEVATION Y0
ALTERNATE ELEVATION ! CF yd x
CONTOUR ELEVATION
�1
3p
SIGNATURE DATE
l
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Effluent fitter 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 aitemate 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\
I
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer P. C. Collova Builders, Inc.
Mailing Address
P O Box 489 Somerset, WI 54025
Property Address 1
(Verification required from Planning Department for new construction)
City /State 42&,J CiChft -h Parcel Identification Number o2Co- 113s'- lb --�oC. 9�
LEGAL DESCRIPTION
Property Location If %,, 5 i�, � � � Q
/,, Sec. T N - R W, Town of �" � tiol {Yl[mCQ
Subdivision Fy A �
�� Lot #
Certified Survey Map # Volume , Page #
Warranty Deed # 6 a 5 Volume $ lc Page #�
Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ 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, restrictedplumber or a licensed pumper verifying 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.
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 a ear exp' tion date.
W NRITJkl# 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
th perty n ed abov , by virtue of a warranty deed recorded in Register of Deeds Office.
u 2
GNA OF APPLICANT DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department."""
** Include with this application: a stamped warranty deed from the Register of Deeds office
i
a copy of the certified survey map if reference is made in the warranty deed
I
l
FROM P C COLLOVA BURS, INC PHONE NO. 715 549 5911 Jul. 21 2001 01:54PM P1
02 "06700 71TE 11:J3 Fail 716 384 U&T 'MISTER OF DM QIIO1
6Yn7 'f<tuk6FtiM13CdMSD►►�.gc ��' o l
�r
'11th Dad, mi,ad han4am 6avea. d: tierrfefc f,
Orma. and P.C. Cask w gutWent, tar., r NlkAreaota Ca DoratlT
QV
J .
Qr�aer, kr a •ntatbb ¢aoctdesrtpe, conveys 10 QUA= tha
topowinY drGerl6ed cr;d estaer h ! Cry ...r�� �MY,
SfAa 4r W heonsle cwmem spree k aca6ad, p1mo am* sddmrd=P
bwfc a a4,
@t 80 Quarter of the 30A;bWru Cmrfer (SE '4 of f W 141 of y aahm liras
2 isnYUiu�natllwia�olSrtim29 .tx1i[NOrrtwrtYoll4thtAvm4¢ � o SOU h le!f
', ALL to it)Tt, it+ng. tl Ate &. C+bht Ca,mey, R'kovneMu µ�.�1 t►rs �� 0 t V
BXCvrPmtalitAofs& 6 =23dwaaladatrMlowacomismoi+ErtN k�7' 0
n* iht
ti4 aon+er of raW tieetiea tdo tlwaw xtuttr � degra e6 nrhxaae Wat oa
Noe of fold Ba.tieu 13; bra f04 thrice Srarh dl dagM 23 rakk=
was a n &dg *0144 6e16 dp asy.ae Od a3taa Fart t2w fto dlrau 2aFmi io cxw 4 �) o�saa-0ur
N"* l de�tae?7 miwuae E lIf! � s d to w:A N4eih tiie;yramq Neetb y9 lrsd Iept�lflo�ua NarWtiltM}
tlAyenl D6 arlAma/ Weft ao aid N Ya.6i7 feu �e iGp of �sjininj .St TWO u eat 1ae�ue p
Cry Coaaly, 1Victcraln. ii0 dt rori
Rica(Nlene t0 aartsatteu E:sraraents. icaltitase:a and e?r;t�,fw:�y otrvaxa. L � �
AL'THINTICATIO>v tCxMOWLYrit:aei AcT
sipauc,Nal Unw, J, owiA STATE OF VISCt}WMW
Codaty )
awA.rgaud a e)y�,of LIUV 10tZ Ti„4o -,4r "me tmfars me dtb _ day of
TTTL - LIFURn STATE BAR OF W11CONSIM a ,a. 4aawa to b. tL. perwa(s) wtm aKSCticad v c W royoi
Orsa +warda.a
toetramoin aaa aaltaaW k taea d,c ean.� "�
'hi &4TRumm WAS J:SLU7H!) av
rosary ftwi4 3wto atwleeoae,d +
� - - - �•.^"� m r;anc,;,.it,a 4 ytnuawx� (If aot, sms sapitat)oF our
��� mS' M �aFaagcrri 4< ratroW.dpa, dedl eA M1II ANWiYi�1 - - _ d
�Nrerac rpm" tyate(/LlMYMmsi M91be"WV KiW Witt =dIWAn.
W AHMHTY ut 4A Mm Na. s. 1Np
I�
I
TEMPORARY CUL —DE—SAC
EASEMENTS (TO BE REMOVED UPOr
UAPLATTED LANDS NORTHERLY EXTENSION OF ROAD)
NORTH LINE SE1 /4 —SW1 /4 SECTION 24
N89'40'38 "W 1300.25'
314.31' b 9 .00 T 00
-- 942.25' -- 1 LOT 19 LOT 10 0 44719 SO. FT. 48764 SQ. FT.1 moo 0 1.03 ACRES 1.12 ACRES �o
JOINT — JOINT
LOT 18 � S89'40'38 "E 292. 0'
I I
' X48004 S FT. N LOT 11 1
1 10 ACRES o bl S
1 ' 0 43800 SO. FT- 0
r' 1.01 ACRES 1 to i in
` 12' I TILITY
I 1 EAST MENT I I
1 I Q I
N85'59 48"W 245,99 S89'40'38 "E 292. 0' H g
I
LO�T17 o LOT 12 I ° { �N I0
2 , 21 44?66 SQ. FT.
43800 SQ. FT.
.01 ACRES n 1.01 ACRES I I I
1 01 '—
I ^ ^ Ip p I
w I z 1 100 1
` W S 9'40'38 "E 291.80' 1 S89 292.60
I I
Nin I ' LOT 13 1
0 0 0 I LOT 16 p 43800 SQ. FT. I
cc G
I N 45746 SO. FT. 1.01 ACRES i d I �
100 1 .04 ACRES � BENCH MARK TOP OF
33' 33' 1 3/4' IRON PIN ELEVAtION 33' 33' —
22 18 996.51 (ASSUMED) i I I I
' \ S 9'40'36 "E 290.01' S89'40'38 "E 292. 0' ,
_- I
\ o LOT 14 �
L 15 s�� '
x 45846 SQ. FT. o
\ 50166 SQ. FT. 1.05 ACRES
\ \ \\ \ 0 1.15 ACRES O
O, I I I
JOINT 19\ -
,\
JUN '40'38"E M — — S89'41
.al► 16 152. 1' r1
gym, �; \ _ — 141 ST AMNUE
3
S89'4W38`E 51 t
N6619'36 W sr 15 0 55.92' 165.00'
i� 63.3W \ \ 13
HWE= \ '587.0 .�� o.
IM
i
dT 156.55' •� � L0�
� �03 / LOT 2 L
,
11 12 10 8090 FT. 64098 SO. FT. _c" 613
,p1 1 X86 ACRES 1.47 ACRES 1.4
S7gy1,1� i j r t x` 11.
l ` ` >>3 fig.
o
I