HomeMy WebLinkAbout026-1135-16-000 in Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
sin
Division
and
INSPECTION REPORT Sanitary Permit No:
430193 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan lD 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- 1135 -16 -000
CST BM Elev: Insp. BM Elev: BM Des tion: Sectionfrown /Range /Map No:
OD / 0 d -61 ! b v /"t.�.� t�� 24.30.18.946
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic _ae Benchmark
!�
D -3TJO �p
Dosing t� Alt. BM 6- r
tom Ob .
Aeration Bldg. Sewer -363
�- L 1 75-7
Holding St/ t Inlet A / 5GH t
Outlet Q `
TANK SETBACK INFORMATION S ck 4 i0
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
�a ►-4
Septic ��l o r Dt Bottom �-
Dosing d Header /Man.
Aeration Dist. Pipe 7 (o
Holding Bot. System (r , c f
Fi de
PUMP /SIPHON INFORMATION
Manufacturer Demand St Cover ,
GPM 1'CS S '3,o / 00. 3
Model Num ✓fir t
TDH Lift Fric ss System Head TDH Ft
Force Length Dia. ist. to Well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width I Le #th , No. Of Trenche� PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/Lo JBLDG IWELL LAKE/STRET LEACHING Manufa `
INFORMATION CHAMBER OR i
Type System: 1 UNI
,f Model Number:
J
DISTRIBUTION SYSTEM 6vt F�tdS
Heade a Distribution x Hole Size 7Hole pa cing Ve to it Intake
9 1� D I 's) p 9� 1 3 Len th D7,� Len th Dia S acin
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 ,,r i, YesNo [ ]Yes i I No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:/ Inspection #2:
Location: 1415 143rd St New Richmond WI 54017 (SE 1/4 SE 1/4 24 T30N R18W) Evergreen Overlo Lot 16 Parcel No: 24.30.18.946
1.) Alt BM Description
2.) Bldg sewer length = + [
- amount of cover
Plan Use other l side for additional information. No
SBD -6710 (R.3/97) Date Insepctor's Signa re Cert. No.
Safety and Buildings Division County `
201 W. Washington Ave., P.O. Box 7162 S ta Perm i t N (to be filled in by Co.)
Madison, WI 5370'7 - 7162 0 93
.9consin (608) 266 -3151
Department of Commerce State Plan I.D. Number
Sanitary Permit Application
In accord with Comm 83.21, Wis. Adm. Code. r personal w s15 Dion yo ) pro t � D Project Address (if different than trailing address)
may be used for secondary purposes , (1
I. Application Information - Please Print All Information 1445
_. Lot # Block #
Parcel #
Property Owner's Na me 8, °
Property Location
Property Owner's M ailing Address
t /4, Section
111 Zip Code Phone Number
Ciry, State r �.. _ = (circle � )
�--1 T 10E
I Type of Building (check all that apply) °� 0`4 `� Subdivisior. Name CSM Number
> 1 or 2 Family Dwelling — Number of Bedrooms
Public /Commercial - Describe Use
'- 1 � Q - I iJCity,i��Vill e�ownship of /
i !! Stale Owned - Describe Use p
III. Type of Permit: (Check only one box on line A. Complete line B if applicable) C)7_6 C (
' ��
3S- b -� •
9. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only
Other Modification to Existing System I
B. ❑ Permit Renewal ❑ Permit Revision Change of ❑ Permit Transfer to New i List Previous Permit Number and Date Issued
Before Expiration
Plumber Owner
IV. Type of POWTS System: (Check all that apply) ❑ Single Pass Sand Filter
Non - Prerized In- Ground Mound > 24 in. of suitable soil L� Mound < 24 in. of suitable soil El At -Grade g
Constructed Weiland ❑ Pressurized In- Ground [I Holding Tank peat Filter Aerobic Treatment Uric [I
Recirculating Sand
Ll ssu �
Recirculating Synthetic Media Filter aching Chamber El Drip Line J Gravel-less ipe ❑Other (explain) _ ::5 ,
C "'
V. Dis ersal /Treatment Area Information: _ r
Design Flow (gpd) I Design Soil Application Rate(gpds Dis ersal Area Required (sf) Dispersal a Proposed (s�
System tevatio ,
S V I Num Manufacturer Prefab Site I S. el Fiber Plastic
VI. Tank Info Capacity in Total . ber Concrete Constructed Glass
Gallons Gallons of Uruts
New Existing
Tanks Tanks f�
Septic or Holding Tank
Aerobic Treattnem Unit `
� I
Dosing Chamber
o ibility for installation of the POWTS shown on the attached plans.
VII. Responsibility Statement I, the undersigned, a resp
MP /MPRS Number Business Phone Number
Plur's.Na me (Print) Plumber's Si re /` /r q L1Lr y l
Plumber's Addre ss (Street, C State, Zip f� /
VIII. Count /De artment Use Onl
Sanitary Permit Fee (includes Groundwater Dace Issued i Issuing ge Sign`ture (No ps)
Approved ❑ Disapproved Surcharge Fee) 2 A� 61 240 3,
❑ Owner Given Reason for Denial J V
IX. Conditions of Approval /Reasons for Disapproval l
_Y11 t�
Attach complete plans (to the County only) for the system on paper not less than Slit x 11 inches in size
PLOT PLAN
PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025
SE 1/4 SE 1 /4S 24 /T 0 /R 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE7 BEDROOM 3
CONVENTIONAL )00( IN- UND PRESSURE 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. Top of Power Box gItA ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL •H.R.P. Same as Benchmark
SYSTEM ELEVATION 94.0/93.9 3.5' below grade
(Alt. BM := Top of Telephone Box @ 100.1'
Plans Designed Using
Conventional Powts
Vent Manual Version 2.0
ALo Standard Biodiffuser .—
Leaching Chamber
with 31.1 ft2 of Area
"
314 Grade at System Elevation
Not enough slope to
establish contour lines
Pro 3
Bedroom �—
Vents House
ST
10' B- 9 <P 15'
50'
2 -3' X 94' cells with >3' spacing
0
� B -3
90' 5'
Tested area has
0' <1% Slope
2 ' B ents
* Alt. B.M.
B.M. 143rd St.
PLOT PLAN
PROJECT P.C. Collova Bldrs InPO/R ADDRESS P.O. Box 489 Somerset Wi 54025
SE 1/4 SE 1 /4s 24 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 7 BEDROOM 3
CONVENTIONAL XXX IN- UND PRESSURE 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 Power Box 5' ASSUME ELEVATION loo' Filter Zabel A -100
❑ BOREHOLE O WELL «H. R. P Same as Benchmark
SYSTEM ELEVATION 94.0/93.9 3.5' below qrade
(Alt. BM := Top of Telephone Box @ 100.1'
Plans Designed Using
Conventional Powts
Manual Version 2.0
kL—Gr Standard Biodiffuser
Leaching Chamber
with 31.1 ft2 of Area
3 4 at System Elevation
Not enough slope to
establish contour lines
Pro 3
Bedroom
Vents House
ST 15'
10' B-
�, 50'
2 -3' X 94' cells with >3' spacing
B -3
90' 5'
Tested area has
pn nts <1% Slope
143rd St.
A
i.
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County J 2 r D
include, but not limited 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.
Please print all information. evie by a
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). l 0 3
Property Own /J Property Location
vl /j1 ✓ate � �,Q GovL Lot jI"' 1/45q_/1/4 SOT N R E (r) W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
�-
.� a
City State Zip Code Phone Number [] City ❑ V lage , own Nearest Road
tc� ol ( ) ; y
ew Construction U642IResidenfial / Number of bedrooms Code derived design flow rate GPD
❑ Replacement Public or commercial - Describe:
Parent material /� �.y Flood Plain elevation if applicable ft.
and recommendati S� .sue.,, EIVED
MAY 2 8 2002
X COUNTY
Boring #
Boring ZONING OFFICE
Pit Ground surface ele4I� ft. Depth to limiting facto 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. � - Effffi 'Eff#2
W C4
at' �1�• o
sm - - 1 A 2 • `{
r } Boring # ❑ Boring
S Pit Ground surface elev. 22 _ 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 'EB#2
Effluent #1 = BOD > 30 1 220 mg/L and TSS >30 < 1 ' Effluent #2 = BOD < 30 mg1L and TSS < 30 ng/L
CST None (Please Print) gnature CST Number
r� l/
Address Date Evaluation Conducted Telephone Number
Property Owner , Parcel ID # Page of
Boring # Boring �
a ❑
JZ 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
�31L
F-1 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/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
F-1 ❑ Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit
Soil Application Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDM
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 nrg/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 -264 -8777.
SOD -8330 (R.&W)
Soil Test Plot Plan
Project Name P.C. Collova Builders Inc. Shau
Address 705 cty rd E
Hudson Wi 54016 TM #226900
Lot 1 6 Subdivision Evergreen Date 3/31/02
SE 1/4 S W 1/4S 24 T 30 N /R W Township Richmond
D Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation (, 00 ft. Top of Power Box = g "* I
S stem Elevation 94.3 *HRpSame as Benchmark
Alit. BM : Top of Telephone Box @ 10 0.1'
Not enough slope to
establish contour lines
Pro 3
Bedroom
House
10' - 50'
a
B -3
90' S'
Tested area has
0' 25' <1% Slope
B -2
;20' * Alt. B. M.
B.M. 143rd St.
I
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
OWNERSHIP CERTIFICATION FORM
Owner/Buyer P. C. Collova Builders, Inc.
Mailing Addrehs
P O Box 489 Somerset, WI 54025
Property Address v4v' 3� I/
(Verification required from Planning Department for new construction)_ SA
City /State Neu parcel Identification Number
LEGAL DESCRIPTION
Property Location %,, 56- y., Sec. a�, T -3 DN -RJW, Town of F)'ick YY1
Subdivision II�Q.I Cat Q 0_r� �V C7 Lot # if .
Certified Survey a # �- — -
Y P Volume � , Page #
Warranty Deed # �Q o� �� Volume l Page # 02
Spec house yes ❑ no Lot lines identifiabl ❑ no
SYSTEM MAINTENANCE
Improper use and maintenanceof 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, journeymanplumber, restricted plumber 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.
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
da e e year expira . n date.
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 perry scri above by virtue of a warranty deed recorded in Register of Deeds Office.
llG / 7
�90NATLMTOF APPLICANT DATE
* * * * ** Any information that is mis- represented mayresult in the sanitary permit being revoked by the Zoning Department- * * * * **
f .
** Include with this application: a stamped wai anty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
i
FROM P C COLLOVA BLDRS, INC PHONE NO. : 715 549 5911 Jul. 21 2001 01:54PM P1
Olf'03i00 TUE LI ;33 FAX 718 364 4887 RU; I $TER OF DEED$ Q001
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TEMPORARY CUL
EASEMENTS (TO
� Cp
NORTHERLY EXT
UNPLATTED LANDS
e e e-n /U� NORTH LINE SE1 /4 -SW1 /4 SECTION 24
( N89'40'38 "W 130
-- 292.00
335.94' 314.31'
-- 942.25' -- I
LOT 20 N LOT 19 o LOT 10 I ��
44796 SQ. FT.
1.03 ACRES 3 44719 SQ. FT. ° 48764 SQ. I 1
o 0 1.03 ACRES tO 1.12 ACRES S
��• N p� I JOINT
S89 "E 292. 0'
FT. 18
L
OT
tES a
\ 8004 S O. FT. c o
1 LOT 11
i o
/ X .10 ACRES o 43800 SO. FT.I
1
1.01 ACRES I
1
12' , I I ii ITlL1T r
N ' 45.16
I I
N85'59 / 48 'W 245.99' o, S89'40'38 "E 292. 0'
24 _,_ 22 � I
2 � \ LOA 17 o LOT 12 1
SQ. FT. � I 44 06 SQ. FT. 1
`� 0 ' 2t F�.
ACRES
�01 ACRES 4 1 01 A RES I
It p
0 1
r w 0D to I zz 1100
WE 292.00' do W
S 9'40'38 "E 291.80' I S89'40'38 "E 292.60
co I mom I 1 ' LOT 13 1
23 o o 0 1 LOT 16 43800 SQ. FT.I
b Ix b tD 1.01 ACRES I
SQ. FT. I 0 ¢ °z Ito 43746 SQ. FT. o to
ACRES I 1 00' Z N 100 1 1.04 ACRES BENCH MARK TOP OF
i
1 33' 33' 996.51R VAtION
(ASSUMED)
,e I I
)5"W 292. \
S 9'40'38 "E 290.01' S89'40'38 E 292. 0'
T 24 �� — LOT 14
) \ LOT 15
SQ. FT. 45846 SQ. FT.
1 ACRES \ 50166 SQ. FT. 1.05 ACRES
\ \ 1.15 ACRES
17 O,
JOINT 19 � -
38'31'00"W 359.261 ���.• - S89'40'38"E
16
1 -141ST 1 A VENUE
LOT 25
27514 SQ. FT. ��►• k ° ,/ — - -
�b� N6699'36 'W ?tr ro 15 %' 55.92'
2.93 ACRES ,
/.y► 63.38' \ ` 9�, 13 �J
0
20 - — _/ rl WE _ 9 87.0 4
156.55' k 0 LC
DRAINAGE EASEMENT 12�s 3 LOT 1
y 80907 SQ. FT. 64091
•� t1 1,86 ACRES 1.4;
s