HomeMy WebLinkAbout026-1135-25-000 Wisconsin D'Nrtmgnt of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Buildkig Division
INSPECTION REPORT sanitary Permit No:
404928 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 - 1135 -25 -000
CST BM Elev: Insp. BM Elev: BM Description:
TANK INFORMATION 1 ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic �� Benchmark 2 L
Lfb
Dosing Alt. BM IV 102 • Ifo
Aeration Bldg. Sewer r
Holding — _
St/Ht Inlet `},30
�
TANK SETBACK INFORMATION St/Ht Outlet �. �'b� R • `f5'
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic t �r r _ Dt Bottom
� D
Dosing Header /Man.
Aeration Dist. Pipe Se
Holding Bot. System
Final Grade
PUMP /SIPHON INFORMATION 11
Manufactur Demand St Cover 1
PM �,1� IC0. 0
Model Number
TDH Lift F Loss System Head H Ft
Forcemain ength a. Dist. to Well
SGI ABSORPTION SYSTEM 6 v $
RE H Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
3 b2•� � L
SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufact n
INFORMATION CHAMBER OR . C� —
Type Of System: t f UNIT Mo 1 umber.
DISTRIBUTION SYSTEM E+
Header/Manifolss IDistribution x Hole Size x Hole Spacing Pipes) Vent to Air Intake
- ` —� 2-5
Lengt Dia u Length Dia Spacing - I 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 No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #11: 7 17- / 2007 Inspection #2: *�
Location: 1410 1443rd St New Richmond, WI 54017 (SE 1/4 SW 114 24 T30N R! 8W) Evergreen Overlook Lot 25 Parcel No: 24.30.18 955
1.) Alt BM Description = �(pQ a��t1 �,,,,Q %e+► . �f(
2.) Bldg sewer length = 4/' " ns% �" A o -yLf_ � r
amount of cover - I - P�'-�►r•C
„ Lo (,.fob $. D : 9Y.0,
- -y- -. - -- - T
Plan revision Required? �: rz Yes r No i 0
Use other side for additional information. Z?
Date Insepctor's Signature Cart. No.
SBD -6710 (R.3/97)
i
Safety and Buildings Division County nn
201 W. Washington Ave., P.O. Box 7162 �► 1, 1- D `�
l fisc ' onsin Madison, WI 53707 - 7162 Site Address
� ,
Department of Commerce * L #o J
Sanitary Permit Application Sanitar Permit Number
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if R evision
ma be used for secondary purposes Privacy Law, sl5. 1 (m
I. Application Information - Please Print All Information State Plan I.D. Number
Property Owner's Name �4 arcel Number O ✓
C.
Property Owner's Mailing Address �Po((erty Location
C 1 ? 7 j .. 14 -A S � T� N.
City, State Zip Code + :Ptrone umlZ i, um Block Number
bivision Name CSM Numpf�/
II. of Building (check all that apply) r i fW 4 ❑City
2 Family Dwelling - Number of Bedrooms +- S []Village
❑ Public/Commercial - Describe Use hip
❑ State Owned Nearest Road
III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line A if applicable)
A For County use
w 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to
S stem Tank Only Existing astern
B. ❑Check if Sanitary Permit Previously baled Permit Number Date Issued
IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use)
44on - Pressurized In- Ground 2111 Mound 47 El Sand Filter 50 11 Constructed Wetland
22 Pressurized ln- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip
45 ❑ At -Grade 46 ❑ Aerobic Treatment ❑ 4ecirculating 30 er -3'S G
V. D' rsaadMmeatment Area Information:
Design Flow (gpd) Dispersal Area Dispersal Area Soil A is don Percolation System E• }ev tion Grade
Required te(Gals./Day Sq.Ft.) (Min./Inch) ��. 9 j �3 Z Elevation
/ P 1 cam'
VI. Tank Info Capacity in Total Number Manufacturer Prefab r I Fiber Plastic
Gallons Gallons of Tanks Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank
Dosing Chamber LAI
VII. Responsibility Statement- I, the unde responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber' cure MPI PRS Number Business Phone Number
2Z- 9 66
Plumber's Address (Street, City, State, Zip e)
VIII. Cotmt /De artment Use Onl
,Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps)
Surcharge Fee) a70 r
El Owner Given Initial Adverse �
Determination
1X. ontlitions of Appr va ors or Disapproval
nkW R F * / a ��� U
Attar oORp oni th em on not less than auz x 11 inches In dze
SBD -6398 (R. 05101)
PLOT PLAN
PROJECT P.C. Collova Builders Inc. ADDRESS 705 Ctv Rd E Hudson Wi 54016
SE 1/4 SW 1 /4s 24 /T 30/ , /R 18 W TOWN Richmond COUNTY ST. CROIX
2/26/02 3
MPRS Shaun Bird 226900 DATE BEDROOM
CONVENTIONAL XXX IN -GR ND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE •9 ABSORPTION AREA 514 # of chambers 30
BENCHMARK V.R.P. Top of Steel Post ASSUME ELEVATION loo' Filter Zabel A -100
❑ BOREHOLE O WELL - H. R. P. Same as Benchmark
SYSTEM ELEVATION 95.5/94.3/93.2
Alt. BM Top of Lath @ 100.5'
Property Line
80'
3 -3' X 63' Cells with >3' Spacing B-3 , 51 ST 81 pro 3
30' ri Bedroom
Vents House
Vents B.M.
80' 20' 25'
60' B_-1 46t. B,NI.
B-2
9%
J Slope
60'
C4
M
Highwater Area/Pond
Xew:
Vent
> 12" Sidewinder High
of Cover Capacity Leaching
Plans Designed Using Chamber
Conventional Powts 6
Manual Version 2.0 6' Long
Grade at System Elevation
34„
4 PLOT PLAN
PROJECT P.C. Collova Builders Inc. 1 ADDRESS 705 Ctv Rd E Hudson Wi 54016
SE 1/4 SW 1 /4s 24 /T 30 /N /R 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE2 /26/02 BEDROOM 3
CONVENTIONAL XXX IN -GR ND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE •9 ABSORPTION AREA 514 # of chambers 30
BENCHMARK V.R.P. Top of Steel Post ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL IH.R.P. Same as Benchmark
SYSTEM ELEVATION 95.5/94.3/93.2
Alt. BM Top of Lath @ 100.5'
Property Line
AL
vJ �-
80'
3 -3' X 63' Cells with >3' Spacing B -3 $, ST 8 ' P 3
30'
Bedroom
Vents House
Vents B.M.
80' 20' 25'
60' TB-1 --,
B-2
9%
Slope
60'
b
M
Highwater Area/Pond
�1
Vent
> 12" Sidewinder High
of Cover Capacity Leaching
Plans Designed Using Chamber
Conventional Powts 16"
Manual Version 2.0 6' Long
34" Grade at System Elevation
i
!1 r
M.Acoresin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must <.—
rO I7C
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. r p�f "� v � (p 0 Re iewed by Date
Personal information you provide may be used for secondary purposes ( ri aw, s. 15.04 (1) (m)). M Z Z
Property Owner LLC Property Location %
d/ v Govt. Lot 114 J4 S T N R /� / E( r) W
Property Owner's ailing Ades Lot # Block # Subd. Name or C M# ))
Ci State Zip � / Code l Phone Number ❑ City 0 Village Nearest Road
ew Construction Use Residential / Number of bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - Describe: /I
Parent material Q Flood Plain elevation if applicable 11�J fT ft.
General comments
and recommendation ! / � • � �/� / �'
F 1-1 Boring # E] Boring g
Pit Ground surface eleG /ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2
X9/3 Z /
Boring #
❑ Boring
Pit Ground surface e Z ft. Depth to limiting factor 7 --m 7� jn
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I *Eff#1 *Eff#2
I -1 g 3�Z G r j --- '' , � -
z s -3d 6
J '
i
CA ZD
Z
' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
' Ic CST Name (Please Print � Signature � C Number
Address Date Evaluation Conducted Telephone Number
SBD -8330 (R07 /00)
i
Property Owner Parcel ID # Page of
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 /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
Boring #
F
E] 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 GP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
F I I T I I
F-1 Boring # ❑ Pit Boring
❑ Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
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 -264 -8777.
SBD -8330 (RA7 /00)
r Soil Test Plot Plan
Project Name P.C. Collova Builders Inc. Shaun B'
Address 507 Cty Road E
Hudson Wi 5016 #226900
Lot 25 Subdivision evergreen Date 2/28/02
SE 1 /4 S W 1 /4S 24 T 30 N /13 W Township Richmond
Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Steel Post
System Elevation 95.5/94.3/93.2 *HRPSame as Benchmark
Alt. BM Top of Lath @ 100.5'
Id Property Line
0 '
B -3 Pro 3
99' 30 Bedroom
98 2 House
B.M.
80' 97' 20' 25'
60'
B -2 B -1 Alt. B,M.
9%
Slope
60'
M
a�
Highwater Area/Pond
a
0
Wisccnsk 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 C r o l
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
APPLICANT INFORMATION - Please I ff midrmatlo&., Reviewed by Date
Personal information you provide may be used for se aiypi6rposes Pvacy Law, s. ISA4 (1) (m)).
Property Owner r" ;, ' Property Location �i
pay C �bva ; 7.
Govt. Lot S � 1/4,1/4,S z y T 30' ,N,R /, E (or)
Property Owner's Mailing Address , i Ll Lot Block# Subd. Name or CSM#
C ka C i Ic
City State Zip Coded Pho &FiCE City ❑ Village own Nearest Road
_.
EPNew Construction Use: residential / Number of bedrooms `'7� Addition to existing building
❑ Replacement LI Public or commercial - Describe:
Code derived daily flow gpd Recommended design loading rate +� bed, gpd/ft trench, gpdfft
Absorption area required 7 bed, ft 7_C trench, rft^2� --1 Maximum design loading rate bed, gpd/ft 9O trench, gpd/fl
Recommended infiltration surface elevation(s) • -� v _ft (as referred to site plan benchmark)
Additional design /site considerations C/7. o
G ( /
Parent material U "
-u a S "1 Flood plain elevation, if applicable i1J — ft
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U = Unsuitable for system [PS ❑ U fia ❑ U 6? S ❑ U ` ❑ U ❑ S 14bu ❑ S to U
SOIL DESCRIPTION REPORT
Horizon Depth Dominant Color Mottles Structure GPD/ft
g Texture Consistence Boundary Roots
�Mr
u in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
2 cs lv� 5
Z ice_ tDyrL4 3 ?- rn -Pr �s _ •5 '.�
Ground 3 - d r t t j� r 5 ✓
elev.
ft. L5
Depth to
limiting
factor
in.
Remarks:
Boring # i 1� _'i SI 1 2 ry abk 4'r C 5 ) V-C' �o
2 Z l4 - J b r `i 13 -- Si 1 a cjk - fr' c. 5 S
2
3 3� -0 10 yr 14 1t f v
Ground 1 4 k -4 t ), 10yrz IlG --- L.5 j C S
elev.
ib . ZS ft. ;
Depth to
limiting
factor
IDI in. Remarks:
CST Name (Please Print) Signature Telephone No.
Sr ho 01,S)zLI 7- Vag
Address Date CST Number
21/3 S) S+, SD"LY -L L 5 q 6 ZS (11 -C6 253 n9
SOIL DESCRIPTION REPORT ! .
PROPERTY OWNER Page of J
PARCEL I.D.# A0
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench
Z. S t r S f vE
�mckb G5 .
Ground 3 t _ lO ir y h m s 0 C5
elev.
/o► do tt. y -t�� ) U/ 3I 1 5 m c s
Depth to
limiting
factor
ia in.
Remarks:
Boring # j
f u...
Z r tLl 1 6 r X13 6d Zarb mfr = �-
3
(q-LO 1 v V r j m_S Osq ME c5 �
Ground '4 -cri L S 1"Y) �+ C S 1 ,• p'
elev.
Depth to
limiting
factor
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots
Boring# p/
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I Bed , Trench
o�3 lbyr,312, rn -cr
Z 43 Id 1/_3 —
mfr c
Ground c,2 -7 I b' L._ I m m cS — .7
elev.
/p /. 76 ft.
Depth to
limiting
� f ctor
' Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in.
Remarks:
SBD -8330 (R.9/98)
PAGE S OF
NAME rC3QJG� LOT 4 e) 5 LEGALDESCRIPTIONSE ' /SN' /o,S ,N,RJ E(or '
SCALE: F'= F30
BM 1 ELEVATION /W.6
BM I DESCRIPTION }z 1c.�,oT �.r /lard
BM 2 ELEVATION q IS , 0 3
BM 2 DESCRIPTION o L ev `p pe. Wl lath
1
SYSTEM ELEVATION g , sn
ALTERNATE ELEVATION q7 00
CONTOUR ELEVATION
•gt�►1 N
8 r^z . h
a� • a3
i
i�
SIGNATURE DATE G �y
Maintenance and Contingency Plan for a Septic System
in PI
Maintenance an
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
s4
Shaun Bird #226900
S'r CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner /Buyer ( IU 6 i j r1 S _3� L.
Mailing Address — 70 , 0v • C' / /v4su.0
Property Address J 1 / V m
(Verification required from Planning Dcpartrnent for new construction)
City /State lV UA) 1hd fyl i e] Parcel Identification Number
LEGAL DESCRIPTION /� �T
Property Location ' /,, ' /,, Sec. `4 . T W N -R�W, Town of
Subdivision __'F (9A 0 A QQ n O LA" 160 Lot// .
Certified Survey Map It , Volume , Page It
Warranty Deed # ... 5 a , Volume I l b Page U
Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its prematurcfailure 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
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -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.
& d&&O 2 /24/02 —
SIGNATURE 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 owncr(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
a PO W,
SIGNATURE Or 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
a copy of the certified survey map if reference is made in the warranty deed
FROM P C COLLOVA BLDRSr INCPHONE NO. : 715 549 5911 Jul. 21 2001 01:54PM P1
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I o LOT 23 j o 0 1 LOT 16
lit j° N i 44195 SQ. FT, I r z I
° 4 SQ. FT. _ .01 ACRES 100 11.04 ACRES
ID z o 1 I 100'
1
Io O 1 33' 33'
Ito w 22 18 I
S8T20'05' 292 16, , \ s8 '40'38 'E 290.01'
9
13 co 0) LOT 24 ` \\ \ �� LOT 15
ONO 4 47641 SQ. FT. \\
1.09 ACRES \ 50166 SQ. FT.
� \� \ 1 1.15 ACRES
p i \
z N \ JOINT 19 � 4►,�
N88'31'00"W 359.26' ?
N ti s�
�• .�
LOT 25
127514 SQ. FT. �; ? �*• h ��°�"
1ri N66WWI
N 2.93 ACRES �i ', V ,
HWE 98 7.0
4�
DRAINAGEENT / 12
" .f. 11 Z 10
NOV
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N86'20'38 "E S ..., r,�► / / 6� i' O
122.55 6675 60 O j c ^
LOT 26 f wN
100597 SQ. FT.
2.31 ACRES ( �. /` OUTLOT 1
in
N CQ 82601 SQ, FT.
( W 6.49 ACRES
) 1215.44
\ 2 5.69/'
.It6 y WETLANDS
-
;Na9'48 s�2 I o o •"' •� r
32 � HWE 98 %.0 �' ►� o
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o .o. N �1•�' 15 2
O O \. ,r + Water
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_ � O •s plc . !� i / , � .
SEE DETAIL A 27
0
ND 3 ALUMINUM MONUMENT
CORNER SECTION 24 •� 6� r,��r