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HomeMy WebLinkAbout026-1411-07-000 \ 2 $ § % j C) a � 2 � $ t(D \ \ \ (D � 2= »// � 0 0 % } CD L ) - � « % k \ co B J z/� R / $ � . ) z k 2 mz- Ja a m w \ k . \ _& ® � � 2 � ) � cy (k $ § § Q \)]k . � f £ % � $ 0 , ) L % ) § o a ) 6 } k k k - # E m - k f 2 a 2 e a / \ 4.; § § k k 2 tt � e - '0 (D co . Cl) 7§ t 1 8 8 § § § o / [ / e Q m f ° a § § f k # \ ƒ i © 0 k k § § \ o co . = 2 3 § ; \ \ > ) ) § / / / & E \ j @ V) k / k d § 2 \ ) \ . f n o 7 \ / ] { § © -� o n ±\ a o z_�e ■ m a « k 0) E $ c k $ IL 5 / J a o 0) J Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division 1 INSPECTION REPORT Sanitary Permit No: 399693 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 Township 026 - 1411 -07 -000 CST BM Elev: Insp. BM Elev: I BM Description: 71 • ,3a CST Ad - Rum v4a C �a.Q,ee TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark I q - Dosing 41 Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet � r TANK SETBACK INFORMATION St/Ht Outlet W 05, IF TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic *> ' r 3� ✓, Dt Bottom Dosing Header /Man. Aeration Dist. Pipe •S'0 $`l•60� Holding Bot. System .S Final Grade IF PUMP /SIPHON INFORMATION 11 . qD Manufacturer Demand St Cover a• �- I K , 35 PM Model Number TDH Lift 1011Q oss System Head TDH Ft Force main Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM RE C Width f Length f No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S GI • ZS } (3 SETBACK SYSTEM TO OI P/L BL / DG WELL LAKE /STREAM LEACHING Man facturer: INFORMATION Type Of System: t CHAMBER OR Model Number 6� t.o DISTRIBUT O STEM �{v fie• P L Header/Mal 1 Distribution x Hole Size Ix Hole Spacing Vent to Air Intake 4 Pip Length Dia Length Dia Spacing 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 #1: /_23 _2&D3 inspection #2: — 7 ­ 7 - ` Location: 1213 117th Al New Richmond, WI 54017 (SW 4 SE 1/4 33 T30N R18W) Duck Pond Lot 7 f - Parcel No: 33.30.18.1011 1.) Alt BM Description v -six - " V�w�. " CD�r J \ r s sly^ 2.) Bldg sewer length = �D I .24 - Q � , tO 2� - amount of cover = 1 � 7,41) a . f ) 3) w - cosy. Q chi 'S Sri $ o5 Plan revision Required? " YeIS r Use other side for additiona tion. Date G9 � �/ Y Inse ct( s signa re e o'}^ SBD -6710 (R.3/97) 4sW l�� (Q � 5 sy .,V PLOT PLAN PROJECT P.C. Collova Builders Inc. ADDRESS 705 Ctv Rd E Hudson Wi 54016 SW 1/4 SE 1/4s 33 /T 3 N/R 18 W TOWN Richmond COUNTY ST. CROIX 5/23/03 MPRS Shaun Bird 226900 DATE E CONVENTIONAL )00( IN -G ND PRESSURE CONVENTIONAL LIFT HOLDING ) TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE "73' iAA HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 121 #' O X$'9 BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE Q WELL *H.R.P. Same as Benchmark Plans Designed Using Conventional Powts SYSTEM ELEVATION 88.7/87.5/86.3 Manual Version 2.0 Alt. BM Top of Telephone Box @ 99.3' 100' 121st Ave 20' B _ Vents 3 -3'X 82' Cells with >3' Spacing 5% Slope 40' B -3 Area of very poor soils, not t suitable for conventional system B- 25 ' Vents 0 ' 50 40' IF Vent Pro 3 Bedroom > 6" Standard House of Cover Biodiffuseer a Capacity Leaching, Chamber 6 Lon g o 34" Grade at System Elevation iF i 40 Safety and Buildings Division County N W. Washington Ave., P.O. Box 7162 sconsin Madison, WI 53707 - 7162 Site Address De artment of Commerce 4 ( z u3 Sanita Permit Application Sanitary Permit Nu n ber In accord with Comm 83.21, Wis..Adm, Code, personal information you provide 399 ( o 3 Check if Revision may be used for s ses Privac Law, s15. I m I. Application Information - Please Print All Information State Plan I.D. No nber Property Owner's Name Parcel Number 33. 3D - 13. 1b 1 l f' � � o�u -`.- " -� b Zb — 1 D1- -- WD Property Owner's Mailing Address Property Location N !� r6 `t; u; 3� T , R B City, State Zip Code ne Nu „, Lot Number Block Number bdivision Now CSM Number II. Type of Building (Check all tha aapply.) City yr "2 Family Dwelling - Number of Bedrooms V llage Public/Commercial Describe Use O State Owned tshi - Li t t � �` �'� Nearest Road III. Type of Permit: (Check only one box on line A. Numbering is for internal use.) (Complete line B, if applicable.) A. 1 w 2 O Replacement System 3 O Replacement of 6 O Addition to For Count Y � Tank Only Existing S stem y use B OCheek if Sanitary Permit Previously Issued Permit Number Date Is IV. of POWT System; (Check all that apply. Numbering Is for internal use.) =C IPressurized - Pressurized In - Ground 21 0 Wound 47 0 Sand Filter 50 0 Constructed We and In- Ground 41 Holding Tank 48 t] Single Pass 52 0 Drip Line 45 0 At -Grade 46 DAerobic Treatment Unit 49 0 Recirculating 30 C3 O ; V. DIspersalflWatment Area Information, b . _51 w ,. - N Design Flow (gpd) Dispersal Area Dispersal Area Soll ApplUdoft Percolation Rate Sy Required Proposed Rate(Gals. Days /Sq.Ft.) (Min./Inch) . Mevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Stebl Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank ti Dosing Chamber 4 VII. Responsibility Statement - l the under, assume elm h' r esponsibility for inataltaU+at of the POW1'3 shown on the attached Plumber's Name (Print) PhunberZSture MP /MFRS Number I Business Phone Number Plumber's Address (Street, City, State, Zip 0 _ pfd z�l x ..5 Viff. Cozen /De ent Use Q 0 Disapproved Sanitary Permit Fee (includes Gro water Issued I i A gent Sigtta (No Stamps) Approved Owner Given Initial Adverse Surcharge Fee) �7 Determination L V ; - • 0 IX. Conditions of Approval/Reasons for Dl pproval l! CUM1,J Attar complete Flaw (to the County only) for the system on paper not less than 81 /2 x 11 inches in size PLOT PLAN PROJECT F.C. Coliova Builders Inc. ADDRESS 5 Ctv Rd E Hudson Wi 54016 SW 1/4 SE 1/4S 33 /T 30 N/R 18 TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 1 /� /02 BEDROOM 3 CONVENTIONAL X00C IN- GROUND PRF�B E CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 670 # of chambers 39 BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION ioo' Filter Zabel A -100 ❑ BOREHOLE O WELL .H R P Same as Benchmark Plans Designed Using Conventional Powts SYSTEM ELEVATION 88.7/87.5/86.3 Manual Version 2.0 Vi Alt. BM Top of Telephone Box @ 99.3' 100' 21st Ave M 20' B _ Vents 5% Slope -3'X 82' Cells with >3' Spacin SyS B- " T 2-D Le Vents 5 ST 25' o3 Bedroom House Vent > 12" Sidewinder High of Cover Capacity Leaching Chamber 16" 6' Long O 34" Grade at System Elevation r PLOT PLAN PROJECT P.C. Collova Builders Inc. ADDRESS 5 Ctv Rd E Hudson Wi 54016 SW 1/4 SE 1/4S 33 /T 30 N/R 18 , TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE N v XXX 1 /,31 /02 BEDROOM 3 CONV ENTIONAL IN- GROUND PR "S � ��E CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 670 # of chambers 39 BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Plans Designed Using Conventional Powts SYSTEM ELEVATION 88.7/87.5/86.3 ,L, Manual Version 2.0 p,�,►„� \ Alt. BM Top of Telephone Box @ 99.3' D �r 100' 1 t Ave M 20' B- Vents 5% e 'X 82' Cells with >3' Spacing • B -3 t 0 B �� S �� Le Vents 5 ST 25' o3 Bedroom House Vent > 12" Sidewinder High of Cover Capacity Leaching nQ Chamber 6' Lon 1 699 Long 34" Grade at System Elevation ° I #�a �M1 .. Wisconsin S-partment 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 C", X 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. Reviewed by Date - A Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). .9Z Property Owners -1 /1 Property Location Govt. Lot �t� 1/4 �� 1/4 S T N R E(3():W I'll Property Owner's Mailing Address Lot t# # Block # Sub . Name or CSM# y� City Ste Zip Code Phone Number ❑ City ❑ Village Town Nearest Ro d � � r New Construction Usee�Etesidential / Number of bedrooms Code derived design flowrigeq °� 5 % GPD ❑ Replacement ❑ ublic or ercial - Describe: r y Parent material ������1 Flood Plain elevation if ap(giGable General comments S / 96-3 and recommendations: G� � `-� ►�'�' �G" c'� C� ' i © Boring # Boring ja 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 � cy- `- <X� ��''J�' -� � �?'� ✓'� 4 � ' I P -11 Boring # ❑Boring rA Pit Ground surface elev. / ' `� ft. Depth to limiting factor 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 'Eff#2 y8 �z y -� .- -_,fig �.�- 1-,� ,. �►� f- a •3 r 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 CST Name Please Print) n _ CST Number Address Date Evaluation Conducted Telephone Number l y Rl -- G�� / /�/' -!/� / �/( vG J r Xj SB -8330 (R07 /00) Property Owner Parcel ID # Page of Boring # t�1 g 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 •Eff#2 z, o- 6 V'- -5 F] 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 `Eff#2 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 '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 (R.07 /00) Soil Test Plot Plan Project Name P.C. Collova Builders Inc. Shau ira\ Address 705 cty Rd E Hudson Wi 54016 M #226900 Lot 7 Subdivision duck pond Date 1/31/02 SW 1/4 SE 1/4S 33 T 30 N /R W Township Richmond Boring QWell PL Property Line, unty ST. CROIX BM or VRP Assume Elevation 100 ft of Steel Fence Post System Elevation 88.7/86.3/87.5 *HRpSame as Benchmark t Alt. BM Top of Telephone Box @ 99.3' M 100' 121st Ave .M. 91? 92' 93' 94' 5% Slope 40' 2 -3 40' B- 5, 50' Pro 3 Bedroom House 0 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 frRer. 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 dificharge 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 falls, determirxa 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 1 1 Shaun Bird #226900 s CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSIiIP CERTIFICATION FORM Owner /Buyer (� H oVA 6 1 A tt S �N Mailing Address 70J �v . / -�y�)s u•v t' L 5 -� 1 Cv Property Address (Verification required from Planning Department for new construction) City /State t-D K hMcylo�- t- Parcel Identification Number Q2 '�'f�� LEGAL DESCRIPTION 33 -30. Property Location ' /,, sec. ' 63 T �_N -RW, Town of Subdivision I m Lot /I � . Certified Survey I11ap it Volumc , Page It `Varrauty Decd ## G Volumc `(pa), Page if Spec house ❑ no Lot lines icicutitiabic yea 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 liccascd 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, journeyruan 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), fire septic tank is less than 1/3 full of sludge. I/we, the iwdersigucd have read the above requirements and agree to maintain the private sewage disposal system with the standards sct 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 threc car expiration date. NATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all staterneats on this form are true to the best of my (our) knowledge. I (we) ant (are) the owncr(s) of the perty do cribed above, by virtue of a warranty deed recorded in Register of Deeds Office. / Ada z- 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 decd I V;!.1620PAh� 007 STATE BAR OF WISCONSIN FORM 2 .1998 mac} WARRANTY DEED YATHI. FFN H. WALSH Document Number REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Kenneth L. Brown and Kathleen B. RECEIVED FOR RECORD Brown, Husband and Wife 04--18 -pool 9:45 An WARRANTY DEED Grantor, and P. C. Collova Builders, Inc. EXEMPT 11 CERT COPY FEE: COPY -FF. FFP.NSFER FEE: 828.00 RECORDING FEE: 10.00 C:antee. PAGES:. 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Recording Area Name and Return Address David J. Estreen That part of SE 1/4 SW 1/4 and SW 1/4 SE I/4 Sec. 33 T30N -R18W described 304 Locust St. as follows: Lots 1, 2 and 3 of Certified Survey Map recorded in Vol. 13 of Hudson, WI 54016 Certified Survey Maps, page 3698 as Doc. No. 607591. SC Croix County, Wisconsin 026-1096-60-000, 026-1096-60-200, 026- 1096 -70 -000 Parcel Identification Number (PIN) This is not homestead property, Exceptions to warranties: Existing highways, easements & rights of way of record. Dated this .3 of April 2001 + . Kenneth L. Brown Kathleen B. Brown AUTHENTICATION ACKNOWLEDGMENT STATE OF Wisconsin ) Signature(s) ) ss. St. Croix County. ) Personally came before me this !3 day of authenticated this day of April ' 2001 the above named Kenneth L. Brown and Kathieen B. Brown TITLE: ME R �T� ®/\R OF WISCONSIN O T h , +, to nown to be the person(s) who executed the foregoing n`� 06.06, Wis. Slats.) i ment and acknowledge the same. - i% E WAS DRAFTED BY Att etlf' avid J. Estreen 304 LocuiQSt: Hudson, WI 54016 Notary Public, State of Wisconsin —_, ex (SigiaatureSinay be authenticated or acknowledged. Both are not My Commission is permanent. not, state expiration tlon a e: necessary.) ) •Names ofpersons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE DAR OF WISCONSIN FORM No. 2 - 1998 INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 800- 655.2021 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County S'}' , C Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan mu6t 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 informal Reviewed by Date Personal information you provide may be used for sewn u se ( rij✓aFy.La - ,pc s. 15.04 (1) (m)). Property Owner party Location P 64 Lll)�Q Lot SGcJ 1 /4 SF 1 /4 S j 3 T ,3 4 N R l E (or& Property Owner's Mailing Address ` 1 Lplrt Block # Subd. Name or CS Pond s� e City State Zip Code ,F?hone 11 trmber �A0)X y ❑ Village [Town Nearest Road dson L01 ypi ) r tch C ® New Construction Use: ® Residential I Number 9 bedrooms Code derived design flow rate ys _ GPD ❑ Replacement ❑ Public or commercial =rit e: y' A Parent material �� Flood Plain elevation if applicable ft- General comments 5 ,r/ewn e I-ev. 7 `7/'7 44 wu` `l. d and recommendations: d a- - I e v, �� q� Za G•owe-r q p. 3 0 !ff' Boring Boring # C) Z , 3a ft. Depth to limiting factor ~I in. Pit Ground surface elev. g Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ffl in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 2 rny-- , bk t C- I v .5 g S l y 2rrr k c ,*b 3 4 r7Lf 13 sL. 2m nc �r - s .9 F21 Boring# n 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 *Eff#2 O t0 31Z — i( Z- ►�rlo.lok r r,�r C- l v�: s 2 SL 2m b<<- , ,•�-�( - - 9 * Effluent #1 = BOD, > 30 220 mg /L and TSS >30 < <115�0 mg /L * Effluent #2 = BOD, < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) � .G� nature CST Number Address Date Evaluation Conducted Telephone Number z /i3 Qti ,� <sve� 9S LL I 3 E—I `s'6�,S O I`D I I v I O � N I \ C-4 LO �P 7 � 1 I v, nt — — UQ o I N 00 F-I 't o ?tti 3 ocv co CL l I I QQ N _ 77 ,� Ln n N 't � I CY) N Q ^ Im V) Q / Q O N < i ,o aO co ti Cam'/ 9° , / / S�� 5 `Z / 3 � / / l (3 / / cn (n 0 / .- I LL- & L; I / to O s 00 Io M�M W � ��Z88 Jam' t' l PSI \/ CD co l R P \N PGE I / U i (n Z CQ LO O O \ N 06.01'02 W �6 on cv / / — — \ 305.45 �a1 ooA qb � 6 � az g .• E. � l` � I 1 N I oW -51 �� orn ( Mw S � o / to LO rl 30 �� n < O oN I 00 ol co 14