HomeMy WebLinkAbout026-1140-13-000 ST. CROIX COUNTY
WISCONSIN
r • `� _ _____ `'`� ZONING OFFICE
ST. CROIX COUNTY GOVERNMENT CENTER
- 1101 Carmichael Road
r.,. • - Hudson, WI 54016 -7710
(715) 386 -4680 FAX (715) 386 -4686
Friday, November 15, 2002
P.C. Collova Builders, Inc.
1187 121st St
New Richmond, WI 54017
Regarding septic inspection for P.C. Collova Builders, Inc..
Location of Property in St. Croix County:
Municipality: Richmond Township
Subdivision or Plat: Duck Pond Escape
Certified Survey Map:
Lot: 13
Address: 1187121st St
Dear Applicant:
A septic inspection of the above reference property was conducted on June 05,2002.
This property is located in the SW 1/4 SE 1/4 of Section 33, T30N R18W, Duck Pond Escape (Lot 13),
Richmond Township, St. Croix County, Wisconsin. At the time of the inspection, this septic system was
found to be code compliant for a 3 bedroom home.
If you have any questions regarding this, please contact our office at 715.386.4680.
Sincerely,
Kevin Grabau
Zoning Staff
cc: file
Wisvonsin Department of Commerce, PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building DIVISIOP
INSPECTION REPORT Sanitary Permit No: 405059 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID N
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- 1140 -02 -999
CST BM Elev: Insp. BM Elev: BM Description:
ql -64 I ". `* I iocr bmf IP uL fy qtc
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark T` � 9,(0%
Dosing Alt. BM
60 •ro3
Aeration Bldg. Sewer
Holding St/Ht Inlet �[ • - 78.33
TANK SETBACK INFORMATION St/Ht Outlet 5 b �• oa
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic SO 1 r , ` Dt Bottom
Dosing CX Header /Man.
Aeration Dist. Pipe 1 ,
Holding Bot. System
3 •9,�
PUMP /SIPHON INFORMATION Final Grade 1 - 3
Manu cturer Demand St Cover f
GPM 3•`{O K�C O 1 • `f
Model Nu ber
TDH Lift ction Loss System Head TDH Ft
Fon:emain Length Dia.
SOI SORPTION SYSTEM
__7 RENC Width , Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIM S 3
SETBACK SYSTEM TO P/L 113FLDG IWELL LAKE /STREAM LEACHING Manu gtrer: rt
INFORMATION Type Of System: } CHA OR Model Numbg� st
11
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hol Vent to Air Intake
/_'
Lengt Dia Length Dia Specing
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 0 Yes ]N,
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection # /-- Inspection #2:
Location: 1187 I SW 33 T R 7ck Lot 13 G 2 Parcel No: 33.30.18.1017
1.) Alt BM D escription 2.) d1B g sewer len gth = 2t. 13•f0 f _ ( , a 2 - amount of cover = /$ 11 +. `, °1313 _ 0 1'
Plan revision Required? ❑ Yes
No
Use other side for additional informat� � At t �
SBD -6710 (R.3/97) � ( -ex 11G S Insepctor's Signature Cert. No.
�•- u•...= AL ca =arts rr.Ylrucda> uII y dre 13uildings Division
In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave.
IVIsconsin See reverse side for instructions for completing this application PO Box 7302
Department of Commerce Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302
[Privacy Law, s. 15.04(Ixm)) (Submit completed form to county if not
do// y 9 state owned.)
Attach complete plans (to th county copy only) for the system, on paper not less than 8 -1/2x 11 inches in size.
County . State Sani rmit N ❑ Check if i a an Plan I. D. Number
L Application Information - Please Print all Information lion:
Property Owner Name r
� erty Location
APR 3 0 2002 2
(/ f 1/4 3 —1/4, S 3 3T (or
Property Mailing Address
//�� ST. CROIX COUNTY tNumber Block Number
Own s
0, box � � ZONING OFFICE
City, State Zip Code / Phone Number Subdivision Name or CSM Number
II. Type of Building: (check one)
1 or 2 Family Dwelling - No. of Bedrooms: ❑ Village
❑ Public/Commercial (describe use):_ � ;R liewn of
❑ State-Owned
02 e "q p 65 3�x - 1 6 1 ' & -� G /�e�tdr►s �dheS �ar' �'r l� !/ � 4 :Nea�t c �stRoad
Tax N s)O
III. Type of Permit: (Check only one b x on line A. Check box on line B if applicable)
A) L ew 2. 0 Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only Existing System
B) Permit Number Date Lssued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply) _ �s
n- pressurized In- eroimd ❑ Mound ❑Sand Filter ❑ Constructed Wetland
❑ Pressurized In -ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line 31 /
❑ At-grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: 3 Q
V. DispersaVrreatment Area Information:
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate System ation 7. Final Grade
�/j Re Wired Proposed Rate (Galsiday /sq. ft.) (Min./mch) �� Elevation
� Aw. 0
VIL Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existin
Tanks Tanks Crete strutted
❑ ❑ ❑ ❑ ❑
VIII. Responsibility Statement
I, the undersigned, assume responsibility for i9ftaJ of the POWTS shown on the attached plans.
Plumber' ame (print) Plum ature (no stamps): MP/MPRS No. Business Phone Number f /
_PlumbWs A (Street, City, State, e)
DL County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued ssuing gent Si (No stamps)
Approved 13 Owner Given Initial Adverse Surcharge Fee)
Determination �d s.--� fj j i!.�'K��
�Cpnditions pf A oval /Reasons for Dina
gp
rove
2 C41 _ >' 12, 'CnA wr& vk `TGG'i 2,
3D -6398 (R. 07/00)
PLOT LAN
PROJECT P.C. Collova Bldrs. RESS P.O. Box 489 Somerset Wi 54025
SE 1/4 SE 1 /4s 33 /T 35 / J ;8 w N Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 4/29/02 BEDROOM 3
CONVENTIONAL XXX IN -GROUN 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 2" PVC Pipe ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL H. R. P Same as Benchmark
SYSTEM ELEVATION 98.2/97.5
175' Pro Town Road
Vent
ALong Standard Infiltrator
Leaching Chamber
with 3 1. 1 ft2 of Area
Plans Designed Using
2" Conventiona l Powts
Grade at System Elevation Manual Version 2.0
34"
Pro 3
Bedroom
a� House
30'
1~
a T
0 Vents 30'
2
2% B -2
Slope �.�
60' 2 -3' X 94' Cells l�Cv►�- �l�v�/�r� a
with > pacing
a�
a
0' 0
-3
10' 00
B- M
Vents
55' 10' 20 ' B. M. #1
B.M. #2
35'
182' Property Line
,
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
t
include, but riot limited to: vertical and horizontal reference pant (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
Personaj hiformation you provide may be used for secondary purposes (Privacy Law. S. 15.04 (1) (m)).
Property Ovaw Property Location
/ C t�d� �� l Govt. Lot -" 1 /4f 1/4 S�3T �� N R/ E
y s M�IIg Address Lot # Block # or CSR
Props- 2
City State Zip Code Phone Number ❑ City ❑ V, Neared Road
Construction U entiai / Number of bedrooms Code derived design flow rate — GPD
❑ Replacement /❑� Public or al - Describe: - - -- _ —
Parent material � -� r'� _ Flood Plain elevation if applicable /" / ft.
and oommldati s JAN Y Y 2002
T. C R01 /
Nd o 0IJ
a r
ED #- f
Pit Ground srrfaae elev. ` n Depth to limiting fader 2 �, Appl ication Rate
Horimn Depth Dominant Redox Description Texture Structure Consistence Boundary Roots GPDNf
in. Munsel Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 'Eff#2
a Ong # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sol Application bate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
In. Muusel Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 *011#2
• Efltrutt #1 = BOD > 30 < no mgiL and TSS >30 11 • Eftxm t #2 = BOD _< 30 mg/L and TSS 130 mg&
CSP"& ( Please 2 j
7* � { " Date Evaluation Conducted Tetephons Nuruber
Address / b'" `1'.r�
f
PLOT PLAN
PROJECT P.C. Collova Bldrs. ADDRESS P.O. Box 489 Somerset Wi 54025
SE 1/4 SE 1 /4s 33 /T 35 /R 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 4/29/02 BEDROOM 3
CONVENTIONAL )00( IN- D 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 2 " PVC Pipe ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
SYSTEM ELEVATION 98.2/97.5
175' Pro Town Road
Vent
>6 » Standard Infiltrator
of Cover Leaching Chamber
with 3 1. 1 ft2 of Area
Plans Designed Using
6' Long 12" Conventional Powts
Grade at System Elevation Manual Version 2.0
3 4'
Pro 3
Bedroom
a� House
30'
T
Vents 30'
2% 25' B -2
Slope
B- 1 �
60' 2 -3' X 94' Cells
with >3' Spacing
01 0
a.
B -3
10' 00
B -1 M
Vents
55' 10' 20 ' B.M. #1
B.M. #2
35'
182' Property Line
Wisconsin Department of commerce SOIL EVALUATION REPORT Page I of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code ,
County 5 . Cro,
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan mutt
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. (14 6
Please print all info ses r R lew d by Date
Personal information you provide may be used for se ��r utfcy�� s. 15.04 (1) (m)).
Property Owner C * ` perty Location r�z c� Lot $ L 1 /4,$ 1 /4 S3,3 T •3 ` N R ! $ E (ord
Property Owner's Mailing Address _ � Block # Sub . Name or CSM4t
- lam C . -�5� Z
city State Zip Code :.` one Nu — l pity ❑ Village ( Town Nearest Road
c� I .i " ` I5l / C
[3 New Construction Use: ® Residential / Numbe(of Code derived design flow rate yS� / W 66 GPD
� J
- I -
❑ Replacement I El Public or commercial -fi- e
Parent material " I I Flood Plain elevation if applicable /V j ft.
General comments sySfr a /zv ? 7 - 2 0
and recommendations:
I F] Boring
Boring #
�, pit Ground surface elev. 1 3 9. • S ft. Depth to limiting factor - 72_ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /f?
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2
I p-t l0 Si► 2 cg IV4 `J $
Z. 13 -1 1 si I Zrmbk
rn
.�/ Z•4 `I
F Boring # Boring
2-1
pit Ground surface elev. �'7. 5y 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 I *Eff#2
Zf,r,a)ok m �1r' C- V-L
2 2 -10 Lt I `� ` --- S L Z mr�.bk s 5 .9
3 to o r 4I(p - 7.S r 4 s 2 k myk — $
�— 4 �(
y 3
* Effluent #1 = B OD S > 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) Si nature � , CST Number
ZS ;it O
Address Date Evaluation Conducted Telephone Number
Property Owner Parcel ID # Page ?- of
Boring # I] Boring
n 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
I o -I to ;( I Zancb m - cr C
z o -ZO �t --- Ls rn s
�! 2- Z !r
❑ 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 /fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2
F] Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
El Pit
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 I *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)
PAGE 3 OF 3
NAME On) 1 ,oa LOT# / LEGAL DESCRIPTIONSE ' /,SE /e,S;3T3a ,N R/S E (or)®
SCALE: I "= y0
BM I ELEVATION /00.0
BM I DESCRIPTION -, p o 2'�,oyc !> pc � N
BM 2 ELEVATION ?? k. S ec- . 3
BM 2 DESCRIPTION &T Qf ZZ ✓s,_�_
SYSTEM ELEVATION q'7 Z d y 4 - _
ALTERNATE ELEVATION Q ` . Z O
CONTOUR ELEVATION
y 0
A
ti
•63
SIGN ®"^- ♦ ♦3 A _� DATE �
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND wl
nn OWNERSIiIP CERTIFICATION FORM
Owner /Buyer o VA 8 U (t S �1
Mailing Address LJ 1X71 �[U��t -�-- S J
Property Address v �� S
(Verification required from Planning Department for new construction)
City /State OPA" Iii V\yy\ -%d Parcel Identification Number 02JP- y� ' vim.
LEGAL DESCRIPTION 11
Property Localion ; %, =-- ! %, Sec. , T U N -R -1W, Town of
Subdivision C� I_ot it V� .
Cel led Survey A 4 Volumc Page it
Warrauty Deed It to Volumc 7 Page = 4°S
Spec IIOUS9 . yes ❑ do Lot lines icicntificul Kyc-- ❑ no
S I STEM NfAINTENANCE
Improper use and maintenance of your septic system could result in its prcntzturc failure to handle wastes. Proper maintenance
consists of pumping out the septic tank c•rery 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 Departrucnt a ce :titicadon form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed purrncr verifying tbat (1) the on -site wastewaterdisposal system
is in proper operating condition and/or (Z) after inspection and pumping (if necessary), tie septic tank is less than 1/3 full of sludge.
Uwc, the undersigned have read the above requirements and agree to maintain the private se•,vagc 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 die St. Croix County Zoning Office within 30
W t he three ar expiration date.
URE OF APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) lmowlcdge. I (we) atru (are) the owncr(s) of
the rty described above, 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 with this applicnilon: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey reap if reference is made in the warranty decd
Per rnt r - s
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years. -,0 -
*-2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in
o r o 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
Sl q
So
Shaun Bird #226900
FROM P C COLLOVA BLDRS, INC PHONE NO. : 715 549 5911 Nov. 16 2001 09:32AM P1
STAIEnAK OF WISCONSIN FORM 2 -1948
WARRANTY DEED KATHLEEN 11. WALSH
REGISTER OF PEEPS
•
LlogyMCIA Numbf S1. C1;PZX CO., WI
This Deed, snide hetween Kenneth L Brown and KatLhxn B. ASUIVEI FOR P6COR0
Brown, lIasbead and Wifa
04 °18 -2001 9:45 pM
WAR AM DER
Grantor, and P. C. Collovs BuildOTS,11tC. +W EXEQ I
I:W1.e0PT FEE.
COPY FEE!
AMER FEE: 828.00
RECM114 FEEL 10.00
Q0b'm -- 1
GnMee.
Grantor, for a valuable consideration, eoaveys and wuntita to
Grantee the following described teal estoto in St. Croix ( /'c k o M 1 i FS QAf -.
County, State of Wisconsin; yy
Reeerdin Area
Nmoe WA Iretut• Addrea
That port of 86 114 SW 114 and SW 114 SE 1/4 Soo, 33- T3oi` -RI SW described 0 s ue'
es follows: Loss 1, 2 and 3 of Certified Survey 14ap recoHorl In Vol. 13 of I-ludson, Wl 54016
Certified Survey Maps, pogo 3698 is nos. Ns. 607591.
St. Croix County, Wiscongut j ' �
un �
u20 trtl64o -zOC.�
026.106.70.000
' er ear on Nunba (r1N)
Thh 14 no holnestead properly.
(is) (is not)
Exceptions 19 Warranties; Existing highways, easements R rigius of way of Tread.
Dated thin � _ day of April 200)
.Kenneth T„ Brown
• 1 Katitleca 8. Brown
AUTHWTICATION ACIP(MOWLEDGMENT
STATE OF 'Wistgnsin 1
Slansture(s) St. CroIN county. j
porsonafly come !!afore me this , day or
sstnmileated this day of April , "OR date shove Mwd
Kenneth X. Brown well Kathleen D. Brows
TITLE: WV� NOf WISCONSIN ~ — to nown to tx the persons) wbo executed the foregobtg
4 ent and acknowledge the sstne.
0. Wig. stais.)
WAS DNAY TED H Y
Art avid J. Fstreen
3W Wia 54016 Nntaty 1 S tate of WEtconsla (S lyteture�tisay bs Notondest0d or xknowN zfA Both are :tot MY Commission is pen sea no s c expr oa s
neae W.) )
s
•Nona of Oemo slaalaa id say mmity rfiovld be Typed a txinNd below lhdr dBnaRwe
WARRANTY ee1:u "Aft SAa Or W&WANUH
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