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HomeMy WebLinkAbout026-1141-15-000 Wiscon DepartnWnt of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 399508 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 G��la - I i `// - /S tIC'O CST BM Elev: Insp. BM Elev: I BM ascription: fK TANK INFORMATION ELE AT O DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic U 1 U O 1 Benchmark I /�, 7 e A- ( / 7 Dosing Its BM Aeration Bldg. Sewer r Holding Ht Inlet , GC TANK SETBACK INFORMATION t Outlet 3x ( . 3lv TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pi S H ng Bot. System L PUMP /SIPHON INFORMATION Final Grade M _mil M turer and St Cove �--- GPM Model 3.� Model Number TDH Li Friction Loss Syste ad TDH Ft orcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSI No. Of Pits Inside Dia. Liquid Depth DIMENSIONS y / �l - z S 2 ..� SETBACK SYSTEM TO o P/L BLDG IWELL LAKE/STREAM L NG Mall-Ir r* INFORMATION �F OR Type Of System: ]/ i l Model Numb r; DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing 71, to Air Intake —L— 1 -engt) {1 r Length Die Length �i Z 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:/ /�, Inspection #2: Location: 1195 121st Avenue New Richmond, WI 5 (SW 114 SE 114 30 T30N R18W) 'Beck o rid 12 Parcel No: 1.) Alt BM Description = �t6k IT SJkl] 2.) Bldg sewer length = ��� mitts 7'v >36 la&)N s .T46 M� g Pp�Z . aP' 32- /cat - A, - - amount of cover = > f 1 3r c>� 3 ) o .See t -Fes iJSev�c��� � r�r s ih Z�C' er �y� Q�r� Plan revision Required? [ Yes WNo Use other side for additional information. l C � SBD -6710 (R.3/97) - Date Insepctor's ignature Cert. No. � / a � _ .. � , .; '� ti 0 -- - � ` �� � �i1� �� � �`��r�- � ., , idle 5 ,����' o 3 � ��' sy s��— �' � Sanitary Permit Application Safety & Buildings Division NV Isconsin In accord with Comm 83.21, Wis. Adm. Code 201 W Waste Box 7342 Per 7302 See reverse side for instructions for completing this application Madison, WI 5 Box Personal information you provide may be used for secondary purposes Department of Commerce [Privacy Law, s. 15.04(lxm)] (Submit completed form to county if not state owned.) Attach complete plans (to rite county copy only) for the system, on paper not less than 8 -1/2 x 1 i inches in size. Caws ♦ Stare Sanitary Perr�iS,Nuro r ❑Check if revision to + uu application State Plan I. D. Number 1. App lica tion Information - Please Print all Information Locatio Property Owner Name Property Location • �► !/ D [J a� i �; 4�� 1 /4 1 /4, S T ,N, (o w Property Owner's Mailing Address r , . of Number Block Number City, State 'Lip Code ne Nu ' ubd v s on Name or CSM Number Agate ' �:7 SeAi2A II. ype of Building: (check one) C3 City 1 or 2 Family Dwelling - No. of Bedrooms: f �� �� O Village Cl ublic /Commercial (describe use):_ own of 13 State -Owned loe1 Nearest Road / .a r arse ex Num er(s III. T pe of .P mit: (Check only one box on tine A. Check box on line B if applicable) 12-0 . / • /0/ A) I . w 2, Replacement 3. Replacement of 4. 5. 6. Addition to System System _ "Tank Only Existing System $) D Permit Number ate Issu A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) on- pressurized In- ground </ O Mound ❑ Sand Filter ❑ Constructed Wetland 137 ressurized In- ground ❑ Holding 'rank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating O Other: r1 r.. hz r 1-F - I o lnP. 1tr'_� V. Dis ersaUTreatment Area Information: 3 1. Design Flow gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6 S s Elevation r 7. inai Grade Required Proposed Rate (Galsj j /s (Min. /inch Elevation L� c / V1I. Tank Capacity in Total # of Manufacturer Prefab Site ,S�ctI Fiber- Plastic Information Gallons Gallons Tanks Con- Con- _ glass New Existing Crete structed 'Tz- anks Tanks ❑ ❑ ❑ ❑ VIII. Responsibility Statement ! I, the undersigned, assume responsibility for instajjation of P shown on the attached plans. umber l Name (print) Plumber' ' tore (no MP/MPRS No. Business Phone Number Plumber's Address (Street, City, State, Zip .S d 1 IX. County/Department Use Only Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signat re (No stamps LA d (] Owner Given Initial Adverse Surcharge Fee) s I Determ c va ions of Approval /Reasons for Disapproval: -Ina `ttrt fht t!- i � 7 l Z �,t�(NC� pGi r6u Cvt t'(HQ- 'Ci ��e( ('WV 5 r "" fie T S— r r o +w w rtc PozJT5 44a. k e—a a. w. ti� N'G w c. 07101) PLOT PLAN PROJECT P.C. Collova Builders Inc. DDRESs 705 Countv Rd E Hudson Wi 54016 SW 1/4 SE 1/4S 33 /T 30 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/7/01 BEDROOM 3 CONVENTIONAL XX)C IN-GR06N CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RAT . 7 ABSORPTION AREA 668 # of chambers 39 BENCHMARK V.R.P. Top of 1" PVC Pipe i/ � ASSUME ELEVATION loo' Filter Zabel A -100 7 ❑ BOREHOLE O WELL *H.R.P Same as Benchmark e , SYSTEM ELEVATION 97.4/98.0, 97.7 121st. Ave 192' Property Line – 77Z- – 80 ' 7 ( a , B.M. #2 B 100 10' I � 1U 1 40' 15' Property Line B I 0 ' B -3 o µ' Pro 3 �0 75 2���� `��� Bedroom House T B -2T3 T2 TI J6'Long ent �n«.e q q . i R tQO Sidewinder High �.p .F 9l3�3 g9.c3 9q• Plans Designed Using Capacity Leachinge —� Conventional Powts Chamber Manual Version 2.0 16 99 `1 34" Grade at Sys tem ElevationwA.Y PLOT PLAN PROJECT P.C. Collova Builders Inc. DDRESS 705 Countv Rd E Hudson Wi 54016 SW 1/4 SE 1/4s 33 /T 30 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/7/01 BEDROOM 3 CONVENTIONAL X04( IN -GR PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RAT .7 ABBSORPTION AREA 668 # of chambers 39 IL BENCHMARK V.R.P. Top of 1" PVC Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P Same as Benchmark SYSTEM ELEVATION 97.4/98.0, 97.7 121st. Ave °� -r-1 • 192' Property Line — Tz — i 3 T 80' a •'.'�� B.M. #2 B.M. #1 100 10' 40' 15' Property Line B 0' B -3 Pro 3 75 ' Bedroom House 0' 0' T B -2 T3 T2 T1 9 ?f( cl?;? $� Vent qq qq.l ioo. > 12" Sidewinder High Z p % 49 b?j OA 33 Plans Designed Using of Cover Capacity Leaching Conventional Powts Chamber Manual Version 2.0 16" 6' Long 34" Grade at System Elevationga.,t wwor;on Department of commerce SOIL EVALUATION REPORT p I of 3 DrvWon of Safety and Buildings in accordance with Conan 85, W m Adm. Code �1 i County Attach complete site tin or paper not less than 81/2 x 11 inches in size. Plan must include, but not fimiled to vertical and horizontal reference pant W, direction and Parcel I.D. percent slope, scale or dimensions. north artow, and location arxt distance to nearest road. Reviewed bar Date Please print a inrfonnnaf!17 to Z 1 J Personal information you PnY be uaeii yaw, s. 1&04 (1) (m)). r 7, i - , Property Location Property Owner Govt Lot S E 114 ,S r 114 S _3,3 T 3 a N R 1$ E (or) OP ?w # _ f�odc# Subd Name or C" property Owners Nang Add ' � %'.+� �d 1 � � 0 uc.k t b nd S G J" (5 Nearest Road Stage zip Code Photr�b'tpARr ❑ city ❑ Vdlage Lid Town city ZONI ; OFF E Residential I Numtiet QR ' 3 - - Y Code derived design flow rate yso 16 ad GPD [ New construction Use: C� , �� t ❑ Public or oorarnaroal - Demme: N fl �' no , me w " 6Fbod Plain elevation if applicable General comments S y5t a wt. e I e v• 1 77- 00" 7. ( A S C Z - r (a h W N� d' Ntc'� , and rrsoamrlerldatiorls: U f. e� e, V • q&'70 s °' f 5c,cl -- 5a•r'7w G Boring ) ❑ t3orin8 # ® Pit Grorard strfoe etev. 4 . O ft Depth to knitirig nor �_ Rafe Horizon Depth Dominant Color Redwc DSSCdpflDn Texture Structure Consistence Boundary Roots GPOW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *EW1 'Eff#2 I a - Ib 3i 3 Sil 2-mclA m - c S ( VC 5 $ cS — 5 8 Z 3 ZI -` % 5r+ 4 4$-S6 IU r' to ` Sc..l 2m 5bk . . C„ a Boring # © pit Ground surface elev. qf 26 ft Depth to limiting factor — G— in. Rate Horizon Depth Dominant Color Redox Description Texture Structure Comae Boundary Roots GPDw in. Mansell Giu. Sz Coat Color S-1 Sz. Sh. 'EW �f W2 I o -1Z 10 ► -312 5II Zmabk m c 1v� 5 g 2 12 ID rL113 3 24- 10 1 5L 2m5bk r r,1"r^ N U10 - 12 d FIF 1.5 ill SL IDDu lip ` Effluent #1= B006 > 30 220 mgt and TSS >30 150 mglL ' Eflkrent #2 = BOD <_ 30 mg/L and TSS 130 rnglL CST Name (Please Print) S re Z CST Number �7 Date Evaluation Conducited Telephone Number 203 3qn L I a -IBS �� 2 � 3 /1 V Parcel ID # �^ property pwner C O I � � a ❑ 80 " 9 6 a # ® Pit Ground swfaoe eta,. _1— - 0 t to Rate Dot RedaocDescxiPAbon Texture Stu dog 'Eff#2 Hor¢on 00840 Gr. Sz• Sh. i Munsd Qu. Sz. Cont. color o - log r312 -- 5' I Zmabk k f � I3 � _ . 9 Z K m C-s 5= 3 32 � ID 1.Z y � S L rnsb y 4 8 ^) I L5 I ms ---- b F—I Boring # ❑ Boring ur ❑ Pit Ground surface elev. _ ft Depth to timrting factor Soil Rate Heron Depth D Redac Demon Texture GL Caine Boundary Roofs GPM Munsell Qu. Sz. Corti. Color Gr. Sz. Sh. *M 'EfHf:2 i — Ed F] �9 # ❑ t Ground surtooe elev. ft. Depth to fi rating Factor in. ❑ Pit Sod Rate Horizon Depth Dominant Redox Description Texture Consistence Roots GPD/lt? 'Eff#1 in. Muneell Qu- Sz. Cont. Color Gr. Sz. Sh. *Eff#2 - < < 30 _ 3o and TSS _ rrrglt. - > < and TSS >30 < 150 mgll_ EEffluent 42 t30D _ mgiL E1lluent #'I - BOD 30 _ 2Z0 mglL e 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. sB"30 OL07100) r - PAGE 3 OF 3 NAME C U I 0 y G- LOT# I LEGAL DESCRIPTION S E' /.SE' /4,S 3 3 T 3o NR) $ E (or)g / SCALE: 1 "= G ) ELEVATION �� • y BM 1 DESCRIPTION & �/"we A. e tsm 3ELEVATION q$, ?5 SeC 3 3 k - <--/ BM 2 DESCRIPTION fop oT 1 • 'pyc. P. pe- I SYSTEM ELEVATION W — J— — ALTERNATE ELEVATION 70 X CONTOUR ELEVATION fo o G d, R CA Y 3 �O 100 / ZO a_•I Ml /U•4�^ck6 f0O.3o 3% .oZ �S o V //S S a l � SIGNA - DATE O� 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 finer 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 falls, determine cause of failure, use aftemate 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 Shaun Bird #2 :�� 4� P C COLLOVR BURS, INC PHONE NO. . 715 549 5911 Feb. 01 2001 07: - P1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer oYe. 8 1 � n 5 7:r- , Mailing Address 70:% 00. �f d . e Property Address .J� 1 ,Verification required from Planning Departtnent for new construction) CiWStato WAaJ CJAMMd W,= Parccl Ide:itifcation Number LEGAL D ESCIUMON Property Location_ Scc. S l J' f_R W, Tcwn of Cam` Subdivisio d � SC�.�.f)l Lore_, CertMed SL'I'PSv 1 1 1 ,lrap i� Voi=c ;�� " Wa Deed r# volLirt�i �C Y Spec Louse ❑ yes`�}'�t o Lot liu� i�?���titiablcyzr no SYSTEM MALNT != p=per •:-.e and maintea.tacc of your sour °)rstem could remit in its Fr=sst=e -failure to L=dic wastcs. P roper y. jz tcaaccc caesists o(pumping out the septic taak every thrcc year or saoncr, if accded by a licensed plmber. What you put into the system can affect the function of the septic tank as a treatment stage in tho waste disposal syrtetn. The propetty owner agmcs to =bmit to St. Croix Zoning Deps cot a car icatioa form, signcd by ta-, own. and by a mar=Plumber , J Y Pivamber. rtstretcd plumber or it licensed purer-, , e.rifyiag tlmat (1) the on -site wnstcwatcrdisposal system is in proper eperadas Condit!= attdlor (2) after inspection and pumping (if ae_.:r=r), the s eptic tank is less than 113 full of s ludge. Ilwe, the uadarsisnod have read the above requirements sod agree to maintain the pale sewagc di--posal syst= with the standards set forth. h eroin, as set by the Department of Commerce and the Departm of Natural Resources, State of Wisecasia Certification sating that your septic system has bees maintaincd =ust be ccmpleted and returned to the St. C. oix County Zoning Ounce within 30 day"f the i e year tion , f r SIGNATURE OF IA PLICANT LATE OWNER CERTIFICATION ..I.(V0 y that all statements on this form tre true to the ba st of ny (our) knowledge. 1 (we) ant (sre'; the ownet(s) of the Property ative, b tjirt a warranty decd recorded in Rrgiste: of Deeds Oflice. NAWRE OF APPLICAN -I• DATE Rr44 *t information that Is r� • -•••• A.ay p _se7ted stay re6ttht is thte sanitary pctrstit bents revoked by U�c Zoning Department. `• Include with this alfp(leattett: a s:armped warranty decd from the Register of Deeds oMce a eepy of the cartifed survey map if reference is made in the warranty decd voA620PAQ 607 • STATE BAR OF WISCONSIN FORM 2 - 1998 6e14 -3139 WARRANTY DEED KATHLEEN 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 -2001 9:45 AM VARRANTY DEED Grantor, and P. C. Collova Builders, Inc. EXEMPT N CERT,COPY FEE: COPY FEE: IRPZFER FEE: 828.00 RECORDING FEE: 10.00 Grantee. E86ES2„ 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 That part of SE I/4 SW 1/4 and SW 1/4 SE 1/4 Sec. 33— T30N -R I8W described David J. Estreen as follows: Lots 1, 2 and 3 of Certified Survey Map recorded in Vol. 13 of 304 Locust St. Certified Survey Maps, page 3698 as Doc. No. 607591. Hudson, WI 54016 St. Croix County, Wisconsin 49 026- 1096 -60- 000,026- 1096 -60 -200, 026 - 1096 -70 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Existing highways, easements & rights of way of record. Dated this 3 day of April 2001 • . Kenneth L. Brown * l 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 Kathleen B. Brown + J. t, TITLE: T �/1R OF WISCONSIN to nown to be the person(s) who executed the foregoing 1 ment and acknowledge the same. Itt 06.06, Wis. Slats.) E PWAS DRAFTED BY AfIP . David J. Estreen 304 Ld¢u pSt: Hudson, WI 54016 Notary Public, State of Wisconsin (SignatureS� nay be authenticated or acknowledged. Both are not My Commission is permanen . no , sta a expire Ion ate: necessary.) .Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE BAR OF WISCONSIN FORM Na. 2.1998 INFORMATION PROFESSIONALS COMPANY FOND DU LAC. WI 800- 655 -2021 _ DEDICA O J — - -- N q. s THE PU os w ,�.s8. 9 ? , S 77 4 191.60' 233.72' - - - - - - - - - - - - - - - - - - - - -- �6 01, S 9 2 n — \ N 89' 35 53 W 425.32' L. 'S0 23 `-_ _ 121st AVENUE 3� \ � � 24 _ S 89'35'53" E 425.32' - - -- - --- - - - -- -- 47.60' 187.85' - - - 189.87' I r o r 12 Z 3 Sq. Ft. 3 — — — — , Ac. � � LO T 1 � L(� T 14 15 LOT 16 66649 Sq. Ft. 1.53 Ac. 65 68 Sq. Ft. 6Sq. t. 1 66635'Sq. Ft. N I .51 Ac. c.,j 1.57 Ac. 1.53 I Ac. to ol I I z 0 . I I I rh i I I 13.14' 153.36' 207.03' 194.05_ ---- 1 - -- J 0 ' 0 �d •�� w SOUTHEAST CORNER, SECTION 32 T30N, R18W, SET P.K. NAIL FROIv COUNTY TIES NOTE: ALL BEARINGS ARE REFERENCED TO THE SOUTH LINE OF THE SOUTHEAST 1 /4 OF SECTION 33. T30N. R18W, RECORDED AS N 89'43'55" W. 3OUNDARY PROVIDED BY MURPHY LAND SURVEYING. ALL BUILDINGS TO BE CONSTRUCTED IN PROXIMITY WITH DRAINAGE EASEMENTS SHALL HAVE A 7 INISHED FLOOR OR WINDOW WELL ELEVATION NOT LESS THAN TWO FEET ABOVE THE HIGH WATER LEVATION SHOWN. DRAFTED BY: JASON THOMAS SHEET 1 OF