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HomeMy WebLinkAbout026-1141-21-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and,Building Division - INSPECTION REPORT Sanitary Permit No: 408245 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: Village X Township Parcel Tax No: P.C. Collova Builders, Inc. Richmond Township 026 - 1141 -21 -000 City CST BM Elev: Insp. BM Elev: IBM Descri ption: CS t ISskk TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark I k.J-S �- S � �.?a 2.D loz. D IM, fl Dosing Alt. BM h ?, ov 77, y0, Aeration Bldg. Sewer q.cl QB.a T Holding SUHt Inlet , I bo T ZO l �• TANK SETBACK INFORMATION St/Ht Outlet T. tti Q'� •8Y' TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom 30 Dosing Header /Man. Aeration Dist. Holding Bot. System le Final Grade PUMP /SIPHON INFORMATION .1 �}. /O Manufacturer Demand St Cover Model Number TDH Lift Fricti oss System Head TDH Ft Forcemain rh . Dist. to Well SOIL A SORPTION SYSTEM BED/TRENCH Width ( Length INo. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 2 n,/ SETBACK SYSTEM TO aI P/L JBLDG IWELL LAKE /STREAM LEACHING Manufa r �t INFORMATION CHAMBER OR Type Of System: - / t UNIT Model K imbert 1 DISTRIBUTION SYSTEM Header /Manifold �� Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Lengt Dia Length a Spacing SOIL tOVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded Mulched Bed/Trench Center Bed/Trench Edges Topsoil ❑ Yes j k] No T Fjv] Yes 7 No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1 _ Inspection #2: ocati 117 121st A �Ie R• hmond WI 017 G W 1/4 SE 1/4 33 T30N R18 ) Duck Pond Es a Lot 1 Parcel .1025 le k: 4.) Description = Tof D ,� n�h tmj �1�4�Q CJ1A.N.AR) 4�P . u 3 , (P (, . U 2.) Bldg sewer length = ' o Ar �pH,�[ fib•/ -: �j ,� C Co - - amount of cover = 1$ t W 1 owu.,�i a9 L � o zr 1 �,�.„ -be/ ,.CSC Use other r for n' Yes b (' �j form - -- _ - -- - -- - -- -- —� Date pp Insepcto' Sig ure '-^ C No SBD -6710 (R.3/97) � N/) C Qt a� r y( ,�L- ' safely and Dancawg0 "Avw..... - 201 W. Washington Ave., P.O. Box 7162 �-� 1 • l r t� Madison, WI 53707 - 7162 T site Address Nvis-consin St De artme�t of Commerce Z(e 3533 V I Sanitary Permit Number Sanitary Permit Application 6 g Z,�S In accord with Comm 8321. wig. Adm. Code, personal information you Provide 0 Check if Revision may be used for Law, 3 5.040 m I. Application in formation - Please Print All Information RE CE IV ED State Plan I.D. Number property Owner's Name Parcel Number C ,asL U 9 2002 33. 3a. 2� Property owner's Mailing Address ST. Property Location tis V C. ?�:�Ix COU��! i�Y � 22 ZC ;I yr 0FFICE '.1 5f: S J . R E City, state � Code P> one N r Block Number ion Name CSM Number S , �sr X r of Building (check all that apply) 2 OCity 2 Family Dwelling - Number of Bedrooms ✓ � e 0 Public/CoamrretcW - Describe Use I 0 State owned" ZS•q i Lg ato,.�,..ba.' a� N d 30 os�.el 33L Type Permit: (Check only one on line A (m�bering scheme for internal use). Complete line B if applicable) A ce m For County use 1 New 2 ❑ heck R System 3 0 Replament of 6 O Addition Tank soem 8. 0 Check if Sanitary Permit Previously Issued Permit Number Date Issued k22 RE ' - all that apply)(numbering scheme is for internal use) Pres surize d In- Ground 210 Mound 47 0 Sand Filter 50 ❑ Constructed wetland 0 ��nd 41 0 Holding Tank 48 0 Single Pass 510 Drip Little 45 0 AI -Grade 46 0 Aerobic Treatment Unit 49 0 Recirculating 30 0 Other V. Area Information: Design Flow (SPd) Dispersal Area Dispersal Area Sort Application Percolation Ra Sysoem Elevation Final Grade Proposed Rate( Gals. /Days/Sq.FL) (Min./Inch) Elevation m Total Number Ma> weer Prefab Site Seel Fiber Plastic VL Tank Info C apacity C Gsllona of Tanks ^ Concrete Constructed Glass New Ezift �&6e1 T Od Tanks Tacks Clamber VII. ResptmsihW Statement I, the reap 9 for buta)lation of the POWTS shown on the attached plans. is Name (Perot) Plumber's MP/IvIPRS N Business Phone Number Plumber's Address (street, City, Static, j 1 Z Y /De eat Use Approved ❑Disapproved �e permit Fee (includes includes Grarndwaoer Dace Issued Issuing Agent s�� (No Stamps) .9 0 Owner Given Initial Adverse L` f lv c�r3S �oa Determination - A) 4. nditi of Approval/Reasons for Di proval Co t'► ul� -!> G -k 'zc.A1sx. S 112- Attach complde Plans (to the Comfy nob) roe• the ayatem an paper not less than 8112 x 11 belies In size cRn -A (R 05 /01) PLOT PAN PROJECT P.C. Collova Bldrs. Inc ss P.O. Box 489 Somerset Wi 54025 SW 1/4 SE 1/4S 33 /T 30 N W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE /8/02 BEDROOM 3 CONVENTIONAL )00C IN -GRO 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 IL BENCHMARK V.R.P. Top of 2" PVC Pipe ASSUME ELEVATION 100 Filter Zabel A -100 ❑ BOREHOLE (DWELL *H.R.P Same as Benchmark SYSTEM ELEVATION 95.2/95.1 246' Property Line Vent Standard Infiltrator °`^ of Cover Leaching Chamber 2 -3' X 94' Cells wi >3' S ci with 3 1. 1 ft2 of Area 6' Long 12" B - 4 is Grade at System Elevation 34" ans De 'gned Using Conv onal Powts 5% 6 M al Version 2.0 Slope 100' B.M. #2 B.M. #1 B -2 B -1 30' 0' 0' Vents 25' �. V'C s' Pro C Bedroom k House a� Tx'( e ,v► . �1YL4ll ��Za o �r 121st. Ave i D., P, -,, �, Y fir, ,`-t * ; 40 z �S" L PLAN PROJECT P.C. Collova Bldrs. Inc DDRESS P Box 489 Somerset Wi 54025 SW 1/4 SE 1/4s 33 7/T 30 R W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE /8/02 BEDROOM 3 CONVENTIONAL XXX IN -GR 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 1212 # of chambers 39 BENCHMARK V.R.P. Top of 2" PVC Pipe ASSUME ELEVATION 100 7AUG ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 95.2/95.1 4 2002 246' Property Line ST. CROix COUNTY Od Vent >6 „ Standard Infiltrator of Cover Leaching Chamber 3-3'X 80' Cells with >3' Spacing with 31.1 ft2 of Area 6' Long 12" B -3 Vents Grade at System Elevation 34" Plans Designed Using Conventional Powts 5% 6 Manual Version 2.0 Slope 100' B.M. #2 B.M. #1 30' 30' 30' a� B -2 B -1 .5 Vents a 30' 0 d T M 25' Pro 3 Bedroom House 0 121st. Ave i PLOT PAN PROJECT P.C. Collova Bldrs. Inc SS P.O. Box 489 Somerset Wi 54025 SW 1/4 SE 1 /45 33 /T 30 N W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE? /8/02 BEDROOM 3 CONVENTIONAL XXX IN -GRO 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 IL 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 95.2/95.1 dd 246' Property Line Vent >6" Standard Infiltrator Leaching Chamber 2 -3' X 94' Cells wi >3' S ci of Cover with 31.1 ft2 of Area 6' Long 12" B -3 ents Grade at System Elevation 34" ans De 'gned Using Conve onal Powts 5% 6 M al Version 2.0 Slope 100' B.M. #2 B.M. #1 — N- -N � B -2 B -1 30' 30' 30' A a� Vents M F AA 25' 'F '�"'"� Pro 3 Bedroom k House � a a� 'kw 121st. Ave 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 , r � - s Wisconsin bepartment of commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Ws. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 ' n p'l s�Plan mutt include, but not limited to: vertical and horizontal refer pp'Iftt (BM }, dlrp - n and Parcel I.D. percent slope, scale or dimensions, north arrow, an ti 'a7id dittande tbf rest road. Please print all ii� - 1 1 1 on. { �� j ,. Reviewed by Date Personal information you provide may be used for se purpo��lR�v� 8W, s. 15,04 ( (m)). l7 L Property Owner ropy cation �� / �0 a �. Govt -'Ut .$� 1 /45 1!4 S 3 3 T 3 N R f$ E (or t}�i 1 J Property Owners Mailing Address � i T'/ E of Block # Subd. Name or CSM# 70 S- G 10- . �flNING f �SChi City State - Zip Code Phone Number 9 4ity ❑ Village ®.Town Nearest Road Soap w/ I S - q01 (7/ —) S -- 71 Aja f c-k anal C ® New Construction Use: ® Residential / Number of bedrooms 3 - Code derived design flow rate GPD ❑ Replacement // ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable f ft. General comments ?TOO and recommendations: wG„yz. e/c J . lb/ rf� ao Ga4.Cr 96.36 I n F] E] Boring # Boring pit Ground surface elev. C 9. 20 ft. Depth to limiting factor (D K in. Soil lication 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 Zmo qtr C-5 I v � 5 Z 1 ,3 - ZLA 101 , c - 1 3 ` - Si - Zrr Cbl< n4f- cs — 3 Z,I-tob 10� o 'SL 2m k ss — 5 . Leo - toy to . b — st- 2 k - - 5 g Boring ❑ Boring # 9-7. ft. Depth to limiting factor - 10 in. pit Ground surface elev. 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 lo — 31Z Si ► 2 = 4 hic I v • S Z ld`I l L 2 rYi'' c S 5 ^ il 5 1 L, SL Z m Sb � — 5 7 a� * 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) Signature CST Number Address Date Evaluation Conducted Telephone Number Z / a S ir1e� Gi/ YG -e p/ 1 51 1 ; 7 — ya ff`$ Property Owner �d � VR Parcel ID # Page of 3 a a Boring # F1 Boring � in. pit Ground surface elev. 9_� ft. Depth to limiting factor 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 6 -12 1 12- S' 2 nn abL (Y "Y 2 Iz -2s r 1 5� 2m-,kV �r 9 3 Z5 -1 51 SL 2r ,so ❑ Boring # El 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 *Eff#2 El Boring ❑ Boring # 1:1 Ground surface elev. ft. Depth to limiting factor in. Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW 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 (8.07/00) PAGE 3 OF 3 NAME Cis j / O c ca LOW 2 ( LEGAL DESCRIPTIONS E ' /45E' /< S 33T3 o N.R I S E (or)� SCALE: I"= yd BM I ELEVATION /co. BM I DESCRIPTION -op a� DU c- IN BM 2 ELEVATION Qq -? 9 BM 2 DESCRIPTION SYSTEM ELEVATION q O y —. ALTERNATE ELEVATION o g3.DV hover &-sS I CONTOUR ELEVATION S q Q SO S 4 �8 O � a� 0 'P`■ gmZ �a. SIGNATURE ��c- DATE FROM : P C COLLOVA BURS, INC PHONE NO. : 715 549 5911 Feb. 01 2001 07 :33AM P1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM /� Owner/Buyer �. l -i f 10VA g I J n 5 AJ <-- Mailing Address P 1 4 q vCS�Y1►2h.� 4 )j 5q 5 . Property Address ��ll__ 'Q ( , Verification required from !'tanning I)eparunent for new construction) City/Stato I Parcel Identlficatiost Number LEGAL D RIPTION Properly i ,oeatiotic 4 , Sec. ` T j W. Town of S C '- YA' (1r�C Subdivision Lot #. Cerdried Survey Map# VVolume Page # MA WAty Deed # s l0� _ ' 3 � � Volume _ . Page # Spec Douse © yes ❑ no Lot tines identifiable ❑ yes ❑ no SYS' m MAINT .ry NC ; consists Impro use and maurteamcc of your septic system could result in its prerttatme•fad re to handic wastes. Proper maintenance of pumping out the septic tank every tl= years er 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 tho waste disposal system the prapertY owner agrees to submit to St. Croix zoning Department a eertWiication form, signed by d1z ow= and by a m'SW Pb=ba4 joumeyttunphusiber. mtrictcd plumber or it licensed pumper verifying tLat (I) the on -site wart waterdisposal system is in proper operating condition aud(or(2) otter inspection taxi pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the under Wwd have read the above requirements and agree to maintain the private sewagc disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Ct rtifcatioa stating that your septic system has beta maintained must be completed and returned to the St. Croix County Zoning Office within 30 Yeas nation date. stw OF APPLICANT 17ATH QWNIFR CERTIFICATrnly I (Va) Certify that aII statements an this form are hue to the best of my (our) knowledge, I (we) ant (are) rite owmt(s) of de ribed above, by virtue of a warranty deed recorded in Register of Deeds Ofliee. IGNATUM OF APP ' LICANT DATE « �ceit Any information that is mis- represented may result in tilt sanitary pennit being revoked by the Zoning Department. '•'•• «« Include with this appiteatlan: a stamped warranty decd from the Register of Deeds omee a coPy of the certified survey map if reference is made in the warranty decd FROM P C COLLOUA BLDRS, INC PHONE NO. : 715 549 5911 Nov. 16 2001 09: —72W Pi STALE 3AK OF WtSCUNSIN FURM 1. 1998 11 13- 139 WARRANTY DEED KANLEEN N. WALSH REGISTER OF DEEDS v� a S1. :RVIX CO., wi This feed, mnde hetween Kenneth L. Brown a XMbleeu B. ASUN4E) FM AEbORD grown,11usbead and Wife 04-16 -20 9:45 A11 _ (IAR WTT DEED 0= 04 tend P. C Wes Rudders, Inc. W � E) E'VT t CRI .COPT F "ef s - COPY R' ;tW+ ffit FEE: 828.00 " RECM1110 FUI 10.07 G rantee. _.. .......,.... 80G4gs,.. t Grantor, for a valuable consideration, eorveys and warrants to i L Grantee 111* following dwribcd real cstoto in St. Croix (JGL(� �► e s QA f County, State of 1Viscoatin: ileccrdftArcs 4eme rand Itew. Address That pest of 89 U4 SW 114 and SW 1/4 SE 1/4 Soo. 334T36N -RI SIN describal vi� Estes. as follows: Law 1, 2 and 3 of Certified Survey Map recorded in Vol. 13 of 39udWv, WI S4016 Cord fied Survey Maps, page 3698 as rtoo. No. 667591. St. CIOlx County, Wisconsin � OIG- I U9G -a0-0W. U2fr t UYtrull -2UC. 026- IC96.70.000 rated It owficadon Nunbo ('IN) Tbi3 �11 not boutestssd property. (Ira (is not) Exceptions to warranties: Existing highways, e9 entente A rights of way of record, Delvd this f day of April 2001 • . Kenneth L. Brown ♦ Katiticca B. grown AUTHOTICATION ACKNOWLEDGMENT' STATE OF Wisconsin ) Slgnatwe(s) ) 41. Csrolx County-) Personally come before me this I) day of cethtwtiested this _ day of April , 200I the Above , tattuad 1 Kenneth I.. Brown end Katkig 1. Brawa TITos;.. l��x W WISCONSIN noon to be the persov(s) wbe oxeeuted the foregoing Mau and scknnwteoge the toms. 0, Wis. Srots_) WAS DRAY rEU NY Aft ah nvtd J. dstreen 306 WI 54016 NotUY Pahl e, Sure of Wisconsin la authenticated or sekno vied;ed. Both are cot My Commission Is pen ratan nos a exgTd' rVa nsaestasy.) ) Names of twsmn silNea la 2" eoW*y shoeid be typed at pinhd tdew Omit sign am wAr4kANry two ATATC IAa Or wtaCOYSiN tk„M Nw 7 . rqa 1NPOP RATION "urts3RONAL3 COMPANY lotto 00 t.AC. wt LOD.anS•107s it _ I y � / _ M--.kD. • b Q QQ ? 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