HomeMy WebLinkAbout038-1186-40-000 Wiscofth Department of Commerce U
Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count
INSPECTION REPORT St. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 353334
Permit Holder's Name: ❑ City ❑ Village ❑ lDwn of: State Plan ID No.:
P. C. Collova Star Prairie Township
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
. v I m . c7 ' P UC Qtu � S 038 - 1186 -40 -000
TANK INFORMATION ELEVATION DATA (3 - 3 1. 1 �(,
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark 3. �o
a3.y C30.p'
Dosing u Alt. BM 3- 4-o -.p'
Aeration Bldg. Sewer SS— 9,{
Holding St /Ht Inlet
TANK SETBACK INFORMATION St/ Ht Outlet
TANK TO P / L WELL BLDG. A Intake ROAD DI Inlet
Septic f z p ' NA Dt Bottom
Dosing u `� �� Zo' NA Header /Man.
Aeration NA Dist. Pipe S 4 q
Holding Bot. System ti $��� S• ao'
PUMP / SIPHON INFORMATION Final Grade
Manufacturer Demand St cover 5 ag 10'
Model Number p GPM
TDH Lift v� Friction System TDH Ft ead
Forcemain Length Loss C' Dia. Fi t Er Dist.ToWel
SOIL ABSORPTION SYSTEM
dEB THE H Width i Len th r N . Of T nches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 oZ DIMENSION
SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manu cturer. S
INFORMATION Type of CHAMBER M e Num er:�
System: 33 (04 OR UNIT —C acc
DISTRIBUTION SYSTEM
Header/ anifold /f Distribution Pipes) x �eS' e �xHole Spacing Vent To Air Intake
Length Dia. ength Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over 7Bed h Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed/ Trench Center Tren ch Edges Topsoil ❑ Yes ❑ No []Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: ate/ 2( /M Inspection #2:� --
Location: 2107 135th Street, Star Prai 'e, W 54 26 (SW 1/4 SE 1/4,3 T3 N R18W) 3.31.18.945 Prairie Flats -Lot 14
1.) Alt BM Description = � s^�`°` r c�a r cl y d "��
2.) Bldg sewer length=
- amount of cover =
�)�•„�
Plan revision required? V-Yes ❑ No
Use other side for additional information.
SBD -6710 (R.3/97) Date Inspector's Signature Cert No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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Safety and Buildings Division
SANITARY PERMIT APPLICATION 201 W. Washington Avenue
Visconsin P o Box 7162
Department of Commerce In accord with Comm 83.05, Wis. Adm. Code Madison, WI 53707 -7162
0, Attach complete plans (to the county copy only) for the system, on paper not less County If
than 8 1/2 x 11 inches in size.
r See reverse side for instructions for completing this application State sanitary Permit Nu ber
3S3 3,3 7
Personal information you provide may be used for secondary purposes ❑ Check it revision to previous application
[Privacy Law, s. 15.04 (1) (m)J. r te Plan Review Transaction Number
I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION k —
Prope Owner Name Property Location
C_ Cr Shia LC Zia, S /,3 T 3 , Nr R f r�
Property Owner's Mailing Ad ress Lot Number Block Number
n 57 L
City, tat Zip Code Phone Number Subdivisi Name orCSM Nu
U. O C ( 71X) S `
II. TYPE F B ILD NG: (check one) ❑ State Owned Uo o C lt )/ JN earest Road
Public 1 or 2 Family Dwelling - No. of bedrooms K E] To OF J � S 77
111. BUILDING USE (If building type is public, check all that apply) Parcel TaxNumber(s) ,� �g L
1 ❑ Apartment/ Condo — (>
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining
4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable)
A) 1 New 2. ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5. ❑ Repair of an
System ________ System _ ____________Tank Only______________ Existing System ________ Existing
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non - Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 21 [] Mound 30 C] Specify Type 41 ❑ Holding Tank
12 [$Seepage Trench /7 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 E] Seepage Pit 43 ❑ Vault Privy
14 E] System a - A� 6
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation
5_( c-- Feet Feet
Capacit
VII. TANK in Ca allo Total # of Prefab. Site Fiber- Exper.
INFORMATION g Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existin structed
T nks Tanks
Septic Tank or Holding Tank aQ ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ 1 ❑ 1 ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumber' ignat e: (No Stam s) LUPYPRSW No.: Business Phone Number:
"tv G'?Git�° aaa3s a1S- —
Plumber's Address (Street, City. State, Zip Co ):
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater ate I ssued Issuing Agent Signature (No Stamps)
PA roved Surcharge Fee) op pp ❑Owner Given Initial
Adverse Determination o:5
X. CONDITIONS OF APPROVAL! REASONS FOR DISAPPROVAL: 4 Plu" j, = �,,F C
-40 - - —�
SBD -6396 (R.12/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, plumber ,
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit maybe- renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly n;�aintairledr'- The septic tank(s) must be pumped byJ4 pumper whenAer
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsi'te sewage system, contact your local code administrator or the State of '
Wisconsin, Safety and-Elijildings Divisign,'60&266 - 3151. r
To be complete and accurate this `sanitary "permit application must include:
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system isto be installed.._ ;
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appro.priaA prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form. s
IX. County / Department Use.Only,
X. CountyY Department Use Only.
Complete plansand.specifications not smaller than 8 1/2 x 11 inches must be submitked to the county. The plans must
include the following: A) plot plan, drawn to. CaleSor with coTplefe dimensions, location of holding tanks} septib
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump Rerforn ince curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; soil tee *t data on "a 115 form; amd'F),. all sizing information.
GRO , NDWATF.� SURCHARGE
1983 Wisconsin Act 41Q included the creatioh b_ A (fees) fora number oT' egulated practices which can
effect groundwater.
The monies collected through these suritharges are used for monitoring groundwater contamination investigations
and establishment of standards.
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'Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of
Divisiop of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code
Gille Trucking & Excavatin , lnc.
Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and _ St. Croix
percent slope, scale or dimensions, north arrow, distance to nearest road. parcel I,D.#
APPLICANT INFORMATION - P
Personal information you provide may be used ndary urpy*s (Priv 15.04 (1) (m)). R viewed B ate — Z Ctl()
Property Owner C perty Location __
Case ,Dan _ g � I s.- _ Lot SW 1/4 SE im,S _ T 31 N,R 18
Property Owner's Mailing Address I of # Block # SUbd. Name or CSM#
323 Sawmill Lane - S7 CFA 14 Prairie Flats
City State dimly tuber `v [City ❑Village Town Nearest Road
New Richmond WI -4 Star Prairie Hwy 65
New Construction Use: R ' tin aCb ` edrooms 3 ❑Addition to existing building
1 Replacement �� Public or co mercial describe
Code Derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd/ft .8 trench, gpolft?
Absorption area required 643 bed, f 2 562 trench, ftz Maximum design loading rate .7 bed, gpd/W .8 tr ench, gpd/ftz
Recommended infiltration surface elevation(s) S It (as referred to site plan benchmark)
Additional design I site considerations
Parent material Out -wash Flood plain elevation, if applicable ft
S= Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank
U= Unsuitable for system I F� S❑ U ❑ S U E S❑ U ❑ S® U ❑ S® U ❑ S El U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/ft
Boring# Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh, C onsistence Boundary Roots Bed Trench
1 1 0 -10 7.5YR2 ---- - - - - -- SIL 1 FABK MVFR AW 1VF .2 .3
2 10 -25 7.5YR4 ---- - - - - -- CL 1FABK MVFR AS 1VF .2 .3
Ground 3 25 -96 7.5YR5/3 - --- - - - - -- S 0 -GR ML - - -- - - -- .7 .8
ele -- — — -- — - -- — — - - -- -
v .0
Depth to
limiting
factor
96 in.
Remarks:
2 1 0 -11 7 --- - - - - -- SIL 1FA BK MVFR AW 1VF .2 .3
--
2 11 -30 7.5Y - --- - - - - -- CL 1FABK MVFR AS 1VF .2 .3
Ground 3 30 -96 7.5YR5/3 ---- - - - - -- S 0 -GR ML - - -- - - -- .7 .8
ele - -
RZe-
Depth to
limiting - -- - - - - - -- - -- --
factor _
9 in. 3 c- .34e
Remarks: -- - -- --- - - - - -- -- --
CST Name (Please Print) igna re: Telephone No.
Dennis Gille 715 268 - 6637
Address CST Number Ref #
[� t
372 140th Street Amery, WI 54001 f6/97 3409 107
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'• PROPERTY OWNER: Casco Dan S OIL DESCRIPTION REPORT Page 2 of
PARCEL,I.D.# Gille Trucking & Excavating, Inc.
Depth Dominant Color Mottles Structure ! GPD/ftz
Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. onsistence Boundary Roots
Bed 7 Trench
3 1 0 -13 7.SY R2.5/1 ---- - - - - -- SIL, 1FABK MVFR AW 1VF .2 3
2 13 -24 7.5YR4/6 ---- - - - - -- C L 1FABK MVFR AS 1VF .2 .3
Ground -- - - —
elev 3 24 -96 7.5YR5 ---- - - - - -- S 0 -GR ML - - -- - - -- .7 .8
Depth to
limiting - -- -- -
factor
Y }�(• Y
Remarks: _
4/ 1 0 -11 7. ---- - - - - -- SIL 1FABK MVFR AW 1VF 2 .3
2 11 -29 7.5YR4/6 ---- - - - - -- CL 1FABK MVFR AS 1VF .22 .3
Ground
F
3 29 -96 7.5YR5/3 ---- - - - - -- S 0 -GR ML - - -- - - -- .7 .8
c alf
Depth to
limiting — -- -- {— -
factor
96 in. — — --
Remarks:
5 1 0 -12 7.5YR2. -- - - - - -- SIL 1FABK MVFR AW 1VF .2 3
-- - -- —r-
2 12 -30 7.5YR4 ---- - - - - -- CL 1FABK MVFR AS 1VF .2 .3
Ground -
eiev 3 30 -96 7.5YR5/3 ---- - - - - -- S 0 -GR ML - - -- - - -- .7 .8
Depth to
limiting - --
factor S
96 in. - --
Remarks:
Ground — - - -- - - -- - r - —
elev
Depth to
limiting — --
factor
Remarks:
P/o 7 14,— 2a" At&
Scv�'Ey S/3 ! Nl? lS'tJ Cs7' 190
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231 3 i
r� ST. CROIX COUNTY
� WISCONSIN
l i m p " r "■ -_ Rose* ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
Hudson, W154016 -7710
(715) 386 -4680 Fax (715) 386 -4686
October 10, 2000
P.C. Collova Builders
Attn: Laurie
705 County Trunk E
Hudson, WI 54016
RE: Septic Inspection for P. C. Collova located at 2107 135th Street, Prairie Flats
(Lot 14), Star Prairie Township, St. Croix County, Wisconsin
Dear Laurie:
A septic inspection of the above referenced property was conducted on July 21, 2000.
This property is located in the SW 1/4 SE 1/4 of Section 13, T31 R1 8W, Prairie Flats
(Lot 14), Star Prairie Township, St. Croix County, Wisconsin. At the time of the
inspection, this septic system was found to be code compliant for a three (3) bedroom
home.
If you have any questions regarding this, please contact our office at (715) 386 -4680.
Sincerely,
Kevin Grabau
Zoning staff
/sm
cc: file
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
nn OWNERSHIP CERTIFICATION FORM
Owner/Buyer p. t o l l oVA 81 n S %--N <—
Mailing Address - 70- Ov . E /�v�su.v I,
Property Address 0,���' /S S�
(Verification required from Planning Department for new construction)
City /State -.941 ��Lq r2f� Parcel Identification Number 0 3 2) " /f g60 - Yo
LEGAL DESCRIPTION
Property Location W /, /, Sec. Q ,
P �Y �'� , �.3 , T N -R W, Town of d A Pm rfz l C
Subdivision P(2?Ai ai'f -k-J Lot # r
Certified Survey Map # Volume . Page #
Warranty Deed # 6 U o (06 ( Volume �`r . Page #
Spec house O yes no Lot lines identifiable es O no
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 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 wastewaterdisposal 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.
Uwe, 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 year expiration date.
3 /(o /O
GNATURE 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 owner(s) of
"ropei� esc ribed above by virtue of a warranty deed recorded in Register of Deeds Office.
3 / 6 / oo
�f G1 , T,kTURE' OF APPLICANT DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.******
** Include with tills application: a stamped warranty deed from the Register of Deeds office
a cop of the certified serve ma if reference P y p rs made in the warranty deed
HL 1416PAU209 12--
STATE BAR OF WISCONSIN FORM 11 - 1982 600661
LAND CONTR KATHLEEN H. WALSH
indual and
(TO BE USED FOR ALL TRANSACTIONS t WHERE OVER REGISTER OF DEEDS
DOCUMENT NO. $25,OW IS FINANCED AND IN OTHER NON - CONSUMER ST. CROIX CO. WI
ACT TRANSACTIONS)
RECEIVED FOR RECORD
Contract, by and between Daniel J. Casey and 04 -05 -1999 9:30 AM
Ratt - v T� f acr�lr, htichanri anA `.ri fa ac LARD CONTRACT
survivorship marital property ( "Vendor", EXEMPT Y
whether one or more) and P_ C_ Col 1 ova B u i l d e r s• Inc, CERT COPY FEE:
COPY FEE:
TRANSFER FEE: 570.00
( "Purchaser ", whether one or more). RECORDING FEE: 12.00
Vendor sells and agrees to convey to Purchaser, upon the prompt and full performance PAGES: 2
of this contract by Purchaser, the following property, together with the rents, profits,
fixtures and other appurtenant interests (all called the "Property "), in
S t. Croix
County, State of Wisconsin:
THIS SPACE RESERVED FOR RECORDING DATA
Lots 8, 9, 10, 13, 14 15, 1 7 , NAME AND RETURN ADDRESS
18, 19 and 21 of Pra rie Flats JD LSN
w
Addition in the Town of Star `�N �
Prairie, St. Croix County 5- 3,7 S. l�i'dw ' AFE"
Wisconsin. mow R IG Ha�dw
w!
038- 1185 -80 -000, 038 - 1185 -90 -000
039-1181; - 01- 00 311-1 1 R 6 -30 -000
PARCEL IDENTIFICATION NUMBER
038 - 1186 -40 -000. 038 - 1186 -50 -000
038 - 1186 -70 -000, 038 - 1186 -80 -000
038- 1186 -90 -000, 038 - 1187 -10 -000
This is not homestead property
(is) (is not)
Purchaser agrees to purchase the Property and to pay to Vendor at 3 2 3 S a wm i 11 La . New Ri chmond , WI
the sum of $ 190 , 000 00 in the following manner: (a) $ 10 , nn0 00
at the execution of this Contract; and (b) the balance of $ 18 a , 000 . 00 together with interest from date
hereof on the balance outstanding from tune to time at the rate of F i ,3h t- percent per annum until paid in full, as follows:
Purchase price determined as follows: Lots 8, 9 and 10 $19,900.00 each;
lots 13, 14, 15, 18 and 19 $18,900.00 each; lots 17 and 21 $17,900.00 each.
A Warranty Deed will be given for each of these lots upon payment of the
original purchase price (stated above) of each lot, plus accured interest.
Provided, however, the entire outstanding balance shall be paid in full on or before the 29th day of Mar 2001
19_ (the maturity date).
Following any default in payment, interest shall accrue at the rate of 8 % per annum on the entire amount in default (which shall
include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance).
Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably anticipated annual taxes, special
assessments, fire and required insurance premiums when due. To the extent received by Vendor, Vendor agrees to apply payments to these
obligations when due. Such amounts received by the Vendor for payment of taxes, assessments and insurance will be deposited into an escrow
fund or trustee account, but shall not bear interest unless otherwise required by law.
Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any amount may be prepaid
without premium or fee upon principal at anytime after ''I.9 a eh 3 0, 19 9 9 U?F010AFv61i NO(F7f�P hdGX lk
) �3{ B6Ht}1
In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of
principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less than the amount that
said indebtedness would have been had the monthly payments been made as first specified above; provided that monthly payments shall be
continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded herefrom.
Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except:
None.
Purchaser agrees to a the cos
g pay [ of future title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor until
the full purchase price is paid.
Purchaser shall be entitled to take possession of the Property on March 30
C.. Gin One
LAND CONTRACT - Individual and Corporate STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc.
P Form No. 11 - 1982 Milwaukee, Wis.