HomeMy WebLinkAbout038-1186-50-000 I
Wisconsin Department of Commerce
PRIVATE SEWAGE SYSTEM Coun
Safety and Buildings Division �t. Cr oix
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanita J J44VV11// No.:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: ❑ City ❑ illag El JO of: State Plan ID No.:
.C. Collova Builders, tar raine'�1
CST BM Elev.:. Insp. Elev.: BM Description: ParcebT fg � 86 -50 -000
U ( U t
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic k rA ., Benchmark 3�Z 0 d Z ' Leo
Dosing Alt. BM S
�c
t_ Hc � 4 Bldg. Sewer
9 ey/ Ht Inlet a�
TANK SETBACK INFORMATION
TANK TO P/ L WELL BLDG. Ventto ROAD
Air Intake
Septic 1st ` � r Z c/l Z y i NA Dt Bottom
Dosing tSe-l' > / 3 S / NA Header / Man.
A NA Dist. Pipe
Holtling Bot. System (c) r 9S
7z - z 2
PUMP/ SIPHON INFORMATION Final Grade Z
Manufacturer A Demand St cover
Model Number j L GPM
TDH Lift Lriction System TDH Ft
Forcemain Length 4 ' 1 Dia. Z Dist. To Well
SOIL ABSO TION SYSTEM
BED / EN ches Width, S Length No. Of Tren PIT No. Of Pits Inside Dia. Liquid Depth
DIM 1 S Z D
SETBACK
SYSTEM TO P/L BLDG WELL LAKE /STREAM LEA M anufacturer:
INFORMATION Type O 3 7 / CH UNIT R Moe ber:
System: 1 l�
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) `! x Hole Size x Hole Spacing Vent To Air Intake
ro
Length _W Dia. Length v ` Dia. 7 Spacing Z 7? 4 Z q 7 r
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 ❑ ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present etc.) Inspection #1: / / Inspection :
Location: 2117 135th Street, New Richmond, WI 54017 (SW 1/4 SE 1/4 13 T31N R18W) - 13.31.18.946 Prairie Flats -Lot
15 �
1.) Alt BM Description = �o v SrA�` a.
2.) Bldg sewer length= Zy / re, 0; 5"o� P C"y ef,iA, PAP Cccrve,
- amount of cover
3,)ro,f( �a�v—
Plan revision required? JhYes ❑ No
Use other side for additi n information.
Jt� SBD -6710 (R.3/97) Date Inspector's Signature Cert No.
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ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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1 *6consin Safety and Buildings Division
SANITARY PERMIT APPLICATION 201 Box Washington Avenue
Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, o 19e my
than 81/2 x 11 inches in size. �, - / G Yo i K
• See reverse side for instructions for completing this applicati -Fryc)E a� states itary Permit Number
v.,a 0;-,
Personal information you provide may be used for secondary purposes "3 ° �r ❑ Chea l revision to previous application
IPrivacy Law, s. 15.04 (1) (m)). f P
tate`P1 I.D. Number
I. APPLICATION INFORMATION - PLEASE PRINT ALL I F MAT1
Propert Owner Name P b "tion
G r 5 " :; , T 3 , N, R �g E (or) W
Property Owner's Mailing Address At Number , - Block Number
Q
City, State Zip Code Phone Number Subdivisl or CSM Number
II. TYPE OF BUILDING: (check one) ❑ State Owned V ° Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms ° ovvn of
111 BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
0 3F--
1 ❑ Apartment/ Condo I • �-
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor R creational 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. g[ New 2 ❑ Replacement 3. ❑ Replacement of 4_ ❑ Reconnection of S. ❑ Repair of an
______System ________ System_____________ Tank Onl�r______________ Existing System ________ Existing System
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 ❑ Mound 30 ❑ Specify Type 41 []Holding Tank
12 ULSeepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 []Seepage Pit 43 ❑ Vault Privy
14 ❑ System -In -Fill s7 DCAACk
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. Syst m Ele 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) s. o Elevation
4<5e S! 2 ?e r eet fr ff Feet
Ca aclt
VII. TANK in gallons Total # of Site
INFORMATION Manufacturer's Name Prefab. Con- Fiber- Plastic App -
Gallons Tanks concrete steel glass App.
New Existin strutted
Tanks Tanks rry
Septic Tank or Holding Tank 'X g v A' ! ❑ ❑ ❑ ❑ E]
Lift Pump Tank /Siphon Chamber I I I ❑ 1 ❑ 1 ❑ 1 ❑ 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's Signature (No Stamps) MPRSWNo.: Business Phone Number:
'44 - / er- I*. S r . f
Plumber's Address (Street, City, e, Zip Co e):
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IX. COUNTY / DEPART ENT USE ONLY
❑ Disapproved S Mary Permit Fee Surcharge Fee)
(includes Groundwater E22 I ssued Issuing Agent Signature (No Stamps)
\
Approved [:]Owner Given Initial ( Adverse Determination
X. CONDITIONS OF APPR VAL / REASONS FOR DISAPPROVAL:
SBD- 6398 (R.11197) 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 may be 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 maintained. The septic tank(s) must be pumped by a licensed pumper.whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608 - 266 -3151.
To be complete and accurate this sanitary permit application must include:
I. Property owners name and mailing address. Provide the legal description and parcel tax numbers of where the
P Y ' 9 9 P P O
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
Ill. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete tine 8 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.
Vill. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
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 performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
----------------------------------------------------------------------------------------------------
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
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Wisconin Department of Commerce SOIL AND SITE EVALUATION Page 1 of
- Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code
Gille Trucking & Excavating, Inc.
Attach complete site plan on paper not less than 814 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal refers BM), direction and St. CTO1X
percent slope, scale or dimensions, north arrow,�a lo��i n n�i nce ton arest road. —
Parcel I. D.#
APPLICANT INFORMATION - Pls�;Arint all
Personal information you provide may be used f secondary p rivacy L • .04 (1) (m)). vleWP BY -- Date
Property Owner P perty Location
Case , Dan __ { R w t, Lot SW 1!4 SE 114,S 13 T 3 N,R 18
Property Owner's Mailing Address "� /'' # Block # Subd. Name or CSM#
323 Sawmill Lane 1 00 . 15 � Prairie Flats
1
City State ZIR Code �qe City ❑ Village MTown Nearest Road
New Richmond W1 540 715 -246 - Star Prairie Hwy 65
El New Construction Use: EX] Reside ' um edrooms 3 ❑Addition to existing building
El Replacement ❑ Public or commercial describe
Code Derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd/ft .8 trench, gpd/ft
Absorption area required 643 bed, ft 562 trench, ft Maximum design loading rate 7 bed, gpd/ft .8 tr ench, gpd/ft
Recommended infiltration surface elevation(s) 3 ft (as referred to site plan benchmark)
Additional design / site considerations
t Parent material Out - wash Flood plain elevation, if applicable ft ble for system Conventional Mound In - Ground Pressure AT - Grade System in Fill
Holding Tank
itable for system NS 0 U M S❑ U NS EI U ❑ S U ❑ S N U ❑ S® U
SOIL DESCRIPTION REPORT
goring# Horizon
Depth Dominant Color Mottles Structure GPD/ft
in Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Cie Boundary Roots
Bed Trench
1 1 0 -14 7.5YR2.5/1 --- - - - - -- SIL 1F MVFR AW 1VF .2 .3
2 14 -34 7. 5YR4/6 ---- - - - - -- CL 1FABK MVFR AS 1VF .2 .3
- -- --
Ground 3 34 -96 7.5 YR5/3 ---- - - - - -- S 0 - M - - -- - - -- .7 .8
ele - -- - - -- - -- — - - -
�g
Depth to
limiting
factor _
96 in. -- - -- - - -- ,
Remarks:
2 1 0 -14 7.5YR2.5/1 ---- - - - - -- SIL 1FABK MVFR AW 1 VF .2 .3
2 14 -26 7.5YR4/6 ---- - - - - -- CL 1FAB VFR AS 1VF .2 3
M
-- -- -- - - - -- -- —
Ground 3 26 -96 7.5YR5/3 ---- - - - - -- S 0 -GR ML - - -- - - -- 7 8
ele Depth to
limiting - - -- - ----- - - - - -- - - - - --
factor
9 6 in.
Remarks:.- - -- - - -- - --
CST Name (Please Print) lure: Telephone No.
Dennis Gille 715- 268 -6637
Address DD t CST Number Ref #
372 140th Street Amery, WI 54001 Vf6/97 3409 107
I
TROPERT Y OWNER: Casey, Dan SOIL DESCRIPTION REPORT Page 2 of _
PARC11 i.a.# Gille Trucking & Excavating, Inc.
Horizon Depth Dominant Color Mottles Texture Structure onsistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
3 1 0 - 11 7.5YR2.5 --- - - - - - - SIL 1FABK MVF AW 1VF .2 3
2 11 -28 7.5YR4/6 ---- - - - - -- C L 1FABK MVFR AS 1 VF .2 .3
Ground
elev 3 28 -96 7.5YR5/3 ---- - - - - -- S 0 -GR ML - - -- - - -- .7 .8
C T? -V5 11 " J
Depth to
limiting -
factor
96 in -
Remarks:
4 1 0 -14 7.5Y R2.5/1 ---- - - - - -- SIL 1FABK MVFR AW 1VF .2 -3
2 14 -27 7.5YR4/6 ---- - - - - -- CL 1FABK MVFR AS IVF .2 .3
Ground - — --
elev 3 27 -96 7.5YR5/3 ---- - - - - -- S 0 -GR ML - - -- - - -- . 7 .8
el — - --
Depth to
limiting -- — - -- - - --
factor
96 in. - - - -- - - -- - - - -- — - - -- -- --
Remarks: —- - - -- _ —_- --
5 1 0 -12 7.5 ---- - - - - - - SIL 1FAB MVFR AW 1VF .2 .3
2 12 -31 7.5YR4/6 ---- - - - - -- CL 1FABK MVFR AS 1VF .2 .3
Ground -- —
elev 3 3 96 7.5YR5/3 ---- - - - - -- S 0 -GR ML - -- _ - -- .7 .8
—+ - - - --
Depth to
limiting
factor
96 in.
Remarks:
Ground
elev
Depth to
limiting -- — - — - - --
factor
Remarks:
30 g
,
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4u� ReAt lo 7"'
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
n �
Owner/Buyer I oVA g S
Mailing Address — 70 , �) 0v E Ala Qsury
Property Address 2 //7 3-s A S f
(Verification required from Planning Department for new construction)
City /State 4W K (C?gr4cW 6 Q: parcel Identification Number
LEGAL DESCRIPTION
Property Location -SW %,, 5 C y Sec. 13 . T 3 � N -R /d W. Town of
Subdivision ✓ aA E Lot #
CertiCed Survey Map # Volume . Page #
Warranty Deed It 6 Dv & ( I Volume I
. Page #
Spec house O yes �"o Lot lines identifiable yes 0 no
SYSTEM MAENTENANCE
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
masterplumber, 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 of the three year expiration date.
4 //a /w
S 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
WIGNA escri bed above, by virtue of a warranty deed recorded in Register of Deeds Office.
OF APPLICANT DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * **
** Include with 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 deed
YOL 1416PAU209
STATE BAR OF WISCONSIN FORM 11 - 1982 600661
LAND CONTRACT KATHLEEN H. WALSH
Individual and Co orate
(10 BE USED FOR ALL TRANSACT(t)Ni WHERE ovr:R REGISTER OF DEEDS
DOCUMENT 25,000 IS FINANCED AND IN OTHER NON - CONSUMER ST CROIX CO. WI
UMENT NO ACT TRANSACTIONS)
RECEIVED FOR RECORD
Contract, by and between Daniel J. Casey and 04 -05 -1999 9:30 AM
AP f - -t n_ ( , hushanrl and wi f.e_ as LAND CONTRACT
surviv marital propert _ ("Vendor", EXEMPT I
whether one or more) and 2. ( o l ova Builder CERT COPY FEE:
COPY FEE:
( "Purchaser ", whether one or more). TRANSFER FEE: 570.00
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
St. Croi County, State of Wisconsin:
THIS SPACE RESERVED FOR RECORDING DATA
Lots 8, 9, 10, 13 1 15 1 7 , NAME AND RETURN ADDRESS
18, 19 and 21 of Prairie Mat:
Addition in the Town of Star �O/� N
Prairie, St. Croix County S39 S S
Wisconsin.
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038- 1185 -80 -000, 038 - 1185 -90 -000
038 —IlA6 -01 -00 038- 118 -30 -000
PARCEL IDENTIEICATION NUM ER
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 Sawmi 11 La . New Ri chmond , WI
the sum of $ 1 q n no() - 00 __ in the following manner: (a) $ 10 , 000 on
at the execution of this Contract; and (b) the balance of $ 1 R n , 000 . 00 , together with interest from date
hereof on the balance outstanding from time to time at the rate of F i "h L 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 $17,900.00 each.
A Warranty Deed will be given for each of these lots upon payment of the
original purchase price (stated above) of each lot, plus accured interest.
Provided, however, the entire outstanding balance shall be paid in full on or before the 29th day of Mar 2001
19_ (the maturity date).
Following any default in payment, interest shall accrue at the Tate of --- 8 - % per annum on the entire amount in default (which shall
include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance).
Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably anticipated annual taxes, special
assessments, fire and required insurance premiums when due. To the extent received by Vendor, Vendor agrees to apply payments to these
obligations when Such
g due. amounts received by the Vendor for payment of taxes, assessments and insurance will be deposited into an escrow
fund or trustee account, but shall not bear interest unless otherwise required by law.
Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any amount may be prepaid
without premium or fee upon principal at anytime after ' f.' i ` 1i 3 0 , 19 U?1J?thkl� tY1CIlC Y 9f>4i 9#
�3{ 1H >$t}�JO1#t1€OkTlbXia'l�d{1�rXX
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 pay the cost 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 ' 1999
Cross Out One
L:1ND CONTRACT — Individual and Corporate STATE BAR OF WISCONSIN Wisconsin Legal Blank Co_ Inc.
po rate Form No. 11 — 1982 Milwaukee. Wis.
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ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
ST. CROIX COUNTY GOVERNMENT CENTER
Ilxxnrnrnr --
r. 1101 Carmichael Road
Hudson, WI 54016 -7710
(715) 386 -4680 Fax (715) 386 -4686
July 24, 2000
P.C. Collova Builders
Attn: Laurie
705 County Trunk E
Hudson, WI 54016
RE: Septic Inspection for P.C. Collova located at 2117 135 Street,
Prairie Flats (Lot 15), Town of Star Prairie, St. Croix County, Wisconsin
Dear Laurie:
A septic inspection of the above referenced property was conducted on July 14, 2000.
This property is located in the SW % of the SE '/4 of Section 13, T31 N -R1 8W, Prairie Flats
(Lot 15), Town of Star Prairie, 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.
Since , oy%. --5
Jon Sonnentag
Zoning Technician
/sm