HomeMy WebLinkAbout038-1088-40-200 Wisconsin Departmtnt of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building
INSPECTION REPORT Sanitary Permit No:
463308 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: City Village X Township Parcel Tax No:
P.C. Collova Builders, Inc. I Star Prairie, Town of 038 - 1088 -40 -200
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
��p \ cs 21.31.18.363B20
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 0 3 r4" Benchmark
Dom- ►+�-
160 664-o aF 5� �; O •S(o c 18 '
Aeration Bldg. Sewer �, 1
Holding St/Ht Inlet
9 5. - 1 93.E
TANK SETBACK INFORMATION St/Ht Outlet 13 , 3
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \
Septic p / 3� -7 1 -7 0 _ Dt Bottom
Dosing / Header /Man.
Z.1
Aeration Dist. Pipe q�
( I Z _C v
Holding Bot. System �_ R/
Final Grade 9G ��
PUMP /SIPHON INFORMATION ? j - Z-` T /
Manufacturer Demand St Cover
GPM , (p 1 1 - 7-7
Model N er
TD Lift Friction Loss System TDH Ft
Forcem ILength D' Dist. to Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width / Length / No. Of Trenc PIT D MENSIONS No. Of Pits Inside Dia. Liqu pth
DIMENSIONS 3 j `Z, Z 70— „ � \
SETBACK SYSTEM TO 10 P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
TypeC�
fO1jw� ` � / Z UNIT Model Number
:��� System:
DISTRIBUTION SYSTEM I vii" l e c, e � Z— cc,
Header /Manifold Distribution x Hole Size x Hole Spacing Vent }o Air 5n,ak e
I L J // Pipe(s) \ \ \ Y r
Length X Z Dia T Length Dia Spacing \ ,^
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only -e
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed /Trench Center �l�!` Bed/Trench Edges \ Topsoil \es No Yes Nu
COMMENTS: (Include code discrepencies, persons pres ent, etc.) Inspection #1: / / Inspection #2: / /
Location: 2065 Cook Drive Star Prairie, WI 54 (SW 1/4 NW ff 1/4 21 T31 R1 8W) NA Lot 15 Parcel No: 21.31.18.363B20
�o+h v 5 GIB d— ., e< k�
1.) Alt BM Description = J ACS
2.) Bldg sewer length = 1
- amount of cover = //
L i�
Plan revision Required? Yes No
Use other side for additional information. - -
Date Insepctor's S' ature Cert. No.
SBD -6710 (R.3/97)
E and Buildings i vision Co'r"ry �� ��O II 201 W. Washington Ave., P.( 1. x 7162 S Madison, W1 53707 - anitary Permit Numbec (to be f A in by Co.)
608 266 -3151 3 30 iscon ►s - L mentof Ccinrr
Depart Application 0 y ®(p
S a: nit try Perm APP l information you Pr'* ie ject Address Cif WOW Mm mung sddten)
In accord it t'� 93 Z se l conduY P Code Law• �`�'.
` v
L Appli�on'nformadio t
,-I lease Print All Infotrmation d Blodt #f
�--- parocl �
— X3
propeay Oyvmc's N -�
b N r , p ml7C1 ty ioeation
pmpertytDwoer'a gAd. Lvss ZONING OFFICE'
Phntte Numt u �� 3(n 3 Qj " 20 )
Cod° �� (
Trp
City, State 07 T /_-1-- N: or •
(� 5 Otte Nttmber
la
IL a of Building (chef 1; all that apply) ']� 4d SZ W
VIM
owus
PoblidCotntttercial - Iksc be [
State Owned - Dtzcribe U.
I1L Type of Permit: (Clr dy one boz on lieu A. Complete line 13 if applic able) O M to Es�ti, sysoem
A. f Plaoeatettt System TreYmoent/Holtiing Tank Rc tlaoemeru Only
Sy - List previous permit Number at Data issued
Change of Petmil Transfer:o New
B, permit Renewal i croit Revision plumber Owner
Before Ep'u ntion
IlV. of pOWTS t m: ;Che of su
ck all that s 1) Z At a Single Pass Sm Filter
?A in. of suitable soil Mound < 24 in. itabiv soil Sand I ca
_p1essuriwd yu Mounds Aerobic Treatment Unit Recirculating
Bolding Tads Peat Filter
Constructed Wedand p sstr ltd is Gravel less Pip Other ( lain)
C'hau� 17np T S— _
S c Ivied u lilt • ey :)h
nrr nt A rye ormatlon: Area Requited � st) Dispersal Area Proposed � S
Dis
Desiga Flow tSPd) Dtxi ; s So AppyeaCOn Rase (gPdsD
_ Site to Aber Plastic
.p in T Number M2nofa toter �� Constructed Glass
Tank into
I. a [ia1loas of Units W / ,t� /QD
Nev :iiZ 1
Tao c ranks
Septic or Koons Tack
Aecobie Trsataent Udr
DosinS � Ation of the POW TS shown on the attached tans
e oasibility for ia4tal - — Buda= pb umber
VII, onslibility Stab : net - I, thawderai ° Mp/i iPRS Number �/ J � /
Plumbers
Plumber's Address (Streek t : :ty, :! ate,
at e I tt U e Onl Date issued LMW Arad
VDI. Coon /De Sanitary permit Fa (tnduda C ttxmdwau:c
Approved //} Surcharge Foe) 1 3 , CO x
_ casott for — ✓
IX. Conditions of Appr c verb teasona for Uisappro
SYSTEM OWNER:
1 Septic tank, effluent filter and
dispersal cell must all be serviced / maintaiMg
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable code /ordinances
Attach coanplete Plans
(to the Couch' tt *) iw the � on papa' oiot kss than 02 s It inches is siee
PLOT PLAN
PROJECT P.C. Collova Bldrs. Inc. A SS P.O.Box 489 Somerset Wi 54025
SW 1/4 NW 1/4S 21 /T 31 N/ W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 2 BEDROOM 3
CONVENTIONAL X00C IN- GROUND ESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers none
hk BENCHMARK V.R.P. Top of PL Wood Stake g ( ASSUME ELEVATION 100' Filter Zabel A -100
❑BOREHOLE O WELL *H.R.P. SameasBenchmark Alt.B.M.
SYSTEM ELEVATION 93.6/93.5 3' below qrade @ B -1
op of Survey iron @ 97.3'
246P.L.
Well is to meet all Plans Designed Using
setbacks required by Conventional Powts
WDNR Manual Version 2.0
Pro 3
J Bedroom
` Cook Drive House
°o
W Q O 2 -3'X 69' Cells with >3' Spacing
B -5 80' Ventsl0'
25
Vent B-4
>6„ Standard Biodiffuser 50'
of Cover Leaching Chamber B-3
with 3 1. 1 ft2 of Area 51
6' Long 11 "
3 491 Grade at System Elevation 80' _ 0 /
�M
285' Property Line
c
op
PLOT P N
PROJECT P.C. Collova Bldrs. Inc. Au SS P.O.Box 489 Somerset Wi 54025
SW 1/4 NW 1/4S 21 /T 31 N/ W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 2/3/05 BEDROOM 3
CONVENTIONAL XXX IN- GROUND ESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers none
BENCHMARK V.R.P. Top of PL Wood Stake = g„� ( ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark Alt.B.M.
SYSTEM ELEVATION 93.6/93.5 3' below grade @ B -1
� 0 — p of Survey iron @ 97.3_'_
- 246P.L.
Well is to meet all Plans Designed Using
setbacks required by Conventional Powts
WDNR Manual Version 2.0
Pro 3
J Bedroom
Cook Drive House
°o
15'
O 25 2 -3'X 69' Cells with >3' Spacing
B -5 80' Vents 10'
Vent B_4
15'
>6 „ Standard Biodiffuser 50'
of Cover Leaching Chamber B 3
with 3 1. 1 ft2 of Area 15'
r6'Lng
11"
3 411 Grade at System Elevation B -2 80' - 0 10'
�–
7B. NM.
285' Property Line
Wisconsip. of Commerce SOIL AND-019 ]EVALUATION
Division of Safety and Buildings Page of
Bureau of Int *jrated Services in accordanc, vtiiE�.)C- vmm 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 112 x 11 inchq�i pine n must County M
include, but not limited to: vertical and horizontal reference Point (t31d�), direction and
percent slope, scale or dimensions, north arrow, and location a d dstance to,.neWest rood. - • Parcel I. D. #
6 ..
APPLICANT INFORMATION - Please print all infbirmation. FRevi ed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.64 (1) (m)).
Property Owner Property Location 0
Gt 4 /�l1t ` � � Govt._Lot 1/4� /4, '� T _31,N,R/ E (�
Property Owne s Mailing Address X Lot # I Block# Subd. Name or CSM#
City State Zip Code Phone Number ( Nearest Road
❑ City El Village j " _Town .�
New Construction Use: residential / Number of bedrooms Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow � gpd Recommended design loading rate 7 bed, gpd/ft ! ° trench, gpd /ft 2
Absorption area required _ bed, ft .Z trench, ft 2 Maximum design loading rate � �bed, gpd /ft � trench, gpd /fiz
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design /site considerations
Parent material ®4J 4 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 1 [3 S ❑ U .LAS ❑ U -®'S ❑ U I .TS ❑ U I ❑ S IM U ®''S ❑ U
SOIL DESCRIPTION REPORT C ow
Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft
in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots
Bed ,Trench
�g
Ground 8 ��t�L /ice •� -7.
gg elev. T
Depth to
limiting
factor
Remarks:
Boring # / 1 _
Ground
lev.
��ft.
Dept to
limiting
factor
> in. Remarks:
CST Name Please Print) Signature Telephone No.
/.
Address Date CST NL aber
OIL DESCRIPTION REPORT
PROPERTY OWNER y �� �� Page of
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots MV
` in.. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. p Bed , Trench
/ s
Ground r g ,
elev.
Depth to
limiting
fact pr
�L
��in.
. Remarks:
Boring #
loll 10
Ground
eleV
ft.
Depth to
limiting
factor
in.
Remarks:
3 . Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /fly
in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh Bed , Trench
Boring #
.
X.
-�:
Ground
el v
y�ft.
Depth to }
limiting
Z -� in. Remarks:
Bor g #
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
SBD -8330 (R.9/98)
Soil Test Plot Plan
Project Name Vladimir Bydzovsky Byron Bird Jr.
Address 2052 Cook Dr. A tc-1-1 /o
Somerset Wi. 54025 CSTM 20527
Lot 15 Subdivision --- ------ Date 4/20/0
SW 1 /4 1/4S T 3 1 N /R W TownshipStar Prairie
Boring 0 Well PL Property Line County ST. CROIX
,BM or VRP Assume Elevation 100 ft.top of wood PL stake
System Elevation 93. H.R.P. PL line stake
Alternate B.M. top of PL pipe y) ;3 ls� �1�. Alt.
B.M.
Cook Dr.
246'
184'
Cook PL
Dr.
B5 80' B4
Pri.A 10'
15'
,
B3
Rep. A 15'
285' 80
B2 ' B 1 10,
PL B.M.
II
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
tion # . If system fails, determine cause of failure, use � `,ornate at6a and install new
system in tested replacement area.
Option #2. Install system at a lower elevation, by removing chambers, removing biomat,
and install new system.
Option#3. No adequate area is suitable for replacement area, and system elevation
cannont be lowered. Install holding tank as last resort.
3. Replace any other failing components as needed.
Plumber: Shaun Bird 715- 246 -4516
St. Croix County Zoning 715- 386 - 46 86
Pumper Tom Mondor 715- 246 -5148
Shaun Bird #226900
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer P. C . C6 11(1 60 3 A a� J� C
Mailing Address PO LnX 9 O )nn r l S 4 L 1 5q 0 0 s
Property Address J 0 (o 5 06n k O< . (Vne ;e Li 1 5 0 ogs
(Verification required from P anning Department for new construction.)
C� I �� (
City /State �Jf�Yr1Ql �J Parcel Identification Number
3(. 3 g - Zo)
LEGAL DESCRIPTION
Property Location 3 W '/4 , A) W '/ , Sec. 1 , T 3 1 N R I � W, Town of 156 A I'C 1' f
Subdivision C On k A K , Lot # ) 5 .
Certified Survey Map # C¢ a L 5 a (, p , Volume l , Page #
Warranty Deed # Volume Page ("
Spec houses U no Lot lines identifiable yes U 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 County 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 wastewater disposal
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
rtmcrtt within 30 days of the three year expiration date. P. C. CO LLOVA '- � L ERS, INC.
(715)247 _2742
P.O. Box 489 //�
yies — - " a SIGNATURE OF APPLICANT SOMERSET, WISCONSIN 54025 DATE
OWNER CERTIFICATION
I/we certify that all statements on this form are true to the best of my /our knowledge. Uwe am /are the owner(s) of the
=d described above, by virtue of a warranty deed recorded in Register of Deeds Office.
P. C. COLLOVA D'; '"'L ,, ; S, INC.
(715) 247 2742
SIGNATURE OF APPLICANT P.O. Box 489 DATE
SOMERSET, WISCONSIN 54025
* * * * ** Any information that is misrepresented 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 and a copy of the certified survey map if
reference is made in the warranty deed.
J 2 19 9 P 12 6 7 1 6 4 3 5 1k
STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
Document Number I ST. CROIK CO., WI
« RECEIVED FOR RECORD
This Deed, made between Vladim ;r Bydzovsky and Martha
z husband and wife
Byd zovsky, , 04/08/2003 03:15PH
WARRANTY DEED
EXOPT #
Grantor, and P. C. Collova Builders, Inc. REC FEE: 11.00
-- TRANS FEE: 210.00
COPY FEE:
CC FEE:
PAGES: 1
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the
following described real estate in St. Croix County,
State of Wisconsin (if more space is needed, please attach addendum):
Recording Area
That part of SWIM NW 1/4 Sec. 21- T31N -RI8W described as follows: Lots Name and Return Address
(Dind 17 of Certified Survey Map recorded in V olume 14 of Certified —' KRISTINA OGLAND
Survey Maps, pag 3871, as Document No. 624526. ESTREEN & OGLAND
304 Locust
Hudson, WI 54016
038 - 1088 -40 -200 & 038 - 1088 -40 -400
Parcel Identification Number (PIN)
This is not homestead property.
04) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
VA
Dated this day of March 2003
* * Vladim ;r Bydzovsky
b
* * Martha Bydzovsky
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Vladimir Bydzovsky and Martha Bydzovsky, STATE OF WISCONSIN )
husband and wife, ) ss.
County )
authenticated t isw day of March z- Q 2003
Personally came before me this day of
the above named
« Kristina Ogland
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing
(If not, instrument and acknowledged the same.
authorized by § 706.06, Wis. Stars.)
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristina Ogland Notary Public, State of Wisconsin
Hudson, WI 54016 My Commission is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) •)
« Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Company, Fond du Lac, w1
STATE BAR OF WISCONSIN 800655 -2021
WARRANTY DEED FORM No. 2 -1999
RONALD F
JOHNSON FILED
6-1 1 t�� Ol JUN U 8 2000 ►
APA E'R Y ,w�
Wil3 �ay' S o� KAMLEM N. WM-&f
vw�!' �� _ �1 M �O ReOist�f of Deeds
f 9, •• 6 %CraxCo "WI
#49 •.ERTIFIED SURVEY MAP
Located in part of the Southwest Quarter of the Northwest Quarter of Section 21, Township 31 North,
Range 16 West, Town of Star Prairie, St. Croix County, Wisconsin.
Prepared for and at the request of: LE Cont Section Corner Monument
DE
Vladimir do Martha Bydzovsky of Record
2052 Cook Drive • Set 1" x 24" Iron Pipe weighing —
Somerset, W1 54025 a minimum of 1.13 pounds per
linear foot.
Drafted by. Ty R. Dodge S / `
O Found 1" Iron Pipe P N O
1>
n I
ul
U JI I gl NI Y C00Y DRY PIE _ 59
a:I ,I S89'17'52 "E 128.91'
T N V =101 f � ?i \_
i / W
I Vii' �i \1 LOT 15 T
of ° I i TOTAL AREA: w N TH ~
ai E = I �I S rd ��yy
u a + I <I-1 'n 1.28 ACRES
to C nm pl'il� I 1z g
e0 W
o f c 3 Fo1
I31a1 LINE O
°'o I d g(/ILWr1G R
J
AC W) r r
a o
a, * __
v f (100' FRS r I
�r ao I Z
NB9 "W 284.75' °
.-a a y l I
E ., o ° of I - I cli
4b,
od J ' 1 m LOT 76 <� - -- Z
1 ° � TOTAL AREA:
t o o° I 1 N 58,365 SO. FT.
1.34 ACRES I N 3 I
c q
°0 2m a 0� I n i wI m
N W i J I �'
M
na
I o
y,r as a
r--- C N
a O a_ CO
zr 0 6 `i I ° i <
=LOT 17 0'
TOTAL AREA: ►PPROVED
Qi o 70,749 SO. FT.
1 ' ST. CROIX COUNTY
2 - -�_- 1 ACRES .� PlanMrgZOninpandParka
CD
N 5 SO. FT. N JUN U 8 2000 ,!
1.33 ACRES I z N
I ' 1 If nO1 rsaorded within 30 days of \ 6
4 I 1 i , R -O -W t\ 41R{1KlVi) d8te &WOvai shalt be �H I
J I _ N89'10'57 "W 279.04'_ _ — — wA � v W
Ln 1 r
S89'11'33'E r 283.81' �� F G T.H. C" S89'11'33'E 4721.57'
�\ r
N89'1 1'33'W 278.39'' —
\ i C. T. H ' C a EAST - If£ST 1/4 L /NE
- - - 589'11'33 "E - - - -- 5283.77' - - - - - -
JOB #99070A U N P L A T T E D - L A N D S
Prepared by. 100 0 100
A & E
LAND SURVEYING & CIVIL ENGINEERING GRAPHIC SCALE
Phone No_ (715) 246 -4319 SCALE IN FEET: 1 inch = 100 feet
109 East Third Street, P.O. Box 325 BEARINGS ARE REFERENCED TO THE EAST -WEST 1/4
New Richmond, WI 54017 LINE OF SECTION 21, TOWNSHIP 31 N., RANGE 18 W.
Sheet 1 of 2 WHICH IS ASSUMED TO BEAR S89'11'33 "E_
Vol. 14 Page 3871