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HomeMy WebLinkAbout038-1088-40-300 I Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430014 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: I City Village X Township Parcel Tax No: P.C. Collova Builders, Inc. Star Prairie Township 038 - 1088 -40 -300 CST BM Elev: Insp. BM Elev: BM Desc' tion: Section/Town /Range/Map No: 1j 9 (, tJ1•a� 21.31.18.363B30 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / Benchmark Dosing Alt. BM ud 2L ! S — 1 0/ Aeration Bid Sewer q 6 7, Wo Holding St/Ht % *4 4 0 q S d G� TANK SETBACK INFORMATION SUHt Outlet /o" / TANK TO P/L WELL BLDG. Vent it Intake ROAD Dt Inlet f Septic Dt Bottom Dosing Header /Man. -7.0 9 Aeration Dist. Pipe Holding Bot. System 1 O OP , Z PUMP /SIPHON INFORMATION Final Grade Manuf'd turer Demand StSt C p�� I GPM Model Numbe TDH Lift Fric ' Los System Head TDH Ft Forcemain L Dia. Dist. to SOIL ABSORPTION SYSTEM i BEDITRENCH Width t Len No. Of TrencJyps PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREA LEACHING Man er• INFORMATION Ty Of System: CHAMBER O { 'f� ` 1 �" UNIT Model Number: �J DISTRIBUTION SYSTEM Header /Manifol Distribution Tole Size I x Hole Spacing Vent to Air Intake / �D Pipes) 'L (� Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over "1 Bed/T yy Depth Over xx Depth of xx Seeded /Sodded 1 xx Mulched Bed/Trench Center rench Edges Topsoil Yes [ , No Yes '� ,_l No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #11: 1 ,0/ #2: / / Location: 2061 Cook D . rriiv^e Star Prairie, WI 54026 (SW 1/4 NW 1/4 21 T31 R1 8W) NA Lot 16 f n � Parcel No: 21.31.18.363B30 1.) Alt BM Description 2.) Bldg sewer length =36 - amount of cover =� / Plan revision R Yes f No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Sign ture Cert. No. r Softy nd BdIdmv Division cootY 1 201 W. W Ave, PA Box 7!!982 -) / • Oro ar I53 7082 S= t WFcuntl (tobe to byCa) 1 - 0" 1 13COA DePortmeM Of Ct»n: W08 (� Sanitary Permit Application �°° �° Ibm acc d wf ctrtmt WM. DVSs. Aim. Code, pe,sood mf vnMW e _ may bo used fw ncos&uy pumasc+ Y X—. SISAq x -) RECEIVE rn"k r�fd�t tbsa L AP bvfwmdlm— PamPrMAOIOin- os 5?, o&/ i yowmies # tat# Block# hopexWou wesMaW ZONING ')FF = ±CF ) ci StIft J rApcode Pboco mtbac %&—" SeetiGn Tnmofg (dinkONOM ) �4�) S buu:e cSUrb,aIho orZrka* — NosbaofBe&oo= U " W&.2 y 6 ❑ Pubft Coamm mid —muse Der ©samsovvnea— nesc�euse -z a IfZ 1�ypr: of Pam (L'ieeJc oaljr eae its o+tt lie a Comae lie s �appe) " A- r�vsystm. �l � Holdia�gl7eok�i fl meaalo�9ystmt List B. ❑ pamitBtmemml o PMUkRaVWM ❑ Cbmwof °pumitri�sfaarlaa► Pievioua P�eto NmtbaasdIIaueltaeed Befeiel a rhumba 011ow N: of POWI'3 t;�eit t NM—p edL►-rAama [JMo=d2 :2ieie.of soB aMomtaC24ia.of�ablewff ©at aue ❑su�er�sSMdf la ❑ fl r kr,,,Md C1 HeberTa * ❑ pat F w ❑ Aerobia Tfrastm=A Ub t ❑> - Madta Fite Cbowbw ❑ UW ❑&av&IM V. ilk Saii/+pn�at;OnRate( �a>terptimd(s� Ptopowd(afl sett 4(-1 A �? ..: Pwft sted lba 7 �— pbafic VL Tad! b& Capocky in rota! Nmsba Glow c, clams of unin Tasks Sep(+�arTade A �tuna > .f gtero%*" abtnn oa me atged phM faunow lvaame(Pr>) B ftOW ZZ De ft " PhombalsAddrM (Smock Ow. gift Y6 Uft 6 A" ° � © Q tat�+�em11 �neo�al for Dkopprovol I'j1ar . S3 . q 3 - -1 Affai ptasi� C�b�? � i°P'�eetksdmEllZ :ll aha6e SBD -6398 (R. O8102) PLOT PLAN PROTECT P-C: Collova Bldrs. Inc. f/1 RESS P.O. Box 489 Somerset Wi 54025 SW 1/4 NW 1 /4S 21 /T 31 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5/19/03 BEDROOM 3 CONVENTIONAL XXX IN- GROUND PR SURE 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 chamber 22 BENCHMARK V.R.P. Top of Wood PL Stake ASSUME ELEVATION loo' Fitter Zabel A -100 ❑ BOREHOLE O WELL sH.R.P. Same as Benchmark SYSTEM ELEVATION 92.8/92.7 4 , below grade 284' Property Line Vent >6 „ Standard Biodiffuser Plans Designed Using of Cover Leaching Chamber Conventional Powts with 3 1. 1 ft2 of Area Manual Version 2.0 6' Long 11 " 3 „ Grade at System Elevation Pro 3 Bedroom p House — 4o .e_,a_r�' N ' O 1 25 O T 2 -3' X 69' Cells with >3' Spacing 25 B -2 80 , B -1 10 , 10 ents Vents 15' B -3 50' 15' B-4 0 , B -5 B.M 282' Prop Line 1 V ,� y PLOT PLAN PROJECT P.C. Collova Bldrs. Inc. AADDRESS P.O. Box 489 Somerset Wi 54025 SW 1/4 NW 1/4s 21 /T 31 N/ 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 A DATE 5 BEDROOM 3 CONVENTIONAL XXX IN- GROUND PR SURE 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 chamber 22 IL BENCHMARK V.R.P. Top of Wood PL Stake ASSUME ELEVATION loo' Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark SYSTEM ELEVATION 92.8/92.7 4' below grade 284' Property Line Vent >6 „ Standard Biodiffuser Plans Designed Using of Cover Leaching Chamber Conventional Powts with 3 1. 1 ft2 of Area Manual Version 2.0 6' Long 1191 34 Grade at System Elevation .. 1~ Pro 3 a Bedroom House N N Q 25' 0 0 T 2 -3' X 69' Cells with >3' Spacing 25 B -2 80 , B -1 10 , Vents Vents 15' B -3 50' 15' B -4 B -5 B.M * 282' Pro pert Line 1 6 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 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer P. C. Collova Builders, Inc. Mailing Address P O Box 489 Somerset, WI 54025 i Property Address 0 J _ )(DV_ (Verification required from Planning Department for new construction) City/State VeA- ?\i Chi cA-)T—' Parcel Identification Number 493S 'lDfg' %Q 6 6 LEGAL DESCRIPTION Property Location l,J ' /4, l,� '/,, Sec. l . T N -R6W, Town of J zi-Ay Subdivision 1 5 V I - CC �R �ot # f � Certified Survey Map # ( o� ��,� Volume Page # Warranty Deed # _7( (v �5 Volume 2- 1 . Page # r 2 9 Spec house 0 yes ❑ no Lot lines identifiable4yes ❑ 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 masterplumber, journeyman plumber, restricted plumber or a liceasedpumper verifying that (1) the on -site wastewaterdisposal system ism proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, 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 f e e ye 'on date. P R S SI TURE 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 pe U cribed ve, by v' a of a warranty deed recorded in Register of Deeds Office. � "A4. SiGNATiAM 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 a 4 V1F cousin Qepartment of Commerce $OIL tE E`VALUATION 3 Division of Safety and Buildings k Page of Bureau of Integrated Services in accordre Ith frC�fT1,�.09, W Adm. Code ,. Attach complete site plan on paper not less than 8 1/2 x 11 incheg in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), 046tion and percent slope, scale or dimensions, north arrow, and location and distance to neorestroad. Parcel I. D. # " APPLICANT INFORMATION - Please print all information. Rev' a Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Own j Property Location vt. Lot 71ac / % Go �, 1/4 G /1/4,S ` T N,R E ((W Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# City tate ,Zip Code Phone Number 15� / ❑City Village f` -" Town Nearest ad 5"ew Construction Use: residential / Number of bedrooms Addition to existing building 0 Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate - 2 bed, gpd /ft ` D trench, gpd /ft Absorption area required _ t? � bed, ft 2 _Z 47 0 trench, ft 2 Maximum design loading rate bed, d /ft g g �_ gp trench, gpd /ft Recommended infiltration surface elevation(s) �' ft (as referred to site plan benchmark) Additional design /site considerations �� v Parent material Flood plain elevation, if applicable S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system s ❑ u j - S ❑ u S ❑ u s ❑ u ❑ S �u ❑ s $`u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench Ground elev. Depth to limiting G� factor in. �• Remarks: Boring # / loll 0 0 rll� r Ground Depth d' limiting fact _>44—in. Remarks: CST Name (Please Print) Signat r 'y Telephone No. L-' d/� /`j ./�✓ ire Address Date CST Number ' �`, 0� DESCRIPTION REPORT PROPERTY OWNER Page of PARCEL I.D.# Boren # Horizon Depth Dominant Color Mottles Structure 2 Boring in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench -42 /. `, G - Ground elev. Depth to limiting facto !.f Remarks: Boring # , Ground el� eye,; ft. Depth to limiting fa for S �`7�in. Remarks: Horizon Depth Dominant Color Mottles Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench Boring # g 'r" '-' Ground elev. De�h to limiting % o 5 z& in ' Remarks: Boring # Ground elev. ft. Depth to limiting factor ' Remarks: SBD -8330 (R.9/98) V .- ' Soil Test Plot Plan Project Name Vladimir BydsOvsky By n Bird Jr. Address 2052 Cook Dr. Somerset Wi. 54025 KTM #220527 16 - - - - -- Lot Subdivision Date 412010o SW 1 /4 1/4S T 31 N /R W TownshipStar Prairie Boring Q Well PL Property Line County ST. C R O IX ,BM or VRP Assume Elevation 100 ft top of PL wood stake System Elevation 9 H.R.P. P sta ke Alternate B.M. top of PL pipe Elev 97.3 284' PL 2 ' PL Al. Cook Dr 206' LNsB.M. 100' BI , Pri. A 15' B3 x_50' Rep. A 15' 80 282' PL B5 ' B4 10' 10' B.M. J. 2 19 9 P 12 9 7 1 6438 STATE BAR OF WISCONSIN FORM 2 • 1999 KATHLEEN H. WALSH REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between Thomas Greene and Janice R Greene, husband and wife, 04/08/2003 03:15PH WARRANTY DEED EXERT N Grantor, and P. C. Collova Builders, Inc. — _ _ _ REC FEE: 11.00 TRANS FEE: 105.00 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 what art of SW 1/4 NW 1/4 Sec. 21- T3IN -RI8W described as follows: Name and Returq tWISTINA UV"- Lot 16 f Certified Survey Map re orded in Volume 14 of Certified Survey ESTREEN & OGLAND Maps, ge 3 87 1, as Document No. 624526. 304 LOCUSt Hudson, W1 54016 038- 1088 -40 -300 k _ Parcel Identification Number (PIN) This is not homestead property. CK) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated thi day of March 2003 QLZ dL + * T as Greene + Janice R. Greene AUTHENTICATION ACKNOWLEDGMENT Signature(s) Thomas Greene and Janice R. Greene, husband STATE OF WISCONSIN ) and wife, ) ss. 0.7 County ) authenticated t is day of March 2003 VZ Personally came before me this day of :r — the above named • Kr istina 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. Stats.) 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. Irdormatlon Proressionais company, Fond du Lac, vVn WARRANTY DEED STATE BAR OF WISCONSIN at>as55•�ort FORM No. 2 - 1999 RONALD 'f !� JOHNSON 1 FILED e AfNERY ERR 0' JUN U 3 2000 ► Wi$ /' � Sa � KATHLEEN H. V ALSH % ti 6 ftislzrofDeeds 9 N '• St. Croix 1i0., WI ERTIFIED SURVEY MAP Located in part of the Southwest Quarter of the Northwest Quarter of Section 21, Township 31 North, Range 18 West. Town of Star Prairie, St. Croix County, Wisconsin. Prepared for and at the request of: IFGENO: OWNER: 0 County Section Corner Monument Vladimir & Martha Bydzovsky of Record 2052 Cook Drive • Set 1" x 24" Iron Pipe weighing _ Somerset, N 54025 a minimum of 1.13 pounds per linear foot. Drafted by. Ty R. Dodge 0 Found 1` Iron Pipe N 0 �' E� y Y Zi I Ne P�" 0IF. i F w v --- rn x101 I a NI ft COGiK OYP/4£ j ug a z a a I -1 wl I < ai 1 o ° Di0 I JI S89 2 129.91' �- " ! Uj z. o, V s I � - - - ( n le i ' LOT 15 ' ° - ° .° I 6 1 �1 I TOTAL AREA: °' E u'e I �i 55,852 SO. FT. NO TM !° E o o I o ��� n 1.28 ACRES N 5 am o X01 < m $ E c i I I3 1 3 \ SACK LINE O I a o rn p G R-O i i BUILDW -W � F ROMI g C m I (100' md I i a o N8910'57`W 284.75' °I z y l I o �c zi� '' �°'I j oI _ ' . 2 — — <1 -JJ' pr 1 01 V i �I I 1 t I LOT 16 c o. u ° TOTAL AREA: ' 1 'a o 0 , o I 1 0 !d 58,365 50. FT. ° m•° I w 04 i 1.34 ACRES ° � ^N WI I I h l •f �� �N a3 0 o I � L 0 v < I j I \ N89'10'57 "W 281.90' 01 o J I I \\ U � N c a x 1 i ° z r °ci — zj I jl 1 I ° :LOT 17 19 70 7 TOTAL AREA: I PPROVED a 2� I ° 1 62 ACRES FT •� o �T.CROIXCOUNTY 'n • ......... ........�.. to Z�irq and Parks Comm tl I N AREA EXC. R--O -W N R N 57,776 SO. FT. JUN 0 8 2000 V 1 4 � 1 I 1.33 ACRES N If a N a I1 2 U nM01 recorded within 30 days of 6 \ VW date apllrovai shah be v j R -O-W J I _ _ N89 10' " W 279.04'_ _ — — �d vokf I in S89'11'33 "E ! 283.81' i F CT.N. C' I ` \ —, ��° - 589'11'33 "E 4721.57' I N89 11'33 "W 278.39' 1 H 'C ' EAST -14ES7 114 LINE U N P L ±-L T E D LAN D S JOB �99070A - 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'I1'33`E. Vol. 14 Page 3871 C w 0 d c O A X O Z Vl Z O A p (p N O CL O O 7 • m fD - y W V _ (D O A @. oo OD O O I C. W \ , w IP w w to a CIO 00 ~� O g C C = p cn D a 3 N I a PO O rn m Z N _ 0 o 8 n r m O w x (A c � • I v RC .� 0 0 00 0 W \ J l! a co to M "0 G C/,Q �oc� c w N A c, W OD !' N p D 7 i N. c I � a N CL j' I •• 00 T Z O i► Z 3 °D y Z A W ft I I Q o — Z I fi ft N O O W 1 O � CD O ry � 4 ti WW O L ~ y ti