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HomeMy WebLinkAbout038-1221-03-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 430360 0 GENERAL INFORMATION 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. Star Prairie Townshi CST BM Elev: Insp. BM Elev: BM Description: Section own /Range /Ma o: eS T il?�, • 3t.31.18. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 't_� �- ,A /,c.>C<::�> Benchmark y'� /'07- I Dosing G Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet 3 TANK SETBACK INFORMATION St/Ht Outlet 7 ` Q g•� TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ Septic r Dt Bottom Dosing Header /Man. Aeration Dist. Pipe I C1 3 Holding Bot. System 5 PUMP /SIPHON INFORMATION Final Grade /S 3 Manufacturer Demand St Cover Model Nu ber TDH Lift > FiTc Loss System Head TDH Ft Force n Length Dist. to wen S IL ABSORPTION SYSTEM BEDITRENCH Width Length _;, No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS — - - tl ca1v,ti ` ^. SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manuf cturer: INFORMATION CHAMBER OR 1i • v c( Type Of System: T i � Model Number: _, DISTRIBUTION SYSTEM c1h Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake 1 �! 1 Pipe(s) �.._ �C Length Dia Length Dia Spacing_ SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over t.. f 5 '' Q ,� }„ Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges ` Topsoil C t+�17 f Yes ( No Yes No COMMENTS: (Include code discrepencies, ersons p esent etc.) Inspection #1: rb /24/_6 Inspection #2: Y. r , w e W114 Rte-- -. Location: 1892 90th Street Somerset, WI 54025 (NE 1/4 32 T31N R18W) Prairie Pond Breaks Lot 3 Parcel No: 32.3 .18. 1.) Alt BM Description= Cy ;ate c`b � v t_ 5 �,,.� �•�/ ' 3� V,,, e _ c 9 ^ Z" C h p�2✓ 2.) Bldg sewer length - amount of cover = [ f Plan revision Required? °:J Yes No - - -- - ��' Use other side for additional informa ' n SBD -6710 (R.3/97) Date nsepctor s Signature Cert. No. 09/09/2003 TUE 09:15 FAX 715 485 9246 POLK COUNTY 002 Safety and Buildings Division Colmty / C lVisconsin 201 W. V-+'ashington Ave., P.O. Box 71(2 7 AF W Madison, WI 53707 - 7162 S an- Peron -t Number (to be f111od 1n I: -.? Co.) De artment of Commerce ��°� Sanitary Permit plication State Number in accord with Comm 81.21, Wis. Adm. Code. t o P'�vide may fx used for secondary purposes Pr- y ls�( MO Project Address (if different than mailial .address) 1. AppUmdon information —Pleme Print AU Inform ST. CROIX COUNTY # I Z -6 ZO NING Property Owner's Name Parcel N g i i lock o P (- e //n ✓ Property owner's Mailing Address Pro)mty on � c r �. � v., section ) City. Stare Zip Code Phone Number T 3 1 1t[ __ 11. Type of Building (check alt that apply) z a s � 1 of 2 Family Dwelling - Number of Dedmoms �? Sutrdiviatat fume CSM' umber ❑ Public /Commenial - Describc Use ❑ State Owned - Describe Use ncity_ ❑vii ownsltip l III. Type of Permit: (Check only one box on litre A. Complete line B If applicable) A. cw Syatera d Replacement System ❑ 1'rrulmertUHoldiogIank Replacement C my ❑ Other Modit)cat -on to Existing S yste l t B. ❑ Permit Renewal ❑ Perm it Revision ❑ Change of ❑ PcMit Transfer to New List Previous Prnnit Number and Date I. suet) Before Eap-ratioa Plumber Owner IV. T of POWTS Sys tem Check all that a pply) on - Pressurized in- Cnound ❑ Motmd >- 24 in. of suitable sal ❑ Mound a 24 in. of suhabk ; oil ❑ A( -Grade ❑ Sittg)e Pass Sand Filter ❑ ConsMwted Wetland ❑ Pressurized in Ad ❑ Holding Tank ❑ Peat Filter ❑ Aerobic 1 •reatorent Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter hceg Chamber ❑ Drip Line ❑ Gravel -lees Pipe ❑ Other (62 V. Dispersalffreatment Ar nformadon: Dpipr Flow) Design Soil APplicetirm Itute(gpdst) Disperssj -- Required (at) Dtsp�sal Area P opened (s0 System Gov tioo ! ? 4! !5 L, 3 © y7 i VI. Tank Info Capacity in ToW Number Manu&duter Prefab its Steel Fib: Plastic Gallona Gallons of Units Concrete Constructed Gle; s New Frieling Tanks Tents Septic ar Holding Tank Aerobic Trearmem Urdt Dosing Chamber VTT. Responsibility Statement- 1, the undersigned. assume reepaeaihility for iastanstion of the POWTS shown an the attached Plane. Plumbor'a Name (Print) Plum s Signature MP/WRS Numb. r Business Phone Number' ,alq c A. �> 2.2 �t� 7 r- Plumbers Address (Street, C ity, S M _ Vh1IL CountyAD!NlggMnt U Only_ X Approvrxt 0 Disapproved Sanitary Permit Fec C eludes GratmJwslef Date Issued Issuin A t Signate:5m Sutrharge Fee) .. ❑ Owner Given Rcasmt for Denial . DL Conditions of Approval/Rc sons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintainer as per management plan provided by plumber. 2. All setback requirements must be maintained as per a licable co /ordinances. Atumb eempietc plam (tn the ceaaty any) toe the qsu= on paper not It m than 81/! z 11 imbes is sine SBD -6398 (R. 01/03) PLOT PLAN PROJECT P.C. Collova Bldrs. Inc. ADRESS P.O. Box 489 Somerset Wi 54025 E 1 NE 1/ 31 /T 31 / 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 9 /9/03 BEDROOM 3 CONVENTIONAL )= IN -GROU PqqRESSURE 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 22 BENCHMARK V.R.P. Top of survey iron ^ Z" - (a)ASSUME ELEVATION 1 00' Filter Zabel A -100 ❑ BOREHOLE O WELL 'H. R. P Same as Benchmark Plans Designed Using Conventional Powts SYSTEM ELEVATION 99.8/99.3 4' below grade Manual Version 2.0 Alt. BM Top of T' pipe 95' B.M. V ent Alt. kL andard Biodiffuser M. aching Chamber th 31.1 ft2 of Area 3 4 Grade at System Elevation 120 not enough slope to establish contours 0 9 *4 0% Slope Vents B - � -) 0 30' 10 35' 2 -3' X 69' Cells with >3' Spacing $z, 0' B -2 i 20' Vents T 15' Pro 3 Bedroom house 37' u �� -re--- 90th 90th St. PLOT PLAN PROJECT P.C. Collova Bldrs. Inc. DRESS P.O. Box 489 Somerset Wi 54025 E 1/4 NE 1/4s 31 /T 31 / 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE9 BEDROOM 3 CONVENTIONAL XXX IN -GROU RESSURE 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 22 BENCHMARK V.R.P. Top of survey iron �^ 6 a)ASSUME ELEVATION no Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark : Plans Designed Using Conventional Powts SYSTEM ELEVATION 99.8/99.3 4' below qrade Alt Manual Version 2.0 . BM Top of 2 pipe Q 195' B.M. V ent Alt. >6" Standard Biodiffuser M. of Cover Leaching Chamber with 3 1. 1 ft2 of Area Long , Lon 3 4 Grade at System Elevation 120 not enough slope to establish contours 0% Slope Vents 30' B - 10' 35' 2 -3' X 69' Cells with >3' Spacing B -2 20' Vents T 15' Pro 3 Bedroom house 337' 90th St. Wisconsin DepaMurd of Camieme SOIL EVALUATION REPORT pap of avisiorr of sawand eulidings in accordance wm Comm tie. Vft Adm. code Cou* + ( r o t Mach complete alts plan on Paper not lass than 8 W X 11 Inches In size. Plan must Include. Mit not BmBed to: vertical and herb=" point (BM), direction and Parcel l.D. Percent stops, scats ordirnensiom north arrow and location and distance to nearest road. Meese print 8l1 i by Date v yowta' / Properly �. g L �,�! 1/4�y T 1 31 N R/ E( W 2 M S y p + q Lot # # S d. Name or CSMII state ap Code Ptrone sl 0 Vftos g Town Nearest Road New construction us ResidercGai / Number of bedroom _ Code derived Clow rate d ❑ PuMc or cornmercial - Deso tw Parent matelot e!5 20 z,= c z Flood Plain elevation N applicable it/ /�} 1t and racomrrrerrdado►rs: E eoti V # � � Pit Ground suface elev R Depth tD GrniNrt9 fear �Ll� in. Sol Application Rate t(orimn Depth DorNrwt COkx Description Textrae Wr.SWz Cor>srclerrce soutlery Roots GFeff in. MLWVM ML S7- Cont. Color Z a Bo o pit Z>t Depth to 601dn9 1n- sal Alopkaft Rate GPM Hor mrr Depth Dm*wtCdw Redox Description Taft" Structure Corrsistenoe Botprtiery Roots »ANreell CkL Sz. Cad. Cdor Gr. Sz Sin. •M TIM 1 ' ► zz - 56 � jz 5C 3 _ $ l ,Z 2 E& M t #1 = SM > 30 220 mglL and TS8 >30:S 15: • EtlMr Nd #2 = 80C 130 rngiL and TSS x 130 mplL. csr (Pleaa. alnA , `� o ?a i c.C� Date condr,c+ed Telephone "wM Property Owner Parcel ID # Page of 3 p 80r6>8 Grand srataos elev. ' 7� I Depth to kndk g factor - EL Sod AppOcadon Rate Horizon Depth Dominant Color Redox Description Texture Sir mb" Cmsbknm 8ourday Roots GPOW Munsd Qrr. Sz. Cont Caton Gr. Sz. Sh. 'E#1 MW lbfl 'y2 S L 2 it , .9 r 2 S fY HJ ►`I �. . F soft ❑ ❑ Pit Ground aurfaos Mav R Depth to tinft thclor i<r Sot Rate Horizon Depth Dominant Color Redox Delsor"on Tadure Smmwm Ca mmarnce aorrdary Roots GPOW in. Munsel CkL Sr- Cant. Cda Gr. Sz Sh. 'EM 'Efi#2 F - 1 0 Pith etev. i4 Depft fedor it Rate timimn Depth Dmr*wtcdm Red= Dese*tiarr. Team Strumm Consistence Wmday Roots GPDff ii Munsel Qu. SL Cad. COW Gr Sz Sh *EM 'E2 . Eftxmt #1. app 30 <?ZO mall and TSS >30 450 ffQ& ' Efkm t #2 = OCCk :S 30 n L and TSS _< 30 nV& The Depatttnad of Commerce is an equal appordmity service provider and employer. If you neW assistance to access mVices or need material in an alternate format, please contact tip department at 608- 266 -3151 or TTY 60 8-264 -8777. snvsmoer AM Soil Test Plot Plan Project Name P.C.Collova Bldrs. Inc. Sha it Address P.O. Box 489 Somerset Wi 54025 CS #226900 Lot 3 Subdivision Prairie Pond Breaks Date 4/9/03 E 1/2 NE 1/4S 3 T 31 N /R W Township Star Prairie N W 1/4 W 32 F1 Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 99.8/99.3 *HRPSame as Benchmark Alt. BM Top of 2" pipe @a 100.2' 195' B.M. Alt B.M. 120' not enough slope to establish contours 0% Slope B -1 30 0 , B -3 35' 0' B -2 37 Pro Town Road Maintenance and Contingency Plan for a Septic System Maintenance Plan pumped once ever 3 years. Y 1. Septic Tank is to be pump larger filter is being installed in 2. Effluent filter is to be cleaned once a year. Please note: a order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected vi a the inspections pipes at the ends of the cells. rees to limit greases, garbage, and water conditioner discharge into the system. 4.Ow ner a 9 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 ifs y stem fails, determine cause of failure, use alternate area and install new system or 1. 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 - Shaun Bird #226900 I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer P. C. Collova Builders, Inc. Mailing Address P Q Box 489 Somerset, WI 54025 Property Address >( �C! � erifi lion req ' ed from Planning Depa t for new construction} City/State Parcel Identification Number. LEGAL DESCRIPTION Property Location AJ l %4, NO ' /,, Sec. JO� , T21 JN -R W, Town of 5 Zt kttk& j Subdivision V �d l 1 6 1 Q c 5 Lot # e �. Certified Survey Map # . Volume . Page # Warranty Deed # 60 0 1/-- 1 I Volume Page # CQ Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no SYSTEM KAI NTENANCE 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, journeymanplumber, restrictedplumber or a licensedpumper 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 sta ' o tic system has been maintained must be. completed and returned to the St. Croix County Zoning Office within 30 tda ear expiration date. i P. C. COLLOVA BUILDERS, INC. SI A OF APPLICANT (715) 247 -2742 DATE P.O. Box 489 SOMERSET, WISCONSIN 54025 O R C & RT— MCATION I ) rtify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of e bed above, by virtue of a warranty deed recorded in Register of Deeds Office. P. C. COLLOVA BUILDERS, INC. SI NA OF APPLICANT (715) 247 -2742 DATE oo P.O. Box 489 * * * * ** Any information that is mis- represented may result in a sans my pe % 40 2 g 5 e 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 i V 2021P 029 STATE BAR OF WISCONSIN FORM 2- 1999 6 9 5 4 1 9 KATHLEEN H. VALS WARRANTY DEED H Document Number REGISTER OF DEEDS ST. CROIX Co., VI This Deed, made between Cecil Brighton and Cleo Brighton, RECEIVED FOR RECORD husband and wife, 10 - 23 -2002 11:00 Ai'I WARRANTY DEED Grantor, and P. C. Collova Builders, Inc. EXERT # REC FEE: 11.00 TRANS FEE: 720.00 COPY FEE: Grantee. CERT COPY FEE: 1 Grantor, for a valuable consideration, conveys to Grantee the PAGES: following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): ��� £ ` CjN� -� 8 re S S Recording Area NW 1/4 of NW 1/4 of Section 32, Township 31 North, Range 18 West, St. Name and Return Address Croix County, Wisconsin. 038 - 1131 -60 Parcel Identification Number (PIN) This is not homestead property. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. CK) (is not) Dated this day of September 2002 A� - * * Cecil Brighton V * + Cleo Brighton AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. St. Croix County ) authenticated this day of Personally came before me this — 14ee _ day of September 2002 the above named Cecil Brighton and Cleo Brighton, husband and wife, g g TITLE: MEMBER STATE BAR OF WISCO (If not, to me kn to be a on(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instru d le ed the same. THIS INSTRUMENT WAS DRAFTED BY * , Attorney Kristina Ogland Hudson, WI 54016 Notary Public, State of Wisconsin ' M Commiss' n �perm�anent (If not state ex (Signatures may be authenticated or acknowledged. Both are not necessary.) ' Names of persons signing in any capacity must be typed or printed below their si tun:. lnfortna,Jw Profmionala Company, Fond du tae, wa STATE BAR OF WISCONSIN 800-655f, 21 WARRANTY DEED FORM No. 2 - 1999 X ,g• Q,F�i O g M'�� CL 1 :3 W Q �D� I i � �vpt0�0 C m a Nto`j ?y ?�QW�4""AS�V�A�O� ?Q flr W w rOr ee R1 a e " �••"'•"r V , A N ►.. �.. r W � .,. p.. r rte. W � ►" ;.1 L A r S �� a 9 g j 1 �t�J1N000 (J a p p"r OWOJAA00A�O��t�J1�60� rr�LiOi o o o 3 W ; gtay�c:��4gi�t _ zx� i o o z a -9 - Z v ' ' �; f(] x 0 r '~ 3 n � v x i W N"y' liar,. `SAW c 00 o CY7 O 0 O P o �p o e o 0 0 0 0 o p o A N 0 0 �_ to N -�0 A otA�Nw •�tACWO�ONOONNO�N��p SA �NO�O�r� '.tJ�t.WjA�A.1WN����j,CA�lO00 O �G to i to N t i a lA a tJ� a lA = = t s tT 0 z z tA ���r�rA����� r► A �� x ��• OA O� N tJ W N Q LA m o )I i g �mj �� �tnnTj 33 OP i Zw o 00 0 a s O i Ito t n�tntztT , WESTLIIVE OFC.S.M. VOLUME9PAGE UNPLA TTED LANDS N00 °10'39 "W _-- _ - -_ - -_ 975.00' — 195.00' - 195.00' 195.00' 195.00' � V v J z 8 �O O kA 0) U1 Z z z 00 W 00 U1 01 W OD W W c0 (� t4 1% W 1r O tzi W t0 Q LA L A co co 0 n co n . p .A s CD ' N /\� -S O VI s (D m N -� N v N m CO) m to A – –– – 1103.51' – – – –– I ....... ; \ Ln I — 195.00'— _ 195.00' — 128.39'– \ -4 –195.00 L� ' — — w 1160.18' 1.34 '""' TH 49 w � S 00'10'39" E 270.39 6� 0.71' — ' _ — – 384.84' -- cn (— 246.47 o v23.92' Z ........ I ... .... OD .......... 5��,oa...... O i � ....................... • .r W I .p N