HomeMy WebLinkAbout038-1221-05-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
453070 0
GEN ERAL 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 Township 038 - 1221 -05 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
/ CD , p 1 /0 to _ (J 6k) C 31.31.18.1205
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic to Benchmark s Z f 16 6- 0
Dosing ^ UZS Alt. BN]j. �� WAJO.P
�-f O,S`S y_
Aeration �" Bldg. Sewer 30 y
'ScN qo ( a . Z5
Holding S Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent it Intake ROAD Dt Inlet
r�akv -1
Septic y of ` 2 Dt Bottom
Dosing Header n.
Aeration Dist. Pipe Z
Holding Bot. System J -- --
PUMP /SIPHON INFORMATION Final Grade rj !oJ 9p (
Manufacturer Demand St Cove f 2
GPM S
Model Number
TDH Lift n Loss System Head TDH Ft
Forcem Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM ( /
BED /TRENCH Width 3' Length r No. Of Trenche PIT DIM IONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS (�
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Man4gtyrer: q
INFORMATION CHAMBER O 1J 1 0 CL
TypQ,Of SysteyL^�l�.�C , � UNIT
Model Number:
DISTRIBUTION SYSTEM
Head anifold Distribution x Hole Size x Hole Spacing Vent to it I ke
1 u Pipe(s) /� ��e�
Lengt Dia Lengt ti _ Dia Spacing
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
1 0 61 Bed/Trench Edges Topsoil J Yes ` ! No 1 Yes No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: Y 1 ;?X 0 Inspection #2: i 1
Location: 1884 90th Street Star Prairie, WI 54026 (NE 1/4 NE 11/4,, 3-1,T3n1_N RI 8W) Prairie Pond Breaks Lot 5 _ Parcel No: 31.31.18.1205
1.) Alt BM Description = f� 8-r� (�(XX -S CllAaL�,i
2.) Bldg sewer length = 204,
AI-
- amount of cover = � , A 1 � 3
Plan revision Required? Yes No 93
Use other side for additional information._
SBD -6710 (R.3/97) Date Insepctor' Signature Cent. No.
I
County
C l���,r a n j �! Bui
92 1 ' Division
201 W. Washington Ave., P.O. Box 7082
Madison, Wl 7082 sanitary permit Nupber (to be Had in by Co.)
NV4&conzin (609) 26, M-654 _6 1 0- 70
consin
Department of Commerce State �1..LD. N.. r
u'r
Sanitary Permit ApPlIcatiod
personal infbrmaticn�You Ptoq_, U g address)
in accord with Comm 93.21, Wis. Aden. Code- PC" s �ftproj� Address (i different
m ay be used for secondary P urposes Privacy Law, x1 5.040 1 �(m)
A7
App lication Information - Please age Print All Information - J* 2?, 1 C
I. App
1# Lot # Block
Property, I 2S
Property 1g;Aun
Proper� Mailing �Address
Section 3
— city, State zip Code Phone Number ircle el
T .3/ N; dilE or 0
; IL e
T of Building (check all that apply) ivi Nome M Number
2�2& B Dwelling - Numbor of Bedrooms
ou
.1e
❑ Pub - Describe Use []Cily wriship 0
0 St owned - Describe Use A b I 57- 0-
III. Type of Permit: Check only one box on line A. Complete line 8 if applicable)
❑ Treatmen Tank Replacement C101Y ❑ Other Modification to Existing System
W S y s tem D ReplacetrwIlt System List Previous Permit Number and Date Issued
B C] permit R enewa l C) pe Revision change of ❑ Permit Transfer to New
B.
B e f ore Expiration plumber Owner
IV T 9 of P wTs S stem: (Check all that SLVDIV) Mound < 24 in. o f s soil At-Grade ❑Single Pass Sand Filt
u A z edin-Ground [) Mound ? in. ofSWtzblcsoil
[3 p ressu Az e d in Ground [] H Tank El Post Filter C1 Aerobic Treatment Unit rcu l a ti n g Sand Filter
construc Weiland i
IV.T el
on -Press
11
IV. 0
5 r i 0n = ' ,n,_ ;t W
R S y nthetic Media Filter bins C er 0 Drip Line 0 Gravel-less Pipe Q Other (explain
'
V. DispersaLlTreatment Area Infolirms on: I Ar Proposed (Sf) El
Design Flow (gpd Design Soil Application W
Ratedsf) Dis Area - quired (SO Disp
0
Prefab Site Steel Fiber Plastic
n Total Manufacm=
VL T E;P i Number A _ Concrete Constructed class
Tank Info ns Gallons of Units
Gallo
-- We. Existing
Tanks TW*S . ................. .... . .. ....... . .. . . ......
�ptxorHolding Tank
Aerobic rroato:ent Unit
Dosing Chamber
V11. RestionsibilitY State eat- 1, the unders " resn.nsibilltv o f t h e pOWrs shown on the attached plans,
p1MPRS Number Business Phone Number
Pi s Name Plumb re
Plumber's Address (Street, City, Stafti,
oun eipartment U se Only P Sanitary Foe (includes Groundwater VALV Issued en Signature ps)
Approved ❑ Disapproved Surcharge Fee) e ) f;� !� i
❑ _. �/ _& z
Owner Given Reason for Denial
IX Conditions of Approval/RKSons for Disapproval
SYSTEM OWNER: 1
1 tank, _eTR_uent filter and (i C/ (AA
dispersal cell must all be serviced / maintained
as per applicable man pplicable a ement plan provided by plumber, IM" -3
set ack requiremen s mu in ine
a as pp licable code/ordinanceS,
s per a code/ordinances,.rrM J73, t"3
is ( t h e C only) for the SYS m go paper a sthanst :11 l es to siu
SBD 98 (R. 08/02)
PL T PLAN
PROJECT P.C. Collova Bldrs. Inc. DRESS f.0. Box 489 Somerset Wi 54025
SE 1 / 4 NE 1/4s 31 /T /W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 3 BEDROOM 3
CONVENTIONAL XXX IN- GROUND WESSURE 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 ASSUME ELEVATION 100° Filter Zabel A -100
❑ BOREHOLE O WELL H. R. P. Same as Benchmark
SYSTEM ELEVATION 95.9/95.7 4.5' below qrade r�
195' Property Line
d�
Well is to meet all Plans Designed Using
setbacks required by Conventional Powts
WDNR Manual Version 2.0'
130'
Vent Vents V11- j Standard Biodiffuser B -2 0 ,
ver Leaching Chamber 2 -3' X 69' cells
with 31.1 ft2 of Area with >3' Spacing K 1 1 " B -3 09
Long
3 4" Grade at System Elevation
35'
30'B -1
T
5'
Za'
P 3
B droom
use
337'
Property
Line
90th St.
PL T PLAN
PROJECT P.C. Collova Bldrs. Inc. 14DDRESS Y.O. Box 489 Somerset Wi 54025
8E 1/4 NE 1/4s 31 /T 31 18 W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 3/29/04 BEDROOM 3
CONVENTIONAL XXX IN- GROUND 9ESSURE 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 ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
SYSTEM ELEVATION 95.9/95.7 4.5' below qrade
195' Property Line
Well is to meet all Plans Designed Using
setbacks required by Conventional Powts
WDNR Manual Version 2.0
130'
Vent Vents
>6"
Standard Biodiffuser B -2 0'
of Cover Leaching Chamber 2 -3' X 69' cells
with 3 1. 1 ft2 of Area with >3' Spacing
6' Long 11 91 B-3 0,
3419 Grade at System Elevation
35'
30' 30' B -1
Vents
T
425'
Pro 3
Bedroom
House
337'
Property
90th St. Line IF
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
Property Address I} f 0 4-N S
(Verification required from Planning Department for new construction)
City /State New Richmond, WI Parcel Identification Number 0 39-- 21
LEGAL DESCRIPTIO
Property Location %. 'V4, Sec. _ 31 3l , T N -R 18 W, Town of C J" h�.f"'�V
Subdivision Prairie Pond Breaks Lot # J t
Certified Survey Map # j Volume . Page #
695417 2021 27
Warranty Deed # <' . Volume - , Page # _
Spec house yes Cl no Lot lines identifiable [dyes ❑ no
SYSTEM � ` MAINTENANCE /
Improper use and maintenance of your septic system could result in its prematurafailure 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, joumeymanplumber, restrictedplumber or a licemedpumperverifying 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 113 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
e three y iration date.
P. C. COLLOVA BUILDERS, INC. �
�( (715) 247 -2742 3 /fib/ O
SIGNA OF APPLICANT P.O. Box 489
SOMERSET, WISCONSIN 54025 DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (arc) the owners) of
the rib e, by virtue of a warranty deed recorded in Register of Deeds Office.
P. C. COLLOVA BUILDERS, INC.
(715) 247 -2742 1 /� �/ "1'
sidNATtkRE 6 F APPLICANT P.O. Box 489 DATE
SOMERSET, WISCONSIN 54025
* * * * ** 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 co of the certified s urve y y map if reference is made in the warranty deed
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. Watershod is to be diverted away from system.
8. Discharge ' em is not exceed those required as per Comm. 83
„ into system
C y Plan
O;7f system fails, determine cause of failure, use alternate area 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 -4680
Pumper Tom Mondor 715 - 246 -5148
Shaun Bird #226900
APR 1 2003
VVIsectisin DWW nerttof commerce S6i '') ON EP4RT p age d�
Division of safety and Buiclrrgs
in accordance Mau► Comm M Mr. Adm. cone CMYS
Attach complete site plan on Paper not less than 8112 x I I kv* es in Giza. Plan Met °
include. but not mrltad sm vertical and horizontal refisrence point (W. direction and Paces I.D.
percent sue, scale "dirnerislons. north arrow. and location and distance to nearest road.
Pbmo pdint all kdbnMOM by Data
Persmcel bdonrrsdm you proves nW be uaed for secondary pmpmn (may Lam a 15.04 (1) (m)). l
prnpertYOw // //
Propert yLocalkin
GovL I.At R j E (a W
pol pis B Addr Block * t+ mw or CSW
Mgr ❑ city ❑ V JaTown Meares Road
Nlew CanslrtX11M U denUcl / NNxnber of bedram Code derived design flown rate
❑ RepISoamert Q Pdit or carrcrrerdd - Desat --
Parent material Pmd Plain deva6on 7 applicable
Gwwgaxmiwft
and tsoonrxrrerrdetuwrs: J
• �;� 01.:3 7 • �la>✓c.f !/ �
BO,bv 51 Pit Gmund surface atay. 6 tl Depth to WdWV A in- soil Application Rate
Hall= Depth Dominant Color Redox Desc dpuon Texture sbuchre Corobboroe Boundary Rows GPOW
in. fAurisell CAL Sz. Cat. Color Gr. Sz. Sh. •elm+
41V
as ��
s� 5�
Pit Ground surface dev. R factor. g Role
Hatton Depth Dw*=tCdm Redorc Desaiption Text" structure Consistence Boundary Ruda GPM
(n. thanes Qu. Sz. Cat. color Gr. •EIIIH •EM2
(. a - etc c5 1-
Is 4L
-
• Elouent lit = BOD > 30 < 220 mglL and TSS >30 _< 1 • eih,ent #2 = BOD <_ 30 mgll. and N� 90
r� V # L
CU ( 0 ? 0 2 6 l.�
Address
Date ewsluelon Conducted Telephone *.mbar
I
Property Owner Parcel ID # page d
a Soft #. Ug ph Ground owlimos elev / , % R Depth b kni" WOO In. Sol Appkxdm Re1e
Hoo aon Depth DormirundOolor Reckon Description Texture Struchre Consistence Boundary Roots GPOW
In. k4unsell Qu. Sz. Cad. Color Cu. Sz Sh. 'EWl 'EM
10 / 5L :_ 2 t n - Lyn
D `/A. Fr w . ,
Q Soft # ❑ Baft
❑ Pit factor in. soli Application Rate
Horiaon Dept mn*u rd aft Redre Dmc*don Texture Skuc " Carsistenos Boundary Roots GSW
In. Munsell GM Sz. Cad. Color Gr. Sr_ Sh. *M 'EW
I
F fig #
❑ Pit Grournd sn>rfa� Depth b8 factor in
Soil Appilosibn Rate
Hoon Depth Domlwast Redox Descriplm. Texture Sine" Cansisterm Boundary Roots
t
GPOR
ta
in. Munsell Qu. Sz. Cad. Color Gr. SL Sh. *EW TIM
• EI&Mt #1 = BOD > 30 <220 rnglL and TSS >30 450 n91L ' Eta #2 m 60[ :S 30 na" and TSS S 30 nom'
The Deartntent of Commerce is an equal WoMmity service provider and employer. If you teed assistance to aces savices ex
need nuft6sl in an llternate format, please con fire elepuu=t at 608 266 - 3151 or TTY 608 264 - 8777.
s�wotRSaot
Soil Test Plot Plan
Project Name P.C.Collova Bldrs. Inc. Sha
Address P.O. Box 489
Somerset Wi 54025 (Frm #226900
Lot 5 Subdivision Prairie Pond Breaks Date 4/9/03
E 1/2 NE 1/4S 31 T 31 N /1318 W Township Star Prairie
N W 1/4 W 32
F1 Boring 0 Well PL Property Line County ST. CROIX
(0A orVRP , Assume Elevation 100 ft. Top of Survey Iron
System Elevation 95.9/95.2 *HRPSame as Benchmark
Alt. BM Top of 2" Pipe @ 100.2' ,�
5 '
Alt
M.
not enough slope to establish contours
B -2 0 130'
1% Slope
B -3
70'
35'
30' B -1
I
37'
Pro Town Road
I
LEGAL ST. CROIX COUNTY, WISCONSIN NEW TXSCR02
REAL ESTATE TOWN OF STAR PRAIRIE
COMPUTER NUMBER 038 - 1221 -05 -000 Parcel Number 31.31.18.1205
OWNER NAME: First Last P C COLLOVA BUILDERS INC
PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment
1884 90TH ST
SECTION 31 TOWN 31N RANGE 18W 1 /4160 NE 1 /440 NE
Line Description Line Description
TOTAL ACREAGE 1.510 PLAT PRAIRIE POND BREAKS 3/37 '03 LOT05 BLK
01 SEC 31 T31N R18W PT NE NE 15
02 PRAIRIE POND BREAKS LOT 5 16
03 (1.510AC) 17
04 18
05 19
06 20
07 21
08 22
09 23
10 24
11 25
12 26
13 27
14 28
F1- General, 174 -Prev. Parcel, F5 -Next Parcel, 177- Valuations, F8- History, F10 -Exit
LEGAL ST. CROIX COUNTY, WISCONSIN NEW TXSCR02
REAL ESTATE TOWN OF STAR PRAIRIE
COMPUTER NUMBER 038 - 1220 -02 -999 Parcel Number 31.31.18
OWNER NAME: First LOTS 3 THRU 37 Last PRAIRIE POND BREAKS'03
PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment
SECTION 31 TOWN 31N RANGE 18W '/4160 1 /440
Line Description Line Description
TOTAL ACREAGE 77.820 P LAT PRAIRIE POND BREAKS 3/37 '03 LOT BLK
01 SEC 31 T31 N R18W PT NE NE 15
02 PT SE NE & SEC 32 ALL NW NW 16
03 INCS PT OF LOT 1 CSM 9/2686 17
04 TAKES PTS 038- 1125 -10 -100 & 18
05 038 - 1127 -70 (515D & 518B) & 19
06 ALL 038 - 1131 -60 (536) 20
07 21
08 22
09 23
10 24
11 25
12 26
13 27
14 28
F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit
U 2021P 027
STATE BAR OF WISCONSIN FORM 2 - 1999 r="3 5 4 1 7 .
' Document Number
WARRANTY DEED REGISTER OF D EEDS
ST. CROIX Co., MI
This Deed, made between Douglas A. Strohbeen and Eileen RECEIVED FOR RECORD
Strohbeen, husband and wife,
10 - 23 -2002 11:00 AM
WARRANTY DEED
Grantor, and P. C. Collova Builders, Inc. EXEMPT #E
REC FEE: 11.00
TRANS FEE: 1260.00
COPY FEE:
Grantee.
CERT COPY FEE: Grantor, for a valuable consideration, conveys to Grantee the PAGES: 1
following described real estate in St. Croix County,
State of Wisconsin (if more space is needed, please attach addendum):
Recording Area
Part of the NE 1/4 of NE 1/4 and part of SE 1/4 of NE 1/4 of Section 31 Name and Return Address
Township 31 North, Range 18 West, St. Croix County, Wisconsin, described
as follows: Lot 1 of Certified Survey Map filed September 17, 1993, in
Vol. 9, Page 2686, Doc. No. 505678, St. Croix County, Wisconsin.
038 - 1125 -10 -100 & 038 - 1127 -70 -000
Parcel Identification Number (PIN)
This is homestead property.
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. (is) NXOQ
Dated this y of September 2002
+ + Douglas A. Strohbeen
—
* + Eileen Strohbeen
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
) ss.
St. Croix County
authenticated this day of ;,•
Personally came before me this y of
September 2002 the above named
j Douglas A. Strohbeen and Eileen Strohbeen, husband and wife,
TITLE: MEMBER STATE BAR OF I
(if not, to me known to be the rson(s) who executed the foregoing
authorized by § 706.06, Wis. Stats. �C1
instru nd a ed the same.
g
t1 OF WIS�,,
THIS INSTRUMENT WAS DRAFT9D )3Y"
Attorney Kristine Ogland Notary Public, State of Wisconsin
Hudson, WI 9016 ommission 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 si ture. Information Professionals Company, Fond du Lac, WI
STATE BAR OF WISCONSIN 800.855 - 2021
WARRANTY DEED FORM No. 2 - 1999
NOW 1.,,> .;
CCs =
p WESTLINEOFC.S.M. VOLUMB9PAGE2686
IN 00010'39" W UNPLA TTED LANDS
00 °10'39" W 975.00'
195.00 195.00' 195.00' 195.00
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S 00'10'39" E 970.71' - w _S — 9W
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