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HomeMy WebLinkAbout038-1221-13-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453367 0 GENERAL INFORMATION (ATTACH TO PERMIT) W . State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)J. Permit Holder's Name: City Village X Township Parcel Tax No: P.C. Collova Builders, Inc. I Star Prairie Townshi 038 - 1221 -13 -000 CST BM Elev: I Insp. BM Elev: BM Description: Section ( rown /Range /Map No: 0. o o . 3o CSI g ►M Z 31.31.18.1213 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 1• loo. Iat, Dosing Alt. BM Aeration Bldg. Sewer�� 1 93. Go Holding St/Ht Inlet v / � 92�y-o TANK SETBACK INFORMATION St/Ht outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic '2 / Dt Bottom Dosing 1 Header /Man. g ps, C1 f Aeration Dist. Pipe v, r f • D O.2 S Holding Bot. System 90.5`D DS .ZS P MP /SIPHON INFORMATION Final rade `emu Manufact er Demand St Cover 1 r GPM 3 � Model Number M TDHLift Frictio ss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM DMCtENCH Width I Length t No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS (2-) QCL SETBACK SYSTEM TO P/L JBILDG IWELL LAKE /STREAM LEACHING MarAiqiclurer INFORMATION CHAMBER OR t Ot71 Ff:q& Type Of System: 'f 76 / Y • UNIT Model Number. I I J r DISTRIBUTION SYSTEM 5. PL- Header /Manifo Distribution Hole Size x Hole Spacing Vent to Air Intake rr Pipe(s) r Lengt Dia_ Len h Spacing 7 5 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 0 Yes [l No' Yes �L'i No S: (nclu code d' encies, persons present, etc.) Inspection #1 Ep l Jt Inspection #2: t l ` Wek vZ 90th St New Richmond, WI 5 017 (SE 1/4 NE 1/4 31 T31 R1 8W) Prairie Pond Breaks Lot 13 Parcel No: 31.31.18.1213 1.) Alt BM Description = ►,fir,,, s o, S ►�.,s / :ts -� �t P - 2.) Bldg sewer length = j, 5 o.ccar�+ - c„c . i"'. Pnl� r - amount of cover = I / 1I_ �ab 14'�w E 1 4 0 / e \ ) an revision Required? Ye No 2� � � j �� Use other side for additional information. L v'.- —,- - - -- — - - - -__ I Date Insepctors Signature Cent. No. SBD -6710 (R.3/97) Safety and Buildings Division county- - 201 W. Washington Ave., P.O. Box 7162 J , ( r 0 SCQI �SI � Madison, l 53747 - 7162 Sanitary Permit Number (to be filled in by Co.) - Department of Commerce (608) 266-3151 S3 Sanitary Permit APP -- --- W_. State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal i n may be used for secondary purposes Privacy , sl m) Project Address (f different than mailing address) L Application Information - Please Print All Information s z L1 0 4, i $ SL�' 9'0 Property ownees Name l r :, ` - Parcel IN ( / Lot* Block* Property Ownees Mailing Address Property Location City, State a O Zip a Phone Number J 4. �r �, on� L/ z 4*;) J C � T N: R I L Type of Building (check all that apply) or 2 Family Dwelling - Number of Bedrooms Subdivision Name M Nuunber Public/Commarcial - Describe Use State Owned - Describe Use 2 5 3 7 79 ( City Villa, of 14 10 S III. Type of Permit: (Check only one box on line A. Complete line B if applicable) o39'- 12- 2.1 - t 3 — am (. 1 A System Replacement System Treatment/Holding Tank Replacement Only Other Modification to Existing System B • Permit Renewal Permit Revision Change of Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that appl X- Pressurized In- Ground Mound> 24 in. of suitable soil Mound <24 ice. of suitable soil At -Grade Single Pass Sand Filter Constructed Wetland Pressurized In- Ground Holding Tank Peat Filter Aerobic Treatment Unit Rechwbtti Sand Filter Recirculating Synthetic Media Filter ' g Chamber Dri p Line Gravel -less Pipe Other (explain) V. Disp ersaVrreatment Area Information: .� l Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area aril (sf) . Dispersal Area Pm sed (st) Elevati llt'�� i VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Skel I Fiber Plastic Gallons Gallons of Uri - ►� ^ Concrete Constructed Glass New I Existing wI GoJB�L A -lace /+ f �� Tanks Tanks I I Septic or Holdrag Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, a responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's MPlMPRS Number Business Phone Number ` Plumber's Address (Street, City, State, tip Code) VIII. CnIODepartment use Only Sanitary Permit Fee (includes Groundwater Date Issued Sigtratnre (No Sta-ps) Approved Disap veil o -� Surcharge Fee) S 0� IX. Conditions �pproval/Reasoos for Disapproval 3 ) No SYSTEM OWNER: —T -- - 1 1 Septic tank, effluent filter and - t7AQ S dispersal cell must all be serviced) maintained as per management plan provided by plumber. 2. All setback requirements must be maintained , 1 i _ ,.{� � t - ( A F ,J ) as per applicable code /ordinances. °"` " S . Attach coesptete plans (to the County only) for the system on p4er not teas than 5112 x It inches in stu P T PLAN PROJECT P.C. Collova Bldrs. ADDRESS P.O. Box 489 Somerset Wi 54025 SE 1/4 NE 1 /4S 31 /T 31 /R 8 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE /29/04 BEDROOM 3 CONVENTIONAL XXX IN-GROI PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 664 # of chambers 22 IL BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A -100 [:]BOREHOLE O WELL «H Same as Benchmark SYSTEM ELEVATION 89.5/89.3' 5.5 below qrade Alt. BM Top of 2" Pipe @ 101.3' Well is to meet all Plans Designed Using setbacks required by Conventional Powts NR Manual Version 2.0 j Standard Biodiffuser Leaching Chamber with 31.1 ft2 of Area Grade at System Elevation 34" 441' Pro 3 Ro o To w 125' 1% Bedroom Slope House 2 -3' X 69' cells with >3' Spacing 35' B -3 30' �u w 30' 20� Vents B -1 70 , B 2 1 S ' 10 *B. Z-� 4J31/R T PLAN PROJECT P.C. Collova Bldrs. DDRESS P.O. Box 489 Somerset Wi 54025 SE 1/4 NE 1/4s 31 / 8 � W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/29/04 BEDROOM 3 CONVENTIONAL XXX IN -GR PRESSURE 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 lk BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE (DWELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 89.5/89.3' 5.5' below q Alt. BM Top of 2" Pipe @ 101.3' Well is to meet all Plans Designed Using setbacks required by Conventional Powts NR Manual Version 2.0 >6 „ Standard Biodiffuser of Cover Leaching Chamber with 3 1. 1 ft2 of Area 6' Long 11" 34 Grade at System Elevation 441' 7 Pro 3 ro Towi i Ro 125' 1% Bedroom Slope House 2 -3' X 69' cells with >3' Spacing 35' B -3 30' 30' 20' T Vents B -1 B -2 70' 10' �k 1 Alt. 1S ' LS- 1 k t w , Deparbrtent corranence SOI� EVALUATION REPQIRT Page of pivisbrt of Satiety and e in accordance vv�ft 1 ARach complete site plat, on paper not less than a la x 11 inches in size. Plan must l inckKW but not IirrtNed lo: vertical and horizontal mote point (BM). direction and Parcel LO. percmtt slope. scale ordirnensions. north arrow. and location and dMance to fW est road. Phme print all inibmw Ym by Date PwsmW into =Mm tm pwWAft aM be wed fw eacadwy t WeNaW Law, 6.15.04 (7) (m)) Prop" OvIffW I Gv /�v G Govt Lot T 1w ,� N R y p ,b ad*m trot Blodt # � Nlente or CSW State ZOC=b Phone ❑ City ❑ vtMage Town Nearest Road Sa ��s LrJf .Sy 0o7s lhi - L16 2 I fec New Construction tki9 Residerr6al / Number of badnt roos _ -3 Code derived design lbw rate GPD C1 PApbmnwt ❑ Pttlt6c or commercial - Describe: Parent matelot C21' Z 7' ",z Sr� Rood Plain elevation 9 applicable ,mot/ /f} !t General convaents *, S 0 Pit Bo na # e«b� Grwatd surface elev S, R Depth o factor 42 0 _ in. sort Rate Horbm Depth Dm*wt Color Redox Oesaiptiort Teo" Sbucb" Consistence Bowtdary Roots K tee OA. SL Corti. Color Gr. Sz. Sh. c -! L 0 ,- 3!L --- ik O Z- soft# ❑ eoring A ? R P,t Ground solace stem` 1t Deplh to *W *V factor Sd Amlicabn Rate Horlmn Depth Don kWd Redax Description Texgae SbtrcWre C.onsis tce Y Hods GPOR it Munnn du. Sz. Cont Color Gr. Sz. Sh. *EW1 - Etfp2 J ld , L r m r!r c s m 8 �o 11 7 C- L- 1 m F �' rG 2 , • EtAuetti #1= POD > 30 220 rtglL TSS 3' , 30 -` 1,g�f!_ - eftwt # IK _ 30 uq& and TSS 130 WO L csT (Please P" CST Dale Evakraam Conducted Telepttorte NcaNter Propecty Owner Parcel ID # Page or F 3 - 1 # ❑ Pit Ground mism elev. � it Depot b Ong factor / 2 EL "orimn Dot Dominant Coki Redwc Texdme Strudure Corwister,oe soN RaAe Boundary Roots GPWIP i in. Mtmsel Oyu Sz. Cont. Color Gr, Sz. Sk 'EM TOM 1 0`1Z © 3�L (. M F' LS 9rh �� Z 93 s/ C.- i k r w l 2 - 3 B ❑ mxm ❑ Pu Gtamd atdaoe elev. ik Depot b soy Ram l kxl= Dept Dornirtmrt Colm Redoot Dsstxipliart Tetture Stns Consiatertoe amil ry Roofs GPM EW in. Mond fm. Sr- Carle Cobr Gr. Sz %L 'E1 1 • LJ Borng # ❑8 ❑Pit Ground atrrface elev. R Depth to M*k9 mClor in. Soi PvMbftn Ram tiodxon Depot Domim" Re*W Dem n iption. Texture Strutat" Commence Botmdary Roots GPM in. Mtmsei Om Sz Cont. Golan Gr Sz Sh. 't 1 'EfAlt2 • emwent #1= B�J 30 <_ RV& and TSS 2-80 a 150 a*& ' Biwa = 8OD 80 rrtgt4 anti TSS < 30 a g& The Department of Commerce is an equal opportunity service provider anti employer. If you need assistance to saxes services a need material in ao ahernate format, please contact the department at 608 - 266-3151 or TTY 608 - 264.8777. �- etoo(R.sao� Soil Test Plot Plan Project Name P.C.Collova Bldrs. Inc. Shaun / Address P.O. Box 489 1/ Somerset Wi 54025 CSf #226900 Lot 13 Subdivision Prairie Pond Breaks Date 4/9/03 E 1/2 NE 1/43 31 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 r VRP Assume Elevation 1 ft. Top of Steel Fence Post System Elevation 89.5/88.7 *HRPSame as Benchmark �.B Top of 2" Pipe @ 101.3' 441' S � 125' 1 % E S pe 35' � Not enough 49 -►o slope to establish 30' contours B -1 B -2 70' 150' 10' B. 10 A —.� � 5 2S f - Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. i in installed 2. Effluent filter is to be cleaned once a year. Please note. a larger f' filter it e s being 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 envy Plan O 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 71 5- 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 Property Address 9 (Verification required from Planning Department for new construction) City/State New Richmond, WI Parcel Identification Number _ f) 38 - I ZZI - /3 - Oro ( IZ / 3) LEGAL DESCRIPTION Property Location SE %,, NE V4, Sec. 31 . T 31 N - 18 W, Town of J hu(` w� Subdivision Prairie Pond Breaks Lot #. Certified Survey Map # — Volume , Page # 695417 2021 27 Warranty Deed # 695419 Volume 2021 , Page # _ 29 Spec house ❑ yes 0 no Lot lines identifiable ❑ yes ❑ no SYSTEM MAIlV'I'ENANCE 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, journeyrranplumber, restricted plumber or a licensedpumperverifying 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 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 d of the three year expiration date. Ij & 1 . C. COLLOVA BUILDERS, INC. . . O'n (2 W � (715) 247 -2742 - / d OF APPLICANT NT P.O. Box 489 DATE SOMERSET, WISCONSIN 54025 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. L ad L �A 0 Li,. ,, . P. C. COLLOVA BUILDERS, INC. / � (715) 247 -2742 SIGNATURE OF 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. '* Indude 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 U 2021P 029 STATE BAR OF WISCONSIN FORM 2- 1999 6 can 4 1 9 Document Number WARRANTY DEED :. REGIST ER OF DEEDS ST. CROIX Co., WI This Deed, made between Cecil Brighton and Cleo Brighton, RECEIVED FOR RECORD husband and wife, 1 0 - 23 - 2002 11: 00 :: A?f WARNM DEED Grantor, and P. C. Collova Builders, Inc. EXEMPT i TRANS NSFEE: 720 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 NW 1/4 of NW 1/4 of Section 32, Township 31 North, Range 18 West, St. Name and Return Address Croix County, Wisconsin. A/� 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. ) (is not) Dated this le" day of September 2002 Cecil Brighton V + + Cleo Brighton AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ;.:�. ) ss. St. Croix County authenticated this day of yi Personally came before me this —A!!X day of September 2002 the above named Cecil Brighton and Cleo Brighton, husband and wife, 1 h OF VliS���: TITLE: MEMBER STATE BAR OF WISCON' IN.,. (If not, to me kn to be a on(s) who executed the foregoing authorized by § 706.)6, Wis. Stats.) instru d le ed the same. THIS INSTRUMENT WAS DRAFTED BY • , Attorney Kristine Ogland Hudson, WI 54016 Notary Public, State of Wisconsin M Commiss' n is permanent (If not, state expir ion d (Signatures may be authenticated or acknowledged. Both are not necessary.) �iy� • Names of persons signing in any capacity must be typed or printed below their sigpiture. Information Profmionsis company, Fong du in, wl WARRANTY DEED STATEBAR OF WISCONSIN eoossspst FORM No. 2 - 1999 U 2021 P 027 STATE BAR OF WISCONSIN FORM 2- 1999 6 9 5 4 1 7. KATHLEEN H. YALSH WARRANTY DEED Document Number REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Douglas A. Strohbeen and Eileen RECEIVED FOR RECORD Strohbeen, husband and wife, 1 0 - 23 -2002 11:00 AM WARRANTY DEED Grantor, and P. C. Collova Builders, Inc. EXEMPT # REC 11.00 TRANS 1260.00 C OPY 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): Recording Area Part of the NE 1/4 ofNE1 /4 and part of SE1 /4 of NE1 /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. Dated this Z g�tay of September 2002 Douglas A. Strohbeen fi ' + 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 f Douglas A. Strohbeen and Eileen Strohbeen, husband and wife, TITLE: MEMBER STATE BAR 017 I I MOW s (If not, to me known to be the rson(s) who executed the foregoing instru Wnda ged the same. authorized by § 706.06, Wis. Stets. OF C tt• WIS - — THIS INSTRUMENT WAS DRAFT9b"BY" + Attorney Kristine Ogland Notary Public, State of Wisconsin Hudson, WI 54016 lommission 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 P rofessionals c ompany, Fond du Lao, N STATE BAR OF WISCONSIN 800455-2021 WARRANTY DEED FORM No. 2 - 1999 ° W o a L o 4.46 acres to NW N N Q w Lo 7 � ��, L.B.O. 852.1 oo \z . Q Q - c°1l _ en W LorA7 � `\ $. Z Z a 116,444 sq. ft. \ ° �- s `s \ 1 ` mQ-j \ 29G+ 2.67 acres �. �'` �' 6 �I t L.B.O. 852.1 C Q I b 72- W 1 Cv 1 e z LOT ff LC 0 73,470 sq. ft. 1 M 1.69 acres j 80,44E a I 1.85 •j / 9 .5 p 64.24 N 331 8 p.Op� ' '. L f • � \ , IJOIN� DR /VE, y U EASEA:f ,CNT \ A) LOT m s'r •s 78,681 sq. ft. °' s' 1.81 acres \ s ° • L.B.O. 873.0 °i �sroR I WA M ` RET�N71pN AREA .� 6� � T. N H. WE. 8 69.0 aa40 s 79.4 ¢' !v OT ITV STpR WA R in 99, ft. RVr/V)70,V AREA co L.B.O. •5 acres HWE. 8755 /� N00' 7 1.04' „ � W \ S 9'46'11" E .2Z� \ 4484.0.3' �2�.37 N 89 °46'11" W ��_� N 89'46'11" W WEST 1/4 CORNER SEC. 31 -31 -18 UNPLA TTED LAN (FOUND ALUMINUM — -- — — — — — — — MONUMENT) 1 l b J