HomeMy WebLinkAbout038-1221-14-000 Wisconsin Department of Commerce Count
PRIVATE SEWAGE SYSTEM St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
453124 0
GENERAL INFORMATION (ATTACt'-I 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:
Collova, P.C. I Star Prairie Township 038- 1221 -14 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No;
1 i
W, W ,p WI' n 31.31.18.1214
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic etc Benchmark "•20, C 00 Or
Dosing V Alt. BM
Aeration Bldg. Sewer 3•30 }'�I
Holding St/Ht Inlet
I
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic f f Dt Bottom
> 30
Dosing Header /Man.
Aeration Dist. Pipe t .q0 s• O
ho - 2.o .c'o
Holding Bot. System
I L L I S• 4 15•.41
1110 Io o
Final Grade r
PUMP /SIPHON INFORMATION 446 -t7� II•o (M-2A
Manufacturer geraQnd St Cover
GPM 05,80 O�+ /
Model Numb
TDH Lift' ction Loss System Head TDH Ft
Forc In Length Dist. to Well
SOIL ORPTION SYSTEM
/TRENCH ) Width Length ( No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIM S 3 1 ( ea .) ll /2
SETBACK SYSTEM TO P/L LID L LAKE /STREAM LEACHING Manufact r:
INFORMATION CHAMBER OR 1`O�S
Type Of System; UNIT
8 I rjL1 �� Model Number: 1 1 It
`71C
DISTRIBUTION §YSTEM 1 '
Header/Mani,210 Distribution x Hole Size x Hole Spacing Vent to Air Intake
Length Dia 'T Length 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 Bed/Trench Edges Topsoil
Yes No Yes No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1:f Inspection
Location: 1843 90th St �Unknown (SE 1/4 NE 1/4 31 T31 R1 8W) Prairie Pond / Breaks Lot 14 Parcel No: 31.31.18.1214
1.) Alt BM Description = '- /'°"/ % WJL ��• �"�• �j s) tom'[ � � COr1s�u�
2.) Bldg sewer length = SS t -�"— ' CP C UX
amount of cove = 4z -t- �+` o °b (O S `� '
Ian re Ision Required? Yes No
Use other side for additional information.
SBD -6710 (R.3/97) Insepctors Signature I r s
Safety and Buildin C uunq'
201 W. Washin on Avc2 f Madison W. n itary Permit Number (to b tilled [it by Co.)
�SCO/1 S/l t (6 8) 26 rf 453 Z
1
Department of Commerce ate Plan I.D. Number
Sanitary Permit Applica ionA.) R ; 3 ZON
In accord with Comm 83.21, Wis. Adm. Code, personal infort ation you providt I oject Address (if different than mailing address)
may be used for secondary purposes Privacy Law, sl .04(1)�T CRUIX (;OIi
1. Application I nformation —Please Print All Information FFICE v gT -3 5 Q S 7
1 Par el # Lot #
Property Owner's Nai
Property ocati 7
Property Owner' iIing Address , /
Section
City, State
Zip Code Phone Number
T -3 / N; E o
�r s
II. vpe of Building (check all Subdi on Name CSM that apply) v i umber
2 Family Dwelling - Number of Bedrooms
❑ Public /Commercial - Describe Use ❑ v
f City_ ❑Villa � ,ff w�iship o
[I State Owned - Describe Use 1 Z.
III. Type of Permit: (Check only one box on line A. Complete line B if applicable) Q3 g - i 2,?J _
— 17z7'!) • Ill
A_ System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
R ?F_ Permit Renewal El Permit Revision ❑ Change of ❑ Permit Transfer to New
List Previous Permit Number and Date Issued
LieD Lxp
nber Owner
❑ Single
e soil ❑Mound < 24 in. of suitable soil ❑ At -Grade g e Pass Sand Filter ❑
� �/ - ;Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter o LQa �_ Q �- _S S S i 32
_ L_ _ ❑ Drip Line ❑ Gravel -less Pipe ❑Other (explain)
- -- _ t Dispersal ersal Area Proposed (st) ystem Elevation
~ Dispe l Area Required (st) p
— – -- - - - - -- - - - -- - - -- 6
1 0// h� fiber Manufacturer Prefab Site S el Fiber Plastic
'A ( L Inits oncrete Constructed Glass
IS90 I
"me responsibility for installation of the POWTS shown on the attached plans.
-- — - -- - MP /MPRS Number Business Phone Number
W E
t utary Permit Fee (includes Groundwater Date Issued I sui g Agent Sign ure o Stamps)
- --
rcharge Fee) 0 T" Z 4
C
- = I , o plumber.
-_ -_
- - -- — _- _— —ltained
Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size
SBD -6398 (R. 01/03)
PLOT PLAN
PROJECT P.C. Collova Bldrs. Inc. ADDRESS PO 489 Somerset Wi 54025
SE 1/4 NE 1 /4S 31 /T 31 N/R 18 OWN Star Prairie COUNTY ST. CROIX
4/11 3
BEDROOM
MPRS Shaun Bird 226900 DATE
CONVENTIONAL XXXX IN- GROUND PRESS 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
IL BENCHMARK V.R.P. Top of Steel Fence Post ,g„M 1 ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
CAJBM SYSTEM EL EVATION 95.3/95.0 5.5' below qrade
A Top of Steel Fence Post @ 99.3'
Plans Designed Using
Conventional Powts
Well is to meet all Manual Version 2.0
setbacks required by
WDNR 261
Vent
>6 „ Standard Biodiffuser
of Cover Leaching Chamber
with 31.1 ft2 of Area
422'
6' Long 11"
Grade at System Elevation
34"
Pro 3
Bedroom
rowi Road House
1 JB
S
6%
0' Slope 101'
_-
100'
40'
_XJ�kn A rt. B -3 99'
110' B
394'
PLOT PLAN
PROJECT P.C. Collova Bldrs. Inc. ADDRESS P. J &x 489 Somerset Wi 54025
SE 1/4 NE 1 /4S 31 /T 31 N/R 18 TOWN Star Prairie COUNTY ST. CROIX 4/11 /04
.ter
MPRS Shaun Bird 226900 ✓ ' DATE BEDROOM 3
CONVENTIONAL )00( IN- GROUND PRESSEE 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
IL BENCHMARK V.R.P. Top of Steel Fence Post m g„ k i ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
CAJBM SYSTEM EL EVATION 95.3/95.0 5.5' below qrade
A Top of Steel Fence Post @ 99.3'
Plans Designed Using
Conventional Powts
Well is to meet all Manual Version 2.0
setbacks required by
WDNR 261
Vent
>6 „ Standard Biodiffuser
of Cover Leaching Chamber
422' with 31.1 ft2 of Area
6' Long
11"
Grade at System Elevation
34"
Pro 3
Bedroom
row, Road House
10'
ST
10' 6%
B Slope 101'
100'
40' A--
A t. B -3 99'
110' B
394'
i
d
Vftw sinDep=amantof Corrsaerce S IL EVALUATION REPORT page of
DMsmofssfel NWB
in accordance with Comm 85 Wis. Adm. Code
aaadn completa site plan on paper not less than 81 x 11 indies in size. Plan must
include, but not Il mi6ed toe vertical and horizontal reftwence point OM, d mdbn OW Patel I.D.
paRxnt slope. sadeordirrisinsions. north array and tocWan and distance to nearest road.
pn t as wbtWO Date
pWWW x*w atom Yon WwAft May be o edtor ai ondwy PWPOM W*MY LOW. a 16.04 (1) tm »•
pmpatyow w Property , / ltt
'� '� Govt trot L 1J4 T 3 N R/ E( W
A
f ` , Gv /� G
property Owners Melling
Address; 19 9 # Bloclt # Name or
state ZoGaw Phone NuIrdw p CAy 0 ~ Tm Road
.�
New Constitution us Resiaenmal i Number of bedrooms _ Code derived design Eow rate .�lJ GPD
[] Rat ❑ Public or iximmerded - Desuire:
parent mdww Flood Plain sWisdon if applicable
General comments ' 3 1
9.
and ted�Ons �/
B °''"g # a 0 Boring Ground see elev. 1 0 0 ' 3 1L ,Depth to kd trg factor ' � � in Soil Rsle
Ho hM Depth Dominant Color Radom Dr on Texture Sdudure Consistatoe Botatday Roots
in. Mansell M Sz. Cont. Color Gr. Sz Sh. 'EM
Z s ter` l e t
V),4
P o Z
®Boring # O n. Depth ID i d ft feclor in
( Pit Gnxsrd stafaoe elay. sou Rate
Horizon DWIh DqIIIIIIIat Coolor Radar oesaiption Texture Structure Catsistatoe Boundary Robla GPOW
it I Munsd Qu. SL Cont Color Gr. Sz. Sh. VIM '
- d 8
J L.. 0? r CS 10 v
0 1 vv ,5'lq S L
3 (,- to s/ c L 1 Z • 3
RS. 3D�
• Emuent #i = BOD 3o = 220 mg& and TSS 40 < ��%f • bent 02 = DOCk = 30 mgk and TSS < 30 nQ L
CST (plBaBe P** r CST Number
AYddress _ Date Evaluation Conducted Telephone Number
Property OMW PaFoel ID # Page of
Bor;v# ❑
Pit Ground rfaceelev. Z n Depth to factor /I 0 im
Hannon Depth Dm* Redooc Soi Rate
Descr�on Texk�ne StrucUre C.oree B Roots GPD�
in. Muneefl tlu. Sz. Cont. Color Gr. Sz Sh. •EWI
0--1 S -
p I NI w
E soft# ❑
❑ pit Gwund sutace elev. R Depth to 0 A ig factor i
Horizon DOM Do *wd Redoot suit Rate
Dssp�flon Texture Situcture Corawe Boixndaiy Rooks GPpyg<
in Murwd Qu. SE taunt. Color Gr. SL Sh. I •
M �# ❑ Boft
❑ Pit Gnxnd surbace elev. R Depth to knOV factdor Ir
Soi Awk0m Rate
Hodmn Depth Dominant Cdw Itedmn TexkM Sbuctue Conskftnw BowWary Raft
in. Munsel tits Sz. Cont. Color Gr. Sz Sh 'EW 'Etfl{Z
Effluent #1= BCC � > 30 220 atlL and TSS >30 a 150 mgiL • Effkxm t 42 = SOD,, c 3D mg& and TSS < 3o mgll
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please comact tlm department at 608- 266 -3151 or TTY 608 -264 -8777.
SOWWoM6"
Soil Test Plot Pla
Project Name P.C.Collova Bldrs. Inc. Sh
Address P.O. Box 489
Somerset Wi 54025 6 6 STM #226900
Lot 1 4 Subdivision Prairie Pond Breaks Date 4/9/
E 1/2 NE 1/4S 31 T 31 N /R18 W Township Star Prairie
N W 1/4 W 32
[� Boring 0 Well PL Property Line County ST. CROIX
B or VRP, Assume Elevation 100 ft. Top of Steel Fence Post
System Elevation 95.3/93.7 *HRPSame as Benchmark
lt. BM Top of Steel Fence Post @ 99.3'
261'
422'
0
3
0
N
0
6%
B -1 Slope 101'
B -2
r 7'30 35'
'
100'
40'
* 99'
110' B
KAIC
394'
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
ency Plan
Option #1. If system fails, determine cause of failure, use alternate area and install new
m 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: >haun Bird 715 -246 -4516
St. Croix County Zoning 715- 386 -4680
Pumper Torn Mondor 715- 246 -5148
Shaun Bird #226900
ST CROIX COUNTY Y .°
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 1 2 6 )41--
(Verification required from Planning Department for new construction)
New Richmond WI
City /State Parcel Identification Number b3$ ( 2Z( - 4 - 0z:F0(• 1 2-4)
-)
LEGAL DESCRIPTION
Property Location SE V" N E y,, Sec. 31 , T 31 N -R 18 W, Town of 5 fiut'' '1"��i,lc�
Subdivision Prairie Pond Breaks Lot #.
Certified Survey Map # Volume , Page #
695417 2021 27
Warranty Deed # 695419 . Volume 2021 , Page # ^ 29
Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ 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 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.
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
stat that your sep c system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
IrT y expiration date.
�. C. COLLOVA BUILDERS, INC.
SIGNAARLI OF APPLICANT (715) 247 -2742 DATE
P.O. Box 489
OWNER CERTIFICATION SOMERSET, WISCONSIN 54025
(we) certi
tall statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the cri bove, by virtue of a warranty deed recorded in Register of Deeds Office.
C. COLLOVA BUILDERS, INC.
(715) 247 -2742
SIGNATURE F PLICANT SOMERSEI'0. Box 489 DATE
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 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 9 5 e+ 1 9
KATHLEEN H. WALSH
WARRANTY DEED
Document Number :.REGISTER OF DEEDS
ST. CROIX CO., MI
This Deed, made between Cecil Brighton and Cleo Brighton, RECEIVED FOR RECORD
husband and wife,
10 - 23 -2002 11:00 A�
YARRAMTY DEED
Grantor, and P. C. Collova Builders, Inc. EXEMPT #
TRANS 720000
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 NW1 /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. CK) (is not)
Dated this %r day of September 2002
• • Cecil Brighton V
• • Cleo Brighton
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
- ;} ��' ? St. Croix County ss.
authenticated this day of r ye,
�.. > Personally came before me this A! !9 day of
September 2002 the above named
• '''�� = s Cecil Brighton and Cleo Brighton, husband and wife,
1 h OF VlISC�,��
TITLE: MEMBER STATE BAR OF WISCONS'IN.
(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 Kristine Ogland Notary Public, State of Wisconsin
Hudson, WI 54016 M 4Comiss' n is permanent (If not, state expir ion da
(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 lure. treormauon Pm(esalonsts company. Fond du Lac. N
WARRANTY DEED STATE BAR OF WISCONSIN 800-655IP21
FORM No. 2 - 1999
U 2021P 027
STATE BAR OF WI$C,ONSIN FORM 2- 1999 6 9 5 4 1 7.
. Document Number
WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed made between Douglas A. Strohbeen and Eileen RECEIVED FOR RECORD
Strohbeen, husband and wife,
10 - 23 -2002 11:00 AN
WARRAVTY DEED
Grantor, and P. C. Collova Builders, Inc. EXEMPT #
REC FEE: 11.00
TRANS FEE: 1260.00
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):
Recording Area
Part of the NE1 /4 of NE1 /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. (is) X)fdQ
Dated this 24 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
V <, '.•, September 2002 the above named
j Douglas A. Strohbeen and Eileen Strohbeen, husband and wife,
TITLE: MEMBER STATE BAR OF -'I � s
(If not, to me known to be the rson(s) who executed the foregoing
authorized by § 706.06, Wis. Stats. instru nd a ged the same.
1t OF WISE 0 .,- ..
THIS INSTRUMENT WAS DRAFTI�b )3Y'
Attorney Kristine Ogland —
Hudson, WI 54016 Notary Public, State of Wisconsin
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 sig% ture. Information Professionals Company Fond du Lac, W1
STATE BAR OF WISCONSIN 800455-2021
WARRANTY DEED FORM No. 2 - 1999
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NE I14 OF SEC. 31
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