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HomeMy WebLinkAbout038-1221-18-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 463354 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: Village X Township Parcel Tax No: City P.C. Collova Builders, Inc. Star Prairie, Town of 038 - 1221 -18 -000 CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No: �1'N 31.31.18.1218 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Ilt9 Alt. BM Aeration Bldg. Sewer � . 7 9' Holding St/Ht Inlet C1 90.9 q TANK SETBACK INFORMATION St/Ht Outlet /6,1 /o ' co TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic WO O ' 2 i ' Z� � Dt Bottom � l0 Dosing Header /Man. to 1 $ �� q Aeration Dist. Pi / P e Holding Bot. System PUMP /SIPHON INFORMATION Final Grade J • Z 5 Manufacturer Demand St Cover A % GPM (p- _] Cv Model Number O 1 T Lift Friction Loss System H I T Ft Forcemain Len Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length No. Of Tre PIT DIMENSIONS No. Of Pits Inside Di\ T uid D� ( O r DIMENSIONS : 1 C, CZ-) 7 (( G I __ A \ �,_ SETBACK SYSTEM TO ` P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR e " Type Of System: �1 Q 7 �x1 UNIT Model Number: r � VJ DISTRIBUTION SYSTEM l J Z Z �o Header /Manifold Distribution Hole Size Hole Spacing Vent to Air Inta i Pi \ \ ve N V%, Length �� Dia Length Dia Spacing i x x �1 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over / Depth Over xx Depth of xx Seeded /S dded xx Mulched Bed /Trench Center I S Bed/Trench Edges Topsoil Yes No es No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1; / Inspection #2:__, Location: 1867 90th Street New Richmond, WI 54017 (SE 1/4 NEE ��/4 31 T31 R1 8W) Pra - Pond Breaks Lot 18 Parcel No: 31.31.18.1218 1.) Alt BM Description 2.) Bldg sewer length = �� amount of cover = r Plan revision Required? Yes ��lo / 6e, (o, � Use other side for additional information. Date Insepctor's Si nature Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County L ,/ 201 W. Washington A 7}�2 s 4-( �� /- i s�onsin Madison, WI 5 anitary Permit Number (to be filled in by Co.) (6os 3 3 S Department of Commerce ,. Sanitary Permit Appliea n � S e Plan LD. Number In accord with Comm 83.2 1, Wis. Adm. Code, personal informa on you provide maybe used for secondary purposes Privacy Law, s15. (1)(m) l,°' �, ;a (1(j ;ect Address (if different than mailing address) I. Application Information- Please Print All Information ST,C ROIXC, {,0,, Property Owner's Name � 0 I # / L9t# Block # i - C� C © v T Property Owner's Mailing Address� � Property Loc�ati V4, / �., Section City, State Zip Code Phone Number { j ucl ne) V T N; RA& W 11. Type of Building (check all that apply) pp 1 S r2 Family Dwelling -Number ofBedrooms _ _. A0 Subdivision Name CSM her 11 Public/Commercial - Describe Use LTO ❑ State Owned - Describe Use ❑City ❑village- bewtship of II1. Type of Permit: (Check only one box on line A. Complete line B if applicable) 0 - 12-2- _ .- CVV 1 /�' A. System ❑ Replacement System E] Treatment/Holding Tank Replacement Only 11 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 apply) Pressurized in- Ground ❑ Mound > 24 in. of suitable soil El Mound < 24 in. of suitable soil 11 At-Grade El Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter aching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treat ent Area information: 2 X (fl IODlF �S Design Flow (gpd) Design Soil Application Rate(gpdsf) 'Dispersal Area Required (sf) Dispersal Area Proposed (sf) yttem Elevation), 6 �7 VI. Tank Info Capacity in Total Number Manufacturer �� oncrete efab Site Steel Fiber Plastic Gallons Gallons of Units! A -/� Constructed Glass New Fasting r Tanks Tanks ` Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Stateme - 1, the undersigns ,—Anne, res ponsibility for installation of the POWTS shown on the attached plans. Pl b s Name (Print) Plumber's ' ature MP/MPRS Number Business Phone Number ZZ 66 umber's Address (Street, City, State, Zip C D d lI. County/Department Use Onl Approved ❑ Disap Sanitary Permit Fee (includes Groundwater Date Issued wing gent Signature (No Stamps) Surcharge Fee) ? � El Owner Given Reason for Denial IX. Conditions rov al SYSTEM OWNER: 9 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances 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) LOT PLAN PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 1 /�� 1/4S /T N/R 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 3 /21 /05 3 BEDROOM CONVENTIONAL XXX IN -GRO D 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 hL BENCHMARK V.R.P. Top of Steel Fence Post 4-( ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 89.6' Alt. BM Top of Steel Fence Post C 100.2' Well is to meet all 42' setbacks required by WDNR Plans Designed Using Conventional Powts Pro Town Road Manual Version 2.0 tam P 50' 0% Slope Vents Pro - 60' —B- 20' �{ Bed Ho se 20' 25' 2 -3' X 69' Cells with 30' >3' Spacing B - , Vent >6 „ Standard Biodiffuser of Cover Leaching Chamber 468' with 31.1 ft2 of Area r6'Long 11 " Grade at System Beva ' rte/ 3 4" � V&PO LOT PLAN PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 li 1/� 1/4S 2�\ !T N/R 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 3 /21 /05 BEDROOM 3 CONVENTIONAL )00( IN -GRO D 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 BENCHMARK V.R.P. Top of Steel Fence Post 4-( ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 89.6' Alt. BM Top of Steel Fence Post @ 100.2' Well is to meet all 42' setbacks required by WDNR Plans Designed Using Pro Town Road Conventional Powts Manual Version 2.0 50' 0% Slope Vents Pro 3 - 60' 20' Bedroom House 20' ST 25' 2 -3' X 69' Cells with 30' >3' Spacing 40' IF El B -2 Vent > 611 Standard Biodiffuser of Cover Leaching Chamber 468' with 31.1 ft2 of Area 6' Long 11 " Grade at System Elevation 34" r j W c �.e tt of OL Conv EVALUATION REPORT Page of Owls( of Safetyand Bur Wes k IA a000b8F10B With l: iMl18J.YVI3. ; Adh. Code .,. ARach complete sloe Ow on paper not less then 81/2 x 11 inches in size. Plan Met Cr i ktokrde. but not Wrifted to: verecal and horwmW reference point (8141). direction and Panel I.D. p and kxmdortarxtdisfartcetonearestr +oad. Please print am lnrommoon. by Date �l pWSO 1. ram --*, yon provkle _ be wad for - CWW Wy P (Privacy Law. a. 15.04 ( (m))• l p�typ�� / Property d E Gott {.d 1 T 31N R j S E ( W pl p 9 A L t jj mode # Name or CSW �, y CRY ❑ Cly O VSage T own Nearest Road .5'a ems i tit -5 •� � �� e New Cambuction Lh 3 eW ttial / MxAw of bedrooms _ . ._ Code der(ved demp low WD O Replsimmert 0 PL*gc or conwrterdid - Describe: Parent mdww < .L mood Plan dw4Wm if gpBcebie and reoonurtertdalorts: [ ge o f fir' F-I I Borktg # 0 ' V pit Grtxxtd surfaos eietr. 1� ft. Depth to factor v lisle Horti m Dsplh oamktant RsdGK Doman Textus Strtxxue Cor ablence Bmndwy Roots im muns l ttr,. SL Cont. color Gr. SL Sk ' o V, 3(L J4 ❑ soft 0 B«kg Pit Ground surface elev. ft. Depth to Kmft factor _ in �y Rate Horizon Depth Dominant Redoor Description Talk" Sbuctxe Corts me Boundary Roots GPM kt. Mured Ott. SL Cont. Color or. SL Sh. - L L, m w Z vi 1 . • etkmrtt = SOD > 30 -c 220 mqL and TSS >30 _` 1st • - Eft #2 = BOD _ 30 ngil arrd Tss _ 3a rrgn CST (Plus • m n CiST 0 6 26V Date EvettaGon Conducted Telepttons Number 2r 3 Property Owner Parcel ID # Page of # ❑ F3-1 Pit GrouaudstafaceSlay. �, I. D ept h Sal n Rate Redox Texture Cor>s�ruoe Baax�y Roots OPDdl� irL Mural o Sz. Gon. Co lor Gr. SL Sh. I — 7 mfr• — 14 10 r y js o vPr [C ,7 / rn }, mGr C LAJ r` l a g - 3 Ilk5 Os ►-,� i ,, n /mac /. fflid �# ❑ Bwln ❑ Pit Gr o nd aaface elev & Depth to Wmb ,ate iR Horizon Depth Daninard Redwc s� Rate Desu"on Texture Struckso, C,o enoe Botaudery Roots GPD F in. Murusell tau. Sz. Gad. Calm Gr. Sz. Sh. F-I „�# ❑ ❑ Pit Ground awfte etev. R Depth to Waft tacw in � Rate Mfto Depth Dorr*ard C4M Redac Description. Terctue S6wxure Comore Boundary Roots CIPM IM Munsell OU. Sa Cord. Color Gr. Sr- .'W Eftsent #'t o SCC a > 30 <220 nV& end TW 3 15o mgll. ' Bkoerd 02 = BW < 30 mg& and TW 30 a gll_ Tla 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 contact the department at 608- 266 -3151 or TTY 6o &264 -8777. seaanotRAW Soil Test Plot Pla Project Name P.C.Collova Bldrs. Inc. S ird Address P.O. Box 489 Somerset Wi 54025 STM #226900 Lot 18 Subdivision Prairie Pond Breaks Date 4/9/03 E 1/2 NE 1/4S 31 T 31 N /R W Township Star Prairie N W 1/4 W 32 Boring Q Well PL Property Line County ST. CROIX ileva tion VRP Assume Elevation 1 ft . = Top of Steel Fence Post 89.6' *HRPSame as Benchmark ".B= of Steel Fence Post @ 100.2' 42' Pro Town Road 250' Alt B -3 60' B -1 20' .M. 0' 0% Slope 40' B.M. B -2 68' 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 1 Plan Option #1. If ystem fails, determine cause of failure, use alternate area and install new 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 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 0� 1 (Verification required from Planning Department for new constriction) City /State New Richmond WI rY Parcel Identification Number LEGAL DESCRIPTION av'o Property Location SE ''V., NE 'V4, Sec. 31 . Z' 31 N -R 18 W, Town of C ) ham' Subdivision Prairie Pond Breaks Lot # . Certified Survey a # `�- Y P . Volume , Page # 695417 2021 27 Warranty Deed # 695419 Volume 2021 Page # _ 29 Spec house ❑ yes ❑ no Lot lines identifiable E' yes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof 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 licensed pumper verifying 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 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 stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 of the three year expiration date. P. C. COLLOVA BUILDERS, INC. (715) 247 -2742 P.O. Box 489 / q /4 lays po SIGNATURE OF APPLICANT SOMERSET, WISCONSIN 54025 DATE OWNER CEATWICATION 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. P. C. COLLOVA BUILDERS, ERS INC, (715) 247 -2742 3 /7/0s GNATURE OF APPLICANT P.O. Box 489 SOMERSET, WISCONSIN 54025 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 U 2021P 027 • STATE BAR OF WISCONSIN FORM 2 - 1999 6 9 S 4 1 - 7. Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., YI This Deed, made between Dou gla s � A. Strohbeen and Eileen g RECEIVED FOR RECORD Strohbeen, husband and wife, 10 - 23 -2002 11:00 AN WARRANTY DEED Grantor, and P. C. Collova Builders, Inc. EXEMPT # REC FEE: 11.00 TRANS FEE: 1260.00 COPY FEE: CERT COPY F EE: Gran Grantee. 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. Dated this y of September 2002 + Douglas A. Strohbeen f i a + 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 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 706.06 Wis. Stats. instru nd a ged the same. authorized by § tt OF WISzl� " - THIS INSTRUMENT WAS DRAFT9b)j Y • AF4 Attorney Kristine Ogland Notary Public, State of Wisconsin Hudson, WI 54016 ommission is permanent. (If not, state expiration dater (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. Informad n Professionals Company, Fond du Lao. N STATE BAR OF WISCONSIN 80"55-2021 WARRANTY DEED FORM No. 2 - 1999 U 2021P 029 STATE BAR OF WISCONSIN FORM 2- 1999 6 9 ES 4 1 9 WARRANTY DEED KATHLEEN H. WALSH Document Number : OF DEEDS ST. CROIX CO., MI This Deed, made between Cecil Brighton and Cleo Brighton, RECEIVED FOR RECORD husband and wife, 1 0 - 23 -2002 11:00 AM WARRANTY DEED Grantor, and P. C. Collova Builders, Inc. EXEMPT # REC FEE: 11.00 TRANS FEE: 720.00 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 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 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 r yi, Personally came before me this day of September 2002 the above named Cecil Brighton and Cleo Brighton, husband and wife, I OF ils� ° ,��_ TITLE: MEMBER STATE BAR OF WISCONSIN.. (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 Hudson, WI 54016 Notary Public, State of Wisconsin M Commissjpq is permanent (If not, state expir ion dg e: Si natures may be ( 8 Y authenticated or acknowledged. Both are not necess J Names of persons signing in any capacity must be typed or printed below their si Lure. Information Pror,,,io,,.i, C ompany, Fond au L;, - N — STATE BAR OF WISCONSIN 800-655 PZt WARRANTY DEED �. FORM No. 2 - 1999 CD Cl p. C12 PD Ln to OD ip bD Nw G 00 0 �. S �iS` /.� /t 4� /0 Ln CY) V fl o N v � � cn \ x3 th o Ul a 5 2 qp2 �9 v Q, rn 0N � �' g SS i o -- 927.03' -- VAR /ABLE NE 11 40 SEC 33 467.98' `SD' WIDTH 'x`10'39" E NW W11 o s c i 1325.67' S 00' 10'39" E 2651.34' UNPLA TIED LANDS tz b H b f'A �5 00 .g oo o b. ftl on co ?� � z �o�