HomeMy WebLinkAbout038-1221-21-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
453119 0
GENERAL INFORMATION r (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 -21 -000
C T BM jlel . G`�I1 Irysp. BV Elev: / I BM Description: Section /Town /Range /Map No
11 -`•" � 100 •a p,.: .31.18.1221
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic rk
Dosing Alt. BM
Aeration Bldg. Sewer • pT q�• 80 r
Holding St/Ht Inlet O" �
• 30 9' 30
TANK SETBACK INFORMATION St /Ht Outlet 7•5 q .10�
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic , ,'rE I Z Dt Bottom
Dosing Header /Man.
Aeration i ( w. - ) 73 •
Holdin Bot. System . Z,0 p
92 • a'
p
PUMP /SIPHON INFORMATION Final Grade
Manufacturer Demand S Cove, 2 .2d /
GPM y p r,
Model Number
TDH Lift Fricti Loss System Head TDH Ft
Forcemain Length Dia. Dist. to Well
S0116APS SYSTEM CA-,_"
TRENCH Width Length 1 No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMe1VSt01qS •�
SETBACK SYST TO O P/L JBLDG WELL LAKE /STREAM LEACHING M utiactu er
INFORMATION Type Of System: r CHAMBER OR 26400
33 Model N: ej: W-G , WQ
DISTRIBUT ON SYSTEM r R,o, d
Header /Manif Distribution x Hole Size x Hole Spacing Vent to Air Intake
u Pipe(s)s
L Dia_ LDia 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 r ;_' No ' Y es es -�' No
( To,cazo n u : CCM11�NTnclude �od� discencie„s, perso etc.) Inspection Inspection #2: '� /
902 189th Ave UnknA*wn ( 1/44 N 1/4 T31 R1 8W) Prairie Pond Breaks ��'N^ S Parcel No: 31.31.18.1221
1.) Alt BM Description = S ;' wt�► W`<< I) g ` S f �� ���"^ �MtV re -
2.) Bldg sewer length ='L be.. 6.111". " 4;. 2K.
- amount of cover = 36 « f , q� A A _ . � e _ � {� a ,
Plan revision Required? i ,Yes No --
Use other side for additional information. �_ _- I I I I __ � _i -_
Date�pQ ` S Cert. No.
SBD -6710 (R.3/97) Z01 ?�� — _ pd,;•S r�
Safety and Buildings Division Count' n
201 W. Washington Ave., P.O. Box 7162 1 l
vNisconsin Mrdison, V:1 53707 - 7162 I itary Permit Number (to be tilled in by Co.)
(608) 26 - 3151 RECEIV 5 S I I °►
Department of Commerce v State PI n 1.D. Number
Sanitary Permit Applicatio >�R 1 3 20
In accord with Comm 83.21, Wis. Adm. Code, personal information a prov roject ddress (if different than mailing address)
maybe used for secondary purposes Privacy Law, s 1 5.04(1) )
L Application Information - Please Print All Information ZONINGOFFI E
3 , r el # of -
Property O+ +iter's Name --
Property Locati r
Property Owner's Mailing Address - 72 I t
1 w 4 >L- /V A section
City, State Zip Code Phone Number f
) �� /�ircl one
II
N; R E o �W
. ype of Building (check all that apply) 0' S L& Subdivision Name SM Nwnber
r 2 Family Dwelling - Number of Bedrooms & r
4-1 n
❑ Public /Commercial - Describe Use
2 t K � � S City_pVillage Hmship of
El State Owned - Describe Use �.
III. "Type of Permit: (Check only one box on line A. Complete line B if applicable) 03$- (2Z( �(' ' 12Z1
A. w System ❑ Replacement System [I Treatment/Holding Tank Replacement Only [I Other Modification to Existing System
List Previous Permit Number and Date Issued
B. ❑ Permit Renewal ❑ Permit Revision El change of ❑ Permit Transfer to New
Before Expiration Plumber Owner
IV. T e of PO \�VTS S stem: (Check all that a 1 Cl - Pressurized In-Ground El Mound > 24 in. of suitable soil
El Mound < 24 in. of suitable soil El At-Grade [I Single Pass Sand Filter
Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank El Peat Filter [I Aerobic Treatment Unit ❑ Recirculating Sand Filter
❑ Drip Line El Gravel-less Pipe El Other (explain)
Recirculating Synthetic Media Filter cbing Chamber p
V. Dispersal/Treat nt Area Inf mation: ersal Area Pr f) System Elevat on
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (st) Dis p� 'n (J/ oposed (s pn
a aci in Total Number Manufacturer Prefab Site
C t Fiber Plastic
1 1. Tank Info Gall Gallons Gallons of Units �(co
oncrete Constructed Glass
New Existing l
Tanks Tanks
Septic or Holdim, "rank 1t'
/ I
Aerobic Treaunent Linit
Dosing Chamber _
VII. Responsibility Statement- I, the undersigned, as responsibility for installation of the POWTS shown on the attached plans.
Bus
b
Numer in ess Phone Number
Plumber's Name (Print) Plumber's Sig e MP /MPRS
- -Z44— V / /
Plumber's Address (Street, City, State, Zi��
flta J (/
V111. County /De artment Use Onl
Sanitary Permit Fee (includes Groundwater Date Issued I suit Agent Signatur (No Stamps)
Approved ❑ Disapproved Surcharge Fee) 2 5D— 046/
11 Owner Given Reason for Denial y 3;10
IX. Conditions of Approval /Reasons for Disapproval
SYSTEM OWNER:
1 Septic tank, effluent filter and
dispersal cell must all b serviced I m aintained
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 SV2 x 11 inches in size
SBD -6398 (R. 01/03)
PADDI PLAN
PROJECT P.C. Collova Bldrs. Inc. RESS P.O. Box 489 Somerset Wi 54025
SE 1/4 NE 1 /4S 31 /T 31 s W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 — DATE 4/12/04 BEDROOM 3
CONVENTIONAL XXX IN-GRWePRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 643 # 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 93.1/92.0 4.5' below qrade
Alt. BM Top of 2" Pipe 4 100.2' Plans Designed Using
* Conventional Powts
Pro Town Road 75' anual Version 2.0
Alt.
Well is to meet all M.
setbacks required by
WDNR 40' 97' 96'
98' Vents ,
rc wn Road
35'
2 -3' X 69' Cells with >3' Spacing
70'
- 5%
•
Slope
Vents
10'
T 323'
25'
i
03 cop
edr om
Ho se Vent
> 699 Standard Biodiffuser
of Cover Leaching Chamber
with 3 1. 1 ft2 of Area
6' Long 11 „
Grade at System Elevation
349t
OT PLAN
PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025
SE 1/4 NE 1/4S 31 /T 31 / 18 W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 4/12/04 BEDROOM 3
CONVENTIONAL XXX IN -GRO 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 643 # of chambers 22
BENCHMARK V.R.P. Top of Survey Iron ` &V^ ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL * H. R. P . Same as Benchmark
SYSTEM ELEVATION 93.1/92.0 4.5' below qrade
Alt. BM Top of 2" Pipe @ 100.2' Plans Designed Using
,� Conventional Powts
Pro Town Road 75' anual Version 2.0
Ac Alt.
Well is to meet all B.M.
setbacks required by
WDNR 40' 97'
98' Vents 96'
T wn Road -
135
2 -3' X 69' Cells with >3' Spacing
70' _
B-3_ 5%
Slope
Vents
10'
T 323'
25'
Pro 3
Bedroom
House Vent
>6 „ Standard Biodiffuser
of Cover Leaching Chamber
with 31.1 ft2 of Area
6' Long 11 "
Grade at System Elevation
34 99
s i
V&wnsin Depa Vmt of Coexnerae SOIL EVALUATION RrPOkT Page d
Diva worSafetysrndtirr rgs -., _.... _ .._._.,...
in acowdwrce vrlltr Comm 85. Vft Arlen. code
Attach corrrplate sibs plan on paper not lass than 8 V2 x 11 kx*res in $ine. Plan must r� t
krctuda . but not Ted toc war" and hodaorrtai mk mm potat {Q. (Mec n and Parcel LD.
pnucw t slop•, scats crdimensions. north arrow. and location and dkstarroe to nearest road.
Please print an kdbnnaftm by Dabs
Parsono hWom odoa you provide may be owdlor vocondwy Purposes (PrivaW Law, a. is of (1) (m)). Z l
pmper woww
Govt Lot 114A 1M I N R W
Acidwas a� 18k)ck# -� j
State Phone ❑ cky Town Road
ee
New Cot>*UC* n t Number of bedrooms _ Code derived design Clow rate '�J YJ GPO
OP O Pubic or =nmenaal - Desu be: _
antmallocial lG ? ��sl� RoodPldn Vapplicable
General corrarrerts s e led
and y '_ '
FI - I HOrir'o 19 Pa Ground surface d b lk
ev. tt Depth nlirg rector - In. R Horizon Depot Darrkrant Redox Desaiplion Textrsa Structure Consk�noe Bowidary Roots ! (iu 5z Cora Color
Car Sz Sh 'Ei
Al
a�1 93• ro
o
M Boft# O ftwng
p ft Growl suiace elan. ?R Depth b ImNtrg �' �.�— Sot Rate
Hmftn Depth Domkrarrt Rad=Desatp M Teft" Struck" Carisisterrce Ruda y Roots l3SW
in. mu "# CkL
ft color fir. ft Sh. 'EW �
0'FZ lo 3�- 5 2 r M I - LM �
3 - ,Y I l.2
4 g3•l,)
•
Eft wt lh s WD > 30 1220 mgll. and TSS >30 S 19 • EMuo t #2 - DOD <_ 30 mgt. and TSS c 30 mgil.
CSTNumber
csr t I 6 &
Address _ D�atb Ev Conducted Teisphons / Number
a�
Properly Owner Parcel ID # Page of
a # �� al
c+r ound �siaoe elev. ' ft. Depth to 6nev lector 11 im soil APPkMm bale
Horton Depth Dominant Color Redoc Description Tendons Structure Consistence Boundary Roots GPOW
In. Mu nseil Q L Sz. Cont. Color Gr. Sz Sh. •Etf#1 'Etf#2
Z 12— KO SL , w ,�'•�
5 a
Borbig # ❑
❑ Pic Ground surface elev R Depth to imang in. soH Reis
Horizon Depth Dw*mtCdm Redoc Description Texpre Stnncsu m Consistence Bo nfty Roots GPOW
&n. Nbud Qu. Sz. Cont. Color Gr. Sz. Sh.
Boring ❑9
❑Pit Gtourtd surLaos slay. R Depth to imi5ng factor in.
Sot Reis
Horizon Depth Do"dnent Color Re&w Desaiplicn. Tom" SMXWM Consistence Boundary Roots GPM
in. Murnsd Qu. Ss. Mont Color Gr Sz Sh. 'E1i#1 I 'E1fiR2
+ Eft #1 x BOD > 30 <ZO malt, and rM >30 1150 OQ& ' 011uent # = BOD 30 nV& and M 30 no&
is an equal service vider and mlployer. If you need assistance to amass services or
The Department of Commerce eq opporatnrty pm
need malarial m an alternate format, Please contact the departneent at 608-266-3151 or TTY 408- 264 -IrM.
seossjOOtA t
Soil Test Plot Plan
Project Name P.C.Collova Bldrs. Inc. Shaun, rd
Address P.O. Box 489
Somerset Wi 54025 C& #h6900
Lot 21 Subdivision Prairie Pond Breaks Date 4/9/03
E 1/2 NE 1/4S 31 T 31 N /R18 W Township Star Prairie
N W 1/4 W 32
Boring Q Well PL Property Line County ST. CROIX
O r VRP . Assume Elevation 1 f t. Top of Survey Iron
Sys Elevation 93.1/92.0 *HRpSame as Benchmark
Alt. BM ; Top of 2" Pipe @ 100.2'
Pro Town Road 75'
Alt
.M.
40' 97'
98' 96'
30
3 '
-
0
0 5
70'
- 5%
B -1
323'
I
348'
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 extEfnd 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
Contlp_gpncy Plan
ion 1#1.'f system fails, determine cause of failure, use alternate area and install new
y stem in jested 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 0 Box 489 Somerset, WI 54025
Property Address 0 a 1 O A
(Verification required from Planning Department for new construction)
City/State New Richmond WI Parcel Identification Number 2l - 0zr0 �• ( Z21)
LEGAL DESCRIPTION
Property Location SE V" NE %4, Sec. - 3 T 31 N -R 18 W, Town of 3 ,r �z
Subdivision Prairie Pond Breaks Lot # 69 1
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 SL Croix Zoning Department a certification form, signed by the owner and by a
masterplumber, journeymanplumber, 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
stating that your septic ystem has been maintained must be completed and returned to the SL Croix County Zoning Office within 30
da f e thk e iration date.
P. C. COLLOVA BUILDERS, INC. O
(715) 247 -2742
SIGNA OF APPLICANT 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
r by virtue of a w m tyy deed recorded in Register of Deeds Office.
c. COLL05A BU INC. '' II
247.2742 �( / /
SIGNATURt OF APPLICANT some RS r wlsc ®�sIN 54025 DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning DepartmenL * * * * **
•* 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 E' `� S 4 1 7
Document Number
WARRANTY DEED REGISTER OF DEEDS
�f ST. CROIX Co., III
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 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 NE 1/4 of NE1 /4 and part of SE1 /4 of NE1 /4 of Se ction 31, Name and Return Address
Township 31 North, Range 18 West, St. Croix County, Wisconsin, described
as follows: Lot I 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.
(is) X)100 Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this y of September 2002
* + Douglas A. Strohbeen
eis / -LL�G
• + Eileen Strohbeen
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN }
) ss.
St. Croix County }
authenticated this day of ;,-
r j T_ Personally came before me this � �y of
September 2002 the above named
I y Douglas A. Strohbeen and Eileen Strohbeen, husband and wife,
• ;f 4
TITLE: MEMBER STATE BAR OFI (R$�
(If not, to me known to be the rson(s) who executed the foregoing
_ instru nd a ged the same.
authorized by § 706.06, Wis. Stats. OF CO�
�t•- WIS _ -
THIS INSTRUMENT WAS DRAFT DAY' "'� ~ •
Attorney Kristine Ogland Notary Public, State of Wisconsin
Hudson, WI 54016 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 information professionals company, Fond a, Lac, N
STATE BAR OF WISCONSIN 800.655.202[
WARRANTY DEED FORM No. 2 - 1999
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