HomeMy WebLinkAbout038-1221-26-000 .iscorift Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 463033 0
GENERAL INFORMATION State Plan ID No:
Personal information yob *ovide 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. Star Prairie Township 038 - 1221 -26 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
10 G S 1 32
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark 2 /min
Dosing � � j Alt. BM r � � ,� 1 �• $ //� 5 .
t 0 Cyr dJ
Aeration Bldg. S wer
Holding St/Ht Inlet �• 1
St/Ht Outlet
TANK SETBACK INFORMATION 5 - S
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ �`
Septic � O It „ f ^ � � Dt Bottom �
Dosing Header /Man. 6j - 7 - 7
Aeration Dist. Pipe - 7. - 1 ° I' 7
E .9 9$
Holding - -- Bot. System q{ . ( 4
77, 3
Final Grade
PUMP /SIPHON INFORMATION 3 IO
Manufacturer GPM nd St Cover 2 , �jf 9
i
Model Num r _
t �b•� 1)1 - 7 1, /o3.z.-
TDH Lift Friction Loss System Hea TDH Ft
Forcemain Le ist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS '2 /
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: - nr+
INFORMATION CHAMBER OR Q) 4 ` c /
Type Of System: �� e �/ / �/� UNIT Model Number: /►
66 d�v w��n 10 ("r N ��T a , dt
DISTRIBUTION SYSTEM
Header /Manifold 4 Distribution x Hole Size x Hole Spacing Vent to Air Yak
0 i 1 Pipe(s) ` k
Length Dia T Length \ Dia Spacing 1
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only 0_%, -
"
Depth Over Depth Over xx Depth f 1 Xx Seeded /S ded xx Mulched
Bed/Trench Center —1 Bedrrrench Edges Topsoil
I L es [ No Yes L No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2:
Location: 934 189th Avenue Star Prairie, WI 540Z6 (SE 1/4 NE 1/4 331 T31 R1 8W) Prairie Pond Breaks Lot 26 Parcel No: 31.31.18.1226
1.) Alt BM Description = o Y
e
2.) Bldg sewer length = Z
- amount of cover = `f d 1
Plan revision Required? Yes No
`] � w 3 -7 �
Use other side for additional information. _ _
Date Inse ctor's ature Cert. No.
SBD -6710 (R.3/97)
Safety and Buildings Division County
1% f i 201 W. Washington Ave., P.O. Box 7162 s�- sconsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.)
Department bf Commerce (6 266 -3151 43
Sanitary Permit Appli spate Plan I.D. N umber
In accord with Comm 83.21, Wis. Adm. Code, personal ' o n ou provide
rosy be used for secondary putposes Privacy . s (1 ) S E P 0 9 Z 0 0 Pwic t Address (if different than mailing address)
L Application Information - Please Print All Information 5T. CR 01i(C0 U N i y)
Z nl! ��
Property Ownces Name . P. N Lot 11 Block
Pmpav owner Mailing Address Pro Location
City, State Zip Code Phone Number K / Z A, Section
SA D r R E w )
IL Type of Building (check all that apply „� �:, N . a r�o 5 T S "' on Narpe CSM Number
�Or 2 Family Dwelling - Number of S . Wj-
' Public/Commercial - Describe Use
State owned - Describe Use City Village of
III. Type of Permit: (Check only one box on Mine A. Complete line B K applicable) p - 39 ' - 221 2 _pap u(p
A / Mm, System Replacement System Treatment/Holding Tank Replacement Only Other Modification to Existing System
B. Permit Renewal Permit Revision Change of Permit Transfer to New Ltst Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. Type of POWTS S m: (Check all that a 1) 2 S 7 Z t
on - Pressurized In- Ground Mound _> 24 in. of suitable soil Mound <24 is of suitable soil At -Grade Single Pass Sand Filter
Constructed Weiland Pressurized In and Holding Tank Peat Filter Aerobic Treatment Unit Recirculating Sand Filter
i
Recirculating Synthetic Media Filter Chamber Drip Line Gravel -less Pi pe Other (ex 'n) j
V. D' ersallTreatment Area Information:
D M Design Soil Application Raw(gpdsf) Dispersal Area Required (so Dispersal Area posed (sf) �
VL Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units wj zz "64 A -!op Concrete Constructed can
Tanks I TX013
Septic or Hel ft Tank '
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement - L the ass►nae responsibility for Installation of the PONVIS shown on the attached Plum
P :7z 7 )-3j,,i-Q ' nt) Pl i MPIMPRS Number Bustness Phone Number
1
Plumber's Address (Street, City, State, Tv )
VIII. Coun /De attment use Onl
A ppfov ed Sanitary Permit Fee ('includes Groundwater Date Issued Issuing t Signature (No Stamps)
Surcharge Fee)
ven R for Denial $ 2 S
2� `
IX. Conditions of ApprovaVReasons for oval
SYSTEM OWNER:
1 Septic tank, effluent filter and
dispersal cell must all be serviced I 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 SW x 11 Inches in size
I
PLOT LAN
PROJECT P.C. Collova Bldrs. Inc. ADURESS P.O. Box 489 So merset Wi 54025
SE 1/4 NE 1/4S 31 /T 31 N/R wN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 9 BEDROOM 3
CONVENTIONAL XXX IN- GROUND PRES U CONVENTIONAL LIFT HOLDING TANK
, ff --
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 Wood Corner Po s K,w. SUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H. R. P. Same as enc mark
SYSTEM ELEVATION 96.9/96.0 4.5' below grade
Alt. B Top of wood pd§t @ 100.5'
434' It B.M. 120'
Well is to meet all 3 Vents
setbacks required by
WDNR -1
3 '
Plans. Designed Using 70 ,
Conventional Powts lop
Manual Version 2.0 B -3
B2
15'
ST
jL Standard Biodiffuser 80'
Leaching Chamber
with 31.1 ft2 of Area 15' Grade at System Elevation
3 4
Pro 3
Bedroom
House
co
Pro Town Road
VC10
PLOT LAN
PROJECT P.C. Collova Bldrs. Inc. AD ESS P.O. Box 489 So merset Wi 54025
SE 1/4 NE 1 /4S 31 /T 31 N/R WN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 9/6/04 BEDROOM 3
CONVENTIONAL XXX IN- GROUND PRES U CONVENTIONAL LIFT HOLDING TANK
, ff
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 Wood Corner Pos � ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *g, R. P. Same as enchmark
L AI�t. �B Top of wood p6s @ 100.5' SYSTEM ELEVATION 96.9/96.0 4.5' below grade
A ,
434' lt. - B.M. 120'
-4 L - 7\� 9
Well is to meet all 30' Vents
setbacks required by
WDNR B -1 3
35'
Plans Designed Using 70'
Conventional Powts 10%
Manual Version 2.0 B -3
B -2
Vent 15'
ST
> 6„ Standard Biodiffuser
Leaching Chamber 80'
of Cover with 3 1. 1 ft2 of Area
15'
6' Long 11 "
34" Grade at System Elevation
Pro 3
Bedroom
House
i
Pro Town Road
S
Wboonsfn Deparbtlent of Corrunerce SOIL EVALUATION REPORT page of
Division of Satety and Bu klrvs
in accordance �f, M. "1tW Cole C=yS
Attach complete si a plan on paper not less than 8112 x 1 i inches in sloe. Plan must p '
Include. but not ladled to verkel and hotnontai reference point (BMA). demon and Parcel ID.
percetrt slope scats ordlmeraions. north arrow and location and distance to nearest road.
Please print aft inhwMahbm by � Date
Pamonal you provide racy be -W for woonduy t„•no os ttftW* r usw, a 15.04 (f) tar »• L Z I'
Prop" Props Locallon
cati - "
GovL tat 1f4/y V4 j Ti R E ( W
property Ownees Maiing gddre Loot #� 1 8kck# I Name
D, �X i S--
State Zip Code Phone Number ❑ cky ❑ Vftge JaTown Nearest Road
wf syoas
New C ndruclon 1 Number of bedrooms _ Code derived design low Tale '�J � GPD
0 Replacement ❑ Punic or cornrtrerdal - Descrfm --
pow ma"M Rood Plan elevation If appicebie ,it/ /e} R
ana /
ED Boling # 0 eon
19 PO Ground surface eiev.. R Depth t0 11TIM6 faclOr In. SOS Rule
iiaimn Deplh DM*WtColor RedoK Descriptor Texkn Siruckn Consistenoe Boundary Roots GPON
in. Mtnsei CkL Sz. Cott. Color Gr. Sz. Sh *M
5 �
# p Bon
Pit Ground surface elev. Depth to lirrrMV Mme' �. L—.� n. Shc Rate
tiori w Depth Dorrinvi t Redox Desaipion Texture 9Mruc6ure CorusisAerroe Boundary Roofs GPOW
irr. MLMA Qu. Sz. Cont. Color Gr. Sz Sh -SW 'EtM2
3l� S 2 G c Z r
(5 v ru s h
«� 9Y•�v
5Y 9v
• t3l UN t in Btu > 3o 5 220 mgL and TW >� ' Etiuerrt _ BOD 30 mglt and T$S 30 mplL
CU Name Fdose P as 6V
Address
Dote Evoluelon Conducled Telephone mb
Nuer
f
C�
"owner Parcel ID # POP —Of
F3 - 1 - Qg Ground surFace etev. -t-� =-L— D epth >D +9 — soil APPkadon Rate
Horizon Depth Daniwd CWkir Redo= Description Texbwe SU m k :1 CorA&tenoe Boundary Boater GPOW
In. Munsell am sz. cont Color Gr. Sz. Sh. 'Eff#! `Etf#2
Z r y t . c s zY�,, , s
94.90 -
Sy Fo
t—! Bodm # ❑ Borhs
❑ Pit Gmund surface siev. n Depth >p fader it Sol AppRcarlon Rays
Horimn Depth Dm*vntCoim Redox DescrkA n Tm*m Sgudwe Canddence Bwndery Roots GPON
im Morse/ Cm Sz. Cat. Color Gr. Sus Sh. 'EWn 'EM2
I
F Bait # O � � t,Uormd Wbm elev. R. Deptlr to am" ft w ir.
Sol Rata
Wftm Depth Do*rart Qkw Redo= Desaip6on. Teorise Strrrftm Cmaisterroa Boundary Roots GPM
ir. Murrell ML W - C" t. Color Qr. Sz sh 'eat 'Et6ie2
I
EfMm t #1= BOD > 30 < M rrpll. and TSS -' 150 RQ& ' Mat #2 = BOD._< 30 nVL arrd M:5 30 ffg&
The Department of Commerce is an equal opportunity service provider and employer. If yon aced writs m to access services or
aced material in an alternate format, Please contact the department at 608 - 266-3151 or TTY 608- 264 -8777.
setss�o�+oe
Soil Test Plot Plan
Project Name •P.C.Collova Bldrs. Inc. Sha it
Address P.O. Box 489
Somerset Wi 54025 TM #226900
Lot 26 Subdivision Prairie Pond Breaks Date 4/9/03
E 1/2 NE 1/4S 31 T 31 N /R18 W
N W 1/4 W 32 Township Star Prairie
F1 Boring Q Well PL Property Line C nta[_ Sl� CROIX - -- - - --
BM or VRP Assume Elevation 100 ft ,Top of Wood Corner Post-- Ig f
System Elevation 96.9/94.4 *H
Alt. B Top of wood p Qa 100 .5'
434' < & B.M. 120'
30'
30'
35'
10°10 70'
Slope B -
B -2
99'
101'
80'
i
Pro Town Road
I
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
9 Y q
ncy Plan
Option # . If system fails, determine cause of failure, use alternate area and install new
system in tested replacement area.
j 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 U I �►
(Verification required from Planning Department ( q g ep rtment for new construction)
City /State New Richmond WI parcel Identification Number 03F r U -
LEGAL DESCRIPTION
Property Location SE %, NE '' /,, Sec. T 31 N -R 18 W, Town of 6 ,r
Subdivision Prairie Pond Breaks Lot # ab .
Certified Survey Map # Volume , Page #
695417 2021 27
Warranty Deed # 695419 Volume 2021 , Page # _ 29
Spec house ❑ yes 1� 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, journeymanplumber, restricted plumber or a licensedpumperverifying 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.
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
days of the three year expiration date.
Q P. C. COLLO" BUILDERS, INC. /' ,p
SIGNAT M OF APPLICANT (715) 247 -2742 DATE
P.O. Box 489
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.
SIGNATURE OF APPLICANT P. C. COLLO" BUILDERS, INC. / / �-
(715) 247-2742 DATE
P.O. Box 489
« * * * ** Any information that is mis- represented may AM%j b revoked by the Zoning Department. ssss « «_
•* 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 4 1 9
WARRANTY DEED KATHLEEN H. WALSH
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 - -2002 11 :00 .: AM
WARRIa M DEED
Grantor, and P. C. Collova Builders, Inc. EXEWT #
REC FEE: 11.00
TRANS FEE: 720.00
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
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.
CK) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this day of September 2002
* * Cecil Brighton V
* * Cleo Brighton
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
ss.
St. Croix County )
authenticated this day of
Personally came before me this day of
September 2002 the above named
Cecil Brighton and Cleo Brighton, husband and wife,
h' '• g g
TITLE: MEMBER STATE BAR OF WISCONSIN V'1cC�.'
(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 Commis' n is permanent (If not, state expWion
(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, Fora du tae wl
STATE BAR OF WISCONSIN
WARRANTY DEED FORM No. 2 -1999 '
U 2021P 027
STATE BAR OF WISCONSIN FORM 2- 1999 6 9 5 4.1 7.
WARRANTY DEED KATHLEEN H. WALSH
Document Number REGISTER OF DEEDS
<. ST. CROIX Co., YI
This Deed made between Douglas A. Strohbeen and Eileen RECEIVED FOR RECORD
Strohbeen, husband and wife,
1 0 - 23 -2002 11 :00 AM
i
WARRNM DEED
Grantor, and P. C. Collova Builders, Inc. EXEMPT #
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 ofNE1 /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 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) 9)[00 Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this 2
day of September 2002
gee..
* + Douglas A. Strohbeen
i
* + 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
Douglas A. Strohbeen and Eileen Strohbeen, husband and wife,
s;
TITLE: MEMBER STATE BAR OF' I (> !R$� s.
(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
it* OF
THIS INSTRUMENT WAS DRAFTb�81'
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.) , $!!� .)
* Names of persons signing in any capacity must be typed or printed below their sig%ture. imamauon Prorautonaie company, Fora du Lao, W
STATE BAR OF WISCONSIN 800.855 - 2021
WARRANTY DEED FORM No. 2 - 1999
BREAK$
THE NORTHEAST QUARTER OF THE NORTHEAST QUARTER AND PART OF THE
18 WEST, TOWN OF STAR PRAIRIE, INCLUDING PART OF LOT 1 OF A CERTIFIED
LEEDS OFFICE FOR ST. CROIX COUNTY, WISCONSIN.
NO OWNER OR RESIDENT SHALL DO ANYTHING WHICH WOULD INTERFERE WITH OR CHANGE THE OPERATION OF
THE APPROVED COMPREHENSIVE WATER DRAINAGE AND SOIL EROSION PLAN FOR THIS PLAT, THIS INCLUDES
BUT IS NOT LIMITED TO BUILDING UPON, OBSTRUCTING, ALTERING, FILLING. EXCAVATING OR PLANTING IN ANY
POND EASEMENT. WATER DRAINAGE DITCHES, WATER RUNWAYS, WATER CULVERTS, BERMS OR GRASS
SEEDINGS.
N0,R7HLINE OF THE
Nw114OFSEC.32 UNPLA TTED LANDS
S 89'54'00" W 2628.78'
N 89 0 54'00" E 1314.39'
434.39' 450.7
396.28' � �.8 oos
-- 1281.39' --
N
' L OT q ft. ,,,; % a �(o' LG
.53 acres 9 LOT d0 0 87,541
a.O. 886.3 1 ft. `�' s 2.01
36 .pg "W 2.65 acres •
1� o
5g7. o Ss? /�—
i
�• �' ! �� /
T
3q.
cres
-86.3 7.54 5Z3 32! 2p p6 G /
09 a+
� � I
6' LOT25
1 127,964 sq. ft. /
91.18 2.94 acres
N ,
= cu NF
Z v LOT 22 s r
86,749 sq. ft. ,, rn r
�. ft. ? "' 1.99 acres +
, es �o s �r, r t° M
o• F �' ° 71
h