HomeMy WebLinkAbout038-1221-28-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St . Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 453007 0
GENERAL INFORMATION 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 -28 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
CD . • D � I l7fl.t�� � _ S�� v�C L C 5 r 32.31.18.1228
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark i
WAG• -l�. (� ,� O o�!•� .� !3� • c�
Dosing Alt. BM
l• D 1o3•Zo
Aeration Bldg. Sewer 1
�•ag 4�• 3�.
Holding St/Ht Inlet 9. 6s- ,
9s 9s
1
TANK SETBACK INFORMATION St/Ht Outlet S.S s•�S
TANK TO P/L WELL BLDG. Vent to Air
3 Intake ROAD Dt Inlet
Septic � I $ / �� Dt Bottom
Dosing 1 V Header /Man. a• / s
Aeration Dist. Pipe t Ail D. S Holding Bot. System f (. 2u `T I � i
PUMP /SIPHON INFORMATION Final Grade 6 X50
Manufacturer Demand St Cover
GPM 3• SD 9 •1 O
Model Number
TDH Lift Fri oss System Head T Ft
Forcemain LengtV Dia. D ist. to Well
SOIL &EISORPTION SYSTEM,
4F&r RENgW Width Length INo. Qf Tren es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DI NS �{ / 9 %• e4• (
SETBACK SYSTE ✓ M TO l P/L BLDG IWELL LAKE /STREAM LEACHING M uNctur
INFORMATION r CHAMBER OR t
G(
Type Of System: f
— 36 � �) � UNIT Model Number: ) � tt
DISTRIBUTION SYSTEM `�° ' -6
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake,
Pipe(s) 1
Length Dia I Length Dia > I (m
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
discr, pe
COMMENTS: (Include i p rsons present, etc.) Inspection #1' O Inspection #2:
� 8 tev 4
L -cation: 937 18 th Avenue Star Prairie, WI 5 26 (SE 11/4 NE 1/4 32 T31 N R18W Prairie Pond, Breaks Lot 28 Parcel No: 32.31.18.1228
1.) Alt BM Description t'o C� T) �� "ter M f g dlilll .4 ad z
2.) Bldg sewer length = ^• qs 1 l(,.. -e 'e C � m
amount of cover
3) A�1 o,Jr�: + " Ve . ( Z"�low a�► k o,VJ "D pl -
Plan revision Required? Yes X No �, ,
Use other side for additional information. _ - / S2 7
SBD -6710 (R.3/97) Da {e Insepctor's Signature Cert. No.
ty
Safety and uildit� Box 7082
201 W Washin n AYe + S litary Permit Number (to be SUed in by Co.)
Madison, 53707 -7082
isconsin (608) 261•"x{ 0 1 ZR4 oa�-
S to P LD. Number
Department of Commerce lieati n ;�T cr�oix COUNTY
$an1tSl'3' Permit AP n<ufomtati nyouPtt�rj�{NGOFFICE
in accord with Comm 83.21, Wis. Atim. Code, I Project Address (if different than mailing address)
may be used for secondary purposes sa Pei Y Law, x15.04
934- Iii 14-X Avc-.
I. Application Information - Please Print All Information Lot i WA41•
Parse # �-j
Property 0. a ,•�' (
d._"' property Location
Pro Owner's Mailiag Address r^ 3
Section
x Zip ode Phone Number
ZE. r o City, State T -- N;
e a umber S
II. Type of Building (che e, w% "' ek all that apply) � _ s YfSSOD�"n"
S
or 2 Family D- elling -Number of Bedrooms _ �
pubiicJComtnerciai - Describe Use t _ cityy ['Vial *msbip tlf . ✓!�
❑ State owned - Descnbe Use A K `
t 22(
III. Tpe y of Permit: (Cheek only one box on U e A. Complete tine B if applicable)
A w System ❑ Replacement System
Trattalent/iiolding Tank Replacement Only
C) other Modification to Existing System
❑ Change of ❑ Permit Transfer to New
List Previous Permit Ntunber sad Date Issued
B. ❑ Permit Renewal ❑Permit Revision Plumber Owner
Before Expiration
IV. T e of POWT'S S tern: Check all that a 1
Non -� In Ground Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil C] At -Grade [] Single Pass Sand Filter 1]
constructed Weeland ❑ Pressurized la- Ground ❑ Holding Tank ❑ Peat Fitter C3 Aerobic Treatment Unit L ire�ing Sand Filter ��
hin Chamber ❑Drip Line
❑ Gravel -less Pipe other (explain
R Synthetic Media Filter
V. Dls l Area Pro Bed (s�
� Dispersal Ara Required (st) Dispersal S Elev�oa
ersallTreatment Area Information:
Design Flow (gpd) Design Soil Application Rate(gp f)
A re Ile Prefab Site Steel Fiber Plastic
Capacity in Total Number Ma°ufacttusr Concrete Constructed Glass
VI. Tank Info Gallons Gallons of Units
New Existing
Tanks Tanks
Septic or Holding Tank
Aerobic r awasent Usk
Dosing Chamber
VII. Rp onsibill Stateme - I, the undersign sums responsibill for installarion of the pOWTS abov+n on the attached plans
M Nu bee Busineas Phone Number _
Plumber' Name( Plumb
Plumber's Addrsss (Street, City, State, i Code)
✓L CS /�/ iC.C� �(� !2ZJQ�C
VIII. Coun /D artment Use Onl
Date issued 1 uin gent Signature ft Stamps)
Sanitary Permit Fee indudeB Groundwater
I APproved [I Disapproved Surcharge Fee) r1 7 v rn _ J _-� O ❑Owner Given Reason for Denial •G. � y .-
IX. Conditions of Approvd/Rasons for Disapproval S T�xs 3\ � � i S
SYSTEM OWNER; �f�'t^^ 41 .,�
1 Septic tank, effluent filter and � C, ` rp
III dispersal cell must all be serviced /maintained
s �
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable Code /ordinances
to the Caus only) for tha system os paper sot less this 8112 s 11 Inches is size
Attach complete plans
SBD -6398 (R. 08102)
I
P OT PLAN
PROJECT P.C. Coll Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025
SE 1/4 NE 1 /4S 31 /T 31 N/R W TOWN Star Prairie COUNTY ST. CROIX
2/26/04 3
MPRS Shaun Bird 226900 DATE BEDROOM
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 684 # of chambers 22
BENCHMARK V.R.P. Top of 1" Pipe ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
SYSTEM ELEVATION 93.9' 4' below qrade
Alt. BM Top of survey Iron @ 93.8' Plans Designed Using
Conventional Powts
Manual Version 2.0
Pro Town Road Well is to meet all
setbacks required by
WDNR
Pro 3
0
ouse
30' 1erF� 1.
Vent
S �.
>6 „ Standard Biodiffuser
30' Leaching Chamber
' of Cover
B- Vents
with 31.1 ft2 of Area
7% Slope 6' Long 11 "
Grade at System Elevation
70'
34"
B-
b
35'
Ven 30'
Alt.
120' B.M.
P 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 N/R W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE2 /26/04 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 684 # of chambers 22
BENCHMARK V.R.P. Top of 1" Pipe ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
SYSTEM ELEVATION 93.9' 4' below qrade
Alt. BM Top of survey Iron @ 93.8' Plans Designed Using
Conventional Powts
Manual Version 2.0
Pro Town Road Well is to meet all
setbacks required by
WDNR
Pro 3
Bedroom
House
30'
Vent
ST >6" Standard Biodiffuser
' 30' of Cover Leaching Chamber
B-
Vents with 3 1. 1 ft2 of Area
7% Slope 6' Long
11"
Grade at System Elevation
70' 34"
35'
Vents - 30'
Alt.
120' B.M.
1
Wisoonsin Dqmbnent if commerce SOILS EVALUATION REPORT Page of
Division of Sateh� and Brr�gs
in a000rdlance vrllh cona. Wis. Adm. _ ode
Attach complete site plan on paper not less then 8 112 x 11 kwhes in sine. Plan rtwst yJ `
kckKW but not tkn#ed to: vertical and twft r w reference point (w. direction and Parcel I.D.
Percent slope. scab ordknensions. north arrow. and location and distance to nearest road.
Please print a N k fOrntaftn. y Date
pwoonal k�torm ilw you p ovkb may lra wad tot sOCondWY PWPo.e9 4�aoY l.aw. 9.15. (I) On))- dA T
pmp"pwner_,n Pmpert L ocation �t.c
Gv//v� G. Govt tmt a 1 MA 9 3 N R E (m](
Rq)ww Address Lot # I Block# Name
r9 ~ 4 &adez s
citya e4A 50'9 s Phone �� - $ Road
New Co *Wcdorr uea rte:a al Number of bedroans _ Corte derived design slow rate C;PD
D PAPMM=t ❑ Pubic or aorrrnerdel - Describe. --
Parent rllakww Flood Plain eteralion If applicable
Generalcominents
and remninendatiwn
ge
ED D
Hong # Pit Ground surface elev. ! t R Depth to tknbkrg factor I In. stall Apokelon Rate
Horixoo Depth Domim" Color Redcrc Dessxiption Twome Structure Consistence Bourndery Roots emy
in. GUr. Sy- Coat Color Gr. Sz. Sh. *M 0 3iZ ,s C�
D
® # pit Ground surbos slev. IL Depth to inlidng Tactor il. So� Rake
Hortcon Depth Dw*=tCokx RedoxDesm"on Texture Sbuckm Consistence Boundary Roots GPDR
In. Munsell Qu. Sz. Cunt Color Gr. Sz Sh `EMH
p -! 3 J S - L r» Fr C S Z J .
2 NJ�, (S o, vrr z� I • Z
' EtAu " #1= BOD > 30 720 nV&. and TSS 4WO _< 1�: ' Sluent 82 a BOD 1 30 mgiL and TSS c 30 fnpll
CST Horm as 6'"
Data Evairafion Caxkx ted Telephone Number
Address /
s 5lal
Prop" Owner of
F3 -1 �y Parcel ID # Page
Boring #. Y71 pit uxbw etev. A Depth So Wniti V factor im Soil Appicadon Rage
horizon Depth Don*mtCakx Redox Descdprim Texture Sbuckm ConsWence Bo xfty Roots GPOW
in. Morsel QtL Sz Cont. Color Gr. Sz Sh. •EW1 - Eff#2
u 3 � z�n_ S dim
2 J 2-32, 101,0A L „,ter
Ca 6 o Z
soft # ❑ e
❑ Pit Grorrrd eurfaoe ale,► iG Deptlr sa factor h sot Rai
tlorbm Depth Mff*mdCcft Redox Descr4" Ta*m O*uc " Consistence Boundary Rods GAM
im Mursel QL Sr- Cont. Color Gr. Sz W •1m1 •EW
F Bo�# ❑
D Pit Gt°a"d arrface elan. ft i b factor in
sot Applbdon RaOs
Modaon Depth pow Colm Redox Desaiplon. Too= Struckse ConsMance Boudery Roots WON
iR Muhl CkL Sz. Cont. Color Gr. SL Sh. 'EiEII i Z
• Effkatt WD > 30 ZW gngL and TSS >30 150 ff*L • eMm t fit = BOD, nV& and TSS 1 30 nVL
Tlu Dopattmeat of Comnm= is an equal opportunity service Provider and employer. If you need assistance to acc= services
need material in an alternate format, Please contact the deperhnent at 608 - 266-3151 or TTY 60 8-264 -8717_
otr�+om
Soil Test Plot Plan
Project Name P.C.Collova Bldrs. Inc. Shaun B'
Address P.O. Box 489
Somerset Wi 54025 CS #226900
Lot 2 8 Subdivision Prairie Pond Breaks Date 4/9/03
E 1/2 NE 1/4S 31 T 31 N /R18 H►
N W 1/4 W 32 Township Star Prairie
Boring Q Well PL Property Line County ST. CROIX
"B or VRP Assume Elevation 100 ft. , Top of 1" Pipe
System Elevation 93.9 *HRPSame as Benchmark
Alt. BM z Top of survey Iron @ 93.8'
Pro Town Road
203'
98'
B -2
7% Slope
0' -3
s'
Alt 15'
120' B.
374'
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
7 #tnW. Plan
0io n #1.system fails, determine cause of failure, use alternate area and install new
system to 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 g Zonin 715 - 386 -4680
Pumper Tom Mondor 715 - 246 -5148
Shaun Bird #226900
r
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 q 3 3 - 1 701 i *�
(Verification required from Planning Department for new construction)
City /State ew Richmond, WI (Z�
ty /State Parcel Identification Number (� � ) ?Z I — ,fig da0� ,
LEGAL DESCRIPTION
Property Location SE V., NE '' /., Sec. 31 . T 31 N -R 18 W, Town of 3 +zx r
Subdivision Prairie Pond Breaks Lot #
Certified Survey Map # Volume , Page #
695417 2021 27
Warranty Deed # 695419 Volume 2021 Page # _ 29
Spec house ❑ yess no Lot lines identifiable yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its prematumfaiiure 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 licemedpumper 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.
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
ITer . t your sep 'c system has been maintained must be completed and returned to the SL Croix County Zoning Office within 30
ee xpira tioa date.
P. C. COLLOVA BUILDERS, INC.
SIGMA O APPLICANT
(715) 247 -2742
P.O. Box 489 DATE
SOMERSET, WISCONSIN 5025
OWNER CEATEICATION
(we) ce t all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
tht c ' ve, by virtue of a warranty deed recorded in Register of Deeds Office.
P. C. COLLOVA WILMS; INC.
(715) 247 -2742 / 0
SIGNATURE OF CANT P.O. Box 4851 DATE
SOMERSET, WISCONSIN 54025
* * * * ** 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 029
STATE BAR OF WISCONSIN FORM 2- 1999 6 9 5 4 1 9
Document Number
WARRANTY DEED REGISTER OF DEEDDS
ST. CROIX CO., MI
This Deed, made between Cecil Brighton and Cleo Brighton, RECEIVED FOR RECORD
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: 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): �� fjN�> 6w
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. A7v' I
038 - 1131 -60
Parcel Identification Number (PIN)
This is not homestead property.
(9) (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,
TITLE: MEMBER STATE BAR OF WISCO1491N F V'�SC
(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 Kristina Ogland Notary Public, State of Wisconsin
Hudson, WI 54016 M Commiss' n is permanent (If not, state expiration 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 sigoture. Information Profenionab c ompany. Fond du Lee, wI
WARRANTY DEED STATE BAR OF WISCONSIN 800455f, 21
FORM No. 2 - 1999
U 2021P 027
STATE BAR OF WISCONSIN FORM 2 - 1999 KA�TH EE N H 1 -7 WALSH
.
Document Number WARRANTY DEED REGISTER OF DEEDS
M 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 AM
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 NE 1/4 ofNE1 /4 and part of SE 1/4 ofNE1 /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.
(is) 08X00 Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this 20.day of September 2002
} • 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
s v '!,''.•, September 2002 the above named
Douglas A. Strohbeen and Eileen Strohbeen, husband and wife,
TITLE: MEMBER STATE BAR OF' I 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. 0F Cil:: .
THIS INSTRUMENT WAS DRAFT96 - ) '�- +
Attorney Kristina Ogland
Hudson, W! 54016 Notary Public, State of Wisconsin
ommission is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) , A?D $!!� •)
Names of persons signing in any capacity must be typed or printed below their sig%ture. Inrormadon Pn)(Mionaia company, Fond du Lac, WI
STATE BAR OF WISCONSIN 800-655 -2021
WARRANTY DEED FORM No. 2 - 1999
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