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HomeMy WebLinkAbout038-1221-29-000 n CO) Q 3 o d M ID m :1 d co ID 3 = !I4 0 3 d w cn a w n w • ,' w 4° N c CD o w III d. oo O N 01 r � O-0 A > 0) N CO R o 4 c N I,, p CO p 3 o O H ° o f CD FL v tn zD m cn D I� a 3 C T 3 C7 3 ° c 00 rn N O CD O C)D CL Z o o fO n r 0 A A . C D i Q �• `m 3 0 0000 Oro 3 W p � N 0 a '3 1 U! Ul CA m I � @ O = N 7 a - - 0 CD O C 7 OAl a w N 3 d Cp W CD CL y Z _ w O t1 ? CD = (D C- N N 3 7 A C C CA 0) CD - N % < w m' 5. m ,= p Z O CD -1 U) i p �O N D A 2 CD CD 3 c -' ;a a n m p a A z o 0 c m O j � 3 a �a CD T m W Y C1 CD i N A Z CD '% Z - a 3 m 00 0 z CD C.0 I \ I O C y CL o Q C , 3 CA 0) C CD p o Z a m 3 m p CD 0 y CD o v c C � a � CD a CD N CD dQ O N N ti y (1 ti < m CT i CD - 7 O 0) O C O I a O Q ti N yQ CO ti I I i Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453293 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.1 5.U4 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: P.C. Collova Builders, Inc. I Star Prairie Township 038 - 1221 -29 -000 CST BM Elev: Insp. BM Elev: IBM Description: Section/Town /Range /Map No: q 5 s — 1 0 p V07 .31.18.1229 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM l.t Aeration Bldg. Sewer { �.5 Holding St/Ht Inlet Kr- Io �•`� NK SETBACK INFORMATION St/Ht outlet TANK TO P/L WE BLDG. [Vent to Air Intake ROAD Dt Inlet Septic S t 'JG? 33 Dt Bottom \ Dosing Header /Man. \ Aeration Dist. Pipe •r- t $.I r -2- -Ct< Holding Bot. System T- I 7 -7 Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Co r Model Nu ber TDH Lift tion Loss System Head TDH F rcemain Length Dia. Dist. to well SOIL ABSORPTION SYST / BED/TRENCH Width ength . Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 9 3 ? j - 7 SETBACK SYSTEM TO BLDG W LAKE /STREAM LEACHING Manufacturer. cc INFORMATION HA BER OR Type Of System: Model Number: cono - : c� �. 2 2 -►-So nl °�; ►. N lA 5ti DISTRIBUTION SYSTEM ZZ prop° Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake s Pipe(s) I Length LO' Dia L4 Length Dia Spacing �" 8 s SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over (M 0 . W "�`� Depth Over xx Depth of xx Seeded /Sodded xx Mulched t Bed/Trench Center • V> Bed/Trench Edges Topsoil Yes L-] No � ''� Yes '� No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 9 / I2. 04 Inspection #2: Ivt w Location: 929 189th Ave Unknown (SE 1/4 NE 1/4 31 T31 R1 8W) Prairie Pond Breaks Lot 29 Parcel No: 31.31.18.1229 L 3 S b. � w � v �d b �-•- -8 �'b � � s w...P w � � c� � � � j ( 1.) Alt BM Description = Te 3 o� a f +�• co.....c %hT r) C w R t5� - 'rG�t .c y S F e /✓� Q r Q,ti4x P4� 2.) Bldg sewer length = �j'� �� O,. g . �, :„� 13. M . C1 s +r. -7 --+Q_ 1 AlA . 0 5 amount of cover = e % 4" O s- r Plan revision Required? Yes k o Use other side for additional informati __-L L L A____ 1-- ._.J___ Date aR 3 kr�� Insepctor' Sign e - / art. o. SBD -6710 (R.3/97) 6 J M v "" �p�� «v �j P d Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 Vsconsi Madison, WI 53707 - 7,162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 -3151 S3 Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Aden Code. personal information ou tray be used for secondary purposes Privacy La , s E I V F Project Address (f differertr than mailing address) _ ,r e I. Application Information - Please Print All I or T� property owne 71 C. E Parcel # Lot # Block # i, Property Owner's Mailing Address �r _ Property Location City, State Zip Code Phone Number K M Section _ S [ O -5 T ! N. R�fi II. Type of Building (check all that apply) PQr S tM t 2 Family Dwelling - Number of Bedrooms el , Subd ision Name Numbs Public/Conmercial — Describe Use C �! State Owned - Describe use 2 3 k b i J Croy— V ownslrip °P r U G III. Type of Permit: (Check only one box on line A. Comp ere 'ne B if appli ble) 3�) ` A ' ew System Replacement System TreatmetiMolding Tank Replacement Only Other Modification to Existing System B. Permit Renewal Permit Revision Change of Permit Transfer to New List Previous Permit Number and Date issued $cfote Expiration Plumber Owner IV. Type of POWTS System: (Check all that apply) A= - Pressurized In- Ground Mound 2t 24 in. of suitable soil Mound < 24 in. of suitable soil At -Grade Single Pass Sand Filter Constructed Wedand Pressurized in Ground Holding Talc Peat Filter Aerobic Treatment Unit Recir sting " �Fdterr Recirculating Synthetic Media Filter g Chamber Drip Lute Gravel -less Pi Other (ex lain) . J t V. DispersaVrreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Am Required (sf) Dispersal Areas proposed (st) yste oy, O JC / ./ Y� VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Ateel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Tmatmem Unit V Dosing Chamber VII. R onsbili Statement - 1, the undersi ed, assume respe risibility for installa of the POWT shown on the attached plans. Plu s Name (Print) Plu mbffl Signature MP/NIPRS Number Business Phone Number Plumber's Address (Street, City, State, ) rev $ q te.� l� b r ? VIII. Coun /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued Its ' Agent Signature (No Stamps) Appm Disapproved Yen Reason for Denial 2 IX. Conditio ppro SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be service t maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable codelordinances. Attach complete plans (to the County only) for the system oa paper not less than &In x 11 inches in size PLOT PLAN PROJECT P.C. Collova Bldrs. Inc ADDRESS P.O.Box 489 Somerset Wi 54025 SE 1/4 NE 1 /4s 31 /T 31 /R 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/2/04 BEDROOM 3 CONVENTIONAL XXX IN -GROUN RESSURE 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 0�BENCHMARK .R.P Top of Wood Corner Post ;::: o'� ASSUME ELEVATION 100 F Zabel A -100 r ❑ BOREHOLE O WELL *H. R. P Same as Benchmark SYSTEM ELEVATION 91.7/91.4 4.5' below qrade Alt. BM Top of Survey Iron C& 99.5' Pro Town Road W ell is to meet all Plans Designed Using setbacks required by Conventional Powts WDNR Manual Version 2.0 350' B -2 30' 30' 22' S Pro 3 �►��� Bedroom -� B -3 House 70' � 35' 2 -3' X 69' Cells B -1 0 = >3' Spacing Vents (;0 80' Vent >6 „ Standard Biodiffuser Leaching Chamber 20' B.M. Cover with 3 1. 1 ft2 of Area 6, Long 11 34" Grade at System Elevation Alt. v 197' PLOT PLAN PROJECT P.C. Collova Bldrs. Inc ADDRESS P.O.Box 489 Somerset Wi 54025 SE 1/4 NE 1/4s 31 /T 31 /R 18 'W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 3 BEDROOM CONVENTIONAL XXX IN -GROUN RESSURE 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 .R.P. Top of Wood Corner Post BO= ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark SYSTEM ELEVATION 91.7/91.4 4.5' below grade Alt. BM Top of Survey Iron @ 99.5' Pro Town Road W ell is to meet all Plans Designed Using setbacks required by Conventional Powts WDNR Manual Version 2.0 350' B -2 30' S 30' 4% Pro 3 ,;Innf Bedroom B -3 House 70' 35' 2 -3' X 69' Cells B -1 t-00 with >3' Spacing Vents 80' Vent >6„ Standard Biodiffuser Leaching Chamber 20' B.M. of Cover with 3 1. 1 ft2 of Area 6' Long 11 " 34" Grade at System Elevation Alt. 197' J3 M / 1 Wm mm Deparbnent of Commerce Sol EVALUATION REPORT Page of Dihtsion �sai;etymhd Btu , l accordance wlth thy, vAs. Adm. code 5 AQach complete aita Pon on pepw not lass than 8112 x 11 kxihes in aim Plan must ` r o h Mckx , fiat not invited toc wwftal and horjaontal mfwwm post (Brig, direction and Parcel I D. pwcent slope scale ordknerAlons. north arrow and location and distance to nearest road Please pint an lnforrnalon. by Date Personal idorendion you pride NY be and for secondary purposes (Privet Low. s. 15.04 ( Location T Property Property Owner A // / "^ (r Govt. Lct L^ 1/414 j N R E ( W G D !3[/Gc/ a9' Bl ock Subd Namear � 0 , S -- state Cow ❑ aty L7 VOW Town Neared Road New Coristuction use Residential / m irriber of bedroorns —_ Code demred design now rate ' (� (3PD ❑ Raplaoement ❑ Pubic or con ordal - Describe: _ Parent material c , L Flood Plain if applicable N //} R Clenwamew eral hnheridatiahs s� �, 91, 7 9�' 3 and zcajf:� F -11 # 0 soft 0 a pt hound SUrrBCe elev. s R Depth to tktiigng factor k, R lc� Hatt Depth Dontrherht Now Oescl4w n TehrMConsistence e Smxb" Co B nifty Rotes our In. Mhnsei C1u. SO- Carr<. Color Gr. Sz Shh. `EtJ#1 z , 3 am . s - r S /r1 1 - - �, Z ir off 90.S -off pt Ground atsiane ahev. Si 3 R Depth to imi6ng faclar in sa Appliddion Rate Hwiton Depth Dominer t Redox Description Tgxb" Sbucb" Cary Boundary Routs GPM in. Mtneel C1u. SL cant. Color Gr. Sz Sh. TIM G 3 — 5 2 rn r r i✓S Z n- °l r `1 LS r'vi✓JC�r e V0 I z 7 1, 2 go .90 EMum t #1 = BOD > 30 <_ 220 - and TMW >30 < 1 / , ' Etiluant #2 - h30D <_ 30 mgL and TSS c 30 mgit. CST (Please P" Numilm as Address _ Dale Evakialion Conducted Telephone WOW Ae AVI .5-�/O/ . i t2� Parcel ID# Pa of Borin # , � pit Ground arios elev / l b ' z a D t 6.ah g for �- sou Applicallm Rate Horimn Depth Doruiirwt Color Redox Desaiplim Texture Stru ckm Cormislarice Botmdary Roots GPDAF Im Mrrrsl Qu. Sz Corti. Color Gr. Sz Sh. •Etffil la 3 /Z 5 L 2 F c 2 � L s rVIv r 1 IF ( Z 1,Z- F ear# O (] pit Ground surface elev ft. Depth to mow factor iR sofa Rafe Horizon Depth Domm t Color Radox DescripBon Texture Stnr:Oure COMISIlence Barxtay Roots GPM in. murad CU Sz Cont Color Gr. SL Sh. M a # ❑ Pi Gnxrd srrEaoe etev, IL Depth fo *A" factor ir. Sou Applicaliort Rate Horhm Depth Dom mt Color Retim nesaipf'an• Texture structure Consist nce Borrrdary Roots GPDff kL IMu nsa9 Qu. Sz Cod Odor Gr. SL Sh *M •Efllf2 • EMUart #1 BOD > 30 <_ 220 mgit. and TSS >30 <_ 150 mglL ' Effluent d2 = BM, _< 30 mglL and TSS 1 30 nv& The Deparmunt of Commerce is an equal opportunity service provider and employer. If you need assistance fo access services or need material in an alternate format, please contact the depardnent at 608- 266 -3151 or TTY 608- 264 -8777. sansMOW" Soil Test Plot Plan Project Name P.C.Collova Bldrs. Inc. Shaun Bird Address P.O. Box 489 Somerset Wi 54025 CSTM #226900 Lot 29 Subdivision Prairie Pond Breaks Date 4/9/03 E 1/2 NE 1 /4S 31 T 31 N /13 W Township Star Prairie NW 1 /4 W 32 Boring 0 Well PL Property Line County ST. CROIX BM r VRP Assume Elevation 100 ft. --Top of Wood Corner Post System Elevation 91 *HRPSame as Benchmark Alt. BM ; Top of Survey Iron @ 99.5' Pro Town Road 50' 95' B-2 96' 4% Slo -3 70' 35' 1 30' 80' 20' F B.M. 0' LRn4 197 ' '�j Maintenance and Contingency Plan for a Septic System Maintenance Plan e d once every 3 years. 1. Septic Tank is to be pump installed in 2. Effluent latter is to be cleaned once a year. Please note: a larger filter is being order to extend the maintenance interval of the filter; the inspections pipes at the ends of 3. Once evt:ry $ years, cells are to be inspected via P the COOS. 4.Owner I 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. Watershod is to be diverted away from system. omm. 83 8. Discharge into system is not exceed those required as per C C Plan O ion #1..j If system fails, determine cause of failure, use alternate area and install new Pt system in tested replacement area. r elevation, by removing chambers, removing biomat, option #2. Install system at a lowe 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 -468 Pumper Tom Mondor 715 - 246 -5 148 Shaun Bird #226900 i 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 dM A (Verification required from Planning Department for new construction) Cit y /State New Richmond WI ty Parcel Identification Number LEGAL DESCRIPTION Property Location SE %, NE y,, Sec. 3 �". T 31 N -R 18 W, Town of J" 4z�,r Subdivision Prairie Pond Breaks Lot # l� l 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. Ile property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner. and by a masterplumber, jourueymanplumber, 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. 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 4A4 (7 15) ree year x Lion date. R C. COLLOVA BUILDERS, INC. / O APPLICANT 247 -2742 DA P.O. Box 489 OWNER CERTIFICATION SOMERSET, WISCONSIN 54025 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 the property describ jb, by virtue of a warranty deed recorded in Register of Deeds Office. A PI:ICANT 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 5 4 1 7. KATHLEEN H. WALSH WARRANTY DEED Document Number 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 Alf 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 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) NXdQ Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this y 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 s}`�l� <,!''.•, September 2002 the above named f X, Douglas A. Strohbeen and Eileen Strohbeen, husband and wife, TITLE: MEMBER STATE BAR OF' I � t (If not, to me known to be the rson(s) who executed the foregoing authorized by § 706.06, Wis. Stets. � instru nd a ged the same. 11 OF WISt,;10' THIS INSTRUMENT WAS DRAFT�D�Y'' 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.) , /�D 6!!� •) Names of persons signing in any capacity must be typed or printed below their sig% ture. Information Profassionals Company, Fond du Lae, WI STATE BAR OF WISCONSIN 800-655-2021 WARRANTY DEED FORM No. 2 - 1999 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 - 23 -2002 11:00 AM WARRANTY 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): ��� £ � 4 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. 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. (M) (is not) Dated this day of September 2002 * * Cecil Brighton v ' * Cleo Brighton AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ss. �'., =;•fr St. Croix County ) authenticated this day of Personally came before me this day of September 2002 the above named + Z 0 Cecil Brighton and Cleo Brighton, husband and wife, t OF 11SC��, TITLE: MEMBER STATE BAR OF WISCONSIN.. v:..,;�_ (If not, to me krigmon to be a on(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instru o&led2ed the same. THIS INSTRUMENT WAS DRAFTED BY * , Attorney Kristina Ogland Hudson, WI 54016 Notary Public, State of Wisconsin MY Commiss' n is permanent (If not state exp (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, information p rofessionals c ompany. Fora au sec +nn STATE BAR OF WISCONSIN 800455f 21 WARRANTY DEED FORM No. 2 -1999 w C6 / lh Co 0 % ci S• W 34 1 364 •C w CD , 4 4• n N 1A 33 . E 6 �O �3? • a •a• \ N 6 C •o \ \ to \ \ OD O1 0 cD CO) \ \ y \ \ 0 Q r+ \ \ (A N I \\ \\ I .... :............. m _ .... ... i... N �- \ \ o -- 157.53 _ \ \ _ .20 .44' .O 55" W 366.97' \ 1 r � — — 366.9 6 ' 55" E ' C') \ - 197.25. 41.23'x \� C-1 \ -128.49'- .. .... .... � \� N rn A LA I °- °� r.. z z ao � m w O 0 c a LA 0) Y - 4 v N S 4 Ln 00 N �D W A ~ �! co Oo _ co CA s 1038.12 �+ 239.48' 197.45 202.62' 66 00' S 00 0 20'52" E 1323.28' E4STLBWOFTMNwI/4OF 80' RADIUS TEMPORA CUL -DE -SAC EASEMI THEIVW 114 OF SEC 32 TO BE EXTINGUISHED UNPLA TTED LANDS EXTENSION OF THE R