HomeMy WebLinkAbout038-1221-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Div*Ncn
INSPECTION REPORT Sanitary Permit No.
463376 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: City Village X Township Parcel Tax No:
P.C. Collova Builders, Inc. Star Prairie, Town of 038 - 1221 -30 -000
CST BM Elev: Insp. BM Elev: BM iI Description: Section/Town /Range /Map No:
/.p m 1 GS1 32.31.18.1230
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic /� Benchmark
Z . Z /OZ
Alt. BM
Aeration St/Ht Outlet q +' 5
Bldg. Sewer / 175
Holding St/Ht Inlet ,
TANK SETBACK INFORMATION 7
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic 5 1 I g
` '39' 3 � I Dt Bottom
IV fi
Dosing Header /Man.
7 2S 93.5 S
Aeration Dist. Pipe
Holding SQt. System
C�ea�
PUMP /SIPHON INFORMATION Final Grade S C f `7. 7
Manufacturer Demand St Cover
GP 3,-5
Model Numb .� 1 9`%
/
TDH Lift Friction Loss System Hea TD Ft TZ. 9 3 -3
Forcemain Length la. Dist. to Well - -.-
SOIL ABSORPTION SYSTEM
BED/TRENCH Width I Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 2 &C CZ 7 ;� [�
SETBACK SYSTEM TO 1 /L C.• BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR o d �'
Type Of System: ^ 51+ 7 , , f UNIT Model Number:
DISTRIBUTION SYSTEM S od r 2c,� ZZ, d a+t,— ,
Header/Manifold Distribution x Hole Size x Hole Spacing I VVto.Air Intak Pipes) \ \ \ 8 A
Length Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over / Depth Over xx Depth of xx Seeded /Sod ed xx Mulched
es No
Bed /Trench Center 4 �[ Bed/Trench Edges �� Topsoil `Y
1 \ es No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: ! / Inspection #2: /
Location: 925 189th Avenue Somerset, WWII 54025 (VW 1/4 NW 1/4 32 T31 R1 8W) Prairie Pond ] Breaks
Lot 30 Parcel No: 32.31.18.1230
1.} Alt BM Description = a #ark.. 0 S '
2.) Bldg sewer length = 39
- amount of cover = "
Plan revision Required? 7
1
Use other side for additional in Yes o �j n� CG k'v /
formation. [J v �
Date Insepctoi'Y lure Cert. No.
SBD -6710 (R.3/97)
Safety and Build s 'vist n County t
m m 201 W. Washington 71ib2 �� 1
` COnsii� Madison, WI 53707 ' 1b2��(/ / Sanitary Pe it umber to be filled in by Co.)
(608)266 - 3151 ( /
Department of Commerce
Sanitary Permit Application State Plan DRumbpr _
In accord with Comm 83.21, Wis. Adm. Code, personal mflormati
may be used for secondary purposes Privacy Law, s15.04 1)(m) RECEIVED Proj t Address ( different than mailing address)
I. Application Information - Please Print All Information A PR U 5 200
Property Owner's a
C Block #
�a // ✓�i-� /G� ICE 3 2Z/
ST. CROIX COUNT
Palce,
Property Own is Mailing Address roperty Loclion
0 t L7 7 / A1LAA,,A /,, Section l
City, State Zip Code Phone Number
9(
(✓�L N J W
U. Type of Building (check all that apply) l//
r 2 Family Dwelling - Number of Bedroom U C� Subdi ion Name CSM Number
❑ Public/Commercial - Describe Use
❑ State Owned - Describe Use L7)ST� C�� -(.-� L✓��r' C� ❑City ❑Villap� Towns gof
III. Type of Permit: (Check only one box on line A. Complete line B if applicable) f•
A ystem ❑ Replacement System g p Y g Y
❑ Treatment/Holding Tank Replacement Only El 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, a of POWTS S stem: Check all that apply)
on - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressu6 - ound Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Fil g Chain ❑ Drip Line ❑ Gravel -less Pipe Other explai
V. Dis ersaVrreatment Arewfn formatton:
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispers1l equired (sf) Disp oposed (sf) System Elevation
�, . 3 1 3 3 22
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- I, the undersign. ssume responsibility for installation of the POWTS shown on the attached plans.
Plumber's ame (Print) Plumber' at MP/MPRS Number Business one Number
Plumber's Address (Street, City, State, Zip e)
VIII. C n / 7EIDigapproved artment Use Onl
roved Sanitary Permit Fee ncludes Groundwater Date Issued uing Agen ign re ps)
PP Surcharge Fee)�t�U 0 (� Owner Given Reason for Denial
]X �TEI�O ovaUReasons for Disapproval
Septic tank, effluent (liter and , y� �3 J��
dispersal cell must all be serviced / maintained
as per mana
9' 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)
PLOT P AN ?. P 3 P
PROJECT P.C. Collova Bldrs. Inc. A SS P.O. Box 489 Somerset Wi 54025
1/4 1 /4 S /T 31 N/ W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 4/5/05 BEDROOM 3
CONVENTIONAL XXX IN- GROUND PR URE 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 Survey Iron ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
SYSTEM ELEVATION 93.3/93.2
Alt. BM Top of 2" Pipe C& 100.2' Plans Designed Using
Conventional Powts
Well is to meet all Manual Version 2.0
ALong t setbacks required by
WDNR
Standard Biodiffuser
Leaching Chamber
with 3 1. 1 ft2 of Area
Tow Road
3 W Grade at Syste m Elevation
329
Pro 3
Bedroom
House
20'
ST
,,2 -3' X 69' Cells with >3' Spacing
25' 3 -3 35'
Vents
30'
b 1 60'
" 3
1%
Slope 90'
�2
Not enough slope to 4kt)
establish contours
Al
B.M. t.
336' B.M.
PLOT P AN
PROJECT P.C. Collova Bldrs. Inc. A SS P.O. Box 489 Somerset Wi 54025
1/4 1 /4 S /T 31 N/ W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE4 /5/05 BEDROOM 3
CONVENTIONAL XXX IN- GROUND PR URE 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 Survey Iron ASSUME ELEVATION 100 Filter Zabel A -100
❑ BOREHOLE O WELL * H. R. P Same as Benchmark
SYSTEM ELEVATION 93.3/93.2
Alt. BM Top of 2" Pipe @ 100.2' Plans Designed Using
Conventional Powts
Well is to meet all Manual Version 2.0
Vent setbacks required by
WDNR
>6 " Standard Biodiffuser
of Cover Leaching Chamber
with 3 1. 1 ft2 of Area
Tow Road 6' Long 11 "
34" Grade at System Elevation
329
Pro 3
Bedroom
House
20'
ST
,2 -3' X 69' Cells with >3' Spacing
25' �f.3 -3 35'
Vents
30'
60'
B -1 70'
9q-% 1%
Slope 90'
Not enough slope to
establish contours
Al
B.M. t.
336' B.M.
of
Wb Depwvnerlt of Con nerve SOIL EVALUATION REPORT
3
Division of sow aad sui
in accordance vft owm a5. Vft S
Attaeh r m plea site pW on paper not lass thBn S l 2 X 1 t ina,es in size. Plan must
kwkxf% but not loriited tm vertical and horfnontai reference point (W. direction and Paroet I D.
percelltslope. scdoorf& neraiars. norihamw . and locallon =nddstancetonearestwIld
Please print an kworm UML by Dare
pa=W won you provide tray be wed for--ndwy pwp-- VMV-V L—. a -15-oe (l) (m)1- ` F
y� , PropertyLOCKM ---
�. G !7 /�!/t'�k / G• Govt Lot 1 y 1/4 3 N R J E ( w
p 1 Lot # Block # Nana
, of ax O - S
❑City ❑ v age XTOM Ne Road
e,.se44- �f syoas ( , J�a - °�
New Qral uclion Usk .Resider I Number of bathrooms _ _. _ Code derived design flow rate
0149placernard ❑ PtMc or commercial - Describe: --
Parent material /7�s �c�i� ,5,,�i Flood fthplevallm if applicable
Clanwal convents; a s sus . e /�� .�n� l; l q 3i2
ED Bodng# ❑ /
pit gourd surface elan►. �� ft Depth to IirriBrrg %Cl0r r l in. sd Rds
Horisar DOM Dominant Redo( Description Text Structure Corwistence Borsdery Roots
in. MLN sal Cjtr. Sz. Coat. Color Gr. Sz. Sh. •Elf# I •Et#12
1 0 -2.
z�
Z
�3•�v
S`f 90
pit Ground suriaoe etev. EL- ft Depth a Ihiiting in- Sol, Appkalon Rafe
Horizon Depth Dm *wt Color Redox Description Teldm Stru kwe Cadence Boundary Rods GPM
trr. Mknsel tlu. Sr- Cont Color fir: Sz. Sh T--W •Efi#2
I y l- L rn L 2 hl S
r �F $
C) L h .
/, z
• teai,ent ip = BOD > 30 22D mgL and Tss -30 : IS +g • f luent fIC2 =Boo _ 3o rngiL and TSS 3o fnglL
CST Number
CST � as
--
Date Evakiafort Conduced Tebptrone �Msnber
Address - /
Parcel 1D # Page -21- of 3
5 - 1 �# ❑ Ug pit t3rorrod oepti, b � Sol Rate
Hart= Depth DomlnantColor Redox Descriprion Texture Struckwe Covdstsnoe Boundary Roots GPDN
In. Munsd OU Sz. Cord Color Gr. Sz Sh. 'tw1 'Et1g2
vvl 5
eon# ❑
❑ Pit gourd surface eiev. fL Depth b irnill g ir< Sol Appkdon Rd
Hodson Depth Dominant cdor Redox Description Texture Sbuct to Consistence Boundary Roots GPOW
&r. Munsetl flrr. SL Coat. Color Gr. Sz. Sh 'Em 'EM2
I
❑ Bodrg
b facbr it
D ❑Pit Grorr� surface elev. #- �r irniGrg Sol Rabe
Hoftm Doh DomWmt CMN Redox Description. Tetra Sno" Co Boundary Roots
in. Munse• CkL Sa Cont Color ( Sz Sh *M 'Eif#2
I
• EMuent #1= DW > 30:S 220 nV& and TSS >.V IN ffQL 'Effluent #2 = MD, < 30 rrq& and TSS 130 nq&
The Department of Cottune= is an equal op m mitt' service provider and =Wloyer. If you need assistance to acccss services or
need material in an alternate Format, please contact the deparbmmt at 608- 266 -3151 or TTY 60 9-264 -8777.
I seoas3spe:rao�
l
r
• K
Soil Test Plot Plan
Project Name P.C.Collova Bldrs. Inc. Shaun B'
Address P.O. Box 489 i
Somerset Wi 54025 CSfA #226900
Lot 30 Subdivision Prairie Pond Breaks Date 4/9/03
E 1/2 NE 1/43 31 T 31 N /1318 W Township Star Prairie
N W 1/4 W 32
❑ Boring Q Well PL Property Line County ST. CROIX
e em or VRP Assume Elevation 1 f t. Top of Survey Iron
Elevation 93.8/93.3 *HRPSame as Benchmark
Alt. BM Top of 2" Pipe @ 100.2'
0
0
3
0
0 329
3
\
1 30'
60'
1 70'
B -2
1%
Slope 0
\\ 0
\
N ot slope to
\ establish contours �
M� �
336' ? �'
S'
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer P. C. Collova Builders, Inc
Mailin g Address P O Box 489 Somerset, WI 54025
_
G `rh
Property Address ! q/
P rtY � !
(Verification required from Planning Department for new construction)
City /State New Richmond, WI Parcel Identification Number d 3$ -- L as — 3 0 — 000
LEGAL DESCRIPTIO
2 3 �
Property Location T N -R 18 W, Town of J h , . , r'�'�,i.�
Subdivision Prairie Pond Breaks Lot # � V .
Certified Survey Map # Volume , Page #
695417 202 27
Warranty Deed # 6954 9 Vol 2021 Page 29
Spec house es ❑ no Lot lines identifiable D- ❑ no
SYSTEM MAIN'T'ENANCE
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
caa 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
masterplumbcr, journeyman plumber, restrictedplumber or a liccnsedpumper 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
=1 ' that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
of th three err a ira 'o date. �r
V A
LA j 1 /dq
SIGNATURE OF APPLICANT DATE
OWNER CEATMICATION
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
perry sc ' ed above virtue of a warranty deed recorded in Register of Deeds Office.
VO A t) �A Aft% /N
0<410
SIGNATURE OF APPLICANT 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
Maintenance and Contingency Plan for a Septic System
Maintenance Plan ed once every 3 years.
1. Septic Tank is to be pump
leaned once a year. Please note: a larger filter is being installed in
2. Eff luent filter is to be c
order to extend the maintenance interval of the filter. actions pipes at the ends of
fns
3. Once every 3 years, cells are to be inspected via the p
the cells.
rbage, and water conditioner discharge into the system.
4. Owner agrees to limit greases, ga
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.
Discharge into system is not exceed those required as per Comm. 83
8. 9
n cy Plan , -�:
If stem fails, determine cause of failure, use emate a. ( and install new
Option #1. Y
sy in tested replacement area.
Installs stem at a lower elevation, by removing chambers, removing biomat,
Option #2. Y
and install new system.
No a d e q uate area is suitable for replacement area, and system elevation
Optton#3. �l
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
Pumper Tom Mondor 715- 246 -5
Shaun Bird #226900
U 2021P 029
STATE BAR OF WISCONSIN FORM 2- 1999 6 9 5 4 1 9
Document Number WARRANTY DEED A REGIS OF DEEDS
ST. CROIX CO. F YI
This Deed, made between Cecil Brighton and Cleo Brighton, RECEIVED FOR RECORD
husband and wife,
10 -23 -2002 11:00'AM
YAR&%Ty DEED
Grantor, and P. C. Collova Builders, Inc. EXERT #
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): P �1 /�� f /�'� �N /� s
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. AvOr
038-
Parcel Identification Number (PIN)
This is not homestead property.
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if an LX) (is not)
Dated this day of September 2002
* Cecil Brighton
' * Cleo Brighton
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
ss.
St. Croix County )
authenticated this day of
D tt . Personally came before me this day of
- September 2002 the above named
Cecil Brighton and Cleo Brighton, husband and wife,
JF
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 K 4a Ogland Notary Public, State of Wisconsin
Hudson, WI 54016 M �,Comm�iss permanent (If not, state exWion
(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. Udamation profewk). b company. Farad du Laa wI
STATE BAR OF WISCONSIN SOD-665 21
WARRANTY DEED FORM No 2 - 1999
U 2021P 027
STATE BAR OF WISCONSIN FORM 2 - 1999 K6 g c 1 7
Document Number WARRANTY DEED REGISTER OF DEEDS
M ST. CROIX CO. , WI
This Deed made between Douglas A. Strohbeen and Eileen n � RECEIVED FOR RECORD
Strohbeen, husband and wife, \�
10 -23 -2002 11:00 AN
WARRAVTY 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 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.
(is) NX00
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this y of September 2002
3 Douglas A. Strohbeen ,
• + Eileen Strohbeen
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
) ss.
St. Croix County )
authenticated this day of
t ;' T Personally came before me this & o q Ay of
September 2002 the above named
Douglas A. Strohbeen and Eileen Strohbeen, husband and wife,
TITLE: MEMBER STATE BAR OF I (>1Et8�
(If not, to me known to be the rson(s) who executed the foregoing
authorized by § 706.06, W is. Stets. �F C �� .
instru nd a ged the same.
t WIS ' - –
THIS INSTRUMENT WAS DRAFTE")'W
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.) , AinD 6 )
• Names of persons signing in any capacity must be typed or printed below their si ture. hdormauon Prores3ionab company. Fond du Lac, wt
WARRANTY DEED STATE BAR OF WISCONSIN
e00455-2021
FORM No. 2 - 1999
L
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S 00 0 20'52" E
EASTLINE OF THENW 1/4 OF
p N THE NW 114 OF SEC. 31 UNPL A T TEL
- - - ---
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FROM :PC COLLOUA BLDRS INC FAX NO. :17152943632 Apr. 06 2005 04:32PM P1
P. C. COLLOVA BUILDERS, INC.
34 260th Street
Osceola, WI 54020
Tel: (715) 294 -3245 Fax: (715) 294 -3632
email: collovabe @yahoo.com
Fax Transmission Cover Sheet
Number Faxed To:(
To: Kevin Date: 4 / 6 / 2005
Company: Zoning From: Pam
Regarding: Dev_ Prairie Pond Breaks Lot # 30
Address: 925189th Str
City: New Richmond
Urgent Response Requested X For Your Review Please Comment
.Number of Pages Faxed - Including Cover Sheet: 5
COMMENTS:
Sending plans per request from our plumber Shawn Bird of Bird Plumbing, Inc.
Confidentiality Notice
This transmission is intended only for the use of.the individual or entity to which it is addressed and may
contain information that is privileged and confidential. If the reader of this message is not the intended
rea lent you are hereby notified that any disclosure, distribution, or copying of this information is strictly
P , Y
mmediatel b tele hone or fax.
prohibited. If you have received this transmission in error, please notify us immediately y P
J
!son
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