HomeMy WebLinkAbout038-1221-31-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
453304 0
(ATTACH TO PERMIT)
GENERAL INFORMATION o s State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j.
Permit Holder's Name: City Village X Township Parcel Tax No:
P.C. Collova Builders, Inc. I Star Prairie Township 038 - 1221 -31 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
�Ck �- l r0 �^ 31.18.1231
TANK INFORMATION LEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
Z.v 94
Aeration Bldg. Sewer 7 c7q
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
93 .
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \
Septic - zo Dt Bottom \
Dosing Header /Man. - t 2 9 3. W
Aeration Dist. Pipe
Holding Bot. System C f. Z 2
P Final Grade MP /SIPHON INFORMATION 3 -`'I 96.4
Manufacture Demand St Cover
GPM �<_ K ��� ). /G c. .
Model Number
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dia. Dist. to
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS L `G 7 � Z
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manuf turer: (
INFORMATION CHAMBER OR i Q . i
Type Of System: , T
c` ^ v¢ r4 ; G r �3S N A UNIT Model Number. 5
DISTRIBUTION SYSTEM Ve nkS ohs . f n z'� C•M
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake 1
r , Pipe(s)
_Length /3 Dia Length Dia Spacing - �
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over A - t�j Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed /Trench Center cv BedlTrench Edges Topsoil �„
7 - U � Yes [� No F, j Yes j No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: � Inspection #2: / /
mow/
Location: 921 189th Ave Unknown (SE 1/4 NE 1/4 31 T31 R1 8W) Prairie Pond Breaks Lot 31 Parcel No: 31.31.18.1231
1.) Alt BM Description = -T � t , � �d ^ ^ � � � °'t' c W 0-
2.) Bldg sewer length = (Q
- amount of cover
Plan revision Required? Yes No / 2 Ic , L�
Use other side for additional information.
SBD -6710 (R.3/97) Date Insepctors Signature Cert. No.
Safety and Buildings Division County t
m m 201 W. Washington Ave., P.O. Box 7162
�sevnsin j Madison, WI 53707 — 7162 Sanitary Permit Number (to be filled in by a.)-
Department of Commerce (608) 266 - 3151 5 0
Sanitary Permit Applicati � Stagy Plan I.D. Number
In accord with Comm 83.21, Wis. Adm. Code, personal inform ion yot rbvt 1 V E
may be used for secondary purposes Privacy L a 1 xm) ject Address (f different than mailing address)
L Application Information - Please Print All Information
Property ownePs Name
ZONING OFFICE # Brock#
Property owner's Mailing Address
Pro perty
City. State tip Code Phone Number v, L6 v. Section
t one T� N; 1�/ E III. a of Building (check all that apply) \� y S
O r - 2 Family Dwelling - Number o v 1 S Subdivision Name CS Number
PubiiclCommercial - Describe Use
State Owned - Describe Use K ZZ _ Village *owns* o ��
III. Type ' : {Check only one box online A. Complete line B U applicabl 21 _ �_ 3�
`� ste Replacement Systetat Treatment/Holdi Tank R `
ng Re placement Only Other Modification � Existing System
B • Permit Renewal Permit Revision - c of Permit Transfer to New List Previous Permit Number and Date issued
Before Expiration Plumber Owner
IY. T of POWTS Systemm: (Check all that appl
n - Pressurized In-Ground Mound Z 24 in. of suitable soil Mound < 24 in, of suitable soil At -Grade Single Pass Sand Falter
Constructed Weiland Pressurized Fn- Ground Holding Tank Peat Filter Aerobic Treatment Unit Recirculating Sand Filter
Recirculating Synthetic Media Filter g Chamber Drip Line Gravel -less Pipe Other (explain)
V. DispersabTreatment Area Information:
Design "w (gpd) besign Soil Application RaWgpdsf) [D ispersal Area R (sf) Dis Area Pro sed (sf) System Elevation
3
VL Tank Info Capacity in Total - Numberl Manufacturer Prefab Site S Fiber Plastic
Gallons Gallons of Un, t,.s�.6,4 ,¢_. 0 I ncrete Constructed Glass
New Exisdog _ " r J ty"
T Talcs
Septic or Holding Talc )
AaoWc Treatment Unit [1
Dosing Chamher t
VII. Responsibility Statement- I, the and a%,.e nsibinty for Instntlation of the :'OWTS shown on the attached plans.
Plu Name (Print) Plu ignanue MV!MPRS Number Business Phone Number
Plumber's Address (Street, City State, Zi ) r
VIII. artment Use Onl
Approved roved Sanitary a Fee ) t Fee includes Groundwater Date issued t Signatu (No Stiunps)
Denial Surcharge F) 2 �
1 r
IX. Conditions o proval/Reasons for Disapproval t
SYSTEM OWNER:
1 Septic tank, effluent filter and
dispersal cell must all be serviced / 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 QWY) for the sYstem on paper not less than SM x 11 inches in size
�'LfTl f; 2(14 fD nl in IV,
j1/ T PLAN
PROJECT P.C. Collova Bldrs. DDRESS P.O. Box 489 Somerset Wi 54025
SE 1/4 NE 1 /4S 31 /1 W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE6 /6/04 BEDROOM 3
CONVENTIONAL XXX IN- GROUND SRESSURE 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 Ir = Q "'- ( ASSUME ELEVATION 100° Filter Zabel A -100
❑BOREHOLE O WELL *H, R. p, ameasBenchmark
SYSTEM ELEVATION 93.0/92.8 5.5' below qrade
Top of 2" Pipe @ Q0.2'
336' B.10'
Al
10' B.M.
-2
awi Road 2 -3' X 69' cells with >3' spacing 30'
Vents
O' T - Z
10 B-1 T-
1 35' 35' B -3
T 399'
10 ' y
Pro 3
Bedroom
House
Vent
>6 „ Standard Biodiffuser
of Cover Leaching Chamber
Plans Designed Using with 3 1. 1 ft2 of Area
Conventional Powts 11 "
Manual Version 2.0 6' Long
34" Grade at System Elevation
446'
Well is to meet all
setbacks required by
WDNR
P
I
<�:�'
�.
OT PLAN
PROJECT P.C. Collova Bldrs. ADDRESS P.O. Box 489 Somerset Wi 54025
SE 1/4 NE 1/4S 31 /T 31 /R 1 W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE6 /6/04 BEDROOM 3
CONVENTIONAL XXX IN-GROUND'JRESSURE 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
IL BENCHMARK V.R.P. Top of Survey Ir fl =g"* ( ASSUME ELEVATION 100 Filter Zabel A-100
❑ BOREHOLE O WELL *H.R.P. ame as Benchmark
SYSTEM ELEVATION 93.0/92.8 5.5' below qrade
Top of 2" Pipe @ 1p0.2'
336'
Al
10' B.M.
B -2
owi i Road 2 -3' X 69' cells with >3' spacing 30'
Vents
0 '
10 B -1
35' 35 B --
T 399'
10'
Pro 3
Bedroom
House
Vent
>6 „ Standard Biodiffuser
- of Cover Leaching Chamber
Plans Designed Using with 31.1 ft2 of Area
Conventional Powts 11 91
Manual Version 2.0 6' Long
Grade at System Elevation
34"
446'
Well is to meet all
setbacks required by
WDNR
P
P
4
Wisconsin Dep8rMMtOf Corrllrterse SOIL tVALUATION f Rpm Page of
Division of sawand e
in accordance wiu+camm6k+nic.:adm Code
CorntY J . ��p y
Attach complete sRe plan on paper not less than 8 U2 x 11 inches in same. Plan must
include, but not W*ed to: vertical and horizontal mWenae poia (BM). direction and Parcel ED.
per sera slope. scale ordirnenelons. north arrow and location and dista nce to nearest road.
• Please print an k*wma*w. by Date /
Pamonel admmadorr you PvAde may be tnedfor emcmulmy Perposem (MmY Low. a 15.04 (1) (m)). . 12 y
/ 2
tY . G l� /�t�Y.t/ / �r (r � PropartyLocation 1l4� M 3 N R / E WO
PmpwWOwneesiiitAVAddress Lo Bfod(
at # Name
i (Ji f %
CRY State zip GOO Phone Number o Ctiy ❑ Vltiage JaTown Noofed Road
New Caratruction (Jsa;0Residentiai / Number of badroonw 3 — Code dwAmd dugs flow rate '��J �1 GM
do ❑ Repieoemera ❑ Pubic or oanvnerciat - Describe:
Palest material /'3i� i ii ..�. s i good Plain Arvallon if applicable it/ //� it
and rlltrwxkdions
rg,6,
�SY.s' elm
2 ,
ED eori'e a pit Groundsurfaceelev. 1' JfL Depth to WnflkV fector I- Sol Appkadon Rde
HmtoDn Depth Dm*Ot Redm( Description Taxlrre Structure Consistence Boundary Roots GPOW
in. murnee CA SL Cola. Color Gr. Sz. Sh. 'E1i#1
0l )o / lzr :o
0,+
,t o z
® Beft ° Qg''
Ara Grand surface elev. tt Depth 1k) liffift factor' n. SOR Rate
Horizon Depth Dominant Red= Description TOO" Ruch re Conswe nae Bo(>ndenY Roots GPM
it M(ned CkL Sa Cont. Color Qr Sz Sh. '1 1
IO 3 z
�'� 1 r y �� L� w /, Z
E l
-5 0 r s/ �- C L m 3
• ElpueM IM BM. > 30 Z0 n and TSS 40 11 • E( mM 02 = BDD 130 m9 L and TSS S 30 fn9 L
( P" < �- as
- e a Address '— _ Date evaluation Conducted Teleph" Number
Property Owner Parcel ID # pap of
5-1 Borrw # Grr M surface etev fL Depth to imi ft factor �/ ` im
Soil Appicallon Rate
Horiaort Depth Dominant Redooc Description TeAve Sbucki a Canoe Boundary Roots GPOW
in. Aftin ;ell Qu Sz. Corrt. Color Gr. Sr- Sh. *EWl 'E1f#2
t p — / ovy 3j l S c_ m Fr 5 Z
Z 1 16 s a vve- - r G till
o . 9 3.o
F Z �o
eon# a
❑ Pit Ground sauce elev- R. Depth to lirnift factor in. Sol AppNoWan Rate
Hard Depth Dom' and Cdor Redox Desaip6on Teomm Siruc.wm Cansiste = B=Wwy Rook GPOW
in. Mcanse0 CkL Sz. (wont. Color Gr. SL Sh. -M *EN2
F-1 Wiv # D pit Grotiro surface etev. ft Depth ID tint factor :n
Sol Rate
tlorimn Depth DombwtCC& Reclux Description. Team 4 WucWm Consistence Boundary Roots
in Manse/ cim S - goof. Color Gr SZ Sh. 'EtiIF9
.EgWt#1 L BW6130<ZWntgLadTW >3G)5l50nV& � eMmt #2 =WD5:530 rnA and M 530 nQ&
The 1tpartment of Commem is an eclW opportunity service Provider and employer. If yon need assistance to access services err
txe8 material in an alternate format, Please contact the deparmnent at 608-266-3151 or TTY 60 8-264 -8777.
seosnoptAw
t .
Soil Test Plot Plan
Project Name P.C.Collova Bldrs. Inc. Sha d 1
Address P.O. Box 489
Somerset Wi 54025 C§YMI #226900
Lot 3 Subdivision Prairie Pond Breaks Date 4/9/03
E 1/2 NE 1/4S 31 T 31 N /R W Township Star Prairie
N W 1/4 W 32
M Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 1 ft. Top of Survey Iron ?
System Elevation 9 3.0/92.8 *HRpSame as Benchmark
Alt. BM Top of 2" Pipe @ 100.2' dIA -
336' 90'
.M.S
b
10'
3
0
E�
30'
B -1
Id B -3
35' 35'
1% Slope not enough 399
t� t, y slope to establish
contours
446'
Maintenance and Contingency Plan for a Septic SYstsm
Maintenance Plan pumped once every 3 years.
1. Septic Tank is to be pump
2. Effluent fitter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the fitter.
3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of
the COS.
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. Watershod is to be diverted away from system.
8. Discharge into system is not exceed those required as per Comm. 83
Contin ency Plan
Option 1. system fails, determine cause of failure, use alternate area and install new
system in 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
cannons 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 P
(Verification required from Planning Department for new construction)
City /State New Richmond, WI Parcel Identification Number D 3 F- (T 'z mo 1.2;1)
LEGAL DESCRIPTION
Property Location SE '/,, N E ' /,, Sec. 31 , T 31 N -R 18 W, Town of C J' �'Zx
Subdivision Prairie Pond Breaks Lot #.
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 St. Croix Zoning Department a certification form, signed by the owner and by a
masterplumber, journeyman plumber, 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 system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
o the a expiration date.
P. C. COLLOVA BUILDERS, INC.
(715) 247 -2742 / -3/ i/
SIGNA OF APPLICANT P.O. Box 489 7
SOMERSET, WISCONSIN 54025 DATE
OWNER CEATIFICATION
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
theQr � 4cjlbed above, by virtue of a warranty deed recorded in Register of Deeds Office.
1A P. C. COLLOVA BUILDERS, INC. / 3 / ma y
(715) 247 -2742
SIG14AtL4W OF APPLICANT P.O. Box 489 DATE
SOMERSET, WISCONSIN 54025
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 KA�THEEN H H . -7.
Document Number WARR4NTY DEED 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 AM
WARRAVTY DEED
Grantor, and P. C. Collova Builders, Inc. EXEMPT #
REC FEE: 11.00
TRANS FEE: 1260.00
COPY FEE:
Grantee.
EAT COPY '
FEE•
Grantor for a valuable consideration
s to Gr antee 1
t conveys the PAGE S.
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 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) RXdQ
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this 2 of September 2002
* * Douglas A. Strohbeen
1
* * 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,
TITLE: MEMBER STATE BAR OF' 1VI$� t
(If not, to me known to be the rson(s) who executed the foregoing
instru nd a ed the same.
g
authorized by § 706.06, Wis. Stats. UF C��
1 916 WIS : -
THIS INSTRUMENT WAS DRAFT�b'13Y"
Attorney Kristine Ogland Notary Public, State of Wisconsin
MY Hudson, WI 54016 C ommission is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) , Z .)
* Names of persons signing in any capacity must be typed or printed below their sig% ture. Information Professionals Company Fond du tao, w1
STATE BAR OF WISCONSIN two- ees -2ort
WARRANTY DEED FORM No. 2 - 1999
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