HomeMy WebLinkAbout038-1221-33-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
453320 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. I Star Prairie Township 038- 1221 -33 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
oo. o c, ��, a W- flo h R31.18.1233
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
l�c.x.5 / O CEO 9.38 X09. Leo. �a
Dosing Alt. BM
Aeration Bldg. Sewer
Holding St/Ht Inlet /o'i. 9L
St/Ht Outlet S, 7$ 103.60
TAN ETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \
Septic 7 101 N A Z 3' Dt Bottom
Dosing Header /Man. n t g,t ioi
Z
Aeration Dist. Pipe
Holding Bot. System T- t
T- i - io . 3 14.68 ✓
PUMP /SIPHON INFORMATION Final Grade y _Z6 101. &_--
Manufacturer Demand Sj j Cover
GPM S(oc k L.3 /u7.o8
Model Number
TDH L' Friction ss System Head TDH Ft
F remain Length Dia.
OIL ABSORPTION SYSTEM
BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 G Z,
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer.
INFORMATION I CHAMBER OR 5 S
Type Of System: , ,
Go n uc, »4 " o noQ C�,
"'�O 6 3 N/� �_ UNIT Model Number:
z Sra
DISTRIBUTION SYSTEM 1 -f �"
Header /Manifold Distribution x Hole Size x Hole Spacing ent to Air Intake
Pipe(s) / '
Length 13 Dia y Length Dia pacing pyy, as
SOIL COVER
x Pressure Systems Only xx Mound Or At - Grade Systems Only 7 es Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center
Bed/Trench Edges Topsoil L.,., _] Yes L1 No [ "_ Y No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 8 / 1?- Inspection #2: / /
Location: 915 189th Ave Unknown (SE 1/4 NE 1/4 31 T31 R1 8W) Prairie Pond Breaks Lot 33 Parcel No: 31.31.18.1233
1.) Alt BM Description =
2.) Bldg sewer length = Z
- amount of cover
Plan revision Required? I Yes No �/
Use other side for additional information. _ � " L. _ -_ -. `
SBD -6710 (R.3/97) Date Insepctors Signature Cert. No.
r - -
i
Safety and Buildings Division Court
201 W. Washington Ave., F.O. Box 7162
N v ll' sconsin Madison, WI 53707 - 7162 Sanitary - P ermit Number (to be filled in by Co.)
Department of Commerce (608) 266 -3151 � 332D
Sanitary Permit Application State Plan I.D. Number
In acootd with Comm 83.21, Wrs. Aden Code, personal information you provide !
may be used for secondary purposes Privacy Law, s 1 1 m Project Address (if different than mailing address)
I. Application Information - Please Print Ali Informati s w
l �
Property Owner's big=
JUN I 4 ;Parcel # � # Brock'_
200��
Property Owners� Address Property
t V, NLE u. Section —6�--
City, State Zip Code Phone Number
N. Ka
of Building (check all that apply) 5
or 2 Family Dwelling - Number of Bedrooms ybSlivision Name Number
PmblidCoimnercial - Describe Use
State Owned - Describe Use Gty_ Village / yShin
III. Type of Permit: (Check only one box online A. Complete line B if applicable) 030 Z24 - 3 3 - OVO • 3 3
A ew System Replacement System TreatmendHolding Tank Replacement Only Other Modification to Existmg System
B • Permit Renewal Permit Revision Change of Permit Transfer to New Last Previous Permit Number and Date Ensued
Before Expiration Plumber Owner
IV. Type of POWTS System: (Check all that apply) �E
- Presturizod in (around Mound Z 24 in of suitable soil Mound < 24 in of suitable soil At Grade Sin an�Ft
Constructed Wetland Pressurized in Ground Holding Tank Peat Filter Aerobic Treatment Unit rntitlating Sand Filter
Recimila
fig Syncretic Media Filter g Chamber Drip Line Gavel -less Pipe Other (ex (7
V. ffErxsalfrreatwent Area ormation:
Desi Flo (gpd) Design. Soil Application Rate(gpdsf) Drs ersalArea Required (sfl . ASid (st) S � 7; 4,2
VL Tank Info Capacity in Total Number Manufacturer Prefab antic
Gallons Gallons of Units t,r 0fl Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank
Aembic Treatment Unit
Dosing (umber
VII. Resp onsibility Sta t- I, the undeakA assure responsibility for installation of the POWTS shown on the attached
Pl s ame (Print) rumbeffeignatuxe MPlMPRS Number Business Phone Nu
Plumber's Address (Street, City, State, )
VIII. me artment Use oil
"(0v Disapproved Sanitary Permit Fee (utcludes Gtvundwater Date Issued Agent signatutt Stamps)
Surcharge Foe) �� s
ven Reason
11X. Conditions of Approvai/Reasous for Disapproval
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 oaty) for the system oa paper not less than tills x it inches in size
PLO P� .O.
PROJECT P.C. Collova Bldrs. Inc. A Box 489 Somerset Wi 54025
SE 1/4 NE 1/4S 31 /T 31 N/R TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 6/12/04 BEDROOM 3
CONVENTIONAL XXX IN- GROUND PRES E 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
Well is to meet all SYSTEM ELEVATION 100.7/9. 6' below grade
setbacks required by
WDNR Plans e ' �ng
Alt. BM Top of 2" Pipe C 100.2' Conventional Powts
Manual Version 2.0
Pro Town Road
Vent
Standard Biodiffuser
247' ALo Leaching Chamber
with 31.1 ft2 of Area
1 "
Grade a t System Elevation
34"
2
Pro 3
Bedroom
House \
30'
Benz 1 c�7 T
2 -3' x 69' cells with >3' spacing 50'
-1 B -2
20' 70'
Vents
3
90
OP
35' B -3
10%
Alt. Slope
M.
B.M. 407'
I
I
vcioa
I
PLOT P
PROJECT P.C. Collova Bldrs. Inc. ADD S P.O. Box 489 Somerset Wi 54025
SE 1/4 NE 1 /4S 31 /T 31 N/R 1 W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 6/12/04 BEDROOM 3
CONVENTIONAL XXX IN- GROUND PRES E 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
Well is to meet all SYSTEM ELEVATION 100.7/9. 6' below qrade
setbacks required by
WDNR Plans e ' ng
Alt. BM Top of 2" Pipe CC 100.2' Conventional Powts
Manual Version 2.0
Pro Town Road
Vent
247' >6„ Standard Biodiffuser
of Cover Leaching Chamber
with 31.1 ft2 of Area
6' Long 11 "
Grade at System Elevation
34
Pro 3
Bedroom
House
30'
T
2 -3' x 69' cells with >3' spacing 50'
B -1 B -2
20' 70'
Vents
3
90'
35' B -3
10%
Alt. Slope
.M.
B.M. 407'
w
i
P
J
•
vi wonsin Dqwvnent of corrwnerce SbIL .EVALUATION, REPORT Page of
oiviaon of safety and ,
in accordance wlthiCotnon s& W adm, Coda__ cow+ J
Attach aorr kft site Plan on gaper not teas then 8112 x 11 inches in sits. Plan must
induce, but not Drilled roc vertical and hodaoreai refierence point (B14. direction and Pared I.D.
pied elope, scae ordhoeralons. nornh arrow. and location and distance to nearest road.
please print an infbrmeflon. by Date
persona taaerr obca you provide nay be used for seoorwwy purposes (Pyhow Low, s. 15.04 (i) t ")• . 1
PmpeftLocdbn
i'roP" �I���IJ� / C� 114 �! N R / E( w
p pis MAB Address td #� Sloct # Sub& Now
'0"'7 zy'aA C-S
CRy S Ste zip Code Phone Mirriber ❑ CRY ❑ Town Nearest Road
Sa ems G�i JAW-s
New Co nstuctiort t1 .Residerrtial / Number of bedrooms _ Code denied design low rate GPD
OftPlacevnent 0 Pubic or oomrn=W - Describe:
Parent maw /Iii �.� �ryc 1 Rood Plain eis+raMn WOcarde A/ /Ic!::E it
Gerwalcommenis ���� 2 lw� 1 �0 �i► r � .
and raooerenendiionx
D erg# p Baring
5( pit GMWW srrfaoe elev��R DePdh b liMIllina faclor
Mixon Dq* DornineritColor Reclux Dasaiption Texprre Slrucsre cOnsistence Botswery Roots Gppff
in. munset (1u. Sz. Cad. Color Gr. Sz. Sh.
3— l 7 XTO
Pit Ground surface dev. 06 It. Dept► b uniting l for Z� u M Applicallon Rate
HorWon Depth Duninartt RsdoxDesa(ptim Tsxewe StucUre Consistence Boundary Rcols GPM
yh m nsett au. Sz. Cod Color Gr. Sz. Sh `ice '�
-IZ ID rah 2
2 12-34 lovy yj6 Z rn f i✓�
28
4 I ��
• IBi #1 - BOD > 30 < 420 uQ& and TSS >30 < �' - Elhrent 02 = BM = 30 mgit. and TSS 30 mall
Address ' : _ Dale EAation Cordtrclad Tebpihahe Nrrrtber
®MR1mF ", 3� �
r , sii
v
Soil Test Plot Plan
Project Name P.C.Collova Bldrs. Inc. Sha it
Address P.O. Box 489
Somerset Wi 54025 C #226900
Lot 33 Subdivision Prairie Pond Breaks Date /03
E 1/2 NE 1/4S 31 T 31 N /R W Township Star Prairie
N W 1 /4 W 32
Pem 9 ng ()Well PL Property Line County ST. CROIX
or VRP Assume Elevation 100 ft. Top of Survey Iron
Ele vation 100.7/98.8 *HRpSame as Benchmark
Alt. M `, Top of 2" Pipe @ 100.2'
Pro Town Road
247'
20' 70' 107'
-2
B -1
30'
90' 105'
35' B -3
10%
Alt. Slope
M. It
407'
IINN-
1
M
aintenance and Contingency Plan for a Septic System
Maintenance Plan Pu mped once every 3 years.
1, peptic Tank is to be pump installed in
2. Effluent fitter is to be cleaned once a year. Please note: a larger filter is being '
order to extend the maintenance interval of the filter: he ins ections pipes at the ends of
3. O nce eV,;ry $ years, cells are to be inspected via t P
the ceiis.
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 a s p er Comm. 83
7 mgen y Plan e sltemate area and install new
O ion . If system falls, determine cause of failure, us
system in tEsted replacement area.
option #2. install system at a lower elevation, by removing chambers, removing biomat,
and install new system. ands Y stem elevation
Option#>:3. No adequate area. is suitable for re placement merit area,
cannont be lowered. Install holding tank as last resort.
3. Replace .any other failing components as needed.
Plumber: 6Shaun Bird 715 -246 - 4516
St. Croix County Zoning 715- 386 -4680
Pumper Tom Mondor 715- 246 -5
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 - 0 11 5— (T- `,4-N �-
(Verification required from Planning Department for new construction)
City/State New Richmond WI Parcel Identification Number 0 /Zz/ - 3 3 - e l • 1 33)
LEGAL DESCRIPTION
Property Location SE %, NE ' /,, Sec. T 3 N -R 18 W, Town of S 4z,,r
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
c -ffect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to SL Croix Zoning Department a certification form, signed by the owner and by a
masterplumber, journeyman plumber, restricted plumber or a licensed pumper 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 113 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 SL Croix County Zoning Office within 30
of the three year expiration date.
SIGNATURE OF APPLICANT • C. COLLOVA BUILDERS, INC.
/Q
IV
(715) 247 -2742 DATE
P.O. Box 489
OWNER CEATIECATION 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
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIGNATURE OF APPLICANT DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * **
** Inciade with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey reap if reference is made in the warranty deed
U 2021P 027
STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN S H H 1 MA
Document Number WARRANTY DEED REGISTER OF DEEDS
ST. CROIX Co., YI
This Deed, made between Douglas A. Strohbeen and Eileen RECEIVED FOR RECORD
Strohbeen, 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: 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 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 vl
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.
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this y of September 2002
' Douglas A. Strrolibeen
' + Eileen Strohbeen
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
) ss.
St. Croix County )
authenticated this day of •-•-
y ' T Personally came before me this y of
September 2002 the above named
Douglas A. Strohbeen and Eileen Strohbeen, husband and wife,
TITLE: MEMBER STATE BAR 0 v
(If not, A _ to me known to be the rson(s) who executed the foregoing
instru nd a ged the same.
authorized by § 706.06, Wis. Stats. .
OF �0
� WIS _._
THIS INSTRUMENT WAS DRAFTS "BY•
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.)
' Names of persons signing in any capacity must be typed or printed below their si ture. information Professionals Company Fong du Lac, wt
WARRANTY DEED STATE BAR OF WISCONSIN
e00455
FORM No. 2 - 1999
tsJ, i to sq. it. :— ►
1.93 acres o °
0 .o m
1
�^ I N
/ 71
As• ? A, ' LOT 24 1
,EA ti �A• � I
�oN H . 9 • 94,961 sq. ft.
0y �. 2.18 acres
sr0+
S64'
6
4,518 sq. ft. 3 .,
1.71 acres ^� � _ i / •�
L.B.O. 892.0 N G6 ✓ou OR /VE
Iry
97.6 /
►3.12'
.30' ............ %P
3 to LOT
L0734 � ,�
\ 3 77,243 sq. ft. U) `�
° Co � Tw ��► �• 79,093
rER ;' N q 7 96 ft. /� mss 1.82 a
� rn 1.77 acres C \ - F
° L.B.O. 892.0 1.61 acres C
38 ° �' L.B.O. 892.0
A4M WA
90.6 N \ 9.9 N E AREA .99
232.23' 403.28' aae.O
S 89 0 4745" W 1318.33'
SOUTHLINE OF THE NW 114 OF TBE
MW 114 OF SEC. 32
UNPLA TTED LANDS