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Home My WebLink About038-1221-34-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 479259 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 -34 -000 CST BM Elev: 01 Insp. �M El BM Description: / Section/Town /Range /Map No: C) -t�-/1 31.31.18.1234 TANK INFORMATION ELEVATION MfA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing V Alt. BM Jfi Cz C/— Aeration Bldg. Sewer , J b Holding 44 AAAW St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet 1'7- TANK TO P/L 1� BLDG. Vent to Air intake ROAD Dt Inlet Septic ( 2_0' Dt Bottom Dosing Z Head -7 (� f ( o - Aeration Dist. Pipe �� G �' 96 -� Holding Bot. System I Y /o �S 2 v Final G c/ PUMP /SIPHON INFORMATION 3- d %0 0� Manufacturer GPtM and St Cover � / i � / L V Model Number "� TDH Lift Friction Loss Sys ead TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM 2 avvl� BEDITRENCH Width j 1 Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG JWEL LAKE/STREAlr LEACHING anuf er' J INFORMATION Typ f System: CHA "AIME OR l Ur [�/ ModeNumber S DISTRIBUTION SYSTEM -S _ Header /Manifold IDistribution f� / x Hole Size x Hole Spacing Vent to Air Intake 1 h Pipe(s) � rlj f // IX / _ /' x 7 S/ Length Dia Length Dia Spacing f�_ 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 2 _ Yes No [] Yes ( No COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1: / 7 /mil Inspection #2: Location: 911 189th Avenue Star Prairie, WI 54026 (SE 1/4 NE 1/4 31 T31 R1 8W) Prairie Pond Breaks Lot 34 Parcel No: 31.31.18.1234 1.) Alt BM Description = S1 v/ 2.) Bldg sewer length = 20 - amount of cover = �� Plan revision Required? Yes F!<No Use other side for additional information. (C Date Insepctor's Signature Cert. o. SBD -6710 (R.3/97) County Safety and Buildings Division " 201 ington Ave., P.O_ Box 7162 ►�� ) = Madi 53707 — '7162 Sanitary Permit Number (to be filled in by Co.) isconsin Department of Commerce State P1anLD.Number Perll�it pl[��,tion -- Sanitary o ou provide In accord with Comm 83.21, Wis. Adm. personal infdxfnaf {� Project Address (if different than mailing address) may be used for secondary Pure s L2 0 I. Application Information — Please Print All Informati / �/C fi/C arcBlock # Pf-# Lot # Property Owner's N / `` Property Lo n _ Property Owner's Mailing Address l ll Gi y,, bl�%, Section Phone Number circl Zip Code ( one) City, State (,( --- �� ✓ // N; E W M Number 1 n 11. Ty a of Building (check all that apply) Subdivision Name � �5 '9 Family Dwelling — Number of Bedrooms ❑ Public/Commercial — Describe Use llCity ❑Villa To sly of E] State Owned — Describe Use _ _ III. Type ermit: (Check only one box on line A. Complete line B if applicable) Only ❑ other ZZ 3Y fi� tO� ng System A. S stem C1 Replacement System E] Treatment/Holding Tank Replace List Previous Permit Number and Date Issued ❑ Change of ❑ Permit Transfer to New B. ❑ Permit Renewal ❑Permit Revision Plumber Owner Before Expiration S IV. a of POWTS S stem: (Check all that a 1 ) 2 Single Pass Sand Filter ❑ In- Ground ❑Mound >_ 24 in. of suitable soil ❑Mound < 24 in. of suitable soil ❑ At - Grade g Q on — Pressurized ❑ Aerobic Treatment Unit ❑ Rc culating Sand Filter Constructed Wetland 11 Pressurized In -G and ❑ Holding `tank 11 Peat Filter ❑ Other (plain) J ;3e, c �'� El Drip Line ❑ Gravel -less Pipe Recirculating Synthetic Media Filter ng Chamber P Area Pro sed ( System Elevati n nformatioa: sired (sfl DrsPeT 3 V. Dis ersal/I reatment Are Disper 7A ,, Re4 �7 D i Flow (gpd) Design Soi�plication Rate(gpd� a �� ✓ ' Z-� / Prefab Site 1 Fiber Plastic VI. Tank Info Capacity in Total Number Manufacturer Concrete Constructed Glass Gallons Gallons of nit `(°o n New fisting '7 -� Tanks Tanks -.. Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement I , the undersigne ame responsibility for installation of the POWTS shown on the nessPhone Number Plumber' afore MP/MPRS Number ^��✓ / (/ Plumber' Name (Print) Plumber's Address (Street, City, State, Zip L VIII. Date Issued sing gent Signature (No Stamps) Coun /De artment Use On Sanitary Permit Fee (i odes Groundwater ` Approved ❑ Disapproved Surcharge Fee) 1 4 ❑ for Denial IR. Conditions of ApprovallReasons 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 only) for the system on paper not less than 8112 % 11 inches in sure SBD- 539& (R. 01103) f P OT PLAN PROJECT P.C. Collova Bldrs. ADDRESS P.O. Box 489 Somerset Wi 54025 SE 1/4 NE 1 /4S 31 /T 3 N 18 W TOWN Star Prairie COUNTY ST. CROIX 6/17/05 BEDROOM 3 MPRS Shaun Bird 226900 DATE CONVENTIONAL XXX IN -GR D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE �HOL�DING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 ( BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 1009 Filter Zabel A-100 O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 95.6/95.3 5.5' Below qrade Alt. BM Top of 2" Pipe @ 100.2' Plans Designed Using Conventional Powts Well is to meet all 247' Manual Version 2.0 setbacks required by WDNR p Vent >6 Standard Biodiffuser 9 of Cover Leaching Chamber R with 31.1 ft2 of Ar 11" Be om 6' Long H f 3499 Grade at Syste Elevation 20' S k� 1 30' B -1 35 -2/ aa•37 Vents ' Y 2 -3' X 69' Cells with >3' Spacing B -3 \ 5% X 30' Slope ` J � 219' M. 19 J i P OT PLAN PROJECT P.C. Qollova Bldrs ADDRESS P.O. Box 489 Somerset Wi 54025 SE 1/4 NE 1/4s 31 /T 3 N 18 W TOWN Star Prairie COUNTY ST. CROIX 6/17/05 3 MPRS Shaun Bird 226900 DATE BEDROOM CONVENTIONAL >00( IN -GR D 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 ( BTNCHMARK 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 95.6/95.3 5.5' Below qrade Alt. BM Top of 2" Pipe @ 100.2' Plans Designed Using Conventional Powts Manual Version 2.0 Well is to meet all 247' setbacks required by WDNR Vent >6 „ Standard Biodiffuser 9 of Cover Leaching Chamber R with 31.1 ft2 of Area Pro 3 P4 Bedroom 1 1 " Lon g 6' J Grade at System Elevation House 34" 20' ST �\ I 30 1 35' � B -1 B -2 Vents 30' 2 -3' X 69' Cells with >3' Spacing B -3 J �- 5% k J 30' Slope 219' B.M. 19 f Wisconsin Department of Corrmr m SOIL FVA[ UATION REPORT Page of We= ofSafe NXI Bu&klgs aY .,.... in accordance vAh Comm 85. Vft Adnr. Code Attach compiala aft plan on paper not Was than 8112 x 11 inches in abs. Plan awst hrclMxte, but not MOW t0: variicai and horfxmW reference Point (BM). direcon and Parcel I.D. Pe ra M slopm scale ordkrrensiom north arrow. and Wcaion and distance to nearest road. Please print all lnfor maim by Owe POMM M i ftWAd- You wovide MY be undfor 800MMWY FWPOM (Pma�Y Low. s. 15.04 (1) (m)). Location a y GU t// / G Govt Ldp 4J 114 3 N R / E ( W p MaftAddrew Ld # B!n # Name ` � e�s� G� f'Oo?.S � � C �� - own Nearest Road New Conatruclim th ReaidenUaf / Numrer of bedrooms_.. _ Code derived design low rate t%J GPO ❑ Repbcmwt ❑ Pubic or cmmremw - Desa w Patent "NAM MI 7�ii Zn c Hood Bain it appicabie !t / //} fL General comments G r artd reoomrnettdatiorts: — � � � to � . p Q � # Pk fi Ground surface r. l l 1 fL Depth to il1dill g factor I- Sal te Ra Mor)aat Depth Da *wd Color RsdcK Desaplon Texture Mmcitse Caublenca Boundary Roots it. Munsei Qu. SL Coat. Odor Gr. SL Sh. 't 1 Z 0-3 0 2- �# ° � GtorRtd surface elan. l tt D�tlr tD Wn9 M so Rsla Ftori wn Depth Don*%"Color Relsw oesa(ption To*" sktx " Cash"" " Boundary Rods GPM in tuna Qu Sa Coat Color Gr. Sz Sh. 1 XA i,. a • EMU" #1 BOD > 30 _5220 mgtl. and TSS >30 =1q_ f�' #2 =BOO _< 30 ntgil and TSS 3tf rrgll CST (Please P" CST �= as Address Date Evaknlm Cottducied Tebptarre Number 11 zv� �A �l mum 1 II'�I1 �• „ rl • F I (� .1t 11 i �1�1'1'.w .ri: -�11 "I . Ir • U: I' Soil Test Plot Plan Project Name P.C.Collova Mrs. Inc. Sha i Address P.O. Box 489 Somerset Wi 54025 M #226900 Lot 34 Subdivision Prairie Pond Breaks Date 4/9/03 E 1/2 NE 1/4S 31 T 31 N/1318 W Township Star Prairie N W 1/4 W 32 Boring Q Well PL Property Line County ST. CROIX M or VRP Assume Elevation 100 ft.—_ Top of Survey Iron System Elevation 95.6/94.0 *HRpSame as Benchmark A t. B �;- Top of 2" Pipe @ 100.2' 247' 0 3 101' B -1` 5 5 ❑ B -2 1 99' B -3 5% 30 Slope 219' B.M. °�� M. 195 Ma intenance and Contingency Plan for a Septic System .. Maintenance Plan 1. Septic Tank is to be pumped once every 3 Y ears. r er filter is being installed in 2. Effluent filter is to be cleaned once a year. Please note: a larger order to extend the maintenance interval of the filter. ins ections pipes at the ends of 3. Once every 3 years, cells are to be inspected via the p the cells. to limit greases, garbage, and water conditioner discharge into the system. 4.Owner agrees g 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. per Comm. 83 6. Discharge into system is not exceed those required as p C y Plan stern fails, determine system of failure, use a`aernate ajr9Q and install new #1. Y in tested replacement area. Install s chambers, removing biomat, option #2. In stem at a lower elevation, by removing Y and install new system. Option#3. No a dequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank 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 -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 14'\ (Verification required from Planning Department for new construction) City /State New Richmond WI tY Parcel Identification Number 0 J - 13Y -0 0 0 LEGAL DESCRIPTION Property Location SE %,, y,, Sec. 31 T 31 N -R 1 W, Town of Subdivision Prairie Pond Breaks Lot # Certified Survey a # � Y P . Volume . Page # 695417 2021 27 Warranty Deed # 695419 Volume 2021 Page # _ 29 Spec house ❑ yes I 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, journeymanplumber, restricted plumber or a licensedpumper 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 stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 dava EL 'A 6A of the three year expiration date. P- C. COLLOVA BUILIV RS, INC. A SIGNATURE OF APPLICANT (715) 247 -2742 DATE 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. ryks � a (A o P. C. COLLOVA BUILDERS, INC. 131 a SIGNA OF APPLICANT (715) 247 -2742 DATE P.O. Box 489 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 029 STATE BAR OF WISCONSIN FORM 2- 1999 6 9 5 4 1 9 Document Number WARRANTY DEED RF.GIST�ER 11. YALSH ST. CROIXOCo., VI . This Deed, made between Cecil Brighton and Cleo Brighton, RECEIVED FOR RECORD husband and wife, 10 -23 -2002 11:00 AM WARRANTY DEE 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):�� Recording Area NW 1/4 of NW I/4 of Section 32, Township 31 North, Range 18 West, St. Name and Return Address Croix County, Wisconsin. A11 � 038 - 1131 -60 Parcel Identification Number (PIN) This is not homestead property. LX) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of September 2002 — 7 * Cecil Brighton * * Cleo Brighton b 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 * y u 2 Cecil Brighton and Cleo Brighton, husband and wife, TITLE: MEMBER STATE BAR OF WISCONSIN V" ' '�C (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 MY Commiss is permanent (If not, state exWiion (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 gpiture. Information Proteumnab company. Fora du lao, vm STATE BAR OF WISCONSIN eoo-ses WARRANTY DEED FORM No. 2 -1999 U 2021P 027 STATE BAR OF WISCONSIN FORM 2 - 1999 6 `� S 4 1 7 Document Number WARRANTY 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 A?! 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 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 s Douglas A. Stro , ' # Eileen Strohbeen AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. St. Croix County } authenticated this day of i , • j Personally came before me this Py of September 2002 the above named { Douglas A. Strohbeen and Eileen Strohbeen, husband and wife, TITLE: MEMBER STATE BAR OF�/I$� (If not, to me known to be the rson(s) who executed the foregoing instru nd a 9 ged the same. authorized by § 706.06, Wis. Stats. �� _ OF WISE - -- THIS INSTRUMENT WAS DRAFT�D - 8a r Attorney Kristina 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. 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