HomeMy WebLinkAbout038-1221-35-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 463220 0
GENERAL INFORMATION State Plan ID No:
Personal information you provide � 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 Township 038 - 1221 -35 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
1 0S r -3r+t t- 31.18.1235
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Y Benchmark
Dosing - -- - -• .- _ Alt. BM
Aeration Bldg. Sewer q
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet f
Septic N v Dt Bottom
1 --
c. 2.3 _
Dosing Header /Man.
Aeration Dist. Pipe 6 & -(o' i g3 3 S
Holding Bot. System w : �, 4 °! z '/a, - 4—
Final Grade <
PUMP /SIPHON INFORMATION �l'uc�� `1 `17•S
Manufacturer Demand St Cover T
GPM �'.7'�� C hJ -2 i
Model Numbe
TDH Lift Fric Loss System Head TDH Ft
Forcemain Length Dia Dist. to Well ,
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3
SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR (� " d 0(
Type Of System: !U cs T UNIT
Model Number.
DISTRIBUTION SYSTEM 2 — ti + �"—
Header/Manifold De Size x Hole Spacing Vent to Air Intake
r .� Pipe($)
Length 10 Dia H Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over - Depth of xx Seeded /Sodded xx Mulched
Bed /Trench Center \ Bed/Trench Edges Topsoil
I 1:1 Yes [� No � Yes [� No
COMMENTS: (Include &de discrepencies, persons present, etc.) Inspection #1: /Z / t / Inspection #2: 1 /
Location: 907 189th Avenue Somerset, WI 54025 (SE 1/4 NE 1/4 31 T31 N R1 8W) Prairie Pond Breaks Lot 35 Parcel No: 31.31.18.1235
1.) Alt BM Description = t Lnv' �G C:�C�� c� E3
2.) Bldg sewer length = 2 3 d4 vk_4�J A Cf j /� p -
- amount of cover = jC,' y(�' `�
Plan Use other de for in Yes No
q
� �
format
SBD - 6710 (R.3/97) , —
Date Insepctor's Signature Cert.
Safety an d Buildings Division County t
201 W. Washington A ex�62`"-
Madison, WI 5 07 - nitary omit Nmmbec ( % -� in by Co.)
con' sin (608)266- 151 r
Department of Commerce x arc Pll LD.Numbe
Sanitary Permit Application 1 ; A
In accord with Comm 83.21. Wis. Adm. Code, personal information yo provide project ddress (f Qi Trent titan mailing address)
may be used for secondary purposes Privacy Law, sl5.04(lxm
I. Application Information - Please Print All Information D
paret N Block #
Property
property Owner's Mailing Address Pr°perty
r �v_
i t7 Section
City, State Zip Code Phone Number
v S�D a� TkN R o W
i Type of Building (check a_ ll that apply) � - v ,**' - 3 g � d� Subdi a Name CSM N umber
4 _. 2 Family Dwelling - Number of Bodroo rn4
PublidCommercial - Describe Use City_ y . of
State Owned - Dtscribe Use
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A- ew System Replacement System Treatment/Holding 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 Owner
Before Exp'uation plumber
IV. of POWTS S Check all that appl J s
- Pressurized In -Ground Mound _t 24 in of suitable soil Mound < 24 in. of suitabl , soil At Grade Single Pass Sand Filter
Tank Peat Filter Aerobic Treatment Unit Recirculating Sand Filter n f
Constructed Wedand Pressurized In and / v n A
Recircu Synthetic Media Filter Chamber Line Gravel -less Pi Other (ex lain)
V. Di Area (/ �I s
Plow (gpd) Design soil Application Raoe(gpdsf) Dispersal Required (st) Disp Area n °
Pn°posed (st) S y�Oem F1rys�
6 (/s
0
Manufacturer Prefab prefab site S Fiber Plastic
VI. Tank Info Ga
Cap> on s Total Number Concrete Constructed Glass
liao Gallows of Units
New Existing
Tanks Tanks
Sepueor Hol&ng Tank
Aerobic Treatoror Unit y j J'
Dosing [�arnber .
�, risibility State - the and a bill for installation of the POWTS shown on the attached
MP/MPRS Number Busmcas Phone Nu
Plumber's (print) Plumbees
PlutnbePs Address (Stre 'ty, State. Ztp
YIIL Coon 1De t 10se Only ( Issued Agent gn (No )
Sanitary Permit Fee Cincludes Gsottadwatcr
Appmv
Disapproved Surcharge Foe)
Owner Given Reason for Denial -
IX. Conditions of ApprovaivReasons for Disapproval o Ili
STEM OWNER:
q eptic tank, effluent filter and
dispersal cell must all be serviced / m in fined
as per management plan provided by plumber.
All setback requirements must be maintained
as per applicable code /ordinances.
AHach complete plans (to the County only) for the system OR paper not less than 812 111 inches in sim
i
4 DDR PLAN
PROJECT P.C. Collova Bldrs. Inc. SS P.O. Box 489 Somerset Wi 54025
SE 1/4 NE 1/4S 31 , /T W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 11/21/04 BEDROOM 3
CONVENTIONAL XXX IN- GROUND P ESSURE 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 92.6/92. 3' bel�qrade
Alt. BM Top of 2" Pipe @ 100.2'
Well is to meet all
setbacks required by
219' WDNR Al
Plans Designed Using B.M. t.
Conventional Powts �k
Manual Version 2.0 M.
S T- 80'
2 -3' X 69 Cells with >3 spacin Venu y
a
DIN Road B -170' B
20' 20'
Pro 3
Bedroom 0'
House 5
2- ` -3 35'
r I
L f 0 mot``
7% Slope
Lent
>6 „ andard Biodiffuser'
of Cover aching Chamber
th Lon 31.1 ft2 of Area
Grade at System Elevation 203
34"
x 0y �
PL PLAN
PROJECT P.C. C ollova Bldrs. Inc. DDRESS P.O. Box 489 Somerset Wi 54025
SE 1 14 NE 1/4,5 31 ° /T 31 W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 11/21/04 BEDROOM 3
CONVENTIONAL XXX IN- GROUND P ASSURE 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 Iron ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE • WELL * Same as Benchmark
O H.R.P.
SYSTEM ELEVATION 92.6/92.2' 3' below qrade
Alt. BM Top of 2" Pipe @ 100.2'
Well is to meet all
setbacks required by
' 219' WDNR AI
Plans Designed Using B M t.
Conventional Powts �k
Manual Version 2.0 M.
I
80'
2 -3' X 69' Cells with >3' spacing Vents b
1 557 ,
ow Road B -1 7 B
20' 20'
' Pro 3 S
Bedroom 0
House
B -3 35'
4� 1
7% Slope
J nt
Standard Biodiffuser
Leaching Chamber
with 31.1 ft2 of Area
,
34 „ Grade at System Elevation 203
v i
R
S
i
vim► Department of commerce e SOIL ,EVALUATION REPORT PO � of
Ohrfs+orn �Safiatyard Bt�rrgs ? in acaordenca WW";q� vf,c.- Ad Colo r5
Attach complete as plan on paper not less than 61/2 x 11 hv*m in size. Plan nwd
include. but not il No to: vertical and horizontal rakwence point (BAAf. direction aid Parcel W.
psnm t slope. scMe ord beer pions. north emow, and location and distance m meanest road. 0 3Y — IZ Z 3'
r r� a e„rae „ma ee wad for seconasrr auaoses Macy r raw. s
15.o4 c�i trail L pas . 12
Property Owner / Property Location 76 `'--
l , ''� (i GmL Lot lc-bt 114, 114 3 N R r E "10
Pl pia Ma" Address Block iglkd I I a
city SM a e rs � GrJf SfOo?.s O �� _ T$ Neared Roaa
Ngw cataNtrc6on ! Number of bedroans Code derviea design sow rate J r"1 GPD
p Risplacernert ❑ Public or oomrnardel - Descrkw
Parent nrdedal ��• "�� "c�,S,�d Flood Plait d&w$on If able
General comments
and reoorrarnendattons: , d
O Borin
D Pit �
E Bodng# ground su ff" elev. J ' �R Depth to Rr�g factor � it• goll Rde
Hodizat Depot Dw*wtt Redord Dow"on Texture St udue Consistence Boundary Roots
in. murmeg t1u. Sy- Copt Color Gr. SL Sh.
-
qz -G�
� fiZ
® # a p Ground atsface sle v. 5 ' OIL DepthliDlimillmleclor � rL soy Awkslon Rana
Mort Depth Dominant Redox Description Texture structure Carrsistertce Botaalary Roots flPDilr?
irr. CkL SL Cant Color. Gr. SL Sh.
D� 3 2 r rn •fir c S LM
yl� S( � ��
g s L w .�
W. G
zkIr Gq-f
•
Bust #1 a BOD > 30 < 220 n#L TSS 330:15; ' Etlirent #2 = BOD <_ 30 nwL and TSS 30 nm L
CST t 0? 02 CST Number
6 &
Address -
Dale Evaluation Conducted Tebphone Number
wig r+ '
■ _, _
f -
• Soil Test Plot Plan
Project Name P.C.Collova Bldrs. Inc. Shaun Bird
Address P.O. Box 489
Somerset Wi 54025 CSTM 6900
Lot 35 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 0 Well PL Property Line County ST. CROIX
BM VRP Assume Elevation 100 ft. vTop of Survey Iron
em Elevation 92.6/91.0 *HRpSame as Benchmark
A�BM Top of 2" Pipe @ 100.2' t�
219' 1A
.M.S
80'
0
70' B -2 0 ,
H
0
95' 0'
B -3 35'
94'
7% Slope
203'
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 i n 7 � — RR
`T_
(Verification required from Planning Department for new construction)
City /State New Richmond WI parcel Identification Number �3n /Z2
LEGAL DESCRIPTION
SE NE 3 18 23 5
Property Location /., /,, Sec. T 3 N -R W, Town of J
Subdivision Prairie Pond Breaks Lot #
Certified Survey Map # Volume . Page #
695417 2021 27
Warranty Deed # 695419 Volume 2021 . Page # _ 29
Spec house ❑ yes A no Lot lines identifiable 4 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.
I/we, the undersigned have road 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
of the three year expiry on date.
4" �j � ag ,
P. C. COLLOVA BUILDERS, INC. 11 /0 /Qy
SIGNATURE OF APPLICANT (715) 247 -2742 DATE
P.O. Box 489
OWNER CEI TUMCATION SOMERSET, WISCONSIN 54025
1 (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
p d property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
M A � A A �jo&?� P. C. COLLOVA BUILDERS, INC.
(715) 247 -2742
SIGNA F 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
Septic System
Maintenance and Contingency Plan for a Se p
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Eff luent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of
the cells.
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. Watershed is to be diverted away from system.
8. Discharge into system is not exceed those required as per Comm. 83
onting y Plan
Option #1. system fails, determine cause of failure, use e'ernate aria and install new
sy m 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
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 -4680
Pumper Tom Mondor 715- 246 -5148
Shaun Bird #226900
U 2021P 029
STATE BAR OF WISCONSIN FORM 2- 1999 6 9 5 4 1 9
KATHLEEX H. WALSH
WARRANTY DEED
Document Number . REGISTER OF DEEDS.
ST. CROIX CO., WI
This Deed, made between Cecil Brighton and Cleo Brighton, RECEIVED FOR RECORD
husband and wife,
10 02 1
1.00 A?1
WARRANTY DEED
Grantor, and P. C. Collova Builders, Inc. EXEMPT #
TRANS 720.
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): /N/ f � N `�
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.
Parcel Identification Number (PIN)
This is not homestead property.
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. (X) (is not)
Dated this day of September 2002
* * Cecil Brighton
' * Cleo Brighton
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN }
ss.
- `•G :., St. Croix County )
authenticated this day of
Personally came before me this day of
,. September 2002
the above named
Cecil Brighton and Cleo Brighton, husband and wife,
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me kn to be a on(s) who executed the foregoing
authorized by § 706.06, W is. Stats.) instru d led ed the same.
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristina Ogland Notary Public, State of Wisconsin
Hudson, WI 54016 M Commiss n is permanent (If not, state ex (Signatures may be authenticated or acknowledged. Both are not necessary.)
* Names of persons signing in any capacity must be typed or printed below si to
tYP P ow t re. Infartnetion Profa� .J. Company, Fand du Lac wn
;
WARRANTY DEED STATE BAR OF WISCONSIN 90044 �,� 021
FORM No. 2 - 1999
U 2021P 027
STATE BAR OF WISCONSIN FORM 2 - 1999 K6 HEEN H 1 -
Document Number WARRANTY DEED ALSH
R
REGISTER OF DEED
ST. CROIX ca., MI
M
This Deed, made between Douglas A. Strohbeen and Eileen 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:
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 NEI /4 ofNEI /4 and part of SE1 /4 ofNE1 /4 of Section 3 I 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) ��ii30
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this 7 y of September 2002
60
f {
Douglas A. Strohbeen
' + Eileen Strohbeen
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
) ss.
St. Croix County )
authenticated this day of .. ...
,.,.•; y • : 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 cRB�
(If not, 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 C
THIS INSTRUMENT WAS DRAFTE
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 cure. Inrormatlon Profeaalonala c ompany. Fong du Lac, N
WARRANTY DEED STATE BAR OF WISCONSIN
eoosss•zort
FORM No. 2 - 1999
►'
� M
►d O �50'- rW
N N , _ s
I to LOT m A
Lor 86,749 sq. ft.
W 76,0 93 s "'
: q• ft. z 1.99 a cres 4,
�
N 1.75 acres
l o n
T DRIVE
pp oo I EASEMENT 2 N mo
O. ...................... �..
N I $15.41' LOT23
1 — — - 222.53' 83,919 sq. ft.
S 88'42'41" E 237.94' \ 1.93 acres
50 — —
° N 88'42'41" W 236.25'
.ry h
• '
� o ' I 0 ETEN �� �S• ��
cv WATER
I n S TORM gg2 \
N N• W E•
Co
• ;' LOT 35
83,644 sq. ft. o � 'SA ZG
cn 74,518 sq. ft. 3
1.92 acres
w� 6 6' 1.71 acres
I L.B.O. 892.0
i L8.0. 892.0 0) N
f r*-
h \ \
o
97.6 /
.k' W 202.189 , 203.12'
N 89 6 F 405.30'
LOT 34 0
• LOT �7 3 77,243 sq. ft.
ini s> N 1.77 acres N
�`TOVnav \ L.8.0. 892.0
} QCrQ3 �M E.
8880 A o
375.76' _ 232.23' • .
' S 89 W ^^,
K4
NW 1/4
QIS.
CO RNER. UNPLA TTED
OiJND
I" IRON