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HomeMy WebLinkAbout038-1221-36-000 County: Wi €cosin Department of Commerce PRIVATE SEWAGE SYSTEM St. Croix Safety and Buildiflg Division INSPECTION REPORT Sanitary Permit No 499127 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, Town of 038 - 1221 -36 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /b 4 � GS .31.18.1236 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Z ^7 /Q Benchmark m'–I nming �^' Alt. BM ' dr/� Q C', t�e �_ � a v le ew a �. t Aeration Bldg. Sewer �.5 Holding St/Ht Inlet 7 -6 16Z , 55 TANK SETBACK INFORMATION St/Ht Outlet 7. 5 1 -6 Z • Z TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet ` Septic J � , A Dt Bottom N 1 Dosing Header /Man. q Aeration Dist. Pipe 7.5 / ,06.7 – Holding Bot. System /a. T Z , Final Grade PUMP /SIPHON INFORMATION" Manufacturer Demand St Cover GPM Model Numbe TDH L t Friction Loss Syst ead TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length ♦ No. Of Trenches PIT DIMENSIONS No Of Pits DIMENSIONS 3 z t7e,.,` —_ . SETBACK SYSTEM TO lD P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer/7, INFORMATION CHAMBER OR NJ0 A Type Of System: (� / g I /v � 1� UNIT Model Number: Ar � z / O C01- 10Z� o t \ X I , /�J DISTRIBUTION SYSTEM /3 f' /3 z Z(, d-bt Header /Manifold 01 Distribution x Hole Size x Hole Spacing Vent to r Int Pipe(s) \ Dw� L Lengt Dia ` Spacing \ I l+ 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 G Bed/Trench Edges Topsoil Ps No \ veS No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1.i Inspection 92 Location: 1879 90th Street nknno 1/4 N 1/4 31 T31 R1 8W) Prairie Pond Breaks Lot 36 Parcel No: 31.31.18.1236 1.) Alt BM Description = /O if Y � - t, 4%S 2.) Bldg sewer length = Z7 d ��l,Jf–,— - amount of cover = 'T / J Plan revision Required? ': Yes o ! CA Use other side for additional Information. D nsepctor's S' ature � N " SBD -6710 (R.3/97) 1 Safety and Buildings Division County C 201 W. Washington Ave., P.O. Box 7162 1* is �O��i,1� Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) (608)266 -3151 Z Department of Commerce 4 1 State Plan I.D. Number Sanitary Permit Application In accord accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, sI5.04(1)(m) Project Address (if different than mailing address) 1. Application Information - Please Print All Information 0. # Lo # Block # Property Owner's N Property Owner' Mailing Address i G` Property Locatio ✓ � `' 0 LtJ y4,�4, Section City, State Zip Code Phone ` Numbert � t p.V !� 1 c one N; R or, W II. T pe of Building (check all that apply) r__ 00(G ubdivisio Name CSM N ber 1 or 2 Family Dwelling - Number of Bedrooms S� ❑ Public /Commercial - Describe Use El State Owned - Describe Use ❑City_ ❑Villa T of� e III. Type of Permit: (Check only one box on line A. Complete line B if applicable) - 221 . - CM I2 A " New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System ' List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New Before Expiration Plumber Owner , IV. a of POWTS System: Check all that app I c - W. 2 on - Pressurized In- Ground El Mound > 24 in. of suitable soil [I Mound < 24 in. of suitable soil ❑ At -Grade ❑Single Pass Sand Filter ❑ Constructed Wetland 11 Pressurized In- Ground El Holding Tank El Peat Filter 11 Aerobic Treatment Unit 11 Recirc�ati / ng Sandilter ❑ Recirculating Synthetic Media Filter Leaching Chamber ❑ Drip Line El Gravel-less Pipe 11 Other (explain) 7". _ V. Dispersal/Treatment Areif Information: stem levation Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) ispersal Area Proposed (sf) Sy VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constricted Glass New Existing Tanks Tanks Septic or Holding Tank Dosing Chamber VII. Responsibility Statement - 1, the undersigned responsibility for installation of the POWTS shown on the attached plans. Plug's ame (Print) Plumber's t MP/MPRS Number Business Phone Number Plumber's Address (Street City, State, VIII. Coon /De artment Use Onl Sanitary Permit Fee ( cludes Groundwater Date Issued Issuing Agent Signature (No Stamps) Approved ❑ Disap roved Surcharge Fee) ` ❑ O ven Re or Denial vV 4 IX. Conditions ppi o 3 \ 19 LJLtCt" C SYSTEM OWNER: 1 Septic tank, effluent filter and Lq �� 0_. P� dispersal cell must all b mined /maintained/ 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 8t/2 x 11 inches in size SBD -6398 (R. 01/03) I P O LAN PROJECT P.C. Collova Bldrs. Inc. A D ESS P.O. Box 489 Somerset Wi 54025 NW 1/4 NE 1/4s 31 /T 31 N TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 8/16/06 BEDROOM 3 CONVENTIONAL XXX IN- GROUND PRES ft 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 650 # of chambers 26 hk BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark SYSTEM ELEVATION 99.9/99.5 4.5' below qrade Alt. BM Top of 2" Pipe @ 100.2' Pro Town Road Well is to meet all Vent setbacks required by 80' WDNR >6" ARC 36 Biodiffuser wn Romans Designed Using of Cover Leaching Chamber Conventional Powts with 25.0 ft2 of Area Manual Version 2.0 1 1 » 5' Long Grade at System Elevation 36" pop Pro edroom Ho se 30' -2 ST 0, 0' 6% Slo B- 0' 35' 69' Cells with >3' Spacing 10 a a B -1 5 ' 202. B M. B.M. t. P O bE PROJECT P.C. Collova Mrs. Inc. A .O. Bo x 489 Somerset Wi 54025 NW 1 /4 NE 1 /4S 31 /T 31 N TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 8/16/06 BEDROOM 3 CONVENTIONAL XXX IN- GROUND PRES (t _ 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 650 # of chambers 26 IL BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 99.9/99.5 4.5' below qrade Alt. BM Top of 2" Pipe @ 100.2' Pro Town Road Well is to meet all Len, setbacks required by WDNR >6 �, RC 36 Biodiffuser 380' wn Ro eaching Chamber 14 Designed Using of Cover ith 25.0 ft2 of Area Conventional Powts Manual Version 2.0 5' Lon Grade at System Elevation 36 Pro 3 Bedroom House 30' O B -2 ST 30' 0' 6% Slo 0 ' AL 35' 2 -3' X 69' Cells with >3' Spacing 10 Vents �_ 35' 202' B.M. t. I 3 � � yin DepwWmtof Cornrneree S61L EVALUATION IREPORT of Division ofsatstyand "dir gs I . -­­ in acoordance vAh Comm 85. Wis. Adm Code Aftech compie+a she plan on Paper not lass t 8112 x 11 inches in size. Plan must kx*jde. b►rt not bribed to: vertical and horizonW reference point (OW. d redion and Parcel ED. Percerrt slope. acffis ordimmnsiorm, north anoW. mid location and distance to nearest road. Please print a n krftmwuwL b' Date Persond k onm*mr you p any be wed for *mcwWwY purpoeme (PAwsr Lew. s. 18.04 (1) ( /4.q . 2 Z PruPeKy &,.- 1/4114 R W ProperlyOhs Afts s Cot 6 Block# Name IR 07 th< � 3 p r .S� CRY State Code Phone ❑ Clly Q Yagage - Tmn Nearest Road S'a e1.s� GrJi Sf�Oo7s" t �S�a.- New Condruldon U der>>ial I Pprrrrber of bedraarrns _ Code derived dewgn flow rate '��J O GPD ❑ Rapiaoement ❑ Pu lac or odnmerdal - Dembw -- _ Parent material QLL ��� �� ,S.S! Rood Plain elevation N appkable General commenis andrer,end F-1 Bating # eak># I ( Pit Groundsurfaceetev. 2A R Depth to factor In. Sol Appicalon Rate Hannon Depth DarvirmtColor Redox Desaipdon Taftre SrucWm Considence Boundary Roots in. m nsd QtL Sz. Cont. Color Gr. Sz. Sh. `EW1 'E1812 g4.5a_ 3 € -1 # ❑ egg ��� ® Pit C�ratnd strtoe elev. It. Depth to fay 7""'-- im Sou Appkadon Rate Hodzon Depfii Don*=tCdm Radon Descriplion Texture Sbucb" Consistence Boundary Rods GPD1W K munew tiu. Sz. Cont Cdw Gr. Sz. Sh. *FM 'Eti#2 P C%_l b r r: /y p� ' S • Effluent #1= BOD > 30 1 220 ffQ& and TSS >30:1g „' - Efa wd #2 = 80C S 30 vrgL and TSS c 30 mgti CST {Please P" cw �� as a.) Date Evalua#on Carrducisd Telephone Number Address - A ll Syr/ -7 -, 3 Property Owner Parcel ID # page of F31 Pit Ground surbos elev. tt. Depth tb 6ndteg taclor - in. Rata Harmon Depth Don and Redox Description Texture Structure Consistence Boundary Roots GPDW in. murrsd am Sz. Cont. Color Gr. Sz Sh 'EW1 'E02 CS Zvi S , - 17 /- Z- a4- 7 T Elf ❑ Pit Guum ice elev R Depm W thrift tenor in. Rat Hormorr Depth Dom aft War Redox DGBC* m Texture Structure Considenoe Boundary Rods GPDAt• In. Winsee flu. Sz Coat. Color Gr. Sr- Sh. 'E4 ' Boft o ❑ ❑Pit mum elev t< Depth tofactor in. "AXAcallon Raze HoMm Depth Dar *wt Color Description. Texture SIMM" Cmmftm Boundary Rods GPM- in. Munse9 Qu. SZ Cad. Color Gr. Sr- Sh 'EfHf1 'Eflyg2 . E #i a WD j,, 30 < ZQ mgtL and TM >30 a 450 ff*& Eflhx3M #2 = BW. < 30 mU& and M S 30 ffq& Tlu IVrtmeut of Commo= is an equal opportunity service provider aad employer. If you need assistance to accasa mvioes mr aced maftnal is as Wteraate faricr % please contact the &W memt at 608-265-3151 or TTY 608-264 -8777. saos33operaol , Soil Test Plot Pla Project Name P.C.Collova Mrs. Inc. S Bird Address P.O. Box 489 Somerset Wi 54025 STM #226900 Lot 36 Subdivision Prairie Pond Breaks Date 4/9/03 E 1/2 NE 1/43 31 T 31 N /13 W Township Star Prairie N W 114 W 32 n Boring 0 Well PL Property Line County S T. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 99.9/98.2 *HRPSame as Benchmark Alt. BM Top of 2" Pipe @ 100.2' Pro Town Road ° 380' 0 3 0 S 103' -2 105' 40' Slo a B -3� 5 ' B 10 AL 35' 202' M. .M. Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent 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 Con ' cy Plan ption #1. ystem fails, determine cause of failure, use alternate area and install new s em 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 n Bird #226 Shaun 0 u 90 i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer P. C. Collova Builders, Inc Mailing Address �' S ���r �C)r� l 1 bz(02 -� Property Address V . Q C/ (Verification required from Planning Department for new construction) City/State New Richmond WI Parcel Identification Number _ LEGAL DESCRIPTION Property Location '/,, %, Sec. 31 . T 31 N - 1 W, Town of 3 hu(" �,.i,u� Subdivision Prairie Pond Breaks Lot # � . Certified Survey Map # Volume -�� , Page # 695417 2021 27 Warranty Deed # 695419 . Volume 2021 Page # _ 29 Spec house r yes ❑ no Lot lines identifiable f9 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 wastewaterdmposal 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 o fate of Wisconsin Certification that your septic system has been mainta� C $t 'County Zoning Office within 30 yS o f the 4OFPL expira -o date. PRODUCTION OFFICE (715) 294 -3245 3/) d SIGNATURT 34 260TH S TR. DATE OWNER CEATMICATION MCEO A, WI 54020 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 p perty describ abov , b A a of a vi2r�ty OV [ MA Rnpi UMemd'q QMQ& �` L t SIGNATURE OF AP LICANT PRODUCTION OFFICE C A DATE * * * * ** Any information that is mis- represented may result 5 Q4' eing revoked by the Zoning Department. s *ssss ** Include with this application: a stamped warranty �!�j � e�j�e �e ' office a copy of the ctrtifie� Ile c yy��de in the warranty deed r U 2021P 029 STATE BAR OF WISCONSIN FORM 2- 1999 6 C-3 , 2 5 4 1 9 XATHLEEN H. WALS WARRANTY DEED H Document Number REGISTER OF DEEDS . ST. CROIX Co., ItI This Deed, made between Cecil Brighton and Cleo Brighton, RECEIVED FOR RECORD husband and wife, 10 - 23 -2002 11:00 A1J WARRANTY DEED Grantor, and P. C. Collova Builders, Inc. EIEEWT # TRANS 720000 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): ;� ��� £ ' 42"NJ /`j i'' k 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. 03 3-1131-60 Parcel Identification Number (PIN) This is not homestead property. N) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of September 2002 i * Cecil Brighton 3 * Cleo Brighton b AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ss. - ` G �f 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, • '�?h. pF v�IcC�.. �-� 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 led ed the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristine Ogland Notary Public, State of Wisconsin Hudson, WI 54016 M Commiss n is permanent (If not, state exWjon (Signatures may be authenticated or acknowledged. Both are not necessary.) *Name of persons signing in any capacity must be typed or printed below their si tun , .......nation professionals C ompany, Fond du Lac_ wn STATE BAR OF WISCONSIN 8004W -40 WARRANTY DEED FORM No. 2 -1999 }1 r 46 U N y r U N 1 I I I I I , -- - 1103.51 - - - - I ........... i.......... ............... i ...... ... - ................. o — — — - 195.00' - — — - 195.00' — — — 195.00 — — 195.00' S 00'10'39" E 1160.18' M — - - - - - o - � �00�T0'3� - 2651.3 ' %7V T S 00'10'39" E 970.71' - - S 00'10 187.24'— +- — -- — - 384.84' N S00 9T °- '3. '.'. 5.7.20$'....... oo I a 1325.67' �, .. ... v ........ t .. S QQ'la ....... 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