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Home My WebLink About038-1168-40-000 ST. CROIX COUNTY ZONING DEPARTM ` AS BUILT SANITARY REPORT RE� Owner �/�C G o�/'d ✓ L,,► T ,1,2' . �l , l A' Address GO 4P 4' 3T CPO 499 ^ J City /State Irv/ OOr JACLC Legal Description: / Lot � 2 _ Block " Subdivision/CSM # e aQ _ ,, ;W e- �s 7 Z '/4 SL '/4 ,,e�!L, Sec. .2ff, T 3 ! N -R(6 W, Town of �✓,��„'�,'� PIN # 0,'3D SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer 1i?.%/&l e- .v7 Size ST/PC 4 221 Setback from: House i Well Wx-y P/L 1,5 Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: Co ti Width /_ Length 15' Number of Trenches Setback from: House 124'_ Well X ek- PAL Vent to fresh air intake i 5'O ELEVATIONS Description of benchmark T..1 s<- , �` ' Elevation rG d , ' Description of alternate benchmark w Elevation L! Ar Building Sewer Af 9, ST/HT Inlet Z4, fel ST Outlet le 4. .S PC Inlet PC Bottom Header/Manifold * . 77 Top of ST/PC Manhole Cover Distribution Lines ( ) ,9,`,G „z. O ( ) Bottom of System ( ) F? ( ) ( ) Final Grade ( ) r /010 e ( ) ( ) Date of installation 4 7 Permit number Q State plan number Plumber's signature ✓ License number - a,? 7!? 1 ?d Date Inspector ,L Complete plot plan �* I Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County Safety and Buildings Division ST . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitargi?jri1tM_: Personal information you provice may be used for secondary purposes [Privacy LaAy, s.15.04 (1)(m)J. Permit Holder's Name: T wn of: State Plan ID No.: P.C. COLLOVA BUILDERS �P �`� CST BM Elev.: / Insp. BM Elev.: BM Description: Parcel T(�� 0j .-116 8—[} ( Dc7 r 100 z /- L .Z — h�r�h TANK INFORMATION ELEVATION DATA A9800174 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. +�,y Se l�l So/w4K YI'o GI.C'f' t I/ Bench A p 3.72 103.72 /occ) Dosing ,Alf. g M 1 / l• o / — r-G, ! /l (o / Aeration wu Bldg. Sewer /// 0/ L�•aL /OG .� , Holding S y t Inlet (e `7 TANK SETBACK INFORMATION St W Outlet /•11,0/ y. Z, /p G. 51 TANK TO P/ L WELL BLDG. 4 "'tak e ROAD Dt Inlet Septic L� P� •, /eA 1-7 NA Dt Bottom Dosing A Header /Man. (03. 405- '75 Aeration Dist. Pipe p 9 � mil S 1 �l8'•� Z. Holding Bot. System / o3' ,S�j7 0/7-9,7 PUMP/ SIPHON INFORMATION Final Grade /q•,7 3,( /VD. o7 Manufacturer Demand P f/.�'� /11 t/•61 99. Z/ Model tuber 7_� _ -tank 1. te 1/10/ f • 3 / Ve/ G TDH ft Friction S s i TDH Ft Forcemain Length j Dia. Dist. To well SOIL ABSORPTION SYSTEM E TRENCH Width t length i No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth V DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHIN Manufacturer: INFORMATION Type r CHAMBE Moe Num er. Sys e Z ( I /U OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length _� Dia. L/ Length 3L' Dia. 4 Sp SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over D �th ver xx Depth Of xx Seeded / Sodded xx Mulched Bed /Trench Center eench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) Go-f Z �r1 LOCATION: STAR PRAIRIE 28.31.18,SW, W 104TH STREET 1 (o ��, -�T �lue i -1� r o►u o 1b4 /rt loo Gteaol -C�/ N� r'`� �o(a 1F /a.ti Sly o�✓ 4)0/ Ian revision requir6d? VYes No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector' ignature ert Vi sconsin Safety and Buildings Division SANITARY PERMIT APPLICATION 2 1 Box Washington Avenue W. Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. SrG.rra �' k • See reverse side for instructions for completing this application State Sanitary Permit Number 2 "'C' Personal information you provide may be used for secondary purposes Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION -� Property Owner Name Property Location G ' v 50)114 ��I /4, S T , N, R E (06 Pr perty Owner's Mailing Address Lot Number Block Number -sK 9 City, State r Zip Code Phone Number Subdivision Name or CSM Number S . ! ( > I. TYPE F BUILDING: (check one) ❑ State Owned ❑ !t(a Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms Y O Town OF 'yy' A 7% .5' III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo . � $' 61 i f ' 0 3 8 / I � 8 t ic 2 [] Assembly Hall 6 E] Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. j New 2 ❑ Replacement 3_ ❑ Replacement of 4 ❑ Reconnection of 5_ ❑ Repair of an System ________ System____ _________TankOnly______________ Existing system ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 KSeepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 E] Pit Privy 13 E] Seepage Pit 2 - '� S� r 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade 56 Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation �.3 6- (, �J Feet 1 d Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Ex er. INFORMATION Gallons Tanks Manufacturer s Name Concrete Con- Steel lass Plastic Ap New Existin strutted g pp Tanksl Tanks Septic Tank El El 13 El Lift Pump Tank /Siphon Chamber ❑ ❑ 1 ❑ 1 ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on th attache plans. Plumber's Name: (Print) Plumber's Signature (No Stamps) P PRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): n � - I . COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary P it Fee (includes Groundwater D ate Issue n t Signature (No Stamps) EI / A roved Surcharge Fee) �� / / IJ pp ❑Owner Given Initial Adverse Determin 6Zegt� X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11197) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber i SANITARY PERMIT APPLICATION 201 Saf W and s B n il gt r on g A D'vision 14scons In acco r d w 3 05, Wis. Adm. Code P.O. Box 7969 t h ILHR Department of Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. S ; 7,- • See reverse side for instructions for completing this application State Sanitary — P ermit Number The information you provide may be used by other government agency programs E] Check it revision to ...p Ic1 n [Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property Owner Name Property Location G l eL e, • e v St�l v4 W 1/4, S 2r T 3l , N, R E (or� Property Owner's Mailing Address Lot Number Block Number 17 , City, State Zip Code Phone Number Subdivision Name or CSM Number `j S ( ) w -a T II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ !t Nearest Road Village Public 1 or 2 Family Dwelling - No. of bedrooms _ own of �Q 4 r/1 S 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo () 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1 1& New 2 ❑ Replacement 3 ❑ Replacement of 4 ❑ Reconnection of 5 ❑ Repair of an System System -_____ - ____ -__ ___________ __ Tank Only Existing System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 []Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 [a Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 5 X57 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation A 46 - 6 _4V S 7 d .. ,UGc- 77 ?-S Feet di 7; Feet VII. TANK Capacity i g allons Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete Con Steel glass Plastic App New Existing structed Tanks Tanks Ic an I- +Iehdn"qT3nk X. Qd0 / Gjl.1 G 7`Ct/!J ®— ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ 1 ❑ 1 ❑ 1 ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans. r Plumber's Name: (Print) Plumbe Signatur • (No Stamps) P PRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): 4 %'U ,r1 IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved nitar Permit Fee (IncludesGroundwater at ssue Issui Ad ept ture (No Stamps) kA roved Surcharge Fee) ' A a pp ❑Owner Given Initial r Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FO DISAPPROVAL: SBD-6M (R 17196) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber O Ci 4PCoot A e I or u M � t)o ti of 4 m �ICA- d G ° z a a n 2% " v� S 4 M Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION R TE PROPERTY OWNER: PROPERTY LOCATION Dick Tdier GOVT. LOT ST ;? 1/4 1A] 1/4,S 28 T 31 N,R 18 1±JDr) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # I SUBD. NAME OR CSM # 3550 N. Lexington Ave. 22 1 n/a Recd Pine Estates CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE t35OWN NEAREST ROAD ( nha Star Prarie 104th. St. [ New Construction Use Vj Residential / Number of bedrooms 4 [ ] Addition to existing building I ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate • 7 bed, gpd /ft - 8 trench, gpd/ft Absorption area required 857 bed, ft 750 trench, ft Maximum design loading rate • 7 bed, gpd /ft - 8 trench, gpd /ft Recommended infiltration surface elevations) 97.75 ft (as referred to site plan benchmark) Additional design / site considerations n/a Parent material outwash Flood plain elevation, if applicable n/a ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK. U = Unsuitable for system 06 El M El En El U LAS ❑ U ❑ S IV ❑ S � SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 1 0 -12 1 r4/2 none sl. 2. /n /sbk mfr c/s 2 f .5 .7 2 12 -96 10yr5 /4 none co.s. 0 /sg rr1 n/a n/a .7 .8 Ground elev. 10 Depth to limiting factor >96 Remarks: Boring # 1 0 -15 10yr4/2 none L. 2/m /sbk r r c/s 2/f .5 .6 2 15 -20 10yr4 /4 sbk mfr F/w 1 /f_ none si_l 1 /f. /.. • • 3 20 -92 10yr5 /4 none co.s. 0 /sp, rnl n/a n/a .7 s .8 Ground elev. 1 Depth to limiting factor >02 Remarks: CST Name: — Please Print Phone: Gar L. steed_ 175 -246 -5200 Address: 54 200th. Av. p), PTew Richrnond, WI. 54017 Signature 5-15- Date: 2208 CST Number: �2 xf STEEL'S SOIL SERVICE Gary L. Steel 1554 200th. Ave. C.S.T. 2298 nick Wier New Richmond, WI 54017 MPRSW -3254 STJ %NTOJh 52.8- T_HM - RHT� (715) 246 -6200 tovm of Star Prarie lot 22, Red. Pine Fstates I V 609 NX / x A, 2� TI-- 2 e s J ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM P.C. COLLOVA BUILDERS, INC. Owner/Buyer T 03 I �� V,4 1 �� S - C__ 12575 Keller Ave. Mailing Address PH. (612) 439 -9547 ID. #1073 Property Address IS 4 (2l S- (Verification required from Planning Department for new construction) City/State Parcel Identification Number 0 31 - 114 4 LEGAL DESCRIPTION Property Location 5111 %,, !W 1 /,, Sec, a 9 , T_3_LN -R�W, Town of 5 4A Q r"ns} nn , F Subdivision t'' (<j d_ 5 Lot # Certified Survey Map # Volume . Page # Warranty Deed # 5_6 G .7 4'(o Volume . Page # � 3 Spec house yes ❑ no Lot lines identifiable es ❑ no �y SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature•failum 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 licensed pumper 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. 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 days of the three year expiration date. GNATIM OF APPLICANT DATE OWNER CERTIFICATION 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 the p3ppezW4escribed above, by virtue of a warranty deed recorded in Register of Deeds Office. GNATURE OF APPLICANT DATE * * * * ** 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 " < < ALL IN SECTION 28, IT31N , R18W , TOWN OF STAR PRAIRIE, U. S.,6. S.) IAP H•OI. 44) ass UNPLATTED LA NORTH LINE OF SI/2 OF S88.47'100*W 260.00' 60.00 440.00 eo.00' Y so 500.00' Nw "• 14 s 15 ''a 93,179 SO. FT, +� 4 90.139 SO. FT. JJ� 2.14 ACRES �. $• _- 16 ^ 2.07 ACRES d� 4 h y °j 13 = 86.368 SO. FT. 126,624 SO. FT. W 2.03 ACRES 2.91 ACRES V� a ' '234 .00 AA / 1 1 -14. ' #0 1,► \ D 12 z 23 \s Q // i i 1 N \ f d D. 96.947 so. 70,715 30. FT. J �- 2.23 ACRES 1.62 ACRES a �' 4 / I 1 : g 92,869 SO. FT. w 6 , j IA g 1 83.604 SO. FT. 2.13 ACRES 4 \ \ / c .,1.92 ; ACRES .$, \\.` / c c 1 I N D � \ I , `0 22 284.11' 000. \♦ I \ N71 165,069 S0. FT. ' 1 a00 3.79 ACRES / 0 0. 6 >• ) / S 41'1' �•SB� 1 � � / / �-� � A s 9 20 N 266,113 ACRES I 8.11 ACRES y ^ 143.994 SO. FT. / N W 3.30 ACRES ; lE 4 X ^\ I d 1 7/ 78.36' N69643'20'E / 1316.69' SOUTH LINE OF THE SWI /4 OF THE NWI /4 OF SECTION 2 ' �JNPLATTED LANDS No 1 •,. t' '�� NYHAGM 8.140? UD�ON p P�y .w NC m ` .460. e4p),4 D 10 470.96 \ _ 00— do _ ioc9 /,t4 59.64 1 ° co v .. \ °° c RT ' v I \ 00 CD co f 4 0, 1 yzBOV 1 / Ow v co ro v _ CD 1 N \ Ze 4t1 O N w OD— ff D 04 b 0 \ 3d 9 Im ~ \ , IM I . 43 9.13' \ _ CD i O OD Y O o Gl Ito 1 U s C vW 4�` y , 4- . a o y O 1 N w o w - 1 � '\1 p N X S 03 OD is o`° o o _z c N Ln D p T7 A I Gi ao w n D k v\ �1 45L s s 0 ST. WI SCI COUNTY WISCONSIN ZONING OFFICE I IN N N NN4■ ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 January 25, 1999 P.C. Collova Builders Attn: Lori 705 County Trunk E Hudson, WI 54016 RE: Septic Inspection for P.C. Collova located at 1968 104th Street, Lot 22 of Red Pine Estates, Town of Star Prairie, St. Croix County, Wisconsin Dear Lori: A septic inspection of the above referenced property was conducted on October 1, 1998. This property is located in the SWY4 of the NW' /a of Section 28, T31 N -R1 8W, Lot 22 of Red Pine Estates, Town of Star Prairie, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions regarding this, please contact our office at (715) 3864680. Sin rely, od Es anger Assistant Zoning Administrator /sm