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HomeMy WebLinkAbout018-2003-11-000Wisconsin Department of Commerce PRIVATE SE1i'UAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) 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 P.C. COllova Builders, Inc. Hammond Townshi CST BMEIe~:~ // ` d Insp.BMDEIgv:~ 1I // BM Description: ' 3 ~ ~ ~ Lt VV / - Su-r~/ S c~ 1 a- TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ ,~ /` . w / l v Dosing ~ ~ `D Aeration Holding TANK SETB~"-CK INFORMATION TANK TO P WELL ~- BLDG. Vent to Air Intake ROAD Septic ~~ ~ ~ 2S Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer errand GP Model Num r TDH Lift Loss System Head TDH Ft Forcem Length Dia. Dist. to well ELEVATION DATA County: $t. CroiX Sanitary Permit No: 430042 0 State Plan ID No: / N Parcel Tax No: ction/Town/Ra /Map No: 18.29.17. STATION BS HI FS ELEV. Benchmar ~~ ~• /D~q I /~-a Alt. BM a I ~~` D Bldg. Sewer ~. L •3 St/Ht Inlet S/SGH O ~ ~~. SUHt Outlet ~ D~S~ Q ~• ~ ~• Dtln /~ /_ ~- ~~ Dt Bottomeottom / ~~ Header/M Dis~~ ~ ~~'~ ~D ~. ~ Z.Z Bot. System ~ ` f - ~ ( . Final Grade St Cover y8- ~ SOIL ABSORPTION SYSTEM / ~ .~.{p~~ ~ ?~-~.~,Q BEDITRENCH DIMENSIONS Width ~ ~t ~ Length ~ ~ No. Of Trenches Z/ PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM EACHIN CHAMBER OR Manufactj Q T e Of~ ~ / ^ / /~ ~ UNIT Model Number: // ~• ~ / ~. RIBUTION SYSTEM IAJ/ZS Header anifold / ~ Distributio ~ ~~ ' `Pipe(s) ~ x Hole Size x Hole Spacing , l, th Di • ~ l! ~ fi9 ~ L ~ ~ ~! ng a ~ ength Dia pacin SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Onlv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~ Yes [ No ~_ ~ Yes [] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ ~/ / b Inspection #2: / / Location: 1556 97th Ave Hammond, WI 54015 (NE 1/4 NE 1/4 18 T28N R17W) Crick Bottom Overlo k Lot 11 Parcel No: 18.29.17. 1.) Alt BM Description = ~f~GUY~ ~---• ShI~~C-~ 5~ ~S'~i ~ ~ ~ S~tY!'h ~r6~ ~~o+P~'`-- 2.) Bldg sewer length =3~/ - amount of cover = ~ 31 Plan revision Re wired? Yes No ~ ~ ~ ~ ~ I I ~j~~~~~I Use other side for additional information. _ ~ J ~~-- --- ----- _- ~~i'~il/~/1.~ _~ ~`__-- - SBD-6710 (R.3/97) Date Insepctor's Si Cert. No. ~ Cl~rh tti... Vent to Air Intake I .. ~~~ ~ Comtj-~ ~ / J zai w wA~.,ro HoX~ pepat'tmeM of COm~itet'Ct: (~ 261-6546 !~ ~ ~ 3 0 D 2 San~t~tary Permi# Agplieation ~~~~% ~" ~°° LD'' ~ ~~esea~rmrosesr.~v~y>~,:is-~X~) ~caaa~G:'eu,/~s3 L AppHtI~Or~n-PlsaSeriintwnwormaHea ~ /S$7o ~ 7^ ~'~ .~- x~'S r~eoas ~ ~ r~yo~8 1 r~~' ~~ ~ n ~~ ,~w~: - ~c~ ~~~~ sew-~--- IL oil {diedc ~ t~ appiyj ar2Fiu~'lpD-1~iarobc~9ochaams ~ z~ CSM~a O ~-nera~vsc `~~~ ,`'`,' Os~o~ea-~ ~! Ov>n~ ' m. ry~,e.r~e~ (CLedc ody oae bow on ~e w. Comae ffie B ~te> ~ yy~, O x,sysam O~TadcR~tsoemaxt~4r O ~ha~toosmEs~ $. ©r~iuxe,~t O rei~cxa~on O c~u~eof Or~ntTia~ertorkw LiscPi~sviousplt~aaudDttei~ued sew o~ -.rya uz-c~a Cl u~a>_24 ie. e~fa sal CI 6tamd <2~ ua ~'~bie am'! ^ a:-c~a~ O s~ r,~ spa ~ ^ ea=wa~a c !7 rya ©s rat ©~ ~ D A~ rmm,~ c~c O ~ ~r . - u~~ - c D - ~ Oc~,~a-~~ O~uer(o~ ~ cS ,~2 ~c.~ ~ nest~so~n~nx~e(~. tit? ~(~1 l~L Tttek Inds ".. ~Y ~ C Yotal Cm Number afi~iis a PaeS6 Comae Coustru~od Sleet i~c C>~Ss Pf~ic ~, t ~ the >~e ey ferLen of the POWi~ s6swa as Uu: aWeied ph>s. p>oa~a s~id~{3uxt. fSb, S~ ) ~ ~, O ~ _ ~ .~. __-_- ~ z2s---- h'~3 O o~er+c~ trees ~r newt - ~ b ~ -~-~*-~ o~ -(~' (~. ~ Zvi clLc~ wlau ,, ,~ D~ ~p~~ A~ puastaueC!~m4,o.4')~'~37~• ipAK'~ ~rilt:iliadaLaia SBD-5398 (R 08/02) r~'~, PROJECT P.C. Collova Bldrs. inc. AD ESS P.O. Box 489 Somerset Wi 54025 1!4 NE 1/4S 18 /T 2 / 7 W TOWN Hammons COUNTY ST.CROIX 5/28/03 BEDROOM 3 MPRS Shaun Bird 226900 DATE CONVENTIONAL XXX IN-GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE ~ 000 gallOnS LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of cbambe 30 ,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 91.0/90.5 5' below grade s 25 .M.g/ ~~ _A_ lt. B~ ~ Top of 2" Pipe @ 100.0' 206' Property Line 3q ~ .M. 2-3' X 94' 25' Plans Designed Using Cells with >3' Vents Conventional Powts Spacing 40' B-1 Manual Version 2.0 s-3 6% 40' 5' B-3 B-2 Vents 30' ~~~ ~ T 30' Pro 3 Bedroom House Vent ~~ C~~ >6„ Standard Biodiffuser S~ ~_ ~ of Cover Leaching Chamber ~ h,,,(,(y`' with 31.1 ft2 of Area / _ ~" 6' Long 11 " {'p-r Grade at System Elevation S~ 1-~ (D .~ a PROJECT P.C. Collova Bldrs. inc. ADD Ess P.O. Box 489 Somerset Wi 54025 1/4 NE 1/4S 18 /T 2 / 7 W TOWN Hammons COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE5/28/03 BEDROOM 3 CONVENTIONAL XXX IN-GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 30 ,BENCHMARK V.R.P. Top of Survey Iron _ ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark Alt. BM ) =Top of 2" Pipe (a~ 100.0' SYSTEM ELEVATION 91.0/90.5 5' below grade Plans Designed Using Conventional Powts Manual Version 2.0 2-3' X 94' Cells with >3' Spacing 6% 40 25 Vents 40' ~ ,~ ~k 25 .M.g~ B-1 5' B-3 B-2 Vents 30' T 30' Pro 3 Bedroom House Vent >6" of Cover 6' Long111 " Standard Biodiffuser Leaching Chamber with 31.1 ft2 of Area at System Elevation a~ .~ 1~ a~ a i` I Wisdarrsin Department of Commerce SOIL EVALUATION REPORT Page ~ Division of Safety and Buildings in accordance wrtn ~;omm ru, wns. rwm. was ' -~- 9 t Attach complete site plan on paper not less than 8112 x 11 mcltxle. but not limited to: vertical and horizontal reference percent slime, scale or dimensions. north arrow. and location es in (BM , D distance to nearest road. l.D. Please print all information 6~fom~ation,rou may ~ asea ror seeandary MAY 0 ~ z 0 0 3 ter ~, s. 15.04 (~) (m)). ~ ~' ~O~b o 3 Property Owner ZO IN O ICE ~ ~ t71 ©~ l T N R E( w /4 ~ 1/4 S prop~y Owner' ~g address # Block # '" Name or CSt~ G ~iG City State Zp Code Phone Nurnber (N1 ~( ) City ^ VNiage Town Nearest Road New construction use: 1 NumF~er of bedrooms Code derived assign now rata S Q GPD ^ Replaoemerrt / ^ ~ c or - Desrx~e: ~ - Parent msderial ~IGLC:~.er.G ~~~~ Flood Piatn etevatior- if applicable 1'`~ 1 R' R taerteral o0rrrrrterds ~~~ ~ ~ a J ~,d recomm~rdanons: ~~ ~~~.,, e l2 du,~Z~~' ~~ # ~ Ground surface rev. ~~ R to tacxor ,lo~~-. - Pit Sod Rafe Horimn Depth Dornin~t Redox Description Texture Structure Consistence Boundary Roots GPDIfF' 'E~1 ~~ in. Mur>sea (~u. Sz. Coat. Color Gr. Sz Sh. t / ® o, ~ y ,S .~Q.9 ,o _--- ~r. ti.v t3ortr,g# Pit Groans surface ` ~ n Depu, to amibns factor ~ G n- Sod Rate horizon Depth Dominant Redox Description Texture Structure Boundary Roots GP D,ffF in. MunseR 11u. Sz Cont. Color Gr. Sz. Sh. `Eff#1 'E1f/F2 ~. ~ u Y/ - c. ~. fi, ~ ~f ~ ,. y/e S ~- a• m~ r~ F2 . S • t~,ent #1= BOD > 30 < 2zt) mgit_ ants TSS >30 < - Ei n2 = BOD < 3o mgt and TSS < 3o msit- - csT Number c~ease ~ i~ /,~yQ /`/~ J J~/J /~ A A /////~ ~) t J Dace Evalt,auoft condur~d /f ,/~Te~eq,orte r~.r~er L!/~D /7/L.~Y JA7 wQ/ /t /!1/' IAGS.w.~i /!/,~ 1y~1 ~ /~r~ •~/ `/J __~a ~6"~~/~ ~o-ril Property Owner Parcel ID # Page of ® ~~ # ~9 it Ground surface elev. J ft. Depth to IimiUng factor __~! [1.C~ in. Soq Rate tiaimn Depth Dominant Redoa Description Texhme Sinx~ure Consistence Boundary Roots GP DlfF in. Munseq Qu. Sz Cont. Color Gr. Sz Sh. 'Eff#1 'Etf#2 '.6 ~~j, S~- am r m~~ ~ 5 ~ ~S ,~.cl ~- s/ ~ ~- ~-- o~{ m m F w I ~' ~ `/ ^ Pit Ground surface elev. ft. Depth to gmit~rg factor in. # ^ ~~ Soq Rate tiorixon Depth Dorninant Redox Description Texture Sblxxcxe Consistence Boundary Roots GP DIFf in. Munseq Qu. Sz CoM. Cola Gr. Sz Sh. 'Eft#1 'Eft#2 ~~ # ^ Bonng ^ Pit Ground surface elev. R Dept to Cur~g factor ~. Soq tt~e Horimn Depth Domin~t Redox Description. Texture Strucdue Consistence Botrnd~r Roots GPD/fF in. Munseq Qu. Sz Caa. Color Gr. Sz Sh. 'Eff#1 'Eff#2 'Effluent #1 = BODs > 30 < 220 mglL and TSS >30 < 150 rr-gIL ' Eftluerd #2 = BODs < 30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-877?. ~ot~i .„ • ~ Soil Test Plot Plan Project Name P.C. Collova Bldrs. Inc. Sha d Address P.O. Box 487 Somerset Wi 54025 M #226900 Lot 11 Subdivision Crick Bolton Da a 12/4/02 1 /4 NE 1 /4S 18 T 29 N/R17 W Township Hammond Boring ~ Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 91.0/90.5 *HRpSame as Benchmark Alt. BM Top of 2" Pipe @ 100.0' '~ 25' .M.S~ 25' 0' B-1 6% 40' 85' B-3 B-2 97' 95' 96' a~ a~ a 0 r 'l 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 aver system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. 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 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer P. C. Collova Builders, Inc. P O Box 489 Somerset, WI 54025 Mailing Address Property Address ~ ~ ~ CD q ~--~ (Verification required from Planning Department for new City/State C~~ Parcel Identification Number LEGAL DESCRIPTION Pro a Location %,, 1 P ~Y L~~1L /+, Sec. T D~G N-R~W, Town of t~. Subdivision Lot # ~. Certified Survey Mapff# Volume ,Page # Warranty Deed # l~ ~~,~ ~ ~ Volume ~~~~, Page # Sa Spec house ^ yes ^ no Lot lines identifiable ^ yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result is its prematurafailure 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 is 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, restrictedplumber or a licensedpumper verifying that (!) 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 da a expiration date. ~~~ SIGNATURE 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 rho prope described above, by virtue of a warranty deed recorded in Register of Deeds Office. ~s~~'~ SIGNATURE OF APPLICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** r.. ** 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 1950P 5281 STATE BAR OF W ISI;ONSIN FORM 1-1998 WARRANTY DEED I husband and wife .Grantor, and P C Cdlova But~ders. Inc. .Grantee. Grantor, for a valuable consideration corneye to Grantee the following described real estate in St Crobt County State of Wisconsin (the "Property'): 667242 XATNLEEl9 R. MALSN REGISTEE OF Of3EDS ST. CROIX CO.. 1fI REC6IVfiD FOR RECORD 08-16-2002 9:00 AN EIElPT ## !I® REC FEE: 13.00 TRANS FEE: 1155.88 COPY FEE: CERT COPY FEE: PAGES: 2 ~~ Pl C/Cogova Hulldera, tnc. x Awxrue mood . WI 54015 /~'~'~~ 9s~o9 O18-1039-20-000 / 018-1039- 018 1039 80 000 Parcel Identlfleatlon Numbsr (PIN) Thla la not homestead property. (IS) (Ia nOt) Sae Exhibft A attached hereto Together with all appurtenant rights, tlUe and Interests. none Grantor warrants that the title to the Properties good, indefeasible in simple fee and Nee and clear of encumbrances except Dated this 15th day of Auoust, 2002. (SEAL) (SEAL) • hn J. Iton arolyn G. alton (SEAL) (SEAL) • A, l0~~'.lCi ;i:at~oF~s Signature(s) at:thentlcated this NO ' 3llC $T-A~EJ TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stets) THIS INSTRUMENT WAS DRAFTED BY Caldwell Banker Bumet 1301 Coulee Road Hudson, WI 54016 2-32470 (Signatures may be authenticated or acknowledged. Both are not necessary) ACKNOWLEDGMENT State of Wlseonsln, } ss. St. Croix County Personally came before me this 1 ~ day of eUgyigj, 3Q0~ the above mad a and arol It n a nd Wif W w~k~ r~z• Notary Public. Slate of Wisconsin My commiaaion IS pe anent. (If no4 state expiretbn date: ~~5 ~~ , • Names of sl In In an ca Must be or rioted below theirs nature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Ina WARRANTY OF FORM No. 1 -1998 Milwaukee, Wla. C/~,(CsC F~ N-~ ~U E (/~Lb OK l o +~ 2 t~ti ~;.,.: . ' S. .•. w •.1.. irwv.r:~.,-i+.Vtr: GCii~virHer,_ ... .. ~ '. ~ ~ t A part of the NE'/. of the NE /and In part of the NW Y. of the NE '/, and in part of the S1At ; of the NE Y. of Section 18, Township 29 North, Range 17 West, Town of Hammond, St.Croix County, Wisconsin and more parttwlarfy described as; Bagirtning at the Northeast comer of said Section 18; thence S89.33'31"W 372;01 feet along the North line of the NE'/s Of said Section 18; thence S89'33'31"UV along the North line of the NE '/, of said Section 18 775.94 feet; thence S00°52'23'E 250.00 feet; thence S89.33'31'IN 968.24 thence S89'33'31'W 528.00 feet; thence S00°52'23'E alor~ a North~outh guar a ~Se~~f lane of said Section 18 1311.77 feet; thence N89'33'39'E 826,33 feet; thence N00°31'25"W 30.23 feet; thence N89'33'24'E 692.78 feet; thence N00'S2'23"W among the East line of the SW % q~ the NE '/. 330.31 feet; thence N89°33'24'E along the South Tine of the NE Y. of the N>_ '/. 949,Og fast; thence N00'S2'24"W 1321.19 feet to the Point of 8egtnnfnQ. ,..._.,_ ,, . :.tiV.~~.::.t. ~r ... i 4. .~'. 6 V ~2-L-~v ~ 2 °~ ~- ti r ~tr< ~ ~r Stu ~ur< LOT 1 LOT 2 ~~-IE ~c cn a~~"lsf~-' erf' ~ °° NORTH 1 /4 ~ CORNER, ° rw SECT{ON 18, ° -~ T29N, R17W. O W UNPLATTED LANDS ITI N68'27 25 W ~ ,~, ~/J 0 86.54' ~' o ~~ / // v 013' a ~ `~ ~ / ' / / , . 206_32' ~ ~s.s3' 206.00 ~ ~ t ---- / ~V rn 5~~9'0T37" W 412.32'w,,, 12 ~~~ / ~ - ~ - - ~ ~ ~ z 0 0 NN 0 O N ow 277.52' w 0 LOT \ ~ 723 \\ 1.6E ~s?, ,, ~~ `''' ~ ~ o { LOT 8 65369 S.F. 1.50 Ac. N 89'33'31" E 241.26' / BENCHMARK TOP OF 3/4"I IRON PIN ELEVATION 1028.28' (ASSUMED) LOT 10 110616 S. F. 2.54 Ac. 0 1 ~N 0 .~ fV m N w co BE REMOVED UPON WESTERLY EXTENSION OF /~ ROADWAY. ' ' " S 88 28 50 E / t 25.36' ~n o / / N 89'33'31" E 528.00' 205.03' 206.01' LOT 12 LOT 11 98586 S.F. 0 98425 S.F. o 2.26 Ac. 0 2.26 Ac. o L80 ~ 1016' N N ~ m ~ 0 80' TEMPORARY ~ v CUL-DE-SAC EASEMENT. TO ~ o