HomeMy WebLinkAbout032-2141-50-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
. INSPECTION REPORT Sanitary Permit No: 420749 0
GENERAL IN (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: X
City Village Township Parcel Tax No:
P.C. Collova Builders, Inc. I Somerset Township 032 - 2141 -50 -000
CST BM Elev: ( Insp. BM Ele v: BM Description: , Section/Town /Range/Map No:
(rp . (`'b .a.1� = C.st i s� «+ s� I u 03.31.19.1235
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmar I O /
CAS 0, 930 . o
Dosing 0 It. BM
Aeration Bldg. Sewer 1
Holding St/Ht Inlet y f o S. 20,
TANK SETBACK INFORMATION St/Ht Outlet
• 3 9�f.
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic , 1 1 Dt Bottom
Dosing Header /Man.
Aeration Dist. Pip CT10
Holding Bot. Syste To '70,90
r
0.00
f
PUMP /SIPHON INFORMATION Final Grade
nufacturer Demand St Cover i
o • ss 98• `FS
Mode umber
TDH Lift = FrictionLoss System Head TDH Ft
Force m Length � Dia. Dist. to Weu
SOIL ABSORPTION SYSTEM
SED)T RENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIME 31 1 69 • 2
SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR -, 0.1;
Type Of System: 1 1 UNIT n I
V
5O 29 , Model Numb . �11n�ad�R�t
DISTRIBUTION SYSTEM
Header /Manifol Distribution le Size x Hole S a ' Vent to Air Intake
11 Pi es �• 3 �1
Length Dia_ Length Dia Spacin
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
0 Yes No [ Yes J No
COMDM (Inpcclupdae, code d2crap c rs s pre nt, et .) I�sp ion . 3 Inspection
Location: 2370 53rb St Somerset, �NWdII 54025 (SE 1 S 1/4 3 T31 N R19W Trail Estate � Parcel No: 03.31.19.1235
1.) Alt BM Description = V4f S•T. co, , .
2.) Bldg sewer length = 2 310
- amount of cover= + ,,4, � „� �� q Qv ��•
r
Plan revision Required? Yes No
Use other side for additional information. i—
SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No.
C oi-��►
1 N
L
41.
0 7�
0
1 �
Q5
1
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Safety and Buildings Division County T f
` m m 201 W. Washington Ave., P.O. Box 7082 r p /`,,�
,scans, Madison WI 53707 - 7082 Sanitary Permit Number ()g be filled in by Co.)
Department of Commerce (608) 261 -6546 1 42 0 --4 ti
Sanitary Permit Applicatl State Plan LD. Number
In accord with Comm 83.21, Wis. Adm. Code, personal in f on you EIV
V
may be used for secondary purposes Privacy Law, s15. i xm) Pro r, Address (if different than mailing address)
n t. F
I. Application Information - Please Print All Information �; r -� rc r, ) 'J
Property Owner's palrel # Lot # Block #
� � i' �' � SUP. }°
OF FIC L
Property Owners Mailing Address 1� Q C c
/ , (/ , / >d x l l� ✓� ��.,/ � ��., section —
City. State Zip Code Phone Number
s
II. Type of Building (check all that apply) �..,i e►r•
T N; 1��E olf
or 2 Family Dwelling — Number of Bedrooms
1 Subd' • ion Name CSM Number
❑ Public/Commercial — Describe Use MM / /
❑ State Owned — Describe Use 2 3 r X $ - cas ❑City ❑Vii waship of
III. Type of Permit: (Check only one box on fine A. Complete line B if applicable e Q ; " - ZI (� 5 -
A. System ❑ Replacement System ❑ Trestment/Hoiding Tank Replacement Only ❑ Other Modification to Existing System
B. ❑Permit emit Revision ❑Change of ❑Permit Transfer to New
List Previous Permit Number and Date issued
Before Exph*6 Plumber Owner �Z o) A � �� 2003
IV. of POWTS System: Check all that apply)
' �
-Pressurized In -Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At- (T ❑ Single Pass Sand Filter ❑
u
Constr red Wetland ❑Pressurized in acrd ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unrt ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter hing Chamber ❑ Drip Line ❑ Gravel-less Pipe ❑ Other (explain) i
e
V. Dis ersal/Treatment Area I ormation:
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sl) System Elevati
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank _ /
Aerobic Treacm en ,Q ew Unit E:&
y A-ltD .
Dosing Clpmber . I
VII. Responsibility Statement - I , the ua ssume responsibility for installation of the PO shown on the attach plans.
Plumber's Name (Print) Plum i MP/MPRS Number Business Phone Number
3r f( - 7 � 7 a ��v� ,
Plumber's Address (Street, City, State, Zip e
VIII. Corm /De artment Use Onl
}�{ Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date issued t ing en`Signature (N tamps)
Surcharge Fee)
❑ Owner Given Reason for Denial � r— 2(P UZ3
IX. Conditions of Approval/Reasons for Disapproval
Attack complete plans (to the ounty only) for the on paper not than 81/2 I l irehes a size
SBD -6398 (R. 08/02)
Soil T t and S PLOT PLAN
PROJECT P.C. Collova Bldrs. Inc. RESS P.O. Box 489 Somerset Wi 54025
SE i/4 NW 1/4s 3 /T 31 N/ TOWN Somerset COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 3/19/03 BEDROOM 3
CONVENTIONAL XXX IN- GROUND SSURE 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 nail in Basswood 5ft fk(` ASSUME ELEVATION l oop ) Filter Zabel A -100
❑ BOREHOLE O WELL •H.R.P. Same as Be nchmark
Alternate Benchmar is Top of
Nail in Tree @ 99 .7' SYSTEM ELEVATION 91.0/90.0 5.5' Below Grade
130' Prope Line
Vent
ALong Standard Biodiffuser
Leaching Chamber
95' 97'
5 with 31.1 ft2 of Area
Vents 1 " B -2 3 4 „ Gr ade at System Elevation
9%
Slo
Pro 3
Bedroom Plans Designed Using
House Conventional Powts
B.M. * Manual Version 2.0
0 , 10°
B -3
- 5' 10'
T Alt. B.M.
10'
a�
-3
Vents
S3f�s�
a
2 -3' X 69' Cells with >3' Spacing
0
o
B oom
ous
N — Property Line
Soil T t and System PLOT PLAN
PROJECT P.C. Collova Bldrs. Inc. RESS P.O. Box 489 Somerset Wi 54025
SE 1/4 NW 1/4s 3 /T 31 N/ TOWN Somerset COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 3 BEDROOM 3
CONVENTIONAL XXX IN- GROUND SSURE 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 nail in Basswood /n 1 ASSUME ELEVATION Filter Zabel A -100
❑ BOREHOLE O WELL *H. R. P Same as Benchmark
Alterna e Benchmar is Top of
Nail in Tree @ 99 .7' SYSTEM ELEVATION 91.0/90.0 5.5' Below Grade
130' Property Line
Vent
ALong Standard Biodiffuser
Leaching Chamber
95' 5 with 31.1 ft2 of Area
97' 1"
Vents B -2 3 4 " Grade at System Elevation
9% _
Slo
Pro 3
Bedroom Plans Designed Using
House Conventional Powts
B.M. * Manual Version 2.0
B -3 ro
—' 5' 10'
T Alt. B.M.
10' Grp ?
a�
-3
� Vents `
0
2 -3' X 69' Cells with >3' Spacing
0
o
B oom 0
ous
Property Line
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page J— of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code County'S
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. MAR '
Please print all information. viewed by Date
Personal information you provide maybe used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Z
Property Owner Property Location
C • Govt. Lot, r 1/4 j1/4 S S T3/ N R E (or W
Property Owner's Mailing Address Lot # I Block # Subd. Name or GSM#
P . U 1 rL q $ r —/: " .
City State Zip Code Phone Number ❑ City ❑ village Town N rest R
I
New Construction Us Residential /Number of bedrooms Code derived design flow rate — C, GPD
❑ Replacement ❑ Public or mmerdaI - Describe: .
Parent material � :vai Flood Plain e Cjatioonnniif applicable 1 ft.
General comments
and recommendations:
a Boring # Boring
Pit Ground surface elev < , ( ft. Depth to limiting factor in.
Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 •Eff#2
0 -/ Z l- 3/
3 s OS A11,4
X 3. 2 p9.
® Boring # ❑ Boring
CA Pit Ground surface elev. ft. Depth to limiting factor in.
Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDHf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 (9 $ 10 v, 3 51 1 /0 0 --3- 1 .S -
. 0
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/- ' Effluent #2 = BOD 130 mg/L and TSS 130 mg/L
CSC (ne(Pease Print) i – – Signature �umberr
Address Date Evaluation Conducted Telephone Number
3—c2
I
2 3
Property Owner _ Parcel ID # Page of
❑ Boring g
F-31 Boring # 0 pit Ground surface elev. ` - J ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
3 S S h�l
A,1)4
.� qo.o
GG l02
F-1 Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 [I Boring
ng # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil Application Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
El
Effluent #1 = BOO > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
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 -8777.
sBD -6330 (8.6/00)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Divisiort INSPECTION REPORT Sanitary Permit No: 420749 0
GENERAL ; NFORMATION (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 Somerset Township 032 - 2141 -50 -000
CST BM Elev: Insp. BM Elev: 7 Description: Section/Town /Range /Map No:
03.31.19.1235
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer
Holding SUHt Inlet
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
Dosing Header /Man.
Aeration Dist. Pipe
Holding Bot. System
Final Grade
PUMP /SIPHON INFORMATION
Manufacturer Demand St Cover
GPM
Model Number
TDH Lift Friction 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
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System: UNIT Model Number:
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s)
Length Dia Length Dia Spacing
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
Bedrrrench Center Bed/Trench Edges Topsoil
Yes No [] Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:
Location: 2370 53rd St Somerset, WI 54025 (SE 1/4 SW 1/4 3 T31N R19W) Deer Trail Estates Lot 10 Parcel No: 03.31.19.1235
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
Plan revision Required? J Yes E] No
Use other side for additional information.
SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No.
Safety and Buildings Division County
® IN N 201 W. Washington Ave., P.O. Box 7082 C f V i�A
isconsin Madison, WI 53707 - 7082 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce (608) 261 -6546 -, f 20 -+i L I
Sanitary Permit Applic i State Plan I.D. Number
In accord with Comm 83.21, Wis. Adm. Code, personal inf atiotl%GE I V E D
may be used for secondary purposes Privacy Law, 5.04(i)(m) Project Address (if different than mailing address)
I. Application Information - Please Print All Information MAR 2 0 2003 0 23 �U 53 S
Property Owner's Name ST. CROIX CCJUN7 Y Parcel # Lot # Block #
• �� ��p ZONING OFFICE / 1
Property Owner's Mailing Address Property Location
ss� c�
O 1 D / � y 'y. Section
City, State Zip Code Phone Number
5 L0 -5— TVN; j (circle e
II. Type of Building r E W
yp g (check all that apply) � as Pa/ s �+ oµs.
)44 or 2 Family Dw . g - Number of Bedrooms 'Sion Name - , D CSM Number
11 Pubiic/Commercial - ribe Use ! G �C
El State Owned - Describe U 2 3 k b y • Q,. ,e S City ❑Villagawvnship of
III. Type of Permit: (Check o7vone box on line A. Complete line B if applicable) 9F O 32- — 2-1 4 — $ - OZYD
A ' ew System ys ❑ Repla t System El Treatment/Holding Tank Replacem my ❑Other Modifi tion to Exist t
B ist Previous Permit N ber Date Iss
❑ Permit Renewal ❑Permit Revisi ❑Change of ❑ Permit T sfer to New
Before Expiration Plumber Owner
IV. Type of POWTS System: Check all that a
on - Pressurized In- Ground ❑ Mound > 24 in. of \bep E) Mound < in. of suit ❑ A ingle Pass
Constructed Wetland ❑Pressurized In- Ground ❑ H ❑ Peat F ❑Aerobic ment Un' eci atin nd F' // El Synthetic Media Filter Ching Cham Line
Gravel -less Pipe ❑Other (expla 6 aLc�
V. Dispersal/Treatment Area In rmation:
Desi Flow (gpd) Design Soil Application Rate(gpdsf) Dispers Required (so Dispersal Area Proposed (st) stem Eleva ion
'so r 63(1
VI. Tank Info Capacity in Total Number I Prefab Site tees r
Gallons Gallons of Units Concrete Constructed
Ex
New isting
Tanks Tanks
Septic or Holding Tank / �Lr17 YL
Aerobic Treatment Unit 7\
Dosing Chamber
VII. Responsibility Statement- I, the under i ed, sume responsibility for installati n of the PX7S shown on the attached plans.
PI u ber's Name (Print) Plumb i re MP/MP S Number Business Phone Number
Plumber's Address (Street, City, State, Zip Code)
VIII. County/ e artment Use Onl
XApproved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Is uin Agent Signatur No Stamps)
Surcharge Fee)
❑ Owner Given Reason for enial 22!�_
IX. Conditions of Approval/Reasons fo i p oval
AAA
Attach complete plans (to tWC4An6o ly) for the system on paper not s t an 81/2 x 11 inches in_size
SBD -6398 (R. 08/02)
e
� w
P44 -Ak
A .
PLOT PLAN
PROJECT. P.C., Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025
SE 1/4 NW 1 /4S 3 /T 31 /R 19 W TOWN Somerset COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 3/19/03 BEDROOM 3
CONVENTIONAL X0( IN-GROU1W 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
IL BENCHMARK V.R.P. Top of nail in Basswood ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL sH.R.P. Same as Benchmark
SYSTEM ELEVATION 89.6/89.3
Property Line 75'
Ac
Vent
>6" Standard Biodiffuser
of Cover Leaching Chamber
with 31.1 ft2 of Area
6' Long 11 " 80'
3 Grade at System Elevation B.M. #
Plans Designed Using ents
Conventional Powts
Manual Version 2.0
' .M. #1
Please note: all 2
dimensions are 3%
assumed due to the Slop 0 15'
1" =100' scale
B -2
B-
20'
20' T
7g
Pro 3
Bedroom
House
Property Line
I
PLOT PLAN
PROJECT P.C.. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025
SE 114 NW 1 /4S 3 /T 31 /R 19 W TOWN Somerset COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE3 /19/03 BEDROOM 3
CONVENTIONAL X00( IN -GRO 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
BENCHMARK V.R.P. Top of nail in Basswood ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL "H.R.P. Same as Benchmark
SYSTEM ELEVATION 89.6/89.3
Property Line 75'
Ac
Vent
>6„ Standard Biodiffuser
of Cover Leaching Chamber
with 3 1. 1 ft2 of Area
6' Long
1 80'
3 4" Grade at System Elevation B.M. #
Plans Designed Using ents
Conventional Powts
Manual Version 2.0
Please note: all 1 2
dimensions are 3%
assumed due to the 01 15'
1" =100' scale
B -2
B -3
20'
20' T
Pro 3
Bedroom
House •
Property Line
M
��.. Sri►
f'
t
r -.
' WiscOisin Department of Commerce SOIL EVALUATION REPORT Page / of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County S+� ��%
Attach`cbmplete site plan on paper not less than 81/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 032 — Z/4/ — S% _gyp C tz3S
Please print all info ► � ev' wed by Date
Personal information you provide may be used for sec 6*y' ses N`acy Law;'s, 15.04 (1) (m)).
Z0
Property Owner Property Location
" �' �' ' Govt. Lot 1 /4 1 /4 S T a r N R E (or)O
Property Owner's Mailing dress Lot.# Block # Subd. Name or CSM#
Z th � 'r -1 Al l ov i `; tGI;D it 17. e r rte. -
4:' -
e
City State Zip Code P Nu r 0 City ❑ Village RTown Nearest Road
U lJ T•
Q9 New Construction Use: (A Residential/ Numt> p #e rc oiri,,s Code derived design flow rate (9 0 d GPD
❑ Replacement ❑ Public c commercial
Parent material b L) +tAj '- S I-\. Flood Plain elevation if applicable ft.
General comments $ �/��e vy� e k- C>
and recommendations:, , l� V• yU• �iV
Boring #
F Tl
F1 Boring
® Pit Ground surface elev. . Zd ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
I 0- 1 r 312, — SiI ! cs Ic •2
3 — LS m I - _ -1 1.2
.mil &� • roo
F Boring # Boring
2- ]
pit Ground surface elev. 9 S. 7d ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
I O �- sil Irrzbk wyk cs 1
Z - 42 I 2 8
cal• • 60 ��
s S s by , qr
* Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature CST Number
Sch nxi ( Z5
Address Date Evaluation Conducted Telephone Number
21) 3 S�)Tb S +. Somc- rse.-} LO ! z 9-1- C 7/ - Z. 7 -*4
Property Owner AurkA Parcel ID # Page Z of
F-31 Boring # ❑Boring
❑� pit Ground surface elev. 93.86 ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Ef1#2
- 0 31z 5 ;I in ank c s l c .2 .3
2 7 -yZ 5 1 1 c I vF . 5
LS
F-1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Ef1#2
I
F Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
El Pit Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Ef1#2
* Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
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 -8777.
SRD -8330 (R.07 /00)
PAGE 3 OF_�>
NAME LOT# 10 LEGAL DESCRIPTION S t' ' /aNwl /a,S T 3l,N,R / qE (or)CWJ
SCALE: 1 "= ldd {
BM 1 ELEVATION /,00 . y
BM 1 DESCRIPTION ha { A loe &2.S5 'j 0 d
K
BM 2 ELEVATION / 06 . J 3
BM 2 DESCRIPTION 11-C
SYSTEM ELEVATION 7 d• Z U
ALTERNATE ELEVATION ! O • 7, 0
CONTOUR ELEVATION
J
{
• • p/ 1
pM1
•
1
6 �
N (
0
l
1
i
SIGNATURE DATE
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
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
Owner/Buyer P. C. Collova Builders, Inc.
Mailing Address P O Box 489 Somerset, WI 54025
r
Property Address Q c� rJ \�
(Verification required from Planning Department for new construction)
City/State C 0 Y�Q t S4 Parcel Identification Number D 32 ' 2 f4 - S°- yc� �.1 3.T)
LEGAL DESCRIPTION
Property Location 5 U %,, /U () �/., Sec. �S . T -aW, Town of
Subdivision L 067 - S 4zz6/) Lot # �.
Certified Survey Map # -- , Volume . Page #
Warranty Deed # �q 5 7 z Volume Page It
Spec house ❑ yes no Lot lines identifiable yes ❑ no
SYSTEM KAINTENANCE
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, restrictedplumber 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.
I/we, 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 a year exp' on date.
1 1'7 1 63
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
tribed above, by virtue
3
of a warranty deed recorded in Register of Deeds Office.
/ l U
DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department."""
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** 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
06./14.01 THU 11:19 FAX 715 388 4687 REGISTER OF DEEDS
i� WARRANTY DEED !�
j: 3TATL 103 .W y _ FO I I KATHLEEN H. UAL311
Di CL1b76WT 1 {Q, i YO' fAh; a t t y l RECTISTi:R OF DEEDS
6T. CRGXX Co., wl
AECEILEi FOR RECOkO
is This indcature, %Lie chic 1dCh dayot
_Z ppl , i D5.2l -2P01 9:3D AM
bJttwea �4iol 31i1,..�1 ns, Iri; I
+ Corpurauon duly NARRr1 DEED
organl:dd end Yx614% under and by virtu: of the 6via or the Stan of Wucurmn, located at !1 REERTIOpY FEE.
Wisconsin, party of Ilia lirst part. raid COPY FEEt
P.C. C0110va isu112ots, L t a Wi4coaa1tl toYooration T&IRW R FEE- 115F.30
- - RECM,ND Ff : X0.00
part ids of Thai second part. •:
iVftnesacth I'fut the said parry nl the Ara µin, rot and In eoraidaranon of IN sum of !:
D Co. Do
av id b tier said t - o(the second purl• !tta raeaipr whrtrol is heeaby cunrez;ed
ii; , p+ t�Pi,++ —. r "IJ 'sPACa PELEPVfO fCY aEGOP.D�M: DATA
;nd ac roawh; Lad, hA; Owen. limns ;d, biNamcd, sold, rem:sa released, alithid, cmveyed ,i NAua AND A. ebol -Ca ••••••
and Conirrmed, and by lliw presents tires Live. ymnr. horgain. soil. Teriuse. alien, enncey and j
canOrm unn3 lye sAUI pM 10 the senxtd pan, — chain _hairs 9 OAKEY d OAKFY 1'T•!' *_L
s as:pl the frllou•InD drecnued rmil tuata,
-Ahmed in d,c County of v Bowl 126, Osceola, Wt 54020
of Wueortt:in, lo•wic ',
LuCS 6. 4 t0 11, i'
12, 17, l8, 19, ZU, and 21 a! the i
s
Plat of Dee Trail Estates, according Co Ulu recorded M9
plat On file a u CrieOY n the Officer of the 032- 2141 -40-00 ;!
RugistcT Of Deeds. St. Croix County, Wisconsia. e040 t U92 '- r
032- 2141 -50 -00
037.- 2141 -'0 -00 I
C32- 2142 -20 -00
032_2142 -30 -00 !I
032 - 2142 -40 -00 I
032- 2142 -5C -00 I
1 V NlCC MAY. CONTtrrl!f G[•SCIt;Pnoti ON Ra vEnsa SIUEI 032-2142-60-00
'iogothcr I Ath All and sinjulit the hgmilks mcnis and appurltnaM4 thereunto belonging or Ii any wise: appertaining; Ind lilt the a tak.
alga, title, irtemat, claim or dcmarw whoitottra, of 911t; said party of iho fret 10111, eI :her in law or equity, either in poaussian or expirvanv/ i f,
in and ro the above hstgainca pmrilua, and their heed) :amerts and appurTenanccs.
TA; love and I0 hold uic said pronuca as abort descdbcd wiih the heredlurhenis and appurtenances, u,uo ilia said, an a nc. of the
accnnd pan. and to —their heirs And aisig's 70kam
And lho said Kguriltl Varma.
pang 31 the first pun, Lx 0.selrand its sucrmsors, does covenin►, !;runt, bargain and agree to W with the said port - f of tht umnd part, li
the hells and A&SI4L5, that :u die time of the enseahng and delivery of there! pres:nu it Is adll itt:ed of the FnmiFes !
oboe dcacribed, is of a Lrxd. sure, perfect, absolute and :ndrfcaslble estate of inkeri+nce in the inn•, in fec s,mplY, old drat the ;Prat are free and
near ./aorta ell irambraaeta wh :revcr, — _„
alto dais d,: uk've bargained Fri Mises m the gr:ie ' peaceable puYausion of the all ld pAI'Li=✓ _ of the see or. d part, their _
her a. ar,d cr dgrs. '$ain't ;11 and twerp p;rion or ptriur,t lawfully 0aiminit the whole or Any pin thcmar. it will forever WARRANT and DEFEND.
Iq Wilrela Whereof, the said _trroucki Forme. Ir.e,
pan)•uithellnt frt,haseataed llkteepriunutobaziAnod by ,Q xiaky4eki
Ili ihdaldtM, grid wuetd :; Hwd by Norttsn Kuireun,k{ h; Sccrclaf /,
�VUcinaa, and iu cerpo rte sccl to be hem ,.ntr attired thill
turn day r, y A.D .. 1& 7 171 .
is
SIGNED AND S:AUD IN PUS6NCO OA
.4oy Farms, Irre.
Pialcitra
lor naT� ie - >
Rogar Yukow
- MUNTERSIONI:D:
s ue,
:d:tKWry
` Normnn Kukawgiii
Stntd of Wlr•consln, l - • - - - --
Dolk Cuur,,y
PCrx�nAllyValli —, ttlilt, ihia...... da may A.D,.iytr_3i]11,
RoyeF Rt:kOHn l=a,,,.,_, . Crt:aidenl. and . ,�
nl tie above nametl Ct 2a rtton, to ntd knov -u ur b: :ran (a nom who executed Inc foregoAll Instrumeni•,vtd ru lob inpuat to be sauh Prot idcnl
Arid .iecmtary of said CAY)K•ranJll, iud 9t4cnuwl:dgid :luu thq• a :teuwd ilia fnreymng�rstru XM As Sa �ttttfdi a; llie,dkti! of:aid Cnr•.nranor,
nit
by authority ,
I
Thtg aJP,,TRGA: -Ni WAS L'w'1e0 Ev
itanald L. 1 111*9 Nt i 9 EVa11 ;Yt1i M�OR3
V AN DYC 0 80YLE SIUR, S,C,
Pont Mice Box 1 $ Wary Pudic ; , ��it County. Vas.
arm Rfrhmu Myeommus.atleafi,r.)(cl 9%2/2001
,Sc, SJ illr•��,4e Wu•nant„l_tn ruw,4.Ilw 4yNwf.Yf LP in' N:,rU.JfAia ha W4 :Y,JN1 l,-, + R`•,. •• ,"•�- ••:• •~1 _.•.. •. '.'..
;YSIi. :nil -, .. dM" I1 I p nvT., annn,,.Y'q,M +10.1 qq },•;4 -
,+ula wd, Baru unww:i�Y lr p to.upiJ,y Yaw cr. , LrnonmtlrNhlc n'arM'fl '
51'Als 01' trSCr�NTIN
n'nnRArvrr oet:u - A) c:urperun,:, rYtat . � wKeu,tn taPm part. ea. rte.
u4auuo, wrt.
UNPLATTED LANDS
5061.98 - - - -- - - - --
S02030'05 "W 2433.43'
380.18'
,I 66.03' 1000.00
o I 380.18'
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-- 380.18' - _ - - - -- I 99� I
'0'05 "W 444 _J• 33 L-- - - - - -� _ I
.47' -- • - 38 0.18' - I
Q S02'30'05 "W 34.10'_
- - -` -/70 414.28'
S02'30'05 "W 924.79'
o
- - 3 84.04'-
Y
I - - - -343.79' --
'` - 1 34.52'- - •
5.4 s 9 9
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cp �....
oc W N rn 14. a
N e 14: ° � h W ryo� W ry "�L
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3b�0pE. 00 S0172 ?5'ly �
S E 18 = ?4 N 90.77
ov
-� ,� . W kc
y �. 305.07' \ \4'0,� QQ
10 ..97' ` 2 J ^ M6j•
s4.75'
343.83'
m WE .3 N 02'39' 17"
E 995.15' 346.25'
UNPLATTED - LANDS OF OWNER 98400
II