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HomeMy WebLinkAbout032-2155-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division V INSPECTION REPORT Sanitary Permit No: 453459 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 Somerset Township 032 - 2155 -30 -000 CST BM Elev: Insp. BM Elev: BM Descrip n: Sectionlrown /Range/Map No: /� l� I C's r 03.31.19.1338 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION B HI FS ELEV. Septic j Benchmark /0 Dosing .- Alt. BMC ®'Z`�' fjfi_' F , I��• Sfa Aeration Bldg. Sew 2.91 oZ .ti Holding St/Ht Inlet 3.'s /3 TANK SETBACK INFORMATION St/HtOutlet , J I �� lot TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet `f 7/6o �. Septic Dt Bottom Dosing Header /Man. 94 •l2. io.l 95 Aeration Dist. Pipe 8. 9 G.12 - io �Ift . -2 1757 Holding Bot. System ( ,1- 9 - Cl 1 34• --:5 9S • Z 6_4 -f sc,/ PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover M 3 C - Mode tuber TDH 'ft Friction Loss S ead TDH Ft Forcemain Leng Dia. 7 " ell SOIL ABSORPTION SYSTEM 11 2,Z BED/TRENCH Width Length r No. Of Trenches PIT DIMENSIONS No. Of P its Inside Dia. Liqui Depth DIMENSIONS O °� SETBACK SYSTEM TO O P/L BLDG WELL LAKE /STREAM LEACHING EMofel anufactu • , INFORMATION CHAMBER OR / Type Of System: x t (� I r UNIT Number : LJ DISTRIBUTION SYSTEM HeaderiManifold/ � ,jL /� Distribution x Hole Size x Hole Spacing Ven / t to Air Intake 1 Pipes) Length Dia Length Spacin SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded 1 xx Mulched Bed/Trench Center p Bed/Trench Edges Topsoii ` . 1 ` es E] No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: �?' / / Uq Inspection #2: Location: 513 235th Ave. Somerset, WI 54025 (NW 1/4 SW 1/4 3 T31 R1 9W) Deer Trail Estates 1st Lot 2 Parcel No: 03.31.19.1338 Y 1.) Alt BM Description = - 6 �• '_ LO`yE'� ;k- .4 1%) v' � Y 2.) Bldg sewer length = Z7 � � �� - amount of cover = 6k �( s•�3� tibti v_ Plan revision Required? ] Yes ;� No' Use other side for additional information. _ _ _______ SBD -6710 (R.3/97) Date Insepctor's i nature Cert. No. CV ti� Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 V V& co �' Madison, Wl 53707 - 7162 Sanitary Permit Number ( be filled in by Co.) usin (608) 266 -3151 1- 1 !5 - 3 De artment of Commerce State P1anLD Number Sanitary Permit Application in accord with Comm 83.21. Wis. Adm. Code, personal information you provide project Add (f different tlun� lia8 address) be used for secondary purposes Privacy Law, sl5,04(lxm) } - . i .. RE L Application Information — Please Print AU Ynformatio* PropY t Parcel 1 sN �� 1 Block e Z � a 5 -s=3 Val Owners Mailing Address ; Section J . ` 0 City. State Zip Code Phone tuber t' $ rW LL Type of Building (check all that apply) subdi 'ion Nazi Number or 2 Family Dwelling - Number of Bodrooms --- - al - Dcsatbe Use PabtiidComtoact City Y Towaabtp State Owned - Describe Use S J ' . �"� �` III. Type of permit: (Check only one b" on line A. Complete line B if applicable) A• System Replacomwt System Treat icaMolding Tank Replacerimt Or Other Modficatiou to Exiatiag System for to New B. Permit Renewal Permit Revision Change of permit Trans . List Previous Permit Number and Date 11110110d Before Expiration Plumber O'er IV. a of POWTS S Check all that a i ) n mud in- Ground Mound 124 in. of suitable soil Mound < 24 in. of suitable soil At -Grade Single Pass Sand Filter / Constructed Wetland Pressurized in -Ground Holding Tank Peat Filter Aerobic Treatment Unit Ro*W . Said meter R ecirculadog synthetic Media Filter iing Chamber Dri Lire Gravel-less Pi , .� J.3t V. Di tment Area Info on: Area Required { Area Pro (st) S ffi Design Flow (gpd) Design Soil Application fl Disposal 31 anafacntrer Prefab Site cal Fiber c VI. Tank Info Capacity in Total Number Concrete Constructed Glass Gallons Gallons of Units New E:istiag Tanks Tanks Septic - Hordioa Tank Aerobic Trcaunmt Unit w Ibsiag C3amber bill for sts"don of the FORTS shoan on the Ausehed ns. VII. Res ottslbW Statement - l" the and MP/MPRS Number Business Phone Number Plumber (Pint) Plumber' Z b �7 j j Plumber's Address (Stree . CitY. State. z p ) 1 _C n viII. Coon me t Use only e > Gy ) Sanitary Permit Fee ( includes Gmunll watr App Disapproved Surcharge Fet) L r- owner Given Reason for Denial IX, Conditions of Approval/Reas for Disapproval J ,/��� m �Sn�TEM R_ 3• ry ffluent fi ter and ' / " ` must all be serviced 1 MA intaine d as per management plan provided by plumber. 2. All setback requirements must be maintained form not kss than 31/2 _ ti inches in stn iouipleta'plans (to the County Y) LOT PLAN PROJECT P. C. Collova Bldr Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 SE 1/4 SW 1 /4S 3 /T N/R 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 8/5/04 BEDROOM 3 CONVENTIONAL XXX IN -GRO D 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 1" pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Alt. BM Top of 2" Pipe @ 101.4' SYSTEM ELEVATION 95.1/93.5'4.5' below qrade Well is to meet all setbacks required by WDNR Pro 3 Bedroom 20' House T 2 -3' X 69' Cells with >3' spacing q 20' 30' B- Vents 4 4X'-0 B- -1 ' 10 70' 11% Slope Plans Designed Using Conventional Powts Manual Version 2.0 ' Property Line C25O' 563' Property Line Vent >6 „ Standard Biodiffuser of Cover Leaching Chamber with 31.1 ft2 of Area 34' 74' 6' Long 11 " 3 4" Grade at System Elevation LOT PLAN PROJECT P.C. Collova Bldrs. In IDPR�E ADDRESS P.O. Box 489 Somerset Wi 54025 SE 1/4 SW 1 /4S 3 /R 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 8/5/04 BEDROOM 3 CONVENTIONAL XXX IN -GRURE CONVENT IONAL 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 1" pipe ASSUME ELEVATION 100 Filter ZabelA -100 ❑BOREHOLE O WELL *H. R. P. Same as Benchmark Alt. BM Top of 2" Pipe @ 101.4 SYSTEM ELEVATION 95.1/93.5 4.5 below qrade Well is to meet all setbacks required by WDNR Pro 3 Bedroom AL 20' House T 2 -3' X 69' Cells with >3' spacing, la ' 20' 30' B -3 Vents 4 4 a B -2 Alt, B -1 15' 10' 70' B. 11°Io Slope Plans Designed Using Conventional Powts Manual Version 2.0 ' Property Line 250' 563' Property Line Vent >6 „ Standard Biodiffuser of Cover Leaching Chamber with 3 1. 1 ft2 of Area 34' 74' 6' Long 11 " Grade at System Elevation 34" `Wisconsin Department of commerce SOIL. EVALUATION REPORT Division of Safety and Pulldings Page of ` In *ftWdence with Comm 8b, Wts. Adm. Code 1111 County r zT t.bii:3. Attach conO ft bb plan on paper not less than 8112 x 11 Inches in size. Plan must iriclude, but trot Arnbd b; vertical and hodzontai reference point (BM), direction and ttercent slope, umle or dirnensione, north arrow, and location send distance to nearest road. P I i. D. l zcxr +roc; c;�s c PWSO print all lnform000n. vlewed by i — Parm ai Inkwffdtlon you provide may be used for ascmdary purposes (Privacy Law. a. 1S.o4 (1) (m)). I / prowly caner Property Lo In� 'P r` r Govt Lot 5 1i4 N / 7" 4 S 3 T N R E (o! Property Owner's Malling ress Lot # Block # Subd. Name or CSM# mfe ne Number (city 01/lllage �°W^ Nearest Road I . Pr a7aua. 1J4W Construction Use: RsaldenLW / Number of bedrooms Code derived design fioty rate GPD Replacement ,q © Public comirnerciai - Describe: Parent matwial �../ u� Flood Plain elevation if applicable General carminents and recctvlrurtendatloms: ��/ ele ,S J 4J Ong # � Boring Pit Ground surface elev. ft, Depth to Ilmiting factor in. Soli A loation Rate Hortzm Depth Dominant Color Redox Description Texture Structure I Conalstence Boundary Roots; GPD1W in. Munsell Qu. St. Cont. Color Gr, Sz. Sh. 'Eff#1 I 'Eft#2 0- 1 " _`_ S 9 G,r 02^,x• r --3 zo Lo -1 S s✓ -./l ? 2 a7� `t3• S 40 oring �) B Own Pit Ground surface etev /X V ft. Depth to limiting factor oil l=tion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Etf#1 " Eff#2 l z - I Q s/ ----- , S �,� , 7 2 D Effluent #1 = BOO, > 30 220 mg /L and TSS '3 < 150 mg/L •Effluent #2 = BOD < 30 mg /L and TSS 30 mylL CST N �tne l:Please Prince) r Sign C89 14 umber Addr Date Evasuation Conducted Tesep Number - S1810-8330 (R07/001 � o 2, Property Ohm Parcel 10 # Page of 0 Boring # Boring / / 2 �lt Ground surface elev. ft. Depth to limiting factor ( in. Soil Application Rate Horizon Depth Dominant Color Redox Descriptlon Texture Structure Consistence Boundary Roots GPD/ftz In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 `Eff#2 q .lp � o n Boring # Boring L.�J ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil A piication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 •Eff#2 i Boring # LJ Boring 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 /ft= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 i i " Effluent 01 = 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 (RAN00) r Soil Test Plot Plan Project Name Kowski Farms Inc. Sha Address 6A 260th St. ' Osceola Wi 54020 lC6q #226900 Lot 24 Subdivision Deer Trail Date 11/17/01 1 /4 1 /4S 3 T 31 N /R 19 W Somerset � Township Boring 0 Well PL Property Line County ST. CROIX Assume Elevation 100 ft. To of l" Pipe BM or VRP p System Elevation 95.1/93.5 *HRpSame as Benchmark Alt. BM Top o Pipe @ 10 1. ' 4 100 + / Soil test was done to satisfy zoning requirement, test may not be suitable for owner's desired building location f 30' - ki, 99' 45 98' Alt. -1 15 1 B-2 10 B. 11% VIN t~ � 250' 563' Property Line N 0 i , 74' r ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND rrll 1 OWNERSHIP CERTIFICATION FORM OwnerBuyer `Y. G. C o nJa 60 m e S .�.-►r . Mailing Address 00 &x q �q 5 5 �3 Property Address X 4 *1 (Verification required from Planning Department for new construction) City/State % tre qe� C,1( Parcel Identification Number 0 3Z �S � d LEGAL DESCRIPTION Property Location I`J uJ '/4, '/4, Sec. 3 . T N -R 19 W, Town of �_%rnefsLA Subdivision jDte4 I � A 1 A- Nc A t +, on Lot # o2 q Certified Survey Map # Volume , Page # Warranty eed # —7 �S �- a l O � ty l Volum , Page # �� Spec house ❑ yes tK no Lat lines identifiable IR yes ❑ no SYSTEM MA=NANCE 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 licensed pumper 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. 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 of the three year expiration date. UM n L IDA P. C. COLLOVA BUILDERS, INC. a q M %-,A La SIGNATURE OF APPLICANT (7 P.0 Box 489 DATE SOMERSET WISCONSIN 54025 OWNER CE1TMCATION 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 tht property described above, by virtue of a warranty deed recorded in Register of Deeds Office. LtDLY �ZAA . P. C. COLLOVA BUILDERS, INC. (715) 247 -2742 8 /3 / SIGNATURE OF 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 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 Co cy Plan ption # If system fails, determine cause of failure, use alternate area and install new sys 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 Shaun Bird #226900 LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF SOMERSET COMPUTER NUMBER 032 - 2155 -30 -000 Parcel Number 03.31.19.1338 OWNER NAME: First Last P C COLLOVA BUILDERS INC PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment 513 235TH AVE SECTION 3 TOWN 31N RANGE 19W 1 /4160 SW 1 /440 NW Line Description Line Description PARCE L VOLUME & PAGE HISTORY TYP OLUME PAGE DOC# IVOT S ► D 21 06/ / 482 705324 KOWSKI ARMS INC TO P C COLLOVA BUILDERS INC Use Arrow Keys to Select, F7 -ROD, F10 -Exit r uC ili U1 ALUA uo:uri rAA %iU doe •kua n.euA.a-LZA% Ur ✓LL✓.J W-.j vv� ACKNOWLEDGMENTS I STATE OF MARYLAND ) ss I COGN'CY OF j4W)L4l Personally came before me the above named Bradley 5chiafolbQ`n, to 11" me known to be one of the persons who who executed the foregoing and acknowledged — the same. II i DATED Merck 1997 Notary Public, ` County. lja�ty Land,,. w ` My cbm Expires STATE OF ILLIN0 } SS NUT:JIY flif:G": ` COUNTY OF COOK ) My Comm, .ion fxn�a. - �ugvst 2100G Personally came before me the above named Dwayne SchiefeLbein, to me known to be one of the persons who who executed the foregoing and acknowledged the same. DATED March 3 7 199; • — �Lw Notary Public, Cook County, Illinois My Commission Expire "OFFICIAL SEAL" STATE OF WISCONSIN ) ELAINE SCHIEFEL132IN ss NOTARY PUBLIC, STATE CF ILUNO15 COtim OF My COMIAMN EVRE510/11 f 2000 Personally came before me the above named Garall Shanahan, to me known to be one of the persons who who executed the foregoing and ackno 1edged;FhiC•'... same. DATED March 20 , 1- f�� /� .` - w A Notary, blic, ., ! County. wiscq" pin �iy, C,9nunissior. Expires -•.. STATE OF WISCONSIN 1 ss COUNTY Of' Personally came before me the above named Patricia Morris, to me known to be one of the persons who who executed the foregoing and acknowledged the same. DATED March 1997 � L a Public, county, wiscq NA" My Commission Expires $ - Y) L� y , 0 . I i I d N 02'12 co Ln Ul \ � i a I ►► o . , Q� i V o Z fp �S. C 6 S- 97 >16? iS V � , ti i ? 00• S 14 if W m ' 4 oD (� N (!i y ) Ij / i OD % (,,, Z O a ti KS z 4�4 ti OD W 7 g .�.L ca ca ,S_ ' ....... i i �� W G1 co 00 -69 - TI n y 46Z•��t� tiff ! i • Ul Q i 44 is , .._.. 246.62' 108.34' 71 / 306.61' i / S02'39'12 "W 661.57'1' R =N 6070'53 "E i Z � ► 1 c _. �� I ; �� � p Cn ip i 1p rnN C„