HomeMy WebLinkAbout032-2159-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
479307 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, Town of 032 - 2159 -20 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
/6/1-5 1 (� °Z 66n 12.31.19.1370
TANK INFORMATION VATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark 2 lei/
Irt` �" w S /W0 f1J- fd�+ J
l� Alt. BM tY� cA Z.5 /63 -T
Aeration Bldg. S wer 15-5/o
Holding SVHt Inlet 1 5"? SUHt Outlet K.! 7
16 I c
TANK SETBACK INFORMATION (o. IS 1 06 , 1 5
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet 1_
Septic C / / ^ _ , 3 f / Dt Bottom
Dosing rJ � Header /Man. Y.5 9 7.
Aeration Dist. Pipe g
9. Z 1 7
Holding Bot. System
C_j
Final Grade
PUMP /SIPHON INFORMATION «�- t 4. 1 /6 1 `
Manufacturer GPM and St Cover 2,V 163
Model Number i
TDH Lift Friction Loss System He 7DH Ft
Forcemain ength Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width ) Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid epth
DIMENSIONS
SETBACK SYSTEM TO Q P/L BLDG WELL LAKE /STREAM LEACHING Manufactur
CHAMBER OR
INFORMATION Type Of System: UNIT Model Number. i
�
DISTRIBUTION SYSTEM LJ84 - c Z Z-
Header/Manifold Distribution x Hole Size x Hole Spacing V`en� to Air Intake ,
i 1 ' Pipe(s) �/- ' ✓1
Length ! 1 Dia 4 Length Dia Spacing
~�
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over I x x Depth of xx Seeded /S dded xx Mulched
Bed/Trench Center Bed/Trench Edges` Topsoil �` _ es No _ Yes L_f No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2:
Location: 2202 74th Street Spmerset,VI 54025 (E 1/2 SW 1/4 12 T31 R1 9W) Wild Turkey Retreat Lot 2 Parcel No: 12.31.19.1370
1.) Alt BM Description = r �d CJL 6 V
2.) Bldg sewer length = 13 v
- amount of cover = 2_0 I/
Plan revision Required? m Yes No
_ I l
q [ � w
Use other side for additional information. - i V �_— _ --
Date Insepctor's Sig ture Cert. No.
SBD -6710 (R.3/97)
Safety and Buildings Division
County
201 W. Washington Ave., P.O. Box 7162
AV Madison, Wl 53707 Sanitary Permit Number (to be filled in by Co.)
� W A (60$) 266 -3151 � 1 so
Department of Commerce State plan T.D.Number
Sanitary Permit Application
Pr an oject Address (if different th mailing address)
may be used for secondary purposes p in accord with Comm 83.21, Wis. Adm. i law, s 5.04(1 (m) provide
j
1. Application Information — please Print All Inform Block #
Property Owner's Name /
• i�� ` Q ✓�—� - opertY Location
Property Owner's Mailing Address C
,,r�ctt Section[
v 1 1 b Zi ode Pho e OFFICE ' (cir on
City, State � ^` � � / N ��E or W
3 S e+�
e of Bu CSM Number
11. yp n S Subd;visi �
Building (check all that apply)
o ity Dwelling— Number of Bedrooms
❑ PubliclCommercial — Describe Use ❑City ❑Villag iP o
❑S tate Owned — Describe Use
JIL Type o ermit: (Check only one box on line A. Complete line B if applicable) 3 e � Mpdtfication to Existing System
acem
A. stem ❑ Replacement System C] "freatment/14olding Tank Replacement Only
List Previous Permit Number and Dare issued
❑ Change of ❑ Permit Transfer to New
B. C3 Permit Renewal ❑ Permit Revision Plumber Owner
Before Expiration u
e of PSystem.-
S
Z �f2nn C] OWT S (Check all that a 1 ❑ Sin Pass Sand Filter
In - Ground ❑ Mound ou? 24 in. of suitable soil ❑Mound <24 in. of suitable soil C3 AL Treatment Unit ❑ Recirculating Sl ❑
Non — Pressurized Aerobic Sand Filter
ConsTsucted Wetland ❑Pressurized In- round ❑Holding Tank ❑ Peat Filter
Pipe Other (explain)
❑
ing Chamber � Drip Line
Recirculating Synthetic Media Filter S stem E]evatio
yl0p°sed (st) Y
V.Dis ersalfPreatmentArea aformation: Dispe
�� rsal AreaReq aired (sf) Lisp
Desi Flow (gpd) Design Soil Application Rate(gP � f)
� -� � Y Prefab Site SteEl Fiber Plastic
VI. Tank Info Capacity Total Number
in
Manufacturer Concrete Constructed Glass
Gallons Gallons of Units t
New Faasting t
Tanks Tanks
Septic or Holding Tank /
Aerobic Treatment unit
Dosing Chamber
VII. Responsibility MPlM er Business Phone N bar
-�
undersign same responsibility for installation of the POWTS shown on the ariaebe pl
State en 1, the und
P Name (Print Plumber' ature
l er' }- �l
�-�-
Street, City, State, Zip e
Plumber's Address
5� o staznps)
VT1I. Coun Me p a Use On permit Fee 'ncludes Groundwater Date Issued Issuin t Si
Agengnature CN
Sanitary _
Approved El Di prov Surcharge Fee) �v� J [Z T
n Reason or Denial
IX. Conditions Approv 1 3) Ivp
SYSTEM OWNER:�S `
1 Septic tank, effluent filter and
dispersal cell must all be serviced /maintained
as per management plan provided by plumber.
2. All setback cable meet rmust besmaintained
as per applicable
poach complete plans t the County only) for the system on papa not Less than 81/2 x 11 inches in size
SBD -6398 (R. 01 /03) ,
LOT PLAN
PROJECT P.C. Collova Bldrs. Inc. AD PRESS P.O. Box 489 Somerset Wi 54025
E 1/2 SW 1/4S 12 /T 31 N/ 19 W TOWN Somerset COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 7/7/05 BEDROOM 3
CONVENTIONAL XXX IN -GROU
�
PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK IZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22
B NCHMARK V.R.P. Top of 2 " Pipe ASSUME ELEVATION 100 Filter Zabel A -100
BOREHOLE O WELL * H. R. P. Same as Benchmark
SYSTEM ELEVATION 97.3/96.3 5' below qrade
Alt. BM
Plans Designed Using
f Top of 2" Pipe CCU 98.7' Conventional Powts
Manual Version 2.0
460' Property Line 200'
Alt.
0° Vents
B
15 15
2 -3' X 69' Cells
with >3' Spacing
10% -3
Slope
70' Z
35'
B -1
)th ve Vents
Vent
>6 „ Standard Biodiffuser 30'
of Cover Leaching Chamber
with 3 1. 1 ft2 of Area ST
11"
6' Long 20
J4- Grade at System Elevation IF
Pro 3
Bedroom
House
289'Prope 13
Pro Town Road
OT PLAN
PROJECT P.C. Collova Bidrs. Inc 431N/ AD RESS P.O. Box 489 Somerset Wi 54025
E 1/2 SW 1/4S 12 19 W TOWN Somerset COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 7/7/05 BEDROOM 3
CONVENTIONAL XXX IN -GROU
� r
PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK &E 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22
B NCHMARK V.R.P. Top of 2" Pipe ASSUME ELEVATION 100 Filter Zabel A -100
BOREHOLE O WELL *H.R.P Same as Benchmark
SYSTEM ELEVATION 97.3/96.3 5' below qrade
Alt. BM
Plans Designed Using
Top of 2" Pipe @ 98.7' Conventional Powts
Manual Version 2.0
460' Property Line 200'
lb
Alt. 10' Vents
15
B ' �-2
��
2 -3' X 69' Cells
with >3' Spacing
10% -3
Slope
70'
35' r
B -1 \�
)th ve nt Vents
fi Standard Biodiffuser 30'
Leaching Chamber
with 3 1. 1 ft2 of Area ST
Grade at S ystem Elevation 20
Pro 3
Bedroom
i House
289' Prope rt3
Pro Town Road
f �
• l
I
wnscortskr Department of Conxrterce SOU. FE UATION REPORT Page of
Divleion of Selby and sumngs , v Adm. Code
„I, �on,tpteoe site plan on paper not less Ow 8112 x 11 inches in size. Plan must
include. but not MrNted lo: vertical and horizontal mWenoe point (SM), direction and Parcel I.D.
percent scope. sole ordirnarmlons. noM amow. and location and distance to nearest road. 03 2 - 2( - 245 - cm( . 1 �
Pease print all information. � Date
pe,.ona + x m r tieU_awr_o WOM nu<no —(ter t.— . :.so.t,�cm »- , R
Propefty PropetiytACadon
-, C- G d ca i Govt. Lot t 114 S `� T 3 N R E
PropedyC s > gAddress # # s�tbd CSIuUf
My State Zip Phone Number (3 City O vmage own 61fiarest Road
( t s) - --59 Ja A Z
Newer Use: Residential / Number of bedrooms Code derived design flow rate GPD
O � O PLd*c - Describe. - - - --
Parent r �'� A A�71 cif .5�� Flood Pl elevation It IL
Geyer aioonmenis Pi�.PicJ� J � J r
S�,P.a✓ /
i
and co"WM-0--d-filrim.
Q pit eoii GratedAfflace elev. �/ 3 fl. Depth a factor LSD=— Rate
Hoe" Depth Dominant Color Redox Description Texture St ruc t ure Con ice Boundary Rooms GPM
im Munsm OL SL Copt Color Gr. Sz. Sq. 'Eff#1 'Eff#2
Boring /�
Fd-- � # R pit Ground stafaae Bleu. 4 � ft. Depth to g s� O in Rate
Horizon Depth Dominant Color Redox Description Texture Structure Cwsistence 8otmdaty Roots l3PDJfP
in Munsell QL Sz. Cont. Color Gr. Sz SK •Etf#1 •EIM
Auer ,0
3
• t�nuert #1 = MD i < 22o not and TSS .30 12 • EMuert #2 = WD <_ 30 rn%& and TSS <_ 30 mglL
CST Nurnber
T Nom 0219M ,_ 2� S OD
t �- t731e Evaluation Conducted Te Numvw
Address ;7
1 _
1 ,tz
Property Owner Parcel 1D # Page d
# o ,-i
® Sorirg ph Ground surface elev. jl.�ft- Depth to 9 factor y at Ski Rate
Hart= Depth Oontinant Redox Description Texture Sbu:bre Consistence Boundary Rods GPO/1f
in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. `EWI TIM
3 i f .
Q Bairg # ❑ Baring
❑ Pit Ground surface elev. it Depth to br il" factor lo- Sail Rate
Hloriaon Depth Oomirwit Color Redox Description Texaae Saurgure Consistence Boundary Roots GPDVif
in. Munsell Ou. Szs Cont. Color Gr. SL Sh. 'E1 'EtF#Z
eorlm # 0
❑ Pit Ground surface elev. ft Depth to limiting factor in- Sob Rate
Horizon Depth DomkwdColof Red= Description. Texture Shvcaae Consistence Boundary Roots GPD1f
in. Mursell Qu. Sz. Cont Color Gr. SL Sh. `01#1 `Eff#2
Efiwent #1 = SOD, > 30 ^ 220 nV& and TSS >30 150 mg1L ' Effluent #2 = SOD, 1 30 mg& 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 -8777.
sao433etR6+m)
• Soil Test Plot Plan
Project Name
P. Collova Bldrs. Inc Shaun
Address P.G. Box 489
Somerset Wi 54025
M #226900
Lot 2 Subdivision Wild Turkey Retreat Date 9/6/02
E 1/2 S W 1/4S 12 T 31 N/13 W Township Somerset
Boring 0 VV4 d PL Property Line County ST. CROIX
(JL —
�BrVRp stame Elevation 100 ft. — Top of 2" Pipe
Sy tem Elevadon = 7.3/96.3 *HRpSame as Benchmark
Alt. B T r :: i;ic cz 98.7'
4((;' Line 200'
Al q*
B -2
15
10% B -3
Sloe --�
70' S
30' Please Note: Tested area
Q B -1 may not be suitable for
.E desired building area.
101, 103' Check system location
before excavating. Also,
survey was not completed
at time of test. Set backs
from lot lines may
change.
t�
a
o�
00
N
Road
z
Z 30 L 133HS Wnwo 909 as MUM
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££ I I II N 0121 E is
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Maintenance and Contingency Plan for a Septic System
Maintenance Plan pump once every 3 Years.
1. Septic Tank is to be pump
ear. Please note: a larger filter is being installed in
2. Effluent filter is to be cleaned o nce a of the filter.
order to extend the maintenance interval insp ections pipes at the ends of
3. Once every 3 years cells are to be inspec - ted via the
the cells.
o limit teases, garbage, and water conditioner discharge into the system.
4.Owner agrees t 9
g The owner agrees to save this plan.
6. Don plant lant trees nor park nor drive over system.
7. Watershed is to be diverted away from seste
d tho re as per Comm. 83
8. DischgMe into system is not excee
by Plan ..;� and and install new
• n # � #system fails, determine cause of failure, use ��.�..rnate .
pt�o ,
tested replacement area.
Option #2. Install sy stem at a lower elevation, by removing chambers, removing biomat,
and install new system.
area is suitable for replacement area, and system elevation
Option#3. No adeq
can nont be lowered. Install holding tank as last resort.
3. Replace any other failing components as needed:
i
Plumber: Shaun Bird 715 -246 -4516
St. Croix County Zoning 715- 386 -4680
Pumper Tom Mondor 715- 246 -5148
Shaun Bird #226900
ST. CROLY COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
OwnerBuyer ( l �d�_()1'd rsj 1 / 1 ( l
Mailing Address qv
Property Address Q a o a `
(Verification required from Planning Department for new construction.)
t
i �r Parcel Identification Number ac�a c�J�� —' g20 00
City /State 0
LEGAL DESCRIPTION n Q
Property Location L%� "j . y(.l� "� ,Sec. 1 TN R W, Town of _ '_ JE
Subdivision U { 0 ) ��P .I I > � � ; Lot r A.
Certified Survev Niap = Volume ; Pa2e
Warranty Deed # (977 . Volumc 1 R�,� Pale a - 79
Spec house _ yes _ no Lot lines idenuilabiexyes - 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 mto
the system can affect the function of the septic tank as a treatment state in the waste disposal system.
The property owner agrees to submit to St. Croix County Zoning Department a certification form. si;rted by the owner and
by a master plumber• journeyman plumber, restricted plumber or a licensed pumper verifying that (l) 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 113 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 Narurai Resources. State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning
De ent within 30 days of the three year expiration date. Ja a rj 6 �,, a P. C. COLLOVA BUILDERS INC.
(715) 247 -2742 DATE:,
SIGNATURE OF APPLICANT P.O. Box 489
SOMERSET, WISCONSIN 54025
OWNER CERTIFICATION
I/we certify that all statements on this form are true to the best of my /our knowledge. I /we amiare the owners) of the
pr described above, by virtue of a warranty deed recorded in Register of Deeds Office.
t - � r 5 L U &Le . C. COLLOVA BUILDERS, INC. 0,5 SIGNATURE OF APPLICANT (715) 247 -2742 DATE
C P Box 4 NN 89 NN
cc,, pp rr��
* * * * ** Any information that is misrepresented may result in the sA n�t b r9�i� V Dy R? oning Department. * * * * **
Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the certiifed survey map if
reference is made in the warranty deed
FROM P C COLLOVA BURS, INC PHONE NO. : 7!5 247 2747 Oct. 28 2002 02:14PM P1
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DRAFTED BY: ROB OHMAN SHE r