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Home My WebLink About032-2159-40-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix - Safety and Building Division = INSPECTION REPORT Sanitary Permit No: 453466 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 Townshi 032 - 2159 -40 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: OD .fl / Cn 0' C STg M ( 12.31.19.1372 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing 0 Alt. BM I Z < <a� nl� • .S'� Aeration Bldg. Sewer 3.3 o i• io Holding St/Ht Inlet 5 9e. (0s' TANK SETBACK INFORMATION St/Ht Outlet 5 9 S ��• `{ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic , 2 3 i Dt Bottom Dosing -7C Header /Man. Aeration \ Dist. Pipe - Holding Bot. System 1540 g cf p 90 , CID PUMP /SIPHON INFORMATION Final Grade Man facturer r° emand St Cover Model PhTr TDH Lift Friction Loss System Head TDH Ft Forcemai Length Dia. Dist. to Well S RPTION SYSTEM RENCH idth ! Length I No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS is;- (Z) SETBACK SYSTEM TO P/L JBLDG JwELL LAKE /STREAM LEACHING Man ctur INFORMATION CHAMBER OR ib Type f System: / UNIT Model Number: I ( e DISTRIBUTION SYSTEM Header /Manif Distribution x Hole Size x Hole Spacing Vent to Air Intake L I t� Pipes) > � r 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 Bedfrrench Center Bedrrrench Edges Topsoil r - [] Yes 0 No [] Yes L�_, No MM NTS: nclude code is a enc es, s s r sent, etc. Inspection #1: • 3 E Inspection #2: cation: 2214 74th Street Somerset, WI 540, (SW /1 S_Ey1/44112'TT31N P,1 9W) Wild Tur ey Retreat Lot 4 Parcel No: 12.31.19.1372 1.) Alt BM Description = o� I 1 avert 2.) Bldg sewer length = 2 3 - amount of cover = IS ar t. Plan revision Required? LJ Yes XINo 61 Use other side for additional information. SBD -6710 (R.3/97) 1 e, t Insepctor's Signature Cart. No. Safety and Buildings Division county, W. Washington Ave., P.O. Box 7162 r� ) Madison, WI 53707 - 7162 Sanitary Perrin Number (to be frilled in by Co.) V Viscons i n (608) 266 -3151 53 ( Department of Commerce �_ Stau Plan I.D. Number Sanitary Permit Application In accord with Comm 83.21, Wis. Adm. Code, Personal information you provide Project Address (f diffa=t than mamw admras) may be used for secoudaty purposes Privacy Law, sl5.04(ixm) L Application Information - Please Print All Information 2 14 •4 l Lot N Block i property Owner's y Ow N Property Owner's _Mailing Adds ss Loma Sewoa._ Zip t/0 12Z II. T of Building (check aA that apPly) ` ` Subdivision CSM Numb pr or 2 Family Dwelling - Number of Bedrooms ` -� dComrnacial - t emft Use d ` qty- VdlagC o State Owned - Describe Use .. 2 15 fete line B if applicable) p3Z -- '� - lII. Type of permit: (Check only one b" on line A. p pp A. ew System Replaaaient System Tratment/Holding Tank Replacement Only Other Modification to Exiatmg System B. Permit Renewal Permit Revision Change of Permit Transfer to New List Previous permit Number and Date issued Before Expiration Plumber owner 2 C IV. a of POWTS System; (Check all that a 1) Single Pass Sand Fitter on - Pressodzed E,_Cm +nd Mound >_ 24 in. of suitable soil Mound c 24 in. of suitable soil At gl Constructed Wetland Pressurized la d Holding Tank Peat Filter Aerobic Treatment Unit V rhtting Films Recirculating Synthetic Media Filter Chamber Dri Lutc Gravel -less Pi Othet ( Isin) J� ED V. DI Design n pe ig H anent Ares o Requicod ( Area P posed (sf) D am. Soil Applicatio Itauc(gpds f) a ✓ Prefab site U Fiber Plastic Tank Info Capacity in Total Number Manufacturer Glass Gallons 0 of Units Concrete Constructed New Ealsdng Tanks Tanks Septic or Hofdmg Tank Aerobic Treatment Unit Dosing C3araber (Print) bill for instanation or the rowTs shown on the attse ted ns. VII. Res onsibilf Statement- I, the uad MP/MPRS Nu Busuiess Phone Nu Plumber's Tigate _ � °�e plumber's (Street GtY tate.2+P sy - 0 VIII. Conn Me Use 001 Date Issued Si (No SUMP) sanitary PermiLE ee c tncludes Grouudwatec A m �pP v R Surcharge Fee) 2- _ ��X U IX. Conditions o pproval /lteasonsfor Disaipproval 3 � SYSTEM OWNER: _ akU& 1 Septic tank, effluent filter and dispersal cell must all be serviced 1 maintained . as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach eoatpkte plans (to the Counly only) for the syskw on paper not leg than 81/L :11 inches in sine PLOT AN PROJECT P.C. Collova Bldrs. Inc. AD ESS P.O. Box 489 Somerset Wi 54025 E 1/2 SW 1 /4S 12 /T 31 N/ 9 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 8/9/04 BEDROOM 3 CONVENTIONAL XXX IN- GROUND PiWURE 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 2° pipe t l; � ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL * C' H.R.P. Same as Benchmark SYSTEM ELEVATION 96.4/96.3 4' below qrade Plans Designed Using Conventional Powts Well is to meet all Manual Version 2.0 setbacks required by Alt. B Top of 2" Pipe @ 99.5' WDNR 221' Property Line Al Vent B.M. Standard Biodiffuser >6" 15' * of Cover Leaching Chamber 580' B.M. with 31.1 ft2 of Area Property 15 , II o Line 6 Long 314 „ Grade at System Elevation 1% Slope 70 B 3 ' Not enough slope to establish contours 5' 100' B -1 2 -3' X 69' Cells with >3' Spacing 10' T 175' 25' Please Note: Tested area Pro 3 may not be suitable for Bedroom desired building area. House Check system location before excavating. Also, survey was not completed at time of test. Set backs from lot lines may change. 0 0 Pro Town Road PLOT AN PROJECT P.C. Collova Bldrs. Inc. AD ESS P.O. Box 489 Somerset Wi 54025 E 1/2 SW 1 /4S 12 /T 31 N/ 9 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 8 /9/04 BEDROOM 3 CONVENTIONAL )00( IN- GROUND P URE 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 2" pipe = V, „,`I ASSUME ELEVATION 100' Filter Zabel A -100 ❑BOREHOLE O WELL *H. R. P. Same as Benchmark r— SYSTEM ELEVATION 96.4/96.3 4' below qrade Plans Designed Using Conventional Powts Well is to meet all Manual Version 2.0 setbacks required by Alt. BM — WDNR ,- Top of 2 Pipe C 99.5_ 221' Property Line f15 >6„ Vent Standard Biodiffuser of Cover Leaching Chamber 580' B.M. with 31.1 ft2 of Area Property 11 ” o Line 6 Long 34„ Grade at System Elevation 1% B -3 Slope 70' Not enough slope to establish contours 35' 100' B -1 ' 2 -3' X 69' Cells with >3' Spacing 30 10' T 175' 25' Please Note: Tested area Pro 3 may not be suitable for Bedroom desired building area. House Check system location before excavating. Also, survey was not completed at time of test. Set backs from lot lines may change. Pro Town Road I r-- T r Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of otvision of safety end Buudurgs in a000►danoe rvitti Comm -1 wis. Adm cone �r Attach complete site Plan on Pepe not less Ow 81/2 x 11 � in , P(an must "1,- � t - 0 ) incluft but not Waited to: vertical and horizontal refererroe (BM). diredian and I.D. Percent slope. scale ordirnenstons. north arow. and tocatlon knddistance . 0 — Z 1 — 40 -M �• ! 3 �Zj Please paint ap lntormatlon : ;;' �� Dade Personal Mdomgeon You proves may be used for se000dWY (P��Y Low. s. 15 01 (t) (m)). jPLAA w _.,... IM S /d—T 3 N R dE ( W Yaov'T t� ' Ply # Subd. CSM# e x �' cny State ZiP Code Phone Number city ❑ burn 3st Road ( cJ �� I1 � rp�� p Now Co structiarl Use: Residential / Nurnber of bedrooms Code Code derived design Clow rate GM ❑ Repiaoemmt ❑ Public - Describe. - - - -- Parent ma�rWi ��j`l - Hood Plain if applicable A/ /j9: tt Gwww °°mn,anls .6 OWN # Pit Ground surface sta If r. ) R Depth to tim rV fad S App R als HoW Depth Dominant Calm Redox Description Tend" struck" Come Boundary Roots In. Munsell Qt. Sz. Cont. Color Gr. Sz Sh 2 2 Z �S G' w • 2 3 q6 .Yo ® # Pi Boffry Ground surface elev. tt. Depth to Mktg favor � in Soo Application Rode Horizon Depth Dominant Redox Descrig0on Texture Structure Consistence eolrrdary Roots G in. /7 Munsell Qu. SL Cont. Color Gr. Sr - Sh. *8M TIM e ,j— 1 Kam- c � •�a • Eiikrert #1 =SOD > 30 220 aqL and TSS > 30 < 1 04 - EtOuent #2 - BM : 5 30 ffS& and TSS _< 30 mglt. CST Nurrdw / • r Dale Evakuabon Conducted Telephone Number Address �8 12 i S/Gi Property Owner Parcel ID # Page of ©Borkrg # ❑ 8onrg V Pri Ground ft d surface elev. _JI,L�� Depth b C9 i' Sol Rate Horbw Depth DwftmtColor Redox Description Texture Structure Consistence Boundary Roots GPDRF in. Munsell Qu Sz. Cont. Color Gr. Sz Sh. - EW *FJIf#2 E Bodm# 0 BO&V 1 ❑ Pit Ground surface elev. fL Depth to factor irL Sol Rate Hodwn Depth Dominant Color Redox Description Texture Strucoxe Consistence Boundary Roofs GPDAf In. Munsd Qu. Sz. court. color Gr. Sz Sh. 'EM *OW El Borx�g # ❑Pit Ground surfim elev. ft Depth to t fador in. Soti Application Rate Horizon Depth Dominant cow Redox Description. Textrxe Structure Consistence Boundary Roots GPM in. &Aunsell Qu Sz Cont. color Gr. Sz Sh. 'E1f#1 'EN#2 Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 rng/L - Effluent #2 = BOD, _< 30 rng& and TSS < 30 rnWL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or treed material in an alternate format, please contact the department at 608- 266 -3151 or 'TTY 608 -264 -8777. saoa33otxaoo� Soil Test Plot Plan Project Name P.C. Collova Bldrs. Inc Shau Address P.O. Box 489 Somerset Wi 54025 M #226900 Lot 4 Subdivision Wild Turkey Retreat Date 9/6/02 E 1/2 S W 1/4S 12 T 31 N /R19 W Township Somerset M Boring O Well PL Property Line County ST. CROIX M VRP Assume Elevation 100 ft. Top of 2" Pipe em Elevation 96.1/96.4/96.6 *NRpSame as Benchmark Alt. BM Top ol 2" Pipe @ 99.' 221' Property Line fB 580' Property Line 1 R Slp70 B 3 Not enough slope to establish contours 35' 100'- 30' 175' Please Note: Tc area may not be suitable for desired building area. Checl: system location before excavating. Also, Sul - Vey was not completed at time of test. Set backs from lot lines may change. Pro Town Road I I Z JO L 133HS wmv ewt ;Ae auim 3 ,£0' 9oeL — — — — — — — _BI��SZ— LL'LZZ .69 I ,LO'981• � — — 1 � ££ I I I ZI PY R 0171'3Y E I � 7 N O IN N 039 °•19' 157.86' 33 33' I I N O Oo �ii I N R O L" m 57. 100.09' 888 t r Do 3 4r r F ti� s aai• r te. 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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 Ian. 9 p 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 cy Plan Option . f sy f it determine f failure, u altern to area � fails, d e cause o se a nd install new s tested rep lacement 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 i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND n/+ OWNERSHIP CERTIFICATION FORM Owner/Buyer f (.. • CAOVQ I < AU3 Tn e-- Mailing Address 6X q sq 80Me_(&C-+ (J 1 5'40 P5 Property Address �2 y - 74 4 " cS+c qq (Verification required from Planning Department for new construction) NX City/State �JGh'te 6e+ �J 1 Parcel Identification Number o32 LiS9— ' - C. 1 3�Z� LEGAL DESCRIPTION Property Location 3Q '/4, SW '/4, Sec. 1 a , T 3 N -R W, Town of 5 0n'►f-(_ ,5 t4 Subdivision u C Y,2�1 R� 7. (- -P—o.+ Lot # _. Certified Survey Map # Volume Page # Warranty Deed # Lel 5 to e- I Volume 3(e 8 Page # a� Spec house ❑ yes QE no Lot lines identifiable ❑ yes ❑ no SYSTEM MANTENANCE Improper use and maintenance of your septic system could result in its premsture.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 113 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 dNs of the three year expiration date. u P. C. COLLOVA BUILDERS, INC. $ / 5 / 0 q SIGNATURE OF APPLICANT (715) Box 48 42 P.O. Box 489 DATE 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) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. �% d " w P. C. COLLOVA BUILDERS, INC. g i S i 0� SIGNATURE OF APPLICANT (715) 247 -2742 DATE P.O. Box 489 « * # * ** 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 FROM P C COLL0VR BLDRS, INC PHONE NO, : 715 247 2747 Oct. 2e 2002 02:14PM P1 iV� .10);)l ILLXq 11,Ul PA.& 11" JI" 4U01 ArWA-3LUIL UP ljl":Vj Lw U Loi. v 6 7 � V Z88cP 2 ft7w 1 7 suds ga L WARRANTY 0120 9a mm Go., vz m mcbu ill= Ay 'Fri Now A= ; as 151,� of 1 e � o 4ow I cwwy, W Mass Iim Imam A46U3 Ft Pew kkFulto Nmw(nm� W02 A ux . as Am" ?I c 5 Catty x!b WfvkWav STATE OF W-:0USN 14MOMIly 4MW IA& M Mf thk Ule k6oveoqtj"�I: TITUL MIN". $',A r: MK %1jSCQN4.0 �,4 Woo, ivw-. ,.urA md sck� o+ IIKUcd Ac amt. P"Jk, stme of Ivis"Aila law M *AL' II&M Writ mo Mintd. Xinud b*w }dwe NIft WARRAury Zen y v 1Cr� Tr h 0 0; O ��1i/84'S4'4800 W 76 1 5 2 244. 10 —i TOP OF 3/4" IRON / ' - � ; RER BENCHMARK v C N 967.21' LOT ,, _ - :�, o �� 6 HwE - pp-- _ s O �o, ��, `rte o i� � 2 .� �'� �"' 174423 S.F. 967.8 a ` - 4.00 Ac. O a f C.B. 1.45 Ac. �. ' p r M ro /a LBO = 970.00' F�2 10 cd . m 6` n S 8454' E 48" s 202.81' _— —_ 7 5.72'3 -_ e v (, N 696.64' LOT 5 tn o ° 150415 S. F. co h' �l �.1 F, G 3.45 Ac. / OD cIJ , c a, C.B. 2.05 Ac. o I ^ HWE N. , �''_ LBO = 962.00' / N / o z 960.0.' w '06 E 99. S 83'30" N 197.78• — r �;► HWE � 634 N ` 960.0' y�� ,�ti°� --- N 5 ,� LOT 4 / 10 130712 * F. °� / N� �A�. 3. Q 0 Ac. (°/ 00 a o F.P 1 l b C.B)�N5 Ac. d% 6 S• \�` LBO = 962.00' 20 3.00' ` r' f4 n S 84'25'09" E 0 13 I 5 80-47 ` ° 10 8.52' �P`�P�� LOT 3 o ,N , z 130721 S.F. 8 0 14 �« I 1 1 a �.