HomeMy WebLinkAbout032-2159-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 430302 0
GENERAL INFORMATION 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 - 2159 -50 -000
CST BM Elev: Insp. M E ev: BM Description: �� Section/Town /Range /Map No:
`b S -� 12.31.19.1373
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
&. 3 b
Dosing Alt. BM
Aeration Bldg. Sewer 1 2 . ( D .
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic \ Dt Bottom
Dosing ! f Header /Man.
Aeration Dist. Pipe I`N I f Z Q
Holding B0t. yS stem
PUMP /SIPHON INFORMATION Final Grade
Manufacturer Demand St�gysr
Model Num
TDH Lift Fric System Head TDH Ft
Forcemain Len Dia. D
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Tre es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS („
SETBACK SYSTEM TO 1 � P/L BLDG IWELL I LAKEfSTREAM LEACHING an turer: r
INFORMATION T e Of System: / CHAMBER OR
y UNIT Model Number:
L4XV I W
DISTRIBUTION SYSTEM
Header /Manifold Distribution ` x Hole Size x Hole Spacing Vent t Air Intake
[Z G Pipe(s) k l 1 �' 45—/ /
Length Dia Length Dia Spacing 1 i
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only SD l2
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil . I 'am,
a [] Yes F] No Yes ; ] No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: // 0 3 Inspection #2:
Location: 2220 74th Street Somerset, WI 54025 (E 112 SW 11412 T31N R19W) Wild Turkey etr8at Lot 5 Parcel No: 1
1.) Alt BM Description 2 ,
2.) Bldg sewer length = /
- amount of cover = l• e/ — C � i yL
Plan revision Required? j :j Yes (_ No
Use other side for additional information. __
Date Insepctor's Si nature Cert. No.
SBD -6710 (R.3/97)
i
;— Safety and Buildings Uivtsion k.uuiay
201 W, Washington Ave., P.O. Box 7162 r k
iS���S m Madison, WI 53707 - 7162 Salutary Permit Number (to be filled in by Co.)
Department of Commerce (608) 266 -3151
Sanitary Permit Application Sta Plan I.D. Number
j In accord with Comm 83.21, Wis. Adm. Code, personal information you provide
Pro ect Address (if different than mailing address)
may be used for secondary purposes Privacy Law, sl5.04(1)(m) J
I. Application Information - Please Print All Information
I
Prop e wner' a me n P ) I �/ -4-ot ;f 50�_66 Block k
( l
Qv �t ,,- �W
l o v
Prope wner's M ailing Address ' s ' Property Location , (3:73
i
2
�► � � � (�� ��k,Section
City, State Zip Code �Phol<te
�� TN; H E rW
Zor Type of Building (check all that apply)
- Subdivision N CSM Nurnbe
2 Family Dwelling - Number of Bedrooms _
ju Public /Commercial -Describe Use �A S
�
State Owned - Describe Use k ❑City_JVillagexnshi
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
i
[I ❑ Treatment/Holding Tank Replacement Only Other Modification to Existing System
A ' ew System El Replacement System i
List Previous Permit Number and Date Issued
B. ❑ Permit Renewal f--7 Permit Revision ❑ Change of ❑ Permit Transfer to New
i
Before Expiration Plumber Owner i
I I
fV. Type of POWTS System: (Check all that apply)
Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil ❑ At- Grade ❑ Single Pass Sand Filter
Constructed Wetland ❑ Pressurized In- d lding Tank ❑ Peat Filter 1-1 Aerobic Treatment Unit ❑ Recircul n Sand Filter f Aw
Recirculating Synthetic Media Filter " eaching Chamber Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dispersal /Treatment Area Informatt I c -
Desi Flow (gpd) Design Soil Application Rate(gpdsf) Dispers a equired (s� Dispersal Area Proposed (sf) System Elevatio G,
V1. Tank 'Info Capacity in Total Number Manufacturer Prefab Site S e1 Fiber lastic
Gallons Gallons of Units / �(J( Concrete Constructed Glass
New Existing /i2� A /!/v
I Tanks Tanks
r
septic or Holding Tank
I
Aerobic Treatment Unit
Dosing Chamber
i
VII. Responsibility Statement- 1, the undersi , assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Na me (Print) Pj'umber'sF gna I
MP/ Num ber , Business Phone Number
ska', ,'
I
Plumber's Addre ss (Street, City, State, Zip e)
o ✓' t
VIII. ount_v /De artment Use Only
Approved ❑ Disapproved Sanitary Permit Fee (, ludes Ground�yater D Issued Issuing A ent Signature tamps)
Surcharge Fee) (J
❑ Owner Given Reason for Denial
IX. Conditions of Approval/'Reasons for Disapproval NzG(./
SYSTEM (?wNER:
1 Septic IPoK 4 f ,ert filter and - intal nu '
dispsrs�s +.;� + Ill , �' ' -� serv9ced ! rnaintai V J / OV ' "
1 :r:c y ,4tlmb9r. (hw Sh,l�.v
as per mandge ii _ 1
2. All setbacn re,j k 1, i l talni: 2 -
GC�z
as per appiiL1
D i
3- (�
Attach complete plans (to the County only) for the stem on paper not less than 81 x 11 inches in sue
SBD -6398 (R. 01/03)
1
PLOT PLAN -�—
PROJECT P.C. Coiiova Mrs lnc. V31/R ADDRESS P.O. Box 489 Somerset Wi 54025
E 1/2 SW 1/4S 12 / 19 W TOWN Somerset COUNTY ST. CROIX
9/5/03 3
MPRS Shaun Bird 226900
DATE -_ BEDROOM
CONVENTIONAL )= IN -GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK
1000 gallons LIFT TANK SIZE DOSE TANK
MOUND SEPTIC TANK SIZE -
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 6 # of chambers 22
BENCHMARK V.R.P. Top of 2" Pipe ASSUME ELEVATION 100' Filter Zabel A -100
Q BOREHOLE O WELL •H.R.P. Same as Benchmark
SYSTEM ELEVATION 97.6/97.4
Alt. BM Top of 2" Pipe @ 98.8' Plans Designed Using
Conventional Powts
Pro Town Road 112 ye,
o 3 Bedroom
ouse
/3�
10'
Vent ST 2 -3' X 69' Cells with >3' Spacing
A Standard Biodiffuse o 20' 35' -3
Leaching Chamber 50'
with 31.1 ft2 of Area 2
i
1 " N� ents .r
Grade at System E vation B -1 ,
34" nts
1 B.M.
/0 l 4% Slope 15'
It. B.M.
c
.a
T
G,
Please Note: Tested area
may not be suitable for
desired building area -
Check system location
before excavating. Also,
survey was not completed
at time of test. Set backs
from lot lines may
change.
218' Property Line
z
Cl =B0 CO t,0 d
PLAN
PROJECT P.C. Collova Bldrs Inc. V31/R PLOADDRES P.O. Box 489 Somerset Wi 54025
E 1 /2 SW 1/4S 12 / 19 W TOWN Somerset COUNTY ST. CROIX
9/5/03 BEDROOM 3
MPRS Shaun Bird 226900 DATE
CONVENTIONAL )= IN -GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE
1000 gallons LIFT TANK SIZE DOSE TANK
---�—
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22
BENCHMARK V.R.P Top of 2" Pipe ASSUME ELEVATION ioo' Filter Zabel A -100
BOREHOLE (DWELL sH.R.p. Same as Benchmaek
SYSTEM ELEVATION 97.6/97.4
Alt. BM Top of 2" Pipe @ 98.8' Plans Designed Using
Conventional Powts
Pro Town Road
0 3 Bedroom
ouse
10'
Vent ST 2 -3' X 69' Cells with >3' Spacing
>6 „ Standard Biodiffuser 20' 3 5• _3
of Cover Leaching Chamber
with 31.1 ft2 of Area 50'
6' Long 11 Vents
Grade at System Vents on 0 B -1 30'
34 '
B -2 70'
15' B.M.
4% Slope 15'
lt. B.M.
c
.a
a
Please Note: Tested area
�—" may not be suitable for
desired building area 00
Check system location
before excavating. Also,
survey was not completed
at time of test Set backs
from lot lines may
change.
218' Property Line
z -d =s0 E0 0 d
WIlsoorsinr pest of Commeroe SOIL EVALUATION REPORT rase of 3—
DMWM of Safety and Buildings in accordance with Comm as Nils. Adm. Code /f
Altadt complete site plan on paper not less than 8112 x 11 in _..� . _:. Owd
Include. but not lirnked W. vertical and horiaontd r�nce (BMf�bn and � � pal I.D.
percent slope. scale or dimensions, north arrow. an d locadon w4distance
Please print all lnfoama by /D
_ p
PemwW Y� pmv� rwy be used for seconds Y (Privacy taw. 8- 15.04 (1) (m)).
p roperty Location
upt- �1 114 S 1 T 3 N R E( r
property # Subd. CSIM
o�rere "lau"'gAdaress
qty We Z.cp Code Phone Number ❑ City o own Road
v OdS t s > SY —S9 Jot j1°
fr'`tJ
New Cafatru cdon use Residential / Number of bedrooms Code derived design Now rate GPD
oR� 0
t Describe:
e: - ---- ---
Parent ati I Z 7 1 Flood Plain elevation if applicable /t/ Jit2 R
General oornmerits �!
' and nsoorrafreridations:
ILI
9
e a d "A * pit Ground surface elev. D ft. Depth to mug fay in. Soli Application Rate
H01201 , Depth pornineM Color Redox Description Tao*" St u t" Consistence Boundary Roots GPM
in. Munsel ML SL Cor t. CAW Gr. SL Sh. -Eff#, •Etf#2
Z-
1 .3
® Boring * 0 Ground surface elev` `4, R Depth b timitin9 facer ` in. Sol Application Rate
Pit
Horizon Depth DomirvintCalor Redox Description Textire Structure Consistence Boundary Roots GPO1lP
/ in. Morsel CkL Sz. Cont. Color Gr. Sz. Sh. *M1 'Eff#2
• Eflluer>t = gpp > 30 220 mg& and TSS > • Efl OD Nrent #2 = B < 30 mg& and TSS < 30 mglL CST Number
� �? 22��'d
Date Evaluation �xted Telephone Number
Adder S�(jl � 7 A � , 17
"W8
r �
Property wner O Parcel ID # Page of
O OWN # ❑
A Pit Ground surface etev. / 9 Z R Depth w >i reft toclor � � Soll ANkadon R*e
Horizon Depth Dominant Color Redwc Description Texture Structure Corwistence BmxWy Roots GPDRP
in. Munsel Ou. Sz. Gant Color Gr. Sz- Sh. 'E1ft11 'Eff#2
2 - ) r-S -
❑ Boring # ❑ Boring
❑ Pit Grouts surface elev. ft. Depth b l factor in. Rde
Horizon Depth Doff*wrt Coolor Redox Description Texture Structwe C.orisisterrae Boundary Roots GPDW
in. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 'EffN2
Boring ❑ # ❑ Bat>ng
❑ Pit Ground surface elev. ft. Depth b Cxruting factor in.
Sol Application Rate
Horizon Depth Dominant Color Redox Description. Texture Stucture Consistence Boundary Roots GPM
in. Munsel O1u Sz. Cont. color Gr. Sz. Sh. -Eft#1 -Eff#2
Effluent #1 = BOD > 30 220 mg& and TSS >30 < 150 mgA_ ' Eftxx t #2 = BW, < 30 mg& and TSS _< 30 mWL
The Department of Commerce is an equal opportunity service provider and employer. if you need assistance to access services or
teed material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777.
seasM(Rmw)
I
Soil Test Plot Plan
Project Name P.C. Collova Mrs. Inc Sha Lrd
Address P.O. Box 489
Somerset Wi 54025 M #226900
5 Wild Turk Retreat
Lot Subdivision Y Date 9/6/02
E 1 /2 S W 1/4S 12 T 31 N /R19 W Township Somerset
Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of 2" Pipe
System Elevation 97.6/97.4 *HRPSame as Benchmark
Alt. BM Top of 2" Pipe @ 98.8'
Pro Town Road
Please Note: Tested area
may not be suitable for
desired building area.
Checl: system location
before excavating. Also,
sUrVey %V is not completed
at time of test. Set backs
from lot lines may 35' -
chan��e. 102'
50'
30'
B -1 30'
10 B -2 70'
1'
15' �
B.M.
4% Slope 15' Alt.
B.M. `' en
a
�o-
00
218' Property Line
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
Property Address
(Verification required from Planning Department for new construction)
City /State t�-� , Parcel Identification Number 0
LEGAL DESCRIPTION
Ef
d V-�
I 3
Property Location �_L% %4, Sec. 1 . T I N- R�W,� Town of 1 .
�j't
Subdivision ll Lot #
Certified Survey Map # Volume , Page #
Warranty Deed # C 0 CQcQ I Volume y c Page It
-Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ 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 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
master plumber, 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
gn 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
IT e xpiration date.
ff 7h
P. C. COLLOVA BUILDERS, INC.
I OF APPLICANT (715) 247 -2742 DATE
P.O. Box 489
SOMERSET, WISCONSIN 54025
OWNER CER TIFICATIO N
I (we) cerd all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
th lde ve, by virtue of a warranty deed recorded in Register of Deeds Office. P. C. COLLOVA BUIL INC. SI NA PPLICANT P.O. Box 489
SOMERSET, WISCONSIN 54025 DATE
« *sssa
An information that is -
Y mis m resented may result is the sari
p y sanit 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
Maintenance an d Contingency Plan for a Septic System
30 56-z—,
Maintenance Plan pumped once every 3 years.
1. Septic Tank is to be pump
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. ipes at the ends of
3. Once every 3 years, cells are to be inspected via the i p
the cells.
rees to limit greases, garbage, and water conditioner discharge into the system.
4.0 caner a g
5. The owner agrees to save this plan.
6. Do not plant trees nor park nor drive ove r 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. Ifs stem fails, determine cause of failure, use alternate area and install new system or
Y
install system at a lower elevation.
om onents as
needed.
2. Replace any other failing c p
Plumber: Shaun Bird 715-246 -4516
St. Croix County Zoning 715- 386 -4680
Pumper Tom Mondor 715- 246 -5
Shaun Bird #226900
FROM P C COLLOOR BLDRS, INC PHONE NO. : 715 247 2747 Oct.. 2B 2002 02:14PM P1
1111 ,141 ALL 11 -U1 C.Yb !leo J 'W31 RLV1dLLA ul' L/L•L'UJ — i6uU
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am
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gm ;f Wbomin (Lrirm•P spade a rAwAd. ;am WAO oml:
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Dated dsy Viareh �Otl7
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aatluoriasd 4y;i 74S.Oi� •a: ,ees.) - - - - -- —
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WARRANTY'UM STATZ&MCMidMOWN
RON1r 7+P.7.l9dV
P PLAN
PROJECT P.C. Collova Bldrs. Inc. 4A DRES P.O. Box 489 Somerset Wi 54025
E 1/2 SW 1/4S 12 /T 31 / 19 W TOWN Somerset COUNTY ST. CROIX
,�'
MPRS Shaun Bird 226900 DATE 8/11/03 BEDROOM 3
CONVENTIONAL XXX IN -GROUN ESSURE 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 ASSUME ELEVATION 100 Filter Zabel A -100
❑ BOREHOLE O WELL - H.R.P. Same as Benchmark
SYSTEM ELEVATION 97.3/96.3 5' below grade
Alt. BM To ' Plans Designed Using
P of 2" Pipe @ 98.7 Conventional Powts
Manual Version 2.0
460' Property Line 200'
Alt. 10' Vents
B. B -2
5 15'
2 -3' X 69' Cells
with >3' Spacing
10% B -3
Slo
70' 35'
30'
B -1 Vents
A6ng Vent
Standard Biodiffuser 30'
Leaching Chamber
with 3 1. 1 ft2 of Area T
1 20
3415 Grade at System Elevation
Pro 3
Bedroom
House
a�
a
0
o�
00
N
Pro Town Road
S(Wv O -3llb'id - Wn
,trL'trS9Z
� l M „ tr0,tr0.00 N
LL' LZZ ,68'8 LZ , LZ'OtZ r
�o
NI �
N
N I
a ' 01'21'32" E o CD m ° v
I _ _ N
71.9 4' 2 ao o o N I
co
03'18'19" Ei 1 57.86' 5 •� N z�
57.77' cD Z o "6'•.
100.09' > A
v1 O O z o
O O �y�
N 13- 07 , 0 6 '.
x z
4% �, H II 29 c 7 2.26 166. ?0' E i
w �� . ` 93 . 9
9 + co 0 60 'l, / c.? r ?�?O., ` S 130 N
/ �V CO ,�Z. 7 .` Gb
00 O - o p 00 N
I o� O. s ? � o w
O N °' „ o ,� I 139 os� ° D c N
D D I •1 � .
0 co
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0
_ _ I I • ' g . N 07 '232
8 2.91'
\156 83 I rn = a
v ti c
O \ O TATI► T ` 237 440 16.85' .�g�,�p F 0°
AD 1 - II o ui
O c
+
88 4 2 � a
_ ` ` N 15'20.32�� , \ 243'2 ��2
\ o°v 223 l g' \ \ S 15. 20 . 3 2 M E 85 2.59 • 9c �^
85 2 59
0. s2 _
287 4