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HomeMy WebLinkAbout032-2159-60-000 Wisconsin Department of C901merce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430614 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information ou provide may be used for seconds purposes [Privacy Law, s.15.04 (1)(m) � Y P Y �Y P P I Y Permit Holder's Name: City Village X Township Parcel Tax No: P.C. Collova Builders, Inc. Somerset Township 032 - 2159 -60 -000 CST BM Elev: Insp. BM Elev: IBM Description: Section/Town /Range/Map No: tLV • :'O q-�12 g� 12.31.19.1374 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic , , 1 Benchmark Q z � o3 •' O - �, Dosing W Alt. B Aeration Bldg. Sewer 3 ti -(p(7 Holding St/Ht Inlet St/Ht Outlet p TANK SETBACK INFORMATION �� 3S' TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic �5 / �, 0 f � Dt Bottom Dosing Header /Man. Aeration Dist. Pipe , Z p 3 4 1 5. Holding Bot. System , Ip §. CO .QS Final Grade it PUM /SIPHON INFORMATION 2•'fo (cb•�b Manufacturer Demand St Cover GPM • SD I D24.0 Model Number TDH Lift Fr • n Lo System Head TDH Ft Forcemain thX Dia. Dist. to Well SOI SORPTION SYSTEM t ITRENCH Width f Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO I P/L BLDG IWELL LAKE /STREAM LEACHING Manufact rer: INFORMATION Type Of System: r ti CHAMBER OR d C 30 UNIT Model Number: DISTRIBUTIgN SYSTEM / Ls1 Sp, L Header /Manifo1 u Distribution x Hole Size x Hole Spacing Vent to Air Intake - " 1 Pipe(s) Lengt Die Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of eeded /Sodded 1 xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil xx S [ Yes j No I Jj Yes , No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Qb!� / ZA V3 Inspection #2: / Location: 2226 74th Street Somerset, WI 54025 (E 1/2 SW 1/4 12 T31 R1 9W) Wild Turkey Retr t Lot Par I No: 12.31.19.1374 1.) Alt BM Description = 5 T. s� L �A� 46_ "" 2.) Bldg sewer length = - 7- 3 6 I°�^"` 5 W�� r - amo nt of cover = I 0 t ! tn, c�5 � eQo$L- . A -100 OUA4 - - -- - - - --� Plan revision Required? j Yes No - 1 Use other side for additional information.. Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) Safety an t y ' tr'(2 I y, WHO 201 W. Washin on HO mitary P it Number (to be filled in by Co.) 715consin Maa iso ) 5 707 —7082 30 ( 261546 Oe 9rtment of Commerce rate Plan I-D.Number Sanitary Permit App ica 'on _ in accord with Comm $3.21, Wis. Adrrr. Curie, personal info on y P"}261X COUNTY oject Address (if different than mailingaddress) may be used for secondary purposes privacy Law, 515. {1)( ,) ZONING OFFICE � / I. Application Information — Please Print All Information Z22.(.o � Parcel # Lot # Block N Property Own 's Name R C m dy Pr operty ah Property Ci Mailing Address � Section 1 Phone Number Zip Code Ciq, State � y r - N SY CO L S 2 (circl IL Type of Bening (check all that apply) Subdivisjon CSM Num t or 2 Family Dwelling- Number of Bedrooms 0publiclComrrtacial- Describe Use QCity QVillage Townsbi ❑ Stan Owned — Descnbe Use r IIL Type f permit: (Check only one box on line A. Complete line B if applicable) A. ❑ Tra menvHolding Tank Replacement Only ❑ Other Modification to Existing System Kew Systan ❑Replacement System ❑ Change of ❑ Peratit Transfer to New List Previous Permit Number and Date Issued B. ❑p Renewal ❑Permit Revision Plumber Owner Before Expiration IV. a of POWTS System: Check all that a l N —p 1n-Ground � Mound > 24 in. of suitable soil [j Mound < 24 in. of suitable soil ❑ At-Grade ❑Single Pass Sand Filter a d Q Holding Tank Q Peat Filter Q Aerobic Treatment Unit Q R � culating Sa�pd Filter Constructed Wetland 1:1 Pressurizod la noun � 1 .� Recirculating Synthetic Media Filter ping Chamber Q Drip Line Q Gravel -less Pipe ❑ Other (explain) �J Y. Dls M&Irl reatment Area Information: Dispersal Area Requ red {sf) Dispersal ea Proposed (sfj teen El no Desi flow (gpd) Design Soil � Rate(gpdsf) .f /A Z, r rJ - - � Prefab Site S Fiber Plastic Capacity in Total Number Manufacturer concrete Constructed Glass VL Tank Info Gallons Gallons of Units New Existin g Tanks Tanks Septic;; Holding Tank Aerobic Tre"Mat Unit Dosing Chamber VII, Responsibility Statement- 1, the undersl tied, responsibility for installation of the POWTS shown on the attached plans. lvtpIMPRS Number Business Phone Number PI s Name (Print) Pltunher's Si Plumber's Address (Street City, State, Zip C VIII. Coun ID artment Use Onl Sanitary Permit Fee (' dudes Groundwater Date Issued g Agent Signs e o Stamps) Approved ❑ Disapproved I Surcharge Foe) 0 Owner Given Reason for Denial GJ t IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and V tt� C dispersal cell must all be serviced / maintained as per management plan provided by plumber. ,, 2. All setback requirements must be maintained W 1' � � . . as per applicable code /ordinances. ' Attach coatpkta pleas (to the County only) for the system oa paper not has tbaa f I/2 s 11 lodes la size 08/02 SBD -6398 (R ) PLOT PLAN PROJECT P.C Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 1/4 SW 1/4S 12 /T $ N/R 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 12/6/03 BEDROOM 3 CONVENTIONAL XXX IN -G PRESSURE CONVENTIONAL LIFT HOLDING TANK - 09 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 97.8/97.2 3.5' below g rade Alt. BM Top of 2" Pipe Qa 98.8' 74th St. Pro 3 Bedroom House 10' a T 30' c 35' B =-- �o Plans Designed Using Conventional Powts Verts 30 Manual Version 2.0 Vents 2 -3' X 69' Cells with >3' Spacing B -1 70' B -2 15' Vent B. > 6 Standard Biodiffuser t. Soo ° e Lea Chamber M. p of Cover with 3 1. 1 ft2 of Area 6' Long 11 " 34" Grade at System Elevation C3OO' Please note: Drainage easement is to be properly staked before installation will begin! Property operty Line 1 PLOT PLAN PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 1/4 SW 1/4S 12 /T N/R 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 12/6/03 BEDROOM 3 CONVENTIONAL XXX IN -G PRESSURE RE SURE 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 22 # of chambers IL 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 97.8/97.2 3.5' below grade Alt. BM Top of 2" Pipe @ 98.8' 74th St. Pro 3 Bedroom House 10' T 30' B 35 r Plans Designed Using Conventional Powts Vents 30 Manual r V ion 2. Version 0 Vents 2 -3' X 69' Cells with >3' Spacing B-1 ' 70' B -2 Vent 15 g Standard Biodiffuser t. 10% >6" Leaching Chamber M. Slope of Cover with 31.1 ft2 of Area 6' Long 11" -14- Grade at System Elevation 300' Please note: Drainage easement is to be properly staked before installation will begin! 240' Property Line i f a J vvisca>sin o of Ccnw,►eroe SOIL EVALUATION REPORT Page of Division of safety and suNrin� in acoordence v tth Como a5. Wis. "n. code /'► Attach complete site plan an paper not less than 812 x 11 irhdwes in StM, Ptah mast include. but not limited to: vertical and horizontal referanoe poin} (BM), direction and Ptlrcel I.D- percent dope. scale ordinensions north arrow. and locellon * distance to newest toad. Please print all Inrormatlon. ',.' We Penoner k o " M o W n y o u povide —y be w e d torn eeoondWY 9UrP0*- (6+-Y taw. a. 15.04 (1) (MR. ` I C 1 l * PropertyLocallon Pwperly r L d cv °._._. � 45019 S 1� T 3 N R E( w PtopwtyGist'sMaili Address Lot # Stbci CSMIf p( state zip Coda Phone Number ❑ City ❑ vtitage jSjown Road New Construction Use: Residential / Plumber of bedrooms code derived design flow race GPD ©ReplaommPt 0 P / u � W / - Describe: , _ -- - - - -- Parent rTeireria) �i ,4 /.Y Flood Plain elevation if applicable x/ / .42 tL cameral aorhhrnerrs and reoorrhrrhrrrhdtttions: S ��• �/� d � '7 `' Boring o f G round Depth toirniting factor _1 in. Sol R Horizon Depth Dominant Redox Description Texture Struc4ae Consistence Boundary Rods GPDW im Munsell CAL Sz. Cont. Color Gr. Sz Sh. •Etf# OEM Z ,Z _.--- M - �� �� N 7 0 Boring � ®� # dpi Pit Ground surface eley Depth to Wnfling factor i" ci0ll Application Rate Horizon Depth Dm*wt Color Redox Description readtse Sftft a Consistence Boundary Raets GPM in. Munsd Qu. Sz Cont. Coon Gr. Sz• Sh *M1 'E.f#2 Z I2- �-� c / it ta &;t q .Z - 1 /A Ed W E ht s Bpp , 30 220 < 150 • Eftktent #2 = BoD _< 30 mg& and TSS _< 30 mglL cS r N E-j?"l CFPWW 0-mass P-nm zZ er!`' `'" ✓ : Date Evaluation Comducled Teleph Address c.�� �.-. Yl 1 S�(1i 7 ''tom az / e/7d Z,17 Property Owner Parcel 10 # page d # ❑ Borirg ® z PH Ground surge elay. la5 D m 9 --� - sou Applicytiog Rate Horizon Depth Oomirwd color Redox Description Texture Struetwe Consistence Boundary Rods GP in. MunseB )I flu. Sz. Cont. Color G` Sz. Sh. •Eft#1 •E1f#2 I z— -zG ..ter 6 - a = 11 02— Q # ❑ � ❑ Pit Ground surface elev. ft. Depth b ant" factor in. coif Applicat Rabe Horizon Depth Dominant Color Redox Description Texture Sbnuctue Consistence Boundary Roots GPDff in. Mind flu. Sz. Cart. Coker Gr. Sz. Sh. 'EfW1 •EM F � # O ❑ pit Gm and surface eiev. R. ► m g Soft Application Rabe Horimn Depth Dornirwitcolor Redox Description. Texture Structure CorwWance Boundary Roots GPDVfF in. Munsell Qu Sz. CorM. Color Gr. Sz. Sh. 'EM *01102 • Effluent #1 = BOD, > 30 < 220 nvk and TSS >30 1150 mg& ' Effluent #2 = BOD < 30 mgA. and TSS ,� 30 mgA. 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. S804L o(eAM) Soil Test Plot Plan Project Name P.C. Collova Bldrs. Inc Sha Address P.O. Box 489 Somerset Wi 54025 STM #226900 Lot 6 Subdivision Wild Turkey Retreat Date 9/ 6/02 E 1/2 S W 1/4S 12 T 31 N /R W Township Somerset [] Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 2" Pipe System Elevation 97.8/97.2 *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. Check system location before excavating. Also, survey was not completed at time of test. Set backs from lot lines may change. a� a. 35' B -3 103' lion ON 0' B -2 101 B -1 15' B.M. Al 10 % 15' M. l?e c 7 t �Y\ V V 240' Property Line Soil Test Plot Plan Project Name P.C. Collova Bldrs. Inc Sha Address P .O. Box 489 Somerset Wi 54025 C§A #226900 Lot 6 Subdivision Wild Turkey Retreat Date 9/6/02 E 1/2 S W 1/4S 12 T 31 N /R W Township Somerset F1 Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 2" Pipe System Elevation 97.8/97 *HRP 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. Check system location before excavating. Also, survey was not completed at time of test. Set backs from lot lines may change. w 35' B -3 103' � o� 30' `O B -2 101' B -1 FB.M. 15' 10% 15' Slope I t New dimension established due to not � 300' properly staked lot lines at the time of testing 240' Property Line 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 O system fails, determine cause of failure, use alternate area and install new system 'n tested replacement area. Op ' #2. Install system at a lower elevation, by removing chambers, removing biomat, d i all new system. Opt' 3. No adequate area is suitable for replacement area, and system elevation ca nont 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'd dSS =ao 60 ST 38a 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, W154025 Property Address �- (Verification required from Planning Department for new construction) City /State SbftASej L GJ�' Parcel Identification Number 03 2-"2 -151 - Ot ro6 1331) LEGAL DESCRIPTION Property Location %,, %,, Sec. a.. T-3LN -R 19W, Town of Subdivision &�AA . Lot # (O Certified Survey Map # . Volume , Page # �'— Warranty Deed # (O - �' - S co Volume Page # _ 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 ownerr and by a masterplumber, journeyman plumber, restrictedplumber or a licensedpumper 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 Croix County Zoning Office within 30 da three ye a lion date. P. C. COLLOVA BUILDERS, I (715) 247 -2742 P.O. Box 489 SIGNA F APPLICANT SOMERSET, WISCONSIN `>� DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the be e. I the dcsc 'bed ; �Q� ed we g ( ) am are ( ) the owne � s ) of p , by virtue of a warrp�ty(��Q �ods Office. (715 ox P.O. B 489 54025 54025 �� SOMERSET, wlsc , 2 , 3 SIGN OF APPLICANT DATE I * * * * ** An information that is mis- Any � 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 U 1868P 279 STATE BAR OF WISCONSIN FORM 2. 1999 56 6 1 WARRANTY DEED KATHLEEN H. DEEDS REGISTER OF DEEDS Document Number ST. CROIX CO., WI This Deed, made between Shann Dinan Quinn, Colin Quinn, RECEIVED FOR RECORD Kelly Quinn, D evin Quinn and Foley Quinn, -- —,— . 04 -08 -2002 11:20 AN — — — — _ IIRRPMTY DEED Grantor, and P. C. Collove Builders, Inc., a Minnesota Corporation, EXEIPT # — — -- — — REC FEE: 11.00 — - - -- — — — — TRANS FEE: 1440.00 COPY FEE: — -- — .— PAGESCOPY FEE: Gr Grantor, for a valuable consideration, conveys to Grantee the following described real estate in — St. Croix _ _ County, State of Wisconsin (if more space is needed, please attach addendum): E1 /2 of SWIA of Section 12, Township 31 North, Range 19 West, St. Croix Recording Area _ County, Wisconsin. Name and Return Address FrLc_ P (' 1 I9c�_ Y c rl L' ).�- 5W­ L L 032 - 1034 -40 -000 & 0 - 1034 -70 -000 Parcel Identification Number (PIN) This — Is no t - - — homestead properly. 04) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of March — 2002 ;�/7 INK r 41 hannon Dinan Quinn -- • Keil� b�Colin Qutnn, attorney -in -fact — _ _ _ * C o in Ginn _ • Devin Quinn _— AUTHENTICATION ACKNOWLEDGMENT Signature(s) Shannon Dinan Quinn; Colin Quinn, individually STATE OF WISCONSIN ) and as attorn -in -f for Ke lly Q uinn; Devin Quinn and Foley - -- -- ) ss• County ) authenticated this2'� day of March 2002 Personally came before me this day of the above named • Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN t me known to be the persons) who executed the foregoing (117110t, -- _ _ - -. -- instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.) — - - - ^ -- THIS INSTRUMENT WAS DRAFTED BY • — Attorney K ristina Og land — -- —.,— - -- — Notary Public, State of Wisconsin Hudson, son, W 54016 -- My Commission is permanent. (if not, state expiration date: (Signatures maybe authenticated or acknowledged. Both are not necessary.) — —, -- + — .) I Names or persons signing in any capacity must be typed or printed below their signature. trd"ation Profailmots company, Food du Lx. W 800-655.2021 WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 1999 I I I i I I (n O G rj M I h C co � ISO co pz 9 � I r \ `8Z \ss M lg O6 \ I .OZ•s�Z — ' ZS8 — — M Z Z d ybd 'Zt��,-- 3`Z�.Ol.St N —` — e t , 8 41 OD �� O 0 o st 11 a��� ��ti SS'9t •�� ��Z— — ~'�1 o N 1 r \ rp [ 6 t8 \ C) ^3 ` 3 0 N" "`,^ 206 .6f 6tt N -y0Nti ,� \ o M w 6 N °°' Ir. Q I CI o ro a I I I ° ICO N O 7 n O d O m °m Uj U u • o ° o Ss�,N. �- J I i Q Q N I I �t � .� 9 a � w I Q tD . � 00 : � s �9z s _ (o o � LO 0 o � o � CD 00 1 cn co Ln b9 •f� a `— E r � _ 1 � 23 1 2 . 9g[ 1 " to co 20 �p 3 ec, 32 . 'y h -150• C-% 5 fo 9�� v► S oC., , c► // ti „ys �s ►t, 'xm' l • , r Y .3 pt 9 . 9 2 Z Zt [ af [ ty a Ltd o o, O o NIi �� °� 2 as v y 60'OOt IN I N of J 240.21' 218.89' rn 221.77' N 00 W 1875.03' 7L:r-A '7A'