HomeMy WebLinkAbout032-2159-70-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: 8t. Croix
Safety and Boding Division
INSPECTION REPORT Sanitary Permit No:
430148 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 - 2159 -70 -000
CST BM Elev: Insp. BM Elev: BM Description: Sectionlrown /Range /Map No:
12.31.19.1375
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
OD 5.0 1616.0
Dosing � Alt. BM /.
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet 7
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic ( , r� /' >� DtBottom
Dosing J f � N _ Header /Man.
A eration Dist. Pipe a
1
Holding Bot. System /v
Final Grade
PUMP /SIPHON INFORMATION y.
Manufacturer Demand St Cover /
GPM
Model Nu
TDH ift Friction Loss System Hea TDH Ft
Forcemain Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of S 1Vj UNIT Model Number:
DISTRIBUTION SYSTEM
Header /Manifold JP� ti on x Hole Size x Hole Spacing t to Air Intake
/r e(s)
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 1 xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil
I &2Q I LJ Yes No a Yes iLJ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:/ /f� Inspection #2: / /
Location: 2234 74th St Somerset, WI 54025 (SE 114 SW 1/4 12 T31 R1 9W) Wild Turkey Retreat Lot 7 Parcel No: 12.31.19.1375
1.) Alt BM Description = Ji � SfQ( � �/ 1 -6k,0 0 ' Gci4,2
2.) Bldg sewer length = 3 � Wwj O-
- amount of cover = >
q 31' - — — - - - -- -.._
Plan revision Re uired . Yes No /Z
Use other side for additional inform ion. C1 J
Date I Actors
Signature Cert. o.
SBD -6710 (R.3/97) `fir- I
Safety and Buildings Division County
A r P.O. Box 7162 T �r'c7 1 x
201 W. Washington Ave.,
i►seonsin Madison, WI 53707 - 7162 Sanitary Permit T ?umber (to be filled in by Co )
(608)266 -3151 / 3 Q
Department of Commerce State Plan LD. Nu ber
Sanitary Permit Application
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide
may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address if different than ailing address)
I. Application Information - Please Print All Information _. _._ ... --- --- _ 2 S - 2
9
Parcel # Lot # Block #
Property Owner's Na me ! /)
Property Location
/,
Property Owner's M ailing Address t Ea / 3 03( , d 61 1 /a , Section 0
City, State Zip Code
(circl�6rii e
L
v T N; E
li. Type of Building (check all that apply) subdivision Name CSM Number
or 2 Family Dwelling - Number of Bedrooms ` • j� '/
❑ Public /Commercial - Describe Use
- JCity_JVillage fownsh p of
J State Owned - Describe Use
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
. ❑ ❑ ❑Permit Transfer to New
List Previous Permit Number and Date Issued
B Permit Renewal E-1 Permit Revision Change of
Before Expiration Plumber Owner
IV. Type of POWTS System: (Check all that apply) i
Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At Grade Single Pass Sand Filter
E constructed Wetland ❑ Pressurized Ii round ❑ Holding Tank ❑ Peat Filter
❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter
❑ Recirculating Synthetic Media Filter eachwg Chambe r Drip Lin ❑ Gravel -less ipe ❑ Other (explain)
V. Dispersal/Treatment Area Information: 22 3t .1
s is ersal Area Proposed (sf) S stem El anon �G
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area q uired (� P�
/ Site S•.eel Fiber Plastic
C in Total Number Manufactyre Prefab I
VI. Tank Info P Y / (4-16)( Concrete Constructed Glass
Gallons I Gallons of Units
New Existing C /��T��
"ranks Tank's
Septic or Holding 'rank V" i
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement I, the undersigned assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Na me (Print) Plumber's tune
MP /MPRS Number Business Phone Number
Plumber's Addre ss (Street, City, State, Zip ode ) JS o/I 7
VIII/County/Department Ose Only
Sanitary Permit Fee (includes Groundwater Date Issu d suing A ent Si a No Stamp:
❑Approved ❑Disapproved Surcharge Fee,& ,7
11 Owner Given Reason for Denial �r
Conditions of Approval /Reasons for Disa roval � 162
�,,�-
ad'
y
Qi c o p (t a un y onl or the system on paper not ess th 81 2 x 1 inches in size
r
131N/ OT PLAN
PROJECT P.C. Collova Bl drs. Inc. ADD ESS P.O. Box 489 Somerset Wi 54025
SE 1/4 SW 114S 12 / 9 W TOWN Somerset COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 7/1/03 BEDROOM 3
CONVENTIONAL XXX IN-GRO11W 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 2" Pipe ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
Alt. BM Top of 2" Pipe @ 97.7 SYSTEM ELEVATION 99.0/98 3' below grade X02. ar
/O/ s
Pro Town Road
Vent 250' Plans Designed Using
Conventional Powts
ALo Standard Biodiffuser Manual Version 2.0
Leaching Chamber
with 31.1 ft2 of Area
"
Grade at Sy stem Elevation
7' 34" 130'
0
A~
Alt.
F M. 9°l0
o Slope
15' *B.M.
15' v
B -2 � B -1
Pro 3 30' ' 8
Bedroom
House
av
.—
T 5' B -3 1 * 0 v 10
2- 69' Cells with >3' Spacing
Please Note: Tested area
may not be suitable for
desired building area.
Check system location �'
before excavating. Also, w ►�
survey was not completed
at time of test. Set backs
from lot lines may
change.
P OT PLAN
PROJECT P.C. Collova Bldrs. Inc. ADD ESS P.O. Box 489 Somerset Wi 54025
SE 1/4 SW 1/4S 12 /T 31 N/ W TOWN Somerset COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 7/1/03 BEDROOM 3
CONVENTIONAL XXX IN -GRO 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 2" Pipe ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
Alt. BM Top of 2" Pipe @ 97.7' SYSTEM ELEVATION 99.0/98 3' below grade
Pro Town Road
Vent 250' Plans Designed Using
Conventional Powts
ALo Standard Biodiffuser Manual Version 2.0
Leaching Chamber
with 31.1 ft2 of Area
1
1p Grade at Sys tem Elevation
34 130'
0
A4
Alt.
!° M. 9%
o Slope
15, B.M.
15' z
70 , 10 1
. 12/
B -1
Pro 3 30'
Bedroom
House
aD
20
T 35' B -3 I o v
2 -3' X 69' Cells with >3' Spacing
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.
wisoonstrh Department of Commerce SOIL EVALUATION REPORT Pie � of
Division of safety and 8uldirhhgs
in accordance with Comm M was. ndm. Code
Countys V
Attach complete site plan on paper not less than 81/2 x 11 iodise iR site. Plan must
include. but not limited to vertical and horizonfel reference pcpnt (8Nl)s h and Parcel I.D. —�/ � " O
percent slope. scale or dimensions. north arrow. and IocationPnd distance to nearest road. D 3 L oats
Please paint all Infoarnatlorl
Pw=W Won abon you p—� -W be wee for secondary (fir L-- S. 5.Ot (t) (rt l)- 16 63
f'fopertyLocation
may . C � L d cv C04 Lot. ` y 114 S /9T N R E( W
Propert golres wing Address tot Alodc # Subd. C.SMq
- 7 1 j C e
CRY state zip Code Phone Number ❑ City ❑ ohm Road 9
New CwW nxcion Use. Residential / Number of bedrooms Code derived design flaw rate GPD
O pAvlacement ❑ Public Qr comnwdal - Describe: - - --
Pannt n wAerial fir. .r �i �j� Flood Pain elevation d appkcabte Nl t! n
(;Www MUM
and OU"Ooni S o eodm Boring / 'J
a it Pit Ground surface elev. DC i IL Depth ID fmiting factor P 0 i Rate
FloAaon Depth Dominant Rdedox Description Texture Structue Consistence Boundary Roots
in. Munsell (kr. St. Conk Color Gr. Sz. Sh. *Ml OEM
— -� cz,
P71 # B --Q�
Pit Ground surface elev. I J n, DePtlh to hg few _l S�S1— °- Sol Application Rate
!tad= Do D Redox Description Textrxe Str>x#ure Consrstenoe B !toots CaPD/l
in. Murhsel CAL Sz. Cola Color Gr. � �- 'Et<#1 ��
0
< � and TSS 30 mgfL
Eft" t in = BOD 2 220 mg& and MSS > < mgil
Efiu� #2 800 _ mgfl.
CST PNarriber
CF / Name (Freese Prir>h G�� c��aa
c�/�Ct 4 / 1 ✓' Teteptane Number
Address Oete Evdkhaion Conducted
Property Owner Parcel ID # Page 2- of —�`--
a Borurg #
0 n9
Pit Ground surface eiev. � ft. Oeptlh >D ft0or ir' Sol Application Rate
Horizon Depth Dominant Color Redoa Description Tod re Structure Consistence Boundary Roots GPD/fF
in. Munsel flu. Sz Cant. Color Gr. Sz. Sh. 'Eff#1 `Eff#2
Al 4 fill
❑ Borkv # ❑ BorkV
❑ Pit Ground surface elev. R Depth to kniting facbr irr. Rate
Horizon Depth Dominant Color Redwc Description Texture Structure Consistence Boundary Roots GPDM
irr. Munsel Qu. Sz. Cart. color Gr. Sz. Sh. •M •E02
F 9 # ❑9
❑ Pit Grourrd "face elev. fl. Depth to tinting factor in
Sol Application Ram
Horizon Depth Dominant Color Redox Description. Textue Structure Consistence Boundary Roots GPOM
IM Mutsel ou. Sz. Cord. cola Gr. Sz Sh. - 'EfF#1 •011112
• Eilluent #1 = BOO, > 30 < 220 "A. and TSS >30 < 150 ffQ& ` Efluad #2 = BOD < 30 mg& and TSS < 30 nxyL
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 or TTY 608 264 - 8777.
saawota -eoo)
•
It 1 . 3�
Soil Test Plot Plan
Project Name P.C. Collova Bldrs. Inc Sha d
Address P.O. Box 489
Somerset Wi 54025 TM #226900
Lot 7 Subdivision Wild Turkey Retreat to 9/6/02
E 1/2 S W 1/4S 12 T 31 N /R19 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 100.0/99.0/98.0 *HRpSame as Benchmark
Alt. BM Top of 2" Pipe @ 97.7'
Pro Town Road
250'
Please Note: Tested area
may not be suitable for
desired building area.
Check system location
before excavating. Also, 130'
survey was not completed
c
at time of test. Set backs
3 from lot lines may Alt.
change. M 9%
Slope 100'
15' B.M.
1'
101'
7
B -2 B -1
102'
30'
35' B -3
I
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
1. Ifsystem fails, determine cause of failure, use alternate area and install new system or
install system at a lower elevation.
2. 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
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 C;
(Verification required from Planning Department for new construction)
City/State `-�iW �2 2P L ( -"�T— Parcel Identification Number 13 - -2 151-10
LEGAL DESCRIPTION 31 5-
Property Location V,, aZ) V., Sec. �, T-3--LN -R -aW, Town of S6
Subdivision Lot #
Certified Survey Map # Volume , Page #
Warranty Deed # +5 COG Volume IT Page # o EEQ.
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.
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
Vt statiriff that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
e expiration date.
P. C. COLLOVA BUILDERS, INC.
SIGNATftE OF APPLICANT (715) 247 -2742 DATE
P.O. Box 489
OWNER CERTIFICATION SOMERSET, WISCONSIN 54025
(we) certify t4at all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the
( M rty scri ove, by virtue of a warranty deed recorded in Register of Deeds Office.
R C. COLLOVA BUILDERS, INC. l i
SIGNA OF APPLICANT (p O) Box 2742 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
U 1868P 279
STATE BAR OF WISCONSIN FORM 2.1999 5 6 H. WALSH
WARRANTY DEED 1
RA R EGIST H. DEEDS
REGISTER OF DEEDS
Document Number ST. CROIX CO., MI
This Deed, made between Shann Dinan Quinn, C olin Quinn, RECEIVED FOR RECORD
Kelly Quinn, D evin Quinn and Foley Q 1,nn, --. — . — 04 - 08 - 2002 11:20 All
— -- - -- __ -- WARRANTY DEED
Grantor, and P. C. Collova Builders, Inc., a M innesota Corporation, EXEMPT #
— — — REC FEE: 11.00
_. —.— — — — — — TRANS FEE: 1440.00
— -- — — — — -- — — -- — COPY FEE:
CERT COPY FEE:
Grantee. PAGES: 1
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 SW 1/4 of Section 12, Township 31 North, Range 19 West, St. Croix Recording Area
County, Wisconsin. Name and Return Address
FFL-C=
P, v 13 ,,t.
032 - 1034 -40 -000 & 0 - 1034- 70
Parcel Identification Number (PIN)
This — is no t, — — homestead property.
(KI (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this day of March - -_, 2002
1 Q /
S ha nnon Dina Quinn +Kelly Quinn, by C olin Quinn, attorney -in -fact
s
C . 1 uinn — * Devin Quinn
AUTHENTICATION ACKNOWLEDGMENT
TATE OF WISCONSIN )
Signature(s) Shannon Dinan Quinn; Colin Quinn, individually S ) ss.
and as attorney -in -fact for Kelly Q uinn; Devin Quinn and Foley _ _ _ County )
authenticated this day of Ma 1002 ^ Personally came before me this _ _ _ day of
the above named
a Kristina end
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing
(If not, -- _ _ - -- instrument and acknowledged the same.
authorized by § 706.06, Wis. Slats.) —_
THIS INSTRUMENT WAS DRAFTED BY • _. —.-- --
Attorney K ristina Ogland — -- —_.— —., —_ Notary Public, State of Wisconsin
Hudson, W 54016 — _ My Commission is permanent. (If not, state expiration date:
(Signatures may he authenticated or acknowledged. Both are not necessary.) _ -- - -- — — — ' -- —
Info maiion protafalonats Company. Fond du Lac. W1
• Names of persons signing in any capacity must be typed or printed below their signature. aeo sss -zoz�
STATE BAR OF WISCONSIN
WARRANTY DEED FORM No. 2 -1999
FROM P C COLLOVA BLDRS, INC PHONE NO. : 715 247 2747 Oct. 28 2002 02:14PM P1
lY /CO�Yi 3LU\ 11. U! Clib llil in AU131 AVY44MA ul• ULLW-3
zt Los aQ 2
STAYS MR or wirGChXW PGRM3. 10" ft lyow dr L WARRANTY MZD n6ia9
Tl310esNi, mods lsotutaon Skaasaa t)im Q�i aa,, ` C oHa Qdnn. _ il FO! >!1
Ke1 QYia�.$)ada aim ead Foia�Q 04-*-3M 111M AN
womw Qra9tD!1`1 �f ,rl B Ylldal��a..dll�7o��dOSlr,� ppppgggg�e
Grated. Cra.xa, a valuable <enldcadow oaa•vYa b Gtau— *0 } `
/bt74wh`d+aewmod a�� cauniv.
sm O wbo sto acmes, VMS it aaaded plaaaa VAO t l'
4113 gf$Vhl of,%WW !;,, Tvaar}iC 31 1Vith, ZaaO1 19 Wtal. 9L Clolk i lioeadloa Ana
cys,ny, Md was a.+eT A46M
� 1.;07e , •sp�WO k a naa.�oaa�a
?�zt ttttell1ce110a N7arxr
tX1 11W I1l1
EM�aS$411aZ9 t' it. Ma' nCn13,< u3; f! CiIC: 1Bi� .".Ylljtitr•Jf'w
DOW Ow+'aay of Ytareh idol . -
�"• wr i
also _....�._.. • Ae+M Qrinn .�- — -- -.. _..... __._ —.�.. _- --
AVINENTMAYlON ACKNOWLEDCM&ST
c .+ mn. }�.' leenldlws, STATE ❑F W-SZONSIN )
3SgRS1Y[Kal '��■ ,� 1
i tr >v �� litdtt�,a Drvin�Wan + Paid � . �. 1 �'
autna,7Uwc 1lls� Cf ._ — — .. J`O%Cr lllY 41MW b lb.r ne MR O
�--
(tC not. � ror I�aa+m 1v 4r t1n V■�i> why �iwr�it • lhr ;m�laway
iotm —rt ad ieknawlad,lcd rMc coos.
! autbodaod 1'q � 7P8.Oi� �•: —
ntla rsulrA t;MGt+t WASpWihS - aD 0Y • _ —
K,>r✓a ..—
_ Htxary PaYslk, of W Ise+yilo
My Ccmohua, is pemoneM. tlf ne4 sm" =pis= a- d" i
I tsyaorta m■I !s suti7tatle Z a 9ed7 cre = lmrxy -- l .— — . _ _ _ ... _ - _ _ . — —.1
•Mt ,7f B1Qe71¢Ga{a't9W le tyas)a lrveed btinw s7rnipMin �nOn■IMNone■wW�Aawx
WAAAAiyTY oalrs ST,M1TLSAKGFVUC NM-N
Ft�lt 74•. i• 1111
f� — ru�tl���
I ---- Y IL - VI 1
,trL'tr99Z
„ tr0, - V0-O0 ' N 'V/ l MS 3Hl 30 Z/ l 3 3Hl 30 3NIl 1S3M
'Otlz r - - - - -- _ — J (Ln. 99
.06' l8�
I I xr
1
x r
to M -4 im m y I I .
1 2 Vf < t$o m Oo ; z�
00 O � I� > ^'- D �� t o
Cl() �p
°.
I I I�
I �`. I
? I ( co I
� 6 F — — 02
S. o \ Z N _36_37" E I I w
- = DD Gr Ol
504
{: r .20' • I
461,07 O I n1 9�
i• S S' o w \S1 II I W I N I • �'F
�8 co N � ` I O 1
� N o o I .00L I �' to p�),. t—�7
1v I Ln ?
cn y D D
I
O N � � A I W
29 G J i �, n W I I T V
ao 1 0 o w _ �'� % p
00 I
�Z�� •'� �' S 04'52'00" W I
_
17 9.49' -- I
9 N072.3
82.9 o j� 525.42 — -
-. 57.08' I N
CD
/ N O
O n � D / �� / N V /
° X599 ��G p
2�S 2o, / S �• \
F
2 • ,. � i \ �O c,
A so 287 46
�^ v 9� w !:P-
\ 1' �ti� II Z 26 � �Z , S S9 9, �� \ 9910 t �' • ZS
�\ c^ V 6\ , - - M