HomeMy WebLinkAbout032-2160-30-000 -
Wisconsin Depa ommerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Buildi
INSPECTION REPORT Sanitary Permit No:
463316 0
GENERAL INFORMATI F (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. Somerset, Town of 032 - 2160 -30 -000
CST BM Elev: Insp. BM Elev: Description: e,,,,,) n Section /Town /Range /Map No:
BM
/ffi yv\ \ � k ° ^'� - , 12.31.19.1381
TANK INFORMATION ELEVATION DAT
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic J C� /66^0 Benchmark (P ,-7 iD(v, /CZ)
Dosing Alt. BM t� � t cl ,7
ion J T1 ,5
Aerativrt" % co Bldg. Sewer //` 9 p � '
Holding SUHt Inlet "� ! 1Z.1 193-9
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \
Septic G O 4' A/^ T 3Dl - Dt Bottom 100911
17
Dosing , t x /�/— J j - 6 � Header /Man. f /66
+ '
Aeration f V Dist. Pipe 4,
Holding _. - - -- Bot. System C1 ' 15 9 7 , 5
PUMP /SIPHON INFORMATION Final Grade •b /o/.
Manufacturer 1 Demand St Cover / _ C
GPM e:•n. 1p•1� C fq. ]S
Model Number n � y •7/M
TDH Lift Friction { Loss System ! Head TDH LV Ft , O
/6. 7- 1 M I \
Forcemain Length I Dia. _Z_ 1 Dist. to Well A/&
'7S
SOIL ABSORPTION SYSTEM
BED /TRENCH Width / Length No. Of Trenc PIT DIMENSIONS No. Of Pits Inside Dia. Ltq,<dDepth
DIMENSIONS (_ l 6Z Z_ \ r \
SETBACK SYSTEM TO tl7 P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR t -J 1�
Type Of System: i UNIT Model Number:
I Colir\L)Q_4"D�\C4 DISTRIBUTION SYSTEM ZZ ie
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
q / L) Pipes)
Length 1 Dia t Length Dia Spacing \� Z
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
Bed /Trench Center ` ' Bed/Trench Edges 'N111 Topsoil G Yes No Yes 1 No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: A / zp / OS A Inspection #2: ! /
Location: 2252 74th Street Somerset, WI 54025 (E 1/2 SW 114 12 T31 R19W) Wild Turkey treat Lot 13 Parcel No: 12.31.19.1381
1.) Alt BM Description =
2.) Bldg sewer length = 36
- amount of cover
� Z r ve, t,j
Plan revision Required? Yes [_ ] No
T -- - - SI
Use other side for additional inf rmation. 5 ; - -
Date Insep is Sip ture Cert. No.
SBD -6710 (R.3/97)
Safety and Buildings Division County
� 201 W. Washington Ave., P.O. Box 7162
s�Cans n Madison W OS I 53707 -7162 S Permit � umber (to be filled in by Co.)
Department of Commerce e-cV (0 3
Sanitary Permit App ion Sta Plan I.D. Number
In accord with Comm 83.21, Wis. Adm. Code, person o rol 'dq� h
may be used for secondary purposes Privacy v �+ 4 005 Project Address (if different than mailing address)
I. Application Information - Please Print All Information COUNTY 2-2 z— 74 �k 54
FICE
Property Own N Parcel # Lot # Block #
Property Owner's ailing Address Property Location
City, State Zip Code Phone Number Section
T N; or W e
II. ype of Building (check all that apply) r -�
1 or Family Dwelling- Number of Bedrooms S ubdivision N c % CSM Number
El Public/Commercial — Describe Use i
❑ State Owned — Describe Use ❑City ❑villag o ip of
c
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
`; ew S stem
y ❑Replacement System ❑ TreatmentlHoiding Tank Replacement Only ❑Other Modification to Existing System
B. El Permit Revision Permit Renewal El Change of El Permit Transfer to New List Previous Permit Number d Date I�s
Before Expiration Plumber Owner 1 1 33 / (— z S D 5
IV. Type of POWTS System: (Check all that a pply)
n Pressurized In- Ground ❑ Mound 124 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In -G d El Holding Tank 11 Peat Filter El Aerobic Treatment Unit 11 Recirculating Sand, Filter ❑
Recirculating Synthetic Leachin Chamber
g Yn g ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) �
V. Dispersal/Treat ent Ar nformation:
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Ar a Proposed (sf) I Sys %m Elevation
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site eel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank
Aerobic Treatment Unit
Dosing Chamber —
t_
VII. Responsibility Statement- I, the undersigned, a responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's ure MP/MPRS Number Business Phone Number
_ i vy 7
Plumber's Address (Street State, ode)
VI . Count /De artment Use Onl
pproved El Z tfn �Ronfor Sanitary Per Fee (includes Groundwater Date ssued Issuin nt Signature o S S)
Surcharge Fee) q
❑ i al C)
IX. Conditions of Approval/Reasons for 'sapproval f I
�1 / 5 '
4 m-- t= l e, )c , 6 V\_ q7-55 �7',3
Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size
SBD -6398 (R. 01/03),
SoLRESS stem PLOT PLAN
PROJECT P.C. Collova Bldrs. Inc. Box 489 Somerset Wi 54025
E 1/2 SW 1/4S 12 /T 31 NOWN Somerset COUNTY ST.CROIX
MPRS Shaun Bird 226900 ! DATE 4/28/05 BEDROOM 3
CONVENTIONAL XXX IN- GROUND PRE URE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE630 DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22
BENCHMARK V.R.P. Bottom of Siding ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
SYSTEM ELEVATION 97.5/98.2 4' below qrade
Well is to meet all Plans Designed Using
setbacks required by Conventional Powts
WDNR Manual Version 2.0
Pro 3
ropey I a Bedroom
House
__RB.M
30'
Combo Tank
2 -3'
X 69' Cells with
B -3 >3' Spacing Pro Tow 1
30'
30 10% 60' Vent
Slop
ALo Standard Biodiffuser
B -2 Leaching Chamber
with 3 1. 1 ft2 of Area
1"
15' B -1
Grade at Syst em Elevation
70' 34"
100' 15'
609' Property Line
Property Owner _ Parcel ID # Page of
Boring # ❑ oring �`
it Ground surface elev._ ft, Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
a Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
F-1 Bor,ng # ❑ Pit Boring
❑ Ground surface elev. ft. Depth to limiting factor in.
Soil ication Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
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.
SBD -8330 (8.6/00)
vage Ut
SEPTIC TANK & PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
u/, Cl VENT PIPE 12" MIN. ABOVE GRADE wEA THERPR00F
?:25 FROM DOOR, WINDOW OR JUNCTION BOX APPROVED
FRESH AIR INTAKE WITH CONDUIT W1 MA
FINISHED GRADE - WARNING LABEL
� Kn. •- •.,•., MIN.
ty"
is I N . y� C • Z. t1bS x. A.
rltE es M,►�•
INLET
WATER TIGHT SEALS GAS-
�" TIGHT \/APP
A SEAL JOINTS WITH
FILTER —L_ ALM APPROVED PIPE
APPROVED B ' ON 3' ONTO
PIPE 3' "t SOLID SOIL
ONTO SOLID , C '
SOIL PUMP OFF ELEV ,�j O FT • - -- OFF
D
n
3 APPROVED BEDD ING UNDER T
ANK
CONCRETE PAD
SPECIFICATIONS l ✓I �`` "`���
SEPTIC f DOSE ,�..
TANK MANUFACTURER
�^ �,� - NUMBER DOSES PER DAY
�-f-2 GAL, DOSE VOLUME INCLUDING
TANK SIZES SEPTIC - GAL. FLOWBACK: � 1 .� GAL.
DOSE � v 2
CAPACITIES. A = l INCHES = J_,� GAL.
ALARM MANUFACTURER:
MODEL NUMBER: B 2 INCHES = GAL.
SWITCH TYPE: < " �-
-, _ S �S GAL.
PUMP MANUFACTURER: 7`��/ C - I NCHE S
MODEL NUMBER: D INCHES = ��
Ji '- S GAL.
SWITCH TYPE: /'(
REQUIRED DISCHARGE RATE '� � GPIt PUMP E ALARM WIRING AS PER ILHR 16.23 WAC
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE / ° FEET
+ MINIMUM NETWORK SUPPLY P ESSURE
FEET FEET
+ .�s FEET FORCE 1, X 1 ,21 00 F -roTAL DYNAMIC .j _ FEET
WIDTH 4 �_ _ ; DIAMETER
INTERNAL DIMENSIONS OF PUMP TANK: L �•`' ��
NUMBER: �O/ l�v DATE: 7
SIGNED: LICENSE -
1 /88
FROM BRIAN VAUGHT PUMP FAX NO. 7154258035 Mar. 30 2005 09:57AM P1
iWAI F.)YNANPi",
R MWj1'F_
IFR-")R'VA!4CJ CLAVE
UP1 UEN1 AND 1 0
MODEL
Feel Motors Or F e pq�'. cul. I Liters
e
';'0 -
5 45 261
69
42 231
Li 15 4.5 7'r 2 1 W.
151 20
20
167 A 52
25 7.6 20 129 J4
— —
15—
3.1
20
87
4 N 35 10.7 1 22
40 12.2
F 1.6(n
'; 0 60 a0 100
160 240 320
FLOW PFR MINUTE 0140"nup Model 151 Models 1521153
CONSULT FACTORY FOR 6)162 1 1
SPECIAL APPLICATIONS 3 718 3 27/32 J
• 1/3
Timed dosing panels available.
• Electrical ahemators. V duplex systems, are avalilable and
s with an alarm.
• 7/8
Variable level control swillChCS are available for controlling
single phase systems.
• Double piggyback variable level float swa6es are available
for variable level long and short cycle Controls.
• Sealed Qwik-Box available V ouldow instaltAbOAS See
FM1420.
• Aver 1301;. (SA*C,.) Special quotation required.
it
1 5111521153 Series .....
13111s2n53 GELS CW*HA dKto"
Model Vas-Ph mods Alp, nupka
W51 tt5 1 Non 60 I 2or3
. jeNJSJ 115 1 _Aub 6.0 included 2or3
L!Ljt— 230 I lion 3.2 1 — 2w3
LBE15L )X 1 Am 3.2 Included 260
N152 115 1 No_ ts — I — 2or 3
ll 9r �52 JIS I Auio M _hziied 2or3 I
E152 1 Non 4.3 1 200
SE162 230
4 — Auto 4.3 Included 2or3
llilg' - 1 is I MCA 110.5 1 200
1 8NI531 tis Auto 10.5 Inclu SELECTION GUIDE
L
P53 I 23D__" I Nun 5.3 1 2or3 yback variable l t w
at Ach or double piggyback vanable level float
AP-0 23D 1 1400 5.3 wvw 2 Nowr 3 1 1 S4 *
Switch. Rotor to FM0477-
11 CAUTIC=m 2. See FW712 f e model of Electrical Alternator E-P$k•
Ail Iftsullatim of controlli. omtecdoo d"kw and wiring should be done by a quallflod 3, va level control sWdch 10-0225 used as a conW activator. n-ify duplex (3)
licensed electrician. A electrical and sorely codes should iw followed Including the mots or (4) float System.
recowit National Eletbic Code (NEC) and Oe OtcullIstonlill 98MY 00l olm Ad (Om�
RESERVE POWERED DESIGN
For unusual conditions a reserve safely factor is engineered ift the design of every Zoeller pump.
Ka M. AQ BOX 10
� KY 402364347
Ml 9 GW RLO ftO
Lagislift KY 4WH erlr PLOW X/" /"S
(Wa 778-2M QSPWP
774,3W
i
Al Safety and Buildings Divisio i County
201 W. Washington Ave., P.O. Bo c 7162 J T, e `
` ��� ; Madison, WI 53707 — 7162 Sanitary Permit Number (to be filled in b �o.)
Department�Con i �e (608) 266 -3151 3 3 /(o
State Plan I.D. Number
Sani.ta y Permit Application
In accord with Conan 8 21, Wis. Adm. Code, personal i as rovide Q
I. Application Information - le se Print All Information 6�� �C 1
may be u i xA fo secondary purposes Privacy Law s15.04(Nhee 7 t � Project Address (if different than mailing idress)
P;
_ A
< lzx�
Property Owner's Name J arcel # Lot # B k #
Pro rty Owner's Mailing Addre "S v ! P 1 G 0 f Fi C E Property Location
Section
City, State Zip Code Phone Number —
D c s )` _g b )_, / l circle pn
- -, N; /R E W
II. ype of Building (check a I th t apply) / Subdivision CSM N. tber
or 2 Family Dwelling — Nun hero 3edrooms 5 • _
❑ Public /Commercial — Describe Jse _ &J
❑ State Owned — Describe Use ❑City ❑Vill wn " of
III. Type Permit: (Check only one bo x o n line A. Complete line B if applicable) 3Z — ? /(Qp — p — O>5D 3�'/
A" ew System ❑ Aepl; :ement System ❑ Treatment/Holding Tank Replacemc nt Only ❑ Other Modification to Existing System
B. ❑ Permit Renewal El Perm Revision ❑ Change of ❑ Permit Transf ;r to New List Previous Permit Number and Date >s� :d
Before Expiration Plumber Owner
IV. T Vve of POWTS System: _(Cl ack all that appl Op S 2 X
— Pressurized In- Ground 111 ound > 24 in. of suitable soil 11 Mound < 24 in. of suit, ble soil 11 At-Grade El Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressi sized n round El Holding Tank El Peat Filter ❑ Aero sic Treatment Unit 11 Recirculating Sanilter ]
Recirculating Synthetic Media Fil to ing Chamber ❑ Drip Line ❑ Gravel -less Pil e ❑ Other (explain
V. Dispersal/Treatment Area Info mation:
Des" Flow (gpd) Design S� � IA lication Rate(gpdsf) Dispersal Area Requir (sf) I )ispersal Area Proposed (sf) Syste levatio 7 0 /, &Y3
VI. Tank Info Capa :ity it Total Number I M ufactu Prefab Site Steel Fiber Plastic
Gal I rns Gallons ofUni w ��bb A_ I ca oncrete Constructed Glass
New Exist ig
Tanks _ Tank
Septic or Holding Tank I
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statem , to undersig , a ume respo nsibility fo r installation of the POWTS shown on the attache plans.
Plumber's Name (Print) Plumb t store MP/MPRS Nt mber Business Phone Number
- i��
Plumber's Address (Street, City, f t
H. Coun /De artmeat
Approved ❑ D' over // Sanitary Permit Fee includes Groundwa er Date Issued Issuing nt Signature Stamps)
Surcharge Fee)
2
El 2wner "ve , _ m for Denial
IX Conditions pprova
SYSTE R:
1 Septic tank, effluent filter and OAkg . (e
dispersal cell must all be serviced / maintained \
as per management plan provided by plumber. )
2. All setback requirements must be maintained
as per applicable code /ordinances.
Atta i complete plans (to the County only) for the system on paper u )t less than St/2 x 11 inches in size
SBD -6398 (R. 01/03)
PROJECT P.C. ova Coll Bldrs. Inc. LOT PLAN
A RESS P.O. Box 489 Somerset Wi 54025
E 1/2 SW 1148 12 /T 1 19 W TOWN Somerset
- -- COUNTY ST. CROIK
MPRS Shaun Bird 226900 2/14/05 3
DATE BEDROOM
CONVENTIONAL �CX IN -G UND 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
IL # 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 17
Alt. B .- Top of 2" Pipe C 101.6' S j
Well is to meet all Plans Designed Using
setbacks required by Conventional Powts
WDNR Manual Version 2.0
Pro 3 /
Bedroom
House
i
rope a 25 ` .
i
30'
B -2
14%
Inn Tow 1
B -3
-�' 70' Ve t
35' i
2 -3' > 6" ii Sta Bard Bio iffuser
X 69' Cells with of Cover ( Leac 'ng Chard. r
>3' Spacing with 3 ft2 of A
30' B 6 , Ong 11�
Vents ' Grade at S P
175' 3
B.M.
609' Pr erty Line
r �
2- ( 0
LOT PLAN
PROJECT P.C. Collova Bldrs. Inc. A RESS P.O. Box 489 Somerset Wi 54025
E 1/2 SW 1 /4S 12 /T 1 19 W TOWN Somerset COUNTY ST.CROIX
MPRS Shaun Bird 226900 2/14/05 g
DATE BEDROOM
CONVENTIONAL W IN -G UND 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 00 _
Filter Zabel A
100
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
SYSTEM ELEVATION 17
Top of 2" Pipe @ 1 01.6 ' S �
7
ell is to meet all Plans Designed Using
tbacks required by Conventional Powts
DNR Manual Version 2.0
Pro 3
Bedroom
House
i
ropey e ,-
25'
30'
l
/
140% Tow 1
B -3
-�" 70' Ve t
2 -3 35' >6 „ 11 Sta dard Bio iffuser
X 69' Cells with of Cover ( Leac 'ng Cham r
>3' Spacing with 3 ft2 of A
,
30 6' Long
Vents Grade at S tem Elevation
175' Alt 3
B.M.
0 ` 609' Pro erty Line
r
Y r
VVIscoini De of C4m mew SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in acoordamce wan Comm es., vws. Adm. code
Aftechoomplete site on papeirnotlessthan 8 112 x 11 Mom M slze.. Plan must
include. but not armed to vertical and horizontal reference (SM). direction and POOH I.D.
percent elope, scale ordimensions. north arrow. and location a rid distance to nearest road. 0S Z -
Please print all informadon. 7 Data
Persone tera wsw You Wavide m6Y be used IN semxWnY P OPOWK WAY taw. 6.15 04 (1)
Propaity Location
pwped /
/, C L d� cv C�aR Lrit 1/4 S �� T N R E( W
,,s1 I3 subd
q(y State 7p code Phone Number ❑ city ❑ d Nags own Road
New coast uctlon Use. Residential, Number of bedrooms Code derived design flow rate GPD
❑ Repfaoenert ❑ Public qr conwnqrdW - Describe: - - - --
Parent �
Flood Plain elevation if /yZAA! ft
r-4wwM converts
and
136
B«ry
f Pit Ground surface elev. fL Depth to brining fa�a' /
❑ Sill Application Rate
Horiaon Depth Dornkwt Cdor Rsdooc Description Texture Structure Consistence Boundary Roots
In. Munsd flu. Sz. Cont. odor Gr. Sz. Sh. 'EfNl1 •Eff#2
Z � mil (/
SOf k'g a BMW
Ground surfeoe Get// fL
Pit Depth to krdting factor — in. soa Horizon Depth DonrhineM Redooc Description Texture Strhxfiue Consistence Soudary f in, Munsd qu. SL Cont.
Color Gr. Sz Sh
dv
1 7.
. e'Ly
�' gsYa
leo 9 �
•
Effluent #1 BOD > 30 220 mgil and TSS > 30 _< 1 ' Efkm t 92 = WD <_ 90 mgiL and TSS `- 90 mg►L
CSr Number
(Please P—" z2 e;"1 d0
✓ f Date Evaluation Canducled Telephone Number
Address
;7
�I
r
property owner Parcel ID # Page of
F-31 Boring #❑ 71 Bodro
a Pit Ground surface etev. A t. Depth to W rillin g fay _ / !_�.-1 im soy Applicati Rate
Horizon Depth Oaninant Color Redox Description Texture Structure Consistence Boundary Roots GPDNf
in. M un seb Qu. Sz. Cord. Color /- Gr. Sz. Sh. 'E##1 'Eff#2
✓
1/ 3 J C — w� 1
D
eai+o # ❑ eorkV
❑ Pit Ground surface elev. IL Depth b 8 FMV factor in. Sol Applicaticr Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDA'f
in. Munsd Qu. Sz. Cont. Color Gr. Sz. Sh. 'Et>#1 'Ef#!Z
F BodrV # ❑
❑ pit t surface Bleu. it Depth to limiting razor in. Sol Application Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD1ff
in. Munsell Qu. Sz. Cont Color Gr. SL Sh.
Effluent #1 = BOD > 30 220 ag& and TM >30 150 mg& ' Effluent #2 = BM, : s 30 mg& and TSS 1 30 rrgll.
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.
sOD43wtabool
Soil Test Plot Plan
Project Name P.C. Coliova Mrs. Inc Sha 'r
Address P.O. Box 489
Somerset Wi 54025 #226900
Lot 1 3 Subdivision Wild Turkey Retreat p e 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
e em or VRP Assume Elevation 1 ft . -Top of 2" Pipe
Elevation 96.0/95.4 *HRpSame as Benchmark
l Top of 2" Pipe @ 101.6',
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
104' 102'
100'
0
14%
Sloe
0
70'
5'
30' -1
5'
Al �
175' B.M.
609' Property Line
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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
Cq ; ,ngen y Plan
Option #J.!lf system fails, determine cause of failure, use mate of and install new
stem in tested replacement 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 -468
Pumper Tom Mondor 715- 246 -5148
Shaun Bird #226900
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer Rc (A a mJa BOi 102CS zn .
Mailing Address �Q 66 x q a 9
Property Address a J 422
(Verification required from Planning Department for new construction)
City /State Parcel Identification Number _ 3a -- altp0
LEGAL DESCRIPTION
Property Location 511 ;'. 3c.,! ', :, Sec. 1 a . T 31 N -R W, Town of (5meme-
Subdivision ti 0 1 3 .
Certified Survev Man "oiume Page ..
Vv arrsnty Deed T C�`���(�� I �i o1 =e paz�
Seec house �.—' yes )(I no Lot ;;ne idendLcbie yes r.e
SYSTEM NLALNTENA INC'E
Improper use and maintea.ance of your septic system could recuit in its prey :.rur: failure to ha die wastes. P- maintenaccc
canna's of pumping out the septic tan's cve ^! three year: or sooner, if needed by a Licensed pumper. What you put into *hc system
r :n affect the function of the septic tank as a tre atmeat serge in the - A-a a disposal s =cm.
7ne property owner agrees to submit to SL CroL Zoning Dc partme :t a c crducatien form, signed by tEe owner
s: sterpiumoer, journe ;�manpiumber, resit- :ctedplumber or a lic..�edaumperverifying that (1) the on -site wastewaterdimcs i systeW
is in proper operating condition and/or (2) aver inspection and pumping (if necessary), the septic tank is less than 113 foil of sludge.
Uwe, the undersigned have read the above requirements and a-,-c-- to maintain the private sewage disposal system with the s•,andaro
set forth, herein, as set by the Department of Camme:ca and the Department of Natural Resources, State of Wisconsin. Cer-Eftcation
stating that your septic system has been maintained must be comnletcd and returned to the St. Croi.,- County Zoning OfEce within 30
of th three year expiration date.
P. C. COLLOVA B'JiLUERS, INC.
(715) 247-2742
SIGNATURE OF APPLICANT, P.O. Box 489 DA i a
SOMERSET, WISCONSIN 54025
OWNER CEI T=CATION
I (we) certify that all statements on this form are true to the best of my (our)snowiedge. 1 (we) am (are) the owners) of
e prope, described above, by virtue of a warranty deed recorded in Register of Deeds Officc.
P. C. COLLOVA BUILDERS, INC. IQ /al / O
(715) 247-2742 DATE
SIGNATURE OF APPLICANT 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.
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 trade in the warranty deed
FROM P C COLLOVR BURS, iNC r I`tU. r _J C - " ( r 4 r co cuc..:
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