HomeMy WebLinkAbout032-2160-50-000 ` I :
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County St. Croix
Safety and Building Division
INSPECTION REPORT sanitary Permit No:
430223 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)). 4/3
Permit Holder's Name: City Village X Township Parcel Tax No:
P.C. Collova Builders, Inc. Somerset Township 032 - 2160 -50 -000
CST B1 Elev: Insp. BM Elev: BM Description: Section/Town/Range /Map No:
0 L 0 0. 0 .Z �i��' M�� 12.31.19.1383
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV.
Septic - 106D Benchmark
Z • �Z. � a .
Dosing Alt.
a U &,0 s 3
�.
Aeration Bldg. Sewer -
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P1L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic / I rl� / ,. `p � ,Q � Dt Bottom -
`�-
Dosing
Aeration DistP e o � ' ( 1) 3. 1 6
3.
Holding Bot. Syst
PUMP /SIPHON INFORMATION Final Grade (� S
� Y
Manufacturer Demand St Cover �/ A
GPM S V1
Model Number
TDH Lift �� Frictin s System Head DH Ft
Forcemain Len t D%a. h Dist. to Vvell
SOIL ABSORPTION SYSTEM
BED/TRENCH Width / Length / No. Of Trenches PIT DIMEN S No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO JBLDG WE L LAKE /STREAM LEAPHIVG Manufacturer:
INFORMATION T Of S s m: CHAM OR
yy , ` ` i D Model Number:
DISTRIBUTION SYSTEM Ca J �)
Header /Ma ' Id Distribution r /� x Hola Size x Hole Sp;ng I ve t r In ke
�y Pipe(s) 2 c/
Length Da Length Dia Spacing v
/7
SOIL dOVER x Pressure Systems Only xx Mound Or At - Grade Systems Only S
Depth Over h of Seeded/Sodded ed xx Mulche
Bed/Trench Center I / Bed/Tre ch Edges Topsoil xx J Yes 01 No Yes Ll No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1' / / 1 Inspection #2: // d
Location: Parcel No: 12.31.19.
2247 74th Street Somerset ��``���p
Wl 54025 (E 1/2 SW 1/412 T31 R1 9W) Wild Turkey Retreat Lot 15
1.) Alt BM Description = 5 � W v G — if o Y Vik ( r
2.) Bldg sewer length =,.3, / :S� S
- amount of cover
Use other side for additional information. /
Plan revision Required? ', Yes ' No
SBD -6710 (R.3/97) Date Insepctor's ignature Cent. No.
Safety and Buildings lltvtston k uuttt y I
201 W. Washington Ave., P.O. Box 7162 .✓5 /,x
r�S M Mad WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.)
cons
(608) 266 -3151 30 22- 3
Department of Commerce
Sanitary ermit Application State Plan I.D. Number
Y pp 263 = l res. 10
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide oject Address (if different than mailing address)
may be used for secondary purposes Privacy Law, sl5.04(1)(m)
L Application Information - Please Print All Information 4 ; 5
Parcel # Lot Block #
Property Owner's Na me ��11 // ^�
.�• 1 � J
Property Own 's M ailing Address Hroperty Loca
A GJ Section
/
City, State Zip Code Phone Number
�• �� (circ ne)
je j � T � N; E or
II. Ty a of $uilding (check all that apply) f S'►
Family Dwelling - Number of Bedrooms a- ic.-
Subdivision e CSM umber
❑ Public /Commercial - Describe U /
17 State Owned - Describe Use
O 1' 2�F ("L (_ ❑City_ ❑villaow ip f
III. Type of Permit: (Check only one box on line A. Complete line B if applicable) 03Z
A. ew System ❑ Replacement System 11 Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Permit Transfer [o New
List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
N. Type of POWTS System: (Check all that apply)
J Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable s At -Grade Single Pass Sand Filter
❑Constructed Wetland El Pressurized In- Ground El Holding Tank ❑Peat Filter ❑Aerobic Treatmen rat Recirculating Sand Filter
❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dispersal /Treatment Area Information:
Design Flow (gpd) Design Soil �Application Rate( f) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
V1. Tank Info Capacity in Total Number Manufacturer Prefab ite Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank v
Aerobic Treatment Unit /�
Dosing Chamber
VII. Responsibility Statement- 1, the under gned, assume responsibility foie `installation of the POWTS shown on the attached plans.
Plumber's Na me (Print) Plumb s Si gnature MP/MP A Number Business Phone Number
1Qd_A,-1,0 U__ � ED
Plumber's Addre s (Street, City, State, ode) l
/
VIII. County/Department Use Only
Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing A ent Signature QA Stamps)
Surcharge Fee)
❑ Owner Given Reason for Denial 35D f � Z
I IX. Conditions of Approval/Reasons for Disapproval
�ly`Qdnti7C'OJe�R�J o0 �" �l�LC�P'
I , j complete plaps (to theCounty only) for the sys m on pip r not les, 61/2 x SB�398 (R. X1 /P ^�w
I�
PLOT PLAN
P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025
1
/2 SW 1/4S 12 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX
7/18103 3
BEDROOM
RS Shaun Bird 226900 DATE
CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK
t
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 gallon
HOLDING TANK SIZE LOAD RATE ,5 ABSORPTION AREA 900 # of chambers none
IL BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION loo' Filter Zabel A -100
❑ BOREHOLE O WELL
H.R.P. Same as Benchmark
SYSTEM ELEVATION 99.0'
74th St.
Scale = 1/4" = 10'
Wel is to meet all
Comm. 83
\1 �6
Area 15' below system is Sl
to remain undisturbed Alt.
uffcutt Combo tank
3
Bedroo
House 9 8' B - 2 f
Tank is to be properly 99
bedded and provided with .,
lockdown covers with
CD
approved warning labels
100
Grading is to be done to divert
run -off away from system
Pro p ert Line
r
f Safety and Buildings
Y 4003 N KINNEY COULEE RD
LA CROSSE WI 54601 -1831
TD
#: (608) 264 -8777
�,sconsin www.wisconsin.gov
.wis c ons
.wisonsin.gov
Department of Commerce
Jim Doyle, Governor
Cory L. Nettles, Secretary
i
July 31, 2003
CUST ID No.226900 ATTN. POWTS Inspector
SHAUN R BIRD ZONING OFFICE
BIRD PLUMBING, INC ST CROIX COUNTY SPIA
1008 192 ND AVE 1101 CARMICHAEL RD
NEW RICHMOND WI 54017 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 07/31/2005 Identification Numbers
Transaction ID No. 894263
SITE• Site ID No. 662753
P.C. Collova Builders Inc Please refer to both identification numbers,
2247 74TH St above, in all correspondence with the agency.
Town of Somerset
St Croix County
E1 /2, SW 1/4, S12, T31N, R19W
FOR:
Description: Three Bedroom At -Grade System
Object Type: POWT System Regulated Object ID No.: 913994
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
The following conditions shall be met during construction or installation and prior to occupancy or use:
General Approval Requirements:
• This system is to be constructed and located in accordance with the enclosed approved plans and with the "At-
grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater Systems" SBD-
10570-P (R.6/99) and the SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST
(01/81)
• Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area.
Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal
are prohibited.
Condih
• The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption APP
area. chs. NR 811 & 812c
DEPARTMENT
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the M OF
requirements of Sec. 145.135 and 145.19, Wis. Stats. M "
SEE CORRE:
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the
designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat
• Comm 83.22(7) A copy of the approved plans, specifications and this letter shall be on -site during construction
and open to inspection by authorized representatives of the Department, which may include local inspectors.
SHAUN R BIRD Page 2 7131/03
Owner Responsibilities:
• Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and
maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.
Comm 83.54(1).
• Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as
required under s. Comm 83.54(4) shall be considered a human health hazard.
• Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the
county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the
component(s) utilized in the POWTS.
All permits required by the state or the local municipality shall be obtained prior to commencement of
construction/installation /operation.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions
should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this
review shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter to the owner and any others who are responsible
for the installation, operation or maintenance of the POWTS.
Sincerely, Fee Required $ 175.00
Fee Received $ 175.00
Balance Due $ 0.00
Charles L Bratz
POWTS Reviewer II , Integrated Services WiSMARTicode: 1633
(608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday
cbratz@commerce.state.wi.us
cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544
Cover Page s� C z z zoo
toys fli
Shaun Bird
Bird Plumbing Inc.
1008 192nd Ave
New Richmond Wi 54017
715- 246 -4516
Date: 7/18/03
Owner: P.C.Collova Bldrs. Inc.
Location: E1/2 SW 1/4 S12 T31 N,R19 W Lot 15 Wild Turkey Retreat Somerset
System type: At -Grade
Manuals Used: At -Grade Component Manual version 1.0 SBD 10570 -P (R.6/99)
SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-
SAS (01/81)
Page#
1. Cover Page
2. At - Grade Plot Plan
3. At -Grade Cross Section
4. Pipe Cross Section /Pipe Layout
5. Pump Chamber Cross Section
6. Pump Curve
7 -9. Maintance and Contigency plan
10 -12 Soil test
�nally
Shaun Bird / NED
Signature CONVERGE �y pO$
License number 900 :PONDS
N
PLOT PLAN
PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025
E ` 1/2 SW 1/4S 12 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX
i
MPRS Shaun Bird 226900 DATE 7 /18/03 BEDROOM 3
CONVENTIONAL AT -GRADE M CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 gallon
HOLDING TANK SIZE LOAD RATE ,5 ABSORPTION AREA 900 # of chambers none
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 99.0'
74th St.
Scale = 1 /4 11 = 10'
Well is to meet all setbacks
found in Comm. 83
.M
B-
Area 15' below system is 8 Slope Alt. B.
to remain undisturbed
Huffcutt Combo tank
Pro 3
Bedroom
House 98'B-2 .B-3�
w
Tank is to be properly 99,
C°
bedded and provided with
lockdown covers with °
-a
CD
approved warning labels
100
Grading is to be done to divert
CD
run -off away from system
Prop erty Line
I
L
>5` B >
5
PVC FOUX-MNI ._Iw
>5s r2s "TURw— UPS •,
_ F [ ________ -- -------- -- - --
k-- CtsrKC''_ITtawt LAtfc.RAt
A �Sr e+B►�: ��D ae- =.`�R
WELL
- '_'a
5`
( /6B �
l/2 B
A = 40— R.
B = _ Ft. , H
L. = �-=-- R. CELL of MC3GltF_ Gl
V J Z Ft
P0??ka%FEb SYNaTtiEnL Fabri { Distribution Later
STAB101 V_b Observation ---- ---_,, J.J-�R � � Soil Cover
Well 2"
i L& WEb LA`lEQ
>_ 5`
A ��� : �5'
plan View and Cross Section of Wisconsin At-grade Unit with a
Single Absorption Area on a Sloping Site
�ILE14SE. # :
S.1CaNATUKE.:
Page Of
Distribution Pipe Detail for Lateral Metwor
Di s ,QC C e Sr
'
TURN -uP �CLEttnout
PVC Force Hain
l3istribution Pipe
P
* Last Hole Should Be Next To
ruu -UP
Gr .
Hole Diameter . Inch
P Ft. n
X Inches Lateral Diameter
�- Inch {es}
Y Inches
Force Main Diameter Z Inches
of Holes /Wipe _
Invert El evation Of Laterals Ft.
Signed:
License dumber:
Date:
S£PTiC TANK PUMP CLAMBER CRt?SS S
ECTiON AND SF£CIfICATIONS
WEATHERPRMF A PPROVED
MZH. ABOuE GRADS JUNCTTON BOX P P R OLE COVER
y „ �Z 1tRNT PIPE I WINDOW OR WITH CONDUIT
> Z�: FROM D44R, wf PADLOCK F-
FRESH AIR INTAKE WARNING LABEL
.� �.. 4" MIN
FINISHED GRADE
n z�
° Mti1s-
y' c.s.
28° IN.
INLET
GAS- �JpPpRDVED
MATER TIGHT SEALS A TIGHT
A SEAL ► JOINTS WITH
APPROVED PIPE
F I LT ER ALI"1
B s ON 3 �jg SOIL
APPROVED
PIPE 3= C T OFF
ONTO SOLID �
PUMP P flFF ELEV (__.J— F �
TAN IC
3t= APPROVED BEDDING UNDER ))_ , =NCRETE PAD
-�— /' • q�'L/�L/Yr�/"
SPECIFICATIONS c
Nt1MBEg
OOSES PER DAY: r --
SEPTIC f DOSE GAL -
CT INCLUDIN G � ---- --
TPaAiK MANUFA LOSE v4LME J
CAL . F LOWBAC K = f
SEPTIC '� " = 6 6AL-
GAL.
TANK SIZE ' DpSE �. A _ INCHES .�
; eAzl CA P AC I T I ES : GAL.
���
S = .. 2 INCHES = •� �--
A y AgY{ Mpt3tiFAC'1�iRER s GA
MODEL MODEL HU14S£R = � �_" INCHES = L__- ---- --
SyiITCH TYPE: C
Nf�iE AC = v
pUmp M TYPE ` ���' g ALARM WIRING AS PER ILHR �--�
t� -> GPM PUl3I' EE
REQUIRED DISCHARGE RATE —�--" pISTRI'SUTIt�3 FSP£ •�.. -- EET
pump OFF AND / . C � °_���' FEET
vggTiCAI. FrIFFERENCE $ET�'lE£N - .FRICTION FACTOR - FEET
£Tf �� FT • TI0T.0 jjj:AAD = /'.. s
+ MINIMUM At£'T'�tORK SUPPLY P T TAL
+ pEET FORCEMA.IN X �'
DI /�, WIDTH L? ._.�` DIAMETER ._..�—
L£KGTK i "'''
IN'f£RjAL MENgIDNB flF
PU P's? TAN L.IQifID `�
DATE=
LICENSE N UMBER - --'— r
—
SIGNED=
:f88
P.
L U G" T
IF
RIv, L
Y
H
F
A
----------
7
7
20
4-.
0
100
:D
T E'
ATIONS
RY FOR SPECIAL AP
PLIC
CONSULT FACTO
-i do panels a ,aiiable and supplied with
for duplex s, sterns
ie pn3se
-n alarm. jvjjcheS are available for controlling Si
V level contro s
Systems
tacn for variab
i1cre s a re availabl level float WA , '
variable
Double
)g and shot[ Cycle Controls.
ee R
level
lo ations. c-� /1 1420
ava ilable f outdoor inStall
Sea!&d Qwik-Bo)( 3
0,er 13�0'F. (, special quo tation required.
1521153 Series P°
Q
�110Q-E—L-s pie. . -X-13�4
F.Iode, - T
- vs I
I -, - 2 0'
i
No-
Included or
2 ECTION GUIDE
tt A, 3 SEL� ack variable float
yb
w;Kh or double P199
on
ate 1 4 ---= -'—` . i V,1(16-
,1 c ded I
, 1 ; 0 , 1
: :.�- — - � , 1. si P
2 or
` Re t C,�d1047T
sv�,cch. I
Mvi F-Pak .
r cooed ;T.ode'
1 95 used as a C 0001 Oct ive cifj duplex (3j
variabie
CAUTION
o should be done by a qu alified
at o f Controls, Proiecdon devices 3, F)c w'f' f float Sysle
-
t"I install s hould be f in cluding the most o l - rl-
A ll elec l6cal and safety codes 5 , i i Act (OSHA)�
licensed electrician. onal safety and He-V-
ecent National Electric Code (K.EC),rl GccuP -
Eor-D ESIGN D
RESERVE POW IXL- f —_-,
I s engineered into the des!gn 0,
Unus%,31 conditions a reserve safetY W tOf l 16347
For
MAIL TO: P.O. 80- '� man, 1,111:aCtur2r Of
LouisvJ118 KY 40256-0
3549 Cane Y /
SHjp To
17
4. &!w
Fh /�� Zd `E .
Lous"il;e
�29
(50,1) 778-273' ( -
F �y 774-�,
- ESP
Zoeller C0
Maintenance and Contingency Plan for a At -grade System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Dose Chamber is to be pumped at the same time as the septic tank.
3. 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.
4. Once every 3 years the mound is to be inspected via the inspections pipes in the at-
grade. The laterals are to be inspected via the cleanouts.
5. Owner agrees limit greases, garbage, n water conditioner discharge into the s
to es, arb , a d ate stem. y
9 9 9 9 9
6. Pump and electrical components are to be checked at the time of the pumping.
7. Owner agrees to leave the area 15' below at -grade undisturbed.
8. The owner agrees to save this plan.
9. Trees, shrubs, and other similiar vegitation are not be planted on system. The system is
not be driven over.
10. Effluent Quality is not to excede the requirements found in Comm. 83
Contingency Plan
1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if
needed, then bypass pump float and try pump without float. If this works, float is bad,
replace float. If pump still does not work, check power at the pump with a electrical device
such as a hair dryer. If no power, check breaker inside house and call a electrician. If there is
power, then pump is bad and needs to be replaced by a plumber.
2. If at -grade fails, determine cause of failure, test another area or remove pipe and sewer
rock, retill soil, install new mound system.
3. Replace any other failing components as needed.
Important Phone Numbers
Plumber: Shaun Bird 715- 246 -4516
Pumper: Tom Mondor 715 - 246 -5148
St. Croix County Zoning 715 - 386 -4680
Page of
OWNER'S MANUAL & MANAGF - T PLAN
P pWTS SYSTEM SPECIFICATIONS
bvZ"> al ❑ NA
Septic Tank Capacity l --�
FILE INFORMATION ❑ NA
Owner yn i t' "`' ✓
1 0( LA Septic Tank Manufacturer
Permit # Effluent Filter Manufacturer
e _1 ❑NA
DESIGN PARAM�RS l ❑ NA
a Effl Filter Mode
✓,
' al O NA
Number of Bedrooms Pump Tank Capacity cJ
NA
Number of Commercial Units U al/da Pump Tank Manufacturer
Estimated
flow (average) pump. 2� ❑ NA
led . P P
aVd -? � s 2 ❑ NA
Design flow (peak)• (E x
ted Pump Model
S' aVda 4f
Sol Application Rate Pretreatment Unit ❑Peat Filter
Monthly average fa Sand/Gmvel Filter
InfluentlEtfluent Quality S30 mg/L ❑Mechanical Aeration I-] Wetland
Fats, Oil & Grease (FOG) ❑ Other
Oxygen Demand (BODS) 524 mg/L L] Disinfection
Biochemical OxY9 S S 5150 m /L P70D ufacturer
Total Suspended Solids (T ) te a{ 4:,etl(5)
Monthly average" round (grav y) [I In -ground (pressurized)
Pretreated Effluent Quality S30 mg[L -grade ❑ Mound
en Demand (SODS) ❑ Other
Biochemical Oxyg SS 530 mg /L
Total Suspended Solids (T SS) ri ine
eometric mean) f y. 10' cfu /100mi wastewater and
Fecal COliform ( g Values typical fof dO�1e' tic (non comr it
in ch diameter septic tank effluent Max imum Effluent Particle Size .. Values typical for pretreated wastewater.
Frequency
MAINTENANCE SCHEDULE Service Freq ar(s} (Maximum 3 yrs.)
Service Event � ❑ months
At least once every equals one-third (y,) of tank volume
Inspect condition of tank(s) When combined sludge and scum eq
Pump out contents of tank(s) At least once every
❑months ear(s) (Maximum 3 y rs.)
dispe rsal cell( C] months �}ear(s)
Inspect At least once every ❑ NA
❑ months ar(s)
Clean effluent filter At least once every Ks) ❑ NA
pump controls & alarm ❑month
inspect p ump, At least once every - ❑ NA
Flush laterals and pressure test At least once every ❑months CI year(s)
L] Other. months
year(s) ❑ NA
At least once every
ether
MAINTENANCE INSTRUCTIONS n one of the following licenses or
of tanks and dispersal cells shah be made by an individual carryi g sing or broken
POW'TS Maintainer, Septage
i Restricted Sewer, POWTS Inspector Master plumber e s to identify any mis
e for any back up
cer tifications: Master Plumber to check the effluent levels
O rotor. Tank inspctions must include a visual inspection of the tank
Servicing Pe measure the volume of combined sludg nsc and to n the
hardware, identify any cracks or leaks, dispersal colts shall be of y The ponding of effluent o
or ponding of effluent on the ground surface. �' ddp9 of effluent on the ground surface au thority.
d to check for any po
in the observation pipes an req uires the immediate no of the local regulatory
ground surface may indicate a fatting condition and req equals one-third (X,) or more of the tank volume, the
i
and scum n any tank eq eret and disposed of in accordance vAth ch- NR
When the combined accumulation of sludge a Septage Servicing Op
entire contents of the tank shall be removed by nents, and anY
113, wsconsin Administrative Code. retreat ment compo
' uent filters, mechanical or pressurized POWTS componen by a certified POWTS Maintainer.
The servicing of effl at intervals of 12 months or less shall be perform °f co mpletion of any service event.
other maintenance or monitoring autho within 10 days
A service report shah be provided to the local regulatory p roducts or other
� for the presence of painting p
START UP AND OPERATION use use of the POVVTS check treatment tank( cells }. If high concentrations are
For new construction, Pri or de the treatment process a o nd/or damage the dispersal r W prior to use.
chemicals that may imps removed by a septage serng pe
detected have the contents of the tank(s) vici
I
Page of
shall not occur when soil conditions are fr ozen at the infiltrative surface- IS restored the excess
System start up flit above normal highwater levels. When po wer
During power outages pump tanks dY a
g p the dispel cells) in one large dose, overloading the cell( tank removed by a e
a ed to contents of the pump
vrastew or surface be dish rg e of or contact a Plumber or PO
efij}rent To avoid thi situation have the
backup or surface discharg p to the effluent pump VVTS Maintainer to
Septage Servicing Operator prior -to restoring P°
assist in manually operating the pump controls to restore normal levels within the pump tank
park vehicles over or tanks and dispersal Cells. Do not drive or park over, or otherwise disturb or compact,
Do
not drive or pa at-grade soil absorption area.
I of n mound the area within 15 feet down slope an rote the performance and prolong the life
a
i
stream m P
ter Y
e w astewaters .
Reduction or - eli min a tion of the following from th degreasers, dental floss; diapers,
of the POWTS: antiblotics; baby wipes; cig�ae butts; condoms; cotton swabs; g rease ; herbicides; meat
disinfectants; fat foundation drain (sump pump) water, fruit and vegetable peelings; gasoline;
scraps. medications; Olt painting products; Pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMMENT taken out of service the following steps shall tie taken to insure that the
When the POWTS fails and/or is perrnanentiy
in compliance with ch_ Comm 83.33, Wisconsin Administrative Code:
abandoned Sealed.
s tem is p roperly and safety pipe openings
P and sed of by a Septage Servicing the a
cis shall be disconnected
All piping to tanks and p - Servicing Operator
• The contents of all tanks and pits shall be removed and property
all tanks and pits shat( be excavated and removed or their covers removed and the void space
After pu mping ,
filled with soil, gravel or another inert solid material.
CONTINGENCY PLAN
vide a code
If the POVYTS fails and cannot be repaid the following measures have been, or must be taken, o pro
compliant replacement system:
El suitable replacement -area has been area d be prof ted from d st rbance location
nd compa and should not
absorption system. The replacement Se d structure, lot lines and wells. Failure to
b required setbacks from existing and propo site evaluation to establish a suitable
be infringed upon Y e4 he need for a new soil and
protect the replacement area will result in t with the rules in effect at that time.
comply
replacement area- Replacement systems must tback A suitable replacement area is not available due last resort to epoace iff1e ed PO
V1rTSng advances in POVVTS to se
be installed as a
technology a holding tank may n failure of the PO
WTS a soil and
The site has not been evaluated to to Locate ass suit able replacement a Upon t If no replacement area is available a
e valuation must be performed -I POVYTS-
va) a failed site e the
to replace holding tank may be installed as a last resort p
at at
ound and at -grade soil absorption Systems may be reconstructed in place following , effect removal o t h time.
he i surface. Reconstructions of such systems must comply
<<WARNING» MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN.
SEPTIC, PUMP AND OTHER TREATM ENT TANKS DER ANY
CIRCUMSTANCES. [)EATH MAY
DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UN
RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY
DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POVI(TS MAINTAINE
POWTS INSTALLER _
Name r" r � � :� •"t
Name e°e. 4e �-' / "— — e _j '/ 4"
Phone
Z
Phone f. — �—
SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHOR
SEPTAGE Agency h e, 4 1
E Phone
J °� agencies-
Tills document meets
file Staff Of the Green Lake, Marquette and Waushara County Zoning and S ag
This document was drafted by cep (?10 t )
the minimum requirements of ch. Comm 83 22(2)(b)(1)(d) &(fl and 83.54(1), (2) & (3), vriisconsin Administrative Code" Use of this document does n0
guarantee the performance of the POVVTS.
7
muconsnr Deparwoerrt of commice SOIL EVALUATION REPORT Page of
Division of safety and Buildings
in accordance vrirtr Comm 85. wig. adm cone y` / � Cr
Attactr complete site Pm on paper not Mass than 8 W x 11 in size. Plan must include. !� )
include. but not wnited to. vertical and horizontal reference pout ). won and Parcel I.D. Percent sloPe. scale or dimensions. north avow, and Wcation roe to nearest road.
bqeowed y Date
Date
Pi®ase print ail hformat/on.
m •12
.04 , Ga
be uses to
taw. s. 5 O t )i• ' , lam.
wrsorrei wrrormeson yar provA,e m" seoorWerY vurp— `
i Ply
L• �13� cv Govt tea t 7 1 114 S /� T N R E( W
property g Address tot #� # Subd CSNtII
qty State Zip code Phone ❑City ❑Village o�nm Rom
t -5Y6VS I ( 1 S ..55P -S9
New Construction Use: Residential / Number of bedrooms Code derived design now rate � -- Gm
❑ Replacernent ❑ Public cir cmvrwciw - Describe: - - - --
Parent �/ �- // Food Plain elevation if applicable A— R
art S S�,P.� i of <Pi tJGx -� , 6)
6�/A a- 2
i � Borin g #
1
pit Grotxtd stxface elev, ' L ft. Otter to kni" factor Sill Appkadon Rate
Horizo n 060 Dorrirmt Color Redox Description Tedlure Structure Carsistence Boundary Roots GPOIIF
irr. LtNtse9 Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Ett#2
Borkv Bortrg #
Pit Ground surface eM3v v ' �ft. Depth torritin9 factor in. So il A pplica ti on Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDRP
in. Mansell Qu. Sz. CorlL Color Eif#
Gr. Sz. Sh. '1 TdW2
cam- � s -
• E1lkterd = BOD > < 220 nrgA. and TSS >30 <_ 150 E�Ouent #2 = BOD <_ 30 mgil. and TSS < 30 rnWL
CST Number
( �2c��00
✓ ✓� Date Evaluation Conducted Telephone Nub
Address
o
Property owner Parcel 10 # Page of
Di Borkv # ❑ e« ��
� p� Ground surface elev. ' R Depth b tinnl8ng l - �-�—'" sot Rabe
Horbw Depth Oommant Redoc Description Texture Structure Consistence Boundary Roots GPD fE
in. Munsel Qu. Sz Cart. Color Gr. Sz. Sh. 'Etr#1 7
-�
7- i t r ° -S
Z -Q r
M Boring g # ❑ sorms
❑ Pit Ground surface elev. fl. Depth 10 lirrift factor Ir Sol Rate
Horizon Depth Oorrinant Color RedocDescription Texture Structure Consistence Boundary Roots GPDM
in. Munsel Qu. Sz. ConL Color Gr. Sz. Sh. •1201 •Etf#2
F � ❑ Pit Ground surface elev. R Depth to wing factor in
Sol Appkadon Rate
Horizon Depth Do n wnt Color Redox Description. Texture Structure Consistence Boundary Roofs GPOW
in. Munsel Qu. Si Cont Cola Gr. Sz. Sh. - 'Etf#1 •Eff#2
• Effluent #1 = SM > 30 < 220 ntglt. and TSS --30 150 ffv& • Effluent #2 = BOD, < 30 mg& and TSS _< 30 mg1L
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.
seo-auo(RAM)
Soil Test Plot Plan
Project Name P.C. Collova Mrs. Inc Shaun B`
Address P.O. Box 489
Somerset Wi 54025 #226900
Lot 15 Subdivision Wild Turkey Retreat Date 9 /6/02
E 1/2 S W 1/4S 12 T 31 N /13 W Township Somerset
Boring Q 7eli PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of 2" Pipe
System Elevation 99.0' *HRPSame as Benchmark
t. BM Top of 2" Pipe @ 99.8'
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 c
change.
8% S
Slope 10' 11A 0 ,
0 '
30'
98' 60' B -3
125'
B-2
99'
100
296' Property Line 10+1
•
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
V
(Verification required from Planning Department for new c traction)
City/Stat LP,+ w Parcel Identification Number 03Z - Z160 - ,Sb
LEGAL DESCRIPTION
Property Location %,, S(,7 '/4, Sec. (a . T3LN -R W, Town of
Subdivision r Lot # �.
Certified Survey Map # �— Volume Page #
Warranty Deed # . L - � L 5 �0 (2; Volume 1 . 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 owner and by a
masterplumber, journeymanplumber, restrictedplumberor a licensed pumper 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.
Uwe, 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
F o f a
that septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
year expiration date.
P. C. COLLOVA BUILDERS, INC. - 7 / of 0 3
SIGN TURF OF APPLICANT (715) 247 -2742 DATE
P.O. Box 489
SOMERSET, WISCONSIN 54025
OWNER CERTIFICATION
(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
th desc by virtue of a warranty deed recorded in Register of Deeds Office.
P. C. COLLOVA BUILDERS, INC.
SIGNA O APPI; CANT ( P O Box 4892 —I / t H/ 3
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
FROM P 1 C MlLOVA HL.DRS, INC PHONE NO. : 715 247 2747 Oct. 28 2002 02:14PM P1
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F�
O F^ I Q I I
I I N 23't s 0, E LOT 14
0 00 86.72
�s `= 130823 S.F.
--- (� 3.00 Ac. 0
z cn Oo I v
07.26' p 80' RADIUS TEMPORARY
Ij I ^j CUL-D -SAC EASEMENT (TO C.B. 2.89 Ac.
212.94' • c BE REOVED UPON OD
304.01 91 07 m I v v NORTH RLY EXTENSION OF ha h;
w , ( ROAD)
S 45'11'24" E �� rn S 89'11'11 E
127.39' v L -- —
LOT 12 w N 100' — — 439.91' -- — — — -,
136020 S.F. ,i C
0 3.12 Ac.
�, , LOT 5
130775 S
3 S.
C.B. 1.35 Ac.
S 87'41" W 0
'00 N
i - G �,� p .00 Ac.
� 143.50' o ID o"
HWE = \ F C.B. 2.29 Ac. C
LBO = 972.00 N 97Q.0� LBO = 972.00' A&LA I
/ , N m
�,
/ 6 .88'49'52" 461.85'
/ /57.75 Z 211;36' \ �, 92.74' Z
1a ° ° LOT 16 °" (2 s o
Ln
0
130690 S.F, = 3 S F m
' A,b 3.00 Ac. HWE V
/ � ,' � -'�' HWE rn I N a� 970.0
970.0 (;\`
?p> n j
S 8 6'08'47" p"� f ro �I W / C.B. 0.78 Ac.
- - \ %0 �%K S LBO = 972.00'
�
1 82.52' \ O
\ \ — N 88'59'56" E
\ \ \ 4.7s
HWE _ \ 38.99' 482.54 836
967.8' LO T 17 38.81 '
TJ \ \ 130723 S.F.
;OT 7 3.00. Ac. LA
059 S.F. C.B. 2.64 Ac. I�
.01 Ac. ' p�a / LBO = 970.00'
•. /