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HomeMy WebLinkAbout032-2161-10-000 Wisconsin Department of Commerce Count Safety and Building Di;�ision PRIVATE SEWAGE SYSTEM St. Cro ix INSPECTION REPORT Sanitar Permit No 463330 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. Somerset, Town of 032- 2161 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No /dt� GS 12.31.19.1389 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark , Desipc,}- Alt. BM Aeration Bldg. Sewer �G Q7 ZS Holding St/Ht Inlet �, C SUHt Outlet TANK SETBACK INFORMATI TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic G � 39 Z9 / rte Dt Bottom Dosing -J a Header /Man. . Aeration Dist. Pipe 1 �c �1 Holding _..... -._ _ - • °-• - - -� Bot. System n PUMP /SIPHON INFORMATION Final Grade 4 • Manufacturer Demand St Cover GPM • Z • (3 Model r .,.._ ..., ` 1 �y 9S • / TDH tift Friction Loss Systelxread TDH Ft ` qq ' Forcemain __..,._ Dt9. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width I Length No. Of Trenches A PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 C > Z SETBACK SYSTEM TO P/L IBLD G WELL LAKE /STREAM LEACHING Manufactur r:, INFORMATION Type Of System: �, t CHA UN OR Model Number r �L DISTRIBUTION SYSTEM o o 1 ci ZZ Header /Manifold �� Distribution x H e Size x Hole Spacing Vent to Air Intake ` L q Pipe(s) ` V a- Length / Dia Length Dia \ Spacing 2 SOIL COVER x Pressure Sy stems Only xx M ound Or At - Grade Systems Only Depth Over I No J Depth Over xx Depth of xx Seeded /Sodded xx Mulched renc es I Topsoil Bed /Trench Center Bed/Th Ed \\ g Yes Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 2213 74th Street Somerset, WI 54025 (NW 1/4 SW 114 12 T31N R19W) Wild Turkey Retreat Lot 21 Parcel No: 12.31.19.1389 1.) Alt BM Description 2.) Bldg sewer length = Z J - amount of cover = Plan Required? Use other revis for additional in Yes /No - _ formation. - - - Date Insepctor' Signature Cart. No SBD -6710 (R.3/97) I Safety and Buildings Divisio i County L 201 W. Washington Ave., P.O. Bo, 7162 �`�— , b lvi �� �;I L 1 `, a WI 5370 — S nary Permit Number (to be filled in b o.) DepartmentofCo ,e ( K��'� J San i_ta y Permit Applicati n , ; , Stn Plan I.D. N ber In accord with Co nm 8 21, Wis. Adm. Code, personal informati you ppizi4k may be u r:d fo secondary purposes Privacy Law, s 15.04 )(m) Proj t Address (if Oem n ma iling ldress) I. Application Information Ple se Print All Information ZON'N - =` Property O is Name r Parcel # rc� t # B :k # 7C,c, 1 �a� U14 o_ Property Owner's Mailing Addre c:; Property Lo F. Z�l 1 13, o _ji- ?� A?A) /" S �)/. Section 2- �- V3 j) Cit State ip Code Phone Number \ p , ) 1 °� � T / i N; or ctr on V W II. Type of Building (check; 1 II th t apply) ...� 3 �►21G1�YS �� 1 or 2 Family Dwelling — Nun her o 3edrooms �� Q1/}�.0 - Subdivision Nam CSM N fiber ❑ Public /Commercial — Describt Ise C / Q � � El State Owned — Describe Use _ . S C�7i� (� _ ❑City_❑ Villag sh of _ !3 x4p 1 III. Type of Permit: (Check nnly fine box on line A. Complete line B if appriica e) A. ❑ iteph .ement System ❑ Treatment/Holding Tank Replacenu nt Only El Other Modification to Existing System B. El Permit Renewal ❑Penn Revision L1 Change of El Permit Transf :r to New List Previous Permit Number and Date Is: d Before Expiration Plumber Owner ly of POWTS System: _(C] eck all that apply) n — Presszed Inhruund -- ❑ 1 o.d > 24 in. of suitable soil ❑ Mound < 24 in. of suit► ble soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressi i ized n- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aero )ic Treatm mt Unit ❑ Recirculatin and Filter Aer Recirculating Synthetic Media Filtr mg Chamber ❑ Drip Line ❑ Gravel -le Pile 'n) c J ge V. Dis ersal/I reatment Are, nfi •mation: ,i Z Design low ( Design S ,` Ap Ion Rate(ggdsf) Dispersal Area Required (sf) 1)i a osed (sf) System Elevn VI. Tank Info Capa: ty irit Total Number Manufacturer 8 Prefab Site Steel( Fiber i Plastic Gallons Gallons of Units Concrete Constructed Glass New Exlsl g Tanks Tank Septic or Holding Tank �n Aerobic Treatment Unit �11 Y Dosing Chamber VII. Responsibility State t 1, ►e undersijohmAssume responsibility for installation of the POW TS shown on the attached plans. Plumber' " Name (Print) Aode gnature MP/MPRS NL mber Business Phone Number _ c _ G Z - 6 Plumber's Address (Street, City,,' tste, : ° VI Co un /De artment Ut a On Approved ❑ Disapprovec Sanitary Permit Fee (includes Groundwa erDatg Issued I ing A t Signature (N ps) ❑ Surcharge Fee)��� a� Owner Give i Rea in for Denial � IX. Conditions of Approvataleasl is for Disapproval YSTEM OWNER: Septic tank, effluent filter and dispersal cell must all be serviced al as per management Plan 2, c requirements must be maintained as per applicable code /ordinances. Atta i complete plans (to the County only) for the system on paper nit less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) T PLAN PROJECT P. C. Collova BldrsjInc. ADDR S P. O. Box 489 Somerset Wi 54025 NW 1/4 SW 1 /4S 1 2 N/ W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 2/24/05 3 DATE BEDROOM CONVENTIONAL )00C 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 chamb BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Zabel A -100 ❑BOREHOLE SWELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 94.6/94.5 5' below qrade Alt. BM Top of Lath @ 103.0' Well is to meet all setbacks required by Plans Designed Using Vent WDNR Conventional Powts Manual Version 2.0 Please Note: Tested area >6" Standard Biodiffuser may not be suitable for of Cover Leaching Chamber desired building area. with 31.1 ft2 of Area Check system location 11 " before excavating. Also, 6' Long survey was not completed 34" Grade at System Elevation at time of test. Set backs from lot lines may change. Pro 3 Bedroom House 25' '74th St. ST 25' B -3 35 , 3 kents 30' Tested area has 0% Slop e 2 -3' ' B -1 75 Alt. 2 M. 230' AT.01' Property Line PN/ N PROJECT P. C. Collova Bldrs. Inc. S P.O. Box 489 Somerset Wi 54025 NW 1/4 SW 1 /4S 12 /T 31 W TOWN Some rset COUNTY ST. CROIX 3 MPRS Shaun Bird 226900 DATE 2/24/05 BEDROOM CONVENTIONAL )00( IN-GROVIe 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 chamb s 22 IL BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100° Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 94.6/94.5 5' below qrade Alt. BM Top of Lath @ 103.0' Well is to meet all setbacks required by Plans Designed Using Vent WDNR Conventional Powts Manual Version 2.0 Please Note: Tested area >6 „ Standard Biodiffuser may not be suitable for of Cover Leaching Chamber desired building area. with 31.1 ft2 of Area Check system location 11" before excavating. Also, 6' Long survey was not completed 3 499 Grade at System Elevation at time of test. Set backs from lot lines may change. Pro 3 Bedroom D n JC. House 5' 74th St. ST 25' B -3 Eli e is Tested area has 0% Slope 2 -3' X 69' cells with >3' spacing� -2 75' B -1 Alt. 20' * M. 230' B.N .01' Property Line t t of commence SOIL EVALUATION REPORT Page t �. a wisaornsrn Departmen -� Daision of Safety aria in accordance with Comm 85, Wis. aim. code ... Attach complete site plan on paper not less than 8 x 11 kowes in size_ Plan must include, but not by ted to vertical and horizontal reference (BM), direction and Pleix i 1 pernt a lope. scale ordimensions. norm arrow, and location distance to nearest road. b 3 ce Please polnt all lnformathn. � 2 by Date ¢ PWSone it kmmoon you provide may be used for secondary Purposes �vacy Low. a. 1S.04 (1) � 0 K ill Y ProPedY I OCatiOr1 t �• �d� w Coat. Lot M S Ig T 3 N R E ProPerlY 0 w MaFmg Address 7 ! Pet /t e el city e Zip code Phone Number ❑ City ❑village own Oftrest Road Lll� i7dS 1 s) —� ? �° r New Construction Use Residential / Number of bedrooms Code derived design flow rate GPD E�3 Rep lacement ❑ Paretic - Describe- �nt fnateriat� J .c"� / Flood Plain elevation if applicable 1 1 ft 19 GUM > fob a 8 Baia r SON Pn Ground surface elev. S ft. Depth to Bitting factor im Sol Application Rate Morison Depth Ooffrirnant Color Redox Dam "on Texture Slruct<r+e COnSistence Boundary Ra>fs in. Mu>sel OLL Sz. Cont. Color Gr. Sz. Sh. • EW 1 • S� 9 • � p ❑ Boring Q B« # ,tai Pit Ground surface el" —Ot�'j L h Depth to Ong factor tn. Rate Horizon Depth Dom Redox Texttxe St Consistence Boundary Roots GPM in. Mt�ell CkL Sz. Cont. Color Or. Sz. SK *M1 'Efi#2 .s 2 — �4 lie • Effluent #1 = B01 > 30 < 220 mWL and TSS >30 <_ E kwd #2 = BOD 130 nV& and TSS <_ 30 mgfl. CST Number Date EvaNiatiom rCon Telephone Ncxrnber Address � �� z 1 Property Owner Parcel lO # page of © t3orft # u9 R Depth fo 9 tailor ! - : k im rt Ground sure elev. Soil Rate Horizon Depth Dominant re Redox Description Texd St uam C mistence Boundary Roots topOV(t' In. Munsel Qu. Sz. Cont. Cdor Gr Sz. Sh. Tam 'Eff#2 6 3• 99. ❑ ❑ Baft # ems ❑ P8 Ground surface elev. 1L D ep th to itrrritirug i" Soy Appkabon Rate Horizon D"M Dominant Coo Redox Desaiptiort Texdxe St mcdre Consistence Boundary Roots GPDIfF in. Mutsel OLL Sz. Cont. Color G` Sz. Sh. 'Em 'Em �rr9 F-1 Borx� # ❑ pit Gm nd surface etev. ft. Depth to IdniUrg factor in. S N Rate Horizon Depth Dominant Color Redox Description. Texture Sducdre Consistence Boundary Roofs Gi�OVf� im Muusell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eit#2 I Effluent #1 = BOD, > 30 < 220 mglL and TSS >30 150 nV& ' Etik>ent #2 = SOD, < 30 mg& and TSS 130 m91L 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. seoauotR.sAO/ ` Soil Test Plot Plan Project Name P.C. Collova Mrs. Inc Shau Address P.O. Box 489 Somerset Wi 54025 M #226900 Lot 21 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 Well PL Property Line County ST. CROIX 4�m r VRP Assume Elevation 1 f t. Top of Survey Iron System Elevation 94.6/94.5 *HRPSame as Benchmark Alt. BM _Top of Lath @ 103.0' 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. o E� 0 a 35' 30' Tested area has 0% Slope B- 7 5' Alt. B -1 2 230' B.M. 'Property Line No L r Z Z d0 6 133HS wnH0 WN M 03LWW co I 3 oVwL X99 , £0'21.91 I I. I — — ,4O'9St — — — — r — .61 — , LL'Lzz p .69'9LZ •..• I I �I ; 11 P N 0121'3r E N I W D IN I N FF = JJ ft 1 . 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CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer � I /1 / _& A L I �j _T / C _ Mailing AddressU Property Address (3 3 - (Verification required from Planning Department for new construction.) City/State rY1e0E± / W1 Parcel Identification Number � — ol LEGAL DESCRIPTION C/1 c 0 � 3° Property LocationA)L) , y�.l) %'_ , Sec. , T N R 19 W, Town of Subdivision (� � Lot r _ L. Certified Survey Map = Volume : Page Warranty Deed # s Volume age a � . Spec house . es _ no Lot tines idenui LO o 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 County Zoning Department a certification form. signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that ( I ) 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 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 Department within 30 days of the three year expiration date. C �, a — _q IGNATURE OF APPLICANNT DATE OWNER CERTIFICATION Uwe certify that all statements on this form are true to the best of my /our knowledge. I /we am /are the owner(s) of the r pe described above, by virtue of a warranty deed recorded in Register of Deeds Office. ;� /2 q; 0 SIGNATURE OF APPLICANT DATE Any information that is misrepresented 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 and a copy of the certified survey map if reference is made in the warranty deed. I Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. • 2. Eff luent 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. age, and water conditioner discharge into the system. 4. Owner agrees to limit greases, garb 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 Option #1. If system fails, determine cause of failure, use amate gf and install new system in tested replacement area. Option #2. Install system at a lower elevation, by removing chambers, removing biomat, ' s II new stem. and costa Y 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. I - Plumber: Shaun Bird 715- 246 -45 St. Croix County Zoning 715- 386 - 46 80 Pumper Tom Mondor 715- 246 -5148 Shaun Bird #226900 FROM P C COLLDUA BURS, INC FK]gE_NO. 715 247 2747 Oct. 28 2002 02:14PM P1 1Y /tO /UL_ Aul L1.Ul PA.A. lid SOU "131 RLV1JLZA u,• urd:u.r vuA !! LBSaP 27 tlNwnY.siw ! 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Tlfi�: 118SiDEDt TS';a7: li.►R:1P'3r;3Cv"I`.'.� � my l.na+•a sat%m - ..dWiLkc,rna. aediorised t� a 1�?B.Of, 's: �rn.) tlil7i MA'nt ww'. WAS 90.f. •TsD aY .461 .Krwmcw Nazw Palk. SWv at Wises"s - - - MyCaaoisutne ,pernancx.fHno4sanaePJana-:au. 'N,Ctl afD3>id119C5L11R.l�Y^J�AaM btYada;rvud `.�nr a+.rs�unn iwant..r,..ssinv,6lrc.N. WAiMRA:17Y U= S'..tTE r+1i Ol M1.C:7Mily FOeA[ ;rra� a,W I i 130736 S.F. I / 3.00 Ac. LID C.B. 3.00 Ac. I N S 88'29'26" E 604.70' LOT 20 i 134411 S.F. to 3.09 Ac. IW / C.B. 3.09 Ac. 1 S 89'17'23" E / 663.97' — ` LO T 21 / 157218 S. F. N 1 3.61 Ac. o ? ' TOP OF 3/4" IRON r C.B. 3.61 Ac. REROD BENCHMARK c C 979.02' I I C — — — S 89'17'23" E 701.34' — — 231.10' 234.15' 236.09' ILO 221 1 LOT 23 I I LOT 24 1 S. Fl 130802 S.F. I I 131856 S.F. 1 3.01 Ac. I I 3.00 Ac. I I 3.03 Ac. C.B. 2.70 Ac. I I U) C.B. 3.01 Ac. I N C.B. 3.03 Ac. a' Z �I IQ Ln I� cn N I I� I Ln Iz Irl I� . # to Ni IZ I L IWO I 1N