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HomeMy WebLinkAbout032-2161-30-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No 600265 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 Township Parcel Tax No: MICHAEL GOMEZ TOWN OF SOMERSET 032-2161-30-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: I;;fl,;, co )--k 12.31.19.1391 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic _ Benchmark I c~ 3 c (6ca.y l lrrdy-l Dosing Alt. BM Aeratior~ Bldg. Sewer Holding St/Ht Inlet W TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom i Dosing Header/Man. 71~ 7 .3 3 Aeration Dist. Pipe J _,zz ^^77 ~q Holding Bot. System T jai')', G",-3 , PUMP/SIPHON INFORMATION Final Grade x•03 Manufacturer Demand St Cover GPM (7 (7LX 10A O2. Model Number TDH Lift Friction ss System Head DH Ft Forcemain Length Dia Dist-4o-Weff~ SOIL ABSORPTION SYSTEM BED/TREN H Width Length No. Of Trenches PIT DIMEN IONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS f, ! / i 1 31 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufactures INFORMATION CHAMBER OR Type Of System: f ~ UNIT Model Num 'vr'-ln.~'h> 4>~ zi L? 5 r 4 DISTRIBUTION SYSTEM f (p j h~ j Header/Manifold Distribution x Hole Size Ix Hole Spacing Vent to Air Intake / r l Pipe(s) Length > Dia Len th Dia Spacing '~J f! ~ 9 SOIL COVER x Pressure Systems Only xx Mound Or At-Grad Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoi No es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 746 220TH AVE 1.) Alt BM Description = 2.) Bldg sewer length = a y t~jt - amount of cover = Plan revision Required? ❑ Yes ❑ No I1 Use other side for additional information. y l SBD-6710 (R.3/97) Date Insepctor's Si atur Cert. No. IV 1' ST. CROIX COUNTY ZONTING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTr'G SEPTIC TANK(S) A This is to certify that I hayTe inspected the t°xlstmQ ~ septi'c and/or dose tank presently sensing the following residence: (Street address) located at: 1i4, 1/4, Section , Town N, Range W. Town of St. Croix County Wisconsin. T?pon inspection T certify that T have found the tank(s) to the, hest of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be lunctlo=g properly. Most recent date of inspection or service Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: c', c, Construction: Prefab Concrete k' Steel Other Manufacturer (if known): Age of Ta (if known): Permit nu /gibtr (if known)__ (Licensed lumber ib azure) (Print Name) (Title) (License Number) MP/A_ 9RS zZ 2~_)' f , 7 (Date) Form to be completed by licensed plumber (Dept of Commerce Chapter 5 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 9/2008 "m' oanty 1 S~°TO~ Industry Services Division _ 1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.) SP , K P.O. Box 7162 S ST. CR( CquN Madison, WI 53707-7162 ~hg ~ t1N1 ~ ~QP O _ Z_ 6-) ~TSIO~tP1' ~ lry~ GN State Transact Number Sanitary Permit Application ,~~~Ilp► In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form t, O .crrtmental unit is required prior to obtaining a sanitary permit. Note: Application for- OPT%n rUWTS are submitted to t Address (if different than mailing the Department of Safety and Professional Services. Personal infom _ provide may be used for secondary Pr 'ec address) purposes in accordance with the Privacy Law, s. 15.04(I)(m), Stars Aj& e`L~ ~.l^ licationInformation-PleasePr' Information A/ ~lCJ~~~ 1. Application Information - Please Pr* Property Owner's Name ' Parcel # WZ Property Owner's Mailing Address Property Location GovL Lot } ~J 'f City, State I Zip Code Phone Number S~ %s, 5 t i, Section II. Type of Building (check all that apply) - Lot # I or 2 Family Dwelling - Number of Bedrooms 1-7) Subdivision Name ❑ Public/Commercial - Describe Use Block ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of Town of III. Ty a of Permit: (Check only a box on line A. Complete line B if applicable) ^Qi A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System/Component/Device: (Check all that apply) Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound 2:24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank Other ispersal Component (explain) ❑ Pretreatment Device (explain) t!r`R~".,•o~~ V. Dis rsal/TreatmenY ea Information: Design Flow (gpd) Design Soil Application Dispersal Area Required (sf) Dispersal Area Prop (sf) System Elevation Rate(gpdst) VI. Tank Info Capacity in V c Gallons Total # of Manufacturer U U - r Gallons Units 2 o in F V &Z v c New Tanks Existing Tanks M. U Septic or Holding Tank ❑ ❑ ❑ ❑ Dosing Chamber ❑ ❑ ❑ ❑ ❑ J VII. Respo ibility Statement- I, the undersigned, assume respo ' 'lity for installation of the PORTS shown on the attached plans. Plum amV(P ni Plumber's aI re MP/MPRS Number F usiness Phone Number Plumber's Address (Street, City, St e, Zip Code) VIII. Co /Department Use Only pproved esenpTmre'e Permit Fee Date I ued ` Issuing gent Signal pll&~~ co ven Reason for Denial $ s'! / IX. Condi eat ns fort Disapproval t 4/tl t :~n 11 a <h uisper; v i cell must A be Ic, s ' r,+< ; t?c as per ~nar^.ayemenr plan ono ndeA bt►y plu~ni>er. 1 2. A& aeftw* rer.k,h+. norms rnust.tk rlantalred J C _ ) a per rAXliCW,,% c t da / ,:rrlinarlow. Attach to complete plans for the system and submit to the County only on paper not less than 8 112 x I I inches in size 1 i i Q ,06 ~e 1 i f-~ 14 4144 i ~ f ` i I r ,IV CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Owner's Name: Owner's Address: Legal Description: Township: County: Subdivision Name: Lot Number: Parcel ID Number: Page 1 Index and title Page 2 Plot Plan Page 3 _ System Sizing & Cross-Section Page 4 Filter Specs E k;.>> Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat House Plans Attachments: Sail Test & Designer/Plumber: License Number: Phone Number Date: / • }?7- ~ Z..-- Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). i Page ~i i i TI III i ; I III i T I , i- $(Ai so tjon System c Sewn ~ Drade 4s 5dwdL 1e4O PVG VertE Pipe vent cap " Leaching Chamber Sys, Elevation ®i~ lSEA $t~ti $ttS> tl € 3 t Vi ~G TE ft r\ LeacNng Trenri~ 5 ft vent Or Observation Pipe Chambers Trench 2 Header Manufacturer And Model EISA Rating _ S4 ft per chamber Saii Application Rabe ~ gpol.sq It gpd Design Flow . % Soil Application Ram r EtSA Chambers Z mws of &rdmbem each. Page._ OT POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner _ Tank Manufacturer: ❑ NA Permit # Cl Septic ❑ Dose ❑ Holding Volume: (gal) DESIGN PARAMETERS Tank Manufacturer: ~NA Number of Bedrooms: ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal) Number of Public Facility Units: ❑ NA Vertical Distance Tank Bottom(s) to Service Pad: (ft) Estimated (average) Flow : (gal/day) Horizontal Distance Tank(s) to Service Pad: (ft) Design (peak) Flow = (estimated x 1.5): ' (gal/day) Specific servicing mechanics must be provided if vertical is >15 feet or if horizontal is >150 feet. Specific instructions to be provided on back. In Situ Soil Application Rate: (gal/day/fe) Effluent Filter Manufacturer: ❑ NA Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model: Fats, Oil & Grease (FOG) <30 mg/L Pump Manufacturer: Biochemical Oxygen Demand (BOD5) 5220 mg/L ❑ NA G~-NA Total Suspended Solids (TSS) <150 mg/L Pump Model: High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L Manufacturer: (BOD5) >220 mg/L tf4 NA ❑ NA (TSS) >150 mg/L ❑ Mechanical Aeration ❑ Peat Filter ❑ Disinfection ❑ Wetland Pretreated Effluent Monthly average ❑ Sand/Gravel Filter ❑ Other: (BOD5) 530 mg/L Soil Absorption System (TSS) <30 mg/L Vr NA Fecal Coliform (geometric mean) <104 0 In-Ground (gravity) ❑ In-Ground (pressure) ❑ NA ❑ At-Grade ❑ Mound Maximum Effluent Particle Size % in dia. ❑ NA ❑ Drip-Line ❑ Other: Other: ❑ NA Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) V1 When combined sludge and scum equals one-third (%3) of tank volume ❑ When the high water alarm is activated Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 9 year(s) Inspect dispersal cell(s) At least once everY ❑ month(s) (Maximum 3 years) ❑ NA ® year(s) Clean effluent filter At least once every: ❑ month(s) ❑ NA J year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) &~NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) NA ❑ year(s) Other: At least once every: ❑ month(s) A~ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The soil absorption system shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one-third (Y) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. GMW-005 (02105) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will be discharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the treatment tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with s. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator (pumper). • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, - gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. 1( The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: POWTS INSTAYLER POWTS MAINTAINER Name i Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name " , r Phone Phone _ This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will be discharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the treatment tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with s. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator (pumper). • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: POWTS INSTA-LER POWTS MAINTAINER Name / Name Phone Li'/_ `i L 7 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY X x,41. Name Name f~z Phone Phone 7 This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAZrf ENANCE AGREEMENT AND OWNERSFIlP CERTIFICATION FORD 0wmer/Buyer 1\48iling Address Property Address (Ve1ifcation required from Planning & Zones Department for new construction.) Parcel Identification Number- 1 City/State LEGAL DESCRIPTION 7+ 7~ F 1/4 . Sec- 1 ..1 ~N R C W, Town o j Property Location 1/4 ~r , Lot Subdivision Plat: . Volume ,Page # Certified Survey lYlap # # (before 2007)Volurne Page Warranty Deed # ' Spec house 0 yesAno Lot fines identifiable 0 yes O no SYSTEIVI nNANCE AND OWNER CERTII`ICA'10N Improper use and maintenance of your septic system could result is its premature failure to handle wastes. Proper put into t ing out the septic tank every three years or sooner, if needed, by a licensed pumper-What you he system me can affconsistsect the function of the septic tank as a treatment stage in the waste disposal system. (?weer maintenance the responsibilities are specified in §SPS• 38352(l) and in Chapter 12 - St. Croix County Sanitary Ordinance. Q ees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and The by a property master plumber, journeyman Plumber, restricted plumber or a licensed pumper verifying that (1) the on-site after ection and pumping Cnecessary), the septic tank is wastewater disposal system is in proper operating condition and/or (2) ~p less than 113 M of sludge. Q Uwe: the undersigned have read the above requirements and agree to maintain the private sewage disposal system -with the as set by the Department of Safety And Professional Services and the Department ofNamral Resources, standards set forth, herein, that your septic system has been maintained must be completed and retumed to the St. Croix State of Wisconsin. Certification stating County Planning & Zoning Department within ail days of the three year expiration date- Uwe certify that all statements on form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the described above, by virtue of a ty deed recorded in Register of Deeds Office. property Number of bedroom e.- DATE S NATURE OF APPLICANT(S) exit being revoked by the Planning & Zoning Department *~`Any information that is misrepresented may result in the sanitary P g I~ Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the cued surtey map if reference is made in the warranty deed- • -A l NOTE: L'EY RETREAT ALL BEARINGS ARE REFERENCED 70 THE SOUTH LINE OF THE AND THE SE 1 /4 OF THE SW 1 /4 OF SECTION 12, S89.18.'3'E 1/4 OF SECTION 12 T31N, R19W, RECORDED AS NN OF SOMERSET, ST. CROIX COUNTY, WISCONSIN. ALL BUILDINGS TO BE CONSTRUCTED IN PROXIMITY WITH DRAINAGE EASEMENTS SHALL HAVE A FINISHED FLOOR OR WINDOW NELL LOCATION MAP ~yAnO, SHONH~ THAN Two FEET ABOVE THE HIGH WATER ]i OR CHANCE THE (NOr TO SCALE) EROSION PLAN FOR THIS 385 FROM SE CORNER OF PROJECT TO NEXT DRIVEWAY EASTERLY. NG, ALTERING, FILLING, OR SECTION 12, T31N, R19W, CHES. WATER RUNWAYS, FRONT SETBACK - 100. SIDE SETBACK - 12.5', REAR SETBACK - 25. UTILffY EASEMENTS NO POLE OR BMED CABLES ARE TO BE PLACED SUCH THAT THE SCALE: 1' 100' INSTALLATION WOULD DISTURB ANY SURVEY STAKE, OR OBSTRUCT AND TOWNSHIP LAWS, VISION ALONG ANY LOT LINE OR STREET LINE, THE DISTURBANCE OF ARCI1 ETC) BEFORE ° 100 400 A SURVEY STAKE BY ANYONE IS A V10LAIION OF SECTION 236.32 r- 50 XX COUNTY ZONING OFFICE WISCONSIN STATE STATUES. UTILITY EASEMENTS AS HEREIN SET OLOCATION FORTH ARE FOR THE USE OF PUBLIC BODIES AND PRIVATE/PUBLIC E UTILITIES HAVING A RIGHT TO SERVE THE AREA. ]B- 1 ]3' UNPLATTEU LANDS I T• UNPLAIIm I.APIDS 209.72' 207.53• - - - 22&OY 55&5Y 1 1 V) ° a = I I I I I gl y ,o a E ;E a ~ i I I I 1 I ~o 1 i t 11 I I S I n~ I _ W I ,I Q~ ui c 5,4 1 I I I I I S 00WOr E i ' I LL: p n08mi 1 ~ 1 I1 S5&6Y---- 1 ~i 17E a ° 1 1 ~7 r°~ 11 9 r I I t, E C"_$ n l 1 .-4 I( ci a i I .r o i l lam a t W I• 1 cQ vi I I HI I S "'~oN °E C4 , E s I S 1 I a j 1 I 0 LL 11 11 °I 4NM 11 gMn I I - v 1 I m ~ ' NI 1 1 1 I I S0n•2"E II I I N o 5M7Y 1 ; I I 1 nt a R 00 I ~I ~ ~ ~ d `3l56W~~~ of 1 _ erz~ 3 ~AZre S _ , 9rr - aL - - a - - - I ftQt r n 11 r, ~,~t` _ O N E S 1 I • ~ ~ o is - Lw 22' S Dowse' wN_ E 10s.34' a o . WSW f. I I to (n V O W I 1 li ' N/ cQ Q f 0 1 r, c~ 99 r I I E o A 81 i E no o d I E r` ° a d~ ♦ I" .07 Cal 1. R j \ ►rr, n ~ ~ + v I - - - - S 00'04'13' S % fN ° off/ - - - - - - 1 N 9 X11 ,y~~~ ""1003.3yr~ g5j o' 1 - s59.66 I jj `Oyu s y I 1 1 k X L~ I 3' 3 of-'r r / to I .-d Q ! _ I I 3 S (n U `o • ~_eomt rryes cq•l E 'A = 1 I 1 S = u N,~i'kk .9P'[St 7 •elALLb N I ty O + i~1 .L'C p \ Z I 1 I M M d J 3 .Zf,tZ10 M lid IN I I I J I 3a 1 >1• 21a89' - - n1.7T 254.17 - 45&oY - _ I 3 1075.0 ' - Q3 W ,90&0.7• r kiC l I MAFIFD Or M OMM SHEET 1 OF 2 =I Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County" St. Croix Safety and Building Division ` INSPECTION REPORT Sanitary Permit No: 420532 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 Township CST SM Elev: Insp. BM Elev: BM Description: _ q0.o~ C0•01 CST &RA 2~ L TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM r 103- [ ration Bldg. Sewer , 1, 9Z o . /(o lding St/Ht Inlet O V. 7,r TANK SETBACK INFORMATION St/Ht Outlet t~(p 62, TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic r / Dt Bottom > ) ZS Dosing He r/Man. Aeration Dist Pipe d) `Xi •.SZ Holding Bot. System > qS• 8. s. z Final Grade (,j b PUMP/SIPHON INFORMATION l' 9~•6 7 Manufacturer Demand St Cover r GPM 2 0 ~,DV >7Z • 02 Model Numbe TDH Lift on Loss System Head TDH Ft y o , Forcemain ength Dist, to U SOIL ABSORPTION SYSTEM RENCH Width r Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. iquid Depth 45 DIMENSION $ • et• (.2) SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufac red r~tX.Yc INFORMATION Type Of System: , CHAMBER OR UNIT Model Number. t • p rr DISTRIBUTION SYSTEM Header/Manifo Distribution x Hole Size x Hole Spacing Vent to Air Intake ILIQA ju Pipe( q LDia -t Length Dia Spacing ~ 1 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded MuIchad Bed/Trench Center Bed/Trench Edges Topsoil Yes [#n No #1 Yes ©No COM E7-j ' (Inncllude Cod disrxe ~jerrrS0nresen etc.~){_'~,`'~~` Inspection #1: Inspection #24"t, /-2~ f cld Turkey Retreat Lot 23 vp Parcel No Ln: a e t, W5 (SE 11eW 1/412 T31N Wi 1.) Alt BM Description = ly r+t S14r.rmq jt,,pyQ,~W~o~Oert•~a/ 2.) Bldg sewer length = 2 9r U 1 3 - amount of cover Plan revision Required? [1 Yes No Use other side for additional information. IO 2 J", rI'Qaie •S Insepctors Signature Cart No. SBD-8710 (R.3/97) I PLOT olILAN PROJECT P.C. Collova Bldrs. Inc. Ess P.O. Box 489 Somerset WI 54025 SE 1/4 SW 114S 12 IT 31 TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/28/02 BEDROOM 3 CONVENTIONAL XXX IN-GROUND-/d ESSURE 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 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 95.5/95.3 Alt. BM Top of 2" Pipe @ 100.0' Plans Designed Using Vent Conventional Powts Manual Version 2.0 >6" Standard Infiltrator of Cover Leaching Chamber with 31.1 ft2 of Area 12 6' Long Grade at System Elevation + - 341, '7 IV, Pro 3 Bedroom House 20' T oA 2-3' X 69' Cells with >3' Spac' , 40' B-3 Vents 3 ents e . ? ok• o i J B- o ~ 2 B.M. * lope Alt. B.M. - ~ 55 Property Line 5 PLOT LAN PROJECT P.C. Collova Bldrs. Inc. ESS P.O. Box 489 Somerset Wi 54025 SE 1/4 SW 1/4S 12 /T 31 / TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/28/02 BEDROOM 3 CONVENTIONAL XXX IN-GROUNDESSURE 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 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 95.5/95.3 Alt. BM Top of 2" Pipe @ 100.0' Plans Designed Using Vent Conventional Powts Standard Infiltrator Manual Version 2.0 of Cover Leaching Chamber with 31.1 ft2 of Area 12" Long Grade at System Elevation 34' Pro 3 Bedroom House 20' T 2-3' X 69' Cells with >3' Spacing 40' B-3 Q 35' Vents 30, Vents N i B-2 44 70' B-1 20' 3% Alt. B.M B.M. * lope B.M. 5 Property Line 5 300 Safety and Building: Division Camcy Bo:7162 NV &consin 201 W. Waddogbm ty and Bo Ave.. Dm Madison. WI 53707 - 7162 Site AO Umd Department of Commerce o~oZO • - Sanitary Permit Application S In accord wilt Comm 83.21. wis. Adm. Code. personal information you R -C-0 i..° 0 3 S- Z, W used for law s15. 1 m L Application hdormfflon - Pkase Pdmt An Infa =atim Star Plan . Number t Progxty Owner's Name ^ ' PkQ ¢ 632- 03y- oz7A 90 I ~ - PA'faty s Mailing Ad&= !t S ~Z T3/ N .8' City. State zip code Phone Number Block Number . 0 ~ I ; tip- Cxhf Number II. of Building (cheep an that apply) 2 Pan* DweEft - Number of BWrwm ~ ~jp + 0vk~, 0 ~-i -~Desedx Use ❑ State owned oS -Jui ,tAi, !i✓/ r ( 2'L Nearest Road 13"X &I CVzq- A ~ IQ, Type of Permit. (C2teck only one bbx on line A (numbering scheme for internal me). Complete line B if applicable) A. 2 0 Repiacenx= System 3 0 Repiaoememt of 6 0 Addition to Far County we Tank Only sw= E. 0 Check if Sa ty Permit Previoudy hsad Permit Number Date Issued IV. T~Pft of Permit: (C7teck all that apply)(nmotbering scheme is for internal pore) r n Pw=mt ed lo-Grand 210 Mound 47 O sand Pr70er so 0 Constructed waland 310 / 22 P..iaed In•0mund 410 HoWg Tads 48 0 Sonde Pass 510 Dtip line ZI OW C1 low 45 0 AvGtade 46 0 Aerobic Treatment Unit 49 11 Recirculatiq 300 Be V. Area Information: Design Plow (o Dispersd Area Dispersal Area / Soil Apphadon Percolation Rate system Final (grade Poe' Raytired Proposed / Rax(Gah./D"VSq_P! (Min./Inch) 9.s j FJeradw 3 60 VL Task Info Capaaty is Total Number Maauficmaer Ptefab Six Steel Flba Plastic calloaa Clanont of Tads Coocrex C onsumted Chu New Esieft ngt Tam Sep& or 1101d-ax Tank - iliT D VM Regmasibility Statement- 14 the tamed, mAnne mpaosWlety for imtaDaflan of the POVYIS shown on the attached plans. PbumbWs Name (Print) Phtmbees s MPACMNNumbcr Business Phone Number Plumber's Address (Street, City. Stax. zf-w l~ 0~ EE eat use Signaw ) 0 Disapproved Sanitary Petmit Fee Includes Gmundwater Da/ft Issued Asaft 0 Owner Given Initial Adverse Surdr, Fee r l/ ( e k Determination EL Condhioos of Appr*v"ewms for DI pprnwal ? vhf S[1,1r~ 3` 'eO ~~jO~ d44 ~4` g~y` " 2 ' -rt o s~uF~ ~t.vmQ 44- (D &UA&Ao, M04,011] ~.d 4001 Aaaeh CNEEkk Ph= M the Cf* SSW ear nee asst= ON Peer ant bw ulna Sla m li ladles In dw D-6398 (R. 05101) y • Wiscarnsh-Depart mernt of Commerce SOIL EVALUATION REPORT Page I of awe of Satety and Budd'ngs in accordance with Comm 85. Wis. Adm. Code Attach cornpete site pan on paper not less than 81/2 x 11 Wxhes in size. Plan most 'ti • ~i'x include. but not tiled to: vertical and horizontal reference Point (BM), dreuOon and Parcel ID. 03 2 / 0 3 O v -70_ Pment slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print ail Wbr►nation. Data Personal i Amon aft you a-Aft may be used for secardwy pr•vom (13 Low. s.15.04 (1) (m)1 Property Owner Rqxwty wcafioft- - C. l! Q Govt. Lot5 4 1/4Sj, l/4 S )Z T 3 N R E( W Property Owner's Maims Address W* IMDck# rjj Name or CSM# LIS 47w,k UlY State Mp Code Phone Number p uty ❑ image awn Nearest Road %b, 2,.f(7)2-)512-rf 7 S Gz04 JRr New c«gtn,cson Umo Residential / Numlw of bedrooms _-3, code derived desw flow rate y s-o elm D Replacement p Pubic or mrrnrruerdal - Descrbe: Parent material Flood Plain elevason if applicable R r sons:` 'S- RECEIVED JUN 1 1 2002 Boring # D Boring n ST. CROIX COUNTY f Pit Greund surface etev. ~ft. Depth to Writing factor ZONING OFFICE f-~-~- Applicallon P--ft Horizon Depth Dominant Color Redoc Descripion Te dure Structure Consistence Boundary Roots GPDW in. Mrxnsell Qu. Sr- Cont. Color Gr. Sz. Sh. 'EfWl 'Eff#2 Borrlg # ~ 9 Ground surface elev. R Depth to 6nift factor in. Soo Applkadon Rate Horizon Depth Dominant Color Redact Description Texture Structure Consistence Boundary Roots GPDOW in. Munser Qu. Sz- Cont. Color Gr. Sz- Sh. ,I 'tff#1 -002 O 30 ~.s' Jdg J/ x 1~7 L 1 7-- ' Effluent #1 = BODs > 30 < 220 mot. a >30 150 • Effluent = BODg < 30 nuglL and TSS < 30 rrrgti CST Name (Please Print) CST Number 6 Number Address Data E Conducted Telephone . i v ~f . Parcel 3 ID PW" Owner i © # Barr<rs Ground surface elev. Depth to limiting taclor4~1fk" - ffi~plt soil Appicabon Rate Portion Depth Dominant cow Redox Description Texture Struck we Consistence Boundary Roots GPDlltr in. Mansell Qu. Sz. Cont Color Gr. Sz. Sh. *EM •Eti#2 I 3J2- v ❑ Boring p~ Ground surface elev. R Depth b ~r9 factor in, Sod Application Rants Horizon Depth Dornb arrt color Redox Description Texi re Struchre Consistence Boundary Roots GPDfiF im mnsell Qu. Sz. Cont color Gr. Sz. Sh. 'E1f#1 -EfF#2 F1 0 Baring # 0 ~ ng Grand surface elev. R Depth to knit g factor in. Soi APPS Rate GPD/W Horizon Depth Dorrinard Color Redox Description Texture Structrre Consistence BorrxtarY Roots m Mures Qu. Sz. Cons Color Gr. Sz. Sh. 'Eff~l 'F • Eta i t =GODS > 30 < 220 nV& and TSS >30-'c 150 ff*& ' Effluent #2 = B0(), < 30 nV& and TSS < 30 ffQ& The Department of Commerce is on equal opportunity service provider and employer- If you need assistance to access services or need material m an ,Iterate format, Please contact the department at 6W266-3151 or TTY 608-264-911 sanuw(rtmAO9 3 a~- 3 Soil Test Plot Plan Project Name P.C. Collova Bldrs. Inc Sha d Address P.O. Box 489 Somerset Wi 54025 STM #226900 Lot 23 Subdivision Wild Turkey Date 6/7!02 SE 1 /4 SW I MS 12 T 31 N/R19 W Township Somerset Boring Q Well PL Property Line County ST. CROIX BM or vRP Assume Elevation 100 ft. Top of 2" Pipe System Elevation 95.5/95.3 *HRpSame as Benchmark Alt. BM Top of 2" Pipe @ 100.0' I i I 35' B-3 100' 009 i 30 B-2 70 B-1 99' 20, % B.M. * lope N Alt B.M. 55 Property Line 5 300'