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HomeMy WebLinkAbout018-2007-04-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATIONJ (ATTACH TO PERMIT) ,=,h ,~ Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township P.C. COllova Builders, Inc. Hammond, Town of ;ST BM Elev: Insp. BM Ele~v,~^y BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic tj -~ ` ~Z~l/ Dosing ` _ ~AtiK~ _ 7 ~~ F,ht't ;orr ~+ ~~ ~~ ' Holding TANK SETBACK INFORMATION TANK TO P L WELL BLDG. Vent to Air Intake ROAD Septic 5~/ 33i 3' Dosing y--7 ~ cJ N 33 ~ 33~ Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand ZU ,(' GPM Model Number ,' 1 I C ~ ~~ TDH Lift 3~~ Friction Loss 2 sX System ea TDH Ft z3•a3 . Forcemain Leng i Dia. ~ ~ Dist. to Weu ~~ ~~ SnIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 487963 0 State Plan ID No: Parcel Tax No: 018-2007-04-000 Section/Town/Range/Map No: 05.29.17.943 STATION BS HI FS ELEV. Benchmark `~ ~3 ~ /w Alt. BMr ~q ~1 7 ~ Bld .Sewer SbHt Inlet 13.5 ~`~ • `i St/Ht Outlet Dt Inlet ~ ~ Dt Bottom 1~.r ~ ~~ Header/Man. 3 • (~ ~~ , g. Dist. Pipe 3 ~ ~fr7•Ss Bot. System LJ ~ rlg+~M~ V Final Grade z, c.~ ~~ r St Cover ~~ ~ S - ~i~ca.s ~ l¢ ~ ~ ~~ • BED/TRENCH Width ~ Length ~ No. Of Tr nches PIT DIMENSIONS No. Of Pits Inside Dia^ Liquid Depth DIMENSIONS /1 G ~-77 '' J ` //y~ l•`J ~ ~- ~ SETBACK T SYST E M O P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: INFORMATION Type Of ystem: , ~ /off ~~ UNIT Model Number: ~ ~z o~ nISTR16l1TFON SYSTEM c5ov+~ Header/Manifold' ~ ,f 2 $ I /Z DistributiGO~n C2, ~ f t Pi,3e(s) ~ ~ ~ 7 ~ I x Hole Si e ~ ~ ~ C/ x Hole Spacing 5 ~ Ve~p.(}to Air Intake ' ~° Length Dia ' / Z S Length Dia pacing U 2 , C G C(lll CCIVFR ., o.,.~~...., e..~•e..,~ nni.. ,.., Mnnnrl nr ~t_r:rarla Svsfamc l7nly Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ • ~ C' Bed/Trench Edges Topsoil I ~ ;, es r~, No ~ es ,'I No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~~ / Z / C~`--> ~~ Inspection #2: / /_ ~~j' Location: 1681 113th Av/enue Hammon , WI 54015 (NE 1/4 SE 1/4 5 T29N R17W) Farm View Ridge Lot 4 (~+ ~1 Par'cel` `N `: 05.7.94 1.) Alt BM Description = r~ ~ ~ ~J4~ ~ 1'~a-~ ~^-'S ~' ~Cr~S ~~ ~ 2.) Bldg sewer length = ~~ ~ ~'^'- ~d`~ ~ ~' -amount of cover = i------~ Plan revision Required? ~ _~ Yes o ~ ~ ~ Use other side for additional information. i__ ~ ~ ~ I Date SBD-6710 (R.3/97) V~v~~~~ _--1---1- i-- ' Cert. No. Division ldi County l ngs Safety and Bui Washington Ave., P.O. Box 7162 1 W ~~` ~ ~ ~ . Madison, WI 53707 - 71 b2 ~ Sanitary Permit Number (to be filled i by Co.) (60$) 2b6-3151 ~ l;~~O~~ 7 Department of Commerce ~E~E`V PI I.D,Number Sanitary Permi p ation ' ~ 7~s. D on yo provid ~'r In accord with Comm 83.21, Wis. Adm. Code, nal o be used for secondary purposes Priv Law, (I)(m ~l r" ~t ~,s (if different than mailing address) + may l/ 1. 1. Application Information -Please Print Al! Information ST. CROIX CO NYY ~ y I ~ ~ ~~ ZONING OFF ~rceltf Block# Property Owner's Name J u/ ~ ~ ~ C l l C / '7 '0 . Property Owner's Mailing Address property Location • ~ a (~ ~ ~ ~ ~ _ ~ /(/L= '/.,.~G %., Section City, State ~ Zip Code Phone Number u on W ~~ 1 ~ ~`' N; or T a ~ ~ II. Type of Building (check all that apply) t/~ ~ t0 G,~'~~ ti ~ ~ ~C Subdivision Name CSM Num 1 . amity Dwelling -Number of Bedrooms M ~ r!~ f ~~~ ^ Public/Commercial -Describe Use ^City ^Vil Town i f ^ State Owned -Describe Use III. Type Permit: (Check only one box on sine A. Complete line^B if applicable) A. stem ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System List Previous Permit Number and Date Issued B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit'rransfer to New Before Expiration Plumber Owner ~ /- ~" IV. T e of POWTS S stem: (Check all that a 1) ^ Sin le Pass Sand Filter ^ ~' ~ of suitable soil ^ At-Grade g d < 24 in . ^ Non-Pressurized In-Ground ^ Mound ? 24 in. of suitable soil oun latin S ~ essurized In-Ground ^ Holding T ^ Peat Filter ^ Aerobic Treatment Unit ^ Recircu ^ P ~~ r try~ Constructed Wetland Recirculating Synthetic Media Filter ^ Leaching Ch ^ Dri Line ^ Gravel-less Pipe ^ Other (explain) o~ ~ _ V. Dis ersal/Treatment Area Information: Dis ersal Area Pro ed (sf) System Elevation ow (gpd) Design Soil Appl'cation R~ dsf~ Dispersal Area fired (sf) P Fl Design Z ~/ , / ~ 2 %~5 ~J Z25U f~ Z tic Fib Pl ~` ~i~~ ~ er as efab Site Steel ! Tank Info Capacity in Total Number Manufacturer Concrete Constructed Glass VI . Gallons Gallons of Units 7Ve~v Fasting Tanks Tanks Sepric or Holding Tank Aerobic Treatrnent Unit Dosing Chamber VII. Responsibility Statement- I, the undersign ssume responsibility for installation of the POWTS shown on the attached plans. ~~ Plumber' store MPJMPRS Number Business Phone Number _1 / s Name (Print) P J ~ ~ ~ ~ Y ~~~ =z~~ ~ / ~ Plumber's Address (Street, City, State, Zip ) / r VIII. nn /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date sued uing Agent ignatwe ps) Approved ^ Disapproved Suroharge Fee) ~ ) ,~" ~ ~~ y `~ I ~ J ^ Owner Given Reason for Denial IX. Conditions of Approval/Rt:asons for Disapproval ~ ,,Q„ r rti,~{,4~ ~~ YSTEM OWNER: GCX ~d~~j~~~G~ p lc an ,effluent filter and UU'~ ~. dispers'~~etl-must all be serviced / maintained - i d l ~ ' b S um de by p ,~r. y.~ ,-E as• per management plan prov vtt ~ d C~~,~(,~ C t (==2~. All setback requirements must be maintained ~ GG ~9~ ~ ~ ~ ' ~ ~ as per applicable code/ordinances. ) ~ (~~Q/j" ~ Q / / ~ Attach comp etc p ns to my only) for the syste paper not kss than 8102 x 11 inches in size '-1Y~'~ t' ~ ~d ~ SBD-6398 (R. 01/03} . PLOT PLAN PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 NE 1/4 SE ,1/4S 5 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 98.6' 2' sand lift 3 BEDROOM CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE ~ 000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of chambers none BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark 113th Ave Scale = 1 /4" = 10' Pro 3 Bedroom House Well is to meet all setbacks found in Huffcutt combo tank Comm. 83 B -1 Area 15' below system is to remain / undisturbed 3% Slope Tank is to be properly bedded and provided with lockdown covers with approved warning labels i 326' Property Line 96.6' ~j-a3~of" ~~Y-~ Grading is to be done to divert run-off away from System 9 6' Property Line B-2 9 7' B.M. * 1 AIt.B.M. l~ commerce.wi.gov ^ ~ ^ ~scons~n Department of Commerce Safety and Buildings. 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.wi.govlsb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary October 27, 2005 CUST ID No. 226900 SHAUN R BIRD BIRD PLUMBING, INC 1008 192 ND AVE NEW RICHMOND WI ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/27/2007 Identification Numbers Transaction ID No. 1209697 SITE: Site ID No. 706630 PC Collova Builders Please refer to both identification numbers, 1681 113TH Ave above, in all corres ondence with thew enc.... Town of Hammond St Croix County NE1/4, SE1/4, S5, T29N, R17W Lot: 4, Subdivision: Farmview Ridge FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1048085 Maintenance required; 450 GPD Flow rate; 13 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1); Biofilter 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. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, ~O: d~ stats. ~4 ~ ~~~~~ The following conditions shall be met during construction or installation and prior to occupancy or use: EP .RTME Reminders ~~ aF G~ SEE CORF • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.O1/01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.O1/O1). • 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. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. SHAUN R BIRD Page 2 10(27(2005 • Inspection of the POWTS 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 83.22L'n A copy of the approved plans specifications and this letter shall be on-site durine construction and oven to insRection by authorized representatives of the Department, which may include local inspectors. 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 maybe made to me at the telephone number listed below, ox 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, ~~/Jll~ Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commerce. state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Y Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 10/20/05 Owner:P.C. Collova Bldrs. Inc. Location:NE1/4 SE1/4 S5 T29 N,R17 W Lot 4 Farm View Ridge Hammond System type: Mound System Manuals Used: Mound Component Manual Version 1.0 (6/99) Pressure Distribution Manual Version 2.0 (01 /31) Page# 1. Cover Page RECEI~/~I~ 2. Mound Plot Plan O C T 2 4 2005 3. Mound Cross Section $AFE`~Y ~ I~ul~~IrV~S 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-11. So Shaun B Signatui License '/, ~. ,_ ~,. ~. ,~, 4r:,..~~,,,c :. CGS a'C;f`v'DE,1,'C~ > PLOT PLAN PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 NE i/4 SE •i/4S 5 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 98.6' 2' sand lift BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of chambers none BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark 113th Ave Scale - 1 /4" = 10' 326' Property Line Pro 3 Bedroom House Well is to meet all setbacks found in Huffcutt combo tank Comm. 83 B - 1 n 96.6' Area 15' below system is to remain undisturbed 3% Slope Tank is to be properly bedded and provided with lockdown covers with approved warning labels i ~j•~3~~' ~ih~ Grading is to be done to divert run-off away from System Property Line 9 6' B-2~ 97' AIt.B.M. .M. ~~ . Designer_ No Date 4" Observation Fipe Perforated $elow Filter Fabric AS~I G-33 S o n d -.~ `~ ~~ Topsoil ._ .-...J + ~: Scope y Non-Woven Filter Fabric ~Distribulion• Pipe • -~ ~--------~--- F o Bed 0t;f~- 2'2 Drain Rock Forst Koin From Rump Gress Section Qf A Mound S stem Usin A ged For The Absorption Arta p ~~''Ft. r~ F iaw e d Layer ,~ ~~ F / ~, G ,.,_~ ii ~_ g ~ Ft. ~ ~kl' T Ft.~ ~ ..22 ~' . - d~ ~~ K. E l,~ Ft. L,~~2 -.; L I,`{Ft. .. _ ti,,~ ~~ Ft . -------- ----- ~ 4~Observation Pipe-~~ K J E ____--------- ' _ _ ~ _ ~ ~~ ~_^_~ y ___ ____---------------------- - ~ Farce Main ~ A ~ _ ------------ ~ --- --------- From Pump c j ~. ~ pistributiort Bed Of ~Z ' 2't ~ Fipe -Drain RocK i 4 Obt-ervotion Pipe =-:-~=~~.~= Permonent Marker ~. pipe or Rods Plon View Ot Mound tft:ln A Bed For The Absorption Areo PAGE ~F_--- Cf~4 f toLated Qa 8oti9m. 'e ERua~y SDOatd %tRST Y{bLL AILKY TO CnrttltC}'~ i/ ~ Lt r'/~ .., ~~.5" - - ``'- ~isitsbation P:pt layout ~~ L Signed: ~+~ense NumbAr; Oates. ~~' f t . ~ ~ ~ ~' F{, X ,~~~Ini„hes ~r .~-=r. Inches t1 Hale Diameter /~ Inch Lateral ~" I ' f'-~ Inchies ) 'pan i fo7 ~ ~ Inches Force Main 'Z. inches ~vf holes/t~fpe~r Invert €Iev~tioaz of Laterals i~, r Ft... Pe-$esateG ~tCS Detoii ~- Ah~ SPECK FC ATZQt~S ~ B£R CROSS SEPTIC SANK r s~~P C~,~M SECTiC'~ ~AtKE~tPR~F ,~~= C;} V~la'T pTP£ }Z'* MIN. :~BUVE .GRR13E ~ .3;~~CT~di~ $QX ApPR{}i1 ED iNt}L£ CG~Eit _ ~-~~~ ~'RO~S D4fl1~. ~tli~i#OS1 4R ~I'TH C~3Nt3E3IT ~/ PP-DL~K ~ c R£a~ ~ ~.~ C ~ d ~tTAK£ ~ ".IR ~iARlil~[G tA$E:. ~x~~ ~~ //// a ~~ _ ,_ ~ `. INLET ~ ~ i~A~'£R ~`IG~i'T SEALS ~ ~~~T : . ~a T5 itlTli 1 ~' ` AI.M APP~~ g2PE $, ~ i ON $(}~.~g SAIL ApPt~i€ES3 ~ ~ . ~i~ 3` Ql~i#'t} Std;~ ~! ~FT _ C. --~-.'_ FF BEi)I1~1~G LSNI3ER '~AI+tIC +~ App~tt3~t Ei? C~DNCRETE PAS 3 s~~~z~xcA~~a~s ~y. ~'.' ~,r;K MAt,1<~J~ACTLiREE~ : ~t ~,~•~~~ ~Ri. TAIiK S; Z£S = SEPTIC -~~ 6A'~. }3t?S£ ALAR?~ ltA~Fl~iC'~3RER,- V1 ~G~'1~ r' ~ ~ ~TTCi~ ~<'~PE sES ~~R ~~~ : _..._,_.__ r~urra~R ~~ ~a.C3 CAgACE~` Z~S = A ~/ _ ~. C HES ACHES __.. .,.- ;~ AL c .sue----~~L -_ ~~GAL ~~.~-GAL p~MP ~F 16.23 H{}p£L N[~3'iBER : - • ~ ~ ,~ r s Lax gyt;?Cfi 3'YPL"= W t/ p,g ~IIRI~tG AS PER < --~ ~n~,,f - :~TTfP £ PmL;fiR FEET REQIsTR~i ~3;SCI~,R~E ~T~ ~gOT~vN FIP£ - - _-.---- ~. S-- 3-b FEET E£N PiJHP Oi F` AI+tiE; gIS~ - _ < _ -------' FE£"r VER'FZCAL i~IFF£R'ENCE $~T~ ~ ~ ~S$~TJZt~B FT< -FRIC'Tlt~i~ FACTOR . ^. f ..~ + PfIi+4M ~E~t~~{KjRC~iAI~ PRFS=~ ~£3`f~iL I}YNAI'~IC ~i~ j FEET '' _~~?..~---- FEAT FNT£R~AL DIi~£NSIDI~~ ~~ ~-I~~I~ ~ --DATE = _~-----'~-` EI,CENS£ ~MBFR = - 6 S;GPiED: ;,{$8 T^vU,L CYN~tiC HEfiD~CAPAGITY PER MINUTE EFFLUENT ;:ND DEWATERING ~d a ~a 0 'V FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. t" .Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. . c~~ed lDwik-Box available foroutdoor installations. See FM1420. • Over 130°F. {54°CJ special quotation required. 15?1153 Series O CAUTION All installation of controls, protection devic wdensdswhuuld be foliuwed including the most. licensed electtictan. Alt dectrial and safety recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). ~ MOC ! EL ~ 15 2 t5 3 Feet i Meters Go(. Lifers Goi. l Liters g 1.5 65 ~ 261 77 291 10 3.1 6? 231 70 i 265 t5 ! 4.S ~ 53 201 61 23t 1 20 .~ 6.1 ~ 44 i 67 f 52 i 97 ~- 7.6 34 129 42 t59 30 9-1 '.3 87 33 ! 125 I 35 le.l ! -- T ~ --- z2 ~ s5 ?0 ~ 12.2 ~ -- -- 11 ~ G2 i - - __"-_~-- L ock VOlvc: 38.0 Ft. (t t.6m) 44.0 Fi. (t3.4m) o;asoa ~7 :2 i~ ~ 1 ,/s ,~ ~ I i 1~ ~~: r ~ ~ ---~- ! i s~~ SELECTION GUIDE 1. Single piggyback variable level float switch or double piggyback variable level float switch. Reter to FM0477. 2. See FM0712 for correct model of Electrical Alternator E-Pak 3. Variable level control switch 10-0225 used as a control activator, speedy duplex (3) or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeiier pump. Aaaf>_ ro: a.o. aox ts347 Louisville, KY 40256-0347 Manuhac4versof. SHIP r0; 3&19 Cana Run Road Q~aurr peas S~v~E /939 ° ~ Q ~ Louisville, KY 40211-1961 ~ ~,/M~ ~~ (502) 778-2731.71600) 928-PUMP lJ FAX I ~2) 774-3624 ~np y/~mnyzoeller.com © Copyright 2000 Zoeller Co. All rights reserved: PLAN NER'S MANUAL & MANAGE GEF ~ ~oNs . ~paWT'S 01N SYSTEM sPE TIOK Septic Tank CaPaatY OitMA C . ~ ~.~~ ~ ~ 1 ~ ~ $eptlc Tank t~anufacwrec' .~ ~~_ Effluent Filter Manufz-durer ~~ ~ ~~ ~I Units Ntrmb~'~ t~13ma~ i~aw {avefa9e~ (~•stimated x 7 ~) r1~n 11vw (P~, ( - colt App~°f 1 ~~ Influenttirt'flu+~t Qua~Y OxY9~ Demme e ( Os~ t3iocftemlcel nded Solids Tots[ SusPe ---~ P~ went QuaCdY BO s) B'iodiemical Oxygen Demand Total Suspended Solids ~~) Fecal Corrfatm (geometric mean) Max~rcnum Effluent Partide Size Service Event lnspe~ Cond~ion of tank(s) ntents of tank(s) Pump out °O Inspe~ disper~ cell(s) Clean B~uent {ilter Inspe~ lump, pump controls 8. alarm sand pressure test Flush taberal __ ~ E~uent Flier Model ~ Pump~Tank CaPa~ ~ pump Tank Manufactumr ~...: .Pump Manu~fiactu~ I ~ --- -- Monthly average` Si0 rr-9n- 42~ mgJL Monthly average"` S30 mgn- 534 mgn- Y inchdiameter Page~pf v ~~~ ~~ J..3"~ t7 NA .fl NA O NA ..-..-: [~ NA o Na ~] WA Q NA+~ ^ lriA Pump Model , Pfe~~ent UruF't•~ _ ^ Peat Filter p Sand~G~'~ n fl Wetland p Mechanical Aerate ^ Other. p Disinfection ^ in-ground (gravltY) Q qt-grade p yy-ground {pressur¢ed) O Dri ne ~yLer.na values typr~ ~ doh can-ootnme ~~ ~krrat rot Preveated +~r+sie~ier. t. values tyP ~----- Service Frequency p months a+ At least once every `"'°' uals w-.en combined sludge and scum e4 "-` At least once every At least once every ,at (east once every At feast once every At least on°e every At feast once every ;) (Maximum 3 Yrs•} (y) of tank volume ~) (Maaclmum 3 y~•) ^ NA ~ NA p rnonm ~--•-. p months fl Yews) fl NA NA p months II Year(s) fl on~r- licenses or n one of the {pliowtng ONCE INSTRUCTIONS an indtvldual ca S [nspe~r P'O~S ~ntainer, Septa9e its shall be made t7y a f1itSS~ pr broken Inspections of tanks plumber` Master Plumber Reseed Se4~e~ ~~ s to iden~Y nY for any ns: Master on of (fie tank() ~le ets oertit~ ns must indude a vrsuai inspetti a and scum and s7o ~ ~e e~1Uen SeNidn9 pperator, Tank inspedJO measure the volume of combined sludg of e~ueni on the hatd~m. tderttity any ~~`' or leaks, The disper'~ Celt(s) shag be visua[ty inspe~ ~ ~~g ~~, round surface- nding of effluent on the ground surface. The po ulat~Y Sud.,oritY- ~ tttg of etTtuent on the 9 tnr any Po lion of the local re9 in the obsenra~ QrP~ and to chedc~nd~on and fegeitres the ~Imrnediate notifica or more Of the tank volume ~ NR ground su~Ce m~- indcate a failing min any tank equals one-~1~ ~~ ~ of in accordan°e `"~' ~'• e and sw erator and disPo When the combined accumulation of sludg a Septage Servicing Op and any: entire contents of the tank shall be res~p1fed ~' m~t~ment components', 113, YVisc~ttsin Administrative Code. pOYYI"S components. p fled pOVITfS Maintainer. anicaf or pressurized ~n,~ by a c~rtl , The ~ridng ~ went filters, meal _ of compieixon of any service event intenance or monitoring at intervals Of 12 monthaumority ~Itin ~ otherma I r ulatory A ~>~ report sha~t'be Pn~d~ tO ~1e Iota ~ roduds or other ~ ~e presence of paunting trabons are sTgRT UP ANO OPERATION S check treatment tank{s) ersal t:elt(s)• if high ccncen qr to use of the PO mss artdtor damage the lisp riot to use_ FOr DeW+DOnSfi'uC60t1, PR a the treatment P to a servicing operator p chemicals that may impel of the tank(s) removed by a sep 9 detected have the Conte ..-' .; dill ns are frozen at the infi}trative stsrfaoe_ p~ ~~ shaft not ocxur v~rtten soil con o is trt'StQ[ed the excess System start up . stages pump tanks maY ~ above nomtat KK3Mnrater levels. When P sand may result in the During Per ~ the d-~persal pelt(s) in one Large dose. overloading the cep( ~,~erv~l be discharged To avoid this situation have the contents of the p~P tank temoved by a b2tckuP or surface d~ of effluent. ~ the effluent pump or contact a Plumber or POYYTS Mairttainec to age Senrrczri9 Qpetator prior.to restaoring P~'er ;3SS~ 10 r((arl[1a11Y operating` the pomp porttrols to reston' normal levels witftin the pump tank-. drive or vehides aver tanks and dispersal Mils. Do not drive or patfc overt or attiecwise disturb or compact, the area ~~ t5~feet dog Slp~ of arty mound or at-grade srn1 absorption area. Reduction or-efrmtnatton of the ~[lotnring from the vrrastes~xater scream may impnave the perfiomtance and prolong the fife of the POWTS= sntibla5es; ~bab}-~ dgar~ette butts; condoms; oatton swabs; degn3asers; dental floss; drapers; draht {sutttp PAP} v~rater, Exult and vegefiable peeClitgs= gasotme* gteast:;~ herbiades; meat disinfedan~: ~ frwrida6on ficxdes; sanr'tarY nap[dns; tampons: and mater softener brine. ~; ~; ~ pairtSng products: pe5 _ ABANDON~ME~ taken out of service ~e fot[ovsrfng steps shaft ~ taken to Insure that the When the POYYiS fail and/or is perrnartentiy ~~ is pnoperiy aid safety abandoned in compfance vrith ch_ Comm 83.33, yrrsconsin Administrative Code: . AQ piping fA tanks and pits snail -be disconnected and the abandoned Pipe openings seafed- • . The contents of aft ranks and pits shall be removed and property disposed of by a Sepiage Servicing Operator. After pumping, ail tanks and pits shall be excavated and removed or their covers removed and tfie void space ~~ y~ soil, grave! or another inert solid material CONTINGENCY PLAN Zfte following measures have been, or must be taken, to Provide a code if the pOWTS fails and pnnat be repaired cornprrant replacement system: ^ A suitable ~plaoement area has been evaluated and may be utilized for the focafion of a repraoement socl absorption system- The mplapement area should be protected from disturbance and cornpadion and should not be infringed upon b}r requind seffiacks from existing and proposed structure, rot tines and vvelts_ Failure to protect the repiacernent area vrt71 result in Lhe need for a new sail and site °evatuaiian to establish a suitable repracement area. Replacement systems muss comply with the rules in effect at that fime_ ^ A suitable replatiement area is not avartabie-due to setbac4c and/or soiE [imitations- Barring advances in POWTS technology a hording tank may be installed as a last resort to replace the failed fa0 ~ ~ the POVYTS a so0.and The site has not been evaluated ib identify a suitable replacf,ment area. Upo errs evaluation must be performed fQ bcate a suifabte replacement area_ tf no reptac~ment area is available a hordng tank may be irtstaited as a last resort to replace the failed POVYTS. Mound and at-grade sor7 absorPtian systems may be reconstructed in place frstlowing removal of the biom3t at the infittraWe surface. Reoortstructwns of such systems must comply vriif'f the rotes -tn effect at that tirne_ <g1{fARNINGy~ SEPTIC, PUMP AIdD OTHER 1RFATMENT TANKS MAY GO~T7-AtN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEH- DO NOT ENTER A SFl'T[C, PUMP OR OTHER -TREATMENT TA1HK ut~tDER ANY GlRCLtMSTANGES. DEATH MAY RESULT. RESCUE (}F A PERSON FROM THE INTERIOR OP A TANK MAY BE DIFFICULT OR iMPOSS(BLE. ADQETJONAL COMMENTS POVYTS lNSTAi.LER Name ~ '~' ~ Phone '~ ~ ~ ~ -- pOVYTS tl1WIMTAINER Name y~~rt.1,~ ~~~ / Phone 7 } ~;-"-.~ , ~S~l SEPTAGE SERyiCING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY A en figrxk ~ u.n N3 9 cY ~~ nlame v Phone ~ ) >,~ 7 ~'~ ~ Phone °i ) ~ ~' .,~~ 6'~ This dowmentwas Gutted try the erase of the Green Lake. Marquetfe and Waushara County Zaning and Sanitation agendBS_ This tinwrrlent meets the minimum requirements of cti Comm 83~(2j(b}{1}(djd~f) and 83.5x(1). {:2) ~ (3}, W+scoasin AQmrnb-Fta6v8 Code. Use of tl~ls document does rtor r_utW x2101) guarantee the performance of the POWfS. bll Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code ~nry J ~ ~~ 3 ch plate site plan on paper not less than 8 1!2 x 11 inches in size. Plan mu~t,.,_,_..-..., 1 D Page ~ of Alta com but not limited to: vertical and horizontal reference indude r ~~ ~,, mT( ` Aba~ie 9ct oad. Paroe b --O(~(~ i ~~ "~O , percent slope, scale or dimensions, north arrow, and Iocatio ,and ~ Re ~ewed b Date, Please print all Informatioa!it. ~ '~ 3~ t7~ be used for secondary purpos~s (Priv~gli,~w. rte 1$3oa~19 ~~) i de may Personal information you prov // Property Owner ~ (~ ~~~ ~ x~` ~ ~ ~~ Property Location ~ ~, N R - c~?~ . F ° 1l4 114 S ~T C.7t ~ E (or W ~~~.' , 1. ` ~, Subd. me or CSM# , ~ ~ Property Mailing Address / ... Phone Number od Ce/ ~ State+ Zip C City ^ Village Town Nearest~R/o~ ~ ~ ~ ~ GPD New Construction Us Residential /Number of bedrooms Code derived design flow rate ^ Replacement ^ Public or commerdal -Describe: '~ ' ~ ' ~~ ------ Flood Plain elevation if applicable ~U ~ ~ y R _ s ~ n~ _ ~ -r Parent material nts l ` / ~ ~ ~~ ~Z~~ 8 \ ~ ~~ ~ comme Genera and retomtmendations:.~y,~~v ~ (~,/rc~~ ~/ ~ 3 ~ ' Q~ ~. r i ywy~ 3 . 2 1' l~ ~ ~ ~ ~ S(~/ l. M ' Boring ~ Boring # J ft. ~' Pit Ground surface elev. T /~ in. Depth to limiting factor Soil lication Rate Bounda Roots GPD/ff e Sdvdure Consistence ry `Eff#f `Eff#2 ~ Gr. Sz. Sh. .,... _ /1 ~ 7 ~ l .. Borin Q ~ g goring # V pit Ground surface elev. Horizon Depth Dominant Color Redox Description in. Munsell Qu. Sz. Cont. Color D n• Texture ~• epth to limiting factor Structure Consistence Boundary Gr. Sz. Sh. ~ Roots Soil lication Ra GPD/ff `Eff#1 `Eft#2 3 /~-yv 1 Uyr~ ~.~. ~ Z ,-~ ~~ r ~i~/ ~ ~ . ~ Vl ' ~/ Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Textur 't._ ,~ S" ~~/~ ~" ~~ / r S ~. ./r Effluent #1 =GODS > 30 ~ 220 m9n• and TSS >30 `-150 CST Nanls (Please Print) Sii Bird Plumbing, Inc. Shaun Bird Address 1008 192nd Ave, New Richmond, WI 54017 `Effluent #2 = BOD ~ 30 mg/L and TSS < 30 ~ CST Numtber ~ 226900 Date Evaluation Conducted Telephone Number ,(' ~,_..s~ c/ 715-246-4516 ~ ~ Page ~ of prop ONmer Parcel 10 # ~~~ # Q Bo~n~ ~ ~ ~ in f d © -~- ft• Pit Ground surface elev. or • a Depth to limiting Soil Horizon Depth Dominant Col Redox Description Texture Structure Consistence Boundary Roots GPD~ 'Eff#1 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. /1 ( ~ I-L s .. / r---- ~' s'~ ~ ^ Bonng # U ~~ ^ Pit Ground surface elev. ft. Depth to limiting factor in• Soil lication Rate ti i D Texture Structure Consistence Boundary Roots GPD/ff Horizon Depth in. Dominant Color Munsell on p escr Redox Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 U Bonng ~~ # Ground surface elev. ft. Depth to limiting fador in. ^ Pit Soil iption Rate Horizon Depth in. Dominant Col Munsell Redox Desrxiption• Qu. Sz. Cont. Cdor Texture Sure Gr. Sz. Sh. Consistence. Boundary Roots fE~GP DIf~ ft#2 ' Effluent #1 = BODE > 30 < 220 mglL and TSS >30 <_ 150 mglL ' Effluent #2 = BODS < 30 mgA. and TSS < 30 mglt. 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. seasaw trtsiaol -~ 3 Soil Test Plot Plan ~~ .Project Name P.`C. Collova Bldrs. Inc. Shau ird Address P.O. Box 489 Somerset Wi 54025 C M #226900 Lot 4 Subdivision Farm View Ridge Date 5/8/04 NE 1/4 SE 1/4S 5 T 29 N/R1 ~ W Township Hammond Boring ~ Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 98.2' *HRPSame as Benchmark Alternate Benchmark Top of 1/2" Pipe @ 100.2' ~~ , ~' .M. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer P. C. Collova Builders, Inc. Mailing Address ~' Property Address ~r (Verification required from Planning Department for new construction.) City/State Hammond, WI Parcel Identification Number~~~ ~~7'~)~ mil] LEGAL DESCRIPTION ~~~ s Property Location ~ '/~ , SE '/4 ,Sec. 5 , T ~9 N R 17 W; Town of Subdivision Farm View Ridge Certified Survey Map # Lot # `1 Volume ,Page # Warranty Deed # ~~_~~ ,Volume ~~ ~~ ,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 County Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumbec, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than I/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. C ~fication stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning ep rtment within 30 s of the three ear expiration date. P. ~.`, COLLOVA SC?ILAERS, INC. (715) 247-2?42 P.O. B 489 ) a / lt(/ p S SOMERSET,~~N~VStN 54025 SIGNATURE OF APPLICANT 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 pr pe describ d above, by virtue of a warranty deed recorded in Register of Deeds Office. P. C. COLLOVA Ii~6~ILDERS, INC. (715) 247-2742 ~/~/ Q~ SIGNATURE OF APPLICANT P.O. Box 489 DATE SOMERSET, WISCONSIN 54025 ****** Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department. ****** R~~ Hammond 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 ~ ~ 2536P 3'i? '75'7959 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEfiH H. IiALSH Document Number ~ WARRANTY DEED REGISTER OF DEEDS ST. CROIII CO. , MI This Deed, made between Michael B. Marshall and Dawn RECEIVED FOR RECORD Marshall husband and wife Grantor, 03/29/2004 12:50P11 and P. C. Collova Builders. Inc.. a Minnesota Corporation NARRAATY DEED Grantee. EXEMIpT ~ Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin REC FEE: 13.00 (if more space is needed, please attach addendum): COPYSFEEE: 2012.40 See Attached Exhibit "A" CC FEE: PAGES: 2 Recording Area Name and Return Address 018-1008-60-000; 018-1008-80-000 018-1008-90-000: 018-1010-00-000: 018-1010-10-000 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. 4N^ Dated this ~~ day of March ,2004 * * AUTHENTICATION Signature(s) Michael B. Matshall and Dawn__Marshall, _ husband and wife tl~- authenticated this ~ day of March , 2004 * Kristine land -~ _ ___ TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 70b.06, Wis. Stets.) '~"/~( L~c~l. Off. ~avt,n.iWt/k-- ..- . * Michael B. Marhsall _~ _ ~? M~~ _--- * Dawn Marshal! ACKNOWLEDGMENT STATE OF ) County ) Personally came before me this __ _ _ day of the above named to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristine Ogland __ Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are tat necessary J Notary Public, State of -_--_------- ---- -_---_ -~- My Commission is permanent. (If not, state expiration date: .) * Names of persons signing in any capacity must be typed or printed below their signature. tnfocmadon profusionats Co., Fond du lac, wl STATE BAR OF WISCONSIN 800655-2021 WARRANTX DEED FORM No. 2 -1999 "i U 2536P 3y8 EXHIBIT "A" Part of the NE'/. of the SE'/.and Part of the NW'/ of the SE'/. and Part of the SW'/ of the NE '/< and Part of the SE '/< of the NE'/ of Section 5, All in Township 29 North, Range 17 West, Town of Hammond, St. Croix County, Wisconsin described as follows: Commencing at the Southeast comer of said Section 5; thence N00°05'29"W 1315.84 feet along the East line of the SE'/~ of said Section 5 to the aoint of beginning; thence N89°25'01"W 2639.28 feet along the South tine of the N'/ of the SE'/. of said Section 5; thence N00°21'34"E 258~t.45 feet along the North-South'/. section line; thence N89°51'32"E 1316.00 feet along the North line of the SW ~/, of the NE'/.; thence S14°12'09"W 5&6.08 feet; thence S56°30'45"E 166.57 feet; thence S05°58'41"W fi17.95 feet; thence S89°26'33"W 230.23 feet; thence S00°08'03"W 557.04 feet; thence N89°26'33"E 9601.66 feet; thence S00°05'29"E 758.82 feet along the East line of the SE'/. to point of beginning. r"~ o D ~ ~ m cn c m r*i n oo rT-I D oxovr•,~co ~ z om~°z~m I fTl D ~Nr= ~m°~ z G~ ~O~ Oz ~ ~ ~ fTl Z~ ~~NO ~ ~on~ ~ ~ cn 0 \ _ ~ r z ~ f*1 O N U! rn O 0 0 - ~ o m ~ z N N rn CD O. N ~ fTl (n m I~ z v +r D m ~ I 0 Ir z ~ ( -~ \ II II ~'~ ` o~ `n ` `~ `~ °'.o g5 ~~-- ~~C~ t7L~ ~ ~ ~ ~ ~ ~, ~ ~ N I r z~ ~ ~ °~ ~z~ ~ O ~ ~ ~\ ~~ o N II III rn~~ ~ <W ~ o of D ~ ~~ ~ \6, I I Im Z a 1 ~^' I o~ rn ~ N ~ + x i ~ ~ ~I ~ ~I I~ , o /- ~~ ~ L~ o Nf~ ~ / ~~' I - - ~~ DSO ~ S~ ~°~ G' z \ \ ~ ~ ~ ~ ~~ ,~C,,~° -, can p ~-~~ ~ J w Ulf \ \ ~~~ \~ \ ' . \ \ ~~ ~ \ \i ~ ~~ \I ~ -- N 04°14'27"_E 39342' I ~' c~ I ~ g'~0~ N ` ~ -~ ~) ~ ~I V I ~ ~ cn ~ ~~Z ~ v o N N~ ~ ~ ~ Ip~ ~ ' y V, ~ -P I ~ ~ ~ v` /.~ ~ - - ~N 06'24'13" E 323.55' ~ c„// ~Q; ~ ~~ - -- G w ----~ ~/ ,~ , SEE SHEET 3 'a~i5 '~4~dLlim: ~r.Y'