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HomeMy WebLinkAbout018-2007-28-000•Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township P.C. Collova Builders, Inc. Hammond, Town of CST BM Elev: Insp. BM Elev: BM Description: • s TANK INFORMATION r 1 1 ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic Dosing /~ ~ (-~"ht, U ~-J~ Aeration Holding ,-- TANK SETBACK INFORMATION TANK TO P/L W E~ BLDG. Vent to Air Intake ROAD Septic ~ / I D / ~~,p, Dosing ' ~~ r ~.e Aeration Holding ° PUMP/SIPHON INFORMATION ~, 1 Manufacturer ~/~ Demand GPM Model Number 6 ~~ TDH Li `~~~'3 Fricti n Loss ~.b System He 3~ TDH Ft l3• Forcemain Leng thy Dia. ~. r Dist. to ell~r / / SOIL ABSORPTION SYSTEM county"- St. Croix Sanitary Permit No: 514993 0 State Plan ID No: Parcel Tax No: 018-2007-28-000 Section/Town/Range/Map No: 05.29.17.967 STATION ~. BS /• ~ 1 . t FS ELEV. Benchmark Alt. BM ~ Z Bldg. Sewer S Ht Inlet SUHt Outlet ~~ ~- Dt Inlet ~ Dt m ~- 33 / v' a Hea Man. ~ d d O 7~ •~ J J Dist. Pipe d 3. a 07.3 Bot_ Sy= ~ ~ ys ~~ ~ Final G ade St Cover ~2 3.~0 raj-5 ,e~f ~ r ~ ~ •f ~ ~. ~Q~• ~.. r> - ` ~. i ~~5.~ BEDITRENCH DIMENSIONS Width ~ Y Length Sr n / No. Of Trenches ~~ PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK SYS-EM TO P/ BLD WELL LAKE/STREAM Manufacturer: INFORMATION R Type f System: ~ `'~O / I ~ t UNIT I Number: DISTRI~I.TION SYSTEM Heade d Distribution x Hole Size x Hole Spacing Vent to Air Int e ~ l 2 rr Length Dia ' Pipe(s) / ,. ~/ Length ~~ Dia Z Spacing ?J / (o ~ y rr SOIL COVER v Prcccnrn Sve4cmc Anly ~Y Mnunri C)~ At-Grarle SVStems Only ~ Q'ciC2a~ C;~L~ Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoi ~ -Gt~ Yes [~ No ~ Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: - / v = ~// ^ e Inspection #2:~/ ~/~~~ ~~ ~r,.~- t !rte, ~ _` Location: 1174 167th Street Hammond, WI 54015 (SW 1/4 NE 1/4 5 T29N R17W) Farm ;view Rit9ge Lot 28 +. Parcel No: 05.29.17.967 1.) Alt BM Description = ~ ~\. 2.) Bldg sewer length =~D 1 ~ ~(J~~ ~~it-~K~- ~, „ - amount of cover = +'-~~ Plan revision Re uired . Yes No j U G~,!~~~~ ~ i Use other side for additional information. _I ' O~ ~G ~- - 3~ - SBD-6710 (R.3/97) Date Insepctor's Signat re Cert. No. C.1NI.gOV Safety and Buildings Division County ^ 201 W. Washington Ave., P.O. Box 71b2 ' ~ Madison, WI 53 707-7 1 62 Sanitary Permit umber (to led in by Co.) 5/ 99 Sanitary Permit Application ! State Transaction Number S^g --~ In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the opriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for stato-own are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may for secondary ses in accordance with the Privacy Iaw, s. 15.04 1 m , Stats. I. A Iication Information -Please Print All Information Parcel # ' Property Owner's Narite t~ Property OWrler'T Mailing Address ~~ LocaLOn D I $ ~ ZW ~ -~- Z p " C ~ ~ ~ ~ City, State Zi de ~ ~ Phone Nimtber V Gc.~ Y,/ /'C %., Suction le nn ~/) AXE ~"C./ ,~ T~~-N; R of W l - - '-7 - _ y) that app ail Type of Building (check ~ 7k n L-. Subdivision Name ~ t 1 or 2 Family Dwelling - Number of Bedrooms ~-~ ' ~ ~G~• Block # ~ ~D ~~ .' GZ /~ ~%(- L,~, ^ Public/Commercial -Describe Use P ~~ R~ V City of 08 SM Number Village of ^ State Owned -Describe Use ~ 2 C C t] 2 ~j r own of ~ 5 7 ~ B JC. III. Type of Permit: (Check only one boz on line A. Complete line if ap ~lX E A. w System ^ Replacement System ^ Treatment/[-Ioldin Tank Re N ly ^ Outer Modification bo Existing System (explain) B. ^ Petntit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New List Previous Pernut Number and Date Issued / Before Expiration ~~ 1V. T e of POWTS S stem/Com onent/Device: Check all that a ^ Nun-Pressurized In-Ground ^ Pressurized In-Ground ^ At-Grade and >_ 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ Holding Tank ^ Other Dispersal Component (explain) Pretreatment Device (explain) ~~ , V. Dis ersallTreatment Area Informatio 4 ~ ~ (~ ~~ E~~ _ Design Flow (gpd) 'ga Soil Applic n Ra dsf) Uispe~ al Area ltequi (sf)~ Dt~ Arm ~ .`/" t ~ L • + D t .S t L )"~ ~l VI. Tank Info Capacity in Gallons Total Gallons # of Units Manufacttuer ///~~t ~ ~ U ~ ~ ~ New Tanks Exiadng Tanks ~ ~ „ L ( , ~Q" , r"'~ 0. ~V~l C~A :~ •~ W C'~ Q+ __. _ Septic or holding Tank .... _.. _.. ._. Vv~ ~ .-~ - Dosing Chamber ~ VII. Responsibility Statement- I, the undersigned, a responsibility for installation of the POWTS shown on the attached plans. P~ 's Name (Print)s ~ PI Signature MP/Iv>pRS Number Business Phor~ Number / / _ tz,~.. Pltunber's Address treet, City, Stat^, Zip e) ~^, ~ ,,, ~. i d l J\ [ d., OL f fj ' oun /De artment Use Onl Permit Fee Date I tud Issuing A Sigtiattne pproved isapproved $ ~ ~ + UD ~~~ 0~ rven Reason for Denia IX. Condit~~~~egsons for Disapproval TD rOJ~ ~{, /ktJ Ot,.~+t~ f 3 ~ ~ ~ ~ ~,~r,"..e..,~-; ev~~ 1. Septic tank, eftlGant filter and /~tt~t,t Jf~ ~ / / i t i ,~ , n a m~ ces dispersal cell must all be serv __ __- ~_---....,.e..~ wh.. r,rmdrlsrt by nb~Mhwr _ ai pc,n,onaycn...... ~...... ,..-..-..-~r. r.._____ ~ ~ I 2. AN'selbeCk requirements must ire makttaktsd ~ Y..d/G/~ i ~S i~1. J~~'~~ ~Le. e~~. • .ti. L ~ ,~ r eon e e p ans or a system and submit to t~ oty only oa pa~ not ~ 6aa 8 r/= a cues in site tti/ DG~•~/,ih~t.~ TL~a SBD-6398 (R. 01/07) Valid thru 01/09 / ' PLOT PLAN PROJECT P. C. Collova Bldrs. Inc. ADDRESS 705 Rivard St. Somerset Wi 4025 SW i/4 NE 1/4S 5 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 106.6' 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 i .0 ABSORPTION AREA 456 # of chambers none ~~\ ~~1fff, BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100° Filter BEST GF10-8 ~L~J BOREHOLE t~ WELL * H. R. P. Same as Benchmark '"Q.~~~ 486' property line C ®~ >~x 2 acre lot 105.6' "1_ ~ ~ 106' ~~ 681' property line • ~ PLOT PLAN 'PROJECT P. C. Collova Bldrs. Inc. ADDRESS 705 Rivard St. Somerset Wi 4025 SW 1/4 NE 1/4S 5 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 106.6' 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 456 # of chambers none BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter BEST GF10-8 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark 22' ~ 2 acre lot 385' Property Line 681' property line Well is to meet all Grading is to be done to divert setbacks found in run-off away from system Comm. 83 Tank is to be properly bedded and provided with lockdown covers with approved warning labels Area 15' below system is / / B.M. * to remain undisturbed 2 5 0' // ~L/ B -1 g _ 3 // //// (\ Huffcutt Combo tank 8% Slope 486' property line 104' / B - 2 Pro 3 167th St. 105.6' bedroom 10 6' house commerce.wi.gov isconsin Department of Commerce Safety and Buildings 3824 N CREEKSIDE LA HOLMEN WI 54636 TDD #: (608) 264-8777 www.comme rce.wi. gov/sb/ www.wisconsin.gov Jim Doyle, Governor Jack L. Fischer, A.I.A., Secretary September 16, 2008 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 12 O 1 CARMICHAEL RD 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/16/2010 SITE: PC Collova Builders 1174 167TH Street Town of Hammond St Croix County SW1/4, NE1/4, S5, T29N, R17W Lot: 28, Subdivision: Farmview Ridge FOR: Identification Numbers Transaction ID No. 1587485 Site ID No. 742371 Please refer to both identification numbers; above, in all correspondence withi'he,agency. Description: Three Bedroom Mound System /New construction / 8% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1200135 ~y Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original Bade; System(s): Mound Component Manual- Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual- Version 2.0, SBD-10706-P (N.01/01) The submittal described above has been reviewed for conformance with applicable Wisconsin Administative 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, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • .This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. • 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. • 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 ofSec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • Maintenance information must be given to the owner of the tank explaining that periodic clewing of the effluent filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A copy of the approved plans, s ecifications and this letter shall be~ on-site durin construction and c~iie4~IfV.T.~• inspection by authorized representatives of the Department which may include local inspector C1 D1 Itlt~l?Cl!~~y P~ R~~ DEPARTMENT OF' COMMERCE SHAiJN R BIRD Page 2 9/16/2008 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate q~eration and maintenance manual and/or owner's manual for the POWTS described in this approval. • 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). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • 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. 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, /G~-~ erard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon -Fri, 7:15 am - 4:00 pm j erry. swim@wisconsin. gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. RF~'~=~uEp sFP ~ ~ 2008 Cover Page SA~~ ~~ ~ ~~uiLnINGS Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 9/ 8/08 Owner: P.C. Collova Bldrs, Inc. Location:SW1/4 NE1/4 S 5 T29 N,R17W 1174 167th st. Hammond System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01 /31) Pressure Distribution Manual Version 2.0 (01 /31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contig n plan 9-12. Soil test Shaun Bird Signature License number SEE GORR ~ONDE:NCE r ~~ Observatiaa ~'ige Perforated $elow F33ter Fabxia . ~ffi x-33 Sand " Topsott . ~-- _,.~ : 14oa-Wovaa Filter Fabric r D~striDvt:'an. Pipc ~,.. _ ~ F _~_..~= ~ Stapa . ~"s a ri O f f~ 2 %2 ~. Drain Rack Forst t~EOeA From Peen ~_~ ,~.~F~ ibwe ~ p - L.~rsr ~ Cocas Setiion ~~! A ~oaad ~~~__~ ys'~ F ~r ~ ~' A Bsd For Tlss Absorption Area / ~ ~-~_ / p ~.~6 Ft- ~.. " ~~ 5~ g. Ft_ <:, . f,. 3, ~.I' ~~~ • ~' ~Ft. . ... _ fi ~E"""t. . . a2 ~~ 1 l.. . si Qbse rvo! ion Pipi-~ ~ - ~ ~• -- ~- --- ~ c. ~ ~. .Moen Farce ~ ----- -------- ---_. --__--_---------_-__- ~ Frdrb~Pc~mp ' ~ Oi~frib~tiort Sad Gt %~~~' 2 lZ .- Pi~ - D~e~ Rax ,~ 4 t3bsarvation Papa ~L~Ca.~c:~ Pertaaaeet• ktarklr Pion View Ot.iViound ~3zin~ A Bed •For T~~t A~torp!#on_Acso, ~ ~ . P~-tiE~OF..,,,_ 1 ~forcte~ ai~~ 0teo~i _.. C~ sac~~ss an i~iimo. ~ eoo+.r ~~ Ft. ~ ; ~, ~~ ~ f I • ~ IM?te~ / '~•, Signed: ~~ 3io3e D#~mseter ~,,1~ isc~ .`._.. License ~ ATs~ber: L~t#,e~"i~ ~" -~" ~ hfC~t~es) t3ate: i~tnifolQ •• _~ I:t~tes ~~ _ - ~ of ~o~es/Af#~ ~rerert ~evatf~ of laterals` _:~;,~~ fit. •~~ ~, / ill .~:~~ `~ ~ . ~ ~ ~ ~ . ~ . ~ • . I, :~; ... .,:. ~~` ~, 3: I r • ..T'~. ~• • • , ' ~ ~' i .. ~ ~ S?EC~~•FClt3'~t3i~i5 ' Cit~SS 5~'F~ A~ SEPTIC TA#3~ £ ?~E3I~4r~ C~3Ri"~8£R . .. ~a ~ @'E~' ~~ ~~'~ 3E2~. ALE ~3tEit Tr ~~I 4 i ~ d~! 1 { ~ Itt~ ... ... $- s t • ~~ ALL ~ ~ ~ • ~~ ~ E ~ ~~ ~ ~ ~ ~~ '. ~ Sat Q91P~? SED~~ti6 V~~ `. ' ri Cp~ETE PAID A~"3'g _ :;. '„~' DflS ~ f i~ FAICIR3S~= ~~ v8i8 ~ FLO~' . _ • ~ ,ar,~ . 8' _ . g• . IIIC~S = . ~ ~~ ' ~ /' ~ r ~ ~IRI~C ~ FED =L~ ~~~ Z'~t~- ~~. - ~ ~ FED ~~ V£R'FICA~. 3fIF~~~ Y ~ESSURE - - 'FF~ ~~g C~'T~ ~'ACT~ -~i. FEET SIB ~ ~~~' $~1 B ~~•~ ~" -,.~-- I~~. DID i.ICE3iS~ 3tE3~-~:~ ~ t ~1/ w 7 _ ~ - 1 i s •• Sent $y:~ ~ Laserlet 3t0o; • ~~~ ~~ , ``\ „cas .Nr a~~e ~ ~ awe ~ sis ~ ~ rsa~riesoaw = ~ m w are ¢~_~ tae ~ eva- .rts iu aK rya ,oao ~ ~ ~ a I:Z as ~ ~ as in:nas~ sew ~ ~ ~ ao a~ es ,aoo m ~ ~ ., is ue s , x :n:;ue:.~. ar no +aoo ~ ~ s e+ sae ,ae g a an : ~~:ess s~ ~ ~ ++s - yt as ~ aZ a< ~ a _ 's2 tsf 7a a itf :'lt9fa~ : . ~w.ewa~rwrl ~ . se.nv- itttas~+ouit ~ Momo~ {1o~oed Cast.Iron • ~~ id Power Cord S,t'F~11,A ~ . . ~~ ~ MecL~aaicd Shaft Scab ~ ~ ~ s ~ Shaft _~.r ~ __ ~ia~s Shed :.. r~ ~~ Uppor ~ end L~r i ~aii 8~ o ... . ~~~~' etrra saas•tssM...BS,a~ a,.,~ ~nri~us -trs MSSatsse s...~ ~ vam ovs2~a-apps vc c.;xx-,., .4y~ ~,.. E ~~~ ~~ 1~ 7i5 ~~ e~ur ; ~~ ~~ ~~ • ~p~1tTS f.S ~~~iK4 R iRSSG~-...e~sa-a ~. mat Ul~s wed ~ 3 .,...~.._:..a ~~ / L7 Ftlbar Ptmtp•Taaic t pum1P ~t~ o~anno lJLodsl ~~ Ursa mQ/L ot~JY areragee"' . sso milt. s3o mars sit3` dcJ~OCimI 3( lncltdlame~ i7 ~ Fdb~ D Mechae~ ~satfon fl ~ 0 l~~l IeA a i~ ~o - ~ a Na -~ D lVA i NA ~ ~) a NA L3 Fa~at t~sr L1 Wieiesd Q Oltsec p~1~~cartss~ . ' Q its~gt~ {Pf Q /tt-grime i~~~ ~ V~~yrdeee~4CtAanQ ~ ~C lJkEt~e,~ 3 Sarvt~ Fr+~4ussu.7/ gersrlce Evaat AL feast once every s) ~ t7 E~~ 3 yrs.} iltspCr.'t~ of'dti~(ij (~ Of ~rsk VOtUrri!! Wrlei's oocxsbine~d aiudge ~ttttl ~ e4~ Plttrtp rxrti'10R3Co0~ Crl tsrtk(ys} ~ a tr+o~ s} (~ s ~~ . Inspect ~:3 nt feast arses every ssae every ' t ~ s} • tart ~' o ~ leas II mcrrshs s} ©11tA :nsPsat pump, l>~ ~ alsrsxr Rt least os~os every Cl t!!Otl1l'1arf$~ t7' iYA F3t~ ~~ ahd ~ At Iesst crsci every -~ II r F3 y~s'f s) O NA ~; At feast onus s~wry ~,..~ At least arses ese+~esy Q LI Y~is) DNA uuerr~iu~c~ inspsr,6oas W~ ~~ ~ g ; Tye irss~ns mtsex k Y sett'' exadec ar rsseasr arm aiexs the scaiace. ~ uses obser+~ors yipea and ~ Check t+o~ ~ grveasd ser!aes essay irs~aEs e: vVhets the oosss~rsed aeon ~ s e eaonbESnts d# the tank shag face r+err+oved b 113. '91Ys gtrlive Cedes. - }~~ of et~t ms's. ~~ ar ~~~~~~ sftt~e re~aes# at~ltbe prnride6 ~ ~ ~ l sr~t' ~ ~ o~anoH for new a~ prbc bo raoe ~fhe PaW'1 t~~~.d~ spa l~ d~3eegttf tla+ne the; ovnbe+rts of the tarn3cEs) r+ama+ e- rrse~ by an i::d:vidttat eras od sAe soars*es or rr Ris6ic~Od Sower: POM1KT3 tttspe~: P~5 ~LrdO a ~ Od' ~ ~~ ~ it~I ~ ~ hrdasn e fhe vreemsa ~ oorriWrssd a and sw:YS and ev chock !br any bade u~ fie ~pertsat caifts) shoe ~a vi~u~l ku'p«'~ firs clrsdc she effluent lsvaifc cxsd'~ of e~tluerrt ors thes ~rosittd Tliei ~ °~ efS~ers °n ~ arse! rsegcilr~ss she ~nars:edia6e- rso~Qon eat the- Iocad rragaieloey d Sim rn any tank e4+~s t:~ a a>o~s e>f the t~ wtu~ ~ a Septage3 S C?~ersbor ~ ad irs loor>ts~nad soh ch- ~ t~sul~ed ix~wrs campar:el~c, Ms~~ . i2 moms a~ less shalt be ~ by ~~ authottiy wflftin tt1 of ~ ~~'s~vfre . :3~xtc.t<+ee~rne~ rank(s) for thes ~ t~~ tx ems' eridJex the despofsgt oatt(s~. If t ads aye 3 by a sep®ge a~ vldng' ope~bor P~Or ~ tat .. 'i i '' strait not Uocrit virtteri sc>~ canditions are lrrozet- ai the infr~trative sur~Faoe. , Fage_ of System start uP cs restiored the ex~ °L tip ~~`'t~4lt'~ above aotrrta4 heghwaLer iev~ets. Wren paver- . rwlt be disdtarged m the dispel oet~s) in one tacge dose. ovelioadir~g the cell(s) aced may nit in the badoup or sorfacs disd~ttge of t Ta avoid Sets srt>satioee Have the canbfrti:5 of the pang lernOVed by a Sep~ge Serviobreg ppeYaisor pcior.6D t ~' the effluent pump or cortCa~ $ Pturrebec oc POYVT'S ~ to asS~St ~ ~ ~ ipvmp"oor~tt+ois iA testor~e [format Levels wi[hirf the pump tank. (}o tlOt dtinae M ~ vl~tiides 01ALF ~ t3ttd tfsSpet&~ t~5. ~ tit dmrs Of ~Ydf~C t~2fj OC ~ tftsb~trb tN CORi, fife atf~a wffi>(tf t5 Beet down slope +of t;<tIy lu at-grade sit absalp~orf arm. - Redcrchort or-~f of the ~ fram the waste~aber sfnf3am may impcnve the perfiomisltoe attd pttiffosg the f6e of fife P01cYT5: ~~Y'~~ butts; condoms; aoifon swabs; degreasers: dettfal ~losst; drapefs d~ ~ fbceidattor~ dtf~ct { ~PctmFp~, ~~ F scraps ~ ~ P~'sgn9 g~ . AsA~tDO~~xr ' Vlitttere me POWis faits aredtor' is perinanently.tataere out of service me foIIo~ving steps shah ~ taiGOrt ~ ~ro that fie sysacm is pr~operljra~rtQ?t~N abandoned in comprranoe with ch_ Comm 83.33. Wrsoonsin.4dri>inistra6iv+e Codes • A8 pipdtg fi tanks and pits shall be drsconnecxed and the abandoned Pipe openings seated. The oorfte~C art at1 tanks snd ~ ~~ be3 terreoved and properly dssposed of 6Y a Septage SeeYtdttg OparaOm: . giber p~rrP&tg. 8.lI taNpe.and pTis shat[ be excavated and tiemovEd or tteelr corers r+erswvsct~ Sts vn~cE sp®be tr'IIed wtltt soQ grawet orarroS~ec' inert sotrd rnateriat. COtt78~tGEl~tCY PFJ~t1t ' !f ties POVYI'S fails and c~neevt be reps the fe![owing measures have been, cr must be taken, m provide a code campftartE t~epiaoelsreM SystemL' D A setrwabie r:3pi~eos<reaet'araa has been evacuated and may be crt7ized for the to~catton of a tent soa ~~ The n~cement area should be protected fram drsturteanae and oorslpactJon and sleoucd trot ~ wed ttp+on dY rtisqutrtsd Setba~ from e'asb`ng and proposed struei:ue. cat IInes aced welt5_ Failure lp proDe~ctthe repbecerreerei area t~r#1 riesrrli in ttee need for a new soil and site °evaluaAiaf tp establish a serrtable r+aplaeaemeret ~r'+ta. r3eplaoemeteL systems must cornpty v+rittt the rotes in efFieGi at that tint~- p A suQabie r+~ptaoerreent artia is no! avar7abie' due to setback and/or sot! frrreitations_ t3arrr<tg advances in PQWTS tedueotogy a teoiding Lank ireay be ~t1ed as a last resort to replace the far7ed PO1lYTS. `The site has not baeq avaiv80eQ Co identify a suitable replaaerrter+t ar+ea_ Upon far~ttne of the POWTS a soa.and / site evatuatiore must be perlonneQ fi Locate: a suitable rep1acernent area_ ff no raptaoeiteertt area is avaifaMe a t~kiutg tank may be insfiUed as a Last resort to n+piaae See tared POVYfS_ _. ~Mound and at-grade soE ab~socpdon sy~s may be reoonstrucoed #n pcaaa fetJowing retrioval o€ See biamat ai ~ surer, of such sysrerres must comply with cite Mss in effect at fiat tirrte. <cYftAt2NiN4~ SEPTIC. PUtYlP AND [?TREK TRFA?MENT TANKS tillAY COfit7AtN LETHAL:. QASSES ANDIOR Q~cSUFFIC(1=NT OXYG~I. DO IStGT ENTER A SEPTiC, PtJfl[P QR 07NER TREATMF.IVT TANK UNL)F~2 ANY CIRCf 3t4[STANGES. DF11TH 6tAY RES(ILT_ RESCUE OF A PERSON FROM THE INTERIOR O!G A TANK ifftAY BE DIFFICULT OR il{~P.OSS'[BL.E. ADt)t7rQIYAL COItdME.NTS ~ . POtliFd'S tNSTAiiER t~Iaflf@ ~ ~~ ~ Phone ~/J " - `I ~S . POWT'S IitL41NTAtt+[F~ 11I8tifB /~ ` Pti.~ne ~ ~ _ a r ~'' SEPTAGE SER1/ft~1tG aPERATOR LOCAL I~GULATORY AUYHt?t~ittY E Hama z>tir., •rr,.~ Agency ~ f ~ d c~ phone ~ _. ~~ . "` J~ r~hOr18 ? - `r J~ c3 ~- n+s aoa~4 a.a~s araomul by. f8e sa~dla aftAs ~ tame. Margtratle and Wat+shrn County Zoning and Sat:~ation ~dit~S. This QoeYtleee'N m00ts tae +res of cat. Canon rs~(6i}CiX~CB and fU.SS(S), (z} 6 (3j, t~Yesaonsin Aire Cade. tJss of tlste docranent ~OaS rcpt gvaraatae pea pa'6oonattce of tIK PQW'tS. ' c~W~iJ wsoonsin pepartcnent of Commerce division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete sde plan on paper not less than 81/2 x 11 inches in size. Plan must include' ~ not I~m1ee~ dimensions, north arrow! and location an distance~to nearest road. percent sbpe. Please print. al! information. may tx used for secondary Pu~~ (Privacy Law. s. 15.04 (1) (m))- personal Infprmation you provde _ o.n..nrly 1 nra6~ Ground surface ele~[l ~ • ~. pepth to ('uniting factor ~ ~• Depth to limiting factor ~ in. ' ~ SOIL EVALUATION REPORT Page ~ of Parceil0 # Property Owner Boring 7 ~~ # Ground surface elev. ft. Depth to limiting factor ~l.Pit '•Horizon Depth Dorrrinant Redox Description Texture Structure ~` Qu. Sz. Cont. Color Gr. Sz Sh. ;n, MunseU r-., ~ ~- Page ~ of ~t~-- ~• sou ~Gcation Rai ,~ eoti,,~ry RooB GPD/fP 'Eff#1 •Eff#2 ,. L'am' a~ , ~' ,- L~/ f . ~~~ ,y, ^ Pit Ground ~~ elev. ft. Depth to limiting factor in• ~ Ra ^ Boring # ^ ~~ Redox Description Texture Structure Consistence Boundary Roots GPDfl~ Horizon Depth Dominant Gr. Sz Sh. 'Eif#1 ~~ in. Mtutseq Ctu. Sz Cont. Color ^ Boring in. Boring # Grotutd surface elev. ft. Depth to ('uniting factor ~ ^ Pit Horizon Depth Dominant Redox pescription. Texture Stnuxure ~~ Boundary ~~ -E!f#1 in. MunseB Qu. Sz Copt Color Gr. Sz Sh. > < 'Effluent #2 =800, < 30 mgll. and TSS ~ 30 mgA. • Effluent #1 =BOO; > 30 _220 mg1L acrd TSS 30 _ 150 mglt The Department of Commerce is an equal opportunity service provider~enmai 608-266 315 or TTY 608 264-8777s services or need material in an alternate format, please contact the dep seu~u3o cR.s+oo- project Name Soil Test Plot Pl. P.C. Collova Bldrs. Inc. S Address P.O. -Box 489 ~~ Somerset Wi 54025 #226900 Lot 28 Subdivision Farm View Ridge Dat 5~8~04 Sw 1/4 NE 1/4S 5 T 29 N/R1 ~ W Township Hammond County ST. CROIX Boring. Q Well PL Property Line Assume Elevation 100 ft. Top of Survey Iron BM or VRP System Elevation 106.6' *HRpSameasBenchmark Alternate Benchmark Top of 1/2" Pipe @ 100.2'. ,Wisconsin Department of Commerce SOIL EVALUATION REPORT i9ivision of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County ~ ~ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ~ h( indude, but not limited to: vertical and horizontal reference point (BM), direction and Parcel LD. f~( (/~ V percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Review y v ' f tion Page ~ of a ~~ Date Please pr-nt all -n orma - _ ~~ Personal irrtortnation you provide may be used for secondary Purposes (Priv Law, 04 (1) (m)). ~~ .LL1""/~"'~ ProPeRY ~~ fop rty Location /~ ~^ 14 S ~T p(9 N R / ~E (or W - , ~ ~ ~~l/~ 3 S _~ . .Lot ~~ 1 /4~,~,~r,1 ~.ot # " Block # Subd. or ~~ property Mailing Address ~ ~ ~ ,_ ~ ~, /w v, ~~ ~,,~ ' Village Town Nearest RoF ...~. cr~ro Tin Code Ph" U ~- ', ' ', ^ CnY / ~ _ ~ ,~ L` ;',;' ~,~; ' '' ` ~ , _ Code derived design flow rate y)~ GPD New Construction Us . Residents WwrNrr-a-'" ^ Replacement ^ Public or commerdal -Describe: ------ -~ _ nfh Flood Plain elevation if applicable ~f ~~ ~ fl. Parent material ~, u~ ' , n2 s General oortanertts D~ and recommendations:.~i y+S~C.L ,~ rrr/e.~~ l` , !r Boring ~~ # Ground surface elAv. ~~~' Depth to limiting factor - in. ~~ Pit ~ Sal ication Rate Texture Structure Consistence Boundary Roots GPD/fF Horimrt Depth Dominant Cdor Redox `Eff#1 'Eff#2 in. Munsetl Qu. Sz. Cont. Color Gr. Sz. Sh. ~~ l ~~lL r3f i ------._ ~ v~Gl~ 7 ~ J ~ I / y r..., ~/r ~/ r-- fY~ "' /~2. .>,/~v9 ,n/!~ v~ pit Ground surface ele~D ~ ff• Horizon Depth in. Dominant Cdor Munsell Redox Description Qu. Sz. Cont. Odor Textur ~-~' 3 ~ -- 3 ~.~ >- ~/~ c a d s ~r'y 5~ _ nn , . en .,,,, n/. in f ct ~~ • a or _SG - Depth to limiting Soil lication Rate Structure Consistence Boundary Roots GPD/ff Gr. Sz. Sh. `Eff#1 `Etf#2 a ,. ,~~~ ~5 ~ .v ~ d3 ms IL ~'/ yH., ` Effluent #2 = `Effluent#1 =tiVU ~.w=ccurryr~a~+ ,~-- _ --- - CST ~~ ~ PrinU Si Bird Plumbing, Inc. Shaun Bird Date Evaluation Conducted Address 1008 192nd Ave, New Richmond, WI 54017 ~- ~"'c7 ~/ 30 mglL and TSS < 30 mglL CST Number 226900 Telephone Number 715-246-4516 i~- z ~ property Owner Parcel 1D # Page ~ of U ~~~ Boring # rn. Pit Ground surface elev. ft. Depth to IimiGng factor _~%~ . Soil ication Rate 'Horizon Depth Dominant Color Redox Description Texture Structure Con~ctance Bourxiary Rooms •Eff#GP 'Etf#2 in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. JJ v' ~ ~J i~/ l ~J ~ f ~, S /~ / I Bonng # U ~~ ^ Pit Ground surface elev. ft. Depth to limiting factor in• Sal ication Rate ti i Texture Structure Consistence Boundary Roots GPD/fF Horizon Depth in. Dominant Col Mansell on p Redox Descr Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 U Bonng ~~ # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil ication Rate . Horizon Depth Dominant Caor Redox Description. Texture Structure Consistence. Boundary Roots GPD/ff in. Mansell Qu. Sz. Cont. Caor Gr. Sz. Sh. 'Eff#1 `Eif#2 'Effluent #1 = BODE > 30 _< 220 mgll. and TSS >30 < 150 mgll. 'Effluent #2 = BODs < 30 mglL and TSS <_ 30 mglL The Department of Commerce is an equal opportunity service provider and employee. 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. sso-eaw ta.sraol Soil Test Plot F~roject Name P.C. Collova Bldrs. Inc. Address p.O. Box 489 S m r et Wi 54025 o e s M #226900 Lot 28 Subdivision Farm View Ridge Dat 5/8/04 Sw 1/4 NE 1/4S 5 T 29 N/R1 ~ W Township Hammond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 106.6' *HRpSameasBenchmark Alternate Benchmark Top of 1/2" Pipe @ 100.2' (nl 0 z QI ~I w ~I Q w ZI 0 0 co N o~ Z ~ ~ ~ ~ . sz 8~ ~ ~ .oZ 8 f I ~\ `~ ~ ~ N ~~ ~, s - ue ~ o ~ ~ I ~ ~, N NI , Z s s9 ~ m ~ I ~~ ~- ~ (n U ~~~ I~ ~ ~ a - ~ ~ ~Q ~ ~ ~ t ~~~ N O,~ N ~ o ~ ~ ~ I ~ o`o ~I I °°~ ,-I ~ ~ ~ 001 I O~~ r I _ ~S g~ ~ ~ ~ N cV Z ~ ~ ~, ~ ~ ~ ~ ` ~ ~. S~ -- 8~ lo o I ~ ~ . , ~ l N _ z ~ ~ ~ Q ~ ~I ~I ~ I ~ l l ~ ~..~ ~ _ - .: - - ~ I ~ ~- } -~. } ~ '~ dam- a~~o ~ ~ Q o con ,..: ~`' r ~; a i zo ~~ ~) O O ~ pOp O waW~ ~N M t1') ~ 00 00 ~-- ~ w~ Z~ Z O I p p N N o~awaaxo , C,~., - . ,, ti ;~- r. r- aOUwm~ww~ ~ ~~~~~ ~ ~# ,- It II ~ ~ ~ `.:,, . E. ~ L19 0 ~ m ~ N p3'S5_02=W_ 573_52_- _ -~--" - - , 6, ~{`>,~ ,.,<. _ ~- L2 ___---= -- ~ --_._ _- -- _ _ _ LZ2 O~ ~%,~ J L15 ~ ~ - ~ ~. ~ 0 o w i-- II it Q w C~2 ~ o / / ~J ~ ~ N / / / / / `~ " °~ / / N ~ i ~. ~, ry I~ ~ ~9 ~8 ~ \ / ~ ~ o Cat °' ~ ~ " 6 . ^~~ / ~ . I ° w I~ ~ ~ ~ Z ~ I ~ ~9 6 .8Z 6 ~~8 .~ << / s z~~ goo m~ ~- I ~ r ~ L 3 ~,~~ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer P• C. Collova Builders, Inc. Mailing Address /~~? RIV`C'~l~G~ ~. t~1~~-~ ~~~ ~>1ne~~~ ~) ~ `7~~_ Property Address City/State (Verification required from Planning Department for new construction.) Hammond, WI LEGAL DESCRIPTION Parcel Identification Number ~I ~'r/( ~~]''~~`~Q~~_ Property Location ~ `/4 , SE `/4 ,Sec. 5 , T ~9 N R 17 W, Town of subdivision __ Farm View Ridge Certified Survey Map # Hammond _ .~--~. ,Volume ,Page # Lot # ~. ~. c^ Warranty Deed # ~ ~ ~ -~ J ~ ,Volume ~~ ~~ ,Page # ~) Spec house J, yes ,~(no Lot lines identifiable~.~Cyes '~ 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 plumber, 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 1/3 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. Certification statin that our se tics stem has been main i d m t t an St. oun Zonin e artment withing 0 days of the three year expiration da~• ~~~~~~ ~~~ ~~ ty g • ~~~/// PRODUCTION OF~K;E ~~~~ ~ g SIGNATURE OF APPLICANT (715 2943245 DATE OWNER CERTIFICATION 3~ 260TH ~• Uwe certify that all statements on this form are true to the best~~y ~ Ai wft,~.a/~j~re the owner(sj of the pr p desc bed above, by virtue of a warranty deed recorded in Re f~,~i'~ {~1 V'*V 9/ ~/~ 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. U 279BP y22 State Bar of Wisconsin Form 2-2003 WARRANTY DEED Document Number 11 Document Name THIS DEED, made between Michael B. Marshall and Dawn Marshall husband and wife ("Grantor," whether one or more), and The Collovas LLC ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): See Attached Exhibit "A" 7943~4- KATHLEEti H. NALSH REGISTER OF DEE05 ST. CROIX CO. , MI RECEIVED FOR RECORD 05/06/2005 01:00PK MARRANTY DEED EXERT le R&C FEE: 13.80 TRAAS FEE: 1708.70 CQPY FEE: CC FEE: PAGES: 2 Recording Area Name and Retum Address 018-1008-60-000;O18-1008-80-000;018-1008-90-000 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. Dated ~I,~J y D .Ili Signature(s) AUTHENTICATION authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN (lf not, authorized by Wis. Slat, § 706.06) THIS INSTRUMENT DRAFTED BY: Attorney Kristine Oland Hudson WI 54016 B. Marshall * Dawn Marshall ACKNOWLEDGMENT L) EAL~ STATE OF ) e ) ss. ~(( COUNTY ) ~~ Personally came before me on the above-named Michael B. Marshall and Dawl Marshall to me known to be the pe n(s) who executed the foregoing in me and ackn wle the ame. Notary Public, tale o ~~ ~~77^~ My Commission (is permanent) (expires: ~ ~-rt:~ ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLF.ARI.Y IDENTIFIED. WARR4NTY DEED ©2003 STATE BAR OF N'iSCONSIN FORM N0.2-2003 • Type name below signatures. INFO-PROTM Legal Forms 800-655-2021 www.infoproforms.com Troy L. Turner ~~loi2ry Public 2798P '~23 EXHIBIT "A" APART OF THE NORTHEAST 1/4 OF THE NORTHEAST 1/4 AND IN PART OF THE SOUTHEAST 1/4 OF THE NORTHEAST 1/4 AND IN PART OF THE SOUTHWEST 1 4 OF THE NORTHEAST 1/4 OF SECTION S, TOWNSHIP,29 NORTH, RANGE 17 WEST, T WN OF HAMMOND, ST. CROIX COUNTY, WISCONSIN AND MORE PARTICULARLY DESCRIBED AS FOLLOWS: BEGINNING AT THE NORTHEAST CORNER OF SAID SECTION 5, THENCE S 00 DEGREES 30'46" W ALONG THE EAST LINE OF THE NORTHEAST 1 4 OF SAID SECTION 5, 2463.70 FEET, THENCE S89 DEGREES 26'33" W 1369.24 FEET, NCE NOS DEGREES 58'41" E ALONG THE EAST LINE OF LOTS 31, 32, AND 33 OF THE PLAT OF FARM VIEW RIDGE, b17.95 FEET, THENCE N 56 DEGREES 30'45" W 166.57 FEET, THENCE N14 DEGREES 12'09" E ALONG THE EAST LINE OF LOT 30 OF THE PLAT OF FARM VIEW RIDGE, 5bb.08 FEET, THENCE N 00 DEGREES 2b'09" E ALONG THE WEST LINE OF THE NORTHEAST 1/4 OF THE NORTHEAST 1/4,1218.78 FEET, THENCE N 89 DEGREES 52'25" E ALONG THE NORTH LINE OF THE NORTHEAST i/4 OF THE NORTHEAST 1/4,1317.63 FEET TO THE POINT OF BEGINNING.