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HomeMy WebLinkAbout018-2007-30-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building ~ision ~ INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. 'ermit Holder's Name: City Village X Township P.C. Collova Builders, Inc. Hammond Townshi ;ST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~(_ Dosing Aeration '~` ~.. Holding - _~" TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic , ~ ~ T ,,, - _-___ Dosing Aeration ,__ - -- Holding _ _~ PUMP/SIPHON INFORMATION Manufacturer I ~ ~ Demand vC ~ GPM Mode! Number ~~ nj,'J i s ~ TDH Lift Friction Loss System Head TDH Ft ~~- ~ ~ . ~~ 3. q r7 `> Forcemain Length Dia. ~~ Dist. to Well ~ / L:2rj ~ ci. SOIL ABSORPTION SYSTE~01-~' }.+~ _ `• t•- ELEVATION DATA County: St. CroiX Sanitary Permit No: 463144 0 . State Plan ID No: Parcel Tax No: Section/Town/Range/Map No: 05.29.17. STATION BS HI FS ELEV. Benchmar ~ ~, Zg p _ ~ UD, 0 Alt. BM Bldg. Sewer s. ~~~ ~~~ SUHt Inlet 8 Z~ 9 G ~ SUHt Outlet Dt Inlet Dt Bottom l ~ 21 0 ~ r ic7.. 7 Header/Man. Dist. Pipe ~ ~ ~ /0 2 . B•~ Bot. System Z •~ /02 . f Final Grade St Cover ~ 5, 30 / 5.30 / ~ ~ 3~ BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ %~ -7 ,~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LE I Manufacturer. INFORMATION C MBER OR Type Of System: ~ r ~'~ .,~ ~ 5 ~ ~ '~ ; -. ~"~ UNIT Mode M ~ ,,... c - , I w~ DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake u Length ( Dia ~ ~ Pipe(s) ~ ~ Length 5 y Dia Spacing ~ j / ~ L/ , ~~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over BedlTrench Center E ~~ Depth Over Bed/Trench Edges 1 l S'~ xx Depth of Topsoil xx Seeded/Sodded xx Mulched / i• ~ Yes ~ No ~ Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1~:yO---~~~ ~/ Inspection #2:~/ 7 / ~' nor ~ t/rt ui i , r. Location: 1178 167th Street Hammo~~nlld, WI 54015 (SW 1/4 NE 1/4 5 T29N R17W) Far iew Ridge Lot 30 Parcel No: 05.29.17. 1.)AItBMDescription= ~~''+ "C' ~"~~ 2.) Bldg sewer length = -~- `~ `~ I -amount of cover = ~ .~ Y Plan revision Required? Yes ~ No ~ ~ Use other side for additional information. ~~ ~ 7 ~_~ _ _ _ _ _ - J l-' ~ ~._ SBD-6710 (R.3/97j Date Insepctor's Signature Cert. No. Safety and Buildings Division County ~ ~ 201 W. Washington Ave., P.O. Box 7162 ~g f 9 ,~~~~~,~ Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled ' by Co.) Department of Commerce (~8) `7 ~3 Sanitary Permit Appli eta Plan LD. Number ~ ~ ~ ~ in accord with Comm 83.21, Wis. Adm. Code, persgpal in u~de / O may be asod for secot~daty - ry S m) 2 2 2004 ject Add r ess (if diffett;nt than mailing address) - L Application Information -Please Print All Inf d n Zp IX COUNTS KING 7 ~ l / ~ ~~ ~ ~ ST . OFFI N ~ ~ i arcel # `_ , Lo~S Block ~ ( o i ~ CJ ( J 's Mailing Address petty Locati ~ City, State , p Code Zi Phone Number /, / 1 e ~ II. of Building (check all that apply) / ~ 1 or 2 Family Dwelling - Nnmber of Bedrooms ~ y ~/ Subdivision Narne CSM riu Pu lic/Comtneteial -Describe~ fse n''''tJl State Ownod -Describe Use ! ~I~d ~ ,X S ~ pYl C~G~~O~Q • Gty_ Pillage ownshtp o III. Type Permit: (Cherie ody one boz on line A. Complete line B if applicable) A" ew System Replacement System Trestrtrettt/Holdiog Tank Replacernt Ody Other Modification to F.xistiag System B • Pumit Renewal Perntit Revision Change of Permit Transfer to New List Provious Permit Number and Date Lcwed Before Facpitation Plumber Owner ~-.-- l[Y. T of POWTS S Check all that a 1 ' on -Pressurized in-Ground and Z 24 in. of suitable soil Mound < 24 is of suitable soil At-Grade Single Pass Sand Flitter Coacttucted Wetland Pressurized in-Growrd Holding Tank Peat Filtu Aerobic Treatment Unit Reciratla0ing Sand Filter Redreuta ' S ~c Media Filter reaching Chamber Drip Line Gravel-less Pipe Other (ex lain r/ Y. D' eatmeat Area Informa8on• Deli Plow (gpd) ~ Design Soil Appli 'spersal Area Required (aB ~ .Dispersal Area Pro (sf) System Elevation ~ « ~ '~~ f l ~ ,~ ~~ 13 ~ ~ D~ VL Tank Info eapa«ty;n Total Number Manufacturer Si Steel Fiber Plastic Gallons Gallons of Units n«ete Constmcoed Glass New Esistiug T Tanks Sep6ror Holding Tack y,,,~-~ !~"~ ~ ' Aem6ic Treatrnent Unit ' ~ " l Y Dosing Cham6a YII. onsihility Statement- >6 the a nsibility for lostallation of the POR"IS shown on the attuhed Plumber's Name (Print) Pl MP/MPRS Number ~ Z ~~~ Business Phone Nu ~/~ z ~' ~~~ Plumbers Address (Street, City, State ) , ° s~~ ct~ ~ oT t / VIII. Cou /De artment Use Otil A _„-, ~ 'J'"' ~ppro~ ~ Sanitary Permit Fee (' odes Groundwater Surcharge Fae) ? j~ ~' Issued ~ - Is t Si tamps) V 3 ~' ~ ~ c~ ~ `~ ~ Owner Given Reason for Denial IX. CoadihEM oOf APProvaUResso~ Disapprov~y stl . ,. L ER: ~ 7.u.C/il i optic tank, effluent filter and S' dispersal cell must all be ~ ~ ~ 3 serviced / i ta ---- as per management plan provided by plumber. /~ ~ 2. All setback requirements must be maintained D(-~t~~~~~°~ !~ 5-~~~~~~ as per app-icable code/ordinances. th,. . ~"~f Attach complete plans (to the County ody) far theKys<em oa paper not toss than ill2 z tl Inches in she PLOT PLAN PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 SW 1/4 NE 1/4S 5 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 101.8' BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX)C SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 454 # 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 308' Property Line B.M. Scale = 1 /4" = 10' Alt. B.M. is t. of 1 /2" pipe 100.2' Tank is to be properly bedded and provided with lockdown covers with approved warning labels well is to meet all setbacks found in Comm. 83 Huffcutt Combo Tank Pro 3 Bedroom House Area 15' below system is to remain undisturbed 9% Slope Ig _ 1 R B-3 ~/ ~--~ 10 100.8' B - 2 01' 566' Grading is to be done to divert Property run-off away from system Line Farm view road commerce.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.wi. gov/sb/ www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary October 20, 2004 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: 10/20/2006 SITE: PC Collova Builders Farmview Rd Town of Hammond St Croix County SW1/4, NE1/4, S5, T29N, R17W Lot: 30, Subdivision: Farmview Ridge Identification Numbers Transaction ID No. 1070748 Site ID No. 691169 Please refer to both identification numbers, above, in a1L corres ondence with the a enc . FOR: Description: Proposed Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 987340 Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade 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.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, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD-10691-P(N.01/O1). • The pressure network is to be constructed in accordance with publication SBD-10706-P(NO1/O1) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems -Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81)". • 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 of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. Conditionally ~PPR~l~ _ EPgRTMCU,-.... _ _ ~D SHAUN R BIRD Page 2 10/20/2004 • Comm 83.22(7) - A copy of the approved~lans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. 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 operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) -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 hazazd. 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 aze responsible for the installation, operation or maintenance of the POWTS. Sincerely, Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm j swim@commerce.state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 PLOT PLAN PROJECT ~.C. Cnllova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 • SW 1/4 NE 1/4S 5 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 101.8' BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND ~~ SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 454 # of chambers none BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE ~ WELL *H.R.P. Same as Benchmark 308' Property Line B.M. Scale = 1 /4" = 10' Alt. B.M. is t of 1 /2" pipe 100.2' Tank is to be properly bedded and provided with lockdown covers with approved warning labels well is to meet all setbacks found in Comm. 83 Huffcutt Combo Tank Pro 3 Bedroom House Grading is to be done to run-off away from syst Area 15' below system is to remain undisturbed 9% Slope B-3 / B-1 ~ uu.~s~ 6-2 01' 566' '~ Property a Line Farm view road Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 10/6/04 Owner: P.C. Collova Bldrs. Inc. ~~ F~ 1~ ~~'' ~~~ ~°o~ °~s o,~ Location:SW1/4NE1/4 S5 T29 N,R17W Lot 30 Farmview Ridge 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 Co tigency plan 9-11. Soil test ~~ Shaun Bird Signatu License . ,..,r~~rcCE ,,,,~u F SAFE7Y AND BUILDINGS SEE GOR PONDENCE .. ~~~~ ._ Designer No 'Date Non-Woven Filter Fabric 4" Observation Pipe Perforated Below Filter Fabric ASTli C-33 S o n d --~ ~' Topsoil 7. Stops A ~ Ft. 6 ,5'? - Ft. 1 '~~, ~ Ft.~ . - ~ ~ , ~ Ft. . K Ft. . L ~ Ft. __ h, "~~ Ft . Distribution. Pipe G c D _ ~ ~- Force Moin From Pump Cress Section Of A Mound Sy stem Usin A Bed For The Absorption Area ~ ,, r ~k ~,~ uf~s J °' b A 0 W - L 0 0 I ~~~ }H bed Of E/~- 2'z Drain Rock r Flowed L.oYer ~p 'E~~3 F ~gJ~~ -T G --~--_i r Fi r ~ ~~ ~~ 13' ~'~~ - =---1 4~Obstrvotion PiPe-~ _ K r.--------------------------- -- Force Moin ~----- -------------- --------------------- ~ From Pump ! ' t Distribution Bed Of /Z - 2'2 Pipe ~ Dram RocK .4 Obt;ervotitan Pipe:-~Cz~X. Permonent Morker ~S~r 3/,~ ~ .~~.~ bvf~°~~,LC~I~'P-' Pe or Rods Plon View Of Mound Ucfnq A Btd For The Absorption Areo totaled Qn 8att9m. gqua-ty Spaced Cl~~ E R5T tlotL MixT 'e' a CanntC ~ resit Ft. F~. Signed: License Number: Gate X ~ inches ~~~r~ Y a~ inches J/ -Hole Diameter3 (.6 Inch Lateral ~" o~. ~ Inch(es) Manifold ~. Inches Farce Main " ~- Inches ~ of holes/pipe Invert Flevatior~ of Laterals/~~~-3Ft.~~ Perforated p+Pe Oetcii F• ECTit3?~ AND SF£CIr ICATZONS gEFTIC TANK ~ ?UMP CI}RM$F-R CR©SS S y~EAtN£ItPR~f ,= HIx, ABOyE GRADE 12 ~ Ji3NCTZflN $flX AgFROV ED MANHOLE COVER y,= C; ` ~t £NT pZPE WIND0~1 4R D40R ` W ITK C©NBU I T Wf pApLOCx ~ y ~_~D = . ROM I ~ ~ IR ;~iTA1CE ~ r;~tl,~c ivIARNI~IG iASE:. FRESH , E ~ ~~~~;.z,,,,, g> ~ ~ ~_4„ Mix. Flli~ :: ~`..D GRADE ~~ „ ~Y . Yom. - s,~. ~_-~ 4 s u l$ M1N- i I ti LET ' i ~ ` GAS- _ ~/J1PpRl~YYEI~ ~,,;AT£R ';`I6 HT 5 EALS "'~" A TZGHT r SFA L ; Jt1iA1TS klT~i pppR0ll£D PIPE ~ f tT f~R '~" _}_- , _ ALM ~S $ ' = N OIL ~iU APPl81~~ ~^ C s = i . PIPE 3` Q dFF SOIL pt3#~IP OFF EL£~ - D 8 u APPRO~ ~ BEDDZ~G UNDO TASK CONCRETE PAS ~~ ~ , ~y~~.iJ u~ SP£Crf ICATZONS l+tL1i'IBER DOSES ?~ 3~AY = ,______.--- gEFT1C f DOSE ~j„~ GAL- TANK 2'~ANt1FACTtIRER: UflSE vG'LUME ZNC~DIHG (,~l / ~/ ~, ~~ C,Ai.. F ~,03JSAC K : 1.~~-----^"~l~ SEPTIC w~~~ GAL. _ ~~3 INCHES '.~ GAL- TA1IK gI2£S = DOSE ,j„ CAFACZTI£S s A _ ----- D GAL. ALARIK MAi~NF'AC113RER,• 8 ~?_ ;~iCHES i ~ ---- g ~ MpDEL ~T'YP£ : /~ ' /t.,c.~~j~-' _ ~..7 INCHES - !_....rr ~'. 3, ~L. ~I1•CH ~ 11~-~ t/ C ~ .r A7?4P MANtJFAC3iiRER ~ .v II = ~ xNCI;ES ~- r ~ PFg I LHR 15.23 s,aAC - MSfe124'C~~~ • M HIRZI3G AS ~f'7 G?M ~ PUHp ~ ALAR FEET DISCHARGE RATE _,,.~.=- PzP£ - ~ ` ~..r~..FEET REQUIRl:t3 I~+4P o~F ANn ~~s~~g~'~ZC~t 3 ESN PU - - - , FEET VERTICAL DIFFERENCE $ X~ ~ 1IQg-£,~-.FRICTION FACTOR •_ _ FEET MINII'l=Jl'i Hg~pRK SDPpt,.Y PRI;gSURET N tZC lid ~ ~, ~ pEET FORCEMA.IN ~ T£ITAL ~ H / ~ DIAH~~ ---- ----~--- ~FiDT !a L D 1MENSZ JNS flF PiJH' TANK ~ I.Z{~13 D ~¢'~ ~~''~'' F INTER NA ~ LfCENS£ ~TM$F-R= SIGNED= aAT£ :1~8 w ~ ~ ~ 50 153 12 40 152 0 w ~, 30 HEAD .CAPACITY CURVE MODEL 152/153 ~ 8 o ~/ - :. a 20 ~- - 0 ~- _ 4 ~ 10 -i---t~ 0 20 60 80 100 GALLONS LITERS 0 80 160 240 320 FLOW PER- MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. • 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. • Sealed Qwik-Box available for outdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required, 1521153 Series 1521153 MODELS Control Selection Model Vohs-Ph Mode' Am s Sim lex Du lex N152 115 1 None 8.5 1 2 or 3 BN152 115 1 Auto 8.5 Included 2 or 3 E752 230 1 Non 4.3 1 2or3 BE152 230 1 Auto 4.3 Included 2 or 3 2 3 ' TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT AND DEWATERING MODEL 152 153 Feet Meters Gol. Liters Gol. Livers ' 5 1.5 69 261 77 291 10 3.1 61 231 70 265 15 4:6 53 201 61 231 20 6.1 44 167 52 197 25 7.6 34 129 42 159 30 9.1 23 87 33 t 25 35 10.7 -- -- 22 85 40 12.2 -- -- 11 42 Lock Valve: 38,0 Ft. (11.6m) 44.0 Ft. (13.4m) ° 3 27 i i Iz I/e 5 t /! r -L asssos i2 i2 sxzoe4 N153 115 1 Non 10.5 1 or BN153 115 1 Auto 10.5 Included 2 or 3 SELECTION GUIDE E153 230 1 Non 5.3 1 2 or 3 1. Sin le i back variable level float switch or double i back variable level float BE153 230 1 Auto 5.3 Included 2 or 3 9 p 99Y p 99Y switch. Refer to FM0477. o cnurloN 2. See FM0712 for correct model of Electrical Alternator E-Pak. Ali installation of wntrols, protection devices and wiring should be done by a qualified 3. Variable level Control Switch 10-0225 used as a Control activator, SpeClfy duplex (3) licensed electrician. Ail electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act{OSHA). or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TQ: P.D. BOX 16347 Z Louisville, KY 40256-0347 Manufacturersof. . ~ SHIP T0: 3649 Cane Run Road [~~! o Louisville, KY 40211-1961 QLG4UTY/'UMP9../iNCE ~9~p tl http://www.zoeller.com PUMP ~O e f ~~1 ~ ~~5pp) j7~go3624 PUMP -~; © Copyright 2000 Zoeller Co. All rights reserved. SO1L EVALUATION REPORT Page ~ of Wisconsin Department of Commerce "Division of Safety and Buildings in accordance wRh Comm 85, Wis. Adm. Code County ~ Attach complete site plan on paper not less than 6112 x 11 inches in size. Plan must indude, but not limited to: vertical and horizontal reference point (BM), direction and Pancel I.D. 1, +~. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. R owed G~ Date Please print ali information. ` ~ I ~ Z~4 Peraonal information you provide may be used for secondary Purposes (Pri ~ ~~.-`I (14 (t 1(m))~ property Owner ~ _ m. P perty Loc~atio /n .'l ~ ~ "Govt. Loj~ltJ 1 /4 ,~ 1 /4 S ~T p(/ N R E (or 1 r U LOt # Block # Suhd. or ~~ Property Mailing Address L~.J~€ ~ ~, ~ f, !f^- ll' ~~ ~~ ' `' ~ Town Nearest Ro ..~. c+a+A Zio c e :.. i ~. ' ^ City , ~ ~ Village _ ,> .. ~ New CortstrudSon t!s . Reside . ~ ~ ~~ ~ ~, i 1-~_i ~ ~ F _ Code derived design flow rate ~ ~~ GPD _ ^ Replacement ^ Public or commerdal - Desrxibe: / ~ ~ _ - ------ -- Flood Plain elevation if applicable ~~ ~ ~ ~ ft• .,,~ 5 -+i Parent material ..(~. ~ ti i ~~~ ~ l ons: / a ~i ~ ~z ,~ (¢, /c%~~ andnd recomnt i 1 s~ :~ Boring .~ ~~ # ~ Ground surface elev. L 1.~ V ft. Depth to limiting factor ~ in. Sal ication Rate pit istence C Boundary Roots GPOIfg Horizon Depth Dominant Dolor Redox Description Texture Structure ons •Eff#1 'Eff#2 in. Mur-setl Qu. Sz. Cont. Color tic Sz. Sh. ~ /J ~ ~ Q' I ~ ) / ~/ 7v °---^'~~ ~ /^ C ~ ~ z.. o-~a ~s .~--_ ~ ~~ ® ~~ # Boring ~- ~~~i ~. De th to limiting fact r i^• Soil lication Rate pit Ground surface elev. ~,~-~- P GPD/ff Horizon Depth in. Dominant Cokx Munsell Redox Descxiption Qu. SZ. Cont. Cdor ~ ~ 3/L i 2 ®-l7 ~ ~ ~ Sl 3 -L ~/_y -I,s ~~/~ cad s ~ y Texture Structure Consistence Boundary Roots Gr. Sz. Sh. •Eff#1 •Eff#2 S I am r r~F'/' cs ~M r /.v ~( mS k Fig' w ~ '~ S( I cs I~ F' ~..~ /F • Effluent #1 = BOD > 30 < 220 mglL and TSS >30 _< 150 CST Name (Please Print) Bird Plumbing, Inc. Shaun Bird Address 1008 192nd Ave, New Richmond, WI 54017 • Effluent #2 = BOD _< 30 mglL and TSS ` 30 mglL CST Number 1 226900 Date Evaluation Conducted Telephone Number ~,~~ i/ 715-246-4516 1d~ 3d P ~ of Property Owner Parcel 10 # age [~ Boring ~~ # ~ in f ct Pit Ground ® surface elev. ~ ft. • or a Depth to limiting Sal ip~ ~ `'Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots .E~GPD/ffE~ in. Munsell ' Qu. Sz. Cont. Cdor Gr. Sz. Sh. ' ~s 1 , ~ h '/ - 3 10 r S 1 r ~ m . y-z ~ . f yt~ ..~- ^ Boring Bonng # ^ pit Ground surface elev. ft. Depth to limiting factor in• Sal iption Ra Horizon Depth Dominant t,.olor Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. t;ont Caor Gr. Sz. Sh. `Eff#1 'Etf#2 ^ Bonng a ~~ # Ground surface elev. tt Depth to limiting factor in. ^ Pit ~ x~Uon ~ Horizon Depth Dominant Ca Redox Description. Texture Structure Consistence. Boundary Roots GPD/fP in. Munsell Qu. Sz. Copt Color Gr. Sz. Sh. `Eff#1 `Etf#2 `Effluent #1 = BODa > 30 < 2'10 mglt. and TSS >30 <_ 150 mglL `Effluent #2 = BODS < 30 mglt. and TSS <_ 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. seo-ssw (R.~rool Soil Test Plot Plan Project Name P.C. Collova Bldrs. Inc. Shau Address P O Box 489 Lot 30 S W 1/4 NE Somerset Wi 54025 ~" M #226900 Subdivision Farm View Ridge Date 518J04 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 101.8' *HRpSame as Benchmark Altnrnatp Rpn~hmark Ton of 1/2" Pine @ 100.2' N GJ . ' ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer P• C. Collova Builders, Inc. Mailing Address PO Box 489, Somerset, WI 54025 Property Address ~ ~ ~ ~ ~ l>Z~ c~~~ M. ~. S ~ ~~ . (Verification required from Pl ning Department for new construction.) City/State Hammond, WI parcel Identification Number ~-e/11~ LEGAL DESCRIPTION Property Location ~ '/.: , SE '/4 ,Sec. 5 , T 29 N R 1 ~ W, Town of Hammond Subdivision Farm View Ridge ,Lot #~ Certified Survey Map # Volume ,Page # Warranty Deed # ~ ~ l ~ ~ ~ ,Volume Zs~~, Page # 7 Spec house. ,yes ~ no Lot lines identifiable~ves ~ 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 propem owner agrees to submit to St. Croix County Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (I) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 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 W isconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning artment within 30 days of the three year expiration date. P. C. COLLOVA BUILDERS, INC. ,,c~ (715) 247-2742 ~/ O 5/ ~~ SIGNATURE OF APPLICANT P.O. Box 489 DATE SOMERSET, WISCONSIN 54025 OWNER CERTIFICATION Uwe certify that all statements on this form are true to the best of mylour knowledge. I/we am/are the owner(s) of the r erry described above, by virtue of a warranty deed recorded in Register of Deeds Office. C. COLLOVA BU~~.I)EPS, INC. x/05/ off` SIGNATURE OF APPLICANT (715) 2~t~-2742 DATE P.O. Bor. 489 ****** SOMERSET, WISCONSIN 54t!~:'S ****** Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department. Include wilt 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. ' - VYNER'S MANUAL 8~ MANAGEME~ ca to s - PONVTS O ~vsTfr1A SPEC! Number of Bedr~ er,cial Units Number of Comm ESamatea flow t'~°' (Estimated x ~ _5) pesiQn flew (peak). lion Rate lnfluent/EttfuentQuelity FOG) Fats,.0ii 8 Grease Biochemical Oxyg~ pemand (BODE Tom; Suspended Solids (t'SS) Pretreated Effluent Quality ~oos) Biochemical Oxygen Demand ( Total Suspended Solids (TSS) Fecal ~~Rt, (geometric mean) Maximum Effluent Partide Size service Event ins !don of tank(s) Pump out contents of tank(s) Inspect dispersal cell(s) C(eart effluent filter Inspect pump, Pump controls 8~ alarm Flush ~~ and Pressure test 3 ~3 ~ g~ ~--.5~ aaVday /'. Z7 QaVdaYRt2 Monthly average' S30 mglL 5120 mg/L Monthly average" S30 mg/t_ 530 mg/l. 510' ~u/l0pml Y, inchdiameter SePdre Tanfc CaPadtY Septic Tank Manufacturer Effluent Filter M~~cturer Effluent Filter Model Pump-Tank Capadhr Pump Tank Manufacturer .Pump Mantr(aduref Pump Model P~treatrttent Unit 4 O Sand~Gravel titter O Mechanical Aeration ^ Disinfection ..+..~r-'round (g(SYity) ^ ink ^ gt~rsde p prip-tine Page ~ of v _~ al DNA L ~ hiA ,L ~ DNA ~ '3 %~ 9a1 DNA ~~ ~ /.~ ^ NA 'f .s""Z_ D N a D Peat Fitter D Wetland O Other. ^ { -ground (pressur¢ed) ound O Other. ~- rdaQ rrastewatsr snd Vatuea tYPI~ for domestic (non-oomr*~e ~~ t~ttfc ellquent. ~stewater. Values typlcaf for ~e;reated Service Frequency p months ar(s) (Maximum 3 yrs.} At least once every ugis one-third (Y,) of tank volume m eq When combined sludg e and scu ar(s) (Maximum 3 yrs.) D months At least once every ver D months~~aKs) f • y At least once e r(s) p months ~ p NA At least once every '' D months r(s) ~ O NA At least once every D months D year(s) DNA qt least once every s) ^ months ^ Year( (~ NA At (east once every n one of the following licenses or MpiNTENpNCE INSTRUCTIONS its shall be made by an ind-Niduai ca s ~~~n P(~y~s Maintainer, St~p~9e inspections of tAanks and dispersal ce r, POY~rT' ~ identify arty missing or broken ins: Master Plumber: Master Plumber ResMcted Sewe on of the tank(s) for any bads uP tor. Tank inspections must tndude a visual inspect( a and scum and to check t levels Servidng OPera or teaks. measure fife volume of combined sludg y ~ ~~ the effluen ham' ~~ any ~~ round surface. The dispersal ceQ(s) shat! be visual! inspected nding of effluent on the or pending of effluent on the g for any pending of effluent on tt~e ground surface. The po authority. in ~e observation pipes and to check lion of the local regulatory round surface may indicate a failing condition and requires the immediate notifica or more Of the tank volume, the g min any tank equals one-third (Xs) NR moved by a Septage Servicing Operator and disposed of In accordance with d'• When the combined accurrtulaSon of sludge and scu entire contents of the tank shall be re ~ mtreatfinent components; and any 113,1Nisconsin Administrable Code. onents, p a certified P01NTS Maintainer. Thf; servicing of effluent flltern. mechancca! or pressurized POWTS comp firmed by vent at intenrais of 12 months or tens shall be Ae o f completion of any service e other maintenance or monito ~~ to the local nrgulatory authority within 10 days q sense report shall be provi nti roduds or other nee of pal n9 p , STARTUP AND OPERpT70N s for the Pr'eSe trabons are or to use of the POWTS check treatment tank() ersat cell(s). If high concen For new oonstruCtiOn. ~ e the treatment process and/or damage the dispo rator prior to use_ chemipts fhat may impact removed by a septage servicing Pe de~e~ have the contents of the tank(s) i .• ~ Paged ~ (% '~ ~ editions are frozen at the infittra6ve surface. ~ eXOt~SS when pcwec is restored System start up shall not occur when sal °Q ve nom~al higtrnratef levels. the OeC(s} and may result in the ~~~ pump tanks fiat ~ abo~l(s~ ~ one large dose, overloading tank removed by a Ouring P~.u be dtschan9ed ti° th6 ~~~ id ti1iS sitxtation have the contents of the Pump ~r . dace dischauge of eftf~L TO a'fO to the effluent pump «' ~'~d a Plumber or POWTS Maintainer m backups Servian9 Opersl;or p~'utht» ~tnp~IS to restore normal levels within the Pump ~. assist In manually Ong the p P .. ric over= or otherwise dsturb or otxrtpact, ~~ tanks and dispersal cells- ~ not drive or pa Do not drive or paw vett~s mound or at-grade soil absorption area- thearea wlEhin 15 feet down slope of any ~ stnram may improve the performance and prolong the life Reduction or~el'iminatton of the folkwvln9 f^°m the vvastewa d~~~; dental floss; diaper wI c19~~ butts: condoms: cotton swabs; herbiddes; meat of the POVY'fS: entfbiotics;baby . P~ fruit and vegetable peelings: gasoline; grrrase;~ dsinfecMnts: fat; foundatan drain {sump pun~P) water, s, and water softener brine. scraps mesons; ot1; p~int9ng products: pesficxdes; sanitary napkins: tampon ASANOO[+IMNIENT taken out of service the following steps shad lee taken to insure tl~at the When the POWTS ~~ and/or iS PBmtaner>t1Y Rance with ~. Comm t33.33.1lYsconsin A+dmtnistratnre Code: system is property and safety abandoned in comp Wings sealed. disposed of by a Septage Serviang Operator. All pipcng to tanks and pits ~!!~ all~benremoved a d p ~ Wed Pipe .. The aor-tenffi of act ffinks and P After pumping, all tanks and pits Shan be excavated and removed or their covers removed and the void space filled yvp~ socl, grave! or another inert solid material. CONTINGE(rICY PLAN ~$ following measures have been, or must be taken= to Provide a code if the P01I1tTS fails and cannot be repaired compliant replacement system: O A suitable repfacenlenCan~ has been evaluated and may be utilized for the location of a replacemen soi nt area should be protected from d~-sWrbance and ~padion and should not ' n system- The rePlacerne xistin and proposed structure. tot tines and wells. Failure to a e _ a suitable be i~ 9ed upon by requtr~ setbacks from 9 protect the replacement area wiU n'-su~ ms must comPfY v+nth thefrules n effect: at that timeffib~h replacement area. Replacement sySLe O A suitable reeplacement area is not available s a Last resort o rreplarcethe failed POWTSng advances in POWfS echnocogy a holding tantc may be installed a n falure of the POWTS a sod and a suitable replacement area Upo e site has not been evacuated to identify site evaluation must be performed bo locate a' suitable replacement area. tf no replacement area is available a_ holding tank may be installed as a last resort to replace the failed POVYTS- Mound and at~rade son absorption systems may be reconstructed in place following removal of the biomat at ~~ the tnfittratZrre surface. ReoorlSb'uctiens of such systems must comply with tfie Hiles }n e~ at that time. ~cWARNING'» TAJyKg MAY CONTAIN LETHAL GASSES AN1310R INSUFFICI1r1YT OXYGEN. SEPTIC, PUMP AND OTHER TREATMENT CIRCUMSTANCES. DEATH MAY DO NOT EPITER A SEPTiC, PUMP FROM THE NT~ERIOR OF A TANK MAY IFFICULT OR IMPOSSIBLE. RESULT. , RESCUE OF A PERSON ADO(TIONAL COMMENTS . ' POWTS MaN'TAINER POYYTS 1NSTAL[.ER Name c lit yJ ~ l' ~ ~~ // Name 2 L1.GC ,-- Phone ~ -~Z ~'`7-j•- Phone ~/J = ~~(~~ J LOCAL REGULATORY AUTHORRY SEPTAGE SERVICING OPERATOR PUMPER /~ O~~ ~ ;~ . Agency ~ - Name ~ / Phone 7./ ~~.3 ~-' Phone 7J.~ ~ Z ~" ThIs doarment ~ This aocument was dislUod fyy Cre stall's of the Green l,ke. Marquette and Waushara County Zoning and Sarr~ation a9e~- the mL+imum mquiramartts of cat Comm 83.22(2}(bHiHd)~(fl and 83_S4(1}, (2} ~ (3). Wisa~nsln A~Om(n3str'~ ~- Use of this document does not GMw NoU guarantee the perfortnanoe of Me POWf'S. QOM P C COLLOUA BLDRS, INC PHONE N0. 715 247 2747 Jun. 29 2004 12:12PM P1 S'TA1'E DAR OF'rViSC:ONSII~ i~OR.tit 2 • 1999 w ~RR~iI'~iTY DCED Da:utnent Nu,nber This peed, .made between Mich el B_'~Iarshall and Aawn ?bla~rsilali, hus nd an wi a Grantor, and P. C. Coil va Inc. a Minnesota C iiii Grantee. Grantor, for a vaiaable consideration. conveys mid warratl*s to Grantee the following described real cstato in St. Croix Couat!i , State of Wisconsia (if more spates is r~dtd. please attach addendum): See Attached iibit "A" ACIC4G W LEDG1rIEW'I' STAT[ OF _ } a5. County ) O1S.lUU8-b0-b0U; U18-itJ48-X0-000 ,118- 008-90-OOU: 1I8-101 Q-iQ1U-1Q-t100 Facts! 4lentification :~uuthcr ;PINT -This iK nat hu testead progeny (is) (is trot) E:.ceptietls to •Narranti~s: ~semeats, restrictions art% r'.l,itts-of-way of record, if anv. eW-' Lssed this ~/~ day of ~t3reh ~C+,"rd _~ a f l~ficttael B. Marhsal! ., Da.m Marshall _-,- .. -- AiPrI`<ENTICATIOI~ 5igatture(s) i--iSdtad ~• :Marshall aad Dawn ~isrshsA, huobaad and wile ,-, nn, authettticatt~ this ~ day of :4iarcls . ?mod Tez~s Ogland ~ _ 'I'ITIJi; MEMBER STA'TIr BAR OF~WISCONSIN atttharized by d 106.06. Wis. Stats.) THIS IDISTR[JMF,NT W?~ DR.~tTBD BY Attotaey ICristina Oglnnd Hndson, WI 54016 _. tSigttatutes mny !te sttthattticau~ or sCksfewledfad. Bexit 3'e nat necessary.) ~~ K .~~~~ ~~ I bearding Ate:1 ~~ ~ ~ tinnx and Rrrctrn Address Persunnlty Came t~t'ore me this day of the above tta,-:tcd to me known to be the person{;} wlto executed the foregoing instrututnt atnd acxnowledged she sane. Notary Public, State of --_.__ .-. ----.---- ~sy Cumntissiuu is pei~manetx. (.If not. state .xpimtion date: .) of persons SiSninY in arty capacity must ;x typed or printed haloes tIIair sigmtnre. 371".'SSaA l]F W7SCONSLti W.~RRAKrY D~ FORK ~Lt. 3.1799 tn:ormatioa Proiaswmts Co,, i:utd du Lae. A+1 am-QSS-Zlt' 1 N W ~ I~ ~ p ~ I~ D J ~ ~ ~ ~,.~V I ~ ~ ~ I I ~ ~ WI W ~' ~ I -A ?i ~ cD N l ~ ~ to `°~ ~ Z ;`S 2 , h QD ~ O ~ ... 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