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HomeMy WebLinkAbout018-2007-05-000 (2)Wisconsin Department ofComme~ca PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) 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 Elev: BM Description: /Ob ~ (GS ~ SANK INFORMATION TYPE MANUFACTURER CAPACITY Septic v ~'-' , ,. Dosing I^i l ~ ~~ Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 3 0 33i .33 Dosing / ~ /~ ~ V ~ ~ Aeration Holding PUMP/SIPHON INFORMATION /~1,/ Model Number ~~ tSZ-- TDH / f ~ ~~ Frictio~ L~ System Head TD ; ~' ~~ Forcemain Lenc~,tr i Dia.Z~ 1 Dist. to we'll cl111 ARCnRPTIn[U SYSTEM County: St. CroiX Sanitary Permit No: 487916 0 State Plan ID No: Parcel Tax No: ' 018-2007-35-000 Section/Town/Range/Map No: 05.29.17.974 ELEVATION DATA STATION BS HI FS ELEV. Benchmark Z.Z foz. /~ AIt.~M v ~e ~ ~ ' Bldg. Se r ~P•~ ~ '~ SUHt Inlet /A ~ ~ 7 c. SUHt Outlet ` Dt Inlet .~/ Dt Bottom Header/Man. Z~' `~ • O~j Dist. Pipe Z , 15 ias>s , bs Bot. System ~ + ~ Gq , 1 I Final Grade ~~~ st Co er . ~~ 3 ~ ~ a ~ r P ~ 3, ~1 ~ • 3 BED/TRENCH DIMENSIONS Width J Length ~ i No. Of T~ches PIT DIMENSIONS ~ No. Of Pits ~ Inside Dia. ` Liquid Depth ~\ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING ER OR Manufacturer. ~~ INFORMATION CHAMB Type Of elm: 1 V V ~ ~ `_~ 7 /L jrT ~ /~ ~~,/ UNIT Model Number. ~\ nICTRIR11TInAl SYSTEM Header/Manifol~ ~~ Piserisutio~~ ~Z ~ r ~ x Hole Size / ~ x Hole Spacing/ Ve~ to Air Int~te~ th 7 Dia ~ L th Dia Spacing Len eng g c(lll CCIVFR ., e.e~~~..-e C~rc4nmc n.,t.. VY Ml1IMf1 nr Ot.Grade Systems Onty Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulc ed Bed/Trench Center ~ ` Z Bed/Trench Edges ` Topsoil 1 r~ , s ~ No ~ s I J No )' COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~~ / ~ ~3 / ~~~ Inspection #2: / 1 Location: 1161 167th S reet Hammond, WI 54015 (NW 1/4 SE 1/4 5 T29N R17W) Farm ViewlRid~ge Lot 35 P~ E Parcel No: 05.29.17.974 1.) Alt BM Description = ~`~~ Gd~~"' ~ ~• ~ ~ ~ '~""~~ © ~`'~ ~a 2.) Bldg sewer length = ~ Z 1 CSJ~ + ~ - amount of cover = ~ ~ 1 11p~.~ t111t~O~ ~ C+C~7~" ~.~ ~-p J`~Q.i 1 d~-~` fi'n' ' a r V No ~_I --- - - ---- --- ~~ Plan revision Re uired. ,~~= Yes ~ ~ ~p 3 ~ j p 3 5 Use other side for additional information. l L-~ 6 -_~ -- - - - Date Insepctor' ignat r Cert. No. SBD-6710 (R.3/97) ety and Buildings Division 201 W h' n Ave., P.O. Box 7162 County ~ , I -' 62 r (to be filled in by Co.) umbe Sanitary Permit N ,~~p~~,~ ( -31 ~+~ g p 0 ~ ! ~ ~o Department of Commerce ber state lan LD.1 ,. Sanitary Permit Applies i ~ / ~ ~ T~/4~iU'S rsonal ~nfonnatio you pro fd~' "; ~ : d d C . o e, pe m. In accord with Comm 8321, Wis. A may be used for secondary purposes Privacy Law, s15.04 )(m) Proj t ~'lddress (i different than mailing address) :rc a ~. 'fVr I. Application Information -Please Print All Information ~Cy'~1 a r. ; I / . / D Property Owner's Name Parcel # Lot # lock # J Property Owner's Mailing Address ` to Z Property Locate ~ / ~ ~ r/ ~ / Qx %., Section (~ '/, City, State Zip Code Phone Number /~ ~'' _ ~ ~ circle ) ~ ~ ~ ~ ~~/'~~~~izt-ci"' t~~ ~ ~ ~ E r W N; lI. T pe of Building (check all that apply) ~ ~ ~S ~ Subdivision Name CSM Number 2 Family Dwelling -Number of Bedrooms _ .% ~ ~~ ) /C ^ Public/Commercial -Describe Use U i ^ n ^City ^Vil ship of~ be se State Owned -Descr M. III. Type o ermit: (Check only one boat on line A. Complete line B if applicable) - 280 ~ 3S ~• ~ ~ A' stem ^ Replacement System ^ TreatmentlHolding Tank Replacement Only ^ Other Modification to Existing System List Previous Permit Number and Date Issued B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to i3ew Before Expiration Plumber Owner i t IV. T e of POWTS S stem: (C ck all that a I) 1C = . 0 /Z ^ ^ Non -Pressurized In-Ground >_ 24 in. of suitable soil Mound < 24 in. of suitable soil ^ At-Cnade ^ Singie Pass Sand Filter Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) ,~ V. Dis ersal(rreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dis ersal Area Proposed (st) System Elevation ~ ~/~~v ~..~ ~ ~ U ~ ~S VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units W~~p ~-(Gp Concrete Constructed Glass New Existing -~ ~~. Tanks Tanks Septic or Holding Tank - Aerobic Treatment Unit Dosing Chamber ~ VII. Responsibility Statement- I, the undersi ,assume responsibility for installation of the POWTS shown on the attached plans. Plume s Name (Print) Plumb ignatur MP/MPRS Number Business Phone Number ' ~ ' ~ ~ J Plumber's Address (S eet, ity, State, Zi ode) ~s ~ ~ ~ VIII. Coon /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee ( lodes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ~ ~~ ,3fJ ~~ '-'_ . ^ rven Reason for Deniai Ix. Conditions pro al SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. _ _ .. .. .. _.. __._____.._-.. a...-41h .. 1Y :..n6m :.. e:a. AttaCG complete pwns 1[o tae a,ounry omyr .u. we •7•wu. v.. r-r•^ ~~• ^^~ ---- f7.~./ SBD-6398 (R. 01/03} ' PLOT PLAN P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 i/4 SE i/4S 5 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 99.0' 3 BEDROOM . CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DO5E 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 Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark 337' Property Line 167th St. Well is to meet all setbacks found in Comm. 83 Grading is to be done to divert run-off away from system Pro 3 Bedroom House Huffcutt Combo Tank x Tank is to be properly bedded and provided with lockdown covers with Property approved warning labels Area 15' below system 1 1 % Slope is to remain B _ undisturbed 95' ~ 1 6 B-2 - 7' 98 6-1' B.M. 492' Property Line ~ 200' ~~ 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.g ov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary September 28, 2005 CUST ID No. 226900 SHAUN R BIRD BIRD PLUMBING, INC 1008 192 ND AVE NEW RICHMOND WI 54017 A7TN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/28/2007 SITE: PC Collova Builders Inc 1161 167TH St Town of Hammond St Croix County NW1/4, SE1/4, S5, T29N, R17W Lot: 35, Subdivision: Farmview Ridge Identification Numbers Transaction ID No. 1199292 Site ID No. 705163 Please refer to both identification numbers, above, in all corres ondence with the a enc . FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1041926 Maintenance required; 450 GPD Flow rate; 24 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 resporisible 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 "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.O1/O1) COQ 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. DERARTM Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and OF dispersal are prohibited. `~` SEE COF • This pressure distribution system is designed with a minimum distal pressure of 3.0 feet and a network pressure compensation of 3.9 feet. • 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 9/28/2005 • 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 22L7) A copy of the approved plans specifications and this letter shall be on-site durin~~construction and men to inspection 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, 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 POWT5. Sincerely, ~_. 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 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 RECEIVED SEP 21.2005 SAFE-~ & BUILDINGS Date: 9/15/05 Owner:P.C. Collova Bldrs. Inc. Location:NW1/4 SE1/4 S5 T29 N,R17 W Lot 35 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 igency plan 9-11. Soil test Shaun Bird ~~~~-,~ Signature License numb r 26900 ~f~n~~~y ~~ w ~` .,? OF CO"''•9ERC~ . EY,q ~ U GS -~PONDENCE ~~. ' PLOT PLAN PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 NW 114 SE 1/4S 5 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 99.0' 3 BEDROOM 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 Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark 167th St. 337' Property Line Well is to meet all setbacks found in Comm. 83 Grading is to be done to divert run-off away from system Scale = 1 /4" = 10' Tank is to be properly bedded and Pro 3 provided with lockdown covers with Bedroom approved warning labels House 11 % Slope B-3 Huffcutt Combo Tank 492' Property Line B-2 Property Area 15' below system is to remain undisturbed - 9 S' - 9 7' 9 8' B-1 _ 99, 200' B.M. -~.r---- . '~-, No Designer -- Date 4" Observation Pipe Perforated Below Filter Fabric ASTM C-33 S a n d ~\ "Topsoil rJ t 'I 'S'. Slops r Non-Woven Filter Fabric piitribulion Pipt IH ~ `_ ,o Bed Ot ~J~- 2'z Drain Rock 1=1awe G Layer ~/ O --'-'~ '~E-~, F G ~ ., Fi p ~ J ForCt Main Frorn Rump Cress Section Of A tr~ound S stem Usin A $ed For The Absorption Arta ---- ~ ,; i p ~ Ft. ___--- 5 ~ Ft. I ~`~ Ft.- J ~ - ~ Ft. - yt~~.~j Ft. t_ ~.~Observation Pipt-~_..~..._.,.._ K J - ~ _._---__..,.. _... _ i ~ 1 i ~ ~ ~ Force Main ° A ~----- _________----- --------------------- ~ Frorn Pump W `n ~~ ~. ~ _-- -_- .._- -._ __ _......_ .......- o pistribution Bed Oi /Z~- 2 2 ~ P~Pe - Drcin RocK I ~ `~ 4„Ob>rervotic~n Pipe ~=-ryCc?~~:-c.Y. Permonent Mocker ~s'~~ [ ~~ t. .j ~~;j pipe or Rods Plon Y+tw Of Mound Ut:in A Bed For The Absorption Area PAGE -_ OF__ C/~~z LOLOte<d Qn $olJOm. E4cro~17f Spptea K,S'C' 1'{pLL pi>~.ICS T6 G~MC}~Of! Ft. ~'~. ~~ ~..-W'.i Yt~YLJ~ t ~/ i - ~ p.z X ~„~ I nct~es ~ - ~~' Signed: License NumQer: Gate: ~` °,T__„_ Inches ~ Hole Diameter 3= Inch lateral ~" Z. ~ Inch{es~ ~. Manifold ~ Inches Force Main ~- Inches # of holeslaipe Invert ~ievatior~ of Laterals~~ Ft... Pe-#crattt2 n~D= OetOii ~• :~ S£PT~C__--.~_.~- _ _`- T ~ Alva SP€C'~T ICATZt~t~S F~MP C~,AMB~ CROSS SE~~xfl. ~_~. AB~JuE GRADE ~ ~,f ~* Y ENT PIPE ~4dI ~{g{~4+t CR ~ gip` I`ROM D44R, ~~~n,(^d ~R ;~iTAXE FINS ` : ~ i~ ~£ ~~ 18° I3~'- ~ _~ INLET . ~.:a'I'~'~t '£Z~6H'T S~LS ~~~~ ~i~ 3` ,y''FT- t3li7t~ St~~~ SAIL p~2rfP fl~'f EL£Y - ~--- iA f ~ ~- ~. D ~~~RQ~3~ ,~vNC~~~r~ $c~x W~'TH C4~I~I~ . _ -_- °' ~ s ~ ~. f ~ GA5- ; TI~K~, . SEAS ~ , c t 4 t AgggflV ~D MA~tH{}LE COY Eg W / PAD 3ACx ~ .~}~;NG i.ABE~ _ ,~++ }+1Z33 - ~;pPPR~~~ P£ s SffL~g 50IL $E~O~~~ Urm~ Tart % :=/Sra,1/,,,~,CpC~cRETE PA[~ 3 u ApPR~Y EiJ _~~ SPrCZf ICATIC~~S _ s 1,IVtSB~ O~OS£S ?£R i1Asf = ._.-------/ ~~r~ sEP'~'~ ~ ~ gosE f ~ roc s.r~ ~ J ~A.z. - ~ iAI3K 2~At~>}~'ACTVRER: I3~E vt3.1~t~€E £.~BpyCK= / CAL . ~ s/ / _ ~ b ~~, 6AL TAIiiC SI2£S . SEPTIC CARL j _ I1~iCL~.ES .~...------- fl0S£ , ~ 9 ~ CApACIT` I£~ = A T ~BAL ~ B = ..~- ZIdCI~Es ALAS ~~FAC~3RER;= '~ ~. _~..- nt3DE~. ~ltiM,B~ = ~~~'~ _ ~? SNCHES = 1...~~=~J~ ~A S~I'~~ ~~^IP~ C I~fiES = ~ - =--~i p4ltiP ~~ ,~-~,,,, ;fig 16_+'.3 MODEL NLT3#BER ' ~ ~TIRZ fi'iG AS PAR ~;TCF3 ~''j'PE' ~ o ~a:,gnP £ ASR ~ FEET DISC~#AR RATE -~=---~' ~ ~ -~LCH~t PIPE - ~ ~-~'~.s~-FEET ~~ O I g'F#z Z ~ ~ REST;R;ED pv3°IP 4i F ANE - - - - FEET -FR;CTT©~ FACTOR 's FEET dEtiTZCAL D~pFgR'EIdCE ~E~E£ ~ ~ ~',~/IQO F'~- fiL 7Y~~~C MIS ~ MINiT'~~i~ H~T~'iflRK ~~~ ~~~' ---' ~~T ~" _ AnFTE~ --.-.- + FEET FO ,~ iii ~, - ~~~ gi~jgP TAitK: L£I~~ ~ ~f+~"-~~• ~1MENS~IDt~~ ~}F I.~Q I~i'T~NAL 1}RTL SI6NEI3- _ , ;IBS 1 O w v Q 0 i 0 ~- !0 7AL DYD:AM~C HEAD/CAPACITY T0 PAR MifJUTE EFr"LUEnT ~.nD DEWATERING 752 153 MCOCEL Mzters Goi. Liiers ~ GoI. I Uters Fezt , i I 261 77 5 1 5 E9 291 10 ~ 3. ] 6t 231 70 I 265 53 201 ` 61 15 4.6 231 20 •~ 6.1 I 4a 1 E7 i 52 ' 97 25 ', .6 34 129 42 159 ~~ 87 33 ~ 30 9. t ;D 7 -- ~ ---' 22 j 125 ~S5 35 _0 ~ 12 2 ~_~ ; -- l i i 42 i ock Volve~ ?8.0 Ft. ~i t.fim)~ 4 ~ FtFt~ ~i3'4m)I orasoa 3 .7 U FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS t, • Timed dosing panels available. lied with Electrical alternators, for duplex systems, are available and supp an alarm. • Variable level control switches are available for controlling single p ase systems. • Double piggyba~ variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik-Box available fo uotationrrequared ons. See FM142D. • Over 130°F. (54°C.) special q wrfHrz Raries a CAUTION a uatified Ail installation of cpntrols, protecdon devices and wrong should be done by tghe mo5f licensed electrician. All electrical and safety codes should be followed including recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). S2 (~~ -, l ~ ~~~~' _~ i ~ ,: ve k i l ' ~ . 7 ' ! ~~ y_-- n SELEC710N GUIDE 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. 2. See FM0712 for coned model of EleGirigl Attemator E-Pak du lex 3 3. Variable level control switch 10-0225 used as a ~ntrol activator, specJY P ( ) or (4'1 float system. RESERVE POV~ERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. L?A1L ro: P.o. aox is~4~ ,,~n~ra~rer~of.. Louisville. KY 40256-0347 SHIP 74: 3049 Cane Run RDad ~7 Louisville. KY 40211-1961 [j~rr Peas ~,vcf /r9~i7 r ~ ' f~ / r ® (502J 776-2731.1(BDD) 928-PUMP ° ~,G/!Y/~ l ©' FAX (502) 774-3624 ri ht 2000 Zoeller Co. All rights reserve • hrrP~~'"''a'~`•ZOeller cnm p COPY 9 ' ELY PLAi1 • a~MER,S ~p~UAL & MANA sPE IFICaTIONs QoWT~ s~rsT~ Septic Tar[k CaP~ ~Rt~nOPf cv e~ ° Sepye Tank Manu're` Effluent ter [Vtanitfarxurer 'D Nttmbet of Nutnb~ ~ commercral Units . ~rnated taw (average) Estirr[ated x ~ _5) p,~lgn ttow ~k?, t . Soo ~°+PP Rate usnt Quality trfiusnt/Etfl Fats,. Oil 8, Grease (>=0G) Oxyg~ Demand {BOOS) Biod'te~m ~ ~~~ sor~ds {'fss) P ~uer[t Quat'dY NA en Oemarxt (~ B~herr[icat OxY9 ded Solids (TSS) Total S ~~ (9eOmebric mean) Fecal t;.or Ma~t~ BfflueM Partide Size ~h""`"-' lrvent Service inspect cor-dit3°n of tank(s) Pump ~ CQn~nts of tank(s) tnsped disper~ cell(s) Glean affluent filter mP. PumP convots & alarm tnsped P~ rats and Pressure test 1=1ush late v avL ~ ~ allda Monthly average' s30 m9n- y2p mg1L Monthly average" S30 mg11- ~~ mg 400m1 510 cfu! y, inchdiameter uur~• round (gravity) ^ In-9 ^ At~rade Page of %.v-~ o Na ^ [VA a r~- O NA D tVA _~~ p NA ~~~1 ^ rta D Peat Filter p Wetland p ether. ^ l~ ground (pressurized ^ Other. O [?n ln6 ~ trsrewarer arnr id for doh tnoa~oomrt+e values typ stftuent .. v; a ue t~YP~ for D~~~'~~ter. gen,.ice Fre4uency ear(s) (Maximum 3 yrs.} ., ~ month. uais one-third (l;} of tank volume At least once every a and scum e4 vVhen combined siudg or(s) (Maximum 3 Yrs-) c p months . At feast once every At feast once every p~ feast once every AI least once every At [east once every At least Once every t3 p NA p months y.~ mss) O NA p months II year(s) II ~' Q months II year(s) ^ NA osl~ licenses or UCTIONS n one of the following CE INS't'R ti be made by an indtvidua- canYl 9 clot. POV+rrs ~ntauser. SePts9e [ ce[ts sha Sewer ppvY'CS tns1~ any nvssing or brpken s to iden5fy Inspe of tanks and d-ugPe Master Plumber Restrs~ on of the tank() for any back uP . Master Plumber ed sludge and scum and to check t levels aec~ tor. Tank inspections must indude a visual inspectl ~ ~ cheek the eftiuen SerYidn9 OPera or leaks, measu~ the volume ~uoo~ s~ II be visually ' ~~g ~ ~uent on the ~~ r~ round surface- Tt~ P° authority. ~ ` ~u~n on the ground sufias~- ~ ding of effluent ort tfte 9 and to check for any n and roquires the Immediate notification of the focal r~egulat~Y fume. the in the observatson PrPeS oond'rtw or more Of the rank vo [ndreate a failing tank equals one-bird ~~1 with d1- t~R ground surfer may • e and scorn in any for and d;sposed of in accordance Wt>Bn the combined accun'rutation of sludg a SeP~9$ Servicing OPera meet ~ponents; and any entire contents of the tank shall tie ren+mved g components. pretreat# 'fled POWTS Maintainer- 113, VYisconstn pdmtnistrawe Cade anicaf ol• pressunzed POWT ~ by a cerC n of effluent filters, met' o f ~mpieetlon of any stance event The setvici g at intervals of 12 months or less shall be P? other matntenanCe or rnoa'doring l ulatory authority vritttin 1 Q days A serirf~e TeP~ shaft ~be provided to the loco re9 pr other the resence of painting products STARTUP ANO OPERATION ~y-f$ check Veatment tank{s) cell(s). If high concentmfions ate For new oonstruc~On. prior to use of the PO ~s an:ilor damage the disP r ,;or to use- ~ ttlat,.~y m,pede the treatment P b a septage servicing operato P detected have the contents of the tank(s) removed Y Effluent FIIer Model 'tank Capacity Ptsmp~. pump TarIK Manufacturer r .Pump ~l[an~~r : Pump Model .. PrenG,.~ ~..__ _ ~ $a~~-,ravel Flier ~ Mect[anical Aeration ~ Oismfedion Page of`_ '~+` ~7"condi$ons are frozen at the infiltrarive surface- is restx?tt~d file taccess ~~~ opump tanks maY ~ awe riomtial hEgt~ter levels. When pow . S~~'start up overioadn9 the ceti(s},and tnaY result in the Durins ~'~ °~ . m the dispel ~s~'n one large dose. ~p tank removed by a yy~l be d~~ id this situation trove the contents of the P of POVYTS Maintainer bo ~~ ~~ d-~,arge of eftEueClt Ta ~~ ~ the effluent pu~'+'-P ar ~t~ a PJttn~r baci~ B ~g Op~~ pnor.te res~rL4 to n~tore nomza( levels witfiin the pump ~-_ asst- in man~Y ¢~~ng the P~p'~' mss. Oo not drive or park over, yr othen~(se dsb~Jrb or compact, ~~ ~~ ~an1~ atld dispersal po ~ drive or park mound or at~rade sotZ absorption area- the at%ea yy;thJn 15 feet down slope of arry im rnve the performance and prolong the Cafe of the ~lowirtg from die wastewater strum may P de4t~as~: derifiat floss; diapers: Reduction or-e[amtnatiort kte butts: condoms; ~tton swabs; ~~; meat of tl~e POWTS: antibto6cs; .fir yy; cigars vsrater f>'uit and vegetable peelings; gasotme; greaser d-~' fat ~ . n ~~ ~~P ~ }fro'des; sanitary napkins; tampons: and water softener brine. rttedcs~°ns taken out of service the foltovrlrtg steps sJrail ~ ~~ t° Insure that the artent9y sin Admintstrative Code: AgANt70P1*MEt'JT fa11s andlor is Penn When the POVY1'S d Safety aband~~ in comptianc~ ~'' ~''- Comm 83.33, ~1~nnings sealed- system rs pr~oPedY disconnected and the abandoned Pipe ope ~ e gervicing Operator. Ail piping th tanks and Pits shaJJ ~be disposed of by a Sep 3 .. The contents of all tanks and P~ SttaU ~ removed and properly Af6er pumping. aft tanks and Pits shah be excavated and removed or their covers removed and the void space filed with sots, gravel yr another inert solid material measures have been, or must be #aiCen, to provrde a code CONTINGENCY PLAN the following if the POWYS fads and gnnot be rePa~ cornpfrant rep~cerrlent system: coon and should not A suitable fepiacerttent'atea has been evaisho~uld tie protected frtom d sturba ceband carnpalacement so[I fl abso~~On system. The rep~~ment area kot pones and welts_ Far7ure to be infringed upon by required setbacks from existing and proposed sere, rated the replacement area vrtii result in the need fo I amp the'rules in effect at that time~b~ a sui(abie P Re taoement systems must comp y advances in POWYS replacement area- P , Q A suitable replacement area is not avaiiab[e due to setback ardlor sot! timita5ons_ Bamn9 ology a holding tank may ~ rnstalted as a last resort Lo replace the faded fPa~ re of the POWYS a sot?.and to identify a suitable replacement area. Upo ent area is avaiiabie a The site has not been eva[ttabed ~ toca~ a suitable replacement area_ If no repiacem s cation must be Pe~Om'~ _ d>~ tank may be inst;3ltt~ t3s a tact resort to regiace the failed POVY~S_ and at-grade sots abso[Phon s3'stems may be reconstructed in Pty ~ °e N(esg n eft at that tim~t at the in ' e scrrfaoe. ReconsW~'s of such systems must comply ccVfIARN(Ntr ~ .Z.ME~ T~KS MAY GOt+tI'AtN LETHAf- C'A~ES ~aIOR INSUFFICtENT OXYGEA!- SEPTJC, PUMP AND OTHER TREA TMENT TANK UNDEFZ AI~tY GtRCUMSTAAJCES. DEATH MAY DO NOT ENTER A SEPTIC• PUMP OR OTHER TREA RESULT. -RESCUE OF A PERSOI+I FROItilI THE iNTEt210R OF A TANK MAY [3E DIFFICULT OR IMPOSSlB ADOr{IOiYAt. COMMENTS - POVYTS INSTALLER Name ~~a.u~./ Phone ~ %"-- /''~j~'' POWYS MA1M"AINER i~tame a~-~. I - ~` ~'' 7 J Phone ~/'~ % - J ~ LOCAL K.EGtlLATORY AUTHORITY SEPTAGE SERVICING OPERATOR PUMPS ,v ,,,__ Agency ~~ G ~ /~CI~~f lam' Horne Oiv~.i ~ili" ~ `-jJ~~ ?hone ~ ~~~~. f ~ ntm~ rhUnC ~ / v ~~ ~ 7 }Ire staAs of the Green take. MariTuetfs and Waushara County Zaning arxi Sanitation ag~ ~ Q°O~ not Ttais ooaxnent was diattec! fn! - ~ l^,ade_ Ilse of this dourn1e"t fines the minim~rt- re4uicements of ctt C.octun ffi-~(69{tx~`{f1 ~ E3.56(1}. CZ} &. C.3). Wfsa~nsin Adrrttnlstt'a4ve Day ~pil guatani~ the performance of the POVYTS. SOIL EVALUATION REPORT Page ~ of ~'Wisoonsin Department of Commerce Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County ~ ~ Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must indude, but not limited to: vertical and horizontal reference point (BM), direction and Parcel l.D. percent slope, scale or dimensions, north arrow, and location and d' to nearest road. Re wed by Date Please print all information. ~~ ~ 5~-~-. 30~ ~., pproonal iMorrnation you provide may be used for aeeondary P~n~es (P ~ w, s. 5.04 (1) (m)). Property Location ~ Property Owner ~, jJC~~~~~r'°._.._ .._, ..~. ._' ~~o~.Lot 1l~ 1l4 S ~Tp~~ N R E(or W r', lot # Odc # Subd. Or CSM# , Property Mailing Address ~ ~ Q ~, !r^-- iJ' ~~ /~C~ ~y State + Zip Code Phone Number City ^ Village Town Nearest Ro "° Code derived design flow rate ~ GPD New Construction Us Residential /Number of bedrooms ^ Replacement ~ ^ Public or commerdal -Describe: ------ -- Flood Plain elevation if applicable ~ ~ ~ ft• Parent material ~~r T ~ rP s General aonur-er>Ts _ and recommendations: /~y ~ y~,L ,e (,g, ~~ ~~ n 5 Cj rvt.~' I~. ~ n Boring Pit Ground surface elev. ~~ ft• Depth to limting factor Soil ication Rate Texture Structure Consistence Boundary Roots GPD/ff Horizon Depth Dominant Color Redox Description •Eff#1 •Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ~ ~• W y i 11 '1.~ ~ r 7 ~ W .~- Z nZ~/~(Z~ ~f ~- S'/ C _ nil l4 O Pit Ground surface elev. ~ ft• 1 ~1 ~r~ # Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. CoM. Color Textw •~ ~ 3~Z, ~-- I Z, --~.~ ID r ~/ ~- ~ ~'~~ ~ ~~S r Hl~ r Effluent #1 = BOD > 30 < l1u mgrs a'w ~ .~ -w _ ,.... CST 1Valrle (Please Print) Bird Plumbing, Inc. Shaun Bird Address 1008 192nd Ave, New Richmond, WI 54 7 D epth to limiting factor~• nsistence Boundary Roots C Soil lication Rate GPDHf e Structure Gr. Sz. Sh. o •Eff#1 •EfffF2 ~ ~ ,:~ ' i= , 2, ~ 3 r • Effluent #2 = BOD < 30 mg/L and TSS < 30 mgll. CST Number 226900 Date Evaluation Conducted Telephone Number ~,~~ t/ 715-246-4516 lof 3' ~ Property Owner Parcel ID # of Page ® Boring ~ ~ ~ ~ ~ ~ ft. Depth to limiting facxor ~ ~ d surface elev ~~ # G Soil ication ~ . roun Pit Horizo n Depth Dominant Color Redox Description Texture Strocture Consistence Boundary Roots •Eff#Gp~Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ~, ~ ~ 3 -- s ~ ~.~ ~ w a~.~ ~ j3Z ~ c ~ S ~ ~ G i # ° Bori~ ~rin g pit Ground surfaoe elev.( 1~ ~ '! ft. .Depth to limiting factor in• a Texture Structure Consistence Boundary Roots i ti D Soil ication Rate GPDlftz Horizon Depth in. Dominant Cdor Munsell p on escr Redox Qu. Sz. Cont Cdor Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ _ ~ r3~z --~ S C -~ ~,,,., ~. O ^ ~~~ Bonng # Ground surface elev. ft. Depth to limiting factor in. ^ Pit ~ ~~ ~ Horizon Depth Dominant Col Redox Description. Texture Stnxxure Consistence. Boundary Roots GPOR~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Etf#2 'Effluent #1 = BODE > 30 < 220 mglL and TSS >30 _< 150 mgll. 'Effluent #2 =BODE < 30 mglL 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• seasaw Irtdao> Soil Test Plot Plan ,,~,:% Project Name P.C. Collova Bldrs. Inc. Shaun;l~~~ Address P.O. Box 489 ;. ~~ Somerset Wi 54025 C #226900 Lot 35 Subdivision Farm View Ridge Date 5/8/04 N W 1/q SE 1/4S 5 T 29 N/R17 W Township Hammond Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 99.0 *HRPSameasBenchmark Alternate Benchmark Top of 1/2" Pipe @ 100.2' ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer P• C. Collova Builders, Inc. Mailing Address PO Box 489, Somerset, WI 54025 / rI nn // ..~~ /~ / Property Address ~ ~ ` I l~c~~ W ~ ~~/ (Verification required from Planning Department for new construction.) City/State Hammond, WI parcel Identification Number G ~ 5 ~" 6`a' (.9 ~~ LEGAL DESCRIPTION Property Location ~ '/4 , SE '/4 ,Sec. 5 , T ~9 N R 1 ~ W, Town of Hammond Subdivision Farm View Ridge ,Lot Certified Survey Map # 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 soonec, 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 Counry Zoning Department a certification form, signed by the owner and by a master plumbec, 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 l/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. Ce ~ anon stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning D a ent wit in 30 da s of the thre y ar expiration date. P. C. COLLOVA Bl91LDERS, INC. (715) 247-2742 ~ / ~~ %~ P.O. Box 489 SIGNATURE OF APPLICANT SOMERSET, WISCONSIN 54025 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 desc ~ ed above by virtu of w rranty deed record~'iry$episte~gfJ;~~s ~~S~LDERS, INC. ~~++ LtiVV LL(7VV1V5) 247-2742 C~ /~/ P.O. Box 489 SIGNATURE OF APPLICANT SOMERSET, WISCONSIN 54025 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. FROM P C CDLLOIJA HLDRS, INC PHONE N0. : 715 247 2747 S"TAl'£ DAR OF WiSC:ONSti~ i~aR.'~t 2 • 1994 WARRANTY DCED !]tx:usnent Number This peed, made bttwetn \Zichael B 'ylat•chsll and P w vias~silal hus nd as wi Grantor, iad P. C. Coll vsi nc. a i~innesota C iir Grantee. Grantor, for a val~.rablz consideration. conveys rod warratts to Grantee the fallowing described real estatt: in _St- Croix C;ottnry, Start: O Wisconsin (if more spac° is t>~dtd, please atcac~ addendum): See Attached ExElihit "A" ice' , '~ 8~.:arding Are;t Jun. 29 20@4 12:12PM P1 4 ,~ ,~, Nance and Racrtn Addrtss O13-tUU8-b0-000; OI8-iaQ8-80-OOf1 +11 g- 00&90-000: C18-tflilf-0 Q-iQ34.10.000 Pucct? tdcntif,c3tion ;Jaitthnr ;PIN) Titis 3s hurrtesteati property (iS} (iS I~t! E:.c~dotss ro ~Nar.anties: Easements. regtrctions arc. r~,~itas~f-way of re+:~ccl, if any. ~,. Dated triis ~/~ day of ~t3rch __ ~nry _~ r x lttctrael B. Marhselt „~ ~vrz~lvzzc aTiort Sizruture(s) irlS~aet B. 1~iars6a11 and Aa,m ~iarshaA, husi-assd and wile aM wti~tetrticated this 1i~0 day of l~iarct~ . ?tea 1+rss~as Ogtand t _ _ TITLE: MEMBER STATE BaR OF WI3COA'SIN ~ ~. attthotized by 8706.06. Wis. $tats.) _ ..-- TfiIS L~ISTRUMENT WtsS DR.~.F~Te.D 8Y Attorney ICristioa Ogl>and Hodson. WI 54016 „,~ (Signatures mny he authenticated or acirnoWled£rd. Hextt a^e not necessary.) A CIC.4(7 W I.EDG1rtEtv'T ST.aT[ OF _ ) 1 ss. County ) Persotwlly carne Cefore me rhts day of the sbove rta~-ncd w rnt known to be the person(s) who executed the foregoing instrwucrot u~d ac'snowledged the same. s Notary Public, Stata of _ ---_.__ .. ; _------__-- yty Cotnmission is pei-rrranetx. (If not. State :xpirarion bare: .} tIDG3 of pt:raons rib~nY in airy rapacity muse be typed o: prirrtcd bsuow tltidi: si9rtature. tntotmuioa Proiastonsls Co., rood du Lac. YI 37d'"~ SAR OF W7SCONSLY 3Q}555-ZGL'I W 1RR.1tYlY D~ FORK No.: -1999 `~__ ~ U 2798P 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 rest estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (ifmore space is needed, please attach addendum): See Attached Exhibit "A" 79+354 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO. , MI RECEIVED E'OR RECORD 85/06/2005 01:08PM MARRANTY DEED EIIEIQ'T lR RBC FEE: 13.08 TRANS FEE: 1700.78 COPY FEE: CC FEE: PAGES: 2 Recording Area Name and Return Address O18-1008-60-000: 018-1008-80-000: 018-1008-90-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and-of--way of record, if any. Dated ~I.A ~I ~ ~11i Signature(s) AUTHENTICATION authenticated on • TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorised by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: Attorney Kristine Ogland Hudson WI 54016 B. Marshall ~' Dawn Marshall ACKNOWLEDGMENT STATE OF ) ~ ) ss. ~(( COUNTY ) Personally came before me on the above-named Michael B. Marshall and Daw Marshall to me known to be the pe n(s) who executed the foregoing in me and ackn wle the ame. .. - , Notary Public,15"tate oI` ~~ My Commission (is permanent) (expires: ~ ~'~ ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ®2003 STATE BAR OF WISCONSIN FORM N0.2-2003 • Type name below signatures. INFO-PROTM Legal Forms 81x1-655-2021 www.infoproforms.com Tracy L. Turner ~!otary Public ti 4~1~~ rr~ ~,n~i~eorlsin s 33 $814Q.. - .;: °'~` ~~ x '~ ,~ 1~ `~cb 66474 S. F.' S 89'26'33,. ~ ~/ // //v / 1.53 Ac. ~ EAST-WEST 1 ' o ~i 3 ,,~c, 5 ss ~, 3 / / X46 ~ 68909 S. F. _ 1.58 Ac. / ~/vim//`3~ ~/ ~ ~ ~ ~ 336.94' ~ cn ~~~ ~~/ ,~~,/ / ~ ~ 1.53 Ac. I~ ~ oI ~`~ ~ ,~0~ ~~ ,~O ~ •5`L N o f-- ~, ~~ ~ ~~/`L~~ ~ `til N 88°35'54" E 492.26'____ --- ~~ ~ ~I o~ ~/ -- ~ - - - - - ~ ~ ~' / `L ~b '~ 111321 S.F. ~ ~~ / ~ ~- ~ / / 2.56 Ac. I N ;r~ ~ \ \ ~~ h ~( ` / ~; \ - _ N 87°28'13" W 636_09' - - ~ 1 g ~0~ \. -, ,~ _ 197.96' 253.43' 37 38 39 DRAFTED BY: KEVIN HUMPHREY ENGINEERII