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HomeMy WebLinkAbout018-2007-36-000T -- ,` WisConsiri Department of Commerce Safety and Building,Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GEN.~r~RAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township P.C. Collova Builders, Inc. Hammond, Town of CST BM Elev~O / ~ D Insp. BM Elev: ~~o BM Descr' lion: / ~h %- S '~ . d t . r ~.~ ~ e TANK IN"FORMATION TYPE MANUFACTURER CAPACITY Septidy ~ ~ ~ _ Dosi / ~ t~d~- ~ 3 D Aeration _ ---- Holding TANK SETBACK INFORMATION TANK TO P/L WELL ~~ BLDG. Vent to Air Intake ROAD Septic rn~j~/ ~v-/ ~ 1/mil IN ' ~ v Dosing .~_ C~~ / L Aeration Holding % _ ~ - - __-_ - PUMP/SIPHON INFORMATION DYE., o~-C Manufacturer / /e ~,( GP and Model Number /~r ~ f C 7 G "~ TDH Lif~ ~ ~ Friction ~ ss rp H,eSad. S ys te (/. TDH ~t- 23• C, Forcemain LI n2gt~ / Di 2` Digt. to Wei., ~ Cf111 eRS(1RPT1(1N SYSTEM u ter, . i iir, ELEVATION DATA County: St. Croix Sanitary Permit No: 499163 0 State Plan ID No: Parcel Tax No: 018-2007-36-000 Section/Town/Range/Map No: 05.29.17.975 STATION BS I D• FS ELEV. Benchmark ----- 2 , -j 6 2 . /(fib •a Alt. BM ~,~`~ Off. ~ • Bldg. Sewer I ~ T ~, ' ~., Q3,~ l St/Ht Inlet ~ ~~ nO 6 `7 SUHt Outlet ~.~ ~~ Dt Inlet / /~ Dt Bottom ~/ y ~1 Header an. / •~LJ ab. ist. Pipe Bot. System .~ • ~ ~~_ Final Grade ~ 1 ~... S /~ ~` .StC~~ ~ ~ • 1 /r~ r~ a ~ .{~u~ , f . 3 : 7Eo 9~ / BEDITRENCH Width Length ~ No. Of Trenches PIT DIMENSIO No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~~ ~ ~ h, Q V Y'~ SETBACK SYSTEM TO P/L BLD WELL LAKE/STREAM EACHING anufacturer: INFORMATION CH OR Typ~ ystem: ~ / f} ~w~ ~ ~~~/ ~~ UNIT Model Number: IIISTRIR11TIl~N SYSTEM Nnti n(/n ~annwt. .170_l /~ l~s. Head Mani -~ I n ~ I ~ Distribution ~ / y r, Pipe(s) ` ~'~ S i 2~ J ~~' ~ Di x Hole Size .a~ ~ -~•---~ x Hol ing ~ Z ~ Vent t Air Intake Dia . Length 4. pac ng a Length Crlll f_f1VFR ., o.,........e c..<<e..,~ n..~., ..., nn.,~~.,a nr a+_r~a~lp Svstama Clnly Depth Over ~ ..~1~t..s Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center / ~ ~ G rj Bed/Trench Edges Topsoil Yes ', No Yes -, No ~. ~ i „>> ° - COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 / ^ Inspection #2: i I Location: 1157 167th Stree Hammond, WI 54015 (NE 1/4 SE 1/4 5 T29N R17W) Farm View Ridge Lot 36 \ Parcel No: 05.29.17.975 1.) Alt BM Description ~+ ~~ ~~~ ~~ ~~~~~'~ )~ ~~ ~~~ 2.) Bldg sewer length = 26 f~ 761 ,ro _ /~ ~~- ~ ~a ~ ~j ~~ (.~ - amount of cover = /G~;If 'tea f ~ ,,. ~„__. _ __ ___ _ , Plan revision Required? -~ es ~Q ~~ ~/_ ~~~~ /~i ~ ~ ~~~ ~ o er aid fe or additional information. v - - - - -- _~_~_ ~ [ia--t-r Date Insepctor's Sign lure Cert. No. 0 ~' t ~ ~~~ ~ ~ ~.! ~le t i r --- -----, a~sa ~/. ~;P ¢s Cccnc~~-~i~- S~~ ~f ~yvc,~C- SGT G~"rw~ , . ` ~} ~ ~2 ~~k. ~1 Safety and Buildings Divisio 201 W. Washington Ave., . B 1 my ~' ~~ / ~ ~ /~ ~ JL ,~ Madison, WI 537 1 ` ~~~0~~ nary Permit Number (to be filled in by CoJ 1 (608) 266-31 ~ 163 Department of Commerce Sanitary Permit App ~~(~® ersonal inform ~te~ide Code Adm Wis 83 21 h C i I d State Plan .D. Number ~~ j ~,~ S, ~a ~ , p . . . , omm n accor w t r eren ~ ~ ~ ress) may be used for secondary purposes Privacy L , s 15.04(1)(m) JAS ~' /6 7~~.-S I. Application Information -Please Print All Information _ Properly Owner's N//a'm/e~~J~ // ///~~jr / ST. CROI ~ ~` "`v' ~9 i'I'~ ~ Parcel # t # _ Block # .. l i W l Ci~. Property Owner's Mailing Address J ~ ~ Property Location ~~ ~ r , d~ r %., _ %., Section City, State Zip Code Phone Number ~~ ~1 / ~` ~ r one) T ~N; or W II. ype of Building (check all that apply) ~ !_j ~ Subdivision Name CSM Number - or 2 Family Dwelling - Number of Bedrooms ~ ' ~' ~/ ^ Public/Commercial -Describe Use ^Villa Township of ^Ciry ^ State Owned- Describe Use _ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. w System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System List Previous Permit Number and Date Issued B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New Before Expiration Plumber O r ~ u „ / IV. T e of POWTS S stem: Check all that a 1 ~~ ~ ~ Z ^ ^ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil oun 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter Constntcted Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ RecircuJati Sand F~lter Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) - .~ V. Dis elsal/TreatmentRrea Information: S s levation Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (s~ Dispersal Area Proposed (sf) y ~ /. r ~ ~/ ~ ~•9 Manufacturer fab Site Steel Fiber Plastic VI. Tank Info Capacity in Total Number Gallons Gallons of Units ( G Fop _ 8 o Crete Constructed Glass New Existing Tanks Tanks Septic or Holding Tani: Aerobic Treatment Unit Dosing Cbamber VII. Responsibility Stateme - I, the undersigne me responsibility for installation of the POWTS shown on the attached plans. Business Phone Number Pl 's Name (Print) Plumber' i ure MP/MPRS Numbe'r~) llc~ ~/ ~~ C/ C/ ~/ ~' Plumber's Address (Street, City, State, Zip ~~ VIII. Coun /De artment Use Onl Sanitary Perptit Fee ( cludes Groundwater Date Issued Is uing gent Signature o Stamps) pproved ^ oved Surchazge Fee) ~t-p~ Zz~ ~j6 cJ J(J''- ven Reason enial ` I IX. Condition fAppro 3, ,IVO ~ ~~'~- ~,U J SYSTEM OWNER: , 1 Septic tank, effluent filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. Atl setback requirements must be maintained as per applicable code/ordinances. ,...~ t..~. rhnn 812 s 11 inches in size wtcacn comprere pram ~w .,,~ ~..~...~ .....~~ .... ............»_ _.. , . 'S~ 5~ ~J SBD-6398 (R. 01/03) PLOT PLAN • /~~~ P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 ,' 1/4 SE 1/4S 5 /T 29 N/R 17 ~= w TOwN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 99.8' 1.8' Sand Lift BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND )OOC SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of chambers none BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter BEST GF10-8 ^ BOREHOLE O WELL * H, R. P. Same as Benchmark 167th St. Scale = 1 /4" = 10' Tank is to be properly bedded and provided with Pro 3 lockdown covers with Bedroo approved warning la~ House ~1J-~~0"~' ~ '1 ~ ~,o~ ; W~ ~ d 1`1 Combo Area 15' below system is to remain undisturbed B-4 2 Acre Parcel 3% Slope Property Lin B - 3 97.5' 8.0 ^ ~ B-2 B-1 98.5 Grading is to be done to divert run-off away from system ~ ' • 5 ~~ 636' Property Line B M 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 Mary P. Burke, Secretary September 07, 2006 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: 09/07/2008 Identification Numbers Transaction ID No. 1316834 SITE: Site ID No. 717667 P.C. Collova Builders Inc ~ Pleaserefer to both identificationnurnbers, 1157 167th Street above, in all corres ondence with the a enc . Town of Hammond St Croix County NW1/4, SE1/4, S5, T29N, R17W FOR: Description: New Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1094843 Maintenance required; 450 GPD Flow rate; 15 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual, SBD-10572-P (R.6/99), Pressure Distribution Component Manual, SBD-10573-P (8.6/99) 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 located and constructed 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 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. 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 tanWfilter for maintenance purposes must be provided per Comm 84.25(7), Wis. Adm. Code. • Comm 83.22(7) - A copv of the approved plans. specifications and this letter shall be on-site durinu construction and open to inspection by authorized representatives of the Department, which may include local inspectors. P Q.~rr.~.~. C~~rc~itiojic~lly ' SHA[JN R BIRD Page 2 9/7/2006 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 hazard. 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 6f 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 POWTS. Sincerely, Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon -Fri, 7:15 am - 4:00 pm j eny. swim@wisconsin. gov cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 Cover Page ~ soot s ti ~n~ Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 8/ 28/06 Owner:P.C. Collova Bldrs. Inc. Location:NW1/4 SE1/4 S5 T29 N,R17 W 1157 167th St. Hammond System type: Mound System Manuals Used: Mound Component Manual Version 1.0 (06/99) Pressure Distribution Manual Version 1.0 (06/99) 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 Conti ency plan 9-11. Soil test ~ ~ ~ Shaun Bird Signature License number p._P~R~ftJlt;Nl 01 GCIt.";NIERCL pIVISIQt~ OF SAFETY AND BUILDINGS SF:E GGi~RES JNDENGE PLOT PLAN PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 NW 1/4'SE 1/4S 5 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 99.8' 1.8' Sand Lift 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 450 # 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 167th St. Property Li Scale = 1 /4" = 10' Tank is to be properly bedded and provided with lockdown covers with Pro 3 Bedroo approved warning labels House Huffcutt Combo Tank Area 15' below system is to remain undisturbed B-4 2 Acre Parcel 3% Slope B - 3 97.5' 98.0 ^ ^ B-2 6-1 98.5 Grading is to be done to divert run-off away from system 636' Property Line B.M. Noa-Woven Filter Fabric 4" Observation Pipe Perforated ~ ,p;stribvtion. Pfpt Below Filter Fabric ;' _ _ AS^ai C-33 ~ a ~ ~ ~ . ~ - / `~ 7. Stops s~ Y forte gain `\,~Ffawec# J • 2 Bet! Cif - j~~- ~z From Pump - l.aytr • ~ i?rain Rock . ,. Crass Section {}~ }~ 1~Dttnd S stein Using F - ~ A Std For Tt~e Absorption Arta . ~ =----_ ~' J Ft. ~ ~ f.g ~ R ~ ~~ _ fit. ~• _ ~ - f Tr f f'~~,~uf,s 1 • J ~~ ft. t K ft,. .. ~----- ... ~. .. . _ , ~~~' ~'~t J ~ .~ ~ ~H --_----- ~ A ~__ _ _ ____---------- ---- ~ Force Main -° ~ _ -----------__.... _- Fromm PvsnP Y ~ Bid Qf lZ~- ~'t - ° OiSi ribu! io"t a -Drain Raci4 Pipe I ~NC}bservatien Pips=:~~ Permonen} Morktr -~3~~~ ~1~ ~ -~r'~~ bv>~~,~.~; pe ar Rods Pi~lt View Q~.Mocsnd iTzE~4 ~ Bid _f•or ~ht Absorption ~reo PAG Ei F_...._ 4 Obst rvo! ion Pipt--~ _ K Cam, :.oGaitd OA Boii9s~. ~~sGy ~pp[td E~j' lS~LL ?lL.7C'C TO CCMtC;'bt1 Ft. ~~. .. Signed: License Htmtper: date: x ~,.= s"~~~es - Mole Diameter ~. !-$j €nc~ Lateral -" / ~~?= Inch{es) ~€anffoi~ -(~ I~rches Fo#"Ce 1YF37 n " ~ ~nC#t~S # of holes/~fpe ~~ *r~vert ~iev~t~an of laterals D~•:~at.-- ~_ -._ J a- Fes~esaied ~;Ct Dlitt{i ~• SP€eL~ ~~Ca~~or~~ r ~~oss sEC-~~~:~ ~~~ sE~'r~~ ~~x ~ ~rs~ ~~8-~ ~ ~~~ ~ ~I~~a~ ~~ w~~ ~~u~~T ~~ ~~~~ ~ ~FRES~ '~~~t: i3,tTliiC~ ~ .l,n ~ _____ ~;~t6 IA$E:. ~~i• ~~~~ FIl~1 ` :' ~~ ~ g~kDE ~ ~p . , ~~ - .. _ ~:, I#LET ..: ~ _ ~5- . ~ '. EPP~~ teiA'!'£'ft ~I6~1T 5~~ ~"'" 27ESfIT s s ~' '~#~ ~~ ~ ~~~' r. PIPE 3' C $~ ' ~ S ~ ~ tt . APPEt~ ~ CO ETE ~~ ~ ~~ '~~~r..~~~~ SPy~~~'I~TIOP~S ~ _ sE~cc f ~osE j~~.~ / 111 .~ ~ i six ~~3FAC3~.iRE$~ [ _ 33~~ ~£3~XI~'F£ ~1.~"~ ~~- ,S~`7''' TlU~1K 5Z ZFS = . ~SEp'FI~ ~ ~~.!~ SA.L - ~ ~ -~ - ~ ~~~5~1~ . = s~i2~-- ~~- I?QSE I?i.~5= A.. '. ~ 8 = ~- 2._ Z~~ES tiA~lF~tvtCli3~~~= ' AI. Ri'~ irlUDE~ ~iMSE~ = `V' ~~ ~eQ. r~i~~. ES = l~C~- pFirtP ~~ ~ i - ~ e~~' ~ ~+,}-:_ AL~+kt+€ i~TIR I ~ AS P'~ I / r/~ . Z3 5~U4C S~Ti3'C :~G---~- ~°~ ~ (/ as,I3#P £ ~,~T. SET RE~ZT~t~3 DI ~~iAR~E ~~ 't~i OIL PIP£ - ~ ~-`~--~'~„ FEE? y ~, ~#TFFER~ ~~ YL £PREggURE - - - ~'R~E'IIf~l~ FACTS FEET 3 F~~T Ef? ~I~ET'ER ~~--- 12 - ~`~ I ~iT£g ~. .. ~~~~iED: ~~8 Sent 8y: HP Laser•Jet 3100; 1 715 5a~ Lsts-tt may-a-v~o c.ac~r,r~, , 4y.. "~ ~ ~ ~ ~ ~ .~ ~~~~~~ 9 EH;".." ARIES SUMP/EF'F~-DENT PUM#~ s~catROns s .~ ~ ~,~ ..~.~ t~~,~ 1~ ~ ~~ ..~ ~e.. a as ra t~ a- sBS a'er.kl s s u w ar 0ei Rri Nel a ~:ee 8@l-0Id 509330 OVCSI+ 4f =0 115 3Jd t3.D ttrA 70 54 55 41 32 t38 2U 2d 4.11 Ytifllx894 9BI~Ai 509340 UVCSa ~r0 290 3A 6S 1000 TO 64 55 tt 32 138 20' Zj 311:tiWsQ90 96i~8.9P5 509&50 UtRSn 4K0 115 914 t3A 1000 79 6d SS dt 22 738 2R 7/ 9.1i :1t5taB94 +~-A1°~S 560 OIIS~A aY0 7,~ S'1 S.5 1000 T4 bd 55 E1 32 _ 13~ _ 2C ZI 9.i1 Y1t.6iY8~C tmBemus 0ulyRehd-'bale ~irdW~l~fPaa~a~~atDllGattal6daFY>SbapsslhCYxerlr~ Wk[IW1SYept~IfEdY~~4or'aRSlawa05. Ft_CN- F_tTERS/HOUR www 1littleGillantPuatp.c4l~n Motor Housin Impelitx Material io im _11erTypc voluu _ Power Cord ~~ ~ Mechanical Sha11 Seal 5 ~ a .. .- ~SStCtlefS Y Shaft z.s ------___, . Bearings ~xy Coated Cast Iron V ~~~ sed Vane.-- -. . Nitrite with carbon and ceramic faces Siadlle.Sb SireeE' - Stainl~ StecE Upper Sleeve and Lower Batt Bearings ~,i~~e ~11t1t ~ial~ CA. Pt) Bas t2911F • Oldalwsa Cl~x, OK 73157 Phone:46S.l47.251I •Fas: 406228:1556 Fima7: t~ Form 995235-07873 F'LOV- GALi.i1NSr!IINt1TE PUMP PERr[1RMANCE CURVE 115v 60HZ . ' ' Pagt oi`, . _ ~+IER'$ 1V1AI`lUAL 8~ MAt~AGE1~(E~~Tit?~ . ~awTS o srs-r~ sPECIFC ~~ v ILIA Wort Septic Tank CaPaO~ OR>~ ` . ~ -q l °`~`'~ $epScTank Mangy ~ ~` ~ ~ I ~ 3 ~~{ a ter 1V'~aw ~S~ Q [VA D 1VA DF~K PI~~~RS -. Q Np ~(uettf F~tflet Model lank CsPad~' ~ 3 v DNA ~~vf8edr+oa'ns ~ pomp- ©NA ~ Comtn~ Units pomp Tank Manuia~cer Number tlo~ `} ~ aYd - . Pump Maritsta ~ ~i~ ~ ~ ~ ~. d DNA ~n~p~w(peaq, C~'~ x s~ ~ `> -.-. Pump Modal nt Ursft ©pe+ai Ftiber Soo Ap Rare Monthly ave~e• Q ~ra~ Es'fter lnttusn~u~ QuaditY ~~ ~ mqn- ^ Niec~sanirai aer~on fl Wetland Fats,.0~ !4 Grease {~ - ^ Otlsec - ~oc3se~ O,n Derrland (BODs7 SZ20 rttgn• ^ Disirsfec~on Total SusP~~ Somas {'rSS) 5150 m n- Man ~ C~etiCs) . Morlthiy average" t3ispe ^ [ round (Imessurtred) ~~ QTY ^ in..groand C4~~Y~ sand n- cede p {8O0s~ S30 mg Q At-3 p geodzemirc~l Oscygen ~ Solids (T5S) 530 mom- Q pti ne - Total Suspend metric mean) 51 ti` cfull0omi ;~ for d t~`~.wa ~ Fecal Corsf~arm (;~eO m~diameter vatues~rp ~ue~ . Maw ~~ Particle Size ~8 ,.. v ia~ues typi~ Aor v waster•~ iVIAiNTEN~~ SCHEDULE Service Frraqu®ncy months ~year{s) {Mixlrrsusn 3 yra.) Ses+rtcx Event ~ At least once every uaK ~~~ {y~) of tank vaturne tnspt~ conddien of tank(s) When combined sludge and scorn e4 ' r(s) {Maximutr: 3 ycs-) Pump out contents of tank(s) ~ D morrtt-s AL least Or3Ge every ~~) tnsped drspe~ cell{s) At least once every II rsconths p months s) ~ NA Clean efluent filter ~ least once every s) 0 N,q respect pump, pump oontro[s & atarm ^ cssanttss At feast once every 3 - s) p NlA Rusts and Pam test p months f3 years AL least once every op,er, D months £1 Yews) DNA At least once every one of the ~ ~~~ or tidAINTE~NANCE 1~UG?'tONS l ~, made txy acs ind-~vidutat c8rzyih9 f,dy~5 ~ffiiner: Sept i OG1l5 She! {~gStTiCtl0d $9VYe . li'~s ri{iffii<1g O< IJ[~ lnspec5osss of ~ ~ PituTSber' Qlumtzaes r ppWCSe tank m idersBfY as-Y ~ up oe!'s'. ns must include a visual irsspec5 a and scums and m ch+ed~ ~ ~` ~~ Seim r• Tank insper~o are rtes tiroiume of Combined studg tts check the efti~+t id~Y ~,y mocks flr leaks. meal Ttse dispersal ceU{s) strati tie vrsuaQY inspe~ cE. The pandtrsg of efiittent on tree ~ porsding of efillcent oft the ground surface_ ndusg of effluent on ttte 9rotmd sutra Suttsorln-- m tfse ~ P>i~ and >jo chests for any na nd re4~rtes tree 'immediate notificafi~' of the rock ~u~ indreaffi a ta~9 tx>nd~ or mor>r of ~ tank,ralurrte. ~ grotmd surs~oe ~Y a and room in any tank e~i~ one-#tliirYi (3~ ,~,~ttt ch. ~ When ilia c~vmbicred aaarc>1u~or' a# slcrdg a $eP~9e Sen~irtg UP~~ and drspvsed of in 2~ Entit>e aocsteMS of ttte tank shall be nerrtoved by ~ _ ~~e~secst oQmPonerrts: and any 1t3, Wis~nsln Adrrrirtlstratave t;,ode- - onents. P anirai or PressurYZed pOY~ft'S comp ed by a ~ PDW'~ Maintain The 9 °f effuent filters. reeds - went. o€hertn2lntenan~ or nnoniborirlg at inttartra~ of ~2 months or less shall lee won of any service ~~ p~~d to the loco[ regulatory alr#tttolliy v~riffsin S~ daYa of comp a `~°~ roduds or athe~ S3'ART UP ANO OPERATION tr~atmeat tanks} far the P~ ~ ~~ ~ Far crew oatastruc5on. p~ ~ use of the POw'TS check. c~li s if high ConCentra6i0risere cnemirais that m,ay nrr,pede the ~eaGmerrt pr,pr~ss arldlor damage the die Qefsai ~ ~r ar to rzse_ ~et@C~d hatre the contents of the tanks} removed by a sept`age servicing Pe . r p~~ of ~' S std ~ shall not n~rr ysrtseri so:~ CQnd'sfioris are ;r+~zen at t#~e inf~itrative suEtace_ ~m ~~ PAP tanks cnal(fiti above nom highwaier levels. 1Art~n pon~er is testiDted tfle t ~. Dcrrtn9 po+~ cell{s} in one dose. ouetioad~ut9 tI~e ce5(s) attd trraY n~ltlt in the wilt tae domed m ~ d~pe~ of a To avoid this situation have the acsntettts of the primp fattk tertwved by a g Qp~pttotts r P ~' the etnuent pump or contact a PftrEr3bec or POW'i•S Mather to aS5{Sf tti tifBntJafly ff~e PAP °~~ to tote normal feveEs vein tfie pump tank-_ Do not dtitirt3 or paI#t: veii~cs over tanks and d~per'SaI ~4fs_ Da not dlivE: E)t ¢atfC o~~ or ~etwise dls~ut? or ~otttpas~ tf~e area vsr~fi tS feet down slope flf any motsnd or at~rdde srn1 absotp~ott at~E=a_ t~eQcuxioR ~ el'mttnatSa~n of ~ ~J firm the'"~fes sirEam may improve theme, da~nt'at ~; ~ oft~ePC31A(iS: armb~o~~~ bui#s; condoms, a~tton swabs; deg d+aP~ dam; ~ ~ draft {se~rep P!~F) rYater fntit and vegetable peelings; ~% S hetbicidr~; meat scraps;- ~ ~ ~ ~duc:is; perbcrdes: sate' nap[ciris: compote: ~snd ~nraft~e brute. . ~~~~~ taken out of service the foilavrtng steps shalt tie taken' ~ itssctte that tl~e vt<he~ the POS-1R~ facts andfor is petm~nffy system is plvperlyanQ abandoned in oortaprrance vrifiz crt_ Conan Ei3.83, Y~rscorssin AdrtstnTsbai6sre Code: AII ptpltig to tanks aritf pits shat! -be disoonrtected and tfae abandoned pipe oP~~s ~"~- • . 7rie cantes+ts of act tanks and t~ shall tae removed and property dLSposed of U]/ a Septa3e Setvsctrrg • Atter p~p~$, act tanks and pits shatI be excavated and removed ar their ewers rerno,rad~aad tfse~ vand space filled vtititft sot! gta+ret rx artoS;er inert soled cnateriaL . COt+i7WGENtyY PEAN nn+ide a code tf the P'C11tY'f'S fads and cannot be r8p2tt'~ th$ folEowing measures ha+~e been, or must be taicen< m p corrtpLant reptaoersent system= O A suilabtE repiaaement'acea has I3eett evaluated and may be utc'tized for the Ioca~~ ootnpac~an ent sar7 t area should be protected from d-sturbance and shouE6 trot absorption - The re~° lot trrtes and wretts_ FarTure to tae infrurged upor+ by r~equmed setbaoics firaom existing and proposed sfnrcture, probec# ~e rep>aeement at~t ~ result in the need for a new soil and site °evaluaiioti 'm estabEcsh a sridabie reptacement area- ReplapemenL ems must comply tisrith the r-rtes in effect at that tirne_ D A suitable r~ptacem8nt area is not ayar~ble~due io setback ar;dlor soiE iuniia5flns_ Saurin$ arfvariaes 1~7 POWTS~ ieechnology a IwEd~mg contr. may be instaited as a East resort to replace the far7ed POiNTS_ The site has not been. ,evaluated ~ identify a suitabEa replacement area. Upon far~ure of the POWTS a soa.and site evacuation mast be perfon'ned ~ gate a strziab3e replacement area. If no sett area is available a ho(durg tank maybe tnstaIEed as a East nesorf to repEace the failed FOWTS_ ~~~ ~ the biomat ~ . Mocttid and ai-grade soT a6sorP~n sysienns may be reoonsiructed to place frst(amng EtfiElrafisre sutfatoe., Reoonstsv~diOns of such systems must rximpiy with the rules ~ effect st Ztrat tsr:e_ ~cVEfi4ftTEEt3{~~ SEPTIC, PUlf2lP AND OTHER TREA37NENT TAMILS tYIAY CONTAfit LETHAf.. G~,Sj=S ~~OR iNSUFF[CtENT DO HS7T EKIER A SEPTIC, P'i)tfl[P QR Q"I'I-IEFt TREATMI'=Rt1' TAT1K UNDFR A11tY GSRCFIMSTiath~GES_ DEA7N MAY RESiIt_T_ .RESCUE OF A PERSOl1i I7tOM THir INTERIOR fl~ A TANK MAY BE DIFFICULT OR t>ItEPOSS[BLE. ADDETiONAL COMMENTS POYit'TS INSTALLER Name cLcrr.t.`./ tr Phcme --~~ ,~-_. ,- yJ- POWt'S lfllAli~FAINER N2me ct.r c-./ srC'-~/ Photze ~ 1 J r~! C! l / `~ s~ SEPTAGE SERYFClNG OPERATOR MP LOCAf. R.EGULATQR~ k€lI'FiOR/fJ~ nlame a,,,L ~ ~ A9~cl' ~ ~ ~ G v z~••i~ Phone "~i.,, = oZ ~~-~' tenons ~~,, = 38 rte: a~r.~c,~.as aradeea Dy me sraA§ of ine c?rean trdre, a+tarausrta and wausFrara Cov-rrty ,Zarring and Sanr?atiun This dnarmrnt "~ ate r:renmran rnognulnrerrCS at' dL Gatrnn 832z(~}tt3C~ft3 acrd 83.5a{t), (2) ~ (3), vYcsoansin .4QmirtlsLrat'rvc C~ [hs of ttris doerur~ent dues trot guarantee the perforrrtaaoe of the PCriViS. C~W~t) ,, state of Wisconsin INSPECTIO RECEIVE roy G. Jansky par ment of Commerce Department of Commerce Safety & Buildings Division REPORT 13 .Spruce Street Bureau of Field Operations $EP 2 7 2~jpp a Falis, WI 54729 Inspection Date Z ! t ~ j O(~ Personal information you provide may be u CT n Tv ( i 5) 726-2544 or sec6dA5~r av Cy Law s.15.04(i)(m)]. Name of Premises Addressor Legal Description County cvl~a 3o.~s NL.I~ - s - S, zy ~~~ `~ .; f -~AM NO Nth s; . c/~pl X `~ LvT ~ ~ Master Plumber Name and Address Master Plumber Firm Name and Address Plan i_D. No. ) ~~ --tQRS Slu z..~~g~~ 1ac~F3 (9Zwo Av~ r. _ Sanitary Rermit No. J Soil Tester licensed Person's Name(s) and License Number(s) Owner s Name and Address ..... ._. . ~ G . ~ 4~' 5onn r1~Sa-; W T- 5~ G2 ~'" ~f~-5~ ~ E!S IJg~ ! r 't--n !~ ~'4 NJ GJ~n1 ~i AN! tkLt r~'~`9 r~ U~ ~i~lT~i ?! '}_ /-1f ,. _ .' 'luiJa~1TLwl S Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm $5, 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 I.D. percent slope. scale or dimensions, north arrow, and location and distance to nearest road. wed by \ Please print all information. ovide ma be used for secondary purpose (1~ s. 15.04 (1) (m)). Personal information you pr Y Party Owner r _~~ ~ ., . ,, lProperty Location s, 1_ J ~! i~ :1~~~ ~ _ y j Govt. Lot ~ ~ 1 /4 c/ ~ 1 /4 S /-~ ~ C./ Lot # BVorac # Subd. or ~t Property Mailing Address -, / ,^ ~ cram zio Cod Phone Number ^ City , ~ ^ Village Town tt a~ Page ~ of 3~ Date ~f- 2Zf 2c~ ~ T~ 9 N R E (or W K./ ~ `~~ Nearest Ro (, ~ .. ' ` ` -- V . <._.: ~ ~ - ' New Construction Us . Residential / Number of~bedrooms"~ Code derived design flow rate ~ GPD ^ Replacement ~ Parent material ~ ^ Public or commerdal -Describe: ------ -' ne. ~ / ~~ ~~ Flood Plain elevation if applicable ~~ ~ `y ~ ft• K ~ ~.~,e_y QR,p- / , a recornndations: ~~ ~~C.t_ ~ ~~ /a.riUt.c~~ ~ (~> ~ C 2) ~, ,~ ~~ ~2 t ro(° - Sus- '` e~9 ~ , /~ r~ ¢ p II So~X ~; ~ ~~ Sift--r it r hcp` cu~l~~%~M - ~ T ~ s ~. .~ u ~~ ~ I Boring ~ Y ft. Depth to limiting factor Bonng # Ground surface elev. ~ ~' ~- Pit in• _ Sal iication Rate nce i t Boundary Roots GPDlff Horizon Depth Dominant Cdor Redox Description Texture Structure e Cons s •Eff#1 'Etf#2 in. MunseO Qu. Sz. Cont. Color Gr. Sz. Sh. ~ ' f ~ -'~ Z. J~ 7~ ~ r L 1 l (n~ s ® Boring Boring # ~ pit Ground surface elev. I CJ' t it• ,/ Depth to limiting factor , ~• t R Horizo n Depth Dominant Color Redox Description Texture SWdure Consistence Boundary oo s in. Munsell Qu. Sz. Cont Color ~ ~3 i C-1 S rs' ~ r ~ ~, ~ a,b~ ,~ y Gr. Sz. Sh. s~ s ~~, ~/ L • Effluent #1 = BOD > 30 < 220 m9ff-and T~ >~ -` 1 ~ CST Name (Please Prints ~ Bird Plumbing, Inc. Shaun Bird Address 1008192nd Ave, New Richmond, WI 54017 `Effluent #2 = Soil Application Rate GPDHf `Eff#1 ~ 'Eff#2 L' $ a(/h ~ ~,~ ~ 3 ~_~_ .,/~ .d _ b < 30 Date Evaluation Conducted ~- ~ ~~ `/ and TSS < 30 rtxyL CST Number 226900 Telephone Number 715-246-4516 • T' lof '~ Page ~ of Property Owner Parcel ID # Boring # ^ Bonng ~ ~ r in f ct ti ® .Pit Grou ft ' nd surface elev. . o a ng . Depth to limi ''tiotizo n Depth Dominant Color Redox Description Texture Structure Consrstence Boundary Roots in. Munsell Qu. Sz. Cont. Odor Gr. Sz Sh. at ~~ ,~. Z ~ 3 z.. S I ~ ~ c r ~ ~. ~ 11_.~`~t~ tiro:., ~i, ~ ~ ~ s~~ yiF s,°< rr t, ~ •Eff#1 ~ •Eff#2 .o I _d p~J Boring ,- Boring # ~ ^ Pit Ground surface elev. `~ 1. ~ ft. Depth to limiting factor in. ~.I ~~ ~ ti i D Textr~re Structure Consistence Boundary Roots GPD/fP Horizon Depth in. Dominant Color Munsell on p escr Redox Qu. Sz. Cont.-Color Gr. Sz Sh. •Eff#1 'Etf#2 Z .3 ~i-t I ~-3~ .,~ ~ Y ;~ ~-- ~ ~ ~ !~ ~ L i'c.~1 rru' r- ~. ~7 ~ ~,~ ~.~ ~ O , ~ v ^ ~~~ a Bonng # Ground surface elev. ft. Depth to limiting factor in. ^ Pit ~ ~atwrt ~ Horizon Depth Dominant Cd Redox Description. Texture Structure Consistence. Boundary Roots GPD/iP in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. •Etf#1 'Eri'#2 • Effluent #1 = BOD; > 30 < 220 mglL and TSS >30 <_ 150 mglL ' Effluent #2 = BODs < 30 mg/L and TSS <_ 30 mg/L The Department of Cotttmerce 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. sao-as~o pe.6rool Soil Test Plot Plan Proj •Name P.C. Collova Bldrs. Inc. Shaun A ress P.O. Box 489 Somerset Wi 54025 CSTI~ Lot 36 Subdivision Farm View Ridge Date 5/x'/04 N W 1/4 SE 1/4S 5 T 29 N/R1 ~ W Township Hammond Boring (~ Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 100.0' *HRpSame as Benchmark Alternate Benchmark Top of 1/2" Pipe @ 100.2' Scale is 1" = 40' unless otherwise noted :.- - _= ST. CROLY COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer P• C. Collova Builders, Inc. Mailing Address~~~ N~.IvCtrrl .~~`(- ,~c~,~-P ~ Property Address ~ ~e7 7 ~ lY ~ ,U 1~ ~ ~ ~ `J ~~~ (Verification required from Planning epartment for new construction.) City/State Hammond, WI parcel Identification Number - 4$- Zcm ~- - ~ - ova . 9~5~ LEGAL DESCRIPTION Property Location ~ '/s , SE '/4 ,Sec. 5 , T ~9 N R 1 ~ W, Town of Hammond Subdivision Farm View Ridge .Lot ~'~ W. Certified Survey ,~Iap ~ ,Volume ~- ,Page T Warranty Deed # ~~~~ ,Volume .~, Page ~ 3 Spec house . yes ~ no Lut fines ide;ntitiable (yes _ no SYSTE,tiI t~tA1NTENANCE 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 very 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 a,rees 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 chat (l) the on-site wastewater disposal system is in proper operating condition and/or (Z) after inspection and pumping (if necessary), the septic tank is less than l3 foil of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewa,e disposal system with the standards sei Forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification statin that your se tics stem has been maintai us e t d . ~~ un Zoning D a ent within0 days of the three year expiration date. ~m ~ A ~~~~ ~~ ry p~ODU~T t~FFE ~.,~?~ ion SIGNATURE OF APPLICANT (715 _3~ DATE OWNER CERTIFICATION `~ ~?l1~. Uwe certify that all statements on this form are true to the best ~ the owner(s) of the p op rry desc bed ab e, by v'rtue of a warranty deed recorded in Reais~~e SIGNATURE OF APPLICANT ,~®~ ~ DATE r ****** Any information that is misrepresented may result in the sani ff~•Dl~tting Departtnent. ****** Include with this application a stamped warranty deed from the Register of D ds ~ the certified survey map if reference is made in the warranty deed. °34 OSCE ,1~ 54fl20 U 2S36P 3y? STATE BAR OF WISCONSIN FORM 2 - 1999 Document Number I WARRANTY DEED This Deed, made between Michael B. Marshall and Dawn Marshall. husband and wife Grantor, and P. C. Collova Builders. Inc., a Minnesota CorDOration Grantee. Grantor, for a valuable consideration, conveys and wazrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): See Attached Exhibit "A" 757'359 KATHLEEIi H. liA1.SH REGISTER OF DEEDS ST. CROIx CO. , liI RECEIVED FOR RECORD 03/29/2084 12:50PM MARRAI+ITY DEED EXEMPT # REC FEE: 13.00 TRAKS FEE: 2012.48 COPY FEE: CC FEE: PAGES: 2 Recording Area Name and Retum Address 018-1008-60-000; O1&1008-80-000 ols-loos-9o-o00: ols-solo-oo-ooo: ols-solo-lo-ooo Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to wazranties: Easements, restrictions and rights-of-way of record, if any. Dated this ~~~ day of March , 2004 --- -- --- ~~~~-fit, ~J. ~a~,,,l'~/u~- _._ . _ * * Michael B. MarhsaB -- - - ~ ~ M~~ ---- .. * ---- ~ - - - * Dawn Marshall AUTHENTICATION Signature(s) Michael B. Marshall and Dawn Marshall, husband and wife - - authenticated this ~ day of March , 2004 * Kristine Iand _ . O --_. _ TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by $ 706.06, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristine Ogland _ _ Hudson, WI-54016 ------`--.-- - --- (Signatures may be authendcated or acknowledged. Both are not necessary) ACKNOWLEDGMENT STATE OF ) _...- - -) ss. County ) Personally came before me this ____ _ _ day of the above named to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. Notary Public, State of ---_- --_ - ----- --___ ._ - My Commission is permanent. (If not, state expiration date: .) ~3 * Names of persons signing in any capacity must be typed or printed below their signature. tnforrnation Professionals Co., Fond du Lac, wl SPATE BAR OF WISCONSIN 800.655-2021 WARRANTY DEED FORM No. 2 -1999 79961 S ~ ~ ~ \ 66 S 1.53 Ac. ~ ~ ~ / ~ /I d- \ \ ~3'' ~ , / ~ / o' ~ 1.84 Ac. n/ \ \ \~ 4 0° // ~ /,,~ ~ ~ L _ N 82.2 \ \2\69 co ~ ~ ~, -- -1 33 W 459.0 \ ~ \ ~ _ - ~l rr - ~3 ~~- j ~~ 72161 S.F. / N /~ / ~ \ 1.6 6 A c . ~ °~ ,CO ~ co ~p ~ ~ ~ ~/ ,~ ~ ~ti s 33 ~Q ~ ~ ,` , , _... ~/ ~7 r~ Z / ^~ ~2~Q 88149 S. F'. `,~/ '~ `~ I~ 6 '~ ~ ~ ~ - l ~ ~ ~1j,, 2.02 Ac. "`",,, t.'~` ~ . - ., ~ ~~ ~ ~,~~ ~,~~ _ ~ ~ 3 4 ~--- - - ~~ „~ ~~g~.... ~ '~/~ / ~ ~~ 66474 S.F. S 89'26 3. / v 1.53 Ac. ~'' EAST-WES ~/f \ ~ , / / / ~ ao 1,7 j ~/ /~ , N I o ~/ `3 ,, /~, ~ ~ 55'4 '~ 68909 S.F. ~ ~3 ~ / ~ 6 ~ 4- 1.58 Ac. ~ /~/~O%' /~ ~ '- ` ` W 336.94, o ~~ ' s~ ~ ~ ~ 6~ ~ ~ / 35 Q 74 • ~ ~ / 6' / ~ 66591 S.F. ~ ~ ~~ ~~°/ „~~,/ / ~ ~ 1.53 Ac. ~ ~ of ,~~o ~, `L ~ ,~. ~ - N 88'35'54" E 492.26'_ _ ~`- °po ~~ ' zl ~ ~ ~ / c. ~N / ~ ~h~\~ ~ / ~; \_ - N 87'28'13" W 636_09' ____ / °\ ~' / 18 ~0---1 ~--- --, ~ _ 19 7.96 3,,7 253.43' 38 39