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HomeMy WebLinkAbout018-2007-39-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division '~ j INSPECTION REPORT GENERAL INFORMATION ~+~ (ATTACH TO PERMIT) Personal information you provide may be used for sec.>ndary purposes [Privacy Law, s.15.04 (1)(m)]. permit Holder's Name: City Village X Township P.C. Collova Builders, Inc. Hammond, Town of SST BM Elev: Insp. BM Elev: BM Description: f'~NK INF(~RMOTInN t_ ELEVATION DATA TYPE MANUFACTURER ~~ Z c• ~ael~ - U~ Elz - -tom ~~ CAPACITY Septic Dosing ~ ~~ 4 ~ r Aeration Holding ~.- ~ TANK SETBACK INFORMATION TANK TO P~~ t WELL BLDG. Vent to Air Intake ROAD Septic ~ ~ r ~_.__ Dosing t r ~ t~ ~ 3q Aeration Holding PUMP/SIPHON INFORMATION ° ~~ Manufacturer q~, 5 GP and Model Number ~ ~, TDH Lift Friction Lqs;;- _ System Head TDH Ft ~Z.`r~ ~,~' 3,~0 2~'So Forcemain Length r Dia. Z c t Dist. to Well SOIL ABSORPTION SYSTEM county St. Croix Sanitary Permit No: 463430 0 ate Plan ID No: 2- =T~Fa)5 • D~ Parcel Tax No: 018-2007-39-000 Section/Town/Range/Map No: 05.29.17.978 STATION BS HI FS ELEV. Benchmark /1 ~ ice. 2~ r l a~ . ~ Alt. BM ~•~v ~ r Bldg. Sewer / / boa ,, ~/ ~~ SUHt Inlet rZ•v 93•(oD/ St/Ht Outlet Dt Inlet Dt Bottom ~ Header/Man. Dist. Pipe -C~'S' i (flZ.6~ Bot. system )7, ~ pz. DSr Final Grade ; ~ 4+r'` ~ ~ l J l 3S O~ Z~r St Cover g,~D ~-7~Z01 ~~ (~l ` l~s) 5 ~o ,f~ ~~ . v ~~(;~sk,...l S. 3o S'. 3o S- ~ t~ -1 ~0.9D IMENSIONS Width , C~j v Length ~ C~ J No. Of ~er.~es ~Z~ !~~ 1 PIT MENSIONS No. Of Pits Inside Dia. squid Dep SETBACK SYS TEM TO P/L BLD G WELL LAKE/STREAM LEACHIN Manufacturer: INFORMATION CRAM OR Type Of System: M~~ ~ 3l4 ~-~ 3 ~ .~` NIT Mode r: IIICTRiRI ITICIN SYSTEM Header/Manifold rt' Distribution ' // ~ x Hole Size fl x Hole Spacing) l Vent to Air Intake b t ~ ~ Pipe(s) ~. Q i Q0 3 /~ 2. • Dia Length ng + Dia Spac Length Coll C(~VFR ., o.e«...e c..~•e.,,~ n.,i.. .Y IIAn~mri nr Af.GrarlP Svstamw Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No I _-_I j Yes (_~; No I J COMMENTS: (include code discrepencies, persons present, etc.) Inspectio #1: ~ ~.rli~ Inspection # ~ ( / Location: 1139 167th Street Hammond, WI, 54015 (NW 1/4 SE 1/4 5 T29N R17V`J) Fa m View Rig Lot 39~r/,.,f{~ Parcel No: 05. 7.97ti 1.) Alt BM Description = ~~ q S~ ~°t~ Se.~..~er-; ~ / "`~ 2.) Bldg sewer length = 2 ' d - amount of cover = 3(0 ",h . Plan revision Required? Yes No ~ i t7 ( ,~~ ~ ~~s~ Use other side for additional information. ~ _.r---~_ __ _ - - Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) ~~ _ f~~55'' az~d Buildings Division 201 . Washi)igton ve. P.O. Box 7162 County ~ ~~. ~ ~ ~ Maditio:, WI 53707 - 7162 anitary Permit Number (to be filled in by Co.) l~~O ~~ artment of Commerce D (` ED 3 30 -__ ep fate Plan I. .Number Sanitary Permit Applica ion ~ ~ _.~,~ ~ p # ersonal infor ~ lion yo{~ pff~yid 2QQ5 d C 21 Wi Ad 8 Z • • ~ 5 o e, p , s" m. 3. In accord with Comm i 04 1 r f ~ oject Address (if different than mailing address) ( )( may be used for secondary purposes Privacy Law, s] : / I. Application Information -Please Print All Information S ZONING OFFICE ~ ~~ ~~ Property Owner's Name Parcgl # Lot # Bloc # Property Owner's Mailing Address ''~ Prope lion 1 12 ©~(- --- '/,,~'L'/<, Section City, State de Phone Number Zip C o l ) ~ ( ~ S t t~ ~ e W ~~c T'~JN ~t ~ ~ t/lJ ~ Co ~ ' ` ' w ~.~. IL ype of Building (check all that apply) ~ ~ Numbey Subdivision Name r 2 Family Dwelling -Number of Bedrooms __ 8"^ti- ~ ~ /// r`~_ ~` , ~ • ^ Public/Commercial -Describe Use urn-~/ ~t.tJ'Y1 ^Vill o of Cit ~K ^ State Owned -Describe Use y III. T ype of Permit: (Check only one box on line A. Complete li ne B if applicable) ~ ~ g~ ~~ A" ew System ^ Replacement System ^ Treatment'Holding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision -~ ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Ex iration P Plumber Owner tl I 11 IV. T e of POWTS S stem: (Check all that a 1 _" ^ Non -Pressurized In-Ground Mound > 24 in. of suitable soil ', J vtound ~ 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ~. I Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Kecirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) ~' V. Dis ersal/I'reatmeat Area Information: _ Design F/low (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Pr System Elevation / ..r $~ l 57~ ~ ~J~ ~` ~.. VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units '-~ I n ~ oncrete Constructed Glass ~ '~~C ~ - I New Existing -~1 I~ Tanks Tanks _ _ _ Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- T, the undersigned, a responsibility for instailafion of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's S' a MP/MPRS Number Business Phone Numb Plumber's Address (Street, City, State, Zip C - VIII. Coun ,'De artment Use Onl __" Sanitary Perm t Fee (i eludes Groundwater Date Issued Issuing Age ignature ps) Approved ^ Disapproved F h ee 1 arge Surc ~~~ 2~ ~ ~ `- - Own eason for Denial IX. Conditions o ppro a 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 ~~. a.o.. al h r 11 inchoe in si>p AttIIe6 Complere plans tcu me wooly vu ry :........; a~a.....- .... r-r- x~ ~C r SBD-6398 (R. 01/03) PLOT PLAN .C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 4 SE i/4S 5 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX YSTEM ELEVATION 101.6' BEDROOM 3 ONVENTIONAL 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 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 ~~_B.M. * Pranerty I II'1P Well is to meet all setbacks found in Comm. 83 Grading is to be done to divert run-off away from system 101' -2 6-1 100.6' B-3 100' 2% Area 1 S' below system pro 3 Sloe is to remain p undisturbed Bedroom House Tank is to be properly bedded and provided with lockdown covers with approved warning labels 3 74' Property Scale = 1 /4" = 10' Line G~Pv 167th St. ' ' commerce.wi.gov isconsin Department of Commerce Apri121, 2005 CUST ID No.226900 ATTN: POWTS Inspector Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi. gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/21/2007 Identification Numbers Transaction ID No. 1126778 SITE• Site ID No. 697094 P C Collova Builders Please refer to both identification numbers, 1139 167TH St above; in all comes ondence with the a enc . Town of Hammond, St Croix County NWl/4, SEl/4, S5, T29N, R17W Lot: 39, Subdivision: Farm View Ridge FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1013859 Maintenance required; 450 GPD Flow rate; 30 in Soil minimum depth to Limiting factor from original grade; System: Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/01), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N:01/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. COiifl 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: ~ER EI Approval Requirements: ~ SEE CORF • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.O1lO1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.O1/O1). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • 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 SHAUN R B[RD Page 2 4/21 /2005 • 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. Stat • Comm 83 22(71 A copy of the approved plans specifications and this letter shall be on-site during construction and open to inspection b~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 constructionJinstallation/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 may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@c ommerce. state. wi. us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G 3ansky, Wastewater Specialist, (715) 726-2544 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 ~~~~i ~~~ ~~R I CFO ~~~`.,~ ¢~DOS ~ ~~~~~~ ~,.~~~~' s Date: 4/12/05 Owner: P.C. Collova Bldrs. Inc. Location:NW1/4 SE1/4 S5 T29 N,R17W Lot 39 Farm View Ridge Hammond System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01131) 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 Contigency plan 9-11. Soil test ~ Shaun Bird Signature_ License nu 226900 ~nally ~~E'D rF COA~MER G3 pONDENCE • , ~ PLOT PLAN PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 NW 1/4 SE i/4S 5 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 101.6° BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 MOUND XXX SEPTIC TANK SIZE _ LOAD RATE 1.0 ABSORPTION AREA 454 # of chambers none HOLDING TANK SIZE BENCHMARK V.R.P. To vey Iron ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL *H,R,p, Same as Benchmark I\ B.M. * Property Line Well is to meet all setbacks found in Comm. 83 Grading is to be done to divert run-off away from system 101' -2 B-1 100.6' B-3 2% Area 15' below system pro 3 100' is to remain Slope undisturbed Bedroom House Tank is to be properly bedded and provided with lockdown covers with approved warning labels 374' Property Scale = 1 /4" = 10' Line 167th St. ------.. /~ . .. Designer No Date 4" Observation Pipe Perforated Below Filter Fabric AS7zi C-33 S a n d -~ " Tap=otl ,~ ~ ~~ ~, n u,~ _c F a~ n.. 0 W ~ 0 d Piowe 0 Layer •p ;~E . i, ~ J F ~~ G ~_ to ~ 5 r _ L _..,.___ - ~`ObservQtion Pipe-~ ~ _ K r".-~-_. _.._ _- __ ___---- .-------------------- _ . j ~ ~ Force Moin A _I l~-_.~~__ "- :__---- •-_-___~r_~_._ From Pump ~ w Distribut:o'~ Bed Of ~Z ~' ~'2 Pipe ~ Drain RocK I 4 Observation Pipt =-{-~C•~~.~''~.-~~ Permonenl Mocker ~S~se-- ~0/~ L a.~-~ ~:'''~-~,~"~~~pe or Rods Plan V+ev+ Of Mound Ucir~d _~ar Tie Abxarption Area i ~E r Non-Woven Filter Fabric ,Distribution Pipe ' G ~~ -{ H==- - -. r 1~ m _ ~` p `'4._ \ ~ Z 7. Scope - 2 %2 Bed Ot sj Farce M-ain ~ Or'airl Rock from Pump St~:.tion Of A Cr oss Mound S stem Usin _ ~ ~ The Absorption Arta A Bed Fo _ --- ~ ~ Ft . g ~ Ft. j ~~ ~ Ft.- J~ t Ft• K~~ Ft. .. L~y~ Ft. ~,~ ~~ Ft PI-G Ems, F_--- C~~Q iosa~ed Qa 8o+tom. SRuotlY gpotetl ~KST yd.L tdax~' re CartntG}ion Ft. Ft. ,,,~.-~~r~ , :, - - - ~ Signed : ,_,,.,, License Number: ,~ Oato yyG~ X ~I inches '1 `~ ? ~' ~` ~ :ache .Hale Diameter ~ fnch Lateral .~~ ~ Inches ~ ~.an i fol d ~ Inches FOrca Main ?~, Inches of halesiaipe ~~ ' Ir~verL Fievdtian of Laterals ~~~~ Ft, Per#erbt~G o~Ct Qet4it ' ~ SFE~=fir ~CaTTONS Ft3MP C- S~FTZC •FA~~ ~ ~EA~FR~f APFgaV ED AB~UVE GRADE ~ Ji3I~CTIOI~ $fl?t ~H4L£ CQYE~t ,~ WENT PIPE ~.Z" ~Zrt "~~ ~ITK CC~;~UZT ~/ P~L~K ~ 4 Gk ~~~ga~ i~TARKIRG ;ABEL ` ~.RO~ D4flR, ,~ FRESH - `p T r~~~,-., ~% ~" E ~ - S' a" I8~*n~~- =, -~,~ _ - _. 44 -. i s Z8~ i~ ~~ ~~ ~ t i ~. t i INLET -~ - TI~RT, a iN~tSE~I~ T~~~~ s~~ ~ ~~~. ~ ~~~ i~iAT£R ~ ~ Bids 3, 0~ .-..----~" •-~" s Qi~ ,FiLt~R $ ~,;8 SOIL ",~`_ ~ ~a~rt! ` ~ ~ F a FP ¢~rrl9Y3ii~.~.~~1~ _ ~~ t 1 FT' ~ u p~~p QFF ELE1- ~.:---- SAIL ~ ~,Rpt~ED BEDD~~G tII+Ep~~ ~'A~R' C4}~iClt£TE FAD C F•r----~"~' ~r l - Eg I3AY = ~ ~;+iBiR oOSES P ~ ~ npS£ y. 3~OS~ v~~ME I~C~DIAt6 (~ ~ . J GAL- SEFT;C YACTtIRER= ~+A- - I„L~gACIC. _.------„"'~ / j AG L. TANK I+lANU ~7~-~ CA~,~ j~~• iiG~S - t TAIL SEPEZ L ~ ~ ~ ~ CAF 4CITI~ ~ ~' _ 2 Z3,~CHES ~ ~ ~- K gIZ£S = D~ C ~~ ~ ALAS ~~g1RC1~R~' ~ .~ . r~' % ~ v+ ~ _ ~, 3 INCURS = r..-----1 _...--- ~pDEL ~~~,~: ~ C _ GAL S~I~~ ~ 1ZL/ - ~ IiZCK£S 13 _.--- I i~'Ig 15.23 ~-G ~~ p~~FAC'1~R~ ' J ~''' N[jt'~SF.g :. ~ ,~ f ~~ ` ~ i~IIRI~ A-' PFR I~i01)E~H APE= ~ "~ ~ ~ ~ur:p ~ ~ A~ ~ ~ FEET ~ ,~ipt~1 PIPE ~,--3"'~ FED` IRS DI SCRAR~E gipT~ ~ ~? DI STg I ~ - - - - ~ f/~-'~ FEET REQ1i $£~EEI~ 'PUI+IP {3r F - FACTOR '~"~, F vER'fICAL gIFF~'~CE ppLY PREj~S~R~,T/1Q~-I''~• Fg2C'TIa~~£ ~~ ~~~-- MIN~~ ~ETyi0R1C ~ ZIi ~~-= - T~Ti~L DY'~Ar` Dlpiy£T~ _.------- } `~ _ i}F ~~~P ~~~ • LLN6Z'H ~~~~i~ IKT~~AT' ~iM~~$ID~~ ~~CE?~SE ~fiJ~.B~ SIGNED = _._..,-•----"""~.----- t}A-~£' r~ .1&$ 12 °a w x U Z 8 0 J O 4 0 20 40 60 80 tU~ GALLONS LITERS 0 g0 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 variab: e level long and short cycle controls. • Sea{ed Qwik-Box available for outdoor installations. See FM1420. • Over 130°F, (54°C.).special quotation required. 15y153 6eries 1511753 Model Voka-Ph MODELS Mode Am s Control Sim Iex Selection Du lex N152 115 1 Non 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 3 705 1 2or3 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT AND DEWATERING MODEL t52 153 j f=eet. Meters Gol. Lifers Gol. Liters 5 ~ 10 1.5 3.1 69 61 261 23? 77 70 297 265 15 4.6 53 201 61 231 20 6.1 44 t67 ~ 52 197 25 7.6 34 129 42 159 30 9.1 23 i 87 33 7;%5 35 40 10.7 12.2 I -- -- ~ -- -- 22 17 ES 42 Lock Volve: 38.0 ft. (1t.6m) 44.0 Ft. (134m) 3 27 I i Iz ,/a r-, ~ ~,~ 5 ~ /. t --~-1- 9 Nt53 175 t Non ~ SELECTION GUIDE BN153 115 1 Auto 10s Included 2 or 3 back variable level float E753 230 1 Non 5.3 1 2 or 3 1. Single piggyback variable level float switch Or double piggy BE753 230 1 Auto 5.3 Included 2 or 3 Switch. Refer to FM0477. o caurloN 2. Se e FM0712 for corcect model of ElecVic21 At~mator E-Pak All installation of controls, protection devices and wiring should be done by a qualified 3, Variable level control switch 10-0225 used as a control activator, spedfy duplex (3) licensed electrician. P,11 electdul and safety modes should be followed including the most or (4) float system. recent National Electric Code iNEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual cond'-tions a reserve safety factor is engineered into the design of every Zoeller pump. MA1LT0: P.0.80Xf6347 Louisvi;k,:<Y 40?56-0347 Manulacturersof.- ~' SN1P T0: 3ti-19 Cane Run Road . .0 - ® Louisville, KY 40211.1961 ~TyP~,~~ S,r+cE /9~~9~ (502J 775213 i • % (800J 928-PUMP http:/!ww-vzoelfercom PU/Y/P ~~ fAX i~i'1~ 774-3624 ©Copyright 2000 Zoeller Co. P!I rights reserved ' 'S MAt~'JAL 8~ MANAGEMENT PLAN • 't?owi's• oVVNER SYSTEM SPECiFICATfONS • ~ ~ Septic Tank Capa~ Ftt~ INFORNUi'nON n ~~ {- ~ .:_. ~ u(actsrrer Oar _ ~ / v Vr J Septic Tank Man .~_...,:~ st ~ 3 ~ 30 ~ Effluent Filter Manufacturer Number of Qedtt~ Number of Commerce Units Estirr~d Sow {average) Design flow {peak), (Esfimated X ~ _~ Sod Appr~°n R~ ~ fluent Quality Fats..Oif 8~ Grease (FOG) I Oxygen pemand (BOOS mica ded Solids {YSS) BtoCtleTotal open Pretreated Effluent QuaCrty s) Biochemical Oxygen Demand Total Suspended Solids (TSS) Fecal Cofiforrn (geometric mean) Ma,amum Effluent Partide S¢e ~pINTENpNCE SCHEDUt_E Service Event Inspect cond'rti°n of tank(s) Pump out contents of tank(s) tnsped d~sPersal cell(s) Clean ~effiuent f~ter tnsped purnP, PAP controls & alarm Flush iatierals and pressure test J ~e [7 ~ Effluent t-i(ter Model Pump~Tar'k t;apa~Y aYda pump Tank Manufacturer ~,,,~~ .pimp Manuf2i> Monthly avenge' ~i0 mg/1- Q2p mgr. Monthly averege" 5'30 mgr 530 m9l 5= u;~00mi Y inchdian-c,ter Pagt ~ /~~J qai ^ NA f~~~F-2`'~!-/ ~ DNA ~ /n..~ DNA Q NA t7 NA D NA Pump {,~lodei '~'"' " Pretreatment Unit - ^ Peat Fltter ^ ~~'~~ ~~~ ^ Wetland p Me~anlcal Aeration ^ Other . ^ Disinfec~on Dtspe~rsal Celt(s) O I round (pr+essur~ed) ^ fn-ground (gravity) /und Q qt-grade p Other_ Values typlCat for domestic (non-COn'rne~ trastewat~ and +ePtic tank eBtuerrt. .• Yalues rYP~ for Pretreated wastewater. -------"' Service Frequency ,.------•• ~ p months eels) (Maximum 3 yrs.) At least o+' c;e every uals one-third (~) of tank volume When co'n5rned sludge and scum -w4~R vearis) (Maximum 3 yrs.) At feast c~ ~~~~ every At [east a'r~ every At teas: o'r~ every At least o •l~ every i'~_ At least once every ------- At (east once every p manors ~-• ~-• p months ~eaKs) t3 NA p montfisns) fl ~' ~----- ~- ea s ^ NA p months 1=7 y ~ ) ^ months fl year(s) fl NA .,...~_ one of ttie foilawing licenses or ~~NANCE tNSTRUCTIONS tt be made ~ an individual cact)NM~pe~r POINTS Maintainer, Septage of tanks and dispersal cells she ~ or broken Inspections Plumber. Master Plumber Restrictt°3 Sewer: POIArCS ~ identify arty missing oertifrca6o~~ _ Master ns must indude a visa al inspection of the tank(s) SetYtcln9 Op~tor. Tank inspec~io measure'the volur.~e of combined sludge and scum and to check for any bade IP packs or leaks, r'sal Geli s) shall be visually inspected fo check the effluent [eve s hanturare, Identify arty The dispe { -the ponding of effluent on the or pond"ing of effluent on the ground surface- ding of :effluent on the ground surface- uta authocity- i and to check for any pon u..ES the immediate notification of the focal reg 1~Y in the observation P PeS cond'ltion and req or more of the tank volume, the groin ~~ may indscate a failing uats one third (~) NR mutation of sludge and scxim in any tank eq raror and disposed of in accordance with ~'- When the combined aocu a Septag :. Servicing Ope entire contents of the tank shall be removed by mart components. and any 113, Wisconsin Administrative Code. ~ onents. pretreat# Niaintainer- anicat or pressurize:i POV1fTS comp ed by a Certified P()WTS the servicing of effluent fitters, rr1e~ Spice event ottter maintenance or monitoring at intervals of 12 month's or ~eSS~rn 10 days of completion of any A servrcte report shall •be provided to the focal regulatory ~=-uthority nti roducts or other for the presence of pal n9 P START UP ANtO OPERATION cells tf high ~~t>rations are For new onnsbrudbn. piior to use of the POs a ~ r~ dam ge the~dispersat t )• chernicafs that may impede the treatmen emoved by a septage servicing operator prior to use. detected have the contents of the tank(s) Page of • , l Gprldit10n5 0= E'. frozen at the infiltrative su V BC is restored ti,e e~aoess System ~~ up shalt no[ occur when sm a not,-nat tirgh~nrater levels. When po m result in the abov tun tanks may ~ overloading the ce'~{s) and all Oi1~~ P ed ~ the dtspe~ catt(y) in .one large dose, um tank removed by a Dv~'M~t tie d~~e of eftl~nt To avoid this :~i~ation fiave the contents of the P P badkup rESLonn9 POWer t4 :f,-e effluent pump or cantad a Plumber or P01tYTS Maintainer to d'escd'-atg age Se ~+nS O~~ p~ ~ ~ cp~ttD~ ~ ~~:~e normal levels within the pump tank. assist in manually operafing ~ P P .. rk over, ar ofhetwise disturb or compact, yeludes over Tanks and dispersa c;ells. !Jo not drive of pa . po not drive or park ~ any mound of a-t; rode sot'! ab~rption area. the area ~''~' 15 feet dawn sbpe im rove the performance and pn~lorig the rye tton of the following f?mm the wast,:~vater stream may P • degreasers: dental floss: diapers: Reduction or-elitnlna ~garetie bum;; condoms: cotton srnrabs, of the POVY'f5_ antii~lotics,:.t~Y ~ gip} water; fruit and vegetable peeCtn9s; gaso>ine; gam` ~~; meat . faf: fouttd~n drain (swnF t? .;3n'rta na kins; tampons; and water softener brine. ds~ any; oft: pafiting pnoduc~s; pgsttades: - fY P ABANt)ON~MENT taken ar.t: of service the foltowing steps shaft ~ taken ~ Insune that the When tfie POWTS falls andlor is pe.~anertttY 1`ranc~~ with rh. Comm 83.33, 1Arisoonsin Admintstrative Code: system is properly and safely abandoned in opmp n! s sealed. be disconnect~:a and the aband drs~psed oof by a SeP'ta9e ~~ng Operator. All piping to tanks and pits shat! _ - Thecontents of aft tanks and pits shall be removed and property its shat[ be exc~ati •3 tact and removed or their covers removed and the void space • After pumping, a[[ tanks and P filled with soli, gravel or another inert solid material. COt+i'T'INGENCYpLAN the fol[owin< measures have been, or must be taken, to Provide a code If the POWTS fans and cannot be repaired cemp~nt replacement system- Cares has been evatua_ec! and may be utilized for the Location of a reply ~t should not O A suitable repn tacement area should tie protected from disturbance and comPa absorP~n system' The rep from rx_ sting and proposed strs,cture, Cot fines and wells. Far7ure to be infringed upon by required setbacks protect the replaCernent area ~~ result in the '"'f'd €ar a new soli and site evalu ~ that tirn tablish a suitab e rep{acement area. Replacement items must cnmpty with the rotes in effect a p A suitable replacement area is not avaitled as a `~ st resort o r place'the ~ ed POWTSng advances in POWTS technology a fialding tank may be instal n failure of the POVYTS a soii.and The site has not been evaluated ~ rdentrf)' a sr:.tab(e repfacemerlt area. Upo Site evaluation must be P~o~ to fOCate a s:,iable replacement area. if no replacement area rs avarlable a. holdrng tank may be installed as a last resort to rE=place the failed POVyT'S_ removal of the biomat at ~ound and at-grade so7 absorption systems m<ry be reconstructed in pt~ thelowingn effect at that time. ~~ the in5t6"ative surface. Reconstructions of such.:systems must comply ctY{fARNINa> 'Y'ANKS M,~Y CONTAIN LETHAL- GASSF~ ANDIOR INSUFFICIENT OXYGEN. SEPTIC, PUMP AND OTHER TREATMENT CIRCUMSTANCES. DEATH MAY UO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY RESULT.. RESCUE OF A PERSON FROM THE lNT1=RIOR OP A TANK MAY 13E DIFFICULT OR lMPOSSISL!°_ ADDRIONAL COMMENTS POYYi"S JNSTALLER ,~--..- Name ~ ~ _ ~.,~' -I~ ~ ~ J --- +g - .l Phone ~'')~:+ =- ~' ~~ ~- .~, ~ ••_ POWTS MAINTAINER Name ~r.~ r,,t ~- ~ Phone ?~ ,~~'=~ ~ , LOCAL FZEGULATORY AUTHORITY SEPTAGE St:.ftY[CtfrlG OPERATOR PUMPER .. .--- .,~ Agency ~~ ~i-~ 1cJ~-- Z~'~--' Name ~`~ ~.,~ ~/`' ~ ~W.-//rz? / ----- --a/ > ~~ '' ~ '` C> Phone y ~ ~. ~ d' '~l _.. Phony ~ ~ ;~ "-- meets Triis dopxnerrt was dratted by tJre staffs of the Green J.stre. Alrarquetfa and Waustrara County Zoning 8nd Sanitation - T~ doarment me minimum requirements of cA. Gomm 83_?2(23(b)(1X~~(t1 amd 83.St(1}, (2} & (3}. Wisconsin Adrninlsttati+~ Leda Use of this docrrment QOeSG~ (fit} guarantee the performance of the POYJTS_ SOIL EVALUATION REPORT Page..-of Wisconsin 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 I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Re ' wed by Date Please print all information. ~ 2~ S Petaonal iMorrnation you provide may be used fw secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner~~ rL.~~ !~/1 / / Property Location !~ 9 ~. 1' ,'1 / /~ ~, j ~ ovt. Lot n/l.J 1/4 51/4 S ~T p(/ hl R E (or W Property Mailing Address [[ ,` a , ~ ~ ~ ~ Block # Subd. or CSM# , ~ Q r ~-ti- v->e~ /~ ~ State + Zip Code Phc;'n~ Nur~e~ ~ ^ City ^ Village Town Nearest Ro ~~~~o~ ?off . ~. ..~ ~ ( ~ i ~ Code derived design flow rate ~ GPD New Construction Us . Residenti / Numb~r;rtf tapdrpgrlA~ ~_ ^ Replacement ^ Public or commeraah- ~escnGe:~~.~ _.-__..~ ------ n~I. , ' Flood Plain elevation if applicable ~ ~ - ft. Parent material ~h ~ T [~, nE! s . General oommerrts / /',/ ~ '~ and recommendations: ,~~: ,~~~ ,e r>?,/z~-zw.. / (/~' I /j C~ rv ~ ~ ~ -~- Bonng ' ~ V Boring # l ft. pepth to limiting factor pit Ground surface elev. Sal ication Rate Roots GPD/fP Horizon Depth in. Dominant Color etl Muns Redox Description Qu. Sz. Cont. Color Textu / Qom/ 7 ~ / iJ / ~l L. ._.-~'-_'` Z -2 b J~j S J ^0~-~ ~ 7~ ~ .' x-60 ~>> r ~, ~ .j e Sbvcture Consistence Boundary 'Ef(#1 'Eff#2 Gr. Sz. Sh. } m "' ' ~ ~,1~C , , ~.J , ~ - wr -- n^. r Boring ~" ~` ® ~n9 # ft. Depth to limiting factor ~ ~• Soil lication Rate pit Ground surface elev. GPD/ff Horizon Depth in. Dominant Cdor Munsell Redox Description Qu. Sz. Cont. Cdor (~'- j Z ~ r 3 ~- ~. I Z~~- ~ r `//~ 3 Zz_3~ ~ ~ ,y ~ Texture Structure Consistence Boundary Roots tic Sz. Sh. 'Eff#1 `Eff#2 ~~ C .S e t~ 5t ~ ~ ~ w ~ ~ • E1flueM #1 = BOD > 30 _< 220 mglL and TSS >30 < 150 CST IVartte (Please Print) Bird Plumbing, Inc. Shaun Bird Address 1008 192nd Ave, New Richmond, WI 54017 ` Effluent #2 = BOD <_ 30 mg/l. and TSS <_ 30 mglL CST Number 226900 Date Evaluation Conducted Telephone Number L' ~ ,~~ c/ 715-246-4516 ion 3 ~ property Owner Parcel ID # Page ~ of Bonng _ ~~ # ~ ft. Depth to limiting factor ~P'st Ground surface elev. ~- ''Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. G"ID ~3 ~ ;gym ~ l9'i~i C S 2 _z ~j ~ , ~ w 3 ~ 7 -r ~ ~ sr s k ~r w Roots 1~ ~~ /c Soil ~~^ ~~ •Eff#G~ `Eff#2 . ~ ,L~ /,D , a ^ Pit Ground surface elev. ft. Depth to limiting factor in• Sal ~~ ~~ ~~# ° ~~ ti i D Texture Structure Consistence Boundary Roots GP D/fE Horizon Depth in. Dominant Cdor MunseN on p escr Redox Du. Sz Cont. Color Gr. Sz Sh. 'Eff#1 'Eff#2 ~~ # U Bonng Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil ~~ Rate Horizon Depth Dominant Col Redox pescxiption. Texture Structure Consistence. Boundary Roots GPDlfT in. Munsell Qu. Sz Cont. Color Gr. Sz Sh. 'Eff#1 'Eff#2 Effluent #1 = BODE > 30 < 220 mgll and TSS >30 < 150 mgll `Effluent #2 =BODE < 30 mglL and TSS <_ 30 mg/L 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-uw tR.~ool .•.. Project NamE Address Soil Test Plot Plan P.C. Collova Bldrs. Inc. Shau ird P.O. Box 489 Somerset Wi 54025 #226900 Lot 39 Subdivision Farm View Ridge Date ~~8~04 N W 1/4 SE 1/4S 5 T 29 N/R1 ~ W Township Hammond Boring ~ Well PL Property Line County ST. CROIX P5.3 BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 101.6' *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 Property Address 1 Ln7~' (Verification required from Planning Department for new construction.) City/State Hammond, WI LEGAL DESCRIPTION Parcel Identification Number Property Location ~ `/4 , SE `/4 ,Sec. 5 , T 29 N R 1 ~ W, Town of Subdivision Farm View Ridge Certified Survey Map # Warranty Deed # Hammond Lot # ~. Volume ,Page Volume ,Page # Spec hour' J yes ,~rto Lot lines identifiable-'!`yes ~ no ;,. SYSTEM MAINTENANCE' Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix County Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) 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 1!3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of W isconsin. Ce - tcation stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning D pa ent within 30 days of the three ear expiration date.P- `.. COLLOVA BUIL®ERS, INC. (715) 247-2742 P.O. Box 489 ~/la /~ 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 knowled e. Uwe am/are the owner(s) of the pro a describ abov by virtue f a warranty deed recorde~yn~g~(3~~ ~~~~®ER$, ANC. (715) 247-2742 P.O. Box 489 ~~ tai o,~ 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 COLLOVA BLDRS, INC PHONE N0. ~ 715 X47 2747 . 5"rn7`E 13nR of wtscoNSt*~ Fo~.~t 2 • 1999 WARRAI~iTY DEED Dcxurneac Number This Reed, ,Wade between ~Zich2el B Mat•chal! and Aawn vlarshall husband and wit'e Grantor, Ind P. C Cogovii" "'_' 'nc a Minnesota CocDOmtit}n G!'antCc. GranWr, for a vai~aabte conside:acioa. conveys altd warraas w Granree tha fallowing described real estate in St• Croix C;otinty, 5t3!e of Wisconsin (iFtnore space is needed, please aatacb addendum): Sec Attaelied Exhibit "A" • }fichae! B. MartJSatl "` Dawn yiarshall ___.. .., .-- 3~arding Atea Jun. 29 2004 12:1rPM P1 ~ ~ ,~ Nance and litstrn Address O1S-lUU8-b0-008; OI8-i+948-80-UOi1 ! ,n 8- nob-90-A00: 418-1n1a-b Q-1034-iM10U ` Fucct! ki.cntiftcat%on NutUher ~PINI Yil lS !!S t1UIJ1C6tP.~d jJtOFertY (tS) (iS I:OL) ' E;,ceptiotrs to rrarranti2s: Easements, restrictions z~tv mitts-of-way of record, if anv. Laced triis ?,/~~ dzy of March _____ '!'~'! _--- t AL"7'i~2+t'TIC ~TIOhi Siszrtttt~(s) MSctaei B. liarahalt and t)a+vn ~iarshaA, _ husisaad and vrife au4~ettdcated this G(~ day or :lurch . ?~~- • T~ristiasi Ot;tartd ! TTTI.&: MEMBER STATE BAR GF WI3%Otti'SIN (!f oat, _... _- anthotized by d 706.06. Wis. 3rats.) T4iIS INSrAUMENT W?+S DRAFT~.D BY Attorney ICristioa Ogland Hndst-n, WI 540x6 - - (Sig>ratures r,fny iY authatYlcated or sckne+vledYAd. Hcxh a'e not neceuary•i A C3C`tiG W I.EDG~r1E"v'T STATE 01; _ ) 1 ss. County ) ~~ ?ersottslly came txfUre me this day of the above Warned w ~e known to be the person(s) wtlo executed the foregoing instrtuuznt and acxrwwlydged the xatne. __ _ __ _ Notary Public, State nf --._.__ .. ~ , tify Cornmissiuu is pet•mattetx. f if nor, state :zpiration date: .) :'lalaG3 Of persons signiRY in arty capacity must ve typal o: prinoed bnluw tIIUi: sionamre. Cn:ormuloa Proiesswnals Ca.. rood du l.ac. A+I ~l7aZ'tL' 3AA. 08 W7SCONSLY 8Q16_SS-ZCL'! WARRANTY Dt2t2D FOtrtf :Vo. 3.1999 CIE ~ ~ ~'~~ ~ ~,+ ~1~1 ~~ ~-~~~,~!%~~,' ~~' ~~~I~{ ~' ~~~ ~ ~ t ....~._ . 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