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HomeMy WebLinkAbout018-2007-40-000Wisconsin Department of Corr~`herce 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)]. Permit Holder's Name: City Village X Township P.C. Collova Builders, Inc. Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description: ~vc~. mac:, C`~ ~ ri.~ ~ t TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~,, c ie..TL% /~~r~~~ 3t", Dosing Aeration Holding (~ TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~~ •c r Dosing I 7S~ f,..>c,' ~ 7 LCi Aeration ~. ---- "-~. olding ~''~~ ,-- PUMP/SIPHON INFORMATION Manufacturer Demand ~< .~1( ~.-/ GPM Model Number ! ~Z ~~ TDH Lift Friction Loss System Head TDH It .=f r. ~:~ 3.`r ~G.s~ Forcemain Length _ Dia. ~1 ~ , Dist. to Well ~j ~' d /V c~ ~ ~` t- SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 463142 0 State Plan ID No: Parcel Tax No: Section/TownlRangelMap No: 05.29.17. STATION BS HI FS ELEV. Benchmar 2 `~~ I Oo • a Alt. BM Bldg. Sewer 9~ ~~/.s~ St/Ht Inlet g.q q~.~ SUHt Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe ~ ~ /a/ ~~ Bot. System 3.3 /vim. Final Grade L ~ ~- -G p , q /b`/_ ZO St Cover f. `Y''S /vb.2~ G~,~ ~ 2 `fit so t I EtL~fcrte..r = Z .Yv/ z.ci;~ / 7 -9~ BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside D'a. Liquid Depth DIMENSIONS ~ ~ --~ ~ ` SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHIN facturer: INFORMATION CHAMBER R -' Type Of System: ~ ~- ~~~t ~~ ~ °"" v ~ / N ^ N UNIT _ Model Number: e ®.....- , . DISTRIBUTION SYSTEM - "1 (.~;~ - ~U ~'1 'S Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake / ,. Length ~ Dia ~ Pipe(s) ~ i Length 5~~ Dia Spacing '3 /f H SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ ~, ~ Bed/Trench Edges Topsoil ~ . ,~ Yes [f No I~ Yes ~.J~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~_~_~(_~ 7 Inspection #2: ~O / 2? / o L Location: 1135 167th Street Hammond, WI 54015 (NW 1/4 SE 1/4 5 T29N R17W) Farm View Ridge Lot 40 1 Parcel No: 05.29.17. 1.) Alt BM Description = 2.) Bldg sewer length = h-Z~,, -amount of cover = > ~"U" 7 - --- Plan revision Required? [ 'i Yes No 2 ~ G ~ ~~_ Use other side for additional informs on. ~_ `! i ~_ _ __ _ _._ ~ L v _ __„ SBD-6710.(R.3/97) Date Insepctor's Signature Cert. No. Safely and Buildings Division 201 W W hi A B County ~~ t . as ngton ve., P.O. ox 7162 ' „~ ) ,~~O~~J~~ D sotinWi ~3 162 (~~ 1 Sanitary Pe 't Number (to be filled in by//Co-.7) De artment of Commerce 3 ~ `"1' (~ Sanitary Permit Application ~~ ~' I N ~ ' 4 ~ ~ 3 In accord wiW Comm 83.21, Wis. Adm. Code, personal information you p de ma be used for secondar oses Privac Law ) ~ ~ ~ 2 ro s 15 04 ix ect Add (if different than mailin add ) y y p , p y ( m . I g rrxs ~ L Application Information -Please Print All Information 5T. C G F F I ~E I / 3 S ~ -~.1-G, S ~ ZONIN 7 Property Uvner's N Parcel # Lot # ock # ~~s ~ $ ~ Property Location S ,~~ S i City, State / - '~ Zi Phone Number ~. ect on ~f `~N: rW of Building (check all that aPPl3') ~ ~/)/~ ./?/~_ \~ _ or 2 Family Dwelling - Number of Balmoms Subdivision Name CSM umber ) ~ ~ ~ (J ~ Public/Comrnercisl - Descn'be Use p' ~Tiw /! ~-•~ ,,/ ~ ~ ~~ State Owned - Desrn'be Use ~~~L1~1d X--~~ tN - /,, ~/ ,~~ ~4'.- Village Township of IIL T ype Permi • Check ody one boz online A. Complete line B if applicable) ~ A' System Rephuxarrmt System TreatmeatlHoldiog Tatilc Replacement Onlq Other ModiSt:ation to Existing System B. Permit Revision Change of Permit Transfer to New i.ist ~~0~ Permit Number and Date Lssuod Before Exp'"nation Plumber Owner IV. of POW1S S (Check all that a 1 ' Non -Pnxsurized In-Ground Mound Z 24 in. of suitable soil ~ound < 24 in. of suitable soil At-Grade Single Pass Sand Filter Constnrcted Wetland Pressurized in-Ground Ildding Tank ~ Peat Filter Aerobic Treatment Unit Recirculating Sand Filter ~7 ~ ~ Recircu 5 nWefic Medra Filter Leaching Chamber Drip Gravel-less Pipe pilrer (ex ~ J V. D' reatment Area Information: ~ -- r Design Design Soil Application f) Dispersal etluired (sf) .Dispersal (sf) System ovation (fi /~ !J D to ~~'-U . '~~ ~i~f 2 VL Tank o ~P~ty ~ Total Number Maaatacturer Site Steel Fiber plastic Gallons Gallons of Units t~ncrete Constructed Glass New t3xisting Tanks Tacks Sepriaa Holding Tack Aerobic Treatment Unit „ / 4V /` U Dosing ~rnba VII. onsibility Statement- I, the aodersigned, a billty for h~stallation of iht P'OW1~ shown on the attached Plumber' Name ) S~~ Plumber's Si MPfI~RS Number 2 Z~ ~ Business Pbone Nu ~ ,, = zY~~- -~ Plumbcr's Address (Stnoet, City State, ZP ~ ~~ ~ v ~ ~ VIII. t Use Onl /ved Disapproved Sanitary Permit Fee (urcludes Grow-dwater Surcharge Fee) ? ~ Date ued ~ 0 ~~ Agent igaat (N ) 1~ O Cri R ~ ~ v J jG S~O wrrec ven eason for Denial ` IX. ditions of A provaUReasons r Disa proval~~~~ _ , , J~ ~/,,,_,_ ~ ~~~j Yu~lci 'vv'' ~~'STEM OW R: ~~G` ~~ optic tank, effluent filter and ~ e ~ ~ ~~, dispersal cell must ll b ~ ~r a e serviced /main ire l._i as per management plan provided by pl tuber. 2. All setback requirements must be maintained l~~~d ~~ as per applicable code/ordinances. ®~ D"n ~~~~' ~/ ~/ ~Y. ~` Aetach ~ptere plans (to the eormey only) ror the system oa paper not tens tban a1B z 1t inches in size ~- ~ y . PLOT PLAN PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 ,IVW 1/4 SE 1/4S 5 / 29 N/R 17 W TOWN Hammo2nd COU~iNTY ST~CRhOIX SYSTEM ELEVATIO 101.2' .3' sand lift -^- ~Y~'~ ~ ~ • :J - ,/ " ' ~~ EDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 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 352' Property Line -B.M. * Alt. B.M. Grading is to be done to is top of 1 /2" divert run-off away from pipe C 100.2' system B-3 ~ ^B-2 100' 99.9 Property Line 99' - Huffcutt Combo Tank S ope1 Area 15' below system is to remain undisturbed ell is to meet all setbacks found in omm. 83 Tank is to be properly bedded and provided with lockdown covers with approved warning labels Pro 3 Bedroom House Scale = 1/4" = 10' commerce.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary October 20, 2004 CUST ID No.226900 SHAUN R BIRD BIRD PLUMBING, INC 1008 192 ND AVE NEW RICHMOND WI ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/20/2006 Identification Numbers Transaction ID No. 1070734 SITE: Site ID No. 691168 PC Collova Builders Please refer to both identification numbers, Farmview Road above, in all corres ondence with the a enc Town of Hanunond St Croix County NW1/4, SE1/4, S5, T29N, R17W Lot: 40, Subdivision: Farmview Ridge FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 987335 Maintenance required; 450 GPD Flow rate; 20 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 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, CO] stats. ~~~ The following conditions shall be met during construction or installation and prior to occupancy or use: DE ARTM N 0~ General Approval Requirements: ,~ ,~ SEE COF • 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) 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. • 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 10/20/2004 • 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(7) A copy of the approved plans specifications and this letter shall be on-site during, construction and open to inspection bYauthorized 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 POWTS. Sincerely, i' ~ -~ Lz~ ~;~~~`_ 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 WiSMART 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 SgFF o FcF/lrF~ rY~B~O~s~ 0/~ Date: 10/6/04 Owner: P.C. Collova Bldrs. Inc. Location:NW1/4SE1/4 S5 T29 N,R17W Lot 40 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 Fiortojy 6. Pump Curve ol~~~ 7-8. Maintance and C ntigency plan , ~°~ MERCK' Ncs 9-11. Soil test ..~ ~SPONDENCF Shaun Bird Signature License num r 226900 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 17WTO1W,._N Hammond COUNITY ST~CRhOIX SYSTEM ELEVATIO 101.2' .3' sand lift - y~,f/w~ ~ ~ . ~j - '/ ~I ~ 3 BEDROOM CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 454 BENCHMARK V.R.P. Top of Survey iron ^ BOREHOLE O WELL * H. R. P. Same as Benchmark DOSE TANK SIZE 630 # of chambers none ASSUME ELEVATION 100' Filter Zabel A-100 352' -B.M. * Alt. B.M. Grading is to be done to is top of 1 /2" divert run-off away from pipe @ 100.2' system B-3 ~ ^B-2 100' 99.9' Property Line 99' - 0 Slope Area 15' below system is to remain undisturbed ell is to meet all setbacks found in omm. 83 Line Huffcutt Combo Tank Tank is to be properly bedded and provided with lockdown covers with approved warning labels Pro 3 Bedroom House Scale = 1/4" = 10' Farmview Rd ~~-- ~' No Designer Date 4" Observation Pipe Perforated Below Filter Fabric ASTl~I C-33 San d " Topiot{ ----1 ._.-- ~r J? 7. Stope J t r Non-Woven Filter Fabric ~~islribvti0^. Pipe ' ~M i G e . __.-.-~~-- .., : ~, Bed Of ~f~ Z't Drain Rock Forst Moira From Rump Cress Section Of A 1M!au^d S^SAf~QUsing.. A Bed For The Absorpt~o ~~~~ n vim' , c~ c~C 5cl /!~ • ~ ~ rF ~~ P~ ~~~~~u f A ~ Ft. s I t. I .©Ft.~ ~~7 ~t. k~~?Ft: Pfowe d L 'E. F~~ G ~_ Fi ~3~~ ~ L - ~:'Observotion Pipe" ~K _ ~~ -~.r -~ ~ -- --------- - °' A j ------ i Force Moen ° ---------- --------------- From Pump .~ ~^ o Distribution Bed Of ~Z Z t2 ~ Pipe - Oroin RocK I 4 Obzervo~ion Pipe=-~CL~.~'-c.:~ Permanent Marker /~~~ ~ ~ Pipe or Rods Plan Yie~' Ot Mound Utl~ A Bed For The Absorp~io^ Areo PAG E.,_. OF..--.- C/~`[~ f.pGOteo on gotrpm. E4uo~1Y Spocse ~RST Mali NsxT •re CanneG}'R Ft. Ft. Signed: License Numbe~^ Oate• ~~ X °~ Inches~~-' ~'~~~ Tnche~ Hole Diameter ~.~ Inch lateral •" ' Inch4esa Man i fot d ~ Inches. Force Main ~_ inches ~ of notes/pipe ~ Invert elevation of Late~at~~Ft. PerforottG Pict OttCii ~EFTZ' - -~ CROSS 5£~T:ON AFB SF£CI~ICATZOKS __ V £NT PIPE ~2" 'M2Pt . ASDv E ~,RAD£ ~' C% ~pH DpflR. ~INDDiJ 4i~ ~ ~~~? FRES~r :~.~A ;~T~KE ~~ rEr~~~ ~~ ~,~ ~ f Slit ~ '~~ 18° Iii.- ~~..~------t1 j NAT 3;~..,....-r- wiAT£R T26IiT 5~~ ~ 3 LT E~ ~"~-.-- APP1R~1~ lsiPE 3` pMt~ 54t,iD. p~33+lP OF'F' EL£Y , I~ °.____FT - SOiI ~r C. #3 u£ATH£IZPRflQF AFFROV ED W I1'iiTC€3Nt3U I T MAtiHflLE C0~ ER W / PAS LilCl~ S wA~s~t~ ~+~E~ 3..~.-u" MIN . '- Z.~ :SuM{iii- s, _• 3 ', ~ , C,AS- ~ ftpYE~ TIGHT t ~ SEAL• ; ` JOIt11'S iiiTil ~ Aid'l ~PpRp1/Ep PIPE 1 f ~ ~ 3' pjRap $Q~~B ~~~ s + 3~ APPRCYED SEDDZi~6 Vi+~~ ~~ ~ ~ S~~1~`~pNC1tETE PAD . SPECZFICA':Z©1+i5 - ~ . DpSES PCR DAY - ,r._--~----- DpS£ HLii~iBER ;. SEC f pACT{,lRCK: ~•{yr;iME TNCLUflZRG Pj'1 J~C,AL- TAIfK MAI+R1 ,,~r~ CAL. ~E FUCK' .~.-----~ SEPTIC ~° " - GAL , ~ ~~ ~wZ.. TANK SIZES = aSE I£S: A~ ~ ~~/ gr1CFiE5 ~~~11.~-- D y /~ CRPACIT $~ ~ ~f'~ 8 = .~~ Z3iCHfS = ~ GAL. ~~ MA~RiFACZT3AR~; tiLC./` ~~~L- MDDEL ~YFE : C = ~~/';NCHES . +gyilq`CH ti11 = 4.sy-lGAL- ~ n r ~ INCITES ~FAC3VR~R % ~ ~ ~illC pUl4P ~ ~ d[l![8ER % ' Z~ Gt/l~~ PER I L.HR ` gy;q'CH TtPE= s~ G°I"~ PiltfP £ A£~RP'I yaIBZNG AS . /~ FEET gE,~IRF~ DISCHARGE RATE _~L~ IgU'C'ZC?N ?IPE ,~!--~ EE'F pgJ~4P Ol:'F ANB BZSTR - - J?' -%FE£'r vER'fICAL pZFFER~riC£ $£1'~EPRESSURE - - _ •FEET + M;NIMUH NETWORK SUPPi~ X ~FT/1Q0.FTflTALIflYI~C~H£~ ~.~ ;C~6 FEET f4RCF.~lA ~ ~j piAh~TER _.----- Y~ w~~~~ pIMEN$IONS DF F'tJMP TASK: LENGTH L ~,~QI3ID ~~~ 11~?ERNA . 5 FCf~ED= 0'AT£ ?188 w ~ ~ ~ 0 a w x v ~ 8- r 0 J Q ~ / l~'. 4- TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT AND DEWATERING MODEL 152 153 Feet Meters Gat. Liters Gal. Livers 5 1.5 69 261 77 291 10 3.1 61 231 70 265 15 4.6 53 201 61 231 20 - 6.1 44 167 52 197 25 7.6 34 129 42 159 30 9.1 23 87 33 125 35 10.7 -- -- 22 85 40 12.2 -- -- 11 42 Lock Valve: 38..0 Ft. (11.6m) 44.0 Ft. (1`;.4m) Y19~W 100 LITERS ~ 80 160 240. 320 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik-Box available forotatdoor installations. See FM1420, • Over 130°F. {54°C.) special quotation required. 1521153`Sertes 152/153 M DELS Control Selection Model Yolts-Ph Mode' Am s Sim lex Du lex N152 115 1 Non 8.5 1 2 or 3 BN152 115 1 Auto 8.5 Included 2 or 3 E152 230 1 Non 4:3 1 2 or 3 BE152 230 1 Auto 4.3 Included 2 or 3 N153 115 1 Non 10.5 1 2 or 3 BN153 115 1 Aulo 10.5 Included 2 or 3 E753 230 1 Non 5.3 1 2 or 3 BE153 230 1 Auto 5.3 Included 2 or 3 O CAUTION All installation of wntrols, protection devices and wiring should be done by a qualified licensed elecWcian. Ail electrical and safety codes should be followed Including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act{OSHA). ° 3 27 i i i iz ~/e 5 t/ I -L SELECTION GUIDE t2 ~z 8 sx2oen 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. 2. See FM0712 for correct model of Electrical Alternator E-Pak. 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. afAlL To: P:o, sox 1x341 Z Louisville, KY 40256-0341 Manufactwersof. . ~ SHIP T0: 3649 Cane Run Road ~' Louisville, KY 40211-1961 ~~?? p" ® QLGOUTYPUMPS,,/iNCE ~~~p hitp://www.zoeller.com ~ ' PL/MP !O. f~X11 FAX ~2) 03624-PUMP © Copyright 2000 Zoeller Co. All rights reserved 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. Gliti^- percentslope, scale or dimensions, north arrow, and location and distance to nearest road. Re , wed b Date Please print all information. ~ ~ ~ ~ , Pataomal information you provide may be used for secondary Purposes {Privacy Law, s. 15.04 (1) (m)). ~ Property Location /~ 9 Property Owner '' } , r ,..w, ovt. Lot ~ 1/4 ~ ~ 1!4 S ~T p(/ N R E (or W ~', ~~/l t~ ~ ~ a CSM# Property Mailing Address ~ of # Block # Subd. ~A' ~f ,, i. " '-' ` Nearest Ro ~, State + Zip C e Phone Num { ^ Ciry ^ Village Town ~ ~~~ ~ ~. ~ S ~_ ) Code derived design flow rate ~ GPD New Cor-strudiort Us . Residential /Number ot`b~roorns'- ^ Replacement ^ Public or commerdal -Describe: ------ - ~ _ nil. a =~ Flood Plain elevation if applicable ~' ~ ft- Parent material ..c~resn -'r ~r'~ 5 j General oornntertts _ f, and recommendations: /~' y,~ y~~ ,~ (,~ /t.~i~~ ~ V j . [.- /OGL~jf~y~ ~ /2~.~~ C ~ '~ .~ ~i 3~ s~ ~,~ ~,.~ ~2~, 'r--~' Boring ~1 i + i Ong # Gsv~ ~ it. Depth to limiting factor In. L~.J Pit Ground surface elev. ,~.__ Soil ication Rate GPD/fg I-~rizon Depth in. Dominant Cdor Munsell Redox Description Qu. Sz. Cont. Color Z' '~ 3 s-~~ ~ ~, ~ ~ z s Texture Structure Consistence Boundary Roots Gr. Sz. Sh. •Eff#1 •Eff#2 l ~/ ~ ~ / ~7 ®Boring # ~B°nng / ~ / ft. Pit Ground surFace elev. ~~ ~ i~ Depth to limiting factor r^• Soil lication Ra Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF •Eff#1 `Etf#2 in. Munsell t1u. Sz. ConL Cdor Gr. Sz. Sh. ~ d'~ z 3 -~ 5 t C. ~ lz_2 s _ ~ I `~' • , • Effluent #1 = BOD > 30 <_ 220 mglL and TSS >30 < 150 CST Narttt: (Please Prirttl Sic Bird Plumbing, Inc. Shaun Bird Address 1008 192nd Ave, New Richmond, WI 54017 Eftluen #2 = BOD <_ 30 mg/L and TSS _< 30 mglL CST Number ~/' 226900 Date Evaluation Conducted Telephone Number !' ~,rJ c/ 715-246-4516 property Owner f' ~-1 n Rnrinn Parcel ID # n -, 1b~ ~~ Page ~ of ~I I .~+ I ~ ) 1 Bonng s .J ft. De th to limiting factor Q'~ / in. pit Ground surface elev. ~ P Soil lication Rate cture St Consistence Boundary Roots GPD/fP "Horizon 2 ~ Depth in. 3yZ Dominant Color Munsell r ~ Redox Description Qu. Sz. Cont. Color ~ ,~~ Texture sit: ru Gr. Sz. Sh. ~ ~ - W `.~ ` ~ +E~ . ~ Eff#2 •.3 •~ Bonng # a ~~ ^ Pit Ground surface elev. ft. Depth to limiting factor in• Sai ication Rate ti i Texture Structure Consistence Boundary Roots GP DIfP Horizon Depth in. Dominant Color Munsell on p Redox Descr Qu. Sz. Coat Color Gr. Sz. Sh. 'Eff#1 `Eff#2 ~~ # ^ Bones ^ Pit Horizon Depth Dominant i in. Munsell Ground surface elev. ft. Depth to limiting factor ~• Redox Description. Texture S1nicWre Qu. Sz. Copt Color Gr. Sz. Sh. Roots 'Eff#1 I 'Eff#2 ' Effluent #1 = BOD, > 30 < 220 m91t-and TSS >30 < 150 mgll 'Effluent #2 = BOD, <_ 30 n'rgil. and TSS _< 30 mgll The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. seo-es~o Pe.~ooi ,_ Soil Test Plot Plan Project Name P.C. Collova Bldrs. Inc. Shaun $ d Address P.O. Box 489 ,~`/ Somerset Wi 54025 CST #226900 Lot 40 Subdivision Farm View Ridge Date 5 /04 N W 1/4 SE 1/4S 5 T 29 N/R1 ~ W Township Hammond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 101.2' *HRPSame as Benchmark Alternate Benchmark Top of 1/2" Pipe @ 100.2' ~ J ~ ~- VYNER'S MANUAL ~ MANAGEMEF CA ~ S POyYTS ~ cvsTEM SPEGI Number of Bedt+~s Number of Commeraal Units Estitnatied tiow (avef'a9e) OBSiQn tkyw (P~~ (t~tmsted x 1 SoD Apps""" Rate (7 InfluentlEffluertt t2uar~ Fats..Otl & Grease (FOG) Biochemical Oxygen Demand (BODs) Total Suspended Solids (T'SS) Pry Effluent Quality Biochemical Oxygen Demand (BODs) Total Suspended Solids {TSS) Fecal Coltfotm (geometric mean) Max{mum Effluent Partide Size Service Event inspect condition of tank(s) Pump out contents of tank(s) Inspect dispersal Cell(s) Cteart effluent filter Inspect p~mP• Pun'p controls & alarm Flush tayerals and pressure test ~~ Septic Tank CaPac+tY Sepbic Tank tulanufacturer Effluent Filter Mat~durer • Etfiuent Filter Model . 0 ~ pump Tank CaPadtY aVda ~~ Pump Tank Manufacturer _ `~ aVd .Pump Manuf~duref /. Z~ aUda ' Pump Ntodel PCebr+satment Unit e Monthly average ~ Sand/GrBvel ~~~ S30 mg/L p Mechanical Aeration Q20 mg/L ^ Disinfection Page ~ot C'l~ al ^ NA (' tVA ~~ i-- ^ NA ,-l ~~ O NA 6 Q ~ J at n D ILIA tol~~.it/ ^NA ^ Peat Fltter ^ Wetland ^ Other. Monte Veros 9e" Dispersal Cet-(sl ^ tn.ground (pressurized) ^ in.ground (gravity) ~ d S30 mg1L ~, , oun ^ gtgrade ^ Other- 530 mgll.. 510 cfu/1 Qpml p Ori ine toy for domestic (nocroon+~rdaQ wastewater and • values typ ys inchdiameter ~jcunkefAuent tzeatad nwrsteMnter. s tYP~ ~ ~ l ue .•• Va Service Frequency ar(s) (Maxirstum 3 yrs.) ^ months At feast once every a uals one-third (~) of tank volume m 4 When combined slu dge and scu ar(s) (Maximum 3 yrs.) ^ months At least once every e ^ monthsar{s) ~ ry At feast once ev r Kg) ^ NA p months y At feast once eve ~ ^ months r(s) O NA At toast once every a s p NA ^ months 17 Yen ) At least once every ^ months ^ Year(s) ^ ~ At least once every ---- licenses or tw-INTENa+I~ INSTRUCTIONS os Shah be made by an individual catrrying one of the foi-owing Restricted Sewer, POW'rs Inspector: POWTS Maintainer, Septage Insper~lons of tsrtics and dispersal ce an of the tank{s) to idenMY any missing or b bade up dons: Master Plumber; Master Plumber m and to check for any tor. Tank inspections must indude a visual inspec*i a and scu i levels SeMdn9 Opera or leaks, measure-the volume of combined siudg y ~ Chi tl~e effluen hardware, identity any cn3Cks The dispersal cell{s) shall be visual! inspe~ nding of effluent on the or ponding Of effluent on the ground surface- nding of effluent on the ground surface. The Po uia authority in the observation pipes and to check for any Po ulnas the Immediate notifigtion of the local rag tort' ground surface may indicate a failing condition and req uals one-fi'-i~ (~) or more of the tank volum ~ NR moved by a Septage Servicing Operator and disposed of In ~rdance w~ When the combined ~mhalibbe restudge and scorn in any tank eQ entire contents of the tanks ~ ~ t ment components, and any 113, YYfsco<tsin Administrative Code. - onents, pretrea ~ Maintainer. tfiormed by a certified POWTS The senric;ing of effluent filters. mechan~is of 25mo U'IS o0ess sha l be Pe lion of any service event other malntenancx or monitoring at into ulatory authority within 'iQ days of p0mple A serviQe report shalt be provided to the local rag roduds or other resence of painting P e START UP AND OPERATION if hi h ~centrapons are For new c~onsVudion, Poor to use of the POVYTS and trdamage thekd s)persal cell(s). 9 chemicals that may impede the treatment e by a septage servicing operator prior to use. detected have the contents or the tanks} Page v °! .• , ,_ + conditions are frozen at the infiittab~en is ~~ ~ eICCeSS shalt not occur vvtten soli System startup ~( above normal titghwater levels. m result in the . outages pump tanks rnaY oett(s} in one large dose. ovedo n~tnaf the p~P tank roR1O~ by a . Outing poor to the disPe~ wasts~~'^~u be dlschanBed L To avoid this situation have me ~n~ntaci a Piucnb~ or POY~TS Malntatner Lo backup or sscir~ d~harge of eta ~ ~~~ to the effluent pu P um ~•. age Servidng OP~~ p~ m ~~ls fo restore narmai levels within the p P assist in manually operating the P P .- ~. Oo not drive or park over, or otherwise disttltb or otxnpatx, over tanks and dispersal ~ tion area ' ric yehides rade soli absorp Oo not drive or pa of any mound or at-g rformance and prolong the Gfe the area within ~ 5 feet down slope ~ stream may impr~e the Pe Reduction or~eClminatlon of the following f?'0m the vrastewa d ~~; denfa! $oss; diaper dgarette butts: condoms: Dolton swabs; e9 asotine: l~. ~~~; meat of the POWfS: arltlblOtics; -baby ~!t+IP~ um water fruR and vegetable peelings; g dsinfectanEs: tat: fbucida6on ~~ ioducr~p p~cides; sanitary nap[ans; tampons and water softener brine. rnedicatlo~: oil; pain g P -' AgANOONMMENT taken out of service the following steps shad tie taken to Insune that the When the POWi'S falls and/or is ~~ ~ ~Pi~~ ~ ~. ~mm 83.33• ~s~sin Administrative Code: system Is property and safiey and the abandoned Pipe openings sealed. be drsoonneCtsd and property disposed of by a Septage Sernang Operator. • A[l piping to tanks and pits shall ~ _ snd the void space .. Tr,e contents of al! tanks and pits shall be removed • After Pumping' all tanks and Ptts Shan be e~avated ,and removed or their covers removed filled y~ soil, grave! or another inert solid material. ' e a Cade ken to rovrd P r must be to CONTINGENCY PLAN a following measures have been, o tf the pOWTS fails and cannot be ropair+ed th cemPGant mplaCement system: stable ~plaeAemenCarea ham been evaluated and may be utilized for the location of a rept~ andt should not p A su Cement area should be protected from disWrbance and comps absorption system. The rep from ex)sting and proposed structure. tot lines and wells. Failure to be infringed upon by required setbacks rated the replacement area wiq result in the need for a new soil and site °evaluation to establish a suitab e P terns must comply with the rotes in effect at mat time. re (acement area. Replacement sys ~ and/or soi! (imitations. Barring advances in P01MTS P O A suitable replacement area is not ava~ i~ as a last re o~ t to replace the faded POWTS' a and holdin tank may be instal n failure of the POWTS a so of a S t area. Upo °~ lacemen to identify a su'rtabie rep e site has not been evaluated i suitable 1 ment area if no replacement area is available a_ site evaluation must be Pe . filed as a last resort to replace the failed POWTS_ _ removal of the bioma t Mound and atgrade son absorP#ion systems may be reconsin~cted in Rim ~eirulesgn etfertatthattime. s of such systems must comply m infiltrative surface, ReoDnstru~n <NYARNI TANKS MAY GASSES ANDIOR INSUFFiC[FSIT OXYGEN. SEPTIC, PUMP ~ TREATMENT ER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY DO NOT ENTER A SEPTIC, PUMP RESULT_ ,RESCUE OF A PERSON FROM Tt'tE INTERIOR OP A TANK MAY SE DIFFICULT OR iMPOSSIB ADDiTtONAL COMMENTS POWTS MAII~TT/UNER POWTS INSTALi.ER . ~, Name ~ u y/ //// Name ~ G2.Gl y/ / - Phone ~ -~Z ~'~7-fir Phone ~/J % z/6, J LOCAL REGU1-ATORY AUTHORf7Y PER UM SEPTAGE SERVICING OPERATOR P ~~ v~~ ~~ . Agency ~ - / Name Zi ~ Phone 7~;r---.3 ~' Phone ~J.~ ~` Z ~ Th>s doorment meea this cocvmeM Mras di~tTsd by fhs stalls d the Green farce. Marquette snd Waushara County Zoning and Sanitation'9er>des. the minimum requintrtlaAts of c!t Comm 83.22f2)(bXU(d)~(ti and 83.54(1}. (2) ~ Cj). Waconsln AOminlsYaHve Code. Use of this doa,ment does n~ I1IOi) guarantee the perfortnanoe of the POWT'S. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSH]P CERTIFICATION FORM OwnerBuyer P• C. Collova Builders, Inc. flailing Address PO Box 489, Somerset, WI 54025 Property Address City/State (Verification required from Hammond, WI LEGAL DESCRIPTION Department for new construction.) Parcel Identification Number .D/ Property Location ~ '/~ , SE `/4 ,Sec. - 5 Subdivision Farm View Ridge - T 29 N R 17 W, Town of Hammond ~ ,Lot # ";F Q Certified Survey Map # ,Volume ,Page # Warranty Deed # ~ S~ - (5 I ,Volume ~3~0, Page # 3 Spec house eyes _ no Lot lines identifiabl~~ves'~ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Counry Zoning Department a cenification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than t/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix Counry Zoning D rtment within 30 days of the three year expiration date. P. C. COLLOVA BUILDERS, INC. ~C (715) 247-2742 ~/ ~ J /~ SIGNATURE OF APPLICANT P.O. Box 489 DATE SOMERSET, WISCONSIN 54025 OWNER CERTIFICATION Uwe certify that all statements on this form are true to the best of my/our knowledge. 1/we am/are the owner(s) of the p erty described above, by virtue of a warranty deed recorded in Register oFDeeds Office. C. COLLOVA BUILDERS, INC. ~l~l-~ SIGNATURE OF APPLICANT (715) 247-2742 DATE P.O. Box 48g SOMERSET, WISCONSIN 54025 ****** ****** Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department. Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. U 2S36P 3~i? 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 Corporation Grantee. Grantor, for a valuable consideration, conveys and warrants 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" 7 57'959 KATHI.EEH H. IiAI.SH REGISTER OF DEEDS ST. CROIJi CA. , liI RECEIVED FOR RECORD 03/29/2004 12:50PM IiARRAHTY DEED EXEMPT # REC FEE: 13.00 TRAKS FEE: 2012.40 COPY FEE: GC FEE: PAGES: 2 Recording Area Name and Return Address ~ iw~~ iiy iii ~v~ 01&1008-64-000; Ol&1008-80-000 018-1008-90-000: 018-1010-00-000: 018-1010-10-000 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated this ~i~~ day of March , 2004 * * Michael B. Marhsall * - * Dawn Marshall AUTHENTICATION Signature(s) Michael B. Marshall and Dawn Marshall, husband and wife tlti authenticated this ~ day of March ___ * Kristine Oland _4_ TITLE: MEMBER STATE BAR OF WISCONSIN (If not, STATE OF ACKNOWLEDGMENT _..._.. ) ss. County ) 2004 ~ -- -- -- Personally came before me this_ ____._ __ day of the above named authorized by § 706.06, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristine Ogland Hudson, WI 54016 _________ _ _ (Sigmtures may be authenticated or acknowledged. Both are not necessary.) 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: •) * Names of persons signing in any capacity must be typed or printed below their signature. tnformatton Professionals Co.. Fond du Lac, wt STATE BAR OF WLSCONSIN 800.655-2021 WARRANTY DEED FORM No. 2 -1999 U 2536P 3y8 EXHIBIT "A" Part of the NE'/. of the SE'!• and Part of the NW'/ of the SE'/ and Part of the SW'/. of the NE '/4 and Part of the SE'/< of the NE'/4 of Section 5, All in Tovmship 29 North, Range 17 West, Town of Hammond, St. Croix County, Wisconsin described as follows: Commencing at the Southeast comer of said Section 5; thence N00°05'29"W 1315.84 feet along the East line of the SE % of said Section 5 to the point of beginning; thence N89°25'01 "VN 2638.28 feet along the South tine of the N'/ of the SE'/. of said Section 5; thence N00°21'34"E 2581.45 feet along the North-South'/. section line; thence N89°51'32°E 1316.00 feet along the North line of the SW'/4 of the NE'/.; thence S14°12'09"W 566.08 feet; thence S56°30'45"E 166.57 feet; thence S05°58'41"W 617.95 feet; thence S89°26'33"W 230.23 feet; thence S00°08'03"W 557.04 feet; thence N89°26'33"E 1601.66 feet; thence S00°05'29"E 758.82 feet along the East line of the SE'/. to point of beginning. NAME OF PLAT ~~Lrr~ V ~-C.cJ ~ r d t~ 2~ FILED ~ VOLUME AGE ~ ~- DATE I- a- 4~ Tn~ t o : o ~ ~6I-rY'"7 owNERS p c ~~ ~~ LEGAL: LOTS - BLOCKr„_.,.,,, OUTLOT(S~ PART OF: SuV1~E, sEN ~ , ,~WS~, NESS s/a9~i7 1~'IUNICIPALITY ~ °'~ '~ CHECK# 13 `l ~l 8 AMOUNT ~ `~ va ~ ~.ea~ ~a ~ ~~_ ~` 7 FROM P C COl:L~JIJA BLDRS, INC PHONE N0. : 715 247 2747 Jun. 29 2004 12:1~M P1 STATE flAR OF WfSCONSi!r Ft]R:~t 2 • 149`3 w~xx~,ra~rY Dc~n pa:uitzcat Number T4~is peed, made between ~Zichael B 'Vlat'chatl ''" Grantor, ~arsltal~Lhusband and wig - and P, C. Cop Inc. a iLtirin¢soea C rfttitt Grantee. °' Grantor, for a vaitlabte consideration. conveys attd warrens to Grantee ,~ I 'x Coon ~ State of Wisconsin ~ ~ ~A ~ the failowing described real cstat~ in St- Crot ry , a ~ (if more space is needtd, please attacd addetldltm): See Attac3led Exhibit "A" ~' ~ " err ~~ ~8c;arding Area tinax and Aerirn Address I ~"' ois-laue-sa-ooa; ot~-.otos-awsoo ~~is- nos-qo-Dort: ois.tota.o ~-toZato-goo Pate el 4lcntiScat%on :~ua>her ;PINT ?iris is itutrtestead property (is) (iS I:Ot) B;tcepdcns f0 'NSYrflIliliS: Easements, restr_rtions enc. rights-of-way of record, ii ant. ems" x,~i3 L+~d this .~~ dzy of ~tareh ------ x AL"I'}~*iTICATION 5igtitture(s) :-iSctad ~. Marshall and Das~m ~farsbalt, ht>9band ~d wile -- . ,~, yt, authendcated this lil! day of ~iiarch , 31Ma • Tiris'iast Ogismd t _ T'ITIFi: MEMBER STA'TIr BAR OF~WISCONSIN ~ nom, _....-- authorizEd by 3 106.06. Wis. Srats.) ~, ~ q btlcltael $. Mar-~h-~seli ~M,~/ nn „~ "` Dawt- ?rlarshali _`~ .• -- A CIC.~iG W LE7YGLIEtv'T S'f'ATE OF _ ) 1 ss. _ Cuunty > Peisot~liy came txPore me :his day or the above Ita~-:tcd w ma known to be the person(s) who executed the foregoing instrumztu and acxrtowl,;dgod the same. TbIIS L~ISTRt7MENT W?il DR?.FTBD BY Attorney Kristine Ogiand Hndsoa, 1Yi 540A6 (Sigwtures mny k sttthetYicattd ar sclrnewled¢e4. 13exh a-e not necwsarv.) Notary Public, Start of ----_. - ,_ __.__._-- l•Iy Cuttintissiou is peg manetx. (If not, start .xpiration data: .) ° :'iEIDCa of persons Si;aitlY if1 asry C~6C3LY must h4 rypod or printed bntuw Wii: signa[ure. Cn:armattos Proressionuc Ca., fond du Lai. 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