Loading...
HomeMy WebLinkAbout018-2003-03-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM .Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TC'PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township P.C. Collova Builders, Inc. Hammond Townshi :ST BM Elev: Insp. BM Elev: BM Description: ~.p r ~.~r a ~ S ti'e,ti SANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic ~D ~~ Dosing t_t 1~ "I ~r Aeration Holding / '~---~ TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic , 5D { ~ r 1 Z ----- Dosing u ~, c~ -z 3 ~ ~ Aeration Holding PUMP/SIPHON INFORMATION ~' - _>J ~ti3 ,o. Manufacturer '` Y ~ ~t `~ ~ De and p~t_L 2 ~- M Model Number z~, 3 ISZ H Lift r 115`3 Friction Los I ~~ ~ System Head TDH Ft I~- zz- Forcemain Length, ~ r Dia. tr Dist. to Well SOIL ABSORPTION SYSTEM County: St. CroiX Sanitary Permit No: 453142 0 State Plan ID No: Parcel Tax No: 018-2003-03-000 Section/Town/Range/Map No: 18.29.17.897 STATION ~6enchmark BS 3.i~ HI I fo3.IS FS ELEV. , «~,o Alt. BM Bldg. Sewer ~ 2, DO ~ ~ r, ~s ~ SUHt Inlet /2•so r qo.6 St/Ht Outlet Dt Inlet Dt Bottom /L. ~ u 1 8r - ~S Header/Man. ~ ~ ' O ~ i Dist. Pipe ,/a I .oS Bot. System O S~ I (~' os Final rade ~ w ~ ~ a.~' 12t+ ~ '- St Cover~~ ~ (o,~p _ `1~•S ~-/ S, ~~ 5t ~o ~~ oS RENC Width Length No. Of Tseae4ies PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIME NS D r ~ O f ~~ A ~---- A - SETBACK SYSTEM TO P/L BLDG W ELL L;aKE/STREAM LEACHING M acturer: INFORMATION CHA ER OR Typ O System: _ (/7tY,bLOJ~)u~/ I j ~ 1 9~ '~ ! LIN del Number: DISTRIBUTION SYSTEM Header/ nif rr Distribution ~ x Hole Size x Hole Spacing Vent to Air Intake ~ ~ D ~r Pipe(s) Q~~ 2' ~ ~~ Y Length Length !~ Dia Spacing ~ SOIL COVER x Pressure Systems Only xx Mound Or At-GradeS~istems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsnii Yes No Yes ' No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:_ f~ /µ~ Inspection #2: ---~f-~--7-"~ Location: 1592 97th Ave Unknown (NE 1/4 N_E _1 /4 18 T29N R171W) Crick Bottom Overlook Lot 3 Parcel No: 18.29.17.897 1.) Alt BM Description = ST' w``~°"~ `OtC~ ~J _ ~~ py~ D-[. (,~9~~ 2.) Bldg sewer length = 3 p' ~ J ,r• / ~ I -amount of cover = i ~ n~ c~_tttd~ r')6?C ~ ~ ~ 1n44.E aC ~~ 3~ w~.Q . hey" t~^S '~ ' ____ .Plan revision Required? Yes No ~~_ ~ _`_~ ~ ~ / ~_ Use other side for additional inform lon. __.__ ~~ Z~ ~ ~~ _; _ / D 1 d ate _ _ Q t~ Insepctor's Signature Cert. No. SBD-6710 (R.3/97) ~J l..IL~C- Safety and Buildings Division Co"nq j 201 W. Washington Avc., P.O. Box 7162 L~ / c ~.~ /~\ ` ~S~O~~~~ Madison, WI 53707 - ~~~ ~ Sanitary Permit Number (to be tilled in by Co.) ~.! 531 2 Department of Commerce ~ State Plan l.D. Number Sanitary Permit Appli tion 2~~~ qg~ ~~ ~ = 7~,us. ~o.~ hr accord with Comm 83.21, Wis. Adm. Code, personal inf ' motion Kc~ ~ov"~~ r ct Address (if different than mailing address) may be used for secondary purposes Privacy Law, 5.04(1 ) ~~ ~ ~ ~`/J~.,, 1. Application 1 nformation -Please Print All Information `sT ON1NG pFFICE ~ ~ T/Jd~ls/l„n~ Parcel # Lot # 81ock # Property Ovmer's ~ ~ / ---^ S n. _-~ ~ ~- Property Lo anon Property Owner's Mailing Address ~ ~., ~ f~ + ~ ~ G ,, /., Section ~ t;.~ ~ Zip Code Phone N umber ~ City, State ` c;rc one II. ype of Building (check all that apply) r-1 ~ ~ ~ Su ivision ~ e` CSM Number or 2 Family Dwelling -Number of Bedrooms ~ ) ~,~ ~~ti ~ ~- ~-!/ ^ Public/Commercial -Describe Use p I O X / ~ _ ^City_^Village ~j~tship of J~'m't!1 ^ State Owned -Describe Use -C lIl. Type of Permit: (Check only one box on line A. Complete line B if applicable) p) g - ~iD~ 3 " ~3 ~ D'a'O A. 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 Owner IV. T e of POWTS S stem: Check all that a I ^ ^ Non -Pressurized In-Ground ^ Mound ? 24 in. of suitable soil ^ Mound < 24 in. of suitable soi -Grade Single Pass Sand Filter Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersal/Treatment Area Information: q Dis ersal Area Proposed (sf) Sysi~m F~Jevatio De i n Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Re wired (st) ~ `L jUSY ~ ~ ~ Ca aci in Total Number ' Manufacture Prefab Site Steel Fiber Plastic VI. Tank Info Gallons Gallons of Units wr ~.tpo Concrete Constructed Glass New Existing ~'~ Tanks Tails Septic or Holdin_ "tank Aerobic Treatment Unit Dosing Chamber ~ _ VII. Responsibility State t- I, the undersig some responsibility for installation of the POV!'TS shown on the attached plans. Pl~ber's Name (Print) Plumber' ~ afore MP/MPRS Number Business Phone Number ~>,~ ~~ Plumber's Address (Street, City,_S te, Zi e) ~ J ~,^~ ° ~' II. Counh'/De artment Use Onl Sanitary Permit Fee (includes Groundwater Dlat/e Issued ssui Agent Signat (No Stamps) Approved ^ Disapproved Surcharge Fee) 3s~ ~__._ OT~~/O ~ ^ Owner Given Reason for Denial J V IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all he serviced /maintained as per management plan provided by plumber. 2, All setbac ~ cable codelordinanbes aintained as per app Attach complete plain (to the County Daly) for the system on paper not less than 81/2 x 11 inches in sire SBD-6398 (R. 01103) PLOT PLAN PROJECT P.C. Collova Bldrs Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 N1N 1!4 NE 1/4S 18 !T 29 N/R 17 W~TOWIV Hammond COUNTY ST.CROIX 4/12/04 BEDROOM 3 MPRS Shaun Bird 226900 DATE CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # 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 SYSTEM ELEVATION 98.1' GE SYS~E~ B.M. * ~~TE SE~~ AIt.B.M. is top of survey iron @ 1 d~$~~~~~~~1 Property Line ~" " 98.1' ``~ pt~q BU~1.13i1~~3~ B _ B - 3 Grading is to done 6@ S~.FE~ ~ to divert run-off 0~4lS~aN --~.-~-- away from ORRES~pN©ENc~E system SEE G Tank is to be properly bedded and 99' provided with lockdown covers with 7% 98' approved warning labels Slope B - 2 97' Area 1 S' below system is to remain Huffcutt Combo Tank undisturbed 374' Pro 3 Bedroom Well is to meet all Property setbacks found in Line House Comm. 83 Scale = 1 /4" = 10' 97th Ave i 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.state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary April 19, 2004 CUST ID No.226900 SHAUN R BIRD BIRD PLUMBING, INC 1008 192 ND AVE NEW RICHMOND WI ATTN: Rod Eslinger ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/19/2006 SITE: Pc Collova Builders 1529 97TH Ave Town of Hammond St Croix County NW1/4, NE1/4, S18, T29N, R17W Lot: 3, Subdivision: Crick Bottom Overlook Identification Numbers A°p!` Transaction ID No. 987164 4,~ Site ID No. 682124. Please refer to both identifica on ~d~ above, in all corres ondenc t ~3 ®,~~ Ofi tP~~ `ri7,c a ~ l ~~ ~ FOR: '1,~~ Description: New 3BR At-Graff ~~A i Object Type: POWTS Component Manual Regulated Object ID No.: 953711 Q Maintenance required; 36 in Soil minimum depth to limiting factor from original grade; System(s): At-grade Com~ Manual, SBD-10570-P (R.6/99), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the approved plans and with the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems Version 2.0" SBD-10706-P (N.01 /01). • This system is to be constructed and located in accordance with the approved plans, and with publication SBD- 10570-P (R. 6/99) "At-grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater Systems". A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction,~lnstallation/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. ~s ~ SHAUN R BIRD Page 2 04/19/2004 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. incerely, 9~~~ Dennis R Sorenson Wastewater Specialist ,Integrated Services (608)785-9336 , doorenson@commerce. state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 ECEfV E~ ~ <,ft A~'E°~ & gL®GS DIV. Cover Page Shaun Bird Bird Plumbing Inc. 1 •~i 192nd Ave New Richmond Wi 54017 715-246-4516 ~~ t r ,,~ Date: 04/12/04 Owner: P.C. Collova Bldrs. Inc....t2a,,\ Location:NW 1/4NE1/4 S18 N,R17W Lot 3 Crick Bottom Overlook Hammond System type: At-Grade Manuals Used: At-Grade Component Manual version 1.0 SBD 10570-P (R.6/99) SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01 /81) Page# 1. Cover Page 2. At-Grade Plot Plan 3. At-Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maint~ 9-11. Soil Shaun Birc Signature License ni PLOT PLAN PROJECT P.C. Collova Bldrs Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 NW 1J4 NE 1J4S 18 /T 29 NJR 17 W TOWN Hammond COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE4/12/04 BEDROOM 3 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons HOLDING TANK SIZE LOAD RATE .5 ,BENCHMARK V.R.P. Top of survey iron ^ BOREHOLE O WELL *H.R.P. Same as benchmark SYSTEM ELEVATION 9$• 1 B.M. 98.1' B- B-3 AIt.B.M. is top of survey iron @ 1 ~, ~i~ ~~ . Property Line ,~ ~-~ ~-{ , ~ Gradin is to done ~~ ~~~~ ~R~ to divert run-off 1~11,S0Q~ ~~ ~ away from , ~~g~Zt;~ SSE G~~RtS~- ON system Tank is to be properly bedded and 99' provided with lockdown covers with 7% 98' approved warning labels Slope B - 2 97 Area 15' below system is to remain Huffcutt Combo Tank undisturbed 374' Pro 3 Property Bedroom Well is to meet all Line House setbacks found in Comm. 83 Scale = 1 /4" = 10' LIFT TANK SIZE DOSE TANK SIZE 630 ABSORPTION AREA 900 # of chambers none ASSUME ELEVATION 100' Filter Zabel A-100 97th Ave L ? 5' ~ 8 PvG Fo~MAI t.1 ,r.~ >r~s = 2i - ~~=TUR11- LdPS•• -- --- ~-- DtSTRt`°~.:~1Ttar,1 LA4E.RAL A ~STA$itr~ED oB~~-:YATtOrt WEI.L~ ~ - G > 5' !/6 B ~ - I/6B A=~ ~'t. B = ` ~ ~t. L - ~~ F{. vJ - ~ ~ ~t . 1 ~_____~,2g ~ -.~ ? 5r ,~ ~ ~~ CELL. of fZ ' 2~2 At~GR~~~TE ItQQRdVED SYtsTttE~c. Fabric ST~ati~.~~~~o Observation-----~ We! t rR` ~ t ~~~ Dis#ribuicion La#eral Soil Cover • • I t ~\~~ 7/'/i (2 ~2„ ~~.~ A .~ ~,bvtlED LwYE2 r~ > > 2 } _ ... 5 fo SLOPti Flan View and Cross Section a£ Wisconsin At-grade Unit with a Sfngle Absorption Area an a Slopi:~g Site ~..t~EnISE~= - Stvt.~aTU RE. Page Of PYC Force Main ~- PYC Distribution Pipe P ~QCCe s~' ,~, 3a~ Hole diameter _ Inch p Ft. Lateral piameter Inches} X inches -~T" y ~ ~ inches Force Main Diameter ~'''`Inc~es ____----. ~ Qf Holes/Pipe v Invert Elevation Of Laterals ~ Ft• Signed- License Number: 4ate : _ - .__----- Distribution P'lp£ pet3il ~Or lateral network ~ AND SP£CtiICATIpNS CR~?SS S£~-r`G. E Pt3riP C~;A~IB£FZ gEFTIC TANK ~EA~FRF~~ ApFRaV ~D ABDVE GgAD£ ~ ~~NC'~~0i~ 8flX ~{{pL£ CQVER „ KY~ , w~TK CO~DEJIT w/ PAAL~x ~ ~~+ 0 f ~~NT PIPE L4~INI}a~ 4R idARtilt~6 ~-BE:. ~'R4li D44Ft. ..~~ E ~ © ~0 ,. :, - + s ~.Sn ~~~ ` 2 .- LET .. GAGHT ; ,'~ ED I]~ S~LS ~"~'" T .10IMtS 1iitH AppROY taATEg '~I6HT ~~'i' ALn ED ptFE ....-..a.- ~-- s ,pN 3~,~C~SpII ~iLY~~ $ - -~_" ` - C ~ i t FF pPPi~~ ~ --~-- ~ Y a T- piPE 3` ~~ D~ SQ~• p ¢ff gL f~_____ ~ $OTL ~~ K ROY ED SEDDZI,tG V~'~ '~~~ ~ S +- j~ ~.BNCAETE PAD ~ APP - SprCIPZCATI4N5 . ?fig DAY = NUi~iHI:R pOS~S PTT / DQSE £R: DOSE 31O~ME F~a~gpCK~. ~ ~ ~ G~/'-~iA SE pAC~,JR TANK P4AP1t1 SEPTIC ~J~ ~L: - ~T' -5~22~1CHE5 = ---~''~""_ TA1i1C SIZES = g ~~s~ CZTZ~S' A _ _~---- 6AL. Dos ~~ dn0 CAPA 8 _ ~~ ~ttCttES = 3v -- ~~FACfi3i~~;. _ ~~ j ZNCNES = < GAL S~I,i.Cg TYPE = D _ ~ YOKES - _.~----- w~- RF-~ _ ~ PER z ~R 1s.23 FACTV ~~~~/j _ AS K~ L ~~~ ~ ~ "~ pcsnP £ ~ ABM WiR~~ ~ FEET S~;TC 7t,/ ~ GP~'R ?SPE • • i~ FEE? ~N pUnP flFP f.Ng f3ZS'TRIBU'EZ~ 7~ FEET REQti3IRED DISC~3ARG~ gAT£ - pRE~~SURE f RZC'~SaN FACTQR J • ~ ~ FEET vflt'!"iC1'L g;FF~tEi~ICE ~E~E£ DYNE;C ~'~ i InU~'i liE1'~IOR3C SLTPP ~~ ~ /' 3 fT! XQ ~ - PT • DYpMET~ =- MIS FQg0~. TOTAL ~ FEAT , J~ ; ~~~ H"""---- ~ ; LENGTH 7~,1~ . Ip'~~AL D I1~E~5IOI~~ Q~ L~CEI3S~ ~~BrR ,_„ . 5 IGNEfl = _----'-' 4 Ate- ~ - :~~~ TOTAL CYNAt.SIC HEAC/CA PACITY ' PER MIS\UTE CURVE EFFLUENT ~.n0 OEWATE RING HEAQ CAPACITY MODEL 152/153 ~ ~ ~ ' o- MOCE:. ,53 ~ ~ W j i ~ %ezt i MeterS Goi. ,Liters j Gol. ~ Liters ~ ~ 50 ~' S ~ 1.5 69 ~ 261 77 291 153 ~ ,0 i 3.1 I; E1 ~ 23? 70 j 265 ao I 1E { ~.~ j 53 2e1 c1 231 11 2 i ~I Lr .I 6.1 ~~ I 167 I 52 ':97 ~~~ 7 c 34 129 42 ~ ? 59 v 30 ~ S7 30 9.t 2 ~ 125 I 3 8-~ - i ^ i 85 1 i 7Q I Cri~ l c.2 i '-__ i ~_ 11 I C2 ~ ~-- ~ -- j - , !C~k f'J~ivc' ~~f?.r1 ;.. ~'t1.~~T.) ~44.L , ~~~ ~ ! - G545G3 ~. 10 D t• ~ ~ l 0 ~0 40 ` 60 80 1G0 t GALLONS l LITERS 0 g0 160 240 320 - FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPL1CATl~NS • Timed dosing panels available. ~" ~ ,lied with • Electrical alternators, for duplex systems, are available and supp an alarm. • Variable level control switches are available for controlling single p ase systems. • Double piggyback variable level float switches are available for variable level Fong and short cycle controls. • Sealed Qwik-Box available for outdoor installations. See FM1420. • Over 130°F. {54°C.) special quotation required. 1521153 Series 3 27/ ~- ! i I ,z t/s I i __t_-- :~ 's s~Ga+ SELECTION GUIDE O CAUTION All installation of controls, protection devices and wiring should be done by a qualified licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (pSHA~. 1. Single piggyback uariabte level float switch or double piggyback variable level float switch. Reter to FM0477. 2. See FM0712 for correct model of =!ectrical Alternator E-Pak. du lex 3 3. Variable level control switch 10-0225 used as a control activator, specify p ( ) or {41 float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL 70: P.O. BOX 16341 Louisvi~e, KY 40256-0347 Manu/acturersof.. ` SNIP T0: 3049 Cane Run Road ~ ° ,•;. Louisville, KY 40211.1901 ff~uTYF~UMas SyCE 1999 "'~ a ® (502) 778-2?31 • t (800) 928•PUMP PUMP ~O. FAX 1502) 774-3624 Flttp;J/www.zoeller.com ©Copyright 2000 Zoeller Co. All rights reserved. Y ER's MANUAL 8~ MANAGEMENT PLAN • POWTS OWN SYSTEM SPECIFiCAT10NS Est flow (ave>ia9e) r /J ,~ atid2 7 (Estimated x ~ _5) Design 11ow (Pea~~ ~ , ~aUda !1 SoD APP~'tiOn ~`~ , Monthly average' lnfluerttlEffluent QuatGty .0il 8 Grease (~G) Fats S30 mg~- ~~ mg/L , ert Demand (BODs) Biochem~ OxY9 ded Solids (TSS) 5150 m n- " n Total suspe Monfi~ly average Pretreated Effluent (lual•Ity 8005) l Oxygen Demand ( • s'30 m9/L ~~ mg/L ,ochemica g Total Suspended Solids ASS) ometric mean) 514. cfu/tippml Few Colifocm (ge Yo inchdiameter Maximum Effluent Particle Size Service Event Insper~ condrtton of tank(s) Pump out contents of fsnk(s) Inspect d• Pets rsal cell(s) CleBtt ,efttuent filter Inspect P!rmP~ Pump controls 8 alar'In rats and pressure test Flush late _ Service Frequency ear(s) (Maximum 3 yrs.) --•t p months At Least once every uals one-third (Y) of tank volume When combined sludge and scum e4 ear(s) (Maximum 3 yrs.) - the At {east once every At least once every At least once every At least once every At least once every At least once every p mon -----~--"r" ear(s) months C3 NA ^ months ` eaKs),_. ----- .e~rrsl ^ NA ~ p monu,b ~ --- ^ year(s) G7 NA ^ months ^ months ^ year(s) ^ NA o licenses or ~NpNCE INSTRUCTIONS an ind'tyldual carMn9 one of POf°~~Maintainer, Septa9e Nlpt Its shall be made cued Sgv~rer P0>,~1fTS inspector: an missing or broken of tattles and dispersal ce on of ftie tank(s) to jdentify Y for any tSack up Inspect~ne Plumber. Master Plumber Rests a and scum and to check certit>cations:. Master ns must include a visual inspedi to cher* the effluent levels S~~g pperator• Tank insPed1° asure the volume of combined sludg of went on the or leaks, rrte nding hardwar'e~ bentrfy arty cracks The dispersal cell(s) shalt be visually ins authority- round surface- nding of effluent on tfie ground surface- T~ p° ulatory or ponding of effluent on the g for any Po 4Qn °f me local ~ lume, the in the observation AiPeS and to ~e~CariditiOn and requires the immediate notifica or more of the tank vow ~ NR ground surface may indicate a failing min any tank equals one-xt-ird (~ S~ of in accordance utation of sludge and scu 0 erator and dispo When the combined aawm moved by a Septage Senrtcing P k shall be re t ment components, and any entir$ contents of tine tan onents, Pfe~ ~ ppV1(TS Maintainer. 113, Wisconsin Administrative Code- ressurized pOWTS comp rformed by a certified n of effluent filters, mechanical or P of corrlptetron of any service event The service 9 or monitoring at intervals of 12 months or less ~ntfiln Oda ys other maintenance uiatory authority A serviRe report sha(fbe provided to the local reg luting products or other for the Presence of Pa tlations are STARTUP ANO OPERpT10N of the POV1rf5 check treatment tank(s) ecsal cell(s). If high cone n, Of t0 Use rior to use_ For new aonstrucxlo ~ aliment pr~eSS an~0t damage the dlsP° rator p im a die ~ ank(s? removed by a septage servicing t~ chemicals tilaet th ~ntendts of the detected ha Septic Tank CaPaetty Septic Tank Manufacturer Effluent Fiter Manufacturer E{tiuent Filter Model Pump~Tank Ca1~~Y pump Tank Manufaduief .Pump Manufacturer Pump 11Aodel Pretreatment Unit ~ SandlGr~vel Filter p Mechanical Aeration ^ Disinfection Page of al ^ NA PlA t1 NA .--1~ ^ NA ~ ^ NA ~~~~ ^NA ^ peat Fitter ^ Wetland ^ Other. Dis s ars t Get[(s) a In~round (pressurized) p n.~round (gravity) ^ Mound At~rade p Other p ine ical for dornes~ (non-comme~n'~~~ °~ values typ seP~ tank effluent ~ ,,,~steMrater_ .~ values typ{cal for pretrea Number of (3edro~s NA ~ ttunen~l Units L7'Z~ aVda Numbef of Co Page of_,.,_ !" ce- - ' ~ il•conditions are frozen at the infiltrative su is restored the eXCeSS shall not occur when sO ti hNrater levels. 1~5then ~~ ;Ce~~s~ ~d maY result in the System stall uP ~y ~ above normal ~ . overloading r ~~~ pump tanks t~l c~U(s) -n one large dose, of the pump tank removed by a During Pp1i1fe ell ~ the dtsPe a Plumber or pQVyTS Maintainer to vraste~t ~~ ~ ~~e of eftluent To avoid this situation have me °On~ntad _ ~ ~ ~OCin9 -power to the effluent pu P um ~~ $ep~,ge Sung Ope~~r the Pump ~~pis to rPStote normal levels within the p P assist in manually opemtt 9 ~e(Is. Oo not drive or park over, ar otherwise disturb or compact, over tanks and dispersal Do not drive or park amides of any mound or ai-grade srn'1 abs°r~'bon aroa. ~~ance and prolong the Gfe the area vvtd'-In 15 feet down slope im rove the Pe from the wastewater stream may P degneasef's: dual floss; diapers; Reduction or~el"trnination of the foltowtr-9 dgamtte butts; condoms; cotton swabs; line; grease; herbicides; meat ..baby wlpas~ v+rater, fruit and vegetable peelings; g of the POWTS: antibiotics, sump Pump} , na kins; tampons;'and water softener brine. dsinfedants: fat ~unda6on drain ( fiades; sanitary P medicaoions; oft; pain8ng prodUt~s~ P~ .- taken out of service the foi[owing steps shaft ~ taken to lnsur>° that the ABANDONMMENT and/or is pemtanentiY sin Administrative Code- When the pOWTS fads abandoned in oomplianoe with ch. Comm 83.33, ~~nings sealed. system is proPerlY and safeb disconnected and the abandoned Pipe oPe a Servicing Operator. All piping to tanks and pits shall be _ disposed of by a Septa9 The contents of aR tanks and pits shat! be removed and property • shat( be excavated and removed or their covers removed -and the void space . After pumping, alt tanks and pits fill y~ ill, gravel or another inert solid material. rovide a code CONTINGENCY PLAN ~ the following measures have been, or must be taken, to P If the POVYTS fails and cannot be rope ~ utilized for the location of a replacement soil compliant t.ePlaoement system has been evaluated and may coon and should not p A sutbbie repta~~nt area ment area should be protected from distufiancet~Q co d ~ Its Failure to a~rption system. The replace from existing and proposed structure. be infringed upon by feQuired setbacks for a new soil and site eval at that firne~b~sh a sortable prated the rep-acerrrent area wiU result in the need ~~ the roles in effect replacement area- Replacement systems must comply area ~ not available due to setback one oat r~ mfailed PO~Sng advances in POV1rT acement st resort to P a soil and p A suitable rapt ~ installed as a ca n failure of the POWi'S ~ technology a holding tank-may ~ identify a suitable reptaceRtent area. Upo not been evacuated tacement area is available a. -~.~he site has ~~e~ ~ topte a suitable replacement area. ff no rep / site evaluation must be Pe a last resort tp replace the farted pp111('rS' removal of the biomac at holding tank n1ay ~ insYdlled ~ tams may be reconsiruded in place following urfac~ R~ns~rdions of such systems must comply with ti,e rotes in effect at that time. ound and at-grade soil abSOrPiron ~ e infiltrative s <cyVARNING» ,~EI+IT TANKS MAY CONTAIN LETf ~ ~,Y C RC~MSOTANCESF DtJ~TN MAY GEN. SEPTIC, PUMP AND OTHER TRFA TMENT TANK UND F p PERSON FROM THE INTERIOR OP A TANK MAY BE pIFFiCULT OR IMPOSSIBL 00 NOT ENTER A SEPTIC, PUMP OR Ol'HER TREA RESULT..RE5CUE O ADDfrIONAL COMMENTS - . POVYrS MAINTAINER POVYtS INSTALLER Name cam- , ti '~ _ Name Phone / .~J'" ~7 '~ Phone ~ (~` = ~"t PUMPER LOCAL REGIl1„ATORY AtlTNORITY t SEPTAGE SERVICING OPERATOR Agency ~ ~ ` Name ~~ ~ ~' Phone 7 / ~~' J ?~ , Phone ~ ~ `' ,.- ~.,`t b ~~ ~ Tttls davment meets tfle stall`s of the (;,yeah Lake. Marquette and Waushara County Zoning and San ~ Sgen~ this document does not This documenturas dialled Iry t ~ and 83.54(1). (2) ~ (31. Wisconsin Admtttlstrati~ GNM~ toot) the minanueti+ requineafentS of rlt. Comm 83.?2(Z}(bX 1« <~ guarantee the perfonnanoe of the pflVYTS. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Ofrrisiori of Safety and Build~rgs in accordance wrtn c;omm rsa, vvrs. rwm- was ~Y ~ ` U Attach oompiete site plan on paper not less than 8112 x 11 i es (~r~ ~ D ~ redfidff ~rfld inducts, but rwt limited to: vertical and r-orizontat reference (B scale or dimensions. north arrow. and coca nd distance to nearest roan. portent slope ~ I.D. O $- - 0 3 ' ocz~ l • 89 }' , Please print all informatio ~ AY ~ j 2 ~ ~ 3 ~+ ~ Date Pe~sonet inlonnation you Provide maY be used for secondary (Pfnacy Law. a 15.04 (1) (mp. > ~ 1 T ProperlyOwr~r C- L'nI d ZON G F ICE~h~ 1~4 1/4 S ~ T N R E( W owner ~ndd~ ~ Lot giodc# -- . Norris or CSgtflf C`r~~ ~ ` t~ code Phone Number O city p vuage Town j~iJ1 ( New Corrstruc~iorr Ilse: / Nurrrber of bedrooms Code derived design flow rate S Q GPD ^ Replacement ^ ~ bqc or„ - Oescr~e: ~ - ~ ~ 1g' R Parent matedef Flood Plain elevatio n if appficabls and nrcomrtrerrdatiorrs: S~ ~J~~vi ~ {~ dCC~fll.!//- C~' [ ~ ~ ` ~4 a # ~ ~~ Gnxard surface elev. ` t ' ~. ft. pepth to gmiGng factor ~_ ~. Soq Rate Pit Fl i th O d t D tion Redox Descri Texhxe Strrx~rre Consistence Botmdary Roots rort or ep in. rran orr tNtmseq p tkr. Sz Cont. Color Gr. Sz Sh. 'EtfiF1 'Eif#2 '!~' ~3r~ - S~ ~ s a - s - $_ l S ~ ,- ~ av , 3 - ~ ~ ~ ~ ~ at S - / l3orkg # ^ Pit Ground surface elev. ~ ~ ft Depth to gmgirrg factor/7'° _ ~. ~ ~ horizon De th Dominarrt Redox Description Texture Structure Consistence Botxrdary Rods GP DIf>? p &r. Mt~eq Qu. Sz Cont Color Gr. Sz. Sh. '~1 ~~ ' tent #1 = BOD > sa < 220 rrrglL and TSS >ao <, =Effluent #2 = aoD <_ ao mgn. and TSS _< 3o rrrgll ( ~ csr Nunber q ! r Dad Evahration Conducted Telephorre Number .~~ . ~- b ~~- 3 Paroei ID # Pace - _ ~ ®~~ # ~ Pi$ t ~ Ground surtaoe elev.~~~~ ft. Depth to ru~t~9 factor ~""~` __ __ Sad Rate Horimn De{~h Dominant Redox Description Text~a Struchae Consistence Bound~y Roots GP DRF in. MunceA Qu. Sz Cant. Color Gr. Sz. Sh. 'Eif#1 'Etf#2 ~ Q-dt ~ y 3 Z ~'- S L rn r ~ a r~ °~ 2 Z- r~/~i ~i2 w 3 6-L ~ ~ `~ ~ /r - - ~ i~rz , 3 , S a ^ Pit Ground surface elev. ft. Depth to B factor ~. ~# ° ~~ Soi ira8crt Rabe Horimn Depth Dominant t2edox Description Texture Strucds'e Consistence Boundary Roots GP D/tF kr. Mures Qu. Sz. Cor-t. Coicr~ Gr. Sz. Sh. 'faf#1 'Etf#2 o Bo~# ^ ^ Pit Ground sraface elev. ft. D~ to rxrdting factor in. Soy Rabe Horizon Depth Dondrrant Redox Desa~tian. Texture Strv~e Cayce Baxxi~y Roots GP DIPF in. Munse~ Qu. Sz Coat Color Gr. Sz. Sh. `Eff#1 'Eff#2 ' EfQueM #1 =Bobs > 30 < 220 mgll. and TSS >30 < 150 mglL ' E1flueM #2 = BODs < 30 mglL and TSS <_ 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate farmer, please contact the department at 608-266-3151 or TTY 608-264-8777. .. . Soil Test Plot Pl Project Name P.C. Collova Bldrs. Inc. Address P.O. Box 487 Somerset Wi 54025 Lot 3 Subdivision Crick Bolton Date ~'TM #226900 12/4/02 1 /4 IVE 1 /4S 18 T 29 N/R17 W Township Hammond Boring 0 Well PL Property Line County ST. CROIX ~r VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 98.1' *HRPSame as Benchmark =Top of Survey Iron @~' 9 p~ -3 B-1 7% Slope a~ .~ 0 M 99' B\ 97' 98' 193' Property Line ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer P• C. Collova Builders, Inc. Mailing Address Property Address (Verification required from Planning Department for new City/State ~~IrL,il~(1 ~-l~ • Parcel Identification Number . LEGAL DESCRIPTION o ~~ - 2w3 - 0 3 -~ Property Location %,, ~ %,, Sec. ~, TN-R~W, Town of Subdivision 11 A,P ~(~ ~jQG~~~~ ~(,~~( p~J~ Lot # Certified Survey Map # .Volume .Page # Warranty Deed # _ ~~~~~_ Volume 5 Page # Spec house yes ^ no Lot lines identifiable ~ yes ^ no ~q ~-) 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. Cmix Zoning Department a certification form, signed by the owner. and by a tnasterplumber, journeymanplumber,restricted plumber or a licensed pumper verifying that (1) the oa-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, 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 County Zoning Office within 30 the thre expiration date. P. C. COLLOVA BUILDERS, INC. ~ / (, / ~ ~ SIGN TURF OF APPLICANT (715) 247-2742 P.O. Box 489 DATE SOMERSET, WISCONSIN 54025 OWNER. CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the rty desc 'b above, by virtue of a warr~ty`dee~~~~r~~ BasisSe~ p>;.p~ecis l~..ffice. (715) 24t~37--2742 cK~ IIVC P.O. Box 489 ~ / ~ / ~ SIGNA OF APPLICANT SOMERSET, WISCONSIN 54025 DATE ****** Any information that is mis-represented 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 a copy of the certified survey map if reference is made in the warranty deed P O Box 489 Somerset, WI 54025 U 1950P 52.8 I ~_.___ STATE BAR OF W ISCONSIN FORM 1-1998 WARRANTY DEED ' This peed, made between John ~ patron ana t.arolvn ~. uar husband and wife . Grantor, and P C Cdlova Builders. Inc. . Gr. Grantor, for a valuable consideratlon corneya to Grantee the folioN described real estate in St. Croix County State of Wisconsin (the "Property'): 68724c'-' KATRLEfiN R. MALSN REGISTER OF DEEDS ST. CROIX CO.. MI RECEIVED FOR RECORD 08-16-2002 9:00 AM 0IQDT t;9 ~ REC FEE: 13.00 TRANS FEE: 1155.00 COPY FEE: CERT COPY FEE: PAGESt 2 ~~ P Cc6ova BuiWera, Inc. x Avenue mood . WI SA01b ~~=/c~~ 9s~o 9 Sae Exhibit A attached hereto -01.8-1039-20-•000 / 018-1039-10~OC 018 1039 80 000 P~r~alidentlticetlon Numbsr(PIN) Thla Is not homestead property. (Is) (IS not) Together with all appurtenant rights, title and Interests. none Grantor warrants that the title to the Properties good, Indefeasible in simple fee and free and clear of encumbrances except Dated this 15th day of August. 2002. (SEAL) (SEAL) " hn J. Iton arolyn G. alton (SEAL) (SEAL) A.t~~.iCi -, ~~,TE OF WfSCO~ Signature(s) authenticated this N~ ~{~,~3~,1C $TA~E y`t iJ'~'t~i'~' T1TLE: MEMBER STATE BAR OF W ISCONSIN (lf not, authorized by §708.08, Wis. State) ACKNOWLEDGMENT State of Wisconeln, } ss. St. Croix County Personally came before me this 1,~ day of August ~ the atwve amed J a and I It n ban rtd Wif • VJA u _~w5kz.~rwJ Notary Public, State{of Wiswnsin THIS INSTRUMENT WAS DRAFTED BY My commission u pe anent. (If no4 state expiretion date: Cddweil Banker Bumet A115 V~ .) 1301 Coulee Road Hudson, WI 54018 22470 'i (Signatures maybe atnhentlcated or acknowledged. Both are not neceaaary.) • Names of ors s In In an ca must be or rioted below their s nature. STATE BAR OF WISCONSIN Wisconsin Legal 81ank Co. Ina WARRANTY OFCr1 FORM No.1-1998 Miiwaukea, Wis. ~U E ~Lb o~ f of 2 tom. ~ .. .. . ,. .. ' 1~. .`~, 9 5.,~ ~, 5 2,~..,,., . ~ ~:.~ A part of the NE'/. of the NE ~ and in part of the NW y of the NE'/ and fn part of the SV~'/, of the NE Y. of Section 18, Township 29 North, Range 17 Weat, Town of Hammond, St. Croix County, Wisconsin and mare partkuiarty described as: Begi~ng ~ the Northeast comer of said Section 18; thence S89'33'31"1N 372:01 feet along the North line of the NE'/. of said Sectlpn 18; thence S89'33'31•W along the North line of the NE / of spid Sectlon 18 775.94 feet; thence S00°52'23"E 250,00 faet* thence S89'33'319A/ 968.24 feet; thence S00°52'23"E 420.00 feet; thence S89'33'31"W 528,Q0 feet; thence S00.52'23'E along the North-South Quarter Section line of said Section 1 S 1311.77 feet• thence N89'33'39'E 626,33 fast; (hence N00°31'25"W g~0,23 feet; thence N89'33'24'E 692.78~feet: thence N00'52'23"VV abng the East line of the SW % ~ the NE '/. 330.31 feet; thence N89°33'24'E along the South line of the NE Y. of the NE '/.949.09 feet; thence N00'S2'24"W 1321,19 feet t0 the Polnt of Begfnrstng. 6V~~v~ 2 ~ i= ~. ' 160.00' ' 1~ 9_01' ~~ ---- 189.01' __ M 38.82' ., ~ o W CO ~ ~~ 3.00' ~ OWN CO O.' W `-~ '~19. ~ ~ QZ. I w J d =a o .M °~ O. 1. ~ '~ ~ "' Z O'`' M ~ M ~ ~ U M ~ ~ Q mho ~ ~ ~ I~ ~ Q w ~ ~ r w ~ ~ Q ~ •r~ WI M ~1 ~ ~ a O ~ ~ ~ ~ W •~lc ~~ a~ M ~ ~~~ ~ ~ ~ ~ ,oo ~ z °° ~ cri Q I Z ~ z rn N ~ d' ~ I --- ~ ~ ~ p ~ / ~ rn ~ 88;.81 _ _ ~--1 r ~j ~ ~ 189.01 - - r ~ - r r N 00'00'00" W 277.82' © ~ _ ~ b ~ co / 0 _ ``' ctOO S 00'00'00" E 277.31 0 ~ ~~ _ _ ~, ~ M ~ - - 60.31' ~ ~ / '~~' C M ~ 217.00' ~ ~ ~O ~ o ~ ~ ~~ ~ ~ ~ 1~6'~0~ ~ / z ~ o ~ ~ ~ ~~ti z N ~t U \ / / C ,00 L M o ~ ~ Q \ ~ \ \ O \ N E-+ d- ~ \ I ~~ ~ ,g g - '~ © ~ ~ ~ \ \ \ ~~£ ~E ~ ~ ~ ~ ~ \ M ~ ~ ~ -M ~ S 00'04' 41" W 366.12 _~ , ~~ Z I ~ c~ ~ z ~- ~ N Q ~ w ~ W ~ ~ Q M M~ M ~ ~ I33.00' I Md' I M r Cfl O M ~ ~ N CD M~M~ -~ M ~ I~ 217.00' ~~ pip r' I W ~ ~ ~ N ~ I W ~ ~ z Z N 00'52' 23" z ~ ~' ~ 2~J0.00~ ~~ S 00'04'41" W 3_74'88 _--- ----- "' Q Z J I\ I ~ . Q~ ~: ~ ~ 1 ~- ~- W ~ ~ ~~ M N M ~ ~ N r ~ ~ \ ~ ~ Z E 40`Z 95~ \ \