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HomeMy WebLinkAbout018-2003-04-000Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION ~ . (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township P.C. Collova Builders, Inc. Hammond Townshi SST BM Elev: Insp. BM Elev: BM Description: 7Q~ ~~! ~ ~& ~ ~~~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic lid Ja~d Dosing ~ / ~p3b Aeration ~~ ~ ~, Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~~ J ~~ ~ ~ j Dosing ~ 1 !1 , 1' ~ t ~ J Aeration Holding T PUMP/SIPHON INFORMATION ELEVATION DATA county: St. Croix Sanitary Permit No: 453421 0 State Plan ID No: Parcel Tax No: 018-2003-04-000 Section/Town/Range/Map No: 18.29.17.898 STATION 1r BS f) ~ ~' HI /60. FS ELEV. Benchmark ,~ ~ ~a j, /~ Alt. BM S~; , Bldg. Sewer ~ ~ ~~, ZL 7 a C • S3 D SUHt Inlet ~ ~~ ,~ Q! , ~~ O ~P St/Ht Outlet ~~ Dt Inlet `\ Dt Bottom g z• ~O Header/Man. ~' •' // ~C~ Dist. Pipe ~ ,3' 1 ~ ~, ~~ Bot. System ~ q ~~ Final Grade ~ ~' ( y 4 St C~ e~ tC; ~ iC ~-~- ~• Z ~ - ~$ I `` `.+ZS V~~ ~ ~~ BED/TRENCH Width ~ Length ~ No. Of Tren es PIT DIMENSIONS NQ Of Pits Inside Dia. Liq 'dyL Depth DIMENSIONS qx /C~' SETBACK SYSTEM TO P/L / BLDG WELL LAKE/STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR Typ~System: ^ „ 1 - _ ~ * ~~ /v ~ UNIT Model Number. ( 0. -Q ~ DISTRIBUTION SY~i'EM Header/Manifold ~ J Length Dia ~ Distribution ~ ~ ~ Pipe(s) c~~fxl Length a V Dia Z Spacing x Hole Size t t 3 ~ x Hole Spacing ~ f Z4' Vent to Air Intake ~j, ~ K 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 i ~ Bed/Trench Edges ` Topsoil ~ ~ '• Yes [~ No Yes ~JI No COMMENTS: (Include Bode discr~ persons present, etc.) Inspection #1: 9 / Z / ~ Inspection #2: / /_ Location: 1588 97th Ave. k n (NE 1/4 NWrc 1 18 T29N R17W) Crick Bottom Overlookk L 4 Parcel No: 18.29.17.898 1.) Alt BM Description = ~~^'~ OF ~~~~ ~ ,~-~., u~~b~•" 5 ~tR. 2.) Bldg sewer length = ~ ~ P 1 C_ - amount of cover = `, i ~/r W11 ~5 ~°` 7 ~ ~Q }-~ /~-~+~.~~ Plan revision Required? ~ ;Yes No i ~ ' 2 ~~ Use other side for additional information. J SBD-6710 (R.3/97) Date t ,~ (on K• w ~ 1 Cert. No. SOIL ABSORPTION SYSTEM Safety and Buildings Division 201 W. Washington Ave., P.O. Sox 7162 ' '~ ~ Madison, WI 53707 - 7162 ~~~rQ~~~~ (608) 266-3151 De artment of Commerce Sanitary Permit Application _.,.. In ttcootd with Comm 83.21. Wis. Adm. Cods, pcrsonal info~mation~s , , tray be used for saoondaty purposes Pnracy Law, s)~5.04(lxih ` L Application Ltformation - Please Print All Information >~~ 't. ~~~,t~. ;C~:~~~. _... ~~ Y 1 -1, ~ . ~ c:.. ~..r 1 II. Type of Banding (check an that apply) ~ ~ ~ S ~ ~jpr z Family Dwciling - Number of sodrooms public/Comtnacial - Dcsaib~ Usc /~ X ~ ~ Toro Q State Owned - Desrn'be Use III, Type Pccmit: {Chtxk only one boa< on line A. Complete line B if applicable) A. System Replacement Systeta Tream>eat/HoldittgTunk Replaoetr[ent Only B. Permit Renewal Permit Revisiaa A>a[rge of Pemut Transfer [o New Before Exp'uation Plumber Owner County Sanitary State Plain LD. Number Project ~dtess (f diffecettt.t~-an tnailin8 address; stock ~ Propergf LocapdrL~ Other Modification m Existing System 1 r. 1 J c va i v ...., ....-..--. ~---' - -- - Non -Ptessariud Lr-Gtound Mound >_?~S in. of suitable soil Mound c 24 in. of suitabl4 soil At-Grade Single Pass Sand Filter Constructed Wedand Prrssudned ta-Ground Holding Taalc Peat Flter Auobic Treatment Unit Recurulatin8 Sand Flier p;~u)atirtg SYtrihetic Media lTilter Leac1»ng Chamber Dti Line Gravel-less Pi Other (ex lain) Y. Di tment Area linformation: Area Proposed (sf) System F1eva0ion DesJrg1n Plow (gpd) Design Sotl Application Ratc(gpdsf) ~ R~~ (s~ ' / i"~ ! ~ ~~ / Tank Info Capacity in Total Number tnanuracnrrsr -- Glass Gallons Gallons of Units t..~~ ~.~ f4-IUO~ Concreoe Coastruc[ed ~• the v>II. con rue t ~~ ~m Sant[aty Permit Fee ppmved Pro Surcharge Fee) __-- Owtter Gives Reaso[t for . IIC. Conditions of Approval/Reaconsfnr Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maiiumibe~r. as per management plan provided by p 2. All setback requirements must be maintained as per applicable code/ordinances. for installation of the POWTS slbm+n on the attached ns. MP/M~PRS~Nu/tuber Business Phone Nu ~r des Groundwater Dace Issued 35~-- ~- ,. ~ Zee ~~ ~ Attach t?l~ (to the County only) (or the sYsteat as Paper not less than EllE z 11 inches is ~,, ~~ .~ ECT P.C. Collova Bldrs. Inc. PLOT PLAN A>)DRES~S P.O. Box 489 Somerset Wi 54025 ~E 1/4 NV11 i/4S 18 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX vIPRS Shaun Bird 226900 DATE?/13/04 BEDROOM 3 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK HOUND 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 *g,g,p, Same as Benchmark SYSTEM ELEVATION 96.7 Scale = 1 /4" = 10' Grading is to be done to divert run- off away from system Tank is to be properly bedded and provided with lockdown covers with approved warning labels B= Pro 3 Well is to meet all Bedroom setbacks found in House Comm. 83 C~pY B-2 ~--- mate B. is top of B.M. 2" i .0' B-3 ~~~ Area 15' Below system is to remain undisturbed 4% Slope Huffcutt Combo tank 7' 374' Property Line 97th Ave !~ 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 July 20, 2004 CUST ID No.226900 SHAUN R BIRD BIRD PLUMBING, INC 1008 192 ND AVE NEW RICHMOND WI 54017 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/20/2006 Identification Numbers Transaction ID No, 1024220 SITE: Site ID No. 686622 P C Collova Builders Please referto both identification numbers, 97TH Ave above, in all comes ondence with the a enc . Town of Hammond, 54002 St Croix County NE1/4, NW1/4, S18, T29N, R17W Lot: 4, Subdivision: Crick Bottom Overlook FOR: Description: Three Bedroom At-Grade System Object Type: POWTS Component Manual Regulated Object ID No.: 969632 Maintenance required; 450 GPD Flow rate; 40 in Soil minimum depth to limiting factor from original grade; System: At-grade Component Manual, SBD-10570-P (R.6/99), 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. Cap No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, ~~~ slats. The following conditions shall be met during construction or installation and prior to occupancy or use: t;~P ~ OF General Approval Requirements: • This system is to be constructed and located in accordance with the approved plans, the "Pressure Distribution SEE COi Component Manual for Private Onsite Wastewater Treatment Systems Version 2.0" SBD-10706-P (N.O1/O1) and with publication SBD-10570-P (R. 6/99) "At-grade Component Manual Using a Pressure Distribution ----~•~•~•~-~----~ System for Private Onsite Wastewater Systems". . • 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. Slats. • 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. Slat ;+ SHAUN R BIRD Page 2 7/20/04 • Comm 83 22(7) A copy ofthe 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. 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 shalt 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 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@commerce. state.wi. us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7b33 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 Date: 07/12/04 Owner: P.C. Collova Bldrs. Inc. sq~ AF~E/~F~ ~'Y Location:NE 1/4NW1/4 S18 T29 N,R17W Lot 4 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. Maintance and Contigency plan 9-11. Soil `--` Shaun Biri Signature License ni :~ional y ~o'~ED ~~ COMMEaCF AN ~ =SPONDENCE PLOT PLAN PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 NE 1/4 NW 1/4S 18 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX 7/13/04 BEDROOM 3 MPRS Shaun Bird 226900 DATE CONVENTIONAL AT-GRADE )OOC 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 96.7 11 Scale = 1 /4" = 10' Grading is to be done to divert run- off away from system Tank is to be properly bedded and provided with lockdown covers with approved warning labels mate B.M is top of B.M. 2" ipe 0.0' ~B-3 B-2 Area 15' Below \ system is to remain undisturbed 4% Slope ~9 7' B -1 96.7' 9 6' Huffcutt Combo tank Pro 3 Well is to meet all Bedroom setbacks found in House Comm. 83 374' Property Line 97th Ave ~ 5` W 5' a = ~ ~t wI = ~ Ft >rJ't B _>5 PYC FORC.~.MAIN .~; ~- r 2 j ~ ~~TUR-1- u! RS" ~..,._. --- --- i _ .. - _ - ' - R-- D ~ S Tl41 ~-°..1'~t' to ~t L AT ~.f~i. A ~ A ~ StABiIi~ED 08L4~~YATta~+i V1tELL~ I/6B ~ 1 I/6B I I/2 B r~------ „ n CELL flf ~L ° 2 /Z A6GR£.GATE ~ PP Ro~EE D 5Y ~.sTtfE'C}C. Fo br ~c 5T~81Li~~h Qbservot~on----. Wei ~ . > ~' ~ ~ ~LeV~IE~ i_nYEK ~ I.oPE Plan View and Cress SBCtlon of ~„tiscoSite pt-grade Unit with a Single Absarptian Area on a Sloping E.~cE~iSE~: Disi'ribuTion Lateral _~-- Salt Cover ,_~,_ Zt~ S,1fst~a7U 1~E Page flf Distributiar~ Pipe Detail for Latera3 ~detwork ... ....~ * Last Hole Should 8e Next To tuRr~-~P -_.,. ~~TuRN -uP~~ ~GL~~ou't~ -. PYC Forte Main -;^~ PYC Distribution Pipe P RCCe sf' 3or ~/" --~ Hoi e Diaeter ~f ,?j 1'-Inzh p ~~_ Ft. La~Leral Diameter !_ Inch{es} X ~` Inches ° Force Main Diameter ~~ Inches y ~ Inches Of Holes/Pipe~~ Invert Elevation Of Laterala ~.-L.-= fit' Signed: License Bomber: Date: APT ~O Sp CRASS S£~T1~~ ~- ANx E p~MF C~~RM$F.R ,* ~Zri . agCV ~ ~RAD~ ~ ~~~ Cy ~~pT PZPE Zi+fIN~Ow 4R ~ FROK D 4flR , ~'~R ;KTAiCE / ,fEt~~r~' ~, FAES3~ ~ rri' ~~.: ... zNLET . - - ~ `~ i~iA?£R 'I'IG~i'T SEA ~I1•YE•R ~.-- - ~._ '".~"'_ APp~~ C Pik 3` - ~ ~' ~T- -~"'_ ODD SID g~~4P +OF£ ~L£V ' ---- saz~ r "'~'~- L I T ~A T_.__~ ~ ----_' uEa~~i0~8OX JAN C~hDUZT i3 ~TK -_ Y.a. :~ ~, S 5 ~ j '•ti ~ CsA ~ a ' r s , r ' pgPROV ED MANN4LE COV Ei~ ~/ PADLOCK ~ y,tARtiZNG ~-SEL _ ~tc" HZ~ - 384 *""~• •- - --- ,1taIt1TS 1~iTtt pappROV£D QIF.E 3~•~p~QIL BEI3F~NG V~ ' CONCgETE FAD 3 ~ APPRUY ED ,I ~% I s~ci,! ~~, S prC ZF ICA': Z O__~__NS----- ,? 3~ILIt+ibER / DOSE ItER : ~~ DOS£ ~ {y LT.~ tSE ~ Ley gpCR~'• ~ ' -~ GAL - .. TAAiK ;iiCiiES SEPTZC C-~A1~- p. ~ ~J,S/ -~ T1111f-- DOSE y+.~ CAPACITZ~'~ _L-- h $ = r2 _ Zl,1CHES = ~~----GAL ALARK M~EL ~nSPE = `' ~ ~ ~" C ~ ~ INCHES ~~~x ~ -~ ~~ ~ _ ~' =EKES =1~~ ~~ PF7KP ~~g~: - ~ ~ ara/~'~ 'WIRING AS PER s K~Z~H 3'YPE= ~ GPli - P~Ti~iP ~ ~'`~RN o P£ FEET RATE .~~ TR I B[IT I ~ Y . •,~ ~~~~s_' _" _ FEE? REQ13I~tED DZ SCH!'+RGE -fJI S - I ~ --~"'" FEE BETNEEM PiJI'4P O; F AND QN FACTOR ,e-~--"" FEET OZFFER'ENC~ SURE £gZCTI ~£ ~iF.AD V ER1'ZCAL QRK SUPPLY -PRE FTJ ~D ~ • FT • DYNA~M ~+ MIH;MtII'I NEB '~fl`fAL DYAME'TER - ~~~- FEET FORCER X ~ a .~ - ~Ip~rx f ,._.~..r; S~ ~~ F~~F TANK. L,~gi3SD ~~-"' T~IT£K~~L D iM£NSI'D~ . LICEi3S£ i+iu~D"R SIGpt~D- __---- 4A-`-r :f8~ TOTAL CYNAMiC ;DEAD/CAPACITY PER MINUTE EFFLUENT AND GEw~aTERING CAPACITY CURVE HF~D ~ I MODEL 152/153 ,~~ ~ MccE~ ~ 1~2 i iz W I Fezt 1 Meters Gai. Liters Gol. ~ Liters 1 ~ ~ 50 1 207 77 291 ~G 1.g i E9 _~ i 1l p I 3.? I E7 231 70 1265 153 4 6 53 20i 61 231 is f 12 40 15~ 1 7 67 S2 t 97 I i 2q .~ 6.1 i 44 ~ W ~ 129.1 42 ?69 25 7.6 34 _ v_ 30 87 33 ~ 125 3D 9. t ~ %~ i i o ~0 I ~ __ __ 11 ~ 42 i ~q ~ ? 2.2 ~ y~ a o _ i~i,.e. zgq >>. ~77.iim)~44.0 Ft (73.4m1! ~-- I or:soa 4 10 I p 20 40 60 80 100 GALLONS LITERS 0 80 160 240 320 FL01N PER MINUTE ONSULT FACTORY FOR ESPECIAL APPLICATIONS C • Timed dosing panels available. ~'' ~ hed with • Electrical alternators, for duplex systems, are available and suPP 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. • Sea-ed Qwik-Box available foroutdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. e~i~ tt series p CAUTION NI insta-Iatlon of controls, protection devit~an~d~ ova be followed FntludinQ the most. licensed electrtcian. AU electdu- and safety recent Nadond Electric Code (NEC) and tha Occupational Safety and Haattt-Act (OSHA?• - 3 27 11/S _i i .1_--- ~? :2 's SELECTION GUIDE 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0417. 2. See FM0712 for correct model of ElzcUical Alternator E-Pak. du lex 3 3. Variable level control switch 10-0225 used as a control activator, specify p ( ) or (4J float system. RESERVE POV~ERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.G. BOX X634 Louisville, KY 40256.0347 tdanufacGlrersof. . SHIP Tt): 3649 Cane Run Road ~° ~, ® Louisville, KY 40211.1961 Q~auTY /~iµrvs S%rcf /939 ° ~~~~ +Q (502) 778-2731.1(8001928-PUMP .,. ~" FqX (~2I 77a-362a hnp;/lvrww.zo ell er. c om p Copyright 2004 Zoeller Co. All rights reserve . Paq~ of - • NT PLAN S 01NNER'S MANUAL & MA EM SPEC FiCATIONS pOWT SYST ~ at ^ NA . Septic Tank CaPa~ _ ~ _E INFORMATION r-~ ~~ ,,y ~ nuFac[Urer ~- Septic Tank Ma ^ ~ ~r ~ •~ Effluent Flt ter M~~ctucer ~' ~,~ ~em'ut ~. ^ NA Effluent Filter Model ~ G~ at ~ NA tySIGN PpRAME~s ~ ' d NA . Number of ~~s - Pump~Tank Cale' NA r pump Tank manufacturer ~ - /' t Units ~, al/da ^ ~ Number of Commerce cTZJ Manufaduref `~''~ Estimated flow (average) aVd .Pump ~-~, , J..--~ ^ ~bnnated x 't.5) _~ :.~ _ ... Model DesiDn flow (P~~ ( ~"`~ at/da /ft~ Pump . Pretreatrnent Unit t7 peat Fitter Soo APP~dpf 1 ~ Monthy average p ~nd/Gt~ve- Fitter ~ Wend tnfiuenttEffluent Quality FOG) 530 m9n• O Mechanics! Aeration ~ Other. Fats, Oil ~ Grease 800 5~0 mglL ^ Disinfection Biochemical Oxygen pemand ( 5150 m /L Manufacturer Total Suspended Solids ('rSS) teat Celt(s) ressurized) . NA Monthly avera9e~' Otspe round (gravity) O In-ground (p Pnetraa~ Effluent Cluality ~ In-9 p Mound BOOS) s30 m9~ .grade p purer pnyica! Oxygen Oernand ( 530 m9n• ine B'tocll Total Suspended Solids (rSS) 510' cfu/'f OOmf ~ ica- for domestic (non-comcr~^dan'"~'°Stp11fJ~ ~+d Fet~1 Colifo[m (9eOrT'etnc mean) vetoes typ yeln~diameter ~~fn~p~~a~~ste„Y,ter. .• Velure typ f,Aaximum Effluent Partide tze Sery{ce Freq, u_ enn! Serytae Event lnspe~ condition of tank(s) Pump out contents of tank(s) tnsped dlsPe~ cell(s) Clean Effluent filter Inspect [aurr~p, pump conuots ~ atart'n mssure test Flush tate~ls and P O (Maximum`-? At a t once every ---~ ' • equals one-third (t5) of tank volume When combined sludg e and scum ear(s) (Mlaxlmum 3 yrs.) p month At Least once every ~ months sac(s) At (east once every ~ p months° r(s1 ^ NA At (east once every ~ ^ months Year(s) ~ ~ At least once every ^ months ea s ~ Y ~ ) p NA At least once every ^ months t1 YeaKs) ^ NA At (east once every oet+er_ licenses or one of the following e ~~~~ INgTRUCTI4NS an individual can'y-ng ~~ PDyyTg lVlatntarner, Septa9 Inspe of ~~ and dispersal cents shall be made ~ Sewer p~pwTS lnspe to identify any missing or broken Plumber; Master Plumber Restrt on of ffie tank(s) eck for any back uP oerfil~=. Master ns must inducts a visual inspedi sludge and scum and to ch ore the volume of combined p~~ ~ check the effluent Levels fir, Tank inspeGtio of effluent on the Setvidn9 OPem ~ ~~ or leaks, rReas The dispersal cell(s) shall be vlsuaity ins The ponding hardwP+m• ~~ Y round surface. round surface. authoritY- or Pced~ of effiuent on the g for any ponding of effluent tm tt~e 9 lion of the local regulatory in the obsenrafion Pines and to cd'+edc wires the immediate notifica ice may ind-cate a failing ~nd'rtion and req oats one tt-irti tK~ or more ~ ~e manse (with d~• NR ground su a and scum in any tank t?q Sect of in acco mutatitrn of studg a $eptage c,,ervicing Operator and dispo when the combined accu moved by and any entlt>s contents of the tank shall be re retreat+finent components, 113, Wisconsin Administmt;ve Code. ressurized POWTS components, P P0~'g Maintainer. rformed aY a c~ttified 't'he Setvkiarl9 ~ fluent filters, mechanical of p of completion of any service erent. or monitoring at intervals of 12 months or less. shall be Pz other maintenanve .~ ~ the local regulatory authority within 1 t) days A servic;0e report shat) "be proms nting products or other treatment tank(s) for the presence of pal STARTUP ANO OPERATION POVYtS ctt$~- steal cell(s). If high concentrations are For new oonstruc~iOn, prior to use of the roc~S and/or damage the dls a rotor prior to use_ e the treatmentrpemoved by a septage servicing Pe chemiCdis that may impel detected ham the contents of the tank(51 • -- - Page of_r ° ~ ~~ ` ~ editions are frozen at the infiltrative surface- [~ ~ eX(~,SS "`~ malt not ocatr men soli ~ ti hwteer levels. men P°`"~r is r~nd may result in the gystem start u~~~ pump ~'~ d~Pers~ oeit(s)rt- °ne forge Dose. overloading the oeC( ~ id this srtuation fiave the contents of tl1e Pump tank removed by a During der ed ~ the m or contact a Plumbs[ or pOVYTS Maintainer to discha~9 0 ,nrastewater'""'-I ~ e of raffl~t To av er to the effluent pu P _ taac~cuP °P $"r~°e p prtat.to"ring ~~tOte normal Sevets vtinthin the Pump ~•. gin m~anu~allYg t~perai3ng the pump °~'~ real ~~. Oo trot drive or Park over, or othenMSe disturb or compact, asses yehtct~s ov±sr tonics and dupe at rode sotl absorFtian ar~ea• rk of Ion the fde Do not drive or pa of any mound '9 a rformance and pro g slo ve th Pe own PB ro t d aim the area rritl'-!n 15 fee n from the wastewater stream m y P dental floss: diapers; of the foliowi 9 cotton swabs: degreasers; herbicides; meat Reduction ot~etuntnattor~ ~ dg~tte butts: condoms: stable peelings: gasatine* grease; ~ water, fruit and veg of the POWTS' entlbWtics ~ ~ •ts ~ pumpl na Ides; tampons;'and water softener brine. d t~ ~tyng pr+oduc~. t~~cxdes; santtarY p _ anentty taken out of service the following steps shall ~ taken to Insure that the ASANDONMM~IT andlor t3 Pew When the POWTS ~s g~ndoned in compliance w+th ch. Comm 83.33, IAfisconsin Administrative e: and safieb j Wings sealed. ~~ ~ properly disposed of by a Septa9e Servicing Operator. • , Al! plp[ng to tanks and pits shalt be disconnected and the abandoned P Pecovers removed and the void space .. The contents of aR tanks and pits shall be removed and properly after pumping, alt tanksatl d1e Inertsotid ~ eriaL and removed or their fitted with soft. gravel o to rovide a code CONTINGENCY PLAN aired the following measures have been, or must be taken, P If the POWTS faits artd cannot be rep compliant replaoeR'+ertt systern• en evacuated and may be utilized for the location of a repla~o and Should not eemenCarea has !~ and comps p A suitable repla Cement area should be protected s~ s~~ ~Qt ~~QS and wells. Failure to ~ n system- The I'eP frpm existing and propo ation to establish a suitable a a'Pbo cks •evalu - frin ed upon by rec4uired setba m g It in Lhe need for a new soil and site at that time. be resu ffect wrU in e protect the replacement ones terns must comply with the m1es aoement area is not available due to se sort an Por soil limitations. Barring advances in PO ceplacement area- Reptacen"tent sys io re lace the failed POl~T'3. p A suitable rept be i~ped as a fast re n failute of the POWTS a soil and t~otoyy a hotdtng tank n'aY ~en,ti~v a suitable rep(acen''ent area- Upo - Thesite has not been evalrtated~ to locate a suitable replacement area_ if no replacement area is available a. s valuation must be perf~'T' a Last resort ~ replace the failed POWTS- removal of the biomat at ldfn9 tank may be installed ~ terns may be reconstructed 'sn place fo[towing Mou ~e surface. Reconsbu~°~ of such systems must comply w~ d'ie rules in efted at that time. -in «y{rARNIN©~ t1 OTHER T'l2EA'l~MEtJT TANKS MAY CONTAIN LETHAL GA5CIRCUMDSTANCESF DF~,TH MAY CEN, SEPTIC, PUMP AN DO NOT ENTER A 3EPA PERK OR O?HER TREATMENT TANK UNDER T. RESCUE O N FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. RESUL . ADDITIONAL COMMENTS _ . POVYTS MAlNTAINF~? POIKTS JNSTALLER Name ~ ,,~ ~ )~ Name ° Phone ~ .. rte- ~~ ~' ~S/~ Phone ~" -- ~ ~-~- - LOCAL REGULATORY AUTHORITY ~ SEPTAGE SF.RYtC1NG OPERATC-R PUMPER Agency ~ ~,. ~ ~'f ~'' Name ~ ,~ ~~ Phone . =. Phone :.---- ~ ~' ~."~ This doament meets the stabs Of the Green Lake. Mariquette and Waushara County zoning and San ~e-this dOU,ment does not This aowment was dratted try. Wisconsin AQrrtlnlstrat~1te the minimum roqu'uernonts of dt Comm 83.~N~{tx~~ffl ~ 83.54(1}, (2} ~ (3). DMtW (2101) guarantee the pedorrnanoe Of tfie ppVYTS. .~ ~ Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordarr~ with Comm 85, Wis. Adm. Code -~ ' ~ U I County Attach complete site plan arr paper not less than 81/2 irrckrde, but not fimited m: vertical and horizontal ref po' Parcel 1.D. percent slope, sole or dimensions, north arrow, and I 'on and distance to nearest rna O /$ - 2 cm 3 - -- crap Please print afi inform lion. ~-,,,,~{ y R awed by Date ~ s0 i o4 ( ) (m3f • f~ • (} ?.H.' Privss:y t.avr s. Personal iMor+asfion you provide maY be used fa secondary es ( ProperlYOwner ST. CROIX ZONING (, r~Fl@dlFt-~ r W N R E ~ O>( ~ ~..- 1 (o T 7!4 1/4 S property Owner Mailing Address ~ Lot # Block # Name or CSM# City State Z~ Code Phone Number '^ ^ City ^ Village Town ( lN~ New Corrstrur~ion tJse: ! Nurnber of bedrooms Code derived design flow rate S Q GPD ^ Replacement ^ or, al - Describe: 1'`~ ! ~' ft ~ ~ ~~~ , :~' Flood Plan elevation if applicable CY.,G ~ Parent material ~ Ger>erat rron>rnents S~ ~~~.,~.~- a ~~ ~u~ ~-~, ar>d tescrxrunendations: G ~ ~ A ^~ cr ~ ~~ ~i~ . ~ 1 f - ~, pit Ground stutaoeelev. / ~ r " _ ft. i~epih iQa iantt~lg fatxol' ~ ~ ~ tion Terctrrre sauaune Car>sisterrce Boundary Roots t Redoo< Descri th D Fi im D i Sod Rate « n ep tn. om nan MrmseG p Qu. sz Coat. Color Gr. sz Sh. -Eff#1 'E . r~ .r-- ~ '~ ~ , Pit Ground surface elev. ~ R Depitr to fnniting far3or ~. Sad Rate tiotfzan Depth Dominant Cobr Redox Desgiptiorr Texhme Structure CArrsistenoe Boundary Roots GP DIIF ~. Mur>sed Qu. Sz Cont. Cobr Gr. Sz Sh. 1 ~~ S - s ~ ~ t~,~i2 ~~ r ~' r p b y/ ~~ S ^ m - Vhf n ~- ~ ~ . 3 ~ .Sr ' Etfiuettt #1 = BoD > so < 220 mgA. and Tss >30 < 1 - - = Effluent #2 = BOD _< 3o mgA. and TSS <_ 3o mglL csT Nur~ber ~~) ~~ ~ ;~ q,~,~ Date EvaluaUcr- Cor>~Cted 7el~tlorie Nurlbelr ,, s # _o Lor Parcel iD # Page of g~~_ _ ......_. _~ ~~ _ • •.. ~ r'li ~.• ..............o..ov.v voNu~ wrx•au~y wwn w ^~ Rat9 Horizon Depth Dominant Redox Description Texture Structure Consistence Boundary Roots GP D/IF in. Munseq t1u. Sz Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#Z 4 ~i ~. 3/ z -~ a ~r r r~-1 ~t2 - _ cs a n, • t'~ , ~ 2. ~- a s/ ~ rnF~ w J F r .3 ", it i`~ ~ ~ ~ b V f s " Yn ' r7'r F ~ n p h 13 J # ^ BOnng ^ Pit Ground surface elev. ft. Depth ~ g factor ~. Soq Rabe Horiaon Depth Dominant Redox Descri~ion Texture Structure Carrsistence Boundary Roots GP DIiP in. Munseq Qu. Sz CoM. Color Gr. Sz 5h. 'Cfi#1 'Eif#2 ~8 # ^ Boring ^ Pit Ground surface elev. ft. D~Ih b gmiting factor irr. Soq Rate Horiaon Oepth Dort Redox Description. TexGae Structwe Consistence Botardary Roots GP OVf! in. Munseq t~rr. Sz. Corti. Color Gr. Sz Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BOD, > 30 _< 220 mgll and TSS >30 < 150 mgll • Effluent #2 = Bt~Ds < 30 mg1L and TSS _< 30 mgtL The Department of Commerce is an equal opportunity service provider acrd 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 608-2648777. .~. Project Name Soil Test Plot Plan P.C. Collova Bldrs. Inc. Shaw Address P.O. Box 487 Somerset Wi 54025 Lot 4 Subdivision Crick Bolton 1/4 NE 1/4S 18 T 29 N/R17 W Township Hammond Boring 0 Well PL Property Line County ST. CROIX B r VRP Assume Elevation 100 ft. ~ Top of Survey Iron ystem Elevation 96.7' *HRPSame as Benchmark t. Top of 2" Pipe @ 100.0' 96' 'ATM #226900 Date 12/4/02 97'~ B-2 _ .--- 45' 4% B_'~ 75 10' B-1 a~ .~ a M ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer P• C. Collova Builders, Inc. P O Box 489 Somerset, WI 54025 Mailing Address Property Address cJ ~ ~~V1~ (Verification required from Planning Department for new construction) City/State ~~~y] ~~, t~~ parcel Identification Number _ D/8'- Zem3- o y-t~ao ~~~' LEGAL DESCRIPTION Property Location %., ~ %,, Sec. ~ ~ , T~N-R~W, Town of Subdivision ~/Li .r ~(' , ~j ~ ~(/lP~(.~~~ Lot # ~' Certified Survey Map # '- Volume ,Page # ~' Warranty Deed # ~~~ y`"I ~ Volume ~~, Page # Spec house ^ yes ^ no Lot lines identifiable ^ yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its prematurafailure 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 rnasterplumber, journeymanplumber, restrictcdplumber or a licensedpumper vcrifyingthat (1) the on-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 rctumcd to the St. Croix County Zoning Office within 30 of the three year expiry ' date. r P, C. COLLOVA 1~~111..V~ERS~ INC. ~ ice/ SIGNATURE APPLICANT (73.5) 247-2742 DATE P.O. Box 489 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 e rope desc ' ed above virtue of a warranty deed recorded in Register of Deeds Office. P. C. COLLOVA BUIL[~ERS, INGw SIGNATURE OF APPLICANT (71 O. Box 4892 D ~ O~ P SOMERSET, WISCONSIN 54025 ****** 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 rofcrence is made in the warranty deed U 1950P 52.81 STATE BAR OF W ISCONSIN FORM 1-1998 WARRANTY DEED I This Deed, made between John .f uatron ono ~arorvn ~ uar husband and wife .Grantor, and P C t^,cilova Builders Inc. . Gn Grantor, for a valuable consideration conveys to Grantee the folloe described real estate in St. Croix County State of Wisconsin (the "Property'): 66724"'c KATNLfifiN H. MALSN REGISTER OF DEEDS ST. CROIX CO.. MI RECfiIYfiD FOR RECORD 08-16-2002 9:00 AM E1DPT ## DEED REC FEE: 13.00 TRANS FEE: 1155.00 COPY FEE: CERT COPY FEE: PAGES: 2 t~f Sw Exhibit A attached hereto P CflYova t3utldars, Inc. x Avenue mood , WI 54015 /'~~1 ~~ 9s~D 9 0]8-1039-20-•000 / O1 018 1039 80 000 Parcel {dentlflcatlon Number (PfN) Thla la not homestead property. (Is) (Ia noq Together with all appurtenant rights, tEUe 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 Auoust. 2002. (SEAL) • ~. 4 ~,.~ ~hn J. Iton (SEAL) J arolyn G. alton (SEAL) (SEAL} i ACKNOWLEDGMENT State of Wisconsin, } ss. St Crobc County Personally came before me this 1~ day of Aua L ~ the above med J a and I It ban nd Wif A tp~~~C -: ~ aTE OP WISCO~ Signature(s) authenticated this NO 3uC ~~~~ TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Staley Notary Public, State(of Wisconsin THIS INSTRUMENT WAS DRAFTED BY My commfsafon Is pe anent. (If not, state expiretlon date: t^,oldwell Banker Bumet ~~< Vy ) 1301 Coulee Road LLL ~1 Hudson, WI 54016 2-32470 (Signatures may be authenticated or acknowledged. Both are not neceaaary.) • Names of ones n in an ca must be or rioted below their s nature. STATE BAR OF WISCONSIN Wlaconeln Legal Bunk Co, Ina WARitANTy pt: FORM No. i -1988 Milwaukee, Wis. ~~~~ ~~ OV Et2Lf,oK f of 2 •:~ . ~ ~: ~ ~ ~: .. .. A part of the NE'/• of the NE '/, and In part of the NW '/. of the NE '/, and in part of the SW! Y, of , the NE '/. of Section 18, Township 29 North, Range 17 Weat, Town of Hammond, St, Croix County Wisconsin and more partlailarly described as: Begi~ining ~ the Northeast comer of said Section 18; thence S89.33'31 "W 372:01 feet along the North line of the NE '/. of thence S89'33'31"UV along the North line of the N6 '/. of said Section 18 775.94 f e ~th~,er e~ S00'52'23"E 250.00 feet; thence S89.33'31'W 968.24 feet: thence S00°52'23"E 420.00 feet; thence S89'33'31'W 528,00 feet; thence S00°52'23'E along the North-South Quarter Sectloh line of said Section 18 1311.77 feet; thence N89'33'39"E 826.33 feet; thence N00°31'25"W 930.23 feet; thence N89°33'24'E 692.78 feet; thence N00.52'23"W atgng the East line of the SW % ~ the NE '/. 330.31 feet; thence N89.33'24'E along the South lJne of the NE '/. of the NE '/.949.09 feat; thence N00'S2'24"VI/ 1321.19 feet to the Point of 8egfnning. b U~2-~v ~ 2 or- ~, ~ ~ ~ Q ~ ci `- ~ \ \ 00 O ~ co rM~ S 00'04'4" Y9~ 366.12' ~, ~ rn ~, ~. ~ \ ~ a co ~ Z ~- ~ 1 ,, ~, a ~ ~ ~ 1 ~ ~ ~ . \ N ~ ~~ w ~ ~ W •~ ~0 I ~ ~ Q ~. 5 J M ~ ~ M Mt0 / / 217.00' M~ O N~ MQ, C`~rn I ~/ E rn ~ ~„~ N ~ I ~ O~ ~ V 0'52'23" W °° '~ °°~°° / C ~ Z z ~ I 250'00 U~ S 00'04'41" W 374.88' Q I. ~ ~ Q ~ / \~ \ ~ ~, M o ~~ ?i ~ N ~ \ C ~ ~ ~ ~- 2 95/ \ ~ 0 z 4 '' p ~ .1T 55 % \ \ \ r- z ~ 5 ~% / ~ \~ \ U rn F-I / / \ cwn ~ ~ ~ / ~ 3 \ ~. U \ \ ~ (n \ C Q "~ E...~ ~ lO O CO \ \ \ 9rO \ ~ ~ \ SE W z 0 ~ a ~ ~ ~- _ ~ o _ ~ ~ `~' w ~ W Z J ~ O Q U ~ F---~ ~ E-.I O a0 ,_.. z T~ o `./ Z U O W 0 p ~ `- O Z~ QO ~ w ~ ~-- 1 ~WQC W ~ _, zQW1 U W N7 iY7 ~ = W l.i ~- ~ arn U ~~ 0 0 . 00 Q ~=w~ U ~t Z Z \ ~~~0 W ~ ~ z~.-Oc ~ ~ ~ O W ~ ~ W ~ ~ = D L ~ m ~ W Cr I- CC ~ U Q QL ~ W ~ Q O Z W rr ~ C ~ n !~ n 150TH STREET