HomeMy WebLinkAbout018-2003-05-000Wisconsin Department of Commerce
Sat6ty and Bui{ding Division
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township
P.C. Collova Builders, lnc. Hammond Townshi
CST BM Elev: Insp. BM Elev: Description:
BM
(Oo.C>p -
~ 1GP ~j S'LNYL~ ~~Fj»~ ,~~ ~4/N,L
TANK INFORMATION
TYPE MANUFACTURER CAPACITY
Septic
~ ~ c~~ ®
,~~%,aA
Dosing
Aeration
Holding
'TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD
Septic ~ Z ~ , !~ Ur ^r 7U
~_
Dosing No r
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer Demand
t„~L,l ems' GPM
Model Number t~~} j ~~'
~
S ~ ~
TDH Lift Friction Loss System Head TDH F
i~.~ r. ~i~f ~.ti ~S.y
Forcemain . Length Dia. Dist. to Well
'
I~IC ~- h
N~ - ,
SOIL ABSORPTION SYSTEM
ELEVATION DATA
county: St. Croix
Sanitary Permit No:
453280 0
State Plan ID No:
Parcel Tax No:
018-2003-05-000
SectionlTown/Range/Map No:
18.29.17.899
STATION BS HI FS ELEV.
Benchmark
Z. ~
/oZ,"v
/OCU..erC.~
Alt. BM ~ ~ ~ L
Bldg. Sewer
SUHt Inlet
IZ.v
~}o. c
SUHt Outlet
Dt Inlet
Dt Bottom !S• ~ 8G ~ L
Header/Man.
Dist. Pipe ,3. 5 ~S- ~
Bot. System
Final Grade
St Cover ~ , ~
`f(o.~
C~~ra-I-a~...i 5
Y. +tsilC~ 9 ~ - ~l
q'1 .$
~~
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Liquid Depth
DIMENSIONS I 1 G ~
\ '
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEAC Manufacturer:
INFORMATION CH ER OR
Type Of Syste ~
-
w ~ r i 7,~ ~ N• ~ ~ (
( h
f'` UNIT
I Number:
~
K+
~o `
DISTRIBUTION SYSTEM
Header/Manifold Distribution x Hole ize x Hole acing ~
f Vent to Air Intake
r~ pipe(s) ~-, r ~u ~~.
~ ~ 5~3~ Z, [
7 Ne r
i
Length Dia Length
Dia Spacing i.
SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Svstems Onlv
Depth Over
J Depth Over
t xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center
' ~ Bed/Trench Edges C Topsoil ~ ' ~>-i Yes ! ~ No j ~j Yes ~ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ /~/ Inspection #2: 7 / 1.h /Gt
KW~ QI.A~I.Qn'Eo'~1~/ M.tr~,C ~ n
Location: 991 156th Street Hammond, WI 54015 (NW 1l4 NE 1J4 18 T29N R17W) Crick Bottom Overlook Lot 5 Parcel No: 18.29.17.899
1.) Alt BM Description = ~- ~ 5' ~ o~u.-- ~'~ 3~ Pt61~ Qti' S~ ~'~'~owr Cr~
'.)Bldg sewer length = "~ 9 u t s`'-~"' +~[~ ~- ~o~
-amount of cover = SZ'
vision Required? [j Yes ' _ No
er side for additional inform io .
'R.3/97)
~V~ v
L----L--1- ~ -- --- -- ------ -------- ~ ~ -
Date Insepctor•s Signature Cert. t`
~ ~ Safety and Buildings Division
201 W. Washington Ave., P.O. Box 7162 County t
~~~ ~ - '--
'
'SC
O~s j~ Madison, WI 53707 - 7162
(fig) 266-3151 S~,itary pernrit Number (to be filled in by Co.)
De artment of Commerce S.3 ~/~
V
Sanitar
Permit A
li
ti smote Plan I.D. N
umber
y
pp
ca
on
!n accord wide Comm 83.21, Wis. Adm. Code, personal information you provide 7
J
maybe used for secondary Purposes Privacy La -- _ Project Addre
s
s (if dittereltt than mailing address)
G
~
~
I. Application Information -Please Print All Infor 'o S T .
~ ` / ~ ~
-~ao3- s=moo
r~
~ -~ .c, e~llo~~ ~~ .. _ ~ Parcel # Lot # Block #
~
's ' ingAtldtess ZONING OFFICE
~
~ x Propettyl,ot~tron ~ ~~
t
!
- /A~,u,/
~
Ci ,State ~ Phone Number -~~ Sectioaf
/.~_-+~ y6
T ~N
1Z~E
W
II. Type of Building (check all that apply) :
tIr
J
`.~
~ ~~ Su ivision N CSM Number
2 Family Dwelling - Number of Bedrooms
PubtidComrstercial - Describe U ~
! ~ ~
~ I S71 ~L(-- ~~ X / Q OYl ~ ~~ 8 ~
State Owned -Describe Use Gty
viltage~wnslup of
_ -
I IL Type of Permit: {Check only one box online A. Complete line B if applicable)
A' ~l~w S stem
/ Y R laoematt S m
ep yste TreatmentlHoldi TanY R
ng eplacement Only
Other Modification to Existing System
B • Permit Renewal Permit Revision t7tange of Permit Transfer to New Ust Previous Permit Number and Date Lssuod
Before Expiration Plumber Owner
IY. T of POWTS S s tem: (Check all that a I)
Non -Pressurized In-Ground Mound ~ 24 in. of suitable soil Mound < 24 in of suitable soil At-Grade Single Pass Sand Filter
Constructed Wetland Pressurized in-Ground Holding Tank Peat Filter Aerobic Tteatnlent Unrt Recirwlatiog Sand Filter
Recirculating Synthetic Media Filter Leaching Chamber Dtip Line Gravel-less R Other (explain)
V. Di tment Area Information: s
Deign Plow (gpd)
~ Design Sgil AppGcafio te(gp~st) i Dis Area R it+ed (st)
~
`~
' Disp«sal Area Proposed (sf) Sysoem IIevation_
J '
~ ~~ -rv 2' ~ .~J i ~ ,
VI.' Tack Info ~P~tY i Total Num Manufacturer Prefab rte Steil tber Plastic
Gallons Gallons of Units Concrete Constutcted Glass
New
Tanks Existing
Tanks
Septic or Holding Tank ~~
Aerobic Tteattneat Unit
Dosing Chamber > v
VII. Res onsibility Statement- I, the and a asibility for hu7allation of the POW'I'S shown on the attached lens.
Plulnbe~s (Print)
r Plumber' MP/MPRS Number Business Phone Number
~Ji try- / ~ ~(~ ~ ~~ ~ '" J ~t7
Plumber's Address (Street, City, State, Tlp )
r ~~l~l ~
l
,~ ~~,~/
VIII. Coun /De artment Use Onl
A _,•ed
~v
' ~ Disapprov Sanitary Perndt Fee (rncludes Groundwater
Stu+charge Fee)
~ Date Issu Issuing t S' o Stamps)
l
/ A.~.r-Cutrn R~fnr Denial 3 ~U
IX. Conditions of ApprovaVRea°s~ons~f"or Disapproval Lt:~ S_~~
STEM OWNED: ~~~%~~-~C~it ~~~ ~~,~'2~~
S-Z
~
C~ 3 `
-
1 e 17Z~rit'filter and ~ (iYZ~;~~11~2~~- /~2
/I / I
dispersal cell must all be serviced /maintained ~ ~~ /~ v t,~.~. sT2t~
as per management plan provided by plumber. ~L{~X CUnG~~.~~~~~ ~~
~
~ ,,
All setback requirements must be maintained ~ ~ ~G~~ `~~K~
~
~
G
as per applicable code/ordinances.
~q; 3
Attach complete plans (to the County only? [or the system oa paper not hxs than illL z 11 inehea is size
PLOT PLAN
PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025
NW 1/a NE 1/as 18 /T 29 N/R 17 w TOWN Hammond COUNTY ST.CROIX
5/21 /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 97.8'
AIt.B.M. is top of 2" pipe @ 100.0'
Scale = 1 /4" = 10'
375' Property Line
B-2
Huffcutt
Tank is to be properly Combo Tank
bedded and provided with
lockdown covers with
approved warning labels
156th St.
DewN4lAPfi 7bE of -rim FbWz'S
To Be >5' from property line
B.M. *~
97.8'
B -1~ i
2% Slope
Grading is to be done
to divert run-off
away from system
9 8'
9 7'
B-3
--
-~...~1
-la .~
402' Property
Line
e~...~ ^' 1C~
rp.._.~Q
~ ~e ~-e- s t'~
ca.~.e.
Area 15' below
system is to
remain
undisturbed
Pro 3
Bedroom
House
Well is to meet all
setbacks found in
Comm. 83
commerce.wi.gov
isconsin
Department of Commerce
~?~.A.,~1.JL...~~F r~'
JUN 0 1 2004
CONING OFFICE
May 28, 2004
CUST ID No.226900
SHAUN R BIRD
BIRD PLUMBING, INC
1008 192 ND AVE
NEW RICHMOND WI 54017
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
ATTN: POWTS Inspector
ZONING OFFICE
ST CROIX COUNTY SPIA
1101 CARMICHAEL RD
HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 05/28/2006
SITE:
PC Collova Builders
991 156th Street
Town of Hammond
St Croix County
NW1/4, NE1/4, 518, T29N, R17W
Lot: 5, Subdivision: Crick Bottom Overlook
Identification Numbers
Transaction ID No. 1004316
Site ID No. 684178
Please refer to both identification numbers,
above, in all comes ondence with the a enc .
FOR:
Description: Proposed Three Bedroom At-grade System
Object Type: POWTS Component Manual Regulated Object ID No.: 960570
Maintenance required; 450 GPD Flow rate; 37 in Soil minimum depth to limiting factor from original grade
System(s): At-grade Component Manual, SBD-10570-P (R.6/99), Pressure Distribution Component Manual,
SBD-10573-P (R.6/99); 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:
• 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 POWTS".
The pressure network is to be constructed in accordance with publications SBD-10573-P(R. 6/99) "Pressure
Distribution Component Manual for Private Onsite Wastewater Treatment Systems" and/or the sizing methods
of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81)".
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
• The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil
compaction in this area is prohibited.
• A state approved effluent filter is required. Maintenance information must be given to the owner of the tank
explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided
per Comm 84 product approval conditions.
• Comm 83 22(7) - A co~y of the approved Mans 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. ~ ~~ ~"`i T.S.
C'Qjtc~Ig~onall
t't; III ... _ .v
' SHAUN R BIRD Page 2 5/28/04
Owner Responsibilities:
• The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating
to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and
maintenance manual and/or owner's manual for the POWTS described in this approval.
• Comm 83.52(1)(a) -The owner of a POWTS shall be responsible for ensuring that the operation and
maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.
Comm 83.54(1).
• Comm 83.52(2} - A POWTS that is not maintained in accordance with the approved management plan or as
required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption
system or any of its component parts malfunctions so as to create a health hazard, the property owner must
follow the contingency plan as described in the approved plans.
• The owner is responsible for submitting a maintenance verification report acceptable to the county for
maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized
in the POWTS.
In granting this approval the Division 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,
Gerard M. Swim
POWTS Plan Reviewer -Integrated Services
(608)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm
j swim@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
Date: 05/21 /04
Owner: P.C. Collova Bldrs. Inc.
9F
~~9~~~ ~~` cF2
g FO
so
~`
Location:NW 1 /4NE1 /4 S18 T32 N,R17W Lot 5 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 ontigency
9-11. Soil test
f
Shaun Bird
Signature
License num r 226900
~~,~.
CFPARTMENT OF COMFJcERCE
DfV1SI0N ~F SAFETY AND BUILDINGS
SEE CORRE PONDENCE
REGEIUED
MAY 2 4 >~0~
SAFEfiY & BLDGS D~'I~t.-`:
PROJECT P.C. Collova Bldrs. Inc
PLOT PLAN
ADDRESS P.O. Box 489 Somerset Wi 54025
NW 1/4 NE 1/4S 18 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX
5/21 /04 BEDROOM 3
MPRS Shaun Bird 226900 DATE
CONVENTIONAL AT-GRADE )OQC 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 *g,R,p, same as benchmark
SYSTEM ELEVATION 97.8'
AIt.B.M. is top of 2" pipe C~ 100.0'
DewNSLOPrE. ToE of THE FbvJTS
To Be >5' from property line
B.M. *\
97.8
B- 1i i
Scale = 1 /4" = 10'
375' Property Line
2% Slope
Grading is to be done
to divert run-off
away from system
B-2
Huffcutt
Tank is to be properly Combo Tank
bedded and provided with
lockdown covers with
approved warning labels
156th St.
9 8'
9 7'
B-3
402' Property
Line
Area 15' below
system is to
remain
undisturbed
Pro 3
Bedroom
House
Well is to meet all
setbacks found in
Comm. 83
~:
:_k:.
~t l B ! ~ 5
- r t - PYG F04ZC,E.MAi N .~.~
rJ E 'r 2 - ~_.,.-TURN- 1..3 PS" ~ a
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STA81Lt~~D tJbserva#it3n------~,,`
We ! ! .~
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> ~E
` /a SLOP
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A ~ - 2'
~istribuxion Lateral
.~-~ Soil COVQr
2rr - ••':i
~~
.- Ptav~t~~ i.nYE2
? 5'
Plan View and Cross Section o£ GTisconsin At-grade Unit with a
Single Absorption Area on a Slopi>7g Site
C,tiGNt~?u RE. ; L.1c~N5~.#~ _
Page gf
Distr~tbution Pipe Detail for Lateral ~tetworlc
••T;tRN-uP" ~C1.~~ouT~
PuC force Hain
* Last Hole Should 8e Next To
"'~'"'~ ~ PYG Oistr'ibution Pipe
~~
J/
RC Ce SC'
~~~
P C~ ~ Ft. Ho3 a Di a~aeter ~~ Inch
X ~""I Isn~ches Lateral diameter ~,_ Inch(es)
f
Y .__L.__.. inches Fore Main Diameter `~.-_~___ Inches
~ 4f Holes/Pipe ~__~~,_
Invert Elevation Df Laterals ~_, ~~ ~t•
Signed;
License ~iwr~ber:
Date:
._...-
:Q~ AND SP£CLiICATICNS
A13K ~ p~Mr C{.AMByR CROSS 5£OT`
C '~
.. KZ3~i . ~,BOy E GRADE ~
~» G~ VENT PIPE ~4tINDdi~ QR
y ~ ~'RflK D40R. r
FAEaI* - r f,,,,
18° IN--
INLET ~ _ ... --:: -~,-,.
TI6~iT g~I.S
~fLT£~ `~
APp~~ ~ ~T -
pU24P {}FF ELEV • ._..---
SOIL
~t£FctH£RgRtiQ~
J~33~CTIfli~ $flX
W~TK C4hDL~IT
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BEDDI3~tG V i~DEg TA2+il~ CpN~ ETE gAfl
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SPEC;FZCA'L'IONS
pSES P£g I?AY = f
2+1Lii~f BER ¢
SEpTYC ! DOS£ t ME ZISCL~DIN6 ~GAL-
TANK GAL • - ~f ~L.:~.~-
SEPTZC ~1~~~ 6~P-L . J -~Z3~ICHES
TA11K SIZES = DttSE CAPACITIES= ~'' r a =~~GAL-
~~,, //~ ~ y3,fCHES
~„tA~1FAC'I~3RER;~ L 8 . ~° ~ Ct~ S ` ~-=~~ ~/'L'
ALA MODEL NU!lBER-: ~r - C ZN E ,
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1~ n = ~.. ZriCK~S = /~ --
PEJt4P ~~gAC?LiR~ • -?~ ~ Z ~g 15.23 WA(
-' KaDEL Mf!'I$ER = ' ~ ~, ~r~ty' L.ARM ~tZRIi~tG AS PER
~;TCfI TYPE- ~ ~ -ZGPti - P[1lfP ~ 1'' ~~~j~EET
RpTg ~ •gION PSP£. ~ 'EET
RE~IR~ DISCHARGE DISTgZ8~3 - - ~ = BEET
BE~EEPt pU1~4P fli F ANg - FACTQR J `~aF=FEET
vFR3'ICAL gIFF£R'ERC~ 5U E,E/Ii3g-FT..F:ZZCD~~~~C M~;AD~ ~
.~
+ MYNIMUM H~T'NORK SUPPLY ~R
FEAT FORCEMAI# TpTAi. DI~yETER -----_
* _s~~- y- ~~"-r s~zaTx~
{~~ F~~? TANK. L"~~~ ~ ~~~~
IpT£R~L DiMENSIDI~~
LICENSE IQU~''SBKR
!f88
W
~ W
50
153
12 40 ,52
°a
i
U
~ 8
a~
a
0
.-
4
0
HEAD CAPACITY CURVE
MODES 152/153
20 !
~ . ~~
lp
I
20 40 80 80
dS
2S 0 80 160 2~0 320
FLOW PER MINUTE
1
- .TOTAL DYNAMIC HEAD/CAPACITY
PAR MINUTE
~~~! uFNT AND DEWATERING
MOCEL , 152 ! 153
Feet
i Meters I Goi. , Lifers Gn!. Liters
5 1.5 69 I 261 77 291
7 0 ~ 3.1 I 61 231 70 i 265
15
4.6
~ 53
2 1
0
61
,. t
20 6.1 I 44 i 67 52 1 g7
25 7.6 34 129 42 ? 59
30 9.1 23 E7 33 ! 125
35 1~.7 ! -- --- 22 85
a0 12.2 -- ( __ 11 ~ 42 i
Lnck Volve: 38.0 Ft. (17.6m) 144.0 FL (t3-4m)
D14300
3 27
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Timed dosing panels available. ~ ~ 3 I!ed 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.
• Sealed Qwik-Box available for outdoor installations. See FM1420.
• Over 130°F. {54°C.) special quotation required.
1511153 Series
32
32
I
i~ ,
i
i !
;z ,js I
P I. ~ 5 ,/9
~ _L
~ ! I
SELECTION GUIDE
O C TION
All installation of coevals, protection devices and wiring should be done by a qualified
licensed electrician. All olsetrieal and safety codas should be foflowed including the most
recent National Electric Code INEC) and the Occupational Sefaty and Health Act (GS1iA).
1. Single piggyback variable level float switch or double piggyback variable level float
switch. Refer to FM0477.
2. Sae FM0712 for correct model of Electrical Alternator E-Pak.
3. Variable level control switch 10-0225 used as a control activator, speary duplex (3)
or (4) float system.
RESERVE POWERED DESIGN
For unusual coeditions a reserve safety factor is engineered into the design of every Zoeller pump.
9fA1L 1'0: P.O. BOX 16347
CousviHe, KY 40256-0347 Menufachuersof. .
SNIP T0: 3649 Cane Run Road ~ ,S%vcE 1939 °
~a ® Lo~isville,KY402it-1961 ,Q[GauTYPl.6tfa9
(501 7. ~ (~2~ n4o3~~PUMP
~° PUMP !O.
~lla• rem _
p Copyright 2004 Zoeller Co. All rig s re
•~
wisoonsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of safety and B~Idings
in acooraance wim c;omm aa, vns. gym. was ~, ~ 'D ~ ~
~
Attad- complete site plan on paper not less than 81/2 x 11 i
inducts, but Fat Umited to: vertical and horizontal refererxx3 poi es rn
(BM ~ E D I.D.
( ~ q
-
percent stops, scale or dimensions. north amen. and location rrd distance to nearest road. ovo
"'
p ~` - ~t7D ~ - O$
Please print ail information. MAY 0
~ O 4
~
0 by Date
~~
Personal iMorrnebion yar provide may be used for secondary WxP~ 4 (1
j
t~~Y Lsw, s. 15. y~'~, . ~
~
Property Owner ~ , ~ / ~ f/ ~
0 1 S ZO F I CAE ~ ~ q ~ 1/4 S ~ T N R E ( W
Prop~(y owner Ming pdd~ ~ Lot Block #
-- Name ar
L'r;c
tally State Zq~ Code Phone Number City ^ Viffa~ Twvn Nearest Road
tii)1
New Construc~OrF lase: ntial / Number of bedrooms
^ Replacement ^ ~ c or - Describe:
Parer material ~ w
i° . S~ ~f~,.., e IB ~~~~-
s s~~... ~- ~- ---
Code derived design flow rate r ~
-
Flood Plain elevation 'rf applicable I'`~ ~ A-
~' ~ ~
~
-.
GPD
R
~9 # Ground surface elev. l D . V ft.
Pit l
Depot to I~rirflng fa(xor _ ~~~ in.
Soil
Rate
tioriza n Depth Dom~ant Redox Description TextFUe Strtx~xe Consistmrce Botmdary Roots GP DIf~
~. Munsep Qu. Sz Cord. Cobr . Sz Sh. 'Eff#1 'E
A~ ~ ~ ~ ~• /- P ~ I
~-
Pit Ground surhaoe elev. ® ft Depth to lirniting factor ~. SoH Rafe
® ~ ~ '^"~
horizon Depth Daninant Redox Description Texture SiFUdFFre Consistence Boundary Roots GP D/(~
~. MunseN (au. Sz. Cont Color Gr. Sz. Sh. 'E~1 ~~
~, ~ _ ~/ - S ~ m m~2 w .~
..3 r ~/~ F d r y/iP ioFs - mF2 n ~a a ~ 3 ~ f
Effluent #1 = BOD > 30 < 220 mglL and Tss > mg1L ' Eflluerd #2 = BOD <_ 3o rngll and Tss _< 3o mgA.
CsT Number
~"
q Date Evah~ion Conducted Telephone Number
lam S /`9h.~~ ,~~ /(/,~,~ i~/~ .~ ~.,.,.. /vi < <I~! ~ /a --~ ..~ ?/~'- a ~6- ~.f~
r--°
r ~ 9
~~ V
Parcel ID #
Page of
a
Pit Gnwnd surface elev. ~~ ~ ft. Depth to IimiHng factor Sod Rye
# ° .
tiotimn Depth Dominant Redox Description Texture Stna;hue Consistence Boundary Roots GP D/fP
~. Munsed Qu. Sz Cont. Color Gr. Sz Sh. 'EtT#1 'Eti#Z
-~ 0 3/z ~' S~ ~~'n r n~~rz L S am ~~
S s~ am m~~ ,~ i~ , ~ ,
o ~~# ^
^ Pit Grotxtd surface elev. R Depth m iimit~g faQor in.
Sod Rate .
Horiaon Depth Dominant Redox Description Texdre Strucdxe Consistence Bourxiary Roots GP OVfP
in. Munsen Qu. Sz Cont. Color Gr. Sz Sh. 'Eti#1 'Eif#2
Boring # ^ ~9
^ Pit Grotxrd surf~e elev. ft. Depth th limiting factor ~.
Sod Rabe
Horizon Depth Dominant Redox Description. Te~dtae StnicdAe Consistence Botmdary Roofs GP DVti:
in. Mur>seq t1u. Sz. Cont. Color Gr. Sz. Sh. 'EtT#1 'EtT#2
' EtHueM #1 = BODs > 30 <_ 220 mg/l and TSS >30 < 150 mg1L ' Ettkamt #2 = BODa <_ 30 mglL and TSS _< 30 mgA.
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 608-266-31 S 1 or TTY 608-264-8777.
seoa33c(R-~~
• Soil Test Plot Plan ,
Project Name P.C. Collova Bldrs. Inc. Shaun Bird'`
Address
P.O. Box 487
Somerset Wi 54025 CS 226900
Lot 5 Subdivision Crick Bolton Date 1 X02
1/4 NE 1/4S 18 T 29 N/R17 W Township Hammond
Boring Q Well PL Property Line County ST. CROIX
BM r VRP Assume Elevation 100 ft. Top of Survey Iron
System Elevation 97.8' *HRPSa nchmark
Alt. BM ~ Top of 2" Pipe @ 100.0' ,
B_M
B-1
r-- 100'
45'
30' B'
0'
375' Property Line
45
3%
Slope 402'
Property
Line
98' 97'
EKT PLAN
ppWTS OWNERS MANUAL 8~ MANAGEM
~vsTEM SPEC1FiCATiONS
Number of Bedrooms
Number of Commer'~l Units
Esdmated ~ ~'~~
Design fbw (p~14+ (Estrmat~ed x 1.5}
Son App~~n Rate
l~ ifluent QuaGtY FOG)
Fats.-Od 8 Grease (
en Demand (BOOS?
Biochemicel Oxyg clad goods SS)
Total Suspen
pled Effluent Quality - ~
en Oemand (SODS)
Biochemical Oxyg
Total Suspended Solids (TSS)
Fecal Conform (geometric mean)
Maximum Effluent Particle Size
J E/
Monthy average'
S30 mg/L
420 mg/L
Monmy average"
~i0 mg/L
530 mgn.
5i0' cfu/4QOmt
y inch diameter
^ NA
^ NA
D NA
^ NA'
^ NA
Disper8et ceu~s) ~ p In-ground (pnsssuttzed)
p ground (gravltY) p Mound
.grade ^ Other
~. ---
Ics! for domestic (nc^'~"'^a~Q rrasterrater an0
values tYP
septic tank etlquent. „,~stewster.
.• Values typTal ror preu+ss~
Service Frequency
Service Event
Inspect oond'Rton of tank(s)
Pump out contents of tank(s)
lnsped dispersal rail(s)
Cieaut effluent filter
inspect pump, pump controls 8~ alarm
Flush laterals and pressure test
At feast once every .~
When combined sludge and scum
At least once every
At feast once every
At least once every
At least once every
At least once every
At least once every
p year(s) (Maximum 3 yrs.)
one-third (y) of tank volume
p year(s)- (Maximum 3 yrs.)
p moncns.~s: 4• ~-~
~ months ar(s) O NA
p month ear(s) O ~
p months ^ year(s) p NA
p months ^ year(s) ^ NA
rt one of the fcttowing Ccenses or
MAINTENANCE INSTRUCTIONS an ind'nridual carts nsPe~or: POVY~'S Mainia'snet; Sgptage
inspeGions of tanks and dispersal cells shall be Raest cued Sewer, POV1r'rs ~ missing orbroken
motions: Master Plumber. Master Plumber on of the tank{s} to adendfY y for any back up
ns must include a visual inspedi a and scum and ro check
$e~g Operator. Tank mspedio measure .the volume of comt~ined sludg ~ ~~ the efAueni Levels
hardware. Identify enY packs or leaks, The disperses! cell(s) shall be visually inspected ~ir,tg of effluent on the
,~ wing of effluent on the ground sut~ce. nding cf effluent on the ground surface. Tt18 P° auti,orrty.
i and to check for any po uires the immediate notification of the focal regulatory
in 117e observation p pas or more Of the tank volume, the
ground surface may indicate a failing condition and feq in any tank equals one-third (K) ch. NR
e and scu razor and disposed of in aa~rdance `""~'
When the combined esoatmula6on of studg a $ep~ge Servicing Ope
entiia contend of the tank shat( be removed by ~ment oomponents~, and any
113, Wisconsin Administrative Code• onents, Pm~a certified pOWTS Maintainer.
of effluent filters. mechanical or pressurized POYYTS comp ~~ed try
The setvicyng at intervals of 12 months or less shall be A~ of compienon of any service event
other maiMenanoe or monito ~ 9ed to the local regulatory authority within 10 days
re shalt~be provi
A ser~ige Port eructs or other
for the presence of painting p
STARTUP ANO OPERATION POWrS ~~ treatment tank(s) e~ cell(s). if high conoen~tions are
For new ceny~bruc6on, prior to use of the
e the treatment process and/or dam e9se acing operator Prior to use.
chemicals that may impel removed by a septag
detected have the contents of the tonic(s)
Page~a `~i
- ~~
Septic Tanfc CaPesdri
~c Tank M~~cwrer _
Effluent Filter Manutaduror *'
Effluent FI-ter Model '
~ Pump•Tank CapadtY ~ J~
~ ~~u-
pump Tank Manu{a~urer
.pump Marli.tf~CtUrer -~
j
a Pump Model
P~tr+eatnnent Uni~r p Peat Fl[ter
D SandlG
~~
p Wetland
p Mechanical Aeration ^ Other. •
^ D~infedion
/ _ Page Zof„~,.
r`~~ editions are frozen at the in6ltr'auVe surface-
soi['co wt,en power is restored the excess
System start uP shaft not occur when ~ ab~$ normal higfiwater lee,rels•
~rSoading the oeH(s) and may result in the
Cucin9 ~r °u~es Pump tanks tnay cart(s) ~ one forge dose. tank removed by a
~er,nn"II be dts~a<''9ed to tt~ d1sPe~
e of efttuent. To avoid this situation fiave me ~ncontad as Pltttnber or POYYTS Maintainer m
bac~arP or surface ~ '~ pcior.b0.re3~Ot'ln$ power tQ the efRuent Pu s w[tttin the pump ~.
age Servidng ~ p~P ~ntrofs to rr'store nomzai rave disturb or oompatx.
ash in manually o~'h - ~, Oo not drive or park over, or otherwise .
. or tic vehicles over ~nlCS• and disper'Sa1 rich attys.
Oo not drive Pa 0f ~,y mound or at-grade soft absdrp
the area ~Itlin '15 feet down slope . ter strum may impr~e the perfomtanoe and prolong the life
{tom the wastewa d neaseis: dental doss; diapers,
Reduction or~ei'imination of the ~ollonNtn9 dgat~ette butts; condoms; cotton swabs: e9
of the POWTS: antlbiot3c~; ~babY ~P~~ ~ ~ eftngs; gasoirne; gt+ease;~ herbiades; meat
~ tourida6on dra3in (sump pump) water; trait and vegetabEe Pe ns; snd water softener brine.
disinfectants: ns: 011; Paintingducts; pestiddes: sanitary napk-ns• Campo
~~' m •_ m Insane that the
AgANDON~MF~T taken out of service the fot[owing steps shaft tae taken
When the P~OVYTS falls andtor is Pe~~n 0ompliance with cfi- Comm 83.33, ~scansin Administrative Code:
y.~~ ~ properly atnd safety abandoned neded and the abandoned Pipe ppenings seated-
. All piping tD tanks and pits shaA ~be disoon disposed of by a SePtage Serv[cing Operator.
The contents of art tanks and pits shag be removed and prope~Y
After pumping, a([ tanks 8nd pits Shat[ be excavated and removed or their covers removed and the void space
filled with sail. gravel or anott;er inert solid material
CONTINGENCY PLAN the follow[n9 measures have been, ar must be taken, to Prowde a code
If the POWTS faits and cannot be reP~
compliant reptaCement system.
nt'anea has been evaluated and may tie utilized for the location of a rePt~ and should not
~ a s~ ~tent~p ~ ~ replacement area should be protected from disturbance and comps
aired setbacks from existing and proposed strvc~ne, tot tu'es and wefts. Failure to
be infringed upon by fe9 alt in the need for a new soil and site ~evatuaiion to establrsh a surtable
protect the replacement area mU ces tams must comply with the rules in .effect at that time. nCes in POWTS
replacement anew- Reptaoement sys an or sot -
p its replacement area is not avail
t o m ed as a last resort to replace the failed POWI-S.
• ble re fa t area U failure o e POWTS so7.and
e t n tact ~ a e~ a suits re r P semen a If no PI en S oust le a
s lu n m _
hotdng tank may be installed ss a last resort to replace the failed POVYfS.
Mound and at-grade sot[ absorption systems may be reconstructed in Pty ~ tlowt~ngn ~ ~ mat time. at at
~e infiHraUve surface- Re°ons~~ns of such systems must comply
<cVifARNIIJG» 'TANKS MAY CONTAfN LETHAL GASSES ,ANDIOR INSUFFICIENT OXYGEN.
SF~TIC, PUMP AND OTHF~ TRFAThIENT CIRCUMSTAAlCES. DEATH MAY
DO NOT ENTER A SEPTIC, PUMP OR OTidER TREATMENT TANK UNDER ANY
RESULT. , RESCUE OF A PERSON FROM 7'E-1E INTERIOR OF A TANK MAY BE DtFFtCi1LT OR [MPOSSIBLE.
ADOtTiONAL COMMENTS .
POWTS MAINTAINER
POVYTS INSTALL R
<_ Name u .~ ,
Name . Q sue, !v ~ T
J ~' ~}- ' j~~"~ ~ Phone ~/ .~ ^' ~ 7 ~' ~•~
Phone ~ ~;
LOCAL REGULATORY At1THORITY
SEPTAGE SERV[C(NG OPERATOR P MP6R
Name ~?~-~... ~ Agency ~~ r
Phony ~/ ~°'~-''" ~ ~ 'r
Phone '~ / -°".- ~,. ~ This doarment meets
This aocvmerrt was drsttsd ty the sus of the Green rake. Marquotte and Waushara County Zaning and Sanita~ Uendesttds Qoeument does not
the minimum repuuertients of dt_ Comm 83.22{~(bH1Xd}~(n and 83.54(1}. (2} ~ (3). Wrseonsin Actmtr~ati+m
{-,MW (210U
guarantee the pedorrnartos of the ppVYTS.
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 -
(Verification required from Planning Department for new construction)
City/State (.,~Z- Pazcel Identification Number ~l ~~ a-D 6 3 - O S 6L~ p
LEGAL DESCRIPTION
' 1 _ ~~
Property Location %,, IVG~ i/,, Sec. ~,, T,~N-R~W, Town of C~ `(.~/
Subdivision
Lot #
Certified Survey Mafp # Volume .Page #
Warranty Deed l (~~~(j~'-C ~ Volume Page # C~
Spec house yes ^ no Lot lines identifiable f~ 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 tlu function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner. and by a
masterplumber, journeyman plumber, restrictedplumber or a licensedpumperverifyingthat (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
stn ' t your se ti tern has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
~ o iration date.
P. C. COLLOVA BUILDERS, fNC. .~ / ~gi ~`~
SIGMA OF APPLICANT (715) 247.2742 DATE
P.O. Box 489
_ ___ _ _ SOMERSET, WISCONSIN 54025
that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
above, by virtue of a warranty deed recorded in Register of Deeds Office.
_ P. C. COLLOVA BUIL®ERS, INC. S i ~~7i d~~
SIGMA OF APPLICANT (715) 247-2 ~ 2 DATE
P.O. Box 489
SOMERSET, WISCON9f/~I 54025
****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ******
r''~
** 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
U 1950P 5281
STATE BAR OF WISCONSIN FORM 1-1998
WARRANTY DEED '
Number
husband and wife .Grantor, and P C Cdtova Bulders. Inc. .Grantee.
Grantor, for a valuable consideration corneys to Grantee the following
described real estate in St. Croix County State of
Wisconsin (the "Property'):
687242
KATHLEEN H. MALSH
REGISTER OF DEEDS
ST. CROIX CO., YI
RECEIVED FOR RECORD
08-16-2002 9:00 AM
~iD®
REC FEE: 13.00
TRANS FEE: 1155.88
COPY FEE:
CERT COPY FEE:
PAGES: 2
Area
Sow Exhibit A attached hereto
P' C~/CotlOVa Buiklera, Inc.
Fx/t~~6jr0tl~ Avsm»
mood , WI 54015
~~~ 909
O18-1039-20-•000 / 0
018 1039 80 000
Parcelfdentlflcetlon Number (PIN)
Thla Is oat homestead Droperty
(la) (IS not)
Together with ail appurtenant rights, title and Interests. none
Grantor warrants that the title to the Properties good, Indefeasible in simple fee and flee and clear of encumbrances
except
Dated this 1 th day of August' 2002.
(SEAL) (SEAL)
• hn J. Iton arolyn G. alton
(SEAL) (SEAL)
Siynature(a)
authenticated this NO ~C _
$TA~~ ' ~ .. ~F-'
T1TLE: MEMBER-STATE BAR OF WISCONSIN
(If not,
authorized by §706.08, Wis. Stets}
1~j
ACKNOWLEDGMENT
Stets of Wisconsin,
} ss.
SL Crobt County
personally came before me this 1;~ day of
Aucust. ?f~0 the above amed
a and I It ban nd W if
• ~.~ u ~w~kz,~
Notary Public. State(of Wiswnsin
THIS INSTRUMENT WAS DRAFTED BY My commlasbn b pe anent. (If not, state expiration date:
Coldwell Banker Bumet ~~S Vy )
1301 Coulee Road
Hudson, WI 54018
2-32470
(Signatures may be authenticated or acltrtowledged.
Both are not necessary.)
• Names of ons s n In an a must be or rioted below their s nature.
STATI? BAR OF liY1SCONSIN W isconaln Legal Bienk Co, Inc.
WARRANTY oeEn FORIYt No. 1 -1898 Milwaukee, Wis.
~VE,hLf,oK
~ o~ 2
_ '. ,
';:
.;.
......:....,.,.::.r::~:1-W:~;w-i;,,.a,r~„~,vYr,,~.~w.aruYi"btl,;, -. ~~ ,• ~ ~ , .
r : ~ ~..Q ,
A part of the NE'/. of the NE /and In paR of the NW '/. of the NE'/, and in part of the SNP % of ,
the NE '/. of Section 18, Township 29 North, Range 17 Went, Town of Hammond, St. ~Craix
County, Wisconsin and more partkularty descrit~ed as: BegicrMng at the Northeast comer of said
Section 18; thence S89.33'31"W 372:01 feet along the North ilne of the NE'/. of said Sectlon 18;
thence S89'33'31"W along the North line of the NE '/. of spid Section 18 775.94 feet; thence
S00°52'23"E 250.00 feet; thence S89.33'31'1N 968.24
thence S89'33'31"W 528.00 feet; thence S00°52'23'E alor~ a North-SouOth Qua er Secttoilf Itne
of said Sedlon i8 1311.77 feet; thence N89'33'39°E 628,33 feet; thence N00°31'25°W 330,23
feet; thence N89'33'24"E 692.76 feet; thence N00°52'23"W ~g the East line of the SW % ~
NE Y. 330.31 feet; thence N89°33'24'E along the South Ilne of the NE Y. of the NE '/. 949.09 fast;
thence N00°52'24'W 1321.19 feet to the Point of Seginnlnp.
~~ t ~ go~ M
6 U F-~2-L..~v ~
2 or- ~,
R.A. = N 89'32"25 W
' ~ `/0~ ~b~"~~'~ N 89'33'31 " E
~`~~~ ~.r ~~~ ~~±~ ~--~'v ~• ~ ~~~ 966.24'
~ `"~' '~ 364.35' N 89'33'31" E
277.52' 242.05' -~
~o~
`, ~`~~ ~ ~, LOT 4
LOT 7 ~ LOT 6 "' N
72341 S.F. ~ 66731 S.F. ~ 76393 S.F.
~ S 1.66 Ac. ~ 1.53 Ac. ^~ ~: 1.75 Ac.
3~ ~ .'~
w ~
0
~ ~ [.~ N
~ - ~ ~
2~ ~~' LOT 5
~~ ~
T 8 ~ 72091 s. F. ,
~, ~ 1.65 Ac. J
9 S.F. ~ ~ ~
/ ~ ~ ~
~OD ~ N 37'53'40" W / i ~ ~~
89'33'31" E 329.51' ~ I „9'~ 34.26 / , ~
d ~ ,6
205.21' ~ / / ~ ~ _ O
3/4" _
S ~~ / ~ /
'~j O ~
LOT 9 N 37'53'4,0 W O ~
N 34.2 ~ , / / s
0 89166 S.F. ~ ~ 9~ ~o
~.
g 2.05 Ac. ~ ~- / `~ LOT 22 ~~,,
N / ~ ~i9
/ o r ~,,s ~ 93180 S.F. ~ \
0 0 3 4 Ac. \
/ ~a
cwo. / /~ „~ ~ ~ / o IN ti /ryo~ \ ~ .
/ / ,4 ~ `~ ~/LOT 21 ~~,
~ s. F. ~
/ / ~,~ 102328 \s
"~'s•
/ / / ~ 2.35 Ac. ss
// 4,~ / S o. ~~ ^as Aso = 1020' `~~.
// ~ /\,s 3 N o S \
6 \
/ ~/ / / sue, O),, Qo ~ Sp.
~2.
/ / ~ ~ \
/ LOT 19 ~ 489 ~ ~ "F
/ \ 78397 S.F. N ~ ~A~ , ~
\S
i ~ \ 1.80 Ac. 3
\ L80 1014 ~ ~ ~ ~ ~