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HomeMy WebLinkAbout018-2003-06-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal. inforrrr~tion you provide maybe used for secondary purposes IPrivacv Law, s.15.04 (1)(m)l. 'ermit Holder's Name: City Village X Township P.C. Collova Builders, Inc. Hammond Townshi ;ST BM Elev: Insp. BM Elev: BM Description: ~~ ~ ~~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~ ~G~I, 'tom /~~ Dosing r~ Aeration ~ ~( ~^} ,/~ /~ 4a~.~.., k~ Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic / ~A- , 57 ~ y7 `_ Dosing L i ~ s ~T ~~ ~ ~ 7 ~.7 / ~. Aeration Holding PUMP/SIPHON INFORMATION Manufacturer ~ Demand d GPM Model Number / ~ ~ 2Z(, "~ TDH Lift 5 S Friction Lo~ System Head TD i Ft , + ~ , Forcemain Length ~ ~ Dia..Z / ~ Dist. to we I ~~ SOIL ABSORPTION SYSTEM county: St. Croix Sanitary Permit No: 453393 0 State Plan ID No: Parcel Tax No: 018-2003-06-000 Section/Town/Range/Map No: 18.29.17.900 ELEVATION DATA •7_ _~,~ 102 •05 STATION * BS HI ~ •5 FS ELEV. Benchmark /, ~ ~®~ ~ ~ ~~ Alt B B s'~~ * r 1 ~ ~~~ ~ ~ Bldg. Sewer - ~ 7 r L q/ /~0 SUHt Inlet ~ g , ~ ~~ ~~ SUHt Outlet Dt Inlet ,\ Dt Bottom iZ.Z ~0 ~3 Header/Man. z ~Z5 y 9~ 8 Dist. Pipe Z •~ c- ~ ~ ~ Bot. System 3 ~ Z ~Ss~ Final Grade Z 1~6.~ St Cover BEDITRENCH DIMENSIONS Width ~~~ Length C3~ ~ No. Of Trenche [~ C. PIT DIMENSIONS \ No. Of Pits Inside Di\ Li id Depth SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacture INFORMATION CHAMBER OR Type Of Sy tem: ~~ ~ ~ ~ ~,` ~ 7 ~ ~ ~ ~ UNIT Model Numf~ ~~ DISTRIBUTION SYSTEM Header/Manifold f / Length~Dia Distribution Pipe(s) ~ t/ Length Dia ~ Spacing x Hole Size S' ~/ ~~ x Hole Spacing ~i Z.~ Vent to Air Intake p 1~: ~o• SOIL COVER x Pressure Systems Oniv xx Mound Or At-Grade Systems Onlv "st Depth Over Bed/Trench Center , ~ Depth Over Bed/Trench Edges \ xx Depth of ~ Topsoil ~, xx Seeded/Sodded xx Mulc e~ ~ Yes [~ No Yes L] No COMMENTS: (Include code discrepencies, persons present, etc,) Inspection #1:~/ Z /~ Inspection #2: / / Location: 993 156th Str et Hammond, WI 54q~15 (NE 1/4 NE 1/4 18 T29N R17W) Crick of m Overlook Lot 6 Parcel No: 18.29.17.900 1.) Alt BM Description = ~~~-e~ ~~ ~r dCt ~ ~~~ ~ Idi'"`~ ~' v ~. 2.) Bldg sewer length = g j ~ F~~ ~~ 5 ~ se:tF, arm c~.C~a - amount of cover = u ~ ~ ~ ~v tr~j~ S~~ ~t aw ~~ Plan revision Required? ~ ~~ Yes No Use other side for additional information. SBD-6710 (R.3197) I Date 1/ ~~ Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 Counry~~ ~ ~~'t7 \ ~, jS~~~~j~ .Madison, WI 53707 - 716 Sanitary Permit Number (ta be filled in by Co.) (608) 266-3151 S 3 3 De artment of Commerce Sanitary Permit A ~lication z ~ _ j ~ Stagy Plan `.°. Number ~~~ ~ ~ 2 ~v n ou vide l inf ti C d W Ad 83 1 orma o e, persor ia ts. m o : , In accord with Comm X. .P?~__o..~.____a,_,<_,..,.,,._ maybe used for secondary purposes Privacy Law, si 5.tl~xm '~~ ~~~~~ ~ Address tf different than add<ess) 1 C ~ . sr X93 /s~ L Application Information -Please Print All ~ ~r ~ property Owner's N ~ l~ P l # Block # ~ ~ n ~ , .,. ~ Address ~ _~ r~ i~ ~ - r 1,,- . Ptopetty (1wt~c~g I ~ tng ~ ~ ' /~ ~ _....._.__,..._..~~_•.._....._,_„_. 71f/ V ((f ,~ On f {;-=-~i /~I /~ /~ Sxtron ~~~ City, State L T,rp CoJ <~ Y Phone Number - T~ N:Ht ~ (E o W) ll th t l c app y) ~~ k a a II. ype of Building (che /~ ~~ - Number of B Dwellin il 2 F ubdivision acne CS~~u~b~er _ '~ / / g y am / ' k 9~ ' PublidComrnavial- DasaibeUse ~ (fi't- ~O •J '/~'l~ ~~ X 9~ ~? ' qty- Y~'8e ~P of , be Use State Owaod - Desen III. T ype f Permit: (Check ody one boz online A. Complete line B if applicable) ~!' S m Replacement Systarr Tteatmeat/Bolding Tank Replacement Only Other Modifiin>tioa to Existing System 8. Permit Renewal i ' Permit Revision Change of Plumber Permit Transfer to New Owrxx L,ut Previous Permit umber and Dace Laved ~,,J~~ uat on Befon: Exp lv. T e of POWZS S tem: (Check all that a I ' Non -Pressurized fn-Croand Mound _> 24 in of suitable soil Mound < 24 in. of suitabl4 soil At-Grade Single Pass Sand Filter Constructed Wedand Prrxsurized in-Ground Bolding Task Peat Filter Aerobic Treahneat Unit Rec~rwlating Sand Filter / Recirculating Synthetic Media Pilt~er Lsacbing t~ramber Dri Line Gravel less R Otter (explain) Y. Di reatmeat Area Information Des Plow (gpd) Design So ~ a f) 1Xs Area Required (sf) Di Area Proposed (st) S Elevation 5~ YI. Tank Info ~P~+ ~ Totat Number Mann[acturer Pr+cfab Site Steel Fiber Plastic Gati Gafloas of Units Concrete Constructed Glass New Fsisdug Tanks Taub Septic or Holding Tack Aerobic Tceatureat Unit Y _ • ~ ~ Dosing (7iarnber ~~ YII. Res tlslbili Stetem - I, the aced asst~e "bility for installation of the I'OWTS shown on the attached ns. Busuress Photx Nu ~~ Piumbe~s Name (Print) Pl gttatute MPlMPRS Number Plumber's Address (Street State, lip ) ~ J~) ~/' VIII. Coun at Use Oal Saridary Permit Fee ('includes Groundwater Date Issu leaning Signature ) Awed ~PPro~ Surcharge Fee) ~ 3s~ Gc~ J V ~ ~~ Owner Given Reason for Denial EM OW N~ oas for D' rovalry IW~ .s ~ ~` / Septic tan ,effluent fitter and -~ dispersal cell must all be serviced / m n ained ement plan provided by plumber. 3 Qyl ~5~~ na ... ~~ g as per ma 2. All setback requirements must be maintained ~ tti ~~ ~ l~ er applicable code/ordinances. ~ ~ ~ ~ as g 3-s - fiy~',~ . p bz~hA/?i ltiZ~ 1 ___, ~..~ Attath coatplete plans (to the Counh only) for the system oa paper not kss than gllL x 11 inches is size PLOT PLAN PROJECT P.C. Collova Bldrs. lnc. 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 MPRS Shaun Bird 226900 DATE6/30/04 BEDROOM 3 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' ^ BOREHOLE O WELL *H,g,p, Same as Benchmark SYSTEM ELEVAT1.011L (98.3' Filter Zabel A-100 ~-r of survey iro C~ 100.7' ` B.M. `~\ 364' Property Line 98,3~gg~ 97' B-1 Scale = 1 /4" = 10' ~~ 3~0 Slope Gradin is to be Tank is to be g properly bedded done to divert ~ ~ and provided with run-off away g _ 3 ~~ lockdown covers from system with approved warning labels ti Well is to meet all _ B setbacks found in Comm. 83 Huffcutt Area 15' below Combo system is to remain Tank undisturbed Pro 3 Bedroom House 375' Property Line 156th St. ~~ c~~--- DOSE TANK SIZE 630 HOLDING TANK ,. commerce.wi.gov ^ ^ iscons~n 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 09, 2004 CUST ID No.226900 A7'TN.~ POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SP[A 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/09/2006 Identification Numbers Transaction ID No. 1017622 SITE: Site ID No. 686115 P.C.Collova Builders Please refer to both identification numbers, 993 156TH Street above, in all comes ondence with the a enc . Town of Hammond St Croix County NW1/4, NE1/4, S18, T32N, R17W Lot: 6, Subdivision: Crick Bottom Overlook FOR: Description: Three Bedroom At-Grade System Object Type: POWTS Component Manual Regulated Object ID No.: 967865 Maintenance required; 450 GPD Flow rate; System: At-grade Component Manual, SBD-10570-P (R.6/99), Pressure Distribution Component Manual, SBD-10573-P (8.6/99}; 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, COnG stats. The following conditions shall be met during construction or installation and prior to occupancy or use: ~,pEP TMEb .81~614N OE SA General Approval Requirements: SEE CORE • This system is to be constructed and located in accordance with the enclosed approved plans and with the "At- grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater Systems" SBD- ] 0570-P (R.6/99) and the SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST_SAS (01/81) • Per manual cited above, limited activities are allowed in the area I S feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. SHAUN R BIRD Page 2 7/9!04 • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A cony 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. Owner Resp~xlts.:.---- ------ • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installationfoperation. 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, l~~ 1 ~r Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commerce.state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 ~~~~~ ~ B LDCS pIV. Date: 06/30/04 Owner: P.C. Collova Bldrs. Inc. Location:NW1/4NE1/4 S18 T32 N,R17W Lot 6 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 (01181) Page# 1. Cover Page 2. At-Grade Plot Plan 3. At-Grade Cross Section a~~x~~~" t /P L t P C S ~ ion ipe ayou ipe ross ec 4. ~~MAlERCE 5. Pump Chamber Cross Section u~ s 6. Pump Curve ~'ONaENCE 7-8. Maintance and Contigency plan 9-11. Sc Shaun B Signatu License PLOT PLAN PROJECT P.C. Collova Bldrs. Inc. 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 MPRS Shaun Bird 226900 DATE6/30/04 BEDROOM 3 CONVENTIONAL AT-GRADE )00C 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 364' Property Line Scale = 1 /4" = 10' Tank is to be properly bedded and provided with lockdown covers with approved warning labels Well is to meet all setbacks found in Comm. 83 Pro 3 Bedroom House AIt.B.M. is top of survey iron @ 100.7' I\ 'S~~i98.3'98' Grading is to be done to divert run-off away from system B-2 Huffcutt Combo Tank 375' Property Line 97' B.M. Area 15' below system is to remain undisturbed 156th St. I~ ? 5' B >5 PVC F04lE,E.MA11~! ~- DiSTl4t`a;lTiowf LATERAL '^~ ' i A ~ srAs«.~ Ica O$~~=:YR710f3 wr¢ct I/66 ~ i/6B ~I/2 B ~~- A = ~ Ft. 8 - ~ fit. L, ~~ ~{. ~~QRc~rEa SY~Tt~ie~nc. ~'abr;c - ST~B~ti~~a Qbser~ation-----~.... Well ~ ,~ ~ ~~ CE~.L of ~z " Z lZ AbGRE.~aTE . ,. . > r,,} ~ A . ~ ~0 SIoPE Dis#ribuiion La#erai .~--Soil Cover 2"~ -. !'LewtE~ ~ANFR > 5' Plan View and Cross Section of LJisconsin At-grade Unit with a Single Absorption Area on a Sloping Site z~~ t 6., .,. .~: -',.• ~~ i M C ltartp'fta RE ; Page (}f, Distribution Pipe i}etaii for :; LatFrai Network '' Last 3~1e Should Be Next To ruR~t•uP __... "TURN -uP~~ ~tLLRn~ovtj PYG Force Hain "{'"'~ ~- i~YC Distribution Pipe Aecest' 3Qa ~J Bale Diameter `~1,~'Z..Inch p "`~~~b Ft. X ~-~ ~ inches Lateral Diameter ~ Inch(es) ~~ Force Main Diameter ~ _,Inzhes y ~.._~' inches `/ _ Of Holes/Pipe Z J invert Elevation Of Laterals ~_~'_..~.. ft. ~'~.~Y Signed - _----~--- License Number: Date: ,I. i Ct,,f AN~,,,r.,.. . ~ L pt3M' C~~P-MB£.R Cr~QSS SEC ' crpTlC TANK „ r[Zt~ . ABOVE GRADE ~ ~„ ~} VENT PIPE ~4IIA~~D~ 4R y ~~` ~`R4R DOOR. FRA''~ axA ;HTAKE /Q r~rP,~''f~~~,~~~ DE ! ~~ PZf~~-';;"~~rsRA i~ . r L~ wAT£R TIG EiT 5 ~~ ",,~_ APPtROV~ C . PIPE 3' - ~~ •~T - "~""" ~~ X10 ~~4P OFF' gLEu ' ~ ~ SOZL . _._-- - ~. rQATIONS ~tEATNERpittlOF J~NCTCC3~DUOIT WI;TK - s. ~ `=s ~_ ~ ', r , GA~~T j ~~ r~~ F r ~ ~ I L!3 APPROVED MppQHQLE COVER W/ PADLOCK ~ wAjttilltG iAB£:. ;$"+N~~• .at9IlITS WITH AppR01~ED FIFE IOC SOIL Y ED gEDF~NG V N~~. 'EA3+i~C r ~ ~}NC3tETE PAO 3+~ APpRO l f/,~Q~~II SP£CZFYCATZONS ,_ 5 PEg I3AY = ~jp+S9E~ DOSE SEPTIC ! DQSE T.7IN~ 7~ GAL- ~~ TANK MANUI'AC~R£R: DBE ~G~Mg ~LatigAClCs / ..JGAL. _ GAL. 5 =~ih - SZZ£S = SEPTIC`' 6AL. ~ ~~~;IiGHE TAIiK DOSE ~"' ~ /tom CAP}~CITZES = A ~ (~ GAL- ~~ ~` s = ~z ~NCHfs AL.AR?S 3"~A~FAC1'i3itER;: L-- 7 ~ Gt+L. ~ZTCH TYPE = _ ~~-~Gt,L p~KP 1r1A~FACTUR£R = _ ~J~~'/,i I1,HR 15.23 WAC -" KODEL ~3~,~~ ~ ~ RLAg~ WZAT~ ~` PER ~;~ pt,IKP ~ FEET GPM QSPE • •~ EET RE~WIR~ aISC~,RGE RATa~~.--- DZSTRZ~TZ~ FEET ~tENCE $gTwEEN $ UpE s F f.ND . ~ FACTOR • _ • ® FEET vER'~ICAL RIFF PPL•Y PR~~=-f--F'FI~.OQ•FT. F:tZCT201~ ~ SIR ~ ~flTAL DYN~£C ~~ l MIN I"tt?ti HETwOR1C ~ '' ~ ''~ OIAMET~ ----" } ~~~ FEET FDRC P TANK ' ~~'~`~ ~~'t'-- L~~i~In tNT£R~IAL DIM~NSIO~~ D~ FUG LIC'ENS~ ~~$'.~ ~. _..-- g A-i £ if88 TOTAL DYNAMIC racAD/CAPACITY PER Nirv!JTE EFFLUENT f.ND DEWATERING n r U z a d ~-- I MOC I EL ,5 ~ ~ 15 3 Feet i 'T Meters - r•~ tea.. ~ Lirers ~ Go!. ~ Liters 5 1_g 69 I 201 77 291 ?~ 3,? I 61 231 70 I 265 15 4.6 I 53 2p1 61 231 2p . ~ 6.1 I 44 i67 i 52 1g7 ~g 7.6 34 ;29 42 ?59 30 9.1 23 87 33 ~ 125 3 10J ! -- i --- I 22 ~ 85 yp I 12.2 ~ -- -- 11 I 42 Lock Voive= : ~ _$.p Ft. (i 1.6m) ---" 14=.0 Ft. t .4m1~ (3 ori5oe 0 3 27 u ~- FLOW PAR MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. ~`~' ' • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single p ase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik-Box available foroutdoor installations. See FM1420, • Over 130°F (54°C.) sP~i~ 4uotation required. ~ 521153 Series p CAUTION All installation of controls, protection device~d~ hould be fol owed ncluding the ost licensed electrtclan. All electrical and eafety recerd National Electric Code (NECJ and tho Occupational Safety and Health Act (OSHA). ~^ ~I I ;? t16 I i J..-- sxzoa~ SELECTION GUIDE 1. Single piggyback variable level float switch ordouble piggyback variable level float switch. Refer to f M0477. 2. See FM0712 for correct model of Electrical Alternator E-Pak. 3. Variable level control switch 10-0225 used as a control acgvator, speafy duplex (3) or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. ..MAIL 70: P.O. BOX 16347 ~ Louisville, KY 40256-0347 Manu/acturersof . . SHIP T0: 3649 Cane Run Rcad ~7 ~r ° ~ O Louisvr!!e, KY 40217-1961 - QLLdL/TY P!/MF9 ~NCE /9c~.9 ® (r~217?8-2731.1(800} 928-PUMP ~' PU/il~f'' ID FAX (502) 774.362A hn p;//WwW.sosll or. corn ©Copyri9ht 2000 Zoeller Co. All rights reserve . 3? i2 S ONltyER'S MANUAL 8~ MANAGEMENT Pt-p'N P 0111tT Number of 13edf04ms NA Number of Dornmerc~ali Units a3/da EsSmatad flow (a~9e~ : ~"~ aUd (Estimated x 1.5) pasi9n flow ~ •...: ~ aVda /~ Soil Apps' 1'tate Monthly average' Quaftty lnfluent/Effluent Oil ~ Grease (FOG) t S30 mg/L s,. Fa en Demand (BOOS) 9 t Ox 5120 mg1L /L Y Sg Biochemka Total Suspended Solids {T ) s15a m - Monthly average" . ~ N,q Pretreated Effluent GluafRy d (BOOS) S30 mg/L Biochemical Oxygen Oeman nded Solids (TSS} Total Suspe ;2 530 mg s10~ cfu/'t pOml eonaetric mean) Fecal Cotifomt (9 y ;nom diameter Maximum Effluent Particle Size Pa9e„~of Z fAINTENANGE SCHEDULE Setylce Frequency ar(s) (Maximum 3 yrsJ Service Event At least once every p months uais one-third (~) of tank volume m eq Inspect eondlUon of tank(s) When combined sludg e and scu ear(s) Maximum 3 yrs.) ( Pump out contents of tank(s) At least once every p month r{s) Inspect dispersal celK 3 S ~ ~ ~ t feast ante every O months , ~ ~ month ear(s) Y p NA Crean sf(tuent filter . At least once every ,•, r(s) O NA Inspect pump. Pump controls S~ alarm At least once every p mon h a s 0 Ye ~ ) p NA ure test Flush laterals and press At least once every s O mont Q months D Year(s) ~ NA t~ At (east Once every .....~.. licenses or MpI~NANCE INSTRUCTIONS art individual carrying one of the following ppV1tTS fnspe~r POW>rS Maintainer, Septage of tanks and dtspersat cells shat( be mNa~deMc~ted ~~~ to identiify any missing or broken Inspec~ion>3 plumber. Master Plumbe on of the tank{s} for any back up certifications: ,Master ns must indude a visual inspedi a and scum and to check t frets O tor. Tank lnspecdo pe~ied ~ check the effluen kle~nfitY any cracks or teaks, measure the volume of combined stu 3 of effluent on the round surface. The dispersal Celt{s) steal( be visually ins .~ ponding or ponding of effluent on the g riding of effluent on the ground suriace• utatory a,,dhortty. in the observation P1PeS and to check for any Po titres the immediate notification of the local reg condemn and tact tank equals one-third {X? or more of the tank volume, the ground ~~ may indicate a fatting min any ntula6on of sludge and scu sect of in accordance Huth ~'• N yyr~n tree combined aocu a Septage Setviang Operator and dispo entire contents of the tank shall tie removed by reVeat~ment ~iponents~, and any 113, yyi~ns'ln Administrative Code• orients, P mechanical or pressurized POVYTS come rformed by a certified POyYTS Maintainer. The servicing of effluent fitters, at intervals ~ 12 months or less shall be Ae of completion of any service event other maintenance or monitoring t r utatory authority within 10 days A setvige report shall ~be provided to the iota eg _ roduds or other for the presence of painting P STARTUP AND OPERA o0~ use of the POVi(TS check treatment tank(s) ersai celi~s)• If high concen~a°ns are For new COnSt[liCtion, PR mess and/or damage the dis o retor prior to use. chemicals that may Impede the treatment emoved by a septage servicing Pe detected ham the epntents of the tank(s) • YaluestYPi~ for domestic 4norr.~+~•L~~..,._., ----- ~~ tank eflquent. ,~.asterrater. .« Yalues typical ror Pretreated ~~ Page or_ . ~~ y nditions are frozen at tt~e infittraUve surfaces. il~~ is resto~ the excess System smrt up shalt not oxur vvtter- so.~ a~Ye notmat ~~9hy~ter levels. men ~r s ~d may result in the . r outages Pump ~~ ~y ({s) in one large dose, ovadoading the cep( } Ducin9 tie ed to the dispel °~ um tank removed by a ~t~a~ ~~ce d,~~e ~ emit To avoid thls slbuation have tt~e ~n~ntad a Plumber or ~~S Maintainer to backup ~.~ ILStiOrlnQ power ~ ~e effluent pump age Ser~ng Operattor P um ~apn~ls to restore normal levels within the pump ~-. assist in manuathr opera~ng the p P rsal ce~s• iJo not dnve ar park over, or afhetwise disturb or compact, or ~ vehid++s over tanks and dispe - l7o not drive Pa mound ar at-grade soil absorption area. rforrnance and prolong ttte life ~e any within 'S5 feet down sbpe ~ a tom ~e w,~~~. stream may improve the pe ocel'tminaton of the f+alfo+Mng ~tton swabs: degreasers; dental floss; diapers, Reduction ~ dgarette butts: condoms; eru~ s, asotine; gr+ease;~ herbiddes; meat of tfie POWTS: antibiotic;baby urn water; fruit and vegetable Pe ns and water softener brine. d~nfedants; fat; foundation dialn jsurr-p P P}txxdes; sanitary napkins; tempo ~~; madic~ons; 04 Painting Qroduds: pee _- ABANt?ONMliJ1ENT taken out of service the following steps shaft tt[e taken to Insure that the When the pOWTS faits and/or is pe~~ in~oornPliance with ch. Comm 83.33, ~scensin Adminlstrative Code: system is proPedY and. safey abandon Wings sealed- • Alt ptping to tanks and pits shall .be disc_onneded and the atsand disposed o~y a r~ptage Serviartg Operator. . -rt,e contents of aft tanks and pits shall be removed and properly • Alter pumping, all tanks and pits Shat[ tie excavated and removed or their covers removed and the void spaL•e filled with soli. grave! or another inert solid material. CONTINGENCY PLAN ~e following measures have been, ar must be taken, to provrde a code If the pOWTS fails and cannot be repaired compliant replacement system- utilized for the location of a replacement soil nt-area has been evaluated and may be coon and should not ^ A suitable replaceme lacement area should be protected from disturbance and comps . absorption system- The rep from existing and proposed structure, lot lines and welts_ Failure to be infringed upon by regained setbacks fed the replacement area vri11 result in ~ ust com ty with therrules nrteffect a! that tirnetab[ish a su'rtab e pro replacement area. Replacement systems m P ' ble re lacement area is not avaitabte due to se sortko f P aroe~ failed PO1NTSns advances in POWT ^ A su~ta . P be installed as a ids d ethnology a holding tank may su eplace tare Upon falute of fh OVYTS a table a. ' as not evai iden • re nt a e ~ tea rtable ma res. I ite a lu tion ~ - o(di to be i led as a st resort to replace the fait removal of the biomat a n systems may be reconstructed In place following M\ n a at-grade so a ~ tdyons of such systems must comply with d7e rules m etrtec~ at that time. e infiltrative surface.. RBCOnslru <NYARN ~ TMENT TAAIKS MAY CONTAJiV LeTHai. C'ASSES ANt310R INSUFFICIENT OXYGEN. SEPTIC, PUMP AND OTHt:R TRFJ- CIRCUMSTANCES- DEATH MAY 00 NOT ENTER A SEPTiC, PUMP OR OTHER TREATMENT TANK UNDER ~~ RESULT.. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITrONAL COMMENTS POYIri•S INSTALLER r Name ~ - Ph ne °' -- ~ -~i~ POWTS MAINTAINER Name c~ Phone / - ~'~ 0 LOCAL REGULATORY AUTHORITY SEPTAGE SERVICING OPERATO PUMPERL~_ ,-- Agency ~ ~ r'2p Home ~~ ~ ~„~ Phone ~/..~ ' J~ ~ meet meets rhone ~J .°_-' ~~ °'~ c/ !~ This ~~ ~ siatl~ ~~ Green ~~, Marquette and Waushara County Zoning and San ~ea9U ~~ls document does not 7Ris aowment was Erattod by t and 83.56(1 }, (2} 8. (3}, Wis~nsin Adm-nl5irdttve rna min[mum requir+Bnfents of dt. Comm 83.2?.t:Z)(b)< 3(d?s[fl ~ GMw (2JO1) guarantee the performance of the Pt~11Vfr'S. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer P. C. Collova Builders, Inc. P O Boy 489 Somerset, WI 54025 Mailing Address Property Address ~ / ~ l ,~ ~C' ~ ~`~ (Verification required from Planning Department for new City/State mt~~ (•~•~ Parcel Identification Number Q/ ~ ' ~"~ 3-0~ ~'~ LEGAL DESCRIPTION \ . ~Oa Property Location ~ %+,/~,Z~ %,, Sec. `~ , T~N-R~W, Town of , Subdivision V~ ~ ~0~~~ ©V~Ei(.,~j~ Lot # ~ - Certified Survey Map # ~ ~ ~~e .Page # Warranty Deed # Volume 1 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. Pmper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner. and by a masterplumber, journeymanplumber, restrictedplumberor a licensedpumperverifying 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 da f e e e xpiration date. . P. C. COLLOVA BUILDERS, INC. / Z p t„~ SIGNA F APPLICANT (715) 247-2742 P.O. Box 489 DATE SOMERSET, WISCONSIN 54025 OWNER CERTIFICATION I (we) certi that all statements oa this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the rty es 'b hove, by virtue of a wawa ty deed recorded in Re ister of Deeds Office. P. ~. COLLOVA BUIL~ERS, INC. (715) 247-2742 ~ ~ (~ SIGNATURE OF APPLICANT P.O. Box 489 SOMERSET, WISCONSIN 54025 DATE ****** 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 waczanty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed a a v1?isoonsin oepartment of commerce SOIL EVALUATION REPORT olvision of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8112 x 11 indtes i size. iru~ude, but not smiled to: vertical and txxizontal reference pant {s ~, r~r I V E ~ percent slope, scale or dimensions, north arrow, and location and d' lance to nearest road. Please print ail information. MAY 0 ~ 20 ~e ~ PBf801181 iMormafion you provide roey be used for sBCaWar~' purposes t Law. s. 15.04 (1) (m)). ZO I G OFFICE ~•~QIa~ 1 Property owner Ming Address ~ ~ t a Broom # j ~ -"' G ~., City State 7p Code Phone Number ^ City ^ vNage ; Lfh ~( ) Page __~.__ of 018-Zob3- ob-~C• 9~~ by Date X11 1/4S~~ T~,(~ N R` ~ E me o<csM# , Nearest Road New Construction Use: / Number of bedrooms Code derived design flow rate ~ Q CAD ^ Replacement ^ ~ or, - Oescrr~e: Parent material ~ Flood Plain elevation if applicable 1^~ 119' ft. ~nre Pit Ground surface elev. ~`~ R. Depth io timidng factor ~ R~ tiaizort th De Domin~t Red~t Descri tion Textrue Structure Consistence Boundary Roots GP D/f~ p M. Mtersel p Qu. Sz Cortt. Color Gr. Sz. Sh `Effifl 'E ~1 ~ j 3f Z "'.~.... ~ ~~ r S °~ s~ ~ o~ ~ a~~ I s j *T ~ ~ T ~ ,./ ? '~ ~O / ~ / S pw~.i..r. # ^ ~ ~/~~ "`^ ^ ~ Pit Ground surface elev. ~~ tt. D~lh to tirniting factor --~=~- Sob Rate Fiarizon i7epth Dominant Redox Oesaiption Texture Structure Consistence Boundary Roots GP D1fE &~ . MunseN Qu. Sz Cont. Cobr - Gr. Sz. Sh. `~i ~ ~ 1 v Z Z- o s -- - a . ~ ~ .~-... ~ ~ . s- . I.o ` Eflp,ent #1=Boo > ao < 220 mgn. and Tss >so < - • Efnr,er~ m = B~ < 3a mglL and TSS < ao rrrglL CST Nurrber ~~~~ ~ 1 r Date Evaluation Conducted Telephone Number q ~~~ ~ Paroel ID # Pam J ~~# ~~ 1~ Pit Ground surface elev. ft. Depth to limiting factor Soti Rye Horizon Depth Dominant Color Redox Description Texture Structure Corrsist~ce Boundary Roots GP D/flT in. Mansell Qu. Sz. Cont. Color Gr. Sz Sh. •Eff#1 •Eff~ 2 - Drs --- ~ - S la .~ -- -y ~ ~/ , 3 . ~ ^ ^ Pit Ground surface elev. ft. Depth to iuniting iador ~. . # ^ ~~ ~ Rate Horizon Depth Dominarrt Redox Descxiption Texdxe S6uc~xe Consistence BourxJary Roots GP DHF 'ar. Hartsell Clu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •ETt#2 ^ ~9 # ^ Boring ^ Pit Ground surFdoe elev. ft. Deptlt ~ fsniting factor in. SoN Rate Horizon Depth Dorrrtnant Redox Descxiption. Texture Struchrre Ca~tertce Boundary Roots GP D/fF in. Munseti Qu. Sz Cart. Color Gr. Sz Sh. 'Eff#1 'Eff#2 ' ERtuerrt #1 = BODs > 30 =220 mgll-and TSS >30 _< 150 mglL ' Ettiuerrt #2 = BODs _< 30 mglL and TSS _< 30 mglt. 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 fonrat, please contact the department at 608-266-3151 or TTY 608-264-8777. sau.aa3opt.~oo> . Soil Test Plot Plan .~' Project Name P.C. Collova Bldrs. Inc. Shaun ~r'i Address P.O. Box 487 ' Somerset Wi 54025 M #226900 Lot 6 Subdivision Crick Bolton Date 12/4/02 1 /4 NE 1 /4S 18 T 29 N/R17 W Township Hammond 'ng Q Well PL Property Line County ST. CROIX B or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 98.3 *HRPSame as Benchmark It. ;Top of survey iron @ 100.7' _ 364' Pronertv Line 100' 10' B-1 30' 5' 3% Slope 90' B-3 ~- 98' 99' 97' 375' Property Line U 1950P 52,81 ~, STATE BAR OF W ISCONSIN FORM 7 -1998 I WARRANTY DEED J husband and wife .Grantor, and P G l',Oltoya ttuttaers Inc. . gar Grantor, for a valuable consideration corneys to Grantee the tolloM desuibed real estate to St. Croix County State of Wisconsin (the'Property'): Sea Exhibit A attached hereto 667''c42' KATHLEE9 R. MALSR REGISTER OF D6®S ST. CROIX CO.. MI REC8IVfiD FOR RECORD 08-1b-2002 9:00 AM FxEti D® REC FEE: 13.00 TRAAS FEE: 1155.00 COPY FEE: CERT COPY FEE: PAGES: 2 P) CfColbva Bullda~. Ina. x h Awnw mood , WI 34013 ~~ O)8-1039-20-000 / 018-1039-10~OC 01 S 1039 80 000 parcel tdentifiwtlon Number (PIN) Thla Ia not homestead properly. (18) (Is not) Together with ali 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 Puoust. 2002. (S~) (SEAL) '~G ~f L,..~ l' - • hn J. Iton arolyn G. alton (SEAL) (SEAL) • q'IQ~~lri ACKNOWLEDGMENT ; %aTE OF WISCOt~ - Stgnattue(s) state of Wisconsin, ~.~t,v c~„ INS } ss. t !~ authenticated this gj'Js,~E V f ~J - Personalty came t~efore me this 1,~ day of Auoust. ~OZ the above mad a and arol Iton ban WIf TITLE MEMBER STATE BAR OF WISCONSIN (lf not, ~.J ~ ~-'~ L '~~ authorized by §706.06, Wis. Stets) Notary Public, State of Wisconsin THIS INSTRUMENT WAS DRAFTED BY My commfasbn i9 pe anent. (If not, state expiretlon date: Cddwell Banker Bumet ) Q~C~ V~ 1301 Coulee Road - o Hudson, WI 54016 22470 (Signatures may be al~tttentkated or acknowledged. Both are not necessary.) • Names of s In an ce must tie or rioted below their s nature. STATE BAR OF WISCONSIN Wisconsin Lega181ank Co, Inc. WARRANTY OEED FORM No.1-1998 Milwaukee, Wis. ~2(~ ~N~ ~V E ~LbOK ~ of 2 ;i.l .. . ~. 1~ . ~1~9 5 ti`R.~~~ 5~2~9 ..,..:...:,..::.r:+w.:.••:.ci•;;a,•aura,~W,yw~ww.a-..3,__:~_,....~.... _ .,. '. .. .' ". ~. .~- A part of the NE'/. of the NE '/. and In part of tf~e NW '/. of the NE y, and ~ part ~ the SW+; Y. of the NE '/. of Section 18, Township 29 North, Range 17 1Nest, Town of Hammond, St.Croix County, Wisconsin and more partlwlarty described as; Begtcming at the Northeast comer of said Section 18; thence S89'33'31'W 372:01 feet along the North tine of the NE Y. of said Seaton 18; thence S89.33'31"W abng the North line of the NE '/. of said Section 1t3 775.94 feet; thence S00'52'23"E 250.00 feet+ thence S89.33'31'IN 966.24 thence S89'33'31"W 528,00 feet; thence S00°52'23"E atonfg a North-SouOth Qua a Sectior>f ilne of said Sedlon 18 1311.77 feet; thence N89'33'39'E 626.33 feet; thence N00°31'25"W 30.23 feet; thence N89°33'24'E 692.76 feet; thence N00'52'23"W a-gng the East line of the SW / c4f the NE '/, 330.31 feet; thence N89°33'24"E along the South line of the NE '/. of the NE '/s 949.09' feet; thence N00'S2'24'W i 321.19 feet to the Point of Begtnntng. .. ~ ~: . r. ;;, ~> ~ , ~', c~ ~~ g~~M 6 V ~2-~v k 2 or- ~ JRVEY MAP VOLUME 2, PAGE 379 ' I LOT 3 ~ LOT 4 SMALL TRACT R.A. = N 89'32'25" W N 89'33'31" E 966.24' '' 364.35' N 89'33' 31 " E 242.05' -~ ~o~ ~T ~ ~ LOT 6 ^~~ ~ LOT 4 ~' 0 o '341 S. F. ~3 66731 S.F. / ~ 76393 S.F. 1.53 Ac. .66 Ac. ~ ;~ ~ 1.75 Ac. N ~~ ~ ~ LOT 5 72091 S.F. \ ~ , 1.65 Ac. \ J. ~ - ~ ~o ~ ~ ~ _ - E 329.51' ~~ ~~ ~ N 37'53'40" W i i ~QQ `• I '9 /'!i' 4.26 ~ / i I 205.21' ~ / i ~ ,s O ~ ® i ~ - ~ \ ~ ~ ~ ~ /~ +-~~ ~~ LOT 9 N 37.53'4 w 9 ~~~~ 34.2~r ~ ~ ~ ~ / ~ 89166 S. F. / / / ~ ~ 2.05 Ac. / ~°.~ ~ / ~,o / LOT 22 ~~~,