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Home My WebLink About018-2003-13-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and B~'ilding Division INSPECTION REPORT GENERAL INFOF~MATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township P.C. Collova Builders, Inc. Hammond Townshi CST BM Elevrrll f~ /,, Insp. BM Elev: BM Description: V tvv f ~y ~> .; f G: > ' i~rf TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic ~. r ~ /~ ~ / / , Dosing f ~~ - ~~ Aerati n "~ -.~ Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ `, a~•; (J~ C ~~ Dosing ~ t~ ~t ~~ G i , Aeratio - "" '' - Holding ~/ - PUMP/SIPHON INFORMATION Manufacturer _ __ ~ Demand GPM Model Number ~ ~ ~- TDH Lift)-, I Frictipn o~ System Head ~ T H i Ft ', , ! , 1 Forcem~4n L nptt~ ~ Dia~ // Dist. to Well SOIL ABSORPTION SYSTEM /~-ht county: St. Croix Sanitary Permit No: 430115 0 State Plan ID No: ~~ Parcel Tax No: dt~V~ Section/Town/ ge/Map No: 18.29.17. STATION BS HI FS ELEV. Benchmark ~ .~.v i s ° Alt. BM d -1 tI~C 6~ Bldg. ewer ~' ~~ SUHt Inlet // (P•J SUHt Outlet Dt Inlet Dt Bottom a. .7 ' Header/Man. Dist. Pipe ., ~ r. Bot. S stem r ~ _j Final Grade St Cover ,~~- ; ~ - ~ 03~ ~ 3 99,y~ ~ r ~. ~f BED/TRENCH Width [ Length ~ ~ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ` SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM EA NG Manufacturer: INFORMATION CH ER OR Type Of System: ~ J ~ i D Model Number: ~^ ~ DISTRIBUTION SYSTEM Header/Manifold '/ / ~ Distribution Pi e s ~~ ~ g x Hole Size ~ i/ x Hole Spacing i 2 Vent to Air Intake ~ Length Dia Length Dia Spacin ~ p 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 BedlTrench Center - Bed/Trench Edges Topsoil 4J1 Yes ~] No ! ~ Yes L~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #~~ /~ Q Inspection #2: l /~~ Location: 1549 97th Ave Hammond, WI 54015 (Unknown 18 T29N R17W) Crick Bottom Overfool'C Lot 13 Paf~cgel~N : 1 29.1.7. 1.) Alt BM Description = ~~ ~ ""'`~ ~ Doft~ m ~ ~~~,~,~iy~~, ` - /`~~/B~~~~ ~ 9y~ 2.) Bldg sewer length - ~ ~~ ~ ~_1__ ~ ,Q~~ -amount of cover -; ~'/ ~2~.(fW'~-`~ T,t~-C,Q~-S~~rivi CTS/ ~ ,~ plan revision Required? Yes ~ o -+O ~ i~~ ~ /)~ ~ ~~ r side for additional information. , ~- ~ `~ ~ Date n pctors ture Cert. No. Safety and Buildings Division Count. , I ~ ~ r ~ 201 W. Washington Ave., P.O. Box 7162. ~ lseons~n Madison, WI 53707 - 716 Sanitary Permit .tuber (to be filled in by Co.) Department of Commerce (608)266-3151 /~j~p~~,s Sanitary Permit Application . Number State Plan I.D In accord with Comm 83.21, Wis. Adm. Code, personal information you provide q ~ }~9 ~ 1 - ~`~ • I ~•~ may be used for secondary purposes Privacy Law, -~.. roject Address (if different than mailing ddress) I. Application Information -Please Print All Information ~ ! Q ~~ ~~ 1 Property Owner's m ~~ Lot # Block # arce # ~ Property Owner's M ailing Address ~~-','~~~,~' C;Fr=ICr_ 7 ~ ~ O ~ ~ r ~ roperty L on ~ / % I P r V ~k ll/tk,Section City, State ~c_./ Zip Code Phone Number T ~ N; or W w ) ~ (check all that a l of Buildin II T pp y ~ g . ype g CSM Number n Subdivisio i or 2 Family Dwelling -Number of edrooms ~.t.A,e_ o,N,s , , n ~ ^ blic/Commercial -Describe Use ~ 9~ • ~ ~ ~~ ~ C~- r ~ t ^ State Owned -Describe Use _ ~ ' 3 ~ (~~ > ^City_^Villa nship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ^ Replacement System ^ TreatmendHolding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that apply) -~. ~ -(~ ^ 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 Treatment Unit ^ trculatin~ d Filter ~ 3 ~ ~ ~~~ ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (expla~ ~ V. Dis ersal/Treatment Area Information: DesiggFlow (gpd) Design Soil Application Rate(gpdsf) Dispersa ea Required (sf) 3-C~ Dispersal Area Pro osed (sf) ~ L ~ S ~ ~3 ~ /, O . . VI Tank Info Capacity in Total Number Manufacturer P efab Site S•:eel Fi Plastic . Concrete Construct Glass Gallons Galions of Units New Existing Tanks Tanks Septic or Holding Tank ~ L~.J~ Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the ttndersign ,assume responsibility for installation of the POWTS shown on the attached plans. Plu tier's Na me (Pri Plumber' i gnature MP/MPRS Number Business Phone Number Plumber's Addre ss (Street, City, State, i Code) f~, /~ ~ ~/~ ~ ~ VIII. Count a artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater to Issued ss ~ g Agent Si a (No Stamps) Surcharge Fee) ~~ ~ ~ 3zS 7Z s 3 J ^ Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval .~ ~ ~ ~~ ~„ `°-~' ->~-,4-t.~ .,~..~ ate ,~~.•Q-~ ~ ~„a~.~° ~ n qq ^^ ' _ (~ ../~ ~ ~ ~ ~ ~ ,. /y ~ ~ ,y~/~ r _ - r~/1 ~ A t 1 ~ ! _ ~ 1/ I/ n .. . n A/ .. .~) AA ..A /1 wT 1~ _,~dK~l/VW..w~ `^~~.1(.W~ ~\t on paper not less than ~- PLOT PLAN ;T P.C. Colbva Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 i/4 NE 1/4S 18 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX L.c f" / S 6/6/03 BEDROOM 3 MPRS Shaun Bird 226900 DATE CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 MOUND )OOC SEPTIC TANK SIZE ~- HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 454 # of chambers none BENCHMARK V.R.P. Top of SUrvey Iron ~ ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL sg,R,p, Same as Benchmark Scale = 1 /4" = 10' ~ V w ~ ~ U7 ~ ~ O ' ~ -d ~ CD ~ ~ .~ ~ r m m Alt. B.M. 99.6' . B.M. gq•NS' Well is to meet all setbacks found in Comm. 83 SYSTEM ELEVATION 100.9' 1.3' sand I'rft Grading is to be done to divert run-off away system B-3 Pro 3 I Huffcutt Combo Tank house Tank is to be properly bedded and provided with lockdown covers with approved warning labels 626' Property Line B-2 1 Area 15' below system is to remain undisturbed .~ ~ ~ ~ ~scons~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 June 18, 2003 OUST ID No.226900 SHAUN R BIRD BIRD PLUMBING, INC 1008 192 ND AVE NEW RICHMOND WI 54017 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/18/2005 ATTN. POWTS Inspector ZONING (OFFICE ST CROI~{ COUNTY SPIA 1101 CA~tMICHAEL RD HUDSOI~I WI 54016 SITE: PC Collova Builders Inc 100TH Ave Town of Hammond St Croix County SW1/4, NE1/4, S18, T29N, R17W Lot: 13, FOR: Description: Three Bedroom Mound System Object Type: POWT System .Regulated Object ID No.: 907727 Identification Numbers T ansaction ID No. 876919 Site ID No. 660426 Please refer to both identification numbers, above, in all correspondence with the agency. The submittal described above has been reviewed for conformance with app)iicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPR~VED. The owner, as defined in L'Ojtd chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with aQl code requirements. ~~~~ The following conditions shall be met during construction or installation an~l prior to occupancy or use: DEFARTMENI ~DVISi~N OF SAF General Approval Requirements: SEE CORRE • This system is to be constructed and located in accordance with the encl sed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VE SION 2.0" SBD-10691-P {N.O1/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.O1/O1). ', • Per manual cited above, limited activities are allowed in the area 15 feet'Idown 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 i$ located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. '', • Inspection of the private sewage system installation is required. Arrange ents for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145~20(2)(d), Wis. Stat SHAUN R BIRD Page 2 6/18/03 • Comm 83.22(7) A copy of the approved plans, specifications and this 1 tter 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 respon able 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). i • Comm 83.52(2) A POWTS that is not maintained in accordance with a approved management plan or as required under s. Comm 83.54(4) shall be considered a human health h zard. • 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 a~t intervals appropriate for the component(s) utilized in the POWTS. ~, All permits required by the state or the local municipality shall be obtained 1 construction/installation operation. In granting this approval the Division of Safety & Buildings reserves the rig: should conditions arise making them necessary for code compliance. As per review shall relieve the designer of the responsibility for designing a safe bu Inquiries concerning this correspondence may be made to me at the telephot on this letterhead. The above left addressee shall provide a copy of this letter to the owner for the installation, operation or maintenance of the POWTS. Sincerely, ~~ ~~G~~~ Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commerce. state.wi.us to commencement of to require changes or additions ate stats 101.12(2), nothing in this ling, structure, or component. number listed below, or at the address any others who are responsible 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 ~~C~C ~'~ a ~°~so ~V Date : 6/6/03 Owner: P.C. Collova Bldrs. Inc. Location: SE1/4 NE1/4 S 18 T29 N,R 17W Lot 13 Crick Bottom Overlook Hammond System type: Mound System Manuals Used: Mound Component Manual version 2.0 (01/31) Pressure Distribution Manual version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-9. Maintance and Contigency plan 10-12 Soi' ' ' Signature License n~ wally ~~~~ MMERCE U GS ~N~ENCE PLOT PLAN PROJHCT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 SE 1/4 NE 1/4S 18 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX G-c f- ~ _s MPRS Shaun Bird 226900 DATE6/6/03 BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 454 # of chambers none BENCHMARK V.R.P. Top of Survey Iron ~ ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 100.9' 1.3' sand lift w -~ a -~ r r m tD Scale = 1 /4" = 10' Alt. B.M. 99.6' . B.M. ^ B-1 Well is to meet all setbacks found in Comm. 83 Grading is to be done to divert run-off away system B-3 Pro 3 Huffcutt bedroom Combo Tank house I-~ f- Tank is to be properly bedded and provided with lockdown covers with approved warning labels 1% Slope Area 15' below system is to ~ remain undisturbed B-2 626' .Property Line v Designer Date No 4" Observation Pipe Perforated $elow Filter Fabric ASTM C-33 S o n d -` \~ Topsoil - J . t 7'. Stop; Farce ?-!oin From Pump Gress Section Of A Mound S stem Usin ___- A Bed For The Absorption Area ~~ t r u-~'~', t a 0 W ~ 3 0 Non-Woven Filter Fabric ~pistriDution Pipe ~H ~ E ~~_- ~c_ bed Ottf~-2'z Drain Rock A Ft. _ 6 ,~ ~ Ft. I~ ft. J t~ 1~ Ft. .f L- '~,~ F t . W ~ ;, Ft . PioweC L.oyer ' E r'; '-t ' F ~ .-~ l; /'~ ~_ L - 4~Observoiion Pipe--~ ~ _ K J ~` ~~ ____ -- --- .-- _.._..~ . -- -- r....-._ ~~ j.-------------------------------------------- - A ~ 1 ~ Force Moin .. ~° ~ ~._... _. _.._ _-._ . _._. -- --- _ ----- - -- _._.- - - - From P u m p Distribution Bed Of '/~~- Z Dram RocK Pipe I 4~~Obcervotitn Pipe Permonent Mocker Pipe or Rods Plon Vit+r+ Of Mound Utinq A 8~d For The Absorption Area PAGE OF' Q~OC~~~ G~~~~SQ ~~~ f °~~ .! E na ~¢ertocatLa i,' P J% F.pe boles i.oLa,e4 Cn Bot:4m. Arf E~ua!}Y $pocea ~~- ~ ~ ~ n c.7c,C~ "7 '"' ~ ~~u. .% (.~ t j 1 ~~~ ~ ~ r i,~l,_ L~=s~-~ ~~Y:~ i~~~~ J /~ ! C.C.fr ~~y >~ S ~ gnec# : ~.~cense Humh¢~-: Date ;JiSSri~;ttipn rr';p[ LoyasrY FeKST t$OI.~ l~ICX'C TD ^.crtA~G}'~ ~~,/ ! i L . h` `'~.~ Il~i~h~s ~ Y~ No7e I?iameter %f;~',f Inch lateral _' ~ ~ Inches) -~-- ~:an 4 fs~l c~ ~° Inches Force Main ': ~ inctres ~ ~f ~taTeS,°~~Per,~:? I1~er~t ~iev~tio~ ~~' lateraI~!~l ..5~'t,. ptr4ora'aC Pip! OetOii R CROSS S£CTiflN AND SP£CtiFCATIONS SEPTIC. TANK ~ FUl~7P CtiAM1E u£itTHERPR£~F " CZ V£13T 'PIPE I2" i4IN. ABOVE GRAi7£ ~ ,jUNCTi£~t~ $QX APPR,OV £D ~y~HQL£ COVER ~ > ~St ~'ROlS D44R. i~INDOS~ t3R WIT~i CDND~IT W/ PAgLOCK E FRESH pllt Ii~fTAKE ~ y~gRII;NG LA$EL FINISHED GRADE ....~..~~" MZt1. ~~ y'~C.Z. p~ER r. a. 1 tBuMiM~ 44n tii~ ~~• ~~~ ~ j is zr~L~T ~ , • ~iAT£R TIGHT SEALS ~ GAS- s TIGHT' rt ~ L f ~~~lAPPt~£~ ~i3INTS pltN P t it E'R A ~ SEA 6 ALI•t APPROY£0 PIPE - 8 - - s ON 3' 0~ St~.ID SDtI APPRi)YEi3 ~ ' ~ . ¢t}~ITI} 35pi.iD s FT _ C '~ ~ t C}S F 50ti. Pt3MP pFF' £LE1t . D B£Dj}Il+F6 UNDER TAT+I3C xt ~" APPRt1VED ~~ Ca1~CRETE PAD i SP£rZFICATZ(3N5 ~ y.s~ ~'`"~ SEPTIC f DC?S£ ~t ~ ~..~'" ilFalVK i~AI-iU~'AC'I~RER:~"~" ~,: e--~° F~ TAti3C SFZ£S : SEPTIC ,~'~ ~L- ALARIZ MAtrRJFAC2t3RFR MODEI. ~K$ER ~;TCR TYPE p4iHP ~3,~JFAC~3RER = MSStITCH4't''s'~ DUMBER i30SES PER DAY = °--~-------- }gOSE V O ~ ~£ E. LO BAC~ (~ <%„_._.,__..:._~ GAL - INCHES _,..,~-- CRFACITI£S ~ #~ `=~' '- '-` ~ GAL. 8 = Z yNCHES = /__~___- l ` r~ GAL . C = y: ~ " INCHES = t ~==---- ~~ 3 Y AS PEi7 I LHR 15.23 ~C giJ~4P € RLARM iJIR_ivG ~' ~°' z'~~ FEET RAZE l P£ - ~~--^. Rg~IRED DTSC~iARGE ---•-"-' DISTgZ80 Y L ~ FEE'E T I Chi g EEN PU3''IP Oi F #iNB - - -~-, °~=--,r---=~ - FEET V ggTyCA3. I3IFF£R£IdC£ H ~ T/ 1Q Q - FT . - rRiC'TIE~N FACTOR J - .~.:-.-- - FEET + MINZt4t~M p~£T'~IORK SUpFLY PgESSUFt£ TD'I'RL DYNAMIC HF,AD ~,~--~~-- + .~_ p£ET FORC£MA1N X °-_...~--~-- ~ WIDTH ~! D;RMET£R ___,..-- LENGTH ~ ~-~----""' -. ~r~_•_____-r_ . FN'F£Rh1AL DIi"t£NSIDNS 4F PUN? `TAi~IK: LIQUID ~~~ LICEl3S£ I+1iIM$Yg = SIGNED: 4RT£= :ass TO7Al. GyNF.ty?lC iiF~G~CAPAi,I(Y PER '~'~iIJUTE EFFLUENT Ati~ rJE'~1ATERING G d W cv r 4 I Y 0 ~-- 0 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik-Box available for outdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. 1521153 Series I I ~ ~-~ MODEL j ~- I t 5 3 i I 1 ________. I Meters I Gel. Litl erg l Feet ' ~ Gol. I li±ers I ~c"i oa I----i 1 i7 j 'Jq? I ' 10 ~~ 3.1T ~ 231 ~ 10. ( ~65~ -r-- (- ?5 i 4.p ~ 53 ~ 2,:,? i i T 61 I 23; I j 2p .i o. t 44 f ? 6 ~ 52 ' S7 j 129 6 ~ 34 I 25-~7 j 42 ?59 j i ~ L.: I 87 30 I ~ ---- - ~ 3 --. _ 125 ~ -s : - ~ ~ ---, T ~., - : , K i _ F.-_-. j 4G ~ ?2.2 I -- -- ~ I ~ G I ? J i~- j38.0 -_ {1Lor,~ cck_Volve_ ~44.r Ft. (13.en')J _. _ -_.-.--- - i - o,<soa = ---7-'_1--~- ^,~~; :i 17/3? i ~ - a i -T_- _- I i 12 1/8 i -~--- samosa SELECTION GUIDE D CAUTION All installation of controls, protection devices and wiring should be done by a qualified licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM(3477. 2. See FM0712 for correct model of E:ectrical Alternator E-Pak. 3. Variable level control switch 10-022~ used as a control activator, speafy duplex (3) or (4) Heat system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAtL 70: P.O. 80X 16347 -~"~~~~ e•, ~'~ Louisvile, KY 40256-0347 ~Lfanufacturerscf.. SH1P T0: 3649 Cane Run Road 5, ~9~~ I ~/ ~~~ ~~~~ ® Louisville, KY4U217-1961 QvaUrYPOirJPS iNCf i (502) 778-2731 ~ 1(800) 928-PUM,P ~' ~ PUMP III= FN((502] 174-3624 ht[p:llwww.zoetter.com ---------~-- n rnnvrioht 2000 Zoeller Co. Ali rights reserved. BLOW PER MINUTE Maintenance and Contingency Plan for a Mound System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Dose Chamber is to be pumped at the same time as the septic tank. 3. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 4. Once every 3 years the mound is to be inspected via the inspections pipes in the at- grade. The laterals are to be inspected via the cleanouts. 5.Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 6. Pump and electrical components are to be checked at the time of the pumping. 7.Owner agrees to leave the area 15' below mound undisturbed. 8. The owner agrees to save this plan. 9. Trees, shrubs, and other similiar vegitation are not be planted on system. The system is not be driven over. 10. Effluent Quality is not to excede the requirements found in Comm. 83 Contingency Plan 1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if needed, then bypass pump float and try pump with out float. If this works, float is bad, replace float. If pump still does not work, check power at the pump with a electrical device such as a hair dryer. If no power, check breaker inside house and call a electrician. If there is power, then pump is bad and needs to be replaced by a plumber. 2. If mound fails, determine cause of failure, test another area or remove pipe and sewer rock, retill soil, install new mound system. 3. Replace any other failing components as needed. Important Phone Numbers Plumber: Shaun Bird 715-246-4516 Pumper: Tom Mondor 715-246-5148 St. Croix County Zoning 715-386-4680 . ~ . f POWTS OWNER'S MAt1UAL ~ MANAGEMEN~aTIO s F[LE INFORMATION ~1 pwner : C- 6 ~-- Permrt #. DESIGN P~AETERS a ^ ~ ~~ Number of $edrooms Number of Commercial Units A , r Estimated Bow {average) ~°`~ ~~~ allda Design flow (Pea(t), {Estimated x "-.5) '' ~''~ aVd ~~=~ ~'~ ~' aUda lftz Sol Application Rate Monthly average` InfluentlEffluent Quatity Oil 8~ Grease {FOG) Fats S30 m /L 9 , en Demand (RODS) S;oct,emical OXy9 4201 mglL. Total Suspended Solids {TSS) s15t7 m /L NA Pretreated Effluent Quatity ~ Monthly average" Biochemical Oxygen Demand (SODS) Total Suspended Solids (TSS) S30 mg/t- 53(7 mg1L ' Feea{ Coliform (geometric mean) cfu1100m1 5~0 Maximum Effluent Particle Size Y inch diameter Page - of MAINTENANCE SCHEDULE Service Frequency Service Event r~ }lea s ^ months; K) Maximum 3 yrs.) ( Inspect condition of tank(s) At least once every When combined scud a g •,~ uals one-third (Y) of tank volume and scum eq Pump out contents of tank(s) °`= ^ months -ear(s) (Maximum 3 yrs.) At least once every ,,,~- Inspect dispersal cell(s) ve ^ monthsyear(s) ~' ~ Clean effluent filter ry At least once e - , ~' ^ months ,:;year(s) ~ ^ NA controls 8~ alarm inspect pump. Pump At least once every ~ ~ 9 <= ^ months year(s) O NA Flush laterals and pressure test At least once every ~.~. ^ months e ^ year(s) ^ NA ~~ At least once every ^ months ^ year(s) ^ NA _ _ At least once every MAINTENANCE tNSTFZUCTIONS n one of the following licenses or inspections of tanks and dispersal cells shalt be made try an individual canyi 9 ctor POINTS Maintainer, Septage certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspe to identi any missing or broken Servidng Operator. Tank inspections must include a visual inspet~ion of the tank(s) ~' back up hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check or any ed to check the effluent levels or pond"rng of effluent on the ground surface. The dispersal cefi(s} shall tie visually inspect ndin of effluent on the in the observation pipes and to check for any ponding of effluent on the ground surface. The Po g authority. ground surface may indicate a failing condition and requires the immediate notification or mar of theutank volume, the When the combined accumulation of sludge and scum in any tank equals one-third (Y) contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR entire 113, Wisconsin Administrative Code- retreat meat components, and any The servicing of effluent filters, mechanical or pressurized pOWTS compone~t~~ed by a certifed POVVTS Maintainer. other maintenance or monitoring at intervals of 12 months or less shalt be pe letion of any service event. A service report shall be provided to the local regulatory authority within 10 days of comp START UP AND OPERATION ~ for the presence of painting Products or other For new construction, prior to use of the POWTS check treatment tanks, ersal cell s if hi h concentrations are chemicals that may impede the treatment em~sed b d/os P~9~ Sernec~rs9 operator p ar to s e. detected have the contents of the tank(s) Values typical for domestic (ion-con'^''erda>y ~Stewatar ena septic tank effluent Values typical For pretreated vrasterrater. ~ . ~. . Page of System startup shall,not occxir when soil conditions are frozen at the infiltrative surface. fill above nomla{ highwater levels. When Power is restored the excess During power outages pump tanks may wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharige of effluent 70 mower to the effiuentVe me cones tad a Plumber or POWTS Maintainer to Septage Servicing Operator Prior.to~restoring po Pu P assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehides over Tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the fife of the POWTS: antibiotics; baby wipes; dgarette butts; condoms; cotton swabs; degreasers; dental floss; Japers; disinfectants; fat: foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbiddes; meat scraps; medications; oil; painting prndt#s; pesticides; sanimry napkins, tampons; and water softener brine. ABANDONMMIENT When the POWTS falls and/or is perrrtanentiy taken out of service the following steps shalt tze taken to Insane that the system is properly and safey abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of a!1 tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, grave! or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ^ A surfable replacement~area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and welts. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at thaf time. ^ A suitable replacement area is not available due to setback and/or sot! [imitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area_ If no replacement areea is available a ~"holding tank may be installed as a last resort to replace the failed POWTS_ ~®®..(ulound and at-grade soil absorption systems may be reconstructed in pwlathce~el~ s " effect atthat time. at at the infiltrative surface. Reconstructions of such systems must comply «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES A1VD/OR INSUFFICIENT OXY DO SOT E~ C E OF A PERSONOROM THE NTERIOR OOF A TANK MAY BE D FIFICUILT OR MPO S gLE MAY RE ADD1TtONAL COMMENTS POWTS INSTALLER Name _:.~- ~ ~ ~ `~~t ;~,~ Phone ~°~;~ >> ~. ~„.' ~ ~ ~ " ; - ~ ~'- POWTS MAINTAINER ~' ~~, ~ , Name ~,,~~- ~`~ r. =:=~` Phone ,.~ ,~ r'. ~,~;:: ~ ~1 . y- .,~ ~. SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY , Agency 'y~,r ~°..~; f ~ ^d-~.v-~ •~~; -r.=- ~:;~ .r°?'=% r' fit/'/ r' ~~ Phone .~..- ~'''~,~." ~~~` ~ f '~' Phone ,; a ,-_ f ~ f : ~ ., ~ ~ This document Nras drafted try the sfaHs of the Green Lake, Marquette and Waushara County ZonJng and Sanitation agertcles_ Thls document meets the minimum requirements of ch_ Comm 83.22(2)(b}(t}(d)&(f} and 83.54(1), (2} 8 (3). Wisconsin Administrative Code. Use of lids document does GNiV~r (~') guarantee the performance of the POWTS_ 5T 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 , D Property Address ~ ~ ~ ~ ~ ~~" ~' (Verification required from Planning Department for new construction) CitylState ~~ Parcel Identification Number i2Qwn ,U.l~~ LEGAL DESCRIPTION `' Property Location %., ~%,, Sec. ~ d , T~N-R~, Town of ll __ ~-- ~^, _ i~7Y~- _~~n Subdivision .1 (' ` -~~~7Nrl ~(~/1 Lot # ~. Certified Survey Map # .Volume ~~ .Page # Warranty Deed # ~~~~ 1 Volume ~ 5 Page #Jr~ Spec house ^ yes ^ no Lot lines identifiable ^ yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature.failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage is 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, restrictedplumber or a licensed pumper verifying that (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 returned to the St. Croix County Zoning Office within 30 days of the three yeaz expiration date. SIG T ~~'GTZ742 EIRS, INC. ~ / / DATE P.O. Box 489 Q~jLi R6~M~~~i~i~3~4025 I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty de recorded ' Register of Deeds Office. -13IUJ.I.D.EBS, INC. /~ / t~ SIG A OF( I1~t7AatTlf2 DATE -g MM~~~~ P.O. Bo~~x~~489 ****** A~i~i'~fbSrm~altronstha~rs~ m s~repcesented may result in the sanitary pemut 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 52.81 .---~- ~ STATE BAR OF W ISCONSIN FORM 1-1998 I WARRANTY DEED I Thb Deed, made between John J. uaiton ana t,arotvn ~. uat husband and wife .Grantor, and P C Colbva Builders. Inc. . Gn Grantor, for a valuable consideration conveys to Grantee the folio" described real estate in St CrolY County State of Wisconsin (the "Property'): Sao Exhibit A attached hereto 687242 KATNLfifiU R. MALSB REGISTER OR DEEDS ST. CROIX CO., MI RECEIYfiD FOR RfiCORD 08-16-2002 9:00 AM EY~E)P~t 1!~ REC FEE: 13.00 TRARS FEE: 1155.00 COPY FEE: CERT COPY FEE: PAGES: 2 ~~ ~U E 12th OK t o~ 2 P~ C/Cdbva BuUders, Inc x/d~nOCt Avemis mood . WI 34015 O18-1039-20-•000 / 018-1 018 1039 80 000 Parcel Identlflcatlon Number (PIN) at: Thla Is not homestead property. (Is) ps not) Together with all appurtenant rights, title and Interests. none Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this 15th day of Aucust• 2002. (SEAL) • hn J. Ito (SEAL) -: C. ATE OF WiSCO~ Slgnatttce(a} „r~ttw ct,, . ~Nd atnltantlcatee tats NO T~,~p3~L(C TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stets) (SEAL) arolyn G. alton (SEAL) ACKNOWLEDGMENT State of Wisconsin, } ss. St. Crobt County Peroonally came before me this 1,~~ day of Aucust ?~0~ the above mad a arol D It b nd Wif • w.c u~~ (.c.~ ~kz, tw... Notary Public. State(of Wisconsin THIS INSTRUMENT WAS DRAFTED BY My commiaston is pe anent (If not, state expiretlon date: Coldwell Banker Bumet V~ ) 1301 Coulee Road Hudson, WI 54016 22470 (Signatures maybe at:tttenticated or acknowledged. Both are not neceaaarY.) . u.,.......s .......... et~,d~~ In env rmnorHv must he tvoed or tainted belOW their signature. STATE BAR OF WISCONSiN Wisconsin Legal Blank Co. Ina WARRANTY OEED FORM No. ~ -1998 Milwaukee. Wis. ~:.~ A part of the NE'/. of the NE Y, and In part of the NW '/. of the NE'/, and to part of the SVIf. Y. of the NE Y. of Section 18, Township 29 North, Range 17 Weat, Town of Hammond, St. ~Craix County, Wlscansin and more partla,larty described as: Begi~rting at the Northeast comer of said Section 18; thence S89°33'31"W 372.b1 feet atom the North line of the NE Y. of said Sectlon 18; thence S89'33'31"W along the North line of the NE % of sand Sectlon 18 775.94 fast; thence S00°52'23"E 250.00 feet; thence S89°33'31°W 968.24 thence S00°52'23"E 420.00 feet; thence S89°33'31"V1I 528.00 feet; thence S00°52'23`E along the North~outh Quarter Sectlon Ilse of said Section 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 692.78 feet; thence N00°82'23"W NE '/. 330.31 feet; thence N89°33'24"E along the South Iine of thee NEE%$of Atha NE :949 9~fset thence N00'S2'24°VII 1321.19 feet to the Polnt of 8egfnnfng. c~ t~ g~~M 6 UF~ZL-~v ~ 2 or- ~ ~: Wisconsin Department of Cornrnerce SOIL EVALUATION REPORT Page of Division of Safety and Buildrrtgs " in accordance with Gomm t3.5, wrs. f-am. was ~ ~ r ~ attadt oompiete site plan on paper rest less than 81/2 x 11 i in ~'~/ E D indude, tart Trot limited m: vertical and horizontal reference pa (BM), north arrow, and Location a distance to nearest road. scale or d~rrensions ercent slo e P I.D. , , p p Please print all information. Personal iarormation you provide malt be used rot saoondary purposes MAY 0 1 2003 taw. s. 15.04 <+) (m)). R ~ ~' ` /2S 103 J ~, ~0! Q~ Z NI G F I 114S ~ T N R E{ W property Owner' Mai~rlg address ~ ~ ~ State 2~ Code Phone Number Lot # Btodt # Name or CSN~ ~3 -- _r, ^ Cily ^ ViNage Town Nearest Road New Cor~trudiorr Use: / Nunes of bedrooms Code derived design flow rate ~ 0 GPD ^ Replacerrrent ~ic ~, 'al - Descn'be: - Parent material ~ . Flood Plain elevation if applicable - /~ ~ ~" ~ ~: ,~~ ~~~~ e l~ ~u,%~' /mod ; ~' ~ c/ - J( 7/w~ - ~ - - Pit Ground surface env. - Z ft. Depth m lirrating fades _G.LS.L_- in• soa Ram ,~ ~~ J" 2 ~ i ture T SUtrdtme Cor~terrce BourtdarY Ram P D/ff Florizon Depth in. Dorrdrrarrt Munseq on Redox Descript (~u. Sz. Cont. Color ex Gr. Sz. Sh. 'Eff>Y1 'Eit#2 ~ ~p_ S ~ _____^ ~ -- ''- .. .- # ~ a ® ft. Ground surface elev. ,~ Pit Depth to limidrtg factor ~~~ L_ ~. SoB Rate flan i D R d Texture Slnrrrture Consistence Bounda ry Roots GP D11t~ Horizo n Depth Dornirrant p ox escr e 'Etf#1 'Etf#2 in. Murrsefl Qu. Sz. Corrt. Cobr Gr. Sz. Sh. - ~ ~ ~ ~ 2 ,3~L ----- s~ ~ ~ a~ ,.r . rz-z ~ .~ s c , ~ . ~ ~ _ s l ~ ~- ,-- ,~ , • Eftltl ertt #1= BOD > 30 < 220 tnglL erld TSS >30 _< _< 30 irlglt S S ~ EtikterN #2 - BOD <_ 30 mglL and T ~ ~Y ~ W ~ pp~~ ' r,w~ addr ess r ~ ~ Evad~lfon Candtx~ed Telephone Nth f f :~ rn ~ ~ A _ A /e ~ - _ // /i>> ,/ ~t.//11 7 ~~''Y",9?i 7~f-a ~6-~.r~ Lv~o / l ' ~at~~ Parcel !D # Page of ^ Ong 3 emirs # ~ Pit Ground surface elev. ` ~ 8. to fimitmg fade _~ S L_~ ~• ~ ~ ~ horizon Depth Dominant Redox Description Texhxe Stnx~rxe Consistence Boundary Roots GPD/ff in. Mansell Ctu. Sz Cont. Cobr Gr. Sz Sh. '~I ~ff#2 1 ~ d~ ~' `d 3~ Z r S" P~ rn /' ,/ff ~ r ~ S / .~ ~ ~ ~ t~ Ip ,- s/,G tnt2 ..,~.. /Z - ~- .-- r---, r~ a~ ~ ^ eori"g U U Pit Ground surface elev. ft Depth m I~Ing tarxor n. floriaorr Depth Dominant Color Redox Desuiption 7extrre Strtx~e Cor>sisterroe Boundary Roots Soft Rate GPD/ft< &r. M Qu. Sz Cord. Cobr Gr. Sz Sh. 'Etf#'I 'Ef~2 o # ^ ^ Pit Ground surface eteV. R Depth tD Ming factor ~. Sofl Ra Horia~r Depth Donrnant Redox Desa>ption. Texdxe Strud~xe Consistence Boundary Roots GPDIfF in. Mures flu. Sz. Cord. Color Gr. Sz. Sh. 'E~ ~~ • Effluerd #1 = BOD, > 30 < 710 mgiL arrd TSS >30 < 150 mglL 'Effluent #2 = BODS _< 30 mglL and TSS _< 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an aiten~ate format, please contact the department at 608-266-3151 or TTY 608-264-8777. saoas3a~.bruoj ` .. Soil Test Project Name P.C. Collova Bldrs. Inc. Address P.O. Box 487 Somerset Wi 54025 lot Plan Shaun Bir `~ iTM #226900 Lot 13 Subdivision Crick Bolton Date 12/4/02 1/4 NE 1/4S 18 T 29 N/R17 W ownship Hammond Boring 0 Well PL Property Line ounty ST. CROIX BM or VRP Assume Elevation 100 ft. T p of Survey Iron System Elevation 100.9' *HR Same as Benchmark Alt. BM Top of 2" Pipe @ 100.0' a~ a~ a 0 .o 435' (~ Alt L~B.M. 154' ~ B.M. 10' 40' B-1 40' 1% Slope u so' B-3 Property Line enough slope to establish contours 10' B-2 w = Oi N / V 012 s_32' ~ - 2os.oo' - ,G , ''~ / 78.93' ~~9'0T37" W 412.32' ~ ~ , 2 ~~~~ ~1, ' _ / . rn rn _ - _ 0 0+ N 89 7'37" E 412.32' w 13 ~ °~ - - _ -~ ~ ~ ~ 154.00' 37.70' ~-~ 6. 0 15 62 _~ Z -~ ~ ~- 0 N LOT 17 ~~ -' ~ ~ LOT 16 ~ N ~, ~ ° o ° 102763 S.F. ` v_ w o ° ~; 67999 S.F. ° ~ N LOT 14 N LOT 15 N N 2.36 Ac. N N 1.56 Ac. \ N w w w Leo = 100' 67497 S.F. ~ 67405 S.F. ~, Leo = 1oos.s' m ~ z 1.55 Ac. 1.55 Ac. ~ O ~ ~ w ~ _ ~ ~ LBO 1006' ~ ~ 5 '13!~ N 79'59 ~ ~ ~ N 80'43'16" ~ 266.3fi 156.45' W i~ ~ BENCHMARK TOP OF ,3 HWE = 1003.5' H~ _ ~~. ~~ -I 3/a" IRON PIN ~^ S ELEVATION 1009.92' ~~°W' F f ~~i~ ~ (ASSUMED)o~i ~~ cJi+_ psF u qC F Q ~ HWE 1003' ~° ^ 2x.03' ~F~i ~ ~ 154.6 154.00' 154.00' ,, T 345.12' ---I rn 8'33'24" E 562.'34' 277.73' N J ~ / ~~ O ~ L 1 ~ ~~~ ~~ ~ ~~iL N 87'16' 32" E O ~ ~ '4C 99.70 ~ z 2359 7 S.F. ~ F o 5.42 Ac. ~ ~'Q~ w w' L80 1006' p~ /P;~ ~ ~ -~ ~~~ ~ N N 7 HWE = 1003' wts.~• ~ ~ ~ RAE L---~ ~ 26s.oo' 255.35' 105.98' ;; N ~ , n SOUTH 1 /4 CORNER, S 89 33 39 W 0 N O SECTION 18, T29N, R17W. 626.33 J N UNPLATTED LANDS O IV -P W ~ ~ ~~~k l"-c1i