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HomeMy WebLinkAbout018-2003-14-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH j0 PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.n4 (1)(m)]~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ OLYS Dosing ~ ~~a Aeration ~ ~ ~ ~~ Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ r ~ ~ f ~ Z 1 ~~ .~-- Dosing /, ~d/ 1, ~-~) ~Zf '_'_ Aeration Holding PUMP/SIPHON INFORMATION Manufacturer ~ Demand ~~ GPM Model Number ~~ ~ •~~ TDH Liftr~ Friction Lo~s~ System H~d TDH Ft , ll i ~ ~ Force ai n t t Length D ia. t Dist. to well ~t/ ~ SOIL ABSORPTION SYSTEM (~ ELEVATION DATA county: St. Croix Sanitary Permit No: 453196 0 State Plan ID No: Parcel Tax No: 018-2003-14-000 Section/Town/Range/Map No: 18.29.17.908 STATION BS HI FS ELEV. Benchmark ~ ~ 7~3 / ~~~~ Alt. BM st-. c,o~ ~ s~.~~5 ~. 35 Bldg. Sewer tQ•~ p 8.0 St/Ht Inlet /a 2 q~, St/Ht Outlet Dt Inlet ~~ Dt Bottom ~ q® / Header/Man. Dist. Pipe 11 .L~ ' `' /~ . ~~ / ot. System , I C,Y[ "'~ J ~~ `'~ Final Grade , ~P ,~~ Z 5 St Cover ; I ~ i~ ~,- 5.75 1`~, 3 F BEDfTRENCH DIMENSIONS Width ~ ~ Length / ~~ No. Of Trenches PIT D MENSIONS No. f Pits ~ Insi a Dia. ~ Liquid Depth \ SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/BYRE M LEACHING CHAMBER OR Manufacturer: O S Type yst ~: /D/ ~~~ / UNIT Model Number: DISTRIBUTION SYSTEM ~ ,~ , Header/Manifolc~r Length ~ Dia / ~ ~ Distributio//n I Length 7~ ~ Dia ~ r'~ 1}~ Spacing ` x Hole Size ~ x Hole Spacing ~ ~. Vent t/o Ai Intake C_... ~o SOIL COVER x Pressure Svstems Only xx Mound Or at-Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil I ~ ~, ` f - °' Yes (Ji No es ~ :,~ No COMMENTS: (Include code discrepencies, persons present, efc.) Inspection #1: L / ~ / ~~ ~ Inspection #2:~/ o f~ ~ur~ Location: 1553 97th Ave Unknown (NE 1/4 NW 1/4 18 T29N R17W) Crick Bottom Overlook Lot 14 Parcel No: 18.29.17.908 `J~-: Goy e,~.. `j 9. 3 ~j 3 ~/~ Q] ~~,,. ; .. a k 1.) Alt BM Description = t 2.) Bldg sewer length = ~j(j /I ~ Qom„ ,~Qy_ ~`~„/~-- - amount of cover = ~Z ff'"'~~°° \`;' - 3.) Contour = ''~ ~" -- --- ~~-- I I - -- it ; Use otherlside for additional ~ Yes o "7 I ~ ~ ; ~ ~--- information. L_ I___ --- __ SBD-6710 (R.3/97) Date InSepctor's ature Cert. No. Permit Holder's Name: City X Village Township Collova, P.C. Villa e of Hammond CST BM Elev: Insp. BM Elev: BM Description: Safety ~d Build ings Division County ~^~~ C' ~ `X, O 1 W W»hiagtoa r,ve.,. P.O. Box 7082 Madison, WJ' 53707 - 7082 Sanitary PPermit Numbs (to be 5lled in byCa.) v' ~sfn (608)26i~546 ~S~ --- j Department of Commerce _ •~ Permit AppC~ ; i ~~ ~ S to Plan LD. Number ~S~zr l (SUS. ~Q # a 3 tary a~`:, ~ San accord with Cottlm 83.21, ~s• A~• 04(I)(m) al 5 w I L ~ ~ oject Address (if different than tnailiag sddms) . , st a vs cy sea Pn tnaY be used for secondaD' P~° i o t, Application Iafortnation -Please Print All lnformat ~1 # tAt Block+M / ~---- --•..------- Property Owner's Na~ n /J / C ; C~ Lot ert P v ! G' r/ GC . y rop ~ Property Owner's ailing Address ) ~~ ; ~~ '~s /., Section / - " Cit~State ~ i C e o~ ~ LL Phone Number ~ ////// ~ ~~rcl one) . N. E VJ ~` 1 l T CS N ber 3 ~ Ij, yp! Of Bulldlag (check all that apply) S ^ ~ ~' ' ~~~' ame ~~ G ~~ '~ I,vr 2 Family Dwelling - Number of Hedroems - i ~ o''a ~ Yilla ~~ I]City_~ ge sbip of _ ^ publidCotntaercial- Desctibe Usc tom. ~~ ` D stater owned - Descnbe use e B li b a p ll , z~ 3 lIL T n ype f Pertttit: (Cheek only one box on line A. Co plete lacement Only lc A Ta a eP ldia /H Q Orber Modifieatioa to Existing System A. 9Ystcn ^ Replacement System g o ^ Trratmeat List Previous Para»t Number and Date Issued Q Change of ^ Permit Trasisfer to New B. ^ Permit Renewal ^ Permit Revision plumber Ownar Befort: Fspitatioa ~ IV. T e of POD'S S f tlm' C k alt that a 1 ~ of suitable soil Mound 24 in. of suitable soil ^ 24 ia ^ At.Orade ^ Single Peas Sa°d Filw rculstin Sand Filw ~ it ^ Rnci g U . in~round o~> ^ Non-Pressurized Ta:tlc ^ Peat Filar ^ Aerobic 7reatm Q I'IO~g ` n enc ;n irotmd ~ vel-1 s Pipe ^ Other ex s t.oostructed Wetland [] P urizod In~1 ^ Drip Line .. t9 2. ~ I.eaehia bar Recirculstin Syathatic Media Filter = 0 errialrPreatment Area Information: Disper~l pres Required (s~ Di V x a ed (sf) Dispersal Ares P~ -- System F.Ievadon r s . Design 50' Application Ru dsf) Design Flaw (gpd) ~ 1 ~J~ /G,f Jam ~~ ire Stoel Fiber Glass Plas ~ ~"'-'J J Tom Nurnba Manufacturer Concrete Constructed VL Task Info Capacity in Gallons Gallons of Units I flew Tanks Eteittiag Tanks Septic or Hoklinj Tadt Aerobic Traat+neea Unk I?osiat (3amher `3G for iastallatioa of the POV:'TS shO"P6 ott she attached alms assume responalbility ~ Easiness Phone Number ~ r l i ~ 8 YLi. Responsibility gtatetsteat- I, the uadees Nanne (Prins) Plumb gnature x MPIMPRS Num ~~ i /J /~ _~ V ` Ptum~ s ~ ,~ Plumber's Address (Str~ State' Ztp ~ !J cY Date issued 1 ui Agent Signaturo o Smm; . Coun /D artmeat Use Onl - Ssaiten' permit Foe (includes Oroundwster proved ^ Disapproved Surcharge Fce) ~ 2 ~ ~- .J ,Z {] awn r Given Reason for Denial IX. Conditions Appror SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all ~ serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. wt ~,~ than stn : II lathes to eta r the Csusty only) for the system os pape a: ee Attae6 complete pier l i.~n_~~4Q I'R. 081021 commerce.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce. state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary May O5, 2004 CUST ID No.226900 SHAUN R BIRD BIRD PLUMBING, INC 1008 192 ND AVE NEW RICHMOND WI ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/05/2006 SITE: PC Collova Bldrs. Inc 1553 97TH Ave Town of Hammond St Croix County NEl/4, NW1/4, S18, T29N, R17W Lot: 14, Subdivision: Crick Bottom Overlook Identification Numbers Transaction ID No. 995621 Site ID No. 682955 Please refer to both identification numbers, above, in all corres ondence with the a enc . FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 956332 Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, L'Oifll~lll stats. ~~~ The following conditions shall be met during construction or installation and prior to occupancy or use: DEF RTMENTC General Approval Requirements: ~E SEE CORRE~ • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 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 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 5/5/04 • 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 copy of the approved plans, specifications and this letter shall be on-site durine construction and open to inspection by authorized representatives of the Department which may include local inspectors Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure; or component. Inquiries concerning this correspondence maybe 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, J Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commercestate.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 . ~cE,v~ 2004 MAC ~ 3 D,v. & B~-0~`S S~E~ haun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 04/29/04 Owner: P.C.Collova Bldrs. Inc. Cover Page LocationNE1/4NW1/4 S18 T29 N,R17W Lot 14 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 7-8. Maintance and Contigency plan 9-11. Soil Shaun Birc Signature License ni ~~~~'i, ~~. fi~~E ~G~ `~ ~~ INGS ,v~~,vc~ . PLOT PLAN PROJECT P.C. Collov a Bldrs. ADDRESS P.O. Box 489 Somerset Wi 54025 NE 1/4 NW i/4S 18 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE4/29/04 BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND )OQC 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 100.1' Tank is to be properly bedded and provided Pro 3 with lockdown covers Bedroom with approved House warning labels Huffcutt Combo Grading is to be done to divert run-off away from system Scale = 1 /4" = 10' 97th Ave Area 15' below system is to remain undisturbed \ 4% B - 2 Slope Well is to meet all setbacks found in Comm. 83 437' Property Line B -1 98' \9~ 99.1' 100' I Alt. B.M. is top B M of 2" Pipe C~ 100.0' Alt. B!I Property Line w r-- w °¢ w x U a S 0 r¢- 0 r- 4 100 80 160 240 FLOW PER MINUTE 320 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 foroutdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. 1521153 Series - TOTAL DYNAMIC HEAD/C APACITY PER MINUTE EFFLUENT AND DEWA7 ERING MODEL ?52 t5 3 Feet Meters Gol. Liters Gol. Liters 5 t.5 69 261 77 291 10 3.1 61 231 70 265 15 4.6 53 201 61 231 20 6.1 44 167 52 197 25 7.6 34 129 42 159 i 30 9. t 23 87 - 33 - t 25 35 10.7 --~ -- 22 85 40 12.2 -- -- 11 42 Lock Volve: 38.0 Ft. (? 1.6m) 44.C Ft. (13.4m) oiosoa 3 27 32 32 I ~ ~ ~2 ~/e I i 5 1/ l ---~-t- 8 sK2osa SELECTION GUIDE O CAUTION All installation of controls, protection devices and wiring should be done by a qualified Ilcensed 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 toFM0477. 2. See FM0712 for correct model of Electrical Alternator E-Pak. 3. Variable level control switch 10-0225 used as a control activator, specify 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 T0: P.O. BOX 16347 Louisville, KY 40256-0347 Manufacturersof. . Z SHIP T0: 3649 Cane Run Road ~s ~ Louisville, KY 40211-1961 QVq(/TyPUMP9 ,,//NCE ~il.~i~M ® (502) 778-2731.1(800) 928-PUMP http:/lwww.zoeller.corn P~MP ~O FAX (502) 774-3624 ©Copyright 2000 Zoeller Co. All rights reserved. Page of ENT PUN -" ~ ~ ER,S MANUAL 8~ MANAGE ctFtCATtvNs _ pOWTS ~VYN SYSTEM SPE j ~, al ^ ~ " $eptic Tank Capaaty " ^ tQA pttE tNFO~pTtON `, tec ~ t,/: !s .-- g~tlcTank ~~~ rer _---~ ,~ O fVA Owner ~~ Peek ~- S31 `) G Effluent Flter Manufactu ~ j o ~ PAt~-w-ETE~ .:. '~ d NA Effluent Fttet Model _ OESiflN ~~ ~~ at ^ NA Number of 8ed~s Nq Pump~Tank Cgpa~y „ umber' ~ ~~pmial Units ~ aUd pump Tank Manufacturer ~ 1 NA N Mani1~-~~ r ~matad fb~tr ~~~ x 1 5) ~...i ~ aVd I~ .Pump ,-, sJ ~ ~ ^ NA (Estimaoed ~ '~'~$~ Pump Modet 0es[Qn if01M (Pew l_ U ~ pro~~nent Unit O Past Fitter 5150 ~• Man ~ C~eII(s) Soli ApP~°^ ~` Monthly average' ~ ~ndlGn~vet Filter O Wetland irtfluent/El'flusrtt t2uaditY 530 mgn- ^ Mechanical Asratian ~ Other. OxYg~ ~ (BOOe? Sl2fl mg/L ^ Disinfection Bioehe~l Suspended goods {TSS) Montt-b average" Dispe ^ In-ground (pressur¢ed) ^ qt-grade ~ravttY) ound Pry Effluent Qual•RY BODs) S30 mgJl. ^ Other_ B'tOd~~ en Demand ( !L ins Total Suspended SordS {'TSS) ~Q<~~100m1 ^ Orf '~ for aomesttc t~o^-~t1Aef d'n'"'st°"~'ter sne Fecal Coiifocm (geometric mean) values eye r, ind,diameter m„kerrtuent wastews~r .+ values tyP~ for pfe~eatad Maximum EnlueM Particle Size . $enl~e Event Inspect oond'Non of tank(s) Pump out contents of tank(s) inspect dispef~ Oelt(s) Clean zffluent fitter Insp®d p~urnP~ P~np controls & alarm Flush laterals and p~sure test Service Frequ_en~cy Maximum 3 p months ~jgaf(S) ( At"'~ once every ` oafs ond~ird (Y) °f ink volume When combined sludge and scum eq _-...~ r(s) (Maximum 3 yrs.) At least once every At least once every At least once every At least once every At least once every At least Once every O D D O O NA O NA p months ~ Ye ~ ) ^ months fl yeaKs) ^ NA omar_ _ licenses or MpIN~NpNCE INSTRUCTIONS 1 ~f~ shaft be made by an ind'nAdual paying one of the foElowingintainer, $eptage r, PC)111f•i'S Ma mfg ~ broken ingpa~pn5 oftanits and dispe~ r Piumt~' ResCilcted Sewer; f~OWTS fnsp~o~ tdentafY nY Master plumber. Masts on of the tank(s) m end Lo check for any back up ~ ~ ~ ns must inducts a visual lnspect3 a and scu s~~g ~~r, Tank inspecdo measure the volume of combined sludg to check the effluent levels hardware. iden9h any ~~ °r leaks. The dispersal cell{s) shall road s ~ce .~ ~~ing of effluent on the or ponding of ethuant on the ground surface- nding of effluent ott the g ulatory authority. pipes and to check for any Po utres the ~Immediats notification of the local reg in the observa~ or maze of the tank volume, the groin ~~ may ind'u;aie a fat rng oondiflon and req in any tank equals one-third (~ seQ of In accordance with d1• NR When She ootnbirted ~urnulation of sludge and Scu of the tank shall be removed by a Septag8 Senrldng Operator and dispo entire contents retreatfinent components, and any 113, Wisconsin Administrative Code- onents, p ressurized POWTS comp rformed by a certified POWTS Maintainer. 1'he servicing ~ effluent filters, mectianipi or P of completir~n of any service event er matntenanoe or monttorin9 at interyats of i2 months or less shall be Pe o~ •ded to the local re9Ulatory authority witfiin 1o days A SC1vfQe report shalt'be prow roduds or other START fJP ANO OPERATION f the POWY'S ctledc.treatment tank(s) t ~ cell(s)•nif high conboentr'ati°ns are For new opnstivction. prior to use o s and/or damage the disPe fm' a the treatment pis a septage servicing operator prior to use. dtemicats that may Ped removed by dCi,CC'~ed have the contents of the tank(s) _.. Page of„_ ~^ v,Rten ~i•conditions are frozen at the infiltrative sutfiace• is rrsto~ ~ excess wait not occur ~ hMrdter tevsls. When p~ Sand may result in the system Stan up above notm~ ~ the ceC( } des pump tanks triaY ~ ~ It(s) in one -arge 'dose. overloading ~ t$nk re~+~ b'Y a eater nn'1I be dischan8'ad tp ~° ~pTo avoid this sihtadon have the contents of the P P of pptrYl'S Maintainer to p or s~irlace d~7e~e of eta ~~ er to the affluent puts vtrt~ ~ihe p a PIllmDec umP Yank. ppenatior prior n!~ P~ More normal lave image Servidng ng the Pump ppn ~ over, ar oft~terwise disttlrb or camparx, assist in manually oP~~ land dispersai cells. Oo not drive or pa . po not drive or park v over o~anY mound or atgrade soil absorption area- ~a within 15 feat dawn slope a ~„astewater stream may impn~e ft7B performance and PAS the fife the of the following f*'0m th s, d~r,Basers; dental floss; diaper's. Redudion ocetimination ~~ butts; condoms; cotton swab ~ asotin~e; gre~~. herbicides; meat of the POiA(TS: erttfbk>>xs: ~Y v~p~; ump} iera~r, fruit and vegetable pee ns9salgd wrater softer btfine. disinfectants; t~ fpDndatlCn drain {S ~[? ~sictdes; sanitary napkins: tamp0 . medications; ori; painBng Pn~d the fottawing steps shah tae taken ~ lnsum that the ABAN~th POWTS fall andlor is ~~aner>tiy.take~n~ ~ ~mm 83.33, Wisconsin ActmMistative Code: Ylthen Boned in oornP i nings sealed. system is property and safely aban dtsconneded and the abandoned p Pe oPe AU ptptng ~ tanks and pits shat! ~be disposed of by a Septage Servicing Operator. the void space -rr,6 oont9n~ of alt ffinlcs and Pits sha11 be removed and property ttS Shall be excavated and removed or their fivers femOYed and after pumping al[ tanks and p filled with sat. gnsvel or af'otMer inert solid material. ar must be taken. to provide a code CONTINGENCY PLAN the following measures have been, if the POWTS fails and cannot be repay ~ utilized for file location of a fep~eement soil ~mpGant r~eplaoement system- has b¢en evaluated and may coon and should not p. A suitable r!eptaoement•area bso n ~~ The replacement area should be protected Sri 5~~~ ~~r~~ ~ d ~rrs_ Fairure to a ~° wired setbad~ from existing and propo be infringed upon by ~4 ~u result in the need for a new soil and site •eval attt~at ~rnt',stablrsh a suitable prated the Cepia~ment an3a terns must comply with the rules in effect replacement area- Repla~Rtent sys ant area is not avartable due to setback a e ~ce'~ n~ ~ Q~~Sng advances in POWT' p A suitable replacem be instaued as a fast resort to P n failure of the POWTS a so~.and technology a holding tank may x{entify a suibbte reptaoernent area. Upo The site has not been evaluated to • evaluation must bs pe~~ t° locate a suitable replacement area. tf no replacement area is avaiiab e a ~ removal of the biomat at olding tank rnaY be installed a ~ ~s~~s m y be reoonsirucced ion place fo[lowing infittrativets ffac;e.oReoons~clions of such systems must comply wiil'~ the rules In effect at thattime. the _ <cy{fARNIN©~ TANKS MAY CONTAIN LETHAL GASC RCUh1lDSOTANCESF DIEATH iiAAYGENI. SEPTIC, PUMP AND OTHER ~~'1'1iilENT DO NOT EI~iTER ~°- BEpTiC, PUMP OR OTHER TREATMENT TANK UNDI^R ANY RESULT. , RE8CUE OF A PERSON FROM THE INTERIOR flP A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDfT10NAL COMMENTS • pOWTS MAINTAINER POVIftS INSTAt.t.F,R N2R~8 ~•`~ r,~- /l Name ~ ~' '~~~ ~ Phone ~ ,/ ,,-~.~1~~`' Phone 1 • =L '- ~-~r LOCAL FZFG(lLATORY AlPTHORITY SEPTAGE SERYIC(NG OPERATOR PUMPER ~~~ '.'' ~~ ~~ ~~ Agency C ,. ~- Name /~/~11~ ~ - ~ 7 / Phone ~J --- ~' . This doarment mesa Phone ~ /CJ~'" ""~ ~7` the stags of the green Lake, Marquette and Waushara County Zoning and Ssn~atioc-! ag .. ,T1Ent does not 'this aoam+ent was draRed by Wisconsin Adminh'frative rcade~. Use of tl+is Bow the minimum roqu;nemants of en. Comm g3.22fz](bXtXdta(~ and 83.SS(t), f2] ~. (3). GNryV l1/Oty guarantee the perforrnaooe of the pOVYTS. f JJ t vlr~soonsin ~ ~ SOIL EVALUATIQN REPORT Page of umsron or aarery a as o,nu~ y~ in aa~adaanoe with Comm . V1fi~~r. E - ` n - - r j ~ (~ ~ Pdtactt complete site plan ~ paper not less than 81/2 x 11 irxhes but Trot timited to: vertical and horizontal reference poird (B irxiude size. Plan must ), direction and Par~oel 1 Lo. ' I p ( 9 ~$/ , scale or dimensions. north arrow, and location and ercent slope tanpl~aret ~ 3 _ ~ . - Z(Ja 3 - I T . p Please print all Information. ` by Date Personal information you provide may be used for secondary Purposes t cT ~ R ~ t.aw, b: tS.OS' '~ U N / - ~ . l~- '~ ProP~Y J / Lot 1/4 114 S ~ T N R E (ar W Govt ~ ! © :~ l . Property Owner Mai'li'ng Address ~ t # Block # ~Name or CSM# ~~ ''"' L 1 ~G ~ ply State Zip Code Phone Ntxnber ^ City ^ Ygage Town Nearest 12oad (illl ( ) New Construction Use: t Number of bedrooms Code derived desi~ lbw rate ~ 0 GPD ~^% 'ai -Describe: - ^ Replacen~rtt ~ `~ 1 ~- ft / PareMmaterial 9/ ...~ Flood Plain elevation if applicable I , General cortrrrants ~ r, .~iT~.v a j~ r/~~ ~ / and nrconurrerxfatiorts: ~ /0 ~, / 1 (,, ~ ~ .Q- d - Jf ~~ -... ,~ ~~.. l ~u~ ~~ # Pit G~nd surface env. ~' . ft. ~ t. Purutins tacMr in. ~ Rabe t T Structure Cow Boundary Roots GP DAF Horizon p~ &t. ppninarrt Mrmseiti Redox Description Qu. Sz. Cont. Cobr ex ure Gr. Sz. Sh. `Eff#1 'EB#2 ~ -d / - U r3/L ..~ ~- - ~ .~ ,v-> > S -s , ~_ ~ ~ ~ ~~• ~ 1~ ® ~8 # LJ Pit Ground strrfaoe elev,/~ ft. DeP~ ~ leg ~~ ~~ Soil Rate Horga n Depttr DonuttaM Redox Description Texture Structure Consistence Boundary Roots GPD/P! 'Eif#1 ~~ trt. Murts~ lhr. Sz. Cont. Cobr Gr. Sz. Sh. ! 3 n ~ J p r ~- .rte s r- +-~ ' Eflkrent #1 = BOD > 30 < 220 TSS >30 < 150 mglL ' EflYrerd #2 = BOD <_ 30 mgll and TSS <_ 30 mgfL CST Number ( Prird) 1~ Adt~ess Date Evaluation Cortdix~ed Telephone Ntstiber Property Owner I~ ~~l Parcel ID # Page of ~8 # ^ ~it Ground surface elev. fL Delrih ~ rurata,g factor 3 ~ in. soa ~ Rode Horizon Depth Domin~t Redox Description Texture Structcu'e Consistence Boundary Roots GPD/tf in. Munseq Qu. Si. Cont. Color Gr. Sz Sh. `Eft#1 •Etf#2 1 ~` 1 3/z .--- ~ r rn~' ~ s a m ~ 5 ' ~' 2 j -- ~ ,_ r r ~ I e= ~ S ~-' 5/ b Li~~~~~ ~ ~ ~- r- ^ Pit Ground surface elev. ft. Depth b kmiting factor in. Soil xation Rate # ^ ~~ Horizon Depth Dominant Redox Description Texture Structure Conuistence Boundary Rants - t3PD/fF in. MunseU Qu. Sz CoM. Corr Gr. Sz Sh. ~ft#'1 ~~ ~~ # ^ Bonng ^ Pit Grorntd scrface ~' R Depth m farms ~. Sod Rye Horizon Depih Dom~ant Reda~c Description- Texture Strucdxe Consistence Boundary Roots GPD/fF in. Munse9 t1u. Sz Cori. Cobr Cx. Sz Sh 'Etf#1 'Eff#2 • Eflluert #1 = BODs > 30 < 220 rrglL and TSS X30 _< 150 mgA_ • Etl~ #2 =BODE < 30 mglt. and TSS _< 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-26b-3151 or TTY 608-264-8777. wtR.aroot ST CROIX COUNTY SEPTIC TANK MAIN~'ENANCE 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 City/State _ tl~ ~ . Pazcel Identification Number 4 /~ - 2~3 - 1~- ~ ~' 9~/ LEGAL DESCRIPTION Property Location %,, ~ %,, Sec. ~ T~N-R~~W, Town of Subdivision _ ~~ l~t/ .f~l ~~-~~Y~ ~ ~i~.~iL~~i~ Lot # I'7 Certified Survey Map'# ~ Volume .--- ,Page # ~_ Warranty Deed # ~-L~ 0 ~" ~~,~ Volume ,> V Page # Spec house ^ yes ^ no Lot lines identifiable ^ yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its prcmaturafailure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. (~oix Zoning Department a certification form, signed by the owner. and by a masterplumber, journeymanplumber, restricted plumber or a liccnsedpumper verifying that (1) the on-site wastcwaterdisposal 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. Certifcadon stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 the eaz expiration date. P, C. COLLOVA BUILDERS, INC. Y i~7i ©Y SIGN OF APPLICANT (715) 247-2742 DATE _ P.O. Box 489 OWNER CERTIFICATION SOMERSET, WISCONSIN 54025 I (we) certify that all statements oa this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of de ~ above, by virtue of a warranty deed recorded in Register of Deeds Office. P, C. COLLOVA BUILDERS, INC. (715) 247-2742 Y ~?~ [~~ SIGNA OF APPLICANT P.O. Box 489 SOMERSET, WISCONSIN 54025 DATE ****** Any infonaration 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 W ISCONSIN FORM 1-1998 WARRANTY DEED ' This Deed, made between John J uallon ana carolm ~. canon. husband and wife .Grantor, and P C. Cdbva Builders. Inc. .Grantee. Grantor, for a valuable consideration corneys to Grantee the following described real estate in St CrotY County State of Wisconsin (the "Property'): 66724c^ KATHLfifiH A. MALSR REGISTER OF DEEDS ST. CROIX CO., YI RECEIVED FOR RfiCORD 0B-lta-2002 9:00 AM E~QPT t ODD REC FEE: 13.00 TRANS FEE: 1155.00 COPY FEE: CERT COPY FEE: PAGES: 2 t~f C2~CrrC ~ I~-o/''1 ~V E ~~.b oK t of 2 Sae Exhibit A attached hereto 'J'°~ ~a t3ullders, Ina x Avsnue mood , wl 54015 /~'~'~~ 9~D 9 078-1039-20-•000 / 018-1039- 018 1039 80 000 Parcel Identlticatlon Number (PIN) Thla la not homestead properly. (Is) (IS not) Together with all appurtenant rights, title and Interests. none Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this 15th day of eytoust• 2002. (S~) (SEAL) '~..f ~~ /' - ~ hn J. Iton arolyn G. ' alton (SEAL) (SEAL) • ga~~~Ci ;~atEOFw-sco~ Signature(s) authenticated this N~ va~9~~_, - SjJ~'~Qi- WiSW TITLE: MEMBER STATE BAR OF W ISCONSIN (If not, authorized by §706.08, Wis. Stets) THIS INSTRUMENT WAS DRAFTED BY t;oldwell Banker Bumet 1301 Coulee Road Hudson, WI 54016 2-32470 (Signatures maybe authenticated ar acknowledged. Both are not neceaaary.) • Mn.n.a of n.e:nne ,~k,nlrra M env ~naclly must be tVDed ACKNOWLEDGMENT State of Wisconsin, } ss. St. Croix County Personally came before me this 1,~ day of August. ZQ_02 the above med J and rbl It n ban nd Wif Notary Public. State of Wisconsin My commlasion Is pe anent. (If not. state expiration date: ~~5 ~~ .) STA7E BAR OF WISCONSIN Wisconsin Legal Blank Co, Ina WARRANTY OtEED FORM No.1-1998 Milwaukee, Wis. . .. ;.1~:,-.~<1, 9.5..,E F, 5.2,x.,. ~1. .. a, r 1 ~' 1 ... .. A part of the NE'/. of the NE'/. and in part a BrNyy~+j~~,~~ ~ ~ , the NE '/. of Section 18, Township 29 North, Range 17fWest, Tow~o Hammond, S~Croix County, Wisconsin and more partlwfarfy described as: Begfgn{ng at the Northeast comer of said Section 18; thence S89.33'31'Y1I 372:01 feet along the North Line of the NE'/. of said gectlpn 18; thence S89'33'31 "IN of pqg the Norht fine of the NE '/. of sriid Section 18 775.94 feet; thence S00°52'23"E 250.00 feet; thence S89'33'31 "IN 966.24 thence S89'33'31°V11528.00 feet: thence S00°52'Z3'E alot a North-ScuOth Qua a SectQlotlf Ijne of said Section 18 1311.77 feet• thence N89'33'39'E 62.6.33 feet; thence N00°31'25'W 3~Q,23 feet; thence N89°33'24"E 692.76~feet; thence N00.52'23"W gfgng the East line of the SW +/. q~ the NE '/. 330.31 feet; thence N89°33'24`E along the South line of the NE Y. of the NE '/° 949.09' feet; thence N00'52'24'W 1321.19 feet to the Point of Beginning. ~:' 6V F~2.L-~Uk 2 °~ ~- PLOT PLAN . Collov a Bldrs. ADDRESS P.O. Box 489 Somerset Wi 54025 4 n1W 1 /4S 18 /T 29 N/R 1 7 ' W TG`WN Hammond COUNTY ST. CROIX 4/29/04 3 PRS Shaun Bird 226900 DATE BEDROOM 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 RATF, 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 100.1 Tank is to be properly bedded and provided pro 3 with lockdown covers Bedroom with approved House warning labels Huffcutt Combo Grading is to be done to divert run-off away from system oQ~ G Scale = 1 /4" = 10' 97th Ave Area 15' below system is to remain undisturbed 4% B _ 2 Slope Well is to meet all setbacks found in Comm. 83 -1 9' 100' Alt. B.M. is top B M of 2" Pipe C> 100.0' Alt. ~ 437' Property Line 9 8' ~' ~./ ~~ ~ 99.1' ~`~~. ~ N ~~, SE ,,~ ~~ C` Y 3~ Property Line Project NamE Address Soil Test Plot Plan P.C. Collova Bldrs. Inc. ~ ~ Shaun P.O. Box 487 Somerset Wi 54025 Lot 14 Subdivision Crick Botton C~ #226900 Date /4/02 1/4 NE 1/4S 18 T 29 N/R17 W Township Hammond Boring Q Well PL Property Line County ST. CROIX B r VRP Assume Elevation 100 ft. ^Top of Survey Iron ystem Elevation 100.1' *HRpSame as Benchmark t. BM -Top of 2" Pipe @ 100.C Designer Date ~~.. No r Non-Woven Filter Fabric ~DistriDution. Pipt _~ i ~ iH ° 4" Observation Pipe Perforated Below Filter Fabric ~I C-33 S c n d -~ ~. ~~ Topsoi~ +~ ~ ,: r Ikr~u,FS i Ffowed Lnyer* ~~ E i `~',. F ~~ ~ .~ __!.___ }i i,a - L 4~Observotion Pipe--~ _ K J ~ _~e _ ___,_,.__ ---- ~~ ~ A ~ ~ Force Moin -° ~ - r ------------- ------------------- _ 1 From Pump f._ L 3 1 ~ ~' ° Distribution Bed Of /z - Z'Z ~ -Drain RocK Pipe I 4~Obcervatio~n Pipe-:~c.~~ Perrnonent Marktr ~!~~'"".. ~ f L''~~ ~S :~~~.^,,, b~~f~~C';~.,.:~'<P i pe or Rods P{on View Of Mound UcinQ A Bed For The Absorption Areo !` _ Z '.• S'ope fled Of ~ 2 % Force Moin Drain Rock From Fump Cress Section Of A Mound S stem Usin A Bed For The Absorption Area q ~ Ft. g ~' `- Ft. . - ~ `~? ~7 Ft. K~Ft. ~ ~ ~ C. Ft. _- 1^~ `_~~Ft PA G E _,,, O F t t_otated On Botto~+. e Eatiaity SROtea %tRST 1+1o1.L µS.%T ro Can/1tG+'~ ~ ~ rti _ ~~~,'~ :~ ~p- aisfribtttyon Pipe LoYovt P ~ Ft. R ____._.. ~#. Signed: E.icense Nurr,~er: Gate: z X ~ inches '~ Fnches Hole Diameter ~~ Inch Lateral ~" ~ ~ Inch(es~ Manifold '~- Inches_ Force Main ~-- Inches # of holes/pipe Invert Elevation of i.ater~a?s ~ ~. } ~~Ft.. Perorated ~+R~ Detaif PTZC TAN3C 5 z~M~ C _~ ~T.GN AN~-~' ~~ TCATIDnS Cr~•{?~5 SE v E GRADE ~ » 1-'ENT PIPE iZ" I~SZN . ~,BO ~ c~ ~at~r~aw ~~ y ~D` FROM DOOR , ~ ~ ~ ~ FR$~1 SIR iidTAK'E + ~ T~r~ ~~ Ql ~ I ~~~~ p~ 35t?L SOIL TIGHT S~z'' ~iLTfR '-'- ~~~~~FT- ~~g 4FF £LEY - ..~.--- B Cr D ~~ ~EAtHERf'Rt}QF ,113NCTI~~Qtt©T WITH C S.D :1 ~:; ,• t' ~ •~ ~,S- s 'TIGHT SEAL ` ~ ~ i t ppggQV ED MpAfHQLE CQYEi~ id/ F~IDLGCK ~ r y~pRlIING ~-DE.. .s+ss KIN • - ~SuMf1i- ~p~~-~IPtPE 3~Lyp AIL fig. TAbF .~ .~-----~'"''~~- ~~ CQi~1CRETE PAfl a APPROY~ .a~aT3~T~G ~~ ~ / ~~~~~ ~?AR 3 1 ~--i ~. SP~CZFICt'-TZOi+FS J . DOSES ?~:R 3?AY = .r---~""' _ ~+ILI?i 9CR _ ,! / DQSE ~ ~t{SLUME ZNC~D ~ ~,, ~ ~~~ ,-- ...~ SEA riAt+NFAC~REK : pOSE g LavSACK = ..-----""'~ ., EPTTC;/~t'~" 6AL.• _ E~ - ~~ ~IPIGHES =~r°-GAL 5 T 2ES : S __._ ..5~ GAL TAli1--- DDSE ~~ " , ~~, CAPACiT2~' 8 = ~ 2 INCHES .- ~.----' ALA I''~~1FAC1[37tER,` x ~ ~ . GAL r,r,. 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