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HomeMy WebLinkAbout018-2003-27-000aVisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division 9 INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) i 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 Elev: Insp. BM Elev: BM Description: ~ ~Z • ~ / ' . "> . ~~ .~ Soc. ~' TANK INFORMATION ELEVA ION DATA TYPE MANUFACTURER CAPACITY Septic ~ D v Dosing ,/ ~ r Aeration Holding TANK SETBACK INFORMATION TANK TO P/L~ ~() WELL BLDG. Vent to Air Intake ROAD Septic \~ ~ / ` I ~ Y >I Dosing ~ i t I ~ // Aeration Holding PUMP/SIPHON INFORMATION ~ ~~ l' county: St. Croix Sanitary Permit No : 430013 0 State Plan ID No: GG//~ /,, Q Olo7 lY0 Parcel Tax No: i? ction/Town/Ra Map No: 18.29.17. STI),,TION )'-'1 ~ BS HI FS ELEV. Benchmark d ~ LI,IC.-~ i ~~ Y Q3 J wer . 83 . Lo SUHt Inlet .~ SUHt Outlet Dt Inlet Dt Bottom Header/Man. Z. • USA Dist. Pipe ~ o ~J Q tj 2 Bot. System 1~~ '~'~ o~ 0 , Fina~ade ~i "~ ~ ' I /~ S.. St,~pus~, p c~~1 -~-~ ~ 3 5~ 1 ~3., l~~.~ ~_ Manufacturer Demand ~~ GPM n Model Number 2L.I~. 7 ~ ~~ TDH Lift ~ Friction L s System H ad T ~ Ft Forcem n Length Dia. ~ h Dist. well ~" SOIL ABSORPTION SYSTEM BED/TRENCH Width Len th No. Of Trenc s PIT DIMEN~PIS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / f1 D~ / SETBACK SYSTEM TO P/L i BLDG WELL LAKE/STREAM LEACHIN Manufacturer: INFORMATION C M OR Typ~f System: //'/'~~ r Z ~ ~~ ~( NIT Model Number: DISTRIBUTION SY$JfEM Header/M~fold ,~1 ~r L th Di Distributi h Pipe(s) ~7 ! x Hole S' t~ /~~r' x Hole Spacm~ ~Jq ~ ' / Vent r take / C ~ eng a y Length Dia !/ Spacing 9 {4 SOIL COVER x Pressure Systems Only 7 xx Mound Or At-Grade Systems Only (1'6-~a.1~() . Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil '~ Yes ;JI No ~, ~ ] Yes ,J No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ / G 7 Inspection #2:~/ ~ 7/ b Location: 973 158th St Hammond WI 54 1 NE 1 ~ Parcel No: 18.29.17. 0 5 ( /4 NE 1/4 18 T29N R17W) Crick IBottom Overloo Lot 27 1.) Alt BM Description = ~` ~ ~ ~ D LUt(/1.Y1(7t,L~ ~~~ 1~4,~" t~~ ~ I ~ ~ ~.~~ 2.) Bldg sewer length = 100 ~ ~ ~U s-~~fi.rr~° '-" ~ ~Se~~e`~.. g `~ -amount of cover = ~ c Plan revision Required r '__ Yes No j ~ ~ i ~J --,I - -- _- ~ - - ~~ I ~ /~ ~~ J Use other side for additional information. I ~ ~___ 4111 ,~~QL~__- I SBD-6710 (R.3/97) IDate Insepctor Signature Cert. No. O~LS~u~ti~~ (Uw~~) t~ C~.e'~v,'.,~u'~ Wt~Sc clz-~t,rl?,~,aei~~ `. ~,~,: !S ~ Zit Q~~~,~-~ 2oi w wAve., P:a soot 7l~2 r~ J ~: r ~ c~~,.~ ueparwnern of Comxr~erce Sau~itary Permit Appli ' s~ P>~ in r ~ -r,~.a,~s . ~ b ~ma coos woad mss l~ecan~ sszl a ~ . , . a to~. a~tybeOCedfaraeooe~-PO~Pti~Y ,alSA9(lXmj CD ~~Cd~~6~ j sr cf, -, ~D~l ~/Cw ~/ '~ ~0,'~'LN"kC~ill~/~~, ~~~ acs s~oetr ~,e~'w~ sMa~'PmgAdd~ess ~~'0q~ J O ~ ~c ~~ ~ j =y°'~ S°cti°° ~~y~ 1 _ ,~ TspCode PAOaeldamba S[~ L.c., ~~ +~ Z ~ ~~~ ~ w _ ~. ~c~>g~~a,~ 3 ,~ ~ ~~ iartFam~lyDwel6ng-2~afBed~OOms ;G,i. ~ tT fl ~~-n~m~v~ ~ ,,c/ pi i Clru~, Clv - of [3~o~nea-n~z~ ,~~ IIL 1~ypa ~Per~ (Citelc otd~r es~e lsoz ae llsleA. Come use B l!'e) A' NewSyas® ©RSySOrm ^ ~TaakRepiOr~e~mcOabr ~ OdmrmlgS~stma B. ^ pelmtiR~eOewal Be6aeEaptiatim ©P~tRavisioO ©l~maof M~ ^gRmitTO~SrbNew Owaer LiatYtaviousPamitTlm~beraodDrmebsued 1V. atPOW19 Cleeeir ~ ti~ - ^ IZm ^ Momad>_I~i nt. ofso~b aO~ Q Momd <24 iO, afa~ble a+lO ~ SiOgie Pass Saadl~eer ~~ D rya ~r~aoea ©-rte o ~ ~ ^ ~~ xa~>w~ spa ter ~ - Me~aFtf6er CI t~smbar ~ l3Oe ~Gcavd-kas [1od~i Y. ~~ _ _ A~aeRegOise~{stj. IhspaSSi~sPsOposed(~I ~- r/ Are: ~ /) n ~ Destgn~l 3_ ~ ~ ~ ~ f V~• J S ~ V . ~ ~ ~ P~dab ~e Srerl T~ Plastic ..,.. VL Taak Iafs Capacity in Tani Nnmbc _ ~~g Coasboceod less __. MOOS ofUsifs .,/ ~~ r Naa >~ y ~/~ Timlls Tide Sepfa:arHet~o~Tast ~l AaeWO'ttesawrmt ikdl > 6 vII. s~_~~ s~aru~rovvrss~..a..m~aec.aea~. rn a ~ rye ru~i~ / // ~ ~lV V" r / i 1 / l ~/ ~. UH - ~~YY a 0ama Gina AeasoO far Dmiai ]) ~~~'~L Qy ie~.~°l'Y"~'~~_ ~~' ~ (~ i ~~K~~~~ ~~C/~~ ~ ~~ i IX V ~ i j v (/ ~ ~' a6z,~~ ~ Yom ~ ~ - ~r7 ~ , 2 ~~ ~ / ~/JfJ ~•~/1./ ~/ ~~ / _ ,` ~ // _ ~ ~ . // // ~`M~i~~/~~~fiVV`~ ~ /Iii •. [ ~ (/ ~ I' , - A~ y JJ ~ ~ I~~ ~f~ °~ ~ iJ' 1 ~~° SBD-6398 (R. 08!02) ~~d ~~~~ tit.d~ Cdh~S PLOT PLAN PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 NW i/4 NE i/4S 18 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE5/9/03 BEDROOM 3 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of Chambers none ,BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL •H.R.P. Same as Benchmark SYSTEM ELEVATION a$4ti4' /0~'7 ~ 1 158th St. ~ Well is to meet all setbacks found in Comm. 83 Property Line \ ~-- ;not to scale) Tank is to b ~1, properly be ed and provided wi lodcdown with approved warning labels s~t~ C'ORRF 1 04' SppN~~NC - f 1 03' 1 02' Scale 1" = 40' Ct~~Y Pro GtP~~`' Be oom Grading is to be done to use divert rune off ~w~from I ~ ~12 r~~ - Huffcutt Combo Ta ~g ~ ,,~\ S ~~~~ ) ~~ ~o ~ ~° B-2 ^ B-3 4% Slope [D B-1 Area 15' Below System is to remain undisturbed Property Line B.M. Alt. B.M.. 8 0' ~~ , ~~ ~k; ,~~ r ~~ ~~ w w N v 0 m .. r m ~ ~ ~ ~i ~ ~ ~scons~n Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary 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 May 19, 2003 CUST ID No.226900 A?'TN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 3~a~3 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/19/2005 Identification Numbers Transaction ID No. 867168 SITE• Site ID No. 659103 P. C. Collova Builders, Inc Please refer o both identification numbers, 973 158TH St above, in all correspondence with the. agency. Town of Hammond, 54002 St Croix County NW1/4, NE1/4, 518, T29N, R17W Lot: 27, Subdivision: Crick Bottom Overlook FOR: Description: Proposed Three Bedroom At-grade System Object Type: POWT System Regulated Object ID No.: 903360 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. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans, the "At-grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater Systems" SBD-10570- 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 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. ~~~~ i~ • Comm 83.44(6)(a)2.The orientation of the cell is to follow parallel to the surface grade contours on sloping ~~~ ~I(J1-sites. The upper effective edge of the cell is to follow the 103.5 foot contour. DEF'ARTME ~~ ~ NOFSi /• The off setting (D) is proposed to be at six inches from the bottom of the tank. The pump pad, along with the SEE CQRI legs of the pump, may leave the impellers out of the liquid effluent before the pump off setting is reached. This should be checked at time of construction to insure this condition is not encountered. This setting maybe adjusted, with the inches coming from the reserve capacity area. t/ • 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 SHAUN R BIRD Page 2 5/19/03 • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. • The changes made to this plan on 5/19/03 by this reviewer were acknowledged and approved by the system designer. 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 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, ~~~~z~~ ~~~~~. Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@c ommerc e. state. wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G 3ansky ,Wastewater Specialist, (715) 726-2544 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 RECEIUEa MAY 12 2(i0:i SAFETY & BLDGS D1V`. Date: 5/9/03 Owner: P.C. Collova Bldrs. Inc Location: Lot 27 Crick Bottom Overlook NW 1/4 NE 1/4 S18 T29 N,R17W Hammond System type: At-Grade Manuals Used: At-Grade Component Manual version 1.0 SBD 10570-P (R.6/99) SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST- SAS (01 /81) Page# 1. Cover Page 2. At-Grade Plot Plan 3. At-Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-9. Maintance and Conti/gency plan 10-12 Soil test Shaun Bird Signature License number 26900 5/9/03 Pona~Y ,~~ED MMERC~ Y D ~~NGg ~PONOENCE PLOT PLAN PROJECT P.C. Collova Bldr`s. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 NW 1 / 4 NE 1 /4 S 18 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE5/9/03 BEDROOM 3 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none ,BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100° Filter Zabel A-100 ^ BOREHOLE O WELL 'H.R.P. Same as Benchmark SYSTEM ELEVATION 158th St. a-94..4' 1 c' ~: ~ _/ Well is to meet all setbacks found in Comm. 83 Property Line Pro 3 ~ ;not to scale) Bedroom Grading is to be done to ~ , Tank is to be House 8 0 properly bedded and divert run-off away from provided with system lockdown covers with approved Huffcutt Combo Tank warning labels sf~CO~ 104' ~ B-3 RFSPONDF NCF _ - 1 03' ^ ^ w B-2 40~, B-1 ~'- 1 0 2' Slope o .a m Area 15' Below `` System is to remain undisturbed CD Scale 1 " = 40' B.M. ' Alt. B.M. Property Line ,5t YY ? 5r ~Jt ~ B > ~i ~ PVC FbRC.E,.MAi N ...~ .r 2 ~..~. t }-- i3;Stitt v~.iTtarl LA?E..RI4tr ~ ~ }~ ~ SrA~tt.t~ED a~~LV~rta.s 1[J~LL ~~ ~- ~~ I/6 B ~ I/66 ~I/2B ~~ ~ _ ~t- 8 = ~~s~. fit. ~. ~ ~-~,. VJ = ~ ~ Ft . ~" CELL o~ fz - ~/Z AC3G+2~GArrE ftQP~dtfEb SY~.1Tt~ETiL ~{Ibr;C -- 5~'~at~.t~~h Qbserv~~ian-----~ ilVe ! i ~c ~,t , ~ ~ ~ S~ A Plana View and Cross Section of Wisconsin At-grade Unit with a Single i~hsorgtian Area an a Sloping Site L~iS~'t'ibUTiOt't ~aT21'tI~ Sai! Cover Y ~Q'~o~a 1.-.-- ~LavvE~ ~nY~ ~ ~ ' ?' ~' i_ _ Page flf Distribution Pipe I3et~il for lateral ~Ietworlc '~ 'Last ale Shtwld 8e Next To ~, Ti.iR~r~~.. ~C~Rt~:Ot1T PVC force Main '~ -PVC Distribution Pipe P ----~ Ac c~e r~ ~~~ P ~ ~t• Hole Diameter ~1 Inch X ~ ~ Inches Lateral Diameter `~' Inch{es) ~`~ Inches force Main Diameter ~ Inches Of }#oleslPipe ~.~ Invert E~evatian of Laterals ~ Ft. ~ ~l /. Signed: License 1Wsmber: Date: SEPT ,~" CI VENT PIPE 12" MIN. ABOVE GRADE ~ > 25` FROM DOOR. 4dINDOW f2R FRESH AIR INTAKE FINISHED -GRADE D ltr~~i.a. IN WATER TIGHT SEALS "~ i'r 1 LT Ts.R '- A __~_._ APPROVt:D $ PIPE 3` ~ p~ Sfll.If} SOIL PUMP OFF ELEV - ~ T?T. ~-- (/~.. L; D wEATNERPR~F JUt~iCTTON $OX WITH CONDUIT ~, a =. ~, ~ `. GAS- , `~ TIGHT ~ SLAG ~ r r t APPROV l:D MANHOLE COUER W / T'AD LOC K ~ WARKIMG LABEL 4" MIN. ~`\J~IPPt~itED JOINtS uITN LM APPROYED PIPE N 3S~IDSOII 3" APPROVED BEDDING UNDER TAl31C l ONCR£TE PAD SPECIFICATIONS ~ = ~~ SEPTIC 1 DOSE ~ NUHB£R DOSES T'ER DAY: " TANK MANUFACTURER : ~~ ~r TANK SI2£S : SEPTIC GAL . DOSE V flL[}ME I NC LURING i~.L':=--- GAL T' LOtw1T3AC K n -~r DOSE _._- cAL' ~' " C ~,..~, CAPACITIES = A = ~l`.~INCHES = ~ZL~.:---GAL. ALAR!! S4AANF'ACTi3RER ; ~'~/' /` -'' GAL. ""'~- MODEL NUNSER : ~- '~ g 2 INCHES = c'rC~' _ SS~iI'TCH TYPE: d ~ ~' ~Q ~• .~ INCI~E5 = ~-~ GAL. PF1ltF MAI~3FACTVR£R: 3'~ ~ir~SPQAD C _ TIES = ~ GAL. MODEL NUMBER: - ~Y ~_~ INC swlTCx TYPE: •,~,~" ~ ~''~'~ ~NC~°~ REQUIRED DISCHARGE RATEf~~~GF'H PUMF ~ ALARM WIRIt3G AS PER ILHR FEE, YrN PUMP OFF AND DISTRIT~UTION PIPE ~ l/ VERTICAL DIFFERENCE T3ETWE ~J ~ FEET + MIAIIHUH NETWORK SUPPLY PFtESSURT'TI 100 ~ FT • ~ FRICTION FACTOR ~ FEET ~ ~ F££T FORCEMAIN X ' ~ TflTAL DYNAMIC HEAD ~_ ~ ~ E FEE? ~J w~~D~.H~; DYAM£TER INTERNAL DFMENSIONS QF PUHP TANKS LIQU D ~';"~,~~~~..-.-. SFGNED: ~ FUMP CIiAMBER CROSS SECTION AND SpECIFIGATIt}NS LICENSE 13t73°TBElt - [3ATE 3188 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT AND DEWATERING 1 0 a w a z 0 J Q ~. 0 0 "'"" 0 80 160 240 32U FLOW PER 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 phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Owik-Box available foroutdoor installations. See FM1420. • Over 130°F. (54°C.} special. quotation required. 1521153 Series 152!153 MODELS Control Selection Model Volts•Ph Mode Amy Sim IeX Du lex N152 115 i Non 8.5 1 2 or 3 BN152 115 1 Auto B.5 Included 2 or 3 E152 230 1 -Non 4.3 1 2 or 3 BE752 230 1 Auto 4.3 Included 2 or 3 N153 115 1 Non 10.5 1 2 or 3 BN153 115 1 Auto 10.5 Included 2 or 3 E153 230 1 Non 5.3 1 2 or 3 BE153 230 1 Auio 5.3 Included 2 or 3 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). MODEL 152 153 Feet Meters Gol. Liters Gol. Liters 5 L5 69 261 77 291 10 3.1 61 231 70 265 15 4.6 53 201 61 231 20 6.1 44 t67 52 197 25 7.6 34 129 42 159 30 9.1 23 87 33 125 35 tOJ -- -- 22 85 40 12.2 -- -- 11 42 Lock Volve: 38,0 FI. (t t.6m) 44.0 Ft. (13.4m} 3 27 32 32 _ I i ~2 1/a ,~, I 5 r/ 1 ~L SELECTION GUIDE 8 sKZOSe 1. Single piggyback variable level float switch or double pggyback variable level float switch. Refer to FM0477. 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 i14A11 TD: P:O. BOX 16347 Louisville, KY 40256-0347 ManuiacGuuarsoi.. ~ D SHIP 70: 3649 Cane Run Road p ,~ .: ~ "~:: ' . ~ W® Louisville, KY 40211-1961 QLGOL/TYPUMP9 ,_/iNCE ~i9c~c/ p / ~ PVMP ~0 (502) 7 FAX 5021703624 PUMP hitp://www.zoelier.com ( ) © Copyright 2000 Zoeller Co. All rights reserved. ,. ~ c tNn Depaua~nent of Comrr~rce SOIL EVALUATION REPORT Page _._(_ of 3 ~~..,~ ~~~ ~ Bulkinas - - - - - - in accedence with Comm c ~ ~ C ~E I V ' '©+ Attach complete site plan on paper not less than 8112 x 11 indres in include. btd not limited to: vertical and horizontal reference pant (B . direction and Parcel I ~~~~~ scale or dimensions north arrow, and location and rcent slo e road. t est p . Pe 2 ~ AY ~ ~e by Please print all inforntation. / //__,^,__-- G, G~ Z / Personal irrfamarion 1~ D ~Y be used for secondary Pwposss (Priv Law. 5 vv~~ ~, ~D! ~~~ ~ PGovtl~at ~1/4 S ~ T N R E(or W ~ a Name ar CSN~ --- c ; COY ~ State Code Phone Number ^ ~Y ^ VfUage Town Nearest Road New Constrtrdan Use: / Nurr~er of bedrooms Coda derived design flow rate •S O GPD ^ ~ ^ ` ar - Desrnbe: Parent material ~ ' Flood Plain elevation if applicable ) ~' ~- ~: ~~ ~~,~~ a l2 ~u~ ) 0`f ~ ~ y~e~ ~ ~ ~- d ~r >~-~ ONfl~ R Pit Ground surface elev., ft. Depth to m• Sod Rate i i xture T Stnwiure Corrsister~e Boundary Roots GP D/([ lioriaon 1 Depth in. -~~ t~ Dominant lM,unseq (/ l~L on Redox Desa pi (fir. Sz Corrt. Color ,~-- e Gr. Sz Sh. 01 G..~ // O` r~ 'Etf#1 ~ ~ 'Eff#2 ,. S~ ,q O ^ ~Q ~ ~~ ~ ~5~~ r J ~ f n ~l _ - .. n .Borirua 1 /I.. ~7 L1 J ~`r Pit Ground surface elev. ~ ft. Depth to 5rrtititing ~~ ~~~ ~ Rate D ~ ti Texture Struchrre Cor>s~ae Botmdary Roots GP D/it~ Ftaizon p~ in. ~ p~narrt MunseR o v 32 orr Redox es p Gtu. Sz Cont. Cobr ,..- S~ Gr. Sz Sh. ~rn `Et(#1 rS •EtTtl2 ~~ 4 -- t. m i' PVr ~' w +~ - ~ ~ r /Z F }'' S r /tom ~ +cS ~ - h-i ~ r n a h . 3 ~ S`" " EflhJent #7 = BOD > 30 <_ 220 -ngA-and TSS >30 _< 150 #2 =BOO _< 30 mg1L errd TSS _< 30 mgll. csr Number (Please Prir>h 1 ~ Oate Evaluation Carrduded TBIepFrone Nunb~ Address // // ~/ Property Owner ~d~-Z~ it Ground stsface elev. ~ tt. D~th ~ 9 ~8d~ Sod Rate a# ° ~ ~ J tiortzort Depth Dominant Redox Description Texture StnxUse Roots GPD!(tt in. Munsed Qu. Sz Cont. Color Gr. Sz Sh. 'EtT#1 •Etf#2 Z - D o s/ .~ ~ , ~ ~ n0'~ O f ~~ .~ Y)'1~'~' ' w p i D ~ '~/z. ~= ~ 5~ ~ vas _ - +"r n a n a ~ 3 e«~ # ^ ^ Pit Ground surface elev. n Depth to iirrating fadar in. sod ~ Horiarxr Depth Dominant Redox Description Texture Strix~e Consistence Boundary Roots GPD1fE ar. Munsed Qu. Sz. Cont Cobr Gr. Sz Sh. '~~ ~~ ~9 # ^ ~9 ^ Pit surface elev. ft. Depth b 9 facts in. Sod Rate Normon Depth Dorrmt~t Redox Description. Texture Strucdxe Consistence Botardary Roots GPO/If in. Munsed flu. Sz Cbn<. Cobr Gr. Sz Sh. •~~ 'E~ • Etlluerrt #1 = BOD, > 30 <_ 220 mglL and TSS >30 < 150 mgll. • Etlkrent #2 = BOD, < 30 mgA. acrd TSS _< 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance W access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. s~~ot~, .. Soil Test Plot Plan ~ ~' Project Name P.C. Collova Bldrs. Inc. Shaun B' ~ Address P.O. Box 487 ` Somerset Wi 54025 C ~ #226900 Lot 27 Subdivision Crick Bolton Date 12/4/02 3~~ 3 1 i4 NE 1 i4S 18 T 29 N/R17 W Township Hammond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 104.4' *HRpSame as Benchmark Alt. BM Top of Steel Fence Post @ 104.4' 2' Property Line Maintenance and Contingency Plan for a At-grade 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 at-grade undisturbed. 8. The owner agrees to save this plan. 9. Trees, shrubs, and other similiar vegetation 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. 1f 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 at-grade fails, determine cause of failure, test another area or remove pipe and sewer rock, retell 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 POWTS OWNER'S MANUAL & MANAGEMENT PLAN . ~ r.~cnr~~uertn[a! i Owner L~ ~' C ;.,~ ~lC ,~..~ ` Permit#. .~ ~/ .,r~+...•r owowuCTGRS uc~w~~ rlVV~,oa~.~.__ Number of Bedrooms ~ ~ ^ NA Number of Commercial Units NA Estimated flow (average) "©~~ al/da pesign flag (peak), (Estimated x 1.5) ~ .,~~ aVd Soft Application Rate aUda /ft~ Inftuent/Effluent Quality Monthly average' Fats, Oit 8~ Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODE) x220 mg/L Total Suspended Solids (TSS) 5150 m /L Pretreated Effluent Quality ^ NA Monthly average''' Biochemical Oxygen Demand (GODS) 530 mg/t_ Total Suspended Solids (TSS) 530 mg/L Fecal Coliform (geometric mean) 510` cfu/100m1 Maximum Effluent Particle Size Y inch diameter svsTFM SPECIFICATIONS Page ~ of~ Septic Tank Capacity ~l~ al ^ NA Septic Tank Manufacturer ^ ~ Effluent Filter Manufacturer p NA Effluent Filter Model ..~ ~J't'7 ^ NA Pump Tank Capacity ~~ al ^ NA Pump Tank Manufacturer ^ NA .Pump Manufacturer ~ p Nq Pump Model /~ ~'~, ^ NA Pretreatment Unit ^ Sand/Grdvel Fitter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other Manufacturer Dispersal Cell(s) ^ In-ground (gravity) ^ In~round (pressurized) -grade ^ Mound ^ ri ine ^ Other. • Values typical for domestic (non-oonunerdaQ wastewater and septic tank effluent •* Values typical for pretreated wastewater. MAIry 1 CryA1Vl.C ~4nGVV~c Service Event Service Frequency Inspect condition of tank(s) At least once every ~ ^ month ear(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third {Y,) of tank volume Inspect dispersal cell(s) At least once every ~S ^ month ar(s) (Maximum 3 yrs.) Clean effluent filter At least once every ^ months . ear(s) Inspect pump, pump controls & alarm At least once every ~ ^ months ar(s) ^ NA Flush laterals and pressure test At least once every ~ ^ months ear(s) ^ NA Other At least once every ^ months ^ year(s) ^ NA oa+er: At least once every ^ months ^ year(s) ^ NA MAINTENANCE INSTRUCTIONS tnspedions of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer, Septage Servidng Operator. Tank inspections must indude a visual inspection of the tank(s) to identify any missing or broken hardware, identity any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or pondtng of effluent on the ground surface. The dispersal cell{s) shalt be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the Immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y,) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servtdng Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. . The servicing of effluent filters, mechanical or pressurized POWTS components, pretreattFment components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A servle~e report shall be provided to the local regulatory authority within 10 days of completion of any service event. STARTUP AND OPERATION For clew construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other Ch2(11~~S ~13t iC18y lln~8 ale ~ealment process andlor damage the dispersal cell(s). 1f high concentrations are detected have the contents of the tank(s) removed by a septage SeNlCing OperatOf prlOf t0 USe. i ;, ~/ 'System start up shall not occur when soil'r:onditions are frozen at the infiltrative surface. Page ~ r?~% ..During power outages pump tanks may fill above normal highwater {evels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cen(s) and may result in the backup or surface discharge of effluent To avoid this situation have the contents of the pump tank removed by a Septage Servicng Operator prior to-restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels with{n the pump tank Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otfterwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction ore{imination of the following from the wastewater stream may improve the petformar-ce and prolong the fife of the POWTS: antibiotics; baby wipes: dgarette butts; condoms; cotton swabs; degreasers; dents{ boss; diapers; disinfedartts; fat; foundation dra{n~(sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oi4 painting products; pesticides; sanllary napkins; tampons; and water softener brine. ABANDONMMENT When the POWTS faits and/or {s permanently taken out of service the following steps shall qp taken to insure that the system is properly and safely abandoned in compliance with rh. Comm 83.33, wsconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings seated. • The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator. • After pumping, alt tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot tae repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ^ A su'Rable replacemenYacea 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 wells. 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 that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. 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 evacuation must be performed to locate a suitable replacement area. tf no replacement area is available a olding tank may be installed as a last resort to replace the failed POWTS. curd and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rotes in effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. D~TH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name _ «Lfa..~ ".~~' Phone ~ j"-~ ~--~~ J" SEPTAGE SERVICING OPERATOR (PUMPER) Name iii ~ r., ~ ~7J Phone -^ ~ rs? ~-~ ~~ POWTS MAINTAINER Name s~ Ll~/ ; !- Phone LOCAL REGULATORY AUTHORITY Agency „~ ~ l~ ~~C ~rn~ Phone "'~~ ._,_~~ This document was drafted try the staffs of the Green lake, Marquette and Waushara County zoning and Sanitation agencies. This document meets the minimum n3quirements of ch. Comm 83.?2(2)(bxt)(d)3(t) and 83.54(1), (2) 8 (3),111rtsconsin Adminlstrative Cade. Use of this dorxrment does not guarantee the performance of the POWTS. GMVd (ypt) ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer P. C. Collova Builders, Inc. P O Box 4$9 Somerset, WI 54025 Mailing Address Property Address _ ~ -~' ~ ~ S X ~~~ n ~ (Verification required from Planning Department for new construction) City/State arC~ ~.~~- Pazcel Identification Number ~iin LEGAL DESCRIP~N,T11,,ION r ~ Property Location I~~ %,, /~~%., Sec. ~, T~N-R~, Town of Subdivision l 1l a C~c c~7~~-c~-v1 ~(itPrt ~ O?~C Lot # ~~T Certified Survey Map # Volume ,Page # Warranty Deed # ~D ~~~~~ Volume Page # _~~,~' _. Spec house ~ yes ^ no Lot lines identifiable !1]'yes ^ no SYSTEM 11'IAINTENANCE Improper use and maintenance of your septic system could result is 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 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, restricted plumber or a licensedpumper verifying that (1) the on-site wastewaterdisposalsystcm 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 c~' a three year expiration da S , ~ 03 SIGNATURE OF APPLICANT DATE OWNER. CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the prope described above, by virtue of a wa my deed recorded in Register of Deeds Office. S ~ 03 i i SIGNATURE OF APPLICANT DATE «««««« Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. **«s«« ,. «« 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 t U 1950P 528 / ~--. STATE BAR OFWISCONSIN FORM 1-7998 WARRANTY DEED I tusbartd and wife .Grantor. and P G ~~~+ r3ueoers. mc. . un Grantor, for a valuable coneideratlon conveys to Grantee the fdlotn iee«ibed real estate kt St Crobc County State of Nistxxtsin (the "Property'): t~f P' C/Co9ova BuUders. Ine. x Avenue mood , wf 54015 078-1039-20-000 / 018-1 018 1039 80 000 ~Panxl {dentlBcatlon Numgsr (PIN) This Is not homestead pmD«tY• (Is) (Is not) Sw Exhibit A attached hereto Together with all appurtenant rights, tkle and Interests. none Grantor warrants that the title to the Properties goad, indefeasible in simple fee and free and clear of encumtxances except Dated this 15th day of A~oust. 2002. (SEAL) • hn J. Iton (SEAL) • A,tu~~aCi -;~a~oFVlns ' Signature(s) W}C-?~ T-S"' tNA authenticated thfe N~ .31.~C TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stets) THIS INSTRUMENT WAS DRAFTED BY Cddweil Banker Bumet 1301 Coulee Road Hudson, WI 54016 2-32470 (Signatures may be atrtttenticated or acknowledged. Both are not necessary.) WARRANTY OEED arolyn G. alton AC}CNOWLEDGMENT 687242 IUTRLEti9 8. MAI.SR REGISTER OR DBEDS ST. CROIX CO.. YI REC62YfiD FOR RfiCORD 08-16-2002 9:00 All E1DPT tt ~ REC FEE: 13.00 TRABS FEE: 1155.00 COPY FEE: CERT COPY FEE: PAGESt 2 State of Wisconsin, (SEAL) (SFJ~L) } ss. SL Croix County Personally came before me this 1 ~ day of Puoust. ~0 the above med a and I D h ba nd WK Notary Public. State of Wisconsin My commission is pe anent. (If not, state expiretbn date: ~~5 ~~ .} STATE BAR OF WISCONSIN FORM No.1 -1998 Wisconsin Legal 81ank Co, Inc. Milwaukee, Wis. ~~~~ ~~ OVE/~-~K ~ o ~= 2 at: • , ice` .. > .... `. ~.. ~~ ~ ~U•`~~,~."9 5.O~F..5~~2,g _ .':tJ ~ ` w .w.:w.r...s::r:+.wg.`:i;y~y'M°iM4s , t ~ , . '.;:.~.. .. _ . A part of the NE'/. of the NE'/. and In part of the NW '/. of the NE'/, and to part of the SVb!'/, ofn ~J~~L, the NE '/. of Section 18, Township 29 North, Range 17 Went, Town of Hammond, St.Croix C: R (('(~, ~O 11vM County, Wisconsin and move partkularty described as: BeplcTning at the Northeast comer of said Section 18; thence S89'33'31'W 372.01 feet along the Naith Nne of the NE Ya of said Sectlon 18; thence S89'33'31'W along the North line of the NE '/. of said Section 18 775.94 feet; thence 6 V E 2 ~ C K S00'52'23"E 250.00 feet; thence S89.33'31'W 968.24 feet; thence S00'52'23"E 420.00 feet; thence S89'33'31'W 528.00 feet; thence S00°52'23`E along the North-South Quarter Section line of said Section 18 1311.77 feet; thence N89'33'39'E 826.33 feet; thence N00°31'25"1N 330 23 2 e F ~" feet; thence N89'33'24'E 692.78 feet; thence N00'S2'23"WV NE %330.31 feet; thence N89°33'24'E along the South line ot~the NEE/ of the NE :949 ~9 feet; thence N00'S2'24'W 1321.19 feet to the Point of 8egtnntng. ,;foQ "~~ ~ ~ I ~ ~ LOT 28 \ / ~ \ 76304 S. F. ~ o / '~'O 1.75 Ac. ~ I~ ~ ~~ rv cn ~ m io .y ~ Iw ~ d I =~ S ~~ S2 ~3 I o \ \~~~ e \ \8~' ~~ ~ ~ ~ ~ ~~ ~ ~ LOT 27 ~D _ s 93891 S.F. I~ v `~~~ 2.16 Ac. O ~* o 3 LOT 26 ~~ ~ ~'~ 84789 S.F. ~~~, N ~ 1.95 Ac. ~'~ , ~ ~~ N r I~ ~ BENCHMARK TOP OF 3/4" I~ ~ p \ IRON PIN ELEVATION ~ 1019.93' (ASSUMED) I I~ N I~ fV O-VO 366.97' 113.87 _ -1E, NE 1 /4-NE 1 /4 „ W 949,09' ~ ~dG~ l ~ ~j~j 89'54 47 E 1J1- ~IlK3~ 'S U~ ~ tC~ s~ct~o~c ca wt~ ~ ~~~ ~ SURVEY MAP VOLUME 9. PAGE 2410 d tip AD., o~r _ - _ _ _ _ t do~odc M Reoa~elyd xi ~at~s ~1. ~. Cr~'x Cr.~t~tty~er a~ DRAFTED BY: JASON PAUKNER SHEET 1 OF 3