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HomeMy WebLinkAbout018-2003-29-000Wisconsin Department of~ommerj PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)l, Permit Holder's Name: City Village X Township P.C. Collova Builders, Inc. Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description: I o b . O , o S(,~ r ec ° rove NE piu . Gvrn.e~ TANK INFORMATION r r TYPE MANUFACTURER CAPACITY Septic l~oa Dosing Aeration Holding r TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic , So . n o4- 'n ~ 38 ,~ ~Z.,~ Dosing ~ // S Aeration Holding PUMP/SIPHON INFORMATION ~U~+" ~.tAIW-'~'~ Manufacturer Demand GPM Model Number ~ ,/ ,~ ~~ TDH Li~~ ~ Friction ~ Systerr~iead,~ ~ ~ T~2`~~t Forcemain Le t Dia. Z Dist. to Well ~ // SOIL ABSORPTION SYSTEM county: ~ St. Croix Sanitary Permit No: 430521 0 State Plan ID No: Parcel Tax No: p~~-Zpo~ -~9,apv Section/Town/Range/Map No: 18.29.17. CJ' ELEVATION DATA 2 ,2 u 2 .Z l Qa ~ +~ STATION BS HI FS ELEV. ~ •3 Da ~ Benchmark l /vl. f•9 /oC-a-o ~rr1l Alt. BM ~ r' ~"", ' ~ ~ h L,~, (o ,3 U ~ er o .3 J. Bldg. Sewer -~ •ao 9o-/S SUHt Inlet ~ ~~ Q Rq.3~ Dt Inlet Dt Bottom ~. ~• ~~ Head r/Ma~ N Z. 3~ 99 ~~ Dist. Pipe ~,.~ ~9. S Bot. System 3. o q R_ Z Final Grade ~ ~ ~~~ /~ St Cover ~ ~ /,., ~ orc U 7 ?~ ~S ~S~a-k.e-~(~ C~ ~/ Gs. BED/TRENCH DIMENSIONS Width ~~ Length ~~ ' No. Of Trenches ~ f _' e -Y+" PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM L ACHING Manufacturer. INFORMATION / CH OR Type Of System: e.~,t1 ~ v >.S / > c5~ ~ I g0 /~ U T Model Number: DISTRIBUTION SYSTEM , .,, _ _ _., _ ,l /' ll~t,r ~ ti il, t2c~, D l S r/Il nr, L t Header/Manifold N Distribution Pi e(s) ~ x Hol ' e ti x Hole Spacin Vet A take L h ~ ~ Di 2 p 4 / 2 L g ` engt a ength Dia Spacin (p SOIL COVER 1 x Pressure Systems Only xx Mound Or At-Grade Systems Onlv Depth Over Bed/Trench Center ~ / ~ Depth Over BedTrrench Ed es xx Depth of To soil xx Seeded/Sodded xx Mulched ~ n.n0/ g p Yes ~Ji No Yes L:; No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ ~ $ / J3 ~ In pection #2:~/ d~ Location: 981 158th Street Hammond, WI 54015 (NE 1/4 NW 1/4 18 T29N R17W) Crick Bottom Overlook Lot 29 .29.17. 1 ~~ s~- 1 JAlt BM Description = S-r~ CdZ~~ ~/ cS07.~ -~c~- - ~Y~ / /.,~ j'~ 2.) Bldg sewer length = `3FS1 / ~~ ppv~~~r C - amount of cover = ~ y.;,2 " Cut~N Pr^' ~ lwtyl /Jcr ~au~ `~ ~ li/ G~"G~ . ; - 7/ rL~~ S rv~a„,1~ ~~.~: Plan revision Required? ~~ Yes +[~No i ~ ~ ~I j ) (~ Use other side for additional information. ~._~ j _ _ - _ _ --~~~~--~ -~ ~---_ L - - SBD-6710 (R.3/97) Date Insepctor's Si ature Cert. No. Safety and Buildin Divi " ~ty~ , ~ ~ ~ ` 20l W. Was tnBt ~2 ~ ~ X ,~~~~5,~ 2 ?TO'1"~9 Madi n, }7l~'1 W Sanitary Permit Number (to be filled in by Co.) Department of Commerce ~8) 261-6546 3o52r Sanitary Permit Applic tl State Plan LD. Number T~~,t~ ~~ Wis. Adm. Code, personal inf ion In accord with Comm g3.21 ~° qq,v Qe ' ' ~3 ~ ' ' , ~ V ~"COUNTY p dd e s) if diff t th ili Add may be used for secondary purposes Privacy Law, 15.A4(m ZZZ NING OFFICE r eren an ma ng a s roject ress ( I. Application Information -Please Print All Information ~rJ ~ /~(~/,/ (~ J Oy"• Property wner's Na Lot # Block # Parcel # Property Owner's Mailing Address Property Location n ~ ~ J ~ ~ ,, j Section ~~~ ~' City, State e~r / A )' ( Zip Code Phone Number ~~ ~/ . ~ ' ~~ rrcl one) l~~E W N of Building (check alt that apply) II aM.S ' . p~ ~ ~ Subdivision Name CSM N tuber „ 2 Family Dwelling -Number of B rooms ^ Public/Comatercial -Describe Use ~ , ~$', jar S ^ state Owned - Descnbe Use ^City ^Nillage`~Township of IIL T ype of Permit: (Check only one box on lime A. Complete line B if applicable) A. System ^ Rephusement System ^ Treatment/Holding 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 Expimtion Plumbs Owner IV. T of POWTS S stem: Check all that a 1 ^ Non -Pressurized in-Ground and > 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 ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching C ber ^ Drip Line ^ Grav less Pi (explain) V. Dis ersal/Treatment Area Information: - UO Design Flow jgpd) Design it Application Rat f) Dispersal Area Required (sf) Dispersal Proposed (sf) ~ Syst Elevation ~ o ~ ; ~ , VL Tank Info Capacity in Total Number Manufacturer Prefab Conctete Site Constructed Steel Fiber Glass Plastic Gallons Gallons of Units New Existing Teaks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. ResponslbUity Statement- I, the undersigoe a responsibility for installation of the POWTS shown on the attached plans. Plum 's Name (Print) Plumber's re MP/MPRS N~ Business Phone Number l 2 J//~ G , L/ ~ wry ~ i ~ Plumber's/Address ( trce~City, State, Zip }, ~^I Coun /De artment Use Onl V III . ~ t roved A roved ^ Disa Sanitary Petmrt Fce includes Groundwater Date Lssued I u' g Agent Signatu o Stamps) pp tat pp Surcharge Fce) ~~~ ..-- ~ ^ Owner Given Reason for Denial r 9U IX. Conditions of ApprovaUReasons for Disapproval ~ SYSTEM OWNER; 1 Septic tank, effluent filter and dispersal cell must all be serviced /maim is ned as per management plan prgvided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. ..__ .~_ ...r u.. these stn :11 laths la size l Attlee COmpaere puns Res auc w~uay owyr ......» .r.--- _- r-~ SBD-6398 (R. 08/02) Jessie N ti~~~`r~ Subject: S. Bird, Collova, Lot 29 Crickbottom, 430521 Location: Hammond Start: Mon 12/8/2003 3:30 PM End: Mon 12/8/2003 4:30 PM Recurrence: (none) 18.29.17. ~~~ _ ~' ~~ c.. ~~ ~ ~~" !~E /off ~-~ > a~ erze. `' ~fu ~ ~ '' tabu-a _~u~~~~ "~ G~~zc~ ~~ D ~ ~; ~oZi3 ~'' .>-' `~ ~ PLOT PLAN ~T P.C. Colbva Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 .9.~i~N 1 / 4 NE i /4 S 18 /T 29 N/R 17 w TOWN Hammond COUNTY ST. CROIX 10/12/03 BEDROOM 3 MPRS Shaun Bird 226900 DATE CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND )00C 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 99.0' 98' Property Line COPY Please note: Lot shape changed from when original test was done. B.M. ear isc®nsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. com merce.state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary October 30, 2003 CUST ID No.226900 SHAUN R BIRD BIRD PLUMBING, INC 1008 192 ND AVE NEW RICHMOND WI 54017 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/30/2005 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: Pc Collova Builders Inc 981 158th Street Town of Hammond St Croix County NW1/4, NE1/4, S18, T29N, R17W Subdivision: Crick Bottom Overlook -lot 29 FOR: Description: Proposed Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 927622 Identification Numbers Transaction ID No. 934922 Site ID No. 667353 Please refer to both identification numbers, above, in all corres ondence with the a enc . 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: • 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). • 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. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The proposed well shall be a minimum of 25' from the treatment tank and a minimum of 50' from the mound. The down-slope toe of the mound can not be located within 5' of the property line. • 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. ~ ~.~~~.T ~. Cortditional'iy SHAUN R BIRD Owner Responsibilities: Page 2 10/30/03 • Comm 83.52(1)(a) -The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-?892, Mon. -Fri. 7:30 am to 4:15 pm j swim@commerce.state. wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 ~~~~Q R~~ 3 OCR ~ 5 200 p~S p1~1. S1~FE~ & B` Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 10/12/03 Owner:P.C. Collova Bldrs. Inc. Cover Page Location: NW1/4 NE1/4 S 18 T28 N,R 17W Hammond 981 158th St. 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 Conti envy plan 10-12 Soil test Signature License n~rhber 226900 pEi'ARTMENT Of COfJ~MERCE pIVIS1UN 9f fETY AND BUILDINGS SEE CORRESP DENCE PLOT PLAN PROJECT P.C. Collova Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 NW 1 / q NE 1 / 4 S 18 !T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/12/03 BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND )00C 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 99.0' 97' 98' Pro ert Line 96' Huffcutt B - 2 Well is meet all Combo Tank setbacks found in Comm. 83 7% ~ Grading is to be Pro 3 Slope ~ done to divert run- Bedroom N off away from House Area 15' Below system System is to remain undisturbed Tank is to be properly bedded and provided with lockdown covers with approved warning labels Property Line 99' B-1 SEE ~0 ~_z Please note: Lot shape changed from when original test was done. B.M. Alt. ~ ._ ENE Designer Date .---°-. /~. . No 4" Observation Pipe Perforated Below Filter Fabric ASTli C-33 S o n d es ~' Topsoil ~~. Slope ~ ,; _ ~Jt y Non-Woven Filter Fabric ~Distribulion Pipe o ~-..- E ,~ ~' -• bed Otlf~-2%2 Drain Rock Forct Moin From Rump Flowed Layer ,p ~~ ~ ~ I~~~ Cress Section Of A Mound ' S stem Usin F A Btd For The Absorption Arta G ~- p~Ft. Fi .S g ~ Ft. I j ,eZFt.~ 3~~ ~_ Ft. . K ~ ~. - Ft. _ _:~ _ _ L .0 Ft. _ ins '. Ft . a~' ._ L 4~Observotion Pipe ~ E _ -K r-._--------- ~---------- ~ - ~. A ~ © ~ ~ ~ ~ ---- ------------- --------------------- 1 Force Main Yy v, ~ _~~ _ ! _ _ From Pump _ -- 3 ~° Distribution Bed Of %2~- Z'2 Pipe ~ Drain RocK I ~„ 4 Obrervotion Pipe -~~c~z~~ permonent Morker ~5~,"' ~ ~~ I'S r~~v.,-,~.~ bv~'~-C-~ ~ pe or Rods Plon View Of Mound Utlnq A Bed For The Absorption Areo PAG E_,-,,.,OF CI=a4 !i toLatsd O~ BoltOm. •! ggya~ty $ooced rcRST t!IO1.L NT.XT ra CanntC~'of ~ C.c. /' /L - C.t„ q- ~ ~ / •jY- distribution Pipe Layoul Signed: License Number: Oate: X inches Y a Inches 3~ Hole Diameter ~ Inch _.._.._ Lateral •" ~~ Inch~es~ Manifold ~ Inches Force Main ~ Inches ~ of hales/pipep ~.~ Fnvert tievation of Lateralsl~S Ft.~• Per4orot=a oiRe Detoit SEPTIC TANK ~ FUMP Ci#RM8£R CRfl5S 5£CTiON AND SP£CIFICATIt?KS W£ATHERpR40f yaa GI VENT PIPE i2 ° MIN . ABOVE GRADE ~ JUi~CTI~3N BQX APPROVED ? ~ ~' FROM DOOR . 1dI NI30~ {1R WITH C£}NDU I T M,4Ai~FOLE COv ER FRESH AIR Ii~'TA.KE ~ W/ ~'ADLOCK ~ ~ -- WARMING LABE;. FINISHED GItAD£ ` f ._.~,, 4 ~~ MI1~ . n. M>>R• ~a ~~ Z• t1~5ERWTw~f =' b. u ~£ a ~ a I N L£T ~ •• ` isiAT£R TIGHT SEALS "~' C,AS- i , TIGHT ~ ~ VAPPRQ1tE0 A SEAL JDIiiTS uI~i ~FSLTfc,R ~ ~ = ALH /lPPR0YE0 PIPE APP~tOYEii ~ B ---;-- t a ~ , , QN ~~ Q~ SOLID SOIL PIPE 3' 0liT0 SOLiQ (~j _ AFT . 'J _~_._ F OFF SOI! Pi3~fP OFF ELE1l - ~ T 3r: APPROVED BEDDING UNDER TANK ~ CONCRETE PAD ~ / ~ ~ y~ ~ ~ ~ <<493~ SPECIFICATIONS SEPTIC / DQSE TANK MANUFACTURER^ .---- GAL. TANK SIZES = DOSEIC 1Z~-'s Q GAL.. ALARM MANttFAC3Ti3RER ~ ~~'n' ~ MODEL Ml1~iSER' ss~xTCx ~g~= ~,,~ , . PUHF MAi~tJFAC'TLIRER = ?~ MODEL t+1U!"iBER ' ~ Sy,TITCI~i TYPE- E RATE ~_ GPM R DOSES ?ER DAY = ~ _____- I~UMBE UflSE V {3 Lt2 ME F LOLiSAC~ ~ , GAL - i CAFACZTi ZES = A = ~ GAL. 8 = ~ 2~ 2~INCHES :b~J_ INCHES - ~• `~ ~~'- c - I ~iC fiES = L•--~----~L - D -t-'~ 16.23 WAC PLII~lP ~ ALARM S~JZRI NG AS PER I LHR REQUIRED DISCHARG _ ~~ FEET PU1rIP OFF AI~B DIS'FKIBU'IIf?N FIP£• •~,~ FEET vEgTICAL I~ZPFEREATCE ~ETWE~N 3 £'Tl1Q0'FT• .pR;CTIdN FACTOR ,L~..----- FEETI~d + MI Itft3i4 N£T~10Ri~ SUFFLY pRE~SUR£ + ~~, pE.£T FORC£HA.IN.j---- T£3TAL DYNAI~ZC HEAD ~ /~-- L f ~ D i AM ET£R ~____- ~ / F~ENGTH ( S IDTH 'f£RNAL DIMENSIOi~S i?F FUMP °TANIC: L,I~-3ID ~~'•----a---~'' FH DA:L: LIC£I3SF. NUMS~R = SIGNED: _ 1188 HEAD CAPACITY CURVE MODEL 152/153 W w ~~ 153 12--I 4u 0 a ~, 30 z 8 r 0 a 20 ~- o 4~ 10 0 20 40 60 80 100 GALLONS LITERS 0 80 160 240 320 F OW PER MINUTE CONSULT FACTORY OR SPECIAL APPLICATIONS • Timed dosing panels available. • Electrical alternators, for duplex sy terns, 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 1521153 MODELS Control Selection Model Vohs-Ph Mode Am_~S_ Sim lex Du lex N152 115 1 Non 8.5 1 2 or 3 BN152 115 1 Auto 8.5 Included 2 or 3 E152 230 1 Non 4.3 1 2 or 3 BE152 230 1 Auto 4.3 Included 2 or 3 N153 115 1 Non 10.5 1 2 or 3 ' TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT AND DEWATERING MODEL 152 153 Feet Meters Gol. Liters Gal. Liters 5 1.5 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 30 9.1 23 87 ~ 33 125 35 10.7 -- -- 22 85 40 12.2 -- -- 11 42 Lock Valve: I ---- .SS.O t. (11.6m) ----___1 44.0 Ft. (13.4m) 3 27/ I ~ -1 1z 1/a ,~~ it ~~ i 5 i/ 1 I ~ 32 i2 8 sKZOea BN153 115 1 Auto 10.5 Included 2or3 SELECTION GUIDE E153 230 1 Non 5.3 1 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float BE153 230 1 Auto 5.3 Included 2 or 3 switch. Refer to FM0477. D CAUTION 2. See FM0712 for correct model of Electrical Alternator E-Pak. All Installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) 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). 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 Z ~.~' t3 ` .' Louisville, KY 40256-0347 ~ ~ SHIP T0: 3649 Cane Run Road Manufacturersof. . ~ ,~~ 'j~~! .1® Louisville, KY 40211-1961 ~7 ~7p" „= ~~~~ ~0 (502) 778-2731. 1(800) 928-PUMP QVi1L~TY~UMPS SNCE ~~j~7 h#p://www.zoeller.com FAX /5021774-3624 © Copyright 2000 Zoeller Co. All rights reserved 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 cieanouts. 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 page of POWTS OWNER'S MANUAL 8~ MANAGEMENT PLAN l .......r.-.. ~oc~-1FtCAT(ONS FILE INFORMATION _ Owner _.__-------- , , Permit;~- Service Frequency Service Event ~ ^ monthsgear(s) Maximum 3 yrs.) Inspect condition of tank(s) At least once every als one-third (Y,) of tank volume When combined sludge and scum equ Pump out contents of tank(s) r3 ^ monthsear(s) (Maximum 3 yrs.) Inspect dispersal cell(s) At least once every ^ months ar(s) - Clean effluent filter At Least once every t once every l ^ months ~yEar(s) ^ NA Inspect pump, Pump controls 8~ alarm eas At ^ months ear(s) ^ NA Flush laterals and pressure test At least once every ^ months ^ year(s) ^ NA o~,~. At least once every ^ months ^ year(s) ~ NA ,,.~__ At least once every MAINTENANCE INSTRUCTIONS one of the following licenses or Inspections of tanks and dispersal cells shall be made by an individual carrying ctor, POWTS Maintainer, Septage certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspe missi or broken Servidng Operator. Tank inspectiaks, rrteasureUthe volume of ~mbined s edge and scumnand to check for any back up hardware, identify any crack or ponding of effluent on the ground surface. The dispersal cell(s) shall round surface.. Tire ponds 9 of effluent on then in the observation pipes and to check for any ponding of effluent on the g ulatory authonty- ground surface may indicate a failing condition and requires the immediate notification of the local reg 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 Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. retreat ment components, and any The servicing of effluent filters, mechanics! or pressurized POWTS compon rf~P~ by a certified POWTS Maintainer. other maintenance or monitoring at intervals of 12 months or less shall be pe letion of any service event. A service report shall be provided to the local regulatory authority within 10 days of comp STARTUP AND OPERATION resence of painting products or other For new construction, prior to use of the POWTS check ,treatment tank(s) for the p chemicals that may impede the treatment eroces~s b a°SePta9e sernec~ng operato iipnoritoh s e~ncentrations are detected have the contents of the tank(s) Y • values typical for domestic (norr~commerciat) wastewater and septic tank effluent .•• Values typleal for pretreated wastewater. MAINTENANCE SCHEDULE :.:-`"~ f Page of System start Up shall noC occur when soil~conditions are frozen at the infiltrative surface. During power outages pump tanks may fi~ above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the ced(s) and may result in the backup or surface discharge of effl~rent To avoid this situation have the contents of the pump tank removed by a Septage ~erviartg Operator prior.tA nestorin9 Power to the effluent pump or corttad a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank Do not drive or park vehicles over tanks and dispersal cells. Oo not drive or park over, or othetwlse disturb or compact, the area within 15 feet doom slope of any mound or at~rade soil absorption area. Reduction or.elimittatiort of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes: dgarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbtddes; meat scxaps; medications; oi4 Painting products: pesticdes; sanitary napkins; tampons: and water softener brine. ABANDONMMENT When the POWTS faits andlor is pemtanentty taken out of service the foltowirtg steps shall 4se taken to insure that the system is properly and safely abandoned in compliance with ch_ Comm 83.33,1Arisoonsin Administrative Code: • All piping to tanks and pits shag 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, all tanks and pits shat[ be excavated and removed or tftetr covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and pnnot be repaired the following measures have been, or must be taken. to provide a code compliant replacement system: ^ A suitable repiacement~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 wells. Failure to protect the replacement area wi!! 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 soli 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 evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. Mound 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 compty with the rules in effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TRFJITMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS ontnrTC tntCTAt I FR . v Name - ~ j --~,~ ~v Phone ~~ Z ~ -' J' POWTS MAINTAINER Name a~n~ l / Phone ,~ ,~ Z ~'' `tf/ SEPTAGE SERVICING OPERATOR UMPER LOCAL REGULATORY AUTHORITY ~ Name may. / Phone ~ - Z `~~ `.~~ Agency ~~ ~k/ Phone ~~,~ = 3,y 6 This document meets This document was diafted try the staffs of the Green Lake. Marquette and Waushara County Zoning and Sanitation agertdes. the minimum njquin;ments of ch. Comm 83.22(2)(bxt)(d~(f) and 83.54(1), (2) ~ (3). Vlrisooasin Administ(ative Code. Use of this document does not C,NrMV (~ t ) guarantee the performance of the POVYTS_ tArisoortsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings .,_. in accordance with Comm , Wis~p~tlVE Attach complete site plan on paper not less than 8112 x 11 inches i size. P'rla~`n`~m.. uvvst~"~ ty include, but not limited to: vertical and horizontal reference point (B ,direction and arcel percent slope, scale or dimensions, north arrow, and location and di nce t~re~ rc1ad~ Q Please print all information. C n ReviQ)v Personal information you provide may be used for secondary purposes (Priv Law,`t~~,~(` 'i, 0 U T Y i / Property Owner Page of by Date ~ 1 • ~ ~' N R 1 ~ E (orl p ~ ~ / c.. J Govt. Lot 1!4 ~ 1/4 S ~ T Property Owner' Mailing Address ~ ~ ~ L Block # S /~. Name or CSM# ~ '" L /~/ G City State Zip Code Phone Number ^ ~ ^ Village Town Nearest Road ~1 ~( ) New Construction Use: esidential / Number of bedrooms Code derived design flow rate S o GPD ^ Replacement ^ P~blic or eraal -Describe: ___ -_._. Parent material 9/G:~~GI~C. ~ Flood Plain elevation if applicable I'`~ i J~ ft. and reaommerxiations: S~ .ST ~,,~ a r~ t/ ~C~ / / `Boring p ~~ # Pit Ground surface elev. ~' ft. Depth to limiting factor ~ 0 Sod ication Rate Horizon Depth Dominant Cdor Redox Desaiption Texture Structure Consistence Boundary Roots GP D/fff? in. MunseA Qu. Sz. ConL Cdor Gr. Sz. Sh. 'Eff#1 'Eff#2 o ~ D ,,3 /z - - Pr o~ - s 2- Sl-~ D ,- ~~ .ten ~ ~ S - Boris # ^ nng _/ Pit Ground surface elev. ~ `~ ft. Depth to limiting factor ~ ~. sa, ice, ,~ Horizon Depth Dominant Color Redox Description Texture Stnrcture Consistence Boundary Roots GP D/ff' in. ell Muns Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Eff#1 •E 1 / z /J Z I S Z~ -~ J~ ' i- ~~ 7~ S- '- yr/,~ N -~ • Effluent i!1 = BOD > 30 < 220 mall and TSS > molL 'Effluent #2 = BOD_ < 30 mglL and TSS < 30 mglL C`~j ~~(Please Prirrt) Sig CST Number l~ A,ddre~ Date Evaluation Conducted Telephone Number 1a~8 >'Q ~ ~ ~ is - -~ ~~f-l ~6-~-rr ~ (o~-aq Property Owner Parcel ID # Page of Boring # Boring pit Ground surface elev.~~~ '' ft. Depth to limiting fador~ in. ~ iced ~e Horizon Oepfh Dominant Colo Redox Destxiption Texture Stn~cture Consistence Boundary Roots GP DIft? in. Mansell Qu. Sz. Oont. Caor Gr. Sz. Sh. •Eff#1 'E z 30 ~ ---~ S ~n ~ r' 3 d- Z -~ v-~ -m^ m ~r~ 1~ , 3 ~ .~ ^ Pit Ground surface elev. ft. Depth to limiting factor ~n• Soil lication Rate Horizon Depth Dominant Color Redox Dlescxiption Texture Stnx:ture Consistence Boundary Roots GP D/ff in. Mansell Qu. Sz. (lord. Cdor Gr. Sz. Sh. •Eff#1 •Eff#2 ~~ # O Bonng ^ Pit Ground surface elev. ft. Depth to limiting factor in. Sal ication Rate Horizon Depth Dominant Redox Description. Texture Structure Consistence Boundary Roots GP DKf in. MunseB Qu. Sz. Hord. Cdor Gr. Sz. Sh. •Eff#1 •Eff#2 'Effluent #1 = BODS > 30 < 220 mglL and TSS >30 < 150 mglL ' Eftluerd #2 =GODS < 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 alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. sau-asw cR.broo~ /o~-aq Property Owner Parcel ID # Page of Bonng # Bonng pit Ground surface elev.~~~ ft. Depth to limiting fador~_ in. Soil t'+cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftt in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'E a Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor ~n• Soil liption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 •Eff#2 Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil igtion Rate Horimn Depth Dominant Colo Redox Desrxiption. Texture Structure Consistence Boundary Roots GP D1fP in. Munsell t1u. Sz. Cont. Color Gr. Sz. Sh. 'Eif#1 •Eff#2 'Effluent #1 = BODS > 30 < 220 mg1L and TSS >30 < 150 mg1L '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 alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. sao.s3w pts~oo- ~, t , Soil Test Plot Plan Project Name P.C. Collova Bldrs. Inc. Sha ird Address P.O. Box 487 ' i Somerset Wi 54025 M #226900 Lot 29 Subdivision Crick Bolton Date 12/4/02 1/4 NE 1I4S 18 T 29 N/R17 W Township Hammond Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 99.0' *HRPSame as Benchmark Alt. BM Top of 2" Pipe @ 100.0' 99' _ Prouertv Line 97 ~ ~ \ _ 95' 15' \ B-2 0, -1 0' 7% Slope Property Line • i, -~~,w l~~ OwnerBuyer P. C. Collova Builders, Inc. P O Box 489 Somerset, WI 54025 Mailing Address Property Address ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM (Verification required from Planning Department far new City/State N~+~IN1IM ~~ Parcel Identification Number 4 LEGAL DESCRIPTION Properly Location %,, N~ %., Sec. ~ T~N-R~W, Town of Subdivision Certified Survey Map # Lot # a~. Volume '--: Wage # Warranty Deed # ~ ~ ~ ~ Volume ~ ~ Pa a ge # c5 Spec house ^ yes ^ no Lot lines identifiable ^ yes ^ no SYSTEM iti'IAINTENANCE 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 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, nstiictedplumberor a liceasedpumperverifying 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 t your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 th ear expiration date. P. C. COLLOVA BUILDERS, INC. ~ ~ ~~a SIGNA OF APPLICANT (715) 247-2742 DATE SOMERSET, IN SCONSIN 54025 OWNER CERTIFICATION I (we) certify that all statements oa this form are true to the best of my (our) knowledge. I (we) am (aro) the owner(s) of the p describ ve, by virtue of a warr~}r~:~{~~ e~4f-pied NC.ce. 015) 247-2742 ERR55 ~ , ~ / SIGNA F PI:ICANT SOMERSET; WISCONSIN 54025 DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** r ,. ** Include with this application: a stamped 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 5.281 ~--. STATE BAR OF W ISCONSIN FORM 1-1998 WARRANTY DEED I Number wsband and wife .Grantor, and P G Collova tfunaers Inc. . uranse Grantor, for a valuable consideration conveys to Grantee the following iescribed real estate In St CrotY County State of ~/isconsin (the "Property'): 687242 KATHLE68 H. MAi:SH REGISTER OP DEEDS ST. CROIX CO.. YI RECEIVfiD FOR REGARD 08-16-2002 9:00 AM ExQPT ~ DEED REC FEES 13.00 TRANS FEE: 1155.00 COPY FEE: CERT COPY FEE: PAGESs 2 1~f P) C/CoNova Builders, Inc. ~x~T~~r~, h Avenue mood .'An 54015 078-1039-20-•000 / 018-1039- 018 1 39 80 000 Parcel Identlflcetlon Numbx (PIN) Thla Is not homestead properly. (le) (IS not) Sow Exhibit A attached hereto Together with all appurtenant rights, tfUe 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 August' 2002. (SEAL) /I hn J. Iton arolyn G. alton (SEAL) q lO~~~Cr -. - ATE aF VYISCO~~ Slflnature(s) authenticated th b"~p-~~ .. ~L.1~~ - TITLE: MEMBER STATE BAR OF W ISCONSIN (If not, authorized by §706.06, Wls. Stats) (SEAL) (SEAL) ACKNOWLEDGMENT State of Wlseonsln, } ss. St Croix County Personaly came before ma this 1~ day of eucust. ?Q0 the above amed a and roi D It n ban nd Wif w w 5kz cwJ Notary Public. State of Wisconsin THIS INSTRUMENT WAS DRAFTED BY My commlasbn is pe anent. (If not, state expiretlon date: t;,oidwell Banker Bumet Vy .) 1301 Coulee Road Hudson, WI 54016 22470 (Signatures may be authenticated or acttrtow{edged. Both are not neceaaary.) . u.........1 ,.n..M. drndnn In nnv rs~nwcily must be tvoed Of DflRted below their S nature. ei2ccc~ ~ I-~-o~`~ ~U E ~~.b OK f of 2 STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Ina yyA~Afpy ps+ FORM No. 1 -1898 Milwaukee, Wis. ~~ ~ `I~ `. ,2~ 9 5:~ 0 `P .. 5 `2 ~~ :~~; .: ~ ;. a .. ... , .._ ~+~+'w~a~.,~u~'~,fY„~'~~V(b~+rlt~i~;i~•,fSC,l~er,;+~.:'i~-,.a Apart of the NE'/° of the NE Y. and In part of the NVy +/. of the NE'/, and In part of the SW!'/, of the NE '/. of Section 18, Township 29 Noah, Range 17 West, Town of Hammond, St.Croix County, Wisconsin and more partkularty described as: Begi~ng at the Northeast comer of said Section 18; thence S89.33'311N 372:01 feet along the North line of the NE'/. of said Sectlpn 18; thence S89'33'31"W abng the North line of the NE '/. of said Section 18 775.94 feet; thence S00°52'23"E 250,00 feet; thence S89.33'31'VV 966.24 thence S89'33'31'W 528.00 feet; thence S00°52'23'E alonf g e North-South Qua a Secttonf I1ne of said Sectbn 18 1311.77 feet; thence N89°33'39°E 62$.33 feet; thence N00°31'25"W 330.23 feet; thence N89'33'24°E 692.78 feet; thence N00.52'23"W abng the East 11ne of the SW % ~ the NE '/. 330.31 feet; thence N89°33'24'E along the South line of the NE '/ of the NE '/• 949.09' fit; thence N00'S2'24°W 1321.19 feet to the Point of 8egtnntng. r. ~~,' . . ,s.. ~~ tom. g~~M 6 V E~2-C.o~ ~ 2 or- ~. r 1321.15 " ~ 1288.19' 378.42' 332_93' \_ 160 ;00' -`- ~ o ~Z a o ~ aQ M 0 o W 38.82' ~ `~` li %~ " ~ - ~ ao<j ~ U W <z ~wy ~ ~ Q ~ ?a ~z ~ ~9. ~ ~ ~ ~ ~ Q ma x °• o O ~"~ m~~ M ~ a ~ ~ ~ CD ~p~ / O ~ ~ ~ ^~ ~ 0~0 N R~h~ ~ vi Q ~ :~~ ~ ~ rn F, ~ .~~ O°/ ~ ~ ~ ~ ti z ~viQ / t0 ~ ~ ~ Q rn _ rn ~ ~ ~ ~ ~ ~ ~ o~~ -- -_ ` M \ / r 0 i\ M ..Zb.LZ.~ ~ 0~~ tip` ~ ~`~~' -_- s ~ ~ ~ - n \ \ ~~ ~~~ ~ s o O NN \ ~ Q ~ \ ~ ~ ~ ~, ~ o \ o~~ ' 9 ~ s~ ~Zb ,. W 366.12' \ ~ ~ ` --1 ~ ~ o,`~/ / \ Off. ~~'n M "9Z `~ e tij 9 W °~ ~ ~ 'sc 3 ~ v _ .~~ ~ u' Q \'S~ a ~ M M ~ ~ ~ i~/~ . 6' CO I M~ M Qj I I / E-~1 ~ ~ / ~ . ~~ ago'- V / ~ CO / ,~ I N Z I / ~1 W 374.88' / O O ~~ -1 •o ~ \ \ ~~ ~~ \ ~ \ / ~~, Q ~, ~ ~~ \ ~ ~ Q ~ ~~~~ ~ ,~