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HomeMy WebLinkAbout018-2003-30-000Wisconsin Department of Commerce 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)]. Permit Holder's Name: City Village X Township P.C. Collova Builders, Inc. Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description: ~ LO} 1~~~'~' /~,c? C5~ /~' IMF ~ `~ corm.- TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic 0,~~ Cl~i, 1.'! /~ Dosing _ (t,6yvr, ~ b // __ l~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic y ~.,,~ * \ J Dosing I { ~i Aeration Holdi PUMP/SIPHON INFORMATION Manufacturer ~ Demand q - GPM Model Number ~ `~~ y n ~-~7 TDH LiftL.,~ Friction Lo~ System Head ~ ~ ' TDHI ~ ~. t 5 Forcemain Length / Dia. r~ Dist. to Well ELEVATION DATA County: St. CroiX Sanitary Permit No: 430201 0 State Plan ID No: Parcel Tax No: i~ Section/Town/Range/Map No: 18.29.17. STATION BS HI FS ELEV. Benchmark y,y ,oy.~ ~oo.~ Alt. BM vase t' 0~•7 a~•7 Bldg. Sewer $.0 9 SUHt Inlet 11,15 `~3 , z SUHt Outlet Dt Inlet Dt Bottom q ~. 1 ~ ,~D Header/Man. Dist. Pipe ~ , ! . ,(e /~, [ Bot. System ~ , 30 ~ . ,3 ~ ~ ` .,~ Final Grade S Cover do.3~ , I O '~..~o WrrA S'f~-~- SOIL ABSORPTION SYSTEM C antoh~ / 3 .SV 3.75 '~ ~ 7 d BED/TRENCH Width ~ , Length DIMENSIONS ~ ~t No. Of T~1Ches l ~h{,Yr„~y ~ PIT DIMEN S No. Of Pit Inside Dia. Liquid Dept ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of S ytAtem: ~ (~ 1 ~`\ Y UNIT Model Number. , `~ /I " J DISTRIBUTION SYSTEM • ~- ~ M~~ ~. l~ f{1 = / m'`/~(~ ~1J ~=/00 Header/Manifold !~ Length ~ Dia ~ /J Distribution ~ pipe(s) 1r~ Length J ~ Dia ~~ ~ "~ Spacing x ole Size I ~/ x Hole Spacing p~ / Vent to Air Int SOIL COVER x Pressure Svstems Onlv xx Mound Or At-Grade Svstems On[v Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~- j <<i Yes ~;~ No -- r;'~;i Yes j ~_I No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection 1:~/ 7 /~~ Inspection #2: / / i Location: 989 158th St Hammond, WI 54015 (NE 1/4 N~ 1!4 18 T29N R17W) Crick Bottom Parcel No: 18.29.17. 1.) Alt BM Description = '~ I~'V l (~va~ 'LOO eV = ((~~ ~1 ~ 2.) Bldg sewer length = °'~ 0~, w ~. - amount of cover = ~ ~ P~tt,N/I~yQ,/ •~~ ~~ 1~ bQ ~ 2 ~ ~,py.j't rc ~ b ~'/-owe ~r~(q '{{~ '~t ~lan revision Required? Yes No ~~ -_ - - ___ ~ • _ _ _ _ _ _ ~S 1 ~a~ Use otherside for additional rnformatlon. ~ d _ !__ _ ~ __, ~- - - ~~ ~"! _ - °~ - I ' ' ~ ~J ~ _' 3. 1 . - -- ~- _ __~_- S, Date Insepctor's Signature Cert. No. ', ~~ BBD-6710 (R.3/97) ',~ ~ Safety and Buildings Division Counq' ((~~ ~ ' P.O. Box 7162 ton Ave Washin 01 W ~ l~' C ~ ~ ., g . 2 ; ~I~ Madison, WI 53707 - 7162 Sanitary Permit A?ui~ ~ bi fil~ ~ by Co.) ~~®~ (608) 266-3151 0~- Department. of Commerce State Plan I.D. Nttmber Sanitary Permit Application rovide ou i f ,~~. ~~'S~0~0 p on y ormat In accord with Comm 83.21, Wis. Adm. Code, personal in may be used for secondary purposes Privacy Law, s15.04(1)(m) project Ad~ess (if differen~ mailing address) !~ ' ~~ ° l ~ ~~ I. Application Information -Please Print All Information Parcel # of # Block # Property Owner's Na m~ ~, ~ ~ ~j c ~~~ o~ . . n Property Owner's M ailing Address f ~ ~ "' `Property Location ` a l' ' City, State -~~ Zip Code ' ~~(~~ ~ Phone tNy[mber i . , ~ `~ ctrcl one ~~ N; R~E~ II. Type of Building (check all that apply) ~ i_..~.w.__..__ ubdiv~ision Name CSM Numb 2 Family Dwelling -Number of Bedrooms --~ /1 ~J ^ Public/Commercial - Describe/U~se -4 d /` ~ ~r /~ / ^Ciry_L!Villag nship of ^ State Owned -Describe Use / III. Type of Permit: (Check only one box on line A. Complete line B if applicable) a' System ^ Replacement System ^ TreatmenUHolding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner N. Type of POWTS System: {Check all that apply) ^ Non -Pressurized In-Ground nd > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter r ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter Constructed Wetland ^ Pressurized In-Ground ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ~ ^ Other (explain) t7 _ ~~ V. Dis ersal/Treatment Area Information: G Ud " . Design Flow (gpd) Design So' pli Rat~sf) Dispersal Area Required (sf) Dispers 1 Area Pro used (sf) System Elevation ~ ~ J io 3 - sol ~s~ ~'sv o ' VI. Tank Info Cap city in Toral i *~•~nufacturer efab Site S•.eel Fiber plastic oncrete Constructed Glass Gallons Gallons New Existing 'ranks Tanks j Septic or Holding Tank ~~> Aerobic Treatment Unit Dosing Chamber _ ~ ~ VII. Responsibility Statement- I, the undersign ~ on the attached plans. Business Phone Number Plumber's Na me (Print) Plumber's {' ~ Plumber's Addre ss (Street, City, State, ~ Code /~ ~ ~ ~/ ~ ~ _ r ~ ~ D ~ ~ .~ s . ~~ VII County/De artment Use Onl r' ` ~f ,led uing~ nt Signattu Stamps) Approved ^ Disapproved ""rte /J'~ ~ ~ ] ~ ! ~ / ~ _ / j,(,~ _ 1 (/ /Q 3 iii i~ ^ Owner Given Reason for Den lX. Conditions of Approval/tceasons t"or JJ~ _ ~ ~ S.. J~~ ~r2~i-Lc~a ~L w~-~- w ~c~ ~ nticca~ ~° z`~c-~ ' - /~Lc~~- ~'3. sz aid G,~ e / /~~ ~e~_ ~ l: //~is . ('~G~. os~ G%GGB'ti ~ ~ ./~'11.fiYi'I~~~n~t~Ct` n ^^ r '^ ^ Attac comple~ (to the County only) r the gys on paper not less lh 1/2 x 1 inches in size PROJECT P C. Callotva Bldrs. Inc. A SS P•O• ox 489 Somerset Wi 54025 SW 1/4 NE 1145 18 /T 29 N/R w OwN Hammond COUNTY ST. CROIX 6/26/03 BEDROOM 3 MPRS Shaun Bird 226900 _ DATE CONVENTIONAL AT-GRADE ~ CONVENTIONAL LIFT HOLDING TANK SEPTIC TANK SIZE ~ 0 gallons LIFE TANK SIZE DOSE TANK SIZE 630 MOUND XXX 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 w SYSTEM ELEVATION ~ 03.3' Property Line Scale = 1 /4" = 10' Pto 3 Bedroom House `~ Well is to meet all setbacks found in Co n 83 z-d 466' Property Line Tank is to be property bedded and provided with lockdown covers with approved warning labesl Huffcutt Combo tank Grading is to be done to divert run-off away from system 02.3 1 03' 102" B-2 I O' \ ^ 9% Slope Area 15' below system is to remain undisturbed B-3 B-' ~' w V A r m P. 2 dZE=90 EO 1•T InC ~(2nv~ C .(! . 1}% >(v~~ y, ~ ~ I ~~0~~~~ Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary July 15, 2003 CUST ID No. 226900 SHAUN R BIRD BIRD PLUMBING, INC 1008 192 ND AVE NEW RICHMOND WI 54017 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/15/2005 SITE: PC Collova Builders Inc Town of Hammond, St Croix County SW 1/4, NE 1/4, 518, T29N, R17W Lot: 30, Subdivision: Crick Bottom Overlook ~~ Identification Numbers ~ Transaction ID No. 885040 Site ID No. 661604 Please refer to both identification numbers;" above; in all correspondence with the FOR: Object Type: POWT System 450 gpd Mound System Regulated Object ID No.: 910842 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDTTIONALLY 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: SVJ' Pursuant to outlet filter product approval stipulations, maintenan . the POWTS explaining that periodic cleaning of the septic tank outlet filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. • The manifold diameter shall be 1 1/2 inches so that velocity is 2.0 feet per second or more. • The mound dimensions are designed using a 9% slope. Dimensions K, I, and J shall be as per the approved plans. 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. 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 stets 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, ~' oy G. J sky, Waste ter Spec' 'st (715)726-2 44 Voice (715)726-2549 Fax ljansky@commerce. state. wi, us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7:63:3 . RE~EiVED :JUN 26 1003 Cover Page SAFETY & BLDGS D11C. Shaun Bird Bird Plumbing Inc. ~~ 8 5 O~ O ~~ 1008 192nd Ave P.O.W.T.S. New Richmond Wi 54017 GC~DZC~ltlOl2l~~h7 715-246-4516 ,~ DEPART MF~dT OF COMMERCE DIVIS~ Of SAFETY AND BNI' INGS Date: 6/26/03 ~,, Owner:P.C. Collova Bldrs. Inc. -E coy EsPOND cE Location: SW1/4 NE1/4 S 18 T29 N,R 17W Hammond 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 Contigency plan 10-12 Soil test Signature License number 226900 PROJECT P.C. Collova Bldrs. Inc. A SS P.O. ox 489 Somerset Wi 54025 SW I/4 NE 1/4S 18 /T 29 N/R W OWN Hammond COUNTY ST. CROIX MFRS Shaun Bird 226900 DATE6/26/03 BEDROOM 3 CONVENTIONAL AT-GRADE ~ CONVENTIONAL LIFT HOLDING TANK MOUND X)OC SEPTIC TANK SIZE t 0 gallons LIFT TANK SIZE DOSE TANK SIZE &30 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 «g,g_p, Same as Benchmark SYSTEM ELEVATION 103.3' Property Line Scale = 1 /4" = 10' Pro 3 Bedroom House Tank is to be property bedded and provided with lockdown covers with approved warning labesl Huffcutt Combo tank 1 }= ~ (c~~ 102„ 101' B-2 100' ~C Well is to meet all setbacks found in Comm. 83 9% Slope Area 15' below system is to remain undisturbed 466' Pro Line Q~ Grading is to be done to divert run-off away from system 2.31 1 03' B-3 w V A r m B- ~: z-d dZE=90 EO bi i~C ,--'- No Designer Date 4" Observation Pipe Perforated Below Filter Fabric AS1Zi C-33 5 c n d --~~ "Topsoil ` _-.-J ~ y A-~~=t''~~+Ja Non-Woven Filter Fabric ~DistriDution• Pipc ;" ~ -}H-== ---- r ~G ,._ ~ _ o ~ ~•. S1ope bed Of f~- 2 %I Force M.oin ~ From Fump Drain Rock ~ r~ Cress Section Of A Mound SY__ ster" Us-nq A Bed For The pbsorpt~on Area q Ft. g ~ Ft. I~~j ~ ~ Ft.~ - J ~~ Ft. • K~~ 3 Ft. L 7~ Ft. WD1~ Ft _ Flowed . Loge/ ,p ! F ,$~ k /, ~ L ¢~Observotion Pipe--~ ~ ----- E -----'- _ --~-- K ,.,_ ,_,., V-- - - - - - - - ~~ j ----------! - --' ----------------------- eNr~zs ~ ~ 0~~~- 5 one n. A ~ ~ Force Moen ~_ ry, `~' ~° _.~._~...___..._.r~_..._---_~_~_---- From Pump 3 r i' ° Distribution Bed Ot /2 - 2'Z ~ -Drain RocK Pipt I 4~~Obcervation Pipe Pcrmonent Morker Pipe or Rods Plon Vievr Ot Mound UiInQ A 8~d For The Absorption Areo PAGE ~ OF ~ 2- w ~~~ li Lototed On 8o~tom. ~quolty $aoced CST tiO1.L N£%"i~ To CanneG~~e' Ft. ~'~. Signed: i. z tense Numa~er Date: Hole Diameter ~~ Inch ~aterai " 2 ~ Inch( - ~!anifoid ~' Inc es~.~ Force Main ~" inc es of hole;/AipPG~, ~ Invert Eievatio~r of i.ater~ais~~~ Ft.- -nc~es Inches Q. Pe~toraltd P'Re De!oi ~--r- N Ai~It7 SP£t. ti iCATIOhS SEPTIC TALK ~ PG~iP C~#AMB£R CROSS SE~..:C• :s == C i ~t ENT PIPE > ~ ~ t ~R~3!'4 D4Q1~ , FRESH AIR i~tTAK£ FIl3ISH~D ~FtADE - (r ai~w. 3~" :N APPRUYEit PIPE 3` (3}iT~} SQL 5t3IL Jt3IiiTS 11ITH pppR4Y£D PiFE 3' 0~ $(#LIO SQIL L IyiDExZ ~A~+iK ~ 3tx A;'PRduE7 B£DD~i+€G r~ L~~'~.'I'O3+2CRE'TE PAD ij~~c'~ ~:'~CIFICATIt3I3S I~?#BLF DOSES ?rR DA': _ -,----- SEPTIC f DQS£ TA3vK MANUFAO'1'43RER: s aME Ti~CLUDZNG s GAL . i3t3SE L' 4 ~• r Ld&,t$AC iC : ~' J GAL - TAN1{ SIZES: SEPTI~~iZ, GAy- ~'-±~~AL- DpS£ ~~ TIES = A = ~~ NCfiES - ~.- '' z ,~ CAgACI GAL. ALARM riAi~i.tFACZ~3RF.R: $ ~ Z ZTiCHES - _____-- --"'-"'" M DD £ L N[1If S ER : /L~;~"~ ~- ~~ .~~ GAL . g~rTCH TX~'E= ~-CS/~ t/J d ~ . J INCHES ~ ~~.---- P{7iSP pfA~FACq'i~R£R = _ II = "~"""~ MODEL Nt7ii8ER : ' _~? _ LHR 26.23 WAC g~;TGIi T'YPF: ~._/1 '~~,~~~ MP £ Ai..e•RM ux~T~ AS P~sZ :. ~~ ~ FEET RP.W~%ZRFD I}iSCHARGE I8d"iZ(~ ~'~-~'£ .~--~f'E£'T £N P;JMP 4: F A3~D D:a.STR _ _ _ - - ..~~ 3._.,.----- FEE2 VggTYGAL DIFFEg~3dCE 3£T~£PR£SSiIR£ - - ~',gCTQR , _ - ~f EET ~ P'SI IMZ3M P!£ i` 3r10~?1C Si.f FPI...Y .~ ~'"~r` lI3'D F'T . T R iC'TI f~~ E H:.A~ !~ ~££`F f 4RC£3~.AI1~ ~ -~' '~~- ~£1TkL DYNA'3 _I + ~ - Dg,RM£TER ~- i,~ ns F~MF TAi1 iC: i7. TYl'3GtT~ ~,~"-,Lf~, _, i ITT LL~1.171~ 11 T~L37ST di'~~ •.ta L, i'l~lJ t ~-'"" ~ iG~~.~- *, M T t~ . ?. B ~i'~ £ GRAD ~ ~?~~ti3~~ JR t~El1IHERf'F .~~r~c~~~r~ aox t~,tlT~ CDi~I3t]IT 2Y S. C. a,{~ . , ~ , GA.S- a , 'F'Zi,HT F s FA t~ :~ ~JALM s ON f ! _~ AgF~av ~~ MANHOLE ~0~ E.~c b~ / PAD LQC K E WARNI~dG lAB£L ~s' MIN. u ~$ M4~1- y°'>C.x. e~~s~w~~ ~~~ i.:A'i'£FZ T3~~~ SEALS _~ _ A ~ 1 i.7 ~~ ~--_ fi ~_ ~! C D `~} ~.Ti L :IBS ~- S i i 1 0 Q x U z a z r 0 a 0 r- » 3 i7/ .z - 10?AL DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT AND DEWATERtNG 152 153 MODEL ~ L.~ I Feet Meters Goi. I L,ters Gol. liters 5 1 5 I 69 i 261 77 291 ~ 10 ; 3.7 I 61 ~ 231 70 265 1S 4,6 53 ~ 201 ~ 67 ~ 237 I 2C 6 1 44 j 167 52 197 ! 25 7.6 34 129 i 42 159 ~'~p _ 9 ;~ 2z ~ 87 ~ 33 ~ 125 I ---li ~ 2? ~ 85 ~5 1C.7 ~ -- -- 40 i 2.2 -- -- 11 42 ~ F. '13.4m Ler_v Vclve: 138.0 r I1'.6m)i44.u t ~ 1 c~asoa ip CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. ` " • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik-Box available for outdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. 1521153 Series B 5 1 2 or 3 115 1 715 1 Non Auto . 8.5 Included 2 or 3 230 1 Non 4.3 1 2 or 3 230 1 Auto 4.3 Included 2 or 3 715 1 Non 10.5 1 2 or 3 715 7 Aulo 10.5 4ncluded 2 230 1 Non 5.3 7 or 3 nn i auto 5.3 Included ! 2 or 3 D CAUTION All installation of controls, protection devices and wiring should be done by a qualified rtecent National ElectrAclCode (NEC) and th Occupational Safety and Health Act (OSHA)~~ .~__- i I I ,z 7/s I T :2 3 sK2ow SELECTION GUIDE 1. Single piggyback variable level float switch or double piggybackvariable 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 conVol 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 Zoe-ler pump. MAfL 70: P.O. BOX 16341 -, -. ,~~~-~~~,_ Louisville, KY 40256-0347 Manufacturersof.. Z ~ SNIP T0: 3649 Cane Run Road Q~urrPu~PS ,sNCE /~3~ a ~ i Louisville, KY 4021 1-7 86 7 . ~ ~~~' ~"' '~~` ® (502) 178-2731.1(800) 928-PUMP a ~/'~ PUMP !D FAX (502) 774-3624 h2tp:Ilwww.zoeiler.com ~ / __ r, ~,..,,,~hhr ~nnn Zoeller Co. All rights reserved. ~/ FLOW PER MINUTE M Wisoor~in Oepartmerd of Commerce e-.~s___ SOIL EVALUATION REPORT Page / ~ 3 in accordance with Comm Wis. ~~ ~ V ' + /1 , -j- ~ (~ ~ Attach complete site plan on paper nd less than 81/2 x 11 inches in but not gmfled to: vertical and horizontal reference point (BM irtdude e. Plan mint direction and Paroet I. .,R,Q,~ ~,~,..' , scale ar dtirrensions, north arrow, and location and die ercent slo e ce tt(~d. 2 , p p Please print aN information. ~RL, L~xx,[~ O U Rew T Y ~~ ~ ~ ( Personal intimation You P~de maybe used for secondary PiPo~ t taw. sS ~S.w trt tm~ /O Property Owner ~ / ~ ~, ~ Govt. Lot 1/4 1/4 S ~ T N R E ( W Properly owrKr Mar'gng PKidress _ q ux ~#~ Block it (/ ~j Name or cSi~ G /'iG ah+ ~ State ~ Cade Phone Number ^ City ^ Viia9e Town t j~lll ( ) New Cor>strttdion Use: / Nurrd>er of bedrooms Code derived design flow rate S Q GPD ^ Replacerrrertt ~ or 'al -Describe: - `~ / ~' tt Parerd materi~ ~ ~ Flood Platir elevati on if appgcable I General oommerds and nrc~ommendations: ~~' y v7'~~ e j2 ~~,~~ ~ /0~/' 3 Pit Ground surface elev. ~ R Depth to r~n9 factor ~. Soq Rabe a#~ t T Struchxe Consistence Boutrdary Roots 1-bri~on pepth tit. ppriinant Mtarseq Redooc Description Qu. Sz Cord. Cdor ex txe Gr. Sz. Sh. 'Eff#1 'Eff#2 3 ©~~ ~ b-+F~ 0 3iz 06 -r- ~- S.- ~ ~~, ~ ~ ~- L/ ,~' ,~ ' s . s ' . ~ a Pit Ground surface elev. t fL Deptit to gmiting fads' n• ~ Rabe # ~ ~~ r ti i D Texture Structure Consistence Boundary Roots GP D/(l~ Flotrzon Depth in. Dominant Mrrrts~ o t esa Redox p Qu. Sz. Cord. Cdor Gr. Sz. Sh. `Efflii 'Effrf2 I '2 3 o f - ~ a 8' 3/ 4 1D ~c~ ~°/z - sir S -~ y~~ s ~- 5 L ~~s a ,~.,~, t- - m - r= r m~'~ ~^' ~ ~ Y ~ 3 r ~r , fl ,.S' • Effluent #1 = BoD > 30 <_ 220 mgll-and TSS >30 <, ~ Eflhrent #2 = BOD _< 30 mgll and TSS <_ 30 mglL ( ~~ CST Nurriier C$Z~~~ j r Date EvahtaUon Catduc~ad T N~ hddress //,, // ,/ /~:~ rn. ~ /1 / /r '/l_ /i>, ~L/nl ~ ~.~~r",91i 7~f~a~o_~.fl ~of 3d Paroel 1D # T I Page ~ Boring # ^ Boring Pit Ground surface elev. vim'' R Depth to fimiUng tailor Sod nation Rye Horiz~ Depth Dominant Redox Desaiptior- Texture Strtx~ure Roots GPDIff in. Munsed Qu. Sz Cont. Color Gr. Sz Sh. •Efi#1 'Etf#2 - ~ Z 3 . -- ~ ~ ,-r,e ~- ~r c s ~ ~ S ,8 ~/ ~ ~ r y v~ -rn- m~',' n/a n /u ~3 ^ # ^ ^ Pit Ground surface elev. ft `Effluent #t = BtJD, > 30 < 220 mgll. and TSS >30 <_ 150 mgll m uniting tailor ~. • Eith~ed #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 is an alternate format, Please contact the department at 608-266-3151 or TTY 608-264-8777. setsss3ot~t of ^ ^ Pit Ground surface elev. R Depth tD limiting factor ~. Sod Rate Noriaon Depth Dom~arrt Redooc Desorption. Te~une Strtxfixe Coro 8otxrd~y Rods GPD/fF in. Mur>.sed Qu. Sz Cont. Cabr Gr. Sz. Sh. •Efl#1 ~~ .. Soil Test Plot Plan Project Name P•C. Collova Bldrs. Inc. Sha Address P.O. Box 487 Somerset Wi 54025 Lot 30 Subdivision Crick Bolton 1/4 NE 1/4S 18 T 29 N/R17 W Boring Q Well PL Property Line BM or VRP Assume Elevation 100 ft System Elevation 103.3' ,S1t RM Tnn of 7" Pins n 1(1(1 (1' M #226900 Date 12/4/02 Township Hammond County ST. CROIX Top of Survey Iron *HRPSame as Benchmark Maintenance and Contingency Plan for a Mound System ~'`f 30~ ~ Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Dose Chamber is to be pumped at the same time as the septic tank. 3. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 4. Once every 3 years the mound is to be inspected via the inspections pipes in the at- grade. The laterals are to be inspected via the cleanouts. 5.Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 6. Pump and electrical components are to be checked at the time of the pumping. 7. Owner agrees to leave the area 15' below mound undisturbed. 8. The owner agrees to save this plan. 9. Trees, shrubs, and other similiar vegitation are not be planted on system. The system is not be driven over. 10. Effluent Quality is not to excede the requirements found in Comm. 83 Contingency Plan 1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if needed, then bypass pump float and try pump with out float. If this works, float is bad, replace float. If pump still does not work, check power at the pump with a electrical device such as a hair dryer. If no power, check breaker inside house and call a electrician. If there is power, then pump is bad and needs to be replaced by a plumber. 2. If mound fails, determine cause of failure, test another area or remove pipe and sewer rock, retill soil, install new mound system. 3. Replace any other failing components as needed. Important Phone Numbers Plumber: Shaun Bird 715-246-4516 Pumper: Tom Mondor 715-246-5148 St. Croix County Zoning 715-386-4680 ~. ~~ 1 pnWTS OWNER'S MANUAL 8~ MANAGEIV(E.KT P),J~N - _ _.,r-.-~crrAT10NS ~ 1 =tLE INFORI1AATlON ~ ~ , ./~ pvvner °t'~ ) Permit #. DESIGN PARAMETERS ~ ~ N Number of Bedrooms Number of Commercial Units ~ aUd~ Estimated flow (average) ?7 aVd~ ~ (Estimated x 1.5) Design flow (peak), : L, Soil Appfigtion Rate aUda !1 Monthly average` influentlEffluent Quality FOG) Oil Z3< Grease ( Fats S30 mg/L , Biochemical Oxygen Demand (BOOS) ended Solids (TSS) l Sus 420 mg/L 5150 m !L p Tota Pretreated Effluent Quality ~ Monthly average" SODS) Biochemigl Oxygen Demand ( lid (TSS) S;iO mg/L ~0 mglL s Total Suspended So Fecal Coliform (geometric mean) 510' cfu/100m1 Y8 inchdiameter Maximum Effluent Particle Size MAINTENANCE SCHEDULE (~ Service Event Inspect condition of tank(s) Pump out contents of tank(s) Inspect dispersal cell(s) Clean effluent filter Inspect pump. Pump controls 8~ alarm Flush laterals and pressure test Page ___.~ot y Service Frequency ^ months Year(s) (Maximum 3 yrs.) At least once every ~ y) of tank volume When combined sludge and scum equals one-third (3 m 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 (Mazlmu ^ NA ^ NA ^ m^ no the ^ year(s) ^ NA p months ^ year(s) ^ NA other. n one of the following licenses or MAINTENANCE INSTRUCTIONS ctor, POVYTS Maintainer, Septage Inspections of tanks and dispersal cells shall be made by an individual carryi g to identify any missing or broken cerrt;fications: Master Plumber, Master Plumber Restncted Sewer, POWTS nsPe back up Senridng Operator. Tank inspections must include a visual inspection of the tank(s) ~ to check the effluent levels handware, identify any cracks or leaks, measure thde'SOlu~e cell) txaled~luvdg a ~ d SCP~ and to ~~ a fluent on the or ponding of effluent on the ground surface- The pe round surface. The ponding ndin of effluent on the g authority- in the observation pipes and to check for any Po g wires the immediate notification of the local regulatory ground surface may indicate a failing condition and req uals one-third (l~) or more of the tank vow h ~~NR When the combined accumulation of sludge and scum i e Servicin Operator and disposed of in accordance entire contents of the tank shall be removed by a Septag g vents, and any 113, Wisconsin Administrative Code. onents, pretreattgment compo a certified POWTS Maintainer. The servicing of effluent filters, mechanical or pressurized pOWTS comp rfonned by other maintenance or monitoring at intervals of 12 months or less shall be pe of completion of any service event. A service report shall be provided to the local regulatory authority within 10 days for the presence of painting products or other STARTUP AND OPERATION tf hi h concentrations are For new construction, prior to use of the PO ~s ndlorrda age tfie d spersal cells?• 9 chemicals that may impede the treatmentremoved by a septage servicing operator prior to use- detected have the contents of the tank(s) '? ^ months r ^ months ~ ^ months ^ months • Values typical for domestic (non-canmeruaq'''~SLe""°`°~ °' "' septic tank effluent •+ Values typical for pmtreated rrastewater- Page ~ of y r° System start uP shall not occur when soil conditions are frozen at the infiltrative surface. war is restored the excess During power outages pump tanks maY fill above normal highwater levels. When po wastewater will be discharged to the dispersal celKs) in one large dose, overloading the ceu(s~ and may result in the To avoid this situation have the contents of the pump tank removed by a backup or surface discharge of effluent Septage Senricang Operator Prtor bo-restoring power to the effluent pump or contact a Plumber or POWTS a stainer to assist in manually operating the pump controls to restore normal levels within the pump tank Do not drive or park vehides over tanks and dispersal cellde soil abso boor area.over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at~ra ~ rEorman~ and rolon the life Reduction or elimination of the following from the wastewater stream may improve the pe P 9 of the POWTS: antibiotics; baby wipes; dgarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; fouridatian drain (sump pump) Hrater; ~~ and vegetable peelings; gasoline; grease; herbicides; meat scxaps; medications; ofi; painting products; pestiades; sanitary napkins; tampons; and water softener brine. ABANDONMMENT shall t2e taken t0 Insure that the When the POWTS fails and/or is permanently taken out of service the following steps system is property and safety abandoned in compliance with ch_ Comm 83.33, ~~onnln s sealed. We Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe Pe 9 • The wntents 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 ff the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a e compliant replacement system: D A suitable replaceme~e ~ ~~ ~nt areatsho~uld be protected flrom d st rbance and compaction and should not absorption system. P be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure o 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. O A suitable replacement area is betinstalled as a last retsort tto eploace ithe failed POWTSng advances in POWTS technology a holding tank. may ~~~-p~~r/vi'S a soil and e s' as not been evaluated to iden6 unable replacem - - lu 'on m be rformed ovate a su cement area. If no replacement area is available a ho rig tan be instaAe a last resort to replace the failed POWTS. curd and at-grade soil absorption systems mays reconstructed P P~~ ~etl~ s9 n effect a~that bme. at at the infiltrative surface. Reconstructions of such s tams must com ly «WARNING» SEPTIC, PUMP AND OTHER TRFATME TM~R TREATMENT TANK UNDER ANY C RCUMSTANCESF DIEATH MAY GE . DO NOT ENTER A SEPTIC, PUMP OR O RESULT_ RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAYBE DIFFICULT OR IMPOSSIBLE. ADDfT10NAL COMMENTS POWTS INSTALLER Name ~ tt_Ll.~ ~i r ~ J Phone '~' 3 ..~ `; POYYTS MAINTAINER Name ~ ,;L i~' Phone j %Z ` ~ ~~'~.~ LOCAL REGULATORY AUTHORITY SEPTAGE SERVICING OPERATOR PUMPER ~ ~~~ ..--- Agency ~~ r ~ Name ~ ~ /0? /~ v, /~ ~ Phone ~/ ,j - ~ ' Phone / ''`j ~ ir7 r rots documentrras drafted by the staffs of the Green Lake' Marquette and Waushara County Zoning and Sanitation agendas. This dowmea~~o the minimum requirements or ~- Comm 83-22(2)(b)(t)td)~(t) and 83.54(1), (2) 8~ (3), Nlfisco°5in Adminlsttathra Code. U58 of this dOCU G~ `~') guarantee the performance of the POVYTS. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer P. C. Collova Builders, Inc. Mailing Address P O Box 489 Somerset, WI 54025 ~y ~ Property Address ~ '7 ~ ~ ~ ~ ~ . (Verification required from Planning Department for new City/State t~it.fhm~or ~~ Pazcel Identification Number,aGriGl/,n'a/ LEGAL DESCRIPTION Properly Location ~ %,, Subdivision Certified Survey Map # Lot # _s~~. Volume .Page # Warranty Deed # ~ ~ ~'' ~~-( vv~ . Volume ~ Page # ~ - Spec house ©yes ^ no Lot lines identifiable yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result is 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. Croix Zoning Department a certification form, signed by the owner. and by a masterplumber, journeymanplumber, restrictedplumber or alicensed pumper verifying that (1) the on-site wastewaterdisposalcystem 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 stn ' t your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 f e eaz expiration date. P. C. COLLOVA BUILDERS, INC. (715) 247-2742 ~_ /~ / ~'~ SIGNA F APPLICANT P.O. Box 489 SOMERSET, WISCONSIN 54025 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 rty c ove, by virtue of a warranty deed recorded in Register of Deeds Office. P. C. COLLOVA BUILDERS, INC. ~ X2.3 ~- ~ A I:ICANT (715) 247-2742 P.O. Box 489 DATE SOMERSET, WISCONSIN 54025 ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** r ~~ '/,, Sec. ~~ . To2°~ N-R ~ ~' W, Town of Ta-+r~L . ** 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 195OP 5281 f (STATE BAR OF W ISCONSIN FORM 1-1998 I WARRANTY DEED husband and wife .Grantor, and P . t:,oliova tiunaers, mc. . gar. Grantor, for a valuable consideratlon cornet's to Grantee the follow desalted real estate in St Croix County State of Wisconsin (the "Property'): 667242 KATHLEfiH R. MALSR REGISTER OR DEEDS ST. CROIX CO.. MI RECfiIVED FOR RfiCORD 08-16-2002 9:00 AM EYDPT tt ~ REC FEES 13.00 TRANS FEE: 1155.08 COPY FEE: CERT COPY FEE: PAGES: 2 t~ Sw Exhibit A attached hereto P' Cf Cosova Busders, Inc. xtr~~n h Avsnue mood , WI 54013 ~~~ 909 O}8-1039-20-•000 / 018-1039-10~OC 018 1039 80 000 Parent Identlticatlon Number (PIN) Thla Is oat homestoed property. (Is) (is not) Together with all appurtenant rights, title and Interests. none Grantor warrants that the title to the Properties good, Indefeas(ble in simple fee and free and clear of encumbrances except Dated this 15th day of August. 2002. (SEAL) •4~.~ -~ ~hn J. ~blton (SEAL) • Aa'~~~0 -. C.,~TE OF WiSCO~ Signatuce(a) authenticated this NO 3UC TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized ny §706.08, Wis. Stets) THIS INSTRUMENT WAS DRAFTED BY Cddwell Banker Bumet 1301 Coulee Road Hudson, WI 54018 2-32470 (Signatures maybe authenticated or acknowledged. Both are not necessary.) (SEAL) Carolyn G.~alton (SEAL) • ACKNOWLEDGMENT State of Wisconsin, } ss. SL Croix County Personally came before me this 1~ day of August ~ U:e above mad J a and rol D Iton ban nd Wif W w5-~ r~ Notary Public, State of Wisconsin My commiasbn is pe anent. (If not, state expiration date: ~~5 ~~ .) ' Names of s n man ca muai oe ~. STATE BAR OF WISCONSIN Wisconsin legal Btenk Co. Inc. yyA~AMy pip FORM No.1-1998 Milwaukee, Wis. ~U ~ ~Lb OK ~ o~ 2 ;:, . ';I~. , ~'1, 9 S. ,ti . F. 5.2,~ ..,.,~1. .. ~ :~ a . , . .. .. A pert of the NE'/. of the NE '/. and In paR of the NW '/. of the NE'/. and irr part of the Stro+` ; of , the NE '/. of Section 18, Township 29 North, Range 17 West, Town of Hammond, St.Croix County, Wisconsin and mare Partkulatty described as; Begicming at the Northeast comer of said Section 18; thence S89'33'31 °W 372;01 feet along the North line of the NE '/. of said Sectlcst 18; thence S89'33'31"W along 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'IN 968.24 (sett thence S00°52'23"E 420.00 feet; thence S89'33'31"W 528.00 feet; thence S00°52'23'E along the North~outh Quarter Sectiotl line of said Sedlon 18 1311.77 feet; thence N89'33'39°E 826,33 feet; (hence N00°31'25°W 330,23 feet; thence N88'33'24"E 692.78 feet; thence N00'S2'23"W adgng the East line of the SW % q~ the NE '/. 330.31 feet; thence N89°33'24'E along the South line of the NE '/. of the NE '/.949.09 feet; thence N00'52'24°VV 1321.19 feet to the Point of 8eginninq. :u''. ;,;; . . ~•R>:.: ~'r2 cedC g~~M 6U~~v~ 2 or- ~ ~g /~~. . a, s D ~ n -~ ~~\. 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