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HomeMy WebLinkAbout018-2003-31-000Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information y"ou provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Hoider's Name: City X Village Township P.C. Collova Builders, Inc. Villa e of Hammond CST BM Elev: Insp. BM Elev: BM Description: U r ~ ~ ~~ TANK INFORMATION E EVATIO DATA TYPE MANUFACTURER CAPACITY Septic ~~ tt t.t r r Dosing I Ae Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~ / ~J ~ r ~ Dosing yfyt Un t~' Aeratio - _~- -____ __., r ------- . .~ _-_ , Holder :: ~. PUMP/SIPHON INFORMATION ManufacturrYr ~ ~ .~ ~ ~ Demand GPM Model Number TDH Lift 5 Frictio Lo System Head TDH F~ , 5 Forcemain Length, I Dia ,/ ist. to well , F SAIL ABSORPTION SYSTEM County: $t. CroiX Sanitary Permit No: 429949 0 State Plan ID No: Parcel Tax N Section/Town/Range/Map No; 18.29.17. STATION BS HI FS ELEV. //11 Benchmark ~(~ lU, ~ao~ ~ Alt. BM ~ ~~ {~ ~ •C.t7 Bldg. Sewer St/Ht Inlet i ~ x SUHt Outlet - ~ Dt Inlet Dt Bottom ~ ~ "1 Header/Man. G ~ J n 7 D~t. Pipe a 5.~s~ ~~9s~ ~o Bot. ystem ~~ ~ 1~ _ '~ J Final Grade St Cover ~ Y (j ~/ c3 . ~ 1 ~D G~j / ~ •~ ~~ „r . ~~;~""' ` SEt3iTRENCH W idth Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. 'quid Depth DIMENSIONS ~ ~ rJ. r SETBACK SYSTEM TO P/L BLDG WELL LAK STR M LEACHING Manua r INFORMATION CHAMBER OR TypMfSy siem: ~~I .'~~ ~ h I ~ { ~ ~ UNIT Model Number. l ~; ~1 11 DISTRIBUTION SYSTEM "I Header/Manifold ~[ I t l Distribution Pipe(s) / r t l ~ ~ x Hole Size ' x Hole Spacing Vent to Air Intake ~~ Length 1 Dia Length Dia^ Spacing _ ~t~(' SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Only Depth Over I Depth Over l xx Depth of xx Seeded/Sodded xx Mulched Bedlfrench Center ' Bed/Trench Edges \ Topsoil ~ Yes No 0 Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~/ ~~ Inspection #2: //~, Location: 995 158th St Hammond, WI 54015 (NE 1/4 NE 1/4 18 T29N R17W) Crick Bottom Overloo t~Lot 1 Parcel No: 18j~r28.7T.~ 1.) Alt BM Description = ~ ~~rn 6 ~ SI'~~ ~ ~( 2.) Bldg sewer length = 7S - amount of cover = L~ 3.) Contour = ~'~ -T-- ; -- -~ ~.- _. - ----- - - Plan revision Required? {~', Yes ~ ~ No ~ ~ Use other side for additional information. ~_. ~ ~ ~~~ --- G~'~~-~_ _ //~/1~~ SBD-6710 (R.3J97) Date Insepctor's Sign lure ~ S S Cert. No. ~~~~~ Safety and Buildings Division 201 W County~~ n ~ ~ ~ ~ ' . Washington Ave., P.O. Box 7162 C: ~S~Q~~ ,~ Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (~8) 266-3151 ~ Sanitary Permit Application State Plan .D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ma be u ed f d ~xvf y s or secott ary purposes Privacy Law, s15.04(lxm) Projec t Address (if fferent than mailing address) p ~ I. Application Information -Please Print AU Information ~! ~ ~ 5 ~ ~ ' Property Owner's Na the Jf Block ~ P e~i Lot / Property Owner's M ailing Address Property Location L~ ~U ~ ~ City, State Zi Code Pho N be ~k.L~ Y,Section ne r um s L~C~ ~ ~~/ 2S 7 ~ (ci p one ~ II. Type of Building {check all that apply) R or w N; r 2 Family Dwelling -Number of Bedrooms S i ision ame CSM Number ^ Public/Commercial -Describe U/s~e 20 ~`~ , ^ State Owned - Descri Use /"/ d (,{/ ~ ~~ r S . j, - - ^Ciry ^Village nship ~ CROIX COUN Y III. Type of Pertrdt: (C heck only one box on line A. Complete line B ' applia"~ A. w S stem Y ^ Replacement System ^ TreatmendHolding Tank Replacement Only ^ Other Modification to Existing System B• ^ Petmi[ Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. of POWTS S stem: {Ch all that a pI ) ^ Non -Pressurized In-Group > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ A[-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ R~irculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis rsal/Treatment Area Information lta ~,c, y12(il%~ • Ob 0~ Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sfj Dispersal Area o (sf) Sys Elevation ~ ~Sc~ ~ ~'tr Sa .r- ~ ' VI. Tank :nfo Capacity in Total Number Ma nu facturer Prefab Site • Steel Fiber plastic Galloru Gallons of Units W ham ~ Q Concrete Consavct d Gl New Existing /<?~~c ~ / , ~ LiJ ` e ass Tanks Tanks Septic or Holding Tank , Aerobic Treatmen[ llnit Dating Chamber VII. Responsibility Statement- I, tti~ and ,assume respousibilitq for installation of the POWTS shown on the attached plans. Plum meme (Pr~ Plum i gnature MPlMPRS Number Business phone Number 2Z~ ~ ~ ~--~~~-~ ~~ ' Pitunber s Addre ss (Street, Ciry, S ip Code) _ / VIII. ount 1De ent Use Onl Approved ^ Disapproved SanuarY Permit Fee (includes Groundwater Date Isstr ' g gent Si Stamps) ^ Owner Given Reason for Denial Surthar a Fee ) C!D g ) ~a S -~` ~ n ~ ~D (1 I' ~....,,~ht~Pr~~c~o~ i~ tsapprovat !_ D ~ t,~//`~1`Z~n~~~-,e~C~ uu-~e (C~~~+~ I ~_ `te~u-t 71~~ ~~/ u~ ~ ~ ux~h _ ~- ~~~' nrracn comd~lete P~ (to the County ody) for the system on paper not less than 81/2 x 11 Inches in size SBD-6398 (R. 01/03) INiin Department of Commerce SOIL EVALUATION REPORT Page ~ of 3 i]l„isia, ~ safety and Buildings ` in accordance wim tomm , VViiJ~grs ~ E R l~ ~ e ~ ~' Attach complete site plan on paper nM less than 8112 x 11 inches ust lan m size. P irtclude, but not limited to: vertical and horizontal reference point ( percent slope, scale w dimensions. north arrow. and location and }, dired'ion and tancar~t~oa~~ O I.D. ~~ Please print all information. Rew Y Date Peesonai intimation Yi- Pro+~~ ~Y tie used for seciMary PwP~~ ( ~ t.awTs. ~ ~f~F)~ N ~~ ~~(~ ~,6 ~~ Property Owner J D/ ~~ 1 Gwt, Lot 1/4 1/4 S T N R E( W Property Owner Mailing Address ~ ~ Lnt # Biodc # r ~Name or CSM# L ~'~G City State ~ Code Phone Ntmber ^ City ^ Vti~e Town Nearest Road New conswdion tree: ~ r Number of bedrooms code derived design tlow rate .r a GPD O Rep~ge~eM O a, ~ - Describe: ~ ~ / J9' ft ' Par~artt material . rf applicable ~ Flood Plain elevation General oorrrneMs and ~ S~ ~f ~.r e l~ ~u.~~r' ~ ~~~ ~- ~ ~ -~',,~ ;, ~ ¢~'3~ ~ - --- - a ~# ~ Pi Gsu~i~e~~~ft. D~htolariit~rgfa ~ ~. Sg~ R~ Horimn Depth DorNnaM Redox Description Textixe Strudwe Roots GPD/l~ in. MurtseA flu. Sz. Coat. Cabr Gr. Sz. Sh. ~ft#1 ~1Fry2 Pit Ground stnfaceelev. ~ ~ Depth to limiting factor in. Soif Ram Horizon Depot Dominant Redox Description Texture Stnrcture Consistence t3ourrdary Roots GP DI(P ut. Munseti Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'EtfJf2 'Z- ,- p r ~ -- S L ~. w 1-l~ , 5 ~ ~ 6 0 v ~/ i' ~ S r yI~ ~ S - m- ~' n ~ 3 S • Eflka3M #1 = BOD > 30 < 710 nglL artd l SS >'d0 < 7 - +~c = ow _ vv nyn. ~~, . w _ .,.....~~ ~} CST Wurriber jr /q/~~,~7~ //~9 ///Date Evaluation Catdt~ted A ,/'Tetepftorte Ntrr~fe~ ~I r r . Loy- 3 J P~roel ID # Page ~/~ 8orin9 # ~~ '~~ Pit Ground surface e~/ ft. Depth m flrrritlrrg factor~~ in. Sod Fiala Horizon Depth Dominant Redox 'pCwn Texture Struchrce Cor~stence $ourtdary Roots GP D1ft' in. Munsed flu. Sz. Cont Color Gr. Sz. Sh. 'Eif#'I 'Etflt2 2 - ~/ -- ~- w ~' ~ 5 a ^ Pit Ground surface elev. is Depth ~ 9 factor n. # ° ~~ Sod Rate Horizon Depth Dondnartt Redox Desaiptiorr Texture Structure Consistanoe Boundary Roots GP D/f1~ irr. Munsed t1tr. Sz. Cont. Color Gr. Sz Sh. 'Et(#1 'Etf#2 o # ^ ^ Pit Ground surface elev. ft. Depth m dmitMg factor in. sod Rate Horizon Depth Dominant Redox Desa9pfion- Textrrre Structure Cars 8ound.~rry Roots GPDJff in. Munsed flu. Sz. Cont. Color Gr. Sz Sh. •Etf#1 'Efffla • Effluent #1 = BtJDs > 30 < 710 mglL and TSS >30 _< 150 mglL ' Effluent #2 = BOD, < 30 nglL 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 fon~nat, please contact the deparhnent at 60&266-3151 or TTY 608-264-8777. sso.e3wprbao~ i Project Name Soil Test Plot Plan P.C. Collova Bldrs. Inc. Shaun Address P.O. Box 487 Somerset Wi 54025 i Lot 31 Subdivision Crick Botton Date i~T'~VI #226900 12/4/02 3~3 1 /4 NE 1 /4S 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 93.8' *HRPSame as Benchmark Alt. BM Top of 2" Pipe @ 100.0' PLOT PLAN PROJECT P.C. Colbva Bldrs. Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 NE 1/4 IVE i/4S 18 /T 29 NCR 17 W TOWN Hammons COUNTY ST.CROIX MFRS Shaun Bird 226900 DATE4/22/03 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 sg,R,p, Same as Benchmark B M. SYSTEM ELEVATION 93.8' 1,~ Alt. B.M. Property Line Grading is to be done to divert run- off away from 94' ~ system B-1 ~ B-2 9 3' 9 2' 91' .~ Huffcutt Combo Tank 6=3 Scale=l/4"=10' w ao -~ a r 7 Ar 15' Below .. Syst is to remain undisturbed Pro 3 Bedroom `, I~~ House _ _; Well is to meet all setbacks found in Comm. 83 Tank is to be properly bedded and provided with lockdown covers with approved warning labels ~v~~~-w~-'~ w ~ ~~ 0 -~ m r m 158th St. ~~ isconsin Department of .Commerce Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary Apri129, 2003 CUST ID No.226900 SHAUN R BIRD BIRD PLUMBING, INC 1008 192 ND AVE NEW RICHMOND WI 54017 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/29/2005 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD ~/L~~~J HUDSON WI 54016 % / SITE: P C Collova Builders 158th Street Town of Hammond St Croix County NE1/4, NE1/4, S18, T29N, R17W Subdivision: Crick Bottom Overlook -lot 31 FOR: Description: Proposed Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 900994 Identification Numbers Transaction ID No. 863315 Site ID No. 658352 :Please refer to both' identification numbers, ; above, in all .correspondence with the agency. 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 Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans. • 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. p~ • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank v -- explaining that periodic cleaning of the filter is required. Access to the i ter or c eanmg 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. • 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. •,.. C~~~zc~r~~`~f~c~I~ SHAUN R BIRD Owner Responsibilities: Page 2 4/29/03 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 maybe made to me at the telephone number listed below,. or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, ~~`--~ Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm jswim@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 r Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 4/22/03 Owner: P.C. Collova Bldrs. Inc. Cover Page Location: NE 1/4 NE 1/4 S 18 T29 N,R 17W Lot 31 Crick Bottom Overlook Hammond System type: Mound System Manuals Used: Mound Component Manual version 2.0 (01 /31) Pressure Distribution Manual version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-9. Maintance and Contigency plan 10-12 Soil Signature License nl 4/22/03 RECEIVED APR ~ 5 ~00~ s~En ~ B~D~s a~u.== ~' DEPARTMENT OF CQC;gf~ERCE DIVIS-pN OF fETYANU BU~LDINGS SEE CORRES ONDENCE PROJECT P.C. Collova Bldrs. Inc. NE 1/4 NE i/4S 18 /T 29 PLOT PLAN ADDRESS P.O. Box 489 Somerset Wi 54025 N/R 17 W TOWN Hammons COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE4/22/03 BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 454 # of chambers none BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A-100 ~ ^ BOREHOLE O WELL *H.R.P. Same as Benchmark B.M. ~.~ Alt. B.M. Property Line Grading is to be w ao 0 m r m done to divert run- off away from 94' ~~ system 93B-1 ~ B-2 92' Huffcutt ~ Combo 91 ~ Tank 7% Slope B - 3 Area 15' Below System is to remain undisturbed Pro 3 Bedroom House ~ ~ w Well is to meet ~ all setbacks o found in Comm. ~ 8 3 Tank is to be properly .~ bedded and provided with ~ lockdown covers with approved warning labels 158th St. SYSTEM ELEVATION 93.8' Scale = 1 /4" = 10' wesigner No Y Non-Woven Filter Fabric ~ Distribution Pipe t H as_~.rs_ F G Date 4" Observation Pipe Perforated Below Filter Fabric ASS C-33 San d ~C~" Topsoil J~ 7. Slope /r . ~k ~n wps fled Ot ~~ 2 %Z Grain Rock Force M.oin From Pump Cress Section Of A Mound'SY stem Usinq A Bed For The Absorption Areo A ~ Ft. 6 ~ ~ Ft. I t3.2 Ft.- . J )~~ ~ I~ Ft. ~-11 •V Ft. t , 0 Ft. wa ~.3 Ft: ~, `t=lovr•e d . loge `D i ~ -~~, F • 8S G ~~ ---y Fi ~, S -- -~ _ L _-~-- -, ~ 40bservotion Pipe _....- E%-._.,_ - - --- ~ - K ~ A ' 1.._ - ------------------- 1 Force Main ~ to ---- -------------- - ----- From Pump ., 3 p Distribution Bed Of %Z~- 2 %2 Pipe Drain Rotk I 4 Obt-ervotion Pipe (TYP~ Permonent Morker f.oGATfO ys't~. To y~o~. t3 Pipe or Rods FR.oM oTN AND 5 Pion Vit:v+ Of Mound Uefnp A Bed For Tt-e Absorption Areo PAGE OF . J~~ ~ toeoeee On Bottom. •s EgnanY Spocsa ~tRST t4aVt UItLtGT t0 Conntc~ia ,i % Zc r ~ _ u.~~ - _ - Gist:ibutipn Pipe layout Signed: License Number: Oa to ~ .J ~Ft. R ~ Ff. X °? Inches ~ ~ Inches ~j~ Ho?e Diameter =3:Ls5 Inch i.atera? -" o` Inch{es) ~nni foi d ~ Inches Force Main p ~ Inches ~ of ho?eslA7Pe~ Invert £levdtiott of Later~ats g..~Ft. PerfarateC pipe Detail TZONS ~" Ci VEIiT PIPE 1Z" 24IN. ASOYE GRADE E ~ Zgt FROM DOOR• WINDOW OR FRESH AIR INTAKE QRADE ~ ir~paM. 26" IP ~~~ SDI. hfE ~ TIGHT SEALS FILTER -- KgpTHERPR00F JUNCTION BOX WITH CONDUIT GAS' "~'-' TIG g SEA _.!__ g _ pt3MP OFF ELEV .~~~T. ""'~ D S. A. ~= t~ ~ ~. ~ ~ ~ ~ HT• . L ~ ' ~ ~ APPROVED MANHOLE COYER W! PADLOCK S MtARNIIiG LABEL _ ,ta+~ MIN. ~~ M{M. ~iNTS WITH IlppRdyEO PIPE g01,j0 ~Il. ~- 3~ APPROVED BEDDING UNDER TANK / CONCRETE PAD SPECIFICATIONS `~ ~Sy~"~~~~ ~ 14'•93 ~S/ Wt1MBER DOSES PER DAY : ~/ ' SEPTIC ! p~~RFR,: 'ppNK ISA1+1U DOSE yOt~uME IHCI~IDING 'j / ~L. SEPTIC ~' - FL01dgACK: /~%~... TANK SiZE$~ DOSE GAL. J CAPACITIES s A = ~_? 5 Ii~ICKES = ~ I2Z .5 GAL• ALARM Mpi+H7FACIURERs g = ~ 2 Ii1CHES = /~ ., ~L. MODEL RDHBER : .....- . .~..,_. SWITCH 3,'YPEs C = ~.S I1tCI1ES = l /' •~ GAL. FACTURER s ~~''' = ~Q GAL. pUHp l~1AtR3L NUISBER s ~ S ,,,-~ D ~ I~KES ,~--_ My~WITCIi TYPE; x WIRING AS PER ILHR 16.23 U1AC ~ p~,1Mp E ALAR REQUIRED DISCHARGE R~-TE ...!- GPN Q FEET g~yiEEN PLiMP OFF AND DISTRIBUTION PIPE. • ~~~FEET V ER'!'ICAL DIFFE~LF•IiCE - `!~rL-,- FEET + MINIMUM ppRK SUPPLY PRESSUR~T~100•FT. FRICTION FACTOR FEET F©RCEMAZN X .~!~ TDTAL DYNAMIC H£AD ,j /~~~"'FE~ sue. LENGTEI ~ J ~~~~~~__.._-- INTER1~tAL DIMENSIONS OF ~~''iP TANK: L;QUID :Q`_.--- SIGNED: . DRT£: LICEWSE MIMBER: 1188 HEAD .CAPACITY CURVE MODEL 152/153 12 s ~ 8 a J H 0 4 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT AND DEYYATERING MODEL 152 153 Feet Meters GoL Liters Ga{. Liters 5 1.5 69 261 77 291 10 3.1 61 231 70 265 t5 4.6 53 20t 6t 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: 38.0 Ft. {i1.6m} 44.0 R. (t3.4m} 10 0 20 40 60 80 100 GALLONS ~~ 0 80 160 240 320 _ 3 FL W PER MINUTE CONSULT FACTORY FOR SPECIAL APPL1CATtONS • Timed dosing panels avat~ble. ~ • Elecerical alternators, frx duplex systems. are available and supplied vagt ~, alarm. • Variable level control sttatt~tes are available for kxxtirohing single phase systems. • Double piggyback variable level float switches are evadable for variabte level tong and short cyde oontrds. • Steed {~wifk-Box available foroutdoor insulations. See FM1420. • Over 1~°F. (54°C.} special quotatia- rt'gttired. 15'2/'153 Belies 15ZH53 11{0~l voks•Ph Mode N152 115 1 Non 8.5 1 2tx3 BN152 115 J AtAo fl.5 InrJuded 2or3 E152 230 1 Non 4.3 1 2a3 BE151 230 f Aulu '- 4.3 d~duded 2or3 N753 115 1 Idoa 10.5 1 2ar3 BN153 115 1 flub 10.5 tnduded 2a3 E153 230 1 Non 53 1 2or3 BE153 230 1 Auto 5.3 hx9uded 2or3 O CAUTION AN bmtsflsdon of eantrots, W'otecf;on deviars mid wiring shadd be done by a qua0fled Ikmsed etechtcian. Afl eiedrial mid safely codes adould be to0owad i~tudktg the most raeeMNadonal EbchitCode (NEC)m~dlheOceupationN Safelymid NeaNhAot(OSHA)_ t I I t t2 t/8 i SELECTION GUIDE sz ~+ s ~/s s~ 1. Single piggybadt variable level float stwUdt ar double piggybatic variable level float switch. Rekr b FM0477. 2 See FM0712 ~r sorted model of F. Alternator E-Pak 3. Variable level ~h'ol switch 10-0225 tined ~ a catVd acfjvalor, sptt~r duplex (3) or (4) Boat system. RESERVE POWERED DESIGN Far unusual kronditions a reserve safety factor is engineered into the design of every Zoeller pump. - UAY. TIQ: P.Q 8QX 16347 Larisv~7e. KY 40256-0C1'17 Jt~oofaeprersd. . L SfgP Tt): 361,9CaneRurifdoed Lv o m~~o2tt-1ss1 ,(~rc~rr-Ps,iv~' ~9.9~9r ~' PUMP !O. `~ nAxF ~'n800J Irrlp~AVww.zoeller rronr ® CoPYright 2000 Z.oefler Co. Ail 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 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 POWTS OWNER'S MANUAL ~ MANAGEMENT PLAN Pase_____W Dt r/y~cs csw f~llNfiber Of 13edroans ~ NA N~~r ~ Corruner+cial Units ~ NA E~m~ed flaw (eve) inn flap {pee[, (Est~nated x 1.5) ~-- -- . Soil Appi&~tion Rata ~ ~ lnfluer~Emuent QtraC~ty ~n~ f'atSr ~ 8c GteaSe (FOG) 530 mgn- Biod>entk~l t?xygen Demand (t30Qra 5220 mgA. Tohai Suspended Skids {TSS) 5150 Pretreated Etter Quauh- -,~A Monthly average" gjp~~ OXygen Demand (t30D~ 530 m9n- Totat Suspended Solids (TSS) 530 mgJL Fecal to6forrn (geometric mean) 510` dtrtl tmml Maximum Effluent Par6de $Re Yt inch diameter SYSTEiiA SPEgt-t~ ~ was Septic Tank C / at O tdA Septic Tank Manutacturec ^ NA Etfhterrt Fier Mautufactur~ ~ / DNA oNA Pwrtp-Tank Capad~y .~ et DNA Ptxtip Tank Manufacturer DNA .Pump ~ zo ~ ~~ i'mnP Model 15~. ^ NA merit Unit NA p ~ Fgber ~ ^ Peat Fster D ~ Aeration D Wetland D D'winfec6ott Manufacturer D Other. s p rav&y) - D tr~nwnd {pressurized) nd D At-grade ~'M~ ~ r , f v~stta W`.~~~~~~ .~ v~N~. MAINl'ENANCE iNSTRUCTtONS one Of the ~OiW~ig fioense.S O< lr>SpeCti0rls ~ tanks and dispersal c~.s shaA be made by an kidrvldirai carrying r~ertificetiotts: Master Plumber: Master Plumber Restric~+ed Sewer; POVV't S inspector POWT'S Maatta~er; Septa9e Operator. Tank inspections must iru~ude a visuaa inspeetiai ~ the tams) to any or broken hardw~e, kienlifY any packs ~ leaks. measur+ee the vdume of oombkied shrdge and scum arm to check for any baNc up or potidirig of ettkierit on the ground surface. The di persai a~{s) shaN be visu~lY tD Hof eft~ent ~ the observation pies and to check for atnr ponding of effluent on the grolaid surface. The poriduig ground surface may kidreate a fa~in9 condition and requires the immediate notification of the local regulatory authority. When ttie combined accumulation of sludge and scum in any tank equals one-tliird (X,~ or more of the tank volume. the entina contents of the tank snail be removed by a Septage Semcin9 Operator ark disposed of in acx:ondance with di. NR 113, Wisconsin Administrative Code. ~ . Tt~ ~ ~ etltuent tfiters, mectiank~! or pressurized POWTS components. pretreatpi>ertt components. and any at intervals of 12 months or less shaft be pedonned by a certified POWfS Maintainer. othef makitenance oc monitoring - of a service event A report shag fie provided to the kx;al regulatory authority within 10 days of completion ny START' UP ANO OpERATiON prior to use of the POWTS check treatment tank(s) for tl~ presence of Painting products or other Fru new constrtrr~ion, s . if concentrations are c~lerrticals that may impede the treatment process and/or damage the dispersal oetK) high detected have the contents of the tank(s) removed by a septage servidng operator prior to use. System start up shaft not occur when sod'conditions an: frozen at the infr~6ratiwe surface. - P~ °~ Du~9 P~ ~9~ t~P tanks a~ t8 above nomlai Idgtlwater levels. When power is r~es6oned the exoe~ wastewater tNN be dis~2uged to fire dispersal red(s) in one large dose. overloading fife Dad(s) and may r ~ ~ bxlgrp ~ st~rfaoe age of ert#. To avoid !f>is sin haws the oorttertts ~ the pt~ tindk removed by $ ta~'~ P~'er ~ the effluent pump or cooled a Plumber- or POW7'S Matnf, to assist in marai~y operatfig the ptnrlp cor~rois do restore normal levels wiltt~ the ptunp tacdk. lb cwt drive or parts vehitdes over tardes and disperst Dads. Oo not drive or park aver. or olhecunse drsttub ~ cotrrtpact, the area wdtdn 15 feet down sbpe of arty mated or at~rade sod absorption area, Reduction or-e~CNrcahorr ~ the foduwtrtg t+-rom the ~ sttsatn ~,y ~ Pie and ~i9 the fife of the P01N7'S: ant~iotics; -baby r s txN~ oatdoms; oceon sums; deldal lbssy d~nfec ~ t<on dra~rt (sturq: tip) : btdt and vegetable peed gasolkte; : meat ~ ~ Pte: Pte: sar~- rcaplc~s; tarr~ons:'srrd ulster brine. At3ANDONMMENT . When fife POVVi'S fads atdlor is perrrlsy.talaen art of astute the fodowlrlg steps shad file taken ~ ir~+e that the ~ i~PedY and Sadetlf abandoned &t ~ wl~ dr. Comm 83.33 iflFisoonsin Administrative Code: • Ad p~btg b tanks and pks shad be dfsoo and the abandoned pipe openings sea{ed, • The oonberlts of ad tanks and pis stta~ be rerftoved and properly disposed of by a Septage Servic~g Opp • After ptmtphtg, ad tanks and ptis shat! be excavated and removed or their covers removed ,and the v~ space >~ w~h soil. gravel or aatl>er inert sold maberiat. CONTINGENCY PLAN If ti~ POWTS fads and caruiot be tr3paired the fclowing measures have been, or must be taken. to provide a code compliant r+epladcement system: D A siiitab~ repNaoerrtertt-area has been evahrated and maybe utidzed for tine ktcation of a t+eptaoetrtertt sod absorptioct system. The reptace<nent area should be protected from disturbance and compaction and should not be infringed upon by r+d setbacks from existing arld proposed structure. lot and weds. Failure bo protect the replacement area vvN result in the need for a new sod and site `evaluation m estabCislt a strilaMe n~piacartettt area. Remit systems must comply with the rules to effect at that time. t7 A suitable ~t area is not avadacte due to setback and/or soft dmilatiais. Barring advartoes in POWTS nokigy a holding tardk may be installed as a last n~ort to n~ptace the faded POWTS. ~stie has tint been evak~ad bo identify a suitable replaoerrterit area. Upon fadtae of the POWTS a sod and site evaluation must be performed b locate a sti~ble repiaoemerit arse. If rw r+epiaosrnerrt area is available a //~~ twtding hank may be d as a fast resort b replace the failed POWTS. ~~Mound and at-grade ~ absorption systems maY be r~eoonstruk~ed in pt~e lodoNraig r~errwval of the bksnat at the fr~fid+rative surface. Reaonstructians of such systems must comply with the odes ~ effect at that time. «WARNiNG» SEPTIC, PUMP AND OTHER TREATMFM TANKS MAY CONTAIN [~THAL GASSES ANOrOR tNSUFFH~ENT OXYGEN. DO NOT ENTER A 8EPTtC, PUMP OR OTHER TREATMFM TANK UNDt~t ANY CBtCUMSTANCt~. DEATH MAY RESULT.. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. aoomoNAt_ CoMMF.NTs POWTS INSTALLER Name ~~,~,,~ ~ Phone _ '' 6- '~-~ s l ~ SEPTAGE SERVK~IG OPERATOR iPUMPERI Name ~~,,,, - Phone ~ ~ .~ , o~ ~ " ~'" POWTS MAINTAINER Name ~ Q.u.~ 3, Phone ~~ ~ ~ L t_ocat. REGUU~TORY atrrHORmr ~~ ~ ~ - Phone ,~.T ~~ b ~d This aoaanerK was draRed by the staffs of the Green 1.~, Mtargrrette and Wauahara Cawdp Zordrg sold Sasdtation ~geitdes_ 'f Ids aoar~e+a mew the minimum requi~ernerds of cfr. Comm 83.22t?atbXlXd}Sm aM t13.5t(i). (Zl ~ tai, i~f~aorrsirt ~ Code. Use of ads doarsnerd does rwt guarantee the performance tithe POWrS. Giuw cvoif ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer P• C. Collova Builders, Inc. P O Box 489 Somerset, WI 54025 Mailing Address Property Address "I `1 (Verification required from Planning Department for new construction) ~~" City/State ~t~n d.. ~.~.~ Parcel Identification Number LEGAL DESCRIPTION Property Location %,,1~~'/., Sec. ~ T~N-R~W, Town of Subdivision ~( `~1 C_X~- c~ Lot # ~~ Certified Survey Map # ,Volume ,Page # Warranty Deed # Volume ,Page # Spec house ^ yes ^ no Lot lines identifiable ^ yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature.failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or soonez, 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, journeyman plumber, restrictedplumber or a licensedpumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da of the three year a ti a e. 1o2~1d SIGNATURE OF APP ICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this farm arc true to the best of my (our) knowledge. I (we) am (arc) the owner(s) of th property described above of a warranty deed recorded in Register of Deeds Office. ~{/Z(/ O~ SIGNATURE OF APPLICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ~.: ** 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 r--,. • Document Number U 1950P 5281 STATE BAR OF W ISCONSIN FORM 1 -1998 WARRANTY DEED husband and wife ,Grantor, and P G Cotlova Builders Inc Grantee. Grantor, for a valuable consideration conveys to Grantee the following described real estate in St. Croix County State of Wisconsin (the "Property'): 68742 KATHLEEN H. NALSH REGISTER OF DEEDS ST. CROIX CO.. MI RECEIVED FOR RECORD 08-16-2002 9:00 AM WNR~ # GEED REC FEE: 13.00 7RAHS FEE: 1155.00 COPY FEE: CERT COPY FEE: PAGES: 2 t~ P~Cotbva Bulkiera, inc. x Avenue mood , wl/54~015yA 9// ~~rj ~~t~W// ~f TD J O) 8-1039-20-•000 / 018- 018 1039 80 000 Percetidentlflcatlon Number (PIN) Thla ~ not homestead property. (19) (is not) Sea Exhibit A attached hereto Together with all appurtenant rights, title and Interests. none Grantor warrants that the t)tle to the Properties good, indefeasible in simple fee and free and clear of encumtxances except Dated this ] 5th day of Auoust. 2002. (SEAL) ~/ (SEAL) hn J ` Itan Carolyn G. alton (SEAL) (SEAL) • A I .~~~C -; i ~t'E OF iMS Signature(s) authentlcated this NO 3LlC gTprE~IV~~' TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §70ti.Ot3, Wis. Stets) ACKNOWLEDGMENT State of Wisconsin, ss. St. Croix County Personally came before me this ~ day of Auoust. ~0 the above amed J nd a l D It n ban nd W I • VJR Sw~-~,~• Notary Public, Stete(ot Wisconsin THIS INSTRUMENT WAS DRAFTED BY My commission is p~~ntC ent. (If not, state explratbn data: Coldwell Banker eumet `I l~1 ~~ 1301 Coulee Road Hudson, WI 54016 2-32470 (Signatures may be authenticated or acknowledged. Both are not necessary.) • Wmm~a n} nanenna nMnlna In env C9OaCHV must t/8 tVDed Or Drinted bek:vv theif signature. __ _ WARRANTY GEED STATE BAR OF WISCONSIN FORM No.1-1888 W Isconsln Legal Blank Co, Inc. Milwaukee, Wis. O[ C71/~~i2 LAO K I o+F `~ " ~! ..19S~P 529,x. ,. :..w~.rw~...::.Mw~Y{::':L~(yvi.jhN IM~Wt~4YW ~• ~ .' ~p~y.~ IY~C~'." ',f, ~ ^,"'a~~'~'`~.iS1~:'Jii.fj~v `y':'~7'wlii~ A part of the NE ~/. of the NE '/, and In part of the NW ~/. of the NE Y, and in part of the Sys +/ of the NE Y. of Section 18, Township 29 North, Range 17 Weat, Town of Hammond, SL ~Crflix County, Wisconsin and more particularty described as: Begjryrling at the Northeast comer of said Section 18; thence S89'33'31"W 372:Oi feet atonfl the North Iine of the N!~ ~/, pf said Section 18; thence S89°33'31"W along the North line of the NE '/. of tsaid Section 18 775.94 fast; thence S00°52'23"E 250.00 fast; thence S89.33'31"VV 966.24 fast; thence S00°52'23"E 420.00 feet; thence S89°33'31"V1f 828,00 feet; thence S00°52'23`E along the North-South Quarter Section tine of said Section 18 1311.77 feet; thence N89°33'39°E 626,33 feet; thence N00°31'25"W 3~0 23 feet; thence N89°33'24"E 692.78 feet; thence N00°S2'23"W g-gng the East tine of the SW % qrf the NE '/. 330.31 feet; thence N89°33'24"E along the South Iine of the NE ~/. of the NE '/. 949.09 feet; (hence N00°52'24'W 1321.19 feet tp the point of SeAinning. ;' _..... 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