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Home My WebLink About018-2003-32-000nsin Department of Commerce y and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT ENERAL INFORMATION (ATTACH TO PERMIT) ersonal 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: CS7'" TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~y.TFtM.~t'~'" (dub ~~ Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ' ~ ~ 1 ~~ ~ Dosing t~ ~~ ,t -.. ~ ~ Aeration Holding PUMP/SIPHON INFORMATION ELEVATION DATA """`'~ St. Croix Sanitary Permit No: 420549 0 State Plan ID No: Parcel Tax No: ~. s~ Ili, C+•~~i STATION BS HI FS ELEV. Benchmark .D t~.D~ loJ. ~ Alt. BM ~, .r• Bldg. Sewer q ~O • ~ ~ t v SUHt Inlet lo.~ $~. ~ ~ SUHt Outlet Dt Inlet Dt Bottom !~. ~ ~~ Header/Man. Dist. Pipe !,$( '8 ~ ,D 4~• ig Bot. System Z.S`v . ~-So Final Grade St Cover .~ 9S ~ r DIMENSIONS INo. Of Pits Ilnside Dia. INFORMATION ~ CHAMBER OR Type Of System: ( I ~r \ /~ UNIT ~,~ J el Number: DISTRIBUTION SYSTEM y S~- ,~ ~jo., Plj. Header/Manifold ~ 4 Distribution ~ Pipe(s) t1 x Hole Size p 3 x Hole Spacing u Vent to Air Intake --.-^ • Length~•~ Dia Z Length ia~ Spacing 1• ~ /~(r 2 _ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center BedlTrench Edges Topsoil Yes ~] No ~ Yes ~ No 6f ~~OtM~MTS: ,(Includ~~oo~de d~ i~cr@,pen~ s, ggrs~on~s prey s nt etc.h~r Insp~;ion #1: ~~ / ~ /~~ Inspection #2: `'7-'-t---~ Location: 1589100th Ave Hammond, WI 54015 (NE lpl/4 N~E 1/4 1d8LT29N R17W) NA Lot ~ ,..~~ ~ Parcel NR I..~a. cam-. y) ~.~-~1' ~~- ~ dI.C~• ~~ E+a-•. 1.) Alt BM Description = ~K'~ S•~• ~~ ~ vt~ ~ ~ ~ In ` 2.) Bldg sewer length = -x-49 ~ ~ n ~i.x, t~C -' :t(p~,=,~ k o. i. ~+~,~.~ ~. n - amount of cover = y'Z ~~'S~ 3 ~ °~ ~G Y ~ ~ 3.100 c.* tE~ - laU.o~,~ ~ 1,~~ . ~,S~~w,. q.. 3.) Contour = p S ~` ( n a w~~ ~ ~n~ (~f~ Plan revision Required? iJ Yes No ~ ~ ~ 'i Use other side for additional information. ! ( ~ G ~'~-Q,1.>~ ~ ~~_~ Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) S IL ABSORPTION SYSTEM /T1lt'_IVC7i Width f Length No. Of &enehes IMENSIONS g S~ t ~ 1~}~; -~,~ SETBACK SYSTEM TO ! P/L BLDG WELL Safety and Buildings Division County ~ ~ ~ 201 W. Washington Ave., P.O. Box 7162 . ~ ~,~ ,S~~~sI n Madison, WI 53707 - 7162 Sine Address ~ De artment of Commerce `_pL, f~J~, 1 c3b Sanitary Permit Application Sanitary Permit N"n'b" ` ~2oS~FQ In accord with Comm 83.21, Wis. Adm. Cade, personal information you provide ^ Check if Revision ma be used for Priva Law, s15. 1 m I. Applit~tion Information -Please Print All Information State Phw I.D. N bee Property 's N,pme~ /' 1 Number , . 6 2402 L ~~ t ~aQ ~ ~s Property Owner's Mailing Address perty tIOA ~ ~C . CR~1X OFF G~ iJ if Sf ; S a T ~ N. R City, State Zip Code ~ k Number ~- C'"' Z ~-- ~~ ~/ 1 ' ' n Name CSM Number ~'+ ~ ~ 1 II. Type of Budding (check all that apply) ~ ~ ~ tty p ~ or 2 Family Dwelling -Number of Bedrooms ~ 5 --- b0.tR.~x~ 5 ~~ e 8 ^ Public/Commercial -Describe Use vo ~.d~'asw~.5 ~ ~~P /r1 - ^ State Owned ~ja~w ~ ~ S- ~ N ~ " •• ,, / /n~ t:P,l:~ .s..p '~ z t •D ~ C~Zu u+~dl ~r 8 ~ K ~ V~lo ~ . III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A' 2 ^ huxment stem Rep Sy 3 ^ Replacement of 6 ^ Addition to For Coumy nse stem Tank ON stem B. ^ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that appiy)(numberutg scheme is for internal ase) ~ -IaD t , 44 ^ Non -Pressurized Ia-Ground 21ound 47 ^ Sand Filar 50 ^ Constructed Wetland 22 ^ Pressurized In-Grotmd 4~1 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 4S ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other V. tment Area Informat ion: Desiga Flow (gpd) Dispersal Area Required Dispersal Area Proposed ~ Sb~ Soil Application Rate(Gals Ft /Da s/S ) Percolation Rate (Min /Inch) System Elevation Final Grade i , . y q. . . ~~ ~ l on VI. Tank Info Capacity in .Total Number Manufacturer Prefab Site Steel Fiber plastic Gallons Gallons of Tanks Concreu Constructed Glass New Existing Tanks Tanks Septic or Hoklit~g Tank ~( _ L~ Dosing Chamlxr VII. Responsibdity Statement- I, the and a responsibility for installation of the PO shown on the attached plans. Plumber's Name (Print) Flambe ' i lure MP/MPRS Number Business Phone Number Z~, ~ ~~o ~~~ =Lid-~.s~6 Plumber's Address (Street. City. State, Zip e) , ~ ~ ~~ 2 ~ ,G C~t/~ ~ VIII. Coup /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) ^ Owner Given Initial Adverse Surcharge ~- ~ I !/ Sl / I ~ Determination . O Z IX~.{C~onditioac of ApprovaUReasnons four Di~sap~prov~al _n ~_- -,,, ~ ~p,~rQ ~ p~~p.~~n, ,,_, J.~ 1 v„''s '`~'~' e'^' l~e~ 1 ~" ~ ~."u'Ei_ ~ tra-Q ~ s ~v~/ tea.. d-M.a7~- ~,4-.1~5 tr d ~- ~~ ~ `~ t f 1~ ` ~ ) ( y ~ ~ n .~' faro 1~7~-uL w! IcJ~9.t+~C~N ~~T~, ~c~r ~ ~~' ~ ~ ~n $ .~ r~~hlo '~ ~'t't-~ 3 4 Q~t11 ) 1 . .~ . ~ ( /~ vr.w~- ~ ( -!~~!`4~'"''1n ~ C. ~w ,4 _9-C~Xi, a.,~ `~[`Ct~ .. a ~ Dr ~ ~ w r.... u ~-e r Vl.,~ Q _ f At<acL ~t~ ~ Uo tLe or t~atem oa not kss : es b 5~t~~ . SBD-6398 (R. OS/Ol) ~~ P.C. Colbva Bldrs. Inc. PLOT ~ ADD -~1/4 NE I/4S 18 .O. Box 487 Somerset Wi 54025 /T 29 N/R 17 ~N Hammond COUNTY ST. CROIX RS Shaun Bird 226900 10/22/02 3 CONVENTIONAL DATE BEDROOM _ AT-GRADE CONVENTIONAL LIFT _ HOLDING TANK MOUND ~ _ SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of chambers none BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL "H.R.P. Same as Benchmark SYSTEM ELEVATION 96.2' B.M. Scale =1 /4" = 1 p' Tank is to be properly bedded and provided with lockdown covers with approved warning labels Grading is to be done to divert run-off away from system Huffcutt Combo Tank Pro 3 Bedroom 2% l..b~ Slob B-1 B-3 ^ Well is to meet all setbacks found in Comm. 83 355' Property Line Area 15' Below System is to remain undisturbed 1 0 .a r m B-2 Alt. B.M. 94' 95' 9 6' isconsin - Department of Commerce Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264-8777 www.commerce.state.wi.us/sb www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary November 04, 2002 CUST ID No.226900 SHAUN R BIRD BIRD PLUMBING,INC 1008 192 ND AVE NEW RICHMOND WI 54017 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/04/2004 SITE: P C Collova Builders 100TH Ave Town of Hammond St Croix County NE1/4, NE1/4, S18, T29N, R17W Lot: 32, Subdivision: Creek Bottom Overlook FOR: Description: Mound 450 Gpd. Object Type: POWT System Regulated Object ID No.: 879014 Identification Numbers Transaction ID No. 804418 Site ID No. 652814 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: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" Version 2.0 SBD-10691-P (N.Ol/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10706-P (N.Ol/O1). • Comm 84.10, All materials used in this installation shall conform to the provisions of this chapter. 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 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 o intenance of the POWTS. Sin~gery~, Fee Required $ 175.00 ~,((// Fee Received $ 175.00 zs"'-- ~"~ Balance Due $ 0.00 Thomas E Devereaux Plumbing / POWTS Reviewer II ,Integrated Services (715)634-3026 , 7:45 am - 4:45 pm Mon. -Fri. WiSMART coder 7633 tevereaux@commerce. state.wi.us ATTN. POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 F' ~ ~~~ .• <°F ~~ F.•. O ~~J cc: Leroy G Jansky ,Wastewater Specialist, (715) 726-2544 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 10/22/02 Owner: P.C. Collova Bldrs. Location: Lot 32 Crick Bottom Overlook 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 Contige ff cy plan 10-12 Soil test ~ l~ Signature License numbe 10/22/02 ~~~ ~~ry ~~~ ~: ~~ :~:. ;, '`~ ,` E ~S pMM ~,~.~hT lJD ~ ~F SAS ~Or1G~~J~'` GG~-~R~S~~~ PLOT PL PR~OJEC'I' P.C. Collova Bldrs. Inc. ADDR s .O. Box 487 Somerset Wi 54025 NE i/4 NE i/4S 18 /T 29 N/R 17 w WN Hammond COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 10/22/02 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 450 # of chambers none BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100° Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 96.2' B.M. Scale =1 /4" = 10' Tank is to be properly bedded and provided with lockdown covers with approved warning labels Well is to meet all setbacks found in Comm. 83 Grading is to be done to divert run-off away from system Huffcutt Combo Tank B-1 Pro 3 2% ~ Bedroom House 5~.1. o_pe B-3 p Area 15' Below System is to remain undisturbed 0 .a m r m B-2 355' Property Line 94' Alt. B.M. 95' 9 6' Date 4" Observation Pipe Perforated Below Filter Fabric AS"~ C 33 Sond " Tapsoll _Ji 7. Slops 13on-iioven Filter Fabric ribution Pipe se d of ;jam 2 2 Qrain Rock ~ Ir `~~~,Ps ~Observotion f'i Cress Section Of A Ir!oundSystem Usin A Bed For The Absorption Area A ~ ft. 6ti~~ Ft. I ~~ Ft.• • J FL:~ $' L~ >~ Ft. ~~ S~• Ft. Force Moen from Pump -.: ~ lov.ed l.dytr ~ ,p / ~~-1~~~r F ~ S~ G ~_ ~ h ~ J~ .i K J ~~ ~ ~~ ~ - -° A ~ --- ------------- --------------------- ~ N ~° _ ~._..._~._.__... ------._~ L .... ~ • 3 ~ Distributio:~~ Bed Ot !2~- 2'Z a - Orain Rocti Pipe I ~ 40bservation Pipe Permanent Morker- Pipe or Rods Ptah Yiew Of Mound Uclnq A Bed For The Absorption Areo ~. Force Moin From Pump PAG E,_,_,.OF ,~ a .ocotea On Bottom. Eq~snY $pacea R5T 1101.E N>1X'C TO C~}~ Ft. Ff. Signed: E.icense Nuff~er: ~2 ~ ~ ~~ date: ~:~.'~.~-~' ~ T x~ Inches Y Inches Hole Diameter 3~Inch taterai -" ~ Inch(es) Manifold C Inches Force Main " ~ Inches ~ of holes/pi~ Invert Eievatian of i.aterais ~. Ft. Perforoted D;pt Uetoil TANK ~ p C~{prlSER CROSS S . ,.~~ ECXFICATIONS WEATHERPROOF q++ CI VENT PIPE 12" MIN. ABOVE GRADE ~ JUNCTION BOX APPROVED > gS+ FROM DOOR, WINDOW OR WITH CONDUIT MANHOLE GOY ER FRESK AIR INTAKE W/ PADLOCX 5 --WARNING LABEL FINISHED GRADE C.Z. pd~E .X. D. ~ a 18" IN. fltE. ' ;•. t8 «~~a. ~• INLET i ', GAS- ~ ' WATER TIGHT SEALS -T- TIGHT ~ ~. p ~rIt1ER A SEAL ~ ~ ~OIN~TSE1iIT11 ...~.,_ + LM IIPPROItED PIPE 3 APPAd01tEp 8 - ~ ON PIPE 3' "~"' ~ SOLID SOiL o~r0 sa.ta ~ ~ ' SOIL PUMP OFF ELEV - ~°,____! FT • "~"' OFF D g" APPROVED BEDDING UNDER TANK ~' f CO ~`f ETE PAD SPECIFICATIONS ~ ~' / `~ QG~~'' SEPTIC ! DOSE TANK MANUFAC'11JRER TANK SIZES: DOSEZC ~ GAL. GAL. ALARM MODEL NDZtBER S'~rilTCti TYPE: p_Mp ~NUFACTUR£R MODEL NUMBER:. H TYPE' NUMBER DOSES PER DAX: _!~ . DOSE V OIIIME F LOWSACK'G'. / ~ ~ GAL • _ a~ •1 INCHES ~ ~~~~ ~ C'AL. CAPACITIES: A g ~ 2 INCHES = _. GAL. w- .~° GAL. C a ,.. J°_ INCHES = ~,,,~.,,^., ]) a ~ INCHES = GAL. SWITC REQUIRED DISCHARGE•~••- ,~,,,.,.T- PUHP S ALARM SiIRING A5 PER ILHR 16.23 WAC FEET VERTICAL DIFFERENCE gE'pWEEN PUMP OFF AND DISTRI~fTION PIP£- ~ FEET + MINIMUM NETWORK SUPPLY pRES5URE - FEET FEET FORCEMAIN X ~FT/lOO~FT. FRICTION FACTOR ~~FEET +c~_ TOTAL DYNAMIC BEAD %,/ ~ / H ~ DIAMETER INTERNAL DIMENSION ~ PUMP TANK: LIQUID t.•~~_~~~.~..--. ~°iL. ~~~DATE,e~D~~~`~Zi LICENSE NUMBER: SIGNED: 3/88 TOTAL. DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT AND DEWATERING x U_ 0 J Q F- 0 ~0 CONSULT FACTORY FOR SPECIAL APPLICATIONS • T'ut-ed pariets available. ~°' • Electrical altemabors, fa duplex systems, are available and supplied vvilh an alum. • Variable level oatird swdches are available for controlling stingle phase syystems- • Double ptggybadc variable level switdtes are avaflab~ for variable level long and short ~ oatirols. • Sea~d Qwik-Bo~c ava~able for outdoor insulations. See FM1420. • Over 1~°F. (54°C.) speaa! quotation required. 15?1153 Series 1 Model Vo11s Ph (lode N152 115 1 Non 8S 1 2ar3 9N/52 115 1 Aub = 65 6riuded 2or3 E152 236 1 Non 4.3 1 2or3 l~15Z 230 1 Aldo '- 4.3 h~duded 2or3 N153 115 1 10.5 1 2or3 8N153 115 1 Aub tOS induded 2or3 E753 230 1 Non 5.3 1 2or3 X153 x10 1 Auto 5.3 bn:Nided 2or3 O CAUTION /W hrstallaHoo of controls, protection devices aad uming should be done by a qualiflad ticeased electriaan. Pell electrical sad ~Y codes should be fatioured iadudtn9 tiro arost recentNationei Electric Code (NEC) and tice Occupatiawl Safety and Fleaitlr P# (~~ MODEL 152 153 Feet Meters Gol. Liters Goi. Liters 5 1.5 69 261 77 291 10 3.1 61 231 70 265 t5 4.6 53 20t 61 237 20 6.1 44 t67 52 197 25 7.6 34 129 42 ]59 30 9.1 23 87 33 t 25 35 10.7 -- -- 22 85 40 12.2 -- -- t 1 42 Lock Voive: 38A fL (11.6m) 44.0 ft. (13.4m) ousos 32 I r iz ya 5 r/f sE~ECTtoN cutoe 1. Single piggybawlc variable Jevd float swtch ~ da~ble pggybadr vatiade level float switch. Refer to FM04n. 2. See FM0792 fior coned model of Electrical Alteraa~r E-Pak 3. Variafrie level caltrd switch 10-0225 used as a oongd aerator, specify duplex (3) or (4) float system. RESERVE POWERED DESIGN For unusual catditions a reserve safety factor is engineered into the design of every Zoeller pump. //Ai[. T0: P.U BQX 18347 L SfiiP 3W9 Abed A4amfeckrersel.. e Louisrrl<e. KY 40211-1961 ~.~vg ~,7IBCE' ~. s~r ~' (592)778-2731.1(80tg 928-PUA1P h1rD:urvww.~ae~e,:~om PL/MP !O. FAxt5021 n4-3s24 -- FLOW PER MINUTE Maintenance and Contingency Pian 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 viathe 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 Shaun Bird #226900 10/22/02 SCHEDULE Service Event Inspect condfian of tank(s) Pump out contents of tank(s) inspect dispersal ts) Cteart effluent t~tex Inspect , ptanp controls 8~ aYaim Ft~ fa6erais and pressure test Service Frequency At least once every ~ O months D Yew(s) (Maximum 3 yrs.) When combined sludge and sden equal one-third (Y,) of tonic volume At feast once every ~ ~ months ~ year(s) (Maximum 3 yrs.) At feast once every At feast orioe every At least once every At least once every At least once every ~ months7a•year(s~ ______-- f3 months or(s) 01VA ^ months -~jpgar(s) ^ NA ~ months ^ Year(s) G NA ^ months D Year(s) ^ NA MAINTENANCE MISTRUCTtONS o~ shaft be made by ~ irxlivWual t~rryin9 one of the faibwing or Inspections ofl~ and dispersal ; POWTS Icy: POWTS Maintainer: Septage Master p~~- Master Plumber Reshided of the iardc(s)13o kien6fy any rri~ssin9 or broken pp Tatdc ~ must e a visual inspection and scum and to d~edc f+or any bads up hardware. idenfi<y any cmdcs or leaks. measure the volume of combined serge ~ ~c ~ eftl~nt levels of effluent on the ground The dtsPersa! C@~(S) ShaN be ~~ ~ went on the observation pipes ~d bo check for any p~9 of etiluent on the ground surta ~ ~ kx~l regctaborY authority. ground surface may ~ a fang c~diGon and reQuir'es the immediate natrfr~on ~ amd scutr- ~ any tank equals one-third (X1 or more of the tank volume, the When fhe caanbir>ed aocumulatia- sludge and deed of in acca'd2~nce with ch. NR entke confienfs ~ the tank shag be removed by a Septage Servldn9 ~Pe~ 113. Wisconsin A+dmin~trative Code. - POWTS cow, Ixetreat~~t O°m~nb'' and any ~ by a oert~ed POV1fTS The servickr9 ~ effluent ~ Maintainer other maintenance or mon~n9 ~ intesvafs of 12 months or ass shaft be P - - A shaft ~ provided to ~e local regulatory authority vittNn 10 days of comps of any serwce event. START UP ANO OPERATION For new mnshvctior-. prior to use of the POWTS check t tank(s) ~ ~ ~ are chemicals that may knpede the treatment process and/or damage the dispersal ceb( )• to use. detected have the contents of the tank(s) removed by a septage servkdn9 P~ • • anW'YS aWNER'S MANUAL 8~ MANAGEMENT PLAN ~°~ ~ + ~ > ` Sjisfem startup sltaa nOt OOCUf wtlmi Sad t:Ot1S are fromen at the infiltrative Sutfar~. . ~9 ~eS tmdcs may ~ above normal tligtlvvader levers. When power is restored the e~ooess s ~ Orie tatge dose. ovefl0a(~tg ~ ~s~ ~ may r at the Wa~gNla~ 11U~ be ~ fp thB disp~ 3 tardC tercloved by a - baclarp or shoe disd>atge of - To avoid this sifRladial have Iris ar a ~ POWTS tu~itainer bo e servicing Opr t?~~ ras6or&>S paww ~ the p~F- tank. ' assist in ~ t~P oor>e<ois tD rr3stor+e rwrmat levels vin the pump - ~ o~ t a~ d~spersai ceAs. Do not drirre ar park abler. or otllecwise disturb or oompad. 0o not drive a Pack the area wit 15 f~ da~am slope of any trwund a at-grade soN absbrptbn arm. ~ ~ the ~fe R ~a.~or- of the foaowxing frntcl the wastewater stream may irnpcmre ~ ~ the PO'VVi'S: ~ ~/ ~~ condoms; cotton swabs: deg( 9 h.- meat . dam: ~ ~ draft ~ pump) water; fnit mid vegetable peelings sotben~ brine- saaps: medicmtiats: o~ p ~ ` sa~Y ABANDONMENT taken out of service the fob f shelf ~ taken to ~e that the When the POwi S faits and/or is perrttmtetdly ~ . v~ ch. Comm 83.33.1Arisaortsirt Adrt~ ~' system is prnpedy and safely a~rtdated in oorrtp~ance seed.. AN p~irtg bD taidcs and pgs Shea be discflnneded and fhe abandoned pipe operlktgs ~ The contents of a8 talcs mid pks shalt be removed and properly disposed ~ iyy a Septege S - s After pumping. a~ taudcs and pks shag be eaa~vated and removed or titer covers tlsmoved and the void space tad vditl so0. graver or mtotlter sett sow material. CONTINGENCY PLAN red the fdtowing measures have been. or must be taken. to provide a code tf the POWTS lmis atcd cannot be ~ corrtpGant n~piaoernectt system: O A str~able replacemeat~m+ea has beery evakiated and may be ut~zed for !fie bcation of a replaoemand stwlitd not - The replacement area should be protected from disturbar>ce be infringed upon M~ r s from e~3sting and proposed • ~ ~ a suitable P the r+epiacernent area wN resort in the need for a new sal and site evacuation ~~ area. Replaorarierit systems must comply with the rules in effect at that trcrie. 0 A ~ ~{acernsttt atea is not anradable due to setback and/or' sod fnmfiatiorts• t3arretg advances ~ POMffS tedlnobgy a hotdutg tardc may be klstaded as a cast resort to replace the faded POWTS. The sae figs not been evaWreed t~ identify a suable reptaoemer>< area. upon failure of the Powys a sod and 1u locate a surTable replacement area. If no n~ arr3a is avanab~ a sde evaluation rt>ttst ~ ~ ~ resort b reptaoe the faded POWTS. ltel~rtg tank ~l ~ iced removal ~ the biorrtat at j~I~~Aound and at-grade sod a~ocptton sy ~Y be ra~oonstruded ~ P~ 9 the ~tratilre surface. ~ such sysOerrts must comply with the rules in effec# at that tkrie. «1NARNlNG» ANDNDR MISUFFICIENT OXYGEN. SEPTIC, PUMP AND ETHER ~OROTHER TRFA~YFN~T TANfC UNDER ANY C~CUMSTANCES. DEATH MAY DO NOT ENTER A SEPTIC, PUMP RESULT. ,RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY t3E DIFFtCtA-T OR pNPOSSIBI.E. ADDITIONAL COMMENTS POVYTS 1NSTAU.ER POWTS MAINTAWER Name ~ `~''/ Name ~~„ Phone ~,,- '" f~.r~ Phone ~ j,j ~ -- ~ ~ SEPTAGE SERi/1CiNG OPERA PUMP LOCAL RC-GIJLATORY AUTHORITY . age<i~y ~5~. ~~ Name syv Phone ~f~ ' ~ ~ ~ ` ~ Phone ~j ~-- ,~~ '- and SaNaibn ~ T~ "1 rnis aoa,menc ~ d ~ ~ staff a me C~een t.aloo. ~d w Co~- ~ Code. flse of nods document does iwt tl-e mWnumn ~ d ch. Cantu 83.22(Z~(bXtl(d>~} and 83 54(1). (2! i~ t3?. " SUN (2101) ~a~~ ~ ~ ar me PowTS. Wisoonsin~DepartmentofCommerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings m accordance wrtn ~.omm oa, wis. rwm. wue _ ~~ ~' ~ ~ r not less than 6112 x 11 inch let site Alt l a d Plaa must ' size , a e p an on p pe . l comp .. .. ~ n . inducts, but not limited to: vertical and horizontal reference poin percent slope, scale or dimensions, north arrow, and location a (BM), dired'~on aril: ~ distahceto nearest Rsal7 p LD. Please print all information. ~77 ' R 'awed by Date Personal irAormation you provide may be used for seeondary purposes ( ,~ )> ~~~;` ~4~ 'vary Lew, s. 7 sj04 {+~) tMYI ~~ f_ ~ 11/l3'0 2 Properly Owner /~ ~~ Property Location ~ ~ `, T ~ N R I ? E W ~/ I . lr't~ ~ p/ ~ 1/ Govt. L9t „t ( x X1/4 S Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# ~ f~ ' b t7y., ~ ~ '" O .~ one Number CKy State Z ip C ode ^ City ^ Vllage ~T .Nearest Road ~f o ~j~ n G Construction dential / Number of bedrooms Code derived design flow rate ~/ ~~ GPD ^ Replacement ~blic o®r comm/eraal ~- Describe: ___ __ ____ Parent material ~~~y/~~~L~C /S~T~/7/>~y /' Flood Plain elevation ff applicable 1/1 /t' ft. and recommenda~ti'ons: / / / I~ c~ r~.G !"` ~t+ , ~ ~ Pit Ground surface elev. J t ft. Depth to limiting fador ~ in. Sofl ication Rate Horizon Depth Dominant Color Redox Desaiption Texture Structure Consistence Boundary Roots GP D/fflz in. Mansell lZu. Sz Cont. Color Gr. Sz Sh. •Eff#1 •Eff#2 3 ~ s ~1 s -- ~ ~i 3 , ~' ® # a Boring `~ Pit Ground surface elev. ~~ ft. Depth to liming fador in. Soil icafion Rate Horizon Depth Dominant Color Redox Description Texture Stnfcture Consistence Boundary Roots GP D/fP in. Mansell Qu. Sz. Cont. Cdor Gr. Sz. Sh. •Etf#1 •Eff#2 nn 2, ,-- ~ T , S . 9 tri r ~ ~~ - - ~ r/1 i9" • Effluent #1 = BOD > 30 < 220 mglL and TSS 50 ' Emuent #'1= BvD < ~ ~ aria i ~y/<~~~m~ CST N~me~(Please ~ ~ 'gnature ~ fySTf~ Address Date Evaluation Conducted Telephone Number Property Owner Parcel ID # Page Pit Ground surface elegy . ~ ft. Depth to limiting factor s:~, in. ~ ~~ Rate ~~ # ^ ~~ ~~ Horizon Depth Dominant Color ,~Redox C~esrxiption Texture Stnxxure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. ~;ont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 d ~- r 3l ~~ ~ ,~' '' fw r S ,`~ ~ `l ^ Boring # ^ Boring ^ Pit Ground surface ele~r. ft. Depth to limiting factor in. Soit ication Rate Horizon Depth Dominant Color Redox C~esrxiption Texture Stnrcture Consistence Boundary Roots GP D/Ff in. Munsell Qu. Sz. ~ 7oM. Cdor Gr. Sz. Sh. 'Eff#1 'Eff#2 a ~~ # ^ Bonng ^ Pit Ground surface ele r, ft. Depth to limiting factor in. Soil &alion Rate Horizon Depth Dominant Odor Redox [ ~esrxipt<orr. Texture Structure Consistence Boundary Roots GP D/iP in. MunseO Qu. Sz. ~:ont. Cdor Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BODS > 30 < 220 nxyL ar ~d TSS >30 < 150 mglL 'Effluent #2 = BODs < 30 mgll and TSS < 30 mglL The Department of Commerce is an equal c pportunity service provider and employer. If you need assistance to access services or need material in an alternate for mat, please contact the department at 608-266-31 S 1 or TTY 608-264-8777. saauw (R.6I00) • Soil Test Plot Pla Project Name P.C. Collova Bldrs. Inc. Sh Bird Address P.O. Box 487 Somerset Wi 54025 STM #226900 Lot 32 Subdivision Crick Bolton Date 10/22/02 NE ~/4 NE 1/4S 18 T 29 N/R17 N/ Township Hammond ~] Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevatio 00 ft. Top of Steel Fence Post System Elevation 96.2' *HRPSame as Benchmark Alt. BM Top of Steel Fence Post @ 102.8' B.M. saa rropeny une Please note: This soil testis to be for the >35 Acres parcel, and also to be used for future lot 32 of Crick Bottom Overlook 0 .a c~ .. r m ST CROIX COUNTY SEPTIC TANK MAIIJTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address ,~ ~ .5~0,~ ~.[ ~~ `~~ya°a s~ Property Address ~ Jc- ~ ~ ~ b ~ ~ ~ ~ (Verification required from Planning Department for new City/State Parcel Identification Number LEGAL DESCRIP,T~IO~N Property Location ~'~ '/4, ~ '/., Sec. Subdivision ~/ra~~i0`2~.~~ T~~N- W, Town of Lot # Certified Survey Map # ~ ,Volume _ '~- ..Page # Warranty Deed # G ~ ~ 2' 4 Z ,Volume ~ ~" S~ .Page # ~~ Spec hous~yes ^ no Lot lines identifiable~es ^ 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 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal 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 statin our septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 ~of the ye xpiration date. / / SIGNATURE OF APPLICANT A~ OWNER CERTIFICATION I (we) certify that ll statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of ro rty desc ' d e, by virtue of a warranty deed recorded in Register of Deeds Office. ~/ ,~ %~ ~ 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 U 1950P 5281 STATE BAR OF WISCONSIN FORM 1 -1998 WARRANTY DEED Num Husband and wife, Grantor, and P C. Collova tiultders, Inc. ,game Grantor, for a valuable consideration conveys to Grantee the following described real estate in St. Croix County State of Wisconsin (the "Property'): 687c'"~4c"' 1SATHLEEti H. MALSH REGISTER OF DEEDS ST. CROI% CO., NI RECEIVED FOR RECORD 08-16-2002 9:00 AM iIRRAANTY DEED EXEI~i t REC FEE• 13.00 TRANS FBE: 1155.00 COPY FEE: C£RT COPY FEE: PAGES: 2 ~~f mgqq~~ss_~snnnddd Relum Address H~va Sulkers, Inc. x Avenue mood , WI 54015 C~'r~~ 9~0 9 0)8-1039-20-•000 / 018-1039-1 01 X1039 80 000 Parcel ldentlflwdon Number (PIN) This Ia not homestead property. (19) (IS not) See Exhibit A attached hereto Together with all appurtenant rights, title and interests. none Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this ]~h, day of August, 2~2. (SEAL} (SEAL) hn J. Iton arolyn G. alton (SEAL) (SEAL) A~IQ~~aC ~.-~1'E OF WISE Signature(s) -1~rC~r;ar ~^~ ~ 1_1N~ authendcatexi this IVO 3LIC TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stets) ACKNOWLEDGMENT State of Wisconsin, ss. St. Croix County Personally came before me Phis 1~ day of August, ~ the above mad J . Da n n I n It n ban If Notary Public, State(of Wisconsin THIS INSTRUMENT WAS DRAFTED BY My wmmission Is pe anent. (If not, state expiration date: Coldwell Banker Burnet Y~ ) 1301 Coulee Road Hudson, WI 54018 2-32470 (Signatures may be authenticated or acknowledged. Both are not necessary.) WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1 -1998 Wisconsin Legal Blank Co, Inc. Milwaukee, Wis. U ,195QP 529:•. . . -.. ..~., .w....~s.w :..':::.~.:....'~7CYa.siYLLYIN ~O1::tYwt'°'C WiY~ri,4p'.VY`1 ~~ ~~ ~~ ~'~t.9vJx,"~rEW,+~f~;r~i„~.rYSSiSf~i:.~:R~s..~,.n~v,,,:::~ :. Apart of the NE "/e of the NE '/, and in part of the NW '/. of the NE Y and in part of the SVtf Y, of the NE '/. of Section 18, Township 29 North, Rartge 17 West, Town of Hammond, St. Qrolx County, Wisconsin and more particularly described as: Begirl~ning at the Northeast comer of 8a1d Section 18; thence S89°33'31°W 372:01 feet along the North line of the NE'/. of said Section 18; thence S89°33'31 "W along the North line of the NE "/. of said Section 78 775.94 feet; thence S00°52'23"E 250,00 feet; thence S89°33'31"1N 966.24 feet; thence S00°52'23"E 421).00 feet; thence S89°33'31"W 528.00 feet; thence S00°52'23°E along the North-South Quarter Sectivh Ilne of said Section 18 1314.77 feet; thence N89'33'39"E 626,33 feet; thence N00°31'25°Vi/ g~0,23 feet; thence N89°33'24"E 692.76 feet; thence N00°82'23"W along the East Ilne of the SW ; (qf the NE '/. 330.31 feet; thence N89°33'24"E along the South Ifne of the NE '/ of the NE '/s 949.09: Feet; thence N00°52'24"W 1321.19 feet to the Point of Beginning. t!. ,;; -; ~` ,\ . ; ;',. `,