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HomeMy WebLinkAbout034-1053-10-100 '.sin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix F-. Building Division INSPECTION REPORT Sanitary Permit No: 404993 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ., ID No: 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 Parcel Tax No: Mahon Brian I Springfield Townshi 034 - 1053 -10 -100 CST BM Elev: Insp. BM Elev: BM Description: r - la$ / / Ord' S-��. YW-,A sca1�e- rnru TA 14K INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � Benchmark . 0 .� y 51 G �c�♦p Dosing Alt. BM SnCo 0 Aeration Bldg. Sewe 98 M Holding St/Ht Inlet �• fi gG.05 TANK SETBACK INFORMATION St/Ht Outlet I s -, 4-P • G TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic -f / OI D r Dt ttom Dosing ,_ \ Pie Di Headerf n d • 3 l - / Aeration / st. /p� Z, 3 I tD 2 1 Holding B0t �� Z Ta /02. 303 l .eS L • ! S �Jf / �3 PUMP /SIPHON INFORMATION Final Grade l T Manufacturer t Demand St Cover d GPM Model Number TDH Lift / Friction Los System Head TDH Ft •ys i0.3 ,S •�l Forcemain Len th ;(,/ Dia. /� Dist. to Well 7i t� cN' S ABSORPTION SYSTEM P A4 606 G �' ED/ RENCH Width Length I No. f Trenc - PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS FF�I�'dd���� / SETBACK SYSTEM TO P /LS IBLDGW WELL LAKE /STREAM LAC NG Manufacturer: INFORMATION Type Of System: CHA IT OR Model Number: DISTRIBUTION SYSTEM �G (' n4A44 s .P.c.c�/ (oQ , R; .s t Header /Manifold I D istribution x Hole Size x Hole Spacing tVent Air Inta a H'V g Pipes) L Length_ Dia I Spacing (' SOIL COVER x Pressure Systems Only xx Mound 6r At - Grade Systems Only Depth Over IDepth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center , I Bed/Trench Edges Topsoil Yes gj No Yes No �7 COMMENTS: (Includic discrepencies, persons present, etc.) Inspection #1: / cad // �� ' Inspection #2: �� t � Location: 875 325th St Glenwood City, WI 54013 (NW 1/4 NE 1/4 24 T29N R15W) NA -Lot Parcel No: 24.29.15.36911 1.) Alt BM Description = 5 Tco Val ) 4b s 0`7 c""A' � 2.) Bldg sewer length = 3 '/ b - amount of cover = ) Q a + 4A4,-- Pd 6a - tt�- KR.I ° L1 )'S PIS U P I• - f�G ' l t'Yd' 3.) Contour= U-7� �,��yu �fV� pro t-/ - 5ox-c ` rrX- ' 24 - �+'r+•- Plan revision Required? J Yes Use other side for additional Information. -- Insepctor's ignature Cert. No. SBD -6710 (R.3/97) s I � - . tO ro l A o � 0 r Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ST. CROIX Madison, WI 53707 - 7162 Site Address .� r►sconsAwn - s Department of Commerce Sanitary Permit Application spy Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide Rt � 911 ❑ Check if sting may be used for secondary purposes Privacy Law, s15. 1 m I. Application Information - Please Print All Information RECEIVED State PlanI.D. N IITE ID# 642531 RAMS ID # 32 Property Owner's Name Parcel Number BRIAN MAHONEY APR 0 3 2002 34- 1053 -10• - Property Owner's Mailing Address ST. CROIX COUNTY Property Location PO BOX 274 ZONING OFFICE ' NW if NE u' s T 2 N R 3690 City, State Zip Code Phone Number Lot tunber 81oCk N ��II tt1M N/A N WOODVILLE WI 54028 715/698 -2425 �� Subdivision Name CSMNttpapli;'' 6F� -6 35n f W) N/A II. Type of Building (check all that apply) 066 rw S 44 ❑City 1 or 2 Family Dwelling - Number of Bedrooms 3 ❑Village ❑ Public /Commercial escribe Use &ownship springfield ❑ State Owned Nearest Road .J (CC r n ` ,, D rt �'. -� Zr�f 25TH ST III. Type of Per 't: (Check only one box on ` line A (numbering scheme for internal use). Complete litre B if applicable) A. For County use 1 ❑, New 2 ❑ Replacement System 3 11 Replacement of 6 ❑Addition to Sy I Tank Only Existing System B. ❑Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply) (numbering scheme is for internal use) tob 44 ❑ Non - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 0 Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 11 Other V. D s ersal/Tlreatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grads Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min./Inch) 1OZ' it Blevadoa 450 450 450 1 N/A 4665- 104.08 .: V1. Tank Info Capacity in . Total Number Manufacturer Prefab Site Steel Fiber pjutle Gallows Gallons of Tanks Concrete Constructed Glans New Existing Tanks I Tanks Septic or Holding Tank IOOOJ 1000 1 HUFFCUTT CONCRETE X Dosing Chunber 8001 800 1 HUFFCUTT CONCRETE X VII. Responsibilit Statement- I, the undersigned, assume responsibility for Installation of the POWTS shown on the attached 1atu. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number ENNIE HELGESON 220292 1 715/772-3298 Plumber's Address (Street, City, State. Zip Code) W1229 770TH AVENUE, SPRING VALLEY WI 54767 VIII. Corn iDe artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent SfgoaWre (NO Approved ❑Disapproved Surcharge Fee) dD ❑ Owner Given Initial Adverse . Determination IX. Conditions of Approv a oas for Disa oval ' 3� :%=,.e ` `s 5 t err ° `c� a {�.�r, # re ea t t uo t� sy- � etN►t� o= i k� C&OIJ wt84 1 11f%A�n. tntitt����tt goQC� Attach complete plant (to the County Drily) for the rystem ou paper not leas than 81/2 =11 ttuhd la sine 'i _ ( .tom0 Ptja rA = a 6 , AyQr C _ ) QPn_61QR M. 05101) -Sr 4 � a � � v vi �\ 4r 0 � \ o oL s v S Z � d 4 o-� o s \ �\ 4- ` L 1 a o ° - - — - — - — - - -- Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601 -1831 TDD #: (608) 264 -8777 �sconsin www•commerce.s i.usts www.wiscon isconsin.gov Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Secretary March 29, 2002 CUST ID No.220292 ATTIC• POWTS Inspector BENNIE W HELGESON ZONING OFFICE HELGESON EXCAVATING ST CROIX COUNTY SPIA W1229.770TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/29/2004 Identifi ers Transaction ID No Q!!31 SITE• Site ID No. 642531 Brian Mahoney Please refer to both identification numbers, 325TH St above, in all correspondence with the agency. Town of Springfield St Croix County NWIA, NEIA, S24, T29N, R15W FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 834438 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10572 -P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD - 10573 -P (8.6/99). • 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. • Per manual sited above, limited activities are allowed in the area 15 feet-down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c •ntlJ't) Cvnd� • 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. gpl sit Of G • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made wi Of 8 a designated county official in accordance with the provisions of See. 145.20(2)(d), Wis. Stat i • Comm 83.22(7) A copy of the approved plans, specifications and this letter shall be on -site during construction 8EE C USP and open to inspection by authorized representatives of the Department, which may include local inspectors. BENNIE W HELGESON Page 2 3/29/02 Owner Responsiblities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /instal lation/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), no 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, Fee Required $ 175.00 7 Fee Received $ 175.00 �, ✓ ` �,,� , - Balance Due $ 0.00 Charles L Bratz POWTS Reviewer 11, Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz@commerce.state.wi.us INDEX SHEET � Fj PROPERTY OWNER: BRIAN MAHONEY �Z P. O. BOX 274 eQ WOODVILLE, WI 54028 `i°�4 �� A so PROJECT NAME: BRIAN MAHONEY PROJECT LOCATION: NW 1/4, NE 1/4, S 24, T 29 N, R 15 W ` MUNICIPALITY: TOWNSHIP OF SPRINGFIELD COUNTY: ST. CROIX DESIGN: PRESSURE DISTRIBUTION MANUAL SBD- 10573 -P(R /99) MOUND COMPONENT MANUAL SBD- 10572 -P (R 6/99) CONTENTS: Page 1: Plot Plan Page 2: Cross Section and Plan View of Mound Page 3: Distribution Pipe Layout Page 4: Septic Tank & Pump Chamber Cross Section & Specifications. Page 5: Huffcutt Concrete Tank 870642 Page 6: Pump Specifications Page 7: POWTS Owner's Manual & Management Plan - Pg. 1 Page 8: POWTS Owner's Manual & Management Plan - Pg. 2 Name: Bennie Helgeson Signed Address: W1229 770th Avenue Spring Valley, WI 54767 rry Credential Number: 220292 Date: March 25, 2002 JE D MMERCE 0, iLDINGS . JNDENVE" Oo Q� s o a 0 In Q = L a 4Y v i � d a N ry Cl- a V .V t.J �•.', r W4 ffl a k oneN Page- & Of Synthetic Covering Distribution Pipe AST /vI c 3.3 Medium Sand G Topsoil F Top , /OD•.S y % Slope Plowed CELI.Of 2�— 2 %Z Force Main Aggregate From Pump Layer D .1S Ft. E Ft. Cross Section Of A Mound F Ft. G . S Ft A �/, Ft. H /__ Ft. Signed: g loo Ft t K _� t. License Number: L Z Ft. Date: j 2, Ft.. T Ft. W Ft . Observation Pipe K Al --------------------------------- L T Distribution 6`l-L Of Pipe Aggregate �7S-pv �s4 4r<< Observation Pipe �a�� Plan View Of Mound Pcrlorolnd Plp. 0-1 oll End VI.W Porlorulco � r 1l ' PVC Pip( Holes Located on Bottom . are Equally Spaced L r Sl fj� It lV C2 K� to QVI �O{ �H Q l I�(tib�G�tL7.5 -"'� QiclrlDullon.. PIP, Discribucion Pipe Layout P Y1. 8 S 30 '� X Y1 - 1 Hole Diameter �_ Inch Signed: •• Lateral l� Inch (es) License Number: Manifold " Inches Dace: Force Main " q Inches 75� ;s S Pe tr �a+ek--o- � x � '7(, PUI•'%P CHAP\5-LR CkuS`_• `EC" Aub c/.Il0W. Ve►JT CAP y ' EZT PIPE WEATHERPROOF MANHOLE COVE F. � ul✓z JUMCTIOQ BOX LL pp ?. : zo. DOOR. / X' k r}IS`' 12 "MIU. ritJCCW OR FRESH AIR ftJT.AKE GRADE - T COW DU IT -- - -"'- - -- - - -- i e" hl I ►J. \��� PROVIDE I IIJLET AIRTIGHT SEAL I I II APPROVED JO►u'S APPROVED JOINT A I II W /C.I. PIPE I. PIPE I II ALARM EXTLMDIUG 3' O SOLID SOIL E X T E N D I N G 3' I 1 1 010TO SOLID SOIL D I I o . c I LLEV. FT. PUMP OFF r COUCRETE BLOCK R15ER EXIT PERMITTED OIJLy IF TAM K MAIJUFAGTURE VHA - vokme ratio) ^ 1s.7.r, " � X SPEC, IFItATIOtJS 5 t � - 4 SEPTIC f DOSE L.— o nlf TAI AS MAWUFACTLJRER: •js ,� , itd.�6eT AWK SIZE: g ©� GALLOWS DOSE VOLUME ' w. �h �. 3r GALLONS T Oiclr l ' DOS-0- VO U" ALARM MAWLIFACTURER: MODEL IJUMBER: �!l^I �� — CAPACITIES: A= 3 11JCHE5 OR.�'� -. �ELOUS vo-r IUCHES OR -1 a GALLOM5 SWITCH 'TYPE: C IIJGHES OR i a. anc LOU5 �1(�A PUMP MANUFACTURER: c. L a � Ud�s INCHES OR /LO, GALLOMS MODEL ►DUMBER: I ,�� En5 Ds ` - '7' - DE SWITCH TYPE: 1�u��`� i'C' '� �eo-f` DOTE: NMP`LED DI CIRCUITS MIIJIMUMI DISCHARGE RA E 3� GPM VERTICAL DIFFERE BETWEEW PUMP OFF ARID 015TRIBUTIOW PIPE.. 7' 7� F EET + .MIkJIMUM NETWORK SUPPLti PRESSUR�T . . . . . . . . . • + S FEET OF FORCE MAIN X �•SO F/IOOrT.FRICTIOU FACTOR..�� Q� F ET _ TOTAL 0`JIJAMIC HEAD = �'�'. —=�- FEET • LIAUIO DEPT H 11JTER►JAL DIMEWSIONL OF TAIJK:'i•LE'.�GTH ;WIDTH ' a3,1 6. pr SiGIJE D: - - - -- LICEWSF DUMBER: DATE: r Z r • m -1 51,5' 43' 8.5' 2.5' 40.5' Yn 3.5' I' 4' DIA. "' 2 ' _ N r U1 LA O N a F NN -� NN m m 20' 2' D O 0 O r D Z m x t .'O 011�t�lOh �' iA Z �R 1 c - �y��64P, toff ID D N 4 il hj � c ° RR 5.25' rn N In o I •. . v p r1 , , D -4 a D O � O Fiy D C Z -1 M X I< 40' 11.5' a A, g D d A 37.5' o m n = .. N N O 4' DIA. 2' n 4 O . r1l v n 0 g $ A '1_.J D "' p <. ry W .75' a < -4 N 5' DIA. In r Qv c C3 � g 20000703 71 ---- --- - --- ND = Z x 96' ° i y N 91' o c r U — _ r -4 -4 D w .� 87' o i �r r D N I A � ° d I y iy ° A v "s C r I R i.. f T® 3 In D — D m N V ;11 d < I ® ci0 Z - n 9) MAY 2 4 2000 ° z z - - D 0 z D SAFETY & BLUUS DIY. mn Z � 0 ii I A y ]• N •,0 CD m I C Z UI A m - -4 L1 > 01 D I m N I D D m I c rr °Z ---------------------- t 1 737 HERBERT.-STREET j "EMAE9$.:_pF! p TANK, 8 H U F F C U T T C 0 N C R E' T E CHIPPEVA FALLS, VI 54729 NATIONAL PRECAST CONCRETE ASSOCIATION i R 800 GAL. LDV PROFILE (715) 723 -7446 ■ FAX (715) 723 -7111 VISCONSIN PRECAST CONCRETE ASSOCIATION C800) 924 -1516 SEPTIC, HOLDING, AND PIMP TANK THIS DRAVING SHALL NOT BE COPIED OR SUBMITTED TO OTICRS VITHOUT CONSENT•OF,THIS COIF •' ■■■■■■■■■■■■■■■■■■■■ \■■■■■■■■■■■■■■■■■■■ , \ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ,■ \� ■ ■ ■ ■ ■■ ■ WOMEN ■■■■■■■■ \ ■ ■�'�' \� ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ M No ME WOMME \ ONE ■► ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ iMa ■ ■ ■ ■ -ON M ► ■ ■ ■ ■ ■ ■ \ ■■ ■SEEN -4100 \M\` .MEMM ■ ■ ■■ ,: ■ ■ ■ ■E\■ ■ ►� ■ ■■ ■■S■ ■NONE Oman NONE NONE OEM M No . ■■ ■BOSS ■SSSSO ■ ■S ■ ■ ■S ■ ■ ■NN ■ ■■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ MODEL 388 MEN ■O ■E ■ ■■ ■MOOD ■MS Solids MN ■■ ■ OMEN ■■■■■■■ ' \ ■ ■ ■ ■ ■S ■ ■OOM ■ ■ ■ ■ ■ME■■■■ N MEN ON MEE ■EMMMMS■EMOMM■ SEEM ■ \ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ ., ■ENNEWIN■E ■NN ■■ ■ ■ MEMO ■■KMEN ■E■■ ■ ■M \ ■ ■■ ■NONE■■■■ MEN ■■ MOMMOOMMONE MOMM No ONE ON No MEN MENOMONEE ME MEMO EOEE■EMEN ■ENENMNN■EMEN Room MMEEMMM\■■■■■■■■■■■■■■ `:1NO■■NNENN■ ■■ ■ ■ ■ ■ ■ OEM RI N■ M`►�M ■■■■■■ME■■■■■■■■■■■ ■ENE 19ENNNN ■ ■ ■NNN■ NNE M ■■ ■■■ ■1 ■ ■mMMSEEN ■E■OESE ■ ■M■ EEME■ ■1■■ ■ \ ■MM WOMEN ■MMEEMO■ ' ■ ■ ■ NONE ■EENEEEM■ MENEMNf ■ENN \GENE ■ \\MM ■■NOMEN 'ME ■ ■ MSI�SSSSE ■■ ■SSE ■N ■ MEN ■SNS■ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pafle R FILE INFORMATION SYSTEM SPECIFICATIONS MAHONEY Septic Tank Capacity al O NA P Septic Tank Manufacturer HUFFCUTT G:ONC ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ZABEL 0 NA Number of Bedrooms 3 ❑ NA Effluent Filter Model A -100 12" x16" ❑ NA Number of Commercial Units IN NA Pump Tank Capacity 800 gal 0 NA Estimated flow (average) 300 qaVday Pump Tank Manufacturer HUFFCUTT CONC 0 NA Design flow (peak), (Estimated x 1.5) 450 gal/day . Pump Manufacturer GOULDS PUMPS Ilp NA Soil Application Rate .5 g aVda /ftz Pump Model 3885 ❑ NA Influent/Effluent Quality Monthly average' Pretreatment Unit ® NA O Sand/C�ravel Filter ❑ Peat Filter Fats, Oil &Grease (FOG) 530 mg /L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BOD 420 mg /L ❑ Disinfection O Other. Total Suspended Solids (i SS) x150 m /L Manufacturer Pretreated Effluent Quality 6 N Monthly average" Dispersal Cell(s) Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- ground (gravity) ❑ in -ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ At -grade M Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip-line ❑ Other: Maximum Effluent Particle Size Y Inch diameter Values typical for domestic (non- commerclaQ wastewater and •• septic tank effluent. Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every 2 ❑ months iA year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y) of tank volume Inspect dispersal cell(s) At least once every 2 ❑ months W year(s) (Maximum 3 yrs.) Clean effluent filter At least once every 1 ❑ months . Ej year(s) Inspect'pump, pump controls & alarm At least once every 1 ❑ months 9 year(s) ❑ NA Flush laterals and pressure test At least once every 3 ❑ months Q year(s) ❑ NA Other At least once every ❑ months ❑ year(s) ❑ NA E l Other At least once every ❑ months O year(s) ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an Individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Malntalner, Septage Servicing Operator. Tank inspections must Include a visual Inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually Inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of In accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreattment components; and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within W days of completion of any service event START UP AND OPERATION. For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. ,OWNER: BRIAN MAHONEY Page $ or System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power Is restored the excess wastewater will be discharged to the dispersal cell(s) in one. large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWf S: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss ;'diapers; disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products;' pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with ch. Comm 83:33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of ail tanks and pits shall' be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction. and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result In the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules In effect at that time. • A suitable replacement area Is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. • The site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area Is available a holding tank may be Installed as a last resort to replace the failed POWTS. ® Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. « WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS IN STALLER POWTS MAINTAINER Name HELGESON EXCAVATION INC Name JOHNSON SANTTAjT0tL_ Phone 1 715/772 -3278 Phone 715/273 -5811 SEPTAGE SERVICING O PERATOR PUMP LOCAL REGULATORY AUTHORITY Name JOHNSON SANITATION Agency PIERCE COUNTY ZONING Phone 715/273 -5811 Phone 715/273 -6747 This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies. This document meets the minimum requirements of ch. Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. GMW (2/01) f i V � i 1 �� i ,� r ' "ORIGINAL 1367 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix _ include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 034 - 1053 -10 -000 Please print all information. iewed By at Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.14 (1) (m)). r 2 OD Property Owner Property Location Mahoney, Brian Govt. Lot NW 1/4 NE 19 S 24 T 29 N R 15 W Property Owner's Mailing Addrew Lot # Block # Subd. Name or CSM# P.O. Box 274 _ CSM Pending City State Zip Code Phone Number �j City Village Town Nearest Road Woodville WI 1 54028 1 715 - 698 - 2425 Springfield 325Th St. New Construction Use: M Residential / Number of bedrooms 3 Code derived design ©W rate 450 GPD Replacement j Public or commercial - Describe Parent material till Flood plain elevation, if applicable NA General comments of and recommendations: install 4' x 1125 rock unit mound on 100.5 contour as upslope edge ofi.91, TOW ' W Boring # 1 Boring ' Pit Ground Surface elev. 98.7 ft. Depth to limiting factor 25 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -6 7.5YR 3/2 sl 2 m gr mvfr cs 1f /m .5 I .9 2 6 -13 7.5YR 4/4 - sl 2 m sbk mfr gs if .5 .9 3 13 -25 5YR 4/4 - scl 1 c sbk mfr cs 1 m .2 .3 4 25 -32 5YR 4/4 - scl 1 c sbk mfr - - .2 .3 r horizon 4 is @ field capacity w/ multiple side seeps T Boring # j Boring Pit Ground Surface elev. 100.5 ft. Depth to limiting factor �--in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz, Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 I 0 -7 7.5YR 3/2 - sl 2 m gr mvfr cs 1f /m .5 .9 2 7 -11 7.5YR 4/4 - sl 2 m sbk mfr gs if .5 .9 3 11 -24 5YR 4/4 - scl 1 c sbk mfr cs 1m .2 .3 4 24 -34 5YR 4/4 f2d 7.5YR 5/3 scl 1 c sbk mfr - - .2 .3 i perched ground water @ 34" ' Effluent #1 = BOD > 30 < 220 mg /L And TSS >30 < 150 ' E uent #2 : BOD S 30 mg /L and TSS _< 30 mgr CST Name (Please Print) Signatur CST Number Henry F. Grote 222 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 547 4/20/2001 715- 233 -0398 Property Owner Mahoney, Brian Parcel ID # 034 - 1053 -10 -000 Page 2 of 3 F3� Boring # J Boring Pit Ground Surface elev. 100.5 ft. Depth to limiting factor 1 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtftl in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -8 7.5YR 3/2 - sl 2 m gr mvfr cs 1f /m .5 .9 2 8 -15 10YR 4/3 - sl 2 f -m sbk mvfr gs 1 m .5 .9 3 15 -30 5YR 4/4 f3d 7.5YR 5/3 scl 1 c sbk mfr - 1 m .2 .3 Boring # Boring j Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I I ❑ Boring # -j Qoring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMI in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I I I i r Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608- 264 -8777. SBD -8330 (R.07 /00) Certified Soil Testing ,P' r $ - • j �. o IA , Of i D C' S ! ar i l rs rj T 9 qj i \ b d i� C—r 3 rj e J � 3 r A -� a � � 3 J � S ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND � S L) OWNERSHIP CERTIFICATION FORM wner/Buyer iN �^ ►Yl A-Gk� N Mailing Address Wz (t� Property Address C'c /�( 13 (Verification required from Planning Department for new construction) City /State w(S Parcel Identification Number / 03q 106 - 3 - 1 , 0 LEGAL DESCRIPTION Property Location N f� ' /a, %a, Sec. , T a N -R i W, Town of S Pici N A z &'4' o 7- N w yy , NF- tl y g r c c-v 4 W' -s 4 rto i Subdivision 'r' Lot # Certified Survey Map # , Volume , Page # "— Warranty Deed # 40i540? 3 i , Volume 1 , Page # L/ Spec house ❑ yes 90 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 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. I/we, 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 days of the three year expiration date. d=eL-�� — — - 3 /A/ 6 L— SIGNATURE OF APPLIC DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. 3 /2-v/ o SIGNATURE OF APPLIC DATE * * * * ** Any information 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 1719 534 656739 STATE BAR OF WISCONSIN FORM 2 - 1999 Document Number WARRANTY DEED 'REG1QTER OF "DEEDS :t7Ix C iI This Deed, made between Barry M. Mahoney and Mary Barbara RE�KVED FOR RECORD Mahoney, husband and wife 1,_;,_20�15 10:30 AM - �iAnRANTY DEED Grantor, and Brian R Mahoney and Debra J. Mahoney, husband and C`RT COPY FE'E: wife, holding as survivorship marital property TRANSFER FEE: 180.00 RECORDING FEE; 1L00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): The Northeast Quarter of the Northeast Quarter (NE 1/4 of NE 1/4) and the South Two Hundred Sixty-four (264') feet of the Northwest Quarter of the Recording Area Northeast Quarter (NW 1/4 of NE 1/4), EXCEPT the West two (2) rods of Name and Return Address said Northwest Quarter of Northeast Quarter (NW 1/4 of NE 1/4), Thomas A. McCormack All in Section Twenty -four (24), Township Twenty -nine (29) North, Range PO Box 2120 Fifteen (15) West Baldwin, WI 54002 034 - 1053 - 10;034- 1053 -20 Parcel Identification Number (PIN) This is not homestead property. $W (is not) Exceptions to warranties: Easements and restrictions of record. Dated thi day of 2001 - �T * * Barry M. Mahoney * * Mary Barl Mahoney AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) )Ss. St. Croix County ) authenticated this day of - _ - Personally came before me this day of 2001 the above named — Barry M. Mahoney and Mary Barbara Mahoney s TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be th ecuted the foregoing (If not, instrume t d ackno authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY * TA . Thomas A. McCormack Notary Public, Statet wis`consia: Baldwin, WI 54002 — My Commission i state expiration ate: (Signatures may be authenticated or acknowledged. Both are not necessary.) * Names of persons signing in any capacity must be typed or printed below their signature.-ma orma o esslonals company, Fond du Lac, vin STATE BAR OF WISCONSIN 800- 655-2021 L WARRANTY DEED FORM No. 2 -1999.