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HomeMy WebLinkAbout042-1065-40-100 I - - Wisconsin Departmentof�commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 463375 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: I Pechuman, Jordan Warren, Town of CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 5 \ 23.29.18. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. SR�� � 5, b ia5.a Oas Septic Benchmark 1600 2 .65 /oz . o �o Dosing 1 Alt. BM b w�,b b J o if T �K.7 Bldg. Sewer 12-11 e • _ � Holding St/Ht Inlet � TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Q i „7Z 3V r TLI J Dt Bottom b - .7 ,� Y c. 3 L 1 T Dosing / r ' ' � Header /Man. 35 3 Z 7 162 Z �w� Aeration Dist. Pipe Alf Z 142. Z Holding Bot. System 3 /' 4 / I , PUMP /SIPHON INFORMATION Final Grade -7 O � Manufacturer / Demand St Cover 47 ��i� -� a� �' 47 W , 7 d GPM Model Number ' TDH Li/ 97 Frictior� Lo 4 System Hg � T� Forcemain Len j), D Dist. to Well 7Z— I SOIL ABSORPTION SYSTEM BED/TRENCH Width 7 Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / 0 L. �- �� l. SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of CHAMBER OR ystem: + / UNIT 'r 1,L / Model Number: v / DISTRIBUTION SYSTEM Header /Manifo;d Distribution �� r x I x Hole Spacing f/ Vent to Air Intake Pipe(s) { i Length 3 ft Di� ` Length 72 / Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /SodW xx Mulched Bed /Trench Center t 1 Bed/Trench Edges ` Topsoil ' No es ` 'j No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: -7 / Z g / 0 5 I Inspection #2: / / Location: 811 130th St t R rts, WI 54023 (SW 1/4 SW 1/4 23 T29N R18W) NA Lot 1 C Pa o: 23.29.18. cel N +� p �j �k ��� 1.) Alt BM Description = '' o �,�i� �" 2.) Bldg sewer length = * 3``T Li amount of cover= 7� b��,� revis 4ae Plan Use otherside for additional information No Insep Cert. No. SBD -6710 (R.3/97) Date Safety Buildings Division County ` 201 W. Wa l In n fie., P.O. Box 7162 ST. CROIX i sconsin a 07 7 Sanitary Permit Number (to be filled in by Co.) (6- Department of Commerce Sanitary Permit Appl' �E�VED S TRANS. ID # 1121616 In accord with Comm 83.21, Wis. Adm. Code, personal i ormat rovrde may be used for secondary purposes Privacy La sl5.04(lXm) Q � J Projectt Address (if different than mailing address) I. Application Information - Please Print All Information 00NTY S I / 3 v nt S Property Owner's Name S G OFF' areel # Lot Block # JOR N PECHUMAN 3 Z0 t4 Property Owner's Mailing Address Property Location 2379 20TH AVENUE SW SW� City, State Zip Code Phone Number '�0, '�4, Section 23 BALDWIN WI 54002 715 - 688 -2397 29 1 �cireleone) II. Type of Building (check all that apply) T N; R r ✓ d 1 or 2 Family Dwelling - Number of Bedrooms 3 Subdivisio Name CSM Number T 788197 Public /Commercial - Describe Use El /'G State Owned - Describe Use eA 4( ' �1 � ❑City_ illage Township of RE N III. Type of Permit: (Check only one box on line A. Complete line B if applicable A. ❑ New System ❑Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System B. 11 Permit Renewal ❑Permit Revision ❑Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Chec a ❑ Non - Pressurized In -Grown El Mound > 24 in. of suitable soil 0 and < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter 13 Constructed Wetland ❑ Pressurized In- Ground 11 Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber 13 Drip Line Q Gravel -1 s Pipe ❑ Other (explain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design S it Application Rate( dsf) Dispersal Required (if) Dispersal Proposed (sf) System Elevation 450 1 r 0 , h S 450 I ZS 450 // 2S 101.64 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 1000 1000 1 WIESER CONCRETE X Aerobic Treatment Unit , , / y5 Dosing Chamber 600 600 1 W CONCRETE I X VII. Responsibility Statement I , the undersigned, assume responsibility for installation of the POW17S shown on the attached plans. Plumber's Name (Print) PI 's Signature MP/&MRS Number Business Phone Number BENNIE HELGESON 20292 715/772 -3278 Plumber's Address (Street,. City, State, Zip Code) W122 , 9770 AVENUE, SPRING VALLEY, WI 54767 VI . County/ e artment Use Onl Approved ❑Disapproved Sanitary Permit Fee cludes Ground Date sued suing Agent ign re ps) Surcharge Fee) ❑Owner Given Reason for Denial IX. Conditions of Approval/ on or Disapproval YS OWNER: C��Y�'D pt": S �J I Septic tank, effluent fi r and �`� dispersal cell must all be serviced / maintained /,� _ „L-- as p er management plan provided by plumber. 2. All setback requirements must be maint as per applicable code /ordinances Attach complete plans (to the County only) for the system on paper not less than 81n x 11 inches in size SBD -6398 (R. 01/03) � N ,rCp of �t✓C�i' 1 ✓ji`'C3cUc? n 1 nn k, (3roc pev ql Co S . r t t bin La 6� c TL j _ t I co Safety and Buildings 4003 N KINNEY COULEE RD commerce .Wl.gov LACROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www.commer govsb, I t l en of Commerce www.wisco isconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary March 29, 2005 CUST ID No.220292 ATTN: 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: 03/29/2007 Identificaton.Numbers Transaction ID No. 1121616 SITE: Site ID No. 696199 Jordon Pechuman Please refer to both identification numbers, 130th Street above, in all correspondence with the agency. Town of Warren St Croix County SW1 /4, SW1 /4, S23, T29N, R18W FOR: Description: Proposed Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1010047 Maintenance required; 450 GPD Flow rate; 26 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual, SBD- 10572 -P (R.6/99), Pressure Distribution Component Manual, SBD- 10573 -P (R.6/99); Biofilter 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. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. 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 publication SBD- 10572- P(R.6/99) "Mound Component Manual for Private Onsite Wastewater Systems ". • The pressure network is to be constructed in accordance with publications SBD - 10573- P(R.6/99) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) ". • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of t he tank e��eriodic cleaning of the filter is required. Access to the filte for cleaning must be provided per Comm 84 product approval conditions. tic c 4 ,r� . k- t __. DEPARTMENT M rnaeee�' BENNIE W HELGESON Page 2 3/29/2005 • 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. Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • 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 acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, • Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm WiSMART code: 7633 jswim@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 ' INDEX SHEET RECFIVED MAR z 4 ? SAFETY& BUILDINGS PROPERTY OWNER: JORDON PECHUMAN 2379 20TH AVENUE BALDWIN, WI 54002 PROJECT NAME: JORDON PECHUMAN PROJECT LOCATION: SW 1/4, SW 1/4, S 23, T 29 N, R 18 W MUNICIPALITY: TOWN OF WARREN 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 and Specifications Page 5: WLP1000 /600 -MR ZABLE Tank Specifications 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 Credential Number: 220292 Date: March 23, 2005 ulm "UN SAF T AND BUILDINGS r SEE CORRE NDENCE VVk C11- VV.-I.— A 4E 0 ql, I ccc- eta C- I Ra A Or Synthetic Covering Distribution Pipe ASTM (-33 ios.y Medium Sand H G Topsoil c� _ — =_ F id D E � 3 b p r:Ie- u , / 00. 15 S' % Slope Plowed C E Li. 0 f 2�— 2 Force Main Aggregate From Pump Layer D „S� Ft. E 1. Ft. Cross Section Of A Mound F Ft. G Ft. A Ft. H / Ft. Signed: g 75' Ft. e Number: K Ft. Z� Licens � L Ft. Date: d Ft. I Ft. W Qa. Ft. Observation Pipe d K I ° A� --- - - - - -- C �l_L O f �„_ Distribution 2 Pipe Aggregate I � Observation Pipe i3a5a.] Plan View Of Mound 3 oF8 PorforotnA Plp. Ontoll e5; C-; ' End Vlow Porforoltd PVC PIPr o``o Holes Located on Bottom are Equally Spaced rc- co ci M 4 h- Q olslflbullon. PIP0 Distribution Pile Layout R S -3 X � c � 1- i c Yom. Hole Diameter Inch Signed: Lateral " l Inch (es) License Number: 1 Manifold " ` Inches Date: Force Main " �,_ Inches .i,U VE R-T II ;� • i y �40te-S Pe e rats = '� _ Alm e—r : J O CA6 n - I't� C -� u. rvt ck- h Page � LOf 8 SEPTIC TANK - & PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS u .PLX -VENT PIPE 12" MIN. ABOVE GRADE b NEATHERPROOF 25' FROM DOOR WINDOW OR JUNCTION BOX APPROVED > ' WITH CONDUIT MANHOLE COVER FRESH AIR INTAKE W/ PADLOCK E WARNING LABEL 4 " M I N . zy r, S. D. 18" IN. 18 rniN. INLET . WATER TIGHT SEALS GAS- TIGHT- \APPROVED A SEAL ' JOINTS WITH FILTER _L ' ALM APPROVED PIPE APPROVED Za$� , B ON 3' ONTO PIPE 3' - T - I SOLID SOIL ONTO SOLID C i SOIL PUMP OFF ELEV . 94, 'D FT. -- OFF D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: Lj2i_e_5��- —L - SEPTIC GAL. DOSE VOLUME INCLUDING TANK SIZES SEP �_ CK GAL GA f 3,. c� F LOWBA O. DOSE l_ O _ GA G ALARM MANUFACTURER: CAPACITIES: A = I INCHES = (GAL• MODEL NUMBER: I Q 1 LLB— B = 2 INCHES = SWITCH TYPE: _ /cxoA_ PUMP MANUFACTURER: C = Co INCHES = I ,�O.S� GAL. MODEL NUMBER: D = 1C) INCHES = 1 �AL• SWITCH TYPE: REQUIRED DISCHARGE RATE %, f �, GPM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE FEET , + MINIMUM NETWORK SUPPLY PRESSURE . . • • • • • . ' ' ' ' "Q FEET + -- FEET FORCEMAIN X ,�;� FT /100 FTOTALIDYNAMICAHEAD �� FEET INTERNAL DIMENSIONS OF PUMP TANK: LIQ WIDTH DIAMETER UID b�`R 36" 6111 AV " `k plea s -e SIGNED: LICENSE NUMBER: DATE: 1/88 1 a O J � ` Ut Jn m U z _ a W J LO N0. , Q 'Ln w Ix IxNS �. U d Z` F p r p � LCD O Q Y� WO ZN 'WO O 0 p p F- a 'nVI �' M 'p CL C Q � L J � - �� ^ O O � C X � O Q J U J J W 1. E 0 W a. W N V O W W W W O p O N O CL V) V) O W a R �m °Q <oo m W N� QW(n v Z 0 O m NH p O� Q F J I� F- -- Q R R N �117 e W� WU WJZN ) Z R M L L;j c Z W W h-- N f"' O x J� 0 oz� Q N ow o°� Q ZZ o W J J O p z Z J J uj z ■ I I ' S` s , -- > w ' N 1 i O J V) 1 1 1 I 1 z U. 1 I � I I i I• I j j V F- �,,, W o „6£ i ', r i (� V t 'Pil; • � ! 1 (7 Y� t� �1f1 �� C.i-Y 1 t A t� r' VI 101'AL DYNAMIC HEAD /CAPACITY HEAD CAPACITY CURVE PER MINUTE I AND DEWATERING MODEL 152/153 � - - MODEL 152 153 50 Feet Meters Gal. Liters Gal. Liters 153 5 1.5 69 261 77 291 10 3.1 61 231 70 265 12 40 152 9 15 4.6 53 201 61 231 _ 20 6.1 44 167 52 197 30 25 7.6 34 129 42 159 8 30 9.1 23 87 33 125 o 20 35 10.7 -- -- 22., 85 0 4 12.2 -- -- 11 42 4 Lock Valve: 38.0 tt( 11.6 m) 44.0 ft. (13.4m) 10 014505 0 20 40 60 80 100 GALLONS 6 1 /4 LITERS 0 80 160 240 320 3 27/32 4 5/8 FLOW PER MINUTE 3 27/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS o/ 4 • Timed dosing panels available 3 27/ - Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. - Double piggyback variable level float switches are available for variable _ level long and short cycle controls. I • Sealed Qwik -Box available for outdoor installations. See FM1420. • Over 1307. (54T.) special quotation required. 1 1521153 Series 12 1/8 15211 MODELS Control Selection Model volts -Ph Mode I Amps Simplex Duplex 5 1/8 N152 115 1 Non 8.5 1 2 or 3 BN152 115 1 Auto 8.5 Included 2 or 3 sKxoat E152 230 1 Non 4.3 1 2 or 3 SE152 230 1 Auto 4.3 Included 2 or3 N153 115 1 Nan 10.5 1 2 or 3 81 115 1 Auto 10.5 Included 2or3 SELECTION GUIDE E163 230 1 Non 5.3 t � 2,0 1. Single piggyback variable level float switch or double piggyback variable level float SE153 230 1 Auto 5.3 Included 2 or 3 switch. Refer to FM0477. o CAUTION 2. See FM0712 for correct model of Electrical Alternator E -Pak. All Installation of controls, protection device and wiring should be done by a qualified 3. Variable level control switch 10 - 0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA), Or (4) float System. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 Louisville, KY 40256.0347 Manufacturers of.. O SHIP TO: 3649 Cane Run Road Louisville, KY 40211.1961 rklrr PaM PIF I f rr /999 • r (502) 778.2731. 1(800) 928 -PUMP htfp:/Mrww.zoeIter com PUMP 49. O FAX (502) 774.3624 © Copyright 2001 Zoeller Co. All rights reserved. q VA y Wisconsin Department of Commerce EPORT Page of Division of Safety and Buildings Code county ..�- G Ax) + 7� Attach complete site plan on paper noust include, but not limited to: vertical and d Parcel I.D. percent slope, scale or dimensions, n'of est road. Please print all information. Review y Date c Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Prope Owner Property Location V r9AiN Pea Govt. Lot .SW 1/45W1/4 S Tag N R E (ore Property Owner's Mailing Addresq Lot # Block # Subd. Nam r CSM #' 0 0 3' O I��e • , I o0 City State Zip Code Phone Number ❑ City ❑ Village ® IT06i Nearest Rog _ i r X1 5 0 b. c 7/5 )4 - a 397 3 a New Construction Use: P Residential / Number of bedrooms Code derived design flow rate _ GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Jo_.5_ m) e-w :7r•) Flood Plain elevation if applicable ft. General comments $ V5 Sa s y 7$ Na 0 %-' t' se- 4 and recommendations: DI Boring i Boring # /� I FA Pit Ground surface elev. R 7 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 I 'Eff#2 10 pltydW Ll Sys -Ilq 0M , . e St.. 6 FY Boring # Boring Pit Ground surface elev. _9.3 5 ft. Depth to limiting factor _5_ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rots GPDlftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. l 'Eff#1 "Eff #2 3 J g -3 S`t� "1 -- —"" c L F5b tL, r L& r G �, q '7 ` Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BO D- < 30 mg/L and TSS < 30 mg/L Name (Please Print) Signature CST _Num Address ate Evaluation Conducted Telephone Number c. , - r 1 / -4 CD —D `l I f D r, La Property Owne11 r4--V%) Parcel ID # <_ Page of U Boring # ❑ Boring I { pit Ground surface elev. &L1ko ft. Depth to limiting factor _ In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary = Roots GPDfff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 {err J DU: - -- :5,L j2 w 3 1 3 10—Y Y - ----- I F,5bw rmn Fe- GL-v f j F , y , 7 S a Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in • Soil lication 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 17 Boring # ❑ Boring ❑ Pit Ground surface elev. ft ft. Depth to limiting factor in. Soil 7Application 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 • Effluent #1 = BOD > 30:S 220 mg/L and TSS >30 < 150 mg /L ' Effluent #2 = BOD, < 30 mg/L and TSS 5 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. $BD -8330 (R.6/00) T 30 — 400 Qe,c1 u r^ 4,N` Qr e� • N S«�t ��_a' a1.00l Acr-t. lot Q Nt (-Top 1 _ �e1r „ s4wGI e pe.) t r u t" $ #7 VI f- OF qz a s z w � � Wa I - 0 7 _._ �. Sov-f� t A 1 � 3 a �� 8a 9q,35 � _�3 I a f • �' � "' � ._ 7 r — -- _ -- --- -- --� CERTIFIED S URVEY MAP Earl E Pechttltt>ian pay- 'Part of the Southwest I/4 of the Southwest 1, of Section 23, T2 N, R I8 W, Town of Warren, St. Croix Counter, Wisconsin UGEND WEST QUARTER CORNER Indicates ! "U.D. x !$" Iron Pipe Set SECTION 23. T 29 N, R 18 W OWN. M'SADDItE�S (BERNTSEN'Pr NAIL) i31o;,.T, H W' (Min. Wt. - 1.13 lbs./lin. ft.) ROBFR7S, Brl. Section Corner Monument (as noted) j I UNPIAT?_Ea tANO 0 Indicates Soil Boring Location N 88 0 25'49" E 339. E 36.00' 3o3.6o' 33` 33' ! 1 { e � n i f N l o ► LOT t 2.2;2 ACRES OR 98,990 SQ. FT. O Iw f N (INCL. R /W) rn M 0 C11 0 1 2.ovt ACRES OR 8 %164 SQ. FT. T 3 �' ! (EXCIL. R /w9 LJ' , ea � + z Ja Z {? ui S 8-8 °25 W 112.44' < � m ° bto VKMTT-EQ at Z . N '�• E j G,00' S 88025' 222.91' E N o SOUTHWEST CORNER r SECTION 23. T 29 N. R 18 W : ry zaurix Seats in Feet "= b (BERNTSEN'PK' NAIL) -try e POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 7 of 8 FILE INFORMATION SYSTEM SPECIFICATIONS Owner JORDON PECHUMAN Septic Tank Capacity 1000 gal E3 NA Permit # 1-?� Septic Tank Manufacturer WIESER CONCRETE ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ZABEL ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model A -100 12" x 20 ❑ NA Number of Public Facility Units 0 NA Pump Tank Capacity 600 gal ❑ NA Estimated flow (average) 300 al /day Pump Tank Manufacturer WIESER CONCRETE 0 NA Design flow (peak), (Estimated x 1.5) 450 al /da Pump Manufacturer ZOELLER PUMP CO 0-NA Soil Application Rate 0.5 gal/day/ft Pump Model 152 ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L LI NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L IN NA ❑ At -Grade It Mound — >2V OnQd' Fecal Coliform (geometric mean) 51 ` 100ml ❑ Drip -Line ❑ Other: Other: ❑ NA Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other. [3 NA E3 NA "Values typical for domestic wastewater and septic tank effluent. other: MAINTENANCE SCHEDULE Service Event Service Frequency ❑ month(s) (Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every: 2 151 ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA ❑ month(s) (Maximum 3 years) ❑ NA Inspect dispersal cell(s) At least once every: 2 Ek ear(s) [I month(s) ❑ NA Clean effluent filter At least once every: 13 ❑ year(s) [k month (a) ❑ NA Inspect pump, pump controls & alarm At least once every: 13 ❑ year(s) ❑ monthlsl ❑ NA Flush laterals and pressure test At least once every: 3 Ckyear(s) ❑ month(s) ❑ NA Other: At least once every: ❑ ear(s) Other: ❑ 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 Maintainer; 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 observation pipes and to check for any p of effluent on ace. The dispersal thhe ground surface. The P sp onding t of c effluent on ground surface may indicate a failing condition and requires the te g 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 chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) OWNER: JORDON PECHUMAN Pape STARTUP 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. 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 call(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 POWr$ 11011111111211W 110 ' 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 Q the t�fe of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; B rea l doss; draper, disinfectants: fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbiddea; meet scraps; medications; oil: painting products; pesticides; sanitary napkins; tampons; and water softener brute. ABANDONKMENT 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'AdministraUve Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall' be removed and properly disposed of by a Septage Servicing Operator.. • After pumping, all tanks bnd 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 falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: O A suitable replacement area has been evaluated and may be utilized for the location a replacement soil c 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. O 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. O The site has not been evaluated to identify a suitable replacement area. Upon failure of the POMS 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. tg 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 ANDIOR INSUFFICIENT OXYQEN. DO NOT ENTER ASEPTIC, 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 INSTALLER POWTS MAINTAINER Name HELGESON EXCAVATION INC Name JOHNSO Phone 715/77'1 -3'278 Phone 715/273 -5811 NTIPATTON SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name JOHNSON SANITATION [ ig ST CROIX COUNTY ZONING Phone 715/273 - 52311 715/386- This document was drafted by the staffs of the Ocean lake, ivlarquette and Waushara County Zoning and sanitation sgenclp& This document meets the minimum requirements of ch. Comm 83.22(2)(b)(1)(d)b(Q and 83.54(1), (2) b (3), Wisconsin AdminlstmUY@ Coda Use of this docWrAM do s rA guarantee the performance of the POWTS. GAwIVN(4/01) ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address ` S-� `� -� -- Property Address 8 � I 13 � ' (Verification required from Plaiining Department for new construction) ---- City /State ��� , L Parcel Identification Number LEGAL DIr SCRIPTION �, ) '/4 Sec. A , T ,0 — N -R_ 1 W, Town of Property Location 6 / <, 5..� -- , Subdivision je"C , Lot # �. 1 Certified Survey Map # `7 �?'g 5 - 7 , V011lllie I , Page # Warranty Deed # '7 fS - 7 4 5 , Volume 7 , Page # 7 Spec house 0 yes W no Lot lines identifiable ® yes O no SYSTEM MAINTENANCE stem could re Improper use and maintenance of your septic sysult 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 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 se syste has been maintained must be completed and returned to the St. Croix Gouaty Zoning Office within 30 day of a three a exp tion date. 3/ DATE TURE 0 P ICANT OWNER CE TIFIC TION I (we) certify that a state gnts on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(S) Of the rope described ab v , by v' a of a warranty deed recorded in Register of Deeds Office. .� �/`7/ A OF AP �ICA T DATE ....w. Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * ** • Include with this application: a stamped warran deed from the R of Deeds office a copy of the certified survey map if reference is made in the warranty deed 03/20/2905 22:17 7156843356 COACHMAN PAGE 02 l! 2 65P 507 -7 4B 9-7r=0 KATHLEEN R. N ALSH State Bar of Wisconsin Form 3 -2003 4 REGISTER OF DEEDS _ QUIT CLAIM DEED ST, C1101X GO., W1 R REGORU Document number Document ?Jame A�r16r2 0is38PM A I N DEED THIS DEED, made between Earl F. Pechuman an R. Le nore P *Chunian. EXEMPT 1 8 .: hu sband and w ile REC FEE: 11.00 TRANS FEE: COPY FEE: ("Grantor," whether one or more), and J ordan L. Pec a nd K M. I CC FEE: Pechuman, hu sband and wife PAGES: 1 .. —_. hctitcr one or more). .. ......— ......._ ....._ ._._ —..— __— ( "Grantee," w ... ., . Grantor quit claims to Grantee the following described real estate, together with the 't rents- profile, appurtenant interests, in St. Croix _ 41 Recordi Area . r xtures and o r PP _....._.__. -- � County. State of Wisconsin ( "Property ") (if more space is needed, please ._._ .. . attach addendum): Name and Return Aa c +s Part of the Southwest Quarter of Southwest Quarter (SW 114 of SW 1/4) of J r Rfc , v 1 *&,;, A X 3 4 v Section Twenty -three (23), Township Twenty-nine (29) North, Range Eighteen ° a� � DC (18) West, 'Town of Warren, St. Croix County, Wisconsin, more particularly CS- � described as follows: — Lot One (1) of Certified Survey Map filed February 24, 2005, in Volume 19 of 042 - 1061-40 -0 Certified Survey Maps, Page 4937, as Document No. 78819'7, office of the Rteis 00 ter ,� idemitication Pareei • Number (PIN) or Deeds for St. Croix County, Wisconsin. Thi °r is n ot homestead property - tia31 is not) Dated M iz -tC4 1 6" accts (SEAL) = "`� ^'"! ....... -- _..._(56AL) * Ee . Petltuman ... ,.. (SEAL) <t e � _ _(SEAL) human AUTHENTICATION ACKNOWLEDGMENT 5ignature(s) STATE OF WISC _ C __ .._.., .�._,..,......,.. ) - authenticated on ST. CROIX COUNIY ) Personally came before me on — . ............. _. w -- - -- the above- narnt;4, art F Pechuman and R. Lenore Peehunten, TITLE: MEMBER STATE BAR OF WISCONSIN husband tl� (If not, to me k� t#' ptExson(s) who executed the foregoing a.uthorizedby § 706.06 Wis. Slat. _ — - -_ . -) instru a ge �e same. THIS INSTRUMENT DRAFTED BY: + l„ Mix Thom yrr Mc $4 Cor� McCormack —- My com � �perrr +1 01e plreS: _ (Sigasiores may be autbentieated nr ackobwledged. Billll. tp{Fr" NO IT THIS 15 A STANDARD FORM. ANY MODIFicA•rivri TO THIS FORM A11ok 1,D at CLEARU IDENTIFIED. QUIT CLAIM DEED STATE BAR OF wISCONSIN FORM No. 12003 *Type name Wow signatures. a Sti tt Bar or Wisconsin 203 rNro -M RO' Loyal Forme • :W)M -514M • IMV" --am 3. VOL 19 PAGE 4937 KAMM H. __._ -__ REGISTER OF DEEDS ST. CROIX CO. WI RECEIVED FOR RECORD 02/24/2005 11:45AN CERTIFIED SURVEY NAP REC FEE: 13.00 COPY FEE: 3.00 CERTIFIED SURVEY MAP PAGES: 2 Earl F. Pechuman Part of the Southwest 1/4 of the Southwest 1/4 of Section 23, T 29 N, R 18 W, Town of Warren, St. Croix County, Wisconsin LEGEND WEST QUARTER CORNER SECTION 23,T29 N, R 18W OWNER'SADDRFSS O Indicates i "O.D. x 18" Iron Pipe Set (BERNTSEN'PK' NAIL) 1310 C.T.H. "TT" (Min. Wt. - 1.1 3 Ihs./lin. ft.) ROBERTS, W. 0 Section Corner Monument (as noted) ir N UNPLATTED LANDS o Indicates Soil Boring Location l ------------ - - - - -- N 88 °2�4 " E 3 I .6o' 36.00 303.6o' i 33' 33' ( Q1 i ( N LOT 1 2 .272ACRESOR 98 o SQ. FT,. (INCL. M W i 2.001 ACRES OR 87,164 SQ. FT. o a N U? I (EXCL. R149 O M M I i i 3 � i NOTB - Z I W ,` The centerline of the d ' accessing :7 this 10 'haU be a minimum o feet W i I North of the South iodine. g z o I d Z z � z zl>- Z v W S 88 °2y'49 W 112.44' R 66 a l l �I g go U PLATTED N Z _ c c ' IS ° 0 LANDS ----- - - - - -- tx i N _ W N. 6.00' 186.91' t S 88 0 2549" W 222.91' N i UNK TT D LAID E ` 0 ---- ---- - - - - -- '" � a• ° °eeeeeee °• ,. SOUTHWEST CORNER • SECTION 23, T 29 N, R 18 W w N F (BERNTSEN'PK' NAIL) xY e . - S1713 041 e e -6o 30 0 - 60 e. . a ELDEl*7VILLE Bearing are referenced to the West line 1 �• g of the SW /4 . of Section 23, assumed bearing N Dot '55' W ° •eeee •e g � LAND ^trument Drafted by Mark W. Peavey SHEET 1 OF 2 Vol 19 Page 4937 CERTIFIED SURVEY MAP Earl F. Pcchuman Part of the Southwest 1/4 of the Southwest 1/4 of Section 23, T 29 N, R 18 W, Town of Warren, St. Croix County, Wisconsin DESCRIPTION: That certain parcel of land located in the Southwest 1/4 of the Southwest 1/4 of Section 23, Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin, more fully described as follows: Commencing at the Southwest corner of said Section 23; thence N 00' 44' 55" W (assumed bearing on the West line of the Southwest' /4 of said Section 23) a distance of 282.41' to the Point of Beginning of the parcel to be herein described; thence continuing along said West line, N 00° 44'55" W, 328.50; thence N 88° 25` 49" E, 339.60'; thence S 00° 44'55" E, 218.87; thenceS 88° 25'49" W, 112.44'; thence S 01° 28' 08" W, 109.77'; thence S 88 25' 49" W, 222.91' to the Point of Beginning, containing 2.272 acres or 98,990 square feet being subject to an easement for 130 Street over Westerly portions thereof, as shown on this map, and to any other easements, covenants or restrictions of record. GENERAL NOTICE STATEMENT: Note: Each parcel shown on this map is subject to State, County and Township laws, rules and regulations (i.e. wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel contact the St. f Croix County Zoiting Office and the Town of Warren. State of Wisconsin) County of Pierce) I, Laurence W. Murphy, Registered Land Surveyor, do hereby certify that by direction of the Owner, Earl F. Pechuman, I have surveyed and divided the lands shown hereon in accordance with official records, Chapter 236.34 of Wisconsin Statutes and the Ordinances of St. Croix County and that this map and description are a true and correct representation thereof. Dated: December 2, 2004. APPROVED ST. C1%(X X CpUWY � s znr� c.�n.rrn.a FEB 2 4 2005 If not recorcao wilfiin 3U days of approval date approval shall be null and void 0 LAURENC • w• • e MU • e • # 713 . • DENVILLE� . vvi. .• LANID This Instrument Drafted by Mark W. Peavey SHEET 2 OF 2 Vol 19 Page 4937 Parcel #: 042 - 1065 -40 -000 12/27/2005 02:05 PM PAGE 1 OF 1 Alt. Parcel #: 23.29.18.361 042 - TOWN OF WARREN Current f X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co - Owner EARL F & R LENORE PECHUMAN O - PECHUMAN, EARL F & R LENORE 1310 CTY RD TT ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description ' 1310 CTY RD TT SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres 40.000 P t: N/A -NOT AVAILABLE SEC 23 T29N R18W SW SW 40A lock/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 23- 29N -18W Notes: Parcel History: Date Doc # Vol /Page Type 10/10/2003 743312 2433/316 QC 2005 SUMMARY Bill M Fair Market Value: Assessed with: 79443 Use Value Assessment �\ Valuations Last Ganged: 07/11/2003 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 33.500 5,40 0 j 5,400 NO UNDEVELOPED G5 1.500 20 0 200 NO OTHER G7 5.000 24,0 0 137,100 161,100 NO Totals for 2005: General Property 40.000 29,600 37,100 166,700 Woodland 0.000 0 0 Totals for 2004: General Property 40.000 29,600 137,100 166,700 Woodland 0.000 0 0 Lottery Credit Claim Count: 1 Certification Date: Batch #: 208 Specials: User Special Code Category Amount 018 - RECYCLING SPECIAL ASSESSMENT 15.00 Special Assessments Special Charges Delinquent Charges Total 15.00 0.00 0.00