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HomeMy WebLinkAbout002-1007-50-120Wisconsin Department of Commerce PRIV~4TE ~EWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Ackle , Dou las Baldwin Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic E-IccF~F Ct7n. /ooo Dosing Comb boo Aeration Holding TANK SETBACK INFORMATION ~'~'¢'Q' f1100 ~ I~P.t'' to Air Intake ~ ROAD Septic ' ~ db ~ V1D{` I~ LI Z ~ ~.z~ --- Dosing T ~~ , , - PUMP/SIPHON INFORMATION Manufacturer ~` ( ~ LP ( ~ Demand G (j~ GPM Model Number 1 ~Z l 3 7 TDH Li ~ ~ Friction Los s ~ System ead ~ TDH ~t 3 3 b 3 ~ Zv. Forcemain Length /pd ~ Dia. a ~~ Dist. to Well + i ~ h a SOIL ABSORPTION SYSTEM ~ ELEVATION DATA County: St. CrOiX Sanitary Permit No: 430586 0 State Plan ID No: Parcel Tax No: U6 2-~GY - Sa-/.z-d Section/Town/Range/Map No: 16 S~ 29 04 . . STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer ~ l3•0 q3 y St/Ht Inlet ~ /Y•b 9 i• 8 SUHt Outlet _ Dt Inlet Dt Bottom 4 C~. ~ $~. Header/Man. 3•~ IUZ. S Dist. Pipe 3 ~~. ~oZ. Bot. System ~ 4.~s ~ O / ~ ~ Final Grade 2.2b /a`{. a a St Cover ~ ~'11Q.n (nod r • toC.B ~ r 6.20 l06. (~ /oo.a ~•S- g .Q .~ ~ u~ BEDITRENCH DIMENSIONS Width ~ ~ Length S 7 ~ No. Of Trenches ~ C>! ~~ PIT DIMEN S No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHING Manufacturer. INFORMATION CHAMBE Type Of System: -1G(,J ~~ ~ ]~10 UNIT um ~ ~ in DISTRIBUTION SYSTEM w•e.fi "' w Header/Manifold t , -7 •i Distribution /i , / ~ Pipe(s) / [ ~ x Hole Size 3/ 4 x Hole Spacing 2 / Vent to Air Intake / if el~l,~-- 6K_L c~ th Dia of Len ~ Len th ST Dia S acin `t" ~ ~i ~ g g p g SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Oniv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Ed es g To soil / p Yes No ~ Yes ~ `j No i 3'~`~f- o- ~~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Ulo / 28/ b~ E'L Inspection #2: b6 / Z8• / a DEL. Location: 1147 230th Street Baldwin, WI 54002 (NW 1/4 SW 1/4 4 T29N R16W) NA Lot 1 Parcel No: 04.29.16. 1 J Alt BM Description = ~~ Gtf~ (y) P 1 ~laH sh•i ~ ci // ~ n~ ~ b,,,~- ~}~~ W ~; n bb~%~ 2.) Bldg sewer length = ys ~1L (S~ ~.pvt,'[~ = ~9 .c( Dk' Q / /QU~~~ /QO ~ / / - amount of cover = g• Ek Gt)l1Vt ~t.Qil ~1 (~ OW c p Plan revision Required? ~ 'Yes No ~ -~ ~ ~ ~ ^ ~ ~- -- ~I Use other side for additional information. CS (o ~V d _ i r[ ~ ~;~ _ __- Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) Safety and Buildings Division county ~ ( ~ P.O. Box 70$Z ton Ave hi W ~ ., as ng 201 W. ~ Madison, WI 53707 - 70$2 ~scons~n (608) 261-b546 Sanitary Permit Number (to be SUed in by Co.) ~3p ~j-g(Q Department of Commerce last LD. Number Sanitary Permit Application id ate J~l~ , roNls . ~ e fn accord with Comm 83.21, Wis. Adm. s~ ~~l awf s15.1}4t (I)(m) prov o project Address (if different than mailing address) , may be used for secondary purp I. Application Information -Please Print All Information l ~. Z ~~ ~' Parcel # \ Lot # oc Property O 's Name R. e /ll / Pro Owner's Mailing Address ~ 1 Pro~erty~ •~., ~(~'/,, Section City, State Zip Code ~/n ~~C/ ~ Phone Number circle ~ N; ~E W Type. of Building (check all that apply) ~ CSM Nttmba or 2 Family Dwelling - Number of odrootns _ j 0 ~ ~ /~. Q T~ I J ~ ~ S~ C 11 l . ^ PublidCommercial -Describe Use ,~ Q ~.~p ~' k 5 ^City_^Yilla ownshipof ~. ^StateOwned-Describe Use IIL Type of Permit: (Check only one boz oa llae A. Complete line B if applicable) A• Systw ^ Replacement System ^ Trestmetrx/Holding Tank Replacement only ^ Orher Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner tS IY. T e of POWI'S S stem: Check aU that a 1 ^ Non -Pressurized !n-Ground ^ Mound > 24 in. of suitable soil ound < 24 in. of suitable 'I ^ At-Grade ^ Si a au Filter ^ Constructed Wetland ^ Pressurized In-Grotutd ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter r .~ Recirculating Synthetic Media Filter ^ Leaching C er ^ Drip Line ^ Gravel-less Pipe ^ th r (explain) - , V. Dls ersalll'reatmeat Area Information: ' ~ Dai Flow (gpd) Design it Application Rate(gpdsfl Dispersal Area Required (s0 Dispersal Atea oposed (sfj System Ele~oz/ ~ Gn/ . ~~ , Jam! YL Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Concrete Constructed Glass Gallons Gallons of Units New Exising Tanks Talcs Septic or Holding Tank Auobic Trntntent Unit Dosing Chamber YII. ResponsiblUty Statement- I, the underslg some rea nsibility for ins rion of the PO S shown on the attached plans. MPlMPRS Number Business Phone Number _ ~ ~ Pl s Name (Print) Plumb re ~ ~ ~ ~~~~~ ~ Pltunber's Address (StreetrCitgy, Siste,~Z~/~e) ~ ~d~) VIII. Coon !D artment Use Onl Approved ^ Disapproved Sanitary Permti Fee {includes Groundwater Date Issued Issui g Agent Signature o Stamps) F h arge Surc ee) ~~ ~ . D ~ 2~ 3 ^ Owner Given Reason for Denial IX. Conditions of ApprovaUReasons for DIsapproval 3~ S~ S~ - (~ t~ ~'"' " - _ ""` ~~ . ~ 1 . SYSTEM OWNER: nn~. Ct~~ ~`~~"~ effluent filter and tic tank 4 S , ep `~'t~ ~ n dispersal cell must all be serviced /maintained ~ (G`' t~ ~ Ce~e~~~S rovided by plumber. a:. lan ment f~ p p as per manage 2. All setback requirements must be maintained r _ 1 s -~-o ~ ~ di / nance as per applicable code/or Attath eompkte pleas (to the Cousty only) for the system on paper not less than 81/2 z 11 Inches la size ~~ SBD-b398 (R. 08102) St. Croix County Zoning Detail Sanitary Information Monday, June 21, 2004 at 2:10:12 PM Page 1 of 1 Computer #: 002-1007-50-120 Sub/Plat: NA Section: 4 Parcel #: 04.29.16.58A15 Lot: 1 TN/RNG: T29N R16W Municipality: Baldwin Township CSM: Vol. 18 Pg. 4645 1/4 1/4: NW 1/4 SW 1/4 Owner: Ackley, Douglas 1147 230th Street Baldwin, WI 54002 State Permit: 430586 Issued: 12/03/2003 POWTS Dispersal: Mound less than 24" suitable s Permit: New County Permit: 0 Installed: POWTS Detail: Bed Bedrooms: 3 WI Fund: POWTS Pretreatment: Unknown Notes Inspector As Built Plumber Other Requirements Additional Notes Money Owed Not determined NA Bird, Shaun $0.00 Signed Off: No ~:::; _~~ PLOT PLAN t~•--~~~~>.~~ "rent Acklev ADDRESS P.O. Box 63 Roberts Wi 54023 . 4 SW 1/4S 4 /T 29 N/R 16 W TOWN Baldwin COUNTY ST. CROIX ___. ~_ _~ -,~ RS Shaun Bird 226900 9/10/03 3 DATE BEDROOM CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK 9 LIFT TANK SIZE MOUND ~ SEPTIC TANK SIZE 1000 allons DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 454 _ # of chambers none BENCHMARK V.R.P. Top Of 1` /2_pjpe '-- ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL • `--' tH~ . R. P. Same as Benchmark / /1G SYSTEM ELEVATION 101.8' 1.7' Sand lift U~. ~~~ q ti . ~ ol~ P ~~ ~~"~~ ~ Property Line ~ ~.,,~` AIt.B.M. 00. c ^' ~ji~S~unrey has been ~ completed. Boring and Area 15' Below B ' ~ Benchmarks are now System is to ~ ~` G ~ t. referenced into survey remain ~ ~~ti~l~ undisturbed 5% RSlope 467' Line Scale = 1 /4" = 10' Pole S essory Building 0 GPD B- 3 C f P~A~ 2 SQON N EE ~pR Grading is to be done to divert run-off away from system B_2 ~i5~~ ; ~ y.~~ 9 9' Tank is to be 10 0' properly bedded _ Pro 3 and provided with Huffcutt Combo Tank Bedroom lockdown covers House and approved Well is to meet all warning labels setbacks found in ~ Comm. 83 0 a D op i I _ ~R_'2~ DrnnnA.. 1 :.... t---•_- isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary November O5, 2003 CUST ID No.226900 SHAUN R BIRD BIRD PLUMBING, INC 1008 192 ND AVE NEW RICHMOND WI 54017 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/05/2005 SITE: Brent Ackley 230' Street Town of Baldwin St Croix County ~EE1/~4, SW1/4, S4, T29N, R16W FOR: Description: Proposed Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 922839 Identification Numbers Transaction ID No. 924750 Site ID No. 665780 Please refer to both identification numbers, above, in all tortes ondence with the a enc . 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 Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.OI/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.O1/O1). • 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. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • Comm 83.22(7) - A copy of the approved Mans 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: 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). C~."~'e~ T.~. Catt~~tia~lrr~~'~ ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SP[A 1101 CARMICHAEL RD HUDSON WI 54016 SHAUN R BIRD Page 2 11/5/03 Owner Responsibilities Continued: • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. Note: This approval does not allow the proposed pole shed/accessory building shown on the plan to be connected to the POWTS at this time. The owner(s) must first obtain legal documentation per Comm 83.22(2)(b)5, Wis. Adm. Code, that identifies the individual(s) responsible for the operation and maintenance of the POWTS. Please see the St. Croix County Zoning office after the POWTS is installed to file the legal document and obtain permission to connect the proposed structure to 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, Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm j swim@commerce.state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 1 L Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 RECEIVED S E P 1 6 2003 S~AFEfiY & BLDGS DIV, . Date: 9/10/03 Owner:Brent Ackley Location: NE1/4 SW1/4 S 4 T35 N,R 16W Baldwin 230th St. System type: Mound System Manuals Used: Mound Component Manual version 2.0 (01 /31) Pressure Distribution Manual version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-9. Maintance and Contigency plan 10-12 Soil test Signature_ License nu 226900 Cover Page DLPAFtTMENT OF CO!~IPJ;EI~VE ~ fVISfQtrl Of.Syt~f~TY~1~D BUILDINGS SEE COi~RESFONDENCE ' PLOT PLAN PROJECT Brent Acktev ADDRESS P.O. Box 63 Roberts Wi 54023 NE . i / 4 SW i / 4 S 4 /T 29 N/R 16 W TOWN Baldwin COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE9/10/03 BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND )00C SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 454 # of chambers none BENCHMARK V.R.P. Top Of 1/2" Pipe ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 101.8` 1.7' sand lift Property Line AIt.B.M. Area 15' Below System is to remain undisturbed 5% Slope B-2 99' ' 10 0' 0 -~ m r m B.M. '-~ ~ Survey has been 100. ~o completed. Boring and ~ Benchmarks are now `~ referenced into survey r m Scale = 1 /4" = 10' 467' Property Line B- Pole Sh~ed/ Accessory Building 0 GPD B- 3 I I ...~ ~ ~'~A6~ 2 R 5~v`~ Grading is to be done S~~ C~ to divert run-off away from system ' Tank is to be properly bedded Pro 3 and provided with Bedroom lockdown covers Huffcutt Combo Tank House and approved Well is to meet all warning labels setbacks found in Comm. 83 ' Property Line ~~ No Designer Date ~•~ Scope t3on-Woven Filter Fabric 4" Observation Pipe Perforated Below Filter Fabric AST1Ni C-33 San d Topsoil r~ ~ ~~ k ! ~ rc, f~ S I v a 0 C 3 0 D pistrfibulion Pipe \~ ~ H _ F Bed Of ~ 2'~ Force Moin {~~ ~2 From Fump Drain Rock r G Flowed LOYtr ,4 ~ ~E ~ F ~.~ G ty Cress Section Of A Mound S stem Usin A tied For The Absorption Arco _._-.~- p Ft. g ~ Ft. I~ , Ft.• J I Ft. K Ft. ___ • L~t. L 4~Observotion PiPe~ .K _ ~~_~ r -_--__------ ----- ------------------- --- l _ . A ~~ _------------- 1 Force Moin ~ _ ------------- ------- From Pump 1 ~-, %~ Distribution Bed Of /y 2 t Pipe ~ Drain Rock I 4~Obcervotion Pipe~r~C'~~-~ Permonent Morker _! , r- ~ ~ ~ ~~~~ ~~.7~ , Pipe or Rods /sue /r . ~,~.~ ai.,~ vi~rt ~f Mound U~in9 A Bed For Tie Absorption Area PAGE,-.r ~F--- ~~~~ orated On bottom. ;a~dtty Spoced 9T tlOI.L K><XT TO C~MC}!of 't. ~~. Signed: License Number: Oate~ L X inches '~_,_~~_ inches ~/' / Hole btiameter °_l!~ inch Lateral ~" ~ ~ Inch{e~) Man i fo~l d " ~ Inches_ Force Main ~ inches # ~f hcies/pipe :avert tievatfon of i.ateral~~.3Ft. Peftofoted o~Re Detoit t;AM££R CROSS • SE`TION ANt-} SPLCIr iCATZOrrS S iC ~ P~?MP C EPTIC iAN s== Ci u£NT PIPE ~.~ J~I~CT~Dt~ BJX Agpg(}VFD > ~ 5 t ~R4H D44R , ~?~ A~DO~ f1R WITH CDHDU I i M.A~Ht}L£ COv ER FRESH AZR I31TAK.£ W1 PADLt}£K ~ ~IARi~IidG iABEL gIN;SHED GRADE--- ~ ~,,,,_~_+ MI?i. rr tu+i.n- 2Yu .~. D- u ~t~ i T * rT L~L~i t ~ i ~ ~,iA'~£R T'3G°-3'T S~.ALS "'~'~"" nn CC L32Q J ~ ~ TZ~H'F t ~ ~pp4iQYE{I ""'.." A SEAL ~ ;~ Ji3IirlTS ~~PIPE APPRQYE~ ~ ~ i.T ~FZ -- ~_ _ ~ ALM 3' 0li~ pPPR~1VEt1 & -,~- ~ _ ~ o~ $(}LFa SOIL PIPE 3' 4~fT~ SOLIQ ~~„F ~ ~ ~_ i 83FF' SAIL , PL#?~iF ~~F ELF . D B~D~2:6 tTtdD'EsZ i.AZ~K ~ ~;_ ApPRL3VEs7. //s ~ /COi~#CRET'E PAi~ ^~riZF1CAT~.C3N(-` r --J `~~~ f~(~yd ~- 5 SEPTIC f DQSE TA23K MANUFAC'PE1R£R : . GAL , TANK SIZES : SEPTIC y~~ GA?,. DQS£ MARK MANiJFAC3~3RER ; -- MODEL Il[lt~s~' 51~iZTCK TAPE ~IKF I~'tA~i~JFACTt)R£R C DING Ih LO ~ / AL I3flSE Vfl~ME E F,OygAC iC J - G '~ ' ES = ~/' ,) i2dCFiES A - ~l~ ~ GAL - ~I CAFACZ CAL. / 2 8 = ~NCi~iES = _ _-, (p J INCHES = £S _ ~~~L . ~ _ ~ ;KC~ r-~~ RIKO AS PER I LHR 15, 23 WAS ALgR M ~dI ~ ~~ G?ti - P[Ili~' ~ RATE ~ ?iP£ _ FEET REQ~IR~3 L}ISCHARtsE I8~'TI~ ...~-_~ ~ FEET Q, F AI~I} D I S'ZR r~1C~`. S£T'~£EK gU~SP _ - - FACTOR - - FEET VEgTICA3, gIFFER.. aL6PPLY PItE55URr. ~ '~,T. FR~CTT©*+3 ~?F~D/ r RE:£M.A. /~" ~I}';r~L D'INA,.ZC F MS _r. P;AMP '~Ar~iK: 's.sNGTt~i ~-~~. :~iT£RNAI. O IM£?fig-0 LZ~~ID ~' ~' i' _- S sGNED= :f8~ F 1; 0 w x U a z 0 a 0 ~- 0 - TOTAL DYNAMIC ri"tAD/CAPACITY PER MINUTE EFFLUENT AND DEwATERwG MODEL 152 153 Feet Meters Go.. Livers Gol. Liters 5 1.5 69 201 77 291 0 3. i 61 231 70 265 15 a.6 53 2U t 61 231 20 6.1 44 167 52 ~ 97 25 7.6 34 129 42 159 30 I 9.1 I 23 87 33 125 35 i ? Q7 -- -- 22 85 40 12.2 -- I -- 11 j 42 0 r: 38 0 Ft 6m) 44 (11 ~ ) (?...4~ Lcc k Valve: . . . . . --- o~ssoa 3 27 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. `- Iled with • Electrical alternators, for duplex systems, are available and supp' an alarm, • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik-Box available for outdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. 1521153 Series 32 32 12 1/8 ''~I I '~~ s ~~ s sK2aw SELECTION GUIDE D CAUTION All installation of controls, protection devices and wiring should be done by a qualified licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Cade (NEC) and the Occupational Safety and Health Act (OSHA). 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. 2. See FM0712 for correct model of Electrical Alternator E-Pak. 3. Variable level control switch 10-0225 used as a conVol activator, specify duplex (3) or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. __~~,,, MAIL T0: P.O. BOX 16347 -~,~1 T., ~~:,~ ~ - Louisville, KY 40256-0347 Manufacturersof. . ~ ~ SHIP T0: 3649 Cane Run Road ~ pp Zo ~~~~~~ ® Louisville, KY 40211-1961 ,~/1.dUTY~UMPS d>ti'CE ~9dJ ~ /~ ~~/Y/~ ~0 (502) 778-2731.1(800) 928-PUMP FAX (502) 774-3624 lrttp;l/www.zoell er. com © Copyright 2000 Zoeller Co. All rights reserved. ui~nJ 0 80 16U G4u JGv Maintenance and Contingency Plan for a Mound System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Dose Chamber is to be pumped at the same time as the septic tank. 3. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 4. Once every 3 years the mound is to be inspected via the inspections pipes in the at- grade. The laterals are to be inspected via the cleanouts. 5.Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 6. Pump and electrical components are to be checked at the time of the pumping. 7.Owner agrees to leave the area 15' below mound undisturbed. 8. The owner agrees to save this plan. 9. Trees, shrubs, and other similiar vegitation are not be planted on system. The system is not be driven over. 10. Effluent Quality is not to excede the requirements found in Comm. 83 Contingency Plan 1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if needed, then bypass pump float and try pump with out float. If this works, float is bad, replace float. If pump still does not work, check power at the pump with a electrical device such as a hair dryer. If no power, check breaker inside house and call a electrician. If there is power, then pump is bad and needs to be replaced by a plumber. 2. If mound fails, determine cause of failure, test another area or remove pipe and sewer rock, retill soil, install new mound system. 3. Replace any other failing components as needed. Important Phone Numbers Plumber: Shaun Bird 715-246-4516 Pumper: Tom Mondor 715-246-5148 St. Croix County Zoning 715-386-4680 F[LE pOVYTS OWNER'S MANUAL- 8~ MANAGE~C ~ cA to s~ SYSTEM SP '`~ ~ Septic Tank CaPa~ ' ~' ~' Septic Tank Manufacturer Effluent Filter Ma_. nor DESIGN PARAd-c' ~"' Number of Bedrooms Number of Commercial Units Estimated flow (average) peSign flew (Peak), (Estimated x ~ -5) Sod Application Rate InfluentfEfl'lUent Quarry FOG) Fats, Oil t;< Grease Biochemical Oxygen Demand (BODs) Total Suspended Solids {TSS) Pretreated Effluent Quality ~ D B'~od~emical Oxygen Demand (BO s} Total Suspended Solids (TSS) Fecal Coliform (geometric mean) Maximum Effluent Particle Size SCHEDULE Service Event Inspect condition of tank(s) Pump out contents of tank(s) Inspect dispersal cell(s) Clean effluent filter ~_ Inspect Pump, Pump controls 8 alarm Flush laterals and pressure test Monthly average' 530 mg/L Q20 mglL _ 6150 m~_. Monthly va stage" 530 mgt 530 mgn- 510` cfu/100m1 Y inchdiameter Page of Effluent Fifer Model ~~ -Pump Tank Capa~Y ~ ~ Pump Tank Manufacturer ~.. I Pump Man~cturer ~ . Pump Model Pretreatment Unit L p Sand/Gr~vel Fitter ^ Peat Fllter ^ Mechanical Aeration ^ Wetland ^ Other ^ Disinfection Disp It Ce![(S) ^ in-ground (gravity) ^ At-grade p p~ iris .. ^ NA D NA ^ NA ^ NA ^ NA ~^ NA ~NA ~. ^ NA ^ In-ground (pressurized) ound ^ Other scat for domestic tnon..commerdaA yrastevrater and Values typ septic tank etlquent Values typical for Pretreated vrastewater. Service Frequency 3 ^ months ear(s) (Maximum 3 yrs.) At least once every y of tank volume uals one- } When combined sludg ~a~ j e and scum eq h Y (Maximum 3 yrs•) mont ~ At (east once every . ~ ^ mono' Years) - At Least once every e ^ months r(s} ~ ^ NA ry At least once ev ear(s) ^ months ^ NA At least once every ea s ^ months ^ y r( } ^ NA At least once every ^ months ^ year(s) ^ NA At least once every licenses or MAitVl'ENANCE INSTRUCTIONS n one of the following ~~ POWTS Maintainer, Septage Inspections of tanks and dispersal Dells shall be made by an individual ca S i~~ an missing or broken Master Plumber Restricted Sewer POWT s to identify y for any back up ce~f' tcahons: Master Plumber ions must include a visual inspection of the tank( ) Senridng Operator. Tank inspect tr, check the effluent levels cracks or leaks, measure the volume of combined sludge and scum and to ch hardware, identify any The dispersal cel[{s) shall be visually inspected riding of effluent on the or ing of effluent on the ground surface- round surface. The I~ ulatory authonty- P~ and to check for any ponding of effluent on the g in the observation pipes utres the immediate notification of the la~l reg or more of the tank volume, the ground surface may indicate a failing c;ond ~ and scum in any tank equals one-third (~) Sed of in arxordance `""d' ch- NR When the combined accumulation of sludg a Septag8 $ervicing Operator and dispo entire contents of the tank shall be removed by rents, and any 113, Wisconsin Administrative Code- orients, pretreatfinent compo ~~ned by a certified POWTS Maintainer- The senilang of effluent filters, machaeiq(s of 2sm~ th o~~ shcealtnbe PP m tetion of any service event. other maintenance or mondonn9 to the local regulatory authority within 10 days of co P A service report shat) be provided resence of painting products or other START UP AND OPERATION for the P ersal cell(s). if high concentrations are For new construction, prior to use of the POWTS check treatment tanks e the treatment process and/or damage the dis o rator prior to use- chem'~cals that may impel removed by a septage servicing Pe detected have the contents of the tank(s) ~~~ r rJ` frozen at the infiltrative surface. Page of System start up shall not occur when soli oondrbons are war is restored the excess er outages pump tanks may fill above normal titghwater levels. When Po During pow _ rsat cell(s) in one large dose, overloading the cet!(s) and may result in the wastewater Writ be discharged to the dispe um tank removed by a or surface discharge of effluent To avoid this srtuataon have the contents of the p p backup rtn er to the effluent pump or contact a Plumber or POWTS Maintainer to Septage Servicing Operatoa' prior.to n~to ~ 9 Pa'^r assist in manually operating tl1e Pump controls fo restore normal revels within the pump tank not drive or park vehide~s over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or oampact, Do the area within 15 feet down slope of any mound or at-grade soil absorption are rforman~ and prolong the Crfe Reduction orelimination of the following from the wastewater stream may improve the Pe ry( dgarette butts; condoms; cotton swabs; degreasers; dental floss; diapers: of the POWTS: antibiotics„ baby . ~~ um water, fruit and vegetable peelings: gasoline; grease;. herbiddes; meat disinfectants; fat'; foundation drain {sump p pficides; sanitary napkins; tampons:'and water softener brine. scraps; medications; oil; painting products; pas ABANDONMMF-.NT anentiy taken out of service the following steps shall Ile taken to insure that the When the POWTS faits and/or is perm system is properly and safety abandoned in compliance with ch. Comm 83.33, ~soonnln ~~led tNe e: All piping to tanks and prts Shall be drsconne~ed and the aband a'ed Psi c by a eptage Servicing Operator. • The contents of all tanks and pits shall-be removed and property P° 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 PLA11 It the POWTS faits and cannot be repaired the following measures have been, or must be taken, to provide a e compliant replacement system: lacement soil lJ A suitable ceplacemen e ~ laca~s~e~t afealsho~uJd be protected trorn d stu~rbanceba d''ompacbon and should not absorption system. Th P be infringed upon by required setbms It nr the n reed foaa new sos~ d site evaluation to establish a suitable protect the replacement area writ ! with the rules in effect at that time. replacement area_ Replacement systems must comp y p A suitable replacement area is not availa~bi as a last resort to ep arce rthe failed POWTSn9 advances in POWTS technology a holding tank may be insta n facture of the POWTS a soil and The site has not been evaluated to identify a suitable replacement area. Upo site evaluation must be performed tO locate a suitable replacement area. tf no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. curd and at-grade soil absorption systems may be reconstructed in Place following removal of the biomat at ~~ - mace. Reconstructions of such systems must comply with the rules in etfiec;t at that time. the infiltrative su «Y{(ARNING» SEPTIC, PUMP AND OTHER TREATMENT TA TKREATMENT TANK UNDER ANY C RCUMDSOTANCESF DIEATH MAY G DO NOT ENTER A SEPTiC, PUMP OR OTHER RESULT. RESCUE OF A PERSON FROM THE tNTERtOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDfTIONAL COMMENTS POWTS INSTALLER Name ha, ,i~/ l Phone ~/s G --' i POWTS MAINTAINER Name cy ~ ~' J'7 ~ Phone ~ „~ ~~ `~ •~ LOCAL REGULATORS SEPTAGE SERVICING OPERATOR PUMPER Agency ~ ~A f '' Name ddn- /.' ~ / Phone j ~y ~ ~~ C~ '~ Phone ,~--- ~ ' ~f ~ ~ Th~ document meets This dowment.vas Crafted by the stafrs of the Green take. Marquette and Waushara County Zoning and Sanitation agendas. the min'unum requirements of ch. Comm 83.22(2)(bKt)(d)~(fl and 83_~a(1}, (Z) ~ f3), tN~sconsin Admtnrstrat;va Code_ Use of tfits document does G~ (fir) guarantee the perforrnanoe of the PpVYrS. ' Wisoon',sin Department of Commerce SOIL EVALUATION REPORT page of Division of Safety and Buildings In accoraance wnm ~.vmm 8~, vvis. ram. ~.oae ~ County - _-- -- _ ~ ~ Plan must er not less than 8 1 /2 x 11 inches in size h om lete site n n a Att l + ~ . p p p p ac c a o indude, 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. Please print I inf~~iV E-Q Re 'wed by Date Personal information you provide may be used f secondary purposes (Privacy law, s. .l)4 (1) (m)). ~ ~. D ~, Z„ Properly Own MAY 0 7 2003 ' ~ ~ P ertyLocation ~~ l W T N R ~ E ~ ~ ~ vt. Lot 4 S 1/4 ( PropertyOwn~r's Mailing Address ST. CROIX COUNTY L t # Block # Subd. Name or M# ~ ~ ZONING OFFI ' ~- City State Zip Code Phone City ^ Yllage Town Nearest Road s t~Z (~ ~~) - Y~',3 ~~s'o~, s New Construction Use: Residential / Number of bedrooms Code derived design flow rate 'C7~ S~? GPD ^ Replacement ^ Public or commeraal - scribe: ________ __ _,____.___.__ J Parent material ,~~, "j_r/P'n~ Flood Plain elevation if applicable n/ l ~ ft. and recommendations: m ~ ~ "'K I ~ ~ ~ ~/ ~~ # Boring 9 Pit Ground surface elev. l ~ ft. Depth to limiting factor Soil lication Rate Horizon Depth Dominant Cdor Redox Desrxiption Texture Structure Consistence Boundary Roots GP D/fP in. MunseU Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 r? L- ~ r-~ ,` ~i G1J ~ ~ , s L' Boring # ~ Bonng pit Ground surface elev~ < ~ ft. Depth to limiting factor ~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/if in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 -1 z ,- 3~ ~ s rw . -J 3 - C'z ~ ~ ~' ~ ~.~ ' Effluent #1 = BOD > 30 < 220 mglL and TSS 150 mglL `Effluent #2 = BOD < 30 mg/L and T55 < 30 mg/L CST (Please Print) Signature ~ ~ e ~u -•L.~Z.cr.- C' Address Date Evaluation Conducted Telephone Number ~~ ~ 6rys l0 3 ST EROIn COUNTY SEPTICTANK M~II~ITENANCE AGREEMENT` .AND OWNERSHIP CERTIFICATION FORM ,~, OwnerBuyer Mailing Address Property Address City/State Parcel Identification Number LEGAI, DESCRIPTION ~ ' ation '/, ~'/., Sec., T N-R ,Town of Property Loc ~ ~=~~ .---- Lot # .~.. Subdivision / r--- Certnfied Survey Map # ~`{ ~ ~~~ -- ~ Volume (~ ,Page # ~~• Warranty Deed # ,Volume ,Page # Spec house ^'1` '- yo Lot lines identifiabh~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 but the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeymanplumber, restrictedplumber or a licensedpumperverifyingthat (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. 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 Iepartment of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da a three year expiration da . . //_~~ S GNA"i [JRE OF APP ANT 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 rQoperty describe above, by virtue of a warranty deed recorded in Register of Deeds Office. ` L SIGNATURE OF APPLI DATE ******. Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ~a (Verification required from Planning Department for new ** 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 _ __ • . •. .. :~ ., .. .a _ , ~. STATE BAR OF WISCONSIN FORM 2-1982 THIS SPACE RES~RVED FOR RECORDING DATA vot 11~4PA T151 DOCUMENT NO. 53~93~`~ " ~~ Conveys and warrants to the following described real estate in ~f Gro i 1! County, State of W~ec~nstn: N w y~ a{ .sw %y a {' Je~fr-o.t ~ s- ~ 6,. `K ~~f ffw pa~f ~~ p~ ~ IQs if a~ d J11 Vo ~ • S~ S . Pti~ ~ ~G o TRANSF~IP ~~1 ° This Nl)t hom•!~tead orooerty. (ia! (is not) Exception to Warranties: REGISTER'S OFFICE SL CROIX CO., WI Rat:'d for Record OCT 1 3 :995 ~t b:~ AM ~.a~...,•~. C•~.:~. Regi~tar of Deeds RETURN TO 'fIa /t7.00 't'q, ~a3o~. Tax Parcet No: fk~-~r~'., i~ f~ ek ley pDated this 13th day of October 1995 - (SEAL) I '~ - +r e, j SEAL} (SEAL) AUTHENTICATION Signature(s) authenticated this day of , ig TITLE: MEMBER STATE BAR OF WISCONSIN (If nol, authori2ed by § 7!)6.08, Wis. Stets.) TNIS INSTRUMENT WAS DRAFTED BY (Signatures may be authenticated or acknowledged. BOIh are not necessary.) ACKNOWLEDGlMENT STATE OF WISCONSIN ss. St. Croix county. Personally came before me this ~ 3th day of October t9 95 the above named Et~ene F. Veenendali and Sandra E. Veenedall to me known to be foregoing instrume Paulette • ~-.u.•.ac.r: Notary Pubtic My Commission Ia date: Jan. •" o executed the e. • • ~ ., `S ~ ~ r • ~ roix ~ • o ty, Wis. anent',;,{ir ~ ~•I • to Axpiration • '••....•• , 194L.1 i Names ni persons •~ymn9 m any capauly ahoW 0 be typed or pnntetl below tneir erOnaWref. SBZ NTF 0021 WARRANTY DEED STATE BAR OF WISCONSIN Nako Tax Forma P.O. Box }0208, Green !fay, Wl 513}17-0208 Form No 2 - 1982 .-Z<., 4, ~ -~i;~'t7~i .}~ ,t ~'. pia ~. "~ ,,.C .~ 1:.,~ c'La~c".• ~"° :: ~','F<~ '•~',l t~:1;.,; ,1~4Z.~ ~ . r?::e.~c .,.:~ w_ _ _- ,;_{j 2 .. ._ - i '~ ':_ ~ OOCU~AENT NO. 449600 MIARRANTY DEED STATE BAB OF WISCONSIN FORM =-iMf vt: Lugene Veenendali and Sandra Veenendall, •---.......lis::vfe.~...as..joint::tenants .................................... conveys and warrants to A011~1s1,`3..Ii.r...~~1~a.~Y...~.i(1yd.,_~ut~Iey__,...., ...........A.....Arlcleir.,_..hushand..and.. x.ire.....as...~aizit ............. ............tenant s ..................................................................................... TMIa NACa R[[[RV[O -OR R[COROINe DATA REGISTER'S ~?FFICE sT. cao~x oo., wi Recd for Retad JUL 121989 . ~ nl;'p A ~pYaof9i~•r C ....... ..........................................................._..-...............-.............._.......-.... I R[TURN TO ~ .. ~r ........................................................................................... ...................... i ;~ .. ... ............................. ..County, ~-_._~ -- --- , the folloe:nQ described real asta in ~~ Crroix ~ i. State of Wisconsin: ~ Taft Parcel No----------------•--•-------••-- ,, Part of Northwest Qua er of Southwest Qua~'ter (NW~ of SW~) of Section Four (4),Tow hip Twenty-nine forth (T29N), Range Sixteen West (R16W) descr bed as followsr~ Beginning at the Southwest. (SW) corner of t said Nort est Quarter of the Southwest Quarter (NW's of SW of Sect~.on Four (4); thence North (N) along the West (W) 1 e of said Northwest Quarter of Southwest Quarter (NW's of SW's 920 feet; thence East (E) at right angles to said West (W) 1 e 490 feet; thence South (S) parallel with said West (W) line 58 feet; thence East (E) at right angles 525 feet; thence No th (N) parallel with the said West (W) line 258 feet; the ce East (E) at right angles to the East (E) line of North st Quarter of the Southwest Quarter (NW's of SW~); thence S th (S) along said East (E) line to the South (S) line of sa Northwest Quarter of the Southwest Quarter (NWT of SW's); t ence West (W) along the South (S) line of the Northwest Quarter of the Southwest Quarter (NW~ of WaI) to the point of beginning. This ..........f 3__tlOt_.-_ homestead pro rty. i 7~C (is not) ' Exception to warranties: Edsem nts and restrictions of record. _ Dated .:~is ...................•----.....-•--------......... day of -•-----.....---•--•----.`7uly----••---.......---..-...-•----•--• 18...89. ...--••---••---------•-----•--------•----------------••-•-•------... (SEAL) s ----• .............•--.....----....-•-•----•--•---•---•----•-•--...-. (SEAL) AIITH$NTICATION authenticated this .__._...day ol ........................... 19....._ TITLE: MEMBER STATE BAR OF WISCONSIN (It sot, ----------•-•--•--•--------------------•--------••---••----- anthorized by # 708.08. Wis. Slats.) -'-0`.-....--.U~•!/~2L~-~T---------- ----------(SEAL) Eu ene Veenen 1 ---- -- - r• Sandra Veenendall ,. ''' r ~:+~~ - ------ ----- - ------------- -- - ---- -- -- -- -----.57 .~. .'•'~~ ~'0 ACHNOW:,SDOMSNT- ~ ~ I Z a~~ ~:;~~ ~.~ ~~ t•- 3TATE OF WISCONSIN ss. •~,' -f Z v'1 V ~: ______ ST .._CROIX__.______ County. ~ ~-'~ ~ Personally came before me this -...----.J~!-_d;ly df •---- -_-•--July-------------••-_---. 19.s9.9.. the above named _.._.Eugene_.Yeexlext~lall---ax?w.s~__ S~nd>i a -------- ---. Ye~nendal]----------•-----•----------------------------------- to me known to be the person S---.-.._- who executed the foregoing instrument and acknowledge the same. THtS INSTRUMENT WAS GRAFTED BY Thomas A. McCormack ~R-LAY-----'``---~~~'~-!C~'z'•'~?------------ --- ----- ------- Baldwin r WI 54002 ----- -- - ----------------------- ---- ....................................................................... ~----------e---- county, Wis. ----•--- Notary Public ---•-- l~ C / a~~-------------- (Signatures msy be authenticated or acknowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: .--.Q G~` 7 D-, •------- ------------- - ----- ••-----------, 18.9... > eNnmr of Mraow d[niae In any caDSeity should M typed or printed below their ei[naturea. WARaAN1T DYED BTATB HAA O! WISCONSIN R'i+ennain Le'[al lilonk t•... Inr NORM I7o. R- 198E *i ~:Mr.o k<w•• tYis. ~ _~ '745425 VOL 18 pAt,E 4645 CERTIFIED SURVEY Douglas and Audrey Ackley Located in part of the Northwest'/. of the Southwiest '/. of Section 4, Township 29 North, Range 16 West, Town oJBaldwin, St. Croix County, Wisconsin. wEST uv coRla:R SrCT10N4, T2DN, R 16W (FO WiD COUhIIY ~tNT S6Y NAf J ' 1143 3207H S7REET ~~ ~ i BALDWIN, W151002 ~ MO y I ~ A;ritallard >~ ~Rd ~ !1'la1Dd H~ Cooly 7.Oata6 OrdiS~K-'Iti! plOpoxld ~ YOaa! Oclapaaly is V eo~p6au nilll ~>M'~0~° KATALEEtI H. ~- REGISTER OF DEEDS ST. CROIX CO. MI RECEIVED FOR ~tECORD 11/03/2003 89:30AM CERTIFIED SURVEY MAP REC FEE: 13.00 COPY FEE: 3.00 PAGES: 2 N BEARINGS ARE REFERFJVCED TO THE WEST ffNE OFTHE SDUTHWEST tA{ OF SEC110N 4, T 2Y ~ R 1a W, ASSUMED AS 5 OO~OOtiO' W. SCALE 101 FEET f • ^ 100' ~i ~ $ ~I 2l 3 W'I ~' W~ ~I ~ a I Z ~~ .~.w I 100' xa./s W Ig LOT 1 $ i CONTAWS119,f13SQ.F1:OR2734AC. F"' w t yl (112,843 SQ. FT. OR2.5ti0AC. IXCLUDb41G ~ i TOWN ROAD RIGHTOFWAY) 8 ~ ~ °~ + N s~ . N 89°38'28` W 500.75 UNPLATTEDLANDS 33' ~ ea-1 ~~ N s ~~ ~°38'28' W LEGEND ~ NWCATES 1-1M' O.D. x 18' WON O PIPE SET (AN11. N?. -1.13 LB.A_F.) ~ SOtI BORII~KdS (PROPOSED SEP71C SYSTEM) 0 SECTION f?ORNER MONUMENT (AS NOTED) ~TloniisrTZr.COK~R /a w rFOUMO couvrvar~lrrsr~v ALUMNUMM THIS WSTRUMENT DRAFTED BYJERALD L CARSON Vol 18 Page 4645 APPROVED Br. atolx rouNrY Plrninp ZonUa ~ Pwk+ Cemmxme NOV 0 3 2003 M not scolded within 30 days of approval dale approval shall be nlld anrf vr~A ,r:•,,....,•:• • LAURENCE ~ W. MU~~/~~y~Y *~ --~~LLS J--r/ia :ft 'NVILLE ~ WI. .C ~ J~ ••J~ ~~ LANO 9 a~~a zoa+ SHEFT 1 OF 2 ~3