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HomeMy WebLinkAbout002-1091-80-000~onsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building D~yision ' INSPECTION REPORT GENERAL LI~FORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Willert, Crai and Diane Baldwin, Town of :ST BM Elev: Insp. BM Elev: BM Description: ~a a (3rv~ ~ Gs i SANK INFORMATION TYPE MANUFACTURER CAPACITY Septic I ~ ?r- ~,~~ S I ~ 5 O Dosing ~. 0 5 ~ Holding ~.--- _ ___ TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ,~ i~~ / / ~c'~ b ~ i / -~ Dosing ~ l / f ~ - '_T ~ ~ 3 -° Aeration ~` -___ Holding ~--_ -____ __ PUMP/SIPHON INFORMATION Manufacturer r ( - V Demand ~6 PS` tt~l~~ GPM Model Number ~~a O TDH Li .~p Fric~~ os$s ,,,7 System Heads TD~,iZ `q~Ft Forcemain Len th i Dia. i/ Dist. to Well ~~/ Z ~ SOIL ABSORPTION SYSTEM county: St. Croix Sanitary Permit No: 479281 0 State Plan ID No: Parcel Tax No: 002-1091-80-000 Section/Town/Range/Map No: 36.29.16.522 ELEVATION DATA STATION BS ~~ 73 HI io~.7 FS ELEV. dO Benchmark ~, 'r z I~~,Z /CIA Alt. BM 3.~ ~Y. o Bldg. Sewer <Z . ~ SS .~ SUHt Inlet SUHt Outlet ~ ~. Dt Inlet `- ~ Dt Bottom (7•~ C J~ , Header/Man. Z•~ $, '/~,~ Dist. Pipe ,Z q,or ~$ a...75 Bot. System 3 .63 ~ r ' Final Grade `qC 9~ _ St Cover ~~~ 7 r g~ ~ Jlc~, C_._6 ~ov ~ ~ . ~ 9~~ ~O Width Length / No. Of enche NS~S PIT DIME No. O Pits Inside Dia. Liquid Depth D MENSIONS D ~' 7~ ^ -~ ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: > /~ r ~~ r ' ~~ / ~ ~~ / UNIT Model Number: ~ a~ DISTRIBUTION SYSTEM r °"`v~ Header/Manito~cj j/ (~ I Length_~ Dia , Z" Distribution 7~, ~ /~ rf Pipe(s) ? Length 7Z ~ I I Dia 1 Spacing ~7 ~ x Hole Size ~ / / x Hole Spacing ~ f ~~p ~ ~ Ve t to Air Intake J 1 /,S di~ 3 SOIL COVER v Proccrrro Carchvmc flnhr YY MArrn/t nr Ot.r~ralte SVRtemS CjnlV ~~'~ ~v` Depth Over J Depth Over xx Depth of xx Seeded/Sodded xx Mulch d BedlTrench Center /' ~ ~ Bed/Trench Edges Topsoil ~ ~ a [_ 1 No i ,. y, No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~' _ / Z ~ UJ Inspection #2: / / Location: 644 270th Str1eetl,W,o~~ill~e, WI 54028 (NW 1/4 SSE 1S~ll 36 T29N R16W) NA Lot C'~,'~"Q~'' ~ Parcel No: 36.29.16.522 1.) Alt BM Description = `~~'"'" ~ "" ~~~~aG~/~ ~/ d 2,) Bldg sewer length = ~c;,~~-fC~ d' U(J ( L.~ ~/d /'`J ~ ~~ - amount of cover = 7g ~ ~~ y ~ r d--b Ir.~, ~: ~ o (` cr re~.tt~-~ J I - -- - -- ~--C-- ~ --- i-- -1 ---- - -- --- Plan revision Required? , I Yes o L_ I G~ ~7 i ~ (,, Use other side for additional information.' ~ I ~ _ - - - - I "' - , Date Insepctor's Sig ure Cert. No. . SBD-6710 (R.3/97) i~ A~_ d Buil ings Divl y ` ~ m 2 ~ 'n ve., P.O. Box 716 .~..~ ST. ROIX t irscons~n ~ I~Stidt 3707 112 51 ~ ~ ~~ Sanity ermit Number (to be filled in by Co.) De artment of Commerce , ~. ~QQ Sanitary Permit Applicat' ` ZoN/ 01X ~~'u NT N S lan LD. Number ~~~/(~~ In accord with Comm 83.21, Wis. Adm. Code, personal information you provr ` 1 6387 _ -~-2tq,N S , l ~ . may be used for secondary purposes Privacy Law, s15.04(lxm) P ct Address (if different than mailing address) I. Application Information -Please Print All Information 1 _ Property Owner's Name Parcel # Lot ## Block # CRAIG WILLERT ,ems N/A N/A Property Owner's Mailing Address Property Location 644 270 270TH STREET NW SE Section 36 '~ `fi City, State Zip Code Phone Number ti g WOODVILLE WI 54028 715/698-2577 n ~, ( T ~`~ N; R ~pcirclione) v II. Type of Building (check all that apply) ~ 4 [i 1 or 2 Family Dwelling -Number of Bedrooms Subdivision N e C~ Nu.ber Public/Commercial -Describe Use N/A ~ n `jS aL>ree ~•2ex ^StateOwned-Describe Use ^City ^Village~fownshipof BALDWIN III. T ype of Permit: (Check only one box on line A. Complete line B if applicable) ~~ Z - Q ~ - ~ -~tJO ..SZZ A. ^ New System ~ Replacement System ^ TreatmenUHolding Tank Replacement Only ^ Other 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 Gvlter I 4 IV. T e of POWTS S stem: Check all that a 1 K . ~ ^ Non -Pressurized In-Ground ^ Mound> 24 in. of suitable soil ~ Mound <24 in. of suitable soil ^ At-Grade ^ Singte Pass Sand Filter 0 Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recireula6ng Synthetic Media Filter ^ Leaching Chamber ^ Drip Line Q Gravel-less Pipe ^ Other (explain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 600 1 600 600 98.1 VI. Tank Info Capacity in Total Number Manufactu re r Prefab Site Steel Faber Plastic Gallons Gallons of Units ~ I ~_~ p ~ ~ ~ ~oncrete Constructed Glass New Existing ~~~'~`,~M 1' p ..~ Tanks Tanks Septic or Holding Tank 1250 1250 1 WIESER CONCRETE X Aerobic Treatment Unit DosingCltamber 750 750 1 WIESER CONCRETE X VII. Responsibility Statement- I, the undersigned, assume responsibility For installation of the POWTS shown on the attached plans. Pluraber's Name (Print) Plum 's Signature MP/MPRS Number Business Phone Number BENNIE HELGESON 0292 715/772-3278 Plumber's Address (Street, City, State, Zip Code) W1229 770TH AVENUE, SPRING VALLEY, WI 54767 VIII. Coun /De artment Use Onl Approved ^ Disa d Sanitary Permit Fee eludes Groundwater Date Issued Issuing nt Signature o Stamps) Surcharge Fee) ~~~ ~ e on for Denial ~ IX. Conditions Approv al SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must ali be serviced I meprltain®d as per management plan provided by plumber: 2. All setback requirements must b® maintained as per applicable code%rdina~n~s. Attach complete plans (to the County only) for the system on paper not less than 812 s 11 inches in size SBD-6398 (R. 01/03) d ~Z~ L a ~ 4~ ~~Y i i 0 ~ I IR commerce.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi. gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary June i 7, 2005 CUST ID No.220292 ATTN: POWTS Inspector BENNIE W HELGESON ZONING OFFICE HELGESON EXCAVATING ST CROIX COUNTY SPIA W 1229 770TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON W[ 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/17/2007 Identification Numbers Transaction ID No. 1146387 SITE• Site ID No. 700237 Craig Willert Please refer to both identification numbers, 644 270TH Street above, in a!1 corres ondence with the a~enc . Town of Baldwin, St Croix County NW1/4, SE1/4, S36, T29N, R16W FOR: Description: Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1024042 Maintenance required; Replacement system; 600 GPD Flow rate; 18 in Soil minimum depth to limiting factor from original grade; System: 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: 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 (8.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD-10573-P (8.6/99). • Per manual cited 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. ~0,3tC~lih • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption I area. chs. NR 811 & 812c dEF RTMENT C • A Sanitary Permit must be obtained from the county where this project is located in accordance with the OF E requirements of Sec. 145.135 and 145.19, Wis. Stats. - ~"~~'~~ SEE CORRE~ BENNIE W HELGESON Page 2 6/17/2005 • 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. Stat • Comm 83.220 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: • 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 83.52(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. • 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/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, ~~~~~ ~~ ~~.,-~ Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@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 PROPERTY OWNER: INDEX SHEET CRAIG WILLERT 104 TRIENT DRIVE PO BOX 245 WOODVILLE , WI 54028 PROJECT NAME: CRAIG WILLERT PROJECT LOCATION: NW 1/4, SE 1/4, S 36, T 29 N, R 16 W MUNICIPALITY: TOWN OF BALD WIN COUNTY: ST. CROIX DESIGN: PRESSURE DISTRIBUTION MANUAL SBD-10573-P(R/99) MOUND COMPONENT MANUAL SBD-10572-P (R 6/99) CONTENTS: Page 1: Page 2: ~~G~,v~® Page 3: ~~N 1 ~ 2005 s Page 4: ~~~\~®`~~ Page 5: SPF~~ Plot Plan Cross Section and Plan View of Mound Distribution Pipe Layout Septic Tank & Pump Chamber Cross Section and Specifications W 1250/750-MR 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 Address: W 1229 770th Avenue Spring Valley, WI 54767 Credential Number: 220292 Signed Date: June 7, 2005 '~,~~rlly ~~ co.M~,~~RC~ ~B cs OND _ G~- ENCE . i~ _0 <-r- L ~~ J O r - ~~ d J .+- D ._, 4- 7 r~ i e .Synthetic Covering ~STN1 C 3.3 Medium Sand -~ ~t Topso(I _~ - I E 3 ~~ % Slope Aggregote _ Cross Section Of A Mound Signed: License Number: Date: Distribution Pipe D ,/~„ Elcu, 96.6 DI': /~ctr Force Main From Pump Pfowed Layer , 0 /, ~ Ft.` E ~,3 Ft. F ~ Ft. ~ , S'" Ft . q~_Ft. H ~.yFt. 4 ~ Ft. K //-/~o F t . ' L ~,3~ Ft. D e `~ F t . I ~ Ft. W~ Ft, Observation Pipe ~ ~y~. K s -.-- _ _l _.._._._ - ---~---- _ _'--' 1 ~_ _ ---------__ _-- - --- - - ---- - ~ n.~. A I` - ----------------------------------- j w ~ ~ --,=r--T-----------------' j~ Distribution ~`t"I" Of Z - 2'2 Pipe A99fe9ote I ~ Observation Pipe /' 777 ~'D ,c3~5~-~ ~~'e~' Plan View Of Mound • ••i'L C-~c:~c 1 ,; 71Dr ,: Holes Located on Bottom.. are Equally Spaced. f ~~ i ~ 1~ ~~~ "E o%' r [t vt_i41._~i.__.._ Irs. .l1 ~ I~•~ P e~lorolna I'Ip. Ueloll \~ 1 / End yl~w /Fer loru~<U ~ Pvc P.D. Crul- r" w~l ~~l ~! (.. Distribution Pine Layout Signed: License Number: . Dace: _~,~ R , S 6 y ~~ X a 6 ~'' 1 ,~ rya Hole Diameter ~, Inch Lateral " _.~.... Inch ass) Manifold ~ Inches Force Main " ,~_,._ Ynches .~,~~L~E~rt ~I~e~. 98. ~ ~o(es ler ~ra~2Fa[ ' 3 y Nt.~w. per o T ~-.p~'~e I~b~S X 3 /4 ~ ~o~tS ~ ~ ~ r -{- Page ~ Of g SEPTIC TANK b PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4" ~11~VENT PIPE 12" MIN. ABOVE GRADE E WEATHERPROOF JUNCTION BOX APPROVED > 25' FROM DOOR, WINDOW OR WITH CONDUIT MANHOLE COVER FRESH AIR INTAKE W/ PADLOCK E WARNING LABEL - ~r,~._4" MIN. 2'1 a . ~ .~. D. u 18" IN. ~ ~~ 18 rniw. INLET ~ ~ , WATER TIGHT SEALS GAS- TIGHT ~ ~~ vAPPROVEO A SEAL ~ ~ JOINTS WITH F1~7ER - ! ALM APPROVED PIPE APPROVED ' zA $E-- _ _._ g ~ i ON ~ 3' ONTO SOLID SOIL PIPE 3 ONTO SOlIO ~9,~ ~FT C -~' ~ ' OFF SOIL • PUMP OFF ELEV . D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE ~D,~S X S. ~ ~~ GPI. TANK MANUFACTURER: ~.o )~~SPf'~ TANK SIZES: SEPTIC ~o(S~ GAL. DOSE VOLUME INCLUDING DOSE ~ GAL. ~~~ Gct~. FLOWBACK: O. GAL. f, L ACITIES: A = ~.S INCHES = S___ ~ 3. GAL. ALARM MANUFACTURER: ~. ~~-"`'~'° Sysr~~' .. MODEL NUMBER: /D/ /-l - g = 2 INCHES = „~~.[1~,j--~L. SWITCH TYPE: ~ r Cow" PUMP MANUFACTURER: ~0~~~~(i C = ~y INCHES = , 7 GAL. MODEL NUMBER : ~ D ~ INCHES = ~~t'. SWITCH TYPE: 1-cuv- ~ocs. 16.23 WAC REQUIRED DISCHARGE RATE ~ ga GPM PUMP E ALARM WIRING AS PE VERTICA L DIFFERENCE BETWEEN PUMP OFF•AND•DISTRIBUTION PIPE•• U FEET + MINIMUM NETWORK SUPPLY PRESSURE FEET + ~ 8~ FEET FORCEMAIN X (p'1 FT/100 FTOTALIDYNAMICAHEAD ~=• ~_FEET INTERNAL DIMENSIONS OF PUMP TANK= LIQUID p~'I`A-~ WIDTH DIAMETER k s < < sti.~ct T // /~o. ~ ~ ~ci~. ~er ,r~c~ ~lec.Se ~ eG s SIGNED: LICENSE NUMBER: DATE: 1/88 r1 L/ ~"l f7 ~~ ~ ~c5. \ C t1 i I ~ ~ P.r ~ f ~i ~ O T 155" W1250/750-MR TANK SPECIFICATIONS a -roP vlEw SCALE: 1 /4" = 1' DIMENSIONS: WALL: 2- i /2" BOTTOM: 3" COVER: 6" MANHOLE: 24" LD. HEIGHT 66' O.D. LENGTH: 155" O.D. WIDTH: 86" O.D. BELOW INLET: 53" O.D. LIQUID LEVEL: 47" WEIGHT: 14,795 LBS INLET AND OUTLET: 4" BORE WITH STOP FOR QUIK-TITE, FERNCO GASKET, CAST-A-SEAL B00T OR EQUAL INLET AND OUTLET BAFFLES: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 25.96 GAL/IN (SEPTIC) 16.12 GAL/IN (PUMP) LOADING DESIGN: 7' 0" UNSATURATED SOIL SIDE VIEW SCALE: 1 /4" 1' ~DC~~I~a ~oac~a~~~ W3716 US HWY 10, MAIOEN ROCK, NA 54750 800- 325- 8456 MODEL W1250/750-MR SEPTIC/SEPTIC, SEPTIC/PUMP OR SEPTIC/SIPHON JANUARY, 2.000 F~LF wt?5^ 750-IJR r ~ /1 r ` ~ ar ~ - l~ 5 i L 1 _~r--I- • ~I~ HEAD CAPACITY CURVE __ _ w w 3s 3: n x. P t Q 1a 11 - ttON PEN WNUiE 1>0 1~ -r---r 569 6.0 009903 WARNING: Model 185 should not be subjected to heads less than 30 feet TDH. 185MODELS SingMSeY D185 4185MODELS DoubhSal - Stan and al models • 20 Volts Ph Mode 230 1 Auto h. cord • i H.P. Control Selection _ Amps Simplex Duplex 9.8 1 or 18 8 Listings CSA UL Y Y E185 E4185 230 1 Non 9.8 2 or 2 8 7 3 or 5 8 6- Y<n Y ' H185 - 200.208 1 Auto 11.5 1 8 8 N N ' 1185 ' µ1B5 200.208 1 Non 11.5 2 8 7 3 or 5 8 6 __ N N ' F185 • F4185 230 3 Non 7.4 4 8 6 3 8 4 or 5 8 6 __ _Y Y ' J185 ' J4785 200.208 3 Non 7.5 4 8 6 3 8 4 or 5 8 6 _ Y Y ' 6185 ' 64185 460 3 Non 3.7 486 384or586 -_ Y Y ' BA785 - 575 3 Non 3.3 4 8 6 -_ _ 3 8 4 or 5 8 6 _ _._ Y N_ 188MODELS 41SBMCN)ELS Standard all models • 20 h. cord • t', H P Control --- Selection Listi ngs, SingkSeal Double Seal Volts Ph Mode Amps Simplex Duplex CSA, UL D188 - 230 1 Auto 13.7 1 or 18 8 _ _ __ __ _ N N E186 E4186 230 1 Non 13.7 2or287 3or586_ N N ' F186 ' F4186 230 3 Non 9.2 486 384or586 N N ' 6186 '64186 460 3 Non 4.6 __4 8 6_ __ 3 8 4 or 5 8 6 __ ------------- _ N__ _N 18SMC4)ELS /188MClDEL3 ------ Standard all models • 20 ft. corn '; n.~ . Control Selection _ _Listings SIngNSeal DoubkSeal Vohs Ph Mode Amps Simplex Duplex _ V CSA UL ~'1 D786 - 230 1 Auto 13.3 1 or 1 8 8 _ _N Y E188 E4188 230 1 Non 13.3 2 or 2 8 7 3 or 5 8 6. Yt'I YI'l • H188 - 200.208 1 Auto 16.8 1 8 8 N N ' 1788 'µt88 200-208 1 Non 16.8 2 8 7 3 or 5 8 6_ __ N N ' F188 • F4188 230 3 Non 8.9 4 8 6 3 8 4 or 5 8 6 -_ Y_. Y • J188 • ,µ78g 200.208 3 Non 10.3 4 8 6 3 8 4 or 5 8 6 Y Y • Gt •64788 460 3 Non 4.6 4 8 6 3 8 4 or 5 8 6 Y Y • BA188 575 3 Non 3.5 486 384or586 Y N 1S9MODELS 11NMODELS Standard all models • 20 h. cord • 2 H.P. Control Selection _ Listings SIngNSsai o D189 DtNrbkSeal Vohs Ph 230 1 Mode Auto Amps 17.1 Simplex 1 or 18 8 Duplex CSA N UL r'i o E189 s E4789 230 1 Non 17.1 287 3or586_ Yp+ N'1 • Ht89 - Z00-208 1 Aub 20.5 188 N N • 1788 •µ1B9 200.208 1 Non 20,5 2 8 7 3 or 5 8 6 N N • F789 ' F4189 230 3 Non 11.2 486 384or586 Y Y • J189 •,µ78g 200.208 3 Non 132 486 384or586 Y Y • 6189 • G4t89 460 3 Non 6.0 486 384or586 Y Y • ggtgg 575 3 Nm 5.8 486 384or586_ Y N n WD1~ ' WD4189 230 1 Aub 17.1 2 or 2 8 8 N N 191MODEL Standard all models • 20 ft. cord ~ 2 N.P. Control Selection Listings SiSi SeY Double Seal Volts Ph Mode Amps __ _ Simplex _ _ Duplex _ . _ ..CSA UL E191 - 230 1 Non 14.5 2or287___ ___. 3or586 N _- _N_J • No Molded Pkq (1) l1l lb0ed urdt available with 20 Amp Phlg. {2) CSA APDm`r~ wXhad Dw9 caP• (3) 20 Amp Outlet PM 10-0060 must be used. :a • ~• • e ;' • le 9/16 SK37~ e • E ~ • • . e ~ a 3/' ~~I/~~~ l 20 SELECTION GUIDE SK111~ 1. Integral tfoat operated 2-pole mltchartir~l switch, no exterrlel ca-ad required. 2. Single piggyback variable level float switch or double piggyback variable level float swtch. Refer to FM0477. 3. Mechanical alternator M-Pak 10.0072 or 1l}-0075. Refer to FM1Y195 4. Simplex three phase control panel. Refer to FM1228. 5. See FM0712 for correct model of Electrical Alternate. 6. Variable level control switch 10-0225 used as control activator. specify simplex (3) float a duplex (3) a (4) float system. D CAUTION .. ~:. ~.~ .;:~u., m cenuois, protection devices and wiring should ba done by a 4wtNNd ~,.. ~,~ •~.~.:ruiuan.AllelecVicalandsaretycodesahouWDerolbwedineludinglhamoal ~ ~~c •~~.; ~w.u~„~.,d Electric Code (NEC) and the Oeeupatbn~ Safely and Haahh Act (OSHA). F or in formation on additional Zoeller products refer to r~tak>0 on Plggybadk Variable Level Float Switches. FM0477; Elechical Alterrletor, FM0488; Mectlenical Allema- tor, FM0495; SumplSewage Basins, FM0487; Simplex Ptxnp Contrd, FM1596; Alarm Systems, FM0732; and DisconrlecURaA Syslerns, FM0787. REST-~ :'~~ ~ ~~°~,~ ~<E~ DESiGty For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. © Copyright 1999 Zoeller Co. All rights reserved. I 1/r -11 1/Z NM 7 - 11 1/2 NPT (OR) 1 NPT 1 1/Y -11 1/2 NPT $ - B NPi POWTS OWNER'S MANUAL & MANAGEMENT PLAN „ c .ueno~~nTlnN r~~c .nrv......-......~ Owner GkAll; L~ILLBKT _ Permit if ~~ ~"~ . nwew^ UC.7WIr rr+n~,.,v.•..... Number of Bedrooms 4 ^ NA Number of Public Facility Units ~J NA Estimated flow (average) 40U al/day Design flow Ipeakl, (Estimated x 1.5i b00 yal/day Soil Application Rate U.5 al/day/ftZ Standard Influent/Effluent Quality Monthly aver age' Fats, Oil & Grease (FOG( 530 mg/L Biochemical Oxygen Demand (BODE) 5220 mg/L 6d NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly aver age Biochemical Oxygen Demand (BOD51 530 mg/L Total Suspended Solids (TSS) 530 mg/L ~ NA Fecal Coliform (geometric mean) 510' cfu/100m1 Maximum Effluent Particle Size Ya in die. ^ NA Other: ^ NA `Values typical for domestic wastewater and septic tank effluent. MAINTENANI:t at,.HEDULE Service Event Inspect condition of tank(s) At least on Pump out contents of tank(s) When com Inspect dispersal ce(lls) At least or Clean effluent filter At least or Inspect pump, pump controls & alarm At least or Flush laterals and pressure test At least or Other: At least or Other: Paye 7 of ?~ SYSTEM SPECIFICATIONS Septic Tank Capacity ~ O NA j Septic Tank Manufacturer w•I)SER CUNCRITE O NA O NA Effluent Filter Manufacturer ZABEL j Effluent Filter Model A-lU0 12" xl0" O NA Pump Tank Capacity 750 al O NA DNA Pump Tank Manufacturer I,dIE51~;K CUfrCI:ETB Pump Manufacturer LOI:LLER PU>`1P CO O NA Pump Model 41139 O NA ~7 NA ~ Pretreatment Unit ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Dispersal Cell(s) DNA O In-Ground (gravity) ^ In-Ground (pressurized) ^ At-Grade [Y Mound ^ Drip-Line ^ Other: other: O NA Other: O NA other: DNA Service Frequency ^ month(s) (Maximum 3 years) O NA ice every: 2 ® earls) biped slud ge an d scum equals one-third (Y,1 of tank volume ^ NA !,; 2 ^ rnonthlsl (Maximum 3 years) O NA ice every: ® earls) { ! O month(s) O NA ice every: 13 ^ earls) D month(s) O NA ice every: 13 ^ earls) { ^ monthlsi O NA ice every: 3 ~ year(s) ^ month(s) ^ NA '~ ice every: ^ year(s) O NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or Certificat ohs: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tani. inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any eraCki 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 celllsl 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 combinedk shalllbear'emovedl by a Septag Servicing Operator( and disposedlofrin accordance with chapter NRe11'3~, contents of the tan 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 S12 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. OMW (4/0 t UNDER: CRAIG WILLERT Page ~ of c`i STAR'T' 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. System startup 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 cooled 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 ar park over, or otherwise disturb or compact, The area within 13 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 POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dents! 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. ABANDONMENT When the POWTS fails and/or is pemtanently taken out of service the following steps shall betaken to insure that the System is properly and safely abandoned in compliance with ch. Comm 83.33, W isconsin Adrnirustrslive 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 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, ar 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 slrudwe, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish s suitable replacement area. Replacement systems must comply with the rules in effect at that lime. ^ 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 bern 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 ~ 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 POW'fS INSTALLER POWTS MAINTAINER Name Name ' 1 Phone 715/772-3278 •Phone 715/273-5811 • I ' SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORYAUTHORfI'Y Name JOHNSON SANITATION ~ A9e~~Y ST. CROIX COUNTY ZONING ' Phone 7 7 - 1 Phone 715 386468 This dowmant was dnMd by Iha stsfls o/ Ihs Gtssn Lake, Marquette and Waushara County Zonlnp and Sa1lNatbtt tlpattd~i, TAIi dOgIf11N1~IPINI~ tna minimum nQULamanta of Gt. Comm 83.7Z(Z)(b)(1)(d)d(Q and 83.54(1), (2) 6 (3), VVlsconaln AdmWslratlw COd~. UN dth4 d0011pNAldOM ~ quannta• fhs psAortnsnu of UN POWTS. ~~~ .w , pqo Wisconsin Department ofCommer~~ SOIL EVALUATION REPORT Page / of~ Division of Safety and Buildings __r„ In aCCOfCI Horn. ~.we (~'EC i Pl n mu t 1 TRfCPf l i l 1/2 County ~~ -- ~~~~ es In x te p an on paper not less than Attach comp ete s s ze. a inGude, but not limited to: vertical and horizontal r erence point (BM ), direction an Parcel I.D. percent slope, scale or dimensions, north arrow, a d IocatioR ~dc~li~ar~~near t road. Please prinf all inf mation. Reviewed by Date ~~~~ Personal information you provide may be used for sewn ry pus V2 UNTY ~~. 15.04 ( ) (m)). J! ~~ Property Owner roperty Locatio n1 ` (~ S ~ ~ ~ p ~ 6 ~ S ~ c-l ~ Govt. Lot W o 1/4 ~ 1/4 ~ I T ~ N R ~ E (or W Property Ownet's Mailing Address ~ S"~ ~ Lot # .~ Block # ^ Subd. Name or CSM# r~~ ro~~ 2 7a~'1 . City ~ State Zip Code Phone Number ~ Lf ~ ~ S ^ Ciry ^ Village [~~6wn (d~ ~ Nearest Road ~ 7a,F~ ~~~-~ a ~ ) 9 ~ - -e t~V.~ ,syo~ ~ I ~ a ~ ~ r a ~ ^ New Construction Use: NJ Kesidential / Number of bedrooms ~_ Code derived design flow rate '~/SO GPD [~teplacement ^ Public orcommercial -Describe: ~I Parent material ,~.c~rs c C~C~ er ~. ~ ~ Flood Plain elevation if applipble A /V/~f- ~ General comments ~ s ~ , ~ (~ ~ X 7 S ~ C -e ~ / w ~ ~~ ~ ~ ~ ~ CY G' and recommendations: s~ " C.l ~ ~ h ~ [] Boring Boring # [~ p t Ground surface elev. 9~ ft. Depth to limiting factor ~_ in. Soil A lication Rate n i ti D R d Texture Structure Consistence Boundary Roots GP D/fP Horizon Depth in. Dominant Color Munsell escr p o ox e Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 a - a ~ ~ - L >ti. ~ ~~- t F ~ F • ~ 3 ~ 7.s ~ ~ ~, ~ . ~ - ~ a Boring # o ~ing /~// Pit Ground surface elev. % `~"• ® ft. Depth to limiting factor ~~ in. Soil A liption Rate D th i t Color D Redox Description Texture Structure Consistence Boundary Roots GPD/ff Horizon ep in. om nan Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 ~ -! I Oil K- ~ a rvu.5 r IJ , . ~ t ` / ~f- - ~ .~` ,, ~~ 3 'Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' trnuent ~z = rst~u ~ su mgi~ ana ~ ~~ = ~~ ~~y~~ CST me (Please Print) ignature CST Number ~Etn,~ r ~ ~~ ~ ~S~ Address C Dat valuation Conducted Telephone Number >. Property Owner /"l rS. ~-~0 ~/ ~~ d ~SQ`"~ Parcel ID # Page ~_ of Boring # ~ Boring 3 ~t Ground surface elev. ~ ft. Depth to li~iting factor ~,_ in. Soil A ication Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/f~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 a ~ - eY ~ I r ~ Z~~ ~ -~ .5 y~ ~ ~ u lob t~ l ~~ Boring # ~ Boring /~o~- o~ 'P ~ a~ `Ar ~esS ^ Pit Ground surface elev. r"-' ft. Depth to limiting factor / U in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlft? in. unsel 1 M Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff# 2 /,p7 ' y7.) //~~ \1 / f ~ ~ 'l ~/( /o-i ~ ~ ~s~ ~ 'L /~ ~" /oar ~ 3 S C~ ~ • ~ U Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil A lication Rate riz n H th De Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft'- o o p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I 'Effluent #1 = BODS > 30 < 220 mglL and TSS >30 < 150 mg/L 'Effluent #2 =GODS < 30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-2b6-3151 or TTY 608-264-8777. Sl3D-8310 (R.07/00) ~-±; ~ ~ ~- ! ~ ~ ,~ m 2~`~ .~-- ~` ~ 's s ~ r ~ t -~ u ~ ~ o ~ ~' L ~ N "^ J I !. Fhb !(! ti ~ \/ I ~ _....-__..__........ ,t c ~ ~~~ ~ ~ , Q _ ,,,~f,--__ ~ /mil _ i r I z ` C~.. t~ n c "~ ~- -~- ~ ~ _ ~ M L .. c~ d of s ~ o~1 ~, _. ~--' ~_.Y.__. 'Y- ~ Y~ ~~ s ~ ti~3 ~~ ~ ~ ~ ~~~ s.~~ S`-.1 !! .~ ~ ~ -__. ~ ~ ~ }~-~ ~ ~ _ ~ ~ ~ ~. ~ o ~C. iiJ °` ~ ~~ M \ __ ~ ~;~ ` \ o ~~ ~ oa ~. ~ ~ ° ~ .~ `. , ~ s ~ ~ ~ ~~ ao ~ a~ T ~~ ~ ~ ~. fl~~ ~~a ~ .~ ~g ~~ 4 OwnerBuyer Mailing Address ~~~ Z ~y ~~ ~~~~~ Property Address `~ (Verification requ ~~ ~ City/Siaie ~-4J~d' V LEGAL DF~SCRIPTION _ _ ~/ 5 C Properly Location ., Subdivision Certified Survey Map # /iC.l/~il l r 9~~ __, Volume --- Page # Warranty Deed # ~~~ ~! ~- (.~ ,Volume ~ ~~._., Page # --~--`-"~ Spec house O yes ®no Lot lines identifiable Sl yes C} no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to Kandla wastes. Propermaintiemtace consists of pumping out the septic tank every three years or sooner, if needed by a licensed pu>Ytper. Whit Y~ l~ tttto ~ can affect the function of the septic tattle 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 owtur and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that {1) the oa-site wastewatpcditposil is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full otabidga. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal syrstaaa with the:<audatd~ set forth, herein, as set by the Department of Commerce and the DepaRmcnt of Nattttal ltesottteea, State of W>:COns1a. G~ stating that your septic system has beta maintained must be completed and returned to the St. Catoix Cottnty Zoning Ot~ux~witbia ~ days of the three year expirrrio date. ~~ IGNA OF APPLIC NT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) Iarowledge. I (wa) am (am) rho owa~(s) of the roperry desc 'bed above, b v' a of a warranty deed recorded in Register of Deeds Office. Zz~ O.S~ CA DATE sssa.. • • • • • • Any information that is mis-represented may result in the sar:itary permit being revoked by the Zoning Departmwu ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM L~~~ c ~ ~- ired from Plattning Department for new construction) ee i S~~Pi~el Identification Number ~~~ "~~~"DO- DSO SZZ~ _ '/,, Sec. ;~(° , T~,_N-R~.(,~.W, Town of l~~c.. ?i ~ . •• Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is taade in the warranty fitted ~' ~ ~ 1 ~ ~ ~ V STATE BAR OF WISCONSIN FORM 1 - 2000 WARRANTY DEED Document Number This Deed, made between Carole F. Olsen, sincrle Grantor, and Craig A. Willert and Diane 8. Willert, husband and wife as survivorship marital property Grantee. Grantor, for a valuable consideration, cortveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property") (if more space is needed, please attach addendum): That part of the Northeast Quarter of the Southeast Quarter (NEB SE~t), lying North of the Railroad right of way, Section 36, Township 29 North, Range 16 West, Town of Baldwin 79EyE~28 KATHLEEN H. 1iALSN REGISTER OF DEEDS ST. CROIX CO., MI RECEIVED FOR RECORD 86!03!2085 11:50A1( MARRANt'Y DEED EXEIPT 1« REC FEE: 11.08 TRANS FEE: 1895.08 COPY FEE: CC FEE» PAGES: 1 Recording Area Name and Return Addross Title One Premier Group, Ina 706 19th Street Sovth Hudson, WI 54016 part-of 002-1091-80-000 Parcel Ident~cation Number (PIN) Together with all appurtenant rights, title and interests. TES is homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Roadways, Easements, and Restrictions of Record June 2005 Dated this i s t day of . * AUTAENI Sig;~atu;e(s) authenticated this day .9, TITLE: MEMBER STATE BAR OF WI; (If not, authorized by §706.06, Wis. Stats.) L~ ' ~ *Carole F. Olsen r v * ACKNOWLEDGMENT NOTARY ~ STATE OF WISCONSIN j ss. 3t. Croix County. ) Personally came before me this 1st day of June 2005 the above named ~ Carole F. Olsen THIS INSTRUMENT WAS DRAFTED BY Michael H. Forecki, Attorney Eau Claire, Wisconsin lSianatures may be authenticated or acknowled¢ed. Both are not necessary.) to me known to be the person who executed the i e1 and~lcnA edged the same. ~J' ~~ Notary Public, State of Wisconsin My Commission is pejmanept.(If~ot, state expiration date: •Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN FORM No.1-2000 ~~ IFlttomey Michael H Forecki 3432 Oakwood Hills Pkwy Ste 1, Eau Claire WI 54701-7928 Phone:(715) 835-3029 Fax: (713) 835-4112 Michael H. Forecki 8621S.zfx Produced wiM 2ipFOrm^~ by RE FonnsNet, LLC 18025 F~Ytean Mde Road, CI'xKOn 7owrrshp, Michigan 18035, (800) 983.0805