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HomeMy WebLinkAbout004-1027-60-100v' L : (-~-Ef1i ~5~~ Wisconsin Department of Commerce PRIVATE SEWAGE 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 Rh ,Dan Cad Townshi CST BM Elev: Insp. BM Elev: BM Description: c7p .~ i ~av .o ' ~ 5 1 = GST $ ~~ Z HIVA 1ryr'VI[IYW I IVn TYPE MANUFACTURER CAPACITY Septic t,.~~w.S~ uzsn b~ Dosing ~ 4 Aeration Holding TANK SE BACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 7 ~ ~ LL} r ,_____ Dosing ~ ~~ r ~ u ~ so Aeration Holding PUMP/SIPHON INFORMATION Manufacturer S Model Number ~ dos e H Lift Friction Loss Forcemain Leng j~l Dia. ~ „ ...,...r.-.. remand `~~ t,to ead TDH ~ Ft (o .Sa z[ .41 TR8pb9H Width ~ f Length ' ~ ENSIGNS SETBACK SYSTEM TO INFORMATION , _. _ DISTRIBUTION SYSTEM (-Z~ ~o-'~o.Q-S 1 1'0 "IoS ~1 ~ .. w...i~•pQJ CLCVHI IVIV VMI/1 County: $t. Cro]X Sanitary Permit No: 395137 0 St a Plan ID No: b z s8- mss. ~.# I Tax No: 004-1027-60-100 STATION BS HI FS ELEV. Benchmark Z a $5 tp.1fS I~• ~ Alt. BM l•~ ~S 9}r Bldg. Sewer ~ , o } r 93 • ~8 St/Ht Inlet . ~~ 9/ ~/ ~ SUHt Outlet Dt Inlet ~- Dt Bottom ~. ~ ~~ ~ Header/Man. 2 16 9,~•~ / Dist. Pipe Cq\ J Z' t4 2 . I ~ ~ ~ r Bot. S stem 1 2 Final Grade St Cover ~"' ~~ Z ~' a. ~ (~~S ~t~. ~~ 1 l •~ PIT DIMENSIONS No. f Pits Inside Dia. Liquid Depth E/STREAM LEACHING CHAMBER OR UNIT ~- Header/Manifold ?j,01 2,D if Length Dia Distribution ~ ~~ ~ Pipe(s) ~'f.p ~ ~ 3. D Length Dia Z Spacing x Hole Size I~~ l f x Hole Spacing ,?, ~ t f Vent to Air Intake ~_. SOIL COVER ~Droccnrn Cvc4nmc Anly YY Mnnnrl Ar Of-(;rarla SVStBn15 Or11V ~S ~O7 COMMEN S e(~Include code i~c epertciei, persogs prese~nt~, etc.) Inspection #1: ~~/~/ D ( Inspecti n #2: O ~ / (~ / ~ ( LOa~tion: 3217 50th A~ en a Knapp, WI 54579 (NW 1/4 NW 1/412 T28N R15W) NA Lot 1P~/~~~k Pal No: 12.28.15.184A10 1.) Alt BM Description = G-a.!*~F- 7~(~' J ,~~,,~,~ : l l , 2.) Bldg sewer length = p .~ - amount of cover = Gam` 3.) Contour ~~16 •` o ~) ~~ Plan revision Required? (~ Yes No ~ ~ I /~" O~ ~-~ Use other side for additional information. f_E~ !--- ate Insepctor's Signatun; Cert. No. SBD-6710 (R.3/97) ~l \ ~ < _ (~ (~ Depth Over Depth Over xx Depth of xx SeededlSodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~~ Yes ~~ No ~~1 Yes [)] No 1 Sanitary Permit Application S ety & Buildings Division ~' ' In accord with Contra 83.21, Wis. Adm. Code 201 W. Washington Ave. PO Box 7302 ~ ~, ' ~ Sc~e reverse side for instructions for completing this application WI 53707-7302 Madison n ~L ~~~ ~;~::-~,~,r trr,ent of commerce Personal information you provide may be used for secondary purposes , (Submit completed form to county if not [Privacy Law, s. 15.04(1)(m)) state owned.) Attach compl ete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x I 1 inches in size. ..~~,unry ____._-.____ State Satritary Permit Number ^ Check if revision to previous application State Plan I. D. Number SITE ID#630730. ST CROIX 39S ~" TRAN _ Application Ltformatio a e t • Information Location: _ - 1'rcperty Owner Name ~~ y ~•. . Property Location 15 W ~, ~; ~O ~ DAN RHY ~), ~ ~ W va I/a, s T ,N, R E (or) w 1I~~~_ \ ,, _; -- -------- 1': oprny Owner s Mailin A ess ..7 Lot Number Block Number t~ t,. ,~ `~ip State -- - '~~ p'CO e ~ , ,:~, ' Phone Number Subdivision Name or CSM Number . i l+~~YPc of~Buildittg: one ,c'`~~ i,,,r l.r~ ~,vaw„`~_ ^"" "' lli 3'V °d E 2 F il D vill e g rTMoy,~ or am y we n c~: ~,p,,,~„ , ~ Town of , .i FubliciCommercial (descnb ~)__~, ; .~ - LADY ~:_J State-Owned oaf -~o- o0 ""' R~ • ~O ..~ ~ (p.a Nearest Road OTH AVENUE f . o~~. IS tc ~ v - (- 3~ 6 •Ogj 4 P cel T• ~Iu r(s) C tel. r ~ ~L ~ 1 [I. pe of Permit: (Check only o box on line A. Check box on line if applicable) ---- ,4) ] . New 2. ^ Replacement 3. ^ Replacement of 4. 5. 6. ^ Addition to System System Tank Only Existing System -E) -- Permit Number Date Issued ^ A Sanitary Permit was previously issued [V. Type of POWT System: (Check all that apply) O Non-pressurized In-ground C~ Mound ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other: V. DispersaUTreatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals./day/sq. ft.) (Min./inch) Elevation 450 450 450 1 N/A .97.94 99.77 VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks 1000 1000 1 WIESER CONC ~ ^ ^ ^ ^ o ^ ^ ^ ^ 600 600 1 WIESER CONC X VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) Plum is Signature (nos s): MP/MPRS No. Business Phone um r BENNIE HELGESON 220292 715/772-3278 Plumber's Address (Street, City, State, Zip o e) W1229 770TH AVENUE, SPRING VALLEY WI 54767 IX. County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued . Issu'ng Agent Signature (No stamps) Approved ^ Owner Given Initial Adverse Sur harge Fee) ~ ! Determination 3 Z~• '~ ~ ~( X. Conditio^nps of A/~pproval/Reasons for Disap~roval• ~n,~,,.~~~~ s r ~','S ~,'~' i~ SBD-6398 (R. 07/00) x r .Wisconsin Department of Commerce rliviainn of Cafafv anti Ri iildifieS SOIL EVALUATION REPORT Page ~ of in accordance with Gomm S5, wis. Ram. was City Attach complete efts plan on paper not less than 81/2 x 11 inches in size. Plan must but not limited to: vertical and horizontal reference point (BM), direction and include Parcel I.D. , north arrow, and location and distance to nearest road. scale or dimensions e ercent slo , , p p Please print all Information. R awed by ~~ Personal information you provide may be used for secondary puryoses (Privacy Law, s. 15.04 (7) (m)). Property Owner '71 ~~ - Property Location ~(, (~ ,{~ (,~ f _ 1/4 /v(,t/1/4 S ~~ T ~~ N R ~S E (or W ~ Owner's Mailing ddress Props (rty Lot # Block # St~d~Name or CSA~! < ,,~ any ~ ~b+ti st-. e Ztp Code Phone Number tat S City Village own NearestRoad ^ City ^ `~ ~~ 9 r ~~ U~I~ G / New Construction Use: esidential / Number of bedrooms ~_ Code derived esign flow rate ~~~ GPD ^ Replacement ^ Public or commercial -Describe: ,~~ Parent material ~~cr c i 4 ~ ~~ /~ Hood Plain elevation if appUcable General comments v-~~-e~- [~~ Q ~~ (~ ~ Sa `^ ~ `-~~ ~ e. YYl t / _ Ce ~~ b~ Cou'~ci~ q6• ro n . and recommendations: .5y s ~-c~,-. El~e ~, 9 7, y ~~ c.~s~ ~'u ~S' ~'<<~ LJ Bonng Boring #r,/t Ground surface elev. ~~ ` ~ ft. Depth to limiting factor .~_ in. Soil ication Rate ~ure St Consistence Boundary Roots GP D/fF Horizon Depth in. Dominant Cdor Munsell Redox Description Qu. Sz Cont. Color Texture nx Gr. Sz Sh. 'Eff#1 'Effll2- ~ - ~ -~sdk - ~ c ~ ~ ~ ~ - y ~ - L ~ ~ s~k i- ;,~ I ~ - ~ ~ ~ 1©Y2 ~~ v ~J S w~ 5 ~ U 1/ L( 6 Boring # U Boring Pit Ground surface elev. qy SS' ft. Depth to limiting factor _T_ In• S~ ication Rate t T Structure Consistence Boundary Roots GP D/if Horizon Depth in. Dominant Color Munsell ~~ ~ Redox Descxiption Qu. Sz Cont. Color - ex ure Gr. Sz Sh. ~ b ~, a ~F 'Eff#1 S-- 'Eff#2 . ~ -ab c~ --- S L s 6 w~ ~ ~ w ,~ S d ~ b' rh 3 p ~o YR ~/ F, S ~ • 1 ' ~ u~~ ~ • Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 1 50 mglL • Effluent #2 ~ BOD < 30 rrtglL and TSS < 30 nrglL CST Name (P tint) \ Sign re ~ ~ .~ Address / Date Eva lion Conducted Telephone Number sY ~~ ._ ~l _ Parcel ID #.. . _..._.. Page.. of -3 Property Owner ..... . . Boring..... _.__ . Boring # ~ ~ . _ .. _ . ,.... _. _ _. ~ Ground surface elev b ft. Depth to limiting factor ~_ in. IJ" Pit _ . _ _ _ _. Soil lication Rate _- - -.. . ... n i ti D 'Texture Structure ;Consistence Boundary Roots ~ GP D/H° - __ .. lionzon. Depth in. Dominant or MunseU . p o escr Redox Qu. Sz Cont Color __..._ - Gr~ Sz: Sh: ~7 'Eff#1 . r- '. `EtT#2_ '. ~ ~ -~ aa- ) o `1 ~ ~` T~ y R ~ - ~ a d 7. s ~ ~ L .F- S ~ ~ s bk ~ ~,,.. s b ~ ~! ~J i ~ - - ~( ~ '---1--' Boring # U Boring Q ~ Ground surface elev. ~~, 3 ~. Depth to limiting factor ~ d in• Soii ication Rate i ti De Texture Stnuture Consistence Boundary Roots GP D/ff° Horizon Depth in. b /U Dominant Cdor Munsell Icy y p on scr Redox Qu. Sz Cont. Color L Gr. Sz Sh. °? G~ i J 'Eff#1 r 'Eff#2 , L. _-...... _ ' 1j~ G,... .. .. .. .. a Boring # U Boring ^ Pit Ground surface elev. ff. Depth to limiting factor in. Soil lication Rate xture T Structure Consistence Boundary Roots GP D/ftz Horizon Deptfi in. Dominant Color Munseil Redox Description Qu. Sz Cont. Color e Gr. Sz. Sh. 'Eff#1 `Eff#2 'Effluent #1 =BODE > 30 < 220 mglL and TSS >30 _< 150 mglL `Effluent #2 = BODs < 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 608-266-3151 or TTY 608-264-8777. SBD-8330 (8.6/00) 5~ 3 a~ 3 cos:T. ~~~,~~~ ~-1-~f~~_sn~~ a~~a~~~ ~~ ~l .~ -_--- 70 3a k h ~~~~ ce~.~_ of S'af~ ~~e, r ~ ~ a~P~`~-,k l-o oce`A' ~ 3~5 ~9s Q,`~3 ~~d~ N~, ~XC e ~ ~ ~ S ~`L ~~ ~ 3. N -~ ~ To l-~ ~~ ~ U L ~~~ e v.~~~~, o~ R ~ labo..~ ~ ~ r~ ~ ~0~ 1~T S~c~cy~` ~ ~g t' f3a ~ ~ ~ Qy _ ~ - ti ~. ~_ s~;k~bl~ ~~ ~_ ~,^ - - -~ ~ ,~ .h ~~~~ 99.E Ci,rl ~ i' P~apo6a.eQ 'Qrop.ew~ ~..1h,~~ ~ 1 \ „r ~ ,.1'r Y~, ~ ;~ , 7u t ~~-~„~.~tr, ~~°~n~~ I ICI c,so~=- ^~ ., ~ -^---~ boo' ~- -'-~ P~.I~F$ . _~ 3a~ ~ ~. S-h--~~--~ ~ ~ i s«i~. ~k= ~o' Ek~.~p~- ~ S S Liaw~ i - 8_M ~ I Tb~ ~~ (~,. Luc ~~ god ov w~i-~ o~-~. ~',~bo..~ ~ - a_M ~~ -ro P o~ 5~~,~ ~ '- 3yS N ., ory 1~. ~bo ~- _~ v~ ~. L ~ :;~ ~,r i ~.° ~ ~ .~ r a~ 5° i - - -, -i~~~. _y~~35- -j ~~ ~ ~~~~ ~-- t"ire ~iy.3~ - - - ~ ro ~~ ~ ,. 51 ,c.~ \ r lO~ \~ -~. \ 3.1"t #~ t ` ~~ has ~ .~_ Q~ . 5 m», ~ R ~' ~ ~ ~scons~n 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 Scott McCallum, Governor Brenda J. Blanchard, Secretary May 29, 2001 CUST ID No.220292 BENNIE W HELGESON W 1229 770TH AVE SPRING VALLEY WI 54767 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX BOUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL --- PLAN APPROVAL EXPIRES: 05/29/2003 Identification Numbers Transaction ID No. 642758 SITE• Site ID No. 630730 DAN RHY PROPOSED BLDG Please refer to both identification numbers, ST CROIX COUNTY, TOWN OF CADY .above, in all comes ondence with the a enc . NE1/4 of the NW 1/4, NW 1/4, Section 12, T28N, R15W, 50TH AVE FOR: DESCRIPTION: THREE BEDROOM MOUND SYSTEM OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 792987 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD-1OS72-P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD-1OS73-P (R.6/99). • 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. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound manual, and section VI of the pressure distribution component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • The approved design meets the minimum requirements of the mound manual and pressure distribution manual. -This reviewer has concerns with the large loading rate per pumping event. It is this reviewer recommendation that the dose volume be reduced to five times the void volume of the laterals plus the drain back of the force main. This could be accomplished by making the C dimension 8" or 94.56 gallons. • 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 83.52 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). In addition, the owner is responsible for submitting a maintenance verification report BENNIE W HELGESON Page 2 5/29/01 acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. • 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 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • 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. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, . ~ ~~Q~ Charles L Bratz POWTS Plan reviewer II- Integrated Services (608) 789-7893, Mon.-Fri. 7:45 AM to 4:30 PM cbratz@commerce. state.wi.us FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 BALANCE DLJE $ 0.00 WiSMART code: 7633 ~, INDEX SHEET PROPERTY OWNER: DAN RHY N8029 110TH STREET SPRING VALLEY, WI 54767 PROJECT NAME: DAN RHY PROJECT LOCATION: NW 1/4, NWl/4, S 12, T28 N, R, 15 W MUNICIPALITY: TOWNSHIP OF CADY COUNTY: ST CROIX DESIGN: PRESSURE DISTRIBUTION MANUAL: SBD-10573-F' (R6J99) MOUND COMPONENT MANUAL: SBD-10572-P (86/99) CONTENTS: Page 1: Plot Plan Page 2: Cross Section & Flan View of Mound Page 3: Distribution Pipe Layout Page 4: Septic Tank & Pump Chamber Cross Section & Specs. Page 5: W1000/600-MR Tank Specifications Page 6: Pump Specifications Page 7: POWTS Owner's Manual ~: Management Plan Page 8: POWTS Owner's Manual pg. 2 Name: Bennie Helgeson Signed \ Address: W 1229 770Th Avenue Spring Valley, WI 54767 C~ l,~h~- Credential number: 220292 Date: May 8, 2001 APPR~1rf ED ~.... .~M ~ iIEE p~i ~+ ~~ ~~.~ ;, 7 -- _ ~_ ,~ _ _... _ __ _ -___ _- ~- `1 .ter:--` ti ~; ~,~ ~~ 39g ~ lei. /4.J~ _ ~p 70 S le .ci ! rpm ~~ _~ ~ ~ _ ~ `~ 3. ~t #- t ' ,~~ QI ~'~, ~e'~Z~fr n?- 'SbTry J7U~_ P~.~~F$ . ~- ~~ s«.i~ ~~_ ~o, Ekc~p~- /-~ s S ~~o~•-~ 8~M ~ I Tap o~ ~ ~,, Luc ~IP=~ ~ap,ov cv~~f-~. o~-~. (?',bbo..~ ~po.ov T ,~o~~ u~;~-l. orb . 12.bbo~.. ~-1'rn fl as ccQ . ~abo~6 0 ~hh / Sc~o><~~/lie ~~~rr r ~~ ,~ r ~~ ~I `~a R~ ~ _ ~~`~ ~_ u ~ - ~ . \ \S3 ~~~ ~~ Page ~ Of ~ Synthetic Covering ,~-~STM C 33 Medium Sand ~ _ Topsoil Ji ti 3 -.t= Distribution Pipe ~ie~ y9 ~ 7 TG F Ekv . 96 ~,~ % Slope ~ c: L~.O f ZY- 2 i Aggregate _ Plowed Layer D /=~ F t . E /, 9y Ft . F 6 ~3 Ft . ~ , S Ft. H / Ft. Cross Section Of A Mound Signed: License Number: Date: ~ -_--- Force Main From Pump q ~O Ft. g -~_ F t . K !p, Ft. L ~ Ft. ~ ~.%7 Ft. r~~~ Ft. W ,~~.3 Ft. Observation Pipe J ~ ,~K A !<~~ >~ W ~~ 1 _~ r----- - ~` E ~t_L p f ~„_ 2 ~„ . % Distribution 2 ~ Pipe Aggregate Observation Pipe Plan View Of Mound .. )C a~.o-..r ~ /~-l ~J i'Y~. IE~[W<<x-~7 C' P5 3 0~ ~ PorloroleA Pip• Oo~oll / / `- End Vl~w P.rlorolaC ~ ~ l Holes Located on Bottom are Equally Spaced ~«~ /-fin Fro +'u .,,~ /I IOIC ~~1C/ 'tc~ /"I CIVIC ~O~w ~f°~ Sinned: License Number: Dare: ~~D~ Distribution Pipe Layout P ~`~ / R S 3, X ayl~ .. a~" Y _ 1 Hole Diameter ~_ Inch Lateral ~~ Inch (es) Manifold " ,~,_ Inches force Main " ~ Inches ~.,~~vE~~r- ~~~~~. 9~.~y 3~ Nolen ~Pe~ J~~-.~~-( X o~ ~ ~. ~e -'a `- ~~ i~~les Tet~.l • SEPTIC TANK E PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4 CI 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 FINISHED GRADE ~ /' ~M ` "Y 4" MIN. --- . I I~ Zy" 4r~ PUc. ae~s~aw-aoa ~. n. 18" IN • PIPE Sal, yv ':~~ I$ nn~N• INLET ~~ ~ , WATER TIGHT SEALS ~ , GAS- ~ TIGHT ~ ~, /APPROVED I FILTER ~c ~ A SEAL ~ JOINTS WITH ` e _~ ; ~ ALM APPROVED PIPE APPROVED /Q-/ov /a><i~ B ~ ~ ON 3' ONTO PIPE 3' ~- ~ SOLID SOIL ONTO SOLID C ~ ' SOIL PUMP OFF ELEV . 7f (~-tFT. -~-- OFF D 3 APPROVED BEDDING UNDER TANK 11 CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE NUMBER DOSES PER DAY: TANK MANUFACTURER: (~~~r.cp~ _ i t TANK SIZES: SEPTIC /'r~G70 GAL. DOSE VOLUME INCLUDING -FLOWBACK: ~ ~S~ -,- .. v. ti ~~~- Fix.:l~4 ~ GAL. DOSE ~ GAL. s o APACITIES: A = ~S` 1 C~I frO s~'`~ INCHES = 3c~_GAL. . -~~ ~ y ALARM MANUFACTURER: . MODEL NUMBER: ~ B = 2 f" PE ~ INCHES = ~ 3.~ GAL. : ~•~ r ~- SWITCH TY ~ SEE CORRESPONpE~CE I5 ~ INCHES = / ~'3. ~ ~ GAL. _ PUMP MANUFACTURER: MODEL NUMBER : os~N~ ~t~`L 1 D = ~ ~~~GAL . INCHES = S • . SWITCH TYPE: ur~ REQUIRED DISCHARGE RATE ~~ GPM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE ~~•5/~/ FEET S FEET + MINIMUM NETWORK SUPPLY PRESSURE FT/100 FT. FRICTION FACTOR S ET FORCEMAIN X F FEET ~-.~ EET _ , E + ~ TOTAL DYNAMIC HEAD F = fir; ~/ INTERNAL DIMENSIONS OF PUMP TANK: IGNED: LENGTH WIDTH_ LIQUID b~~ ~l ~~ l1.8~ G~~1. P~~..z~,~~ LICENSE NUMBER: DIAMETER L' S <~ ~ ~%zn ~: /was DATE: 1/88 ~~ ~ ~ ~ 114A" W1000/600-MR TANK SPECIFlCATIONS i~ a A~~ \/GAIT(` TOP VIEW SCALE: 1/4" = t SIDE VIEW SCALE: 1/4" = 1' t S ham./..: ~-~C.~-1Z~Y OUe/ c5 ~-~- ~.< ~- o ~- S ~~ +, C ~.,,,ti~ e \- DIMENSIONS: WALL: 2-1 /2" BOTTOM: 3" COVER: 4" MANHOLE: 24" I.D. HEIGHT: 77" O.D. LENGTH: 114-7/8" O.D. WIDTH: 93" O.D. BELOW INLET: 57" O.D. LIQUID LEVEL: 51" WEIGHT: 12,700 LBS.~ INLET AND OUTLET: 4" BORE WITH STOP FOR QUIK-TITE, FERNCO GASKET, CAST-A-SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLES: WISCONSIN, SEE DETAIL ~#10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 19.61 GAL/IN SEPTIC) 11.82 GAL/IN PUMP) LOADING DESIGN: 7' 0" UNSATURATED SOIL ~D~~C~a ~o~~~~~~ w3716 US HWY 10, MAIDEN ROCK, Wi 54750 800-325-8456 MODEL W1000/600-MR SEPTIC/SEPTIC, SEPTIC/PUMP OR SEPTIC/SIPHON JANUARY, 2000 F~I_ w~ooo boo-~dR l _ ,_ ~ Performance Curves METERS FEET C d LL J H Q F- 2t•~~. ~~ ~µ ~~ P9,looF ~ ~ubrn~rsib~~ effluent Pumps ~1 1 METERS FE 1 1 30 = 20 J fa.. H 15 10 5 1 `~ 0 GPM .,J m'fi GOULDS. PUMPS, INC. semen Fats law tiax oae ET 20 MODEL 3885 SIZE 3/a" Solids 10 WE15HH 00 90 80 70 60 W H 40 , 30 20 10 0 0 10 20 30 40 50 60 70 tS0 au wu ~ w ~a urm ~~~~ 0 10 20 30 m'fi caPAanr ENecUw July, 1985 0 3 (,I~o i 10 a CAPACITY POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page '~ of -~~ c ~-isnaM4TION Owner DAN RHY Permit # .-..~r.-~ o~~AMFTFRS UCJ1~71`1 rn~~•••~-• - Number of Bedrooms 3 ~ ^ NA Number of Commercial Units d~ NA Estimated flow (average) 300 al/da Design flow (peak), (Estimated x 1.5) 450 aVda Soil Application Rate aVda /ftz Influent/Effluent Quality Monthly average' Fats, Oil 8~ Grease (FOG) S30 mg/L Biochemical Oxygen Demand (BODE) 5220 mg/L Total Suspended Solids (TSS) 5150 m /L Pretreated Effluent Quality t7~NA Monthly average" Biochemical Oxygen Demand (BODS) 530 mg/L Total Suspended Solids (TSS) 530 mg/L Fecal Coliform (geometric mean) 510' cfu1100m1 Maximum Effluent Particle Size Y inch diameter cvcrciu cPFCIFICATIONS .,~., --- Septic Tank Capacity 1000 al ^ NA Septic Tank Manufacturer WIE ER CONCRETE ^ NA Effluent Filter Manufacturer ZABEL ^ NA Effluent Filter Model A-100 12-16 ^ NA Pump Tank Capacity al ^ NA Pump Tank Manufacturer WIESER CON RETE ^ NA .Pump Manufacturer GOULDS PUMPS INS NA Pump Model 3885 WE05-H ^ NA Pretreatment Unit ^ NA O Sand/Caravel Filter ^ Peat Filter ^ Mechanical Aeration O Wetland ^ Disinfection ^ Other. Manufacturer Dispersal Cell(s) ^ In-ground (gravity) ^ In-ground (pressurized) ^ At-grade [~ Mound O Dri -line ^ Other: • Values typical for domestic (non-commerclaq wastewater and septic tank effluent *+ Values typical for pretreated wastewater. 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, POV1rTS Maintainer; Septage Servidng Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surtace may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y,) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatr~ment components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. 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. ~Cc)tiefr': ~L~A~I ~~"~ Page ~_ of ~_ system start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose,. overloading the cell(s) and may result in the backup or surface discharge of effluent To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss;'diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMIVIENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servlcing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: . ~ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction.and should not be infringed upon by required setbacks from existing aid proposed stivcture, 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. ~ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. C~ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAYBE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name HELGESON EXCAVATION INC I Phone 715/772-3278 SEPTAGE SERVICING OPERATOR PUMPER Name JOHNSON SANITATION -- ~ Phone 715/273-5811 P[)1NTS MAINTAINER Name JOHNSON SANITATION ~ ~' Phone 715/273-5811 LOCAL REGULATORY AUTHORITY Agency ST. CROIX COUNTY ZONING Phone 715/386-4680 This document was drafted by the staffs of the Green lake, Marquette and Waushara County Zoning and Sanitation ageneles. Tttls document meets tr,e minimum requirements of ch. Comm 83.22(2)(b)(1)(d)8(f) and 83.54(1), (2) 8 (3), Wisconstn Admintstrative Code. Use of this document does not guarantee the performance of the POWTS. GMW (2/01) ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address ~v M ~ ~ 7 Property Address .~ ~ / 7 ~ ~ ~'. ~o ~ - (Verification required from Planning Department for new construction) City/State ~ ~~~ ~ t Parcel Identification Number ~~ ~ ~~~~ LEGAL DESCRIPTION Property Location ~ ~+, ~~ '/<, Sec. 1 ~, . TAN-R~S W, Town of G~~ Subdivision ~ ~ - _ ,Lot # Certified Survey Map # ~0`{01(0~9 ,Volume ~ ~ ,Page # ~~ Warranty Deed # ~ a 3(~~- Volume l~ l ~ ,Page # Spec house ^ yes ~no Lot lines identifiable`~yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restrictedplumber or a licensedptunperverifying 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 septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. °~ t. ~ l~9 /o/ SIGNATURE OF I 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. a O'7 / ~'~/~/ SIGNATURE OF ICA T DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of-Deeds office a copy of the certified survey map if reference is made in the warranty deed Document Number ~1:,.1511PAGE394 WARRANTY DEED K6~3 H S2 H REGISTER OF DEEDS ST. CROIX I:o., wI RECEIVED FOR RECORD Loren G. Berkness and Terri B. Berkness, a/k!a Terri E. o5-i7-2000 9:~5 All Berkness, husband and wife, as joint tenants, conveys and YARRAl4TY DEED warrants to Danny E. Rhy and Mary Jo Rhy, husband and EzEMPT M wife, as survivorship marital property, the following CERT COPT fEE: COPY FEE: described real estate in St. Croix County, State of RECORDIMGFfEE: 10700 Wisconsin: oars: I Recordln Area Name and Return Address The Bank of Spring Valley p0 Hox 159 Spring Valley, WI 54767 004-1027-50, -60 (Parcel Identification Number) The North Half of the Northwest Quarter (N '/s of NW Y.) of Section Twelve (12), Township Twenty-eight (28) North, Range Fifteen (15) West. Exception to warranties: all easements and restrictions of record. This is not homestead property. Dated this ~ day of 1~,, 2000. ., r4~~ g,1 • 1~~0 'Loren G. Berkness 7 'Terri Berkness AUTHENTICATION Signature(s) CO ~~ Prl~~.c~s _ (~rt~ per r t$~'~ ~".,xsA~a~i~r r~ ~r-~ldtdai ter-' authenticated this /~ day of , - ._. signature 7-N~wta3 A. /t1c'.Cd/4'1'1e"k type or print name ACKNOWLEDGMENT STATE OF WISCONSIN ST. CROIX COUNTY ~ Personally came before me this ~ day of 2000, the above named Loren G. Berkness and Terri Berkness to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. signature type or print name TITLE: MEMBER STATE BAR OF WISCONSIN Notary Public St. Croix County, Wisconsin. (If not, My commission is permanent. (If not, state expiration date: authorized by §708.06, Wis. Stets.) ) THIS INSTRUMENT WAS DRAFTED BY 'Names of persons signing in any capacity should be typed or Thomas A. McCormack printed below their signatures. Baldwin, WI 54002 IntormaGOn P~ofesaianala Company Fo~M du Lac, W~sWnsin a00~655-2021 /D . t n CERTIFIED SURVEY MAP LOCATED IN THE NW 1/4 OF THE NW f/4 Of SECTION f2, T.28N., R. 15W., TOWN OF CADY, ST. CRO I X COUNTY, W I SCONS I N DESCRIPTION A parcel of land located in the Northwest'/. of the Northwest'/, of Section 12, Township 28 North, Range 15 West, Town of Cady, St. Croix County, Wisconsin, more fully described as follows: Commencing at the Northwest Corner of said Section 12; thence, North 89°56'05" East, along the north line of said Northwest'/a, 678.19 feet to the POWT OF BEGINNING; thence, North 89°56'05" East, along said north line, 468.50 feet; thence, South 00°03'55" East, 399.00 feet; thence, South 89°56'05" West, 468.50 feet; thence, North 00°03'55" West, 399.00 feet to the point of beginning. Containing 186,931 square feet or 4.29 acres. Subject to right of way for 50'" Avenue as shown. Also subject to any and all additional easements, right of ways or conveyances of record. SURVEYOR'S CERTIFICATE I, James M. Weber, registered land surveyor, hereby certify: That in full compliance with the provisions of Chapter 236.34 of the Wisconsin Statutes and the provisions of the St. Croix County Subdivision Ordinance and under the direction of Dan Rhy, I have surveyed and mapped the above described parcel of land and that this map is a correct representation of the boundary thereof. ~,anuuuci.~~ ,;:,~~„ Dated this 1'1 day of P~p2~~ 2001. ~ ~ /.~v-~ J , JAMES M. '. '---- a ~ WEBER ~7 James M. Weber S-1804 ~ iseos NELSEN-WEBER LAND SURVEYING, INC. ~~ ~~ ~, . Note: The parcel shown on this map is subject to State, County, and Town laws, rules and regulations (i.e., wetlands, minimum lot size, access to parcel etc.). Before purchasing or developing any parcel, contact the St. Croix County Zoning Office and the appropriate Town Board for advice. 2001035A This instrument drafted by Jim Weber SHEET 2 OF 2 VOL. 75 PACE 4776 /.7. a, ~.so x m ., NA3 ~ $ o °o ~JW ca _ c y~q '~ ~ m acv Q+ d ~ W U ••• •• x ~ l!ff~~xrc.-, g ~ ~.. V~wwo ~ =gt,,~m= yyWF-~ ~ N ti,-UI~~oYWtlf xH/, V 1~ ~~24~Ui.7 ~¢iu H- o ~ ~w~._.--....... Y iL J) CERTIFIED SURVEY MAP L OCA TED 1 N THE NW 1 i4 OF THE NW 1 i4 OF SECT ION 12, T. 28N. , R. 15W. , TOWN OF LADY, ST. CROIX COUNTY, WISCONSIN PREPARED FOR: DAN RHY r 9 APPROVED ~ ~ \o BEARINGS ARE REFERENCED TO THE NORTH NE ST. CROIX COUNTY Planning 7.oning and P~rk7 Com ~ UN 2 ~ ~Q L I OF THE NW 1 i4, SECT 1 ON / 2. MEASURED AS N89°56' 05'E 41 ~ . 1ST CROIX COU .1UN 2 7 Toff f L li Ilf~,"a ~ ~~ ~~, ~ NTY COORDINATE SYSTEM) ~ Iflptteooitla0wif1rn30days~ appf~wtldaMapproraiafuYbe N f f~Ml~nd raid UNPL ATTED LANDS NORTHWEST CORNER SECTION 12 -FOUND NORTH LINE OF THE NW li4 NORTH QUARTER CORNER I fit" IRON PIPE SECTION 12 " -FOUND 2642. 13" 3~4 REBAR N89°56' 05"E .50.t,h N89°56' 05"E 468. 50' w ~, S89°56' 05"W 678. 19' w ,(~ yENUE °• 1495. 44 w w N89.56'05'E 468.30 w =C $ ~ w ' ~ :~ ~ 2 :~ y ~ HIGHWAY ......... SETBACK ............................... .. L INf O A ~ r ..... ........... ....................... O { W LOT 1 w ~~ r ~, Z ~' ~ 4. 29 ACRES u ": n y ~ ?~ 186, 931 S0. FT, w rn ^~ ~ Z $ 3.94 ACRES EXC. RAW ~ ~ ~ y Ili, 471 SO. FT. ~ • ~o S89°56' 05"W 468. 50' UNPLATTED LANDS ................... ~~vSH~G/~ ~c`~~S"r`~~~~'' "'~~ LEGEND s i ~~' ~'~ ~~ O SET 1`X24' IRON PIPE WEIGHING M" ~ f. 13 LBS. PER LINEAR FOOT ~ ° 0 GOVERNMENT CORNER AS NOTED ~~~ MRNO UILI.EY € ~ Q; 9 1 " • 100' 5+~~~ - J AMESS'~~nhfr"t,•'WE'B~~ S-1804 0 50 100 250 SHEET I OF 2 NELSEN-WEBER LAND SURVEYING " 7 , Zcrm, \ DATED A~~~. 1 2001035A THIS INSTRUMENT DRAFTED BY JIM WEBER VOL. 15 PAGE 4716 ,/ f .• -` ~~