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HomeMy WebLinkAbout004-1042-30-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division s 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 Zevenber en, Jon Cad ,Town of CST BM Elev: Insp. BM Elev: BM Description: ~~ ~~ \ GS 1 TANK INFORMATION ELEVATION DATA TYPE MANUFACTUREF~ (,~ ~ .^, S CAPACITY Septic r a„~,t~. ~ Dosing ~~t- Ldv~o ~ ~ do f+t~aTian F: ~ n ~ s ZS 1' Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Z5S ~ ~z ~ /5 l6 -~ Dosing Z55 7L - I S / c ! U , Aeration Holding PUMP/SIPHON INFORMATION ,c I Manufacturer errand GPM ~ Model Number ~ 3~ •7J~ t 3 7 TDH Lift ~ ~9 Friction Loss ~ , System Head ~ TDH Ft z . ~ , z~ 3 Z!, Forcemain Length ~ ~ r Dia. Dist. to well ~ a Z ~~ SOIL ABSORPTION SYSTEM county: St. Croix Sanitary Permit No: 488058 0 State Plan ID No: Parcel Tax No: 004-1042-30-000 Section/Town/Range/Map No: 18.28.15.286B STATION BS HI FS ELEV. Benchmark ~ . ~{ 5 l~c~ •+{5 ~ a~ Alt. BM i o~ ~„~a~f-~ a ~/. 35 /~ . ! Bldg. Sewer !3 • b-j 9a • .~ / St/Ht Inlet 1 ~l , i5 9d . 3 St/Ht Outlet ~ ~ Dt Inlet ~ ~ Dt Bottom 17.5 ~ (~, . 9 5 Header/Man. ~,d( /~.y Dist. Pipe / ~ ~ ~ ']" ~ . y Bot. System 51,62 ~9•`d~ Final Grade 3 a' /~ J ~ y St Over ~ F~, J~~ ~ Z t{. fj90 •Z( Ca•~-o~ ~ ~ . y 5 ~~ BED/TRENCH idth ~ Length No. Of Trenc PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS $ ~) ~ O ~ ~ ~ ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer. ON CHAMBER OR INFORMATI Type O as~m: >~ 5„7 / ~a Z 1 A 9~ UNIT Model Number: r'11STRIRlIT1C]N SYSTEM Headerr/Ma~~ , / , ~ Diserisution /~ , 1 411 ~~ ~ x Hole Size I ~~ x Hole Spacin~~ Vent to~Air Intake Length Y/ Dia ~ Length u Dia Spacing Cl111 rn\/GR .. r,____.."_ c~.,..a.....~ n..r., ..., ^e.......~ n. e•_r.~e1e S.rc4eme only c 1.4~ SIC Depth Over J Depth Over - xx Depth of xx Seeded/Sodded xx Mul ed Bed/Trench Center ' ' Bed/Trench Edges \ Topsoil I ~ ~ Yes [~ No I,. 'Yes I'~, No 1 COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: g /~~~ Inspection #2: / / Location: 2731 County Road N Wilson, WI 54027 (SE 1/4 SW 1!4 18 T28N R 5W) NA Lot 1 ~`a~"~ ~~ Parcel No: 18.28.15.2868 1.) Alt BM Description = ~ ~ 2.) Bldg sewer length = ~S - amount of cover = Plan revision Required? Iii Yes No Q ~ 6/ /_ Use other side for additional information. V ~Q 1® Date Insepctors S nature Cert. No. SBD-6710 (R.3/97) ` Safety and Buildit ~ O1 w. wa ~ >~. 7162 County ST. CROIX isconsin disc =,162 Sanitary Permit Number (to be filled in by CoJ ' ' 9~ (608)266-3151 g DSO ~/g Department of Commerce U Sanitary Per 't pl at><~~ State Plan LD. Number ~NTY I d ith C 83 Wi Ad ti ~ 0 21 TRANS. ID # 1230606 n accor w omm . s. m. e, orma on you~ , , may be used for secondary purpos Priv tv 15.04gj(~j Project Address (if different than mailing address) I. Application Information -Please Print All Information ~ 2 ~3i ~-~l Q /I• Property Owner's Name Parcel # of # Block # JON ZEVENBERGEN 004-1042-30-000 ~bg~ Property Owner's Mailing Address Properyy Location 308 6TH AVENUE SE 'fig SW ~~* Section 18 City, State Zip Code Phone Number + BALDWIN WI 5400 715/664-5992 T 28 N; R ~ JI•(circlc one) II. Type of Building (check all that apply) ~ f ,, ,," r ~ 5,,~, o , d 1 or 2 Family Dwelling -Number of Bedrooms 3 _ _ ,.t,o Subdivision Name CSM Number / ` 522093 Public/Commercial -Describe Use ^ State Owned -Describe Use ^City ^Village Qfownship of CADY III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' 0 New S tem ys ^ Replacement System ^ TreatmentlEIolding Tank Replacement Only 0 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 Owner ~~ u r IV. T e of POW'TS S stem: Check all that a 1 X Slo •2S i'K - 22 ^ Non -Pressurized In-Ground ^ Mound> 24 in. of suitable soil ~ Mound <24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter Constructed Wetland ^ Pressurized In-Ground ~ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculafing Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber 0 Drip Line Q Gravel-less Pipe ^ Other (explain) V. Dis ersaVTreatment Area Information: _ •~ Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 450 1,p J~^~ 450 450 99.83 VI. Tank Info Capacity in Total Number Manufacturer Ptefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 1000 1000 1 WIESER CONCRETE X Aerobic Treatment Unit Dosing Chamber 600 600 1 WIESER CONCRETE X VII. Responsibility Statement- I, the undersigned, assume responsibility Tor installation of the 1'OWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number BENNIE HELGESON t!', <~ 220292 715/772-3278 ~ N,~ ~ Plumber's Address (Street, City, State, Zip Code) W1229 770TH AVENUE, SPRING VALLEY, WI 54767 VIII. Coun /De artment Use Onl Approved ~ Sanitary Petmit Fee includes Groundwater Date Issued Lssuing Agent Signs (No Stamps) ^ Owner Given Reason Denial Surcharge Fee) //~~ ~ SSt~ ~_ c~ •~ 1 IX. Conditions o Approv exseps-t'wt:-l~i~ppr ~•^r SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable codelordinances. Attach complete plans (to the County only) for the system on paper eot leas than 81/Z x 11 inches io size SBD-6398 (R. 01/03) ~I~b«` ~ ~~~ V- y- --e He I~~GP S'C`yl c~c`~C-` ~~ c ~ p-~ ~s .S~ e~~ r. ~~ P~ ~..e -_ y~ ~~ " ~ ~ commerce.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi.gov/sb/ www.wisconsin.gav Jim Doyle, Governor Mary P. Burke, Secretary January 11, 2006 CUST ID No. 220292 BENNIE W HELGESON HELGESON EXCAVATING W 1229 770TH AVE SPRING VALLEY WI 54767 ATTN.' POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 01/11/2008 SITE: Jon Zevenbergen CTH N Identification Numbers Transaction ID No. 1230606 Site ID No. 708758 Please refer to both identification numbers, above, in all corres ondence with the a enc . Town of Cady St Croix County SE1/4, SW1/4, S18, T28N, R15W FOR: Description: Proposed Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1057945 Maintenance required; 450 GPD Flow rate; 14 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual, SBD-10572-P (R.6/99), Pressure Distribution Component Manual, SBD-10573-P (R.6/99); Bioflter The submittal described above has been reviewed{,for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. • 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 POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of 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. • Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department which may include local ins ecp tors' P.0.4"J.~:S. Conc~itio~aa~ly ~~'~~ BENNIE W HELGESON Page 2 1/11/2006 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) -The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence 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, ~~~~ 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 • ~ ~ L ~ t PROPERTY OWNER: INDEX SHEET JON ZEVENBERGEN 308 6TH AVENUE BALDWIN, WI 54002 PROJECT NAME: JON ZEVENBERGEN PROJECT LOCATION: SE 1/4, SW 1/4, S 18, T 28 N, R 15 W MUNICIPALITY: TOWN OF CADY COUNTY: ST. CROIX DESIGN: PRESSURE DISTRIBUTION MANUAL SBD-10573-P(R/99) MOUND COMPONENT MANUAL SBD-10572-P (R 6/99) CONTENTS: Page 1: Plot Plan Page 2: Cross Section and Plan View of Mound RECEIVED Page 3: Distribution Pipe Layout JAN - 9 2006 Page 4: Septic Tank & Pump Chamber Cross Section and Specifications SAFETY & BUILDINGS Page 5: WLP1000/600 Tank Specifications Page 6: Pump Specifications Page 7: POWTS Owner's Manual & Management Plan - Pg. 1 Page 8: POWTS Owner's Manual & Management Plan - Pg. 2 Name: Bennie Helgeson Signed __ Address: W 1229 770th Avenue Spring Valley, WI 54767 Credential Number: 220292 Date: January 4, 2006 utrlsK~MENT OF COiJMERCE OIVIS-0N0 FEY NpBUILDINGS j SEE GORRES ONDENCE .. ~~ P1d-t- ~I ate. f ~- ~I~ ~~~ _ ~ ~ ~~ C rtp-I~ ~5 S~h ec..~r. ~ ~ r~e.S ProP~sc~ \N,~ ., C~a~S --------~,.- ~ gs +~ ~s~ ~ ~.t~< ~ Flhc t /too ~ ~/'o tv iep,ce :~~c~os~~-SQ P~;sr~Q ~~ R ~R ~r- p` y Ii7 (33 /. ~- y ~~, i3": "'~. t cc. c ~~ $Pt k~ n ~bbor~ `~'a~r K rill ~~~ -- / ~iK. ~il~ TrP~ ~~ Q~ ~-` .~e~ '~~' _~ / -~a_ Jr `_ % ~~ ~~~q~r; loh z~e ,. Page ~ Of Synthetic Covering ~' Distribution Pipe aSTM C 3.3 ,,, ,, o/. 3 Medium Sand ~ H ' 7opsoll --------'~~_- ""'" ~~ . F p ~ - J ~ u 3 E ~ ~ / ~ n b _ Con / C kv, 9'F''L, Slope Force Main Ptowed ._~~~.~Of z - 2 %2 From Pump Loyer Aggregate D /, p3 Ft. E J.•/S-Ft. Cross Section 01 A Mound F t$p Ft. ~ , S" Ft . Signed: License Number: Date: ~rc-L. Ma ~h ~"rOw~ ~-~~ L -------- q S Ft. H ~_ Ft. aS~c.~ t. is ,37 Ft. L '74.9 Ft. J ~ Ft. r ~ Ft. W ~ Ft. Observation Pipe ~ K a --~_r_____. ~ r. _" _"--_ -_------------------------T ---~ --~ l~_~__+___---_______ _ _.:_ ~~ i ~. ~t_ p f i„_ 2 %2 / Distribution Pipe Aggregate r ~rt o~- = ~ ~ a S,- o Observation Pipe ~~s~/ Plon View Of Mound 8~ C ) ea~.e~---f f'r'cCr5~ ~ ..~.~ r,e~t~~~ C~'- ' C. ~ ~ E «N Cw-~ ~G~ C ~~'~ rrp~ t 1 Signed: License Number: Dace: 3©~ Porio~ol~a t~lP. UntuU ~ ~~ / Eno Vitx P~rlorurcU P v c Pip ~ Crul f~..w,,~ E„1 ~_.. ~. Holes Located on Bottom are Equally Spaced r ~ /1 T ~ t'c c / l u L r1 ~1rG ~ ~'~-'~+a~- Distribution Pipe Layout R 6Y/~ ~,~ S X ~~~ ~~ ,~ Y Hole Diameter ~8' Inch .. ~ Lateral ~~_ Incn (es) Manifold ~ Inches ~~ _~ Inches force Main ~.,t,~ LSE R~ t I~e~. / cc. 3.3 t-IolFS {~cr pct+er2.l ._ ~ 5 ti~w,.,,.bL~ ~ ~ ~..c~~-e~L~s - X 3 ro ~Q I ~-l ~l~s ~ ~ s fe~VlA,r; ~on z.~ve ~t ~erGe~ Page~Of • SEPTIC TANK E PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS v" ~11C_VENT PIPE 12" MIN. ABOVE GRADE 6 >_ 25' FROM DOOR, WINDOW OR FRESH AIR INTAKE C, ~'~~ ,., r ._.,, . ....... 18" MIN INLET APPROVED PIPE 3' ONTO SOlio SOIL WATER TIGHT SEALS I FILTER A ~a wx /~11 T c PUMP OFF ELEV . ~_FT. -~-- D DOSE VOLUME INCLUDING ~ . •3 `I C-~, ~ -~F LOWBAC K : . / GAL . CAPACITIES: A = /g INCHES = ~/~E GAL. APPROVED MANHOLE COVER W / PADLOCK E WARNING LABEL -4" MIN. •u 18 MI1~• APPROVED JOINTS WITH APPROVED PIPE 3' ONTO SOLID SOIL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS __Yot~~ rwis z~ ~~+~~ SEPTIC I DOSE ~ /~,~''7 X S SI• ~S~ ~c3~, TANK MANUFACTURER: (,(~ieSev TANK SIZES: SEPTIC '1C,T_ GAL. .DOSE _.ti'~~ ALARM MANUFACTURER: ~~ ~ ~ ~TrB MODEL NUMBER: ~ r,_ ~- SWITCH TYPE: oa'~ PUMP MANUFACTURER: ~_~e I~~- MODEL NUMBER: ~__ /~ 7 SWITCH TYPE: r~[. ~ F1R2f- REQUIRED DISCHARGE RATES `C,°___,~'GPM uEATHERPR00F JUNCTION BOX WITH CONDUIT Zy/, S. D. `~ ~ 1~ I ' GAS- , ,~~ TIGHTS , SEAL ALM ' ON ~ , ~ ' i OFF B = 2 INCHES = 335-•? GAL. C = (~ INCHES = /~ GAL. D = ICC` INCHES = /GAL. PUMP E ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE j(,_,3~ FEET + MINIMUM NETWORK SUPPLY PRESSURE ~~ FEET . ~l~ FEET FORCEMAIN X ~,O'7 FT/100 FT. FRICTION FACTOR _~~ FEET TOTAL DYNAMIC HEAD = /Q. '2~FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH DIAMETER LIQUID 6EP'ITFf- 3(v ~i C ~7 (o C•~cl..~. O~PV . rat e ~ I~PQ s e s~ ~ 7nv1` Sj0'~'L - s ~~ ° ~ ~ SIGNED: LICENSE NUMBER: DATE: 1/88 `~o~ z~ve~ b~,r 1so' .; , ~ . ~ , M,~ ~ ~ ~ ~ . ~ ~ ~ , ,~ ~ - i ~ i . TOP VIEW SCALE: 1/4' = 1' OUTLET :~ O~ M SIDE VIEW ~~ °~ wu>> ooo/soo-MR zABUE TANK SPEt~FICATIONS DIMENSIONS: WALL• 3' BOTTOM: 3" COVER: 5" MANHOLE: 24" I.D. HEIGHT: 56" O.D. LENGTH: 150' O.D. WIDTH: B4' O.D. BELOW INLET: 42' O.D. LIQUID LEVEL: 36' WEIGHT: 14.795 LBS. INLET ANO OUTLET: 4' BORE WITH STOP FOR QUIK-T1TE, FERNCO GASKET, CAST-A-SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLES: WISCONSIN, SEE DETAIL X10 (OTHER STATES SEE CNART7 LIQUID CAPACITY: 27.88 GAL/IN (SEPTIC) 16.76 GAL/IN (PUMP) LOADING DESIGN: 7 0' UNSATURATED SOIL ILET N __ C~~~Q ~oa~o~~r~ Yi13718 US HWY 10. MAIOEN ROp(, WI 54750 800-325-8456 MODEL WLP1000/600-MR ZABIE SEPTIC/SEPTIC. SEPTIC/PUMP OR SEPTIC/SIPHON JANUARY, ?000 Fi~E: wtP~ooo sao-U~ _ ~ i~ h 'L~r ' ~B n 7k~v err bar ~ ~ HEAD CAPACITY CURVE MooEts ts7nss MO DELS 137/ 139 Ft ~~~ ~ Ltrs . 5 1.52 93 352 s 2s 10 3.05 79 299 15 4.57 64 242 s Y0 20 6.10 36 136 25 7.82 8 30 odc Valve: l 26 R t s . . 4 F 0 i !0 30 ~0 50 60 70 8b 90 100 110 90 1a0 2~0 J20 400 fLOw PER MINUTE pppo2t CONSULT FACTORY FOR SPECIAL APPLICATIONS • Ttxae phase pumps are available in 200/20tiV, 230V or 460V. • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Mechanical alternators, for duplex systems, are available with or without alarm switches. • Simplex Panels are available for 3 phase pumps. • Control alarm systems are available for 1 phase pumps. 137 Sarine . d7 the 139 Series - 51 Ibs s.y - - Control Ee leellort Model Volt-Ph Mode Du CEA UL M137N39 115 1 flub 10.7 1 a 13 8 ~ Y Y N137n39 115 1 Non 10.7 2x267 3ar5 8 Y Y BN/37 115 1 1.7 Y Y D137/13a 230 1 flub 5.8 1 or 13 8 - Y Y i 7/13a 1 Non 3 or 8 Y Y • N137/t39 200• 1 AtAo 8 168 Y N • 1137/13a 200.208 1 Non 82 2 67 3 or 5 8 Y N • J137/139 200.208 3 Nm 2.6 4 364x568 Y Y • F137/1~ 230 3 Non 2.8 4 364 a 568 Y Y ' G137 180 9 Non 1~ 4 364 a 568 N N • G139 160 9 Non to 4 364 ar 568 N N ' No nlokbd PwD ~~ piBCY~ swibh kldltded. Pumps mwt be operated b upripl+t paeitlon. ihrM pheN unit rogtrYs a corlhd swild- b apuake an exkmN maq>s8c oorlmcior. For hbrrrlefor- on addi8onal Zaekr products rerer b ~ on Pippyback Variable Level Fbet Srtilchee, FMWn; Elacirleel ANemabr, FA10188; Alecharlical ANerrlshor, FM0195; Alarm Padraps, FMD732: and SunplSewape BaeMu. FMD487. sK3fl • Variable level cbrttrol switches are available for controlling single and three phase systems. • Double piggyback variable level float switches are available for variable level long cycle controls. • Over 130°F. (54'C.) Specal Quotation required. • Refer to FMOti06 for 200° F. applications. SElECT10N GU{DE 1. Irdegral float Operated 2-pols rrhedwrhial swrOd4 no exkrrwl conbd raqu6sd. 2. Single piggybadk variable level float swNch ar dolrbb piggyback variable letrel noel ewltch. lister b FMO4n. 3. Mecharlkxtl aNertwbr td•Pak 10-0072 a 10-0075. Refer b Ftd0495 4. SNnplex three phw oattrd panel. Refer b FAt1228. 5. See FM0712 br oomact model of t7ectrical Anerrtabr. 6. Variable level oontrOl switch 10-02 used as A oonlrol atdivator, specfy duplex (3) a (4) float aYatem• CAUTION All Installation of controls, protection dwkes and wiring atauld be done by a qualHied Ilansed •lectrkian. AU electrical and safely modes should be followed includ(ny tie most recent National Electric Code (NEC) and tiN Occupational Safety and Halth Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safely factor is engineered into the design of every Zoeller pump. aue.7kx Pa e~x tw+r `~ ~~ ~ ~ mod.. e t.olAakdl., icr +o2f fas>Qf ~n• p,,~„ S~or /939 • (502) na2731.1 f800J D28•PIANP btt,J,lv,vwsoNa,.eon, PUMP !O. FAx(5o2J na3a2+ 'z7~"`~ 4 13/16 _ -~ 1 1/2- - 11 1/2 NPi ® Copyright 2001 Zoeller Co. An rights reserved. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 7 of 8 FILE INFORMATION Owner JUN ZJVhN13);'},-:GEN Permit ~ ~ESI(3N, PARAMETERS Number of Bedrooms 3 ^ NA Number. of Public Facility Units ~ NA Estimated flow (average) al/da Design flow Ipeak-, (Estimated x 1.5) 45U al/da So11 Application Rate al/da /ft2 Standard Influent/Effluent Quality. Monthly average " Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODE) 5220 mg/L ~ NA Total Suspended Solids (TSS1 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODa) 530 mg/L Total Suspended Solids (TSSI. 530 mg/L ~ NA Fecal Coliform (geometric mean) 510° cfu/100m1 Maximum Effluent Particle Size Ye in dia. ^ NA Other: ~ ' ^ NA Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity lUUU al ^ N`4 Septic Tank Manufacturer ^ NA Effluent Filter Manufacturer ZAL1;L ^ NA Effluent Filter Model A-lUU ll" x 2U" ^ NA Pump Tank Capacity 5UU al ^ NA Pump Tank Manufacturer WIESEIi CU~~ChEi'i; ^ NA Pump. Manufacturer ZUELLEIc 1'Ucil' CU ^ NA Pump Model 137 ~ ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: ~ NA Dispersal Cell(s) DNA ^ In-Ground (gravity) ^ In-Ground (pressurized) ^ At-Grade m Mound ^ Drip-Line ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA MAINTErvArvI:C scntuu~~ _ Service Event ~ Service Frequency ' •~ ~ InspectcondRion of tankls) At least once every: 2 ^ monthls- (Maximum 3 years) ~ earls) ^ NA Pump,out Contents of tankls) When combined sludge and scum equals one-third (Y31 of tank volume ^ NA Inspect dispersal cellls) At least once every: 1 ^ monthls) (Maximum 3 years) yearls) ^ NA monthls) ^ NA Clean effluent filter At least once every: 13 yearls) ~ monthls) ^ NA Inspect pump, pump controls & alarm At least once every: 13 ^yearls) ^_ monthls) ^ NA Flush laterals and pressure test At least once every: 3 ~ yearls) Other: k, y At least once every: ^monthls) ^ yearls- ^ NA Other .~ ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tankls- 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 cellls) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire cdntetlts of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment unlta;' and•any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A Service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page 8 of 8 ST'94RT~UP~A(VD bPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting. products or other chemicals that may impede the treatment process and/or damage the dispersal cellist. If high concentrations are detected have the contents of the tankls) removed by a septage servicing operator prior to use. ~~. . System start up shall not occur when soil conditions are frozen at the infiltrative surface. - --~•~• • During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewat®['!~l~fwJ38 discharged to the dispersal cellls) in one large dose, overloading the cellls) and may resulf in the' backup or surface discha~pg~p~ effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to Irostoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controMko .,:. . 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; disinfectan~s~ falt;_ 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 permanently taken out of service the following steps shall be taken to insure that, the system is, properly and safely abandoned in compliance with chapter 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 Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with s:+:,:: ~~: . 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: , ~ D A suitable replacement area has been evaluated and may be utilized for the location of a replacement so~I, abslprRtjan system. The replacement area should be protected from disturbance and compaction and should not be infringed"upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement-.a[eS..>IagF result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement sySterYls;(f1u8t comply with the rules in effect at that time. ~ ~' ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS' technology a holding tank may be installed as a last resort to replace the failed POWTS. , ._„,:,,, ,; ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and`site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding',tank: may be installed as a last resort to replace the failed POWTS. ,. ;, dl 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. D~1 NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF"A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. • > ~~~~ ~~ ADDITIONAL COMMENTS ,,. ~: POWTS INSTALLER POWTS MAINTAINER Name r:LL~LS{~i4 LX1;A4~A'T1Ui~~ Ii~dC Phone •71~/77~-3l7u Name Phone 715/173-btfll ;_.,: ,., SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY • Name '~ Name ;;~,.., ~ui.iv5iJili 5A\I'i'A'1'IU~' ,~:.. Phone - Phone 715/3tfb-46i3U This document was drafted in compliance with chapter Comm 83.~2121(bl(1)(dl&If- and 83.54(1), 12) & (3), Wisconsin Administrative Code. Wisconsin Depa a tof Com roe SCI EVALUATION REPORT Page ~ of~, Division of Saf pd~Buildings i E'a ~ '~P~ ~ ir~~ccordfin~e4rh~ Com 85, Wis. Adm. Code (~ County S ?' ~~ Attach complet s n on p per n e inche in size. Plan must / include, but not I ed : verti Ian" point M), direction and Parcel LD. percent slope, s ~ en ` istance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 9 Propperty Owner ~ e S ~ 61 Property Location •• ''~ °~ e r ~~ ~ Z ~, v~ ,b P ~., e Govt. Lot ~~ E 1/4 S (A./1 /4 S ~~ a N R /S E( W Prope Owner's Mailing Address Lot # Block # Subd. Name or CSM# City State Zip Code Phone Number ^ City ^ Village own Nearest Road (;~,,~t(Sov~ ~,~ s'~Da7 (IS) 69g -~ g(ob ~~ ,T ~/ r 1, ew Construction Use: Residential / Number of bedrooms _~_ Code derived design flow rate ~l,~"U GPD ^ Replacement ^ Public or commeroial -Describe: Parent material .L ~ ~ Sl 6 U er T ~~ Flood Plain el/evation if applicable ft. General comments ~ ' X ~-~ , aS ~ C C~~ W/~iC ~ 2 ~~ San ® u~ ~~~ ~'~-~~ r 2~~,e an u~~' _ ^~ n ~~` CO ~r" Boring # ~ Boring G~ Q p t Ground surface elev. /~ ft. Depth to limiting factor ~ in. Soil licetion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ~ - S s ,t ~, ~~.~, - S ~ - /~o ~ ~,s1 s ~ L ~s,6 u ~J f~ -y~ = caa ~ s v S ~~ Boring # I~~ Boring // L~ pit Ground surface elev. 9 7, ~ ft. Depth to limiting factor ~ ~n• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ~-- ~ ~ ~s~ rn~~~- w .~. t~ ~ h • g ~ to ~~ c s L_ ~~c~ - .3 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST ame (Please Print~J Signature CST Number ~~L 6~ i~,P 1-12 ~ e5 ® ~ ~ n~ f ~ Address ~ ~ //~ ~ Evaluation Conducted Telephone Number ~,,,..,~,,, m,..,,,.~ a5 S5r76 7 Property Owner ~ Z1~Y` 1 ~~- l ~ O 4'L Parcel ID # Page c~ of 3 Boring # o B~ng U Plt Ground surface elev. ~ ~. ~ ft. Depth to limiting factor ~ 7 ~n• Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. *Eff#1 *Eff#2 - 7 ~r~ ~ - ~ ~s~k ~ ~- 0.~ ~' ~o . g ~ ~1 /~ ^ Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil A igtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. *Eff#1 *Eff#2 ^ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fE in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) ,, c~~ ' V O a'l 2~11e~-i~Cl'"'q~n ~e_r , ~~~- ~~3~•t'ro~rT~ LIwE' ~ ~j ,E}C f c5 ~3~b~~. ~~ ~~ ~ p~o~e~+y 1-t~-e G ro ~~~~ ~(~`~ . 160• ~~ bra x , i ~ 3 T3~ ~. ~o ~e ~ B.M - Icy. o0 ~0. _ __ \ po~Gc Tr~~ i ~ _ ~ ~ ~9 ~ ~1~1, ioo.~o QI ~~P ~-fi ~ y "~Pvc •~~ ~ Q s -~ B3 ~ ~r~~~ ~ ~ ~ ~~~ s~ op-~- ~ .. ~yv 3 ~~' ~ ii ScQIQ I"= Yo ~xc~pf 1~s S~tow~ x{90 ~o ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer e Mailing Address 3t~ 8 ~eTI` ~ t,P~ u~~..., ~~ d ~ -~ I -t ~ ~ ~ 4 C'G~ ~~31~ ~ ~~ ,~ .~ Property Address (Verification required front-~aitning Department for new City/State I~~t~l 5011 ~_ Parcel Identification Number ~,~~ ~~ ~07` 2 ~ 3r~ ~ ~~ LEGAL DESCRIPTION Property Location S~ '/., ~ '/., Sec. ~~, T~_N-R I ~ W, Town of ~~ ~ - Subdivision Lot # ~,_• Certified Survey Map # .~~~0 5 ~ ,Volume ~ ~ ,Page # ~$a~_• Warranty Deed # ~d 7 ~ ~ ~ Volume ~l ,Page # ~ Spec house ^ yes ~ no Lot lines identifiable ~I 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 pltunber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal rystam is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full Of ~Se. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards sec forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. CertlSCation stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning OtI•ice within 30 days of the thrce year expiration date. SIGNATURE OF APPLICANT / / DATE OWNER CERTIFICATION I (we) certify that all statements on dais form are true to the best of my (our) knowledge. I (we) am (are) the ownet{s) of the pr rry des above, by virtue of a warranty deed recorded in Register of Deeds Office. / ~/ SI ATURE A PI;ICANT DATE Any t ormation that ts-represented may result in die 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 g~46~9 2 8 7 5 P y 2 O KATHLEEN H. wALSH REGISTER OF DEEDS WARRANTY DEED sT. CROIX CD. , NI RECEIVED FOR RECORD This Deed, made between Robert D. Nelson, and Donna IC. 08/252005 1e:3eAn Nelson, husband and wife, Grantors, and Jon A. Zevenbergen and Lynn A. Zevenbergen, husband and wife as survivorship marital MARRANTY DEED kxEi~T iF property, Grantees. Grantors for a valuable consideration, convey to Grantees the following described real estate in St. Croix County, REC FEE: 13.0A TRAKS FEE: 300. ®0 State of Wisconsin (the "Property': COPY FEE: CC FEE: PAGES : 2 See attached legal description RETURN TO: t;cemc nnF Iwo ~asrw~cr. wc. no ~ocusr star, s~ t r+~soN.vn sw~e~ ~~,/78 Parcel No. 004-1042-30-000 Together with all appurtenant rights, title and interests. This•te/is not homestead property. Grantor warrants that the title to the Properly is good, indefeasible in fee simple and free and clear of maces except easements, restrictions and covenants of record. Dated this 1 y>~day of . !as 2005. AUTIl~NTICATION Signatures of Robert. D. Nels~ and Donna K. Nelson authenticated this day of _ , 2005. Robert D. Nelson t9~ ~f ,C, X`' Donna K Nelson IS~,~~~~'~~Z~u~~~ TITLE: MEMBER OF STATE BAR OF WLSCONSIN {If not, authorized by §706.06, Wis. Stets.) STA/TE O~F?~ WISCONSIN) THIS INSTRUMENT WAS DR,B7~COtt ECi<h y came before me this ~9ay of Nab f Notary PUbilC2oo5 The above Hamad Robert D. Nelstm and Donna K. James R. Bartholomew `' _'_^.te of Wiseon~~ to me known to be the persons who ta~utea BARTHOLOMEW LAW OFFICE, S.C. ~ ~~~~"~' . ~. ~ ~ ~ - . oing instrument and acknowledged the same. 220 Locust St, PO Box 27 Hudson, Wisconsin 54016 .~..~t'~~~- Notary Public, State of Wisco`n'sin (3i~tstures tnay he ataheatirffied «~ admawledgtxL Both are Hat necessary) My Commission (expires): ~/-// ~S +Nmne ofpaeaoe si®aiog is eay capacity t~hosld 6e typed or posted 6eloN etroir eigpetmae. i U ~8?5P 'i2]. GRANTORS: Robert D. Nelson and Donna K. Nelson GRANTEES: Jan A. Zevea~bergea~ and Lynn A. Zeven PARCEL ID: 004-1042-30-000 Property Transferred =- ~~~~~ ~S~` I~ ~ ~ _~~, . ~~ ~ ~ ~~~ A parcel of land located in the Southeast Qu er of the Southwest Quarter of Section 18, Township 28 North, Range 15 West, Town of Croix County, Wiscons' described as follows: Commencing at the Southwest corner of Section 18, thence North 89 degrees 53 minutesl6 seconds East 1313.61 feet along the South line of the Southwest Quarter Section 18 to the Point of Beginning; thence North 00 degrees 41 minutes 07 seconds East 1322.50 feet; thence North 89 degrees 56 minutes 27 seconds East 664.59 feet; thence South 00 degrees 35 minutes 22 seconds West 1321.86 feet; thence South 89 degrees 53 minutes 16 seconds West 666.80 feet along said South line to Point of Beginning, containing 880,101 square feet; (20.204 acres) more or less and being subject to all easements, restrictions and covenants of record. EXCEPTING THEREFROM THE FOLLOWING: A parcel of land located in the Southeast Quarter of the Southwest Quarter of Section 18, Township 28 North, Range 15 West, Town of Cady, St. Croix County, Wisconsin, described as follows: Commencing at the Southwest corner of Section 18; thence North 89 degrees 53minutes 16 seconds East 1313.61 feet along the South line of Southwest Quarter of Section 18 to the Southwest corner of that Certified Survey Map recorded in Volume 10, page 2826 and the Point of beginning; thence North 00 degrees 41 minutes 07 seconds East1322.50 feet along the West line of said Certified Survey Map; thence North 89 degrees 56 minutes 27 seconds East 15.50 feet along the North line of said Certified Survey Map; thence South 00 degrees 37 minutes 12 seconds West 1322.47 feet to the South line of Section 18; thence South 89 degrees 53 minutes 16 seconds West 17.00 feet along said South line to Point of Beginning, containing 21,488 square feet (0.493 acres) more or less. ~-'~ a2209~ CER T 1-EI E~ S UR VE Y M.4 F' Located in the Southeast quarter of the Southwest quarter of Section 18, Township 28 1~Torth. Rahge 15 West, Town of Cady, 5t. Croix County, Wisconsin. NORTH LINE OF THE SEI/4 OF THE SW I/4 C_ T. -H- -- ~~-N I~ - - - - - - - - - -~--~- r 99'x'-"' E' ~B~''~'9'' - N` -- -~ - z - - - 2287' N 69'14'23•E 664,77' OWNED BY= 14.73` HAGNER GUNDERSON 13' 100` SETBACK ..._ LINE_...FROM„R.O;W:,,,,. 32, BOX 291. 270TH ST. ................... WILSON. W1. 54027 Q N ~®7l 1 i 880, 101 Sq. Ft. (20.204 Ac.) 3 ~- Including right-of-way. i ,~, 0 607 Sq. Ft. (19.918 Ac.) 867 _ , Excluding right-of-way. - o ~ m a IO W ~ W ~ y F (A • _ M W W W _ I ~_., N ~ N I NI V, ~ " 7 01 2~ LL R} s-1 ~ 2 I 2I WI O y ~ N Z' W ~ J H O N W ~ ~ .r ~- 3 W J ZI I ~ W 4 I ~ O QI I 3 s n f` O ~ OI I U m Y ~ n1 N m 1- W 'a! I ~ ~ ~ ~ = JI WI W U O -~, Wl c '? I' ZI 3~ W ~ W N tp ZI 3I W O O O ]I OI N 'I OI Z ~ O 2 Z O ~ J Z N '~ W d1 ~ W Z ~ w ~ y m J .L I a W POINT OF BEGINNING 6 N 89° 83` 16" E 1313.61 ` 666.80' 2667. 22` N89°53~ 16~~E i S e9.53~ 16"W 666.60' I' 51/4 COR. SW CORNER I SEC. 18 SECTION 18 SOUTH LINE OF SECTION 18. T28N,R15W UNPLATTED LANDS' - LEGEND''- O VAN F_„_D BY QT ji~t5~ ~' SECTION CORNER MONUMENT ~ I " X 24" IRON PIPE WEIGHING 1.68 LBS./LIN. FT. SET. -x~ FENCE SCALE IN FEET 1" =200` O` 50 100` 200` 400` This instrument drafted by: JS.I. SE COR. SEC. IB Voi . t 0 Page 2826 4942349