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HomeMy WebLinkAbout008-2009-06-000 % of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 499272 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Larson, Dean I Eau Galle, Town of 008- 2009 -06 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: q7. s— C ? & M k Z 01.28.16.573 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS tHl FS ELEV. Septic � Benchmar / ! ` 7 , / 7. 5-i Dosing Alt. BM P �T GVQ / 7 E ldin B ldg. Sewer 1 - RM Sf/ t Inlet �¢ Vj / V TANK SETBACK INFORMATION St/Ht Outlet / N TANK TO P/1 , WNW BLDG. Vent to Air Intake ROAD Dt Inlet h ga; 2Z Septic > ' / 1< r "i� v t Bottom � L ?o 9 r Dosing tri Head (r an. • d 3 Aeration Dist. Pipe Holding Bot. System Final Grade S ' Ste. � -�'�- PUMP/SIPHON INFORMATION Manufacturer De and St Cover / I Z. Z Model Number / l TDH Lift (,00 Friction Low Syste Head TD � .^f F Forcerniin Length / Dia. „ Distto i I va Q SOIL ABSO P ION SYSTEM BED/TRENCH Width Q Len th No. Of Trenches I PI DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ,Z SETBACK SYSTEM TO P/L o JBLDG IWELL KE /STREAM LEACHIkG Manufacturer: INFORMATION MBER Type Qf,$ystem: , , �' > I UNIT odel Number: DISTRIB TION SYSTEM Header anifo Distribution 2 x Hole Size I x Hole Spacing Vent to Air l ke N O Length Dia Length Dia ___(-! - Spacing W SOIL CO x Pressure Systems Only Or - Grad a Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulc 1 e ' d Bed/Trench Center Bed /Trench Edges Topsoil –7 12 4, i � Yes ' No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / � FQ Inspection #2:�_/ 2 Location: 2687 60th Avenue Woodville,, WI 54028 (NE 1/4 NE 1/4 1 T28N R16W) White Pine Meadows Lot 6 Parcel No: 01.28.16.573 1.) Alt BM Description �vp 4 ' " "" w --`' d .� r - / - , ei ! �T 1 R 2.) Bldg sewer length = 2 9 -i-v �C, � -G��C- - amount of cover = � ^, IM13 7l�wv� Plan Use other l side for additional in Yes o t�` ���►� ` formation. —. �! -� -- -- _ Cert. No - Date Insepctor's gnature SBD -6710 (R.3/97) Y Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ST. CROIX N piscons i n Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 -3151 _ Y71z7Z Sanitary Permit Application State Plan Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide 1339278 may be used for secondary purposes Privacy Law, s15.04(1 Xm) t Address (if di than ma address) I. Application Information - Please Print All formR- C Z p 7 (O,o • k 4 Lk 4::�N t Property Owner's Name Parcel # Lot # Block # DEAN LARSON DEC 2 1 2006 008- 2009 -06 -000 6 �, Property Owner's Mailing Address Property Location 596 270TH STREET ST. CROIX COUNTY NE '/s NE ' /e, Section City, State a Phone Number 1 WOODVILLE WI 54028 715 -441 -9998 T 28 R r<circli one) S 7 ) II. Type of Building (check all that apply) � l7 ✓ / 3 �`' rte ' 6"6"". � Subdivisi N; on Name CSM Number ❑✓ 1 or2 Family Dwelling - Number ofBedrooms WHITE PINE ME/� Public /Commercial -Describe Use 1 ❑State Owned - Describe Use 4 0 1 -Y 5l'p, OJ t/ \ ❑c ity ❑VillageQTownshipof EAU GALL III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. 0 New System y ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only 13 Other Modification to Existing System B. ❑ Permit Renewal 0 Permit Revision [3 Change of 0 Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that apply) p ❑ Non - Pressurized In -Ground ❑ Mound > 24 in. of suitable soil 0 Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter 0 Constructed Wetland ❑ Pressurized In -Ground [3 Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter 2 Recirculating Synthetic Media Filter ❑ Leaching Chamber 13 Drip ine ® Gravel -less Pipe ❑ Other (explain) 5q„nal 1, 1, 93 , V. D' ersal/Treatment Area Information: -1 gn w pd) I Design Soil Application te(gpdsf) 1 Area R "red (sf} raO�� al Area Proposed (sf) System Elevation 400 1 a C5 400 �Q btS 0 - 3 !v • Z5 97.63 ✓ VI. ank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units //�� Concrete Constructed Glass New Existing Tanks Tanks r !✓ L 0 G L K. 5L? , ,/ Septic or Holding Tank 1000 1000 1 WIESER CONCRETE X Aerobic Treatment Unit Dosing Chamber 600 1 600 1 WIESER CONCRETE X VII. Responsibility Statement- I, the undersigned, assume responpibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum er's Signature ,,.. MP/MPRS Number Business Phone Number BENNIE HELGESON `" 92 715/772 -3278 Plumber's Address (Street, City, State, Op ode) W1229 770TH AVENUE, SPRING VALLEY, WI 54767 VIIL our /De artment Use Onl roved ❑ Sanita Issuing ry Permit Fee (includes Groundwater Date Is ued Signature (N to s p isapprov Surcharge Fee) er Given Reason or Denial / Z !: L �(o IX. Conditions of Approval/Reasons for Disapproval �1 SYSTEM OWNER: 3� G O naQt /A sda� eJ �e 1. Septic tank, effluent filter and r ,� � dispersal cell must all be services !maintained �-- a-t as per management plan provided by plumber. 2. AN setback requirements must be maintained as per applcable code / ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) c -A � , f� T 1 /" eahwS 1 ,het -ems IJ 1 to �' M "' 4-4 I V l�Pr �V c- e '5r- te J 3 �Q� t ©o. C) c� Pi C) Pam QG. C, S- (2- � ; eh n e e sa g .M q'7. v O 10, off' i a AC1,-eS IV N E � Scc, I I I 7" 8 15 Al C3 3 Lill t S loe I P ro oS��k \ joog /boo G41. Se�P �„c- e ro V DoSEC� �Qikiq . 1312 �4o e t0 C o c, T� c4 1�" Pow P,0e 3 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page Of Division of Safety and Buildings in accordance with Comm 85 Wis. Adm. Code _ County Attach complete site plan on ap2f not I ss than 8 1/ x 11 itr� P must include, but not limited to veF dzo I nce p�i�(d eimrl Parcel I.D. percent slope, scale or dime on n w arnd cation and distance to nearest toad. Please print al r L atiati. 1eW Date Personal information you provide may be used for seconds purposes (Privacy Law, s. 15.04 (1)(m)). L- 0 Property Owner \ � „� location -P Je�� ©GL G&f.- DOT”, ,) E 1/4 1/4 S Tag N R E(or aLJ Property Owner's / Mailing dress p Lot # Block # Subd. Name or CS1vW D 6 � �J ®G1 l�� . 6; P, ✓l •e / v 1 e C�A� co City State Zip Code Phone Number ❑ City ❑ Village own Nearest Road ec'L,1 e.._ fit DNew Construction Use: E3 Residential / Number of bedrooms _ Code derived design flow rate GPO ❑ Replacement ❑ Public or commercial - Describe: Parent material -f. ©t)dEg /( Flood Plain elevation if applicable General comments /� r , c d &U A-, GY -6,- 4 5da e 6 A- and recommend tions: GGS� J J 96.3 ( J� ❑ Boring I f —J I Boring # Ground surface elev � ft. Depth to limiting factor ��_ in. l�"Pit Soil ADolication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 tu I Boring C] B�n9 g PPit Ground surface elev" '" 3 ft. Depth to limiting factor in nGPD/ff ion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#Z 3 3 S t( �� k Vt't r Ct� i l U� �� i J q- ' Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg/L ` Effluent #2 = BOD _< 30 mg/L and TSS 5 30 mg/L CST Name (Please Print) nature e�� CST Nun's iA Address a Evaluation Conducted Telephone Number �l C X �G �, Property Owner ��w I � `Saf Parcel ID # Page 1 of 3 a Boring # ❑Boring �p 3 s it Ground surface elev. � ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color t Gr. Sz. Sh. 'Eff#1 •Eff#2 r ! U S ht�t— C /u N. c) -` ? 7 sY dl t ov j S 6 s --6 17 0 t ,- Boring # ❑Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor (n• Soil Application Rate I 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 1 i a Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit SoU Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I I i Effluent #1 = BOD > 30 i 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 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. 1 1131).8330 (R.07 /00) Property Owner PO-C- Me sc l n- Parcel ID # Page C)4 of 3 Boring # ❑ Boring 3 9 Pit Ground surface elev. 7 7-3s ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description, Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 a r-� L t 3 S d s � Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor (n• Soil Application Rate I 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 i i I i F-1 ❑ Boring Boring # El Pit ft Ground surface elev. . Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 I I Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 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. S IM -8330 (R.07 100) Pl t i 0 ►� ��� � � �� 3 „Lek ock A VE. T o 97 R � V-3 qq �-3 �96.3 � f I B.ft, [c .e� Safety and Buildings commerce.wi. OV 4003 N KINNEY COULEE RD g LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www.w isco n sin.go / isco sin.go Department of Commerce isconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary November 07, 2006 CUST ID No. 220292 ATTN: POWTS Inspector BENNIE W HELGESON ZONING OFFICE HELGESON EXCAVATING ST CROIX COUNTY SPIA W1229 770TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/07/2008 Identification Numbers Transaction ID No. 1339278 SITE: Site ID No. 720246 Dean Larson Please refer to both identification numbers, 60th Avenue above, in all correspondence with the agency. Town of Eau Galle St Croix County NE1 /4, NE1 /4, S1, T28N, R16W Lot: 6, Subdivision: Pine Medows FOR: Description: Three Bedroom Mound System / New construction Object Type: POWTS C =Frat Regulated Object ID No.: 1105956 Maintenance required, 450 GPD 20 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manua , (R.6/99), Pressure Distribution Component Manual - Version 2.0, SBD- 10706-P (N.01 /01) 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 located and constructed 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. • The proposed well shall be a min. 25' from the treatment tank and a min. 50' from the dispersal cell. • 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 tank/filter for maintenance purposes must be provided per Comm 84.25(7), Wis. Adm. Code. Note: Comm 83.22(7) requires that 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. P? O.W.T.S. Conditionally APTR'110VED BENNIE W HELGESON Page 2 11/7/2006 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 may be made to me at the telephone number listed below, or at the address on this Ietterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 5 erard M Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swim@wisconsin.gov cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 INDEX SHEET RECEIVED N o l Zoos PROPERTY OWNER: DEAN CARSON SAFE & BV I �iN� 1100 OAK STREET BALDWIN WI 54002 PROTECT NAME: DEAN LARSON PROJECT LOCATION: NE 1/4, NE 1/4, S 1, T 28 N, R 16W MUNICIPALITY: TOWN OF EAU GALLE COUNTY: ST CROIX DESIGN: PRESSURE DISTRIBUTION MANUAL SBD- 10573- P(R/99) MOUND COMPONENT MANUAL SBD- 10572 -P (R 6/99) CONTENTS: Page 1: Plot Plan Page 2: Cross Section and Plan View of Mound Page 3: Distribution Pipe Layout Page 4: Septic Tank & Pump Chamber Cross Section and Specifications Page 5: WLP 1000 /600MR Tank Specifications Page 6: Pump Specifications Page 7: POWTS Owner's Manual & Management Plan - Pg. 1 Page 8: POWTS Owner's Manual & Management Plan - Pg. 2 Name: Bennie Helgeson Signed Address: W1229 770th Avenue Spring Valley, WI 54767 Credential Number: 220292 Date: October 31, 2006 n C1 W Vvin lel �l:.0 6� SAFETY AND BULDINGS E CO S PONDENCE CE So-" Page Of Synthetic Covering Distribution Pipe y3 A STM C 33 i �risti v Medium Sand _ H G Topsoil I: r.ti. ✓ ��� 3 )I E 11 b Lora u.v' ���. 9 �v • 3 7 % Slope Plowed CELLOf 2 2 i Force Main Aggregate From Pump Layer D /,33 Ft. E .n _ 81 Ft. Cross Section Of A Mound F , �(D Ft. G , S Ft. A � Ft. H / Ft. Signed: g �)5 Ft. License Number: K &.0 Ft. L 7.71 Ft. Date: _ D Ft. Ft. W Ft. Observation Pipe � K -- - - - - -- A I` - ------------------ - - -- — - - - �----------- -- - - - - -- j W _ r----- -- - - -- — — istribut ion t.L Z - 2 L Pipe gate Observation Pipe � / /��, • �S �� Plan View Of Mound C�'t e� ✓1 v' �/ Y► 1�C� r C�r� aJ 0 Per 1orulnn hIP, (jn l u ll C Team / / End Viau PVC Pip( � C` Holes Located on Bottom are Equally Spaced // ! Pip, Discribueio,_ ,_�?i c Layou� ' x a Ji Y Hole Diameter __:_ L Inch Signed: 11 A Ynch (es) Lateral License Number: Inches rlanifold " DaL'e: Force Main � Inches f�uw -�.� er o � �,a.•� f� 5 -� __O e - ; _Vep_v► Lo-y G v► Page_�_Of SEPTIC TANK 6 PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS PX,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 S WARNING LABEL �k� ya•p - 1 � � 4" MIN. 2y „ 18" IN. , 18 rniN, INLET WATER TIGHT SEALS GAS- ` / TIGHT /APPROVED FILTER A SEAL JOINTS WITH i_ ALM APPROVED PIPE APPROVED P �� B ' ON 3' ONTO PIPE 3' S 5 - F` SOLID SOIL ONTO SOLID C I ' SOIL PUMP OFF ELEV . �I — OFF D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS y I` _ _� D 5�. �7 � I � z ^ L d I Y SS 1►� SEPTIC / DOSE XZx s = 7 TANK MANUFACTURER: TANK SIZES: SEPTIC /Q00 GAL. DOSE VOLUME INCLUDING DOSE OD GAL. 141,x,7 6, �c,SD GAL. t CAPACITIES: A INCHES = C 6 GAL. ALARM MANUFACTURER: S - �eLl�rcS MODEL NUMBER: B = 2 INCHES = 33 GAL. SWITCH TYPE: � "U MP MANUFACTURER: z pELI��� C = INCHES = /�_S GAL. MODEL NUMBER: /S3 D INCHES = Ik7• GAL. SWITCH TYPE: FQU 1 R ED DISCHARGE RATE 3O.7 SGPM PUMP 6 ALARM WIRING AS PER I LHR 16.23 WAC FEET ✓ERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE / 7. S FEET � MINIMUM NETWORK SUPPLY PRES FEET FEET FORCEMAIN X ,p: FT /100 FTOTALIDYNAMICAHEAD FEET . ; WIDTH DIAMETER ERNAL DIMENSIONS OF PUMP TANK: LENGTH LIQUID 710 Per, rNG ��eccs� IGN LICENSE NUMBER: DATE: ED: /86 F L1,J ] o r6 LLJ < � Ln C) cn Li LJ Z u 0 ea LY 0 0 CL N LLJ D Lo V-, 50 C) 00 C; m z Z Z) 1-- J < - < V) < U) -j LL- 0 < < LLJ LJ 00 z a- v) 0 W W m 0 0 m om 0 0 to 1 L , ) < L� 0 N LD 00 r- < W 0 w Lo M 0 LLJ L'i (N C5 " �- 3r ' 0 r- ~ -Q — < cn C14: w w (D 0 q > F V) 0 In - Lr) �j - Fn 0 -1 co Ll D 0 :z) Z U� U 0 O�:: 0 0 0 0 L'i < U) :E F-- L) M a- 0 z z i-- z 0 0 T m In U) < C)-JI-- <FJZO-JO Z., < z < 0 0 < CD < L) 3: m om= --j z L W LLJ C) fi Ln > F- LLJ Z NJ ----- ------ A --!� - — 1 0i --------- Lli LLJ 0 CL 0 L/7 V) Z > j � �. i � , � _ I I S: . TOTAL DYNAMIC HEAD /CAPACITY HEAD CAPACITY CURVE PER MINUTE EFFLUENT AND DEWATERING MODEL 152/153 Of w MODEL 152 153 50 Feet Meters Gal. Liters Gal. Liters 153 5 1.5 69 261 77 291 12 40 10 3:1 61 231 70 265 15 4.6 53 201 61 231 _ (�!5 20 6.1 44 167 52 197 30 �L 25 7.6 34 129 42 159 z 8 30 9.1 23 All 33 t 25 20 35 10.7 -- 22 85 40 12.2 -- 11 42 4 Lock Valve: 38.0 ft. (11.6m) 44.0 Ft. (13.4m) 10 014508 0 20 40 60 80 100 GALLONS 6 t/4 LITERS 0 80 160 240 320 3 27/32 4 5/8 FLOW PER MINUTE L327/32 32 CONSULT FACTORY FOR SPECIAL APPLICATIONS e _ I — • Timed dosing panels available. O® • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase l systems. Double piggyback variable level float switches are available for variable level long and short cycle controls. l Sealed Owik -Box available for outdoor installations. See FM1420. Over 130 °F. (54 °C.) special quotation required. I 1521153 Series 12 1/8 1521153 MODELS Control Selectio Model volts•Ph Mode I Amps Sim lex Duplex 5 1/8 N152 115 1 Non 1 8.5 1 2or3 BN152 115 1 Auto 8.5 Included 2or3 sK208+ E152 230 1 Non 4.3 1 2 or 3 BE152 230 1 Auto 4.3 Included 2or3 N153 115 1 Nan 10.5 1 2or3 BN153 115 1 Auto 10.5 Included 2or3 SELECTION GUIDE E153 1 230 1 Non 5.3 1 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float BE1531 230 1 Auto 5.3 Included 2 or 3 switch. Refer to FM0477. D CAUTION 2. See FM0712 for correct model of Electrical Alternator E - Pak. All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10 - 0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed including the most 4 recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). Or ( float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 Louisville, KY 40256.0347 Manufacturers of. . Zr SHIP T0: 3649 Cane Run Road ® Louisville, KY 40111.1961 QvaurrPawa � e N /9. Cr 99 ® t (502)778-2731-1(800) 928 -PUMP http://www.zoeller.com PL/MP !O. FAX(502) 774.3624 © Copyright 2001 Zoeller Co. All rights reserved. Page POWTS OWNER'S MANUAL & MANAGEMENT PLAN of FILE IIUFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity al ❑ NA Dean n Permit Septic Tank Manufacturer Wieser Concrete ❑ NA Effluent Filter Manufacturer Polylok ❑ NA DESIGN PARAMETERS ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model PL -525 Number of Public Facility Units NA Pump Tank Capacity 600 a l ❑ NA Estimated flow (average) 30U al /day Pump Tank Manufacturer Wieser Concrete ❑ NA ❑ NA Design flow (peak), (Estimated x 1.5) 450 gal/day Pump Manufacturer Zoeller Puiup Co 153 ❑ NA Soil Application Rate gal/day/ft Pum p Model Standard Influent /Effluent Quality Monthly average' Pretreatment Unit Q NA Fats, Oil & Grease (FOG) 530 mg /L 0 Sand /Gravel Filter ❑Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L IN NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5 ❑ Disinfection ❑ Other: 150 mg /L ❑ NA Pretreated Effluent Quality Monthly average Dispersal Cell(s) Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) 530 m /L IN NA ❑ At -Grade W Mound Total Suspended Solids ITSS) mg /L Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other: Other: ❑ NA Maximum Effluent Particle Size Y. in dia. ❑ NA - O Other: ❑ NA Other: ❑ NA Other: ❑ NA 'Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Frequency Service Event I ❑ monthls) (Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every: 2 12 earls) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA _ ❑ month(s) (Maximum 3 years) ❑ NA Inspect dispersal cell(s) At least once every: 2 [R year(sl IR month(s) ❑ NA Clean effluent filter At least once every: 13 0 year(s) Q month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: 13 ❑ year(s) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: 3 C year(s) ❑ month(s) ❑ NA Other: At least once every: ❑ year(s) - ❑ NA Other: 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. Tangy: inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any c round surface. racks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the 9 ondincg The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any p 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 (Y or more of the tank volume, the entirr. contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/011 c`S. b OWNER: Dean Larson Page of START 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 start up shall not occur when soil conditions are frozen at the infiltrative surface. � restored the excess During power outages pump tanks may fill above normal highwater levels. When power wastewater will t discharged to the dispersal cell(s) In one, dose, overfoading the ceii(s) and may result In the removed by a backup or surface discharge of effluent. To avoiid t is the Lion nt pump or contact a Plumber o POWTS Mafntalner to Septage Servicing Operator prior to restoring Po 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. the !fie Reduction or elimination o f the following from the wastewater stream may Improve the performance and prolong R o f the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss,!* b rs, disinfectants; fad foundation drain (sump pump) water, fruit and vegetable peelings; gasoUne; grease; pesticides; sanitary napkins; tampons; and water softener brine. scraps; medications; oil; painting products; ABANDONItMENT When the POWTS fails and/or Is permanently taken out of service the following steps s Admt tly sur ethat the system is properly and safely abandoned In compliance with ch. Comm 83:33, • 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 property 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, or must be taken, to provide a e compliant replacement system: en A suitable replae em The re placement area be protected uti d sturbance and compaction and should not absorption up P proposed structure, lot Imes and wells. Failure to be infringed upon by required setbacks from existing and prop 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. 0 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 e p erformed to e a r eplacement area. area. U n d o replacement area is available a site evaluation must b p 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 blomat at the infiltrative surface. Reconstructions of such systems must comply with the rules In effect at that time. « WARNING>> SEPTIC, PUMP AND OTHER TREA OR OTHER TREATMENT TANK UNDER ANY CIRC MDSTANCESFDEATH MAY OXY DO NOT ENTER A SEPTIC, PUMP RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSlB ADDITIONAL COMMENTS POVY(S INSTALLER POVYTS MAINTAINER Name Hel °son Excavation INC Name Johnson Phone 715/772 -3278 Phone 715/273 -58 LOCAL REGULATORYAUTHORM SEPTAGE SERVICING OPERATOR PUMPER Agency St. Croix Count Zonin E e Johnson Sanitation Inc e 715/273 -5811 Phone 715/386 -4680 This document was dratted by the stiffs of the Green Lake, Marquette and Waushars County Zoning and SanlUtlon agondfs. This doaunant meets the minimum t air drafted or ch. Comm 83.2e Green Lake and 83.54(1), (2) & (3), w isconsin Administrative Code. Use of this document doe! riot G1dW (1)01) guarantee the p erformance or the POWTS. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer _Dean Lrt -rso-xj Mailing Address Jr" 94, '7 6f 066aL.), It)j -, �55D,.V Property Address �6 tP d C11- (Verification required from Planning & Zoning Department for new c ction.) City /State Parcel Identification Number OD - 63o,6 5 04 - 06 6 LEGAL DESCRIPTION Property Location AJE '/ , NL- 1 / , Sec. i , T ,&_N RAW, Town of Subdivision b i'+I ; 4-- e ft vt �P_ 4w Jo w S , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # 9j 0 a L/ , Volume , Page # Spec house 0 yes N no Lot lines identifiable 0 yes ❑ no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and /or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the 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 Planning & Zoning Department within 30 days of the three year expiration date. 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. Number of bedrooms 3 110_� � l r--- l). / -- / 0 6 SIGNA RE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) KATHLEEN H. W DOCUMENT NO STA,n BAR OF WISCONSIN FORM 1 - 1982 RROx$T M OF 11V= WARRANTY DEE13 ST. CROIX Co.. MI RECEIVED POR RECORD THIS DEED made between genalletal 7.ovostrnanss, Inc., a Wisconsin 12198J26" RHtMAN Corporation ("Grantor") and 'Dean Larson and Ruth Larson,-Husband and Wife MARRAHTY D= a% Survivorship Marital Property ( "Grantee "), iiiUMT 8 RSC FEE t 1.1. 110 TRANS !: EE s t19.78 WITNES$ETH, chat rite said Grantor, far valuable consideration convoys, to Grantee = FEE the following described real eatate in St. Croix County, State of Wisconsin: phGESt r 1 Lot d, Plat of White Pine Meadows, Town of Eau - Galle, St. Croix County, FATURN TO Wiaconntn. Ameridmut Title Services - SCV, LLC P.O. Box 1156 Hudson, Wisconsin 54016 Tae Parcel No; This __"fjgti_ homestead property, (tax ot) Together With all and singular the hereditaments and appurtenances thereunto balonging; And Beneficial, lavesimants, Inc., a Wisconsin Corporation warrants that the title is good. Indefeasible in fee aiil a and free and clear of encumbrances oxcepi Easements, restrictions, and encroacbment:s of record. and will warrant and defond the same. Dated thin l day of 15C-m am - 2W6, (SEAL) t (SEAL) • Benefcial Ih.trejLments, Inc.. a Wisconsin C4rbqe�tian by Paul R Nelson (SEAL) (SEAL) w , AIJTHENT'ICATl ON ACKNOWLEDGMENT Signature(a) _ __. - _ STATE OF WISCONSIN authenticated this _ day of _, 2006 St. Croix County ` Personally came before rite this day of , TITLE: MEMBF -k STATE BAR OF WISCONSIN - 2006 the above named Beneficial investments, Inc, a Wisconsin (If not, Corporation to me known to be the per9ons ted the authorized by # 706,06, Wis. Stata,) fore g ' iltrsnd acknowledge the P. THIS IMSTRUMewt WAS DRAFTED By 122X R. Schrader + 1 IL aw Notary PublicC t R My Commission is pcnnanent (If not. star (Signatures may be authenticated or acknowledged. Both are oot 13.2.19 -Wb necessary.) 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