Loading...
HomeMy WebLinkAbout028-1012-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 556348 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: McFadden, Thomas E. Rush River, Town of 028-1012-10-000 CST BM Elev: Insp. BM Elev: BM Description: / Section/Town/Range/Map No: _ ~ is , 9~m 10.28.17.636 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. ` Benchmark Septic 1 .45 ~bb o /o W / ,o Dosing Alt. BM ` Aeration 1 r Bldg. Sewer I /Y1uc-►~ &V-4-9- G!a add: 6ti+ Holding St/ net r /o s y a o• q St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/ W BLDG. Vent to Air Intake ROAD Dt In]gt~, Septic S-p~ ~-Ub' / t Dt Bottom 2 y, .th / D6 y/. Dosing J Header/ n. / G+e~- / -o / Aeration VAC4,yt 1144--e L-- Dist. P' sue, 0'2- /o/ , Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St over 01 i GPM .S D ? • S Model Nu ber yt CPO J2 '4- et)z T H Iq Fri ion~l qss Syste Hegg TDItQ Ft b r ' G / I r I t 7 O Forcemain Le h Dia. Dist. to Well 7l 1 c Cam' 1! ~ SOIL ABSORPTION SYSTEM 47 BED/TRENCH Width Length > No. Of Trenches PIT DIMENSIONS No. Of Pits side Dia. Li d Depth DIMENSIONS st,,Z~ SETBACK SYSTEM TO P/L BLDG WE LAKE/STREAM ACHI G Manufacturer: INFORMATION , CHA R OR Typp-OfwSyst~ ~ D / > > Model Number: N~ u Ul.~^Yetf"LA JIk~~E7 . I ~~11, DISTRI ON YSTEM 3 6-,h,- ug, t/) Head anifJrDia F Distribution nv-~ r x Hole Size x Hole Spacing Vent o Air Intak h Length / Dia l , Spacing I y A SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over / " xx Depth of / 1XX Seeded/So a xx Mulc ed Bed/Trench Center Bed/Trench Edges Topsoil y 1 , Ip'r I es No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:10// (inspection #2: 3 / - Location: 404 187th Street Baldwin, WI 54002 (SW 1/4 SE 1/4 10 T28N R17W) meters bou df Lot Parcel No: 10.28.17.636 1.) Alt BM Description = I ~ P cl-f- W" W Q * evb S_- 0--, a-0 CLAv~ 2.) Bldg sewer length = ?_0 C/J/C~QA (D O - amount of cover = -7 s= / Q/(~ I I ~ y b / 0-h0_U;o/ Plan revision Required? 72 Yes Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Signatur Cert. No. commerce.wi.gov Safety and Buildings Division Cou 201 W. Washington Ave., P.O. Box 7162 ,~e,;r i sco n s i n Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce 5-( a ? 0,14 M Sanitary Permit Application. State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the apprdpriateagnxcmmental 2 f/ r2 unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04 1 m , Slats. 1. Application Information - Please Print All Information Property Owner's Name Parcel # "T"h Property Owner's Mailing Address Property Location / ! 3B) ' Govt. Lot - City, State Zip Code Ph Number ff A~/ Sw Section ~o a !d O ! _.V_73 T p (circle one) ~ ~ ~ )O N; R17 Eor W I1.. Type of Building (check all that apply) Lo # M 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name S/Block # ❑ Public/Commercial - Describe Use ❑ City of llage of ❑ State Owned - Describe Use CSM Number T❑ Vi Town of I/1C~ III. Type of Permit: (Chec on in Complete line B if applicable) A. ❑ New System Replacement System ❑ reatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number an Date Issued n Before Expiration Owner f kA /D,(/UAI 17a), 0 v' V ~~j IV. Type of POWTS System/Component/Device: Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil Pound 124 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device explain, Ot 7) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Appli;0. te(gpds Dispersal Area Re 'red (sf) Dispersal Area Propo d (SO System Elevatibii a{SO . 0 2 s, Tfsa 1130. Sv /DD - s- p/ VI. Tank Info pacity in Total # of Manufacturer Gallons Gallons Units Lip o New Tanks Existing Tanks? 7l- / y V V v " F ~ ~ ~ is <d O wU v, ti wC7 a Septic or Holding Tank E ado i Id2l e-- Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print / Plumber's ature MP/MPRS Number Business Phone Number -1 ~11 el ~s~,~ a a -11e, 77703- Plumber's Address (Street, ity, State, Zip Code) A)74q q r/ vi VII Count /De artmen Use Only Approved ❑ Disapproved Perr,,mit Fee Date issued Iss g Agent Si atur < ❑ Owner Given Reason for Denial $ `e' IX.3 6S1Fd '.val/R , sons fo Disapproval 3 - / 1 Septic tank, effluent i~ter antlr dispersal cell must all be serviced /maintained Sf S 3 J'3 3 / 3 as per management plan provided by plumber. 2. All setback requirements must be maintained '44^.k erapplicable code/ordinances Attach to complete plans for the system and submit to the Co o y p per t less th 8 1a I1 inches In site z co l SBD-6398 (R. 02/09) Valid thru 02/11 plot AOL V" i cr- n ~n ~ •c e~ cs~.ti ~ a~ y'~ qu ..f A)6fi:: , W-e-<< 65 C>01 /kjo-t-k Z~ 00 3 B~a~ {~om e Guar ~ nn pS ~ 'W" u Sw-~ of 5E y Sc<< l66 tul' 3D3~ Tas 7 r dy _ ,,D J - ~tF~~secti~~~ahou..7,S O v ©y Tcsp of ~n S w a~~o 1-~ s n nn sr ioool(~C'C' T&Kk L,')-4!7 a 4v \ too.ss ,g,s- ~ ©r . Ribbo►, EIcLp, ~C Sr~r. gs 96• es 1l ,PAkRTAkr Safety and Buildings ?5ti' ~~n 3824 N CREEKSIDE LA 0 9~ 31 D HOLMEN WI 54636 S Contact Through Relay P www.dsps.wi.gov/sb/ S ` www.wisconsin.gov A~Ossror.°tiS~~ Scott Walker, Governor Dave Ross, Secretary September 19, 2012 CUST ID No. 220292 ATTN: POWTS Inspector BENNIE W HELGESON ZONING OFFICE HELGESON ENTERPRISES ST CROIX COUNTY SPIA N7649 STATE ROAD 128 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/19/2014 SITE: Identification Numbers Thomas McFadden Transaction ID No. 2147882 404 187TH St Site ID No. 783953 Town of Rush River, 54002 Please refer to both identification numbers, St Croix County above, in all correspondence with the agency. ' SW1/4, SE1/4, S10, T28N, R17W FOR: Description: Three Bedroom Mound System / 6% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1391575 Maintenance required; Replacement system; 450 GPD Flow rate; 18 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD-10691-P (N.01101), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01101); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code P.~=WT. requirements. condltl0 No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06APPon ®stats. The following conditions shall be met during construction or installation and prior to occupancy or use: DIVISION OF SAFETY Reminders _6l • A sanitary permit must be obtained from the county where this project is located in accordance with the SEE GORRES 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. • 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 SPS 384 product approval conditions. • The area within 15' of the downslope of the dispersal cell shall be undisturbed. Vehicular traffic, excavation or soil compaction in this area is prohibited. • 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. • The existing POWTS shall be properly abandoned per SPS 383.33(3), Wis. Adm. Code. BENNIE W HELGESON Page 2 9/19/2012 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. • The owner of the POWTS shall be responsible for ensuring that the operation and maintenance occurs in accordance with this chapter and the approved management plan under SPS 383.54(1). • 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 letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 erard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swiin@wisconsin.gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety & Buildings will be modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. INDEX SHEET PROPERTY OWNER: THOMAS MC FADDEN 404 187TH STREET BALDWIN WI 54002 PROJECT NAME: THOMAS MC FADDEN PROJECT LOCATION: SW '/4 , SE '/4 , S 10, T 28 N, R 17W MUNICIPALITY: TOWN OF RUSH RIVER COUNTY: ST. CROIX DESIGN: PRESSURE DISTRIBUTION MANUAL VERSION 2.0" SBD-106706-(N. 01 /01) MOUND COMPONENT MANUAL VERSION 2.0" SBD,: 10691-P (N.01/01) ally CONTENTS: 4ED Page 1: Plot Plan jo BUILDIKt S Page 2: Cross Section and Plan View of Mound Page 3: Distribution Pipe Layout ENCE Page 4: Septic Tank and Pump Chamber Cross Section and Specification Page 5: WLP1000/600 -MR ZABLE Tank Specifications Page 6: Pump Specifications Page 7: POWTS Owner's Manual & Management Plan- Pg I Page 8: POWTS Owner's Manual & Management Plan- Pg 2 Name: Bennie Helgeson Signed: Address: N7649 Hwy 128 Spring Valley, WI 54767 Credential Number: 220292 Date: 09-06-2012 plat FI QV\ [ ~F S 46 A Ir,• Thomas Mc i x Ack-e-h W-e lI 65 ~ S'f. Croi~r Caun-f-r ~u`s~"'9 f,'us Towkglio~ g~~ {~on.e Gara~ SLOJ aF 6E Scc. 1b : T.-s V R 17 w Tc be- ~~"^^p~cQ y,r P Ahd rt Ile C ICGtNO~.t..~ Y v ~ J Bel-wee.- Clean b lc-j 7 0 Top ofnSw~a~oh safe Pbwe4-Ple izk p~~s 5 0~ A/~os-e- TaKk u,44 c, k 63 II► \ lr t~~_ \ r= rev . a 1`1, 100 00 xs B.') - 98 gs- W „~~ly, gs 9b• gs Wisconsin Department of Commerce 10 VALUATION REPORT Page i of 3 Division of Safety and Buildings c Co 5, Wis. Adm. Code County S f. in accolF~encenc Attach complete site plan on paper not less 1 inches in size. Plan must include, but not limited to: vertical and horizo re poi nt (BM j, §tian and Parcel I.D. percent slope, scale or dimensions, north arrow, and location a to nearest road. f3'1 e - l QJ.2 Please print all informa Revi ed b 4 Date R`~ i o Personal information you provide may be used for secondary purposes (Pr' a~ L 15.04 (1) (m)). Property Owner Ppi ocation -rho VYX 0.S Mc- 5, 'k A.e v~ Govt. Lot S U) 1/4 S ~ 1/4 S ~ 0 T N R 1'7 E (or Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# N O y /87 f h -17-77 or a ; er or; City State Zip Code Phone Number ❑ City ❑ Villa Nearest Road ~r~c~win l~t~T 59062 (71S i6~y-a 833 flea,5pnnr 19 7fk S~. ❑ New Construction Use: IrResidential / Number of bedrooms -3 Code derived design flow rate '!V,!M GPD Weplacement M ❑ Public or commercial - Desc Parent material OPSS QA) er 5 Flood Plain elevation if applicable N)A ft. General comments lG -7 7 r and recommendations: on covL+our ND2ND 9g, gs Sys F Boring # E] Boring Q o t Ground surface elev. 7 7~ 3sft. Depth to limiting factor- in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff##1 *Eff#2 ) c v' ( (6, C (v~ 3 -3 - 5 7.s VA -'EY C_ F~51 Boring # F~/Boring G In Pit Ground surface elev. 94 r b.-ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-91 o 3 in S b W a" , 4. . 9 'y '6 a 0y - of o o 62 7 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please -Ednt) Signature CST Number Address ` Date Ev ation Conducted Telephone Number /U76 t Ile W1 .f'y,76 2 8-~~ (7/,)7;P 3f78' PropertyOwnerTAn1M4%c /-jCEajdey_ Parcel ID# Page cs~ of 3 F-3-1 Boring # ] /Boring Ed' Pit Ground surface elev. 96• ~sft. Depth to limiting factor- in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 f o Y2 3 57d a m 5 b k C_ W- v , le _l /o V 41 61 a) of if , 9 -y R. J~PD s YX -'9 6 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. F-1 ❑ Pit Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 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) • 1" 1 0' I n~~ ~ Tic~'~ 3 of 3 A6 RES S• • ! cnvtl e e~ ct'e 11 ~do~ y o40 d .~J N o rn ~ ~sdr . i 17 (,USE s koC fi"~D D~ k ST. Ga rt~-C ti Arc ~ - J ~ ~g7 Yl~ F ►,c~ 8,m tn`1.85 fo r To o-E Ft rn5w e, v Dr~ . R,. bba r 7'n Powev pole, r .7 14 X1133 ~ .s4 , ~ 7 to 5i op.v ~ ~ fig. SS Top 0f "T 'P-V\t \ Cv/org. R;bbo~~ ~q~~ ~,~qy.8~ 3vD' cch`c~a. 4.Uw e hma2b I7 C Ole-" Pxa.e ,1 Of3 Synthetic Covering A5T'M C 33 Distribution Pipe Medium Sand Topsoil E D 3 ~ fin, ~i~ 9~ Sa . 6 °/d Slope, C L Of ?M- 2 Force Main Plowed Aggregate From Pump Layer D Ft. E 1.98 Ft. Cross Section Of A Mound F Ft. G S~ Ft. A g Ft. H I. y Ft. Signed: B S6,ZFt. License Number: K '0/ , 7 Ft. Date: L 77.~5Ft. j Ft. Ft. r=orce. /~to-;v. W ~7-/ Ft. ~o~ 'pcnw.dG L. Observation Pipe B 7i- K V-_'------------ - I w T - Distribution Of 2~~- 2 Pipe Aggregate Observation Pipe it 3 W Plan View Of Mound Perforated Pipe Detail i Cleanout Access Threaded e ~ o Cleanout Porloro1ao PVC Pip( End Manifold Holes Located on Bottom Are Equally Spaced / Force Main From Pump X~ S First Hole Next to Manifold e / Cleanouts Distribution Pipe Lam P R Y S -30 X x? r. Y ;Z r, Hole Diameter Inch Lateral Inch (es) Manifold Inches Signed: Force Main " -~2 Inches License Number: a Invert Elevation /,00. O Date: Holes Per Lateral IQ S- Number of Laterals 3 Total Holes 7s Page q Of _8 T SEPTIC TANK & PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4 " PLX- V ENT PIPE 12" MIN. ABOVE GRADE E WEATHERPROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER C~4-~7u.~cQ ~~c1 bbd- ~ W1 PADLOCK .E WARNING LABEL --1_-- 4 1 MIN. 2y 11 18" IN. X.D. , 18"MI N• INLET , I' WATER TIGHT SEALS GAS- , 'I TIGH: _p SEALT : tI APPROVED FINER , JOINTS WITH APPROVED ALM APPROVED PI;PX PIPE 3' B ' ON 3' ONTO ONTO SOLID- ' SOLID SOIL SOIL I PUMP OFF ELEV . ~FT. OFF D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE .-Tate r~IS 2~. L ~r~t TANK MANUFACTURER : U)/her- ~D7 X 's _57 BS hex TANK SIZES: SEPTIC /000 GAL. DOSE VOLUME INCLUDING DOSE 6 pD GAL. S 7 Gil. FLOWBACK: .$~^7 SS~ GAL. ALARM MANUFACTURER: 6,TE t~ceS CAPACITIES: A = INCHES = 301.~~ GAL. -MODEL NUMBER: ' SWITCH TYPE: g r /7a ii t ca Floaf - B = 2 INCHES =33.5 GAL. PUMP MANUFACTURER: 60, l nn a -c. C = 6 INCHES = /OO,S(. GAL. MODEL NUMBER: C- P014 11 SWITCH TYPE: F/a, D = INCHES = /~7• GAL. REQUIRED DISCHARGE RATE ,7S-GPM PUMP & ALARM WIRING AS PER I LHR 16.23 WAC r VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE ro'y~FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . FEET + ,36 FEET FORCEMAIN X FT/100FT. FRICTION FACTOR 3 FEET FEET TOTAL DYNAMIC HEAD = Z3 / INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH DIAMETER LIQUID DTMvM_ ~6. 7 GGc./, 'mar cC,~ f PC2s e sew ~r~ Sd~ ems. SIGNED: LICENSE NUMBER: DATE: 1/88 o Pal zJ m0 qg LL._ N S quiz JLJ ~ ~ a Q O Fm 0 In o0: SE U) 0 1-- U) Y I- w D a N co CL ¢ ~~r~ ovwiF Q Or 00 op In IL ~G V o-i ZZ 00 0 P-rLq O J 0W °0 J = ' Q U J J cn (7f =1 0 a Q- N (3 vi o~ En < ww 00 D ~N 00 ccnn0 r D W D-)< NCO ia li°En con a J Q W co -oK'L mww co 0 CL ° `V I a N. O O F= _i I- cn m U) Q N - O Q I-- r, co a Mm .,o LO W * Uj WWU z 0X M.. -i . J.. OXI- O O Oi or-: 3: B= Z O=~ ..O°= 0CoU) °U2 n. ° Z OJQOOQWZOW = QUZ. Q Zip. V z N3mOMM9 sum3 a.r c~ < 0 LLJ J J 5 z z Or 0 V) p L „Z* a S Z s - M ile •'a' 1 I ~ i ! r- ' i . I W ail „9 W - st I 5 d' o LLI _3 -i V a• V V) V) 1 1 Z I + 1-_~~ I I a 71- ~ ' 1 1 1 H ..fig 0 ash ~ ,.99 MODEL. 7 Submersible SIZE. 3/4" SOLIDS. RPM, . 1550 Effluent PumP HP: 0.4 METERS FEET } 8- 25 7 O z 6 20 U g 5 15 4 O J 3 10 2 5 0 OL-L- 10 20 30 40 50 GPM. 0 2 4 6 8 IV 12 011 CAPACITY NGOULDS PUMPS INC. w Eflecdve Wober, I no _ _ .._..r i,r_ oniumn w 11:2,.' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 7 of 8 FILE INFORMATION SYSTEM SPECIFICATIONS Owner Thomas Mc Fadden Septic Tank Capacity 1000 al ❑ NA Permit Septic Tank Manufacturer ❑ NA Wieser Concrete DESIGN PARAMETERS Effluent Filter Manufacturer 11 NA Number of Bedrooms 3 ❑ NA Effluent Filter Model Pol lok 525 ❑ NA Number of Public Facility Units ® NA Pump Tank Capacity."- 6UU gal ❑ NA Estimated flow (average) 3UO gal/day Pump Tank Manufacturer Wieser Concrete ❑ NA Design flow (peak), (Estimated x 1.5) 45U day Pump Manufacturer Goulds Pumps Inc ❑ NA Soil Application Rate al/day/ftz Pump Model ❑ NA Standard Influent/Effluent Quality Month Pretreatment Unit W NA Fats, Oil & Grease (FOG) _<30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODS) :5220 mg/L ® NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cellls) ❑ NA Biochemical Oxygen Demand (BOD5) <_30 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) :_30 mg/L p NA ❑ At-Grade :EI Mound Fecal Coliform (geometric mean) 510' cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y8 in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once everv 2 ® year(s)month(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 2 Q month(s) (Maximum 3 years) ❑ NA 0 year(s) Q month(s) ❑ NA Clean effluent filter At least once every: 13 1 year(s) _ Inspect pump, pump controls & alarm At least once every: 13 IN y ar(sl(s) ❑ NA Flush laterals and ressure test At least once ever ❑ month(s) ❑ NA P y' 3 year(s) Other: At least once ever ❑ month(s) ❑ NA y: ❑ year(s) Other: ❑ NA r 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 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 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 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. Owner: Thomas Mc Fadden Page'_ of R START UP AND OPERATION For new cpnstruction, 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. ;ysien 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. 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 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 and proposed structure, 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. ❑ 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. bd 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 MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Bennie Hel eson Name Johnson Sanitation Phone 715-772-3278 Phone 715-273-9811 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Johnson Sanitation Name Phone Phone 715-386-4680 w This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ~~a r~ c~ ~lrt Mailing Address t4Q f g 7'Fk 5+-s e e- Property Address (Verification required from Planning & Zoning Department for new construction.) City/State 1 ~1 trr c n 4 W1 Parcel Identification Number 16 - v Q dca LEGAL DESCRIPTION Property Location 1/ , 1/ , Sec. 1 O , T ;78 N R W; Town of 9" 9 t le-Ar Subdivision , Lot # Certified Survey Map # Volume , Page # Warranty Deed # 73 f 0 , Volume Page # C -Q c Spec house ❑ yes no Lot lines identifiable 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. Cerrification 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. Uwe 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 J -SWINATURE-OF-ATP-LICANT(S) DATE ***Any inform on 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) - SmATF- eume ~ %TsCG_-CS_xN- Foam -a 327310 D0915r1$S,3ra.2"^ a+7PT90sa a~ 30RG2 -~a~~ F' 1GtSTF-RSl X . T85 Dom. sz"sedr lwraeali:x _ ST:. GFit17:C iL~ 97ST1S. _ 4BY r Tb51, lie ~eaoy - scso~~ ..~4~.19~ - -.:.t~ imr a v^rlmia4+r tp~.~±im.Ong 'g~lxar c s ¢ r s~ t & ~ ~ Rzzdparr =ri° *.'.aqs~ deTat n- -C$.>tf0~ sivd at&or va'loabxe cons! 5t CrbC GcaaYY _ eo~rys ao Gavoaane'fEaec Yollea~".aas*r..~ib2e+lrical~asio e~.T-~--------- v State of wispceugr= The East 300 feec of the SbuGh 715 feec of , the -swk or than SW$ r.: Kra Secitfoa IQ. -Township` 28 North. Range ' 17 Vest. _ t~arsa was Ta4pabew Wiab all sea 7&A=Wda - alre kraradiaaaoeags and slapaava d 3 thdscuaaa awfoazima or is -rsr ari:ax ,3 perospaetig. - 1~aL1 i :i T~ _T ~v>> ~ a> .,vim C C. H9 i„ flrad--^- - - er aaS. sbsa abe Bale -'rx go,". iada3es~iibRr im Yc"e simply 0=41 iaese MaJ ck-mr of gwg ~ . nod +rail wonmaa and dmread alor ,some. L oreoiacP+ rfY;-._ er_ "toy of S[Sn~-MD J NO SEAL' Ill PRESS CE OF -.FAi..~v~'S~.V.i~..~~Q~.2: Y'+~4~Ly~.~..~~zs=s--i-e•c-.-......... M ~'a ' ~i+>°6 Laq' t~~"'1.'--•.w ~G• B.I r~h~M1 ~r~Gi~►~..~ - C, :go avrhenaacnaed rbYs . x _ . T.t-. ?•ir :.bey Sa:.: n..' • f SL'; •:-,m,:r- -•r KIcF^.~ P:er:+• s-rA- OF WISCONSIN t fierce April PrranaaAic G 3me before nc .1 and Ni 1 £@ > the aboc.- n•,r~3 Douglas,. C.. Eor~erso~+ and Joyce C G~orgetson, husband to ka:.•-~ a•.-, t:e the person. S whn e•s _•~u-♦. -e :A>. . f ~ tom. • . _ v ~ 'h` This u-V-: ,ent -•:JK drafted S~ John 1.1. Davison ye C' a:,._ River Fa11sr W1 54022 + The us.. :i xs3rtc .~_S Es opz: 3a°. PLEASANT VALLEY RUSH RIVER T 28 N-R• 17 W ' i I E"d.,er d ,J • ■ SEE PAGE 31 91 rn/cep C~ h\ o ~ 6ei T • • f/easant i s. '`r c-Fh~_ f/¢~n ~ ~ aa 'h u, v~ C/y ■ O. C 4. ~~-I' e m V"ewGuerrtsc a Q?~ o ¢r7JO rl ~ D Vl h uv GV bet ~C^~ ¢y~e'. ~h~ Q tlp 0 Fa.m,l c. ofi~uisf ash P. Georg~e,h w u v cT3 y ^ 'Da..-o/d .P~ Lo°c,f /'7e i5/ l C /3997 0 63 Q /6039 B38 ~ .BoSSrnarl 94 73 w Mey/y ~ /J9. ~'7 ~ h ~e e x ss Mery/ s,y, G. a ,E ~s cC ~Pa/ h u :9 Co a' C cs ~ d Thors°r7 h bo q' C br y,`'• Vh errioi7c c • ~ a n .,.5.~~ e so o ~ v w rrsSe~, ~ h h tl p, y y ~ y° o/so~7 C ~ ~ ~ s~.sz ,\r h y - ¢6~ ~ ~ /BZ¢ ,q~~,~ .C~ ~d~ /o ~ Names /z/ lr C Cyt tl C ~y Ly/c a ~ ~ C/ac c \ l m oz N LJ • 'C N ° ¢o•n HBO o~i 9o a p u m Q tl : a a ~lo./yr~ e : Qo n `e F Z •~J V v 9 §T s ro X06 f /ter / U o -C/a~cncc cf/ Jcn °~/c t}, 'Qu6~/M V-~/ y ts i7 Q 3 9 ' ar/e Da y/ s •Pwi/ ~ /6 0 t ~ ~ \ L ra.,a 4Ph //!s ' 0'70/ • Fed Bahl ~ o Bafnscn ~%ian, y m 1, h/ Os✓er7s L 4.O 6 //e•rrz Cfiaioin y\~0 - W u C Bo Yincc,7t 4 cSo r7s l ,ee f /ao /6D N y fz"g /cns u 8O tic 3 o n h' . 6vean o H/.ce /'✓¢/Gr7 ~i/ v C n pp~~ /SB • ~l ~ tl~ C~) Cp~ ve on rubmcfn • • Ne/so /sB.7s web ~Q~ p ~J ti ct ~ O/./7 ■ 4a• ■ ~xY/l • iJ/~a ' Jv • 3 ~`y' N v i. Fred p\ .ZI \ h • r • C D C ; • u\ 0 . G/ac[ys ~SadlG... Al Owens ~ i ~ 0 . \ e 0'~ o h ~ ~//am ~ 4o h al U~ %~on v C Newton Lnd/puis>< S /SZ34 U f( tl ~ V l~ 0 p,•C ~ 0 ~ l 0' h /s0 T~' V' ~v~~ ~ N ` ra. tl ~ ~ C ro a J 0 4Dcz~/enc ~v a ~ o ~ f/nm~n¢/7 \ ~ e vy /i6 Hov Aso ~ c ~ DO ~~a o ~ ~ •~S'/o/goc/ 3°,r ~ v ~ /moo C O/s n F.nc[- /s~o • ~l> Q Ida h Q qJ v~ law zo 9o N T,4;71VI, zoo ~ • ~ ! /o0 60 • 7 Bo' l~• zo z° ~.R • h W • • { zsNesY ~d • C • ' • ~ ~ • W C/a,•e,7c o Ct v6. E ~ p cTon-De-Fprln, j h 4 ,5/c%~ U N ~ Ra/ph E. ¢a V y Q l~//Om ~ //9 6o I c. Joco.cso . 4 cumor~ r/s Nart e, go ~ ~ /SB 4 vc R 3e-e.F 0.\`a /zo Bo S /sset~x 0 V .C a e° /?/a/e~ /ey /Ga C C W ~ ~ n~ • ~ ~ La on 6/ rso~ ~ ~ ■ ~"J' Gm Lesfe n e d \ rn: G~or7e Jahr7s0 ~ ~ /;/owo d Q;J tl Y • Farres>< o ?Jic/rcr7s Ct ,Q2.E .Ec aa' vx ~hnson ym J 90 Bo ■ • /zo poi E .C~ v is U v .To/in f.Do~ ~2 •J r7 /z0 ,~-/oiv ff Rio doi7 f/ c7 ~c ~o~ ~ ~ ■ p /6o C 0 /Yau/c _ 9o Neu nr7 fo v'° d .B.a.F.Ee ~ /GO efu-r ~ g° ~ pp v .JM• sp /sue ~~50 .%9 • /GO \~Q Jas. E Esc Y T /fc ~~,2 J. lemon .Fors Do a/d t . ~ C tl o sse • eaenbo Bros Y: d-Act - iPo.9er(` 0 o ti~ N e /oo s° so y elan s soil 0 0~ ro Person d. Schu.n¢chai- 4\b 'C • ~v ao go Bo h ~7B /zo m Lawrence °y w p 71- Z~ ebey .4 a . .uf.•CD Per- G'ho Fi?•• P~ued 0. ~Tohnson C C • v ou er7 V D ° r,.~ U > son Lor7 e.- C!17ou9/ s /sa C a 0 C C~ v~ \ /zo io 4° •/v rt d6 90 /bs dch zdo. 9 O C ~ o ~ ~ p ~ . y Jo/7 C ~ r„> sM r Wes, sr~'r . /GO 27'J.s ~Q Y`U'~ ~IJ /za roo ItlC~ E.c.Esa.7 Sa~'r ob63' V Q 6B C F7rG ee s0 O /4 • t • Afy C/.Les/e f C ¢ii- 4 / gOr dr niaa f ~w~ sor7 ah V c Fy cTcw i/ do •om6c~- cSu//iVdn f1/o d V0. C N c/c~.7 aJ r✓omor7d Fo • /so - ,~sf~ B/B o Bo ~9usf U,r' C ~ V /ao 1 ~4°o66or~ cB~~n ."7ay • o ~ ¢o ibeau r has. 9 f t r /d Lyy/c s E C y a: FJrno% Dona/d N y s T tl v o rho ~a s.LG sr-mss/ M v C Sever/ iPoe Freeman HGe/S h ~ ~ so ~/¢r'ance 20 w u y ,5/ T .7z ~ er7 6p C1 0 ~ B31 zo c5'v6by S~c~7so~7 C `Y /Qo cr7 Firlncis 9. • HaBC/ .1~ ~ Z.40 /.20 /63 2r7ry c~ or/sy• /20 ~ifjl.C udrey /ZO `O • CSc/ii/ en, r • • • ° BO• eY~X ~USf ~/iT/ Gr0/ .E'O /JO ~ Q A . > V V M ao SO mss. s vv s ■:o' as ~ v G(/i//¢r25Mar.e. ~ ° _ -9nni~C •C tnson 9~ e/a ~ Yr ~ 'y, C LarB.~or. o/ o~ V k orsfod3 v co oJ~us /~-1a..fh 0/7' .~zs. /zo ~o no ,zo ~ ~ ENTER L:: I~o~naG7~~ ~~6y [ W 'emu 6/ o e c None w0 C °.yd e CQr/E Q y p \0~ 9/0.7 a .c,ah o' J,Q, 36 63 °iU m9 G//' n \ h ,47ut ~°efer•so.7. ~ ~ ~ 0 Jro.7~7e 6}~u cy fiaei7 Char/ 4/`'/an~ /yo {f- u ~0 ;¢o ~ c7ar7 0 00 /zo ~ \ ~ ~ Uwer's 5a .EC 40 ~ izo dG- iS3 9o f° • S%/ O/Y7z P c Ef d M,a~ u6/s ° Ra w i 97¢ PIERCE ° PLEASANT VALLEY TWP 0 I e COUNRTY USH f~'~" ~r7Yyh's_ RIVER TWR Baldwin Oil Company RUDE REALTY *FARMS *HOMES 4-H CAN MAKE *BUSINESSES STATION & TRUCK SERVICE DELIVERIES THINGS HAPPEN PHONE: 796-8801 PHONE: 684-2194 - BALDWIN, WISCONSIN JOIN NOW Hammond, Wisconsin