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HomeMy WebLinkAbout012-1075-40-000Wisco~lsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Walker, Todd Erin Prairie, Town of CST BM Elev: {~ Insp. BM Elev: BM Description: ~/ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing ^ / ~ (~yy) !, ~ O O Aeration ~~ S25 ~ o Holding county: St. Croix Sanitary Permit No: 506105 0 State Plan ID No: Parcel Tax No: 012-1075-40-000 Section/Town/Range/Map No: 36.30.17.544 ELEVATIONDATA STATION BS ~ Z FS ELEV. Benchmark ,1 ~ , [ , ^ / 0 - l OO ~ ~ 1~ AI~ 0 6 ~ !~ CO p ! ~- ~ (o Idg. Sewer t/ Inl- .SGI--F ~ ihfv ~ 3. f7 ~ O6 SUHt Outlet / ~_ Dt Inlet ~ Dt Bottom !! / Q Heade an. • I/ /OD: to 3 Dis~pe , ~ / A~• ~ 3 Bot. System 00~ O Final Grade ~0 2~ ~ St Coyer ~Ow~ IN ~ ~*~ ~z• y t - r i SrQ ws _ ~ s7 ~ TANK SETBACK INFOI~NIA~'IQN' ~e11 t P~6C}"J(~ rr'~tl ~-n TANK TO 0 P/L ~C(L(~ W~ BLDG. Ven o Air Intake ROAD Septic l / ~b ~ ' P ~s Dosing (,~,V // ~'~ , 0 ~ 3 Aeration Holding PUMP/SIPHON INFORMATION Manufacturer / _ / Demand ~`~~ GPM Model Number ~~D ~ 3v ~~ TDH Lift Friction Loss System Head TDH Ft 3.01 2-~°l 22•`f Fo cemain Lent , ~-~ l Dia . 2 ~~ Dist. to Will~t ~ S(711 ~~RSw7RPTl(7N SYSTEM . ~~w_ ~ I _ ~) UBJ ,n1L, ,. /1 _ "~ ` BEDITRENCH Width Length No. Of Trenche v PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ `,~~ ,~ _ SETBACK SYSTEM TO P/L BLD W LAKE/STREAM L CHI Manufacturer: INFORMATION CH M OR Type ystem: t Za ~ j ` / I Model Number: ~ b b ~ L~ ~~ DISTR113l1TION SYSTEM m. ~-{~(16.irt a_ ~-/'NO.{'•i' ~--~~ f'IT~~~ C..o'7~~ Head Manifol Distribution ~ f ii x Hole Size ~~ x Hole Spacing . I/ Vent to Air Intake ~ ~ Di pipe(s) in ~ ~ th ~~ Di ~~ ~ S L ~ ~~ ~r~~~~ a Length g a pac eng SOIL COVER r Pracenra Svstams only YY MnN~~Dr At-Grade Systems Onlv Depth Over Depth Over xx Depth of xx Seede ded xx Mulched Bed/Trench Center ~ Bed/Trench Edges Topsoil y'b~ Yes No r, Yes ~, No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~/~~ Inspection #2: ~ / ~ /~ Location: 2085 130th A enue Baldwin,{,.~WpI 54002 (NE 1/4 NE 1/4 36 T30N R17W) 40 acres Lot ''11 Parcel No: 36.30.17.544 1.) Alt BM Description =~ ~ ~' ^ ~~ 2.) Bldg sewer length = - amount of cover = , I-~ Plan revision Required? ~I~~ Yes No ~ t~l ~~~~~~ Use other side for additional information. / Date Insepctor's Sign ure Cert. No. SBD-6710 (R.3/97) GQ1111'f11'KC@.W~.~AV Safety and Buildings Division County ~, ~ 201 W. Washington Ave., P.O. Box 7162 ST CRODC ~~~ ~ ~ Madison, WI 5 3 707-7 1 62 Sanitary Permit Number (to be filled in by Co.) Depa~rtmemt of Catnmerca ~ Qf _ /v Y ~ Sanitary Permit Application State Transac ti on Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate go 1 1376145 unit is required prior to obtaining a sanitary permit. Note: Application forms for state-o POW a oje ddress (if different than mailing address) submitted to the Department of Commerce. Personal info a ton ~g~}-P~'1 condary ur osesinaccordancewiththePrivac Law, s.15.04(1)(m),S ts. rCClr ~ ~ ~ p I. A lication Information - a Print All Inform tion ~O ~ ~~~ D Property Owner's Name / ~ A R 1 9 2 0 7 Par # TODD WALKER 12-1075-40-000 Property Owner's Mailing Address 420 14TH AVENUE ST CR OIX COUNTY Property Location ~'~~ . o Govt. Lot City, State Zip Co NE %s, NE '/<, Section 36 BALDWIN, WI 54002 715/220-2873 (Cheek one) II. Type of Building (check all that apply) _ ~k ~ Lot # T 30 N; R 17 ^ E Q W /^ 1 or 2 Family Dwelling -Number of Bedrooms ~ S~b~Ant /A Subdivision Name N/A ~.~d~~~ ^~Cti`~~ ^ Public/Commercial -Describ U " Block # e se ` N/A City of ^ State Owned -Describe Use CSM Number ^ Village of ~ r 'r S S NIA ~ ~ ~ Town of ERIN PRAIRIE , Z ~ Dv.ti ~-- III. Type of Permit: (Check only one box on line A. Complete 'ne B if applicable) A' /^ New System ^ Replacement ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System (explain) -°~--~a..~~- System B. ^ Permit ^ Permit Revision ^ Change of ^ Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plumber New Owner / Ex iration IV. T e of POWTS S stem/Com onent/Device: Check all that a 1 W ^ Non-Pressurized In-Ground ^ Pressurized In-Ground ^ At-Grade /^ Mound >_ 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ Holding Tank ^ Other Dispersal Component (explain) ^ Pretreatment Device (explain) /~ ~~ `~ V. Dis ersal/Treatment Area Information: Design F1pW (gpd) ~ Design Soil Appli n Rate(gpdsf) Dispersal Are quired (sf) Dispersal Area P osed (sf) System Eleva 'on 450 1 ~ ~~ 450 ~~ 450 3~ 100.00 VI. Tank Info Capacity in Total # of Manufacturer Material Gallons Gallons Units New Tanks Existing Tanks f ^ / ,~/ ~ G/r/ a Septic or Holding Tank 1000 1000 1 WIESER CONCRETE Prefab Concrete Dosing Chamber 600 600 1 WIESER CONCRETE Prefab Concrete VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print/ Plumber' 'gnatwe ' MP/MPRS Number Business Phone Number BENNIE HELGESON ~ 220292 715/772-3278 Plumber's Address (Street, City, State, Zip Code) W1229 770TH AVENUE, SPRING VALLEY, WI 54767 VII oun /De artment Use Onl Approved _ tsa Permit Fee Date Issued Issuing A t Signature _ ner son for Denial $ . ~ ,3 ~ G ~~ -1 IX. Conditions of Approval/Reasons for Disapproval sYS~IuI owrtl~R: ' ~ ~ ~ ; ~ ~ 5~- ~ 3 , • - w ~ o 1. Sepik: tank, eftktent ~ and ~ ~.. ~ ~'~,~, t~ e~. dispersal ceH must all be servates / maYthi>rd ~~- as per management plan prtwided by pYllrlbsr, 2. All setback requirements must be msd ~ ~ aPPa9~wet000lPQFOIR~lIOplte system anti submit to the County only on paper not less than S 12 x 11 inches in size SBD-6398 (R. 01/07) Valid thru 01/09 ~_~ ~ ~~ "~ ~ LCt~ b~ ___ ~~ - __. --,. -- (_ T--~ - _____ ._ _- U ~- ~_.__ k ~• S ~ l-- -f-~ r `~ t ~~~ ~~~~L ~'~ y o~ IUE 4 .J~'C... 3~ fi.3o ~ r-7iv E r~~ P--ci i t --e ~. S -F-, LR F l u Sep-~,c ~ ~sc Tyr k "~~~(~ la !~ ~ 1}-~~ ~~ ~ C4P~ t3.M, 1~~~~~ ~~~ , 14, bboh i~ 1''= ~Cl~ ---~c'c~~~ - ---- ~kcf~~ ~ ~s ~~2 ~~ ~. ~ m c 's'~ ~ s~a~ ~~ Y~o ~-~ ~ ~'' ~':.~c t~,~~ %~ ~-j ~~ ~ ~~ ~~ 63 , ,_ -i -~ ~~~( ~~~ ~~ SS"b~a~°' ~~w~ti ~~~ ,6,~ e` `~ (~-~- ~ l~ 4. ~~ _ __-~-~- -f~- _ --._ - _ - ~ ~ e P ,c ~~~~9~ ~ ~~~- ~~ 'I ~ C~c cF' ~-(J-Q 1 a~~P ~ ~ ~~~~~ S1 ~. 5 ~~-. ~ ~U ~ . ~, 1L~ ~ 1 o f ~ ~ -~- .~ ~' L . 3 ~ t3 0 lQ 17 lv ~ ~ ~ y ~/ 5 ~ LR ~ I ~ ~~~pos ~-~~ a Eris Pt-ciir~-er <~ 13Q~- i o 7~ `"~ C r~`S ~ ~orv.~j ~ 4"\ i / q / ~. 5C'~'1'r~ l f~Sl ~ctv~ U u~.Po l~ (o ~ ~ ~~~~ ~, ~. G ~c Y~ ~>ss._ ~ ~ s 9~3 S- /o~.s f' ~ ~..M, ~~C`.G`C~ I / ~~ o r~ , f~, bboh 8z - --~---~-! - - J ~ ~~ l l~ ~ ~< B~ ~s 9b -- ----~ i f ', _ ~ Ll ~ _ ~ Sao \ c' cg, I Ekc~~ ~- ~s ~h ~-~~ ~ \ 13.J~{, (C~~.Oc~ ~ -~ -('gyp o-~ 1 ~r' ~c.+C -~~~-e /~. ~~~ F?~ 6 b~ ~~ ~3 ~ 7'78r commerce.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. com merce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary March 13, 2007 OUST 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: 03/13/2009 Identification Numbers Transaction ID No. 1376145 SITE: Site ID No. 723128 Todd Walker Please refer to both identification numbers, 130th Avenue above, in all cones ondence with the a enc . Town of Erin Prairie St Croix County NE1/4, NE1/4, S36, T30N, R17W FOR: Description: Three Bedroom Mound System /New construction Object Type: POWTS Component Manual Regulated Object ID No.: 1121461 Maintenance required; 450 GPD Flow rate; 33 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 -Version 2.0, SBD- 10706-P (N.O1/O1) 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 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. • The area within 15 feet horizontally down slope of the dispersal cell 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 inspectors. R.O.V.-.T.S. calzd~~~o~~tty BENNIE W HELGESON Owner Responsibilities: Page 2 3/13/2007 • 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, erard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon -Fri, 7:15 am - 4:00 pm j erry. swim@wisconsin. gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. RECEIVED INDEX SHEET MAR 1 2 2007 SAFETY & BUlLl~i~~`~S PROPERTY OWNER: TODD WALKER 420 14TH AVENUE BALDWIN, WI 54002 PROJECT NAME: TODD WALKER PROJECT LOCATION: NE 1 /4, NE 1 /4, S 3 6, T 3 0 N, 17 W MUNICIPALITY: TOWNSHIP OF ERIN PRAIltIE 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 1000/600-MR ZABLE Tank Specifications Page 6: Pump Specifications Page 7: POWTS Owner's Manual & Management Plan - Pg. 1 Page 8: POWTS Owner's Manual & Management Plan - Pg. 2 Name: Bennie Helgeson Address: W 1229 770th Avenue Spring Valley, WI 54767 Credential Number: 220292 Signe Date: March 9, 2007 UL, p~t7MEN~ OF GUt~ B -La`NGS DNISIUN f SAFE7Y AND ~ SEE CORR SPONDENCE _C'~~~ lvdd La~~ ~ ke.~ Synthetic ~::overing ~-1ST~~l L 3 Medium Sand -~ Topsoil _.~ i E -Distribution Pipc \--T~G 0 to Con 99 ~~ Force Moin From Pump Slope: i ~.d.-0 f 2 ~- 2 2 Aggregate ~" Cross Secti~~n Of A Mound Signed: License Number: --- Date: "-- w q 8 Ft. Q ~~~'F t . ~;~ZFt. ~ ~,_~,5-~F t . d ~_ Ft. I /~ Ft. w ~X,~/ Ft. Plowed Lcyer p , S Ft. E ~~ Ft. F , g0 Ft . G . ~ Ft• H _~_- F t Observation Pipe ~K ------ -- ---------------------_-_ _.J _ ~-------'-- r ~ „ E` t_t_ O f z- 2 2 Distribution e ate Pipe A99r 9 r~c~.. = 1,3~~~ S Observation Pipe C3aSu-~ plan View Of Mound %~'I~, ti~ `ter . l o d I,v a l k ~~ _ ~.,:.~ Access - 1~ E Tlueaded `' Cleanou~ / ~,~ ~ .o Perforated Pipe Detail .~, ~ F~ 1 End Vl~w. lF'o~lolclaU ~/ PVC ~ :'~ ~ End Manifold jj. .,, . j, -~ ~'.:~r, Holes Located on Boitom ~~%~ ~ ! ~ Are Equally Spaced (~ ~// / ,ice' ~ ~ ~ ~~ Force Main From Pump ~~ First Hole Next to Manifold '~ ~,,~~ ~% ,~ ~~ ;~- // ~-~ Clcanouts Distribution Pipe Layout Signed: License Number: Date: P ~/ R ~ T /r S ~/ X ~~,~ r ~-7 '~ Hole Diameter ~_ Inch Lateral " ~ Inch (es) J 1 ,/ Manifold ` / ~ Inches Force Main " a Inches Invert Elevation /~''7, S~ Holes Per Lateral ~~ Number of Laterals ~_ Total Holes ~~ ~C~F C~ • ~?~~;~1~Y~' ~ v dcl l-`~A t~~~- Page~Of S SEPTIC TANK 6 PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4 ~~ .RUC. V ENT PIPE 12 " MIN . ABOVE GRADE E NEATHERPROOF JUNCTION BOX APPROVED > 25' FROM DOOR, WINDOW OR WITH CONDUIT LL W~NPp V~R FRESH AIR INTAKE ~ OCK ~ 1.2~ qSO~ WARNING LABEL ~ ~.._,~._. v " MIN . ~ I/ ,~ Zy . ~. D. ~~ 18 " IN . ~:~~ 18 rn~N. INLET ~ ~~ ~ ~• • GAS- ~ WATER TIGHT SEALS TIGHT ~ ~~ ~/APPROYED A SEAL ~ JOINTS KITH ~ FILTER (o k -L-- ~ ~ ALM APPROYED PIPS ,;PYkOV"tD p~~~ , B ~ ON 3' ONTO ,,, pE 3 ~ 5~5 -F-" ~ SOLID SOIL ~,O I L PUMP OFF ELEV . GFT • -~- OFF D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS __1 C~tC.~ ~ 1 r T_ 1 nl `~ ' >i:PTIC / DOSE 11 1 ~~,~'7 x s ~ ~~, ~c-l', TANK MANUFACTURER: l,~ JIeS~~ ' TANK SIZES: SEPTIC 10C~~ GAL. DOSE ~ rG-AL. ALARM MANUFACTURER: 5 ~~ ie~fr~ _ -MODEL NUMBER: 1 r~i 1-f-~ L SWITCH TYPE: /t'l~c~~-/L-~ ~~~7 'UMP MANUFACTURER: ~~~ f MODEL NUMBER: O L~ SWITCH TYPE: ~--T J t: L:QU I R ED DISCHARGE RATE ,, GPM DOSE VOLUME INCLUDING ~~• ga ~~~ FLOWBACK: 7 . ~ 7 GAL. CAPACITIES: A = ~8 INCHES = al•6 GAL. g 2 INCHES = 33_. S-~ GAL. C ~ INCHES = OCZS GAL. D IO INCHES = IC~7 ~o GAL. PUMP 6 ALARM WIRING AS PER ILHR 16.23 WAC ;,eRTk~ L DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE M.. IM NETWORK SUPPLY PRESSURE ' 4l i FEET FORCEMAIN X AFT/100 FTOTALIDYNAMICAHEAD .=• ~y. FEET ~3`a~ ~~ FEET mac' FEET c _FEET f ~;~~"' ~ L DIMENSIONS OF PUMP TANK: LENGTH WIDTH DIAMETER __ .. , c.Rr~A LIQUID b~1'A-,~_. SIGNED: LICENSE NUMBER: DATE: i; ae 0 U Z W J Q li. m W ~ ~ ~ ~~ J_ ~ ~ Y ~ W ~ Q ~~ O~ vv ~ ~ U ~ m ~Q Z Z ~ O Q J V J J ~ O U o N m ~N O ~ JWw W ON ~~ fA~ s ~ ~ N [O J U ~M r !n Q W Q w (n CD 0D ^ rca c ~ /~ ii. p ~ rn U I- - Q Iw~ N ~ j~ ~' /^~ `VI 1-~JJ1~ Nr O J M ~ ~ t ~ J U w Q J Z V ~ Z O > e ~ !d, = Nw ~ZJ -W - F ~ ~ ON U C~ O Y O Z M~..o~= ~ cii ..Orr =f- ..30= F = opw mY oow U= a ~ w o '~ Q = °aooQww°°°~".1 a~~ a~° ~ ~' Z~imU~2J~S0]JS t7 Z w w w ~ Q Q Z z a o w „Z~ z O _~ ------- ~ -------- I ~ I• . ~ i I I' I I i !~ I I I I I I 1 • I 1 ; I 1 I I i I •I I I I 1 I I I., ~I __ I 1 . ~ ~ ~ ~\\ I 1 ! ~ I .~ I j I• j `~~ i I ., I I .' I i I I . I I ; . I I ' I I ,I I I I . I I I __ I ~.~ I ! ``. I `~ ~ I ~ ! I . 7 ~-- .e -I W II ~ w O J U (n r c M 4 ~~ ~ G~ ~ w a ~ o ~ ~ ~ Z ` G O ~ i ;;~~ Z ~ U °- o~ O i o O t;.i o : r- L_J ~ 0 ~JU S ~ _ V . a W C ~N nnr j C ~ ~ u r: 2 / ~ `~ 5 .y ; _.. T i I Li.r ~ ~ .~. ^w J J (!: ~- w~ I ~ „6~ - ----- .,~s ~,~vn ~p 1 ~oc-~ c1 ~~AI ~~~ i- • •••••M VrI4411WQ11U1W rCa~ures ana tSenettts /~/ and'/: HP • EP04 impeller- semi-open design Up to 60 GPM with pump out vanes to protect Maximum head to 32' mechanical seal. Discharge size 1'/:" NPT •EP05 impeller -enclosed design Solids:'/<" maximum for improved performance. Motor • Rugged glass-filled thermoplastic atl motors feature ball casing and base design provides gearing construction. superior strength and corrosion >ingle phase: 115V resistance. Materials of Construction • Cast iron motor housing for ;ast iron efficient heat transfer, strength, hermoplastic and durability. ~tainless steel •Corrosion resistant threaded stainless steel shaft. •Available for automatic and manual operation. •CSA listed models available. ~~eration and feature stainless steel hardware. .ir~n~~ nTll11J POWTS OWNER'S MANUAL & MANAGEMENT PLAN ILC IlYf vn~r,~,.v.. owner Todd Walker Permit ~ Number of Bedrooms 3 ^ NA Number of Public Facility Units l~ NA Estimated flow (average) 3UU al/day Design flow (peak(, (Estimated x 1.5) 450 al/day Soil Application Rate U.5 al/daylftZ Standard Influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOG) 530 mg/L Fsiochemical Oxygen Demand (BODE) 5220 mg/L $] NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand IBOD51 <_30 mg/L Total Suspended Solids ITSSI 530 mg/L 1~7 NA Fecal Coliform (geometric mean) 510° cfu/100m1 Maximum Effluent Particle Size Y8 in die. ^ NA Other: ^ NA 'Values typical for domestic wastewater and septic tank effluent. .ircr,In~irC cruFlll ll F Service Event Inspect condition of tank(s) At least once e Purnp out contents of tank(s) When combine Inspect dispersal cell(s) At least once e Clean effluent filter At least once e Inspect pump, pump controls & alarm At least once e Flush laterals and pressure test At least once e Otr,er. At least once e Other. nrnlrln AT1A1~IC Page 7 of 8 J 1 V 1 ~. - -- Septic Tank Capacity lUUO al ^ NA Septic Tank Manufacturer Wieser Concrete ^ NA Effluent Filter Manufacturer pol lok ^ NA Effluent Filter Model pL-525 ^ NA Pump Tank Capacity 6U0 al ^ NA Pump Tank Manufacturer Wi set n ^ NA Pump Manufacturer Gould Putu ^ NA Pump Model 3371 EPU5 ^ NA Pretreatment Unit NA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Dispersal Ce(lls) ^ NA ^ In-Ground (gravity) ^ In-Ground (pressurized) ^ At-Grade t$ Mound ^ Drip-Line ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA Service Frequency 2 ^ month(s) (Maximum 3 years) ^ NA rery: Q year(s) _ I sludge and scum equals one-third (Y3) of tank volume O NA 2 ^ month(s) (Maximum 3 years) ^ NA rery: ^ year(s) ~ month(s) ^ NA rery: 13 ^ year(s) ts) O ^ NA rery: 13 year(s) ^ month(s) p NA rery: 3 I~ year(s) ^ month(s) ^ NA rery: ^ year(s) ^ 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 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. Tt,e 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 ~rnmediate notification of the local regulatory authority. when tt,e combined accumulation of sludge and scum in any tank equals one-third (Y,1 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• GMW (4/01) Uwner: Todd Walker Page $ of ~ START UP AND OPEKATION For new construction, prior to use of the POWTS check treatment tattk(s) for the presence of painting products or other c}tcttticals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents ofthe tank(s) removed by a septage servicing operator prior to use. System startup shall not occur when soil conditions are frozen at the infiltrative surface. lluring power outages pump tattks may fill above normal highwater levels. When power is restored the excess ~~ astewater will be discharged to the dispersal cell(s) in one -azge 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 Soptage 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 pazk over, or otherwise disttub or compact, "flte area within IS 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 soRener brine. ~F3ANDONMENT ~Vhmi the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the System is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed • The contents of all tanks and pits shall be removed and properly disposed of by a Septage 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 tttaterial. CONTINGL'NCY 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: O 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 Bile evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. O A suitable replacement area is not available due to setback and/or soil limitations. Bamng advances in POWTS technology a holding ta~ilc may be installed as a last resort to replace the failed POWTS. O 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 maybe installed as a last resort to replace the failed POWTS ($I 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. «y1'ARNING» SEI''I'1C, 1'UbiP AND OTHER TREATMEN'T' TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OKYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH ~fAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. :\DDITIONAL COMMENTS POV-rl'S INSTALLER POWTS MAINTAINER ' Name Nama I Phone 715/772-3278 •Phone 715/273-5811 SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGUTATORYAUTHOR11tY . ~ Name n ~ Agency St . Croix Count Zonin .. ~ Phone Phone 715 38 -4 715 273-581 Tnis documanl waa drsltad by th• stalls of tJu Glean t.ako, htarquatto and Waushara County Zort4fy and SanUaUon aQOrtel4a~ Thlt dOpYltttdl~ RN~lti tno minimum naukamants of ch. Comm 83.2Z(2)(b)(1)(d)6(t) and 83.54(1), (2) 6 (3), Wfstansln AdminlsUaWtr 0006 UN O~fttli d00Y11NMt;lONAO~ ,?' " guarantee Iha puiormsnu of tha POWTS. 131WVQp>) t , Wisconsin Department of Comm ~~~~~~iC~~L LUATION REPORT Page ! of~ Division of Safety and Buildings , ;~ s.... ~v~j}A.l/Uyrl WIUI l,Vllll OV, F)UII ~/l, C Vv .~~ lll6 nn~~ ~ Attach complete site plan on per rr]]~~t less than 81/ x'Yt''inche in size m ^~nfil l' •7 ~ ~r //~//1 ~ I include, but not limited to: ve cal art~J~io~ ference point percent slope, scale or dime naiQ)t~~I~lAkr~ion an F . M), direction a ~ distance to nearest road. parcel LD. C'', ~ Z /b `J _.. '- /C~ ~ ' Please print all to Rev ed by Date Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ z~ Q Prope_rty~O'wner /~ / ~ ) / / ©G~GC l•'lO(~( ~e G~ Property Location Govt. Lot _ 1 /4 1 /4 3 T ~ b N R ~ `7 E (or W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# City State Zip Code Phone Number ^ City ^ Village own Nearest Road New Construction Use: Residential / Number of bedrooms ~ Code derived design flow rate T Ste' GPD ^ Replacement ^ Public or com~mercial -Describe: Parent material . ~ ~ ~~ D UCG' / ` ~~ Flood Plain elevation if applicable ft General comments and (.L S ~. ~' ~ X csln. ~ S ~ C ~~ L W ~ {"~ ~ S ~ •~ ~ t:,~.~ -Qc_ ~~~-~ e-~-~,,U p w c ov~f-a~d_ ~j_ Oc.c v~ ~ 5 5 ~~~ ~/pu . 1. ~=-~ ^ Boring / Boring # / ~Plt Ground surface elev.( ~.•~ ft. Depth to limiting factor ~~_ in. Sal lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 `~ _ 1e -y reYr. ~ f -~ ~ ~ ~ ~ ~ y y s s 1 o r3s G+- r1 ~ , Boring # ~ Boring C~ ^ pit Ground surface elev. ~' / ft. Depth to limiting factor 3 ~ " in _ . Sal lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I b- ~b ~ ~- / ~ s k 1 ~% ' '~ ~ ~ ~ ~ - 3 - S o - ~ ~ ~~ ~ ~a 3 .~ r ~/ ~ i tttluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST me (Please Print ignature CST Number eu t 2~ e ~' ~~ ~~~a Address ate Evaluation Conducted Telephone Number (,.(~1~~~ X70-~~-~ ,~~ ~ ,-~,~ ~~ ~ ~ c.~ ~ ~~ GS 77~~...~7~ Property Owner ~ ~ ~ ~~(~" Parcel ID # Page ~ of Boring # ^ Boring ~ ~-~ [~ p t Ground surface elev. / ~ ft. Depth to limiting factor in. Soil ication Rats 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 'Etf#2 ~`-~ ~O a.~ rl ~ . s ~ SCE ~ ~ b ~ -. ''---v. Boring # ^ Boring ^ Pit Ground surface elev. _ ft. Depth to limiting factor in. Sal ica6on Rabe 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 'E(f#2 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil Gcation 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 `Effluent #1 =BODE > 30 < 220 mglL and TSS >30 < 150 mg/L 'Effluent #2 =BODE < 30 mglL and TSS _< 30 mg1L 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) f l d-t ,~ (a.~ .., . ~ ~ ~ ~~ ~~ ~~ - ~c~' ~ «. (-~ f ~Xc ~~p~- ~s Sh ©~~ ~~~ 3 ~ -f 3 /3c~fh /-~~e~ _.__ .. .? 7 $ ~ I . ~, q ~- {froPosyr~ lei ~ s ~_ ~~-~ .1"e.~ ~ ~ ~ ~ ~, ~,~~ P P=Q ~'ar~. R~bb~~. Ia2 f~ f ~ ~ ~ ~ '~. 81 is ~ ~ s~a~ ~~~ ~ ~ ~, ~ , l D ~.C Z`? ~ ~ d .~+~c~, ~. ~~ev~ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~ d dc~~ I ~)n I l~~ ~ Mailing Address ~c'7y0 1~ ~~.~ f I ~ ' ~ 4.~~ ~ ~'~oo ~ Property Address ~ ~ D~ City/State Parcel Identification Number i2~-io?5-~{0 .-ooo LEGAL DESCRIPTION Property Location ~, '/a, ~ '/<, Sec.,~_, T~_.N-R 17 W, Town of ~'^~~ y"r~t r, ~ Subdivision Lot # Certified Surve Map # ,Volume ,Page # ~eea -~ ~ ~ 9 ~ ~ 5 08 Warranty Deed # ~ ~ -~D75 -yD• 0~0 Pik ,Volume ~~ ~ ~ ,Page # Spec house ^ yes ^ no Lot lines identifiable ^ yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restrictedplumber or alicensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days a three year expirati dat r SIG ATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pr erty described above by vi a of a warranty deed recorded in Register of Deeds Office. ___~__ ~. ~ . a3, U ~ ~ SIGNATURE OF APPLICANT DATE * * * * * * Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. *''t"* " Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is trade in the warranty deed '1'8'1 (Verification required from Platuring Department for new C~Op~( Ihx umcnt Number U .2545 P 208 STATE BAR OF WISCONSIN FORM I - 2000 WARRANTY DEED This Deed, made between Howard C. Walker and Edna G. Walker Grantor, and Todd B. Walker Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property") (if more space is needed, please attach addendum): Northeast Quarter (NE 1/4) of the Northeast Quarter (NE 1/4 ), Section Thirty-six (36), Township Thirty (30) North, Range Seventeen (17) West, Town of Erin Prairie, St. Croix County, Wisconsin. Recording Area 7 5 9 1 6 5 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO. , MI RECEIVED FOR RECORD 04/12/2004 10:00AM NARRANTY DEED EXEI4PT N 8 REC FEE: 11.00 TRANS FEE: COPY FEE: CC FEE: PAGES: 1 Name and iiciuui Adwcsn BAKKE NORMAN S.C. P.O. BOX 280 MENOMONIE, WI 54751 Together with all appurtenant rights, title and interests. 12-1075-40-000 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements, lrigltways, utility rights and reservations of record, and will warrant and defend the same. Dated this ~ da of V~~ 2004. Y * Howard C. Walker ~~~ ~~~ * Edna G. Walker AUTHENTICATION Sienature(sl authenticated this day of TITLE: MEMBER STATE BAR OF WISCONSIN ([f not, authorized by $706.06, Wis. Stats.l THIS INSTRUMENT WAS DRAFTED BY ERIN M. HECK BAKKE NORMAN, S.C. (Signatures may be authenticated or acknowledged. Both are not necessary.) • Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED FORM No. I - 2000 * ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. ST. CROIX County ) Personally ame before me this ~ day of- ~ ~ 2004 the above named Howa-rd C. Walker and Edna G. Walker to me known to be the person(s) who executed the foreeoine instrument and acknowledsed the same. es~c~ns`n Notarv Public, State of WISCONSIN My Comnussion is permanent. (If not, state expiration date INFO-PRO (800)655-2021 www.in(oprofomu.comSTATE BAR OF ~~'ISCO