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HomeMy WebLinkAbout018-2001-12-000.;onsin Department of Commerce PRIVATE SEWAGE SYSTEM ,afetyand 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 Eckman, Chad Hammond Townshi CST 8M Elev/1 Insp. BM Elev: BM Description: V ~~ ~Q~ t~ ~~ ~/ TA K INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic - !Ol' (~ Dosing / «(~~l~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Y ~ y f Aeration Holding PUMP/SIPHON INFORMATION /~l y I 1 Manufacturer Demand GPM Modef Number /~ ~ % ~ ~ . I U TDH Li ~5~0 Friction Loss 2 •~f Z Syst m Head TDH Ft ~ Forcemain Leng th , Dia y Dist. to We~~ /~ SOIL ABSORI~TION SYSTEM ' county: St. Croix Sanitary Permit No: 430135 0 State Plan ID No: Parcel Tax No: S ction/Town/R ge/Map No: 14.29.17. STATION BS HI 3• FS ELEV. oo~a Benchmark 3< ~~3, ~D . a Alt. BM ~ ~~~° . Bldg. ewe xx / St/Ht Inlet d b• Z~ Q !G• ~r SUHt Outlet ~- ~ Dt Inlet `~ Dt Bottom . ~ , S . 92~ d Header/Man. _ Z~, '~ ~` z~ll0 • y' Dist. Pipe ~,T- /17 Z. 2 ) Z_ 2~ 1 L_ 2 1 71 / ~ 3 Bot. System • ~ 3 .ao~73 Final Grade .}. ~,~- s ~( - .~s~ ~o Z •'~ 1 over - . 33 3. ,iE .0~7 3 .7~ y BED/TRENCH W idth ~ Length / No. Of Trenct~s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ~ ~ r ~ ~/ SETBACK SYSTEM TO P/L BLDG W +~ LAKE/STREAM L CHI Manufacturer: INFORMATION CHA OR Type j~f ~yste_ m: ~ ~ Vl ULt/Gl,d ()~ ~ ~ / ~ ~- Model Number: DISTRIBUTION SYSTEM Header/Manifold / _ ~ I/ Length Dia 2 Distribution Pipe(s) Length ~ / j / Dia '~~ ~ Spacing ~ x Hole Size ~ /~ g x Hole Spacing ~ / Vent to it Intake Q ' SOIL COVER t x Pressure Systems Only xx Mound Or At-Grade Systems Only ~ -~`~ ~~~ ~ ~~' Depth Over L Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center / 7 ~ Bed/Trench Edges Topsoil - -i I ~_i, Yes ~,_, No I _1 L- Yes _, No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~~, In pect' n #2: I / ~ U j Location: 920 193rd St Hammond, WI 54015 (NE 114 SW 1/4 14 T29N R17W) Forest Ridge Estates Lot 12 ~ arcel No: 14.29.17. 1.) Alt BM Description = s ~' Wr~~ ~ a ,d.Q,p~~~ ~(,(I~,(/~,7~iRy~ 2.) Bldg sewer length = U i ~" (//+ ~,,p ~_t,lrn~3 BI~ -amount of cover = ~~ ~~t'1~ ~ ~ a ~ ~~ `""0 GG~ ~ ~~ (/ ~ -, - - - - -- -~~ - i -_ ~ __ _ _ , ~~ ~ ~~ Plan revision Re uired . I I Ye Use other side for additional q information. o t__- ~~ _~ ~~ -~ ~_ . a.2~ -- -b~!'~`- ~ --~ i v. "L L__-~ 3 Insepctor's ure Cert. No. SBD~710 (R.3/97) •t- H-c mss ~r 7Zcr1x~./~' Safety and Buildings Division County ` ~ ~ 201 W. Washington Ave., P.O. Box 7162 ST. CROIX SCOOSIO Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co. .. De artment of Commerce (~8) 266-3151 Sanitary Permit Application state Ptan I.D. Number TRANS. ID N0. 874841 / In axord with Comm 83.21, Wis. Adm. Code, personal information you provide _ may be used for secondary purposes Privacy Lay[..s,15~04(1)(m) w Proje ct Address (if different than mailing address) g Plea P i t All I I I f ti f ti ~ A li ti / 2 d ~~3 ~D' ST' on - r n - . n orma se n orma pp ca on on ~ Property Owner's Na me ~ . a ~ . ,, ~~ ~ Parcel >Y of A` 12 Ores~°~~`d CHAD & REBECCA BCKMA ~ p - -000 Property Owtter's M ailing Address s,' Property Location 111 W ASH ST `""" ~"`" ` ~ - ~ ~ _ ... i " ..`. ` '"..` NE tk SW t 4 secdon 14 City, State Zip Code Phone•Number , , , ROBERTS, WI 54023 X13-701-3360 (circle e) R 17 E T 29 N W~ II. Type of Building (check all that apply) of ; 1 or 2 Family Dwelling -Number of Bedrooms 3 ~ Subdivision Name CSM Number ^ Public/Commercial -Describe Use ~D?.Ur?o~ Sf, X ~ l ~n ~au2 FOREST RIDGE ESTATES 1 / ^ State Owned -Describe Use / ~ i] °`[ lc'~ ~~ `' ~ ~• ~ S~ ^City_^Village Township of HAMMOND III. Type of P Check only one box on line A. Complete line B if applicable) A' ~ New System ~ ^ Replacement System g p y ^ Treatment/Holdin Tank Re lacement Onl ^ Other Modification to Existin S stem g y B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner 1V. of POWTS S stem: (Check all that a 1 ) ^ Non -Pressurized In-Ground ~ Mound > 24 in. of suitable soil ©Mound < 24 in. of suitable soil ^ A[-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis rsal/Treatment Area Information: Design Flow (gpd) / Design Soil Applica io te( sf) / Dispersal Area equired (sf) Dispersal Area Pro sed (sf) System Elevation ~ 450 ' 1. -~' l~ ~ S 450 ~~ S~ ~ 450 cl ~~ 100.75 VI. Tank Info Capacity in Total Number Manufacturer refab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 000 1000! 1 WIESER CONCRETE X Aerobic Treatmeru Uni[ Dosing Chamber 750- 750 1 WIE ER 0 RETE VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plum is Si gnature MP/MPRS Number Business Phone Number BENNIE HELGESON 220292 715/772-3278 Pltunber's Addre ss (Street, City, State, Zip Code) W1229 770TH AVENUE, SPRING VALLEY, WI 54767 VIII. otmt /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued ssuing Age t Signature tamps) Surcharge Fee) ~ ~ 3 ~ ~ ~ ^ Owner Given Reason for Denial ~ ~ Q 1X. Conditions of Approval/Reasons for Disapproval ~ ~ / ~~~~ ~ p l / 1 ~~~ ,~-il yyt~~ ,,¢tvlR-.`'~~,P.~.Q/GG~2~C ~ ~~~ ~ `~ ~~i'N/~Za~ .~%~C 41? f~~n.c~ ' ~ ¢ . Sadll~i~n- ~~ia~ La 73 of ~-ti-~.r-s... ~ . ~/l~-t . ~o / ~/~ J ~ ,,< ~ ~, ~~z~i,~d2 oZv~rt ~ ~~` >~ca~ ~Cu'`Q_'~Z~r~o 3 " SZ G ~ if L'ov~." ` ti n- ~~ ~ ~' ~ ~( / n s ~ ta i-~~ 3 ~,,, / ~ / ~ / ~ " ~ ~ ~ ~ ~ ~~ / l = IGI~n QiYt2 C.~ ~~P~t2 G~cc.,Q.2 1/n 'V e Est wttach omptete p as (to a County only~for the sy em o paper n less Wan 81/2 x 11 inches in size ~ ~~a' ~cfJ ~~ t 1 ~: ~i v' 0 6~' N ~ °~ `~ S U ~(( T ~ tC!' a~i o- i ~- ~ ~' 1~ .1 ~ ~jl ~ ,~ ~ ~ --~- 1u v -L-' ~' yc Q V ll ....+~ ~1, r Jo C` 1l,.1 1 ~ 1 v 1f s ~ ~ ~- ~~ ~ ~ Y ,~ ~ ~ Q i !vi V1 I I 1 ~ ~ ~ ~, x>, I ~ ~: j ~ I ~ a J .~ 15.1 4 ~' J 0 A" i O_ ~ C 4 . 0 M ~. A 7 f .d isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary June 11, 2003 CUST ID No.220292 BENNIE W HELGESON HELGESON EXCAVATING W1229 770TH AVE SPRING VALLEY WI 54767 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/11/2005 SITE: Chad Eckman CTH E Town of Hammond St Croix County NE1/4, SW1/4, S14, T29N, R17W FOR: ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Identification Numbers Transaction ID No. 874841 Site ID No. 659988 Please >•efer o both identification nun above, in aIi correspondence with the a Description: Proposed Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 906233 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. The following conditions shall be met during construction or installation and prior to occupancy or use: Conditions of Approval: • This This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD-10572-P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD-10573-P (R.6/99). • Limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. ~• A state approved effluent filter is required. Maintenance information must be given to the owner of the tank exp_ laining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • Comm 83.22(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. P ~.1~'~.`1`:~. CU~~cI~°~r~,~~~u~~'~~ BENNIE W HELGESON Owner Responsibilities: Page 2 6/11/03 • 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 per Comm 83.55, that is 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 to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm jswim@commerce.state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 INDEX SHEET PROPERTY OWNER: PROJECT NAME: CHAD ECKMAN 111 W ASH STREET ROBERTS, WI 54023 CHAD ECKMAN PROJECT LOCATION: NE 1/4, SW 1/4 , S 14, T 29 N, R 17 W MUNICIPALITY: TOWN OF HAMMOND 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 & Specifications Page 5 WLP750-MR Tank Specifications Page 6 Pump Specifications Page 7 POWTS Owner's Manual & Management Plan - Pg. 1 Page 8 POWTS Owner's Manual & Management Plan - Pg. 2 Name: Bennie Helgeson Signed ~ - Address: W 1229 770th Avenue Spring Valley, WI 54767 Credential Number: 220292 Date: May 28, 2002 R.~~-~ DEPARTtJIENT Gi~ Ct~YP~YlF~_nCE D{ViSlfaN SAFETY AND BUILDINGS SEE GORRES ONDENCE ~~~~-' •. ~.~Ylc~d ~c ~vh a n Synthetic Covering Medium Sand Topsoil 3 % 51ope~ J ~ ~ .~' 3 l~ Cc(I Of 2-- 2 %2 Aggregate Page ~ Of g Distribution Pipe _~~,,, jD~. ~'SF _ G F ~~ D / ~ , ~ I.cu ~~q •75 Forc~lOfain From Pump Plowed Layer 0 _~ Ft . E /. ~7 Ft. F ,~9Ft. G , r Ft . Cross Section Of A Mound System Using A Bed For The Absorption Area Signed: License Number: Date: Force Main L T A ___~_ Ft . H 1 Ft . B SO Ft . K ~ Ft. ~ ~~ L lob. (o Ft. ~ p~c~ ~ ~~ Ft. ~ si ~ ~ T _9. Ft.~ ~" rte`'"- ~ W~ Ft ~~~ ~ v ~ ~~ ~ Observation Pipe J B K ---. I~-----~------ ---------- ---'~ i 1.~~~9~- A ~~---- ©--------------- ----------------------•~ o~ Cell w r =-- -T------- -- --- .__---~~ a Distribution Cell Of 2 - 2 %2 Pipe Aggregate I ••Observation Pipe C/ca.r o«~'s 9Qo ``' ~s~. ~ ,~•t.~i. w,i~l~ ,gcc rss BoX- Plan View Of Mound Using A Geld For The Absorption Area 1JjJn ~~' ~a.,d f~~rn~. n C )ep.~.o~~1" ~cCrS~ C. I E [tv~ O`-L~ Perforoled f lp• peloll ~ / C! End VI•w P•rlorolyd . e ~e0.h pw~ Holes Located on Bottom are Equally Spaced ~ ICI ~~v G Distribution Pipe Layout P ~yl .. R , S ,~_ ~~ X .~ Y /, Signed: License Number: Dare: Inch ~ meter Di _ a Hole Lateral ~ Incn (es) Manifold " a Inches force Main " ~. Inches ~,,VVE~`~ ~l~e~. ~©i. as het- ,~~,.~ Ho I.zs ~ ro-~ ' I 3 _ 1 / o f i-i o1,e S ~' P4 ~ o ~ ~ _ PU!•1P CHA.MP,e.R CfiU55 `EC~"Ili:.; AN'G :,PECIFIi:l.IlU~!`: VENT CAP .~' i ~ [ ~,, PIPC ? TS - 2;,•"') GOOK wI~JDOw OR FRESH AIR ItJTAKE 18"hIIN. IfJLET APPROVED JOIIJT A W/C.I. PIPE EXTENDING, 3~ ONTO SOLID SOIL D C ELEV. LZ~ ~. FT. D SEPTIC E DOSE TANKS ALARM PUMP RISER EXIT pERM17FED C)IJLy IF SPEGIFI~GATIOAJS MAtJUFAGTURER: "- I'~'~r TAIJK SIZE : 7~~ GALLOIJ~,Sp MANUFACTURER: ~' -~-~-~'~'--~~ MOD[L I.JUMBER: /bl SWITCH TyPC: ,,~~~' MANUFACTURER: ~G"'~~r MODEL NUMDER: SWITCH TYPE: r~ MINIMUM DISCHARGE RATE GPM i'3c.~~~low Clo lu.m, ~' a 9 gt ~ 61~-I . DOSE VOLUME _ 37, fo S'"` GAttONS To`fcr. l Doses 101 ~-~+^~ "' CAPACITIES: A= ~`~-IAICHES OR .~L=L--~pAILOWS 8 =_ ~ IIJCHES OR5~b. S" (aALt0AJ5 Ga~11JGNES OR Jss~l~QA GAttO-J5 p •, _1,.-_ INCHES oR .~.OJ•/~ pAEL0~J5 DOTE: PUhIP AND ALARM ARE TO DE INSTALLED ON SEP/.RATE CIRCUITS VERTIC^L DIFFEREIJCE DETWEEU PUMP OFF ANO DISTRIBUTlO-J PIPE.. ~ FEE•T •S FEET {- .MIf.11MUM NETWORK SUPPLY PRESSUR,,E//. . .+ ~Q_ FEET OF FORCE MAIN X ~_f/po-r.FRIC71oN FACTOR.. FEET ----. .,.,.~..e~~ ~c~n = ~2c0.~- FEET nE~ y ~/ 77 , •WIGTN ~ i LIQUID DEPTH ~/ IiJT ER-.lAt_ DIMEIJSIOAIf OF TA ~~L~.~CaT ~ ~~~~ ~/e¢s~ ~~~ -Th G S~~C ~~e ~ /~7 l~- _!_ LICEIJ~E rlUMBER: UATE: SIG +~ E D : ~---'- WEATHERPROOF JUNCTIO-.I BOX 12"M I U. GRADE GOIJDUIT I I' `__. V PROVIDE AIRTIGHT SEAL rn~.~ ~1 p ~ ~j... MA-JHOL E COVE f'. `1" MIN. ~ ~ le'nlu. • - -_- I~i ~~ III APPROVED JOIW!: (I I w/C.I. PIPE IIII ALARM EXTEUDifJG 3' -i 0-JTO SOLID SOIL I I ~ oN . ~I I I PUMP -~ -~ pFi CONCRETE DtOCK JQ H K TURE:R HAS SUCH APPROVAL ~ l pbS~ Vo~uW-t° ~D'~O-~ tOa.~S.~1n Fdl~l'i s9xs Z ~ Q ~U I V I. Z O U 4~ J , , a L~ J W N F ~ 10 Y Z 0 O ° ~,. ~ ° O ~ ~Q ~ ~ o m O Q J ~ z J D p a • O~Op W W l NFa-W O i O f9^ ll f Z O O V) W ~ ~ ~ OF j N ~ ~ N N o0 N ; }.. ~ F- 4 O OF- f7 ~ mW ~i1 N 'Q f` ~ ~ Z J~ p F ~ p 0 ~ ~ a Z avc~ Z N O a~.. V O~ a Z vl3m ~ ~c~m 3 o z_ ~ J J _O O O ? ? J = J ~' «Zb W J N =~1 «9t! a ~ ~ 1(^ h Q~ ~ Y ~~~ O~ ~ f In ~ ~ Z ~ ~,~ N ~-moo M ~ ~ 0~ p ~ ~ i ~ O °~ t`F °~ a N r N Oro W ~ Z M 3 ~ I I ~ S~ ! s~ £ w~ d «b « w O U «94 ~ ~ ~ o «Ob «19 • w ' HEAD CAPACITY CURVE MODEL 98 i ,5 I I ~ 6 ~ 20 x ~ 15 z °1 0 ~ 110 0 2~ 5 - ~ i U S GALt.ONS 10 20 30 40 50 60 70 80 LITERS t 60 240 oo~r~ p 80 ftOW PER MINUTE 6 r 3 7/B - 6 I/4 r 4 5/B -~{ __~.. ~i ~~~~I V "'l ~ 3 5/8 t r~~±~~~ ~ \ 3/ 16 1 1/21 1 -11 1/2 NPT 16 8x1107 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and Variable level float switches are available for controlling single supplied with an alarm. and three phase systems. • Mechanical alternators, for duplex systems, are available Double piggyback variable level float switches are available with or without alarm switches. for variable level long cycle controls. ca....d~..1 III w..,rlelc _ Wcinht 39 Ihs_ -'/: H.P. 98 Series Control Selection Model Volts-Ph Mode Am s Slm lax Du lax M98 115 1 Auto 9.4 1 - N98 115 1 Non 9.4 2 3 or 4 8 5 osB z3o ~ AuW a.7 ~ - E98 230 1 Non 4.7 2 3 or 4& 5 SELECTION GUIDE 1. Integral float operated 2-pole mechanical switch, no external conUd requked. 2. Single Pi99Ybadc variable level float swltdt rN double.plggybadc variable level, float switch. Refer to FM0477. 3. Mechanical alternator 10-0072 or 10-0075. 4. See FM0712, for correct model of ElecUical Alternator. 5. Control switch 10-0225 used as a control activator, specify duplex (3) a (4) float system. CAUTION For iniomwtion on additional Zoeller products refer W catalog on Piggyhadc Variable Level SvAtches, All installation of controls, protection devices and wiring should be done by a quallflsd FM0477; Electrical Ntemator, FM0486; Mechanical Alternator, FM0495; SumplSewage Basins, FM0487; licensed electrician. All electrical and safety codes should be followed including fhs moat Single phase Simplex Pump Control, FMt596; Alarm Systems, FM0732. recent National Electric Code (NEC) and the Occupational Safely and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. AWL TO: P.17. tltAT rosy LouisvAle, KY 1025fi~0341 ~f~~ c(, . ~~ SHIPTO: 3649 Cane Run Road L~7 ~e t.awwiue KY 40211-1961 Q~rrPu~ S~cE /9.99+ PUMP !O, f~~l na2731.1 f6oo) 9s6.PU~ httpJ/www.:oallercorn FAX(502) n1-362I ® Copyright 2001 Zoeller Co. All rights reserved. Jun 24 03 06:34a Precision Excavating 715-584-3299 p.l ST CROIX COUNTY SEPTIC TANK MAiNTIrNANCE AGREEMENT .4ND OVdN~F~SHIP CERTTFTCATION FORM r- r\I\ OwnerBuyer _ _ NA`~ ~`•~~ ~~ L ~` Mailing Address Property Address CitylState LEGAL DFSCRTPTION Property Location iU ~ 'f<<, -~ r/d. Seo. ~ T~-N-R rZ-W, Town of ~Id.~n-m-r~-`'-°~• _-__-~ Subdivision ~~~ ~b~.S~ RtPGiE ~S``t~i-c~ C Lot # .~_.• Certified Survey Map # Volume ~~Z__-____~ Fago # .1+• Warranty Deed # ~ o)y ~~~ ,Volume ~~__. Page # a Spec house ^ yes ~ no Lot lines identifiable ~ yes ^ no SYSTE'1'1 MA.TNTENANCE Istlpmper use and maintenance of your scptic system could result is iu premai~ut failturr in handle wastes- Proper maitstessatsce consists of pumping out the septic tank cvcry three years or sooner, if needed by a licesssed pumper. What You Put into the system can affect the fiwctian of the septic tank as a treatment stage in the waste disposal sysKtzn_ The property owner agrees to submit to St. Croix Zoning DepasTment a certification form, signed by the owner ~ by a nlastcr plumber, journeyalan plumber, resaietedplulnber or a Iicensod pltniperverifying that {I) the oss-site wastewaterdisposal trystem is is! proper operating condition andlor {2) after inspection and ptamping (if necessary), the scptic tank ~ Iess than ~ ~ Cf sludge. I/wc, the undersigned have read the above requirements and agree to maintain the private sewage disposal system wtth rise set fertb, herein, as set by the Depargmcnt of Commerce and the Depa^tsnent of Natural Resources, State of ~iVisco O~Ce~ ~~ scaring that your sepric system has bees maintained must be completed and returned to the St. Croix County Zoning ~d'a'~ys of th(e'~three year expiration date. DA'I'S SIGNATURE OF APPLICANT OWNER CER'1"~FICATION are the owncr{s) of I (wc) terrify that all statements on this form are true to the best of my (our) knowledge. l (we) ash ( ) the property described above, by virtue of a warranty deed recorded in Register of Deeds O~ca. / /~ `~'~- DATE SIGNATURE OF APPI:ICANT ss~ss• +***+* Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Depariultnt. •• Include with this application: a stamped warranty deed froth the }register of Deeds office a copy of the certified survey map if reference is shade in the warrussty deed {Ve17fiCatlCn rCQtllred fra271 Planrling DCpartmeri[ [Dr nCw GVi1JUUVUV=.~ P~,~+- o ~ Parcel Identification Number o 1 - ~ ~ ~~oo POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORMATION Owner CHAD ECKIvI Permit # ,[~~j j MAINTENANCE SCHEDULE Service Event Inspect condition of tank(s) Pump out contents of tank(s) Inspect dispersal cell(s) Clean effluent filter Inspect~pump, pump controls ~ alarm Flush laterals and pressure test Service Frequency At least once every ^ months ®year(s) (Maximum 3 yrs.) When combined sludge and scum equals one-third (Y~) of tank volume At feast once every 2 ^ months D year(s) (Maximum 3 yrs.) At least once every 1 ^ months . ~ year(s) At least once every 1 At least once every 3 ^ months ~ year(s) O NA ^ months C~year(s) O NA At least once every ^ months ^ year(s) DNA At least once every ^ months D year(s) DNA 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 Servidng Operator. Tank inspections must Indude 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 (Y,) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment components; and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. STARTUP AND OPERATION. For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may Impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. Pafle 7 of t SYSTEM SPECIFICATIONS Septic Tank Capadty 1000 al D Np Septic Tank Manufacturer IESER CONCRETE ^ N~ Effluent Filter Manufacturer ZABEL ^ NP Effluent Filter Model A-100 12"x 20" ~ NA Pump Tank Capacity 750 al O NA Pump Tank Manufacturer WIESER CONCRETE ~ NA .Pump Manufacturer ZOELLER PUMP C@ D ~` Pump Model 9g DNA Pretreatment Unit ®NA ^ Sand/C~ravel Filter ^ Peat Filter O Mechanical Aeration ^ Wetland ^ Disinfection ^ Other. Manufacturer Dispersal Cell(s) p In-ground (gravity) ^ In-ground (pressurized) O At-grade ~ Mound ^ Drip-line D Other: • Values typical for domestic (non-oommercJa~ wastewater and septic tank effluent. •• Values typical for pretreated wastewater. UWNER: CHAD ECKtMAN System. start up shall not occur when soil conditions are frozen at the infiltrative surface. Page $ ot~ 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 surtace 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 PONIr'fS Malntalner 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. ABANDONMNIENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to Insure that the system is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.- • The contents of all tanks and pits shall be removed and propetiy 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 placement system: 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 compactlon.and should not be infringed upon by required setbacks from existing artd 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 technololgy/~holding tank may be installed as a last resort to replace the failed POWTS. he sitet`'tyas Mot bee a lusted to ' enti a suitable repl men ai ur a soil and sr'te eval --1g-1 must~be pe to locate uitabl placement area. If no replacement area is avatlable a 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 POVYTS INSTALLER ' Name Phone 715/772-3278 POWTS MAINTAINER Name ~' ~' Phone 715 27 - ,, SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY ' ~ Name JOHNSON SANITATION Agency ST. CROIX COUNTY ZONING OFFICE Phone 715/273-5811 Phone 715/386-4680 ~ This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies. This document meets one minimum requirements of ch. Comm 83.22(2)(b)(1)(d)8(Q and 83.54(1), (2) 8 (3), Wisconsin Administrative Coda. Use of this document does not guarantee the performance of the POWTS. cluweyot) X20 ~~3 ~ ST• v,+tK,or,.e, wpere,rnt or C.OrrlTerW SOIL EVAI.UAT)ON REPORT P , .,~_, of _ 3 ol~t«- ors.r.tr e,+d Bufidhpe M aoooldenn with Cantu e.1' .1Me. Adm. Code Aeedi o•rrrpleM aka plan on pepw not Net then d !/2 x 1 ! lnchee M etse. Pten mutt ~~ S? r~.~r X Irr.Mde. btA net ltmked to: ~wNe~t erd )lorimwl wiu'ann Oc4t! (~Mj, dlrtretbn end Para I.O. p,ro•-d elope, ante or dMenalons, nerk- errew, end loaetyen end dlelana b neereet road. ~, PEN rll} 6 Pfeete print elf /nlormedon. a•~•w•d r flsee 0•nenN tleR pau o^>"d~ rwryr ~, wN -« a•ean~~ry ew•a•e !/rNaar tar., ~. 1 f.M (+) Sr^lf• /f/liyt /.~i~ ~ r ~"/!(J/ M L !_~ ~«• • -~ lv ~' tr~5~ !r~ s J y r ~ H R 17 ~w rtytJwnere Addreee tat N tilodc N t)tAd. tQerry a W , 'p t ~ 151 brJ ST ~ 2 -' E 1062. ATE • p • CMy NMepe Town tWueat osd ~ BALLS I oz~ 15 -4802 e.T. r ~ New Constttrt!!on Vee: ~'Restdentlel! hA+mba d e+eroerrre _,~,_ Code dulwd dalpn Row me _,,,_, GPQ R,ptoemont Q Poetic a ool+xn.rdal - Oesobe~ ..~ ._._.. Perent mWAal '~I L~~'Yta1A 'S}'~ FIOOtl Pleh elevitbn tf sppltabMr A}. A .,,,~ _ ., "'~`r n. ,,.__._~ t3Kwe1 oonrr+wtb ~ ~ ~ ~ end reconrrwndetTonr: ,/t/L otr,,r.1 D sV ST eM I . v s R 13 ~ F t ~'- Ors (-t}flDWCo Rpt'i~. .. ~ - Sa S~t~:(~ ~ /n ~f 0 ~~->4 q~.ay~ r• { Bork+p ~ ~ pit Ground turltee etev. ___ .~ f4 Depth to Iirnldnp hctor ~= +, f-• in. """` ~ t.f7t 11 ~ V Crw'1 a nnKr.l:rv, R•r• Ftorizon OaptA Oom#nsnt GoF Redoa Deeulptlon Texture Structure Conel>yenu t~oundery Roots GP f in. Munrap ou, 5t: Cont. Color Gr. Sz. Sh, 'E}FU1 'ErntZ ! Q-i2. 0 "' all r Li mJ~tr ,8 ~- t2- )Oyx 3~ "" ~ Z~-ma mJ Y C. ~- ~, f .2 zN-4o 0 3 s W ~5 0 tut L -vet 0~ t~orl * p Halnp g8.7q`~C t ~ h ..r -~1 't,[1 Pit Ground swtece eterv. _ _ k. D.pth to Ymltlnq hda 2 ~ , M• e.,n e,..weytlerr t2n• - n i H - r De tn t?orninenl Cola Redox Oeeafprion Texture SUucturs - Consitttencw 9oundery Roots GPpMf or :o p h. #duMalt t]u. 3t Cunt, t;,pfpr Gr. 92. Sh. 'Efb/t 'tiffK;t ~ aid I -~. ~ - 0 2 D.'S ~ _ to y ~ a ~ s;f , o z . ,~ _ ~~Y ' EAtuent M1 ~ BOD ~ 3D s iav n+pti an• r a~ -a.+ ~ rw *w~ •.r- ~- -- ~ - - - - - - - - - ~. »~r11e ~e• Prtrst) Q{pn.ftln ~ PAIT~ber H L ~ D valu.tlon ~• o-+o^• Addrean W98?5 i.40.-tiAVE, Rtt)~ I-1,SS WT '54022 l U3-~7--OZ '7t y21s-1'17 E1StSE©' o4-Ig-0 t~LOT tZ~ Properly Owner ~~S~L ~ _~ Parosl 10 it ~+~?nIN~^ Papa ~' _ or~_ R~ ~~^~x~p~1 B~In~ i~o.lq (y0~ li} 1'~I pU Ground surface elev. ______,_ R Depth to limlt{ng factor LID in. Sod IUflom Rate Horizon Depth Dominant t..otor Redox Desvfptton 7exlurs Structure Condstence Boundary Roots GPO1R In. Munaes Qv. Sz. Conf. Cdor Gr. Sz. Sh. 'ERMt 'Effar2 I p-'J toY~t z ~ 3~-~ cs 3vf .5 0, Z' 10 tR 3! ` m sb t/' CS Z.J .M 0, D `I ~- -'!-~,.OV~ s1 lmsb m~ w Gs Iv -m 0~ f), I~ t~ I srx+na r _ C~ ~""° ~1J ~-t ~ ~ ~ p Ground surface elev. - ^~ n. Deptn to umnlnp rotxor - ~ m. Soil cAUOn Reis horizon Depth Dom Cdor Redox OesrzlpNon Texuere Structure Conslstsnce Boundary s GPOItf In. Muns Qu. Sz. Cone Color Gr. Sz. Sh 'Eflflt 'ERli2 i 0-~ 10 ~~ z l Z _tT r 0.~ 0, Z ~ - la ~~. ~ ~; ,S ~ It)- IOYky 5i1 0.S 0. 4, 9. r 3t - s1 r l O,y 0, j - C ~ 00 oK.l E p goy Q-5 ~~i i ® Plt Grountl surface elev. _ __-,., Horizon Depth Dominant Color Red viption in. Munsed ~ Cool. Color 11. Texture Depth mitlnq facor ~ in. Sotl A kaUon Rste Shuctur Conslatence Bounndary Routs GPOltf Gr. Sz. Sh. •ERf11 'EMP2 ~ ~ -9 IOY rt lI=. -- L Z S 0, ,~ q-i 10 - '~1 m .Z I _ S -- ~ ~ r ~- o.y x - - '~ _' ' Etduent frt = 60D, > 30 < 220 rrp/L end TSS >30 ~ t50 mpll ' Efeuent tY2 ~ t300r <_ 30 rt>~!. and TSS S 30 rrgfL The Ucpartrnent of Commerce is an equs) opportunity aervice provider and employer. 1f you need aaxistanee to access servicea to need material in sn alternate format, ptesse contact the department at 608-266.31 S I or TIT 608-264-8777. S91)•f}fOlR.Y0f11 ~~ ~,~ .` • ~, ~ ~ ~._ , . X SFc. ,~i T29+~~ A~~vJ ST~'TTcs ~~..i~ p~•~~{3 2 s ~'=yd' _ _ _ ~ Z~c,opTOU.~ u~~ REV~sEr~ : 09-~4-a'Z • RSV-Sr~D ; ID-i~- oZ ~~ 80' R EASEr '. SOU TI •~ 14~,49~ ~ , N.B. 14- ~~ - --- _~ . B . 3 ,, _ t° .. • ~ W ~ ~~ -~ _ __ PYc -p,p~,~ - - ~ - ^ ~. ~ ~ clay'- _.-_ ... ._ - - :96~~~ -- 1--t !oAou~T1D ~ t.:a ~ ~Z 1 gssu,M~o t co,o ~.~ q6.'?4 ' X 1 1 ~ i `~ .. . , ,. ,~ gm ~-~sPt~~ FtJ -~ .73`AB~~ ~w~ " - - to~.73~ Jun 24 03 06:35a Precision Excavating 715-684-3299 p.4 Jun 24 03 06:35a Precisian Excavating ~J 226`iP 277 STATE BA.R OF W ISCONSIN FORM 2 - 1999 WARRANTY DEED Document Number This Deed, made between E. W. Homes, Inc., a Wisconsin Corporation, Grantor, and Chad A. Eckman and Rebecca A. Eckman, husband and wife, ' Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate ir. St. Croix Counly, State of Wtscoristtr~(ttin3ce-space is needed, pir:ase attach addendum): Lot 12, Forest Ridge Estates, Town ~f Hammond St. Croix County, Wisconsin. , 715-684-3289 p.2 7'4562 KATHLEEN H. tiALSH REGISTER aF DEEDS ST. CROIX CQ. , ~!I REC EDP 06/05/2003 09:30A11 WARRANTY DEED i:xt~r ~ R&C FEE: 11.00 TRANS FEE: 172.30 DOPY FEE: CC FEE: PAGES: 1 Name and Return Address ~ fil-~t7 Yt a~g' 6u~+-~t kw ! i t t~Cs l-~' Partof0t8-1030-40.000 _ ?arcel ldentit~cationNumbcr (P1N) This is not homesteadprupmy. Exceptions to warranties: Easements, resttictions and rights-of--way of record, if any, Dated this ~~ 0~) (is not) day of May ZOQ3 E. W. Homes, I -- ~` • By, Mark B. S,~1 ~ • resident r AUTHENTICATION Signature(s) E W. Homes, Inc., a Wisconsin Corporation, by Mark B, Sylla, President, ¢ukf+.~riticated t '. day of May 2403 -. ~ .. 4;; .c a w.~.: ,~a'. r ~,~L~~ ~••';•5.,,~'ATE BAR OF WFSCONSIN ~~flltoi, ~'J."•~, ` Namcs of persons signing in any capacity must be Typed or printed below their signature. tnmrrn.Gon Pron.:w~a~ cowpony, Fong o~ ~x, w. 80(1ti:5.2021 WARRANTY DEED STATE BAR OF WISCt3NSIN FOAM No. 2 - 1999 authorized by § 706.06, Wis. 5tatt.j THIS INSTR(fMEN7 WAS DRAFTED SY Attorney Krishna Ogland ludsoa, WI 54016 ;Signatures may be authenticated or acknowledged. Both are not ncccssary.) ACKNOWLEDGMENT STATE OF W1SCdNS1N ) ss. ''ounty ) Personally came before me this _ day of 'the above named _~ .~~.,, to me known to be the person{s} who executed the foregoing inskpmcnt and aoknowiesdgad the same. Notary Public, State of Wisconsin My Commission is permanent. {If not, state expiration date. -j 14 Jun 24 03 06:35a Precision Excavating ^15-684-3299 p.3 N 119"ydC(1'~~f. t; •r.s~•..~ SEE Si1EE'~ ' i I 1 I I r 4 ~ I ' I ', I I - _._ N_a8}9'SL' .~ e9 os_ _ - I m I ! --____ ,---- --- ; I~ {' I I I- ~ { ~,~ I `'b~p?S~ SEE SHCEY T 1 I i . 1 I ,~ I LOT~2 IN z T.3 I to ~ '~ ° ~ ". N LUT 5 I roi "~ o ~ 708523 S.F, u Itl ~' Z R I~ ., a of m ~ ~ ,41 8 '; I I 2.49 Ac. I o C9 73 S. F. I .~ I o n m ~ I - Im m °o ,~ I 7.11 Ac. I i N ~' i I ~ SI o G'v ID i m ~ I _.._ - ~LR3~~S?" ~+$Q.:L - - .-._ I l i C Ir o °+• -+9~ _ N 89'34'00- E 777,8: - - - I t ~ )~ ( LDT 21 Iti ~ Nib n z - - - - - - ). tcssat s.i. I > ~I~ i. ~Nr .q~ `_~'\o~Y^'_ I ,~ I l ~ ~.Y~y IOP d v/,- I t _ /~M ~~// ,` R 182131 SF, I ~ ©~ / I - N ~9_38'ST E 48246' - - _. 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