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HomeMy WebLinkAbout018-1082-10-030 o: ~~ r% Wisconsin Department of commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)[. Permit Holder's Name: City Village X Township Halle Builders Inc. Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description: ~ ao .fl' c~.~ ~ '` ~A. . Cst' gvu~f TA\II! 1\ICA~r/^ATIA\I CI C\/ATIA\I 11ATA TYPE MANUFACTURER CAPACITY Septic W ~~ S ~2 1 ZSn ~ Dosing ~ ~ e. c Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. ~ Vent to Air Intake ROAD Septic ? f 1l Dosing L c tc l l ~~ r Aeration Holding PUMP/SIPHON INFORMATION i~ ) Manufacturer Demand GPM Model Number ~0~ t~~ ,L[.~Z TDH Li Friction Loss System Head TDH Ft ~- ~~ ~bS .Sa (S.'~2. Forcemain Length t Dia. N Dist. to Well z SOIL ABSORPTION SYSTEM V VV •f111V1\ Y/11A County: St. CroiX sanitary Permit No: 430460 0 State Plan ID No: q of ~ Parcel Tax No: 018-1082-10-030 Section/Town/Range/Map No: 30.29.17.566 STATION BS HI FS ELEV. Benchmark ~ ~•Zo~ ob• 6D .~ Alt. BM Bldg. Sewer 9.ro t 9 ~. {o SUHt Inlet 9~~Es' b.~f SUHt Outlet Dt Inlet Dt Bottom { ~ 2~ 2 ~ e LQ r T / Header/Man. ~ 2~ cso .q31 Dist. Pipe S.;~ .? S'. 3~ I ~.~ Bot. System S:R S9 ~ ao,261 Final Grade y W; l! lje ~- ct 12 fi .- - ne St Cover 3 ~ ~ / oZ•~ ED Width Length No. Of Tse-+ehes PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth ENSIGNS t / ~, f 1~ ~\ J SETBACK SYSTEM TO P1L BLDG WELL LAKE/STREAM LEAC IN Manufacturer. INFORMATION CRAM OR Type Of System: ,Y~v111 ~~ / ^, •. NIT Model Number. DISTRIBUTION SYSTEM .~, {1p ~, Y(L Header/Manifol ~ / f Di Distribution t f+ f ~~ h 3z i i x Hole Size f~ x Hole Spacing tf Vent to Air Intake a Length Lengt a Spac ng D SOIL COVER Y Praws1ur11 S'VSfRmA Anly YY Mnund Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx SeededlSodded xx Mulched Bedlfrench Center Bed/Trench Edges Topsoil Yes ~ No ~ Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: { z~ 1 Inspection #2: -"'7'-Tr Location: 709 159th Street Hammond, WI 54015 (SE 1/4 SE 1/4 30 T2 1R17W~t Meadow idge_1Lot 3 / Parcel No:~3p0,..29.1~7.5,66 1.) Alt BM Description = S.T INAp~~ C.OVQ~ , ~~J ~) W~ ~ ~'"~ ~ `V~~I~""" '" 2.) Bldg sewer length = ~ ~ f _-- -amount of cover = Z..~ cf ~ ~,e~ Plan revision Required? ®Yes No ~ • S.- ~ ~ ~ ~ / Use other side for additional information. So Date Inse 1's Signature Cert. No. / SBD-6710 (R.3/97) Safety and Buildings Division County ~ ~ 201 W. Washington Ave., P.O. Box 7162 ST. CROIX SCOOSIO Madison, WI 53707 - 7162 Sanitary Permit Nttmber (to be filled in by Co.) De artment of Commerce (~$) 266-3151 3 ~ p Sanitary Permit Application Stag Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide TRANS . ID# 926017 may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if different mailing address) " ~ ~9 ~5~~ ~' ~ I. Application Information -Please Print All Informati n _.y®,;;,;~ €~ i Property Owner's Na me Parcel q Lot y Block (1(~, °) M1)l~ ~ HALLE BUILDERS INC ~'~- ? r 018-1082=10-0300 3 Property Owner's M ailing Address ~., - { a Property Location 1113 HWY 64 `~ =...-... 1 -~ SE u,secdon 30 SE ~k City, State Zip Code Phone Number , NEW kICHIvIOND WI 54017 715/246-6813 (circle ' e) ~E ot~ j T 2~ N; R ~ ., e of BuildinE (check all that apply) 'T` II __ _ yp .~ 5 . Name CSM Number bdi i i S ®1 or 2 Family Dwelling -Number of Bedrooms 4 h~~ v u s on D • SO ^ Public/Commercial -Describe Use = 9G}' • 9(o r `~h r = MEADOW RIDGE _ i ~ ^ State Owned -Describe Use ~ X fo ~ ~ - ^City_^Village ®1'ownship of HANiMOND III. Type of Permit:.. (Check only one box on line A. Complete line B if applicable) A' X$ New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T of POWTS S stem: (Check all that a 1 ) ^ Non -Pressurized In-Ground ~(MOUnd > 24 in. of suitable soil ^ Mowui < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sard Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tartk ^ Pea[ Filler ^ Aerobic 1'rea[rnent Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Urip Line ^ Gravel-less P'p~ ^ 0 ter (explain) V. Dis ersal/Treatment Area Information: ~ - ba Design Flow (gpd) Design Soil Application Ratc(gpdsf) Dispersal Area Reyuircd (st) Drspenal Arca P •f) System Elevation 600 ~ 1.0 600 (00 3 100.46 VI. Tank Info Capacity in Total Number ivlanufacturer Site Steel Fiber plastic Gallons Galloru of Uniu Concrete Coruttvcted Glass New Existing Tanks Tard:s Septic or Holding Tank 1250 12 0 1 WIE E Aerobic Treatment Uni[ t)osing chamber 750 750 1 6JIESER CONCRETE X VII. Responsibility Statement- I, the tutdersigned, assume respotxsib' 'ty for uutallatlon of the POWTS shown on the attached places. Plumber's Na me (Print) Plum 's Si gnature MP/MPRS Number Business Phone Number BENNIE HELGESON 2 .292 715/772-3278 Plumber's Addre ss (Stmt, Ciry, State, Zip Code) W1229 770TH AVENUE, SPRING VALLEY, WI 54767 VIII. Count /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued I ui Agent Signatur No Stamps) ^ Owner Given Reason for Denial Surcharge Fee) ~~ ~^ © I ~ ~ IX. Conditions of Approval/Reasons t'or Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintaine~F as per management plan provided by plumber. 2. ~ Igetback requiremenb must be maintained as per applicable code/ordinances.. Attach complete plans (to We County ody) for the system ou paper not less th:ut 81/1 x 11 inches in size ~- - .~'~~ ___ ~~ r~ ' \ ~\ ~ 1 ~- ~_ ~ _ ,,J_rILL~ // l~r-~ - i / i ' % copy ,_ ~~i~~ ~ ~~ _. lsc~v~~:•~ -~. I _~ 7 l~ecX 1 ~ U v.1 i., i I y_ -. _.....__._.-....____ _...~I ti •'r'/c -„ U -, ~le~~. vy yw .- _ ---------- bleu, y % S v ~---__ P`~s'~- /v ~~ S<«~ I=~c r ~asv~ 7 ~~ ~~1, S e~ F-~ ~ ~ /~~s r I LlN 4 ~~ ~ C c~~ a 3:a)o -~- x Q3 -~ -- -_, ~~ Q •~. 100. $D t~~e 1 P,p'.~ ~~..~. 9y. 9~: ~r a ~ ~scons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 uwvw. commerce.state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary October 09, 2003 CUST ID No.220292 BENNIE W HELGESON HELGESON EXCAVATING W1229 770TH AVE SPRING VALLEY WI 54767 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/09/2005 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI -54016 SITE: Halle Builders Inc 159TH St Town of Hammond St Croix County SE1/4, SE1/4, 530, T29N, R17W Lot: 1'~, Subdivision: Meadow Ridge FOR: '~ Description: Four Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 923583 Identification Numbers Transaction ID No. 926017 Site ID No. 666007 Please refer to both'identification numbers,:;..: above;'. in all correspondence with the: agency. 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: General Approval Requirements: • 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 (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" R SBD-10573-P (R.6/99). DEFARTMI N OF • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. SEE COFi Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • 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. Stat • 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. BENNfE W HELGESON Page 2 10/9/03 Owner Responsibilities: Comm 83.52 Responsibilities. 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. • Comm 83.55 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction installation/operation. 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, C~~ ~,t~z Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commerce. state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WSMART code:.7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 PROPERTY OWNER: PROJECT NAME: INDEX SHEET HALLE BUILDERS, INC 1113 HWY 64 NEW RICHMOND, WI 54017 HALLE BUILDERS, INC RECEIVED S E P 2 2 ~t;~,~ SAFETY & BLDGS DIV. PROJECT LOCATION: SE 1/4, SE 1/4 , S 30, 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: W 1250/750-MR Tank Specifications Page 6: Pump Specifications Page 7: POWTS Owner's Manual & Management Plan - Pg. 1 Page S: POWTS Owner's Manual & Management Plan - Pg. 2 Name: Bennie Helgeson Address: W 1229 770th Avenue Spring Valley, WI 54767 Credential Number: 220292 zonally o~vED ~~MMERCE ~j'W E01 SPpNDENC Signed Date: September 19, 2003 e ch ~" ~°~ //<~/J ~ \ \\ h 1 ~~ ~L~ ~~t ,' / r/ ~. ___. __~_c~.-_. /--_ ~~ _~-------_ .,;~~ ~n~_; ~ C'~ l7 r ~.: e G ~~ ~~i J.. 1 GC+~ ~' Ci ~ _ ~ __-- ~ le~~. y/ Yw ----- ---~ ----. ~~ S e~ ~-~ c ~ /~os c rc.r. P ~~---~---__ -~`'`' ~~ C~ .,M. 100. $O 3.J7~ ~t~e~ P,p.~ ~' ri Q3 ---_ 13..x(, 9~/,. 9E: r~r ~f .~ ~~St~.~ f ~P~~ ~u~V12-~' ',_ ~ ~ cal I P ~ i.~ , 1 ~ s , •--..~.- ~..~c.- _ Medium Sand Topsoil Synthetic Covering I ~ "~ 3 ;C Page ~ Of -Distribution Pipe Fly v, /D..~ . ~ ~/ G F t.> Ols y~ . D _, F I b C. ~ leu, ' / % Slope y9 9~ Cc(I Of 2~- 2 z Force Main Aggregate From Pump Cross Section Of A Mound System Using A Bed For The Absorption Area Signed: License Number: Date: Force Main __._ L_ A (~ F t . B ~ Ft. K~~ Ft . L ~/• 7~, Ft. d ~ Ft. T /.~, Ft . W ~7~ Ft. Plowed Layer D ~.5 Ft . E v 8~ Ft. F ~ Ft. G , 5 Ft. H / Ft. ~ Observation Pipe ~- i3 _ ----- o ~ ~,9h A I~--- ---------------- ----------------------.~ o~ cet,l w r _-- -~------------------ ~I Distribution Gail Of 2 - 2 %2 Pipe Aggregate I Observation Pipe C'/~4„ ~;;~.fS . - /SOO a5a ~e~-~ Plan View Of Mound Using A C.~(~ For The Absorption Area n (.~e.~~; ~~l lam. ~~~ , I~ P ~ :~_:;~; //yc )ea~,o~.r /! G~t JCS ,~ .Ih r~,._,,i r.. ' C- IE~ctv~Ck-~~ If rip. Perforoled Plp• Onloll J U / / / End Vle~r Perloroled PVG Pipt 7 e ~e0.h Ow~ n Holes Located on Bottom are Equally Spaced Distribution Pipe Layout: P 3~ ~ ~'.'~ : . R 7 ~ ~~ ~~ 3 s 1 '' ~ ~3 ~ X 1 " Y ~ ~ - Hole Diameter ~ Inch Signed : ~~ Lateral ~_ Inch (es) License Number: ~ " s h I o Manifold e nc Dace: ' force Main " ~ Inches H~ ies Per ~0.~r r~l = i7 r o+~~ ti~,.r,~.b~ ~- ~f No1~e s ~ /G~ (~/1~~ ~all~ f.~u,i lc~•e.,r~, =u~• Page ~ Of $ SEPTIC TANK E PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4" .~IK.VENT PIPE 12" MIN. ABOVE GRADE 6 >_ 25' FROM DOOR, WINDOW OR FRESH AIR INTAKE FINISHED GRADE .. ~ ri~n. 18" IN. ~I,r~,U~ C1~SERw-Tionl PIPE NEATHERPROOF JUNCTION BOX WITH CONDUIT APPROVED MANHOLE COVER W/ PADLOCK E WARNING LABEL INLET ~- WATER TIGHT SEALS -•~- ~II.TER -- A ZA $ ~ I- __3__._ APPROVED ~~„x~~„ B PIPE 3 T ONTO SOLID /, C SOIL PUMP OFF ELEV . 97•S FT. -~' D 3" APPROVED BEDDING UNDER TANK SPECIFICATIONS 4" MIN. • ~~ ~$ MIN• ~IAPPROVEO JOINTS KITH A LM APPROVED PIPE ON 3' ONTO SOLID SOIL OFF 2y.. .T. A. `~ ~ ~~ l' GAS- ~ ,~, TIGHTS , SEAL r r* ~ ' CONCRETE PAD SEPTIC / DOSE Y (~/~S I _•_Z TANK MANUFACTURER : ~ ~ TANK SIZES: SEPTIC /~~ 5`~ ~ ~-~FLOWBACKG DO (0 AL y~• ~ % GAL. DOSE , . G L = ~S ~rv S~-~"'~APACITIES: A ~I INCHES = 03 GAL. ...L--- ALARM MANUFACTURER: MODEL NUMBER: e~ S J /O ~ ,~ g = 2 INCHES = ~..a GAL. SWITCH TYPE: ~ ~ INCHES = ~7~6AL. / C ~` • PUMP MANUFACTURER : MODEL NUMBER : W ~• / 0 ~~o~f- D = ~ " INCHES = ~S I GAL. SWITCH TYPE: .e~ Cu~~ ~PM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC REQUIRED DISCHARGE RATE ~ ~• Y~ FEET VERTICA L DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE• • ~ FEET + MIN MUM NETWORK SUPPLY PRESSURE FEET FORCEMAIN X ~~FT/100 F CAHEAD I ~~~ FEET •_ „/// FEET + ~ DYNAMI TOTAL P LS Q~ Y - INTERNAL DIMENSIONS • WIDTH OF PUMP TANK LIQUID T} -~ ~/7~~ ~ R __ T E M E I A D -~ ~ fy ~C r ~. ~ ISG.'~ ~P(~ ~1/l C ~1 V ~E'd.SE ~ P / ct n SIGNED: LICENSE NUMBER: DATe: 1/88 1 r a ~~ ~ ~ L~J ° ~ ° [~ ^ ~ o z r, ~ U u~ wQ Wilco a a O ~ W Z Z ~a J ®~ ~ Np ~ ^~ ~ YO a~ Wo ~+ o ~ ~ F(n v Om ~Q z ~ no CO \VW p wQ U \\ Q n~~~~ ~ NaN N ((~ °o w vira-w Qa z uG=~ ~NO r //~~ ~ ~ ~ J Q w ~p N = J Q 0 66. - ` OOO~~O~i 2N mNFw- tl1~ p ~^ ~ Z n N N ~ ~= N O~ O w J~ W~ V w Z N N~ ^ 3 ~ ~ Z ~ p~ F- OOW OOW U N Q N J~>Z~Z~-O~~ OmQ pNO Q p pQOOQww~wa'~i.I z~c~ z3`. N3mU~2J'S Q1J3 Q Q U ~ z z o ~ ~ ~ a a o z z J O „yFi II w_ 5~ J O ~ N L F s 3 u w= 5~ o N „aa r - (Uw-nP,r; N~11~. ~ lvlers mac. ~.-_ „ i Pttmp Specifications '/~ HP i Up to 40 GPM ~ Discharge size 1'/+" NPT Solids:'/~" maximum Motor Single phase: 115V Materials of Construction Brass/thermoplastic Features and Benefits ~ ., • Top suction eliminates impeller clogging. • Corrosion resistant construction. •Float actuated switch. \rr~e Mf EENS fFEF ' 25 .. ... _. _... ... _~ 1 ~ i MODEL DVP03 6 ~ ~ i ~ 1. i , w_ Is ,_ 1 .__. . ^C A ~ 4 > ~ Io I a 2 5 uI o i..... _.._i_. _ ... I o s to Is 20 2s ~o as .o u.s.crm ~, 0 2 e s e tom~A~r cAPACnr 0 MEIEII S FEFI .. Io ~ ' MOOEL' 3871 9 ' 30 _. .._. 1 I ; ~ a ._ _ .. __ ._ .___. ~ ~ 2s -- -_•-. _ ._ i.. , 1 ,• ..- 1--•-- • i -. _ ; . .. r 6 -- 20 -' . __ S , ..._ a Is ~ EPOS ~_ ~ ~ _ , . a ~ ,o - -- l .. , 2 .....i.._.___.~..._ __...~._j. ~ ~EP01. r , ~ 1 ; ' - ~ - ~ ._ ~_. ;__ .. ... ~_._ _ o i 0 -- ~ 0 --- - ;o ... _ _._.,;_--- , ~ Kiw 0 2 ~ 8 0 IO 12 uPM Pump Specifications '/+o and'/: HP Up to 60 GPM Maximum head to 32' Discharge size 1'/:"NPT Solids:'/~" maxirnunl Molor All motors feature ball bearing construction. Single phase: 115V Materials of Construction Cast iron Thermoplastic Stainless steel CAS IICI7~ ~~ 0 Z ~1n-. Features and Benetits • EP04 impeller- semi-open design with pump out vanes to protect mechanical seal. • EP05 impeller -enclosed design for improved performance. • Rugged glass-tilled thermoplastic casing and base design provides superior strength and corrosion resistance. • Cast iron motor housing for efficient heat transfer, strength, and durability. • Corrosion resistant threaded stainless steel shaft. •Available for automatic and manual operation. • CSA listed models available. All Models are designed for continuous operation and leature stainless steel hardware. ' POWYS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORMATION Owner HALLE BUILDERS INC Permit # DESIGN rArcr~m~+"`~ Number of Bedrooms 4 'DNA Number of Commercial Units g NA Estimated flow (average) 4 0 aVda Oeslgn flow (peak), (Estimated x 1.5) 600 aVda Soil gppiicatton Rate 0 aVda /ftz Influent/Effluent Quality Monthly average' Fats, Oii 8 Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BOOa) 420 mg/L Total Suspended Solids (TSS) 5150 m /L Pretreated Effluent Quality .• DNA Monthly average•* Biochemical Oxygen Demand (BODa) 530 mg/L Total Suspended Solids (fSS) 530 mg/L Fecal Coliform ( eometric mean) 510` cfu/100m1 Maximum Effluent Particle Size Y, Inch diameter Pa~ 7 M V SYSTEM 5rt~+rrwf-~ wn.~ Septic Tank Capacity ai : ~:~ ~ Septic Tank iHanutactNr$r. vr' WIESER CONCRE ~ Effluent Filter Manufacturer ZABEL ~ ` '~ > O. ~ Effluent Filter Mode! . A-100 12" x' Pump Tank Capacity 750 a `~ ~~_~'~ ~ Pump Tank Manufacturer WIESER CONCR~~ ~ ,Pump Manufacturer OULDS PUMPS ' ~' '~ Q ~ Pump Model 3871 EP05 ~ "~ Q ~ Pretreatment Unit _ , NA O Sand/Czravel FUter O Peat FUter O Mechanical Aeration O Wetland O Disinfection O Other: Manufacturer ~ Dispersal CeU(sj ' O In-ground (gravity) O In-ground (pressurized) ' O At-grade C~ Mound O Dri line t7 Other: • Values typkal for domestic (non~comrnerclaQ M~stlwstK and septic tank effluent ' •+ Values typical for pretreated wastewator. MAINTENANCE SCHEDULE Service Event Service Frequency ) - um 3 c~ i M Inspect condition of tank(s) Pump out contents of tank(s) Inspectdispersal cell(s) Clean effluent filter Inspect~pump, pump controls & alarm y . m ax At least once every 2 D months [~~rearis) ( • When combined sludge and scum equals one-third (l~ of tank volume ~'`' "'' At least once every 2 O months Ilyear(s) (Maximum a y1'sj At least once every 13 [~ months . O year(s) months O year(s) O NA At least once every 13 ~ DNA ressure test ls and h l t At least once every 3 O months year(s) p era a Flus O NA other. other. At least once every At least once every O months O year(s) ^ months O year(s) ^ NA MAINTENANCE INSTRUCTIONS . Inspections of tanks and dispersal cells shall be made by an individual carrying one of:the following Ucenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWYS Inspector; POWYS 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 file _ ~, ground surface may indicate a failing condition and requires the immediate notification of the. kcal 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 Cit. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWYS components, pretreatment component', and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWYS Maintainer. -:: . A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION. For new construction, prior to use of the POWYS check treatment tank(s) for the presence of painting products or othef '~ 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. 'OWNE)~: HALLE BUILDERS INC . ~, System start up shall not occur when soil conditions are frozen at the infiltrative surface. Papa,~.,_ of,$_ 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 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 oompac* 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 ptarformance and prolong the of the POVVTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; denial floss;'diapers; disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbk~des; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMIUIENT When the POWTS fails and/or is permanently taken out of service the following steps shaA be taken to Insure that the system is properly and safely abandoned in compliance with ch. Comm 83:33, Wisconsln~Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealtad.~ • The contents of all tanks and pits shale be removed and properly disposed of by a Septage SerYtcirlg 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 compactton.and should not be infringed upon by required setbacks from existing aid proposed structure, lot Imes and wells. FaUure 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. O A suitable replacement area Is not available due to setback and/or soil limitations. Barring advances (n POVyTS technology a holding tank may be Installed as a last resort to replace the felled POWTS. ^ The site has not been evaluated to Identify a suitable replacement area Upon faUure of the POWTS a soU and ,. site evaluation must be performed to locate a suitable replacement area. If no replacement Brea is available a holding tank may be installed as a last resort to replace the failed POWTS. ~ 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 AND10R 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 MAYBE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name HELGESON EXCAVATION INC Phone 715/772-3278 POWTS MAtNTA1NER < ~~ Name .Phone 715/273-5811 • SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORYAUTHORI'i'Y ' ' Name JOHNSON SANITATION Agency ST. CROIX COUNT ~ •~ ,•, ~. Phone 715/273-5811 Phone 715/386-4680 This document was draRed by the staffs of the Green lake, INarquatte and Waushara County Z:onlnp snd SanBatlon a~ondgs. This d0alRtartt rrtsets the minimum requirements of ch. Comm 83.22(2)(b)(1)(d)8(f) and 83.54(1), (2) & (3), Wisconsin Adrnlnistratlv0 Codo. Uss Ot this doCUm6r-td00s ROt guarantee the performance of the POWTS. ~yY ~"" , . Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT p'~/0 Page ~ of ~ ni awvraance wiui wmm ao, vns. /Wm. was Coanty ~~ ~ 1 ~ Attach complete site plan on paper not less than 81/2 x 11 inches in size Plan must , ~ . . include, but not limited to: vertical and horizontal reference point (BM), direction and t l l i di p~ I,p, d ~ ~' o$ ^ ~ ~ ~ 3oa l percen s ope, sca e or mens ons, north arrow, and location and distance to nearest road. O p Please print all information. evi ed by Date ~ ~ 0/ Personal information you provide maybe used or se r .15.04 (1) (m)). 20 j Prope O/wner I ~ A `/l° ~UI / p l°fs ,, , ;,-, roperty Location vt. t_ot ~jE 1/4~~ „4 S 3o T a9 N R ~ 7 E (o~ Property Owner's Mailing Address ~ ~' Lot # Bbck # .Name or CSM# City - fate Zip Code Phgyr~.uN,~rn~ ,6~r,,- - ~l r ~ i ~. F- ^ Ci Villa a Town Nearest Road ty ^ g New Construction Use: ~ Residential 7 Number of bedrooms 3 Code derived design flow rate 5 GPD ^ Replacement ^ Public or commeraal -Describe: Parent material t'.7~ W ~• ~ ~n C7uL ~" ~ r ~ ~ Flood Plain elevation ff applipble ft. General comments = S V `Jsc- 5 -d- G`- (n r X 75 r S ~i. ~ ~ t)..v ``tM Dv ~" ~. 4 and recommendations: J G~ 4-~ 10a. Y~j ~ I'I Boring # ^ Boring ® pit Ground surface elev. ~~ ~ S ~ ft. Depth to limiting factor ~ in. Sal ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. $z. Sh. 'Eff#1 'Etf#2 l D_q 10 R 3a SL a~~ tn-~~ a aF .S .9 a 9-a ~,sy y SL a sQ rnF cV`1 F .S .9 3 a~-ya 7 5 YR `'! " spy ar sg 1 C lv F S q . n ~ . . ya- s y yl F ~, s y~ e ~ s~~ ~s m - ; - . a .3 r - Pa c -e a-~ Sy ~ 5 ~3 FS Boring # ^ Boring pit Ground surface elev. ~ ~, 9 t~ ft. Depth to limiting factor 3 Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/IP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-~ IoyR3l SL am F a aF .5 ,q a lye ~.s yl s~ aFSQ -m c~ .s ,q 3 a~-33 ~,syR ~1 - "~~`~ aw~st3K w~ ~J v F .s .9 33 ~o ~ sy~yl ~,s y2 6 g s~~ w~sa ,MF; --~ - .a ,3 3'~ - Po <lce ~'s o'F 5 s 3 ~'S ' Eftiuent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 ntglL and TSS < 30 mglL T Name (Please Print) Signature CST Number o~ s a~ ~ aa~~ y Address Date Evaluation Conducted Telephone Number alb aUo~' s~. 5~ar P~;~s~, wl syoab ~-I -03 ~i5-ayg-35g~ ' c .,,,~ Properly Owner ~ ~~-- iJV • ~~ ~ Cam'' Parcel ID # Page ~ of 3 Boring # ^ Boring Q(~ A ~ pit Ground surface elev. 1 y,DS ft. .Depth to limiting factor 3 ~ i Soil 'cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/tF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I o-8 IoyR 3/a S,~ FR QS aF .S .$ of 8-i 10yK`+I icy. aw~sr3K mF C 1 •`I 3 Iq-33 7,5`IRS~ ScL. a~1S~3 MFR CW iv y 33-3~ ~,5`1R5~ FS aF56K Yr1v~' C~J ,S .9 s 3,- syR~ F~ ~,s yR ~ s~~ ~S~ ~~; - .a ,3 ^ Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Sal ication Rate Horizon Depth Dominant Color Redox Descriptan Texture Structure Consistence Boundary Roots GP D/fl= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#'I 'E1I#2 ^ Boring Boring # Ground surNace elev. ft. Depth to limiting factor in. ^ Pit Soil 'cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DftI~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 =GODS > 30 _< 220 mgJL and TSS >30 < 150 mg/L • Effluent #2 =GODS < 30 mglL and TSS _< 30 mglL 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 608-2648777. SF'1y~ SE'ly~ Sc.c.. 30, -t agn~, R. t~7w ~i ~ N SGa~G. ~ ~- ~/C7 x,00 a.~re. \ \ ~~ S l~n.G. ~~nn+~ ~', 5-~~.rd~.. es-~+~ a~-r7yc~ ~~3~ 39' ~~M ` '~vPS t~at~ ~$~a S-tcc.l ~~~g ~ bQ,~..k. -~~ ~. ,~ - -~ s e.1 ~.~~-~; onJ (~ RbQ ~5~ ,~. Q 3 qg .gs n 00 ~6 f/ 3 ~ ~ ~. o ~~ ~ 4~~ f ~Q~ ~i l v+, ~i IcQ,.~Q' ~ +~ -~ ~ O ~ ~, ^~ 3 ,~~ ~ "' v, --._._ , ~s -_._, _.,~~.. ..._~_._._ ' ~~O ~ ~5oui'~ I o+ 1 ~ hc~ ~~ 1 loD,n~ ~ ~~-~. +tior:z, ~ ~ ~ 9g,$g ~ rcfe.r~+c.~ ~~s ~ /00,5 ~ ~ ~, 99.g~ v ~~, f 99i 16!'~t~~3 1 ~1: 7.3 725i4v f =', i Mr:;i..L~ LIILi}~.~'S =~!(- PAGE ~.1'' Q~wuerBayer ST CR~IX Ct?T.T1~'~'Y SBP'tT~ TANK MAiIw'T`ENANCS ~.GR.~'~I~fitT A.N]] o~~~$~ ~~ C~T~r~-Ti©z~ ~a~ ~> ~~ III ~>~.~; ~ ~~u ~!~~-~ n, ~~ ~ T~ s-~,~. ~ ~ ~p ~~ _ `~ ~ `i.. is~ Wit- ~-_--.____.--_ ,/ .._ (Veii~ca~.on xeru~ from Pianpir~,Dcpartuc;~t for n,easr ccnstrsFCtion) CityiState ~-~a. w7url~r.~~ ~ ( ^_ Parcel Idantifi .anon !I~tyttt.~ ~ ~~~ , 1~ 'a . ~~~) LECA~._A~SC~XP'x'xON ~rapcrty Locaaiion _~ ~ ~ ~/.~, S c '/, Seg. ~ o T ~ ~ ~I-R t ~~ --R'r T~+~tn of '~. 4~'.•,~•, ~---~. Subdivision ~~-v~J _~ ` ~r~ ~,..e __ ~.~ I.at # Cetfifiecl Survey Map #~ ~ --_--~. '~ta~ua:.e -Wage F~'arratxiy Deed ~ H y 3 `~ 3 ~. .Volume ~_~~ Yage #~ ,~ I I , Spec $au~~ !~ yes ~-no Lot lance ident~iaol~ ~ yc,~ u na S'YSTF MAYN'C`ENA'V'G?~. Improper use and rntiwt.c~ ~° your sepl~c system co uid rrsutt in i>s preszaature fgilure tc ,cwc~,e wastes. Draper maixite~a~.;e eausis~ a£ parnpiug oat the septic >~.c1c cvcrf :3rec years ar sooner, of z~edcd tap x ttr,,ensed pumper. ~i you Intt inka the sY~~m can affect the fisnctiou of the reeptic funk as a trr.atzucat rtage is the Rrasbe disposal sysktts3. "Clue property owner mgracs to wit m St. t~obt Zoning Depsz~cnt a ccciifiratian ford, si~acd by the ov~rnei ~.d by a rPl~~'.]e~ piesmTocr. rrstieeadplumber or a Ciceratdpasrtnt~[ verifyieg t#ttt (X) the nn-site wu,~waterdlsposal is a~ ~+mpes' apecatiag Ctr~xdi~tion andfor. (2) aBEa' iitsl+CCtion and ~tu~apR.~g (if aef-~,ssaxy'), itte septic tactic is less than lt3 foil of slad~rc. 1/are, t6c ~dersigned havo road the Alao+ra raYau~esseea~ asd agree to ao:s3atain the pravate sewage d-ixasal aystein wi.#- the 4',acl3ards set forth. herriti, as set try the Ciepartmeat of ~ommerae and. ffie Eatpaztmaut of datuxax Resourocs, State of Wisevssain. G-xtificatiaa sfitit~ that Y~ 4 system has bees asaiataincci m+sst bc~ ceatpic±ad and acl to ~.he 5t. CY+oix (:aunty Zoning Qt'fice wit;zia 30 days of flee tbmc x ' Lion date. F APFLICAIdT DA1~ 0 ~ (rte) oettify ti'.at air stateRaeate oa this facet are true to the best of m3" (o~sr) fai~w?e?gt. i (wr.) am (are) the ox~~{s? cs£ des a ~, by virtue of a warrsut}, deed recorded in Register of T1c~:ds Off'icc. A"C'tFltB APPLICADTI' DAT13 •«.«4« ,~,y iufotvSation that is mis~represesaiccln~y rra~:it iu the s~tutxry perm;( Being, rcva'<ai by the Zoning pep~uuent. «+~«~.• ~°' Iaelude with this sppiicatiaa~ s stamped waxtattN deed Isom tfie Regitea of Deeds ofhrc a ~y of the cetlifitd sruvcy reap if referoax is assd~ ir- trt vr'aaan*v decd . 0~%19%lEsJ3 ,_: 5E ~:~_u67=_- i.iLE l:ui~~c:+.. _~+'_ r'~3E H- • . • ~~. iii UE 8•L`ti 78C 1:12 'AI 'Z3 s:E ~dc' REGYSTEk GF ]EEU3 OQCUMSH': NO. 1 r.wra .,~ww .va y~..y,,,:~ rr. ~'P.l1?.9M4~ '~.E° D ~' IIirASC sas at wi~ooxR~trr ruse[ t-tst` .. r ~ .as. M _ ~. rte< a~~.°°~~! TEN'S Grr~wc ~v4bJ O.i1.w. ~iTR.d.AR.' .41+~9Q77~1IS. $,...3~'~...~PAC QRa1.. _......_... ~ ) O~iVl.4 ML ~LZf~M! tI ..~. 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Fl" ~` .~ ti `, .i ~' =AGE k~3 m ItiiB9°~ ti ~ ~. ~. ~$7° 39'47 u1M 293. s~9' ti ~~~~D ~,, ~ t i ~ ~~ ° t ~ ..>,:. , 33` 33` - f'~ t~ 2.OQ ,4~RE~ ~ co 0'1 y ~` 8? cl23 ~Ql. ~, ~ m ~ r ~ tv ~ :. ~ 1 ~~ W t~ .4~D. .~ coo 5 ~~~ a~ ~ ~ ~,~~ ~t~' I r~ _i I r S89°!7 `24"E .• 338. ~i9" ~-r`"~ ~~ w ~' ~ ~, a~ ~ rv I~ ~_ r a S89° 58' 1 C!~ 0 .i- Jessie Subject: Helgeson/ Halle/ 430460 Plowing Location: Hammond Start: Tue 11/25/2003 10:00 AM End: Tue 11 /25/2003 11:00 AM Recurrence: (none) Meadow Ridge Lot 3 018-1082-10-030 30.29.17.566 Final at 1:00