HomeMy WebLinkAbout184-1000-40-000 Wisconsin Deparlit of CcVmerce PRIVATE SEWAGE SYSTEM County St. Croix
Safety and Building Division
INSPECTION REPORT Sanitar Permit No
404914 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No
Personal Info6 iation you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City X Village Township Parcel Tax No
Last, Doug Village of Spring Valle 184 - 1000 -40 -000
CST BM Elev: ` Insp. BM Ele BM De ri�r, ption: A /
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer
S•5 z- 9
Holding St/Ht Inlet
�.0� 9a S
TANK SETBACK INFORMATION St/HtOutlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic / Dt Bottom
2i/
Dosing � � Header /Man.
d
Aeration Dist. Pie o,
Holding Bot. System rnih
, ;,. -7 6' 1 3,
Final Grad q
PUMP /SIPHON INFORMATION / n/- S Jiw 6-f'
Manufacturer Demand over
GPM •C�1 7 ' T /
Model Number 2 C _ l � G 7 r1
l.6t,', I 0 L-
TDH Lift Friction Lo s System Head TDH Ft
Forcemain Len Dia /, Dist. to Well ?
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length No. OfTrgpGhes� PIT DI�111 6NSIONS No. Of Pits Inside Dia. Liquid Depth LID DIMENSIONS 7 �o�lC�� `���
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LNCHIK Manufacturer:
INFORMATION CHA OR
Type Of System: � � L /�� � Model Number: r
DISTRIBUTION SYSTEM I d C
Header /Manifold Distribution x Hole Size x Hole Sp Intak
acing Ve to Air ,
z I/ Pipe(s) / 4 2/ ` z 67
Length J Dia 2 Length Dia 1 /7 Spacing �J
SOIL COVER x Pressure Systems Only xx Mound O r At -Grade Systems Only �" S
Depth Over �— ^ ,e J Depth Over xx Depth of T eeded /Sodded j xx Mulched
Bed/Trench Center rJ l/ Bed/Trench Edges Topsoil Yes No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:� 17/ G Z Inspection #2:
Location: Spring Valley, WI 54767 (S 1/2 SE 1/4 30 T28N R1 5W) NA Lot & "Ss to ad dyy, lLI f I O Parcel No: 30.28.15.4
1.) Alt BM Description —
2.) Bldg sewer length = 0 21 0 �� ,
- amount of cover = qt /
3.) Contour
Plan revision Required? Yes /No b _ /J / 7 S �D5 (L
Use other side for additional information. J
Date Insepctor's Signature Cert. No
SBD -6710 (R.3/97)
,- Nlon � R d
Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162
Nvisconsin 0�/ o Z iss ess
Madison, WI 53707 - 7162 Si ddr
l O ue- ��`t•�`q`
Department of Commerce o 9(o Sanitary Permit Nupbe
Sanitary Permit Applicatio A fo
In accord with Comm 83.21, Wis. Adm. Code, personal info o ❑ Check if Revision
way be used for second ses Privacy Law, State plan I.D. Number SITE ID # 64106
I. Application Information - Please Print All Information ko> TRANS ID # 707958
t Parcel Number
Property Owner's Name
DOUG LAST • n"
Property Owner's Mailing Address �T - Property Location
411 LAKE STREET NORTH.. ..± SE u SE s 30 T 28 N R 15W/li
Zip Code Phone Number Lot Number BlockN ymber
City, State �A
Subdivision Na CSM Nt r
PRESCOTT WI 54021 715/262 -3f�3 N/ .«
II. Type of Building (check all that apply) ov ❑City V
1 or 2 Family Dwelling - Number of Bedrooms 2 — 4NS.
❑ Public /Comme D scribe Use _' ownship
❑ State Owned k a N N NN
5 O D z LIZ COUNTY RD
III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Comp cable)
For County use
A
1 Q New 2 ❑Repl 6 ❑Addition to
acement System
Tank Onl
3 ❑Replacement of
S stem Existin S stem
B. [I Check if Sanitary Permit Previously Issued
Permit Number Date Issued
]V. Type of Permit: (Check all that apply) (numbering scheme is for internal usQWt&XDAX i r — lam
44 ❑ Non - Pressurized In- Ground 21& Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland
22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line
45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 4911 30 ❑Other
V. Dis ersaMeatment Area Information:
Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Gratin
Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min./Inch) Elevation
300 300 300 1 N/A 93.75 95.54
VI. Tank Info Capacity in Total Number Manufacturer C oncret e Si Steel Fiber
Glass
b Platic
Gallons Gallons of Tanks
New Existing
Tanks Tanks
Septic or Holding Tank 000 1000 1 WIESER CONC
Dosing Chamber 600 600 1 1 WIESER CONC X
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on We attached plans.
Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number
BENNIE HELGESON 2 02
Plumber's Address (Street, City, State, Zip ode)
W1229 770TH AVENUE, SPRING VALLEY WI 54767
VIII. Coln /De artment Use Onl
Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps)
Approved ❑ Disapproved Surcharge Fee)
❑ Owner Given Initial Adverse . 325- Zp
Determination J
1X. Conditions of ApprovaURe o for i u p ova V .w 146` 6A" • tor` 4e I3SIKJ
Q vrctQ v+�►; ' 1
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mp ere h
,:: SBD -6398 (R. 05101) -
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St�Otic/ Dosc - ra pt r1,
SCCL
I
Safety and Buildings
' 4003 N KINNEY COULEE RD
LA CROSSE WI 54601 -1831
TDD #: (608) 264 -8777
iscons�n www.commerce.state.wi.us /sb
www.wisconsin.gov
Department of Commerce
Scott McCallum, Governor
Philip Edw. Albert, Secretary
February 13, 2002
CUST ID No.220292 ATTN: PO WTS Inspector
BENNIE W HELGESON ZONING OFFICE
HELGESON EXCAVATING ST CROIX COUNTY SPIA
W1229 770TH AVE 1101 CARMICHAEL RD
SPRING VALLEY WI 54767 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 02/13/2004 Identific ion ers
Transaction ID No. 07958
SITE: Site ID No. 641061
Doug Last
Please refer to both identi ers,
County Rd Nn above, in all cones o c �Vi ei
ty �
Village of Spring Valley c
St Croix County RECE1 \
SETA, SE1 /4, S30, T28N, R15W VEQ
FOR:
Description: Two Bedroom Mound System oZ
Object Type: POWT System Regulated Object ID No.: 829069 . c "
Zs trative:T%es , �Th e su bmittal described above has been reviewed for conformance with applicable Wisconsin !, j
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner; eioo ,
i,
4
L ,
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:
• This system is to be constructed and located in accordance with the enclosed approved plans and with the
"Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /01)
and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION
2.0" SBD - 10706 -P (N.01 101).
• 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. In addition, the
owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the
Mound manual, and section VI of the pressure distribution component manual are complied with. A copy of
this letter including instructions and information relating to proper use and maintenance of the system
must be given to the owner and each subsequent owner upon completion of the project.
• 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
• Per manual sited above, 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.
• Comm 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the
initial installation of the POWTS in accordance with an approved management plan shall be conducted by a
person who holds a registration issued by the department as a registered POWTS maintainer.
BENNIE W HELGESON Page 2 2/13/02
• 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). In addition, 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.
• 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.
• 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
• The changes made to this plan on 2/13/02 by this reviewer were acknowledged and approved by the system
designer.
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. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/instal lation /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, Fee Required $ 175.00
Fee Received $ 175.00
G Balance Due $ 0.00
Charles L Bratz
POWTS Reviewer II , Integrated Services WiSMART code: 7633
(608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday
cbratz @commerce.state.wi.us
Safety and Buildings
4003 N KINNEY COULEE RD
LA CROSSE WI 54601 -1831
* TDD #: (608) 264 -8777
isconsin www.wisconsin.gov
.wis c ons
.wisonsin.gov
Department of Commerce
Scott McCallum, Governor
Philip Edw. Albert, Secretary
February 13, 2002
CUST ID No.220292 A7TN. POWTS Inspector
BENNIE W HELGESON ZONING OFFICE
HELGESON EXCAVATING ST CROIX COUNTY SPIA
W1229 770TH AVE 1101 CARMICHAEL RD
SPRING VALLEY WI 54767 HUDSON WI 54016
CONDITIONAL APPROVAL
Identification Numbers
PLAN APPROVAL EXPIRES: 02/13/2004
Transaction ID No. 707958
SITE• Site ID No. 641061
Doug Last Please refer to both identification numbers,
County Rd Nn L above, in all correspondence with the agency,
Village of Spring Valley
St Croix County
SETA, SETA, S30, T28N, R15W
FOR:
Description: Two Bedroom Mound System
Object Type: POWT System Regulated Object ID No.: 829069
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:
• This system is to be constructed and located in accordance with the enclosed approved plans and with the
"Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /O1)
and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION
2.0" SBD - 10706 -P (N.01 101).
• 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. In addition, the
owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the
Mound manual, and section VI of the pressure distribution component manual are complied with. A copy of
this letter including instructions and information relating to proper use and maintenance of the system
must be given to the owner and each subsequent owner upon completion of the project.
• 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
• Per manual sited above, limited activities are allowed in the area 15 feet down slope of the component area. Conlum
APPRI Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal
are prohibited. DEPAOMENT 0
• Comm 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the ` Nom/ •E
initial installation of the POWTS in accordance with an approved management plan shall be conducted by a SEE CORM person who holds a registration issued by the department as a
registered POWTS maintainer.
I
BENNIE W HELGESON Page 2 2/13/02
• 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). In addition, 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.
• 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.
• 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
• The changes made to this plan on 2/13/02 by this reviewer were acknowledged and approved by the system
designer.
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. 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, Fee Required $ 175.00
Fee Received $ 175.00
A � Balance Due $ 0.00
Charles L Bratz ✓✓✓
POWTS Reviewer II , Integrated Services WiSMART code: 7633
(608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday
cbratz@commerce.state.wi.us
INDEX SHEET
PROPERTY OWNER: DOUG LAST
411 LAKE STREET NORTH
PRESCOTT, WI 54021
PROJECT NAME: DOUG LAST
PROJECT LOCATION: SE 1/4, SE 1/4, S 30 T28 N, R, 15 W > G
qP 1 �p
MUNICIPALITY: VILLAGE OF SPRING VALLEY �Q pp�
COUNTY: PIERCE ��
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: Wieser Concrete W1000/600-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 Signed
Address: W1229 770Th Avenue NED
Spring Valley, WI 54767 " COMMA
Credential number: 220292 Date: February 7, 2002 T� P 6
3PONDEN E
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Page 04
Synthetic Covering
Distribution Pipe
,A.sTM C: 3 3 E lk f s
Medium Sand w
H G
—� a !3.75
Topsoil ------ = -�-=- F —
E
b E,cLk
J f % Slope 9 >
Force Main Plowed
i t:Ua0f i -2 'z
Aggregate
From Pump Layer
D I Ft.
E Lss_ Ft.
Cross Section Of A Mound F o-7 Ft.
G , j Ft.
A Ft. H _�_ Ft.
Signed: t '
License Number:
K Ft. '
b{_ Ft.
Date: J ,j`; D Ft.
T Ft.
W Ft.
L
--T Observation Pipe
f ---------------------------------- - - - - -a - --
A
7 ---------------- - — — -- --
Distribution ALL O 2 —2
Pipe Aggregate
i & sJ Ar« _ S 8 8
Observation Pipe
Plan View Of Mound
3 6�4
Pof�UCUlnn
Pip. Onloll
5; C-;
c . le av cJ
End Vleu
Perlorolau � •
PVC Pipe
\� Holes Located on Bottom
are Equally Spac
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OItlrlbullon..
PIP*
Discribucion Pi e�Yout
R
S
X - 2 - L'
Y
1
Hole Diameter — 0 Inch
Signed: ••
Lateral Inch (es)
License Number:
Manifold Inches
Dace: '
Force Main ” a Inches
Ho le S PL �a4e L I = S-
YotcrL ( N tee = sv
Page Of
r• SE IC TANK E PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS WEATHERPROOF
4" CI VENT PIPE 12" MIN. ABOVE GRADE E JUNCTION BOX APPROVED
>_ 25' FROM DOOR, WINDOW OR WITH CONDUIT MANHOLE COVER
FRESH AIR INTAKE W/ PADLOCK b
WARNING LABEL
FINISHED GRADE .
+
T t � 4 " MIN .
Tien yrf
2
y' Q81SERvnT'onl s. D. u
18T11I N. PIPE
e
, e
INLET
WATER TIGHT SEALS GAS- e
TIGHT i VAPPROVED
SEAL t JOINTS WITH
{
_ � t
✓FILTER A PIPE
_,_ ALM APPROVED
APPROVED �¢ /o° Z� $�� B ' ON 3' ONTO
PIPE 3' � .,xtt �— t SOLID SOIL
ONTO SOLID C '
SOIL PUMP OFF ELEV. $q.y FT. OFF
D
3" APPROVED BEDDING UNDER TANK
CONCRETE PAD
SPECIFICATIONS
i der tTC� T 1
SEPTIC / DOSE � S 37.5
TANK MANUFACTURER : (�J��Sers
TANK SIZES: SEPTIC /QDD __ GAL. DOSE VOLUME INCLUDING
DOSE _ /p0 GAL. 9. 78 6,. /. z, FLOWBACK: 7,a8 GAL. /n.iK,
ALARM MANUFACTURER: CAPACITIES: A = I•? INCHES = O/- GAL.
MODEL NUMBER: / B = 2 INCHES = 33•S� GAL.
SWITCH TYPE: �
PUMP MANUFACTURER: C = �o INCHES = /Ol7.sb GAL.
MODEL NUMBER: f ,?Q7/ F�OU D = ! to INCHES = allL GAL.
SWITCH TYPE: ,[ -,_•VI .. r 7 )=1
REQUIRED DISCHARGE RATE GPM PUMP & ALARM WIRING AS PER ILHR 16.23 WAC
S-
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE FEET
. FEET
FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . • • • • • • ' ' ' FEET
+ _,60_ FEET FORCEMAIN X 39 FT /100 FT.
TOTALIDYNAMICAHEAD FEET
• WIDTH DIAMETER
INTERNAL DIMENSIONS OF PUMP TANK LIQUID � •�_
74 G� / /r,v P/«se
SIGNED:
LICENSE NUMBER: DATE:
1/88
56"
39" 0 84"
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MODEL: 3871
Submersible SIZE: 3/4" SOLID,
RPM: 1550
Effluent Pum p HP: 0.4
METERS FEET - - -- -
8 25
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CAPACITY
MGOULDS PMY!,PS; N e
Effoctive OctOtMf, 1986
_ .__� .. .... u..e urrruM R ►J�ITICF PRINTED IN U.S.A.
. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 7 of 9
FILE INFORMATION SYSTEM SPECIFICATIONS
Septic Tank Capacity 1000 al ❑ NA
Owner DOUG LAST
Permit # Septic Tank Manufacturer WIESER CONCRETED NA
DESIGN PARAMETERS Effluent Filter Manufacturer ZABEL 0 NA
Number of Bedrooms 2 • ❑ NA Effluent Filter Model A -100 2" x 16" ❑ NA
Number of Commercial Units 13 NA Pump Tank Capacity 600 gal ❑ NA
Estimated now (average) 300 gal/day Pump Tank Manufacturer WIESER CONCRETE❑ NA
Design now (peak), (Estimated x 1.5) 300 gal/day . Pump Manufacturer GOULDS PUMP INC❑ NA
Soil Application Rate 5 gal/day/fl? Pump Model ❑ NA
Influent/Effluent Quality Monthly average' Pretreatment Unit M NA
Fats, Oil &Grease (FOG) 530 mg/ L
❑ Sand/Czravel Filter ❑ Peat Filter
Mechanical Aeration ❑Wetland
❑
Biochemical Oxygen Demand (BOD 5220 mg /L ❑ Disinfection ❑ Other'
Total Suspended Solids (TSS) 5150 m /L Manufacturer
Pretreated Effluent Quality 1 1 ❑ NA Monthly average" Dispersal Cell(s)
Biochemical Oxyg en Demand ( BOD 530 mg /L ❑ In- ground (gravity) ❑ In -ground (pressurized)
s) e
Total Suspended Solids (TSS) 530 mg /L At -grad IM Mound Other:
Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip-line ❑
Maximum Effluent Particle Size Y Inch diameter s lue ty p i cal for (non- commerclaQ wastewater and
Values typical for pretreated wastewater.
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every 2 ❑ months M year(s) (Maximum 3 yrs.)
Pump out contents of tank(s) When combined sludge and scum equals one -third (Yj of tank volume
Inspect dispersal cell(s) At least once every 2 ❑ months ER year(s) (Maximum 3 yrs.)
Clean effluent filter At least once every 1 ❑ months . ER year(s)
Inspect pump controls & alarm At least once every 1 ❑ months Ilyear(s) ❑ NA
❑ months earls) [3 NA
least once eve Y
At le every �
laterals and
p ressure test 3
Flush p
Other. At least once every ❑ months ❑ year(s) ❑ NA
Other. At least once every ❑ months ❑ 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 Maintalner, Septag e
Servicing Operator. Tank Inspections must Include a visual Inspection of the tank(s) to Identify any missing or broken
hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up
or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels
in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the
ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority.
equals one-third Y
and scum
in an tank a (a) or more of the tank volume, the
When the combined accumulation of sludge Y 4
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, pretreattment 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
START UP AND OPERATION.
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other
chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are
detected have the contents of the tank(s) removed by a septage servicing operator prior to use.
OWNER: DOUG LAST
, Page 8 of 8
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power- outages pump tanks may fill above normal highwater levels. When power Is restored the excess
wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the
backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a
Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintalner 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.
ABANDONWENT
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 properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space
filled with soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code
compliant replacement system:
• A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil
absorption system. The replacement area should be protected from disturbance and compactiork and should not
be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to
protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable
replacement area. Replacement systems must comply with the rules in effect at that time.
• A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
• The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and
site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a
holding tank may be installed as a last resort to replace the failed POWTS.
IM 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
1
POWTS INSTALLER POWTS MAINTAINER
Name HELGESON EXCAVATION INC Name JOHNSON SANITATION
Phone 715/772 -3278 Phone 715/273 -5811
SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY '
Name JOHNSON SANITATION Agency ST CROIX COUNTY ZONING
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,
the minimum requirements of ch. Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not
guarantee the performance of the POWTS. GMW (2101)
. Wisconsin DepartmentofCommeroe SOIL AND SITE EVALUATION Page 1 of 3
Division of Safety and Buildings in accord with Comm 83.05, W is. Adm. Code
ACE. Soil & Site Evaluations
Attach'complete site plan on paper not less than 8'h x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal referer►ce poi direction and St. Croix
percent slope, scale or dimernsions, north arrow, and 1� J disiaFt to nearest road.
Parcel I.D.#
APPLICANT INFORMATION - Pleas �U informal` in. 004- 1073 - 10-000
Personal information you pro�de may be used for purpose%IP t Law, s. 15,04,(I) (m)). Revi Y Date
Property Owner r .,.` - ;:' , P' Location
Douglas A. &Kathleen F . Last Govt. L_ SE 1/4 SE 1/4 S 30 T 28 N,R 15 W
Property Owner's Mailing Address S f� Lot* ? Block # Subd. Name or CSM#
411 Lake Street North C� CHp�
City State zip Ph on E] Village NTown rest Ro d N ►�
Prescott WI 5402 `' ,L 262 -36 1, Cady C `, ,
Z New Construction Use. Z Residentia r f s 2 ❑Addition to existing building
❑ Replacement [_] Public or commercial describe
Code Derived daily flow 300 gpd Recommended design loading rate .5 bed, gpd/ft .6 trench, gpdff
Basal area required 600 bed, tl! 500 trench, ft- Maximum design loading rate .5 bed, gpd/W .6 trench, gpd/fl
Recommended infiltration surface elevation(s) 93.75' at 12" above 92.75' contour. ft (as referred to site plan benchmark)
Additional design / site consideration
Parent material Glacial drift over weathered limestone bedrock. Flood plain elevation, if appli Cable NA ft
S- - Suitable for system Conventional Mound In Ground Pressure AT - Grade System in Fill Holding Tank
U= Unsuitable for system ❑ S M U ® S❑ u ❑ S® U ❑ S M U ❑ S ®u ❑ S® U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPDV
Boring# Horizon in Munsell Qu. Sz. Cont. Color Texture Gr. Sz Sh Consistence Boundary Roots Bed Trench
1 1 0 -6 10YR3/2 None sl 2fcr mvfr cs 2fm 0.5 0.6
2 6 -13 10YR5 /3 None sil 2f &msbk mvfr gw 2fm,lc 0.5 0.6
Ground 3 13 -21 7.5YR4/6 None sl 2msbk dsh cw - 0.5 0.6
elev
91.131 4 21 -27 7.5YR4/6 None Is Osg dl cw - 0.7 0.8
Depth to 5 27 -31 7.5YR4/6 f2f 7.5YR5/6 Is Osg dl aw - 0.7 0.8
limiting
factor 6 31 -37 5YR4/4 f2f 5YR5/6 sc Om mfi aw - NP i NP
27" 7 37 -49 10YR7 /4 m2d 7.5YR5/6 L.S.B.R. - - - - NP NP
Remarks: Horizon #7 consists of 2" - 6" X 2" thick limestone fragments comprising >50% of horizon. Voids and crevices between limes tone
fragments filled with 10YR4/4 sicl & 10yr4/6 sL
Z 1 0 -6 10YR3/2 None sl 2fcr mvfr cs 2fm 0.5 0.6
2 6 -19 10YR5 /3 None sil 2f &msbk mvfr gw 2frn,lc 0.5 0.6
Ground 3 19 -24 7.5YR4/6 None sl 2msbk dsh cw - 0.5 0.6
elev
87.64' ft 4 24 -28 7.5YR4/6 None Ifs Osg dl cw - 03 0.8
Depth to 5 28 -37 7.5YR4/6 f2d 5YR5 /6 Ifs Osg dl aw - 0.7 0.8
limiting
factor 6 37 -46 5YR4/4 f2f 5YR5/6 scl Om mfi aw - NP 0.2
28° 7 46 -58 10YR7 /4 7.SYR5 /6 L.S.B.R. - - - - NP NP
Remarks: Horizon #7 consists of " - 6" X 2" t4ick Iimestone ents coo >50% of horizon. Voids an d crevices between limestone
ftagin filled with 1 YR4 /4 sicl V 1 4/6 A
CST Name (Please Print) Sign re: Telephone No.
James K Thompson -i-� 715- 248 -7767
Address A.C.E. Soil & Site Evaluations Date CST Number Ref #
340 Paulson Lake Lane, Osceola, tr54020 8/24/99 3602 1095
r
' PROPERTY OWWER: DwiglasA&KaddowF.Lag SOIL DESCRIPTION REPORT toss Page 2 of 3
PARCEL WJ 004- 1073 - 10-000 A.C.E. Soil & Site Evaluations
Horizon Depth Dominant Color Mottles Texture Structure � siste� Boundary Roots GPDM
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
3 1 0 -5 10YR3 /2 None sl 2fcr mvfr cs 2f rn 0.5 0.6
2 5 -14 10YR5/3 None sil 2f &msbk mvfr gw 2fm,1c 0.5 0.6
Ground
elev 3 14 -30 7.5YR4/6 None sl 2msbk dsh cw - 0.5 j 0.6
93.48' ft 4 30 -33 7.5YR4/6 None s Osg dl cw - 0.7 0.8
Depth to 5 33 -53 7.5YR4/6 f2d SYR5/6 s Osg dl aw - 0.7 0.8
limiting
factor 53 -64 5YR4/4 f2f 5YR5/6 scl Om mfi aw - NP 0.2
33"
7 64 -71 10YR7 /4 m2d 7.5YR5/6 L.S.B.R. - - - - NP NP
Remarks: Horizon #7 consists of 2" - 6" X 2" thick limestone fiagnents comp rising >50% of horizon. Voids and crevices between limestone
aements Med with sic s .
Ground
elev
Depth to --
limiting
factor
Remarks:
Ground
elev
Depth to
limiting
factor
Remarks:
Ground
elev
Depth to
limiting
factor
Remarks:
3"T
Ownt.l'�
�okq leas A. 4 C 1ea F — z 19i'�
Las4
tolv:5co& CAX Sy0z ■ So'IObser N
♦ C"lelfa
3 zO � f � ��
,Loco -4 cn sere
StYs( SEyy Sec. 30 i .2rl. iP /Sw;
Cady, 56 • c. v;,r e L .4� 1.
l'lal
iv► uJN;k� .ne.
�SSu =► ¢I2Y.'=
/ad.AD'
rt/gprmc. "
Grade
e.le� � I o1.5't I
I
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1
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■
PIS L'o/l�kr.
o 82
alb. B.M. Too �'!rs! "�
b, -St all
at vve ?made.
Flee. 6888.
6= . / ta
Q/2 �//�
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer 101 4 a s�
Mailing Address Syb-D /
Property Address � A) j(V, 5 PR urn �C `� . tAJ`� .
(Verification required from Planning Department for new construction)
City /State 6 WLf i Parcel Identification Number _
LEGAL DESCRIPTION PD . ZS,
Property Location _ ' /a, '/<, Sec. c) , T !N -R W, Town of
Subdivision , Lot #
Certified Survey Map # :tr e . Volume , Page #
Warranty Deed # 14 r!A ( P 5 8 78 S� , Volume /o? 78 , Page # �F�
Spec house O yes ,K no Lot lines identifiable l yes O 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
masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
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
sta ' t your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
da s of a three ye expira . n date.
C'1 / 4/ o
SIGNA- 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
t pr erty M above, irtue of a warranty deed recorded in Register of Deeds Office.
of 11'9'l6v
SIGNATTA OF APPLI ANT DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * **
** Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
I
ol
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ITS
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iZ.{- T.J..t��. _. Y +� s ": .ti►..� �{11'"`.!ts. �_
~.� - �� rcV� r Mr : -w'� 1✓f ` 1Fr X " v ±� .T�! .w `ti °� - �. a 't -
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4— ..1�,.:ca►TC,wn.i` _ :3�`~r
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VOL.���PlS�
• 5��� -yp� STATE BAR OF WISCONSIN FORM 3 - 1982
I C7 I QUIT CLAIM DEED
•
DOCUMENT NO.
I
REGISTER'S OFFICE
ST. CROIX CO., Wi
Village of Spring Valley, a Wisconsin Municipa R•c'd for Record
1: Corporation NOV 2 0 1997
! q uit- claims to
Douglas A. Last and Kathleen F. Last, husband an II 3'45 F M
wife as survivorship marital property I " R:rO•
of I
the following described real estate in St. Croix County,
State of Wisconsin:
T. SPACE R ESERVED FO R R ECORDI NG DATA
!� NAME AND RETURN ADDRESS
Southeast One Quarter (SE}) of the Southeast One p Is s q-
Quarter (SE}) of Section Thirty (30), Township 2 "I
Twenty - eight (28) North, Range Fifteen (15) West, 1 - { ( L/flctc ST. r)v-
except the west 200 feet thereof containing 6.1 acres,
and except the south 26 rods of the east 12 -3/4 rods t'C'aSCOT tc7 :o�Z(� I7L5'
of said Southeast One Quarter (SE0 of the Southeast
One Quarter (SE}). Approximately 31.8 acres. — - -�
II
PARCEL IDENTIFICATION NUMBER
I�
I-
_�
I .
I:
J
This is not homestead property.
(lily (u not) / ,,(� p
Dated this �e/ day of __ / 11 -tel /ter 19 7 7
VILLAGE OF SPR VALLEY
(SEAL) ` X�l'In, � (SEAL)
• Martha Olson, - Trustee/President p ro tem
(SEAL) (SEAL)
� �Ju�rn,, V Administrator
�I I
AUTHENTICATION ACKNOWLEDGMENT
Signuupe(s)� H� K Olson and Lance J. State of Wisconsin,
Gurnia
J County
I, au , 19 Personally came before me this day of
19_, the above tamed r
I'.
TITLE: MtftOw STA BAR 0 WI 0 N 1.
(if not,
authorized b §706.06, Stars
�! to me known to be the person who executed the foregoing ,
instrument and acknowledge the same.
TH MENT WAS DRAFTED BY
Jory R. Gavic
Spring Valley, WI 54767 Notary Public, County, Wis.
(Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date
necessary.) 19 )
Names of parsons signing in any opacity should by typed or printed below their signatures.
QUIT CLAIM DEED STATE 8AR OF WISCONSIN WisCOnan Leal Slw* CO_ tnt.
Form No. 3 — 1982 MMVtMAw. Wia.
LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02
REAL ESTATE
G VALL
rce EY
COMPUTER NUMBE 1al Number 30.28.15.4
OWNER NAME: First DO F Last LAST
PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment
SECTION 30 TOWN 28N RANGE 15W '/4160 SE 1 /440 SE
Line Description Line Description
TOTAL ACREAGE 31.880 PLAT LOT BLK
O1 SEC 30 T28N R15W 31.4A SE SE 15
02 EXC S 26 RDS OF E 12 3/4 RDS 16
03 & EXC P481C DESC VOL 789/238 17
04 ANNEXED FROM TN OF CADY 18
05 4/1/66 VOL 421 PG 101 19
06 FKA 004 - 1073 -10 (481A) 20
07 21
08 22
09 23
10 24
11 25
12 26
13 27
14 28
--------------------------------------------------------------------------------
F1- General, F4 -Prev. Parcel, 1 -Next Parcel, F7- Valuations, F8- History, F10 -Exit
® `
01999 Cloud Cartographica, /nc. St. Cloud, MN 5630/
SEE PAVE 41
60TH AV y
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6 5 p 4 128 3 1
G c>`
53RD I AV NORSEMAN RD
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AV
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9 45TH AV e
7 8 10 1 �,
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40TH AV H
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1 8 1 16 ~_ 14 N
N
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30TH AV
27TH AV
19 20 25TH AV 21 22 23 r Gilbe (}
I � .a
0 20T V 20TH AV 20TH AV h
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30 v0 29 28 27 26 25
p 128
v/
o 10TH AV 29
W NN
m 32 ~� 33 BB 34 ����Q 35 36 PI
N
Eau 29
Galle
Reservoir IERCE ST CROM RD PIERCE ST CROIX RD
2700 4800 900 PIERCE Courm 3000 3100 3200 3300
i
( e-D f Bank of Spring Valley
& Plum City Branch
Fom moA COMPLETE BANKING SERVICE
FARMS - USA
F oremost Dairy Marketing V
487 Hwy. 128 - Wilson, WI .54027
(71 5) 772 -4211 - Fax: (71 5) 772 -3210 Spring Valley •— (715) 778 -5537
Plum City — (715) 647 -3791
y�j O 1999 Porcmosr Farms USA 2