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HomeMy WebLinkAbout022-1012-70-000 Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 Too #: (608) 264 -8777 www.w iscons f� www.cornmerce.s isconin.gov Department of Commerce Scott McCallum, Governor Philip o rstary January 18, 2002 CUST ID No.226900 A7TN: POWTS Inspecto SHAUN R BIRD ZONING OFFICE . eAox BIRD PLUMBING, INC 1008 192 ND AVE 1101 CARMICHAEL RD ' NEW RICHMOND WI 54017 HUDSON WI 54016 L CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 01/18/2004 Identification Numbers Transaction ID No. 701233 SITE• Site ID No. 640307 Yang, Cher Residence Please refer to both identification numbers, Cth N above, in all correspondence with the agency. Town of Kinnickinnic St Croix Coun NE1 /4, SE1/ , S5, T 8N, R18W FOR: New moon , GPD Object Type: POWT System Regulated Object ID No.: 826642 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 Conditions: • 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- 10691 -P ( N.0 1 /01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" 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 component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The maintenance plan for this system must be given to the owner of the POWTS. Site Specific Conditions: • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. SHAUN R BIRD Page 2 1/18/02 • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(i). • The designer proposes to install a state approve outlet filter to achieve the requirement of wastewater particle size. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the septic tank outlet filter will be required. The outlet filter shall be installed per product approval stipulations. • Provide frost protection per COMM 83.43(8)(c). • Holes must be-drilled with a sharp bit and all burrs and foreign matter removed before installation. • Turn up ells with valves and valve boxes or other means of flushing the lines shall be provided. 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 copy of th" letter to the owner and any others who are responsible for the installation, operation or maintenan of the PO S. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 G� Balance Due $ 0.00 Patricia L Shandorf POWTS Plan Reviewer, Integrat Services WiSMART code:' 7633 (715) 634 -7810, Fax: (715) 634 -5 0,M-F7:4 m - 4:30 pm pshandorf@commerce.state.wi.us cc: . /it: o 2 2 f � i f R © cp Z 0 ■ o I 0 o%/ 3/ q , $O %C$ §2 \ - > E @ g ® @ k � �§CL 7� / n to \2% \ » \�6 3 E E co § E f o k ) 0 § ° ( / §± ¢�/ C m CL R k § $ \ Q Q § C D / R § E \ n r @ . . � : : M V "a 7: © 0 2 k k k 2 \ # \ ■ ■ 2! 2 E ®E g i 90 ~ A E § { ! — i ƒ ƒ = / k k / / a \ } } / ■ o , C k ; 0 C. / z E E @ � $ � g \ \ cn e ; # z § i 1 q 2 ƒ i » E»k %§E § i 0 E 0 -4 x v $ � ; 0 t I ® . � 0 � { 2 z � ƒ + � o w < k ; � 8E I �7 r - Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 399686 0 GENERAL INFORMATION (ATTACH TO PERMIT) S to Plan ID No: Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. 1 40 SZ33 = 1_-U,, tSu {D ' Permit Holder's Name: City Village X Township Parcel Tax No: Yan , Cher I Kinnickinnic Township 022- 1012 -70 -000 CST BM Elev: Insp. BM Elev: BM Description: , gy11(o 1 9l'.6 1 p104- /10-ki TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � SE ' BenDhrk Dosing { _ Alt M 01 rl% Aeration Bldg. Sewer I , Holding St/Ht Inlet / 2 -35 c ric -3S TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 1 I Dt Bottom - 55 04-- a Dosing 11 k( l l Z I Header /Man. G- )k3o I O / Aeration Dist. Pipe $ r SZI ' LM ,p t Holding Bot. System O 9q. zS Final Grade ,, PUMP /SIPHON INFORMATION ��+ lae l + Manufacturer p Demand St Cover '1 JID a t L GPM 7 Model Number Sv �� TDH Lift Friction Loss System Head TDH Ft �• - 4-- (o5 . R , � o i s- z 2- o • og • / p orcemain Length t Dia. ti, Dist. to well #3 �•3S - 3 S r (o0 2 p i� - %w+ I SOIL ABSORPTION SYSTEM ED Width ( Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth ENSIONS b I O (' „-tom ,� o _ SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHIN15 Manuf r: INFORMATION Type OfSystem- .. 25 I t CHAMBER OR (a & DISTRIBUTION SYSTEM �5 h� tr•� �4 • 1 Header /Manifo d Distribution f / (/ II I x Hole Size t/ I x Hole Spacing Vent to Air Intake r 7i Pipe(s) Length (V . 0 Dia L a I 2 Spacing A i SOIL COVER x ressure Systems Only xx Mound Or At - Grade Systems Only - I Depth Over Depth Over xx Depth of x IX Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No OM ENT (Incl c de discrepenci s, persons present, etc.) Inspection #1: 7 1 /0 Inspection #2; OT / Z /- O Z - c Location: 1099 County Rd N WI 54023 (NE 1/4 SE 1/4 5 TZON 18W) NA Lot 77A Parcel No: 05.2 .18. 7A tAIX4. 1.) Alt BM Description - (4� r.- 18 so/ t I Sb I.� s lea d "m_w .y 2.) Bldg sewer length = 4�S C � h SC���rvuY►►p �Ic ink► . tn�(� �� ir�VO`s2d �P11'c �. � ��t(�'& 1 * - amount of y� — 3.) Contour = �, 2 S� �' J� + SSSKKK��- r Plan revision Req �' o 2 Use other side for additional informat f2__ Z - /�`afa i t (G G sD Cert. No. SBD -6710 (R.3197) 1 SEPTIC TANK E PUMP CHAMBER CROSS SECTION AND SPECXFTCATIONS 4 Cl VENT PIPE 12" MIN. ABOVE GRADE WEATHERPROOF > 2S' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W/ PADLOCK & FINISHED GRADE - WARNING LABEL 6 oil�a. 4" MIN. 18" IN. fl y� C•Z. a>WN;aW►doa �Ya S. b. INLET I' WATER TIGHT SEATS GAS- TIGHT ► �IAPPROVED F ALTE R --•-= A SEAL j tNTS WITH APPROVED a 4LM APPROVED PIPE 31 PIPE 3' _ N SOLO SOIL ONTO SOLID SOIL P UMP OFF ELEV . 3" APPROVED BEDDING UA �. CONCRETE PAD SPECIFICATIk SEPTIC / DOSE . n� NUMBER DOSES PER DAY: ., TANK MANUFACTURER: 1�--- TANK_ SIZES SEPTIC GAL. DOSE VOLUME INCLUDING '� / -'"'� DOSE 5 GAL. FLOWBACK: GAL. ALARM MANUFACTURER: ✓ CAPACITIES: A = INCHES = _� E GAL. MODEL NUMBER: B = -2 INCHES = GAL. SWITCH TYPE: �() PUMP MANUFACTURER: C = 2 INCHES = GAL. MODEL h / > MODEL NUMBER: D = INCHES = !3 GAL. SWITCH TYPE:44 REQUIRED DISCHARGE RATE G M PUMP E ALARM WIRING AS PER ILHR 16.23 wAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE D FEET + INIMUM NETWORK SUPPLY PRSRE . . . . . . . • . • . . . A� FEET +J FEET FORCE MAIN X3 F.S FT /100 FT. FRICTION FACTOR . _ • FEET TOTAL DYfTAMIC HEA / -� ET L U INTERNAL DIMENSiON,OF MA TANK: LIQU WIDT4 DIAMETER ID .� I i �j SIGNED: LICENSE NUMBER* �UV DATE 1/88 Aft ENGINEERING DETAILS 7 9 I Performance Data lump Characteristics Po" /Motor Unit SowlersBtle sa Mamtd Models 150? M1 M4 M5 M2 M3 25 AutomaN Models els Al A2 - - - 80 ' Horsepower 1/2 70 , - - h Full Load Amps 15.0 1 1.6 1.2 20 0 = T 'tor Start 30 E 6 Motor Type tap°° 3450 X15 D SO }. - `1/2 h 4. R.P M m p Phase 4 0 0 3 0 = 40 => ` ' tlohoge 115 2owmo z 60 575 , _M 100 M2 M4 MS 10 30 M oriel t } Automatic Models A2 - - 20 Horsepower 1 5 - {- { Fall Load Amps 113 .6 /12.11 sa /s a 2.8 1.9 10 _ Motor Typo Cnpadtor Start 3 0 0 0 - RPM 3450 Capacity, US GPM 0 10 20 3o 40 50 60 70 80 90 Phase 10 30 literWseoond 0 1 2 3 4 5 6 Voltage I zoo sso 12w2ni 460 1 S75 + Hertz 60 cu meters/hr 0 5 10 15 20 Temperature 140° F Max Fled Temp. NEMA Destgtt L B Told Ham (feet) 17 25 40 50 60 65 70 80 93 NORA De Chins S GPM 1/2 HP 69 63 50 36 10 0 i HP — 40 80 72 1 63 1 57 50 1 35 1 0 Okdr W Size 2" HPT Std. Sys H=Mq 3/4" Unit WWO 58 Mss. (50) 1 65 is. 000} Pow" C"d 11SV,14/3, S1TW -A; 230Y, to, Dimensional Data 16/3 STW-A, 30,16/4, STW A, AN cot& 20 std with 3W opt. 1. All dimensions in inches. 2. Component dimensions may vary +/- 1/8 inch. 3. Not for construction purposes unless certified. Materials of Construction 4. Dimensions and weights are approximate. 5. We reserve the right to make revisions to our products and their HomBe Stainless Steel specifications without notice. 6. Float switch (automatic models only). Lubriwtnuj 09 WWedrk 09 y -15118 7 -t //8 1 Mow Housatg cost Iron /4 at/e Po " Cosbg Wtt � &ll/16 4-9116 OISCI1AfHiE NP 2'f Shah Stainless Steel &11118 DISCIIAR(iE 2' NPT -� 1 Medwoicd Seal Faces: Corbon /C eremk 1^ — -- — Shaft said Said Body: Bross ig: S 5tdnless Steil 1t H Bellows: Bunt -N DISCHARGE PIPE NOW boneorell �� NOT INCLUDED NOT I NCLUD ED AFIGE PIPE I � Upp er Bemmg Singh! Row BellBeafmg >Z 12 -118 .e SM04 i FLOAT J Low" Bearing Single Row Bell Berg 1 Bottom Note Polyester Coated Steel 4 / 4 Fasteners Stainless Steel - - -- �— } Legs Eagiaeered lhermoplostic SHEF50 SHEF 100 AURORA /HYDROMATIC Pumps, Inc. O_ J A_L1_ _J f%L:— AAOI%C 1A7AtA00_,lAAd% I y 1 i � i 1 �a j --- N. y i z r D� Safety and Buildings Division County , 201 W. Washington Ave., P.O. Box 7162 / N visconsin Madison, WI 53707 - 7162 Site Address Department of Commerce -- st - (c ' Al Sanitary Permit N tuber Sanitary Permit Applic4fi* n 9 39°I NO In accord with Comm 83.21, Wis. Adm. Code, personal information you rovi a Check if Revision may be used for second purposes Privacy Law, s15.04(lxmA I. Application Information - Please Print All Information State Plan I.D. Number 233 Property Owner's Name t ' A Al 2 � 2002 - Parcel Number O ZZ " MI ( qT CP,Otx Property Owner's Mailing Address ' Property Location . Z - t"^Nlttf3'U� C� 'k.�G 'ti' S v N, R E City, State Zip Code Pho Lot Nu! tber Block Number •-X S ivision Name CSM Number H. Type of Building (Check all that apply.) /* "s far s "'Z 1 ❑ City or 2 Family Dwelling - Number of Bedrooms �J �s►�.Se. 13 Village ❑ late Owed ci al - Desch Use ❑ State Owned L v+v 9 nshi 1 Nearest Ro 0' ` mA CW " D v — 1.90` ZZ, , ' III. ype of Permit: (Check only one box on line A. Numbering is for intern use.) (Complete lins4, if applicable.) A. 3 ❑ Replacement of 6 ❑ Addition to - System 2 ❑Replacement System Tank Only Existing System For County use B ' ❑Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of POWT System: (Check all th apply. Numbering is for internal use.) *&"6t_ —I nD 44 ❑ Non - Pressurized In- Ground 47 ❑ Sand Filter 50 13 Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 13 Aerobic Treatment Unit 49 ❑ Recirculating 30 13 Other V. Dispersal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals. )Days /Sq.Ft.) (Min. /Inch) Elevation l . Tank Info Capacity in Total Number Manufacturer Prefab She Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank G C Dosing Chamber VII. Responsibility Statement- I, the unde assume rasp, y for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum 's tore MPIMPRS Number Business Phone Number Plumber's Address (Street, City, Sta Code) l k t t ee� /:�o VIII. County/Department Use Onl Disapproved Date Issued Issum Agent Signa a (No Stamps) Approved ❑Owner Given Initial Adverse Sanitary Permit Fee includes Groundwater Determination Surcharge Fee) 3 ZtA IXConditions orovaURe for Disap oval � � l � � — c. Q.�o , .. - �►,.t ,d�.i. � �f� oo pm, uno�l�,t,��t -c!_`S Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size K) a ZOMY& G PLOT PLAN "Yana ADDRESS 917 Edmund Ave St. Paul Mn 55104 E 1i4S 5 /T 2 /R 18 W TOWN Kinnickinnic __ COUNTY ST. CROIX S Shaun Bird 226900 1/11/02 g DATE BEDROOM ONVENTIONAL IN-GROUND—PRESSURE CONVENTIONAL LIFT HOLDING TANK IOUND X)00( SEPTIC TANK SIZE 2000 gallons LIFT TANK SIZE DOSE TANK SIZE (OLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 900 # of chambers none j BENCHMARK V.R.P. Top of 3/4" Pipe ASSUME ELEVATION 100' Filter Zabel A -100 J BOREHOLE O WELL - H.R.P. Same as Benchmark SYSTEM ELEVATION County RD N Grading is to be Scale = 1 /4" = 10' done to divert runoff away from System Area 15' below system is to remain 6% undisturbed f 96' Slope B - 3 9 7' 210' O 98 B.M -#2 ❑ B -1 B -2 T B.M. #1 CMG Huffcutt 2000 septic tank Pro 6 Bedroom A House w - cn - 0 Well is to meet all setbacks found in Tanks are to be properly - a ° Comm. 83 bedded and provided with ,a '- lockdown covers with approved warning labels Pro ert Line g i � � a Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (t:08) 264 -8777 iscons/n www.commerce o ns / www.�Niscnsin.gov Department of Commerce Scott McCallum, Governor Philip Edw. Allan d, Secretary January 18, 2002 CUST ID No.226900 A7TN. POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 01/18/2004 Identifi ion N b s Transaction ID N . 701233 SITE• Site ID No. 64030 Yang, Cher Residence Please refer to both identification numbers, Cth N above, in all correspondence with the agency. Town of Kinnickinnic St Croix County NE1 /4, SE1 /4, S5, T28N, R18W FOR: New mound, 900 GPD Object Type: POWT System Regulated Object ID No.: 826642 P.O The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes CndZ 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. A. OM flu The following conditions shall be met during construction or installation and prior to occupancy or use: DI DEP RTMEN General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans and w' "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10691 -P FFE CORRE ( N.01 /01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" 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 component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The maintenance plan for this system must be given to the owner of the POWTS. Site Specific Conditions: • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. SHAUN R B!RD Page 2 1/18/02 • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Mate, ials shall conform to the requiz ements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(i). • The designer proposes to install a state approve outlet filter to achieve the requirement of wastewater particle size. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the septic tank outlet filter will be required. The outlet filter shall be installed per product approval stipulations. • Provide frost protection per COMM 83.43(8)(c). • Holes must be-drilled with a sharp bit and all burrs and foreign matter removed before installation. • Turn up ells with valves and valve boxes or other means of flushing the lines shall be provided. 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 copy of thi letter to the owner and any others who are responsible for the installation, operation or maintenan of the PO S. Sincerely,,--­ Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Patricia L Shandorf POWTS Plan Reviewer, Integrat Services WiSMART code: 7633 (715) 634 -7810, Fax: (715) 634 -5 0,M-F7:4 - 4:30 pm pshandorf@commerce.state.wi.us cc: I Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 11 /8/01 Owner: Cher Yang System type: Mound System Manuals Used: Mound Component Manual version 2.0 (01/31) Pressure Distribution Manual version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan' 3. Mound Cross Section 4. Pipe Cross Section /Pipe Layout of o 5. Pump Chamber Cross Section ° L LD +IS 6. Pump Curve � 7 -9. Maintance and Contigency plan 10 -12 Soil test 2-o12-33 Signature r License number 226900 1/11/02 PLOT PLAN PROJECT Cher Yana ADDRESS 917 Edmund Ave St. Paul Mn 55104 NE 1/4 SE 1 /4S 5 /T 2 ! /R 18 W TOWN Kinnickinnic COUNTY ST. CROIX \ 1/11/02 6 MPRS Shaun Bird 226900 `' DATE BEDROOM CONVENTIONAL IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND )000( SEPTIC TANK SIZE 2000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of 3/4" Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P Same as Benchmark SYSTEM ELEVATION County RD N Scale = 1 /4 11 = 10' Grading is to be done to divert runoff away from system Area 15' below system is to remain undisturbed 96' 6% B -3 Slope 9 7' 210' 98 B.M. #2 (� ❑ B -1 ' B -2 DT B.M. #1 Huffcutt 2000 septic tank Pro 6 Bedroom House 0 2 CD Well is to meet all Tanks are to be properly setbacks found in - bedded and provided with � Comm. 83 lockdown covers with ` Pro p ert Line approved warning labels I I page Of Synt,tietic Covering �Sf-i - DIstribution Pipe Sand G 3 _J li p % Slope Bed Of Z 2 Force Main Plowed Aggregate From Pump Layer E Ft. f� Cross Section Of A Mound System Using F —�-- Ft. A Bed For The Absorption Area D G Ft. A Ft. 14 f S� Ft, Signed: B Ft. i.iCense tf mber: K Ft. Date: /' Y Z- L XIF t . J _Ft. 5 Ft. Force Main Observation Pipe —.,, ------- r A (r___ - - - - -- --- -- - - - -- - -- -------- - --��� t Distribution �� Bed Of z — 2 % s W. Pipe Aggregate I r r Observation Pipe Permanent Markers I P 1 14 T,i 5�-a,�e¢ �r�m e 14 ,,!! C P// Plan View Of Mound Using A For The Absorption Area Page PerfCrated Pipe Detail i End View � Perforofea PVC Pipe Holes Located On Qo :tom, S Are Equo'ty Spoced �r -- PVC Force Moir, V" Q r� PVC !�, f Moniiold Pme / ` . Do , 1, ibution Alternote Posit ;an Of — }-�r�J Pipe Force ,%join Disiributi0n Pipe Layout s /' P � / -.�' S Ft . R° S' X 3 Inch PS -^- Y inches Signed: Hole Diameter S �Inch License Number: �a� Lateral %Z Inches) Da6e: /.,/ f � Manifold Z Inches Force Main 2 Inches # of holes /pipe Invert Elevat of Laterals,/ Y�i1V' vAv F wt�T�;CltIR00+" r Rp.h+ seem, 1 :ljRJC";ch box 4 ��°" � •'rROyC A �.CGettAlG t1 ���uM4t C avt R .ryppWOm t �rR :; r )f +p"Nlr�,i, GOIw01i1T —+'� r �— ir/RIAi. " y f�A � wrrr • rr+ rr i !il o t Av AKM f *APPROVED ! I:tk / PT APRROVE� � ' � 3' ONTO SOLID SO I L C4yCRtt! •4CC.1� ' R+1stR CM Y SCOLAt'fit,a A�11iPAGT1r1 MAi i'riOM A�I►ROVtV X01! It{ LLIR EA T I �f� M A 41 yRAt'!'1riRN:R: .C� TANK lltr � �C � Lihl�1:R O F 00sci � +�iR �►s �h�lQ MARYfPAaT ""w 6AUL06i6 bos Y06WAC Yf�fi<fc► ,,.¢�� �WCLUIDt1NQ+ fA61t1rL1 >W: MOA11wf„ NYMAifR: ' '�- -`"`�" _ .� O'I►+r.ow1 Twsl cI►rACirtt�r �►>. — ':.ai,crir� opt v►��.e�►� �t MMiiltAtTIiARMti an —�".." is .....iANGe+ii ON iMA:. e,ar11 'MOOii. A11iA40*ik: d G ■ r.. +AIAMtip OQ B�LAa4i �w�'I�N Ttiril G f D • ..ING NIS 04 .,�....,,� f/Ati�,01►tti NItMIMum OfA0NAR66 KATE IPWOtP AWC AtwARM Agg Tr* turwk6 Os�PtRtNi � roO � lN&'rk6 = ►I,,i SkP�f�ATi C�RQ41T� !!1'olrsN l�W Ityp asErRssur:ou il,rc . « �,At�tNuM NCTWaAK Su'► f +et+�sti'fkc ' o ... , �.`: eccT 0 ��,ll P 99T or roue[ OWN x � Aso � � Rt. ra4tt►ou s.,cro,�.� ror.w a rAMl� "CAA // TTRVA6 01 MCM #10 ©► 'rAAtK; L.f►Nib7h � r / 50 ....r... a rCCQ.E' A.1W#ACE.!t. q /�.. En g i neer i ng , • A Performance Data 40 30 PU Characteristics Mew 3atlaWI" r 20 mmul Meda{s SH0401 I I SttE ON Aeteaadle XWets SW40A1 I SHMOA2 10 -- Ifer 4110 ql ry 14 L•alf Aw 12 1 6.5 8bta Typ SAoded Pab p Pab) 0 RAL 1336 10 20 30 40 60 70 1 t GPM 115 230 Total Head (Fwt) 10 { 14 17 2l 23 28 30 33 Herb 60 120° F Max. NOW (m) .0 4. 3. b.1 7.6 1 NiMA A GPM (US GPM) 70 60 50 40 30 20 10 0 10111111" Close A ( s see .4 3.8 .S 1.9 .63 S" 11324NPT Dimensional Data ift 28 Na. �r� ►—ems t,se.a� 1. All 6nonsions In itic m- (N4e * for PDWW tad 18/3, Sim 26 std c�a.ae «_b, ray) � intarnotional use). (fir 2. Component dimensions may elidema 3.�re Materials of Construct vary vary * 1/8 inch, 3g 72 DISCHAAGE 3. Not _ for cflastruction purpose (98x) ��' 1 -1!2" Npr unless certified. 1110w bodu FLOAT H 4. Dimensions and weights we gob bw approximate. 11 ed'tor ' Seel h". 4rb1l/t01111c S. We reservq the right to stake sti.ft'seid SMi fteirt Anedlacl Steel revisk" to our pwod. and their StaWea $t«I speziRcofions v Mim WNW. „ .Mw 0 Zx . Y ;� \ \ a111M1 Y . i, S:l i . 1 8 rometice Pumps, Ashk Ohio. All Rig is Rese (� NYDRUMATIC - YourAuthori a r16 1840 Busy Road A"", Ohio 44805 Tel: 419 -M -3042 Fax: 41 9.281`4087 O ff/ Yob She- wew.perMir"'cam SALES OFFICES IN All MAJOR CITIES AND COWRIES Refer to "Pumps" ln the yellow pages of your phone diratcry tot your local Distributor Iternfl W02.6680 1 198 5M POWTS OWNER'S MANUAL MANAGEMENT PLAN Noe FILE INFORMATION SYSTEM SPECIFICATIONS Owrw Septic Ta Cap achy 70 0D o NA Permit # 6 �� 8eplic Tank Manufaiturec D NA DE8IGN PARAMETERS Effluent Fiber Manufacturer 0 NA Number of Bedrooms a NA ant Fitter Model p a NA Number Of Coranter+dal Units AfNA Pump Tank Cgxwky D i al Q NA Estimated Now (average) Pump Tank Manufacturer O NA o es i on 4 flow {peep, (Eetlmated x 1.5) d Pump Manufacturer � �''Q NA golf Apploatlon Rye , da IR= PumP Model �{� G 0 NA (nNuenffM%HKtt Ouafity Monthly sverage' Pretreatment Unit Pats, Oil & Grease (FOG) 00 mg& a Sari VGMvel Filter a Peat F Bkdwni al Oxygen Demand (800 5220 mg& a Mechanical Aeration Oa Other 'd TOW Suspended Solids (TSS) S160 rn Disirtfet.` � Pretreated Effluent Quality O NA Monthly average" M w Dispersal Ced(s) Bkwhemk* Oxygen Demand (BOD S30 mgR. 13 In-ground (grwtlty) a I"round (pressurized) Total Suspended Solids (TSS) :5W mglL O At -grade +pd Fecal Colform etri mean s10 ctu/100m1 o Drip-l O Odw. Maximum Effluent Particle Size Y Inch diameter vokm tjpW br darrmse (nom mrrmerdal) waalewdw end spun tank eflkaMt " Vskres typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service F requency inspect condition of tank(s) At least once every _3: O rnontl e years) (Maxim 3 yre.) Pump out contents of tan When combined sludge and scum equals one -third (Y,) of tank volume inspect dispersal oaks) At least once every „-3 O montlas ,;Ud/ear(s) (Maximum 3 yrs.) Clean effluent filter At least once every a moat - is ar(s) . x �o Inspect pttmp. PUMP 0 months rears) O NA controls S alarm At least once every _____^_._ Flush laterals and pressure test At least once every 3 O months jayear(s) a NA Olher. At least once every (3 mon 0 year(s) a NA otMr: At Mast once every t3 months o year(s) O NA MAINTENANCE INSTRUCTIONS one Of the following goeneee or Inspections of tanks and dispersal ells shall be made by an individual carrying cartilloptlim: Master Piumber: Master Plumber Restricted Sewer POWTS Inspector, POWTS Maintainer, Septege SerA tg Operator. Tank Inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identity any cracks or leaks, measure the volume of combined sludge and scum and to check for any back UP or ponclng of etfluertt on the ground surface. The dispersal eel($) shag be visually inspected to dock the effluent levels in the observation Pipes and to check for any ponding of effluent on the ground surface. The pondiftg of eMuent on the ground surface may indicate a failing Condition and requires the immediate notification of the local regulatory authorilt►. 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 servic" of effluent fitters, mechanical or pressurized POWTS components, pretn3at9ment components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed ty a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of cornpWon of eny service event. START UP AND OPERATION �� or Sher tr For new wrtauvtion, Prior to use of the POWTS d*ck treatment tanks) for the presence of painting p chemicals that may impede the treatment process andlor damage the dispersal kepis). it high concentrations are detected have the contents of the tank(s) removed by a septage serAc" operator prior to use. i System start up shall not occur when toil conditions are frozon at the Infiltrative surface. Pre of During power outages Pump tanks may 1111 above normal highwater levels. When power h� restored the excess wastewater will be discharged to the dispersal cell(s) In one large dose, overloading the cell(s) and may result In the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist In manually operating the pump controls to restore normal Well; 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; herblo:ldes; meat scraps; medications; oil; Pa intin g products: mdddes: sanitary naokins; tampons; and water softener brine. ABANDONMENT When the POWTS falls 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. e All piping to tanks and pits shall be disconnected and the abandoned pipe openinip sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. e 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 solld 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: 13 A suitable replacement area has been evaluated and may be utilized for the locatk)n of a replacement soli absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Fallur: to protect the replacement area will result In the need for a new soil and site evaluation to establish a suitable replacetrient area. Replacement systems must comply with the rules In effect at that time. C3 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. site has not been eriaivated 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 installed as a (list resort to replace the failed POWTS. and at -grade soli absorption systems may be reconstructed In place following removal of the blomat 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 mpnrtitsn111. ADDITIONAL COMMENTS POWTS INSTALLER_ POWTS MAINTAINER Name Phan SEPTAGE SERVICING OPERATOR {PU MP R LOCAL REGULATCAY AUTHORITY A8enn` Wisconsin Department of Commerce SOIL EVALUATION REPORT Pa e 1 of 3 vision of safety and Buildings g Y in accordance with Comm 85, Wis. Adm. Code County S l C Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must � �X include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. � AJ E, percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Rlease print all information Re iewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 3� Z Property Owner Property Location T � v �' �— Z Geut.LoL N E 1/4 SE 1/4 S S T ' - a N R LS E (or W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# P-O $CS zo,Z I — �1Z��OSEb C_ I.A4_ City State Zip Code Phone Number ❑ City ❑ Village] Town Nearest Road L ►v S (6LZ)�Z3 -�o8? `► - c. �>v�1C�lN�JIC cTN New Construction Use: ® Residential / Number of bedrooms �_ Code derived design flow rate Z GPD ❑ Replacement ❑ Public or commercial - Describe: .+ Parent material Flood Plain elevation if applicabl ft General comments � and recommendations: � , P vM 0 F S A h/D F=l L L F-1 Boring # ❑ Boring ® pit Ground surface elev. ft. Depth to limiting factor � 4n. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 0_�a) lzmV- -31z_'• — s i Z'�sbk "-q S - I s 2 S ZO > o Y li 3! C 3 2 - 0 -3y 2.SL' rz33 - . -S`� 1 eSbk �� — - • 3 a Boring # ❑ Boring ® pit Ground surface elev. Z ft. Depth to limiting factor n. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 • S f3 3 \� SyR 3l3 L O � �e sls3 L -SCI T�z �� - • z • 3 Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = SOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) N i Si atu CST Number Arthur L. Wegerer O�`S9 -� _ 220254 Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Hain St. River Falls, WI 54022 L/_2 715 -425 -0165 1 a .0 Property Owner Parcel ID # - P ExM hl G Page Z of 3 Boring # ❑ Boring ® Pit Ground surface elev. 9 b • ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 -a You- L — si Z - I 10 712 2A - S>> 2`� h1 `Ph CS - • S .8 3 1�► -30 �•S'tiz313 C I•Sye Si8 L - scl l cs�h F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.. 'Eff#1 'Eff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mglL ' Effluent #2 = BOD 30 mg/L and TSS < 30 mg/L ' The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or ' need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. seo 68330 (RUroo) PLOT PLAN Page 3 of 3 Scale 1' = 5p' . CTt � _ 1 w l � P 'rt A 0 f � �o r�oT -b"pp- 'r oR 1 L� �TvR TAI s q(o CF — _� 3 - \24 �5 1 � �� 3nq I t+ 2 0 0 1 0 J I- a J L 100 'ON - 1 ``E tGH, 3 /y" DIA. PVC Pt PE w!LA771 - -- o�. S - l -0 715- 425 -0165 220254 O -- S� , CST Signature Date Telephone No. CST No. Job NO. l � I ST CROIX COUNTY bs7 4 Sg 2z SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �'� a 'l+AJ6 Mailing Address 1 9 t iW / Lf l Property Address lbqg U t`Ijri (Verification required from Planning Department for new construction) City /State Parcel Identification Nivubw b LEGAL DESCRIPTION Property Location '/ %., Sec. , T.N -R W, Town of � # Subdivision Lot Certified Survey Map # , Volume , Page # Warra Deed # V l Volume Page # S —AL Spec house ❑ yes Mo Lot lines identifiable f yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. C AO-, — / /Z/ DZ SIGNATURE OF AP CANT 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 owners) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. / /� Z SIGNATURE OF APPL ATE * * * * ** 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 r STATE BAR OF WISCONSIN FORM 1 - 1998 667$1 IL WARRANTY DEED KATHLEEN H. WALSH p REGISTER OF DEEDS =`T. CROIY. Co., WI Document Number VQL 558 RECEIVED FOR RECORD This Deed, made between Lenert z Farms, Inc. 01 -10 -2002 8:40 AN WARRANTY DEED _ EXENN # Grantor, CERT CORY FEE: and COPY FEE: TRANSFER FEE: 119.70 RECORDING FEE: 11.00 PAGES: I Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in — St. Croix County, State of Wisconsin (the "Property "): Recordinz Area Name and Return Address BURNET TITLE 7550 FRANCE AVE S SUITE 220 MINNEAPOLIS MN 55435- 0 E 22 1019 10 000 S Parcel Identification Number (tc)a i (�SS�� sn rr o ''s t n t horn d property. Parcel 77A, Section 5, T rAdt rth, Range 18 West 2A Nor'tYt�t3 fof East 200 feet of Northeast Southessessed W/022- 1012 -80 o ZZ�� o ( 2- Together will all appurtenant rights, title and interests. none Grantor warrants that the title to the Property is good, indefeasible in simple fee ar.8 free and clear of encumbrances except Dated this day of -November 2001 t) (SEAL) (SEAL) b — _. Lc_nertz Farms, Inc. _ (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGEMENT q, Siguature(s) State Of Wisconsin, WI ) ss. NOTARY PUBLI St. Croix County. authenticate Personally came before me this th day , ^A aa November _ ,2001 the above named Lenertz Farms, Inc. *_ - -- -__ P TiTLE: MEMBER STATE BAR OF WISCONSIN to (If not, _ me known to be the person who executed the foregoinglS authorized by §706.06, Wis. Slats.) instrument and acknowledge the same. K 1K THIS INSTRUMENT WAS DRAFTED BY Caldwell Banker Burnet 01 -33731 1301 Co �� k4� Not tc, State of Wisconsin � •� ` Hudson. WI 54016 _ My ctAiission is permanent. not, state expiration date: ( Signatures may be authenticated or acknowledg,d. Both are N� ff �t -1 o7col�;•) not necessary.) Names of enon> si - min in an ­P city must be ed or •rated below their signature. MXIF, ISAK OF WISCuNSM Wisconsin Lego Ban 'o.,Inc. WARRANTY DEED FORM No. 1 - 1998 Milwaukee. Wis. ' KINNICKINNIC T 28 N:- 18 W. " SEE RAGE 29 I. W . F/oyd T Merton • Geoye E C 07- ers7an 'Po er f/ansen s :. 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