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HomeMy WebLinkAbout022-1074-40-000 Wisconsin Department of Commerce r ! PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 420320 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Hinz, Ken I Kinnickinnic Township 022 - 1074 - 40-000 CST BM Elev: Insp. BM Elev: BM Description: U 10 � �. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark cTt s�rz.. w � mrol�w 0. Dosing Alt. BM u�C -� / of. 70 loo Aeration Bldg. Sewer Holding St/Ht Inlet 10.12- 4 - 3 St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > 2 UO , �/ + 7 S Dt Bottom l� , Dosing , Header /Man. ;. sr4 ? ZUO P > P 0 3, Aeration Dist. Pipe 3 -s > Holding Bot. System � 0 (�• S i Final Grade PUMP /SIPHON INFORMATION Manufacturer I Demand St Cover GPM - Z Model Number ` S TDH Lift Friction Los System Head rDH' Ft Forcemain L ngth 3/ Dia „ Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length / No. Of Trenches PIT D1 ONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS �] Z SETBACK SYSTEM TO 7 P/L JBLDG IWELL LAKE /STREAM LING- Man rer: INFORMATION Type Of System: CHA EACH R OR Model Number: WAMAbhl DISTRIBUTION SYSTEM , SZ— Header/Manifold Distribution x Hole Size x Hole Vent to Air Intake !I Pipe(s) r (/ r 1� t� 1 1-ength _3L�_ Dia Z Lengt Dia L rl Spacing_ SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes ❑ No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:e /2"P/ Inspection #2:/�/ B2 i Location: 110 Ponderosa / Drive River Falls, WI 54022 (SE 1/4 SW 1/4 26 T28N R18W) NA Lot Parcel No: 26.2A.P412 1.) Alt BM Description = 5* 2.) Bldg sewer length = �s - amount of cover = 7 (� 3.) Contour Plan revision Required? ❑ o . Yes No Use other side for additional informati _ Cert. o. ___ SBD -6710 (R.3/97) Da a Insepc ' 'gnature i . t Safety and Buildings Division County ST. CROIX 201 W. Washington Ave., P.O Madison, wi 53707 - 7162 . Box 7162 Site Address nsin Visco 110 PONDEROSA DRIVE Department of Commerce g _U s Permit Number . Sanitary Permit Application L 1 40 3 J-0 83.21 Wis. Adm. Code, personal information you provide ❑ Check if Revision i 1II accord with Comm . ses Privacy Law, s15. 1 m ma be used for seco State Plan I.D. N D 1. Application Information - Please Print All Information - __�q26 Trans ID # 766045 a ._ l Number Property Owners Name Oat- 1074 -40 -000 KEN HINZ ' ' ' Property Location Property Owners Malng Address SE % SW , S 26 T28 N R 18W 110 PONDEROSA DRIVE Lot Nu�ber Number zip Code & N 1 A A City, Stan CSM Number Subdivision Name RIVER FALLS WI 54022 715/N/A > 35A H Type of Building ( l check all that appy) 1-25 i�w�- ❑City 3 L (S fi vt a ❑Village E3 or 2 Family Dwelling - Number of Bedrooms owttshi KINNICKINNIC C3 Public /Commercial - Describe Use a - Barest Road ❑ State Owned Alaw / e �N q-7 PONDEROSA DRIVE / p o t!>2 DEL Type o Perrnt : (Check only one box on line A For County use (numbering scheme for internal Comp line B applicable) A ' 1 ❑New 2 [� Replacement System 101 Replacement of F6O Additi on to 0� in S stem Date Issued S stem Permit Number B. El Check if Sanitary Permit Previously Issued IV. Type of Permit: (Check all that apply) (numbering scheme is for internal use) 50 ❑ Constructed Wetland 44 El Non ❑ Sand Filter Non - Pressurized In- Ground 219Mound 51 ❑ Drip Line 41 Holding Tank 48 11 Single Pass 22 ❑Pressurized In- Ground 30 ❑Other 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating V. D'u ersail'I�eatment Area Information: percolation Rate System Elevation Final Grads Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Elevation Required Proposed Rate(Gals. /Days /Sq.F � N/A 97.5 99.33 450 450 450 1 • 5�' Total Number Manufacturer Prefab Site Steel Fiber Plastic VI. Tank Info Capacity in Concrete Constructed Glass Gallons Gallons of Tatilcs New Existing L(� �d 4 -'160 �7 i 'Y Tanks Tanks Septic or Holding Tank 000 WIESER CONCRE E Dosing Chunber 600 WIE ER CON RET VII. Res onsibilit Statement 1, the undersigned, assume respo i111Y for installation of the POWTS shown on th$ attache P Number Pl Signature TrIP/1v1PRS Number Plumber's Name (Print) 715/772 -3278 BENNIE HELGESON 92 Plumber's Address (Street, City, State. tp ode) W1229 770TH AVENUE, SPRING VALLEY WI 54767 VIII oun /De artment Use Onl Sanitary Permit Fee (includes Groundwater to Issued ent Stgttature o Stmyts Approved ❑ Disapproved Surcharge Fee) ❑ Owner Given Initial Adverse Determination IX. Conditions of Approvesappr ns for Disapproval 1� � P ig � Cr Attach piece plena to toe county only) f� On Fsper ) not less ehan 8la X u ine in In Was _/ — Alm CL l � 1 1 L of ° Un L v �a 3 Z s x `u t° d d • c .qp i N v s j O � S Erosion Control Plan for 1 - &r 2- Family Dwelling Construction Sites According to Chapters ILHR 20 bt 21 of the Wisconsin Uniform Dwelling Code, soil erosion control information needs to be included on the plot plan which is submitted and approved prior to the issuance of building permits for 1- bt 2- family dwelling units in those Jurisdictions where the soil erosion control provisions of the Uniform Dwelling Code are enforced. This Standard Erosion Control Plan is provided to assist in meeting this requirement. Instructions: 1. Complete this plan by filling in requested information, completing the site diagram and marking appropriate boxes on the inside of this form. 2. in completing the site diagram, give consideration to potential erosion that may occur before, during, and after grading. Water runoff patterns can change significantly as a site is reshaped. 3. Submit this plan at the time or building permit application. PROJECT LOCATION . S e .SIA.) y -� �0 T - NJ 't? 19 0 please indicate north BUILDER OWNER 41t, b y completing the arow. WORKSHEET COMPLET1513 BY DATE ''�S_ —� I IN SITE DIAGRAM Scale: 1 inch = _feet I C- i L 1. i I I I J I I EROSION I CONTROL PLAN LEGEND I _ _ PROPERTY(. I LINE EXISTING I DRAINAGE TO TEMPORARY DIVERSION I FINISHED DRAINAGE ' j I `T LIMITS OF - I GRADING I SILT FENCE r--f —� STRAW I I BALES I GRAVEL I VEGETATiiJN SPECIFICATION t- L. TREE I I LIZA PRESERVATION STOCKPILED SOIL i ' m EROSION CONTROL PLAN CHECKLIST J Check (✓) appropriate boxes below, and complete the site diagram a , with necessary Information. d O z Site Characteristics North arrow, scale, and site boundary. indicate and name adjacent streets or roadways. [) Location of existing drainageways, streams, rivers, lakes, wetlands or wells. F / Location of storm sewer inlets. Location of existing and proposed buildings and paved areas. The disturbed area on the lot. Approximate gradient and direction of slopes before grading operations. Approximate gradient and direction of slopes after grading operations. ;fir, C3 Overland runoff (sheet flow) coming onto the site from adjacent areas. Erosion Control Practices C) Location of temporary soil storage piles. Note: soil storage pies should be placed behind a sediment fence, a 10 foot v=oet ative strip or should be covered with a tarp or more than 25 feet from any downslope road or drainageway. Location of access drive(s). Note: Access drive should have 2 to 3 inch aggregate stone laid at least 7 feet wide �,. and 6 Inches thick. Drives should extend from the roadway 50 feet or to the house foundation (whichever is less). K I!!ca r Location of sediment controls (filter fabric fence, straw bale fence or 10- foot -wide s;Fti' vegetative strip) that will prevent eroded soil from leaving the site. t: Location of sediment barriers around on - site storm sewer inlets. Location of diversions. Note: Although not specifically required by code, It is recommended that ccncen- :: trated flow (drainageways) be diverted (re- directed) around disiurbe areas. Overland runoff (sheet flow)from adjacent areas greater than 10,000 sq. ft. should also be diverted around disturbed areas. Location of practices that will be applied to control erosion on steep slopes (greater than 1:• 12 grade). '^ f (. Note: Such practices include maintaining existing vegetation, placement of additional r sediment fences, diversions, and re- vegetation by sodding or seeding wi.h use of erosion control mats. Location of practices that will control erosion on areas of concentrated runoff flow. :K Note: Uns[abilized drainageways, ditches, dhersions, and inlets should be protected i' from erosion through use of such practices as in- channel fabric or straw bale barriers, erosion control mats, staked sod, and rock rip -rap. When used, a r g iven In- channel barrier should not receive di ainage from rnore than two acres of unpaved area or one acre of paved area. In channel practices should not be installed in perennial streams (streams with year round flow). Location of other planned practices not already noted. •' V Indicate management strategy by checking (✓) the appropriate box. A a O. Management Strategies �i z ❑ Temporary stabilization of disturbed areas. ' Note: It is recommended that disturbed areas and soil piles left inactive for extended periods of time be stabilized by seeding (between April 1 and September 15), or by other cover, such as tarping or mulching. Permanent stabilization of site by re- vegetati ,n or other means as soon as possible (lawn establishment). • Indicate re- vegetation method: Seed ❑ Sod ❑ Other x Expected date of permanent re- vegetation: _ • Re- vegetation responsibility of: ❑ Builder Owner /Buyer • Is temporary seeding or mulching pl3p.ned if site is not seeded by Sept. 15 or sodded by Nov. 15? P es ❑ No fl,r use of downspout and /or sump pump outlet extensions. Note: It is recommended that flow from downspouts and sump pump outlets be routed through plastic drainage pipe to stable areas such as established sod or pavement. l,d Trapping sediment during de- watering operations. Note: Sediment -laden discharge water from pumping operations should be ponded behind a sediment barrier until most of the sediment settles out. 7E Proper disposal of building material waste so that pollutants and debris are not carried x IF'Li1 off -site by wind or water. Maintenance of erosion control practices. • Sediment will be removed from behind sediment fences and barriers before it reaches a depth that is equal to half the height o f the barrier, r Breaks and gaps in sediment fences and barriers will be repaired imme- diately. Decomposing straw bales will be replaced (typical bale life is three months), • All sediment that moves off -site due to construction activity will be cleaned up before the end of the same workday, • All sediment that moves off -site due to storm events will be cleaned up before the end of the next workday. • Access drives will be maintained throughout construction. • All installed erosion control practices will be maintained until the disturbed areas they protect are stabilized. For more assistance on plan pr`paraticn, refer tc the Wisconsin Uniform Dwelling Code, the DNR Wisconsin constructio,) Sire aeSt Management Handbook, and UW- Extension publication Erosion Control for Home Builder,. The Wisconsin Uniform Dwellirg Code and the Wisconsir Corsiruclion Site Best Management Handbook are available through the State of Wisconsin Document Saes, (608) 266 -3558. Eio_ion Control for Home Builders (G% '0001) can be ordered through Extension Publications, (608) 262 -3346 of the Department of Commerce, (60F,) 207 - 4405. - i M 91 � o j o ` e �� 3 Qj L 1 L 1...�� v� C \ ' 7 4O � g Ct i .� p, u a � a s j Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Wi 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code couinty g 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 Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. o oZ A 1 0'7 Y — Yo — Please print all Information. a by Date _ Personal information you provide may be used for da ' s.15 (1) (m)). 5 t7 LL Property Owner Pr Location e „ .� -) I Z Go Lot S 114.S 1/4 S .�6 T o N R E( W Property Owner's Mailing Address Lot Block # Subd. Name or CSM# 1 P0h A.r_Y -eS A r . City State Zip Code hone G OFFICE ❑ itY ❑ Village own Nearest Road r1 t c��vas�- 17r'• ❑ New Construction Use: 0 Residential / Number of bedrooms — Code derived design flow rate S GPp tt -Ke'placement ❑ Public or commercial - Describe: l Flood Plain elevation if applicable Parent material - General comments CSC x 7S C� // wl �� -Sd`��� G«`Ae- and recommendations. mocfv'c� F p Borin Boring # [D/ Ground surface elev. C� L� ft. Depth to limiting factor 7 in. Soil Uplication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efl1#1 Lj o w t� 3 I 0 V 4 V a cj � t c Boring # ❑ Boring 4 cam+- // D�t Ground surface elev. I G ft. Depth to limiting factor 7 In. Appl ication Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f>F in. Munsell Qu. Sz. Cont. Color Gr. Sm Sh. *E 5 3 - y c - S v►1 b 1- LL I F , - e^ 2 `� 7 S ea l C S(, - F f C�r,cJ 3 C 5 b v , Effluent #1 = BOD > 30 <_ 220 mg1L and TSS >30 150 mg/L ' Effluent #2 = BOD 1 30 no t and TSS 1 30 mg/L CST Name (Please Port r Signature WT Number P n r .0 ¢ S Q le__ c Date Evaluation Conducted Telephone Number Address Ul lP 770 f� 7 TH � - �� � • A Parcel ID # Page a Of 3 Property Owner 7►,°Hi /7111 Z F _-3] [] Boring Boring # r ., t g ft Depth to Iimiting factor In. Application Rate Lam p Ground surface elev. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff - .:.. , in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. � ( 0 'Eff#1 'Eff#2 o : Z1 k CA t u F a _ 3 -S 5 Z 7 e S t I S F-1 ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in Soil Application Rate ❑ Pit GPDM Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 - Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. i I Boring �. Boring # Ground surface elev. ft. Depth to limiting factor Appl ication F Rate ❑ Pit Roots GPOlff Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary *Eff#1 •Etf#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I Effluent #1 = BOD > 30 < 220 mglL and TSS >30 150 mglL ' Effluent #2 = BOD _< 30 mg1L and TSS _< 30 mg1L Th p ' The Department of Commerce is an equal opportunity service provider and employer. Y need assistance to access services or p em to er. If you - _ need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 8777. SBD -8330 (RAW) Z O a w , o C � , P ; `ri f CO � O � n w Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 Mir TDD #: (608) 264 -8777 erc Visconsin www w ww.commerce.state.wi.us/sb ons .wisonsin.gov Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Secretary July 16, 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 PLAN APPROVAL EXPIRES: 07/16/2004 Identification Numbers Transaction ID No. 766045 SITE: Site ID No. 647421 Ken Hinz Please refer to both identification numbers, 110 Ponderosa Drive above, in all correspondence with the agency. Town of Kinnickinnic, 54022 St Croix County SE1/4, SW1/4, S26, T28N, R18W FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 860058 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 Condit (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10573 -P (R.6/99). APP+ • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. DEP RTMENT ( Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal E are prohibited. - - - SEE CORRE; • The existing POWTS must be properly abandoned per Comm 83.33 Wisc.Adm. Code. • 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. w BENNIE W HELGESON Page 2 7/16/02 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 component(s) for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for o the 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, Fee Required $ 175.00 Fee Received $ 175.00 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 cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544 4 INDEX SHEET RECEIVE '6 S L11V 28 2002 AFETY & DLD GS DIV. PROPERTY OWNER: KEN HINZ 110 PONDEROSA DRIVE RIVER FALLS, WI 54022 PROJECT NAME: KEN HINZ PROJECT LOCATION: SE 1/4, SW 1/4, S 26, T 28 N, R 18 W MUNICIPALITY: TOWN OF KINNICKINNIC 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 WLP1000 /600 - MR ZABEL Tank Specifications Page 6 Pump Specification .y Page 7 POWTS Owner's Manual & Management Plan - Pg. 1 CO6} D Y MERCE Page 8 POWTS Owner's Manual & Management Plan - Pg. 2 +JILL) -PONpE Name: Bennie Helgeson Sign d Address: W1229 770th Avenue Spring Valley, WI 54767 Credential Number: 220292 Date: June 26, 2002 S r6 b s rib 04 7T� Vz- gul �C J s-. � T obi 0 c, o — G 1 P � 1 � 1 'b C Li Lo fi o c o Q I � i T U i E �EA1 i tiz Page . Of$ L , Synthetic Covering Distribution Pipe AsT!vvl C 33 Medium Sand H G Topsoll =— == .s 3 E b E % Slope Fkv, y C[:fr�.Of 2�— 2 i Force ain Plowed From Pump Layer Aggregate '/ D t S Ft" E •7y Ft. Cross Section Of A Mound F , �3 Ft. G . Ft. A ! Ft. H / Ft. TS' Signed: g 7 Ft. ✓ License Number: K 13�Ft. j L gI7 Ft. Da te: j _ Ft. T Ft. W 2 Ft. L Observation Pipe D K IV, - - - -- -- -------------------- - I W �� 1- - - - - -- - - -- j r 1 % Distribution ��l.L Of 2 — 2 2 Pipe Aggregate Observation Pipe �rea Plan View Of Mound l� KEN i z 3 0 g t . Perlorolod Pipe Oeloll iE'CiVO�}� 0 End View Perloroled PVC Pipe �0 Holes Located on Bottom are Equally Spaced Pipe I Distribution Pipe La out P R S X �r Y Hole Diameter _ Inch Signed: License Number: Lateral " / Inch (es) Manifold " a_ Inches Dace: Force Main " 2 , Inches - Y TWO '76 -r6 _,(J1�ll! i✓ l2,' KEIv • i7 / iZ Page__�Of_L_ SEPTIC TANK 'E PUMP CHAMBER CROSS SEC TI ON AND SPECIFICATIONS Lill fkK.. VENT PIPE 12" MIN. ABOVE GRADE 6 JUNCTION WEATHERPRO APPROVED 25' FROM DOOR, WINDOW OR WITH CONDUIT MANHOLE COVER FRESH AIR INTAKE W/ PADLOCK E FI 4IN. ED GRADE WARNING LABEL , 4" MIN. 4'�PUC 0e6ERVAt s•D• u 18" PIP E INLET 1 .. GAS- WATER TI SEALS '� TIGHT �� \APPROVED A SEAL JOINTS WITH S1 ER __f___ ALM APPROVED PIPE APPROVED � x ��,, B ON 3' ONTO PIPE 3' _F_ SOLID SOIL ONTO SOLID C ' SOIL PUMP OFF ELEV.� FT. --- OFF D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE // /_3Y x S TANK MANUFACTURER: TANK SIZES SEPTIC %Qoo GAL. DOSE VOLUME INCLUDING 74 GAL. DOSE (00 GAL. 1 �� 3 &, � , �— F LOWBAC K : _11_ ---- 5.3. ��.S �FS CAPACITIES: A INCHES ? O .� GAL. ALARM MANUFACTURER: MODEL NUMBER: B = 2 INCHES = 33. SS.) GAL. SWITCH TYPE: (� / _ PUMP MANUFACTURER: Z©elh� C = 6 INCHES = /Gd,�� GAL. MODEL NUMBER: D = f INCHES = &1 - GAL. SWITCH TYPE: REQUIRED DISCHARGE RATE �. �p GPM PUMP li ALARM WIRING AS PER ILHR 16.23 WAC /. S VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE FEET FEET + MINIMUM NETWORK SUPPLY PRESSURE FEET + =7 FEET FORCEMAIN X �.(� FT /100 FT. FRICTION FACTOR TOTAL DYNAMIC HEAD INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH DIAMETER LI UID b __ 3�" �ncLt� C•.S�t� SIGNED: LICENSEE NUMBER: DATE: 1/88 ` a � 1330 8 ES � d�� Na Lr) �NW a Q oO 2 = W Z F �a y O C.) IL I� O 1O F� U rn 8F� F= x �m zz of M. O VS Up WWI �t9 0 w p m,09 Via WN C9 C o lid 4M if) A w O * r- t FZ �.,� 30 z o s . Z .a- Z 3 A -- 1 W • w • t 1 I 5 W in t N w � o • s C w�g w 99 O K�5 ti ///A) z o $ HEAD CAPACITY CURVE MODELS 1371139 4 13/16 7 7 /16 2 MODELS 137/139 Ft. Meters Gal. Ltrs. ' 4 6 1/8 a 5 1.52 93 352 25 10 3.05 79 299 0 15 4.57 64 1 242 o 4 13/16 6 20 20 6.10 36 136 o ' — 0 25 7.62 8 30 15 Lock Valve: 26 ft. 0 1 1/2 - 11 1/2 NPT a 10 2 5 I 0 13 .S. GALLONS 10 20 30 40 50 60 70 80 90 100 110 TIERS e0 160 240 320 400 I I 4 0 FLOW PER MINUTE 009921 1 SK373 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Three phase pumps are available in 200/208V, 230V or 460V. • Variable level control switches are available for controlling single and three • Electrical alternators, for duplex systems, are available and supplied with phase systems. an alarm. • Double piggyback variable level float switches are available for variable • Mechanical alternators, for duplex systems, are available with or without level long cycle controls. alarm switches. • Over 1307. (54 °C.) special quotation required. • Simplex Panels are available for 3 phase pumps. • Refer to FM0806 for 200° F. applications. • Control alarm systems are available for 1 phase pumps. 137 Series - 47 lbs. 139 Series - 51 lbs. SELECTION GUIDE Single Seal Control Selection Listi n s 1. Integral float operated 2 -pole mechanical switch, no external control required. Model volts - Ph Mode Amps Simplex Duplex CSA UL 2. Single piggyback variable level float switch or double piggyback variable level M137/139 115 1 Auto 10.7 1 or 1 &8 — Y Y float switch. Refer t0 FM0477. N137/139 115 1 Non 10.7 2 or 2& 7 3 or 5& 6 Y Y BN137 115 1 Auto 10.7 •• Y Y 3. Mechanical alternator M -Pak 10 -0072 or 10-0075. Refer to FMO495 D137/139 230 1 Auto 5.8 1 or 1 & 8 — Y Y 4. Simplex three phase control panel. Refer to FM1228. E137/139 230 1 Nan 1 5.8 2 or 2& 7 3 or 5& 6 Y Y • H137/139 200.208 1 Auto 6.2 1&8 _ Y N • See FM0712 for Correct model of Electrical Alternator. • 1137/139 200.208 1 Non 6.2 2&7 3 or 5 & 6 Y N 6. Variable level control switch 10 -0225 used as a control activator, specify duplex • J1371139 200.208 3 Non 2.6 4 3 &4 or 5 &6 Y Y (3) or (4) float system. • F137/139 230 3 Non 2.6 4 3 &4 or 5 &6 Y Y • G137 460 3 Non 1.4 4 3 &4 or 5 &6 N N • G139 460 3 Non 1.4 4 3 &4 or 5 &6 N N No molded plug "Single piggyback switch included. Pumps must be operated in upright position. CAUTION Three phase units require a control switch to operate an external magnetic contactor. All installation of controls, protection devices and wiring should be done by For information on additional Zoeller products refer to catalog on Piggyback Variable Level Float a qualified licensed electrician. All electrical and safety codes should be Switches, FM0477; Electrical Alternator, FM0486; Mechanical Altemator, FM0495; Alarm Package, followed including the most recent National Electric Code (NEC) and the FM0732; and Sump/Sewage Basins, FM0487. Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO. P.O. BOX 16347 ` Louisville, KY 40256 -0347 Manufacturers of. . O / SHIP TO. 3649 Cane Run Road e FAMW 1(502) Louisville, KY 40211 -1961 (J&AUrY�!/d/Pff S1 , 07 �f�9 http://www.zoeller.com PUMP 7 FAX (502) 774-3624 928 - PUMP © Copyright 2001 Zoeller Co. All rights reserved. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page --6—of19 FILE INFORMATION SYSTEM SPECIFICATIONS Owner KEN HINZ Septic Tank Capacity 1000 a l ❑ NA Permit # Septic Tank Manufacturer WIRSER CONCRETF NA DESIGN PARAMETERS Effluent Filter Manufacturer ZABEL ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model A -100 12" x 16'0 NA Number of Commercial Units (2 NA Pump Tank Capacity 600 gal ❑ NA Estimated flow (average) 300 gal/day Pump Tank Manufacturer WIESER CONCRETV NA Design flow (peak), (Estimated x 1.5) 450 gal/day . Pump Manufacturer ZOELLER PUMP COO NA Soil Application Rate 0 5 al/da /ft Pump Model 137 ❑ NA Influent/Effluent Quality Monthly average* Pretreatment Unit (3 NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand/C;ravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 420 mg /L ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 m /L ❑Disinfection ❑Other. Manufacturer Pretreated Effluent Quality . O NA Monthly average" Dispersal Cell(s) Biochemical Oxygen Demand (BOD 530 mg /L ❑ In -ground (gravity) ❑ In -ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ At -grade M Mound Fecal Coliform (geometric mean) 510' cfu/100m1 ❑ Dri line [3 Other Maximum Effluent Particle Size Y inch diameter Values typical for domestic (non- commerclaQ wastewater and septic tank effluent. ++ Values typical for pretreated wastewater. MAINTENANCE SCHEDU Service Even Service Frequency Inspect condition of tank(s) At least once every 2 ❑ months 11 year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y,) of tank volume Inspect dispersal cell(s) At least once every 2 ❑ months 12 years) (Maximum 3 yrs.) P Clean effluent filter At least once every 1 ❑ months . [ year(s) Inspect pump, pump controls & alarm At least once every 1 ❑ months 11year(s) ❑ NA Flush laterals and pres te At least once every 3 ❑ months Qyear(s) ❑ NA 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 Maintainer, Septage Servicing Operator. Tank inspections must include a visual Inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the Immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (1) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatipment 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 hi h concentrations are Y Pe P 9 P g detected have the contents of the tank(s) removed by a septage servicing operator prior to use. it OWNER: KEN HINZ S TAhT UP AND OPERATION Page __7 of 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. 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 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 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. ABANDONMENT 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 chapter 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 compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and 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. 0 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 POWTS INSTALLER POWTS MAINTAINER Name HET-GESON EXCAVATION INC Name JOHNSON SANTTATTON Phone 715/772 =3278 Phone 715/273 -5811 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name JOHNSON SANITATION Name ST CROIX COUNTY ZONING Phone 715/273-5811 Phone 715/386 -4680 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �C E? ►� �� I V I -z— Mailing Address I I b 'P of E-ro C --7�)r', r) P, Property Address Q S� r U (Verification required from Planning Department for new construction) City /State l'l U 2a( V"`) UJI Parcel Identification Number LEGAL DESCRIPTION Property Location S5 ' /4, SU) 1 / a, Sec. Q6,_, T _N -R _W, Town of �h c �'!n n! c, Subdivision tq/'q , Lot # t Certified Survey Map # , Volume , Page # Warranty Deed # Z3 '? IRA , Volume Page # Spec house ❑ yes I9 no Lot lines identifiable M yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, 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 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. 16"ax — . )0� -- - I / - 1 - 4/oz SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. t 7 /A9/ ov SIGNATURE OF APPLICANT 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 230 WARRANTY DEED. STATE OF WISCONSIN —FORM No. 1 - I NUMBER This Indenture, made this 12th, day of May A. D., 19 56, between John Hinz and Hulda Hinz, husband and wife - 239986 part ies of the first part, and Kenneth 0, Hinz and 3etty J. Hinz, husband and wife, as joint tenants part ie s of the second part. WITNESSETH, That the said part ies of the first part, for and in consideration of the sum of Two thousand five hundred dollars (42,500.00) and no /100 cents to them in hand paid by the said part ie s of the second part, the receipt whereof Is hereby confessed and acknowledged, he ve given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and by these presents do give, grant, bargain, sell, remise, release, alien, convey and confirm unto the said part ies of the second part, their helm and assigns forever, the following described real estate, situated in the County of St. Croix and State of Wisconsin, to -wit: the idortheast one - quarter (NE-4) of the Northwest one - quarter (N'uo4) of Section thirty -five (35), Township twenty eight (28) ,North, Range eighteen (18) Nest; and the East one -half (E ) six (26 Township ti -ril . ;'-'.:t (28) of the Soutiivest one - quarter (Sir,) of Section twenty xf� �tCh�xr 9:,R��3 .tKS�f6cx r,inFe eighteen (10) !'rest. (s 2.75) (R. S. (Can. ) i i I I I I TOGETHER with all and singular the heroditaments and appurtenances thereunto belonging or in any wise appertaining; and all the estate, right, I title, Interest, claim or demand whatsoever, of the said part ieS of the first part, either in law or equity, either in possession or expectancy of, In and to the above bargained premises, and their hereditaments and appurtenances. TO HAVE AND TO HOLD the said premises as above described with the hereditaments and appurtenances, unto the said part ieS of the second part, and to their heirs and assigns FOREVER. AND THE SAID John Hinz and Hulda Hinz, husband and wife _- 1 for their heirs, executors and administrators, do covenant, grant, bargain and agree to and with the said part ies of the second part, their heirs and assigns, I XWd that the above bargained premises in the quiet and peaceable possession of the said part ie s of the second part, their heirs and ! assigns, against all and every person or persons lawfully claiming the whole or any part thereof,* c' IN WITNESS WHEREOF, the said part ies of the first part be ve hereunto set their hands and seal this 12th. day of May , A. D., 19 54 Signed and Sealed in Presence of John Hinz (SEAL) John i F. 0. Yahnke Hulda Hinz (SEAL) F. 0. Yahnke Hulda Finz Darlene Johnson (SEAL) Darlene Johnson STATE OF MUSOODMMpm TAINNE TA (SEAL ) i as. i Faribault County.T Personally came before me, this 12th. day May A. D., 19 54 the above named John Hinz and Hulda Hinz, husband and wife i to me known to be the person who executed the foregoing Instrument and acknowledged the same. Received for Record this 11th. day of F. 0. Yahnke F. 0. Yahnke May A. D., 19 54 , at 4 o'clock P.M. Minn. ' (SEAL) Notary Public, Faribault County, Yc David Hope Register of Deeds. My Commission expires April 12 A. D., 19 60 Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 ,scons in www.commerce.state.wi.us /sb Department of Commerce RECEIVED www.wisconsin.gov Scott McCallum, Governor JUL 6 2002 Philip Edw. Albert, Secretary S ZONIONG OFFICE July 16, 2002 CUST ID No.220292 ATTN: 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 PLAN APPROVAL EXPIRES: 07/1612004 Identification Numbers Transaction ID No. 766045 SITE: Site ID No. 647421 Ken Hinz Please refer to both identification 110 Ponderosa Drive numbers, above, in all Town of Kinnickinnic, 54022 correspondence with the agency. St Croix County SE1 /4, SW1 /4, S26, T28N, R18W FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 860058 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.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10573 -P (R.6/99). • Per manual cited 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. • The existing POWTS must be properly abandoned per Comm 83.33 Wisc.Adm. Code. BENNIE W HELGESON Page 2 7/16/02 • 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. 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. c BENNIE W HELGESON Page 3 7/16/02 Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday WiSMART code: 7633 cbratz @commerce.state.wi.us cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544