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HomeMy WebLinkAbout028-1054-02-000 \ y \ -0 % � » § j & \ 0 7 0 m \ \ � . & � \ � G � , 5 \ L6 E ± a a \ z / § { \ t § � } \ \ } § k ) E E 5 % / to S ' \ '0 ) t # R k k k \ 0 § _ ( # G ` E % £ § \ m co U) E @ \ ~ \ / K \ K '� 0 \ 7 2 2 2 7 § \ 4 N N \ 2 ] \ q \. 8 8 � ƒ \ k k ) o < q o s \ a \ > \ # 7 / ® . 0 \ C, \ \ / 2 M G ° 2 8 \ 9 m§ C _= 2 = N 04 / ® - : \ m r \ \ \ . & G / \ > > 7 ° » / § § J \ 6 \ o k { } }) \ _ \ § J $ a \ \ § CL - _ . > " IL » a CL _ < t , c t c k a. \ k k ) uacuasD3, VP I I p \ \ a6o b' .I N 0) 494' rn N II I J / / Q � f ' v / ✓ ' \ / , 8l 00 N/ cp / 510 : — i I �/ y / —O cr) 000 / / : Q� I ��/ 4- 508 ' Zr / / // / r7I O 00 loot -- — It —010— ono (L a r•7 1,91.00N - \, Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety anVuilding Division INSPECTION REPORT Sanitary Permit No: 420526 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)]. ZO ZSv Permit Holder's Name: City Village X Township Parcel Tax No: Ellis, Jeff Rush River Township 028- 1054 -02 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: (�D •O 0(0 K7 Q& at g Z 13.28.17.352 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION dg BS HI FS ELEV. Septic Benchmark r 1 ciao Am e: •" IcxDISo �jb •o Dosing `t Alt. kw. A& 0� I' !4 ' zo r Aeration Bldg. �•�� - 1 I c T� Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ? t ` <0 Dt Bottom OZ p t • 8 t 2• `f Dosing t� lc tt g� t Header /Man. 3.10 � r Aeration _ Dist. Pipe � 3 O r Holding Bot. System . (O �b • I to Final Grade PUMP /SIPHON INFORMATION L- t ,,, ' t U I -U�:Q - - ed Manufacturer Demand St Cover p i rc`LC —Q d GPM 2'2� ! $'2� Model Number 31.0 6 �' S• �fo Li% • (Z Friction Loss System Head TDH Ft gy p• •$Z 3 -3o .2 Forcemain Length t Dia. 2 t� Dist. to Well 6 S ABSORPTION SYSTEM ) s = .In E Width Length t No. Of Fremehes PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth —15 IMENSIONS $' ! ' Q21 1 � S SETBACK SYSTEM TO P/L / BLDG WELL LAKE /STREAM LEAC G A01arMffachirer. INFORMATION CHAMBE Type Of Syste Z2 D f C � I ` 1YnV � ) el Number. DISTRIBUTION SYSTEM 1,�{o A9o. PAL Header /Manifold Distribution ( !t x Hole Size tt x Hole Spacing u Vent to Air Intake Pipes) �7 ,t,(. / tL �^ Length .Q Dia 2 Length Dia L Spacing t' �1 /(o T 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 IN No Fai Yes [N No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: � O6 / Inspection #2: ' ---- 5�� .A44'D Location: 2012 37th Ave Baldwin, W I , 54002 (SW 1/4 NW 1/4 13 T28N R1 7W) Rus `h Wood Point Lot 2 Parcel No: 13.28.17.352 1.) Alt BM Description t`f ' e. 2.) Bldg sewer length n - amount of cover = t+2,'(+ t+2,'(+ -A t - J CAD Plan revision Required? N Yes X No Use other side for additional information. SBD -6710 (R.3/97) Dat Insepctors Signature Cert. No. r ` -� Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division • • INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 420526 0 GENERAL INFORMATION 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: Ellis, Jeff Rush River Township 028 - 1054 - 02-000 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS � ELEV. `� OD• 9lo,D Septic Benchmark Uvfl /,6 30 Dosing � I Alt. BM t Aeration B1 6g. S6 ,h , Holding St/Ht Inlet • 2 , TANK SETBACK IN ORMATION St/Ht Outlet TANK TO P/L LL BLDG. Vent to Air Intake ROAD Dt Inlet Septic t Dt Bottom Dosing Header /Man. Aeration Dist. Pipe 3 - f o 3 . `In 0(.1 Holding Bot. System /V ./b Final Grade \0tN4 PUMP /SIPHON INFORMATION Manufacturer Demand St Cover ' S( Z. GPM ZS Z - Model Number TDH Lift Friction Loss System Head T ) Ft c Forcemain Length � i Dia. Dist. to Well LC SOIL ABSORPTION SYSTEM S, 0 S. ?.0 5 I o BED /TRENCH Width Length No. Of Trenches DIMENSIONS N Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG / IWELL LAKE /ST AM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: ZZ / OS f UNIT Model Number: DISTRIBUTION SYSTEM L-4 f' i Header /Manifold Distribution x Hole Size E pacing Vent to Air Intake Pipe(s) Length Dia Length Di Spacing SOIL COVER x Press re Systems Only xx Mound Or At -Grade Systems Onl Depth Over Depth over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed ench Edges Topsoil A, Yes ❑ No Fis Yes ] No COMMENTS: (Include code dis pencies, persons present, etc.) Inspecti #1 IOs ection #2: �—a / —� Location. 2012 37th Ave Bal in, WI 54002 (SW 1/4 NW 1/4 13 T28N R17W) RusPrWood PomtLot 2 It".'- Pa el No: 13.28.17.352 1.) Alt BM Description = 2.) Bldg sewer length - amount of cover = 3.) Contour = revis Plan Use others de for additional inlformation. No — — SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. L i Safety and Buildings Division County Vv 201 W. Washington Ave., P.O. Box 7162 6consin Madison, WI 53707 - 7162 Site Address De artment of Commerce 2o)2 3 }� Sanitary Permit Application Sanitary Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision�� may be used for secondary ses Privacy Law, sl5. 1 _ to I. Application Information - Please Print All Information State Plan I.D. Number 71(4 7Co Property Owner's ame� �" , �v `o Parcel Number Z �, c!i ,,�4 , - v [• ozg - IDS nz- ergo (. 352 rty Owner's Ma#Kg AddressSQL Property Location City, State Zip Code P ne Number �O0 t Number Block Numbe r S� t N N d_ G Subdivision Name CSM Number Z � � Z �st- wt� Po II. of Building (check all that apply) ,� 4X4- ❑City r 2 Family Dwelling - Number of Bedrooms G�r�/ ❑V Se ❑ Public /Commercial - Describe Use ownship ❑ State Owned MAI net 10 / e0 � X �'�' �-� 0-"- e 9S � / Nearest Roa -t l = I . M. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. ew 2 ❑Replacement System 3 El Replacement of 6 11 Addition to For County use stem I Tank Only stem B. ❑Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. of Permit: (Check all that appl umbering scheme is for internal use) 44 Non - Pressurized In- Ground 47 ❑ Sand Filter 50 ❑ Constructed Wetland ❑ Pressurized In- Ground 41 ❑Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dispe rsaUTreatment Area Information: D Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals./Days/ .Ft.) � h) Elevation 7116 . Tank Min Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks / Concrete Constructed Glass New Existing (� Tanks Tanks Septic or Holding Tank _9� Dosing Chamber VII. Responsibility Stat ent- I, the undersigrod, Asume responsib ty for installation of the POWTS shown on the attached plans. Z Plum Name (Print) Plumber's �S RS N b Business Phone l Plumber's Addre7? , State, Zip / r VIII oust /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Da Issued Is Signature Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse 2 2 ^) Determination J � IX. Conditions of Approval/Reasons for Disapproval rl Attach � /f? dz+-►� d •>/o � �+J� -� �- c.�.�!A>w liter S� ��jl ��`�'�` ��ef� <0 /iS! /0 Z � !� r� �/ complete plans (to the only) for the em on paper less than 81/2 inches S -63 (R 98 � /Ol � � 3�/� ' PLOT PL PROJECT Jeff Ellis ADD s 8504 Jensen Ave S. Cottage Grove Mn 55016 SW 1/4 NW 1/4S 13 /T 28 N/R W TOW Rush River COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 9/26/02 BEDROOM 3 CONVENTIONAL AT- CONVENTIONAL LIFT HOLDING TANK MOUND XXX)C SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of chambers none BENCHMARK V.R.P. Top of steel fence post ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. p. NE corner of property SYSTEM ELEVATION 96.4' Scale = 1 /4" = 10' o Couldesac to Cty Rd Y o m r m Grading is to be done to divert run -off away from system - o Pro 3 Bedroom fD House r m Tank is to be properly bedded Huffcutt Comb Tank P Pe Y and provided with lockdown o covers with approved warning labels Q B.M. c B -1 B -2 96' 95 Alt. B.M. 94' 93' B -3 150' Well is to meet all 8% setbacks found in Comm. Slope Area 15' Below System 83 j �f 3 ( is to remain undisturbed Property Line r Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 *isconsin TDD r .sta 264 -8777 www.commerce.state.wi.us/sb www.wisconsin.gov Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Secretary October 14, 2002 CUST ID No.226900 ATTN.• 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: 10/14/2004 Identification Numbers Transaction ID No. 794761 SITE• Site ID No. 651519 Jeff Ellis Please refer to both identification numbers, Cth Y above, in all correspondence with the agency. Town of Rush River St Croix County SWIA, NWIA, S13, T28N, R17W FOR: Description: Mound 450 Gpd. Object Type: POWT System Regulated Object ID No.: 874040 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: Correspondence Notes: • This plan action is subject to designer notes / comments on the plan. • 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" Version 2.0 SBD- 10691 -P (N.01101) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD- 10706 -P (N.01 /01). • Comm 84.10, All materials used in this installation shall conform to the provisions of this chapter. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to 0 inspection by authorized representatives of the Department, which may include local inspectors. All permits 3R 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. Iti r SHAUN R BIRD Page 2 10/14/02 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 Thomas E Devereaux / Plumbing / POWTS Reviewer II, Integrated Services WISMART code: 7633'' (715)634-3026, 7:45 am - 4:45 pm Mon. - Fri. tdevereaux@conimerce.state.wi.us cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 9 /26/02 Owner: Jeff Ellis Location: Lot 2 Cty Rd Y 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 5. Pump Chamber Cross Section 6. Pump Curve 7 -9. Maintance and Contigenc plan �. 10 -12 Soil test �s WID 11D1N Signature License number/046900 P�ypENc 9/26/02 -Z�- . 7 / PLOT PL PROJECT Jeff Ellis ADD s 8504 Jensen Ave S. Cottaae Grove Mn 55016 SW 1/4 NW 1/4S 13 /T 28 N/R W TOW Rush River COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 9 BEDROOM 3 CONVENTIONAL AT- CONVENTIONAL LIFT HOLDING TANK MOUND Xxxx SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of chambers none BENCHMARK V.R.P. Top of steel fence post ASSUME ELEVATION 100' Filter Zabel A -100 [:]BOREHOLE O WELL +H. R. p. NE corner of property SYSTEM ELEVATION 96.4' Scale = 1/4" = 10, o Couldesac to Cty Rd Y o m r m Grading is to be done to divert run -off away from system Pro 3 0 Bedroom CD House r CD Tank is to be properly bedded Huffcutt Comb Tank P P Y and provided with lockdown o covers with approved warning labels o B.M. o 96' B -1 B -2 95 ' Alt. B.M. 94' 93' B -3 150' Well is to meet all 8% setbacks found in Comm. Slope Area 15' Below System 8 3, is to remain undisturbed Property Line No G 6 Y a Date 4" Observation Pipe Perforated Non -Woven Filter Fabric Below Filter Fabric Distribution pi / A ' S'a[ C-33 Sand � ' 4 _" Topsoil ~ G E ice. 7. Slope q�,�� Bed Of YIL 2 Forte M.oin Flawed Drain Rock From Pump Layer Cress Section Of A Mound •System Using A Bed For The Absorption Area F � G A 2S Ft. I Ft.- J 0 Ft. - - - _ K i Ft. !n was W Ft. L J 4 Pipe CL aL A W t'n �--: - - -- -------- - - - - -- --------------- - -• - -_ Force Main From Pump p Distribution Bed Of 72�— 2 Pipe Drain Rock 4 Observation Pipe Permanent Marker Pipe or Rods Pion View Of Mound Using A Bed For The Absorption Area PAG E_„i3OF_ Perforoted Pipe Wall �0 % Eno View ) Perforate* PVC Pipe Moles Located On $ottmA, / Are Equally Spocsd S(� r PVC Fares Moist is A - � t'tRST t1o1.L *ttiX4 re CanAtG+tor! PVC Mota Pipe I tt. •'"/L ... t.[.Jos - Distribution Pipe La yout - P Ft. R R. Inches Inches Signed- Hole Diameter nch License Number: ���j�� Lateral " ;F Date: f 'v Z- -- M4nifold Inches_ • .._ Force Main " Inches # of holes /pip /� Invert Elevation of Lateral &,) Ft... rage ur SEPTIC TANK E PUMP CIfAMBER CROSS SECTION AND SPECIFICATIONS v" Cl VENT PIPE 12" MIN. ABOVE GRADE 6 WEATHERPROOF > 2S' FROM DOOR, WINDOW OR JUNCTION 8OX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W/ PADLOCK 6 FINISHED GRADE WARNING LABEL Tp PCOA• 4" MIN. a 18" xN. ' C.Z. isl6ER z D. INLET • WATER TIGHT SEALS GAS- , ' TIGHT - \.APPRMD flur A SEAL , ' JOINT$ WITH APPROVED B ; • PIPE 3 —�— , ONTO ONTO S�.IQ C I ON SOLID SOIL SOIL PUMP OFF ELEV . ��FT. _+_ OFF D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS I �'ls�c SEPTIC / DOSE TANK MANUFACTURER: L NUMBER DOSES PER DAY: TANK SIZES SEPTIC GAL. DOSE VOLUME INCLUDING DOSE tiAL• FLOWBACK: GAL. ALARM MANUFACTURER: CAPACITIES: A - ��_NCHES - � s GAL ' MODEL NUMBER: B = .2 INCHES = �6AL. SWITCH TYPE: � � PUMP MANUFACTURER: -_ C = INCHES = GAL. MODEL NUMBER L3ti/ !s' a D = � INCHES = GAL. SWITCH SWITCH TYPE: REQUIRED DISCHARGE RATE 3 GPM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE ./ FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . - - - - M FEET +cJ' FEET FORCEMAIN X _? FT /100 FT. FRICTIOMICAHEADFEET - ---- -• TOTAL DYNA INTERNAL DLMENSIO O PUMP TANK: LENGTH Dy e DIAMETER LIQUID iTV'I'H� SIGNED LICENSE NUMBER DATE /� 1/88 TOTAL DYNAMIC HEAD/CAPACI HEAD CAPACITY CURVE EFFLUEN P ER D rERUtc MODEL 152/153 UJ MODEL 152 153 50 Feet Meters Col. Liters Gol. Liters 153 5 1.5 69 261 77 291 12 152 10 3.1 61 231 70 265 15 4.6 53 201 61 231 = 20 6.1 44 167 52 197 30 8 25 7.6 34 129 42 159 0 30 9.1 23 87 33 125 20 35 10.7 -- -- 22 85 40 12.2 -- -- 11 42 4 1 Lock Volve: 38.0 FL (11.6m) 44.0 R. (13.4m) �' o�ssoe .D 0 •, Q 20 40 60 80 100 GALLONS LITERS o 80 160 240 320 6 1/4 3 3 27/32 4 5/8 FL PER MIN CONSULT FACTORY FOR SPECIAL APPLICATIONS 3 27/32 3• 4 • T"prled dOS�J panels avail". �° " • E1ex*IcEd araw ilaM fbr duplex sysimm, are avalaWe and supplied W11f1 3 27/32 an alarm. • Variable level control switi tm are available for cmbv mg mj& ( I • Dolllle piggybadt vaM* level flod swile s are amil" for vmaMe level 10t1g ad shat cycle controls. • Sealed QA-8ax ava&bie for Outdoor mstallaftm. See FM1420. I • Over 130°F. (54'C.) special quotation required. 152f153 Series' 12 1/8 I isms MOORS Cop" Selection Yodel Volts•Pb Node Ams Duda N152 115 1 Non 8.5 1 2or3 5 1/8 BM62 115 :1 Aub 8.5 Included 2or3 E152 MO i Non 4.3 1 2or3 slranet BE152 230 1 Aub 4.3 bcladed 2or3 N153 115 1 Non 10.5 1 2or3 BN163 115 1 Auto 10.5 included 2or3 SELECTION GUIDE E153 230 1 Non 53 1 2or3 1. f9le p variable lave! flaet sw0G1 «double OF-153 230 1 Aub 533 bEluded 2or3 piggybacitvariableleval00at swNch. Refer to FM0477. n CAt nft 2. See FMD712 br MnW model of Electrical Atier1a11or Epp& Ae bsWom of convols, p vtwdw devices and + kft sbouid be dons by a *Waled 3. Variable level aonbd swrNeh 10.0225 used as a aordrd activator, spa* dupblx (3) Bonged dochieian. A9 electrkat and safety codes sbadd be Wowed inciu ft the own neeratNdiwWEloWkCodoOfMand the Occupatload Safetyand Heft Ad{0SNA1. or ( syftm RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. YAK 10: P.O. BOX 16347 `. taisuiati KY 4256401/7 Uaeraasof. . `G SNO'T0: 3619 Can Run Road w iLausrrlb KY 4021 1 -1961 PL//L1/° 7�� 1.1 fXQ 99~ 774,3624 0 Copyright 2000 Zoeller Co. All rights reserved. ya Maintenance and Contingency Plan for a Mound System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Dose Chamber is to be pumped at the same time as the septic tank. 3. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 4. Once every 3 years the mound is to be inspected via the inspections pipes in the at- grade. The laterals are to be inspected via the cleanouts. 5. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 6. Pump and electrical components are to be checked at the time of the pumping. 7. Owner agrees to leave the area 15' below mound undisturbed. 8. The owner agrees to save this plan. 9. Trees, shrubs, and other similiar vegitation are not be planted on system. The system is not be driven over. 10. Effluent Quality is not to excede the requirements found in Comm. 83 Contingency Plan 1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if needed, then bypass pump float and try pump without float. If this works, float is bad, replace float. If um still does not work, check power at the um with a electrical device p p P pump such as a hair dryer. If no power, check breaker inside house and call a electrician. If there is power, then pump is bad and needs to be replaced by a plumber. 2. If mound fails, determine cause of failure, test another area or remove pipe and sewer rock, retill soil, install new mound system. 3. Replace any other failing components as needed. Important Phone Numbers Plumber: Shaun Bird 715 - 246 -4516 Pumper: Tom Mondor 715 - 246 -5148 St. Croix County Zoning 715 - 386 -4680 Shaun Bird #226900 9/26/02 POWTS OWNER'S MANUAL & MANAGEMENT PLAN P a ge � or FILE O"RMATtON SYSTEM Sp FiCATtONS Owner �, j �' -Tx nk Capaa'� O al ❑ NA �( Tank Manufa rer p NA oEStGN PARAMETERS F� � -e p NA l�taflbe1' 8ednoo 3 FMer Model O p NA Nun*w of Commence Urns NA Pn Tank t h ., 5 al Cl NA 80nafed Now (avefa9e) � Pump Tank a +er M p NA Design flaw (06010. r Pump S ?� p NA .zA Application Rate k EfifdMd ouaw mil/ p knent Uri dU o� A Grease (FOG) 53o mgll. D sandfGfgvr�i Fflter p Peed MW F Fa p M Aeration p wetland M)MM" Oxygen Demand {mss) p DWrifecion p Ofher. Total Sum Solids O'W) 5150 MMtufac —MW Pretreated E Q Monthly averag •• p perset COW Biochemical Oxygen L ( BO D s ) 530 mg& p InVOWW L p to - ground (pressurized) Total Suspended Solids (M) 530 mglL p At- 510` cfufl 0 Fecal CoGForm (� man) . Maximum Effluent Particle Size K Inchdiame VA= typical for domestic (non -Comm 0) wastewa1w and � tonic eAMbnt. •• V M,es typiasi for p *beded wastew W MAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tank(s) At least on every �s p s (Maximum 3 yrs.) Pump out contents of tank(s) When ed sludge and scum equals one- tf>;nd (K) of e Inspect disixulal mss) At Least every 13 months s) um 3 yrs.) clean effluent ftlter At least every (3 months . s) inspect pump. Pump contnot A alarm At least every 13 s) p NA Flusft lateraft and p ressur e test At least every p months s) ❑ NA OMW At least onc a every 13 months O y ear s) 13 NA Odw- At list every p months p year( O NA MAINTENANCE INSTRUCTIONS stiaN be made by rallying one of the fotlowlt9 licenses or ftm inspec ceriffic of Mae deli dispersal POWYS Maintainer: Septage IlAester Plumber: Masher Plumber Restricted . POWYS Inspector: $e ms Operator. TO* rr�ecWW must irwkx a won of the tanks) to identity any missing or Waken hardware identify any c radm or ids. measure the of conubbtied sludge and scum and to check for any back up po g of effluent on the ground surface The d cetl(s) shall be v i sua lly inspected to check the effluent levels or and to check for any Pig an the ground surface, The pond g of effluent m the g the o a swfh tiat Pipes condiffion and req the immediate notion of the local regulatory suttxxity. g round surface may incCate a faNrig When the combined accumulation of sludge and scum in tank equals one tl*d (YO of more of the tank volume. the entke cordents of the tank shall be removed by a Operator and disposed of in accordance with ch. NR 113. Wi aonsin Adn Code. - components, and any The servicing of effluent gels, e, mechanical or pressurized compor"ft Pretreawnem at intervals of 12 months less shall be performed by a certi red POWYS Maintainer - ofher maintenance or mor>gorin9 � W" 10 days of completion of any service event A s shall be provided to the local regulatory START UP AND OPERATION For neiwr oorusfructiout, prior t use of the POWYS c h eck . t ta nk(s ) d' p wwm of �� p DductS � other chemicals that may impede the treatrnen Process to use. detected have the contents of the tank(s) removed by a s tage servking operator p rior Pape ! of y System stmt up dud not occur when WN'GmKMions are at the infiltrative surface. � power � pump may 0 above normal levels. When power is restored the excess id to wasbewater will be d the dispWW OWs) In � dose. overloading ft cells) affil may M SW in the or disdnarge -. & oiler. To avoid this base the contents of the pump tardc removed by a backW S per Pam mskwft power b effluent p assist in nm= t opMft the FEW X00 rang or canted s Pkmber- or POWTS Maintakw to i to restore levels within the pump tank. Do no t drive or park v�ehicdes over UWM and dktpersai Do not drive or park over. or otherwise disturb or compact, the area wkhin 15 feet down slope of any Mound or sole absorption area Reduction or e&rnkradion of the f Wit from ft stream may improve fir m e performance nce and Prolong the Cie. of the POWT'S: au bb**;� - but* Cotton swabs; delpeofts; dente hoes; disirrfectar s; fai; f kWi&n *aim (amp pnW) and P W � meat scraps; me o ns; oil; p� P : - and water softener bare. ABANDONOMENT When fha pOWTS faits andW is perm► -taken out service the slaps s� tp to Insure that the Prof safely dwWon ed in cori>p�a we dr. Comm 83.33. Wisconsin Administrative Code: system is • All ptping So tuft and pis shall be disconnected the abandoned pipe opm kW sealed. • The contents of at tanks and pits strati be and properly disposed of by a Septage Servicing Opel • nd removed or tl>� Covers removed and the void space tit with soa. grave! or another solid a CONTINGENCY PLAN It the POWTS fad and cannot be repaired the foibwing ores have been, or must be taken. to provide a Code comple"t replacement system: D A suftbie reptaoem t'area has been evaluated may be ut�ed for the location of a replacement sod absorption System• The mplacerment area be protected from disturbance and compaction and should not be kntrkved upon by required setbacks from arid Proposed structure, tot fines and wells. Fail re to probed the replacement any WE msuk In the for a new sod and site evaluation to establish a suitable replacement area. Replacement systems must with the tiles in effect at that tine. D A suitebte replacement arm is not available due seWack and/or soli OmRadons. Barring advances in POWTS a hddkng tank may be installed as a resort to replace the failed POWTS. POWTS a sod arid The site has not been e+ralsabed to y a �M area U if no replacement area is available a ; site evaluation must be performed I locate a reptacesnent hank may be instal as a last resort to the failed POWTS. ins Mowed and at -grade sod absorption systems maY be reconstructed In place "ow r�no�vdi of the biomat at I surface. Reconstructions of such must Comply with the Hiles in effect at that frame «WARNING» SEPTIC, PUMP AND OTHER TREATMEN TANKS MA CONTAIN LETHAL GASSES AND= INSUFFtC131T OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREA TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE- ADD COMMENTS POWTS INSTALLER POWTS MAINTAINER Name dl6i✓ ! . Name Phone l�Iwne SEPTAGE SERVICING OPERA MP LOCAL REGULATORY AUTHORITY Name /?7 q Agency Phone /f� Z !f Phone /✓�! 9 ! (J ilas domom t vase dialled by Go stems of the Green. Ldw6 WWFNAB ipf.- 5inua Couray Zonft and 8=&W0n spamdes Thb doa� nhe lnkiknum fieQl�lefnOtltS � d1. I.enMn Ittxd>sm and e3 ��• � �` �i• . C0d°' flee � ptis �$ GNAW (ZM 9eaBnDee �• perromWioe of"POWTS. WiecondnO�AdCa SOIL EVAt.UAT101V REPORT awmmarseftwoodoulftw tn,ow ds oejftCoan g%VV 6. Adm. code Oomb J► A ban MC �"°"pnotUsdtansuzxllM�db" t° ``05 _01 kK*Xb,a,Nacl ll.abcva�6� � focedonod�dlNm�osb� �' oaa . pr � . �waioM ecele ardimsnsiONW .� .ZZ, lGet alr �n � � �jouaoda.1►e.weator m Q,,.w.. Owner t c� K 3 T o2 N R /� F. 4Q - g � 5, ST CF?OIX Town Neemsiftood / NG OFF � tiownete yJrQ �1 NawOa w lNtMF*A raf � 6edioon�s ---� t�odede�iMeddeeian � o l�ri / - Oeeallw 7 O W Nag INN Ago � " V s, pepW b in salt ReAe E s O Pit pnourelsurfaOSaiev.� Taodus O D PAdmtDeecdpion `pJfd1 ' Depth clu. sr. coot. owor c: sz. si< L � J d -I V se, — Rob 0a soft 60 ; V tt. Depdsb� C7 aPO ale�l Y Hodmon Depth Dom* AL SL De * cdo Ts°�° ar. &a � tduaief tiu.8z. C+a�N.Cdar . ��aeop <3l1wBIL.anaTBS��oa • Eakr�nit #t = > 30 22o mall -s�t1 Tss ��+3D < M Ntrri�er s �f 1 �,,,� �,,� oeb>y cand�xled Talephons r. _ is .•� � - ■ r i= :•i - - :J'i 1 mil � • 1 w N • •.vl :11,1 :+IUr i• a 1'1 r,4�• v ✓Irl« r• �; 1'I �•'.: rill • �• rrr:na n '.0 i� ^nr.rr I: ua I �.. •urrv, w Ir; r.w:r ut;�r ,r • 1 : I I • I I : r ' Soil Test Plot Plan Project Name Jeff Ellis Shaun Bir ' Address 8504 Jensen Ave S. Cottage Grove Mn 55016 CS #226900 Lot 2 Subdivision --- - --- Date 6/02 S W 1/4 N W 1/4S 13 T 28 N /R 7 W Township Rush River Fj Boring Q Well PL Property Line County ST. CROIX IL BM or VRP Assume Elevation 100 ft. --Top of Steel Fence Post with orange ribbon wt( System Elevation 96.4' *HRPSame as Benchmark Alt. BM Top of Steel Fence with Orange Ribbon Scale = 1/4 = 10' N 0 Couldesac to Cty Rd Y o - a cu r CD m Pro 3 Bedroom r House cu D a 0 x CA) Q 96' 95' Alt. B.M. 94' 93' B -3 150' 8% Slope Property Line Safety and Buildings ` E C E a ' EE 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8777 *iSconsin t 2QQ2 www.commercewi Department of Commerce y www.wisconisconsin.gov n.gov T Scott McCallum, Governor Philip Edw. Albert, Secretary October 14, 2002 CUST ID No.226900 ATTN: 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: 10/14/2004 Identification Numbersi Transaction ID No. 794761 SITE: Site ID No. 651519 Jeff Ellis Please refer to both identification Cth Y numbers, above, in all Town of Rush River correspondence with the agency. St Croix County SW1 /4, NW1 /4, S13, T28N, R17W FOR: Description: Mound 450 Gpd. Object Type: POWT System Regulated Object ID No.: 874040 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: Correspondence Notes: • This plan action is subject to designer notes / comments on the plan. • 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" Version 2.0 ;._ . a and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) • Comm 84.10, All materials used in this installation shall conform to the provisions of this chapter. 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 SHAUN R BIRD Page 2 10/14/02 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. M SHAUN R BIRD Page 3 10/14/02 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 Thomas E Devereaux Plumbing / POWTS Reviewer II , Integrated Services (715)634-3026, 7:45 am - 4:45 pm Mon. - Fri. WiSMART code: 7633 tdevereaux@commerce.state.wi.us cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544 r SHMC TANK ALAMMAHM AGREEMM AND O MtSW CEWMCAIION FORM Addc t�l .S_ -<, O l -� o Prope y Address ZL 6 r-.- (VaifiadwwWwd ftm Pk=ft DquU matte now candaw io$L O Parcel IdeaWfication Number ��AL D OPI propet Locgio� v., sec. W. Town aAdZg,�dJ iy Lot# - ai Mbd Sawa y Map # . vo hmw Page # Warty neca # (o vohmme page # 6 s h ❑ ya ❑ no Lot li= idmtdifiable ❑ Yes ❑ no bV og a uwmdm oeo�yaaf s c� c�ilspr etomm�+a .rm r its ofvmWkB oat dbe septic U* avwy dnae y W w*.M if =c&dby a l cwftdpanapec '9f►bstyoa P t iab dbe'J i cm meat fire ��e asaic sus a � in ere.v�e 'sbc pwp�y an�noer b =&.& St. CWk z�aaiap Depamww a ca oaf. b9 da owaat aoaby a msOrPtaoa�PP�ocaSoamodpa�ti) essae�iswaalocd�gsod sy� kin ooa�oa sadfar (2) aver inapeam sod pmipbC (if neoessorA *a sepft rands AM >bM 113 W of sisd�e. L*,.&, dbmread *ooftmmq mdgpwbmsi dm*tPavata fte sonduft aetfogft Lavin.assetby&eD tGfC=MVMaaad&eDeafrb�aal8 of�itieoomta. ft ft "yaw sepftgsftnhwbem=d tod® ednantbecomPedandrata�odbfie .C�oaCormtyT�odaS d me abcoe year d - tW APMCAW DATE O = ccox I (�) ortW *A all as *k farm area m b &e best of mY (onr)1 I ( ) (ow) �° $) of at pwpecty am=' od above„ by of a wm=W decd s mt&d in R Odw of Deeds OlSioa. Oz- 9BUM OF AMJCAW DATE 00*0 « p is nus -�+ep edauay remtlt in the as Y P b ** iadnde,"* g& a ppUcsfim a stumped vauant deed from abe >f Rqodw of is mad* � � � a Dopy of &C ceeK" MV , p C n p � • t\ U_ V 3 U` Su 8 OF WISCONSIN FORM 2.1999 6 7 2 9 9 0 Docuent Num m ber WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between William M. Findlay and Ann Louise RECEIYF.D FOR RECORD Findlay, husband and wife -- - 03 -08 -2002 8:25 AM - -- - - - -. - - -- WARRANTY DEED Grantor, and Jeffery R . Ellis and Diane K. Ellis, husband and wife EXEMPT i - -- — REC FEE: 11.00 —_ __ - - - - - -- - -- TRANS FEE: 150.00 - ------- - - - - „_ COPY FEE: Grantee. - -- CERT COPY FEE: Grantor, for a valuable consideration, conveys and warrants to Grantee PAGES: 1 the following described real estate in St. Croix ___ _ County, State of Wisconsin (if more space is needed, please attach addendum): Lot Two (2 Plat of Rush Wood Point i n the Town of Rush River. Recording Area Name and Return Address FIRST NATIONAL BANK OF BALDWIN 990 Main St PO Box 2060 Baldwin, WI 54002 028- 1019 -80 _ Parcel Identification Number (PIN) This is not — homestead property. Exceptions to warranties: Easements and restrictions of record. k;v (is not) Dated this day of 2002 iJ William M. Findla ' _____.___�� _. • Ann Louise Findlay AUTHENTICATION ACKNOWLEDGMENT Signature(s) _ —� STATE. OF WISCONSIN ) ) Ss. ' St. Croix County ) authenticated this day of .._ —' Personally came before me this --, day of __ -..._. .._._ _.._ 2002 the above named Wi lliam M. Findlay and Ann Louise Fi TITLE: MEMBER STATE BAR OF WISCONSIN — (If'not, to me known to be the a sc�t(s) who executed the foregoing -- — - instrument a ack iY sam . authorized by y 706.06, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED BY + �����/ a l � — Thomas A. McCormack _ — _— _ Notary Public, StaWof Wisconsin Baldwi W1 54 002 My Commission Is' errnanent. 1 f - not, state ex trahon ate: c P p Snnatures may be authenticated or acknowledged. Both are not necessary.) _ u.. _ �s2_ •} N hies c' persons signing in any capacity must be typed or printed below their signature. ; 14—flat— Prof, S-13 CanPny, Fo,a dw tai. vm STATE BAR OF WISCONSIN aoo�ss2ort WARRANTY DEED FORM No. 2 - 1999 d- w .. W a �i , � �' b Ps±,v;, SAP tn�t z:. -;.� .� i r W$ Ln Q r W A,. W I d EAST LINE a g¢ 75.53' W LL. N co Cr co "N 1 0 Lo . � W Q Z '<<t'0) CO- N d LL - 0 \1 � �W Z I \ N u\ r LJ cn Q uj ZT p m WO F - OD tv q00.� I •` i Z W t. e„ \ S0005OW .. ui 77' "p C p co CU c U N , $ iv It kin CD y r r? ,� t ;if -:; •� k �• .3w u�. i t�.3 r t..... /� r� � t� M1 ,.> �' s . h 4^ 1 a § (D n I (n I co 01 I N N I F- r� J' Z I I L I err �'- . I I v ___ J �� -- -_ i V l� � `ti �� �� _. 1372 SOIL EVAL �dNi R PORT Page 1 of 3 Wisconsin Department of Commerce Division of Safety and Buildings ., A.C.E. Sal & Site Evaluations in accordance with C' Adm. Code complete site Ian on paper not less than 8'% x 11 inches in siz Plan mus "' Attach com County P P P Pe � '. St. Croix include, but not limited to: vertical and horizontal reference point (BM),' direction an percent slope, scale or dimemsions, north arrow, and location and distance to nearestmad. n arm LD'• 028 ±1019 -80 -000, IN 13.28.17.103A Please print all information. .-: � j; Revi y Date Personal information you provide may be used for secondary purposes (Privacy Law s. 15.04'(1) (m)1 Property Owner ` ,Property L , :,j William & Ann Findlay �. C 4"Lot �` NW 1/4 S 13 T 28 NR 17 W Property Owner's Mailing Address # 130 k ubd. Name or CSM# 355 County Road Y 2 Proposed Plat S�{tiv City State Zip Code Phone Number J City J Village p e Town Nearest Road Baldwin WI 54002 715 -684 -3088 Rush River I County Road Y New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD f Replacement Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable na General comments and recommendations: System elev. = 100.50' at 13" above 99.35' contour. Boring # j Boring Pit Ground Surface elev. 99.02 ft. Depth to limiting factor 24" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft° *Eff#1 *Eff#2 1 0 - 10 10yr3 /2 non sil 2%bk mvfr as 2f 0.5 0.8 2 10 -19 10yr5/4 none sil 2fsbk mvfr cw 1f 0.5 0.8 3 19 -24 10yr4/4 none sl 2msbk mfr cw - 0.5 0.9 4 24 -30 7.5yr4/4 f2d 7.5yr5/8 sl 2msbk mfr cw - 0.5 0.9 5 30-48 10yr4/6 none Is 1 msbk mvfr aw - 0.7 1.2 6 48-60 10yr6/3 m2p 7.5yr5/8 & scl O mfr - - 0.0 0.0 Horizon #5 saturated. Ground water seepage observed throughout horizon, stabilizing at 33". Redox features unobservable due to s M im Boring # I Boring Pit Ground Surface elev. 99.05 ft. Depth to limiting factor 30 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF *Eff#1 *Eff#2 1 0 -11 10yr3/2 none sl 2fsbk mvfr as 2f 0.5 0.9 2 11 -19 10yr4/4 none sl 2fs bk mfr cw 1 f 0.5 0.9 3 19 -30 7.5yr4/4 non Is 1 msbk mvfr gw - 0.7 1.2 4 30 -38 10yr5 /6 m m2d 10yr6 /3& Is 1 msbk mvfr aw - 0.7 1.2 5 38 -51 10yr5/6 na Is 1 msbk mvfr - - 0.7 1.2 Horizon #5 saturated. Ground water seepage obs roughout horizon, stabilizing at W'. Redox features unobservable due to saturation. * Effluent #1 = BOD ? 30 < 220 mg/L and TSS 4 < 150 * uent #2 = BOD < 30 mg/L and TSS <30 mg/L CST Name (Please Print) Sign ure: CST Number James K. Thompson 3602 Address A.C.E. Sal & Site Evaluations r Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 0 4/3/01 715- 248 -7767 Property Owner William & Ann Findlay Parcel ID # 028 - 1019 -80 -000, ID# Page 2 of 3 a Boring # Boring 01 Pit Ground Surface elev. _ 9 8.14 ft. Depth to limiting factor 23" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 1 0 -11 10yr3/2 none sil 2fsbk mvfr as 2f 0.5 0.8 2 11 -17 10yr5/4 none sl 2fsbk mfr cw 1f 0.5 0.9 3 17 -23 10yr4/4 none sl 2msbk mfr gw - 0.5 0.9 4 23-42 7.5yr4/4 m2d 7.5yr5/8 & m2d 1 /3 scl Om mfr - - 0.0 0.0 ❑ Boring # J Boring J Pit Ground Surface elm ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPM' *Eff#1 *Eff#2 F—I Boring # I Boring J Pit Ground Surface slap.. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots 2 *Eff#1 *Eff#2 * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 <-30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. 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