HomeMy WebLinkAbout030-1080-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT sanitary Permit No:
538793 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:
Kerrick, Family Partnership c/o Jon Kerrick St. Joseph, Town of 030 - 1080 -20 -000
CST BM Elev: Insp. BM Elev: IBM Description: (�� -^_n ,m Section /Town /Range /Map No
/00'o II f jo, b I� t ( 2830.19 290E
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark 0 /
Dosing Alt. BM
Aeration Bldg. Sewer
Holding St /Ht Inlet
�T1
TANK SETBACK INFORMATION St /Ht Outlet OW 11
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
Ste $ANNa-
Dosing H er /fMar�(7t t -f X17 5• � o �
Aeration Dist. A pe
Holding Bot. S stem g -U
PrOD 1 ,
L'bla 0
�
PUMP /SIPHON INFORMATION � 1" IIO�w S • 2 9�
Manufacturer Demand S_t Cover 1- C n ,b�, o
GPM
Model N
TD Lift (� iction Loss System Head TDH Ft I
021, For main gth Dia., „ Dist. to Well Ip
S0hL ABSORPTION SYSTEM VJUU *c — C 6-L-5
BED/TRENCH Width Length No. Of Tr s PIT DIMENSIONS No. Of Pits Inside Dia Liquid Depth
DIMENSIONS 3 2
SETBACK SYSTEM TO P/L BLD WELL KE /STREA EACHING Manufacturer
INFORMATION CHAMBER OR
T Of System: /I '7 � O i UNIT Model Number:
DI IBUTION SYSTEM �((/ l(/ a4
Hea anifojd Distribution r / I x Hole Size g� I x Hole Spacing Vent to Air Intake
//� Pipe(s)
Length �"' Dia i Length Dia Spacing r I
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 /L, Bed/Trench Edges Topsoil CI Yes [] No Yes No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1:L9 2 � / / 1 Inspection #2 __/_ /______
:
Location: 502 Perch Lake Rd. Hudson, WI 54016 (Gov't Lot 3 28 T30N R1 9W) etes & bounds �Lot
- Parcel N�o. 28.30.19.290E
1.) Alt BM Description = �,A2.) Bldg sewer length =
- amount of cover
�� vhl �S r�r• -� Pd�t� � c,Gta�
Plan revision Required? Yes No �j p� � �� � ��!� ���►/t�>ti _ �p� r J ( /I�
(�
Use other side for additional information. L 1
Date Insepctor's Sig ature Cer1 No
SBD -6710 (R.3/97)
; C 0 erce.wIgov Safety and Buildin s Division County 201 W. Washingto v oSt. Croix
' C 20 11 ► Madison, V3 Sanitary Permit Number (to be filled in by Co.)
nt of
&t6& N Application State Transaction Number A4
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental Project Address (if different than mailing address)
unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are
submitted to the Department of Commerce. Personal information you provide may be used for secondary Same
p urposes in accordance with the Privacy Law, s. 15.04 1 m , Stats. ✓ ✓✓ �,. ' I _ ��
I. A lication Information — P se Print All Information f
Property Owner's Name / Parcel #
030 - 1080 -20 -000
Kerrick Family Partnershi
Property Owner's Mailing Address Property Location
502 Perch Lake Road Govt. Lot
City, State Zip Code Phone Number SW '/4, SW ' / +, Section 28
(circle one)
Hudson, WI. 54016 715 - 549 - 6507 T 30 N; R 19 E or W
II. Type of Building (check all that apply) Lot #
❑ 1 or 2 Family Dwelling — Number of Bedrooms 3 1 Subdivision Name
Block # Na CSM
❑ Public /Commercial — Describe Use 1 `
❑ City of
❑ State Owned — Describe Use CSM Number ❑ Village of
Vol. 6, Pg. 1735 6r ❑ Town of St. Joseyh
7 GL.a,oe l
III. Type of Permit: (Check only onq box on line A. Complete line B if applicable)
A' ❑ New System eplacement System g p y g y (explain)
❑ Treatment/Holdin Tank Re Onl Other Modification to Existin S
B• El Permit Renewal ❑Permit Revision ❑Change of Plumber ❑ Permit Transfer to New
List Previous Permit umber and Date Issued
Before Expiration Owne S
Owner 0 (o 118 O3 Q
IV. Type of POWTS S stem/Com onent/Device: Check all that appl
on- Pressurized In- Grou ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dis ersal/Trea ent Area Information: 35 nfiltrator " Q-4" Plus standard cham & 5 r. endca s
Design Flow (gpd) Design Soil Application (gpdsf) Dispersal Area Require sf) Dispersal Area Proposed t) System Elevation
450 gpd 0.70 gpd/sq. ft. 642.86 sq. R. 751.00 sq. ft. 94.00'
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units o b
New Tanks Existing Tanks i Z G►/ t � A (n w 3 a
Septic or Holding Tank Na 1,000 1,000 1 Wieser Concrete X
Dosing Chamber 1 Na 00 650 1 1 Combination X
VII. Responsibility Statement- I, the u dersigned, ssume responsibility Sgroinplillation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plu er's Si MP/MPRS Number Business Phone Number
James K. Thompson MPRS 30021 (715) 248 - 7767
Plumber's Address (Street, City, State, Zip Code
340 Paulson Lake Lane, Osceola, WI 54020
VIIL Coun /De artment Use Onl
Approved ❑ Permit Fee Date Issued Issuing t Signatur
❑ iven Reason for nial
IX. Condit' easons for Disapproval So t
d�BRrGRY e.�,l
1. Siptic tank, effluent finer and �' ""�
dispersal cell must all be servien / maintained
as per management plan provided by plumber.
2. AN 6e166ck requirements must be. maintained
Attach to complete plans for the system and submit to the County only on paper not less than 81/2 x 11 inches in size
SBD -6398 (R. 02/09) Valid thru 02/11
I
Index & Title Sheet - Existing Dispersal Cell Replacement
Project Name: Kerrick 3 bedroom Dispersal Cell Replace
Owner Name: Kerrick Family Partnership
Owner address: 502 Perch Lake Road, Hudson, WI 54016
Site address: Same
Project Location
Subdivision: Lotl, CSM Vol. 6, Pg. 1735
Legal Description: SWt /4 SW1 /4, Sec. 28, T.30N., R. 19W., Town of St. Joseph, St. Croix Co., WI.
Parcel ID #: 030 - 1080 -20 -000
Page 1 Index and Title Sheet
Page 2 Site Plan
Page 3 Dispersal Cell Sizing Calculations
Page 4 Dispersal Cell Cross Section
Page 5 System Management Plan
Attachments: None
Mater P ber Restricte Service: James K. Thompson, Dept. of Comm. edential # 0021
Signature: Date: .2-3 ZO //
Page 1 Of 5
Design pursuant to In- Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD- 10705 -P (N.01 /01)
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DISPERSAL CELL SIZING CALCULATIONS
1. (3 bedrooms)(100 gallons estimated flow)(1.5 design factor) = 450.00 Gpd design flow
2. Infiltrative capacity of native soil = 0.7 gpd/sq. ft.
3. Absorption area required: 642.86 sq. ft.
4. Absorption area as proposed: 751.00 sq. ft. (35 chambers & 10 end caps total)
Infiltrator "Quick 4" = 20.00 sq.ft. EISA per chamber, Infiltrator "Quick 4" end cap = 5.10 sq.ft, EISA
642.86 sq. ft. — (10 endcaps)(5.10) = 591.86 sq. ft.
591.86 sq. ft. /20.00 = 29.56 chambers required
Number of trenches: 5@ 7 chambers per trench
Trench width: 2.83'
Trench length: 30.00'
Trench spacing: 6.00' on center
Total system area w/ 6' trench spacing: 27.00'x 32.00'
Pg. 3 of 5
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Dose Conventional POWTS Management Plan
Pursuant to Comm 83.54, Wis. Adm. Code
General
The conventional septic system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall be maintained
in accordance with component manual SBD- 10567 -P (R.6/99). All local and/or state rules pertaining to system maintenance
and maintenance reporting shall be complied with.
Septic Tank
The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The
septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The
contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to
service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment,
maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge
accumulation in the tank. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge
should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed
from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank
manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for
service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective,
or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an
effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank
as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with
Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or
chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be
approved for septic tank use by the Department of Commerce, Safety and Buildings Division.
Pump Tank
The pump (dosing) tank shall be inspected at least once every two years. All switches, alarms, and pumps shall be tested to
verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary.
`- Soil Absorption Cell
Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should
be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for
vegetative maintenance) over the system is not recommended. Soil compaction may hinder aeration of the infiltrative surface
within the system and will promote frost penetration during cold weather months. Cold weather installations (October -
February) dictate that the system be heavily mulched for frost protection.
Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not
exceed maximum design flow specified in the permit for the installation.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the
owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring.
Contingency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by removing
biologically clogged adsorption and dispersal media and replacing said components as deemed necessary or by installing a
new soil absorption cell to bring the system into proper operating condition.
Questions on the operation or maintenance of the system should be directed to Jim Thompson, the master plumber in charge
of the system installation, or your county zoning inspector.
Sa .�'S
2250
Wisconsin Department of Commerce SOIL EVALUATION REPORT P age 1 of 2
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations
Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must County St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. .
030-1960-2
Please print all information. Revie b6 By Dat
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(l) (m)). ` Zt f II
Property Owner Property Location
Kerrick Family Pamership Govt. Lot SW 1/4 SW 1/ S 28 T 30 NR 19 W
Property Owner's Mailing Address Lot # Block # Subd. Name r CSM#
502 Perch Lake Road 1 CSM Vol. 6. Pg. 1735
City State Zip Code Phone Number I City _]Village ii/f Town Nearest Road
Hudson WI 1 54016 715 -549 -6507 St.Joseph I Perch Lake Road
J New Construction Use: 01 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
10 Replacement I Public or commercial - Describe:
Parent material Glacial Outwash Flood plain elevation, if applicable Na
General comments
and recommendations: Soil profile evaluated to confirm depth of suitable soil for installation of replacement dispersal cell.
Boring # I Boring
J Pit Ground Surface elev. 99.17 ft. > 105° in. Soil A loation Rate
Depth to limiting factor pp
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 "Eff#2
1 0 -9 1Oyr3/2 none sit 2fgr mvfr cs 3fm,2c 0.6 0.8
2 9 -23 1 Oyr5 /4 none sil 1 msbk mvfr cs 2fm,1 c 0.4 0.6
3 23-43 7.5yr4/6 none Is Osg ml gs 1vf 0.7 1.6
4 43 -93 10yr5/6 none s Osg ml aw - 0.7 1.6
5 93 -105 10yr4/6 none s & gr Osg dl - - 0.7 1.6
Z
"Effluent #1 = BOD 30 < 220 mg /L nd TSS >30 < 1 41 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L
CST Name (Please Print) Signatur . CST Number
James K. Thompson 's—�` 3602
Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number
340 Paulson Lake Lane, Osceo , WI 54020 6/23/2011 715 - 248 -7767
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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit Nb
506118 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:
Kerrick, Family Partnership c/o Jon Kerrick I St. Joseph, Town of 030- 1080 -20 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
G 6�'. 0 (� a PV'C 28.30.19.290E
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic � 1.0 Benchmark • Z 1176.
Dosing Alt. BM j
c,N. 6 S � �„� -gar. la &. 90. / I, 1 Z
n pa Bldg. Sewer �/• �� 7 f
Holding St/Ht Inlet
IZ•o 7Y /o
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO Q P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
a
Septic / i / Dt Bottom ' �� W
75 15 — 7 T
Dosing 7 5/ r, 1 ` / Head /Man. q • I J ? , 7. 2 9
Aeration J Dist. Pipe 12 , gb 3S
Holding Bot. System, a �¢�
-� A� final Grade .� Ole PUMP /SIPHON INFORMATI N F D �►+ 5'��•CXGa / • G f B, 3
Manufacturer DemanA St 5r
GPM
Model Number Q J0 2 /0• 7 ' Pam 9s
t
TDH Lif ricti n Lo TDH System He d �i
Forcemain Lengt Dia. Dist. to Well
SOIL ABSORPfION SYSTEM +,,(,t Cavo 1G 2-iP
BED /TRENCH Width Length Y No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS Z
SETBACK SYSTEM TO P/L LDG WELL LAKE /STREAM LP*CHING.7 anufactur
INFORMATION C AMB R
Typ Of System: / Model Number: 41 70-113aa
�, s� >� IT s�
_ PISIRIBUTION SYSTEM at "rv(At 0 1 S 4,
Hea n ifold/ Distribution �' / x Hole Size x Hole Spacing Ve t t Air t e
� Pipes) Z4 u Ze Leng Dia Length Dia 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 -F Bed /Trench Edges Topsoil Yes No Yes No
/-
COMMENTS: (Include code discrepencies persons present, etc.) Inspection # / Inspection
Location: 502 Perch Lake Rd. Hudson, WI 54016 (Gov't Lot 3 28 T30N R19 metes & bounds Lot Parcel No: 28.3 .1 90E
1.) Alt BM Description = all i/lat.J
2.) Bldg sewer length
1 �J
� - amount of cover = -
Plan revision Required? Yes!
Use other side for additional information.
Date Insepctor's Signat re /�J Cert No
SBD -6710 (R.3197) �'�('/'YLCP� ����,1'�j', ,f�/� �,d1� -''' ys /�C/,�"
r - � commerce.Wi.gov Safety and Buildings Division County `
201 W. Washington Ave., P.O. Box 7162
� Madison, 53707 -71 G2 Santta
S V// ��.s on��� son, ry Permit Number ( to be till ed i nbyCo)
} - -�. Dapartrnte+rtt of Cor»mare�
Sanitary Permit Application StateTransacnonNumber
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental
I unit is required prior to obtaining a sanitary permi(. Note: Application forms for state -owned POWTS arc Project Address (jrdifferent than mailing address)
submitted to the Depattnient of Con•linerce. Personal information you provide may be used for sectimlary n
to )Oses in accor dance with the Privacy L aw, s. i 5.04(l jjm) Stats. _ 5/
jiti c;rtion Inform ation - Print m
All lnf ratior __ U
Property Owner's Name
Parcel
Properly Owner's Maihrrb Aridness LAPR O Property Location
Ye
fy> 2007 1 t G1 l �, Govt. Lot
Ct Zip Code Section
j�G �1 itJ /1 LLif/ (circle ones I
a l i t 1. T c of Bulldin r N: R F otJ '
Yp g (check all that apply) Lot #
1 or 2 1^amity Dwelling - Number of Bedrooms � Subdivision Name
` ❑ Public/Commercial - Describe Use —
I ❑ City of
❑ Stare Owned - Descrax• Use _ -_ ❑ Village of
ti Town of S T�se
- - � e
III. Type of Permit: (Check only one box on line A. Co mple t e line - B if applicabfe
A. -
1 ❑ New System Re tl nrSyatwt► ❑ Treatmentiliolding Task Replacement Only ❑ Ottier Moditicaiiun to lixisting System (explain) {
0 b
r
Permit Nu M and Date d
Issue I�
n• � Permit Renewal � ❑Permit Revision, ❑ Change of Plumber ❑Permit Transfer to New List I
L Betbre Expiration Owner tJA xAJ6 j� 7 --
I V . Type of POWTS System /Component/Device: Check all that apply)
I V, Noo•Pressur•ized In -Ground ❑ Pressurized In- Ground ❑ At -Grade C1 Mound 24 in. afs •' ab I ❑ Mound <24 oti ofsuitable. sail
/ �/�
� Q Bolding Tank 11 OUrrr Dispersal Component (ex},iain) G_ `� vice (explain)
V. Dis ersal/Treatment Area Information: .rC�
Design Flow (gpd) Design Soii plication te(gpds0 spersa ea Required (st) Dispersal Area Proposed (st) System ! evation
O ? � �l3 _
( .3 • mod. � c�.t/
Vi. Tank Info C' , ity in Total k of Manufacturer
Gall Gallons Units n u o v u
New Tanks Cxistuir Tanks r u
_
��,/ _ �-14Z
Septic or Holding Tank �i / ��1��
Dostnb tlranbcr c,�J � F. �
Vil. ! esponsibfl(ty Statement 1 , th e undersigned, ass resp onsibility for installation of the POWTS a on the attached plans, i
Plumber's Name (Print) Piumtmer's Signature P PRS Number Busittess Phone Number
Plumber's Address (Sii eel, City, State. Zip Code)
gpproved C nt IDc artmenI Use
❑ Disapproved Permit Fee
Dat f sued is tng Agetx 5i lure C � 62e JU
❑Owner Given Reason for Denial
IX. Conditions of Approval/Reasons for Disa .rov ��� �/ 1
,n I --�
YSTEM OWNER: pf 3 C! "
1 Septic tank, effluent filter and
dispersal cell must all be serviced / maintaint3t yLti� �Liaa
rent plan provided by plumber.
,
�'. All setback re uirements must be maintaine �d �$�
as per applicable coMbrNfru� plant wr rrr m and submit to rh ouniy aaty on paper not fe t n a in a t t Z75 i115 e
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SEPTIC TANK E P UMA' CHAMaZ C R O SS vtC 'iON AND SPECIFICAT
4 "' Cl VENT PIPE 12 MIN. ABOVE GRADE 6 WEATHERPROOF
> 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED
FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER
W1 PADLOCK E
:INISHED GRAD£ — WARNING' LABEL
4" CI RISER �'--"""-_
7-
u'" MIN .
18' IN. 6 " MAX.
14LET
WATER TIGHT SEALS GAS• 1
TIGHT , 1�i APPROVED
A SEAL JOINTS WITH
PROVED -- ; ALM APPROVED PIPE
B +
".!ON 3 ONTO
IPE 3' SO LID - r" SOLID SOIL
NTO s C
A ft* RISER. EXIT
OIL
PUMP OFF ELEV. F T. ---- O rr
D PERMITTEL ONLY '
IF TANK
MANUFACTURrR
HAS APPROVAL
3" APPROVED BEDDING UN' DER TANK
CONCRETE PAD
SPECIFICA ",IONS�
:C t DOSE „•�
TP%NK MANUFACTURER: .. i. e . �� ' NUMBER DOSES PER DAY:
TANK SIZES: SEPTIC ?,� GAL. DOSE VO1d3Mr INCLUDING
._ DOSE G GAL. FLOWBACK: „L•.? ... GAL
A LARM MANUFACTURER: — 1 t°a,.I� CAPACITIES: A : ly INCHES z _.3& _ . GAL-
MODEL NUMBER:
SWITCH TYPE: ice. B = INCHES = 1,2 GAL.
GAL.
PUMP MANUFACTURER : 'aC C = S INCHES = � GAL
a�
MODEL NUMBER: O p _ INCHES = _GAL
SWITCH TYPE; ,��__
R EqU IRED DISCHARGE RATE GPM PUMP P E ALARM WIRING AS PER I LHR 16.23 WAC
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . Z
FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . • . • • . • • • • • 4 --- -� .,
FEET I'ORCEMAIN X 2. FT /I00 FT. FRICTION FACTOR . FEET
�j TOTAL DYNAMIC HEAD = FEET
WIDTH ; DIAMETER
DIMENSIONS OF PUMP TANK: LENGTH ; �� - � -----
DATE: - --
1/88
r
[qGOULDS PUMPS Submersible
Effluent Pump
3871 EPO4
EP05
APPLICATIONS • Fully submerged in high ■ EP05 impeller: Thermoplas- ■ Bearings: Upper and lower
designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing
Specifically g lubrication and efficient improved performance. construction.
following uses: heat transfer. ■ Casing and Base: Rugged
• Effluentsystems
• Homes � Available for automat °sc and thermoplastic design provides AGENCY LISTING
superior strength and corrosion 41 Canadian st&WWs Assoalkln
• Farms manual operation. Auto- resistance,
• Heavy duty sump matiac models Include
• Water transfer Mechanical Float Switch ■Motor Housing: Gast iron (CSA listed model numbers end
• Dewatering assembled and preset at the for efficient heat transfer, in "F" or "C ".)
fattory strength, and durability.
SP ECIFICATIONS ■ Motor Cover. Thermoplastic Goulds Pwq%is ISO 9001 Regi WW-
FEATURES cover with integral handle and
=Solids handling capability: FEATURES switch attachment points.
V4" maximum. ■ EPO4 Impeller: Thermoplas- ■ Power table: Severe duty
• Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant.
• Total heads: up to 31 feet. pump out vanes for mechanical
• Discharge size: 1 NPT. seal protection.
• Mechanical seal: carbon -
rotary/ceramic- stationary,
SUNA -N elastomers.
• Temperature:
104 (40 continuous
METERS FEET
140°F (60 intermittent.
. ... .._.._ __
• Fasteners: 300 series
to __
stainless steel. 9 30 . - 5GPM
• Capabie of running
dry without damage to p
1 i 2 Fl
�....._
components.
G 7 _
Motor: z
• EPO4 Single phase: 0.4 HP, 6 2c
115 or 230 V, 60 Hz, 1550
RPM, built in overload with 5
automatic reset, a d r 's EPOS
• EP05 Single phase: 0.5 HP, _
115 V, 60 Hz, 1550 RPM, ~ 3 10'" � . _ . _ _. ...�... ,._... _
built in oveTioad with _ EPO4
automatic reset. 2
• Power cord: 10 foot S
standard length, 16/3 1 _
SJTOW with three prong
grounding plug. Optional 20 0 % zc 30 ao 50 GPM
foot length, 16/3 SJTW with
three prong grounding plug `��� ` ` t 0 12 m/fi
h
0 2 4 6 S
(standard an EP05).
CAPACITY
Goulds Pumps
0 2000 Goulds Pumps <& ITT Industries
Ettect ue February, 2000
83871
i
"' OIL . ALUATION REPORT #1955
n
Department of Commerce ance with Comm 85, Wis. Adm. Code Page 1 of 3
Division of Safety and Buildings Steel's Soil Service
Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must County St. Cr ix
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions north arrow, and location and distance to nearest road. Parcel I.D.
030 -10 - 00
Please ree a�i�QTaq Review By Date
Personal information you provide may d for second — a - ® ® ry p (Priv y Law, s. 15.04 (1) (m)).
Property Owner S EP 1 Property Location
John Kerrick L Govt. Lot 3 SW1 /4, 1/4, S28, T29N, R19W
Property Owner's Mailing Addres ST. CR�)ix C(:)UNTY Lot # Block # Subd. Name or CSM#
15001 Highland Ln na na Na
City State Zip Code ] City [ I Village [� Town Nearest Road
Minnrtonka MN 55345 952 - 938 - 5481 St.Joseph I Perch Lake Rd
E� New Construction Use: E Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
{� Replacement Public or commercial - Describe: na
Parent material outwash Flood plain elevation, if applicable 91.86 ft.
General comments Conventional system, system elevation 96.8 0ft. Trenches spaced and depth to code O below grade.
and recommendations: _ . `
0
Boring # El "" F -11 —N Ground surface elev. 99.80 ft. Depth to limiting factor �q _ in. Soil Application Rate . 7
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 0 -6 10yr3 /1 none I 2msbk mfr Cs if .6 .8
2 6 14 10yr4 /4 none sicl 2msbk mfr gw ivf 4 6
3 34 -80 7.5yr4/4 none ms osg ml na na 7 1.6
it
ri
❑ Boring #
Ground surface elev. 99.80 ft. Depth to limiting factor 80 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 0 -10 10yr3 /1 none sil 2msbk mfr Cs if .6 .8
2 10 -25 10yr4 /4 none sicl 2msbk mfr Cs ivfd .4 .6
3 25 -50 7.5yr4/4 none Is osg mvfr gw na 7 1.6
4 50 -80 7.5yr4/4 none ms osg ml na na 1.6
1
t�
* Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L
CST Name (Please Print) 1 ,_ Si re: CST Number
David J. Steel - ' 248956
Address Steel's Soil Service Date Evaluation Conducted Telephone Number
994 200th St. Baldwin, WI 54002 9/1/2006 715- 760 -0347
SBD -8330 (R.07 /00)
Pr6perty Owner John Kerrick Parcel ID # 030 - 1080 -20 -000 Page 2 of 3
F31 Boring # E
E Ground surface elev. 97.80 ft. Depth to limiting factor 80 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 0 -9 10yr3 /1 none sil 2msbk mfr cs if .6 .8
2 9 -21 10yr4/4 none Sid 2msbk mfr cs 1vfd .4 .6
3 21 -36 7.5yr4/4 none Is osg mvfr gw na 7 1.6
4 36 -80 7.5yr4/4 none ms osg ml na na 7 1.6
J
Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff #2
F-1 Boring # El 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 mg /L " 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.
SBD -8330 (R.07100) Steel's Soil Service
it
STEEL'S SOIL SERVICE 3 of 3
David J. Steel John Kerrick 994200 th St.
CST- POWTSM SW1 /4,SW1/4,S268T29N,R19W Baldwin, WI 54002
Lic. #248956 Town of St. Joseph, St. Croix Co. Direct 715- 760 -0347
Gov. Lot 3 Fax 715- 684 -3449
Legend N
" =40'
Benchmark Ele. 100.00 ft
Top of 3/4" pvc pipe
• 7A-1t efich E e. 99.80 ft
Top of 3/4" pvc pipe
❑ = Borings
Boring Elevations
BI = 99.80 ft
B2 = 99.80 ft
B3 97.80 ft
a B4-= X 0.00 ft
�., 175.
we rl
- ee
a
cic
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP C'- RTIFICA FORM
Owner/Buyer o f'1 ke rrl cl� -)�Y ea &C- L �Y�? /G� ���l P
Mailing Address / S S�3f'S
Property Address
(Verification required from Planning Department for new construction)
City /State Parcel Identificatio umti r * - laS Zp - ooa
LEGAL DESCRIPTI
rvv '� L-� ✓ 3 �$Ot:
Property Location r / k/ 1 /., s w %., Sec. TN -R 19' W, Town of
Subdivision `� /�I S �� �6 U / 175 , Lot # ( �
Certified Survey Map # llpva 6s 6 Volume , Page # /
Warranty Deed # �sd' / `� , Volume 7 / . Page #
Spec house ❑ yes no Lot lines id tifiable yes ❑ no
SYSTEM MAINTENANCE �p i TI d N f i��N6V Awl �l0(I S TU �� 3 `5 p—
Improper use and maintenance of your septic system could remit in its preaoatare failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
masterplumber, journeyman plumber, restrictedplumber or a licensedpumperverifying 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 fall 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 34
days of the three year expiration date.
GNATURE 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.
'C. 7 /J9Ja2
GNATURE 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
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page —L of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner '� Septic Tank Capa AV Q al 13 NA
Permit # Septic Tank Manufacturer rrC.SE, ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer 66 e- ❑ NA
Number of Bedrooms ❑ NA - Effluent Filter Model ❑ NA
Number of Public Facility Units A Pump Tank Capaci G S"Q ga l ❑ NA
Estimated flow (average) 3QZ� g al/day Pump Tank Manufacturer sh ❑ NA
Oesiga flow (peakl, (Estimated x 1.51 ' al /da Pump Manufacturer ,e ❑ NA
Soil Application Rate al/da /fe hump Model ❑ NA
Standard Influent /Effluent Quality Monthly average" Pretreatment Unit ❑ NA
Fats, Oil & Grease (FOG) 530 mg /L 0 Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD 5220 mg /L Cj i I ❑ Mechanical oration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg /L a Disk on ❑ Other:
Pretreated Effluent Quality Monthly average Di al Cell(s)
Biochemical Oxygen Demand (BOD 530 mg /L P4n-Ground (gravity) ❑ In- Ground (�ressurized)
Total Suspended Solids (TSS) 530 mgiL A ❑ At - Grade 0 Mound
Fecal Coliform (geometric mean) 510` 1 00m ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y in dia. ❑ NA Other' ❑ NA
Other: ❑ NA Other: ❑ NA
"Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tankls) At least once every: month(s) (Maxin um 3 years) ❑ NA
saris)
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: months) (Ma)drm t 3 years) O NA
3 earls)
Clean effluent filter A p� At least once every: m ear(s) ) ❑ NA
Inspect pump, pump controls & alarm At least once eve , ._.- ❑ m y
1 ❑ NA
Ins
p P P every: ❑ earls)
O month(s) ❑ NA
Flush laterals and pressure test At least once every: ❑ year(s)
Others At least once every: ~ month(s) p NA
❑ year(s)
Other ❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following 1'jcenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer: Septage Servicing Operator. Tank
inspections must include a visual inspection of the tankis) 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 (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 chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, 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.
Page
START UP AND OPERATION nt tank(s) for the presence of painting products or other chemicals
For new construction, prior to use of the POWTS check treatme
that may impede the treatment process and /or damage the dispersal Collis). If high concentrations are detected have the contents
of the tankls) 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 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. Da 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; ail;
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 shalt 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 seated.
• 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 ca of be repaired the following measures have been, or: must be taken, to provide a Cade compliant
replacement system:
❑ A suitable reps area has been evaluated and may be uior the location of a replacement soil absorp upon ' b n
system. The replacement area should be protected from disturbance and compaction and should not be infringed p y
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a now soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
17 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 POINTS.
A o T Site d site if nn mnlajtAmal" e tank
TS
.,
O 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 affect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL (SASSES AND /OR INSUFFICIENT OXYGEN. DU 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
Dame `�!', cc sY._S�ln �1�i31 Name —
Phone 7 _ _ Phone
SEPTADE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name !Name ` &
Phone Phone l � - 3 �/,ij
This document was drafted in compliance with chapter Comm 83.22(2)(b0)(dl6lfl and 83.54111, (2) & 131, Wisconsin Administrative Code.
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Parcbl #: 030 - 1080 -20 -000 04/02/2007 04:15 PM
P A G E 1 OF 1
Alt. Parcel #: 28.30.19.290E 030 - TOWN OF SAINT JOSEPH
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
O - KERRICK FAM PARTNERSHIP
KERRICK FAM PARTNERSHIP
15001 HIGHLAND AVE
MINNETONKA MN 55345
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description " 502 PERCH LAKE RD
SC 5432 SOMERSET
SP 1700 WITC
Legal Description: Acres: 1.000 Plat: N/A -NOT AVAILABLE
SEC 28 T30N R19W PRT GL 3 W 16 RDS S OF Block/Condo Bldg:
9
LK & NLY OF RD
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
28- 30N -19W
Notes: Parcel History:
Date Doc # Vol /Page Type
07/23/1997 871/121
2007 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/08/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.000 115,500 62,600 178,100 NO
Totals for 2007:
General Property 1.000 115,500 62,600 178,100
Woodland 0.000 0 0
Totals for 2006:
General Property 1.000 115,500 62,600 178,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch #:
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
STATE BAR Of W1..0'%S1W–F0Rtt S
0<.V_U N0. CWij Ct.Alm DUO '
` , to `1^1 THIS yA{f aESE*v40 FOR aE {0•pl »G DATA
4 S 71--- ---- -- REGISTER'S OFFICE
Aqf e Kerr ck ��ins1� - .uPX�- - — ST. CROIX CO., Wi
- ---- -- Recd for Record
quit- cl.im+t toilp n rshi, a ener of MA "�� M
- - - - -'-: ^ •1ric1Pr t e dw I"I� � � �"�
t� C
�� Register of Deeds
St Croix Cou tX County, —
the following described real estate in RETURN T
State of Wisconsiry
All that part of the SW# of SW} in Section 28- 30 -19,
lying S and W of a body of water called ?erch Lake,
and N of the Town road as it is now laid out and used Tax Key No.
and W of a line running N and S, which line is 16 rods
E of the W boundary line of said section 28.
This 1 S — homestead property.
(is) (is not) '19 90
Dated this day of
1',,• L T c � (SEAL):
(SEAL) AgnE Kerrick
j,
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
% i �''.
Sig STATE OF WISCONSIN natures authenticated this— day of ` ss.
19 -~ `
County.l ,
Personally came efore me, this 1 day of
1 1 9 90 `_ the above named
Agnes Kerr ick a c;nale perso
TITLE: MEMBER STATE BAR OF WISCONSIN - -
(If not,
authorised by 4 706.06, Wis. Stets.)
This instrument was drafted by
Donald 0. Smith to me known to be the person,__ who executed the fore -
THOMSEN NYBECK JOHNSON. 50 00UET , going instrument and acknowledged the same.
VAN VALKENBURG, OHNSTAD & SMITH, P.A.
Suite 600 3.100 Edi nbnrnuoh Way s
Edina. MN 55435 -- County, Wis,'
(Signatures may be. authenticated or acknowledged. Both , t Co mmis on is germane (If not, state expiration
are not necessary.) 19 __ )
date
QUIT CLAIM --EED -STATE BAR OF •ISCO FORM. N01J - :977
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