HomeMy WebLinkAbout030-2121-70-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
IF INSPECTION REPORT Sanitary Permit No:
' 453384 0
GENERAL INFORMATION (ATTACH TO f)ERMIT) 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:
Fineline Builders St. Joseph Township 030 - 2121 -70 -000
CST BM Elev: Insp. B Elev: BM I Description: Section/Town /Range /Map No:
, � I �s 30.30.19.989
TANK INFORMATION ELEVATION DATA
TYPE M UFA TURER CAPACITY STATION BS HI FS ELEV.
L� 66 �"/ S1 low <vl 9�- S
Septic Benchmark D f
Dosing GO �a �\ Alt. BM Z S
Aeration Bldg. Sewe
Holding St/Ht Inlet
�
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WEL BLDG. Vent to Air Intake ROAD Dt Inlet
Se ptic _� / I ' / / D Bottom v ry / 3 7 �G
7
Dosing 0 Ik C Heade an. i,d /. O �� 3 D�
a 1 `i ,
Aerati n Dist. Pipe 3
Holding Bot. System
Final Gr 7
PUMP /SIPHON INFORMATION L L f
Manufacturer Demand St Cov / /�
i GPM � t� /P • � (�
Model Number /,� zz r� 2`3 ? ZY
TDH Lift Friction Los System Head T D Ft /
/ - C � 3- `l S "7 ►-�s e vs �. D
Forcemain Length Dia. �� Dist. to Well -I— _T
2 / z
SOIL ABSORPTION SYSTEM °
BED/TRENCH Width Length No. Of TrenclWs f V PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 1 5-6 ' " —J
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION AMBER OR
Typ ystem: UNIT
o f f Model Number:
DISTRIBUTION SYSTEM OCR
Header /M Distribution x Hole Size x Hole S ng Vet take
Pipe(s) f / l"
Length / Dia Z Length Dia / U Spacin �r
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
1 ...,,, � Yes `i, No F- ! Yes No
COMMENTS: (Include code discrepencies, persons present etc.) Inspection #1: �� / o(pL _ t� Inspection #2: /�/
Location: 370 132nd Ave Hudson, WI 54016 (SW 1/4 SE 1/4 30 T30N R19W The Sanc 'L to 7- / I Parcel No- 30.30.19.989
1.) Alt BM Description ='� 6 f(4 W �S� /7
/
2.) Bldg sewer length =
- amount of cover =
Plan revision Required? Yes L-: No
Use other side for additional information. __
SBD -6710 (R.3/97) Date InsepcWs S nature Cert. No.
Safety and Buildings Division County 1
201 W. Washington Ave., P.O. Box 7162
V con.sin Madison, WI 53707 - 7 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce (608) 266 -3 ,5,1 3
Sanitary Permit Application State Plan I.D. Number
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide 1 0 C 5 7 9 9
may be used for secondary purposes Privacy Law, s """" Project Address (if differenythan mailing address)
rl EjVEE, 37 0 1 3 V h
I. Application Information - Please Print All Information i /4 JS 0).
wa
Property Owner's Na me ayl #�1 Zt � Lot q
•!
Fl Q
n � � +h G wr Me* 1_ UT -1 CROIX CU f , W - vty p
Pro pe Owner's M ailing Address ZONING OFFICE Property Location
0 0 K G ��� w ) bi,��l4,Secdon
City, State Zip Code Phone Number
-
QQ L ��11 S `i z, S 040 " ° 5 400
(
50 "' W y .circle e)
II. Type of Building (check all that apply) 144 It T N; R 1 q E or
1 or 2 Family Dwelling - Number of Bedrooms �bdiisiori v Name C�'94vfNh libel'
t SahC f I�Lp,r
❑ Public /Commercial - De
t
-❑ State Owned - Describe Use )C - ❑City_ ❑Village `Township of
t. a - O tt
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A' y ❑ Replacement System g p y 8 Y
New System ❑ Treatment/Holding Tank Replacement Otil ❑Other Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. Type of POWTS System: Check all t hat apply)
❑ Non - Pressurized In- Ground Mound > in. of suitable soi ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter
❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter
❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dispersa l/Treatment Area Informa
Design Flow (gpd) Design Soil Application Rate( so Dispersal Area Required (so Dispersal Area Proposed (so System Elevation
0 9 50 D SO 1 100
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units _1l Concrete Constructed Glass
New Existing /)
Tanks Tanks
Septic or Holding Tank / iteD `-- t'
Aerobic Treatment Unit W
Dosing Chamber l OD �- 0 Z—
VII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Na me (Print) Plumber's Si gnatur MP /MPRS Number Business Phone Number
r j t? i SG' �� 4 / S �a5 17S
Plumber's Addre ss (Street, City, State, Zip Code)
/a92- s sy= �i -k- F4 1 5g�zv
VIII. Count /De artment Use Onl
A proved ❑ tme Sanitary Permit Fee i eludes Groundwater Date Issued Issuing enwSignature ( o Stamps)
Surcharge Fee)
LF — Owner Given Reashp for Denial 1 390- ' 5 , 2 m
IX. Conditions of Approval/Reasons for Disapproval 3 ) � i � � ��I
SYSTEM OWNER: -� t , I
aAg
1 Septic tank, effluent filter and t � A-Z 1
dispersal cell must all bg s2rviged / maintained
as per management plan provided by plumber. tr
2. All setback requirements must be maintained NON µ l O0
as per applicable code /ordinances.
(Sea-
Attach complete plans (to the County only) for the system paper not less than 81/2 x 11 inches in size
SBD -6398 (R. 01/03)
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Safety and Buildings
4003 N KINNEY COULEE RD
commerce LA CROSSE WI 54601 -1831
TDD #: (608) 264 -8777
i sco n s i n www commerce.state.wi . us /sb
www.wisconsin.gov
Department of Commerce
Jim Doyle, Governor
Cory L. Nettles, Secretary
June 04, 2004
CUST ID No.220554 ATTN: POWTS Inspector
CARL P HEISE ZONING OFFICE
CARL HEISE EXCAVATING ST CROIX COUNTY SPIA
1042 S MAIN ST 1101 CARMICHAEL RD
RIVER FALLS WI 54022 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 06/04/2006 Identification Numbers
Transaction ID No. 1005779
SITE: Site ID No. 684509
Fineline Builders Please refer to both identification numbers,
Town of Saint Joseph above, in all correspondence with the agency.
St Croix County
SW1 /4, SE1/4, S30, T30N, R19W
Lot: 7, Subdivision: The Sanctuary
FOR:
Description: Three Bedroom Mound System
Object Type: POWTS Component Manual Regulated Object ID No.: 961824
Maintenance required; 450 GPD Flow rate; 25 in Soil minimum depth to limiting factor from original grade;
System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01),
Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 /O1); Biofilter
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.
Condi��,a
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,
stats. APP EYE
The following conditions shall be met during construction or installation and prior to occupancy or use: E RTMENT OF
N OF TEY
General Approval Requirements:
7
• This system is to be constructed and located in accordance with the enclosed approved plans and with the SEE CORRESH
"Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD - 10691 -P (N.01 /01)
and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION
2.0" SBD - 10706 -P (N.01 /01).
• The changes made to this plan on 6/04/04 by this reviewer were acknowledged and approved by the system
designer.
• The manifold diameter must be reduced to 1.0 inches so that the velocity of the effluent is 2.0 ft/sec or more.
• 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 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
r
CARL P HEISE Page 2 6/4/04
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of See. 145.135 and 145.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the
P P g Y q g P
designated county official in accordance with the provisions of See. 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 ermits required b the state or the local municipality shall a obtained p rior to commencement of
P q Y P h' b P
construction/instal lation /operation.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter to the owner and any others who are responsible
for the installation, operation or maintenance of the POWTS.
Sincerely Fee Required $ 175.00
Fl ?� 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 @c ommerce. state. wi. us
cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544
MOVE THE EARTH
CARL HEISE EXCAVATING
1042 South Main 227
RIVER FALLS, WI 540 A` �06
CARL P. HEISE TITLE SHEET A U (715) 425 -2175
Owner �o
MOUND SYSTEM y(v, O
FOR /�
BEDROOM RESIDENCE -�
LOCATED IN THE sv OF THE IL I OF SECTION30 T 3 N, R � W,
TOWN OF T > 7 C r o ► COUNTY, WISCONSIN .
INDEX
PAGE 1 of 7
TITLE SHEET
PAGE 2 of, 7 SYSTEM MANAGEMENT PLAN
PAGE 3 of 7 PLOT PLAN
PAGE 4 of 7 PLAN VIEW -CROSS SECTION
PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT
PAGE 6 of 7 PUMPING CHAMBER CROSS SECTION
PAGE 7 of 7 PUMP PERFORMANCE CURVE
PREPARED FOR
FINELINE BUILVE4
P, 0 . 0 o e
14UDSONI VE
PREPARED BY i)13 �
�� B NGS
�NDENCE
CARL P. HEISE
CST /MPRS 220554
1042 SOUTH MAIN STREET
RIVER FALLS, WI 54022
PHONE 715 -425 -2175
FAX 715-425-
j5a SEE CORRESPONDENCE
This plan has been prepared in accordance with the Mound Component
Manual SBD- 1Z -57 =P and the Pressure Distribution Manual SBD -1 -0 -573 -P
G 0e J Fri �iJNJ B ILLERo INr 15�L57 '_5
Mound System Management Plan page Z of 7
Pursuant to Comm 83.54, Wls. Adm, Code
Septic Tank
The septic lark shall be maintained by an irdivldual certified to service septic tanks under s, 281.48, Stara. The contents of the
teptic tank shall be disposed of in accordance with NR 1 1 3, Wis. Adm. Code. The operating condition of the septic tank and
outlet filter shall oe assessed at least once every 3 years by inspection. The outlet filter shag be cleaned es necessary to
ensure proper operation. The niter cartridge should not be removed unless provisions are made to retain solids In he tank ttvt
may slough off tho filter when removed from its enclosure. If the filter Is equipped with an alarm, the filter shall be serviced if
the alarm is activated continuously. Inlarmittont filler alarms may Indicate surge flows or an Impending continuous alarm. The
septic tank shall have Its contents removed when the volume of sludge and scum In the tank exceeds 113 the liquid volume of
the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shag advise
the owner of when the next service needs to be performed to maintain less than maximum scum and sludge' accumulation in
the tank. The addition of biological or chemica! additive* to enhance septic tank performance is generally not required.
However, if such products are used they shall be, approved for septic tank use by the Department of Commerc Safey and
Buildings Division.
Pu mp Tan
The pump (dosing) tank shall be Inspected at least once every 3 years. All switches. alarms, and pumps shall be tested to
verify proper operation. If an effluent filter is installed within the tank it shag be Inspected and serviced as necessary.
! Mound and Prvs;yr Ist rIkullon System
No trees or shrubs should be planted on the mound, Plantings may bo made around the mound's perimeter, and the mound
snag be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traflc
(other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the
Infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather
Installations (October-February) dictate that the mound be heavily mulched for frost protection.
Influent quality into the mound system may not exceod 220 m9 1L 8005, 150 mg/L TSS, and 30 mg/L FOG. Influent now may
not exceed maximum design flow specified in the permit for this Installation.
The pressure distribution system is provided with a flushing point at the end of each lateral, and It Is recommended that each
lateral be flushed of accumulated solids at least once ovary 18 months. When a pressure test is performed it should be
compared to tho initial test when the system was Installed to determine if orifice clogging has occurred and if orifice el8911-I y Is
required to maintain equal distribution w'i'thin the dispersal cell.
Observation pipes within the dispersal cell shell be checked for effluent ponding. Ponding levels shag be reported to the owner,
and any levelss above 4 inches consldored as an Impending hydraulic failure requiring additional, morelrequent monitoring.
n ral
This system 3h3il be oparated in eccordance with Comm 82.84 Wis. Adm. Code, and shag maintained !n accordance with its'
component manual (UC- 10572•P (R, 6/99)] and local or state rules pertaining to system maintenance and maintenance
reporting.
No one should ever enter a septic or pump funk since dangerous gases may be present that could cause death. Septic and
pump tank abandonment shalt be In accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as
POWTS components.
1. SapUc or pump tank manhole risers, access risers and covers should be inspected for water lightness and soundness. Access
openings used for service and assessment shag be sealed watertight upon the completion of sorviee. Any opening deemed
unsound, defactive, or subject to failure must be replaced. Exposed aceeas openings greater than 8- inches In diameter shall
be secured by an effective locking device to prevent accidental or unauthorized entry Into a tank or component.
ContingoncYPlan
If the septic :ank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system In proper operating condition.
If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be
Immediately repaired or replaced with a component of the same or equal performance.
If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired
or replaced in its' present location by increasing b8531 area If We ieakoge occurs or by removing biologically dogged adsorption
and dispersal media, end related piping, and replacing said components as deemed necessary to bring the system into proper
operating condition.
Questions on the operation or maintenance of this system should be
directed to the County Zoning office at 384 -44,80 or to the
licensed plumber who installed the system.
PLOT PLAN
L r7
3, o28
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9
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C�
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SM� TOP
P
TOP'
Page o
i
Synthetic Covering
ASTM C33 Distribution Pipe
Sand
H G
6" Topsoil _ __ - -- --- F SYS. ELEV.
E D
3 '
Y
(� %Slope
Bed Of 12,--2 12 Force Main Plowed
Aggregate Layer
(6 Below Pipe) D 1-0 Ft.
� ��
Cross Section Of A Mound System Using E Ft.
F Q- Ft.
A Bed For The Absorption Area �Y
G s Ft.
A Ft. H Ft. `
B ;;6 Ft.
K Ft.
L 70 Ft.
- -- �_ Ft.
Alternate Position I �_ Ft.
of W � Ft.
Force Main
L
1 Observation Pipe ---,,,
I r =-------------- - - - - -- - - - - -- __ - - -� -
I Force Main
__ -
W I° —- - - - - -- --- - - ----
��Distribution Bed O.f ?�- 2 %2.
Pipe Aggregate
•I
Observation Pipe Permanent Markers
Plan View Of Mound Using A Bed For The Absorption Area
Distribution Pipe Layout Page 5 of
Place the holes at the bottom of the distribution pipes
at equal spacing. Remove all burrs from the Pipe and holes.
Extend the end of each uo with the use of long turn or 45 fitting to a point critt si
un Y
inches of the final grade. Terminate the ends of the laterals with a Val, g,:tlireaded cap or
threaded plug. Provide access from fl al grade for the valve, threaded cap or threaded plug.
7`i F' C1) L
pvc pvc we
lal oral Manifold Later —
z z z z v2 1 z11 z z z x
L31 oral l.endh — Lateral ungtit — P
istri ution ne
Pr r-3
itc C-5 s S4
— ----------- 7
– -o
S
P C `mtcz
i
P r f Hole Diameter Via Inch
Lateral eS )
Manif Id ° .Inches
Force 'M " Inches
H ? crl; �
oaf.' l
SEPTIC TANK E 'PUMP CHAMBE CROSS SECTION AND SPECIFICATIONS
4" CI VENT PIPE 12" MIN . ABOVE ABOVE GRADE E WEATHF�R PROOF
?25' FROM DOOR, WINDOW OR JUNCTION BOX • APPROVED
FRESH AIR INTAKE WITH CONDUIT MANHOLE'* OVI
FINISHED GRADE 4" CI RISER ,W /;PADLOCK,!
6" MIN. WARNING'hABI
y ABOVE G ADE ��'
-f•..� k n :: MI .
18" IN. 6" MAX. � ;�� ':;►.;.
T_NLET �•, t
WATER TIGHT SEALS GAS
_ '
f TIGHT i APP '
4" A SEAL t �
CI PIPE Zf- � i ROVED •
lam, ; ALM JOINTS;.W .�rCl
3' ONTO r�G g ON PIPE , 3' ONTc
SOLID , 4^
SOLID".
SOIL C ► .�;:j,.
PUMP OFF ELEV .FT: -- OFF RISER}C
D PERMITTED202-
' �� IF:'• TANK
MANUFACTUREF
HAS APPROVAL
3 APPROVED BEDDING UNDER TANK
CONCRETE PAD
SPECIFICATIONS
SEPTIC / DOSE. ;
TANK MANUFACTURER: NUMBER DOSES PER DAY:
TAN SIZES SEPTIC I000 GAL. DOSE VOLUME INCLUDING
DOSE 0 0 GAL. FLOWBACK: I S GAL. •�
ALARM MANUFACTURER: = 0 CAPACITIES: A = INCHES = GP1
MODEL NUMBER: lo
SWITCH TYPE: yvicrcu.i B = 2 INCHES = 33.5ca
crW 3 7
PUMP MANUFACTURER: �OFt ZE(L 75 C = ;�✓ INCHES = I
MODEL NUMBER: _L52 '
SWITCH TYPE: VYl crc D = -&LI5INCHES' _ I
---,-
REQUIRED DISCHARGE RATE GPM PUMP E ALARM WIRING AS PER ILHR 16. 23'-W.
VERTICAL DIFFERENCE SETWE PU P OFF AND DISTRI U�TION PIPE . 1jjS FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . . . 5_ FEET
+ _ 55 FEET FORCEMAIN X G.�.Z /100.FT.•FRICTION FACTOR . FEET.
TOTAL DYNAMIC HEAD = FEET.
INTERNAL DIMENSIONS OF' TANK: LENGTH ; WIDTH ; DIAMETER
a t
LIQUID DEPTH
SIGNED: LICENSE NUMBER: DATE:
1/88
TOTAL DYNAMIC HEAD/CAPACITY
HEAD CAPACITY CURVE PER MINUTE
EFFLUENT AND OEWATERING
MODEL 152/153
MODEL 152 153
J
50 Feet Meters Gal. Liters Gal. Liters
153 5 1.5 69 261 77 291
2 a0 10 3.1 61 23t 70 265
t52
15 4.6 53 201 61 231
0
20 , 6.1 44 167 52 197
I lk
30 25 7,6 1 34 129 42 159
`z 8 30 9.1. 23 87 33 125
} 20 f 35 10.7 -- -- 22 85
0 40 12.2 - -
-- 11 42
a Lock Velve: 18.0 ft. (11,6m) i44.0 Ft. (13.4m)
10 • "s°'
0
20 40 60 80 100
2ALLONS 6 1/a
LITERS 0 80 160 240 320
1 '�' 3 21/32 ; 14 5/8
`FLOW PER MINUTE
3 27/32
CONSULT FACTORY FOR SPECIAL APPLICATIONS _
Timed dosing panels available. 0 3 27/32
Electrical alternators, for duplex systems, are available and supplied with
an alarm.
vanable level control switches are available for controlling single phase
systems.
Double piggyback variable level noat switches are available for variable
level "and Short CYCIO controls.
Sealed Owik -Box available for outdoor installations. See FM1420.
Over 130'F. (54'C.) special quotation required.
I
— 1521153 Series 12 1/e
I 62 M L onw • on
►soul vohsah Mods Sim Du 5 1 /5
N152 115 1 Non 1.5 1 tx
BN 1521 1 15 1 Aub
052 230 1 Non 4.3 1 2 or 3
BE 152. 230 1 Aub 41.3 Ywdtb•d 2 or 3
N153 115 1 Non 10.5 1 1 ar 3
eN153 115 1 1 Aw
10.5 r,dtai•e 2 or3 SELECTION GUIDE
P 53 230 1 Non 5.3 1 1 2014' 1 1. Single piggybad variable level Aoat switch or double pippybadt variable level loot
BE 153 230 1 Aub 5.3 Y,rJtd•d 2 or 3 switch, ReW to FM0477.
s CAU TION71 2. See FM0712 for oafred model of ElecMd AM MAW E-Pak.
au nstallation of controls. protection devices and wiring should be done by a qualified 3. variable level control switch 10-M used as a aofttol 8dfe110 sP'* duplex (3)
i.censt0 electrician. All electrical and safety codes should be followed including the most O( (4) loft fystem.
recent National Electric Code (NEC) and the 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.
NAA TO: P.O. BOX i6N7
LoWavlse, Ky 102360311 awmta m of . .
r LAW SW T0: 36411 Can• Rtn Rod Louisville, Ky .0211.11161 n O aWW SA (502) 771731. 1(100►1126•P1AMP nrtp:1AvwWJ"1•r.com !O. FAX (301)n1a621
m Copyright 2001 Zoeller Co. Ail rights reserved.
r
s
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
In accordance with Comm 85, Wis. Adm. Code
Cry
Attach complete site plan on paper not less than 81/2 x 1 inches in size. Plan must
include, but not limited to: vertical and horizontal n ,direction and Parcel I.D.
percent slope, scale or dimensions, north a ata� � Is to nearest road.
Please print ormatlo `� by Date
y'✓ � `
Personal information you provide may be es�d tpr secondary . acy I.M. 5.04 (7) (m)).
Property Owner A . `a _ � Cop s
Lot 1/4 1/4 S, T N R
Propertyowners Mani Address S7 cgp # BI # Subd. Name or CSM#
1�
�un►ty r
City S e Zip Code a E ❑ V/ lage ® Town Neares
New Construction Use Residential / Number of rooms Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - cribe: - --
Parent material Flood Plain elevation if applicable 8.
General comments
and recommendations:
F Boring Boring ry � 2.ep
1 # ® Pit � ft. Depth to limiti ,
Ground surface elev. ng factor In. Sal icafion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
In. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •0111 2
e .b
.4°
r
® Boring # a Boring
® Pit Ground surface elev. ft. Depth to limiting In.- Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
In. Mnnsell Qu. Sz. Cont. Color Gr. Sz. Sh •Etf#1 •Eff#2
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. 1 1
•
Effluegi #1 = BOD > 30 < 220 mg& and TSS >30 < 150 mg/L • Effluent #2 = SOD _< 30 mg& and TSS < 30 mg&
CST – _ Sig CST Number
Address to Evaluation Conducted Telephone Number
1,4 --
Property Owner n) f Parcel ID # Page � of
Boring # ❑ Boring A `7
JZ Pit Ground surface eiev. ft. Depth to limiting factor 9 in.
Soli Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe
In. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. •Eff#1 •Eff#2
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F-1 Boring # ❑ Boring
❑ Pit Ground surface eiev. ft. Depth to limiting factor in. Sal Appli cation Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. •Eff#1 `1202 F-1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Sod Application Rate
Horizon Depth Dominant Color Redox Description. Texture StnKture Consistence Boundary Roots GPD/ff?
in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. •Efl#1 'Eff#2
• Effluent #1 = BOD, > 30 1 220 nV& and TSS >30 1150 mg/L • Effluent #2 = BOD < 30 mglL and TSS 130 nV&
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.
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
owner/Buyer F3NE LENE 9 VT -1 EeS uiP A V OS O N -T� -
Mailing Address jl 1-t-n — nICE N VU� o� WT- S 4 ut b
f 3z NA AVt=. �
Property Address LO ° - R - T. CZoiX CUNT wa S��n rte/
(Verification required from Planning Department for new construction
City /State . kUDSO► ..1 WT- Parcel Identification Number U30 •- ZI ZI '7 go
LEGAL DESCRIPTION
C7 0
T N -R 0 W, Town of sT . joSiz� 14
Property Location � W _ %4, .SE V4, Sec. 3 _
Subdivisio Lot #
Certified Survey Map # , Volume . .Page #
Warranty Deed # '7 (o3 - Volume . Page #
Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no
SY,97 FM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you Put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
masterplumber, journeyman plumber, restrictedplumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin- Ce rtification
F?ff system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
expiration date.
(0/
SIGNATURE OF APPLICANT DATE
OWNER CERTIFICATION the owner( of
I (we) certify that all statements on this form are true to the best of m y (our ) knowledge. I ( we ) am (are)
the prope bed above, by virtue of a warranty deed recorded in Register of Deeds Office. JL
L DATE
SI 'IURE OF APPLICANT
s « « « «« A information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department•
ss 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
l�
U. 2 5 7 8 P 12 1 ?6a`+E'-7
STATE BAR OF WISCONSIN FORM 1 2000 KATHLEEN H. MALSH
Document Number WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed, made between RWP Investments LLC, a Minnesota RECEIVED FOR RECORD
limited liability company, Grantor, and Fine Line Builders of Hudson, Inc., 05/21/2N4 11:45AN
a Wisconsin corporation Grantee. WARRANTY DEED
EXERT t
Grantor, for a valuable consideration, conveys and warrants to Grantee
the following described real estate in St. Croix County, State of Wisconsin (the REC FEE: 11.00
FEE: 390.90
"Property") (if more space is needed, please attach addendum): COPYSFEE:
CC FEE:
Lot 7 Th Sanctuary St. Croix County, Wisconsin PAGES: 1
Recording Area
Name and Return Address
Edina Realty Title, Inc.
400 South Second Street � 2
Suite 115
Hudson, WI 54016 y3 U t,% f - Z
Together with all appurtenant rights, title and interests. 030- 2121 -70 -000
Parcel Identification Number (PIN)
This is not homestead property
f isj (is not)
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
Dated this 12th day of May 2004
Gt�
* * I estments LL By: Roger W. Plath
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN _ )
- -- -- —
ST. CROIX _ County )
authenticated this day of
Personally came before me this 12th day of
May , 200 the above named
RWP Investments LLC, a Minnes lim liab com pany
*
By: Roger W. Plath
TITLE: MEMBER STATE BAR OF WISCONSIN Its Chief Ma nager __
(If not, _ _ to me known to be the j (s)ewh authorized by § 706.06, Wis. Stats.) instrument and ackno tIR l4
THIS INSTRUMENT WAS DRAFTED BY — n 0 � -- A Ah ( ,�J� D�)
Brent R. J ohnson - L ommen Nelson Law F irm
Hudson Wisc —_ Notary Public, State of _
My Commission ie- parMa+te (I not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) P,�[n�� fuS.
• Names of persons signing in any capacity must be typed or printed below their signature. — - ' INFO -PRO (800)655 -2021 www.infopmforms.com
STATE BAR OF WISCONSIN
WARRANTY DEED FORM No. 1 - 2000
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