Loading...
HomeMy WebLinkAbout030-2141-00-010 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix 'Saftsty and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 515211 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: Grand Properties LP, do Mike Germain I St. Joseph, Town of 030 - 2141 -00 -010 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 9 4 3-3 CS T 36.30.19.2060 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER , CAPACITY STATION BS HI I FS ELEV. Septic Benchmark fir. �4.• /aoc) ?7. D ' g )f o �p , 5ZS Alt. BM e; Ge �, 1: '9' 7. Aeration Bldg. Sewer 7. Z q4" 6 Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake •5 ROAD Dt Inlet Septic 5� i 7 5a Dt Bottom Dosing ✓ Header /Man. 9. � qY• Zr Aeration Dist. Pipe Holdin Bot. System 16. Le 5 3..Z PUMP /SIPHON INFORMATION Final Grade 9 q7 Manufacturer Demand St Coveyy--. r� ' 171 . G GPM 4�,'► �a, Ca,r -L, Model Number TDH Lift Friction Loss Syste ad Ft Forcemain Le la. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length f„ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside D(�_ Liquid Depth DIMENSIONS 3 Gy SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer: //.. INFORMATION CHAMBEROR Type Of System: t 2,0 � t f� A /^ UNIT Model Number: ^ 6_ 4 + pN,✓ DISTRIBUTION SYSTEM Sow / 4 -I (,, Z 32, .1, 4 Header/Manifold Distribution x Hole Size x Hole Spacing Vent ' to Intake Length Di Lengt Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only 4 Depth Over Depth Over xx Depth of xx Seeded /Sodded T Mulched Bed/Trench Center �(� Bed/Trench Edges Topsoil \ Li s � No Yes t��No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1273 84th Street New Richmond, WI 54017 (SE 1/4 NW 1/4 36 T30N R19W) Natalie's Ridge Lot 10 Parcel No: 36.30.19.2060 1.) Alt BM Description= �' '�� Gl,o ; „� c �- C-k5 2.) Bldg sewer length = '33 - amount of cover = Plan revision Required? F1 Yes VNo Use other side for additional information. SBD -6710 (R.3/97) Date nsepct Signature Cert. No. $af and Buildings Division County commerceml.gov 2 on Ave., P.O. Box 7162 S ' 53707 -7162 Sanitary Permit Number o be filled in by Co.) De "parC�rtt of Gbintrner�ce State Trattsaction Number Sanitary Permit Appl'ca�iep l In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of is fo ernmentaa Project Addres � f �q-� s (if different than mailing address) unit is required prior to obtaining a sanitary permit. Note: A plica n fo ����II' ]]''QQ r submitted to the Department of Commerce. Personal information y u provide may be Use second ry - / ��� O � t/ t� p urposes in accordance with the Privac Law, s. 15.04 1 m Stats. T � I. Application Inform tion - Ple int All Inf , ion Parcel # Property Owner's Name r �/�,,� k ev G // 2 � S7. CROIX COU 6,10 z / /~ "' Ip ��nn ING OFFICE Property Location Property Owner's Mailing Address T l A ', e"14 .% � GG %l C1 Govt. Lot Zip Code Phone Number s'� y,' /,, Section 3 ! City, State (circle one)) S YSc T sL5 N; R E Lot # II. Type of Building (check all that apply) Subdivision Name 9 1 or 2 Family Dwelling - Number of .,. i ! BI /✓ v ❑ Public /Commercial -Describe Use 6 46 � {� ❑ City of CSM Number ❑ Village of ❑ State Owned - Describe Use Town of ,Z w III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. RNew System ❑ Replacement System El Treatment/Holding Tank Replacement Only El other Modification to Existing System (explain) -"� B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑p e Transfer to New List Previous Permit Number and Date Issued Before Expiration IV. Type of POW TS S stem /Com osent/Device: Cheek all that appl xNon•Ptessurized In-Ground El Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Pretreatment Device (explain) ❑ Holding Tank ❑ Other Dispersal Component (explain) V. Dis ersallTrest ent Area Information: iC Application Rate( sf) ispersal Area Required (s Dispersal Are a Pro ed (s System Elevation / Design Flow (gpd) Design Soil App x -1 -6 ` 7 T Manufac rer V Capacity in Total # of ° o VI. Tank Info ° Gallons Gallons Units w New Tanks Existing Tanks P � a k. 5 Z'S ° C aU � Septic or Holding Tank Dosing Chamber J Q e VII. Responsibility Statement I, the under signed, assume responsibility for installation of the POWTS show RS Number Bus Phone Number Plumber's Name (Print) Plumber's Signature Plumber's Address (Street, City, State, Zip Code) VII �ppmed De artment Usc Onl Permit Fee Date Issued Iss ❑ =�?.�Rems-1 a d $ 76. ❑ for Denial IX. Conditi � gsons for Disapproval 31 .4 ,p 1. Septic tank, effluent filter and } dispersal cell must all be services / maintained as per management plan provided by plumber. 2. Alt setback tequirements must be maintained ttac o comp e e p is or a system and submit to the County only on paper not less than 8 U2 x 11 inches in size SBD -6398 (R. 02/09) Valid thru 02/11 I v � ti h v tt N m � �i I � y N Si k t o b a � o v Ecc o P r b to v 10 v � c 'F CEIV ED � 1323 t Wisconsin Departmentof Co rceN j 20QGSS01. E A AQN I --) RT p t 3 Division of Safety and Buildings ` Tom Schmitt in accordsa 1,with m 85, Wis. Adm. C Attach complete site plan o paper�ti �� iX vU r County �1F1Tinches' e. Plan must St. Croix include, but not limited to: v ical a nt (BM), direction and percent slope, scale or dim no arrow, and location and distance to nearest road. Parcel I. D. D/ Please print all intonation. Revi B Da cl Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location � Grand Properties, LP Govt. Lot SE 19 NW 1/4 S 36 T 30 NR 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 712 Rivard Streeet, Suite 300 10 Natalie's Ridge City State Zip Code Phone Number J City _j Village tI' Town Nearest Road Somerset I WI 1 54025 715 - 247 - 5900 St.Joseph 1 80Th St. 1/ New Construction Ilse: Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement J Public or commercial - Describe: Parent material Outwash Plain Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a conventional system with a 0.7 gpd/sgft rating. Possible system elevation for Area 1 is 94.40'. Slope is 2 %. Boring # J Boring 01 Pit Ground Surface elev. 99.28 ft. Depth to limiting factor 97+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f? 'Eff#1 'Eff#2 1 0 -12 1Oyr3/2 none sil 21sbk mfr as 2m,2f .6 .8 2 12 -19 1Oyr3/4 none sil 2fsbk mfr gw, lf,lvf .6 .8 3 19 -32 10yr4/4 none sicl 2msbk mfr cw 1vf .4 .6 4 32 -77 1Oyr5/4 none grcos Deg ml cs .7 1.6 5 77 -96 10yr5/6 none ms Osg ml — .7 1.6 Boring # _J Boring 59 0 Pit Ground Surface elev. 98.05 ft. Depth to limiting factor 98+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' 'Eff#1 'Eff#2 1 0 -12 10yr3/3 none I 2fsbk mfr as 2f,1vf .6 .8 2 12 -25 1Oyr4/6 none sl 2msbk mfr gw 1vf .6 1.0 3 25 -98 10yr5/6 none grins Deg ml — -- .7 1.6 /I Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD <30 mg/L and TSS <,0 mg/L CST Name (Please Print) Signature: // CST Number Thomas J. Schmitt /4/� 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 12/16/04 715- 247 -2941 Property Owner Grand Properties, LP Parcel ID # Page 2 of 3 3] Boring # Boring 1/ Pit Ground Surface elev. 97.90 ft. Depth to limiting factor 96+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 1 0 -19 10yr3/2 none sil 2fsbk mfr as 2vf .6 .8 2 19 -30 10yr3/4 none sicl 3fsbk mf gw 1vf .4 .6 3 30 -48 10yr4/6 none grls 1 csbk mfr cw .7 1.6 4 48 -96 10yr5/6 none grms Osg ml — — .7 1.6 1 �2 F—I Borin Boring # Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP *Eff#1 *Eff#2 Boring # Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *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. Page 3 of 3 Conducted by: Conducted For: Schmitt Soil Testing, Inc. Name: Grand Properties, LP Thomas J. Schmitt, CST 227429 Address: 712 Rivard Street 1595 72nd St. City, State, Zip: Somerset, W1.54025 New Richmond, W1.54017 Phone: 715- 247 -2941 Subd.Name: Natalies Ridge /&'d 5/ r Lot No.. /0 Legal Description S1C 1/4 N *11/4 S36 T30N R19W Township o£ St. Joseph, St Coix County Bench Mark EL 100.00' Top of 1/2" rebar Alternate Bench Mark EL �- Q.I ' Top of 1/2" rebar Slope = __.2,Pc_ Contour Line EL IYX_ scale 1 = 40' /Vo Fee r S� l 71 / V j �6 /78' > y� 817 This soil report was done to fulfill a zoning requirement. A preliminary plot map was used, no drainage easements or driveway locations were established at the time this soil and site evaluation was conducted. COUNTY PLAT OR NATALIE'S RIDGE SURVEYOR: PREPARED FOR: DWCUS ZANIER GRAND PROPERTIES, tP LOCATED IN PART OF THE SWI14 OF THE NW114, PART OF THE SETA OF THE NWI/4, PART OF THE SAN LAND PART 2920 ENLOE STR T SOMERSET, , WI N 5 5402 1025 LOCATION SKETCH NEI /4 OF THE SW114 AND IN PART OF THE NW1 /4 OF THE SWI /4 OF SECTION 36, T30N, R19W, TOWN HUDSON, N 54016 TOWN or ST. JOSEPH OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN. p1b OF WIS M y DOUGLAS 3. * �us S r " 5 4 C.T.H.'E SECTION 36, T30N, R19W N1p DDA 9eC. 3e UNPLATTED LANDS KOM UNE OF W � — N8r5lVrW 2642.99' S1/2 W nc W / { ° 23f.Jr ORAINACE 6PAINACC M269 66.29', -- � � _ GS[NfNrY - / ]]' 7J' 2 p•p FASEAEN17E � - �/ I 6lty - -� ED' RAOA15lELP011N1 - -- aL -DE -SAO EASOUT TO BE ' Dllr� N�iF ROAD 1P01 LOT 8 LOT 10 IC A= �. I f I 1&000 �. ' ro g g r­75­7 I g 79- i I > R R IG LOT 6 r LOT 7 q S"'oex Baer a �1.on 4610 ���. r LAO. WA i I m I LINE TABLE I I l LINE TABLE DRAINAGE LOT 9 I LOT T 1 Ate 1 , DRAINAGE EASEMENT'G' a txeM sn Fr. I EASEMENT'H' 9 mmv wr 136QI1 SQ rt I 7A 69' LAO. a" � / NIMI 651. CI Sa310eT a NM51L6T 7751' N.RE. W A4434 6699 T N7 MI131'MT 6A50 LOT 19 ' W .S293,td 6600' — .. 0 — .. — 6' I L _ _ — .. — NJ 5007979T 6661' GI 37$39357 77.70' 77' 3J' C3 N693ib9'W 10000 1EASEAIK . ..' w931IM'W 51.63 (�, x ,• y I L Von - 56➢'S17AYE 7061.21' �. NI SM3 162.67 �. —1— — 8 rm67t'06'W ,311.66 -- - — - — - — - — -� 26TH AVENUE — - - N6rn'06'W MT.6W � KI — -- — — -- -- — u . Iu , — — -- -- — LOT 21 µ E1.06160 m V LOT 12 13s2�u7AM b I �I • I 1 1013 AM � i1.. I: r (A 9 ' Ls.o.- 9160 LOT 20 I S 7S- I I 6RAMAFL A 3.005 ACRES EA56War 7F• 131,071 S6 Fr. LsA. 623.1 I sacs is� you IN , In m t = LOT 22 7, b 7 j IMCH NANIQ 1.09 1 Z R� Ax s OF 1' 11011 Pie, i g 4 u SFXWr l' — . ✓ % / OEWAnD11 I 19 As', 3 LOT 18 y4 `�' / % ` 1 : aO� T 1 �3 i ].022 AM / . — �� 170,917 SO. FL C 131,1650. FT. C15 LOA. 918. , I r LOT 23 41 G 116 I LOT 14 +i 3.000 AM LOT 17 bsj \ LAO.. 9,0. 6y 1011 AM a 131,,41 SO. Ft. LOT 15 m ao L.. 16.9 / s x060 ACES I / ej 1306556 So. Ft. EASSIO � � RV x' / ' �� . K '� \� ��/ / r , E• 0060 LOT 16 m LOT 24 LAO, 910 �KI7 N 4 ,1,216 SG Fr. ' 1 b 1J3V" FFE Acres D i2 �/ LAO. 0163 i 8. `-'• N • .E HAS •' 9RARAW i K1Sy_ — AD y.99 ° 1 9'1T'E'� 19T 16C. 31 LOT 25 WON MARL TOP �✓ , -'� Um"Alm 6110 , / / LINE TABU? DRAINAGE EASEMENT le prAVdL6� +p J 6WECmw ASK 1 MCDON asr. �Ct N''� KI N693,216'W $600' Km S71W7911 11075' $ °OSAir / / - K2 S001979T 74OW K16 AWWWT 31139' KJ S693/Ww ra09• Kn N00" 49.6 r T / Kl SW7979T 2)361' NIB xWWWT IR6Y K5 S602510 71.06' K19 00Wr171F 12x29' N 1]S K6 SA073:73T 1660' K2 SM 30W1Y 1SW' K7 NnSll w 1.65' K21 SB6V472'W 19ASJ' E9 L K6 S001979T $306' K22 559'1914*• 22f.,6' QQQ 3 4 �1L1' 0 S6672'IO'W 1690• K81 Nlr$OJ6M IJSOW' i t \� KID 53J7XJV W 1322)' K24 N537000T 256.90' KII 566'191111' 277' K25 NN30W11' 2200' met 1112 AN1713111• 2143' K26 Str10 201.54' KIJ S763970'W 225.4 K77 S7rJ971'W 297.10' y 9 3 KII S=4 2291' SCALE IN FEET 1' 100' t ® tws 145110191T ORAFED e1. 91W MANE 7D0 ND. e0-1 DAZE ro/22/05 SHEET 3 OF 3 SHEETS 1 . d ko LOT 10 t t ` x 184.3 { - { 1 { I { 74wIC�.) x Stu Z P - s x V t a1w t x 1R".i.4 i 1 i 12 1 �Aa { u�• haai s�.s t i 1 t t � i t t $eta: POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYST SPECIFICATIONS E P m ,Septic Tank Capacity Q�Q al 13 NA # Septic Tank Manufacturer r'C.SE' ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 1 0 41, 1 A cam• k ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model "�,� ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity 4 a l ❑ NA Estimated flow (average) .11 g al/day Pump Tank Manufacturer Se ❑ NA Design flow (peak), (Estimated x 1.5) 5'4 gal/day Pump Manufacturer 45:4 d ❑ NA Soil Application Rate al /da /ft2 Pump Model ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510° cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other ❑ NA Othe Other: (3 NA er. ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: O NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: onrth(sl (Maximum 3 years) ❑ NA Mea Pump out contents of tank(s) When combined sludge and scum equals one -third %) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 3 Wyear sl s) (Maximum 3 years) El NA Clean effluent filter At least once every: month(s) ❑ NA ear(s) Inspect pump, pump controls & alarm At least once every: r— 13 y e n j(s) ❑ NA ' Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) ❑ month(s) Other: At least once every: 13 ear(s) ❑ NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tanks) 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. t Page of START UP AND OPERATION a of painting Products or other chemicals For new construction, prior to use of the POWTS check treatme f i Deli {si If high concentrations are detected have the contents that may impede the treatment Process and /or damage the dispersal of the tanks) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. red the excess wastewater will be Y is resto s, When power urn tanks may flit Grove normal highwater level in the backup or surface discharge of outag resu During power 9 pump e cells) and may res , n t he restorin effluent. To avoid this_ situa discharged to the dis(rersal cel!(si in one large dose, overloading a e Servicing Operator Per to rest r to tion have the contents of the pump tank removed by a Sapt 9 o the pump power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually p g restore normal levels within the pump tank. not drive or ,park vehicles over tanks and dispersel cells. Do not drive o o ark r park over, or otherwise disturb or compact, the area P Oa .. , within 15 feet down' slope of any mound or at -grade soil absorption area. performance and prolong the fife of the Reduction or elimination of the following from the wastewater stream may idegvcoeesers, floss; diapers; disinfectants; fat; POWTS: antibiotics; baby wipes; cigarette butts; condoms, cotton s$ o grease; herbicides; meant scraps: medications; ail; foundation dram (sump pump) water; fruit and vegetable peelings; 9 painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT shall be taken to insure that the system is When the POWTS fails and/or is permanently taken out of service the following steps properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: P ro P Y s sealed, • AN piping to tanks and pits shall be disconnected and the abandoned pipe opening ator. d of b a Septage Servicing Y • The contents of all tanks and pits shall be removed and property disp ose • Open . • After umping, all to and pits shall be excavated and removed or their covers removed and the void space filled with P sail, gravel or another inert solid material. CONTINGENCY PLAN a following measures have been, or, must be taken• to provide a code compliant the POWTS falls and cannot be repaired the soil absorption replacement system: [3 A suitable replacement area has been evaluated and may be utilized for the locat and shaulde�noe infringed upon by P area will system. The replacement area should be protected from disturbance and compacts t s stems must to establish a suitable replacement area. Repiacemen Y required setbacks from existing.. and proposed structure, lot lines and wells. Failure to protect the Ted result in the need for a new soil and site evaluation comply with the rules in effect at that time. Ong advances in POWT` E3 A suitable replacement area is not avall bl a last resort o r the soil i POWTS s sitE technology a holding tank maybe installed tan/ ° e � I A removal of the biomat at th ,r Mound and at -grade soil absorption systems may be reconstructed with the in effect at that [3 infiltrative surface. Reconstructions of such systems must comply OXYGEN. Did NO CIEN 7 < <WARNING> > I NS UFFICIENT SEPTIC. PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AN ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUM D�►TH `Y gULT. RESCUE OF PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSI ADDITIONAL COMMENTS pOWTS MAINTAINER POWTS INSTALLER FNa e N ame ne Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHD t iel6; N ame i!rlame '54; &.. Ceu... Mane Phone ♦ 7-1 Thla document was drafted in compliance with chapter Comm 83 22(2)(bl(tl(dl &(f► and 83.64(1), (2) & (3), Wlsoonain Admkostrative Code, SEPTIC TANK S PUMP CHAYBER CROSS ` CTION AND SPECIt ICA'luav� 4" CI' VENT 'PIPE 12" MAN. `ABOVE GRADES WEATHERPROOF >_ 25' FRAM DQOR, WTNDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MAN HOLE COVER FINISHED GRADE WARNING LABEL 7- 4 CI RISER 4" MIN- l8" IN. 6 MAX. ' N LET 1, WATER TIGHT SEALS TI TIGHT � �► PPROVED A SEAL JOINTS WI TH ,,.i— ; LM APPROVED PIPE PPR OVED B ON 3' ONTO IPE 3' "i + SOLID SOIL NTO SOLID C < < � RISER E XIT OIL PUMP OFF ELEV . �FT OFF PERMITTED ONLI D IF TANK MANUFACTURER HAS APPROVAL all APPROV BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE NUMBER DOSES PER DAY: TANK MANUFACTURER: /.�, `� s ✓ ......._- TANK SIZES SEPTIC 1„ GAL, DOSE VOLUME INCLUDIN : �__- -- GAL• DOSE 4 GAL. INCHES � pt,� GAL. _ MANUFACTURER: o! CAPACITIES: A = IN .,.3 �?...C. --- ALARM MODEL NUMBER: ,_, y. ,....,..._ B 2 INCHES s 3 Z� GAL SWITCH TYPE: Wig - PUMP MANUFACTURER: ocM/ C = B INCHES = / GAL. MODEL 14UMBER : X! © � D = INCHES = GAL SWITCH TYPE : - 16.23 WAt REQUIRED DISCHARGE RATE GPM PUMP E ALARM WIRING AS PER ZLHR � FEET VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE -•-1- FEET + MINIMUM NETWORK SUPPLY PRESSURE • • FEET + FEET FORCEMAIN X 3;,,,,FT/ I00 £TOTALIDYNAMICAHEAD _ • FEET T • WIDTH • DIAMETER N L DIMENSIONS Or PUMP TANK: LENGTH �- -�-- -' T A I N ER D �• l � .� L Q NSF. NtaMB£R: 7Q�4..._.,. DATE: �'�. -- LICE SIGNED; I /B$ H GOULDS PUMPS Submersible Effluent PUMP 387 1 EPO4 EPQ5 ■ EP05 Impeller. Thermo*- ■ Bearings: Upper and lower APPLICATIONS • fully submerged in high enclosed design for heavy duty ball bearing =and oil for construction. specifically designed for the lubrication and efficient improved performanco. following uses: heat transfer. ■ Casing and Base: Rugged AGENCY uSTING • Effluent systems thermoplastic design provides • Homes Available for automatic and superior strength and corrosion �• sunderds o Fames on' Auto- • Heavy duty sump m anu a l models dude re sista n ce . Cast iron (CSA listed model numbers end • Water transfer Medtanical Float Switch for efficient heat transfer, in or or "C • Dewatering assembled and preset at the strength, and durability. dory- ■ Motor Cover. Themhoplastic col& MW is ISO gm SPECIFICATIONS cover with integral handle and •Solids handling capability: FEATURES float switch attachment points. 1 P , ma)dmum. ■ EPO4 Impeller: Thermoplas- M power Cable: 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 - rotarylceramic- stationaty BUNA - elastomers. •Tempperature: 104°F (40°C) continuous 1 . _ ......._- METERSFEET ---_._....,.,.,...,...,,..__.._. }_....__.......,..._..._......i , 140T (6K intermittent. 10 1 _ ..__ _. �.... .......... ..........._.. ...._.....__ ............... ... _...._._._ - ' • Fasteners: 300 series GPM stainless steel. _ ....,,. ._..._...�.--- .._......r__.. --- .___�._ --► 5 9 30 .. ......,.....__ l i L.._ dry Ca thout damage to $ 25 � ._...._......+._.._ ...._.. {.... '- components. �.. _._. -... ' ....... _. � - Motor - • EPO4 Single phase: 0.4 HP, " e zoo ! _ 115 or 230V, 60 Hz 1550 5 l..'. .,...' _ RPM, built in overload with automatic reset. q ... F ._. • - EP05 Single phase: 0.5 HP, __._. 115 V, 60 Hz, 1550 RPM, 3 10 , __. Epos 1 �..._. butt in overload with z l ' -- automatic reset. + - - -- • Power cord: 10 foot standard length, 1613 t' . _ _ _ SJTOW with three prong 30 40 SD GPM grounding plug. Optional 20 o °o t zo foot length, 16/3 SJTW with s 10 12 cWlh three prong grounding plug 0 2 a s (standard onEP05). CAPACITY Goulds Pumps ' ITT Industries © 2000 Goulds Pumps < & Effective February, 2000 83871 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIF CATION FORM Owner /Buyer c ' n �J 17_. Ll c Mailing Address K n � , ' n Property Address l r 7 3 '11q P — (Verification required from Planning & Zoning Department for new construction.) City /State I , i(' k h✓ rt --t Parcel Identification Number LEGAL DESCRIPTION Property Location S� 1 /a , 1 /a , Sec. , T _DN R W, Town of � I Subdivision ft ci Lot # Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # Spec house yes no Lot lines identifiable yes ) no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I /we, 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 Planning & Zoning Department within 30 days of the three year expiration date. 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. Number of bedrooms SI ATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) 1 U 2 8 1 2 P 6 1 8 �/ I 796404 II KATHLEEN H. WALSH DOCUMENT NO. �+ STATE BAR OF WISCONSIN FORM1 —1 REGISTER OF DEEDS ! ST. CROIX CO-1 WI WARRANTY DEED RECEIVED FOR RECORD 06/01/2005 11:40AN This•• Deed- �macle_- T�eWen__ Rcl__ y_._ a-__ Eirsawn ___axad__ ___________ ______ WARRANTY DEED • -• -° .Fed --axxorCe- _J_- ..J3.rc>rdn.husband. and_.�zi£�Y6santass---- - - - -- EXEMPT • -----•-------------------------------------••-----------•----------------------- ---- ---- ---- -- -- -- --- --- ------ REC FEE: 13.00 and Gr and- _ Proper- tij. s-,--- L. E------------------------------------------------- - - - - -- i TRAITS FEE: 5445.00 ........................ Qr e amte----------------- -----•------- - - - -- -- COPY F CC FEE: PAGES: 2 ._ . ---• - -- ---- . --• - - - -- -- -• - ---•-- -- ----- _.- ••--------------•------------------ the following described real estate in SLt_.._ Cr jaiX------------------------ State of Wisconsin: wcrvwN To See Attached Exhibit A j1 ZS�$tllu I - i =1 Tax Parcel No-P13 _l !' 3 t , '_ Ca�1J -�l� -moo i Together with all appurtenant rights,title and interest. Grantor warrants that the Title to the Property is good, indefeasible in fee simple and free and clear of encumbrances This ......... ng.t............ homestead property. (is) (is not) Dated this ............. ...3.1.5 ....................... day of ................ K?- Y........ 1920A.5 (SEAL) 1.�7G?sCs1Sl ... ............ (SEAL) " ...................•----.._........ ..._........................._. , RaY._ G. :.. $ ------------------------------------- ......(SEAL) . ..............(SEAL) . ................................... .•--•-•••......._. ............ ........................ AUTHENTICATION AOBNOWLDDG}MENT Signature(a) ________________________ ____________'�V.Cre. STATE OF WISCONSIN ----- ---- ---- --- --- ----�'f�jQ � VI?G�L1_ . St_ �rnix. y as. ._. .Count ))) authenticated this -------- day of__IAQ.___�5___, 19 ------ Personally came before me this _.31_st ----- day of O May-.......... 192f2A_5the above named -•---•--••-- •--- •---- -- -- ------ ----------- '�c?+ - ------ ----- --- ----- -- -- --- -- . R-QL Y_.. C;-.-. 5r- QWnL.. a.Ud-- El�eannra..J_.._._- ......- I _.&x_asvaz husband .. and ..wife . ... ..... .............. TITLE: MEMBER STATE BAR OF WISCONSIN _____________•_--____-----___-----_---__--__-----__-__._________-_____- (If not authorized by § 706.06. 1Via. Ststs.) to me own to be th perso ......... who executed the fore frame an e e to same. THIS INSTRUMENT WAS DRAFTED BY I+ ...... C x'Ai g ..A.....Fz:i aks an .. 1 Erickson and Schuller LLC •• tt� ........... . .... .......... ...................t........... Notary Publi t,I,/15.� 4 J ....... Qounty, Win. (tiiunntures may be authenticated or acknowledged. Both My Com iss on is permanent. (If not, state expiration are not necessary.) date: ... - --- - ---- ------------------------------------ 19 ......... n® o§ s I 0 c a n ƒ__/ z o e o e§ S Q, - 7 O\ k $ B: w e 0-4 ® - Ch CL } 2 © m � 0) } (D § i _ao 6 U r K o f / a tee& Co /\ CL �\ i o , § ( C @ 0 § & 2 \ � [\ rrc � c � CL 0 0 o j \- 2§ Oro e z ° aq ■ _: 3/ o v e E , !R £ m ■ a \ / � X CD §I\ U \ E - ! \ m )_ ;u\ � > k \ 0 £ ?\I\ � @e: 5 w : 2 // : w■ \ ■ z , § E \ § $ \ 2 H w ID CL } \ z ° § F \ z 2 7 z � > . 0 § \ i / ƒ \ 0 e \ ; � \ . � � \ � � a � \ � � 2 � cz � K 0 \ < Ali / l ( \ Cl