HomeMy WebLinkAbout030-2125-10-000 Wlsconsin.,epartA - f Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and P # Division
INSPECTION REPORT Sanitary Permit r 506189 U
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID N
Personal information you provide may be used for secondary purposes [Privacy Law. s.15.04 (1)(m)).
Puim;t Holder's Name: City Village X Township Parcel Tax No
William, Benjamin St. Joseph, Town of 030 - 2125 -10 -000
CST BM Elev. Insp. BM Elev: BM Descri ti Section /Town /Range /Map No:
110" d p0. D ♦ 1. .J r te' �s 25.30.20.1015 i
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
---- f>
(2
Dosing Alt. BM
IN Sz3
Aeration Bldg. Sewer
maw
Holding t Iril t � �. U
Ht Outl I
TANK SETBACK INFORMATION 6•g� �I7' l
TANK TO P/L W BLDG. Vent Air Intake ROAD Dt Inlet A Septic Dt Bottom > ED / / Dosing Y eader / Man. old , 7 Aeration DPie
• '� 9 3
Holding Bot. System
�(. '7
-Final Grade dl
PUMP /SIPHON INFORMATION .X�u,, - - • 3 •75
(vianufacturer Demand St L C , 0yVr 1 `
GPM L ' ? j S �C` 7 / D
Model Number /
TDH Lift Friction Los yste TDH Ft
Forcemain gth Dia. Dist. to well
SOIL ABSORPTION SYSTEM 73- X Z
BEDITRENCH Width Length No, Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3
SETBACK SYSTEM TO I P( BLD WELL LAKE /STREAM LEACHING Man r
INFORMATION CHAMBER .R r
T�q: ,�f System 4 LIN Model Number.
q!aWIBUTION SYSTEM.d
q H�eadanifold d Distribution ' x Hole Size x Hole Spacing V to Air Intake
Pipe(s) gth__ Dia �" Length Y� Dia Spacing �y
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over / Depth Over xx Depth of TSeeded /Sodded xx Mulched
Bed /Trench Center I p� r I B.d/Tr.nch Edges Topsoil Yes Na Yes No
`r 11
COMMENTS: (Inclu e i re n
code cie ,per ns es nt, e Inspection #1:_ 7/ -/ spection #2: / /
Location: 1315 Birch Park Road Houlton, WI 54082 (SW 1/4 SE 1/4 25 T30N R20W) Birch Park Lo 11 Parcel No: 25.30.20.1015
of A-Z Ixd�v{�� --� G��- S� -S/�°��r�,�� (/121/0
_Ap �•�
1.) Alt BM Description Sk�/�d� "t
2.) Bldg sewer length = ,Z / f- Sl/STv{'yl AAA/
- amount of cover = � G p 1 _ A � I d �/`I,�,� � q'f�' ���,ti �. /� ; u re � j,/I � � `"— Plan revision Required? Yes fit 7 6 � Use outer side for additional
information Cate Irsepctor's Sign Cert. No.
SBD -6710 (R.3/97)
"�- commerce.W1.90v Safety and Buildings Division County
201 W. Washington Ave., P ox 7162
Madiyott, W [ 53�Q 62 SaE; Saa/ Pgtmit Numb- b tilled in by Co.)
i
toletwimenit of Coirm"ree
S c o n C i
'— late Transact! n Number
Sanitary Permit Application
In accordance with s. Comm 83.21(2), Wis. Adm. Code, submission of this form to the appropriate go mensal
unit is required prior to obtaining a sanitary permit. Note: Applicai ign forms for e POW c Project Address (if different than marling address)
submitted to the Depaiirnent of Commerce. Personal information y u pro secol r ju
purposes in accordance with the Privacy Law, s. I5.0 )(m ,Stars. � �`� -- S /t�GL•
11. Application I nfor m ation - Please Print All Inf ormation
Property Owners Ndme JUL 0 3 2007 Parect M
-
Property Owner's Mailing Address ST. CROIX COUNTY Property Location /
Govt. Lot, t • � 0 / �� t
City. State Zip Code Phone Number �� y. ��" Y., Section ,2 � E
L � T N; R
II. T �<J ype of Building (check all that apply) Lot tt
Subdivis Name
�I or 2 Family Dwelling - Number of Bedrooms
lock # L
0 Public /Commercial - Describe Use _._ 1 ❑City
CSM Number G Village of _
❑State Owned - Describe Use
+, Town of
131. Type of Permit: (Check only on box on lin A. Complet line 8 if a pplicab l e)
A New System � Replacement System ❑ Treatment /Holding Tank Replacement Only �;�❑ OUler Modification to Existing System (explain}
\ 1 U Pemett Transfer to New List Previous Permit Number and Date Issued
lZ. G Pcn�rn Renew Permit Revision ❑ Change of Plumber
Before Expiratio Owner D l / / -�Q�
IV. Ty pe of POWTS System /Componentllleyice: (Check all that a � I
X Noti- Pressurized In- Ground O Pressurized In- Ground ❑ At -Gradt ❑ Mo nd ? 24 in. of suitable soil G Mo nd < 24 in, of suitable soil r
❑ Holding Tank ❑ Other Dispersal Component (explain) reatinent Device (explain
i V. Dispersal/Treatme Area Inform ation: _ Ley VV
rDesign Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required ) Dispersal Area Proo3sed (slL I System Elevation
C, a c.�1 C s
VI. Tank Info Capacity in Total K of Matiufacturer w
I Gallons Gallons Units v v _
New Tanks Existing Tanks A
ti. C7 A-
Septic o� I {otdurg Tank Ild l 1 st Y r
i Dosing Chantircr
Responsibility Statement- 1, the undersigned, assume responsib for ins of the P OW TS &kQwn on the atta ched plans. _
Ilumber's Name (Print) Plumber's Signature P MPR.S ;Nu Business Phone Number
?
Plumber's Address (Street, City, State, Zip Code)
Vlll ount /De a rtment Use Onl a__ —
Y
f Approved ❑Disapproved Permit Fee Date lashed !- Is irg Agent Si lure
❑ Owner Given Reason for Denial ( 3
IX. Conditions of Approval/Reasons for Disapl.roval
,ems`
35 .
Attash toe pkte plans cur the systeat and sub I to tine County ealy Oil p�less l�x I 1 Inches in size
SBD -6398 (R. 01107) Valid thru 01/09 �"
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Wisconsin Department of Commerce SOIL EVALUATION REPORT page 1 of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County ST. CROIX
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal neferertce Aµdirpd6on arxi Parcel I.D. 030 - 2125 - 10 - 000
percent slope, scale or dimensions, north arrow, and 1 lion h LMMst roa .
Please print all inform don. Reviewed Date ,(
Personal information you provide may be used for secondary rposes a aA,
Property Owner JJ Property Loca
BENJAMIN P. & COLLETTE E. WILL SST. CROIX T& - - -- W 114 SE 114 S 25 T 30 N R 20 (or)
Property Owner's Mailing Address # Subd. Name or CSM#
10381 Grand Valley Lane 11 -- Birch Park
City State Tip Code Phone Number afty ❑ Village Town Nearest Road
St. Paul, MN 1 55129 1 ( 651 402-1344 Birch Park Road St losenh
E] New Construction UseEj Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material sandstone Flood Plain elevation if applicable ft.
General comments Conventional In- ground trenches -- 0.7 loading rate
and recommendations:
4 4ah- New test conducted to move system area.
A-f-
F Boring # Boring
❑ pit Ground surface elev. 100.04 ft. Depth to liming factor 110 in
Sol Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -3 l0YR3 /3 - s Ifgr ml gs 2vf-m 0.7 1.6
2 3 -110 _ s O ml __ -- 0.7 1.6
Some gr & cos. Q
d D d //
F2 Boring # E] Boring 97.94 107
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil lication 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 -24 7.5YR3/3 - is Osg ml gs 2vf -m 0.7 1.6
2 24 -107 10YR4 /4 s Osg ml -- __ 0.7 1.6
I
Back side & south side of pit had large poc ket of 7.5YR3/4 Is.
some gr & cobs.
Effluent #1 = BOD > 30 220 and TSS >30 _ 150 Effluent #2 - BOD 30 and TSS _ 30
m9d- m9/I- � mg/L
CST Name (Please Print) Si re CST Number
M Jo Hollister ollister's Soil Testin & Desi S Lam. 224832
Address Date Evaluation Conducted Telephone Number
W9875 690th Avenue, River Falls, WI 54022 06-26-07 (715) 426 - 1775
I
Property Owner WILLIAMS, Benjamin Parcel ID # 030 - 2125 -10 -000 page 2 of 3
` Boring
3 Boring # ❑ pit Ground surface elev. x ' 34 ft. Depth to limiting factor 108 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *002
1 0 -30 10YR3 /3 -- is Osg ml gs lvf -co 0.7 1.6
2 30 -108 10YR4 /4 -- s Osg ml -- -- 0.7 1.6
Horizon 2 has some gr.
F Boring # Boring
Pit Ground surface elev. ft. Depth to limiting factor in.
Sal — Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
❑ Boring # Boring
Pit Ground surface elev. ft. Depth to limiting factor in.
Soil AppikWbn Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BOD > 30 1220 mg/L and TSS >30 < 150 mgA- * 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.
M- 6330Test (It07 /00)
Plot Plan for Site and Soil Evaluation Page 3 of 3
Property Owner kNLuA, t vs, �tt., aA, m 1 � : CL t
I" = 40fl.
Le al Descri tion "I ii, et -- A-'. (except where noted)
1
�w Q = Backhoe pit
+ � �=
North
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ACR'�
EL -9-1.01 1 4
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gM' ok �q4.
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Site Locado •
C.T.
. �
Ommerce.m.gov Safety and Bwidings Division Clunly Tc'ra. � -� �...._'
0 201 W. WashiiiSton Ave., P�O. Box 7 1&2
cot Msidison.Wi 537W-7162
,jein Permit Maw �er it') be I"I" in by Co.)
JL
Sanitary Permit Application saction Number
In accordance with s. Conim 83,21(2), Wis Atim, Code, suom.ssioli, of this form to the apprn 1 Lai A
Ali is required prior to obtair a Sanitary permit Note; Application forms tfj,' StAtil • owned POWTS are Project Add
sobaiated I the Utp of Comm ress O'di 'feicrit than mailing add
L-1=-q-x in wc; with ihr, Fiiva VlU liltomiultIOn Yuu PCOvide MaY be used for stcumfwy
informs U on - Please /3 /� 8/�(� Pa���L. K�
7jlloperly Ow tznw :X— Int All lji�qrmshon I arcei a
Cp log
vromjl Owner's Mailin A IYIM I D I-UU J Locat4un rvperty
i �.
a 4,A ST. CROI
City Slate Zip Curls ho ne Nijmber
section
fvIrJc one
tl-�ag WBE (check oil that apply) Lot N T 36 - N; KOIAO
or 2 Family
Subdivision Nsine
�N - k#
Fj PUbk(:/C(jnmvTi;juj Describe lisc
Id SIAC O-A Dj.-d - Deul Us, I FC. VW.Irft Village of
41 YTOW
:3 00
I n e
Ill. Type of Perm in
(C heek only Ont box on ins A. Comple Uise H 1(2 [ppl
C
-cable
l Jew
%ystvni ❑ 1 0 Replacen"Ou System Witit
List Prev r and Date Issued
I Femin Renewal pernilt Rev'sio OD Change of Pill (01pe itTraIrisfertotew
I ims Permit Numbe
Owner
IV. Ty Pe of P( )WTS stem /Coln�onea :k alAihat ja
,&L" In ❑ pl-essur l n d
r4t.wrade LJMO d_y 24 IM4 (il'sultubir. soil 0 Mound < 24 In ofstlits'.)le toil
0 Ho
iding 0 OU10- Dispersal ComponemE (explain)— 0 Pr ireiitnieni arvice (cAplatn)
estillellit Area In forents
Design Flow (Vpd) / Design Soil �lppticaiian RaT ~ilia!} isirersal Area Rrquuetl } L?isprrasl Area Proposed (s Systern Fevan
;7
N I. Tank Info 1- ---
CAI;Wity in Total s of Mantifivisw r--
Gillions liallons
moting Ton
Awl
ek ; --
S tic
g4v
e Y
V11- Res oftsibillity Statement- I
the undersIgn ' Assitinp res imllt&6114. for iastallation of the POW Wit on the attAcked plans. ��
TiZmber's.Nartle S
P1 nber' Signature MP7 PIRS Number Business Phone Number
; vt
Address �5 'I'm. C sty. State, Liu code)
r ti 'li Count
Wpartill , U
In d'11,1311"Sts
Approved it Fee "Issued I ssiang A ism lure
iven Rees "i Den:al
-L—L-7--alt 7 67
I X. Condi",,h for Disapproval
3) nr �e-54- ktl�Alzzlal
1. Septic tank, effluent filter and 7 1
dispersal cell must all be services / maintained
as per management plan provided by plumber.
Z AD setback requirements must be maintained
Atfittli to voiraltet istims for tilt srlttfat snd aabfair to tltt Cou 4411Y 40 paper isot 1IZti;s" I on I I lathes in A64o
SBO-6398 (R. 01/40 Valid thru 01109
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LCommerce CEIVED
Wisconsin Depa erce SOIL EVALUATION REPORT Page l of 3
Division of Safet Q 1 20 0 ►n accorda oe with Comm 85, Wis. Adm. Cod e County ST. CROIX
Attach com an 8 x 11 inches in size. Plan must
inducts, btrtrio(fical and horizontal nce point (BM), direction and parcel I.D. 030 - 2125 - 10 - 000
percent slope, location and distance to nearest road.
Please print all iMormadon. Reviewed b L Date —7
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). - 15
Property Owner Property Location
BENJAMIN P. & COLLETTE E. WILLIAMS Govt. Lot - - -- SW 1/4 SE 1/4 S 2 T 30 N R 20 E
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
10381 Grand Valley Lane 11 1 -- Birch Park
City State Zip Code Phone Number []City []Village ■ Town Nearest Road
St. Paul, MN 1 55129 1 ( 651 402-1344 Birch Park Road
Q New Construction UseE] Residential / Number of bedrooms 4 Code derived design flow rate 60 0 GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material sandstone Flood Plain elevation if applicable NA ft.
General comments �2� ,Conventional In-ground � enc es -- 0.7 load' rate / �e
and recommendations: 1.�1'Yt N'l , (` � �� 1 yV �� Q SOI
`► New test conducted to move system area closer to proposed dwelling. Use initial test for replacement area.
9q 3
<< 2 W(r�� 7 3 � p rQ Ye_
"�
Boring # E) Boring ,
❑ pit Ground surface elev. 98.68 ft. Depth to limiting factor 80 in. I Soil Application Rate -,P_ �
tr
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -24 10YR3/4 sil 2fa&sbk mfr cs 2vf -m 0.6 0.8
2 24 -56 7.5YR3/4 s Osg ml __ -- 0.7 1.6
3 56 -80 7.5YR4/3 s Osg ml __ __ 0,7 1.6
❑
2 Boring # a Borin 97.93 84
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Appl ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -34 7.5YR4/4 s Osg ml -- 2vf -m 0.7 1.6
2 34-6 7.5YR4/3 s Osg ml -- __ 0.7 1.6
3 61 -84 7.5YR4/3 - s Osg ml -- __ 0.7 1.6
h orizon 1 has a Layer of 20-25% gr at 28 -34.
Horizon 2 has 50% cos.
* Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS 5 30 mg/L
CST Name (Please Print) Sig CST Number
Mary Jo Hollister ollister's Soil Testing & Design) 224832
Address Date Evaluation Conducted Telephone Number
W9875 690th Avenue, River Falls, WI 54022 04-24-07 (715) 426 - 1775
�-t
I �[)A
A�v
Property Owner WILLIAMS, Benjamin Parcel ID # 030 - 2125 -10 -000 Page 2 of 3
Boring
B oring # ❑ Pit Ground surface elev. 94.63 ft. Depth to liming factor 60
3 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0- 7.5YR4/4 -- s Osg ml -- 2vf-co 0.7 1.6
2 17 -60 7.5YR4/3 -- s Osg ml -- -- 0.7 1.6
H orizon 2 has some gr at 34 -40 ".
� 1
t f
F-1 rr
Boring # 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 GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
F-1 Boring Boring #
Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Appl icati on Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *042
* Effluent #1 = BOD > 30 5 220 mg/L and TSS >30 _< 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg&
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.
SM- 83307reg (8.07100)
r
Plot Plan for Site and Soil Evaluation Page 3 of 3
Property Owner R+- W A - cou W%uUAM
I" =40ft
Legal Description ugr«, a► ARK (except where noted)
5(0/ OF THE sti et z5 r T,nosO. RZOW, IUwN Of I—� = B ackhoe pit
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North
PcR�
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CP
tffi
F31'R'�`.t f �R1� �J3trJ � 0 0
fc� -9Y.6g �a
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Site Location:
26
Rpr 23 07 11:27a MaryJo 7154264827 p.1
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HOLLISTER-'S SOIL TESTING & DESIGN
Mary Jo Hollister
W9875 690* Avenue
River Falls, WI S4022
(715) 426 -1775 °
Fax: (715) 426 -4827
t
Send to: From-
Attention: ,CC `s Date: 2,^ �, 1
Office Location: Office Location: I
m
Fax Number: j _ Phone Number.
C3 , Urgent
Reply ASAP
2
D Please comment
❑ Please Review
D For your Information
i
Total Pages, including cover: X q
Comments:
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E, Apr 23 07 11:30a MaryJa 7154264827 p.2
Apr -9,0-2007 11:53 AM 3M 6517367081
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SEPTIC TANK E PUMP CHAMBER CRSa SECITL3N AND SrECIF10E.TIO.'tiS �..,.
4" Cl VENT PIPE 12" MIN. ABOVE GRAPZ WEATHERPROOF
> 25' FROM DOCR, WINDOW OR..-,'' BOX APPROVED
FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER
FINISHED GRADE WI PADLOCK &
4" CI .RISER WARNING LABEL
16" IN. 6" MAX.
r
t NLET
WATER TIGHT SEALS GAS - P `,
TIGHT r "IPPROVED
,A SEAL � JOINTS WITH
'IPE03ED B : B ALM APPROVED PIPE
)NTO SOLID ON SOLIDTSOIL
C ; +
SOIL PUMP OFF ELEV. FT. �---- ► OFF +'� RISER EXIT
D PERMITTED ONLY
IF TANK
MANUFACTURER
3" APPROVED BETIDING UNDER TANK HAS APPROVAL
CONCRETE PAD
SPECIFICATION$
SEPTIC / DOSE
TANK MANUFACTURER: NIUMBER DOSES PER DAY: 7
TANK SIZES: SEPTIC 1 .SQ GAL. DOSE VOWME INCLUDING
DOSE $ d�, GAL. FLOWBACK: 9 GAL.
ALARM MANUFACTURER: Utw�i..shfL m CAPACITIES: A = � INCHES = ` _ GAL.
MODEL NUMBER: Qt,V
SWITCH TYPE: _ B s 2 INCHES = L l GAL,
PUMP MANUFACTURER: t C =
MODEL NUMBER: INCHES = �� GAL.
�..___. P
SWITCH TYPE: D = � INCHES - lo gAL.
REQUIRED DISCHARGE RATE y b GPM PUMP 6 ALARM WIRING AS PER I LHR 16.23' WAC
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE I Q, FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . 2.5 FEET
FEET FORCEMAIN X �O FT /100 FT, FRICTION FACTOR � FEET
TOTAL DYNAMIC HEAD = ��� FEZT
INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH DIAMETER _
LIQU ITT'R" _r__8__ -�
SIGNED: � ,1.., -� LICENSE NgJMB'ER : 15 DATE' _
1/68
[RGOULDS PUMPS Submersible
Effluent Pump
it
,. EPO4
,
3 87 1 EP05
APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Hearings: Upper and lower
Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing
following uses: lubrication and efficient improved performance. construction.
heat transfer. ■ Casing and Base: Rugged
• Effluent systems thermoplastic design provides AGENCY LISTING
• Homes Available for automatic and superior strength and corrosion
• Farms manual operation. Auto- resistance, 4 QnMo Sunda rrh Assodatim
• Heavy duty sump matic models include
• Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end
• Dewatering assembled and preset at the for efficient heat transfer, in "F" or "Co.)
factory, strength, and durability.
SPECIFICATIONS ■ Motor Cover: Thermoplastic Goulds Pumps is ISO soot Rogwered
• Solids handling capability: FEATURES cover with integral handle and
9 Pa ity: float switch attachment points.
1 /4 " maximum. ■ EPO4 Impeller: Thermoplas- ■ Power Cable: Severe duty
• Capacities: up to 60 GPM. tic Semi- design with
to 31 feet. g cited oil and water resistant
• Total heads: up pump out vanes for mechanical
• Discharge size: 1' 12" NPT. sear protection.
• Mechanical seal: carbon -
rotary/ceramic - stationary,
BUNA -N elastomers.
• Temperature:
104 (40°C) continuous
140OF (60°C) intermittent. METERS Feel ,
• Fasteners: 300 series
stainless steel. y 30
• -- �,..�� .. — a► soFra'�
Capable of running
dry without damage to s _2s Fr
components. 25..
< 7
Motor:
• EPO4 Si ngle phase: 0.4 HP, 20 _ _._.
115 or 230 V, 60 Hz, 1550 5
RPM, built in overload with
automatic reset. a I
4
EPOS
• EP05 Single phase: 0.5 HP, c
115 V, 60 Hz, 1550 RPM, a 10,
built in overload with
EPO4
automatic reset. 2
• Power cord: 10 foot s
standard length, 1613 1 - -
SKOW with three prong
grounding plug. Optional 20 0 00 o 20 30 ao so GPM
foot length, 1 6/3 SJTW with
three prong grounding plug o z 4 6 s 10 12 ^ miih
(standard on EP05).
CAPACISV
Goulds Pump
a 20 Gourds Pumps ITT Industries
Effective February, 2000
83871
.Wisconsin Department of Commerce SOIL EVALUATION REPORT p age 1 of 3
Division`of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code County St. Croix
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. �3� , Z� . /� -�r�,
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. !7 UV v
Please print all information. Re Date
vie
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ` Y1_
Property Owner Property Location El )W
Quest Development, Inc. Govt. Lot E 1/2 1/4 SW 1/4 S 25 T 30 N R 20 E (or) W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
Suite 150 10700 Old County Road 15 11 1 Birch Park
City State Zip Code Phone Number ity []Village • Town Nearest Road
Plymouth MN 1 55441 1 ( 7¢3 -595 -9512 County Road E
New Construction LlseE] Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD
Replacement Ej Public or commercial - Describe:
Parent material 1 over out wash sand4 Flood Plain elevation if applicable ft.
General comments S
his site is suitable as a below grade conventional system i 4
and recommendations
f
�F
INY
� � l
1 Boring # ring ;
❑
kax H
-- 101 200
pit Ground surface elev. 101.27 ft. Depth to limiting factor >_ 9 � 8 _ ir?. SS C
40il A-DPliq40aMate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence B r(da
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * 1, Eff#2
1 0 -6 10yr3/3 sil 2msbk mfr cs f 1 Z 8
2 6 -24 10 r3/4 sil 2msbk mfr cs if .5 .8
3 24 -96 7.Syr5 /6 s Osg ml - - 7 1.2
2 Boring # ❑ Boring 101.77 >98
Q Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -4 10yr3 /3 sil 2msbk mfr cs 2f .5 .8
2 4 -10 10 r4/4 sil 2msbk mfr cs if .5 .8
3 J 0:32 \ 10yr4 /6 sil lmsbk mfi cs - .2 .3
4 32 -96 7.5yr5/6 s Osg ml - - .7 1.2
I
* Effluent #1 = BOD > 30 220 mg /L and TSS >30 < 150 mg/L * Effluent #2 = BO < 30 mg/L and TSS < 30 mg /L
CST Name (Please Print) Signature CST Number
Thomas C Nelson ` 227387
Address Date Evaluation Conducted Telephone Number
1432 120th Street, New Richmond, WI 10/22/01 715 -246 -2454
r
Property Owner Quest Development.Inc Parcel ID # Page 2 of 3
3 Boring Boring
g 0 Pit Ground surface elev. 101.36 ft. Depth to limiting factor >98 in. Soil Applicabon Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -19 7.5yr4/6 - is 1fgr mvfr cs 2f .7 1.2
2 19 -98 7.5 r5/6 - s Osg ml - - .7 1.2
F-1 Boring # Boring
Ground surface elev. ft. Depth to limiting 9 factor in.
u Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
Q Boring
❑ Boring # Ground surface elev. ft. Depth to limiting factor in.
Pit Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BOD > 30 < 220 mg /L and TSS >30:5 150 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- 8330Test (R.07 /00)
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FROM :SCHUMAKER PLUMBING FAX NO. :7153863121 May. oe 2007 02:19PM P3
ST. CROIX COUNTY
SEPTIC TANK, MAINTENANCE AGREEMENT �
AND
O WNFRSkiil' CERTIFICATION FORM
UtX�tter /Buyer � ,
Maili Address
Property Address /3 / ZL�PAu k — �EZ T
(�'Criflcatiun required from Phina n Z*tiulg Departrrte for 11ew ru nottuction. .. -
City /State • J f Q � _ Parcel Identification Number ,_„_03 b . — —boo
LEGAL DLECEAUI �i
Property Location , W �/. , S C Y.. Sec. a, , 'F 0 N R At Wjown of
Subdivision 131 �. �.
Certified Survey Map # , `'ON= , Page #
Warrsist Deed # _ � � Volulne —... _._ .—. —, Page # _
Spec house yea no W lines identifiable �) no
S H N 'N R .EIt T 0N'
Improper 1LV and maiziumme oryour septic system could result in its premature failure to hardle wastes, Proper
mairtenance consists of pumping out the septic taak every th ee years or sooner, if deeded, by a licensed pamper. What y ptl put into
tk syst= can affect the function of the septic tank as a troatrncnt stage in the waste disposal system. Owner maintenance
t- xponsibilities are specified in f rom n 93.52(1) and in Chapter lw - St, Croix Coutrty Sanitary 0rditWn0a.
The property owner agms to submit to +t. Croix COvAnty NaUninb & Zoning DepatttMnt a oertif"ication fomi. signed by the
towrer and by a master plumber, lowptsyn=plumber, restricted plumber or a ltioamed pumper verifyins that (1) the on-site
wWtitewater disposal system is in proper operating txmditicxr arsWnt (2) after inspection wW pumping (ifneeessary), the septic ttink is
itss than 1/3 foll of sludge.
Uwe, the undersigned have read the above requirements and agr" to mintain 11w private sewage disllosa.l system with thr.
standards ref forth, herein, is Set by the X7epart7ttent of Comrntstee acid the Daparrrtrent of Nantes Resources, State of Wiscotsstn.
Certification stating that your septic system has been mainuitsed must be completed and retuemd to cite St. Croix C.c,unty planning. &
Zoning Depamnant xithin 30 days of the three year expiration date.
I/we certify that all statements vn this form are true to the best ofmy'our knowledge. I/we artt/ara the owner(s) of *c
property described above, by virtlte of a warraM deed re in Register of Deeds Office.
Number of bedroo
F" :;�V
(---S1q1'ATLJRE OF APPLIC.'.RNT(S) DATE
` * infornsation that is misrepresented may result in the sanitaty permit bei:rg revoked by the PlaAW4 & Zosuts£ D e pattmen.t
lnclucte with thja applicaticssn a recarcW r anaty dee' trout tlsc Register of heeds Office and a copy of the certified surroy map if
reference is made in the warranty deed.
(i F.N'.08 /05)
POWTS OWNER'S MAN * MANAGEMENT PLAN ra of
FILE INFORMATION Y$TEIN SPECIFICATIONS
Owner
Permit #
Septic Tank Capacity f J r" �y �Qa G NA
Septic Tank Man p NA
DESIGN PARAMETERS -- --
Effluept F ilte r Manufactur
�.@.
Number of bedrooms p Nq
C7 fVA Effluent Filte Mod el
Number rat Public Facility Units _
_ 0 NA Pump Tank Capacity g d � al ❑ NA
Estimated flaw (average) b G 0 PUMP Tank Manufactu
a lda� �� S E' R ❑ NA
Design flow (peak), (Estimated x 1.5) to 0 O all 8 Pyrnp Manufacturer O NA
�s d v, 0�
Sofi Application Rate
altda x Pump Made) ~~ Q NA
/ft
Standard Influent /Effluent Quality ! Monthly average" Frdtreatment Unit - ❑ NA
Fats, Oil & Grease (FOG) S30 rng /L Q Sand;Gravel Filter 0 Peat Filter
Biochemical Oxygen Demand (BOD.) x:,220 mglL Q NA U Mculrianical Aeration ❑ Wetiand
Total Suspended Solids (TSS) j 5150 mg;L 0 Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Ulapersal Cells ❑ NA
!IiOc hemical Oxygen Demand ( 800 6 ) sib mg /L ❑ In-Ground (gravity) 0 In- Ground (pressurized)
Total Suspended Solids (TSS) s30 mg1L Q NA 0 At -Grade 0 Mound
Fecal Confo (geornet mean) s10 ofu!100ml Q Orip- Une ❑ Other:
Maximum Effluent Particle Size Y in die. q NA p NA
a NA Qth eir; fa N.4
``u' alues typical for dornest c wastewater and sept c tank effluent. Other' —� 113 NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: months)
fear(s) ( Maximum 3 years:) Q NA
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volurrm _._❑ NA
Inspect dispersal cells) At least o sver .: C) month(s) anal
� (Maximum 3 years) ❑ NA
Clean etfiuent filter 13 month(sl
_ At least once e very: l7 NA
Inspect pump, pump controls & alarm At l once every: �.., D manth(s) M p NA
❑ year(s) _
Flush laterals and pressure test — 1 At least once every; D months) ❑ NA
❑ year(s)
At leas Q monthls)
c every t once e DNA
y
.._.- ._...._...._».�..._...,. ......... .._.. 0 year(s) M.M. .....
Other.
Q 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 fns actor; POWTS Maintainer; Se tae Servicing O erater. Tank
P p f� 9 p
inspections must include a visual inspection of the tank(s) to identify any mussing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to cheek for any back up or ponding of effluent on the ground surface.
The dispersal call(s) shall be visually inspected to chock the effluent ieveis in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding at effluent on the ground surface may indicate a failing condition and requires the
imrtrediate notification of the local regulatory authority.
Wben 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 Shah be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
`Msconsin 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 s12 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.
I
START UP AND OPERATION Pwge ..._.__ of
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dlspersal collie), 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 4roien at the 1nf1lttatic'e'surfia'Ce.
During power outages pump tanks may fill above normal itlphwater level$ When power is restored the excess wastewater
discharged to the dispersal cells) In one large dos$, ov$flQadln the ell will of
9 * c. . (al and may result in the backup or surface) discharge of
effluent. To avoid this situation have the contents of the pump tank retnoved by a Septage Servicing Operator prior to restoriry
power to the effluent pump or contact a Plumbs.* or POWTS Malntalner to assist in manually operating the puma controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal Cali 3. Do not drive or park over, or otherwise disturb or compact, the area
within 15 lest down slope of any mound or at-grade soil absorption area,
Reduction or elimination of the following from the +a+aatewater strie irn may improve the performance and prolong the life of the
POWTS: antibiotics;. baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfec
peelln9s; jpsolinerease; her
tants; fat;
inundation drains (sump pump) water; fruit and vegetable ; grease; meet scraps; medications; ail;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS faits andlor is permanently taken cut of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83,33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWYS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
I7 A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturpgnee and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lineal and wells. Failure to protect the replacement area will
result in the need for a raw soil and site evaluation to establi a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area Is not available date to setback andfor soil limitations. Barring advances in POVJ7'S
technology a holding tank may be installed as a lest resort to replace the failed FOWTS.
���❑ The site s n ren evaluated to identity, a suitable replacement area. Upon failure of the POWTS a soil and site
lV evaluation be performed to locate a suitable replacement area. If no replacement area i
may b silo s a last resort to replace the failed POWTS. . s available a holding tank
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surtace, Reconstructions of such systems must comply with the rules in effect at that time,
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONtAIN LITH GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDO qNY C106LUMSTANCES, DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIPFI�CULf- OR IMPOSSIBLE.
ADDITIONAL COMME
POWTS INSTALLER
P S" INTAiNER
Name ` iA� iVame
Phone '7/ s' — 3 — , 3 aL/ Phone
SEPTAGE SERVICING OPERATOR (PUMPER) L AL RE( WTORY AUTHORITY
Name C.o
Dame A
Phone Phone 715
�d
This document was drafted in compliance with chepter Comm $12212t.lb;l1 &(f) and 91540}, (2) & 191, Wiaconsn A
dm Mstrative Code.
START UP AND OPERATION r'mcge of
For new construction, prior to use of the POWTS check treatment tank(s) for the presonce of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal cell(s), If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the Inf }itrat)�e 'suFfiice.
During power Outages pump tanks may fill above normal highwater levels. When Power is restored the excess wastewater will be
discharged to the dispersal ce1Hs) in one large dose a
, vex
„ (o U 11 the cells and
.fNuAnt. To oval $ (} a may result in the back
d this situation have the contents back or surface d res o of
of the umti #imk removed -
� v by a Septage Servicing Operator poor to rester ;n
Power to the effluent pump or contact a Plumber
ar POWTS .WTS lVlalntainar t s'
O a s si st in
manually
restore normal levels within the pump tank, y operating the pump controls to
Do not drive or park vehicles over tanks and dispersal cel's. Do not drive or park over, or otherwise disturb or compac', 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 str eam rtlay improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes: cigarette butts; condoms; Cotton swabs; degreasers; dental floss: diapers; disinfectants: fa *:
foundation drain (sump pump) water; fruit and vegetable peelings; 00soline; grease; herbicides; meet scraps; medications. co:
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanentiv taken cut of service the following steps shall be taken to insure that the systern is
properly and safely abandoned in compliance with chapter Comm 83,33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe Openings sealed.
e The contents of all tanks and pits shall be removed and property disposed Of b a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed Or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the foliowinp rneatlures have been, or must be taken, to provide a code compliant
replacement system:
D A suitable replacement area has been evaluated rind may be utili for the location Of a replacement soil absorption
system. The replacement area should be protected from disturpaQnee and compaction and should not be infringed upon by
required setbacks from existing and proposed 'structura, lot lines and wells, Failure to protect the replacement area will
result In the need for a Pew soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback end/Or stir !imitations. Barring advances in POWTS
1. technology a holding tank may be installed a$ a last roe to replace the failed PO
WTS.
The site s not an evaluated to identify a suitable fe1 laptment area. U an failure of
1 � evaluation be Performed to locate a suitabl F p the POWTS a soil and site
le rePlocernent area. If no replacement area is available a holding tank
may b ' alle s a last resort to replace the failed POWTIS.
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such SyStO 9 must oomply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHE TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK U 'ANY C106UMSTANCES, DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE 010FICULT QR IMPOSSIBLE.
ADDITIONAL COMMENT
S
POWTS INSTALLER
�! $ iNTAINER
Name i `1A t;,
kN J- V'-� "� N ome
Phone '7 f �'
Rhone —
SEPTAGE SERVICING OPERATOR (PUMPER)
Name LO R"o LATORY AUTHORITY
/
Phone tame �. :x (,o✓ 2oI� A
1 -1 Phone 7/6
This document was drafted in cnrnpliance with chapter Gomm 83.2 2(2l.lb)(1)(d) &(f) and 83,54(1). 12) & (3), Wisconsin AdrniNstrative code.
I j STATE BAR OF WISCONSIN FORM 1 1998 j KATHLEEN H. WALE H
WARRANTY DEED REGISTER OF DEEDS
E.T. CROIX CC,. , W
Document Number i RECEIVED FOR RECORD
06/03/2006 10:290AH
Birch Park, L.L.C.,
This Deed, made between — - �i
a limited liability company under the laws of the WARRANTY DEED
— s tate of Min n e a o t a
REC FEE:
Grantor, 11.00
TRANS FEE: 522.00
arid Benjamin P. Williams and Collette E. Williams. TRANS
COPY FEE: , ' II husband and wife, as survivorship marital rg I f CC FEE:
PAGES: 1
Grantee.
Grantor, for a Valuable consideration, conveys to Grantee the following
St. Croix
described real estate in County. State of Wisconsin
(the "Property"):
1 Name and Return Address
Premier Title
Lot 11, Birch Park j 7300 Metro Blvd., #300
Edina, MN 55439 Y
ji O
Return to:
Premier Title Insurance AgenCy, In iI
7300 Metro Boulevard #300 - 2-, - S I
MM 5543
Edina,
952-84
030-2125-10-000
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
jI
Et Together with all appurtenant rights, title and Interests.
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
all easements, reservations and restrictions of record, if any.
Dated this day of July 2006
(SEAL) BIRCH PARK, L L C (SEAL) it
By:
J e s M . Waters, Its Chief Manager
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature (s)
State of MX9JWWffi.Minnesota
SS.
HenneDln County. JJJ
authenticated this day of Personally came before me this day of
July, 2006
the above named
James M. Waters, the Chief Manager of
Birch Park. L.L. .. a Minnesota limited_
l iabi l ity company, n behalf of he LLC
_
TITLE: MEMBER S IVALIAE.% HARRY AI j' ji
ST ATE BAR k,—j to
(if not, A me known to be the person — who executed the foregoing
authorized by §706.06• M C"unissior, E,p:, es 1,.1, :t, 2o' instrument and acknowledge the same.
10
THIS INSTRUMENT WAS DRAFTED BV
it
11
Wilkerson & Hegna, PLLP A& a, CX
7300 Metro Blvd., #300 t' " -2 Irorpo C-,A Al
Notary Public, State of-VAisee"Mw
Edina, MN 55439 My commission is permanent. (if not, state expiration
(Signatures may be authenticated or acknowledged. Both are not -T- 11 Ili (Ahr- S1
necessary.)
N— of persons signing in any capacity must be typed or printed below their signature.
STATE BAR OF WISCONSIN Wisconsin LecjW Blank Co.. Inc.
AFJOAANTY DEED FORM No. I - 1998 Milwaukee. WIS.
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