HomeMy WebLinkAbout032-2134-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
,
a INSPECTION REPORT Sanitary Permit No: 405153 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Wood, Mike I Somerset Township 032 - 2134 - 50-000
CST BM Elev: Insp. BM Elev: BM Description:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATI N BS HI FS ELEV.
2 /DI.2 d . a
Septic D� Benchmark
Dosing Alt. B
L�rn bo O S �'ck 6> i� r 2.3
Aeration t Bldg. Sewer (/
Holding
St/Ht Inlet
TANK SETBACK INFORMATION SUHt Outlet
TANK TO PP WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic ` l ! Z �d Dt B gp ��
ob Dosing t/ !+- Header an.
r
Aeration _ — Pip�e�
Holding Bot. Syste • L v
0 - 3-0
Final Gra
PUMP /SIPHON INFORMATIONS 3
Manufacturer GPM Demand St Cover J ✓9� -)�
69 ut .7j
Model Number
6 s t -9
TDH Lift Friction Loss System ead TD Ft
•y 1 • �- s Q.' 7 •' 7 (a
Forcemain Len th Di Dist. to well
A/d)r / N
SOIL ABSORPTION SYSTEM ' x (�7' 3 d4.�� j O e s
BED /TRENCH Width Length No. Of Trenches V PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS /„ ! / J5�QQ /
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM L CHI Manufacturer:
INFORMATION CHA OR
Type Of System: i NI Model Number:
Na d � a > 1 6U
DISTRIBUTION SYSTE
Header /Manifold I D . M istribution x Hole Size q x Hole Spacing Vent o Air Intake
Length / Dia Z L L engt h to & / Dia Spacing , I 0 h —7
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center + Bed/Trench Edges Topsoil Yes No Yes '',j No
COMMENTS: (include code discrepencies persons present, etc.) Inspection #1: ! Da - Inspection #2: ! 40
Location: 662 207th A e Somerset, WI 54025 (SW 114 NE 1/4 23 T31N R19W) Whitetail Trails LA2 QK ` Parcel No: 23.31.19.1191' Q
1.) Alt BM Description std,
2.) Bldg sewer length
-amount of cover =,%. j0
3. Contour - -�
Plan revision Required? ! Yes No
Use other side for additional Information. -- ! �'' ✓(.� f�- - -- - _ �__
Date Insepctor's Signature Cert. No.
SBD -6710 (R.3/97)
r
Safety and Buildings Division County
vi N W 201 W. Washington Ave., P.O. Box 7162 s . � sco ■Sin Madison, WI 53707 - 7162 Site Address /
Department of Commerce 4k.2 7 mil/. !�
Sanitary Permit Application s anitary Permit Number
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide `f 0SJ
may be used for secondary Privacy Law, s15. 1 m Check if Revision
I. Application Information - Please Print All Information RECEIVED to Plan I.D. Number
Property Owner's Name P cei Number D �2 Z/ j 9-0 --OdO
JUN 0 4 2002 a _ ✓
Property Owner's Mailing Address ST. CROIX COUNTY P perty Location r
I
ING OFFICE 14 !4; S2 T N, R E
City, State Zip Code r Lo r Block Number
Sbbdbdsi Name CSM Number
li. Type of Building (check all that apply) Doty CJ d 1 or 2 Family Dwelling - Number of Bedrooms y ❑Village
❑ Public /Commercial Describe Use °damp �.r.-
❑ State Owned �v�2� �l d y '� ? W � d �� Nearest Road
ce>vfa� 93.0 ,z D y = S/ (n,�;ir
III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applica 1
A. 1 R 2 ❑ Replacement System 3 ❑ Replacement of T6 11 Addition to For County use
System Tank Onl Exis ' S stem
B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued
IV. Type of Permit: (Check all that a ply)(numberin scheme is for internal use)
P g
44 ❑ Non - Pressurized In- Ground 21N"Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland
22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line
45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other
V. DispersaIMMe atment Area Information:
Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade
Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min./Inch) Elevation
VI. Tank Info Capacity in Total Number acturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanks (��1 J'l.@) dt� Concrete Constructed Glass
New Existing / Tanks Tanks
Septic or4loltting'4ank
Dosing Chamber
VII. Responsibility Statement I, the undersigned, assume responoffity for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Signature NHYN DRS Number Business Phone Number
Plumber's Address (Street, City, Stafe, Zip Code)
VIII cunt /De artment Use Onl
Approved 11 Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Is Agent Signature o Stamps)
Surcharge Fee)
❑ Owner Given Initial Adverse . 3 � S- ( x/13 o
Determination
IX. Conditions of &pro easons Po Disapproval b /
S ,- ,GG�t `�✓�ipi,, �- �° ��LCC,��y `� „- a Sid dLt.Dit --
�,.��
pl (to the only) for the syatan on paper not leer 81/2 a inches in dice
SBD -6398 (R. 05101)
�f. pon.�n Department of Industry SOIL AND SITE EVALUATION REPORT Pagel of 3
r arid Human Relations
,Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
J ;PARGEL
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix
not limited to vertical and horizontal reference int B on and % of slo e, scale or . # G ( P ff � dimensioned, north arrow, and location and dist
e nfe t foa ending ';
APPLICANT INFORMATION- PLEASE BY DATE
fA 'ALL IWF011-4''T1 1316
PROPERTY OWNER: 1,AEG�aaj� ROPERTY LOCATION
Forest Oaks Concos, In . � j OVT. LOT SW 1/4 NE 1 /4,S 23 T 31 N,R 19 (or) W
PROPERTY OWNERS MAILING ADDRESS � L � 'J�l OT # BLOCK # SUBD. NAME OR CSM #
11160 190th. ave. N.W. 0u 12 na Whitetail Trails
CITY, STATE ZIP CO PHONEMUSER :: CITY []VILLAGE E]TOWN NEAREST ROAD
5
Elk Riveg, YIN.
3 0 (61 '4k18, Somerset 207th. aVe.
jc ] New Construction Use [x] Residential / r f ¢ 4 [ ] Addition to existing building
j ] Replacement [ ] Public or commercia n e
Code derived daily flow 600 gpd Recommended design loading rate .5 bed, gpd /ft .6 trench, gpd /ft
Absorption area required 500 bed, ft 500 trench, ft Maximum design loading rate .5 bed, gpd /ft .6 trench, gpd /ft
Recommended infiltration surface elevation(s) 93.90 ft (as referred to site plan benchmark)
Additional design / site considerations system el. based on contour line el. of 92.90' f' 3 o
Parent material glacial drift Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable for stem ❑ S �tJ IRS ❑ U EIS K U K7 S ❑ U ❑ S 1 U El Elu
SOI SCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD /ft
Boring # Horizon Texture Consistence Boundary Roots
in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
0 -15 10yr3 /3 none sl 2msbk mfr gw if .5 .6
2 15-46 10yr4 /4 none sicl 2msbk mfr gw if .4 .5
3 46 -1 7.5 r4
6 none e fs Os
/ mvf r na na 5 6
Y
Ground y
elev.
93 ft.
Depth to
limiting
factor
+ 100"
Remarks:
Boring # 1 0 -11 10yr3 /3 none sl 2msbk mfr gw if .5 .6
2 11 -22 10yr4 /4 none sl 2msbk mfr yw if .5 .6
U
3 22 -53 7.5yr4/6 none sl 2msbk mvfr gw if .5 .6
Ground
elev. 4 5 90 5yr4/4 c2d 7.5yr5/8 sl M na na na .3 .4
93 ft.
Depth to
limiting
factor
53"
Remarks:
CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200
Address: 1554 200th. A w Richmond,/RI 54017
Signature: Date: 4 -19 -2100 CST Number: m02298
PROPERTY OWNER Forest Oaks Condos SOIL DESCRIPTION REPORT Page 1
of
PARCEL I.D. # pending
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trends
3
1 0 -11 10yr3 /3 none sl 2msbk mfr gw if .5 .6
2 11-21 10yr4 /4 none sil 2msbk mfr gw if .5 .6
Ground 3 21-4S 7.5yr4/6 none fs Osg mvfr gw na .5 .6
elev.
9 1.9 ft. 4 4 8C 5yr4/4 c2d 7.5yr5/8 sl M na na na .3 .4
Depth to
limiting
factor
49"
Remarks:
Boring #
Ground
elev.
ft. —
Depth to -
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev. i
ft.
Depth to
limiting
factor
Remarks:
i SBD- 8330(R.05/92)
j
STEELS SOIL SERVICE
Gary L. Steel Forest Oaks Condos, Inc. 1554 200th Ave.
CSTM2298 SW4NE1 S23- T31N -R19W New Richmond, WI 54017
MPRSW -3254 town of Somerset (715) 246 -6200
lot #12= Whitetail Trails
N
1 =40'
BM. =top of 1 "pvc piep C el. 100.00'
Alt. BM-= top of 1 pvc pipe C el. 97.60'
CO
3�
Q s
.
Gary L. Steel
4 -19 -2000
t Safety and Buildings
s 4003 N KINNEY COULEE RD
LACROSSE WI 54601 -1831
TDD #: (608) 264 -8777
Viseonsin RECEIVED www.commerce .state.wi.us/sb
Department of Commerce
Scott McCallum, Governor
MAY 1 0 2002
Philip Edw. Albert, Secretary
ST. CROIX COUNTY
ZONING OFFICE
May 07, 2002
CUST ID No.267341 ATT'N: POWTS Inspector
ARTHUR L WEGERER ZONING OFFICE
WEGERER SOIL TESTING & DESIGN SERVICE ST CROIX COUNTY SPIA
PO BOX 74 1 101 CARMICHAEL RD
RIVER FALLS WI 54022 HUDSON WI 54016
yC�Si 5
CONDITIONAL APPROVAL
[de N f . t' umbers
PLAN APPROVAL EXPIRES: 05/07/2004
Transaction [D N .73222
SITE: Site ID No. 64433
Michael Wood Residence Please refer to both identification numbers,
207TH Ave above, in all correspondence with the agency.
Town of Somerset
St Croix County
SW 1/4, NEI /4, S23, T31N, R 19
Lot: 12, Subdivision: Whitetail Trails
FOR:
Description: Four Bedroom Mound System
Object Type: POWT System Regulated Object ID No.: 850476
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
The following conditions shall be met during construction or installation and prior to occupancy or use:
General Approval Requirements:
• This system is to be constructed and located in accordance with the enclosed approved plans and with the
Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10572 -P
( 8.6/99 and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems"
)
SBD- 10573 -P (R.6/99).
• 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 t e treatment and dispersal
are prohibited.
• The well must be a minimum of 25 feet from any POWTS tank, and a minimum o f 50 feet from the absorption
area. chs. NR 81 l & 812c
!i y A Sanitary Permit must be obtained from the county where this project is located in accordance with the
o vtD requirements of Sec. 145.135 and 145.19, Wis. Stats.
) F C041VER . Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the
1118 designated county official in accordance with the provisions of See. 145.20(2)(d), Wis. Stat
;OWUE 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.
ARTHUR L WEGERER Page 2 5/7/02
Owner Responsiblities:
• 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 permits required by the state or the local municipality shall be obtained prior to commencement of
construction !instaIlat ion /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
Fee Received $ 175.00
Balance Due $ 0.00
Charles L Bratz
POWTS Reviewer 11 , Integrated Services WiSMART code: 7633
(608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday
cbratz @commerce.state.wi.us
cc: Leroy G Jansky , Wastewater Specialist, (715) 726 -2544
I
TITLE SHEET Page of -7
BOUND SYSTEM
FOR
A BEDROOM RESIDENCE
This plan has been prepared in accordance with the Mound Component
Manual SBD -1057 P and the Pressure Distribution Manual SBD- 10573 -P
Ccz - b /a.q� Cam. 6 l4g�
LOCATED IN THE SW 1/4 OF THE NE 1/4 OF SECTION Z --, ) , T 3) N, R 1 W,
TOWN OF S<)MI ZS z S C�� lX COUNTY, WISCONSIN.
CoT VL OF Iw1t1T7,- -Tft4L- "TV -Pd I+S
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 RECEIVED
PREPARED FOR MAY - 6 2002
SAFETY & BLDGS DIV.
PREPARED BY
WEGEF:ZEF:;Z SO S L . TEST 11".1
AND .
DES 2 CCN SERt� = CE
P.O. Box 74 421 N. I a i n St.
River Falls, WI 54022 -����, �y
Phone 715 - 425 -0165 ,,...••�- ••.,
Fax 715- 425 - 6864 ;f• `� ?�
AA7MJfd i •�
wEi;E.!F�
D-e1F r
EUSWOAT� i
Cond .
•••....
e c ... � �.�
APPP �.� „�
DE PARTMENT
OF E S_ Z - OZ
SEE CORRESI
JOB NO., OZ- -c'1Y
Mound System Management Plan page Z. of 7
Pursuant to Comm 83.54, Wis. Adm. Code
Septic Tank ��s /�
The septic tank shall be maintained b an i ndividual y ndividual certified to service septic tanks under s. 281.48, Slats. The contents of the
septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and
outlet filter shialLte assessed at least once every 3 e rs by inspection. The outlet filter shall be cleaned as necPSCarV to
ensure oronar spare ±�� he filte should not ee rb emoved unless provisions are made to re tain solids in the tank that
may slough off the filter when remits enclosure. If the filter is equipped with an alarm, the filter shall be serviced if
the alarm is activated continuousltent filter alarms may indicate surge flows or an impending continuous alarm. The
the tank If the contents of the tanemoved at the time of a septic tank shall have its contents hen the volume of sludge and scum in the tank exceeds 1/3 the liquid volume
of
triennial assessment, maintenance personnel shall advise
the owner of when the next servicbe performed to maintain less than maximum scum and sludge accumulation in
the tank. The addition of biological or chemical additives 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 Commerce, Safety and
Buildings Division.
Pump Tank
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 shall be inspected and serviced as necessar
Mound and Pressure Distribution System
No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound
shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic
(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 exceed 220 mg /L 6005, 150 mg /L TSS, and 30 mg /L FOG. Influent flow 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 every 18 months. When a pressure test is performed it should be
compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is
required to maintain equal distribution within the dispersal cell.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner,
and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring.
General
This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its'
component manual [SBD- 10572 -P (R. 6/99)] arid local or state rules pertaining to system maintenance and maintenance
reporting.
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and
Pump tank abandonment P
shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as
POWTS components.
Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access
openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed
unsound, defective, or subject to failure must be replace
be secured by an effective locking device to prevent accidental or unauthorized entry into a grea
k t
or component.
shall
Contingency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition.
If the e 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' P
P present location by increasing basal area if toe leakage occurs orb r emoving
and dispersal media, and related piping, and replacing said componen s as deemed necessary to�bn�ng� the sys em into proper
operating condition.
Questions about the operation or maintenance of this system should be directed to:
The County Zoning Office at 1 � S – 1 9 16 q 80 Sr- C
G R-o IV,
The system installer at F C -nLYy
The tank manufacturer at 8 OU = ZS _$LLSG I' M
The effluent filter manufacturer at R-pt)— ZZ-[, S7y
The pump manufacturer at --
PLOT PLAN - Page -- !, of - 7
Scale 1 "= 50'
F1 LT_ 8M
L-07 Wh!g w
rrl
ZS' S
ISM
I!! I
6 -3 I pp NAT �
1 � 02 DL5iv1ZB
III I
I
IS Ij
8• t g
W
� , �. �. 3 , 5 • J
i
LOT t3 t_ uT \.Z LOT
- LL._ l3(3_0' oN OF ►`�l�l►� PVC PiP� .
OW k ti
SO F►ZUwi riw) D F1 "yv --
FILO
<U� 1 �
�
NOTES:
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install 4" observation pipes with approved caps. ( Z required).
3. Septic tank to be1't gallon capacity manufactured by
wt Q, Co\j L° gew "J/ n — I goo Z" LTL 1 L-`f YR
4. Bench mark Std PO0Vk'
5. Divert surface water around system to prevent ponding at the uphill side.
r -
Page H Of - 7
Approved Synthetic e
Medium Sand Covering
Distribution Pi
- AST:i C33 .� p
�
Topsoil rte_ F IG E� ev
E
3 . X13 S
—O ..
-
b
-S.% Slope
Distribution Cell of a Force Main Plowed
2" to 2 Aggregate From Pump Layer
D O. S Ft.
E 0 -9-S Ft.
CROSS SECTION OF A MOUND SYSTEM F o �) Ft.
G o•S. Ft.
A q Ft. H 1. o Ft.
Linear Loading Rate= �- 95 GPD /LN FT B 6 - 7 Ft.
Design Loading Rate= O.HSGPD /SQ FT I Ft.
J S Ft.
K 8 Ft.
� n zc -Res - L S3 Ft.
W ZS Ft.
- Observation Pipe
E K
A- -- $ - - -- ------------------------ - - - --
6 �--o Force Main
W �t- - - -� -- _ ------- - - - - -_ — - -- ' z �
Distribution " o
Cell of z to 2
Pipe
aggregate
Observation Pipe
(Aachbr se==ely)
PLATT VIED OF A MOUND SYSTEM
Distribution Pipe Layout Page S of �7
Page
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 lateral up with the use of lon turn or 4f° fitting to a point within six
inches of the final glade. Terminate the ends of the laterals with a valve,:threaded cap or
. threaded plug. Provide access from final grade for the valve, threaded cap or threaded plug.
T`t P_1C(� L . C\IQSS. 5'�"`t1
PVC P\jC
Lateral Manifold �� C
Lateral
x �'Ute�ral �Lenath x x!Z �x Q x x x x
— Lateral Lenqth — p
Distribution Line
• F —� �� c[�c ��y;
— — o
hYStltFc�
S
o --
— _ N
P 3 3 Ft. Hole Diameter /`� Inch
S 3 Ft. Lateral 1 Inches
X ?Z Inches Manifold Z Inches
Force Main " Z Indies
# of holes /pipe \
Invert Elevation of. aterals q 4.O Ft.
1`i x u.y i= 6 _Ct L l .81 -G a111
Combination Sept,.c: and
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS ' PAGE OF
- VENT CAP WEATHER Pit00F
JUIJCTIOU 80X .
ti C.I. VEIJT PIPE APPROVE0 LOCKIMG
1 , FROM OOOR. MAIJHOLE COVER PjilH
,iwooW OR FRESH wA(tlJWG L.P�BEC_,
�3P�o>J P tPE A�I1JT/lKE S col.,pulr
w lrYlCLlI s N-r d4rp s ,
ti i
G D E 180 Al11.
IAILET PROVIDE I -
„' AIRTIGHT SEAL
�
• 81i��c M. I I I V
Approved Zfae- r-wrft I I II Approved
joint w/ R —tbpp i II I joint w/
PVC pip - 11
ALARM PVC pipe
6 I I
C
OL - -b— z CLE + __1
i PUMP OFF
D -
C OMCKETE
5LOCK
f
RISER EXIT PERMITTED OIJLy IF TAN MAUUFACTURER HAS SUCH APPROVAL— 3••APPRvttp
BEDO I NQ
SEPTIC E SPEC,IFICATIOUS
DOSE
TALiKS MAUUFACTURER: LJ L / Q�SfZ <20,kj 1JUMBER OF DOSES: S ' 3 PER DAB
TAWK SIZE 00
ALL
G ou5 DCSi< vOLU r
ME
3
AL MAUUFACTURER: SS - e-�7R0 �LS`MM - IKICLUDING, 6A CKPLO W: � 3 � GALLON:
MODEL NUMBER: �O � �Aw 1 a
CAPACITIES: A= UJCHES OR 4 :b GALLOI,IS
SWITCH TtIPC: �k4I LJ I 8= -2 � INCNES'OR 44 "•S G(1LLOIJS
PUMP MAUUFACTURER: G9Ut_)S C: � IuCHES OR GALLOWS
MODEL NUMBER: L S D= ZZZ_
INCHES OR GALLOWS
SWITCH TYPE: M EZs=U u OTE: PUMP A ALARM Rc TO bL 6
MINIMUM DISCHARGE RATE L �1• 8 � pM INSTALLED ON 5EPARATC CIRCUITS
VERTICAL DIFFERENCE OETWEEIJ PUMP OFF AWD..DI5TRIBUTIOIJ PIPE.. FEET
+ UM NETWORK SUPPLY PRESSURE FEET OxL.3)
FEET OF FORCE MAIN X 3-59 F oF�FRtCTtou FACTOR.. X1'3) FEET
TOTAL OyNAMIC HEAD = 8 -FEET
As per manufacturer gal /in. Liquid depth 36 eI
GouldsE
Submersible
Effluent Pump
3871 EPO4
EP05
APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron
Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer,
following uses: • Capable of running lubrication and efficient strength, and durability.
• Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas-
• Homes components. Available for automatic and Motor: tic cover with integral handle
• Farms manual operation. Automatic 'and float switch attachment
• Heavy duty sump • EPO4 Single phase: 0.4 HP, models include Mechanical
Dewatering RPM, , points.
• Water transfer 115 230 V, Hz, Float Switch assembled and ■ Power Cable: Severe duty
• built in overload with preset at the factory. rated oil and water resistant.
automatic reset.
SPECIFICATIONS • EP05 Single phase: 0.5 HP, ■Bearings: Upper and lower
115 V, 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing
Pump: EPO4 built in overload with ■ E construction.
PO4 Impeller: Thermo-
• Solids handling capability: automatic reset. plastic Semi -open design
/a maximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING
• Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. Co Canadian Standards Association
• Total heads: up to 24 feet. with three prong grounding
• Discharge size: 1 NPT. plug. Optional 20 foot ■ EP05 Impeller: Thermo- (CSA listed model numbers
• Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in '7 or "AC ".)
rotary/ceramic - stationary, three prong grounding plug improved performance.
BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged
• Temperature: thermoplastic design provides
104 °F (40 °C) continuous superior strength and
140 °F (60 °C) intermittent. corrosion resistance.
• Fasteners: 300 series METERS FEET
stainless steel. 10 j
• Capable of running
dry without damage to s 30 3
components. I i i ; >► . 5
Pump: EP05 s
• Solids handling capability: c 25 -
%' maximum. a I I
LU
• Capacities: up to 60 GPM. s 20 i
• Total heads: up to 31 feet. 2
• Discharge size: 1V NPT. - -7 4 P' _
• Mechanical seal: carbon- } 5 15
rotary/ceramic- stationary,
BUNA -N elastomers. 4-
! y �•82 - Po5
• Temperature ° 3 10
104 °F (40 °C) continuous
1401(60 °C) intermittent. 2 —
s
1
0 00 10 20 30 40 50 GPM
0 2 4 6 8 10 12 m
CAPACITY
®1995 Goulds Pumps, Inc. Effective May, 1995
83871
r
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
1 AND
OWNERSHIP CERTIFICATION FORM
Owner4g Me G."A; 7rl 7
Mailing Address V - T C,rmg~01) ZOAA • ALmy Div - SON Z .
Property Address (Ili, .2,0
(Verification required from Planning Department for new construction) s/1T
City /State Parcel Identification Number ® /2— ! ®60 - 'IX6
LEGAL DESCRIPTION
Property Location ,!& ' /,, �/E ' /,, Sec. 2.3 , T 3LN- R Town of 7 — .
Subdivision Gyfl.ZT,E 'Tilt. 7iSit<,tLS'
Lot # /Z
Certified Survey Map # , Volume , Page #
Warranty Deed # 6/3L 3 9!J , Volume ZsS3 , Page # 373
Spec house ❑ yes R"no Lot lines identifiable 4'yes ❑ no
SYSTEM MAI
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
t septic to eve three ears or sooner, if needed b y a licensed onsists of pumping out the s p tank every y y p umper. What you put into the system
P P
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
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 re turned to the St. Croix County Zon Office within 30
c
days .of the three vrar
IV
SIGNATURE OF APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
�a, S / 4 /U'Z
S OF APPLICANT DATE
'••••• Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.' " ""
'• Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
j L W i L S H
7 1 3 T f.- n LEEDS
Ur, RECORD
This Deed, made be( Forest Oaks Condos, Inc.
9:30 AM,
�XEAIPT 0
Grantot. and !Michael t.. Wood and Valerie T. NN' husband and LEJRT COPY FEE:
wife, rrpf FEE: 10.70
TR4HSFs -R FEE: I
KURNHS) FEE: 10-00
Grantee.
Grantor, for a valuable consideration. conveys to Grantee the
following described real estate in St. Croix Cuunt,
,State of \Visconsiv (if i space is needed, phase ) addendum j:
Lot 12, 'hitetail Trails in the 1 ot'Soinerset, St, Croix COX11''. 'U,
Wi
DAVID J. ESTREEN
304 LOCUST ST.
ti jr%C %All
vV15401
li T�.: •ignot
�--'. 11 ' a
L 0,-J i n s t N% a r i i i i s: Fa-, of recur
1 mated this 7 day of September 2000
Forest
_ Tqs
1-�' qs 11
*Gerald S resident
AUTIUNTICATION' A C K N 0 L1 1 1' , rf' M L "'T
:V J I N
authcrmcat this day of Pcr -- before me thi 2- day of
7
the �-,hove nam
med
Forest Oaks Condos, Inc., hy Gerald Smith, President
TITL 1 E.M B E R S TA T 13 A R O k1 I S(- ON S per"01'(S" vvil.) executed the 10regoing
(If not ed he sal
authorized by p 706,06, Wis. Stats.)
TTTIS INSTRUMENT WAS DRAFTED BY
Aktiornev Kristina 0gland tae of Wis--onsin
ft 54016 n t
anent. (If not, state expiration date:
-___
(Signatures may be authenticated or acknowledged. Both are not ne essar
Information Professionals Company, Fond du Lac, W1
Names of persons signing in any capacity must be typed or printed b e low the 800-665-2021
STATE BAR OF W
WARRANTY DEED FORM No. 2 - 199
Safety and Buildings
4003 N KINNEY COULEE RD
LACROSSE WI 54601 -1831
TDD #: (608) 264 -8777
N*6co'
www.w
nsin www.commerce.s iscon s i n.gov
isconin.gov
Department of Commerce
p R ECEIV EID Scott McCallum, Governor
Philip Edw. Albert, Secretary
MAY � 7 Zoo2
CROIX
May 07, 2002 S Z COUNTY
ONI NG OFFICE
CUST ID No.267341 ATTN: POWTS Inspector
ARTHUR L WEGERER ZONING OFFICE
WEGERER SOIL TESTING & DESIGN SERVICE ST CROIX COUNTY SPIA
PO BOX 74 1101 CARMICHAEL RD
RIVER FALLS WI 54022 HUDSON WI 54016
CONDITIONAL APPROVAL Identification Numbers
PLAN APPROVAL EXPIRES: 05/07/2004 Transaction ID No. 732221
SITE: Site ID No. 644330
Michael Wood Residence Please refer to both identification numbers;
207TH Ave above, in all correspondence with the agency.
Town of Somerset
St Croix County
SW1 /4, NE1 /4, S23, T31N, R19W
Lot: 12, Subdivision: Whitetail Trails
FOR:
Description: Four Bedroom Mound System
Object Type: POWT System Regulated Object ID No.: 850476
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
The following conditions shall be met during construction or installation and prior to occupancy or use:
General Approval Requirements:
• This system is to be constructed and located in accordance with the enclosed approved plans and with the
Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10572 -P
(R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems"
SBD - 10573 -P (R.6/99).
• 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
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the
designated county official in accordance with the provisions of Sec. 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.
s
r ARTHUR L WEGERER Page 2 5/7/02
Owner Responsiblities:
• Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and
this chapter and the approved maintenance of the POWTS occurs in accordance with p pp management plan under s. g
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.
•
C m o m 83.55 The owner is responsible for submittin a maintenance verification report acceptable to the
g
county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the
component(s) utilized in the POWTS.
All permits required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions
should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this
review shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter to the owner and any others who are responsible
for the installation, operation or maintenance of the POWTS.
Sincerely, Fee Required $ 175.00
Fee Received $ 175.00
Balance Due $ 0
Charles L Bratz
POWTS Reviewer II , Integrated Services WiSMART code: 7633
(608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday
cbratz@commerce.state.wi.us
cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544
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