HomeMy WebLinkAbout034-1021-90-000 sin Department of Commerce Count
PRIVATE SEWAGE SYSTEM St. Croix
9 and Building Division
INSPECTION REPORT Sanitary Permit No:
453219 0
jENERAL INFORMATION (ATTACvH TOoPERMIT) 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:
Ashley, Steve Springfield 034 - 1021 -90 -000
CST BM Elev: Insp. BM Elev: BM Description: � Section/Town /Range /Map No:
I G cJ 10.29.15. /
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic W,. P_<—. A, / W� Benchmark .� L- 2
Dosing Alt. BM
Sd (20 u- 3. zd 7 9 3
Aeration -Z / Bldg. Sewer q � 1 q r
4 _/
Holding
St/Ht Inlet 9, z3 c f 7J
\
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet l
�q
Septic yr} I 'Z 4 � / _ Dt Bottom Iz, D ✓• S�J �JA
Dosing I �/ /� / Header /Man. I /� 3S
I'j � � ✓
Aeration Dist. Pipe
Holding Bot. System 7 f�q (7
Final Grade �� D , W / )I1 ,
PUMP /SIPHON INFORMATION � i , 7
Manufacturer j / GP and St Cover
L Q; Z6 95,93
Model Number /-y Zz[ ? 7 a /\ a J �� r 1
TDH Lift Friction o�� System lead � TiH� � iL
A ...
`6 3.7-
Forcemain Length Dia. /� Dist. to Well
ABSORPTION SYSTEM
BE ENCH Width ✓ Len / No. Of enches PIT D NSIONS Nq Of Pits I irES de Dia. Liqu dl Depth
DIMENSIONS &, \�
SETBACK SYSTEM TO P/L jBLDG IWELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of 5ystem : / i UNIT Model Number:
@U
DISTRIBUTION SYSTEM
Header /Manifold ' Vl Distribution X x Hole Size x Hole Spacing Vent to Air Intake
1 '7i Pipe(s) 3 b 1 t114 J � 3 2 ,!
Length Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over I Depth Over xx Depth o xx Seeded /Sodd xx Mul bkedj
i
Bed/Trench Center 1 Bed/Trench Edges Topsoil „ Yes C No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspec ti tio ` n_ #1: 7 / (6 / Inspection #2: 7
Location: 3051 110t 1 Ave n (SE 1/4 NW 1/4 10 T29N R15W) NA Lot "` P' a Parcel No: 10.29.15..
1.) Alt BM Description = / k)b-
2.) Bldg sewer length = '16 4-6 � 4--
- amount of cover
74-
[
Plan revision Required? Yes No 1
formati n. �
Use other side for additional in
SBD -6710 (R.3/97) Date Insepctor' ignatur Cert. No.
..
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Safety and Buildings Division County
I * J& 201 W. Washington Ave., P.O. Box 7162
sconsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce (608) 286-315f Z
Sanitary Permit Application.. -, r State Plan I Number )
In accord with Comm 83.21, Wis. Adm. Code, personal information you proji ,./ / \ g5 7- o! I = T •
may be used for secondary purposes Privacy Law s15._04(1)(m Project Address (if different than mailing address)
I. Application Information - Please Print All Information � _1 , o
5 7 Ho
Property Owner's Na me f n :, Parcel N Lot # Block k
S o3 i - v
Property Owner's M ailing Address Property Location
')F "CE
City, State r Zip Code Phone Number S C S4, /U k,Section
Alx Q/� �eircle
S . . .) o
ww T N; R_L o
II. Type of Building (check all that apply) � S � �
1 or 2 Family Dwelling - Number of edrooms Subdivision Name CSM Number
IJ Public /Commercial - Describe Use
❑ State O ed - D scribe Use � "_ (p 20.0 ❑City_ ❑Village ownship o ;
.o S
III. Type of Permit: (Check only o ne box on line A. Complete line B if applicable)
A. 2(New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
1V. Type of POWTS System: (Check all that apply)
❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter
❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter
❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
r
s rs eatm a ormatlon: �
Design Flo ) Design Soil Ap lication Ra s Dispersal Are�Required� Area Pro (sf) System Elevation
5 �, Sb
VI. Tank Info Capacity in TotA Number Manufacturer / Prefab Site Steel Fiber Plastic
Gallons Gallons of Units �i/7�) Concrete Constructed Glass
New Existing
_ Tanks Tanks
Septic or Helgixlc
Ae robic��
Dosing Chamber /_ S-�>
VII: Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Na me (Print) Plumber's Si gnature P PRS Number Business Phone Number
Plu ber's Addre ss (Streel, City, State, tp Cod
S77 49 a- 0 �Z
VIII. County/Department Use Onl
Approved El Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Is ing gent Signature No Stamps)
Surcharge Fee) p
El iven Reason for Denial 3 5D 0
IX. Conditio Approv /
SYSTEM OWNER:
1 Septic tank, effluent filter and
dispersal cell must all be serviced I maintain
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable code /ordinances.
Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size
SBD -6398 (R. 01/03)
?L*"j = Z, C)
r -
PLOT PLANT
Scale 1 "= y0' Page 3 of
SCE tI N
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Ck _
__ — o►�
Zk PVC Z1
cICI — �I
C.OxAv"p Utz
►3. Z
U \�Lty
tJrV Z Te�cl(_, 31q biA. eve P1 ► W / L, r .
1 a• S� i '�� S iltf 1 Zr°,'
i
NOTES:
1. Elevations shown are existin �
round el evations unless
2. I g g
Install 4 observation i otherwise noted.
es
with approved
, Pipes
3. Septic tank to be 100 01bSUgallon caacity manufactu edrby uired).
4 Bench mark S S
5. Divert surface water around system to prevent ponding at the uphill s ide.
II I
.m, i'
'§�
C��V� Safety and Buildings
` 4003 N KINNEY COULEE RD
° WI 54601 -1831
�- SEC 1 g 20 TDD #: (608) 264 -8777
,sc0ns n �3 LA CROSSE www.commerce. iscon
ST. �R�� www.wisconsin.gov
ZO X c =o
Department of Commerce NttvG pFFC�Ti Jim Doyle, Governor
Cory L. Nettles, Secretary
December 15, 2003
CUST ID No.267341 ATTN: POPVTS Inspector
ARTHUR L WEGERER ZONING OFFICE
WEGERER SOIL TESTING & DESIGN SERVICE ST CROIX COUNTY SPIA
PO BOX 74 1101 CARMICHAEL RD
RIVER FALLS W1 54022 HUDSON WI 54016
CONDITIONAL APPROVAL
Identification Numbers
PLAN APPROVAL EXPIRES: 12/15/2005
Transaction ID No. 950799 i
SITE: Site ID No. 669340
Steven Ashley Please refer to both identification numbers.
110TH Ave above, in all correspondence with the a Tenc .
Town of Springfield
St Croix County
SE1 /4, NWI /4, S10, T29N, R15W
FOR:
Description: Three Bedroom Mound System
Object Type: POWTS Component Manual Regulated Object ID No.: 935568
Maintenance required; 450 GPD Flow rate; 16 in Soil minimum depth to limiting factor from original grade; System(s):
Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version
2.0, SBD- 10706 -P (N.01 /01); Biofilter
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes Cond ido,
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in App c
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
DE RTMEN7 Of I
The following conditions shall be met during construction or installation and prior to occupancy or use: NOF E:YO
General Approval Requirements:
SEE CORRESP
• This system is to be constructed and located in accordance with the enclosed approved plans and with the
"Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD - 10691 -P (N.0 U01)
and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION
2.0" SBD- 10706 -P (N.01 /01).
• 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 durinor construction
and open to inspection by authorized representatives of the Department which may include local inspectors.
ARTHUR L WEGERER Pape 2 12/15/03
Owner Responsibilities:
• Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and
maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.
Comm 83.54(1).
• Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as
required under s. Comm 83.54(4) shall be considered a human health hazard.
• Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county
for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s)
utilized in the POWTS.
All permits required by the state or the local municipality shall be obtained prior to commencement of
construction/ instal tat 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.
Sincerely, Fee Required $ 175.00
Fee Received $ 175.00
Balance Due $ 0.00
Charles L Bratz c �
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
TITLE SHEET REJ:a Cllof `7
FOUND SYSTEM It (- "`++�
FOR
A 3 BEDROOM RESIDENCE AFETY & BLDG
S Dl.
This plan has been prepared accordance with the Mound Component
Manual SBD- 10691 -P and the Pressure Distribution Manual SBD - 10706 -P
(N.01 101) .(N.01 101)
LOCATED IN THE SE 1/4 OF THE NW 1/4 OF SECTION 10 , T 9 N, R 1 S W,
TOWN OF 1u G �r S`r, etw COUNTY WISCONSIN.
INDEX
PAGE 1 of 7 TITLE SHEET
PAGE 2 Of 7 SYSTEM MANAGEMENT PLAN
PAGE 3 of 7 PLOT PLAN
PAGE 4 of 7 PLAN VIEW -CROSS SECTION
PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT
PAGE 6 of 7 PUMPING CHAMBER CROSS SECTION
PAGE 7 of 7 PUMP PERFORMANCE CURVE
PREPARED FOR
335 vi00b D1z�1 U�
H - v �so�1 �► S 0 1 6
"ally
PREPARED BY QED
W E G 'OMMERCE
E
E R S O I L TEST 2 !mot G NGS
AND
AD 1 .
DES I Gam! SE=RV I CE ONDENC
P.O. Box 74 421 N.Iain St.
River Falls, WI 54022
Phone 715 - 425 -0165 1
Fax 715 -425 - 6864'° 4
l.RT'.,)44l y
-.Ipl W$iSr Ft�17 j
t ELI:': r'JFl1t+
li.
� - 3
JOB NO.
Mound System Management Plan P age Z of
Pursuant to Comm 83.54, Wis. Adm. Code
Seotic Tank .
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the
septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. Theo erating condition of the septic tank and
outlet filter shall be assessed at least once every 3 years by inspection. Th outiet fllte shall be c'eaned as necessary to
ensure pro er operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that
may s --ugh o e i ter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if
the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of
the tank, If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise
the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in
the tank. The addition of biological or 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 necessary.
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 BO05, 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 [ - arid local or state rules pertaining to system maintenance and maintenance
reporting. -1 g•
Sr3� - P
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 shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are n I
POWTS o longer used as
components.
i
Septic or
p 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 replaced. Exposed access openings greater than 8- inches in diameter shall
be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component.
Cont Ingencv 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 dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be
immediately repaired or replaced with a component of the same or equal performance.
If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired
or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption
and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper
operating condition.
Questions about the operation or maintenance of this system should be directed to:
The County Zoning Office at , $ --3 -6;80 ST'- C.R.UIX
The -system installer at
The tank manufacturer at 1&1L1Z
The effluent filter manufacturer at / �y0 — _ZZ(_ S��Z z L
The pump manufacturer at r 3� ��— �(��� GOULAS
PLOT PLPIN
r Scale 1 "= H Q' Page 3 of
)P
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o
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38�12h1 Z �� � Zk PVC � . , z
w �L 0 1�JOY COkii �� �T
o ft
D S
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_ \1\:) T 1A-+f yL. \
S'
NOTES
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install 4" observation ipes with approved caps. ( I required).
3. Septic tank to be l uoo j p bS vgallon ca acity manufactured by
goo J6 3 0 - MyZ 1Ay l Pr - l$ OD
4. Bench mark c,\
s� eve
• S. Divert surface water around system to prevent ponding at the uphill side.
Pace Or - 7
Approved synthetic Covering
ASTM C33 Distribution Pipe
Medium. Sand
Topsoil -+" _ H = - G
F Elev.
3 E 0
b
% Slope
Distribution Cell of Force Main Plowed
z" to 2- A reaate
From r
om Pump Layer
D 1. VT Ft.
E \ . SS Ft.
CROSS SECTION OF A MOUND SYSTEM F 8 -6 Ft.
G o • `z Ft .
A 6 Ft. H \, O Ft.
Linear Loading Rate= 6. OGPD/LN FT B 7 S Ft.
Design Loading Rate= D'.3 FT
I `Z Ft.
J 9_ Ft.
K \1 Ft.
L (.- ft.
feree4 W Z`I Ft.
- L i
I
J` -Observation
tMain Pipe
W 2
�_ Distribuion �-- Cell of c��'r�S `� er
e ` to 22
Pie Q
� P a .
Observation Pipe
(Anchor securely)
PLAN VIEW OF A MOUND SYSTEM
L
• Distribution Pipe Layout Pzoe S of
..
-
Place the holes at the bottom of the distribution pipes
at'equal spacing. Remove all burrs from the pipe and 'holes.
Extend the end of each Iate.al up with the use of long turn or 45 fining to a point within six
inches of the final grade_ Te. -ML=e the ends of the latenais with a valve,:threaded can or
• threaded plug. Provide access from final Bade for the valve; threaded cap or threaded plug,
-
T' 77 % Cr-, L `zs3ss
FVC F��C wC. —
Later! Manrfeld
Lateral
X x x x x/2 I x/2 x x x x
Uteral Length —t Lateral Length — F
Distril uticn Line
C
c
- -a
P 3 =S Ft. Hole Diameter Inca -
S 3 Ft. Lateral 1 "Y Inchfes)
X 3S inches Manifold 1 h z, Inches
Force Main " Inches
l of holes /pipe 13 '
Invert Elevation of.Laterals Ft.
_ - Combination Sept,3 and
PUMP CHAMBER CROSS SECTION AMA SPECIFICATIONS PAGE OF
N EW T CAP WEATHER PROOF
JUIXTIOW e0X
ti C.I. VEIJT PIK kPPROVED LOCKING
10' FROM OOOR. MAUHOLE COVER kAoly
'.iIMOOW OR FRESH u'AptJluG LI�6EL.
�G101J P iPEr
A19 � cosaputr
F! N 1ST tL L O
18'AIU.
1AJLE T PROVIDE I — _—
°� AtRTfGHT SEAL I I
I I I
Approved z>�8�t� -'� I III Approved
joint W/ H -1�j00 III joint w/
PVC p ALARM PVC pipe
a I I II
• I 1
I I ou
C •i I
I I
ILEKR,� -c'i FT
7 PUMP —� OFF
D -
COUCRETE
tFL BR -OO y 5LOCK
RISER EXIT PERMITTED 01JLy IF TAWK MAL'UFACTURE:R HAS SUCH APPROVAL 3 "APP%2oe"
SEDD I N4
SEPTIC F 5PECIFICATIOMS
OOSE
TALJ�C J MALI UFACTUR COIQCQ - �=�� mUMBER OF DOSES: J W
/ PER OA,.
TAWK :,fZE : _ 1�0Z 1-3 5: GALLOAlS D05E VOLUME I
ALARM MAUUFACTURCR: S'5,�� TjZ� S ST IFM S IAJCWDIAIG 6ACKFLOW: GALLONS
MODEL 1 JUM8ER: 1D �W CAPACITIES: Ac l� I OK 3 6 GALLOW5
SWITCH TtiFE: M 8= IWCWUSOR 3 � G�+LLOA15
PUMP MAIJUFACTURE R: GOU C: � ULi1E5 O R 11 GA Uous
MODEL IJUMHER: � o'S _ �
SWITCH TYPE: LTIZ�UIZ -�f' D R 6�l GALLOAIS
WT E: PUMP Am) ALAKM ARE TO 5L
MIMIMUM DISCHARGE RATE INSTALLED ON 5EPARATE CIRCUITS
VEKTICAL DIFFERENCE DETWEEU PUMP OFF AUD..015TIZIBUTIOW PIPEA FEET
+ MIIJIMUM METWORK SUPPLY PRESSURE , -�ZS FEET
-F• FEET OF FORCE MAIN X Z'`��. 3 b FEET
100 FLFKICTIOW FACTOR..
TOTAL UtIMMIC HEAD = �b 6 z FEET
As per manufacturer. i) gal /in. Liquid depth 3 $ "
Gouldsc
• ' Submersible
Effluent Pump
a;
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 tic'cover with integral handle
• Farms Motor: and float switch attachment
EPO4 • Heavy duty sump Single phase: 0.4 HP, manual operation. Automatic models include Mechanical Points.
• Water transfer 115 230 V, Hz, 1550 Float Switch assembled and ■ Power Cable: Severe duty
• Dewatering RPM, , built in overload with
automatic reset. preset at the factory. rated oil and water resistant.
• EP05 Single phase: 0.5 HP, ■ Bearings: Upper and lower
SPECIFICATIONS 115 V, 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing
Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo construction.
• Solids handling capability: automatic reset. -
3 /4 " maximum. • Power cord: 10 foot plastic Semi -open design AGENCY LISTING
• Capacities: up to 55 GPM. standard length, 16/3 SJTO with pump out vanes for
• Total heads: up to 24 feet. with three prong grounding mechanical seal protection. . Canadian Standards Association
• Discharge size: 1 1 /2' NPT. plug. Optional 20 foot ■ EP05 Impeller: Thermo- numbers
(CSA listed model
• Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in " to or "AC".)
de
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 I
• Capable of running -
dry without damage to s 30 I I
components. j I -S GPM
Pump: EP05 6 ; - — - - --
• Solids handling capability: 25 -- --
3 /4" maximum. ° a 7 ; I i
• Capacities: up to 60 GPM. _ - -- - - -- - -- - -- I 1
• Total heads: up to 31 feet. 2 6 20
• Discharge size: 1'h" NPT. z 5 I I i_
• Mechanical seal: carbon- 0 15
rotary/ceramic - stationary, _j 4 j
BUNA -N elastomers. EP05, -
• Temperature. 3 10 - 3U•3Z - - - --
104 1 F (40 °C) continuous j
140 °F (60 °C) intermittent. 2 - - EPO4 _ 5--
i t
0 00 10 20 30 40 5.0 GPM
L
0 2 4 6 8 10 12 m - 1 /h
CAPACITY
1995 Goulds Pumps. Inc.
REGEtvt
Wisconsin Departmei t of Commerce SOIL EVALUATION REPORT Page of 3
Division of Safety an ( Buildin
C. 0 1 NQorda with Comm 85, Wis. Adm. Code
Attach complete sit i plan n 8 1 County
x 11 inches in sire. Plan must X
include, but not I'imi d to:! ������ -
1) �r al ref ence point (Bb,), L.,rection and Parcel LD.
percent slope, scat location and dish ce to nearest road. O 3 - 1 O Z) - �
Piease print all information. Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). - l' 2,0 lj
Property Owner Property Location 00
IT-7 U t - S� 1/4 M" /4 S l �. T Z) N R 15 E (o�Vj
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
itY Slate Zip Code Phone Number ❑City ❑Village [2 Town Nearest Road I
6LV'T w lkl CtW W I s y� 1 � (� ISM S> tiZ � � t
New Construction Use: Residential / Number of bedrooms Code derived design flow rate 4So GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material O V L'1Z '�"] L-L Flood Plain elevation if applicable
General comments
andrecommendations: I�QUY�J� ►� f {� `��S���gi�LV`T11
1 '1 1►.� l h-1 U h� ZQ" 0 r--
-0 '\j `50 v R TL'ev
a Boring # r ❑p� Boring
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The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
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CST Signature Date Telephone No. CST NO. Job NO.
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
. AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address
Property Address
(Verification required from Planning Department for new construction)
City/State Parcel Identification Number ��7 5� -T�.7 ! Qv - QZTO �SZ
LEGAL DESCRIPTION �
Property Location SL� /4, �N `/4, Sec. lam, T,-.)- 9 N -R W, Town of S Pt //L�G 41 5e D
Subdivision Lot #
Certified Survey Map # Volume , Page #
Warranty Deed # `� Volume 1 eL , Page #
Spec house ❑ yes JZ no Lot lines identifiable ❑ yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
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 forthAerein, as set the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
statin your sep st has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
da a three y p' tion
�-
S ATURE OF ICANT DATE
ZY
OWNER aTIFIC ON
I ( certify th 1 statemen n this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the pr v , a de ribed by vi of a warranty deed recorded in Register of Deeds Office.
X �� S lam
SIGNX OF A7ion NT DATE
« « « « «« Any informat 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
1 2 3 1 1 P 4 5 7 ?29939 r
KATHLEEN H. WALSH
REGISTER OF DEEDS
STATE BAR OF WISCONSIN FORM 1 - 1998 ST. CROIX CO., WI
RECEIVED FOR RECORD
This Deed, made between Waldo W. Rott and Donna F. Rott, husband 07/11/2003 12:35PM
and wife, Grantor, and Gary K. Rott and Cheri Rott, husband and wife as
survivorship marital property, Grantee. WARRANTY DEED
Grantor, for a valuable consideration, conveys to Grantee the following EXEMPT i
described real estate in St. Croix County, State of Wisconsin (The "Property "): REC FEE: 11.00
TRANS FEE: 210.00
The North One -half of the Northeast Quarter of Section 10 -29 -15 EXCEPT: COPY FEE
CC FEE:
PAGES: 1
1) Lot 1 of Certified Survey Map filed November 26, 1997 in Vol. "12 ", page
3386, Doc. No. 569036.
2) Lot One (1) of Certified Survey Map filed November 6, 2000 in Vol. 14, Page
3990, as Document #633088. Recording Area
Subject to Easements of Record. RETURN TO: TITLE ONE
706 19TH STREET SOUTH
RESERVATION OF EASEMENT by Grantor, their heirs and assigns, for ingress HUDSON, W1 54016
and egress over the West 120 feet thereof.
034 - 1021 -10 -020 & 034 - 1021 -20.100
Parcel Identification Number (PIN)
This Is not homestead property.
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 None.
Dated this � N � day of 2003.
*Waldo W. Rott
*Donna F. Rott
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
ss.
,• ,y�wawrp rrrr
Lu County)
authenticated this _ day of ~'`, ;�i►�5� �.(.S`L,G,I Personally came before me this 0 NA day of
2003 the r'
abo;gnatypd GJALAn LU .
r �F ny A/wrd__ o T _
* t = to me known to
TITLE: MEMBER STATE BAR OF WIS NS *Se the person(s) who executed the foregoing instrument and
(If not, M i C ocknowle a the same.
authorized b 706.06, Wis. Stats.
Y § allyd'f ** 4C����`
THIS INSTRUMENT WAS DRAFTED Of W19C0 ;�o
Hendrik W. Van Dyk r rasrasaNa ~ * / ►'"'.(� L- _�SC I�b,/2
VAN DYK, O'BOYLE & SILER, S.C. Notary Public, State of Wisconsin
Post Office Box 118, New Richmond, WI 54017 My Commission is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not MARK 1 , MGAI.Sf,�HEUiR
necessary.) Notary Pubhc>- -State of Wisconsin
My Commissi Expires ualober 3,
*Names of persons signing in any capacity should be typed or printed below their signatures
WARRANTY DEED STATE BAR OF WISCONSIN
FORM N.. 1 - 1998
i—�1� INFORMATION PROFESSIONALS COMPANY FOND DU LAC. WI 800- 655.2021
U. 2486P 036 �st�as
KATHLEEN H. WALSH
STATE BAR OF WISCONSIN FORM 2 - 1998 yt REGISTER OF DEEDS
ST. CROIX CO., VI
RECEIVED FOR RECORD
This Deed, made between kt�and Donna F. Rott 81/06/2089 18:00AN
husband and wife, Grantor, an +�
husband and wife as survivorship fiTarital property, Grantee WARRANTY DEED
Grantor, for a valuable consideration, conveys and warrants to Grantee EXEIPT #
the following described real estate in St. Croix County, State of Wisconsin (The REC FEE= 11.00
"Property "): TRANS FEE: 306.00
COPY FEE:
SE 1/4 of NW 1/4 of Section 10- 29 -15. CC FEE`:
TOGETHER WITH an easement on a strip of land 16 feet in width across the PAGES: 1
furthermost NW corner of the S 1/2 of the NE 1/4 of Section 10- 29 -15, to be
used for roadway purposes between the N 1/2 of the NE 1/4 and the SE 1/4 of the
NW 1/4, all in Section 10- 29 -15.
TOGETHER WITH easement for ingress and egress over the West 120 feet of Recording Area
NW 1/4 of NE 1/4 of Section 10 -29 -15 as reserved in Warranty Deed in Vol. Name and Return Address
2311, Page 457, Doc. No. 729939. Hendrik W. Van Dyk
VAN DYK, O'BOYLE & SILER, S;C.
Post Office Box 118
New Richmond, WI 54017
034- 1021 -90
Parcel Identification Number (PIN)
This is not homestead property.
Exceptions to warranties: Subject to all easements, restrictions and covenants of record.
*Waldo W. Rott
_�/
*Donna F. Rott
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Waldo W. Rott and Donna F. Rott STATE OF WISCONSIN )
authenticated this 5i day of January 2004. ) ss.
County )
` Personally came before me this day of
* Hendrik W. Van Dyk
L4 - , above named
TITLE: MEMBER STATE BAR OF WISC SIN
(If not, to me known to be the person(s) who
authorized by § 706.06, Wis. Slats.) executed the foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
Hendrik W. Van Dyk
VAN DYK, O'BOYLE & SILER, S.C.
P.O. Box 118, New Richmond, WI 54017 Notary Public, State of Wisconsin
(Signatures may be authenticated or acknowledged. Both are not My Commission is permanent. (If not, state expiration date:
necessary.)
Imes of persons signing in any capacity should be typed or printed below their signatures
WARRANTY DEED STATE BAR OF WISCONSIN
FORM No. 2 - 1998
INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 800-655 -2021
l
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