HomeMy WebLinkAbout040-1297-10-000 Wisconsin Department of CommeMV PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
t INSPECTION REPORT Sanitary Permit No:
463190 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:
Kingsley, Thomas & Samantha Troy Township 040 - 1297 -10 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
CST BM Elev: Insp. BM Elev: 7
/OD Q V\ 19.28.19.1713
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
3• ios.� Gov
Septic. Benchmark
j J 3.
Dosing Alt. BM
(odd 4. C e - ,55 9`t • Z5
Aeratiei} N , Bldg. Sewer
ad-� o - or, /63 �
Holding St/Ht Inlet
945 qy. 35
TANK SETBACK INFORMATION St/Ht Outlet \1
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \
Septic 7 !56 A gS Dt Bottom
�S 13.55
Dosing / _ Header /Man.
7�0 �s gs a•�5 1151, t5
Aeration Dist. Pipe
Z� 161 ts
Holding Bot. System
3.3 100.5 I
PUMP /SIPHON INFORMATION r •nal rade '
Manufacturer Demand St Cover
� GPM Q� ' 25
Model Number ��
G
TDH Lift Friction Loss System Head TDH Ft
/a ' 70 r
Forcemain Length / I Dia. Z i / I Dist. to well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Tren es PIT DIMENSIONS No. Of Pits Inside Dia. Li i�d Depth
DIMENSIONS G 91 Z
SETBACK SYSTEM TO I P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer.
INFORMATION — CHAMBER OR
Type S UNIT Model Number:
6j^_ - 7/
�--
DISTRIBUTION SYSTEM
Header /Manifold Distribution / x Hole Siz x Hole Spacing Vent to Air Intake
Pipe(s) CZ� I Z G � te.t1
Length Z' Dia Length q� Dia / Spacing SP 5
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over I Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed /Trench Center I G Bed/Trench Edges \ Topsoil I Yes No es No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: tL /D5 Inspection #2:
(
Location: 214 Madison Circle Hudson, WI 54016 SE 1/4 SE 1/4 19 T28N R1 9W) y Trebus Valle Estates Lot 21 v Parcel No: 19.28.19.1713
1.) Alt BM Description = "�' j ""�` ; �S Liz-5 P a�
2.) Bldg sewer length = 85 6.111.
- amount of cover = 'T' C k
Plan revision Required? f '� Yes No r 0 sSigdna Use o ther side for additional information. o .� SBD - 6710 (R.3/97) Date Insep Cert.
No.
1
Safety and B ' ' gs Divisiai
201 W Washington county 5 erb N X
W. n�., P . Box 7162
NVISIcons�� (608) 2 Madison, Wl 53 0�71(� Sanitary Permit Number Number (to be 00d in by Co.)
66 -31 till
De artment of Commerce
Sanitary Permit Applicati n o�oi '°
m accord with Comm 83.21, Wit. Aden. Code, personal You .. S �Te 14 0)
may be wed for seoondasy purposes Privacy Law, sl S. lxm) �I V �jD Prof (if ditFerent than mailing address)
` 1. Application Information - Plem Print All Information i ' ii Z� / rn �D I Soot C 112L _:t
Property Owner's Name rY G�;; • # Lot # Block N
4- 5AW A
propcity Owner's Mailing Address Location
b,�r 71) s 5 ,, Ste Section �9
Ci , State [ Zip Code Ph" Number
T ao N . ?_ `)
H. Type of Building (cbeck all that apply) � Od (X S S' Subdivision Na CSM Number
L�3'1 or 2 Family Dwelling - Number of Bedrooms ❑ Publ ic/Cammm-W- Describe Use ;
C] state owned - Describe Use 6B sbl S ❑City_❑Villw ownthip of �11
Ill. Type of Permit: (Check only one box online A. Complete line B If applicable) 6q - 2 4 7 O - /3
A ' New System ❑ Repiaoamew System ❑ Tr atment/Holding Tank Replaoemam Only ❑ Other ModiSoation to Existing System
B. [I Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Tunsfer to New list Previous Permit Number and Date Lamed
Befcaue Expiration Plumber owner
1V. Type of POWP3 Syst Check all that s K
❑ Non - Pressurized Io-t:in:.md XMound > 24 in. of suitable soil ❑ Mound < 24 in. o suitable soil ❑ AvGrade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In -Ground ❑ Bolding Tank ❑ Peat Filter ❑ Aerobic'Ibealmeut Unit ❑ Recirculating Sand Filter ❑
Rectroulating Synthetic Media Filter ❑ L=Wn awnber ❑ Drip Line ❑ Gravel -lest P Odra lain
V. Db truant Area Information:
Design Flow (gpd) Design Soil on Rate(gpdst) utspersat Am � ( Dispersal Area Proposed (st) System Elevation
VI. Tank Info Capacity in Total Number Mae Prefab site Steel Fi Plastic
Gall= (7alloos of Lim w /Qe_E.,v� g�gE� Concrete Constructed Glass
Now I 8xistims
Tanks Tsdu
�orT O00 /moo
Aerobic T re Um@
DeslaQ Cube. 04 Dy-
VII. Responsibility Statement - 1. the an eras jsslbillty for IastaWtion of the POWTS abown on the attached
Plumber' Name (Priest P s MP Number Business Phone Number �d 1, z_ rIlP 1 5?V 2 711 Z3S y Z�
Plumber's Address (Street, City, State, Zip
6
VIIL Conn me at Use only
Approved ❑ Disapproved �tw' Permit Fa (includes t3roundwata Date Issued Agent Si (No Stamps)
Surcharge Fee) 2
❑ Owner Giv en Rea,:m for Denial 3sa
IX Conditions of Approval/Reasous for Disapproval 2 p n� , u' „
SYSTEM OWNER:
1 Septic tank, effluent filter and
dispersal ceH must afl be serviced / maintained
as per management plan provided by plumber.
2. All setback requirements must be nwintained
as per applicable code/ordinances.
Attack eomplste pleas (to rN Cowtr orty) for tie system err paper rot toss tsar 81/3 x I I loekes to an
SBD -6398 (R. 01/03)
06:09 FAX 715 233 0398 Certified Soil Testing a La% Commerce 10002
Qe F. " /Sig
� •' �l2 /use,':• .
P'
✓G6 '4: 7
0 j
• {reposed 1 � � -�
y x coi2 -ac-k- t4X
lo
1
GL 43
Bur, nieio�: 70 P
of t"ib+r
60.0
o l ST n
>, tL ls:�
At C pipe
Elk pI t ofe
IL
/ 1
, , , � ,►y S 31.19'
�k -S� - �q- z�?•�S�
`' � ~'' ~vim
coo l?*, 3 e��
-�
Safety and Buildings
4003 N KINNEY COULEE RD
commerce.Wl.gov LACROSSE WI 54601 -1831
TDD #: (608) 264 -8777
i sco n s i n
www.coe.wi.gov/sb/
www.wisconsin.gov
Department of Commerce
Jim Doyle, Governor
Cory L. Nettles, Secretary
October 22, 2004
CUST ID No. 139462 ATTN: POWTS Inspector
TODD L SINZ ZONING OFFICE
T L SINZ PLUMBING INC ST CROIX COUNTY SPIA
E5609 708TH AVE 1101 CARMICHAEL RD
MENOMONIE WI 54751 -5520 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 10/22/2006 Identification Numbers
Transaction ID No. 1071017
SITE: Site ID No. 691218
Thomas & Samantha Kingsley Please refer to both identification numbers,
County Hwy F above, in all correspondence with the agency,
Town of Troy
St Croix County
SE1 /4, SE1 /4, S19, T28N, R19W
Lot: 21, Subdivision: Trebus Valley Estates
FOR:
Description: Three Bedroom Mound System
Object Type: POWTS Component Manual Regulated Object ID No.: 987543
Maintenance required; 450 GPD Flow rate; 31 in Soil minimum depth to limiting factor from original grade;
System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /O1),
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
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. c oe d
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, AK t
stats. W f
The following conditions shall be met during construction or installation and prior to occupancy or use: DERARTMEH
N OF
General Approval Requirements:
SEE CORF
• 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.01 /O1)
and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION
2.0" SBD - 10706 -P (N.01 101).
• 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.
TODD L SINZ Page 2 10/22/2004
• 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.
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.
i
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.
I
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, Required uired $ 175.00
q
Fee Received $ 175.00
Balance Due $ 0.00
Charles L Bratz
POWTS Reviewer II , Integrated Services WiSMART code: 7633
(608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday
cbratz @commerce.state.wi.us
cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544
Henry F Grote, Certified Soil Testing
i
i
4
C
Thomas & Samantha Kingsley - Mound <f �
Construction Materials and Techniques Q /I'
All materials must comply with Comm 84 and be installed in accordance with manufacturer's
specifications. Construction methods must comply with the following Component Manuals:
Mound, SBD - 10691 -P (01 /01)
Pressure Distribution, SBD - 10706 -P (01/01)
Location: Lot 21, Trebus Valley Estates
SE 1 /4, SE '/4, Sec. 19, T 28 N, R 19W
Town: Troy
County: St. Croix
Date: October 19, 2004
Owner: Thomas & Samantha Kingsley
Address: c/o B and D Excavating
1025 170 St.
Hammond, WI 54015
Plumber: Todd Sinz
Signature: &IlkL
t1 O��lly
License: MP 139462 %UV
rOF COMM CE ER
Attachments: SBD -10577 - Plan Approval Application T �eIxcS
SBD -8330
.ESP( N 0ENC
Page 1: cover
2: design criteria & calculations
3: plot plan
4: system cross section
5: plan view, lateral detail
6: pump tank exit detail
7: pump curve
8: system management
page 1 of 8
Design Criteria
Residential Wastewater Contaminant Load: 30 mg/L < BOD < 220 mg/L
Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L
Fecal Coliform > 10,000 cfu/ 100 mL
Fats, oils, grease < 30 mg/L
3 Bedrooms x 100 gal/bedroom/day x 1.5 4 S gallons /day hydraulic load
Design Calculations
In situ designed loading rate n 'Z"� gallons /sq. ft. per day
Depth to estimated high ground water in.
Depth to bedrock ? in.
Cross slope at system %
Force main length ft. of Z in.
Manifold/header length ft. of Z in.
Drain -back 4, gallons
Lateral length @ 4 0, o ft. of `� in.
Lateral elevation 3 O t • o ft. @ bottom of lateral
Lateral hole size in. @ to 0' o in. ( S • ° ft.) Spacing
1 C( holes /lateral holes total
Lateral volume b S gallons
i
Total lateral discharge rate gallons /minute @ 2 ft. head
Network pressure compensation losses
Elevation difference 6-0 ft.
Friction loss ft. @ �� gallons /minute
Total dynamic head b ft.
Pump /si 'Oon gpm @ ft. of head
Manufacturer 1A o a �:� Model # "' >r
Dose volume gallons
Lift /sip'kon tank 0- 0 CA- 19w0 gallons
Septic tank `� �'" gallons
Effluent filter d v °.^ ' `Lz v� n
Measurement pump on and off 0 in.
Height alarm from tank bottom in.
Reserve capacity 3�Z.s� gallons
specs.calcs.res
Page Z of
C�
LO/22/2004 06:09 FAX 715 233 0398 Certified Soil Testing LaX Commerce Q002
p rop oS d i tl 6cc 14 1111 H 2;
x — 4,L -�4 -S
4tC.1
h
L.V ribnr
At
o,
l.3
11 w
s tz
0
T
�♦ s
wl ��
Z
Or I rv- .►�-�� 7 `f11 �M �/^�/�� B IY . LA ti .
0.T ML
I
P V L
1 � Ld1 M p 1 '1 O \ ♦ T PAM _` �'
o. 0
w ".j ot, � Qw
CA �j 11
a� �
i WEATHERPRC»F
LIDCKIWG COVER
l</AidNiN
QUICK DI�C.D�r�ICT ----�
c' L-``
IL D
+0 D1P6
no NolsTuaUo
P
�c
Solt. 24 � 4" 40
r,uo� i
iAC4 r
4
cw�wu�. A 25, o mot,
C.7- A v, T- 1
S o wrs BAFFLE
ALA 4 � AL � 3' o-�c
c- ( 0Nkt,kFXk � �� -�r ^ON
Ow"C1a�1
I
D PwyP
9
rr G oNcaec - rte
jG,lGv
b�oCK
16f
SEPTIC E SPEC- IFI'CATIO►J
oo s E
TALI. S MXQUFACTVRtR: (JLtMBEF OF 005C S
5
TA►JK SIZE: ` �� OALL01J 5 DO
SC VOLUME
ALARM 1"k. JUFACTUKER: S� `'��< -tv INCLUDING OACKFLOW: `�
MODEL UUTAicu 1 e 1 1-F _ 21 r
CAPACITIES: A_ IuCN[5 OK
SWITCH TtIPC:
kur�P /1A►JUFACTURCR; -- , d w. K �C 6,o
MODEL ►JUMPER; ci
0' INCHES GR CDA
.,.. •�_
SWITCH T)Jpe- �2b••tiv ,,
IJCITE; PUMP AUD ALARM ARC 'To 8C
h11►JIMUN'1 DISCMARGt RATE GPM INSTALLED ON SEPARATE LIKtu%'TS
VERTICAL DIFFEIREW DETWCCIJ PUMP OFF AUO OISTR16UTI01J PIPE., �'�
FECT
+ MiuIMUM ►J ETWORK SUPPLY PREt .. . . , .. , , . ,
+ 2 � FEET OF FORC[ MAIAJ X 11 - F 0►EFRICTIOU FACTOR. �`�S FEET t� 2 1<
' TOTAL DtjQAMIG HEAD — b
— FEET
��
IUTEf(►JAL. OIMEIJ51OA1R OF TA►JK: LE. AIG'fH
:WIDTH j LIQUID OC PT H
i�a'.c 6 0.
+r
' En Et - •
Pump Characteristics Performance Data
In/ Allotor Uwl Ssrhwsttwbs , st
Asdeaotk M�.Is iNEiA0A1 � �
Non•p�wot .SO �
FW W Aa+p
IMIa ShoQ hb 14 l ■
R.PAL 1 SSO i
rhoe e
� � to .,.........._. .,... �.
Vehop ns
Htrn 60
1«ppsrst•n 12" A c�s,+u tex t i s to >t .o 51
NEINA Dktr,a A urnrs+,w i .,,.. .- -1.... ..__._. . ....- .•�._.
hstfsifas Clm A
E►irdiar She 1 -I /2' Nr1 tJtwttt) Total IEtn11r (feet) I i 12 16 1 4�
0
$ods H"Jbq S�4• U%W d ►M M.S.) 44 36 2 Z= 12
0
Wdt W4111t 30 6s.
hwv C« 11/7, sn% w std. Dimensional Data
Materials of Construction �'�" 4,;isi w«�,o.
No& Swdess S" , ., ,.y : lA �.►
lot) IN 4*000i" P
Utrk b MiKkk of iii a W"
R><ster Has Gstltt• i1
r•y c.eoi ,gb, we
Cse Csst k nn S. av011 bnl 64=Ws
�. wenwvs AO*10 wat
I wMc N w w4w NW tw
' IOD slltpll M1kt
MbcMicd Swd letosl Csistt f Cstros>ak �,,.. • •� �
Shaft Sid SW E?�t Atto�Ml StNI
wst IwtrN
r E tk „• ,��
GA � Slaw 4 'i »
9z1 iso I
lowtt E;rw E?dl Il k to"" Oslo tk ivy s••vs i
up Esowed 1ltst mill tk fill ►, 1'i�b.
Fos1NNi lit•�ftf SiMI
d 1999 N drwraic' Plumps, mhlow" 060 AI R' Rer«ved.
�r1r HYDROMATIC '* You, Auihonstd lacoi Oiwiboar -
ROMMEMMM
1 840 6my Rwd AsNW, 06 44105 Ti. 419.219.5042 Ftr. 419.211.4011
Wsi Site: w"."ft"appcem
SAUS OFFICIS IN All RAJOR CITIES AND COUNTRIES p ,)
nom u:
W-0243601209 6M " 4
System Management
Management of this system is critical. As a condition of approval of these plans this system management section must be
reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. if
problems develop with the adsorption system or any other system components, the installing plumber, TL Sinz, 715- 235 -2644, or the
St. Croix County Zoning Office, 715- 386 -4680, should be contacted for assistance.
General
Proper functioning of an on -site disposal system, "septic system," is significantly dependent on the volume of water which
flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of
contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to
settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as
water, a dose tank or compartment to allow a dose to be accumulated, a pump and controls or automatic siphon, and finally some type
of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health.
1. If the septic tank is installed prior to sheet -rock and/or painting, pump the septic tank before normal use begins to ensure
adherence to contaminant load design criteria.
2. Install water - saving appliances whenever and wherever possible.
3. Repair even small water leaks as soon as possible.
4. Never pour grease or oil down any drain or stool.
5. Garbage disposals are not recommended; if you must have one, use it sparingly
6. No paper products other than tissue should go into the system.
7. No chemicals should go into the system,
8. Avoid surge flows of water; try to spread laundry throughout the week.
9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans.
10. If septic or dose tanks are no longer used, they must be properly abandoned.
11. If construction timing and weather could create a frozen infiltration system, weather - proofing with plastic sheeting and
heavy mulching may be required to maintain a functional system at start-up.
12. If possible, the upslope toe of the mound system should be landscaped with additional fill to blend this area into the
upslope natural grade; this will minimize the possibility of the system trapping surface run -off, final settled slope should
be 2 -3% over the system or 2 -3% diverting surface run -off around the ends of the system.
Maintenance
1. The septic tank must be inspected every three years by a properly licensed person.
2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids
volume equals one third of the tank volume.
3. When the septic tank is pumped, any solids in the bottom of the dose tank must be pumped, and the filter must be back - washed
into the septic tank to remove accumulated material. System use may require more frequent filter cleaning; initial inspections of the
filter should be made every 6 months until a minimum time sequence is determined.
4. Periodic observation pipe inspections should be made by the owner to examine the state of the in -situ soil adsorption cell.
Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption
cell.
5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany
their specifications.
6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the
pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible, The system allows
reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than
one or two days should pass before any necessary repairs can be made.
7. Avoid compaction such as vehicle traffic within 15' down -slope of the adsorption system.
8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system.
9, Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth.
10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run -off into the system
area.
11. Warning: Do not enter septic, dose or other treatment tanks; death may result because they may contain lethal gases or
insufficient oxygen.
Contingency Plan
Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring
may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54
(2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing,
and/or installation of additional treatment components or conversion to a holding tank may be necessary.
Page 8 of 8
1
1513
Wisconsin Department of Commerce SOIL EVALUATION REPORT hum- 2d B S/ Page 1 of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Sal & Site Evaluations
Attach complete site plan on paper not less than 8'% x 11 inches in ' . Plan must County
St. Crobc
include, but not limited to: vertical and horizontal refer an )'jdi nd ^ --
percent slope, scale or dimemsions, north arrow, and b _ �rtd.isttin n t road. Parcel I. D.
040 -1078 -50-M, ID #19.28.303
Please print all fnf °. n �� By Date
Personal information you provide may be used for S-15.04 Flt K 0
Property Owner P
J.T.B. Properties, L.L.P. C/O John W. ie n U A. LW SE 1/4 SE 114 S 19 T 28 N R 19 W
Property Owner's Mailing Address ST C pIX F17 �� .. ,Block # Subd. Name or CSM#
1564 West University Avenue '" -\ Trebus Valley Estates
City State Zip C N' City Village Town Nearest Raad
Saint Paul I MN 55104 `1 -1 7 ,. � Troy County Highway "F"
JM New Construction Use: #1 Residential / Number roam 3 Code derived design flaw rate 450 GPD
. 1 Replacement Public or commercial - Describe:
Parent material Glacial drift Flood plain elevation, if applicable na
General comments
and recommendations: Recommend installing mound system at elev. = 100.50' at 6" above 100.00' contour.
F-1 " �6 . Zvo�
Boring # 16 Pit Ground Surface elev. 100.00 ft. Depth to limiting factor 31 :,.— in. Sal Application Rate I
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft=
- Eff#1 - Eff#2
1 0 -13 1Oyr3/3 none sl 2fsbk mvfr cs 2fm 0.5 0.9 , (o
2 13 -20 1Oyr4/3 none sl 2fsbk mfr cw lfm 0.5 0.9 , (
3 20 -31 7.5yr4/4 none sl 2msbk mfr cw 1vf &f 0.5 0.9
4 31 -79 7.5yr4/6 c2p 5yr4/6 Ifs /sysil 2medpl mfr - 1vf &f 0.2 0.3
H#4 contains stratified layers of colt — Wal Osg s,1 msbk Ifs, Om sl, 2med.pI sit. Loading rate reflects most restrictive perniability within horizon.
Bwn9 # �j Boring
Pit Ground Surface elev. 100.09 ft. Depth to limiting factor 32" in • Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD 1ft
'Eff#1 'Eff#2
1 0 -11 1Oyr3/3 none Is lfsbk mvfr cs 2fm 0.7 1.2 T
2 11 -26 1Oyr4/4 none sl 2msbk mfr cw 1 f 0.5 0.9 '(00
3 26 -32 1 Oyr4 /4 none Is 1 msbk mvfr cw 1 f 0.7 1.2 ,
4 32 -70 1 Oyr4 /4 c2d 5yr4 /6 Wslisit 1 msbk mfr - - 0.2 0.3
— HM contains an unsorted mblure of Osg Is, 2msbk sl, 2msbk scl, & lmsbk sil. -- --
Effluent #1= BOD 30 < 220 mg/L and TSS >30(-- 150 = BOD 30 mg/L and TSS <30 mg/L
CST Name (Please Print) Signal re: CST Number
James K. Thompson 3602
Address A.C.E. Sal & Site Evaluations ate Evaluation Conducted Telephone Number
340 Paulson Lake lane, Osceola, WI 54020 12/5/01 715 -248 -7767
J
propertyowner J.T.B. Properties, L.L.P. C/0 John parcel ID# 0 40- 1078 -50 -000, ID #19.28.303 Page 2 of 3
3 ] Boring # Bori Pit Ground Surface elev. 97.37 ft. Depth to liming factor 40 - in. goti Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GFDIW
*Eff#1 *Eff#2
1 0 1 Oy r 3/3 none sl 2fsbk mvfr as 2fm 0.5 0.9 .
2 6 -14 1Oyr4/3 none sl 2msbk _ mvfr cs 2f,1m 0.5 0.9
3 14 -26 7.5yr4/4 none sl 2msbk mfr cw 2f 0.5 0.9
4 26-40 7.5yr4/6 none Is 1msbk mvfr gw 1f 0.7 1.2 I ,
5 40-63 7.5yr4/6 f2f 7.5yr5/8 Is /sl Om mfi - - 0.3 0.5
H# 5 contains an unsorted mix of 1 msbk Is, Om sl, & 20% limestone fragements. Redox- concentrations appear at intertface of tedural changes
throughout horizon.
Boring F-I # Bori J- --
A Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
*Eff#1 *Eff#2
Bonng F-I # ��
,,� Pit Ground Surface elev. ft. Depth to limiting factor in. Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
*Eff#1 *Eff#2
* Effluent #1 = BOD ? 30 < 220 mglL and TSS >30 < 150 mg/L * Effluent #2 = BOD -i mglL and TSS <JO 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 altemate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777.
L
�e /s/,3
■ .Soi /er/a�cca�'o�
♦ E /e dC�i'o h
T �oPo d
0�
� 0,10
/oo, I � ♦ .enc.L� � /o{� of �'B �eb�►r
o � SSwme� �l ecr -• 1 CJ. cYJ;
s uu„,�d
0
✓.C'. prpe.
er! =
lox 6
Est
3y2,sc"
_3-f3
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSW CERTIFICATION FORM
OwnerB uyer
Vey
1�a s �
Mailing Address
Property Address
(verificau.._ . _ , .d from Planning Department for now construction)
city/State �"�d'�'^ W Parcel Identification Number
"� ((��3)
I-EGAL DESCRIPTION
Property
Location ' /,� SC `/4, Sec. � T 2 � N• R�� W, Town of
�•�- Lot #
1
Subditnston _ _ 1 �s
Certified Survey Map # - J Volume Page #
Warranty Deed # - L e3L 1 (0 . V o l ume ° Page #
Spec house D yes 0-no Lot lines identifiable &yes O no
SYSTEM MAINTENANCE
Improper use and mainteuaneeof your septic system could result in its prcnsature failure to handle wastes. Proper yuaintenancc
consists of pumping out the septic tame every three years or sooner, if needed by a licensed Pumper. What You put into the systetu
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 Departmcnt a *mttScation rom signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verlfyiog that (1) the ou - site wastewater disposal system
is in proper operating condition and/or (2) after inspection and pumping (if oeoessaty), the septic tank is less than 1/3 full of sludge.
roquu eouen !
I/wc, the undersigned have read
the above is and a to maintain the private sewage disposal system with the standards
sct forth, herein, as set by the Department Resources, State of Wisconsin Certifrcatioo
artment of Commerce and the Deparu=t of Na
stating that your septa t= has been maintained must be completed and returned to the St Croix County Zoning Office within 30
da f the iration date.
GNA APPLICANT DATE
O WNE CE R CATION
I (we) ce that all statements on this form are true to the best of my (our) knowledge. I (we) am (arc) the owncr(s) of
th roperty above, by virtue of a warranty deed recorded in Register of Doeds Office.
to 1aaj cc) tL/
APPLICANT DATE
0#0-00 Any ormation 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 Deods office
a copy of the certifiod survey map if reference is made in the warranty decd
Oct 07 04 11:30a Bonte Excavating (715)796 -2519 p.7
U 2669P 542
"776 1 6
STATE BAR OF WISCONSIN FORM 2 - 1999
WARRANTY DEAD KATHLEEN H. WALSH
Document Number REG ISTER CODEEMI
This Deed made between .Tj'�Prgperties. LLP RECEIVED FOR RECORD
Grantor, 10/05/2004 12:43PH
and ][horngNWIU Nd S a 'n 1 ev husband an wifs
Grantee. NARRAKTY DEED
Grantor, for a valuable consideration, conveys and warrants to Grantee EXEMPT #
the following described real estate in St. Croix County, State of Wisconsin REC FEE: 11.00
d M. ace is needed, please attach addendum); TRAILS FEE: 323.70
ebus Valley Estates in Troy Township, St. Croix County, COPY FEE:
CC FEE.
'PAGES: l
*P.
Recording Area
Name and Retum Address
Four Seasons TMO
206 2nd Street
Hudson, WI 54016
040-1298- 10-o
Patceh identification Number (PIN)
This his not homestead property
(is) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this day of September , 004
ropert ies, LLP
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) _ _ _ STATE - 1 )
) $a.
County )
authenticated this day of
Roge Personally came before me this �(/ day of
pt IQ September , 2004 the above named
JTB Properties, LLP �o t1..i 4_1.
* _ _ State of Wisconsi n _ n_ ,(S4 ��
95�
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, _ _ to me known t e persoa(s) who executed the foregoing
authorized by § 706.06, Wis. Stats.) ins t and ac wledged the same.
THIS INSTRUMENT WAS DRAFTED BY �_ _
Attorney Kristin Ogland _ *
Hudson, WI 54016 No ublic, State of
_._ _ —_— — My tamissicytgLs perma=L (If trot, state expiration date: )
(Signaaucs nay be wfb mkated or actnowkdged. Bode are ooh nocimry.)
f Names of persons signing in any capacity must be typed or printed below their signature. laforautton Protessioruk CO., Frond du t.ae. Wt
STATE BAR OF WISCONSIN 800655 -2021
WARRANTY DEED FOAM No. 2 -1999
.� -
Yn
W 8 wds N3d0
-Hi - - -- ` --
- -
—
I I I i
N I
^ z
3333
W � 41 s• / \ I \ I �
t7 \ \ \\ I
cQ
` � I
Y \
1
Z /
as
■■ f
(Y1 � / 1
g
W mYs O�z# r ' N�y� Sf ES�yI
t
t w ,m
jig
a o I i
a
> o yy o t dGrr
3 x
M i V n lip ■ i
bt
»!(10s - ! :l
si�vaL 71vns '1bn has d•"M�- — �•�'�;d � — l�reu nrns� I +
l v
N ti �
� r
.cv
4 1
• CQ �.
0 Im
f
Xl-
`° ��►
vt CIA
co
SAFETY
WARNING - Risk of electric shock. This pump is SAFETY GUIDELINES
supplied with a grounding conductor and /or grounding 1. Read all instructions and safety guidelines
type attachment plug. To reduce the risk of electric thoroughly. Failure to follow the guidelines and the
shock, be certain that it is connected to a properly instructions could result in serious bodily injury
grounded grounding type receptacle. and /or property damage.
2. DO NOT USE TO PUMP FLAMMABLE OR
Your 115V effluent pump is equipped with a 3 -prong EXPLOSIVE FLUIDS SUCH AS GASOLINE,
electrical plug. The third prong is to ground the pump to FUEL OIL, KEROSENE, ETC. DO NOT USE IN
prevent possible electrical shock hazard. Do not remove EXPLOSIVE ATMOSPHERES OR HAZARDOUS
the third prong from the plug. A separate branch circuit is LOCATIONS AS CLASSIFIED BY NEC,
recommended. Do not use an extension cord. ANSI /NFPA70. FAILURE TO FOLLOW THIS
WARNING CAN RESULT IN PERSONAL INJURY
When a pump is in a basin, etc. do not touch motor, pipes AND /OR PROPERTY DAMAGE.
or water until unit is unplugged or shut off. If your
installation has water or moisture present, do not touch wet 3. During normal operation the pump is immersed in
I area until all power has been turned off. If shut -off box is water. Also, during rain storms, water may be
not accessible, call the electric company to shut off service present in the surrounding area of the pump.
to the house, or call your local fire department for Caution must be used to prevent bodily injury
instructions. Failure to follow this warning can result infatal
when working near the pump:
electrical shock.
a. The plug must be removed from the receptacle
j The flexible PVC jacketed cord assembly mounted to the prior to touching, servicing or repairing the pump.
I pump must not be modified in any way, with the exception
of shortening the cord to fit into a control panel. Any splice b. To minimize possible fatal electrical shock hazard,
M between the pump and the control panel must be made extreme care should be used when changing
within a junction box and mounted outside of the basin, and fuses. Do not stand in water while changing fuses
comply with the National Electrical Code. Do not use the or insert your finger into the fuse socket.
power cord for lifting the pump.
4. Do not run the pump in a dry basin. If the pump is
The pump motor is equipped with an automatic resetting run in a dry basin, the surface temperature of the
thermal projector and may restart unexpectedly. Projector pump will rise to a high level. This high level could
tipping is an indication of motor overloading as a result of cause skin burns if the pump is touched and will
operating the pump at low heads (low discharge restriction), cause serious damage to your pump.
j excessively high or low voltage, inadequate wiring, incorrect 5. Do not oil the motor. The pump housing is sealed.
motor connections, or a defective motor or pump. A high grade dielectric oil devoid of water has been
FLOW- LITERS /MINUTE put into the motor housing at the factory. Use of
o so 160 240 320 other oil could cause serious electric shock and /or
60 permanent damage to the pump.
15.0 6. This pump's motor housing is filled with a
dielectric lubricant at the factory for optimum
40 12, s motor heat transfer and lifetime lubrication of the
w
bearings. Use of any other lubricant could cause
w 3° io 0 damage and void the warranty. This lubricant is
non - toxic; however, if it escapes the motor
s housing, it should be removed from the surface
7. ` Q 20 ca quickly by placing newspapers or other absorbent
Li Q material on the water surface to soak it up, so
= s. o
= aquatic life is undisturbed.
10
2. s 7. In any installation where property damage and /or
personal injury might result from an inoperative or
I o o leaking pump due to power outages, discharge litt
0 20 40 60 so 100 line blockage, or any other reason, a backup
FLOW- CALL ❑NS /MINUTE system(s) and /or alarm should be used.
PUMP PERFORMANCE CURVE
115V 60HZ
3
4
INSTALLATION I
Pump must be installed in a suitable gas tight basin which REMOTE FLOAT SWITCH
is at least 18" in diameter and 24" deep, and vented in LEVEL CONTROL
accordance with local plumbing codes.
The RFS series pumps are equipped with a remote float
Pump features a 1Y female NPT discharge. NOTE: DO switch level control. This level control is sealed in a
NOT OVERTIGHTEN DISCHARGE PIPE INTO PUMP polypropylene float cylinder. For automatic operation, the
VOLUTE DISCHARGE. pump must be plugged or wired into a remote float switch.
Pump can be installed with ABS, PVC, polyethylene or Pump will run continuously if plugged directly into an
galvanized steel pipe. Proper adapters are required to electrical outlet.
connect plastic pipe to pump. When the level rises in the basin, the cylinder floats up with
Pump must be placed on a hard level surface. Never place the level. When the cylinder position is at an angle of about
pump directly on clay, earth or gravel surfaces. 45 degrees, the switch activates and starts the pump motor.
A check valve must be used in the discharge line to prevent As the level draws down, the cylinder floats down and
back flow of liquid into the basin. The check valve should when it is again at an angle of about 45 degrees, the switch
be a free flow valve that will easily pass solids. deactivates, and the pump motor stops.
CAUTION: For best performance of check valves, when NOTE: BE CERTAIN PUMP IS SECURE IN BASIN AND
handling solids install in a horizontal position or at angle of CYLINDER FLOATS UNOBSTRUCTED WITHOUT
no more than 45 Do not install check valve in a vertical TOUCHING THE BASIN WALLS OR PLUMBING.
position as solids may settle in valve and prevent opening
on start -up. REMOTE FLOAT SWITCH
INSTALLATION
When a check valve is used drill a 3/16" hole in the
discharge pipe approximately 1" to 2" above the pump 1. The float switch consists of four parts:
discharge connection and below check valve to prevent air a) switch;
locking of the pump. b) cord clamp;
c) clamp screw.
WIRING d) cable tie
NOTE: If screw is lost, use a #10 -16 X 1/2" long
Check local electrical and building codes before tapping screw, longer screws can crack the cover.
installation. The installation must be in accordance with
their regulations as well as the most recent National 2. Attach cord clamp to pump cover as shown in the
Electrical Code (NEC). switch instruction manual packaged with the
switch. The clamp and pump handle must be
To conform to the National Electrical Code all pumps must positioned as shown to allow free operation of
be wired with 14 AWG or larger wire. For runs to 250 feet float. Be sure to locate pump and switch power
14 AWG wire is sufficient. For longer runs consult a cords away from switch float.
qualified electrician or the factory.
3. A 3%" tether length is recommended. When a
Pump should be connected or wired to its own circuit with tether length of 3%" is used, a minimum basin
no other outlets or equipment in the circuit line. Fuses and diameter of 18" is recommended. The tether
circuit breaker should be of ample capacity in the electrical length is measured as shown in illustration at right.
circuit. See chart below.
4. After desired tether length is established hand
tighten clamp screw.
H.P. VOLTAGE FUSE OR CIRCUIT 5. TESTING: Without water in basin plug pump
BREAKER AMPS power cord into switch in -line -plug. Plug switch
4/10 115 20 into outlet. Lift float and watch for pump to operate.
4/10 230 15 Do not run pump for more than 5 seconds.
I
4