HomeMy WebLinkAbout040-1118-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
399445
GENERAL INFORMATION (ATTACH TO PERMIT) Pate Plan ID No:
Personal information you provide may bA sed for secondary purposes [Privacy Law, 5.15.04 (1)(m)]. 8= T 1D
Permit Holder's Name: City Village X Township 'Parcel Tax No:
Zirbel, Ron Troy Township 040 - 111 0 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
Ito -0 1 loo .D` 1 7= 4 — cSria"W. 1 31.28.1 a482C
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS EL V. _ M2.0 I(X
Septic Benchmark
Dosing � � a Alt. BM
Aeration Bldg. Sewer
Holding St/Ht Inlet A
TANK SET6ACK INFORMATION St /Ht Outlet 104p3 )'D3
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic p , L Lf Dt Bottom s � I ?\ 9C.
J 1
Dosing I Header /Man.
101
Aeration Dist. Pipe 3 • 9a,•p3 1
Holding Bot. System ,
Sae l ;
Fin 1 Grade `
PUMP /SIPHON INFORMATION y w:LL Low, m* IZ t -- eo + j
Manufacturer S Demand St Cover
GPM �+
Model Number
TDH Lift Friction Loss System Head TDH Ft o
Forcemain Length 201 Dia. II Dist. to Well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS O — I 4!A�) 2
SETBACK SYSTEM TO P //L JBLDG IWELL LAKE /STREAM L CHING anufacturer:
INFORMATION CHAM
Type Of System: " t
rw►N I Model Number:
f - G rQ a2rz -�+ o 112
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipe
Length Dia Length Dia Spacing
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 Bedfrrench Edges Topsoil
Yes 1] No E] Yes No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: 10 /�/ d / Inspection #2:) o /"Z3/ 1
AR 9
Location: 367 Page Lane River Falls, WI 54022 (SW 1/4 NE 1/4 31 T28N R19W) NA Lot "I cel No: 31.28.19.
�'
1.) Alt BM Description = � ¢ 1 -
2.) Bldg sewer length = SWIIA tnt rw► W4.A WA
r amount of cover = 1 Ge+��l o c {b 0
-so -�.� � � Nfi :102.x`
Plan revision Required? [] Yes 03 It O2
Use other side for additional informatio , J �1uR5 . J
SBD -6710 (R.3/97) a L Insepctor Sg ignatu�t (� s (1 41'�C`^"o
r
- :
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT'S
AND
OWNERSHIP CERTIFICATION FORM 7 -
OwnerfBvper Ra'Ll— Z.. EL
Mailing Address 7 aiU= /-&I , A
Property Address -
(Verification required from Planning Department for new construction)
City /State Parcel Identification Number AP Y2— 1 '16 Ya
LEGAL DESCRIPTION
Property Location &L '/,, Al ' /,, Sec. 3L_, T _N-R Town of —
S ubdivision �— Lot #
S ,
Certified Survey Map # .72 G 33 , Volume / Page #
Warranty Deed # _ - 7,7f JW , Volume ,9S73 , Page # o
Spec house O yes 0 no , Lot lines identifiable yes O no
i
SYSTEM MAI
ro
Im P P
er use and maintenance of your septic system could result in its premature failure to handle wastes. Proper mainte ance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the s stem
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 disposals stem
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sl ge.
I
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the stan ands
set forth, herein, as set by the Department of Commerce and the Department of Natural Resourcct, State of Wisconsin. Certifi tion
stating our tic been maintained must be completed and returned to the St. Croix County Zoning Office with n 30
days the thre veer rv,+i .. a -•-
� 'r
Ll IPLO
SI OF APPLI ANT DATE
OWNER CERT IFICATI
I (we) c 'f that al tate ents on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(;) of
the prope escri d aLlov , by irtue of a warranty deed recorded in Register of Deeds Office.
SIGN F APPLI NT DATE
4
Mtf t ty tfi
Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Depa
•• 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
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SIGNED
_? FORM 3002P
LITHO IN U.S.A.
Wisconsin Department of Commerce t PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
399445
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Oersonal 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:
Zirbel, Ron I Troy Township 040 - 1118 -50 -000
CST BM Elev: Insp. BM Elev: BM Description: AOO
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
(2�7D 'Z•o 1bZ17 1�
Dosing Alt. BM
Aeration Bldg. Sewer 4
�s
Holding St/Ht Inlet 4
St/Ht Outlet
TANK SETBACK INFORMATION *04
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet 44
Septic + Dt Bottom
Dosing .r 3D 1 v ! � / Header /Man.
OT
Aeration Dist. Pipe Z
Holding
113ot. System
PUMP /SIPHON INFORMATION Final Grade
Manufacturer Demand St Cover
GPM
Model Number c,.`. �lLove-.., 4 � �
TDH Lift Friction Loss System Head TDH Ft $( // , 3Z tb`
Forcemain Length Dia. �� Dist. to Well l
20 L
SOIL ABSORPTION SYSTEM
BED/TRENCH Width t Length jNo. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. i
DIMENSIONS D a
SETBACK SYSTEM TO P/L jBLDG IWELL LAKE/STREAM LEACHI nufacturer:
INFORMATION Type Of System: / CHAMBER
� D A � Mo ber:
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size � ._ 4x!Hole Spacing Vent to Air Intake
Pipe(s)
Length Dia Length � Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth of xx Se eded /Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil Yes OM No Yes No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: to / 18 / o Inspection #2:��
Location: 367 Page Lane River Falls, WI 54022 (SW 1/4 NE 1/4 31 T28N R19W)
NA Lot 1 Parcel No: 31.28.19.482C
1.) Alt BM Description = Ste; �"' �"�'� �`� �� Lam" ��� / `� ) CP / coo At l l
2.) Bldg sewer length = �2, '► � C ��, ' � f
. l7
- amount of cover = _"� � tS'psr�
Plan revi�itfn`R3�uired? Al Yes En No
Use other side for additional information.
Date Insepctor's Signature Cart. No.
SBD -6710 (R.3/97)
1
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MIESER 00IRRETE
www.wieserconcrete.com
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Maiden Rock, WI (800) 325 -8456 Fond du Lac, WI (800) 641 -5937
Portage, WI (800) 362 -7220 Spooner, WI (800) 336 -3416
4v-& eArr s ws 6W 0 0
Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave.
`� seonS n See reverse side for instructions for completing this application 15 Box 7302
Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302
Department of Commerce [Privacy Law, s. 15 Q4(.1 (Submit completed form to county if not
• .) state owned.)
Attach complete plans (to the county copy o ¢na r not less than 8 -1/2 x I 1 inches in size.
County State Sanitary P r{nit Number eck if revi ion o' ibps application State Plan I. D. Number
I. Application Infor ation - Please Print all Infortnow urlvty Location:
Property Owner Name ., Property Location
f� G a � CJCCJ 1/4& 1/4,
Property Owner's Mailing Address z ty Lot Number Block Num r
City, State Zip Code r one Num / > e or CSM Number
Il. Type of Building: (cbeck one) ❑ Ciry
❑ 1 or 2 Family Dwelling -No. of Bedrooms : 0 Village
❑ Public/Commercial (describe use):_ I� Town of
YA
❑ State- wned
98 .0 n �^ karest Ro
f X '0 11 0.7 , — tt ce ` u ► ) '� Q9Q�
III. Type6f Permit: (Check only one box on line A. Check box on line B if applicable) a
A) 1. ❑ New 2. 0 Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only Existing System
B) Permit Number Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply zQ A- /8 Cb 6 F.
• Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed g Wetland-
i
• Pressurized In-ground ❑Holding Tank ❑ Single Pass ❑ Drip
Line
l�At-grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V. Dispersal/Treatment Area Information:
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed Rate (Gals. /day /sq. ft.) XMin. /inch) Elevation
VII. Tank Capacity in Total # of • Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
0 ❑ ❑ ❑ ❑
❑ ❑ 1 ❑ ❑
VIII. Responsibility Statement
I, the undersigned, assume responsibility for installation of the PKVTS shown on the attached plans.
Plumber's Name (print) Plumber's Signature (no stam MP/MPRS No. Business Phone Number
,Ow & - D 9. T r6 rlzT r z i - 6 = 60f
Plumber's Address (Street, City, State, Zip Code Jr
2 P C r
��r o c�Ct /-�s/ Yo
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued ssui g Agen=(No
Approved ❑ Owner Given Initial Adverse Surcharge Fee) f
Determination S 3 2S o / 0 81 /
X. Conditions of Approval /Reasons for Disapproval: .
.
.r FLOOO A. A,N = &,je c->
SBD -6398 (R. 07/00)
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page � of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must '
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.U.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. _ Cco
Please print all information. a 'ewes by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s 15.04 (1) (m)). D8 Q
Property Owner Property Location
Govt. Lot $V 114Zf AV 1 /4 S T r N R/ E (c4tT
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
City State Zip Code Phone Number i)y I a Town Nearest Road
A. , F
❑ New Construction User Residential / Number of bedroom "' __ d de 6 fro rate _ GPD
Replacement ❑ Public or commercial - Describe:
rent material _ ; r}won -Pla?n ev i ap{ ca le ft.
General comments ST cptX 1
and recommendations:
I Boring
Boring # Pit
Ground surface elev. _��.� ft. Depth to limiting factor i*Roots oil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bou GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2
z 7 14 -
,yrL (. Z
51 ok -s cz " Me 14s— –141
D Boring #
Boring
Pit Ground surface elev. _�Zr� ft. Depth to limiting factor - in. Soil lication Rate
Horizon Depth Dominant Color Redox Des qColor ure Structure Consistence Boundary Roots GPDIfF
in. Munsell Qu. Sz. CoGr. Sz. Sh. Eff#1 'Eff #2
2 C
IF
3 z e - 0 `- a ?� oit c s �e • 2-
c� rte' e a
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Number
CSTF919 (Pl1 0tBm� ling & Perk Tetlttin� i nettlrL� v .
Address M cKenzie Date Evaluation Conducted Telephone Number
r Spooner, WI 54801 6 � `3 — 10 y'�D y�'•
yoz --021 v6 c 4'
Pro Owner Parcel ID # �7 d ' " � �r Page of 2
Boring # Boring
Pit Ground surface elev. _Q�� __ ft. Depth to limiting factor 63 in. Soil ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
2 .r 3 N4
w
ilk? VF ilIVS IF • �' p
r
((—]( Boring
Boring # /" 4 ®'/
a pit Ground surface elev. _ %�!�! /—ft. Depth to limiting factor _�` in. Soil lication Rate
Horizon Depth Dominant olor Te
C Redox Description xture Structure Consistence Boundary iro � GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh.
L
G
B
❑ Boring # Boring Ground surface elev. _______ ft• Depth to limiting factor in. ation Rate
Pit rE il ic
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ff# GPD/fFEff#2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
• Effluent #1 = BOD, > 30 < 220 mg/L and'TSS >30 < 150 mg /L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. if you need assistance to access services or
need material in an alternate format, please contact the department at 608iZW31f1 or TTY 608 - 264 -8777. _
SBD -8330 (RAM)
•� - Fogerty Plumbing
#221180
28288 McKenzie Rd.
Spooner, WI 54801
(715) 635 -9609
T,op /F T)vrT
3P�
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I f/O,rlE� X = aorc��L jOL .tT- 6.a'ispF
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Nod- �ouNo.
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PLOT PLAN
Scale I "_ ��� ' •Page of 7
r'
01 a(z Pie-sz
SS'Or- r"11n,.4Z�COV�
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NOTES: -
1. Elevations n
s s
hown are existing ground elevations unless otherwise noted.
2. Install 4" observation pipes with approved caps. ( y required).
3. Septic tank to be 120p gallon capacity manufactured by
W L@1 C-0�1 CGLE�T1� I.v /q- 0o Z F1 L'( }7� `ip Re SO 6ftt W! 25
4. Bench marks ; S Pig VN
5. Divert surface water around system to prevent ponding at the uphill side.
Safety and Buildings
+ 401 PILOT CT STE C
WAUKESHA WI 53188 -2439
_;~ TDD #: (608) 264 -8777
N
Visconsin www•�mmercestate.wi.us /sb
Department of Commerce; ? Y /1' www.wisconsin.gov
en �
GU Scott McCallum, Governor
C""t Philip Edw. Albert, Acting Secretary
September 13, 2001 " t <•,y
CUST ID No.691727 � % , `POWTSInspector
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
PLAN APPROVAL EXPIRES: Identification Numbers
Transaction ID No. 673638
SITE: Site ED No. 635653
RON ZERBEL Please refer to both identification numbers, !
367 PAGE LANE above,'in all correspondence with the'agency:
TOWN OF TROY, 54022
ST CROIX COUNTY
SW 1/4, NE 1/4, S31, T28N, R19W
FOR:
OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 810777
DISCRIPTION: 600 GPD AT GRADE SYSTEM
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:
• This system is to be constructed and located in accordance with the enclosed approved plans and with the "At-
Grade Component Manual for Septic Tank Effluent for Private Onsite Waste Treatment Systems" SBD- 10570-
P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment
Systems" SBD - 10573 -P (R.6/99).
• In the event this soil absorption system or any of its component parts malfunctions so as to create a health
hazard, the property owner must follow the contingency plan as described in the approved plans. In addition,
the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of At-
Grade component manual are complied with. A copy of this information must be given to the owner upon
completion of the project.
• Maintenance information must be given to the owner of the tank explaining that perio the filter is
required. Access to the filter for cleaning must be provided per Comm 84 prodt a core
• A Sanitary Permit must be obtained from the county where this project is catedN oho �a fitl, the
requirements of Sec. 145.135 and 145.19, Wis. Stats. . S � Fyn
• Inspection of the private sewage system installation is required. Arrangements RF ' ection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(2)( is. Stats.
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. All permits
J ARTHUR L WEGERER Page 2 9/13/01
required by the state or the local municipality shall be obtained prior to commencement of
construction /instal lation/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.
S , ly FEE REQUIRED $ 175.00
FEE RECEIVED $ 175.00
� BALANCE DUE $ 0.00
r
THOMAS J PERK S
POWTS PLAN REVIEWER, INTEGRATED SERVICES W IWI Taode ,63
(262)521-5064, 7:30 -4:00
TPERKINS @COMMERCE.STATE. WI.US
f TITLE SHEET Page of - 1
AT -GRADE SYSTEM
FOR
A BEDROOM RESIDENCE
This plan has been prepared in accordance with the At -Grade Component
Manual SBD- 10570 -P 'and the Pressure Distribution Manual SBD- 10573 -P
C tZ_ to /aa, C lz.. 6ia -I � .
LOCATED IN THE SW 1/4 OF THE ME" 1/4 OF SECTION 31 , T N, R 19 W,
TOWN OF L f gT'. C�ZO \.K 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 PUh1PING CHAMBER CROSS SECTION
PAGE 7 of 7 PUMP PERFORMANCE CURVE
PREPARED FOR
36 hP%G EE. IP
LZ 1U�Z �'t -LS, �� S�oZZ
PREPARED BY
W1=CCEI=ZER Si3 S L . TEST S tVG
AND .
DES = CS" SERVICE -
P.O. Box 74 421 N.Main St.
River Falls, WI 54022 ,CONS
Phone 715 -425 - 0165•►,,..•••• �..,•��
Fax 715- 425 -6864 $(
_ �GEHEN
-RECEIVED �Jl
AUG 2 7 1001
SAFETY & BLD,3S, DIV.
• °F
tic
JOB NO. Zl
At -grade System'Management Plan
' Pursuant to Comm 83.54, Wis.Adm. Code Page ? of _]
Septic Tank
The septic tank shall be maintained by an individual 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. CodeZXoEerating condition of the septic tank and
outlet fitter shall be assessed at least once every 3 years by inspection. Tn utlet fill . s hall be leaned as necessary to
ensure ❑roper aoP_rn The filter cartridge should not be removed unless provisions are made to retain solids in the ink that
may slough off the filter 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
Suiidings Division.
Pumo 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..
At -grade Component and Pressure Distribution System
No.trees.or shrubs should be planted or allowed to grow on the component. Plantings may
be made around the perimeter and the component 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 component is not allowed. Cold weather install-
ations require the component to be heavily mulched for frost protection.
Influent quality into the at -grade system may not exceed 220mg /L BOD 150 mg /L TSS and
30 mg /L FOG. Influent flow may not exceed the 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 call
Observation pipes within the dispersal cell shall be'checked for effluent ponding.
Ponding levels should b'e reported to the owner and any levels above 4 inches considered
as an impending hydraulic failure requiring additional, more frequent monitoring in
accordance with 83.52 (2).
General
This system shall be operated in accordance with Comm '82 -84 Wis.Adm.Code and shall be
maintained in accordance with it!s component manual SBD 10570-P (R.6/99) and local and
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 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, amass 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 84nches in diameter shall
be secure by an effective locking device to prevent accidental or unauthorized entry into a tank or component
Continoen Plan '
It the septictank or any of r'ts components -_ -- _ - -- - - - -� -. _ -
become defective the tank or component shall be repaired or replaced to keep the '
s 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 at -grade component fails to accept wastewater o�eRias — to discharge wastewater to
the ground surface, it may be necessary to install an aerobic pre- treatment unit or
_replace the component. Additional site and soil' evaluations may need to be done and
additional plans may need to be prepared and approved by the Department of Commerce,
Safety and Buildings Division. .
Questions.about the operation or maintenance of this system should be directed to
The County Zoning Office at ls_ 3 -_ L4 680 S1rIZ 1X
The system installer at - VS - 635 - Q6o9 F6 'i
The tank manufacturer at 6 �N EEStTTt
The effluent filter' manufacturer at ()L) - LZ I - SZgZ
i
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A = O T
C= 3 F � Linear Loading Rate = U ,O GPD /LN FT
Loading Rate= GPD S
O / Q FT
L Des = � S t�rr g - �' . .
w = 3 rt�r
_ Distribu� ion
Observation Well - - - L ateral ral o� - g8-
R s., 2r:utt�i c- .
Fabric -.�,, g .S ��, Q 1� --- ;-, ,. Soil
Cove r
6 ,
>5 1 A r 2' C A -2' >5' j
Plan View and CrCss Section of a Wi_`.:•onsin P.t -grade Unit with Two
-- -- Absorption Areas With in a Sirale Unit on a SicoL, Site
• Goulds
Submersible
Effluent Pump
0
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. in Motor Cover: Thermoplas
components. tic cover with integ handle
Homes Available for automatic and g
• Farms Motor: and float switch attachment
has P,
• EPO4 Single e: 0.4 H manual operation. Automatic p oints.
Heavy duty sump 115 or 23 V 60 e: 0.4 H0 models include Mechanical
• Water transfer Float Switch assembled and ■ Power Cable: Severe duty
• Dewatering RPM, built in overload with rated oil and water resistant.
automatic reset. preset at the factory.
• EP05 Single phase: 0.5 HP, RPM, Upper and lower
inle
SPECIFICATIONS 115 V, in le phas : RPM, FEATURES heavy duty ball bearing
construction.
Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo-
• Solids handling capability: automatic reset. plastic Semi -open design
3 /4 ° 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
m
otal heads: up to 24 feet. with three prong grounding ■ EP051 Impeller: Thermo-
Discharge size: 1 NPT. plug. Optional 20 foot P (CSA listed model numbers
• Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in "F 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
° superior strength 04 F (40 C) continuous and P 9
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 _. F-777 r s�Pti
components.
Pump: EP05 $
2 5 F
• Solids handling capability: c 25
3 /° maximum.
• Capacities up to 60 GPM. s 20
• Total heads: up to 31 feet.
• Discharge size: 1W NPT. _ z 5
• Mechanical seal: carbon - c 1s
rotary/ceramic - stationary, _j
. BUNA -N elastomers. 4 EP
• Temperature: ° 3 10
i
104 °F (40 °C) continuous
:140 °F (60 °C) intermittent 2 31,1 EPO4 /
5
{
1
K ' 0 0 0 10 20 30 40 50 GPM
'.
0 2 : , 4 6 8 10 12
CAPACITY
0 1995 Goulds Pumps. Inc. Effective May. 1995
` ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Ownerffit er
Mailing Address Z - W l
Property Address
(Verification required from Planning Department for new construction)
City /State I r/Alle'r Parcel Identification Number
LEGAL DESCRIPTION
Property Location S ' /4, ,4Ar, ' /,, Sec. 3L_ T R_, Town of _
Subdivision , Lot #
Certified Survey Map # rZ - 9 Volume / , Page # _ Irz
Warranty Deed # -.?l f X , Volume , Page # 4d
Spec house ❑ yes 0 no , Lot lines identifiable yes ❑ no
SYSTEM MAI
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.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days-Qf the three Venr Pv j_jo __ A-
c
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.
SIGNATURE OF APPLICANT DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Depa « * * * **
`* 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
V_
DOCUMENT N0. STATE BAR OF WISCONSIN-FORM 1 i
f t � WARRANTY DEED i
voL 5'3 V THIS SPACE RESERVED FOR RECORDING DaTA
REGISTERS OFFICE
TIUS DUD, made between _l7o_ua1as C. P _ 57. CROIX CO., WtS. �
Pa e rusbezl
.__ Rec "d. for Record this 2 h
Gran•ur day of Apr A.D. 19?7
� an d cianal d U _ Urbe and Jeann ,rbe1, husband_ and _ _ at 3:� 15 P ht {
i wife as of nt tenants ;}
Grantee,
W I t r v s a.• t h Tat the said Crint0r for a valuable consideration` ight.y' Fi,Vq _
! a
Thousnd and no �0 3rs
—_ _ 1l
conveys to Grantee the following described real estate in St (,roll _ __._ County RETURN TO
State ,t That certain parcel of land described as Lot 1
on %citified Sarvey [sap recorded in Vol. 1 page 181 of fi
Certified burvey Maps together with roadway easements across
that „arcel described in Vol. 1 of Certified Survey Ma ;s page 165 Tax Ke
and to ; ether with roadway easements an utility easements shown This is nOt� homestead property.
in Vol. 1 f Certified Survey Maps Fage 181. A,!-o,
That certain parcel of land located in the Southwest 4- of the Northeast I of Section 31,
Townshi; 28 orth, flange 19 ' est, Ton of Troy, St. Croix County, Wisconsin, b ^ing also
;part of Lot 3 of Certified Survey Map recorded in Vol. 1 on page 181 and more fully
d.escribcl as folloxs: Segjnning at the most Soutaerly corner of said Lot 3; thence go N
28° 18 35 " J akng 'he Southwesterly line of said Lot 3 a distance of 278.19 feet.; thence
s 6 7 0 Gl' 35" -� a distance of 146.80 feet to the East ?ine of said Lot 3; thence S 00* OC'
Lot' N a distance of 189.24 feet to the point of beginrdng. The above described parcel
containing c;.29 acres and to become part of Lot 1 of said Certified Survey i. Ap recorded in
Vol. 1 on iage 181 of the records of St. Croix County, '.tysconsin.
Together with all and singular tl'e hereditaments and appurtenances thereunto belonging or in any wise appertaining;
Do l C, Fa a a nti Y arn pier aret Fa -e huscand and wif FEE
And — -- _- - &— —� -' - - - - -- - -- -- - -- _--
warrants that the title is good, indefeasible in fee simpl: and free and clear of encumbrances except Sub t0 _rOar�Wa _�
ease u s�W"n—c ; ; P d_ sur�ts - - --
{ and will warrant and defend the same. y
tY Executed at FdVer Falls, ' Asc Onsin — _this 26th day of _
tj ri1 II
SIGNED AND SEALED IN PRESENCE OF 7 (SEAL)
'
%Dq C . Page `
y Rit, o g f 9 (SEAL)
i� Mar I� argaret Page
;SEAL)
_ (SEAL)
t
Signatures cf Dough . C. . and Marry Margaret Page if
of
i authenticated this th day of April _ , 141 }
Title: or tither Party
Authorized under Sec. 706.06 viz. �rs
MI' commission eapireat 9/ 25M
STATE OF WISCONSIN ?t
ss.
County.
Personally came before toe, this day of _ —• ism t
the above named —
to me known to be the person— who executed the foregoing instrument and acknowledged the same.
w
This instrument was drafted by -
Wph E. Senn, Attorney
Notary Public
i.ver Falls, Wisconsin
The use of witnesses Is optimsL My ComralssioR (Expires# r
w
F
C IFames of peesons signinW im soy cap should be typed. or printed below theme 4lgost
� :WARRANTY DEED- 4VyA?E 8Alt Of WISCONSIM, FORM NO. 1 1971
_ '� ""
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C / O , Oeed [
3 29633 CERT3FnD SURVEY MAP l �n y �
z
Part of the SW 1/4 of the NE 1/4 of Sect: 3 Township 28 North, Range 19 West,
Town of Troy, St. Cro County, Wisconsin
DOUGLAS PAGE
N 90 °00'00 ".e 6 2 b.o6
I / g 227. 74, 3 96.30
w
RJ-
Easamant
3
�6 ao
SCa1d: 1 000 N 3.68Ac�s�
1 200' True y/ 2 �
O ti �.
�� S.Ua Acr¢s 00 .a
`Y W 0
N B9 °/7'25 ri/ ¢4-7.06
60' 30 O
S
Z 3. - 7 1 A
C. S. ya1. 1, P9 /65
N
N8! °¢4'00 "E 833.03 S89 °f¢00' "Yti 4�l. /O
- t4 • Indicates 24" long iron pipe stake weighing1.13 # /ft.
N
m
N
S !/4 Corner
S 31, T28 N, R 19 YY
Description:
That certain parcel of land located in the SW 1/4 of thNE 1/4 of Section 31,
T 28 N, R 19 W, Town of Troy, St. Croix County, Wisconsin, more fully described
as follows: Commencing at the south 1/4 corner of said Sedtion 31, thence go
N 00 26' 0 W along the North /South 1/4 line of said Section 31 a distance of
2633 .14 feet; thence N 89 44 00" E a distance of 833.03 feet to the Point of
Beginning of the parcel to be herein described; thence N 00 00' 00" E a distance
of 240.15 feet; thence N 89 17l 25" W a distance of 447.06 feet; thence
N 25 02 25" E a distance of 620.38 feet; thence N 90 00 00" E a distance of
626 .06 feet; thence S 00 00 14" W a distance of 810.81 feet; thence
S 89 44' 00" W a distance of 441.10 feet to the Point of Beginning, together
with roadway easements acrdass that parcel described in Certified Surveys Vol. 1,
Page 165, St. Croix County, Wisconsin, and together with and subject to roadway
easements and utility easement as shown above.
State of Wisdonsin)
County of Pierce )
me
s L. Murphg, Registered Land Surveyor, do hereby certify that by direction
a er, Douglas Page, I have surveyed and divided t lands shown hereon and
p and description shown hereon ?`tre a true t representation
s`
ti
on of the lands as divided; and that' with all the
of Chapter 236.34 of the Wisconsin St& g, dividing,
describing said lands.
J .
1811
y Maps Regist' w il e eyor
ItY. Wis. - ..
i_
All
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