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HomeMy WebLinkAbout042-1020-10-130 Wisconsin Department of Commerce Safetyprid Fsaildings Division PRIVATE SEWAGE SYSTEM Count y St. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary3�br lj o.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. S �3 / Permit Holder's Name: ❑ City ❑ VilI e El wn of: State Plan ID No.: Robb, Pat loarren '�ownship /o# .(3894 CST BM Elev. : - Insp. BM Elev.: BM Description: arcel T x No.: �.9, oo b, = GsT f3Vx*1 842- 1020 -10 -130 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark D Alt. BM Dosing Yw� -Rv Aeration ------- Sewer o 10*1 •z0 COQ 1 02.00 St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet , p TANK TO P/ L WELL BLDG. Air I ntake ROAD Dt Inlet Air Septic p Imo' NA Dt Bottom A '6 , v-, Dosing y oo r I (� $ NA Header / Man. Aeration NA Dist. Pipe I (�'� / ' (1 ILV . 9 Z Holding Bot. System S&_4__ a, GO Z' PUMP/ SIPHON INFORMATION ` Final Grade `� 5 WgUL Manufacturer — 1 1 , 1 11 De d St cover Model Number 6 7 �j3'�GPM TDH Lift x,32 Friction p 93 System S TDH(Q.�Ft orcemain Length p Dia. F K� Dist. To Well SOIL � A L50RPTION SYSTEM Bf� REN Width , Length No Trenches PIT No. Pits Inside Dia. Liquid Depth DIMENSIONS 9 Im 1 DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Man a SETBACK CHAMB INFORMATION Type O > 3 p' Z r — NIT M o a Nu System: DISTRIBUTION SYSTEM Header / M nifold Distribution Pipes) i x Hole Size x Hole Spacing Vent To Air Intake Lengt Dia. Z Length T ` ) Dia. _ff ' Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over FBed h Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Tren ch Edges Topsoil ❑ Yes o ❑ Yes ❑ No 11 L COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1 • [ [ / L ZiU° Inspection #212 /dF / CTD Location: 1077 110th Avenue, Roberts, WI 54023 (NE 1/4 NE 1/4 8 T29N R1 8W) - 082918113A30 -Lot 5 1.) Alt BM Description = r (� � 5 ( L� 2. ) Bldg sewer len h - - amount of cover =— ,- 42Z 3} C r te,., C4 tM .1Z � � '�O� P� ` &Ae- I c'° Pla r vision quir ❑ Yes No Use other side for additional information. �Z �� Z I r SBD -6710 (R.3/97) Date Inspector's Signature Cert ADDITIONAL COMMENTS AND SKETCH r SANITARY PERMIT NUMBER: 4v_..,.� 4 � s [ t ... .--- . . _.. , � k � 4 s e 1 i �.v E ; ti to - += b Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 'Wi sconsin Personal information ma ou p rovide be used for second p urposes Madison, WI 53707 -7302 Department of Commerce y p y p [Privacy Law, s. 15.04(1)(m)) (Submit completed form to county if not I I state owned.) Attach complete plans (to the county copy onl o _ Wxjs stprO n, er not less than 8 -1/2 x 11 inches in size. County State Sanita 6 P 3 umber c if revs o pre application State Plan I. D. Number , ' 67 � �► 3 8 I. Application Information - Please Print all Inform04W REMO Location: Properly Owner Name Property Location /�� Po ' 1 2000 � /V,L 1/4 /t/,61 A, S 6 T ,N, V ,fi (or) W Property Owner's Mailing Address: S T CBOt Lot Number Block Number 1, 7700 ��/� "Go�F,CE I" City, State Zip —Co C j hone Number Subdivision Name or CSM Number II. Type of ilding: (check one) 2 ❑ City A� 1 or 2 Family Dwelling - No. of Bedrooms: ❑ Village ❑Public /Commercial (describe use):_ town of ❑ State -Owned Nearest RUoa / V Parcel Tax Nu ber(s III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) 9- 291 - 1 9 . 11 1,A — S0 A) 1. X New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing Syste $) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) k /00 ❑ Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line jWAt -grade G.7: 100 ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: . V. Dispersal/Treatment Area Information: , 57 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.) (Min. /inch) Elevation D % 00 / /o7 , S 1 101,64 VII. Tank Capacity in Total - # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed f Tanks Tanks l ❑ ❑ ❑ ❑ VIII. Responsibility Sta 75 S0 G k -kat- \— I, the undersigned, assume Tesponsibility for installation of the POWTS showp on the attached plans. Plumber's Name (print) Plumbe ' Sig ture (n I MY/MFRS No. Business Phone Number Plumber's Address (Street, City, State, i Code) IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Incl des Groundwater LDate ssue d Issuing Agent Signature (No stamps) Approved ❑ Owner Given Initial Adverse Surcharge Fee) Determination 3p - ?_gyp X. Conditions of Approval /Reasons for Disapproval: ^ X4 5 / ►v. wn� U L C SBD -6398 (R 07/00) / 0 /1 D Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave. lVisconsin See reverse side for instructi r c m this application PO Box 7302 Personal information you p r r e dary purposes Madison, WI 53707 -7302 Department of Commerce � (Submit completed fo ty if not [Priv y�L� , s. 15. 4(1)(m state owned. Attach complete plans to the coup 1 f on pa n (x less than 8 -1/2 x I 1 inches i County State Sanitary Permit N �. r ❑ vision to pre � lication State n I. C 340 334 "jt I. Application Information - Please Print all Infor a on 1 L on: Property Owner Name �� ST rROIX rty Location CQl1NTY E :. 1/4 4 Property Owners Mailing Address N I Lot Number Block Number 7 , City, State Zip Code N Subdivision Name or CSM Number 5' 1 II. Type of Building: (c eck one) r f Su p ❑ C ity i or 2 Family Dwelling - No. of Bedrooms : ) 08 ❑ Village Public /Commercial (describe use):_ Town of ❑ State -Owned Nearest 11) �AD ZIOa �L P yN s III. Type of Permi Check only one box on line A. Chejp6ox on line B if applicable d-1. IV . 1 13 d A) 1. r New 2. ❑ Replacement 3. ❑ Repffement of 4. S. 6. ❑ Addition to System System TanWhly Existing System B) Permit Number Date Issued ❑ A Sanitary Permit was pTeviously issued IV. Type of POWT System: (Check all that appl P C r r >C Qfl ❑ Non - pressurized In- ground ❑ Mound 0 Sand Filter ❑ Constructed Wetland Pres ized In - ound r ❑ Holding Tank ❑ Single Pass O Drip Line Ctr At-grade) ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Informati • Q'N 1. Design Flow (gpd) 2. Dispersal Area ispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required roposed Rate (GalsJday /sq. ft.) (Min. /inch) Elevation J Do _ L, VII. Tank Capaci Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gall Gallons Tanks Con- Con- glass New jfxisting crete strutted Tanks Tanks .�-- d Gd,� =� S ❑ ❑ ❑ ❑ Lz % ") I VIII. Responsibility St ement I, the undersigned, ass a responsibility for installation of the P TS shown on the attached plans. P tier's Name (print) Plumber's Signature (no stam �YMPRS No. Business Phone Number ie 'r G G3 S- lumbets Address (S City, State, Zi Code) �. L�•F /C '-c IX. County /Dep tment Use Only isapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) Approved Owner Given Initial Adverse S charge Fee) ' etermination O7l 1 —1 3 X. Conditions Approval /Reasons for Disapproval: � fii-� S - _lAb cukl r11= &c / Safety and Buildings 1340 E GREEN BAY ST STE 300 SHAWANO WI 54166 TDD #: (608) 264 -8777 *isconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary October 01, 2000 CUST ID No.267341 ATTN.• POWTS INSPECTOR ARTHUR L WEGERER WEGERER SOIL TESTING & DESIGN ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/01/2002 Identifica °' bars transaction ID . 4389 Sit ID No. 199861 SITE: Pl se refer to both identification numbers, Site ID: 199861, PAT ROBB i y i b �" ; 4� ,,in all correspondence with the agency. ST CROIX County, Town of WARREN _1.1 -0TH AV`1~, c1 .,,,, NE 1/4, NE1 /4, S8, T29N, R18W ' , s , • � FOR: Description: AT -GRADE SYSTEM FOR PAT ROBB, Object Type: POWT System Regulated Object ID I?fio::'3648$4' 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 installation: • The i in used for the force main shall comply with Comm 84.30 e pP g 1 PY 2 ()( . ) • The distribution piping shall comply with Comm 84.30 (2)(d). • The aggregate used in the distribution cell shall comply with Comm 84.30 (6)(i). • The synthetic fabric used to cover the aggregate cell shall comply with Comm 84.30 (6)(g). • Documentation shall be provided to the County to show that the effluent filter is a State - approved product and to show that it is capable of filtering out all particulate matter that is greater than 1/8 inch in size. • An access opening of sufficient size to allow removal of the filter must be provided over the outlet "tee" baffle of which this product is installed. This access opening must terminate at or above grade. 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 required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. ARTHUR L WEGERER Page 2 10 /1 /00 Sincerely, DATE RECEIVED 10/01/2000 .�.y.� --a• -- FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 KEI H A WILKINSON, POWTS PLAN REVIEWER BALANCE DUE $ 0.00 Integrated Services (715) 524 -3630, FAX: (715) 524-3633, M -F 7 AM - 3:45 PM KWILKINSON @COMMERCE.STATE.WLUS W� etude: cc: FOGERTY PLUMBING & PERK TESTING PAT ROBB TITLE SHEET Page l of ` AT -GRADE SYSTEM FOR A 3 BEDROOM RESIDENCE This''pl has been prepared in accordance with the At -Grade Component Manua,''ISBD- 10570 -P and the Pressure Distribution Manual SBD- 10573 -P C tz.. r. ! 4 9) LOCATED IN THE NC 1/4 OF THE NE 1/4 OF SECTION ,T. � N,R 1$ W, TOWN OF Lv PCCZ2C�1 , Sr 0-I'?_tj IX COUNTY, WISCONSIN. Lor S 0r IN 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 O' kT 6 (1 11AN E PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT PAGE 6 of 7 PUMPING CHAMBER CROSS SECTION PAGE 7 of 7 PUMP PERFORMANCE CURVE PREPARED FOR -- - t°DTTP'c�C G c - 7i ly S Sol l; PREPARED BY WECEF�EFZ SOS L . TEST S NG AND . . 3JES 2 Get SE:FZV 2 CE P.O. Box 74 421 N.Main St. River Falls, WI 54022 Phone 715 - 425 -0165 CO P.0. W. T.S. Fax 715 - 425 -6864 .t��•••M"" „•,..�N Conditionally r ..f ARTMJP L S WEGERE D815 1' V t EtLSWORTN, WIS. DEPARTMENT OF COMMERCE ti a ••• DIVISION OF SAFETY AND BUILDINGS ••.•••.••s'• '0�40 ' •"S I G l; �. SEE CORRESPONDENCE -00 3 13 JOB NO. : At -grade System Management Plan Pursuant to Comm 83.54, Wis.Adm. Code Page Z_ 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. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank 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 v' p ad 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. 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 BOIIS, 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 cell. Observation pipes within the dispersal cell shall be for effluent ondin . Pondin levels g g should be reported to the owner and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring in accordance with Comm 83.52 (2). General This system shall be operated in 'accordance with Comm 82 - 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 POWTS com on ents. 83.33, Wis. Adm. Code when the tanks are no longer used as p Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. - Any opening deemed unsound, defective, or subject to failure must be 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. Continaencv 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 at -grade component fails to accept wastewater or begins to'discharge wastewater to the ground surface, it may be necessary to install an aerobic pre - treatment unit or . replace the e c omponent. Additional itiona 1 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 on the operation or maintenance of this system should be directed to the County Zoning office at11S 38C� V68por to the system installer. / PLOT PLAN Page 3 0f - 7 Scale 1"= q r3 �j O • `1 5 — 1 0 Tei- � oT lD S CA LE Su GG g��i� ►%j �Ll. IL 0 'LZIOb� "L Z" Co U eyt a \ is' OF z PUC_ V- - M a w,ttz 1a.3 tr-L 2 LFL ►p0 z x - LrLCj° Cp'.- ''rUv2 eLtTU, 100.0' 1'1 Uk.l I_ " VAC tOOO 'FD L 1000 _ p W(i • �z , 100. S T d � �4c f+P- 0 000 C3. : evations shown are existing ground elevations unless otherwise noted. I n 4" observation pipes with approved caps. ( required). ptic tank to be b\1n0 ga ty manufactured by cou c%'-E -\_--, 4. Bench mar �# ITL t00.o� 0111 TDP SM �_V�Z 99 -V QU a-- S►tit�_L s L NT T 5. Divert surface water around system to prevent ponding at the uphill side. 1 Page y of - 7 L } 5' B > 5 > 5, -2, ( W � 4 \ r1 -ZZ�I _ tF6GtZ� - � A� jw� II o L 0 >5 o$se�tu,h- w WELL _ 2 ,o 1/6 B 1/6 B A= c Feet B= 10O Feet - - Linear Loading Rate= 1 4-S GPD /LN FT L= L10 Feet Design Loading Rate= O.SGPD /SQ FT W= Feet Celd e� �'= Z % ►, ��� raw +� Fabric Distribution - LatemuI Observation Soil Cover Well 072. 2 >5' A � : X5 1 Plan View and Cross Section of Wisconsin At -grade Unit with a Single Absorption Area on a Sloping Site , t Distribution Pipe Layout PA&e S or 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 lat up with the use of Iong turn or 45 f rtina to a point v�jthia six inches of the f nal grade. Terminate the ends of the laterals with a valve,: threaded cap or threaded PIus. Provide access from final grade for the valve; threaded caD or threaded plug. I \- i P 1 C1� L �jS s s'`��101y FVC Later) huC' � L r) X I X X x x x x " Lateral Length —� Lateral Lenqth — Distribution Line P 0-- f AOss pox P q 9 Ft Hole Diameter 3) L 6 Inch Lateral l Inches) X = Inches Force Main " Inches # of holes /pipe ZS Invert Elevation of Lateral s Lod• 5 Ft. ' PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS PAGE Cz OF 7 VE►.lT CAP 'i'c.I. VENT PIPC ' WEATHER PROOF APPROVED LOCKING MANHOLE LO' FROM DOOR, JUJJCTIOW BOX ' COVER WITH WARNING LABEL � IZ•MILI. wIU00W OR FRESH I AIR INTAKE I GRAD I �.. l00 • S � I `i' MIAJ. • � - � 18'MIiJ. COAJDUIT IJULET PROVIDE AIRTIGHT SEAL APPROVED JOI A Tank construction shall comply I I APPROVED .JOINTS with COMM 83.15 and COMM 83.20 I I I I I ALARM e �I II C I I ON I - -GLEN. X14 -" O FT __ J PUMP --� OFF D E77 q GOUCRETE DLOLK RISER EXIT PERM111ED OIJLy IF TAit+iK MAIJUFACTLIRi~R HAS SUCH APPROVAL 3" APPRWEI> %&DOING 5PECIFICATIOKIS DOSE TANKS MA►J UFACTURER: IJUMOER OF DOSES: `�' SS P1=R OAS TANK 51Z1` : - S O GALLOWS DOSE VOLUME I ALARM .__MAN FACTIJRCR: — S -S �-� -o S� ZS INCLUDING, bACKfLOW �o� � �A�LOnJs MODLL WUMBER: LOS Nw - CAPACITIES: A= 8 ' JJCHESOR 3bS-2 GALLONS-- - 3WITCH TUPC: 15= Z INCHES OR t L 6 G{ LLOM5 PUMP 1AAWUFACTURER: U l_ S C - -S INCHES OR 161 L / GALLOWS MODEL 1JUTAZER: -- 3$7 I O Da \ \ 1 INCHES GALLOAIS SWITCH TYPE: wI�IZC -�f' u OTE: PUMP AIJO ALARM Rf TO bC MIM11AUM DISCHARGE RATE 33.0 GPM INSTALLED OM SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEU PUMP OFF AUD_DISTRIBUTIOW PIPE.. L FEET + MIMIMIJM NETWORK SUPPLY PRESSURE . , .. , ?' S Fi:ET + 1 S FEET OF FORCE MAIN X -Z ` IZ FT / - OPT.MtCTIOU FACTOR FEET TOTAL OtIMAMIC. HEAD = FEET _..... Q pr As per.'manufacturer • Z-O -Z$ gal /in. Liquid depth Goulds Submersible Effluent Pump Jill o 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. tic cover with integral handle Available for automatic and • Farms Motor: and float switch attachment • EPO4 Single phase: 0.4 HP, manual operation. Automatic • Heavy duty sump g p models include Mechanical points. • Water transfer 115 or 230 V, 60 Hz, 1550 Float Switch assembled and ■ Power Cable: Severe duty • Dewatering RPM, built in overload with preset at the factory. rated oil and water resistant. automatic reset. ■ Bearings: Upper and lower SPECIFICATIONS • EP05 Single phase: 0.5 HP, FEATURES heavy duty ball bearing 115 V, 60 Hz, 1550 RPM, construction. Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo- Solids handling capability: automatic reset. plastic Semi -open design AGENCY LISTING 3 /4" maximum. • Power cord: 10 foot with pump out vanes for Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. Co. Canadian Standards Association } - "total heads: up to 24 feet. with three prong grounding Discharge size: 1 NPT. plug. Optional 20 foot ■ EP05 Impeller: Thermo - • plastic enclosed design for (CSA listed model numbers Mechani seal: carbon- length, SJTW with /ceramic- stationa three p rong improved performance. end in F or AC .) rota ry ry, p g grounding plug 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 ter. • Capable of running dry without damage to s so I -i 5GPiu1 components. Pump: EP05 e I I:_ �2SFT • Solids handling capability: c 25 %" maximum. a I i • Capacities: up to 60 GPM. X " s 20 • Total heads: up to 31 feet. j • Discharge size: 1 /2' NPT. Z 5 • Mechanical seal: carbon- c 15 I f I rotary/ceramic- stationary, 4 I I I I BUNA -N elastomers. o EPOS' • Temperature: 3 10 1 I t �• i i 104 °F (40 °C) continuous x 140 °F (60 °C) intermittent. EPOa 5 6X o o 1 I I i I v / 0 10 20 30 40 50 GPM -L L 0 2 4 6 8 10 12 m CAPACITY ©1995 Goulds Pumps. Inc. Effective Uay. 1995 ? Wisco sin 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 A999 include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions,. north arrow, and location and distance to nearest road. _ Please print all ' ti r Reviewed by Date Personal information you provide may be us po n Law, s. 15.04 (1) (m)). 0 Property Owner mob Property Location RICEIVEQ ` rte+ Govt. Lot is� 1/4 & 1/4 S T N R IX E (oo Property O nets Mailing Address r - - of # Block # Subd. Name or CSM# — 1 7 76a h-t,e Z-- f 2000 _ S' City Wp te Zip de Phon �` ❑ City ❑ Village XTown Nearest Road C � ,l - Gd E New Construction Use: yf Residential Ir b � _ Code derived design flow rate 0 GPD / �f ❑ Replacement ❑ Public or commercia - scribe: Parent material .� ft. '7'F�9' S T L�/¢17''I Flood Plain elevati on if applicable _ /7 General commen and recommendations: a/OGIGv // •�JfJL � ��E 7 Boring # ❑ Boring (/� pit Ground surface elev. . ft. Depth to limiting factor .�'� in. l — Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 00 1 SL s .s G c s . el .; -- G ofL R-C ex Boring # ❑ Boring Pit Ground surface elev. A V. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff #1 *Eff#2 m _ Z S .7 c 9 32 — _ t S'- - se L- of 14E 7V .v # — e- 4 L4\ Of Effluent #1 = BOO, > 30 < 220 mg/L and TSS >30 _< 150 mg/L ' Effluent #2 = < 30 mg/L and TSS < 30 mg/L - CST Name (Please Print) Si na CST Number i&�� Zl lIxe Address Fogerty Plumbing & Perk Testing ate Ev uatio nducted Telephone Number 28288 McKenzie 713 _ 40- WI 54801 4� • r Property Owner ��aa _ Parcel ID # l� �.Z— �D 2 0 lam 0� Page .Z of Fs-1 Boring # ❑ Boring ❑ Pit Ground surface elev. _ ft. Depth to Iimlbng factor ` X?_—In . Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 & '� SL /jt 17S zF 5 - F-1 Boring # E] Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Etf#2 0 1i� D 3 lo a Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting (actor In. Soft Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 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 t need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608- 264 -8777. SBD -6])0 (R.000) Fogarty Plumbing #221180 28288 McKenzie Rd. Spooner, WI 54801 r �o (715) 635 -9609 � f x� �x —�s r As tlA�/ 3a�, �o� of s��ayiLC steel- ' ONT x—.Aee -SAE" Ate; yo / /30' RSA PI: Y' V I.Sy • = FmI�IY� LBT CVAVE9 uwEtT LdT 4'NE B-�3 „ � S T.crG K�S' - s7�/�S I�7�v�fx7V��• x Q — � rYo °ssE ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer � - 149 kf Mailing Address 7 Lr*w/rlL Afi Property Address . / 7T_4!�D '� ,� A�'r B Y O (Verification required from Planning Department for new construction) 1 y s City /State Parcel Identification Number OSrI — 10-W-7 /o _ LEGAL DESCRIPTION Property Location l/` '/4, A I IE '/,, Sec. �' , T �_N -R /� W, Town of 4 ,ri Lot # - Subdivision S � � 3 � $ t Certified Survey Map # , Volume _ . Page # Warranty Deed # Gl� 957 , Volume / Page # Spec house ❑ yes no Lot lines identifiable P 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 masterplumber, joumeymanplumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal 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 - Certific sta ' t your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 e piration date. S ICANT 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 ; t h e r W*ove, by virtue of a warranty deed recorded in Register of Deeds Office. GNATURCANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed • Safety and Buildings r 1340 E GREEN BAY ST STE 300 SHAWANO WI 54166 TDD #: (608) 264 -8777 isconsi►n www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary October 01, 2000 CUST ID No.267341 / `,4 TN: POWTS INSPECTOR ARTHUR L WEGERER, WEGERER SOIL TESTING & DESIGN ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY SPIA PO BOX 74 �� ,(�? 2101?- C4RMICHAEL RD RIVER FALLS WI 54022 yj2 Otx HUDSON WI 54016 CO>aNTy / RE: CONDITIONAL APPROVAL Z ZONING C)FFIGE. 1 PLAN APPROVAL EXPIRES: 10/01/200 ``) Identification Numbers Transaction ID No. 438993 -- _ Site ID No. 199861 SITE: Please refer to both identification numbers, Site ID: 199861, PAT ROBB above, in all correspondence with the agency. ST CROIX County, Town of WARREN; 1 10TH AVE NE1 /4, NE 1/4, S8, T29N, R18W FOR: Description: AT -GRADE SYSTEM FOR PAT ROBB Object Type: POWT System Regulated Object ID No.: 764884 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 installation: • The piping used for the force main shall comply with Comm 84.30 (2)(e). • The distribution piping shall comply with Comm 84.30 (2)(d). • The aggregate used in the distribution cell shall comply with Comm 84.30 (6)(i). • The synthetic fabric used to cover the aggregate cell shall comply with Comm 84.30 (6)(g). • Documentation shall be provided to the County to show that the effluent filter is a State - approved product and to show that it is capable of filtering out all particulate matter that is greater than 1/8 inch in size. • An access opening of sufficient size to allow removal of the filter must be provided over the outlet "tee" baffle of which this product is installed. This access opening must terminate at or above grade. 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 required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. ARTHUR L WEGERER Page 2 10 /1 /00 Sincerely, DATE RECEIVED 10/01/2000 FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 K A WILKINSON, POWTS PLAN REVIEWER BALANCE DUE $ 0.00 Integrated Services (715) 524 -3630, FAX: (715) 524 -3633 , M -F 7 AM - 3:45 PM KWILKINSON @COMMERCE.STATE.WI.US WiSMART code: 7633 cc: FOGERTY PLUMBING & PERK TESTING PAT ROBB FAX ST. CROIX COUNTY ZONING OFFICE 1101 Carmichael Road Hudson, WI 54016. (715) 386-4680 DATE: TO: Fax Number. Name: FROM: Fax Number: 386 -4686 Name: u - Number of Pages Including Cover Sheet: IF COMPLETE AND LEGIBLE INFORMATION IS NOT RECEIVED, PLEASE CONTACT: NAME: /ti TELEPHONE NUMBER: l 3%— - 4 k b 1484 234 616955 Document Number WARRANTY DEED KATHLEEN H. REGISTEK OF DEEDS DEEDS This Deed, made between, ST. CROIX CO., WI ANNE T KURKOWSKI RECEIVED FOR REM Grantor pi -14 -2000 3:30 PM and, Patrick Timothy Robb and Jennifer Lynn Robb, WARRANTY DEED husband and wife, as survivorship marital property Grantee. EERT I FEE: Witnesseth, That the said Grantor, for a valuable consideration of one dollar and COPY FEE: other valuable consideration conveys to Grantee the below described real estate in TRANSFER FEE: 164.70 St. Croix County, State of Wisconsin. RECORDING FEE: 10.00 This IS NOT homestead property. PAGES: 1 Together with at and singular heredliaments and appurtenances thereunto betongYtg; And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except RecofiJing Area easements, covenants, and restrictions of record, Name and Return Address and will warrant and defend the same. ed. "� R,. /fly 7;'r /�- (Parcel lderaketion Number) i,/0 5 '?, d S j 042 - 1020 -10 -000 OT F CERTIFIED SURVEY MAP, FILED DECEMBER 22, 1999 II�VOLUME 14 OF CERTIFIED VEY MAPS, A 781 AS DOCUMENT NO .615935_ LOCATED IN THE NE 1/4 OF THE NE 1/4 OF SECTION 8, T 29N R1 8W, TOWN OF WARREN, ST. CROIX COUNTY, WISCONSIN. ;;�Oo0 Dated this 10 day ol %je 'ANNE T KURKOWSKI AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN COUNTY ST. CROIX Personally carne before me this 10 day of °n the above named ANNE T KURKOWSKI authenticated this _ day of to me known to be the person(s) who executed the foregoing l7nsins en and adcnowle ge same. a hoe or orb name type or pint name TITLE: MEMBER STATE BAR OF WISCONSIN Notary Public fib • ST. CROIX (if not, My commission is permanent. (If noL state e)*ation date: authorized byI706.06, Wis. Slats.) / S � , .) THIS INSTRUMENT WAS DRAFTED BY 'Names of persons signing In any capacity should be typed or Robert F. Wall printed t (Signatures may be authenticated or acknowledged. Both are not REBECCA J. PHANEUF s necessary.) NOTARY PUBLIC STATE OF WISCONSIN ■ FILED s DEC 2 2 1999 ► � KAIHLEEr1H.WALSN ReQisterofD0ds 1'7: SLCWGDI.WI ' s IV en C ER T I F T ED S UR V E Y MA P Located in the NE1 /4 of the NE1 /4 of Section 8, T29N, R 18W , Town of Warren, St. Croix County, Wisconsin. Owner: Ann Kurkowski " 270 Station Circle North Iidson, Wi. 54016 i UNPLATTED LANDS North line of the NE 1 /4 S *08'4 ' \S 89 397.96' _ _ _ N99 o8'4o "w � 1295.25 ^ 897.29 _ M N1/4 Corner _ _ — � _ _l lO TH _A_VE NE Corner Section 8 S 89'12'07 "E 398.20' Section 8 IMUM (1' iron pipe found) . (1" iron pipe found) . . , .,. l00' SETBACK LINE I � 1 lL0T 5 Legend 395, 719 Sq.ft. Section corner monument (9.085 ac.,) N I (as note O including row CD - 370,977 Sq.ft. n N �R -gn IA ( 8.517 ac.) m OD • 1" Iron pipe found. excluding row. 0 b 1 "X24" Iron pipe wbighing : W 1. 16 pounds/ lin. ft. set.M m n 1 0 1 Bearings referenced to i „� v cc) I –i I the North line of the O cu NE 1 /4 of Section 8, r+ J assumed S89 D O O�1 W O Z ? N v �I (01 U1 OI z OI � cl: I y Cl- HA R V EV G JOHNSON N 88'00'41 "W 402.07' ' HMSON - - — L� �vIS ` UNPLATTED LANDS SUR linfe APPROVED SCALE IN FEET i "= 150' ST. CROIX COUNTY Planning Zoning and Parks Commihee O /00 200 300 n1 :r% llllwws�— A) W onsin•flepartment of Industry S OIL AND SITE E V A L U AT I O N _FM R,O_R T -" Page 1 of 3 Loornd t3uman Relations !, - -•�w� fj o of Safety & Buildings ! in accord with / ILHR $3.05, i �Adm'Code COUNTY ! 5r �n� /a34 , �,•� ,h`1�. ' /�,,, �y S t . C r o i x A ach complete to paper not less than 1/2 x 1 inc eF nn size. �n . 'ust incl f not limited to vertical and horizontal reference point (BM), direction and % slope, scale or P ARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. (' j 110 042- 1020 -10 -000 APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION, REVIEWED BY DATE PROPERTY OWNER: ROPERM& Pat Robb GQVT. LOT NE ti 1i4;S 8 T 29 N,R 18 :)E (or) W PROPERTY OWNERS MAILING ADDRESS LOT < 'BLACK # U$D. NAME OR CSM # 17700 L amer Ave. S. 5 na.' _6sm CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE K[FOWN NEAREST ROAD Cottage Grove, M. 55016 (651 768 -9358 Warren 1 110th. Ave. [14 New Construction Use [x ] Residential / Number of bedrooms 4 [ ] Addition to existing building I ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate • bed, gpd /ft trench, gpd /ft Absorption area required 500 bed, ft2 500 trench, ft Maximum design loading rate • 4 bed, gpd /ft ' 5 trench, gpd /ft Recommended infiltration surface elevation(s) 101.50 ft (as referred to site plan benchmark) Additional design / site considerations system el. based on contour line of el. 100.50' Parent material limestone uplands Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem I EIS 13U ®S ❑ U I [Is g] U EIS E U ❑ S U U ❑ S I U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Bourg Roots Bed Trey .... _ 1 0 -10 10yr3/3 none 1 2msbk dsh gw 2f .5 ( .6 2 10 -25 10yr4 /4 none sicl 2msbk dsh gw if .4 .5 Ground 3 25 -45 7.5yr4/4 none sl 2msbk dsh yw if .5 .6 elev. 1 4 1 45-70 5yr4/4 none scl M na gw na np .2 Depth to 5 70 -75 2.5y7/4 none fractured lime tone na na np np limiting factor 45" Remarks: H-4 contains less than 50% 2.5yr7/4 fractured limestone Boring # 1 0 -13 10yr3 /3 none 1 2msbk dsh gw 2f .5 .6 2 2 13 -22 10 r4/4 none sicl 2msbk dsh yw if .4 .5 3 22 -42 7.5yr4/6 nose S1 M na gw na .3 .4 Ground - elev. 4 42 60 7.5yr4/6 none sl 2msbk dsh w na .5 .6 g 1 5 60 -80. 2.5y7/4 none fractured lime tone na na np np Depth to limiting factor 60" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715 -246 -6200 Address: 1554 200th. Ave. New WCkmond, WI 54017 i� Signature: Date: 10 -26 -99 CST Number. m02298 l PROPERTY OWNER Pat Robb SOIL DESCRIPTION REPORT Page 2` ofd PARCEL I D. 042- 1020 -10 -000 # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ><,..:..3 0 -10 10yr3 /3 none 1 2msbk dsh gw 2f .5 .6 ................. 2 10 -27 10yr4/4 none sicl 2msbk dsh gw If .4 .5-, Ground 3 27 -42 7.5yr4/6 none sl M dsh gw if .3 .4 elev. 97 ft. 4 42 -54 2/5yr7/4 none fractured limestone gw na np np Depth to 5 54 -72 5yr4/4 none scl M dvh na na np .2 limiting factor 42" i Remarks: Boring # Ground elev. ft. — Depth to - limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) s • STEEL'S SOIL SERVICE Gary L. Steel - 1554 200th Ave. CSTM2298 Pat Robb New Richmond WI 54017 town o w n o f Wa rren S 8 -R18W (715) 246 -6200 town o N lot #5 -csm 1 " =40' BM.= top of 14" pvc pipe C el. 100.00' Alt. BM.= top of 14 " pvc pipe C el. 95.00' /D% IL t o r �m d Ilk- Gary L. Steel 10 -26 -99 Parcel #: 042 - 1020 -10 -135 01/27/2009 12:52 PM PAGE 1 OF 1 Alt. Parcel #: 08.29.18.113A -35 042 - TOWN OF WARREN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - TALLEDGE, KEITH D & REBECCA L KEITH D & REBECCA L TALLEDGE 1077 110TH AVE ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 1077 110TH AVE SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 13.166 Plat: 3781 -CSM 14 -3781 & CSM 14 -3937 OL 1 SEC 8 T29N R18W PT NE NE BEING CSM Block /Condo Bldg: LOT 5 14/3781 LOT 5 9.085AC & INC CSM 14/3937 OUTLOT 1(4.081AC) FORMERLY Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 042 - 1020- 10- 130(113A -30) & PT 08- 29N -18W NE NE 042 - 1020 -10 (113A) Notes: Parcel History: Date Doc # Vol /Page Type 04/01/2003 715463 2190/499 WD 01/14/2000 616959 1484/235 WD 01/14/2000 616958 1484/234 WD 03/26/1998 575815 1309/136 QC more 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 251912 Use Value Assessment Valuations: Last Changed: 05/31/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 48,500 300,500 349,000 NO AGRICULTURAL G4 8.166 1,200 0 1,200 NO Totals for 2008: General Property 13.166 49,700 300,500 350,200 Woodland 0.000 0 0 Totals for 2007: General Property 13.166 49,700 300,500 350,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: Specials: User Special Code Category Amount 018 - RECYCLING SPECIAL ASSESSMENT 15.00 Special Assessments Special Charges Delinquent Charges Total 15.00 0.00 0.00