HomeMy WebLinkAbout042-1045-80-150 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 515289 0
GENERAL INFORMATION State Plan ID No: ;—,/ ��
P ersonal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. /�
Permit Holder's Name: City Village X Township Parcel Tax No:
Stanislaw Robert J. & Judith I Warren, Town of 042 - 1045 -80 -150
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
J 6 MY\ j (,'ST' 17.29.18.260A17
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic , �,,._ i Benchmark
/Z60 q 7-b 5i 167. /
Dosing Q 3 Alt. BP ! , /
( ration Bldg. Sewer A � ✓� `
frig
Holding St/Ht Inlet
.Z 161•'7 7 W-5
TANK SETBACK INFORMATION St/Ht Outlet y ,75 57 3
TANK TO P IL WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic 7 Sa y 1 A r Dt Bottom
Dosing ' 1 A)A-- & (3 / Header /Mar 1 j�� ` `a ` 9 75
Aeration O Dist. Pipe 1� �M �• ,'. �` LS
Holding Bot. System
1Z . �7• $ J
PUMP /SIPHON INFORMATION Final Grade I6 •�j . 5
Manufacturer Demand St Co r
GPM .x A_
Model Number f�
b 3 oti� �' �z . z 9S • a5
TDH Lift ,/ Friction ;o�s� System Head TDH t ,q
Forcemain Length Dia. 1 Dist. to Well
s� z jA-
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length No. Of Tr n ties PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of S stem ' / UNIT
Model Number:
DISTRIBUTION SYSTEM
Header/Manifold Distribution Z x Hole Size /f x Hole Spacing // Ven to Air Intake
Pipe(s) /'� j �Q 7 3
Lengt 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 M hed
Bed/Trench Center S Bed/Trench Edges \ Topsoil ` (�,�
\ \\ �`tl"" t� � Yes No Yes � No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: o /_V 1 pection #2:
Location: 1085 100th Av Roberts, WWII 54023 (NE 1/ SE 1/4 17 T29N RI 8W) NA Lot 13 - ' t '� 0'RiYy Parcel No: 17.29.18.260A17
1.) Alt BM Description = V j t 16J�.�� 7F ,, r� p�.� — i �
2.) Bldg sewer length = 'f� / �/- coo
- amount of cover = y I K
Plan revision Required? Yes
Use other side for additional informati
SBD -6710 (R.3/97) Date Insepctors gnatu Cert. No.
I qN�
commerce.wi.gov Safety and Buildings Division County 1 �J
201 W. Washington Ave., .P 7162 �l . L /t- 0 i X
i Madison, WI 537�f7 1 Sanitary Permit Number (to be filled in by Co.)
sco n s i n
Department of Commerce !
Sanitary Permit Application Sta Transaction Number
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental J - 2+ /
unit is required prior to obtaining a sanitary permit, Note: A lication forms for state - owned POWTS are Project Address (if different than mailing address)
submitted to the Department of Commerce. Personal informa econdary �d J led
Ourp oses in accordance with the Privacy Law s. 15.04(t)( m , Stat
I. Application Informa ' n - Please Prin All Informati n �,�Qi�f5 r✓v' - s Mf 7
Property Owner's Name , � i -1 , f �� Parcel #
130 6 - f'a,�; s/r ift 0 (�1� yZ- lU'l��' 1 " 6S'
Property Owner's Mailing Address ST, CROIX UUUNI Y Property Location (P
- Z 3 36 y? i I £ 6+, PLANNIN & ZO NING OFFICE Govt. Lot
Cit tate +•� Zip Code Phone Number � 1 ) 7
ty p �' /., � � /., Section
cT� 3 7 I�c��.. � /J (circle one)
T � � N; R �— E or
II. Type of Building (check all that apply) ~ Lot #
tpt Subdivision Name
or 2 Family Dwelling -Number of Bedrooms i
Block # v 0 i•
❑ Public /Commercial - Describe Use w% .:' 1,w ° ~
❑ City of
CSM Number ❑ Village of
❑State Owned - Describe Use
r - '7 'Y k - Town of K. a k�t• JV
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. ti ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner
IV. Type of POWT Syste m/Component/Device: Check-all that apply) //I
r f
❑ Non - Pressurized In- Ground ❑ Pressurized In- Ground ;, t -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) "` ❑ Pretreatment Device (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design oil Ap lication Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) St Elevation 4
(poi Soo / Tuo 9y. S ®'
VI. Tank Info 4,% Capacity in Total # of Manufacturer
Gallons Gallons Units t , j d y
New Tanks Existing Tanks QQ d c
Ej rs-1 �'! r f�
Septi or Holding Tank
Don C r
VII. Responsibility Statement I,. the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
ber's Name (Print) Plumber's Signature M R Number Business Phone Number
Q C- k £ �ot i!► S LZ I Z - 8 7Z 4 y77- - L yL l
Plumber's Address (Street, City, State, Zip Code)
Z(,0 5 9 /,Td -1'I -t, H c,r S1�ST 3
VIIL ounty !De artment Use Only
Permit Fee Date Issued,, Issuing Agent 5ignature
['Approved ❑ Disapproved
❑ Owner Gi Reason for Denial
IX. Conditions of Ann` — asona fnr TM °-
?;- -- SYSTEM OWNER:
1 Septic tank, effluent filter and
r „ r ,,, VJU U dispersal cell must all be serviced I maintained
Z ' w a , lie lsn lE a l as per management plan provided by plumber.
F V?*l'rs�p .
rg 3��1 � I g 2. All setback requirements must be maintained'
Attach to completc:� j2rgytilgubmit to the County only on pag99r4* alb09 nceS.
d :`ri - � r ✓`ii of i f J y' } i
SBD -6398 (R. 02/09) Valid thru 02/11
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Safety and Buildings
10541 N RANCH ROAD
Cott me1'Ce.Wi.gov HAYWARD WI 54843
Contact Through Relay
i s c o n s i n www.commerce.wi.gov /sb!
www.wisconsin.gov
Department of Commerce
Jim Doyle, Governor
Aaron Olver, Secretary
July 07, 2010
CUST ID No. 222872 ATTN. • POWTS Inspector
JACQUE M HAWKINS ZONING OFFICE
HAWKINS SOIL TESTING & SEPTIC SYSTEMS ST CROIX COUNTY SPIA
2659 150TH ST 1101 CARMICHAEL RD
LUCK WI 54853 HUDSON WI 54016
CONDITIONAL APPROVAL
Identifi 1 8 1 Numbers
PLAN APPROVAL EXPIRES: 07/07/2012
Transaction ID No. 1812545
SITE: Site ID No. 757852
Bob Stanislaw Please refer to both identification numbers,
Lot 13 100TH Ave above, in all correspondence with the agency.
Town of Warren
St Croix County Condit
NE 1/4, SE 1/4, S17, T29N, RI 8W
CO
FOR:
Description: At grade, 4 bedroom residence
Object Type: POWTS Component Manual Regulated Object ID No.: 1271335 ;pt
Maintenance required; 600 GPD Flow rate; 40 in Soil minimum depth to limiting factor from original grade; zg
At -grade Component Manual, SBD- 10570 -P (8.6/99), SSWMP Pub. 9.6; Effluent Filter
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
r�NE
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed
and located in accordance with the enclosed approved plans and with any component manual(s) referenced above.
The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code
requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by thb Department per s.145.06,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
Key Item(s)
• In the event this soil absorption system 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 the At Grade Component Manual are complied
with. A copy of this information must be given to the owner upon completion of the project.
• The designer proposes to install an effluent filter to achieve the requirement of wastewater particle size.
Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the septic
tank outlet filter will be required. The outlet filter shall be installed per product approval stipulations.
L Reminder
• The orientation of the at grade system must be such that the longest dimension is oriented along the surface
contour per COMM 83.44(6)(a)2.
• Limit activities in the area 15' beyond the down slope edge of the at grade per At grade Component Manual.
• Surface water drainage shall be diverted away from the system area.
• Materials shall conform to the requirements of COMM 84.
JACQUE M HAWKINS Page 2 7/7/2010
• Maintain well and waterline set backs per COMM 83.43(8)(1).
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.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any
others who are responsible for the installation, operation or maintenance of the POWTS.
Sincere Fee Required $ 250.00
Fee Received $ 250.00
Balance Due $ 0.00
l
Patricia L Shandpfrf
POWTS Plan Reuiewe'r , Integrated Services WiSMART code: 7633
(715) 634 -7810, Fax: (715) 634-5150, M -fr 8:00 - 4:45
pat.shandorf@wisconsin.gov
f
cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 828-5902, Monday, 7:00 A.M. To 3:30 P.M.
Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in
Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings
Division of the Wisconsin Department of Commerce.
"Construction business" means a trade that installs, alters or repairs any building element, component,
material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the uniform
dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs. Comm 81 to
87, or the public swimming pools and water attractions code, ch. Comm 90. The term does not include the
delivery of building supplies or materials, or the manufacture of a building product not on the building
site.
For further information, go to our website: www.cominerce.wi.14ov/SB/SB-BuiIdingContractorProzram.html
RESIDENTIAL AT -GRADE DESIGN
Pressurized - Sloping Site
A 9
INDEX AND TITLE SHEET
Project Bob Stanislaw � c bS At-Grade
G
Owner Bob Stanislaw
Address 2350 Bratley Court
Inver Grove Heights MN 55077
(651) 994 -4293
Legal Description NEI4-NE1 /4- NE1 /4 -SE1 /4 Sec. 17 T29N -R18W
Township Warren County St.Croix T' t.l iallY
Subdivision Name Lot No. 13
CE
Parcel ID Number
ET`l A
Plan Transaction Number
' ESPO NDEN
Index sheet Page 1
Calculations Page 2
At -grade drawings Page 3
Laterals and dose tank Page 4
Specifications Page 5
Management & contingency plan Page 6
Pump Curve Page 7
Plot Plan Page 8
ti v t�C Joc
Designer Jacque Hawkins License Number / MPRS# 222872
Signature Phone Number (715) 472 -2421
Date /14/10
Designed pursuant to:
At -glade Component Manual for POWTS SBD- 10570 -P (R.6/99), and
SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST - SAS (01/81)
Version 3.11 (05/01) Page 1 of 8
L
PRESSURIZED AT -GRADE DESIGN
At -grade Design Worksheet - Sloping Site
Flows and Site Data Entry.
(r or c) r Residential or commercial?
400.0 Estimated wastewater flow (gpd)
600.0 Design wastewate r flow (gpd)
16.00 % Site slope
94.00 Contour elev. below lateral (ft)
40.00 Depth to limiting factor (in)
0.40 In -situ soil application rate (gpdtft ^2)
Distribution Cell Information
(1 or 2) 1 Influent wastewater quality
10.00 Linear loading rate gpd/ft
10.00 Effective absorption width (ft)
10.00 Max. effective width permitted (ft)
150.001 Aggregate length (ft)
Pressure Distribution Data Entry
(c or e) c Center or end lateral connection
2 Number of laterals
0.125 Orifice diameter (in) e.g. 0.188
No final 2.00 Estimated orifice spacing (ft)
culation
Z {• /' 2.00 Forcemain diameter (in)
3.21 Forcemain flow velocity (fVsec)
L !� L/
115.00 Forcemain length (ft) y or n y Does fonemain drain back?
J 89.00 Pump tank elevation (ft) y or n y Are laterals at highest point?
NA
6.5 System head (ft) x 1.3 18.8 Forcemain drainback (gal)
4.50 Vertical lift (ft) 1 68.01 5x Lateral void volume (gal)
2.43 Friction loss (ft) 1 86.81 Minimum dose volume (gal)
13.43 Total dynamic head (ft) 31.4 System demand (gpm)
Lateral Diameter Selection Gallons /Inch Calculator (optional)
Pipe diameter Design option Design dvioe Total Tank Capacity (gal)
Designer 1 in Total Working Liquid Depth (in)
must select 1.25 in x Gatlin (enter result in cell G46)
one lateral 1.5 in x x
diameter 2 in x Treatment Tank Information
3 in x 1250 Septic tank capacity (gal)
Skaw Concrete Manufacturer
Effl Filter Info rmation Dose Tank Information
Best J Filter manufacturer 754.41 Dose tank capacity (gal)
GF -10 Filter model number 16.11 Dose tank volume (gaVin)
Skaw Concrete Manufacturer
Project: Bob Stanislaw At -Grade
Transaction Number: Page 2 of 8
AT -GRADE PLAN VIEW
1/6 B observation pipes (2 typical) A 10.00 ft
D B 150.00 ft
1/6 B 25.00 ft
W C 12.00 ft
D 5.00 ft
E 2.00 ft
D
L 160.00 ft
B
W1 22.00 ft
A x B 1500.00 ft "2
—L
Cap
Typical obs. pipe.
= Total aggregate cell A x B Slotted in the lower
6", and anchored
= Plowed area L x W securely.
s ^
AT -GRADE CROSS SECTION
Svnthetic fabric cover
95.79 ft Finished grade
Lateral elevation
invert elev. 54.50 ft
.F— Observation pipe
at aggregate toe
E
1 °
6 /o Slope
Surface contour ur 0
.00 ft
A
i ® C
and system
- 1
elevation D
® = 12 in. topsoil and subsoil Plowed layer
over aggregate and tapered to toes.
below L x W
0 = 6 in. aggregate below
pipe(s), and 2 in. above pipe.
Project: Bob Stanislaw At -Grade
Transaction Number. Page 3 of 8
PRESSURE DISTRIBUTION AND DOSE TANK
Lateral Diagram - Center Connection
I P
AM-
� X—+xl2 02 � Laterals & force main of PVC Sch 40
Last hole drilled next to end cap (per COMM Table 84.30-5)
Holes dried on the bottom of the lateral,
equally spaced i = Turn -up wfball valve or cleanoutplug
Lateral Specifications
0.125 Orifice diameter (in) Center Lateral connection point
X 1.97 Orifice spacing (ft) 2 Number laterals
38 Orifices/lateral P 73.88 Lateral length (ft)
15.7 Lat. discharge rate (gpm) 1.50 Lateral diameter (in)
2.00 Forcemain diameter (in)
31.4 Sys. discharge rate (gpm) 115.001 Forcemain Length (ft)
13.43 TDH (ft)
Typical Pump Chamber Layout
Approved manhole cover with
Weather -proof
Final grade warning label and locking device
junction box
4"
disconnect
Tank component is ARemate 7
properly vented �� outlet
location 18" min.
Electrical as per NEC 300 and A( Approved outlet
Comm 16.28 WAC joint
Tank full
= Inches Gallons JA Provide 114"
C A 27.5 442.2 Alarm on weep hole or
= B 2.0 32 antisiphon
E C 5.4 86.8 Pump on B device.
o D 12.0 193.2 90.00 ft C
Totals .91 754.4 pump oft
D
3" Bedding under tank �— 89.00 ft
Goulds Pump manufacturer S.J.Eleetro Alarm manufacturer
EPO4 I Pump model number I Tank Alert Alarm model number
Project: Bob Stanislaw At -Grade
Transaction Number. Page 4 of 8
At -grade System Maintenance and Operation Specifications
Service Provider's Name Tri- County Sanitation Phone 715 - 386 -0114
POWTS Regulator's Name St. Croix County Zoning Office Phone 715 - 386 -4680
System Flow and Load Parameters
Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in
Estimated Flow - Average 400 gpd Maximum BOD5 220 mg /L
Septic Tank Capacity 1250 gal Maximum TSS 150 mg /L
Soil Absorption Component Size 1500.0 ft Maximum FOG 30 mg /L
Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL
Service Freguency
Septic and Pump Tank Inspect and/or service once every 3 years
Effluent Filter Inspect and clean at least once every 3 years
Pump and Controls Test once every 3 years
Alarm Should test month
Pressure System Laterals should be flushed and pressure tested every 1.5 years
t
Mour"11 Inspect for ponding and seepage once every 3 ears
r Other
Miscellaneous Construction and Materials Standards
1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap,
and are secured in as shown in the at -grade component manual.
2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code.
3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code.
4. Tillage of the basal area is accomplished with a mold board or chisel plow.
5. The at -grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion
and help reduce frost penetration.
6. Areas within 15 feet of the downslope toe will be protected from compaction.
7. All other construction details are as per the at -grade component manual SBD- 10570 -P (R. 6/99).
Lateral Turn -up Detail
Finished
Grade ��
6 -8" Diameter Lawn / Threaded Cleanout
Sprinkler Valve Box Plug or Ball Valle
Distribution
Lateral
'may Long Sweep 90 or Two
45 Degree Bends Same
Diameter as Lateral
Project: Bob Stanislaw At -Grade
Transaction Number: Page 5 of 8
At -grade System Management Plan
Pursuant to Comm 83.54, Wis. Adm. Code
General
This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its'
component manuals [SBD- 10570 -P (R. 06199) and SSWMP Pub. 9.6 (01/81)] and local or state rules pertaining to system maintenance
and maintenance reporting.
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death.
Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as
POWTS components.
Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access
openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound,
defective, or subject to failure must be 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.
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 fitter cartridge should not be removed unless provisions
are made to retain solids in the tank that may slough off the fitter 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 113 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.
Puma 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 fitter is installed within the tank it shall be inspected and serviced as necessary.
At -arade and Pressure Distribution System
No trees or shrubs should be planted on the at- grade. Plantings may be made around the at- grade's perimeter, and the at -grade 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 at -grade is not recommended since soil compaction may hinder aeration of the infiltrative surface within the
mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October - February) dictate that the at-
grade be heavily mulched as protection from freezing.
Influent quality into the at -grade system may not exceed 220 mg /L BOD5 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or
30 mg /L BOD5, 30 mg/L TSS, 10 mg/L FOG, and 10 ckdl00 mL for highly treated effluent. Influent flow may not exceed maximum design
flow specified in the permit for this installation.
The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be
flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test
when the system was installed to determine if orifice dogging has occurred and if orifice cleaning is required to maintain equal distribution
within the dispersal cell.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any
levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring.
Contingency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition.
If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) 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 will be repaired or
replaced in its' present location by increasing basal area if toe leakage occurs or by renovating the biologically cogged absorption and
dispersal media, installing new piping, and replacing other components as deemed necessary to bring
the system into proper operating condition.
See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider.
Project: Bob Stanislaw At -Grade Transaction Number. Page 6 of 8
. Page 7 of 8
RGOULDS PUMPS Submersible
Effluent Pump
3871 EPO4
EP05
APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower
grade turbine oil for tic enclosed design for heavy duty ball bearing
Specifically designed for the lubrication and efficient improved performance. construction.
following o lowing heat transfer.
• Effluent systems ■Casing and Base: Rugged
• Homes Available for automatic and thermoplastic design provides AGENCY LISTING
superior
• Farms manual operation. Auto- resistance. strength and corrosion
resistan Canadian stab Asoaauon
• Heavy duty sump matic models include
• ■ Motor Housing: Cast iron CSA listed model numbers end
Water transfer Mechanical Float Switch 9
• Dewatering assembled and preset at the for efficient heat transfer, in "C" or 7 ".)
facto ry strength, and durability.
SPECIFICATIONS ■ Motor Cover. Thermoplastic colitis KrMs is W 9001 Axiswed
FEATURES cover with integral handle and
• Solids handling capability: float switch attachment points.
3 /<" maximum. ■ EPO4 Impeller: Thermoplas- S Power Cable: Seven: duty
• Capacities: up to 60 GPM, tic Semi -open design with rated oil and water resistant.
• Total heads: up to 31 feet. pump out vanes for mechanical
• Discharge size: V/2" NPT. seal protection.
• Mechanical seal: carbon-
rotary/ceramic- stationary,
BUNA -N elastomers.
• Temperature:
104°F (40cC) continuous
140°F (60cC) intermittent. METERS FEET
• Fasteners: 300 series 10
stainless steel.
9 30 sGPM
• Capable of running
dry without damage to $ 2.5 Fr
components. 25
¢°
Motor: _
• EPO4 Single phase: 0.4 HP, v_ 6 20
115 or 230 V, 60 Hz, 1550 s
RPM, built in overload with 'c 15
automatic reset. a a
_. .
• EP05 Single phase: 0.5 HP, o EPOS
115 V or 230V, 60 Hz, 1550 3 10 -
RPM, built in overload with EPO4
automatic reset. 2
• Power cord: 10 foot 5
standard length, 1613
S1TOW with three prong
grounding plug. Optional 20 ° ° o 10 20 30 40 so GPM
foot length, 16/3 S1TW with
three prong grounding plug
(standard on EP05). 0 2 4 6 s 10 12 W1h
CAPACITY
Goulds P umps
® 2001 Goulds Pumps ITT Industries
Effective May, 2001
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. Wisconsin Department of commerce SOIL EVALUATION REPORT Page / of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County �-t- e� o x
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.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. a }1Z -- O - 'o -/ C
Please print all information. Reviewed by �-- : Date
Personal information you provide may be used fa aw, s. 04 (1) (m)). < , i `� - -7 A
Property Owner Pr perry Location �t ., - A- -
5O 6 a N� LA-.-* Go . Lot £ 1/4 1/4 S ' 7 T 29 N R A? E (or) W
Property Owner's Mailing Address Lo I Block # Subd. Name or CSM#
0:5 sU t)ti.L- n C i
City State Zi Code Pr e "ZONING OFF 2OCity ❑ Village IR Town Nearest Road
,vVl.C, 4400C 1 ^-- ��0 T 7 �JV �f .c .c- tom✓ / O O �"` Cl vf,
New Construction Use: 92 / Number of bedrooms �_ Code derived design flow rate Coto 0 GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material Flood Plain elevation if applicable ft.
General comments
and recommendations:
a Boring # 0 Boring ft ,(_
Vsr Pit Ground surface elev. 7 �' . Depth to limiting factor jO ` 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
1
C ' – /O �d /Z -- Sl //..n n•+ - a A -Y .7
a "° aye 1"%;'e-' — S / a s /,,, - - ?
3 Za D /c y/y �' rSl l./m 7.c� QS / ✓7 - 'q ' 7
• 3
Fcil Bo ring # Boring
R-Pit Ground surface elev. �S• 0 ft Depth to limiting factor � in. Soil A lication 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
. $ D v ' —' S le)-)56K ✓��- a Y • '7
-
* Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CS N me (Please Print) Signature CST Number
G 14 : ",�-S 2LL877--
Add ref s Date Evaluation Conducted Telephone Number
Zl� I �t4 c Iti J1853 (o -5 Y7 -Li''21
Property Owner Parcel ID # Page L of 3
3 Boring # ❑ Boring L'
Pit Ground surface elev. 90 ' 0 ft Depth to limiting factor 73 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff-
P P rY
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
� �= S''fi�.i - t l�' �- ,� % � C l - t'cTal� ,� -- • Z • 3
❑ Boring # ❑ 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/ff
in, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
❑Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil Application 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
* 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 608- 266 -3151 or TTY 608 - 264 -8777.
SBD -8330 (R.07 /00)
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Parcel #: 042 - 1045 -80 -175 07/08/2010 02:46 PM
P AG E 1 O F 1
Alt. Parcel M 17.29.18.260A -17 042 - TOWN OF WARREN
Current OX ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
04/04/2005 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
O - STANISLAW, ROBERT J & JUDITH J
ROBERT J & JUDITH J STANISLAW
1509 W PINE ST
STILLWATER MN 55082
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1085 100TH AVE
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 13.318 Plat: 4964 -CSM 19 -4964 042 -2005
SEC 17 T29N R18W PT NE NE & PT SE NE Block/Condo Bldg: LOT 13
(15.83 AC) CSM 17 -4582 LOT 11 NKA LOT 13
CSM 19 -4964 (13.318AC) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4)
17- 29N -18W NE NE
Notes: Parcel History:
Date Doc # Vol /Page Type
05/04/2005 794032 2796/217 WD
04/04/2005 791167 19/4964 CSM
08/19/2003 736226 2378/272 WD
08/07/2003 734383 17/4582 CSM
more...
2010 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 12/09/2009
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 13.318 140,000 0 140,000 NO
Totals for 2010:
General Property 13.318 140,000 0 140,000
Woodland 0.000 0 0
Totals for 2009:
General Property 13.318 140,000 0 140,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch M
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
i
AND
OWNERSHIP CERTIFICATION FORM
Owner /Buyer _ ' 6.06 J 4,g""
Mailing Address 2 50 & 014 / c d t J 7
Property Address 10%5 100
(Verification required from Planning & Zoning Department for new construction.)
City /State ;� ' 'r `S Parcel Identification Number 0 Y2- - �' `�S - �o ✓`
LEGAL DESCRIPTION
/vC N£
Property Location '/4 , /4 £ ' , Sec. / - 7 Z 0 / N R /8 W, Town of JA-1 a.�.c ->f�
Subdivision Plat: , Lot #
Certified Survey Map # , Volume , Page # --�
r nt Deed #
`' r before 2007 Volume �= ,Page #
Warranty
Spec house yes /'no Lot lines identifiable Ves no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
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. Owner maintepance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
to St. Croix Count Planning & Zoning The property owner agrees to subnut y g g Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that ( l ) the on -site
wastewater disposal system is in proper operating condition and /or (2) after inspection and pumping (if necessary), the septic tank is
less than 1'3 full of sludge.
I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal systenn
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 Planning &
Zoning Department within 30 days of the three year expiration date.
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.
Number of bedrooms 4
SIGNATURE OF APPLICANTS) DATE
** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * **
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
I
7 9 1 1 6 7
VOL 19 PAGE 4964
KATHLEEN H. M7CCS717
REGISTER OF DEEDS WI
RECEIVED
CERTIFIED SURVEY MAP 04/04/ 08:45API
LOCATED IN PART OF THE NE1 /4 OF THE NE1 /4 AND THE SE1 /4 OF THE NE1 /4 OF CERTIFIED SURVEY "AP
SECTION 17, T29N, R1 8W, TOWN OF WARREN, ST. CROIX COUNTY, WISCONSIN, ALSO REC FEE: 13.00
BEING LOT 9 OF A CERTIFIED SURVEY MAP RECORDED IN VOL. 14, PG. 4017, AND LOT 11 COPY FEE: 3.00
OF A CERTIFIED SURVEY MAP RECORDED IN VOL. 17, PG. 4582 AT THE ST. CROIX PAGES: 2
COUNTY REGISTER OF DEEDS OFFICE.
SURVEYOR: PREPARED FOR:
DOUGLAS J. ZAHLER ERIC & CAROLYN LENT TERRY & JENNY PABICH
S & N LAND SURVEYING, INC. 514 CHAPEL COURT 1081 100TH AVE.
2920 ENLOE STREET EAGAN, MN 55121 ROBERTS, WI 54023
HUDSON, WI 54016
M[I�P�44CD _
RTH LL,1�1D�3
NO LINE OF THE NE7/ N88 2631.83'
N1/4 CORNER V-0THAVENUE -� (N8e °4MW'*^/)
SECTION 17 N88 °4 (N88 °40'09'1) NE CORNER
001 "W o2 0� g ° 4 ' n 78. ' —�
1537.16 °' N88 ° 40Ot'W 81 SAW SECTION 17
4 12.33 ' of �a -- -�--�
413.31' 8. 66,
S88 ° 40'01'E 479.31' 8 '
................ $ C
............
WW --►
I I a �° _°. NOTE:
I� 1
LOT 1 co CTI I p THE PABICH'S ARE OWNERS OF LOT 9 OF
CD 5.348 ACRES INC. RAN C4 E co CERTIFIED SURVEY MAP VOLUME 14,
177 232,952 SQ. FT. f ' 1 PAGE 4017, ACQUIRED BY DEED
5.035 ACRES EXC. RNV ��, °'' j- 1 �S THEY HAVE ALSO DOC UMENT
RED A PART OF
z I
C.
219,329 so. Fr. p
N o fg 1 ' –` l i VOLUME 17, PAGE 4582, BY DEEED
uWi g I ��"aJ I j VOLUME RECORDED AS DOCUMENT NO. 788310.
w p` i u I 1 k THIS CERTIFIED SURVEY MAP SHOWS THE
j ° RESULTING LOTS. NO ADDITIONAL LOTS
2 Z °4 I ARE CREATED BY THIS INSTRUMENT. ALL
uw7 1 �' CONDITIONS, RESTRICTIONS, NOTES,
UJ p I.1ZWO T00"E " 1 1 ETC., LISTED ON THE PREVIOUS
cl CERTIFIED SURVEY MAP OR PLAT, ARE
O w �. j ° APPUCABLE UNLESS OTHERWISE
cn Z j ° y I INDICATED.
z ^ m 1 45 �C�l' OF W�SC,0
177 s. i °
O y DOUGLAS J. Z
ZA
LOT 13
13.318 ACRES INC. R/W
(N89°27'31 - W) 58o,148 SO. FT.
N89 0 27'23' W 13.268 ACRES EXC. R/W .S
577,970 SO. FT.
I 158.58' a ,
I � 'Ca �3
LEGEND
FOUND ALUMINUM COUNTY
SECTION CORNER MONUMENT
0 FOUND 1" IRON PIPE /
SET 1 "X 24" IRON PIPE WEIGHING 1.13
0 LBS. PER LINEAR FOOT
0 STEEL MASONRY NAIL FOUND
............... 100 FOOT ROADWAY SETBACK SCALE IN FEET V'= = 200'
( ) PREVIOUSLY RECORDED
200 0 200
THIS INSTRUMENT DRAFTED BY: WILLIAM KANE
JOB NO. 6080 -W DATE: 03 /14/2005 SHEET 1 OF 2 SHEETS
'
Vol. age
DOCUMENT NO. STATE BAR OF SI1�FQRj 1 -1985 �'� 4 � \3
WARRANTY DEED KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed, made between Eric N Lent - _and___________________ RECEIVED FOR RECORD
- ---
__________ husband 05/84/2005 16 :30Al1
-•--- ----- --- ----- ------ - ---- ---- --- - --- •- ----- -- ------ •--•----- -- ------- .............................. ...... WARRANTY DEED
- -----• -• --°----------- ---•-
------ ----- --- ----•-- ---- --- ---- - -- --------- ------- --- --- Grantor. EXEMPT 6
•
and---. R9- b9LrJ;... _- Jgj4i th- —J.-------------•----------
Stanislaw . ............................. husband w
and ife as REC FEE: 13.60
t__ t s
enant_*_ _______________________________ TRANS FEE: 4
--•----•• -- •--- ---- --•-- •-- --- ---- - - -•• COPY FEE:
-•---•----------------------- -- ----- -•---•-- °-- -•--- •-- ----- ------ ---•----•-- ---------- -- ---- --• Grantee, CC FEE:
Witnesseth That the said Grantor, for a valuable consideration. - - - -- PAGES: 2
...... .......................•---...........-•---•--...._..._._.._.....--.•....... .._.._.._....._...._......__ - -- II
conveys to Grantee the following described real estate in ........ RETURN TO Stillwater Title CO.
County, State of Wisconsin: PO BOX 206
Tax Parcel No: 042 -1
Legal description attached:
I
1 -
This ----- __F?Q --- - - - - -- homestead property.
(is) (is not)
Together with all and Singular the hereditaments and appurtenances thereunto belonging;
And------------------- -----------------------•---•----------------------- --- -•- ----- ----- ------- --- - -•-- ...................................................
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
and will warrant and defend the same.
Dated this ........ ath--------------------------------- day of .......... April.,._.2A.0a ............. --.......- --- - -.... I9.........
-- -•---- ----- -- ---- ---- -- ---- ---•------ ---•---- ----- ---- -- �_
---- -----(SEAL) -- • � ---- -- .......................... (SEAL)
------------------------ ----
.Eric N. Lent
°. (SEAL) v^. --- -tom" ............ ........(SEAL)
' --------------------•-------- --- -------- --- -- -- --- --- -- - - --• .Carolyn '?' Lent
----- ----- -- -- ------
AUTHENTICATION ACSNO'W LNDt}MSNT
Signature(s) ----------------------°•--- ---- - ---------- --------- --- -- --- STATE OF ` M61 MINN SOTA
---------------------------------- -- ---- -- ----- ---- ------ --- St. Croix as.
._County.
authenticated this - - - - -- -.day of ........................... 19...... Personally came before me this --- 8th ...... day of
Ap r i 1, _ 2 n
0 0 5 the above named
--------------------------------•----------------------------------------------- _Eric N. Let and Carolyn J Lent
- husband _ _ and wife
--------- -----------------------
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not. °. °.06. ----- 'Win- ----- -------•----------------- — --------------------------------------------
authorized by § 706.06, W StatsJ to me known to be the person ------------ who executed the
foregoing instrume and acknow edge the same.
THIS INSTRUMENT WAS DRAFTED BY
David M. Newberg, PO Box 206 ----------- -���- ------ -- - ----- ---- -- ---
---
Stillwater, MN 55082 ' •-- •---------------- - - - - --
-------------- ---- ------- ------ --- --- - - - --- -
-- -----------•--•----------- --------------- ------ --------- -------- --- Notary Public - --•-- -- -------- ----- --
u Wia.
(Signatures may be authenticated or acknowledged. Both My Commiasi nation
are not necessary.) date:_____ 1 _.._....)
'Names oL Derons -iiaiae in any eapacity should be typed or printed below their -{=natures. �M
WARRANTY DICED STATE BAR OF WISCONSIN wiecondn Leal 81.nk Ca Ina
FORM Ne, 1-1952 MII —k... wi-.
2796P 218
Legal Description
Lot 13 of Certified Survey Map, recorded April 4, 2005 in Vol. 19, page 4964, as
Document No. 791167 located in part of the NE 1/4 of NE 1/4 and SE 1/4 of NE 1/4
Section 17, Township 29 North, Range 18 West, Town of Warren, St. Croix County,
Wisconsin.
Tax Parcel no. 042 - 1045 -80 -150
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