HomeMy WebLinkAbout042-1077-50-000 0 W p 0 cn O s m n rjq
0 y O f C O
3
O CD 3 O CD C1 N V
K '0 71
ID '
a
O
Cn x T & *re ° A C/) C_ ;0 O W Cl) N O r,,,i •
C� CD CD N i'a W O 3 4. IN A N N a+
I co a >> m n c 3 cn rn rn 3 m 7
O N Qy N N to CD (Q N A J O
0 0= fD C C n g fQ C) S 7 ° °+
3 O j p O O
7 N 0 N CT O O
Dl m A Im
fD A R
cu v D m a o G D¢ o t
OD
N A N p, 3 N N a C
W
o °
N 3 10 C CO W CD C ° •`°
J { O O N CD r N
N
CD O O y y O C
� A A N � .. ZS
CD < Of Z
CL 0 0 0 0 0 0 �+
C ' w N N 3 o
a� CD v q 3
(D N O A N o0i
N d
CL
0 3 °1
D D o D D o
G 3 O C:
E'r °- CL t�q
CD N N
CD A
tV
CD p CD O
c 3 3
p o
3 m 3 CD
CD CD N -i N
c �
zT tS .p z p
CD CD .. r) 7
N
O �.
W p N 000
CD ID p , a ID ` M W
- z
0 3 0 3
3 3 r: rn 00
H D N z
CL CD
A CL A
O
- `< CD S� ? � 3 0 6 Q O a O O? 2
�3° < >cm-p 0 3 c Q o°i Z CD �n a
CD A> -0 a) CD ;L �' 0. O O O� 0 N CD O.
(D 0 N C
T
O
O N —p`C CD - C �. - C i m
7 C) (D 3
Cp O N '6 x
CD " � 5 o w m o
CD � p O y Cn r2 00 C. x 0 n
N N N a CA
<. z .0 O p N 7 N C N I ( =. C"? O
0 CD x 3 o 0. m m m m a 3 0 0 LIZ
coam 3cQ
CL = °' � ° C v
Ln a� m n m "c m m 3 On_
o N p O y W N a p N
i u 41 m y m CD Cn o� a
CG . 7r CD 0,1 N a CD . ° C)
O O N °O -p 0 y N 3 CL A O A
O C^ . n p v d°�j 41 ^� 0 N d O p O
30 =r omu, @ 0 G30 0
00 amm cc
°
o c 3 a 0.�(D o
a
fD O CD N y
CL
A
COD CD C
O O C A
C) e 6
. p a.
o � �� d
{
x 0
(n m C Z O ( c) N
S T N +' 0 . I O N I..q •
1 I O p O
3 3 N � � � O r• l�
O
O W 4
v U) f D a J
rn (D 0 y N C. , I I
CD
CD ao c a o m
N 3 O ° - - 1 V
10 0 CL
S'.
W J
((A c co a ql c
f0 tp C
7 M
z 000
;�
���o
�' t o yy Cy "aao8 0
(DD ..
�
z
N
z c
D D o
d O
b 3 a H
CD CD
c I
w m
a 3 _
o a �. Z C
N J i
9. A C 7
o.
7
CL z
c °r-
3 00
�^ z
0
11 3 a 0 CD
w �
CL
Er c
o °
I c , `�° z
0
m y y 0 °
c m N
b `a r
aco y
CL
o aay
(D a
m o �
C L
0 a
cr
�� o 0
a
0
ft (D
6p ti
C O tiW
y a
O CL y
ti
Parcel #: 042 - 1077 -50 -050 01/03/2008 03:25 PM
PAGE 1 OF 1
Alt. Parcel #: 28.29.18.441 B -05 042 - TOWN OF WARREN
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
08/12/2005 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
O - SOLIMAR, KEITH F & KAREN L
KEITH F & KAREN L SOLIMAR
1144 70TH AVE
ROBERTS WI 54023 -3966
Districts: SC = School SP = Special Property Address(es): " = Primary
Type Dist # Description
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE
SEC 28 T29N R18W PT GOV LOT 6 LYING ELY Block /Condo Bldg:
OF TN RD;RUNNING NLY ACROSS SD LOT 6 EXC
CSM VOL 1/228 ORD EZ- U- 1450/197 EXC CSM Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4)
20 -5043 28- 29N -18W
Notes: Parcel History:
Date Doc # Vol /Page Type
08/12/2005 803215 20/5043 CSM
05/05/2005 794113 2796/623 EZ -U
12/14/1998 593683 1386/461 WD
07/23/1997 1165/560 DJ
more
2007 SUMMARY Bill #: Fair Market Value: Assessed with:
226885 683,700
Valuations: Last Changed: 06/08/2007
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 25.251 113,600 389,700 503,300 NO 2
UNDEVELOPED G5 11.530 1,200 0 1,200 NO
Totals for 2007:
General Property 36.781 114,800 389,700 504,500
Woodland 0.000 0 0
Totals for 2006:
General Property 36.781 114,800 366,300 481,100
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
0'0 00'0 00'0 Ielol
0
sGAe4a ;uenbullaa saBJe4a leloadg s;uewssessV leloadg
;unowv tioBa ;ea epos leloadg Jas
:SIepedS
:# 431e8 mea uolleo6l:peo 0 :;unoa w1eI3 :}IpaJo AJ
0 0 000'0 puelpooM
00£`ZL6 001.`L17 OOZ'SZ1. 0£8717 f4jadoJd leJauaa
:17002 Jo; sle;ol
0 0 000'0 puelpooM
00£'917£ 000I,ZZ OOZ`5Z6 0£8'Z17 A:pedad leaaua0
:SOOZ Jo; sle;ol
ON 00Z' l, 0 OOZ' 6 OCT I• L 90 43dOl3A3aNn
ON 001.`517£ 006`6ZZ 000'17Z6 00£'1.£ 1.0 1VUN341S3H
uoseaa a ;e ;g 1e 101 anoJdwl puel saJoV ssela uol ;dlJosea
5002 /ZZ /90 : paBue4a Ise-1 : SU01 }ell IBA
0
:4 1Inn pessessy :enleA ;ailJeW me3 :# Ilia Abdwwns 500z
OI 98 L /£Z 1.1. L66 6 /£Z /LO
fa 099/996 6 L661.1£Z 1L0
aM 69b /98£ I• £89£65 8661./171./2 1.
n - Z3 £Z9 /96LZ £ 1.6176L 500Z/90/90
edAl eBed /IoA # ooa a;ea
:Ajo ;s!H lamed :sa;oN
M81. N6Z
(17/1. 096 17/6 017 BUN-uMl-oaS) :(s);oeJl L61./05176 OHIO 8ZZ /I, IOA WSO
OX3 9 101 aS SSOb3V A'1N JNINNnu!OH NI 30
:Bp18 opuoa/)lool8 AI3 JNIA1 9101 AOJ id MM N6Z18Z 03S
3I8tlIIVAV ION /N :Ield 0£8717 :seioV :uol;dlJosea leBal
011M OOL 6 dS
IVNIN30 XIONO 1S ZZVZ OS
uol ;dposea # Isla edAl
tiewud =, :(se)ssaappV A:padoJd lepedS = dS I 00 4 3 S = OS mows1a
996£ IM SIN380H
3AV HlOL 17171.6
NVVYIIOS l N38VA V 3 HIGH
I NM:IV)I 'R .-J H113N 'NVVY1IOS - 0
jeumo- o0;uanno = o 'jauen0;uenno = 0 :(s)Jeumo :ssaJppv xel
0 00
adA 1 MLuJ # I1wJad # uol ;eollddt/ eater sales # deyy a ;ea leolJO;sIH ales uol;eaJO
NISNOOSIM `A1Nf10O XIO2IO '1S X ;uenna
N3NNVM 30 NMOl - Z170 81.1717'86'6Z'8Z :# IaoJed 'I IV
L:10 I. 39Vd
wd 9040 900MV90 000-05-LLU-M :# IGDJed
%4 Department of Commerce County:
p PRIVATE SEWAGE SYSTEM St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No: 453450 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Solimar, Keith Warren Township 042- 1077 -50 -000
CST BM Elev: Insp. BM Elev: T Description: Section/Town /Range /Map No:
28.29.18.441 B
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic L Benchmark
7 I= LtOr fD Cfl
Dosing l 11 Alt. BM 49-1
• 00 /
Aeration Bldg. Sewer � 1
Z
Holding St/Ht Inlet G.Z 6
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic > s 1 ,' fi r � Q ! Dt Bottom
i
Dosing 4 / / -•., ul -.. H
Aeration Dist. Pipe
Holding Bot. System
Final Grade
PUMP /SIPHON INFORMATION
Manufacturer Demand St over
GPM G.0
Model Number r
S.T. let►.41
r q 3
TDH Lift Z,;. tion Los System Head TDH Ft 44 41%4 A
S4 +
Forcemain Length + Dia. fs I Dist. to Well
SOIL ABSORPTION 4 h F tK -si + 19Q9
BED/TRENCH Width Length No. Of Trenches PI IMENSIONS, No. Of Pits Inside Dia. squid Oe
DIMENSIONS
SETBACK SYSTEM T P LAK STREAM LEACHIN nufacturer.
INFORMATION CHAMBER 0
Type Of Sy em: UNIT
t -
Mo er:
DISTRIBUTION SYS
Header /Manifold Distrib n � Hole e x Hole Spacing Vent to Air Intakl%-
Len is Len h Y ' aciAg�A
SOIL COVER x ressure Systems Only xx Mound At - Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
113ed/Trench Center Bed/Trench Edges Topsoil - ,
Yes No Yes ] No
��. COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1:,� �� b Inspection #2:
* Avation: 1144 70th Ave. Roberts, WI 54023 (Government Lot 6 28 T29N RI 8W) NA Lot Parcel No: 28.29.18.4418
r 1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
- - -1
Plan revision Required? e o
2/
Use other side for additional or ti
e natuu Ce No.
SBD -6710 (R.3/97) � G2i n Ai WDS
1-t> ytslos:
' Safety and Buildings Division County
at 201 W. Washington Ave., P.O. Box 7162
Nv hsownsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co )
Department of Commerce (608) 266 - 3151 53 q 5D
State Plan I.D. Number
Sanitary Permit Application
In accord with Comm 83.2 1, Wis. Adm. Cade, personal in( Or
grm p n
may he used for secondary purposes Privacy Law s15.04 You . 1L rovide pro J ect Address (if different than mailing address)
,I- V
1. Application Information -Please Print All Information } ; �O 1 4 6
Property Owner's a e l 1'. `- t.'� ± Parcel # Lot ' Block #
s
6
Property Owners Mailing Address y _,.� ) Property Locat
z o CJ pC A - _ - Swl Y4, SFY., Section
City, State } Zip Code 7 Phone Number ^�
N �� /O t U�dt '7 T � N; R /� E ow
H. Type of Building (chec all that apply) Subdivision Name CSM Number
K 1 or2 Family Dwelling - Number of Bedrooms` °`�
❑ Public/Commercial - Describe Use Qbl QBW
❑City_ ❑Village Township of
❑ State Owned - Describe Use
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A ' ❑ New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only & Other odihcation to Existin System
B. ❑ Permit Renewal ❑Permit Revision Change of ❑ f
Permit Transfer to New
ist Pr rmit Number and Date Issued
Before Expiration Plumber Owner
IV. Type of PO System: Check all that appl
❑ Non - Pressurized In- Ground Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter El
Constructed Wetland ❑ Pressurized In -Ground ❑ Holdin Peat _ fit ;: : Ae bic Treatment Unit Rec n Sand Filter ❑
Recirculating Synthetic Media Filter ❑ Leachin tuber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dis ersaVTreatment Area Informat'
Desi n Flow (gpd) Des' licat n Rate(gpdsf) Dispersal Area Required (st) Dispersal Area Proposed (sf) System Elevation
VI. Tank Info Capacity in Total Number Manufacturer - rte Steel Fiber Plastic
Gallons Gallons of Units on rate Constructed Glass
Nov( Existing
TarA. Tanks
Septic or Holding Tank
Aerobic Treatment Unit '?7'
Dosing Chamber
VII. Responsibility S Ment- I, the undersigned, assume responsibility for ins Ilation of the POWTS shown on the attached plans.
Pi u bar' N m (Print) Plum s Sign re P PRS Number Business Phone Number
�C o 1 S 95's
P umber's Address (Street, City, State, Zip C e
VI I. Count /De artment Use Onl
Sanitary Permit Fee �ipcludes Groundwater Date Issued Issuin Agent Signatur (No Stamps)
'Approved ❑ Disapproved Surcharge Fee) _
C ❑ Owner Given Reason for Denial
IX. Conditions of Approval /Reasons for Disapproval > J
SYSTEM OWNER: b—
1 Septic tank, effluent filter and
dispersal cell must all be serviced/ maintained �' ' -�(�
as per management plan provided by plumber. l5 �`�� "'`9i 0- n "T T
a �
2. All setback requirements must be maintained �)3 j,e �p
as per applicable code /ordinances. t S
Attache plete plans (to the County only) for the system an paper not less "a 81/2 a 11 inches in sift
SBD -638 (g 3 A' c if n
b
o
o
0
Q�
4 �
0
0
o c�
o COPY
b
1
cltllo/ )
0
4
O
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page , of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner S' Septic Tank Capacity QOCD g a l ❑ NA
Permit # 3 / /Y,5-4/P _Q n Septic Tank Manufacturer (, .� ❑ NA
DESIGN PARA ETERS �6C Effluent Filter Manufacturer ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model --1 Q <3 ❑ NA
Number of Public Facility Units ❑ NA Pump Tank Capacity e OO g al ❑ NA
Estimated flow (average) ��d al /day Pump Tank Manufacturer, ❑ NA
Design flow (peak), (Estimated x 1.5) W �,o�1 gal /day Pump Manufacturer 11 NA
Soil Application Rate gal/day/ft' Pump Model Ar e ❑ NA
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA
Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) :5150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand IBOD :530 mg /L n- Ground (gravity) ❑ In- round (pressurized)
Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At- Grade llllound
Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
*Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
R ❑ month(s)
Inspect condition of tanks) At least once every: J�'year(s) (Maximum 3 years) ❑ NA
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
0 year(s)
filter At least once every: [I month(s) [I NA
Clean effluent to y year(s)
Inspect pump, pump controls & alarm At least once every: $ yea�(s)(s) ❑ NA
' ❑ month(s) ❑ NA
Flush laterals and pressure test At least once every: ❑ year(s)
Other: At least once every: El month(s) ❑ NA
❑ year(s)
Other: ❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
Page 6f y
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
T
alua ' a o ring tank
W/
be ' FpDNlB T1ez,. ` bR- A16'^J CO&J5 UC710"
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
i
POWTS INSTALLER 4 0 POWTS MAINTAINER
Name Name
Phone ` _ C) i Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name St. ckb l (7U ZDll�ll(f
Phone Phone �(S— 3gCv_ o o
This document was drafted in compliance with chapter Comm 83.22(2)(bI0)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
IBS
N
ST. CROIX COUNTY ZONING DEPARTMENT
AS BUII.T SANITARY REPORT/"
Owner a �'
Property Address - .
City /State
C OUNTY
Legal Description:
Lot -- Block Subdivision/CSM #
4�g 1 /4 4, Sec. ,22, TAN -RAW, Town of 'L(ar r r r•
SEPTIC TANK — DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer i� Size ST/PC Z01 ° Setback from: House Well PIL,�2
Pump manufacturer , —Model
Alarm location =5z
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM:
Type of system: Al Width _ Length Zg,- Number of Trenches he— Setback from: House �- ,���
Well A& PAL r Vent to fresh air intake ,/ /
ELEVATIONS
Description of benchmark 164 Elevation
Elevation f._.1 �8 6
Description of alternate benchmark 1 �' °"
c�t� e- 100- ,6-0 / o/ ,-2 7 sb a/. o V
1,200 9
Building Sewer ST/HT Inlet 93 ' a � ST Outlet T PC Inlet -f a 7 f
7 g-b /o Y.
PC Botto Header/Manifold 9� Q Top of ST/PC Manhole Cover faoo 19,Y7
Distribution Lines
Bottom of System () �'9 3 () ( )
Final Grade () l Dl ,6 () ( )
Date of installation 0 / �/ `� Permit number 3 I State plan number
Plumber's signature
License number — Date LO / / J1
Inspector 7 v r � Complete plot plan
L
W
NOTIC • Please provide t - following:
CA plan view etch sho 'ng eve g within 100 feet of the system. r
Orwo horizonta refer4nce p ints toTc��iter of septic tank manhole cover. '
o U n
• _ r-�how alternate b nh k,. i apdc
o �
C,
� PLA.N-�IEW
M 9
ki
S
= o S .r rn r r) 6
rN
b P
b r
_ n
3
1100 � 7
/) 0
0 '2 c Tit
1/3J 9 3 b
m O P
C) oo r, CA
INDICATE ORT
►� o P'
✓A
4 ann Department of Commerce PRIVATE SEWAGE SYSTEM d Buildings Division County:
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: IX
Personal information you provice maybe used for secondary purposes [Privacy Law s.15.04 (i)(m)). 344566
Perng',&ldgr '� �I ameICEITH ❑City Village Town of: State Plan ID No.:
CST BM Elev.; Insp. BM Elev.: BM Description: W ARRE N
Tax No.:
�d 6 Q 1A (' G 042- 1077 -50 -000
TANK INFORMATION /d /5 ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic , 7 04 Benchmark Z /U U
c
Dosing �• .{ 74 Odd W'�. `fit I0 3,R
Bldg. Sewer q'• 3 y
it
ding /Ht Inlet f.3 ,
TANK SETBACK INFORMATION r A Ht Outlet s?
I ntake �
TANKTO P/L WELL BLDG. Air to ROAD Dt Inlet -h Air - 3
Septic ) ®0 i Aj NA Dt Bottom 13.4 Z c
Dosing ' A )h A AIA- NA Header / Man. 3 1 .r'j, f 7
Dist. Pipe 3 ' 9 ' f 7
Ho Bot_ System 4 �/�9 ?q, 3 Z-
PUMP / SIPHON INFORMATION Final Grade
Manufacturer r, . 1/ s Demand
Model Number ✓ 6 (� '/G PM
TDH Lift a, 3 Lri s "1 -� S earl � ,� TDH Ft
' F
Forcemain Length Zo r Dia. Z, " Dist. To well
SOIL ABSORPTION SYSTEM
ffQ5 T7RENCH Width Length No. Of Trenches PI No. Of Pits Inside Dia. Liquid Depth
DI MENSION S ` �i DIM
P/L BLDG WELL LAKEISTREAM HIN anufacturer:
SYSTEM TO
SETBACK „-
INFORMATION Type O ^ =NIT
System: 7/ Q Q/'fa" AIA- 7 Z �d
DISTRIBUTION SYSTEM
Header/Man L/ i old 2 iI Distribution Pipe(s) �� x Hole Size ,. x Hole Spacing Vent To Air Intake
Length T Dia. / Length _i� D ia. Spacing � I/� y N oil
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded F-XE ul ched
Bed / Trench Center Bed / Trench Edges Topsoil E] Yes El No Yes [] No
COMMENTS: (Include code discrepancies, persons present, etc.) //!1
;ATION: WARREN 2 8.29.18.441B,SW,NE 1144 70TH AVE — GOV'T LOT 5 & 6 Av pf
J D it✓' _ ` # 3 r C� l� NOa Al /jiv i� 1
�K V, � loo' �- � m •- � r�Y �
Plan revision required? ❑ Yes ❑ No
Use other side for additional information. (( Z fl7f
SBD -6710 (R.3/97) Dat4 Inspecto Signature Cert. No.
Safety and Buildings Division
SANITARY PERMIT APPLICATION 201 W. Washington Avenue
/ ent . In accord with ILHR 83.05, Wis. Adm Code P O Box 7302
of Commerce Madison, WI 53707 -7302
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8112 x 11 inches in size. ST CROIX'
• See reverse side for instructions for completing this application state sanitary Pe mit Number
31yS� �
Personal information you provide may be used for secondary purposes D check if revision to previous application
(Privacy Law, s. 15.04 (1) (m)].
State Plan I.D. Number SITE ID 175779
I. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATI N TRANS ID 234323.
Pro Owner Name Property Location - p y
KEIN SOLIMAR SW 114 NE 1/4, S � K/
T 29 r N R 18 7 W
Property Owner's Mailing Address Lot Number dpoU Block Number
6902 LAKE TERRACE E N/A ,S N/A
Cit State Zi Code Phone Number Subdivision Name or C M Number
'WOODBURY MN 55125 (651)714 -0603 N/A
11. TYPE F B IL ING: (check one) ❑ State Owned °❑ ci WARREN Nearest Road
Public 1 or 2 Family Dwel - No. of bed rooms [ Town OF Public AVENUE
III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Numbers) l
4q�
042 - .1077 -50 042 7 1077 -90 �
1 ❑ Apartm'ent /Condo
Z8 . ?9S• �� �y-
2 ❑ Assembly Hall 6 ❑ Medic al "Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑Campground J, ❑Merchandise. Sales /Repairs 11 ❑ Restaurant /Bar/Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel/ Motel 9,.0 Office / Factory 13 ❑ Other. specify
IV. TYPE OF PERMIT:' (Check only one box online A ` Check box online B, if applicable)
A) 1. ® New 2. ❑ Replacement 3, ❑ Replacement of 4, ❑'Reconnection of 5_ ❑ Repair of an
- - - -- _System -- - - - - -_ System ___ Tank Only Existing System Existing System
--- -- - - - - -^ r--- --- ------------ --- ----- -,_��.�__ --------
-- - --
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM :,,Check only. one) ;..
Non - Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ® Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 t1se epage7rench " 22 Q'In= Ground'Pressuie 42 Q Pit Privy
13 ❑ Seepage Pit 43p Vault Privy
14 C] System-In-Fill '3D -
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation
600 500 500 1.2 N/A 99.30 Feet 101.6 Feet
VII —TANK Capacity
in gallons Total # of Prefab. Site Fiber- Plastic Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con Steel glass App.
New Existin strutted
Tahksl Tanks
IcTa a 1950 1 950 2 MIDWESTERN PRECAST ® ❑ ❑ ❑ ❑ ❑
Lift Pum Tank /Si e,j 10001 11000 1 MIDWESTERN PRECAS ® ❑ ❑ ❑ ❑ ❑
V111. Kr_ NSIBILITY STATEMENT - 7Sa C6r -*-� ft!'k, W . - Lar -
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plum is Signature: (NoS m s) MP/ PRSW No.: Business Phone Number:
BENNIE HELGESON 01 220292 715/772 -3278
Plumber's Address (Street, City, State, Zip Code):
W1229 770TH AVENUE SPRING VALLEY WI 54767
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater F� Issued Issuing Signature (No Stamps)
L ❑ Owner Given Initial = c�v Surcharge Fee) /
Adverse Determination 7aO 3 C ) ?
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD- 6398 (R.11197) DISTRIBUTION: Original to County. One copy To: Safety 6 Buildings Division, Owner, Plumber
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
i
r
i
.3
ve
2
}
E
t -
i
g� _ {
d'+t
I
ry o 3 ° o
a
y i
�Y o
a
I
o I
N
O
h
O
Z N
O Z
c
LL c
3 i
Q
� I
Z N
co W
Z a m
rn
N H �
O
O Z j
y Z a c O
N H O Z
I � M
m I
i
� C
C Q f6
Z S `
Z
C N C
d C N
.. m
O
zLoCD ° z
hh�� a = o
IL CL IL En
o m CL 0
fq J U = rn rn Z
W ° o
N _ "
06 �
m q) a
V! V!
O a0 d N C
r
�+ O m N m
CCU O I 04 �
U G Y C
O co 4) N N
O C O co
eye' G Oj N O O V! O
' 1 ~ N O C L
N N N C t6
O O N !n M O Z C m U)
I
• o a d
r `IV +�+ E c c °: 3
r A cia U
o Il0Uiu
GOULDS PUMPS Submersible
Effluent Pump
EPO4 & EP0
Series
APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower
Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing
following uses: lubrication and efficient improved performance. construction.
• Effluent systems heat transfer. ■ Casing and Base: Rugged
• Homes Available for automatic and thermoplastic design provides AGENCY LISTING
• Farms manual operation. Auto- superior strength and corrosion
• Heavy duty sump matic models include resistance, S P. Canadian Standards Association
• Water transfer File # LR3asa9
Mechanical Float Switch ■ Motor Housing: Cast iron
• Dewatering assembled and preset at the for efficient heat transfer Goulds Pumps is ISO 9001 Registered.
factory. strength, and durability.
SPECIFICATIONS ■ Motor Cover: Thermoplastic
• Solids handling c
FEATURES cover with integral handle and
7 �i
/< maximum. ■ EPO4 Impeller: Thermo las- float switch attachment points.
• Capacities: up to 60 GPM, tic semi -open design with p 0 Power Cable: Severe duty
• Total heads: up to 31 feet. pump out vanes for mechanical rated oil and water,resistant,
• Discharge size: 1'12" NPT. seal protection.
• Mechanical seal: carbon-
rotary/ceramic-stationary,
BUNA -N elastomers.
• Temperature:
1041(40°C) continuous
140°F (60°C) Intermittent, METERS FEET
• Fasteners: 300 series t0 T - - -_
...... ......:.................._...,.
stainless steel.
.......... .............
• Capable of running 9 30
dry without damage to
g
components, 2.5 FT
25
Motor:
__. ,_
• EPO4 Single phase: 0.4 HP, L) 6 zo
115 or 230 V, 60 Hz, 1550 a
RPM, built in overload with > 5
automatic reset. ° 15
• EP05 Single phase: 0.5 HP, o a
...................... .
_ ,......_.... .. EP05
V or 230V, 60 Hz, 1550
RPM, built in overload with 3 10
automatic reset. ..
z _ _ .....
• Power cord: 10 foot 5
standard length, 16/3 1 - ----
SJTW with three prong -
grounding plug. Optional 20 0
foot length, 16/3 SJTW with 00 1 20 3 a0
a� n,9� 50 GPM
three prong grounding plug /�- --
(standard on EP05). 0 z 4 6 s
10 12 m
CAPACITY
Goulds Pumps
® 2003 Goulds Pumps
Effective July, 2003
83871 ITT Industries
I
- • - •� %AM 0L K CROSS SECTION AND SPECIFICATIONS
4" CI VENT PIPE 12" MIN. ABOVE GRADE E WC•ATHER PROOF
> 25' FROM DOOR. WINDOW OR JUNCTION 80X
FRESH AIR INTAKE APPROVE
FINISHED GRADE 4' CI WITH CONDUIT MANHOLE
RISER W/ PADL
6" NIN. WARNING
--- A80VE G ADE
18" IN. 6" MAX.
INLET
WATER TIGHT SEALS GAS_
pn / T TIGHTS
CI PIPE BAFFLE —_/ A SEAL � APPROYeC
3' ONTO B LN JOINTS M
SOLID -7— ' ON PIPE 3'
SOIL C ' SOLID SO
Pump 0 F �
F ELL'Y .
FT. OFF +• RISER
D PERMITTr.
IF TANK
MANUPACTI
3" APPROVED BEDDING UNDER TANK HAS APPRi
SPECIFICATIONS CONCRETE PAD
EPTIC / DOSE - - - -- -. _................. .
TANK MANUFACTURER: '
NUMBER DOSES PER DAY:
TANK SIZrS SEPTIC GAL. DOSE YOLUHE INCLUDING
DOSE &oQ GAL
f LOWBACK: GA 1_ L .
ALARM MANUFACTURER:
MODEL NUMBER: CAPACITIES: A z Ia �jNCHES =
SWITCH TYPE:
8 = 2 INCHES
r'UMP MANUFACTURER: _
MODEL NUMBER: C S 7 / INCHES = _ �
SWITCH TYPE: D _ .�
INCHES = _7 g y�
REQUIRED DISCHARGE RATE
S GPM PUMP c A LARM WIRING AS PER ILHR
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE 16.23
• MlNIKUt NETWORK SUPPLY PRE SURE ��FEET
FEET FORCEMAIN X �FT/ IC)o FT. FRICTION F ACTOR '_FEET
.
TOTAL DYNAMIC HEAD _ ' 3 FEET
INTERNAL DIMENSIONS OF PUMP TANK: LENGTH - S FEET
i,�IDTH ; DIAMETER
LIQUID DEPTH 3 9 `! -
%IGNED:
LICENSE NUMBER..
5, 70o
ST. CROIX COUNTY ZONING DEPARTMENT-
AS BUILT SANITARY REPORT
Owner K e C� I 1 1^A .
" / ` .. :�
O
o� _
Property Address
City /State
Legal Description:
Lot Block Subdivision/CSM #
'/a ' /a, Sec. Q2, T N -RAW, Town of C cue A:ar r' t in, PIN # Q �� %0 ZZ �S o yd `��ps
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION
7v- 0 0
Tank manufacturer i Size ST/PC J / / Setback from: House A)A- Well P/L ,,&n2
Pump manufacturer odel
Alarm location
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM
Type of system: n Width , Length Number of Trenches he-
Setback from: House Well PAL - t n o-,�' Vent to fresh air intake r O A
ELEVATIONS
Description of benchmark ej S� Elevatio o �
Description of alternate benchmark r- 1-1kle- 7kr1s1 ifnrrX'e1- Ric Elevation 106. 6
C-raoz�e- 109 -27 16'0 l , o/. _� 7 7S /D /, o y
C c%j-"Q . yP y 13 /-`0 93 , 1 1 I .Q°° 9 3, x;'
Building Sewer ST/HT Inlet ' ST Outlet PC Inlet 3 •3
756 — / ®y. 7
PC Botto Header/Manifold 9� Q Top of ST/PC Manhole Cover �aoo — ?9,Y7
Distribution Lines () �X f 3 () ( )
Bottom of System () f', .3
() ( )
Final Grade () /0/4
() ( )
Date of installation Permit number. ?�y � State plan number l S'7 5
Plumber's signature fLLicense number Date
Inspector
Complete plot plan �
X
w
NOTIC �Piease provide t Tollowing: ~
• - CA plan view etch sho ng everyii g within 100 feet of the system. r �,
�'wo horizonta refer4nce p ints tc46iiter of septic tank manhole cover. .
A
• how alternate b n� k, i " applicau'e.
G , +,
\ S
PLA,1 IEW
_ r 1
� , O �c P ki
r)
( 5
'`
e
' nt p P A %
\� r, C
\ INDICATE ORT
A l i .
A
G o ✓�
S .
3
s
_ �
Wisconsin Department of Commerce
Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No -: IX
Personal information you provice may be used for secondary purposes [Privacy Law s.15.04 (1)(m)]. 344566
Per St Na; eKEITH ❑ City Ville Town of: State Plan ID No.:
CST BM Elev.:- AK Insp. BM Elev.: BM Description: W � Parcel Tax No.:
�d 6 ) u G 042- 1077 -50 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic � ^ ZD� Benchmark ZG Z /UU
D os i ng �t'l`e( ,( lode 1' ��� Io3,R too
Bldg. Sewer
din / Ht Inlet ,
g � � 9 �'
TANK SETBACK INFORMATION 19/ Ht Outlet 9 57 1
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet �'� ,�
Air Intake
Septic ) oa i M& A/ U fa NA Dt Bottom �-
Dosing ��� ` n1/� IJ4- C /A ( NA Header / Man. 3 �'l. `. 7
Dist. Pipe 3 -9 93
HoldimC Bot. System G y�9 °74- 3 Z
PUMP / SIPHON INFORMATION (� Final Grade
Manufacturer A / Demand S aje
Model Number ✓ 6 [� 3 `GPM '
TDH Lift a,3 Lriction3�� Syste Z �� DH /L _61t
oss Forcemain Length Z Dia. Z Dist.ToWell
SOIL ABSORPTION SYSTEM
TRENCH Width Len No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 5 c l 10je'r:y!( DIM
SYSTEM TO P / L BLDG WELL LAKE / STREAM HIN anufacturer:
SETBACK CH
nn
INFORMATION Type Of m er:
System: • 7/ Q AI A 7 Z �d / UNIT
DISTRIBUTION SYSTEM
Header/Manifold L/ 2 P Distribution Pipe(s) �/ x Hole Size ,.� x Hole Spacing Vent To Air Intake
Length � Dia. / Length � Dia. Spacing l y ,/V f}'
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 Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION: WARREN 28.29.18.441B,SW,NE 1144 70TH AVE — GOV'T LOT 5 & 6 &v'
c� &Ye// Ai Al- ~ /� jd / / /r / ¢ g l� , /`
� � r �u�"Y C �' ' o." P � ` L% (�Y T r Or�. G�i�� �Y c�a�►
> c�tX�.
Plan revision required? ❑ Yes ❑ No
Use other side for additional information. (( Z
SBD -6710 (R.3/97) Dat4 Inspecto Signature Cert. No.
I
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
._.
4 _. �w
iv eio�
E
a ®�
a
3
3
4
w .
e f
t
@
mma
K
��� , ... � � ... �. � .gym _ M, t• _e .� _,. ...._ � _.. ..,�.}._.
A
� ... s .
€
_ .,S...m
... _ . .a_._. ... M.. _. . �..... _ .. .. - --- . W .... .. e
E
@
m.
f t i
f
qqq
{ e
D P r
. e E
i x f t
H
e
r
f � 9
3 � • `
i t E
g
e
m�. ...
a.
€ � i
3 E e
t
SAN Safety and Washington Avenue
Division
SANITARY PERMIT APPLICATION
201 W. Washin ton
14 sconsin In r i i . P O Box 7302
Department of Commerce acco d with ILHR 83.05, W s A dm. Code Madison; WI 53707 - 7302
• Attach complete plans (to the county copy only) for the system, on paper not less County
than 8 1/2 x 11 inches in size. ST CROIX"
• See reverse side for instructions for completing this application state sanitary Pe mit Number
qyS� ,
Personal information you provide may be used for secondary purposes C] Check if revision to previous application
[Privacy Law, s. 15.04 (1) (m)).
State Plan I.D. Number SITE ID 175779
I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION TRANS ID 234323
Pro Owner Name Property E cation 29 r 18 ��
KEITH SOLIMAR SW Zia 1/4, S T N, R W
Property Owner's Mailing Address Lot Number 6?0 U Block Number
6902 LAKE TERRACE E N/A :gj N/A
City, State 2is5125 Phone Number Subdivision Name or C M Number
Y MN
W (651)714 -0603 N/A
II. TYPE F I ING: (check one) ❑ State Owned it Nearest Road
Public 1 or 2 Family Dwelling - No. of bedrooms 4 ° Town of WARREN 115TH AVENUE
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s)
042 - 1077 -50 042 - 1077 -90 ?9) L8� �
1 Apartment/ Condo 24 .2 9:"-`F
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash
5 ❑ Hotel /Motel 9 ❑ Office/ Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable)
A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an
------ System ________ System _____________ Tank Only- ----------- -- - Existing System ________ Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non - Pressurized Distribution Pressurized Distribution Experimental Other
11 []Seepage Bed 21 ® Mound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 Vault Privy
14 ❑ System-In-Fill e -30
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min-/inch) Elevation
600 500 500 1.2 N/A 99.30 Feet 101.6 Feet
VII. _TANK Capacity
INFORMATION in gallons Total # of Manufacturer's Name Prefab. Con- steel Fiber- Plastic Exper
New Existin Gallons Tanks Concrete structed glass App.
Tanks I Tanks 1Z.
Ic7a a 1950 1950 2 MIDWESTERN PRECAS ® ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /S er 1000 11000 1 1 MIDWESTERN PRECAST ® ❑ I ❑ I ❑ I ❑ I ❑
NSIBILITY STATEMENT -- 75 1 C� Ja ,>t e..� P11:5114 I�
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plum is Signature: (NOS m s) I MP /MPRSW No.: Business Phone Number:
BENNIE HELGESON 220292 715/772 -3278
Plumber's Address (Street, City, State, Zip Code):
W1229 770TH AVENUE SPRING VALLEY WI 54767
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued Issuing I ent Signature (No Stamps)
:` Surcharge Feel � !
ef ' Approved []Owner Given Initial �c��oo I r71111 C n ����
Adverse Determination
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD- 6398 (R.11197) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber
t
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3_ All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be propedy maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608- 266 -3151.
To be complete and accurate this sanitary permit application must include:
I.; Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system.areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
II through surcharges r used for monitoring groundwater contamination investigations
The monies collected t oug these are g g e
and establishment of standards.
Safety and Buildings
2226 ROSE ST
LACROSSE WI 54603 -1905
TDD #: (608) 264 -8777
*&consin www.commerce.state.wi.us
Department of Commerce Tommy G. Thompson, Governor
Brenda I Blanchard, Secretary
July 06, 1999
CUST ID No.268093 ATTN.• POWTS INSPECTOR
ZONING OFFICE
HELGESON EXCAVATION INC ST CROIX COUNTY SPIA
W1229 770TH AVE 1101 CARMICHAEL RD
SPRING VALLEY WI 54767 HUDSON WI 54016
RE: CONDITIONAL APPROVAL
APPROVAL EXPIRES: 07/06/2001 Identification Numbers
Transaction ID No. 234323
Site ID No. 175779
SITE• '5 g' Please refer to both identification numbers,
Site ID: 175779 above, in all correspondence with the agency.
St. Croix County, T of Warren
SW1 /4, NE1 /4, , 29N, R18W ( 'YV'U 4 �a
Facility: Keith Solimar Residence
FOR:
Description: Three Bedroom Mound System
Object Type: POWT System Regulated Object ID No.: 477690
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED.
The following conditions shall be met during construction or installation and prior to occupancy or use:
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. 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
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.
Sincerely, DATE RECEIVED 06/25/1999
FEE REQUIRED $ 190.00
FEE RECEIVED $ 190.00
6rard M. Swim BALANCE DUE $ 0.00
POWTS Plan Reviewer - Integrated Services
(608)785-9348, Mon - Fri, 7:15 AM - 4:00 PM
jswim @commerce.state.wi.us WiS IAR ' "
INDEX SHEET
PROPERTY OWNER: KEITH SOLIMAR F
6902 LAKE TERRACE E '
WOODBURY MN 55125 99 9
PROJECT NAME: KEITH SOLIMAR 4 /
PROJECT LOCATION: SW 1/4, NE 1/4, S 5, T 29 N, R, 18 W
MUNICIPALITY: TOWNSHIP OF WARREN
COUNTY: ST CROIX
CONTENTS:
Page 1: Plot Plan
Page 2: Cross Section & Plan View of Mound
Page 3: Distribution Pipe Detail
Page 4: Cross Section & Specifications of Septic Tank &
g p p
Pump Chamber
Page 5: Pump Specifications
Name: Bennie Helgeson Signed —,, _ �
Address: W1229 770Th Avenue
Spring Valley, WI 54767
Credential number: 220292 Date: June 22, 1999
. o
Note: Owner wishes to install a bathroom in his poleshed.
C01I t pn ljy
This is for his own personal use. v i D
CE
94; �14 VOF COMME�IDINC4
• �,• �ea rc�er � �..�
, C1
w
J
z
- 5
n
kj
_ s U
lt
e 4 a
C CO-
c
c
T,A �
R
n
4
b
LA , s
Page Of
9 — —
Straw, Marsh Hay, Or
Synthetic Covering
Distribution Pipe
Medium Sand �
S�ucrt'I Q17.$0
H �' 9 3U
Topsoil -- -- ��= F
E l; D
3 /
' a
qg,3
% Slope.
Bed Of
in 2 %2 Force Main Plowed
Aggregate From Pump Layer
D Ft.
.�8
Cross Section Of A Mound System Using E Ft. F Ft.
A Bed For The Absorption Area G / Ft.
A Ft. H Ft.
Signed: B Ft.
License Number: K Ft.
L JLI�(Ft.
Date:
j 01'•_3 Ft.
T 7 Ft.
Force Main W 3 (_ Ft.
L
I Observation Pipe
o
. A I _ ----- ------------------
— '� Distribution Bed Of z — 2 2
Pipe Aggregate
Observation Pipe Permanent Markers
Plan View Of Mound Using A Bed For The Absorption Area
_ ' (JZ.I�•IL) e: -lr'' �t L I - VI �U 1 1 �'l.�l.Y
Perforated Plpe Oeloll
0
End Vle.w
) Perforated
-End Co '' "
t -40%.0 C' s PVC P. °` Permanent End Markers
s Holes Located on Bottom
are Equally Spaced
PVC Force -Main
* From Pump
/Q PVC
ENO Manifold Pipe
CAP
Pvc.
Oislr button...
Plpe
Lost Hole Should Be
Next To End Cop
Distribution Pipe Layout
P 3�
R
• S
X
Y
Signed: Hole Diameter Inch
License Number: Lateral " Inch (es)
Date: Manifold " a Inches
Force Main " �_ Inches
116�t�S per- 0.��
Eteu, 171
r I C
Uw 2►2 ` \e,I TYI oJO I WICK 1^ Pant F
PUPIiP CHA11,5 CROSS SE_ - AIVG _t"ECIFICAr10
VENT CAP - T `i "C.I. VEUT PIPE WCATHERPROOF APPROVED LOCAIMG
JUNCTION BOX MANHOLE COVER
Z.: = RO•^1 GOOK, 12 "MIU.
WWCOW OR FRESH I
AIR INTAKE I
f r
GRADE i 4" M
COWDUIT -- a_ -
-
- ----- - - --
-- - - - - --
\ 11 �
PROVIDE ( --
INLET AIRTIGHT SEAL
- T
I I I V
i I + I
APPROVED JOINTS
APPROVED JOIWT A II W /C.I. PIPE
W / C.I. PIPE ( I I EXTEUDING 3'
EXTENDING 3' ALARM ONTO SOLID SOIL
OUTO SOLID SOIL B I II
I 1 x
• I ON
C � I
ELEV. =00 FT. PUMPS --�
OFF
o
CONCRETE BLOCK
,. „
/0oo G f RISER EXIT PERMITTED OWL IF TANK MINUFACTURE:R HAS SUCH APPROVAL
750 CTa(• SPEC.IFI*GATIOAIS
SEPTIC
DOSE �A f �pS�Prv� TrcC cPcS� IJUMBER OF DOSES: =� -- -PER DAy
TANKS MALIUFACTURER:
TANK SIZE: 1 GALLOWS, DOSE VOLUME 10
'� INCLUDING BACKFLOW: °� GALLONS
ALARM MAUUFACTURER: '�' �I��- �'° c e — s 4A r 60J.
MODEL WUMBEK: 10 1 tlLA) CAPACITIES: A= INCHES OR -/- GALLOWS
SWITCH TYPE: Mr r&(Alr= B = — INCHES OR S�;Z • GALLONS
PUMP MANUFACTURCR: � -' -� C s, L..—IWCHES OR /0-.� GALLONS
MODEL NUMBER. l F 3 L D- 2,-S INCHES OR . 1 GALLONS
SWITCH TYPE: - I-� M''Pm Flbo7 MOTE: . PUMP AND ALARM ARE TO BE
MINIMUM DISCHARGE RATE GPM INSTALLED ON SEPXRATE CIRCUITS IF
VERTICAL DIFFERENCE BETWEELI PUMP OFF AND 013TRIBUTIOM PIPE. FEET 99 -6 0
+ MIAIIMUM NETWORK SUPPLY PKESSURC.... . . . .. E
� 5 �-� FET
+ FEET OF FORCE MAIN X 3 F 1 n FRICTIOU ,
FACTOR...�t =..[_ FEET
TOTAL O'SUAMFC. HEAD = Ls2 FEET
f/ .i
INTERNAL DIMCUSIOMS OF TAWK: LEW&TH ;LIQUID DEPTH
- )6. 3 ( J. I Pr J riG�
51GUED: LICENSE WUMBER: DATE:
{ ,A:
WAAMns Top
MEMO
� r A
4
,� \ ■ ■��� ■ ■v \ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■
' ■ter. ■� ® ■ ■ ■ ■ \� ■ \� ■ ■ \� \ ■ ■ ■ ■ ■■
-,.'v tl ,',k�l i. i <'S i i X1 tit '7u t �.�r' ?. r '_ ,. is � •
i. F• ,w, e ,i I(; it u,�; � ht i; S� r'!.�; .ni t,�j i� .t,: to ,.,,_ ., 0 _
� r e
,�� ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ MODEL 388
SIZE 1/4 It Solids,
. .........................■
.................... ■......
mi■■■■■■■m.■■■■■■■■■■■■■
LL',v��T� 1��5 c�✓�
Wisconsin Department of Industry is. MAW
]' EVALUATION /
Labor And Human Relations ' "'°"�, Page of
Division of safety and Buildings In accordal a with s. 1�t R 83.09, Wis.
Attach complete site plan on paper not less than 8 1/2 x 11 Inches in size. + Olen must County
Include, but not limited to: vertical and horizontal reference paint (BMh di r on an
ST C,('oi X
percent slope, scale or dimensions, north arrow, and location anddstanc; are gt Parcel I. #
y� ' /O 7 7• SO
QuN? v 04 • /D O
APPLICANT INFORMATION - Please print all AY6Yffjjff 7VAewed by Date
Personal information you provide may be used for secondary purposes (Pfivegl.., (m)).,,,
Property Owner - Property Location p
Govt. Lot 574/ 1 14AIg 1 /4,S T .2 / ,N,R /,g E (or V1�
Property Owner's Mailing Address L�� 4BIock# Su�. Name 661) , / �� `o
City n State Zip Code Phone Number Nearest Road
AW I ss /Zs (�isl) 7�y 4 ❑ Cly V a Town
ew Construction Use: DOesidential / Number of bedrooms Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
y5" 10—
Code derived daily flow && V gpd Recommended design loading rate bed, gpd/fe ' S trench, gpd/ft
Absorption Area required bed, ft 2 ✓ eo trench, ft Maximum design loading rate bed, gpd/ft • s trench, gpd/ft
Recommended infiltration surface elevation(s) SeZ • 3 �,cft (as referred to site benchmark)
Additional design/site considerations Si'�E Uji1?�S * -V ,&lfJ rev j S ly T
Parent material !9&& 19W19 eL`X Flood plain elevation, if applicable ft
S = Suitable for system F�C MMou ' In- Ground Press AT -Grade System in Fill Holding Tank U = Unsuitable for system S t�'u L`fs U ❑
S ll�u [Is u ❑ S El s u
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft
In. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench
0-7 /oYre 31 L.S' 74 e4e cS z r� - . 7 g
/o yve 3 1Y G S 44,4 1'11 - e CS /7t ` 7 - 6
Ground .4J /0 Y � — LS �, y "r S • 7 . U
elev.
Depth to
limiting
factor
Remarks:
Boring #
/o LS / fir
Ground /6 Y/Z 6
May. S VA
58` ft. ,
Depth to
limiting
fa or
In. Remarks:
CST Name (Please Print) Signature Telephone No.
7/s 386. 9/8s
Address Ulbricht & Associates Date CST Number
Private Sewage Consultants
655 O'blell Rd
Z.
Hudson, Wis. 54016
0RIG1NAL
PROPERTY OWNER Page of
Sb�i�irY' SOIL DESCRIPTION REPORT Z 3
—„
PARCEL I.D.ff 7 CMG o 4/1 / D 7 7 - Sa Qy� - /67 7 • Sp -
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench
9 SOW 3/) Gs i1" fle ' 4n �
Ground , l /0YJ Y/4 5 - 1& 1.7Cr ", 6p
elev. rt S s cots SQL ���nj� /YN 7`"i
Depth to 's A,
limiting
fac or
Z In.
Remarks:
Boring #
Ground
elev.
h, ;
Depth to
limiting
factor
In.
Remarks:
Horizon Depth Dominant Color Mottles Structure GPD/
Texture Consistence Boundary Roots
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring # ;
Ground
elev.
ft.
Depth to
limiting
factor
"' Remarks:
Boring #
13
Ground
elev.
R
Depth to
limiting
factor
� in.
Remarks:
SBDW -8330 (R. 08/95)
t
d�
I
G �
O
LN w
C�. N :Q
a �
o
a
tv.
O t
o
i
V s
y
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND I
OWNERSHIP CERTIFICATION FORM
Owner/Buyer KEITH & KAREN SOLIMAR
Mailing Address 6902 LAKE TERRACE EAST, WOODBURY MN 55125
Property Address 114 ID 4 "
(Verification required from Planning Department for new construction)
City /State Parcel Identification Number 042.1077.50 & 042.1077.90
LEGAL DESCRIPTION
Property Location SW %4, NE %, Sec. 5 , T 29 N -R 18 W, Town of WARREN
Subdivision , Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # �9 , Volume 13 , Page #
Spec house ❑ yes q 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
master plumber, journeyman plumber, 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. Certification
stating that your septic system has been maintained ust be completed and returned to the St. Croix County Zoning Office within 30
da s of the three ye expiration date.
SIGNATURE OF APPLIC 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 roperty describ d above, byvirtue of a warranty deed recorded in Register of Deeds Office.
c
OF P CANT 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
`COL- ,3S1?i
WARRANTY DEED KATHLEEN H. WALSH
REGISTER OF DEER
3T. CROIX CO., WI
' Document Number: RECEIVED FOR RECCWIV
12 -14 -1591 8:00 An
W RANTY DEED
Y
Retum Address: EXEMPT II CERT COPY FEE:
CORY FEE: '
i• TRANSFER fEf: 9Cb.00
RMSDIH6 Fff: 10.00
Parcel LD. Number (PIN): 042 1077 - 50; 042 - 1077.90
This Deed, made between Frederick G. Lenertz, aik;a Frederick G. Lenertz, Sr., Grantor, and K.ah F.
Sclimar and Karen L. Solimar, husband and wife as s;:rvivorship mac:tal r ^r- ert
F y, Gra ntee, x
Witnesseth, That the said Grant., ;or a valuable cons; de,at;oc,, conveys to Grantee the foliow;ng
desc +ibed real estate in St. Croix County, State of wsc -,ns ^.:
Ail of governme it lot five ;5} of Sect;on 2F, Township 29N, Range 18W. Also, all of
government lot six 16) of Spction 28, Township 29N, Range 18W, except that parcel
desc bed in Certified Survey titap, Vole -:me C%rre, page 22<% Document No. 332738.
xe
This is not homestead property.
Together with 0 and singular the here :;tarnents and appurtenances thereunto belongin
g� y:
And Frederick G. Lenertz warrants that the title is_ good, indefeasible in fee simple and free and clear of
encumbrances except easements and restrictions of record and will wcPrant and defenA the :.=me.
Uated this 11 th day of Dec ber, 1998. s
`� -
Steven B. Goff, Power of Attorney f r
Frederick G. Lenertz, a,kia Frederic G rtz, Sr. '
ACKNOWI- FOGMENT tl
STATE OF WISCONSIN f
ss.
ST. CROIX COU14TY f ;
Personally carrlc 5efore me this 11th day of December, 1998, the above namac" Steven B. Goff to me
known to be the persc)n who executed the foregoing instruriers an6 ack;iowledge the sarge.
Parnela A. Skorude, Notary Public U _
St. Croix County, Wisconsin
Tt`i� IWSTRUMt;�iT DRAFTED BY:
10y Commission expires %larch 17. 2001 U $ �
-
Steven 8. Goff
;ye, Goff & Rohde, Ltd. ^' �'•...�
PO Box 187
River falls, WI 54C22
SB61ENEF! ?21iCreuziget1D1 WD
T