HomeMy WebLinkAbout040-1303-00-043
county: St. Croix
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division INSPECTION REPORT sanitary Permit No: 538852
(ATTACH TO PERMIT) State Plan ID No:
GENERAL INFORMATION
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Parcel Tax No:
Permit Holder's Name: City Village A Township 040-1303-00-043
C&J Builders Inc., c/o Jeff J. Husby Troy, Town of
Ins BM Elev: BM Description: tion: Section/Town/Range/Map No:
16 1 ie o l~ en 22.28.19.1778
CST BM Elev: P p /1 u1 A 1 l C.Jl!
~lJ ~V 6
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER , CAPACITY STATION yBS6 /OHI FS ELEV.
Septic z Benchmark gG /a~•~y /
w;~ z5a J a
Q 0, /64P
Dosing w~~e ~ D G Alt. BM r l
✓
A"aUen Bldg. Sewer
Od ld AC, 3.
St/Ht Inlet 3,7(P 14T Z
Holding
St/Ht Outlet 7. 3 /is Z. ~ `7
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent toAirIntake ROAD DtInlet c/9.3y
Septic Dt Bottom ci Gf ` ,
Dosing 0 J Header/Man. L~ C~ ~a Z p
1 '
5, /17
Aeratio Dist. Pipe 16Z. CZ
Holding Bot. System S, ~GJ / 3 C,
Final Grade ~ . ~g /Q 3~ b Z
PUMP/SIPHON INFORMATION O djZ
Manufacturer Demand St Cover
Z 61B GPM r~ ( p ,
Model Number ^ ( SZ~ ,/OO /S
TDH PEI Friction ~ sLSystem 3ai5 T 16/ 311Ft c~
Forcth / Dia. A Dist. to Well , s 1
Zd Z
SOIL ABSORPTION SYSTEM
Di.
PIT DIMENSIONS No. Of Pits Inside a Liquid Depth
BED/TRENCH Width ~ Length No.Oy~Tren EWELL
DIMENSIONS
SETBACK SYSTEM TO P/L BLDLAKE/STREAM LEACHING Manufacturer:
CHAMBER OR
Model Number: `
INFORMATION Type ystem: /6UNIT
J
DISTRIBUTION SYSTEM Air to
/ r
Header/Manifold x Hole Size x Hole Spacing vent to
7
to
=Le /
" Spacing
Length Dia 1'~j
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only ,a Mu ed
Depth Over Depth Over xx Depth of xx Seeded/Sodded
Bed/Trench Center BedlTrench Edges Topsoil I P t .yes a No es No
/f section
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection # 1610 p
Location: 220 Walnut Way Riv r Falls, WWII ,54022 (NE 1/4 NE 1/4 22 T28N RI 9W) Walnut Hill Farm aka The Trl Qute ot_Parcel No 22.28.19.1778
1.) Alt BM Description
2.) Bldg sewer length = g. 5
- amount of cover = i
Plan revisio
n Required? Yes o Use other side for additional information. Date
3 4Snture
InseCert. No.
F4
SBD-6710 (R.3/97)
t~mmerce.wl. \Safety and Buildings Division County
201 Washington Ave., P.O. Box 7162 57-
C-y-oi,A
scO Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.)
me 4
e
,to
D O S 5Z
Sa Itd r 1~ icafion 4fi'atoTransactionNumber
11 V
In accordance with s. Comm. 83. (2), B of this form to the appropriate g( venunenta
unit is required prior to obtainin a ote: Application forms for state-owned POWT Prod ss (if different /mailing address)
submitted to the Department of ersonal information you provide may be used for secondary
purposes in accordance with the Pri aw, s. 15.04(l m , Stats. ,rte
1. Application Information - P e P ' 11 Information U
Property Owner's Name / 3 J Parcel #
to. Gd-- ~~:1 QCs o 116 a~
Property Owner's Mailing Address Property Location '~f Q~
n/ ~ i e d Ae (KI Pr - Go Lot ~ ~I l f ! V
City, State Zip Code Phone Number , /1E ?
q Section
1V/cy Z f211 a - y73 T N; R c~rcleone
1~ E or V~
H. Type of Building (check all that apply) Lot #
Subdivision Name
1 or 2 Family Dwelling - Number of Bedrooms
n4
❑ Public/Commercial - Describe Use
v ❑ City of
❑ State Owned Describe Use / I-J d PPOC o - CSM Number ❑ Village of
c It Town of Tr & k
III. Type of Permit: (Check only one bog on line A. Complete line B if applicable)
A. .4 New System
❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B • ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber F00WP---1 mit Transfer to New List Previous Permit Number and Date Issued
Before Expiration IV. Type of POWTS System/Component/Device: Check all that apply)
❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) /
V. Dis ersalffreat ent Area Information:
Design Flow (gpd) Design Soil Application Ra (gpdsf) Dispersal Area Re Dispersal Area Propo d ( System Elevation
6D ~0 i7) fDl~ .
VL Tank Info Capacity in Total # of Manufacturer ,
Gallons Gallons Units a w o , v
New Taaks Existing Tanks °
IAI f _ U
p la IBC 'J~ t3 r'8n w c7 a
Septic or Holding Tank f
Dosing Chamber t? .p LQ 1 +
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Signature MP/1v1PRS Number Business Phone Number
C'~ doss ! 3~ 991x' l
Plumber's Address (Street, City, State, Zip C e)
VIII. County partment Use Only
Approved ❑ ed Permit Fee Date Is Issuing t Signature
❑ rven Reason for Denial $ 1(1(x./ Z 7 / /
1X Conditi ~ easons for Disapproval
3 0,,;4 ve Aew v%e-bL - .
1 'teptic tank, effluant filter and
dispersal cell must all be services / maintained W`'t'~A
as per management plan provided by plumber, • ~(b.~RQ ~,RZ,~Q.(,
3 -All $06acktequ~tet>1e~lt must.be;maintained 4, I~
Attach to complete pbuis for the system and submit to the C 1 S
ounty only on paper not less than 8 i2 z 11 inches In size
SBD-6398 (K 02/09)
C
PLAN LO,T4 5 5 522.T29t~ I<IIW
15 AC. SCALr 1 r40
~ 46 AO a
4
Ffkce N a PrL f7n.`~j` L e
8Z 2 u~►1 °
%i'ggTee
C.o►+dw+~
j VJ=FJ~
750~Al-
f
~,ES~~ cG~c A,~d d
~ ~ 1250 GHi. (S,~riG
w/POLY LbG 5Z5
Pro posed
,aom~ 1
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4 w~-u o 1;
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RORD LOT-3 E-LIa~2.3 FOUND
v~y~aT~rF Safety and Buildings
3824 N CREEKSIDE LA
o~ P HOLMEN WI 54636
® Contact Through Relay
P S www.commerce.wi.gov/sb/
www.wisconsin.gov
_ ¢a
ssroNq Scott Walker, Governor
Dave Ross, Secretary
September 19, 2011
CUST ID No. 220554 ATTN: POWTS Inspector
CARL P HEISE ZONING OFFICE
TOTAL EXCAVATING ST CROIX COUNTY SPIA
W9905 710TH AVE 1101 CARMICHAEL RD
RIVER FALLS WI 54022 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 09/19/2013 Identification Numbers
Transaction ID No. 1979623
SITE: Site ID No. 770156
Jeff Husby Please refer to both' identification numbers, ,
Lot 43 Walnut Hill Farm above, in all corres ondence with the'agency,
Town of Troy
St Croix County
, SETA, S22, T28N, R19W
Lot: 43, Subdivision: Walnut Hill
FOR:
Description: Mound / Four Bedroom / Sloping Site
Object Type: POWTS Component Manual Regulated Object ID No.: 1328364
Maintenance required; 600 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade;
System: Mound Component Manual - Version 2.0, SBD-10691-P (N.01/01),
Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01/01); Effluent Filter
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
Reminders
• This system is to be constructed and located in accordance with the enclosed approved plans and with the
component manuals listed above.
• The float switch shall be a type that does not contain mercury. The 2009 Wisconsin Act 44 prohibits the n
installation of a float switch that contains mercury. Please specify an alternative product prior to applying for a
sanitary permit.
F
• Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. a
Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal c)rpp.RTMEW
are prohibited. hot:
Gam'
• The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption ;;EL t;Ca2P
area. chs. NR 811 & 812c
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
CARL P HEISE Page 2 9/19/2011
• Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated
county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat
• Comm 83 22(7) A copy of pproved plans specifications and this letter shall be on-site during construction
and open to inspection by authorized representatives of the Department which may include local inspectors.
Owner Responsibilities:
• Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and
maintenance of the PO WTS occurs in accordance with this chapter and the approved management plan under s.
Comm 83.54(1).
• Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as
required under s. Comm 83.54(4) shall be considered a human health hazard.
• Comm 83.55 The, owner is responsible for submitting a maintenance verification report acceptable to the county
for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s)
utilized in the POWTS.
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.
Sincerely, Fee Required $ .250.00
Fee Received $ 250.00
Balance Due $ 0.00
Charles L Bratz
POWTS Reviewer II , Integrated Services WSMART code: 7633
(608)789-7893 , 7:45 am - 4:30 pm Monday - Friday
charles.bratz@wisconsin.gov
cc: Carl J Lippert, Wastewater Specialist, (715) 634-3484
Total
Excavating',
N8618 1090th River Falls, WI 54022 Tel (715)426-1777 Fax (715)425-7314
TITLE SHEET
MOUND SYSTEM
FOR
A BEDROOM RESIDENCE
L o-T 4 -3
LOCATED IN THE X1/4 OF THE 1/4 OF SECTION.2V . T QB N, R~ W
TOWN OF .S7 Crai i _COUNTY, WISCONSIN.
INDEX
PAGE 1 OF 7 TITLE SHEET
PAGE 2 OF 7 SYSTEM MANAGEMENT PLAN
PAGE 3 OF 7 PLOT PLAN
PAGE 4 OF 7 PLAN VIEW - CROSS SECTION
PAGE 5 OF 7 DISTRIBUTION PIPE LAYOUT
PAGE 6 OF 7 PUMPING CHAMBER CROSS SECTION
PAGE 7 OF 7 PUMP PERFORMANCE CURVE
PREPARED FOR
&~x Omsby
319 Or
Byer 34I4s wx 540Z-Z-
PREPARE BY ~Carl Heise ~
CST/MPRS 2'20554
W9905 710th Ave.
River Falls, WI 54022
Cell 651-492-8594~`~y
Fax 715-425-7314 DVED
OFCOMME Cc
This plan has been prepared in accordance with the SBS Manual
=SPOND@N
I
Y
Mound System Management Plan
Pursuant to Comm 83.54, Wis. Adm. Code
She septic tank shah be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents o the
The s
septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and
outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to
ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that
may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if
the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 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, Safety and
Buildings Division.
Pump Tank
The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to
verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary.
Mound and Pressure Distribution Svstem
No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound
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 mound 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 mound be heavily mulched for frost protection.
Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg1L FOG. 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 clogging has occurred and if orifice cleaning is
required to maintain equal distribution within the dispersal cell.
Observation pipes within the dispersal cell shall be 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.
General
This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its
component manual [SBD-10572-P (R. 6199)] 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.
Continctency Plan
if the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition.
If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be
immediately repaired or replaced with a component of the same or equal performance.
If the mound 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 removing biologically clogged adsorption
and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper
operating condition.
Questions on the operation or maintenance of this system should be directed to your county zoning or health inspector.
C
VLOT PLAN LOT 5 5j~V4 522.T291,)I` ►lW 1-
I5 AC• SCAIr 1"f40'
~ 46 Aa
~-34 T4
B3
i~ ' ' " Y ? r ~~hG C N
aT
o~J,.~7jr L i w
8'(A , 2 Fok~~ °
7be l 'd z ~
Lon
FL,1 oo,LB
750GAL J
1~w~ ~ tl~.mbay~ I
f r
W t g51v K C OM 1250 GAi, S~QriG
/Pour Lbk 525
l e c(rccti~ r~Lw
Pro posed f
140 I
i
r
I
'o~p ,SP~L3 EL007,23 ~but~~
i
Non-Woven Filter Fabric
4" Obseriation Pipe Perforated
! Below Filter Fabric Distribution Pipe
j ;
ASM4 C-33 S a r %d
~N G
a Topsoil :sr.::.vr°- i ~l• dd
2 Slope
Bed Of Forte Noin "-~Flowed
Drain Rack From Pump Layer
1,12
F
CrCSS Section Ot A V.3und 5 ;teen Lsin E
A Red For The Absorplion Arco
G 0,5
A F E 1,0
6 4 Ft.
7 Ft.
F : .
K J2 Ft.
Ft.
C;
Force Hain ZI ~ Ft.
L
T j 4:'Observalion Pipe
E I ' -r K
_ ~ Force Main
W to From Pump
p Oistribufian bed of %Z"- 2
Pipe Drain RocK
I
Obifrrvetion Pipe Permanent Market'
Pipe or Rods
r
Pion Vier Of Mound Using A Bed For Tht Absorption Area
oars n-
Fy r:, ; 1 ✓M L_UND BUILDCRS LNG_ 715-•l
Distribution Pipe Lam P.0ge S of
Place the holes at the bottom of the distribution pipes
at equal spacing, Remove all burrs from the 'pipe and holes.
Extend the end of each lateral up with the use of long turn or 41, fitting to a point within six
imches of the final grade. Ter=inate the ends of the laterals with a valve,-threaded cap o:
threaded plug. Provide access from final grade for the valye; threaded cap or threaded plug.
`C P 1zt? L C, Znt S 5 u
1..3lersl M~nrktd tatsro!
Y t : xfI xn x x Y '
ofww Math - Ltien►JLtrpth - }P
(Pubh6 on 'M _
• h~t'rt•J V~~J
?-1 tCU 1 'rJ 44
~ ~1C,11v
• gy=p q.t`r Y~ t;L.
Hole diameter inch
S_ n Lateral " {'inch(es)
X-3-L Indhes Manifold " Z inches
1 We NTMAYr IT4 P Force Main ~--inches
b at e s t ne l itt r't)
#of holes/pipe
Invert. Elevation of-Laterals ~aJ,4 Ft.
45 X Zx.3o x ~ 5c:~ G.P.M.
• _trz12___.~t~4
,illaq,a-.,-
, :.i,u•~.:. v~ , = v.: ~ ..v .l. , K TA
?Iy.tLn'W:.age.-
PUMPCHAMBER CROSS SECTION grit' eP
r rr . :k: Yen>r Cap
' Weather Proof a
Junctton fox Appraved lacking manhole
cover w/ warning Labe[
12' MIN
I Final I ! a /
Grade i q 1l 4' MI1.5- MIN
Conduit
18' MIN ' Inleroved ! Provide i I
~JolrrC u A Airtight Seal 1 III Approved
Al I I I Jolnt5
!1 1 I III - ~ .
, I Alarm 4
r I 1
11 I G Pump I on
ELEV. ft Off ELEV, ft
{ 1
! IF Concrete Block «
V approved bedding material under tank
SPECIFICATIONS
z'~S~ Izd
Note: Pump and alarm are on separate Number of Doses: Per Day
circuits as per ILHR 16.,Y3 Wis. Adm. Code Gallons'Per Day of Doses: X26Gallons
za Volume of Backflow: o?; 5 Gallons
Tank Manufacturer: Ua 1 F'SE~ CQNC,ff0V Total Dose Volume: V2Z A5 -Gallons
Tank Size: Gallons
Alarm Manufacturer:-_-s_.. L 1 CC,*0 Capacities: A q inches or 41DI) Gallons
Model umber: ON ENCE B Z inches or2 Gallons
7Tu C " inches or 12,445 Gallons
Pump Manufacturer: zb L D I(Y,74 inches or 11112- Gallons
Model Number: 5 Total - a inches or44 , 9 q Gallons
Minimum Discharge Rate: EJA GPM
Vertical Difference.Between Pump Off and Distribution.Pipe ~JFL
Minimum Required Supply Pressure: + ?,5_ Ft.
13- Ft. of Force Main xL+LL Friction Factor/100 Ft + ,41 Ft.
Total Dynamic Head = ILQ Ft.
Internal Pump Tank Dimensions: Length Width Depth to inlet
+5~' afaa': .
~i.
•4
:F+ ••L• `:'13'.: - _ ..5., •,~:.~da _ ~F'.. ~''i:. rat,
.rSlgnature: License'Number 'Date
i
-
`c
.
P , V
_ TOTAL DYNAMIC HEAD/CAPACITY
HEAD CAPACITY CURVE PER MINUTE
EFFLUENT AND DEWATERING
MODEL 152/153
MODEL 152 153
J
I~ 50 Feet Meters Gal. Liters Gal. Liters
153 5 1.5 69 261 77 291
40 10 3.1 61 231 70 265
2-? t52 15 4.6 53 201 61 231
20 6. t 44 167 52 197
30 25 7.6 34 129 42 159
z 8 30 9.1 23 87 33 125
I 35 10.7 22 85
a 20 _
40 12.2 - 11 42
1
4 ) Lock Valve: 38.0 Ft. (11.6m) 44,0 Ft. (13.4m)
10 eusa
20 40 60 80 100
Gx~iONS 6 1/4
BITERS 0 80 160 240 320
3 27/32 sJ6
FLOW PER MINUTE
3 I7/32 •
CONSULT FACTORY FOR SPECIAL APPLICATIONS _
Timed dosing panels available. 3 27/32
Electrical alternators, for duplex systems, are available and supplied with tttttI---- ;
an alarm I f---~-
Variable level control switches are available for controlling single phase I
systems.
Double piggyback variable level float switches are available for variable
level long and short cycle controls. '
Sealed Qwik-Box available for outdoor Installations. See FM1420.
Over 130'F (50C.) special quotation required.
1521153 series 12 1/8
_
_ t521t5J 6100E S ontrol Seloctl"
5 1 /a
Model , Volt ^ foode_ Shn~tac Duo"
NSS2 115 1 NM 6S 1 0r3
11N t 52 ! 115 1 1 AUO 6.5 k%kKW 2 or 3 slaosa
J
E 152 270 t Non 4.3 1 200
BE 152, 230 1 Aub 41 ktckded 2 or 3
N151 115 1 Non 10.5 1 2 of 3 SELECTION GUIDE
8++153 115 1 j AM 10.5 Irdided 2or3
E 153 230 1 Non 5.3 f 2 a 3 1. Single piggyback variable I" Am( switch or double piggyback variable level Aoaf
BE 153 230 1 ALO 5.3 ktrltded 2 or 3 switch. Refer to FMO477.
a A N 2. Sae FMOT12 for correct model of Electrical AAemoor E4)zk.
au eostanation of controls, protection devices and wlriny should be done by a quslhled 3. Variable level control mw O 10-TM used as a ow" aCOveor, spe* duplex (3)
kCtnseo 1400nGan. All oWbiul and safety codes should be followed includlnp the most W t4) Aoat system.
•ecem Nauonal Ettotic code (NEC) and the Occupational safety and Health Act (OSHA).
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
MAX TO: P.O. BOX 16317
coueviire,KY 402664347 atrratadtreraor..
SHIP T0: 3649 Carr Rip Road
tl toulevAe. KY 40211.1961 (aurrPiauw S+a'~ 47 Ja y
h rra; fnv+vw. zt»lhr. cunt PUMP !f!, rso2f FAXr5027 ~0j~26
0 Copyright 2001 Zoeller Co. All rights reserved.
Oct-19-2010 01:59 PM St. Crcix County Plan/Zon ng 715-386-4686 1,`1
ST. CROIX COUNTY
SEPTIC' TANK MAINTENANCE AGRI.EWNT
AND
OWNERSHIP CERTIFIICATIO/N~ FORM
Owner/Buyer _ --S5 Y dCC
jjq
Mailing Address
Property Address W aJ L& X W-LI
(Verification required from PIAnning & Zoning Department for new c structiun.)
r.
City/State t if Parcel Identification Number
LEGAL DIE PTION
Property Location 14. Sec. 02J , TQ 9 N R) f W, Town of T o
Subdivision Plat: w A,, L t#-43
.
Certified Survey Map Volume, Page #
Warranty Deed # 9 ;3 Q (before 2007)Volunie Page #
Spec house yes Ito Lot lines idenliliablo - yes : 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 fttnction of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities aro specified in §Conun. 83.52(l) and in Chapter 12 - St. Croix County Sanitary Ordinance.
7'he property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, sighed by the
owner and by a master plumber. journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposd system is in proper operating; condition and/or (2) after inspection and pumping (if necessary), the septic lank is
less than l!3 toll of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards sat 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.
Ilwe certify that all statements on this form are trite 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 Offto&.
Number of bedrooms
1'/
r r
SI NATURE OF APPLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. r
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. 08105)
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I
8 0 3 0 8 8 4
Tx:4021836
STATE BAR OF WISCONSIN FORM 3 -2000 938028
Document Number QUIT CLAIM DEED BETH PABST
REGISTER OF DEEDS
THIS DEED, made between Citizens State Bank, Grantor, and C & J ST. CROIX CO., WI
Builders Incorporated, Grantee 06/24/2011 08.S6 AM
Grantor quit claims to Grantee the following described real estate in St EXEMPT#. NA
Croix County, State of Wisconsin (the "Property"}: REC FEE. 30-00
Lots 33, 43t 44 44 55, 58 and 72 of Walnut Bill Farm All in the Town of TRANS FEE: 623.40
Troy, St Croix County, Wisconsin.. PAGES. 1
i
i
Recording Area
Name and Return Address:
Title One # 16514
i
Together with all appurtenant rights, title and interests. 040-1303-00-072, 040-1300-00-049, 040-1303•-
00-058, 040-1303-00-043, 040-1303-00-044, i
Propex•ty sold 'as is'. 040-1303-00-055, 040-1303-00-033
Parcel Identification Number (PIN)
This is not homestead property.
ank
* Thornas W. Van Pelt, President & CEO
_ i
f
AUTHENTICATION ACKNOWLEDGMENT {
STATE OF WISCONSIN }
Signature(s) ST. CROIX COUNTY. ) ss
1
authenticated this Personally came before me this 1'7th day of .June, 2011
the above named Thomas W. Van Pelt, President & CEO of
* Citizens State Bank, to rice known to be the person(s) who
TITLE: MEMBER STATE BAR OF WISCONSIN executed the foregoing instrument and acknowledged the
l
(If not, same 7 .
authorized by § 706..06, Wis Stats ) _ OEA i
I141S INSTRUMENT WAS DRAFTED BY L,(r1~'puipl~ 1r * el M se er
E pl8
Notary Public, State of Wisconsin
My commission is permanent. (If not, state expiration date:
Michael H. Forecki, Attorney
(Signatures may be authenticated or acknowledged. Both are not necessary) 8126/2012 ) I
*Names of persons signing in my capacity must be typed or printed below their signature
F
QUIT' CLAIM DEED STATE BAR OF WISCONSIN FORM No. 3-2000
s
1 of 1 s
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1I I T UND} B7-
E I/4 CORNER
WALNUT I =rI 8 k nEt>ZQI~I SEC. 22 g0.15'-
HILL FARM ;;RN; I lw bA, ne24 _ b45Y 2M,N' b7.617
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42 I.
LOCATED IN PART OF ll[ SOUTHEAST 1/4 OF THE SOUTHWEST NW r I \ I BI 46 Ix I µ h I / m2e7 s.F.
1/4 AND IN THE SOUTHEAST 1/4 OF THE SOUTHEAST 1/4 AND IN W \ 48 I ' 16tH SF 116708 SF. 14 143 1.18 Ac. 1
PART OF THE SOUTH" 1/4 OF hTE SOUIIEAA 1/4 AND IN 47 ~.os A<F I xl 1.06 At i~ 11.07 k I" I 5 A, 4yy N N~eyr E n7-n
r.. 91 \ \ h B THE NORTHWEST 1/4 OF 1HE SOUTHEAST 1/4 AM NI PART OF ~0A' `a C r \ s ~J17 xh fl 111---4 I--J" I /A j 41
THE SOUTHWEST 1/4 OF THE NORTHEAST 1/4 AND IN PART OF 1r ill \ \\'N k \ S\ G : + \ IRAti / 4446 IF.
Ig N
THE NORTHEAST 1/4 OF THE SOUTHWEST 1/4 AND N4 PART OF II I 7" L i \4 s\ AS I . I -I.., @ / =02 Ac.
THE NORTHEAST 1/4 OF THE SOUTHEAST 14 OF SECTION 22, I -
TOWNSHIP 28 NORTH. RANGE 19 WEST, TOWN OF 1ROTT, ST. CROIX I 140 48 : N N,1(7 E A
: 5mo xf. -
COUNTY, WISCONSIN. 111a6It IF.
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SETBACKS: 9~IAT 41 ,,,o+? will N u= AXT
FRONT SETBACK = 75' (UNLESS OTHERWISE NOTED) { I I 511177 E 2177Y 4 I °o
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SIOE SETBACK = 25' (UNLESS OTHERWISE NORM) T I r =51 h ! A y / 88 '
\ I 1 15'51' I snw'
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REAR SETBACK = 25' (UNLESS OTHERWISE N' IN I sl I I _ -1 t [7 62869 IF.
(FRONT SETBACK MEASURE FROM A-O-W) 1.44 At
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I I 111 I: /t/ n of Ji~IS r 49101 IF,
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\ 311 I~ ` ' ` ~ 1 ?0 - y
(Km OHM Non) N 122 Aaw 1 lull'
SET . if
DRAINAGE EA WNW 1 1501L6 6roNPx Sys I' 120 IN sI'- T x s~' l\ Nokir
NEE • 0 WATER EXION AI ALL OTO 10 BIERS 49671 s.f.l~ 81 1A I - - y7- - \ ~I 30 ( „A r
I \ 71 1.14 At. kI 27 Ia 128 I SI I 47722 SF.I
LBO• LOWEST BUtDrlOOPENNO_ _ _ _
9 ML 1 i... Vt I § 55361 S,FI" 115277 Sf. °I E
r 1 I110 At./
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' I 1L--~ I- I I----11 1.04 Ac.---\
NNW' 1 ` U7.OY I/L91 ricsY 752.51' A. Ue)e•
2129.11' MATTED Lµ05 SOUIN lNE OF RE SE 1/4 SE CORNER
S WSW W 276212' Qr~D~y~ SEC. 22
RENSED: 11/06/03
SHEET 3 OF 5
t
saorlsirt Department of Commerce SOIL EVALUATION REPORT Page ~ of 3
WDivision of Safety and Buildings
in accordance with Comm 85. Wis. Adm. Code county 57-.
Attach compietr C
include, but not EROSION CONTROL PLAN must be Parcel I.D. 407-
percent rN
.vD~~ G-- b
►d pe
completed before sanitary permit issuance Re by Date
P-0" ►ntorr Wn you provide may be used for secondary purposes (Privacy Law. s. 15.04 (1) (m))-
Propertiowner rev.9 Property Location D
T-OPP B31r R5 Te7fl T- 5/0 A!!G^' #A, Govt, Lot A/1 vn ~ 1 /4 L T Z~ N R I ! & (or) W
Property Owner's Ma&M Address Lot # Block # Subd. Name or CSM#
f'oot5 CAWi/,I- AU-e- 3 wALNvr tl FAR !
City SNi R State Zip Code Phone Number City ❑ Village (,d Town Nearest Road
6.9000 ..H73; M,v 5SD76( &51) 2.1y' r. f -r-Roy so. 6110068
0
OZ~ GPD
(INew Constudion Use: M Residential ! Number of bedrooms Code derived design now rate ~ r
❑ Replacement ❑ Public or commercial - Describe: - f
Parent material /Oars 00p, Tr !1 S Food Plain elevation if applicable ft.
General comments
m
and neomrr . /t-,p SUrTi~Ql~` i9' /f'I JU.Vv S y~'? 3H
and urfeadations: rT
AlSi,v G- -Ft i I .
NN
F/ Boring # ❑ Bong I q • 1 GI s -S✓
o Pit Ground surface elev. ft. Depth to limiting factor ` in. Sol Application Rate
Horizon Depth Don *wt Color Redox Description Texture Structure Consistence Boundary Roots GPDW b
In. Munsell Qu. Sz. Coat color Gr. Sz. Sh. •Eff#1 TOM
L /fSbk GS 3
2 11:2Y !v y/f vie e- 51t- / S k CS • Z • 3
3 -33 .5 R 42 m 073 G L ShK vG~ 5- • Z • 3
Ago U042
3' y /0 S 3 P rt o r5 5! G v° u
norlng - Z
# ® P Boring
Ground surface elev. ft. Depth to limiting factor ZS n..S •.S%S'
Soil Application Rate
Horizon Depth Dominant Color Red ox Description Texture Structure Consistence BoundaryRoots GPM I1►
in. Munseti Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
J 0-13 io y~ 3l SiL a ~s K lit 1-w 3 l • 5 N
z 13 • /81 /6 Y9 S1 Z- ! S K zf Gw • Z- • 3 N
g• z5 '/0Y4 S/ SiL 2,,w Sh CS . S
7.
Effluent #1 = BOD > 30 < 220 mg& and TSS >30 < 150 mg& ' Effluent #2 = BOD 130 f%& and TSS 130 mo-
csT Name (Please Prim R , Zt ~E3 R i G k~ Sgnaa,<e W - 3 5
Address Ulbricht & ASS9CiateS Date Evaluation Conducted Telephone Number
Private 7U- • 77A • 3 yy Z-
2812 10th Ave.
Spring Valley, WI 54767
j N A L
13 W,41,tiV r- h"111 lt~ / M
-TOV~ s r~oT-
Property owner i~arrer ll7 Zo T y 3 Z 3
Page of
05 -5-S.
3 t Ground surface elev. CM
It. Depth to rim" factor?~_ irL Y.
H torfzsm Sal orxetior3 Rate
CeVth Dominant Coktr Rector Description Texture Stn.octurr~
Munse#i Cu. Sz. Cont. Color Gr. Sz. Sh. Consfstertce Boundary Roots GPF3fllr
irt. `Etf#1 *EM
2
/ 0.1( /0 VR a 2~F ~QcS 7~ • S
3 4 '21/ io Sig ~Sh c . s
/o R cav- Mors S~cL /~FSh~ X
/0
Baring ft ❑ POwing
it Ground surface elev. _ 1t. Depth to limiting factor. in.
Norizort Soir icatiort Rate
C~pth Dominant Reftx CtiescrlpfW Texture Sure Consistence Boundary Roots GPC
Munson Qu. Sx. cont. Color Gr. Sz. Sh. `Efl#9 `l`fffl';
_ J ❑ Pit Ground surface elev. ft. Depth to limning factor in,
Svc Rate Offication
Horizon t]epttr t7arrotnant Color Ftedox Description, Texture Structure steroce Boundary Roots GPi?lfil?
In. Munseit Qu. Sz. Corot. Color Sz. Sh. `Et 1 `Eff#2
Boring X ❑ Boring
❑ Pit Ground surface elev. Zft. Depth to limiting favor in.
Soli} Rate
Hortzon Depth t' mtnant Color Redox Desert Texture Structure CDnsistence Botmdary Roots GPDffe
In. Munsell Qu. Sz. Cent. Qbw Gr. Sz Sh. `E#f#t `Eff#2
PLOT PLAN WALNUT HILLS FARM. LOT # 3 Pg. 3 of 3
= Contour elevation lines.
• = Backhoe Soil pits.
0 = Benchmarks set, maRKED WITH FLAGGED
lathes. 1/2" steel conduit pipes.
SCALE : 1" = ZO I
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Xr 7K
f D of
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oy 0
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rip" D o to
lie
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of
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