HomeMy WebLinkAbout002-1067-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No: • " . 20415 0
GENERAL INFORMATION (ATTACH TO PER. ✓IIT) 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:
Nelson, Adam I Baldwin Township 002 - 1067 - 10-000
CST BM Elev: Insp. BM Elev: BM Descn tion:
TANK INFORMATION - ELEVATION DATA ' z�'I 6 - `f 0 - 7
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ov h al Benchmark ! / bG • 0
Dosing Alt, BM
Aeration Bldg. Sewer
8,7g /00t 5 _7
Holding SUHt Inlet
_ q. ("� 11. `7 /
TANK SETBACK INFORMATION St/Ht Outlet 3 9�j -Sli
TANK TO P/L W_ E,�L BLDG. �to Air Intake ROAD n e 1 �
W e
Septic t tat Bottom
Dosing SO Header /Man.
Aeration Dist. Pi e� If
Holding Bot. System
-l•97 t1v.�
Final Grade (�-
PUMP /SIPHON INFORMATION lip
Manufacturer Demand St Cover 2
GPM N ti -L-eV 3 L -
Model Number 0 - ti - d
h�-5 1 a �!
n Li ' / Fric`io L,yss Syste Head TDH Ft
(% 3. Gao IDO. o
Forc main I Length Dia. Dist. to� Wei
� Sf & / . -3 f ob 2 IQd • d
b✓ r'� d i== 1�'/l'' & 7
SOIL ABSORPTION SYSTEM -. 4 r
BED/TRENCH Width ength No. Of rrepches� PIT DIMENSIONS No. OF Pits Inside Dia. Liquid Depth
DIMENSIONS /�
SETBACK SYSTEM TO P/ BLDG IWELL i_AKE /STREAM LEACH1UP Manufacturer:
INFORMATION T e f stem: CHAM OR
Ty y /�� �5( NIT Model Number:
DISTRIBUTION SYSTEM (J
Header /Manifold Distribution / I It x Hol Si e x Hole Spacing Vent to Air t e
!, # Pipe(s) CM r " t' —364
Length Dia 1 1-ength Dia Spacing _' /
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil
I I Yes Ljj Yes LEI No
COMMENTS: (Include code discrepencies, persons present etc. Inspec ion #1: 1-2" r y Inspection #2: / / Q 3-- t'4' I - 7 /0 Z — �u In s eR e (�
411 � c ,
Location: 769 240th Street Baldwin, WI 54002 (SE 1/4 NW 114 27 T29N R16W) N of Parcel No: 27.29.16.4 r
1.) Alt BM Description =
2. ) Bldg ewer length = 1��4s
9 g �� �� ► §� 0� � bR �; ny I f y/1' ktA,re obsew" G� Q,� So / Olurrnbtr "I VI rhJ <6Q
- amount of cover
3.) Contour q�
Plan revision Required. Yes Fit, / --
Use other side for additional information. t
SBD -6710 (R.3/97) Date Insepctor's Si nature Cart. No.
°I 2 yo
Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave.
`SC0I1S See reverse side for instructions for completing this application PO Box 7302
Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302
Department of commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not
9 - 30 - 6 z___ !1 f A05'S state owned.)
Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size.
County State Sanitary Permit Number ❑ Check if revision to previous application State Plan I. D. Number
C 1 3
I. Application Information - Please Print all Information .
anon•
Property Owner Name a r Pr rty Location p 7
lobw •
f 1/4 "/ 1/4, V7 T.? >N> 1 i E (oCl�'
Property Owner's Mailing Address 2 02 Lot umber Black Number
City, State Zip Code Phone N her S, T. f: " e or C.SA4�Fnmber
II. Type of Building: (check one) as ?w s a•+s. ❑ City
❑ 1 or 2 Family Dwelling -No. of Bedrooms: ❑ Village
13 Public /Commercial (describe use):_ �4�L �py al of
❑ State - Owned �/fL
Nearest Road
.Z
nn "n /I n sT,
�o r cf0 h1V6U. CJtxaC. ��b « _ �20. rr Sa>1ndC P I� Nu Ks) _
III. Type - of Permit: (Check only one box on line A. Check box on line B if applicable)
A) 1. ErNew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only Existing System
B) Permit Number Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply) .
• Non - pressurized In- ground [Mound ❑ Sand Filter ❑ Constructed Wetland
• Pressurized In- ground ❑ Holding Tank ❑ Single Pass , ❑ Drip Line
• At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V. Dispersal/Treatment Area Information:
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed Rate (Gals. /day /sq. ft.) '(Min. /inch) Elevation
VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
91- ❑ ❑ ❑ ❑
LzY ❑ ❑ ❑ ❑
VIII. Responsibility Statement
I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (print) Plumber's Signature (no stamps) 74APA4P No. Business Phone Number
Plumber's Address (Street, City, State, Zip Code)
ZXZ,?,P' W z y o
IX. County/Department Use Only
❑ Disapproved Sanitary, Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No starups)
I�Approved ❑ Owner Given Initial Adverse Surcharge F eQ
Determination 3Zs� , 20 - 2 2
X. Conditions of Approval /Reasons for Disapproval: e
4 n� /
,- C am. /wLtlL.t•. �. C- -�-,.� .�I V ' V -i il, jit.- t^v, -
SBD -6398 (R. 07/00) /.
PLOT PLAN
Scale 1 q 0 Page -3 of
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L^ 4C� 5�� ' 1 g•3.
YU
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NO_ Tom_
1 • Elevations
2• shown are existing Install 4" observation ground elevations unless otherwise noted
3 • Sept' I ttank to be �� p with approved caps. ( Z re u'
gallon capacity manufactured by lred).
4 • Bench marks w /1�_lgop
pz� c40 0 cc.,
S Pn3 UU
�• Divert surface water around system to
Prevent ponding at the uphill side.
' Safety and Buildings
' 4003 N KINNEY COULEE RD
LA CROSSE WI 54601 -1831
a G ^ � ) TDD #: (608) 264 -8777
isconsin www.commerc .wis ons
q
�° .- -- www.wisconsin.gov
Department of Commerce n ?
ST Scott McCallum, Governor
" ' Philip Edw. Albert, Secretary
September 03, 2002
CUST ID No.267341 ATTN: POWTS Inspector
ARTHUR L WEGERER ZONING OFFICE
WEGERER SOIL TESTING & DESIGN SERVICE ST CROIX COUNTY SPIA
PO BOX 74 1101 CARMICHAEL RD
RIVER FALLS WI 54022 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 09/03/2004 Identification Numbers
Transaction ID No. 783106
SITE: Site ID No. 649540
Adam Nelson Please refer to both identification numbers,
240TH St above, in all correspondence with the agency.
Town of Baldwin
St Croix County
SETA, NW1 /4, S27, T29N, R16W
FOR:
Description: Four Bedroom Mound System
Object Type: POWT System Regulated Object ID No.: 867609
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
The following conditions shall be met during construction or installation and prior to occupancy or use:
General Approval Requirements:
• This system is to be constructed and located in accordance with the enclosed approved plans and with the
"Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /01)
and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION
2.0" SBD- 10706 -P (N.01 /01).
• Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area.
Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal
are prohibited.
• Access to the filter for cleaning must be provided per Comm 84.25 (7) and (8),Wis. Adm. Code product
approval conditions.
Tonally
• The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption
DAVED
area. chs. NR 811 & 812c
COMMERCE • A Sanitary Permit must be obtained from the coup where this pro ect is located in accordance with the
K II.DI n' county p j
requirements of Sec. 145.135 and 145.19, Wis. Stats.
ONDEN
• 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. Stat
• Comm 83.22(7) 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.
ARTHUR L WEGERER Page 2 9/3/02
Owner Responsibilities:
• Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and
maintenance of the POWTS 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 to the owner and any others who are responsible
for the installation, operation or maintenance of the POWTS.
Sincerely, Fee Required $ 175.00
Fee Received $ 175.00
'A / Balance Due $ 0.00
Charles L Bratz
POWTS Reviewer II, Integrated Services WiSMART code: 7633'
(608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday
cbratz @commerce.state.wi.us
cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544
TITLE SHEET Page of 7
FOUND SYSTEM
FOR
A L � BEDROOM RESIDENCE
This plan has been prepared in accordance with the Mound Component
Manual SBD- 10691 -P and the Pressure Distribution Manual SBD- 10706 -P
(N.01 101) (N.01 101)
LOCATED IN THE S�E 1/4 OF THE 1\ 1/4 OF SECTION �� , T Z N, R W,
TOWN. OF 1�11�- L_pyjIN �wlX 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
RECEIVED
- - - --
AUG 15 7002 61 5 3 tiS O sT, ►V ,
SAFETY & BLDGS DIV.�
PREPARED BY
WEGE�EI� SO S L , TEST S NG
AND.
117ES I cs" Sj I CE
P.O. Box 74 421 N.Main St.
River Falls, WI 54022
Phone 715- 425- 0165,��
Fax
715-425-6864
j AATM1q
wfCERE�
�� D-915 P
C Eu sw
C ond i t 1s.
4- c E3_ 3—OZ
JOB NO.
.Mound System Management Plan p age Z of - 1
Pursuant to Comm 83.54, Wis. Adm. Code
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the
septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and
outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to
ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that
may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if
the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 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 System - y
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 BOD5, 150 mg/L TSS, and 30 mg /L 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 P&D 4GS72 -Iz{ . 6f9� and local or state rules pertaining to system maintenance and maintenance
reporting. - 'S3I) _ \Z6 cl I -P
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.
Continaencv Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition.
If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be
immediately repaired or replaced with a component of the same or equal performance.
If the 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 about the operation or maintenance of this system should be directed to:
The County Zoning Office at lS- 38 O —4 f0 $ S'T'- C.
The system installer at �1 LS —6 — 01bZ)q F-0 GM - `i—_ .
The tank 'manufacturer at — TA S _,Z,L4 6 _ S z�S w LT� — }zS
The effluent filter manufacturer at $cz Z - ?I _ S q -
The pump manufacturer at — 6 3�— $ - 4�l( � GOVL
PLOT PLAN
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2
NOTES:
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install 4" observation pipes with approved caps. ( Z required).
3. Septic tank to be 1200 gallon capacity manufactured by
1� �5 C-L1 amvs ,J /PT-IBM 7,n\_T - F-ILtluz 'Rn
4. Bench marks S Ph3UV�
5. Divert surface water around system to prevent pondIing at the uphill side.
Pace Of
Approved Synthetic Covering
AST! C33 Distribution Pipe
Medium. Sand
Topsail rH = W s
i ,• F Elev. . l t3 .7
3 E D
t
I
b
% Slope
Distribution Cell of Force Main Flowed
Z" to 2'Z" Aggregate From Pump Layer
D 1.7 Ft.
E z .o Ft.
CROSS SECTION OF A MOUND SYSTEM F p, $ Ft.
G o. S Ft.
A Ft. F;
Linear Loading Rate= 6.o GPD /LN FT 8 1 ZO Ft.
Design Loading Rate= p 33 GPD /SQ FT j 1Z Ft.
J 8 Ft.
K Ft.
a4e Position L Q_ Ft.
of — � Farce Main W Z 6 Ft-
— L I
I
1. - Observation Pipe
— — 8 •— -- I -- — - — ----7 Acct -ss
°------------- - - - - -- --------- - - - - -- - - - - -- + '� BOX
A i --'�6 $ ° A �
�Distribufiion \- Cell of %" t
0 2
Pipe aggregate
Observation Pipe
(anchor securely)
PLAN VIEW OF A MOUND SYSTEM
Distribution Pipe Layout Paoe 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 IatzMl un with the use of long turn or 45' fazing to a point within six
inches of the final �*ade- Te urinat the ends of the laterals with a valve,:threaded can or
threaded plug- Provide access from final Bade for the valve, threaded cap or threaded plug.
FV C - FUG PV C
Lateral Manifold Lateral
x x x x!Z I xfl z x x x
Lateral Lngth —� Lateral Length — P
Distribution Line
F i i}cc: -s sciX
_C
a— --
P Ft. Hole Diameter �fS Inch
S 3 F Lateral " 1 Inches)
X 3 Inches Manifold Z- Inches
Force Main " Indies
# of holes /pipe 11
Invert Elevation of- Laterals 102: Zft.
68(3112662 11:36 17154256864 WEGERER SOIL TESTING PAGE 03
PLUMP CHAMBER CROSS SECTION AKID SPECIFICATIOMS PAGE 6. OF
VENT CAP
ti C.L VENT PIPC wrArraEll plLOOp
APPROVED LOCKING MANHOLE
10 fR DooR• JUQCTION BOX COVER WITH WARDING LABEL
WINDOW OR FRCSK 12�M1L1•
Alit IAiTAKE -
L I
GRADC
COWDUIT
Ia•MfAI.
11�
IAJLET • PROVIDE
AiJtT(GMT SEAL
1 V
APPRpVCD JOIAIT A I APPROVED JOIAI
I I��
( AL-MA
e I
• 1 I oa
C �1
�C CIE K 2fT _�
P UMP -` OPir
n
L i -bQ ( C00kRETf !!LOCK
R15CR EXIT PEKAI1rCD OWLy IF TAWK MAJJUPACTURCR HAS SUCW ArPROVAL. 3 "APPw9D
$E"C I ks
SPECIFICATIOKJ
p05 is -
T A11Kj MAAIUFACT;jRCR: I Q S COIF] C A!L{NtIICR GF QaSES: 1 PfwR OA,s"
TANK SIZ>` : laoc GALLOWS DOSC VOLUME r
AJ -AR!j __ J!L�cTUrtcit: S 3�- 2 S`i.S � .5 114CLUIDIN& 6ACKFl ow. 6ALLpNS
AODEL �IUMBtR: kJ - - CAPACITIES: Ate ~ � SZ .` 6 WLLONS ^ � -
SWITCH TUPL: �� U
- 1S ;
Pump MAMUFACTUKEIL: C- --21' L ?WtatS OR 1 1 1 -7 GALL -OWS
MODEL NUADEn: 0 'M-- � \ • +`- \ INGIiES OR Z 3 1 GALLOAJri
SVIt7Gli TyI►E; N o y _ upTE: PUMP AMD ALAR ARt '0
MINIMUM DISCnA -RGC RATE Z�•$a GPM IN5TALLEO OIJ 5EPARArg CIRCUITS
VEKTICAL DIFFERESICIE DETWCEN PUMP OFF AUD_DIS�'RtISUTIpu PIPE.. '
• FEET
t A NETWORK SUPPLY Pp-rimft - c ......... •SO" FLET
♦ f E ET OF Folta MAIAJ x\ •L /po fLFRIGTIOL! FACTOR ' - "� FEET
TOTAL 0tJWAMIC HEAD ... . ...
FrrZT
rl
As per: manufacturer gal /in. Liquid depth ? I
,0$/31/2002 11:36 17154256864 WEGERER SOIL TESTING PAGE 04
Goulds 1 °f
Submersible
�-� Effluent Pump
_ EPO4
38 71 EP
APPLICATIONS • Fasteners_ 300 series • Fully submerged in high IN Motor Housing: Cast iron
Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer,
following uses: • Capable of running lubrication and efficient strength, and durability.
• Effluent systems dry without damage to heat transfer. ■ Motor Cover. Thermoplas-
• Homes components. tic cover with Integral handle
Motor: Available for automatic and
•Farms manual operation. Automatic and float switch attachment
• Heavy duty sump EPO4 Single phase: 0.4 HP, modals seclude Mechanical points.
• Water transfer ROM, , 230 n v to Hz, 155 it Float Switch assembled and ■ Power Cable: Severe duty
• Dewatering RPM, built in overload with ated ail and water resistant r
automatic reset, preset at the factory. ,
SPECIFICATIONS • EP05 Single phase: 0.5 HP, ar Bearings: Upper and lower
115 V, 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing
Pump: EPO4 built in overload with ■ EPO4 Impeller. Thermo
construction.
• Solids handling capability: abili _ automatic reset.
-
'/: maximum • Power cord: 10 foot with out vanes for AGENCY LISTING
• Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. �. CatnaalanStandarlkA�aodatlan
• Total heads: up to 24 feet. with three prong grounding
'/ • Discharge size: l' /2" NPT, plug. Optional 20 foot m EP05 Impeller: Thermo- (CSA listed model numbers
• Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in "F" or "AC ".)
rotary/ceramic- stationary, three prong grounding plug Improved performance_
BUNA -N elastomers. (standard on EP05)_ ■ Casing and Base: Rugged
- Temperature: thermoplastic design provides
104 °F (40 °C) continuous superior strength and
140 °F (60 °C) intermittent. corrosion resistance.
• Fasteners: 300 series MEMRS FEET
stainless steel. to
• Capable of running
dry without damage to s 30 , =
components.
Pump: EP05
r,
• Solids handling capability: c 25
z
ttY� j
34' maximum. -ac i
• Capacities: up to 60 GPM. s
• Total heads: up to 31 feet. I
• Discharge size: I'h' NPT, z 5
• Mechanical seal: carbon-
rotary/ceramic- stationary, 4
BUNA -N elastomers.
• Temperature: 3 to
104 °F (40 °C) continuous j i —�(—
140°F (60 °C) intermittent. 2 --
5
1
0-
0 o t 20 30 40 5a GPM
0 2 4 B 9 10 12 M"
CAPAWY
0 1995 Goukis Pumps. Inc. ENe*m May. 1995
2—
0 A 2 11; le ED:W4REAL.TY 4 559i6516Z,-,-x,419 'Cj 557 W4
1452
8041. EVALLIATIONREPORT pop — ! — d.. 3
Division 0! SA" and SuNiryt In lcc&dw= VAh Cerra, 86 Wis. Ad" cow Ac.r.. sii & siw E �as
A981h camOle Me 0 OR (SPA' not lft4 OM 9 * x 11 Indwa In An, ►w rnigst ccwwy St. Crew
N*O. ire imam to: ,**0 04 toac"tal re P60 IBM) divecw am P&IN 9)
mml voce. VA.9 ar A_4miwi, WA amw, and lc� and 6$Wd to Parser %d
Masse PM1 all lWarrRavoil. Gy
I Feropwlv Oww
1 1 Gavt LA SE IA NEI A S V 29 -
Pro NF4 . 1 6 . ,N
3% TSChi0a
p" O*Tw V.8'WVMdMw . Qcx "Ame of esut
[ W12a7C 670th Ave,
City Stamm rip CK* Pww Number &Y I% VJtW ]V- TOOr Naera6t P40W
Presr t wl 1 54021 j 71 5-M -682 "0 Caldwin 2407 Reef
J t'hame cl wows ccwde+4d daKA flaw Fate cp-.) 7 i
:j PLItk Cr WMRWZIW - Oftobig;
parent matanw Giacip TA Flood plain 6*06*1. 1 0000awA
ar4raw mound system ekv. = 10! .47'at20" above 100-00' COtOut.
J 19"
PR OroundSwdamaw. Owh b lknogng 4rAor
r 5mmant UW Rados C 490 * 90 s ee - V*4 -
0-9 1 none 2kbk
ds 0.5 0
2 1 919 1 OW413 2msbk dsh cw 2h
M
3 19.21 QyW4 Rd ?-Syr" 7�fnstk Mir c.w
4 V-32 7.5yr4A m2d 7.5yr5I8 2rmsbk 1 Mi cw f
7
fn3d7 SW513 0 4 0.6
2c3bk
5
m2d I Oyr64
4 ------- f
BOA ft Ban
!6 -in Af*pabr,^ Roo
ja pit Grourta gwfmm IftV. _ 96: 96 L_ ft Ompth to fiftrAiIV #WQr
_kw
Daftwt color R650A Descu" a
0-9 1 O)f4n nano 1 $if 2fSbK ds
none
9-16 1 OyrA44 2 dsh cw
I Oyr4M rZO
3 18-25 7 syrsm 2,'nst* MIr cw 1 f 0
r4o 7 5Yr% a ew 3
1 4 25-321 1 .0 2mift -no
Yr 12d i
sc: bk MA
' 6�lt
32-43 7. yr4r- 2cs
all
L
goo, -L3o,,*L end TS _XVL
[CST N&Me (PWUe P") Sion rc CST Nv►tiw
James K Thompson
Ad6res S A-C.E• Sal & S41 EvOunas pale vduetian C a W L x: W d Tetephom Nwrbw
Roulaw Late LW4. Oscsw, .7 767 I
90 3E)Vd NOS - 131130C ZZ 10Z TGO 913 TZ A"Ot", /E.", /�O
1452
Wisconsin Department of Commerce SOIL EVALUATION REPORT page I - of - 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site E valuations
Attach complete site Man on paper not hiss than 8% x 11 inches in size. Plan must county St. Croix
include, but not limited to: vertical CO point (8M), direction and -- 0 - arcel - ID.
percent slope, scale or climern r'd and distance to nearest mad.
002 -1067-10-000, ID#27.29.
PI telfflin BY Date
Personal information you ay be i �arY PUrPDSN Y Low, s. 15.04 (1) (m)).
A Property Location
pl Owner
Greg Tschida Govt 29 N R 16 W Lot - SE 1/4 NE 1/4 S 27 T ---
- 7
--] Subd. Nam or CSM#
Property Owner's Melling s ST Lot Block #
W 1 2470 570th Ave.
City _j City _j Village #f Town Newest ROW
Zt"M j
Prescott I , 4021L -9823 Baldwin 240Th Street
Code derived design flow rate 600 GPD
New Construction Use. IA umber ofbedrooms 4
vJ Replacement o Public or commercial - Describe.
Parent material Glacial Till Flood plain elevation, if applicable na
General comments
artdrecommeridations: Mound system elev. = 101.67 at 20" above 100.00' contour.
Boring # Boring 190
Pit Ground Surface elev. 100.40 ft. Depth to limiting factor in. Sol Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW
Eff#1 - EfF*2
1 0-9 1 0yr4J2 none sil 2fsbk ds as 2fm 0.5 0.8
2 9-19 1 Oyr4/3 none sl 2msbk dsh CIN 2fm 0.5 0.9
3 19-27 1 0yr4/3 f2d .5 0.5 0.9
sl 2msbk mfr cW I frn I
4 27-32 7.5yr4/6 m2d 7.5yT518 sl 2msbk mfi CW - 0.5 0.9
5 32-45 7.5yr4/6 m3d7.5yr5/8 & scl 2csbk mfi - 0.4 0.6
m2d 10yr6/2
o Boring # _j Boring
Pit Ground Surface elev. 99.96 ft. Depth to limiting factor 16 in. So► 4Micatlon Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots QPQ1W
I - Eff#1 *Ef W2
1 0-9 1 Oyr4/2 none sil 2%bk ds as 2fm 0.5 0.8
2 9-16 1 Oyr4/3 none sl 2msbk dsh cw 2f,lm 0.5 0.9
1 Oyr4/6 f2
3 16-25 �6�18 sl 2msbk nnfr CW I f 0.5 0.9
4 25-32 1 0yr4/6 f2d I GyT6/2 m2d, 7.5yr5/8 & sl 2msbk Mfi Gw 0.5 0.9
5 32-43 7.5yr4/6 m30.5 yr5/8 & scl 2csbk rnfi 0.4 0.6
m2d 1
Effluent #1= BOD ? 30 < 220 mg1L and TSS >4< 150 mg1L BOD,S30 mg/L and TSS <-30 mg/L
CST Name (Please Print) CST Number
James K. Thompson 3602
Address A.C.E. Soil & Site Evaluations - Date usfion Conducted Tde*m Number
340 Paulson Lake Lane, Osceola, WI 5 8 715-248-7767
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�. 3 of'.3
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner /Ettger
Mailing Address 2143- /.5 '1'/ s :a 03r
Property Address ^7 C. 0 4-h
(Verification required from Planning Department for new construction)
CitylState Aj4 T �U� .� Parcel Identification Number 2 —/067 /a
LEGAL DESCRIPTION
Property Location ' /., fi W ' /,, Sec. 2Z, T ,29 N- R��l�, Town of l�Llr.�J
Subdivision Lot #
Certified Survey Map # , Volume r' , Page # -----
Warranty Deed # ( F7Z3je; , Volume /9.re , Page #
Spec house O yes C`/no Lot lines identifiable l� yes O no
SYSTEM MAI -
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
.set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days -of the three ve.ar py"jmfi__ a
SIGNATURE OF APPLICANT vi*7,e 7cvl'4 - 5 ' . DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIGNATURE OF APPLICANT DATE
* « * * *« Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning 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
.09/16/2002 14:29 6517620172 JOENELSON,. PAGE 01
OOt 16 02 I O t Sop F UUtre t r r+ vr�o a 1.v
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owrierf%yel
Mailing Address G
p Addrea
(Verificsrioo required from planning Department for new construction)
Parcel identification Numbu
�. rsr. �ESC RI. PTtON •
Lion ''/.. t V 'A. Sec 2, 7- . T 2 t N'R -A—W, Town of (._ -
Property Lora -��. .
Lot #
Subdivision
Certit"ted Sum) Map ft _ -- _ , Volume page fil - ----"`
Wartaaty Decd N _ Volwnc „ _ Page
.—
Spec horse G yes [9
Lo: lines identiflabie ryes (7 ro
5XXS , N -10 VSE
lmproperuse and mainteeaaceof your apiic system could result in Its premature failure to handle w astes. Pro�tr msi►ttenaa'e
consdus of pumbine out ux septic tank every aces years or sooner. it needed by a lic ensed PuaPet• Wbat you put into the system
coo affr! the 1Nacti of the septic rnnk as a 7eatMat stage is the waste disposal system.
The property owner agrees to submit to Si. Croix 2onia8 Depat inear a certifcstioo form, signed by the owner and by a
mater plutaber, i*urneyman plumber, restricted plumber of a lietase9pumPOT verifying that (1) tits oa -site wastewstord+aposaI system
is in proper operating condition srnb'or (T) after inspection slid purnpit►g (if necessary) the septic tank is less than lt3 fur; of sludge
1 /w•e, the oWerigned have read the above requirements a n d agree to moirt(ain the Pcivlite sewage dispossl sysletn wt111 the stardatds
act forth, herein, as set by the Department of Commerce and the Dtpartment of Natural iCe•oarces, State of W :sconstn. Certification
stating that your septic system Was been vdietained ;oust be eoaptieted and returned to the St, Croix County 7.orung Off►ee ""'n ,0
days,nf the dwer •r *• •• ^ ;�' : ^^ "_••
F GJE
SIGNATURE OF APPLICANT � 4 amr • r 7'F • DATE
Q `NIrR D'N
I (we) cedei that a statements on this form are true to dw best of my (our) knowledge. I (wo) am (are) the owrret of
the pr y dcRcribed above, by virtue of a wanipty deed recorded in Register of De--dl Orfice.
SIGNA Of A PP L ICANT DA
.'••" Any informstion that it: rnis• pr esentedruay result in the su::tary permit being rtty5ked by the Zoning Department. • " °'
•• Inelade with this apOieatioa: a dawtped warranty deed from the Register of Deeds ofTice
a copy of the certified aarvey map if refcrente is made to the warranty deed
U 1950P 996
687236 0
KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
DOCUMENT NO.
RECEIVED FOR RECORD
08 -16 -2002 9:00 AM
This Deed made between GREGORY S. TSCHIDA WApWWy DEED
and JEANETTE M. TSCHIDA, husband and wife, EXEMPT I
Grantors and ADAM J. NELSON, REC FEE: 11.00
Grantee, TRANS FEE: 261.00
COPY FEE:
CERT COPY FEE:
Witnesseth, That the said Grantors convey to Grantee PAGES: 1
the following described real estate in St. Croix County, State
of Wisconsin:
SE 1/4 of NW 1/4 of Section 27, Township 29 North,
Range 16 West, St. Croix County, Wisconsin.
Together with the right of ingress and egress over the Tax Parcel No. 002- 1067 -10 -000
easement as described in Vol. 1439, Page 22, Doc. No. RETURN TO;
606105. 0 f I A t.- QZ� — c-t?) (.f S
This is homestead property. P �
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And Grantors warrant that the title is good, indefeasible in fee simple and free and clear of
encumbrances, and will warrant and defend same.
Dated this day of August, 2002.
SEAL
rego y . Tschida
(SEAL)
1 4eanette M. Tschida
STATE OF WISCONSIN
)SS
ST. CROIX COUNTY
Personally came before me thisay of August, 2002, the above named Gregory S. Tschida and
Jeanette M. Tschida, to me known to be the persons who ecuted the fore oing instrument and
acknowledged the same.
L ary Public tate of Wisconsin
My Commission (expires):
THIS INSTRUMENT DRAFTED BY: Traci L. '- ^er
Attorney Barry C. Lundeen Notar� Public
MUDGE, PORTER, LUNDEEN & SEGUIN, S.C. State o, WV coons'
110 Second Street, P.O. Box 469
Hudson, Wisconsin 54016
Parcel #: 002 - 1067 -10 -000 02/16/2005 11:28 AM
PAGE 1 OF 1
Alt. Parcel #: 27.29.16.407 002 - TOWN OF BALDWIN
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): ' = Current Owner
ADAM J NELSON " NELSON, ADAM J
767 240TH ST
BALDWIN WI 54002
Districts: SC = School SP = Special Property Address(es): " = Primary
Type Dist # Description * 767 240TH ST
SC 0231 BALDWIN - WOODVILLE AREA
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE
SEC 27 T29N R1 6W SE NW Block/Condo Bldg:
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
27- 29N -16W
Notes: Parcel History:
Date Doc # Vol /Page Type
11/04/2002 696949 2033/436 EZ
08/16/2002 687236 1950/496 WD
07/02/1999 606104 1439/021 WD
07/23/1997 1007/424 .29
2004 SUMMARY Bill #: Fair Market Value: Assessed with:
42527 Use Value Assessment
Valuations: Last Changed: 06/28/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 10,500 120,300 130,800 NO
AGRICULTURAL G4 32.000 2,700 0 2,700 NO
PRODUCTIVE FORST LANC G6 5.000 3,500 0 3,500 NO
Totals for 2004:
General Property 40.000 16,700 120,300 137,000
Woodland 0.000 0 0
Totals for 2003:
General Property 40.000 17,200 53,900 71,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch #: PRGRM
Specials:
User Special Code Category Amount
010 - GARBAGE SPECIAL ASSESSMENT 45.00
Special Assessments Special Charges Delinquent Charges
Total 45.00 0.00 0.00