HomeMy WebLinkAbout030-1043-70-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division Sanitary Permit No:
INSPECTION REPORT 552374 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)J.
Permit Holder's Name: City Village X Township Parcel Tax No:
Associated Bank, foreclosure St. Joseph, Town of 030-1043-70-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
G {n GS'f 20.30.19.158i
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
c
Septic IG /o Benchmark z ® /6Z. f
X~ Sf r~
Alt. BM p~, ~ S
Aj 5e&-I C- 66,
AeML=- Bldg. Sewer
Holding (rch~ St/Ht Inlet
St/Ht Outlet czej L/
TANK SETBACK INFORMATION M inn aft W-1 f-7-"
T
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet cl- (
O t0 T
Seepti 7Z5 S J / Dt Bottom 13 ~L
OIL
Dosing 7 S yc3 / , Header/Man. 7
`t 7-3
4$
Aeration Dist. Pipe -7.0
-7- 74- (o
Holding Bot. System Ir • Z. S
T- T 13,4
Final Grade
PUMP/SIPHON INFORMATION Z 1 C~9 '
Manufacturer Demand St Cover pl C~ c~~
GPM ~
Model Number ~
TDH LiftFriction c~Los~ System Head t ^ - TDH~ ` Ft
/~J 4T"
Dist. to Well
Forcemain Length / 7~-Z I I I ~
SOIL ABSORPTION SYSTEM
BEDITRENCH Width 1 Leng No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 p I _ ~/L..
SETBACK SYSTEM TO ~Q P/L BLDG ! WELL LAKE/STREAM LEACHING Manufacturer: ~
INFORMATION CHAMBER OR Type/Of System: 1 r W5 J1 ~-3 t J06 . UNIT Model Number:
DISTRIBUTION SYSTEM A+410 3Z
Header/Manifold E / Distribution x Hole Size x Hole Spacing Vent to Air In ke
Pipe(s) 5
Length Dia_ Length _ Dia _ Spacing`
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over 7Beddrrrench th Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center 5 Edges Topsoil es 7 No No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / /
Location: 430 Valley View Trail Houlton, WI 54082 (SE 1/4 SW 1/4 20 T30N R1 9W) metes & bounds Lot Parcel No: 20.30.19.158i
1. Alt BM Description = 6 ` ~ WC~~~ pJv~~ei,- 1ocX; ecx5 Pc, Ix a-,J
2.) Bldg sewer length = CAJ ~otl w~ r"~ V."-r y t 4&
~
- amount of cover = 3
7, Z-
Plan revision Required? ❑ Yes No
Use other side for additional information. (9
Date Insepct Sign Cert. No.
SBD-6710 (R.3/97)
Safety and Buildings Division^ County J nt
co mmert:e.wl.gov T X
201 W. Washington Ave., P.U. Box 7162 - l I
i aeon s i n Madison, WI 53707--7162 Sanitary Permit Numbeer (to filled in by Co.)
Department of Commerce --=-t-
- State Transacti i jumber
Sanitary 'ca ' n -
In accordance with s. Comm. 83.21(2), Wis. Aode stun of this rm to t appropriate governmental
unit is required prior to obtaining a sanitary perms . Note: Applicati forms f e-owned POWTS are Project Address (if different than mailing address)
r
submitted to the Department of Commerce. Personal information provide sed for secondary
u oses in accordance with the Privacy Law, s. 15.04 1 (m , Stats.
1. Application Information - Please Print All I Parcel It
Property Owner's N me ~~i~i n k' 'f
s S Pro Location
~/59 ,
Property Owner's Mailing Addrerss perly
Govt. Lot C
Zip Code Pho JS 1/4, Section Z
`le on
City, State
C ?
Try V -N; R E r W
Lot #
11. Type of Building (check all that upply Subdivision Name
or 2 Family Dwelling -Number of Bedroo
t-_ Block #
❑ Public/Commercial - Describe Use ❑ City
CSM N ❑ Village of
umber ----T--~- -
❑ State Owned Describe Use
III. Type of Permit: (Check only on box online A. Complete line B if applicable) -
A, ❑ New System lacement System ❑ TreatmcntlHolding Tank Replacement Only ❑ Other Modification to Existing System (explain)
List Previous Permit Number and Date Issued
El Change of Plumber ❑ Permit Transfer to New
B. El Permit Renewal El Permit Revision Owner _ 7-7
Before Expiration
IV. Type of POWTS SystemlComponent/Device• (Check all that apply)
on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound> 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Pretreatment Device (explain)-_- -
❑ Holding Tank ❑ Other Dispersal Component (explain)__..__
V. Dis ersat/ reat ut Area Information: Dis crest Area Pr po d evati
-
s o
Deig{rF~(gpd) sign Soil Application (gpdsf) Dispersal Area Required (s ~ ~3 If
Capacity m Total # of Manufacturer
le VI. Tank Info
Gallons Gallons Units
y rn i,. C7 G,
New Tanks Existing Tanks
Septic or Holding Tank T -
Dosing Chamber 30 -
for installation of the POWTS shown on the attached plans.
VII. Responsibility Statement- I, the undersigned, assume reap b
Plumber's MP/M FR S Number Business Phone Number /
• Na a (Print) umber's Si
SQu " , 7 IIIJJJ
Plumber's Addres (Stye j, St te, Zip Code)~D , - ~ 1 C, VIII. Count /De artment Use Onl Permit Fee Date I ued issuing t Signature
Approved ❑ pro $ / ("/75 -66 ~ g 12- - 1
❑ en Reason for nial
Masons for Disapproval 3~ 61 ~ 5 a,
IX. Condit-- J
:.ef,t lt w prow
per"l cell must al be visasl nlaipta
so lw management plan provided
w. IM106Z
r1
Attack to complete plane for the system and submit to the County only on paper not less than g Ilx x 11 inches in size
SBD-6398 (R. 01/07) Valid thru 01/09
PLOT PLAN
PROJECT Associated Bank ADDRESS 1305 Main ST. Stevens Point Wi 54481
SE 1/4 SW 1/4S 20 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST. CROIX
6/4/12 3
DATE BEDROOM
MPRS Shaun Bird 226900
CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT XXX HOLDING TANK
1000 gallons LIFT TANK SIZE 630 DOSE TANK SIZE
MOUND SEPTIC TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32
BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100' Filter SIM-TEC
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
All piping shall be SDR.30/34, within 10' SYSTEM ELEVATION 93.7/93.6 5.5' below qrade
of tank, piping shall be Schedule 40.
V alley V iew Trail
Vent
Scale is 1" = 40'
unless otherwise >6„ Quick4 Standard
of Cover Leaching Chamber
noted with 20.0 ft2 of Area
10.2ft^2/pair of end caps
4' Long 12 Grade at System Elevation
Plans Designed Using 34"
Conventional Powts Well Well is to meet all
Manual Version 2.0 15; setbacks required by
340' Property Line 20' WDNR
Old tanks are to be 35' Existing 3
Bedroom House
pumped and buried 10' B.M. *
DW T
25' Pool
D W 40'
25' 2-3' X 66' cells with >3' spacing
0% Slope
30'
B-3
Huffcutt 3 Vents
Pump tank 30'
75'
75' B-2
B-1
50'
;r~ 340' Property Line
Cover Page
Shaun Bird
Bird Plumbing Inc.
1008 192nd Ave
New Richmond Wi 54017
715-246-4516
Date: 6/4/12
Owner: Associated Bank
Location: SE1/4 SW1/4 S20 T30 N,R19W 430 Valley View Trail St. Joseph
System type: In-ground absorbtion system(conventional)
Manuals Used: In-ground absorbtion system (version 2.0)
Pressure Distribution Manual (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4-6. Maintanance and Contingency Plan
7. Filter Specifications Sheet
8. Dose Tank Cross Section
9. Pump Curve
10. Existing Septic Tank Form
Signature
License number #226900
PLOT PLAN
PROJECT Associated Bank ADDRESS 1305 Main ST. Stevens Point Wi 54481
SE 1/4 SW 1/4s 20 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST. CROIX
6/4/12 BEDROOM 3
MPRS Shaun Bird 226900 DATE
CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT XXX HOLDING TANK
SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE 630 DOSE TANK SIZE
MOUND
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32
BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100' Filter SIM-TEC
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
All piping shall be SDR 30/34, within 10' SYSTEM ELEVATION 93.7/93.6 5.5' below qrade
of tank, piping shall be Schedule 40.
V alley V iew Trail
Scale is 1" = 40' vent
unless otherwise >6„ Quick4 Standard
of Cover Leaching Chamber
noted with 20.0 ft2 of Area
10.2ft^2/pair of end caps
Long 12"
Grade at System Elevation
Plans Designed Using 34"
Conventional Powts Well Well is to meet all
Manual Version 2.0 j 5---' setbacks required by
340' Property Line 20' WDNR
Old tanks are to be 35' Existing 3
pumped and buried Bedroom House
10, B M. *
DW T
25 Pool
D W 40'
25' 0% Slope 2-3' X 66' cells with >3' spacing
30'
B-3
Huffcutt 35 Vents
Pump tank 30'
75'
75' B-2
B-1
50'
340' Property Line
Cross Section of Infiltrator Quick 4 Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 ft2 of Area per Chamber To be >1' above grade
10.2ft^2 pair of end plates
Finish grade elevation
Typical Installation 99.0'
Vent Grade Vent
3' 4" 3'
,A/30/34 Septic Tank
5' Long 1 19 5' S' Long 1 Grade at System Elevation
3691 Grade at System Elevation
Spacing 5'
2-3' X 66' Cells
Same on other end Observation tubeNent
At end of cell
A
B
16 chambers per cell
System elevations:
A-93.7
B 93.6
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Septic Tank Capacity gal ❑ NA
Permit # Septic Tank Manufacturer Px;,(❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
'Orr Number of Bedrooms 3 ❑ NA Effluent Filter Model
6,4 (9' -"41 El NA
Number of Public Facility Units *V~NA Pump Tank Capacity ~a3 0I ❑ NA
Estimated flow (average) QCj gal/day Pump Tank Manufacturer Nk,64 01
Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer NA
Soil Application Rate ! gal/day/ftz Pump Model ❑ NA
Standard Influent/Effluent Quality Monthly average*! Pretreatment Unit NA
Fats, Oil & Grease (FOG) <_30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODO :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 (BODO <_30 mg/L In-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/LAIA ❑ At-Grade ❑ Mound
Fecal Coliform (geometric mean) 510° cfu/100ml ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size in dia. ❑ NA Other: ❑ NA
Other: Other: A ❑ NA
*Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event I Service Frequency
arth(s) (Maximum 3 years) ❑ NA
Inspect condition of tank(s) At least once every: 0pon
Pump out contents of tank(s) When combined sludge and scum equals one-third (%3) of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: month(s) (Maximum 3 years) ❑ NA
P15-year(s)
Clean effluent filter At least once every: / ❑ onth(s) ❑ NA
/ t ear(s)
Inspect pump, pump controls & alarm At least once every: ❑ month(s) NA
)
Flush laterals and ressure test At least once eve ❑ month(s) NA
P ry: ❑ year(s)
Other: At least once every: ❑ month(s) kN A
❑ year(s)
Other: A
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 (%3) 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 <_12 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.
GMW (4/01)
Page of '
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
replace ent system:
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.
The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ /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
POWTS INSTALLER POWTS MAINTAINER
Name ,0
2~- Name
Ze 01
Phone
Phone
I
SEPTAGE SERVICING OPERATOR (PUMP 5E) LOCAL REGULATORY AUTHORITY
Name Name
Phone 7/✓ Phone
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
Page of
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:
e 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
replace ent system:
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.
The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ /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
POWTS INSTALLER POWTS MAINTAINER
Name Name
Phone Phone
SEPTAGE SERVICING OPERATOR (PUMPF LOCAL REGULATORY AUTHORITY
Name Name r g
Phone Phone
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address /3 O r
Property Address 'Y.3 o
(Verification required J*h Planning & Zoning Department for new construction.)
City/State Parcel Identification Number
LEGAL DESCRIPTION
1 51
Property Location.S~e '/4, '/a , Sec."Z 0 , T 30 N R_//W, Town of l. JD
Subdivision , Lot #
Certified Survey Map Volume , Page #
Volume ~ Page #
Warranty Deed #
Spec house yes (!V Lot lines identifiabl ye no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & 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.
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 must be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on th)s 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 w anty deed recorded in Register of Deeds Office.
Number of bedroo
z
SIGNATURE OF APPLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
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Dose Tank Cross Section And Pump Performance Specifications
Tank Manufacturer Wit E Minimum Pump Performance k.equired
Tank Model Number ' 1,ro GPM Ft TDH
Total Tank Capacity O
Max. Bury Depth i
Total Dynamic Head (TDH) - Feet
Pump Manufacturer Elevation Head
Pump Model Number 13t\) 57 Distal Pressure
Alarm Manufacturer L LC Network Pressure Loss
Alarm Model Number ~c Force Main Pressure Loss
Switch Type e ' Total
7 _
Manhole Min. 4" Above Grade
With Locking Device
Vent Min. 12"
Above Grade Weather-proof
With Cap Junction Box
Finished Grade - ` 0" NO
1 t`-
Depth of Cover .s Ft , Disconnect
Means
Yt>SYt t Y4 ~i Yt
{ Outlet
4
Inlet YS Switch Settings and Reserve Capacity
y; Tank Volume = GPI
Dimension Inches Volume Gal. A
t 4
(reserve) A ' S 0 Weep
e (alarm) B 2 3 l7 B
Hole
(dose) C Off Elev.
(dead) D 7Ft_ G 's
;s Total 6p Q,s ;
t Y Bottom of Tank Elev. Ol J Ft D i
t i' 4
> 4 4 4 4 4 4 4
Y ~Y i i Y>> 7 Y 7 7 T T Y Y> Y i>> 7> T i i i> Y> Y> i i Y> Y Y>>> Y Y Y Y i > Y i
t i t s 4 t{ c i t t t t t i i i t t t i K K K K K f S S S S< K 4{ i K i t t< C S i F t 4 S t S s S t i< t e t
GENERAL INSTALLATION: The dose tank is bedded and back filled in accordance with the
manufacturer's product approval specifications. Maximum depth of bury as specified by the
manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have
an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved
material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling; or
sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the excavation and is sealed
watertight. Electrical service complies with NEC 300 and Comm 16.28 Wis. Adm. Code.
03/05lgj Page of
kn
` CAPACITY CURVE 101AL DYNAiMiC' HEAD/CAPACITY
t iODELS 53/55/57/59 PER ,\,'m\i! TE
25 EFFLUENT AND DEWA.TFRING
6 20 FIHIAD
Mode; i 53/55/57/59
Ft Aeters Gal. f trs.
15 43 63
z 4
r 29
10 15 4_6 19 72
rsut-off Heod 19.25 ft. (5.9m
2 J -
5-
3 15/16f F 6 5/32 -
+I
I I
~ FI a J' 8 I
/2 / NFr
U.S. GALLONS 10 20 30 40 50 LITERS I f e
0 SC 3 15
FLOW PER MINUTE 009897
100
4 !/1r
"lk
Variable level float switches available. i
Variable level long cycle systems available.
Available with special cord lengths of 15', 25', 35' and 50'.~
Alarm systems available. -
.
Duplex systems available.
3 3,/32
V-a-
SK858
Single Seal - - - Control Selection Listin s~
Model Volts Phase Mode Amps Simplex Duplex CSA UL ~a 4 .
I. Integral float operated mechanical switch, no o extemal control r squired.
M53155 & M57159 115 1 Auto 9.7 1 Y Y~
N53l55 8 N57/59 113' - 1 Non 9.7 2 3 or 4 & 5 Y r 2. Single piggyback variable level float switch or double piggyback variable level
BN53 115 1 _ Auto 9.7 Y Y float switch. Refer to FM0477.
BN57 115 1 Auto 9.7 N y 3. Mechanical alternator "M-Pak' 10-0072 or 10-0075.
BE53157 230 1 Auto 4.8 Y - 4. See FM0712 for correct model of Electrical Alternator.
D53155 & D57/59 230 1 Auto 4.8 1 Y Y 5. Variable level control switch 10-0225 used as a control activator, with Electrical
E53/55 & E57/59 230 1 Non4.8 2 3 or 4 & 5 Y Y~ Alternator (3) or (4) float system.
Single piggyback switch included. -
Forinformation on additional Zoeller products refer tocatalog on Piggyback Variable Level Float Switches, FMO477; -L-r, 3caunow
Electrical Alternator, FM S v a 6
0486; Mechanical Alternator, FM0495; Sump/Sewage Basins, FM0487; and Single Phase ;0
ar lr,. <ri , a ass c o _ -
Simplex Pump Control/Alarm Systems, FM0732.
,a_'! zd
RESERVE P"WRE6
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
L TO• P.O. BOX Rl
L Louisville, KY 40250 Manufacturers of..
SHIP TO. 3649 Cane Run Road
® ®
Louisville, (502) 7782731-1(800) 928-PUMP Q~uirr PucsPS SrNCE /9~9
htfp;llwww.zoelter.com PUMP IO FAX (502) 774-3624
.
0 Copyright 2002 Zoeller Co. All rights reserved.
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
to certi.f that I have inspected the septic tank. presently
!~;carving the 0residence located at_: Section T-: 7 N, R~ ~
W, Town o i
1 L? .
OS Upon inspection, I certify that I have founcl
t:he tank and baffl__e_s to be in good condition, and it appears to be
functioning properly.
Last time serviced: 12 ~}2cs~
Oi.d flow back occur from absorption system?
Yes No (If no, skip next. Line)
n:
all.ons minutes
Approximate volume or length of time: g
Construction: Prefab Concrete___'____ Steel other_ _
Manufacturer: (If known) : LL /?/lei 7OLl/,--
Aqe of T (if known)
.,tgnature) (Name) Please print
License Number)
Pa t.e
Form to be completed by licensed plumber (s.145.06, Wiscons:i-n
Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative
Code.)
1"lumber (applying for sanitary permit) Certification:
ti accepting the above statement regardin
I ti xisting septic tank. tank condition, I certify ment hof ILHR 83h We Ad f.mCodeo(exCePt fnr
+
conform to the require
inspection opening over tlet baffle). rp~~
MP MPRS~~_~~~,~ C/
Name, ~lCk~ signature /
i
SHERIFF S DEED 1~ 111111111
8 0 4 4 6 1 4
Tx:4032555
DOCUMENT NO.
947311
STATE OF WISCONSIN CIRCUIT COURT ST CROIX COUNTY BETH PABST
REGISTER OF DEEDS
ST. CROIX CO., WI
ASSOCIATED BANK, N.A. 12/15/2011 12:54 PM
EXEMPT#: 14
Plaintiff, REC FEE: 30.00
VS. Case No. 10-CV-617 PAGES: 1
Hon. Howard W. Cameron
Br. 4
THOMAS W. DEAL RETURN TO:
LORI A. DEAL Mallery & Zimmerman, S.C.
500 Third Street, Suite 800
Defendants. P.O. Box 479
Wausau, WI 54402-0479
PIN #030-1043-70-000
WHEREAS, pursuant to a Judgment of Foreclosure entered in this matter on January 4, 2011, the property described
below was sold at public auction, at the Entrance of the Government Center, 1101 Carmichael Road, Hudson, WI 54016
in the City of Hudson, St Croix County, Wisconsin on July 12, 2011 to Associated Bank, N.A. for the sum of One
Hundred Sixty Three Thousand, Five Hundred and 00/100 Dollars ($163,500.00) being the highest and best bid,
therefore;
Now, therefore, the Sheriff, by virtue of said Judgment and pursuant to Wisconsin Statutes §846.16, hereby transfers,
sells and conveys to Associated Bank, N.A. the following described land situated in the County of St Croix, in the State
of Wisconsin, to-wit:
Part of the Southeast Quarter (SE 1/4) of the Southwest Quarter (SW 1/4) of Section Twenty (20), Township
Thirty (30) North, Range Nineteen (19) West, Town of St. Joseph, St. Croix County, Wisconsin, described as
follows:
Commencing at the Southwest corner of said Section Twenty (20), thence East on South line of said Southwest
Quarter (SW 1/4), 1314.0 feet; thence North 01 ° 03'20" West 18.0 feet to the place of beginning; thence North
01° 03'20" West on West line of said Southeast Quarter (SE 1/4) of the Southwest Quarter (SW 1/4), 339.59 feet;
thence East 339.95 feet; thence South 01° 03'20" East, 341.76 feet; thence North 89° 38'20" West on North line
of Town Road 340.0 feet to place of beginning.
Dated this 021 day of August, 2011.
A. Shilts, Sheriff
St Croix County, Wisconsin
ACKNOWLEDGMENT
STATE OF WISCONSIN)
) ss.
ST CROIX COUNTY)
Personally came before me on /Z the above named
THIS INSTRUMENT DRAFTED BY: John A. Shilts, Sheriff to me know to be
John A. Cravens the person(s) who executed the foregoing =in
Mallery & Zimmerman, S.C. thesame.
500 Third Street, Suite 800 j, P.O. Box 479 Wausau, WI 54402-0479 Notary Public, State of Wi csin
My commission expires: ` ~a
.,4
's
Wisconsin Department of Commerce rSQLL EVALUATION tCtt'V _ Page of ~
Division of Safety and Buildings
in accordance ' h Co , de n c
County. l ~c91
Attach complete site plan on paper not less than 8 1/ x 11 inches in size. Plan
include, but not limited to: vertical and horizontal refe nce porn~(BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, an ovation aotib *Wnc~e t nearest roa -7d D j
R ewed Date
Please print all inf atiol -hO IX
01 (D
Personal information you provide may be used for secon~ W ~/d~ p4 (1) (m j
Property Owner go tion
S U C 3'q QK' Govt. Lot 1/4/4 S Z(~ T_3Q N R E (or
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
3 v c,-i -
City State Zip Code Phone Number ❑ City ❑ Village o Nearest Road
❑ New Construction Use. esidential / Number of bedrooms Code derived design flow rate yJ2J GPD
eplacement ❑ Public commercial - Describe:
Parent material (1( taz Flood Plain elevation if ft.
General comments
and recommendations: S:
System Typed J~'7-- System Elevation
Boring # r~t Boring Q
F-i lia pit Ground surface elev. Z' ft. Depth to limiting factor 1 1 O in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
OL-ly
Bori 3 S O <
❑ Boring
® ng # O-Pit Ground surface eleq vl ' ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence 'Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
Z
_ ~l c
• Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/- and TSS < 30 mg/L
CST Nam (Please Print) Signature CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 r' 715-246-4516
s'
Property Owner - Parcel ID # Page of
a Boring It a Boring
Pit Ground surface elev. ft. Depth to limiting factor ~ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
1-- l1 1 C off, i
F-1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
Boring # ❑ Boring
F-1 ❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SOD-8330 (8.6/00)
Property Owner _ Parcel ID # Page of
F1 ng # Boring
Pit Ground surface elev. Depth to limiting factor ~T in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
J'r
Z T7__ 'Stk /f) 16- L2 bf
-TI
❑ firing # El Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
❑ Boring
Boring #
F-I El Pit Ground surface elev. ft. Depth to limiting factor in.
Soil ication Rate
Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence. Boundary Roots GPDAf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BOD, > 30 < 220 rrglL and TSS >30 < 150 mgA_ ' Effluent #2 = BOD, < 30 mg& and TSS 130 mglL
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-9330 (R6100)
Soil Test Plot Plan
n
ro'ect Name Associated Bank Shau
P
Address 1305 Main St.
Stevens Point Wi 54481 #226900
Lot Subdivision Date 6/3/12
SE 1/4 S W 1/4S 20 T 30 N/R19 W Township St. Joseph
County ST. CROIX
Boring Q Well PL Property Line
BM or VRP Assume Elevation 100 ft. Bottom of Siding
System Elevation 93.7/93.6 *HRPSame as Benchmark
V alley V iew Trail
Scale is 1" = 40'
unless otherwise
noted
Well
15'
340' Property Line 20
35' Existing 3
Bedroom House
10' B.M.
DW T
25' Pool
DW
25'
30'
B-3
30' 0% Slope
75'
75' B-2
B-1
0'
340' Property Line