HomeMy WebLinkAbout014-1073-10-100
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
556315 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Miller, Roger A. & Susan Forest, Town of 014-1073-10-100
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
00 6m G 34.31.15.543C
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 1i o Benchmark
514 kJ ,t z' S~ '7•
Dosing Alt BM
Bldg. Sewer
Aamv" ; I I--
F
Holding St/Ht Inlet
• 7 1 ,do . 7
TANK SETBACK INFORMATION St/Ht Outlet 17.15 AM • ~15'
TANK TO PT WELL BLDG. Vent to Air intake ROAD Dt Inlet
t ~1•
Septic > 56 //7/ Dt Bottom I • 3 93 3
Dosing Header/Man.
v~ 722 /y7 147 - q S.z
Aeration Dist. Pipe
614-1
Holding Bot. System 146,1 97• 6 s
PUMP/SIPHON INFORMATION Final Grade /q
G/ • Z
Manufacturer 61 d J GP nand St Cover I/ ( 3 . S
r• /d
Model Number Z3 1r
TDH Lift ,f c~ Friction Loss System Head TD Ft
/ 6.!51 ~.ZS 1(0
Forcemain LenV6 Dial i Dist. to well zZL /
SOIL ABSORPTION SYSTEM i . Ili
PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
BED/TRENCH Width Length No. Of Tre het
ENSIONS 7Z 9e ~
DIM 7
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer!
INFORMATION CHAMBER OR
Typ;Tr te : rq ^ Z /7/ UNIT Model Number:
K)•L
DISTRIBUTION SYSTEM ! e
Header/Manifold Distribution L J x Hole Size Ix Hole Spacing g Vey~o Air Intake
th \ Dia Le Length h g4-1-3 Dia:l-.5 SPacing-.-~- 1 (0
Len 9
/r
SOIL COVER x Pressure Systems Only X X I ound Or At-Grade Systems Only t - If
Depth Over Depth Over xx Depth of xx Seeded/S dded xx ulched
Bed/Trench Center f Bed/Trench Edges \ Topsoil ' Yes FRI No Yes 0 No
r/
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 2979 Hwy 64 GIenwod City, WI 54013 (NE 1/4 NE 1/4 34 T31 N R15W) NA Lot 1 P rcel No: 34.31.15.5430
1.) Alt BM Description i,v t)
2.) Bldg sewer length ~~e
- amount of cover = r n n
Plan revision Required? ❑ Yes No Z k
Use other side for additional information. Date Insepctor' Signatur Cert. No.
SBD-6710 (R.3/97)
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commerce.m.gov Safety and Buildings Division County A
201 W. Washington Ave., P.O. Box 7162 T c .tom v J ,e
sconsin RE(,-e,vE,) Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.)
Itinepartment of Commerce
State Transaction Number
Sanitar application V7/-7
In accordance with s. Comm. 83.21'Adm; Code, ~2'isssn oof this form to the appropriate governmental a j 3 unit is required prior to obtaining a sanit IdkLxpjl j~~ tite?'
Application forms for sta ed POWTS are Project Address (if different than mailing address)
submitted to the Department of Commerce. Persona 7n you provide may secondary
purposes in accordance with the Privacy Law, s. 15.04(1 m , Stats.
71 1. Application Information - Please Print All Information f f
Property Owner' ame l Pazcel #
Property Owner's Mail g Address Property Location
Lot
City, State / Zip ode Phone Numb-e7r Govt.
/V 6 / t y,, Section .37
£~✓f~JDUa ~,T TY0 C3 /'L0900 ~ N; R (circle one)
EorW
H. Type of Building (check al that apply) Lot # T "3
1 or 2 Family Dwelli44p - Number of Bedrooms ySubdivision Name
,v 1 Block # e~) C+-' VO~
❑ Public/Commercial Describe Use "
Cs El city of
CSM Number El Village of
11 State Owned - Describe Use e i _
U`Town of e
i
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of P ber El Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner
IV. Type of POWTS System/Component/Device: (Ch a1I'lhat a 1
❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground t-Grade Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain)---,' ❑ Pretreatment Device (expla
0 11 V. Dispersal/Treatment Area Information: r- .4
k
Design Flow (gpd) Design Soil Application Rate( dsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation/'-`
5no soy , ' 41~. Z S ~
3 a o ✓ to 11P
VI. Tank Info V Capacity in Total # of ManufActurer J
Gallons Gallons Units U y
New Tanks Existing Tanks d oG Y a R
{ C, U vl y w C7 C,
Septi or Holding Tank V D - 4 W
osing 6 ber ~(f t`a ~ ~ ~ K,,~
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
tuber's Name (Print) 'Plumber's Signature Number Business Phone Number
a C tt e LLZS'? Y7L-Z-YL
Plumber's Address (Street, City, State, Zip Code)
C YS~S3
S
Z~
07
VII Coun /De artment Use Only
Permit Fee Date Issued Issuing Age Si ture :
('J
Approved ❑ Disapproved $ ~T,
❑ Owner Given Reason for Denial t
fw-i
IX. Conditions of Approval/Reasons for Disapproval
SY~'fE~f~ /J Z . c~~0- ~O?cSJ C N"4>3167
1 Septic tank, effluent filter ands.
t~
dispersal cell must all be serviced /
as per managemen"t&tptVWtJL*dt " WtSiY m !a and submit to the County only on paper not les/ than 81/2 x 11 inches in size
2. All setback requirements must be maintained
as per applicable code/ordinances.
SBD-6398 (R. 02/09)
p~c4T~Fyr Safety and Buildings
10541N RANCH ROAD
S 9~ HAYWARD WI 54843
p
3 ! s p' Contact Through Relay
9 S F www.dsps.wi.gov/sb/
w www.wisconsin.gov
A ~v
~OF~SSION P~ Sw
Scott Walker, Governor
Dave Ross, Secretary
August 16, 2012
CUST ID No. 222872 A7TN.• POWTS Inspector
JACQUE M HAWKINS ZONING OFFICE
HAWKINS SOIL TESTING & SEPTIC SYSTEMS ST CROIX COUNTY SPIA
2659 150TH ST 1101 CARMICHAEL RD
LUCK WI 54853 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 08/16/2014 Identification Numbers
Transaction ID No. 2134717 P 0
SITE: Site ID No. 782713 IL
Roger Miller Please refer to both identification numbers, 077".
2979 Hwy 64 above, in all correspondence with the agency,
Town of Forest r
n pF
St Croix County
15,1T31N, R15W
Description: At grade, 2 bedroom residence SfC r,O
Object Type: POWTS Component Manual Regulated Object ID No.: 1386512
Maintenance required; 300 GPD Flow rate; 39 in Soil minimum depth to limiting factor from original gra e; System(s):
At-grade Component Manual, Version 2.0, SBD-10854 (N.03/07), SSWMP Pub. 9.6; 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. This system is to be constructed
and located in accordance with the enclosed approved plans and with any component manual(s) referenced above.
The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code
requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
Key Item(s)
• In the event this soil absorption system malfunctions so as to create a health hazard, the property owner must
follow the contingency plan as described in the approved plans. In addition, the owner must insure that the
operation, maintenance and monitoring duties as described the At Grade Component Manual are complied
with. A copy of this information must be given to the owner upon completion of the project.
• The float switch shall be a type that does not contain mercury. 2009 Wisconsin Act 44 prohibits the installation
of float switches or relays that contain mercury.
• The designer proposes to install an effluent filter to achieve the requirement of wastewater particle size.
Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the septic
tank outlet filter will be required. The outlet filter shall be installed per product approval stipulations.
Reminder
• The orientation of the at grade system must be such that the longest dimension is oriented along the surface
contour per SPS 383.44(6)(a)2.
• Limit activities in the area 15' beyond the down slope edge of the at grade per At grade Component Manual.
JACQUE M HAWKINS Page 2 8/16/2012
• Surface water drainage shall be diverted away from the system area.
• Materials shall conform to the requirements of SPS 384. SPS 384.10. No fixture, appliance, appurtenance,
material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system,
unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and
ch. 145, Stats.
• Maintain well and waterline set backs per SPS 383.43(8)(i).
A copy of the approved plans, specifications and this letter shall be on-site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation/operation.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any
others who are responsibl installation, operation or maintenance of the POWTS.
Sincerely, Fee Required $ 250.00
Fee Received $ 250.00
Balance Due $ 0.00
i
Patricia dorf'
POWTS Plan Re-Viewer, Int ated Services WiSMART code: 7633
(715) 634-7810 Fax: (71 634-5150, M - F 8:00 a.m. - 4:45 p.m.
pat.shandorf@w gov
cc: Charles L Bratz, POWTS Reviewer II, (608) 789-7893 , 7:45 am - 4:30 pm Monday - Friday
Jacque M Hawkins, Hawkins Perc Testing & Septic Systems
Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety& Buildings will be
modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the
relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety &
Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future
reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366.
RESIDENTIAL AT-GRADE DESIGN
Pressurized - Sloping Site
INDEX AND TITLE SHEET
Project Roger Miller At-Grade Mound
Owner Roger Miller
Address 2979 South HWY 64 Sall
Glenwood City WI 54013
AN 7--
715-557-2888
Legal Description NE1/4-NE1/4 Sec. 34 T31N-R15W
Township Forest County St.Croix
Subdivision Name Lot No. 'x
Note: References to the previous Dept.
Parcel ID Number 014-1073-10-J00 of Comm are consistent with the Dept.
of SPS Chapters 382,383 + 384Plan Transaction Number
Index sheet Pagel
Calculations Page 2
At-grade drawings Page 3
Laterals and dose tank Page 4
Specifications Page 5
Management & contingency plan Page 6
Pump Curve Page 7
Plot Plan Page 8
Designer Jacque Hawkins License Number MPRS# 222872
Signature Phone Number (715) 472-2421
Date /01/12
Designed pursuant to:
At-grade Component Manual for POWTS SBD-1085- -1'GN .03 0'/)
SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST - SAS (01/81)
Version 3.11 (05/01) Page 1 of 8
PRESSURIZED AT-GRADE DESIGN
At-grade Design Worksheet - Sloping Site
Flows and Site Data Entry.
(r or c) r Residential or commercial?
200.0 Estimated wastewater flow (gpd)
300.0 Design wastewater flow (gpd)
10.00 % Site slope
95.75 Contour elev. below lateral (ft)
39.00 Depth to limiting factor (in)
0.60 In-situ soil application rate (gpd/ft^2)
Distribution Cell Information
(1 or 2) 1 Influent wastewater quality
7.00 Linear loading rate gpd/ft
7.00 Effective absorption width (ft)
10.00 Max. effective width permitted (ft)
72.00 Aggregate length (ft)
Pressure Distribution Data Entry
(c or e) c Center or end lateral connection
2 Number of laterals
0.188 Orifice diameter (in) e.g. 0.188
Not a final
calculation 2.00 Estimated orifice spacing (ft)
2.00 Forcemain diameter (in)
2.43 Forcemain flow velocity (ft/sec)
40.00 Forcemain length (ft) y or n Does forcemain drain back?
90.00 Pump tank elevation (ft) y or n Are laterals at highest point?
NA
3.25 System head (ft) x 1.3 6.5 Forcemain drainback (gal)
5.25 Vertical lift (ft) 32.0 5x Lateral void volume (gal)
0.51 Friction loss (ft) 38.5 Minimum dose volume (gal)
9.01 Total dynamic head (ft) 23.8 System demand (gpm)
Lateral Diameter Selection Gallons/inch Calculator (optional)
Pipe diameter Design options Design choice Total Tank Capacity (gal)
Designer 1 in Total Working Liquid Depth (in)
must select 1.25 in x Gal/in (enter result in cell G46)
one lateral 1.5 in X X
diameter 2 in x Treatment Tank Information
3 in x 800 Septic tank capacity (gal)
Skaw Concrete Manufacturer
Effluent Filter Information Dose Tank Information
Best Filter manufacturer 799.8 Dose tank capacity (gal)
GF-10 Filter model number 19.2 Dose tank volume (gal/in)
Skaw Concrete Manufacturer
Project: Roger Miller At-Grade Mound
Transaction Number: Page 2 of 8
AT-GRADE PLAN VIEW
1 /6 B Observation pipes (2 typical) A 7.00
D B 7.0
t 1 /6 B 12.00 ft
C 9.00 ft
W C D 5.00 ft
E 2.00 ft
D L 82.00 ft
D B W 19.00 ft
A x B 500.00 ft^2
L
Cap
Typical obs. pipe.
= Total aggregate cell A x B Slotted in the lower
e and anchored
= Plowed area L x W securely.
--i
6°
AT-GRADE CROSS SECTION
Svnthetic fabric cover
97.54 ft Finished grade
elevation
Lateral
invert elev. 96.25 ft
Observation pipe
at aggregate toe
E
10 % Slope
ta'' Surface contour 95.75 ft C A
and stgM D
® = 12 in. topsoil and subsoil Plowed layer
over aggregate and tapered to toes. below L x W
= 6 in. aggregate below
pipe(s), and 2 in. above pipe.
Project: Roger Miller At-Grade Mound
Transaction Number: Page 3 of 8
PRESSURE DISTRIBUTION AND DOSE TANK
Lateral Diagram - Center Connection
I P I
dr-
IE X IE xl2 I x12+I Laterals & force main of PVC Sch 40
Last hole drilled next to end cap (per COMM Table 84.30•5)
Holes drilled on the bottom of the lateral.
equally spaced • = Turn-up v4bsll valve or cleanout plug
Lateral Specifications
0.188 Orifice diameter (in) Center Lateral connection point
X 1.99 Orifice spacing (ft) 2 Number laterals
18 Orifices/lateral P 34.83 Lateral length (ft)
11.9 Lat. discharge rate (gpm) 1.50 Lateral diameter (in)
2.00 Forcemain diameter (in)
23.8 Sys. discharge rate (gpm) 40.00 Forcemain Length (ft)
9.01 TDH (ft)
Typical Pump Chamber Layout
Approved manhole cover with
Weather-proof warning label and locking device
junction box
Final grade 4"
disconnect
Tank component is Alternate
properly vented 'rte outlet
^location 18" min.
Electrical as per NEC 300 and Ir Approved outlet joint
Comm 16.28 WAC
Tank full
= Inches Gallons JA Provide 1/4"
A 25.7 492.5 weep hole or
Alarm on
B antisiphon
2.0 38.4 B
E C 2.0 38.5 pumpon device.
l
G D 12.0 230.4 91.00 ft C (S
Totals 41.7 799.8
Pump off
D
3" Bedding under tank ~ 90.00 ft
Goulds Pump manufacturer S.J.Electro _ Alarm manufacturer
EP04 Pump model number Tank Alert Alarm model number
Project: Roger Miller At-Grade Mound
Transaction Number: Page 4 of 8
.
At-grade System Maintenance and Operation Specifications
Service Provider's Name Powers Sanitation Phone 715-246-5738
POWTS Regulator's Name St. Croix County Zoning Office Phone 715-386-4680
System Flow and Load Parameters
Design Flow - Peak 300 gpd Maximum Influent Particle Size 1/8 in
Estimated Flow - Average 200 gpd Maximum BOD5 220 mg/L
Septic Tank Capacity 800 gal Maximum TSS 150 mg/L
Soil Absorption Component Size 500.0 f:2 Maximum FOG 30 mg/L
Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL
Service Frequency
Septic and Pump Tank Inspect and/or service once eve 3 ears
Effluent Filter Inspect and clean at least once eve 3 ears
Pump and Controls Test once eve 3 ears
Alarm Should test month)
Pressure System Laterals should be flushed and pressure tested eve 1.5 ears
Mound Inspect for ndin and seepage once eve 3 ears
Other
Miscellaneous Construction and Materials Standards
1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap,
and are secured in as shown in the at-grade component manual.
2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code.
3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code.
4. Tillage of the basal area is accomplished with a mold board or chisel plow.
5. The at-grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion
and help reduce frost penetration.
6. Areas within 15 feet of the downslope toe will be protected from compaction.
7. All other construction details are as per the at-grade component manual SBD-10570-P (R. 6/99).
Lateral Turn-up Detail
Finished
Grade
6-8" Diameter Lawn Threaded Cleanout
Sprinkler Valve Box Plug or Ball Valve
Distribution
Long Sweep 90 or Two
45 Degree Bends Same
Diameter as Lateral
Project: Roger Miller At-Grade Mound
Transaction Number: Page 5 of 8
At-grade System Management Plan
Pursuant to Comm 83.54, Wis. Adm. Code
General
This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component
manuals [SBD-10570-P (R. 06/99) and SSWMP Pub. 9.6 (01/81)] and local or state rules pertaining to system maintenance and
maintenance reporting.
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death.
Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as
POWTS components.
Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings
used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or
subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking
device to prevent accidental or unauthorized entry into a tank or component.
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, 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 fitter when removed from its enclosure. If the fitter is equipped with an alarm, the
filter shall be serviced if the alarm is activated continuously. Intermittent fitter 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 1/3 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.
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 fitter is installed within the tank it shall be inspected and serviced as necessary.
At-grade and Pressure Distribution System
No trees or shrubs should be planted on the at-grade. Plantings may be made around the at-grade's perimeter, and the at-grade shall be
seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for
vegetative maintenance) on the at-grade is not recommended since soil compaction may hinder aeration of the infiltrative surface within the
mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the at-
grade be heavily mulched as protection from freezing.
Influent quality into the at-grade system may not exceed 220 mg/L BOD5. 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30
mg/L BOD5 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow
specified in the permit for this installation.
The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be
flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test
when the system was installed to determine if orifice 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.
Contingency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition.
If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately
repaired or replaced with a component of the same or equal performance.
If the at-grade component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or
replaced in its' present location by increasing basal area if toe leakage occurs or by renovating the biologically dogged absorption and
dispersal media, installing new piping, and replacing other components as deemed necessary to bring
the system into proper operating condition.
See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider.
Project: Roger Miller At-Grade Mound Transaction Number: Page 6 of 8
Page 7 of 8
NGOULDS PUMPS Submersible
Effluent Pump
EP04
3871 EP05
APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower
grade turbine oil for tic enclosed design for heavy duty ball bearing
Specifically designed for the lubrication and efficient improved performance. construction.
following uses: heat transfer. ■ Casing and Base: Rugged
• Effluent systems thermoplastic design provides AGENCY LISTING
• Homes Available for automatic and superior strength and corrosion
• Farms manual operation. Auto- Canadian standards Asstxiadon
• Heavy duty sump matic models include resistance.
• Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end
• Dewatering assembled and preset at the for efficient heat transfer, in "C" or "I"'.)
factory. strength, and durability.
SPECIFICATIONS ■ Motor Cover: Thermoplastic Goulds Ptrnps is ISO 9001 agsoefed.
FEATURES cover with integral handle and
• Solids handling capability: float switch attachment points.
'/a" maximum. ■ EP04 Impeller: Thermoplas- 0 Power Cable: Severe duty
• Capacities: up to 60 GPM, tic Semi-open design with rated oil and water resistant.
• Total heads: up to 31 feet. pump out vanes for mechanical
• Discharge size: 1'12" NPT. seal protection.
• Mechanical seal: carbon-
rotary/ceramic-stationary,
BUNA-N elastomers.
• Temperature:
104°F (40'C) continuous
140"F (601C) intermittent. METERS FEET
• Fasteners: 300 series 10
stainless steel. 9 30S GPM
• Capable of running
dry without damage to B 2s Fr
components. 25
°a
Motor: _
• EP04 Single phase: 0.4 HP, v_ s 20
115 or 230 V, 60 Hz, 1550 s
RPM, built in overload with c 15
automatic reset. a a
• EP05 Single phase: 0.5 HP, o EP05 -
115 V or 230V, 60 Hz, 1550 3 10
RPM, built in overload with EPOa
automatic reset. z
• Power cord: 10 foot s
standard length, 16/3 1
SJTOW with three prong
grounding plug. Optional 20 0 °o 10 zo ao 40 so GPM
foot length, 16/3 SJTW with
three prong grounding plug
o z a s s 10 12 min
(standard on EP05).
CAPACITY
Goulds Pumps
Ef 2001 Goulds Pumps ITT Industries
Effective may, 2001
B3871
~j 16 o
1
x ~ 1~3 ~o ~1
a
o ~
T..
Z,
j
M
Ifisconsin SOIL EVALUATION REPORT ~w•Mw~+'""'""""''ter 1 0#2320
Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page
Division of Safety and Buildings Gusturr Septic Service
Count
Attach complete site plan on paper not less than 8'/~ x 11 inches in size. Plan must rolx
include, but not limited to: vertical and horizontal reference point (BM), direction and _ w<
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parce I.D. _
200 / _UL~(._J
Please print all information. Re a ed B D !7Z Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). UNTY
7 6
Property Owner Property Location
Miller, Roger Govt. Lot n/a NE /4, NE1/4, S34, T31N, R15W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
2979 St. Hwy 64 n/a n/a N/A t~ l -
City State Zip Code Phone Number City Village 11 - Town Nearest Road r~
Glenwood City WI 54013 715-557-2886 Forest } State Hwy 64
✓j New Construction Use: t Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
! Replacement -J Public or commercial - Describe:
Parent material ground moraines over sandstone Flood plain elevation, if applicable, n/a ft.
General comments Part of 134 acres. Recommend at-grade system along 95 75 contour. and recommendations: t `S G
. t~ , . fem. a. `yi" p'
u try=°'7t ah"i YMr'1ry
1 Boring # F-1 Boring
Pit Ground surface elev. 96.45 ft. Depth to limiting factor 39 / in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsetl Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
1 0-7 10yr3/3 none A 2mgr mvfr as 2f,im 0.6 0.8
2 7-11 10yr5/3 none sil 2msbk mvfr Cw if 0.6 0.8
3 11-18 10yr4/4 none sl 2msbk mvfr Cw - 0.6 1.0
4 18-39 7.5yr4/6 none Is lmsbk mvfr Cw - 0.7 1.6
5 39-55 10yr5/6 c2-3p10yr7/2 sl 2msbk mvfr - - 0.6 1.0
7.5yr5/8
2] Boring # - Boring ✓
Pit Ground surface elev. 96.45 ft. Depth to limiting factor 42 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2
1 0-6 10yr3/3 none sil 2mgr mvfr as 2f,im 0.6 0.8
2 6-12 10yr5/3 none sil 2msbk mvfr Cw if 0.6 0.8
3 12-21 10yr4/4 none sl 2msbk mvfr Cw - 0.6 1.0
4 21-32 7.5yr4/6 none Is imsbk mvfr Cw - 0.7 1.6
5 32-42 10yr4/6 none sl 2msbk mfr Cw - 0.6 1.0
6 42-55 10yr5/6 c2-3d10yr7/2 sl 2msbk mfr - - 0.6 1.0
7.5 r5 8
* Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD5 S30 mg/L and TSS s-30 mg/L
CST Name (Please Print) Signature: CST Number
Tom Gustum 227618
Address Gustum Septic Service Date Evaluation Conducted Telephone Number
N13450 937th St. New Auburn, WI 54757 6/14/2007 715-658-1344
.RT)-8330 lR 07/001
1
Property Owner Miller, Roger'-
oger Parcel ID # Page 2 of 3
.4'
F3 1 Boring
Boring # Pit Ground surface elev. 93.75 ft. Depth to limiting factor 40 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-8 10yr3/3 none sil 2mgr mvfr as 2f,1m 0.6 0.8
2 8-12 10yr5/3 none sil 2msbk mvfr Cw if 0.6 0.8
3 12-20 10yr4/4 none sl 2msbk mvfr Cw - 0.6 1.0
4 20-40 7.5yr4/6 none Is lmsbk mvfr Cw - 0.7 1.6
5 40-55 10yr5/6 c2-3p10yr7/2 sl 2msbk mvfr - - 0.6 1.0
7.5 r5 8
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/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
Boring
Boring # _j Pit Ground surface elev. ft. Depth to limiting factor in.
F-1
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BODS> 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
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-877'y
cxn_R330 rx 07/001 Gustum Sentic Service
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Feb-25-2011 02:23 PM St. Croix County Plan/Zoning 715-386-4686 1/2
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
ietlBuyc.r o ~ _ZAf,-l
C?wt
f r~
Maiiing Address
Property Address
(Verification required from Planning & Zoning Doadrncnt or new consuuctlon.)
City/State Parcel Identification Number 0/k/-/0Zj-
LEGAL - C)
ES RIP'TION .L
Property Location /Vl ~!s - %4 , sec. 3 . T ~N R / SW, Town of /"a 4 6 S I
Subdivision Plat: Lot # / .
Certified Survey Map # V
oiktrt;ie ~ . page # 5 ~ ~ r~ •
Warranty Deed #
(before 2007)Voltune Page #
Spec house yes Lot lines identifiable no
SYSTEM MAINICNANCE AND QWNER Ci, Etn CATION
Improper use and maintenance of your septic system could result in its premature fwlure 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 treattmt stage in the wage disposal system Owner maintenanca
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. CMIX County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Departmenk a emir tion forth, sighed by the
owner and by a master plumber. journeyman Plumber. restricted plumber or a licensed pumper verifying that (b) the on site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping tit neccssary). the xapptic tank is
less than 1,3 tali otsiudge.
1/we, the undersigned have read the above requirements and agree to maja in the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the DeparuneIIt of Natural Resources, State of Wimmia
Certification stating that your septic system has been maintained roust he completed and returned to the 5t. Croix County pianniug &
Zoning Department within 30 days of the three year expiration date.
I/we certify that ail statenhents on this form are true to the beet of nhyfour knowledge. !!we am/are tide owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Decds Ofrfrce.
Number of bedrooms c-)-
Ic3NATURE OF APPLICANT(S) lei r v
DATE
'Any information that is mwvpttsaemted may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranty decd from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08105)
$ OTx34027716 0
i
942639
BETH PABST
REGISTER OF DEEDS
ST. CROIX CO., WI
CERTIFIED SURVEY MAP R10/06/20 FOR
2:09 PM
PART OF THE NORTHEAST 1\4 OF THE NORTHEAST 1\4• EXEMPT
OF SECTION 34, TOWNSHIP 31 NORTH, RANGE 15 WEST REP FEE: 30.00
COPY FEE: 3.00
TOWN OF FOREST, ST.CROIX COUNTY,WISCONSIN PAGES: 2
UNPLATTED LANDS
STH "64_ 2664.52' ,
1_33_2.2_6' S89.10'11 "E 310.00' 1022.26'
S89.10'11 °E 63.72' S89'1O'l1°E-
North 114 Corner Jseback 63.37' Northeast corner
Section 34-31-15 s8s•14'04"E 3099w°/ Section 34-31-15
1.25' Iron Pipe q`VI' Steel Survey Nail
ung line iv
Z silos
91
CR re N
( V
C) O
to rn
rncn well cn
LOT L-t
UNPLATTED ~ r-LANDS rn - -
cD
217,900 sq.ft.
N 5.00 acres
00
incl. r-o-w UNPLATTED
0 198,204 sq. ff ° o LANDS
PREPARED FOR: 4.55 acres ort C:1
RECEIVED
Roger & Susan Miller o not incl. r-o-w
3025 HWY 64 CD
Glenwood City, WI M
Z F E B 2 0 2012
I
N 89'1 O' 11 " W 310.00 ST. CROIX COUNTY
SURVEYOR'S RECORD
Note: Each parcel on this map is subject to State and County laws, rules and regulations
(i.e. wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing
any parcel, contact the St. Croix County Zoning Office and Town Board for advice.
DRAFTED
BY:
Joel A Brandt d 3~..• ~y
JB SURVEYING LLC * r '~OELA
SRANDT
..(k.E*Wi CRY,
SCALE: 1' .150' - '
0' 150'
300'
a'
LEGEND
North is referenced to the ........Found Government Corner
~
North line of the NE Quarter o...... ...Set 7\8" x 18" Iron Reber weighing '
of Section 34-31-15 2.00 lbs. per lineal foot WINNOW
which bears S89°10'11"E ...........Found 3/4" Iron Reber Sheet 1 of 2
(St Croix County Grid System)
1 of 2
Vol 25 Page 5798
r „w
E 1 1 AM
Parcel 014-1 qn-10-100 z 08/23/201P AGE 2 08:34
P OF 1
Alt. Parcel M 3 %-31.15.543C 014 - TOWN OF FOREST
Current ~ ST. CROIX COUNTY, WISCONSIN
Creation Date Hmal.EM
a Map # Sales Area Application # Permit # Permit Type # of Units
10/06/2011 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - MILLER, ROGER A & SUSAN M
ROGER A & SUSAN M MILLER
3025 HWY 64
GLENWOOD CITY WI 54013
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 2979 HWY 64 BARN
SC 2198 SCH DIST GLENWOOD CITY
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 5.000 Plat: 5798-CSM 25-5798 014/2011
SEC 34 T31 N R1 5W PT NE NE BEING CSM Block/Condo Bldg: LOT 01
25-5798 LOT 1 (5.OOAC)
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
34-31N-15W NE NE
Notes: Parcel History:
RETIRED 2011 FOR 2012; TAKES PT OF Date Doc # Vol/Page Type
014-1073-10-000 (543A) FOR REMAINDER OF 10/06/2011 942639 25/5798 CSM
014-1073-10-050 (543A-05) & CSM 25-5798 10/01/1997 566170 1267/257 WD
014-1073-10-100 (543C) 03/17/1980 363225 609/357 LC
2012 SUMMARY Bill M Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 05/08/2012
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 4.000 200 0 200 NO 00
OTHER G7 1.000 5,000 5,300 10,300 NO 00
Totals for 2012:
General Property 5.000 5,200 5,300 10,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch M
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00 •
- -
7 =W
YGL $26 ! PACE257
57At E BAR t:.rt= WISCONSIN 2 - 1922
WARRANTY DEED
DOCUMENT NO.
j i REGISTF-R'S OFrI(:F-
Francis E. Swan~oel, a/k/a Francis Emil ! ST, CROIX CO , W1
~i Swanepoel, ant9 Betty Lou Swann-epoel, husband mold (or PooarA
anz-v-ifc •"--T int tenants
OCT 01 1997
_ - - 9
:1 convc an&warrantsto-Roomer A. Miller and_ Susan M. „ 9:30 Pali
)Miller, husband and wife, as-joint tenants
r: i Register of 0aoda moll
I, j~
Ii - i
3hAr'.E RESERVED FOR Rts C:~Rr:u.3 CAtn
1~ - - r _ _
fINAME AND FLSTURN ?)DRt 5S
St'. Cray
1 the following described real estate in County,
State of Wisconsin CiMUNS 11STAT s BANK
I
140 Main S,
Woodville, W1 U4028
{i Southeast Quarter (SE4) of section Woodville, ~i
II Twenty--seven (27) ; East Half of Northeast 014-1656--46, 50, -60, 70 .1
j Quarter (Ek of NE4) of Section Thirty- 014 107 -i(1,-~Q 014-1075-60 I
four (34) EXCEPT East 150 feet of West PAR~et IOENTrFICATtON NUTABER ;
~l .460 feet of North 300 feet thereof and
Northwest Quarter of Northwest Quarter (NW4 of NW4) of Section
Thirty--five (35) EXCEPT North 208 feet 8k inches of West 208 j{
feet 8k inches thereof and EXCEPT East 330 feet of North 660
~I feet thereof, ALL in Township Thirty-one (31) North, Range
ji Fifteen (15) West.
' I.
This deed is given in fulfillment of that certain Land Contract
1{ between the parties dated December 10, 1979, and recorded in the i
office of the Register of Deeds for St. Croix County, Wisconsin,
+ on March 17, 1980, in volume 609 of Records, at Page 357, as ;i
Document No. 363225.
TRA ; Q JFP
homestead toners~~~
This is not
1• }((j~)X (u not)
Excepiiuntowarranties: Easements and restrictions of record, and except any
1 {i liens of encumbrances created or suffered to be created by the acts
II and defaults of the grantees, their 'heirs, successors and ass gns.
4 I ,p m
~
11 Bated this ~-tt* S day of LY A.D., 19 9 7
(SEAL) - - Lt se tZ-C1~ 'G (SEAL)
yl Francis E. Swanepoel- t,
`i - - -
- (SEAL) (SEAL)
-BBe ty Lou Swanepoe
it
AUTHENTICATION ACKNOWLEDGMENT
State of Wisconsir2, „
Signature(s) -
St. Croix _-County.
authenticated this _ day of 19 Yccs nail, ca a before tae this day of
v' 19 g the r bovg named
_ Francis E. Swanepoel, a_lc/a _
Francis Emil Swanepoel ana-
? Betty Lou Swanepoel -
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not.
authorized by 5706.06, Wis. Stats.) to me kno\vn to be the p r-on S \ foregoing
instrum a cknoKl ge the same.
- THIS INSTRUMENT WAS DRAFTED BY
---Thomas A. McCormack
Baldwin, WI 54002 Notary Public, T.-.S$• c"~1.------- county. Wis
(Signeturcs Ina)- he authenticated of acknowkdgcd. Bath are not My .-timm~rrssion is permanent. (If not, state rspir.ri!yin ,late
" necessary)
traroe<.! pcrwnv,;mn +r, Jn) olpa. ap %I-'Iti I" er J or panted below 'ha. ..tin.nura
STATE.. DA4 or wiscoNsi~ W.S,r.•rsn i.,.g,y El+ar- .
Form No. 2 - 1982 ~rw;R.r v:re
.
p
t
3 ~ +T I
¢ f ,9aTv1
i
3
1
t
m~u•wutyFiga i
w,w .+.K.ru^.,+e~uawtKwR ~.....oMe+r ..av®•,y m..
RECEIVED
AUG 2 3 2042
,r ST CROIX COUNTY
OFFICE
F PLANNING & ZONING