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HomeMy WebLinkAbout022-1042-40-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 556330 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: Colonial Savings, F.A., foreclosure sale Kinnickinnic, Town of 022-1042-40-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: / 8►'1'1 1 6.5-F 15.28.18.228D TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. S /o /05• I /ad Septic Benchmark ` A 9 O 101.98 An6 Dosing Al BM I. z 9f Aeration I ti l Bldg. Se er 1 X~ 'r kipldiags-1~~$~ St/Ht Inlet W 1 GSs1~ St/Ht Outlet TANK SETBACK INFORMATION p,, j~_t .44 1 IM. (p(P TANK TO (P/L~ WELL BLDG. Vent to Air Intake ROAD Dt Inlet 91. 9 /3. / Septic i 3 00 ; .1cf Dt Bottom s~ 5 ,g A158 vs . sZ Dosing 35 > N 7 i c? Header/Man. Aeration Dist. Pipe v$ Holding Bot. System # y 9Z- 5 Final Grade PUMP/SIPHON INFORMATION Manufacturer ^n Demand St over C l7a~Jlcl~ GPM GI,,e / Z~ ~S•85'' Model Number O Z~ (/ova 1 Ov 9. ~g rj'z . 5 TDH Lift Friction LossZ System Head Z~ TDH~ t Forcemain Length r Dia.. of Dist. to Well 2(m SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of ench PIT DIMENSIONS No. Of Pits Inside Dia. 7id Depth __1 :1 DIMENSIONS ~ Q) ae SETBACK SYSTEM TO a P/L cJBIBLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type f Syste D CHAMBER OR n}' r0. /7Z UNIT Model Number DISTRIBUTION SYSTEM p J / " rJ Header/Manifold Distribution x Hole Size Ix Hole Spacing Ve Air Intake 7 Pipe(s) -70 Length Dia Length_ Dia Spacing 77 v SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of eeded/S dded xx Mul hed Bed/Trench Center 1.72 Bed/Trench Edges Topsoil xx S J Yes E No Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / / Location: 364 OLD CEM TERY RD River Falls, WI 54022 (SE 1/4 NE 1/4 15 T28N R18W) NA Lot 4 cj,..,u!<1 Parcel No: 15.28.18.228D lqlb Li 1.) Alt BM Description = ✓ GG~,~~~ f- ) pIO~ Dl-~ 2.) Bldg sewer length / a -amount of cover kG ~'OJ V C Plan revision Required? ❑ Yes No Use other side for additional information. L9 SBD-6710 (R.3197) Date Insep is Sign re Cert. No. 00 o 00 ~ h v a DO w k ~ 0 M ~ ~ tS O O ~bU U o 0 op V o Con - 00 c,~ h p erg O~ O V w~ ~ O ~ o Con 4 ~ a 0 0 W o r$~ d' i ~ ~ U tj ' ~ ~ III ~ 4 V 00 a y 2 M o W ~ ~sy 72 a u N c W W W y y p N v~ 3 ~ W 3 ° ~ ~ C7 w o d ~ 2 ° a w CM lio O Z. r rid O tt r ~ It y NO ~ y O ~ d ~d y . • ~V y - ift. y ~ d ~ n d M..~ Q O y r-N y d r ~ o ~ ~ O w O d Litt C~ ~j I S o rx', ~ ego A m a ^o ~ ego C s+ MC r9 rn mOQ"7 ~`''C`-'S•• l J fD O 7 C y 3 Aa'oo mQ•eoo'm_.A 'O C J ~ QO y ~ .q 00 A m .O m O K W ~ A 77 n O 01 .~.y y A !=9 C .O A OmQ O r+ O g 0 ~ 3 m O O ~ S f9 i-+ M~ ~ ~ A~ y A y A y ~ 40, 4 C A N ,e tD e9 •t T O. O w n V` ~ O~~~ m y R e~ ~=m~,~• m, m~3,~3 z o °e Q eeo A Q A o y 0 `G Vi I~ QQ y < "'1 y y N RA ~a~~ a,s~ y m T O Zo O v Safety and Buildings Division County Nviscoi • 201 W. Washington Ave., P.O. Box 7162 , 7- t' % rf ~ Madison, Wt 53707 - 7162 Sanitary liermit Number (to be filled in by Co.) (608) 266-3151 3 Department of Commerce law 3 Sanitary Per l Cadon State Plan I.D../Number In accord with Comm 83.2 1, W e ►nfotmation you provide / ( 2 may be used for secon4ftp vary Law, s I I V E D P% Address (if ifferent than mailing address) 1. Application Information - Please Print All Information SEP 1 201z C~~( -P- 1.7 Property Owner's Name Parcel # Lot # Block # Property Owner's Mailing Address Propeftj Location (,2, Section - City, State Zip Code one Number W R ,4E 1. Ty of Building (check all that apply) Subdivision Name CSM Number 1 or 2 Family Dwelling- Number of Bedr.o ~ t' S - Q ❑ PubliclCommercial - Describe Use 3121611V17:1 C/ - ❑ State Owned - Describe Use []City []Village Q ownship of 111. Type of Permit: (Chet x A. Complete line B if applicable) A. ❑ New System 41acemcet System Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision El Change of ❑ Permit Transfer to Necv List Previous Permit Number and Date Issued wner 77 Before Expiration Plumber -OW-- IV. Type of POWTS S stem: Check all that apply) ❑ Non -Pressurized In-Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soi At-Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland Pressurized In-c- ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter .aching Chamber ❑ !Drip Line ❑ G vet Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpds fl Dispersal Area Requ (sf) Dispersal Area Propose {sf) System Elevation Vx %g , C52) VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units a 6 L Cgeycrete Constructed Glass - -t ) 011 New Existing h l7/p Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber r VII. Responsibility Statement- n the undersigned, assume responsi ' .ly for installation of the POWTS sbown on the attached plans Plumber's Name (Print) Plumber's MP/MPRS Number Business Phone Number ~5 - -725 -i Plumber's Address (Street, City, S Zip Cod V ill. un !De rtment Use Only Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Da iss sluing Agen i ps) t ❑ Owner Given Reason for Denial Surcharge Fee) 4 2 Ix. Conditions of Approval/Reasons for Disapproval a' J SYSTEM OWNER: ` !at 1 Septic tank, effluent filter and q lM- . dispersal cell must all be serviced / maintained z5M 2- = ~p~ as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Attach complete plans (to the County only) for the system on paper not less than 812 a 11 inelm in size SBD-6398 (ROll03) -<x a--/- 0 C' ~l~t'ta ppARTAg1U Safety and Buildings x'0%1 10541 N RANCH ROAD 0 P HAYWARD WI 54843 3 j S Contact Through Relay ` www.dsps.wi.gov/sb/ 92 P S w www.wisconsin.gov e` °F~'ssr0114 Scott Walker, Governor Dave Ross, Secretary August 30, 2012 CUST ID No. 648443 ATTN.• POWTS Inspector ZONING OFFICE KEITH E KNUDTSON ST CROIX COUNTY SPIA 927 150TH ST 1101 CARMICHAEL RD ROBERTS WI 54023 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/30/2014 Identification Numbers Transaction ID No. 2142157 SITE: Site ID No. 783172 Colonial Savings Please refer to both identification numbers, 364 Old Cemetary Rd above, in all correspondence with the agency. Town of Kinnickinnic St Croix County E1/2, NEIA, S15, T28N, R18W FOR: Description: At grade, 3 bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 1388300 Maintenance required; Replacement system; 450 GPD Flow rate; 44 in Soil minimum depth to limiting factor from original grade; System(s): At-grade Component Manual, Version 2.0, SBD-10854 (N.03/07), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01101); Effluent Filter C;ond The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes K? t and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed ~E 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. SEE CO 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. • Use bench mark #2 as there is conflict between the CST's plot plan and the designer's plot plan regarding the location of enc mar . • 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. KErFH E KNUDTSON Page 2 8/30/2012 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. • 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. • The existing POWTS must be properly abandoned per s. SPS 383.33 Wis. Adm. Code. 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 responsible for the installation, operation or maintenance of the POWTS. erel Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 PatriciaL Shandorf POWTS Plan Review r , Integrated Services WSMART code: 7633 (715) 634-781 ax 634-5150 , M - F 8:00 a.m. - 4:45 p.m. pat.shandorf wisco sin.gov J cc: Charles L Bratz, POWTS Reviewer II, (608) 789-7893 , 7:45 am - 4:30 pm Monday - Friday 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 Colonial Savings At-Grade Owner Colonial Savings Address 2626 West Freeway Fortworth Texas 76102 612-414-6057 Legal Description E1/4-NE1/4 Sec. 15 T28N-R18W Township Kinnickinnic County St. Croix Subdivision Name Csm# 340126 Vo. 2 Pg. 371 Lot No. Parcel ID Number 022104240000 Please note references to the previous Dept. of Comm zre consistent with the Plan Transaction Number new Dept. of SPS Chps. 382, 383 + 384 Index sheet Pagel tLp11ally Calculations Page 2 At-grade drawings Page 3 Laterals and dose tank Page 4~NGS Specifications Page 5 4E1~( Management & contingency plan Page 6 Pump Curve Page 7 AND Plot Plan Page 8 tHESP Designer Keith K dtso License Number MPRS#648443 Signature Phone Number (651) 470-1737 Date 08/07/12 Designed pursuant to: At-grade Component Manual for POWTS SBD-1085 --P (N - 0307 ) SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST - SAS (01/81) Version 3.11 (05/01) Pagel of 8 PRESSURIZED AT-GRADE DESIGN At-grade Design Worksheet - Sloping Site Flows and Site Data Entry. (r or c) r Residential or commercial? 300.0 Estimated wastewater flow (gpd) 450.0 Design wastewater flow (gpd) 12.00 % Site slope 92.50 Contour elev. below lateral (ft) 44.00 Depth to limiting factor (in) 0.70 In-situ soil application rate (gpd/ft^2) Distribution Cell Information (1 or 2) 1 Influent wastewater quality 8.00 Linear loading rate gpd/ft 8.00 Effective absorption width (ft) 10.00 Max. effective width permitted (ft) 81.00 Aggregate length (ft) Pressure Distribution Data Entry (c or e) a Center or end lateral connection 1 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) 2.76 Forcemain flow velocity (ftisec) 30.00 Forcemain length (ft) y or n Does forcemain drain back? 85.50 Pump tank elevation (ft) y or n Are laterals at highest point? NA 3.25 System head (ft) x 1.3 4.9 Forcemain drainback (gal) 6.50 Vertical lift (ft) 64.0 5x Lateral void volume (gal) 0.48 Friction loss (ft) 68.9 Minimum dose volume (gal) 10.23 Total dynamic head (ft) 27.0 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 Gal/in (enter result in cell G46) one lateral 1.5 in diameter 2 in x x Treatment Tank Information 3 in x 1000 Septic tank capacity (gal) Wieser Concrete Manufacturer Effluent Filter Information Dose Tank Information Pol -Lok Filter manufacturer 750.4 Dose tank capacity (gal) PL-525 Filter model number 20.3 Dose tank volume (gal/in) Wieser Concrete Manufacturer Project: Colonial Savings At-Grade Transaction Number: Page 2 of 8 AT-GRADE PLAN VIEW r.L 116 B Observation pipes (2 typical) A 8.00 ft p B 81.00 ft 1 /6 B 13.50 ft r 'T C 10.00 ft W C D 5.00 ft E 2.00 ft I L 91.00 ft D B W 20.00 ft A x B 642.86 ft^2 L Cap Typical obs. pipe. = Total aggregate cell A x B Slotted in in the lower 6", and anchored = Plowed area L x W securely. 6" AT-GRADE CROSS SECTION Svnthetic fabric cover 94.33 ft Finished grade elevation Lateral invert elev. 93.00 ft Observation pipe at aggregate toe E 12 % Slope Surface contour 92.50 ft C A and system _l elevation D T = 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: Colonial Savings At-Grade Transaction Number: Page 3 of 8 PRESSURE DISTRIBUTION AND DOSE TANK Lateral Diagram - End Connection P - Last hale dried neat to end cap iE X ~I Laterals & force main of PVC Sch 40 Holes dried on the baton of the lateral (per COMM Table 84.30-5) equalls Spaced • =Turn-up wtball valve or cleanout plug Lateral Specifications 0.188 Orifice diameter (in) End Lateral connection point x 1.97 Orifice spacing (ft) 1 Number laterals 41 Orifices/lateral P 78.80 Lateral length (ft) 27.0 Lat. discharge rate (gpm) 2.00 Lateral diameter (in) 2.00 Forcemain diameter (in) 27.0 Sys. discharge rate (gpm) 30.00 Forcemain Length (ft) 10.23 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 outlet location 18" min. Electrical as per NEC 300 and X Approved outlet joint Comm 16.28 WAC Tank full Inches Gallons JA Provide 1/4" A 19.6 397.3 Alarm on weep hole or B 2.0 40.6 B antisiphon C 3.4 68.9 Pump on - 40 device. o D 12.0 243.6 86.50 ft C -411 Totals 37.0 750.4 Pump off D 3" Bedding under tank 85.50 ft Goulds Pump manufacturer S.J.Electro Alarm manufacturer EPO-4 Pump model number Tank Alert Alarm model number Project: Colonial Savings At-Grade Transaction Number: Page 4 of 8 aX P,,~6 3 17A 3,33 At-grade System Maintenance and Operation Specifications Service Provider's Name Powers Sanitation Phone 715-246-5738 POWTS Regulator's Name St. Croix CountyZoning Office Phone 715-386-4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 642.9 ftz 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 monthly Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Inspect for ondin 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: Colonial Savings At-Grade 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, Slats. 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 filter 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-amde 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: Colonial Savings At-Grade Transaction Number: Page 6 of 8 Page 7 of 8 GOULDS 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. • Effluent systems ■ Casing and Base: Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms manual operation. Auto- superior strength and corrosion Canadian standards AWOciation • 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 7".) factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic Garlds Purips is ISO 9W1 FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. 'I<" 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: 1112" NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40'C) continuous 140OF (60cC) Intermittent. METERS FEET • Fasteners: 300 series 1 ° stainless steel. s 30--- _ 5 • Capable of running dry without damage to s z.5 Fr components. 25 Motor: _ • EP04 Singe phase: 0.4 HP, v 6 20 115 or 230 V, 60 Hz, 1550 s RPM, built in overload with } automatic reset. ° a 15 • EP05 Single phase: 0.5 HP, o EPOS 115 V or 230V, 60 Hz, 1550 3 10 RPM, built in overload with EPOa automatc reset. z • Power cord: 10 foot s standard length, 1613 1 SJTOW with three prong grounding plug. Optional 20 ° °0 10 20 30 ao so GPM foot length, 16/3 SJTW with three prong grounding plug o z a s 8 10 12 (standard on EP05). CAPACITY Goulds Pumps 2001 Goulds Pumps E ITT Industries Effective May, 2001 83871 00 o o~ y ao 0. O te) Ua 0 W K --4 ' M p U ~ ~ cv a, ? o~°°U m 0 Uk~r~az ' Ch o N ~O UO ~ 0., v II tt U ~ E a. ~ N o Ts ~ ~ A ° A y 4 ~ a I b Q ov h h M ad x ~ o ~ N II Ts d 1 'S ~ cf U "!z „O i C 42 r 3 ` o cs g RECEfve WieaoninDep~nw~tdtaaarae~os SOIL EVALUATION REPORT Paps~_ d A i'~+r~ondBaiN~larai8iidnpa UG a~q S in viit?aap85 Yft Adm. Mode Cam ` AMadhoomplftdkepenwpeper"~r~iw4Q 11 idmsbotaLPh,emet -r l. r•~ I -r inautle:te rnottadteaiac lavaboriooatiisafeaaac~poinc(M4d1 01,md - -p 1 0.1 'MIN s~aisardimentfoxe~ aaQiocaronanads~anoeb~Maxestwm. Pie print as Alftnmlft& Dab PASO.tli~Maa..iawa.etas..ra...oaron.m.ey..vo..~~Nwq►V..=tmc.~p 0 30 / Gm& trot C 1M ,`C 4M Sy-- T N R E i s LA*# jmmcm#j&Kmajl:w t,Stiy v 2 37 aft, caft DaV Vwage arm t~teaeat Y' Vlq-kS-71 p NawOaretudon ttaec Reidan~itrivab~arafbe oohs 3 Cod,ae~iredae~nt~or.$ate GM MB Rw oema<a Pabiaar M. m ~ 0 i- - - Paentaaeiaial_J'v. & f%wdF%ineiWj5" fapp/" R AM IC ' dp atJ ez& eolbg# 0 so** © PE em"+dsui~oeew. 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F f Q 9aouadaorRosalw~ 9~D R Dap*%&MgftW IL Reis Holt thm& Dookme iieiatDoan"= Tama 8f~aada ftm" as 6siada~ %Ob 6PdE I& Mime fig eL canteft eG aL BULL $t ` f LL - 0 ~ Aoud~a~Irosalaa: tG " ft OrpM~ioaa'igfaeaor iR AdAmaw-mRde Nataoa Doper 000drAMCdo RadwtOrsaosw Twom ammms cmddesm Abaft GPM W Wale/ CIL8L Osit©a w OteLsk 'E~wntD1~SOQy>a9~~a~.aad'l~a00~1S0aig~ •diwRSZ=f00~~i~a~.aadTdlt~79wg11. - 7~eDgnAre~tof isaieeq~aa~t"o~1~9~ P"+imid Tfymawdaaad mwloaosesssaioesor _ lead arldiat i sr< atfeerls f~ liior~o aoaStet die ie~eiaeot at ®9A~66-3tSi acTlY 609~t~7'rT_. . I "'N A ~ C y "0. V q. Io ST. CRC7►IX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR IYUILIZATION OF AN EXISTING !SEPTIC. TANi{. This is Co ccrtify that I have inspected the s ptic Uik presently servi3n-Ithe reside ce located at: 14, 4, Section N, fkange W, o,,)vn of e~,~ St. Croix Count-v -Wisean,,3in. Upon inspection, I certify that I have found the tank(s), to the bo--st of-my knowledge, will conform to the requirements of Comm,. $4.25, and it (they) appeaT+ s) to he functioning properly, Most recent date of service Did flew hack occur frow absorption systecm? Yes d'am' h o L~ (if no, sl6p next line.) Approximate volume or le of time: _ gallons minutes Capacity: ~ Construction: Prefag Concrete Steel Other Manufacturer (if knoivn): Age of Tank (if known): ( icensed t lurnb r S gnattze) (Print Naxac} _ (Title) (License Number) W MPRS Fnrn-a to be completed by licensed plumber (s145,06, Wisconsin Stat-Ites) or licensed disposer (N,R 113 Wisconsin Administrative Code) Firstar Stillwater Bank, N.A. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ~ S Mailing Address Property Address L .e• (Verification required from Planning & Zoning Department for new construction.) City/State r y~~ -e-e 161 -1 Identification Number 1Z),V,2 ' e714 d LEGAL DESCRIPTION Property Location '/o , Sec. 1yrT g X_N Rj,~-W, Town of Subdivision Plat: , Lot Certified Survey Map # 3 ~01 L(, , Volume Page # Warranty Deed # q j c,-/ T a (before 2007)Volume , Page # Spec house O yes o Lot lines identifiable Wes ❑ 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 chaster 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 Planning & Zoning Department within 30 days of the three year expiration date. Uwe 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. Number of bedr00919 '3 SIGNATU 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. 09/07) LOCATED LOT LINE SKKT C H Located in part of the Southeast Quarter of the Northeast Quarter of Section 15, Township 28 North, Range 18 West, Town of Kinnk*innic, St. Croix County, Wisconsin; being the northeasterly line of Lot 4 of the Certified Survey Mop recorded in Volume 2, Page 371 at the St. Croix Register of Deeds Office. 0 Prepared For. KNUO TSON PLUMBING & CONTRACTING 927 - 150th Street _N, Roberts WI 54023 ms's ~t • DEMOTES FOL#0 IRON PIPE moo, [9 DENOTES SET LATH ALONG LOT UNE -0 DENOTES SOIL BORING ti Ir -EVCE W=S 0 10 20 ~y s 1 INCH = 20 FEET 1ho 4~0IL BORING t ? SSG O ° CE E LOT 4 X- M1'Z 2031 C.S.M. dXM- 11A 4 U 0-L U---E Z PA G E 379 Vo~` l As" 01 SOIL BORING #1 ~ a Lot 1v v PROPERTY ADDRESS W C; "'2 364 OLD CEMETERY ROAD O RIVER FALLS, W QS01L BORNG #2 N8737'00"E 321.59' RECORD H87137E 321-74' ACCESS ROAD wed Rose I:and Surveyors PROJECT NO.. 2012-41 P.O. BOIL 11 DRAFTED BY: J. VOGEL NEW RICHMOND. MN 64017 CA 7E. AUGUST 22. 2012 716.441 7380 SHEET 1 OF 1 Z*d £ZOL-96L-91.L uoslpnuN yueN eGR:90 Z L g7. Bny 0Cn01 3-0 n tz f~ eo ~1 T A III CD V n O O N O ° O Vt N • S C ? N IV 1~1 N M d d CD N H n O rp CS 00 CL g :z CD CD N a m ~ ~ N ~ N A C 1 3 a 0 o O 0 o .4 f ° O I p ~i ~ QD i o R v cn z D - a C7 M > CL a o o 3 0 CD CD o o t~ j z CD co 0 r- CO) O 0 0 N M C v 3 ~ tii tV 000m °r. O O O x~ ml c AD o v O O O m w 3 d VIII I ~ -n N DCo" O C/) Z 7 N A N• 70- 0 0- N C~ _0 H l!`i1 a0 - a~ N N , N 7 y CD O O C O O a. 3 O A fD d o 3 3 d~ m ID N CD CL SOD (A z 0 N N G) OD O O ~p N d a N ~ m I fn ~ cn WM m 0- OD a \ z O3 C A M z 0 3 m ° N = y Z \ I W A O I O CL N D G C m z a O n vOi m x fi S?o I y 21, N I a a Ij C C I a ti w p N A O V All O N t» 0 i r FILEU MAY _I_ 1977 Ji4!ICa ,hl~l~I ST. CROIX COUNTY SURVEYOR'S RECORD ~ Sc. ,'.r.i r ,'sa I, ~l Wi . CERTIFIED SURVEY MAP b'~ Y \ v GERALD EMHOLT.Z Part of the Northeast 1/4 of Section 15, Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin Z _o F- Q ul A187037'001* 165.16' 0 Vo d Z V s3 3 V d 0 N W (n W. Z pQ, (P m 0 U Z SCA LE -1" =/00' o (n -J cc > O 0 N Nt9 7-- ce ~a2 0 0 N ` LOT z- ~a ~L, U. ~ t 2.13 ACRES o 0 O IO t Q 33LUWV 05 emwoz aw a > z Z 0"INNVld S)iaVd 3AISN3H3adW0~ o O A1NhOG )(IOYO IS g w a s u61 8 t ~dW ; 9¢e w ~ 33 Q~n421ddt/ . W 5870 3TWO w y 66 ' f~OADWA y~- s~o Description : 06 That c(wtain parcel of land located in the NE 1/4 6 of Section 15, T 28 N, R 18 W, Town of Kinnickinnic, St..Croix County, Wisconsin, more fully described as follows; Commencing at the East 1/4 corner of said Section 15, thence go N 520 06' 16" W a distance of 1402.13 feet to the Point of Beginning of the parcel to be herein described; thence go N 280 50' 28" W 425.74 feet; thence N 870 37' 0$" E 165.16 feet; v'- thence S 470 15' 00" E 490.77 feet; thence S 02 17' 00" W 33.31 feet; thence S 870 37' 00" W 321.74 feet to the Point of t ~ V4 Coa Beginning, the above described parcel containing 2.13 acres, c- -c 2 8 - 113 and including an easement for roadway purposes over and across the 66 foot wide right of way easement adjacent on the South side of the above described parcel as said easement proceeds Easterly to the Town Road. State of Wisconsin ) County of St. Croix) I. James L. Murphy, Registered Land Surveyor, do hereby that by direction of the Owner, Gerald Emholtz, and according to official records, I have surveyed and divided the lands shown hereon and that this map and description are a true and correct representation thereof; and that I have complied with Chapter 236.34 of the Wis. Stat. and St. Croix County Ordinances in surveying, 'viding, ma ing and describing the same. I Dated : 6 April 1977 Jill Hill// q~~~i,~. ^ 1 Vol. 2 Page 371 St. Croix County Records J# Ev L.J Certified Survey Maps R gise L Y = 0r: s St. Croix County, Wisconsin 7oS' 04 2 ~ ' RIVER FALLS, • WISC.4~` SHERIFF'S DEED 8 0 5 4 7 7 5 Tx:4040774 DOCUMENT NO. 954827 STATE OF WISCONSIN CIRCUIT COURT ST CROIX COUNTY BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI COLONIAL SAVINGS, F.A. 04/20/2012 12:18 PM EXEMPT#: 14 Plaintiff, REC FEE: 30.00 vs. Case No. 10-CV-1510 PAGES: 1 Hon. Scott Needham Br. 3 GREGORY G. JOHNSON CATHERINE A. JOHNSON i. ASSOCIATED BANK, N.A. RETURN TO: Defendants. Mallery & Zimmerman, S.C. 500 Third Street, Suite 800 P.O. Box 479 Wausau, WI 54402-0479 PIN # 022-1042-40-000 WHEREAS, pursuant to a Judgment of Foreclosure entered in this matter on August 8, 2011, the property described below was sold at public auction, at the Entrance of the Government Center, 1101 Carmichael Road, Hudson, WI 54016 on February 21, 2012 to Colonial Savings, F.A. for the sum of One hundred eight thousand one hundred twenty-nine and 74/100s Dollars ($108,129.74) 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 Colonial Savings, F.A. the following described land situated in the County of St Croix, in the State of Wisconsin, to-wit: That part of the Northeast Quarter (NE'/) of Section Fifteen (15), Township Twenty-eight (28) North, Range Eighteen (18) West, Town of Kinnickinnic, St. Croix County, Wisconsin, described as follows: I Lot Four (4) of Certified Survey Map recorded in Volume 2 of Certified Survey Maps, page 371, as Document No. 3401126. Together with roadway easement as described on said Certified Survey Map. Dated: A. Shilts, Sheriff ACKNOWLEDGMENT t Croix County, Wisconsin STATE OF WISCONSIN ) ) ss. ST CROIX COUNTY ) Personally came before me on 3 aQ/ the above-named John A. Shilts, to me know to be the person(s) who executed the THIS INSTRUMENT DRAFTED BY: foregoing instrument and acknowledged the same. John A. Cravens Mallery & Zimmerman, S.C. AA M* I 8tt8 500 Third Street, Suite 800 Notary public P.O. Box 479 State of Wisconsin Wausau, WI 54402-0479 Notary Public, State of Wisconsin Y&c nimission expires: i06-dq-