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032-2183-21-000
Wisconsin Department of commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 56345 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: Belisle, David Somerset, Town of 032-2183-21-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: / OQ I c5 T- 23.31.19.1569 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ys CAPACITY STATION BS HI FS ELEV. Septic Benchmark /O $ 3.~ 3 gesin Q / 52 Alt. BM c-,7 c Aeration Bldg. Sewer 97 Holding St/Ht Inlet 7.75 -65 TANK SETBACK INFORMATION St/Ht Outlet S. 67 --15A-3 TANK TO P/L WELL BLDG. Vent to Air Intake OAD Dt Inlet Dt Bottom Septic /q 4 2- Header/Man. Dosing to Id.~ ~z-~s5 Aeration Dist. Pipe Holding Bot. System PUMP/SIPHON INFORMATION Final Grade 5.5 ~ • ,3 Manufacturer Demand St Cover 1 9 ` 31 Model Number C-j Z -75 11!5 TDH ift Friction Loss System TDH Ft Dist. to well Forcemain Length JD SOIL ABSORPTION SYSTEM BEDITRENCH Width Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 / z SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of System: CHAMBER T OR Model Number: 5,q UN DISTRIBUTION SYSTEM West-- f / OiIlb Header/Manifol~ / Distribution x Hole Size _ x Hole Spacing Vent to Air Intake Length Dia Spacing ~4 Length 5 Dia ~t L~ di SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded T M hed Bed/Trench Center r / 5 Bed/Trench Edges Topsoil \ y.. Yes 0 No ? s ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: 1 / Location: 640 210th Ave Somerset, WI 54025 (NE 1/4 NW 1/4 23 T31 N R1 9W) Gavin's Acres South Add Lot 21 Parcel No: 23.31.19.1569 1.) Alt BM Description = If ~ (_.A 0*-, ~ 2.) Bldg sewer length= 2-7 -amount of cover = 1 Plan revision Required? 0 Yes No I G ( - - j~,~'T5! Use other side for additional information. \ ' 1 S BD-6710 (R.3/97) Date Insepctor' Signature Cert. No. J County Safety and Buildings Division e. 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) 35` S P S 751 Madison, Wl 53707-7162 If' t y 4w,6 tit Application ON State Transaction Number In accordance with Spejj' 151(2), Wis. Adm. Code, submission of this form to the apps priate governmellta it A) is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are subm o Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used`for secon / u ses in accordance with the Privacy Law, s. 15.04(1 m , Slats. 1. Application Information -Pie nt AU Information Property Owner's Name / Parcel # C~ -7; Property Owner's Mailing Address Property Location tGovL Lot A7 Section City, State Zip Code Phone Number (circle one T N; R E oi( H. Type of Building (check all that apply) Lot # Subdivision Name 1 or 2 Family Dwelling -Number of Bedrooms ❑ Public/Commercial-Describe Use ❑ City of CSM Number ❑ Village of ❑ State Owned -Describe Use LJ CL ~ Town of ~~9/.~ikfSl=„ 2 D III. Type of Permit: (Check only o e box on line A. Complete tine B if applicable) A' 19 New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) kn List Previous Permit Number and Date Issued B. ❑ Permit Rene I pt Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiratio Owner IV. Type of POWTS S stem/Com onent/Device: Check all that apply) X Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound? 24 in. of suitable soil ❑ Mound < 24 in- of suitable soil a Holding Tank ❑ Other Dispersal Component (explain) C1 Pretreatment Device (explain) -1'^-~~ V. Dis ersal/Trea ntArea Information: Design Flow (gpd) Design Soil Application Rat pdsf) Dispersal Area Required (S Dispersal Area Pro posed (System Elevation i VI. Tank Info Capacity in Total # of Manufacturer c e, Gallons Gallons Units d v ° New Tanks Existing Tanks Aa '51-- ip is C7 ii n. V A A Septic or Holding Tank ~ S x Dosing Q~K Chamber VII. Responsibility Statement- I, the undersigned, assume respous' ility for installation of the POWTS shown on the attached plans. Pluam Print i Plumber's Si atu MP/MPRS Number Business Phone Number V lumber's Address (Street, City, State, Zip Code S 14 VIII. un /De artment Use Onl Permit Fee Date I ued Issuing ent signal pprov ❑ Disapproved $ Z even Reason for Denial IX. Condi ' easons for Disapproval 899P11., / 1. it tank, effluent fifter'and A%persal ce# must all be services t maintained as-per management plan provided by plumber. 2, AD seftwk re4uirements must be, maintained Bi Per alQpliCabls code / ordittarices: Attach to complete plans for the system and submit to the County only on paper not less than 3 in x 11 inches in size CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Owner's Name: Owner's Address:' ostI ' 74-),L Legal Description: ~'~S/_ Township: County: Subdivision Name: Lot Number: r,21 Parcel ID Number: Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing Page 4 System Cross-Section Page 5 Filter Specs Page 6 Maintenance & Mana ement Plan Page 7-9 Septic Tank Maintenance Form Page,B' q Warranty Deed Page 9ja CSM or Plat Designer/Plumber: License Number. a Date: 5--_ Phone Number Signature Designed pursuant to the In-Ground Soil Absorption component Manual for POWfS Version 2.0 SBD-10705-P (N.01/01). Page 1 1J -/.r, c 1, fdo 22- ~V ~ ~ i ~36c 3 40/10 / 4 Soil Absorption System Cross Section ft k44* Schedule 40 Final Grade PVC Vent Pipe Wiith Vent Cap ~ft Leaching ~ Chamber System Elevation ft ft Soil Absorption System Plan View ft ft Leaching Trench 1 Vent Or Observation Pipe Chambers 4' Dia. Trench 2 Header Leaching Chamber Specifications Manufacturer And Model - EISA Rating, sq ft per chamber Soil Application Rate gpd//sq ft gpd Design Flow Soil Application Rate + b-,X EISA Chambers 2 rows of chambers each. Page of F INSTALLATION INSTRUCTIONS Inc. 1103OX WssfewwafemrF rode"e Zabel' " °hU"° °`Pob.ftInc. PL-525/PL-625 FILTER INSTALLATION INSTRUCTIONS I • f i i ; Center filter f with opening : ! , - ~ art - - jEO rr Add:6onaf pip"ear Polxlok Extend 8Lok " _ ~ for ee%itenng W_ Glue " Step 1: Step 2: (A) Locate the outlet of the septic tank. (A) Before installation, lace the Step 3: pipehe filter housing on the outlet Glue (B) Remove tank cover and pump tank filter housing on to the outlet pipe' if necessary. (B) Make sure that the housing (B) insert the filter cartridge in the is positioned so the filter can be housing, making sure the filter removed from the tank for cartridge is properly aligned and maintenance and service. completely inserted in the housing. MAINTENANCE INSTRUCTIONS ` a Step 1: Step 2: Locate the outlet of the septic tank. Step 3: (A) Remove tank cover and pump (A) Insert the filter cartridge back D NOT USE • PLUMBING if necessary. into the the housing making sure WHEN FILTER IS REM OVED (B) Pull the filter out of the housing. the filter is properly alighed (C) Hose off the filter over the septic tank. and completely inserted. rw-Make sure all solids fall back into the (B) Replace septic tank cover HEh! CL1=ANtNG FILTER septic tank. 4 Soil Absorption %M km Cross Section /20 ft Final Grade 4° Schedule 40 PVC Vent Pipe With Vent Cap Leaching Chamber n,T ft System Elevation -Y ft ft Sol] A h(0 1.0 m Plan View ft ~3 ft i ft Leaching Trench 9 Vent Or Observation Pipe ~ Chambers 4' Dia. Trench 2 Header Leaching Chamber S ecifications Manufacturer And Model EISA Rating sq ft per chamber Soil Application Rate gpd/sq ft gpd Design Flow Soil Application Rate _ 4 EISA = Chambers 2 rows of _-,ZS chambers each. Page of POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page -f _ FILE INFORMATION SYSTEM SPECIFICATION Owner - Septic Tank Capacity al ❑ NA Permit # Se tic Tank Manufacturer ❑ NA Effluent Filter Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Model ❑ NA Number of bedrooms ❑ NA Pump Tank Capacity al ANA Number of Commercial Unit t~ NA Pump Tank Manufacturer Rf NA Estimated flow (average) gal/day- Pump Manufacturer ANA Design flow (peak), (Estimated x 1.5) Q gal/day Pump Model ANA Soil Application Rate `7 al/da /ft Pretreated Unit Influent/Effluent Quality Monthly Average* o Sand/Gravel Filter o Peat Filter Fats, Oils & Grease (FOG) <30 tng/L n Mechanical Aeration o Wetland Biochemical Oxygen Demand (BODs) <220 mg/L o Disinfection o Other: Total Suspended Solids (TSS) <150 mgfL Manufacturer Pretreated Effluent Quality ❑ NA Monthly Average** Dispersal Cell(s) Biochemical Oxygen Demand (BODs) <30 mg2 9 In-ground (gravity) ❑ In-ground (pressurized) o At-grade o Mound Total Suspended Solids (TSS) 530 mg/L o Drip-line ❑ Other: Fecal Coliform (geometric mean) <104 efu/100mL Maximum Effluent Particle Size '/a inch diameter * Values typical for domestic (non-commercial) wastewater and septic tank effluent. Values typical for pretreated wastewater. lV1AINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once eve o months ears (Maximum 3 rs) 'Pump out contents of tank(s) o When combined sludge and scum equals one third ('/3) of tank volume Inspect dispersal cells At least once eve o months m' ears (Maximum 3 rs) Clean effluent filter At least once ever ❑ months vf year(s) Inspect um um controls & alarm At least once, eve o months ❑ ear(s §dNA Flush laterals and pressure test At least once eve o months o ear(s) im NA Other: At least once eve o months ❑ ear(s) ig NA Other: At least once eve o months ❑ year(s) 1$t NA 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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment components, and any other maintenance or monitoring at intervals of 12 months or less 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. 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 my impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tanks(s) removed by-a septage servicing operator prior to use. START UP AND OPERATION Page 7 or 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 replacement system: A 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 -IOWTS INSTALLEB/ POWTS MAINTAINER Name Name Phone r _ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone `his document was dra ::a-:;'°ance with chapter Comm 83.22(21(b1(1)(d)1,(fl and 83.54(1), {2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK NLA-E iTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address (Verif ication required from Planning & Zoning Department for new construction. Cif/Mate Parcel Identification Number LEGAL DESCRIPTION Property Location V,, V., Sec. r::7 3 , 1-HIV rZ_W, Town of s _hn1'VIslor! J ~S ~ r~7 Lo, Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION proper use and maintenance of your septic system could result in its prematm-e failure to handle wastes. Proper zaintenance 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 qty Pi,rmin g & 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 ;vastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is ess than 1/3 full of sludge. L',ve, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the s:aadar~ set forth- herein. as set by the Department of Commerce and the Department of Natural Resources, Stage of Wisconsin. `e yi~caton stating that your septic system has been maintained must be completed and returned to the St Croix County Planning & Zo--.iiv De_ a-unent v3thin 30 days of the three year expiration date. Z% ve cerd fv that all statements o form are true to the best of my/our knowledge. Uwe amlare the owner(s) of the property described above, by -virtue of a *rranty deed recorded in Register ofDeeds Office. tiu€tab f bedrooms c~ 2/ a G'~a SIGNATURE OF APPLICANT(S) DATE A-y infortuation that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department de With this application a recorded warranty deed from the Register of Deeds Office and a copy of the certif ied survey map if :_-e7ce is made in the tivarranty deed. 1 8 0 8 7 7 7 7 SPECIAL WARRANTY DEED Tx:4067140 963707 BETH PABST REGISTER OF DEEDS This Deed, made between Central Bank, a Minnesota banking ST. CROIX CO., WI corporation, successor-in-interest to The RiverBank Grantor, 09/19/2012 10:39 AM and, David R. Belisle , 0 51 rig k n"eimn' l EXEMPT#: NA Grantee, REC FEE: 30.00 WITNESSETH, That the said Grantor, for a valuable consideration TRANS FEE: 60.00 conveys to PAGES: 1 Grantee the following described real estate in St. Croix County, State of Wisconsin: RETURN TO: SCAT 252 S. Knowles Ave, New Richmond, WI 54017 PID 032-2183-21-000 Lot 21, Gavin's Acres South in the Town of Somerset, St. Croix County, Wisconsin- Seller to convey the title by special warranty deed without covenants of the title or the equivalent for the state the property is located. Seller makes no representations or warranties, of any kind or nature whatsoever, whether expressed, implied, implied by law, or otherwise, concerning the condition of the title of the property. This is not homestead property. Dated this day of September, 2012 Central Bank " AUTHENTICATION ;G., / • Signature(s) (S) By, Zach Mc Broom its Assistant Vice President authenticated this day of (SEAL) TITLE: MEMBER STATE BAR OF WISCONSIN -By: (if not, ACKNOWLEDGMENT authorized by s706.06, Wis. Stats.) STATE OF MN } " } ss. THIS INSTRUMENT WAS DRAFTED BY COUNTY OF } Personally came before me this day of LOBERG LAW OFFICE September. 2012 the above named Central Robert L. Loberg Bank by: Zach McBroom (Signatures may be authenticated or acknowledged. Both are not necessary)191sw to me known to be the person s who executed the JENNY LHUNDLEY~ 2;,,,P ng instrume and.acknowl ge the e. Notary Public { Minna NMI@. r NoMrYm,ublic County, MN. My ssion is a anent. (If not, state expiration dat - 3 - t ) 1 of 1 . i I fill Ifllllfll II Ill fl Ifl 8087777 Tx:4067140 SPECIAL WARRANTY DEED 963707 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Central Bank a Minnesota bankinn 09/19/2012 10.39 AM corporation successor-in-interest to The RiverBank. , Grantor, EXEMPT#: NA and, David R Belisle 0 511lig k pefyo l REC FEE: 30.00 Grantee, TRANS FEE: 60.00 WITNESSE71-I, That the said Grantor, for a valuable consideration conveys to PAGES: 1 Grantee the following described real estate in St. Croix County, State of Wisconsin: RETURN TO: SCAT 252 S. Knowles Ave. New Richmond, WI 54017 • PID 032-2183-21-000 Lot 21, Gavin's Acres South in the Town of Somerset, St. Croix County, Wisconsin- Seller to convey the title by special warranty deed without covenants of the title or the equivalent for the state the property is located. Seller makes no representations or warranties, of any kind or nature whatsoever, whether i expressed, implied, implied by law, or otherwise, concerning the condition of the title of the property. I This is not homestead property. Dated this day of September. 2012 Central Bank AUTHENTICATION (SEAL) Signature(s) By- Zach Mc Broom, its Assistant Vice President authenticated this day of (SEAL) TITLE: MEMBER STATE BAR OF WISCONSIN By- (If not, ACKNOWLEDGMENT authorized by s706.06, Wis. Stats.) STATE OF MN . ) ) ss. THIS INSTRUMENT WAS bRAFTED BY COUNTY OF ) Personally came before me this ( day of LOBERG LAW OFFICE Seotember. 2012 the above named Central Robert L. Loberg Bank by: Zach McBroom (Signatures may be authenticated or acknowledged. Both are not necessary) lglsw to me known to be the person s who executed the JENNY LMiUNDLEY for oing instrumen and.acknowl dge the e. Notwy Pubfic _ 11~llfl/Odt/ . Notary Public a MN. My Cop is a anent (If not, state expiration data 1 of 1 morth 714 Section 23- (found clu Count rrmont 1271.30' 219.95s 17038 210.€0' 726` 8l?.8 ' sq. ft. W 7cres co ' i co 21 0 co PO (6 2 t3O, 851 sc. ft. P tat, 549 sq. A J. 00 E acres J. Q2 acres -A -180.00 S81 _ - /72.52" ~ .err N8E Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer Pump Manufacturer Tank Model Number Pump Model Number Total Tank Capacity Alarm Manufacturer 6 Max. Bury Depth Alarm Model Number 1 Switch Type Filter Manufacturer Total Dynamic Head (TD - Feet Filter Model Number Elevation Head Distal Pressure Network Loss Minimum Pump Performance Required Force Main Loss GPM @ 16 Ft TDH Total Outlet Manhole Min. 4" Above Grade With Locking Device. Inlet Manhole Manhole Min. 4" Above Grade < 6" Below Grade Sealed Watertight Securely Mounted With Locking Device Weather-proof I Junction Box Finished Grade o Depth of j Cover Vent Min. 12" Above Grade Disconnect Ft With Vent Cap Means < { < ;><>< {y{ < <>< { < < ; < < < < < < < < < < < }S} Sy< >S { ' Outlet Outlet Filter Inlet >i> Inlet Baffle {>s }S} S S > S A > o-{a < Switch Settings and Reserve Capacity <}< I4„ Tank Volume = 3 GPI <;< Weep << > > y a{y Dimension Inches Volume Gal. <>< B < Hole r- dj6 > > (reserve) A (alarm) B 2 <>< Off Elevation C ;s; (dose) C 7 Ft (dead) D Bottom D > Elevation Total Ft ; S S > } } } } S > > } > > Y S S } } } Y } S ! S > } } } } {S; > > J P } > } > } } }t SSlSlSySYSY{a{y{a{Si}{S{S;>{>S>{Y{SS>iYt>ti{!{S{}{>{yry{ytyty;y{y~y<y°y{}{y{yiy{y;ytyi,;y;,;y{y;y{y{y{y{S{S{ySy;}{y; GENERAL INSTALLATION: The septic/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 tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28 WAC. 02/05 LJ Page of Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer Pump Manufacturer Tank Model Number Pump Model Number /04 :ilL Total Tank Capacity Alarm Manufacturer Max. Bury Depth Alarm Model Number 1 Switch Type Filter Manufacturer Total Dynamic Head (TD - Feet Filter Model Number Elevation Head z Distal Pressure Network Loss Minimum Pump Performance Required Force Main Loss ' GPM @ Ft TDH~ -2 Total Outlet Manhole Min. 4" Above Grade With Locking Device. Inlet Manhole Manhole Min. 4" Above Grade < 6" Below Grade Sealed Watertight Securely Mounted With Locking Device Weather-proof -41 n Junction Box D Finished Grade - - r . ~ ~ Depth of Cover Vent Min. 12" Disconnect Ft Above Grade Means With Vent Cap > > ) > > > > > Y > > Y > > > > > > > > > > > > > > > > > S S{ S S S S S S t t t S {'S> >t '444444, S{ S{ S< { S{} {S{ ,S < ' Outlet > Outlet Filter ~y < Inlet t- - Inlet Baffle {,s - > 7<Y <,< A !{Y Switch Settings and Reserve Capacity <}< V45S Tank Volume = GPI iy{ Wee p >i. Dimension Inches Volume Gal. {>i B Hole S i q, -2 rta (reserve) A (alarm) B 2 Off Elevation C > (dose) C 7. <}< >i> (dead) D t < Bottom D Elevation > } Total ~ Ft 7 tt } } } > Y } > > Y 7 } > } S S Y } S S i 7 } f S } } > } } 7 > > 1 > > > > T > > > i S<< S S i i i i{ S{{{{;<{;< i i i{{ S S i i{{ S{; i i t{<; i; t i{{ i S S S i S > > > }i i S S S{ S > > > Y S Y ! S > S > S S S > Y > Y Y > Y S ! > ! ! > ! } > S S S Y Y Y > ! > > > > Y > } ! } Y > S } } } } > } > } GENERAL INSTALLATION: The septic/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 tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28 WAC. 02/05 LJ Page of Wisconsin Department of Commerce SOIL EVALU P T Page of Division of Safety and Buildrrrg(~ 1 Midance m 85. Vft Adm. C4Qe Co Y L27g Attach complete site pfi A less than 8112 x 11 Inches in size. Plan must include. but not limited to: ve tat reference point (BM), direction and Parcel I.D. rth ed location and distance to nearest road. percent stops, scale or dirrtensions Please print all information. by Date Personal information you provide may be used for secondary purposes (Privacy Low, s.15.04 (1) (my) . Pmpwty omw Property Location Govt. Lot 114 114 31 N R E (or s ib 9~-- - - _5~ Property dwner's Mairmg Address Lot # lode or e Zip Code Phan Number ❑ Cfly ❑ Vflla M Tow Nearest Ro>Id ® New Construction Use: Residential / Number of bedrooms _ Cade derived design flaw rate GPD ❑ Replacement ❑ Public; or r mmwdal - Describe: Flood Plain elevation if apprazrbie ft Parent rrrateriel General comments .1 and recommendations: 10, ; i~ties/~°~ ~'j I've. 8.~ Boring # tD❑i Boring /I tai Pit (around surface elev. W,1,5- % Depth to ruing factor In. Soll Application Rate F Horizon Depth Dominant Color Redox Description Texture Structure Consistence Borrndary Roots GPOW In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. TOM "E1112 S D a Z . t Boring # ❑ Boring ® Pit Ground surface elev.. 9A.,Z!5- ft. Depth to flrniffig factor in. Shc Applipedon Reite Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPI In. Munsell tau. Sz CO)t Color Gr. Sz. Sh. 'EW1 TEM sw _ ¢ 9 • #1 = BOD > 30 < 220 mglL and TSS > At r1glL #2 = < 30 nrgll T S8 130 org1L CST i CST Nrxnber Date valuation Corkluded Telephone Number Adc" / r ~Z2 -2 -91-Z Property Owner parcel ID # f /R S' /-11r ~P~ of ❑ Boring So" # Pit Ground sts b. elev. 2z ad- ft Depth to fec3ot ~ in Soli Rate GPOW Roman Depth Dominant Col Redox Desaiptlon Teodtae Gr r% Sz. Sh. a Consistence Boundary Roots orM In. Munsell Ou. Sz. Cont Color , 6 7 R ,(S k/ - / _ 9 Q '7- Nt- IT, F-I soft# Boring ❑ Pit Ground surface elm ft Depth to i8 fads' Sol Application Ratae Mortron Depth DornHmrd Color RWw Description Texture Struchue Consistence Boundary Rotas GPDM In. Munseti CAL Sz. Cont. Color Gr. Sz. Sh. `EIWI *E1192 ❑ Soft # ❑ Pitt G~ ~viace elev. ft. Depth to Wdfv~g factor Sol Rama Horimn Depth Dominant Col Redox Description. TeA s Strudkee Cone Boundary Roots GPOW In. MunseA QLL SZ Cora color Gr. Sz. Sh. •EMM 'EM • Eftwd #1= SOD,> 30 1220 nV& and TSS >30 1150 mg/l. ' Effluent #2 = BC05 < 30 nigh. and TSS = 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access serviees or aced material in an alternate format, please contact the department at 608-266-3151 or TTY 608-2648777. ssn.a~tornsroo~ Property owner Parcel ID # --=2L-,9f 0 Page ~ of 8onng # ❑ Boring pit Ground surface elev. R. Depth to limiting factor ~ in. Sol Application Rate Horizon Depth Dominant Cot Redox Description Texture Structure Consists Boundary Roots GPbJtF In. Munsetl Qu. Sz. Cont. Color Gr. Sz. Sh. ,EW i J" Z 2Z 1-4 s F-I ~S i✓- Boring # 0 Boring ❑ Pit Ground surface elev. ft. Depth to ntnlting lector in. ~ App9cation Rate Hortm Depth . Dominant Colo; Redox Descxrptiort Texture Structure Consistence Boundary Roots GPDM In. Munsen Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ew 'Ew Boring Boring # ❑ pit ❑ Ground surface elev. it Depth to Grnitirg factor in, Soil Applicedw Rate Horizon Depth Dominant Cokx Redox Description. Texture Sh!Sz. e Consistence Boundary Roots . Gib In. Munson Qu. Sz. Cont Color Gr. Sh: ' EtT#i 'EMM Effluent #1 = SOD,> 30 220 mg& and TSS >30 5 750 mg& ` Effluent #2 = BODE 5 30 mil. and TSS 30 nx1R. The Departtnt nt 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 608-266-3I51 or TTY 608-264-8777. ssn:asocRAW) 71- ~ C~IGc /oc e'er County ,ff Safety and Buildings Division , , 'XI ? ` ~ 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Si~ SLR 2 6 2012 Madison, WI 53707-7162 n t 55C~ 3A15 anitary Permit Application State Transact)io/n~Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit A rf is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1 m , Stats. 1. Application Information - Plea Print All Information Property Owner's Name Parcel # o3z-21'3 3-.2 -600 Property Owner's Mailing Address Property Location 160 a Govt Lot C 7 J City, State Zip Code Phone Number y y- Section -2-Y_ (circle one E or Lot # T N; R _a_ II. Type of Building (check all that apply) 1 or 2 Family Dwelling - Number of Bedrooms C__12 N / Subdivision Name Block 1 -1 d6)r, C.J~, ❑ Public/Commercial -Describe Use J ate- ❑ City of V%0 ❑ State Owned - Describe Use CSM Nu r ❑ Village of Town of U w 13 Cl,,~, eC III. Type of Permit: (Check my one box on line A. Complete line B i ap ica e) A' New System ❑ Replacement System ❑ Treatment/Holdin n Re .cement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ (ermit Revi on ❑ Change of Plumber Y ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner 1 ` IV. Type of POWTS System / om onen W9 k all at app, y Non-Pressurized In-Ground Pr urizAt- Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank Other Dispers Co o❑ Pretreatment Device (explain) C V. Dis ersaVrreatmentArea Inf mat Design Flow (gpd) Design Soil App ' Dispersal Area Required Dispersal Area Proposed (s System Elevation VI. Tank Info Capa 'ty in Total # of Manufacturer Gallo Gallons Units .a 0 0 u New Tanks Exis ' arks t3 y s l! v; O ! D fG rz 5 a U V) w C7 a. Septic or Holding Tank Dosing Chamber 5 [ / - VII. Responsibility Statement- I, the undersigned, assume rqsponsibility for i tallation of the POWTS shown on the attached plans. Plum er' Nam (P ' t) Plumbers S' atu c MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) ~E VIII. County/Departm;nt Use Only Approved ❑ sappy Permit Flee Date Issued Issui Agent Si at ❑ Owne rven Reason Denial $ 7 0O 9~ 0 IX. Condi M easons for Disapproval tank, etnuent filter and ;dispersal cell must all be servlCes I maintained as.per management plan provided by plumber, 2.:Aq back reguyemerft must be maintained as per apple" code I ordinariow Attach to complete plans for the system and submit to the County only on paper not less than 8 1!2 x 11 inches in size CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Owner's Name: Owner's Address: l Legal Description: sin 3- T'3//9 u~ Township: County: Subdivision Name: Lot Number: Parcel ID Number: Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing Page 4 System Cross-Section Page 5 Filter Specs Page 6 Maintenance & Management Plan Page 7 Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Q /o l um~ u~J~ / I ~oSK % C~:'t655 ^SEG.Ti Dr1 Designer/Plumber:- License Number: Dater Phone Number Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01101). Page 1 /X44,) ~Jk cr,' ~ fi' loo ' ~i UG /Pl©.p 117 64 f-J - ~ fi qK y w~ra ~,~~A Y SAC/11GX'/00 D300 GL~~C 0 lee I I t Soil Absorption System Cross Section ko ft 4" Schedule 40 Final Grade PVC Vent Pipe VM Vent Cap ft Leaching Chamber f-- -ft System Elevation ft ft Soil Absorption System Plan View ft ~ ft 1 ft Leaching Trench 1 Vent Or Observation Pipe Chambers 4° Dia. Trench 2 Header Leachinc Chamber ecftatimns Manufacturer And Model EISA Rating,,;~ sq ft per chamber Soil Application Rate gpd/sq ft ?1) to gpd Design Flow z_ Soil Application Rate EISA = Chambers 2 rows of IS chambers each. Page of eS- hOL~''►]I°G INSTALLATION INSTRUCTIONS °"=mPh` Zabel' &Waslewzler Products A OM Divlsrasbn at Polylok Inc- PL-525/PL-625 FILTER INSTALLATION INSTRUCTIONS Center filter with opening WH Y h Additional f-ipe or Polylbk F-tend & Lok- Glue fOr ceniering: - _ Step 1: Step 2: Step 3: (A) Locate the outlet of the septic tank. (A) Before installation, place the (A) Glue the filter housing on the (B) Remove tank cover and pump tank filter housing on to the outlet pipe. outlet pipe. if necessary. (B) Make sure that the housing (B) Insert the filter cartridge in the is positioned so the filter can be housing, making sure the filter removed from the tank for cartridge is properly aligned and maintenance and service. completely inserted in the housing. MAINTENANCE INSTRUCTIONS jj Step 1: Step 2: Step 3: Locate the outlet of the septic tank. (A) Remove tank cover and pump (A) Insert the filter cartridge back if necessary. into the the housing making sure DO NOT USE PLUMBING (B) Pull the filter out of the housing. the filter is properly alighed I L WHEN FILTER IS REMOVED (C) Hose off the filter over the septic tank and completely inserted. t1$E RUBBER G! ©~ES Make sure all solids fall back into the (B) Replace septic tank cover 11VHEN CLEANING FILTER septic tank. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 4 of FILE INFORMATION SYSTEM SPECIFICATION Owner &d le- Septic Tank Capacity al o NA Permit # Septic Tank Manufacturer - o NA Effluent Filter Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Model o NA Number of bedrooms o NA Pump Tank Ca acit p al o NA Number of Commercial Unit ❑ NA Pump Tank Manufacturer NA Estimated flow (average) gal/day Pump Manufacturer ❑ NA Design flow (peak), Estimated x 1.5) al/da Pump Model o NA Soil Application Rate al/da /ft Pretreated Unit I Influent/Effluent Quality Monthly Average* o Sand/Gravel Filter o Peat Filter Fats, Oils & Grease (FOG) <30 mg/L n Mechanical Aeration o Wetland Biochemical Oxygen Demand (BODs) <220 mg/L o Disinfection ❑ Other: Total Suspended Solids (TSS) <150 mg(L Manufacturer Pretreated Effluent Quality ❑ NA Monthly Average** Dispersal Cell(s) gra Ain-ground (gravity) ❑ In-ground (pressurized) Biochemical Oxygen Demand (BODs) <30 mg/L o At-grade o Mound Total Suspended Solids (TSS) <30 mg/L o Drip-line o Other: Fecal Coliform (geometric mean) <104 cfu/IOOmL Maximum Effluent Particle Size '/8 inch diameter * Values typical for domestic (non-commercial) wastewater and septic tank effluent. Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once eve o months >z4 ear s) (Maximum 3 rs) 'Pump out contents of tanks When combined sludge and scum a uals one third (1/3) of tank volume Inspect dispersal cells At least once eve ❑ months f e s (Maidmum 3 rs) Clean effluent filter At least once ever o months ear(s) Inspect pump, um controls 1x. alarm At least once eve o months O- ears o NA Flush laterals and pressure test At least -once eve o months et ear(s) "A Other: At least once eve o months ❑ ear(s) 'NA Other: At least once eve o months ❑ year(s) 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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment components, and any other maintenance or monitoring at intervals of 12 months or less 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. 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 my impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tanks(s) removed by-a septage servicing operator prior to use. Page T OT 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 shalt 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 replacement system: A 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 setbabk 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 POWI'S. ❑ 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 3OWTS INSTALLER POWTS MAINTAINER Name k Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name y Phone Phone. L ~rz `his document was dray =-J - ance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. North 114 Section 23- (found afu County moat 1271.30' 9.95' 176;38 210.00" 72- (C5- sq. I ft. FLU rcres CO • .Fv C) z 2, 13 , E351 sq. ft. M* O- 15f, 549 20 sq. A J. fIQ acres z 3.02 acres ~P ~ r \ \ \ ` _ ^ Y' .rte l \ / r .wwwr. vvv -180.00 S81 72.52 4 ~ Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer A '41, X_' Pump Manufacturer Tank Model Number Pump Model Number Total Tank Capacity Alarm Manufacturer Max. Bury Depth Alarm Model Number Switch Type Filter Manufacturer Total Dynamic Head (TD -Feet Filter Model Number Elevation Head Distal Pressure Network Loss Minimum Pump Performance Required Force Main Loss GPM @T. 16 Ft TDH Total Outlet Manhole Min. 4" Above Grade With Locking Device. Inlet Manhole Manhole Min. 4" Above Grade < 6" Below Grade Sealed Watertight Securely Mounted With Locking Device Weather-proof Junction Box v 'F-Finished Grade Depth of Cover Vent Min. 12" Disconnect Above Grade Ft With Vent Cap Means S S S S i S S S S S t S S Iff= Outl e t Outlet Filter Inlet Inlet Baffle _ < A Switch Settings and Reserve Capacity 1/4" Tank Volume = 3 GPI <;< 't Weep >{Y Dimension Inches Volume Gal. a>; B Hole (reserve) A AJ6 -C -C }i> } } (alarm) B 2 t>i Off Elevation C ;s <; C Ft (dose) y{ >t} 7 . < ♦ < Bottom Y<' (dead) D > } S ~ D YS Elevation Y s Y Total Ft }iy } S } ! ! ! Y < SYi i i i{ S S S S Y{ } y } } } } y y 7 7 } y } y y } } } } } } } } } y } y y } y } YSYSSS}SYi}iYSYiSSSiliyiy<y{yiy{SiyiYSyiyt}S}i}iyiyiyiyiyiyiyiyiyiyi,tyiyi,i,i,iyi,i,i>{yiy{y{yi,iyi}SSS, S, SyiSi3{~S GENERAL INSTALLATION: The septic/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 tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28 WAC. 02/05 LJ Page of /Y lF~ o~ HGOULDS PUMPS Submersible Effluent Pump :r PE "UENT PUMP SPECIFICATIONS MOTOR FEATURES Pump - General: General: ■ Corrosion resistant Discharge: 11/2" • Single phase construction. . NPT • Temperature: 104°F (400C) • 60 Hertz ■ Cast iron body. maximum, continuous when • 115 volts ■ Thermoplastic impeller and fully submerged. • Built-in thermal overload pro- cover. • Solids handling: 1/2" tection with automatic reset ■ Upper sleeve and lower maximum sphere. • Class B insulation. heavy duty ball bearing • Automatic models include a • Oil-filled design. construction. APPLICATIONS float switch. • High strength carbon steel ■ Motor is permanently Specially designed for the • Manual models available. shaft. lubricated for extended Pumping range: see PE31 Motor: following uses: service life. • Mound Systems performance chart or curve. • .33 HP, 3000 RPM ■ Powered for continuous • Effluent/Dosing Systems PE31 Pump: • 12.0 Maximum amps operation. • Low Pressure Pipe Systems • Maximum capacity: 50 GPM • Shaded pole design ■ All ratings are within the • Basement Draining • Maximum head: 25' TDH PE41 Motor: working limits of the motor. • Heavy Duty Sump/ PE41 Pump: • .40 HP, 3400 RPM ■ Quick disconnect power gth, Dewatenng • Maximum capacity: 60 GPM • 7.5 Maximum amps cord, heavy 20'duty 16/3standard d len den with SJTW • Maximum head: 29' TDH • PSC design NEMA 5-15P, three prong, PE51 Pump: PE51 Motor: 115 volt grounding plug. • Maximum capacity: 70 GPM • .50 HP, 3400 RPM ■ Complete unit is heavy duty, • Maximum head: 37' TDH • 9.5 Maximum amps portable and compact. • PSC design ■ Mechanical seal is carbon, METERS FEET ceramic, BUNA and stainless 40 PE51 - MODELS. PE31, PE41, PE51 steel. P• ..33-40-50 j N Stainless steel fasteners. H 35 10 -i► 2 GPM AGENCY LISTINGS 30HPE4 w 1FT X31 t.m _ i C .P LU 25c `l Z Tested to UL 778 and Q 20 CSA 22.2108 Standards Standards Association 15 = n f € BY Canadian #LR38549 0 File F.. • r - i Goulds Pumps is ISO 9001 Registered. 10' _ 51 ~y; 0 0 _ 0 10 20 _ 30 40 50 60 70 GPM 80 0 5 1t0 15 m3/h Goulds Pumps CAPACITY (a 7(107 Gniddi Pumns w ' 1232 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tan Schmitt Attach complete site an on r not less than 8% x 11 inches in sae. Plan must County d paper St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Please print all information. Rev' By Date wC J Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). '40, ~ ko-1 Property Owner Property Location Grand Properties, LP Govt. Lot NE 19 NW 1/4 S 23 T 31 N R 19 W Property Owner's Mailing Address; Lot # Block # Subd. Name or CSM# 712 Rivard Streeet, Suite 300 21 Gavin's Acres: First Addition City tate a nj"Pober City _]Mllage *I Town Nearest Road Somerset I 54025 715-247-59 0 Somerset 210Th Ave V1 New Construction Use ms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: Parent material Outwash plain elevation, if applicable na General comments and recommendations: Area is suitable for a conventional system with 0.6 gpd/sgft rating. P ssible system elevation for Area 1 is (high trench)97.0' (low trench) 96.0' Slope is 8 S Boring Boring # S./ Pit Ground Surface elev. 100.24 ft. Depth to limiting factor 94+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF *Eff#1 *Eff#2 1 0-8 1Oyr3/4 none is 1csbk mvfr 9w 1f .7 1.6 2 8-18 1Oyr4/3 none Is 1msbk mvfr 9w 1f .7 1.6 3 18-31 1 Oyr4/6 none is 1 msbk mvfr 9w - .7 1.6 4 31-51 7.5yr4/4 none sl 2msbk mvfr cw - .6 1.0 5 51-94 1Oyr5/6 none s Osg ml - .7 1.6 qLa -1 11 II Fil *I Boring # J Boring Pit Grand Surface elev. 100.24 ft. Depth to limiting factor 92+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF *Efr#1 *Eff#2 1 0-9 1Oyr3/4 none is 1csbk mvfr cs 1f .7 1.6 2 9-24 1 Oyr4/6 none Is 1 msbk mvfr 9w - .7 1.6 3 24-39 1Oyr5/4 none IS Osg ml cis .7 1.6 4 39-92 1Oyr5/6 none s Osg ml - .7 1.6 (o n II 2" bands of 7.5yr4/6 Is 1 msbk * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS <,V mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 422/04 715-247-2941 Property owner Grand Properties, 1P Parcel ID # Page 2 of 3 r 3] Boring # Boring Pit Ground Surface elev. 97.24 ft. Depth to limiting factor 96+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtft2 *Eff#1 *Eff#2 1 0-9 10yr3/4 none Is 1csbk mvfr as 1f .7 1.6 2 9-20 10yr4/4 none sl 2msbk mvfr gw if .6 1.0 3 20-34 7.5yr4/6 none sl 2msbk mvfr 9w if .6 1.0 4 3447 7.5yr5/4 none s Osg ml 9w .7 1.6 5 47-96 10yr5/4 none s Osg ml - - .7 1.6 From 4T' - 96" 2" bands of I Oyr4/6 Is 1 msbk ❑ Boring # j Boring - j Pit Ground Surface elew ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 F-1 Boring # i Pit Boring Ground Surface elev. ft. Depth to limiting factor in. _ Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD *Eff#1 *Eff#2 * Effluent #1 = BOD 30 < 220 m and TSS >30 < 150 m * Effluent #2 = BODs -i.30 m and TSS < 30 m y> _ 9~ _ 9~ 9~ _ 9/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. Re, l~3z f • ° Page 3 of 3 Conducted by: Conducted for: Schmitt Soil & Site Evaluations Name: Grand Properties, LP Thomas I Schmitt, CST 227429 Address: 712 Rivard St. Suite 100 1595 72nd St. City, State, Zip: Somerset, WI 54027 New Richmond, WI 54017 Phone: 715.247.294 4 Subd. Name: C~avin's Acres, First Addition ~...~K-~rtst o ' Lot No. o? / 6/6-114, IVW 1/4, S 23, T 31 N, R 19 W Township of Somerset BM EL 100.00' o? " 1~yc 0!?/ ,.O,e Alternate BM EL /oo. 2 Slope = % Contour Line EL I 1 4 Scale: I"= 40' 171' 0~ 04 _ gw1 CIO, /06 / g6 Slope 41, .28 9 PI-q os-e-d Roc d (0? /a 6,'e This soil report was done to fulfill a Zoning requirement. It may or may not be in a location that is suitable for your use. No permanent lot markers were in place when the test was conducted. SNb3d 3Sf10H NMOHS SV3tvOS £t~~~-SSL N 0 WILOMSNOO 3131dmo 03BOISNOO ION OZO-kg IM `V-1030S0 31N SNVId 'S~ONVN~210'F D I " - -A38 "3nt/ HIO! LC9Z -ny SN4 V_L ~ 'S3GLON $3215 'SNOISN3Mb c It/n/«-31dv '~11 S30A?13S lylf T- -iw Ajam lsnrl mwo $ zomine _l-,6 .F-.9 V V ~ o _ N A Z o ~ _ ~ o rv - O O < 0 4 -.BL LL = v v p a u N o Z X U d" $ y m W W ° O. ' ^ v R G Sn v Z o z Vf ` 6 u ^ > ~ w ~Xr! 'ate m Ap Y J Y E ° o p W 5 Z co 1O, - e S5f12t1 j00ii ~ a n o o a t _L/1 t-.9 -B-.F d;L/t. 4-.9 n w rt w m ~ ¢ o wt NL WL -3 F a w. g q_j aI 's o 0 0 0- F m m H33W . -sz ~p s3 , ,O z o e ~o 1 dil all I > . W \ > wW 14- o ~ Z W- D z m o N .'o N- > o > O J E J c S. U LJ O W W w Q ~ ~L oy -9/1 t .9 a z 0 Q ❑ o x,.,. . r W L_A_1 Jp fR } i i :i .net 3 y . 9 s ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owrner/Buyer -j Mailing Address --7 3 v ~ Property Address L~ 2 (Verification required from Planning & Zoning Department for new construction. City/State Parcel Identification Number LEGAL DESCRIPTION Property Location r/4 , rtJ r r/a , SeC. r , ':F--,,,a-N RZ97_W, Town of ~ Lot Certified Survey Map # Volume , Page # Warranty Deed # Volume , Page # Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER. CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper amintenance 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 ouaer agrees to submit to St Croix County Planning & Zoning Department a certification form, signed by the o-mer and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site ,,-astewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is ess than 1/3 full of sludge. Ywe, 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. ex ca on stating that your septic system has been maintained must be completed and returned to the St Croix County Planning & Zoniz- Department within 30 days of the three year expiration date. Ii- e certifv that aU statements o4Ads 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 deed recorded in Register ofDeeds Office. uzntab f bedrooms SIGNATURE OF APPLICANT(S) DATE «*Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department =ode vzth this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if is trade in the warranty deed. 8 0 8 7 7 7 7 SPECIAL WARRANTY DEED Tx:4067140 963707 BETH PABST REGISTER OF DEEDS This Deed, made between Central Bank, a Minnesota banking ST. CROIX CO., WI 09/19/2012 10.39 AM corporation-successor-in-interest to The RiverBank. , Grantor, EXEMPT#• NA and, David R. Belisle , 6151119 t< Re rSml REC FEE: 30.00 Grantee, WITNESSETH, That the said Grantor, for a valuable consideration TRANS FEE: 60.00 conveys to PAGES: 1 Grantee the following described real estate in St. Croix County, State of Wisconsin: RETURN TO: SCAT 252 S. Knowles Ave. New Richmond, WI 54017 PID 032-2183-21-000 Lot 21, Gavin's Acres South in the Town of Somerset, St. Croix County, Wisconsin. Seller to convey the title by special warranty deed without covenants of the title or the equivalent for the state the property is located. Seller makes no representations or warranties, of any kind or nature whatsoever, whether expressed, implied, implied by law, or otherwise, concerning the condition of the title of the property. i i This is not homestead property. Dated this day of September, 2012 Central Bank . AUTHENTICATION -~7 / e ~y (SEAL) Signature(s) By: Zach Mc Broom, its Assistant Vice President authenticated this day of (SEAL) TITLE: MEMBER STATE BAR OF WISCONSIN BY: _ (If not, ACKNOWLEDGMENT authorized by s706.06, Wis. Slats.) STATE OF MN } ) ss. THIS INSTRUMENT WAS DRAFTED BY COUNTY OF } of Personally came before me this day LOBERG LAW OFFICE September. 2012 the above named Central Robert L. Loberd Bank by: Zach McBroom (Signatures may be authenticated or acknowledged. Both_ are not necessary) Iglsw to me known to be the person s who executed the JENNY 4HUNDLEY fo oing inst4ear~ent. nd.acknowl dge the e. Notery Public AAhMMeolta . Not ry' Public County, MN. My Co ission i(If not, state expiration dat - ) 1 of 1 l Standard Erosion Control Plan for 1- & 2-Family Dwelling Construction Sites According to Chapters Comm 20 bt 21 of the Wisconsin Uniform Dwelling Code, soil erosion control information needs to be included on the plot plan which is submitted and approved prior to the issuance of building permits for 1- & 2-family dwelling units in those jurisdictions where the soil erosion control provisions of the Uniform Dwelling Code are enforced. This Standard Erosion Control Plan is provided to assist in meeting this requirement. Instructions: 1. Complete this plan by filling in requested information, completing the site diagram and marking appropriate boxes on the inside of this form. 2. In completing the site diagram, give consideration to potential erosion that may occur before, during, and after grading. Water runoff patterns can change significantly as a site is reshaped. 3. Submit this plan at the time of building permit application. PROJECT LOCATION /vim ~~m~ el- Please indicate north BUILDER'I,o 'OWNER y ~'~L~ 1L✓ by completing the arrow. WORKSHEET COMPLETED BY s, dv~ ,.,~:Li SlC DATE 2- SITE DIAGRAM scale: 1 inch = feet N EROSION CONTROL PLAN LEGEND PROPERTY LINE r EXISTING t_ DRAINAGE TD TEMPORARY DIVERSION I s FINISHED ' DRAINAGE LIMITS OF GRADING SILT 4 ~ FENCE 11, F- I STRAW BALES I GRAVEL VEGETATION O SPECIFICATION TREE PRESERVATION STOCKPILED SOIL