HomeMy WebLinkAbout040-1097-10-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 561090 0
GENERAL INFORMATION 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:
Fox Real Estate LP, c/o Richard A. Fox Troy, Town of 040-1097-10-000
CST BM Elev: Insp. BM Elev: BM Description: Sectionlrown/Range/Map No:
25.28.19.386C
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing L GAS Alt. BM , 110-16
Aere4ien Bldg. Sew r
3, j o d z 40
Holding St/Ht Inlet JC L
.7 7
TANK SETBACK INFORMATION St/Ht Outlet , 415 1.
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet $ .a?
Septic ' SC > Dt Bottom ~f `!47 C1 / • 3":5.
Dosing *7 50 7/46 1 56 Header/Man.
Aeration Dist. Pipe
Holding Bot. System
Final Grade
PUMP/SIPHON INFORMATION
Manufacturer
De nd St Cover
L6 "X -P 15 A. I L14-A- 166-24- 5.25
Model Number 5
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length It D~, Dist. to well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 11-1 1 SETBACK SYSTEM TO C WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System: k4- UNIT
Model Number:
DISTRIBUTION SYSTEM
Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s)
Length Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:(0 /1-Y/ 13 Inspection #2:
Location: 157 Hwy 35 River Falls, WI 54022 (SE 1/4 SE 1/4 225T28N R19W) metes &/boouundds Loot Parcel No: 25.28.19.386C
1.) Alt BM Description 4- 40 ~~LJ
2.) Bldg sewer length c l
- amount of cover = ~j(~ ^ T /~5 / V • rl Jry /
G~; r,
le 6 e~er.~-tl u 4
I:w
Plan revision Required? ❑ Yes I No 1„7 / -7~ C
Use other side for additional information. ~
J
s Si
g ur Cert. No.
SBD-8710 (R.3/97)
Date as :;f
o"r t
Safety and Build Division County 5717
' 201 W. Washington A 0. Box 7162 Sanitary Permit Number (to be filled in by Co.)
Sp`' K Madison, WI 5in--2
>y s ~ 5~ l D4o
Transaction Number
Sanitary Permit Application State ~A.,
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate ve unit
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS e s mitted to Project Address (if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used or secondary ~ -7
purposes in accordance with the Privacy Law, s. 15.04 1 (m , Stats.
L Application Information - Please Print All Inform 'on
Property Owner's Name ' AO Parcel # Q 13+16 -7'7
Mqr a i1o, 105 --io -
n
Property Owner's Mailing Address O Property Location
$r 3%.G ,
C D
3 '?o/x Govt. Lot ".WA c
Q -w City, State Zip Code Phone u 5 Section 2 5
`4~0 Z Z (circle on
Qt 1IGr G ~~5 7 T Z$ N; R ,4 circle
`v
II. Type of Building (check all that apply) Lot #
elo Subdivision Name
❑ 1 or 2 Family Dwelling -Number of Bedrooms
Block #
Public/Commercial - Describe Use ❑ City of
CSM Number ❑ Village of 11
❑ State Owned - Describe Use
P ~ own of r0
v `
III. Type of Pe it: (Check only one boa 16 n line A. Co ete line B if applicable)
A. ❑ New System ❑ Replacement System Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
Chan List Previous Permit Number and Date Issued
B. El Permit Renewal El Permit Revision El ge of Plumber 11 Permit Transfer to New
d 75
Before Expiration Owner '923515
IV. Type of POWTS System/Component/Device: Check all that a 1
❑ Non-Pressurized In-Ground Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in, of suitable soil ❑ Mound < 24 in. of suitable soil
El Holding Tank El Other Dispersal Component (explain) Pretreatment Device (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
e. Z 9451 45"~r-/Z
ti
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units t j y =
New Tanks Existing Tanks 2 o J ~ r r2
1- lb /'/'/Q a U rn v) : C7 a,
Septic or Holding Tank IM& 600
S
Dosing Chamber
VIL Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Pl r Sign e MP/MPRS Number Business Phone Number
Q .2
adkf-b - ~
Plumber's Address (Street, City, State, Zip Code)
z8` C g t w'~- S'~ ZZ.
17
VIII oun /De a e
Permit Fee Date ued Issuignatur
proved CC, q
enial v /J
1X. Condieasons for Disapproval
y4
1. ` peptic tank, effluent filter and
.dispersal cell must all be ser0ces I maintained
as -per management plan provided by plumber.
2. Aq aq i 1C requoerneMs must bs tnainta6>~d
as Code! o~arices.
Attach to complete plans for the system and submit to the County only on paper not less than 8 In z 11 inches in size
SBD-6398 (R. 11/11)
r
r
TANK / FILTER VAULT INSTALLATION
4 FOR AN EXISTING
MOBILE HOME / DUPLEX COURT
10 j~
Owner's Name Fox Real Estate'
157 Hwy 35
River Falls, WI 54022
Located in the Section 25, T 28 N, R 19 W.
TOWN OF TROY
SAINT CROIX COUNTY
Parcel # 040-1097-10-000
Previous Permit #
INDEX
Page I Index & Title
Page 2 Project Description
Page 3 Original Septic tank blueprint
Page 4 Original pump tank blueprint
Page 5 Wieser septic/pump tank drawing
Page 6 Plot Plan
Page 7 Aerial View
Page 8 Pump curve & duplex control
Page 9 Dose tank View
Page 10 Management Plan
Prepared By Michael Rodewald
285 County Road SS
River Falls WI, 54022
715-821-6229
MPRS 931384
05/31/2013
Project Description
Goals.
1. Replace existing precast pump tank
2. Install effluent filter
3. Replace defective pumps
4. Replace defective duplex control
5. Increase safety of existing septic tank by installing a better manhole with locking
device.
The pump tank will be replaced with a Wieser 1000/600 gal combo tank to allow for
installation of a Polylok P1.625 Commercial filter. The pumps will be replaced with Goulds
EP05 230V Iph operated by a Sje Rhombus model 122 Duplex controller.
Due to the current location of the force mains outlet out of the bottom of the existing pump
tank, the new pump tank will be installed approx. 5' lower in elevation to allow for drain
back to pump chamber.
The existing 4' x 4' wooden access cover of the 14500 gal septic tank will be replaced with a
concrete cover with a 24" dia. Manhole with a locking device.
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VU11141S TTater lechnol'ogy
Wastewater
APPLICATIONS _
• SJTOW resist
ant
Specifically designed for the following us
es: power ca=`
• Homes, Farms, Trailer Courts, Motels, Schools, •'/3 - 1 HP rounding
Hospitals, Industry, Effluent Systems plugs.
SPECIFICATIONS • 1112 HP ar ends.
Pump Three pha%: :i
•Class 10
• Solids handling capabilities: 3/4" maximum. ided in
• Discharge size; 2" NPT. separate) ,
• Capacities: up to 140 GPM. • STOW pc ends.
• Total heads: up to 128 feet TDH. • Designec ratings
• Temperature: are withii mended
104°F (40°C) continuous, 140°F (60°C) intermittent. working
,sly with-
• See order numbers on reverse side for specific HP, out damp
voltage, phase and RPM's available. • Bearings: o aD bearin
construe M g
MOTORS o - 3
• Power Ca x >1 ; a o Q ter resis-
• Fully submerged in high-grade turbine oil for lubri tant. Epo Q Z6 S 3 v 0 3 ondary
cation and efficient heat transfer. moisture = ¢ a page and
• Class B insulation on 1/3 - 1'/z HP models. al le gthr N o 2 z Q ~ 2 Option
• Class F insulation on 2 HP.models. N a co 3 Vi o` o) :5
• O-ring: A a
~ ~N c.0S o -
~ tami-
Single phase (60 Hz): nants any E 2 .2) ° E
2
J
W
• Capacitor start motors for maximum starting torque. AGENCY L ❑ a ~ z Q o
I
• Built-in overload with automatic reset. @0. Tee
us By
(
METERS FEET
40 - 130
EIS SERIES: WE
120 S'
SIZE: 3/4" SOLID
35 _ _ RPM: 3500 & i
110 - _ 1750
2 b
~ - 5 GPM
30 100
5 FT
Q 90
.
z 25 80
v -
:_5 70 -
¢ 20 Q - -
I
60
r
Q 15 5
Irv j
10 :0
5
10
0 00 ' 10 20 30 40µm 50 60 70 80 90 100 110 120 130 140 150 ' 160 GPM
0 5CV\ 10 15 20 25 30 35 m3/hr
PAGE 44 CAPACITY
E~ }K OPA ~'c~jple? pAS~ ~r fie)
Dose Tank Information
Z-
ace Je Vv
s
Electrical as per NEC 300 and i a, e a: e 7 o -
_
Comm 16.28 VVAC Disconnect 4 n min
Tank component is properly vented -~-i Alternate outlet
location
ForcemaiViameter
Weiser Manufacturer ~"in,
Capacit 600,00 Gallons
Volume 11.82 gal/inch A
Weep hole or anti-
Dimension Inches Gallons B siphon device
A b aJI r
B 2.00 23.64 C Pump off elevation (ft)
Cf - -
Total 50.76 600.00 D
Pose tank elevation (ft)
~J-~-Min. 3" Bedding under tank. C_^
Alarm Manufacturer
Alarm Model Number
Pump Manufacturer
Pump Model Number
Pump Must Deliver gpm at otp~]ft TDH
Project, _'rit` Page /(7
Septic System Management Plan
System Owner Fox Real Estate 715-410-5711
System Installer Michael Rodewald 715-821-6229
Septic pumping Tri-County Sanitation 715-386-2130
Regulating agency Saint Croix County 715-386-4680
General
This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall be
maintained in accordance with it's component manuals 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 manhole risers and covers should be inspected for water tightness and
soundness.
Exposed access openings greater than 8-inches in diameter shall be secured by a locking device to
prevent unauthorized entry into a tank.
Septic Tank
The Septic tank shall be maintained by a certified individual under s.281.48, Stats.
The contents of the tank shall be disposed of in accordance with NR 113, Wis. Adm. Code.
The operating condition of the septic tank shall be assessed at least once every 3 years by
inspection.
The Septic tank shall have it's contents removed when the volume of the scum and sludge
exceeds 1/3 the liquid volume of the tank.
The addition of biological or chemical additives to enhance septic tank performance is generally
no required. However, if such products are used they must be approved for septic tank use by the
Department of Commerce.
Pump Tank
The pump tank shall be inspected at least once every 3 years. All switches, alarms, and pumps
shall be tested to verify proper operation. The effluent filter installed within the tank shall be
inspected and serviced as necessary.
Contingency Plan
If the septic tank or any of its components become defective they must be repaired or replaced to
keep the system in proper operating condition.
If the dosing tank, pump, pump controls, filter, alarm or related wiring becomes defective they
must be immediately repaired or replaced with a component of the same or equal performance.
If the septic system fails to accept wastewater or begins to discharge wastewater to the ground
surface it must be repaired as necessary to bring the system into proper operating condition.
2013 Property Record ( St Croix County, WI 40
Assessed values not finalized until after Board of Review.
Property information is valid as of JUN 02 2013 10:27PM .
OWNER CO-OWNER(S)
FOX REAL ESTATE FAMILY LIMITED PTNSP
PO BOX 186
HUDSON, WI 54016
PROPERTY DESCRIPTION
PROPERTY INFORMATION SEC 25 T28N R19W PT S 1/2 NE COM NW COR SEC 25, TH E 1086
1/2 FT TO CL HWY 35, S 52 DEG E ON CL 2175.8 FT, E 387.4 FT, S
Parcel ID: 040-1097-95-000 29 DEG E 488.1 FT TO POB: N 57 DEG E 163.8 FT S 32 DEG E 400
Alternate ID: FT S 57 DEG W 220 FT, TH N 32 DEG W 400 FT TH N 57 DEG E 56
School Districts: Property Address:
SCH DIST RIVER FALLS Municipality: TOWN OF TROY
Other Districts:
CHIP VALLEY VOTECH DEED INFORMATION
Section Town Range Qtr Qtr Section Qtr Section
25 28N 19W Volume Page Document #
2196 252 716091
Lot:
1694 214 653039
Block:
521 542
Plat Name NOT AVAILABLE
TAX INFORMATION LAND VALUATION
Valuation Date: 19870709
Net Tax Before: .00
Lottery Credit: .00 Code Acres Land Value Improvements Total
First Dollar Credit: .00 0.000
Net Tax After: .00 Total Acres: 2.006
Amt. Due Am Paid Balance Assessment Ratio: .0000
Tax .00 .00 .00 Mil Rate: 0.000000000
Special Assmnt .00 .00 .00 Fair Market Value: 0.00
Special Chrg .00 .00 .00
Delinquent Chrg .00 .00 .00
Private Forest .00 .00 .00 INSTALLMENTS
Woodland Tax .00 .00 .00
Managed Forest .00 .00 .00 Period End Date Amount
Prop. Tax Interest .00 .00
Spec. Tax Interest .00 .00
Prop. Tax Penalty .00 .00
Spec. Tax Penalty .00 .00
Other Charges .00 .00 .00
TOTAL .00 .00 .00
Over-Payment .00
PAYMENT HISTORY (POSTED PAYMENTS)
General Special
Date Receipt # Source Tvpe Amu Tax Status Assess. Status Interest Penalty Total
2
1694PAGE214
DOCUMENT NUMBER 7r S `30 ZEN '9 _40
QUIT CLAIM DEED KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
08-06-2001 9:30 AM
Richard N. Fox, a/k/a Richard Fox and Julia Fox, a/k/a Julia F.
Fox, a/k/a Julia Frances Fox, a/k/A J. Julia Fox, a/k/a Frances Fox, QUIT CLAIM DEED
s/k/a Fraaces J. Fox, husband and wife, quit-claims to Fox Real Estate EXEMPT M 15S
Family Limited Partnership, the following described real estate in St. CERT COPY FEE:
Croix county, state of Wisconsin: COPY FEE:
TRANSFER FEE:
RECORDING FEE: 14.00
See attached Exhibit ^A" for real estate description. PAGES: 3
NAME AND RETURN ADDRESS i
Leo A. Beskar, Attorney '(J
RODLI B
ESKAR, BOLES & KRUEGER, S.C.
219 North Main Street, P. 0. Box 138
River Falls,
40-1097-10-000;
40-1097-95-000
Parcel Identification Number
This is not homestead property.
Dated this lot day of April, 2001.
i
(SEAL) (SEAL)
Ri and N. Fox
(SEAL) (SEAL)
lt& F. Fox
AUTHENTICATION ACKNOWLEDGMENT
Signatures of Richard N. Fox and Julia F. Fox STATE OF WISCONSIN )
as.
COUNTY )
auth 'c ted this 1st y of April, Personally came before me this day of
20 the above named
to me known to be the person(s) who executed the
foregoing instrument and acknowledge-the same.
Leo A. Beaker
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by 5706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY: Notary Public County, Wie.
Leo A. Beaker, Attorney my commission is permanent. (If not, expiration date:
RODLI, BESKAR, HOLES & KRUEGER, S.C.
219 North Main Street, P. O. Box 138 )
River Falls, WI 54022