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HomeMy WebLinkAbout018-1098-07-000. i Department of Commerce and Building Division , ~. .aENERAL INFORMATION Personal information you provide may be Permit Holder's Name: ~C~.~? Stout, Richard ~~u~~--~~ TANK INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION RERORT (ATTACH TO PERMIT) for secondary purposes [Privacy Law, s.15.04 (1)(m)j City Village X Township Hammond Tc ev: BM Description: fj~ TYPE MANUFACTURER CAPACITY Septic ' , 1 ~,J /~ ~ O Dosing ~~ Aeration , ~~ Holding TANK SETBACK INFORMATION TANK TO /L 1 WELL BLDG. Vent to Air Intake ROAD Septic ~ SD / J z~~ Dosing ~ ~ ~ / ~ .~' ~ ~/ ~ IOiO , Aeration Holding PUMP/SIPHON INFORMATION n[....,, Manufacturer Demand ' GPM Model Number ~ ~~ TDH Lift Friction Loss System Head TDH Ft Forcemain Length i Dia. ~~ Dist. to well ' ~ h~ ~ O W SOIL ABSORPTION SYSTEM ELEVATION DATA County. St. Croix Sanitary Permit No: 420726 0 State Plan ID No: Parcel Tax No: 018-1098-07-000 Section/Town/Range/Map No: 30.29.17.814 ST TION BS HI FS ELEV. to ~ D 3 . 3- . o Benchma G~ • (~ (0~'(• L d ~+ U Alt. BM Bldg. Sewe~~ • .r ` q St/Ht Inlet .~ ~ - Q d SUHt Outlet ~ s `3 0.~~'3 Dt Inle /~ ~ •30 ~ ~7 Dt Bottom ~ d /3.7 ..~'. 76 ea er an. aQ i. ~vr.vv Dist. Pipe ~ ~,2 /7 Bot. Syste q -Z t ~f ~jn !~/V ~)~~r /U©r77 Final Grade . 2Z St Cover 3i ~ /D~.OG cl'• ~L ~ 6 •Z /03• Z~o ~~~ I I~~( BED/TRENCH DIMENSIONS Width r Length ~ O ~ No. Of Trenches ~ ~ / PIT DIMENSJAtdS No. Of Pits Inside Dia. ~ Liquid De SETBACK INFORMATION SYSTEM TO P/L BLDG WEL LAKE/STREAM ACHING CHA E Manufacturer: T yp~Systea m: ~ 11N~ .~ul~/ ~ V / ~ \ i~ ~ ! Model Number: DISTRIBUTION SYSTEM Header/Manifold ~ , ~ , / Distribution / / ` x Hole Size 4 t / !/ x Hole Spacinag~ / Vent to Air Intake Length Dia Length~~ Dia ~ `~ Spacing ~ ~ U °`' ~ ~;~ / `,~ 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 BedlTrench Edges Topsoil ' ~ Yes ~ No Kes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspe~n~#1:~ //~/~~ Inspection #2:~!~~/~~~/y/S/~ Location: 1522 73rd Ave Hammond, WI 54015 (NW 1/4 SW 1/4 30 T29N R17W) Emerald llPyt;res Lot 71~~ Parcel No: 30.29.17.811~.4~ ~., ~ 1.) Alt BM Description =~'(~pY~IL ~~~ ~~ -1iu~b~Jti-~ ~/~.,l~itxR.l' r;!!1- 2.) Bldg sewer length = Zy 7 ~ ~2~'1 G .~ ~ ._ -amount of cover =~ 3~ Z~'S (/ ~ -~ (~! 5 0 ~~ ~~/~1 3.) Contour = b ~ ~a~~~?Zf[.. Plan revision Required? ~ ~ Yes ~ No Use other side for additional information. SBD-6710 (R.3/97) ~ I Q i~` _ Date Ins or' ture ~ Cert. No. ~u'~~-= 1~G~0~ Sa~- and Buildings Division Co~Y wasdiwt~goon Ave., P.O. Box 7x82 201 w ~ iscvnsin . ~ ' ~ ~~ - ~ ~ Add ~ l7e artment of Commerce ,~ Sanitary Permit Application ~''L' ~.o t m aocmrd with ~ 83.21. Wis. Awha. Code. ide [} l~eCt if Rtwision ma be wwsed for I. Application infoamsdion - Pkwt9e Paint AH inf Stast Phm I.D. Nw~6er ~ ~irst~t t r own~•s Na me M A R ~ ~ .2 003 ~' ._ ..-cm P+ Owwsx~'s M admg Address ZONING O F F I C E Y Lawat~n 'a ` C'uy, State Zip Code Phone Number Lot Nmnbwx 131od~ Nwta-ber iviston Name CSM Number ~u son/ c~c~ v G -- ?3 r- s IL~'~rpe of Building tt~eCk alt that. apply.) ~, . ' Dc;xy (B 1 or 2 FamBy Daellu~ - Number of Bedroa+na z Dv D Pdtl' Die Use ~~~~~`~ ~~ ~'¢x.C~~ 0 O State Owned "D ll = I o ~ (l2~ l RQ '' _ N ~~ ST ~ . 00 ln~lo+w~0! c~ liI. Type of Ptarwwai~ (Check only o~ boz on Bne A. Ntmsber3ng is for iaaternat nse.) (Comp lete B+ if aPP-) A. 1 2D ~ System 3D 1Lcp{aopaeatof Tads Od 6D Addition to Fm, Cosartr late 8' DCheck if Sanitary Pamir Previously bisttod FermK Number Date )ssumd rv. T•~e of t,'OWT sue: (Chtxk au that apply. lvwautbeaing is for inttxnal ~• 4- ~ Nao ~ In-c~nd al naval - a~ D ~,d lamer so o aoed~ w«ama 22 0 Presswwriaed In-Ground 41 D Holding Tam 48 0 siggle Pass sl 0 Drip I.iue 45 D At-Grade 4G DAnobic 1Y~eapnem uttit 49 D Rxircntating 30 DOWer V. - Area informat ion: D~ Flow (~ DispasN Ara Dispersal Arta sal Apphca6un Pecoohuion ]taae Elaration Find Grade Regwtited Proposed RasaC~Jn~an/Sct-tea cldia.Rra:n) E . ~d VI. Tank info Capacity iww Tom Number ~ Prefab She Sled Fiba~ Plastic Galbns GaIIaas of Tads Conde Coastnwceed Ghss . t~e.- Tanta Taalcs ~ or Ht~ 7`aw~ 2®O "~ 1, t / T I/ YII. Respon6'BfiGty Stateauet4t- I, tLe taatlarsi~ned, atrtoswe srapossdbiiity bastsBatien of the IPOW'PS shows aee the attaeiewl plows. Plumber's Na wne t~U Phanber's - 8mouee '10@1MPRS Nnn~er llusioess Phtwae Naotber Fogerty Plumbing de Pet*k esttng ~ ~~ ~~ ~® Phtwtwber's ss ;Zip /~ Spooner WI 54802 - ~ CIE'GL- ~SF.. p7~~.~/0~ viii. u~ Approved ~ C]~ ldaal Adverse Satridry Ptrmh Fee Csramdwater y. ~ ~ Date ltswwod Agana Si (No Smips) - ~ ~S (1 3 UC. cont~tittt~ of ApprovailRessons for vai ~--- `~- _ W~ - S ~'c.e.t~+~c. S ~ lm t!e Caa t-e~~ dot :11 indwes la she - f _ -~.,.. PLOT PLAN Scale 1"=yp'~ page 3 of 7 DoT _ 3 tq, ~,Z . Uwe. ~gnn#1 - ~L_ 100~0`O~v 1~~ vC:_l?tD~.. __. y J Q b Nnr Cd„LP~- OR ~ D l ~lv 1't..p ~H S ~tcfilq . J w~ / s~ e.Z ~'~, ~• ~ ~~~ ~~~ ~- ~ ~e,`a .>~ ~~ ~~°~ ~ \\~ ~, . ~ ~i~ m /// i o`a i- ~~ s. i s pt ~, o m aoo `t ~-o 1St `l-N ST. NOTES• 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required). 3. Septic tank to be tz6a gallon capacity manufactured by w~~s Cty,,etZ~, w 1 ~ -1 ~ oD 7~3 ~- Fj ~.t~ • ~ v'-- P -~~*n-~ lU Q ~ ~~ O 6 f~ t~y t~1~S 'rA~v1~z, 4. $ench mark S ; S~ ~oyE _ , ~. Divert surface water around system to prevent ponding at the uphill side. / ~ ~` /~ Zo`oGZ~~~C ~M . ~ F ~O~o~ r ~ ~ 2aS~ a .~-~~ ~~ isconsin Department of Commerce February 13, 2003 CUST ID No.267341 ARTHUR L WEGERER WEGERER SOIL TESTING & DESIGN SERVICE PO BOX 74 RIVER FALLS WI 54022 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 02/13/2005 SITE: Richard Stout 73rd Avenue Town of Hammond St Croix County NW1/4, SW1/4, 530, T29N, R17W Subdivision: Emerald Acres -lot 7 FOR: Description: Proposed Four Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 891587 Identification Numbers Transaction ID No. 836896 Site ID No. 655777 Please refer to both identification numbers, above, in all corres ondence with the a enc . The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans. • Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the septic tank outlet filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • Comm 83.22(7) - 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. Owuer Responsibilities: • Comm 83.52(1)(a) -The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. P.4.~"~'.T.~. COIZ~~I'~l (~'/P lZt~®~I RECEIVED FEB 1 8 2003 S ~. CROP ~ ~UCE Y Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary ATTN. POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 ARTHUR L WEGERER Page 2 2/13/03 Owuer Responsibilities Continued: • The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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 addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm jswim@commerce.state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WSMART code: 7633 cc: Leroy G Jansky ,Wastewater Specialist, (715) 726-2544 TITLE SHEET Page ~ of 7 ROUND SYSTEM FOR A y BEDROOM RESIDENCE This plan has been prepared in accordance t~ith t I4anual SBD-1057 P and the Pressure Distribution LOCATED IN THE Nw 1/4 OF THE ~ 1/4 OF SECTION TOWid OF ~`Ry~jy~j01`1~ ST. CR-c- LX INDEX he Mound Component 1!Ianual SBD-10573-P CR. 614R~ 30 , T Z.°~ N , R t ~ 6d , _ COUNTY, WISCONSIN. ~~~ PAGE 1 of 7 TITLE SHEET /~ ~v.'V. ~ ~ ,r~' PAGE 2 Of 7 SYSTEM 1~IAIrAGEMENT PLAN ~+ ~ PAGE 3 of 7 PLOT PLAN N~.~ ~1 ~``~ ~`~•- PAGE 4 of 7 PLAN VTEtd-CROSS SECTION ~'' n"~ ~~ ~~:~ PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT ~ ~~ ~©~,,a PAGE 6 of 7 PUI4PING CHAMBER CROSS SECTION ~''•~'~ PAGE 7 of 7 PUMP PERFORI•iP;NCE CURVE ~'~~~ ~y~~ PREPARED FOR l C 1'-~-~}- ~Z t~ SZ'tx1T _. __ ---- -- --- 1-~-U~ Spw , w ~ : Sal Ol PREPARED BY WEGEt~ER SO S L . TEST S NG AND . I7ES I GN SERVICE P.O. Box 74 421 N.Aiain St. River Falls, TdI 54022 Phone 715-425-0165 Fax 715-425-6864 ~...rr~KiiVItN~ OF DIV1St ~F 5AFE7Yq-~p PdE1-SCE BU1LDth1GS SEE CORK ~ PONDENC~ .,- N 4^. Y ~~ ~ - ~~ R ~; w,..'s~ Y' .. '3LL` ~'~ ,u ~ r; l.FiF~+i;,~ ~ 1i-4-i ;. ~+ ~ Ell:; /v (.; ~i7~ • /~ / ~M1'i:i. n F -lp- D3 JOB NO .. ~ 3 - l 3 Mound System Management Plan Page Z of ~ Pursuant to Comm 83.54, Wis. Adm. Code - ~Seotic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are-made to retain solids in the tank that may slough off the filter 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 filter 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, Safety and Buildings Division. 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 filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution S stem No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound 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 mound 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 mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg/L 8005, 150 mg/L TSS, and 30 mg/L FOG. 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 testis 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. General - This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manual [SBD-10572-P (R. 6/99)] grid local or state rules pertaining to system maintenance and maintenance reporting. - No one should ever enter a septic or pump tank since dangerous gases maybe 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. 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 dosin tank um 9 , p p, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the mound 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 removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions about the operation or maintenance of this system should be directed to: The County Zoning Office at ~ ~S~~b -~I680 S7'. CfLU1X The system installer at 1.LS --(,3S-a6d4 ~tlr;(a?T•"~' The tank manufacturer at 1~~ ~.Z ~,_SZ$S w~l-zS The effluent filter manufacturer at X00 -Z.Z) _ 571 Z Z~aSL The pump manufacturer at ` ~ 30-~ZA-1~y(~ GOV~p~ . ~ PLOT PLAN • Scale 1"=l~ p' Page 3 of 7 DoT ~ 31q, ~Z - ~ -- . ___ Bw-~Z.: =-(.'c-~6~~' ~~ 1" PVC PIPS y J JI to ~ 1uuT- COw1P/'t~T o2 D l gT1 ~Zp ~ S ~pr~, . ~• ~ ~p~ • . ~~ c~ ~, . ~~ ~v J~ ~~ ,-~ ~~°~ w~ / 's` ~ ~ B.Z ~~ , / 7' / ~ ti ~C ~rq . / ~ / ~ zo oG~- ~ i~ / ' ~ _/ i g_P Up o~y4~~~ Za~o~ ~~sg• ~ /~ a qN Fi \ \ 2.. % / ~~ \ v o -~~-r_~r~~u~t TR?~k-S _--- - -------- - ~L. `73 r~ 'AV~~ NOTES • -_ . 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Ins-tall 4" observation pipes with approved caps. ( Z required). 3. Septic tank to be ~z6p gallon capacity manufactured by w~~s Ctw~-~.~ w ~ ~ - ~ ~ oD 7~ ~ Fj L'~ZT'R - ~ ~ M P `1`P~*n-c_ ~l Q ~ ~i0 O G tK- 1,t~ ~S `TPnv1z, 4 . $ench mark S : S ~ t~-~oyE 5. Divert surface water around system to prevent ponding at the uphill side. Pace ~ Of 7 Approved Synthetic Covering ASTM C33 Medium. San`'d Topsoil L a ~~ ~ E 3 i ~ I Slope - Distribution Cell of %" to 22" Aggregate 2 ,' istribution Fipe G ~~ F. ~~ p ~~ ~~ .// a` ,i; i , e ,Force Main From Pump CROSS SECTION OF A MOUND SYSTEM Linear Loading Rate=6 •~ GPD/LN FT Design Loading Rate=~j.3Pi.GPD/SQ FT ~~t Position . OT Farce Main .. ~ a ~,/------------------ w ~ - --- - A ~ Ft. B tom Ft. I 1 C7 Ft . J ? Ft. . K ~° _ Ft. l 1l8 Ft. w Z 3 Ft. Elev. L00_ S Flowed Laver 0 1.0 Ft. E 1-2~ Ft. F 0-~'i Ft. ~ G-S Ft. !; 1. ~ Ft . I ~ I ~ -Observation Pipe I - ~ K =___. ~__ -- ~~ BcX ss T ---------~ Distribution ~-- CeI %" ~ ~~ _ 1 of z to 2 z Pipe a;gregate Observation Pipe (Anc~cr securely) PLAN DIET~1 OF A MOUND SYSTE:4 Distribution Pipe Layout Paoe S of Place the holes at the bottom of the distribution pipes . at'equal spacing. Remove a1I burrs from the pipe and holes. Extend the end of each lateral up with the use of IonQ flan or 4f° fttinQ to a point within six ~~ inches of the final Q*'ade. Tem,inate the ends of the Iate.-aIs with a vaive;'tilreaded caD or • threaded plug. Provide access from final fade for the valve; threaded cap or threaded pIuQ. ' ~~ ~ ~ cr, L LAS s s~`~1 ~ t~ FVC ~ F~JL PVC Latent Manifold Laterl x ~ x ~ x ~ x~ x2 ~ x!Z ~ x ~ x ~ x ~ x ~ ~ . Latent Lenath_-~ _ ~ Latetal~Lpnath ~ P ~ pLPrN ~l~c~-~7 _ ~- ~ - ~ ~ ~ i}CC:}S Spy. a- - l~},5,..~, - -O ~-r1t''SJ1F~~ G- -- ~ --~ F y9 Ft, ~ Hole Diameter ~~$ Inch~~ --"~ S 3 Ft. ~ ~ Lateral " ~ I ~~~. InchEes) X Z ~ Inchps Manifold Z• Inches ~- ~ ~ Force Main " ~ Inches ~ of holes/pipe Z S - w Invert Elevation of.Laterals~~~•O Ft. PUMP CHAMBER CRO55 SECTION AND SPECIFICATIONS ' PAGE C-~ OF '.~ , VEiJT CAP ~ • `I" C.Z VEAIT PIPC • WEATHER PROOF APPROVED •LOCKING MANHOLE ~ 10' FROM oooR. JuA1CT101J 80X ~ COVER WITH WARNING LABEL wIRIDOW OR FRESH 12~1N11J. I AtR WTAKE I y~•~ 1GRAOE I L.C. I.C)O• ~ I I `1~MI1J. ' I ~ 18' MIIJ. COIJDUIT ~-'- ______ __ 18'!'l1Al. ~ ------- -- ~~ ~l~ 11ULET • PROVIDE I = _- '~j"' AIRTIGHT SEAL I ~ I I I I I APPROVED JOUJT A I III APPROVED JOIIJTS I i I I I I I AI.ARH e II II I • ~ I I orJ c •I I PUMP--~ OFF D . tL~ • QO ,~a ~ COrtCRETE CLOCK ~- RISEK EXIT PERM!'IfEO OuLy IF TAWK MAlJUFACTURi~R HAS SUCH APPiLOVAL~3,•AVPRovED Ba<D011~ • SPECIFICATIUI~IS DOSE •r_,~'~~ MAWUFACTURiVR: W~tS~S °LO~CR IUUMbEA OF OOSES• ~•~•, pFR p~,y TAAJK SIZE: S~~ GALLOAJS DOSC VOLUME t • ALJIRl9 __~!~AIJUFACTURER: S -, _~t-`~~"12:q S~$"T~..1 S IRICLiJDiWG 6ACKfLOW: X30' b ~ 6A«ONS MODCL NUMBER: lOl Fll.v - VCAPAClTIES: A_ ` L113.-. ~_ •---•._---- -~IJ-ICHES OR ~ CALLOUS swITCH Type: }"~ ~~~R-y B = ~ IucHES oR y 3' S G~+~LO~s PUS MAWUFACTURCR: GOy L D S C = 6 IIJCHES OR ~'~ 0''6 GALLOIJS MODFL J-lUM81<R: ~ 0 S p= l~ Z 1-~.••6 INCHES OR GALL01J5 sW1TCH TYPE: - ~ ~L~J~2_L/ IJOTE: PUMP AAIp ALARM AR TO d US• ~ Ml1JIMUM DISCH/4RGE RATE ~~~ • y GpM INSTALLED Osv SEPARATE CIRCUITS YEATICAL OIFFEREtJCE OETWCCIJ PUMP OFF AUD.OISTRIBUTIOtJ PIPE.. 1l)}'~-1 FEET + nIUIMUM NETWORK SUPP~y PRESSURE , , , , , , 6- S 0 FEET C S • a xl• ~> ~' -Z'l~ FEET OF FORCE MAIN X ~"~6 F~ d b ioorxFRlCTloty FALTOR._ - 9 FEET ,a, lSg _ _ . _ •_._ TOTAL Oy1JAMIC HERO = 1-f '~~•FEET • • As per:>aanufacturer • Z~_Z6 gal/in. Liquid depth 3~1- • ,.-~, _~- Goulds Submersible Effluent Pump I~JE ~7 0~= -7 MODEL 3871 EP05 APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes •Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS Pump: EP04 • Solids handling capability: 3/a° maximum. --~ • Capacities: up to 55 GPM. _,j ~ • Total heads: up to 24 feet. • Discharge size:l'/2' NPT. • Mechanical seal: carbon- ., rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Pump: EP05 • Solids handling capability: 3/`maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size:l'r~Z' NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. ®1995 Goulds Pumps, Inc. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: l0 foot standard length,16/3 SJTO with three prong grounding plug. Optional 20 foot length,16/3 SJTW with three prong grounding plug (standard on EP05). METERS FEET ,o 9 3 8 2 o ~ a W x v 6 20 z 5 C 15 '' 4 0 3 10 2 5 1 0~ 00 ~V GV JV 4u au GPM ~ ~ , , 0 2 4 6 8 ~ 10 12 m~/h CAPACITY • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Automatic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ^ EP04 Impeller: Thermo- plastic Semi-open design with pump out vanes for mechanical seal protection. ^EP05 Impeller: Thermo- plastic enclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover: Thermoplas- ticcover with integral handle 'and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING SP• Canadian Standards Association (CSA listed model numbers end in "F" or "AC".) i ~ i ~~ ; ' ~~ a --~ ~ i ~ f } i . ~~ i :_ -- ~ ---~- ---- - ~ - ~ - i r - ~ --- ~ I j ! ... ' - P ' --}--- i o i E 05 - -1 j - ~ i I I U Wisconsin Department of Commerce 6ivision of Safety and Buildings SOIL EVALUATION REPORT P~ z-~socP Page ~ of u~ a~.w~aaa n.c vnui vv~um u.i, vrw. nuns. vwc 1 ~ County -~ C y Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must ro l- include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Revi wed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~~ I I Property Owner Property Location ~,~~ -j' Govt. Lot ~ f 1I4 ~ 1/4 S ~j T Z 4' N R (~. E (or~ Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# i~ S3 -ee ~~ ~ met-~~cl res City State Zip Code Phone Number ~3~ ~ 5~lOIt ~~ 549-( ^ Ciry ^ Village [Town Nearest Road sd f" s~ ~ 0 ~ c ) ~ ~ .~~. New Construction Use: ~ Residential / Number of bedrooms 3 _ y Code derived design flow rate ^ Replacement ^ Public or wmmeraal -Describe: I, Parent material r~~ ~ ~ Flood Plain elevation if applic a ~; General comments SY S /Y~ e ~ ~ t! ~ f (TU. S~ ~ '-'" and recommendations: t ' ,' _,.. ~'J`oOd GPD ~~ ti rn^ ~f ~, ~. "~ ~ 1 ~ C ~:7 t;4~.~;a 1 ^ Boring `J`am Boring# ._">~'~ 1G'tvtPiGC7f•h1Gc ~"~ ®pit Ground surface elev. • ~d ft. Depth to limiting factor Z ''~ . m ' $ Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bo ' GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ~ O-l2 ID~ r312 5/~ Z m-~r c5 ~ ~~ • 5 . ~ Z 1Z-Z~ -U ry ~ S•c.l ZmS.bk m~r c - ~ ~-/ ~ ~O 3 -310 1d r3~/o C ZP ~. S r y (0 5 c ~ m Sb~~ mfr _ ~ . ~/ ~ ~ i Z Boring # ~ Boring p [,~ pit Ground surface elev. 90. ~ ft. Depth to limiting factor 3~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I U -~s Id l i -- s, Z e ~~ • 5 -~ 3 3~ yL 113 it ti C Z ~. ~ Y/~o s ~J 2-~r-t k r~-,-~I- - ~ . `-~ . ~ "Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 _< 150 mg/L * Effluent #2 =GODS < 30 mg/L and TSS < 30 mg/L CST Name {Please Print Signature CST Number cxl,-~I masker ~~~~ _ ~ __ Z s33o9 Address ~z"Date Evaluation Conducted Telephone Number 21-3 ~0~~- immerse-~~~~ ~~oz5 ~Z-~~_oi C~~s~Zy~-yao~ -' SBD-8330 (R07/00) Property Owner ~-~ov~ Parcel ID # Page Z of a Boring # ^ Boring Q Pit Ground surface elev. ~~ •3~ ft. Depth to limiting factor ~_ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 I d-(Z ((~ Z S~~ b i'1'1~r c5 ~v .~J . ~ Z i 2-3v 13 i cJ Z k r ~ 5 -- ~-/ . ~o -3 3o-sb ~ ylc~ cZP~-S r ~pl~ ~1 f'Y1J~k rn~~ - - - ~f ~~ ^ Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDJftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 "Effluent #1 = BODS > 30 < 220 mg/Land TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBA8330 (R.07/00) PAGE~OF ~ NAME ~~ U T LOT# ~ LEGAL DESCRIPTION N~ ~ S w i4 ,S 3o T ~ 4 ,1~,R, ~ ~ E(or~ SCALE: 1"= y~ BM 1 ELEVATION ~Oa . U BM 1 DESCRIPTION ~op a-~ ~ ~• pug- p~'Pt BM 2 ELEVATION 9 $~ SG BM 2 DESCRIPTION 7~p o~/ ~~~ ~ ~ e $-rc• 3 ~ SYSTEM ELEVATION /QG • S~ ® ~ ALTERNATE ELEVATION ,.~iil9- _ fi CONTOUR ELEVATION Q~. S o I ~J S - %' - Uc'_ SIGNA E~,,.~/ ~.,. ~ -- DATE_ ~y'` ~~'~ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer _ - ~.rc~/~ S7r~~sT Mailing Address / 3S3 /~i.~TGcIC~~ Yom' . ' /GrrDfoit/. cam' _r = ~lml/ Property Address /~ .2 L 7 ~ ~~ (Verification required from City/State Department for new Parcel Identification Number /~ / o f ~ -i 7-e~o6 LEGAL DESCRIPTION Property Location~,li~ %4,,~Gd '/4, Sec.3o , T~_N-R~W, Town of ~i~~~o~ Subdivision ~ssrmGs~t~A ,11~-~,tr'.s .Lot # ~ Certified Survey Map # ~_ .Volume _ ..Page # Warranty Deed # ~~~' , Volume ~ 732 .Page # Spec house ^ yes ~o Lot lines identifiable i~es ^ no SYSTEM 1~~iAINTENANCE 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. The property owner agrees to submit to St. CYoix Zoning Department a certification form, signed by the owner and by a masterplumbcr, journeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on-site wastewaterdisposal system is is proper operating condition and/or (2) after inspection and pumping (if necessary). the septic tank is less than 1/3 full of sludge. IUwc, 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 Zonin Office within 30 days of the three year expiration date. ~~~'~ SIGNATURE OF APPLICANT ( DATE OWNER CERTIFICATION I (we) 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 desen'bed above, by virtue of a warranty deed recorded in Register of Deeds Office. , ~,P~-~~- ®<~~~-/~ _ i i SIGNATURE OF APPLICANT °DATE «««*«« Any information that is mis-represented may result in the sanitary permit being revoked by the Zo «««« «« Include with this application: a stamped wacraaty deed from the Register of Deeds office a copy of the certified survey map if reference is made is the warranty deed ~- ~~.1732PA~E Q4 Document Number STATE BAR OF WISCONSIN FORM 2 - 1999 WARRANTY DEED This Deed, made between Atnos M. Schultz, Grantor, and Richard O. Stout and Janet P. Stout, husband and wife Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix Cotmty, State of Wisconsin (if more space is needed, please attach addendum): ~,rNi X58248 I;RTHLEEN H. WAL5H fiEGISTEk OF DEEDS ST. CkOIX CO., WI kECEIVED FOR RECORD 10-04-2001 8:30 AM MARRANTY DEED EXEMPT N CERT COPY FEE: COPY FEE: TkANSFER FEE: 1905.00 RECORDING FEE: 11.00 PAGES: 1 ~~.-~ ~ - o~~ - Io9g- o~ -wo - 30. ~9. ~~. ~1 Rewrding Area Namr and Return Addr4ss SE'/.ofNW'/,;N%,ofSW%. and SW %.ofNW'/.ExceptLotlaf l/ t61 Certified Survey Map in Vot. 7, Page ]917, Doc. No. 43227], all in Section g~1 ~/y 30, Township 29 North, Range 17 West, St. Croix County, Wisconsin. ~ ~~~ ! 018-10(7=10,018-1067.30,018-1067-40,018-1067-50 Parcel Identification Number (PIN) This is not homestead properly. OE) (is not) Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated this ~ day of October 2001 . AUTHENTICATION Signature(s) Amos M. Schuhz, authenticated this day of October ,2001 L!^ ~ Kristina Oland Amos .Schultz ~-- s ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. County ) Personally came before me this day of the above named TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by ~ 706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Notary Public, State of Wisconsin Hodson, W 15401b My Commission is permanent. ([f not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) •) Names of persons signing in any capacity must be typed or printed below their signature. hrortnation aiaraubnab camparcy. Fina a Lec. WI STATE BAR OF W ISCONSIN 800~~t WARRANTY DEED FORMNo.2-1999 ~IL__ i j i i ~'~ ~~ i ~.~ ~~~ _~- ,~~_~ - _ _ f ~H.w.~. = 101 a.oo _ ~_ _ _ _ _ 314.69' a 319.62' a a L-10 - ~L. O ba4~~// ~. ° ~ j y G~'~`~je / / ;~ m ~ V~ ,a, , ~ A ~ / J O_ _ ~ / ~~ ~ q Q / L-13 cz oNi (Il . r ~ o - ~ 'Oj 6 V V a.00 ACRES 217,800 SQ FT m i ~ ~ W A u m u _--- ~~ ~~ ~~ ~i ~~~/ ~~- / \ ~. M~ ~ 4,Z9 ~ C3 -f3°1 47.72' 1 ~'~ 1 ~ C2 ~ ~ •MI 29 o- 1 C °14 g4 ; ~.q0 , . 30.72' / ~ ~ 1 889°44', 6wv , 4a0.: 36,q~, I ~ ~'~ 7 a.00 ACRES 217,800 SQ FT V ° V m m J S -~ 1 319.62' \ \ ~\ •~ .\ W N89°44'S6'E 891.18'-; ROAD -- - -- W 889°44'66"W 891.18'-- 184.34' 2~3.a4'~ .. - _..-. I -.. ..-..-.- ..-.. 8 ~ ~~ ~~ ~~ r s ~, C' '~ a 0 t c O m ao cC 11. a> ~' 0 Ver son ~. 4 ~ - - - ~>: 10pbA1 - az oe Cau rmm man Nel $on ~`"" $ neth Ro n a 80 • ~ ~~;,, ~ F Inc 140 ~ McNel ~a its Ka rlne ev ( r ~~ F ck b & Tho ~n 100 e ry ~ Rf ~ °`~ d3- - ~ - ~ -~ G n & K r __._ Ott 266.79 is 1 222.48 r Doroth Sather 40 t85 80 .~ v z B .80.65 S to s ~ ~ ~ aul& 1~ ~ E 74.49 rmsa i" E d E I;kmald ~ >' A7.I5 ~ 3[)8,.62 7~n 12 39 ~~ ns 75 c ,u ~Fem 5=_ _i do une bra ~ _ a 1 . p~7 107.75 . K~~~ ~.e V • ~ ~ ~~(~r$ ~~~ tea ' s 4~`1 Kusi ~ ~~ ~ Doreld k Nancq Patricia 40 luk & Parma e 155 ~ ~~ 155 131 I- Ia ki FfbO"' e Sylla M lby n . w [s ~ ~ sxa~ y„ cent R °8'ei er M ~ lissz ane Lorrfa '~ ^ ~ M ~g 117 87 Beti lard wmi~ ` v~.n_ zc o~mn & Jlme Rivard I w s ~ lss.7e a ~r®m«r tya . ~ ~ I R iS Medelfin 8D dt; C ~dr01 crai r Farms I '' . ~ ' 362 ~ ~ 236 r y ~ E °^ tti h d 4 K H O~ F eritlk } a Rolle I 85 nc 155.5 ~ ~ 7g a o _ ; i ~ _~ ?~ ~ 3 c ar atluyn tidle o i arms IK 1 ¢0 7 < ~, Inc t ; 12 ` -..~R0~4j,,6t U '~ y _L~'~` G ~. 155.43 we...e &hWq s cwau~a d 1 ~ , nss ,M I~~~ ~m wain ~.t ~~a ""'"`° $ u 3 ~$ 5~ wY6 j 8812 [ .indq st ~ r 72. 6 ~~ 's .ion °n W O ' ~ j Fm°retSk l° < D'~M & iAm1 s $a ~ ~ ~ ' Rid~ard KathsY^ f^ ~ i ° •~ ~pJ ore.oxx'r~e ~ 199.3 ~ : L i ~ 1 ~O - ~ :? 115 m r+..x.ss ndk ' .° « 3 120 . IIU w ew s ~ T i ° ~ 3 . a ~ gg ~ ~ w u ner n a • "' ro ti al > 14z ~ C ~ tst s6 "'„~~ ~ Paul & ~ 1": 7s a> , n r ~ ~j 3 m" - Ken-Rich Brian Joan ~ a - ~°~ RF ' $ w . _ lam Dolores - ., s ~;x 1 5 ~ ~ Farms Inc R SO ' s ,y' c ~* ' Ph & " m rmxw ~ orm,~6 413[ sdwat - 136.SS ~ i ~ 3 ^ lohcewr m ~ L o fir' Taut& Ilotores 147 rrs x ~~ { 1 143.93 . ** ~ 1 44 65.07 ~• ^ 1442a T 5t T x wIr °' ~ " 5~ x a g~ ~ s: ~ s r 1 :r+s 1 Gilli] ; Farms ', c~ I`;` ~ old • - ; ~ ^ I ttc 121.42 a`i'r` ~ 40 117 Aru~bei k ~ j we~BWwe,s sye r Richard W ~ ~ ~ > E Dann Inc f ,,,~ rvy ra x ~ vl *ae y vicen ;f 5os ~ A ~R„ ~~ ami Marvi„ ~ &FsOrr Trost ~ { a w° v~ kRnnn RR i ;~ a ~ 194.6 I ~ • a e Fvn 4 5+65 r Pr 114, um , 149.21 Tmyk s~ ~'~ Wflli ~ m r ' 1~ aWIb66r, 1 T ~ ~ 4 c A N D Bu Hol ~ B ~ n )i Cen-Ri ct't »n an 3 .r,.a. a ~-° .u.-. ~' ~ '< ~, .4GR :~....J roes dr ores ar ~~ * H Farm MN ¢ y Erling q r MurraY d Witliam $r~aau t ~1° ~ Fazm Inc _ ~~ Haw ' ~ ii ~ • u t OO etl ~ ~ 79 .79 Fae mer 8a AO ~ a n } m 40 ~ sc i 4o yr. J 1 e ~, i ce _ v a om.c s ~ ~ v s I I S rke Y .~^ - 7 . ~Gltlh f LC - ~ Cartl n~er c°°P ~s rne Rvnn- ~^~' [.woy oe~ma ~rM ~ + r u we rs JS nbe Fari n '.. F~amt 136 16 .___._ Fm HL ean ._._ 766 ~ Gk r Jolin v ° Dom- tof c n i .. . 121.7/ 116.95 Hawkins Ikib~o . ( 100 R 123.4 { ~ B0 ~. loBnn 80 ~ 97.7 ~ Inc ~ 154.53 F Rck6N ttn z: Ro en h J k d ' BW na "~"`y 1 1' ]18 79 R t ~ ~ & je ~ fifer ys ~ E~ ~\ . ~ T 2~ yyaYne FC AdrM ~amily wis & J ne 155= ~ x & Neue ~ fiver 6- & rinse rr usc ~ o, ~ - , InBdc F"O1 a € u,.Y,.• IS 59 Ken-Rich 1 10021 aas , Wa ne dr ev.:r ~ a<i`"Ra'r tia~kuJ. n d Farkas lnc F114.86 W s r De-oreis I.oock w m '~ stt 35]5 r~ 160.08 ~ 5 ~u 2 ~ ~ 40 63 tsoo ' Is00 I~oO See Page 16 1s0o 2000 zl0o~ ~ ~ _ & Apple Farm SHALOM VALLEY Highway 63 & !-sa Baldwin, Wisconsin TIRE SERVICE -- (715) 684-2856 = APPLES FROM YOUR HOMETOWN ORCHARD 614 Highway 63 • Baldwin,Wl 54002 ® FULL SERVICE LALVN & GARClEN CENTER • G/FT' SHOP & MUSEUM WE ARE OPEN EVERY DAY FROM 8 A.M. TO 8 P.M. FARM •AUTO •TRUCKTIRES HAMMUND ~", T.29N. - R.17VN E S ~,~~G,~.,B„.~,,~. • «~,a, tom, Sep Page 48