HomeMy WebLinkAbout038-1239-39-000 comy
�1 & Safety and Buildings Division /
K 201 W.Wasttington Ave.,P.O.Box 7162 Sari P to be fined in by Co.)
.P Madison,Wl 53707-7162
Tron
ermit Application i c ?
S PP M� Ro, 0/¢ ,rf
In accordance with SPS 3832 is. Code,submission of this form to the appropriate governmental taut N/ �'
is required prim to obtaining a permit Note:Application forms for state-owned POWTS are submitted to Project Address mail ng address)
the Depattmaot of Safety and Pro essional Servies. Personal information you provide may be used for secondary 0
purposes in accordance with the Privacy Law,s.15.04(1)Cm),Stets. 915-
L Application Information-Please Print All Information
Property Owner's Name Parcel# �
Property Owner's Mailing Address Property Location
�• /3oa�
-2-3040 Q G F�^�4,1 GovL Lot
City,State Zip Code Phone Number %,,/�J(,�'/. Sxtion 7
TN; R�E�W /
,ol EL Type of Building(check all that apply) Lot# L/
2 Fanuly Dwelling—Number of Bedrooms Subdivision Name
Block# S�,U�t.(_,rJ 4,4 64
❑Public/Commercial-Describe Use
City of
❑State Owned-Describe Use CSM Number ❑Village of
own of
III.Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. ew System ❑Replacement System ❑TreatmentiHolding Tank Replacement Only ❑Other Modification to Existing System(explain)
IB• ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Pemit Transfer to New List Previous Permit Number and Date issued
Before Expiration Owner
W.Tjm of POWTS;S stem/Com onent/Device: Check all that apply)
Pressurized In-Ground ❑Pressurized In-Ground ❑At ❑ 2=fle il MooEd 2❑Holding Tank ❑Other Dispersal Component(explain) C t ere(exPtem)
V.Dispersal/Treatment Area Information: [� �-
Design Flow(gpd) Design Soil Application Rate(gpdst) Dispersal Area Required(sf) Dispersal Area Proposed(st)
VL Tank Info Capacity in Total #of Manufacturer
Gallons Gallons units o
New Tanks Existing Tanks :..��L e u
Septic or Bolding Talc 3l
Dosing Qtamber
VII.Responsibility Statement-I,the undersigned,ass risibility for installation of the POWTS shown on the attached plans.
Plumber's ame(Print} Plumber' MP&IPRS Number Business Phone Ntnnber f
/j-G ✓ J
Plumber's Address(Street,City,State,
oun /De artment Use Only
Approved ❑Disapproved Permit Fee OV Date sued Is g Agent
❑Owner Given Reason for Denial S Y75',
✓
DL qyo�d ? pa easons for Disapproval �(� LU oq
1.Septic tank,effluent filter and da�' 6(O
dispersal cell must be serviced/-maintained _�/
as per management plan provided by plumber, l,� � � �( w pa"ZA4.2.All setback requirements must be maintained f.�
dS,Pet e for the system bmit m theCoaoty o o■paper rot less than 8 iR:11 inches in sift
if
jvM SBD-6398(R 11111)
��� Z � 3 �.
Community Development Department Page 2
No vegetation removal is approved outside the construction area shown in the approved plans or
within 3 5' of the OHWM.
Installation of approved erosion and sediment control products(e.g. silt fences, straw waddles,
and/or sediment logs)between areas of exposed soil on the construction site and the 35' vegetative
buffer or neighboring roe to control contaminated runoff.
Submit a stormwater management design for review and approval by the CDD staff for review and
approval. It must include specific details and location(s)of infiltration devices that will provide
adequate capacity to handle stormwater runoff from impervious surfaces on this site.
If required,the applicant shall record an affidavit referencing the approved stormwater
management plan with the Register of Deeds prior to commencing construction see enclosure).
The applicant shall obtain all applicable permits and approvals required for construction of the
driveway and house. The contractor will need to provide the erosion control plan to the town's
building inspector for compliance with Uniform Dwelling Code requirements.
The sanitary permit issued for installation of the POWTS will require compliance with all
conditions of the land use permit and contractors must be made aware of the conditions regarding
erosion and sediment control
The applicant shall maintain all erosion and sediment control measures until permanent, self-
sustaining vegetation is successfully established on all disturbed areas of the site.
No phosphorous fertilizers shall be used on the disturbed areas of the site,unless a soil test
confirms that phosphorous is needed for establishing permanent vegetative cover.
Within 30 days of completing the project,the applicant shall submit to the CDD photos of the
stormwater infiltration devices and stabilization of disturbed areas for documentation of
compliance with permit conditions. Photos may be sent electronically via e-mail attachment.
This approval does not allow for any additional construction,structures or structural changes,grading,
filling,or clearing of vegetation beyond the limits of this request. Your information will remain on file in
the St.Croix County Community Development Department. It is your responsibility to ensure compliance
with her local,state,or federal rules or regulations,including obtaining a building permit from the
T n.
ommunity Development pt.Authorized Staff Signature
Enc: Land Use Permit LU88262
Stormwater Management Affidavit form
Cc: Building Inspector,Town of Star Prairie
Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, Wl 54016 Fax 715.386.4686
www.sccwi.us/cdd www.focebook.com/stcroixcountyw cdd Pco.saint-Croix.wi.us
Land Use
ST. CR O I K N i 1 , Planning&Land Information
Resource Management
Community Development Department
May 20,2014 File#: LU88262
Robert Kish
2360 Legion Lane N.
Lake Elmo,MN 55042
Land Use Permit for Parcel#17.31.18.1300.Town of Star Prairie
Site Address: 915 218th Ave..Lot 39 of Squaw Lake Estates
Community Development Department(CDD) staff have reviewed your application for filling and grading an area
>10,000 sq. ft.within 100 feet of the Ordinary High Water Mark(OHWM)of an unnamed navigable wetland to
construct a single-family dwelling with attached garage and a private on-site wastewater treatment system
(POWTS),which can be permitted per Section 17.30.H.Ld.
Staff determined that the proposed project meets the spirit and intent of the St. Croix County Shoreland Overlay
District ordinance based on the following findings:
Code Proposed Project Standards&Requirements
References
17.301.4 & The proposed principal structure will meet height and structural setbacks per submitted plans.
GI &G.2 The navigable wetland setback is 75' from the OHWM.
17.30.1.1 & Filling and grading>10,000 sq. ft. on slopes>12%within 1000 feet of an OHWM is allowed
2.b. with a land use permit. Land disturbance estimates: 13,000 sq. ft. for the principal structure,
2000 sq.ft. for installation of the POWTS and 2350 sq.ft. for the driveway.
17.30.7.2&3 Impervious surface calculation area within 300' of the OHWM is 96,703 sq.ft.and the
proposed impervious surfaces equal 7.8%of the lot. Up to 10% is allowed as part of this permit.
17.30.K.1. Stormwater management must be incorporated in the plan to provide infiltration for the first 1.5"
of any rainfall event. The house is 5200 sq. ft. and will require 650 cu. ft. of capacity for roof
runoff.
17.30.K.2. The applicant and other contractors will implement the approved erosion and sediment control
plan during construction.Appropriate erosion control and sediment control measures will be
installed between areas of disturbed soil and the OHWM prior to begin ning excavation. Erosion
control measures will be maintained until self-sustaining permanent vegetation is established on
all disturbed areas.
17.30.L.1 The applicant will be required to maintain vegetative cover within a 35' shoreline buffer zone
from the OHWM.
17.30.M Mitigation—N/A
17.30.0. Nonconforming uses/structures—N/A
Based on these findings, approval of the land use permit is subject to the following conditions:
Compliance Conditions for land use permit approval
Date
A pre-construction on-site meeting must be scheduled with the CDD staff to verify placement of
erosion and sediment control measures and recording of the stormwater affidavit, if required.
Photos will be taken to document re-construction site conditions for enforcement purposes.
The applicant or their agent will be responsible for implementation of storm water management
and erosion/sediment control plans.
Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, Wl 54016 Fax 715.386.4686
www.sccwi.us/cdd www.focebook.com/Stcroix coun tywi cdd(@co.saint-croix.wi.us
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Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 5/11/14
Owner: Robert Kish
Location: NW1/4 NW1/4 S17 T31 N,R18W Lot 39 Squaw Lake Estates Star Prairie
System type: In-ground absorbtion system(conventional)
Manuals Used: In-ground absorbtion system (version 2.0)
Pressure Distribution Manual (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4-6. Maintanance and Contingency Plan
7. Filter Specifications Sheet
8. Dose Tank Cross Section
9. Pump Curve
10.-12. Soil Test
Signature
License numb r 226900
PLOT PLAN
PROJECT Robert Kish ADDRESS 2360 Leaion Ln N Lake Elmo Mn 55042
NW 1/4 NW 1/4S 17 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST.CROIX
MPRS Shaun Bird 226900 DATE 5/12/14 BEDROOM 4
CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT )00( HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 LIFT TANK SIZE765 DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE ABSORPTION AREA 1212 # of chambers 60
BENCHMARK V.R.P. Top Of 2" pvc pipe ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
SYSTEM ELEVATION 93.5/92.5/91.5 5.5' below qrade
All piping shall be SDR 30/34,within 10'
of tank,piping shall be Schedule 40.
Pro 4 Bedroom House Scale is 1" = 40'
unless otherwise
noted
15'
96'
100'
4 '
Huffcutt Combo Tank 125-0175 Z
B.M.* B
-4
3-3' X 82' cells with>3' spacing
115'
120' 18% Slope
Vent
0�
B-6 • >6" Quick4 Standard
of Cover teaching Chamber
with 20.0 ft2 of Area
35 5.6ft^2/pair of end caps
��-e[ 4' Long 12
Vents at the end 1201' g5g3 34" Grade at System Elevation
the cells / p B-3
98
9'
B.M
185' Property Line
5 8' 10'
Cross Section of Quick 4 Standard Leaching Chamber
Typical cross section for 2 of 3 cells
Quick 4 Standard
Leaching Chamber with
20.0 ft2 of Area per
Chamber 5.6ft^2 pair of end plates To be >1' above grade
/ Finish grade elevation
Typical Installation 99'
Vent Grade Vent
4, 4„ 4,
X30/34 Septic Tank
4' Long 111 51 4' Long 199
Grade at System Elevation
34" Grade at System Elevation 34"
Spacing 5'
3-3' X 82' Cells
Observation tubeNent
Same on other end To be located on end of Cells
A
B
System elevations: C
A_93.5'
B 92.5' 20 chambers per cell
C-91.5'
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner ^ ,, / Tank Manufacturer: ❑ NA
Permit# XSeptic ❑ Dose ❑ Holding Volume: /2S'-b (gal)
DESIGN PARAMETERS Tank Manufacturer: AAW&41tt ❑ NA
If
Number of Bedrooms: ❑ NA ❑ Septic O-Dose '75-D Holding Volume: "� (gal)
Number of Public Facility Units: NA Vertical Distance Tank Bottom(s)to Service
Estimated(average)Flow: yLT� (gal/day) Horizontal Distance Tank(s)to Service Pad:
Specific servicing mechanics must be provided if vertical is>15 feet or
Design (peak)Flow=(estimated x 1.5): o6o C (gal/day) if horizontal is>150 feet. Specific instructions to be provided on back.
In Situ Soil Application Rate: ,. (gal/day/ftZ) Effluent Filter Manufacturer: fS FA2 ❑ NA
Standard(Domestic)Influent/Effluent Monthly average.. Effluent Filter Model:
Fats,Oil&Grease (FOG) 530 mg/_ Pump Manufacturer: @
Biochemical Oxygen Demand (BODs) 5220 mg/L ❑ NA ❑ NA
Total Suspended Solids(TSS) 5150 mg/L Pump Model: .
High Strength Influent/Effluent Monthly average Pretreatment Unit
(FOG) >30 mg/L Manufacturer:
(BODs) >220 mg/L XNANA
(TSS) >150 mg/L ❑Mechanical Aeration ❑ Peat Filter
Pretreated Effluent Monthly verse ❑Disinfection ❑Wetland
Y 9 ❑Sand/Gravel Filter ❑Other:
(BODs) s30 mg/L Soil Absorption System
(TSS) 530 mg/L NA ,,r
Fecal Coliform(geometric mean) 510'" ,R In-Ground(gravity) ❑In-Ground(pressure) ❑ NA
Maximum Effluent Particle Size X in dia. 11 NA ❑At-Grade ❑Mound
❑Drip-Line ❑Other:
Other: A Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Pump out contents of tank(s) ❑When combined sludge and scum equals one-third('h)of tank volume
❑When the high water alarm is activated
Inspect condition of tank(s) At least once every: ❑month(s) (Maximum 3 years) ❑ NA
Inspect dispersal cell ❑month(s)s) At least once every: -�-year(s) (Maximum 3 years) ❑ NA
month(s)
Clean effluent filter At least once every: year(s) [I NA
Inspect pump,pump controls&alarm At least once every: O.y ar(c)s ) El
Flush laterals and pressure test 'At least once every:_ ❑month(s) NA
❑ year(s)
Other: At least once every: ❑ month(s) NA
❑year(s)
Other:
NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper).
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 a check for any back up or ponding of effluent on the ground surface. The soil
absorption system 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 treatment tank equals one-third (%)or more of the tank volume,the entire
contents of the tank shall be removed by a Septage Servicing Operator (pumper)and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code:
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units,
and any servicing at intervals of<_12 months,shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 30 days of completion of any service event.
GMW-005(02/05)
Page of
START UP AND OPERATION
w construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other
For ne c , p
chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are
detected have the contents of the tank(s)removed by a Septage Servicing Operator(pumper)prior to use.
Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these
conditions is not recommended, as the excess wastewater will be:discharged to the soil absorption system in one large dose causing an
overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the
contents of the pump tank removed by a Septage Servicing Operator(pumper)prior to restoring power to-the pump or contact a Plumber
or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
Do not drive or park vehicles over tanks or the soil absorption system. 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 treatment
tanks and soil absorption system: acids, antibiotics, baby wipes,-cigarette"butts, condoms, cotton swabs, degreasers, dental floss,
diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat
scraps,medications,oils,painting products, pesticides,sanitary napkins,solvents,tampons, and water softener brine discharge.
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 s. Comm 83.33,Wisconsin Administrative Code`' ;
• All piping to tanks,pits and other soil absorption systems 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(pumper).
• 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 the time of their permit issuance.
❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be
rehabilitated and barring advances in POWTS technology,a holding tank may be installed as a last resort.
❑ 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 maybe 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
TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK
1� SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY
RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE.
ADDITIONAL INSTRUCTIONS:
POWTS INSTALLER POWTS MAINTAINER.
Namgjr` �t Name f
Phone Phone r
SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY
* i
Name Name C` '
Phone �l J � C, Phone 2 46" D
This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections
Comm 83.22(2)(b)(1)(d)&(f)and 83.54(1),(2)&(3),Wisconsin Administrative Code.
�VL O Sl
ILTER
CARTRIDGE INSTRUCTIONS
2OQS TM
Installation
STEP ! Dry fit the filter case onto the end of the outlet pipe to ensure it is
centered under the access opening. If not, then either insert more pipe into the
tank through the outlet or solvent weld (glue) additional pipe onto the outlet
pipe.
STEP 2 While the case is still dry fitted on the outlet pipe, measure the length
of 3/4-inch pipe needed to brace the filter to the tank end wall if utilizing the "
optional supplemental side support. If side support method is not utilized,
proceed to step four.
STEP 3 For installations utilizing the optional supplemental side support:
solvent weld the 3/4-inch pipe onto the filter case. If side support method is not
utilized, proceed to step four.
STEP 4 Solvent weld the filter case onto the outlet pipe. Insert the filter
cartridge into the case, pressing down until the filter locks into the bottom of
the case. = !
STEP 5 If a VRS switch is utilized: insert into the filter and lock by turning
clockwise 90 0. s,
Maintenance
1. The effluent filter should be cleaned every time the septic tank is
serviced.
2. Open the outlet access opening to inspect the tank and filter.
k4
3. Pump the septic tank completely, making sure to remove the sludge g s
layer on the bottom of the tank and not just the scum and effluent.
4. Once the effluent level has been lowered below the invert of the
outlet pipe, firmly pull up on the filter handle to dislodge the
cartridge from the case. '=
5. Slide the cartridge up and out of the case for cleaning.
6. If a VRS switch connected to an alarm is present, the switch
should be removed by turning counterclockwise 900 and cleaned
with water only.
7. While holding the cartridge on its side (large flat surface facing
down) over the access opening, rinse off the cartridge with water -'
only, making sure all septage material is rinsed back into the tank. '
8. If VRS switch is utilized, replace by inserting into filter and f` x
turning clockwise 900.
9. Insert the filter cartridge back into the case, pressing down until
the filter locks into the bottom of the case.
10.Replace and secure the access opening on the tank.
BEAR ONSITET"FILTER CARTRIDGE-FIVE-YEAR LIMITED WARRANTY
Bear Onsite filter cartridges are warranted to be free of defects in material and workmanship for five(5)years from the date of
consumer purchase.
BEAR ONSITE-Filter Case-Lifetime Limited Warranty
Bear Onsite warrants the filter case will be free of defects in material and workmanship during normal use for the period of time
the original purchaser owns the product.
If a defect is found in normal use,Bear Onsite will,at its election,repair,provide a replacement part or product,or make
appropriate adjustment.Damage to a product caused by accident,misuse,or abuse is not covered by this warranty.Improper
care or malfunctions resulting from units not installed,operated,or maintained in accordance with instructions provided will
void the warranty.Proof of purchase(original sales receipt)must be provided to Bear Onsite with all warranty claims.Bear
Onsite is not responsible for labor charges,removal charges,installation,or other incidental or consequential costs.
In no event shall the liability of Bear Onsite exceed
the purchase price of the product
ffllc�ff" X712
0�cqln awn S.116
�k �
ST.CROIX COUN '!
SEPTIC TANK MAINTENANCE E'�GREEMENT
AND
OWNERSHIP CERTIFICATION FORM
o—im-uyer
Mailing Address 23 � D 2 c z A./ /(,./ a G l.wr� yI'Y
Property Address 91 / 6, O/ y°/-A A-Ve- vn Z
(Verification required from Planning&Zoning Department for new co ti )
City/State SD mC S �r (�� Parcel Identification Number
LEGAL DESCRIPTION
Property LocationAU VA, V., Sec. ,T N RLZ W,Town of
Subdivision Lot# /�.
Certified Survey Map# ,Volume ,Page#
Warranty Deed# 7 0 O 4 ( , Vo lume ,Page#
Spec house- no Lot lines identifiable Y06F
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result m 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 wasps disposal system Owner maintenance
responsibilities are specified in§Comm 83.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance.
The property owner agrees to submit to St.Croix County Planning&Zonutg 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
wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is
less than 1/3 full of sludge.
Lwe,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 Depart:raent of Natural Resources,State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St.Croix County Planning&
Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s)of the
property described above,by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedroo
SiGNA OF APPLICANTS) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. ***
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV.08/05)
i
i
Septic)-Dose Tank Cross Section And Pump Performance Specifications
Tank Manufacturer Pump Manufacturer
Tank Model Number ; -D Pump Model'Number S3
Total Tack Capacity s- Alarm Manufacturer c
Max. Bury Depth Alarm Model Number D u-
Switch'Type
Filter Manufacturer /Z _ Total Dynamic Head(TDH)- Feet
Filter Model Number 1 Elevation Head v
Distal Pr"Oure
Network Loss A
Minimum Pump ferfbrmame Required_ Force Main Loss
�L> -GPM. I @ Ijl. Ft TDH Total
Cutlet Manhole Min.411 Above Grade With
Locking Dv4icc, Inlet Manhole Manhole t h Lock' n Min.4"Above Grade
With
<6"Below GrWe Sealed Watertight Securely Mounted 'Wng ®vice
_____,.,`� Weatherproof
Junction Sox _--
4. Y� am boo �'- Finished Grade � •- •� Yrr °• �• -• .• .••
t
—+►
Vent Min. 12" Disconnect
Above Grade Means
With Vent Cap
:••• ,.,.'...+,.Is:::>r•r•i Y•i: a•Ys'i• :>i.>f::•+,r,r,+,+,Y,Y,Y,�ryr,Yir,Y,Y,r, sr
,
Outlet Filter
h2le Raffle X*-
Inlet
.. Y •;:
X: .'.; A. 1/4":; switch and Reserve Capacity
Weep
Tank
1.>. ,Y,Y
Tank Volume= GOT <Y1; �:�
': H Hole
1;<.< Dimension: Zucltes Volume Gal.
NO
(reserve}
4 E4eva'tiion
(alarm)
H: 2 C
.:>
•':
�' {doss) C 01 �' ;. . Ft Bottom
,.,.
(dead) D J :� D Elevation
Total j Ft
'•1•a
V<:f/rIw'�Y<<<,<:+fl,IY�Y<Ya1'Y<:i•r<1 r<r<Y•:Y�Y/Yr:YI:<Y//SS:::Y<ri::.•:Y<i<:Y<:::1 Y•Y<Y<Y.I<1 t+<Y 1<•<:.<Yt:r<r<YS:::Yt:r<:Y<':i r<•<I<:+•::Y"Y:1•
I I I a a t Y.•r•a V t Y a t i..i V/V i r i i t i i r i s Y•.i a l Y Y t f i i 1 1 a t 1 i Y/Y I I Y r s l l+/t 1 t 1 i r V i t i f i f i i..f i i r I f 1 1 r i f i l t
GENERAL MTAL, LATiom The septic/dose teak is bedded and,back filled in accordance with the
manufacturer's product,approval specifications. Maximum depth of bui"y as.specified,by thO manufacturer may not
be exceeded without pi;iox dppraval. 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 moot is sleevedvitlt 4"Sch.40 PVC to bridge the tank
excavation and the.sleaove.is sealed*Owfight. Electrical w-,vice complies with NEC'300 and Comm 16.23.
02105 U Page of =-
N TOTAL DYNAMIC HEAD/CAPACITY
w w HEAD CAPACITY CURVE PER MINUTE
MODELS 53/55/57/59 EFFLUENT AND DEWATERING
25
Model 53/55/57/59
6 20 Ft. Meters Gal . Ltrs
�� 5 1 1.5 43 63
0 15 ~ 0 3.1 34 '29
M
0 4
15 4.6 19 72
10 Shut–off Head 19.25 ft. (5.9m)
0
5 3 15/16 --6 5/32
j
—1 4 5/8 ill
? ?/2 —11 /2 NPT
0
U.S. GALLONS 10 20 30 40 50
LITERS 0 gp 160
FLOW PER MINUTE 009897 1 41
yy--�� 4 1/16
C v f. S F i
FOR SPECIAL APPLICATIONS-
_, -„F
W Variable level float switches available.
Variable level long cycle systems available.
Available with special cord lengths of 15', 25', 35'and 50'.
l
Alarm systems available.
10 11/116
Duplex systems available. +
l 3 3/32
SKW
Single Seel Control Selection Lists s SLEC T iC�i� aiiOE
Model vow Phase Mode I Amps simplex Duplex CSA UL 1. Integral float operated mechanical switch,no external control required.
M53155&M57/59 115 1 Auto 9.7 1 -- y y 2. Single piggyback-variable level float switch or double piggyback variable level
N53r55&N57/59 115- 1 Non 9.7 2 3 or 4&S Y -2L float switch.Refer to FMO477.
`BN53 115 1 Auto 9.7 y y 3. Mechanical alternator"M-Pak”10-0072 or 10.0075.
rE53/55 BN57 115 1 Auto 9.7 — N Y BE53r57 230 1 Auto 48 — y y 4. See FMO712 for correct model of Electrical Aftemator.
D53/55&D57159 230 1 Auto 4.8 1 —• Y 5. Variable level control switch 10.0225 used as a control activator,with Electrical
&E57159 230 1 Non 4.8 2 3 or 4&5 Y Y Alternator(3)or(4)float system.
'Single piggyback switch included.
�CA
For information on additional Zoeller productsrefertocatalogonPiggybackvariable LevelFloatSwitches,FM0477 icr Of o- vls,^rte icr dev,ces and wiring should De u,e by a qu
Electrical Altemator,FM0486;Mechanical AHemator,FM0495;Sump/Sewage Basins,FM0487;and Single Phase n. d 40 eie^Wr A and safety codes sr.oLld be aed c't e r.g the most
Simplex Pump ControUAlamt Systems,FM0732. n a :tc-r c Cote ECj and&t e Occcpatcnal Safe', nd y a n Act
RESERVE POWERED DE'SVi
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
MAIL T0:P.O.BOX 1x217
Louisville,KY 40256- Manufacturers of..
SHIP TO:3649 Cane Run Road �!
O Louisville,KY 40211-1961 Q�iaurr Put.P6,/iNCE 1939"
httP://www.zoellercom PUMP !O. ® ( ) FAX(502)773624 PUMP
0 Copyright 2002 Zoeller Co.All rights reserved.
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PROJECT: 4154 123rd STREET N.P.C.A. CERTIFIED PLANT
�•� HUFFCUTT CHIPPEWA FALLS, WI 54729
MP OR GALLON MEMBER OF:
PUMP OR SEPTIC TANK (,► n`►R E T E. n`► (715) 723-7446 ■ (800) 924-1516 I E=g FAX (715) 723-7111 )K www.huffcutt.com ,aj NATIONAL tt WISCONSIN PRECAST CONCRETE ASSOCIATIONS
State Bar of Wisconsin Form 2-2003 8 0 0 3 6 3 5
WARRANTY DEED Tx:4002912
Document Number Document Name 920041
BETH PABST
REGISTER OF DEEDS
THIS DEED,made between M&G,Inc.,a Wisconsin Corporation ST. CROIX CO., WI
RECEIVED FOR RECORD
("Grantor,"whether one or more), 08/03/2010 1:35 PM
EXEMPT #• N/A
and Robert A.Kish
("Grantee,"whether one or more). REC FEE: 30.00
TRANS FEE: 63.00
Grantor,for a valuable consideration,conveys and warrants to Grantee the following Recording Area PAGES: 1
described real estate, together with the rents, profits, fixtures and other appurtenant
interests, in St. Croix County, State of Wisconsin ("Property") (if more space is Name and Return Address
needed,please attach addendum): KRISTINA OGLAND
Lot 39,Squaw Lake Estates,St.Croix County, Wisconsin ESTRE E N & OGLAND
304 LOCUSt
Hudson, WI 54016
038-1239-39-000
Parcel Identification Number(PIN)
This is not homestead property.
(is)(is not)
Exceptions to warranties:
Easements,restrictions and rights-of-way of record,if any.
Dated Z`�J 7.L�U M&G,I
(SEAL)By: (SEAL)
* *Mic ael J.Ge ain,president.
(SEAL) (SEAL)
* *
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) M&G, Inc., a Wisconsin Corporation by
Michael J.Germain resident STATE OF )
authenticated on 2t U )ss.
' COUNTY )
*Kristine Qgland Personally came before me on
TITLE:MEMBER STATE EVAR OF WISCONSIN the above-named
(If not, to me known to be the person(s) who executed the foregoing
authorized by Wis.Stat. §706.06) instrument and acknowledged the same.
THIS INSTRUMENT DRAFTED BY:
Kristina Op-land,Estreen&Ogland Notary Public,State of
304 Locust Street,Hudson,WI 54016 My Commission(is permanent)(expires: )
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED ®2003 STATE BAR OF WISCONSIN FORM NO.2-2003
*Type name below signatures. INFO-PROTM Legal Forts 800-655-2021 www.infoproforms.com
1 of 1
J •
1295
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 4
Division of Safety and Buildings in accordance with Comm 85,Wis.Adm.Code Tom Schmitt
Attach complete site plan on paper not less than 8'%x 11 inches in size. Plan must County St.Croix
include,but not limited to:vertical and horizontal reference point(BM),direction and
percent slope,scale or dimemsiom,north arrow,and location and distance to nearest road. Parcel I.D. 2 k-
Please Please print all information. - —on. Revi By / Date
Personal information you provide ,s.15.04(1)(m)). --
Property Owner Property Location
Grand Properties, LP E Govt.Lot NW 1/4 NW 19 S 17 T 31 NR 18 W
Property Owner's Mailing Address j 4 Lot# Block# Subd.Name or CSM#
712 Rivard Streeet,Suite 300 39 Squaw Lake Estates
City Sta e Zipode P�b►ie (tttber J City J Village Town Nearest Road
Somerset - Star Prairie I 218Th Ave.
ig New Construction lase: JA Residential/Number of bedrooms a derived design flow rate 450 GPD
J Replacement _ Public or commercial-Descri 1 JL— AJ ¢ 1Albe-
Parent material Pitted glacial drift Flood plain elevation,if�appplicable na u
General comments 3 -VaA4 a" /Xi P4— a
and recommendations: Area is suitable for a conventional system with 0.4 d/s ft rating. Possible system elevation for Area 1 is
(high trench)95.9'(mid)95.0'(low) 94.5'.Slope is 18%. More.�/aft k& mm 5 w,'(
1 Boring# J Boring let v;t e o Sa;l "F'k- (.
❑ "' Pit Ground Surface elev. 100.33 ft. h to limiting factor 94 in. Soil Application Rate
� 9 APP
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff
*Eff#1 I *Eff#2
1 0-8 10yr3/2 none I 2mgr mvfr as 2m,2f .6 .8
2 8-27 10yr4/3 none sl 2msbk mfr gw 2m,21' .6 1.0
3 27-72 7.5yr5l4. none gums Osg ml cw — .7 1.6
4 72-98 10yr5/6 none grm Osg ml --- .7 1.6
ar-
1
Boring# J Boring
16 Pit Ground Surface elev. 98.36 ft. Depth to limiting facto 39 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
*Eff#1 *Eff#2
1 0-8 10yr32 none sl 2fsbk mvfr as 2m,2f .6 1.0
2 8-20 10yr4/3 none sl 2msbk mfr gw 2f .6 1.0
3 20-39 7.5yr5/4 non sl 1 msbk mfi gw 4 7
4 39-65 10yr5/6 m 101 /3/6 sl 1 msbk mvfi gw -- .4 .7
5 65-92 10yr5/4 none grms Osg ml - --- .6 1.6
!r
*Effluent#1 =BOD?30<220 rng/L and TSS>30<150 rrg/L *Effluent#2=BOD a 30 mg/L and TSS<30 mglL
CST Name(Please Print) Signature: CST Number
Thomas J.Schmitt �' .�d�— 227429
Address Tom Schmitt Date Evaluation Conducted Telephone Number
1595 72nd St.,New Richmond,WI 54017 729/04 715-247-2941
Property Owner Grand Properties, LP Parcel ID# Page 2 of 4
3]
F Boring# Boring
�/'{Pit Ground Surface elev. 95.43 ft. Depth to limiting factor 104+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
*Eff#1 *Eff#2
1 0-7 1Oyr3/2 none SI 2mgr mvfr cs 2m,2f .6 .8
2 7-21 1Oyr4/4 none sl 2fsbk mfr gw 3m,3f .6 .8
3 21-50 1Oyr5/4 none grsl 2msbk mfr gw 2f .6 .8
4 50-104 7.5yr5/4 none grms Osg ml - - .7 1.6
1 7-
i
F4] Boring# J Boring
Pit Ground Surface elev. 96.78 ft. Depth to limiting factor 102+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
*Eff#1 *Eff#2
1 0-7 1 Oyr3/3 none Is 1 msbk mvfr cs 3m3f .7 1.6
2 7-21 1 Oyr4/4 none Is 1 msbk mvfr gw 3f .7 1.6
3 21-36 1Oyr5/3 none Is Imsbk mfr gw 1f .7 1.6
4 36-51 7.5yr4/4 none sl 1 msbk mfr gw ---- .4 .7
5 51-102 1Oyr5/4 none ms Osg ml -- - .7 1.6
F-s-I Boring# l Pit Boring
Ground Surface elev. 99.31 ft. Depth to limiting factor 102+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP
*Eff#1 *Eff#2
1 0-7 1Oy13/3 none sl 2mgr mvfr cs 2m,2f .6 1.0
2 7-14 1Oyr4/3 none sl 2msbk mvfr gw 2m,1f .6 1.0
3 14-31 1Oyr5/4 none sl 2msbk mvfr gw 1f .6 1.0
4 31-38 1Oyr5/3 none sl 2csbk mfr cw -- .6 1.0
5 38-5 7.5yr4/4 none sl 1 msbk mfi gw ---- .4 .7
6 56-102 10yr5/6 none grls 1 msbk mifr - -- 7 1.6
3V �
*Effluent#1=BOD s>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD5.30 mg/L and TSS<30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format,please contact the department at 608-266-3151 or TTY 608-264-8777.
I
Property Owner Grand Properties, LP Parcel ID# Page 3 of 4
6]F Boring# J Boring
Pit Ground Surface elev. 98.0 ft. Depth to limiting factor 100+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP
*Eff#1 *Eff#2
1 0-7 10yr3/2 none sl 2msbk mfr cs 3m,2f .6 1.0
2 7-29 10yr5/3 none grsl 1 msbk mvfr cs 2m,2f .7 1.6
3 2940 10yr5/6 none Is Osg ml cs 2f .7 1.6
4 40-105 10yr6/4 none grms Osg ml — ---- .7 1.6
F-1 Boring# Boring
I Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP
*Eff#1 *Eff#2
F-1 Boring# �� Boring
_f Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
*Eff#1 *Eff#2
I
*Effluent#1 =BOD y�30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD5 S_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.
4 - '
s
e
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i
N
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Page 3 of 3
�Con&xftd by: Conducted For. Ref No. 1a 9 S
-Scbmnitt Soil and Site Evaluations Name: Grand Properties,LP.
Thomas L Schmitt,CST 227429 Address: 712 Rivard St. Suitel00
1595 72nd St. City, State,zip: Somerset,WL 54025
New Richmond,W1. 54017
Phone: 715-247-2941 Subd.Name: Squaw Lake Estates
Lot No.:
Legal Urn:
NO NW I/4 S17 T31N R18W
Township of Star Prairie,St.Croix County
Bench Mark EL 100.00'Top of 2"pvc pipe
Alternate Bench Mark EL %d Top of 2"pvc pipe
Sbpe= A Contour Line EL IY!/
Contour Line Length
Scale 1"=40'
c �
Aft
If ,
This soil report was done to UM a zoning requirement. No permanent lot markers vier+e in at the tines the best was
cmkided. The area in which it was done may or may not be aftsUe for vour use.or in the location dawrL
`4 $ "E r CO
L69 49 co
.Qt� �
i0ol co
` %'ld
8 � Tim
....�. x
w�
a
�. wW L x=
a R
�4 \tv 96, 712 s 8 t.6'
2.22 Does _
.B.0. =985.2 o clo
0
H L.
N 982.or
997
—1751 -931—
* "W*
UNPLATTED LANDS