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HomeMy WebLinkAbout020-1439-12-000 (3) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 569563 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)J. Permit Holder's Name: City Village X Township Parcel Tax No: Kelly, Robert& Constance I Hudson, Town of 020-1439-12-000 CST BM Elev: Insp.BM Elev: BM Description: //GG Section/Town/Range/Map No: 9'7 0 a Z 6 25.29.19.2738 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER f,. CAPACITY STATION BS HI FS ELEV. Septic �; � r �„,.x Benchmark �' � ���. 9 7, � oe Deeing— Alt.BM ,7.-7 Bldg.Sewer F.' 14 Pa I k 1 7.0 Holding St/Ht Inlet IZ-72- 5 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Intake ROAD DtInlet Septic / f D Bottom Dosing ^ Header/Man. 17 7- s,5 �1 b 2_4 Aeration Dist. Pipe 7►,4 y` g Holding Bot. System 4,V C3 •9' PUMP/SIPHON INFORMATION Final Grade 3J y9 Manufacturer GFmNland St Cove , I � -7-7 .Q Model Number TDH i Friction Loss System Head TDH Forcemain Len gt Dia. / Dist.to Well IVA- SOIL ABSORPTION SYSTEM y$ BED/TRENCH Width Length No.OfTrenche PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS L�/ SETBACK SYSTEM TO / `O P/L BLDG (( WELL LAKE/STREAM LEACHING Manufacturer INFORMATION CHAMBER OR Tim Type Of System: '-7 / UNIT Modelmber:, r DISTRIBUTION SYSTEM k3 3,3 X4 ,4 4JS Header/Ma pifo / istribution x Hole Size x Hole Spacing Ven t Air Intake ,�� ✓ . / Pipe(s) �_ �� =� Length Dia �J Length Dia Spacing V 1 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only ° Depth Over Depth Over xx Depth o>1 xx Seeded/Sodded xx Mulched Bedlrrener Center I Depth Over Edges Topsoil O 1(@s i No '� Yes � No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 794 Sumac Trail Hud n,WI 54016(NW 1/4 NE 1/4 25 T29N R1 9W) Indigo Ponds Lot 12 Parcel No: 25.29.19.2738 1.)Alt BM Description= (; 2.)Bldg sewer length= Z ' / -amount of cover= I �J Plan revision Required? [a—] Yes No � 7 Use other side for additional information. L_ �__� SBD-6710(R.3/97) Date Insepctor' Signatu Cert.No. I PUMP PERFORMANCE CURVE PUMP PERFORMANCE CURVE EFFLUENT MODELS • � 318".11T&314'SOLID PASSING CAPACrty 'MENEM EMS MIN im hilmoommm ■■■■■■■m°°�eeeee°o®m°°■�momv°©° MMEM ©me°°°e■e�°eis°0000mmo�0° .� �■\■■■■�o°eee°eee°°°°e°°°a®tea©® ' ■■■■■■■�°e°eee�o■°sasses°ee°°°°i fqla\m11moom■■■■■■ o©0mmm°e°eom®o0o©m ovvommeevv0m®®©m an■\11s1■■■O■■■■■ 0o0vvveaom0■ ®mom �■■■1���■■■■■■■■■ oo©0omom°� iovmo0ov0 \\\►11��■■��, ■■■■ o°o®®o.■�.�oo°°°mom \��1111\\■■■��■■■■ °ee°©0oo©m®moimom �� , aaa°0oeaomomi®0om \■■I11II0■■■■■■0■ °°eeea°a®®©oo■mvm WREN , ®■\■11\\�■■►�■■■■n■ °a°°°e°°°°°e°evo®°ee°eve � °°aaaa°°ae°aeaoo ■\\11►1�■■�■■�■n■ eaa°°aaaaa°a°s0o m smmommm ■gym■ OWNIS ■■■■1:��\■►\■■■■■■ n ©®omv®�000�©0v0mvo�ve.s�®©v 000m00000vov0oov®o®vssoo�o ®©oo�o�oo©voo0ovo®©�o00 :explosion proof pump,see FM021 9. NONE SEWAGEAND DEWATERING nMEMO n■omssos0omoovom©0voo©0v©vvo o0sssossssssv00000©oov0�®° o�osassassssassso0v®vv®oov � o®sassasssassssssso0oo©��� .■■■■■o©ssasssssassassss0oo�o0®� , ■■',.■■■©®sossssssssasssasssasovov ®sassssss�sassossssss®000 ®sssasssassssasasssssssoo PRESS No ■■■■■■■■ONE■■■ , v■n►\M\��■■ONE■■ONE■■■■ 414 \`�■■■■■■■■■■■ No ON OR MEN EMEMEN9■■■n■■■®■�■nrn■■■■��n■� °fit . Pgof Private Ong-Site Wastewater Treatment System(POWTS) PLOT PLAN FILE INFORMATION PROPERTY LOCATION Owner V CND` _ CoI71716 8e, -_— V,,!� '/a, Section T1 N,RZ E oi& PIN# OCity, OVillage, OTown of S_/l Cr©iX r�Utl��ara County, WI N W s �rQr� ��c�o JeC � /�eneh r _r - - _ i 41 each :7 --� a I 4-'p,r� ,� � �_ Propc /010 972 J - 1 UntilGaD well Qrek � /X .J mud i r County Safety and Buildings Division -rdlA 201 17V. Washin 62 Sanitary Permit Number(to be filled in by Co.) Madison - c;. 5�9 s6 3 Sanitary Permit Applieat' State Transaction Number C)IX COUNTY /�,� In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this fy��p it is required prior to obtaining a sanitary permit. Note:Application forms fell 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 Privac Law,s. 15.04 1 m Stats. I. Application Inform 'on-Please Print All Information Property Owner's Name PC 0,(0d_( p �j gfi,t or ? Parcel# `± �r I b Z0 . 1 35-/Z- Property Owner's Mailing 4A�ddress Property Location 3_�CJI x t�c� ,r �(, Govt.Lot J City,State Zip Co/dje Phone Num�b[er /� /���✓ �/�y,,//ff y4, Section ari T/��.�C�� ✓(i'/lam �Q /"��l�l/—�(/t/✓ T N. R (circle Type of Building(check all that apply) Lot# �i 1 or 2 Family Dwelling-Number of Bedroo�( /a Subdivision /Name 70s/ L Block 17Q1* 'PC 1 ❑Public/Commercial-Describe Use dl�- �, 4�` '1 T/• ❑ City of ❑State wned-Describe Use CSM Number ❑ Village of / X Town of V Q C'i9 n III.Type of Permit: (Check only he box on line A. Complete line B if applicable) A' New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) B. ❑ Permit Renewal 0 Permit Revision ❑ Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner - F tL Oak- IV.Type of POWTS S stem/Com onent/Device: Check all that apply) Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound>24 in.of suitable soil ❑ Mound<24 in.of suitable soil Ck,6 ❑ Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dis ersal/Tre tment Area Information: Design Flow(gpd) Design Soil Application Rate( sf) Dispersal Area Required(sf) Dispersal Area Proposed sf) System Elev • Jr �1- 9140le VI.Tank Info Capacity in Total #of Manufacturer , u C Gallons Gallons Units c ? t j u y New Tanks Existing Tanks !I I u o & g U Septic or Holding Tank LOr x Dosing Chamber -A cref VII.Responsibility Statement-I,the under ignedi, e responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plurfiber'i Signature MP/MPRS Number' Business Phone Number Plumber's Address(Street,City,State,Zip Code) -1/3 S � VIII. ountv/De artment Use Only pproved lsappro Permit Fee 5. 00 Date issued Issuin ent Signat e r Given Reason Denial $ ` 7 "� easons for Disapproval 3 e O s �'n a•t IX.Condi ,•_ _t _ 1:-'',,septic tank,effltient fitter and dispersal cell'-must all be services I maintained CA4-e- as per,management plan provided by plumber. 2.. All sftack"utrements must ba':maintained as pet applicable codal ordinances. Attach to complete plans for the system and submit to the County only on paper not less than 8 In x i t inches in size SBD-6398(R. 11/11) Pg of Private On-Site Wastewater Treatment System (POWTS) Index and Title Sheet Owner: Pab `*' b � Project Name and System Type: 3� r-Pn.» �n-grn�•� Location: SUmCtC /r i -/-'7 e/fyd ' "'7 4/6 Street Address Legal Description �_ 1 S7 -r - Township/County Contents: Page 1: 1 ) q. Page 2: Page 3: ►"oo.&- Sc.c` 10/q Page 4: I7I' �°Cs Page 5: ��ii�1�"�/1 C:n F �llJj Page 6: Page 7: Page 8: Page 9: � Or _PI Q,+ Attachments: /y c f 'Dra�Se--r� r 0 SS Plumber/Designer: i'117/S alt Signed: r Credential Number: Date: Pg of Private Ong-Site Wastewater Treatment System (POWTS) PLOT PLAN FILE INFORMATION PROPERTY LOCATION Owner Sc�q- CO/I/j L°i �`l '/a, .1f '/4, Section O� , T a?% N,R _E oie PIN# OCity, OVillage,OTown of S°1•CroIX, r�UO�.S�n County,WI Ar i E s Rod) S-Igk e ('our,"d lU3o� L00, e d Q� each In cL,re wc�d C� propGSe_d ivov/Gov well t2re, 00 k /X w00d-e Soil Absorptlon System Cross Simon .t--- ft ?- __ft 4°Schedule 40 Final Grade PVC Vent Pipe With Vent Cap Leaching C' Chamber System Elevation ft ft �ft l v' s y�,fiE�n e(�V• o� s yam e(� Soil Absorption System Kan View -7� ft ft Leaching Trench 1 ft Chambers I Dia. Trench 2 Header Vent Or Observation Pipe Trench 3 Leachi,ng Chamber Specifications Manufacturer And Model � � EISA Rating �" sq ft per chamber Soil Application Rate gpolsq ft gpd Design Flow a l Soil Application Rate + �A b EISA= �hambers 3 rows of L_ chambers each. 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II I�� I III II I II I '111i I I� I1'LI II1, i�''I�I�� I��I1�111�1111111��I1���11 ��I �Ill.i I I I 1111111 IIIIIIIIIIIIIII IIIII I ,� 111�I IIIIf 1�Illlll 111111 1 I IILjl1 ' I� 11 w !11i11'11i1 / // I /Jll/'���1 • • ,\ `,� 'l%� ;/i�%ll,ll,l ,l°l�l�!llllllllllllll�'llll � ,_� l ,� aiaaai�i la��o�����������o�����/11111,11//1�,1/l�/1111/ll/,ll • ji �"P � • Pale (J o� 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. ABANDONEMENT: 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 ch. 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: POWTS INSTALLER POWTS MAINTAINER Name Dennis Hewitt Name Phone 715-821-4682 715-386-8668 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Agency r (` Q _-Z h'J Phone Phone /6— 216— 406 This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies. This document meets the minimum requirements of ch. Comm 83.22(2)(b)(1)(d)&(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. Use of this document does not POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page...6—i of FILE INFORMATION SYSTEM SPECIFICATIONS Owner ,,� UofvMb, e Septic Tank Capacity ❑ NA /000 gal Permit # :"' &q 6__(� "i - i Septic Tank Manufacturerer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer /d ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model e ❑ NA Number of Public Facility Units AP NA Pump Tank Capacity 606 gal ❑ NA Estimated flow (average) gal/day Pump Tank Manufacturer WIPser ❑ NA Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer �Za e��� ❑ NA Soil Application Rate gal/day/ft' Pump Model �.V ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit !Q1 NA Fats, Oil & Grease (FOG) :530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (B0D5) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODS) :530 mg/L It In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) <_30 mg/L NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA year(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 0 year)1 month(s) (Maximum 3 years) ❑ NA 13 0 Clean effluent filter At least once every: ❑ month(s) ❑ NA ® year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA `3 IN year(s) Flush laterals and pressure test At least once every: ❑ month(s) X NA ❑ year(s) Other. At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: k0 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 (Y3) 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 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 :02 months, 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. Page all 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. ABANDONEMENT: 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 ch. 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: POWTS INSTALLER POWTS MAINTAINER Name Dennis Hewitt Name Phone 715-821-4682 715-386-8668 Phone . SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Agency r t' OPf31 i� Name ' Phone Phone i6— 20 — to This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies. This document meets the minimum requirements of ch. Comm 83.22(2)(b)(1)(d)&(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. Use of this document does not Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer /Lo e Pump Manufacturer Tank Model Number /000 Aim Pump Model Number Total Tank Capacity Alarm Manufacturer Max.Bury Depth r $ Alarm Model Number Switch Type Filter Manufacturer Total Dynamic Head(TDH)-Feet Filter Model Number Elevation Head 700 Distal Pressure Network Loss Minimum Pump Performance Required Force Main Loss ,414 GPM I @ — Ft TDH Total Outlet Manhole Min.4"Above Grade With Manhole Min.4"Above Grade Locking Device. Inlet Manhole With Locking Device <6"Below Grade Sealed Watertight Securely Mounted Weather-proof Junction Box .. Finished Grade ' ` " © Depth of Vent Min. 12" Disconnect 1 Cover Above Grade Means Ft With Vent Cap ` Outlet Outlet Filter --_ y Inlet Inlet Baffle ><> t < >'> ' A ` t t Switch Settings and Reserve Capacity }� ' Tank Volume= GPI <>< >� Weep > > t < � Hole B >t >t> Dimension Inches Volume Gal. t t > >t >'Y (reserve)A i;. (alarm) B 2 Off Elevation C >i ° t < > >;> (dose) C '-ff- �,< Ft� Bottom >�> (dead) D <;< D Elevation Ft Total > r tt > 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 `� �! / p SECTION:2.20.010 QL/.4L/TY PLIAOR SAVE IS,7 .2 0410 " °MA 0 0102 Product information a �` ® Supersedes presented here reflects `;L PUMP !O. ® 1099 conditions at time of publication. Consult factory ,•„ ,, ` regarding discrepancies or MAIL T0: P.O. BOX 16347•Louisville,KY 40256-0347 visit our web site: inconsistencies. SHIP TO., 3649 Cane Run Road •Louisville,KY 40211-1961 http://Www.Zoeller con? (502)778-2731•1(800)928-PUMP•FAX(502)774-3624 COMPARE THESE FEATURES 53 - 57 Cast Iron Series • Non-Clogging vortex impeller. • Float operated,submersible(NEMA 6)2-pole mechanical 55 - 59 Bronze Series switch&variable level long cycle systems available. • UL-listed 3-wire cord plug;9 ft.standard for automatic, 15 ft.standard for nonautomatic. (For Pump Prefix Identification see News& Views 0052) Corrosion resistant powder coated epoxy finish. " MIGHTY-MATE " • No sheet metal l ar arts to rust or corrode. • Stainless steel screws,switch arm,guard and handle. rr • No screens to clog. SUBMERSIBLE PUMP • Watertight neoprene"0"ring between motor and pump ® : housing. FOR 8wm•o^ >v DEWATERING CRA • Solid buoyant polypropylene float. (SUMP) • Motor-60 Hz, 1550 RPM,oil-filled,hermetically sealed, OR automatic reset thermal overload protected. EFFLUENT (SEPTIC TANK SYSTEMS) SSPMA • Upper and lower sleeve bearings running in bath of oil. /2 Z ER • Entire unit pressure tested after assembly. PASSES' " SOLIDS • Carbon and ceramic shaft seal. • Maximum temperature for effluent or 1'/2" NPT DISCHARGE AND wACe dewatering-130°F (54 0C). AUTOMATIC PUMP MFRS.ASSN. • Passes 1/2"inch solids(sphere). • 11/2"NPT Discharge. MODEL . ��• On point-81/2" • Off point-31/4". • Major width-10 3/32". • Height-10 1/16'. v SPECIAL MODEL FEATURES: MODEL 53 MODEL 55 •Cast iron switch case,motor& •Bronze switch case,motor& pump housing. pump housing. •Glass-filled polypropylene •Glass-filled polypropylene base. base. VORTEX TYPE •Engineered,glass-filled,plastic •Engineered,glass-filled,plastic IMPELLER impeller with metal insert. impeller with metal insert. •Stainless steel guard&handle. •Stainless steel guard&handle. •Bearing-lower&upper oil fed •Bearing-lower&upper oil fed cast iron. bronze. MODEL 57 MODEL 59 •All cast iron construction. •All bronze construction. •Stainless steel guard&handle. •Stainless steel guard&handle. •Bearing-lower&upper oil fed •Bearing-lower&upper oil fed cast iron. bronze. ALL MODELS ARE COMPLETELY SUBMERSIBLE POWDER BN MODEL HERMETICALLY SEALED COATED TOUGH' Watertight-dust tight. Permanently oiled bearings. VARIABLE LEVEL CONTROL MODELS AVAILABLE SYSTEMS AVAILABLE • Automatic or Nonautomatic • "53-57"-.3 HP,115V or 230V Note: The sizing of effluent systems normally requires variable level " "55-59'-.3 HP,115V or 230V float(s)controls and properly sized basins to achieve required with Piggyback&BN5iable L available packaged pumping cycles or dosing timers with nonautomatic pumps. with Piggyback Variable Level Float Switch ©Copyright 2002 Zoeller Co.All rights reserved. V, TOTAL DYNAMIC HEAD/CAPACITY U w HEAD CAPACITY CURVE PER MINUTE U U_ J MODELS 53/55/57/59 EFFLUENT AND DEWATERING 25 Model 53/55/57/59 6 20 Ft. Meters Gal. Ltrs. w 5 1.5 43 163 r 15 10 3.1 34 129 a / / r 4 15 4.6 19 r7,2' 0 10 Shut-off Head 19.25 ft. (5.9m) 2 5 3 15/16--6 5/32 —I 4 5/8 1 1/2 —11 1/2 NPT 0 U.S. GALLONS 10 20 30 40 50 LITERS 3 15/16 0 80 160 FLOW PER MINUTE 009897 4 1/16 CONSULT FACTORY FOR SPECIAL APPLICATIONS I I • Variable level float switches available. •Variable level long cycle systems available. • Available with special cord lengths of 15', 25', 35'and 50'. • Alarm systems available. 10 1/16 • Duplex systems available. -� 3 3/32 SK858 Single Seal Control Selection Listings SELECTION GUIDE Model Volts Phase Mode Amps Simplex CSA UL 1. Integral float operated mechanical switch,no external control required. M53/55&M57/59 115 1 Auto 9.7 1 Y Y 2. Single piggyback variable level float switch or double piggyback variable level N53/55&N57159 115 1 Non 97 2 3 or 4_&5 Y Y float switch.Refer to FM0477. BN53 115 1 Auto 9.7 ' Y y 3. Mechanical alternator"M-Pak"10-0072 or 10-0075. *BN57 115 1 Auto 9.7 N Y 4. See FM0712 for correct model of Electrical Alternator. BE53157 230 1 Auto 4.8 - Y Y D53/55&D57/59 230 1 Auto 4.8 1 ----- Y Y 5. Variable level control switch 10-0225 used as a control activator,with Electrical E53/55&E57/59 230 1 Non 4.8 2 3 or 4&5 Y Y Alternator(3)or(4)float system. 'Single piggyback switch included. A CAUTION For information on additional Zoeller products referto catalog on Piggyback Variable Level Float Switches,FM0477; All installation of controls,protection devices and wiring should be done by a qualified Electrical Aftemator,FM0486;Mechanical Aftemator,FM0495;Sump/Sewage Basins,FM0487;and Single Phase licensed electrician.All electrical and safety codes should be followed including the most Simplex Pump Control/Alarm Systems,FM0732. recent National Electric Code(NEC)and the Occupational Safety and Health Act(OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0:P.O.BOX 16347 Louisville,KY 40256-0347 Manufacturers of.. O SHIP TO:3649 Cane Run Road ® Louisville,KY 40211.1961 Q�/rY)U11NP6 SNCE I999� ® (502)778.2731.1(800)928-PUMP http://www.zoeller.com PUMP �O FAX(502)774-3624 ©Copyright 2002 Zoeller Co.All rights reserved. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing ilin Addres; ��CS �v '—✓UC// � ��'� Property Address a (Verification required from Planning&Zoning Depa t for new construction.) /'► tate -/ Parcel Identification Number City/S ✓U t� r� ��/ LEGAL DESCRIPTION a��j Location /y `/4 `/4 , Sec. �✓ , T c�( N R� W,Town of 77VC�S' Property -- , Lot# Subdivision dl U S Certified Survey Map# Volume ,Page# Volume , Page# Warranty Deed # 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 u put into maintenance consists the pumping out the septic p ctank every treatment t stage in theewaste disposal l system. owner maintenance P the system can affect the function o responsibilities are specified in§Comm. 83.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance. The roe owner agrees to submit to St. Croix County Planning&Zoning Department a certification the on-site i ed by the T property m' owner and by a master plumber,journeyman plumber,restricted plumber after licensed and pumping(if necessary),the septic tank is wastewater disposal system is in proper operating condition and/or(2) P less than 1/3 full of sludge. the ain the private sewage I/we,the undersigned have read the above requirements and agree e Department of Natural Resources, State lof Wisconsin. standards set forth,herein,as set by the Department of Comm Planning Certification stating that your septic system has been maintained must be completed and returned to the St.Croix County Zoning Department within 30 days of the three year expiration date. we certify that all statements on this 4-0yrdeed m are true to the best of my/our knoOwledge. I/we am/are the owners)of the I/ Y property described above,by virtue of a warr recorded in Register of Deed 7—SIGN of Pedro s �-//7/ A/_DATE AT OF PLICANT(S) isre resented may result in the sanitary permit being revoked by the Planning&Zoning Department. *** ***Any information that ism p 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 III�I IIIIIII�IIIIII��)I)I i�) 8210871 TX:4173796 STATE BAR OF WISCONSIN FORM l -2000 992467 WARRANTY DEED BETH PABST Document Number REGISTER OF DEEDS ST. CROIX WI THIS DEED, made between Rosamji, LLC, a Wisconsin Limited Liability 0ST. CR IX CO.,O., PM Company, Grantor, and Robert T. Kelly and Constance L. Kelly, husband EXEMPT*: NA and wife as survivorship marital property, ran ee. REC FEE: 30.00 Grantor, for a valuable consideration,,conveys to Grantee the following described real estate in St. Croix ounty, State of Wisconsin (the TRANS FEE: 135.00 PAGES: 1 "Property"): Lot 12, Plat of Indigo Ponds,Town of Hudson,St.Croix County, Wisconsin Recording Area Name and Return Address: Land Title Inc.#414383 2200 W County Road C#2205 Roseville,MN 55113 Together with all appurtenant rights,title and interests. 020-1439-12-000 Parcel Identification Number(PIN) This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Easements, Restrictions,Reservations,Roadways and Rights of way, if any,of record Dated this 28th day of January,2014. Rosamji, LLC * M sch, ere Treasurer• * AUTHENTICATION ACKNOWLEDGMENT Signature( ) s ..�' SC_Hgn:. STATE OF WISCONSIN ) ST.CROIX COUNTY. )ss. authenticated this 28th day of January,2(g,,F,-: pI AR r �,` Personally came before me this day of January, 2014 Uthe above named Mary R. Rusch, Secretary Treasurer of 2 Rosamji, LLC, a Wisconsin Limited Liability Company to me P11B�' 2 known t be the person(s) who #, xecuted the foregoing TITLE: MEMBER STATE BAR OF WISE Ll\I O' If not �'•�qT rostrum tand acknowledged the same' authorized by§ 706.06, Wis. Stats.) '�+++•••• ' THIS INSTRUMENT WAS DRAFTED BY *Connie M.Schroeder Notary Public,State of Wisconsin Larry S. Mountain, Attorney at Law My commission is permanent. (If not,state expiration date: 1/1/2017 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their SlgmtlnrC St. Croix County 992467 Page e 1 of 1 WARRAN r Y DEE STAT IRAR OF WISCONSIN FORM No. I-?noo 1307 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85,Wis.Adm.Code Steel Soil Service County Attach complete site plan on paper not less than 8'%x 11 inches in size. Plan must St.Croix include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel LD. v Q ' �����(� percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Please prin rsed a Re ewed By '/ Date Personal information you provide may be r se co A6 spy Law,s• 5.04(1)lm)). (�t,�(/Yt�— /& Property Owner Property Location ROSAMJI,L.LL MAY 1 3 20 Govt.Lot na NW 1/4 NE 1/4 S 25 T 29 N R 19 W Property Owner's Mailing Address Lot Block# Subd.Name or CSM# ST.CROIX COON?y 12 na Indigo Ponds 2141 Cty Rd.C City State Ip r City —J Village a Town Nearest Road New Richmond WI 1 54017 1 715-248-7071 Hudson Prairie Meadows Drive Y' New Construction Use: 0 Residential/Number of bedrooms 4 Code derived design flow rate 600 GPD J Replacement J Public or commercial-Describe-na Parent material Sream terraces and pitted outwash plains Flood plain elevation,if applicable n Vy- General comments and recommendations: system elevation 97.10 ft,trenches spaced and depth to code 6.00 ft below grade ' 0, 7 I oad r�� a Boring# Boring 1/ Pit Ground Surface elev. 103.10 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. `Eff#1 -Eff#2 1 0-5 10yr2/1 none I 2msbk mfr gw 2c .5 .8 2 5-14 10yr2/2 none sil 2msbk mfr gw 2c .5 .8 3 14-24 7.5yr4/4 none scl 2msbk mfr cs na 4 6 4 24-120 7.5yr4/6 none cos osg mvfr na na .7 1.6 ✓1'1 �a S-� Boring# Boring 1/ Pit Ground Surface elev. 97.65 fl. Depth to limiting factor 96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 PDlft*Eff#2 in. Munsell Qu.Sz.Cont Color Gr.Sz.Sh. 1 0-5 10yr2/1 none I 2msbk mfr cs 2c .5 .8 2 5-24 10yr4/4 none sl 1 csbk mfr gw 1 c .5 .9 3 24-48 7.5yr4/4 none scl/Is 2msbk mfr gw na 4 6 4 48-96 7.5yr4/6 none Is osg mvfr na na .7 1.2 Effluent#1 =BOD?30<220 mg/L and TSS>30<150 mg/L Effluent#2=BOD5<30 mg/L and TSS<30 mg/L CST Name(Please Print) Signatur : CST Number David J. Steel 248956 Address Steel Soil Service Date Evaluation Conducted Telephone Number 1564 CR GG,New Richmond,WI 54017 5/8/2003 715-246-5085 Property Owner ROSAMM, L.L.0 ndin Page 2 of 3 Parcel ID# pending F Boring# Boring 1/ Pit Ground Surface elev. 97.65 It. Depth to limiting factor 110 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-6 10yr2/1 none I 2msbk mfr gw 2c .5 .8 2 6-24 10yr3/2 none sl 1csbk mfr gw 1c .5 .6 3 24-60 10yr4/4 none scl 2msbk mfr gw na .4 .6 4 60-120 7.5yr4/4 none Is osg mvfr na na .7 1.2 10yr6/4 sift lems at 72",4"in diameter ❑ Boring# J 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 GP in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 F-1 Boring# I 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 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 *Effluent#1 =BOD5>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. Page 3 of 3 STEEL'S SOIL SERVICE INC. David J. Steel 1564 Cty Rd GG CST-POWTSM ROSAMJI, L.L.C. New Richmond,Wl 54017 Lic. #248956 NW1/4,NE1/4,S25,T29N,R19W Bus.(715)246-6200 Town of Hudson,St.Croix Co. Fax.(715)246-9372 Indigo Ponds Lot 12 This soil evaluation was conducted to satisfy a zoning requirement,it may or may not be suitable for your use. The location of this test may or may not be as shown,as permanent lot lines were not established at the time the soil test was conducted. Legend 1"=40' ♦ =Benchmark Ele. 100.0017t Top of 1/2"pvc pipe •=Alt Benchmark Ele.99.40Ft Top of 1/2"pvc pipe ❑ =Borings 3 /�{� Y Boring Elevations 1-( r0 ` B2=97 65Ft t '37, ` ��Z�f B3 =97.65Ft B4=00.0017t �I n 7 , r' A0 - 6- IPA ,,�AAA,�AAG,�IA�►� �.�.A �. • 9AA A ��$AA�� MA ►A G�t - ' !i'�AAA . ���`•A'��'i��i�. ,�'A����fe'��A� ���.��.�eA ,��� AAA ®tAo�� ,��►��� ,.,. .�� -►QzOA 0013 t��c,�MAW S AMOW03, 0M►tA,l5'�t►M W AAA• '' ��A ~����A��';,G +►�iA�• Arm G ♦ � ®�4 ��, d A AA'�Ali A G! ��•►� ; 'A AAAi�G'� ��G- ♦ , ��G�k�AA�� �'►lOIAG'' ► ; A Page 3 of 3 STEEL'S SOIL SERVICE INC. David J. Steel 1564 Cty Rd GG CST-POWTSM ROSAMJI,L.L.C. New R.ichmond,WI 54017 Lic.#248956 NWl/4,NE1/4,S25,T29N,R19W Bus.(715)246-6200 Town of Hudson,St.Croix Co. Fax.(715)246-9372 Indigo PondS Lot 12 This soil evaluation was conducted to satisfy a zoning requirement,it may or may not be suitable for your use. The location of this test may or may not be as shown,as permanent lot Imes were not established at the time the soil test was conducted. Legend P'=40' A=Benchmark Ele. 100.00Ft Top of 1R"pvc pipe •=Alt Bendnnark Ele.99.4OFt Top of 1!2"pvc pipe 0=Borings Boring Elevations p /o/ BI=103.1OFt B2=97.65Ft r T1- ,Y9Zfrr B3=97.65Ft B4=MOOR y� �r /bit, 3/o J- es�a� lis lid Ilk sOL ,; OD C-J d 1 Mon • '1,X04 z M 4¢ Fn-_ Em .. mu Connie and Bob Kelly 'iq4 Sumac Trail �11�P.t vfriCS, 1Nt. rnom:651-02-14.10 Hudson, Y41 54016 PAGE .�f3 Msxxe(�w�k�.A^Vexut Est Page 1 of 1 I Pam Quinn From: Pam Quinn Sent: Wednesday, September 14, 20114:58 PM To: 'steve west'; 'Mark Erickson' Cc: Kevin Grabau; 'Wenholz, Michael D-DNR'; 'Pericak, David M - DNR'; Steve Olson; David Fodroczi Subject: Sarrack Lot 4 Indigo Ponds and Shoreland zoning Attachments: Indigo Ponds wetland delineation.pdf Hi All, After extensive review of documents contained in the Indigo Ponds subdivision development folders, it does not appear that lots in the northerly portion of the subdivision were intended to be subject to Shoreland zoning requirements. The attached 2003 wetland delineation identified the area on Lot 6, labeled"wetland"on the plat, as a depressional area, not a navigable water body. Mark Erickson has taken time to research the navigability issue and provided support for a finding that the area on lot 6 is non-navigable and should not be subject to the filling and grading permits required under county Shoreland Zoning. The "depressional area" on lot 6 is within a recorded 75' setback and drainage easement, which will provide a buffer against land disturbance occurring on adjacent lots. Permanent stabilization of disturbed areas is required in Item 7.3 and erosion control during construction is required in Item 7.9 of the recorded Declaration of Protective Covenants (Document 770482). A hand-written note by a county staff member was attached to a copy of the preliminary plat, which specified the following lots within 300' of the year-round Indigo Ponds as being subject to Shoreland zoning: 36, 37, 38, 39, 40, 41, 45, 46, 57, 49, 50, 51, 52, and 53. The Town of Hudson zoning ordinances are applicable for lot 4, but not the county Shoreland overlay district. I have issued the sanitary permit for Lot 4 and recommend that the special exception and land use permit applications be withdrawn. The application fees paid for the special exception and land use permit will be refunded. The Sarracks may now obtain a building permit from Brian Wert and proceed with the construction of their house, driveway and septic system subject to town ordinances and recorded subdivision covenants. Pamela Quinn, Zoning Specialist (PO` I'S) St. Croix County Planning &Zoning Dept. 1101 Carmichael Road Hudson, 'WI 54o16 715-386-4680 ,2am,7@co.saint-croix.wi.us 9/14/2011 =K1 K'1'K 91. IIV ".,, .HL'H1HZ M,C0,6Z.00S (w40 I1MM�)x.•.,tY.y ryl R'ilYt_:./• \ i 3.K p]M•yv•�•1'. -,ly 1)MI0J i 1 ..ISK .4 •..K 1lMlIS10{A 7M1 1NJIIlf1Ct �a AAA s ', 44"' g �■C�. VVV 't....zr•..i a b 0 If 44�3 iIWM—� 21 $ { ~ L S,tY7 5 e M R p g¢g5 R�d a ���y����9������ §� `�i rte, ✓'� � `� / p ���4~�� I r ,'M,LTT p ,SZ,005� ,06'9Z9L M.4 t.qz OOS - SS'£9L- ,4A'O4M M,L L,SZ.005 It ¢� $ ¢ I �i ay F E \ N agj \•s m too CO aY. � a R e / �� / \ / fl• y Q 3���E c��i �tl i`/ •a �._... ..._•_�.....__ _� 4 'd L <�i`'� � / ./ i \ 1\ I a��g6�1 too / n iii d cc.v4oa L Sir If aY y " n ll p QQ o as? 6$s I I %'. Nn I .r�„I `...z M•r�=i�1 R ; f 6 d � I t i L--�. j Y°'° \\ r L,ry J;b oil KYy<.ovtwvl W ;M� �.n:1 �• IS �� �'�\ � \ 4-W oil VIA g FN ll Q� li� d r4 as .t0911 �j' `Iti.u. g if_a e. I�S �" ii 1h,111- ¢p>r =l��n„iw•,f� �� � 1�r\\' d9 �'"b �1 I Ala I _°r• ��d i1R�J f� t�,< �6� � r"I � !, m- •�r+K V.T M �k- .x•`L :.-'jya . m•r,n wrc. b 3'141•:'8a' L`t�'�'.1{ 83 ,.-,� 'rte I