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HomeMy WebLinkAbout008-1072-80-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM ..„.y. St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No GENERAL INFORMATION (ATTACH TO PERMIT) 633935 State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s 15.04 (1)(m)] Permit Holder's Name City Village Township Parcel Tax No Adolf Johnson Trust I TOWN OF EAU GALLE 008-1072-80-000 CST BM Elev: I Insp. BM Elev BM Description: n I SecbonfrownlRange/Map No TANK INFORMATION 2 f4 r ; h, S b rt Gi TYPE MANUFACTURER CAPACITY Septic J)'e Dosing (( O lMJ vJ M. &sZs Holding TANK SETBACK INFORMATION C.00 �r, G G11�„ y C TANK TO ,P/j' WELL Vent to Air Intake ROAD Septic 7Z5 y //BLD/G Dosing (O ! Aeration Holding PUMP/SIPHON INFORMATION M 4 O --?7, Manufacturer Demand - (�pJ �C� GPM Model Number t yy TDH Lyft b Frictiop Loss System Head � (ttoo Tt 6 ` t 'J Forcernam Len�� r Iola �7 •` Oist Well��a • SOIL ABSORPTION SYSTEM ELEVATION DATA STATION BS HI FS ELEV. Benchmark `� I J O Alt B1v1( r ONc✓ - 1 ! )f !b� • 44 Bldg. Sewer y,ss /00.7b SVHt Inlet y zs 9 / Z 6 SVHt Outlet Dt Inlet Dt Bottom izb7 9z.8 Header/Man. V q8 p B Dist. Pipe 67 *?41 But System 98 z-G Final Grade St?,71f/ q1 �o o Aou r B.Bf 9G•7 BEDrrRENCH DIMENSIONS Width U / . 5 ` Length I � No- Z 10-�� Is PIT DIMENSI No Of Pits Inside Dia Liquid Depth SETBACK SYSTEM TO PIL� BLDGI WELL LAKE! T EA L ACHIN Ma acturer INFORMATION Typ f System' �I�ou ��• ��Or ��• C AMBER R UNIT Model Numbe DISTRIBUTION SYSTEM Header/Manifold • Dia '3Length Dstnbut r Pipe(s (I Dia Spacing x Hole Size p Hale Spacing %%NrLength Vent to Air Intake 70 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only fle I- P/17 ,.- %, r Deg{p-9ver--- Bed�ry -�eq r 8 ••G Y I Depth Over edfrrench Edg - xx Depth q` Topsoil J z rn nr Seeded/Sodd d - xx Mulched y I / Tq- Yes �:_� Na /, Ves No -[__ COMMENTS: (Include code discrepancies, persons present, etc ) Location: 2637 12TH AVE 191 {� 1.) Alt BM Descnption = 1l�a CDwlr 2.) Bldg sewer length= -a 32' e?%,'4lr� 7 3l• 6,y -amount of cover = y z H Oh fq'i 1 a I 5 �') I Co L Cmj Plan revision Required? ] Yes X No )O n 7-1 1 Use other side for additional information. / r Date SBD-6710 (R 3/97) Inspecti flow I D/ I Z'nspection #2 40� /cDll aPud . Insepclor's Signature Can No. —�fr �� i-.t 7--v I a - Safety and Buildings Division t // / - C -e/ r ' �� 2021 201 W. Washington Ave, P.O. Box 7162 Sanitary Permit Number (to be filled m by Co.) SEP Madison, WI 53707-7162 tiO2nanv� St. C,'ox i.o„a�me t con " a Permit Applicat State Transaction Number In accordance with SPS 383.21(2), Wis. Adm Code, soof this form to the ap r �vemmrntal and z d g2(O /0'7- G Project Address (if different than matting address) is required poor to obtaining a sanitary permit Note. Application forfor stated ed POW ub ed [o fo the Department of Safety and Professional Serves. Personal information you pro be pA co my /� 12 71/(:�. purposes m accordance with the Privacy Law, s. 15.04 l m , Stals (i Z 63 1. Application Information - Please Print All Information Property Owner's Name V(r •E•vgo.-, �Ip / Giurr'a �z+rrS� O o g^ /072 8 0-000 j Property Owner's Mailing Address / bAL4E,3bh Property Location 263^? /2yE�1 e V Govt Lot $� y$_. y,, Section 2� City, State Zip Code Phone Number Gt�6'O dVI/et w/ S'�U2� 7/s-Y9593-�� T -2;? N: R t&ctrclE one �D— 11. Type of Building (check all that apply) Lot u Name SubdlnsZol A or 2 Family Dwelling -Number of Bedrooms 3 q Block ❑ City of ❑ Public/Commercial - Describe Use CSM ❑ State Owned - Describe Use ❑ Village of �y i¢TOwn of C�C 4 Number � III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A, ❑ New System placanent System ❑ Treatment[Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) F R. El Permit Renewal ElPcrmit Revision ❑ Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner / tV.Ty of POWTS S stem/Coin onent/Device: Check all that apply) ❑ Non -Pressurized In -Ground ❑ Pressurized In -Ground ❑ At -tirade ❑ Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil ❑ Holding Tank ❑Other Dispersal Comporirn (explain) ❑ ant Deviee ( plain) I it V. Dis ersal/Treatment Area Information — ' Design Flow (gpd) Design Soil Application te(gpds0 Dis Required (st) Dis mat Area Proposal (so System Elevator '{gip t Z 25n 223a �,/% VI. Tank Info Capacity in Gallons Total Gallons M of Units Manufacturer nor � • l�.�s �. 8 y V .VL 1• ti(1Jil f 1 �^ u p h .moo. B' Z V New Tanks Existing Tanks a` U ,., rn Septc or Holding Tank Dosing Cbambcr 1. _e L,) VI 1. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the PORTS shown on the attached plans. Plumber's Name (Print P tuber's Si re MP/MPRS Number Business Phone Number % p/5-21oZY//5 Plumber's Address ($tree City, State, Zip Code) VIII. Coun /De artment Use O I Approved ❑ Disap v Permit Date ued sin Agent Signature ❑ rven Reason or Denial yFleeye �j CEO iTEM (_epee IX. Condition of Approy I \a:01, OWNER tank, emust filter andnispersal cell must be servLced I maintained `kA p> ,( ,,,i,,,,r�,(� , — s per management plan provided by plumber. \f J 44& `III setback requirements must be maintained-1 as per app complete plains for the syst�,i, mit to t County on on "Pt. ot les�rhaa 8 x 11 ts in na h J1r c - V0CUivl, SBD-6398 (R. I I/11) CHECK BOX AS APPUCAS E CHECK BOX AS APPIL CABLE. ❑ SOIL EVALUATION Scale: to =40• 0✓ SYSTEM PAGE 2 OF 6 SITE MAP I 4D PLOT PLAN PROJECT NAME: (tBa) 10' DESIGN FLOW: 450 GPD Adolf Johnson Trust Attach design flow calculations for Commercial plans. PROJECT ADOREss: 2637 12th Ave, Woodville, W I Pipe Material / ASTM Standard (Tables 384.303 & 384.30-5) swft y Sewer. PVC / ASTM D3034 BM Symbd'� BM Devadon: 10— FFTN Force Maln: PVC / ASTM D2665 @ wost fieldate SM Descdptlon: grade west pg WkWe mnh by IMPORTANT: Slope Gradient % ) t 3% Well symbol (B appnrable): p draabg an anq Show ground elevation contours at suitable intervals. of Tested Area: on the appnaprM fine. K--- S'!o • L— — pew L--(I&., August 27, 2021 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2023-08-27 Plan Review: PWTS-082102107-C MICHAEL J MYERS 2943 130th Ave Glenwood City WI 54013 SITE: Adolf Johnson 2637 12th Ave Town of EAU GALLE St. Croix County Total Amount: $250.00 FOR: Description: 450 GPD (3 Bedrooms — Replacement) Maintenance Required DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY VN 54304-5211 Contact Through Relay http:ildsps.vA.gov/programsfindustry-services waw.wisoonsin.gov Tony Evers - Governor Dawn Crim - Secretary Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE Mound Component Manual — Ver. 2.0, SBD-10691-13 (N.01/01, R 10/12) Pressure Distribution Component Manual — Ver. 2.0, SBD-10706-P (N.OI/Ol, R 10/12) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. All loose organic material to be removed from POWTS Dispersal Area. the site is too wet to prepare If it crumbles site preparation can proceed If the site is too wet to prepare do not proceed until it dries. • Abandon Existing System per SPS 383.33 • Pump Floats to be set and serifed per approved plan Am changes mas result in vamp resiziri to meet '1-Dll and GPNI Specifications. • Divert surface water from POWTS Area. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • Well setbacks to meet chs. NR 811 & 812. • kreas that are occupied pith rock tmgmcnts. tree roots, stumps and boulders reduce the amount of soil ❑eadable for proper treatment. It no other ,ite is a\ ailable. trees m the halal vea ul the 1'0%i TS Dispersal Area must be cut off at ground loci 4 Iaeer fill area is necessary %Olen am_ of the abo%c conditions are encountered. to provide sufficient Infi II rati%C area Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state scats 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 left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Thanks, �9 divr U,n,�r�eest POWTS Plan Reviewer — Wastewater Specialist Department of Safety & Professional Services I Division of Industry Services email: tin- u•,Jerleeu ct �si�eonsm uo� Cell: 608-516-6134 PAGE 1 OF 6 Mound Plan Index & Cover Sheet Component Manual Design References: Version 2.0, SBD-10691-P (N 01/01, R. 10/12) & Version 2.0, SBD-10706-P (N.01/01, R. 10/12) Pg 1 of 6 Index & Cover Page Pg 2 of 6 Plot Plan Pg 3 of 6 Mound Cross -Section & Plan View Pg 4 of 6 Distribution Network Specifications Pg 5 of 6 Pump Tank Specifications Pg 6 of 6 Management Plan Pump Curve POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description Adolf Johnson Trust Owner Name(s): Adolf Johnson Owner Address: 2637 12th Ave, Woodville, WI Project Address: SAME Govt. Lot: SE 1/4 of SE Township: Eau Galle Project Parcel ID #: Phone:715 495 Zip: 54028 9376 1 /4, Section 25 T 28 N-R 16 E ❑ or WWI County: St. Croix Designer Information Designer Name: Michael Myers Phone: 715 -265 -4115 Designer Address: 2943 130th Ave, Glenwood City, WI E-mail: mcmyers@centurytel.net Condrtmnally License Number: 267985 APPROVED DEPi. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES Remarks: Zip: 54013 SEE CORRESPONDENCE Signature: " Date:'- 2 26 7 / Ongmal signature�requin4 on each submitted copy. CHECK BOX AS APPUCABIE ❑ SOIL EVALUATION SITE MAP PROJECT NAME: Adolf Johnson Trust CHECK BOX AS APPLICAELE. Scale: 1" = 40' 60 0✓ SYSTEM PAGE 2 OF 6 0 40 60 80 PLOT PLAN (•;ph grd) iD+ DESIGN FLOW 450 GPD Attach design flow calculahons for Commercial plans. PROJECTADDRESS. 2637 12th Ave, Woodville, WI Pipe Material /ASTM Standard (Tables 384.30-38 384.30-5) BM Symbd)'.�) (` BM Elevdmn 100.00 FT �— N Sanitary Sewer PVC / ASTM D3034 PVC ASTM D2665 aM Deacnption. grade A west post field gate Force Mann- / Slone Gradient(%) of Tested Area 13% well Symbol (tt Inai er,onh by d, .m n, arro.v IMPORTANT' Show ground elevation contours at suitable intervals on,rc ap;rwme ern i �f------ sip 1'fa r 5WA,,to 0.5' TO 2.5' WASHED AGGREGATE (min.6.W beneath distribution Npe-min.2.0' MIN. 6.0' OF TOPSOIL COVER averdiarbutim pipe, and covered with approved synthetic Tatum) mir. 1.0 If L ASTM C-33 SAND FILL min. 0 5 It I I p Z ft Plowed SuRace Surface Contour 13 %Sloper Elevation = 96.67 I W = 30.1 ft (Show force main manifold and flush valve beaters on plan view ) 1 112 ' 0 Schdl 40 PVC Lateral _ (lypcal) — 1- B = 100 IT Bend as necessary to follow contour DOWNS[ OFF TOE L= 121.6 « III SINGLE -CELL MOUND DISPERSAL AREA D= 1_5 ft E = 2.09 It System Elevation = 98.17 It Lateral Invert Elevation= 98.85 if CROSS SECTION VIEW (No Scale) PLAN VIEW (No Scale) 1 3 = 61 it 16.67 ft ltM-y� Vk'°SrPkall_ _—___—_--.—.—. Prohibit disturn,mre and vehicular traffic within 15 feet of downslope toe. Reset Page I= 19.5 I K= 108 ft twPlral DISTRIBUTION NETWORK SPECIFICATIONS (No Scale) ti 2 '0 Schdl 40 $.' PVC Force Moir (slope to punt, tack FLUSH VALVE DETAIL (riser pipes fordralnsarx) (No Scale) + opliooal) F Ord" in _ _ _ Lateral Spackg Valve Box Center of Threaded Cep \ � $ = 3 it for Head Testing (Insulation optional) (opllonaq \ 2 '0 sd 40 First Orifice, I \ Shed onho, fa PVC Manifold (typical) Ball l 1 \ grevelless applrabors (optinnlare Laterals to be level (p ) Q .v` \ Schdl40 PVC Lateral O = 1112 in (typal) Lateral Length(P)= 99 0 Numberof Orifices per La" = 45 au:,es equally spared [uht, kl m OR b) belov4 _ \ a) alag bonom of 1'leral Orifices equally spaced Orifice Discharge Rate = .41 gpm -- Flush Valve along bottom of lateral L b) l slag tap of lateral Assembly Number of Laterals= 2 valh every_ th hole (lyplrai - sec decal) se Mowg dove LAI ERAL INVERT ELEVATION = 95.85 ft (typical) OBSERVATION PIPE DETAIL (W Scab) Screw-Tyye or Si'q Cap (larse( FFlhhed Grade (mulched a seeded) 4'0 PVC Ppe Topsol Cover Top of pipe to team ete (mini. 1 foot) at or above finished grade ' (4) 1/4'-i l2- x b' Sb6 V 90 'part Anchoring Device Infiltration Surface Last Orifice Lateral Discharge Rate = 18.54 gpm (typical) Orifice Spacing (X)= 27 in pypkal) TOTAL DISCHARGE RATE = 37.07 GPM Orifice Diameter= .125 In (lyw-l) First Orifice (typical) x( wi —� END MANIFOLD Check lya�al) CONNECTION applicable box. Man@old Frsl Orifice (riser pq» optional) D typical) G) m 4— x— I -xn xn—}—x —{ j, urlx uypr2 ❑ CENTER MANIFOLD n Manifold CONNECTION rn ne er pipe optional) PAGE 5 OF 6 "A".= 19.9 Inches = 338.3 Gallons "Crr = 6.3 Inches = 107.1 Gallons SEPTIC / PUMP TANK SPECIFICATIONS 4'0 Vent Pipe (No Scale) > 10 9 lrom Building Eleclncal must comply wit, 12' Min. or 20 ft above SPS 316 and NEC 300 Established Flood Elevabon WealnarProof Extend manhole riser as necessary. (hronl) Approved Junction Box Vent Cap Approved Looking Manhole IMPORTANT: with Warning Label Attached Anchor tank(s) a1383.43(8)(g) ssary I (bmm ) Conduit pursuant to SPS 4' Min. or 2.0 ft above Established Flood E"hon �Ainight Seal Finished Grade CAPACITIES @ 17 gaVin Depth (in) Volume (gal) A 2" _354-7- 2.0 34 ((B [C] 5.4- iji-.-3 D 10 170 *Pump Tank Liquid Level = 38.2 in Force Main Diameter = 2 in nnect 1B' Min. (bplual) pp/Oved Jdnls withproved Pipe 3 fl onto JA� TBlock Solid Ground (lypio9l) VATIOEVATION = 86.8 ft Concrete IDE BOTTOM VATION = 86 ft 100 ft 3' Approved Bedding Material BeneaN Tank Force Main Length = � 2( Force Main Void Volume = 17.4 gal � Vertical Head = 12.0 ft + Min. Supply Head = 6.5 ft (CI Total Dose Volume (TDV) 107.4 gal/dose + FM Friction Loss = 2.87 ft — (5X total lateral void volume S TDV < 0.2X design flow) - + (force main drainback volume) + Fitting Loss' = 1.95 ft '(min. supply head x 0 3) MIN. PUMP DISCHARGE RATE = 37.1 gpm = TOTAL DYNAMIC HEAD = 23.32 ft PUMP TANK: SEPTIC TANK(S): Volume = 650 gal Total Volume = 1000 gal Manufacturer. Wieser Conctrete Manufacturer(s): Wieser Concrete Pump Manufacturer: Goulds Install approved effluent filter at the septic tank outlet Pump Model: PE51 P1 (See attetlred pump verve 1 immediately immediately upstream of the pumptank inlet. Filter Manufacturer: Polylok Controls/Alarm Manufacturer. SJE Rhombus Controls/Alarm Model: PSP120V6H150P17A Filter Model: 525 Float switches containing mercury are prohibited PAGE 6 OF 6 Mound Management Plan IMPORTANT: The owner of this mound system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc, Admin, Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = 450 gpd; BODS <_ 220 nrl TSS 5 150 mgL-'; FOG <_ 30 mgL" Inspection Checklist INSPECT EVERY 3 YEARS o type of use c age of system o nuisance factors (i.e. odors, user complaints, etc.) c mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) c material fatigue (i.e., leaks, breaks, corrosion, etc.) ., solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (i.e.. exceeding design capacities, prohibited activities, etc.) c extent of ponding in distribution cell prior to dosing o dosing irregularities (i.e., pump re -cycling, float switch settings, etc.) o electrical components (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. o Distribution laterals shall be flushed once every 3 years or when necessary. System maintenance reports shall be submitted to the proper local government unit In accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Northland Plumbing Inc Phone: 715-265-4115 Local government unit: St. Croix County Local government unit address: 1101 Carmichael Rd, Hudson, WI Phone: 715-386-4680 zip: 54016 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed mound dispersal component may be re -constructed within the originally approved area after removal of all failed components. System Abandonment If use of this POWTS is discontinued. it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code JOULDS PUMPS APPLICATIONS Sceciai'y des'gned for the `odow ng uses: • Mound Systems • Effluent/Dosing Systems • Low Pressure Pipe Systems • Basement Draining • Heavy Duty Sumo/ Dewatering SPECIFICATIONS Pump — General: • Discharge: 1'h NPT • temperature: I 040p (400C) maximum, continuous when fully submerged. • Solids handling:'h" maximum sphere. • Automatic models include a float switch. • Manual models available. • Pumping range: see performance char or curve PE31 Pump: • Maximum capacir: 53 GPM • Maximum head: 25:TD� PE41 Pump: • Maximum capacity: 61 GPM • Maximum head. 29' TDH PE51 Pump: • Maximum capacity: 70 GPM • Maximum head: 37' TDH VETERS FEET a0 ._. ' PE51 r 35I 10—'— .--'�— n z 25 `FE- 20 Submersible Effluent Pump MOTOR General- • Single prase • 60 Hertz • 115 a^d 230 volts • Sulr•:^ t-e,^al ovedoac oro- tect,on Ivni aL20matic reset • Class 9 ins labor • Od-filled design. • r?ah st-e,oth carbon steel shaft. PE31 Motor: • .33 HP, 300C RPM 115 vcs • Shadeo role des,gr PE41 Motor: • .40 HP, 3400 RPM • 115 and 230 volts • PSC des:gr PES1 Motor, • .50 �iP, 3400 RPV • +' 5 arc 23C vci's • PSC desigr ------ YODELS PE31 PE41 PE51 33 4C 5D --, -j 2 Goan — — 5 00 +0 20 30 40 SC --8� _ 0 GPV 8c If O 2004 ;TT water Technebgy. Inc ENecn.e lure 200• B'E31/41 5 •o 15 CAPAO-v FEATURES ■ Corroslcs resista^t construction ■ Last 'rc^ 000y. ■ Tl-ermoD astir impeller and cove. ■ UDoer sleeve and lower heavy duty ba' Dearng construction. ■ %lotor is permanentiy �jbncated for extended service life. ■ Powered for cent nuous coeration. ■ A;i ratings are w't`•,n the working lim"s of the mote. ■ Cuzk aisconnect cower cord, 20' standard length, ^eavy duty 1613 SJTW with 5 or 230 vo:t gn:urc'ng o:uc ■ Compie:e unit is heavy duty% cortable arc Compact ■ Mechanical seal is arbor, cearric, BONA and stainless steel. ■ Stainless steel `aste ie,s, AGENCY LISTINGS 0a .:S Tested to UL 778 and CSA 221 108 Standards By Canadian Standards Assoda0on File *LA38549 Goulds Pumps is ISO 9001 Registered. Goulds Pumps <X> ITT Industries w Ws Dept o` Safety ano Professona: Services SOIL EVALUATION REPORT Page / of Div!son of Safety anc Buildings m accoriance, with SPS 385 Ws Aden Code County Attach complete site clan on paper not less than & V2 x 1' inches insize. Plan must I S�- 674c4K include, out not limited to verficaf anc horizontal reference ooim (BM) eirectior. and Parce I D oercent slope scale or dimensions. north allow anc IOcatior and distance to neares! roac. i Please print all information. I Reviewed by Date 'ersonai information you oroviae may be usec for secanoary purposes (Privacy'_aw. s. -5,04 (t) {m)) Property Owner j (( Property Locabon .� V .4d' ? �/.+-K.s� 7V'LL $+- GOAL Lot S� 114S4C1114 S Zis2- T U N R ((Q E (ori N I Property Owners Mail= Address Lot # I Blocx # Sum Name or CSM# 2,m37 (2Act City Stale Zic Cooe Phone Number ❑ Cary ❑ Village [Town Nearest Road Li a¢rlU; 4 1 'I-Syr,4, (Zf5) fY5 937G '_j New Constructor Use x ,Resioen ial i Number of bedrooms 3 Code eenvec cesign flow rate ySO GPD ZReolacement PubPublicor commerda! - Describe Parent material d 1p-LL- .i 4 L( R000 Plain elevation if applicable General commems and recommenoauons Bonric # M Boring p,r Grouno surface elev tl �% (✓ �l f nenth tr, llr„.fl ll ;.-t— I Soil Ao licatior, Rate Hgnzon f Dept^, in i Dominant Colo-1 Munsefl Redox Description j Texture Cu Sz Cont Color I V Structure r Sz. Sin consistence oundary Roots GPD) t ' -ff#2 I a- o /eY�c•3/2 i ! s ' 2.4s1 �v :- ' c s i l� : � I , S' /?-Ict b tLs/ SG �/��SbK {� i c'S o.v o,v II�'�I b/� 1 C i�° 5/ iZ� I��xOY(oS S C- i �7 SLaK � i�-Y - S I /� O. [i O• �; jBoring # �' Borng q ` pit Ground surface elev 3 YI ft Depth to lim�ung factor Horizon of In Dominant Colo• Reoox Descnpbor Texture Munsef Cu. Sz Cont Colo Stricture Gr. Sz Sh onsistence am Bounoary Roots GPDtf( •Off#1 ff#2 /d : {6 LZ3/2 Sv / pp j5 /hVYr ' le— ?' /� 7rc-3/ i � � L�r-S6K .�tV�✓ C'S / � , �r • �' ii I lei— /o rest 7-srte"/a �'td .%S Sc- ?,><s1K Me.�� ' J I I i _men: e i = nQtl , ' Sl < L U mg/L anc 155 13, < 150 :3 1267�. /L ' Effiue,a #2 = BDD . < 30 mo_/L and TSS < 30 mot; e CST Number Date Evaluation Coneuceeo Telephone Numt 3 ?'/l020� ?r5 2Gry, PropertyOvmer �ol...-c�.r�, Parc=:IDft �r—� Boring # ® Borino i ❑ pit Ground surface e!ev_ l-20 f:. Depth to limiting `actor i- Page Z of 3 Hodzan ' Deptr. Demmant Color Muns=11 Redox DescnpLor. ; extura Strud wire bormstenoe Out Sz. Conn cotor " Gr Sz. Sh. �oundsry j Roots •5f : w:, nwn:.ewr Hale GPD.Yt r l tffa:2 At I, !ix 1 /-P I .4 ! ! 0,0tr6k, A?04, c.s' /-P , 2 ,, 3 -7. T• Oz, &'/S' Dv >p_l Sc- i h*, 56 K i /h41 i 9.y — e u I O e) � _� f�` YZ �lr tK, �/i i7.5�t��/B�ldJpertj •�'s � Din � /� {�i� �e S � _ 1 S , � a � Boring * U Boring t_I ❑ pit Ground surface elev. ft Deptn to limiting factor In. Horizon ( Depth ' ir. Don:mant Colo Munse!I Redox D=_scnpt,on , Texture Ou, Sz. Cont, Cola: Strucbre 4onslsh_nce ; Gr. Sz. Sr.. oundary .Roots - G?Dift ff#1 •t::f#2 I j I i I I , ,� r ❑ Boring Boring ❑ pit Ground surface slev_ t•.. :Depth to limiting factor in, r�---- Snit arvdl irahnn Rero Horizon Depth ! Dominant Colorl Redox Description. Texture ! Structure Gonsisterce in. j Munsell Ou Sz. Con:. Colo, ! Gr Sz. Sh_ I oundary I Roots I GPD/f; j 'ct`C.' tf92 ' Etiuent tt = BOD , > 30 - 220 mglL and TSS >3J < 150 mgl_ ' Effluent #2 = BCD : < 31-'mg/L and TSS < 30 ny.L The Dept. of Safety and Professional Services is an equal opportunity service provider and anployer. if you need assistance to access services or need material in an alternate format. cronmot the department a: 608-266--151 or T-IN through Relay SaDd33 (al III:) CHECK BO%AS A?PLICABLE. ✓0 SOIL EVALUATION SITE MAP PROJECT NAME: Adolf Johnson Trust CHECK BOX AS APPXABLE. Scale: 1"=40' SYSTEM PAGE 2 OF-3 o ao so so PLOT PLAN t,C tl goal 1D' OESiGN FLO'N GPD Attach design flow calculations for commercial plans. PROJECT ADDRESS 2637 12th Ave, Woodville, W I Pipe Material 1 ASTM Standard (Tables 384.30-3 8 384.30-5) N SanM y Sewer BM Symw 100.00 OO.� eM Elevatlon FT Force Main: 7 BM Doscdwn grade Q west post field gate i�.aKam noon o-r IMPORTANT Gradient(!6) SlopeArea ( 3o Wen Symed(Vappscaole): O /o arawinv an a.o., Show ground eletion contours at suitable intervals va of Teslerted on Ida approprNe M i t=e-wcr Its _ 9lr 4•t`— —,— — —B Ac IC --o" o.lTrusf s6 vY Sw 'ly S 25 2-8 Al jii� haw C�er� T s'P g2 95 8.3. t33 = 9z zo ts`!c SkPy Roll, s,�jkw� i as - — — 92.1Z 1 It. 59' Ii0 --I ST. CRo UNTY SANITARY SYSTEM Filece Office Use Only OWNERSHIP/ADDRESS FORM Created 212021 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the Property Files Scanned weblink. OWNER/BUYER INFORMATION Owner/Buyer t'q41'f1X f,4elt 4ce5- Mailing Address 2637 (2v`�A� �- City/State/Zip /,(jael"& J-YpZ� Phone Number (required) :1 r S - tf%5— %3 %40 Email Address Parcel Identification Number 00g'- 1672 - $ o -Ooa (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location 515 1/4 , S� t/4 , Sec. J T 28 N RAW, Town of Subdivision Plat: 4 c a Cw Lot # CTertifYed S B ey M a # S _ Volume Page # Warranty Deed # l l2 $11 O (before 2006)Volume —� -Page # Number of bedrooms (2 Spec house CI yes R( no Lot lines identifiable JKyes a no OFFICE USE gNLY /� New Property A ress �%�03 /Yk' Z Z�f^ Ae- -'Cr%i QRt' GcC s Nenficatio of new address required from Community Development Departent for new construction.) �4 0/ (stiff Initials) (Date) This form must be submitted with all Private Onsite Water Treatment System (POINTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Once and a copy of the certified survey map if reference is made in the warranty deed. Community Development Department - Land Use Division 715-386-4680 St. Croix County Government Center cddPsccwi.gov 1101 Carmichael Road, Hudson, WI 54016 715-245-4250 Fax www.Scaingov Parcel #: 008-1072-80-000 Valid as of 09/30/2021 05:28 PM Alt. Parcel #: 25.28.16.380 Owner and Mailing Address: JEFFREYJ JOHNSON DARLAJJONCAS N534 RIVERVIEW DR SPRING VALLEY WI54767 Districts: Dist# Description 5586 SCH DIST SPRING VALLEY 6100 CHIP VALLEY VOTECH Abbreviated Acres:40.000 Description: SEC 25 T28N R16W 40A SE SW EXC N 1 RD TOWN OF EAU GALLE ST. CROIX COUNTY, WISCONSIN Co-Owner(s): HARMON, DEBORAH L JOHNSON, DALE E JOHNSON, DIANE M JOHNSON, DOUGLAS S more... Physical Property Address(es): * 2637 12TH AVE Parcel History: Date Doc # Vol/Page Type 04/19/2021 1128110 / TI 04/19/2021_-128111 / QC 10/09/20_17 ;1055233 ;/ COINS 08/31/2017 10 4- _ WD more.. Plat Tract (S-T-R 401/4 1601A GL) Block/Condo Bldg * N/A -NOT AVAILABLE 25-28N-16W 2021 Valuations: Values Last Changed on 08/31/2021 Class and Description Acres Land Improvement Total Gl-RESIDENTIAL 2.000! 12,000. 00', 94,400.00 106,400.00 G4-AGRICULTURAL 17.000 2,000.00 0.00 2,000.00 G5-UNDEVELOPED 18.000; 19,600.00, 0.00 19,600.00 G5M-AGRICULTURAL FOREST- - -� 3.000 _ 3 900 00' 0.00 3,900.00 Totals for 2021 General Property 40.00� 37,500.00 94,400.00 131,900.00 Woodland --', 0.0001 0.00 0.00'. 0.00 Totals for 2020 General Property 40.000 37,600.00 94.4.0. 0.00 132,000.00 _ —_ Woodland _ 0.000 O.001 0.00 0.00 2021 Taxes Taxes have not yet been calculated. Key * - Primary Ws Dept. of Safety and P fessiona� viQl9 2p21 S IL E TION REPORT Division of Safety and Bwldi gs Jr yi15p,,c »nCe ' S 385. Wis. Adm. Code eve�op County Attach complete site plan o p r;vaoP 112 x 11 inches in size. Plan must include, but not limited to. v horizontal reference point (BM), direction and Parcel I.D. percent slope scale or dimensions north arrow and location and distance to nea res t d roa Please print all information. Re Wed. by Oersonal Information you provide may be used for secondary purposes (Privacy Law. s 15.04 (1) (m)) ,J/nw Page I of-j - -8,O^000 Date hd,t sLl1l4 S ?5T N R /(q E (or) Property Owner's Mailing Address Lot # Bbck # Subd Name or CSM# I 2,&;'7 (2 Av-t- City State Zip Code Phone Number ❑ City ❑ Village (aTown Nearest Road WilluedutIAt I Wf I-SYvZ 8 1 (71S )'f15-93761 $v,o. Qaat/e. 1 /2-1* " ❑ New Construction Use Residential / Number of bedrooms 3 Code derived design flow rate ZSO GPD replacement ❑ Public or commercial - Describe Parent material _ q L"-,L,4 L( Flood Plain elevation if applicable General comments and recommendations 0 i Bonng # 16! Boning / ❑ pit Ground surface elev. 4,1. ft Depth to limiting factor / In. C^, z^) Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsisboundary Roots GPD/ft, 2 ((#i {ryf2 D- o 3/7- s' Z • !e , b" 2 0--/7 0?4 '1Y s o.o I - orl�si Zsie61sprds S Y-37 r� t R �lI 1. yt�fc 7s�'I'd r FS O n. y e S tnYtL-SAS Sir - Boring /� # Boring 51— q ❑ Pit Ground surface elev .5. 83 ft. Depth to limiting factor // in 1r-7 ---7-1 Horizon Depth m. Dominant Color Munsell Redox Description Qu Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence oundary Roots GPD/fl ' f1#1 - ff#2 /-!d /p K3/Y pp /o— 7 /e i43/ Zmsxk .wV CS / G �' 3 /?-t 7 /o 14S/ -. /10- s/ ?-sYleb%8 Ord .fs sue. P.r fc irr eL S l� a. � 3 Emuent S I = uvu , > su < z2U mg/L and I SS >30 < 15() mg/L • Effluent #2 = BOD , < 30 mg/L and TSS < 30 mg/L CST Name (Pl/leasas (P'nt S�nature CST Number i ttCAtt, t-cc.I/rii.r7<X// up'/ S Address Date Evaluation Conducted Telephone Number Z`!'/3 /36 �h�-�i �f ,ss®� �i Ski 3 7 /!0 2m Z-11" -7 e S 265 y//5 Property Owner J*"-41.41— Parcel ID # pan. Z ,.f _�? 1157 Bonno # ® Boring ❑ pit Ground surfaceelev. Z - ZO P. Depth to limiting factor in. Soil Ao liafion Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont Color Texture Structure Gr. Sz Sh. onsistence Boundary Roots GPDKI a Eff#1 • ff#2 4-� /oyes/y sr/ 2MstGlc ir, c s /� , /C 4,4 $ 3 /- /0 *-s/Y .5,-- Zest sr6 k onA* cs / �' , Z 3 -L` Katit,'/Y 7,61c4,1Y,Pdp� s� A, 6K s — o,v a. u 5 -` 2- 0 ,� 8/� 7 s s r. o D Boring # ❑ Boring ❑ pit Ground surface elev. fL Depth to limiting factor in. r-----m Hor¢or, Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structuf Gr. Sz. Sh. Consistence Boundary Roots Glo ft a 11#1 - H#2 a ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. a�u n�I-i Horizon Depth in Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr Sz. Sh.l`tg11 onsistence Boundary Roots GPDRt a - ff#2 Effluent #1 = BOD , > 30 f 220 mg/L and TSS >30 1150 mg/L ' Effluent #2 = BOD 3 130 mglL and TSS f 30 mg1L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an altemate format, contact the department at 608-266-3151 or Tn' through Relay. 38"339(RI Ill 1) CHECK BOX AS APPLX:ABLE. CHECK BOX AS APPLICABLE Q✓ SOIL EVALUATION Scale: 1"-40' SYSTEM PAGE 2 OF ° 40 BD SITE MAP PLOT PLAN PROJECT NAME: 10' DESIGN FLOW: GPI) (101 Adolf Johnson Trust Attach design flow, Calculations for commercial plans. PROJECT ADDRESS: 2637 12th Ave, Woodville, WI Pipe Material 1 ASTM Standard (Tables 384.3M & 394.30-5) f oo.oa FT N Sanitary Beer BM symnol BM Elevation Force Maln: / BM Descdglon, grade Q west post field gate Indkaro noun M IMPORTANT: Slope Gradlera (%) 1Well Symbol (dappicaole). 0 drnulrg an anon Show ground elevation contours at suitable intervals. of Tested Area: on tine appropdta als F=exce Ifs _ 9e4'7- — — 14`rG SIcPa q 5.85' — — q 3 '78' EIIA4l, !"5k , — — 93 - — — f2." I 'I A&Ifr''316" f s6 Y.{ sK 'ly S 25 7— 28 A/ K / o w Cow qdAite— -Ts'P 3 t = 9?. lv -/ r3z = 95 33' 33 9z. Zo ( 9q(4e&,q&T ' ^ STIWI)e couNrr NO. 633935 STATE SANITARY PERMIT TOWN OF K. .4LLB SEC�,T N, R.�� AND/OR LOT BLO SUBDIVISION NO. STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought and that changed regulations may impede renewal. (1) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. ISSUING OFFICER - DATE I r,2,,A,.Z / UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI1/20)