Loading...
HomeMy WebLinkAbout038-1177-50-000 Nisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 479327 0 (ATTACH TO PERMIT) GENERAL INFORMATION St to Plan ID No: Personal info tion you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. = 7"AK . - Permit Holders ame: City Village X Township 1 Tax No: Fireside Enterprise LTD I Star Prairie, Town of 038 - 1177 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: UU .O •O CS w` ( 04.31.18.880 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURE CAPACITY STATION BS HI FS ELEV. 4 ' Po/ %•�- SZS Septic V Benchmark Dosing t. BM �r S:G� -� IISSa �, oq.� Aeration INdg. Sewer 33 Og;ff Holding St/Ht Inlet t 9. L S loS.82 St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic , / Dt Bottom , 93 IT Dosing l t( 2 + , / 3 + Header /Man. i Aeration T" Dist. Pipe o7 - � + Holding Bot. System 8 -5 0 1 O:1.80 Fin I Grade u PUMP /SIPHON INFORMATION y W ro be 1241 ~ 6 6 W J Manufacturer / n �s GPM Dema St Cove p O r O . SZ Model Number TDH Lift Friction Loss System Head TDH Ft n „ B ( p D.3 D -g gt Forcemain Length I Dia . ++ Dist. to Well $ A� p ZZ .a+ 2 SOIL ABSORPTION SYSTEM RENCH Width t Length t No. Of T enches PIT DIMENSIONS No, Of Pits Inside Dia. Liquid Depth DIMENSIO O 13 SETBACK SYSTEM TO P/L LD WELL LAKE /STREAM LEACHING Manuf t rer. INFORMATION CHAMBER OR Type Of System: n_ UNIT �rGtde o tuber: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size p x Hole Spacing Vent to Air Intake Pipe(s) r 0' I (p // Length Dia 2 Length / D• 32 Dia Z Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of ded xx Mulched 1 TX Seeded /Sod Bed/Trench Center Bed/Trench Edges Topsoil 1 Yes No [ Yes No �G. CO ENT : (In; ude d discx[e ncies,prsonsppr ent, etc. Inspection #1:1A �� / 7-M5 Inspection #2: -1 Location: 2398 110th Street Star Prairie, WI 54026 (NE 1/4 NE 1/4 4 T31 N R1 8W) Mallard Run Lot 18 0: 1.) Alt BM Description = D� S , ' 2.) Bldg sewer length = 3 5 + ��" p•Z - amount of cover = 4 a „(.,Q 3) Gs r -- Plan revision Required? ] Yes No J�9 0 Z r, ,�7 - �rt �I / ' J � Use other side for additional information. v � Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County ` 201 W. Washington Ave., P,O. Box 7162 ii Madison, WI 53707 - 7162 Sanitary Pe it Number to be died in by Co.) s�ansin G artment of Commerce (608)2 6=gjS1 PI LD. Number Sanitary Permit Application _ s a /) In accord with Comm 83.21, Wis. Adm. Code, personal information y provide may be used for secondary purposes Privacy Law, s15.04(1 x ) 1 S 2 ject A dress (if different than mailing address) 1. Application Information- Please Print All Information OFF CE Property Owner's Name _ race U I of N 8 B tx k N — 1 / 0- tin 038 ��-5 C. Property Owner's Mailing Address Property. Location Section _ try, Late Gip Code Phone Number • cl cire r T,�L N, R , * o ) II.1'ype of Building (check all that apply) ar g w1oY►r� � ,N(1 or 2 Family Dwelling - Number of Bedrooms Ong Subdivision Name E1v4 Pktrnber ❑ Public/Commercial'- Describe Use ❑ State Owned - Describe Use ❑City ❑vi agVj8 hip of 4WI k- III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. � New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision . 11 Change of ❑ Permit'liransfer to New List Previous Permit Number and Data Issued Before Expiration Plumber Owner v' IV. Type of POWTS System; Check all that appl ❑ Non - Pressurized In -Ground ❑ Mound >_ 24 in. of suitable soil ❑ Mound <24 in. of suitable soil At- redo ❑ Single Pass Sand Filter © ` Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leachin Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersaVl'reatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (sf) Dispersal Area Proposed (so Systani $lt>wation VI. Tank Info Capaciry in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass Now Existing Talcs Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Climber VII. Reapo sibility Statement- 1, the undersigned, ss9umey`esp,,,ibi for installation of the POWTS shown on the attached plans. Plumb is am ( ' t) Plumber' ignatur MP/MPRSNumber Business Thone 3 7-f;3-7 _k Plu ber's Address (Street, City, Ste , 'Lip Code Vlll. Coun /De artment UNe Oal Approved ❑ Di / Sanitary Permit Fea includes Groundwater Date Issued Issu Apat Sigtlature (No stamps) ' Surcharge Fee) o ❑ Owner Given Ron r ial T �� �� eas IX. Conditions o prove Rome is fe ffisapprWMI SYSTEM MlffER: -- 1 Septic tank, effluent filter and CS j dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained is perapplicable codefordinances. Attach complete plans (to the County only) for the system on paper not lie than 81/2: I Inch" in 4" SBD -6398 (R. 01/03) - i_ i i 1 , i tl o j � � 1 { a i _I I a7 i I M , Azs YL y I s :)py -- Safety and Buildings 10541 N RANCH ROAD commerce.wi.gov HAYWARD WI 54843 TDD #: (608) 264 -8777 i sco n s i n www.commerce.wi.gov /sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary July 12, 2005 CUST ID No.224263 ATTN.• POWTS Inspector KIM A O CONNELL ZONING OFFICE K.O. CONSTRUCTION ST CROIX COUNTY SPIA 504 3RD AVE 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/12/2007 Identification Numbers Transaction ID No. 1151216 SITE: Site ID No. 700960 Fireside Enterprise Ltd Please refer to both identification numbers, 110TH St above, in all correspondence with the agency. Town of Star Prairie St Croix County NEl /4, NE1/4, S4, T3 IN, R18W FOR: Description: New at grade system, 3 bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 1026517 Maintenance required; 450 GPD Flow rate; 40 in Soil minimum depth to limiting factor from original grade; System(s): At -grade Component Manual, Sl3D- 10570 -P (R.6/99) a The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes r 4 and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in F chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. 7' T No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.0 , stats. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans and with the design manuals noted above. • In the event this soil absorption system malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described the At Grade Component Manual are complied Key Item(s) • The designer proposes to install an effluent filter to achieve the requirement of wastewater particle size. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the septic tank outlet filter will be required. The outlet filter shall be installed per product approval stipulations. Note • The proposed pump settings have been adjusted provide a dose volume that is greater than 5 times the void volume. An older version of the CREW was used to design this at grade system and there is a glitch in the program allowing too small of a dose. Reminder • The orientation of the at grade system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. KIM A 0 CONNELL Page 2 7/12/2005 • Limit activities in the area 15' beyond the down slope edge of the at grade per At grade Component Manual. • Surface water drainage shall be diverted away from the system area. • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(i). 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 Safety& Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee a 1 pro ' e a copy of this letter to the owner and any others who are responsible for the installation, operation maintenan of the POWTS. Sincerel Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Patricia L Shan POWTS Plan Reviewer, Int rated Se ices WiSMART coder 7633 (715) 634 -7810, Fax: (715 634-5150, M -f 7:45 am - 4:30 pm pshandorf @commerce.stat i.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 RESIDENTIAL AT -GRADE DESIGN Pressurized - Sloping Site INDEX AND TITLE SHEET Project FIRESIDE ENTERPRISE LTD Owner FIRESIDE ENTERPRISE LTD Address 225 185TH ST STAR PRAIRIE WI 54026 Legal Description NE-- NE-- SEC4 - -T31 N--R1 8W Township STAR PRAIRIE County ST. CROIX Subdivision Name MALLARD RUN Lot No. 18 Parcel ID Number Plan Transaction Number Index sheet Page 1 0 M CE Calculations Page 2 Y AN B i cs At -grade drawings Page 3 Laterals and dose tank Page 4 ;pCNp CE Specifications Page 5 Management & contingency plan Page 6 PUMP CURVE Page 7 PLOT PLAN Page 8 �p Designer KIM A. OCO N UL License Number 224263 Signature Phone Number 715 - 755 -3145 _Z Date 06 /20/05 Designed pursuant to: At -grade Component Manual for POWTS SBD- 10570 -P (R.6/99), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST - SAS (01/81) Version 3.0 (R. 03/01) Page 1 of 8 I PRESSURIZED AT -GRADE DESIGN At -grade Design Worksheet - Sloping Site I Flows and Site Data Entry. (r or c) r Residential or commercial? 300.0 Estimated wastewater flow (gpd) 450.0 Design wastewater flow (gpd) 7.00 % Site slope 107.50 Contour elev. below lateral (ft) 40.00 Depth to limiting factor (in) 0.40 In -situ soil application rate (gpd /ft ^2) Distribution Cell Information (1 or 2) 1 Influent wastewater quality 4.50 Linear loading rate gpd /ft 10.00 Effective absorption width (ft) 10.00 Max. effective width permitted (ft) 113.00 Aggregate length (ft) Pressure Distribution Data Entry (c or e) E Center or end lateral connection 1 Number of laterals Not a final 0.125 Orifice diameter (in) e.g. 0.188 calculation 2.00 Estimated orifice spacing (ft) 2.00 Forcemain diameter (in) 2.40 Forcemain flow velocity (ft/sec) 50.00 Forcemain length (ft) y or n y Does forcemain drain back? 100.00 Pump tank elevation (ft) y or n y Are laterals at highest point? NA 6.5 System head (ft) x 1.3 8.2 Forcemain drainback (gal) 7.33 Vertical lift (ft) 90.0 5x Lateral void volume (gal) 0.62 Friction loss (ft) 98.2 Minimum dose volume (gal) 14.45 Total dynamic head (ft) 23.5 System demand (gpm) Lateral Diameter Selection Gallons /Inch Calculator (optional) Pipe diameter Design options Design choice F70 Total Tank Capacity (gal) Designer 1 in x 1 51 JTotal Working Liquid Depth (in) must select 1.25 in x 19.6 Gal /in (enter result in cell G46) one lateral 1.5 in X diameter 2 in x X Treatment Tank Information 3 in x F S tic tan capacity (gal) WEEKS Manufacturer Effluent Filter Information Dose Tank Information Zabel Filter manufacturer 800.0 Dose tank capacity (gal) A100 Filter model number 211.81 Dose tank volume (gal /in) WEEKS Manufacturer Project: FIRESIDE ENTERPRISE LTD Transaction Number: Page 2 of 8 AT -GRADE PLAN VIEW � D 1/6 B Observation pipes (2 typical) A 10.00 ft D B 113.00 ft t-- 1/6 B 18.83 ft C 12.00 ft W c D 5.00 ft E 2.00 ft L 123.00 ft D B W 22.00 ft A x B 1125.00 ft ^2 L i Cap Typical obs. pipe. = Total aggregate cell A x B Slotted in the lower 6 ", and anchored = Plowed area L x W securely. 6" AT -GRADE CROSS SECTION Svnthetic fabric cover 109.33 ft Finished grade Lateral elevation invert elev. 108.00 ft �— Observation pipe at aggregate toe E Surface contour 7 % Slope and system 107.50 ft C A elevation ® = 12 in. topsoil and subsoil plowed layer over aggregate and tapered to toes. y below L x W = 6 in. aggregate below pipe(s), and 2 in. above pipe. Project: FIRESIDE ENTERPRISE LTD Transaction Number: Page 3 of 8 PRESSURE DISTRIBUTION AND DOSE TANK Lateral Diagram - End Connection P Last hole dlrilled next to end cap 1+ x I Laterals & force main of PVC Sch 40 Holes drilled on the bottom of the lateral (per COMM Table 84.30 -5) equally spaced • = Turn-up vwlbsll valve orolesnoutplug Lateral Specifications 0.125 Orifice diameter (in) End Lateral connection point X 1.97 Orifice spacing (ft) 1 Number laterals 57 Orifices /lateral P 110.32 Lateral length (ft) 23.5 Lat. discharge rate (gpm) 2.00 Lateral diameter (in) 2.00 Forcemain diameter (in) 23.51 Sys. discharge rate (gpm) 50.00 Forcemain Length (ft) 14.45 TDH (ft) Typical Pump Chamber Layout Approved manhole cover with Weather -proof —` warning label and locking device junction box Final grade 4" disconnect _ Tank component is Alternate properly vented R outlet location 18" min. Electrical as per NEC 300 and 0 X' Approved outlet joint Comm 16.28 WAC Tank full Inches Gallons q � a Provide 1!4" A ZZ 4 &CAlarm on weep hole or . d B 2.0 43.6 g antisiphon l: C $•C7 . Pump on device. G D $.0 174.4 100.67 ft C Totals 800.0 -� Pump off 3,7.0 D 3 Bedding under tank ~ 100.00 ft Goulds Pump manufacturer JSJ Electro Inc Alarm manufacturer WE0311 L Pump model number 1101 HW Alarm model number Project: FIRESIDE ENTERPRISE LTD Transaction Number: Page 4 of 8 At -grade System Maintenance and Operation Specifications Service Provider's Name KIM A OCONNELL Phone 715 -755 -3145 POWTS Regulator's Name ST.CROIX COUNTY ZONING Phone 715 - 386 -4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 1125.0 ft Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Ins ect for ponding and seepage once every 3 years Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the at -grade component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The at -grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. 6. Areas within 15 feet of the downslope toe will be protected from compaction. 7. All other construction details are as per the at -grade component manual SBD- 10570 -P (R. 6/99). Lateral Turn -up Detail Finished .., ......••. .. ..............................* Grade 6 -8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: FIRESIDE ENTERPRISE LTD Transaction Number: Page 5 of 8 At -grade System Management Plan Pursuant to Comm 83.54 Wis. Adm. Code General This iystem shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10570 -P (R. 06/99) and SSWMP Pub. 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet finer shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. At-arade and Pressure Distribution System No trees or shrubs should be planted on the at- grade. Plantings may be made around the at- grade's perimeter, and the at -grade shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the at -grade is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October - February) dictate that the at -grade be heavily mulched as protection from freezing. Influent quality into the at -grade system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5, 30 mg/L TSS, 10 mg/L FOG, and 10 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the at -grade component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by renovating the biologically clogged absorption and dispersal media, installing new piping, and replacing other components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: FIRESIDE ENTERPRISE LTD Transaction Number: Page 6 of 8 MGOULDS Submersible Effluent Pump MODEL 3 88 5 FJ WE Series muyy, ww , PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. APPLICATIONS ■ Shaft: Corrosion - resistant, Single phase (60 Hz): can be operated continuously stainless steel. Threaded • Capacitor start motors for without damage when fully Specifically designed for the design. Locknut on all models maximum starting torque. submerged. following uses: to guard against component • Built -in overload with ■ Bearings: Upper and • Homes damage oil accidental reverse automatic reset. lower heavy duty ball bearing • Farms rotation. • S1TOW or STOW severe duty construction. • Trailer courts oil and water resistant power • Motels ■Fasteners: , series p ■ Power Cable: Severe duty • Schools stainless steel, cords. •'h and ' /: HP models have rated, oil and water resistant. • Hospitals ■ Capable of running dry NEMA three prong Epoxy seal on motor end • Industry without d,unacle to provides secondary moisture • E:ffluenL systems eomponenb. grounding plugs. • 3 /a HP and larger units have barrier in case of outer jacket prevent oil and to ■ Designed for continuous bare lead cord ends, damage P operation when full wicking. Standard cord is 20'. SPECIFICATIONS P y Three phase (60 Hz): submerged. optional lengths are available. Pump ss overload protection P • Cl 10 ld t ■ 0 -ring: Assures positive • Solids handling capabilities: MOTORS mu provided 9 must be i P sealing against contaminants ' /t" maximum. separately ordered starter and oil leakage • Discharge size: 2" NPT. ■Fully submerged in high- unit. g ' grade turbine oil for lubrication • STOW power cords all have •Capacities: up to 140 GPM. and efficient heat transfer, bare lead cord ends. AGENCY LISTINGS • Total heads: up to 128 feet Tested tD UL 778 and TDH. ■ Class B insulation on ■ Designed for Continuous C� ® CSA 22.2 108 Standards • Temperature: '/3 -1'/2 HP models. Operation: Pump ratings are Bycawimstand,%* 104 °F (40 °C) continuous ■ Class F insulation on 2 HP within the motor manufacturer's u S Ass0dati0n File #1838549 140 °F (60°C) intermittent. models, recommended working limits Goulds Pumpsisl Registered • See order numbers on reverse side for specific HP, METERS FEET voltage, phase and RPM's 40 130 E15H _ ___ __ __. SERIES: WE available, 120 _ } SIZE: 3/.• souos 35 I _ _ .- .. _......_.. RPM: 3500 & _ II r_ FEATURES vvz K __ .- .- e,[. -5GPM ..._ _. _ 110 30 10Q �— _ ._.... .. _..._..._. i ■ impeller: Cast iron, semi oo wEt H f ". _ - �. . st open, non -clog with pump -out q 25� sol - -�- W _ vanes for mechanical seal _ ------ . .. _ _ ^_ �.. _ protection. Balanced for 2 -" - Q , r smooth operation. Silicon > 60 20 lo 1 _. H bronze Impeller available as ° W 0 - r - - - - - -_ - . � is so - .. T _ - - .._ - an option. 40- - ■ Casing: Cast iron volute type 10 W 3U' _.._ for maximum efficiency, 2" NPT discharge. s 20 ", _ 4 III Mechanical Seal: SILICON 1 o r , i _. � _ _ ___ _... - -- ---1- CARBIDE V$. SILICON 0 10 20 30 40 50 40 70 80 90 100 110 120 130 140 150 160 GPM CARBIDE sealing faces. _ u J I I I , Stainless steel metal parts, 6 s 10 15 20 z5 30 35 m BONA -N elastomers. CAPACITY Goulds Pumps 6 Goulds Pu mps ITT Industries Eff ectwe July, 2003 �,vvvv .yvuids,cgm 338b I ' I I , i ,v I I ; o � � , i I I dy Wisconsin DPoartment of Commerce N REPORT Page of Division of Safety and Buildings in acco ance wit d Adm. oe " county Attach complete site plan on paper not less tha 81/2 x ch�s n si e. Plan m t include, but not limited to: vertical and horizontal referela�e ind(BI),}on an Parcel I.D. c� percent slope, scale or dimensions, north arrow and location and distance to near st road. 63 L ST .CROIX COUNTY Date Please print all i formq%G OFFICE Personal information yo pro ide may be used for sec on a t1 (m))• Property Owner I p Property Location a N)'5 D t' LID Govt. Lot f 1/4 1/4 S T,31 N R E( W Property Ciwner Mailin Address Lot #� Block # T r � Name or CSM # as 5 N6` `" St. T 1• �ti A.1^ utV Ci State Zip Code Phone Number ❑ City ❑ Village �A Town Nearest Ro � r- r� -: t^�L S New Construction User Residential / Number of bedrooms Code derived design flow rate _ S GPD ❑ Replacement —►'� / / ❑ Public or commercial - Describe: Parent material (_' I l vt o es 1-% V►1 X Flood Plain elevation if applicable _ ft. General comments -:r: :5 5 � 5 .{ c� r X 5 `,off$ , t S { ti� 1 D M0 V•^ S 4L and recommendations: ' J } 1 Curoc�- /D 79 �ba..S�� ova Ib1.213" Gon`f'��r� U Boring # Boring I� Pit Ground surface elev. ft. Depth to limiting factor 31_ in. .Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 I `Eff#2 o s x5b �L - G.w aF: G 1 1j\ an�sy'VL -34 25�P-Y/Y ^` FS ogbbvt sv►aF� Lw lu�r , S /, V Us F a FS.� rnJ�r� a Boring # El Boring L I ® Pit Ground surface elev. aD• 33 ft. Depth to limiting factor ' `' in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 5 fhb k tMFr e w F 1.0 R5 w\,,) fr 4-w 10 is 1 Now I Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD 5 30 mg/L and TSS 5 30 mg/L CST Name (Please Print) I Signature Address � .� (, s„� � Date Evaluation Conducted of Telephone Number A. S L/ t) a i Property Owner l.�'r- r tea -v►S N Parcel ID # Page A of F3� Boring # ❑ Boring Q 9 Pit Ground surface elev. S ± +� ft. Depth to limiting factor / _ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 3 - l0 7�Y(Zy /y a►Msb� MFr Gw uF 1, o -ya �•sy�.y m56w c.ti .3 s c. o -w, w� ; — • a . F 1-1 Boring # ❑ Boring rp Pit Ground surface elev. 0• a.7 ft. Depth to limiting factor 37 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 -� Na — LF 1 b i CA r�► M�lr w rN1 y , to r Y y ---- s L A sb k SFr e - W I . y ,g F7,5YRG S L. l> p"1 /�� � G w -- - 9 , !o '115YQ51N a -5 w► L -'" ,'] 1, (o -r 1 F Boring � Boring # nn Ground surface elev. �a ft. Depth to limiting factor in. 4 Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 o - S i) a L - d S K, rA c� w � r+1 • S 5 c_ ' ' M fg - Se, v%f< e- !vF lv 7.3 � c L ll" W% e- Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L ' Effluent #2 = BOD, < 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. SBD -8330 (R.6 /00) T 7 fi 1 f ►; AA Z T- ` -,-- - _ T o . • -- - Coll . a C - 6 L do tn vi s ► � -t- - .r o oz CD ca `a a LU _.. _. i _. ___ ___ __ .___ _. __ _ _._ ____ __ _.__ __.__ _.. _ _. _. _. _.. _.._ _._ _. _ .. � _ _. _ _.. _. __. __ 1`7HY- Y''L iOb' b7 : N 1 F'PI tlL REFERENCED TD U.S. G.S'. w r um, 59.Of RAW NAT. ,GE00VICAL oArum OF MR X ROAD N.8e 5 E. 1319.53' _ �- , N.88 E, 1286.38' 51.19 -- ---- - - - -•- —__ _ .178.00 --- -- T_330.20-- •-- - -1 33 33' A.P. U } o W, EL. - 997.2 /� , f. 83 AC. y I N 1 HI, W. EL,+ 997.2 / �7 3 25' 25 IN 100 to y' o -� 8 v, o so, Fz ? --- 338.aa -- o 4. / AC. $ AP $ O 'o + 17 0 IM 67, 650 S4, F w o o PONO� 209, 00 s4. FT, o+ / 35.4C. I I � o .—� ►' 4.80 AC. w „ I S p W. El. IOOi.0 HI A EL., * 100 i N � C � A ' P 145A7 f � � ;� \ W.Et.: 1 010.4 na \, 9 W EL.= 1001.1 H1.W. ELr 1010. 6` NI. W. Et.i IOOLS r V � 0 6T, 650 $0. F o `+] b 0� o \�,D ;, ;' POND ,� 0 1. AC. ' o w �' { a90 00 `;oo,'w. ; �, S.90 0 " w1 330,00' ` N. A0 33 1 S4 ,0o --,.. 176. /6B, P • K 90 °0000 "E. 490.86' 249.00' , I W. Et.: 1016.4 S 94 4d W 8 80.5 % 1 HI, W. EL. = 1016.8 N I J �w ce 0 LANDS i Jr 0 , s /�® 3.OT AC. �► N,90 0 E. 2094d 1 u` 8.90'00 1 2 0, f t2 ;.00 176.00 _ .- ,-� : J ea rwM =gi E�s�3'�EaRe�� $ �F M L 0 r S N 9 15 200.04M foo - 00 - W 300.00 ' 40 , too' ' I sG. F ��* , I oo r. 4C , $ I� 781.40 ` F i U 28 19 P 3 7 4 797 1 - 7a XATHLEEN H. WALSH State Bar of Wisconsin Form 2 -2003 REGISTER OF DEEDS WARRANTY DEED ST. CROIX Co., MI RECEIVED FOR RECORD Document Number Document Name 06/89/2885 18:15AM WARRANTY DEED EXEMPT it THIS DEED, made between David L. Persells and Cheryl A. Persells, husband and REC FEE: 11.08 wife TRANS FEE: 128.78 ("Grantor," whether one or more), COPY FEE: and. Fireside Ente rprise, LTD CC FEE: ( "Grantee," whether one or more). PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following Recording Area described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property") (if more space Name and Return Address is needed, please attach addendum): j 2. f D-4 Lot 18, Mallard Run. St. Croix County, Wisconsin. P C) &X DSceo(oL �I s'yoa© 038 - 1177 - 50-000 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 0 !�j 3 1 1 1 1 0 (SEAL) (SEAL) * avid L. ersells (SEAL) _D (SEAL) * *Cheryl A. Persells AUTHENTICATION ACKNOWLEDGMENT Signature(s) David L. Persells and Cheryl A. Persells, husband and wife STATE OF ) ss. authenticated on COUNTY ) Personally came before me on *Kristine O and the above -named TITLE: MEMBER STATt BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and acknowledged the same. authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: Notary Public, State of Attorney Kristina Ogland My Commission (is permanent) (expires: ) Hudson, WI 54016 (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 C 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 * Type name below signatures. INFO -PROTM Legai Forms 800 - 855 -2021 www.intoproforms.com Wiscdnsin Department of irr dnstry; SOIL AND SIT TION Labor•and Human Relations t t t Page of Division of Safety and Buildings in accordance ! h A , 3 �� r CC Attach complete site plan on paper not less than 8 1/2 x 11 inches in si a an s C0 include, but.not limited to: vertical and horizontal reference point (BM) df tion percent slope, scale or dimensions, north arrow, and location and dis nce to n road'{, P c I L.Di # /�. 3d', � APPLICANT INFORMATION - Please print all informs ��'�` Re e b Date Personal information you provide may be used for secondary purposes (Privacy La s. . (1) (m)). Y, Property Owner aJ < o 3 t '� /✓fi /4,S T T3/ ,N,R /8 E (or) W Property Ow is Mailing Address Lot # Block# Subd. Name or CS # City State Zip Code Phone N u m b e r d/j ffdF` i Nearest Road Sf �fjd / X ��S L jTVd ( ?1 %93- 3.32'8 City ❑ illage .® Town I // fh ,RNew Construction Use: IgResidential / Number of_ bedrooms ' Addition to eXs 'n build' g El Replacement a ❑ Public or commercial - Describe: Code derived daily flow gpd , Recommended design loading rate ._ bed, gpd/ft • � t nc , gp Absorption area required AJ - a bed, ft ' 0 ° trench, ft Maximum design loading rate r bed, gpd/ft -. ? trench, gpd/ r Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site considerations C. i 2,6� �o� Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure I AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ s O U I W s ❑ U I ❑ S M U ❑ s LR u ❑ S ®U ❑ S 0 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ground c� B� , S yl'f �/ C o ,,, c�61� ,�.,, 7` i' G �✓ Z , 3 elev Depth to limiting factor in. Remarks: Boring # 13 .21 7. S y11 J . z. Ground V 2 a 7 •S`f T s1 8 -7 o IS. ft sz- 7SyA J/v sc ��;' — — , P P• v, Depth to limiting factor S Z In. Remarks: CST Nam Please Print) Si nature Telephone No. Address / Date CST Number r to /S ��4 Oil• �NC �� f�8s� S'�� r0 4 Il Q/ u SOIL DESCRIPTION REPORT ' ? PROPERTY OWNER Page o� of y PARCEL I.D.# 4 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 w Id 3 !3 G S J 8 0 7 J 7,e- Y 1 4 Sri— C' .r.,db�+c ,G o �� — bZ ;•3 Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ; �3: 6C . Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) ` Co .� � � � M 4 kA v � a 0 i d c� ♦ r ' Parcel #: 038 - 1177 -50 -000 05/06/2005 02:20 PM PAGE 1 OF 1 Alt. Parcel #: 04.31.18.880 038 - TOWN OF STAR PRAIRIE Current X', ST. CROIX COUNTY, WISCONSIN • Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * DAVID L & CHERYL A PERSELLS PERSELLS, DAVID L & CHERYL A 1089 POLK/ST CROIX RD NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 2398 110TH ST SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 1.830 Plat: 2170 - MALLARD RUN SEC 4 T31 N R1 8W PT NE NE LOT 18 MALLARD Block/Condo Bldg: LOT 18 RUN 1.83 AC Tract(s): (Sec- Twn -Rng 401/4 1601/4) 04-31N-18W NE NE Notes: Parcel History: Date Doc # Vol /Page Type 04/20/2000 621594 1504/256 WD 07/23/1997 1227/632 WD 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.830 30,800 0 30,800 NO Totals for 2005: General Property 1.830 30,800 0 30,800 Woodland 0.000 0 0 Totals for 2004: General Property 1.830 30,800 0 30,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer r S �n /Se, T''D Mailing Address Property Address (Verification required from Planning Department for new construction)_ City /State < D§r 000"o f l✓• t L" Parcel Identification Number LE GAL DESCRIPTION Property Location ' /,, '/4, See., T& _2&_ _W, Town of t Subdivision �f1 ,�) —, Lot # Certified Survey Map # , Volume , Page # Warranty Deed # �����2 , Volume 2_? , Page # Spec house 1A yes ❑ no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning 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 wastewaterdisposal 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. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that is ti em has been maintained must be completed and returned to the St, Croix County Zoning Office within 30 d so et ar e i ation date. SIGN 0 APPLICANT DATE OWNER CERTIFICATION I e) rtify th t all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the ownor(s) o 0 e p e d a e, by virtue of a warranty deed recorded in Register of Deeds Office. SIGN URE O APPLICANT DATE Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. "* Include with this application, a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed tl U 2819 P 37 4 797 1 72 XATHLEEN H. WALSH State Bar of Wisconsin Form 2 -2003 REGISTER X ODEEDS W DEED RECEIVED FOR RECORD Document Number Document Name 06/09/2005 10:15AN WARRANTY DEED EXEMPT i THIS DEED, made between David L. Persells and Cheryl A. Persells, husband and REC FEE: 11.00 wife TRANS FEE: 128.70 ( "Grantor," whether one or more), COPY FEE: and„ Fireside Ente rprise, LTD CC FEE: ( "Grantee," whether one or more). PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following Recording Area described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property") (if more space Name and Return Address is needed, please attach addendum): e( d Zf (� Lot 18, Mallard Run. St. Croix County, Wisconsin. Pd QSceo(a c_clt syoa© 038- 1177 - 50-000 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 O fEl (SEAL) (SEAL) * avid L. Persells (SEAL) _e- (SEAL) * *Cheryl A. Persells AUTHENTICATION ACKNOWLEDGMENT Signature(s) David L. Persells and Cheryl A. Persells, husband and wife STATE OF ) ) ss. authenticated on COUNTY ) Personally came before me on , *Kristina Qg1and the above -named TITLE: MEMBER STATt BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and acknowledged the same. authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: Notary Public, State of Attorney Kristina Oeland My Commission (is permanent) (expires: ) Hudson. WI 54016 (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 C 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 Type name below signatures. INFO -PROTM' Legal Forms 800 -655 -2021 www.infoproforms.com WERENCED TQ VJ S G. S. DA TUM, Cd GE®DE r1cA` DATUM pF Igeg R/ __j 4Q ob 4L r cr 79,58: 50. F T.. ° 1.83 AC. r+, l ! 25' 25` ~ p p i 8 0 1 A.P g o Ar 00 00 { ;� 1 X! � a � 17 (P fi © 67, 650 SQ?. F ° /. 55 AC. 4C. r� Lai- 0 (ZP� `. i L r ��Z