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HomeMy WebLinkAbout038-1034-20-000 o ��o g $ % k c k T ' ' § f .. $ƒ J 7 0 A 0 \/ S Q �• § ° ' ® C 4 � k r � 2» k C , o E P o ; I 2 + § o r n , « o @ c f m . / % 6 ■ ro cn � a ) m ^ _ © F � CD / §£ ¢ a 3 \ }2C � 4 \ 2 4 § § z $ 2 2 $ � k �- � ■ .. -n k k \ 0 ) \ ch ■ ■ 2 m o § 7 ( ƒgam a E � �..� -� k E ; { § § o k � 7 \ I . � � e a e E k CD 0 / / z E / R R � { OD w T 2 2 E § z Z % k � aCL CD 2§d\ . �fS § n ƒ() z § \ //CD CL � )§ /� �/j � )\k � ƒ E en ) 7 E] %\\ $ / \� 2 5D 2 0 / -\ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety and Building Division' +r\ INSPECTION REPORT Sanitary Permit No: 463056 0 10 GENERAL INFORMATION (ATTACH TO PERMIT) 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: Village X Township Parcel Tax No: City Nordahl, Luke Star Prairie Township 038 - 1034 -20 -000 CST BM Elev: Insp. BM Elev: BM Description: SectionfTown/.Ran p N R IM k 05 1 31.18.152F TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic n Benchmark Dosing Alt. BM' d;e_6je nFiolding L A- /� Bldg. Se er l3.31 St/Ht Inlet t ' TANK SETBACK INFORMATION St/Ht Outlet I o T? 't TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet N-6 V ' 2 J Septic �.�; Zy 24 DtBottom 11 � � *� G�1 Dosing y �U , p 1 Zq / Header /Man. . 4 T 1_1 Aeration [ Dist. Pipe Z. Holding Bot. System 3 PUMP /SIPHON INFORMATION Final Grade ' yq Manufacturer ✓ � 5 G emand St Cover ` o 34 Model Number TDH Lift Friction Los System Head TDH Ft J j , ,� Z�� Z6 -9 Forcemain Length 2— Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No. OfTrenc s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth '1� DIMENSIONS 3 1-f ` �� N___ SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: _\ INFORMATION CHAMBER OR Type Of System: 7 i /J UNIT L tT Model Number: OJ DISTRIBUTION SYSTEM "icy Header /Manifold 1 Distribution o x Hole Size x Hole Spacing Ven to Air Intake if Pipes) 2—k ,� 14 2 J Length Dia Length J Dia \ 1 Spacing J t �p Z �►^a SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over / Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges To soil g p `— t es L — ] No es v ii No COMMENTS: (Include code discrepencies persons present, etc.) t� ®! Inspection #1: 16 / "7 / 6 nspection #2: / / Location: 914 221st Avenue New Richmond, WI 54017 (SW 1/4 S 1/4 Tf T31N R18W) NA Lot ' i 0,J b � Parcel No: 17.31.18.152F 1.) Alt BM Description = 66p,4- Jr.oJ � a„�,ti G�.: P �B � Q 2.) Bldg sewer length = Z °(� �-° t \ P°r �.� �s (,)J� pc�c) �`j - amount of cover cab ;,�� a Plan revision Required? Yes No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor' gnatur Cent. No. MA, Safety and Buildings Division County 20 Washin on Ave P.O. Box 7162 diso 7.162, - Sanitary Permit Number (to be filled in by Co.) iiscr�nsin Department of Commerce _� -• z� 3 0 Slo Sanitary Perini `"ipliction S tate Plan LD. Number In accord with Comte 83.21, Wis. Adm. Code, personal inf tion you provide may be used for secondary purposes Privacy Law, 15.04(1)(m) Project Address (if different than mailing address) I. Application Information - Please Print All Information Property Owner's Na me Parcel t/ _ Lot # Block # Property Owner's Mail l ing Addr s Property Location ', �Ga J 'k, %,Section Ci , State Zip Code Phone Number X---9 (.v!/ /_ O O 1 (circle one) II. Type of Building (check all that apply) IIII �y /� a.+s T �_ N; R o® 0"I or 2 Family Dwelling - Number of Bedrooms Z ✓/ tk�cx �a e_ > Subdivision N e CSM Number � oer h,.�.w. ❑ Public /Commercial - Describe Use - ❑ State Owned - Describe Use ocity L01 ownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. I9'New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. El Permit Renewal ❑ Permit Revision 11 Change of El Permit Transfer to New List Previous Permit Number and Date ed Before Expiration Plumber Owner t IV. Type of POWTS System: (Check all that appl a 2 ❑ Non - Pressurized In- Ground laQ &I.224l irt' ti W6`soil IN Mo < 24 in. of suitable so" If� ❑ At -Grade ❑ Single P and Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ FVr (explain) r V. Dispersal/Treatment Area Information: -- 7 Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation - Z (b0 S°J) m _71PO I W. 7 - VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks - GO AO%4 - Z Septic or Holding Tank / lr/ v Dosing Chamber t / - v Pod � lis�L S VII. Responsibility Statement- I, the undersigned, assume risponsiWfity for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plu is Si gnature - NfWMPRS Number Business Phone Number Fogerty Plumbing #221 go I 1?A111ri Plumb jgg e ht QtAete, Zip Code) 7 1S -�v3.5 Spooner, WI 54801 6S! ot. a6 c- VIII. Co Wse Only - el 7,9 - 7 3 7 C. Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued uin gent Signature (No Stamps) Surcharge Fee) 35 f _ �� T A " -J�� ❑ Owner Given Reason for Denial ' t 1X. Conditions of Approval /Reasons for Disapproval 3 \ S SYSTEM OWNER: l W a o�wyQtr�BOMts y`,� S 1 Septic tank, effluent filter and CJ dispersal cell must all be serviced / maintained w as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only for the system on paper not less than 81/2 x 11 inches in size PLOT PLAN - page 3 of 7 r' f Scale 1 i i Z SDQ ` f 6, dN%VKO7 5 13 -a 'CXLL SL�66 f t r t s am *-! bit. 2 o � z atatu _j s� v� "t N-3� ZZt sr U — NOTES: C O O 1. Elevations shown are existing ground elevations unless otherwise noted. 2. install 4" observation pipes with approved caps. ( Z required. 3. Septic tank to be $00 gallon capacity manufactured by 4. Bench markg % S 5. Divert surface Hater around system to- prevent ponding at the uphill side. Safety and Buildings 4003 N KINNEY COULEE RD co LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 scons www.commerce.state.wi.us /sb Department of Commerce www.wisconsin.gov Jim Doyle, Governor Cory L. N Secretary July 29, 2004 CUST ID No.221180 ATTN: POWTS Inspector DAVID B FOGERTY ZONING OFFICE FOGERTY PLUMBING & PERK TESTING INC ST CROIX COUNTY SPIA 28288 MCKENZIE RD 1101 CARMICHAEL RD SPOONER WI 54801 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/29/2006 Identification Numbers Transaction ID No. 1026682 SITE: Site ID No. 636370 Delta Construction Please refer to both identification numbers, 221ST Ave above, in all correspondence with the agency. Town of Star Prairie, 54026 St Croix County SWIA, SW1 /4, S17, T3 IN, R18W Lot: 152 F, FOR: Description: Two Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 971871 Maintenance required; 300 GPD Flow rate; 9 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual, SBD- 10572 -P (R.6/99), Pressure Distribution Component Manual, SBD- 10573 -P (R.6/99); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, Con t d stats. r' A [ — The following conditions shall be met during construction or installation and prior to occupancy or use: DE RTM 0 NOF FfE General Approval Requirements: SEE CORREt • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10572 -P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD - 10573 -P (8.6/99). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. DAVID B FOGERTY Page 2 7/29/04 • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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 shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 ,� Fee Received $ 175.00 Balance Due $ 0.00 J Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 Page 1 of 7 Index and Title Sheet RECEIVE9 JUL 2 6 2004 Project Name: Mound for a Two Bedroom Residence SAFE D p Property Owner: Delta Construction D �" c DI V■ Address: 206 2 "d Street Hudson WI 54016 Legal Description: SWI /4 of the SW1 /4 Section 17 T31 N -R 18 W Township: Star Prairie County: St. Croix Subdivision Name: Csm. Vol. i Pg. 152 Lot 152F Comp. #/Parcel ID: 038-1034-20-000 CONTENTS Page: 1 Index and Title Sheet Page: 2 System Management Plan Page: 3 Plot Plan Page: 4 Plan View -Cross Section Page: 5 Distribution Pipe Layout Page: 6 Pump Chamber Cross Section Page: 7 Pump Performance Curve jA Soil and Site Evaluation Report Enclosed co�ER Mound Component Manual Used = SBD- 10572 -P (R.6/99) ANU WNGs Pressure Distribution Component Manual Used = SBD - 10573 -P (R.6/99) _ JO NllENC Plumber Dave erty MPRS# 221180 Signa r ' Phone # (715) 635 -9609 Date: 7/20/04 Mound System Management Plan Page Z of Pursuant to Comm 83.54, Wis. Adm. Code Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents at th septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shalt be deared as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that MY $tough off the filter when removed from its endosure. if the filter is equipper with an alarm, the filter shalt 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 sc.im in the tank exceeds 113 the liquid volume of the tank It 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 perormed to maintain less than maximum scum and sludge accumrilation 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 shalt be approved for septic tank use by the Department of Commerce, Safety and Buildings Division, P uma Tank The Pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to vedly'proper operation. If an effluent filter is Installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distn System Na trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound - be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (ether then for vegetative maintenance) on the mound is not recommended since sail compaction may hinder aeration of the irxr"ltra-tive surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations ( October - February) dictate that the mound be heavily mulched for frost protection. Influent: quality into the mound system may riot exceed 224 mg/L 800- 150 mgfL. TSS, and 30 rg/L FOG. Influent flow may not exceed maximum design flow specified in the pem* 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 inifiai test when the system was installed to determine if orifice dogging 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 pcndmg. l=anding Levels shalt be reported to the owner, and any levels above 4 inches considered as an impencfing hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82-84 Wis. Adm. "Code, and shall maintained in accordance with its' component manual [SBO- 14572 -P (R. 6199)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangercus gases may be present that could cause death. Septic and P=V tactic 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 lnspec:ed for water tightness and soundness. Access openings used for service and assessment shop be sealed watertight upon the completion of service. Any opening deemed unsound, defer ve, oc subject to failure must be replaced. Exposed access openings greater than 84nches in diameter shalt be secured by an effective lacking device to prevent accidental or unauthorized entry into a tank or component. - coo finaency Plar If the septic tank or any of Its components became detective the tank or component shall be repaired or replaced to keep the system in proper operating condition- If the dosing tank, pump, pump controts, alarm or related wiritZg becomes defective the defective component shall be immediately repaired or replaced with & component of the same or equal performance, if the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in fie" present location by Increasing basal area if toe leakage ocaus or by removing biologically clogged adsoq)don and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions about the operation or maintenance of this system should be directed to: The County Zoning Office at -- IIS .-. 3P6- L1 689 S T'_ 0-LLo l(, The system installer at — 1 !S 3S — at 6.09 FOGt2`!ry The tarok manufacturer at `115_ Z , j - S'z�5 lyE - Ln2 -s The effluent filter manufacturer at 1 ;2)t�Q— "2.. 1?- Z-- fine The pump manufacturer at • 630- % "t jpUt.,t� S iL 'LOT PLAIN Page 3 of 7 Scale 1"=30 aF i c .%L watt „� { � t ' ` • g am- r o UM M Ott. �o cur enr�.� t�•e.�'- `• r J Tvn S MCA J "t - c� • tis rr, � ,�, NOTES: I. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required). 3. Septic tank to be $Op gallon capacity manufactured by k^) E_ z Chu z w/ R-_48 0 ZpazL E s- . Pip ` '+u Bw Mo n-t- wt��s_ 4. Bench marks—. S ZI rszUVg� �— . Divert surface water around system to -prevent ponding at the uphill side. page 9: Of 7 P_norove_ Sr. theme? c Caveri-n'g _ AST_M C33 Distrittition Pipe Medium Sand . • -�� ,� H ,.,r 1 G Topsoil le Ct "� S 3 � ` . 8. % Slope Distzibut_on Cell of - Force Main Flowed ' to W Angregate From Purnp Loyer D z,ZS Ft. F Z.°l - ? Ft. CROSS SECTION OF A MOUND SYSTEK F 0 -b Ft. G b -S Ft. A Qi Ft. t: 1 -4 Ft. r -s.._ 'B _ F 3 t. .�ia ee� L oading � � -- .� F is .. - � C_ 0 Ix'Y r s I Design Loedina RGt�= o,3G_� c - C-D FT I ! I VI Ft. J. 9 Ft. Ft. n ?� L 6Z • . < <� Ft. 9011 Me — M W 35 Ft. Observation Pipe- Force Main _Distribution Pipe . Cell O k" to 2- ( aggregate Observation Pipe — ' ' PLAN VIETr OF A MOI SYSTEX D stributwon Pipe Layout Pz;e S of PlaCe the holes at tua bottom- 0.'; the G - u'_ at eCTI2Z aDcCl. ^_,:-. Re move all burrs frOM the - PiDe and holes. FXce d .7 ] .c7 L'Ii TvI + Lhe eS-. Oi 1OnS = Gr =� ° L `'�c t0 2 DCL= Fre I�Cves ai tae f � , , 1P f -.� rue :e ci tYe Ia: K - 21s Wfth a Y2lvp,, , t'-^ cw or • €iI _ Prav+:c. s �m f ? e for the valve; _,. e or Lateral Manifold x x x x x/2 Lateral Length m -- f ws� r►�F: s M lc-Ok - $ox P 3 Z Ft. HOle D;'czeiwr 'It6 in -" S Z Ft. Lateral tt Inch(es) . X ? _ Inches & oTd Z Inches Force Bain " Z Inches ai holes /pipe 1'7 Invert Elevation aI .Laterals COO.Z SFt. i ` PLIMP CHAMBER cRoss SECTtom wo SPECIFICATIOMS g):GE YEAfT C)tP . `CC.T- VEUT PIPC WEN- ,HEX FILOor APPROVED LOCKING MANHOLE ? 1 FRGM DOOR • JUIJCTIOIJ BOX - COVER WITH W7-RNING LABEL WINDOW QR FRrBH 12'Mt1[. I AIR IJUTAKE 1 CRADE 1. ci 1 JA" • 1 � i8'Mif1. COI DUIT �"— _ _ � 1 1Ai L1= T PROVIDE j -- � v APPfEpY>:t) J01111 A 1 1 APPROVED JCIMT: 1 I is I I �. L > ow I LLE1G 8�'S�'x PuMF OFF . D COuCRrTE 6LaCY 3 FI$rF, EXIT Pr- F-mI'IPED OIJL� IF TAUIC MAuuFACTURrR HAS 51lCIi APPROVAL 3 APPROVED • APP � SPE 4W IL - _ v � N V✓114V j ` '�,�� MAiIt,IFACTtIit>`ti: � — - I♦1tllrlSrA of 005£5: � - � P5K o" TAUK 51ZS;: Bo GALLOWS DOW VOLUME r ALAR?N MAyfelFitGTURLR: S_J• — ° TRO S IW.LUUIJdG DACXFLDW: Cr %LLONS 1�SC10!6L MUJAB[K: `VD "I� LAPAGfTtES: A= _ � �' f1JCIiES OR 3t Z_ z CAJLOyS awlTCn Tum �'� 1��utZ -` r3= Z 1w -UtsoR 4 3 GOLLOLIS Pump PJWUFACTUKtx: C. a S - I&ICNES OR CGALLOUS MODEL LIUMBER: D- L $ UNCHESOR 3S 1"�A Lom'S SWITCH TUPE: — .�ll� --� LIOTE: PUAP AkJD ALAPm AR - m - t - G SECfLb MI&JIMUM DISC"RGE RATE 33. 6 GPM INSTALLED OM SEPARATE CIRCUITS VERTICAL DIFFEItEMU QETWEEM PUMP OFF AUD 015TRIbUTIOU PIPE- �3.-1S FEET + M M • NETWORK SUPPI.y PRESSURE ........... 3 ' z -FLET '1 FEET OF FORCE MAIM y, 2 L! f OFLFRICT1 FALTCR 3 FEET TOTAL MAJAMIC HEAD = Z �� FEET -- -- - As per - Manufacturer lOt. S 1 _ gallin. T Liquid depth �_ Goulds Submersible Effluent Pump - EPO4 38 EP 05 APPLICATIONS • Fasteners: 300 series - Flu {iy submerged in high t motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. - • Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas- • Homes components. tic cover with integral handle • Farms Motor Available far automatic and and float swftch aftashment manual operation. Automatic • Heavy duty sump • EPO4 Single phase: 0.4 HP, models include Mechanical' • Water transfer 115 or 230 V, 60 Hz, 1550 Float Switch assembled and ■ Power Cable: Severe duty Dewatering RPM, twin in overload with preset at the factory. rated oil and water resistant. automatic reset ■Bearings~ Upper and lower SPECIFICATIONS • EP05 Single phase: 0,5 HP, heavy duty salt bearing 115 V, 60 Hz, 1550 RPM, FEATURES Pomp: EF04 built in overload with ■ EPO4 Impeller. Thermo- construction. • Solids handling capability. automatic reset. plastic Semi -open design AGENCY LISTiMG e maximum. ' - • Power cord: 10 foot with pump out vanes for • Capacities; r! t standard le 16/3 SJT paw P o 55 GPM. C mechanical seal protection. Sg canaa�n srsnaarasassaaas� otal heads: up to 24 feet with three prong grounding Discharge size. NPT, plug. Qptionai 20 foot • �� impeller. Thermo (CSA listed model numbers ` • Mechanical seal: carbon- length, 16/3 SJiW with plastic enclosed design for end in "f" or "AC ".) rotarylcerarnic- stationary, #tree prong grounding plug improved performance BONA - eiastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: . thermoplastic design provides 104 °F (4M) continuous superior strength and 14OPF (60°C) intermittent corrosion resistance. • Fasteners: 300 series luaus FEET stainless Steel. 10 I E • Capable of running dry without damage to compo nents. • Solids handling ca _ 9 pabiliiy: a 7 , Ve maxmum:. ;. LU • Capacities: up to 60 GPM. - x s 20 • Total heads: up to 31 feet. _ I • Discharge size: 1 NPT. • Mechanical seal: carbon- 5 1s rotary/aeramic- stationary, a 4 t r i i BUNA -N elastnmers. EM • Temperature: ° s 10 f I I 33 6 I 0 104 F 4r r ( ) carrtinuous �. I 140 { I EPa4 F (60°C i ntermittent } z 5 L tt �-,-` ,�--- 0 00 10 I r ! ao t Sri I GPM " 0 2 4 6 8 10 12 msth CAPACr rY 0 1995 Gourds Pumps, me _.. -- - • _ -- Wi sconsin Department of Commerce . EVALUATION REPORT Page 1_ of Division of.Safety and Buildings QQ��FG((;'';�� � in aA Al fce ith Comm 85, Wis. Adm. Code _ County = Attach complete site plan on paper not less th� /2 x 11 incjtes in size. Pla Cearest ` include, but not limited to: vertical and h rizontoj erence point (BM), di Parcel I.D. percent slope, scale or dimensions, no arrow, and location and distance to road. p _ Please grin all i49� W, 0011 ` Rev wed by Date Personal information you provide may be us dary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location s . Govt. Lot W 1/4 SW 1/4 N R 19 E (orav :FG Property Owner's Mai )ng Address Lot # Block # r CSM City State Zip Code Phone Number ❑ City ❑ Village o n Nearest Road 0 New Construction User Residential / Number of bedrooms Code derived design flow rate YSC2 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable 4/�f,� h• General comments and recommendations: S6f1'CX7ZP LAr17 — r' ❑ Boring # 0 Boring JU Pit Ground surface elev. (t• Depth to limiting factor �n Soil Application Rat Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO /fN in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. ]' 'Eff#1 'Eff#2 r — 1 3 = r V AW S" -7� • J - a w I Boring # ❑ Boring pit Ground surface elev. Q6•/ ft. Depth to limiting factor 1 �2- in. Soil Application Rat Horizon Depth Dominant Color Redox Description Texture structure Consistence Boundary Roots GPD /ft' in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. ,E 'Eff#1 'Eff#2 •Z j 3 _ — sL s F - • Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = SOD < 30 mg/L and TSS < 39 MW - .. PST N me (Please Pri nt r-- Signaturq, CST Number �� Tele hone Number Address Fogerty Plumbing & Perk Testing to Evaluation Conducted P 28288 McKenzie Rd. SDooner. WI 54801 1 r Properly Owner �,E�r11� ADd>0 Parcel ID # Page Z of 3 Boring # ❑ Boring ❑ pit Ground surface elev. 9A? ft. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fl In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf #1 'Eff#2 r 2 e- .�� Z- r 3 - s 4- �w v 3_ 7. 5 -111 - — 3 s M NVEZ - © Boring # ❑ Boring ❑ Pit Ground surface elev. _ 9G. / ft. Depth to limiting factor 2 5 In. Soll Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consislen169 Boundary Roots GPD/fl° in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 r L 2FOK MAe AS IM T P 2 - s--/p _ L rH t S -G7 M T — G , ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /W In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 'Eff#2 _r 7 ' Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L ' 1 4c 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. SOD -9330 (RAM) h _ 0 Z 4 � o o i a I , 0 0° 00 ' N A °' , / f p a tl,�''� A a A 4 AV Q A tb �, a ti v �, h L \ - ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Gvtlt;c Mailing Address w ryo 17 Property Address (Verification required from Planning Department for new construction) City /State Recd Za ij a�� cv� Parcel Identification Number �'�. �, Z --�' LEGAL DESCRIPTION Property Location crw/ '/4, LWL V4, Sec. TAN -R__W, T own of .0oL Subdivision Lot # _ Certified Survey Map # Volume , Page # Warranty Deed # Volume 2 GS - 7 . Page # 9-Z Spec house 0 yes U46 Lot lines identifiable 0 —yes O no ' SYSTEM MAINTENANCE Imprailreraaesal oneat yoursepticsysiemeoaldiesWtmi sprcmmum& m iohmdlcwastes.Prwmmamsemm consists of pumping out the septic talk every three years or some, if weeded by a licensed posoper What ym pot into the system can aH'ax the fraction of the septic track as a treatmret stage in the waste disposal system. TLe prape=ty owner agreea to saI it to SL Cruk Zosaug Department a man fain, skmcd by the owner an.d by a masiciplunAw,jonmeymaoill I rest actedplosiberoraLceasedpumpervedfyecgthst( I) theaer :5hewaste system is id proper 6peiatmg condition aealor (36 iaspectim and pmgft (if necessary), do septic teat is bps tLan U3 full of sludge. Yam, the nod have rod ttie above and son to maintak dre private sewage ftosal system with the standards sct frith, berm% as set bg the Department of Coomc= smd tie Dapnrlma tof Natural Resowa*, State of Wiseonsm. Ckrtification A .- rep& sy�ft hart boon mmimtibW mud be eompimd aodietmod au ahe SL Qo& ammy Za®g C oe within 30 three ym - q- /3� E OF MPLICANt DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) lmowledge. I (we) am (are) the owner(s) of the descnlbed e, by a of a warranty deed reeoided in Register of Deeds Office. SIGNATURE OF APPLICANT DATE- Any infornratim that is min- repr�ented may result in the sanitary permit being revoked by the Zoning Department. ** Include with this application: a stamped warraanty, deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed N011VGNnoj „i - ,8b � I i M V M A L� s e�ln O Vk o N G 0 3 O' �. � N 6 -,b N O -,6 3snoH do co W I N113NVd oOOAA*kld 03HSIN; = O � � a 0 o ac 0 7 1W o m co I 5u w 21 U 2 6 5 7 P 19 2 7 - 7446, E6 \, KATHLEEN H. WALSH REGISTER OF DEEDS WARRANTY DEED ST CROIX GO. W DOCUMENT NO. RECEIVED FOR RECORD 09/15/2804 03:30PH WARRANTY DEED This Deed made between DELTA EXEWT i CONSTRUCTION, INC., a Wisconsin corporation, REC FEE: 11.00 Grantor, and LUKE M. NORDAHL and TAMMY J TRANS FEE: 90.80 NORDAHL, husband and wife as survivorship marital COPY FEE: CC FEE: property, Grantees, PAGES: i Witnesseth, That the said Grantor conveys to Grantees the following described real estate in St. Croix County, State of Wisconsin: Part oftheSW' /ofSW % +of Section 8, Township 31 North, Range Tax parcel No. 038- 1034 -20 -000 18 West, St. Croix County, Wisconsin described as follows: From RETURN TO: the SW corner of ection -31 -18 go_ North 400.16 feet; thence s &e sank ° n S88 40 50 E 700 feet to the Place of Beginning; the e North P.O. Box 427, Amery, WI 54001 c 254.59 feet; thence S88 1 40'33 "E 582.86 feet; thence S009 3'56 "E 5.65 feet; thence S79 0 21'28 "W 93.55 feet; thence S64 °05'28 "W 170.48 feet; thence S60 °21'28 "W 293.75 feet; thence N88 °40' 50 "W 82.06 feet to the Place of Beginning; Together with a non - exclusive easement over the 66 foot right of way Wly to the Town Road on the West side of said Section. This is not homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances, and will warrant and defend same. Dated this 3rd day o�stb1604. DELTA CONSTRUCTION, INC. J� I. (SEAL) By: Virgil edorenko, President STATE OF WISCONSIN )SS ST. CROIX COUNTY Septmember Personally came before me this 3 r d day of August, 2004, the above named Delta Construction, Inc., by Virgil Fedorenko, its President, to me known to be the person who. executed the foregoing instrument and acknowledged the same, being authorized so to do. ,ti+1u ' s Larr E iiotd'y b�c Mate of Wisconsin My Comrr ai h {Wr rs .7- '02 - 06 THIS INSTRUMENT DRAFTED BY: �� .....** CC4 Attorney Barry C. Lundeen MUDGE, PORTER, LUNDEEN & SEGUIN, S.C. 110 Second Street, P.O. Box 469, Hudson WI 54016 _ a to n 14 . - \ fo r m a r 4 � N \ � N tOZ M 69'6921 , � . N IUL \ � a N �, 3 / k * r w ° J % k 2 � ■ � � E � � rr O [ / o ° & 0 ® B S - +aE )= @ 2/ k E o _ E 00 o CD E @ -n 6 I (A}) 8 E F 2: © /§t � \ :3 $C � \ — � Q ) \ {- 3 Oro -n k k k 0 2 E ■ C@ 2 ® ca i o R § E I /m E � ■ E E ƒ ° 0 CL k ( CD 2 ± g � C. § ! ` \ , @ �_ k / � � a ƒ .Q9 00 E ] z 0 C') 7 2 � cE%CL °° § 4� ) ;E "n q,= CD 0 E 5 @/ k 9ƒG £ \k � r- �/ k CD °° f \ ( D 5D § I co o w � (D t )? § CD � 2 Parcel #: 038 - 1034 -20 -000 11/10/2004 02:20 PM PAGE 1 OF 1 Alt. Parcel #: 8.31.18.152F 038 - TOWN OF STAR PRAIRIE Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): ' = Current Owner * DELTA CONSTRUCTION INC DELTA CONSTRUCTION INC 206 2ND ST HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 1.780 Plat: N/A -NOT AVAILABLE SEC 8 T31 N R1 8W PT SW SW COM SW COR; TH Block/Condo Bldg: N 400.16 FT; S 88 DEG E 700 FT TO POB: N 254.59 FT; S 88 DEG E 582.86 FT; S 0 DEG Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) E 5.65 FT TH S 79 DEG W 93.55 FT, TH S 08 -31 N-1 8W 64 DEG W 170.48 FT TH S 60 DEG W 293.75FT; N 88 DEG W 82.06 FT TO POB Notes: Parcel History: Date Doc # Vol /Page Type 08/24/2001 654661 1705/360 WD 05/05/2000 622479 1508/266 WD 2004 SUMMARY Bill M Fair Market Value: Assessed with: 31,100 Valuations: Last Changed: 10/13/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.780 31,600 0 31,600 NO Totals for 2004: General Property 1.780 31,600 0 31,600 Woodland 0.000 0 0 Totals for 2003: General Property 1.780 21,600 0 21,600 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