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HomeMy WebLinkAbout038-1239-09-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 515284 0 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: City Village X Township Parcel Tax No: Hall, Jeffery & Doni I Star Prairie, Town of 038 - 1239 -09 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: 161 , .5 4 1 4— &,\ 17.31.18.1270 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER �t CAPACITY STATION aBS HI FS ELEV. Septic � ,'S Benchmark /ACS 11 /a /.54 Dosing 1 p AIt.B •' J IZ 5 �����j Bldg. Sewer 4•I /2 • , � Holding f}y J St/Ht Inlet , TANK SETBACK INFORMATION St/Ht Outlet TANKTO P/L WELL BLDG. Vent to Air Intake ROAD DtInlet �- J Septic 3Z 2 Dt Bottom 1, z, 92 Dosing / Header /Man. // z /U 3 S3 3 6 z Aeration Dist. Pipe ?• IKS / d ` Z Holding Bot. System J '�—' PUMP /SIPHON INFORMATION Final Grade Z. � /�'I • Z Manufacturer Demand St Cove +�� �Z c /� I ] e J Model Number ��'1 7,C) -�� TDH Li; �/ Friction Lo$s� System H ad TDZ 3 F J // Z_ Forcemain Lengt I Dia. z N Dist. to Well SOIL ABSORPTION SYSTEM 9 BEDITRENCH Width Length No. Of T�che PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth 5 DIMENSIONS //`✓ e \� _ \ SETBACK SYSTEM TO I P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Typep�� stem: 1� �� DISTRIBUTION SYSTEM UNIT /y/a J ���,' f�d N Model Number: �( 0 Header/Manifold O f/ Distribution �� I x Hole Size I x Hole Spacing Ve to Air I take 3 6 �.� Pipe( � / S Zp. /- acin 30 !�$ 36 Spacing Length Dia Length • is p g SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over c xx Depth of ^, xx Seeded/ odded xx Mulched Bed/Trench Center / 7S Bed Edges \ Topsoil 1 J_.L.. Yes No des No /• 1 ��11 COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / >6 spection #2: / / Ck. L- Location: 2197 92nd Stre t New Richmond, WI 54017 (NW 1/0 NW 1/4 17 T31N R18W) Sgqua�`l�(`L•atke E tates Lot 9 Parcel No: 17.31.18.1270 1 1.) Alt BM Description = l 6420A,_ / t� is f a �/� 6t A a, ps 7 2.) Bldg sewer length = /61 �ldl ✓�C'v.tPJ�.. �.. � - amount of cover= Plan revision Required? ❑ Yes No 5 J� Use other side for additional information... _ SBD -6710 (R.3/97) Date Insepctor's i nature Cert. No. Commeree.wl.gov Safety and Buildings Division County x 201 W. Washington Ave., P.U. Box 7162 i j Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) Drtmertit of Commerce 5 Z State Transaction Number Sanitary Permit Application �f In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental �`• unit is requiri d prior to obtaining a sanitary permit. Note: Application forms for state - owned POW are Proje Address (if different than maven address) ) submitted to the Department of Commerce. Personal information you provide may be used for secondary J, p urposes in accordance with the Law, s. 15.04 1 m), Slats. 7 T+ /• G I. Application - 'Please Print All Information Property Owner's Name Parcel # Property Owner's Mailing Address Property Location / /Z_ 70 S _ ` • Govt. Lot City, State Zip Code Phone Number (\� y, �W y,, Section 1— ��\\ �� ((�� � �-y a) (circle one ►"e vJ I� �C M r. T 3� — N; R — Eo0i II. Type of Building (check all that apply) �� Lot # Q 1 Subdivision Name 1 or 2 Family Dwelling - Number of Bedrooms �y , �,��„`•, # ❑ Public /Commercial - Describe Use � Block ❑ City of CSM Number El Village of ❑State Owned - DesFribe Use �, Town of IISI 5 k 10 or III. Typ of Permit: (Check only one box on line A. Complete line B if applicable) A. t;New System 11 Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. _[ 11 - Permit Renewal 11 Permit Revision ❑ Change of Plumber 11 Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS S stem /Com nent/Device: Check all that a 1 ❑ Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade j6t�Z und> 24 in. of suitable soil Mound < 24 in. of suitable soil ❑ Bolding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) II V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Ra gpdsf) Dispersal Area Required Dispersal Area Proposed (s System Elevation y y� �- VI, Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units 2 V New Tanks Existing Tanks D ! )� Septic or Holding Tank X Dosing Chamber ' \\ VII. Responsibility Statement - 1, the undersigned, assume responsibility for installation of the OWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number C19 �1t5 -38� ~ 31a 1 Plumber's Address (Street, City, State, Zip Code) 1© c co KJ 44 �,u 5b Wal S 0 VIII. county y /De artment Use Onl Approved trap Permit Fee Date sued I L A g A ❑ caner Given Reason for $ �oZJ ( ��' /b IX. Condit' asons for Disapproval 9€IM 3, G -: o � .s Septit: tank,ef k*M filter ant! dispersal cell must all be services / maintained ���-- 1 ,S nit per management plan provided by plumber. L A adilbsck $6*kements must be maintained Attach to complete plans for the system and submit to the County only on paper not less than 8 112 x 11 inches in size SBD -6398 (R. 02/09) Valid thru 02 /11 II Pro(�s�d we.li o IPes.alenu w; csc� G,►, c.�c�e c.<JL,o /, u� /6 so rr�rP ;� b ' ldcn Sc..ac� s.7 Fa »ta;17 S( vtd tlrou,,C 4e 5c SPaCf -C( 2•S3; 5ysftr., L "S�►.N el14 = / 2CJ "4,6oc1c ioT50' �'orrc rr�a:� mss, E o cam✓. � 0 r r / ; poi. s f�' r� 83 r r r r 81 ` I r i Q r r r r S �9-r r r � 8 r= o love ner^: r r �ssumcd lee, -e' , r� V r - Safety and Buildings • 10541N RANCH ROAD commerce .Wl.gov HAYWARD WI 54843 Contact Through Relay I s co n s' n www.commerce.wi.gov /sb/ www.wisconsin.gov Department of Commerce Jim Doyle, Governor Aaron Olver, Secretary June 21, 2010 CUST ID No. 227990 AT7N.• POWTS Inspector WILLIAM C SCHUMAKER ZONING OFFICE SCHUMAKER PLUMBING ST CROIX COUNTY SPIA 1070 SCOTT RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/21/2012 Identification Numbers Transaction ID No. 1805722 SITE: Site ID No. 757459 Jeff & Doni Hall Please refer to both identification numbers, 2197 92ND St above, in all correspondence with the agency. Town of Star Prairie St Croix County NW1/4, NW1 /4, S17, T31N, R18W FOR: C Description: Mound, 3 bedroom residence on di iC Object Type: POWTS Component Manual Regulated Object ID No.: 1269642 V Maintenance required; 450 GPD Flow rate; 20 in Soil minimum depth to limiting factor from original grade; Sy� t)P Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 101), SSWMP Pub. 9.6; Effluent Filter O�p�� t ,�g1� 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 construpted ,, and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. gEE 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: Key Item(s) • 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. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the protect. • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. 1 WILLIAM C SCHUMAKER Page 2 6/21/2010 • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(i). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. 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 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. Sincerel / Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Patricia L Shan rf POWTS Plan R view , Integrated Services WiSMART code: 7633' (715) 634 -7810, Fax: (715) 634-5150, M -fr 8:00 - 4:45 pat.shandorf @wisconsin.gov V cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 828 -5902 , Monday, 7:00 A.M. To 3:30 P.M. Notice: Starting July I, 2009, no person or entity may engage or offer to engage in construction business in Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings Division of the Wisconsin Department of Commerce. "Construction business" means a trade that installs, alters or repairs any building element, component, material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the uniform dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs. Comm 81 to 87, or the public swimming pools and water attractions code, ch. Comm 90. The term does not include the delivery of building supplies or materials, or the manufacture of a building product not on the building site. For further information, go to our website: www.conimerce.wi.Gov/SB/SB-BuildinaContractorProzTam.html WILLIAM C SCHUMAKER Page 2 6/21/2010 r • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(i). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. A co of the approved PY pp d 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 ' ' � q or additions should conditions arise making them necessary for code compliance. As per p p state slats 101.12(2), nothing in this review shall relieve the designer of the responsibility gn for designing a safe building, gn g g, lure, or component. Inquiries concerning his correspondence pondence 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. ePatricia Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 han orf POWTS Plan R - view ,Integrated Services WiSMART!code: 76331 (715) 634-7810, Fax. (715).634 -5150 , M -fr 8:00 - 4:45 pat.shandorf@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 828 -5 Monday, 7:00 A.M. To 3:30 P.M. ti Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings Division of the Wisconsin Department of Commerce. "Construction business" means a trade that installs, alters or repairs any building element, component, material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the uniform dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs. Comm 81 to 87, or the public swimming pools and water attractions code, ch. Comm 90. The term does not include the delivery of building supplies or materials, or the manufacture of a buildingproduct not on the building site. For further information, go to our website: www.commerce.wi.izov/SB/SB-BuildinRContractorPro.pram.htrnl , MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Hall 3 bedroom residential mound Owner's Name: Jeffery S. & Doni A. Hall Owner's Address: 1643 95th Street New Richmond, WI 54017 Site Address: 2197 92nd Street Legal Description: NW1 /4 NW1 /4, Sec.17 T.31 N., R. 18W. Township: Star Prairie County: St. Croix Subdivision Name: Squaw Lake Estates Sally n �,® Lot Number: 9 Block Number: Na GE Parcel I.D. Number: 038 - 1239 -09 -000 Plan Transaction No.: NGe c N Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank I 0 Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Attached soil evaluation report i Designer: Bill Schumaker License Number: 227990 Date: 05/21/10 ✓ �� Phone Number: (715) 386 -3121 Signature: �Lz Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SD13- 10691 -P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706 -P (N. 01/01) Version 5.1 (R. 06/06) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 83 -44 -3 in -situ soil treatment for 1.50 Peaking Factor (e.g. 1.5 = 150 %) fecal coliform of <= 36 inches. 450.00 Design Flow (gpd) 8.00 Site Slope ( %) 107.50 Contour Line Elevation (ft) 20.00 Depth to Limiting Factor (in) 0.60 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 90.00 Dispersal Cell Length Along Contour (ft) = 5.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft 1 I Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) c Center or End Manifold 2.50 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) 2.50 Estimated Orifice Spacing (ft) = 6.25 ft /orifice 2.00 Forcemain Diameter (in) 220.00 Forcemain Length (ft) Does the forcemain drain back? Y 95.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 35.89 Forcemain Drainback (gal) 13.33 Vertical Lift (ft) 56.42 5x Void Volume (gal) 4.17 Friction Loss (ft) 92.31 Minimum Dose Volume (gal) 0.00 In -line Filter Loss (ft) 29.66 System Demand (gpm) •` 'I / 24.01 Total Dynamic Head (ft) / Lateral Diameter Selection Manifold Diameter Selection 2 in. dia. options choice in. dia. options choice 0.75 1.25 x x 1.00 x 1.50 x 1.25 x x 2.00 1.50 x 3.00 2.00 x 3.00 x Gallons /Inch Calculator (optional) Treatment Tank Information 646.00 Total Tank Capacity (gal) 1000.001 Septic Tank Capacity (gal) 38..001 Total Working Liquid Depth (in) Wieser Concrete I Manufacturer 17.00 gal /in (enter result in cell B49) Dose Tank Information Efflue Filter In formation 646.001 Dose Tank Capacity (gal) Pol Lok Filter Manufacturer 17.001 Dose Tank Volume (gal /in) PL -525 Filter Model Number Wieser Concrete Manufacturer Project: Hall 3 bedroom residential mound Page 2 of 9 Mound Plan and Cross Section Views 1 1/10 B ......... ( ... J .... ..... Observation .............. Pipe .. .- 'r+r.'• -•: 5 A tititi {ti{ :;ti {ti {ti {ti ;ti {ti: {ti {;:;ti ?tit { { { {ti {ti: :ti:t: _ W 1: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .•. •. T ....0 . ................ ...... 1 L Mound Component Dimensions A 5.00 ft E 20.80 in H Elft ft K 9.91 ft B 90.00 ft F 9.25 in z ft L 109.83 ft D 16.00 in G 0.50 ft J ft W 23.16 450.00 (ft Dispersal Cell Area 1517.27 (ft) Basal Area Available 5.00 (gpd /ft) Linear Loading Rate 9.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 110.60 (ft) —► .,,........ * H G 1 I . F Cell Dispersal 109.33 (ft) Latera 108.83 (ft) - ► — Invert Dispersal Cell [ Elevation . _ a ;'�. � ,. �c' y F ...1_tl, k � -: k x. _s. �' L ! - k, i . l { ' 3 'j •<� ' .l. J.�. .. � -� - '` ` 107.50 (ft) Contour Elevation 8.0 %Site Slope Geotextile Fabric Cover Shading Key d 4) Dispersal Cell See lateral details on [] S Topsoil Cap c a 1.5 ft Page 4 for number, size, Subsoil Cap c : "`::: '.;.:; and spacing of laterals. �;':` Laterals are equally ASTM C33 Sand :: .::: ;::rsa':_: °::'': 'a F spaced from the Y ^ -x- Tilled Layer d 0.5 ft Typical Lateral U) distribution cell's Aggregate o� `. centerline in the }_ A * distribution cell (AxB). Project: Hall 3 bedroom residential mound Page 3 of 9 Center Connection Lateral Layout Diagram Force main cordwodoe via We or cross to manftld at and point. Laterals are identical J. I P �Ic. • - Tum -up %#boll valve or X—>K xi2 I x12 Laterals & Force main of PVC Sch 40 oleanoutplug per COMM Table 84.30.5 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter 1.25 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 44.28 ft Orifices per Lateral 18 Lateral Spacing (S) 2.50 ft Orifice Density 6.25 ft /orifice Lateral Flow Rate 7.41 I gpm Manifold Length 2.50 ft System Flow Rate 29.66 gpm Manifold Diameter 1.25 in Total Dynamic Head 24.01 Ift Forcemain Velocity 3.03 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC AF Comm 16.28 W 4 in. min. Tank component is properly ven`: 4 Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Capacityl 646.00 Gallons Volume 17.00 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 18.57 315.69 C B 2.00 34.00 Pump off elevation (ft) C 5.43 92.31 1 96.00 D 12.00 204.00 D Total 1 38.001 646.00 1_1 4 Do elevation (ft) 3" Bedding under tank. F7755.00 Alarm Manuafacturer ILevelArm — � Alarm Model Number I DLV I Pump Manufacturer Goulds Pump Model Number 13871 EP05 Pump Must Deliver 29.66 gpm at 24.01 ft TDH Project: Hall 3 bedroom residential mound Page 4 of 9 GOULDS PUMPS Submersible Effluent Pump 3871 EPO4 EP05 APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the lubrication and efficient improved performance. construction. following uses: • Effluent systems heat transfer. ■ Casing and Base: Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING superior strength and corrosion • Farms manual operation. Auto CO. Canadian Standards Association • Heavy duty sump matic models include resistance. O • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron Goulds Pumps is ISO 9001 Registered. • Dewatering assembled and preset at the for efficient heat transfer, factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. 3 /4" maximum. ■ EPO4 Impeller: Thermoplas- 0 power Cable: Severe duty • Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size: 1 NPT. seal protection. • Mechanical seal: carbon - rotary/ceramic stationary, BUNA - N elastomers. • Temperature: 104 °F (40 °C) continuous METERS FEET 140 (60°C) intermittent, • Fasteners: 300 series 10 -- + stainless steel 9 30 ►�5GPM • Capable of running dry without damage to 8 -- components. .2-YA1 'r; ° a 7 -- -- -- - - - -- Motor: = i • EPO4 Single phase: 0.4 HP, U 6 20 115 or 230 V, 60 Hz, 1550 RPM, built in overload with > 5 I �— automatic reset. ° 4 15 ~ _ * - - -V - -- - - • EP05 Single phase: 0.5 HP, o EP0 5 - - 115 V or 230V, 60 Hz, 1550 3 10 RPM, built in overload with I ------ - -- -- - - -- a ..... - - - - - -- -- EPO automatic reset. 2 • Power cord: 10 foot 5 standard length, 16/3 1 - -- _ - SJTOW with three prong grounding plug. Optional 20 ° ° 0 10 20 1 0 — 40 50 GPM foot length, 16/3 S1TW with ,2.9.4Ga A sr. r�,'�� mum 4S4'M /y �z �c �tf5 three prong grounding plug p 2 4 5 8 10 12 '�i /h (standard on EP05). CAPACITY Goulds Pumps © 2002 Goulds Pumps ITT Industries Effective September, 2002 a �9 B3871 o� CwC -c�c- Sam q .Z Ad s. ,•e c zq Z, 2-/97 9,2 ^ ^d s b - cam, /1k,YVy n wyy -Sr c. f'y, T 3 /`! e. /Bcc1 Q 6-�,- JQ"a in Croil( C'o� call, p 6( 6 38 - 1,2- 3,9- a9 ae Lcl 1-77ac , 'e. 5 p,� weal o r+aecsea �a�aJe 3 k,tdroov„ - -- ; Rees . d -enu k Ca�nb;na6�n {i'c 6 "• 5c01?J,C, ,SeP M Q CAO-w4A bw ld��y Sc..a� S.T. 01,E /t f• n � arc w(a:n f� !►c S!¢avt�l tfvou3� 40/o cd /Yto�dab Z 3./6 r /oRB�/ Four �yJ /iy "/Q Gcnc.Cs �,00 cZdctf �' Z. 50: /8 y& ariF 'ces ,a" /m- +6ci�c/ S,ecccdo 2•S3; 5ysfri» Z "S�i•'/OP•d.0 4] Z_4"_ Zo "a &OLA(, ioTSo' /N4;7 Cal 6.0 r r / r � r r r � ' , w , i / o r � .Sim , / j'4r r .4ssumcd� /ur: � �r - P 4 R`�V �erc. C� -a�? - q� '" �oJse, S ,-fie, r,,,. ao e-9 . . Wisconsin Department of Commerce1 accordanc 1i D SOIL EVALUATION REPORT Page _, j_ of Division olSafety and Buildings e with Comm 85, Wis. Adm. Code County Attach complete site plan on paper rVir ess than 1/2 x 11 inches in size. Plan must Include, but not limited lo: vertical and horizontal reference point (BM), direction and Parcel I.D. c percent slope, scale or dimenslons, north arrow, and location and distance to nearest road. P1 on R 'owed Dale Personal Information you provid may b d ry purposes rivacy Law, s. 15.04 (t) (m)). 7 l Property Owner n Property Location �U Govt. Lot �( 1 /4A)tj1 /4 S 17 T 3 1 N R� E (or W Property Owner's Mailing Addres Lott # Block # Subd. Name or CSM# Oho �'t c 1 ST.CROiXGOl1N PICE ! 5%v � LaKe � S�q�e City State U4=o Ct. /J} ❑ City ❑ Village fA Town Nearest Road 1 L] New Construction use: §ZI Resldentiai / Number of bedrooms 3 Code derived design now rate 45 D GPD ❑ Replacement ❑ Public or commercial - Describe: _ Pa,enImator;al--. a _ t I Flood Pte,^ cicvation if appfcabl6 General comments and recommendations: S e5 Q. 75 •* o'r� mo v r� .5c Q+ 1 0,� , � 3 I S .1 eBoring (b4SjLb1 0 ov # rC1 Boring W pit Ground surface elev. _ 7 ' 6 . 3 ft. Depth to limiing factor - QQ _in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. I I I 'Eff#1 'Eff#2 6 -R 0.1 R,v L a-F k 1 m r r - -)7 Di R L rn e I C w t F 16, S D ql J.V �F7S p 9 1 S L fir~ I C w — 1 y L — - , a . to ® Boring # n El Boring tP Pit Ground surface elev. X07 X03 ft. Depth to limiting factor _ � Z_ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture structure Consistence En+rndary Roots GPG /ff In. Munsell Qu. Sz. Cont I Gr. Sz. Sh. I I 'Eff #1 I 'Eff#2 12 3 - L aIESS V11 r R - 2 D 5 L FS r I 1 Q y -i l►1 C w y a y P. e 'Effluent #1 = BOD ;, 30 220 mg/L and TSS >30 150 mg/L Effluent #2 = BOD < 30 mg/L and TSS < 30 mgrL CST Naine (Please Print) Signature CST Number t� a-7s6 �� D le Eva l on ducted Telephone Number .� r V f? r—z2 s 9 Property Owne' �� � Parcel ID# Page _Q_ of . _ F:3� Boring # ❑ Boring —^ Pit Ground surface eiev. ft. Depth to limiting factor C �_ 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 'Eff #2 4 I o�l '{a - -� L rn F c� a F _ 1 5 -- L (A- C- 1� ` P Y f E154 Q It M fr I lJF ❑Boring # ❑Boring —_ ❑ pit Ground surface elev. _ h. 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. Con(. Color Gr. Sz. Sh. 'Etf #1 - Eff #2 F-1 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 /ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 'Eff #2 i ' Effluent #1 = BOD > 30 220 mg/L and TSS >30< 150 mgt ' 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 =:cess services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 - 8777. SBD•1))0 (U=) i Property Owner �'F &A Parcel ID# Page' � _ of r3 Boring # ❑ Boring • Pit Ground surface elev. Depth to limiting factor _ In. SOA App lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff #1 'Eff #2 _ ---- 5(A- c. 1- 't Ry S� 1 rnr W E , F-1 Boring # ❑ Boring ❑ pit Ground surface elev. h. Depth to limiting factor _ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 3PCi /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 'Eff#2 ❑ Boring # ❑ Boring -- ❑ Pit Ground surface elev. tt. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color �Redox Description Texture Structure I Consistence Boundary Roots GPD /ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ett#1 'Eff#2 ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mq& ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. !f 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 -1)JO (R.6rW) ILA -h Vt7 3 � G� s2 P _ 6 1 IA L 3 7 (N W �- �✓YV r �`— w k liz JJ v �+ J o � o s S/ _ � 4 G 1 CO �e9 �-) REGISTER'S OMCB 'es t 114, th e ST. CROIX CO, WS - all in Section 17, de for d this - ?nsin. 8A - 10 0 , •9 Ctj: " Ru ccorded in Volume [ d of # pq g o t UNPLATTED LANDS )orary Cu/ —de —sac — — — — — — o ._�� xtinguished upon road) S88'36'02"E 2569.13' .64' 66.00 N01 • 66.00 - 522.55' • '� • \ ,501'23'58 "W 1 26.72:: v1 6 6 p'`i i 2 —1468 • ��' �BOR I sq. ft. / LOT9 • •'`�' ti� 00 lcres `,� 77,144 sq. ft. �. ,�• ON N i 1.77 acres � N O co � 393.98' 58836'02 "E 452.88' .OT 7 cow ,� LOT 1n w 76 sq. ft. _ 00 b LOTS �n 02 sq. ft. n' ; 1.76 acres — — . o �- M V acres 9. 980.3' 2 L.B. O. = 974.7 \� i AL • ALH.W.L.= ` Z 171 i 972.7' S88'36'02 "E 277.00'- C` - ' 1 66 ' • ) 1 J*L \ o 3 �� / N LOT 12 LOT 6 r^ In 1 • 946 sq. ft. , o N '. 75 acres_-. • 1 ' LO 7. 0.= 978.1' i , of r- r 8953'18 E N 78•�9 ' 0 � „E ?76.1' ; ; L � •� ` 66 oo' 92.9 rh 8 / Ak I + w CO - \ N O ,trOj Ci 3 r W. 97 L. �- 3 5' LOT 11 �, LOT 7n O �, N N h�o ,p ;'� 170, 247 sq. ft. Z ` w 2 N h 3.91 acres L. B. O. =9 76. 7' � o : • \� 66' iZ / H.W.L.= U I 1 l ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ,7,0s'F ! b Aj i , d-1( --c Mailing Address �0 /� t /S !�S'OIV T o/( property Address 7Z .�t' S'd✓Lt �2 S' T - (Verification required from Planning Department for new construction) City /State S6 y';1 E S tE i Parcel Identification Number 3 - / 2 3 0 9 -00 6 L FGAL DESCRIPTION Property Location b Al %., /V Al V., See. 1 . T - /r( W, Town of Subdivision _T AAA t2 L A ec SS' . Lot # 9 Certified Survey Map # , Volume . . Page # Warranty Deed # 90 Volume , Page # Spec house ❑ yesX no Lot lines identifiable `yes ❑ no SYSTEM 1V+LAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle washes. 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 fimction of the septic tank as a treatment stage in the waste disposal system. The properly owner agrees to submit to St. Croix Zoning. Department a certification fomp, signed by the owner and by master plumbed joumeymauplumber, resttictedplumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal syste m 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 your septic system has been maintained must be completed and returned to the St. Croix County Zoning offi within 30 days O M year expliation date. )1K 6,3, � v SI F LICANT DATE OWNER CERTIIZCATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we am (are) the owner(s) of the pro 'bed a e, by virtue of a warranty deed reworded in Register of Deeds Offices OF APPLICANT DATE « « « « «« A information that is mis- represented may result in the sanitary permit being revoked by tivc Zoning D epartmOt •« 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 l f�f�l ��Nf�f�ff lEl�ffl�lffl!!!I!I!1!I!!�i * 0 0 6 2 1 State Bar of Wisconsin Form 2- 2003 9 8 �g(�g� WARRAN'T'Y DEED BETH PABST Docuasent Number Docament Name REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 12/04/2009 08:OOAM THIS DEED, made between Grand Properties Limited Partnership aWa Grand WARRANTY DEED Properties, LP MPT a ("Grantor," whether one or more), REC FEE: 11.00 and Jeffrey S. Hail and Doni A. Halk husband and wife TRANS FEE: 63.00 ("Grantee," whether one or more). PAGES: 1 I �. Reoarding Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Name and Retun► Address interests, in St Croix County, State of Wisconsin C`Propertyl (if more space is Ww7A - r Ci' � I kv=- needed, please attach addendum): igOO L--4o& 424, Lot 9, Squaw Lake Estates, Township of Star Prairie, St. Croix County, Wisconsin Nair•+ Hv-tej hot rn MN ml t2 I 038-123949 4009 Parcel Identification Number (PIN) This Is not homestead property. (IS) (is not) Exceptio nst Easements, restrictions and rights -of -way of record, Kany. Dated U [ �d"� Grand Properties Limited Partnership wWa Grand Properties, LP (SEAL) (SEAL) * **[MbrManagemeA LLC, by Michael J. Germain, its Chief Manager (SEAL) (SEAL) * s AUTt AWTICATION ACKNOWLEDGMENT Signature(s) G rand Properties Limited Partnership a/1t/a Grand Properties LP by MMG Mannemen(, LL by STATE OF ) Michael J. Germain Its Chief M a er ) ss. authenticated on COUN'T'Y ) VZM Personally came befote me on *Kristin land I the above-named TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the petson(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 Kristin Oeland, Estreen & Oetand My Commission (is permanent) (expires: ) 304 Locust Street, Hudson, ; W1 54016 (Signatures may be�ratheatieafed or aelcaorrtedgtd. Both acre not acces nuy.) NOTE: THIS IS A STANDARD FORM. A1LIY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARtRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 Type naate below signatures. INFO-PROTM Loyal Fmm 006855-2024 www.kftputnm.com com 1 Of 1 A � w l • � 'fir G +h 7 J r tht,�y91 ' b. Y , ,fit M: -:: •w w M -- i r I ?` t xqr .5 i r. c 71S 2 4 513 S G j, 3 - 218 - e ll 7� L i J Y tAI Go VIP, t - ' 00 - 09L s. . 3..9S.2Z. IDN r C4 IL wl U) C4 co - ° n '2 w ** , 1 C4 col LLI z - • zp ""~ is 60 �t s "ia :.. .8g• �3 4 1264 Wisconsin Department of Commerce SOIL EVALUATION REPORT P age 1 of 3 Division of Safety and Buildings in accordance with Idince 85 T T Tom Schmitt County Attach complete site plan on paper not less than 8%: x 11 inches lan must St. Croix include, but not limited to: vertical and horizontal reference point ctiop.and percent slope, scale or dimensions, north arrow, and location an to he6nkt road.. Parcel I.D Please print all information. Re By Date Personal information you provide may be used for secondary purposes ( , s`5 (f) tl• �� Property Owner Property Loch' - Grand Properties, LP Govt. Lot NW 1/4 NW 1/4 S 17 T 31 N R 18 W Property Owners Mailing Address Lot # Block # Subd. Name or CSM# 712 Rivard Streeet, Suite 300 9 Squaw Lake Estates City State Zip Code Phone Number J City I Village A Town Nearest Road Somerset I WI 1 54025 715 - 247 -5900 Star Prairie I 92Nd St. 16 New Construction Use: J6 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD I Replacement = Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a mound system. System elevation is 102.2' based off of contour line established at 100.76'. Slope is 10 %. Depth to limiting factor is 19 ". Boring # .J Boring 16 Pit Ground Surface elev. 100.76 ft. Depth to limiting factor 19 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence ndary Roots GPD/ft *EtT#1 *Eff#2 A t 1 0-7 10yr3/3 none sl 2mgr mvfr as 3m,2f .6 1.0 Z st 2 7 -19 10yr4/4 none sl 2fsbk mfr gW 2f .6 1.0 3 19-30 10yr4/6 c1f7.5yr5 /6 scl 2fsbk mfi gW if .4 .6 7.5yr6/1 4 30-43 7.5yr416 "' 1 1 /2 /6 sl 1 msbk mvfi cw .4 .7 5 43 -61 5yr4/6 m2 /6 Is 1 msbk mvfr — .7 1.6 a Boring # Boring Pit Ground Surface elev. 100.81 ft. Depth to limiting factor 27 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF *Eff91 *Eff#2 1 0-10 10yr312 none sl 2mgr mvfr as 3f .6 1.0 2 10 -27 10yr4/4 none N 2msbk mfr gW 2f .6 1.0 3 27-45 7.5yr4/4 to ld 1 /1 A sl 2fsbk mfr gW if .6 1.0 4 45-66 7.5yr4/6 c1 10yr6 1/ /6 gds Osg mvfi cW — .7 1.6 5 66 -72 5yr4/4 m � /6 sl Oma mvfr ---- — .2 .6 * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * // Effluent #2 = BOD 30 mg/L and TSS <30 mg/L CST Name (Please Print) Signature: J� CST Number Thomas J. Schmitt "�"� 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, Wl 54017 7 %� — O 715- 247 -2941 I Fr . Property Owner Grand Properties, LP Parcel ID # Page 2 of 3 3 ] Boring # _] Boring sm Pit Ground Surface elev. 97.91 ft. Depth to limiting factor 29 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Text S ructure Consistence Boundary Roots ep edo Texture t ry . Eff#1 'Eff#2 1 0 -8 10yr3/3 none sl 2mgr mvfr as 3f .6 1.0 2 8 -21 10yr4/4 none sl 2msbk mfr gw 2f .6 1.0 3 21 -29 10yr4/6 none sl lfsbk mfi gw — .4 .7 4 29-62 5yr4/6 mld 7.5yr6/6 sl Oma mvfi — .2 .6 7.5 /1 l i Boring # Boring ❑ �j 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 "Eti#1 *Eff#2 I I F—I Boring# -I Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 'Eff#t 'Eff#2 I " Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 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. l .� Page 3 of 3 ' Conducted by: Conducted For: Ref No Schmitt Soil and Site Evaluations Name: Grand Properties, LP. Thomas J. Schmitt, CST 227429 Address: 712 Rivard St. Suite100 1595 72nd St. City, State, Zip: Somerset, WI. 54025 New Richmond, WI. 54017 Phone: 715 -247 -2941 Subd.Name: Squaw Lake Estates 7,1 - O SC Lot No.: Legal Description: AV IM IVA -114 S17 T3 IN RI SW Township of Star Prairie, St. Croix County Bench Mark EL 100.00" Top of 2" pvc pipe Alternate Bench Mark EL W S/ Top of 2" pvc pipe Slope= /d A Contour Line El. /60, Contour Line Length dd ' I Scale I"= L r n/t'' /od � 40' � � e� i l � e� AGm JM This soil report was cone to fulfill a zoning requirement. No permanent lot markers were in at the time the test was conducted. The area in which it was dome may or may not be suitable for your use, or in the location shown.