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HomeMy WebLinkAbout040-1000-40-000 W Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix , Safety ahii Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 514838 0 GENERAL INFORMATION 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: Goulette, Ross D. I Troy, Town of 040 - 1000 -40 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: C T' 01.28.19.1 D TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ` CAPACITY STATION BS HI FS ELEV. Septic 31p Benchmark (.�Jese.k5 13 6 ' , doo b. ao fop /t�t� J* Alt. BM JA.; e, C, 5 A 1 /Q Ud Ga3w . 4.5z- 7 160 - /Z Bldg. Se er 3.3 9 7- 3q( St/Ht Inlet �. Q � s • 7 �[ TANK SETBACK INFORMATION St/Ht Outlet S• Z �t5• `f j TANK TO P/L WELL BLDG. Vent to Air Intake ROAD BFhrti=L — ` 3? Septic 1SZ /V ! . s G �-; DJ�.,` S. - r!5. J Dosing / 3 N /� I I Header/ an. Aeration Dist. Pipe Z / 41 'Z Holding Bot. System PUMP /SIPHON INFORMATION Final Grade 3• ZZ I 0/7• 4 1.751 Manufacturer Demand St Cover pJ� dd GPM �v �•7z 9l0 Model Number �7 TDH 1 1_i . � G Frictio0os�S System Ii4ad TDH ' v q 35 RI ZI D ( � ' Forcemain Len I Dia. � * ( Dist. to welt ^� �� AA- �l o / .6 . L SOIL ABSORPTION SYSTEM BED /TRENCH Width f Len th No. Of Trenche PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth [ DIMENSIONS _ 8. ! 1 --- SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION /� / n ' n CHAMBER OR Type o � 60 , , �,� � `" / i r �/ UNIT Model Number: DIST RIBUTION S YSTEM Header /Manifc Id Distribution L a x Hole Size x Hole Spacing IVVto Air Intake Pipes) length 3 Dia Length Z �' Dia 5 Spacing • 0 p 3 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 BedfTrench Center ' / 4 Bed/Trench Edges \ Topsoil • Yes [] No �` 1gs No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 592 Boundary ad Hudson, WI 54016 (NE 1/4 NE 1/4 1 T28N R19W) NA Lot 3 S °; Parcel No: 01.28.19.11D 1.) Alt BM Description =� G6 U �� ��+ �"� P O•� 2.) Bldg sewer length = G - amount of cover = I /�� ! l 7 GTC j Plan revision Required? Yes No Use other side for additional information. l y _ _ _'"`. — -.___ _. _______________.I SBD -6710 (R.3/97) Date Insepctor's Sig ature Cart. No. r r comme me.wl.gov Safety and Buildings Division County �sconsin 201 W. Washington Ave., P.O. Box 7162 Or Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co ReparWOR of Comte Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental A5 fs 3 Co merce. Personal information unit is required prior to obtaining a sanitary permit, submitted to the Department of Note: Application forms for state-owned POWTS are Project Address (if different than mailing address) es i n accordance with the Privacy Law, a. 15.04(l) m , Stats. or secondary f� n L A lication Information — Please Print All In for 5 5 Property Owner's Name n G J / Parcel # ProPefty Owner's it MAR 19 2008 g Address ST. CROIX COUNTY Location City, IS Zip Code ZO Govt. Lot V.. Section H. Type of Building (check all that apply) Lot # circle onsetI -), TN ' R � ° I or 2 Family Dwelling — Number of Bedrooms c -�� �' Subdivision Name ❑ Public/Commercial — Describe Use Block # — ❑ City of ❑ State Owned — Describe Use CSM Number \ ❑ Village of Town of III. Type of Permit: (Check only one box on line A. Complete line B if appy able) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber El Permit Transfer to New Lial Previous Permit Number and Date Issued Before Expiration Owner IV. a of PI 3 tem/Com onent/Device: Check all that a 1 ❑ Non - Pressurized In -Ground ❑ Pressurized In -Ground ❑ At -Grade ❑Mound > 24 in. of suitable soil 11 Mound <24 is ofsuiffible soil ❑ Holding Tank ❑ Other Dispersal Component (explain) V. Dis ersaUTreatment Area Information: El Prntreatment Device (explain) Design Flow (gpd) Devi Soil A lication Ra da A / PP f) Dispersal Area Required (sf) Dispersal Area Proposed e S ✓ �qP (t) Ystem Blevation / . Tank Info Capacity in 75 Z 3 Z P +� Total # of Manufacturer ' Gallons Gallons Units pl g New Tanks Existing Tanks E V Septic or Holding Tank U v "j W a Dosing Chamber ?� i VII. R onsibility Statement - L the undersigned, asanm r Plumber' Name rin esponsibility for ins anon of the POWTS shown on the attached plans. PI t' ign MP/MPRS Number Business one Number P her 's ddress (Street, City, State, ip Code) VII I. Cozen /De artmt nt Use Onl S W pproved ❑ pro Permit Fee Date Jasued Issuing ent Si rven Reason Denial 3 Zfi b Q IX. Conditions of Approval/Reasons for Disapproval O SYSTEM OWNER: 1. Septic tank, effluent fiker and i _ t'� _ i /�� dispersal cell must all ' beservIces / maintained �'cc�l / as per management plan provided by plumber. 2. All setback requirements must be maintained MW r e system and ssbmlt to the County only on paper not less than a 1/3 x 11 inches in size SBD -6398 (R. 01/07) Valid thru 01/09 Q ILL i 4 rr 1 I ` r 'y \h EC OP 0 N �c a `< r Y l • j r 1 �\ I A� I i 1 Q O � 3 � � J i S ti 'x 51) I n f N'\ Safety and Buildings 10541 N RANCH ROAD commerce.wi.gov HAYWARD WI 54843 TDD #: (608) 264 -8777 i s c o n s' n www.commerce.wi.gov /sb/ www.wisconsin.gov Department of Commerce Jim Doyle, Governor Jack L. Fischer, A.I.A., Se c r etary February 22, 2008 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: 02/22/2010 Identification Numbers Transaction ID No. 1506838 SITE• Site ID No. 734550 Ross Goulette Please refer to both identification numbers, Boundary Rd above, in all correspondence with the agency. Town of Troy St Croix County NE 1/4, NE 1/4, S1, T28N, RI 9W FOR: Description: Mound, 5 bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 1170991 Maintenance required; 750 GPD Flow rate; 16 in Soil minimum depth to limiting factor from original grade; PS System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 101), SSWMP Pub. 9.6 C nd 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 APP constructed and located in accordance with the enclosed approved plans and with the component manual(s) Of referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06; stats. The following conditions shall be met during construction or installation and prior to occupancy or use: 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 project. • The bottom of the distribution cell shall be level per the Mound Component Manual. The "D" dimension shall be a minimum of 20 ". The maximum finished slope of the mound surface shall be equal to or less than 3:1 per the Mound Component Manual. • 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. KIM A O CONNELL Page 2 2/22/2008 • 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. • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(1). 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 address s a rovide a copy of this letter to the owner and any others who are responsible for the installation, operatio or maintbnance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Patri orf POWTS Plan Review ed Services WiSMART code: 7633 (715) 634 -7810, F :05150, M -f 7:45 am - 4:30 pm pat.shandorf @wis ons cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: ROSS GOULETTE Owner's Name: ROSS GOULETTE Owner's Address: 544 BRIANA LANE HUDSON WI 54016 Legal Description: NE -NE SEC 1-- T28N - -R19W Township: TROY County: ST. CROIX Subdivision Name: CSM � Tn atty Lot Number: 3 Block Number: Lr�� Y D _ E Parcel I.D. Number: 040 - 1000 -40 000 c � M 00 E S NE9 No Plan Transaction No.: - --CA— Page 1 Index and title RESPO NCB Page 2 Data entry Page 3 Mound drawings � L Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan Designer: KIM A OCONNELL License Number: 224263 Date: 02/06/08 h e Number: 715 - 755 -3145 Signature: – i Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 4.01 (R. 09/04) Page 1 of 8 • 1 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) Residential or Commercial Design Note: Sand fill (D) calculations assume a 500.0 1 O' Estimated Wastewater Flow (gpd) Table 83 - 44 - in sol treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of <= 36 inches. 7 7 7 - 50. - 00 - 1 Design Flow (gpd) 6.701 Site Slope ( %) 84.00' Contour Line Elevation (ft) 16.00; Depth to Limiting Factor (in) 0.40; In -situ Soil Application Rate (gpd/ft) Distribution Cell Information 125.00 Dispersal Cell Length Along Contour (ft) = 6.00 Celli Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disrbution Information network? Enter Y or N (c or e) E Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation (ft) 2 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 3.50 Estimated Orifice Spacing (ft) = 10.42 ft /orifice 2.00 Forcemain Diameter (in) Forcemain Length (ft) Does the forcemain drain back? Y ` 85.30 Pump Tank Elevation (ft) Enter Y or N ( _r,, 6.50 System Head (ft) x 1.3 5.71 Forcemain Drainback (gal) ` �C`t" 10.20 Vertical Lift (ft) 113.36 5x Void Volume (gal) riction Loss (ft) 119.07 Minimum Dose Volume (gal) 2 .36 Total Dynamic Head (ft) 29.66 System Demand (gpm) ,J Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options I choice �} l 0.75 1.25 x v 1.00 1.50 x X 1.25 2.00 1.50 x X 3.00 2.00 x 3.00 x Gallons /Inch Calculator (optional) Treatment Tank Information 1000.00 Total Tank Capacity (gal) 2 -1000 Septic Tank Capacity (gal) 49.00 Total Working Liquid Depth (in) WEEKS Manufacturer 1 2641 gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Information 1000.00 Dose Tank Capacity (gal) BEST Filter Manufacturer 21.761 Dose Tank Volume (gal /in) GF1 O Filter Model Number WEEKS +Manufacturer Project: ROSS GOULETTE Page 2 of 8 Mound Plan View T 1/10 B Ot�servation Pipe . _ : :- ' �:.:. ;.:. l W I .. :....... B .. I I 3 Mound Component Dimensions A 6.00 ft E [ AO.50 in H A7.39 ft K 10.98 ft B 125.00 ft F in 1 ft L 146.96 ft D 20.00 in G ft J ft W 26.01 ft 750.00 (ft Dispersal Cell Area 2327113 (ft) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 12.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 97.46 (ft) h G H . , .. I F Dispersal Cell ;:;:;.= 96.17 (ft) Lateral 95.67 (ft) —► -- , Invert Dispersal Cell Q = t Elevation R F acs 94.00 (ft) Contour Elevation 6.7 % Site Slope Geotextile Fabric Cover Shading Key o Q �— Dispersal Cell See lateral details on 1Q Topsoil Cap .a 1.5 ft Page 4 for number, size, Subsoil Cap a c 0 0 and spacing of laterals. © ASTM C33 Sand 4° ° J Laterals are equally Z w 0.5 ft Typical Lateral F spaced from the ® [ Tilled Layer c a o distribution cell's 05 Aggregate `� c centerline in the A --� distribution cell (AxB). Project: ROSS GOULETTE Page 3 of 8 End Connection Lateral Layout Diagram Laterals cantered over the A & B dimension ♦ = Turn -up m' ball valve or cleanoutplug ,I P All laterals are identical Hol es drilled on the bottom of the lateral S eq-4 spaced Force main connection via tee or cross to manifold at any point. Laterals & force main of PVC Sch +0 (per OMW T able 81.30 -5) Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 3.53 ft Lateral Length (P) 123.55 ft Orifices per Lateral 36 Lateral Spacing (S) 3.00 ft Orifice Density 10.42 ft /orifice Lateral Flow Rate 14.83 gpm Manifold Length 3.00 ft System Rate 29.66 17.36 gpm Manifold Diameter 1.501 Total Dynamic Head ft Forcemain Velocity 3.03 ft/sec Dose Tank Information Locking cover with warning NEC abel, 2nd.locking device and sealed watertight Electrical as per EC 300 and --� Comm 16:28 WAC" Disconnect 4 in. mar: Tank component is properly vented E— Alternate outlet location Forcemain diameter WEEKS Manufacturer �_ 2 -in. Ca acit 1000.00 Gallons Volume 21.76 gal /inch A _ Weep hole or anti - Dimension I nches Gallons B siphon device A A 7 1 , 4,;W g C B 2.00 43.52 � Pump off e levation (ft) C 702 � G. _t F 85.97 D 8.00 174.08 D TO 45.96 1000.00 Dank elevation (ft) 3" Bedding under tank. 85.30 Alarm Manuafacturer SJ ELECTRO Alarm Model Number .HW 100 Pump Manufacturer GOULDS Pump Model Number WE0311 L Pump Must Deliver 29.66 gpm at 17.36 ft TDH Project: ROSS GOULETTE Page 4 of 8 Mound Svstem Maintenance and Operation Soecifications 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 750 gpd Maximum Influent Particle Size 1/8 in Estimated Flow -Average 500 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 2 -1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 750 fe Maximum FOG 30 mg /L Type of Wastewaterl Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should 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 Inspect for ponding and seepage once every 3 ears 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 mound 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 mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turin-up Detail Finished ............... Grade \ �1 :.::: :..:.:.:.:.:.:.:. ^ 6 -8" Diameter Lawn ! Threaded Cieanout ..... Sprinkler Valve Box Plug or Ball Valve ............ i I Distribution Lateral �y Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: R TT � ROSS GOULE E Page 5 of 8 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals (SBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01181)] 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 84nches 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 fitter 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. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound 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 mound 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 mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD 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 6 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 components) shall be immediately repaired or replaced with a 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 its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said 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: ROSS GOULETfE Page 6 of 8 [ qGOULDS PUMPS Submersible Effluent Pump 17. MODEL :: Y WE Series PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. APPLICATIONS ■ Shaft: Corrosion- resistant, Single phase (60 Hz): can be operated continuously Specifically designed for the stainless steel. Threaded • Capacitor start motors for without damage when fully following uses: design. Locknut on all models maximum starting torque. submersed. • Homes to guard against component • Built -in overload with ■ Bearings: Upper and • Farms damage on accidental reverse automatic reset lower heavy duty ball bearing • Trailer courts rotation. • SJTOW or STOW severe duty construction. • Motels ■ Fasteners: 300 series oil and water resistant ■ Power Cable: Severe duty • stainless steel. p. Schools power cords rated, oil and water resistant. • Hospitals ■Capable of running dry 0 1 /3 — 1 HP models have NEMA three prong Epoxy seal on motor end • Industry without damage to provides secondary moisture • Effluent systems components. grounding plugs. barrier in case of outer jacket • 1'/i damage HP and larger units have d a and to prevent oil ■ Designed for continuous bare lead cord ends. g P SPECIFICATIONS phase (60 Hz): Optional Standard cord i 20'. operation when fully Three submerged. P Optional lengths are available. Pump g • Class 10 overload protection • Solids handling capabilities: ■ 0 -ring: Assures positive 9 P MOTORS must be provided in %" maximum. separately ordered starter sealing against contaminants • Discharge size: 2" NPT. ■ Fully submerged in unit. and oil leakage. • Capacities: up to 140 GPM. high -grade turbine oil for • STOW power cords all have AGENCY LISTINGS • Total heads: up to 128 feet lubrication and efficient heat bare lead cord ends. TDH. transfer. Tested to UL 778 and Designed for Continuous CSA 22.2108 Standards • ■ D Temperature: ■ Class B insulation on g S • By Canadian Standards 104 °F (40 °C) continuous '/3 -1' /z HP models. Operation: Pump ratings are Association 140°F (60 °C) intermittent. ■Class F insulation on 2 HP within the motor manufacturer's c us Me SLR38549 • See order numbers on models. recommended working limits, Goulds Pumps is 150 9001 Registered. reverse side for specific HP, voltage, phase and RPM'S METE FEET _ _.. available. \wE15HH SERIES: WE 120 SIZE:' /: SOLIDS 35 RPM: 3500 & 1750- FEATURES 110 wE20H —a. SGPM ■ Impeller: Cast iron, semi- 30 100 5 � open, non -clog with pump- o eo WE1SH — out vanes for mechanical = 25- so ,oH seal protection. Balanced for _.. _ smooth operation. Silicon a 20 E0 7H bronze impeller available as o so an option. < 15 50 t FVE05H ■ Casing: Cast iron volute ° 40 type for maximum efficiency. 10 30 -WE03M .- 2" NPT discharge. 3 ■ Mechanical Seal: SILICON 5 CARBIDE VS. SILICON CARBIDE sealing faces. ° ° 0 10 zo 3' 40 50 60 70 80 90 100 110 120 1 30 i40 150 160 GPM Stainless steel metal parts, BUNA -N elastomers. 0 5 10 1s 20 25 30 35 m cAPAaTr Goulds Pumps <;5�> ITT Industries -- -- - - - - www.goulds.com �/ P-A� Wsconsin Department of Commerce SOIL EVALUATION REPORT " ....We Of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Revi by Date 1� Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 3 4 G A Property er RECEIVE Location J_ Govt. Lot 114 l 1/4 S N R (or Property Own is Mailing Address MAR 19 200 Lot # Blo # Subd. Name or CSM# City State Zip Code hone Number ❑ ❑ Village Town_ Nearest Road ( ST. CROIX COUN JZ New Construction Use Residential / Number of bedrooms _ Code derived design flow rate �� ✓� GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material - ;2 Flood Plain elevation if applicable ft. General comments and recommendations: s f � �� �� ��u� �� 4 � Boring # 1:1 Boring Pit Ground surface elev. ft. Depth to limiting factor ' Z_ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ffr in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 G r / I Boring # Boring Pit Ground surface elev. cfZ , 7 ft. Depth to limiting factor /_ in. Soil Appi ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ffr in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 r - _ i > _ <o Effluent 1 - BOD 30 _220 m9n- and TSS 30 _ 150 mglL Effluent #2 BO _ 30 mglL and TSS _ 3 mg/ L CST Name (P Pri ) Signature CST Number / - �7; 3 Address Date Evaluation Conducted Telephone Number (\TT flln/\ In/\n inf\\ i Page of Property Owner � ni �� Parcel ID # f� �`= Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor /La 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 *Efr#2 '? _ c i F 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. *Eff l *Eff#2 F-1 Boring # ❑ Bonng ❑ 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. *Eff#1 *Eff#2 * 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. SB04330 (R 07/00) 0 D �J :9 l i r P c, Ga ® 1983 L a 7 3 - �'40 Cb CERTIFIED SURVEY MAP LOCATED IN THE NEi /4 OF THE NEI /4 OF SECTION 1. T28N, R19W, TOWN OF TROY, ST. CROIX COUNTY, WISCONSIN FOZ. C=F o OZGa >`1v,o.�c.: - NE CORNER SECTION 1, T28N , R I9W - UNPLATTED - - LANDS - ------ - - - - -- - - -- RIGHT LINE X1 " 31 1 N 89° 28`46 "W 1323.71' 1 90 1284.19' 1 'c Se r 39.52' 1 z r P/C C 9 oS 5o m ( D r i co a a1 a 1 y ID m w 2 3 992' 1 o w p . r 1 '1 O w S89 ° 25'39 "E 295.171' 0 Z `m _ A a 9.129ACRES ( 397641 SQ.FT.) INCLUDING 255.25' 1- m m O RIGHT-OF-WAY Z o T m 8.963ACRES ( 390432 SQ.FT) EXCLUDING A o C `w (p_ RI GMT-OF-WAY o O 2.000ACRES(87124SQFi+! a o u y" O - o INCLUDING RIGHf•OF _ S 89 °25'39 "E 1027.04' m BARN r q p le rn ' = m� •� I m (�� _ /(]w — �6 Mj w NOOSE ( ro 1.727ACRES(75240SQH 471 0) 3 / X EXCLUDING RIGHfOFWAYni to • �J 254.57' 1 •�) w 9.129 ACRES C 39764 SQ.FT.) INCLUDING N89 °25'3<J'W 295.17' 1 �(— �m RIGHT -OF -WAY 40.60'' ( ID 8.949ACRES (389810 SQ.FT.) EXCLUDING '_ ' RIGHT-OF =WAY s e°I - I 'Z - 1279.70' t m S 89°22'32 "E 1320.73' ' SOUTH LINE OF THE"NEI /4 OF THE NEI /4 POINT OF BEGINNING o' r • I I m z o rn m UNPLATTED LANDS ° o z N N LEGEND Note: This map prepared rn g a m pursuant to St. Croix County _ m SECTION CORNER MONUMENT m Zoning Ordinance Section OM o I "X 24 IRON PIPE WEIGHING 5. 1 D. 2. a. "Transfers of o Z m 1.68 LSS./ LIN. FT. SET interest ...by will... " oao EI /4 CORNER m -( SECTION 1, T28N,R19W m = m DESCRIPTION SCALE IN FEET I "= 20d D -i A parcel o` land located in the NEI /4 of o lod god Sod 500 z the NE 1 /4 or Section 1, T28N, R 19W , Town of Troy, St. Croix County, "' 0 Wisconsin, being further described as follows: __q Commencing at the EI /4 corner of said Section 1; thence NO 56 - m 1309.01' along the East line of the NE 1 /4 to the point of beginning; thence continuing N0 "E 668.58' along said East line; thence N89 "W 1323.71' to the West line of the NE 1 /4 of the NE 1 /4; thence SO -W 666 .17' along said West line to the South line of the NEI /4 rif the 1VF' i Id- 1 J r ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address _ ,� 1<"'J Property Address (Verification required from Planning & Zo g Department for new construction.) City /State Parcel Identification Number 61 LEGAL DESCRIPTION Property Location 1 /4 ,' /4 , Sec. T N R4W, Town of �d t Subdivision Lot # 3 Certified Survey Map # 1 , Volume , Page # Warranty Deed # , Volume , Page # Spec house yes no Lot lines identifiable j yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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 wastewater disposal 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. Uwe, 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 Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of mylour knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 7 � - f_ SIGNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** -!elude with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if ==e rence is made in the warranty deed. REV, 08!05) U 2 5 2 0 P 6 2 5 - 713 s -,83 STATE BAR OF WISCONSIN FORM I - 2000 KATHLEEN H. WALSH Document Number WARRANTY DEED S R E GI S TER . CROIX CO.. I II This Deed, made between DENNIS RIVARD and CATHERINE T. RECEIVED FOR RECORD RIVARD, husband and wife 03/03/2004 01:30PH WARRANTY DEED EXEMPT # Grantor, and ROSS D. GOULETTE and KAREN A. GOULETTE, REC FEE: 11.00 husband and wife as survivorship marital property TRANS FEE: 510.00 COPY FEE: CC FEE: Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in ST. CROIX County, State of Wisconsin (the "Property") (if more space is needed, please attach addendum): PART OF THE NE' /. OF THE NE' /. OF SECTION 1, TOWNSHIP 28 NORTH, RANGE 19 WEST, ST. CROIX COUNTY, WISCONSIN Recording Area DESCRIBED AS FOLLOWS: Lot 3 of Certified Survey Map filed Name and Return Address S�lr August 10, 1983, in Vol. 5, Page 1324, Document No. 386861. tat ER RE STATE 200 E M STREET �O 30 x j( RIV F , WI 54022 {3� d(,0 o (,U r 5,(L02- 040- 1000 -40 -000 Parcel Identification Number (PIN) This is not homestead property. Together with all appurtenant rights, title and interests. OX) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Dated this day of MARCH 2004 * * DENNIS RIVARD U2P2 AU s * CAT RIME T. RIVARD AUTHENTICATION ACKNOWLEDGMENT Signature(s) and STATE OF WISCONSIN ) ) ss. ST. CROIX County ) authenticated this day of Personally came before me this S� day of MARCH , 2004 _ the above named DENNIS RIVARD and CATHERINE T. RIVARD, husband and wife TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) ins ent and ac wledged the same. CUA THIS INSTRUMENT WAS DRAFTED BY * ) dDil i C l t STUART J. KRUEGER Notary Public, State of WISCONSIN RODLI, BESKAR, BOLES & KRUEGER, S.C. My Commission is permanen f not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) « .) * Names of persons signing in any capacity must be typed or printed below their signature. JODI WARRANTY DEED STATE BAR OF WISCONSIN ST�iY PUBLIC ♦10� FORM No. 1 - 2000 ; ;QM" W2t V .-infoproforms.corn M Wisconsin Department ofC mert>�E iainformation. ED IL EVALUATION REPORT Pag � of Division of Safety and Buildi s g ra with omm 85, Wis. Adm. Code Attach complete site Ian o L County p paper'lAbt� 8 1/2 x 11 i hes in size. Plan must ST • C..� �}� include, but not limited to: v ital and q *W ice p 'nt (BM), direction and Parcel I.D. percent slope, scale or dime sions$ Zo cati nd distance to nearest road. �°� Re ' we y 'Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). � - 2 - 1 Property Owner Lf_�)yV \S \7 1 ,p Property Location met 1/4 NE 1/4 S T N R g E (o W J; Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# Cs ►"1 v o �. S , S' 9 t 3 Z City State Zip Code Phone Number ❑ City ❑ Village f -Town Nearest Road ® New Construction Use: 0 Residential / Number of bedrooms Code derived design flow rate - 7 SQ GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material T l Lam, Flood Plain elevation if applicable ft General comments / oJQ Lo T f and recommendations: ��U'I�rJ W ! � 1 Ntt`1UW1 ( v u OF- S j Fl LL . V 0 -w-i�AZ LZj::�\) , q Boring # ❑y Boring Pit Ground surface elev. S ft. Depth to limiting factor LAS in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 'Eff#2 ' o - � l o� tz3 L — s 1 z. sty l-c L� �r- �S �.� , s i Z b - tO 5�:r wt1. �v� . S L Borin ❑ g ❑ Boring # n, U ® pit Ground surface elev. "1 3 ft. Depth to limiting factor 3 U in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0 -6 1�K R 3 11 — s l s bk w1�t- S w . c F C w 3�S O S �-tR -3 � � ��, • S y 2 S � � L. O� `Ft. � , 3 , 5 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) Signatu CST Number Arthur L. Wegerer �y =OQ 22025+ Adder W e g e r e r Soil Testing & Design S e r V 1 c e Date Evaluation Conducted Telephone Number 421 W. 1 -lain St. River Falls, WI 54022 Z _q _ py 715 -425 -0165 1 a Property Owne �OV y- , = Parcel ID # 04 n - WOO -4 h -00 d Page �' z of F3-1 Boring # ❑ Boring ❑ Pit Ground surface elev. - 1 S Z ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD 1ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff #1 'Eff#2 2 s 13 Z`4 in b 1Z V)1 ` y � /� t � -- / V. 3Z -q S -fl(21-31 `PS - 1 •S Li2s�8 F-1 Boring # ❑ Boring ❑ Pit Ground surface eiev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP6/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # Boring ❑ El 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 /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 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) L PLOT PLAN Pa ¢e of 3 Scale 1' =y G C 0 EL . �i S. 0 So soot �I i L0-' U h1 I I 1;21-.1 D -0, o' C`ry ►v PNA ` 3 � Q'(8 u V L G LZ -U*� 1 YV 2- LI � 1 P}, a v 715 -425 -0165 220254. OL( `QL� CST Signature Date Telephone No. CST No. Job NO. i nt/ P ILE Pic, /a La �3 CERTIFIED SURVEY MAP LOCATED IN THE NEI/4 OF THE NEI /4 OF SECTION I, T28N, R19W, TOWN OF TROY, ST..CROIX COUNTY, WISCONSIN Fob NE CORNER SECTION I, T28N,R19W UNPLATTED LANDS I ------- -- - - -_ -- _ - - - -- RIGHT-OF-WAY LINE �'133 3 1 N 89 2846 "W 1323.71' 1\ 4 C & 1284.19' 1 i I C Z m Y� e. ^ 39.52' z P/ G I D z N m I;' D -� W i I rrI 1 O irw S89 0 25'39 "E 295.17 a ? 9.129ACRES ( 397641 SO.FT.) INCLUDING q m 1m 10 m 0 RIGHT- OF-WAY 255.25 iz 0 1 1 m 4S 8.963ACRES ( 390432 SQ.FT.) EXCLUDING ? 0 1 10 1 A (O RI GHT -OF -WAY a L 2.000 ACRES(87124SOFIn w m p INCLUDING RIGHT OFiNA m Z 1 S 89 0 25'39 "E 1027.04' m BARN w� m M 01 �/� v[�6 --YV Q4 ( HOUSE 1 lo w 0 I m 1.727ACRES(75240SOFly� A 0) 3 / - EXCLUDING RIGHT�OFiNAYnt w � 254.57' 1 1 r °+ 9.129 ACRES (397641 SQ.FT.) INCLUDING N 89°25'3Q'W 295.17' I � I D w RI GHT -OF -WAY 40.60'1 1 z 8.949ACRES (389810 SQ.FT.) EXCLUDING 7 I ,D i0 RIGHT-OF-WAY .° o�e+Ti 21 - I ' bDI m 1(/) I � 9 e 1279.70' 41.03' I m S 89 1320.73' ' i z SOUTH LINE OF THE NEI /4 OF THE NEI /4 POINT OF BEGINNING o ( ( m Z 0 z rn m m UNPLATTED_ _LANDS_ ° Z ;U A Z c < N N LEGEND Note This map prepared m a M pursuant to St. Croix County 3 - SECTION CORNER MONUMENT m m Zoning Ordinance Section o o m O I "X 24 °.IRON PIPE WEIGHING 5. 1 D.2. a. "Transfers of o z 1.68 LBS./ LIN. FT. SET interest ...by will..." o EI /4 CORNER SECTION I, 0 0 ° T28N,R19W m M M n DESCRIPTION SCALE IN FEET I "= 200' A parcel of land located in the NE 1 /4 of o Iod 200' 300' 50d Z the NE1 /4 of Section 1, T28N, R19W, Town of Troy, St. Croix County, M Wisconsin, being further described as follows: 0 = Commencing at the El/4 corner of said Section 1; thence NO "E M 1309.01' along the East line of the NE 1 /4 to the point of beginning; thence continuing N0 "E 668.58 along said East line; thence N89 "W 1323.71' to the West line of the NE 1 /4 of the NE 1 /4; thence SO "W 666.17' along said West line to the South line of the NE 1 /4 of the NE 1 /4; thence S89 11 E 1320.73' along said South line to the point of beginning, containing 20.257 acres (8824 sq. ft.), subject to Boundary Road right - of - way over the Easterly portion th --reof; subject to any other easements" or restrictions of record. Volume 5 Page 132►