HomeMy WebLinkAbout040-1270-60-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
♦ INSPECTION REPORT sanitary Permit No: 487913 0
GENERAL INFORMATION (ATTACH TO PERMIT) S to Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m) Z 3 TMU /D
Permit Holder's Name: City Village X Township Parcel Tax No:
Appletree Builders Troy, Town of 040 - 1270 -60 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
m ID 1 1 C. T 1 20.28.19.1493
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURE CAPACITY STATION BS HI FS ELEV.
Septic l S"Z— 12,C0 I Benchmark A ,Q n o � 3
Dosing Alt. BM
Aeration - - - -- Bldg. Sewer
S�f� o�f.
Holding _ St/Ht Inlet
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
34'
Septic 20 / Dt Bottom
Il•�o q�.9S'
Dosing u << <, 4S r Header /Man. /03 / O 1
Aeration Dist. Pipe
S1� 103-10
Holding Bot. System z 3a 3.3o r
o2.•3S
Fi al Grade u `
PUMP /SIPHON INFORMATION LC use I et-er –
Manufacturer ,,((�� Demand St Cover L L
66u.A GPM , 3.0 v
o•.. e T' ps 0S i
Model Number t) /2 qS (A) q
TDH Lift r Friction Loss System Head TDH Ft
f Forcemain Length l Dia. Dist. to Well
�.
SOIL ABSORPTION SYSTEM
B Width Length No. Of Ttenchgf' PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
ENSIGNS / r I 1 s
Ip 02 •� w4�A�t.
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHINGV Mane cturer:
INFORMATION CHAMBER O
Type Of Stem: 36 / UNIT od
el Number:
DISTRIBUTION SYSTEM
Header /Manifold a r Distribution x Hole Size Hole Spacing Vent to Air Intake
Pipe(s) l ) -2 . ` I I rr �r
Lengt Dia1? Length �' 3 ` ~ Dia _ Spacing 7 O 3 0
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 Topsoil
Yes D No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: I'D / Zo / Inspection #2: ) A / nS_
Location: 291 Day Farm Road Hudson, WI 54016 (N 1/4 NW 1/4 20 T28N R19W) Troy Wood Lot 17�, Parcel No: 20.28.1 .1493
S .T. N� l•t�f - t p T c t�..�er s a.) o
1.) Alt BM Description = � �^•� �`
i
2.) Bldg sewer length = 3fo n f 6
�(
amount of cover = � o 'f 7L°" 7 _- Ao' �) RtAA, , — a-, L CU� t "w:w -(%
�aa...
-e
,
Plan revision Required? Yes X No
Use other side for additional information.
SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No.
Safety and Buildings Division
� ns 201 W Washington Ave., P'.0. Box 7162
Madison, WI 537 Lary snit Number !to be rifted it by Cc)
Depart of Com merce (408) x66 -3 %EIV ,
Sanitary Permit Ap at an 1.. 1,8" Pl I.D. Number
In accord with Comm 83.21, Wis. Adm, Code, Ital 1 tion +�u ro�ide / /9S 3 -Tt �¢+tJt . 10
10" t
may be used for secondary purposes Privac w y
Ad ress (if different than mailing sdJrrs,j
Appl ication Informatn -
pleas - _ _ZS2lYl(? OF ICE
io
e Prlatt All Iriforrnation
Pr tped rr y Owner's Na me _ _
i Par el X
Lor X � Block N
f
_ e
q Property Owner's iii ailing Address M
Property Location
i
e--
S ur `te o? dS
Cit // Zip Cade Phone Number
cirCie
11. Type of Build nj (check all that apply) Ste " T CIF N; R ,1_,?,.. 8 aq
or 2 Family Dwelling - Number of Bedre>,;:ms ,�rr..�r� + Subdivision Name CSb! Number
PubliclCommeieW - Describe Use -
-
` .Stare Owned - Describe iae
Village (ownsitip o;
-_
III. y on
Type of Permttt (Check onl box on Brae A. Complete line B - ef a licelble)
�.. pip
vew System �' Re lKenieni SySte
I p f Treaunent/Holding 7'a?ak Replacement Only � r7 ether M1lodiftcauon to Existing System
B L I Permit Renewal T I -_l Permit Revision Li Change of i� � Ptrmit�Trarsfer to New
'List Previous Permit Number and [)ate Issued
! Before Expiration Plumber Owner
IV. T
- y . 'r of P(JWTS SSVste (Ch eck all that aPP) (p' X 102. M a U H_ - 2/.0 7T -�;- --�} - —;
Nun - Pressurized In - Urtx rid Mound a 44 in. of suitable soil Mound t 24 u,. of suitable soi: � L At -(:irade L Single Pass Sand Filter
Constructed Wetland Ll Pressurized In- Ground ',_' Holding Tank IJ Peat filler Aerobic Treatment Unit `-i Recirculating Sand Filter
L.., Recirculating Synthetic Media Fi lter j i_ i
Y C Leaching Chamber ,.� Drip Line D Grave! - {esa Pipe �!. Ot her (exp lain)
��'• Dispers /Treatment Ar Information: _ — - `- -"
Design Flow (gpd) Design Soil Application Ratr(dsf) D
gpispersal Area Required (sij Dispersal Area Proposed (st) ystrm Elevation
ain - 40 , 461 i �
�VI. 'Tank Info Capacity il; Total Number '.Manufacturer Prefab' Site Stae! Faber
Gallons Gallons of Unit. Concrete Constructed Glass
- Te ° "ne w�Pa�rlo� P4-szs I
Tanks , Tanks
ac l�
�-•- - -- ---- -- I
tic or ......— ��__-- _- ---► -- - -- -- - -..__ _._ .. - - --
� NokitrgTank
Aerobic Treatment Unit l "" - ---- -- - --
~ Uosing Chamber i *"— _.___._.�.�` _____ ___` _ _-- -- -- - -._._ ____�.___.___
r VII Res mibil Statem I, the tundersi gned
�__Ylu_ ber's Na — —_� , assume res�aoatstbilily ror it # Uattlon of the POWTS shown on the att ached plane.
;n rue (i'rint) P Si gnarure `ui , Fi W umber I Businass Plwne Number
_ — _
GJ, lle`Q yx .1 '•G huda�4� C�� "_' ---- o Z y ? < C I D 1 7l S - 3 �r� -31i�j
.
Plumber's Adaire ss (Street, City, State, Zip Code)
V 11i Count /De rt ment tine Omy _— --
- - '
Ap raved 1 U ' S e a 12tas n for genial Surcharge roe)
Fee etude = 9water A oe Issued Issuing gent Si - _.......__. _.._ _.. u
f < p 'lud gaa e t No Stam
I L1. Conditions Appro /R emmis fat
SYSTEM OWNER:
1 Septic tank, effluent filter and
" dispersal cell must all be serviced / maintained
as per management plan provided by plumber. i
I 2. All setback requirements must be maintained
as per applicable code /ordinances. i
Attach com ete plans (to the County onl y) for the aystem on pa er not leas than Bl.'2 x l i Inc -' - - -
p! P k p hes Ira size
PV
/Qoao/ 0 /oc_aYc- d ?rcjv. S
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Safety and Buildings
4003 N KINNEY COULEE RD
commerce .Wl.goV LACROSSE WI 54601 -1831
TDD #: (608) 264 -8777
i s co n s i n
w ww.co e.w i. gov/s /
www.wisconsin.gov
Department of Commerce
Jim Doyle, Governor
Mary P. Burke, Secretary
September 23, 2005
CUST ID No. 227990 ATTN.• 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: 09/23/2007 Identification Numbers
Transaction ID No. 1198723
SITE: Site ID No. 705034
Appletree Builders Inc Please refer to both identification numbers,
Day Farm Road above, in all comes ondence with the -agency.
Town of Troy
St Croix County
NW1 /4, NW1- /4, S20, T28N, R19W
Lot: 17, Subdivision: Plat of Troywood
FOR:
Description: Four Bedroom Mound System
Object Type: POWTS Component Manual Regulated Object ID No.: 1041513
Maintenance required; 600 GPD Flow rate; 15 in Soil minimum depth to limiting factor from original grade;
System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 101); 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,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
Reminders
• This system is to be constructed and located in accordance with the approved plans, and the "Mound Component
Manual for Private Onsite Wastewater Systems Version 2.0" SBD - 10691- P(N.01 /01).
• The pressure network is to be constructed in accordance with publications SBD- 10706- P(N01 /01) "Pressure �,� flh
Distribution Component Manual for Private Onsite Wastewater Treatment Systems - Version 2.0" and/or the
sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS
(01/81)... i
OF /
• 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 - E
dispersal are prohibited. SEE CG(° M
• 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.
WILLIAM C SCHUMAKER Page 2
9/23/2005
• Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated
county official in accordance with the provisions of See. 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
C� r Fee Received $ 175.00
� Balance Due $ 0.00
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
MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN n
Residential Application
INDEX AND TITLE PAGE S, C��I/F40
Sq Fp 2 20
Project Name: Appletree Builders, INC. 4 bedroom residential mound F�r o5
Owner's Name: A letree Builders, INC. 111N
PP G
s
Owner's Address: 1687Woodlane Drive, Suite #205
Woodbury, MN 55125
Parcel Address: XXXX Day Farm Road
Legal Description: NW1 /4 NW1 /4, Sec. 20, T.28N., R. 19 W.
Township: Troy
Y
County: St. Croix
Subdivision Name: Troy Wood
Lot Number: 17 Block Number:
Parcel I.D. Number. 040- 1270 -60
Plan Transaction No.:
Page 1 Index and title
Page 2 Data entry
Page 3 Mound drawings
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 Site Plan
Page 9 Concave distribution cell deflectio calc
Page 10 Soil Evaluation Report
Designer: Bill Schumaker License Number: 227990
Date: 09/11/05 Phone Number: 715 386 -3121 >d
I I
9 R YA!! U
Si .
nature: � � ._•� --- . -s
' Sf'ONDFf,IC �—
Designed Pursuant to the e
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) Pagel of 10
Mound and Pressure Distribution Component Design
Design Worksheet
Site Information
(r or c) _R` Residential or Commercial Design Note: Sand fill (D) calculatbons assume a
400.001 Estimated Wastewater Flow (gpd) Table 83-44-3 situ soil treatment for fecal
_ __ -..— ._ -- cd'rform of <= 36 inches.
1.501 Peaking Factor (e.g. 1.5 = 150 %)
600.00 Design Flow (gpd)
2_3.001 Site Slope ( %)
1 00.38 } Contour Line Elevation (ft)
15.001 Depth to Limiting Factor (in)
0.60; In -situ Soil Application Rate (gpd/ft)
Distribution Cell Information
_. _.._ -._. 6.00 Cell Width (ft)
,
102.00j Dispersal Cell Length Along Contour (ft) _
0.98 Dispersal Cell Design Loading Rate (gpd /ft
.
11 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
3.00 Lateral Spacing (ft) If N above, enter the elevation (ft)
4; Number of Laterals of the highest point.
0 Orifice Diameter (in) (e.g. 0.25)
2.50! Estimated Orifice Spacing (ft) = 7.65 ft /orifice
2 00 Forcemain Diameter (in)
40 Forcemain Length (ft) Does the forcemain drain back? Y
96.001 Pump Tank Elevation (ft) Enter Y or N
6.50 System Head (ft) x 1.3 6.52 Forcemain Drainback (gal)
5.63 Vertical Lift (ft) 41.03 5x Void Volume (gal)
0.92 Friction Loss (ft) 47.56 Minimum Dose Volume (gal)
13.05 Total Dynamic Head (ft) 32.95 System Demand (gpm)
Lateral Diameter Selection Manifold Diameter Selection
in. dia. options I choice in. dia. options choice
0.75 _ 1.25 x
1.00 x x 1.50 x x
1.25 x 2.00
1.50 x 3.00
2.00 x
3.00 x
Gallons /Inch Calculator (optional)
Treatment Tank Information 800.64' Total Tank Capacity (gal)
1200 OOi Septic Tank Capacity (gal) 36.661 Total Working Liquid Depth (in)
Wieser Concrete Manufacturer 2224 gal /in (enter result in cell B49)
Dose Tank Information Effluent Filter Information
800_64 Dose Tank Capacity (gal} Polyl-ok Filter Manufacturer
22.24! Dose Tank Volume (gal /in) PL -525 Filter Model Number
Wieser Concrete Manufacturer
Project: Appletree Builders, INC. 4 bedroom residential mound Page 2 of 10
Mound Plan View
t
. .. ....... J
1/108 ;. ;•;. ;. ;•:•.•. observation Pipe '
K —+
::• s ; A
W .� . i . —
... .
;.' ;. ;. ;.'.'.'.'. . ;.:. . ;.: I
...... ...............................
Mound Component Dimensions
A 6.00 ft E 37.56 in H 1.00 ft K 12.57 ft
B 102.00 ft F 9.00 in 1 42.39 ft L 127.14 ft
D 21.00 in G 0.50 ft J 5.33 ft W 53.71 ft
612.00 (ft Dispersal Cell Area 1 4935.48 (ft Basal Area Available
5.88 (gpd /ft) Linear Loading Rate 1 10.20 (ft) 1/10 B Obs. Pipe Placement
Mound Cross Section View
Aggregate Dispersal Area
Finished Grade 103.88 (ft) ►
2
F Dispersal cell
— 102.63 (ft) Lateral
102.13 (ft) — Invert
Dispersal Cell
:...
Elevation E D ... . . .:.:'.'.'.
. 4
` 100.38 (ft) Contour Elevation
23.0 % Site Slope
Geotextile Fabric Cover
Shading Key b' 7 Dispersal Cell See lateral details on
10 ® Topsoil Cap c a 1.5 ft Page 4 for number, size,
Subsoil Cap c and spacing of laterals.
ASTM C33 Sand 6 F Laterals are equally
0 Tilled Layer m
0.5 ft ! Typical Lateral spaced from the
0 0 Aggregate v I distribution cell's
+ centerline in the
distribution cell Ax8 .
Project: Appletree Builders, INC. 4 bedroom residential mound Page 3 of 10
Center Connection Lateral Layout Daigram
Force main connection via tee or cross to manifold at any point. Laterals are identical
S
P
•= Turn -up %idball valve or 1<-X----->J<-x12 I x1241 Laterals & force main of PVC Sch 40
cleanoutplug per COMM Table 84.30 -5
Holes dried on the bottom of the lateral.
Number of Laterals 4 Orifice Diameter 0.125 in
Lateral Diameter 1.00 in Orifice Spacing (X) 2.58 ft
Lateral Length (P) 50.31 ft Orifices per Lateral 20
Lateral Spacing (S) 3.00 ft Orifice Density 7.65 ft /orifice
Lateral Flow Rate 8.24 gpm Manifold Length 3.00 ft
System Flow Rate 32.95 gpm Manifold Diameter 1.50 in
Total Dynamic Head 13.05 ft Forcemain Velocity 3.37 ft/sec
Dose Tank Information Locking cover with warning
label and locking device and
sealed watertight
Electrical as per NEC 300 and —�
4 in. min.
Comm 16.28 WAC
Disconnect __t
Alternate outlet
component is property vented F---
location
Forcemain diameter
Wieser Concrete Manufacturer 2 in.
Cae acity 800.641 Gallons
Volume 22.24 gal /inch A
Weep hole or anti -
Dimension Inches Gallons B siphon device
A 19.86 441.72
B 2.00 44.48 C P ump off elevation (ft)
97.00
C 2.14 47.56 �
D 12.00 266.88 D
Total 36.00t 800.64
D ank elevation (ft)
3" Bedding un er tank. 96.00
Alarm Manuafacturer LevelArm
Alarm Model Number DLV
Pump Manufacturer Goulds
Pump Model Number 3887 EPO4
Pump Must Deliver 1 32.95 gpm at 13.05 ft TDH
Project: Appletree Builders, INC. 4 bedroom residential mound Page 4 of 10
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 (01/81)] and local or state rules pertaining to system maintenance and
maintenance reporting.
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death.
Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as
POWTS components.
Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings
used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject
to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to
prevent accidental or unauthorized entry into a tank or component.
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. 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 filter shall be assessed at
least once every 3 years by inspection.
The outlet fitter 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 fitter when removed from its enclosure. If the finer 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 113 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.
PU p Tank
The pump (dosing) tank shall be inspected at least once every 3 years. AN 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 riot 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.
Continency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper
operating condition.
If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired
or replaced with a component of the same or equal performance.
If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in
W 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: Appletree Builders, INC. 4 bedroom residential mound Page 6 of 10
, �7 GOULDS PUMPS Submersible
Effluent Pump
3871 EPO4
EP05
APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lo
grade turbine oil for tic enclosed design for heavy duty ball bearing
specifically designed for the lubrication and efficient improved performance. construction.
��liowing uses: heat transfer. ■ Casing and Base: Rugged
• Fff!uent systems
�o�Te� Available for automatic and thermoplastic design provides AGENCY LISTING
'
Farms manual operation. Auto- superior strength and corrosion Sp resistance, Canadian Standards Association
• Heavy duty sump matic models include
• ; ^Vater transfer Mechanical Float Switch In Motor Housing: Cast iron
• Dewatenng assembled and preset at the for efficient heat transfer, Goulds Pumps is ISO 9001 Registered
factory. strength, and durability.
SPECIFICATIONS ■ Motor Cover: Thermoplastic
FEATURES cover with integral handle and
• Sol:ds handling capability: float switch attachment points.
maximum. ■ EPO4 Impeller: Thermoplas- 0 Power Cable: Severe duty
• Capacities up to 60 GPM. tic Semi -open design with rated oil and water resistant.
• "otai heads up to 31 feet, pump out vanes for mechanical
• Discharge size 1'i," NPT. seal protection.
• r.lechari(al seal carbon -
otar;;ce stationary,
BU%A -N elastomers.
• Tempe�ature
04 F 140'C) continuous
40F (60 C) intermittent. METERS FEET
I �
• rasteaers 300 series ,O �
sta niess steel 9
30 ► �f -5 GPti
• Capable of running LJ
dry without damage to 8 2 s FT
components
2s
a �I
Motor: _
• EPO4 S ncle phase: 0.4 HP, — 6 �r 20
or 230 V, 60 Hz, 1550 a
PP'J, built In overload with >
automatic reset. /3,os s _
• EP05 Single phase: 0.5 HP, 7. D, , o EPOS
1 15 V or 230V, 60 Hz, 1550 3 L 10
RPM, built in overload with i EPO4
automatic reset. 2I
• Pmver cord. 10 foot s
standard length, 16/3 r
STOW with three prong
grounding plug. Optional 20 o' 0 0 10 20 30 40 GPM
*got length, 16/3 SJTW with 3 �,9So.ir. ,y�,��;�nu.n �joly rote - 7d.
mree prong grounding plug — - --
0 2 4 h 8 1 0 m` h
standarr, on EP05).
CAPACITY
Goulds Pumps
;5 ITT Industries
", I)er 2002 �'�/ 0, -/6?
�.
�0. y
�o cid Fa
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Property Owner APPletree Builders, Inc. Parcel ID # 104- 127 -60 Page 2 of 3 _
a �Bo�ng# ��� _
/_f/ Pit Ground Surface elev. �•� ft. Depth to limiting factor 25" in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 Eff#2
1 0-8 10yr3/3 none Sil 2fcr mfr CS 2fm,1 c 0.6 0.8
2 8-20 10yr3/2 none sil 2fsbk mfr Cw 2vf,f 0.6 0.8
3 20-25 10yr4/3 none SCI 2fsbk mfi Cw 1vf 0.4 0.6
4 25-37 10yf6/6 none LSBR Na Na 1vf 0.0 0.0
I
F-I Boring # J9
J Pit Ground Surface elev. fl. Depth to fimfing factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 ` Eff#2
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Boring # J Boring
F
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 QP09f _
in. Munsell Qu. Sz. Cont. Color i Gr. Sz. Sh. `Eff#1 `Eff#2
` Effluent #1 = BOD ? 30 < 710 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.
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Wisconsin Department of Commerce S OIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Gustum Septic Service
Attach complete site Ian on paper not less tha : i County
p p pap �8 �T"rsin size. Plan must St. Croix
include, but not limited to: vertical and hori�@l�e1tp4pa o on ind.di� c �ection and
percent slope, scale or dimemsions, no arrow cati t6h to nearest road. Parcel I.D.
pending
Please pHr' t II fi atit�h. Reviewed B Date
�l r'.'
Personal information you provide maybe tiSed for sewn 'pry �ikpbe�c 0-1y Law, s. 1504 (1) (m)).
Property Owner ; ' _... A ft ; .� ., ; . Pr Location
Corporation it
Humbird Land Co I "'' `' ` ' , Go . Lot NE 1M NW 1/4 S 20 T 28 N R 19 W
'- _ '
Property Owner s Mailing Address \ Lqt # Block # Subd. Name or CSM#
332 Minnesota Street, East 1404\ CC, N'v
r iNG oF�iCE ;' 17 n/a Troy Wood Subdivision
City State Code. .Phone Numbef,< `. ' _j City __j Village e, Town Nearest Road
Saint Paul I MN I 551'0 ' / 0 i4 2*55\15/ Troy E Cove Rd / Day Farm Road
yI New Construction Use: a Residential ! Number of bedrooms _ 3 Code derived design flow rate 450 GPD
Replacement –J Public or commercial - Describe:
Parent material shale bedrock Flood plain elevation, if applicable n/a
General comments
and recommendations: Part of 2.54 acres. BM #1= 100.0'. BM #2= 96.3'. Recommend mound system along 95.3' contour.
Boring # I Boring
e Pit Ground Surface elev. 94.3 ft. Depth to limiting factor _ 1 1 9 — in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft'
*Eff#1 *Eff#2
1 0 -7 10yr2 /2 none sil 2msbk mvfr as 2f,2m 0.5 0.8 Cp
2 7 -11 10yr3/4 none sil 2msbk mvfr cw 2m,1co 0.5 0.8
3 11 -16 7.5yr4/4 none sil 2msbk mvfr cw 1m,1co 0.5 0.8
4 16 -19 7.5yr4/6 none sil 2msbk mfr cw 1 m 0.5 0.8
5 19 -30 10yr8/3 none UWB m m - - 0.0 0.0
Boring # Boring
1/ Pit Ground Surface elev. 96.3 ft. Depth to limiting factor 23 in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
*Eff#1 *Eff#2
1 0 -7 10yr2/2 none sil 2msbk mvfr as 2f,2m 0.5 0.8
2 7 -12 10yr3/4 none sil 2msbk mvfr cw 2m,1co 0.5 0.8
3 12 -16 7.5yr4/4 none sil 2msbk mvfr cw 1m,1co 0.5 0.8
4 16 -23 7.5yr4/6 none sil 2msbk mfr cw 1 m 0.5 0.8
5 23 -35 10yr8/3 none UWB m mvfi - - 0.0 0.0
* Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 50 mg/L * Effluent #2 = BOD 30 mg/L and TSS < mg/L
CST Name (Please Print) Signature: CST Number
Tom Gustum 227618
Address Gustum Septic Service Date Evaluation Conducted Telephone Number
N 13450 937th St., New Auburn, WI 54757 11/17/00 715 -658 -1344
Property Owner Humbird Land Corporation Parcel ID # pending Page —2-- - of 3
F Bori ]
ng # - j Boring Id Pit Ground Surface elev. 94.3 ft. Depth to limiting factor 20 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boun ary Roots GPD/ft' . - - --
*Eff#1 "Eff#2
1 0 -8 1 non sil 2 mvfr a s 2f,2m 0.5 0.8
2 8 -12 10yr3/4 none sil 2msbk mvfr cw 2m,1co 0.5 0.8
3 12 -16 10yr4/4 none sil 2msbk mvfr cw 1 m,1 co 0.5 0.8
4 16 -20 7.5yr4/6 non sil 2msbk mfr cw 1M 0.5 0.8
5 20 -35 10yr5/6 f2 -3d 10yr7 /1 7.5yr5 /8 sl - m mefl _ - 0.0 0.0
❑ Boring # -- Boring
J Pk 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'
*Eff #1 *Eff#2
I
F-1 Boring # I 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 /ft:
*Eff#1 *Eff#2
i
• 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.
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer Q���Q�/'t� %�c%fS �✓�C
Mailing Address -14 tie '�ZQs u2n&dbu'r
Property Address a qj L�
(Verification required from Planning Department for new construction)
City/State Parcel Identification Number
LEGAL DESCRIPTION
Property Location ' /., ' /a, Sec. ZQ, T.. N -R W, Town of - rr'oV
Subdivision - 71 -- ev L J, 7 , Lot # _ 7
Certified Survey Map # ✓f 4 , Volume 144 Page #
Warranty Deed # Volume -?W60 , Page # /2-3
Spec house ❑ yes 2'
Lot lines identifiable 9 ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site 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 rein, as set b the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating t your septic stem has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
da s o ee ye piration date.
SIGNATURE OF APPLICANT DATE
OWNER CERTIFICATION
I (we) certify at all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
Vtheypre/escribe ove, by virtue of a warranty deed recorded in Register of Deeds Office.
y
SIGNATURE OF APPLICANT DATE
* * * * * * Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * *
•* Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
22 QQ 3 747125 l
STATE BAR 'OF4&9N l l 1499
2? KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
Document Number 57. CROIX CO., WI
RECEIVED FOR RECORD
This Deed, made between Christopher J. Simonsen and Heather 11/20/2003 12:30PN
R. Simonsen, husband and wife Grantor,
and Appletree Builders, Inc. WARRANTY DEED
Grantee. EXEMPT #
Grantor, for a valuable consideration, conveys and warrants to Grantee REC FEE: 11.00
the following described real estate in St. Croix County, State of Wisconsin TRANS FEE: 328.50
e space is needed, please attach addendum): COPY FEE:
t I , Plat of T roy Wood i n the Town of Troy, St. Croix County, CC FEE:
Isconsin.
PAGES: 1
Recording Area
Name and Return Address
040- 1270 -60
Parcel Identification Number (PIN)
This is not homestead property
(is) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this day of A jjhaqW L 2003
* * Christopher J. Simonsen
* * Heather R. Simonsen
AUTHENTICATION CKNOWLEDGMENT
Signature(s) STATE OF Lkff )
ss.
- - - - -- eC a V County )
authenticated this _ day of �u�
Personally came before me this day of
(�S� September 2003 the above named
Christopher J. Simonsen and Heather R. Simonsen, husban
O� and wife _
TITLE: MEMBER STATE BAR OT WISCONSIN
(If not, ___ to me known to a the person(s) who executed the foregoing
authorized by § 706.06, Wis. Stets.) " s ment and c ged the same.
r
THIS INSTRUMENT WAS DRAFTED BY _
A ttorney Kristin Ogland (/
H_ udso WI 54016 Notary Publ State of
My Commission is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) — { L 1 _ __ ___ __ )
* Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Pond du Lac, WI
STATE BAR OF WISCONSIN BOD-655 -2021
WARRANTY DEED FORM No. 2 - 1999
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Jessie Nye
Subject: Schumaker, Troywood Lot 17, 487913 (plow)
Location: Troy
Start: Wed 10/19/2005 1:30 PM
End: Wed 10/19/2005 2:30 PM
Recurrence: (none)
Meeting Status: Meeting organizer
Required Attendees: Kevin Grabau
Final Thursday at 2:00 with Ryan
040 - 1270 -60 -000
20.28.19.1493
291 Day Farm Road
1
l
Distribution Cell - Concave Deflection Worksheet
Appletree 4 bedroom residential mound
Lot 17, Plat of Troy Wood, Tn. of Troy, St. Croix Co., WI.
Site Information:
1. Design wastewater flow: 600 gpd (4 bedroom)(100 gal/bedroom)(1.5 peaking factor)
2. Depth to limiting factor: 15"
3. Land slope: 23%
4. Infiltrative capacity of soil at system elevation: 0.60 Qyd
5. System elevation: 102.13' at 21" above 100.38' contour.
Dispersal cell sizing:
600 sq.ft. required (600 gpd / 1.0 gpd/sq.ft. ASTM C33 med. sand)
Cell length (B) 100.00'
Cell width (A) 6.00'
Dispersal cell deflection:
1. Percent deflection: (6'deflection/98' down slope effective cell length)(100) = 6.12%
2. Adjusted cell length: [(6.12% x 0.00265) + 1] x 100' contour effective cell length =
101.62'.
3. Actual cell length along contour = 102.00'.
I
Pg. 9 of 10
1947
Wwonsin Department of Commerce SOIL EVALUATION REPORT P age I of - 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations
Attach complete site plan on paper n County ot less than 8% x 11 inches in size. Plan must St Croix
include, but not limited to: vertical and horizontal reference pant (BM), direction and —
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D.
104- 1270 -60 _
Please print all information. Reviewed By Date
PersorW nformation you pvf& may be used for secmday pr+Pows (Pm*wY Law, s. 15.04 (1) (m))
Property Owner Property Location
Appietree Builders, Inc. Govt. Lot NE 1/4 NW 1/4 S 20 T 28 N R 19 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
1687 Wooc lane Dr., Suite #205 17 Plat Of Troywood
City State Zip Code Phone Number J City _]Village J✓ Town Nearest Road
Saint Paul MN 1 55125 1 (12) 889 - 7766 Troy I Day Farm Road
✓ New Construction Use: V1 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
_! Replaoement _I Public or commercial - Describe: - -- _ --
Parent material loess over fissured dolomitic limestone _ _ Flood plain elevation, if applicable n
General comments
and recornrnendations: Site suitable for mound system with 21" sand lift & 6'x 100.0' dispersal cell. Dispersal cell to be place along
100.38' contour, system elev. = 102.13'.
FT] Boring # I Boring
✓ Pit Ground Surface elev. 100.48 ft. Depth to limiting factor 16" in. Sal 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
1 0 - 10yr3/3 none sil 2fcr mvfr cs 2fm 0.6 0.8
2 7 -16 10yr5/4 none sil 2fsbk mfr cW 2vf,f 0.6 0.8
3 16-38 10yr6/6 none LSBR Na Na - 2vf,lf 0.0 0.0
i
H#3 consists of 1 "x1 "xt" - 3"x4 - W' Limestone fragements comprsising approx. 80% of horizon. Voids between fragments filled with 1 Oyr6/6 sl
M Bori # I Bori 15" in. Sal
✓ Pit Ground Surface elev. 100.33 ft. Depth to limiting factor Appl ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz _
in Murrell Qu. Sz. Cont Color Gr. Sz. Sh. `Eff#1 `Eff#2
1 0-6 10yr3/3 none sil 2fcr mvfr cs 2fmc 0.6 0_8
2 6-15 10yr5/4 none sil 2fsbk mfr cW 2fm,1 c 0.6 0.8
3 15-32 10yr6/6 none LSBR Na Na - 2vf,lf 0.0 0.0
I
H#3 consists of 1"x1')1" - 3544'"x6" Li one f cornprsising approx. 80% of horizon. Voids between fragments filled with 10yr6/6 sl. –
` Effluent #1 = BOO ? 30 < 220 mg/L TSS >30 < 150 L uent #2 = BOD S mg/L and TSS <_0 mg/L
CST Name (Please Print) Signature: CST Number
James K. Tho mpson 3602 - -�<
Address A.C.E. Sal & Site Evaluations �Eluat on Co nducted Tr
340 Paulson Lake Lane, Osceola, Wr54020 9/92005 715 -248 -7767