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HomeMy WebLinkAbout463031 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 463031 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: Jurisch, Carl I Forest Township 014- 1042 -70 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: / J� \ 20.31.15.310A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. loy • 2 /66 Septic Benchmark X63 Dosing 1lzb Alt. M C) , b 75ta CL— At3re1i0n Bldg. Sew r g . , (i Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet • lvS RS • 5S TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / i l Dt Bottom -7 /6() 7 60 Z 1 I � Z �g yI Dosing I , / Header /Man. ' /L� 7�n Z ZI �' `l� 9SS• Z Aeration Dist. Pipe Holding Bot. System -�S ell , 55 Final Grade PUMP /SIPHON INFORMATION �y Z— I .$ Manufacturer i1 Demand Stever- .� GPM S� �i d� ( 7 • ' 75 S Model Number P6; - I � TDH Lift Friction Loss System He d T t Forcemain Length Dia. Z � � Dist. to ell 7 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. On ench PIT DIMENSIONS No. Of Pits Inside Di-,—,— Liqui Depth DIMENSIONS (_ / 38 SETBACK SYSTEM TO J P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of em: Jv� UNIT Model Number. DISTRIBUTION SYSTEM U �V Header /Manifold If Distribution t /i i x Hole Size I x Hole Spacing Ven_�Air Intake Z , /Z Pipe(s) 6 � ` F r 1 �I Z . 3 1 s/ 3 Z 3g I ,• k� Length Dia Length Dia spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodde xx Mulched Bed/Trench Center / Bed/Trench Edges Topsoil G 5 ` s [] No _It �,_Xks No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: {{/�� Z Oq Inspection #2: Location: 2719 210th Av nue Deer Park, WI 54007 (NW 1/4 NW 1/4 20 T31N R15W) metes boGnds Lo C Parcel No: 20.31.15.310A 1.) Alt BM Description = �� 2.) Bldg sewer length OJ = C/ • i � / � _� ev��.e.� - amount of cover = I Plan revision q Use other side for information. No '_ �_ L — " is- Yes SBD -6710 (R.3/97) Date Insepetor's ignature Cert. No. Safety and Buildings Division County tr 201 W. Washington Ave., P.O. Box 7162 6 �� l k 8v eons�n Madison, WI 53707 - 7162 S8n — airy Permit Number (to be filled in by Co.) Department of Commerce (608) CE1\1E 1 4 903 Sanitary Permit A 14�75 - n S tate lan I.D. Number In accord with Comm 83.2 1, Wis. Adm. Code, pe ma io you in6tq )) ?Q LC SSZ T T = i INls. 1 may be used for secondary purposes Priv ( (m) Project ddress (if different than mailing address) 1. Application Information - Please Print All Information Z011111V O' Property Owner's Name Parcel # -[.at # Block # C.ra. % U _ l 5G+i 0 14 - - 1 o A7 _ - i o ©oo 6 1c)A) Property Owner's Mailing Address Property Location 2 19 V cU AV 0 w ,, r Zcj e Phone Number �s. Section City, State Zip Cod L WI � .�4�-7 �15�2(o3 Z-` (circle ne) I[. T of Building T � N; R _E o� Type g (check all that apply) It nt er I or 2 Family Dwelling - Number of Bedrooms El Public /Commercial - Describe Use i ❑ State Owned - Describe Use u y_ ❑Village PQTownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' ❑ New S7 stem Replacement System g R y g ys ❑ TreatmwrtMoldin Tank R lacement On1 ❑Other Modification to Existin S B. ❑Permit renewal ❑Permit Revision 11 Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of PO System: (Check all t hat a I y ❑ Non - Pressuri; ed In- Ground , Mound > 24 in. of suitable soil 9k Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Weth nd ❑ Pressurized tn- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Syn hettc Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Ti eatment Area Information: 7 c Design Flow (¢pd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed ystem Elevati on 4C� 11 43 1, (000 LW •e cl�.5 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units W,Z2a.11e A- JCfl 6r. Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Te nk 17&0 l� n - K Aerobic Treatment L nit Dosing Chamber _1 150 --- ^15� VII. Responsibility Statement- 1, the undersigned, ssume responsibility for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) P is Sig lure �ivt�1 � i�t�� P PRS Number Business Phone Number i✓t�. 22.t,5k4 - 115)63 Plumber's Addres; (Street, City, State, Zip Code) 4-1 1 _"+ AN . 13 PT:?, t 54 1 z VIII. Count /De artment Use Onl X Approved Q Sanitary Permit Fee eludes Groundwater Date Issued I suin gent Signatur o Stamps) Surcharge Fee) IX. Conditions of Approval /Reasons for Disapproval 3 \ ki SYSTEM OWNER: J �� 1 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than gl/2 x 11 inches In size SBD -6398 (2.01/03) S ITE .PLAN Ul Ti ye Sal �� tc i Co `44 q5 'Ci . 4 Dry P-w, Z� sc,H 4o Wc. llou3 S IM weu, N 4 ,„ 30 - 3 1 , , V PVC, (.0 BM Bench mark EL 100.00 V / .i `Jt9u.�YL.. t'i p1a(A TO c3rn, NAIL. � F1..r►6, to lU 1n >pw ,, IZt3Q . FOR. 5138 PITCH A Comm f!A •t U �n R. i y P 8 Gf' ltill�Tc'�iG A �.• l)S� O. Pump U1nmBd2. 5au.3s3R.- Laav Flom N Ous6 T o T A aK, SKAV) I2ov _15L)9'NA_ 1c to f T_uss��.P.TC3v �siZComm. E3z (�1� 4,(,7- � � � i 3Q'' C; O ? o . 4 a x 13 Gs u— Z5.3 O' k 157-11-3 ��.,�, vrsRS,O►� Z.0 5(3c) —loco e11 Safety and Buildings 10541N RANCH ROAD commerce.Wi.gov HAYWARD WI 54843 TDD #: (608) 264 -8777 isconsin www.commer isco sin.gov www.wisconsin.gov e partment of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary August 31, 2004 CUST ID No .226564 ATTN.• POWTS Inspector RONALD E FRIEDELL ZONING OFFICE FRIEDELL PLUMBING ST CROIX COUNTY SPIA 1419 13TH AVE 1101 CARMICHAEL RD BARRON WI 54812 HUDSON WI 54016 IdentifiCatpn Numbers CONDITIONAL APPROVAL Transaction ID No. 1055247 PLAN APPROVAL EXPIRES: 08/31/2006 Site ID No. 688682 SITE• Carl Jurisch Please refer to both identification numbers, Town of Forest, St Croix County above, in all Correspondence with thu NW 1/4, NW 1/4, 520, T3 IN, R15W a FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 977431 Maintenance required; 600 GPD Flow rate System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01) 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: • Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the septic tank outlet filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. • 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(NO1 /01) "Pressure 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) ". 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. RONALD E FRIEDELL Page 2 8/31/04 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 4 — Balance Due $ 0.00 Leroy G. sky, W tewater rcialist Integrated Services Bureau V�iARTcde: (715)726 -2544 Office Ijansky@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 i MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Carl Jurisch Owner's Name: Carl Jurisch Dwner's Address: 2719 210th AV Deer Park WI 54007 (715)263 -2936 i -egal Description: NW NW S20 T31 R1 5W Township: Forest 1;ounty: St Croix :3ubdivision Name: I -ot Number: Block Number: Parcel I.D. Number: 014 - 1042 -70 -000 [Ilan Transaction No.: 10 5 2 ` /y � 7 r Page 1 Index and title P. 0 . W. T S • Page 2 Data entry C'011 did 011 t711y Page 3 Mound drawings A r% EWA Page 4 Lateral and dose tank f- F . Page 5 System maintenance specifications DEPARTMENT OF COMMERCE Page 6 Management and contingency plan DIVISION OF SAFETY AND BUILDINGSP 7 Pump curve and specifications Page 8 Site Plan c RRES NDL:N Designer: Ron Friedell License Number: 226564 Date: 08/09/04 Phone Number: (715) 637 -3020 ;signature: �J 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 (0181) Version 3.11 (R. 06/01) Pagel of 8 I I r Mound and Pressure bistribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 8344 -3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 % coliform of - 36 inches. 600.00 Design Flow (gpd) 8.00 Site Slope ( %) 95.75 Contour Line Elevation (ft) 15.00 Depth to Limiting Factor (in) 0.40 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 130.00 Dispersal Cell Length Along Contour (ft) = 4.62 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /fe) 1 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 2.31 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.156 Orifice Diameter (in) (e.g. 0.25) 3.00 Estimated Orifice Spacing (ft) = 7.15 fe /orifice 2.00 Forcemain Diameter (in) 120.00 Forcemain Length (ft) Does the forcemain drain back? 85.00 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 19.57 Forcemain Drainback (gal) 12.42 Vertical Lift (ft) 81.77 5x Void Volume (gal) X 4.97 Friction Loss (ft) 101.34 Minimum Dose Volume (gal) 21.94 Total Dynamic Head (ft) 45.23 System Demand (gpm) Z a S Lateral Diameter Selection Manifold Diameter Sele in. dia. options ch oice in. dia. options choice 0.75 1.25 x 1.00 ~ 1.50 x x 1.25 x x 2.00 x 1.50 x 3.00 2.00 x 3.00 x �~ Gallons /Inch Calculator (optional) T reatment Tank Information Total Tank Capacity (gal) L 1254.00 Septic Ta nk Capacity (gal) total Working Liquid Depth (in) kaw Pre -Cast IManufacturer gal/in (enter result in cell 1349) Dose Tank Information Effluent Filter Information 754.00 Dose Tank Capacity (gal) JZab Filter Manufacturer 16.05 Do Tan Volume (gaLfin) JA100 Filter Model Number S kaw Pre -Cast IManufacturer Project: Carl Jurisch Page 2 of 8 Mound Plan View t� . t ... J 1/10 B Observation Pipe ; ;:;:; ':':'::{f ?�,.'iT } : {ij;:;';;. •:''itii:.a: Vii,. {,' ti.`. }: }L }T3:i:ii�': } ?i: ?. arl 1 } } 1 �:! ?f: }Yf} }% •Y} } }'}�} •• .1 L y,� ; +` + ii`' `y+ Y, {fY y, + : Y # :{ , ? i Yfif1fifi� } } {� • i {� ;!ii:i' A +� l LY}\: �y tfLy f l ••1 + \ {{ +� }llt�fSJ�f�.•�! . W X B ..... :......: •.•.•.•...•.• ...... ............................... I :'. .• .....::::.:::::.::::.::::::::::::::::::: ::.::::::::•:.:::::::::•:•..... ......................... Mound Component Dimensions A 4.62 ft E 25.44 in H 1.00 ft K Aft B 130.00 ft F 9.25 in z 13.38 ft L ft D 21.00 in G 0.50 ft J 7.31 ft W ft n600l(gpd/ft) (fe) Dispersal Cell Area 2340.43 (fe) Basal Area Available Linear Loading Rate 1 13.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 99.27 (ft) /!! G ♦ H . , /i�Ii /I!I!llll /I!l /IIIII!!!!!I . I F Disprsai can 98.00 (ft) Lateral 97.50 (ft) — Invert Dispersal rsal Ce II • 3 • • D E • • 3 • I ' E evab on t • ,� • 4 AIQ � x ` 95.75 (ft) Contour Elevation 8.0 % Site Slope Geotextile Fabric Cover Shading Key s a Dispersal Cell See lateral details on 1[] ® Yopsoil Cap a 1.5 ft ,:,:,; }� Y, } :,�1: ;� Y :Y }r Page 4 for number, size, C {•Y.Y•Y• +f { {Y � Y . Y {{ {.{ Y� S { Subsoil Cap a o 5 '� > }::} } •. }� $${ and spacing of laterals. i f.l.f • y f. l :TI./. ASTM C33 Sand w f, {•Y•Y•Y .') {. ;� {.,,t {.; , { 7,�.r # : F Laterals are equally '.ii Typical Lateral :,:; }w spaced from the ® Gilled Layer c a 0.5 ft i:.::�:.rr: =�i�:�i;:�a�� ❑5 "Y °''i` }: } "` { ' { ' "' ` `' distribution Dell's }•! f.:. f:}::f �:Y. Aggregate o ::• .s. }. 5 centerline in the distribution cell (AxB). Project: Carl Jurisch Page 3 of 8 Center Connection Lateral Layout Daigram Force main connection via tee or cross to manifold at any point. Laterals are identical � P s M- Tum-up wlball valve or X -4Ke12 f02+1 Laterals & force main of PVC Sch 40 Discinoutplu9 per CMW Table 84.30 -5 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.156 in Lateral Diameter 1.25 in Orifice Spacing (X) 3.13 ft Lateral Length (P) 64.17 ft Orifices per Lateral 21 Lateral Spacing (S) 2.31 ft Orifice Density 7.15 ft /orifice Lateral Flow Rate 11.31 gpm Manifold Length 2.31 ft System Flow Rate 45.23 gpm Manifold Diameter 1.50 in Total Dynamic Head 21.94 ft Forcemain Velocity 4.62 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and —� Comm 16.28 WAC Disconnect 4 in. min. 'lank component is properly vented f Alternate outlet location Forcemain diameter Skaw P re-Cast Manufacturer 2 in. Cap acityl 754.00 Gallons Volume 16.05 gal /inch A Weep hole or anti - Dimension Inches _Gallons B siphon device A 31.66 508.21 B 2.00 32.10 C Pump off elevation (ft C 6.31 101.34 85.58 D 7.00 112.35 D Total 46.98 754.00 � Dose tank elevation (ft) 3" Bedding under tank. 1 85.00 Alarm Manuafacturer IS J Electra Alarm Model Number E01 - - w —� Pump Manufacturer Go ulds Pump Model Number PE Pump Must Deliver 45.23 gpm at 21.94 ft TDH Project: Carl Jurisch Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name [— Friedell Plumbing Phone 715 637 -3020 POWTS Regulator's Name [ St Croix County Zoning Phone 715 386 -4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1254 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600.6 fe Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should Ins Mt and dean at least once eve 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should b flushe and pressure tested eveg 1.5 years Mound _ Ins for ndin and seepage once eve 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)(1), 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 Turn -up Detail Finished ....��.......•. .....•......... Grade 6-8" Diameter Lawn Threaded Cieanaut Sprinkler Valve Box Plug or Ball Valve Distribution Lateral �e --- Long Sweep 90 or two 45 Degree Bends Same Diameter as Lateral Project: Car. Jurisch Page 5 of 8 i 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.01101) 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 subiact 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 filter shall be cleaned as necessary to ensure proper operation. The finer cartridge should not be removed unless provisions are made to reta[i solids in the tank that may slough off the filler 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 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 fitter 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 infiRrative 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 cru /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 acxum:ilated 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 shalt 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. CContinaency 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, tt 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: Carl Jurisch Page 6 of 8 "GOULDS PUMPS Submersible Effluent Pump I PE "PUW SPECIFICATIONS MOTOR FEATURES Pump — General: General: ■ Corrosion resistant • Discharge: 1' NPT • Single phase construction. • Temperature: 104 °F (40 °C) 1, 60 Hertz ■ Cast iron body. maximum, continuous when • 115 volts ■ Thermoplastic impeller and fully submerged. • Built-in thermal Overload pro- cover. • Solids handling: '12" tection with automatic reset. ■ Upper sleeve and lower maximum sphere. • Class B Insulation, heavy duty ball bearing • Automatic models include a • Oil- filled design. construction. APPLICATION float switch. • High strength carbon steel ■ Motor is permanently • Manual models available. shaft. lubricated for extended Specially designed for the • service life. • Pumping range: see pE31 Motor' following uses: NP ■ Powered for continuous • • Mound Syste ns Effluent/Dosin 5 stems PE31 Pum p : • 12.0 Maximtum amps performance chart or curve. .33 , 3000 RPM operation. t All ratin s are within the y • 50 GPM & Shaded pole design g •Low Pressure Pipe Systems Maximum capacity: Y� working limits of the motor. • Basement Draining • Maximum head: 25' TDH PE41 Motor: ■ quick disconnect power • Heavy Duty Sump/ PE41 Pump: • .40 HP, 3400 RPM cord, 20' standard length, Dewatering • Maxinnnn capacity: 60 GPM • 7.5 Maximum amps heavy duty 1613 S1TW with • Maximum head: 29' TDH • PSC design NEMA 5 -15P, three prong, PE51 Pump: PE51 Motor: 115 volt grounding plug. • Maximum capacity: 70 GPM " .50 HP, 3400 RPM ■ Complete unit is heavy duty, • Maximum head: 31' TDH • 9.5 Maximum amps portable and compact. • PSC design ■ Mechanical seal is carbon, MEIERS F .1 _ _ ceramic, BUNA and stainless 0 MODELS: PE31, PE41, PE51 steel I E5 1; I W.31.40-50 ■ Stainless steel fasteners. I 1 10 I. i i '- ►- 2 GPM { I AGENCY LISTINGS I FT ��a 1 25 . _... `.. c us i lJ 4.. - Tested to UL 778 and } 20 r _... i : .... t 2mdald3ll#�' btl4o* BY 5t n 15 r° + 1 _ "k iout*49 o J I Goulds mumps Is ISO 9001 g11115*red. _.. _ 1 0 O il 10 �20 30 40 50 60 70 GPM 80 - - - Goulds Pumps f , s 10 1 s r»�n, — CAPACITY M 2002 Goulds Nmps (/`�/ ITT Industries Effective Novembr r, 2002 V -7 RPE31l41 P5 l SITE PLAN t D Ti 07 f� f� i f 4 Do � t4ouso , Sc,H 40 I I pr, W eu. N 4" 30'--?,+ Pv( � ri = (, O WeRA. "AT100 BM Bench Mark M 100 .00 54guxqu Vi p1N4 - fo MeesT Coma% ft-'!3 f3rn NAIL f R*6, 10 'iu "mt>pw "tZlff4. Foe. 11JV C)ia�l�rz. -. "S r 51 8 3 PIfL1'� r+1" o Vt7���M /..J'T•� U Jim., tjm � # FLrau I Q "Pow fioR• 14 P 6F MAYferlUM. 05460. �tL L4,at3 FiLcm% Moos* To A Sew T a K. SFWµ, lZcx�lSc�r C�K�•gU �Ar1K to =•Ws��t�v BZ�SU�t, w`y.t3aL P.--tcv f►i 4,UZ Y, t 3Q" �{ M�+"� VcscLs�o►.► 2• ©560 — I�co c� t . P(r�at �atJ P Wisconsin Department of Commerce SOIL EVALUATION REPORT Page f of _3_. owisjon of safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 112 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 infoo Re 'wed by Date SOW Q `� Personal Wonne iien you provide may be used for second .,y w. 15.04 (? (m ) v / Property Owner Property Location ' ` (AVt. L O W 114 t4 0 114 S I LO T 31 N k 1 W,(or) W Property Owner's Mailing Address l # Block # Subd. Name or CSM# lot T-H AV city State Zip Code Phone u y ❑ •— Village Town Nearest Road j�aR WE 54gc ( t )2.4p3 -2236 r ®we 2,) O T AV ❑ New Construction Use: ® Residential / Number of bedrooms �_ Code derived design flow rate loo GPD Replacement ' 1 El N KQW 1,j Public or commercial.- Describe: Flood Plain elevation appli Parent material V General comments �Gu and recommendations: M Ou rJ c> MAY 24 2004 aL�o a i,.a co,�ov2 Ppa ST. CROIX COUNTY ZONING OFHUE Boring # [] Boring () I ® pit Ground surface elev. � 4.1 ft. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft In. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'EH #2 M r fo °Ile i O - t J trt 2 - 5 " —'" 5 I *v� 1 r W 5 Y?_ 4'1' 8 2 S I Crwodb IQ if � + -55. 3c p i Boring # D Borin ' ®pit Ground surface elev. a4 • �._ 8. Depth to limiting factor � Sdd Appliqtiort Rate Horizon Depth Domina nt Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft" In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff #2 n - ?5 15'f a-3 h- - 51 Zm r r 5 Z. . 40 1,0 2 18-11, 101P -514 51 I w•ck b k Y' CU . 4 2.5y2 3 Ito- (q 2-5 s3 2 5 lib k rv+ r &5 — • car 0 P 2.� -r¢.4- 5 t 1 ca.b k v►n ' 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) Signatur CST Number JR Address Da t Evaluation ducted Telephone Number �'j AJ BAFZRDtJ i�i��r 5 11 5 (o - 20 7 Parcel f D # 0 1 4' — l o4-4— -= 1v - 000 Page Z of 3 Property (homer ; ® # ❑ Boring , Boring �_ fl Depth to limiting facto in. Sop Application Rate p Ground surface elev. L •. Sn. —_ Texture Structure Consistence Boundary Roots GPD/ftz Horizon Depth Dominant Color Redox DesaipticKn •Eff#1 'Eff #2 In. Munsell ou. Sz. Cont. Color Gr. Sz. Sh. Stl ZrnSb l� 2 . � • $ 5 1 b 2.512 E 21 S f 2 r ,, abk CAS ZSy¢,4 CL 5c.) !n kb K ,4 EE - ------------ R. � ❑ Boring # ❑ Boring fl: Depth in. Soil to limiting factor Applicafion Rate Ground surface elev. ❑ Pit GPO/ftz ` Horizon Depth Dominant Color Redox Description 1 St Consistence Boundary Roots 'Eff#1 •Eff#2 In. MunseY Chu. Sz. Cont. Color Gr. Sz. Sh. O E] ng # ❑ Boring to in. Ground surface elev. fl. Depth W" fades Sop Apppcation Rate ❑ Pit GPD/flz Redox Description Texture Structure Consistence Boundary Roots Depth Dominant (:Dior •Eff#1 'Eff #2 Horizon In. Munsep Chu. Sz. Cont. Color Gr. Sz. Sh. ' Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 nngll. • 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. SIin -R1" M 0'1100) r • SITE PLAN PROPERTY OWNER: G A R.L- Z uKk PROPERTY LOCATION: LJ� NI,J 1 Sc�c 2 0 T31 R15c►.� I� VI 4 � 1.J 0 a ra�_:;r — ST ckoI k Cam N 2.10*"AV / -2- 4z 43` `i4 q5` q� p BM BENCHMARK: L4 100.0' '* 5rnZ Mmt- � •FL A& � N ICI O A BORE HOLES: Ron Friedell #226564 9 Gt,rB 4 • z �-g3 9b .v` * om,L, loc.^Tti o o SALE �Atzc.,�lr ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer � f T () r ; Mailing Address _Q to T Property Addres �� Q" ►„ ,� S y �� (Verification required from Planning Department for new construction.) City/State e. " t ,i Parcel Identification Number aQ LEGAL DESCRIPTION Property Location K , %4 , Sec. , T S/ N R W, Town of Subdivision , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # 5- 1 , Volume /a ( , Page # y Spec house yes Po Lot lines identifiable es 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. 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 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 Zoning Department within 30 days of the three year expiration date. (" � 9 SI OF APPLICANT DATE OWNER CERTIFICATION Uwe 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 property scri ed Ive, by vi5111 of a warranty deed recorded in Register of Deeds Office 91 S 71JRlP OF APPLICANT DATE * * * * ** Any information that is misrepresented 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 and a copy of the certified survey map if reference is made in the warranty deed. i STATE BAR OF WISCONSIN ORM l - 1982 ' 565612 W ARRANTY DEED DOCUMENT NO. VOL 265PACEOi't l/ 1. This Deed made between UGISTF-R OFFICE ST. WI R OIX RRC O,. Grantor SEP 19 1997 and d� -. w vti a� ter �« 1:45 \\ P i� — GJwla� ` Register of ONdtl Grantee, Witnesseth That the said Grantor, for a valuable considetat � THIS SPACE RESERVED FOR RECORDING DATA conveys to ,ranee the following described real estate in G `�' j�,2s —_ _. - County State Of Wisconsin: NAME AND 4ETURN ADDRESS Sec c1 T 31 Al R lSw SA TN N w Nr✓ c ot Y. w�iscl. 27/1 Qfor4 ave C om 781..2 E d t273. 1 1 '5 0� N tv Gorner, Q Ber G��k, 6✓: S Y o17 Tf S 500.9; rN E 'Y10', N Soo. 9', -- a0 31, j S 3 /0 PARCEL IDENTIFICATION NUMBER T M w yy 0' ro / 0 08 $ T SyFER I This homestead property (is) s not Together with all and singular the hereditaments and appurtenances thereunto belonging; And warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except and will warrant and defend the same. 'i Dated this 12 day of L1 Y-r ,19 97 I .r L 4�44<L4lJ -r� (SEAL) "(SEAL) • r UUU L (SEAL) (SEAL) ,i • � Y E �` � � I •NN••• it �`�•�;.• •,yam ,� Cj 1 AOTARY AUTHENTICATION ? KNOWLEDGMENT Signature(s) _ � P1t6 � f ' s Sin, ma � j /'�'" County. authenticated this day of 19_ t1 y came. me this day of IZVC� 19 the above named r TITLE: MEMBER STATE BAR CF WISCONSIN to 0. � r t S (If not, lvtnCe• itStw authorized by §706.06 Wis. Stats.) to me known to be the person 12---- who executed the foregoing inst ru 9 std acknowledge a same THI INSTRUM NT WAS DRAFTED BY L PP � IGL 1265FA 045 "�Uc'�ce'c3 in the Nort{iitiest Quarter of Northwest gbwnship 31 North, Pange 15 West, Town of Forest, St. Croix County, Wisconsin, 4 rrorefully described as follows; Comence at an iron pipe set 784.20' East and 273.13• South of the Northwest corner of Said Section 20 as the point of ' for thence Peed South a distance of 500.90' to an ironnpinn� parcel orth to be described; dstance of 440' to an iron i p ipe; thence North 89 54 East a p thence North a distance of 500.90' to an iron pipe; then South 89° 54' West a distance of 440' to the point of beginning, said parcel containing 5 acres. Above bearings based on west line of Section being due North and South. Together with an edsenent of ingress and egress from the town road locates] on the North si Of the Northwest Quarter of the Northwest Quarter (NWN NW4) of Section 20, Township 31 Nora Pange 15 West, Town of Forest, St. Croix Gounty, Wisconsin, over the driveway that is now located in the West Half of the Northwest Quarter (MI NW4), Section 20, Township 31 North, Pange 15 West, Town Of Forest, St. Croix County, Wisconsin. x t t i 3 FOREST PLAT T -31 -N • R -15 -W E� j (Landowners) POLK CO. ee Page 112 For Additional Names. � �....._./ C 2600 POLK / ST CROIX RD 2700 0� 3000 3700 3200 ZB00 Lout & G a P �.'� P Pad & ' tl � Harold & Sandra Strw 8 & $, � [ Rosen e Patrick 4 e Carol 6 O Cormican $trdf 7 a Grendahl Delores 3 _ � 9 66 Levendoski & 4z Janet ` !Is C 102 g RMeed N I &Roger m K Marl Scepurek I e R sst C b p • N �ROe PHebe t $ er 137 CREEK V °' trust (�(�F Sandra 167 d & aMf 62 83 ay GREEN 43 133 u) Cormican 224 C � 63 161 s... - Dorothy Laga s ox &KB R $ R Fuller e0 a i� MO I ' OO s Klos- Beau' o cOr- -' $W$N s n Jo $ 1 I Laursrn 90 70 o a Biskupski 80 '"'Si y I Ze net 40 net vaV; loo 40 H 40 �� shy 34 card B F Todd S I ,. F zo &RIG _ D avid $ Fred t]emu y_. oas 80 & Ina L 7 16 0 ( ^ • LE 36 80 68 50 z Deewse ` 6p PO 260 P Blomberg Nitchey 80 39 40 756 1 T t Jasa ., Star Ne0 &37 230TH VE $ & R Pepe & save, Phyllis a5 v a i I r Progenies Bo 40 Ulrich 40 w $hirlee ., ©a ' i ` , Kevin & 7: So v. Rose, Wayne v Harold & Brooks .+ 1 40 LoAnII 'o O `,.` .. m 0 & Beverly Bradl Shirlee ,�d & Lombardo u � XX 80 � t �1 rJd Alverman 120 Cress 60 Brooks 120 160 sO° 60 r 12 40 3 M. cn Larry & Mi elo n o Leon & 'c,� ntkhad Jr a W & 60 �D H n &EBB y�' dith �^. " � ` Ulrich 160 147 gaw 1 William & P�� s 40 Nflssen 15 160 Bergmann e3 1 '� eson � waa Oareeze Richard a+ Hall Dennis Patrick o F S Lynn uWtt a 00 'x` 8�� & Kathy & trade 80 v - z y �0 r Gak 42 cRp 71 srh�ia &� Heibel g 96 S te get 760 l s — — � & 80 80 O rF �j 220th AVE ,q N� & LorsJal 6 97 F 40 o $anftaers I t Z gg {! `�° ph1. La Icch N Pod So Qc 39� N N L. e wam N &.Krefts G q & DOrts Scher $ ^ D avid & p LE S Anderson li 74 h: h 140 20 160 Schmtdt 80 ��� Ju 160 , a ew usan r P 8 A s Edgr& � 270 ~ Fouks T160;1 'F 0D De v o G d+�J ,,,, �� Inc F \ 6 a Kurt �E, .. farms , allm OdJ 1 oj] a 48 s g I eq Monty& Rene - xia — 2 2 r 'F' 340 lamas t7 120 40 t F ism°, 1 a 220 ::]]p _ Pry- Edwa d a Robert Ras 20 Kurds & 270th AVE $ g & Scott H Joda Joni pQ3! FstaerS1 aioBra Eggert ° ® 40 David &/ Buh s a sd o s°a�+o 40 40 �+ BCrnartl Flie Old Laurie a Dennis David & $tVatJ�Oti BGLEN L„ ' 'a o ^.� c�-u t Moll 11 I t- M 112 Trutt 155 � 1 160 r Ros�enbn rumm 120 � / 160 40 160 40 m Ne9 & o o aoa,.,, 0a 0 205th VE Melissa I Iwila�h �, �t Moll 49 Edwin ,7p � Ohn 198 g g SD 'w jy� 40 So Hall 9 K..s 'Inchggm�5 r �� o2&J o . o (Laura $ Paul& �.. Florence 168 ° 78 IS a US IIIC 116 N 3 �n m ° dfv 3 , f0 DLLVaB 1 5 Ulrich BO $ 160 160 _ _ f R r S -- �F�- 1.-� 200th AVE J a Terrance , & Lawrence wn & Rhea �,�a is 10 rrlsw of go Lawrence 49 Alice Badge 76 .00 SD Deboer a 160 So 40 x Voelfz t°D G & McNamara John C James & Keith °m reu0aha Alfred & sm> m �J Mary Strom 80 0 40 �°` So L a 200 233 . ,- m 3 .w$ Jackelen 75 s 160 711 Orville �J ,dTt ° KKe th � Otto e & a Jaim s � ° Ted °o oo I 0D I 121 I ��S 01 &- GPIs BOrmet Robert& aurtrn g m tram 4o Annette nod` Bethdl g a E ' Hill is Kuhn Scott sra., So amah & Fr ances Maier sown s :a ° 229 Ali &CW s 201 8 rs ae 80 &rs` Heinbuch 120 160 131 4-t 40 80 a '�� a Gti Q 120 bi o 0 W ppy�1a� n 1 se a ao m Dale & $ A[lene Diamond 0 5 Shell y ,y 0 d! Y p m 34 Ri F- 80 Hill so K Farms kg3 b C I Endres ey 60 3 �u B Inc Z Z CTi v, S 155 X 40' " t�f+S 220 �� VW � 128 8E 340� Bonn 8o w D Norman Ryan & m ,g ve M & Gerald & o f Sheldon m IABen & i+ Melvin & & g d` Forest o C w f Karen u 00 l Sandra ur a $ Ruth ] Ardys X. I Laura Michie 100 Hint L o E3 as s Ludemann ; E 1 So ti Carufel B o Simonson aao rs I Warner a Simonson Kenneth Club ° u g 94i Harol .^ m Schmidt V H s 25 &Ida U lacadm F 120 255 5 & � G wa�ix t r 158 L 160 80 S 160 1 Ic ra»tora Abbott 79 121 40 So EMERALD PAGE 54 GLENWOOD PAGE 56 MIRY GLEMOOD CITY, WI 54013 (715) 265 -4429 (715) 265 -4384 (715) 265 -7255 FAX (715) 265 -7604 72