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Home My WebLink About016-1077-50-000,Wisconsir:cDepartmentofCommerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) 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 Walker, Mar Glenwood, Town of CST BM Elev: Insp. BM Elev: BM Description: i~ ~~ t TANK INFORMATION (~t ..e 1, ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic r ~.~.r.... ~- ~ ~ l bO~ 3 Dosing ~ o 3 ~ ~ ~~ O ~b c7 Holding TANK SETBACK INFORMATION TANK TO ~ ~P/Ln,~ WELL BLDG. Vent to Air Intake ROAD Septic ~~ ~ 7 ~ 3C7 _ Dosing t o I ~ y ___,_ Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Ga ~( s Model Number ~~ ~' Demand ~ GPM Z'~' 7Z TDH l~'i_,f~,,y Frictiof Lsss Syste Hea~ TDH ' Q t Forcemai~n Lengtty~ / Di ~ •' Dist. to well ~ ~ ~ O SOIL ABSORPTION SYSTEM County: .St. CrOIX Sanitary Permit No: 514931 0 State Plan ID No: Parcel Tax No: 016-1077-50-000 Section/Town/Range/Map No: 35.30.15.5326 STATION BS HI FS ELEV. Benchmark ~' ~ , ~~,~) / Alt. BM •~~... Gb~ 3 •z ~~/~ y$ Bldg. Sewer ~.0~ ~ • 6D D SUHt Inlet 7•Z3 ~ ~` ~ d O SUHt Outlet ~ ~ Dt Inlet '~ ~ Dt Bottom ~~ •~ c'~• 5. Header/Man. ~. ~ ~~/• ~~ Dist. Pipe 3.~Z ion • ~ Bot. System 3.7 ` /b f Final Grade .~ G ~~Z. ~J St Cover 3, Z ~(~ ~ ~'~g o~~- ~ 4.~ 99. ~ BED/TRENCH DIMENSIONS Width ~ Length / 7 S No. Of nche e PIT DIMENSIONS _. No. Of Pits Inside Dia. ! Liquid Depth SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: \ INFORMATION CHAMBER OR Type ystem: ~ ~ ~. ~~ Q ~ ~ /~~ , 1 ~ UNIT Model Number: DISTRIBUTION SYSTEM 11z,&~l. ~ Header/Manifold Length~_ Dia_ Distribution t Z L P gth ~/ ~ Dia /t ~ Spacing ` x Hole Size ~( ~t / V x Hofe Spacing // /~ V to Air take J SOIL COVER x Pressure systems Only xx Mound Or At-Grade Systems Onlv ,Ill .i.n. ~t~ Depth Over / / Bed/Trench Center Depth Over Bed/Trench Edges xx Depth of Topsoil ~ ~. xx Seeded/So ded Yes ~ No xx Mulched Yes [] No y ~ / 7 ~~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 7 / Z~ / d$ Inspection #2: / / Location: 1247 Rustic Ro d 3 lenwood City, WI 54013 (NW 1/4 SW 1/4 35 T30N R15W) NA Lot G~-SEJC- Parcel No: 35.30.15.5326 1 ~' L,o~~_ J e ~ 1.) Alt BM Description = 2.) Bldg sewer length = Sg n ~ t ~ ~' J - amount of cover = .t~~`^5 .~1 ~~ ~f ~~ ~~ T~ - -~ , --- - __ _ Plan revision Re uired? ~ Yes o Use other side for additional information. ~ ~ ~ ~ ~~ 1 ~-"'-~~~~ -L-- Ji Date Cert. No. SBD-6710 (R.3/97) commerce.wi.gov Safety and Buildings Divisi 201 W. Washington Ave., P. . Bo 7162 County n .ST CRO/ i s e o n S i n f C D - A4adson, W 1 53707- 2 , '~ ' Sanitary Permit Number (to be filled in by Co.) ~ ~L' / ~ 3 ommerce epartment o ~ ] °'e Sanitary Permit Application State Transaction Number ' submission of this form to the appropriate go rnme~,,~ Wis Adm Code 21(2) In accordance with s Comm 83 ~ .~S/73 /5 . , . . . . . a unit is required prior to obtaining a sanitary permit. Note: Application fottns for state-owned PO TS roject .4ddrcss (if different thantrrailin address submitted to the Department of Commerce. Personal information v rY u ses in aceordancc .vith the Privacy Law. .15.04(1 (m). Scats. ///~ ~ ! Z~~ //~L '~ I. A lication tn(orma[ion - Plcasc ro ->,II Information / Propeny O•vncr's Name / YGtI~(~Y t~+~c.K~ ~ 7 2C~8 Parcel n 0/l0 - /077- $D - oar's Mailing Address Property O w Property Location ~ ~ ~ ~ n u ~ / i ~Z 7 (~S'~[G •~bJEp ~ ST. CROIX COUNTY Govt. Lot `• City. State Zip Code ~~ /, ~~'/., Section ~5 /.( C (T uJ ( 5y~ o r 3 't ~ 5 ~ 245- 3.~/ (circle o T ,3o N; R ~5 _-~w~ Type of Building (check all that apph•) li Lot x . I or 2 Family Dwelling - Number of Bedrooms ~ Subdivision Marne '~, Block # ^ PublidCommerciai -Describe Use ^Cmof ^ State O•vned -Describe Use CSI~t Number ^ Village of ~ Town of G ~E~l[Alae?~ ~~ , e/.ti G III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ^ New System ~,/ I~.Replacement System r ^ Treatment/Holding Tank Replacemen[ Only ' ^ Other Modification to Existing System (explain) $. ^ Permit Renewal ^ Permit Rcvi<ion ^ Change of Plumber ^ Permit Transfer to New List Previotts Permit Number and Date Isstted / Before Expiration Owner fV. Tv a o(POWTS SvstemlCom onent/Device: Check all drat a I D O/ ^ Non-Pressurized In•Ground ^ Pressurized ln-Ground ^ At-Grade Mound > 24 in. ofsuitable soil ^ Mound < 24 in ofsuitabl s ~~ ^ Holding Tank ^ Other Dispersal Component (explain) Pretreatment Device (explain) V. Dis ersal/TreatmentAxea Information: Design Flow (gpd) / f Design Soil Application Rate( sf) Dispersal Area Required (st Dispersal Area Pro sad (sf) gb Sysum Elevation / y~' ' / 30o Soo .Soo ? boo, VI. Tank Info Capacity in Total p of Manufacturer ~ Gallons Gallons Units a v V u w = New Tanks Existing Tanks ~ ~ ~ ~ ~~ ~ ~ V $ ~ N r ~ to ~ ~ i% V G. ~ s n Septic or Holding Tank /o-0 0 /~~ ~ C~ _ /A~s~ 6~/C•/ ~+~~ Dosing Chambtt / CO u s 7 /_5G l ~ / L [`C.1 Ir ~n. ~ / v ~ l C.I l 9 '~ G 4` _ he attatbed plate. VT S shown n t O t h e PO VII. Responsibility Stateme ot - I, the undersigned, afsume respoos ibility for installation of , Plumber's Name (Print) Plu ber's Signature MP/MPRS Ntrrnber Business Phone Ntrmber tclwl // ~ ~trS ?..l0?985 /5_ZG,S~y/~5 Plumbers Address (Street. City. State. Zip Code) 2 f.E, vE ~G6J ~ ~`~ / ai V I II. Coen •/De artment Use Only ~ , / Qf.Approved tsapprov Permit Fcc D a te 1 sued Issuing t Signatu 1 S ~ ~ ` ~ ~ ~ ~~ ~ er iven Reason for nial • / IX. Conditi~tgt~(~~easons for Disapproval 3 / ~! r J!~~ ('~ ~,e 1 j ~ `„ 1 1 (gyp 1 f 1. Septic tank, effluent filter and t M ~ ~ / ~ G(~„s,~~..•/ dis ersal cell mu t ll b k e ~F~C ~ p s a e serv : / s / majntahtad ~ ~G ~ /l C. as per management plan provided by'plurttbtlr. 2 All setbackret~ i ern t t b '~ ~ . u en r s mus e rrNaitthilt~d ~ a S ~ °~,, a,4 ~'"" 't'rATPYf1i"t~t11P1!'hl'lIISltfllltte system and submiF to the County only o~ pap r not~m than 3 IR s t I mcnes to stze t~O~Q SBD-6398 (R. 01/07) Valid thru 01/09 N u ~ '` Z ~ ~ li z ~. r ar I ~' =- ~ ~ ~ y ~ ~ 3 ~ °` M ''` ~ ~ ~ ~ 1' ~~~ ~ ~ T'" n ~ ..:: ~ ~9 3 h o _ s~ V ~ `i c1~ O` d`' ~ d ~ ~ ~ t~ " titi ~ ` ~ z ~ `~ ~ ~ ro ~ ~ e._, ~ _._________~~ __ .r~..: _~. _____. _,.___~______ __._~._ ~- ____ _ _ ~~rn ~~ ~~~ ~ i ~' I ~ ~ a ~ ~ ~ ~ ~= 1 ~ 4 A I ~ ( Vy N ~ r ~~ a ~ ~ ~ , i ~ ~ ~- ~ ~ ~ ~( ~ ,' ~ ~ } RI '`J ~ t ~ ~ ' Q'- i t t lflf f V \. ~ ~. i l . f~ ~' ['. ds, ~, a ~ ~ ~ ~ ~ ~ '1 '`,n ~ ~ ~ v'.9 ° ~ ~ ~~ ~~ ~~ t ~'~x v~ ~i ~Gpp~, u i- -~" ~ ( . ~ i ~~ ~ a ~ ~ ~ ~ ~= ~ ~ ~J p ~ ) ~. ~ l ,i ~ ~'- ~ M ~ I ~~ ! ` ~• s ' i a) '~ ! i '1 ~~ ~~ ` ~~ ~ ~: _1 ~ ~~, ~~ ~ c. ~r6. M cr` a J F- N ~ Z ~ Y J 3 ~. z ~ m ~- ~ ~ 3 ~ ~ ~ ~ ~ ~ ~ ~ o ~ li ~. «~ ~, ~ ~ „ O a . , a ~ue~. ~ ____~--~ 4~'°~ ~r~.sn ~_'~~. ~~m~n °a A N ~ ~ ~ ~ ~ z x~~~ ~~ l1' ~~y ~- ' commerce.wi.gov ~ ^ ~scons~n Department of Commerce Safety and Buildings 141 NW BARSTOW ST FL 4TH WAUKESHA WI 53188-3789 TDD #: (608) 264-8777 www.commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Jack L. Fischer, A.I.A., Secretary July 09, 2008 CUST ID No. 267985 MICHAEL J MYERS NORTHLAND PLUMBING INC E1556 STATE RD 64 BOYCEVII.LE WI 54725 A77N.• POWTSInspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/09/2010 SITE: Mary Walker 1247 Rustic Rd 3 Town of Glenwood, 54013 St Croix County NW1/4, SWl/4, 535, T30N, R15W ~ Identification Numbers ~ Transaction ID No. 1555173 Site ID No. 739354 Please refer to both identification numbers, above, in all correspondence with the FOR: Description: Mound, 2 Bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1189331 Maintenance required; Replacement system; 300 GPD Flow rate; 37 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1) 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 constructed and located in accordance with the enclosed approved plans and with the component manual(s) 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: This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.O1/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.O1/O1). In the event this soil absorption system or any of its component parts malfunctions so as to create a t1i the property owner must follow the contingency plan as described in the approved plans. In addi ~ ~t e>r" must comply with the operation, maintenance and monitoring duties as described in section ~I o~j d component manual. A copy of this information must be given to the owner upon completion of~je'~ o~ All holding/treatment tanks are to comply with Comm. 84.25(7)(a). SF~. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. MICHAEL J MYERS Page 2 7/9/2008 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. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. 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. 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. 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 slats 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, Julia Lewis-Osborne POWTS Reviewer 2 ,Integrated Services (262) 397-6005, Fax: (608) 283-7481 j ulia. Lewis@wisconsin. gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMARTcode: 7633 Mound System Cover Page ~ ~ ~ 6 WIESER COACRETE Project Name: WALKER-MOUND Owner's Name Mary Walker Owners Address 1247 Rustic Road 3 Glenwood City, WI 54013 Legal Description Nw ~ %4, Sw ~ '/. Sec 35 T 30 N, R 15 w ~ Township Glenwood County Saint Croix . RECEIVED Subdivision JUN 2 5 2008 Lot# SAFETY & BUILDINGS Parcel ID# Table of Contents Pg• 1 Cover page 2 Mound Sizing Calculations 3 Pressure Distribution Layout and Dynamics 4 Dose Tank 5 Management and Contingency Plan 6 Plot Map 7 ~.-~c~ C'r~,rz ~~ total # of pages: 6 Designer Name: Michael J. Myers MP/License #: 267985 Date: 6/20/08 Ph. #: 7 5-265-4115 , rl0 Signature: ~ ~Zl Mound System Design Methods Used "=Fly c0,y tii per "Mound Component Manual For Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10691-P (N.01/01) ; ~~e~~~ per "Pressure Distribution Component manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10706-P (N 01/01)L~~i~~~ J~A C ~~~~, , _ Spreadsheet provided by: 3tu4dvisement N12486 220th St, Boyceville, WI 54725 Ph: 71543-6068 email: 3ba(dl3badvisement.com ~ • s ,~ Mound System Mound Sizing Calculations Project Name: WALKER-MOUND Site Conditions Project Type: 1 or 2 Family Dwelling ~ Slope: 3 # of Bedrooms: 2 Depth to limiting factor: 37 in. Absorbtion rate of fill material: 1 gal/ftz/day Absorbtion rate of in-situ soil: 0.6 gaUft2/day Effluent quality Eff#1 • Max BOD effluent value: 220 mg/I Max TSS effluent value: 150 mg/I Design of Entire Fill Cell depth at upslope edge (D)_ Cell depth at downslope edge (E): Distribution cell depth (F): Cover thickness over edge (G): Cover thickness over center (H): End slope width (K): Fill length (L): Upslope width (J): Downslope width (Toe) Fill Width (W): Page 2 of 6 6.0 in. 7.5 in. 9.5 in. 6 in. 12 in. 7.1 ft. 89.2 ft. 5.0 ft. 6.4 ft. 15.4 ft. Design of the Distribution Cell Basal Area System Design Flow: 300.0 gal/day Basal area required: 500 ftz Distribution cell width ~: 4.00 ft Basal area available: 780 ft2 Distribution cell length (B): 75.0 ft Area of Distribution Cell: 300.0 ~ Observation Pipes Contour Elevation of Mound: 99.98 ft Location from end of cell (Z): 12.5 ft System Elevation of Mound: 100.48 ft Final Grade of Mound: 102.27 ft Mound Plan View ~ Observation Pipes ~ ~ ~z~~ ~ K--s o Dlstribt.rtion Cell A.~ 'r B k-K I Tilled AreaarFiil Material L Mound Cross Section Final Grade Synthetic Fabric Distribution Cell System Ele~ration bn ~ d H bservation Pipe ~'~° I I~F Gower Material ~ ~~~ D Fill Material Tilled Area Slope u ~Forcemain~System Contour Notes: Fill material to consist of ASTM C33 Sand Distribution cell aggregate to comply with Comm 84.30(6)(1) Synthetic Fabric covering on cell per Comm 84.30(6)(8) Distribution Cell to have minimum 6" aggregate below lateral and 2" above. Mound System Pressure Distribution Calculations Project Name: WALKER-MOUND Lateral Layout Lateral elevation: 101.0 ft Rows of Laterals: 1 ~ Manifold type: center ~ Orifice diameter: o.1z5 ~ In. # of Laterals: 2 Distal Pressure: 5 ft Lateral Length: 37 ft Orifice Spacing/Distribution Orifice spacing (X): 15.05 Inches Orifices per lateral: 30 Avg. ft2/Orifice: 5.00 ftz Page 3 of 6 Lateral/Manifold Design Lateral diameter: 1'/~ ~ In. Lateral spacing (S): L.~ft Lateral to cell edge: 2 ft Lateral discharge rate: 12.36 gpm System discharge rate: 24.72 Apm Manifold diameter: z . In. Manifold length: 0 ft Forcemain Friction Loss Forcemain length: 60 ft Forcemain diameter. 2 ~ In. Friction loss in forcemain: 0.813 ft Lateral Side View Lateral Plan View Lateral Length OriFices on bottom of lateral equally spaced Clean Out Detail Clean-out plug Grade ~ or ball valve Sprinkler Box Long Sweep 90 ori+ao 45's~...._ Turn-up walball valve or cleanout plug IIV P'VC laterals and Forcemain to comply with spec~ications per Comm 84.30[2][e] Observation Pipes ti" Minimu~ L dJater tight cap or plug .Slot Note: poset Co1ar may be used n place of 3I8" bar '~-318' Bar .S ,~13 1, ~ Mound System Tank Information Pump tank manufacturer: Wieser Concrete Pump tank size/model: wiooo/65o-MR ~ Pump tank gallinch: 17 Actual Pump Tank Volume: 646 gal Tank bottom elevation (inside): 90 ft Septic tank size/model: wlooo/65o-MR ~ Pump and Filter Pump Manufacturer: Goulds / Pump Model: PE41 P1 J Effluent Filter: Polylock Note: Access opening of sufficient size to be provided to allow removal of filter. Opening to tem-inate at or above grade. Septic, Pump and Dose Tank Project: WALKER-MOUND Dosage to absorbtion Cell: 39.1 gal Forcemain volume: 10.5 gal Total dosage: 49.6 gal Page 4 of 6 Dosage Volume Forcemain drains back to tank? OQ Yes O IVo Lateral void volume: 7 8 gal Total Dynamic Head Are laterals highest point? y if not, enter highest elevation: 0 ft System head (distal x 1.3) 6.50 ft Vertical Lift ("D" to lateral) 10.31 ft Friction loss in forcemain: 0.81 ft Pressure loss from filter: ~p ft Total dynamic head (TDH): 17.63 ft Pump Tank Diagram Dose Tank Levels Watertight Locking Cover In. Gal 4 InchWith Worming Label finished A Reserve 25.1 426.4 Minimum Grade g pump off to Alarm 2.0 34.0 ARemate C Total Dosage 2.9 49.6 Outlet Location D Effluent depth for pump 8.0 136.0 Elect per Comm i s.2s and Total Ca aci p ~' 38.0 646.0 r ~ NEC 300 Weep Hole p` or Anti- Siphon 6 Device C D Pump must be capable of: 24.7 GPM and head pressure of: 17.7 Feet Mound System Management Plan pursuant to Comm 83.54 W. A. C. page 5 of 6 Owner's Responsibility: The component owner is responsible for the operation and maintenance of the component. The county, department or POWTS service contractor may make periodic inspections of the components, checking for surface discharge, treated effluent levels, etc. The owner or owners agent is required to submit necessary maintenance reports to the appropriate jurisdiction and/or the department. Septic Tank: Septic tank(s) are to be inspected routinely and maintained by department approved individuals when necessary in accordance with their approvals. The use of chemical/biological "treatments" is not required or recommended. 1f such additives are used, make sure they are approved by Department of Commerce, Safety and Buildings Div.. Effluent filters are to be removed & Leaned as necessary, with provisions to keep solids ftom passing the septic during removal. No more than 1/3 of the usable tank volume may be occupied by sludge/scum. 3 year inspection: If tank has greater than 1 /3 volume sludge, tank contents must be emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved individual. If the inspector does not recommend pumping of the septic tank, then the owner must be notified of when pumping should be done as to not exceed 1/3 sludge volume. Septic tank should be routinely inspected to be watertight and of good repair. Pump/Dose Tank If an effluent filter has been installed in the pump/dose tank, it must be removed & Leaned as necessary, with provisions to keep solids from passing to the mound component during removal. The pump, float switches and alarms must be inspected at least every three years for proper operation. Pump/dose tank should be routinely inspected to be watertight and of good repair. Mound and Lateral System The mound system component must remain free of ponded surface water prior to pump operation. If 4 inches or more water level is detected in the observation pipes, the owner must be notified of possible problemsffailure. The designed daily flow capabilities of the component should never be exceeded. Trees and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the component. Activities OTHER than mowing/maintenance (i.e. excessive walking, pets, vehiGes, etc...) could compress the component and reduce it's absorbtion capabilities and/or possibly cause it to freeze in winter conditions. Lateral distribution pipes should be flushed out/tested every 18 months using the Geanout points at each end of the component to remove scum that may clog orifices. Performance Monitoring: Performance monitoring must be done at least once every three years following the installation or at the time of a problem, complaint, or failure. Contingency Plan: If the septic tank, pump tank or any of their components therein (inGud+ng floats, alarms, pumps, etc) become defective, the defective tank or component must be replaced immediately to ensure that the system can operate as designed. If the mound component cannot accept wastewater or ponds wastewater to the surface, the component must be repaired or replaced in it's current location by either: extending basal toe to provide added absorbtion area; or by removing the clogged bacterial mat,aggregate cell, and distribution piping within the mound and replacing said components in order to return system to proper working order as required. Y;Y ITT APPLICATIONS Specially designed for the following uses: • Mound Systems • EffluenVDosing Systems • Low Pressure Pipe Systems • Basement Draining • Heavy Duty Sump/ Dewatering SPECIFICATIONS GOULDS PUMPS Residential Water Systems MOTOR General: • Single phase • 60 Hertz • 115 and 230 volts • Built-in thermal overload protection with automatic reset. • Class B insulation. • Oil-filled design. • High strength carbon steel shaft. PE31 Motor: • .33 HF 3000 RPM • 115 volts • Shaded pole design PE41 Motor: • .40 HN 3400 RPM • 115 and 230 volts • PSC design PE51 Motor: • .50 HP 3400 RPM • 115 and 230 volts • PSC design AGENCY LISTINGS S~® c us Tested to UL 778 and CSA 22.2 108 Standards By Canadian Standards Association METERS FEET Fle #LR38549 aor--r- r_-~_--------------- --..___ _ MODELS: PE31, PE41, PE 51'x, ! PE51 ~ i '~ 35 --~--- ~ l __ - _ _.. 1 ~ i Goulds Pumps is ISO 9001 Registered. Pump -General: • Discharge: 1'h" NPT • Temperature: 104°F (40°C) maximum, continuous when fully submerged. • Solids handling:'/:" maximum sphere. • Automatic models include a float switch. • Manual models available. • Pumping range: see performance chart or curve. PE31 Pump: • Maximum capacity: 53 GPM • Maximum head: 25' TDH PE41 Pump: • Maximum capacity: 61 GPM • Maximum head: 29' TDH PE51 Pump: • Maximum capacity: 70 GPM • Maximum head: 37' TDH ---~ 2 GPM 30 . P~~:. : _ _ .. --- ~ - - 1 FT Q lJ Q 201_ ___-__.__ ____. ___ -_ _... _ ~ _-_}_ } ~ ~ ~ O ~ i , 10 ~- -- - -- -+-- -'~'~---- - -, ~ --- i i 5 i ~-f- -- - --- -- ----, o~ ~o 0 40 ---- 50 ----60- -- ~ -- ---- 0 GPM 80 15 m3/h 5 10 CAPACITY ~~sc~ans~n Department of Commerce Division of Safety and Buildings RECEIVED SOIL EVALUATION REP T #52 in accordance with Comm Adm. ode ,. ,•,;- -,r Page 1 of 3 ,i~; t` ~U~ ~ ~ ~~'~~ N rthland Plumbing, Inc. Attach complete site plan on paper not less than 8% x 11 inches in size. PI mu ounST. CROIX CU~t~roix include, but not limited to: vertical and horizontal reference point (BM), direct a percent slope, scale or dimensions, north arrow, and location and distance to a t d. G 7 7 ~ So ~ r~ O Please print all information. Re By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15. (1) ~ ~'] a Property Owner Property cation Mary Walker Govt. Lot NW1 , SW1/4, S35, T30N, R15W Property Owners Mailing Address Lot # Blodc # Subd. Name or CSM# 1247 Rustic Road 3 City State Zip Code Phone Number ~ City ^ `~Ilage ®Town Nearest Road Glenwood City WI >•013-43 715-265-4331 Glenwood Rustic Road 3 ^ New Construction Use: ®Residential /Number of bedrooms 2 Code derived design flow rate 300 GPD ® Replacement ^ Public or commercial -Describe: Parent material Glacial Till Flood plain elevation, if applicable ft. General comments Mound site with 6" sand lift on 99.98 contour. and recommendations: ^~ ------- 1 1 I 11..~__II Boring ~k ®Boring f ^ Pit Ground surface elev. 99.79 ft. Depth to limiting factor 40 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/ftz in. Munsell Qu. Sz. CoM. Color Gr. Sz. Sh. 'Etf#1 'EtT#2 1 0-10 10YR3/2 sil 3sbk mvfr is 3f .6 .8 2 10-16 10YR5/3 sil 3sbk mvfr cs 2f .6 .8 3 16-40 10YR5/4 s Osg ml a .7 1.6 4 40-60 10YR5/6 10YR6/8 fif spots s Osg ml a .7 1.6 5 60-70 10YR6/2 10YR6/8f2d spots sd Om mfi cs 0.0 0.0 2 ® Boring ,~ Boring # Pit Ground surface elev. 99.74 ft. De th to limitin factor 37 in. ^ P 9 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GP DIft$ in. Munsell Qu. Sz. Cont. Color Gr. Sa. Sh. 'Efi#1 'Eftfl2 1 0-14 10YR3/2 sil 3sbk mvfr a 2f .6 .8 2 14-20 10YR5/3 sil 3sbk mvfr cs if .6 .8 3 20-25 10YR5/4 cos Osg mfi a .7 1.6 4 25-37 10YR5/6 s Osg ml cs .7 1.6 5 37-50 10YR5/6 10YR6/8 fif spots s Osg ml gs .7 1.6 6 50-55 10YR6/2 10YR6/8 f2d spots sd Om mfi a .0. 0.0 7 55-72 10YR6/8 7.5YR6/8 f2d spts s Osg ml a .7 1.6 'Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signatuf ~~ ~ CST Number Michael J. Myers ~,t,~;~C,rt,LC 267985 Address Date Evaluation Conducted Telephone Number Narttlland Ptumbirlg Irlc. snsro8 ?1 S'-?-~S y~i5 2943 L301h Ave SBD-8330 (807/00) Qemvood (Sly, A'I SA013 Property Owner Mary Walker Parcel -D # Page z of s 3 Boring # ®Boring 1 P8 Ground surface elev. 9.47 ft. Depth to limfing factor 40 in. ^ ~ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture. Structure Consistence Boundary Roots GPD/fY in. Munsell Qu. Sz. Cont. Colof'~• . Gr. Sz. Sh. "Erfael 'EflA2 1 =0-11 10YR3/2 sil 3sbk mvfr c5 2f .6 .8 2 1i-19 10YR5/3 , l 3sbk mvfr a if .6 .8 3 19-40 10YR5/6 ~ s Osg ml cs .7 1.6 4 40-60 10YR4/6 10YR6/8 f1f spots fs Osg mfi a .5 1.0 ' Effluent #1 = BODS> 30 < 22I1 mg/l_ and TSS >30 <_150 mglL ' Effluent #2 = BODS < 30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If youveed assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. .Property owner Mary Walker Parcel ID # Page 2 of 3 3 ®Boring ' Boring # ~ Pit Ground surface elev. 99.47 ft. Depth to limiting factor 40 in. Soil Appliption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsell Qu. Sz. Cont. Colon , Gr. Sz. Sh. ~EN#1 'Eff#2 1 = 0-11 , 10YR3/2 •;;; sil~ 3sbk mvfr cs 2f .6 .8 2 11-19 10YR5/3 ~ , - _ 'I 3sbk mvfr a if .6 .8 3 19-40 10YR5/6 ~ s Osg ml cs .7 1.6 4 40-60 10YR4/6 10YR6/8 fif spots fs Osg mfi cs .5 1.0 ' Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < I50 rn~ • Effluent #2 = BODS < 30 mg/L and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need inaterial'in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. r ~ . r u ~ ~ Z ~. z °~ r H o ~ ~ ~ ~, r "~ ? ~ tip • ~ a 3 3 m h oc r V 3 ~' '2 ~ o~`,- ~ ~ oC ;.. '+~ 1~ n ~ ~ « ~_. .~__ __---_ __. ._. _ .__..... __._.._ _..~ ~.~____~._ ~ ~~ o ~ _ ._. ~ 1 ~s ~~} _ ~r~~ ~, ~.~adQ~~, ~ ~~ ~ x ~ ~ ~ ~ i ~ ~ ~ fv~ ! ~ ~ ~ r~ ~ ~ f ~ `~ ~ ~ 3 a w I I ~ e i~~ ( s~~~ ` c9 -* ~ 1 ~~-~---~ ,~ ~ 4 4 -v . s o ~ ~N~N "') .~ l S, °~' ~ ~ ~ ~' ~ ~ ~ ~ ~~' r~ ~' c. d~ a 0 _~ n ~ .~_.,__ __ ..._ __ ~1y'7 ~ya'~'~G'' --~ s L/ t- -;s STATE BAR OF WISCONSIN FORM 5 - 2000 PERSONAL REPRESENTATIVE'S Document Number DEED Dixie Croes, as Personal Representative of the estate of Stella G. Anderson ("Decedent"}, for valuable consideration conveys, without warranty, to Marv K. Walker. a sinele person Grantee, the following described real estate in St. Croix County, State of Wisconsin (the "Property") (if more space is needed, please attach addendum): The West Half of the Northwest Quarter of the Southwest Quarter (W 1/2 of NW 1/4 of SW 1/4) of Section 35, Township 30 North, Range 15 West, Town of Glenwood, St. Croix County, Wisconsin. 111111 IIIII IIIII IIIII IIIII IIIII IIII Illlll IIlI IIII * 8 5 6 0 9 9 1 85fi099 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., wI RECEIVED FOR RECORD 07/23/2007 11:OOAM PER50NAL REPRESENTATIV EXEMPT t REC FEE: 11.00 TRANS FEE: 359.70 PAGES: 1 Recording Area B' RETURN TO: S~L~ 21~ ~- 3l Wisconsin Assured Title, LLC A 1810 Crest View Dr. # 1 B Hudson, WI 54016 Personal Representative by this deed does convey to Grantee all of the estate and 016-1077-SO-000 interest in the Property which the Decedent had immediately prior to Decedent's death, Parcel identification Number (PIN) and all of the estate and interest in the Property which the Personal Representative has since acquired. Dated this ~ day of July, 2007. ~~t~~~~~, C~1?~~: * Dixie Croes Personal Representative AUTHENTICATION Signature(s) authenticated this day of TITLE: MEMBER STATE BAR OF (If not, tr ~~R/~! /- i PU authorized by §70h:06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Brian D. Byrnes~of Bakke Norman, S. C. 3l4 Keller Avenue North -Amery, WI 54001 (Signatures may be authenticated or acknowledged. Both ate not necessary.) Personal Representative ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. . ~ r U t ~ County ) Personally came before me this I~~h day of July , 2007 the above named Dixie Croes to me lalown to be the person(s) who executed the foregoing instrtlm owledged the same. n '~ * - lJe CVO Notary Public, ate of Wisconsin My Commission is pe ent. (I ot, state expiration date: ' Names of persons signing in any capacity must be typed or printed below theif signature. INFO-PRO (800)655.2021 www.infoprofonns.com STATE BAR OF WISCONSIN PERSONAL REPRESENTATIVE'S DEED FORM No. 5 - 2000 1of1 ~p ,' ~-?- ~,~ . ~n ~ ~ ~ ~ ~^ ~ ~ G \~ ~~ ~ ~_ -- ~ ~ ~ ~ w ~~ ~ ~, ~ y _ ,~ ~ ~ w ~. ~~ 'Z-. ~ ~ ~1 4 a ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~N~~~ G(~Ati,~CC-~ Mailing Address /2°~'~ J~uS'7'/E 1~o~4I~ 3 Property Address (Verification required from Planning Department for new construction) City/State ~ (~,/~,t~lrc~ ~~Ty, wf Parcel Identification Number LEGAL DESCRIPTION Property Locarion/~~~ `/., Se~1 `/., Sec. ~ T_~ N-R >S W, Town of ~c~n~~'~'~ Subdivision ,Lot # Certified Survey Map # ,Volume ,Page # Warranty Deed # ,Volume ,Page # Spec house ^ yes ,~no Lot lines identifiable ~l yes ^ no SYSTEM MAINTENANCE - improper use and maintenance ofyour 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 wastewaterdisposal 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 sct 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 Office within 30 days of the three y r e pirarion te. '~ /~/ U~ SIGNA F APPLICANT DATE OWNER CERTIFICATION I (we) certify tha all statements on this foztn are true to the best of my (our) knowledge. I (we) am (are) the ow;~cr(s) of the describe ab ve, by ~rtue of a warranty decd recorded in Register of Deeds Office. SIGNATURE ~ APPLICANT DATE ssssss •••••• Any information that is mis-represented m~ result in the sanitary permit being revoked by the Zoning Department. •• Include with this application: a stamped warranty;dct'd from the Register of Deeds office a copy of the certified stuvcy map if refcrcnce is made in the warranty deed