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HomeMy WebLinkAbout026-1165-21-000 County Safety and Buildings Division d2e 201 W.Washington Ave., P.O. Box 7162 X. Sanitary Permit Number(to be filled in by Co.) 5 K Madison,WI 53707-7162 5i 52- �o I St. State Transaction Number Sanitary Permit Application In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the ropriate governmental unit is required prior to obtaining a Sanitary permit. Note:Application forms for state-o S are sus Project fires different than mailing address) the Department of Safety and Professional Servies. Personal information you rovi a #- � 5 / ql oUUmil purpo ses in accordance with the Privacy Law,s.15.04 1 m),Stars. I. Application Information-Please Print All Information parcel# Property Owner's Name 3 A�2 rz'K 20T C �14�o Property Location Property Owner's Mailing Address ��� D Bo Z'z S � �7 Q 06 Govt. City,State Zip Code Phone Number y� 5[� t/4, Section '/ 0 � A5- 715% �j /'c(cucle one �J�tA) JZJcW N!# a b tA � 37 Z- Iv T N, R [ b E II.Type of Building(check all that appl _ Lot# Subdivision Name I or 2 Family Dwelling-Number of Bedroo Bloc U4 JOY r ❑Public/Commercial-Describe Use °� ❑ City of CSM Number ❑ Village of ❑State Owned--Describe Use Town of ��e44~ .AJ A V 1 Pvl`J uj �a k ZO♦-� l.ilh0.w. III.Type of Permit: (Check ont one box on line A. Complete line B if applicable) Zo A. $-New System ❑Replacement System ❑Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑Permit Revision ❑ Change of Plumber ❑Permit Transfer to New _ Before Expiration Owner ,.( 2, IV.Type of POW TS S stem/Corn onent/Device: Check all that apply) r IJ� $;-Non-Pressurized In-Ground 13 Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil El Mound<24 in.of suitable soil G�� ❑ Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dis ersaUTreat ent Area Information: Design Flow(gpd) Design Soil Application te(gpds Dispersal Area Required(sf) Dispersal Area Proposed(sf) System Elevation �I�o Cl Y 7 VI.Tank Info Capacity in Total #of Manufacturer U Gallons Gallons Units B New Tanks Existing Tanks 7 A ) °Q i I v 4 A—I D Septic or Holding Tank z t l"♦� 2 V✓ I ` f(5 IVIC-M-J Dosing Chamber 500 v(� W VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's Signature MPi14�AB Number Business Phone Number PC D tr 12269 7 171.5--, Z 73' 4�f�S� Plumber's Address(Street,City,State,Zip Code) --C- I- SWu-/Z-4- (-F w t o VIII.Court /De artment Use Only Approved ❑Disa Pemtit Fee Date Issued Issuing ent Sign ❑ en Reason for Denial $ co 31Z6ZI IX.Condit,�Amwfpeasons for Disapproval 3) �7!1 `( 1. Septic tank,effluent filter and dispersal cell must all be services/maintained L✓t 5a as per management plan provided by plumber. 2.<rt�p sN k,AgalrernVft pat 10e1rifarintalg6cf r per ' !orditce: Attach to complete plans for the system and submit to the County only on paper not less than 8 in z 11 inches in size SBD-6398(R 11/11) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: D 9i; Owner's Name: Q Q Aa A-k Ci r� Owner's Address: P,t�. G1C Z Z A) LI) �2(c f 1!0 N dJ u,/ �Z'e;17 Legal Description: — N l2 30 Township: 164/1l©ni County: Subdivision Name: L (,l l/(4 y," p G(J- Lot Number: Z Parcel ID Number: p Z b— // (o.r _Z — 006 Page 1 Index and title Page 2' Plot Plan l0 4-Luic(T- /.v Page 31 System Sizing & Cross-Section ( ( f-R-�Iz c►2°f5 c Page 4 Filter Specs l 2 (p ��, Q a lt u 19 Page 5i Maintenance Information Page 6i Management Plan Page 71' St. Croix Cry Septic Tank Maintenance Form Page 81: Warranty Deed Page 9 i CSM or Plat Attachments: Soil Test& House Plans Designer/Plumber: /U /I/ License Number: 2 z r f19� Date: j° 7—zz Phone Number Z 3 7 � 1s Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P(N.01/01). Page 1 � b � 'Z ( t U A)Ay� M 6-Pfo n U/ !V $3 I c PLA 8Nt 6� Z�pDo,Z 9q,z 3 9S-S 00 Iti�ry�G e W Ec c pe i Soll Absorption Svstem Cross Section �� 2 �$ ft 4"Schedule 40 Final Grade PVC Vent Pipe . cl Z ft With Vent Cap ,l Leaching Chamber �. `l3� ft System Elevation ft _ ft �ft Soil Absorption System Plan View SO ft ft { ft Leaching Trench 1 Chambers 4, 4°Dia. Trench 2 Vent Or Observation Pipe Header Trench 3 Leaching Chamber Specifications Manufacturer And Model C Nl L{-2&(Z &tat e(z OLD! EISA Rating Z_sq ft per chamber Soil Application Rate_ gpd/sq ft 8 gpd Design Flow:t Soil Application Rate x EISA= U Chambers -LQ 3 rows of C�0 chambers each. Page of 10013, 001600m Series The original ZABEL'Disc Dam Filter was patented in 1959. The 12"series filters have been filtering wastewater longer than any filter in the wastewater industry. In 2000 Zabel made the best even better by introducing a complete redesign of the original with more great features and finer levels of filtration. A 100-12T M Series . ;: The A100-12 is the commercial filter chosen by more engineers and installed in k. r more localities than any other filter on the market. The reliable performance and flow rates from 3000-6000 gpd allow this filter to be utilized in almost every application. The new ZABEL Versa-Case' is available with built-in reducer and outlet hub that accepts either 4" or 6" SCH 40 pipe. The A100-12 Series is also y popular in many areas for residential use due to its high quality effluent and large capacity. Independent research has shown the A100-12 decreases TSS by 50-90% and CBODS by 20-40%. Filtration Available lengths 20" 28"& 36" A300-12"m Series Long heralded as the ultimate grease trap filter, the A300-12 provides 1/32" filtration and has been shown to reduce FOG by as much as 50-98%. The A300-12 is also used for onsite wastewater systems which require ` a finer level of TSS removal, such as Laundromats and dog kennels. As with all ZABEL Filters extra filter cartridges are available to speed service time and allow offsite cleaning of the used cartridge. 7�3 Filtration Available lengths 20", 28"& 36" A600-12rm Series The newest addition to the ZABEL Filter line incorporates the proven performance of the disc dam design with the finest level of filtration available on the market. The 1/64" filtration of the A600-12 provides optimal filtration levels for those unique applications with very fine particulates and suspended solids. Every A600- 12 Series filter includes the exclusive SmartFIlter®Alarm switch to alert the owner of required maintenance. 164"Filtration Available lengths 20" 28"& 36" For further technical Information: www.zabeizone.com 050103-244 POWTS OWNER'S MANUAL &'MANAGEMENT PLAN S FILE INFORMATION SYSTEM SPECIFICATIONS. Owner ��� Septic Tank Capacity D al D Permit Septic Tank Manufacturer ❑ t Effluent Filter Manufacturer Z,4� CAL ❑ f DESIGN PARAMETERS O r Pn f Bedrooms 4(80D :� ❑ NA Effluent Filter Model f Public Facility Un O NA Pump Tank Capacity (� (� al O 1` flow (average) 0 a l/da Pump Tank Manufacturer e,�cti�fN w (peak), LEstimat ('v al/da Pump Manufacturer ® G Lip D N ation Rate 0 ai/da /ft2 Pump Model ❑ N Monthly average* Pretreatment Unit ❑ N. nfluent/Efflueht QuY Fats, 011 &.Gr0 mg/L 0 Sand/Gravel Filter ❑ Peat Filter ical Oxygen Dem20 mg/L ❑NA ❑ Mechanical.Aeration ❑ Wetland otal Suspended S60 mg/L ❑ Disinfection 13 Other: Pre treated Effluent Quality Mont hly average]CO3NA Dispersal Cell(s) D NI Biochemical Oxygen Demand (BOD&) 530 mg/L in Ground (gravity) D In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑At-Grade ❑ Mound Fecal Coliform (geometric mean) 510'cfu/100m1 ❑ Drip•Line E3 Other: Maximum Effluent Particle Size Y In dia. ❑NA Other: ❑ NA Other: ❑ NA Other: 0 NA Values typical for domestic wastewater and septic tank effluent. Other: O NA MAINTENANCE SCHEDULE Service Event Service Frequency At least once eve. ? [3-month(s) (Maximum 3 years) D NA Insp ect condition of tank rY�s) -? Eil year(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Ys) of tank volume ❑ NA Inspect dispersal call(s) At(past once eve D month(s1 (Maximum 3 years) O NA P every: � ®year(s) Clean effluent filter At least once every; U month(s) D NA® earls) Inspect pump, pump controls & alarm At least once eve if month(s) O NA ry: 3 H year(s) Flush laterals and pressure test At least once eve : O month(s) O NA P ry IV.year(s) Other: At least once every: 1 ean(j(s) ❑ NA Others ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an Individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sower; POWTS Inspector; PO WTS Maintainer• Se ta9 e Servicing Operator.erator. Tank inspections must Include a visual Inspection of the tank(s)to Identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum and to check for.any back up or ponding of effluent qn the ground surface. The dlspersal'c011(s) shall be visually Inspected to check the effluent levels In the observation pipes and to check for. any ponding of effluent on the ground surface.. The ponding of effluent on ther ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y,) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Oderator and disposed of In accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to thenservicing•of effluent filters, mechanical or pressurized components,.preireatment units, and any servicing at intervals of 512 months, shall be performed by a certified POMS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. OMW (4101) START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tacell(s).o if high rconcentra tons Ia a detected have hthe ccontent that may impede the treatment process and/or damage hordtopuseal of the tank(s) removed by a septage servicing System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater the levels- When power and may resiult restored n the backup cor surface i discharge ii o discharged to the dispersal collie) in one large dose, overloa g effluent: To avoid this situation have the con or POWTS Ma ntainerotodassi t in Pmanually operating the rpump tcontrols'ti power to the effluent pump or contact a Plumber restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells, Do not drive or park over, or otherwise disturb or compact, the are: within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life s; the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation draln,(sump'pumpj water; fruit and vegetable peelings; gasoline; grease; herbicides; meat.scraps; medications; oil; painting products;pesticides; sanitay napkins; tampons; and water softener brine. ABANDONMENT in steps-shall be taken to insure that the system is When the POWTS fails and/or is permanently taken out of service the following P properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed., • The contents of all tanks and pits shall be removed and properly disposed of by'a Septage Servicing-Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system:__ O A suitable.replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed.upon by required setbacks from existing and•proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to.establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. El A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be Installed as a last resort to replace the failed POWTS. O The site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area Is available a holding tank may be installed as a last resort to replace the failed POWTS. ,. 0 . Mound and at-grade soil absorption systems may be reconstructed in place following removal of the blomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER.A,SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name O 2 N Ir 1.-S O/V Name Phone 5-- Z 7:3 — 7"-7! Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name 7W A-j t"a J .5°A-^1t it Af-a.v Name .5 C&__0 !>C Zd AJ f ti Phone Z 7 3 Sjri Phone 7f✓5 -3$ 0 'z�6 This document was drafted in compliance with chaptei Comm 83.22(2)(b)(1)(d)0)and 83.54(1), (2) &(3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer -�"D D P AlZ16-K Mailing Address 0}C Z7 N �w t ck(41v'10 j"'y Property Address 14Z 5 l H.e (Verification required from Planning&Zoning Department for new cons tion.) City/State 14 E LA,) Ia,(GN Mo 40 Parcel Identification Number 0 °oa LEGAL DESCRIPTION Property Location 1 1/4 Sec. Z?T �4 , O N R //�WTown.of /y o tiM Subdivision Plat: L �� YS ��� , Lot# . Certified Survey Map # , Volume , Page# Warranty Deed # 17 �� 0 f (before 2007)Volume , Page# Spec house ityes❑no Lot lines identifiable$('yes❑no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(1)and in Chapter 12- St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning&Zoning Department a certification form, signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is less than 1/3 full of sludge. Uwe,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning&Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s)of the property described above,by virtue of a warranty deed recorded in Register of Deeds Office. Number umber of bedrooms z_�_ ��� 9)0� 'a_A� J l 1 7/'l Y SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) Viii°'H` Oda A � ki " ^° ''• -h ��3��/ �sN .! ��� LLJ k C,�` Y3'Ygl Ad ril OF or— J � ,�' ��� S �� \\\, ` ��- �- M tt� aSn fir-•- ` �� - Ago.O° h�� {`�•' Imo' Q�•^e 1 a ,1��,�a•Y ` .y ytOCSj <w 5•N �•<:. `��� � '; // Sze•`'Uzi'� ,�;• O�� e ! � / CA w ,� •�rY r 135 �' �'. s Of i A• �+. 49� 010 it �w ! �� //•,its• 1 �� ��'^ � a� ��'�•g' t1• N.00 Gt!s / //l •,y�J?9, {9�/i9 N r.tML I y [_ � a; w �° 1.4 �6�d �K A 77 �3—af o s fiy fiy �r - mss 14 4u �r O Ooh � /.� M / .... • � oil 10 Jog. 9 '••��` ,��.. � rpp I / ' i '°,gip w �s� 3 7�n, fir\ `\ (►, �`• 1� g �Zy,L g'li,F,•t^"i 6 S M 11 �j,+, N l 0 ` °a, N 1 41 .N qN 51IV A.�r�0i� or tASS50b %Y3 OV:OZ VTOZ/9T/CO 00 1z 4 Quick4 Plus Standard Chamber Side and End Views 48" 4 (EFFECTIVE LENGTH) s iE 34"--� I----- luick.4 Plus All-in.-One 12 Encap Front, Side and End Views 11.2" � 13" 8"INVERT ERT 8"INiERT 5.3"INVERT E Y �----18.2" 33" Quick4 Plus All-in-One Periscope ? OUICK4 PLUS ALL-IN-0NE IPVEL OP6� a s" PIN U.4 PLUS 12.7"INVERT ALL-IN-ONE END1z ?' £. ENOCAP 5" 9" ' l Quick4 Plus Standard Chamber Specifications Size (W x L x H) ............. 34" x 53" x 12" (86 cm x 135 cm x 31 cm) Invert Height .,..:......,.,,.. 0.6", 5.3", 8.0", 12,7" (1.5 cm, 8.4 cm, 18.5 cm, 22,6 cm) Effective Length ..................................................,..... 48„ (122 cm) - INFILTRATOR SYSTEMS,INC.STANDARD LIMITED WARRANTY (a)The structural integrity of each chamber,end plate,wedge and other accessory manufactured by Infiltrator("Units"),when installed and - operated in a leachfield of an onsite septic system in accordance with Infiltrator's instructions,is warranted to the original purchaser("Holder") a against defective materials and workmanship for one year from the date that the septic permit is issued for the septic system containing the Units; provided,however,that if a septic permit is not required by applicable law,the warranty period will begin upon the date that installation of the - septic system commences. To exercise its warranty rights,Holder must notify Infiltrator in writing at Its Corporate Headquarters in Old Saybrook, Connecticut within fifteen(15)days of the alleged defect.Infiltrator will supply replacement Units for Units determined by Infiltrator to be covered by this Limited Warranty. Infiltrator's liability specifically excludes the cost of removal and/or installation of the Units. s (b)THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH(a)ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT i.' TO THE UNITS;INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE (c)This Limited Warranty shall be void if any part of the chamber system is manufactured by anyone other than Infiltrator. The Limited Warranty INFILTRATOR special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages, x nd to incidental consequential.s c 9 does not a to p , s'i e m s inc. { including loss of production and profits,labor and materials,overhead costs,or other losses or expenses incurred by the Holder or any third party. y Specifically excluded from Limited Warranty coverage are damage to the Units due to ordinary wear and tear,alteration,accident,misuse,abuse I or neglect of the Units;the Units being subjected to vehicle traffic or other conditions which are not permitted by the installation instructions;failure to maintain the minimum ground covers set forth in the installation instructions;the placement of improper materials into the system containing 6 Business Park Road • P.O. Box 768 the Units;failure of the Units or the septic system due to improper siting or improper sizing,excessive water usage,improper grease disposal, a Saybrook, CT 06475 or improper operation:or any other event not caused by Infiltrator. This Limited Warranty shall be void if the Holder fails to comply with all of the Old Sa y terms set forth in this Limited Warranty.Further,in no event shall Infiltrator be responsible for any loss or damage to the Holder,the Units,or any 860.577.7000• FAX 860.577.7001 k Third party resulting from installation or shipment,or from any product liability claims of Holder or any third parry. For this Limited Warranty to 9 k apply,the Units must be installed in accordance with all site conditions required by state and local codes;all other applicable laws;and Infiltrator's installation instructions. 800.221.4436 R i' (d)No representative of Infiltrator has the authority to change or extend this Limited Warranty. No warranty applies to any party other than the www.infiltratorsystems.com original Holder. The above represents the Standard Limited Warranty offered by Infiltrator. A limited number of states and counties have different warranty 4 requirements. Any purchaser of Units should contact Infiltrator's Corporate Headquarters In Old Saybrook,Connecticut,prior to such purchase, to obtain a copy of the applicable warranty,and should carefully read that warranty prior to the purchase of Units. �16' aY U.S.Patents:4,759,661;5,017,041;5,156,488;5,336,01T 5,401,116;5,401,459;5,511,903;5,716,163;5,588,778;5,839,844 Canadian Patents:1,329,959;2,004,564 Other patents pending. Infiltrator,Equalizer,Quick4 and Quick4 Plus are registered trademarks of Infiltrator Systems Inc.Infiltrator is a registered trademark in France.Infiltrator Systems Inc. is a registered trademark in Mexico.Contour Swivel Connection is a trademark of Infiltrator Systems Inc.0 2009 Infiltrator Systems Inc.Printed in U.S.A. PLUS051010151 2 d I. l Combination SepG,:tc 'Tank an PISMP CHAMBER CROSS SECTI AIJQ SPECIFICATIOfJS ON v • .1., / VCWT CAP. WCATHER PROOF n� 6K JUIJCTIOIJ HOX j%.1, VENT PIPE APPROVED LOCKING IO' M *ROM DOOIC. AIJHOLE COVER wll� F • � wA52tJItJG LP,6EL.. •'AWDOW OR FRCSH cor�0u�r ALINTAKE S w!Pr�czT1 s qi"�rrP �, tj I II �•.nw, l00 T I / I 4 AIM. I ie'MIU. ----------- �•� PROVIDE I 11J L E T � � f AIRTIGHT SEAL I A• I III APPROYED J0147 APPROVED JOINT -EmI L PILE ..'k, I I I W/C.1. FIPE�w W/C.I. PIPLOR Tank construction I 1 with I II ALARM shall comply P �I II TLHR 133 . 15 and 83.20 a I 1 I I oIJ C I I PUMP--,- '-'J • ` OFF 0 COQ FETE OLOCK RISER E:XIT PERMITTED O1JLy IF TAWK MANUFACTURER HAS SUCH APPROVAL API sCPTIC r' SPECIFICATIOUS ___......jjjLLL___...... DoSE TAWKS MA&JUFACTURCR.: W I1�5,Z�Z CokjC•l T� WUMbER OF DOSCS: PER DAy TAMK SIZE: ZDV 6A,LLOiJS DOSE VOLUME AL,IRM MANUFACTURER: SLITI _2 IIJCLUDING DAGK•-f7IOW: GALLONS MODEL wum5cR: [Ol Hw CAPACITIES: A= `-?1 CHE5 0R 'L GALL01.1S 5WI7CH TIJPC:—• 8= Z- INCHES OR -1L G�LLOU$ PUMP MANUFACTURER: ,S// 4IuL C; —INCHES OR /�1�C,,�tLLOUS MODEL MUMCER: T� J 0°-10—iI XHES OR f Z 3, �6ALLONS SWITCH TYPE: peW7£: PUMP AMD ALARM ARE TO OL MWIMUM •DISCHARGE -3-- GPM 3��NSTALLEO ON SEPARATt CIRCUITS 10 VERTICAL DIFFERENCE DETWCCIJ PUMP OFF ANO.DISTRIBUTION PIPE.. --0-=- FEET t MWIMUM NETWORK SUPPL V PRESSURE . ; , , , . , , , , , 0 FLU + FE ET OF FORCC MI X '*joo rLFRICTIOU FACTOR.. FEET TC7TAL. IMAM, HEAD )) `7 _ -•-µ-=-L FEE T As per . manufacturer gal/in. . APR-12-2005 16:28 FERGUSON ENT HUDSON 715 386 6144 P.01 6 RGOULDS PUMPS Submersible Effluent Pump PE '"WINT PUMP SPECIFICATIONS MOTOR FEATURES Pump—General. General: ■Corrosion resistant • Discharge: 1'A"NPT • Single phase construction. • Temperature: 104°F(400Q • 60 Hertz ■Cast iron body. maximum,continuous when • 115 and 230 volts a Thermoplastic impeller and fully submerged. • Built-in thermal overload pro- cover, • Solids handling:'/" 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. APPLICATIONS float switch. • High strength carbon steel n Motor Is permanently Specially designed for the • Manual models available. shaft. lubricated for extended following uses: • Pumping range:see PE31 Motor, service life. • Mound Systems performance chart or curve. • .33 HP,3000.RPM ■Powered for continuous- • Effluent/Dosing Systems PE31 Pump: • 115 volts operation. • low Pressure Pipe Systems • Maximum capacity:53 GPM • Shaded pole design ■All ratings are within the • Basement Draining • Maximum head:25'TDH PE41 Motor working limits of the motor. • Heavy Duty Sump/ PE41 Pump: • .40 HP,3400 RPM ■Quick disconnect power cord,20'standard length, Dewatering • Maximum capacity:61 GPM • 115 and 230 volts heavy duty 16/3 SJTW wih • Maximum head:29'TDH • PSC design 115 or duty volt grounding PE51 Pump: PE51 Motor. plug • Maximum capacity:70 GPM • .50 HP,3400 RPM ■Complete unit is heavy duty, • Maximum head:37'TDH • 115 and 230 volts portable and compact. • METERS FEET PSC design ■Mechanical seal is carbon, 40 r- --,• _� ceramic,BUNA and stainless PE51r I I I I I MODELS:K31,Peas,TEs steel. ;.. I HP .33..ao..5o 35 ■Sitdi.`°iless steel fasteners. 10 b I j I' I i' —,► 2 GPM l I ; ' i AGENCY LISTING 3 64 I I I S �f i 1FT I i I I + I 1 • I, Z •' l I I i I ' I i I I I • U ki �.. r. i ; i L. j C U S zo Tested to UL 778 and CSA 222108 Standards i— 15 ' —f— I" I BY CaWlan Standards Association (I Pile#u116549 ,10 ^°-� i i I .-� I I i• +'' 1 "d Goulds Pumps is ISO 9001 Registered I I i o I � , III , i � � '. .j. ..�..I •�. i11 ^III , it I 0 0 10 20 30 40 50 60. 70 GPM 80 0 5 10 15 m3/h Goulds Pumps CAPACITY ®ZOOa ITT*,290Techttolapy,Ine ��� EN•ctiv Jun*,ZG04 BPESY/41 ITT Industries t Wisconsin Department of commerce SOIL EVALUATION REPORT Page–L of Division of Safety and Buildings in accordance with Comm 85,Wis. Adm. Code County r-,-/ /9 Attach complete site plan on paper not less than 8 112 x 11 inches in size.Plan must L 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. D Z , i �CV GYJ Please,xint all irtfOrm t+on,_•_ Re w Date Personal information you provide ma be used forsecondary purposZs(Privacy Law,s.15.04(1)(m)). / 6 Property Owner S ✓ Property Location Govt.Lot 1/ 1/4 S ZZ T N R E(o W Property Owners Mai' Address f Lot� Block# Subd. Name or M# City Slate Zi Code. Phone Number ❑city 1:1 Village�T Nearest Road a _. -_....,. New Construction Us X Residential/Number of bedro=44 Code derived design flow rated GPD ❑Replacement Public or p9inmercial-Describe: -- Parent material -�7i> Flood Plain elevation if applicable —���,�/� ft. General cornments 2 and recommendations: Boring -� Boring# [i] Pit Ground surface elev. all J 1t. Depth to limiting factor in. Soil to Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 D Z ;/z S Cis S 2 p s •art z 3 S /12 Ir/ I I +{ '1 Ibb ® Boring# Boring /—a , Pit Ground surface elev.� ft. Depth to limiting factor�Z� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu.Sz. Cont Color Gr.Sz.Sh. 'Eff#1 'Eff#2 j o _z I(� �/ C �mseh SFr- - y� _ s �s5 ' ' / i6 I Effluent#1 =BOD >30<220 mg1L and TSS>30<150 -Effluent#2=BOD <30 mg/L and TSS<30 nVL CST Plante(Please Print) na re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54 7 — f�__ v 715-246-4516 Property Owner_ arcel ID# Page of F3-1 Boring# ❑ Boring / � pit Ground surface elev /ft. Depth to limiting factor____<:GLL in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eft#2 3/Z-- —' s L o1 ra, LO Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor )n• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 ❑ a Boring# Boring Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPO/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 *042 Effluent#1 =BOD.>30<220 mglL 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. SBO-8330(R.NW) Soil Test Plot PI Project Name William Stock/Steve Dalton B' Address 1748 112th St. New Richmond Wi 54017 STM #226900 Lot 21 Subdivision Lundy Meadows Date 8/11/03 N 1/2 SE 1/4S 22 T 30 N/R18 W Township Richmond F1 Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 93.6/93.7 *HRpSame as Benchmark Alt. BM Top of 2" Pipe @ 100.2' Please note: Installer must verify all lot lines and setbacks before installation. 342' Property Line 10' 40' B-3 45' Alt. B.M. Slope 1°Io 5' *B.M. B-1 30' Scale is 1" = 40' unless otherwise B-2 Not enough slope noted to establish contours a a� a 0 00 N Please Note: Tested area may not be suitable for desired building area. Check system location before excavating. t,595 s ft. .� T 22 1.64 acres - . . . - � ��'� 7r;b? c�es {.. L. {'' ' • _ ���' 2.05 i� t Ira 74.909 sq. ti. . I.6J acres N, `• ` 394.55' -,,OT 19 , - ; . ft o ��.: - I !�?' elf State Bar of Wisconsin Form 1-2003 8 Tx?4053436 9 WARRANTY DEED 960901 Document Number Document Name BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI 08/01/2012 12:48 PM THIS DEED,made between William B.Stock EXEMPT#: NA ("Grantor,"whether one or more), REC FEE: 30.00 and Todd Marek TRANS FEE: 351.00 ("Grantee,"whether one or more). PAGES: 1 Grantor,for a valuable consideration,conveys to Grantee the following described real estate, together with the rents,profits, fixtures and other appurtenant interests, in St. Recording Area Croix County,State of Wisconsin("Property")(if more space is needed,please attach addendum): Name and Return Address Lots 9,14,15,16,1 apa nd 3 1,Lundy Meadows, GLAND Lot 13 Whit 1 KRISTINA O etas M� ES TREEN & OGLAND This is not homestead property. 304 Locust Hudson, WI 54016 026-1165-09-000;026-1165-14-000;026-1165-15- 000:026-1165-16-000;026-1165-19-000:026-165-21- I 000;026-1165-23-000:026-1 165-31-000:026-1160- 13-000 Parcel Identification Number(PIN) Grantor warrants that the title to the Property is good,indefeasible in fee simple and free and clear of encumbrances except:easements,restrictions and reservations,if any,of record. Dated (SEAL)Bv: (SEAL) * *William B.Stock (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s)William B.Stock I I I i authenticated on O 4 ZE1 Zi STATE OF ) )ss. COUNTY ) *Kristina O land TITLE:mEmBA STATE BAR OF WISCONSIN Personally came before me on (If not, the above-named authorized by Wis.Stat. §706.06) to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Kristina Oeland.Estreen&OQland 304 Locust Street,Hudson,WI 54016 Notary Public,State of My Commission(is permanent)(expires:_ i (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED O 2003 STATE BAR OF WISCONSIN FORM NO.1-2003 "Type name below signatures. INFO-PROT"Legal Forms 800-655-2021 www.infoprofbrms.com 1 of 1