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HomeMy WebLinkAbout040-1304-14-000 Wisconsin Departmento°Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 574358 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: Folstad, Lee& Leslie I Troy, Town of 040-1304-14-000 CST BM Elev: Insp.BM Elev: IBM Description: r Section/Town/Range/Map No: 10"t 5, L-04 1J,y,¢_ 130 swv t °� 08.28.19.1820 TANK INFORMATION r=LEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. /S& &44%o Septic n 00 Benchmark_ ' •�� Z C ^_O l !� �re�Lt�f��. �•Y f �--f b. Dosing AI 07 IZ- Aeration Bldg.Sewer ' .3 �9 Holding St/Ht Inlet TANK SETBACK INFORMATION SUHt Outlet Z r �hco TANK TO /L WELL BEDG/] vent t Air Intake ROAD Dt Inlet �„ Septic , 3 Dt Bot tom',-�v11 "'!- +-12--7 17.73 99 1/.q a Dosing r t�s 3 a e an. -4 E .o q03J Aeration Dist. Pipe o --kn 47,0 7 p0 3• C- Holding Bot. System • L r 2 OZ.Final Grade PUMP/SIPHON INFORMATION (30'c� k� /� Q Manufacturer /? n Demand St Cover t� Gl.lLf�.o' GPM •�-!1-.}C r' s`S o-7.12- i Model Number D l X152 TDH Lift Friction L Syste e A TD#. Ft 04 Forcemain Length Dia. „ Dist.to Well SOIL ABSORPTION SYSTEM yZ G .dze�y —_ BED/TRENCH Width r Length No.Of Trenches PIT IONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 / No. SYSTEM TO / P/L BLDG WE LAKE/STREAM EACHING Manufacturer: INFORMATION HAMBER O Ty Of System: /% 1 f / U Model Number: gIgRIBUTION YSTEM ,� Heat r/Manifold istri ution &&—,tA Hole Size - x Hole Spacing Vent t Air Intake Lot Length Lot _ Dia Length Dia Spacing C SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Centerct •�'�i Bed/Trench Edges Topsoil Yes No Yes r No COMMENTS: /(Include code discre encies,persons present,etc.) Inspection#1: /__L/__Iy Inspection#2: / / Location: 444 Horizonurt.Hudson,WI 5401 / / 6/(,[VE 1/4 SW 1/4 8 728N R19W) Sunset Valley Lot 14 Parcel No: 08.28.19.1820 1.)Alt BM Description= iXX�n�ittLL�P.•JJ.•�t�� �n VLB-L2- �.G L, rn�(1,�1 I^5 T`�- ���� �f 2.)Bldg sewer length= -f -amount of cover= o, f — �Qe ^ � Q✓hGd 'S r'e �'S/(i"�� Plan revision Required? Yes No b r Use other side for additional information. L ----L1 Date Insepctor's Signature Cert.No. SBD-6710(R.3/97) &-A . z AJ . Lo.F I ® 66 r q o� PC p� ( e e�� 9� �k �• Z3, ;c �L W 3B �"aT"un g�,��., e •_ � County �� C $M Safety and Buildings Division d 1.O, _ 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) �S � Madi�ca,, 5 7162 AUG / 4i l ( k � �SIONA . f �; F q,�.*�� State Transaction Number 1 �y'J`6 �t Application to the appropriate governmental trait j In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form is required prior to obtaining a sanitary permit. Note:Application fors for state-owned POWTS are submitted to Project Address(if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law,s. 15.04 1 m,Slats. � �OU OE-it 1. Application Information-Please Print All Information Parcel# Property Owner's Name / L Le '�'� p O—1 O — / O t, L. Property Owner's Mailing Address Property Location / � �L I ff Govt.Lot City,State Zip Code Phone Number A) C—/.,�(�1/,, Section G� ,� G-1- 75//2. 7(o 3 3 t1U-77 T Z l�(circle one) N; R J - E orC II.Type of Building(check all that apply) Lot# Subdivision Name �1 or 2 Family Dwelling-Number of Bedrooms 4- a F� ���Z 1 Block# �/� L C"c ❑Pub[ic/Commercial-Describe Use ' ❑ City of CSM Number ❑ Village of El State Owned-Describe Use 9/ 1+�- 'own of 7 tz V III.Type of fermi (Check only one box on line A. Complete line B if applicable) A. New System ❑Replacement System ❑Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) B. El Permit Renewal ❑Permit Revision El Change of Plumber 11 Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner e o S S m/Cora onent/Device: Check all that apply) Non-Pressurized In-Ground I ❑Pressurized In-Ground ❑At-Grade ❑/)4 and>24 in.of suui le so� �o d< 4 in.of suitable sod ❑ Holding Tank ❑Other Dispersal Component(explain) v���` CL CTPretreatment�dvicd( am V.Dis ersaUTreatment Area Information: -f i 11pt 14 Xlfl" 1; Design F,logw�(gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required(sf) Dispersal Area Proposed(st) System Elevation �V C/ S8 S 49, 8 VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units , _ `� A _ Z. y New Tanks Existing Tanks Ar-�`�x /t o �; T a `� aU v� y h wC7 0. Septic or Holding Tank Z B� j -IO'A -4 Dosing Chamber �}y] — `j + i fC 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 MP/1>9lt&Number Business Phone Number V6--6,At1J Z Plumber' ddress(Street,City,State,Zip Code) VI Coun /De artment Use Only Approved ❑ Disapproved Permit Fee d Date lssuel wing gent rgn ❑ Owner Given Reason for Denial J r �� IX.Conditions of App_roval/Reasons for Disapproval SYSTEM OWNER: 0 �-F .-t D 1.Septic tank,effluent filter and D S/ f, _ y�� �} v� tJ�.`rVA Pv-w dispersal cell must be sery iced./maintained 1 ter" U as per management plan provided by plumber. 2.All setback requirements must be maintained 0 o p hs 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: Owner's Name: f!f✓y! Owner's Address: -I 12. e— I C� Legal Description: l It)6 _57to w Township: County: Subdivision Name: Lot Number: Parcel lD Number. Duo --/3vel Page 1i Index and title A) 71- ,V�e Page 2 Plot Plan u, U-,_VV Page 3!. System Sizing & Cross-Section l Page 4, Filter Specs Z Gtt!R' s�12 f Page 5' Maintenance Information Page 6'. Management Plan Page 7i Croix Cty Septic Tank Maintenance Form Page 8: Deed Page 9 CSM or Plat Attachments: Soil Test& House Plans Designer/Plumber: .O 6ew 19T&A01,61 License Number: 5e,9_7 Date: -2$/ Phone Number / Z7 Signature OF Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P(N.01/01). Page 1 r - r� � Z(-AAI-., AJ . Lo* L rNCj C1,6 ' A-J� � ru- 6/s � a are �1406 Ok Cq rW�iGL LL AJ �o�r� �—or 2— Family Dwelling In-ground Soil Absorption System (2-cell Conventional) Daily Wastewater Flow(DWF) _ #of bedrooms x 150 gal/day/bedroom = �� gal/day Design Loading Rate(DLR)or Soil Application Rate= 17 gpd/ft2 (per SPS Table 383.44-1, 2,or 3) Required Distribution cell area=DWF bCV gal/day +DLR r 7 gpd/ft2 = F-576 ftZ #Chambers=Required Distribution cell area - ftZ _ 2 ft'/unit EISA Chambers rw/ Chamber Manufacturer and Model: (/0 f fR 44411- d9U,1 G le 7 AY- Q Actual Distribution cell area=Required cell area �® ftZ + z ft'/unit EISA End Cap Pa ir= �J 7o, 7ft2 r Cross-Section In-ground Soil Absorption System (2-cell): 4"Schedule 40 PVC �—vent pipe with vent cap L12 es minimum 12 inches minimum C106, 6 g 3 rJ inches Soil Cover Trench 1 Sys- tem Elevation ��inch Chamber Height .6 Z. Q 0 / R Trench 2 Syste m Elevation � ft ft Trench Separation Leaching Chamber Width �ft to limiting factor Plan View In-ground Soil Absorption System (2-cell): Trench 1 Modify ft header/ design as ft �Leaching Chambers � 0 needed. .. Trench 2 4 inch Header Sch..Lo 3 y _0 _ft with end camps Draw 0 for a Vent and for Observation Pipe above. They will be located _�ft from the end of the cell. Vent pipes shall be Schedule 40 PVC and extend at least 12 inches above finished grade. Observation pipes that extend above finished grade must also be 4 inch Schedule 40 PVC. Page of • 7@111MWRIM�. 01600w� 121# series A "er c Dam Filter was patented in 1959. The 12"series filters have been filtering n any filter in the was tewater 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 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 Al00-12 Series is also 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 CBOD5 by 20-40%. „z 1/16"Filtration y� Available lengths 20'; 28"& 36" A300-12TM Series fi 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. 40k1/32"Fiftadon Available lengths 20" 28"& 36" A600-12T M S-erieS 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. 1/64"Filtration Available lengths 20" 28"& 36" For further technical information: www.zabeizone.com 050,03.244 POWTS OWNER'S MANUAL &*MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS. Owner Septic Tank Capacity 2 6,V gal ❑ N/ Permit /t Septic Tank Manufacturer W/6�Le^ ❑ NI DESIGN PARAMETERS Effluent Filter Manufacturer A�� ❑ N/ Number of Bedrooms ❑ NA Effluent Filter Model /OL112 ❑ N� Number of Public Facility Units �NA Pump Tank Capacity �� al ❑ NA Estimated flow (average) al/da Pump Tank Manufacturer (�<� , ❑ NA Design flow(peak), (.Estimated x 1.5) &*V gal/day Pump Manufacturer Ao u 6-oo ❑ NA Soil Application Rate y %� al/da /ft2 Pump Model ❑ NA Standard Influent/Effluent Quality Monthly average' Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODE) 5220 mg/L ❑NA ❑ Mechanical Aeration ❑ Watland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cells) ❑ NA Biochemical Oxygen Demand (SOD,,) 530 mg/L Olin-Ground (gravity) ❑ in-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L XNA ❑At-Grade ❑ Mound Fecal Coliform (geometric mean) 510`cfu/100m1 ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Ys in dia. ❑NA Other: ❑ NA Other: O NA Other: Q NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 ❑ month(s) (Maximum 3 years) ❑ NA � ear(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y) of tank volume ❑ NA Inspect dispersal cell(s) A ❑ ml nth(s)t least once every: El earls) (Maximum 3 years) 13 NA Clean affluent filter At least once every. 13 month(s)ear(s) .❑ NA month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: 0 3 119 year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA '®. ear(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ 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 Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. 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 dispersal goll(s) shall be visually Inspected to check the effluent levels In the observation pipes and to.check for.an ponding g ground of effluent on the g d surface.. The ponding of PP effluent on the ground surface may indicate a failin condition and requires the 9 q Immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum In any tank equals one-third %) or more of the tank volume, the_ entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, Including but not limited to the:,servicing-of effluent filters, mechanical or pressurized components,.pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW(4/01) START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemical that may impede the treatment process and/or damage the dispersal call(s). If high concentrations are detected have the content of the tank(s) removed by a septage servicing operator prior to use. 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 levels. When power is restored the excess wastewater will b� discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge o effluent: To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restorin( power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls t( 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 arez 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 of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products;-pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is 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 fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant repl;7A/sultable system: 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. ❑ 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. ❑ 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. [3 . Mound and at-grade soil absorption systems may be reconstructed In place following removal of the biomat 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 © 2 C L S O Name Phone S '" Z 7 3 _ 7 T Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name �© il/� •(J -F l2 Name Zo,�v(n/ Phone 2 73 Sg j t Phone Q This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f)and 83.54(1). (2) &(3),Wisconsin Administrative Code. 4 r 2.� C.62tr-t� -Ayd h �� fir. felon se,. &!../ �32 survey op %Z 5 Volom f is so" Lot mwo t# r j AmPmw m9m'-www#71 As of It Val fto AN BRIM iC Yr1 �p �k ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner uyer EE LESLIE f-d L S r-14 -) Mailing Address Property Address q L/ 7-4 J (2 T (Verification required from Planning&Zoning Departle t new construction.) City/State f p l h S (v . O.1 Parcel Identification Number 3� LEGAL DESCRIPTION �25 V / 1/4 Sec. T ?v N R W, Town of Property Location 1/4 , Q Subdivision Plat: �u 4 cr VAL-Ge-Y ('-7 7 3 (a , Lot# . Certified Survey Map # �j� -C�- , Volume i , Page# Warranty Deed # 0 (before 2007)Volume , Page# Spec house❑yes❑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 v' warranty deed recorded in Register of Deeds Office. Number of bedrooms 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) ii liiililliilillll111llliili iii State Bar of Wisconsin Form 7-2003 " � " 6ncin 3 TRUSTEE'S DEED ZW 14 991263 BETH PABST Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED,made between Arthur N. Feyereisen and Marilyn E. Feyereisen 01/09/2014 2:24 PM as Trustee of The Feyereisen Revocable Trust dated December 28, 1995 EXEMPT#: NA ("Grantor,"whether one or more), REC FEE: 30.00 and Lee Folstad and Leslie Folstad,husband and wife TRANS FEE: 210.00 PAGES: 1 ("Grantee,"whether one or more). Grantor conveys to Grantee, without warranty, the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in Recording Area St Croix County,State of Wisconsin("Property")(if more space is needed,please attach addendum): Name and Return Address River Valley Abstract&Title Lot 14, Plat of Sunset Valley, St. Croix County, 1200 Hosford St. Suite 201 Hudson Wl 54016 Wisconsin. File 2810939 040-1304-14-000 Parcel Identification Number(PIN) Dated December 27,2013 (SEAL) T (SEAL) * Arthur N. Feyereisen,Trustee * Marilyn E. Feyereisen,Trustee (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) )ss. authenticated on ��[�z;�: "'�" ST CROIX COUNTY ) r iFi0"rsR�, s`�x.sm di^. * L-. -0 1AI ry L,;t¢=W jti;C,ONSIN Personally came before me on December 27,2013 --�._„I the above-named Arthur N. Feyereisen and Marilyn E. TITLE: MEMBER STATE BAR OF WISCONSIN Feyereisen,Trustees of the Feyereisen Revocable Trust (if not, authorized by Wis. Stat. §706.06) to me known to be the person(s)wh the'aregoing instrument and wledged h mew / THIS INSTRUMENT DRAFTED BY: * Lorrie eMars Fran Iverson 1200 Hosford St. Suite 201 - Notary blic, State of consm Hudson WI 54016 / My mmission(,is�ae manent)(expires:_March 20,2016 ) (Signatures may be authenticated( acknowledged. Roth are not necessary.) NOTE:THIS IS A STANDARD FORM. ANY MODIF CATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. TRUSTEE'S DEED Q 2003 STATE BAR OF WISCONSIN FORK(N0.7-2003 .tTO b&11",VW6f2b3 Page 1 of 1 F VOL liw 10 OOCUMEN r .51,3828 128K Ri$W r t ` - W - LOT 1 t LOT 14 1 JW7 ACM a� ST. • 1.7' 7 ACME' 67A" sr. l LOT ,Loo �s ' Sr. Raw ... 4�j c ` qPb ;40 \ A�41 &M ACM � � r 1 1 l Combinatio.n Sep> ic:Tank SndCIF CATIONS ' PUMP CHAMBER CROSS SECTION AND E I $ VE1JT CAP. WEATHER Pjt. • Ju1JCTIOQ 80X . H`C.1. VENT PIPC APPROVED LOCKING. jQ ' FROM OoOR, MAIJHOLE COYER Wl- ,AQ0OW OR FRESH wARrJI1JG LABEL . "sPkz-Ma>J PIPE ALP- IUTAKE r S ca..,pu�r i•r PROVIDE I ----'-- e . 1 IIJLE T AIRTIGHT SEAL ,� I III APPROVED JOIJJT Zf'I$�L. Ftl� APPROVED J014T 1J�C.T. PIPEaK Tank construction I III W/C.T. PIPE R) shall comply with I (I ALARM ILHR 1;3 , 15 and 83.20 C ou Pu F-�P--�, __J . ` OFF D COAICKETE qZ a g BLOCK RISEK EXIT PERMITTED OQLV IF TAWK MANUFACTURI`R HA 3"AGPf;c��: S SUCH APPROVAL 3DDING SEPTIC F SPECIFICATIOUS DOSE TA i1 KS MAMUFACTURCR.: �� CZkJLZ� WUMbER OF DOSES: P E K DA, TAMK SIZE : - 8OZ) GA,LLO-US DOSE VOLUME (� ALARM MAWUFACTUF ZIZ: S,--S =- Lc) S�-(ST �I� INCLUDING OAGKFLOOW: l + GALLONS MODEL WUMBER: 10L Nw CAPACITIES: A= z°,,C815 OK Y—L GALLOij5 SWITCH TyPt; .ke&-- 8= Z- INCHES OR 4 li Z G�LLOUS HUMP 101AlJUFACTUItEA: &// C=-_INCHES OR L^�r��,71•ALLOUS MODEL 1JUMDER: _ C T/ ,INCHES OR11_GJ614 6 A L L 0 M SWITCH TYPE: ' r )JOIE: PUMP AUO ALARM ARE TO OL MIQIMUM -DISCHARGE RATE GPM INSTALLED OIJ 5EPARATC CIRCUITS VERTICAL DIFFERENCE DETWCEIJ PUMP OFF O,DISTRIBUTIOW PIPE.. �LZZ FEET t nl'Zul�nUM NETWORK SUPPLY PRESSURE , ; , , , . FEET + ...�!LFEET OF FORCE MAIN X /F pftFKICTIOUFACroR..� FEET TOTAL DylJAMIG H1"A0 FEET As per . manufacturer gal/in . APR-12-2005 16:28 FERGUSON ENT HUDSON 715 386 6144 P.01 HGOULDS PUMPS Submersible 1 Effluent Pump MODEL PE IgtVINR PUMP I SPECIFICATIONS MOTOR FEATURES Pump-General; General: 2 Corrosion resistant • Discharge: 1 rA"NPT • Single phase construction. • Temperature: 104°F(40°C) • 60 Hertz ■Cast iron body. maximum,continuous when • 115 and 230 volts N Thermoplastic impeller and fully submerged. • Built-In themmal overload pro- cover, • Solids handling:'h" 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 s Motor Is permanently Spedally 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 Dewatering • Maximum capacity:61 GPM • 115 and 230 volts cord,20'standard length, • Maximum head:29'TDH • PSC design heavy r duty v6/3 SiT wit PE51 Pump: PE51 Motor: lu • Maximum capacity:70 GPM • .50 HP,3400 RPM g' • Maximum head:37'TDH • 115 and 230 volts ■C Complete unit is heavy duty, • PSC design portable and compact. n • METERS FEET g ■Mechanical seal is carbon, 40 r-- _•V ceramic,BUNA and stainless PE51, ! I I I I r I 1 1 MODELS:PE31,PEai,Pest steel. 35 ' ` I ! 1 I I HR.33,.40•s0 ■Staff;less steel fasteners. .. �- I I I I T I I• 1 1 1 I 30 •�E4 ! + 1--.'- 2 GPM AGENCY LISTINGS �!y' ! i 1 Fr W eEr ! ' I � , I ; 1 !' I I ! , r• �i i � i ; ; .; I, T 25 k® i C u5 c zo UL to 7 Tested ` 78 and 15 - ` I ! I I I CSA 221108 Standards o l --1 1 By Canadian Standards Atdodadon �" I I i t i I 1• I. ! I ! I , I File#1R38S49 Goulds Pumps is ISO 9001 Registered • Ill { lIl •I � �I - ' ! i � ; .I � ! ;• I J. I II7 �,M. I Ir 0 10 20 30 40 5 70 GPM 80 0 5 i0 15 j;3 Goulds Pumps ®2004 11T water Technology.Inc. CAPACITY i EH•ctiva Jun• Z BYE3T/41 ' 004 ITT Industries All Q C)uick4 Plus Standard Chamber Side and End Views Z 48„ (EFFECTIVE LENGTH) 12" L 24� �4C S l _ 34" � �----- r `wickA Plus All-in-One 12 Encap Front, Side and End Views 13" • 8"INVERT ERT 8"INVE T 5.3"INVERT 4 I 33"---� '<�.xic.�:4 Plus All-in-One Periscope OUICK4 PLUS ALL-IN•ONE SWIVEL ERISCOP� p a 6" 12.7"INVERT ou- u3 ALL-IN-ONE 12 ENDCAP 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" g (1.5 cm, 8:4 cm, 18.5 cm, 22.6 cm) j 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") 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 it 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 1" by this Limited Warranty. Infiltrator's liability specifically excludes the cost of removal and/or installation of the Units. ' (b)THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH(a)ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT 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 does not extend to incidental,consequential,special or indirect damages. InfiltratQr shall not be liable for penalties or liquidated damages, including loss of production and profits,labor and materials,overhead costs,or other losses or expenses incurred by the Holder or any third party. systems inc. Specifically excluded from Limited Warranty coverage are damage to the Units due to ordinary wear and tear,alteration,accident,misuse,abuse 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 he Units_failure of the Units or the septic system due to improper siting or improper sizing,excessive water usage,improper grease disposal, 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 Saybrook, CT 06475 arms 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 hird party resulting from installation or shipment,or from any product liability claims of Holder or any third party. For this Limited Warranty to 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 (u)No representative of Infiltrator has the authority to change or extend this Limited Warranty. No warranty applies to any party other than the wwwainflltratorsystems.com original Holder The above represents the Standard Limited Warranty offered by Infiltrator. A limited number of states and counties have different warranty requirements, Any purchaser of Units should contact Infiltrator's Corporate Headquarters In Old Saybrook,Connecticut,prior to such purchase. Io obtain a copy of the applicable warranty,and should carefully read that warranty prior to the purchase of Units. U S Patents:4,759,661;5,017,041;5,156,488;5,336,017;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 ouick4 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.®2009 Infiltrator Systems Inc.Printed in U.S.A. PLUS0510101SI-2 a► t ' RECEIVED yWsconsin of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and uildings�.j lUJ 2 2 iq da with Comm 85,Ws. Adm. Code � ST.CROIX Attach complete sit plan p not less than 81 PI include,but not Gm' t0. {._ di Parcel I.D. percent slope,sca dime7N{nJp>�Ffinr,and I and_dstance road. Please print all information. Re b Date Personal information you provide may be used for secondary purposes(Privacy Law.s.15.04(1)(m)). Property Owner Property Location ■ ARTHUR&MARIYLN FEYEREISEN Govt,Lot --W 1/4 SW 1/4 S 8 T 28 N R 19 E(or)W Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# 420 Townsvalley Road 14 - Sunset Valley City State Zip Code Phone Number Village ■ Town Nearest Road Hudson, WI 54016 ( 715) 386-2122 Townsvalley Road E] New Construction Use[D Residential/Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or cxlmunercial-Describe: Parent material outwash/sandstone Flood Plain elevation if applicable MA ft. General commerft Conventi -ground trenches-to be designed by installer m�nd�Oce' 0.5 or .71 din rate depending on location of trenches SYS �Z4 � Gt,a e_ 0- 7 gf l-6'� al Boring# Boring a pit Ground surface elev. 906.66 ft. Depth to limiting factor 108 in. Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu.Sz. ConL Color Gr.Sz.Sh. i -Eff#1 -Eff#2 1 0-8 10YR2/2 - 1 2f-msbk mvfr cb 3vf-m 0.6 0.8 2 8-14 10YR2l2 - 1 2f-mabk mfr ai 2vf-m 0.6 0.8 3 14-25 10YR3/4 - 1 2f-mabk mfr aw 2vf-m 0.6 0.8 4 25-38 10YR3/6 - s Osg ml as 3vf-m 0.7 1.6 5 38-72 10YRY6 cs&gr On ml as -- 0.7 1.6 6 72-108 10YR4/4 - fs Osg as - 0.5 1.0 7 108- 10YR4/ c2f 10YR4/6 fs Osg ml - - 0.5 1.0 Boring# ❑ Boring 906.23 - >113 0 Pit Ground surface elev. ft. Depth to limiting factor in. Soft Application Rate B H&4zon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDRf? in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'EWI *Eff#2 1 0-4 10YR2/1 - 1 3fabk ds cb 3vf-m 0.6 0.8 2 4-17 10YR2/1 - I 2f-ma&sbk ds ai 2vf-m 0.6 0.8 3 17-3Qj 10YR3/4 - sil 2f-msbk mfr cs 2vf-m 0.6 0.8 I 4 30-42 10YR3/6 - s Osg dl cs 2vf-m 0.7 1.6 g 42-113 10YR5/4 - s Osg ml - - 0.7 1.6 (Horizons 4& 5 have some gr.) "Effluent#1=BOD >30:5 220 mg/L and TSS>30<150 mg/L 'Effluent#2=BOD a 30 mg/L and TSS:5 30 mg/L CST Name(Please Pnrd nature CST Number Mary Jo Hollister (./rim. 224832 Address Date Evaluation Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 01 -13&07-08-04 (715) 426-1775 Property Owner FEYEREISEN,Arthur(Lot 14) Parcel ID# (Pending) Page 2 of 3 i Boring# Boring ` u El Pit Ground surface elev. 906.68 ft. Depth to limiting factor >110 m Soli Application Rate Horizon Depth Dorrunant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Murrell Qu.Sz. Cord.Color Gr.Sz.Sh. -Eff#1 *Eff#2 1 0-4 10YR2/1 - I 3fabk ds cb 3vf-m 0.6 0.8 2 4-12 10YR2/1 - 1 2fabk ds as 2vf-m 0.6 0.8 3 12-20 1OyR3/3 - I 2f-mabk mfr cb 2vf-m 0.6 0.8 4 20-34 I p - sil 2f-msbk mfr cs 3vf-m 0.6 0.8 5 34-41 10YR3/6 -- s Osg ml gs 2vf-m 0.7 1.6 6 41-110 10YR5/4 - s 0sg ml - - 0.7 1.6 (Horizons 5& 6 have some gr.) F-1 Boring# Boning Pit Ground surface elev. ft. Depth to limiting factor in. Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPOW in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. -Eff#1 -Eff112 ❑ Boring# Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Appkadon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu.Sz. Cont color Gr.Sz.Sh. 'Eff#1 'Eff#2 *Effluent#1=BOD6>30<220 mg/L and TSS>30<150 mg& 'Effluent#2=B005:5 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. 813"Meg(s.mioo) l PWf M PAM-5ff Y Or 'oN �P�S .sc-r-.x 9 TROY, sL C RMY s -501.vom W/ V"m NO GOMM M PROM M5 I.�s7�eat>✓s � I� I g 10 0 L-DT �y ' —P15 o�- -909. 18' ,�. B-14C °r 1 906. ' s B-1 J15B Vh , �t C 2345t` �w OD y�e .`)0 0 B—13B 905.63731' s �cry I LAND USE= GRICUL�`TURE V E 109CR6 SENT -ZONING=AGRIC LTURE---x I _AGE 7 4 RR RESID TIAL DOCUM_ E 90R.o 105 x 907 \, 910.89 � \ ' sos x— -- �z — — 2 .61' / '910.6 � . t907 0 x %904.9 LOT 14 v, ' LOT A 5 \ 1.757 ACRES I o 1. 557 A REST 6,534 S.F. w ' 844 S.F. ' e- (A Qo I c \ �w I ° • 907^ \ O x rn x in,\ 907.4 LOT � 13 , o 91 o: ' (LB0=904.0) / c.4 LJ x .504 ACRES O�G 910-8 X IL 165,492 S.F. 6 U F— I ` x x 905.5 of I 904.7 \ U x I J5 =80' 75 I Q QBy�p N 0 Q p 0s.o G S 3°50 '7 .D � , \ z z x \ Q 0 UTLO ;;�� : �s �. , -i N 3.07 ° °� 5 ACRES a ° . . B- 12 � I-- F-- \ ,133,959 )S.F. x �, o``'.•' 2 °' z 905.7 W W ` 902. 1 p°� o �t? :D Z !� .08.41 4.93 l DRI�AINAGE . / Z . •_ SASE T , \ Z � °� °; 5 5g ; G°c Q1 ° °; G Z i ad ;o �S- 900.2 jV 900. x W898.7 898.2 _ • / o ? x STORMWATER ►��'?/ v� ' (b� POND 3P CD ro ' ��'• HWE=902.0 rn ti GjJ/ 4) i Parcel #: 040-1304-14-000 08/28/2014 10:46 AM PAGE 1 OF 1 Alt. Parcel#: 08.28.19.1820 040-TOWN OF TROY Current OX ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units 09/08/2004 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner 0- FOLSTAD, LEE&LESLIE LEE&LESLIE FOLSTAD 13893 HEATHER ST NW ANDOVER MN 55304 Property Address(es): "=Primary *444 HORIZON CT Districts: SC=School SP=Special Type Dist# Description SC 2611 SCH DIST OF HUDSON SP 1700 WITC Notes: Legal Description: Acres: 1.757 SEC 8 T28N R19W PT NE SW BEING SUNSET VALLEY('04) LOT 14(1.757AC) Parcel History: Date Doc# Vol/Page Type 01/09/2014 991263 TD 09/08/2004 773695 10/24 PLAT 11/20/2003 747093 2459/594 EZ Plat: *=Primary Tract: (S-T-R 40%160%GQ Block/Condo Bldg: * 10-024-SUNSET VALLEY 040-04 LOTS 5/2 08-28N-19W NE SW LOT 14 i 2014 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 11/09/2009 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.757 69,900 0 69,900 NO Totals for 2014: General Property 1.757 69,900 0 69,900 Woodland 0.000 0 0 Totals for 2013: General Property 1.757 69,900 0 69,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00