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HomeMy WebLinkAbout040-1078-10-200 Wisconsin Department of Commen a PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 579038 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: Gillis, Joshua & Carmen Troy, Town of 040-1078-10-200 CST BM Elev: Insp. BM Elev: BM Description: SectioNTown/Range/Map No: AA 6A ~ 19.28.19.2991 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 3, 35 /03.3 oz~ Septic y~ Nt Benchmark LJ: /ZOO 3. 15 63.E / z~ Dosing ,4S Alt. BM 60 ~11~on gvC~ P. G a 5 9 Y, g 5 Awetihz- Bldg. Sewer 974." a 1 o k ~z~ 9. ~l q 3. gq Holding St/Ht Inlet 16 Z (V 11.13 C. TANK SETBACK INFORMATION St/Ht Outlet ` TANK TO P/L WELL BLDG. ent Air Intake ROAD Dt Inlet I ~ Septic ' So I { O Z/ 30 Dt Bottom Dosing /62Z 30 4L I Header/Man. 3 .ob 160,35 Aeration Dist. Pipe 3.61 ICC~ 3 Holding Bot. System M. 58~ 3, 77 99 •5'S Final Grade PUMP/SIPHON INFORMATION 7• oc~ 16113.5 Manufacturer Ul- GPM nd St Cover P, C s > o u 5 t'` Model Number PE 51 3Z 31 CD>tiV 9'7.7 TDH Lift Friction Loss System Head TDH Ft /0 ; (03 4-5-6 / 1 Forcemain Length if Dist. to Well I ,6 z /v2 SOIL ABSORPTION SYSTEM BEDITRENCH Width 1 Length NPIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS D -76 a 1-~ I--_ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: \ INFORMATION CHAMBER OR Typfflo ystem: 7 vti 51) '7s ' u Ajit- UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold ~Distribution /CZ x Hole Size f~ x Hole Spacing Ve o Air Intake Length/ Dia / Length 3-37 Dia Spacing ✓ ~Z Z- 53 J.~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center / % 77 Bed/Trench Edges Topsoil Yes 0 No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / Inspection #2: Location: 224 Cty Rd F Hudson, WI 54gj6 (S 1/4 SW 1/4 19 T28N R1 9W) NA Lot 6 Parcel No: 19.28.19.2991 P 1.) Alt BM Description = J ~ V~ r tF2 , tiS bW O 2.) Bldg sewer length= ca - amount of cover = 14 a v-, a_`-L t-0'k-S d v~ Plan revision Required? Yes No Use other side for additional information. 1 7 sl SBD-6710 (R.3/97) Date Insepctor's ignatur Cert. No. i oAxrsrr°~ 14.. e County ? Industry Services Divisi0 1400 E Washington Av ' p S IJU 2 ' P.O. BOX 7162 ani ernmit Number (to be filled in by Co.) per, Madison, WI 53707-7162 ST, CROIX 0OUff4 S77039 W Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit Z5 7Z .SS'3 is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address (if different than maili address) purposes in accordance with the Privacy Law, s. 15.04(1 (m), Slats. JJ ZZ r 1. Application Information - Please Print All Information Property Owner's Name 65 or.. 4- CclrM e_^_ Parcel # .S Property Owner's Mailing Address Property Location y y7 Govt. Lot p l City, S Zip Code Phone Number ''/4, 6wJ '/4, Section 1 (circle 004 II. Type of Building (check all that apply) Lot # T11-41 N R E o 14 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name ❑ Public/Commercial -Describe Use t~N Block # r_1 State Owned - Describe Use 14.11- ❑ City of ` CSM Number ❑ Village of X 7 ~7 ~o ✓ 2 61 Town of III. Ty a of Permit: Check onl one box on line A. Complete line B if applicable) Z6 x, A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) R El Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System/Component/Device: (Check all that y ply) t1 r- ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in, of suitable soil ( Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) /J V. Dis ersal/Treat nt Area Information: Q I Design Flow (gpd) Design Soil Applicatjon Dispersal Area Require sf) Dispersal Area Proposed (sf) System Elevation l Rate(gpdsf) L`/ 5~ VI. Tank Info Capacity in r S Gallons Total # of Gallons Units M ufacturer w b v ti Y a; New Tanks Existing Tanks a. U ~ V ~ R w T A Septic or Holding Tank _ ❑ ❑ ❑ ❑ Dosing Chamber - ❑ ❑ ❑ ❑ ❑ VII. Res o ibility tement- he undersigned, assu a res nsibili or' t llati of the POWTS shown on the attached plans. Plumbe ame (Pri Plumber' Si tore - MP/Iv1PRS Number Business Phone Number Plumber's Ad ess (Street, City, late, Zip Code) VIII. un /De artment Use Only XApproved Permit Fee Date,lssued Issuin gent Sign r iven Reason r Denial $ fp25 l~ 7 IX. Condit8itf8ToEM RReasons for Disapproval 3 G J Jv!~A 1~ rJ L l.. avr, 1'. Septic tankY of ant filter and dispersal miuefee be lw*aa I .1-A 1 `f, "Upo1lrtt pleat pro - 6yl~um~Mf, I ,tined Attach to complete plans for the system and submit to the County only on paper not less than 8 to x I I inches in size ~ gL) ~lJ~9r✓ GC~~ .J ~G~~l~ I~~ Ev. Ix/ ide ' 5 1 / it c4 5~G ~ r S 1 /,Bra? - it T , /9~rTE~T DIVISION OF INDUSTRY SERVICES 10541 N RANCH ROAD HAYWARD WI 54843 K I Contact Through Relay Ps http://dsps.wi.gov/programs/industry-services www.wisconsin.gov SS1or Scott Walker, Governor Dave Ross, Secretary July 27, 2015 CUST ID No. 224263 ATTN.- POWTSInspector KIM A OCONNELL ZONING OFFICE KO CONSTRUCTION ST CROIX COUNTY SPIA 504 3RD AVE 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/27/2017 Identification Numbers Transaction ID No. 2572553 SITE: Site ID No. 814571 Jeffrey & Jill Loomis Please refer to both identification numbers, 224 Co Rd F above, in all correspondence with the agency. Town of Troy St Croix County SE1/4, SW1/4, S19, T28N, R19W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1344714 Maintenance required; 600 GPD Flow rate; 14 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12), SSWMP Pub. 9.6; Effluent Filter 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 any 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: A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. r KIM A OCONNELL Page 2 7/27/2015 Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Carl J Lippert Wastewater Specialist, Division of Industry Services WiSMART code: 7633 (715)634-5035, M-f 7AM - 12PM carl.lippert@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Kim A. O'connell, Ko Construction KIM A OCONNELL Page 2 7/27/2015 Sincerely, [Balaalance ee Required $ 250.00 ee Received $ 250.00 Due $ 0.00 Carl J Lippert Wastewater Specialist, Division of Industry Services WiSMART code: 7633 (715)60-4-5035, M-f 7AM - 12PM carl.lippert@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Kim A. O'connell, Ko Construction MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Jeffrey & Jill Loomis Owner's Name: Jeffrey & Jill Loomis Owner's Address: 224 CTY RD F Hudson WI 54016 Legal Description: SE--SWiisec19--T28N--R19W Township: Trot County: ST Croix Subdivision Name: eftDITIONALL9 Lot Number: 6 Block NumberAPPROVED DEPT OF SAFETI"AND Parcel I.D. Number: 040-10781-0200 pROFESSIONAL SERVICES Plan Transaction No.: DIVISION OF INDUSTRY SERVICES Page 1 Index and title / Page 2 Data ent rY Page 3 Mound drawings SEE ESPONDENCE Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan Page 9 Soil Evaluation Designer: Kim Oconnell License Number: 224263 Date: 06/28/15 Phone Number: 715-381-7917 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SBD-10691-P (N. 01/01, R. 11/12), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01, R. 10/12) Version 7.0 (R. 11/12) Pagel of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 383-44-3 in-situ soil treatment for 1.50 Peaking Factor (e.g. 1.5 = 150%) fecal coliform of - 36 inches. 600.00 Design Flow (gpd) 3.60 Site Slope 97.35 Contour Line Elevation (ft) 14.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 75.00 Dispersal Cell Length Along Contour (ft) = 8.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) E Center or End Manifold 4.00 Lateral Spacing (ft) If N above, enter the elevation (ft) 2 Number of Laterals of the highest point. 0.156 Orifice Diameter (in) 2.50 Estimated Orifice Spacing (ft) = 10.00 ft2/orifice 2.00 Forcemain Diameter (in) 55.00 Forcemain Length (ft) Does the forcemain drain back? Y 88.50 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 8.97 Forcemain Drainback (gal) 10.52 Vertical Lift (ft) 67.32 5x Void Volume (gal) 1.22 Friction Loss (ft) 76.29 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 32.31 System Demand (gpm) 16.29 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x x 1.25 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallonslinch Calculator (optional) Treatment Tank Information 1250.00 Total Tank Capacity (gal) 1250.00 Septic Tank Capacity (gal) 48.00 Total Working Liquid Depth (in) Wieser Manufacturer 26.04 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information -7,1-0 Dose Tank Capacity (gal) Plo lock _ Filter Manufacturer 16.12 Dose Tank Volume (gal/in) PL 525 Filter Model Number Weiser Manufacturer Project: Jeffrey & Jill Loomis Page 2 of 9 Mound Plan and Cross Section Views T 1/10 B ; J Observation Pipe I:fJ • • - K:- - O A W .f B I - I L Mound Component Dimensions Down slope toe extension made. A 8.00 ft E 25.46 in H A8.46 ft K 11.31 ft B 75.00 ft F 9.50 in z ft L 97.61 ft D 22.00 in G 0.50 ft J ft W 28.46 ft 600.00 (ft) Dispersal Cell Area 1500.00 (ft) Basal Area Available 8.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 100.98 (ft) ..rriii rrrr... * H .,rrrrrrrrrr rrrrrrrrrn,. G •I 99.18 (ft) - Dispersal Cell 99.68 (ft) Lateral Invert Dispersal Cell Elevation D a =x 1 = 4 97.35 (ft) Contour Elevation 3.6 % Site Slope Geotextile Fabric Cover Shading Key Dispersal Cell See lateral details on Q ® Topsoil Cap c a 1.5 ft 7-~ Page 4 for number, size, rrrrrrr, Subsoil Cap c `lam and spacing of laterals. ASTM C33 Sand ° Laterals are equally Tilled Layer 0.5 ft Tvpical Lateral F spaced from the Aggregate c - distribution cell's centerline in the A ♦ distribution cell (AxB). Project: Jeffrey & Jill Loomis Page 3 of 9 End Connection Lateral Layout Diagram Laterals centered over the dimension ~-Turn-upwfball valve orcleanoutplug F P All laterals are identical IF X ~ I Holes drilled on the bottom of the lateral equaay spaced S Force main connection via tee or cross to manifold at anv Doint. Laterals &forcemain Sch 40 PVC per S P S Table 384.30-6 Number of Laterals 2 Orifice Diameter 0.156 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 73.37 ft Orifices per Lateral 30 Lateral Spacing (S) 4.00 ft Orifice Density 10.00 ft2/orifice Lateral Flow Rate 16.16 gpm Manifold Length 4.00 ft System Flow Rate 32.31 gpm Manifold Diameter 1.50 in Total Dynamic Head 16.29 ft Forcemain Velocity F::730 fttsec Dose Tank Information Locking cover with warning label and locking device and Electrical as per NEC 300 and sealed watertight SPS 316.300 WAC 4 in. min. Disconnect ect Tank component is properly vented E- Aftemate outlet location Forcemain diameter Weiser Manufacturer 2 in. Capacityl 750.00 Gallons T- Volume 16.12 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 31.79 512.51 B 2.00 32.24 C Pump off elevation (ft) _t F C 4.73 76.29 89.17 D 8.00 128.96 D Total 46.53 750.00 Dose tank elevation (ft) 3" Bedding un er tank. 88.50 Alarm Manuafacturer SJ Electro Note: Switches Alarm Model Number 101 HW containing mercury may not be used in Pump Manufacturer Goulds this system. Pump Model Number PE 51 Pump Must Deliver 32.31 gpm at 16.29 ft TDH Project: Jeffrey & Jill Loomis Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name Kim Oconnell Phone 715-381-7917 POWTS Regulator's Name ST Croix Zoning Phone 715-386-4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1250 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Should inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Inspect for pondin and seepage once eve 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished _ Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lon~gg Sweep 90 or Two 45 De ree Bends Same Diame~er as Lateral Project: Jeffrey & Jill Loomis Page 5 of 9 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01, R. 11/12), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706-P (N. 01/01, R. 10/12)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5, 30 mg/L TSS, 10 mg/L FOG, and 10' cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, lt will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. [qGOULDS PUMPS Submersible Effluent Pump PE t: P ll "~I UENR PUMP SPECIFICATIONS MOTOR FEATURES Pump -General: General: ■ Corrosion resistant • Discharge: 1 Y2" NPT • Single phase • • 60 Herconstruction. • Temperature: 104 F (400C) ■ Cast iron body. maximum, continuous when • 115 volts ■ Thermoplastic impeller and fully submerged. • Built-in thermal 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 ■ 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: • 12.0 Maximum amps operation. • Low Pressure Pipe Systems • Maximum capacity: 50 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: 60 GPM • 7.5 Maximum amps cord, 20' standard length, • Maximum head: 29` TDH • PSC design heavy ty 1/3 SJTW t PE51 Pump: PE51 Motor NEMA 5-15P, ee prong, 115 volt grounding plug. • Maximum capacity: 70 GPM • .50 HP, 3400 RPM ■ Complete unit is heavy duty, • Maximum head: 37' TDH • 9.5 Maximum amps portable and compact. METERS FE • PSC design ■ Mechanical seal is carbon, 4 - - - ceramic, BUNG and stainless PE51 - + MODELS PE31, PE41, PEST! steel. 35 ' 1 HP 33_40, so ■ Stainless steel fasteners. _v 1IT 10 2GPM 30 PE41 AGENCY LISTINGS ,al, 25 ?E31 U G ! _ _ L ~ck us - Z 20 - - Tested to UL 778 and CSA 22.2108 Standards 0 15 ; _ 4 By Canavan Standards Association t- IVe #LR38549 - 1 Goulds Pumps is ISO 9001 Registered. 10 u 5 0 p~._. 20 30 ..d.40.' w _.50 - -60 70 GPM 80 0 5 10 15 m3/h Goulds Pumps CAPACITY ,n 7M7 (nutria Pumns ~ ~~~-gyp L sSY dc It r/ l i L~ 21 J U G~err~~c C ) 3s" 3 ST. CROIX COUNTY SEPTIC TANK 1\1AI22\'TENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM 0,Amer/Buyer 5'041 ell, yz lei S Mailing Address 147 o j' v Property Address r9 `f (\xerification required from Planning & Zoning Department for new co 'on.) City/State ~•r~ r t-- Parcel Identification Number 6 ~ - /67f ry ' &6 LEGAL DESCRIPTION ,~C4 1/{ , S„✓ ; Sec. /I ; T 29 N Rif W, Town of Property Location rO Subdivision Plat: 0'--t , Lot # Certified Survey Map # Volume /.;71 , Page # 3;1- ~7 Warranty Deed # (before 2007)Volume , Page # Spec house 0 yes fd no Lot lines identifiable yes O no SYSTEM MAINITENANCE 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 farm, 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 113 full of sludge. Itwe, 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. Certificazion 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 form are true to the best of my/our knowledge. Itwe am/are the owner(s) of the property described above, by virtue of a w r deed recorded in Register of Deeds Office. Numbe /'1/ r of bedrooms RECEIVED JUL 2 7 zm ~ rNATURE OF APPLICANT(S) ST. CROIX COUNTY DATE .:OMMUNITY DEVELppM /"Any information that is misrepresented may result in the sanitary permit being revoked by the Plangn-g Zonitsa 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/x2) EXHIBIT "A" LEGAL DESCRIPTION LOT SIX (6) OF CERTIFIED SURVEY MAP IN VOLUME TWE 12 OF CERTIFIED SURVEY MAPS PAGE 3271 AS UUUUMENT NUMBER: 60 1''11 ST. COUNTY RE TER OF DE , BEING LOCATED IN THE SOUTHEAST QUARTER OF THE SOUTHWEST QUARTER (SE1/4 OF SW1/4)A HE 7 NORTHEAST QUARTER OF THE SOUTHWEST QUARTER (NE1/4 OF SW114) AND THE NORTHWEST QUARTER OF THE SOUTHWEST QUARTER (NW 1/4 OF SW1/4) OF SECTION NINETEEN (19), TOWNSHIP TWENTY EIGHT (28) NORTH, RANGE NINETEEN (19) WEST, AND INCLUDING PART OF OUTLOT 8 OF TROY VILLAGE, TOWN OF TROY; FORMERLY BEING PART OF LOT 4 OF CERTIFIED SURVEY MAP IN VOLUME 4 OF CERTIFIED SURVEY MAPS, PAGE 993, AS DOCUMENT NUMBER 366634; FORMERLY BEING PART OF LOT 4 OF CERTIFIED SURVEY MAP IN VOLUME 2 OF CERTIFIED SURVEY MAPS, PAGE 556, AS DOCUMENT NUMBER 346822. TOGETHER WITH PERMANENT EASEMENT FOR PRIVATE ROAD AS SHOWN ON CERTIFIED SURVEY MAP IN VOLUME 4, PAGE 993, AS DOCUMENT NUMBER 366834, AND EASEMENT IN VOLUME 567, PAGE 208, AS DOCUMENT NUMBER 345657, ST. CROIX COUNTY, WISCONSIN. maybe authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS AtSTANDARD F ORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED, WARRANTY DEED 2003 STATE BAR OF WISCONSIN Type name below signatures. FORM NO. 7-2003 File No.: 26222 Page 2 of 2 St. Croix County 1013475 Page 2 of 2 RECEIVED RECEIVED 11! A 1 1) JUL 14 ZO ib JUL 14 2015 5s ~ 4Saa $1 R4 ~~fessional Services ST. CRWk_C9O►AUATION REPORT ,omm IsTdf 6 ngs COMMUNITY DEVELOPMENT Page of in accordance with SPS 385, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. i D 79 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). C4H(4 VAAf7a t~ Z 7 Prope y Owner Property Location (~l~ t iC J Govt. Lot 114 1/4 S T N R E (or lVj' Property Owner'S- ailing Address Lot # Block Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑Village Town 'Nearest Road New Construction Use: Residential / Number of bedrooms Code derived design flow rate Li~L GPD ❑ Replacement Public or commercial - Describe: Parent material Flood Plain elevation if applicable ft. General comments and recommendations: -'j Boring Boring # 171 pit Ground surface elev. 9. Q { ft. Depth to limiting factor / in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 * ff#2 .s ~ ,_2 az ~a 7 3 I Set 3 7zzell' C _ (Wey{~.w~, Sam Boring # Boring ® Pit Ground surface elev. ft. Depth to limiting factor in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2 3 6 * E ent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L e = BOD 5 < 30 mg/L and TSS < 30 mg/L CST Na lease P' ) Signature CST Number Address Date Evaluation Conducted Telephone Number 17 SBD-8330 (RI 1/11) » ,R yw:ws:Yd+ rdMR wu -rod«u+,+ Property Owner Parcel ID # 7Yf/~ /,I Page of _ ❑ Boring Boring # ,3 ® Pit Ground surface elev. ft' Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots GPD/ft z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2 .5' L -fS - F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2 Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#l * ff#2 * Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD 5 < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBA-8330 (Rl1/I I) Property Owner 1.../ i dL h~j;~i, S Parcel ID # Page of Boring # F1 Boring F3-1 ® Pit Ground surface elev. ,55- ft. Depth to limiting factor /-5 in. -go-IF-Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -f#1 ff#2 ..7 1 i ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 * ff#2 Boring Boring # F-1 ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2 * Effluent #1 = BOD , > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD e < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBD-8330 (R11/11) RECEIVED JUL 14 2015 Wis. Dept. of Safety and Professional Services ST. CRggog_CP 7 LUATION REPORT Page of Division of Safety and Buildings COMMUNITY DEVELOPMENT in accordance with SPS 385, Wis. Adm. Code County Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must _ Zoe include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 7 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Prope Owner Property Location 1 Govt. Lot 1/4 / 1/4 S T N R E (or A 75Z Property Owner's ailing Address Lot # Block Subd. Name or CSM# City ir- State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road New Construction Use:® Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement Public or commercial - Describe: Parent material Flood Plain elevation if applicable ft. General comments and recommendations:3 Boring # Boring 10 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2 -5- le xr -7 /'y A 7 - / 3 =i4_1 4~1 7 C - s' Boring # Boring pit Ground surface elev. 97.,5 ft. Depth to limiting factor /:Z_ in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 ff#2 s / 7 T 7 O/Z * E ent #1 = BOD 5 > 30:<5 220 mg/L and TSS >30 < 150 mg/L e = BOD 5 <,30 mg/L and TSS < 30 mg/L CST Na lease P ' ) Signature CST Number Address Date Evaluation Conducted Telephone Number s . iz SBD-8330 (RI 1/11) A /Uo _i i lrQara,.£o muS,N: 9 ' i I j ji; u f ~ _ w 4 - 13 , S T. C R O I Y Land Use ~A Planning & Land Information Resource Management Community Development Department July 24th, 2015 DSPS, Attn: Carl Lippert 10541 N Ranch Rd Hayward, WI 54843 Re: Loomis Soil Test Field Verification Parcel 040-1078-10-200, Town of Troy, Lot 6 of CSM V. 12, Pg. 3271 Carl, I did an onsite verification of the soils on the lot referenced above, on 7/21/2015 with Kim O'Connell. I found his profile descriptions to be adequately described for use in designing a mound. There were a few notes I have made below, pertaining to the fine sand (described by soil tester as loamy fine sand) horizon. The high value and low chroma matrix that was described in boring #3 as horizon #3, is a fine sand that extremely dense with massive structure. In my opinion it is extremely weathered bedrock from a sandstone parent material devoid of any organic matter or clay content, which yielded the stark white 7.5YR 8/2. The upper 12"-20" of this fine sand (Ifs) horizon appears to have high chroma mottling that is not necessarily from seasonal saturation causing redoximorphic features. It is confined to root channels and/or is from being in a red pine plantation where the acidic organic matter had elluviated sesquoxides and tannins from horizons above this, while the pores/channels are the only place transmitting water downward effectively. There were also common 5-10 mm silica concretions/parts of the sandstone that hadn't weathered as much, and few 2-5 mm iron concretions that were most likely highly weathered rock that was high in iron content. The lack of structure and varying degrees of density in the fine sand horizon is not conducive to the treatment of wastewater and should be treated as a limiting factor, as it still exhibits some properties of the partially eroded sandstone parent material. If you have any questions, I can be reached at (715) 386-4742 (8:00 A.M. to 5:00 P.M. weekdays) or by email at Craig. DantoinC co saint-croix wi us Thanks, L/ At/ek~ Craig Dantoin Land Use Technician Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, W/ 54016 Fax 715.386.4686 www.sccwi.us/cdd www.facebook.com/stcroixcountywi cdd(cDco.saint-croix.wi us Wisconsin Department of Industry, SOIL k EYQ I T E E V A U AT I O N REPORT Page f of 3 Labor ar4 Human Relations ~ ` Divisionjof Safety & Buildings i~CCOr y1(ALHR 83.05)/,I wis. Adm. Code 71166 COUNTY Attach complete site plan on paper not les f 81 r*A 1 inches in size. ust include, but t X not limited to vertical and horizontal refers a intBM), dierio % e, scale or PARCEL LD. dimensioned, north arrow, and location an distance to rmreqtj9a Z~ / Z~ APPLICANT INFORMATION-PLEASE R~tNT Q~ 1 J ATIO~R WE G ~ DAT 7 ~6 PROP RTY OWNER:. j 1 - r \ ROPERTY LOCATION L "'A /~•--l,'V~ r I f GOVT. T IS - 1/4 SL,) 1/4,S /9j T N,R d E (or) W PRORERTY OWNER':S MAILIN ADDRESS L # LOCK # SUBBD. NAME OR CSM # a~3 ~l CITY, STATE ZIP CODE PHONE NUMBER ❑CI VILLAGE OWN NEAREST ROAD , ( ) `r- cr -4 , New Construction Use [ ] Residential / Number of bedrooms jj'N w ] Addition to existin building ~jv T Q ~ j J Replacement (J Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 _ trench, ft2 Maximum design loading rate 0,: bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) It (as referred to sit benchma ) a h k Additional design / site considerations - Ac &L Parent material Flood plain elevation, if applicable S = Suitable for system CONVENTI L t~O,UND IN-GROUND PRESSURE T-GRADE SYSTEM FILL HOLDING T K U=Unsuitable for s stem ❑ S U ICJ S❑ U El S U S❑ U ❑ S ~ U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends -1 n~ 5L, / /n r Z. 6.4 Ground $ 7 -4-7 S' /hr S `Z elev. _ Qz. z ft. Depth to IRA 27 5 y -3 A-7 limiting factor- 7.7 ff7i) Remarks: r 4 Boring # Z 1`2-36 Y~ S; C_ r CL Jl to.~ Q 7 ,S 3 rte-- S • r I'h I' S O, Ground elev. nzAST `d Rt~c IL 9b c a ft. Depth to limiting I tor C~t, 0~31 Remarks: a 36 CST Name:-Please Print t JQ Phone: S~& ~E n Address: l l / i ~~u d v Signature: c~ Date: 2-L1419:7 CST Number- q 4 PROPERTY OWNER SOIL DESCRIPTION REPORT Pape. Z of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground elev. ft. Depth to limiting factor Remarks: Boring # ~ 0-16 E-3 C}- IDyk, - 5C OsbK~~^ G;~c~ ©.2 €d.~ Ground elev. g J,4N~5iUn~t ~A~c-K ! . 9 g4 1L Depth to limiting f ctor , C+8 Remarks: Boring # A *ZS- d ^ ? J C~-24 iL~Y~3 S~- C~yhs~f< ,r w `I Ground Q~ r elev. (p 5At~,~, ft. Depth to limiting factor S•7S Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) PROPERTY OWNER SOIL DESCRIPTION HtF'OHT rage w PARCELL M , Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ranch 13 Ground elev. ft Depth to limiting factor Remarks: Boring # 0-16 /DYQ 4 A 'S 1, M 4 2 13 Ground` - - S 0 rti v ,S O.G elev. /JN>DSiGn~ g~A %Z A- ~ ft Depth to limiting Remarks: Boring # A o-z4 Ground elev. ft Depth 10 limiting factor 5,75 . Remarks: Boring # 131 Ground elev. ft Depth to limiting factor Remarks: SBD-8330(R.05/92) 1Q AG .J d 00 C} ~e! 1 6` 1 1 f 1/> cr r 1 / M cQ N • Parcel 040-1078-10-200 02/17/2006 05:11 PM PAGE 1 OF 1 Alt. Parcel 19.28.19.2991 040 - TOWN OF TROY Current X] ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner JEFFERY J & JILL K LOOMIS O - LOOMIS, JEFFERY J & JILL K 422 S FORK DR HUDSON WI 54016 ' = Primary Districts: SC = School SP = Special rr. Type Dist # Description SC 4893 SCH D OF RIVER FALL S SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 3.000 Plat: 3271-CSM 12/3271 SEC 19 T28N R19W PT SE SW & NE SW BEING Block/Condo Bldg: LOT 6 LOT 6 CSM 12/3271 869/296&304 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 19-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 06/17/2003 726159 2278/249 WD 07/20/2000 626735 1528/115 WD 869/296 2005 SUMMARY Bill M Fair Market Value: Assessed with: 102640 166,200 Valuations: Last Changed: 07/20/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 160,000 0 160,000 NO Totals for 2005: General Property 3.000 160,000 0 160,000 Woodland 0.000 0 0 Totals for 2004: General Property 3.000 160,000 0 160,000 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 Parcel 040-1078-10-200 10/30/2008 04:52 PM PAGE 1 OF 1 Alt. Parcel 19.28.19.2991 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner JEFFREY J & JILL K LOOMIS O - LOOMIS, JEFFREY J & JILL K 422 S FORK DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 224 CTY RD F SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 3.000 Plat: 3271-CSM 12-3271 SEC 19 T28N R19W PT SE SW & NE SW BEING Block/Condo Bldg: LOT 6 LOT 6 CSM 12/3271 869/296&304 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 19-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 06/17/2003 726159 2278/249 WD 07/20/2000 626735 1528/115 WD 869/296 2008 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/28/2007 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 90,000 0 90,000 NO Totals for 2008: General Property 3.000 90,000 0 90,000 Woodland 0.000 0 0 Totals for 2007: General Property 3.000 90,000 0 90,000 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