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)n% , in Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix oafety and Building Division INSPECTION REPORT Sanitary Permit No: ' 420343 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal inforn ation 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: Wilcox, Donald & June 9999((((���� Pleasant Valle Township 024 - 1000 -30 -000 CST BM Elev: Insp. BM Elev: TBM Descrip: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic W /� Benchmark 102. l y 6 Dosing /011' t7a Alt. BM Aeration Bldg. Sewer Holding 97t Inlet . 2 jq. 2i St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic - � , Dt ottom Dosing Header /Man. 8- Y Aeration Dist. Pipe Holding Bot. System �- ( � Q f PUMP /SIPHON INFORMATION Final Grade w v Manufacturer J ^ ^ Demand S Cov er - / - (./ GPM Model Number TDH Lift Friction Loss System Head TDH Ft /3. �. -/s 110 S 1 2 2.75 ForcemaLa4.jLeny ia. 2 y Dist. to Well / 0 SOIL ABSOR SYSTEM _. _t' f{c,� j ; L _c ma c_. _. ! BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS _., SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of System: , CHAMBER OR �o "_ h rJ UNIT Model Number: DISTRIBUTION SYSTEM _ / 'V- Header/Manifold Distribution x Hole Size x Hole Spacing e'n`t to Air Inta & �` k Length ipe(s) � y 2 g a ength o�� Di Spacin T> SOIL COVE .. -- x Pressure Sy Only xx Mound Or At -Grade Systems Only Depth Over , Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges j Topsoil Yes j] No L Yes j No COMMENTS: N eb,�p z. (Include code "� discreperlcies, persons present, etc.) Inspection #1: /�� / Inspection #2: 1-24 // '0,3 Location: 1769 60th Avenue Hammond, WI 54015 (NW 1/4 NE 1/4 4 T28N R17W) NA Lot �k Parcel 7,28, 1.) Alt BM Description = � � 2.) Bldg sewer length - amount of cover = 3 1 3.) Contour revis Plan Req Use otherside foradditional nformati 1\ ��� C3 J - - ___ _J •I SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No.-- J 1 -VV . 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U l U 1 � .. 7 � t•T[ %S=2 AiNf1O0 XI0�1O ' C 11 — 0 �6 a9 , wnoap!tgnd n 9 smaotpati 7° 1xlmnv _ I. - 39ep �Dr-b -T o adS 'IT i - — (,ildde rceir Ifs V 9?) �° Hrn i - — M N -- - obi a� �3�3ZI (r 1 S l� C� Tz[umt; iV�. -.? aute[y ane!pgn$ �lelg'dTlJ ar['°oN uu Ogd 49 0 ssuppY augwW s.3'u Cuadoad -- _ - -- L° Q % >tiro[k s.jalmo �adwct C � N t� - u cca w uottta. y "I ! -- - d I • ywrn� y ncNPIM fir' rid assald - L'' ,4, - ![,[ a t ustTt map �a n op e°td tlod �/ rl uoumgddy ITU 1S � a:�►�, ad iic s� —.. � - aa�ai�i�to� a � u weaeQ s=ppv s 1 Z911. - L06ES IM 'ww" '. f Z9IL we d T ^V uoi8 itl2 J , ✓ 1 } O �� �� � �e�Te +QTR a?3tfn)IIAQ Ma..• •mow + —.� —+ _ _ t t E � \ E $ } / z 0 ~ E CD m ) . / / /}^ ƒ z \ » \ 7 2 / / @ \ k @ ° 2 ° \ « z \ § i o 2 u ° k? I / $ \ 21 2 CL ®m a ± < E 2U R 3 \ D /� o @® « ® E \ #% 2 o k k m / 7 \ ƒ \ E E i C \ / ) t r- a- CO u ( f § \ / J { \ \ ) § » ® = 2 2 @ }§ § & » 0 / < z 7 = a Q -� / 5 / c 2 2 0 a / § ƒ k Q ¢± j O �§ \k �f & =w 2 z q@ o= oI o - o� :3 ] I & k E ] m E $ ) g § E / § E \ �f 2 I (A m 22 7 E §: $ k �� CO) 7 k /�k )� k « � §2� _ m© §\ p 7 / 0 \) / E / / \} (D J a } f E ° / k\ [ ƒ§ \ °\ \ 4) )' m 3/ 7 I I z ) 0- z $ \ a E t '3T:f . �d !- 1:1!1 • WA:%:Z1 *#r# Dito 345PAcf259 i� 75 1na l • 'i`hii I3eed..ai.. >,.t -r,.a ..Lillian- Wilcox, ra............ �'�. ON R�.�d 0A.. 20th ant •zriod .tfCea.n .... ................................................................. ............................... day of = OC! ' ./(.0.1 "b ............................................................... ............................... Gran'ar, ..sad..xifa ... aa1. joint - -ter. ants, ................. ................. .............. ................ _.....-•-• .................................................. ............................... ....... ... ... ..._ ........... .. . ................................... ............................... uraatae, . Witnesseth. That the said t: rantar, for a rsluable consideration.... -. . # == .... ..........................Good. and. . .Valuabla..Conuideration...... z save a. n - ' a" to Grvtr the toilewtng dnee -ibsd reel state Is ....... Ot.....CrQi.x..... � TroR+yEY County. Stag at Wisconsin: J �rlLM6% W" of 1P% at Section 4- 28 -17, subject to ease - stents, right -of-way s and Privileges of record. Tas Pwmi No :.....-- •- •-- .---- •.•-- ._.._.. _. The Grantor is retaining a life estate interest in the residence, the garage and the garden area with the right of ingress and egress to the same. b This ....... is .............. bemestead property. (is) (is not) Together with all and singular the haredittuaents and aopurtenances thereunto belon;tng; And... the ... Grantor ......................... ......_ ._ warran4 Chet the title is good.:sdefauible in !se simple and tree and clear of encumbrances except and will warrant and defend the same. Dated this ............ ..................�..�......... day of . ......... . - ---...._... 00 .tObV..I.......... . .............. 19.86 .. a-6 c_ `�... �1 ..............(SEAL) .............. ............................... ......................(SEAL) • .. Lillian. . Wilcox .............................. • .............. r ................. ............................... ...................(SEAL) ..... . ..... ........ ......... ............................ ..._.... (SEAL) s AUTSIfNTICATION ACHNOWLSDOIISNT Slpature(s) ..Q f.._ LAI 114M..IftICQx ................ STATE OF WISCONSIN __ - - - -- _ _- •-- --- _-- ^-------- _ ................... County. j a& as �.. day ay._..nCtL71.... I!_$6 Personally came before me this ................day of ._..... . ... . .............................1 19.. the above named ................ .••---..........--•--•-•-•----. ............................... ... . ........................................... .............._._._ ............. TITLEXEKBES STATE BAS 01 WISCONSIN 1104. —•• --- ......... ........................................ 1111tborlsad by f 70g 06. Wis. StataJ to tae known to be the person ............ who executed the foregoing instrument and rdlnow%dge the same. 7lI14 INSTnVM[aK WAS DIrAR[O fr I ............................. ............................... ............. . ...... JQhn...G1a._ -lies t inge n.._..At ty. ................ ................ Nota Public ..._............ . ......... ....County. Wis. I s (Signatures may be - uthenticated or sAnowledged. Both My Commission is permanent. (If not, state expiration are not necessary.) date: .. _ ..................... 19...... .) •Nse+d Of aeeow 019-1-6 10 a.r -PMiy .\arid +e UP.d •r Print.d bd... t►rir a,natares. 'h Kc�»�+• +® STar roam .r tw Ise stx -- Stock No. 13001 `t ' ?7a.,$ 9►_:. _, "s�1�:4•, -. ,.. .. ir:,tsrs._.. ° }_ :.e .". = ,�_u� "' .:,,.z Safety and Buildings Division County p 1q.6 rt 1 , .; 201 W. Wasla'gton Ave., P.O. Box 7162 Viscoh Madison, WI 53707 - 7162 `• Site Address Department of Commerce 0 Q`� -AV�ET Sanitary Permi Application sanitary Permit Number( n In accord with Comm 83.21, Wis. Adm. Code, personal information you provide / 3 13 may be used for secondary purposes Law. siS. 1 m ❑Check if Revision 0V I. Application Information - Please Print All Information State Plan I.D. Number s &� &3 Owner's Namp h Parcel Number �0 02 'two - - roperty Owners Mailing Address &J, rty Location l 1 `^- UQD ST. C '� f !4; S T N. 2 City. Star Zip Code L PhOW OA09FFIC E N Block Numbe Subdivision Name CSM Number 14 U. Type of Building (ch \rof y) _ ❑City I or 2 Family Dwelling ms ❑Village ❑ Public/Comm ercial - De *]Township F ❑ State Owned /ndUAC 9�� 5 U Nearest Road M. Type of Permit: (Check only one b n line A (numbedn eme for internal use). Complete line B if applicable) `�' 1 New 2 Replacement System Replacement 6 ❑Addition to For County use stem T Onl Eris ' S sum B. eck if Sanitary Permit Previously Issued t N r Date Issu IL IV. Type of Permit: (Check all that apply) YeTreatment eme is for internal-use) 44 1) Non - Pressurized In- Ground 2) M 47 11 Sand Filter 50 ❑ Co edam 22 11 Pressurized In- Ground 41 ❑ 48 11 Single Pass 5111 45 El At-Grade 46 ❑ A Unit ❑ Recirculating 30 ❑ r V. Dispersal/Treatment Area Information: AF Design Flow (gpd) Dispersal Area D' rsal Area Soil Appli . n a An Rate System Elevation mat Grade Required sea Rate(Gals /) Sq.FQ- /Inch) levation N O 7D VI. Tank Info Capacity in F. Total Number acture r,(I/ a Steel Fiber Plastic Gallons Gallons of Tanks • Cone Co tructed Glass New EASfj Tanks Taniff l/v �7 UV Septic or Holding Tank Dosing Chamber ^ , VII. Responsibility Statem - I, the ed, nsib the POWTS shown on the attached plans. Plum is Name (rriit P r' i MP RS r Business Phone Number Plutnb'r's Address (Stree ity, tat', Code �Td,�o un /De artment Use Onl Approved 1 ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Is nt Signature (No Stamps) Surcharge Fee) Q ❑ Owner Given Initial Adverse . � Determination IX. Conditions of Approval/Reasons for Disapproval 3 `7� Attach o�plde phm (to the only) for the xyslWm oa papa not lea than EUS s u Inches In dze SBD -6398 (R. 05101) I XX Y Y y �k q. l k*4 ,k .o- - - -- 3 7 Scale 1"= LIZ Page of ►.����- L.tN� of o- AS M)" � C _r !A yj � �s0 zoo �n 176q (�0 IN+ que> . of 5 a" e Gr2UVy✓p 1+.� P� OY'J `tvP OF Z k PVC F•I,, B•3 i �o ►voT COMpA -e�-- I I (I O Q T-) 1Sly V I 1 1 01 a t—r T T'lS m R � Dill I 0 0 I 'Il Z� + 89 9µ 2 . 1 Ifiz- Et • Q - 3 M of 1 b,-LL � t. , 4 3.5 ' NOTES: 1. Elevations shown are existing ground elevate otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required). 3. Septic tank to be IZ J6S0 gallon capacity manufactured by 4. Bench mark _ SL ABU V E 5. Divert surface water around system to prevent ponding at the uphill side. Safety and Buildings 401 PILOT CT STE C WAUKESHA WI 53188 -2439 TDD #: (608) 264 -8777 ,sconsn www.commerce.state.wi.us/sb Department of Commerce www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary July 11, 2002 CUST ID No.267341 A7TN. POWTS Inspector ARTHUR L WEGERER ZONING OFFICE WEGERER SOIL TESTING & DESIGN SERVICE ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 JJll CONDITIONAL APPROVAL 37 � PLAN APPROVAL EXPIRES: 07/11/2004 Identification Numbers Transaction ID No. 768143 SITE: Site ID No. 647899 Donald Wilcox Please refer to both identification numbers, 1769 60TH Ave I above, in all correspondence with the agency. Town of Pleasant Valley St Croix County NW1 /4, NE1 /4, S4, T2N, R17W FOR: Object Type: POWT System Regulated Object ID No.: 861547 Description: 450 gpd design wastewater flow mound system. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Waste Treatment Systems" SBD- 10691-P (N 01/01) and the 'Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10706 -P (N 01 /01). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. � • Maintenance information must be given to the owner of the tank explaining that8er 4 Ater is required. Access to the filter for cleaning must be provided per Comm 8 rodud 4va a '" y� • A Sanitary Permit must be obtained from the county where this project is log in accb`> ipitth the requirements of Sec. 145.135 and 145.19, Wis. Stats. F O • Inspection of the private sewage system installation is required. Arrangements for ins on shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits ARTHUR L WEGERER Page 2 7/11/02 required by the state or the local municipality shall be obtained prior to commencement of construction /installation/bperation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101. 12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sin erely, Fee Required $ 175.00 ` Fee Received $ 175.00 I ^ ^_ Balance Due $ 0.00 Thomas J Perkins POWTS Plan Reviewer , Integrated Services WiSkRMT coder 7633 (262)521-5064, 7:30 -4:00 tperkins@commerce.state.wi.us cc: Leroy G Jansky , Wastewater Specialist, (715) 726 -2544 � I TITLE SHEET Page of 7 1r0UND SYSTEM FOR A 3 BEDROOM RESIDENCE This plan has been prepared in accordance with the Mound Component Manual SBD -1057 P and the Pressure Distribution Manual SBD- 10573 -P C 2. b/ qq� C ta. (z L 4 4� LOCATED IN THE NW 1/4 OF THE N�_r 1/4 OF SECTION y , T 2.8 N, R 17 W TOWN OF pL SF T VP<LL ST• 0 - . t4 LK COUNTY, WISCONSIN. INDEX PAGE 1 of 7 TITLE SHEET PAGE 2 Of 7 SYSTEM MANAGEMENT PLAN PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 PLAN VIEW -CROSS SECTION PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT PAGE 6 of 7 PUMPING CHAMBER CROSS SECTION PAGE 7 of 7 PUMP PERFORMANCE CURVE PREPARED FOR ST•nPN 5S117 PREPARED BY ' WEGEF�ER SOIL - TEST I htG AbW . DES Z CC;V S1 2 CE P.O. Box 74 421 N. %Bain St. e � River Falls, WI 54022 Phone 715- 425- 0165���s/ Fax 715 - 425 - 6864 AR � . WC 6!lF�EN TH, v JOB NO. 0� -163 Mound System Management Plan p Z of 7 Pursuant to Comm 83.54, Wis. Adm. Code Septic Tank ��016 3 �� The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. 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 113 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, Safety and Buildings Division. 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. Mom nd 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 for frost rotecti n p o. Influent quality into the mound system may not exceed 220 mg /L BODS, 150 mg/L TSS, and 30 mg /L FOG. 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 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manual [SBD- 10572 -P (R. 6199)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or 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. Ccntinaencv 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 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, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions about the operation or maintenance of this system should be directed to: The County Zoning Office at B LS -3$b- L16?J S T. C tzolx The system installer at lS _ y _ �q,S LuP, -►J The tank manufacturer at X00 -3Z S — $ S b LAJLE�S Q�R The effluent filter manufacturer at �Z _ZZ(_ S_2 - Z t E-7- The pump manufacturer at " fj3� _ 8 Z� , LE� C�� G0U PLOT PLAN Scale 1 "= 'Page 3 of 7 ti1�r L1N� of - - ' �1�1 'A-e�� ��e� • o- 3S � i 'tv C� 7`� \SO 200 ' D x � �STti►� 6 ©F A. G Q 6 NFYt �u ►°�uV� -- � Gr2.UVUD 1►.► p.p _. IOV,Q ' `NP OF .\84D1 -1�� .. PV 0- B•3 _ �� ►JOT Cp -e�' � � �� - o tZ ,) I.S'ru j D-�3 i fOi ► si OF 2 -� L , 4 3.5 NOTES: 1. Elevations shown are existing ground elevate otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required) . 3. Septic tank to be k uio /6Go gallon capacity manufactured by \Av I ZQ_ �_z COQ eyZ 1 - i IR — I8o o 4. Bench mark - S�� Pr13UVF 5. Divert surface water around system to prevent ponding at the uphill side. _ Page Of _7 Approved Synthetic Covering ASTH C33 Distribution Pipe Medium Sand Topsoil �__ = -'""' �' Ia F E e r. q 3. 5 .—� p . 3 E s . - � u S - % Slope Distribution Cell of Force Main Plowed z" to 2- Aggregate From Pump Layer D D- 5 Ft:.' E \ -2.Z Ft. CROSS SECTION OF A MOUND SYSTEM F 0_g Ft. G o -S Ft. A Lr t t' U Ft. Linear Loading Rate= °�. b GPD /LN FT B . Desig n Loading Rate =O .q, - 7 GPD /SQ FT j 1 Ft. J S Ft. K `a Ft. n L 6 Ft. W Ft. -Observation Pipe $ K Ao- -�-- -- 8 - - -- -- - - - - -- -------- - - - - -- --- - -- - yy 6 -- - - - - -- - - - -- -- - - - - -- -�--o Force Main SQ, PoS CT'E Distribution 1 �• Pipe L� Cell of z „ to 2 2 aggregate Observation Pipe • PLAN VIEW OF A MOUND SYSTEM - Distribution Pipe Layout Page S of Place the holes at the bottom of the distribution pipes at equal spacing. Remove all burrs from the pipe and 'holes. Extend the end of each lateral up with the use of long turn or 45 fitting to a point within six inches of the final grade. Terminate the ends of the laterals with a valve, :threaded cap or . threaded plug. Provide access from final grade for the valve, threaded cap or threaded plug PV C N n Lateral M niibId Pv C Lateral X x x x x12 x,2 x x x x Lateral Length — Lateral Length - Oistributian Line ftCC s;0}S — —o r1 Ys1.11 Fc� � S t o —_ P �_ Ft. Hole Diameter ��8 Inch S 3 Ft, Lateral ) Inches) • X = Inches Manifold Z• Inches Force Main " Inches # of holes /pipe 1.3 Invert Elevation of Laterals 4.00 Ft. V V3 x 0. y [ = 5,33 sc 6 = 3 l . qa 6pi,', - Combination Sep4c; and PLi-AP CHAMBER CROSS SECTIOM AND SPECIFICATIONS ' PAGE OF NEWT CAP � WEATHER PROOF JUIJCTIOIJ box . `S'C.T. VEIJT PIPE .APPROVED LOCKINIG 1 10' FROM OOOR. MAIJHOLE COVER PJ IV :huoow OR FRESH 1 wP+RNIIJG Ll�6EL, IN 3P �G1oU PIP w ZfTQ ` E R IIJTAKE cot.,twlr t Fl IN Ise{© Gx_,,VoE I ---- - - - - -- IB'MrN1. ---- - - - - -- IMLET PROVIDE I - -- — ••'' AIRTIGHT SEAL I i I Approved z�- �� ` I ( I I Approved joint w/ R_�aeo I I I joint w/ I PVC pipe I ALARM PVC pipe s 'I II I I C I Z8.9 ( I CLEY. F7 __� PUMP � OFF 0 - C. 0wJ RETE 8, 0 0 BLOCK RISER EXIT PERMITTED OIJLtJ IF TAWK MAIJUFACTUR£IZ HAgS SUCH APPROVAL 3 "ADPQowEp ��S?D t>v4 SEPTIC F 5PECIFICATIC)MS DOSE TAWKS MAIIJUFACTUR£ I�IUMgER OF DOSES: PEEL DAy TAMK 51Zr- 1\�00 Aso GALLOAIS DOSE VOLUME r ALAR#% I kAMUFACTUFLER: _S E' 0 S�'LS1L'IS INCLUDIN 6ACKFLOW: l��` 6A LLOIIS AOD1`L IJUMBER: 1Cpl "t,'J CAPACITIES A= �8 306 - lUCHCS OR A L G L 0 us SWITCH TtIPC; k4 $ = Z 11ICH£5'OR G�LL0415 PUMP P'IAMUFACTUREAU 6 U UL 'ZS C _ -7 IUCHES OR 11 q GALLOWS MODEL NUMBER: � O S' D= 1 I IAICH I $ GALLOIJS SWITCH TYPE: F`'1 efLaoZ - y 1JOTE: PUMP AUD ALA ARE TO �t MINIMUM DISCHARGE RATE 3 �'ga GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWEECI. PUMP OFF A DISTRIBUTIOW PtPE.. laL FEET + MIWIMUM METWORK SUPPLY PRESSURE , ... 6 SD FEET (S.OkI,1� 'F• 135 FEET OF FORCE MAINZ X z')9 F j Z -Ol6 I00 FEFRICTIOLI FACTOR.. FEET TOTAL 0y)JAMIC HEAD = Z __ S FEET As per manufacturer 1 gal /in. Liquid depth 3� " Goulds -P of Submersible Effluent Pump 3871 EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. dry without damage to heat transfer. ■ Motor Cover. Thermo las- • Homes I e sstms components. Available for automatic and tic cover with integral handle • Farms Motor: manual operation. Automatic and float switch attachment • Heavy duty sump • EPO4 Single phase: 0.4 HP, models include Mechanical points. • Water transfer 115 or 230 V, 60 Hz, 1550 Float Switch assembled and ■ Power Cable: Severe duty • Dewatering RPM, built in overload with preset at the factory. rated oil and water resistant. automatic reset. ■ Bearings: Upper and lower SPECIFICATIONS • EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing Pump: EPO4 built in overload with construction. ■ EPO4 Impeller: Thermo- • Solids handling capability: automatic reset. plastic Semi -open design AGENCY LISTING /a maximum. • Power cord: 10 foot with pump out vanes for • Capacities: up to 55 GPM, standard length, 16/3 SJTO mechanical seal protection. (Co- Canadian Standards Association • Total heads: up to 24 feet. with three prong grounding _ • Discharge size: 1 1 /2' NPT. plug. Optional 20 foot ■ EP05 Impeller: Thermo- (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in T' or "AC ".) rotary/ceramic - stationary, three prong grounding plug improved performance. BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 • Capable of running dry without damage to 9- 30 ! • I components. I I —'SCAM Pump: EP05 6 EE • Solids handling capability: °a 7 25 Ziy Sy' i /a "maximum. • Capacities: up to 60 GPM. _ U 6 20 • Total heads: up to 31 feet. I • Discharge size: 116' NPT. I — -- -- z 5 • Mechanical seal: carbon- c 15 rotary/ceramic - stationary, i i BUNA -N elastomers. 4 — EP09'- • Temperature: ° 3 10 ' 104 -F (40 °C) continuous j 140 °F (60 °C) intermittent. 2° 1 5 I 0 00 10 20 30 •40 50 GPM L L L 0 2 4 6 8 10 12 malh CAPACITY ®1995 Goulds Pumps, Inc. Effective May, 1995 83871 Wisconsin Department of commerce SOIL EVALUATION REPORT Page i of 3 Divsion of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code & *-N" y Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. — vO 3p — a O o Please print all information. ���d �S Sal Date Personal information you provide may be used for secondary purposes (Pri cy taw, s. 15.04 (1) (m)). Property Owner Property Location `� O N PCB -C� A ivy j U Y'J k, W 1/4 N� 1/4 S LI T Z N R 1 E (o W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# yol k- S — City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road S i P PSV L r-it SS 1 l� (LE 0 Ml �- f� fi V PrLL 6 New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate U S O GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material \.— ns p V k t 'n LL Flood Plain elevation if applicable til General comments RECEI and recommendations: MzuK3� W / r`j'� Sp � �lST\Z113V`RO►J � � L, �-%) ti ImQi , 6 " of s PtLL, JUL 1 7 2002 !! Cc�11Uv(Z �t�V . Q. 3.0 ❑ Boring # ❑ Boring S ZONING OFFICE ® Pit Ground surface elev. q S- Z ft. Depth to limiting factor 3 Z in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 o - l0�rZ3 ti S 1 Z4s S Z I ZIT s 32- -q 6 �S`22�1 `F1rQ 1.S `2Q 3L3 g S� YnTr _ - Z 3 I a Boring # ❑ Boring ® pit Ground surface elev. ft. Depth to limiting factor =` 1 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 4 1�`l'� 3 L — sal Zl t - !S w� v ew z � , s • �, S l 1 Z'FSbk y�`Fh Cw 1 i3 - I.SLi rz / �L - ).S`ZL 313 s I 1,'s biz m4 _ - Z - 3 k Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS _< 30 mg/L CST Name (Please Print) Sig ature CST Number Arthur L. Wegerer 0Z� ) 6 3 220254 Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. 1 St. River r'alls, WI 54022 - 7 3 -0Z 715 -425 -0165 r l Property Owner �L�- -� x Parcel ID # U —1 00 �3� — (� (�� Page Z of Boring # I❑ Boring ICt pit Ground surface elev. q ft. Depth to limiting factor 3 3 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I •Eff#2 z s i i -L f T 1 0 V Z to —Z a oyrz...�16 -- s � z� sbh �l`f �- e� 1-F . s � g 33 -4 0 IS`M V Z 3 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 Consistence Boundary Roots GPD /ftz In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 a Boring # ❑ pit Boring ❑ Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 • Effluent #1 = BOD, > 30 < 220 mg /L and TSS >30 < 150 mg /L • Effluent #2 = 13013,, 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. SB"330 (R.6/00) PLOT PLAN Page 3 of 3 Scale 1' = y 0' j ►�z L��,� o� p_ 3S m lS pTO C 17 6q (, Tti+ e �d -- G r�vt✓� l►� PP S•3 Zv i q� f �o ►JOT Ca � �I O L2. I T � f � -• d Z � 89 L Lam, 43.5 1 -3-A.Z 715 - 425 -0165 220254 OZ -16 CST i Date Telephone Ilo. CST T1o. Job I'10. Safety and Buildings ' 401 PILOT CT STE C WAUKESHA WI 53188 -2439 TDD #: (608) 264 -8777 isconsin w ww.comm www.wisconsin.gov www.wiscon isconsin.gov n.gov Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Secretary July 11, 2002 � CUST ID No.267341 7 ATTN. POWTS Inspector ARTHUR L WEGERER ti ZONING OFFICE WEGERER SOIL TESTING & DESIG SE RVICE ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/11/2004 Identification Numbers Transaction I N ion Nu SITE: Site ID No. 647899 Donald Wilcox Please refer to both identification numbers, 1769 60TH Ave above, in all correspondence with the agency. Town of Pleasant Valley St Croix County NW 1/4, NE 1/4, S4, T2N, R17W FOR: Object Type: POWT System Regulated Object ID No.: 861547 Description: 450 gpd design wastewater flow mound system. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Waste Treatment Systems" SBD- 10691-P (N 01/01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10706 -P (N 01/01). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. I • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits ` F ARTHUR L WEGERER Page 2 7/11/02 required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sin erely, Fee Required $ 175.00 \ Fee Received $ 175.00 l Balance Due $ 0.00 Thomas J Perkins POWTS Plan Reviewer, Integrated Services WiSNIART r=ode: 7633 (262)521-5064, 7:30 -4:00 tperkins@commerce.state.wi.us cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544 Safety and Buildings 401 PILOT CT STE C ' WAUKESHA WI 53188 -2439 TDD #: (608) 264 -8777 isconsin E C .e.. { ,: www.commerce.state.wi.us /sb g www.wisconsin.gov Department of Commerce p „F J L 1 1 2002 Scott McCallum, Governor Philip dw. Albert Secretary rY r <, o u ZU ic July 11, 2002 CUST ID No.267341 ATTN: POWTS Inspector ARTHUR L WEGERER ZONING OFFICE WEGERER SOIL TESTING & DESIGN ST CROIX COUNTY SPIA SERVICE PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/1112004 Identification Numbers! Transaction ID No. 768143 SITE: Site ID No. 647899 Donald Wilcox Please refer to both identification 1769 60TH Ave numbers, above, in all Town of Pleasant Valley correspondence with the agency. St Croix County NW1 /4, NE1 /4, S4, T2N, R17W FOR: Object Type: POWT System Regulated Object ID No.: 861547 Description: 450 gpd design wastewater flow mound system. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01 (110), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Waste Treatment Systems" SBD- 10691 -P (N 01/01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10706 -P (N 01/01). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. `ARTHUR L WEGERER Page 2 7/11/02 • Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation /operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Thomas J Perkins POWTS Plan Reviewer, Integrated Services (262)521-5064, 7:30 -4:00 WiSMART code: 7633 tperkins @commerce.state.wi.us cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544 ST CROIX COUNTY SEPTIC TANK MAINTBNANCe AGRjBBMBNT AND OWNMI{IP CERTIFICATION FORM 6;er 3uycr �( • l a Mailing Address C Property Address (Veri &cation mqu;md rcnm rWaing Depsrtareat for new com�cctioa) c� / S % �' o�_U S e R to p lac city/state �hco CI /t , ParW Ideuti&catiou Number j- Y-1P00- 30- LWAL A SCttik''MON Property Location ;, � �, Soc. . g Na W Town o!d Sdbdivisioa Lot mod SurM Map # Vo1mmc Page # Wunu�r hood # aP;a Volume p ,� p a g e '# 5' SPC.hm= I3 yes 19 no Lot fim WrfiftIe 0 no cma�e pmmpm ofAresss aifirxdodbyst: . .�g�e;atLa�sta�7�beas. .. llrt F- PcdrQwaa ag�axs to mbatat to SL f ix &.i �Q P oba �' .std by &*4u=aodby: Isinpwperop ¢ "(t�6eoaaaee�ea�c -- —. seem P.0 �.���ctadciskss$nait3�'adlof. . 8'ft�� �' �paadco�cofaad meDcp� „aee�cof�g,stateofwisooear�a_ meat ayst6e snclrcacmoato me hwUm oft5e St{4nnc fS+ce wi�m 30 q*m ' da#c,. �Y� O SIGNA MofAPPEEcANt DATE � (RRTFRrd- r�rnrr ( ) OOarty Qnpt ste is oa this form aw tine to &c best of my (era) bwwkdgc. I (wc am (are) the ownm( of Y by vkf ue of a wamt deed rmondod is Re&er of Doody ofike.. cruTV of g� _ DATE s « «««« Ar(y idoamalion that is mis {gm�maY ftwk im do unitw pea nk being mtiwokod by the Uning Depa� ««.••• s« Wudc with ddt ap UM(low a umupod waa ggy deed troam the a of the ' of Doody otI'ioc caPY mtifrod smvcY map if ndcmwe is =do in the warranty dood