HomeMy WebLinkAbout024-1019-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Pivision
INSPECTION REPORT Sanitary Permit No:
399422
GENERAL INFORMATION (ATTACH TO PERMIT) �Ra Plan ID N
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. to r. b
Permit Holder's Name: City Village X Township Parcel Tax No:
Jorgensen, Kurt I Pleasant Valley Township 024- 1019 -20 -000
CST BM Elev: Insp. BM Elev: BM ascription:
/ ( r
p ® �t70 C P� /r
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic - Benchmark
MOO k Z� 5 �6 r D 6
Dosing � Alt. BM
ration Bldg. Sewer 1
13.90 3 lD
Holding Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic r • Dt Bofto �
Dosing N t � t� _ , Header /Man. r
Aeration Dist. Pipe 5 Za
mg Bot. System
/ Ot- I'D
Final Grade
PUMP /SIPHON INFORMATION S AS
Manufacturer Demand St Cover
GPM
Q
t,
C,�� S((
Model Number . v
"Q`
TDH Lift Friction Loss System Head ITDH Ft
rcemain Length Dia. Dist. to Well
V Z u
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length I No. Of Trer►e4wc PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 1 (0 5
SETBACK SYSTEM TO P/L BLDG IWELL LAKE/STREAM LEAC M cturer:
INFORMATION CHAMBER O
Type Of System: UNIT Model Number.
DISTRIBUTION SYSTEM
Header /Manifol Distribution � x Hole Size r r x Hole Spacing Vent to Air Intake
2 11 Pipe() ,) IO 2 / to
Length Dia L Dia Spacing 7 /r
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded r Mulched
Bed/Trench Center Bed/Trench Edges Topsoil Yes No ❑ Yes No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: v /$ /0_� Inspection #2: / ' 1 I
S ,a I No: 28. 7.10
Location: 331 170th Street Hammon WI 54015 (NW 1l4 SW 1/416 T28N R17� Nd L6A (� Parcel
1.) Alt BM Description = 4 br �� °� tnn� 1 � ^^� W `y � wf ��- { � C�e1T�
2.) Bldg sewer length
- amount of cover =
3.) Contour= 5 /,9 S .� – 00, Q
�t�.
an revision Required? Fal Yes No
Use other side for additional information. ��- �; SBD -6710 (R.3197) Date Insepctor's Signature Cart. No.
p
75�.37 , A4'�
Safety and Buildings Division Coun
201 W. Washington Ave., P.O. Box 7162 r /
1 seonsin Madison, WI 53707 - 7162 Si Address
Department of Commerce 3'3 dTr
Sanitary Permit Applicati II Sanitary Permit �N�umber
In accord with Comm 83.21, Wis. Adm. Code, personal info n v �de. 39 l ZZ
❑ Check if Revision
may be used for secondary purposes Privacy Law, m
I. Application Information - Please Print All Information �EIv�O l State Plan I.D. Number
Property Owner's ame Parcel Number `( -, ,
SEP 1 7 2001 0z q— loll -2n - ow
Property Owner's Mailing Address ST�y / Property Location J /_ /
C oN1NG
City, State r Zip Code Number Lot Number Block Numbe
L 9 Subdivision Name CSM Number
II. Type of Building (check all that apply) fow 4"' vv% []city
1 or 2 Family Dwelling - Number of Bedrooms `� {t.saarr.Q_ tlttmwl . []village
❑ Public /Commercial - scribe Use AT ownship
L
❑ State Owned °� . � Nearest Road{
X1- 1 tt�rt _ 1.0 i(a
III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable)
A. 1 XNew 2 ❑ Replacement System 3 ❑ Replacement of 6 11 Addition to For County use
System Tank Only Exis ' System
B. ❑ Check if Sanitary Permit Previously Issued permit Number Date Issued
IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) -k %If C�O -
44 ❑ Non - Pressurized In- Ground 24 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland
22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line
45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other
V. D' ersaI Treatment Area Information:
Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade
Required Proposed Rate(Gals. t.) (Min./Inch) Elevation
•
VI. Tank Info C m
Ca ci Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanks Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank � �) r
Dosing Chamber ����
VII. Responsibility Statement- I, the undersigned, assume responsibility for ' tion of the POWTS shown on the attached plans.
Pl ber's Nam (Print) Plumbe s igna RS Number Business Phone Number
Plumber's Address (Street, City, State, Zip _
VIII. Count apartment Use Onl
Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued su Agent Signature (No Stamps)
Surcharge Fee)
❑ Owner Given Initial Adverse O/
Determination J�-J
1X. Conditions of Approval/Reasons for Disapproval
O't�.6lsYta( �� 1tNuf�tl�7C0Jrnn S4,�G'�b� -N � o,�IP/ ✓tCe"`•r.
Attach complete plans (to the County only) for the system on paper not less than 81/2 x res in she
SBD -6398 (R. OS /Ol)
PLOT PLAN
,Scale Page 3 of 7
� � - 3 ha 1 � TO I '`
P�
4
S U Ga EFSTIM w�C
X
J / __ - - --
� i �i� �•1 q t0`oF LA
AZ
V /
i
Do nor eomorlr�*r OR-
- c�`� 1�tS'iWzg `�l{ -fig Pf►Z�A
0
V/ � too. pmi 12'' L6L� I/ "
1 - V . 98 L ati7 of 80Ut_p.liz -w /Li Sutzw : ti
NOTES:
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install 4" observation pipes with approved caps. ( 2 required).
3. Septic tank to be VZ Boo gallon capacity anufactured b
V lj d4m y y
4. Bench marks gq-, fP� OQ
. Divert surface water around system to prevent ponding at the uphill side.
Safety and Buildings
4003 N KINNEY COULEE RD
LACROSSE WI 54601 -1831
E�U TDD #: (608) 264 -8777
C
NVisconsin
www.commeroe.state.wi.us/sb
Q
Department of Commerce ww . w.wisconsi n.gov ? ��
cn tF Scott McCallum, Governor
Brenda J. Blanchard, Secretary
September 04, 2001
CUST ID No.691727 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
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 09/04/2003 Identificat' s
Transaction ID Na 670666
SITE• Site ID No. 635044
KURT & MARY JORGENSEN Please refer to both identification numbers,
170TH ST above, in all correspondence with the ag ency.
TOWN OF PLEASANT VALLEY
ST CROIX COUNTY
NW1 /4, SWl /4, S16, T28N, R17W
FOR:
DESCRIPTION: FOUR BEDROOM MOUND SYSTEM
OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 809089
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED.
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 Wastewater Systems" SBD- 10572 -P
(R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems"
SBD- 10573 -P (R.6/99).
• 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 the
Mound manual, and section VI of the pressure distribution component manual are complied with. A copy of this
letter including instructions and information relating to proper use and maintenance of the system m_ ust be given
to the owner and each subsequent owner up completion of the project.
• The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet fromthe absorption
area.
• Access to the filter for cleaning must be provided per Comm 84 product approval conditions. Maintenance
information must be given to the owner of the tank explaining that periodic cleaning of the filter is required
• Limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction,
c and activities that ' e treatment and dispersal are prohibited.
excavation, vehicular traffi other sun►tar ac es t a impact the p p
• Comm 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the
initial installation of the POWTS in accordance with an approved management plan shall be conducted by a
person who holds a registration issued by the department as a registered POWTS maintainer.
ARTHUR L WEGERER Page 2 9/4/01
• Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and
maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.
Comm 83.54(1). In addition, the owner is responsible for submitting a maintenance verification report
acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate
for the component(s) utilized in the POWTS.
• mm 83.52 A POWTS that ' the approved management plan or as
Co 2 () O a is not maintained m accordance with pp g p
required under s. Comm 83.54(4) shall be considered a human health hazard.
• 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/instal lation/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.
Sincerely, FEE REQUIRED $ 175.00
FEE RECEIVED $ 175.00
BALANCE DUE $ 0.00
Charles L Bratz
POWTS Plan reviewer II- Integrated Services WiSMART code: 7633
(608) 789 -7893, Mon. -Fri. 7:45 AM to 4:30 PM
cbratz@commerce.state.wi.us
cc: KURT JORGENSEN
TITLE SHEET Page 1 of — 1
FOUND SYSTEM
FOR
A BEDROOM RESIDENCE
This plan has been prepared in accordance with the Mound Component
Manual SBD- 10572 -P and the Pressure Distribution Manual SBD- 10573 -P
C bl9.q Cam �l�a
LOCATED IN THE K 1 /4 OF THE SW 1/4 OF SECTION 1b )T Z8 N , R 1-7 W,
TOWi1 OF 1 pL' �I°m►'" V)c° LL�sy SY . C�22) 1 X 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
0 0
PREPARED BY
WEGEF=<EF: SO I L TEST S tVC3
AND .
DES
P.O. Box 74 421 N.Main St. 0o•m�letN
River v
Falls, G]I 54022 e ay
Phone 715- 425 -0165 � rad�®
Fax 715 - 425 -6864 `°'� " ""� "''••.�
WFGEFREFq
yp D -915 P
Eila'YI0R1F.,
1 W � r•
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APPROVED °•`�
OF
n
JOB NO. D1 -2p S
tw . r
,....,.�.Y...�.�..�..�.,.�
Mound System Management Plan Page Z of �1
Pursuant to Comm 83.54, Wis. Adm. Code
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. Themerating condition of the septic tank and
outlet filter shall be assessed at least once every 3 years by inspection. Th outlet filte shall be cleaned as necessary to
ensure proper operation. The filter cartridge should not be removed unless provisions are made to re gin so lids in the tank that
may sl ough 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, 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.
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 for frost protection.
Influent quality into the mound system may not exceed 220 mg /L B005, 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. 6/99)] arid 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.
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 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 1 S - 3g - u68 o S C1Z61X_
The system installer at `��'S - Z6� _ (o C RS U'rGP4R.t�
The tank manufacturer at €DO -3 qS6 WIesg2
The effluent ,filter manufacturer at �'�0- -e-Z q ZI LZ
The pump manufacturer at b3C —�-Izl - - Lie La GoU\ -DS
PLOT PLAN
- Page 3 of 7
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NOTES:
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install 4" observation pipes with approved caps. ( 2 required).
3. Septic tank to be\2 '60JBoo gallon capacity manufactured by
4. Bench marks S�� 30UN
�. Divert surface water around system to prevent ponding at the uphill side.
Page 0 1
i
Approved Synthetic Covering _
ASTH C33 Distribution Pipe .
Medium Sand
IG
Topsoil F El ev. 10
3
E to
b
1�. % Slope
Distribution Cell of Force Main Flowed
2" to 2 " Aggregate From Pump Layer
0 \_� Fr
E 1-9 _ Ft.
CROSS SECTION OF A MOUND SYSTEM F 0.8 Ft.
G 0• S Ft.
A 9 Ft. H 1• Ft.
Linear Loading Rate=g• /LN FT
Design Loading Rate= 0.39 GPD /SQ FT j 1 Ft.
J (-� Ft.
K 1p Ft.
nip_ _ -_ n t I- 87 Ft.
� M n W G.! q Ft.
- Observation Pipe
-- - -- — --- - -- -- _ - - -- _ - -
A-- -- - - - - - -- --- - - - - -- -------- - - - - -- --- - --
�b Force Main
W t--- T -- - — -- - - - - -- - - - -! L f �c cers
Distribution ,� 2
1 to
. Cell of z 2
Pipe
aggregat
Observation Pipe
(Anch sec=e1Y )
- PLAN VIEW OF A MOUND SYSTEM
Distribution Pipe Layout Page S of '7
r
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 4S° fitting to a point within fix
inches of the final grade. Terminate the ends of the laterals with a valvs:threaded cap or
• threaded plug. Provide access from final grade for the valve, threaded cap or threaded plug.
LC.0 `SS
T`-t
PVC F\1C PVC
Lateral
Manifold Lateral
x x x x xQ I w2 x x x x
Lateral Length — Lateral Length 2
Distribution Line
• P — � C Pros soK
— —o
S,
P 3 3 Ft. Hole Diameter 1 / 8 Inch -
S 3 Ft, Lateral n Inches)
X ZY inches Manifold " Z• Inches
Force Main " Z Inches
of holes /pipe 1`1
Invert Elevation of- Laterals WA -Z SFt.
1-1x\3• qt = -g7k6 = q1. a qpl,_j
- Combination Sep.tc:Tank and
PU -MP CHAMBER CROSS SECTIOIJ AMD SPECIFICATIONS ' PAGE � OF �]
•VE1JT CAP WEATHER PROOF
JU)JCTIOU BOX
ti C.I. VCAIT PIPE APPROVED LOCKII.IG
10' FROM DOOR, T&WHOLE COVER ;VIV
:IUDOW OR FRCSH wARr•IIIJG L.AgEL
ui3P�g1aIJ PtaE A.rR INTAKE cor.,cu�r
• w �H•tCL� c ttT r.�tP � �
U �
Ft N tSl{p I.' Nua . •�. 18 #" j `f HUI.
GafiDE
18 Am
IAILET '�� PROVIDE I - -- —
' `�'' �AIRT(GHT SEAL
.�� v
I I I
Approved z>38� H� I II I Approved
joint w/ joint w/
i II
PVC pipe ALARM PVC pipe
s - I it
. I I
I I IJ
C
0
CLEV. g�'� FT __J
PUMP -1 OFF
0 -
COIJCRETE
' BLOCK
Y
RISER EXIT PERMITTED OIJLy IF TAW MAIJUFACTUR HAS SUCH APPROVAL 3 "AFPf2o.�
. 8r<DO I N4
SEPTIC E SPECIFICATIOKIS
DOSE /a 1'C
TAUKS MA QUFACTURER:
WUMBER OF DOSES: - y -9 PER -
TAMK 5IZE: _l ' Z-8O /800 Ob GALLOQS DOSE VOLUME P
ALARM MAMUFACTURER: _ S -S , �- S \J S`T EM s 1tD CLU01 u G 6ACKFLOW: ` • Z G ALLOMS
MODEL ►DUMBER: IO t1-w CAPACITIES: A= ZD 1>JCHE5 OR U IZ'0 G ALLOAIS
SWITCH TtIPE: " Q2Cl� I1
8- I H
1JC ES OR G(1LLOU5
PUM M C=
P AMUFACTURER: Gou `-1JS - IU tiq q, Z
LHES OR
GALLOWS
3
MODEL MUMBER: �8 S �EO H- C�
D = -- I._ IrIC•�HpES�� 5 OR 1 $s•y GALLOWS
SWITCH TYPE: �1L�Z JZ1`f' DOTE: PUMP AMD ALARM gRC TO �
MI)JIMUM DISCHARGE RATE �' $ Z G PM INSTALLED OU SEPARATE CIRCUITS
VERTICAL DIFFEILENCE OETWCEU PUMP OFF AUO..DISTRIBUTIOU PIPE 11 ' S FEET
f MIIJIMUM METWORK SUPPLY PRESSURE , ; , , 6'5o FEET rs.050
10 OF FORCE . S F T.
+ 3 FEET MA IJ 3
t X ioo FRiCTIOtt FACTO 6
ft: R FEET
TOTAL OtIMAMIC. HEAD = — =O FEET
As per manufacturer Z.V. gal /in. Liquid depth 38'
• Pyr'1P FIZZ- FOa-M CUIZUE 1�ge _7 or- 7
C uouias
Submersible
Effluent Pump
3885
APPLICATIONS • Overload protection must smooth operation. Silicon can be operated continuously
Specifically designed for the be provided in starter unit. bronze impeller available as without damage.
following uses: • Shaft: threaded, 400 series an option. ■ Bearings: Upper and
• Homes stainless steel. ■ Casing:_Cast iron volute lower heavy duty ball bearing
• Farms • Bearings: ball bearings type for maximum efficiency. construction.
• Trailer courts upper and lower. 2" NPT discharge adaptable ■ Power Cable: Severe du
• Motels • Power cord: 20 foot for slide rail systems.
Schools standard length (optional rated, oil and water resistant.
•
lengths available). ■ Mechanical Seal: SILICON Epoxy seal on motor end
• Hospitals CARBIDE VS. SILICON provides secondary moisture
• Indust Single phase:
Industry CARBIDE sealing faces. barrier in case of outer jacket
• Effluents stems •'% Y2 and HP -16/3 SJTO
y Stainless steel metal parts, damage and to prevent oil
with 115 V or 230 V three BUNA -N elastomers. wicking.
. prong plug. g•
SPECIFICATIONS
• 3 /4 -1'/2 HP -14/3 STO with ■ Shaft: Corrosion - resistant ■ 0 -ring: Assures positive
Pump bare leads. stainless steel. Threaded sealing against contaminants
• Solids handling capabilities: Three phase: design. Locknut on three and oil leakage.
1 3 /4 " maximum. • Y2 -1 Y2 HP -14/4 STO phase models to guard
• Discharge size: 2" NPT. with bare leads. On CSA against component damage AGENCY LISTINGS
• Capacities: up to 128 GPM. listed models - 20 foot on accidental reverse rotation.
• Total heads: up to 123 feet length SJTW and STW ■ Motor: Fully submerged in SP Canadian Standards Association
TDH. are standard. high -grade turbine oil for
• Mechanical seal: silicon lubrication and efficient heat I Underwriters laboratories
carbide -rotary seat/silicon FEATURES transfer.
carbide- stationary seat, 300 ■ Designed for Continuous
series stainless steel metal •Impeller: Cast iron, semi -
open, non -clog with pump- Operation: Pump ratings are
• parts, BUNA -N elastomers. out vanes for mechanical seal within the motor manufacturer's
Temperature: recommended working limits,
104 0 F (40 °C) continuous protection. Balanced for g
140 °F (60 °C) intermittent.
• Fasteners: 300 series METERS FEET
90
Stainless steel.
SERIES: 3885
Capable of running dry 25 sizE:3i•souos
H4E1 RPM: VARIOUS ,
without damage to i ►5GPM - -
components. 70
1NE1 5 Fr
Motor 20
m 60 '
Single `phase:
• % HP, 115 V, 200 V, 230 V, 2 15 50
60 Hz, 1750 RPM; Yz HP, 4
Z
115 V, 60 Hz,'3500 RPM; o ao
1 WEO N
/H w i
P =1�HP, 230V, F ' 2 '
60 Hz, 3500 RPM. a 10- 30 , ! i
• Built-in overload with 2 wEO31 ;z .
automatic reset. 0 i
• 5
ll ,o,Class B insulation.��• — j - --- -1 — i
�J Three phase'° x =
10 L.. I .ES2. I
• 1 /z HP =1'/ HP. 200/2 0/. o 0 ;_ ! '
:46U 60 Hz; -3500 R 0 10 20 30 40 50 60 70 80 ` 90 100 110 120 130GPM
1 B insulation. o 10 20 30 m3m
,
< CAPACITY
0 1995 Goulds Pumps, Inc. Effective May, 1995
Vtwonsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3
Division of Safety and Buildings in accord with Comm 83.05, W is. Adm. Code
AC.E. Soil &Site Evaluations
Attach complete site plan on paper not less than 8' /z x 11 inches in size. Plan must Coun
include, but not limited to: vertical and horizontal reference point (BM), direction and
St. Croix
percent slope, scale or dimensions,
sions north arrow, and OTlistonce to nearest road.
.: Parcel I.D.#
`' 1 '+ •' 024-1019-20-00
APPLICANT APPLICANT INFORMATION - p/ e�irr AH_kiform6tion, R y Date
Personal information you provide may be used for fry purpos (P ' y law, s. 15.04 (1) (m)). J '
Property Owner t ` j ,,r; Property Location
Victor &Mira Staut ' , j '� > Go Lot NW 1/4 SW 1/4 S 16 T 28 N,R 17 W
Property Owner's Mailing Address _ Lot a I Block # Subd. Name or CSM#
1718 30th Ave. _ �A ��9 J 1 35 Acre Parcel
City State ddedp� r City Village ®Town Nearest Road
170Th Street
Hammond WI 5 �&-S_ 715- 13. •. Pleasan t Vall
❑ New Construction Use: ❑ Res' ' 1 0` r tr2C0�f s 3 ❑Addition to existing building
❑ Replacement ❑ Public or com escribe
Code Derived daily flow 450 gpd Recommended design loading rate .5 bed, gpd/f1 .6 trench, gpd/ft
Basal area required 900 bed, ft' 750 trench, ft' Maximum design loading rate .5 bed, gpd/ftz .6 trench, gpd1W
Recommended infiltration surface elevation(s) 100.75' at 12" above 99.75' contour. ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material Glacial till. Flood plain elevation, if a plicable NA ft iiiir
S- for system Conventional Mound In Ground Pressure AT - Grade System in Fill Holding Tank
U= Unsuitable f o r system El N U Z S O U E] S ®U El ®U ❑ S ®U ❑ S ® U
SOIL DESCRIPTION REPORT
De th Dominant Color Mottles Structure GPD/ftz
Boring# Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consisten Boundary Roots Bed Trench
1 1 0 -10 10yr3 /2 None sl 2fcr mvfr as 217 0.5 0.6
2 10 -21 10yr5 /4 None sl 2fsbk mvfr cs 2f,lm 0.5 0.6
Ground 3 21 -28 7.4yr4/6 None sl 2msbk mfi cw 2f 0.5 0.6
elev
97.88' ft 4 28 -38 10yr4/6 207.5yr4/6 A 2csbk mfr cw - 0.5 0.6
Depth to 5 38 -56 7.4yr4/4 2md5yr5 /8 scl lcsbk mvfi - - 0.2 0.3
limiting
factor
28'
i
Remarks:
2 1 0 -10 10yr3/2 None sl 2fcr mvfr as 2f 0.5 0.6
2 10 -26 10yr5 /4 None sl 2fsbk mvfr cs 2flm 0.5 0.6
Ground 3 26 -33 7.4yr4/6 None sl 2msbk mfi cw 2f 0.5 0.6
elev
97.83' ft 4 33 -41 10yr4/6 2fd7.5yr4/6 A 2csbk mfr cw - 0.5 0.6
i
Depth to 5 41 -70 7.4yr4/4 2md5yr5 /8 scl lcsbk mvfi - - 0.2 0.3
limiting
factor
33
Remarks:
CST Name (Please Print) Signatur Telephone No.
James K. Thompson 5---- 715- 248 -7767
Address A.C.E. Soil & Site Evaluations Date CST Number Ref #
340 Paulson Lake Lane, Osceola, Wl 54020 8/23/99 3602 1093
PRt orrY O WNM yidor & Mira Staut SOIL DESCRIPTION REPORT Page 2 of 3
PARCEL LU 0241019 -20-00 A.C.E. Soil & Site Evaluations
Depth Dominant Color Mottles Structure GPDM
Horizon in Munsell Qu. Sz. Cont. Color Texture Gr. Sz Sh nsistence Boundary Roots
Bed Trench
3 1 0 -7 10yr3 /2 None sil 2fcr mvfr as 2f 0.5 0.6
2 7 -25 10yr5/4 None sil 2fsbk mvfr cs 2f,lm 0.5 0.6
Ground
elev 3 25 -33 7.4yr4/6 None A 2msbk mfi cw 2f 0.5 0.6
100.33 ft 4 33 -54 7.4yr4/4 2md5yr5 /8 scl 2csbk mfi
Depth to
limiting
factor
25"
3 :
Ground
elev
Depth to
limiting
factor
Remarks:
Ground
elev
Depth to
limiting
factor
Remarks:
Ground
elev
Depth to
limiting
factor
Remarks:
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer �lo'e e, f
Mailing Address `�/ C /�!� ST FP�3
Property Address 331 12
(Verification required from Planning Department for new construction) I � a t- J- A�
City/State 1i3 1 �, / � Parcel Identification Number
LEGAL DESCRIPTION
Property Location IVIV ' /e, 560 ' /4, Sec. r� , T 7,6 N -R W, Town of
Subdivision Lot #
Certified Survey Map # YU 4 , Volume 7 Page It v7
Warranty Deed # Volume 1 . Page #
Spec house ❑ yes J no Lot lines identifiableg yes ❑ no
SYSTEM MAINTENANCE
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.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
masterplumber, journeyman plumber, restrictedplumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
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 Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year expiration date.
SfGNATUR90FOPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
^�
6/ 5 1 e
SIGNATURE 1 6F 0PLICANT DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department."""
** Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
1 471PAG[ 624
DOCUMENT NO. KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
Victor J. Staut and Mira Staut, husband and wife as survivorship i1 -18 -1999 10:00 AM
martial property, Grantor, conveys and warrants to Kurt C. Jorgensen
and Mary K. Jurgensen, husband and wife as survivorship martial DEED
property, Grantee, the following described real estate in St. Croix EXEMPT YARRANTY Y
County, State of Wisconsin:
CERT COPY FEE:
COPY FEE:
A parcel of land located in the NW 1/4 of SW 1/4 of Section 16 TRANSFER FEE: 213.00
Township 28 North, Range 17 West, Town of Pleasant Valley, St. Croix RECORDING FEE: 10.00
County, Wisconsin, more fully described as follows: Beginning at the W PAb'ES: 1
1/4 corner of said Section 16; thence N89 0 46'38 11 E along the North line
of said NW 1/4 of SW 1/4, 1310.17 feet to the NE corner of said NW 1/4
of SW 1/4; thence S00 0 11'43 11 W along the East line of said NW 1/4 of SW
1/4, 710.72 feet; thence S89 0 50 1 36 11 W, 327.40 feet; thence S00 0 12 1 01 11 W,
605.16 feet to the South line of said NW 1/4 of SW 1/4; thence
S89 °54 11 W along said South line, 983.18 feet to the West line of said
NW 1/4 of SW 1/4; thence N00 along said West line, 1313.23 feet . . . . . . . . . . . . . . . . . . . .
to the point of beginning. NAME AND RETURN ADDRESS
/--> V2- t (c--j 31c
It is agreed by the parties hereto that the above
described property cannot be subdivided for a period
of ten (10) years without the Grantor's consent.
024 - 1019 -20
Parcel Identification Number (PIN)
This is not homestead property.
Exception to warranties:
All easements, restrictions and rights -of -way of record, if any.
Dated this / day of November, 1999.
(SEAL) (SEAL)
Victor J. St t
(SEAL) / �/ �1 J (SEAL)
Mit
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
C ) ss.
G COUNTY )
authenticated this _ day of 19_ Personally came before me this — day of November,
1999, the above named Victor J. Staut and Mira Staut
to me kno n to be the er ns who executed the
foregoin nstrug wledge the same.
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by §706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY: Notary Public;, County, Wis.
Leo A. Beskar, Attorney My commission- 14 not, expiration date:
RODLI, BESKAR, BOLES & KRUEGER, S.C. �(
Y,
219 North Main Street, P.O. Box 138
River Falls, WI 54022
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