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HomeMy WebLinkAbout024-1028-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453374 0 (ATTACH TO PERMIT) GENERAL INFORMATION r . I 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: Gilbert, Herman & Sharon I Pleasant Valley Township 024 - 1028 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: • 0 /00 - U 20.28.17.172 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ATION BS HI FS ELEV. Septic Benchmark l Z 85 t0q.9 too. a Dosing Alt. BM O oV �6. Wa,�l �D Aeration ' Bldg. Sewer I� I knJ - a Holding SUHt Inlet -- 7. TANK SETBACK INFORMATION SvHt outlt TANK TO P/L LL BLDG. en 'r Intake ROAD Dt In et fiAn %4 a� Septic ` t �� .�, q KX Dt Bottom VV r 0 r(l� Dosing Header / Matt - 3.ZS 1 0 •5�j Aeration Dist. Pipe ''j, Z� U [ Holding B ot. Syst /D 0 of I - PUMP /SIPHON INFORMATION Final Grade 7 ­ 6 f ( o2• �/L( Manufacturer GP and St Cover Z� /clex ix / Q 1 Model Number ,. , D of i l TDH Lift 9 Friction i -s System Hea� TDH� Ft - S LP D r �G Forcemai / Len I Dia. Dist. to w el l ( i 4- ( Z / "U r / A,I D ' SOIL ABSORPTION SYSTEM Z S BEDITRENCH Width Length No. Of Trenches PIT DIMENSIO No. Of Pits Inside Dia. Liquid Depth DIMENSIONS (f r L f. I -5 ) I G�� SETBACK SYSTEM TO P/L / BLDG WELL LAKE /STREAM LtWING Manufacturer. INFORMATION T e System: t R OR YP Y UN Model Number. DISTRIBUj4qN SYSTEM Qua ( ��UU / C4t.1 P, (s Head r /Manifold / I I Distribution ole Size x Hole S�jalcing Vent to Air Intake, Length 2. 23 Dia �' Length 1 7� Dia d ' / Spacing Z Z � ' x H !Z5 (` 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 Bed/Trench Edges Topsoil Yes [_ No Yes ]No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / ' Z�/ Inspection #2:T/ 3 / Location: 225 162nd Street Unknown (E 1/2 SW 1/4 20 T28N R17W) NA Lot Parcel No: 20.28.17.172 pa a ,/ 1.) Alt BM Description = /WT -"`''� �!/� — 2.) Bldg sewer length ='L?,/ - amount of cover Plan revision Required? Yes J�J No 1 � Use other side for additional information. SBD - 6710 (R.3/97) Date Insepctor's Signaturej Cert. No. Safety and Buildings Division County lvi m 201 W. Washington Ave., P.O. Box 7162 St. CrO1X ".d ,� Madison, WI 53707 — 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266- 3151 5-3 3 Sanitary Permit Application State Plan I.D. Number � / �j I � S .16) In accord with Comm 83.21, Wis. Adm. Code, personal information you provide [ ( v = S ! p • ) may be used for secondary purposes Privacy Law, s I5.04(I)(m) Project ess(if different than mailing address) I. Application Information - Please Print All Information 162nd Street Property Owner's Name arcel bet#- Bim*# Herman & Sharon Gilbert (_ s�; `� 70Q a O Z �.!o 2 Property Owner's Mailing Address Property Location ' 15608 Cty. Rd. 7 NW 01 jj ' E1/2 SW City, State Zip Code -� '/s ' /., Section 20 Clearwater, MN 5532 320 - 558 -650 T 28 N, R . 7 ( circl r one) II. Type of Building (check all that apply) 4 i S io�iiot�e CsM-titrtnlsa Q 1 or Z Family Dwelling - Number of Bedrooms ! Sebdiris� • � ® Public /Commercial - Describe Use ,n ❑ State Owned - Describe Use vt 3S I QCity_ovinage Bfownship of Pleasant V alli III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ll New system ys ❑Replacement System ❑ Treatment/Holding Tank Replacement Only 13 Other Modification to Existing System B. ❑ Permit Renewal [I P Revision [3 Change of 13 Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that ap 1 ❑ Non - Pressurized In -Ground ❑ Mound > 24 in. of suitable soil 0 Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter 0 constructed Wetland ❑ Pressurized In- Ground 0 Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber 0 Drip Line 0 Gtavemess Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) I Design Soil Application Rate(gpdsf) I Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevatio , 600 0.4 600 600.32 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Sep or Hokling Tank l 1200 1200 Weiser x Aerobic Treatment Unit Dosing Chamber 0 750 750 1 1 Weiser x VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb Signature MP/MPRS Number Business Phone Number mb Roger Nelson 226497 715 - 273 -4444 Plumber's Address (Street, City, State, Zip Cr 1swo , If 122 East Summit Avenue rt h, WI 54011 VIII. Coun /De artment Use Onl a pproved ❑ Disapproved Sanitary Permit Fe - includes Groundwater Date Issued sui Agent Sigtuuur (No Stamps) 'r Surcharge Fee) ❑Owner Given Reason for Denial S 3 IX. Conditions of ApprovaMeasons for Disapproval T I _ Le- SYSTEM OWNER: 1 Septic tank, effluent filter and -•� dispersal cell must all be serviced / maintained 1� \ r1 as per management plan provided by plumber. ;e S 9t ceS o, &-r k ¢ - 2. All setback requirements must be maintained as per applicable code /ordinances. e� A ttach complete lane to the County on for the system on r not less than 81/2 x 11 inches in sine mP P ( tY lY) Ys P� SBD -6398 (R. 01/03) Us :V At i 133 98. �� / � J /may /'(�, L' o.+ moo.•► q�. u 7 5 Tw, y "pue 13/11.1 = To ' '' wE rsER ki \9 �i Ot gloom oti t Nokst � I C G Gargge !! O IiNFLL i I�Q � t a Safety and Buildings commerce.wi. OV 4003 N KINNEY COULEE RD g LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 ` ww w.comm www.wisconsin.gov isconsin www.wisconsin.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary June 16, 2004 CUST ID No. 226497 ATTN. POWTS Inspector ROGER D NELSON ZONING OFFICE NELSON PLUMBING ST CROIX COUNTY SPIA 122 E SUMMIT AVE 1101 CARMICHAEL RD ELLSWORTH WI 54011 HUDSON WI 54016 CONDITIONAL APPROVAL Ident��� ion _., PLAN APPROVAL EXPIRES: 06/16/2006 Transaction ID No. 1006387 SITE: Herman & Sharon Gilbert Site ID No. 684679 Town of Pleasant Valley, St Croix County Please refer to tiah ideiitiffcadonutiii s above in al E 1/2, SW 1/4, S20, T28N, R17W l -6drre ndence ft tbtr' e FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 962304 Maintenance required; 450 gpd flow rate System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01) 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. 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: Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the septic tank outlet filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. 01 The installer should consult with an electrician regarding the correct gauge of cable needed to supply the effluent pump with power adequate for proper pump operation. • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD- 10691- P(N.01 /O1). • The pressure network is to be constructed in accordance with publications SBD- 10706- P(NO1 /01) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems - Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) ". 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. I ROGER D NELSON Page 2 6/16/04 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 47 .� Balance Due $ 0.00 Leroy G. ansky, Wastewater cialist Integrated Services Bureau 'O ode. 7 A ' (715)726 -2544 Voice (715)726 -2549 Fax Ijansky@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Gilbert's 4 bedroom Mound Owner's Name: Herman & Sham Gilbert Owner's Address: 15608 Cty. Rd. 7 NW Clearwater, MN 55320 Job address: 162nd Street Legal Description: E 1/2, SW 1/4, S 20, T 28, N R 17 W Township: Pleasant Valley County: St. Croix Subdivision Name: Lot Number: Block Number: P.O.W.T.S. Parcel I.D. Number: G^U"M onally Plan Transaction No.: 9 T A A p COVE D Page 1 Index and title DEPARTMENT OF COMMERCE Pa e 2 Data entry DIVIS N OF SAFETY AND BUILDINGS g v Page 3 Mound drawings - Page 4 Lateral and dose tank EEG RESP ENCE Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan Designer: Roger Nelson License Number: MP 226497 Date: 06/10/04 Phone Number: 715 - 273 -4444 Signature: //x //.J V V / / n= Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 4.0 (R. 04/03) Pagel of 8 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 83 -44 -3 in-,situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of - 36 inches. 600.00 Design Flow (gpd) 3.00 Site Slope ( %) 99.48 Contour Line Elevation (ft) 20.00 Depth to Limiting Factor (in) 0.20 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 135.001 Dispersal Cell Length Along Contour (ft) = 4.45 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft 1 I 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) c Center or End Manifold 2.23 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 4.00 Estimated Orifice Spacing (ft) = 8.83 ft /orifice 2.00 Forcemain Diameter (in) 31V s 0 Forcemain Length (ft) Does the forcemain drain back? Y 91.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 4.89 Forcemain Drainback (gal) 9.48 Vertical Lift (ft) 54.50 5x Void Volume (gal) 0.51 Friction Loss (ft) 59.39 Minimum Dose Volume (gal) 16.49 Total Dynamic Head (ft) 28.01 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection, in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 x x 1.50 x x 1.25 x 2.00 1.50 x 3.00 2.00 x 3.00 x Gallons /Inch Calculator (optional) P Treatment Tank Information Total Tank Capacity (gal) 1200.001 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Weiser 800 - 325 -8456 1 Manufacturer gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Information 800.001 Dose Tank Capacity (gal) JZabel 1- 800 - 221 -57 42 1 Filter Manufacturer 20.601 Dose Tank Volume (gal/in) IA100 Filter Model Number Weiser =Manufacturer Project: Gilbert's 4 bedroom Mound Page 2 of 8 Mound Plan View T 1/10 B - . :. : : : : : :.... 0• :• J Observation Pipe : : : : • : — FK f ......................... .. •,. L. L..,. L..,. L..,. L. L..,. L.., .'L.L..,,.,..,.'...,.L.•..L..,. •,. •,. L..,.L .L;•.. %. W I . — B . : : - I L Mound Component Dimensions Down slope toe extension made. A 4.45 ft E 17.60 in H 1.00 ft K A29.33 ft B 135.00 ft F 9.00 in z 17.77 ft L ft D 16.00 in G 0.50 ft J 7.11 ft W ft 600.75 (ft) Dispersal Cell Area 1 3000.00 (ft) Basal Area Available 4.44 (gpd /ft) Linear Loading Rate 1 13.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.56 (ft) G H �� }r��rErrrrrrrrr�rt {rr...- F Dispe ell 101.31 (ft) Lateral 100.81 (ft — Invert Dispersal Cell . : ::: ; :::: = .::: : . Elevation . D . . ..::: :.:.:.:.:. .. . . . . . . . . . .. .. . . 4 4 99.48 (ft) Contour Elevation 3.0 %Site Slope Geotextile Fabric Cover Shading Key o_. Dispersal Cell See lateral details on 10 _ Topsoil Cap °• 1.5 ft : , .; • . L• .• .• .;•.; Page 4 for number, size, © {f Subsoil Cap 0 c. '�J • Lj' Jti' and spacing of laterals. a iti {:� : ;:;:.•r Laterals are equally ©0 ASTM C33 Sand �•�,.•;' F ® ® Tilled Layer a� 0.5 ft Typical Lateral :••• spaced from the L•L•L :; •;:,: {:. 5 • I distribution cell's ❑5 r•J.J•, Aggregate v c •. r..• •;�: s: •':; • centerline in the A * distribution cell (AxB). Project: Gilbert's 4 bedroom Mound Page 3 of 8 Center Connection Lateral Layout Daigram Force main connection via tee or cross to manifold at any point. Laterals are identical i P s �= Turn -up wlball valve or IE }( —Ifx12 I x121 Laterals &force main of PVC Sch 44 cleanoutplug per COMM Table 84.30 -5 Hales drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter 1.00 in Orifice Spacing (X) 4.05 ft Lateral Length (P) 66.83 ft Orifices per Lateral 17 Lateral Spacing (S) 2.23 ft Orifice Density 8.83 ft /orifice Lateral Flow Rate 7.00 gpm Manifold Length 2.23 ft System Flow Rate 28.01 gpm Manifold Diameter 1.50 in Total Dynamic Head 16.49 ft Forcemain Velocity 2.86 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and --► Comm 16.28 WAC 4 in. min. Disconnect _ Tank component is properly vented F— Alternate outlet location Forcemain diameter Weiser 800 - 325 -8456 Manufacturer 2 in. Cap acityl 800.00 Gallons Volume 20.60 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 23.95 493.41 C B 2.00 41.20 Pump off elevation (ft) C 2.88 59.39 � 91.83 D 10.00 206.00 D Total 1 38.831 800.00 Do se tank elevation (ft) ,,/ -- 3 7 ' — Bedding un er tank. F 91.00 Alarm Manuafacturer IS. J. Electro Systems Alarm Model Number 1101 HW Pump Manufacturer JMyers —� Pump Model Number I ME 40 Pump Must Deliver I 28.01 gpm at 16.49 ft TDH Project: Gilbert's 4 bedroom Mound Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name Installed by Nelson Plumbing Phone 715- 273-4444 POWTS Regulator's Name St. Croix County 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 1200 gal Maximum TSS 150 mg /L Soil Absorption Component Size 600.75 f: 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 every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Moundl Ins ect for ponding and seepage once every 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, 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 • ..... Grad e 6 -8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral g Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Gilbert's 4 bedroom Mound Page 5 of 8 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code • General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01/81)] 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. Septic Tank 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 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 BOD 150 mg /L TSS, and 30 mg /L FOG for septic tank effluent or 30 mg/L BOD 30 mg /L TSS, 10 mg /L FOG, and 10 cfu /100 mL for highly treated effluent. Influent flow may not exceed maximum design how.socified in the permit for this installation. Thftressure 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, it 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. Project: Gilbert's 4 bedroom Mound Page 6 of 8 PQro E - 1 1 • M E40 Series 4/10 HP Effluent and Drain Water Pumps Performance Curve MODEL. ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 IZ 35 10 W 30 W W ~ Z 25 e z z o " 20 5 0 t� 15 Iry 4 10 ~ 2 5 0 O 0 10 20 30 40 50 60 70 80 90 100 C PACITY GALLONS PER MINUTE 1101 Myers Parkway. Ashland, Ohio 44845 -1923 419/289 FAX 419/2894658 Telex W7443 K3326 7/91 Printed in USA- 710 7 'Cl 6M -C74. (CT! 1 • 6 nTALJ'1V7 V]IU61_y7Q d OL _ / f1 4.n C7 fP i.l 133 C „r 99 -L Bmi ®- fl 82 !3M 2 r� r 300' 7 s �T� k y PVC N �' p w Et sER /goo r•... k z L3/'►7 = TOP c F/. Noaft I O UV ELL /�a c Po 13 V y� s �-- Wisconsin Department of Corrrnerce SOIL EVALUATION REPORT Page of 3 Division of Safety and B illdings in accordance with Comm 85. Wis. Adm. Code Cour>ty s T C/P Q /' Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include. but not tinned to: vertical and horizontal reference point (BM). direction and Parcel I.D. Z percent slope. scale or dimensions. north arrow, and location and distance to nearest road. (9 A Q . 5 O O'aa Please print all Information. fte by Date Personri k0mri bo►you provide a" be used forsaowbsry pu+aos ((Privacy Law. s. 15.04 (t) (m)6 JL p ` I Mpa • Owner f /� / ,tom s f D fl Aj 1 , Jo*1 � ✓ B u/ ��mv Govt. Lot C Z 1/4" W 1/4 S 20 T 2 9 N R / 7 q((r) W Property owrtee' /1 5 �„ t_°t� Bloc` # �o i4 � �WN► 717 Z_ (ally State Zip Code Phone Nunber ❑ City ❑ Mige JD Town Nearest Road 11A4to ),2 1 41 1. 1 5YO15 0 796 I 7'r, ,41/-0- e 1 162-44 sT New Constuction use:0,Residertial / Number of bedrooms r Code denied design lbw rate - _ GPD ❑ Replacement ❑ Pubic or commercial - Describe: Pamt material /O ESS O(Z� P AI � -6//Z Flood Plain elevation if applimble tt. General conrnerks and , �-���- T� - �-� sv�• >�►,3i� �.t? �9- �`lo�,�,v Bain t �� t ❑ sss. Pit Ground surface eiev. � - ft. Depth to limiter factor . Z S El EL in. Rage Haim n Depth DoriftontColor Redox Dnmp*m Texture Structure C mMence Boundary Roots In. Munsell Qu. SL Cord. Color Gr. ft Sh *M •EW 0-9 L -,7 S T A S A C5 3 - f . - (,o z 9- X01 /e Z ,Fs • Cp . 3 Yle sL p s C5 • s . 2. 5 • /oYR 4 C2- d, Mars 51e4 fsM — Q Boring # ❑ Boring O_Pit Ground surface elev. / 0 R Depth to factor o b Sol Aipplicallon Rate Haiztn Depth Dor *wd Color Redox Description Texture Structure Consistence Boundary Roots GPDMF It. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 TIM / 0-& id �e 3 L z -F h& 4,5A cS 3 •F • 2- 1 6-1 6 0 /f S 6 •`� 1- .z 75 flf M e1 — S 5 L 19 Aj, GQU CS — .3 . S a YA 5 $. �� Y/ cad r� ors �5 /CL / -Fs V z . 3 • Eflluent #1 = BOO > 30 < 220 mg& and TSS >30 < 150 ffq& • Eftent #2 = BOD 130 mg& and TSS < 30 mg& csT jPO � -2 1 - 'AC/ G 7 Address Date Evaluation Conducted Telephone Number tiOl�• �/' boa 3 711 •77a 3yY Private Sewage Consultants 2812 10th Ave. Spring Valley, WI 54767 0 F\ N A L 1 A d l i •• /7 1 Ir 0 c d f o � - ;Z3 -a 1� o 0 zp• s t �a o Z �{ -�j rz� t 0 o ` N Eli M+VA1 Z- 3 P(Op" Cftfflff parvel ID # page o. 9g • 2d ss•,s . 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"E1 i Etf#2 I - I Effluent #1 = WD > 30 220 mg& and TSS >30 < 150 PKA " Etfluett 92 = BM, < 30 mg& and TW < 30 mWL 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. &eDESIO � 6A0} i r ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer A Z MA � -1- s 3 epc Mailing Address Property Address I t � a (Verification required from Planning Department for new construction gA n Z as � City /State Parcel Identification Numbe 6 Z (0 Z $ ; 16 0 LEGAL DESCRIPTION Property Location 5Ls �/ - a y Sec. Q0 , T oZB N -R-JI_W, Town of J)-eA SAX N(, 1/ jEy Subdivision , Lot # Certified Survey a # y P , Volume , Page # Warranty Deed # �9 Z 9 2 , Volume 2 51 -7 Pag # Z Spec house ❑ yes A no Lot lines identifiable ❑ 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I /we, 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 a iration date. SIGNATURE OF APPLICANT 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. SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Inc. ►aide 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 .. a U 2 5 17 P 2 9 9 7s5arD STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN ti. NALSH WARRANTY DL D REGISTER OF DEEDS Document Number ST. CROIX CO., WI F' RECORD This Deed, made between John S. Neumann and Joan M. RECEIVED OR Neumann, husband and wife Grantor, 02/26/2004 01:15PK and Herman D. Gilbert and Sharon Gilbert husband and wife WARRANTY DEED Grantee. EXE14PT # Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin FEE : 11.00 TRANS (if more space is needed, please attach addendum): TRA FEE: 816.00 COPY FEE: SE t /4of SW r /4of Section 20, Township 28 North, Range 17 West, St. CC FEE: Croix County, Wisconsin. PAGES: 1 AND NE ' /4of SW 1 /4of Section 20, Township 28 North, Range 17 West, St. Croix County, Wisconsin. Recording Area Name and Return Address PV Ai 024-1028-50-000, 024 -102 8-10-000 Parcel Identification Number (PIN) This homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rigbts - of - way of record, if any. Dated this .l- 1 day of February , 2004 * _ * J Neumann —'- - -- — _ -- -- - -- — -- * * J n M. Neum ann AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF W k ) - - - - _ _- -- - - - - - -- - - - -- _ �� —�� 1�f- County ) authenticated this _ day of _ -- Personally came before me this - ��j - day of Febr 2004 the above named Joh S. Neumann and Jo M. Neum husband and wife TITLE: MEMBER STATE BAR OF WISCONSIN (If not, _ to me known to be the person(s) who executed the foregoing` authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY jtpttttngh�, - -- ---� Attorney Kristi Ogland * Hudson, WI 54016 _ —_ —_ _ _ No ublic, State of _ _ _ ••• '� — My Commission is permanent. (If not, state eion te: '9, (Signatures may be authenticated or acknowledged. Both are not necessary.) - -- --- _ - -��— -- 1 * Names of persons signing in any capacity must be typed or printed below their signature. Information Profeff fo. Lac. -W* STATE BAR OF WISCONSIN . Q d0 655 -2x21 WARRANTY DEED FORM No. 2 - 1994 ���i� ^N c�\ ' ///11111111 11\ K 1 3 J 1`7, /'-If APPLICATION FOR TOWN BUILDING PERMIT Property owner: /• RAAA�4 4 Q�Nneo�,[ a ; 113 Contractor /Agent (if not owner:) L_UKb ID LIZS 17 0c- . Mailing address: ],%pa Rb ,7 \11. a} Mailing address: 10 C M4, J 01 e -ARWA EP, M.S U rem uo S 5 1 o Z.Z Daytime phone: ( 3a° !;,!5 p, Daytime phone: ( 7_ 1 S) 'Jo,)S — /13 Property location: EY 7_114, sk) 1/4, Sec. DO , T. a8 N., R. �J W., Town of E ' Atv O Z`{ lozb ) L) Computer #: - - - Parcel #: 0 ©�,p 01 - Zoning Distric J IJL[y � 1 f'- te, AOG(Jl�f Of / h ULA Jq1�/t�t 6 0 Type of Town Building Permit (Check one of the following)• KSingle- family residence ( ) Farm Building O Commercial Buildin ( ) Seasonal Dwellin g ( ) Remodeling g OAccessory Building ( )Industrial Building Application Check List: The following is a list of submittal requirements for a town - building permit per Article 17.70 (3) (b) of the St. Croix County Zoning Ordinance. It is important to submit a complete application, as it will help town officials review the request efficiently. To ensure your application is complete check off the box as you complete U A general written statement that specifically identifies what is being requested. l^_�I A statement indicating whether rivate water or sewage system is to be installed. Ud YP Indicate the type of occu anc (single-family P y (� g y wellin g, personal storage, Ag. related, etc...) SITE DEVELOPMENT PLA D ON 8'/ INCH BY 11 INCH PAPER A complete site plan showing at a minimum the location of the following: - Identify and label any slope 12% or greater, v Dimensions and area'of lot, of Location of any structres with distances measured from the lot lines and centerline of all abutting streets or highways, Location of any existing or proposed on -site septic systems or private water supply systems within 100 feet of the construction, Location of the ordinary high water mark (OHWM) of any abutting navigable waterways and show all setbacks from time OH WM. Location and landward limit of all wetlands, specifications and dimensions for areas of proposed wetland alteration. Existing and proposed topographic and drainage features and vegetative cover, ; r' Location of floodplain and floodway limits on the property as determined from floodplain zoning maps used to delineate floodplain areas, Location of existing or future access roads ✓r And any other unique limiting condition of the property THE BUIDING SITE MUST BE STAKED. The Deputy Zoning Administrator will view the site to ensure compliance with time permit. I agree to withdraw this application if substantive false or incorrect information has been included. Signature Date This review only verifies that the project complies with the applicable St. Croix County Land Use Ordinances. This is not an application for a Uniform Dwelling Permit or to install a private onsite wastewater treatment system. ��STOWNTTSE':ONLY Permit Issuance Date: / / V t Permit # Expiration Date: ➢ The application materials will remain on file with'the TOWN. �� Ie __ ��- U �_T S �-1Ul s