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HomeMy WebLinkAbout024-1033-90-000 n Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix and Building Division INSPECTION REPORT Sanitary Permit No: 488072 0 cNERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: ersonal 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: Raverty, Jeremy & Rita Pleasant Valley, Town of 024 - 1033 -90 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: Q� ♦ CS l 29.28.17.217 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. /6.5 //6"5 i Septic Benchmark Dosing Alt. BM * 3. $gyp !PS �ovw�o sm -SAe - Aere3tion Bldg. Sewer • 15-T $? . v, F, �,k '►d` ��v J Ho ding St /Ht In +� � • 33 -TZ • I Z. S t/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. V ent o Air In ROAD EYtIn epic > /66 1 > $ JI 4 1 B ott om �' 11. 7% . , , 4 9 osing H eader/Man. era ion Dist. Pipe 1.17 161 o ing Bot. System F inal ra e PUMP /SIPHON INFORMATION N 3 , 1 Z- /67.3g anu ac urer n 1i I b em � ana s _ove q, Ov� GPM n/t' C OJe� �.� /v.`� Z3 -%5 S?&o (05 M odel um er /•(o /251/ G✓E as Z • rf �— 7 Z i nc ion LOSS syste m nea 27 .5 Z • 3d ( 5a 3 , `� bw� Z. 7. �� 16.3 • / � orcemain 1 1-en I uia. U151. 10 17U 1 7- 7 Sa rEr IL A1350IRPTION 5Y5 FEM ILU11YU] rIT D11VIE-190101ma Mu. 01 PlLb 111bJut: Uld. [quid Deptil 1 1 DIMENSIONS INFORMATION CHAMBER OR � 255 � UNIT 1 � i� 3 ., Length Dia I Length Dia Spacing x Pressure Systems Only xx Mound Or At - Grade Systems Only Bed/Trench Center /, Bed/Trench Edges Topsoil 1 r` Yes ] No y Yes ANto� COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 7 / ZS / ` nspection #2: 01 ( Location: 102 165th Street Hammond WI 54015 NE 1/4 SW 1/4 29 T28N R17W) 40 acres Lot rra6 f' Op Parcel No: 29.28.17.217 N O " " P1 n�.J 6 F� 1.) Alt BM Description = n 2.) Bldg sewer length - amount of cover = 3 Plan revision Re uired. Yes formati Use other side for additional inf ormation. on. d � i D � ! - -- - - - -- —I L -� - - - - D s-Signa rt o — SBD -6710 (R.3/97) I I . . lad i Si Safety and Buildings Division County ` 201 W. Washington Ave., P.O. Box 7162 St. Croix ,5����i,� Madison, WI 53707 - 7162 emit Number (to be filled in by Co.) Department of Commerce (608)26 ECEIV Sanitary Perini plication . Num Z ber 3 0..d;- 3 f� In accord with Comm 83.21, Wis. Adm. Cod , information y Gii �� `� 3 may be used for secondary p Priv w5.04(1 xss (if different than mailing address) I. Application Information - Please Print All Informs `65th Street Property Owner's Name Parcel # Lot # Block # Jeremy & Rita Raverty Property Owner's Mailing Address Property Location P.O. Box 81 N SW City, State Zip Code Phone Number /', /,, Section 29 River Falls, WI 54022 715 -425 -9455 T 28 R 28 1 7(circle one) r H. Type of Building (check all that apply) 4� /� 10,, , ''/ ✓ B 1 or 2 Family Dwelling - Number of Bedrooms 4 / v ' ` V " / }j Subdivision Name CSM Number ® Public /Commercial - Describe Use l ® ) V ❑State Owned - Describe Use []City ❑Village Township of Pleasant V alli III. Type of Permit: (Check only one box online A. Complete line B if applicable) 4 ' 0 New S st ❑ Replacement System y ep ys ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner / IV. Type of POWTS System: Check all that appl ❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil © Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Qarnber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other explain V. DispersaVlrreatment Area Information: Design Flow (gpd) Design Soil Application Rat gpdsi) Dispersal Afea uired (sf) Dispersal Vea Proposed (sf) I System Elevation 600 0.6 600 ,/ 600 105.50' VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 1200 1200 1 Wieser x Aerobic Treatment Unit Dosingcbamber 800 800 1 Wie x VII. Responsibility Statement- I, the undersigned, assume r ponsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plu 's Sign MP/MPRS Number Business Phone Number Roger Nelson MP226497 715 - 273 -4444 Plumber's Address (Street, City, State, Zip e) 122 East mmit Avenue Ellsworth, WI 54011 VIII. un /De artment Use Onl pproved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Dat Issued uing Agen Signa e o tamps) Surcharge Fee) �/ ev El Owner Given Reason for ��((// Q IX. Conditions of Approval/Reason or Disapproval � �. S ST OWNER: W-64 Septic tank, effluent filter and x �� dispersal cell must all be serviced / maintained L� /�/ , as per management plan provided by plumber. 2. All setback requirements must be maintained as Per applicable plam (to the County only) for the system on paper not less than 812 x 11 inches in size SBD -6398 (R. 01/03) Jeremy & Rita Raverty P.O. Box 81 River Falls, WI 54022 I NE %,SW%,S29,T28N,R17W N Pleasant Valley Township St. Croix County Scale I" = 40' Weiser 12001800 tank BM #1= 0 ' Top of PVC pipe 0.88' above r BM #2 = 103.35' p of spike in tree �� L o rce main y 6 r v H 0- t a v Q� T 1 I j ti er Page 8 of 8 Safety and Buildings 4003 N KINNEY COULEE RD commerce LA CROSSE WI 54601 -1831 iscon TDD #: (608) 264 -8777 �•commerce.wi.gov /sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary February 06, 2006 CUST ID No. 226497 ATIN: 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 PLAN APPROVAL EXPIRES: 02/06/2008 Identificafir °n Numbers Transaction ID No. 1236534 SITE: Site ID No. 709234 Jeremy & Rita Raverty Please refer to both i lentifteahon numbers, 165th Street above, m all v Wisp6 ndenc6 with the a96 C Town of Pleasant Valley St Croix County NE1 /4, SW1 /4, S29, T28N, R19W FOR: Description: Proposed Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1060454 Maintenance required; 600 GPD Flow rate; 18 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 101), Pressure Distribution Component Manual Version 2.0; SBD - 10706 -P (N.01 101); Biofilter 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 us'e: • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. • 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 POWTS 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 • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. 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. • Comm 83.22(7) - A copy of the approved plans specifications and this letter shall be on -site during construction and open to ins ecn tion by authorized representatives of the Department which may include local inspectors. P.O.W.l'.S. Conditionally APPROVED ROGER D NELSON Page 2 2/6/2006 Owner Responsibilities: 0 The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - 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). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. 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. • 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. 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 Gerard M. Swim POWTS Plan Reviewer - Integrated Services (608) -789 -7892, Mon. - Fri. 7:30 am to 4:15 pm W7$M12T cods „G3 jswim@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application E INDEX AND TITLE PAGE CF � V FD JAN 3 020 Project Name: Jeremy & Rita Raverty S AFCIV BUI LDINGS Owner's Name: Jeremy & Rita Raverty Owner's Address: P.O. Box 81 River Falls, WI 54022 Job address: 165th Street Legal Description: NE 1/4, SW 1/4, S 29, T 28 N, R 19 W Township: Pleasant Valley County: St. Croix Subdivision Name: Lot Number: Block Number: Parcel I.D. Number: Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan Designer: Roger Nelson License Number: MP 226497 Date: 01/23/06 Phone Number: 715 - 273 -4444 Signature: A ,, �-- 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) D1V1S!uN � SAFETY AND BUILDINGS • Pagel of 8 O0ARRF NDENCE 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) 15.00 Site Slope ( %) 104.00 Contour Line Elevation (ft) 18.00 Depth to Limiting Factor (in) 0.60 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 60.001 Dispersal Cell Length Along Contour (ft) = 10.00 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) a Center or End Manifold 3.33 Lateral Spacing (ft) If N above, enter the elevation ft 3 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 3.00 Estimated Orifice Spacing (ft) = 10.00 ft /orifice 2.00 Forcemain Diameter (in) Forcemain Length (ft) Does the forcemain drain back? Y ' 90.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 20.39 Forcemain Drainback (gal) 15.17 Vertical Lift (ft) 55.93 5x Void Volume (gal) 1.69 Friction Loss (ft) 76.32 Minimum Dose Volume (gal) 23.36 Total Dynamic Head (ft) 24.72 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x x 1.00 1.50 x 1.25 x x 2.00 1.50 x 3.00 2.00 x 3.00 x Gallons /Inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1200.001 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Weiser 800 - 325 -8456 1 Manufacturer E I gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Infor mation 800.001 Dose Tank Capacity (gal) JZabel 1- 800 - 221 -5742 1 Filter Manufacturer 22.241 Dose Tank Volume (gal /in) IA100 Filter Model Number Weiser = Manufacturer Project: Jeremy & Rita Raverty Page 2 of 8 Mound Plan View 1 /10 B 'Observation Pipe J K _ � ......................... :.: -+ '• L. L. L..• ti,. .,.L.•,.•,.L.•.•L.•,.:.L.•,.•.. •.. •,.•,.•,.•, '•.•.•L•L•L•'.•L •'. • L••.••. 5 W L.. .•.• A ,r.r.1•, • ::r:1':: :::r.r. :� �� ��r� �:�:r:; :r.f:j:f:; .r. ::: .:. r � fL f.. •. f� f .� •.: � fti : f: f: f: fti; .' f: f . :1 . t — . L t . . . I .. ....................... L Mound Component Dimensions A 10.00 ft E Elft in H 1.00 ft K 12.06 ft B 60.00 ft F in z 23.30 ft L 84.13 ft D 18.00 in G J 573 ft W 39.03 ft 600.00 (ft Dispersal Cell Area 1 1997.73 (ft) Basal Area Available 10.00 (gpd /ft) Linear Loading Rate 1 6.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 107.27 (ft) —� Trrrrrr... G 1 H .rrrrrrrrr 2rrrrrrri,. rrrrrrrrrrrrrr177' rrrrfr r,..- F Dispersal Cell 106.00 (ft) Lateral 105.50 (ft) —0. — Invert Dispersal Cell :::::::: Elevation E :: . D :::: :::::::::•. .. . . . •. •. . . . . . _. . . . . .... 4 L 4 104.00 (ft) Contour Elevation 15.0 % Site Slope Geotextile Fabric Cover Shading Key a �T Dispersal Cell See lateral details on 10 _ Topsoil Cap c °• 1.5 ft L• •L•L• + ' Page 4 for number, size, r•r•: •r•r• � �r;: •: •: •r c 5 © rrrrr Subsoil Cap 0 r r'�' L rti' L � ti:ti' and spacing of laterals. ©0 ASTM C33 Sand `-° •. .r' r ' _ r ' r F Laterals are equally a jtir�. ; ti ; ti;ti tip. ;, :• ;. 4 Y ® ®Tilled Lay d 0.5 ft Typical Lateral r;r;; spaced from the Y C W L'L "•'ti' •' ''ti'ti'' r•:•: r•: •r•r•r•:•r•: Tll distribution cell's ❑5 r•r.:., Aggregate o :.:.:;:.: •:.: •:;. •:•: centerline in the *'- A * distribution cell (AxB). Project: Jeremy & Rita Raverty Page 3 of 8 End Connection Lateral Layout Diagram Center the laterals over the A & B dimension •= Turn -up vW ball valve or clean out plug P All laterals are identical I<- X I Holes drilled on the bottom of the lateral S equally spaced Laterals & force main of PVC Sch AO S (per COMM Table 84.30 -5) Force main connection via tee or cross to manifold at any point. Number of Laterals 3 Orifice Diameter 0.125 in Lateral Diameter 1.25 in Orifice Spacing (X) 3.08 ft Lateral Length (P) 58.52 ft Orifices per Lateral 20 Lateral Spacing (S) 3.33 ft Orifice Density 10.00 W /orifice Lateral Flow Rate 8.24 gpm Manifold Length 6.67 ft System Flow Rate 24.72 gpm Manifold Diameter 1.25 in Total Dynamic Head 23.36 ft Forcemain Velocity 2.52 ff/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 Disconnect 4 in. min. _ Tank component is properly vented F— Alternate outlet location Forcemain diameter Weiser 800 - 325 -8456 Manufacturer 2 in. Cap acityl 800.00 Gallons Volume 22.24 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 20.54 456.80 C B 2.00 44.48 P ump off elevation (ft) C 3.43 76.32 90.83 D 10.00 222.40 D Total 1 35.971 800.00 Doe tank elevation (ft) 3" Bedding un er tank. 90.00 Alarm Manuafacturer JS. J. Electro Systems Alarm Model Number 1101 HW Pump Manufacturer JGoulds —� Pump Model Number 1PE 51 Pump Must Deliver 24.72 gpm at 23.36 ft TDH Project: Jeremy & Rita Raverty 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 Zonin 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 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 monthl Pressure System Laterals should be flushed and pressure tested every 1.5 years Moundl Ins ect for ponding and seepage once every 3 years 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 • XMGrade 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: Jeremy & Rita Raverty 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, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet fitter shall be cleaned as necessary to ensure proper operation. The fitter 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 flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, 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: Jeremy & Rita Raverty Page 6 of 8 L(g GO,lLDS PUMPS Submersible Effluent Pump PE PUW SPECIHGTIONS MOTOR FEATURES Pump — General: General: ■ Corrosion resistart • Discharge: IA" NVPT • Single phase construction. • Temperature: 104 °F (4MI • 60 Hertz • Cast :ron body. maximum, continuous when • 115 volts ■ Thermoplastic impeller and fully submerged • Built-in thermal owrbad pro- cover. • Solids handling: r:° teclion with automatic raset ■ Upper sleeve and lower maximum sphere. • Class 6 insulation. heavy duty bail bearing APPLICATIONS • Automatic models include a • Oil -filled design. co float switch. • High strength carbon steel ■ Motor is permanently Specially designed for the • Manual models available, shaft lubricated for extended following uses: • Pumping range: see PE31 Motor: service life. • Mound Systems performance chart or anve. • .33 HP, 3000 RPM ■ Powered for continuous ' EffluenVDosing Systems PE31 Pump- • 12.0 Maximum amps operation. • Low Pressure Pipe Systems • Maximum capacity: 50 GPM • Shaded pole design ■ All ratings are within the • Basement Draining • Maximum head: 25' TDH PE41 Motor. woddng limits of the motor. • Heavy Ditty Sump; PE41 Pump: • .40 HP, 3400 RPM ■ Quick disconnect power Dewatering • Maximum capacity: 60 GPM • 7.5 Maximum amps cord, 20' standard length, • Maximum hear: 29' TDH • PSC design heavy duty 1613 S1TW with PE51 Pump: PE51 Motor; NEMA 5.151 three prang, • Maximum capacity: 70 GPM • .50 HP, 3400 RPM 115 wait grounding plug. um • Maxim head: 37' TDH • 9.5 Maximum amps 0 Complete unit is heavy duty. PSC design portable and compact, METERS FEET • Meftnical seal is carbon, - ttB1' ceramic, IRM and stainless t -• c —� .- % i :. moons: FW1, PHI, PE91 steel, ...i:. . :i -. �...: i 35 ■ Stainless Gees fasteners .. , .... 1 _. .._.. .. ....�....... ..f �r EN f 30 2 AGCY USIINGS ,..... .....�.. -i �1 F 2 5 CR l u s �..a...........1_... Toad ID LK M aura { 'r ......�_. t = * r E s: ' CSA 222106 Stand" 15 i �. r- . -.. - ,. Grtsdiln sibrtb�b pElooldEl .t.. t,• 1 ...;...;._ 4 1 t ' T 1 - t i t ._ Gaft hNp is ISO qoM R T r 1 ;... 40 50 60 ` 70 GPM 80 F4 e- 7 01 0 R .2y,72 10 iS r1" G1mAds 1)s rr 2002 Goulds Amps G �O CAPACITY Effective ee N""d er, 2002 IPE31 /4' A> ITT Industries A A t Jeremy & Rita Raverty P.O. Box 81 River Falls, WI 54022 NE %,SW%, S29, T28N,R17W Pleasant Valley Township St. Croix County Scale 1 " = 40' Weiser 12001800 tank BM#1=10 0 , Top of PVC pipe 0.88' above grq� �/ BM #2 ;=I 03.35 p of spike in tree o rce main y ,6 kA r a � v y V 1 �3 i sr aa2' Page 8 of 8 • lo land ED o Wisconsin Department of Comore Division 2p� 1- T p 1 3 Division of Safety and Buildings u u T with Comm , Ws. Adm. Code NTY Comity ST. CROIX Attach complete site plan on papa in .Plan must include, but not limited to: vertical direction and Parcel I.D. 024 - 1033 - 90 - 000 percent slope, scale or dimensions, cation and distance to nearest road. Please print all information. Re Date Personal information you provide may be used for secondary purposes (Privacy Law. S. 15.04 (1) (m)). r Q v Property Owner Properly Location ■ JEREMY & RITA RAVERTY Govt. Lot — NE 1/4 SW 114 S 29 T 28 N R 17 E (or) W Property Owners Mailing Address Lot # Block Subd Name ar CSM# P.O. Box 81 -- - - City State Zip Code Phone Number . El Village ■ own Nearest Road River Falls, WI 1 54022 ( 715 425-9455 165th Street Q New Construction LlseEl Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: Parent material till Flood Plan elevation if applicable � , e ft. General comments (Second test conducted because of location of house and driveway) and recommendations: Mound System - 1.50 & sand fill - 0.6 Loading Rate E Boririg # ❑ Borin D Pit Ground surface elev. 101.60 ft. Depth to limiting factor 18 n. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture &nr ture Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. 'Efr#i I - Efr#2 0-5 10YR2/1 - sl 3fsbk mvfr as 3vf-co 1 0.6 1.0 2 5 -13 10YR2/1 - s 2f-ma&sbk mvfr cs 2vf-ce 0.6 1.0 3 13 -18 10YR3/2 - sl 2f- ma&sbk mvfr ai 2vf-co 0.6 1.0 4 - l 10YR3/2 flf 10 YR3 /4 sl 2fa&sbk mvfr as 2vf-co 0.6 1 1.0 5 21 -24 10YR3/2 cld 10YR4/6 sl 2fa&sbk mvfr - 2vf-co 0.6 1.0 2 ring # Boring 97.06 23 a Pit Ground surface elev. ft. Depth to limiting factor n. Sot Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Mu nsell Qu. Sz. ConL Color Gr. Sz. Sh. - 0101 - 002 I 0-6 10YR2/2 - sl 3f-msbk mvfr ab 3vf-co 0.6 1.0 2 6 10YR3 /6 - sl 2f -mabk mfr ash' 2vf-co 0.6 1.0 3 23 -27 10YR3 /6 f2d I OYR5 /6 cs & gr Osg ml aw 2vf-co 0.7 1.6 4 27-34 10YR3 /6 c2d7.5YR4/4 is lfabk mvfr aw lvf -m 0.7 1.6 5 34-40 10YR3 /6 c2d 7.SYR4/4 s Osg ml - 0.7 1.6 6 40- - - ti1Uc - - - - - - ' Efllurent #1 = BOD > 30 220 mg1L and TSS >30 150 mg/L ' Effluent 02 = BOD < 30 mg& and TSS _< 30 ng11_ CST Name (Please Print) CST Number Mary Jo Hollister 224832 Address Date Evaluation Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 11-29-04 (715) 426 -1775 Property Owner RAVERTY, Jeremy & Rita Parcel ID # 024 - 1033 - 90 - 000 Page 2 of 3 Boring ❑ Boring # E] P Ground surface elev. 105.80 ft. Depth to limiting factor 28 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stnxdure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 1 0 -11 10YR2/2 -- sl 2f- ma&sbk mvfr cs 2vf-co 0.6 1.0 2 11 -22 10YR3 14 -- sl 2fabk mvfr cs l vf-m 0.6 1.0 3 22-28 10YR3 /4 -- cs s Osg ml cb lvf -f 0.7 1.6 4 28- -- -- c /till -- -- -- -- -- -- F-1 Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 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/1f in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Ef1#2 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 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. BD- 8330Te t R.07 /00 S ( ) FtOf IRAN i AQW NOR s , h >a "W/ � �, (� • - 1�I000MMIffi51r1DY1LK p p 8 D ° E �� I i . Iod i5 - Te o F14'7.W Vi CELLuot.t u I 'l o'i � I a _ J a n ri 1 14'm rive. x Wisconsin Department of Ckimmerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accordance with Comm 85, Ws. Adm. Code County ST. CROIX Attach complete site plan on paper not Less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 1033 - 90 - 000 percent slope, scale or dimensions, north arrow, and location and distance to /pegie-0mad. j Re 7'(ve� Please print all information. Personal information you provide may be used for secondary purposes (Privacy Laws " $.04 Property Owner NE Im SW 1/4 S 29 T 29 N R 17 E (or) W H & RUTH NOLTE, etal (Buyers: lerenaf Govt. Lot Property Owner's Mailft Address tact # Block # &W. Name or CSW 1647 18th , �ve�e City State Zip Code I Phone Number QCAy ❑Vllage Nearest Road Hammond, WI 1 54015 715), ,7961 �2656' 165th SUM , " PI.-s2rit Valley j New Construction Use Resider Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or comrrwdal - Describe: ft. Parent material till Flood Plain elevation if applicable N A General comments Mound System — 1.25 ft. sand fill — 0.6 Loading Rate and recommendations: t ) g ng # 0 Boring G roun d surface elev. 101.51 ft. Depth to kniting factor 21 in. El Pit Sol Application Rate Depth Dominant Color Redox Description Texture Structure Conroe Boundary Roots GPD(ff pti in. munsell Qu. Sz. Cont. Color Gr. Sz- Sh. *Eff#1 *Eff#"12 1 0-7 10YR2/2 sl 3f-msbk mvfr as 3vf-co 0.6 1.0 2 7-16 10YR3/6 sl 2f-mabk mfr cs 2vf-co 0.6 1.0 3 16-21 10YR3/6 sl & gr 2ftk mvfr CW 2vf-co 0.6 - 1.0 4 21- filyc — F 2 ❑ Boring # [] Boring 97.06 23 El pit Ground surface elev. Depth to linift factor in. - Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Shlicwm Consistence Boundary Roots GPD/fF — in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - 091 - 0192 0-6 10YR2/2 A 3f-msbk mvfr ab 3vf-W 0.6 1.0 2 6-23 10YR3/6 A 2f-mabk Infr aw 2vf-co 0.6 1.0 3 23-27 10YR3/6 f2d 10YR5/6 cs & gr OS9 ml aw 2vf-m 0.7 1.6 4 27-34 10yR3/6 c2d 7_5YR4(4 Is I fabk mvfr aw lvf-m 0.7 1. 6 5 34-40 10YR3/6 c2d 7.5YR4/4 s OS9 ml as t 0.7 1.6 6 till/c — — Eftient #1 = BOD, > 305 220 mg/L and TSS >305 150 mg1L Eflluent;12 = BOD5 30 mgA_ and TSS:5 30 mg1L CST Number Signature CST Name Pease Print) Mary Jo Hollister 224832 F F�W F k's Telephone Number Address 1—i - Date Evaluation Conducted W9875 690th Avenue, River Falls, WI 54022 07-02-04 (715) 426 -1775 R PLOP PLAN pAOI-3ff -� '1201'M OUTA m. H 4 Pan+ A) ATE e*o RS . A "46 oM - # = T DF C RFiE . S YE I00 Sw sEe. z _ IN "Ili . 2s' a sr c arp't of VASCO Ash &b ° _ D -5m BONG ° w / PxRa No CDMM S3 PROMM o 40 - d a cs © (3rn 2- y � Ad m LA I C$D�ii;�Alfo � I 1� I� I � I} I I fe rAfM I 1 - I �f I 1 N I Pe �{ I ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buycr e t rr, � i b_ fir. dY Mailing Address _ / (� 5 (n1 <)0C) C+ Property Address .0 f �-f I. ra�lY ,� (Verification required from Plrvl ng & Zoning Department for new corustruction.) City /State oS��ef cl/_S t. ✓ 6 402" parcel Identification Number 0 2 G 10 33 , l 0 -000 LEG DE=PT Property Location A t_ t/- , S � _ r/d , Sec. 29 , T e– 6 N It % 7 'W, Town of Subdivision — -- . Lot # �. CertMed Survey Map # , Volume , PaSe # Warranty ed # �' (((��,..���/// ,volume Page # 6 .� Spec house Vol no Lot lines identifiable yes no §YSTEM N.AJ EN, ANCE_& - M OWNER CERTIFICATION Imptoper use and maintenance of your septic system could result in its premature failure to handle wastes. Prager maintenance consists of pumping out the septic tank every tLM years or sooner, if needed, by a licensed pumper, What you put into the system can aif'eot the function of the septic tank as a treatment stage in the waste disposal system. Owner nuimtenanee responsibilities are ecified in Comm. 8 .S p eP § 3 2(l) stud in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to subnsit to St, Croix County planning & ZorLing Department a certification fbM signed by the owner and by a master plumber, journeymen plumber, restricted plumber or a licensed pumper verifying that (1) the on-siu wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than W full of sludge. 1 /we, the undersigned have read the above requirements and agree to maintain the private se disposal eywom with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification atadng that your septic system Isis been nmaintaiaed must be completed and rat atod to the Sr. Croix Comity Planning & Zoning Department within 30 days of the ftee year expiration date. I/we certify that all statements on this form are true to the best of myieur knowledge. llwe am/are the owner(s) of the property described above, by virtue of a warranty dood recorded in Register of Deeds Office. Number of be+diro /I-- I /..,./ 0 6 S4VATLt± OF APPLICANT(S) DATE ""Any infbrtmtion tat is misrepresented may result in the sanitary permit being revoked by the Plansliag & Zoning Department Include with this application a recorded warranty deed torn the Register of Deeds Office and a copy of time certified survey map if reference is made in the warranty deed, (REV. 08 /M 02/0212006 THU 9:01 FAX 715 386 46 ST CROP 0 0 RHO OF DE X 0002 1003 • �.•2836 368 771416 UTZARK 1. vmm MISTER IF BEEN ST. CAOI= CL, MI STATE BAR OF WISCONSIN FORM Z 2000 am3a p FM mr a am DoaoratrlbadKr WARRANTY DEED M/111204 s2z23P I T= DEED, made bdw= R. R. NoNAW Rat E Nola, hmbmd VAlfiLVM ;Dll;1D and wife as joint 1Cnm and Lwy A. Notice and Jme B. Nolw hmbmd and EMP vide as join Greater, and iftemy W. Rwmw ow Idta M. Ravi w. 71ld1SIn$ B.A. husband and wile, as Sumivars* W r!W Prop", Cslaama Ormw. fbr a valmble cottsideradm co nt p and waasots to (wee FEE: the fo0 esrsbe Cormy, Stabs of Wis suttee i• PMISs 2 e Na dwM Q=nw of the Sou&vmm QgwW (NE % of SW Section 29, Township 2a Nom mie Ra 17 West Town of Plow= Valley, St Croix comly, Wie mmL *a /R /a Henry R. 18olte N@w turd Rctm Add=; Min 400 R - Tftk Saile�115 Exceps" to warnmtiea Hadmm WI 3 016 F.esat cn% muricd m and rW*po&wnw of record Saar. 437US 024.1033A)04W Pmrcd1lidii Mamba (PIN) This h bomesmW propem. Dated this 1 8 1 ? JU&I 400 I �u ' K R. 74 * E. Notre !1►QST rR,cA'1'lOrl ACKNOWLEDGME STe OF WISOONW am= bade the this 8 °= day of the above mmecl H.R. Thies G and am& It Noise` hmbmd and wire as joixt tmmts to me ATE BAR OF WISCONSIN lmow,t be De peraan(s) who e>oe ftd the 6otmg " aum tmd by § 70bA6 Wis. Soft) - the saa�. TEAS B&TR AOff WAS DRAFM BY Pcom • Fran dt - Scevm IC BtwR mmry of W 50 Em Fiffi std St Paat. MN 55I01 toly is ijfw mate dohs: ) (SiBa m Hwy be a pad. m eat seaaaw3L) 'lWmat of I'+tlaolle �a a+grcaprei4y watt be gpaa ar peel bdaurNleir aka WARitAMWD= SlAIEiAH�wISCONSaY >�011M1�ta12010 02/0212006 THU 9102 FAX 715 986 4687 6T CROIX CO REG OF DEEDS W003 /003 - U- -2636P 363 state of 5 r� Chanty of /"/c' C E ss. On before me appeared m me personally b-OWn to be the persodW described in and who executed the foregoing instrument and ad nowledged that she executed the same as their/h' and deed. ac ptAA _ ! 1 1 ,fil = Notary Publlc - e• �p� „a R �GOULDS PUMPS �Er_Z/K Submersible Effluent Pump lee 4 3885 PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. APPLICATIONS ■ Shaft: Corrosion - resistant Single phase: ■ Bearings: Upper and stainless steel. Threaded • Built -in overload with lower heavy duty ball bearing Specifically designed for the design. Locknut on three phase automatic reset, construction. following uses: models to uard against • All single phase models • g g g p ■Power Cable: Severe duty Homes component damage on feature capacitor start rated, oil and water resistant. • Farms accidental reverse rotation. motors for maximum Trailer courts Epoxy seal on motor end ■ Fasteners: 300 series starting torque. provides secondary moisture Motels Schools stainless steel. • '/3 and 1 /z HP -16/3 STTOW barrier in case of outer jacket Hospitals ■Capable of running dry with 115, 208 and 230 Volt damage and to prevent oil three prong plug. wicking. tandard cord is 20'. • Industry without damage to • 3/ -2 HP —14/3 STOW with g • Effluent systems components. Optional lengths are available. bare leads. ■ O-ring: Assures positive ■ Designed for continuous Three phase: g' p SPECIFICATIONS operation when fully • Overload protection must sealing against contaminants submerged. be provided in starter unit. and oil leakage. Pump • ' /z -2 HP —14/4 STOW with • Solids handling capabilities: bare leads. 3 /4 ' maximum. MOTORS AGENCY LISTINGS • Discharge size: 2" NPT. ■ Fully submerged in high- ■Designed for Continuous • Capacities: up to 140 GPM. grade turbine oil for lubrication Operation: Pump ratings are Tested to UL 778 and • Total heads: up to 128 feet and efficient heat transfer. within the motor manufacturer's ® CSA22.z 108 Standards TDH. recommended working limits, cip By Canadian Standards . can erated continuous) • ■ Class B insulation be o U5 Assoaadon Temperature: P Y rile AR38549 104 °F (40°C) continuous without damage when fully 140 °F (60°C) intermittent. submerged. Goulds Pumps is iso 9001 Registered. • See order numbers on METERS FEET reverse side for specific HP 40 130 _SERIES: 3885 voltage, phase and RPM's 120 - Bt H -- -- - - - — - - -} - - — SIZE: 3 /4 " SOLIDS available. 35 - -- RPM: 3500 & 110 170 { — -- - -- -- -- -- -- - --- --► 5 GPM - - - - - -- — - - FEATURES 30 100 --- - }. - -- -- - - } - -- - -- - -- - -- - -- -- - -- - - -- -- -- s Fr - -- - - -- - -- -- -- - -- -- -- ■ Impeller: Cast iron, semi- ° a 90 - - open, non -clog with pump -out V zs 80 — vanes for mechanical seal a 20- 70 a - - -- - -- - - - — + - - - - — - - — - — protection. Balanced for ; 60 smooth operation. Silicon __ _ ____ ____ ___ __ ___ — .__ -_ bronze impeller available as o 15 50 0 W an option. 40 - - - E - � - - — -- — - - - - - - -- ■ Casing: Cast iron volute type 10 30 for maximum efficiency. 5- zo 2" NPT discharge. 10 -- -- -- - - ■ Mechanical Seal: SILICON ° - - CARBIDE VS. SILICON ° 0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 GPM CARBIDE sealing faces. 0 10 15 20 25 30 35 m /hr Stainless steel metal parts, CAPACITY BUNA -N elastomers. Goulds Pumps © 2002 Goulds Pump (% ITT Industries Effective October, 2002 www.goulds.com B3885 l