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HomeMy WebLinkAbout028-1006-50-000 Wisconsin Department of Commerce Count PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 499170 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Johnson, Ray Rush River, Town of 028 - 1006 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: B / 60 POW 1 CS I 02.28.17.29C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. J 1, y ioz • tiV as Septic 3 p,` Benchmark Dosing Alt. BM,�,� o Goo 1. 55 /ca •9 I �� Bldg. Sewer S' L$ 9 _ 7 ( g a Holding St/Ht Inlet S 5c % $7 St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic /pp� a Z6'-/ , /y l 15 / _ Dt Bottom 16, 9z • Z Q> Dosing A•1I Z041 � /c / Header /Man. 33 1 1") • l Aeration J Dist. Pipe ` z•- • 33 Holding _ Bot. System PUMP /SIPHON INFORMATION 41 Final Grade 1 / , / 3 Manufacturer Demand St Cover u l IS GPM LZIA �• s 5 !Da .9 ( l Model Number E4 1 n o_ TDH Lift Friction Loss System H ad TD J Ft 7, $ `7 a , (,q C •5 5 .at, Forcemain Length / Dia. �i Dist. to Well 3! Z Zby SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Tre hes PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS (01 5 // ( 13; - — 7 SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: � I UNIT Model Number: ILL 13L Ga DISTRIBUTION SYSTEM t.,tae Z ' Header /Manifold Distribution CZ� I Hole Size I 1 I x Hole Spacing i Ve t to Airr I take Pipe(s) f b C P - Length Dia Length Dia Z Spacing x 1 J SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center / 5 3 Bed /Trench Edges Topsoil , (� Yes No �es I No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: ` - J • ° / Inspection #2: / / Location: 530 200th Street Baldwin, WI 54002 (NE 1/4 SE 1/4 2 T28N R17W) NA Lot 1 Parcel No: 02.28.17.29C - r-, ( CA- 1.) Alt BM Description = 2.) Bldg sewer length = /q G �� - amount of cover = 2 1c^� t IJ tF� Plan revision Required? Yes >� Use other side for additional information. - - Date Insepctor' Signatu Cert, No. SBD -6710 (R.3/97) Safety and Buildings Division 201 W. Washington Ave., P: x 7 Madison, WI 53707 Permit Number ( be filled in by Co.) ,s nsi Department of Commerce ( )2663151 Y9 " 7170 Sanitary Permit Application State Man LD.Number In accord vh& Comm 9321, Wis_ Adm. Code, personal information ..� .2d may W used for secondary purposes C D Pmjxt Addn�s (if M twt than mailing address) L Application Information - Please Print All Info tion G r Property Owners Name Parcel # -bat#— / .Blee p A COUNTY � � '` d Property Omoes . A ddress 17 0 7. �i� �r. S/= v., section 2, c State Zip Code Phone Number /T/lfT2 00 /.t' 1� / f �� N . R Ir H. Type of B6ildidg (check all that apply) ` 111 O jC Ci.6 Subdivision Name CSM Number ®'1 or 2 Family Dwelling - Number of Bedrooms -? y-� 7 ❑ Pubiic/Commercial - Descn'be Use j ! I/� Ov `it✓ a '�" ' v a l E J ❑ State Owned — Describe Use . 5 x 1� d' ; City ❑Village �wnship of IIL Type of Permit: (Cheek only one box online A. Complete One B if applicable) A. ❑ New System ®lteplacernent System ❑ Treatment/Hokling Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal 11 Permit Revision ❑ Change of ❑ Permit Tiaasfer m New I ism Previous Permit Number and Date Rued Before Expiration Plumber Owner IV. Type of P OW'1'S S Check all that a pply) bw oaf ❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ErAt-Grade ❑ Single Pass Sand Filter ❑ Co t ucted Wetland ❑ Pressurized iwGround ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit Recircuating Sand Filter ❑ Recirculating Synthetic Media Fther ❑ L.wchmg Cnambo ODnpL= ❑ Gravel -less Pipe ❑ 0111017(expl8m) V. DispersalfFreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Requ �(st) Dispersal Area Prnposed (sf) System Elevation Ys� / so VI. Tank Info Capacity in • Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New I E>astmg Tadis Tanks I I M L G C Septic or Holding Tank 0 Aerobic Treatment Unit � f Dosing Chamber Q / G/ VII. Responsibility Statement - I, the undersigned, assmmx responsibi ' for installation of the POWTS shown OR the attached pBtas. Plumber's Name (Print) P s Si W/MPRS Number Busirnss Phone Number Pl Address (Street, City, r. Zip Code) oft A0V VIII. Coati /De artment Use On Approved ❑ Di p Permit Fee (includes Groundwater Daze � mied I 13311' Agent Sigma o Surcharge Fee) 5 C � ❑ ' en Reason Denial J IX. Conditions of Approval/Reasons for Disapproval 3 n O ,� �-� �,5 ✓�v5�' OJAP Sy$TW OWNER: I. Septic tank, effluent filer and dispersal cell must all be services /maintained as per management plan provided by plumber. 2. AU setback requirements must be maintained as per appIc" code / ordinances. Attach eompkoe plain (to Me county o*) for Me system an paper not leas Man sin 111 inches iu siae SBD -6398 (R. 01/03) �,� 7 WWI FROM : ,KEITH AND DBBIE STONER FAX NO. :17153492520 Sep. 11 2006 03:40PM PS Site Plan - Pav 8 G For. Ray Johnson Part of the NEl /4 -SEl /4 Sec. 2 T29N -Rl7W Town of Rush River - St. Croix CmMLY c m 40 Propmad 6.5 x ll6'Awffade Mood 5 Acre P* cd � sow* 0%4 a Elegy. of 9960' 1 fvmk —.o V- SPAM \ saavtrary #31� New 3 Be&wm Home 2 "Scb. 40p- Nwead 4 " Blab sewe Propmed RaverCmawk 1000/Mg Gat Combbmdm Task Il A 2801k SY. ,B O 98.00' Note: Mahkidn mW aNd 99.00' wakrUse adbada per Cmm 83.43(8)(1) Eleyodom Daft B#1= 99.12' smau WE B#2 = 99.10' Barn B#3 = 100.20' ' #1 A BM = Top of 11/4" P1pe Byre of Pmwmr Pak �P S� , Mi = Top of c"W +ae Slab, SOW Eke+. = 101.60' ASSUMED 11". — 180 Q rr- y FROM KEITH AND DBBIE STONER FAX NO. :17153492520 Sep. 11 2006 03:40PM P1 Site Flan paw 8 ° f 8 For. Rsp Johnson Pact of the NEl /4 -3B1 /4 Sm. 2 128N -R17W Town of Rush River - St. mix Camh► 0 20 40 �..■.. Prop gd8.s,: 11drAtarmkMamd SAcneParad i a l *fA a sy4w Ekv. of 99.W ff-b i •► M a. smam #3A� New 3 BeaUWN Hoare t ? "Scli. 40 P.M. Pmpawd 4 AW Sewer Propa�sd iYV Cona+s e 100016M Gat Cam6ftwim Tmk A BM 28tslk S1t $ O 98.00' AWL Makw&W mHand 9900' w&V rbw motbacbper Conan 83.43(8)(1) Eievad" Data B#1= 99.1W WELL $#2 99.1& Bffn B03 = 100.20' #1 ABM = Top of 11/4" Pf" Bak of Power Pole mr - Sam , M $ = Top ofc flew shk saw am. = law ASSi3MED XM. - 148 Q rr nnadn cArnPlete site plan on t>aPef of less matt 812 x 1 1 btcttes ' sr�. Ptah must include. but not limited to. verlyrat d bodznttt d reb dvtc6on and parcel t�- 10 newest toad. percent slope, scale o! dimerrs+ons• orlh a t a�d d by Date Please lit all infampa y P� m*m=sw. yov pwlae a wy be r T s Low- a is as tt) poll erly Owner I F Prop Govt Lot V4 _V& 1/4 'S T N R 7 E (0� e roperty Lot 4 0 P 81tx9c # Subd. Name of �tJl'� ee ling Ad&O -SS �' )O G� - C T. �e p�rown Nearest Road cis �P Ccde l4`ss �m�Y ❑ ❑ gY� ST / 4f w —r u i � z6f us ❑ New Construction., Use Residential I Number of bedraat>is et 3 Code di+aed design eor..ate 41. GPC CgReplaaement ❑ Public or eommefdal - Describe• d applicable Paw* tetateriai YL �7►/ T .[BlftAt l . 77 Hod Plain de�ra6on —r General comments _ ,# AAA VfArw As ��flr�LE and recommendations: x1 � Bating r/ fa I �_ 1 $Ormg tf t � � C,�d �v- /�3 / R Depth m 9"*& 4 ��— �" Soil A9Plita w RaG VW ;Pomz pj, Ha Depth Oortrinattt Cdar Rtsimc D Pfd Texhtre Sfrttrsuce Ca +a ,CL'Y 'EffAtl 'Eff#2 in. tl�trtrtselll Qtr_ St. Cont. Color Gr. - Sh / s _� L / .f z s - 33 — z — . s e 0 r s Borin � BOt" R DgAh to � ae�r_Y /�— SO i npaua&a Ral! F I E ] t� Pit Gnxmd sutlaae elev_ �- Testert c... �s CCe Y Roots GPDItEz Depth DoeinantColas Ds= satp6Qi 'EMM •EfF#2 in. Mrmseif ' du- Sz Coot Color folr- Sr- Stt. i L — 3 _ JS s 1 r till = �s f 30 rrr�tL and TSS � 30 tttglL - • FJOuertt #1 = SOD > 30 < 229) n%YL OW TSS X30 c 15Drngl!- CST Number ( Print) �_. 2 la j .� Date ed Telephmte Number Address Fogerty Plumbing & Perk T sting to 7.Cr- 28M fwwsg� Z ' d 9BZSSE9S T G T 9W I Ewnld AIM3903 dGS = EO 90 b1 des J o� � o J 41 Page Z Property Owner Parcel ID # P Boring # Wng ✓ ED 2 1 Pit Ground surface Slev. No, z ft. Depth to limiting factor — in• Soil lion Hate Texlura Structure Consistence Boundary Roots GPDfff Horizon Depth Dominant color d Redox Description •Eif#1 'Hf#2 In, Munsell au. SZ. Cont. Cal- Gr. Sz Sh. 2 AX cs - 7 1 ❑ Borurg ❑� # Q Pit Ground surface Slay. ft. Depth to I'imiifrrg f in Sail icaBon Rate 'x Horizon Depth Dominant Redox Description TexCrra 5truclsxe Consistence Boundary Roots GPDRF in. Munsell ou• Sz• Cont. Color Gr. Sz Sh. •emi 'Eff#2 ❑ Boring Boring # Ground surtace elev. R. Depth b I"rrr"factor in. ❑ Pit I Soil ���' Ram EJ Horizon Depth Doff*M t Cd Redox Description. Texlure Swchae Consistence Boundary Roots GPDIIE 'Efflf2 in. Murnel Qu. Sz. Cont. color Gr. � Sh. . •CaF#1 Effluent #1 = BOD, > 30 220 mg1L and TSS >30 150 mglL ' Effluent #2 = SOD, _< 30 mglL and TSS c 30 mgfL 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. saau�ooedool E ' d 9B T G T JW I Ewn AIM3903 Ciao :100 90 f' T des s -ry Fogerty Plumbing #221180 28288 McKenzie Rd. Spooner, WI 54801 (7 635 -9609 r ZeArra •`80 i o =eAd Q = J3v�tiJG O crre vo -� a* i i i f -Z �.•r�/D �,rrifLL wrs [ t t 9SESSE9STLT 9NIawnld A183903 d00cb0 90 bI dos • * A Safety and Buildings 10541 N RANCH ROAD commerce HAYWARD WI 54843 TDD #: (608) 264 -8777 www.commerce.wi.gov /sb/ isconsin www.wisconsin.gov Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary September 11, 2006 CUST ID No. 221180 ATTIC• POWTS Inspector DAVID B FOGERTY ZONING OFFICE FOGERTY PLUMBING & PERK TESTING INC ST CROIX COUNTY SPIA 28288 MCKENZIE RD 1101 CARMICHAEL RD SPOONER WI 54801 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 09/11/2008 Transaction ID No. 1315520 SITE Site ID No. 717384 Ray Johnson Please refer to both identification numbers, Ray 2 80TH St above, in all correspondence with the a enc . P. Town of Rush River iti01w St Croix County co td NE1 /4, SE1 /4, S2, T28N, R17W P N FOR: Description: At grade, 3 bedroom residence V r Object Type: POWTS Component Manual Regulated Object ID No.: 1093675 pEpAR�M PC Maintenance required; 450 GPD Flow rate; 43 in Soil minimum depth to limiting factor from original grade; System(s): At -grade Component Manual, SBD- 10570 -P (8.6/99) RR �cpa The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative gEE and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Key Item(s) • The designer proposes to install an effluent filter to achieve the requirement of wastewater particle size. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the septic tank outlet filter will be required. The outlet filter shall be installed per product approval stipulations. Reminder • The orientation of the at grade system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the at grade per At grade Component Manual. • Surface water drainage shall be diverted away from the system area. • Materials shall conform to the requirements of COMM 84. • The existing POWTS must be properly abandoned per s. Comm 83.33 Wis. Adm. Code. • Maintain well and waterline set backs per COMM 83.43(8)(i). i letter shall be on -site during A copy of the approved plans, specifications and this g construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits I DAVID B FOGERTY Page 2 9/1112006 required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. i Buildings es rves the right to require char In granting this approval the Division of Safety & es or additions reserves g q g m necessary for code compliance. As per state stats 101.12 2 nothing in this � should conditions arise making the n ce sary p p (), g review shall relieve the designer of the responsibility for designing a safe building, structure, or component. g p tY g g g p 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 p copy rovide a co 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 Patr orf POWTS Plan eviewer, , I egrated Services WiSMART code: 7633 (715) 634 -781 , ax: ) 634-5150, M -f 7:45 am - 4:30 pm pat.shandorf @wisconsin.gov cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 6 I i I RESIDENTIAL AT -GRADE DESIGN Pressurized - Sloping Site INDEX AND TITLE SHEET Project Ray Johnson At -Grade Mound Owner Ray Johnson Address 870 Walleye Court Amery WI 54001 (715) 2684783 Legal Description Prt of the NE1 /4 -SE1 /4 Sec. 2 T28N -R17W Township Rush River County St. Croix c n Iwo Subdivision Name NA Lot No. NA PEACE Parcel ID Number ENCE Plan Transaction Number Index sheet Page 1 � Calculations Page 2 3 At -grade drawings Page 3 Laterals and dose tank Page 4 Specifications Page 5 Management & contingency plan Page 6 Pump specifications Page 7 Plot Plan Page 8 Designer Davefogerty License Number Mprs#221180 Signature Phone Number (715) 635 -9609 Date 08/15/06 Designed pursuant to: At -grade Component Manual for POWTS SBD- 10570 -P (R.6/99), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST - SAS (01/81) Version 3. 11 (05101) Page 1 of 8 FROM ":KEITH AND DBBIE STONER FAX 140. : 17153492520 Sep. 11 2006 03:40PM P2 PRESSURIZED AT -GRADE DESIGN At -grade Design Waelcsheet - Sbping Site Flovra MW Sine Data EWV- (r or c) r Residential or Commercial? 300.0 Estimated wa stgpow flow ($pd) 450.0 Design wastewater flow (gpd) 5.00 96 Site sbpe 99.60 Contour elev. below lateral (ft) 43.00 Depth to 11ROM faraor (in) 0 .00 in-situ sob applic gtion rate (gpdW D{stribution Can In jonnsdion (1 or 2) 11 lfwkwtt wastewater quality 6 '00 Linear loading mite gpd/ft 0.90 Effective absorption width (n) 10.40 Max, effective width permitted (ft) 116.00 Aggregals IengH+ (ft) PrrtsatMre Dicetrlbttttan �* mil► (c or e) c Center or end lateral Connection 2 Number' of laterals 0.125 Or#!= diameter (in) e.g. 0.188 War" 1.50 Estimated oriPnre spacing (ft) 2.00 Fomemain diameter (in) 3.29 Forcemain lbw velocity (ft/see) 56.00 Foreemasl le KA (ft) y or n Does brcerrrain drain bade? 92,00 Pump tarn elevation (ft) y or m Are NA W10ree at highest point? 8.5 System hwW (ft) x 1.3 9.0 Fo cemair► dr**W* (gaq 7.10 Vertical Uft (ft) 1 52.51 5x L,aterai void volume (tom) 2 ,/ 1.22 Friction bas (ft) 61.5 Minimum dose volume (gat) 10.62 Total dynamic head (>t) 32.2 System derrtsnd (9Pm) 5 / I.steral Diameter 8electivn GaMonannCh calcaistar (optional) cs VAN V Testa t Tank CapatAy (gal) Designer r in Total Working liquid Dept (in) must saw 12510 x C*Yh (enter resUR in cog G46) MW lateral diameter 2 ar x Treavlow Tank h6wwadon 3 in x 1000 is tank talpaGty (0) Y ISM ONWA W Manufacturer Eflf wd Fitter hdorn adon Done T W* N1to"rd t" rP!L4MW!' Fil ter manufacturer 6tank capacity (gal) Filter model number tank volume (9") Manufacturer project~ Ray Johnson At -Grade Mound Pop 2 of 8 Transaction Number: y FROM.:KEITH AND DBBIE STONER FAX NO. :17153492520 Sep. 11 2006 03:41PM P3 i AT -GRADE PLAN VIEW lies s oosarv~ pose t2 typinq A 6.60 ft p B 116.002 Iles 19.33 R C 8.60 R W C p 5.00 It E 2.00 tt L 126.00 It B W 18.50 ft AxB 750.00 ft"2 © Typical in pipe. t3 m Total aggregate cell A x sbt�d +n aye ewer U = PIowul arm L x W W. and anchored AT -GRADE CROSS SECTION SvntbeW fabric cover 101.35 R F grade Lateral ebvation 100.10 R - Observation r pipe at aggregate toe E 5 % Slope Sudke corw" 99.60 ft C A ate D ew"gon =12 in. k0soil and subsoil Plowed layer over aggregate and tapered to lase below L x W = 6 in, aggregate below II � piWs), and 2 in. above pipe. Pnoact: Ray Johnson At -Grade Mound Transaction Number. Page 3 of 8 t ie r � t FROM :KEITH AND DBBIE STONER FAX NO. :17153492520 Sep. 11 2006 03:41PM P4 PRESSURE DISTRIBUTION AND DOSE TANK Lateral Diagram - CefNer Connaaaon (F x --��• a12 i.aterats & Lowe mWnat PVC sch 40 Lau hAN dr0ed rwau to artd cap 1 bw cMw Table &.—v Holes *Wd on the batton►ai tke iatenl. w Turn -up Wbsll vahm or o1mncutplua Lateral Sp�cHkaMons 0.125 Orifice dameter (in) Center Lteral conneclim point X 1.48 OriliCe spacing (ft) 2 Number leaw lt6 39 OrifWaSiibterid P 55.98 Lateral length (ft) 161 tat. d9di8 W rate (gpm) 1.50 LaWW ckuneter (in) 2.00 Forcemain diameter (in) 32.2 Sys. discharge rate (Wn) 55.00 Fomemain Length (fl) 14.82 TDH (R) Typical! Pump Chamber Layout Approved mwtft Dover win+ ~W-Proof vommg kW and WMV doom junction tic �. F" Onds Tw* oornponant is Albmelo Pwa p vaMed �� bcation 16' mM. Eieakwo as W NEC 300 wW X Appro od MW Gann 16.26 WAC Pam TuNt hdl Mclns f3alkins A Provide 114~ A 31.9 378.1 glean weep hole or 8 2.0 23.5 �+P on . B C 5.2 61.5 , T A D 120 141.6 93. Tol* 51.1 602.8 L'urp off D 92.00 It CspuWe, Pump ner S.J. Elewo Alarm manufacturer MadefO 3e714EP05 Pump model rxpnber 101-NH Alarm model number Project Rey Johnson At -Grade Mound Tra wac0on Number Page 4 of $ ss- It �/ /G Page 7 of ti i [QGOULDS PUMPS Submersible Effluent Pump 3871 EPO4 EP05 APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the lubrication and efficient improved performance, construction. following uses: heat transfer. ■ Casing and Base: Rugged • Effluent systems thermoplastic design provides AGENCY LISTING • Homes Available for automatic and superior strength and corrosion • Farms manual operation. Auto- resistance. C Aswda* o • Heavy duty sump matic models include n Motor Housing: Cast iron (CSR listed model numbers end • Water transfer Mechanical Float Switch for efficient heat transfer, in "C" or "F ") • Dewatering assembled and preset at the strength, and durability. factory. ■ Moto' C oves . Thermoplastic Gam R2416 is 190 WM SPECIFICATIONS cover with integral handle and FEATURES float switch attachment points. • Solids handling capability: Pa 1 /4" maximum. ■ EPO4 Impeller: Thermoplas- N power Cow: Severe duty • Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size: 1 1 12" NPT. seal protection. • Mechanical seal: carbon - rotary/ceramic- stationary, BUNA -N elastomms. • Temperature: 104 (40 continuous METERS FEET 140OF (6090) intermittent. 10 • Fasteners: 300 series stainless steel. 9 30 • Capable of running dry without damage to 8 2s n components. 25 7 Motor: 6 zo • EPO4 Single phase: 0.4 HP, — 115 or 230 V, 60 Hz, 1550 } RPM, built in overload with 5 0 15 automatic reset. 4 i Pos • EP05 Single phase: 0.5 HP, c 115 V or Z30V, 60 Hz; 1550 3 10 RPM, built in overload with EPO4 automatic reset. 2 • Power cord: 10 foot 5 standard length, 16/3 1 S1TOW with three prong grounding plug. Optional 20 ° 00 10 20 30 40 50 GPM foot length, 16t3 SITW with , three prong grounding plug 0 2 4 6 9 10 12 m?/h (standard on EP05). CAPACITY Goulds Pu O 2001 Goulds Pumps ITT Industries Effective May, 2001 93871 t` 7'4 7'63a U. 2 4 6 3 P 2 8 9 RATHLEEH H. WALSH STATE BAR OF WISCONSIN FORM 2 - 2000 REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROIX CO., MI This Deed, made between Andrew J. Tubbs, a single person RECEIVED FOR RECORD 11/26/2003 09:30AM -- WARRANTY DEED EXEMPT ll Grantor, and Raymond E. Johnson and Pamela J. Johnson, husband and REC FEE: 11.00 wife, holding as survivorship marital property TRANS FEE: 360.00 COPY FEE: CC FEE- PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum:) Part of the Northeast Quarter of the Southeast Quarter (NE 1/4 of SE 1/4) of Section Two (2), Township Twenty -eight (28) North, Range Recording Area Seventeen (17) West, Town of Rush River, more particularly described Name and Return Address as follows: Thomas A. McCormack Lot One (1) of Certified Survey Map filed October 2,1978, in Volume 3 102010th Avenue Baldwin, WI 54002 of Certified Survey Maps, page 705, as Document No. 352107, Office of the Register of Deeds for St. Croix County, Wisconsin. 028 - 1006 -50 Parcel Identification Number (PIN) This is homestead property. (is) 6ixtGOw Exceptions to warranties: easements and restrictions of record. Dated this � � day of JJ #0e hafK , 2003 * * Andrew J. Tubbs s � AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. — -- St. Croix County ) authenticated this day of ls— Personally came before me this Iq day of - -- - - - - - -- — - - -- _ _ - - - - -- ADI/Pry( �PI� 2 003. �atjp1rt•named Andrew J. Tubbs, a single person TITLE: MEMBER STATE BAR OF WISCONSIN ([f not to me known to be the pers S) w execn(ed the f4re4o $ authorized by § 106.06, Wis. Stats.) instrument acknowle ed th ame. THIS INSTRUMENT WAS DRAFTED BY *�L /(, r,(A► - A1tL Thomas A. A. McCormack Notary Public, State of WISCONSIN Baldwin, WI 54002 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) * Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN INFO-PRO ( 800 )655 -2021 wwwJntopro$onns.wm FORM No. 2 - 2000 cm N Z!t Zex %t e£ 08 09�f Lo Z£ r b v ,Z/ i1 N x Lu rq CY) o v( ,,., ?, dv t a I VM Y(p \ 1 or ( I ° { M M ( T t ko O Ix t ( 1 o N ` a O D U,�o � H LU ro.;p iM in N M m N 14 th M3 N „x ,S P N ( N N p tN n!^ N 0 0 UCt10 4 (� 1 4 1 1 J ro o, n u'r oo U n I aa,o i V (i w N ov N 1 O pp pp M1 N L m. mo a'I N EL i rry K a I a V) O v - ~ w U n 1 , a d' bt p U it O tl -.9 „Z /t E -.t, c N v,r r t "� � c,u I U t� j A . i I CERTIFIED SURVEY NO. Part of the Northeast 1/4 of the Southeast 1/4 of Section 2, Town 28 North, Range 17 West, Town of Rush River, County of St. Croix, State of Wisconsin, described in Volume 3 of Certified Survey Maps, page 70 as Certified Survey No. 70q____ n nn E 1/4 COR SEC 2 T28N,RITW INTERSTATE 94 ss2 °oti'ie'W' m ST. CROIX COUNTY „ 90.73 SURVEYOR'S RECORD NS 2 °4 ° BEARING REF. TO THE 351. a z EAST LINE OF SE 1/4 m,, y SEC 2, T28N,R17W G ASSUMED BEAf�ING o N 00 16 W 0 ^L $KALE 1 =15d _ M ]3 so' ?C 0 50 I00 ` 00 :C Z O /4'x3 1 R OU N D IRON WEIGH LB R rj` Oct p Z °sTad1:.Z t4 N m 70 O FS , � 7 8 LOT I r" ��tl�tp C' 4 QWx ;D 4.98 ACRES= �g N $ :Z i�NS * :z o IS � �5 :(n EXIST. GRAIN BINS' nc O CO T5' man� n� N89 744 E = yt &1345 o ° a2.Q MAO, MII r EXISTING 8U1 Q p _ C `o Go e0 o 0 [ L �� 405.21' 000 33 e9 °5744 w APPROVAL Of THIS MINOR SUBDIVISION V19 P4ATTEp „LANDS , DOES NOT MEAN A FO& BUILDING SITE OR SEPTIC SYSTEM. REFER TO H62 I, THOMAS G. KUESTER, Registered Land Surveyor, hereby certify that I have surveyed, Iw divided and mapped a part of the NE- of the SE4 of Section 2, Town 28 North, Range 17 West, Town of Rush River, County of St. Croix, State of Wisconsin, more particularly described as follows: Commencing at the East quarter corner of said Section 2; APPROVED Thence S. 00 E., 570.73 feet; Thence S. 82 W., 90.73 feet to the point of beginning; Thence S. 00 E., 271.47 feet 9EF 27 1918 Thence N. 89 E., 15.00 feet; Thence S. 00 E. 200.00 feet; ST. CROIX C�u Thence N. 89 E., 42.00 feet COMPREHENSIVc PAMSrLANNIKO Thence S. 00 E., 141.73 feet AN ZONING 00 MMITTEE Thence S. 89 W., 405.21 feet; Thence N. 00 W., 568.76 feet, to the southerly right -of -way of Interstate 94; Thence N. 82 *18" E., 351.03 feet, along the southerly right -of -way of Interstate 94, to the point of beginning. Said parcel contains'4.98 acres more or less. That I have made such survey, land division and plat by the direction of Lyle Nippoldt. That such plat is a correct representation of all exterior boundaries of the land surveyed and the subdivision thereof made. That I have fully complied with the provisions of Chapter 236 of the Wisconsin N Statutes and the subdivision regulations of the County of St. Croix and the Town of Rush River in surveying, dividing and mapping the same. DATED THIS DAY OF 1978. Volume 3 page 705 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM O"er/& Mailing Address p C y < Property Address 5 3 C7 �1 6 (Verification required from Planning &Zoning Department I new cons ction.) City /State / Ll�vt� �.v.� Parcel Identification Number 4� Y --lOyl S'o-- elqj LEGAL DESCRIPTION Property Location We '/4 , SF I /4 , Sec. � , T N R 11 W, Town of AOV- ,�l'yslz Subdivision � _ , Lot # Certified Survey Map # , Volume , Page # '— Warranty Deed # 2!K7 G3 , Volume :1 YG 3 , Page # >_S Spec house yes no Lot lines identifiable (IP no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance responsibilities are specified in §Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification 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. Uwe, 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 Planning & Zoning Department within 30 days of the three year expiration date. Uwe 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. Number o drooms ,3 ­ s ?at I DAT^ ** *Any info misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** r Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08 1057 At grade System Maintenance and Operation Spec ifications eider's Name Tri -Coup Sanitation Phone 715 386 -0114 Service Pro one 715 386-4680 POWTS Regulator's Name St. Croix Co. Zoning Office Ph System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 118 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 750.0 fe Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Freauencv Septic and Pump Tank Inspect and /or service once every 3 ears Effluent Filter 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 eve 1.5 ears Mound Insp2ct 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 at -grade 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 at -grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. 6. Areas within 15 feet of the downslope toe will be protected from compaction. 7. All other construction details are as per the at -grade component manual SBD- 10570 -P (R. 6/99). Lateral Turn -up Detail Finished • ............. ............... Grade Threaded Cleanout 6 -8" Diameter Lawn Plug or Ball Valve Sprinkler Valve Box Distribution Lateral �,,y Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Ray Johnson At -Grade Mound Page 5 of 8 Transaction Number: At -grade 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- 10570 -P (R. 06/99) and SSWMP Pub. 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 POINTS 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, ff the filter is equipped with an alarm, the fitter 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 creeds 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 shah be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. st.arade and Pressure Distribution System_ No trees or shrubs should be planted on the at -grade. Plantings may be made around the at- grade's perimeter, and the at -grade 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 at -grade 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 at- grade be heavily mulched as protection from freezing. Influent quality into the at -grade system may not exceed 220 mg/L BOD5, 150 mg /L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5 30 mg/L TSS, 10 mg /L FOG, and 10 cfu /100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the and 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. CQntincency 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 at -grade component fails to accept wastewater or begins to discharge wastewater to the ground surface, a will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by renovating the biologically clogged absorption and dispersal media, installing new piping, and replacing other 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: Ray Johnson At -Grade Mound Transaction Number: Page 6 of 8