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HomeMy WebLinkAbout030-2131-08-000 4 ° 3 0 N 0 G N a O C w © 0 +aim N U O U L O E�a Naw� ro Cc N O N C > N O. m 0 C N O 0.0 I !fir N (Cp W .+ N N L N N U C N O N c E ro N N O N O C Z V 7 N N 0 N Z ro ro N _ C U) 3 L - - ro N U L N > U ' ' Q N 2'O . W E o y 0 v o Z m m co P N t- Z m c O c C7 - io O 2 d C - (D Z 'a o o - a ° � a E ro m r�lJ i� aD fn i X N L •� � O O C O CL�0 0 O Z C Z w N _ _ E Z C A E > N CJ N N � L C9 0. N N d .I c _C } y - F y - F y - 00 3 � o 0 Z o00 •IV _� '' oaaa tZ o N III t!1 J U V O N O} Iry Z o U ::i E (3) o 0 0 5 ° IL c m � W �1 IL p N Q A *i o v .' Q O CAS O N 0 C Q 0 7 O OD (O I V O U IL 0 9 co v G O _M N N >. (O C m co C •, N M N ( i r x Y ) M M 0 O C ( T (0 O U • y' O N U) (n O Z N X IL " (n .am a CL w • C. 11t ,V d C 0 N O 3 0 O m f r m 0 > > c (D pry (D I m m 3 M z, z x m z O U1 p � � a ro � � W W C i�i!_l; • O N 4R Oo ; N O CD d 7 O O p O (D N O O O C7 ! --I N OD CL > O F p e� 7 O Q C A O D M W D D a a o h 0 CD CD A n z p (D O O Cl) N 0 a !Y 3 CD O O O c C', c 3 N N y CD 3 6 O G A m x � N �1 � d T N O1 Cf O D D O tV m m • N Z I W !I D C C N 0 a 3 7 (D 6 F O ? z n N c ;-a CL A W w w p z 0 3 p ;u 0 : N 3 m p N m I A CL a o' T N C z a 0 N i a. A I ti N �O �I A O CD DC tyn O p V � C a F �.nsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 506186 0 ffl GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, x.15.04 (1)(m)I. Permit Holder's Name: City Virlage X Township Parcel Tax No: Murphy, Martin I St. Joseph, Town of 030 - 2131 -08 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: Q 1 10 • & 23.30.20.1062 TANK INFORMATION V ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Am Septic Benc �a /ob. 10� • o Dosing A lt. B M -7_ -X A f Aeration Bldg. Sewer 3 V ;-,ill . D /o Holding SU t Inlet TANK SETBACK INFORMATION s Ht 0_Utl?? TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / ' Dt Bottom Dosing Header /Man. Aeration Dist. Pipe G Holding Bot. Sys m _ h 9c4A 04 — V O• �`. Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover t GPM 15 0 SL Model Number ZS. TDH Lift Friction Lo Sy Head TDH Ft Forcemain 166 gth Dia. Dist. to Well SOIL ABSORPTION SYSTEM �' 4lJLa 11Z lAe.� BED /TRENCH Width Length No. Of Trey>slles PIT DI ENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS "� O 1 • 3 � VV 1 mit SETBACK SYSTEM TO P/ BLDG WE LAKE /STREA LEACHING Manufacture INFORMATION CHAMBER O Ty Of System: UNIT Model Numb + t * !� �. RIBUTION SYSTEM Heade :11 ifold Distribution II W T x Hole Size x Hole Spacing T to Air Intake Pipe(s) IV v 7 V Length Dia Length Dia Spacing_ 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: /01 inspection #2: / / 1 ___ .__. r.._.___._ .__,_ ____ .nn ❑ennc innnf tin cc 1 1n w Tonni DOMAh cottlor'c r lah nAR Parcel No: 23.30.20.1062 i PAGE OF # L 3o Z a FE Gil �u - ----- CALE:1 "= BM 1 ELEVATION 169- BM I DESCRIPTION AP 06 i BM 2 ELEVATION 1� 2, 0' j BM 2 DESCRIPTION a= i� - ---- - - - - -- SYSTEM ELEVATION S g. Sy Lr w C r 9 4, 5 ® � SYSTEM TYPE CON'T'OUR ELEVATION A) 6 / r v� 3 J ) P F v � SIGNATURE �� ��- 2 DATE CDR."" 5� �' �P6"Xrs 902 .9 yc>> 5 ............... 90 .4 ............904 t... , .. ..... .....�. ... 902.7 X 89.4 X X .909 4 1 f i ® 904.8 4 x ;X 900.7 CRE 907.0 X 908.0 _ x 908.3 LOT ; 9011- 3. 3 3.9 a i 9 �C I`@ .. 898. x . • • • ` I D x 90 I • i 9( x OT 9 i a 8 .7 3. CRES 1 � (2.10 03.8 1 X 900.70 .0. .O 1 897.0: i 0 x : H. .4=903.0 oa 33� .. ....... �.... X 901 ° I� r ..I. ............. 1@ X 901.6 1 �, comrrterceml.gov Safety and Buildings Division County 201 W. Washington Av P.O. Box 7162 .�'�`T� � SCO nS h Madison, WI _7162 r (t — y ) Sanit� Number to be t;lled in b Co of Cotmr J b (.c, O p Sanitary Permit Applicatio State Transaction Nytmber In accordance with s. Comm. 83.2 1(2), Wis. Adm. Code, submission of this form to the appro gove 1 i i4 unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owne OW are Project Address (ii'diff ent than mi ilingad s) submitted to the Depannxnt of Commerce. Personal information you rovide may be used for ririary I t�us�x in accordance with the Privacy Low. s. 15.44(1) {mj Slats. �A i rli cation Information — Piense Pri All it irrit ation RECE N uperty Owner's Name Parcel N 4u �Y P / SAY 4 �npZ 113 Z Property Owner's Mailing ddre � Property Location — � L— 4 e, eY ^a .✓t� �dit�P ST. I City, State Zip Code Gave Lot ��_ V., section 2 3 lj+/ot GJr j '0� 2 (circle one)— 11. Type of Building (check all that a t Lot is T l N; R ___ F. o pn y) 6k _ -0 1 or 2 Family Dwelling - Numherul — Subdivision Name block PubliclCommercial - Describe Use _ sU�M. P_ iti ❑ City of ❑ State 0%ned - Dcsci ibc Use CSM Number ❑ Village of - Z f� (—t�G� a l rownof _ — Ili. Type 0 f Permit: (Check only o e box on line A. Complete lin B if applicable / ew System D Replacement System ❑ Treatmemt/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) J i F O Permit Renewal O Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner I�V�. Tv a of PO WTS System /Comr)onent/Devirp (Cheek ail t hat a > I IEl1 Jon- Pressurized In -Ground 11 Pressurized In-Ground ❑ At -Grade ❑ Mound 2 24 in. of suitable soil 0 Mound < 24 in. of suitable soil v 0 Holding "rank ❑ QthCr Dispersal Component (cxplain) Q Pretreatment Device (explain)___ V. Dis ersal/Treatment Area Information: e5 lc Design Flow (gpd) Design Soil Application R�[e(gpdsl) Dispersal Area Requtr, (st) Dispersal Area Proposed ($0 Systern Elevation ✓ _ S gS9 S 3 e�arJ c o �/ 1 VI. Tank Info Capacity in Total # of Manufacturer Gallons _ C;allons Units o o + v l New Tanks Cxistwg Tanks f� / � �� �.✓ PD `D r! a V v t Yip i� t7 0. Septic or Hold-,% Tank Dos ingUiamber �� � � VII. Responsibility Statement- 1, the undersigned, assume re sponsibility for installation of the POWTS n on the attached plans. Ilumeer's Name (Print) Plumber's Signature P PRS Number Business Phone Number G yx.e r �/� � 27p O 3�'G -3 ixl Ilumeer's Address (Street, City, State, Zip> Cod) ZV Vill. County /D epartment Use Only _ Approved E!�ZMiive-Rem,, PPermmmit Fee Date ssuued Issuin gent Signature or Denial 5 � /�a 7 IX. Conditions of Approval/Remons for Disapproval 81FtTEM OWNERt I 1. Septic tank, effluent filter and dispersal cell must all be services / maintained as per management plan provided by plumber. �- 2. AN setback requirements must be maMtained e system and submit to the County only ou paper not less than a in x t I inches in size SBD -6398 (R. 0 1/07) Valid thru 0 1 /09 s IN Aj ) 4N, ( 19 AN z� VJ,416k F ill- M C _ � b s � K 0 J Q l 3 v � A 4pc qw r r Wisconsin Department of commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code minty . Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must Cr include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all info �, ._..._. �g - -- Reviewed Date Personal information you provide may be used for Property Owner F'rppeily Location I r r^ % J O f G Lot N w 1/4 J (✓ 1/4 S_ 3 T 3 N N R E (or W Property Owner's Mailing Add Lq # Block " Subd. Name or CSM# fl I l S.e�/,er s � /`e City State Zip Code hon dC- - -- - City ❑ Village Town earest Road _ S y ® New Construction Use: ® Residential / Number of bedrooms Code derived design flow rate ����0 GPD ❑ Replacement f ❑ Public or commercial - Describe: Parent material 5k — _ Flood Plain elevation if applicable Y4- n• General comments 51e rY\ e 2� p S() �w Ql 9 -1 S and recommendations: Y I e / 0 3.7 El Boring # ❑Boring pit Ground surface elev. 9 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 v- l I 1 12 I I 2 I r C S l v • 5 . S 2 0- I � U Lq 14 — S t 0 � 5 rr�r � 5 - `l (A d r 2-� Boring # ❑ Boring 1 `� pit Ground surface elev. CJ V d�U ft. Depth to limiting factor in Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/1t in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 -$ b 3l — S I 2 r)o -d(, "v- c I V 5 $ Z $`32 L — 5 i L 2r- ,rr,Vr- c rr�S CAS ml l Z Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < ISO mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number ACIQ. Date Evaluation Conducted T Address elephone Number � L.1�_ ,� -OZj`' Property Owner eacr Ci Parcel ID # Page of 3 3 ` Boring #• t ❑� Boring l=T Pit Ground surface elev. I, D Lt ft , Depth to limiting factor _ In. Horizon Soil Application Ra Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl= In. Munsell Ou. Sz. Cont. Color Gr. Sm Sh. 'Eff #1 • •Eff /12 i - 2-rf - •OJC4k m C5 1 v V 5 Z - 7 -17 Ili r Lt - . . tic. 2mgbk mfr c5 - ,-{ F Boring # ❑Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rai Horizon Depth Dominant Color Redox Description.._ _. Texture Structure Consistence Boundary Roots GPD /fl In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 •Eff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. R Depth to limiting factor In. Soil Application Ralf Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPD /ftr In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff #2 • Effluent #1 = BODS > 30 <220 mg/L and TSS >30 < 150 mgA. ' Effluent #2 = BOD < 30 mg/t4 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. SBI113I0 (R07100) Property Owner ec), C} Parcel lD # Page of Boring #. ❑ Boring Spit Ground surface.elev. Lo L. LL R Depth to limiting factor In Horizon - l Soil Application Depth Dominant Color Redox Description Texture Struchrre Consistence Bounda In. Munsell Qu. Sz Conl Color -' ry Roots GPD/il= Gr. SZ Sh. •Eff #1 •Efl Z 7- l Iv (-41-1 C- Zm"sbk cS — y 7] - L_ F Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to fimiting factor In. Horizon Depth , P Soil Application F p Dornlnant Color Redox Desai lion _ Texture Structure Consistence Boundary Roots GPD /fl= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Effh ❑ Boring # ❑ Boring ❑ Pit - Ground surface elev. R Depth to limiting factor in. Horizon Application Ra on Depth Dominant Color Redox Description Texture - Structure Consistence Boundary Roots GPD /fl' In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff #2 ' Effluent #1 = BODs > 30 <220 mg/L and TSS >30 < 150 mg/L, • Effluent #2 = BOD < 30 m _ M. and TSS < 30 mall_ The Department of Commerce is an equal o , qu 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. M i))0 (-07/00) F 1 PAGES OF 3 NAME a La LOT# LEGAL DESCRI ION V ZV6 0 2a Ror SCALE: I"= BM I ELEVATION 100. BM I DESCRIPTION BM 2 ELEVATION 9f30 BM 2 llESCRIPTION - -- -- -- - - -- SYSTEM ELEVATION Iqp ji ,9 SYSTEM TYPE CONTOUR ELEVATION /00.6 — rt1'1M - /U 7 • u I �6Z o � I t SIGNATURE G DATE f 45/07/2007 04:55 7153815961 CAMERON HOMES INC PAGE 02 1 . ! Illai i ll III Iii Ill Iilll illl III I ills IIII t : a 9 a 9 State Bar of Wisconsin Form 2 -2003 849849 WARRANTY DEED KATHLEEN H. NALSH REGISTER OF DEEDS Document Nwnber Name ST. CRO CO. NI RECEIVED FOR RECORD 05/04/2007 10.30AM THIS DEED, mate between Lee Sisals m_ Homm LLC, a Wisootuin LiM*d WARRANTY DEED Liability Cow — — — _ EIEIWT 1 ("G1anw." whether an or mare), REC FEE: 11.00 and Marlin A. Mvqft gA Lstn M. Motphy husbalW and wifi; TRANS FEE: 252.00 PAGES: 1 ("Cisanler�" WbCtbcr one OF roam). Oranw. for a vatwble eonsidemdon, conveys and warrants to Chmatoe dw following R.ow4a0 Arco described teal estate, together with the resits, profits, 6xtams and other appumtmnant haeresu, its SL Croix County, State of Wisconsin ("Property") (if more Now and Return Addmea space i6 p , pkace attach addptdoal): River valley Ablota • We Lot S, Plat of Settler's Clot in the Town Of St. JOSM11, St. Ceoix County. Wisconsin. 1200 ttatfrd SOeet. sots sot Hwdw& W1 5 Together with and mkject to a joists driveway casement as shown on Ow Plst of Fit* No, 26"26s Settler's Gioaa and m Dedumioa of Common Driveway and Aocm FAmmens recorded is Vol. 2286, Page 021. Document No, 777051. 0342131-08 - 000 Parcel Idoolks6 m Number (FM IU* is not Aowak" popwty. (u) (is not) Exceptions to wwrsntim. Efts mmft lesttrhtimem and rWs- &(-wsy of record, if my. Dated M1 3% 2007 Lea Signume Homes Id,C - (SEAL) (SEAL) • • David L. Lee (SEAL (SEAL) AUI'HEtMCATION ACKN0WtZDGbMNT Stgnatare(s) STATE OF WISCONSIN ) autlterdcvtod on S} Croins COUNTY j U. • Personally lions ow*gjl, 130 2007 , TITLE: hGOMER STATE BAR OF WISCONSIN (If an, • s to me kno (tj cxes:utad ft fore`oing authtlrired by Witt. StaL $ 706.06) i *i� ed llte almte. THIS INSTRUMENT DRAFTED BY: Dom Qial (A4 Edam P�ndrie. NW 55344 NOTti/ TM eta A STAN FORM M audostemsot y MOA�ICw7 =111702M ell0�l1L mi tum"Imm W'MtRA"V OMM O 3003 4TATL BAR OF rvraoar am FORM M 14m � ?Ype mule below ripW ' lafI 05/07/2007 04:55 7153815961 CAMERON HOMES INC PAGE 01 lool • /0 I ; C>>o. I �+r �Noe w I l ! I ' .. wln 31140 WIMN 3M1 3Nn im I I `f. COUNTY PLAT OF: S ETTLER'S GLEN LOCATED IN PARTOFTHE NWV4 OFTHE SWV 4 PARTOF THE NEV40FTHE SWV4, PART OF THE S9314 OFTHESWV4 ,PARTOFTHENWV40FTHESEV4, THESWI /40F THE SEV4 OF 6BCTION 13 AND IN PART OF THE NBV4 OF THE NW 1/4 OF SECTION 26 ALL IN T30N, R]AW, TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN. Ncnm THE RECRMAU)NAL MAIL EASEMENT tl••4a7swlIO TV _ AND THE CONSERVATION EASEMENT _ _.__.__.__.__.__. .__._ _.__-- _.� --- _- SHOVM ON T16 PUT ARE CONJEYED — •w�iw�tST V TO THE TONN OF ST. JOSEPH. m•mrdir5i3Tril fwvi i' " " ..— .• _ �.._. . — q LOT 8 LOT 7 a 000Ap1ES a000 SO.F ■ � 180.880lW FT. �� 18088180. A. :. VOL LOT a 3000 ACAFA / • . L tv •wp `Y < G N►4477'W iN.M A. S:' ... M.ry T. ................ At HW.L j -400.0 \r Lora : ui/ LO yO 1 E 30.M W. d o cT. ' I ''e : �♦ LOT 4 f 1Y.0.�808.0 ♦ 1.OW ApOB ����' H.000 AROB -1 I h � r ♦ - 111,eee eo. rr. I Le.Q -100.0 r.: F; L3Q�tt06D HW.L. wl /WA—AE ,Vy / WA—AE ................. ................. . EAee.ENr M `\ .; ` T 1 .. ......_ ......................r `r / J EneEreiJT I LOT ryto H.W1_ttOtt0 1 t Fr. \ ♦ 4r I aaao nc110 . 1 N y Lao..see.o ♦: LOT 19 \J txAP+en sr. .y i Q �\ EA89ABVTC a002ACJ0 \ fNB�B1r1 ' 1 y Gt /, ` iC \ `� :' ♦:�. teo.'im tl.Pr. \ k LOT 12 1 Lcrr I J I a� p✓ I \\ 1 sooxAalFa '♦ \ ♦ \: At fir.\': ✓— .'n,.ere.na. .y� «+..a+Kie . LOr 1R 1 L O._eeeP ♦� \♦ LOT 17 LOT 10 L 0o1T1 w ST = M atr O.EOTE0. BWM1YIm AW AttINO ` ` \ / , _ SIcN LAND SURVBYING INC. TIIGAII[II OI LT. Ce®[ CO1pTY. W 1�IOY CI]RIY MAT M ` RL'aK p 11Y OiY10C I110V W OOE1itK1 TAY SAL[2 NOW W1110 `\ / `w4 1, .✓: MIOlON /II6r li�i1/ TAYEf QI ACON. AgE2AiM1 K Ol4amu6t�: �1.J00.1MST9R L /rwvml\ , ✓[V11jgr� M lMO 1MCW ®p THE PLAT Ot SETTLLYf fLQI \ �� VP 4MQMW MTE ' CfAN1Y TREAPIAfII '. \ \ •. @ ` :`is :`� MPAII�►01P .p "'1111 ` Q• �P \ si /O�NOEt9DYfMI ' tt+m eluruteltw na nvaTN e/: wtts,wooew B(.cLE N FEET Yg W. YDO¢ w. m SHEET 3 OF 5 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �e><- Mailing Address I —n f- n'1 Property Address (Verification required from Planning N q g for new construction) P City/State t�"fj /.v i Parcel Identification Number LEGAL DESCRIPTION Property Location /VA/ 1 /4, : C. V4, Sec. 713 , T _2 0 N -R-29 Town of St J O Sao H -s Subdivision G Lot # Certified Survey Map # Volume . . Page # Warranty Deed # , Volume . Page # Spec house ❑ yes to no Lot lines identifiable /14 yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 Zoning Office within 30 days of the three year expiration date. . r 51 SIG ATURE OF AP IC 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 owners) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. R 5 / 3 /o7 SIGNATURE OtkPPLIC DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. "" " *' Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the wananty deed • POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION L— Owner YBTEM SPECIFICATIONS - � Se tic rank C a Permit !# - P ap City /,ZS• al ❑ NA Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent F ilter Ma nufacturer La,b �� G NA Number of bed rooms Y Q NA Effluent Filte Mod el ��� p NA Number of Public Facility Units ,Q NA Pump Tank Capacity g w 17 1 J❑ NA Estimated flow (average) • �. O 0 gild Pump Tank Manufacturer W ��, S e ❑ NA Design flow (p (Estimated pe , ( mated x t .5) Pu mp Manufactur r +� p e G ❑ NA Soil Application Rata al /da IW Pump Model Cl NA Standard Influent1ffiueent Quality Monthly average' Pretreatment Unit p NA Fats, Oil & Grease (FOG) ; 30 mg /L 0 SandlGravel Filter (O Peat Filter Biochemical Oxygen Demand (BOD S 5220 mg /L © NA ❑ Mechanical Aeration 0 Wetland Total Suspended Solids (TSS) 5150 mg /L C7 Disinfection © Other: Pretreated Effluent Qualitv Monthly average Dispersal Cell(t) ❑ NA Biochemical Oxygen Demand (SOD.) 00 mg /L 0 In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L Q NA Q At- tirade ❑ Mound Fecal Coliforrrt (geometric mean) ( 510 cfu/100M _ _❑ Grip - Line ❑ Other: Maximum Effluent Particle Size Y in dia. p NA 49thar'" 17 NA E3 NA J 4?thsr; ❑ NA * Values typical for dornesuc wastewater and septic rank effluent, t)ther: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(si At least once ; every month s) ..__..._. ,__ � (Maximum 3 years) Q NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Insp dispersal cell(s) At leas pri ce every; _~ ©monthls) - year(s) (Maximum 3 years) 0 NA Clean effluent filter � � At least once ovgry; O monthls) -�� n NA I / At e Y arts) . _ _.___..___ _ M Inspect pump, pump controls & alarm 71 At la._,. once every: ^- ❑ mont p NA -- - - 4— ____ Flush laterals and pressure test At least once every: .. , D monthls) ❑ NA El V ears) _ other. At least once every: ❑month (s) ❑ NA Other. -------- �. ❑ yearls ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS In$psctur; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tanks) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any track up or ponding of effluent on the ground surface. The dispersal cell(sl shall be visually inspected to cheek the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the imrtnediate notification of the local regulatory authority. VVIien the combined accumulation of sludge and scum In any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shalt be removed by a Septags Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code, All other services, including but not limiters to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of :sl 2 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION Page of' For new construction, prior to use of the POWTS check treatment tankle) for the presence of painting products or other charrica(s . that may impede the treatment process and /or damage this disporstlt Gelll$ }, If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the Infiltrative surface. During power outages pump tanks may fill above normal highweter levels. When power is restored the excess wastewater wi!i bra discharged to the dispersal coil(*) in one large dose, dve►loadln th e cell And may result in the backup acku or . luent. To avoid this situati h p Surface discharge of on ave the contents of the � um, e 9 p R t.,nk removed by a Septage Servicing O era r ri +� power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating t he p • r to n trols to restore normal levels within the pump tank, pump controls to Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact. the area within 15 feet down slope of any mound or at -grade soil absorptkut twee. Reduction or elimination of the following from the wastewater otrsarn may Improve the performance and prolong the life of the POWTS: antibiotics; babv wipes; cigarette butts; pondoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat, foundation drain (sump pump) water; fruit and vegetable peielings; ja*oilne, grease; herbicides meat scraps medications: uil: painting products; pesticides; sanitary napkins; tamlaoni[ and wptAr aof #aria brine. ABANDONMENT When the POWTS faits a:ndlor is permanently taken cut of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits she(( be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excav soil, gravel or another inert solid material, ted eir►d removed or their covers removed and the void space filled with CONTINGENCY PLAN if the POWTS fails and cannot be repaired the following Milbsures have been, or must be taken to provide a code compliant replacement system: l7 A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturpanee and compaction and should not be infringed upon by required setbacks from existing and proposed structures, lot lines and wells. Failure to protect the replacement area will result in the need for a now soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules In effect at that time. D A suitable replacement area is not available due to setback and;or sot) (imitations. Barring advances in POVo "S technology a holding tank may be installed ail a left re . rt r. sR �o epleCd the failed FOWTS. 1 �C7 The a;te as not en evaluated to identity s sVkable { eplacement area. Upon failure of the POWTS a soil and site evaluation be per to locate a suitable replacement area. If no replacement area is available a holding tank may b Calla s a last resort to replace the failed POWT8. El Mound and at -grade soil absorption systems may be reconetructed in place following removal of the biamat at the infiltrative surface. Reconstructions of such systems must Comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP ARID OTHER TREATMENT TANKS MAY CONTAIN LETHAL DO NOT CIi�CIjMSTANCES. GASSES AND /OR INSUFFICIENT OXYGEN. ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK U040 ANY DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DiFFICULt" OR IMpQt4SIBLE. ADDITIONAL COMMENTS POWTS INSTALLER P21til MAINTAINER Na me ; Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOC AL RAG LATORY AUTHORITY Name , Z one Phone 'This document was drstted in compliance with chapter Comm 83.221214b)(1)id)&M and 83.54(1}, (2) & 13), Wisconsin Administrative Code. START UP AND OPERATION Psge _ ot•. For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting t r may i p g p oducts or other cherri t m e � y p d:s the treatment process and /or damage the die r li a ' s tha ps sal ce is), if high :oncentrations are detected have the contents of the tank removed by a saptage servicing operator prior t4 use, System start up shall not occur when soil conditions are frozen at the infiltrative surface, Luring power Outages p ump tanks may fill above normal highwater levels When power is restored the excess wastewater will be discharged to the dispersal ceills) in one large dose, overloading h e cell s) and m ( A. a result in >$ Y the backup .ffluent, To avoid this Situation have the contents of the p utnxt tank removed by a Septage Servicing Operator surface w to restorir q power to the effluent pump or contact a Plumber or POWT Malntainer to restore normal levels within the Pump tank. asssst in manually operating the pump controls to Lo not drive or park vehicles over tanks and dispersal cells.. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption eras Reduction or elimination Of the following from the Wastewate stream may improve the performance and prolong the life of the, POWTS: antibiotics; baby wipes: cigarette butts; condoms; Cotton swabs; degreasers; dental floss; diapers; d fa,_: foundation drain (sump pump) water; fruit and vegetable peellhgs; gasoline; grease; herbicides; meat edications; painting products pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system ysrem is properly and safely abandoned in comp lia nce Once whir chapter Comm 83.33, Wisconsin Administrative l e Code: • Ail piping to tanks and pits shall be disconriactod And Clio abandoned pipe openings sealed, • The contents of all tanks and pits shall be removed And properly disposed Of by a Septage Se rvicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following Measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaivated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from di sturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation, to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. 17 A suitable replacement area Is not available due t4 setback and/or soli lima technology a holding tank may be installed as a last reaprt to �ep(ace the failed FOWTS s Barring advances in POV�'; S [3 The site as not en evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site lV evaluation n be performed to locate a suitable replacement area. If no replacement area is available a holding tank may b tails s a last resort to replace: the failed PANTS, Cl Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must oornply with the rules in effect at that time, < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNOER ANY ClAbUMSTANCES, DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULt. QR IMPOSSIBLE. ADDITIONAL COMME POWTS INSTALLER POWTS Mil iNTAINER Name i `iA L Phone 7 ! — .3 8 ~'�' / 1./ Mons — F SEPTAGE SERVICING OPERATOR (PUMPER( L 4 B4 LATORY AUTHORITY Namel Phone �j� _ 3$� _ This document was drafted in cnmoliance with chapter Comm $3 &(f) and 83.54(1), (2) & 13), Wisconsin Administrative code. • SF PTI(_` TANK PUMP CHAMBER CROSS u ECTIuN AND SPECIF;C :T'ION 4" Cl VENT PIPE 12" MIN. A$O E GRA;),E WEATHERPROOF 26' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE - --•- -- WITH CONDUIT MANHCLE COVER FINISHED GRADE W/ PADLOCK F 4" CI RISER -- - LABEL — - ..._.._- 4" MIN. 16" Slv ". R 6" MAX. j •� aVLET WATER TIGHT SEALS GAS - s ` TIGHT ` FJA PPROVED �PPRQYED ,,,A SEAL ,ADM OINTS WITH WE 3' A PPROVED PIPE I SOLID — ON ' ONTO )N TO � � SOLID SOIL SOIL PUMP OFF ELEV. FT. ---•— E OFF' RISER IT X RMITTED ONLY IF TANK r 1 - MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING U NDER TANK CONCRETE PAD SPECITICATIQN§ :SEPTIC / DOSE TANK MANUFACTURER: 11UMBER DOSES ?ER DAY; `y TANK SIZES: SEPTIC 1'�,S Q GAL, DOSS VOLUME INCLUDING DOSE _ GAL. FLOWBACK: /!'9 GAL. ALARM MAN'�lFACTURER: .,,,►L'�.��. 4APAC I TIES: A = „L INCHES a q6 Z GAL. MODEL NUMBER: __ DL,V � SWITCH TYPE: � & %S B = �2 INCHES = "i� GAL. PUMP MANUFACTURER: G C = 6 INCHES = GAL. MODEL NUMBER: d ti SWITCH TYPE: D = INCHES = GAL. . J'r R C: REQUIRED DISCHARGE RATE L40 GPM PUMP 6 ALARM WIRING AS PER ILHR 16.23 WAO VERTICAL DIFFERENCE BETWEEN PUMP OFT' AND DISTRIBUTION PIPE . . IQ. FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . . - 2.5 FEET + FEET FORCEMAIN X Q,.4+ © FT /100 FT. FRICTION FACTOR . , 57 FEET TOTAL. DYNAMIC HEAD — FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH DIAMETER LIQUiA DTPTR -39' Q J &,4L SIGNED: LICENSE NUMBER: ? Q4 DATE: I/88 �(b]GOULDS PUMPS Submersible AM Effluent Pump �s 3871 EPO4 EP05 APPL ICATIONS • F"ulty submerged in high a EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower 5peciticaily designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing following uses: lubrication, and efficient improved performance. construction. heat transfer. 0 Casing and Base: Rugged • Effluent systems thermoplastic design provides AGENCY LISTING • Homes Available for automatic and thermoplastic strength and corrosion • Fam1s manual Operation. Auto Canadian standaras Assoaadlon • Heavy duty sump mati, models indude resistance. • Water transfer Mechanical Float Switch ® Motor Housing: Cast iron (CSA listed model numbets end • Dewati�nng assembled and preset at the for efficient heat transfer, in "F" or "C ".) factory, strength, and durability. SPECIFICATIONS ■ Motor Cover. Thermoplastic Goulds Pumps is rso k101 A*irered. • Solids handling capability: FEATURES cover with integral handle and float switch attachment points. ' /4' maximum. ■ EPO4 impeller: Thermop'as- � power Cable: Severe duty • Capacities: up to 60 GPM. tic Semi -open design with rated ail and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size: 1 NPT. seal protection. • Mechanical seal: carbon rutaryJceramic stationary, BUNA -N ela5tomers: • Temperature: 104°F (40"C) continuous 140°F (60''} intermittent. METERS veer , • Fasteners: 300 series -- stainless steel. ----- 30 _ 5 c,Fha • Capable of running 31 dry without damage to 8 i. components. Q 7 ' Motor: u • EPO4 Single phase: 0.4 HP, v 6 20 115 or 230 V. 60 Hz, 1550 a - RPM, built in overload with 5 automatic !eset. • EP05 Single phase: 0.5 HP, 0 E�aS 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. 2 EPO4 • Power co" d; 10 foot 5 standard length, 16/3 1 _ STOW with three prong grounding plug. Optional 20 0` 00 10 30 40 c0 PM foot length, 16/3 SJTW with three prong grounding plug ---- --- --� -- ' - - — __ -��_ -- (standard on EP 05). 0 2 4 6 a 10 12 m +:h CAPACITY G oulds Pumps 0 2000 Goulds Pumps ITT Industries Effective February, 2000 83871