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INSPECTION REPORT $qN-2020.321
GENERAL INFORMATION (ATTACH TO PERMIT) ro.nm
a le�cl o.TVillage uaes
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Daniel Klebe o TOWN OF PLEASANT VALLEY hip P � 024-101 $-]0-000
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Septic System and Well Inspection Report
Bird Plumbing Inc
1432 120th St.
New Richmond Wi 54017
715.246.4516
sbird@frontlernet.net
I Shaun Bird, cedify that on 9/20/20 1
XXX Inspected the Septic System (POWTS)
Inspected the Well
Obtained a drinking water sample
Property Owner/Buyer Dan Klebe Site Address 454 County Road T Hammond
As a result of my inspection, I certify that
XXX In my opinion, the septic system was, on the date of ray inspection, in workingg order and in
compliance with the standards set forth by the Department of Safety and Pr5esional Services.
Any exceptions or needed repairs will be listed below
Last date of pumping System appears to be sized for 3_ Bedrooms
In my opinion, the well at the date of my inspection, is in god condition and complies with all WDNR
standards Water sample sent to Quality Water Testing Lab Somerset Wisconsin.
Sae attached Property Transfer Wells form Any exceptions or needed repairs will be listed below
In my opinion, the septic system or the well is not working or not in compliance with the
Departmet of Safety and Public Services or WDNR See attached Property Transfer Wells
Irepectionfonn
System and all components are intent and functioning as per code. This additional structure does not add
additional waste water to the system for it is a accessory structure All structures and components meet setbacks.
Septic System maintance mformationi Pump tank every 3 years and clew effluent filter if installed once a year.
For further information, contact your local zoning office
Disclosure. This test is not a guarantee of future performance t pro#esional opinion. Usage can change from
different owners. This is not a warranty of this system Idle i all liabilry for any loss caused by reliance on this
cedicaeon. Past problems with this system,( if any) need disclosed by the seller
Shaun Bird MPRS/CSTM #226900 DNR# 7640 Date 9/20/20
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ry,NJ,nyAildte„ 459 Conmnty Rd T Hammond Wi 5406
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INYIV O.VIISI
VANANG LABEL EMBEDDED INTO
CONSISTS SENIOR REAM M
VS
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TOPPED CRUISE MATH-DANSOMES TIES
<rw VIEVI /M DIAMEIER CONNOTE (W[R (TYPICAL)
FIC EARN:
THISO`REFINEMENTSMINR
�NTV
SECTION
(TANK BASE, TOP, 6 COVER)
So Ile
52 Ile
FLOtlE PLNI
(TAN( BASE)
e HIGH CONCRETE
TURNED LETTERS
7LCOVER)
OUTLET
RANK BAS
g3 ➢ Tank Cross Section And Pump Performance Specifications
rank Mmnracturer
T=k Model Nmmber
Told I war Capacity
p
Max. Bury Depth
ppmp x. n 0rn m
Pump Model Number
Alarm Manufacturer
Alarm Model Number r/
Switch Tvoe /AC�rv,,; Cn�
Vent Mm, IV' Wes u-pmof
AboveCmde junction Box —�
With Cap
Finished Grade--���--
MaMole Min a- Above GMe
Wide Lackmg Device
Disconnect
Means
ettmgsand Reserve Capacity
A
B
OR EIev. C
Ft
D
^ Ft
-
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-
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--
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Hole
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n
/ GPI
lochs Volume Gal
(reserve)
$
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C
%
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D
i
2
3
blowers of Tad: Etev.
GENERAL INSTALLATION: The dose made is bedded and back filled in accordance wiN fire
manufacturers product appmval specifications Maximum depth of burry as specified by the
manufacturer may not be exceeded wrtbout poor approval MaMole covers exposed to funds have
an effective Inclined; devme (padlock) uostalled Piping at the Met and outlet is of approved
material, contractual to the and wfir ,aredigio finings, and lard on stable soil to prevent setdmg or
sagging The force main is sleeves with 4" Sch 40 PVC to bndge the excavation and is sealed
watertight Elmwcasemcecompheswith NEC300md Cotmn162g
10/07Igj page _of
LE40=SERIES
TECHNICAL SPECIFICATIONS
PUMP
IMPELLER
The pool shall be model
The pump shall have a VORTEX style Impeller
AM anufactured pumps, Bergen, Liberty puBergen, NY,
capable of passing a 2"sphendahsOhd.
orequal
The pump(st Mail have a capacity of
SEAL
at atotal dynamo head of_ feet. Motor size
The went sass shall be of the carbon/ceramic
shall be 4/10 horsepower, single phase, 60 hd
unitized desOn, wItl1 BUNA N ehasl0mers anti
and 115 volt operation
stainless housings.
MOTOR
EXTERNAL CONSTRUCTION
The pump motor shall be of the submarines
The pump valued, legs anti motor housing
type, oil filled, hemieticalysealed and she be
shall be may Iron castings, ASTM class 25 or
thermally protected The ovedead element shall
better. All coatings shall be powder coated
automatically Real Men motor cools
before svera ly.Allfastenermahallbeof300-
MMorwmdmgsshallbe0ftha class B asulanon
sense stainless wheel or brews.
hating.Therotorshaflsballbemadeof416wonn-
lesssteelandshallbesupportedbylower and
LEVELCONTROL
upper ball bearings.
Automatic units shall be controlled by an
The power card shall be of quick -disconnect
adjustable, memury-free, wide angle Taint switch.
design allowing replacement of the card! without
Float cab shall be equipped with a series plug for
breaking seals to the motor and/or oil chamber
mannual bypass operation. "AV"models controlled
by a vertical float switch with sense plug.
MODELS HP VOLTS PHASE AMPS
DISCHARGE AUTOMATIC IMPELLER
LE41A 4/1a 115 1 12
2"Fit NO VORTEX
LE41A 4/10 115 1 12
2"l Wide -Angle Rod v0parl
LE41AV 4/10 115 1 12
2"1 Vemew pact VORTEX
10 rod Aenavd on above ancient For 25' rod
onson a"-2- own, to ont n,wwr
Example LF41L2frr Model UEUA Wit 25P card
DIMENSIONAL DATA: / EO har PERFORMANCE CURVE nee acm
Weight. LE41 M 40 L&S ✓
Lifer, Per Mlwo
9] 303 313 454 SV
Height: 14 25e
All Width: 10]5"nnptleb) (man L 30
6
3 a
5
Mammum now tomperemm 140' F. i
5 e
EI
3a
1F
0 10 .b
io 40 M 60 70 K 90 1M 110 130 IN VW IN
mil`))° SP
usamla,wPwarat.
fAmNy Pumps • rgad Avpm 13.sawase •Da,p.mxewrmm f64te • Plwtewgos4ausp Fa.mc9�4-raao
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mmmw PRIVATE SEWAGE SYSTEM
St. Crolx
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INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Cub Plm to IN
m•MwY La w(1 N^'Il
CM III X Toni
PFral
PiOr IN
e, ROOetlJ Pleasant Vi Town Ot
020.1015-70AAD
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09281783C
TANK INFORMATION ELEVATION DATA
TYPE
MVIVFPCTOREIR
CAPACITY
STRTION
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ax
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103 7
Fs
ELMY
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TANK SETBACK INFORMATION
su>11GmM
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PUMPPSIPRON INFORMATION
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8
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SOIL COVER
COMMENTS Bname cpEe Elacrepanuea pereme vmwnl, ek)
1001 454 C T H T mmaq w1 N015A ISNE 1149TYffl W1 meb Simmil eLm .1100
1)N1Ba
2)Blee wi led°.r�z weak fe 6E. f51ar..vll I$I1 du
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Pao DIN,, gepmweP ❑Yea
Um°Nernae ar.aalllo°al mrwmeu ° IN' S 09
SCnenplR Ye» oen Inwpobw5p
Fj Na I ENE• 13
Jet
09MV C
y wi
I .DID a�vi,5
St. Croix County
Affidavit for a single POWTS
servicing Two Structures via Private Intervening
Main
Name
a I — �}i iP.pe2
name —(sworn. typed or ndmth
berry duly sworn, Antes under ovlA Ibet
of land Inealed an A
Page Do umew
Reti Free
cFac Name and Return si Croix Count,
A Paine Of Insured In In,O£ . nnl� c saawm l� 118N R q call he'll
W. town or ntY Sl Cmn a oml r wuwnem, n[mg aWy p q
reorient ssmuowrt IOl numb[r aria mSITO,nn,CSM or detailed legal
deal .3 t�i �e SF
s 9 T28 N 2 70✓ 01� /ois 7a oo7J
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on �p�m 6ECerm®Por�fo bar wml Vl'n o!disacu• IN[^ iftonallucaay lttDNrd, ea nan gta
m[r if to numbs o; uN somis lM1e
m mreo,*..slgnmcsr enwin be nnaensa oxmen mW.I1 Slid
dus A2-also al mnlemmenl
law,Artiii I nermprtm a I A Selere A r[yQj to toMIN12) 1unaarand an Men conncetheto lie
POwrSvq Pilate "ctopm Mam na el 11m mplena wuM1SPut J92 nIJq IEI IonaenlnM lM1el alulmurt of the
in0rmmion Oil h mWe to anY %rims Inter[elea m pmchssin6 this pwMRY in IM1c lawn
Dnedflas It or, of Slyinter ly, -cifea,y
A(KNOW LEDGMENT
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