HomeMy WebLinkAbout020-1439-06-000 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal Information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]
Permit Holders Name City Village Township
Sophia Ashley Rubbelke TOWN OF HUDSON
CST BM Elev. llnsp BM Elev IBM Description
TANK INFORMATION ELEVATION DATA
TYPE
MANUFACTURER
CAPACITY
Septic
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO
PIT
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
Dosing
Aeration
Holding
PUMPISIPHON INFORMATION
Manufacturer
Demand
GPM
Model Number
TDH
Lift
Fnctton Loss
System Head
TDH Ft
yForcemain
Length
Dia
Dist to Well
SOIL ABSORPTION SYSTEM
STATION
BS
HI
FS
ELEV.
Benchmark
Alt. BM
Bldg Sewer
SUHt Inlet
SUHt Outlet
Dt Inlet
Dt Bottom
Header/Man
Dist. Pipe
Bet System
Final Grade
St Cover
BED/rRENCH
Width
Length
No. Of Trenches
PIT DIMENSIONS
No Of Pits
Inside Dip
Liquid Depth
DIMENSIONS
SETBACK
SYSTEM TO
P/L
BLDG
WELL
LAKE/STREAM
LEACHING
Manufacturer
INFORMATION
CHAMBER OR
UNIT
Type Of System
Model Number
DISTRIBUTION SYSTEM
Header/Manifold
Distribution
x Hole Size
x Hole Spacing
Vent to Air Intake
Pipes)
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 SeededJSodded
xz Mulched
Bed/Trench Center
Bed/Trench Edges
To
I� yes ❑ No
❑ Yes ❑ No
COMMENTS: (Include code discrepencies, persons present, etc) Inspection #1.
Location: 859 PRAIRIE MEADOWS DR
1 ) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
Inspection #2.
Plan revision Required? ❑ Yes ❑ No
Use other side for additional information.
SBD-6710 (R 3/97) Date Insepctor's Signature
Cen No
0�- I, I1-e_ Sf1N.aQaI — 336
fir,
Indusiry Servion Division
Cam}'
�1,
1400 Fy Wtlsttingoon Ave
'2, ' �: t,
P.O. Box 7162'
Madison, w1 S
Sanitary Permit Namher (to be filled in by Co.)
/
t` % SEP 15 2021
-7162
y� n
`% 10
.� .7
5- Sanitary Pe it Applicatio 3
""" an Naa�—
In accordance " h PS'3d321 .-1:'+t n Cock, nAmiutm of this form to lbc spi wut
ki PC
Prgeet Addrcss (if different dam meilmg addrew)
Is required pai g a sanitary Perron- Now, Application forms fm stafa rmd POWTS me to
the Depum¢m of Safety and Pr fmmnd Services. personal mtormatiM you provide may he used fa
1
Dumm N accordance with the Priv IA%Y, s l5. t ar Slats.
M E l
1. Iarormadon- Pkax Print All rabrnatiom
Property (),vine's Name
Pared a
�PNIA ASt)LE`� Rug tL-KE
dz.0-- Itisq-O6-W
Pmpeny 0"er s Mailing Address
Property Locroson
25 Z ot. J9
S�`i9 I�IRI1— MFAU\4S C1K+Jt
.
Govi.Lot
AAj V,_.NL %, Section
City, Swu
Zip Code
Phone Number
a� wi
s�ei�
.�,e
T` Z N, R. E
D. T of BoBd apply)
Type K (cheek a8 tW a
Itu a
I a 2 (amity Dw<Ilmg - Number of Badrmrrs
S�r�� Norse
�%i p lcz �'CfaUS
Block a
❑PublidCo unarcial-Describe Use
❑ City oC_, _
❑ Slate (Tuned - Dcscnbc Use
❑ Village of
CSM Numb"
ID. Type of Permit (Chock wly ooe box" line A. Compkae tine B if aplikles )
A.
❑ NmS yskm
Replacement S)ssnn
49
❑ Trcacnern/ttolJmg Tank Replaxrnmt Only
❑ Other fdodrfiration to Earsurrg System (explwo)
B.
❑ Permit Rmewt
❑ Permit Revision
❑ Charge of Plumber Q Penmt TfmMtr m New
last Pn:viasa I Number and Dale Imed
Betum Expiauon
ow,a:r
7 y 3-f 0 S• - i rf - l4
IV.
ofPOWCSSvtemrCom esUOevitx: CbeekAlltiat vIG
Non-Preasuri ❑ Prtsssaired Ir,Cnnxd ❑ AI -Cando ❑ Mand > 21 m, oCwrtebk soil ❑ Mead < 14 in of swhbk sort
'ffHolding Tunk ❑ Other gisperol Component ( ❑ fkerrmm"rt ()aura (mgdmn)_
V. Dis taaVfreat Arta laformatioo:
Deign Flow (gpd) Deign Sod AppID
Am Proposed
Dtgse� Area R7nt
Sysmn Elevation
S57S9
/�3, cnr ley. Qo
VL Teak lafo
capacity m
Gallo t
Taal
Galtonsg
g�
u
New Tatra
Ftoom To&,
/�
/m-
C
rC
�scsme"
i•�
!�'�
LNt Rlnhz
,�
VIL adbill
Staheseat- t, the osisonlaaaa, ans� br fYhnadea of Me POw"IS ra can as she arbcbed par
Plumber's Name (Print) PI 's Sr _ Number Barmen Plana Number
Plum 's Address; (Streeq City, Suk. Zip Cork)
I
i'.5 E Hl 5 - c-.at:TT k 5"47L
V111. Cora !De rfaacal Use ugly
Approved ❑ Dnapproved Permit Pee
s
Date Z 1
Issuing Agem
❑ Owur Given Reason For Dermal 7S.vv
17 1
IX.fttNERpprovaVIIeasoas Por Dianppra.•al3 )) v S f S Y'iFj'1 .-t
I.-Sephctank, of lueM filterand ,V ).av(�7C r' %�. if P%i�V�rJ�e l
dispersal
cell mk,jt nagement all r ddedbyp n ,r�rN_-' _/ r
as per management plan provided h lumber ' "titr-r0 s` TD �01'�O �J(,,,/ L✓)'l!�'
P. All reyuirpmenN must be (
Pill` maintained ( / /
All parappliCYllYcotla/oMlnnrces 7 r" it s
f �,, s
Anith to
Cj..V too,
7.�/btt✓IaVC �s�•�^-tc.,-t�--��� /•'iJs��Oc. a-�w%z�tsT aIa. it 3G'�
in too,
Z scar"Is
SBiM99R (R 09114)
It W-
5�5 � ;h s/u1G 4� Ivy b -s nn,. ✓�atiS�S� �cccord��
0ZJ�1n 2tv7.
R
5 PLOIT�UAN pp�
PROJECT . DPHipt 45H 'RLCb$ECKE/\ j SS'•- SS�l / "�'%�/� nnFJiDt �i DR•, a I�gON
NW 1/4 NE IMS '25 IT 29 4/B Iq W TOWN Hudson COUNTY ST.CROIX
DATE 0Cf-M. Z0Zj BEDROOM
CONVENTIONAL IN -GROUND PRP-'Jn'YRX NA CONVENTIONAL LIFT X HOLDING TANK pp,
MOUND AA SEPTIC TANK SIZE 1258 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE W LOAD RATE .7 ABSORPTION AREA gq? s of chambers 47
BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION iew Ftilter BEST Filter
❑BOREHOLE O WELL .H,R,P. 3ameasBenchmark
Well is to meet all SYSTEM ELEVATION
setbacks required by
WDNR
Alternate Benchmark Top of 1/2" pipe @ 99.0'
101
Plans Designed Using
Conventional Powts
Manual Version 2.0
Scale is 1" = 40'
150' COPY unless otherwise
/ 01 noted
2 f 3 ' 1 5' from property line
/O
r
2%0' B-3 Proper
Pro 4
Bedroom d4
House 15,
tL,k; D�va£crJc -�o�
16%Slope
2;
Area of poor soils 15
>6'
74ono
verPrairie Meadows Drive„ 12
Line
with >3' Spacing
-4 Y-Al = FicrEK oo oce
Quick4Standard-W %D7lD�
L.eachingrG;, r
with 20.0 ft2 of Area
5.8ft^2/pair of end caps
System Elevation
EMERGENCY LETTER
To whom it may concern:,
SEP 15 2021
This septic Has failed due to biomat build up in drain field and is no longer
draining properly which is causing septage to backup in the house and has
ponded at the drain field and tank area.
Please issue right away.
r
Keith Harings
Mater Plumber
Advanced Septic installation
715-703-3235
PAGE 1 OF 5
PgIof5
Pg2of5
Pg3of5
Pg4of5
Pg5of5
In -Ground Dosed -Gravity Plan
Index & Cover Sheet
compon" INar W Design References:
Version 2.0, SBD-10705-P (N_01/01, R- 10112)
Index & Cover Sheet
Plot Plan
View
Dispersal Area Cross -Section & Plan
ecifi Pump Tank Spcations
Management Plan
Attachments: Enclosures:
Pump Curve POWTS Application for Review
sv,ous TU ecno,) 'PE�Pcri Soil Evaluation Report & Site Ma -
_ '-I�j'� rAa SY�T6,h ^�WN�R�1iP Fob
Project Name I Description
Owner Narns(s): SOP+t IA A St1LO K LkNVL-K]� Phone: - -
OwnerAddress: S5a 'PRA1fZtC AGAMv,S pR, HLAbW th Zip: Sy0/!0
Project Address:
Govt. Lot - Af W 114 of N C 114, Section Z!S , T Zl N-R r q E Dot W
Township: �4uA, l County: Sr Ci?Gl%
Project Parcel ID #: 0z0-1`i i1r - 1b- CGC
Designer Information
DesignerName: MARY JO HUPPERT Phone: 715 _ 426- 1775
Designer Address: 28497 KING ARTHUR'S CT., DANBURY, WI Zip. 54830
E-mail: hollisterdesign@outlook.com Th,b`;�µw
License Number. 1859-007 o�'�;cGo1Nj`�bg
Remarks:
r
AIAHY JO
HUPP9W
D 1859
{, `P+d3t���
�Prnr+mm mraoi
Signature: O Date: g- 09. 202-1
508kim mp*ld WAch auhmow copy.
PROJECT . DPHAR
s
/� _
ASH
L� PLOT4ST-
^Ll�$ECJCE/\S5q IrzlE
M6�°�� �R., -ILAs /v
NW 1/4 NE 1/4S
25
/T 29 N4/R IQ w T(yWN Hudson
COUNTY ST.CROIX
DATE
jfy-e24 2-p2l BEDROOM 4
CONVENTIONAL IN -GROUND PRV-%UR81JA CONVENTIONAL LIFT )r- HOLDING TANK
MOUND AA SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 100
HOLDING TANK SIZE AN LOAD RATE .7 ABSORPTION AREA �qZ• A of chambers 9141/
IL BENCHMARK V.R.P. Top of 1/2' pipe ASSUME ELEVATION too' F11ter BEST Filter
❑ BOREHOLE O WELL • H. R. P. Same as Benchmark
Well ist0meet all SYSTEM ELEVATION �00.t 1D 1I, ja f io3
setbacks required by
WDNR Plans Designed lasing
Alternate Benchmark Top of 1IT' pipe @ 99.0' Conventional Powts
L Manual Version2.0
Pro 4
Bedroom
House
Prairie Meadows Drive
3, y
Scale is V = 40'
50' unless otherwise
noted
5' from property line
to
40' B-3 P
15' 1
t
-1-ia%,x.
16% Slope
Area of poor soils
Vent
>6"
of Cover
4' Lonoll2"
Q Jos•vc'
25
M'
15
Line
with>3' Spacing
Waft /n�
+tw. rleedJN
01
L ;
I cl. l c ;. sysIz7M E4.
51
�N39-;",jIt'�
+ 'tom 1= F1TLI< LL k
Quick4 Standard-W
Leaching ham r
with 20.0 ft2 of Area
5.8ftA2lpair of end caps
at System Elevation
12"", z17'�5
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC TANK(S)
S, -HIA AsnL67 lZu$BttK�
This is to certify that I have inspected the existing septic and/or dose tank
presently serving the following residence:
(Street address) $50I i'eAgjE Ili gAttWS CRNVi located
at: Nla '/4, A1E %4, Section zs , Town 2q N, Range I�r W,
Town of f1St. Croix County Wisconsin.
Upon inspection, I certify that 1 have found the tank(s), to the best of my
knowledge, will conform to the requirements of SPS. 384.25, and it (they)
appear(s) to be functioning properly.
Most recent date of inspection or service
Did flow back occur from absorption system? Yes_ No_
(if no, skip next line.)
Approximate volume or length of time: gallons minutes
Tank Capacity: I Lcc
Construction: Prefab Concrete X Steel Other
Manufacturer (if known): +HUFF
Age of Tank (if known): Doi - Nv - I
Pennit number (if known) _ 5,7q 3c6
(Lic used Plumber Signature) (Print Name)
TUAB�
(Title)
(Date)
a2 y*-5 7
(License Number) /MPRS
Form to be completed by licensed plumber (Dept of Safety and Professional
Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer
(NR 113 Wisconsin Administrative Code)
Rev. 2/2012
IN -GROUND DOSED -GRAVITY DISPERSAL AREA
Stepped Elevation Trenches with Quick4 Standard-W Chambers
3-ft Trench (down -sizing credit)
min 12"
SOIL COVER (typical)
tz"
min tench
deoth
(typical)
3c�,—i
Ilypicali ..
Highest Trench
TYPICAL TRENCH
CROSS SECTION VIEW
(No Scale)
Lowest Trench (as applicable)
System Elevations = 104.00 ft; 103.00 ft; ft; ft; _
Quick4 Standard-W
w/ End Cap
(typical) (Show location of inlet / outlet pipe connection on plan view.)
—---I-------�f---————--
�----
g = 90 ft
Provide minimum 3 ft
separation between trenches.
ft
Observathn Pipe
(typical)
Instal per manufacbrefs
� IretnxtWta.
TYPICAL TRENCH
PLAN VIEW
TT (No Scale)
�A = 3.0 It
(typical)
(typical)
\—Quick4 Standard-W Chamber
INSTALL PER TRENCH:
(typical)
(mfd by In'diratorsystems, Inc.)
22 Quick4 Std-W @ 20 ft' EISA/chamber =
440
It Instal pursuant to manufacturers nsbuctons
�J +
1 Pairs of end caps @ 6 ft'EISA/pair =
6
ft'
�NF
= Proposed EISA per trench =
446
ft, Required Infiltration Area = 857,ILJ ft` Distribution Method
IN
x
2
trenches = Proposed Total EISA = 892 ft= branched manifold
Ut
-0 -
rn
W
0
(31
O
PAGE 4 OF 5
GRAVITY -DOSED
SEPTIC / PUMP TANK SPECIFICATIONS
(No Scale)
4'0 Vent Pepe
10 it ham
Buddom
12' Mn. o> 2 0 It ebove
Estahhshed Flood Flevsho,
INn!cah
IMPORTANT:
Anchor tank(s) as necessary
pursuant to SPS 383.43(8)(g)
Finished Grade
CAPACITIES @ c� CH -r gal/in
Depth (in)
Volume (gal)
A
26.0
4, 6,0• S
B
2.0
5 2,9
[c]
50
)V -e
D
14.0
221.6-
*Pump Tank Liquid Level = tFy in
Force Main Diameter = Z in
Force Main Length = /S ft
Approved
Vent Cap
Force Main Void Volume = gal
(Cl Total Dose Volume (TDV) = 1 z•�
L(� 0.2X design flow + force main void volume)
Vertical Lift = (or l/ ft
TDH
ADD : PUMP TANK:
Volume = Mao gal
Manufacturer: TNT lcr9AT0f-
Elaclncal must mmnty wth.
SPS 316 and NEC 300
�j Wealher(xobl E+tond manhole near as necessnry
JIMCh00 Box
Approved LorJang Menhpla
nth Waning Label Attached
INpItal)
4' Mn o, 2 0 fl above
/
Establ,ved Flood Elevatwn
(Nrucel)
�A,rtlgh, Seal
Guwk D,sconneu
Vs•�.��3
,a -Mtn
_
(typical)
*TT
Weep
Ho'e
�Auproved Jowls xnlh Q Cy r^
ApPmved Pipe 3 fl onto J 'P
A
i
Soko Ground
Natal)
L�
� � �-
B
Alarm
I
on
Icl
PUMP -OFF
1_Pump
t_or
ELEVATION = e?T. _ ft
°
CMCRIa
INSIDE BOTTOM
Block
ELEVATION = `I% Do ft
Wil
3' Aponwed Baddmg Matenel Benealh Tank ._
I.3lljoc- = 0,z1
/gyx .Ito3q oqs/ P. =
z�.Sr'-2. vv5 �fv,• L I 36 r /dose
gal/dose f i5 ¢set
FXf STI f� r SEPTIC TANK(S)7
Total Volume = Laeo gal ( ) VS- )
Manufacturer(s): 14U FC
Pump Manufacturer: 7_OEr_L& P �XI5Y1V�"
C� g Ict AaWapproved-effIT n at the a rim +a k-antlet
Pump Model: all ,see allamed pump curve
Controls/Alarm Manufacturer: _'�JE RficA4 Su$ Filter Manufacturer:
Controls/Alarm Model: �4B TAydr�, •ALE.R fir. _ 17,
Filler Model:
Float switches containing mercury are prohibited
PAGE 50E-S
In -ground Dosed -Gravity Management Plan
The owes of this in -ground dosed -gravity system "I be responsilge for Its perpetual operation and maintenance
pursuant to raWkernents of BPS 382-3U, Wlsa Admin. Code. Pursuant to BPS 383.52 (2), Wisc. Admin. Code, this
System shall be considered a human health hazard N not malWaired in accordance with this approved management
Plan. FUrU mrore, all Inspection and maintenance ac tivifies &M be performed by a registered POWTs maintainer in
accordance with BPS 383.52 (3). VWac. Admin. Code.
.. llian DIUMMI AranLimits:
r` J I :•• f. 220 I rrvC; FOGS 30
Woodon
• • : of use
mechanicalo M • R
• wilds volume In anaerobic huairnart tank(e) and any distribution
x*s) (Le., distribution / drop boxes)
•neglect or Improper 4:e•: • wl f1'
• dosing Irregularities - if appocablie (La, purV re -cycling. flost switch settings, etc.)
• electrical components - N applicable (i.e., wiring, connections, switches, controls. timers, aismrw oft)
• distribullon lateral or lateral orifice plugging (measure lateral distal pressure — compare to design apeciftedon)
Maintenance Chi 8st MAINTAIN EVERY 3 YEARS (or when necessary)
o Seotic and doe* tank(s) shall be pumped by a cart6ied septage servicing operator licensed under &. 201.48 Wis.
Stars. when the volume or solids in the tank(s) exceeds one.third (113) to Ikpdd volume of the lank(s) or
as required by load ordinenca. Disposal of contents shell be pursuant to NR 113• Wise. Admin, Code.
o Effluent flillerfal &hall be Inspected! every 3 year* and shall be cleaned when necessar r to remove any
accumulated solid& according to manufacturer's spacilloetiome. A servicing period will always be greater than 12
months.
System rneintenerxe mPorb shall be submitted to the proper local govemmeM unit in aecordence with
SPS 383.55 YVise. Admirn. Coda Retort any compahent failure or magunaBon to:
Name d irxgvidual or company: ,ApvANCEn St-Ffl 57Ae 1 ATYOA/ Pho e: 745- Zt 3 , Y3
(.oral govemrneri unit 2 �X Co ro1,561AIQ 1 Ty 06VC- Zpm Phone: _ 386, - W,
Local government unitaddres&. 4Lw2.-a� !tIT— ZIP: _=g616
Any defective part of tide system OW be repaired, replaced, or removed pursuant to BPS W3.51 (1 } Wr ic. Admin.
Code. Repair or replacement of failed or malfimctlaing components shall comply with BPS 383. Wear. Admin. Code.
NO product for chemical or physical restoration of the POWTS may be used ynless approved by tie department in
accordance with BPS 384, Wise Admin. Code.
sun r r: ran
11 9,Ewlel 17', W�
if use of this POWTS Is discontinued, it shell be abandoned In accordance with BPS 383.33, Wisc. Adman. Code.
IM-1060 General Specifications and Illustrations
The IM-1D60 is an injection molded two piece mid -seam
plastic tank. The IM-1060 injection mokied plastic design
allows for a mid -seam joint that has precise dimensions
for accepting an engineered EPDM gasket. Infiltrator's
gasket design utilizes technology from the water Industry
to deliver proven means of maintaining a watertight seal.
The two-piece design is permanently fastened using a
series of non -corrosive plastic alignment dowels and
locking seam clips. The IM-1060 is assembled and sold
through a network of certified Infiltrator distributors.
Must be backfilied and installed in accordance with
Infiltrator Water Technologies, Infittrator IM-Series Septic
Tank General Installation Instructions and for shallow
ground water conditions reference the Infiltrator IM-
Series Tank Buoyancy Control Guidance.
Please visit www.infiftrutGrwater.com/-imagesipdfl
ManualsGuides/TANK01.pdf for the latest information.
111
Working Capacity
1094 gal (4141 U
_
Total Capacity
1287 gal (4872 L)
h --
AIr rspace
16 5°h
Length
127" (3226 mm)
Width _
Length -to -Width Ratio
2.3 to 1
1
Height
54.7" (1389 mm)
Liquid Level
44" (1118 mm)
Invert Drop
3" (76 mm)
Fiberglass Supports -- 2 --- —_
Compartments
1 Lx 2
Maximum Burial Depth
48" (1219 mm)
Minimum Burial Depth
6" (152 aim)
_ _
Maximum Pipe Diameter
I 6" (152 mm)
Weight 320 Ibs (145 kg)
INFILTRATOR
4 [wry .» Pak aaad
P.O. Box 78a
OM Se ,o CT 06415
eeo 5n-7oo3 • rRA an-511-1001
www.InllNretoFawater.tem
S. LUP.
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HALF GASKET
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AtIGNMCNT �� T 8
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HALF
MID -HEIGHT SEAM SECTION
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ontact Infiltrator Water Technologies' Technical Services Department for assistance at 1-800-221-44
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CONSULT F;°.CTORY FOR SPECIAL APPLICATIOMIS
EJacrieal alternators, for duplex systems, are available and - Variable level Moat swihfies are available for colltrolft single
supplied with an alarm, and three phase systems.
Mechanical alternators, for duplex systems, are available • Double piggyback Variable level float switches are available
with or without alarm switches. for variable level long cycle controls.
9fnndar.i nil mndarle _ WciNkf IQ %.c IL u M
so aerim tonal BUeeum
moats
VON&^
Mode
Lim
11s 1
Aub
94
1Mta7
13 1
Non
9A
o28
4a5
ON
230 1
AUb
4.7
1 w 1 a 7
flab
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Nun
4.7
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3o— 5
5c'LECI'ION GUIDE
1. Inlpynti anlL Operaled 2 pdo medwlml rAfth, M BI Warwo; owred r@WkW,
2 SkOb plppybea verlep(e Ind IIoe1 arlNth or double pippybm* ved" Ind,
ask edkJh. Rob r b FNW T7.
1 Modardow aAbrlretr 10awn a 10410T5.
4. S FA10712, rar odrorJ rtrodN of Bechkal Aft l .
3. Canlrol VwMa h 10-CM uesd m s oorrbd nciirebr, apaary dupba (3) or JAI
noel sygwn.
6. Four (4) hab J-Prt. Jrndbn bat br wolehplrt cmwmcWn ar wked4n
—q ferl Or (ILOW 0001,e60M 1040M
7. Two (2) hole J-Pak. for we wkWK umnection or splits.
vU i IOtI
Fur hiamfon an addled 7olro pe4ds(a* b cabby dl PIg64igl VmbW4 Lost 3,4almn, All wol-0a1fan ci cmlols.uu=Iien damesand fairing :Mould be done by a qualified
Fm1/77;aedd011Aa10ab,RAMMMKhw"Atlmabr,F11MW,&nToftw mawbe,Fl V. lieaw.ad alertrldan. All sleckiealand safely codes should be fallm'red Including the most
S100ft eSlnpd FMlpCoNld,F1111WA11m ll,eNre,PAM Zen'. N.ellonal Electric Code(NEC) and the Occupnllonal Safely and lleallhAcIJOSHA1.
For unusual conditions a reserve safety factor is engineered into the design of livery Zoeller pump.
Idro'01nrrlo.ar.Mw
WA I& P.O. BOX 16317 __—
ff IarlbrdaKY4256047 Wbdiclaw d..
arsra 36160.I-1 61
LLJJIIIiii7��iOO�..NNN Ldi.l.,KY4szt1-teal
PUMP !O_ "a° 71-mr• I(yeti 1*54M61P Qrurr%7iw sv �4� �
FAX(IM7743621 ------ -. --
KLvv.. --
oW�anw of APR 1 3 ZOO S L EV RAN� E�QRT Paoa_a_
txnrgpa9a eae plan aPar%AstDIMr1 a 112 x 11 i n s¢e. Plan mucl
���nqyi wuwuw. Tvw distance
plrJude, bLR r1o1 Nmaed to: lint and (M), AeadLon and
penat slope, stale or ns, nordl snow, aM brJtbn and to nearest road.
Please print all Information.
Pe Mtlonaaaaa you Pa.�d. nney a.e<a br MomM7 purp^ (PIt'" L.. t 15 04 (1) (m)]
/�AIaQ1
'
Parwl 1.0
R Dn./te
! �� D
prop" 4;
Pmpeny Location l
Gim. Lot/J/(,) 1/ `i/4 T N R E or, W
Proplifty s MaiWq
/O
Lot
Block p
SL*d, or CSW
i
Stale ZIP Code Phone Nuffbar
E 2, s- S6
❑ city ❑ Vi T Nearest Road
-
Ua�Residenpal l Mm tw a(bedr. Coda dwNed deslgl Dow rate GPD
❑ Replaorrbm ❑ PLblic or rcW - Dascribe
Paw Flood Plain elevation If aPP4reWe —A/ /------------ n.
General wrrrom
end rsconrrrrdedons: n
System Type `dwic/�</ya.J[ System FJevat • t7
® Pit Ground surface elev. J-l.1.! • L ft. Depth to lin ti %cbr in Sd7 Applionallon Rate
Horfmn
Doper
in.
Danklrrt Color
MLnsed
Redos Description
Ou. SL Cont Color
Teaare
Swrara
Gr. SL Sh.
Cornisterca
Boudery
Roots
-Ef #1
TIh12
o-f z
e7.r-
- 6
/. a
S<
�y
BOAy a (❑� earx'e
�1 Pit Ground rafica NavAX--a fL Daps+ be WnbM fads rt Sod Application Rate
Holklon
Depth
in.
Don *wt Color
Mused
Redox Description
Cu. SL Cont. Color
Ttomm
Structure
Car. SL Sh.
C.onamence
Boundary
Rods
GPOlR
'EfWl
'002
3�Z
s
C
nn
Acw
6
•C�
30-1r
S
l
N.¢
A4$
Ellluert at a BGD x 30 <= mprL snd TSS a30 < 11 rapt
- _
' Effluent e2 ,: SOD < 30 nq4 and TSS
_
< 30 myL
MY Minna (Pleads PrIM CST Mrnbr
gird Plumbing. Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave. New Richmond, WI 54017 — 0 7 715-246-4516
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