HomeMy WebLinkAbout040-1328-03-000(A)
Wisconsin Department of Commerce
Safety and Building Division
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Law. s 15.04 (1[(m)l
TANK INFORMATION ELEVATION DATA
TYPE
W A 'V ? R I O
APACITY
Septic
Dosing
�? C.Ill
u
If
Aerati
Holding
TANK SETBACK INFORMATION
County' St. Croix
Sanitary Permit Noa.
644761
State Plan ID No
Parcel Tax No
040-1328-03-000
Section/Town/Range/Map No
15.28.19.2235
Header/M ifbld
Distribution
x Hole Size
Ix Hole Spacing
Vent to Air Intake
tl
pipelliq�►
7 r
L
Lengt Dra
Length Dia p
SOIL COVER x Pressum 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 1 No
Yes No
C OMMENTS_'n- Include c e discre ncies. persons resent. etc) Ins ection #1 10Inspection #2
LvJ�K� ) 6 yy � vp-h'� —pe-S
catlon:353MOELTIAA LN
Lo
1.) Alt BM Description
2.) Bldg sewer length = (1 1 d `
- amount of cover = 3,�zf Z, i,YC0/I.twtQ r7r� 1/K,fl wtJ /
3 3evi •. o ,�.NTbw��o r►"aas a►. ]deQ.2
Pen then side
Requiredti j Yes NoLLB40'�4nsePcto(s
. ( _'
Use other side for additional information.
Date nature Cen No
(A) q e�,g a--�- sW,J_0 A -t. x,45. � ,,�,off recS
5 �"fl^�` cvw�.w��. -�o w � �—► u�e�-�re.•� mar, ,
yparitgr
an Buildings Division
JUL
\\\\'��
�r .. Wjashingt n Ave., P.O. Box 7162
Sanitary Permit Number (to be 5ucd in by CO.)
'a
L�`��n, 53707-7162
` q4 �'
�O
of C my
Iry v oPn1e
%%
1�4 TO -
y
amt3ry erm4. �y wn
State Transaction Number
t� this form to
Adm.In accordance with SPS 38321(2), Wis. Ad
Project Address (if different than mailing address)
is required prior to obtaining a sanitary permit N cation forms for state-owned POWTS arc submitted to
the Department of Safety and Professional Servies. ersonal information you provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04 1 m Stars.
t/
3 53 air 6 f La nf�
L Application Information - Please Print All Information
Property Owner's Name
Parcel p o qo. — I o
E 11J
Property Owner's Mailing Address
Property Location
-5-Z to t,L 1 e A 0w DOWE
Govt. Lot
.� I., AJW '/4, Section
City, State
Zip Code
Phone Number
/� ', J
VER G�
�S /66(
cucleone)
T N; R E or4p
II. Type of Building (check all that apply) V
Lot k /
subdwwion Name
1 or 2 Family Dwelling - Number of Bedr tts
4#112f
V f<f4 e c- S ,t e^ M O
❑ Public/Commercial - Describe Use
❑ City of
❑ State Owned'- Describe Use
❑ Village of /
CSM Number
0-Town of
NE
III. Type of Permit: (Check only one bA on line A. Complete line B if applicable)
A.
S rem
❑ Replacemedt System
❑ Treatment/Holding Tank Replacement Only
❑ Other Modification to Existing System (explain)
B.
❑Permit Renewal
❑Permit Revision
❑Change of Plumber
❑ Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration
Owner
TV. Type of POWTS System/Component/Device: Check all that apply)
ebNon-Wcssiauc—dLn—Ground) ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Prreatment Device (explain)
V. Dis ersal/rreatment
Area Information h
Des i Flow d)
90e
Design Soil Application e(gpdsf)
Dispersal Area Required (sf)
ispersal Area Proposed (sf)
Elevau
Ss1
!g7 1 z
6 S
VI. Tank Info
Capacity in
Gallons
Total
Gallons
p of
Units
Manufacturer
/. �p
��
u
New Tanks
Existing Talcs
? (� -t-t ' `—`)
ppc
a U
Septic or Holding Tank
Dosing Chamber
VII. Responsibility Statement- 1, the undemigned, assume responsibility for installation of the POVM shown on the attached plans.
Plumber's N '(Print)
Plumber's ignanure
MP/MPRSNumber
Business Phone Number
e„
V 7
171$7-Z73 VSCW
Plumber's Ad (Street. City, State, Zip Code)
ALL ftJO t-t, O(
Coun /De artment Use Only
�VIII.
yv Approved ❑Disapproved
Per'/mi�tt�F�a
s
Date I�ssju/ed
Issuing Agent Signature
(v ❑
Ste_
—(
n for Dental
✓
T STEM Otio PPr vat 3)
(�
Septic tank, effluent filter and If)
dispersal cell must be gerViced / maintained
IA
as per management plan provided by plumber. ��eftaAs�Ct�+� -�o
ll setback requirements must be maintained
ao Nee c,NNmwuie uxrerptpiy KMplete plans for the systeaa and submit to the County only on paper not less tbaa a to ill inches in size
SBD-6398 (R. 11/I1)
1 r - *All property lines not Banchnuxx brs2zmMuTca
�.--- - -- are
a>1O0Rfrom � Soala«l Taak:
m a9
BM = 100.00 (970.72 MSL)
l c�' j. Top of 1" PVC pipe
�` <P< + (18" above grade)
�r i / < BM2 = 99.38 (970.10 MSL)
L ;- / 4 Top of 1' x2" stake by Pump Taint:
marked wooden lathe
Tree line (6" above grade)
**Well to be located >25ft sSdawokyw6 otrPo OWYA aorsramt
/ from septic tank(s) and >50ft dd
from soil treatment area** irpon°�`""""0fN0.7gp0°
rarpadi'leallP nfniam aepU
/ +DIaWMrtlon:
s
.J +/ j x /
M /
LOCATION MAP (aat to made)
gP-° �, 2a 1s 1 6
i
% l- /A r N 2
/ + / 2a 1
,
1
PREPARED FOR:
/ + Ash properties
_� \ �/ /- / sloeAddress:
SCALE , H 54016
t1.00Acres
ZQ' I l.agw: Lot oS Vistas of ST Croix
0' 401 SE 1 NW 1/4
S115T429N R19W
c�prrO smr.nra m. yr., roa eaw emv� as w,oe.d ti ameaw .un smr ar Lacd codm. m..r u.anrr a.o nww .nan oar r a.weoo ae/v m era. ae an. Town of Tro
arwuomm NO MYVV#W 15 M10E TMT 7M SVSTEM U.I. COWINUE TO FUL- ON POEf1lMY *vtwn mrwt a papwly nnwea"wd. ar.w" yar yv�^• "m-aawnr Pray rar HonVOW a Ora0w a and Sale: 1" - 4(r
/
Pg _L of -7—
Private On -Site Wastewater Treatment System (POWTS)
Index and Title Sheet
Owner's Name:
Site address:
Location: Lot Block , Subdivision/CSM
being part of the iE '/4 of theNw '/4, Section 1.5_, Town Z2N, Rangei-7-W,
Town of Pierce County, W I.
Parcel Identification # 0 q O - 06 - 2 49
o O O
Design: In accordance with Department of Safety & Professional Services (SPS) Wisconsin
Administrative Code ch. SPS 381 through 387 and 391. Design manual (choose one):
O Holding Tank Component Manual [VER 2.0, SBD-10855-P (N. 03/07, R. 1/12)]
In -ground Soil Absorption Component Manual [SBD-10705-P (N.01/01)]
Contents: Page 1: :k f F L F
Page2: PGO�
Page 3:
Page 4:
Pages: S'y5feFm L'(r-05 5 Sa<L
Page 6: Qw.Gk 'Y I- F-/L4A P,�-o�.
Page T o4t AA%�jje'Gl KN k- PLA-Al
Page 8:
Page 9:
Attachments:
Plumber/Designer: 11 B9 e tr JU EL Ste'✓ Signed:
Credential Number: /14 P 2 .1 bI/ q 7 Date: -7- Z'- Z Z
LPG 4 -4
AN
'AI proaay Name not p Benchmark
chow >,Oole from $� Sol e«lna
BM = 100.00 (970.72 MSL)
Top of 1" PVC pipe
(18" above grade)
BM2 = 99.38 (970.10 MSL)
Top of 1'k2" stake by
marked wooden lathe
(6" above grade)
**Well to be located >25ft
from septic tank(s) and >50ft
from soil treatment area**
Talc:
Pump Tot:
STA:
Sdmd tYaw/uabaa kr prapoeea YMM d ST Gab
dd
4puWaxwsadm0bad a*07FWb0ft
mepafta„rm:. u aa*
4)00 e7 mri4Am ° PW (daw6m Um*
Latdr = 99 79
,qw 2 8%
Dbtrilmilos:
+/ X
A + / 11 /
I 0
/ { ry / ,�") �0Q �o LOCATION NAP cant to soda)
/ m4l� \ �► e oc ��° LV u is e
LS u011
�t
/'+
PREPARED FOR:
Ash RWertles
+ . . / � � SrOe
Masker LN
/ / a SCALE H 54016
31.00 Acres
1�/ 20' Legal: Lot 03 Vistas of ST Croix
/ /, / 0' 40' SE 1/4 NW 1/4
/ S15 T29N R19W —
er. sass ery b oM araYdaO +. aoaaEapr CAM stow Loom cob.. n..d o.amrx o ao muet nadn vd.ew han drh"haw a dlo a> patNn beta. a w axar Town of Troy
CWWW sp M—It TM q t. . for' ' do aft W Papa care ak
"d",GNL No vammm a WOE "T TM WS1[m wLL axnuE TO SACTion WCUMMY sretwa more a Popsy nwYrtarw.a. Mn9w rar Mom'^ '^a1Op""a''� p'�' -- _ _ _ _ Scale: 1' " 40'
--
M
14
a
120}'
TOP VIEW
In
4' INLET
�
2 a
21-
„1 I
SIDE VIEW
4OUTLET
`as
M
WLP1250-MR
TANK SPECIFICATIONS
DIMENSIONS;
WALL: 2 1 /2'
BOTTOM: SEPTIC 3'
COVER: 5'
MANHOLE: 24' I.D. PRECAST CONCRETE RISER
HEIGHT: 52 1/2' O.D.
LENGTH: 120 1/4' O.D.
WIDTH: 84' O.D.
BELOW INLET: 41' O.D.
LIQUID LEVEL: 36-
WEIGHT: 8,810 LBS.
INLET AND OUTLET:
4' CAST —A —SEAL BOOT OR EQUAL
GASKET. CAST —A —SEAL BOOT OR EQUAL
INLET AND OUTLET BAFFLE AND FILTER:
WISCONSIN, SEE DETAIL #10
(OTHER STATES SEE CHART)
LIQUID CAPACITY� 34.81 GALAN
HOLDING TANK:
OUTLET HOLE PLUGGED
ACTUAL CAPACITY. 1.253 GALLONS
LOADING DESIGN: 8' 0' UNSATURATED SOIL
MN TANKS:
WILL HAVE ONE VENT OVER OUTLET
AND WILL HAVE TWO VENTS IN,COVER OVER INLET
TANK CAN BE USED AS:
SEPTIC/ HOLDING/ PUMP OR SIPHON
CUSTOMIZED TANKS:
TANKS CAN BE CUSTOMIZED CONTACT WIESER CONCRETE
TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS
0
I
J oW
D 8
z N
I Q
0 m Z
N_ V
W W
V1 of
0 jOF
�QI d
�a
0
J ¢g
�.3[H
CL
Daily VI
Design Loading Rate (DLR) or Soil Application Rate = • •gpd/ft' (per SYb Iauic ,o�•, .• - -
IIarea = DWF — gal/day + DLR �� 6pd/
Required Distribution ce
�5S + Z 0 ft'/ unit EISA = _ Chambers
# Chambers = Required Distribution cell area
f�FlL+r,�A�o2
Chamber Manufacturer and Model: V70 , Z ft'
fti + /Q r z ft'/ unit EISA End Cap Pair = I
Actual Distribution cell area = Required cell area —
4" Schedule 40 PVC
f f vent pipe with vent cap
• 12 inches minimum
161
Trench 1 Sys -
tern Elevation /
_L�Lft
12 Inches minimum
qa, Z
T ,
3, iWiwc Soil Cover
Z Inch Chamber Height
291s ft Trench 2 System
Elevation
ft ft
Trench Separation Leaching Chamber Width
ft to limiting factor
r
Plan View In -Around Soil Absorption System (2-cell): Trench 1
�ft
'ly•
Jr- ft Leachln$ Chambers
_T Trench 2
S
�_ ft with end camps
Modify
header/
design as
needed.
4 Inch Header
ch. 30 411
Draw O for a Vent and 0 for Observation Pipe above. They will be located ft from the end of the cell.
Vent pipes shall be Schedule 40 PVC and extend at least 12 Inches above finished grade.
Observation pipes that extend above finished grade must also be 4 Inch Schedule 40 PVC.
Page of
971:4 9
Quick4 Plus Standard Chamber Side and End Views
48'
(EFFECTIVE LENGTH)
12'
f� 34-
s Quick4 Plus All-iri-One 12 Encap Front, Side and End Views
11.2'
T— 13
8INViERT 8' INVERT 5.3' INVERT
�I
33I�
'
Quick4 Plus All -in -One Periscope
OUIC" PLUS
sLL4aLONE PER/feDP
QUICM
paaWM1aa )
12.7'INVERT t ALL-iwdmeszENDCAP 5-f�
Quick4 Plus Standard Chamber Specifications
1 Size (WxLxH)
Effective Length
INFILTRATOR SYSTEMS, INC. STANDARD LIMITED WARRANTY
Pa merkrlacturad b Infiltrator(-Ungs') when installed and
(a) The Svuclursi Meplty of each Chamber. and plate, wedge and 0 r eccese0ry Y
operated in a wacriald of an omits septic system in accordance with Infiltrator's InstrucWmis warranted to His original purchaser CH0108i )
against delectwe materiels and wortunrtsNp lot one year from the dale that the septic Perms 10 Issued for Ins satiric Systsm Cdntaning Pa Units.
p ow.de0. nowaver, thal P a septic perMl Is not requked by applleeble law. the werrenty Period will been upon the date that installation Of dot
septic system conmoces- To exere4e its warranty tight&. Holder must notify InNtralor In writing al Its Corporate Headquarters In Old SINYbrobk.
Cornecticul man Teteen (15) days C4 the alleged detect. InlilUetor wta Supply replacement UNIS la Units delenrined by Inlilualor 10 be covered
by this l-knkso WSU My. Kgtf*Wr'S sabaity %MillCstly escludse Pa Chat of remove' WXft Imtalktipn of Pa Units.
(D)THE LIMITED Wili AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT
TO THE UNITS. INCL.)DING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE
(c) This Lnwted Warranty Shall be aid a try Part Of the chamder system Is menulaclured by anyone other Nan Infiltrator, The Lsniled Warranty
does not extend to kncid", cortsequential. special a Indirect damages. Inliluatgr shall not be liable lot penalties or aquidaled carriages.
i nctud ng loss of ploduction and profits. labor and materiels. overhead costs. of other losses or expenses Incurred by Ilse Holder of any third Parry.
Specifically suluded I'm Limited Wattanty coverage we damage to the UMW due Io ordinary wet and lest, alteration. accident, misuse. abuse
or neglect of No Units: the Units being subjected to vehicle traffic or other conditions wnith are not permuted by the Installation instructions: failure
to manan the mirwnunn ground covers Set Ion in it* Installation instructions: the pUcrMnl of anproper Mien9l{ Into the system Cdntaining
the Units: failure of the Units of the septic system OW to hproper siting ar improper sairig, exCesslve water usage, improper grease disposal.
or knwoper operation. or any outer avenl not caused by Infiltrator. This L4Nled Warranty ahaa be void it the Holder [sits to Comply with all of the
arms set tome in Pis Limed Warranty. Further. in no evert shell Infiltrator be responsible for any loss ar damage to the Hader. the Units. or any
thud pansy resulting Imm ktataaation or sn)pthan, or from any product IlaDility Uaims Of Holder Or any thud parry. For this Unnited warranty to
apply, the Units mull be initiated In accordance with all site conditions required by sale and Ices) (odes. tilt other applicable Laws: and Infiltrator's
installation instructions. -
(d) No representative of lnftltraior htas the authority to change or extend INS L+Nted Wenwry. No wanany applies to any party other than the
original Holder.
The above represents INS Standard LIINted Warranty offered by Inliltralm.• A Iirilted number of states and counties have different warranty
requ✓emlents. Any pWChASef 01 units Should contact Infftralv's Corporate Headquarters In Old Saypook. COnnecllcut. Dlior to such purchase.
to obtain a copy of the applicable warranty, and should carefully reed that werenty prior to the PUnchase 01 Units.
............ 34' x 53' x 12" (86 cm x 135 cm x 31 cm) Invert Height' ................. 0,6', 5.3', 8.0", 12.7'
48' (122 cm) (1.5 cm, 8.4 cm, 18.5 cm, 22.6 cm)
INFILTRATORS
systems inc.
6 Business Park Road a P.O. Box 768
Old Saybrook, CT 06475
860.577.7000 a FAX 860.577.7001
800.221.4436
www.infiltratorsystems.com
U.S. Paints. 4.759.661. 5.017.041: 5.156.468: 5.3X.O17T. 5.401,116; 5.40t 459; 5.51 t.903: 5.716.163; 5,568.778. 5,B.T9.844
Canadian Patents: 1,329.959". 2.004.564 Other patients pending.
Inlillreux. Equsklar. Ouick4 and Oulck4 Plus ere legislated vadenans of Inflator Systems Inc. NlYtrslor is a rag.sared Trademark In Franca. Infiltrator system Inc
is a registered tradMan in Mexico. Contour Swivel Cornet ion is a Irademark a Infinralor Systems Inc. O 2009 Infiltrator SyStems Inc. Printed in U.S.A.
PLUS0510101SI-2
In round Gravity Management Plan
IMPORT tual operation and maintenantSe pursuant to
The owner of t1kis in -ground gravity system shall be responsible for Its 383.PeTPWisc. Admin. Code, this system shall
requirements of SPS 382-384, Wise. Admin. Coda Pursuant leaps 3 With
th $ a roved management plan,
shall be performed by a registered potWTS Maintainer in
be considered a human health hazard ff not maintained in accordance with this approved
Furthermore. all Inspection and maintenance
acticcordance accordance with SPS383-52 (3). Wisc. Ad
....Nnn 1 I�rtits:
Maximum Dls r9 I
Design Flow = gpd'
BOi), 5 220 mgL TSS 51 so mgL"'; FOG 530 mgL"
Ins ce''tion Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system aims, etc.)
o nuisance factors (La. odors, uselea, switches, 8s, floats. etc.)
o mechanical malfunction (1a;-, pumps, ccrr on, eta)
o material fatigue (i.e., leaks. breaks. (i.e., distribution / drop boxes)
rc treatmerd tank(s) and any distribution appurtanaies, et .)
o salts vduma in anaerob � Prohibited activities, etc.)
o neglect or improper use (i.e., exceeding designPadd",
o extend of ponding in distribution cell prior to dosing float switch settings, etc.)
o dosing Irregularities - if applicable (i.e., pump to -cycling,
- if applicable {/.s., tang, connections, switches' Controls, timers, alarms, etc.) specification)
o electrical componentsmeasure lateral distal pressure — compare to design spew
o distribution caters! of I e{aI t office el -uP into structure served
o surface discharge
MAINTAIN. EVERY 3 YEARS (or when necessary)
Maintenance Checklist
,CYflfi�d aeptage servicing operator licensed under tL 281.48 Wis.
o ¢anal a ando d se_taD�'�l �. � D Ped by aa e�rceods one
third (1/3) the liquid volume of the tank(s) or
Stets*
when the volumeAg solids In the tBnppknterds shall be pursuant to NR 113, Wisc. Admin. Code,
as required by -local ordnance. Disposal to remove any
o �fIIl�nnt flit sl shall bs inspeded every 3 years and shell be cleaned when nYAII ecessary a ys be greater than 12
to manufacturers specifications. A servicing period
accumulated solids according ..
months.
System maintenance a po" shish be*abmittad'006 p�rlocW fl0v n�M a^n In accordance with
faUuro.or �IrraHurtd9on
SPS 353A5 WIt. Adniln- Coda`: RepolYaml cOrnlD IS- Z73 —4A uA
Name of Individual or company:
N p� Phonier
e-0 /,� Z �/ t "/�... -- Phone: T6 sr� fib :I
b g0
G
Local government unit ��-f u o W� f ZIP: `rR1.h
Local go4ilment unit address: _ �'to SPS 303-51 M- WfeG. Admin'
Any defective part of this systemi $hall be repaired,p6p�, or reek, I comply
om with SPS 383. ftc. Admin- Cod
fate-
Code. Repair or replacement of fated or matfunction ing components shall txxply� the department in
NO product for chemical or physical restoration of the POWTS maybe used unless aPP
accordance with SPS 384, Wisc. Admin. Code.
Contingency Plan lam pursuant to
In the eat any vent that failed treatment componerit of thiBpOWTS cannot be repaired, it shall be rep
a plan vent thed to the appropriate agency for review and, approval. A failed in -ground dispersal component may be
abandoned and replaced by a code -complying dispersal component in -a predatermine�,area of suitable soils.
tivate i Abandonment
If use of #&pOWTS Is discontinued, it shall be abandoned In accordance with SPS 383.33, Wisc. Admin. Code.
0
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APPROVED Jo0JT
w/C.x. P►PEbRPUG
19ecie" �
GOo0
5�•G�Q�V�
ii
Combination
y'C.ItiVCAIT PIPE
.tea 1 /ROM 000&
:inibow oit rA rs H
AUj_IuTAKC _1
iao* 1
Tank acid
Ij AAJO SPECIFlCATIOUS
WENT CAP. WCATHCR F" r
,iU)JCTIOIJ eox
APPROVED LOCKIIJG
/AANHOLC COVER wl M
WP+RNIiJ4 L.h6EL. _
s . cououlr
B �tPL6I •�
F
struction
mply with
5 and 83.20 °
,V015
C
I
Y' nlu.
PROVIDE I
--"—
AIRT16HT SC -AL
APPROVED JM
! II
I I
W/C.1. PIPEQ�f
II ALARIA
�I I
I
.I I
• I
PUKP Orr
° COUcKETC
I- PLOCK
RISER EXIT PCKMIITED ONLY IF TAUK MAIJUPACTURCR HAS SUCH APPROVAL
—13"ACPR�•;
UDOING
SEPTIC E SPECIFICATIOUS
oosC �� ml1CI1,L TANK MAUUFACTURCR: ?-Ave �� IJLVN6ER OF 005[S;PER DAy
TANK 91ZC; �Ay GA!_LOMS DOSf VOLUME
L�} &K-M /4A1JUFACTURCR: �- � ��%f t IJJCLUDINCA 6A4K/LOW:�GALLONS
MODCL WUMBCR: •- �d %I CAPACITIES: Ac J,p� ZUfDJC8E3DA ` /0ALL0yS
SWITCH TyPC: a c Z IIJCNCS,OR �rld7 _fZZ6�LLOQ$
PUMP MAMUFACTURCR: q-u _IULHES OR C1 > iALLOUS
MODEL NUADER: �� �, 0� 6 INCHES 0R'��` , GALLOIJL .
SWITCH TYPE: ® UoT[: PUMA AMD ALARM ARE TO dC
MIJJIMUTA-DISCHARot RATE GPM IINQSTALLED ON SEPARATE CIRCUITS
YEKTICAL DIFFERENCE OCTWCCJJ PUMP Off AUO,013TRMUTIOW PIPE.. �S T
t/� II,UMIMUM NETWORK SUPPLY PRESsuKC , ; . , , , , .. . FEET
FEET OF FORCE (VIM X;4F% AU Io,ttFRICT10u FACTOR.. FEET
TOTAL OV)JAMIC HEAD
[CGOULDS PUMPS
APPUCATIONS
Specially designed for the
following uses:
• Mound Systems
• Effluenoostng Systems
• low Prossure Pipe Systems
• Basement Draining
• Heavy Duty Sumer
Dewatering
METERS FEET
I 40 r
O 2004 rrr Watp Tfth WoeY• InG
Iff•db• junk 704
•►u hni
REeENED
BT,t;RO�GODN� GDD
SPECIFICATIONS
Pump — General;
• Discharge: 1 K' NPT
• Temperature: 1040F (4K
maximum, continuous when
fully submerged.
• Solids handling: I/,•
maximum sphere,
• Automatic models Include a
float switch.
• Manual models available.
• Pumping range: see
perfomrance chart or curve.,
PE31 Pump:
• Maximum capably: 53 GPM
• Maximum head: 25' TDH
PE41 Pump:
• Maximum capacity 61 GPM
• Maximum head: 29, TDH
PE51 Pump:
• Maximum capacity. 70 GPM
• Maxi num head: 37' TDH
M-MLY-41a7
MOTOR
Submersible
Effluent Pump
PE
General:
• Single phase
• 60 Hertz
• 115 and 230 volts
• &Nn themlal overload pro.
tectlon with automatic reset
• Class a Insulation.
• 011-filled design.
• High strength carbon steel
shaft.
PE31 Motor.
• .33 HP, 3000 RPM
• 115 votes
• Shaded pole design
PE41 Motor.
• A HP, 3400 RPM
• 115 and 230 volts
• PSC design
PE51 Motor.
• .50 HP, 3400 RPM
• 115 and 230 volts
• P5C design
FEATURES
s Corrosion resistant
construction.
■ Cast Iron body.
• Thermoplastic Impeller and
cover,
■ Upper sleeve and lower
heavy duty ball bearing
construction.
■Motor Is pemwwmly
lubricated for extended
service life.
■ Powered for continuous
Operation.
■ All ratings are within the
working limits of the motor.
■ Quick dlsaonnea power
cord, 20' standard length,
heavy duty 16)3 S11W with
115 or 230 vote grounding
plug.
■ Complete unit is heavy duty,
portable and compact,
■ Mechanical seal is carbon,
ceramic. BUNA and stainless
steel.
■ Stainless steel fasteners.
AGENCY 1.11571NGS
s�•
c Us
Tested b Ul 778 and
CSA 22.2108 Standards
N stan&rer fuodadm
fie #was"
Go&" hm vI is rso gom eia4r•d.
Goulds Pumps
ITTlndustries
Wisconsin Department of Safety and Professional Services Page 1 of 2
Division of Industry Services
SOIL EVALUATION REPORT
In accordance with SPS 385, Wis. Adm. Code County
ST Croix
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include,
but not limited to: vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D.
scale or dimensions, north arrow, and location and distance to nearest road. Pending (Current: 040-1061-20-000)
Please print all Information. Reviewed by Date
Personal information you provide may be used for seconds see Priva Law, s. 15.04 1 m .
Property Owner Property Location.
Ash Properties GovL Lot: SE % NW Y. S 15 T 29 N R 19 W
Property Address Lot # 8bdc # Subd. Name or CSM#
TBD Moel[er LN 03 Vistas of ST Croix (pending plat) _
City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road
Hudson IWI yt016 Troy Moelter LN (proposed road)
® Now Construction Use: ® Residential/ Numberof bedrooms 4 Code derived design flow rate 600 GPD
❑ Replacement ❑ Public or commercial — Describe: _
Parent materiel Loess over loamy drift over sandy outwash (Sattm 1) Fk)odplain elevation if applicable NA ft.
General comments and recommendations: Soil and am evakoWn for proposed vistas or ST Crae pat.
LF • >%* (obeervabon amrd) Inv wrid' o edt+OW trenches with o.7gpdm t2 wadwV rate pwaihM at 1 T minimum depth.
o Boring# [I Boring
®pit Ground surface elev. 99•70 ft. Depth to limiting tailor '� in.
C..it AnrJirsfiM R.+.
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft'
Eff#1
•Etf#2 _
1
0-10
1 OYR 3/3
I
2f-msbk
dsh
Cs
2f-vf
0.6
0.8
2
10-17
10YR 3/6
-
I
lfabk
ds
cs
1f-vf
0.4
0.6
3
1747
1OYR 416
-
cos
Osg
loose
gw
1f-vf
0.7a
1.6a
.irSravel)
47�0
10YR5/4
-
grs-grtbs
Osg
loose
gw
-
0.7a
1.6a
s(s+oxt.�l
60-96
1OYR 514
-
s
Osg
loose
0.7a
1.6a
aBoring #
❑ Boring ® Pit Ground surface elev. 98.70 ft. Depth to limiting factor >A in.
C..it enrJireltnn ant.
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Boundary
Roots
GPD/Ft'
•Efi#1
'Eff#2
1
0-13
10YR 313
dsh
Cs
2c-vf
0.6
O.B
2 nts,sx I
13-34
1 OYR 3/6
-
Osg
gW
1 m-vf
0.7a
1.6a
3(5-1dxrock)
34-56
10YR 4/6
Mej,u,aC(,nConsistence
Osg
cw
1f-vf56-96
10YR 514
Osg
0.7a
1.6a
nnn -'!n
a ,"n mnn ant
TRS > 30
6 150 mofL
Effluent 41 = tSUU, > JU 5 LN FFTKYL en0
too- ov n r w ... -
-- - - -
CST Name (Please Print)
Signature e
CST Number
Ryan Bechel
f$4/
SP-111500001
Address
Date Evaluation Conducted
Telephone Number
779 Spring Creek RD S. Red Wing, MN 55066
06/14/21
(651) 327-0074
SBD-8330 (R04115)
Boring #
❑ Boring
®pit Ground surface elev. 99.70 ft. Depth to limiting factor >96 in.
Soil Aoolication Rate
Horizon
Depth
In.
DominaM Color
Mansell
Redox Description
Ou. Az. CorrL Color
Texture
Structure
Gr. Sz Sh.
Consistence
Boundary
Roots
GPD/Ft2
'Eff#1
'EfW
1
O g
10YR 3p3
sH
if-msbk
dh
es
2o-vf
0.4
0.6
2
9-16
10YR 416
s
Dsg
loose
cw
1m-vf
0.7a
1.6a
3
1"
10YR 514
-
S-cos
Osg
loose
gw
if--vf
0.7a
1.68
4
35-55
1OYR 5/4
-
s
Osg
loose
Cw
ti-vf
0.78
1.6a
5
55-96
1OYR 5/4
s cos
Osg
loose
0.7a
1.6a
F4 Bwft #
0 � ng
Ground surface elev. ft. Depth to limiting factor _ in.
soil Anoiiration Rate
Horizon
Depth
In.
Dominant Color
Munsed
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ftz
•Eff#1
-Eff#2
❑ Bonng #
❑ Boring
Pit Ground surface elev. ft. Depth to limiting factor _ In.
Soil Andication Rate
Horizon
Depth
In.
Dominant Color Redox Description
Munsell Qu. Az. Cont. Color
Texture
Structure
Gr. Sz Sh.
Consistence
Boundary Roots
GPD/Fe
'Eff*1
'01112
Effluent #1 = BOD. > 30 s 220 mg/L and TSS > 30 S 150 mg/L - Effluent #2 = BOD. > 30 S 220 mg/L and TSS > 30 S 150 mg/L
Dnl¢r n
Crtolid SRyool Teatr.Bated
SP-111500001
D"lgru r of Englneariny Syatmna: D 2263-7
ADVANCED
'All property boos rwt O, Benchmerr SYSTEM_
d��mro >e0pft from 4 Sol Bairn Sepik Talc:
BM1 = 100.00 (970.72 MSL)
Top of 1" PVC pipe
(18" above grade)
BM2 = 99.38 (970.10 MSL)
Top of 1'k2" stake by
marked wooden lathe
(6" above grade)
*Well to be located >25ft
rom septic tank(s) and >50ft
rom soil treatment area**
3 �\
Pump Taut:
STA:
Sol as de erlxom kr prnyoeed wen Of ST Croec
plal
.kW-q,a-MWOMW told r11UVWlsift
am pa" al I mwem dove
-0eoeIDM*dm-W(p W400*4
ran. - 9910
,pe
Distribution:
i/t
/ 4 CV / �0i \ / LOCATION MAP ("a to eon.)
/ -F 9,Op u ss / 6 s
/+ p to-\AcY
/ + —
+ / //4�6
�fjOLI
PREPARED FOR:
/ + / .O Aso Properties
/ { / site Address:
/ t / / \a SCALE udson,Wl SdD16/+ T PIo: Teo (PendkV don) :I.00 Aaas
20' I legal: Lot 03 Vistas of ST Croix
40' SE 1/4 NW 1/4
S15 T29N R19W
CW~ Srlarwet TM..YMae io. b.." ddWod and weiiol.d i, asadaar aM Seob ad Lmd MdM The tl beoenwl a.. muM i.mY, p*a ran dYi"baw o�d/o aa�aanm lrhn and der Town of Trot
aaW�etlen. MO mmilimar a WZE T MT TMb SYSTEM ILL COMMA TO rtXM M eOUNSMY. *NW- mmt a d`.oaN ^N'11110 mow ya/ p"W oa. aM Scale: 1' - 49 Date: 6/14/21
i
ST Cizo iuiv rY SANITARY SYSTEM file
Office
Use Only
OWNERSHIP/ADDRESS FORM ��=ed��a�i
Community Development Department will utilize this information to provide the property owner with
information regarding operation and maintenance of your new or replacement sanitary system! This
information will be provided as part of our ongoing efforts to protect public health, your well, groundwater,
surface water, property values, and county resources. Once approved, this completed form and educational
information will be sent to you by email.
OWNER/BUYER INFORMATION
Owner/Buyer 2S n C
Mailing Address / f 20. L�-) rr Vic-
City/State/Zip tV t'_'r ,_L+ S .:5 1 S U ;,-?.-
Phone Number (required) j )le (v
Email Address (required) V64
Parcel Identification Number
(found on the property tax bill)
NEW SYSTEM: LEGAL DESCRIPTION
Property Location 5 E 1/4 , E 0Y. , Sec.13J T� N Rj-�2-W, Town of '�io
Subdivision Plat �/i s4-zr- 4f:- 54 cioi l" Lot #3--
Certified Survey Map # Volume /YA- Page #4_.
Warranty Deed # /C1 6 Z (before 2006)Volume ,.tJ� Page #I_.
Number of bedrooms Spec house yes O no Lot lines identifiablel$�yes O no
New Property Address
V, A-�
(St ff Initials)
OFFICE USE ONLY
(Verification of new address required from Community
(Date)
Gds)
Department for new construction.)
This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications.
New System: Include with this form 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.
Community Development Department - Land Use Division
715-386-4680 St. Croix County Government Center 715-245-4250 Fax
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/
PC57-aaa�-�o7
Wisconsin Department o Safety and Prof e spngvices Page i of 2
vtsa7$11
Dinotlndustryservi LL
SOI EVALUATION REPORT 353 i�ac4� tn w l "
Croix County nt
St. nttY SPS 385, Wis. Adm. Code County
Attach complete site plan on p mu an 8 12 x 11 inches in size. Plan must include. ST Croix
but not limited to: vertical and horizontal reference point (BM), direction and percent slope. Parcel I.D 04 0 - 13 28- O 3- 000
scale or dimensions, north arrow, and location and distance to nearest road.
Plaaaa print all Information. Review+ d by
Pamonal information You orovide may be used for secondary Durooses (Pnvacv Law, s. 15 040)(m)). /{�[_ pi
Property Owner Property Location: r
Ash Properties Govt. Lot: SE '/. NW '% S 1S T 29 N R 19 W
Property Address Lot # Block # Subd. Name or CSM#
TBD Moeller LN 03 1 Vistas of ST Croix
CRY State Zip Code Phone Number ❑ City ❑ Village [j Town Nearest Road
Hudson jWl -W18 1 1 1 Troy Moeller LN (proposed road)
�New Construction Use: OResidential /Numberofbedrooms 4 Code derived design flow rate600 GPD
❑ Replacement ❑ Public or Commercial - Describe
Parent material Loess over loamy drift over sandy outwash Floodplain elevation if applicable NA ft. �� F X Sattre I
General comments and recommendations: sou aria a" evaluation for proposed VISM of sr Croix pIM.
LF • >W (ob"rvewn extent) Inq/amd %onvMfionar trench„ with 0.7gpdffQ loading nits possible aM 1 T minimum depth.
1❑ Boring # ❑ Boring
® PR
Ground surface elev. 99.70 ft. Depth to limiting factor >�96 in.
Snil 4nnll iratim Rate
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft'
•Eff#t
•Eff#2
0-10
1OYR 3/3
1
2f-msbk
dsh
ce
2f-vf
0.6
0.8
h(15.M%
10-17
1OYR 3/6
1
lfabk
ds
Cs
1f-vf
0A
0.6
17-4
1OYR 4/6
cos
0sg
loose
gw
1f-vf
0.7a
1.6a
47-60
10YR514
grs-grcos
Osg
loose
gw
0.7a
1.6a
60-96
1 OYR 5/4
s
Osg
loose
0.7a
1.6a
.O
❑❑ �onng
2 Boring # Q Pit Ground surface elev. 98.70 ft. Depth to limiting factor ' in
Rnil Mnliratim Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Ou. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft'
•Eft#1
-Eff#2
1
0-13
1 OYR 313
-
I
2f-msbk
dsh
Cs
2c-vf
0.6
0.8
200-15%W")
13-34
1OYR 3/6
-
grs
Osg
Osg
gw
1m-vf
0.7a
1.6a
3(5-10%rock)
34-56
1OYR 4/6
-
cos
Osg
Osg
cw
1f-vf
0.7a
1.6a
4 (5-io%rock)
56-96
10YR 5/4
1 -
s-cos
Osg
Osg
0.7a
1.6a
L I,nR, n n
CST Name (Please Print)
Signature /
CST Number
Ryan Bechel
�7+�
SP-11150DO01
Address
Date Evaluation Conducted
Telephone Number
779 Spring Creek RD S, Red Wing, MN 55068
06/1421
(651) 327-0074
ecn_naqn rourl St
❑3 Boring 0
❑ Boring
❑� Pit Ground surface elev 99.70 ft Depth to limiting factor �915 in
Soil Application Rate
Horizon
Depth
In
Dominant Color
Munsell
Redox Description
Ou. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft'
'Eft#1
-Eff#2
1
0-9
10YR 3/3
-
sl-I
1f-msbk
dh
cs
2c-vf
0.4
0.6
2
9-18
10YR4/6
-
s
Osg
loose
am
1m-vf
0.7a
1.6a
3
18-35
1OYR5/4
-
s-cos
Osg
loose
gw
1f-vf
0.7a
1.6a
4
35-55
10YR 514
-
s
Osg
loose
cw
1f-vf
0.7a
1.
5
55-96
10YR 514
-
s-cos
Osg
loose
0.7a
1.6a
O
4 Boring #
•/ v
❑ Boring
❑ Pit Ground surface elev.
ft. Depth to limiting factor _ in.
Soil Application Rate
Redox Description
Qu Az. Con[ Color
5] Boring #
❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor_ in.
Soil Application Rate
Effluent #1 = BOD, > 30 5 220 mg/L and TSS > 30 s 150 mg/L ' Effluent #2 = BOD. > 30 s 220 mg/L and TSS > 30 5 150 mg/L
❑3 Boring #
❑ Borng
0 Pit Ground surface elev. 99.70 ft. Depth to limiting factor >96 in.
Coil Rnfu
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft'
•Eff#1
-Eff*2
1
0-9
10YR 313
-
sl-I
1f-nrbk
dh
cs
2c-vf
0.4
0.6
2
9-18
10YR 4/6
-
s
Osg
loose
cw
1 m-vf
0.7a
1.6a
3
18-35
10YR 514
-
s-cos
Osg
loose
gw
If-vf
0.7a
1.6a
4
35-55
1OYR 5/4
-
s
Osg
loose
cw
1f-vf
0.7a
1.,
5
55-96
1 OYR 5/4
s-cos
Osg
loose
0.7a
1.6a
O
4 Boring #
I�
❑ Boring
❑ Pit Ground surface elev.
ft. Depth to limiting factor _ in
Cnil Annlirofim P.t.
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft2
•EH#1
'Eff#2
Boring #
❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor _ in.
Coil annl lir�linn Gole
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Cu. Az. Conl. Color
Texture
Structure
Gr. Sz. Sh,
Consistence
Boundary
Roots
GPD/Ft'
'Eff#1
I -Eff#2
Effluent #1 = BOD, > 30 5 220 mg/L and TSS > 30 5 150 mg/L ' Effluent #2 = BOD, > 305 220 mg/L and TSS > 30 5 150 mg/L
Designer Ryon BscM
Cerdfkd Sol Tester. SP-111500001
Designer of Engineering Systems: D 2263-7
•AII property lines riot • Benchmark SYSTEM NOTES
ADVANCED drawn are ,10011 from O Septic Took:
.. • • sypern 4$� Sal Bong
+ /' Tree line
+ / O
PY
i�
+� 3
p>� s
BM = 100.00 (970.72 MSL)
Top of 1" PVC pipe
(18" above grade)
4 BM2 = 99.38 (970.10 MSL)
Top of 1"x2" stake by
marked wooden lathe
(6" above grade)
**Well to be located >25ft
from septic tank(s) and >50ft
from soil treatment area**
Pump Tank:
STA:
Sad and de w6jeon la poposed W9es of ST Croe
qa
ln.p" 4aeaeaar Verdes rn d 7gpdt loaIng
rtie posoble at 17' mrimm dspeh
010 N reaNeon = +W (el wAbm east)
rorew = 99 79
slope=6%
Distribution:
.off•+//� /� /�\ /
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q
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1S ' S 6
1
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PREPARED FOR:
/ A / Ash Properties
/ + '/ ` Site Address:
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Scale:I"= 40' Date: 6/19/21
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STATE
PLUMBER
TOWN OF
SECIT"' ,T_�aNq R j
AND/OR LOT 3 B
PERMIT EXPIRES
NO* 644761
TITARY PERMIT
rooemmots L9
6AI, PREVIO NO.
LIC.# 226#71
E/W
)CK
SUBDIVISION
145.135 (A WISCONSIN STATUTES
(a) The purpose of the sanitary permit is to allow Installation
of the private sewage system described In the permit
(b) The approval of the sanitary permit Is based on
regulations in force on the date of approval.
(c) The sanitary permit is valid and maybe renewed for a
specified period.
(d) Changed regulations will not impale the validity of a
sanitary permit
(e) Renewal of the sanitary permit will be based on
regulations in force at the time renewal Is sought, and that
changed regulations may impede renewal
(f) The sanitary permit is transferable.
History: 1977 c.168;1979 c. 34,221; 1981 c. 314
Note: If you wish to renew the permit, or transfer ownership of
the permit, please contact the county authority.
ISSUING OFFICER - DATE
�Pzt
UNLESS RENEWED BEFORE THAT DATE
POST IN PLAIN VIEW
VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION
SBD-06499 (RI 1/20)