HomeMy WebLinkAbout018-2011-40-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division Sanitary Permit No:
INSPECTION REPORT 574393 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Roscon Properties LLC, c/o Richard Stout I Hammond, Town of 018-2011-93-000
CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No:
�0 1 30.29.17.1101 i
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic – Benchmark
Alt.BM . 7
Aeration Bldg.Sewer
Holding [_ St/Ht Inlet
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/j_ WELL BLDG. ant Air Intake ROAD Dt Inlet
E
e+4x S tt
Septic Dt Bottom
Dosing Header/Man. '
Aeration Dist. Pipe /`f•0 "o /OZ,-g7
Holding Bot.System •7• /0/•.3�
3 i
Final Grade / . 417
PUMP/SIPHON INFORMATION S
Manufacturer Demand St Cover 1 _ c'
GPM �.'l a. Ct x r r(,P /J
Model Num
TDH ift Friction Loss System Hea TDH Ft
Forcemain Dist.to Well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length I No.Of Trenches � PIT DIMENSIONS No.Of Pits` Inside Dia._` Liquid Depth
DIMENSIONS 3 / Z —
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHAMBER OR Manufacturer: �, e=4 t�
INFORMATION Type Of System: 3a /50' /V+ UNIT Model Number: C
DISTRIBUTION SYSTEM Al fA-"
Header/Manifold Distribution ` x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s) \ \ ��
Length Dia I Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only 1
Depth Over Depth Over xx Depth f xx Seeded/Sodded xx Mulched
Bed/Trench Center Z Bed/Trench Edges \ Topsoil Yes 0 No I N ' Yes No
COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / 3b/ Inspection#2:
Location: 1514 78th Avenue Hammond,WI 54015(NW 1/4 NW 1/4 30 T29N R1 7W) Emerald Acres 1st Add Lot 93 Parcel No: 30.29.17.1101i
c�J4A—
1.)Alt BM Description
2.)Bldg sewer length
-amount of cover= �5
Plan revision Required? Yes o
Use other side for additional information.
Date Insepctor' Signatur Cert.No.
SBD-6710(R.3/97)
PROJECT Richard Stout PLOT PLAN
ADDRESS 1353 Awautukee Trail Hudson Wi 54016
NW 114 NW 1/4S 30 /T 29 N/R 17
W TOWN Hammond COUNTY ST.CROIX
SYSTEM ELEVATION 101.0 100.6 2' below grade
9/29/14 3
CONVENTIONAL XXX DATE BEDROOM
IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1 150
# of chambers EZ Flows
BENCHMARK V.R.P. Top of 1" pvc pipe
ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O WELL *H,R.P. Same as Benchmark
80'
Property Line
20' B.M.* 101' Scale _ 1 /4" = 101
B-3 102'
0'
System is to be installed upslope of existing
B-2100' system, which was filled in by gophers
20 B-1
103' Vents 2-3' Z 115' cells with>3' spacing
All piping shall be SDR 30/34, within 10'
of tank,piping shall be Schedule 40.
100'
ST
30'
Existing 3
bedroom house
Property Line _
78th Ave
Safety and Buildings Division co ty / . �.
l �` A, 201 W.Washington Ave.,P.O.Box 7162 Sanitary Permit Number(to be filled in by Co.)
. :+ Madison 7
W �` (73
C.)� 'M Sanitary Permit Application State TrartsactionNumber
�Iri a��vdiuda,na with SPS 38321(2),Wis.Adm Code,submission of this form to the apptoptiate govermnental omit /V
prior to obtaining a sanitary permit. Note:Application forms for sure-owned POWTS are submitted to Project Address(if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary
Vzposcs is actorrdimce with the Privacy Law,s.15. 1 m Stats.
L Application Information-Plem Print All Information
Property Owner's Name O,5 �� Pared
9 -moo
Property Owner's Mailing Address Property Location
:�>� 3 Govt Lot /
)
�City,State Zip Code Phone Number V 7-A c/ 'd, Sxtion
I�C-J J V I! T�/ N; R1 or W
II. pe of Banding(check all that app/ ��
or 2 Family Dwelling-Number of Subdivision Name
❑Public/Commercial-Describe Use �• ❑City of
❑State Owned-Describe Use CSM Number A ❑Village of
5b Town of
2- -
IH.Type of Permit: (Check only one bix on line A. Complete line B if applicable)
A ❑New System lacement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain)
B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New Lis/t�Prt Previous Permit NumbeAl Date sued
Before Expiration Owner (�e3 Z�'7 All `� d S
IV. of POWTS S Com nent/Device: Check all that apply) Z_
d t.J t
-Presstaized in-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound?24 in.of suitable soil ❑Mound<24m.of suitable soil
❑Holding Tank ❑ Dispersal Component(explain) ❑ t Device(explain)
V.Dies rsalfl'res cot Area Information: " t9L c/ r
Design Flow(gpd) Design Sod A 1icatiovi Rato(gp Dispersal Arn�equin� sfJ Dispersal Area Propose sf) System Elevhation
!/� O/V
Torok Info Capacity in Total #of /ManufacK= u
c y
Gallons Gallons Units //� ,o
Now Tanks Existing Tanis � �7�t t5 ri(� 4
a U cn in a Ci c,
Septic or Holding Tank
Dosing Chamber
VII.Responsibility Statement-I,the undersigned,assume nwbility for installation of the POWTS shown on the attached plane
Plumber's Yom(Pont) Plumber's MP/MPRS Numbs Business Phone Number
z Z6' 71-)
Plumber's Address(Street,City.State,Zip Code
vm ountv/De artment Use Only
proved Permit Fee Date sued 51hss-umgAgignature
=tank�.ef ason for Denial S �� �uslorDi$approval 1.' Septic fluent filter and
dispersal cell must all be servk:es f malntauted
as per management plan provided by'plur l*. J"
2. All se0W_*r04t 'enMts must beim"01W _11
n per appli6"`code'7 txdlnanc�:
Attack to eompkoe plans for the system and submit to the County only on papa not leas than 8 in x l l inches in sue
I
SBD-6398(I 11/11)
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 9/29/14
Owner: Richard Stout
Location: NW1/4 NW 1/4 S30 T29 N,R17 1514 78th Ave Hammond
In-ground absorbtion system(conventional)
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. EZ-Flow Cross S tion
4-5. Maintanance Contingency Plan
6. St.Croix Cou xistin eptic Tank Form
Signature _
License n9ber#226900
PLOT PLAN
PROJECT Richard Stout ADDRESS 1353 Awautukee Trail Hudson Wi 54016
NW 1/4 NW 1/4S 30 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX
SYSTEM ELEVATION 101.0 100.6 2' below grade 9/29/14 BEDROOM 3
DATE
CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 115 0 # of chambers EZ Flows
BENCHMARK V.R.P. Top of 1" pvc pipe ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
80 Property Line
20' B.M.* 101' Scale = 1 4u = 10'
B-3 102'
System is to be installed upslope of existing
0"--, system,which was filled in by gophers
B-2100'
20 B-1
Vents 2-3' Z 115' cells with>3' spacing
All piping shall be SDR 30/34, within 10'
of tank,piping shall be Schedule 40.
100'
ST
30
Existing 3
bedroom house
Property Line
78th Ave
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Tank Manufacturer: ❑ NA
Permit# ptic ❑ Dose ❑ Holding Volume:f oo-o (gat)
DESIGN PARAMETERS Tank Manufacturer: ANA
Number of Bedrooms: ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal)
Number of Public Facility Units: ;ENA Vertical Distance Tank Bottom(s)to Service Pad: / (ft)
Estimated(average)Flow: LTp (gal/day) Horizontal Distance Tank(s)to Service Pad:
Design(peak)Flow=(estimated x 1.5): UJ (gal/day) Specific servicing mechanics must be provided if vertical is>15 feet or
7 Y If horizontal Is>150 feet. SpecMc Instructions to be provided on back.
In Situ Sal Application Rate: (gatldaylW) Effluent Filter Manufacturer: ��6� /� �(fU 0 NA
Standard(Domestic)Influent/Effluent Monthly average Effluent Filter Model:
Fats,Oil&Grease (FOG) s30 mg/L Pump Manufacturer:
Biochemical Oxygen Demand (Boos) 5220 mg/L ❑ NA NA
Total Suspended Solids(TSS) 5150 mg/L Pump Model:
High Strength Influent/Effluent Monthly average Pretreatment Unit
(FOG) >30 mg/L Manufacturer.
(BOD5) >220 mg/L *NA
SS) >150 mg/L ❑Mechanical Aeration ❑Peat Filter
❑Disinfection ❑Wetland
Pretreated Effluent Monthly average ❑Sand/Gravel Filter ❑Other.
(GODS) 530 mg/L Soil Absorption System
(TSS) 530 mg/L
Fecal Coliform(geometric mean) 510'
In-Ground(gravity) ❑In-Ground(pressure) [I NA
Maximum Effluent Particle Size n�in dia. El NA ❑At-Grade ❑Mound
❑Drip-Line ❑Other:
Other: NA Other:
MAINTENANCE SCHEDULE
Service Event Service Frequency
Pump out contents of tank(s) When combined sludge and scum equals one-third(Y3)of tank volume
hen the high water alarm is activated
Inspect condition of tank(s) At least once every: ❑month(s) (Maximum 3 years) ❑ NA
ear(s)
Inspect dispersal cell(s) At least once every: ❑month(s) (Maximum 3 years) ❑ NA
earls)
Clean effluent filter At least once every: f ❑ onth(s) ❑ NA
i ar(s)
Inspect pump, pump controls&alarm At least once every: ❑month(s) ❑ NA
❑year(s)
Flush laterals and pressure test At least once every: ❑month(s) NA
❑year(s)
Oyer: At least once every: ❑month(s) NA
❑yeags)
Other:
NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper).
Tank inspections must include a visual inspection of the tank(s)to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The soil
absorption system shall be visually inspected to check 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 immediate
notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any treatment tank equals one-third(%)or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code:
a
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units,
and any servicing at intervals of<_12 months,shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 30 days of completion of any service event.
GMW-005(02/05)
Page of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other
chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are
detected have the contents of the tank(s)removed by a Septage Servicing Operator(pumper)prior to use.
Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these
conditions is not recommended, as the excess wastewater will be-discharged to the soil absorption system in one large dose causing an
overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the
contents of the pump tank removed by a Septage Servicing Operator(pumper)prior to restoring power to the pump or contact a Plumber
or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank.
System start up shall not occur when sal conditions are frozen at the infiltrative surface.
Do not drive or park vehicles over tanks or the soil absorption system. 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 area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the treatment
tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette:°butts, condoms, cotton swabs, degreasers, dental floss,
diapers, disinfectants, fats, foundation drain (sump plump)discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat
scraps,medications,oils,painting products,pesticides,sani4ry napkins,solvents,tampons, and water softener brine discharge.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly
and safely abandoned in compliance with s. Comm 83.33,Wisconsin Administrative Code:
• All piping to tanks,pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator(pumper).
• 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 fails 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 evaluated and may be utilized for the location of a replacement soil absorption system.
The replacement area should be protected from disturbance 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 the time of their permit issuance.
A suitable replacement area is not available due to setback and/or sal limitations. If the soil absorption system cannot be
rehabilitated and barring advances in POWTS technology,a holding tank may be installed as a last resort
• The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation
must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a
last resort to replace the failed POWTS.
• 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 comply with the rules in effect at that time.
WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK
SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY
RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE.
ADDITIONAL INSTRUCTIONS:
POWTS INSTALLER POWTS MAINTAINER.
Names,( )3 Names a c
Phone J f� �J Phone
SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY
Name Name j
Phone y Phone
This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections
Comm 83.22(2)(b)(1)(d)&(f)and 83.54(1),(2)&(3),Wisconsin Administrative Code.
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
t'hi.s is to certify that I have inspected the septic tan
s„ - 9
c ivin the �� k presort ly
SeCtlon S L7 resl enCe located
T7_? N, R W Town
Upon inspection, T certify that I have
Functioning properly. totrrcl
the tank and baffles to be
in good condition, and it appears to I.,e
bast time serviced:
flow back occur�ObM absorption system?
Yes
No , ski
• (If � p next line)
Approximate volume or length of time: I
---_.._ gallons
Construction: Prefab Concrete_
Steel Other
h9,rnufacturer: - .._-------
(Tf known)
AcJe of Tan If known) ,: c�(LJZ�
(Name) Please
print
i tl e) - 6?LJr-,�
AL-q��� (Lzcense Number)
[•'Urm to be completed b
Statutes or y .licensed plumber (s. 145. 06, Wisconsin
Licensed Disposer (NR 113 Wisconsin Administrative
Cade)
Plumber (applying for sanitary permit) Certification:
f it accepting the above statement regardi existing septic tank
condition, I certify that the tank to the st of my knowledge will
conform to the requi ements of TLHR 83 i
inspection opening er outlet baffle),. Adm. Code (except for
Name Signature
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w;,conain 5..u,.&.d[,Q SOIL EVALUATION REPORT page I of
Division of Safety .�i(n�(a�wordar wiUtCaron Adrn. Code County
Altadl completrr4t Md3Y1 a 1 x 11 ktdres I usinducts,Irit not k'J horimn War rice point(B din uu / � Parcel I.U.
peleentrtope,sand! tiw�anddlslattcetU 1./M` tR Iowad by bale
s ursd ra rrecondary pmposos(POvacy Low,v.1G.04 1 I)6�r)1•
Property Owner c Piopertyl. allcnt
OL4 GUvL lot rvt,4j 1/4Nk)1I4 S 3v •1• Z9 N It 1-7 e fel
Property Owner's Mailing Address Lot#h IBiuc:k# ll Sulxl.Name or 05111#
13 6v.�ke e Tr. 42 I ���m� A m�
Crty State ZIP code Phone Number (.J City Li- village Lei own Nearest Road
I wi a t5 - -73 , d -ll
ew construction Use:rhmasidential I Number of bedturnns _ Code derived desiyn flow Tale_ L_�pv—_GPD
❑Replacement 0' !Pubilo or commercial-Describe: ----- ------
Parent material �-S1 — _---_--__ Flood Plain elevation if ap{rlicabla ��! --.' _—�—R•
GetteTal calnnerds
and reoonnnendalfats:
Sysf�� "te✓r /va
Boring# La .
Pit Ground surface elev.L�3.�2h it. De 1111116119 pUr to y factor irr• _Sod A I'x:a.lion Rale
horizons DepUt Dornhant Color Redox Uescription Texture SbutaUre Consistence Boundary Rrwts GPUIit'
In. Munseli Qu.Sz. Cont.Color Gr.Sz.Sit. 'Eff#1 THU
I I 3z-
r'
S!cl 2ry66k _ C5
3 - 5L 2nl5U c '5 — �_ I.a
ry
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Boling# Boring � U �� M�►r
Pit Ground surface eiev. /nZ•CX�ft. Depth to IindUng factor in. S
-cl -- Soi Applicalim Rata ,(
Horizon Uepul Duminant Color Redox Description Texture Structure Consistence Boundary flouts TGPDfiF
in. Munsell au.Sz. Crxd.Color Gr.Sz.SIT. 'Elf#1 'Elf#2
Z 10 Z C S _ 1-4-C 5 '$
Si L ZmS S— cam_
_3_ - 3L _ 5
Effkrent 01 a BOD >30<220 mg/L.aTtd TSS>30-c 150 nqL 'Effluent 02=BOO,130 mylL and TSS<30 n4L
CST Name(Please P' t)
lgllqIUW Number
Address Date Evaluation Conducted telephoto Number
/^��) �{•��I- Parcel ID ll—lQ �------ Page
Plopedy Owner511.Z-
❑ Boring
BrnNrg# 'Pit ff�� � Soft A Hestia,Rate
Ground swiace elev.lS.�It- UePUr�prrxang laclur .�Irr•
Horizon DepOr Dornblenl Color Redox Description Texlure Struclule Consistence Buundary Roots •EIiIIGPDA*EOM2
in. Matsell Qu.Sz. Cont.Color Gr.Sz.Sir. —
3 71 ('0
z-4 �. D►ri vn
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U ❑ Pit Ground surface elev. Sol A irstlon Rate
Ilorizar Deptir Dominant Cvkx Redox D@scriptbn Textula Structure Consistence Boundary Roots •EIIMGPD#I'EIIM2
In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. _
. I
r� ❑
' I Boring# Boring Ground surface elev.___�_�It. Depth to limiliny factor -..____iin, _
u
El Pit __ Sol/1 IicaBon Rate
Horizon DepUr Dominant Color Redox Description Texture SUuctun Consistence Boundary Roots •EOMGPOATIM2
In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sir. —
Li
•Emuent#1=BODs>30 1220 mg1L and TSS>30 5150 nrglL 'E{Iluent#2=BOU,<30 mgiL and I SS<_30 rtrglL
I ,
I
'fUe Uepariment of Commerce is an equal opportunity service prvviQer and cttgrivycr. Ityou need assistance to access services or
need material in all alternate format,please contact tine dcpmtttrcttt at 608-266-3151 car'ITY 609-261-8777.
ssou>orx.orrom
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PAGE 501`3-
"\I.DES(
NAME:
SCALE:
15vKkELEVNFIOlq*---.LOQ---,O----..----.. .
I
BNI 2 ELEVATION: T -4-0
BNI 2 DE-SCitil'-1*1()I'I:.4-A-If._L.'-'P--9G.-Pif� .- --...-..
sys'I*E N1 ELEVNI'l(It
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SIGNATURE:
Wi~onsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division r
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
ermit Holder's Name: City Village X Township
Stout, Richard Hammond, Town of
ST BM Elev: Insp. BM Elev: BM Description:
i o o ~ ` GS ~
TANK INFORMATION
TYPE MANUFACTURER CAPACITY
Septic
Z GJ-. Q.;
~OOO
F~ \~ ~~ F~- ~~
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD
Septic ~7. / ~ z ( Z ~ ~ .~-
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer Demand
M
Mode umber
TDH ift Friction Loss System H Ft
Forcemain Le Dist. to well
ELEVATION DATA
County: St. CrDiX
Sanitary Permit No:
463287 0
State Plan ID No:
Parcel Tax No
Section/Town/RangelMap No
30.29.17. /dS
STATION BS HI FS ELEV.
Benchmark
~~.~
~ ~~.
~
~
Q
i T
Alt. BM Q I~ v y' ~ p
~
~ / O ~ ~~
Bldg. Sewer
Z•~ ~ ~~ 47
SUHt Inlet ~ ~ 5 ~~3 . ~z
SUHt Outlet ~ c, ! / Z ~ 7
Dt Inlet
Dt Bottom
Header/Man.
Dist. Pipe
1~~• ~ V~
~~
Bot. System 'G ~ pq ~-7
Final Grade I ~ • ~ ~ d / ,
St Cover Z ~ 7 .~
SOIL ABSORPTION SYSTEM
BED/TRENCH Width ~ Length r Nb. Of Trenches PIT DIMENSIONS No. Of Pits Inside ia. Liquid Depth
DIMENSIONS ~ ~ ~~ ~ ~~ ~~ \
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ~- (1 . 1 , `~
INFORMATION ~~ CHAMBER OR ~ ~ 4~
Type, Of System: n r~ / ~/~ ~ /~ UNIT Model Number: ~
I'11CTRIRI ITI(lAl CYCTFM~i 9 .t!->~"~ 7.x'1 r4- 3 ~
Header/Manifold ~~
~ Distribution
Pipe(s) x Hole Size
\ x Hole Spacing Vent to Air take
~ ~ ~~
y
th / Di
~ \
acin
th \ Dia ` S
L \
Leng
a_ g
p
eng
Cf111 ('(1VFR ,, o..,,«...., c..~Ee...~ n..i., ..., ne.,~~.,.~ nr er-r:PAl~P Svsfemc rlnly ` ' "" -
Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center ~7 Bed/Trench Edges ` Topsoil \ Yes ~ ~, No _ s i ~ No
G/~
~Y
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /
Location: 1514 78th Avenue Hammond, WI 5 15 (NW 114 NW^^1/4 30 T29N R17W) Eme ald Acres 1st Additior~Lot 40 Parcel No 30.29.17.
W v..i1z Ova- t~~; ~ (ell +j JCa., ,,, F-e.~ `~ Code. (~ c~.,~ ~-. ,~-
1.)Alt BM Description = , 1
` lU ~2`N
2.) Bldg sewer length = Z~ dd-' ~ ~S P~' O - Nt,
- amount of cover = // ~ ~t
!~' ~.r r~a(~e.. gage.. ~a. ~` P~~ ~~- t~e.~e
~ `i' - -
- - --
q [---
No i , i ~-,' _- ___ _ _ ,-
Use otherls de foruadditional information. ~_ _ ~ I i
Date Insepctor's Sign re Cert. No.
SBD-6710 (R.3/97) ~ ~/~~ ~ °~~ ~~
r~ ~~ Safety and Buildings Division --- - - C.uunty ~---~ - - ._ -~- ~~~^
----~. ~_-. __~~. 2Ui W. Washi eon Ave,, `
~5~~~ ~ P.O. Box 7162 ~yd,_,1~~~
,~ ~ Madisvtt, WI 53?0? - ?162 Sanitar Permit NNumber (tts be filled in b Co.
~~ Y y )
Department of Cam_merca ~ (~~> 26fi~3ls ~ 3 2 ~ ~- ___ _.~.,_~~_
Sanitar Permit A Iieati n a s~i~ p~ Number ~~~
~' Pp o ~ ~
I In accord with Comm 83..21, Wis. Adm. Code, persotwl istformatlon you provide
may be used for secondary purposes Priva4y Law, slS.OM 1' m
Ian[ Address {if differ,nt than mailing address)
.~._._ _........_ ----- -- - __. - E.r~ t#-G
i. Application Information -Please Print All Information ---€ # ~ S)
f Property Owner's Na me ~ '-'~ ~ i ~, ~~ - , - P cet N Lct p ~ B1uck A' °~
s i V -~
~ ,~~~_ ~ S~°~~ ~ ~ ___
Property Owner's M ailing Address// ''~UI~11~1G OFFICE perry •ation
~iry, State Lip Code Phone Number ~ ~ ~- ~k'~sk,Section ~~~_ ~'
_~..~.~,.. T ~; R
iI. Type of BulitlinE (check ali that apply) ___. S e~ ,~Q, -~• ' ~-~7 £ o
~1 or 2 Family !)welling -'Number of Bedrooms _ ~ ~,.~~ (z~ ' ubdivision Name CSM hurt-t~er
1 _ - -- _ S%~`°--~-`
~~
_ F~lbiiclCornrrrarcial -- Describe Use _ ,
~^ s .roo cttf~ c Y'
' i_. State Owned -Describe Use ~_ ~ --~`-__ 5,~,~,-~- _ ~~~,o~~~t'' _ ~;City_~Vsltage ~i7'awn h p oS...d r~.•~~,ty~ y~
~~ ~~
ILI. Type of lermit: (Check oe>IIy one box on line A, C.omplrtr line E if applicable) ~ -~
a -~---- __ __-- - ~ ~
hew System ~ Rtplacetnzrt S}~st:m ~ 'I'reamrerstr'Holding Tank Replacement Only ^ 0[her Modifi%ation to Existing System
~ I
~` _ _ _ i _
ts. ~_i Prrmi[ ftenzwai ~ L Permit Revssion- '- ;r! Chatsge of ~r Yermit Transfer to New List Previous Permir ~'urnber and Dasr. Issur~d
! !Before Expirarion Ylurnber ' Oarkr
i~,I~;', '1'v,~),x of POWTS System: {Check ai! that a~spl~l ___ _ __
~!,PS.:tion -Pressurized in-Grou[ui ~^ Mound > 24 in. of suitable soil U Mound < 24 in. of suitable soil ~L~ At-Grade C Single Pass Sand Filter Y '
--
~ ^ Constructed Wetland L~. Pressurized In-Ground ~.f Holding'I'~nk ~ Peat Filter !~ A:tabic Treatment Unit ^ Rec;irculating Sat>d Fii[er
i ~ Rcxsrculatirt8 Syntbetic_Media Filter Leachin Chamber ' ' D i Lina _ _
r-_.`_. g_ ~ Cravct•iess~i{x ~ i Orhar ex lain) _ _~ ____
V, Dis real/Treattnet~t Area_Informatioar~ _ ,~ ~ ~~~ _1,~ ,~
~Desi n Ftow ~ ____yr~i[~ '_'`~`'~~IT~ ~FwZ~~"µ""i-- _I
gam/ .C ~(Tgpd~fksign Soii Applicaiiun Raa(gpdsf 1~.Cn rsa area Required {sf1 ; lspersal Area roposed (sf) yst~m eva [ur
~ I ~J (/ r _._L_ _~_/r~~ ~ /(3c~.S~ ~y ~ /~Q `.t~'GGJ~`f4rl~~ i
VI. Tank Info Capocity in Torah ~~Number~ ~ ivlanufacns;er refab~ ite~! j S[eei r !"ibe Plastic ~~
Gallons Gallons of Units ~ ~~ _ /~ j Concrete ; Constructed II ~ G;ass ( , _ p
E Existing
New i ~ ~ `t-~ ~~• ' `V
Tanks 'Tanks
~epuc or Hnldina Tank ,} _~ _"'" --- - i ---~
nero~sc 1'realn~tst Usuc T_-
_ -- --__ _I~-__.___ ~____ I
posing Chamber ~., !
VII, Responsibilit Statement- I, the undersigned, assu[ne respuncibility for ~ Ilatiou of the POW'1'S shown on the attached plans.
__ _,...__._._..-- ... __ _ y
Pittmher's Na me (Print) Plumber's Si mature MP PRS Nun:t~r Business Phuna *aumt~r _ -._-' ~__
~,~r'~~. s~ti~~~x~ y~~ ~ 1l ~.~~~~d ~ ~ ~ 3/mar ~
Plumber's Addre ss (Stree[, City. Stare, Zlp Code} ' -~'~ ~~~~ ~ _ _.-___ .__..__ ..~ ~.,,.,__,.,_~._._.<.~..~
' f
Ii, Count /Dep_tu'tment L'se Only __ _ _ _
unitary Permit C'ee ~ns:ludes Groursdwater~~Dxte Issued ?-Isscin A ert Si [ ah-r No Sam c
j ~ APProvrti ~ ^Disa d 8 d : • ( P~)
~ SurLharge Feel ~ r
0 3a~-
[ven Rca for henial ~~} _
' it X-~ ---- ---_ - - ------ _ ~ .....
- •~--
nn~~tt~~ ~pA vai/Beacons for Disa royal 1 ~~ J ~
~YST~iI ~W~~: pp 3) ~,Slw~a.¢/ tn~ua-~- .ver { ~ ~ ~"
~ 1 Septic tank, effluent filter and -
dispersal cell must all be serviced /maintained ~~ ~ ~ ~ Z _ ~~ tr I n~
I as per management plan provided by plumber. `` ~ P,a
I 2. All setback requirements must be maintained ~ ~~ ~ S~ ~ _ /~}_
I as per applicable code/ordinances. ty.~tQ,i~ S t ~ o~'IDC?.~
~G~,~ 3Td
~a~o
/a ~Y~ /~ ,~/ e ~.-G c~.- ~~~ h~ frt 6.i'~ per.
IN
G ~~ ` O /
l ,~ Uc ~O o e
~-
'~ ` G~ ~~ G d
~~,pY
r G ~ f~~ ~~Q, _ ~ a ~ fir,
5~4 S~ 1 d0
1 ~ ~,~,. ~
~' ~ ~ :~1a-z/
l `= ~0 ~
< <+ e
~~GG 9~, G D'
' wi~cortsin o~artment }~ v~ SOIL EVALUATION REPORT Payo _ j _ of
UivisionolSafety uVy`
in (a~cxrordar wiUr Connn 8 }~ ' . Aron. Gxle c
t~Yt~ 4r.J County ~" ~ ~ `~ O l 1~
Attadr complete plart p¢p rr~t ran 0 1/ x 11 erdres I~ius~ -
Indude, hart not red to:~cU~al end horimn refer nee point (D , dir Paroel LU.
percent s rope, sea or dimensions, ~~ and 1 lion and distance to t a~ _ -
t R iewed by Uale
~~~~~ ~ 11118[IO/l.
Pereonei Infomrelion pro a used fw secondary puipoaos (Privacy Levi, e. 15.DA 11) Im)). • O.S
Properly t7wrrer Pr openly Location
2C~Gtrc~ ~ (~ ^~ Grrvt Lot Nr~.J t11~w1l4 S ~j(~ 1~ Z`~ N I2 ~"~ E (otI'v~
Properly t?wner's Mailing Address Lot # Dluck # Sul»l. Name or' CSh1/E
133 Ptu~~ke e Tr, 4~~~~~t~~ Ac~~ I ~_ ~ i~o_
City State Zip Ccx1o Plwne Number ^ Cily ^ Villaye ~ own Nearest Ruad
~n W l ~-I~l l5 >~ - "73 Get 1> m d - ~T
ew Construdiar Use: esidential ! Number of bedrvonrs ~~ Code derived design flow tale _ ~U_L_ ~w-__GPU
^ Replacement ^ Public or commercial - Uesctibe: _,-___- ---
Parent materiel __~~ _ - , __-___-~__ Flood Plain elevation d api>ficable ____ !~~_--_ _ _-___- R.
General co-nmerds
and recomrnerrdatiars:
Boring # ^ Boring ^;~ -- -
Pit Ground surface elev.1S~t_~_ It. Ucpth to Ilndliny lactor _~ ___ in.
_ __ _ _ __ _ ____ Sol Application Rale
lbrizon Uoptir Uominanl Color Redvx Uescription Texture Sbucture Consistence F3owidary Rrxrts GPU/It' _
in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. _ 'Eff#1 'Eff#2
~ - I 3 2 ~' Si I 2nd ~_,~ ~~ I v-~ _ 5 . $
z f 1 -
' Si cl 2r,~~bk ~ c ~ - . t-f
_
~ - 2 '~ v~~ Q a~-~-> >-,n ~ - ~ ~ ~ • Zo
~-~ .,,,Q :-~ -E-~.e
c:~
at_~
t~Q `~
r
~
^ Dorirty a ~ ~
Boring # ~O
pit Ground surface elev. (n2.C~ tt. Ueplh b limiting (actor _____ in. .~-
Sorl Application Rate
horizon Deptir Urxninarrt Color Redox Uescription Texture Struduie Consistence boundary Ruols GPDIfh
in. Munsell du. Sz. Crnd. Cobr tic Sz. Sh. 'Eff#1 'EIt#2
Z
~_ t Z- Z
3Z- ~~~`f `~
p ~~
--- SQL
.gL. _~m5~~- 'fir-
r r ~-~-.
~ 5
`- - `~' - ~._
~. O
~ ( Z ~
V 5 ~ ~
_
" Elrkrent rM1 = BOD > 3U < 2Z0 nry/l arrd TSS >30 < 1 FiU rtry/L ' EOluent #2 = BOU < 3U my/L and TSS < 30 my/L
CS7 Narne (Plea_ve Print) ,, ~ Signa CST Nunrbgr
Address Uate Evaluation Conducted Telephony Nwnber
S
~~~
Properly Owner ~~~~-
^ Boring
Parcel IU it ~~ ~~ ~ ------ Page -- ` of y~
~--!
Boring # _
~- Pit Ground surface elev. (~.~Q 1t• DePllr to GrrMting factor rrr• Sod n r icalion Rate
Horizon
2 Deptlr
in.
2 Dorinant Color
Mmrsell Redox Desctiiplion
Qu. Sz. Cont. Cobr Texlure
~.,~~ StrudurE
)Gc S~z~S~h,.
2~~k- Consistence
fir Boundary
__~~__- Roots "EfIIfGPD
~ ~ lfFEgg2
~-.
~ I g ~---' Dt-n vYll
U Boring
Boring # ft, Uepth to IimiGn Sector ___ in.
^ pit .Ground surface elev. - g Soi(A lication Rate
' Texture Strudure Consistence Boundary Routs GPDAP
Ilorizar Ueptfr
in. Dominant Culur
Munsell ron
Redox Desrxipl
Qu. Sz. Cont Cobr Gr. Sz. Sh. 'Elf#1 'Elf#2
U Borlny
Boring # Ground surface elev. ______ it• Depth to limiliny factor __-_-__.___ irr• -
^ .Pit _ __ _ Sor7 n licalion Rale
Horizon DepUr
in. Dominant Color
Munsell Redox Description
Qu. Sz. Cont. Cobr Texlure S6udure
Gr_ Sz Sh. Consistence Boundary Rrwts GPOIfF
'ESf#1 'Eff#2
' EHluenl #1 = BODS> 30 < 220 rnglL and TSS >3U < 150 my1L " Etlluent ii2 = BOUS < 30 my1L and TSS < 30 nrylL
"f6e Ueparitnent otComnterce is an equal opportunity service provider and employer. If you aced assistance to access services or
necd material in au alternate fomtat, please contact the deparUnent at G08-2GG-31 S 1 or 'I"I'Y GOB-2GA-8777.
svo-awrR.orroor
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~.
Df~l t DESCRII' I~fOht:~~_o~-~- ~tlC;_~7r`_Pe ___._.-
I3M 2 ELEVr~'I Ii1N: _ ~9~_~_.~ __. /
E3Ni 2 UL•SCIZII' I'1Ohl:~ a.-~__1~~ ~JyG_~~`P~ _ - -- L
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SEPTIC 7P.NK ~ :'UMW' ~-~at':SiR CRASS SLC:.~:'V ANA SFiCT~'ICnTzv~S
+" CI VENTPIPE ~ 12" MtN. `AHOV~
GRADE 5 W~ATHERPRCQF
} 25'
FRESH ,
FROM DOOR, WS1V'DQW OR
AIR INTAKE JUNCTION BOX APPROVED
~ WSTH CONDUIT MANHOLE CQVER
FINISHED GRADE W/ PADLOCK ~
4" CT RISER -" WARNING LABEL
-~.r.~. 4 " MIN .
I8" IN. 5" MAX.
~~
---
"~
N LET ,r
WATER TIGHT SEALS GAS• ; '
TIGHT ~ -- PPROVED
A SEAL r JOINTS WITH
PPROVED -t- + ALM APPROVED PIPE
I PE 3' B
~"" - ~
ON ~ ~ or~ro
Hr0 SOLID ~
~ 50LIO sOIL
QIL PUMP OFF ELEV .
FT. --~--- t
OFF ~~` RISER EXIT
D PERMITTED ONLY
IF TANK
MANUFACTURER
HAS APPROVAL
3" APPROVED. BEDDYNG G'NDER TANK
CONCRETE PAD
SPECIFICATIONS
SEPTIC / DOSE
:SANK MANUFACTURER: /,~, ~~~ NUMBER DQSES PER DAY: _„_,,,,~,,,"
TANK 5IZES; SEPTIC Ll~~ GAL.
DOSE ~,,~`D GAL.
ALARM MANUFAGT'JRER:
MODEL NUMBER:
SWITCH TYPEr
P^UMP MANUFACTURER:
MODEL NUMBER:
SWITCH TYPE:
REQUIRED DISCHARGE
_.~~L ~.la_.._
a.r ~I~r'rr ~rr~rr~~.r
.....r~.t r ~ ,r..._.
rtr,tr~
4 rte. ~..~~ri~.
RATE ~ GPM
DOSE VOLUME INCLUDING
F LOW9AC K : ~~? GAL .
CAPACITIES: A = ~ INCHES = ~t ,~~,CA1.•
B = 2 INCHES = -_r ~,~___ GA L .
C = ~_ 2NCHES =GAL.
D = ~ INCHES = __...1~?...._~'AL .
PUMP ~ ALARM WIRTNC3 AS PER ILHR Ib.23' WAC
VERTICAL DIFFERENCE BETWEEN PUMP GFF AND DISTRI9UTION PIPE ~~.,.j.r...~r«r FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . -~'FE£T
GQ ~, FEET FORCEMAIN X ~. FT/100 FT. FRICTION FACTOR ~ FEET
TOTAL DYNAMIC ~?EAD = _~~'~FEET
INTERraAL DIMENSIONS OF PUMP TANK: LENGTH y WIDTH ; DIAMETER
SIGNEA: ~ ~ LICENSE NUMBER: ~2~?~~Lf DATE: _y,~I~~
. ... ._.,...r----~-~-
1188
..._._
uick~,M
STANDARD CHAMBER
Quick4 Standard Chamber
MultiPort End Cap
~ ~ r r~., __ 7 ~ ~I '~ ~~
2„ -_ `~ r ~
~_^" ~" ----j sinE vleW
~laONT VIEW
sloe view
TOP VIEW
.. ,_ - ~
., ~. r4..
Quick4~Standard~Cham6er Nominal S ecif-cations „ ` ' ,t MuitjP.n~t~.End Cap;Nomfnal'SAecitications r -~;
Size W x L x H 34` x'52" x 12" - Sipe {W x L x H} "~ "34" x 16" x 12"
Effective Length 48» Invert Height 8" or 1.25"
Invert Height 8e
INFILTRATOR GV~7i~$ fNC STAN ARD l4l17ED._WA~RN7Y
jo) Tho siruCtwai intepng or oach rnarnher, erltl Frale. watig¢ and othor aU;gssUry ma~u:raclmoo Iry Ir,~iltrat v j °UnNs'1. wltor~, inslalll?'d anU operated
ar a loaehtield of an onsne ;optic system h aerorC,anos with IMiNrator's instructions, rs wanarued Io the .xigutal putchast;r ('Helder^) against Itedselive
n ~~al¢rials and wgiunun4xp br ono year Num tho state that the sLdNr. permit is Ixs<7rtd dor the septic: system curNawung the Un! ,; provkkd, twwever,
that it a septic Demur is rK:! rec;„'vad trr applicable law, the warranty period will b¢Mn uCAn the date IMI inslaNatizn N ttw septc system commences.
To exercise us warranty rutitts, Hd(]a glust rpttly Infdtratnr ~n writing al its CbrprNate NeariylkYlers in Oid Siyl7rook, Crxlnectrndl within Wteen (t E)
Rays W Iho allut)ad drskx:t, tNlNrahx will soppy rzplacoment Lh>,ts fur Units datemrinen py Infdnata to be covemry by ;his LimilEd Warranty.
InlJlralork Nalnlily sDecifk~alry pxcluUeg the ~t of ronrnval and/or inslaYaliar ut trw !Jn~ls,
tb) 111E LiMITFC WARRANTY ANP nENAFi~IES IN SlH3PARA;iRAPIt l,y ARI:: EEkCLUiiNE ;! I[nL nRC tW? OiIiER WARRANTIES WITH HESPECr
-(J I IC l1Nlr :. IN LLNJNvt: NO MaLIEFr WAR(inNTIEg c7E MEtdC7 dANTAtii: IN UR r-ITNf-;' ; FUI:. A 1'AriTICULAH NUHPCTSE:
t-) lyis I im+ ,f Warta rtv shay be ~nin V any N~rn 117 a drainbor systum u manulaflurW oY anyone otfm than N'ialt+'tt x, rxi I Ir.dtyd Warranty clues
rwl tcmd to nctdon al ronsequental sF>vc;y o ettlrcert Uarnagea, Infdlrilrx shall nut ba bal,k~. Wr {xnapN•s o- Squitlatad damages inrltrtling loss of
Frakmtion and prollts, IatYN ana meleriale, overhead ousts, a otM3r losses or uxtxmsas incurred by tar, Hah#:r or any drird wady, STxdcpicaNy
axckrted Ntxn lilo.;acl Warraryy coverage are tlarryge to th,e Vnits due to crtlinary wear and tear, alt9ralibn, aexidenl, misuse, abuse or neglocf of
trta Units, Vho Units brrkrg subi¢ctetl ro Y~vcle traffic a olhe•.• eonditiuns whir;h are not parmilhM ny the ins+,apatan insl:te,tNans, !aiWro to rtwk~tain the
minimum ground a: ears sat lonh in the mstallalior; mstruc:ipns: the placement ^t impror;n mate!lals into the system contarung the llnits; failure of
fhz Units or Ute sxlic system dt.~e to Urtproper ;Xing a irrWroDer sizirxtl, ex;.r+ssiwa wafer usage, ir>q-,roF,rx grease distxrsai. x improper operation; a
any purer avant not cai,s¢a by Inriltralor. 'this Limited WanarYy shall be votU rf the tioklor faits to Comply wnh al! cf hie tdxnu set brio to this Lirniled
Waranty.
Further m rq evzrd s1v91 trflltratw b¢ rosprnrsibta Iro any toss or damage to the Hdd¢!; the Unrtg, or any Inrcd party resullurg hum rstalkvinn ar stdp-
~nenl, or Iran any irr;xi~x;l IiatvNty Calms of Holy or tuty fhir(f p:x1Y. for Ihls !'~mitetl Warranty to aptly, the struts must U¢ Lnsiallad m aecordarx:e
with all yt¢ cardilions mgltirai hy' state and local cotlps; al cthrn apyrtical:wa laws: aad intdtratnrt insla+laitpr! instructicxrc.
{ci) NO r¢(xax':1L91ive of N ildhalnr hag Iho authnrpy to G+anga c" extend this L+ruta~ Warranty. No ww~;yr?y arYiLas to airy parry otrwr than e,¢ argi-
nai i-ION;ar.
Ttw above: ral'xgsanln the Standam t.im:'ed Wa,ranlY capered by Inlulretor. AlsrAgJ number W status arxf carntiec have drtkren! warrwrry requva-
n Mots. wyY Fx,rtlrasm- or Units should contact Inpltrata's Corporate NBadr/uanefa m ON:t SaYUn~k, C:onnecliput. prior to such purchase. to oMain a
%r~Uy of the a,^.plicats~ warranty, and should c:arafuNy mad that wantWy poor to Nre purchase of Urvls.
•
SYSTEMS I NC ~
En-rhlwtrns~tFat Ontute WssAT+watsv~ Solutions"'
6 E3usiness Park Road • P.O. E~ox 768
Old Saybrook, CT 06475
860-577-7000 • F/NC 860-577-7001
800-721-4436
U. u. Pa?ants. 4,759,661; 5,017,041; 5.956,488; 5,335,017; 5,401,116; 5A01,459; 5,511,503; 5,%?6,1G3; 5,58S.T78; 5,&39,844
Canadian Patents: 1,329,959; 2,004,564 Other patents perusing.
htt~lUator. Equalizer and SideWtntler ate registered trademarks of Infiltrator Systems Inc. tn!illratnr is a lxglstered trademark in France. Infdtrata Systems Inc.
s a rEyislared trademark in Mexico. CQntOW; Crntcwr Sw!vei Cwlnecteon, Mlcrol..aactting.. Potyiuft, SnapLrxk, Charn6erSpacar, PosiLock, CutckCut, OutckPlav Aerrcd.drnvAran
aflri Qt rrkd err dr:,.ym,•.a.ac „~ L.lab.. r... orr,,.,.,, t,,,, ,a •.r .. ,_..,.. _._ .. ._ .. _
V~VrrVrv VICYV
~GOULDS PUMPS
Submersible
Effluent Pump
~~
3871 E~4
EPOS
APPLICATIONS
Specifically designed for the
following uses:
• Effluent systems
• Homes
• Farms
• Heavy duty sump
• Water transfer
• Dewatering
SPECIFICATIONS
• Solids handling capability:
'/~"maximum.
• Capaaties: up to 60 GPM,
• Total heads: up to 31 feet.
• Discharge size; 1'/z" NPT.
• Mechanical seal: carbon-
rotary/ceramic-stationary,
BUNA-N elastomers.
• Temperature:
1O4°f (4O°C) continuous
14O°F (6OgC) intermittent.
• Fasteners: 300 series
stainless steel.
• Capable of running
dry without damage to
components,
• Fully submerged in high
grade turbine oil for
lubrication and efficient
heat transfer.
Available for automatic and
manual operation. Auto-
matic models include
Mechanical Float Switch
assembled and preset at the
factory.
FEATURES
^ EPO4lmpeller: Thermoplas-
tk Semi-open design with
pump out vanes for mechanical
seal protection.
^ EPOS Impeller. Thermoplas-
ticenclosed design for
improved performance.
^ Casing and Base: Rugged
thermoplastic design provides
superior strength and corrosion
resistance.
^ Motor Housing: Cast iron
for efficent heat transfer,
strength, and durability.
^ Motor Cover: Thermoplastic
cover with integral handle and
float switch attachment points.
^ Power Cable: Severe duty
rated oil and water resistant.
^ Bearings: Upper and lower
heavy duty ball bearing
construction.
AGENCY LISTING
~' Canadian Standards Association
(CSA fisted model numbers end
in "F" or "C".}
Motor:
• EPO4 Single phase: 0.4 HP,
115 or 230 V, 60 Hz, 1550
RPM, built in overload with
automatic reset.
• EPOS Single phase: O.5 HP,
115 V, 60 Hz, 1550 RPM,
buih in overload with
automatic reset.
• Power cord: lO foot
standard length, 16/3
S1TOW with three prong
grounding plug. Optional ZO
foot length, 16/3 S1TW with
three prong grounding plug
(standard on EPOS).
Goulds Pumps is Is0 Soot Registered.
_ ! ..... ' _ EPO4 ......_
2
S: _. .__.. ....._ .... ,
t
:.
o OQ td 20 30 ,.,,,.. 40 50 GPM
0 2 '~ 6 8 10 i 2 m~/h
CAPACITY
Goulds Pumps
®2000 Goulds Pumps ~ ITT Industries
Effective Febnury, 2000 ~J
83871
, ; POWTS OWNER'S MANUAL & MANAGEMENT PLAN
DESIGN PARAMETERS
Number of Bedrooms ~ ~~ ^ NA
Number of Public Facility Units ^ NA
Estimated flow leverage)
S4
~f
. al/da
Desig~i flow (peak), (Estimated x 1.5}
~~
ai/da
Soil Application Rate
Standard Influent/Effluent Quality _gal/day/ft~
Monthly average`
Fais, Oil & Grease (FOG} 530 mg/L
13'rochemical Oxygen Demand (BODE) 5220 mg/L ^ NA
Total Suspended Solids (TSS) s150 mg/L
Pretreated Effluent tZuafiry Monthly average
Biocharnica! Oxygen Demand 1BOD8) 530 mg/L
Total Suspended Solids (TSS} S30 mg/L ^ NA
Fecal Coliform (geometric mean) Si 0` cfu/1 UOmI
Maximum Effluent Particle Size Y8 in dia. CI NA
Other:
^ NA
#Values typical far domestic wastewater and septic tank effluent.
MAINTENANCE SCHEDULE
Page of
SYSTEM SPECIFiCA'TiONS
Septic Tank Capacity Q'~ ~ al ^ NA
Septic Tank Manufacturer /, J .'~t~ u ^ NA
Effluent Filter Manufacturer (j O NA
Effluent Filter Model ~ d~ ^ NA
Pump Tank Capacity _
4 al ^ NA
Pump Tank Manufacturer ~ shy ^ NA
Pump Manufacturer l~ala ^ NA
Pump Model O NA
Pretreatment Unit ^ NA
^ Sand/Gravel Filter ^ Peat Filter
^ Mechanical Aeration ^ We#land
^ Disinfection ^ Other:
Dispersal Call(s) ^ NA
^ !n-Ground {gravityl ^ In-Ground (pressurized)
^ At-Grade i7 Mound
^ Drip-Line ^ Other:
Other:
^ NA
Other:
^ NA
Other: ^ NA
Service Event Service Frequency
Inspect condition of tanklsl Ai least once every: ~ month(s! (Maximum 3 ysarsf
earls) O NA
Pump out contents of tanks} When combined sludge and scum equals one-third lYs) of tank volume ^ NA
Inspect dispersal cell(sl At least once eve
ry' ^ month(s) (Maximum 3 ears)
.~ ki'ysar{si y ^ NA
Clean effluent filter At feast once every: month{sl
yearls) ^ NA
Ins ect um
p p p, pump controls & alarm
At least once every: ^ month{s)
~-- ^ ear{sJ ^ NA
Flush laterals and pressure test At least once every: ^ month{s)
'-`-` ^ year{s) ^ NA
Other;
At least once every: ^ monthfs}
^ yearls) ^ NA
Other: ^ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shalt be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing ar broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal celllsi shaft be visually inspected to check 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
immediate notification of the bcal regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third lY3) or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited io the servicing of effluent filters, mechanical or pressurized Fomponents, pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within i O days of completion of any service event.
Page of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemie8ls
that may impede the treatment process and/or damage the dispersal cell(s). 1f high concentrat)ons ire detected have the contents
of the tankls} removed by a aeptage serv)cing operator prior to use.
System start up shall not occur when soil conditions era frozen at the infiltrative surface. ~~
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cells} in one large dose, overloading the tail(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
De not drive or park vehicles over tanks and dispersal cells. Do not drive ar park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at-grade soli absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; far.;
foundation drain dsump pump! water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; ail;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the PpWTS fails and/or is permanently taken out of service the following steps shat! be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 63,33, Wisconsin Administrative Code:
e Aii piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space f)tfed with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
if the POWTS fails 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 evaluated and may be utilized far the location of a replacement soil absorption
system. The replacement area should be protected from disturbance 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 sail and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
C] A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS
technology a holding tank may be insta!!ed as a fast resort to replace the failed POWTS.
~A v T site h d site
e tank
~ 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 comply with the rules in of#ect at that time.
< < WARNING > >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDlOR INSUFFICIENT OXYGEN. D(~ NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF .A
PERSON PROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER
Name ~~`f1,'~c ~.-, y,-s~~L~
lahone 7 l - _ ~ _ ~
POWTS MAINTAINER
Name
r hone
SEPTAGE SERVICING OPERATOR {PUMPER} LOCAL REGULATORY AUTHORITY
Name
Phone
Name T. (X, C~-E,hJ l ~' 2~' o--.~ 1 N~7)
Phone ~S. , '7~ v
This document was drafted in compliance with chapter Comm 83.22(2)(b}(1}(d)&(f) and 83.54it), f2) & 33), Wisconsin Administrative Code.
.U. 2 5 9? P 3 0 Q 76E,Q,~~ ~~ ~ /~
' . ' ' STATE BAR OF WISCONSIN FORM Z - 1999 KATHLEfi>i H. - MALSH
WARRANTY bEED ~ s~ICROIx°cuD~i
Document Number
RECEIVED F°R REC°RD
This Deed, made between Gillis Farms, Inc. 06/16/2084 01:20Pb
Grantor,
and Kernon J. Bast and hard O. Stout, tens is in common as to ri4 IiARRAHTY D£fiD
intent gRch Grantee. EXERT #
Grantor, for a valuable consideration, conveys and warrants to Grantee REC FEE : 1 !. 00
the following described real estate in St. Croix County, State of Wisconsin TRANS FEE: 3300.00
(if more space is needed, please attach addendum): COPY FEE:
CC FEE:
NW T/SIW 1/,, Except Certified Survey Map Vol. 14, page 3829 and also PAGES: 1
except Certified Survey Mag Vo1.14, page 3829 and also except Certifies .
Survey Map Vol. 14, page 3967;
NW t/~ NE t/i,
NE t/i NW 1/., All in Sec. 30-T29N R17W. St. Croix County, Wisconsin.
Recording Area
RETURN T8:
METRO lE6AL SERYfCES, illC.
NN°EAPOU~ ENV 55 t01~2'111~12:~
~1Zetro Legal Services
EDIRE:'[' 43321 A
N and Return Artrtress
2~,~~'a ~~~~
.~.J L~clt, '-'~151~
~ ~ S~`tvf
~~ fi~~~3G}Z-1
370?4~ WD ~9c1~46 1&1066-60-DOO: i8-1066-90-000:18-2067-00-OOo
Parcel Identification Number (PIN)
This is not homestead property
(is) (is not)
Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any.
Dated this ~ ~ day of June , 2004
Gi Farms Inc. .
F~-.a ~.
* Byt ~, ~
____ -- '
* * ---
AUTHENTICATION
Signature(s) Gillis Farms, Inc.
~_.. {{-
authenticated this f ~ day of June , 2004
Kristlna Ogland
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by § ?06.06, Wis. Slats.)
STATE OF
Personally came before me this
1
_ day of '
the above named
~. -..i
to me known to be the person(s) who executed the foregoing
instrument and acknowledged the same.
THIS WSTRUMENT WAS DRAFTED BY
Attorney Krishna Ogland * --•-- ,-1
Hudson, WI 54016 ~ Notary Public, State of _ _ _ _ __ '
• My Commission is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) ~ ,)
* Names of persons signing in any capacity must be typed or primed below flair signature. lnrocmuion Profeuiomla Co., Fmd du , W I
STA1E BAR OF WLSCONSYN &00.65 I
WARRANTY DEED FORM No. _ -1999
ACKNOWLEDGMENT
_ _}
ss.
County )
• ~ V `~LJO IJ W~ ~ l~.lo ~X~JCS~ P ~, ~ ~
~ ~ ~ ~ LOT X13
~ ~ ~ z.oo Aca~s
i ~, ~~ 87,304 SQ. FT.
BENCHMARK
b ELEV. = 7031.85
LOT 44
2.01 ACRES
i1d3B~
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318.Or ~
~ »~.~~~-
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