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HomeMy WebLinkAbout032-2068-60-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 574338 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: Bursch, Craig H. I Somerset, Town of 032-2068-60-000 CST BM Elev: Insp.BM Elev: BM Description Section/Town/Range/Map No: �a 6 GSA" 12.30.20.767B TANK INFORMATION ELEVATION DATA TYPE MANUFACTUREV,ry 3 CAPACITY STATION �B 95 /byl. 9 FS ELE. Septic / Benchmark 7� 111 "( ��ya I GSI-t_ few Dosing c3 / Alt. BM 2.9 IdZ- o A�fl Bldg.Sewer g,�5 16 11 909 Holding St/Ht Inlet 13..33 61 � TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/4 WELL BLDG. ent t Air Intake ROAD Dt Inlet So Septic , �— Dt Bottom Dosing / �7 1 Z� r Header/Man. 3 S. `611/5 Aeration Dist. Pipe 3 Op Holding Bot. System Final Grade PUMP/SIPHON INFORMATION 2 Manufacturer Demand St Cover ( J ,3 /dZ� o 5 (' Model Number 1 7. 77 ✓ ��,3 / TDH Lift 2 .( Friction Los S System Head TDH Forcemain Length / Dia. /( Dist.to well 7 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No.Of T riches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth 5 DIMENSIONS - `� SETBACK SYSTEM TO , v P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION A CHAMBER OR Typ704 ystem: �a/ / UNIT Model Number: N DISTRIBUTION SYSTEM s Header/Manifold Distribution r x Hole Size YVI x Hole Spacing ( Vjn�qAir Int Length Dia � L ngth' Dia � Spacing 3'Z SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes j No No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: ! /��/ Inspection#2: 1 4 E 1/4 12 T30N R20 metes to nds LoT' Parcel No: 12.30.20.767B Location: 1610 28th Street HOULTO/N,WI 54082(SW / S W) �}�� � n IFS 1 L A✓CA- 11.) ! ( d Alt BM Description= / /7 2.)Bldg sewer length -amount of cover= 4— a Plan revision Required? !_ Yes ; No Use other side for additional information. - Date Insepctor's nature Cert.No. SBD-6710(R.3/97) b k.A If I I It l� 1 l I I' o raT�T County Industry Services Division ? " w 1400 E Washington Ave Sanitary Permit Number(to be filled in by Co.) --I D� P.O. Box 716 A Madison,WI 53701 - j,.l 3 3J' ermit Application State Transaction Number si. (a 2�3 X5' 3 ) In accordance w�$�(( )(jr � mission of this form to the appropriate governmental unit is required prior to obtaining a sanitary perms. implication forms for state-owned POWTS are submitted to project Address(if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. /l 7� I. Application Information-Please Print All Information V Parcel# U Property Owner's Name r14 14 �. Property Owner's Mailing Address Property Location�p/�� _ / jQ Govt.Lot City,State Zip Code Phone Number w '/4„SL' '/<, Section 1-2 (circle o e T_�� N Rol E oiojV II.Type of Building(check all that apply) Lot# JZ 1 or 2 Family Dwelling-Number of Bedrooms Z �j Subdivision Name ❑Public/Commercial-De cribe Use Block# / ❑ City of ❑State Owned-Describe Use ❑ Village of CSM Number ® To. U heck onl one box on line A. Com lete line B if a plicable) ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) ❑ Permit Revision ❑Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued Plumber Owner IV.Type of POWTS System/Component/De ice: (Check all that a ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade J Mound?24 in.of suitable soil Mound<24 in.of suitable soil ❑ Holding Tank ❑Other Dispersal Component(explain) ❑ tment Device ex d i V.Dispersal/Treatment Area Information: Design Flow(gpd) Design Soil Applicati n Dispersal Area Required(so Dispersal Area Propo d(sst) I System Elevation Ci 141 Rate(gpdsf) VI. ank Info Capacity in c Gallons Total #of U - N Manufacture 121 Gallons Units 2 New Tanks Existing Tanks P. U N w p Septic or Holding Tank Q i ❑ ❑ ❑ ❑ Dosing Chamber D El El 1:1 1:1 VII.Respoiftibility Statement- 1,the undersigned,assume respon ility for installation of the POWTS shown on the attached plans. Plumber ame rin Plumber's 'gna a MP/MPRS Number Business Phone Number Plumber's Address(Street,City,State,Zip Code) �Z`IpJdff i VIII. oun /Department Use Only r pproved ❑ Disapproved Permit Fee Date ssue �/ ssuin a Sign#e ❑ Owner Given Reason for Denial $ 1 13 L t IX.Conditions of Approval/Reasons for Disapproval SYSTEM OWNEFI' L� ' 1.Septic tank,effluent filter and dispersal cell must be serviced/maintained J as per management plan provided by plumber. tans for the system and sub the Coun y onl o pa r of less than 8 1/2 x I I inc yes in size as per applicable t'd43�NdfdRtSl�:�. y°, _ r t� SBD-6398(R03/14) �1 d � � - ° 1 e� - k KIM A OCONNELL Page 2 8/1/2014 • Materials shall conform to the requirements of SPS 384.10.No fixture,appliance,appurtenance,material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system,unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • Maintain well and waterline set backs per SPS 383.43(8)(i).Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. A copy of the approved plans,specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department,which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review shall relieve the designer of the responsibility for designing a safe building,structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerel Fee Required$ 250.00 Fee Received$ 250.00 Balance Due $ 0.00 Patricia L Shandor POWTS Plan Revie er tegrated Services WiSMART code:7633, (715)634-7810, Fax: (715)634-5150,M-F 8:00 a.m. -4:45 p.m. pat.shandorf@wisconsin.gov cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services(formerly Safety&Buildings)will be modified. Code references with prefixes starting with"Comm"have been replaced with "SPS"to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety&Professional Services.Additionally,all IS(formerly S&B)codes have been renumbered and addressed in a"300" series. For future reference,the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. onxrarE� DIVISION OF INDUSTRY SERVICES T�s 10541N RANCH ROAD P HAYWARD WI 54843 3 k S " K Contact Through Relay www.dsps.wi.gov/sb/ v p o www.wisconsin.gov �OSSIONI��5� Scott Walker,Governor Dave Ross,Secretary August 01,2014 CUST ID No. 224263 ATTIC•POWTS Inspector KIM A OCONNELL ZONING OFFICE KO CONSTRUCTION ST CROIX COUNTY SPIA 504 3RD AVE 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 08/01/2016 Transaction ID No.2439531 SITE: . Site ID No. 804380 Craig Bursch Please refer to both identification numbers, 1609 28TH St above,in all correspondence with the agency. Town of Somerset St Croix County SW1/4, SE1/4, S12,T30N,R20W FOR: Description:Mound,3 bedroom residence Object Type:POWTS Component Manual Regulated Object ID No.: 1495165 Maintenance required; 450 GPD Flow rate; 29 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual-Ver.2.0, SBD-10691-P(N.01 101,R. 10/12),Pressure Distribution Component Manual- Ver.2.0, SBD-10706-P(N.01 101,R. 10/12), SSWMP Pub. 9.6; Effluent Filter CONDITI The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes ppPR and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed DEPT OF S and located in accordance with the enclosed approved plans and with any component manual(s)referenced above. OFESSiON The owner,as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code PR requirements. DIVISION OqC—ORR No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: SEE Key Item(s) • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard,the property owner must follow the contingency plan as described in the approved plans.In addition,the owner must insure that the operation,maintenance and monitoring duties as described in section VIII of the mound component manual are complied with.A copy of this information must be given to the owner upon completion of the project. • The bottom of the distribution cell shall be level per the Mound Component Manual. The"D"dimension shall be a minimum of 7". The maximum finished slope of the mound surface shall not have a slope ratio steeper than 3:1 per the Mound Component Manual Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(6)(a)2. • Limit activities in the area 15'beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. J MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Craig Bursch Owner's Name: Craig Bursch Owner's Address: 272165 th Ave Somerset WI 54025 Legal Description: SW--SE--sec 12—T30N—R20W Township: Somerset County: ST. Croix Subdivision Name: Lot Number: Block Number: Parcel I.D. Number: 032-206860000 )NALLY Plan Transaction No.: WED Page 1 Index and title >FETY AND Page 2 Data entry AL SERVICES Page 3 Mound drawings *STR Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan i Designer: Kim Oconnel License Number: 224263 Date: 07/06/14 Phone Number: 715-381-7917 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SBD-10691-P(N.01/01, R. 11/12),and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS(01/81)and Pressure Distribution Component Manual Ver.2.0 SBD-10706-P(N.01/01, R. 10/12) Version 7.0(R. 11/12) Pagel of 8 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill(D)calculations assume a 300.00 Estimated Wastewater Flow(gpd) Table 38344-3 in-sftu soil treatment for 1.50 Peaking Factor(e.g. 1.5= 150%) fecal coliform of-36 inches. 450.00 Design Flow(gpd) 18.00 Site Slope(%) 99.80 Contour Line Elevation(ft) 29.00 Depth to Limiting Factor(in) 0.40 In-situ Soil Application Rate(gpd/fe) Distribution Cell Information 75.001 Dispersal Cell Length Along Contour(ft) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate(gpd/ft) 1 I Influent Wastewater Quality(1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) E Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation ft 2 Number of Laterals of the highest point. 0.125 Orifice Diameter(in) 3.19 Estimated Orifice Spacing (ft)= 9.38 ft2/orifice 2.00 Forcemain Diameter(in) 50.00 Forcemain Length (ft) Does the forcemain drain back? C Y 92.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft)x 1.3 8.16 Forcemain Drainback(gal) 8.22 Vertical Lift(ft) 67.53 5x Void Volume(gal) 0.45 Friction Loss(ft) 75.69 Minimum Dose Volume(gal) 0.00 In-line Filter Loss(ft) 19.77 System Demand (gpm) 15.16 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x x 1.00 1.50 1.25 x 2.00 1.50 x x L 3.00 2.00 x 3.00 x Gallons/Inch Calculator(optional) Treatment Tank Information 1000.00 Total Tank Capacity(gal) 1000.00 Septic Tank Capacity(gal) 51.00 Total Working Liquid Depth (in) Wieser Manufacturer 19.61 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 600.001 Dose Tank Capacity(gal) I Plo lock Filter Manufacturer 11.821 Dose Tank Volume(gal/in) PL 525 Filter Model Number Weiser Manufacturer Project: Craig Bursch Page 2 of 8 Mound Plan and Cross Section Views 1 1/10 B J Observation Pipe . . . ... ... .. TA B L Mound Component Dimensions A 6.00 ft E ffilft in H 1.00 ft K A28.92 ft B 75.00 ft F in z 19.27 ft L ft D 7.00 in G J 3.65 ft W ft 450.00 (fe) Dispersal Cell Area 1 1895.38 (ft?) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 1 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.18 (ft) ♦ H .....,...... G l F Dispersal Cell 100.88 (ft)Lateral 100.38 (ft)--► — Invert Dispersal Cell Elevation D L4 t 99.80 (ft)Contour Elevation 18.0 %Site Slope Geotextile Fabric Cover Shading Key $ — Dispersal Cell See lateral details on 1❑® Topsoil Cap 1.5 ft Page 4 for number,size, �2 �t�•�•�� Subsoil Cap a and spacing of laterals. ASTM C33 Sand 1° `° '° Laterals are equally `o Z F spaced from the Layer Typical Lateral Tilled La Y c m O ft distribution cell's © Aggregate o �_ ! centerline in the —A * distribution cell(AxB). Project: Craig Bursch Page 3 of 8 End Connection Lateral Layout Diagram Laterals centered over the A&e dWrtension 0=Turn-up wtball valve orolesnoutplug P .I All laterals are identical IE X—>I Holes drilled on the bottom of the lateral s equally spaced Force main connection via tee or cross to manifold at anq point. Laterals Morcemain Sch 40 PVC per SPS Table 384.30-6 Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 3.20 ft Lateral Length (P) 73.60 ft Orifices per Lateral 24 Lateral Spacing (S) 3.00 ft Orifice Density 9.38 ft2/orifice Lateral Flow Rate 9.89 gpm Manifold Length 3.00 ft System Flow Rate 19.77 gpm Manifold Diameter 1.25 in Total Dynamic Head 15.16 ft Forcemain Velocity 2.02 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and -� SPS 316.300 WAC 4 in.min. Disconnect -�_ Tank component is properly vented E— Alternate outlet location Forcemain diameter Weiser Manufacturer 2 in. Capacityl 600.00 Gallons Volume 11.82 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 34.36 406.11 B 2.00 23.64 C Pump off elevation(ft) C 6.40 75.69 92.67 D 8.00 94.56 D Total 1 50.761 600.00 Dose tank elevation(ft) 3"Bedding under tank. 1 92.00 Alarm Manuafacturer JSJ Electro Note: Switches Alarm Model Number 101 HW containing mercury may not be used in Pump Manufacturer Goulds this system. Pump Model Number PE 51 Pump Must Deliver 19.77 gpm at 15.16 ft TDH Project: Craig Bursch Page 4 of 8 i Mound System Maintenance and Operation Specifications Service Provider's Name Kim Oconnell Phone 715-381-7917 POWTS Regulator's Name ST. Croix CTY Zoning Phone 715-386=4686 System Flow and Load Parameters Design Flow-Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow-Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 if Maximum FOG 30 mg/L Type of Wastewaterl Domestic Maximum Fecal Coliform >10E4 cfu/100 ml- Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test monthly Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once eve 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis.Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384,Wis.Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished . . . . ............... Grade v/ 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Craig Bursch Page 5 of 8 Mound System Management Plane, Pursuant to SPS 383.54,Wis.Adm.Code General This system shall be operated in accordance with SPS 382-84 Wis.Adm.Code,and shall maintained in accordance with its'component manuals[SBD-10691-P(N.01/01,R. 11/12),SSWMP Publication 9.6(01/81),and Pressure Distribution Component Manual Ver.2.0 SBD- 10706-P(N.01/01,R.10/12)]and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33,Wis.Adm.Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers,access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound,defective,or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s.281.48,Stats. The contents of the septic tank shall be disposed of in accordance with NR 113,Wis.Adm.Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the finer when removed from its enclosure. If the filter is equipped with an alarm,the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment,maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However,if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump(dosing)tank shall be inspected at least once every 3 years. All switches,alarms,and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter,and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic(other than for vegetative maintenance)on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations(October-February)dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD.5,150 mg/L TSS,and 30 mg/L FOG for septic tank effluent or 30 mg/L SODS,30 mg/L TSS,10 mg/L FOG,and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specked in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral,and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner,and any levels above 6 inches considered as an impending hydraulic failure requiring additional,more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank,pump,pump controls,alarm or related wiring becomes defective the defective component(s)shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface,it will be repaired or replaced in its'present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media,and related piping,and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. [(�GOULDS PUMPS Submersible 1q7 0 Effluent Pump PE "RBENT PUMP SPECIRCATIONS MOTOR FEATURES Pump—General: General: ■Corrosion resistant • Discharge:1'fi"NPT • Single phase construction. • Temperature:104°F(40°C) He ■Cast iron body. maximum,continuous when • 115 volts ■Thermoplastic impeller and fully submerged. • Built-in thermal overload pro- Cover. • Solids handling:'/" tecdon with automatic reset. ■Upper sleeve and lower maximum sphere. • Class B insulation. heavy duty ball bearing • Automatic models include a • Oil-filled design. construction. APPUCATIONS float switch. • High strength carbon steel ■Motor is permanently • Manual models available. shaft• lubricated for extended Specially designed for the service life. • Pumping range:see PE31 Motor. following ses ■Powered for continuous � performance chart or curve. • _33 HP,3000 RPM • Mound Systems • 12.0 Maximum amps operation. • Effluent/Dosing Systems PE31 Pump: ■Al ratings are within the • Low Pressure Pipe Systems - Maximum capacity:50 GPM • Shaded pole design working limits of the motor. • Maximum head:25'TDH PE41 Motor. • Basement Draining • .40 HP,3400 RPM disconnect power • Heavy Duty Sump/ PE41 Pump: cord,20'standard length, Dewatering • Maximum capadty:60 GPM • 7.5 Maximum amps' PSC d W heavy duty 16/3 SIf with • Maximum head:29'TDH esign NEMA 5-15P,three prong, PE51 Pump: PE51 Motor, 115 volt grounding plug. • Maximum capacity:70 GPM • .50 HP,3400 RPM ■Complete unit is heavy duty, • Maximum head:37'TDH • 9.5 Maximum amps portable and compact • PSC design ■Mechanical seal is carbon, METERS FEET _f cerami4 BUNA and stainless 40 F-7— _...;_ MODELS:PE31,PE41,PE511 Steel. PE5.1 r- 'riP .33,.40,.50 ■Stainless steel fasteners. 351 :'l r 2 GPM t ! 10 - ;- t AGENCY USTINGS t t { �cp® i 25} t E } ! i _ Tested to UL 778 and z f CSA 222108 Standards e : t By Smnda*Aoodaft f j I ! Cana&= #LB38549 O G t— PWnps is ISO 9001 Registered. r . 5 : _ 7 . -� O Q�..�...:.- .�....._ .._.�. .._ 0 10 20 �36 400 50 60 70 GPM 80 U 5 10 15 rr3/h G0Uk5 Pumps CAPACITY _ , i Property Owner ? ParcellD# �..� �f� Q Page s"_–,Lof� i Boring# [] Boring jD pit Ground surface elev. 1M,/� ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure tence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. * ff#1 if#2 b E Boring# n Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure 7,onsistence Boundary Roots GPD/ft Z in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. :-fF#1 ff#2 Boring F-1 Boring# Ground surface elev. ft. Depth to limiting factor in. pit So pligoon Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. Inc ff#2 *Effluent#1=BOO >30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD ,<30 mg&and TSS<30 mg/L s The Dept.of Safety nd Professional Services is an equal opportunity service provider and employer. If you need assistance to Y access services or need material in an alternate format,contact the department at 608-266-3151 or TTY through Relay. SBIM330 M I/11) RECEIVED Wis.Dept.of Safety and Professional Sery L�? 20,FOIL EVALUATION REPOR Page / of Division of Safety and Buildings aT ip"1 ,#.MvlW qPS 385,Wis. Adm. Code i ,.�P. r.A i� County Attach complete site plan on pa��Q JPh�a�tY�/tX ��hb§'in size.Plan must ` include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Please print all information, viewed Date Personal information you provide may be used for secondary purposes(Privacy Law.s.15.04(1)(m)). G�t�- � Property Owner Property Location Govt.Lot 1/4 1/4S ,/ T N R E(or) V Property Owner's Mailing Address Lot# Blo # Subd.Name or CSM# City State Zip Code Phone Number ❑City O Village ®Town Nearest Road JQ ( - New Construction User) Residential/Number of bedrooms Code derived design flow rate GIRD ❑Replacement Public or commercial-Describe: Parent material Flood Plain elevation if applicable ft. General comments ,u ) 9 and recommendations: Boring# F/-1 Boring ® Pit Ground surface elev.,/k9•6 ft. Depth to limiting factor _30 in. [Soil Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ff#1 fr#2 Boring# Boring D Pit Ground surface elev. ft. Depth to limiting factor _in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Copt.Color Gr.Sz.Sh. ff#1 ff#2 -/ Effluent# =BOD >30:5 220 mg/L and TSS>30 <150 mg/L 'E ant#2=BOD <30 mg/L and TSS<30 mg/L • CST Name(P rint) 1 Signature CST Number Address ate valuation Conducted Telephone Number SBD-8330(RI 1/11) ' a I_ k � r I .I_ -- I r T I T - t��1C i I i _ tj Nix T AA Zi Az - -� - - 009 s L.L CNJ 0o t0 it tom 0) - i = o —� i t i t` M 3 LLJ Z-- ---+ n cn o � ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Proper�y Address l� (Verification re om Planning&Zoning Department for new construction.) City/State arcel Identification Number � 7 LEGAL DESCRIPTION r Property Lo�ataon s�� l/t fi_1/4 ; Sec. _; T�_N R- W, Town of Subdi-,ision Plat: ./,l .r �e� o ,Lot# Certified Survey Map # , Volume p, ,Page# y Z l -J- d Warranty Deed# � — (before 2007)Volume Page# , Spec house 0 yes4o Lot lines identifiabley yes 0 no SYSTEM MAIl`TTENANCE A 'D OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in§SPS.383.52(1)and in Chapter 12-St Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning&Zoning Department a certification form,signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(I)the on-site wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is less than 1/3 full of sludge. I/we,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,herein; as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St.Croix County Planning&Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s)of the property described above,by virtue of a warrant),deed recorded in Register of Deeds Office. yr 4s7K 33 Number of bedrooms�_ -7 L/I SIGNATURE F APPLICANT( DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the wan-ant),deed. (REV.04112) _fI DOCUMENT NO �I STATE BAR OF WISCONS)N FORM 3-198z = li - II QUITCLAIM PEED ��....�, 477608 )a �3�s � t JFFf i RcGSTERS 'I n 4 Bradt Py J Aursch -ndonly r- himself. I S3. CROIX CO.. WI Recd fat Record JAN "11992 9:55 A. M nmmn i-, JPr,j man.- nns+-Y a I f j-nj-t-_1cest of u the following descrioed real estate in St. f1roi,3r ,_County, (I State of Wisconsin: .RETURN TO See attached Schedule "A^ J+ Tax Parcel No: I! �I t This lG not homestead property. (is) (is not) - II -Dated-this- 7 � day of 19 . __._(SEAL) f (SEAL) BRAD E3 J. Q0 R5 G14 — (SEAL) _ (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature.(s)— _ STATE OF WISCONSIN �) i I 55. II �.� St ounty (i li authen.!icated?him_--daY of f9�....,. Personally came before me this._i tri ,_day a! I' �) )sr:uary 19 ti . 9 ._the above named TITLE:MEMBERSTATE BAR CF LVISCONSIN - ,,�' •-�-r I) , I Ill^ot n A rnf,v,fMa belie pQysnn_,v^ ._who eterl the �I authorized v §706 66 W 5 S+?ts i ^In Ott umL�nt as kno the salsa ,! THIS;NG r»erne^I r do �)„arrr=c,er T rt 3i t-�nU LTot,l r ?3� �( r a r riotar PUt, (31nnatures may be authen LCaieo or �,.-r' - h narrrasn.?^! +n :,nl ;,-it° n p al,n+ f )� vw.,,iy. un,n ,. .. —.. are"not necessary 1 �.._3 r )i 1 �I QUIT CLAIPA DEED STe t=BA cir„v,Sr,ON;Ir+ FORM Alq , t..r ,; PQ Ro*,OiUtl.Green Day.V/f''iA"!Y)7.!,2nR ;r> -77-777-77 - — EX- HZ13IT A��� A."x ) VOL , 39 ,4 J1 O +� �� N -� E O CEO O •« C o Q) O C ,� L C. 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CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner O-BURSCH, BRADLEY J &CRAIG H BRADLEY J &CRAIG H BURSCH 272 165TH AVE SOMERSET WI 54025 Property Address(es): *=Primary Districts: SC=School SP=Special Type Dist# Description SC 5432 SCH DIST OF SOMERSET SP 1700 WITC Notes: Legal Description: Acres: 25.250 SEC 12 T30N R20W SW SE EXC W 1253.75'OF S 385.5' EXC PT TO CSM 14/3831 Parcel History: Date Doc# Vol/Page Type 02/01/2005 786263 2740/351 QC 07/23/1997 929/338 07/23/1997 810/154 07/23/1997 803/462 more Plat: *=Primary Tract: (S-T-R 40%160%) Block/Condo Bldg: *N/A-NOT AVAILABLE 12-30N-20W SW SE 2014 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 04/07/2011 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 20.000 3,500 0 3,500 NO UNDEVELOPED G5 5.250 8,600 0 8,600 NO Totals for 2014: General Property 25.250 12,100 0 12,100 Woodland 0.000 0 0 Totals for 2013: General Property 25.250 12,100 0 12,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M 211 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00