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HomeMy WebLinkAbout018-1070-00-000 Panay St. Croix Wisconsin Department of Comme.'ce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT Permit No: 578990 0 (ATTACH TO PERMIT) an ID No: GENERAL INFORMATION Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. Parcel Tax No: Permit Holder's Name: City Village X Township 018-1070-00-000 Sittlow, Michael & Darlene Hammond, Town of CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 31.29.17.4826 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER /f CAPACITY STATION BS HI FS ELEV. Septic y,, ~OOd Benchmark 7~j ~bZ .s 94 Dosing tr P, Alt. BMdDA ~L~ S Ae~rm C Bldg. Sewer Holding 35 `TS • Z ~ St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/It WELL BLDG. jEm take R OAD Dt Inlet Septic 57I Ali Dt Bottom 87 '$7. L$ ~/5 I _ . Dosing S~ `f Z& Header/Man ! 31) Dist. Pipe d`j 99 77 Aeration Bot. System 3. t cam, g~ Holding Final Grade Z 1 a PUMP/SIPHON INFORMATION elk, St Cover ` Go 3~1 1b2-88 °r . S S Manufacturer ~O hh Demand bot GPM Model Number n C r T. 75 9-7• 1 TDH Lift /2,Z Friction Loss System,3Head 5 TD~a'S$ t 01 ./3 1 Forcemain Length Dia if Dist. to well / l 5 SOIL ABSORPTION SYSTEM o.9 Tren In s PIT DIMENSIONS No. Of Pits Inside Dia. U q.Repth BED/TRENCH ONS Width Length DIMENSIONS DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHLEACHING AMBER OR Manufacturer: INFORMATION Type ystem: l UNIT Model Number: a~~ 33 3~ DISTRIBUTION SYSTEM r a r0. spacing i/ Vent Air Intake ~ D istribution Intake ~dU Header/Manif ill _y THole S3/ ' I rm Pipe(s) ~ L Length 3 Dia Z Length 3~_ Dia / Z`~ Spacing 3 ✓ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over xx Depth of xx Seeded/Sodded Depth Over Mulched To ' No BedlTrench Center Bed/Trench Edges psoil =Yes H No es 0 Ae ction #2: COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1- on a a arcel! 31.29."17.4828 Location: 1580 60TH AVE Roberts, WI 54023 (SW 1/4 SE 1/4 31 T29N R17W) metes & b un of 2.) Bldg sewer length = 21 1.) Alt BM Description = ASigna - - amoun t of cover / Plan revision Required? Yes X No =6_151 F4~ Cert. No. Use other side for additional information. Date SBD-6710 (R.3/97) r xk Safety and Buildings Division County r w, 201 W. Washington Ave., P.O. BOX 7162 Sanitary Permit Number (to be filled in by Co.) 1 } Madison, WI 53707-7162 'ZI old 6tb990 "TNkOr ;q ransaction umbeCr Sanitary Permit Application `''ii~~'AA~~ 1 In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate goJ4FAtAenta 5J is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POva muted to oject Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide u ses in accordance with the Privacy Law, s. 15.04 1 m Stats. f h n , 1. Application Information - Please Print All Information ANT 'fT v Property Owner's Na a Parcel # Property Owner's Mailing Ad ress Property Location t J 58u Govt. Lot ) City, tate a Zip Code Phone Number Section circle one ` T O I N; R E or WW II. Type of Building (check all that apply) Lot# /~j ~~DIlK S I or 2 Family Dwelling - Number of Bedrooms Sabdivision Nwite t!~ M ❑ Public/Commercial - Describe Use Block # tp~ ❑ City of ❑ State Owned - Describe" ]Use / CSM Number ❑ Village of X ! 5' ~ UN l R own of d [II. Type of Permit: (Check only one a A. Complete line B if applicable) d A" ❑ New System Replacement 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 mber and Date Issued Before Expiration Owner C O/7 7 IV. Type of POWTS 5 stem/Com oneut/Device: Check all that a L ❑Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Gra e Mound? 24 in. of suitable sail _b Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) _ V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Applic ion Rate(gpdsf) Dispersal ea Required (sf) Dispe al Area Proposed (sf) Syste Elevatio © U Wb VI. Tank Info Capacity in Total # of A'Aanufacturer Gallons Gallons Units c v 0 V ` y 4) 2 %n New Tanks Existing Tanks 104k 5Z5 4. =g Z 1! -2 J2 a U r%I w C2 Lt. 5 Q. Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- t, the undersigned, assume responsibility for installation of the POWTS shown hed plans. Plumber's Name (Print) pMr's Signature MP m Business Phone Number k ?e,-Y) Plumber's Address (Street City, State, ip Code) Gv 96 )0 e VIII. Count /De artment Use Onl Approved is Permit Fee ~Date Issue 'f Issuing Owner Given Reason for $ (Q 25, b D V' l J (~a5 IX. Condt,.T.M j #iW w8WReasons for Disappr $e~N%. ef`nttent filtertnii! C on d i -t-r'o ~t s i n s'ta.~e_ c dispersal cell must all be servlW / tiv .S t:1~Q✓13VA,~ Mal as per Management plan provided by,Plumber. pG' M.i t-' 2. A Nis met emef Must ~l 5e~s fo c~6t2•ra' Attach to complete plans for the system and submit to the County only on paper not less than 8 in x 11 i es in size D SBD-6398 (R. 11/11) 9'0'\x7ATFA DIVISION OF INDUSTRY SERVICES 3824 N CREEKSIDE LA HOLMEN WI 54636 3 t S a Contact Through Relay J j http://dsps.wi.gov/programs/industry-services w1 www.wisconsin.gov / Scott Walker, Governor ~'ssror+~+1 Dave Ross, Secretary June 03, 2015 CUST ID No. 226375 ATTN: POWTS Inspector ROBERT W ULBRICHT ZONING OFFICE ULBRICHT SEPTIC PLUMBING ST CROIX COUNTY SPIA 2812 10TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/03/2017 Identification Numbers Transaction ID No. 2545523 SITE: Site ID No. 812791 Mike Sittlow Please refer to both identification numbers, 1580 60TH Ave above, in all correspondence with the ag encv. Town of Hammond St Croix County SW1/4, SW1/4, S31, T29N, R17W FOR: Description: Three Bedroom Mound Systeml.5% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1536433 Maintenance required; Replacement system; 450 GPD Flow rate; 25 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. D O N D ITI O No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, APPRO stats. DEPT OF SA The following conditions shall be met during construction or installation and prior to occupancy or use: PROFESSIONA Reminders C "VISION OF INDUS • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be ma e SE CORRESP the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • All POWTS component piping material shall be SPS 384, Wis. Adm. Code compliant. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • 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. ROBERT W ULBRICHT Page 2 6/3/2Ot5 Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • 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. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Division of Industry Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WISMART code: 7633 jeny.swim@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm ROBERT W ULBRICHT Page 2 6/3/24f5 Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • 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. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Division of Industry Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WSMART code: 7633 j erry. swim@wis consin. gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm 28-12 10th Ave. - Spring `Valley, W15475/ 715-772 y992. 1,AAY 112015 "'Y SERVICE PROJECT" INDEX Plan I . D p Date M fly 7- a.a t 5 Owner MIKE PARIENE s i +f l 01,0 ° Phone 715 ' q77 ' D Y6 0 Address 158v ~¢Q { Avc (A•k•A . HwY T 6 ~PT-5 ,S~fa w 1. Z 3 Legal Description S ,Yy 5w %f , SEC. 31 T'L f N R 17 w, M EET$ 3 136v.,a175 . PIN 019-1070 - oo - 000 Town of KAMM WJO County S1-: C,P-0 k a s ~ Tw R. -UL(3 R iG~ f 11(e3 7 Installer Local AuCho-r-Tty/ ST. C- Oi cry. Z6AxA3G_ .PRO-JCCT CRSCRIP7\ICN PtPrC.EA3 T -foe i4 3 T3t± 5 t 1+M . (55T-iAlAF~ 5D DA-l'Ly 10ASTFF/6 C = 30o JA,(5 . s SOIZ "+R45- 5U1*r14131E- F Ok A- CDAuurz~TiaAjA L Mat,ND ~y~~ SYST tii ~S(~~-- o F APPRWU D S,¢A3Z) a 6X15T1 -r4Ajg (A-PPOA aLDa Of ZIN~bWV S/ZE Cp.UD1T/owe To CON 0 ql s s i454A.)0 D k) OFD z Ro w ULBR NQ 01160 s4 HUDSON, R Wt r\T E NT r 'TANKS S P FiQL'S p~ g G14~4.~.. ` eC ai~inrnun~utiati~a C~c Pg®1 PLOT PLAN VIEWS Pg®2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS (REVERSE SIDE DETAILS INSPECTION PIPES & FABRIC/TOP FILL DETAILS) Pg - 3 PIPE LATERAL LAYOUT (REVERSE SIDE SHOWS D-ETAILS OF LA'T'ERAL CLEAN OUTS) Pg-4 DOSING CHAMBER CROSS SECTION & SPECS Pg-S PUMP PERFORMANCE SPECS (REVERSE SIDS; SHOWS PUMP DETAILS) Pg m 6.OPERATION, MAINTENANCE REQUIREMENTS (REVERSE SIDE SHOWS SITE ti SPECIFIC PROJECT DETAILED INFORMATION,TTNIQUT TO LOCALE AND GOVERNMENTAL UNIT AREA) The attached plans and specifications are based On the fo1,°+ov7ing approved manuals. "Mound COmponent Manual For Private nslte Wastewater Treatment Systems i' (Version 2A SBD-lo693, and "Press~urs Distributic)v Component po¢P~e~t Manual F (N~ 1,1 1, Wastewater Treatment Systems" or Priva e- Onsite (version.2.0) SBD® _0706-P(N l/0-1.). aQ ~ D M s r, s COW ZZ/ _r^ Ica ~ os ~ nt~ ~s o coo c:r cm as -i cim v, a- F ..e mmC=p Mo m r a 0po> 9 E M ®z0 CD ®-1z 0 vi m --I c~ co Q D ® s o co 0 - Z c C= W T -n co `oZ r - co --1 - CS tos-m s _ m fi Q m 0 u w -n r Xj- o zz -~~o LA_ _ 44 a z 3 3 3 rv °O 9V 3 t- c° • ~1 M LA V% :p o F4!r T- G o T 4-, CRop LAN125 c.. rc v,> > G CG T O ~J o F- ,M O U I~ w i r ti T3 e DisTRiauT~o,~y I Agg+ecSATE' rk~ ck►~ Fs 9 Pip IA5 G- OP T°P SofL Gv/ T~~i~i•U.fL SysrEM U)Ji Fo K Toe 3 F << . _ i,, i ` SAmP Plewsa raPSoc uu FORM C 5 % 5 i o P E FORCE" M /l~•~ E t t;vAroa UA30E R Rev 17. eo FT. ~ EL E V h T•t o r.3 S ~ q y' 30 5 Fr. - iNVERr of l= N JATGRA (s • 9D FT. Top of Rock cI y6.0 " X2 F -r. it r H . o FT. - TAP OF l IATERA IS y• f'LA N VIEw oF- MowoD wi rtt 13 D CEN TRNL- F&PU MAiN A (o FT I50' L Fr k /0 Fr L FT w F r a Uv 30 fT- 86v aF %,t Pvc cAPPep TO Aq4 RE7,-T'" 0 3SE R Vhrt a,u Pipr= s /oc-+T:a.Js : ~e 'fb /D `TRon "S PERMAuE,uT MARKERS ( refs - of CICAA.2 0c..9% S ev REG?UiRED 13ASAL AQeA `AA~•~y r~hsr z/.7 o _ J -750 S01 L ioli IrpATWE` _z C A?Aci ry Fr. a. PROPOSED 4ASM AReN . B X (A + 1 f - X575 0 1 5 x + ► 5 T. 5Z7 e7'16Aj z (n pipe Distribution cell 6•. ,r- Cover maferial Fill material (ASTM C31 fine aggregate) d Tilled area <~-•Slope Force main Figure 6. Cross-section of a Mound System Water tight cap4 Top of 4" min. dia. leaching Repair couplings chambe Slot 6" min. min. . 4 in.. infiltrative surface , Water Closet Collar Bar(3111. In 41a.) Figure 8 - Observation Pipes 30 h,H 0 7 I( It o ff' a r c C c %,.O~S ef7-,e L/f -n"~ 4 616 IDISTRt5uTio p ptpc LAO uT 3 pg, of G CENTRPAL F o R CE lit AI Isr /fD/E 1 5T NoIE Z I X /f `-t. 2b TOTAL V010 VOIUM E OF NETwoRK 2. 9 ~ls (Z = rT. ,34 5(0 x ~wCAE s 'TOTAL VOID VO(Umff- OF FORCE MAN(1.50') INVERT ELEVINTION3 OF LATERA15 Ho1c- ViAcMETEP (a i N aE5 o,1ReFul1y REmduE All I..RTE R/~L pRilltD ORfICE "30RR5 I I►JGtiES ROILS 10CATED b~) MA* ~ Fcn.0 2. INGI1>r S GoTroM eUWLY FORGE 1`~1~1~1 2 SPACMD. ~ t~01~5 'PER 1NTi:RAt, 3 • 'Dl5TRir30Tio,.l GE(( AREA- PER. oR Fic E- = 60-65 fl. 2 SEE REVERSE 510E FOR TERM11JPsL % L>P-'rA!L PER OTIa ► FOM I WES 1215C( PR-9L RATE To BE lNtc.. PeR MINUTE PER t}olE , a bts-rklIjoTlow DI SCHARSE , RATe FOR EiAc k IATERAI 9,59 Al5 9 /Him • TO'rNL I>lSTV-%B0T'l0JJ pi5Ch/~Rje PATE FoR NC-,rw0Mk 3 q. 3 2 gMS /M►N @ a.5 M►Ni MV M 14eND I)ETA'a- OF CID P/ P67-5 /1- /off- .,9 A/I 13ox 13E-v /RUC /34 p4 laE OF (e SEPTIC TANK 6 PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS sy~a ' 4" CI VENT PIPE 12" MIN. ABOVE GRADE 6 #WEATHER PROOF "l _ LO FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE 1,04AQ WITH CONDUIT MANHOLE COVE: cp4 W/ PADLOCK & -I - WARNING LABE ~l.,.... I i -4" MIN. a~ I NLET ~ GAS- ; - u " 2_ ~,v~~ C ~QGI`~'L~► _ =R TIGHT A I SEAL APPROVED ScD. 40 ~i LTEK -1 l ALM JOINTS W/ pUC pi pr; B 3 fp SOLID Mp~CL ON PIPE 3' ONTO * SOLID SOIL SOIL ffl ~ $ FT, C PUMP OFF ELEV - OFF RISER EXI PERMITTED ON gd.8O D ! IF TANK MANUFACTURER 6F ~~rr 31t APPROVED BEDDING UNDER TANK HAS APPROVAL CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE 3• y '.TANK MANUFACTURER. ~O NUMBER DOSES PER DAY: TANK SIZES: SEPTIC GAL. DOSE VOLUME INCLUDING DOSE GAL. 25 FLOWBACK: I/~'~ GAL. ALARM MANUFACTURER: ~fi/2M ~0 CAPACITIES: A = I1-r!p INCHES = 3&D GAL MODEL NUMBER: V L _ SWITCH TYPE: B = 2 INCHES = 3V GAL PUMP MANUFACTURER: Z U~~~L` /2 C INCHES = 11.5 GAL MODEL NUMBER: t3j~ yZ SWITCH TYPE: jqqy ,.t-, [ /&.4.7- D INCHES = -7-0 GAL REQUIRED DISCHARGE RATE 3S GPM PUMP & ALARM WIRING AS PER ILHR 16.23 W.A. VERTICAL DIFFERENCE BETWEEN PUMP OFF' AND DISTRIBUTION PIPE 9'50 FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . • •3.2FEET + FEET FORCEMAIN X 2.5g FT/100 FT. FRICTION FACTOR.. ,3. FEET TOTAL DYNAMIC HEAD FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH _ WIDTH DIAMETER,,--' C SEE REVERS F $1 rte ) LIQUID DEPTH 381r, SIGNED: LICENSE NUMBER: DATE: P/C SPECS 64 c(,! V o f 1) E P14- /-7 IQs SEPTIC TANK, per Comm.83.44 (2) (c) shall be equipped with an outlet attached approved filter device (*&be Pot-y/ocK fl i ter) . Tank shall have an approved above ground locking manhole cover for regular (every 12 months or less) inspection & servicing by a licensdd service pumper. 05/07/2015 11:23 7156475181 WIESER CONCRETE PAGE 02/02 al-~ 131W 99K-9Zc--008 0 :anal-lso :3tva 00 100/00 -ova 05,04 0 )DOS NMrM oG dMH sn 9IL£IN 1tlfINdW 0f1d35 w ~U. •trys daH ~,e Nxvaa 3!3111,1 21Y1-0g9/000ld1M \ alnad,aa .o-.~~.i ~ ~u Ui 4t ~ J 0> N p ~ Q [7 d^ 00.. } W r. W w~ m v F•• m vs w 0 0 a a U } W U1 w o J w d d o 0 cop 0 ;&M z w LL +t Z W 4 +G W Oa C3 aac F v O~.d O mVW1 WWw C7~ waWZ OF y C~ a _ s a JCS Np N0 (D ~L O N O p M Q (Wll r +OO L', us R b ~°yyC a_ ed G F- c;w F 1 Q t- U) N r W d Q "~R NIArR J ~~J1 C.1 cnN W 0 p0 9 a~ M7'~ a ~OFD~ ©ar OD o:3 E C mF(~% Ca N~ gl: 4i p o YC Z V) edi9 ~d3~ v t4 elO 4Qduaw~wc3 d a- 4 m J 3m~~Jm~ z v w w I Q vl ~ v D Lb 0. R~ ' a w o a S.b ' I*• o~ do ry r LD V p w C5 J W w o „B£ w J rW~ SY0 -V R ~ .,Z-V do 12 W x t ~ z St 003U i .ir8 SV J*Q z M co 4% 21 d 7% r- 6'b w W TOTAL ETERSYNAMICHEADFEET/ 0 HEAD CAPACITY CURVE M MODEL137-139 CAPACITY GALLONS/LITERS / 0 0 4V'4 30' CAPACITY HEAD UNITS/MIN 0 00 + 1'/x11'h 8 FEET METERS GAL LTRS - - 25 5 1.52 104 394 NPT a 5 "/32 w 10 3.05 79 300 x U 15 4.57 64 242 0 2 6 20 20 6.10 36 136 2 a 25 7.62 8 30 26 7.92 0 0 J FQ- 15' 0 4 10' 2 I 12% 0 U.S. 10 20 30 40 50 60 70 80 90 100 110 GALLONS LITERS1 80 160 240 320 400 4 0 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS • Three phase pumps are available in 200/208V or 230V. • Mercury float switches are available for controlling single • Electrical alternators, for duplex systems, are available and and three phase systems. supplied with an alarm. • Double piggyback mercury float switches are available for • Mechanical alternators, for duplex systems, are available variable level long cycle controls. with or without alarm switches. • Long cords are available in lengths of 15-25-35-50 feet. • Combination starters are available. • Over 130°F. (54°C.) special quotation required. Standard All Models - Weight 47 lbs. 1/s H.P. SELECTION GUIDE SELECTION GUIDE 1. Integral float operated 2 pole mechanical switch, no external control required. 137/139 Series Control Selection 2. Single piggyback mercury float switch or double piggyback mercury float Model Volts-Ph Mode Amps Simplex Duplex switch. Refer to FM0447. M137/139 115 1 Aulo 10.4 1 or 1 & 8 _ 3. Mechanical alternator "M-Pak" 10-0072 or 10-0075. N137/139 115 1 Non 10.4 2 or 2 & 7 3 or 5 & 6 4. Combination Starter. Refer to FMO514. D137/139 230 1 Auto 5.2 1 or 1 & 8 - 5. See FM0712 for correct model of Electrical Alternator "E-Pak". E137/139 230 1 Non 5.2 2 or 2 & 7 3 or 5 & 6 6. Mercury sensor float switch 10-0225 used as a control activator, specify 'H137/139 200-208 1 Auto 8.2 1 & a duplex (3) or (4) float system. •1137/139 200-208 1 Non 8.2 2 & 7 3 or 5 &6 7. Four (4) hole "J-Pak", junction box, for water tight connection or wired-in 'J137/139 200-208 3 Non 2.2 2&4 3& 4 or 5& 6 'F137/139 230 3 Non 3.0 2 & 4 3 & 4 or 5 & 6 simplex or 2 pump operation, 10-0002. 'G137/139 460 3 Non 1.5 2&4 3 & 4 or 5 & 6 8. TWO (2) hole "J-Pak", for Watertight connection or splice, 10-0003. No molded plug Three phase units require a control switch to operate an external magnetic or combination starter. CAUTION All installation of controls, protection devices and wiring should be done by a qualified For information on additional Zoeller products refer to catalog on Combination starter, licensed electrician. All electrical and safety codes should be followed including the FM0514; Piggyback Mercury Float Switches, FM0477; Electrical Alternator, FM0486; most recent National Electric Code (NEC) and the Occupational Safety and Health Act Mechanical Alternator, FM0495; Alarm Package, FM0513; and Sump/Sewage Basins, (OSHA). FM0487. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO. P.O. BOX 16347 ` ZZY-ULN" TZ7. Louisville, KY 0347 Manufacturers of . SN/P T0: 3280 Old Old M Milillers Lane Louisville, KY 40216 19,o (502) 778-2731 0 FAX (502) 774-3624 "UAL/TY UMPS /NCE J -sdwnd (03) ,Qna envy J0 4d WASOZ-00Z Joi 6u4su in ON :31011 9d/N/ld Al170',7 0 iapadwl odA1 xaIJoA O a(ge(iene u0)le3ilil,90 d /0 slainjoelnuepy 1 •oossy spiepuels ueipeue0 x • AO£Z JO A80Z-00Z `4d £ -d'H z/, • 6Z9£ 6LL (ZOS) XHd • LBLZ 8LL (ZOS) AO£Z JO ASOZ-OOZ 'ASL L " k4d l "d"H z/L • 91d06 AX '911!nsm07 oilewo;ny-u0N ao oijewolny • 9ue7 S]alliW p10 08ZE -701 dIHS 318V-Ilv" S'1340W L E0-9Sd0 .7 7 L6E91 X08 ' O'd~d 01 71V 11VW J~lfl Jln N0Ild0l7lddd na kA 3H hJ77_7Affz H0=1 o3NJIS3o 31OV IlVAV SW31SAS IOa1N03 13A31 3'18VIUVA 31OVIlVAV SW3I.SAS a3Jd)IOdd 318TIM" SW3ISAS XTIdna aNd X31dWIS a31S11 '„EL-ly6iaH • %L l-y;P!M IOI?VI • 1® ',,C-lu!od go • 91.1.1.89 sq,•s bet „b/e6-~u!od u0 • SEEMS Belies let jagwnN '96ae osl uoµsolljaedS VWdSS y 4 1dN ~z~ L • • . 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XGJJOA 6u!66o10-uoN • S3unIV3A 3S3H1 3UVdW00 639E-bLL (Z09) XV-4 • LEZZ-81Z (209) e(ouede~osip 9/ZOP, AM `alllnsln01 • aue7 sjall!W Pl0 08ZE'01 dIHS saiou6uip~e6a~ eAjolov; lspuals(suooAu( jo nsuo s •uo(leejosp L6E0 99Z06~1X `all!Aslno7 • Lb£9L X09'O'd 0171VW to aw(13B suoio -tio sloa(laa aJay poluesaid uo(lewiolui lonpad 0680 0 3.7NS sd~vn~/ Al/7I'/! ~ sapasiedng ff gdYJ77JZ7Z 16b0 V, G lbOWd 0VoZ'Z :NO1103S ~-0 ~j - - POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner M K E 5 i 'f" +I o w Septic Tank Capacity al ❑ NA Permit # Septic Tank Manufacturer jV je$&2 Co ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Q[. /a G~ ❑ NA Number of Bedrooms •3 ❑ NA Effluent Filter Model 5'2.s ❑ NA Number of Public Facility Units -.EMA Pump Tank Capacity 6a S Q al ❑ NA Estimated flow (average) 3 0-0 al/~a Pump Tank Manufacturer S1~ ❑ NA Design flow (peak), (Estimated x 1.5) Y-456 gal/day Pump Manufacturer iQ ❑ NA Soil Application Rate tO al/da /ft2 Pump Model ❑ NA Standard Influent/Effluent Quality Mo average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) _30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) :5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 150 ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD5) <30 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) :_30 mg/L ZNA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) < 4 cfu/100m1 ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size 36 in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every' Z ❑ month(s) J19 ears (Maximum 3 years) El NA Pump out contents of tank(s) When combined sludge and scum equals one-third (36) of tank volume ❑ NA Inspect dispersal cell(s) At least once every' Z ❑ month(s) jig year(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ;K0 months(s) 0 NA 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) Other: ❑ month(s) At least once every: ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall 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 or 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 cell(s) 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 tank equals one-third (X) 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 to.the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at infervals of <12 months; shall be performed by a certified POWTS Maintainer. 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City/State Ra b e r g s 111f Parcel Identification Number U 161 U 0 U- v U 0 LEGAL DESCRIPTION Property Location S'IO 1/4 , ~&J 1/4 , Sec. , T Q? ~ N R~Town of ,~kC Subdivision Plat: , Lot # Certified Survey Map Volume , Page # Warranty Deed # ~j 7 > (before 2007)Volume ff b Page # Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no SYSTEM MAINTENANCE AND 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 (1) 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 anty deed recorded in Register of Deeds Office. Number of bedrooms I-Avu 11 P, SIGNATURE OF APPLICANT(S) 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 warranty deed. (REV. 04/12) ~ Cn -1 N Z O o~ • N CJ1 T -a x O_ O_ T O m < D -P -i z ? 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CJ ~ 7 ? GJ9 ° O ~ N P-j Ln ° O - 4 N N Cs n Cn O n co u II II II I MAIN, ~mmmmmmimm 0 O © © IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIH 0 I II II II II I IIIBI RECEIVED P AI ii~~''**,, KK 770(~1 Wis. Dept. of Safety and Pro1WXn1A;911e5s S'6IL-EV tON REPORT Page ` of 3 Division of Safety and B •I n , d}'tO1X COUNTY ce with SPS 385, Wis. Adm. Code ST GjZO l :IOMMuNtTY DEVE6K - County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. Q I~ . 1070 • 00 • OD O percent slope, scale or dimensions, north arrow, and location and distance to nearest.road. Reviewed y Date Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location 9 q i M~ ~/E 7 ~R(z~E13C S'tt-rl Dt~i? Govt Lot SW 1145W 1/4 S 31 T I J N R ! E(or W PropeWo Owner's Mailing Address .w Lot #Block # Subd. Name or CSM# - 15 O ~cvZ Nsa 10imu N11 - MET5 z, soo~sos SUROSY i . City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road '(ZD(3ERT5 LUI • 5 va3 1(115417-:64(00 tAMMou D (oo + AtE:. ❑ New Construction Use: IBS( Residential/ Number of bedrooms Code derived design flow rate ~ GPD `fx Replacement F1 Public or commercial - Describe: Parent material 16 9755 D 0CIZ Q EN5f F•1 A3 Lr Flood Plain elevation if applicable N ft General comments ~I~Gt /hC. T 1lfi . and recommendations: Aw Spot Tested suitable for a M WO tFOAT,S,) system using 12.%% Boring Q ~j Q 5, s, SEAS ~N AI y F 1-1 Pi Boring # ~t7 2 O 5 ATV RR t ~l~ Pit Ground surface elev. ft. Depth to limiting factor in. oil A lication 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 ff#2 ID' 7 10YR 3%2, 2r. Sbk UM CS 3f • 6 • 8 2 13 10YR y 3 L 2.f5bK JYA vfR CS (f 3 3•z$ lOYR sG SiL 1ipsbe- M-PR cw • y 2.9-36 -7. S YR c I M o 5 5cl- l f 5W tw► f i , _2,, • 3 5 yR ? I ill I _771 ,~.,.vw~,~., :5.5.5 • Boring O ❑ Boring # Pit Ground surface elev. ft. Depth to limiting factor 25 in. Soil Application 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 ' ff#2 1 0.7 10V 31 L- 2- MA Sb~ mnuflR C5 3f • c~ 2 16YR 3 L Zf5bK r+VfR es if '~-5 ~o`lR 5 51L If sbK M^~R Cw •`f 7 5 YR• C ID M o+s 5cL I f bK /M C i I - . Z 5 yR * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) glure CST Number jZlD?jELZ-r 2t Lj3R•1'C 6T l tP 5 Address Date Evaluation Conducted Telephone Number 2- z g12- /of~- Ave. 6?Rit3&- VAII-t Gul. AML 3o•'15 ?15.17 • ff12- SBD-8330 (R1 1/11) Property Owner M,? P. Siff low Parcel ID # 01$•1070.00.000 Page Z of 3 IT Boring # ❑ Boring Q 2 5 . S. S . ® pit Ground surface elev. 11.3-9 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. Cont. Color Gr. Sz. Sh. ff#1 * ff#2 0-(p /0 YjQ 3~Z L Mn 5 bk M\ u Pk 'C S 3-6 • 2e • 8, z 6• I to y2 L s bk. 4-A u •Fie e s ! • 00 3 51L /0 YR Y/& 2-* 5 W CS T q © 7 5 7-3 9" fob /c~ZA-c fv~2 D M~ 5 .u 0 0 F1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2 F] Boring F-1 Boring # Pit Ground surface elev. ft. Depth to limiting factor in. ❑ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots GPD/ft 2 in. Munsell. Qu. Sz. Cont. Col Gr. Sz. Sh. * ff#1 ff#2 Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD 5 < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY, through Relay. SBD-8330 (RI 1/11) i /Ul.? D• SittloW 019.1670.00.000 2 Property Owner Parcel ID # Page of 3 Boring # Boring 2-5 Ground surface elev. 35 ft. Depth to limiting factor in S. S. S - Soil Application 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 ff#2 (o /D YR 3/Z L * 5 bk u -Pk c 5 3 f g.. Z 1 ~o y,2 Z's bk v FR CS ! 7/4 - 51L 2-A, s W IM fR cs - . y 3 ~5 to s /61 S' 3 7 5YR ~e M i X AXJP D . rm SL Q .i Tt2A© Mn ~ , 5 r3 FX+& -Vq D G ; ~ L 5 A; 45- . 0 0 ❑ Boring # ❑ Boring ❑ 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. Cont Color Gr. Sz. Sh. * ff#1 '(f#2 ❑ Boring ' Boring # Pit Ground surface elev. ft. Depth to limiting factor in. u ❑ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell. Qu. Sz. Cont Col Gr. Sz. Sh. * ff#1 *1:-f#2 Effluent #1 = BOD s > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 5 < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity, service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBD-8330 (Rl l/11) D C' ~ ~ 1 ~ rn ~ ~ ~ Ls ~ ` z v o ~ cn m o - s o D C 00 v N o ` - rn - 45- C 43 i r4 c sa-r ~ OcZ o~ -xj .s~ 9u 3 t c ~ ~ F~sT GoT' ~ , C Pn n L A ,)1.7 C a 4, uj a? F r6 po o u ~c 2 3 a v''i ' s ? ®rC v 2 o au \ 1 41 • V~ o JA_ w 4 i i \w O 0 j ~ ~ ~ 14! ( C~1 2 a C~. ~ tV1 Irv uj -91 cc cn a- 0 0 o - - Q cn LL_ Y ~ M~` o a a N-o O Q ~ w lil o a Z 1- 0 p CZ 0 W c d O~ ti z m Q o tE co a+ d JCCLLI W o H Q!- m a cn 0 an c T i. cc o - cc _ H COD Q J ~ j \IN k w , 0 2 `9 3 I Zs' W _j .o It ~ I Q v ~0 CL_ P V d~' lC~ p G., ro N - API ffiut puimir" I EP04 '3871 EP05 APPLICATIM Fasteners: 300 series Futty submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel grade turbine oil for for efficient heat transfer, following uses: • Capable of lubrication and efficient strength, and durability. • Effluent systems dry withoutWing to heat tran*r. ■ Motor Cover. Thermoplas- • Homes tic cover with integral handle ashmiaft and • Farms NOW. A for and float switch attachment • Heavy duty sump • EP04 Single phase: 0.4 HP, mom hNdW6 I points. 115 or 230 V, 60.,Hz,1550 • Water transfer float Swfth M&vbW aM ■ Pwvw CaMe: Severe duty RPM, built in overload with • Dewatering automatic reset st ~ rated oil and water resistant. • EP05 Single phase: 0.5 HP, • Bow1 = Upper and lower SPECFN~ATgMS 115 V, 60 Hz, 1550 RPM, heavy dory bail bearing Pump: EP04 built in overloadwith m EP04 Impatier: Thermo- construction. • Solids handling capability: automatic reset plastic Semi-open design 314" maximum. • Power cord: 10 foot AGWY LISTING • Capacities: up to 55 GPM. standard WVIh,16/3 SJTO with pump out vanes for • Total heads: up to 24 feet. with three prong grounding mechanical sea! protection. g Them~o- • Discharge size: 11/2" NPT. plug. Optional 20 foot listed • Mechanical seal: carbon- length, 16/3 SJTW with plastic design for end i model numbers improved performance end in "F" or AC rotary/ceramic-stationary, three prong grounding plug BUNA-N elastomers. (standard on EP05). ■ Cuft aW Baae: Rugged • Temperature: thermoplastic design provides 104°F (40°C) continuous superior strength and 140°F (600C) intermittent corrosion romance. • Fasteners: 300 series NETM FM stainless steel. 10 ( i • Capable of running without damage to s ao components. Pump: EP05 ) b a , • Solids handling capability: c 25 3/4 ma)dmum. W • Capacities: up to 60 GPM. x s 2 - • Total heads: up to 31 feet. Q ! • Discharge size: 11h' NPT. z s • Mechanical seal: carbon- 0 is ' rotary/ceramic-stationary, a 4 BUNA-N elastomers. c • Temperature: s ao 1041 (40°C)continuous 14/-0~OF (60°C) intermittent. 2 0 p i 40 WIN 10 20 30 40 so GPM 0 2 4 s s 10 12 nwm CAW1CrrY ®1895 Gouicis Pumps, Inc. ~(l WW E•ffeWm May. 1995 BM71