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HomeMy WebLinkAbout184-1000-20-300 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 589798 State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04 (1)(m)]. 2750355 Permit Holder's Name: City Village Township Parcel Tax No: Jacob & Alyssa Durand VILLAGE OF SPRING VALLEY 184-1000-20-300 CST BM Elev: 1 0.1-01 -top Insp. B Elev: BM Description: Section/Town/Range/Map No: b~ 1 /7,- N, 30.28.15.2C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURE~ CAPACITY STATION S HI FS !~-IN~s I ~~7 11 D, ELEV. b®, 0 Septic / im : f Benchmark a R5 Dosin& PUMP: J d Alt. B . r rka-kd , Qq I6o: b Aeratrort t Bldg. Sewer ~y St/ Pit Inlet - ~G•~W ~ Z~ , TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/ WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom 'At) A I A.6 i ~ 9 ' Dosing . Head an 16.q2 /Vo • J , Aeration Dist. Pipe ~ 9.'{2 / oU.3jv Holding Bot. System Final Grade PUMP/SIPHON INFORMATION - Manufacturer ;r ii Demand St Cover, f,~ /~2 C3t 1~ Ilk) ~ I J GPM U7.`D i Model Number ~ ~ O.15 CI / TDH Qftfi • n Friction Los System Hea TFt Forcemain LeI'gth y Dia. Dist. to Well SOIL ABSORPTION SYSTEM s--- BED/TRENCH Width Length_ No. Of Tserch PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS .I SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of ystem: . UNIT Model Numbe DIST TION SYSTEM Hea /Manifold Distribution x Hole Size a x Hole Spacing Ven to Air Intake - „ Pipe(s) I r fJ r r Length r Dia Length Dia t Spacing j G~ UJIn ChQPJ! SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded t Mulched Bed/Trench a r, , S Bed/Trench Edges yd Topsoil > P'~~f ❑ J~ y Yes No yes No COM TS: (Include code discrep ncies, persons present, etc.) Inspection #1: / Z- 2PJ & In pection #2: N111 00- 1 D60 6,"t ~ Location: N2010 DUGAN RD hose p /~Sl(Qd kON P!' is ~~t 1.) Alt BM Description =L v~~ 7 ins pe~fi~►~-- ~t' ,J ' 2.) Bldg sewer length = 7 lCOrv OC 1,~ ( (~j' I U I amount of cover l D I F. Il Plan revision Required? E~ Yes No ! Use other side for additional information SBD-6710 (R.3/97) Date / 11(ins-E Signature Cert. No. ! p 1RT.4t~ E; e Ell ~ M County /y Industry Services Division cS i n, 1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.) r:' as AUG ~ ~ dui , P o. x7 GQ 0-IN / S T. CROIX COUNTY Madi 37 -71 5$ ~ 7 S S 'r z _ . COMMUNITY DEVELOPM NTFZ State Transaction Number Sanitary Permit Application 2 7 S6.3SS In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) t Z0 `Q n J the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stats. NJ~+) C4 V% 12 I. A lication Iuformatio - Please P 11 Information parcel # Property Owner's Name J41'S4v v Property Owner's Mailing Address Property Location ` r ~ ` 4> (v C p, Govt. Lot /C`i'ty, State lj Zip Code Phone Number S w 1/4, sC 1/4, Section 20 rr ,~rr //GG (N ,,,~~ctrcle one 1"in Vit T 2.8 N; R~-E U. Type of Building (check all that apply) 3 Lot # Subdivision Name 1 or 2 Family Dwelling - Number of Bedrooms VF . 4mb Block Public/Commercial - Describe Use City of CSM Number Village o T---- State Owned - Describe Use d Town of x75 Q P 91 III. Type of Permit: (Check only one box on line A. Complete line B if pplicable) Other Modification to Existing System (explain) A' yew System Replacement System Treatment/Holding Tank Replacement Only List Previous Permit Number and Date Issued / B. Permit Renewal Permit Revision Change of Plumber Permit Transfer to New Before Expiration Owner IV. Type of POWTS 5 stem/Com onent/Device: (Check all that a t ) Non-Pressurized In-Ground Pressurized In-Ground At-Grade mound > 24 in. of suitable soil Mound < 24 in. of suitable soil } Pretreatment Device (explain) Holding Tank Other Dispersal Component (explain) V. Dis rsal/Treat nt Area Information: Design Flow (gpd) Design Soil Application Rate(gp Dispersal Area Required (sf) Dispersal Area Propos (s System Elevation ✓ SD S 041 X00 V ~1~1•S3 Capacity in Total # of Manufacturer VI. Tank Info y ° Gallons Gallons Units u New Tanks Existing Tanks ~ U h H rri t% V 4. r,✓ a Septic or Holding Tank Dosing Chamber 5d VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTSMP[M show o Nthe umber attached Bus tress Phone Number Plumber's Name (Print) PI er's Signa re 7157-26sJI115- F5. P umber's Address (Street, City, State, Zip Code) 2 9 ~3 /30''x, '~G W t VIII. Coun /De artm Onl Permit Fee Datc ssue Issuing nt Signatur Approv Disapproved I G'fo op $ 3a eason for Denial `p IX. CondidM'~EUO1 HKeasons for Disapproval 1~ J.147 (~(~~~ti 1. .Septic, illt, rl urni filar and J C.Ie~f'Gt.~ I ~etwtinr dispertt Mt:ell must all be .tal r's,h....tr!a~lr~~ as per) ragement plan provided by plumber, 2. -AU-s1hikk requirer.'ients must,be n, Wnta&d as pet Wpkmble code / erdinartees. 11 11 Attach to co,upiete plans for the system and submit to the County only on paper not less than i U2 it II inches in size SBD-6398 (R0313) CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE. ❑ SOIL EVALUATION Scale: 1" =10, SYSTEM PAGE 2 OF lv SITE MAP ° ' 0rob PLOT PLAN PROJECT NAME: 5' DESIGN FLOW: 450 GPD Jake Durand Attach design flow calculations for commercial plans. PROJECT ADDRESS: N2010 Dugan Rd,Spring Valley, WI Pipe Material / ASTM Standard (Tables 384.30-3 & 384.30-5) N Sanitary Sewer. PVC / ASTM D3034 BM Symbol: BM Elevation: 100.0 FT Force Main: PVC ASTM D2665 / BM Description: top of 11/2" PVC pipe with orange ribbon Slope Gradient Indicate north by IMPORTANT: of Tested Area: 7 Well Symbol (K applicable): 0 drawing arrow Show ground elevation contours at suitable intervals. on the appro roprite line. a~ ~jk~ f I h6~ iDoa Sogt~~„K S o X77 Jim , r ~,14k fob 1 t..v %j r- Jr ♦Y AR7_41fi~ J..~. DIVISION OF INDUSTRY SERVICES i/ 10541 N RANCH RD HAYWARD WI 54843 6462 Contact Through Relay http://dsps.wi.gov/programs/industry-services www.wisconsin.gov Scott Walker, Governor Dave Ross, Secretary August 19, 2016 CUST ID No. 267985 A7TN.• POWTS Inspector MICHAEL J MYERS ZONING OFFICE NORTHLAND PLUMBING INC ST CROIX COUNTY SPIA 2943 130TH AVE 1101 CARMICHAEL RD GLENWOOD CITY WI 54013 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/19/2018 Identification Numbers Transaction ID No. 2750355 SITE: Site ID No. 827347 Jake Durand Please refer to both identification numbers, N2010 Dugan Rd above, in all correspondence with the agency. Village of Spring Valley St Croix County SI/2, SEI/4, S30, T28N, R15W FOR: Description: Mound, 3 bedroom residence Object Type: POWTS Component Manual Regulated Object 1D No.: 1616876 Maintenance required; 450 GPD Flow rate; 14 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. 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: Key Item(s) • In the event this soil absorption system or any of its component parts malfunctions so as to create a health PROFES; hazard, the property owner must follow the contingency plan as described in the approved plans. In additigr iftION OF 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 G--- completion of the project. • Care must be taken to preserve the bench mark during construction or reestablished prior to plowing. • The proposed pump is near its limit with the proposed total dynamic head. If upon installation, the total dynamic head increases, the proposed pump must be reevaluated and may be inadequate. 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. MICHAEL J MYERS Page 2 8/ly/2016 • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of SPS 384. • Maintain well and waterline set backs per SPS 383.43(8)(1). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. • Insulate building sewer per SPS 382.30(11)(c). 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. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 L Shandorf WiSMART code: 7633 POWTS Plan Reviewer, Division of Industry Services (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 MICHAEL J MYERS Page 2 8/19/2016 • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of.SPS 384. • 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. • Insulate building sewer per SPS 382.30(11)(c). 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. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 L Shandorf WiSMART code: 7633 POWTS Plan Reviewer, Division of Industry Services (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 PAGE 1 OF 6 Mound Plan Index & Cover Sheet Component Manual Design References: Version 2.0, SBD-10691-P (N.01/01, R. 10/12) & Version 2.0, SBD-10706-P (N.01/01, ,Jr 0 VED Pg 1 of 6 Index & Cover Page UG p 4 2016 Pg 2 of 6 Plot Plan Pg 3 of 6 Mound Cross-Section & Plan View SERVICE,, Pg 4 of 6 Distribution Network. Specifications Pg 5 of 6 Pump Tank Specifications Pg 6 of 6 Management Plan Attachments: Enclosures: Pump Curve POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description Owner Name(s): Jake Durand Phone: - - Owner Address: N2010 Dugan Rd, Spring Valley,Wl Zip: 54767 Project Address: Same Govt. Lot: SW 1/4 of SE 1/4, Section 30 T 28 N-R 15 E ❑ or W❑✓ Township: Village of Spring Valley County: St Croix Project Parcel ID Designer Information Designer Name: Michael J. Myers Phone:, -715, _265 _4115 Designer Address: 2943 130th Ave, Glenwood City, WI Zip: 54013 E-mail: mcmyers@centurytel.net °ICES License Number: MP/CST267985 TRy ~,=t Remarks: 'i 'PONDENCE Signature: Date: o"'- 3- 26/<-' Original signature required on each submitted copy. CHECK BOX AS APPLICABLE. CHECK BOX AS APPLICABLE. ❑ SOIL EVALUATION Scale: 1" =10, SYSTEM PAGE 2 OF /a SITE MAP ~ 00 44 PLOT PLAN PROJECT NAME: 52 DESIGN FLOW: 450 GPD Jake Durand Attach design flow calculations for commercial plans. PROJECT ADDRESS: N2010 Dugan Rd,Spring Valley, Wl Pipe Material / ASTM Standard (Tables 384.30-3 & 384.30-5) / BM Symbol: -,$r BM Elevation: 100.0 FT N Sanitary Sewer: PVC ASTM D3034 Force Main: PVC / ASTM D2665 BM Description: top of 1112" PVC pipe with orange ribbon Slope Gradient Indicate north by IMPORTANT: of Tested Area: 7 Well Symbol (f apolicable): on the drawing ppro ropri!e arrow line Show ground elevation contours at suitable intervals. . I I ~doo~sa <~~NK g I w PAGE 3 OF 6 M N > co Co CD Z ll 00 N m CD 2 1- CV U Cfl U U3 u u u u uj O \ W M r- T o w o o C/) Z v >m _>m p Q o I I I I Y N.. ~ W ~ ~ aZ N Q j l I I I w V Ii II a I Cn C0 I-I-o i I W ~ I ia~~ I a, Q \ I w"I I w o, (L W cn M CL w II II II W w U) n II II _ Cn > ~ yl I--w --i II i I I F/) C) z O I I I I o ~ a ~ I I I I > ~ a~ O o \ I , I C: a a 0 ~ to ~ I I I I ) o d z I co I I I Lo I =f w I I I I Mn T u I -0 to Q I I 113 1 o I I 2 I Lo L_J O I I I ti o w o-ia II II c p ~ o V N c0 1' II O ao n on ion l i l m p w CY) ~I o U c UJ a I > Ni NL \ ro 0 "s U) j= 1 1 I I ~ o ~ I I W c" E > a I O W J ~ ~ cnw ~ ~ I I I I ~ O N LU Q a I I Z c.) CO : co I I c °U o-o g I I I I c o cn Z Q~ N o I I m r y a (D Li- I i I > Z Cl) I II C,j (D U) O N N Cl) 3 N b L---j -L 0 ~ o Cl) Q L U) N I E a ' oS _o PAGE40F6 c LL - H ~ c c o N o co u W rn aY rn Z OZ ~o = m O2a~ O a u n u if u li z 0 z0 o ° a w WU c U LL v w io m 1-a .o Q N a o ° > J (1) -,6 a) x ❑ ° Z LLI ° J^ m ° M w m e ~ Z a Q _ c W U r V J ) n CL N -0 _ 0 x Z U W Z a~ 75 o` w p E L) U o O C/) O 1 N ° a o J o z - p _ O Q 0 m v L) O cu Cl) a) •c E Q O m z a _ v x a x > N N a > o c N u p X x•a o0 ° S O m a W co Q N -0 h f~ o Y O 'a M O m II N N~ l n o U•v xa (3) ry L) 0. M N "i✓, ~ + % (n a m O ~ (D V v~ J U ^ Q U U O hpi J ° c o O a~ z _O 76 W n O z -o N U N ~ O Q L N N ~ z cn ~ J " 67 a) `p L a > p 0 O C / O ~ O O (n Q J x Q i NL 0 Q co o' J J `5 ~vcn ^ E w-~~~ rn W m o > / I o > f ii W Q / ) y i r d U? O Z O z LL U > > o m m -Fa W m° E rn (un ^ > / m W W a° a E° o U H~ ao N (nom N (6 (0 c/ m m F- L) U t p - d (1) o E m o W O v fl > O x m ° O o o m o n c Z Ll a o °rn o _ > n o a J v 0 m - m a d' c C c o o m O O Q o m m _ r U N U W 0 ) > w U El. [I N z I- 0 c6 ~ 3 PAGE 5OF6 SEPTIC / PUMP TANK SPECIFICATIONS 4"0 Vent Pipe (No Scale) > 10 ft from Building Electrical must comply with 12" Min. or 2.0 ft above SPS 316 and NEC 300 Established Flood Elevation Weatherproof Extend manhole riser as necessary. (typical) Junction Box Approved Approved Locking Manhole IMPORTANT: Vent ICap with Warning Label Attached Anchor tank(s) as necessary t (typical) pursuant to SPS 383.43(8)(g) conduit 4" Min. or 2.0 ft above Established Flood Elevation (typical) Airtight Seal Finished Grade Quick Disconnect @ 17 ° ° ty Man. CAPACITIES _ gal/in . e ° (typical) _ a Depth (in) Volume (gal) _ A 20.9 355.3 * T Weep ~ Approved Joints with B 2.0 34 Hole Approved Pipe 3 0 -to A Solid Ground d (typical) [C] 5.0 85 Alarm D 10 175.7 On [C] PUMP-OFF *Pump Tank Liquid Level =~~in ± Pump ~-Off ELEVATION = 92.30 ft INSIDE BOTTOM Force Main Diameter = 2 in Concrete 91.5 ELEVATION = ft LyzZZIA 6 Force Main Length = 100 ft 3" Approved Bedding Material Beneath Tank dmmmwww~ = .87 ft Force Main Void Volume = 17.4 gal Vertical Head 7.87 + Min. Supply Head = 6.5 ft [C] Total Dose Volume TDV = 78 gal/dose + FM Friction Loss = 2.75 ft L (5X total lateral void volume < TDV < 0.2X design flow) + (force main drainback volume) + Fitting Loss* = ft *(min. supply head x 0.3) LMIN. PUMP DISCHARGE RATE = 36.2 gpm = TOTAL DYNAMIC HEAD - 17.12 ft PUMP TANK: SEPTIC TANK(S): Volume = 650 gal Total Volume = 1000 gal mm~ Manufacturer: Wieser Conctrete Manufacturer(s): Wieser Concrete Pump Manufacturer: oulds Install approved effluent filter at the septic tank outlet Pump Model: PE41 P1 11 (See attached pump curve.) immediately upstream of the pump tank inlet Controls/Alarm Manufacturer: SJE Rhombus Filter Manufacturer: Polylok Controls/Alarm Model: PSP120V6H150P17A mmnnmm~ Filter Model: 525 Float switches containing mercury are prohibited PAGE 6OF6 Mound Management Plan IMPORTANT: The owner of this mound system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 38152 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = 450 gpd; BOD5 5 220 mgL"'; TSS 150 mgL"'; FOG 30 mgL"' Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities (i.e., pump re-cycling, float switch settings, etc.) o electrical components (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. o Distribution laterals shall be flushed once every 3 years or when necessary. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Northland Plumbing Inc Phone: 715-265-4115 Local government unit: St. Croix County Phone: 715-386-4680 Local government unit address: 1101 Carmichael Rd, Hudson, WI ZIP: 54016 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed mound dispersal component may be re-constructed within the originally approved area after removal of all failed components. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. ITT GOULDS PUMPS Residential Water Systems APPLICATIONS MOTOR Specially designed for the following uses: General: • Mound Systems • Single phase • Effluent/Dosing Systems • 60 Hertz • Low Pressure Pipe Systems • 115 and 230 volts • Basement Draining • Built-in thermal overload protection with automatic reset. • Heavy Duty Sump/ • Class B insulation. Dewatering • Oil-filled design. • High strength carbon steel shaft. SPECIFICATIONS PE31 Motor: Pump - General: • .33 HP 3000 RPM • Discharge: 1'/2" NPT • 115 volts • Temperature: 1040F (400C) maximum, continuous when • Shaded pole design fully submerged. PE41 Motor: • Solids handling: 112" maximum sphere. • .40 HP 3400 RPM • Automatic models include a float switch. • 115 and 230 volts • Manual models available. • PSC design • Pumping range: see performance chart or curve. PE51 Motor: PE31 Pump: • .50 HP 3400 RPM • Maximum capacity: 53 GPM • 115 and 230 volts • Maximum head: 25' TDH • PSC design PE41 Pump: • Maximum capacity: 61 GPM AGENCY LISTINGS • Maximum head: 29' TDH PE51 Pump: • Maximum capacity: 70 GPM • Maximum head: 37' TDH c us Tested to UL 778 and CSA 22.2 108 Standards By Canadian Standards Association METERS FEET File AR38549 40 PE 51 MODELS: PE31, PE41, PE51 35 HP:.33_40_50 10 ~I r 2 GPM Goulds Pumps is ISO 9001 Registered. 30 PE 1 FT 0 w 25 PE31 x _v a 20 z o ,S ~ 15 rU \ 10 5 0 0 0 10 20 30 ' 50 60 70 GPM 80 0 5 0 15 m3/h CAPACITY ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address Property Address DID J ` (Verification required from PI ing Department for new construction) City/State Parcel Identification Number LEGAL DESCRIPTION Sec. 130 , T 21"N-RI-~ W, Town of Property Location Lot # Subdivision Certified Survey Map #~~"Td Volume Page # Warranty Deed # 16Z~0~0~lJ Volume Page # Spec house O yes xno Lot lines identifiable} es ❑ no SYSTEM MAINTENANCE nte Improper use and maintenance of.your septic system could result in its premature failure to handles wastes. Proper mai the sync em consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. a you put into can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix 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. Uwc, 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 Commerce and the Department of Natural Resources, State of Wisconsi Certification 30 stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office days of th three year expiration date. DATE SIG ATURE OF APPLICANT OWNER CERTIFICATION 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 4SIATURE property 7 above, y virtue of a warranty deed recorded in Register of Deeds Office. X DATE OF APPLICANT Any information that is mis-represented mV result in the sanitary perrrut being revoked by the Zoning Department. Include with this application: a stamped warranty de6d from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed LLI tkVSIM'AalleA Hu!jdS 01 o z T. x y F f~ o ~I f.~~ peoy ueBno oTOZN c a z v ■ p z= _ s 7 1~~ PueinC essAlV B a~ef z Z o Z O, w VIj Yi LL ul 5 © , , r , 3JN3OIS321 ONtlanO 3H1 of LL 16 i Dmmism ~ o o o w w 0 - 'I a LL J~ I I a i a 0) ~ Ir LIP i II 2 71 a I I U11 FI ~I of c L9LbS IM'hallcA OuiidS o ~Z o E pl tl r pe0y ueSn0 OTOZN v _ - o Q puem0 esshly a~ef z a 3 W S~oH ~ao~+ g o z : N z 3 i g _ s 3:)N3aIS3N4Nvuno3H1 of _ - ~ = a a ® _ - a r weoamu»ioea y I I I I I I I I I ' I I I ~ I i I ~I I I I I I I v I I { I`~I I I I I II :'1 0~ III I II •,1J II 'Z-oo, J I, ~ z _j I moo _ i z I: oI y o 1 0 ~1 I a L-L 'I 7 L O ` / i Y _ v C \AJ I i v I I I C I = I~ I I I I I I I I I II I,:I I I I I I I I.I I,I II LJ -_J L - - i a ,L9Lb5 I M'Aa;TA rVAS of 01 O ~j //1~ peoy "MC) OZOM of n zz 3 u ° 01 *+i('7 ~S V puednp essAIV S a~ef z~ 21 o o of z x z 3, z, v w z z 3:)N341S38 4Nt una 3H1 ~I - of ~ - u ivvaodni ~d,ord ai - O! 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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. ] lJ Please print all information. a Revie by Date Personal information you provide may be used for secgndary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot Li 1/4<)F 1/4 S, 1 T_~, N R /,S E( W Property Owner's Mailing Address iciity Block # Subd. Name CSM# i SL D Ci`~ f\ !l City rr~ State Zip Code Phone Number , ill age El Town Nearest Road rt~t V0.~~~~ S3' E 7 (7i s) 77- Y~ 5, le 7u c~~~ New Construction Use: Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material 12C)le =~/~L_ _ -iuoo ruin elevarwLn it apptic 'ur.; General comments 1 a r S C~ and recommendati s: wi~~w ~ es^ Ed y o rt Cc w f o~~- < 7 7 (Da" cC Sys fie, El eu, 9 y, y~ !J l Boring # ring 93 ~ pit Ground surface elev. ft. Depth to limiting factor ~ -in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#l `Eff#2 G`I l~ f' yrn S If r~~ S- _ 5 bk~ I t S cJ r G 7, r S I n r bk' ? x C- 3 i r' c i' < w I S k - k -7, 5-.Z SC L ❑ Boring # Boring n j l~ F ,t Ground surface elev. 7 ft. Depth to limiting factor in. _ colr Annlicar'or? ata . Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 iF o -3 51 J I ~o~ I C) 3 /owz 7 7 t' , b t IL 3 1' S~S_' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30:< 150 mg/L ' Effluent #2 = SOD < 30 mg/L and TSS 5 30 mg/L CST Name~Please Print) l / S' nature CST Number Address Dat valuation Conducted Telephone Number Ile, r vrt 41, Parcel ID # Page of Property Owner ~.1 -5-- ❑ Boring Depth to limiting factor in. Soil lication Rate Boring # Ground surface elev. 4~ y S- ft. [3:1 LLI Pit Roots GPD/ff Redox Description Texture Structure Consistence Boundary 'Eff#1 •Eff#2 Horizon Depth Dominant Color Gr. Sz. Sh. / - O n. Munsell Qu. Sz. Cont. Color S 9- i 4 S_ L 4 Boring in. Soil lication Rate ❑ Boring # Depth to limiting factor pit Ground surface elev. GPD/ff Redox Description Texture Structure Consistence Boundary Roots 'Eff#1 •Eff#2 Horizon Depth Dominant Color Gr. Sz. Sh. in. Munsell Qu. Sz. Cont. Color Boring Boring Ground surface elev . _ - _ - - ft Depth to limiting factor in. Soil lication Rate # ❑ Pit Roots GPD/f>? Redox Description Texture Structure Consistence Boundary Roo 'Eff#2 Horizon Depth Dominant Color Gr. Sz. Sh. in. Munsell Qu. Sz. Cont. Color ~I ' Effluent #2 =BODE 30 mg/L and TSS 30 mglL Effluent #1 = SODS > 30 < 220 mg/L and TSS >30 < 150 mg/L need services or 08-266-3151eorr TTYt608e264a8777. The Department of Commerce is an equal opportunity scontacttile vdepartmet employer. if you material to an alternate format, please S13D-8330 (R.6/00) ..9 Pape = d-2, Psroel ID M prows, owrnr p sor4io i ®a M Liround eurfaee elsv. ft COW to WMM WW - F'fl rho mrjon ,p1Y10My R SIM Hortron Oeplh fir. "117 N QvW D°w' W WnkY1Q IrQot h Pit Ground rilmm ahv. It Row Texture Svuaewe Con"Sna 6a~"f°"1' •~tii1 Mori= Dep4h Oppinent Coto Cu. Sz u. 3L troru,Od~or or. Ss sh. ~ t~e1 tenor - Yi 8ot1~0 x Cl C3round evrlaoe ekY. Il. aW~ to ~O Cdor ReQox ow0jp Tsxpue svtr. 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