HomeMy WebLinkAbout032-2174-16-000
e~tsw~sin.>ewnier••. w;nrc,nl: co PRIVATE SEWAGE SYSTEM ~nA• St. CfOIX
;edeh arr. GuiOmy Jivuran
INSPECTION REPORT anla"permrtNO
GENERAL INFORMATION iATTACH -0 PERIII 597305
;:av Pa, It' Nn
°c;nnai m'olmaAx Yau PmrntC may ne u:en nr se;aacsy purpnsns (nnsa Jy WA . `ie<!r P;mi:
r'CI!'if. Hnl:fel'•. Nnr~e (;.,y Jllupe tnµrcnin Parea ]x ho
WILLIAM KRECH & GREG WALLACE TOWN OF SOMERSET 032-2174-16-000
;~T EM Fmv Ivry BM lieu tlM Dex:nntgn S~p]nlTown4anpnW., N.
Cb 27.31.19.1471
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURFRnn CAPACI IY STATION BS HI FS ELEV
P!ptlr. L17 L BenCn nark
15
Desin9 HI1 BM
&ot 4e,
G• Mbo P ' sa • +9 • /
Aerell0~ Blot' 5trmr •
G; po I, k Sz 9.6 Ilodlny .S i-H Inlet
• la. z 50 • st
TANK SETBACK INFORMATION SVHI Utnw.
TANK T^ I'I 4YcLL B_ DS enl l a• Im]FO ROAU DI Intel
af4~
sepnL 5 s 7 rn t:wuom_.
I HeallelrMan
r'D$1n2 ! 79
7 - S•S 9~-~s
Aclallon Dist PipC
- S•5 7-15
f loidsly - 501. Syslcm
_ 5. d /oc•~5 ~.f 9S .7
PUMP/SIPHON INFORMATION Final Grade
~j 9 7. 7
Marxl :3Murer L'a"a"d 1 SI Carer / Qp
Model Numpcr
TDH l,ft ,qL Fncllor L,osS.~ System He~d/~ 70-1 ~eFt
r 7 ~f S 2•.7CJ
Mra•nkuu Lsnytll I Ula Z It
to •a~cf ♦
SOIL ABSORPTION SYSTEM •LJ4-
BEDITRENCH VIItlm Lenp)m uV rercIes PITDMENSIONS No VI PCS Inslpc ~B Lb Pin
DIMENSIONS /OZ Tf
SETBACK SYS 11 hl TO FW BLJG WLLL LAK-PSTRFAM LEACHING Min,waclurc y 1
INFORMATION CHAMBER OR ~~Af"I ~•'•'-i"L
Type OI Sycaem - !
GO OlV~S( I~ 93 /j 7 Z~ UNIT Mace sl:moer
J~
DISTRIBUTION SYSTEM y$ a Z 54- L5 = 75 14r✓
aceceuManlul~r / C:<trc•.:Iwl .m=. Sire
Pryel al z Hok Spaanp Jve c Ainn
Leepm IZ Ula Inndm \ Dra bnann\
SOIL COVER x Prpsure Systems Only xx Mound Or AI-Grade Systems Only q
Oeprc elver CKtam C+er qx DeP ~''1L'SodnM r• Min.-nea
Bea~treno :;enter ~ Heprllen;n 6cg:x ~ l0 d
COMMENTS: ilw de code disuepenoCS persons pr. tern. etc) Inspgtion Y'- Inspe!rnor f2
Wes, nom
I Oration. 1966 5"H Sl
i. i AN BM D srnplion - / /
2) Sdq se'Aer lerKdh = 6 3
amount of cover - S / S[ /1 Q
7 ¢ x_
Plan revision Required? -l Y[ xNC 4 I~ '~L•~
Use other side for additional information 1 17 o VT J
SBDS)ID IR W) Darr Inxr:nrn'z ..r .lie Nn
t,1 RECLi C L Inclizptry Service- 'ivision
1 ! ,-DS P AY [ l1 I L vast Ave Sanitary Pemrit Number (to be filled in by Co.)
MAY ( S xx P.OBox
S CROIXCNPn. . W) 52 162 ' 7X
05
5.9l
a , ST. CROIX cc Rory TXALIMLYDEVELOPUEUT
"a°ni4ary' er it Application S'°"T`a ma"°"> '
in ottordanm with SPS 38321(2), N it Adler Code. wbrmssioa of this fuun to IIw apfroprie =1 unit N
is required prior to obtmmng a stimintx pantry. Note' Applinnton forms for stal",,ned POts gtbaantd by
~.M DeP-+nmcnl of Sakty and Pro(cssiwral Sen ices Pers.++al iafxmation you pw,dc may be 'sopondan' PmJKt Address if diRereru than mailing address)
jmff, s m anordance pith the PnYac. I.ew. s I S Dfl l Rm)• Star<.
t. Application Information- Please Print All Information
. pr' open) Uvner t Tsame ~ Parcel k
r r: /
Property Ooner s Marling Addnss Property Location I t'1 . II-1 1 I
~ at Lot
CA,. Stare Zip Code Phone Nlmtber Scam
,(eiref:ope)
T N R - Eor:W
It. Type of Building (check all that apply) Lot t
1 or 2 family Dwelling Number of Bedrooms Subdivision N•.rae ,
^ _ Y
❑ PublfJCumnxrcial - Docribc l:sc {+/'-r/TL. Bloct:0
470 tnM I C ❑ Cil) of
❑S:ale Usntd IXSCnbr lJse V ADDS - ❑Vdlagcol
-SM Number
;Jy l~ Townof -
3 OIr1tl TTr~- L'~(C~h~ck Duly one box on n A. omplete liac 6 aPlerr Ilir e~
1e~at~n
A. N • ❑ Replacement S,slem ❑ iraalmrnWHn!dmu lank Rcplannenl Only ❑ Oth t Lars ng Svse l 1 1
D
B ❑ Permit Ratcwal ❑ Permit Revision ❑ Change of ❑ Permit I mrokr to Nns Lml Previous Pemtft Number and LY.¢t Lssucd
Before Expiration Plumber ' iMswr y/.~ar~! l1N k
IV. T wCom onenVDevice: (Check all that apply) !JJ-T713f (_V
Non-pre wr zed In"Iroun Pressurized In-Ground ❑ At-0rade [I Mmind'>?I in. of wruble sod C] Mound aq~n_4 in o /u,r wl
110!ding Tank Other lAspenal Cnmpsrcm (explain) ❑ Pretrtalmrnl Un'rtt lexDlam) C• • Qm J ` '
U ep "2Vlreattri Area Information:
fk"g, flow Omit Iksigtl Soil Apph,4*n Dispersal Area Required Isf) T Dispersal Arras Proposed (sf) vsl[I11 Fievetam
Rat<(gpdsD j oK
!
= r I L.
%A. Tank Info Capacla, in
Gallons i w~ $l/ok 52S ^ I _
_ Trawl ? of I I u
Neu Tanks Cxiaiog Tm>f;s Gallons l!nr Xunulacturar
u L U n 2~ t L G' -
Scptica HstlJing lank - / r~- ❑ 1 ❑ ❑ O
Lkrsing (Tunmber _ ❑ ❑ i. C3 10 1 El
\ 11 Respo lbdity Statement- I. the undersigned. assume rnpunsibiRt~ for inuallal us of the PON TS show n on the timeliest plans.- -
Numbc 'S Nume wr0u1 / Plun i s Slgbomr< - / W',NWRS Numhs Busirwss Phony Number
Plumber's Address tStreeL C uo. Sipte. Zip Coder - - - -
r
v.
V111. Coun 'De artme_nt I s_e Oniy
pp-,td Disapprrac Peron Fee Date iss Issuing Agent Si;nalu
m cry Rcasun to; 0.>tial , S 1
U. Conditions of ApprovaL,'Rrasons for Disapproval 3 QL~latart~rt area /1 he n 111,I46-vrdl,
Septic f Ialrk k , Cffl be /~W
1. SephBiuC't 44:" arc / (IJ
Clspersal A muJ 1i,, , j. in tl I tar d, I
ea t s ss a a w mR 1 are C..rrn. wN on uapnf..r hs inter A r. a 11 ixbe io ai<r
2. A11 '1R1I ~nIS ing1 r ❑I IIi I~t I... ~D ~ Per
as per appliCanlr d
wY- e. utas C
5) P~p~lsed P~~~ ~ d~Stvf band ~ ~p< ~ R;vcrsSru~ cla~~l d~prl ~t
1c
f \ \ 8
V ~ ~Fl
1 /
41 }
4
i
CONVENTIONAL COMPONENT DESIGN
Resieenval application
INDEX AND TITLE PAGE
I p :ae t .,jdex and Titlc- ) Pro-ect
Pupa 2 Pint Plan Name:
Pane s System snrng s cross-Sentien owner's
1....l7wie z, i OY, Sp...__.. Name: f -
-.page min2lenancc'lntor*2:alla~z Owners
page
,6 ManagameruPian Address:
?ac}e ; Scf = ar* M 61)tPnance Form
C
a qa 8 ;,Sfn or Plat
Atear,tfrrcna Sbdf'cst
Lega: DescriPPon
Subdivision: _ Lot #
Town: -
i
.ounty -
ParcellD#
License #
Designer/Plumber s,
Signature: Date:-
Cornments
I -
I
Designed pursuant to the in-Ground Soil Absorption Component Manual for PUWTS version 1.u
)ndei,,le 21712012
i
i
i 'Y o
i
8
J
t
v
4 3_Z3
Job , ~
Soil Absorption System Cross Section
l._
,i ft
4° Schedule 40 Final Grade
PVC Vent Pipe
NO Vent Cap
Leaching _ a.
ft
Chamber -4--
JL~~ System EJevatlon
h ft
Soli Absorption System Plan View
ft
ft LI I L
Leaching ;7Tren:ch
tt i Chambers
4° Dia.
Header
Vent Or Observation Pipe
Trench 3
Leachina Chamber Specifications
Manufacturer And Model us
EISA Rating._'- sq ft per chamber Soil Application hate gpdfsq it
gpd Design Flow - Soil Application Rate e - EISA = Chambers
3 rows of l chambers each.
Page of
l. ~t •'`F-`~~.'r`-1-'r Rix~~l`.~=~sf~-'a~L~:.
i :.s nom= -L cf529 FOUTCER,
~INS"?~4C7TC]tv5 -
[h!S'IAi.LAit63i
I .
jrt
4mt upeM9
Step is the A) Giuc the RiEr housll,7
(A) Locate the outlet orme septic tank (H) 8efu~ ~rsrai]a4ia't, i ce outlet pipe-
Tter housing On to hie OAAetpipe- rirjdpe in
(H) Remove ank cover and pump Tani
(E}Nkesu267ataeitwt~y 08)
Wang wa tha MW
if necessary- is posftnsd so the Site- c,-ai, be housing, and
rarnoved from ate tar+k Mr is Y atiwred
maintenance anS r~ - cmmpt~mseroui in to hous9ng-
f
c - ! I
a
II~~yw~'' ~ I I Falr~ s~~ ks
r -
T rv ~
UJI
1T f
-Cc
- SIBrL Sri=: t1a
Step
Locate the o uea r r~-;e ~POL; tank. (A) Ramov6 'd• uvef and pump (A` ihtD fft Ole hoL c "ur=
flecsssafy.
_ "laCef»i
(B) Pull the t-Ilar OUC Otte hOudng- a~nc pleb S'rr~
- (G7Hose Cavvemeroverthes9pGcim ( (B) Rgple, -nic cove,
f I lllralm sure all solids fall back into tle
septic iERk
POWTS OWNER'S MANUAL & MANAGEMENT PLAN
FILE INFORMATION SYSTEM SPECIFICATIONS
Ovone' Septc lark Capacit'y.- gal ❑ NA
Permit 4 Sept r, Tarrk Manufaclurer - ❑ NA
_ i
DESIGN PARAMETERS Effluent ni ter Manufacturer 7 /1" ❑ NA
1?
Nurnhar of Redrecros ❑ NA Effluent Fi.ter Model - O NA
flwnber of Public Facility Jnits L; NA Purnp Tank Capacity i gal ❑ NA
Fstiwated flow (averagel galrJay PR:mp Tan< Aanufacturer J - n NA
Dusiyn flow (peald, IEsvm::ted x 1.51 1.• gaUda• rump ).Manufacturer :_lL;, {w/; _ Q NA
Sail Application Rate gaUdayiit` Pwnp Model ❑ IJA
Standard Influent.'Effluent Quality Monthly average• llretr?atrnent Unit )3 NA
Fats, Oil & Grease (FOG) a30 mg;t. ❑ Sar~d,Gravel rilter ❑ Peat Filter
dio:;hemical Oxygen Demand ibOOs) 5220 mg;L L1 :JA 7 Mecharical Aeration n Wetland
Total Suspended Solids (TSS) --1 SO mgll IT Drs-nter-uon n Other:
Pretreated Effluent Quality Monthly average Dispersal Cellls) L1 NA
53C mguL fib In Ground (gravity) O In-Ground Ipresscrized)
Biochemical Oxygen Demand 03O DJ
Total Suspended Solids 1TSSI _-30 nyrL L9 N,1 Q A:-Gracr: n 10ound
Fecal Coliform (geometric mean) <_10" cfUjJ0Ca-I Ll Drip Line ❑ Other:
Maximum Effluent Panicle S ze I in d-a. E) NA Other. U NA
Other: 171 FJA Other: El NA j
•Val as tY'G ea! (c d-.r rratir. ig ~w~t~r and el Se Tc- -vent. D?her; I J NA 1
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At la ust unca, every: L I ~1 I month(s) (Maximum 3 years) ❑ NA
Pump out comments of tarWsl When combined sl,.dye and scum equals one-third Iii) of tank vo'.urno ❑ NA
Inspect dispersal colts) At least once every: L1 month(s) 13 year(s) (Maximum 3 years) ❑ NA
Clean effluent filter At least once every: Ll month(s) ❑ NA
_ 0year(s)
Inspect pump, pump controls & alarm At least once every: 0 month(sl ❑ NA
0 year(s) -
Flush laterals and pressure test At least once every: n month(s) f'NA
1771 year(s)
Ober. - ❑ niunt 1W CI NA
At least cnee every: ❑ year(s)
Orhe
Nn
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dis PernA cells sha'I he made, by nl i°d •d dual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricred Seeger; POWTS Ins?cetor; POWTS Maintainer, Septage Servicing Operator. Tank
inspections must include a visual inspeeticn of the tank(s) to idrntrhy any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to cneck for any back up or pending of effluent on the ground surface.
The disoersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pending
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 or more of the tank volume, the entire
contents of tho tank shall be removed by a Septagc Servicing Operator and disposed of in accordance with chapter NR 113.
Wisconsin Administrative Codo.
All other services, including but not limited to the servicing of effluent likers, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of <_12 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the Inca! regulatory authority w4hin 10 days of completion of any service event.
GMVV 14jU1)
Page
STARI UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tar;k(sl for the presence of painting products or other chcvnracIs
that may impede the treatment ococess arirl damage the dispersal cell(sl. If high concentrations are detected have the contents
of the tanklsl removed by a septegu servicing operator ptlor to use.
System start up shall not occur when soil conditions arc frozen at the infiltrative surface.
During power outages pump Larks may fill above ronnal highwaler levels. When power is restored the excess wastewater will be
discharged to the dispersal cellls) in uee'arge dose, oveiloadirg the celhsl and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or PO`VTS Me moor to assist in manually operating the pump controls to
restore normal levels within the pump tank,
Do rot drive or park vehicles aver tanks and dispersal cells. Do not crude or park ove•, or otherwise disturb or compact, the area
within 15 Nut down slope of any mound or at-grade soil absorption area.
Peduction of elimination of the irllnveirg from the wastewater stream rnay improve the performance and prolong the life of the
POINTS: antibiotics; baby wipes; cga:one butts: condoms; cotton swabs; degreasers: dental floss; diapers; disinfectants; fat;
foundation drain (sump pmnp) water: fruit and vegetab'o peelings; gasoline; grease: herbicides, meat scraps; medications; oil;
painting products; pusticides; sanitary napkins; tampons: arid water softener brine.
ABANDONMENT -
1 When the. POW-1S fails anti is pm ;0ntly taken cut of service the foftwing steps shall be taken to insure that the system is
properly and safely abardoned in ecmpliance with chapter Comm 83.33, Wigconsin Administrative Code-
0 All piping to tanks and oils shell ba discouoaated and the abandored pipe openings sealed.
• fho contents of all talks and p,ts shalt be removed and properly disposed of by a Scptage Servicing Cpe:r tun.
After pumping, all tanks %nd pits `hall be excavated and removed or their covers removed and the void space I ..'od Minh
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWIS fails and cannot he repaired the following measures have been, or roust tic taken, to provide a code compliant
replacement system:
❑ A suitably replacemert area has been _ a4.ralcd and may he unlized for the Inrati--n of a replacement soil absorption
system. The replacement area should be protected from cistwbancr, and compact on and should not be infringed upon by
required setbacks from existing and proposed sttuc.ure, Io: lines and wells. Failure, to protect the replacement area will
result in :he need for a new soil dud site evaluation to osialb.sh a suitable replacemem area Replacement systems must
comply with the (Liles in c1ect at that time.
❑ A suitable replacement area is not available duo to setbac< anllor soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has net been evaluated to identify a suitable teplacement area. Upon failure of the POW [S a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstricted in place following removal of the biomat at the
nfiltretive surface. Roconsuu(;ti. s of such systems most comply w in the rules in effect at that time.
< < WARNING> >
SEPTIC. PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND10R INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEAT H MAY RESULT. RESCUE OF A
PERSON FROM THE IN fER10R OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
N anro [7N ame hone
Phone T,
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name !
Name _
Phone
Phone
ThLs dutumeot was drafted in cumpl anco wah chapter Comrn 83.22t2)(b)I1)fd)MV) and 8s.b40), (2) G (3), Wlscortsln Adminishativo Code.
Faye of
START UP AND OPERATION
Fur new construction, prior to use of the POWTS chuck v, atinunt iankis) for the prenence of painting pto:tucis or other chemicals
that may impede the treatment process ancior damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a seplage servicing operator prior to use.
System start up shall not occur when soil conditions we frozen at the infiltrative surface.
During power rutafies pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cellist in one large dose, overloading the oellls) and may resul- in the backup or surface discharge of
effluent. I o avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior -.o restoring
power to the effluent pump or contact a Plumher or POWTS I•.faintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do riot drive or park vchi cos over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of ar•y mound or at-grade soil absorption area.
Reduction or elimination of Iho following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wires; cigarette burs; condoms; cotton swabs: degreasers: dental floss; diapers; disinfectants; Oat:
toundaticn drain Isunip punip) waver, fruit and vegetable peelings gasoline: g,ease; herbicides; meat scraps; medications: oil;
painting products: pesticides; sanitary napkins: tampions; and water softener brine.
ABANDONMENT
When the POINTS fails andlor is permar.oatly taken cue of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Com:n 53.33, 1Nisconsin Administrative Code:
• Al. ;:iping'to ianks and pits shall be disconnected and the abandoned pipe openings sealed.
• TI e contents of all tanks and nits shall be removed and properly disposed of by a Septage Servicing Operator.
• After Vumping, all tanks and pi,s shall be arcavated and remove] or their covers runloved and the vo'd space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
Lf the POWTS fails and cannot be repaired t`e foio-eving measures have been, or must be taken, to provide a cede compliant
v?placemuni system:
❑ A siJtao!e replacei°..ent sea has been evabatcd and may be utilized fcr the location of a replacement soil absorption
system. The replacement area should Lo protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing end proposad struniu;e, lot lines and wells. Failure to protect the replacement area will
result in the nerd for a now soil and site evauation to establish a suitable replacement area. Reuiaoement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is riot available cue to setback andiot soil hmitrowns. Barring advances in PCWTS
technology a hclding tank may be installed as a last resort to realace the failed POWTS.
U The site has not been evaluated to identify a suitable replacement area. Jpun falure of the POWTS a soil and site
evaluation must be performed to locate a suitable roplaceme:rt area. if no replacement area is available a holding tank
may be installed is a last resort, to replace the failed POWTS.
❑ Mound and at grade soil abscrption systems may be reconstructed in place fallowing removal of the biomat at t``a
infiltrative surface. Reconstructions of such systems must comp y with the rules in effect at that time. i
< < WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN I FTHAL GASSES ANDiOR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC. PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLERPOWTS MAINTAINER
Name Name
L^L._ by r'
Phone -7 -7 Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name 'y - - -FS~ -
leg
Phone I.. _ Phone ,
This docume.l t was dratted in compliance with chapter Comm 82.2212)(bVil(d)&(f) and 83.54111. (2) & (3), Wisoonsm Adminisuntive Code.
ST. CR(bl~i_ i_'f_)tilYl t
SEPTIC TA VK MAINTENANCE AGREED aNT
~ )
OWNERSHIP CER]IFR A'1'ION
OwnerBuyer
Mailing Address 1-
r
v
(Verification lequured iron: Planning F 7 nutg Depar mct:t fcr n con huction.)
Parcel Identification Number
City/state '
1 to GA DFSCE PTI RI
sec. T N R W, Town of
---fi/
Subdivisiun Plat:
Certified Survey Map # _ Volume Page #
Warranty Deed k VIM More 2007)Volume Page _
Spec house 2Yes 'J no 1 Iit,~_ :,waiiiau'e a no
SYSTEM MAl3N TENAN('E AND OWNER CERTIFICATION
Improper use Ana maintenance oC yuuL septic s•,Stcm CCJd result in irs t+rrmaturr failure to handle wastes- r'mpcr
maintenance consists of pumping out the septic tank every three years or sooner, if ueedee:, by a Licensed pimuper. !ghat Imu Put into
a, sy:,xca can a8ert the function of the septic tank as a treatment stage in the waste disposal system Owner maintc»ance
responsibt':i:ic> afc Sf i~_d fa ' 91.. :-,Wi and Ln Chanter I.'- - 3t. Cmix cvuaty Sao;ta:} Otdiuauco.
The property owner agrees to submit to SC 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 (l) the on-sire
wastewater disposal system is in proper operating, condition and/or (2) after inspection and pumping (if necessary), the septic tank is
iess than i;3 full urAudge.
Uwe. the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
startdads set ru,111, herein, as Sc: by the 11ePartment of Safet'r And Professroual Services and the Del,artnaent of Natural Resources,
state of Wisconsin, Certification stating :hat your septic system ita< bcca mamtuiatd 7.JSL oe complexc, ana retuned i0 the: Si.
County planning & Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statements on dii, form are true to the best of my.!our knowledge. Uwe amiare the owner(s) of the
property desrnbed above, by virtue 'fa r ty deed recorded in Register of Deeds Office.
Number of bedrooms
S] ATURE OF APPLICANT(S) DAS
"'Any information that is misrepresented may result in tire sanitary permit being revoked by the Plmniog & Zoning Department a t °
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey trap if
,zte,mre is made in the'•varran-,v deed-
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( T WLP1585/950 ICA.t t/~'-1' REV NO_ _ ❑NiF.
r WIESER CUACIETE ~Y wT
C) V SEPTIC MANUAL MAIDEN ROCK. w/POR)AGE. M/ )GNG OV VC. M DATE JANUARY 21101
REV JAN. 2005 800-525-84',6 F
Cl J 110.1
1T t4 ~
ocres
H. W.M. /
~d
Cl~
LOT e
j 1 Jf acres
rO O. H. W M.
a L40
h\. a ..K
LOT 15
3.03E acre
7D 0.H. W.
• .off LOT 17
\ y`~ 3.071 acres
TO O.H. W.M. ,
Septic-Dose Tank Cross Section And Pump Performance Specifications
- - -
l ank Manufacturer Pump Manufacturer
Tank Model Nun her Pump Model Number j
/ - -
Total Tank Capacity Alarm Manufacturer r ,
- -
! Max. Bury Depth ,S - Alarm Model Number
Switch Type i
Filter Manufacturer Total Dynamic Head (TDH) - Feet
riper Model Number 1 Elevation Head
Distal Pressure
_ Network I.o_ss
Minimum Pump Ycrfo anu Required Force Main Loss
GPM a Ft TDH Total - _ J -
Outlet Manhu:c Min T' Above Grade A,ith 'J G
Locking Device. Inlet Manhole Manhole Min. 4" Above Grade L
<6" Below Grade Scaled Watertight Secure y Mounted With Locking Device
Weather-proof
Junytion E3-x
FinishedCrrade ~t----
5- 1
Depth of
Cover Vent Min. 12" Disconnect
Above Grade
Ft - Means
With Vent Cap
Outlet
Outlet Filter
Inlet Inlet Baffle
-
j Switch settings and Rcscrve Capacity A V"
Tank Volume - UPI Weep
Dimension Inches Volume Gal. B Hole
(reserve) A - f -
(alarm) B 2 y Off Elevation C
(dose) C Pt
Bottom
(dead) D s
D Elevation
Total J ;
Pt
GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in aceurdance with the
manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not
he exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock)
installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and
laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sell. 40 PVC to bridge the tank
excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28 WAC.
02/05 U Page of
GOULDS PUMPS Submersible
Effluent Pump
PE
~a.
A~ t
r
tl 1
iii t SPECIFICATIONS MOTOR FEATURES
..Y
Pump - General: General: ■ Corrosion resistant
III • Distha«3e 17," NP7 • Smgle phase constluaion.
• Temperature, 1041f (41 • 60 Hertz ■ Cast iron i:udy_
maximum, continuous wrien 115 volts ■ Thermoplastic Impeller and
fully submerged. • 81 thermal overfoad pro- cover
t reset, Upper sleeve and lower
i Solids hardlin9. Who" With au omahc In
maximum sPhera_ • Class B Insulation. heavy duty ball beaeng
• Automatic modals include a •Oil -filled design. construction.
APPLICATIONS float switch. • High strength carbon steel ■ Motor is permanerstlS
Specially designed tot the • Manual models available. shaft. lubricated lot extended
• Pumping range: see PE31 Motor: servlre lie.
following uses performance chart or curve. • .33 HP, 3060 RPM ■ Powered for continuous
• Mound Systems
• ERfuenUDos rig Systems PE31 Pump- 11.0 Maximum amps operation
• Low Pressure Pipe Systems • Maximum rapacity: "(11 • Shaded pole design ■ al ratings are within Ihe,
• Basement Draining • Maximum head: 25' TDH PF41 Motor: working limits of the notes.
40IIP, 34W RPM • coQu.ck ol disconnect p
• i,ravy Duty Sump( PE41 Pump: • curd, 20 standard lenntr
ytl,
Cawanonny • Maximum (apacity. 60 GPM • /.5 Maximum amps neavy duty 1613 SJTW v, in
• Max mum head.. 29' iDH • PSC design NEMA 5 -1SI', three pinny.
PE51 Pump: PES1 Motor: 115 volt grounding plug.
• Max mum capacity: 10 GPM • 50 HP, 3400 RPM ■ Complete unit is heavy duty,
• t,!awmum head: 37' TDH - 9.5 Maximum amps portable and compact.
• PSC desigr ■ MethdOILAl Si IS rarhmn,
nn rl Rs i r remmir, RUNA and slamiess
au G101 It.1 „n r-4. 1W Steel.
P[ s i W, „ 41, .o ■ Stainless steel fasteners
AGENCY LISTINGS
T
90 Pt41 t , H
2, PE31
W cip till
G zit Tested to UL 778 and
CSA 22.2 108 Standards
v
0'/ Gnadian SuIldalds Asslxlvmn
r 15 lie N1A38549
0
tkeilda Pumps Is ISO 70G1 eegizCmd.
10
S
0 00 to 20 30 ao >u 69 10 GPU Ro
0 s 10 5 Imja GouldsPuntrx
CAPACITY
r
vwscorwnDepartment of Corr merle nE' SOIL EVALUATION REPORT Page _j Of Division of Safety and Buildings
f 1n ao=clance with Comm 85 Otis. Arlin Cade
t CuxhtY
Attach complete site plan on patlMeaotlass ltlan C 1r2 x 11 etches in size. Plan must
include. but nut limited in- vertical and hoe¢otal reference poed (BM). direction and Parcel LD
portent slope, scalecr dimensions. north arrow, and location and distance to nearest road. i - _ 7
Please print all information. Rem Y, Date
PenonP mforrnabon you prov de may be used for 6ecomery pu'pose6 (Pdvscy Lew. 6 15 04 (1) (m)I
Property Owner / Property Location
Govt Lot - 114 V/ S", T N R (or) W
Pmperty Owners Mailing Address, Lot P 81ock a Surd. Name u CSMP 11 1 /
- 7
1r Z*z
CdY Sate Zip Code Phone Number ❑ City _ ❑ Village ❑ Town Nearest Road
E) New Construction Use. M Residential Y Number of bedrooms - / Code denvntt design flow rate GPO
❑Replacement ❑ Public or cgnmeroal - Describe
Parent material _ _ Flood Plain elevation it applicable
General owivnerlls
and~rre~com~merdations:
V hl. 144 ltin.- U 3 r ~r d' / - /Gd'1h,(.fir Cv+-. ~J ~.f/trlci r-8~"%n S ~d
1-111 ❑ Bonrg Boring C _
Pil Gourd surtaceacv. fl. Depth b liming factor in
- $pl icatiah Rate
Horizon Depth Dominant Color Redox Descnpion Texture Structure Consistence Boundary Roots GPDRP
in. Mansell Ou Sz. Cont. Color Gr. Sz Sir 'EMP7 •EflP2
i
Borg P Boring ' , Pil Ground sudaeo olovfl ~Dulllllo Inviting factor eh.
Soh? Application Rate
Horizon Depth Dominant Color Redox Descipbuh exture Structure Consistence Boundary Roots GPD/M
in Mu sell Ou. SZ. Cent, Color Cr Sz. Sh. 'Efl#l •EfM2
x!
• Effluent 01 r BOD s 30 < 220 mWL and TSS >30 < 150 mg4 Effluent P2 = BOD < mgrL and TSS < 30 mg(L
CST Name / Signatwe CST Number
Address / - / Da EvaWaem Co ded Number
Property Owner r.-. r Parcel ID # Page - or _ _
Sonng # Durug _
❑ Pit Ground surface alav. k. Depth to limitorig factor n- soa iration Rate
Horizon Depth Dommant Cola Redox Desotptan Texture Shuture Consistence Boundary Roots GPDYf
in. Munsell Ou. Sz Conn Color Gr- Sz Sh. 'Eff#1 'Eff#2
i
Boring If ❑ Bong .
❑ pit Ground surface elev. k. Depth to limiting factor or. Sail Appolicatoori Rate
Horizon Depth Dominant Color Redox Description Texture S6udure Consistence Boundary Roots GPD1ff
at. Murvall Du. Sz. Cont. Color G. Sz. Sh. 'EH#1 'Ek#2
❑ Booing All Ground surface elev --ft. Doper to lending factor in.
Bori ❑ Pin Soil A4xilicaton Rate
Horizon Depth Dominant Cola Redox Description. Texture Structure Consistence Boundary Roots GPON
in. Munsea Ou, Sz. Conn Color Gr. Sz. Sh. 'EIf#7 'Eff#2
_ i
i
Effluent #1 = BOO, > 30:E 220 mg& and TSS >30 1150 mlg& ' Effluent 02 = BOD, < 30 nv& and TSS 130 mglL
The Department of Commerce is an cyusl opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608464.8777.
sw4mct6<n
Properly Owner Par;x: IDk _ PnEe d__"_
Boring # ❑ Boring c?!i
0 pit Ground surtaceetev . ft. Depth to limiting !actor Soil AD iMew Rate
Horizon Depth Dominant Color Rtdun Description Texhnn Smnrtm Consistence Boundary Roots GPDfIf
in. Munsell Ou. Sz. Cont. Color Gr Sz Sh 'Ee#2
l I
/ f -rr
_
I I I I I
11._ Bong # ❑ B."
U ❑ pit Ground surface elev. fl. Depth to flowing factor _ n. Soil Anohcaaor Rate
Honzor Depth Dornnant Golor Redox Des<nptinn Texture Structure :mststence Boundary Roots GPDM
in Munsell Ou. SL Cont. Color Gr. Sz. Sh. *Eft l •Eft2
i
❑ Bon g
Boring #
❑ Pit Ground surface elev. ft Depth to limiting factor
Soil iation Rate I
Honzon Dupdt Dormam Golod Redox Desaipton Tenure Structure Consistence Boundary Roots GPDMF
in. Murrsel Ou. Sz. Corn. Odor Gr. Sz Sh. 'Effk1 'Eft#2
• Effluent!: = BODE > 30 < 220 nVII- and TSS >30 < 150 mA ' Efltuere #2 = BODE < 30 irryL and TSS < 30 nV L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access scn'iccs or
need material in an alternate format, please contact the department at 605-266-3151 or TTY 608-264-8777.
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