HomeMy WebLinkAbout026-1288-10-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. CI'OIX
Safety and Building Division
INSPECTION REPORT Sanitary Permit No
(ATTACH TO PERMIT) 597409
GENERAL INFORMATION State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] 2928185
Permit Holder's Name: City Village Township Parcel Tax No:
BRENT & MACKENZIE CAMPBELL TOWN OF RICHMOND 026-1288-10-000
CST BM Elev: Insp. BM Elev: IBM Description: Section/Town/Range/Map No:
/oa I6rv\ 1 C T 26.30.18.1453
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
ti
Septic S /dam Benchmark I. d 5 ,O~ i5 /da
'
Dosing Alt
C0VIz, R' (~b . BM 60 r1.3`~ ri'
Bldg. Sewer
< a ~2. 5_2 l 77 "F(., :3 8
Holding St/Ht Inlet -7 _7
TANK SETBACK INFORMATION St/Ht Outlet a
TANK TO P/L WELL BLDG. enty Air Intake ROAD Dt Inlet
Septic -76 i A) 6 Dt Bottom /'7, cj'' .7
Dosing 70 i - / / Header/Man. 3- t 5 177
Aeration Dist. Pipe 3.1.51 -7!g
Holding Bot. System W'Ivis
b
PUMP/SIPHON INFORMATION Ab- Final Grade 7-15 `
Manufacturer /I Demand St Coverer~
6 0v l S GPM t";( 9. 37
Model Number ® z
r1 .J Ca IJ-0
TDH Lift Friction Loss System Head TDH
Z t
A (1-5 7-41 13 Forcemain Lent Dia. it Dist. to Well
i
/-96 Z_ I
SOIL ABSORPTION SYSTEM 4
BED/TRENCH Width Length No. Of Trenc4es i PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 66 -
- C7 -
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Typ System
7 UNIT Model Number:
/v
6
7iF
DISTRIBUTION SYSTEM L)eS (v' 1104- A
Header/Manifold Distribution x Hole Size Hole Spacing / Venrt it Intak
a Pipe(s) L
ength Dia Length 10 Dia Spacing l2-'
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only 4
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center r' Bed/Trench Edges Topsoil p es C No _'____Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 15 17 Inspection #2:
Location: 1389 134TH AVE
1.) Alt BM Description = `L,
2.) Bldg sewer length = 30
- amount of cover =
t
i
Plan revision Required? Yes No
13~ ~
Use other side for additional information. ` ~ 1 -7
_ - I L
Signature Cert. No.
SBD-6710 (R.3/97) Date Insepct
V V
County
fety and Buildings Division
"S K REC W Wast ',gton Ave~.?^,P.0. BOX 7162 Sanitary Permit Number (to be filled in by Co.)
P~ Mar ^~I 53 7162
APR 7 2011 S'1 -71-L
D5
S Cl ati On State Transaction Number
In accordance with SPS 38321(2), •i. Code, submission of this form to the appropna °r~t~l3init ~i~
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTI) `ted to Project Address (if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used 1, ry
purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats.
L A lication Information - Please Print All Informati 0 J 1J"
Property Owner's Name Parcel #
Property Owner's Mailing Address H Property Location a& • q$ 3
Govt. Lot
City, State Zip Code Phone Number _4~__'/4, 1/4, Section
(circle one
H. Type of Building (check al that apply) Lot #
`7 Subdivision Name J~~ 1 or 2 Family Dwelling - Number of Bedrooms
ok 6A ~•oJ Blockg - S
❑ Public/Commercial - Describe Use 1 a"- ❑ City of
❑ State Owned - Describe Yse , CSM Number ❑ Village of
Town of
J
r 4' )V o
k bd
III. Type of Permit: (Check only one boa on line 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 ❑ Chanae of Plumber 11 Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration V Owner
W. Type of POWTS System/Component/Device: Ch that apply) Q
❑Ncn-Pressurized In-Ground El Pressurized In-Gro d At-Grade ound 124 in. of suitable soil El Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
11
V. Dis ersal/Trea ent Area Information:
Design Flow (gpd) Design Soil Application Rate( dsf) Dispersal Area Required (Sfl/ Dispersal Area Propos (sf) System Elevation
VI. Tank Info Capacity in Total f* of Manufacturer
Gallons Gallons Units Z c
New Tanks Existing Tanks L a
a 6~ 5 U v~ ~ vz w U C.
Septic or Holding Tank
Dosing Chamber
VII. Res onsibility Statement- I, the undersigned, assume respon~Iity for installation of the POWTS shown on the attached plans.
-
Plum e s Name / Plumber s,SigriYie MP/MPRS Number Business Phone Number
I
71
Pl bet's'ddress (Street ,State, Zip Cie)
VIII. unty/De artment Use Only
proved app Perrm_it Fefe~ Date sued Issuing ent Signature ,
❑ iven Reason Denial $ v ~ ; ' 7/201 11-7
DL CondidOMI MkPp +dd5$Reasons for Disapproval
1. Spptil+ tank emL*m lifts m d ?l ~7~• i D J
aKPew:,, cell must all is s /J / % ~ J
AO%A
~ 1
el~
I~t,per tflaragement plan pio iderf tiv Diu nbe: • Ca rCi
2. A•a111ft pK41t'e!sW"rat i;,e mlirt. li E i
Attach to complete plans for the system and submit to the County only on paper not less than 8 v2 1 11 inches in size
SBD-6398 (R. 11/11)
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~otiynRrsrE~T DIVISION OF INDUSTRY SERVICES
10541 N RANCH RD
HAYWARD WI 54843-6462
3 } DS K
Contact Through Relay
92~ P $ v http://dsps.wi.gov/programs/industry-services
o~ www.wisconsin.gov
ssroNPN' Scott Walker, Governor
Laura Gutierrez, Secretary
April 17, 2017
CUST ID No, 224263 ATTN: POWTS Inspector
KIM A OCONNELL ZONING OFFICE
KO CONSTRUCTION ST CROIX COUNTY SPIA
504 3RD AVE E 1101 CARMICHAEL RD
OSCEOLA WI 54020-8173 HUDSON WI 54016-7708
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 04/17/2019 Identification Numbers
Transaction ID No. 2928185
SITE: Site ID No. 836908
Brent & Mackenzie Campbell Please refer to both identification numbers, ALLY
134TH Ave above, in all correspondence with the a enc . OVED
Town of Richmond F ETY A
St Croix County
SS L S'ER)
NEI/4, SE1/4, S25, T30N, R18W
FOR: yE:'a`a iND S RY
Description: At grade, 3 bedroom residence
Object Type: POWTS Component Manual Regulated Object ID No.: 1700088
Maintenance required; 450 GPD Flow rate; 40 in Soil minimum depth to limiting factor from orig 1 grade; Sy to (s):
At-grade Component Manual, Version 2.0, SBD-10854-P (N.03/07, R. 1/12), Pressure Distributi pON E
Ver, 2.0, SBD-10706-P (N.01/01, R. 10/12), SSWMP Pub. 9.6; Effluent Filter _E t✓
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 malfunctions so as to create a health hazard, the property owner must
follow the contingency plan as described in the approved plans. In addition, the owner must insure that the
operation, maintenance and monitoring duties as described the At Grade Component Manual are complied
with. A copy of this information must be given to the owner upon completion of the project,
Reminder
• The orientation of the at grade 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 at grade per At grade Component Manual.
• Surface water drainage shall be diverted away from the system area.
• Materials shall conform to the requirements of SPS 384. SPS 384.10. No fixture, appliance, appurtenance,
material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system,
unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and
ch. 145, Stats.
KIM A OCONNELL Page 2 4/17/2017
• Maintain well and waterline set backs per SPS 383.43(8)(i).
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
Patricia 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
KIM A OCONNELL Page 2 4/17/2017
• Maintain well and waterline set backs per SPS 383.43(8)(i).
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.
~inCP,rP.w FAA Ro.,,,;ro.i Q 7cn nn
Fee Received $ 250.00
Balance Due $ 0.00
Patricia L Shandorf WiSMART code: 7633
POWTS Plan Reviewer, Division of Industry Services
(715) 634-7810, Fax: (715) 6314-5150, 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
RESIDENTIAL AT-GRADE DESIGN APR 01 ZW
Pressuriz~- - Slaving Site SERVIGF~
INDEX AND TITLE SHEET Ipt~S
Project Brent & Mackenzie Campbell
Owner Brent & Mackenzie Campbell
Address 11005 D Oak Grove Ur
Woodbury MN 55129
Legal Description NE-SE-sec25-T30N-R18W
Township Richmond County St Croix
Subdivision Name Stone Run Estates Lot No. 10
Parcel ID Number 026-1288-10-000
Plan Transaction Number
Index sheet Page 1 CE S
Calculations Page 2 ~,AIJCES
At-grade drawings Page 3
Laterals and dose tank Page 4
Specifications Page 5
Management & contingency plan Page 6
Pump curve & specifications Page 7 ^E
Plot Plan Page 8
Soil Test Page 9
Designer Kim Oconnell License Number 224263
Signature Phone Number 715-381-7917
Date 04/04/17
Designed pursuant to:
At-grade Component Manual Ver. 2.0 for POWTS SBD-10854-P (N. 03/07, R. 01/12), and both
SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST - SAS (01/81) and
Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01, R. 10/12)
Version 7.0 (11/12) Page 1 of 9
PRESSURIZED AT-GRADE DESIGN
n F..e r~P";.` Des 5n VIUnrkshcot - Sloes nq Site,
Flows and Site Data Entry.
(r or c; r<Residential or commercial?
300.0 Estimated wastewater flow (gpd)
450.0 Design wastewater flow (gpd)
3.00 % Site slope
97.00 Contour elev. below lateral (ft)
40.00 Depth to limiting factor (in)
0.50 In-situ soil application rate (gpd/ft^2)
Distribution Cell Information
(1 or 2) 1 Influent wastewater quality
4.50 Linear loading rate gpd/ft
9.00 Effective absorption width (ft)
9.00 Max. effective width permitted (ft) ` C>
100.00 Aggregate length (ft) I
Pressure Distribution Data Entry ~t)
c or e) e Center or end lateral connection
Number of laterals
0.125 . Orifice diameter (in) e.g. 0.25
4 a final 2.00 Estimated orifice spacing (ft)
2.00 Forcemain diameter (in)
2.14 Forcemain flow velocity (ft/sec)
160.00 Forcemain length (ft) y or n y Does forcemain drain back?
82.00 Pump tank elevation (ft) y or n y Are laterals at highest point?
6.5 System head (ft) x 1.3 NA
14.50 Vertical lift (ft) 26.1 Forcemain drainback (gal)
1.60 Friction loss (ft) 45.0 5x Lateral void volume (gal)
0.00 In-line Filter Loss (ft) 71.1 Minimum dose volume (gal)
22.60 Total dynamic head (ft) 21.0 System demand (gpm)
Lateral Diameter Selection Gallons/inch Calculator (optional`
Pipe diameter Design options Design choice 650 Total Tank Capacity (gal)
Desianer 1 in 38 Total Working Liquid Depth (in)
must select 1.25 in 17.1 Gal/in (enter result in cell G46)
one lateral 1.5 in x x
diameter 2 in x Treatment Tank Information
s in x 1000 Septic tank capacity (gal)
Wieser Manufacturer
Effluent Filter Information Dose Tank Information
Ploylok Filter manufacturer 650.0 Dose tank capacity (gal)
PL 525 Filter model number 17.0 Dose tank volume (gaUin)
Wieser Manufacturer
Project: Brent & Mackenzie Campbell
Transaction Number: Page 2 of 9
AT-GRADE PLAN VIEW
D -t
1/6 B Observation pipes (2 typical) A 9.00 ft
D B 100.00 ft
1/6 B 16.67 ft
C 11.00 ft
W C D 5.00 ft
E 2.00 ft
I L 110.00 ft
D B W 21.00 ft
A x B 900.00 ft"2
L
Cap
= Total aggregate cell A x B Typical obs. pipe.
Slotted in the lower 6", and
= Plowed area L x W anchored securely.
6"
AT-GRADE CROSS SECTION
Svnthetic fabric cover
gg.7g ft Finished grade
Lateral elevation
invert elev. 97.50 ft
f- Observation pipe
/ at aggregate toe
E f`
r, 3 % Slope
Surface contour 97.00 ft C A
and system
elevation D
® = 12 in. topsoil and subsoil
over aggregate and tapered to toes. Plowed layer
below L x W
= 6 in. aggregate below
pipe(s), and 2 in. above pipe.
Project: Brent & Mackenzie Campbell
Transaction Number: Page 3 of 9
PRESSURE DISTRIBUTION AND DOSE TANK
Lateral Diagram - End Connection
P
Last hole drilled n .a rt, end cap I~ X -'I Laterals force main of PVC =r , 40
Holes drilled or, the bottom of the lateral per SPS Table :84.:30-6
qualbtspaced • =Turn-up wlball valve or cleanout plug
Lateral Specifications
0.125 Orifice diameter (in) End Lateral connection point
X 1.96 Orifice spacing (ft) 1 Number laterals
51 Orifices/lateral P 0 Lateral length (ft)
21.0 Lat. discharge rate (gpm) 1.50 La eral diameter (in)
2.00 Forcemain diameter (in)
21.0 Sys. discharge rate (gpm) 160. orcemain Length (ft)
22.6 TDH (ft)
Typical Pump Chamber Layout
Approved manhole cover with
Weather-proof warning label and lacking device
junction box r
Final grade 4"
disconnect
Tank component is Alternate
properly vented R` outlet
location 18" min.
Electrical as per NEC 300 and I~ Approved
SPS 316.300 WAC outlet
Tank full joint
= Inches Gallons JA Provide 1/4°
A 20.1 340.9 weep hole or
Alarm on antisiphon
W B 2.0 34.0 Pump on B device.
E C 4.2 71.1
o D 12.0 204.0 83.00 ft C
Totals 38.3 650.0
Pump off
D
3" Bedding under tank 82.00 ft
Goulds Pump manufacturer RJS Rhombus Alarm manufacturer
PE 51 Pump Alarm model number
model number tank alert hw 101
Project: Brent & Mackenzie Campbell
Transaction Number: Page 4 of 9
At-grade System Maintenance and Operation Specifications
Service Provider's Name Kim Oconnell Phone 715-381-7917
POWTS Regulator's Name St Croix County Zoning Phone 715-386-4680
System Flow and Load Parameters
Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in
Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L
Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L
Soil Absorption Component Size 900.0 f:2 Maximum FOG 30 mg/L
Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL
Service Frequency
Septic and Pump Tank Inspect and/or service once eve 3 ears
Effluent Filter Inspect and clean at least once eve 3 ears
Pump and Controls Test once every 3 ears
Alarm Should test month)
Pressure System Laterals should be flushed and pressure tested eve 1.5 years
Mound inspect for ponding and seepage once every 3 years
Miscellaneous Construction and Materials Standards
1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap,
and are secured in as shown in the at-grade component manual.
2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code.
3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code.
4. Tillage of the basal area is accomplished with a mold board or chisel plow.
5. The at-grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion
and help reduce frost penetration.
6. Areas within 15 feet of the downslope toe will be protected from compaction.
7. All other construction details are as per the at-grade component manual SBD-10854-P (N. 03/07).
Lateral Turn-up Detail
Finished
Grade
Threaded Cleanout
Diameter Lawn
6-8" Diame
Plug or Ball Valve
Sprinkler
Valve Box .
wee 90 or Two
Long
Sweep
97.50 ft 45 Degree Bends Same
Diameter as Lateral
Project: Brent & Mackenzie Campbell
Transaction Number: Page 5 of 9
At-grade System Management Plan
Pursuant to SPS 383.54, Wis. Adm. Code
General
This system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall maintained in accordance with its' component
manuals [SBD-10854-P (N. 03/07, R. 01/12), SSWMP Pub. 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706
(N. 01/01, R. 10/12)] and local or state rules pertaining to system maintenance and maintenance reporting.
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death.
Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as
POWTS components.
Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings
used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or
subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking
device to prevent accidental or unauthorized entry into a tank or component.
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic
tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be
assessed at least once every 3 years by inspection.
The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions
are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the
filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous
alarm.
The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the
tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of
when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank.
The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products
are used they shall be approved for septic tank use by the Department of Commerce.
Pump Tank
The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper
operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary.
At-grade and Pressure Distribution System
No trees or shrubs should be planted on the at-grade. Plantings may be made around the at-grade's perimeter, and the at-grade shall be
seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for
vegetative maintenance) on the at-grade is not recommended since soil compaction may hinder aeration of the infiltrative surface within the
mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the at-
grade be heavily mulched as protection from freezing.
Influent quality into the at-grade system may not exceed 220 mg/L BOD5 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30
mg/L BODS 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow
specified in the permit for this installation.
The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be
flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test
when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution
within the dispersal cell.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any
levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring.
Contingency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition.
If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately
repaired or replaced with a component of the same or equal performance.
If the at-grade component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or
replaced in its' present location by increasing basal area if toe leakage occurs or by renovating the biologically clogged absorption and
dispersal media, installing new piping, and replacing other components as deemed necessary to bring
the system into proper operating condition.
See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider.
Project: Brent & Mackenzie Campbell Transaction Number: Page 6 of 9
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Lra'70GOULDS PUMPS Submersible
Effluent Pump
PE
si
SPECIFICATIONS MOTOR FEATURES
Pump - General: General: ®Corrosion resistant
° Discharge: 1'h" NPT ° Single phase construction"
• Temperature: 104°E (4000 ° 60 Hertz ® Cast iron body.
y maximum, continuous when ° 115 volts IN Thermoplastic impeller and
fully submerged. ° Built-in thermal overload pro- cover.
tection with automatic reset Upper sleeve and lower
• Solids handling: h
maximum sphere. ° Class B insulation. heavy duty ball bearing
• Automatic models include a • Oil-filled design. construction.
APPLICATIONS float switch. • High strength carbon steel ® Motor is permanently
• Manual models available. shaft. lubricated for extended
Specially designed for the . Pumping range: see PE31 Motor: service life.
following uses: °performance chart or curve. • 33 HP, 3000 RPM Powered for continuous
• Mound Systems PE31 Pump: • 12.0 Maximum amps operation.
• Systems . Maximum capacity: 50 GPM ° Shaded pole design E All ratings are within the
• Low ow Pressure Pipe Systems
• Maximum head: 25' TDH PE41 Motor. working limits of the motor.
• Basement Draining • .40 HP, 3400 RPM IN Quick disconnect power
• Heavy Duty Sump/ PE Pump: • 7.5 Maximum amps cord, 20' standard length,
• M Maximum capacity: 60 GPM heavy duty 1613 SJTW with
Dewaten ng
• Maximum head: 29' TDH ' PSC design NEMA 5-15P, three prong,
PE51 Pump: PE51 Motor: 115 volt grounding plug.
° Maximum,capacity: 70 GPM ° "50 HP, 3400 RPM ® Complete unit is heavy duty,
• Maximum head: 37' TDH • 9.5 Maximum amps portable and compact.
• PSC design N Mechanical seal is carbon,
METERS FEET ceramic, BUNA and stainless
40 .
_ MODELS: PE31, PE41, PE511 steel.
--PE51
1 HP: -33-40, .50 Stainless steel fasteners.
35
2 GPM AGENCY LISTINGS
_ - t_
30 `-PE41 1 FT
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Tested to UL 778 and
a 20
CSA 22.2108 Standards
oaaUon
0 rds By Canadan
Standa
eC 15 - > _ - - File AR3s549 u
Goulds Pumps is ISO 9001 Registered.
10
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a s 10 1~5 m3ih Goulds Pumps
CAPACITY
cl >nm Goulds Pumps - -I- - -
ST. CROIX COUNTY
SEPTIC TANK MA-D=ANCE AGREEIvIENT
AND
O WNTERSHIP CERTIFICATION FORM
OwnerBuyerr ,
T'
Mailing Address
Property AddressX'
(Verincation required from Planning & Zoning Dep nt for new construction.)
City/State t! Parcel Identificat i on Number 6~ - L- 2 C -
LEGAL DESCRIPTION
Property Location 1/4 1/4 , Sec,-- TAN R~W, Town of
Subdivision Plat: Lot -7'r
Certr_fied Survey Map , Volume , Page #
Warranty Deed 9 (before 2007)Volume , Page #
Spec house ❑ yestpo Lot lines identifiable yes ❑ no
SYSTEM NLALNTENANCE -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
onsibilities are specified in §SPS. 383.2(1) and in Chapter 12 - St Croix County Sanitary Ordinance.
resp
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.
Uwe, 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 Sendces and the Department ofNatu-al Resources,
State of Wisconsin. Certification stating that your septic system has been maintained must be completed and retumed to the St Croix
County Planning & Zoning Department Mthin 30 days of the three year expiration date.
Uwe certify that all statements on this rm are true to the best of my/our lmowledge. Uwe am/are the owner(s) of the
property described above, by virtue of a warn deed recorded in Register of Deeds Office.
Number of bedrooms
livid
10
SIGN TU F 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)
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RECEIVES Fc-)Q r
Wi«,onsin Department of Commea SOIL EVALUATION REPORT Page of
Division of Safety and Buildings ~Et01X Lv`
Z~~ { r(~ r Wis. Adm. Code County
Attach complete site plan on pa .Than 81„'' 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.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ° a
Please print all information. Re wed b Date
Personal information you provide may be used for secondary purposes (Privacy taw, s. 15.04 (1) (m)). 4L
~V
Property Owner Property Location -
Govt. Lot 1/4 1/4 S,,,/ , T_ N R E ( )
Property Owners Ma;ft Address Lot # Block # Subd. Name or CSM#
A Z7
City tate Zip Code Phone Number ❑ City ❑ Village Town Nearest Road
n ` uJ% ~YDI ( )
New Construction Us Residential / Number of bedrooms Code derived design flow rate GPD
❑ Replacement / Public or commercial - Describe:
Parent material x, Flood Plain elevation if applicable
General comments
and recommendations:
~ r~rs'~~ lP~✓C Fa / l 9~~ huue aCl2~ cht~-on a~
A. /Ie,,n,,d is /1d u
Ik~~d /olv
IT Boring # Boring
Pit Ground surface elev. V, 2. Depth to limiting factor in.
Soil Application Rate
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
Al"- 122 -0
Z- 12-Z L , yI K /v&-
Boring # Boring
J it Ground surface elev. CI~ft. Depth to limiting factor- in.
Soil Application Rate
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
/Z 3 t ~7~d Z5
2
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 1 'Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) ignature CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 715-246-4516
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Property Owner _ Parcel ID # _ Page of
Boring
Boring
t Oit Ground surface elev. _ ft. Depth to limiting factor 0 in.
Soil Application Rate
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
M ~_3
❑ Boring # ❑ Boring
❑ 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 Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Boring
F-1 Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit
Soil lication Rate
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
Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30 < 150 mg/l_ ' Effluent #2 = BODS < 30 mg/l_ and TSS < 30 mg/L
The Department of Commerce is an equal 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 608-264-8777.
SB"330 (8.6/00)
Property Owner _ Parcel ID # Page of 3
Boring # Boring
J it Ground surface elev. -ft. Depth to limiting factor in. E*Eftf#1 lication Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#2
M, 3Y
2 1,~ s m ,
3 28x 6 6 s l-
14
F-7 -T
❑ Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil ~Rplication Rate
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
❑ Boring # ❑ Boring
❑ 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 Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2
Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30 < 150 mgA- ` Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L
The Department of Commerce is an equal 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 608-264-8777.
SBD-8330 (8.6100)
Soil Test Plot Pla 33
Project Name Bryan Schaefer Sh4' Bird
Address 1336 140th St.
New Richmond Wi 54017 STM #226900
Lot 10 Subdivision Stone Run Estates Date 12/1/04
NE 1/4 SE 1/4S 25 T 30 N/R18 W Township Richmond
Boring 0 Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of 1/2" pipe
System Elevation 97.0 *HRPSame as Benchmark
Alternate Benchmark Top of survey iron C 997
418' Property Line
Scale is 1" = 40'
unless otherwise
noted
06'
3% Slope 96
- B-2
65' 60'
40'
97'
90'
I B-1
I
* M.
.B.M. 209' Property Line 70'
t3M
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