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HomeMy WebLinkAbout042-1020-90-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 600266 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] Permit Holder's Name: City Village Township Parcel Tax No: CHRIS & KRISTINE RINKEL TOWN OF WARREN 042-1020-90-000 CST BM Elev: Insp. BM Elev: BM Desc ip> i n: ~I~ A~ ~ Section/Town/Range/Map No: 08.29 E u✓ ' 08.29.18.118 TANK INFORMATION , LE ATI N DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS t ELEV. Septic `DL i ~ Benchmark LO ~O t fc t9v Alt. B t` .a3 Aeration Bldg. Sewer q& Holding St/Ht Inlet St/Ht Outle~_ TANK SETBACK INFORMATION 11K, TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Inl ' Septic >lbo Mop y t Dt Bottom ■ 2 pe~~ a 11 J o Dosing Header/Man. q (1 Aeration Dist. Pipe l 7 Holding Bot. System T, Final Grade q PUMP/SIPHON INFORMATION • 3 ,6 t a St Cove Manufacturer Demand GPM Model Number m r 43 d •(,~V TDH Lift Frictio s System Heady TM. Ft C~ J Forcemain Length q ~I Dia. I Dist. to well f SOIL ABSORPTION SYSTEM BED/TRENCH Width Length t No. Of Trenches PIT DIIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3s a l SETBACK SYSTEM TO P/L BLDG WELL LA E/STREAM LEACHING Manufactu r INFORMATION CHAMBER OR Type Of System:' c^~ ~t _ t UNIT Model Nu / AiAt~_ DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake ~-y Length / Dia Li Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of Seeded/Sodded ° xx Mulched Bed/Trench Center Bed/Trench Edges _ Topsoil T Yes ~ No ~ Yes E No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1079 100TH ST Ft, 11W Cc~t,~/ C h,at s~G I.ecX-$ lei 1.) Alt BM Description = 2.) Bldg sewer length = Lib - amount of cover = >L,'a,l~ Plan revision Required? ❑ Yes ❑ No V01 Use other side for additional information. Date Insepctor4Signa e C ert. No. SBD-6710 (R.3/97) 1 to .~t t-' 44 ~:A fv -r?c 1.7 3 ~ 4- E ~ 5'ZKOR7WGT2T9Y aunty St Croix ~ 4 _ ; ©S 201 W. Washington Ave., P.O. box r ~ vz Sanitary Permit Number (to be filled in by Co.) PSf Madison, WI 53707-7162 ' (pLUZCv~P t'ipplication State Transactio umber 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 roject Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary /it 7 / ses in accordance with the Privacy Law, s. 15.04(l m , V 1. Application Information- lea Print All Info do XXXX 100th street, Robert WI Property Owner's Name jr rotron #X..- Parcel # Chris Rinkel -042 1020 90 000 Property Owner's Mailing Address Property Location x l i i , 1700 Deerhaven Drive Govt. Lot City, State Zip Code Phone Number NW NW Section 8 Woodbury MN 55129 T 29 N: R 1~ircleoone) II. Type of Building (check all that apply) Lot # (2 1 or 2 Family Dwelling -Number of Bedrooms Subdivision Name Qg Block # T ❑ Public/Commercial - Describe Use ❑ City of r~ ❑ State Owned -Describe Use /plot CSM Number ❑ Village of WXlZA'ff`') Ge ~ n ❑ Town of III. Type of Permit: (Chec only one a on line A. Complete line B if applicable) ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) A. ew System El Replacement System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) ❑ Non-Pressurized In-Ground Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersa~C m-pponent explain) ❑ Pretreatment Device (explain) V. Dis ersal/Trea ' ent Area Information: Design Flow (gpd) Design Soil Application Ra f) Dispersal Area Required f) Dispersal Area Propo (sf) System Elevation VI. Tank Info Capacity in Total # of Manufacturer L Gallons Gallons Units a v Nah. ew Turks Existing Tanks o aU v," ~ wU' a Septic or Holding Tack f Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signs MP/MPRS Number Business Phone Number Countryside Plumbing & Heating ~va 664713 715-246-2660 Plumber's Address (Street, City, State, Zip Code) 321 Wisconsin Drive, New Richmond WI 54017 VIII. un /De artment Use Only Approved rsapprov Permit Fee $ Date Qsued Issuing nt Signature oven Reason for Denial Gfl • '100000011~~ IX. Condit i"b p easons for Disapproval .3~ `a ((U 1 Se h ark, t;tfltx:nf iitte n i dispe cell must all be s hies -ec T as per ;iar3gemen*. plan p,c oiaeri by plumber. 2. AR setback rect„iw tem moist tie mamtor"E,j as per appliombl coollo ! : rdi a rirmt. Attach to complete plans for the system and submit to the County only on paper not less than S in z 11 inches in sae SBD-6398 (R 11/11) \ N. w m 00 1-4 r Q Q . - m 00 N LL Z Cn ~ ~ Y O N Z w w ro f- 0- LD LL. N J > W O a_ O W co l w J w E- J i C O;~ ' J W w S U d a LL W m g'1 i--I / N S U W In N z dD i of CL z Z U E- O u') / LL Q , / fB w = LL H w Ln Y p w 1- = LL m U U z m o Q O ) m w N rn LLJ 0 CL CL co Y z c~ j O a N LL w 0 1 / L) z I / <Q z m O co z I I j F7 Q W - I / I / Z O o w f-- o < C? 00 O w o CY) S z o r-4 r1i Q o ~O I i j I / 00 p I I / w S C) Qh~ I I Z) Lz z > o w p Z I j w w I I U F- O w j j I I w z j j I w V) I j 1 00 o I I j I C) LU LL n u j 00 I j LL c-i N W O in CY) 0) 1-1 Ln O Y Y Y c~ w o w OI I COP- Q Q aN m O cl ! 0) N LL C7 C7 C9 0- = . 0) I I 0) I S S O z z z o1 ~ ~ I of I U U W w w w a cI o o . o' U w w Q O O O U o f o! o f o! Vn co in co m~ co m L) j v I v j v l 1 i CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Chris Rinkel Owner's Name: Chris Rinkel Owner's Address: 1700 Deerhaven Driv Woodbury MN 55129 Legal Description: NW 1/4, NW 1/4, sec 8 T29N, R18W Township: Warren County: St Croix Subdivision Name: Lot Number: Parcel ID Number: 042-1020-90-000 Pagel Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: Countryside Plumbing License Number: 664713 Date: 10/02/2017 Phone Number (715) 246-2660 ~ Signature ;~___J Designed pursuant to the In-Ground oil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01101). Page 1 00 O V) _ In > J - ri > Q _ Lll O 00 LL V) Z O Z w co F- d , N l O Q U- E / E I O cdc W / O W J W C J / X O m W W = ~ Q w / ~ ~ ° ui co a) Z Z U O a N / w O 0-O~ ' (6 < LO W u- F-- W X / Y O w w m U z ° N O O U co / - ) w W Vl Ql cr -j O n. N Oi a o O O O O / N CC (D CL Y I O ' z a O i i N LL (D I i . W U Z O O I / 1 / co z 22 Q W - I / z O ° w j o 9= x O w O H I I Z p1 a ° ~ ~O I I j I / < 00 O I I I / 44; w = o Q~ I I z ~ ° ° I I I I o z I 1 O a J \ 1 I I U O w H I I -J U Q V) I I w a z j j u I j I ° 0) o uj I I j j M u n I I U- N u.; o p 00 . I j O Y Y Y 0) 0) U-i Ol In OI Q Q Q r-i N m O ° I c l to rn. N I U- (7 (7 (7 0 C3) I -1 0) O Z Z Z OC OI 3 I I pl 7 Oc I O I I c I u w w Q 0 0 0 a U~ O I O I U! o V) co co m co m co u i u I U 1 I h9-s furl Nis %ziepo-/ t(. (O~Y NVId 1503NV1S 3Sf10H 133&S H1001 UN3d021d 33ANiil 6 z~ ri w SMOH no i s no NO12i213O ` i miuw tmrn+® 4 W w w I M r, mp, a~. 0 : ZfOSOON " T Y u rY~ Z i `u a SV3.LSAS'llYNiUOOJ A,LNf10J x101[J . U° t~ t d A `o ° E i ..I W15 FIND. M (I:UVl21<l:[311 -ti i ti Y W O o £INV SJNINVI(1 I is WWI r ~ ~ @@ W n r.. o~ 3 gggg.. n Sh~o1 z n 3 3- 4«9 -F u 7i` a ZO yZrZwy I O K V O P W O : YY ° • ~ W 8 n m W l~~ =O yy K S z $ 6 N'~ In0 N Q^ N ° SOIL ABSORPTION SYSTEM DETAIL/ GRAVELLESS LEACHING UNIT Pagel of 1 Project Name: CHRIS RINKEL 2 No. of Cells 9 Per Cell 3 ft Cell Width 18 Total No of 9 90 ft Cell Length 50 sq ft EISA Per Cell 3 ft Cell Spacing 450 sq ft Total EISA Manufacturer Model Laying Length EISA Rating Infiltrator EZ1203H-5ft 5.0' 25.0 EZ1203H-10ft 10.0' 50.0 Gravelless Leaching Unit Manufacturer: INFILTRATOR Gravelless Leaching Unit Model: EZ1203H-10FT. Typical Cross Section Finished Grade 99 ft Observation Pipe with approved cap or vent ■ Soil Backfill in Geotextile Fabric 98.5 ft Infiltrative Surface 12 in Limiting Factor i 36 in p~ Slotted and Anchored Vent/ Observation Pipe with Cap Plumber/Designer Signature: License 225410 Date: NOV 3 2017 Inc. 'L-525 E f ue t Filter "V l`, aa of i'olykjk Irtc. Pt.-525 Filter The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the Polylok PL-525 has an automatic shut-off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent won't leave the tank. lit attires: 1/16" Filtration Slots • Rated for 10,000 GPD (gallons per day). Alarm switch (10,000 GPD (Optional) 525 linear feet of 1/16" filtration. ? Accepts 1" PVC • Accepts 4" and 6" SCHD 40 pipe. Extension Handle • Built in gas deflector. • Automatic shut-off ball when filter is removed. • Alarm accessibility. Rated for 10,000 GPD • Accepts PVC extension handle. PI.-523 Installation- Ideal for residential and commercial waste flows up to X25 Linear Ft. of 1/16" 10,000 gallons per day (GPD). Filtration Slots 1. Locate the outlet of the septic tank. 2. Remove the tank cover and pump tank if necessary. y' Accepts 4" & 6' 3. Glue the filter housing to the 4" or 6" outlet pipe. If SCHD 40 pipe the filter is not centered under the access opening use a Polylok Extend & Lok or piece of pipe to center filter. 4. Insert the PL-525 filter into its housing. Certified to 5. Replace and secure the septic tank cover. NSF/ANSI standard 46 PL-325 Maintenance: P,. The PL-525 Effluent Filters will operate efficiently for several years under normal conditions before requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped, or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter Gas Deflector needs servicing. Servicing should be done by a certified septic tank pumper or installer. Automatic 41 Shut-Off Ball 1. Locate the outlet of the septic tank. 2. Remove tank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. 4. Pull PL-525 cartridge out of the housing. j-7 7, 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank. 6. Insert the filter cartridge back into the housing making tally sure the filter is properly aligned and completely inserted. Polylokylok, Zabel Sabel l & & Best laten filt=ters Alarm accept Extend Easily a; installs 7. Replace and secure septic tank cover. the SmartFilter® switch and alarm. into existing tanks. Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com an-ooe/WZIdx :31Id 9912-9z2-008 0 \ :bnod-lsod .31VO 00/00/00 :31VO OSL4S IM 'N008 N301VW Ol AMH Sn 9LLcm VOa 1100 V3S31M iynNb'W 0Ild3S w a~ = :?JnOd-3LId 0-,L=.4 l :31VOSI dOM WV 80 31300 W4-008/00Z LdIM U) 0 J LJ it N_ 0 H Q Q J Z Q O U m0 w ° J D Q~ w 0 V) CL a. W d o v° W (L~ o F. N Q o U Wp U) J u w iD l7 m F z ~ o o F~ o F- a ir o m a Z in o z O a C9 m o;izQ zz L w~ H 0 w U M F- -j z = m z u- o a F- W pJ OQ QJU JJ N U W J O Q d ce O Q O U 0_ ND mN JWw do z WZ Z~ N ¢ a O o o= J l w p ~n co 1* cn O Y D < a co06 Wal QWN 14, C14 =O V) = Z 00 LL = O m p d ° V) H m W r) CV Q c O_ 00 < st ° = O VI N M N pp p F (n (n F I F Z Y O w M= ro e W W°° W Q U wW Z~ MO O U 0 Z O O _ CO W0-OaizWmU~~ FfnN F- ~ =N~ WN Fa-~ LLJ N CA ..O WOF~ 30~ OQY OOw Q w mPccn o0 oV _ M: M: C) O OF ~Y °a000F+~W,W~{OQ~Ca.~Q 0 U U <Wio ~m mo Z3m UmSJ ~m J3 F F 0 Z U W~.. OFW Q J J J O Q Z >Z j p W Z Z -i H OJ U F U V7 I a I 0 U z z „6F ~ ~r > ° I m D o_ l W C z II II III I° II it ~ k iI II I I of II II I N II r I~ > I I I > .II J~ I~ ~ I I I _ o II ° J II uF- 92 I W JI w Of I~ I f W II I J°° IP W ,9 Q I uv~ h u£ o I I ~ r= ~ II I I I o ~ r 71 w M w z z ao3a Ir Q „96 sv .2g rn Y Z Q F- POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner CHRIS RINKEL Septic Tank Capacity 1200 gal ❑ NA Permit I Septic Tank Manufacturer WIESER ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer POLY LOCK ❑ NA Number of Bedrooms 4 ❑ NA Effluent Filter Model 525 ❑ NA Number of Public Facility Units EkNA Pump Tank Capacity 800 gal ❑ NA Estimated flow (average) 450 gal/day Pump Tank Manufacturer WIESER ❑ NA Design flow (peak), (Estimated x 1.5) 600 gal/day Pump Manufacturer GOULDS ❑ NA Soil Application Rate .7 gal/day/ftz Pump Model EP04 ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease FOG 530 m9/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical 220 mgL ❑ NA ❑ Mechanical Aeration ❑ Wetland mg/Oxygen Demand (BOD5} - Total Suspended Solids (TSS) 1 50 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODS) <_30 mg/L E)(In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 510a cfu/100m1 ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y8 in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 ❑ year(s)month(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA ry' ❑ ❑ year(s) month(s) (Maximum 3 years) ❑ NA Inspect dispersal cell(s) At least once eve Clean effluent filter At least once eve ❑ month(s) ❑ NA n'' I YEAR ❑ year(s) ► ❑ NA THREE ❑ ❑ m year(s) Inspect pump, pump controls & alarm At least once every: Flush laterals and pressure test At least once every: ❑ month(s) NA ❑ year(s) Other: At least once every: [3 month(s) NA ❑ year(s) 9C Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS inspector, POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y,) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page Z of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) 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 POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is property and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. T a o Ong ank aluat be ' e ai e ?R D44113 TfSn 9::D2- A/ CarvST-R uC7'1 r, f-j ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR 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 INSTALLER POWTS MAINTAINER Name ~i / Name Phone 71.)`= 2-Y-41, - Z'mod Phone xe - Z<<~ SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name f f G LE Name CU Phone 7/f yLf - /o Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ' .lam i t M t o Mailin Address t Property Address ~ , ~ ~(V ification required from Planning & Zoning 13epartrnent for new constzuction.) - City/State Parcel Identification Number t- 2-. - 'V`- Z° C ei LEGAL DESCRIPTION Property Location - , W %a , sec. ' , T ` N R W, Town of Subdivision Lot # Certified Survey Map # , Volume Page # Warranty Deed lfc~ Volume , Page .4 m 3 Spec house yes Cno Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER. CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification foam, signed by the owner and by a toaster plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank, is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three ear expiration date. Uwe certify that all statements on ' form are taste to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a wa my deed recorded in Register of Deeds Office. Number of bedrooms w SIGNATURE OF APPLIC NT(S) -DATI✓ ***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, 08/05) Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer wieser Pump Manufacturer oulds Tank Model Number 1200/800 Pum Model Number epo4 Total Tank Capacity 2,000.00 Alarm Manufacturer si rombus Max. Bury Depth 8.00 Alarm Model Number pedistal Switch Type non mercury Filter Manufacturer 1 lock Total Dynamic Head (TDH) - Feet Filter Model Number 525 Elevation Head 5.00 Distal Pressure 0.00 Network Loss .00 Minimum Pump Performance Required Force Main Loss .00 Zf> GPM Ft TDH Total .00 Outlet Manhole Min 4" Above Grade With Locking Device. Inlet Manhole Manhole Min, 4" Above Grade < 6" Below Grade Sealed Watertight Securely Mounted With Locking Device Weather-proof Junction Box _ F' hed Grade - ~ Depth of Cover Vent Min. 12" Above Grade Disconnect Ft With Vent Cap Means Outlet Outlet Filter Inlet Inlet Baffle A Switch Settings and Reserve Capacity WS Tank Volume = GPI Weep Dimension Inches Volume Gal. B Hole < < (reserve) A 26 578.24 (alarm) B 2 44.48 Off Elevation C (dose) C 5 111.20 Ft t Bottom (dead) D 6 133.44 F< D Elevation Total 39 867.36 < Ft <<<<<<<< ~<~<~e*<>a>s><~<~<>s><~<><><><ss><~<>s>e~<~<y,><~<~<~<'<te><y<~e><>s~<><><~<~<><+e~<~<~c~e~sy<><~<~.><~<~<~<><>s~<~< GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and Ping 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" Sch. 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 LJ Page of NGOULDS PUMPS Submersible Effluent Pump MODEL 3871 5 EP04 & EP05 Series APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermo- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for plastic enclosed design for heavy duty ball bearing con- following uses: lubrication and efficient improved performance. struction. Effluent systems heat transfer. m Casing and ruse: Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms superior strength and corrosion manual operation. Automatic Canadian Standards • Heavy duty sump resistance. • Water transfer models include Mechanical S e association Float Switch assembled and ■ Motor Housing: Cast iron for us File # LR38549 • Dewatering preset at the factory. efficient heat transfer, strength, and durability. Goulds Pumps is ISO 9001 Registered. SPECIFICATIONS FEATURES ■ Motor Cover: Thermoplastic • Solids handling capability: 0 EP04 Impeller: Thermo- cover with integral handle and 3/4' maximum. plastic semi-open design with float switch attachment points. • Capacities: up to 60 GPM, pump out vanes for mechanical E Power Cable: Severe duty • Total heads: up to 31 feet. rated oil and water resistant. • Discharge size: 11/2" NPT. seal protection. • Mechanical seal: carbon- rota ry/ ce ra m i c-stati o nary, BUNA-N elastomers. • Temperature: METERS O FEET . _ , 1041 F (400 C) continuous 1401 F (601 C) intermittent. • Fasteners: 300 series 9- 30! 5 GPM - stainless steel. • Capable of running 8 ~-2.5 Fr dry without damage to 2s' - components. 7 °a w 6 20 Motor: • EP04 Single phase: 0.4 HP Z s 115 or 230 V, 60 Hz, 1550 0 s -f-- ! - RPM, built in overload with - 4 - - - - EPOS automatic reset. o • EP05 Single phase: 0.5 HP 3 10~ - 115 V or 230V, 60 Hz, 1550 EP04 RPM, built in overload with 2 automatic reset. s 1 • Power cord: 10 foot 1 i standard length, 16/3 - - SJTW with three prong ° °0 10 30 40 50 GPM grounding plug. Optional 20 foot length, 16/3 SJTW with o 2 4 6 8 10 12 m3/h three prong grounding plug (standard on EP05). CAPACITY Goulds Pumps © 2005 ITT Water Technology, Inc. ITT Industries Effective January, 2005 63971 ST -T3G -7 -r~ H l -A T Wis. Dept. of Safety and Pro essional Services 5GT17176S71 X4 EPORT Page 1 of 3 Division of Salo ~ 1~1irc ' ~yL~~ in accordance with SPS 385, Wis. Adm. code COUt4Ty .~wr°~ County St Croix Attach co j~, W>A~ , than 8 1/2 x 11 inches in size. Plan must include, bcal and horizontal reference point (BM), direction and Parcel I. 12 0 1020 90 000 percefy~ scale m dimensions, north arrow, and location and distance to nearest road. Please print all information. Revi d by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). J~ $ f Property Owner Property Location Q_ Chris Rinkel Govt. Lot NW 1/4 NW1/4 8 T 29N R 18E (or) W® Property Owner's Mailing Address Lot # Block # Subd. Na or CSM# 1700 Deerhaven Drive City State Zip Code Phone Number LJC1ty Village E]rown Nearest Road Woodbury MN 55129 ( ) New Construction Used Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD © Replacement Public or commercial - Describe: Parent material SAND Flood Plain elevation if applicable ft. General comments SYSTEM NOT TO BE ANY DEEPER THAN 18" BELOW GRADE. and recommendations: _ ✓ ] Boring # 0 Boring ❑ El Pit Ground surface elev. 99.6 ft Depth to limiting factor 54 in. Soil Applicati Rate Horizon Depth Dominant Color Redox Description Texture Structure sistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *E01 * ff#2 A 0-12 10 YR 3/3 S OCSG ML G IF .7 1.6 B 12-27 10YR3/4 S OCSG ML G IF .7 1.6 C 27-54 10YR5/3 S OCSG ML G .7 1.6 C1 54-72 2.5YR3/6 3 OTO 6 RANGE AND DARK RED S OCSG MFI AW .7 1.6 0-1 ~ 01 2 Boring # 11 Boring 0 54 ❑ S pit Ground surface elev. ft Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure sistence Boundary Roots GPD/ft Y in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ff#1 102 A 0-18 10YR3/4 S OCSG ML G IF .7 1.6 B 18-27 l0Y/R3/6 S OCSG ML G IF .7 1.6 C 27-54 l0Y/R6/4 - S OCSG ML G .7 1.6 C1 54-58 2.5YR3/4 2.5YR2.5/1 MANY DARK S OVCSG MFI AW 7 1.6 i nT nDQ AXM Ur A17FQ 11V Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 150 mg1L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number PAUL R KOEHLER 225410 Address Date Evaluation Conducted Telephone Number 321 WISCONSIN DRIVE 10/24/2017 715-246-2660 SBD-8330 (R11/11) I Property Owner CHRIS RINKEL Parcel ID # 012-042-1020-90-000 Page 2 of 3 ~ F1 Boring # 1 Boring 100 72+ ' Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 02 A 0-18 10YR3/4 S OCSG ML G IF .7 1.6 B 18-25 IOYR316 --------_W____ S OCSG ML G IF .7 1.6 C 25-64 10YR5/3 S OCSG ML G .7 1.6 El Boring # Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure nsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 *02 ❑ Boring # Boring ® Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Z;onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 102 ' Effluent #1 = BOD S > 30 < 220 mg& and TSS >30 < 150 mg/L ' Effluent #2 = BOD e < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. 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