HomeMy WebLinkAbout034-1025-20-000 (2)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM county St, Croix
Safety and Budding Dvis on Sanitary Permit No:
INSPECTION REPORT SAN
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No
Personal information you provide may be used for secondary purposes (Privacy Law, S.15.04 OWN)
Permit Holder's Name City Village Township Parcel Tax No
St. Croix County TOWN OF SPRINGFIELD 034-1025- -000
CST BM Elev: Insp. BM Elev. BM Description. Section/Town/Range/Map No
% 11.29.15.17 il~ TANK INFORMATION ELEVATION I
TYPE MANUFACTURER e t CAPACITY STATION BS HI FS ELEV.
r J
Septic Benchmark 16 F rL !a~ • a Z400 Iq v
O!~ O F J v
~2 I~,LP 2
Dosing AIt BM
r 4_3 v7 J
l '.0
ny Bldg. Sewer
.1
Holding ~J ~h+ St/Ht Inlet j6~f Osry 675.
. Z 3
TANK SETBACK INFORMATION SUHt Outlet
TANK TOL q WELL BLDG. Vent to it intake ROAD Dt Inlet
Septic s 1 '7f tJ gog -7 #-S Dt Bottom l / L
/ / Ip j e
Dosing A* / Z. 'q& u~ Header/Man 4
Aeration Dist. Pipe
Holding Bot. System
Final Grade
PUMP/SIPHON INFORMATION
Manufacturer Demand St Cover
1rd GPM (T✓'
Model Number
TDH Lift Fricti~ Lps System Head_ TDH ~ Ft
r y . 5
Forcemain Lengt~ Dia / Dist to Well SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length No Of Trenches PIT DIMENSIONS No Of Pits Inside Dia Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO ` BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System
UNIT Model Number
A
DISTRIBUTION SYSTEM
Heatler/Manifold Distribution Vent to Air Intake
Pipe(s)
Length Dia Length _ Dia cing
SOIL COVER x Pressure Systems only__. xx r At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
BedlTrench Center I Bea/Trench Edges Topsoil Yes No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: -71211)7 Inspection #2: /r
Location: 1049 RUSTIC RD13
~1 40 +Q.L.- A.r A~J
/ r I i ` 6
1.) Alt BM Description = /1' L
2-) Bldg sewer length = G+C~ ,~f ur ltr yam,, 61G
- amount of cover = 1 ~Kg~ JJJ
C
Plan revis Required? Yes ! ,
Use otheriside for additional information No 7 ZT ~ 3 7
Date In Actor's ignatur Cent No.
SBD-6710 (R.3/97)
Y
GOULDS PUMPS Submersible
Effluent Pump
t
PE
U'~LUENT pump
SPECIFICATIONS MOTOR FEATURES
Pump - General: General: ■ Corrosion resistant
• Discharge: 1112" NPT • Single phase construction.
• Temperature: 104°F (400Q • 60 Hertz m Cast iron body.
maximum, continuous when • 115 volts ■ Thermoplastic impeller and
fully submerged. • Built-in thermal overload pro- cover.
• Sol s handi g '14° tection with automatic reset. ■ Upper sleeve and lower
maximum sphere. • Class B insulation. heavy duty ball bearing
• Automatic models include a • Oil-filled design. construction.
APPUCATIONS float switch. • High strength carbon steel ■ Motor is permanently
• Manual models available. shaft. lubricated for extended
ffoollowllowin n designed for the • Pumping range: see PE31 Motor: service life.
g uses: performance chart or curve. • .33 HP, 3000 RPM ■ Powered for continuous
• Mound Systems operation.
• Effluent/Dosing Systems PE31 Pump: • 12.0 Maximum amps ratings within the
• Low Pressure Pipe Systems • Maximum capacity: 50 GPM • Shaded pole design • Basement Draining • Maximum head: 25` TDH PE41 Motor m All wod* limits of the motor.
~ disconnect power
• Heavy Duty Sump/ PE41 Pump: • .40 HP, 3400 RPM
standard d length,
Dewatering • Maximum capacity: 60 GPM • 7.5 Maximum amps cord, heavy d20' uty 16(3 SJTW with
• 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 ■ Mechanical seal is carbon,
METERS FEET
4 ceramic, BUNA and stainless
0
- - -i - : t'-: - - MODELS: PE31. PE41. PE51 steel.
' - - - - _
H F. _40 50 ■ Stainless Steel fasteners. - -
a
35 = - -4-- ---i- - - - - - -
10
f•--------- - - x + 2 GPM - - -
AGENCY LISTINGS
I FT
44,
T
O - -i i - = - - 4--
2 5
C~p
< 20 T US
Tested to UL 8 and
1
" t
_ -
CSA 22-2 108 Standards
By cana&an 5>aodanis As9ona6ol+
-
Q 15 }--q-- ri ~ ~ ~ ' Fife #i1138549
O --;--:-;---r ; i i --rte--- - -t-}-'- - , - - -i---;-- --r-
rLk- - _ - - - - * -
- Pmips is 150 9001 Regae[ed.
+
-4-4-
4-1- - -3 - r - - - rat
5 i ;
7 '
0 0, A
10 - 20T 30 401 50 601 70 GPM 80
0 5 10 15 m3lh Goulds Pumps
CAPACITY
0 2002 Goulds Pumps
=u - ITT Industries
/ Coun
Safety and Buildings Division
201 W. Washington Ave., P.O. Box 7162 Seniury Permit Number (to be filled in by Co,)
► \t= M=' / i✓ ' ` Madison, Wl 53707-7162
~a Qa 3 )Z1
ST c?Olx CouN P~E
State Transaction Number
anituy Permit Application 11A
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 atate-owned POWTS are submitted to Project Address (if difrcrent than mailing address)
/~yl n
the Department of Safety and Professional Sarvies. Personal information you provide may be uacd or secondary
ses in accordanee with the Privacy Law, t. 15.04(l m Stats. / f~
1. A llcatien Information - Please Print All Information
Property Owner's Name Parcel
Property Owner's Mailing Address Properly Location
_ c trrh ; ° Ck~~ Govt. Let
1161
City, State 7.ip CS de Phone Numbbe~r / y. 5 i J 'f/.,, SSffiCtion
✓ 46 / k` 7/! "J S4' T 29-N, R J ✓ lE ore
~LI C~~LTY1 (/L1
1I. 'type of Building (check all that apply) of 0
Subdivision Name
❑ 1 of 1 Family Dwelling - Number of Bedrooms
'J 131ockK -416
ubliciCommercial - Describe Use ► xrt`r+i erL~ ❑ City of
CSM Number ❑ village of
C1 State Owned - Dcscxibe Use P,~ .
:own of '
a IG I CL CJZ ✓u e
111. Type of permiti (Cheek only one : on line A. C plete line B if applicable) X
A' ❑ New System ❑ Replacement System Treatment/llolding T lacemant Only Il Other Modification to Existing System (explain)
I c,, x-12- I el CP, ,n~ e
zIuel
List Previous Permit Number and bat
B. C3 Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ ermit Transfer to New
Before Fxpiration Owner 7 (lj Z~ 1
IV, T of [ OWTB S atem/Com onent/Aevice: Check all that a Iv
[J Non-Pressurized In-Ground 0 Pressurized In-Ground ❑ At-Grade ❑ Mound ? 24 in. of suitable soil ound < 24 in. of suitable soil
❑ •Holding'rartk ❑ Other Dispersal Comlwnent (explain) Q Pretleatment Devicc (explain)
V. Di ersalCl'reatment Area Information;
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Rcquired (so Dispersal Area Proposed (sf) System Elevation
VI. Tank Info Capacity in total a of Manufacturer
Gallons t3a11ons SJniu r-t
New Turks > xisuog Ttvtks
Septic or Holding Teak i iz c ( I ~J, t✓~j2ti~
q60 1 C ~~nt~ ~f
Dosing Chamber 14 L'o
VQ. Respoasibill* Statement- 1, the undenl ed, acs me res oaslblll for los Rattan of the POWTS shown on the atuehed lane.
piumber's Nature (Print) Plum Paw- ivtP/IvIPRS Number Business Phone Number
PAbI.MLJ ~~I State, Code)
3
VIll. Coup /De rtment Use Onl
Permit Fee Date sued Issuin cat Signature
Proved 11 Ppr S 46.66 / Z
❑ er Given Reason for Denial
IX. ConditI. easogs for Aisapproval -
1. }i iptin tark, erfluf ni ift- tint
aisve!:. u cell must all I)e 5?i':fC'.~g !=+Gii1~o..~
as per ,•nar.3gernen! plan pro hued by plumne.. e
tit uu rK1 nt, ir.e i
2. At tte4b?tCk ree,4;Imnems Mw
as per atpFWbls omk-- / rdinanrol..
Attach to eomglete piers for the system and submit to the County only on paper not ku than a 1R:11 inches in AM
SBD-6396 (IL 11/11)
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STC - 104 '
AS BUILT SANITARY SYSTEM /REPORT r
OWNER
6E
ADDRESS 9 2 u cc" SUBDIVISION / CSM#
SECTION LOT # -
T- N-R W, Town of
ST. CROIX COUNTY, WISCONSIN
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
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INDICATE NORTH ARROW
Provide setback and elevation information on reverse of this
Provide 2 dimensions to center of septic tank manhole form.
cover.
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