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018-1048-50-100 (2)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 605060 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: Kelly & Deborah Carlson TOWN OF HAMMOND 018-1048-50-100 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: IM - -1 04 22.29.17.339A-10 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark fix; ~ / • 4,z, 9q.3 9 z . -7 Dosing Alt. BM 75 Qt-7. G 17 Bldg. Sewer ✓ Holding St/Ht Inlet I St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt inlet v Septic Dt Bottom / y• y y. ZS o. Dosing / i Z- Header/Man. ` 7 " G:~13 0 Aeration Dist. Pipe S i r72 • gr Holding Bot. System 7. 92.a Final Grade PUMP/SIPHON INFORMATION Z,7 9G . (c Manufacturer ~y Demand St Cover GPM )r I 7 f f".5 Model Number .Ue ao G. 33 9 Z . 7 TDH I- ,Friction Loss System HeQd TDH F 6-71 a ~r S J~$ to 7. Zei- d ktZAo% r Forcemain Length i Dia. Dist. to Well /66/ 496 SOIL ABSORPTIO SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 `9T Z~~1 SETBACK SYSTEM TO VV P/L BLD`G` WELL +VV LAKE/STREAM LEACHING Manufacturey INFORMATION CHAMBER OR G~~f Type Of System: r UNIT Model Number: Go,~•re~~ e / S 1 r DISTRIBUTION SYSTEM Header/Manifol Distribution x Hole Size x Hole Spacing Ven Air Intake r Pipe(s) Length IF Dia Length Dia _ Spacing~~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoils es ❑ No Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection # Location: 852 190TH ST q• O 1.) Alt BM Description = 2.) Bldg sewer length = "41 's J amount of cover KI 643 41-6 oW e16IL r I Plan revision Required? n Yes No Use other side for additional information. Date Ins 4r, re Cert. No. SBD-671 0 (R.3/97) I GOULDS PULPS Submersible Effluent Pump PE E fiFLU'41 PUMP SPECIFICATIONS MOTOR FEATURES Pump - General: General: ■ Corrosion resistant • Discharge: 1'!° NPT • Single phase construction. • Temperature- 104°F (4000 ' 60 Hertz a Cast iron body. _ • 111; unite m ThprmnnEae r imnPilpr and I11dU111u111, LUnU11UUtU WIIL11 - "'--'°-r'~ •r fully submerged. • Built-in thermal overload pro- cover. • Solis handling: 1h" tection with automatic reset, m Upper sleeve and lower maximum sphere. • Class B insulation. heavy duty ball bearing • Automatic models include a • Oil-filled design. construction. APPLICATIONS float switch. • High strength carbon steel m Motor is permanently Specially designed for the • Manual models available. shalt- lubricated for extended following uses: • Pumping range: see PE31 Motor: ■ Pservice life. owered for continuous • Mound Systems performance chart or curve. • 33 HP, 3000 RPM ration • Effluent/Dosing Systems PE31 Pump: • 12.0 Maximum amps ■ All ra ti are within the • tow Pressure Pipe Systems • Maximum capacity-. 50 GPM • Shaded pole design • Basement Draining • Maximum head: 25` TDH PE41 Motor working limits of the motor. ~ disc~neQ power • Heavy Duty Sump/ PE41 Pump: • .40 HP, 3400 RPM 2Q, Dewatering • Maximum capacity: 60 GPM • 7.5 Maximum amps cord, d i 6!3 standard length with heavy SJTW • Maximum head: 29` TDH • PSC design NEMA 5--t5 P, 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 a Mechanical seal is carbon, METERS FEET ceramic, BUNA and stainless ao - - a- - - - - _ - = - - - - ■ Stainless steel fasteners - • __T__~.__.__.___ - _ 35 - = - - - - - r;- - - 2 GPM - - - 10- - - -t- - -i- t- AGENCY LISTINGS - - ' 4- - - 3e - - --V_ Fr °-s-- ` ° - w i 25 2 -4- - T: C~p ` I I t- - - r- Tested IO dt~ 778 and Q Z 20 - I- - - - - r L -i- CSA 2n 1V8 $tar15 p --fir-!- -i-- - ° - -~--t-_ti_ I By Canadian Staed3rds Amdafion 15 4-~ He #LR38549 Vaukis is BSI 9001 fteown& 5 0 0 T 10 20 30 40 501 60 70 GPM 80 0 5 1~0 15 r /fi Goulds Pumps CAPACITY C 2042 Goulds Pumps ITT Industries I \ D Safety and Buildings Division County C Y art U $ 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) -tom P Madison, WI 53707-7162 ~ JUN 2 Q 2018 0 Ilk State Transaction Number Con i7 uni amt ,-Pe it Appli In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this fopta] is required prior to obtaining a sanitary permit. Note: Applicatitri forms for state-owned POWT ar submittell to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be use or secondary purposes in accordance with the Privacy Law, s. 15.04 1 m , Stats. 1. Application Information - Please Print All Information J r Property Owner's Name Parcel # k_t L t) A -:5D -lei e) P operty Owner's Mailing Address Property Locationar 1-7 Govt. Lot city, state Zip Code Phone Number 5 L y, Section Z-~ (circle one H. Type of Building (check all that apply) Lot # T N; R_ E 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name Block # NA- El Public/Commercial - Describe Use p City of El State Owned - Describe Use CSM Number ❑ Village of 2 d1*5'Y; bVhA MRS w ; ;I T5 Ertl , yt ( L. ( . 39 Town of_~~l~l,°. III. Type of Permit: (Check onl a A. Complete line B if applicable) A. ❑ New System - Replacement System ❑ reatment/fiolding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. El Permit Renewal Permit Revision El Change of Plumber El Permit Transfer to New L Previous Permit Number and Date Issued ❑ ~ / %f '7 Before Expiration Owner u c.....,_ e o Component/Device: Check all that apply) Non-Pressurized In-Ground ❑ ressurized In-Ground ❑ At-Grade El Mound > 24 in. of suitable soil El Mound < 24 in. of suitable soil / l 4 q~ ❑ Holding Tank Other Dispersal Component (explain) El Pretreatment Device (explain) ~`1Cf. V. Dis ersal/Trea t Area Information: Design Flow (gpd) Design Soil Application Rate sf) Area Require J J ; ispersal Area Proposed ( ystem Elevation VI. Tank Info Capacity in Total # of r Manufacturer Gallons Gallons Units o New Tanks Existing Tanks c .2 ?t4 l00 z a. U cz Septic or Holding Tank i / i ' . Dosing Chamber ti.. VII. Responsibility Statement- L the undersigned, assume responsibility f installation of the POWTS shown on the attached plans. Plumber's Name (Print) Pl7b ' S' r MP/MPRS Number Business Phone Number 1 ~ ttl'` `a.......%♦ J . , f7(<~ - (f'.~ j 1. i' ( ? Plumber's Address (Street, City, State, Zip Code) J VII ounty/De artment Use Only q::: ved Permit Fee Date Issued Issuin t Si e roved I~ ven Reason or enial $ g~ do -7 /5 IX. CSq tt M ?J&F yaVReasons for Disapproval 1. Septic tank, effluent filter and diSl; r~ a cell must be serviced maintained i ..iagernent plan provided by plumber. ~,C;Uirements must be maintained for the system and submit to the County only on paper not less than 8 M x 11 inches in size SBD-6398 (R. 11/11) IN-GROUND SOIL ABSORPTION COMPONENT SUBMITTAL REPLACEMENT DRAIN FIELD FOR A 4 BEDROOM RESIDENCE Owner's Name Kelly & Deborah Carlson 852 190th St Hammond, WI 54015 Located in the SE '/4 of the NE '/4 of Section 22, T29N, R17W. TOWN OF HAMMOND ST CROIX COUNTY Parcel # 018-1048-50-100 Previous Permit # 374967 9-18-2000 INDEX Page 1 Index & Title Page 2 Plot Plan Page 3 Dispersal area Cross-section & Plan view Page 4-5 Manual & Management Plan Page 6 Maintenance Agreement Page 7 Existing Septic Tank Certification Enclosures Ez-flow product approval Warrenty Deed CSM Permit File Prepared By Michael Rodewald 285 County Road SS River Falls WI, 54022 715-821-6229 MPRS 931384 Design Pursuant to: IN-GROUND SOIL ABSORPTION COMPONENT MANUAL FOR POWTS (VERSION 2.0) SBD-10705-P (N.01/01; R. 10/12) ~ ~1 I r f i I r- v Jc- C ~1 J ^ Qj- l --J s- ~ aL~~ 2 1 Soil Absorgtlon System Cross Section-f- ~~it~~ lr?.: - - 4" Schedule 40 Final Grade PVC Vent Pipe With Vent Cap 7 ft Leaching] 12 12 9?16~ 0: ft System Elevatio ft 58 ft P) iio 5; FISoil Absorption System Plan View 3 ~S 3 tt { j Leaching fi, Trench 1 i, ` Vent Or Observation Pipe Chambers 4" Dia. ri N 3 Trench 2 Header C.+ i ~ G CZ j, New Gravel-less Trenches Existing Chamber Trenches Manu ac ure: Infiltrator EZ-Flow Manu ac ure: n i tra tor Sidewinders Model: EZ 1203H Model: Hi-Capacity Lay length: 10ft Lay length: G F,4,6171 EISA Rating: 50.0 EISA: JJ-ipi~ht5 Cell Width: 3ft Cell Width: 3ft DF gpd: q'i 0e DF Gpd: 1 z Soil Rate: 0, % Soil Rate: 0.7 Bundles Req: Chambers Ref}: tkSfL) 2 rows of bundles each 2 rows of chambers each C.- Page 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 properly 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 properly 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. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS 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 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 - - - i POWTS INSTALLER POWTS MAINTAINER Name Name - - Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY -Name A, , C 5e'.' fii ~ Name S Cray Phone '7 Phone iS-3~G- ~`~f3G This document was drafted in compliance with chapter Comm 83,22(2)(b)(1)(d)&(f) and 83.54(l), (2) & (3), Wisconsin Administrative Code. y . r 1 ' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner e Septic Tank Capacity U ❑ NA gal Permit # Septic Tank Manufacturer / - ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 2-4 6It ❑ NA Number of Bedrooms _ ❑ NA Effluent Filter Model A _/00 ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity 5d 0 gal ❑ NA Estimated flow (average) U gal/day Pump Tank Manufacturer SiFrit~ CQw.io ❑ NA Design flow (peak), (Estimated x 1.5) Q(() gal/day Pump Manufacturer 11 NA Soil Application Rate Q gal/day/ftz Pump Model (✓4e~ ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit RNA Fats, Oil & Grease (FOG) <-30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODS) <_220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) Atit tEir-b!455L NA Biochemical Oxygen Demand (BOD5) 530 mg/L 521n-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) <--104 cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size a in dia El 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 ever ❑ month(s) py' -3 ®,-year(s) (Maximum 3 years) El NA Pump out contents of tank(s) When combined sludge and scum equals one-third (%3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 5il-year(s) _ Clean effluent filter At least once every: ❑ month(s) L1 NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) ANA ❑ year(s) Flush laterals and pressure test At least once every` ❑ month(s) --.TJA ❑ year(s) Other: ❑ month(s) At least once every: El year(s) C] NA 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 pending 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 pending of effluent on the ground surface. The pending 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 (%3) 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 <-12 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. I POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity } El NA gal Permit Septic Tank Manufacturer ( ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer al ` ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model >JU ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity Estimated flow (average) ~'jqO gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1 .51 gal/day Pump Manufacturer ❑ NA Soil Application Rate It gal/day/ft, Pump Model ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit R-NA Fats, Oil & Grease (FOG) <30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (B0D,) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids ETSS1 <1 50 mn/I n n ~ r,f-+;,,,, n n. H.... ' E Pretreated Effluent Quaiity Monthly average i Dispersal Ceii(s) l1~ ,(gym ~ c!ZrA$[~ NAB Biochemical Oxygen Demand (BODS) S30 mg/L 52In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) { <30 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Cohform (geometric mean) 10' of u; 100ml ❑ Drip-Line ❑ Other: Miaximum Effluent Particle Size i~ 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 ever 11 month(s) y' ;year(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once ever 1:1 month(s) _ y' ij year(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: 11 month(s) ❑ NA 'year(s) Inspect pump, pump controls & alarm At least once every: El month(s) ❑ year(s) ANA Flush laterals and pressure test At least once every: ❑month(s) fs"7VA ❑ year(s) Other E, monthls) ❑ NA At least once every: ❑ vear(s) 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. Tne dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any bonding 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 (Y3) 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 1 13, 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. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM lie, Owner/Buyer `Mailing Address `9f/ t .,_fil~,¢7aalri t~= Property Address (Verification required from Planning & Zoning Department for new construction.) City/State m~.i~rasLtr _t Parcel Identification Number -5' _ 1~rG LEGAL DESCRIPTION Property Location ! y l i' Sec. , T 2~N RW, Town of Subdivision Plat: Lot # Certified Survey Map # A)'_? ~L r Jci -Z',')0'-) Volume Page # Warranty Deed # (before 2007)Volume . Page # Spec house Dyes o Lot lines identifiable [B~esE]no SYSTEM MAINTENANCE AND OWNER CERTIFICATION improper use and maintenance ofyour 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, ifneeded, 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 §SPS. 383.52( t ) and in Chapter 12 - St. Croix County Sanitary Ordinance. 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, joturoeyman plumber, restricted plumber or a licensed pumper verifying that ( I ) 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 113 full ofsludge. 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 Services and the Department ofNaturai 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 year expiration date. 1/we certify that all statements on this Porn , re true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warran deed recorded in Register of Deeds Office. Number of bedrooms SIGNATURE OF 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 front the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 0$/12) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT ' FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) v 52- /-?a 5 t- located at: 6C 1/4, AC~ '/4, Section Z-Z-- , Town ~ ~ N, Range / 7 W, Town of © , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service Gllell Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 12-01 ia6' Construction: Prefab Concrete Steel Other Manufacturer (if known): t yr7rc ~ s 1 Age of Tank (if known): -2-0,00 Permit number (if known) 7 r' q6 7Z 2-11 1 c- 4^ E L lS~ 12a f e a L 1censed Plumber Signature) (Print Name) 93/yes/ (Title) (License Number) MP/MPRS f~2 (Date) / Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 V`~r,~kr;iuti f SAFETY AND BUILDINGS DIVISION Plumbing Product Review P.O. Box 2658 DS Madison, Wisconsin 53701-2658 P S J TTY: Contact Through Relay ;fr6~,__ Scott Walker, Governor Dave Ross, Secretary October 11, 2013 INFILTRATOR SYSTEMS INC. GOVERNMENT AFFAIRS DEPARTMENT 4 BUSINESS PARK RD PO BOX 768 OLD SAYBROOK CT 06475 Re: Description: LEACHING SYSTEM, POLYSTYRENE AGGREGATE Manufacturer: INFILTRATOR SYSTEMS INC. Product Name: EZFLOW DRAINAGE SYSTEMS Model Number(s): EZ1203H (3-12" bundles with pipe in center bundle in 5 ft. or 10 rt. length). EZ1203HP (3-12" bundles with pipe in each bundle in 5 ft. or 10 ft. length). EZ1201P (1-12" bundle with pipe in 5 ft. or 10 ft. lengths), EZ1201A (1-12" bundle containing aggregate only). EZ0701A (1-7" bundle containing polystyrene aggregate only in 5 ft. or 10 ft. lengths). EZ1203H-GEO (1-12" bundle with non-woven geotextile fabric installed at 180 degrees on the upper side of the bundle, pipe in 5 ft. or 10 ft. lengths). (EISA of EZ1203 H, EZ1203H-GEO or EZ1203HP in 5 ft. lengths = 25.0 sq. ft./product, EISA of EZ1203 H; EZ1203H-GEO; EZ1203HP in 10 ft. lengths = 50.0 sq. ft./product, Width = 36 inches, Height = 12 inches, Max. depth of bury = 8 ft.). Product File No: 20130145 The specifications and/or plans for this plumbing product have been reviewed and determined to be in compliance with chapters SPS 382 through 384, Wisconsin Administrative Code, and Chapters 145 and 160, Wisconsin Statutes. The Department hereby issues an alternate approval to s. SPS 383.44(4)(a)1.a.; 384.30(6)(k) based on the Wisconsin Statutes and the Wisconsin Administrative Code. This alternate approval is valid until the end of October 2018. This alternate approval supersedes the approval issued on 4/10/2012 under product file number 20120139. This alternate approval letter shall be incorporated with your previously approved plans and/or specifications approved under product file number 20120139. This alternate approval is contingent upon compliance with the following stipulation(s): • This product must be installed in accordance with the manufacturer's printed instructions, product approval, and plan approval. If there is a conflict between the manufacturer's instructions and the product approval and/or plan approval, the product approval and/or plan approval will take precedence. • When this product is installed in a dispersal cell that is sized based on the EISA rating stated in the regarding block of the product approval letter, this product must receive wastewater having a BOD5 value less than or equal to 220 mg/L, a TSS value less than or equal to 150 mg/L and a FOG value less than or equal to 30 mg/L on a monthly average. • When this product is installed in a dispersal cell that is sized based on the EISA rating stated in the regarding block of the product approval letter, this product must be installed in individual excavations that create a dispersal cell that is horizontally separated from other dispersal cells in other excavations by at least 3 feet. The 3-foot measurement is measured between the closest outside edges of the product listed in the regarding block of the product approval letter. SBD-10564-E (N.10/97) File Ref: 13014502.DOC INFILTRATOR SYSTEMS INC Page 2 October 11, 2013 Product File No: 20130145 • When this product is installed in a dispersal cell that is sized based on the EISA rating stated in the regarding block of the product approval letter, this product must be installed in a dispersal system, which has the top of the dispersal cell at or below original grade of insitu soil. • This product must have geotextile fabric that meets requirements of s. SPS 384.30 (6) (g), Wis. Adm. Code, installed directly on top of the product and extending down along the sides of the product to a point at least 6 inches from the bottom of the product. • This product may be installed in dispersal cells in place of stone aggregate specified in approved POWTS Component Manuals or Department approved systems. When the distribution cell is not sized based on the EISA rating, the dispersal cell area must be equal to or greater than the area required for stone aggregate. • This product may be installed at a depth that exceeds the maximum depth stated in the regarding block of this approval, when the manufacturer provides in writing that the proposed installation depth is acceptable for the individual installation. • The following stipulations apply only to the EZ1203H-GEO, 1-12 in. and 3-12 in. bundles with non-woven geotextile fabric installed at 180 degrees on the upper side of the bundle, pipe in 5 ft. or 10 ft. lengths: 1. When installing EZ1203H-GEO in 5 ft. or 10 ft. lengths, the product must be installed with the geotextile fabric facing upward. 2. When installing the 3-12 in. bundles, trenches must be excavated no wider than 42 in., with a 36 to 40 in. trench width preferred. (Although EZ1203H-GEO is not, to date, recognized in the EZFLOW Mound Component Manual.) 3. Geotextile fabric meeting the requirements of s. SPS 384.30 (6) (g), installed directly on top of the product and extending down along the sides of the product to a point at least 6 inches from the bottom of the product. When installing model EZ1203H-GEO, the fabric width shall be at least 5 ft. wide. 4. When installing the 3-12 in. bundles, bands used in transport must remain intact during installation. 5. Pipe connectors are necessary for the transition between differing pipe materials (e.g., polyethylene corrugated piping and PVC pipe), meeting s. SPS 384.40, and must be used to assure piping does not separate during construction and backfilling. (Example: Include pipe connector such as AC-VCOUPLER-4 for both Schedule 40 and 3034 PVC 4 in. pipe.) • For gravity distribution of wastewater, the distribution cell piping shall meet the following conditions: 1. The cell units (bundles) shall be 12 inches in diameter 1 inch. 2. The cell units (bundles) shall be manufactured in 5 and 10-foot length sections, 2 inches. 3. The 4-inch pipe within the bundle shall be certified as complying with ASTM F 405, Standard Specifications for Corrugated Polyethylene (PE) Tubing and fittings. 4. The 4-inch pipe shall be offset from the center towards the top of the bundle whereby 5 to 6 inches of aggregate is located between the bottom of the pipe and the bottom of the bundle, and 2 inches of aggregate is located between the top of the pipe and the top of the bundle. 5. The 4-inch pipe shall be connected by an internal coupling device to allow continuous connection from one bundle section to the next. 6. The end-to-end gap distance between pipe containing bundle sections, as measured from the straps fixing the netting to the pipe or from the face edges of aggregate on adjoining bundles, shall be no greater than 3 inches. 7. The header or manifold pipe connected to the 4-inch pipe within the bundle shall be at least 6 inches above the infiltrative surface of the distribution cell, or the 4-inch pipe within the bundle shall be connected to the header or manifold pipe using an adapter that raises the invert to at least 6 inches above the infiltrative surface. • The EISA rating reduction may be used in dispersal cells less than 36 inches in width. 1. The maximum excavation width of the dispersal cell is 42 inches for a 33 to 36 inch bundle. INFILTRATOR SYSTEMS INC Page 2 October 11, 2013 Product File No: 20130145 • When this product is installed in a dispersal cell that is sized based on the EISA rating stated in the regarding block of the product approval letter, this product must be installed in a dispersal system, which has the top of the dispersal cell at or below original grade of insitu soil. • This product must have geotextile fabric that meets requirements of s. SPS 384.30 (6) (g). Wis. Adm. Code. installed directly on top of the product and extending down along the sides of the product to a point at least 6 inches from the bottom of the product. • This product may be installed in dispersal cells in place of stone aggregate specified in approved POWTS Component Manuals or Department approved systems. When the distribution cell is not sized based on the EISA rating, the dispersal cell area must be equal to or qreater than the area required for stone aggregate. • This product may be installed at a depth that exceeds the maximum depth stated in the regarding block of this approval, when the manufacturer provides in writing that the proposed installation depth is acceptable for the individual installation. • The following stipulations apply only to the EZ1203H-GEO. 1-12 in. and 3-12 in. bundles with non-woven geotextile fabric installed at 180 degrees on the upper side of the bundle, pipe in 5 ft. or 10 ft. lengths: 1. When installing EZ1203H-GEO in 5 ft. or 10 ft. lengths, the product must be installed with the geotextile fabric facing upward. 2. When installing the 3-12 in. bundles, trenches must be excavated no wider than 42 in., with a 36 to 40 in. trench width preferred. (Although EZ1203H-GEO is not, to date, recognized in the EZFLOW Mound Component Manual.) 3. Geotextile fabric meeting the requirements of s. SPS 384.30 (6) (g), installed directly on top of the product and extending down along the sides of the product to a point at least 6 inches from the bottom of the product. When installing model EZ1203H-GEO. the fabric width shall be at least 5 ft. wide. 4. When installing the 3-12 in. bundles. bands used in transport must remain intact during installation. 5. Pipe connectors are necessary for the transition between differing pipe materials (e.o., polyethylene corrugated piping and PVC pipe), meeting s. SPS 384.40, and must be used to assure piping does not separate during construction and backfilling. (Example: Include pipe connector such as AC-VCOUPLER-4 for both Schedule 40 and 3034 PVC 4 in. pipe.) • For gravity distribution of wastewater. the distribution cell piping shall meet the following conditions: 1. The cell units (bundles) shall be 12 inches in diameter +,i- 1 inch. 2. The cell units (bundles) shall be manufactured in 5 and 10-foot length sections. +i- 2 inches. 3. The 4-inch pipe within the bundle shall be certified as complying with ASTM F 405, Standard Specifications for Corrugated Polyethylene (PE) Tubing and fittings. 4. The 4-inch pipe shall be offset from the center towards the top of the bundle whereby 5 to 6 inches of aggregate is located between the bottom of the pipe and the bottom of the bundle. and 2 inches of aggregate is located between the top of the pipe and the top of the bundle. 5. The 4-inch pipe shall be connected by an internal coupling device to allow continuous connection from one bundle section to the next. 6. The end-to-end gap distance between pipe containing bundle sections.. as measured from the straps fixing the netting to the pipe or from the face edges of aggregate on adjoining bundles. shall be no greater than 3 inches. 7. The header or manifold pipe connected to the 4-inch pipe within the bundle shall be at least 6 inches above the infiltrative surface of the distribution cell, or the 4-inch pipe within the bundle shall be connected to the header or manifold pipe using an adapter that raises the invert to at least 6 inches above the infiltrative surface. • The EISA rating reduction may be used in dispersal cells less than 36 inches in width. 1. The maximum excavation width of the dispersal cell is 42 inches for a 33 to 36 inch bundle. INFILTRATOR SYSTEMS INC Page 3 October 11, 2013 Product File No: 20130145 • Otherwise as permitted in this Alternate Approval, the stipulations of the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems (Version 2.0) October 2012, [SBD-10705-P (N. 01 /01; R. 10/12)] apply. • A copy of the manufacturers' installation instructions shall be onsite and available at the time of installation. • A copy of this alternate approval shall be onsite and available at the time of installation. • Additional information is included as attachment(s) to this letter; see attachment A. In granting this alternate approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making necessary for code compliance. Nothing in this review shall relieve the manufacturer of the responsibility for designing a safe component into the built environment. The department is in no way endorsing this product or any advertising, and is not responsible for any situation which may result from its use. Sincerely, Glen A. Jones, M.S. POWTS Product Reviewer phone: (608) 267-5265 fax: (608) 267-9723 email: glen.jones@wi.gov Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM CountySt. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary3N96,Po.: Personal information you provice may be used for secondary purposes [Privacy Law, q5.04 (1)(m)]. Permit Holder's Name: e f: State Plan ID No.: Kooiman, Roger ❑City ❑ Vift9m@dT AT` &nship CST SM Elev.: Insp. BM Elev.: BM Description: Parcel 91048-50-100 20/ TV o 02- STA .$M w"= TANK INFORMATION ELEVA ION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic [N~i 1~$p 6eo Benchmark -2-0 100.2o t02. zo Alt NT go, 9`$ 4O, Dosing Vi C'elv Aeration Bldg. Sewer (2 . p , 27t r Holding St/ Ht Inlet TANK SETBACK INFORMN St/ Ht Outlet TANK TO P/ L WELL BLDG. Ve Intake ROAD Dt Inlet Air Septic o2 s) 2 ' _ NA Dt Bottom ( S• 4s Z ` Dosing ZZ~ NA Header Man. • ro Aeration A Dist. Pipe 92- -:Tv, Holding Bot. System G~ • o 91-s's, PUMP/ SIPHON INFORMATION Final Grade ,~t (L 96.0 r Manufacturer Demai cover r 3~ w~) Model Number 0 5 GPM ~a b TDH Lift 'kpO Friction 2 29 System TDH 10.1 Ft Loss Head Forcemain Length q6' I Dia. 7 Dist. To Well 1^ ~ SOIL ABSORPTION SYSTEM 5 L ; 2-o BED RENCH Width Lengt }s No. f T enches PIT No. Of Pits Insi a Dia. Liquid Depth 3 4 QIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manu actur r. j SETBACK CHAMBER -r-4 INFORMATION Type O Moe Num er: System: J, ^ _j IV UNIT C _j a DISTRIBUTION SYSTEM Header / nifoId ~c Distribution Pipe(s) f 1._ x Hole Size x Hole Spacing Vent To Air Intake Length APLI Dia Len~jth~-1a. Spacing p SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No` COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1 • j y/c$/e-V Insuection #2: Location: , (SE 1/4 NE,144 22 T29N 7W) - -Lot 2 'X15 2- 1°10'"- 9'W_f" 1.) Alt BM Description CCK G yt~e 5 r~ Gam- etc 1E m 2.) Bldg sewer length = t 3.p 1 t1f u -amount of cover = > Z ( Lyrae r tip ~e Plar~revisi~on qu ired? ❑ Yes No Use other side or additional' formationA 1 t Z- SBp437t (q .3gl) Date Inspector's Signature Cert. No. 52. `ZD Sanitary Permit Application Safety & Buildings Div isio 0 201 W. Washington Avt In accord with Comm 83.21. Wis. Adm. Code PO Box 73 See reverse side for instructions for completing this application purposes Madison. WI 53707-730 Personal information you ro Box 730 ` Department provide for of Commerce pSubmit completed form to county if r [Privacy Law. s. 15.04 (I>(m)} ( state owne, Attach complete plans (to the county co only) for the system. on a er not less than 8-1/2 x I I inches in size. County y State Sanitary Permit Number ❑ Check ifleotion to previous application State Plan 1. D. Number 5 )e- 4- I. Application Information - Please Print all Information i Location: Property Owner Name 1 / i 1 Property Location P, da < h?.e.✓ A` lla ~1/4, Sol02T N. R E or d ~C~O Lot Number Block Number Property ers Mailing Address ST ckc~,~ City. State Zip Code Pbone Ntt b + Subdivision Name or CSM Number utviNGt)FFiCE ~ rr~M ~d ~IID•l5~ ~ sr,7 G~-~o~2 o/iy 9 it Type of Building: (check one) C rr._ L, 0 city O I or 2 Family Dwelling - No, of Bedrooms:_ ---i.! O villge 0 Public/Commercial (describe use): 18CTown of O State-owned 14.1. 0*7 P" o,v °Z III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road / 407-A A) I. XNew System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s) System Tank Only Existing System B) Permit Number -aftel3sow- ❑ A'Sanitary Permit was previously issued S3 IV. Type of POWT System: (Check all that apply) " ACNon-pressurized In-ground ❑ Mound ❑ Sand Filter O Constructed Wetland ❑ Pressurized In-ground ❑ Holding Tank ❑ Single Pass O Drip Line O At•grade ❑ Aerobic Treatment Unit 0 Recirculating ❑ Other: a 7 r K q3-~ S 4-,e °-Q°O 30 5,~~ GJ.`.llt~Gy GGsa h. S 7, l e Y V Dia rsaYTreatment Area Information: 1. Design Flow (Spd) 2. DispersalArea 3. Dispersal Area 4, Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Galslday/sq. ft.) (Min./inch) Elevation VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con• glass New Existing crete structed Tanks Tanks Sept G ~ [1,0a a r s ❑ ❑ o VII Responsibility Statement I the undersigned, assume responsibility for installation of the POWTS wn_up the attached plans. Plumber's Name (print) Plumber's Signature (no stamps): PRS No. Business Phone Number lumbees Address (Street. City, State, Zip Code) /e a t>" lrJ VIII County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) ;dApproved ❑ Owner Given Initial Adverse charge Fee) Determination rats- (3a T- IF-1 < . Conditions Approval ions for D13111 val. G ` f c 41C A SBD-6398 (R 07/00) Sanitary Permit Application ! Satety & Buildings Divisio In accorc with Comm. 92.21. Wis. Adm. Code 201 W. Washington Avt See reverse side for instructions for completing this application PO Box 730 LSCORS%~I I Madison. Wt 53707-730 Department of Commerce I Personal information you provide may be used for secondary purposes (Privacy LaA, s. 15.04(1)(m)) (Submit completed form to county if r state owne, Attach eom fete laps (to the count), co only) for the system. on paper not less than 9-112 x I I inches in size. County State Sanitary Permit Number D Check if jtsvi'lonto, previousaRI cation State Plan I. D. Number S T CYd 'x 't - 1. Application Information - Please Print all Information + Location: Property Owner Name Property Location it da < 1J1ee , 1/4 114, ScVTg N. R! r or Property 5wrier's Mailing Address y } , jCaQ Lot Number Block Number City, State Zip Code '\Pbent Ntt~ttbr+r Subdivision Name or CSM Number C V LAINGUFFICE a rn rn o..'Jd 5 2"W15 11 Type of Building: (check one) ;r? l~ 0 City 0 1 or 2 Family Dwelling - No. of Bedrooms_ 0 village 0 Public/Commercial (describe use): l~Town of 0 State-owned a P" Ole/ o~ III Tyne of Permit: (Check oniy one box on line A. Check box on line B if applicable) Nearest Road i ; A) 1. XNew System 2. 0 Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s) System Tank Only Existing System "K'? - S D i Permit Number -9ateismed- ❑ A'Sanitary Permit was previously issued tea- 53 IV. Type of POWT System: (Check all that apply) - XNon-pressurized In-ground D Mound ❑ Sand Filter D Constructed Wetland C Pressurized In-ground ❑ Holding Tank G Single Pass D Drip Line ❑ At-grade ✓ ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: 7 r x 30 5,de_ W ,'XrZi., C-4 ti, e S 7, V Dis rsal/Treatment Area Information: 1. Design Flow (pd) 2. DispcrsniArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required ( Proposed Rate (Gals)daylsq. R) (Min./inch) Elevation F57 1 X57 , 7 Gr- '?Y• Y 9G- 5'I~ VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con• glass New Existing crete structed i Tanks Tanks ~ D ❑ ❑ D $e~f~ L p~ l DD j ~a r~.r/ 0 C3 C3 1: VII Responsibility Statement the undersi ed assume res onsibili for installation of the POWTS shown the attached lens. Plumber's Name (print) Plumber's Signature (no stamps): PRS No. Business Phone Number 4~2;141'.A #1 1 ~ 1,5 - 3 Plumbers Address (Street, Cit), Sate, Zip Code) /e 7e c a t-7- VIII County/Department Use Only ❑ Disapproved Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No stamps) `,Approved ❑ Owner Given Initial Adversechargc Fee) < Determination 205. (Ta - $'Z,bl'sD IX. Conditions of Approval /Reasons for Disa pr val: G ge.- "'~-e_ ,-A. CSL - -te - ( i-_~ WaA~,~ 4ffbd'~ P k- as SBD-6398 (R 07100) mticwown utopitrcrnYnt or l ommerca SOIL AND SITE EVALUATION ?age / o. Division of Safety and Buildings Bureau of Integrated Services n accordarjcq-w*i-s~._4HR 83,09, Wis. Adm. Code , i , County Attach complete site plan on paper not Bess than 8 1/2 x s in s' Plan rr+tsv' Include, but not limited to: vertical and horizontal refer n ornt ~ snd-' S' C3~a i X percent elope, wale or dimensions, north arrow, and n and nearest lead. parcel I.D. # APPLICANT INFORMATION - P/eeae prl * lnf W""'; ii6 Re ed by oat* Pereonei infomxtion you provide may be used for second FY {Privacy 16YD4 } {m~ ' - 9 - 2dvo Property Owner Providy-tftation 6~0 SE 1/a 1/4.s U TZ N,R 17 E fo( J C p Property ar's Mailing Address l # Blow I Subd. Name or CSM# City State Zip Code Phone Number ❑ City village ® Town Nearest Road S 9~1 7-A ca t d ~'~%Gf/5 a rn New Conatructlon Vsr [RResidential / Number of bedroome Addison to exlsting building ❑ Raptagment ❑ Public or commercial - Describe: Code derived dally flow yS0 gpd Recommended design loading rate 7 bed, gpdRtz_cj~trenct, Dols Absorption area required .~G 3 bed, ftzC-~ trench, ft z Maximum design loading rate . 7 bed. gpdj*. sue-trench, gpd/ tz Recommended infiltration surface elevation{a) z0yl ecaY j.~ pg•~? ~9i r 9z.2 ft (as refemed to sits plan benchmark) Additional deeign/site eonelderations Parent material e- / 4 aZf-~/a c A Flood plain elevation, If appileabie k B Satiable for system Conventional Mound In-Ground assure AT-Grads, System In i ng Tank u. unsultabls for system Ms ❑ u 7 ZS 0 u SID u O-s r_1 u ❑ s z u ❑ s u SOIL DESCRIPTION REPORT BOCfn # Horizon Depth Dominant Color Mottles Structure CO" in, Munsell Qu. Sz. Cont. Color Texture Or. Sz. SK el~r'C° Boundary Root Bed Trench st t ! 0-42 m W ~ /71w6K r C S ~ Ground 3 - p - S S - . 7 Deem to , r / in. 4• oS•6' r--- Remarks: Boring S - S os - < Ground i Up 10 limiting factor y2(~ Jn. Rernark8, CST Name (Plea" Print) signature Telephone No. ' 7~5-3YG-3r2 Ll Addhss Date CST Number l67 v 1~~-~ 5 -~3d of 3 ~i ZEE fewc ~posf /d.2.ad ;c lox 7 ~ ti ~ dz R f I o g64 ~c Q~aae i ~CfoaSt I ~ ~.'tc I 1 4 ~ I I I li i 1 i 4 ~ I J i q +Bm ~ ~9 a r ~~dtkro A-0 e 15 All: >C r3l. ~ ~ ~ = 4nD n old 2 ~i o o e i I I I ~laae s ~ ; i i I i ` i { J I ` tBm ~ /ee G i a ~q + a r ~4atlfro SOIL DESCRIPTION REPORT PROPERTY OWNER - Page _ of PARCEL I.DA Bonng # Horizon Depth Dominant Coior Mottles Texture Structure Consistence Boundary j Roote P 2 In. Munsaii Ou. Sz. Cont. Color Or St. Sh. Bad Tench Ground ev. &Ak Depth to limiting actor Remarks: Boring # / x /o I.f~iA n fly 7 S . 'T@9f v -/0-[ .c 0 - c s S 4/ A W - 3 a_ s Ground elev. 9S Gft, Depth to ' iirrtiting factor gf-in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence' Boundary Roots in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh, bed .Trance Boring # l d -/Y 5',V rS s ~s s- _ I 'Pi "o Vf 3 Ground Depth to & Ilmking taotor ~Mjn. Remarks: Boring # { 7 A I i Ground aiev. ru DOM to Iirrliting factor i" Remarks: SBD-8330 (R. 07106) log F of 3 ~ ~ T~ 06 fe,~c ~pasT'/d2 ad ~ ~ t ` YO LS- ax • ~ ~ • ~3 Bea .8~ p,,,,~oYy .9~ T a~ tae, . of ~ ~~atKj'o fC - PROPERTY OWNER SOIL DESCRIPTION REPORT page ~ of - PARCEL I.D.0 Structure 2 Boring # Horizon Depth Dominant Color Mottles Texture Consistence Boundary Roots In. Munaell Qu. Sz. Cont. Color , or, sz. sh. Bed Tench r „s - . S Ground ev. Depth to limiting cior Remarks: Boring # % I / /~1ll7 FY ! Jr Ground 9sVGn. Depth to 41 limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench Boring # 1 a -iY d oQ 2 f S Ground GIs Depth to Amkinp factor 9-in. Remarks: Boring # x jwji i Ground e. Depth to , llntiting tutor In, Remarks: SOD4330 (R. 07198) 7 Goulds Submersible _ Effluent Pump Lis 11 EP04 3871 EP05 ion* APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without udrndge to heat transfer. ■ Motor Cover. Thermoplas- • Homes components. Available for automatic and tic cover with integral handle • Farms Motor manual operation. Automatic and float switch attachment • Heavy duty sump • EP04 Single phase: 0.4 HP, models include Mechanical points. • Water transfer 115 or 230 V, 60 Hz, 1550 Float Switch assembled and ■ Power Cable: Severe duty • Dewatering RPM, built in overload with preset at the factory. rated oil and water resistant automatic reset SPECIFICATIONS • EP05 Single phase: 0.5 HP, ■ Bearings: Upper and lower 115 V, 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing Pump: EP04 built in overload with construction. ■ EP04 Impeller. Thermo- • Solids handling capability: automatic reset. plastic Semi-open design maximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. SP- Caaad1.. StaWardsA=cWw J'1 * Total heads: up to 24 feet. with three prong grounding • Discharge size: 11/2' NPT. plug. Optional 20 foot ■ EP05 Impeller. Thermo- (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in "F" or "AC".) rotary/ceramic-stationary, three prong grounding plug improved performance. BUNA-N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104°F (40°C) continuous superior strength and 140°F (600C) intermittent corrosion resistance. • Fasteners: 300 series METERS FEET _ stainless steel. 10 • Capable of running F dry without damage to s 30" a components. Pump: EP05 a • Solids handling capability. c 2s Y4' maximum. a 7 W • Capacities: up to 60 GPM. x • Total heads: up to 31 feet 6 20 • Discharge size: I'h" NPT. Z s • Mechanical seal: carbon- 0 15 ' rotary/Ceramic-stationary, a 4 I i BUNA-N elastomers. ! • Temperature: d. 104°F (40°C) continuous I l~ ! 1 140°F (600C) intermitte l o . 2 I EPOa -ice E4 s ~ I .+ivat 1 i I i - 0 0 10 20 30 40 5o GPM 0 2 4 6 8 10 12 MI/h CAPACITY