HomeMy WebLinkAbout032-1000-70-000 (2)
. Croix
PRIVATE SEWAGE SYSTEM St
Sefch 2-nrl uili.inc L`~~'L`.Irn 3er. Prmn No
INSPECTION REPORT tw-, 606903
GENERAL INFORMATION (AI IA^, 'OPiIth~T) StatcPnn
~'ar;Oln u'u•ma:iO'vou ,m mqe ma t ~-cc Wrr.-..dank nvu~ "n:'ac: C'?'. ^ Cd i lilmi] i
~~.mr t Horn!- Name Ciry \nILi9E TO'.en,h,r, P.neei Tax Nc
Michael & Alice Demulling TOWN OF SOMERSET 032-1000-70-000
=.7 1iM F ec Insp GIo1 iev BM Dc {'npbD Secbpn! I(r.vnlRangc'iwlar Nn
6 01.31.19.6
TANK INFORMATION ELEV TION DA A
ryo[ Id.ANJ~A;:1.1~2ER CAPA'.II Ty STATION LS I11 I-S ELEV
~1
ISeptlc j` ~ U(1JCxJ Ren;:hmark !`~.0~ r4LD
l °tie I
~I AI[ 3M
ii051n^y ~ ~n~nr
Bldg. Sewer .2V •4 'klo
Hordurp 3iu!L'Intet ~`~~Itl, pL1
D I -
I
TANK SETBACK INFORMATION -
TANK 7') P!: WELL BI DG. 1-1eCC ROAD OI
°enta: bltlg7- DI bottom
'Cosing Heade ?Aar.
Acratior Dist. Piv
S H/,C
Hu[jil
F Ina Grade
PUMPISIPHON INFORMATION
St Cover
7101do.1 Ctare-GPM NU171Der 7
J I ill Fndhan LOSS tiyslec) Hen T HO
C
orcernaln Lo - 1 Dla ~H i..a rr: ac _ -
SOIL ABSORPTION SYSTEM
RED'-TRENCH Y✓WV3( -cralp I N. '_?I I en:'.=s PIT DIMEN ION$ N5 Pib - I'sd. l%.:I LU:n? :1`pth_
DIMENSIONS
SETBACK SYSTEM ii; BLDG WELL LA -RFAIvt LEACHING rddnu`vcl.;~ _
INr ONMATION CHAMBER OR '-1n$t Y+- U
I rpe C 5I3i en. ! UNIT NU,dcNumter
i 7((YJ - 9t1~9
DISTRIBUTION SYSTEM
-1-. aeer'Ivto:,Pr:.p 1) winulOn - HOie SL_c > H-0 Specnn Ven- IO Ai 177
r 1 `7 - _ Y I a~ D1 I r,-i c - -
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
6r^:I O DEnfr Gv~1 Geph~° , .r_eea ,1 ,an xx I ul : oe
&_dr 1,n r Cen:c~ l.( U 1 3^n.'7rench Etl,c: - np soil - Vgs Ne Y=_s Nr.
COMMENTS: i/lnciude code dlsaepencies persors nresen!, etc i Inspectmi, Pt mspedhon 4;2
Location: 715 POLK SAINT CROIX RD
AL' BM Descnpuor. - Pµ""Q
¢ CC v.wvi longth ° TW" ~~3.: ~4-oV-~S LV~}Q SK
- M-10int Of cover -
n rev%:ur Requfred'~ Yes No 1c4
nthw 51tle for a:idlhonal In`ormailnn
In:w r / Len Nn
Ji11e rit.-- _
'12 iP S!F".
: .C- Safety and Buildings Division
1 W. Washington Ave., P.O. Box 7162 S milwy Permit Number no Inc tilled by o,
~$P Ft I` lvladison, W 53707 7162
r Y .y /l Slate [*ran . on Number
hOll 0',
'f V
wM
c eoverm tat un
au it
in nnkmu ve gh Adm. Code 'uhnti>.I n I Ihn Iorln to All
i~ required prior IJ ht unnt_ a smn ux pcnnn \ It \pphc al a forma tut ..late owned I 0 1 S arc suhmilled I. I'jea Address lit ddfcrenl Than ne add`ess)
the Department of Satets and i'r d +hrn.J Scn lei ll lr onal mlonmuon you provide stay he used Ihr seeondan. Palk
putlL III Iccorlunc dh;hcll is aul.au,. I l/I. 1).:1111 Stals Y
I_%py ication lnfurma on - Please Print All In lion V'a, cel 0
lAxncr'S Nnllle tI
I nq~n) Owncr'> M;lilnm Addre» ( I ro crly I.ncatI'm 0) 31 t
1 ( J ~~LL r r
i4s, llaa /ip Code Phone ♦umtxq S. II'+u _
rrII , -)r ~ (r~ ~ lv1 yylrek unc
131 _ V K I LI I aQk -
IL 'Type of Building (check all that apply) LoI ° _
,iuw,%iann Name
or 2 I :omit Ilvvalling N...t, C1 uI Rcarw+nn 4CA- ilnekH Put+licI*ouonc,:.al - lksaihC (se OIN I Cilx of cI NundKr n \'illaec of
Sla1c I hrnt;l Ua: n c 1 Lc _ _ - ~
lilwn of ~
rIl 1. l yp-c of Permd: (Check on n line it ompletc line B if applicable) i -
\ I Ll New Sydem j( Itepleecmenl Svslem icmmcm.I lAdlm• Ilmk Rcifla tncnl Only 7 <>thar Modification to Fxnlm _ S)5tcm fexplaml
txt Pre+'iolt, Pwma Number and wit Issued
B Permit Itcnew;d I Pennn Itevlsual Ch ur•c oI I'lumher Pcmtul rmislir to New
licli+m Pepoalion Ov net
_ .Type u [emlCnmpunt nUUevice I< heck all that apply)
Noc-Plc.:unnJ In-(irnwu{ 'r; annii :I In-t iruund El .1a(iraJc Maund_?4 nl. ufalnablesoil ❑ Mound- ?4 in. el 'unable u+il l..~n0.•ti`r"--r
t I I p o-ll l mp nenl Iexpl:unl - _ _ _ . I r treaunern Ues ox' (explain) _
Unpcnalilreau nt :tat bllormalum
Unpu/J.fIal/~•lfea ~++cJ.►\!I S}'slcm F.I~;a~^+n
SO. I
Ik uP I/nt Ie•+JI Uc.i,lnS J \p ~I canonK ci r.pd.'I I !lisppccr.a \r'+IA•yuiRdi
~~x V V rt nT-- ~ inol:aoncr O Y` l 1
\'1. Tank lnhl 1 l'a( LIn m ~u
a _
l alluns lUnits
^Va..:mekci+Gnp lankc <
a Inv fl.I la L)~14j„L~-Y ~/\_L -
I Responslbdlty Statement- I, the undershlned, assume responcib lily for installation of the PUN' I S shown on the allachnl plans. -I
' hint r-, NanLL I n u; I'lumhvr s SUnalurc -r \11'. MFRS Number Business ptwnc Number
e
Ilnlllt!.I Atflfexil$Ifl'CI (IIx, SIOIC. /Ip ('l•l el
III. 'ounnlDe )artment l,se Ooh - ._T - -
r I v. ntllQl'ec LYuIC IawcJ Isu :1gcn1 Signature _
dppmvcJ Isappn I fi ~/a
n
❑Uwn• nut ire ["I Denial
el d. It, for 1)ISapproxal
I\. ('ondt it~ j !~b'R(ae
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U SLeI CrU t i I Fie - ?
9s per :aar3gemel Piro vunoe.. G06(Q-
2. AI mftw.k te(;Lits'-ens ml)>t cur.:: rt. v
as per typiicMh c.rk! 1:rd:7.nv;1t. -
l~a~h t....nnnj,,. plain for the,so m and mdno to thr ('nanp only mI paprr n~a In. Than x r: + I I no." in rur
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PROJECT ty:.:,SE:
1M;
~ A;:a:l. o2slgr, OW c3=!ilna^•s for mr.,me; paar~rrS.
Pips i AS 7'.t °s;IGar:' 1: ab,° 3&'.Y,3 a Tc~.3Ca,
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CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name:
Owner's Name I Hell
_ Cl71 I f7` - -
Owners Address: 5 ~U S I Cfu t x (d
t w (Z4 r kr Yl1) Q1 `7 D 1-7
11 i
Legal Description: ~ N W t \A/ - -
l'ownship
County SJ T, C 1
Subdiv'sion Name
Lot Number:
Parcel ID Number: L 0 U)Q -76 ' ()C
Page 1 Index and title
Page 2 Plot Plan
Page 3 System Suing & Cross-Se tion
Page 4 Filter Soecs
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 & I iouse Plans
Designer7Plumber. ; ~~r' 1r L y ~(L (t (n r' License Number Lr 2 j 7 3
Date: F Phone Number 7(S5
Slcnature ~p
Des.Oned pursuant to the In-Ground Soil Absorption component Manual for POWTS Version 2.0 SnD 10705-P 4N.01101).
Page I
CHECK BOX AS APP1:.I&E C/:ECY WXI. APH A:4'\E ^ OF
SGIL E''! ilP.i'fJ~`~ • s ~e:rz .S~.YSTE'd r 'kGE2 O
0 2C 3Q 40
PROJECT WAR DESIGN FL^M. '4 JU G:•+J
rsnurrs) Vii/ I
S ~1~ rcxcn:.esbr,rtowca•«'at~.~sW;.or.•me:oai;ss;rs. '
C).32 • I ~ • 7r ' ~Q ) Pipo F.ia1Z.'.i1 / P.ST'A °Yidam ( aLlet 343,!.3C -3 ZZ
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/4Q kse
New 2cct~n;er.~c( l✓,f
well
i
i
l3ct
tobo1evo ►~user -+~+e
2~ R~us 14 kwrUc ~ ~liti.b~rs
I i
f utth rJorante Pglot
i
Soil Absorption System Cross Section
~lz.8ft
rC Final Grade
Vent ft
Leaching _r
Chamber _ UI ft
System Elevation
_ ft _ ft
Soil Absorption System Plan View
ft
ft {
ft Leaching Trench 1
Vent Or Observation Pipe Chambers
4' Dia.
Trench 2 Header
~I,eachina Chamber Saeciftcat9ons
Manufacturer And Model '1-U~ 14114L> 1%"L~~ ` ti¢l v0!~d fl
FISA Rating sq ft per chamber Soil Application Rate 7 gpd/sq ft
gpd Design Flow + _-I_ Soil Application Rate = EISA 7- Chambers
2 rows of chambers each.
Page of
DIVISION OF INDUSTRY SERVICES
Plumbing Product Rev'0 W
P.O. Box 2658
rdaAison, Wlswnsin 51701 2658
D S P TTY: Contact Through Relay
S
_ Scott Walker, Governor
Dave Ross, Secretary
March 12, 2014
LIFE I IME FILTER LLC
MIKE HORNBACK
146 CLIFTON HALL COUR I
SHEPHERDSVILLE KY 40165
Re: Description: SEWAGE TREATMENT APPARATUS, EFFLUENT Fit TER
Manufacturer: LIFETIME FILTER LLC
Product Name: LIFETIME EFFLUENT FILTERS
Model Number(s): L'I 1/8, 1 T 1/16, LT 1132 AND LT 1164
[SEE ATTACHED TABLE OUTLINING: FILTRATION SIZE AND RATINGS IN GPD]
Prodcct File No. 20140048
The specifications and/or plans for this plumbing product have been reviewed and determined to he in compliance:
with chapters SPS 382 through 384, Wisconsin Administrative Code, and Chapters '.45 and 60, Wisconsin
Statutes.
1 ne Depac t ment hereby lssuos an approval based on the Wisconsin Statutes and the W`sccnsin Administrative
Code. This approval is valid until the end of March 2019.
This approval is contingent upon compliance with the following stipulation(s):
Installation and servicing of this product must be in accordance with the manufacturer's instructions. A copy of
the manufacturer's installation and servicing instructions must be given to the owner of the system.
• Maintenance information must be given to the owner of the tank explaining that periodic deaning of the filler will
be necessary.
A manhole extending to grade must be provided over the filter.
• MAINZ FINANCE: Clean filter at inspection/pumping interval.
• Additional information is included as attachment(s) to this loller, see attachment A.
the department is in no way endorsing !his product or any advertising, and is not responsible for any situation which
may result from its use.
Sincerely,
Glen Jonas,
POWTS f roduct Reviewer
phone: (608!1267-5265
lax:(608)267-9723
email: glen jones(q.)wi.gov
SH:1-10y0a~ (N.'iJl.~i7f Fide Not: 14004nG1 C(:::
0 1 4O0 48
Product Lid Single Other than single family Primary
number Color Family applications in GDP Filtration Size
Code Application
In GDP <300 300-600 601
CBOD' CBOD` CBOD'
13-118 BLACK 3500 3000 2500 2000 118"
11-1/16 -1116 GREY 3350 2750 2000 1500 1116"
LT-1132 GREEN 3000 2500 1875 1500 1/32"
"'LT-64 WHITE 2500 _ 2000 1750 1500 1164"
'TO BE USED IN COMMERCIAL APPLICATIONS. DUE TO EXTREME LEVEL OF
FILTRATION, AUDIO VISUAL ALARM IS RECOMMENDED DUE 10 SHORT
SFRVICF INTERVALS. INSPECT AS NEEDED.
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pane of L
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner
(k-IA.Q1 0,~fyivt 1+ (i_)T~ Septic Tank Capacity L00.7 gal ❑ NA
'ermit fi - -
Septic Tank Manufacturer,, O NA
DESIGN PARAMETERS Effluent Filter Manufacturer G NA
Number of Bedrooms 7 G NA Effluent Filter Model G NA
Number of Public Facility Units Jri NA Pump Tank Capacity ~00 gal G NA
Estimated flow (average) Pump Tank Manufacturer e c -c G NA
7CM~ galidaY L.3 l
Design flow (peak), (Estimated . 1.5) 4~L [jai/day Pump Manufacturer G NA
Soil Application Rate r 9alid-ayffr - Pump Model G NA
Stancard Influent/Effluent Quality Monthly average' Prpneannent Unit X. NA
Fats, Oil & Grease (FOGI <3C rng!L C SandiGravel Filter G Peat Filter
Biochemical Oxygen Demand (BOD,) :4220 mg,-'L kNA t7 Mechanical Aeration G Wetland
Total Suspended Solids (TSS) 15150 mg/L G Disinfection G Other:
Protrealed Effluent Quality Monthly average Dispersal Cellis) ❑ NA
Biochemica: Oxygen Demand (BOD,1 1*30 rng!L ~In Ground (gravityy G In-Ground (pressurized)
Total Suspended Solids (TSS) S30 mg!L. K NA G At-Grade ❑ Mound
Fecal Coliform Ignometric mean) <_104 cfuil 00ml C Drip-Line G Other:
Maximum Effluent Particle Size iy in did. G NA Other. ❑ NA
Jtner: citbac
i ❑ NA ;l NA
'Values *pprcal trr domestic wastewattu and septic tank cfflxnt. Omer: - C NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tankisi At least once every: 3 G mpnthisl (Maximum 3 years) C NA
Pump out contents of tanklsl When combined sludge and scum equals one-third of tank volume ❑ NA
Inspect disoersai celllsl At least once every: ? ❑ month(s) (Maximum 3 oars) ❑ NA
Clean effluent filter At least once every: J I G monthls) P( G NA
year(s) _
C monthls}
inspect pump, pump controls & alarm At least once every: yearisi _ 1.1 NA
Flush laterals and pressure test At least once every: G monthisl ❑ NA
G monthls'
At least once every: G year(s) O NA
inner.
G NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dspersal cells shall be made by an individual carrying one of t'te following licenses or certifications:
Master Plumber, Master Plumber Restricted Sewer; PD1Ar-,S Inspector. POWTS Maintainer, Septage Servicing Operator. lank
inspections must include a visual inspection of the tank(s) to identity any missing or broken hardware, identify any cracks or Icaks,
measure the volUrne of combined sludge and scum anc to check for any bark up or pending of effluent on the ground surface.
the dispersal cellls} 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 pending of offiuent 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 f13) or more of the tank volume, the entire
contents of the tank steal; 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 Off luent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 5 i 2 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 71 of
START UP AND OPERATION
=or new construction, prior to use of the POW ; S check treatment tank(s) for the presence of painting products or other chemicals
that may impedo the treatment process andlor damage the dispersal collls). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start tip 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 restated the excess wastewater wil, be
discharged to the dispersal collls) in aria large dose, overloading the cells) and may result in the backup or surface discharge o:
effluent. 7o avoid this situation have the contents of the nump tank removed by a Soptage 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 celis. 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 aria prolong the life of the
DDItN'TS: antibiotics; baby wipes; cigarette butts: condoms; cotton swabs; dayreasers; 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
What the PO TS fails andlor is permanently taken our of service the following steps shall be taken to insure that the system is
property and safely abandoned in compliance with chapter Comm 63.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and nits shall be removed and properly disposed of by a Soptage Servicing Operato-.
• 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 materia:.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide, a code compliant
replacemont system:
❑ A suitable replacement area has peen 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
•esult 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 andlor soil limitations. Barring advances in POYLTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
J[ Tlw_:ise-pie n nee r co ov c e
lank
ra4y he t s e epee 7 f~Dgl151TEa FD C hJevv 410 ISTR rJGTt prJ
❑ 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 mus: comply •.vith the rites in effect a: that time.
<WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name X111 ~Cl Name
,t `i'ii.. - - _
Phone- Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name_ Name S'(~. CIWI l~CIAI, 20N!~
Phone L.; Phone
Tni. aocon,~n- ores Ufahed in aompl:ante wrn rhapc-sr -umm P.;'_22(_JIb)rt Iidi&Iti anti E2-5M, 71. L21 & (3). Msconsin Administrative Code.
Septic-Dose Tank Cross Section And Pump Performance Specifications
Tank Manufacturer Pump Manufacturer ~l S
Tank Model Ntunber .t/!- 6W ( Pump Model Number
'T'otal Tank Capacity OQ~ (o Alarm Manufacturer
Max. Bury Depth g o f evoe' - Alarm Model Number
Switch Type
Filter Manufacturer Total Dynamic Head (T_DH) -Feet
Filter Model Number Elevation Head Z 3
Distal Pressure
Network Loss A
Minimum Pump Performance Required Force Main Loss
- _ ~ GPM a g , Ft TDH Total - 7-3 . LA
Outlet Manhole Min. 4" Above Grade With +eh
Locking Device. Inlet Manhole _ Manhole Min. 4" Above Grade
<6" Below Grade Sealed Watertight Securely Mounted With Locking Device
Weather-proof
Junction Box
Finished Grade
® Depth of
ct
Cover Vent Min. 12" YOutl,
Ft With Above Vent Cat Cap
: sr-r -i-,T> > > > ,
Outlet Filter
Inlet Inlet Baffle a
A
Switch Settings and Reserve Capacity
Tank Volume GPI Dimension Inches Volume Gal. 13 (reserve) A q31q•
(alarm) B 2 -33,5Z- Off Elevation C
(dose) C J_ (p loci .3{.-' },i
Bottom
(dead) D l ~ ; D Elevation
Total _ -__(00 Ft
GENERAL I • STALLATION: 'I'he septic/dose tank is bedded-and back filledln ' rdancc rth the
manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may nut
be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock)
installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and
laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank
excavation and the sleeve is scaled watertight. Electrical service complies with NEC 300 and Comm 16.28 WAC.
02/05 W Page - of -
-
rr/
GOULDS PUMPS Submersible
Effluent Pump
~Nl
PE
SPECIFICATIONS MOTOR FEATURES
Pump-General: General: ■ Corrosion resistant
• Discharge: 1Y' NPT • Single phase construction.
• 1 emperature: 104OF (4M • 60 Hertz ■ Cast iron body.
maxinuaii, LOritinuous w'hcn • 115 vnlK ■ ThorlnnnlacriC impeller and
fully submerged. • Buih-m thermal overload pro- cover.
• Wids lidudling: 'f.." tection with a wriatk resc4 ■ Upper sleeve and lower
maximum suhere. • Class B insulation. heavy duty ball bearing
• Automatic models include a • Oi -filled design. construction.
APPUCATIONS float switch. • High strength carbon steel ■ Motor is permanently
SDeeially designed for the • Manual models available. shah. lubdaned for extended
following uses: • Pumping range: see PE31 Motor service We.
perionnance &arl or curve. • 33 HP, 30DO RPM E Powered for continuous
• Mound Systems
• ~ffluenUDosinq Systems PE31 Pump: • 12.0 Maximum amps ofIembon.
• Low Pressure Pipe Systems • Maximum capacity. SO GPM • Shaded pole design ■ All ratings are within the
• Basement Draining • Maximum head: 25' TUH PE41 Mato. working limits of the motor.
discortnect power
• Heavy Duty SumW PE41 Pump: • AO HP, 3400 RPM ■ Quick cord,k ditsr sect
Dcwvalerina • Maximum ca
paW. 60 GPM • 7.5 Maximum amps
heavy duty 1613 SJth
• Maximum head: 29' TDH • PSC design NLMA 5-1 SP, three prong,
PE51 Pump: PFSI Motor. 115 vr11t grounding plug.
• Maximum capacity: 70 GPM • .50 HP, 3400 RPM ■ Complete unit K heavy duty,
• Maximum head: 37' 1DH • 9.5 Maximum amps portable and curripad
• PSC design ■ Mechanical seal is carbon,
M[7[NS F 0 _ ceramic, BUNA and stainless
I yrFt. - } IMODLU RJt K4/.FF.t steel.
I+~ r ' .l rm 33_40_50 ■ Stainlms steel fasteners.
4 7 so AGENCY LISTINGS
_ wlA
W 25
V _ _ C us
a 20 - } LL Tested ID UL 778 and
1- - CSA 22.2108 Standards
By Carudan%wdm& Awomfion
a 15 _t FieotB3BS49
O - -
_ 7- _ i GOUI&PUMPS IS 509001 RegiAaed
I~
0 00 10 20 30, 40 50 60 70 GPM 80
0 --s i0 1s r1t1A1 Goulds Pumps
CAPACnv -
420oz w16Fumrv. „ ITT Inriustrips
ST. CROIX COUNTY }t
SEPTIC TANK MAINTENANCE AGRIIFAIFNI-
AND
OWNEIZSIIIP CERTIFICATION FM M
Owncr/Buyer - Y1' I I 1
Mailing, Address
p _ ~~li . ((2(.71' t~kvJ ~i(ArhyY~~l _ w -
i
Property Address I'D ~I?
(Vcriticaiun required tioni Panning & Zoning Department. tier new eonstnicnon.)
~a
I i
CityState _A~~f 1 ll},lLtic,~~~' _ wr-Parcel Identification Number C:);3_- C)oc)
LEGAL DESCRIPTION
Property Location v. . , ' sec. _ f N R (Town of-,
x y1e
Subdivision Plal:__- _ Lot4'
Certified Survey Map # Volume Page'
Warranty Deed # - (before 2007)Volurne . Page
Spec house ❑yespio Lot lines identifiable ❑ycaQno
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and oi.orni lance of y'mtr septic nystrm could result in its premature failure to handle wa?¢•s Proper
inainfennnec consists of pumpow out the si ptic tank every :hroe years or sooner, it needed, by a fcensed puntpcr - what you pot into
tae system can affect the Junction of the septic. tank as a treatment stage in the wade disposal system. Owner maintenance
responsibilities are specified in ASPS. 383.>'(l) and in Chapter 1 - St. Croix County Sarcary Ordinance.
The property owner agrees to submit to St. C roil County planning & 7oning Department it certiticalmn form. signed by the
owner and by a master plumber, journcynian plumber, restricted plumber or it licensed pumper verifying that ( I ) the or.-site
wastewater disposal system is in proper operating condition and or (2) after inspection and pumping (ifnecessary). the septic tank is
less than I I frill or sluduc.
I'we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, asset by the Department or Safery And Prol'cistonal Services and the Department of Natural Resources.
Slalc of wiscollmn- Cell iliCartel] stintrg that your septic system has been maintained mum be completed and returned to the St. Croix
Counq Planning & Zoning Department wnain 30 days of the three year expiration date.
I eve certify that all statements ou its lbnn are true to the best u[ ntylour knowledge. L we anvare the owned,) of due
prnpeny (Icscri'~cd above, by virtue o' it tilanp' decd recorded in Register of Deeds Office.
Number of bedrooms .3
SIGN ATLRE OC APPLICANT(S) DATE
"O".Any in'orniation that is misrepresented may ICFal: in the sunilitry permit being icvokcd by the 1'Lmnin_ & 7onin_ Department.
Include with this application a recorded wananly decd from the Rcgielcr of Decd. Oliice and it copy of du certified sunny map it
relcrence is made in the warranty decd
(REV. 04..12)
J~ iA
CST
Wisconsin rkpamncrg of Safety a.ld`Proresstonal Services Page 1 of 3
Divrs,on of Industry Scivices S
SOIL EVALUATION REPORT
In accordance with SPS 385, "is. Adm. Code County
Attach complete site plan on paper r)ot,I sethari'~ x 11 inches in size. Plan must include. ST. CROIX
but riot limited to vertical'ahdhdizorrtat FeFerence point IBM), direction and percent slope, Parcel LD.
scale or dimensions.-north arrow, and location and distance to nearest road. 032-100 -70-000
Pleas print all information. Rev, d by pate ~J
Personal informahon o0 orovide may be used for secondary Purposes aw s. 15 04i I ifmll. Z 11g
Property (Tuner Location
MICHAFL D6MULI. ING Lot NW NW S 1 T N R 19 E
(or) W
Property Owner's Mailing Address t lock Subd. Narne or CS140
715 POI K ST CROIX RD NA N
c=dy Stale Zip Code Phone N_ City Village Town Nearest Road
NEW RICI IMOND WI 54017 NA SOMERSET POLK ST- CROIX RD
New Construction Use-, Residential i Number of bedrooms _ 3 _ Code derived design flow rate 450 GPD
. Replacement Public or commercial - Describe:
Parent material OUTWASH Flood Plan elevation it applicable NA _ ft.
General comments and recommendations: CONVENTIOAL WITH PUMP
SYSTOM ELEVATION 90.8 X
Boring # Boring
. Pit Ground surface elev. 92.8 ft. Depth to bruiting factor 105, in,
Soil A licalion Ratc
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD;FI'
In. Mansell Ou. Az. Cont. Color Gr Sz- Sh.
'Eff#1 •Eff#2
1 010 10YR313 - SL 2fsbk mfr as 21n 0.6 1.0
2 10-105 7.5YR5.-6 - S 0- ml 07 16
9 J~ 1
It
,Llr
FBoring # Boring 2
2 Pit Ground surface elev. 92.8 _ fl. Depth to binding factor 112- in.
Sail Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDiFt'
In Mansell Ou, Az. Con[. Color Gr. Sz. Sh.
1 0-12 10YR3f3 •EfHf1 •Eff#2
SL 2fsb1k mh as 7m 0.6 1.0
2 12-112 7.5YR5/6 S -0- ml 017 1-6
g0,8 rr
L
' Effluent #1 = 800. > 30 s 220 rn +L and TSS > 30 s 150 AC IA, ' Effluent #2 = BOO. > 30:5 220 rurL and TSS > 30 s 150 rn iL
CST Name (Please Print) Signature CST Number
PETE ERICKSON
1293207
Address Date Evaluation Conducted Telephone Number
1291 170TH ST ST. CROIX FALLS 9.-6!18 952-261 1100
SBD-8330 (R04115)
Boring
F-1 Boring # pit Ground surface elev. 95.5 ft. Depth to limiting factor 144- in
Soil licalion Rate
Horzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1Pf
In, Pdunsell Qu. Az. Cont. Color Gr. Sz. Sh, •Eff#1 'Eff#2
1 06 t0YR3;3 SL 2fsbk mfr as 2rn 0.6 1.0
2 6-144 7.5YR516 S -0- ml - 0 7 1 6
❑ Boring # Boring r -
Pit Ground surface elev. ft. Depth to limiting factor _ gyn.
Soil A r >licatron Rxe
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G10017t
In. rdunsell Cm. Az. Cont Color Gr. Si. Sh. 1E11#1 'Eff#'2
Boling # Boring
J Pd Ground surface elev. II. Depth to limiting factor in.
Sml A lication Ratc
Horizon Depth Dominant Color Redox Desaiption Texture Structure Consistence Boundary Roots GPDIR'
In. tlunsell Qu. At Cont. Color Gr. Sz. Sh. 'Eff#1 'Ef #2
Effluent #1 = BOD, % 30 s 220 mif l- and TSS> 30 5 150 mgt. ' Elflucat #2 = SOD. > 30 s 220 loWL and TSS > 30 s 150 m9f
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