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12ri)I rcn stcr I W nly Val ❑ OII c1 M1'a:'di.: .lion o) Fxi'tin \:>lrm (explain)
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\ Unprl sal l real ent Area information _
t t 1 FI (1 p I I Usslgl x.il 4ppliezu n 2 r ? alt Di>petsa! :\na Regnred D1 p I sl Aica Ve llotei IN I \ 'lent I e[ian
V L 'l'ank Info Cr.pl rt aI - :.,;I ar V 1
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~~DCI/ _ I'clra! I'>= Dale I: ue//1111 li t. n" i t'nt ~tg!'atcr
I\. CoudiltyASyRID1YN1B181 lsans fm Lhsopprnraf / rp,~ / ( s L u P - Za 3 S
1. Septtctark, eAlccnI)iWvnd 3~ ~Md'••~"te+~
oispei: cell ua eli bt! s'. 'IC s ! rn} I1 .@C _ (l'~ - I I Q rM-:
es per ,mar 3gemen plan o o ,aeI by plu noe.
2 All ali reeut•t en's must Irart ire y/mot /)(vim n
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CONVENTIONAL COMPONENT DESIGN
ResiderM Aim
ROU AND TrrLE PAGE
Projed Name
Owners Name
Owners Address: 1 1 1
h#)
Townsbrp.
County.
Subdivision Name_ j
tot Number. -
Parse! ID Number- ^
paye I _ _brdex and We
Page t Plot Plan . Page 3 System SizbV & CrossSSecian
Page Q riBerSpecs -
Page 5 Mafntelrame infomra>l n
Page 6 Management flan
Page 7 SL Ctax Cty Septic Tank Mantenance Fans
Page 8 YVanmty Deed
P-Age 9 CSM orPW
Allxhmenis 90 Test & Fiwse Plans
- l.iamse Number <
Dale: PAvreNunber = 75i
Signabire
Desgwd puss -love rK3arm saAhsorpBnn( / Wsmrtor POYYrS Vlofow 20 aaQfo705-P RLOUO~}
Psm 1
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Soil Abwrpdon System Cross Section
ft
4' Sdedlle 40 Fusel Grade
PV[; Vert ripe
VAM Vent cap
Leaching -
Chamber
. --f System Beratim
$ ft
Sta7 Absorption System Plan View
ft
lull
ft Vert Or Obsema6on tape Chambers Lead*ig march 1
4 bra
_rencf~L] Header
Ir
Leaching Chamber Soeaficafioru
Manufacturer And Model
EISA Rating _ sq R per chamber Sal Appfica6on Rate
_ gpd/sq ft
- gpd Design Flow : _ ' Sol Application Rate a FISA Chambers
- - - 2 rows of chambers each.
Nage of
Filters
PL-525 EFFLUENT FILTER tx ° ~1
Polylok, Inc is pleased to add its -
new commercial fitter to its existing
line of quality effluent fitters. The
PL-525 is rated for over 10,000 GPDz J~ i
Alarm y Ae pts PVC k
(gallons per day) making it one of F aTty " ~~-~-s= e3fthsion hawk
the largest commercial filters in its
dass- It has 525 linear feet of 1:16' t
filtration slots. Like the Polylok t r
PL-122, the new Polylok PL-525 has ' r )
an automatic shut off ball installed 525 rmearfeet
with every fitter. When the filter is of tits' ,
i - lahatioa slots Rated for over g
removed for cleaning, the ball will to ooe GPn
float up and temporarily shut off ( n
the system so the effluent won't §
leave the tank No other filter on 3
the mtadwt can make that claim! Qampts 4' a 6-, _
SCHD. 40 Pipe ~
3
P -525 Maintenance: i ~
The P"25 Effluent Fitter should
operate efficiently for several years ` s
under normal conditions before ` E
requiring cleaning. it is recom-
mended that the filter be cleaned
every time the tank is pumped or F
at least every three years. If the; C
installed filter contains an optional
alarm, the owner will be notified o G
by an alarm when the filter needs
servicing. Servicing should be Gas deflector
done by a certified septic tank Automatic shutoff f
pumper or installer. 'has when Boer E
1. Locate the outlet of the us Paeat NOR rams: tea is removed i
septic tank !t
2.'Remove tank cover and pump - -
tank if necessary. PL-525 Installation: 1. Locate the outlet of the
3. Do not use plumbing when septictank.
fitter is removed. Ideal for residential and com- 2 Remove the tank cover and
4_ Pull PL-525 out of the housing. mercial waste flows up to pump tank it necessary-
5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3_ Glue the fitter housing to the
4
tank- Olla(ke sure all solids fall or 6' outlet pipe. If the
bade into septic tank filter is not centered under the
access opening use a Polylok
6. insert the filter cartridge back Extend & Lok or piece of pipe
into the housing making sure to center filter.
the fifer is property aligned and 4. Insert the PL-525 filter into
completely inserted. its housing.
7_ Replace septic tank cover. 5. Replace the septic tank cover.
`F
POWTS OWNER'S MANUAL & MANAGEMENT PLAN
FILE INFORMATION SYSTEM SPECIFICATIONS
LJ N:1
11-t 1 I D:,So I 1 IIr.!:-ling VrlaMo: r1;.-:p
DESIGN PARAMETERS Inn,, P:1^nuta:aurnr: E-1 NA
Ncmi>er of 13rxircnm:,' iU NA U Septic IA Dose U I lo!ding Vclumo:
Num _.rr cf Put;lic F.::.i'tty Urits: L7 NA VnrtIcal Ui ;t;mcn. I ank Gcttom(s) to S:.I ,i:;e Pad: C;)
Esli•nated t erye' Ft ¢;ta?dayl . In n nt.l I I ,nx I:nk(s) to Ser•.: r i 'd: 00
' D
n: r hr, , erro mq mechanics nh.rsl L•e p:o id(d it •crtica' s >75
i) si(In (t)eat) Flov. (eotl o 'lad x 1.b): L l d hay znrt 1 i. '160'.00C Specific instrrctio s o 1:R yrovided on back.
It: Si!u Soil App l...h _m Hater J (3rr: t,)•n') E fL.crn Filter islanufacturcr. / !?y o - G fJ%i
t lard (Drmr. tt ) Infl E t Efr L r;c i:Urf 1v average I t lu nt I if r Model,
)t• < S -
r t Od G:Va:IV a if Ors -30mt- Purl ilflu(a tutee ~p---
LiaC!cnn al Oxy_:ea Mirt!:n.r 13)(7,7 -i20 mr L F1 NA _ 1-1 NA
Iol.d Brsrenaed 5r.'i:1, tI-SS) 6150rn0it_
High "itrcncth In;lerntrf'ifl-,.r:nt w.cnthly a• eraye: :',-ati-!fiment Unit
i. rG) >sc myrl- Paa^uBsclurcr
r.Or);.i : 2201rgiL [ NA 14 NA
;TS81 :150 mytL I.! At.xhm-im Acrifin (!Peat Rter
❑Siellard
Pretrt:=fed 1-hW1 t P.4nnthfy rwnracc 1 I Sand/: 'avd_Fitter 11 Cth=r
o1);) <so reyiL Soil Absorption Syston
F r.::al C:"i[orm (;teemetri,: ffieant IU" 'r:d3!Ol,rr: lgra¢iy} ❑ In-Circund (pressaro) (J nip"•.
f.laximum G'fl.:cn[ Panicle Size in r• A F1 uul. Ln . nh"
Other: I I NA ?iihcr: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
F^ihnn rnmb-lul slucgc end sc::ra ey.:~:'s s;)c-third tank •dclano
lump out contents of lack(s) the nigh :eater a!aix is g!: •aated
I mr. r;v'
Insuecl cone -con r funks) At least coca e'oely: ? (Maximum 3 years) I I N.4
_ _ ~yearizi.
I I nnrih(s'
in..^,pcrt rII re!I(s) I M. (east orrc crrny: (Maximum 3 years) ❑ NA
nr,trsj
CL•nn ::91r.^nt tiai:r At east r n: c c :rv' ❑
- ❑ NA
Ley ,n ~ _
❑mrn TS;.
Inspect rn!np, pump cantors & c'al'm AC I asl one ::.rd ❑ NA
Flush laterals and os ure test At feast once e% - ❑ ILror
64NA
I 1
El NA
F-
::Cher.
I f fJ:'
MAINTENANCE INSTRUCTIONS
Irupe_ticlts of t..n s and **[)I ti, ,..rl:`:.~ ,,,,,.r-; -ItJI Oc: I:,' :.n i•uriv.dual rs•!.;- -,I cce o Ih-- fc1io.'Vlnq l cen3_s o f17a
.':'aster I'IuT bar, I':hster Fl:.mber Restiuted Sev;r:r. I'U'r:ri ti lnsnc..1o,, P6v1TS f:laintain :r or >cptrip Se^riang Operator (Pu'npel)-
Ten.k'nspeePens crust adl.dc. a visual inspe^tinn of the tallk;s) to idenlify ally or brcken ha!d•.,ale, :denL`y any cracks or leaks,
measurc the Volun'.e of corlb.red sluJVe and soum and a check for any back up ur pondirg; of efillert on the Cround sc are. I lie Soil
:.bsorptign cyst.^m shat be v's.ral;y inspected to check the efflimWevcls m the observation pipes end to shank for:_ry ponding of of luent
c•, the ground surface. the pe-ding of effiuc:rt o:i :ha qro-iid su!fa:r tray n1milic it fa.Fing cordi5on and requires the 'rrmcdiatr.
nctificafion o- the fecal reyutatciy authority
"A let :he ccrnbined atx;urrulr,ton of =;:dgo and scum in any ;!uatrnert tank equals third (Y,) or rrore of the tank vulumo, :ho entire
contents of the tank sihali he removed by a Sept'lp Scn'irinc Operalcr (p-riper' 2nd dsposed of in accordancev,•ith chapter NH "13'
'vVisconsin Administrative C9de_
All other seivices.:nch;d'^g but not :united to the s raicinq of effluent blrers mcichmmai or pmssinizer: romponenls, pretrea6ncrt gulfs.
and any sr.r.ining it irtenva's of -'12 r.!enths, eehall be p. rtn wd by a certified PO'iVTS Maintainer.
Ae; I,I :?ier,r;,l n;hl ~c pmidnu tithe. ~J w~ul Irty .=Lt• -.-Atli n:?) 1_,c rt^or --t;.,nn=an. ev:ill
I'~::t= ~ . of _
STARTUP AND OPERATION
Frr rife: ccrsh:x:tion, priul ,r n i tl:r, :,h.:ck treatment t n, lsi t,,i* u.. ti -e _ , ,;iwr'.y lido.: ; -:r elents or other
Chemicals r.r aecirnent that may intpedn tarn trratrnert Fnutxs:: arrdJor damLi;le die absorption system. It high enncentr bars are
cbetcrtcti havo the contents of the tack(s) c r:;ved by a Seplage Se.vicing Operator (pumper) prior to use.
Ilnnp tanks Ittay fit above normal highlvalui levels pnor to startup or duo to pump tail:.res Start up or restoration of poser under thcsc
rnrditiuns is not reccnuucnccd, as ti'.e excess wastewater will be cisch:ug^d to rho soil absorption system in one large dose v_using an
overload that stay rescit in 3tei bac3up or surface dscharge, or effluent and carnage it) the system. To a'oold this siluafon have the
contents ct the pump lank removed ;,y a Sepfag:; Sencciny OFer~: or (p; riper) prior to restoring pc*er to the pump or contact a Plumber
ur PO6"JTS Paninf:;incr to assist in martially operating the pump ccwlcs ucfl ronral effuunt levels are rnstn-ed within tro pump tank.
System start tin shall ant co:mi when soil oonditiens arc frozen at the infrltra_:e surface.
Do not arilvn or park vehices ov i tanks or the son :_t..;orpticn system. Do rcl drive ur park over, or othornisr disturb or wmpac', •;•:e
an?a witrin IS fee. down slope of any moiwl or of grade soil absciptier, area.
I z2dcctin:n (:I u'i•ninaticI I of Vf e toIIcd>ing `-orzr the waste•mater stream may improve the performance and prolong tt'.e life, of the treatment
a ilia and soi absorption systett: Lintels, ardibioEe baby vaioes, cigam le bulls, condoms, colon scabs, deer r stirs, dental floss.
d'apeus, disin`ecfaats, fats, fourdati:tn drain (sump pump; disGtarcr, fruit and veectable pccl'ngs, gasoline, greases, herbicides, meat
.:caps, mediations, oils, painting prcduC S. pestcides, sanitary r ipkins: scivents, tampons, and water soficnur brine discharge.
AFIANDONMENI
1^Jh^n tic I'U'7.' I_ti fa.- is a:'.d+or is pnrmarcAly ta'aeu out of service the to'Imafng steps 0all be taken to insure that the system is pronc!y
Lilo! safi_ly aba^:roe:xl in nom pl'arce with s Comm A3 33, L"Jisconsin AdminisL ali:a Ccde:
• A.; pips y, b tanks. pits and other soil a'cs:npkou systems shall he disconnected and '°e abardoncal pipe cpenirys sealed
-
• 1 he ccntenIs (;F;11' tanks and pits shall t;e; removed and properly cisposed of by a Septage Servicing Operator (pumper).
• After pumping, Lill tanks and pits shall be excavated and removed or their ce•:ers removed and the void space filled with soil,
gravel or another inert solid material.
CONTINGENCY PLAN
If tlie PU:^JTS "rails and cannot be repairat the to.lovong measures have been, or must. be taken, to provide a mde compliant
roplarn.-merit system:
ty)• A suitable replacement area has boer. evaluated and may be util.zcd for the location of a rep:acernent soil absorption system
I ne rep~ar_einen area should be protected from disturhar:^e and ccnpaction and should not be infrnged ;:pen by required
setbacks front existing and proposed strccGure, lot Iires and •erc!Is. Fa! "ro to pr:tort the replacement area will result in the, need
-,r a new soil and site e:•aluatinn'o establish a .:unable replacement area Replacement systems must ournply wile the riles in
E.Fact at lire time of their perm t issuance.
A suitable roplaeemcnt area is cut ava~lahte due to sotba:•x andi;;r sc: I:mitatmm.. It the set absorption system canno'. be
whabilitated and ba rag advances in PU'J•JFS tcchaclogy, n holding tank may be ins'ailed as a last rosod
I he site has no'. been eva'uatcd to identify a suitable replacement area. Upon faikso of the P0NTS a soil and site cvaluatioc
must be performed to lo(,tte a suitable rep[acettent area If no rep1w anent area is available a helding tank may be irstaled as a
last resrrt to replarc the failed POWTS.
I I tstnund and at-grade soil a'osc,mmn :;y sterns may he re.;ocs:ruc'cc in place rolloe:inc removal of the biomat at the inflltratve
su-tane. K=eonstruc'iors of suc i . vMems anus: eoml y w ct th2 ruir-; in effr.1.a: that rnte.
WARNING
TREATMENT TANKS, PUMP TANKS, AND HOI.DING TANKS MAY CONTAIN POISONOUS GASSES OR LACK
SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY
s••~` RESULT. ESCAPE OR RESCUE FROM THE. INTERIOR OF A TANK MAY NOT BE POSSIBLE.
ADDITIONAL INSTRUCTIONS:
POWfS INSTAIYER POWIS MAINTAINER
Ni-ae r Mante
Phrase; - - c-~ - I'hons
SEPTAGF. SERVICING OPERATOR (PUMPFR) LOCAL REGULATORY AUTHORITY
_j I
I'h:cre plic:ne - Z
Tia dcua:rn1n1 •r:a5 drofted by (be stasis :,I 1nw son Lake,. tlarr,velre and VJau::hart ::Minty PO-AI ifs re;tu alwy aperJes in Ca•npIlance w,lh ;oeiiors
(%t- .n: S37i,9r;b);'j(d;&ti) and P.3.54,1) +LiR i:. tt m ^r'c:i:r -altar:: CocG.
START UP AND OPERATION
ro' n m is tn.::'r r n:r t_ u_ ,Ira sy h I crc_ ni rti _l rr'I,i [s solvents or tithe'
u ,spas or sedimcrt P,-'at Ivey i.uoeJe the Veat! en: proceas =,X CanMaUe the snl absorp inn SyAcr. if ~igr wrnxntratons are
as criaJ '••ave'tie r.:;nteits of the :acta;sj removed by a Septace Servicing Opera:of (pumper) prim'tc use.
FU7TD larks may fit above nOrnal highaeater Irvcls rrn - b Starup or dive to PJTp failures. Start up or restoration o:' poorer w-k,, thew.
unattions is not roc,-.omncndnd, as the ex s ovasie•r;aler ,rill oe discharceJ to the soil abSC!olion system ir. one 6arce dose ran ving an
o'd_-rload tnat may resift in the aact_p cr surface disoharge: o' .-tfuent anc da:nage lc the systax... To s.,:.nid this siuaiior, have the
t:;nts of the uu!no tank reirovec by a Sontag.. Sorvlnmi Operancr ;pwv:.ier; prior to restoring pnvrer -r. trn ?amp cr uunlaut a Plumt:cr
or I VV': TS ;v1ainca:net lc assist in Mann') IV opr.-atrg the p::mp wnt`ols unttl norral effl ;nnt levels are restorec within fire pump tank.
-•,vein start up s~r,all not exrr': h:m soil anicitiens are froz=_n at t-e innttrati':c scrtacc.
Lij not drive or cad< vehicle: over tanks or 'he soil absorpton system. f):, not crlve o: park ever, or othe^rise cisturb or ccmpa~., the
a ea srithic 15 feet Jo'.m slope of any rri or a:-grade soli absorption area.
±uction or elimina* of the tolloiwmg iron'. 'tie ':aasled:tiler wean nay tmpro.~e the per.'nnnance and prolong the life of the tr atrlent
-nn;S and suit absorufon svste'r.' acics antinn'ti:.n oaby vriues; cigarette butts : ~nJons. wt:nn swabs, deg•easers, dental floss,
ciaoea, J.sinfeotacls, fats, foundation train (sump p-n p'. discharge, fri; and veect:Jule peelings, gaso'ine, greases, hcrbiade,. meat
tscrsps, moaioatin^s. oils, painting pro:tuuis, neucides, sati'ary rap <ins, sol':•ents, tampons, anc v+swr so-ener brne dscharge.
ABANUONMFNT
°Jhan thr: PD'e" I-s rails andror s pecnanen:y taken oat of scrvt^n the fol.c*•.Mi iq steps sca:l no taker. tc insure that tie syslex is properly
and ^-.a°.-,I;• a'oardoned in wrtpliance v:ith s. Comm 83,'? i t.Jso::nsin Adrlinistrati e, Colic'
• All piping to tacks, pits and other soil absorptix: systems scat) be disourincte: and the aba::doned pipe openings sealed.
• The artonts of all tacks and pi's shall be removed and p'epmy disposed of b a Septage Servian; operator (pumperi.
• L:ftrr pump ng- all tanks and pits shalt he exn3va-cd and removed or L`!aii ooyers '::moved and the void space filled mdh soil,
n'-r.'= rrt acv:7h=r °f'f sdirl r;reri;l
CONTINGENCY PLAN
If tic 'OVdiS fa :',s and cannot he repaired tic io[mvng measures have been. or must be taken, to provide a code compliant
reptace..aacnt ;y-em.:
A sucahle -oP.--mZncnt area ties been evaluated and ma;• be util.zeJ for the IcOaton of a rc?ncA.rnent soil absorption sys-er..
the repiacerne:t area should be protected r•orc dis-u-bance and ;:oripact'on anshoud -tot be inkirged upon by rc; xed
se-,backs fro- exisi.-r:p and proposed stru°u-e, Ict Eros and yells- Fail-re to pm-e:t the replacement area ma1 resift in the need
for a revr soil and site evaiuaflor to osteblish a suitable :enlacement a'o Replawnect systems :rust corr:)ly vJth the :des in
affect at the time of their permit issuance
A s.;itaNe roplacement are: is tic: a•V2i1abte cue to setbaok acd:o- scit :imitations. If the Sol: a:,sorpt:or. sysier.! cannot oe
rehabiiitetrd an,', barring advances. tr POrA7S techne:ocy.._. hildiig tank ina , be instal:ed as a last rrwr.
Tn:-• site.. has not brier, evaluated 13 iJer:ti°v a su:teb.e repi=^.nmew area. Upon failure et the PO'v1TS a soi: a::J sae evaluator
rr.:st tie pe:fornled to Iccate a sdtab'e •eptaa:ment a-ea. If no reJlaceme^t area is avai.able a Fording tank may be insieted as a
last : ash: t to replace the fai:e_ PO'P.?S.
❑ Nlcxid and al-grade soi' ahsorption srstrns nay be recc:stc!ced in alas-• fckc Jnc re:royal of t-a bicmat at the iinltrafive
sur`x.~.,. Bison.. ,.rf s of Saoh svstar„, r uu. 1X,1:ripl,. 'm`tn th^ tlr incite 't at U:ct titre
WARNING TREATMENT TANKS, PUMP TANKS. AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK
a3t SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY
RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE.
ADDITIONAL INSTRUCTIONS:
POWTS INSTALLER POWTS MAINTAINER
S PAGE SERVICING OPERA-1 OR (PUMPER) LOCAL REGULATORY AUTHORITY
Y-i
Tn,G ;hc:rne'd wan diafloc Dy In_ Graff, if tie 3~eer _ake klare,:ette a u: Vv'-au P.a:a Goumy 'D'dvl ti t yu ale', a?cr.ic; ;r compliance Wit sec?ioca
Garnr F8.22(2?tni(17{ci&fO and II3. 41'1 i. 12; &(3). ~scoaein Adnire;;rahw C;tier.
ST. CROIX COUNTY i
SL?TIC T A-'NTK MALNTENA-NCE AGREEMENT
_A.ND
OWNERSHIP CERTII•ICATION FORM
Owner;*Buver t_. ck o-k-_ p- c l- L . ~7 E c j~:_ e u_ t~ tc _ :-z A. (s &7p-
Mailing Addres 14 l_ r c- 11 D F: -12 P o i D f o g x.11 l
C tawt~ or- 5A use Pk~ s4c>(
Property Addres t 2 W 1 ~ /7 C Fl ! t ~ 6 ! U 0 ' 6?LV W ~
(Verification required from Planning & Zoning Department for ew construction.) G~C} /
city /State 14 ~i5_ ~(~1~ Parcel Identification Number _C5 3 O 2 ) S G O O C)
LEGAL DESCRIPTION LOT
Property Location V4, % , Sec. T N R l C _W, Town of O E (--Z-
Subdivision Plat:_ I T S L. 7 Ce'~; of 4 '
Certified Survey Map n Volume Page T
Warranty Deed n l 0 (c-) G A- --34- (before 2007)Volume , Page
Spec house G yeseKno Lot lines identifiable yes U no
SYSTEM N AINTEN-ONCE AND OWNER CERTIFICATION
luiproper 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 die septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are speciircd in §SPS. 35352(1) and in Cbapter 12 - SL 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; journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wmewater disposal system is in proper operating condition andhrr (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
.s-andards set forth. herein, as set by the Department of Safety And Professional Services 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 year expiration date..
I/we centifY that all statemenU on `may['' form azc trurecoe to the best of my/our knowledge. Uwe am/are the owner(s) of -the
aropcrq• desenbed above, by virtue of a wittranty deed rdedm Register of Deeds Office.
Number of bedrooms
q ze,1
SIGNAIU E OF APPLICANT(S) DATE
Any information that is misrepresented may result in the sanitary permit being revoked by me Planning & Go ifl- DepartneriL "
Include with this application a recorded warrantydeed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(R..M. (14/12)
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(WHITE EAGLE GOLF CLUB)
Septic-Dose 'l'ank Cross Section And Pump Performance Specifications
Tank Manufacturer - Pump Manufacturer
rTank Model Number /fix,
Pump Model Number
r %1 t ,CdYri (i -
Total Tank Capacity Alarm Manufacturer
Max. Bury Depth Alarm Model Number
i !
Switch Type
,:x L. f✓
Filter, Manufacturer / Total Dynamic Head ('lDH) - Feet
Filter Model Numbet Elevation Head
II )i.Stal Pressure -
Network Loss -
Minimum Pump Performance Required Force Main Loss
UPM~t7~-/.--1 Pt TDH j Total
Outlet Manhole Min. 4" Above Grade With
Locking Device. Inlet Manhole Manhole Min. 4" Above Grade
< 6" Below Grade Scaled Watertight 0 Securely Mounted With Locking Device `
----__z~ o Weather-proof 1 J\l
- Junction Box _ D
. - Finished Urade
0 Depth of
Vent Min. 12"
.over Disconnect
Ft Above Grade Means
With Vent Cap
ff "I
Outlet
Outlet Filter -
Inlet > l~ Inlet Baffle
r tl -
I , <
<
LINN':: A
Switch Settings and Reserve Capacity
L lank Volume = GPI y Weep -4 1- Dimension Inches Volume Gal. 13 >
Hole
(reserve)
Krve
(alarm) B 2 Off Elevation C
(dose) C / -G Y Ft ~
Bottom
_(dead)_ D
D Elevation
- Total F't
GENERAL INSTALLA'T'ION: 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 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 WAG'.
02/05lJ Page. JG of
04,
[IGOULDS PUMPS Submersible
Effluent Pump
PE
SPECIFICATIONS MOTOR FEATURES
Pump-General: General: ■Corrosionresistant
• Discharge: 11/5" NPT • Single phase construction.
• Temperature: 1040F (400C) • 60 Hertz ■ Cast iron body.
maximum, continuous when • 115 volts ■ Thermoplastic impeller and
fully submerged. • Will-in thermal overkrad pro- cover.
• Solids handling: 1h" tedion with automatic reset, ■Uppersleeveandlower
- maximum sphere. • Class B insulation. heavy duty ball bearing
• Automatic models include a • Oil-filled design. construction.
APPLICATIONS float switch. • High strength carbon steel ■ Motor is permanently
• Manual models available. shaft. lubricated for extended
Specially designed for the 0 Pumping range: see PE31 Motor: service life.
following uses:
performance chart or curve. 0 .33HP.3000RPM ■ Powered for continuous
• Mound Systems
• EfBuentlDosin Systems PE31 Pump: • 17.0 Maximum amps operation
g
• Low Pressure Pipe Systems • Maximum capacity: 50 GPM • Shaded pole design ■ All ratings are within the Maximum head: 25' TDH PE41 Motor: working limits of
the motor.
• Basemen[ Draining • .40 HP, 3400 RPM ■ Quick disconnect power
• Heavy Duty Sump! PE Pump: cord, 20' standard length,
Dewatering • Maximum capacity: 60 GPM 1.5 Maximum amps heavy duty 16/3 SIIW with
• Maximum head: 29' TDH •PSC design NEMA 5 15P, three prong,
PE51 Pump: PE51 Motor: 115 volt grounding plug.
• Maximum capauly: 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 E[ ceramic, BUNA and stainless
40 WOMB. PEe1. Peat rnsr steel.
PESt .33..A0, su ■ Stainless steel fasteners.
35 t o 2 GPPA AGENCY LISTINGS
30. PE41- t FT _
w 25, PE31
i C IIS
Tested to UL 778 and
20 - CSA 22.2108 Standards
o By Canadian standards Association
G 15, Fie #1A38549
v
r 'GOnIdS Pumps is ISO 9001 Registered.
10
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5
0 on 10 20 30 1 40 50 60 70 GPM BO
0 s 10 t 5 m'm Goulds Pumps
CAPACITY n
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'uVisconsin DepnNl ill Sarety~g¢,Prof[~Mtna~~T'.1 f ST ° a3 I
-ro,r S Pag<: .1 y)
Divisrm of Indu li !r-'~%mricp4 - 1
SOIL E LUATTON-REPORT
1 [ V 1 z~ l~~ In aazo~daace tall: SPS 3fii,. 'Nis. Adm. Coda County
All cemple:e site h•r On pipe not Irsc Ih r 8 V2 x 1 n hes in size. Plan mr, t inclcCO. ' - =.,~;nr~ r X
but net limned to . ca. and hpnzrontal rcfbr6n-x, point t I t r. di. ection and poi clang. Pan el Lfl
scale c, dirlen 011 OII'1 anda L„ lugplht'r_!p,d d'SI- a 1.1 reares' road.
_-~--4Tedse print all information. Ra'r y Ualu /Q
_ Pcrwnal in'onnaUarr you pro•.-ice may be used fr.+sncn_rA.b c", ses iN ' I Jw. S. 1b.04r1 iim li evae
. / o// ,v
Pro only Owner LoI;aton
f19 L .f~*-F.l J' Ci0'd. Lot ,]•~__l•+st✓ Y. S N R /L1 C r,
Property Chmer's lefsilln Address l Lot a Black 4 Subd No, a o' CSh!#
City ~y Si Zip Cude Phony. Nwnber U City ❑ Vi'lage 0 TPIA-I" No west Road i
Nov; Construction Uso'~ Residential l Number of hcdrcrrms Cc<Ie dert•;er'design fl0•a ratr~,y-=(.' (;PD - - -
❑ Replacement ❑ Public or oonlmorcia - uer:rbe.
Parent nralcr at FSiJ.rsr/ _ FIOOd Pla•r elCValion i`appbWblC/_ ft.
General comments and re.rommencalions'
I ❑ P.cain~9 ~y/y`) Boring; X ❑ '.l Gici-id surface elov- Depth to limiting factoi in.
Soi. Application Rate
Han/an U., r Darin gin. Color Rednx Doscr phon -'slue tAjt: rc Consistw•c' Boundary Roots G_PDTt'_
Ir 11dn el. Ou A< i Color Gr Sz. Sh. _ Cff41 •EffC2
HmIn'
_ % q 4 4(TI ~'7! Pd Grc,r.rd wrlacx elev. ~ It. Depth to L,niting factor ir.
Sal Application Rate
Horizcn Deatn Dom. rant Co.cr R,•dcx Des:: ipti0n Texnaa Sirr:rn❑e Corsistenre Br:srdary Rows GPU'Ft`
In I:IUnsell Ua. Az. Cent. Colo' Gr. S<. Sh •Eff#1 'E"2
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FfB.ien r - 30D. > 30' 220 r rc L r : IS r 1 -§f1 n ga ' Fu .nt J ROD. 30 220 n j, L an<I SS > :30 s 1 SC rngil-
CS rm P~asppryt f Sign upr ,C/ C:; I Nu nl r r i
Address I / Date Evaluation Conducted Telephone Number
SBD-8330 (R04.05)
I
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d
Were # boring
Pit Ground surace elev ~fQ ft. Del:ell Io lin!Cm.a faclc•f%!:. in.
Soil Anplica:ion Rate
Horzon Depth Dominant Coer Redcx Descriphan texture Stru-twc L usrslcnce Hounrary Roots GPDrFF
Ir. `dursell Ou. Az- Cont. Colo' Cr Sh.
3 - - r
Hrnng d ❑ t3orind -
L_ ❑ Pd Grourtl surfaco olGa. (t_ Depth to limilinp Iarlor m.
Soil Application Rate
Horizon Ucpln Dominant Color Rerox Uesaiploc IcAve Struclale Con;;tence B•.nndary Roots GPU; t,
In. 4Aunsell Ou Ai. Cont Calur Gr. Sz. Sri* 'FlIll TWO
Horiny 4 ❑ Doric
❑ Pi: Ground surface elev ft. Depth to limitirg laclor _ in.
Soil Application Rate-
Horizon Deptn Dorrinanl Color Rodcx Descrix nn Texlwe, Structure Corsegence. 9aandary Roots GPD:W
In. tal.rnsell UL. Az. Coal Co or G[ .S'., Sh
'Cffg1 'EifiJ2
'Fffuprl01-HOD, >30<220 mgt and -SS %3051SO ra, 'L1llucnl H2-DOD. >3J 220 rny,L and 1SS>30<150 mgA
SUIT AL'J 1qH07,OrDorcinanl Clloi oxtuic Stnr lure RO-t -In. tvlJnsell 6u A_-Coni.:Golor Gr C.. Sri. hr 'EII#2
J sting k ❑ Banng -
~~II ❑ pt GrounA surfacE °lev fl. Depth in iirnihnc factor-
AuGI J-r P_rr
Soil
tinczon Dootn Dominant Cow Redox Des.-rryrea iOxlure l Str irw a Gorsocerce Bounday Roots GPI F.'
In. WLmsaJ Ju A.. Con ..ac' G'. an 'EYAt
3oing q ❑ Borinc
L Pt Giound airtare env. t. Dep:9 L; limiting factor is
Soil Ap fi ahor Pate
Iforzon Depth Doiri'iari Crlor Reflex Dos rpLCO iexluu7 Strict:rr Cor;i5tar;.e Boundary Roos C'PD F:
In, lol.l~sc1 CX A-. COnl COIO' G'- 2. Sh . •c`fAi 'Effk2
Iff:ieti bi - b' C r,':1 . eod `SS ` Si 16J r-rC Lffl =rip; N L. AIL T"` - 3,1 - ;u fr J L
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