HomeMy WebLinkAbout026-1306-00-061 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
'Safe and Building Division
INSPECTION REPORT Sanitary Permit No:
515206 0
GENERAL INFORMATION (ATTACH TO PERMIT) 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 X Township Parcel Tax No:
First National Bank New Richmond, main offic Richmond, Town of 026- 1306 -00 -061
CST BM Elev: Insp. BM Elev: BM Description: Sectionfrown /Range /Map No:
6 n / GST 18.30.18.1668
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark � • /
Dosing d ✓w�0 �� DOv Alt. BNe y. �J3 95 • S�
/a �� Bldg. Sewer �/ �j `7 3
Holding V St/Ht Inlet
I/.75 72,75
St/Ht Outlet ` \
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom ��31
5 7 —
�JA- zy 3� /`7
Dosing 57 / Z 7 3 �p ' Header /Man. . 9 /
Aeration Dist. Pipe
St.3 9c,, Z
Holding Bot. System
Final Grade
PUMP /SIPHON INFORMATION 95r • 4
Manufacturer Demand St Coyye�r
GPM Cop C 1 C ao . 9, S 1
Model Number p 4 56
TDH Lift 1 I Frictior�Lo System He�cJt _ TDH_ _ • t
Forcemain Length 3 a Dia. it Dist. to Well
3 f••t°
SOIL ABSORPTION SYSTEM
BED /TRENCH Width / Length d^ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS - 3 4$� -S`>} E `� - 7
SETBACK SYSTEM TO P BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION e Of System: CHAMBER OR 7
T
Yp � k— UNIT Model Number:
DISTRIBUTION SYSTEM C�af« ZZ d / = Y3
Header /Manifold If Distribution 0 x Hole Size x Hole Spacing Ve ) to Air Intake
Pipe(s) H
J
Length / 3 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 Topsoil Yes D No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /
Location: 982 152nd Av ew Richmond, WI 54017 (NE 1/4 SE 1/4 18 T30N R1 8W) Glens of Willow River'06 Lot 61 Parcel No: 18.30.18.1668
1.) Alt BM Description = � G �� a'`- In ci: �..� o ✓�
2.) Bldg sewer length = 25
- amount of cover = 19 /
Use othes for u additional i I ��.
Date Insep or's Sign re Gen. No.
SBD -6710 (R.3/97)
commerce .Wl.gov Safety and Bui ng ision County
■ ■ 201 W. Washingto e.,1 x'�6 e3 7_, - X
's —con ' i n Madison, 7 - l Sanitary Permit Number (to be filled in by Co.)
DepartMerd of Commerce 5 15 2- C 0a
Sanitary Permit Application State Transact umber
In accordance with s. Comm, 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental
unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address)
submitted t the Department of Commerce. Personal information you provide may be used for secondary ,L �I� /1,52 �� ��
p urposes a in accordance with the Privacy Law s. 15.04 1 m Stars, �
I. Application Information -'Please Print All Information
Property Owner's Name Parcel #
Fe's° ��/�n1G� / �.� OZto /3�D • 60 6
Property Owner's Mailing Address Property Location
Sa~ c 7 Govt. Lot
City, State Zip Code PNub y,, Section L�
II. Type of Building (check 811 that apply) LOM OFFICE T � N; R E or
or 2 Family Dwelling — Number of Bedrooms NNI Subdivision Name
dk � t►1: lock#
El
— Describe Use ❑ City of
❑ State Owned — Describe Use CSM Number ❑ Village of
s� ❑ Town of l/L / 112a .L/d
III. Type of Permit: (Check only obe box on line A. Complete line B if applicable)
A. A New System ❑ Replacement System g p y g y (explain)
❑ Treatment/Floldin Tank Re Onl El Modification to Existing S
B. El Permit Renewal El Permit Revision 11 Change of Plumber ❑ Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration Owner
a TV. Type of POWTS System/Component/Device: Check all that a 1
UzY Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound> 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gpd) I Design Soil Application (gpdsf) Dispersal A ed jpfj Dispersal Area Prop .�dl (sf) System Elevation
VI. Tank Info Capacity in Total # of Manufacturer o
Gallons Gallons Units c $ T a
New Tanks Existing anks
g �Q C.
Septic or Holding Tank
Dosing Chamber
VII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS s wn on the attached plans.
Plumber's Name (Print) Plumber's Signature RS Number Business Phone Number
lit` /l.•��1 Soh w�v,�z�lQ `4� -- 07 � c" —��s' — r�
Plumber's Address (Street, City, State, Zip Code)
le 7e, s e�J /Y , ,d ° a
VIII. County /De artment Use Onl
Approved C:r Permit Fee Date I ng nt S
ed Issuiignature
Given Reason nial
IX. ConditiWWWWRWasons for Disapproval `
t. Septic tank, effluent filter and w 1
dispersal cell must all be services / maintained Q��ir _ �✓ E e I
as per management plan provided by plumber. `""'�-
2. All setback requirements must be maintained
Attach to compiete plans for the system and submit to the County only on paper not less than g t/a x I1 inches in size
SBD -6398 (R. 02/09) Valid thru 02/11
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I VA T 116consin SOIL EVALUATION REPORT - # 1500
Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 3
Division of Safety and Buildings Schmitt Soil Testing, Inc.
Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north a and location and distance to nearest road. Parcel I.D.
61
Please print all i form CCCF r ( Rev' By Dat
Personal information you provide may be used for ndary Pull +', s. .04 ( (m)). l6
Property Owner Pro Location
Sienna Corporation EP 2 6 2006 Govt Lot NE1/ , SE1 /4, S18, T30N, R18W
Property 4940 ikki g e Drive ' Suite 608 Address ST. CROIX COUNTY Lot 1 BI°dc # The Glens Of Willow River
City State Zip Code Pho r City ❑ Village ❑ Town Nearest Road
Minneapolis MN 1 55435 Richmond 1 100Th St.
❑ New Construction Use: ❑ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
❑ Replacement ❑ Public or commercial - Describe
Parent material Outwash Flood plain elevation, if applicable na ft.
General comments
and recommendations: Area is suitable for a conventional system with a 0.7 gpd/sqft rating. Possible system elevation for Area
1 is 95.3'.
F-1-1 Boring # Ej Boring
❑ Pit Ground surface elev. 98.84 ft. Depth to limiting factor 115+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-11 10yr3/2 none sil 2fsbk mfr as 2f lvf .6 .8
2 11 -19 10yr4 /4 none sicl 2fsbk mfr gw ivf .4 .6
3 19 -22 10yr4 /6 none sl 2msbk mfr Cs ivf .6 1.0
4 22-28 10yr5 /4 none grls Osg ml Cs - - - - -- . 7 1.6
5 28-44 none grs Osg ml as - - - -- .7 1.6
44 -115 , 10-y-65/6-
Oyr6 /4 / none s Osg ml - - -- - - - -- .7 1.6
Boring # Boring 2
❑ Pit Ground surface elev. 98.84 ft. Depth to limiting factor 115+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -7 10yr3/3 none sl 2fsbk mfr as 2f,1vf .6 1.0
2 7 -14 10yr4 /6 none sl 2msbk mfr Cw 1vf .6 1.0
3 14 -58 7.5yr5/6 none Cos Osg ml as - - -- .7 1.6
4 58-115 10yr6/4 none s Osg ml - -- - ---- .7 1.6
/
1!
11 3
2•
* Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD <_30 mg /L and TSS 5_30 mg/L
CST Name (Please Print) Signature: CST Number
Thomas J. Schmitt 227429
Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number
1595 72nd Street New Richmond, WI 54017 911512006 715- 247 -2941
SBD -8330 (R.07 /00)
Property Owner Sienna Corporation Parcel ID # 61 Page 2 of 3
Q Boring # E] Boring
❑ Pit Ground surface eiev. 97.77 ft. Depth to limiting factor 115+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -9 10yr3 /2 none sl 2fsbk mfr as 2f lvf .6 1.0
2 9 -18 10yr4 /6 none grsl 2msbk mfr cs 1vf .6 1.0
3 18 -51 10yr5 /6 none cos Osg ml as - - -- .7 1.6
4 51 -115 10yr6/4 none s Osg ml - - -- - - - -- .7 1.6
J
z
a Boring # ❑ Boring
❑ Pit Ground surface elev. 99.61 ft. Depth to limiting factor 115+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -12 10yr3/2 none A 2fsbk mfr as 2f,1vf .6 .8
2 12 -25 10yr4/4 none sicl 2msbk mfr as ivf .4 .6
3 25 -34 10yr5 /6 none Is Osg ml as - - -- .7 1.6
4 34 -115 10yr6 /4 none s OSg ml -- - -- . 7 1.6
1
3 1
,i eo -
hl .
F]Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
Effluent #1 = BOD? 30 a 220 mg /L and TSS >30 <-150 mg/L * Effluent #2 = BOD <- 30 mg/L and TSS <_30 mg /L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777.
ssn -8330 (x.07ro0) Schmitt sol Testing, Inc.
Page –P of
Conducted by: Conducted For:
Sehriitt Soil Testing Inc. Name: Sienna Corporation
Thomas J. Schmitt, CST 227429 Address: 4940 Viking Drive Suite 608
1595 72nd St. City, State, Zip: Minneapolis, MN 55435
New Richmond, WI. 54017
Phone: 7155 - t - 7111 - 247 -2941 / Subd.Name: The Glens of Willow River
Signature: ++� .1J ^^�'� Lot No.:
Date: rg Legal Description: `►1/ 114 SE1 /4 S18 T30N R18W
Backhoe pit Township, County: Richmond, St. Croix
A Bench Mark El. 100.00' Top of 2" pvc pipe
Q Alternate Bench Mark El. !?, Top of `.� /e,,��e (Ll
Slope= _ Contour Line El. N,4 Contour Line Lengt
Lo�fS S"
Scale 1" = 40'
� r
ybf �
br
Q ��w
This Soil and Site Evaluation was completed to fulfill a zoning requirement. It may or may not be in a location suitable for you use.
w
I-M ACRES
x.290 SM FT ,
LOT 2 o !TT
MU ACRES -MV EASEMENT - I
71.191 SO. FT. SEE £AS /ENT i
• TABLE
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3 m ° 160 -943.5 I �.
x LOT 55 N
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A 4 � ? 1.522 10 / it
'FT 67.523 SQk FT. N 66.277 / 1 " — — — —
r'� L80 =943.5 / I +.
IB0�940.0
DRAINAGE EAarmi-NT I N i O i OO
FAS MEN T .�..�H2� N23 - SEE ' EA , T
ISEMENT TABLE ' H `
Y" FOR = 2 D/M£NSIANS ti I
.IONS .. .._..— .._.. —.._.. _ —. ._� ��
9.74' 207.95' 189.99' �� 176.12' % l -
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``N88'1W48 916.86' - - 448.47 30 £LT 9.3a5''� z D i
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T 62 = LOT 61 k I m
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� LOT 60 �
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2024 ACRES I $i
88.185 SO. FT. N
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. I 1.510 ACRES
65.789 SO. FT.
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer r i,e s T �lA—T� e1 nr-4� �� ✓� w� c.� ov ��4�J !L
Mailing Address / U 9 z �—' `� S'7` . tY e_ 'ge' ), 6 9 � t G NJ
S�f o
Properly Address "/. Z 'vd 4v C_ �� '� G a2�.o N /6
(Verification required from Planning Department for new construction)
City 1State ACWAe 1 4mUV 0 Parcel Identification Number
LEGAL DESCRIPTION n G 4 W
/, Sec. T . . 3 D N -R� W, Town of K 1 CJ �V P
Property Location � '/4, SC `
Subdivision / 4 9 - C LC o!= TILG7I VIL40W t� y6k? , Lot #
Certified Survey Map # , Volume . .Page #
Warranty Deed # , Volume . Page #
Spec house $ yes ❑ no Lot lines identifiable( yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
masterplumber, journeyman plumber, restrictedplumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year expiration date.
V.P.
SII�URE OF APPLIC Z H NA �� �,� p� DATE
P
OWNER CERTIFICN
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
9IGNXTM OF APPLIC� DA
Fps � f A4',., 0- 04 -w,k1
« « « « «« Any information t ' mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * **
** Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
POWTS OWNER'S MANY AL & MANAGEMENT PLAN Page of
FILE INFORMATION JYSTJiM SPECIFICATIONS
Owner y $Optic Tank Capacity �,� $' al ❑ NA
t�o.�ti' o
Permit # Septic Tank Manufacturer ° �� �,� ❑ NA
t
DESIGN PARAMETERS �f flisont F ilter Ma Ad4cjt ❑ NA
Nu mber of Bedr A tf!4ent Filter Mod 't2s ' ❑ NA
Number of Public Facility Units CI NA Pump Tan C apa ci ty g O g a l ❑ NA
Estimated flow (average► 1 p O Pump Tank Manufacturer `� S c? R ❑ NA
_ s Xd
Design flow (peak), (Estimated x 1.5)
1 alb 8 PI?mp Manufacturer G o %AA d _ ❑ NA
Soil Application Rate ltd tft? Pump Model _ ❑ NA
Standard Influent /Effluent Quality Monthly avera` s qt, pretreatment Unit ❑ NA
Fats, Oil & Grease (FOG) } s30 mg /L Q Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD 1 5220 m91L 0 NA Mephanical Aeration ❑ Wetland
Total Suspended Solid (TSS) 5150 mg /i. C disinfe ❑ Oth
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD 530 mg /L ❑ Jh4round (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSSI 530 mg /L 0 NA Cl At�Grade O Mound
Fe Coliform (geometric m ean) s10' cfu /100ml Q Drip =Line ❑ Other:
Maximum Effluent Particle Size Ys in did. ❑ NA Othe ❑ NA
Other i� NA Qther; ❑ NA
* VAIUeS typical for dornestic wastewater and septic tank effluent. Others ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
❑ monthis) (Maximum 3 years) ❑ NA
Inspect condition of tank(s) At least on e very: 1( years}
Pump out contents of tank(s) y � When cprnb(ned slirdgo and scum equals one - third (Y of tank volume ❑ NA
❑ monthis} (Maximum 3 years) ❑ NA
Inspect dispersal cell(s) At least once inyery; 3 'R year(s) _
O monthis) ❑ NA
Clean effluent filter At ioa►s onc +every: I R year(al
Inspect pump, pump controls & alarm At least once every; ❑ month(s) p NA
'"`'• ❑ year(s)
__ --- ❑ month(si ❑ NA
Flush laterals and pressure test At least 0110 every: ❑ year(s)
Other: At least allae eve E3 monthis) ❑ NA
ry, Ci years)
Other. ❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made py 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 qnd , to chick for any beck up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to chook the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of efflr'snt on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority:
When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servjcing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but no t limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
s I e performed by a certified POWTS Maintainer.
units, and any servicing at intervals of 512 month shal b p. ,
I
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
Page
of
STA RT UP AND OPERATION k treatment tank(sl for the Presence of painting products or other chemicals
For new construction, prior to use of POWTS chat amage. the dispersal cell(s)- If high concentrations are detected h ave the contents
that may impede the treatment pros servicing operator prior to use.
of the tank(s) removed by a septag
hwater levels. When power is restored the up or surrface dis
m start up s not o of
Systeccur when soil conditions are frozen at the infiltrative surface- tin the backup
During power outages pump tanks may fill above norm al hi g and may r esult prior to
st in manually restoring
tank removed by a Septage Servicing Operator the pump controls to
discharged to the dispersal celols have the acontents of the pump the cellis) o ating
effluent. To avoid this.,situati
ontact a Plumber or POWTS Maintainer to ass
pow er to the effluent pump or c i P�
restore normal levels within the pump tank. ark over, or otherwise disturb or compact, the area
Do not drive or park vehicles over tanks n dis edeasoi( calls.
absorptionardea.e or p erformanca and prolong the life of the
within 15 feet down slope of any mound rove the p diapers disinfectants; fat;
reasers; dental floss; , medications; oil;
Reduction or elimination of the following from cotton swabs; deg tts; the wastewater stream i'naY improve herbicides; meat scraps,
POWTS: antibiotics; babwipeiss; cigarette
fruit and vegetable peelings; gasoline; grease;
foundation drain (sump P
painting products; pesticides; sanitary napkins; tampons; and water softener bane• 1 be taken to insure that the system ix
ABANDONMENT
e with chapter Comm 83.33, Wisconsin Administrative
When the POWTS fails and /or is Perman taken out of service the following steps she
Code:
properly and safely abandoned in comp o by All piping to tanks and pits shall be disconnected and the abandoned pipe °� nin a a Se sealed'
ealed Servicing Operator.
The contents of all tanks and pits shall be removed and properl edso °i�� co removed and the void space filled witf'
• After pumping, all tanks and pits shall be excavated and re
soil, gravel or another inert solid material. rovide a code comp)ian
CONTiNGENCY PLAN
if the POWTS fails and cannot be repaired the following measures. have been, or-MU
st p taken, to p arepl acement soil absarptio
replacement system: be utilized for the location of pl upon b
[3 A suitable replacement area has b een evaluated and may
action and. show the r� � r em ®� area w
ea. Replacement systems mu
prop structure. lot line's and wails. Failure to prated
system. The replacement area should be protected from disturbance an c
required setbacks from existing and Prof
result in the need for a new soil. an s in POW
time. evaluation to establish a suitable replacemen fin advance
comply with the rules in effect at limitations.. Barring due tO
[3 A suitable replacement area „ise lnot a veil as a last areplacedthe failed POWTS• s ga il and
technology a holding tank may tP
❑ T
th— 0i a has
a e removal of the biomat at
� be reconstructW h Place
i effect at that time.
[3 Mound and at -grade soil absorption systems may
infiltrative surface. Reconstructions of such systems must comply AN
< W
O1OR INSUFFICIENT OXYGEN. DO
<ARNINO> > TANKS MAY CONTAIN I -ETNAh GASSES
SEPTIC. PUMP AND OTHER TREATMENT IRCUMSTANCES. DEATH MAY
ENT TANK UNDER ANY C RESULT' RESCUE
ENTER A SEPTIC PUMP OR OTHER TREATM
ANK MAY 8E DIFFICULT OR IMPOSSIBLE.
PERSON FROM THE INTERIOR OF A T
ADDITIONAL COMMENTS
pOWTS MAINTAINER
POWTS INSTALLER Name Name ��11,'ei �� »+���� J. Phone
Phone 7 _ - .4 .%Z
LOCAL REGULATORY AUTHOFSTY
SEPTARfE SERVICING OPERATOR (PUMPER) / g %
Name
Phone Phone 7l 5 - 3 b -< 46V:b
This document was drafted in compliance with chapter Comm 83,22(2)(b)it1(d) &(f) and 83.5411), (2) & (3), Wisconsin Administrative Code.
' GTIQN AND SPECIFICATIONS
SEPTIC TANK 6 PUMP CRAM$
WEATHERPROOF APPROVED
4" Cl VENT PIPE 12" MIN. ABOVE � � � JUNCTION BOX
? 25' FROM DOOR, WINDOW OR WITH CC?NDUIT MANHOLE COVER
FRESH AIR INTAKE W/ PADLOCK
WARNING LABEL
FINISHED GRADE 4" CI RIS��t _.�� ._4" MIN.
la" IN. 6" MAX. "1
[ NLET
GAS -
WATER TIGHT SEALS SIGHT VgPPROVED
.A $EAL JOINTS WITH
ALM APPROVED PIPE
�PPROVEU
3' ONTO
'IPE 3
' , ON SOLID SOIL
'
INTO SOLID i OF RISER EXIT
;OIL PUMP OFF ELEV . , FT PERMITTED ONL
} I F TANK
MANUFACTURER
HAS APPROVAL
3" APPROVED BET+ UD `" T
K CONCRETE PAD
sF
SEPTIC f DOSE QPES PER DAY:
TANK MANUFACTURER: Q.��- �`
TANK SIZES SEPTIC ti GAL. �� uQ INCLUDING 1 GAL.
.._._....�.�..�,. -- � LawaACx: ____ ---
DOSE GAL GAL
FAC'ITI : A = _INCHES = ..
ALARM MANUFACTURER: D �V �, GAL
MODEL NUMBER: B 2 INCHES = --
SWITCH TYPE: '�'�'- �.;-- . - -.—•- ^_ GAL
G = $ INCHES = �$�..
PUMP MANUFACTURER: � p GAL
MODEL NUMBER : ..F. .-- D __ INCHES =
SWITCH TYPE: e. 16,23 W�
REQUIRED DISCHARGE RATE q— Gpm PgMp 6 AI.JARM WIRING AS PER ZLHR
Q FEET
• .
VERTICAL DIFFERENCE BETWEEN PUMP 4�'�' ��D �JBUTTON PI 2 _. -.-- --
5 FEET
+ MINIMUM NETWORK SUPPLY PRESSURE • ' FEET
+ FEET FORCEMAIN X ,bO.F' k .04 I' R E O'NAM F
ICHEAD = FEET
WIDTH �--'' DIAMETER
INTERNAL DIMENSIONS OF PUMP TANK! LANG ' 'go p ut 1
DATE
SIGNED:
r
[IGOULDS PUMPS Submersible
At Effluent Pump
3871 EPO4
EP05
APPLICATIONS • Fully submerged in high ■ EP05 Impeller. Thermoplas- ■ Bearings: Upper and lower
grade turbine oil for tic enclosed design for heavy duty ball bearing
Specifically designed for the lubrication and efficient improved performance. construction.
following uses: heat transfer. ■ Casing and Base: Rugged
• Effluent systems thermoplastic design provides AGENCY LISTING
• Homes Available for automatic and superior strength and corrosion
• Farms manual operation. Auto- resistance. Canadian standards Association
• Heavy duty sump matic models include 0 Motor Housing: Cast iron (CSA listed model numbers end
• fer Mechanical Float Switch
Water trans efficient heat transfer, in F or "C".)
• Dewatering assembled and preset at the for effio
fa�ory strength, and durability.
SP ECIFICATIONS ■ Motor Cover Thermoplastic Goulds Pumps is 150 9001 Registered.
FEATURES cover with integral handle and
• Solids handling capability: float switch attachment points.
1 /4" maximum. ■ EPO4 Impeller: Thermoplas- 0 Power Cable: Severe duty
• Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant.
• Total heads: up to 31 feet. pump out vanes for mechanical
• Discharge size: W NPT. seal protection.
• Mechanical seal: carbon -
rotary/ceramic- stationary,
BONA -N elastomers.
• Temperature:
04°F 40°C continuous
1 { ) METERS FEET
1401 (60r-) intermittent. 10
• Fasteners: 300 series
I
stainless steel. -
_... _..._. __ ..__. S GPM
• Capable of running -
*25 FT
dry without damage to s
components. 25 ......._ ;
7 ;
u] ......
Motor: 6 zo
• EPO4 Single phase'. 0.4 HP, -
115 or 230 V, 60 Hz, 1550 a
RPM, built in overload with c s 15
automatic reset, a a EPOS
j
• EP05 Single phase: 0.5 HP, o
115 V, 60 Hz, 1550 RPM, '' 3 10 _..
built in overload with
automatic reset. z
• Power cord: 10 foot S ......... ;
standard length, 16/3
S1TOW with three prong 0
grounding plug. Optional 20 0 10 20 30 40 50 GPM
._ _._
0 _.
foot length, 16/3 SJTW with
three prong grounding plug 0 2 q 6 g 10 12 m)/h
(standard on EP05). CAPAC TY
Goulds Pum
ITT Industries
2000 Goulds Pumps ® P
Effective February, 2000
83871
i