HomeMy WebLinkAbout030-2086-30-000 (3)GENERALINFORMATION
PUMWSIPHON INFORMATION
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
(ATTACH TO PERMIT)
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SYSTEM PLOT PLAN
Crawley 4 Swim m Septo System
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CONVENTIONAL COMPONENT DESIGN
INDEX AND TITLE PAGE
Protect Name.
Creaky 4 Bedroom Septic System
Owners Name
Lyle B Had Crawley
Owner's Address
413 Rolling Hills Lane
Hudson, WI54025
Legal Description:
NWS/4, SW1/4, 531, T30N, R19W
Township
St. Joseph
County:
St Uma
Subdivisi0n Name:
Johnson Parkway
Wt Number:
12 Bkck Number
Final I.D. Number, 030-2086-30-000
Plan Transaction No.
Page 1
Index and title
Paget
Plptplan
Page
Septic Tank Specifications
Page
Effluent Filter Information
Pages
Valve Information
Page
System Sizing I Costs Section
Page 2
U Flow Information
Page
Management and contingency plan
Page
Septic Tank Maintenance Agreement
Page 10
Warranty Deed
Page 11
CSM car Pan
Attachment 1
Soll Evaluation Report
De4lgnen John Schmitt Licnese Number: MPRS223760
Date', 8/10/2020 Phone Number715-760U486
Signature✓ 4%
Infimund Swl Absorption Component Manual Version 2 0580-10705-P IN. Dri
Page 1
SYSTEM PLOT PLAN
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SAFE AND 9UrtDINO.a CIVlsION
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Allies commerce.wl.gov
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April B. N10
WEEKS CONCRETE PRODUCTS
RAVWEEKS
1032 215TH STREET
NEW RICHMOND WI 54017
Re Deaddit SEWAGE TANKS, CONCRETE
Manufacturer WEEKS CONCRETE PRODUCTS
Product Name SEPTIC, HOLDING OR PUMP
Model Humanist12W
IN IN L L, 21 70 GAUIN CYLINDER Be IN. MAX. DEPTH OF BURY, 004 G.P.D. WHEN
USED AS A SEPTIC TANK BASED ON A 3 YR. SERVICE INTERVAL FOR RESIDENTIAL
WASTEWATER, TANK DIMEN81ONS w N IN. INSIDE DIAMETER X 88IN. Hit
Product File No. MlW129
The sWificabons mwor plans for this plumbing product have been reviewed and Coasts e0 to be In Compliance
with Chapter Comm 82 through 84, Wisconsin Admmlelrative COCA, and Chapters 10 and 160. Wisconsin
Statutes
The Department hereby Issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative
Cade. This approval is valid until the antl of AUGUST 2013.
This approval Is contingent upon compliance with the following abpulesom5t
• This tank must be desni t0 withstand the pressures l0 which It are be subjected.
• ThemanulacWror must keep at the manuladunng plant a Set of plans arM apec0iWigna hawing Me
dalsarlment's stamp Di approval TM plan aW spacdhiaeom mwt b OW 10 nmpemgn ay cn autxised
represemauve of aeperlmem
When this Product recewes wastewater from dwellings eM is used a5 a iota tank, a wih produs a an aboal
quality Mth a maximum monMly average value far BODE of greater Man 30 mi ark We than or pual to 220
ni TSB, or greater Man 30 mgA or hiss Man or equal to 150 mph TSS, and F 0 G. of leas than 30 myL.
• This product is approved b use the following'
Two inch Schedule 40 PVC Cast In riser for electrical wiring.
Pipe materials constructed in conformance with Table 84 30-2 or Be 3011, Wis. Admin. Code poured Into hank
mver or access cover.
Deparfi l approved off Went filter designed b be metalled In a lour Inch diameter tee with extension and
Insisted In accordance with the product approval for the fiber Including a properly sized and located access
opening for Samoa and mWmanann
Department approved U Sel and Polybk Ine 24'rber cut intoMe tank cover.
ThisapprovelsupeMW"thempmv lac uedon8r QW5 uMer product fib numMr200508)5.
ST. CROIX COUNTY TONING 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) 413 amine wine tem located
at: ew' 'G aw '/., Section J Town ao N, Range to W,
n Towof st Janoh , St. Crou 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 data of inspection or service 8 - 3 1 - Z O Z 0
Did Flow back occur from absorption system? Yes_ No_
(if no, slap next line.)
Approximate volume or length of time: gallons minutes
Tank Capacity: 1200
Construction Prefab Concrete x Steel Other
Manufacturtr(ifknown) weeks
Age of Tank (if known): 20 veers
Permit number (if known) a9B9a9
/ / /LIB '9 John schmm (A( ensed Plum er Signanae) (Print Name) Q
Minas 223760
(Title) (License Number) MP/MPRS
6-3/-2o2d
(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
(MR 113 Wisconsin Administrative Code)
Rev. 2/2012
z.mrp w.M PL-525 Effluent Filter
Pt-3 5 Filter
The PIAZ Hire Is raced for 10,000 GPD (gallons per day) making it one of the largest filters in Its clans It has
5B from feet of 1/16- filtration foes Like the Polylok PIL la But Polylok PL-5Z has an automatic and-cff had
innallM enth every filter When the Alter is removed for cleaning, the ball will Beat up and tmponnly shut off
the systien to the effluent won't leave the tank.
s.mmea1/16" Filtration Slots
• Rated for 10,000 GPD (gallons per day) Ala o Serm
•52Imew het of 1/1V fllhrtion -Oeo marked)
• Aaep i 4" and 6" SPM W pp Aoveptn- evc
eudt in ges ame smr bum Eeeme
Aummanc Pdmdmff hall when filler a removed.
• ALrm aaearib yP used on
• Access;Access;PVCestmuicn halWle 4tl9GPD
IT g251nrGl Pal Inn
Ideal for residential and co real waste flows up to 525 Len... FI.
l0,IM0 gallons For day (GPD) rd Io wn
m
I hate the court of the septic tank y
E Remove the lanl[ cave enO pump lank J naeasry
3 Glue the hlter housing to the 4' or 6- outlet pipeif m Dq pap ti-
the fillericnmcentered under the across epervnguse s f
Polylok Erlend k luk or room of pipe to renter filter 1, Me-'
4 Insert the PL525 f@er Imo its housing
5 Replace and ours the wise: mN.cover ® xenuN Iranians Y
I'1.VS Pill mtenana..
The PL-5Z Effluent Filters will opeatee effiamly for
several yens under moral conditions More requiring
cleaning It Is recommended Nat the riper be cleaned
very time the tank Is pumped, or at least every those
years. If the insmlled filter contains an uprising alarm.
the owner will be nntiung by an alum when the filternewdiwrsOdM v
wer" servlmgper orvtgafler Pe Anne byacm(Ied
upnc alik Pumper or wW to
1 locate the suite! of the septic tank 9rvIgILn
2. Remove tank cover and pump Mile J necessary
3. Da not useplumeng when filter is removed 0�
5 poll Free
ter over out e Ne housing I -
5 Hone oft filter over the aeptic aN. Make sure ell
whds fill back into eepnc lank
6 Iren the filter cartridge beck into the housing nuking
suethe More eprvpedy aligmi mdswnpkMynovel klarn,Iehi znn c Best now worst luny wow
Replace and secure Paper tank rover one 5awm'ata®n.'1,n oat lion, mw.um'siunk..
Polylok Inns 317officid Blvd. Wilbngford.CT W92 toll Free 877659363 Fax 203284.8510 uvm.rmlybk.com
paps
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tT
Frame Atom 3—k N.v prd.. mra vlawa ue.r.are cooe.m on s.r.ma
mmmNn CemraN vree.w powmo.m
e�
IMOMWaaR
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4W TUBE
RW
The Bull Run Valve'" Is designed to split Flows to septic
fields or systems. In addition to the advantages of longer
life and easier Installation it the most public health safe IOUr POMT
alternating device available nor wastewater disposal
applications. The use has absolutely no contact with
wastewater due to the value's leak-pmof and Rommel
operating choomr-istics. The Change over mom one
drainage field to another can be accomplished In less than
mute by simply turning tie valve without closing or
diet
T OI POR
Contactwith
wastewater.Th
ff
e Bull Run Valve is available In 4"sch 40 not
and Is suitable wherever septic disposal systems
am used In Commercial, Industrial, and
residential appllcatil
OPERATING THE VALVE
Fuld Field Field?4cEm
The d reRlon comml handle should be rotated
No 1 No ] No 1 Periodically to tllred effluent to one or the other
Olt two septic Melds. After removing the screw Cap
at the top of the riser tube, the valve handle can
Vatve '�' be temed with the valve key famished.
spatooed NpoNo I 2 BULL RUN VALVE
dwng Complete Valve Kit
)ddYemr Srytc er Contains
Turk 1. Bull Run Valve body
2. 28" Valve Key
UNvaWEP
boons .
BULL RUN VALVE A All ONLY
CWBEP
BULL le VALVE Also Vil Cal COVER
Bitiskil
BULL 0.Un VALVE KEY 2W
Ski
BULL RUN VALVE KEY W
MVKEvaB
BULL PUN VALVE KEY 48
3 oser Cap Adapter
4 Watertight Accerni
BRVCHUSER-4"
ADJUSTABLE TO 28" HIGH
Page
IN -GROUND GRAVITY DISPERSAL AREA
�P�T° (S)�
Stepped Elevation Trenches with EZ1203HP Bundles
Weeks Conaeta PrwuM
3-ft Trench (down -sizing credit)
a T"'I'a'"""'" q
tzsa p. _W —m
MwA Rm, W�
Polylok
a m.mr Wear 525
_
V�CRTOSPSI
YCALTRENCH PmIde minimum 3fl
SECTION VIEWsepamoon Weaeen ve nes
(No Scale)
iughazt TmnCh La tTranU (as app ele)
O&SERVATIaO PIPE nErplL
System Eleyarom= 98 75 fl, WJS
sa..-
WCvP
vi
ImumnGe
TYPICAL TRENCH Isroxloodon mime, l ometwce w,realon on pnnxex) "^^m=+
PLAN VIEW 4.0 rye.._._. 1.1 re®m "`
(No Scale) Pe&mied UWmi pa 70 fi
rvmm�
T
-0
__ _______
_
1 Ingren
D
B=90 fl
IT
IT
pam)
INSTALL PER TRENCH: F21203Ha
Wuma)
0
9 10.fl Wndl¢@Saff EISWunX=450 fl' IassW lMm�sy�bre,lic�n�e
# 0 Sfl Wndles@nf EISWWI=fl R' IreduY'purwnlm
A
=Pmpased ElSA pntrmm=450 K Reganedimdlmilw Area=85] n'
Distribution McMod.
x 2 trenches = Proposed Total EISA = 900 K branch manifold
Installation Instructions for
EZJfom Systems in Wisconsin
Wisconsin Bepatmanl of Comments, Sefely, and Braldres
orvrsiin, has rexwed the specfical and/or plans for ors
around aM dekrmmed it to be in compliance WE roadsters
Comm B3 tlaagb 84, Wuconsn Poll Code. and Ctvptm
Ia5 and I W, WbcoronoolLu el z universal
SM
fo Sol f •81 �.wvw.r w...IXSWacc umntMer
kcal regudbas - _—
The approved Enormous we 1203H (3-12e bundles Wth ppe in
rental bonds in 5'or 10lengths) and 1403H11`(&17 bundles
with pipe 0 sir burder in 5' or to, Ienghe
A Barges Ease park smdins a tour kdr peuaeleu ppe and
minded by EPS aggregate al is rated together sum pNy.
someone nemng A single aggregate bundle cemlans eggregsf r
only and is held together with polyamylme nelung
llserad eta Fqulymarn fU W
• EZIbx Burks
• E2Akw Exposure Fable
• EZfiav In" ope CoMrk
PFe for Header and Intel
• Backhre/Euavator
Installation Instructions
The inslrudiums for installation of EZllwv prMucts are goon
bekw The; product mast Ic instaW in e¢gdace with of
miss eenrri in chapters Comm M through i Woomfoun /N
mimsaabve CNe, and Crashers 10.5 and 1 W. Wisconsin Stel-
uhes, of well as The kcal hoi departments current deal
manual
I After the kcal Meth pefwdmel hem personal smrg,
Configuration, and mom for the EZrow stems, adla
of mark weth prom the kcabn of bandal and lines. Be
careful to set soar Wk. most pine, hewer ere or bs-
hidtim bow and hmch MIMn Senator before dsdl-
khon of ppe buntlks.
2 Remove pashc EZllow shipping begs prior to pkcmg
bundles an the hmchbod Remove ury All bogs in he
herM before system a covered.
3. Thor pWuct must hen yoledik fabric that meals m
gwrements of a. Comm 3a. W (6) (9), W0 Atlm Core,
installer dreary on top of the product and orendmg
tlwm along he sloes of the product t0 a pram at head six
motes from the bottom W product.
0. Wien asdelkd in a InnIh this per shod be dug
waem of 3s Inches. This not of ants debor in mwa-
asn, but alw prwmes boner wwaaeng carboy after
backfiling is complete
............................................................. 0.....................
Page 8
MEVow-
y MMelYlw
5. The Pbaprobon area (SF) necessary for a gran site stroll
ber shed based par maumum dal saperages door Si and
lie Personal M the sue. If remain cdtena Is met, the
i s¢hg un be used in Rlsccomin resurong m a 40%
sneler dranfield.
6. Plena EZflw tommoo in the EZllow control ap-
proved by system design permit specified for to bi
lour site The top or center -most bundles obt among ppe
re joined and to end wits an mtemad pipe wiper. Any
addl aggregate only, bundles that may be required,
srauN ne Mted .yaM the Sher aggnytil win
des aM do not oppose arty, byl M cparthn
l The 4ofeachGEOwinder formal afifterftlncpre-
manufactured in provision the noting aM aggregate. The
fabric is inserted to poent soil intrusion . The another
shall make sure he the GEC is posulioned upxand and k
romdd wits the IaMe walaraed in the aQaont C*
M before backfibg
B The Ullow 0.anbdd Systems should be appeal In a
lei trench in all dimNons (both across and doing the
hmch bottom) and should fini the mnmur a the ground
surface elmaflw (uniform depth), with of wnbnuous
solpnhrg 10-foot ryfmdmal bundles placed end a and,
worth central bundle diommumon pce mteramrcciM.
without any daps, slepol or oll water stops
9 The torkh top snug be grtlad such that water will mil
Irma Berl afraid be seMed or w]oed immediately
after compehm to reduts eresom
10. Uhl EPS brar3e are fieaEla artl an fit an oureed
moral as may M responses, to woad trees, boulders. or
over cMtgcks
11 EPS aggtegete rs lighter man wader, 1herej it might
So supported mat natural buoyancy forces vroud tend to
muse Hpow eerformes to float out of ground when
padag occurs. Food erpcenre has down. boierer,
tM the as clout a pmlem when stems teed a minimum
0 Bo of sal from as reranmerdM by manufacturer.
In -ground Gravity Management Plan PAGE 4 OF 4
IMPORTANT
The banner of MIS almond gravity system n all be reslpnxise toya pe Plc Wn ark maintenance pursuant to
gartments of 5P5 3823B1, Wisc Mro n Code Pursuant to SPS 383 U (2), cif Ammm C.cke. tea system shall
Me considered a human health hanld if not maintained in a sompance WI pie Wooded management den.
Furthermore, all inspeNon and maintenance ectivNes shall be preformed by a registered POW S MelnOlner In
accordance vAM1 SPS 383 52 (3), Wisc. Adam. Code
Mexlmum Dispersal Ana Operating Limits
Design Flow • 600 god; BODs 5 220 of TI S 5150 mill FOG 530 Poll
InsOectlon Cludignot INSPECT EYERY 3 YEARS
o type of use
o ape of system
• nuisance factors he Adore, user complaints etc)
• mechanical mWur¢tal (I a, pumps, valves soptures, floe", etc)
• matenal faugue p a, ly breaks, corrosion, etc.)
• Was volume In anaerobm tmeMmn tands) and any duNbuton sp a henlal 0
ance.e, discussion on I drop ha
a reflect or Improper use ti it. exceeding design broadcast, Prohibited aaMdes arc l
• sugovo dis bum cell pnw to dprng
om a ing in doamgmegulamias.darylicoub e. pump rerydmg. neat Patch s Wns, etc.)
oelecmcal mmponems. tl appndMe f e, Anna. cpnnecuons. aatmeP. mneas. omen. alarm; am)
dampuoon lateral or leteres w?y Mugging (measure morm distal p m- compare to deal epdfi m)
o fill Stamps of effluent or sewage call Into Si served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or wren necessary)
o Septic and dote lankel shall W pumped by a certified Wptage s crocmg operator licensed under. 201.48 Wig.
51se when the volume a Wilde In Me tanklet exceeds onHM1lyd (in) due liquid volume otgs Unit(@) or
recall byloW ordinance Dlepwd of contents shall be pureuantto NR 113, WIllo Admin Cade,
i Effluent flftrfal Mall be Irrspeaed every 3 years and shell be leaned when nwmary to remove achy
mulelW Wilde ecwrdirg m menNetlurefe apeGllcellone A eerviung paned WII elweyx Ce greater inert 12
months
System malmenants reports shall W SubmlMd to the proper Iwlpewmment unpin acc lance with
SPS3tl.56fase"Ingin ode Reponany Wmp entUllundrmeaunOone:
Name of individual or Schmitt 8 Sons Excavating, Inc. PM1ortn 715-760-0486
Local government chat St. I County Community Developement pyre. 715-3864680
Loral govemmenturs eddreee 1101 Carmichael Road, Hudson Zip. 54016
Any den "pert a We steam shall ber repnred replecad, or mmw pursueM W SPS 383 51 (1), yNa Admin.
Code Repair a replacement of felled or malfunctioning compon" shall comply WP SPS 383, Woo Admin. Code.
No Padua for chemical or physical National aMe POWl may be peed unless approved by the department In
accordance aih SPS 384, Wisc Admm. Code
Continoencv Plan
In the event that any mllad treatment component of Pis POY?5 cannot be repetW, It shell be replaced pursuant to
a plan submltled b me eppropdele agency for review ant a p vol A elms lnlr nd dlepnul m onenl mey M
abandoned and replaced by a cWcmmgyNp diets l component in a predatermircd area M sulede"is.
System Abandonment
If use of this PONTS is subcontracted, it Shas W abnkwlM N emmdents WM SPS 383.33. Wisc. A anln. Code.
sr mom coO
SEEPIC TANK MAINTENMCS AORE&rd
AND
OWNERSHIP CER71RCAMON FORM
OwnurBuyer LY LE } KRFI CRAWLEY
Mailing Addsea I l0 T Wl I W K{ 50N yII(II rl
er Property AddH'l16 LA OP
(vm(mma mgeh.e d.m __..__rudgw
❑wsme Hgosdrl WI Paroelldeatificd.Nimber (336-a()V.-30
LEGAL DESCRIP'110N 1 , ' I a
Pmpaty W omT IwI y S l_J�J y6 LEac. IA . T—L()YA LW. Towe Of Si.
Subdivision_ 30lsNSer TOA I.LeI. Lute la
CatlEed Garvey Map tl NA vubuoe Page a
Waeraa4D # 56774f - vew o I,;[ pw#e eq
Span how 0 yea Ikm Lat Imes identifiable yes ❑ no
SMEMMAMMIANCE
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ST. CROIX COUNTY ZONING DEPARTMENT
• AS BUILT SANITARY RRPORT
Aearns 4 e lw p r
CITY/Sulu >osoN e.115t.
rvnr %
Lot Description:-
Lol_Block_SubdivisioNCSMp S�wl ati �bgkWay
MAIUY.SU Sec.3d T3U N-RAW, Town of S9- •+i
00-ea
p Ode -A o
aa. HG' r9133. 1"3
SEPTIC TANK — DOE CHAMBER — HO INC TANK WORMATION,
Took manufactures V4c1C1 Svc ST/PCI� SeWack from: House Well/gd� � P/L}
Pump vuvufacaun Mader
Alum location
(HOLDING
Savior mad Vm m frtah av
Mesa location
Alarm kotiov
SOD, ABSORPTI0 SYATRIy_I.
CywVIVDD ��
Type OfryNam: ,1 , l�h 3 fagw �S' Nlmbaofjt
6e@eck fmm: Bouee_wenF d' e/f,�vevtm fmh a'v iohke�U
_
RI EVA7TONc; '
Drmiptim of boaclmak 'Aloe Pf S"rmia
Pmumot NO
Deumption of altmuk benchmmt
Elevation
Buildivg Sewer --- ST/HT Iwet IU .OS n Otow IU3.7 (o PC wet
PC Bosom=Rnda/MmbbW9Lb6 9L-0a T,.fST/PCMmabuk Coves (OS 11,
Disuibution Lines(L)
Bottomo of System ((.)
T4 7 S ( I
Final Cade (t) 9 7-7 9 (14 Y UK ( I
Date Or installation ITM/Weerautaaumbr 339M Seem plan member
Plumber's Signature
-y D/IJmre mmmbn aaa9(,y Dak�
lmpcctO._�%""tu b
e„wya..�•w.
NOTICE: Please provide the following:
A plan view sketch showing everything within IOU feel of the system
hvo honzontel ref points in crnw of eepuc wilt maNwle eovu
Show alwnam benchmark if applicable.
yyy a,nyoy o„°lyn
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
GENERAL INFORMATION
IATTA(N TA Pm MITI
6 KARL
WANUFAULIER
Bmchmah
ounry
plmll ne wino ST. IX
• uxne
I DATA A9900093
BS HI i5 ELEV
AEAeration
Bldg Sewer
urg
St l Ht Inlet
J,1RIOS,
TANK SETBACK INFORMATION
St I Ht Outlet
E-Sif
IPi.sN,
TANKTO
P/L I WELL
OLDL
y e
ROAD
Septr
y4
NA
Dosing
NA
Header/Man
,Z
.jf
Aeration
NA
Get Pipe
B
Holding
Sot System
;t
PUMP/ SIPHON INFORMATION
word Grade
;I. Sf
cfi.g
Marhta
DemaM
0
Mole Num00
GPM
TDH
Dh
TDX
Ft
to m
lmgOi
Oia om mvrtn
SOIL ABKORPTION SYSTEM Its .dw. L.._
e.. a_L...L)
TRF
4, 01 rm
Crimea,
LgWoese
I SYSTEMTO
P/L
BlW
WELL
TAKE/STRFA
LFAOIING
" ,ntw
SAIxAO(
INFORMATON
CNAMREx
um r.
ium laftell r
Sr
35r
+Iai
DR uxR
DISTRIBUTION SYSTEM l('Je.(-F%,.Ifl sir°ji, st
4y1F
w
�P
aea ni /e0
r we
e'ItS
SOILCOVER a Pressure Systems Only ut mound Or At -Grade Systems Only
sure,
h Of
tourist
aef=.we Cema
o..a oxoa
COMMENTS: Im<lude <osedisnepan<res, personspresent, eU l
W6 TION: ST. T09EPH 32.30.19.933,NW,ge 413 ROLLING HILLS LANE
3- Plan rrenuon raptness Dyes load I 11aLtTSZ{r
Use Diner see for additional, lormauon Oa aAZ
t seDa.m ln.anl l�yY•„_p Inmerrw. rr�Pn.ttre .w
so
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