HomeMy WebLinkAbout020-1441-71-000 (2).uaraaee ewa�.alnuwn re PRIVATE SEWAGE SYSTEM "536W29�
Croix
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) 30325.l OnalLa. a re oanitmrl
PaprX neM1Naea a BNergman airy velf Tvµnanp JenBMlchelle BerOman,� TOWN OF HUDSON71-000 s.2797
TANK INFORMATION ELEVATION III
LYPE
MµVFACNflER
CAPACITY
STA➢ON
SS
HI
FS
ELEV
septic
r
ZSa
Senchmar,
2.111
toy,
oL•15
Lwareendrl F
Al'"VA[w.
eag sea,ar
Hoama
srmlml.t
CT704
,I
u
TANK SETBACK INFORMATION
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B.Ib
94.i3
TANHTOiff
Pit
LW
IMAvm
ROAD
M
s.prrc
DI eolmel
Desire
He.aerpe
rr
Din Plpa
Hoiang
sal Scots
11
9. y5
t9.9
POMPISIPHON INFORMATION
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DIMENSIONS
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alto
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INSFEOTnBA K
SYSTEM TO
ry ;ev¢MN�r'cHa
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SOIL COVER
Own, rpi CIMMI4-4.5'�jz"
DepthDepth
COMMENTS: Dmraa ame c¢orepenaee, pemi prl`ex�)
pe ix1.
Location 08 MARY JO AT
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depemal ceu most he offered l m^Wrial PI �ga�n+n
as per moral plan pmmvN Oy plumber 4)pl 1ler, r •�{v _.�
a:.r.!�U^%bt^M"rerme.ew.eev5) R-� 6,
SRDbJ9g (R03II4) iberbm6 Ylr„F,^„pf�h'P� Genitor rIV7?
SYSTEM PLOT PI N
Bsrp a BWE SePBs System
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CONVENTIONAL COMPONENT DESIGN
Heb'den4al Appl,craLpn
INDEX AND TITLE PAGE
Project Name:
Bergman 6 Bedroom Replacement Septic System
Owners Name,
Jon& Michelle Bergman
Owner's Address
668 Ni
Hudson, WI SAMS
Legal Descr,pbon.
SE1/4, NW1/4,$36, T29N, R19W
Township
Hudson
County
St Croix
Subdivision Name:
Comomwood Ridge
We Number.
71 Block Number
Parcel LED Number 020-1441U1-000
Plan Transaction No,
Page 1 Index and title
Paget Plot Plan
Page Septic Tank Specifications
Pages Effluent filter Information
Pages Valve Information
Page System Sizing &Cross Section
Page J U Flow Information
Page Management and coningenq plan
Page Sepbr Tank Maintenance Agreement
Page 10 Warramry Ceed
Page 11 CSM or Plot
Page 12 Exiting Tank Certification
Attachment) Sall Evaluation Report
Designer John Schmitt Llcmese Number: MPR52237W
Date 928/2020 Phone Number 215-760Ue136
Signature:
In -Ground Soll Absorption Component Manual Version 2.0 SBD-10705-PIN. 01/01)
Page 1
SYSTEM PLOTPIAN
Beryman 4 Bedroom
om BaDtic System
s
mDMN
N
""
Scab. I.. N' i
o,
lMr..e.
a
-e
s CAST
W1250-MR
TANK P IFI ATION
gYd5101S
W/ 2 2/le
CAST-A-KAL Doane r
C r
N.ANH E 24I.D. %ECAS! NKAER RSA
CHT w 1/r
L2eme: e'-e'
RDM r-r
Mft N T W
LICND I 4r
WMHT 7.2W IHS
MIST NO WTFT
A CA. A-S DWr M EW4 CAIXET
NUT N WTUT D/EI2 N TIUx
.ECoal. s2x wT l ro
(mNw STATES S£ WIMT)
TW � IlPlq CM v "M Wl/MI
x Tow
WT2T HD£ YLII �D
ACHY CM/Att I.W C UNS
LPACNC XWN IT WSATMATM SIY
S➢M / M / R cm 9R101
LGL(T: WX DESIWI p (MD EHiY)
rNEL. uA D ro (sTmlcTwu r1aT)
W5T = TN
FtA WSLOI TN MWTr T WI CO TE
FOR APPROVAL
Pool
The interval for sandal septic tanks Is set by stale and local code Throughout the United States, Mere is a wide difference of
opinion on what this interval should be, but most regulatory agencies suggest My to five years The Zabel filter, which does not
Howse the frequency of servicing for the tank, sM1auto be cleaned when the septic tank is normally Inspected and pumped.
ever, our tiger Is virtually self-cleaning The continued action of the anaerobic dependence on the Zabel filter causes lodged
slarmldy to ddisitetherateasseml to to bodom of the tank If your filter contains a Smar Flltera alarm, you will be notified by an
S
Step 1:
Locate e Outletmeta of septic lank
and remove me tank cover
'A
SUP 1.
Remove the lank cover and pump the
tank if nerepsaery to prevent any soLda
when the fiCiistremoved seam nets
Step a: Steps:
While holbmg the carindgga overthe Insert the filter caMdg back in the
accessopenmg Mines ofM Mtlga se making sure the filler canndge
with kesM1 water, being caraNd to Mines is properly aligned and completely
all septage metenal back into the lank nessal in tle cal Replace the sgttic
tank cover,
SUP].
Firmly pull the filter handle and slide
me cercdtlge out of the case
aAanpl.o....eerrm m„b. va i..a1animm l"'oauner Ifftcw.mwva u,„ie.nm. w.run.�aov
1477-765-95651 wwev.polylok cum Page
7m F —Amm ma Nan Waeo.s uu..ane rdwwn owe yen.n.
..CCEfie GP
RCEPCM
/WPIER
PAGE
PAGE
i
HANDSHMETOe Bull yst Valve^ Is dion nedtot tp dva flows to ongtic
erfields or systems. In eion III [t eM1e osvpublic s al lhKatef OUFPORrlk rnd egNer lvice Avail It is Me moo tewat M1eahM1 safe a ONPORfarternatlnp Amur A haele eon wenewater ct witl
appnealon[ ue Seth M1va es eels-y n ont.R Mmwastewre era to Me vaTe6 hande of ena a nal
apinage dtoanother Tie ccompl a M1oss eone
an nape flats t0 ply burnun Ee valve hKoU In less Manf IN PoRf
minitte by simply burning Me valve MMou[ digging or
e na with wenewater.
F,dd
PWa
Final
FUW
Mel
No l
Ne 1
Ne l
Valve
0
Visa
Pohmned
Ppnuoma
on No 1
®No l
dwng
ducand
Odd Yeaz
Sepac
gepbo
Evm Yeses
Tank
Took
(WARR
WALL RUN VALVE A -
VALVE Man Ol
RW/GsiCOVER
Ravi
BULL RUN VALVE Wev W
The Bull Run Valve Is available In a' sch 40 pvc
and is suitable wherever septic dlspp{el systems
rrre usecommenced, usi and
inIm
eddentlal applications.
OPERATING THE VALVE
Me alrtNon control handle should be roNma
pencalally to abert amuent to em or Me other
0 two Septic fields. After mi Me Screw up
at one top M the Mine Red, the valve handle can
the fumed with the valve Any Nrnlahed.
BULL RUN VALVE
Complete Valve Kit
Contain
1. Bull Run Valve body
2, 20' Valve Key
3. near Up Adapter
4 WeterlpM Aden Cap
BRVCHUSER-4"
AONSTA LE TO 20"HIGH
Now!,
wi-
IN -GROUND GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with EZ1203HP Bundles
3-ft Trench (down -sizing credit)
µ
m,e, mrm
semc TWIRS) Memseerer
Wieser Concrete
t Sets, TW,At Vcmm ,)
1250
AM -__
ea _ 0_ bet
Zabel
Stamm RIW nt�mr
emUemrncerwar A-100
TYPICAL TRENCH
"m CROSS SECTION VIEW
a L- T — .. (No Scale)
System Elevatmn=955R (bw h promtle minlmum3R
separation between trenches
TYPICAL TRENCH (srwlocaton ormletimTeTse mnrm¢mnan ol¢nme.)
PLAN VIEW
OBSERVATION PIPE DETAIL
sw
(No Scale)
(No Scale)
4' e
uDull W m 10 s.ms
= w
Perforated Lateral
fl
(tyuwal)
oeser aem aoe
Terse) (ryp®p
________
__ __ T
rA-30R
s
----J
1 (rw�n
m
-------------a----------
90
n
w
B=
Ow"o
INSTALL
PER TRENCH
EZ1203H Bundle
Mv�ll
p
9
10.ft bundles @50N EISNum1=450
ry=
(mmErylnfileew 5y¢rems lrc.)
+9
Sfl buMlea lj 25ff EISNima=O_fl'
� dl gnuem to menutenwa5 m mcmrs
= Proposed EISA Per heirs=450
R=
Ran wred myftVI Area=BM R' Distribution Method:
x 2
trenches = Proposed Total EISA= NO ft' branched manifold
R 5
Installation Instructions for
EZjlomSystems in Wisconsin
..........................................
Wrsmrem Department of commerce, Safety and Buildings
Crunch her rdowwetl be modification andror plans for this
product and determined it ro be in conwance who chapters
Comm 82 through 8A Norman Asian plate, and Chapters
145 and 16D, Wisconsin Steal All anee must meet the jIN
ii 5oi Conti ens 6 Locations 3Isoaton distances m noted in
dead regulations
The approved promote are 1203H (3-1 g' bundles cum pipe in
tender bundle in 5'or 10'Iengths) and 12MHP(3- I2-bundles
with pipe in each bundle in 5or 10' worths
A single pipe bundle contains a bur Inch perforated pipe soul
rounded by EPS aggregate and Is held tageNer who bar
eityrom coding A single aggregate bundle conews aggregate
only and is held taretherwnh pchretbykne retard
MNerlala and Fqulpment Needed
• Meet Bundles
• EZflow Geotextlk Fabhc
• EZllew Intemal Roe G.uplers
• Pipe for Header and Inlet
• BaGoce/mAnorter
Installation Instructions
The (reformers for Installation of chips, products we given
below This product must be installed in accmdanre who, state
rules defined in chapters Comm 62lheaugh 84, Wisconsin Ad -
usual Gde, and Chapters 145 and 160, Wit Stat-
utes, as wall as the local health sop om ore cunent design
manual
1 After dueIded town department has deermned suing,
configuration, and layout for the EZAow stems, stake
or mark with paint the knows, of trenches and lines Be
careful to set correct tend, roved pipe, header lima or dls-
Mention Wa and trench bedroom elevations before mskk
Ishon of pipe bundles
2 Remove plastic EZXow shipping bags prior do placing
bundles in the irendi(eeb Removes any castle of in the
tench before system is covered.
3 Thls product must how geokale fial that meet re-
vueemmts of s, Comm 84,30 (6) (9), Ws Arm. Code,
Installed dlredly on top of the Product and downdmg
down along the sides of me worowd to a pint at least as
Inches from the bottom of product
4 When m9alled in a trench the trench should be dug to
a warn ofWarned This not only saves It n reserve -
for, but use provides boner ward-teamp capacry after
baN014ng d compete
VAEZfloww
ytMFR}MAR
................. 6.......................
5. The Pasta on area (Sn nreseey, for a given site shall
de sued based on ma+lmum dally sewage flow (GPD) and
the contra band her the site IF mrlem centers in me, the
Ell spot can be used in Nsswssn, rewPorg in a al
smaller drantleld
6 Piece F2flow wages) in the EZAm conogure4on ap-
proved by ryskm design cennit spetl(led for the Won -
Br site The fop or center-fr i bundles mMaming pipe
are joined and to and van an internal pipe caper Airy
addition ll aggregate only bundles Mad may de spurred,
shwld be butted man to otter apgrtgakmly bun-
dles and do rot ralWre any was of connecllon
9 The top of each GEO broader contars a filter tebrc me -
manufactured lnbet the nemng and repropose The
fabric Is Invented to prevent mil intusm The Instiller
shall make sure the the GEO is contained upward and is
in rvnnfact with the fedtc conter id In the adjacant own -
der before backrllmg
B The li Drall Systems anould be ndow led in a
coal bench in all directions; from across and along the
bench Wttom)andsdoommlbwtM comrade the ground
surface elevation (uniform depW, wM all control
courts IC -foot immirreal bundles Need end to end,
min cenlal bundle tlisinbWion pipe Interconnected
without any tlems, step 5 or enter water steps
9 The trench top shall be graded such mat water volt not
pond, Back(IN should be stal or regard Immediology
after completion to reduce eromm,
10 Mrs, EPS surface we flows and can M in curved
trenches as may be somebody d armed trees, Winders, or
other chances
11 EPS aggregate Is tighter than waee mertkde, it might
ber expected that natural runyanry forces would tend to
se Mary to flohourat of ground when
sweet w economic
occurs. I severance Ms sown, royal
that this is not a pmbkm whw systems have a minimum
of B' of of corer as recommended by msnNacturer
12WH-GEO
G W4O
MekneAs
................. 4........... 4.............
Pape 7
PAGE 4 OF 4
In -ground Gravity Management Plan
IMPORTANT:
The owner of this n1mu a gravity system shall be responsible for as pematual la erallOn and maintenance pursuant to
redwrements of SPS 302J01, Viso Admin Code Pursuant to SPS 33352(2), Also, Admin. Cade, cob system shell
be considered a human health hai It not maintained In aCWMance will this approved management plan.
Furthermore. all inspection and maintenance acnvNas shall be perlpmed by a registered POW S Malmali er in
aaoNance with SPS 303 52 (3), Wasp Admin Code
Wifimum Dlstlennal Anne General Limits:
Design Flow a 600 god; BODs 5 220 nal TSS 5150 mgl FOG 5 30 mgL"
Inspection Checklist INSPECT EVERY 3 YEARS
type of use
age of thatem
nuisance factors (10 all user compamts, etc )
mechanical maiuntllan (I e, pampa, valves, switches, floats, etc)
annual fatigue (!e, leaks, beaks, cormosion, eh)
se ids volume In enaemblc Vestment heads) and any olStnbution appunenanctub (i,e., dIS rroul I drop bores)
neglect or Improper use (I in, exceeding design capacites, gostated actakess, etc I
d extern of pending In dlstdbWan call prior to dosing
• doeinglmeguledtles-Ifeppllceble(le, pump re-cyctng, float switch saplings, em,)
• electrical components- If available (19, wiring, connections. switches, control., Bmers, Name, etc.)
• tlaturalon lateral or lateral omits Wugging (measure lateral dlctel pressure -compere to design epeelnwuon)
o surface discharge of aMuedt or sewage back-up into 9mcture Served
Maintenance Chackllet MAINTAIN EVERY 3 YEARS (or when necessary)
o Seotic and dose all shall be pumped by a canned seepage servicing operator licensed under a 201.40 Win
Stetswhen the volume of "lids in the all exceeds one-Mlrd (1I3) one Hall volume of ate tal or
as required by local oMlnenm. Deposal of contents shall be pursuant to NF 113. Wall Admin. pal
• Effluent Mbrts Shall be hapected every 3 years and shall be tlemrod when r e su ury to remora any
aU mulated sdlds att ,N to mandaMrees spec?cffiions A Senitllp petlM hill alwap be 0roebr Nen l2
months
System maintenance raPelL Shall bs submitted to the proper Ideal government and In .... Me," wIM
SPS 3e3.55 Wtep Admin. Code Repent any component (allure or m difunction to:
Name of individual n ca .. Schl & Sons Excavating, Inc. Phone 715-760-0486
Local gwwnment sore St. Croix County Community Developemenl Phone, 715-386-4680
Lora government unit address: 1101 Carmichael Road, Hudson zip 54016
My defective pan of this syefem shell be repaired, replaced, or removed pursuant to SPS sal (1), WIR. Admin.
Cede Repair or replacement of failed a malfunctioning components shell comply with SPS 33S Wisc. Admin. Cade
No product for chemiGl or physical indication of Me POINTS may be used unless approved by the depadm ad In
documents with SPS 304, Wlsc. Admin Code.
Contingency Plan
In the event that any felled treatment component of this POWTS cannot be repaired, h shell be replaced pursuant to
a plan submitted to the appropriate agency for review and approval A failed lmground dispersal component may be
abandoned and replaced by a code-cdm flying dispersal component In a precletendned area of suitable cold
System Abandonment
If use of this POWTS is discontinued, It shall be abandoned in accordance Sam SPS 383 33, all Admin. Code.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner;Buyea Jon & Michelle Bergman
Mailing Addredi Mary Jo Court
Property Addles.668 Mary Jo Court
(Vmfiee.wn MUq him Pluwng a Zarmg OryaMiem for new eomvunion.)
Coy/StafeHUdSOnt W1 PamellderificauonNwnber020-1441-71-000
LEGAL DESCRIPTION
Property LocabonSE ,NW A. sM. 36.T29 NR19 W, Ton of Hudson
sebma,.,on punt Cottonwood Ridge 1 st_ LN g 71
Cerrifedsurvey Map M age
rtq ,Volume ,P4
Warranty Dead JO.i(a�l' (before 207)Volume , Pope X
Sprc Muse OyesO,o Lot lines idenuNble ayai
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and nmlnlenanoe of your sepnuystem wild rnulun its preoumrc fdwe or hasi worse ?most
of out the topic tank party ,hm,yet,s ur pointer it needed or, licensed pumper Whalyoupulise,
the pumpmy system n alhrurim be Interim ofAeronc nark as atrtm,nem stagan
e the nt disposal system Owns malns,unee
,wine tins are Ski in E9P5383521) and in Chapter 12 VCmUCawny SummaryOrtlnanac
The property owner sgtees In mood to St Croix County Planning d Zoning Cepammrnt a ttn,lul,m from, signed by the,
exa
ct her by a mm,er plumber. lnumevman plumber trendm scientists of or n licensed pumper wall Iret (I ) the on sit,
nJiyvul ryslem uin pnmer opetdiny wnJilun eniLur lElelln inapmim mM ryimping(ilneceaearv) IM1expucwkis
poorthan1:3 full of sludge.
I sure ¢ umawagoad how read toe above m9uuenenta and ag^e somehow the prigr sswtge mepmal ayvem ,in th,
sYrdudr per! auto. Mrem, a ad by Ilrc I3erynmen, ofyle,Y And Professional Nemeses mtl tie OeprrMnt splintered Respvm,
sioeof Wtemrin. Cmirvmnmmmgrunt Your csystem Mshenmamutrcd stun becampMM vA marked re for 8t Cmm
County Pont" ing! Zoning Department wioin 30 drys ofdte throe year eopimmn time
low ri that SH satemenb on this form we true to the ben of my/our knowledge, l/we aNae Ye nwnegs) of
property described some, by older of a shot ty deed mended in RcEshr of auras ORa
N tuber of bN uo 4
1° /
(I ); 09126)20
SIGNATURE OF APPLICANTS) DATE
•Any information that is monothuniM may resell in the order permit being overreact by foe Passing a Laing Depanmem. •'
brings all this applicants a tcuNN was -rams, di train the Register of IMds office eM a copyof tax amfietl gooey map if
rtfermum r made in the wmnmy need
(REV 04112)
JUN 1 6 2003 .
w_,r f(y, iF.M.lRI.xA�.. SN
41OI,EFI, �31� •• •• • .se. � Mei
FM
fit
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) ass Mary do court located
at SE �/, NW 1, Section 36 Town 29 N Range 19 W,
Town of Hudson , St. Croix County Wisconsin
Upon inspection, I certify that I have found the tank(s), to the best of my
knowledge, will conform to the requirements of SPS. 384.25, and it (they)
appears) to be functioning properly
Most recent date of inspection or service
Did Flow back occur from absorption system? Yes_ No_
(if no, skip next line )
Approximate volume or length of time: gallons_.. mitc
Tank Capacity 1250
Construction: Prefab Concrete x Steel Other
Manufacturer (if known) weser conoste
Age of Tank (if known) 17years
Permit number (if known) 430320
H
JMn sin tt
o
(LinPied Plumber Signature) (Print Name)
mZ
MPRS 223760
(Title) (License Number) MP/MPRS
(Date)
Form to be completed by licensed plumber (Dept of Safety and Professional
Services Chapter 305 and s. 145.06, Wisconsin Slimiest or licensed disposer
(NR 113 Wisconsin Administrative Code)
Rev. 2/2012
Page 12
w a •°�°'^'^^ PWATE SEWAGE SYSTEM
• • INSPECTION REPORT
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