HomeMy WebLinkAbout010-1050-90-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County. St. C.rOIX
Safety and Budding Division
INSPECTION REPORT Sanitary Permit No.
(ATTACH TO PERMIT) 630369
GENERAL INFORMATION State Plan ID No
Personal information you provide may be used for secondary purposes [Privacy Law, s 15 04 (1)(m)]
Permit Holders Name City Village Township Parcel Tax No
Mary Speer I TOWN OF EMERALD 010-1050-90-000
CST BM Elev. Insp BM Elev BM Description ( Section/Town/Range/Map No.
OD,-7 1 21.30.16.314
TANK INFORMATION ELEVATION DATA
TYPE
MANUFA URER
f
CAPACITY
Septic
as 71Ct--.0
12o c�
Dosing
S�li IJ
n
Affftffmr
FI I r
DK✓LCo TJiD v
Holding
TANK SETBACK INFORMATION Co,AcrS SC�2vtc/ aN !
TANK TO
Pk I 1
WELL
BLDG.
Vent to Au Intake
ROAD
Septic
> 50 '
L-Ib,
I
Dosing
i5p ,
6-b
//3-Ly
(,O 5 •
7 2—
Aeration
Holding
PUMP/SIPHON INFORMATION MvIS4-- F1Lj)✓C(r 2DcyQh
Manufacturer
I Demand
206114
GPM D
Model Number
D1V , 5Z
D CJFt
TDH
Lift
Friction;55
System Head
T/,
65
Forcemain Lengt(1 O
Dia.Z
Dist. to Well
SOIL ABSORPTION SYSTEM
01
STATION
BS
HI
FS
ELEV.
Benchmark
Alt. BM
Bld Sewer
1�.o
yo.75
St/Ht Inlet
15'U
01, 75
SVHt Outlet
1,5
8q, SS
Dt Inlet
) 5. 5
3T. Z5
Dt Bottom
Q , I
S5 , 35
Header/Man.
g 3
fc. qS
Di t. Pipe
L�
O p 3
,t 4. N5
Bot System
Final Grade
6.Z5
y8. 5
St Cover
ZL + ZZ CA L><,r5
BED/TRENCH
Width 1
Length
No. Of Trenches
PIT DIMENSIONS
No Of Pits
-
DIMENSIONS
A?
/((//
Z
SETBACK
SYSTEM TO
P/L )`BLDG
WELL
LAKE/STREAM
LEACHING
Manufacture�r+ .'I.I
INFORMATION
CHAMBER OR
UNIT
1 H 1" Ymf
Ty p Of System
i
r
O
' J 1
Model Number ^ �L�Ll
DISTRIBUTION SYSTEM 2'/ ' /� Q n ; /01 I,'x4 &-v L.I.
HeaderlManifold
Length .5 ' Dia /
Distribution
Pipe(s)
Length Do Spacing
ole Size
x Hole Spacing
Vent to Air Intake
//
" 7'- ' L
SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only 0-C K}
Depth Over
Bed/Trench Center % _ 2. (�
Depth Over ��
Bedrrrench Edges �' 2
xz Depth of
Topsoil
xx SeededlSodded
xx Mulched
s ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
Location: No Address Available
1.) Alt BM Description
2.) Bldg sewer length = 55
- amount of cover = 7 Z
Plan revision Required? ❑ Yes No Ll Zd 2)
Use other side for additional informati
Date
SBD-6710 (R.3/97)
Inspection #1: Inspection #2:
- Avn, s Dv�
7uwks �rL'�d�r ii w 2-5
-ukU L��,L� s��..�n.w�G(taw�e/rs rnns�pvF
Insepctors Signature Can. No.
_..
Safety and Buildings Division
County
61 , C QO, ,4(
` D S
201 W. Washington Ave., P.O. Box 7162
-� P
Madison, WI 53707-7162
Ssnitan Permit Number Ito be filled in by Co)
S
Sanitary Permit Application
State Transaction Number
In accordance with SPS 383.21(21. Wis. Adm. Code, submission of this form to the appropriate governmental unit
Project
is required prior to obtaining a sanaary permit. Note', Application forts for stat"wned POWTS are submitted to
the Department of Safety and Professmnal Sen ices Personal information you provide may he used for semndary
Address (if different than mailing address)
purpases in accordance with the Privacy law, s. 15.04 I m Stau.
7 �� /�d f�
Print Information
I. Application Information- Please All
V�
.7 _ -t
Property Owner's Name
Parcel N
MA SPct t'
Property Owner's Mailing Address �ioE
Prope"}`ocatinZl• 30• JG 3 i�
Govt [.or
'/. �-1/4 Section
01%, State
Zip Code
Phone Number
•
t5 Qt3
circle m
Toil was
It. lypeofBuilding(checkal hat apply)
Lot
Subdivision
I or 2 Family Dwelling - Number of Bedrooms �L' _
Public / commercial - Describe use
Block k
❑ City of
Na
State owned - Described use --
of
CrSM Number
zo�t x
yJi-'
I11. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A.
New System
Replacement Sy stem
Trcatment/lhrldmg"fank Replacement Only
❑ Other Mrxhficatwn to 6xuung System (explain)
B.
U Permit Renewal
❑ Permit Rev ismn
❑ Change of Plumber
0 Permit Transfer to New
List Previous Pcrmil Number and Dale Issued 1
Before Expiration
Owner
IV. Type of POWTS System/Component/Device: (Check all that apply)
r In-0round ❑ Pressurized In-Gmund At -Grade Mound' 24 in of suitable wil Mound <24 in of suitable sod
Holding lank ❑ Other Dispersal Component (explain) _ ❑ Preuvatmem Device (explain)_____
V. Disper"V11'realment Area Information: Z 3 y ~C x f1R
Design Flow (gpd)
Design Soil Application Rate(gpdsf)
Dispersal Area Required
Dispersal Area I'ropos (sf)
System Elevation
0144000
1
85- 85-7
8 2 8"e3
95•S
VI. Tank Info
Capacity m
Total
0 of Manufacturer
Y
o
r
Gallons
Gallons
Units D )
2
r
C
.9
New Tanks
fi! lee
Septic Tank
1f
—
I1-614
1
5 k Ai
X
Lift Tank 1
VII. Responsibility Statement- 1, the undersi nod, umc res nsib 5y installs ion of the POWTS shown on the attached plans.
Plumber's Name (Print(
Plumber' re
MP/Iv1PRS Number
Busvtnss Phone Numtxr
Lewis Bork
253976
715-231-7375
Plumber's Address (Street. Oty. State. Zip ode)
E7818 Court Road F Meno_
_ _ _ _1_54.751
V III. CountylDepartment Use Only
Uuappmved
FL-1
Permit Fee,Dale
S ?n oo
Date issue Issuing Agcnt Stgn re
I
❑ Owmer Grvcn Reason for Denial
/g
�1y7 Cond��pproval/Reasons for Disapproval 3 J25f q �G� r�• 1� ��
�p
f 96ptle 60C. effluent filler and 1 ��kl .� L U P-ZoZo -o Tj L/ a e'(- i e- f
`sal must be serviced! maintained k r
dispel cell ('
�Dina(
zs per management plan provided by plumber, In I
2 All setb"71i -Fguiremenls must be maintained
as pet 2ppcauie cooeloralnances.
SBD-6398 (R. I1/11)
$�InSA. lie ti- M4-5+
�ro�t S�Si{r+-r �wfai�rnarc.�
��e� o i�Jl.cef f
-:;;"1 —,a(A a ^ IJn n
n ,,
Safety and Buildings Division
County
Si , C����
= 93
201 W. Washington Ave., P.O. Box 7162
Sanilan Permit Number (to be filled in by Co.)\
P= Oil
NOV
Madison, 53707-7162
3o36I
;.`
'- , it
AppllCiatl
State Transaction Number
In accordance wiff 383 21(2), Wis Adm Code, submission of this form to the appropriate gove u
Project
is required prior to obtaining a sanitary permit. Note Application forms for state-owned POWPS are submit ed to
the Department of Safety and Professional Services Personal mformauon you provide may be used for secondary
.Address (if different than mailing address)
purposes in accordance with the Privacy Law, s 15 04 Ixm), Stars
I,
23(U
L Application Information- Please Print All Information
Propem Owner's Name
N'IA SPcJ, f
Parcel N
Propen} Owner's Maitiite Address '
VE'
Property Location ' 3!. l J 3, y
Govi Lot b
/. 1/4 Section
City. Stine Zip Cede
Phone Number
454013
cycle o
NCR
11. Type of Building (check a hat apply)
Lot M
ooms L_
I or 2 Family Dwelling -%use—
Subdivision
Public / commercial - D
Block a
❑ City of
State owned - Described
Na
CSM Num
Villageyo�fwP
l �� C �/
VNK- 4-7 /�
Vim. `fix Yvco 1'Lll�{..e.-\
Town ofG A WD
Ill. Type of Permit- (Check only one box onXne A. Complete line ' applicable)
A.
New System
Replacement System
Treatmentfliold Tank Replacement Only
er Modification to Existing System (explain)
B.
❑ Permit Renewal
❑ Permit Revision
ge of Plumber
❑ rmn
ist Previous Permit Number and Date Issued
Before Expiration
O No
er
IV. Type of POWTS System/Component/Devic (Check II that apply) Z2„ +ZZ 6), G�
Lo P `
Non -Pressurized In-Oround ❑ Pressurized -Ground At-G e Mound > 24 m. of suitable soil Mound < 24 in. of suitable soil
Holding Funk, ❑ Other Dispersal Compo t (explain) ❑ Pretreatment Device (explain)
V. DispersaMeatment Area Info ation: 2 ` 3' 4 6W
Design Plow (gpd)
Design Soil lication Rate(gpdsf)
Dispersal Arc equir fist)
Dispersal Am Pro d (sIf
System Elevation
4la�
7
85 �5�
89 2 �!3
95•S
VI. Tank Info
Capacity in
Total
of
Manufacturer
Gallons
Gallons
U
ew Tanks
Existing Tanks
3
a
c
U
ii
L
P
C
V
Septic T
X
—
IZS`!
I
kA J
X
Lift
VII. esponsibility Statement- ],the undersigned, nine res as billi-ty'llikinstallailion
of the NWTS shown on the attached plans.
Plumber's Name (Print)
Plumber' re
MPfMPRS Number
Business Phone Number
Lewis Bork
53976
715-231-7375
Plumber's Address (Street. City, State, Zip ode)
E7818 County Road E Meno I 54751
Vllt. County/Department Use Only
Approved
❑ Disapproved
Permit Fee
sued
Da[ Issued
1 1 ! Zo
Issumg.Age ignature
❑ (Tuner Given Reason for Denial
�
IX. Conditions of Approval/Reasons for Disapproval 3 �.� GoK i, ! 0 K $ t V -7A2p - p$ Aire- % h 2
W i`1an �-�nY per• ;
SYSTEM OWNER 1,+��-I�C ii�V� l� S�S`�Wt M4 k4r0. VLC2
1. Septic tank, effluent filter and p 1
dispersal
cell m ist be sery i-ea 'maintained ra
8S r,M uiaiinycniem plan prnwaeo oy pi,imber
2. All setback requirements must be mcln!:aned
SBD�39`ffQR2Ylf#Hla ecJasJ r,_„c_..
E
C H ECK BO%AS APPLICABLE.
CHECK O%AS APPLICABLE.
CHECK
PAGE 2 OF6
SOIL EVALUATION
Scale: 1°=40'
SITE MAP
ao
80 PLOT PLAN
PROJECT NAME:
DESIGN FLOW. 4M GPD
Ai ll�
f Situ'
1o,
Attach design lim calculations for colnmeraal plans.
PROJECT ADDREs9,
1140 k PWf—
Pipe Material / ASTM Standard (Tables 38�4.�3�03 &p 3�84.305)
Sanllary Sewer. I
aM Symbol: *
BM Elevatlon:FT
t
`` ''
Force Main: %
BM Descriplbn:
TOP oi' �Irn.l s"C.[A
S
Slope GradW %)
`
I� Well Symcd (It applicable): Q
dmMhgnorth q'
tlthe n an epwv
IMPORTANT:
'
Show ground elevation contours at suitable Intervals,
of Tested Area:(
on the approprlta Me
$KOLW
-75a
I
11 pkpv,x
x/W -
SM _ IDDI
AloA ae
kwJ 'Erf3Aa4, TbakEs -7 NO ACE
PAGE 1 OF 4
In -Ground Gravity Plan
Index & Cover Sheet
Component Manual Design References:
Version 2.0, SBD-10705-P (N.01/01, R. 10/12)
Pg 1 of 4 Index & Cover Sheet
Pg 2 of 4 Plot Plan
Pg 3 of 4 Dispersal Area Cross -Section & Plan View
Pg 4 of 4 Management Plan
Attachments:
Enclosures:
A ry
POWTS Application for Review
Soil Evaluation Report & Site Map
ZsM�
PPlic� o� ti
Project Name / Description
Owner Name(s): mA w SOcGQ Phone:_ y -1-� 23
Owner Address: 23 (a alAW4 or Zip: t-1013 ,
Project Address:
Govt. Lot: _ _1 A of _, 5E_ 1 /4, Sectiono7j. , TS2N-R 1 % E U or W
Township: EmEI[Atd County: Si-(IVAy
Project Parcel ID #: OIO 40SQ - CtO - OaO
Designer Information
Designer Name: Lewis Bjork IPhone: 715 -231 _7375
Designer Address: E7818 County E , Menomonie WI 54751 Zip: 54751
E-mail: lewisbjork@yahoo.com ;
License Number: 253976
Remarks:
Signature: Date: (J)'22-Z0Z0
signature required on ea submitted copy.
SE
CHECK BOX AS APPLICABLE.
CHECK ]X AS APP_CABLE.
PAGE 2OF6
SOIL
EVALUATION
Scale: 1"=40'
SYSTEM
SITE MAP D
aD sD
eo PLOT PLAN
PROCInEECT NAME:
DESIGN FLOW Ciy�) GPD
�AC 1f
.]YL(.(�
To,
Attach design flow calculations for commercial plans.
PROJECT ADDRES
1140 e.
Pipe Material / ASTM Standard (Tables 38�4.3�0-3 &�!3�8,4.30-5)
y"
N %
Sanna'y Sewer, /
r-1
BM Elevatbn I W 1 FT
-
BM Symbol
Force Main: /
BMOeschpibn
Ill' Of ►��
Slope Gradient (°A)
I O Well Symbol (it applldable.)�
lhdk to mN, by
dhe ing an.lone
IMPORTANT:
Show ground elevation contours at suitable intervals.
of Tested Area, on the appropdte line.
t
pKu
9S,s. t*s` 904. 99 S
S o R'f
61
el?,�� V
vit
7:F".64^tt CZ-1 40t
CeLLS 3t iL
elm 9,AA.--
IOD.'►
R/w -
/Yo A R.r-
l
I ODSPS TEEs -7100 Aa
IN -GROUND GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with Quick4 Standard-W Chambers
3-ft Trench (down -sizing credit)
�•S
SOIL COVER
min, 12'
(typical)
Septic Tank(s) Manufacturer
Septic Tank(s) Volume(s):
gal gal gal gal
Effluent Filter Manufacturer:
6tellNeD
Effluent Filter Model ik
12"
min trench
lnew°can TYPICAL TRENCH
a CROSS SECTION VIEW
ityP al) (No Scale)
System Elevation ft
(typical)
Qu1ck4 Standard-W
w/End Cap (Show location of inlet / outlet pipe connection on plan view.)
(typ � I
L------------- ;�' ---------�----
B= *0 ft
(typical)
INSTALL PER TRENCH:
O2Quick4 Std-W @ 20 fh EISA/chamber = �40 ft'
+ Pairs of end caps @ 6 fV EISA/pair = ft'
= Proposed EISA per trench = 44160_ ft2
Provide minimum 3 ft
separation between trenches.
Observation Pipe
(typical)
install per manufacturers
/ Instructions.
IA=3.0ft
(typical)
TYPICAL TRENCH
PLAN VIEW
(No Scale)
Quick4 Standard-W Chamber
(typical)
(mfd by Infiltrator System, Inc.)
Instal pursuant to manufacturers instructions.
Required Infiltration Area= 3-ft ft2
S9
x 9 trenches = Proposed Total EISA = . ft'
Distribution Method:
PAGE 4OF4
In -ground Gravity Management Plan
IMPORTANT:
The owner of this in -ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to
requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall
be considered a human health hazard if not maintained in accordance with this approved management plan.
Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in
accordance with SPS 383.52 (3), Wisc. Admin. Code.
Maximum Dispersal Area Operating Limits:
/
Design Flow = 100�
��gpd; BODs S 220 mgL''; TSS <-150 mgL"'; FOGS 30 mgL"
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors (i.e. odors, user complaints, etc.)
o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.)
o material fatigue (i.e., leaks, breaks, corrosion, etc.)
o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes)
o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.)
o extent of ponding in distribution cell prior to dosing
o dosing irregularities - if applicable (i.e., pump re -cycling, Boat switch settings, etc.)
o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.)
o distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification)
o surface discharge of effluent or sewage back-up into structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis.
Stats. when the volume of solids In the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or
as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code.
o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12
months.
System maintenance reports shall be submitted to the proper local government unit in accordance with
SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to:
Name of individual or company: Lewis Bork Family septic Service Phone: 715-231-7375
Local government unit: Dunn County Zoning Phone: 715-231-6521
Local government unit address: 3001 Hwy, 12-29 , suite 240 , Menomonie ZIP: 54751
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin.
Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code.
No product for chemical or physical restoration of the POWTS may be used unless approved by the department in
accordance with SPS 384, Wisc. Admin. Code.
Contingency Plan
In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to
a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component may be
abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils.
System Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code.
PAGE 4OF5
GRAVITY -DOSED
SEPTIC / PUMP TANK SPECIFICATIONS
{No Scale}
4"0 Vent Pipe
>10 It from
8ullding
Electrical must comply wkh
12"Min. or 20 It above
SPS 316 and NEC 300
Established Flood Elevation
�'1'j yy�therpmof
(typical) Approved
I I Junction Box
IMPORTANT:
Anchor tank(s) as necessary
pursuant to SPS 383.43(8)(g)
Finlshgd Grade
CAPACITIES @ I�• bS gaUn a V.
Depth (in)
Volume (gal)
A
B
2.0
3z.1D
[c]
5
$p.2
D
I I-1.
I
Igs.4
*T
A
j l I
f_ l�
*Pump Tank Liquid Level = 41 in
D
Force Main Diameter �In
Force Main Length = D ft 3"Approved
Force Main Void Volume = 8 15 gal
[C] Total Dose Volume TDV alldose
(< 0.2X design flow+ force main void volume)
Zo�Pv�,
Vertical Lift = 12 ft
Airtight Seal
Extend manhole user as necessary.
Approved Locking Manhole
with Warning Label Attached ��
(typical)
4' Mln. or 2.0 ft above L_
Established Flood Elevallon
(typical) —Z
Disconnect
18' Min.
(typical)
1
Weep
Approved Joints with
Mole
Approved Pipe 3 N onto
Solid Ground
(typical)
_Alarm
_o
PUMP -OFF (�7
_a
ELEVATION = ` ft
concrate . INSIDE BOTTOM
Brock ELEVATION O ft
Beneath Tank
(ZO
FrIL�,'li. L-'55 = Q.9Z/1170 �
4C> lo0
PUMP TANK:
SEPTIC TAWS):
Volume= _j5y gal
gal
Total Volume=rj''�
Manufacturer: SuA�1
r.,
Manufacturer(s): G-,%- J
Pump Manufacturer. Zee 11LYL
Install approved effluent filter at the septic tank outlet
immediately upstream of the pump tank inlet
Pump Model: (Sea auchw mpcurve.)
Controls/Alarm Manufacturer.. 7Gou
Filter Manufacturer: lJrt�y1
Controls/Alarm Model: AIR
Filter Model: t'T-
Float switches containing mercury are prohibited.
150 Series Effluent Pumps', Zoeller Pump Company
https: 'www.zoellerpumps.com en-n&�productslsump-effluent-pumps'ef.
;:— F—
wW
50
14
45
153
12
40
0
35
152
z 10
30
0 8
25t
F-
o g 20
15
4
10
2- 5
01
GALLONS
PUMP PERFORMANCE CURVE
MODEL 151/152/153
160 200 21
FLOW PER MINUTE
11
2nf5
2121,12018, 10:05 AM
/ \�� WARNING DEATH MAY OCCUR IF TANK IS ENTERED
�
Q I WITHOUT PROPER EQUIPMENT
I o I
1 I
TOP VIEW OF MANHOLE COVER
3.00
400 L
1 {— 2700—I 27,00—I
ST�2400— 2400—��
�1600—I 100—I
5
TOP VIEW OF TANK (TAPERED)
NL� / _ OUTLET sKnw eoo
r00Li
1800
_ ::` �5923
41NCH PRESS�
18I 0 4 INCH
j
SEAL GASKET PRESS
INSTALLED SEAL I
1
WHENPOURED AFFLE GASKET
4170
FILTER
3 00SECTION VIEW OF TANK AND COVER —1 F _3,00 OUTLET END VIEW OF TANK
Model Number: 800 SKAW PRE -CAST Phone: (715) 967-2277
Approved for., SEPTIC, SIPHON, HOLDING, OR PUMP 26255 105th Street, New Auburn Toll Free: 1-800-924-8625
Weight Inlet /m. Outlet Dim. Liq. Depth Gal. /In. Max Cap. Wisconsin 54757 Fax: (715) 967-2707
7930 tbs. 46.7" 44.7" 41.70" 19.18 600 gal. www.skawprecast.com
WARNING DEATH MAY OCCUR IF TANK IS ENTERED
Q \ WITHOUT PROPER EQUIPMENT
I o I
1 I
\ I
TOP VIEW OF MANHOLE COVER
00 4 00 L
200- I -2400
24400 24 00 -
500
I-1600- 000J
INLET
G I B 00 � OUTLET
4 INCH PRESS 3.00J 18,00\V 4INCH
SEAL GASKET L PRESS
INSTALLED SEAL
WHEN POURED T ff GASKET
300
Model Number: 1250
Approved for: SEPTIC, St
Weight Inlet Dim. Outlet Dim.
8450lbs. 1 42" 1 40"
BAFFLE
6700
7100
77.00
24 50
118 50
II
11350
FILTER
_I 12 00
500
TOP VIEW OF TANK (TAPERED)
OR PUMP CHAMBER SKAW PRE -CAST Phone: (715)967-2277
26255 105th Street, New Auburn Toll Free: 1-800-924-8625
3' Depth Gal. /ln. max. ap. Wisconsin 54757 Fax: (715) 967-2707
36.00" 34.65 1247ga1 www.skawprecast.com
r�
Quick4.
4V The Quick4"' Plus
INFILTRATOR Standard Low Profile (LP) Chamber
The Quick4 Plus Standard Low
Profile (LP) offers maximum
strength through its four center
structural columns. This chamber
can be installed in a 36-inch-wide
trench, It is shorter in height than
Infiltrator's other Standard model
chambers, allowing for shallower
installation. Like the original line
of Quic1<4 chambers, it offers
advanced contouring capability with
its Contour Swivel Connection'",
which permits turns up to 15°, right
or left. The Quick4 Plus All -in -One
8 and Quick4 Plus Endcaps provide
increased flexibility in system design
and configurations.
Maximum Strength
Quick4 Plus Standard
'Chamber Specifications
Size
34"W x 53"L x 8"H
(864 mm x 1346 mm x 203 mm)
Effective Length
48" (1219 mm)
Louver Height
6.3" (160 mm)
Storage capacity
32 gal (121 L)
Invert Height
3.3" (84 mm), 9.6" (244 mm)
APPROVED in
Qui
Sta
Chamber Benetits:
• Low profile design makes this
chamber ideal for shallow
applications
• Reduces imported fIII needed
for cap and fill systems
• Four center structural columns
offer superior strength
• Advanced contouring connections
• Latching mechanism allows
for quick installation
• Four -foot chamber lengths
are easy to handle and install
• Supports wheel loads of
16,000 Ibs/axle with 12" of cover
Quick4 Plus
All -in -One U ILI 14
Periscope Benefits:
Allows for raised invert
installations
• 1800 directional inletting
• 12" raised invert is ideal
for serial applications
8 Endcap Benefits:
• May be used at the end of chamber
row for an inlet/outlet or can be
installed mid -trench
• Mid -trench connection feature allows
center feed inletting of chamber rows
• Center -feed connection allows for
easy installation of serial distribution
systems
Variable pipe connection options
allow for side, end or top inletting
Piping drill points are set for
gravity or pressure pipe
Quick4 Plus
Endcap Benefits:
• Simple, flat design
Allows installation of a pipe
from the end only
Piping drill points are set for
gravity or pressure pipe
Certified by the International
Association of Plumbing
and Mechanical r)
Officials (IAPMO) (\
ti
Maintenance InstructionsIGO
Biotubem Effluent Filter
How to Clean Your Effluent Filter
To ensure your effluent filter is functioning properly, it should be inspected every year. Under normal conditions, your
effluent filter will function for several years before cleaning is necessary. The filer should be cleaned when it becomes
clogged enough to restrict normal flows out of the septic tank. At a minimum, the fiMor should be cleaned whenever the tank
is pumped.
Most people prefer to have a septic tank service provider take care of fiher maintenance and cleaning. You can find a
septic tank service provider in the Yellow Pages, under'Septic Tanks & Systems.' Or you can contact your county health
department for a list
If you wish to inspect and/or clean your affluentfiRer yourself, be sure to dress properly. Wear full-length pants and shirt,
shoes, gloves, and goggles or glasses. Then follow these instructions:
I. Remove the access lid to your septic tank by unscrew-
ing the stainless steel lid bolts with hex head wrench
provided. If your lid is above ground, it will be easy to
find. If it is buried below ground, find the marker that
indicates its location.
2 Remove the finer cartridge by grasping the tee handle
and lifting it out of its housing (see photo 1)..
3. Spray the cartridge tubes with a hose to remove any
material sticking to them (see photo 2). Ensure the three
orifices in the optional flow modulation plate inside the
fitter are clear of any debris. Make sure the rinse water
runs back into the tank, but do not allow solids material
to fall into the open filter housing.
4. firmly place the cartridge back into the housing.
5. Some effluentfilters come with an alarm that activates
when the filter needs cleaning. If you have an alarm,
checkto make sure It is working by lifting the float
with a sbck. An audible hom should sound. The alarm
panel is normally mounted on the side of the house or
in the garage.
Note: if your effluent fitter doesn't have an alarm system
and you would like one, call your local septic system
installer.
B. Record the date that you inspected and/or cleaned
your filter on the form that follows. if you checked the
alarm or made any other observations about the tank
or system, include that information under'Notes."
7. Attach access lid by placing it on the riser, matching
the openings in the lid with the bon catches. Insert lid
bolts into catches and tighten with hex head wrench
provided.
Photo f. Remove the fiher cartridge bylining it out of its
housing.
Photo 2 Spray the cartridge tubes wiM a hose.
NIN-FTfl 1
aor. it 7M
Page 3 of
8-in. to 15-in. Dia, Biotube Effluent Filters
Applications
Orenoo• 8-inch to 15-Inch Blotube* EMuent fitters are designed to
remove solids from effluent leaving commercial septic tanks. They can be
used in new and existing tanks.
General
Orencoe 8-inch to 15-inch Blotube' Effluent Filters` are used to improve
the Igu Illy of effluent adfing a commercial septic tank. The Biotube
cartridge fits snugly in the vault and is removable for maintenance, the
handle assembly snaps Into the ditches in the top of the vault, and the
tee handle can be extended for easy removal of the cartridge. Abase
War model (see p. 2) Is available for low -profile tanks. An optional slide
rail system, mill on larger models, slmpl'pfies Installation and provides
tank access for servicing,
Handle assembly
Alarm feet assembfy�
(ordered separately)
pipe ooO)ng
r
Smlub%
Vault — I
-Inlet holes O
Support coupling
a�
apulst bracket
Crdawa➢view
'63�Of^abaEe•bHenf nl(NdN WWdd WKIV 4bi*V& 9WMenda'lE'pre
Standard Models
P70854-36,FT1254-36,FT5554-36,FT0822-14B,171`1254-31W
Product CodeDiagrams
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Materials of Construction
vault
PVC
Pipe Wnpllng
PVC
Handle components
PVC
Support awping and Nacket
PVC
abuebee cenrldge
Pohhxopyfene end poprerfn me
Nee: Srlaprrr mraw+p uW nSUHLmbt n awmpre m IRtrKA prd 15+at 61es onN.
Onm Sytbns' hn , 814 Own Ave., audwM% OR 97419 USA . a0D-348-9643 • 541-46"440 • www.orvnmCae MiPfT-R-4
RK 2.0, O a3l17
Pawl Ot t
ST. CROIX COUNTY J p
SEPTIC TANK MAINTENANCE AGREEMENT
AND l %I
OWNERSHIP CERTIFICATION FORM ACT 2 8 2020
Owner/Buyer Mary Lynn Speer
Mailing Address 2346 140th Ave Glenwood Citymi
Property Address 2-3 & C) ��fO T1-( /4 lle —
(Verification required from Planning &
City/State Glenwood City Wisconsin
Department for new construction.)
Parcel Identification Number 010-1050-90-000
LEGAL DESCRIPTION
Property Location s'/<,SC-'/4,Sea21 ,T30 NR16 W,Townof Emerald
Subdivision Plat: iS vy farCc1 9-( Lot#
Certified Survey Map #
Qvq- Oat^
Warranty -Deed # 55(0 115
Spec house ❑yesElo
Volume , Page #
(before 2007)Voltmme , Page #.
Lot lines identifiable ❑yes❑no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
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 Owner maintenance
responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. 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
wastewater disposal 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 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.
Uwe 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.
Number f bedro ms 4
/d
N O P T(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. ***
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 04/12)
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DESC 3,AMYED MINT CUSI ENER9011 IF TOEII 9/1/2020 7 25 AM GI(YI3TATE GLE ODGIY WI 1 l /4Y\ 1 Al i
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isement walkout with patio
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RECF-Ivt✓ �$T-o�a/ �a — a3,6
wvisioninDepartment Of SafetyandBuidings Commerce NU\1 I I N SOIL EVALUATION REPORT Page of y
Division of Safety and Buildings
ST. Gt� @114111Vdh Comm 85, s. Adm. Code
P W R�fi�IttSi11��11Off8Y/2� County S /. ckoi r a I Attach complete site anon s
include. but not limited to: vertical and horizontal refere,.. parcel LD.
percent slope, scale ordimensions, north arrow, and location e.. p / O -/ S - %Q - 47 0 O
Please print all Information. Revl d by Date
Personal information you provide may be used for secondary purposes(Privacy Law, s. 15.04(1) p1,,,
M O_i L C IQ r\ r h 5 P r' !—
Govt. Lot S LJ 1 /4.S E 114 01
T 30 N R t'6 E (o W
Property Owner's Mailing Address
�3V6 /vofk AL'C,
Lot #
Block #
Subd. Name a CSW /1
y0
_
_
.Gzte-
City
Ulan
State Zip Code Phone Number
j
❑City ❑Village own
Nearest Road
v CXXt
w� syOl,j
_ ((7/S) Y/ 7-
73�3
Fvner�I�i
I /5/0 �A .�{ue..
Iff New Conitruction Use: EiResidential/Number ofbedrooms 5/ /o & Code derived design flow rate e)(9 /c 7400 GPM
❑ Public or
❑ Replacement,�
commercial • Describe:
p}L
�/
Parent material CX�FLt�LpS It
General comments
4r" 5
Flood Plain elevation i(appll ble
tC12fe IA /b•.C� E/e SJ(v, O
and recommendations:
07a.n eUJ) U%/')<r7
,S�r$}yvH Cit-J. 3� /3 a17w
yf.�ci� ��L Ca cI �rLIL ..
(r�P/J �4cEme.r �rirP� SE
C%16u. t✓J rri, 4,1 rIM
?8' lo...
7KcQo
d w�
�; /
1 !
� El goring
I Boring # r}/
U7 G� •.
1J72_
.. 0-2Z
✓O%� r O dfc.Jr� \
I L-i rn , , - VGrl111 µl IIIIIIW I4J IOMWI / f/ In,
Soil Application Rate
Horizon
Depth
in.
Dominant Color
Muan+sell
Radox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPDfif
'Eff#1//
'Eff#2 -
/
�../✓
o-miz 3"
`_
rh h
�r
C LJ
F rL F
. , K
i. 6
-3
II
c,L l Boring # BAnng
0'7. 4_ .. �. inn
I U r•1[ vlvwrvawlaw Dior. / , - 11, uepel IV Illlllung Iduwr - - In.
Soil Application Rate
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. S/Ih.
Consistence
Boundary
Roots
GPD&
•Eff#1
•Efi#2
/d
C._ '
t7 R 3
` L
/ J -
, b
�• O
to y`
—
KS
0
7
1, 6
LS
c
7
/,
it
�D
Effluent #1 Is BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = 60D 5 30 nV& and TSS S
30 mglL
CST Name (PI Print)
/
Signature -- CST .Nuf w -
t,,
Address rr Date Ev n Conducted Telephone Number
A)�4k P �', p�' Sl1r7 oct 1e(, r� /1)_/8-/6 i 7/s 77P-3r378'
6� 5
Property0wner /46!21 L Ovtrh SPZc✓ Parcel ID# CJ/O'/G.$'O `rJD-GOO
Boring # 0 Boring 7 8 4
�Pil Ground surface elev. / r ft. Depth to limiting (actor In.
Page a of y
- Soil Aool�te
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/M
'Ef1#1
'Eff#2
C
/r7
L h
! 6 I Boring # iing
C21111154-
�J
I� Pit Ground surface eiev. r n. ueptn to ummng rector i v in.
Sop Application Rate
Horizon
Depm
in.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD1W
*01101
'Eff#2
&
/, C
trU
'
/r0
L
Boring 1, 9
a Boring # Pit Ground surface elev. 7 k. Depth to limiting Factor �� In.
0 Sol Apalleation Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GP
/IF
'Eff#1
'0#2
s L
6k
tviJ�r
vJ
G�
/.
G 5
3
6
%G
_
CL
b
titf I
a 7 5 ti
r
Effluent #1 = BODa> 30 < 220 mg/L and TSS >30 <_ 150 mg/L ' Effluent #2 = BOD,_< 30 mg1L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access Cervices or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
tiliD"8330 M.07/00)
Property Owner. Akr- �- �•fa-N1H SpPt✓ ParcelID:# 0/0.465-6 `?o-00O Page �:- of. lr .
INBoring
# ❑r;'3 �Boring . Or - . -.. ..
C7 Plt Ground surface elev. / i �-ft. Depth to limitingfactw-�l�.. In.
Sod Application Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Ou. Sz, Cont. Color
. Texture
. Structure
Gr.-St. Sh.
Consistence
aoundsrY
::Roots
GPDMI,
.'ew
' 'E
L
vx b k
r
c t cJ
t,
f, O
30
to y1L
—
i�
t.K i
c t,j
fr
e
R �
—
4-50
s
�l.
C'J
�v.k
17/.
49
' V I Boring # Boring
ICJ Li Pit urounu surlcl a eiev. r n. ueps3 w unuung iacuwr Z v Ill.
Soil Application Rate
Horizon
�
Depth
In.
--!
Dominant Color
Munsell
0`1 �
Redox Description
Ou. Sz. Cont Color
�-
Texture
�.
Structure
Gr. Sz. Sh.
,.K s 6
Consistence
h•L t7 F �`
Boundary
_ ca,) .
Roots
' �
GPbAV
t0i
; to
I `Eft#2
�. �
tVsY
5-
ELf 7 s �
s c L
c bh
�t
I
�
Boring # ❑ Boring
Q P t Ground surface elev. 91 9�ft. Depth to limiting factor ��In'.
Soft Arvicatiort.pate,.
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Ou. Sz. Cont Color
Texture
Structure .
Gr. Sz. Sh.,
¢onslstence
Boundary
Roots
Ol?
/fF
'Eff#'I
'Eff#2
/
b�
Intl
_
5
6k
tv(vr
t.9
I fi
46
I
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rry s
13
J
16
-
ao - 5'1(rc�
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a C
j
` Effluent #1 = SOD, > 30:5 220 mgA. and TSS >30 -< 150 mgfL ; Eflluent.#2 = BODs._< 30 mgll. a,J3d TSS < 30 mg1L
The Department of Commerce is an equal'opportunity service provider and employer. Ifyou need assistattodto.accesssetwoos 9r
need material in an alternate format, please contact the department at 608-266-3151 or TFY 608-264-8777:
Snn-9330 (R.07M)
Property Owner
C%enrr per
Parcel ID #
®
Boring #
In
pit
Ground surface elev. �r • � .
ft
76
Depth to limiting factor, In.
Page 3 of It
FS—R—ADDLICation Rate
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Ou. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/fP.
'Eif#1
'Eff#2
�S
0-C�
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_
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-fi
v
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1
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5
NI
--------------
;ra-7 Boring # O Boring
GQ <-
1 O i-,
w J Ly Pit urouno sunace eiev. / i • n. uepm to ummng rector e- i v in.
SoU ADollration Rate
I Horizon
t
Depth
in,
Dominant Color
Munsell
Redox Description
Ou. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/fF
'Eff#1
'ETf#2
- M 5
p
(- y
O
7
it
zi
❑
Boring # El Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor In.
So9 Application Rate
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Ou. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
PD/M
'EW
'Eflt/2
I
II-
F
' Effluent #1 = SOD, > 30 < 220 mg/L and TSS >30 < 150 mglL ' Effluent-#2 = BOD, 130 mg/L and TSS �5 30 mWI
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:
znD.B3Bo (a 07M)
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page Of
Division of Safety and Bufldings
In accordance with Comm 85. Wis. Adm, Code
County
Attach complete site plan on paper not less than 8 1/2 x 11 Inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale ordlmensions, north arrow, and location and distance to nearest road.
Please print all information. Reviewed by Date
Personal Information you provide may be used for secondary purposes (Privacy Law, a. 15.04 (1) (m)).
Property Owner Property Location
Govt, Lot 1/4 1/4 S N R E (or) W
Property owner's Mailing Ad ess I Lot # I Block # I Subd. Name or CS
City
Nearest
❑ New Construction Use: ❑ Resld\Cfl
❑ Replacement ❑ Publommercial
Parent material
General comments
and recommendations:
Number of bedrooms Code derived design rate
• Describe:
Flood Plain elevation if pplicable
GJ p
fL
❑ Boring
Boring #
pit Ground surface elev.
ft. Depth t limiting factor in.
Soil q lication Rate
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Ou. Sz. Cont. Color
Texture
tructure
r, Sz. Sh.
Consistence
Boundary
Roots
GPQffl
'Eff#1
'EffQ
Boring #
❑ Boring i
pit Ground surface elev.�ft. Depth tc limi g factor In. Anil Aed� �� ��
tmuent wi a tswUs > JV 5 [LU mgrL anO 1.YA 1JV 5 l bU mgn. ' Lmuent wz = wuD c 30 mg/L and TSS 130 mgfL
CST Name (Please Print) Signature ,CST.Number -
plod Pod I /4�
tfp A<fgES 1'1,/) e/c.-/cso-qo
1
V of Y
c s i Beni soi 2a� a
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