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HomeMy WebLinkAbout020-1288-30-000 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM '..ruy St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) state Plan ID No. 633869 Personal information you provide may be used for secondary purposes [Privacy Law, s 15 04 (1)(m fl '�— Permit Holders Name City Village Township Parcel Tax No. Blaine J & Beverly A Marion I TOWN OF HUDSON 1 020-1288-30-000 TANK INFORMATION ELEVATION bATA TYPE MANUFACTURER CAPACITY Septic �5 2 Sr. 1M-540 5aZ qqji Aeratio 1 Holdyg TANK SETBACK INFORMATION � 'I'MIN ®M M ' M_- MMM_1�- WM=.WI01F1i= PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Ir ngth Dia ist to well SOIL ABSORPTION SYSTEM BEDRREN CH Width Lengl DIMENSIONS INFORMATION derMan L M gth Di SOIL COVER 1.29.19.1409 �r ' e, a i 01it • ; � -I--�Bot. System -L.Wrir /�,� MINIM ram PIT DIMENSIONS IRO Of Pits Inside Dia IL,qi.ud Deplh -EM TO I BLDG WELL LAKE/STREAM LEACHING )f System. •�� //� f CHAMBER OR O f��IWTiTlowraG 4� �' q� �' UNIT SYSTEM Distnbuhon x Hole Size Ix Hole S Pipe( Length Dia Spacing x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xz Seeded/Sodded zx Mulched Bedrfrench Center Bedrirench Edges Topsoil — Yes C Na - I Yes i No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: O (�p/ZOl/ In pection #2 Location: 505 PRAIRIE LN ' p- ,,. /I�ta �Iev� S • 'J' t.)AII BM Descdpnor NG.�.7 sT �MwJI►s4-'�►�� �P�R+C .5-' Q,1� •, 2.) Bldg sewer length = �E;Y � /dmwwo Z) • �O l •pI, - amount of cover = tJJ l ' 3),45 „r. Q'Vr' ;M •rs ea�2. �.tQ — 3 �2 ?,� q c3 a• Plan revision Required? ❑ Yes -No g//II r+�, �j\ ,��5 •f4 q,�.s L s thetSidgforaddttionalinforma4 ! �) y o,r. MS� p�'1.+it.. DDte (-{�ttQ�+it� as 5 r C 83 bat,.es... a ha .� .. W) 94•sb� 96• yy z--Cpe._ ._�.--.. IndlrllM1 �Cr\'ilCl UitH;UII -_ Ctw tic) O { or tv Cow) P.O. e 7162 =s snmtary I4mut Nwatxr(a be tilid m b) ., -Ps 5t. �i�Y pe�eloDrtent Mad;w -37U 7162 �oTr (�33 g�9 _. Sanitary Permit Applicatr S teTan cnnn Number h, ;+.<'ur[lance wtb 5YS 7N} 21(2). Noe Adm Code wbmtss,wt u11Ms form to the appropm enwi wut n re,uircd pmv m nbtaimng a snnnnry pennn Wxe .\ppbcaupn form. for uarcmvwd {Y)\l' IS ate. tied to Prnlecl Address (tfdtRucm than minting address) I the Department of Satei) mvd flo lns,awl Sm Ica 11crsun3l information you pro, Idc may be usal for scco wrnr •u mcsms<sxdar,cc xnh the Pnyac �v,s IS.ON INm.S¢us /�v��l ' ` -_- J _ _7 1. Application Inmrsnation -Phxsc Print All information Ropeny (hsn:r'� Vmnc 1 Ei 4u,je .J. Pscel: 1 vzc- t ZT o -6)(1 Prnpcny thsr,cr, s Mmhng Adde,, Property I rcel,ni�l ij sck (� (.mr lot SE A. r,r t{\_ S:. section sl CI B. S6VC — 7.w Csdc Phone Number '; I"I �\y.`�!^i �iy i!)[/�l� -X-� - q (clrclent�y}.�-)— IL T\pe of fluildisg (check all that apply) Lor a I Suhdmsmn Name m, 1 o,2 Pal( D,,elbnp- N,mdxr of lted,00m� _ {^L ,^s 1, Pohin'-('umnmmiul IhxnM IJx - - . __. . _-_-. ❑ Orr of [� Slate(),,,o.,t riir li.c village of CCSM Nmnix, I , 111. Type of Per■sit: (Check only one hoc oa line A. Complete line R if appli abk) A �L]Ne"S,stem $Bapix,emrnt S}stcm ElTrc,uaun!91oIJmg Twlk Aeplumnent Gnh ❑(hher Mtd,ficswn ns l:„wngsestem(eaplmnl I --- —� k. ❑ Parmn Rencswl I Ibnmt Rest+wn ❑ ('hanae al Viumi,er ❑ 1'emnl lratulcr to New I tst 1'rn mtts Parma Number and Date l=W licfpre I xp!raucn, ofPOWTS Sint .esn aeallDesice: Check till lhala IrZ_ _._ Prc•;ameed irv6round ❑ Presssxlmd In-Grotmd ❑ A(Aradc ❑ btuund? 2a inof suitable soil ❑ 6luond <2d in W amble sod ❑ floldm• 1'wrk A rDu r al coin '------- L R ta:rle+n lcnpinuq_ ILl1 ❑Preuavlwnl Dcus(ccplun)_______.__ -\'.his I _ J.M n nna f■fortutio.: ' -- — - Us,gn Floss ( Ucs,gn SwI AppfiMtm A () t nab nrw xcymrcd (s Dtsperasl Area i'roposed System tlnanon o.7 a 4w lf, yz ,T. Tank lam Capmaty n, Cmlhns I ' , Gallon I!n'u eu( Sfanu(trcturcr � I I u I iU is F v. �(U L tarn -I lkld,ng Ira -5y� 1 UG'� 15 - _ W)ES Fr< 7AIF ne„�acrnmbe, V11. Rmponsibil1q'Statement- 1, the nndengned, ass respaa MUtyf InUlltion of lie PONTS sho,sa oo the aIwkgd plan Plan,hei s Name(prmt) Phi ,wt FNYMPHS Number Nosiness Ptmm Nun,N, An Cit f 6L -' u'1 C D Ylmn !'a Addree(Slreel- o). SOdv, Zip Code) — -- �- - - ------- ?S5 cf.T<l. � �t Lu Lj Vill. Coaa=Owxr(;L, Appru, cd Ikrmu Fee Dah Ismcd Issmn gApcnt Sipn re Dcnwi /• IefrtS' SYSTEM OWNER:/ T*��)�Ct'r..Ct�Mty �'�(YICs'k'cvaT, 1.�epticlanoll Inlem (tsar ands W fGt P/V S ItT114r. spend cell IrnMt t,p snvkoa...au+hhs_. III per management plan pfmi(Md by plumber. Lawwo �(May I A1 _2. All aMbach reyutrpments must be tnsiMelned hcai(� fl `C 53 Tf Yt�r Vkc-";, yr( cd^&c plaufef roemanttopl_ ____ wK+•elb Mai lrsa ll lain In in ---------._. RR1)-6nR(R OR114) Pot-: z C-P y OWNER _ 5f AWE MAr' ./mJ ADDRESS_ SOS J'kAJl /E- LAA6 fldl)son/ wZ s -ioiF �C/COp Y SUBDIVISION / CSMJ LOT ¢ /? SECTION -a / T of N-R / W Town of /%(Jp So/y Iyo�j ST. CROIX COUNTY, WISCONSIN BOA- r �zP.Y-.CrNw�.*�w�w-PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Q � PRA21f Lp NE 3 c' n ct�3' s1 a n ���t I 44.4z' � PE/�• _ o o a ��yyy,,,V � �M es �{6A /v, V,Do: EHO TNF/t"fIQYOK T1WK "3D!)4 scu, �3r 13�� W/RcTfl� C3 r Ey IST n 1-1,0 sAUM gS 39' I I wits ��" 7cP a� C v�.l0l 4y . fI T 2S� �1Ov5E I GARAcE ✓rr T USX I` L � WEIR INDICATE NORTH ARROW Provide 2 dimensions to center of septic tank manhole cover. ig 285 COUNTY RIVER FALLS 800.828-3723 715-425-8466 8/6/2021 St Croix County Zoning Hudson WI Re: 505 Prairie Ln ECEIVFD AUG 11 2021 St. Croix county 'The drain field at 505 Prairie Ln is failing. It has backed up into the home and they are now conserving water and pumping the tank frequently to keep it from backing up again. We are requesting a higher priority in the permit process due to the pumping costs required to keep it from backing up. Thank you for your consideration. Mike Michael Rodc"ald MPRS ; 931814 PAGE 1 OF 4 In -Ground Gravity Plan Index & Cover Sheet Component Manuel Design References: Version 2.0, SBD-10705-P (N.01fo1, R. 10/12) Pg I 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: Encl ures: '510 ,�JK Sr-lta: POWTS Application for Review P�Xr ° Soil Evaluation Report& Site Ma PRF tC <; Sit- T_si �Vr /TtRy. Sy5TErv\ cw SNiP Fur'M ' kC D1�7e-p Project Name / Description OwnerName(s): BEAT:\C_Ij RE� A- . ARib) Phone: Owner Address: _ t;C=, T— AAlZejk,;E Ilufl�cti Project Address: Zip: z57foi �-_ Govt. Lot: St- 1 /4 of Jy W'i 1/4, Section I T ,�7_N-R I q E Q of WM Township: _ 9U1 ON' County: 5T C A ni'K Project Parcel ID # tl -0.- i28'�- 76 - Dap Designer Information Designer Name: A ARV --I --Hi tP feT Phone: Designer Address:2KLJI?J KIV4, AizTH u 2s C+ lAVE,yt2✓�w= E-mail: �tOt( sf> rdestcin eu+IceK Cery r License Number. I U i - co -1 Remarks: id a1 S5`0 r�- rkL��Z—�z-nlC Zip: sync s sp3re7G4r1`dt8] stamp 0 r/ . T OCC�� Cj L"etttn �LGFG4,G- Signature: ZC / J! e Date: � Oop ri. MANY t HUPPrMTD ?see \,man fiFALLS,' `4a•r..•.•-. • `� esS- of �i:7i� fir: z &� y OWNER _ FLAWE Oti ADDRESS_ 50 f�,,AjglE L L+ r`ldpSor{+ uiZ 'mac% SUBDIVISION / CSM# S L T g SECTION ZI T 7-9 N-R-/jWj Town of A&)P SON W o� ST. CROIX COUNTY, WISCONSIN gm. U 5e SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM P&'A2 t Lp KE In a" ct�-rx w F- 0 � 4q as yi,A�-rrH g5 e6f6- Yy.� /p z ��icz.vs z i v i 06,gz' i 137�Xa.sr,ti� f,P wiEs 3 v' 2+-Tb Nov sE caarwE � S X SO � ai � ✓xrY 4f � pR UIEIL J TNr+Lrrer^rt —MK W` Fr47fR GA U-M +r, /vl vy T IN A INDICATE NORTH ARROW Provide 2 dimensions to center of septic tank manhole cover. IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with EZ1203HP Bundles 3-ft Trench (down -sizing credit) I G Cover Cover RE SOIL COVER 12' min, trench dep-h (typical) System Elevation = q, q2 eft (typical) min 12^ (typical) ENsrht R Septic Tank(s) Manufacturer. R'Wtti C", WIESER INFILTRATOR Septic Tank(s) Volume(s): 1 1000 gal gal gal 540 gal Effluent Filter Manufacturer: POLYLOK Effluent Filter Model #' - 525 TYPICAL TRENCH CROSS SECTION VIEW (No Scale) Provide minimum 3 ft separation between trenches. TYPICAL TRENCH (Show location of inlet / outlet pipe connection on plan view.) PLAN VIEW 4^ 0 Observation pipe shall be installed (No Scale) Perforated Lateral al)unchon between Mo unja Observation Pipe (typical) (typical) ---- OBSERVATION PIPE DETAIL (No Scale) srrew-rypa a, sup Cap (Iori.) 4"0 PVC Pipe -- Top of pipe lu lermmate at or above finished grade (4) 114"-1/jj' X 6" slots — (Q130 apart Anchpnng Device J 10 ft (typical) (typical) (p coef —. 0.7 ij : a-;,7 /„ H- INSTALL PER TRENCH: 10-ft bundles @ 50 ff EISA/unit = W + �_ 5-ft bundles @ 25 fe EISA/unit = r ft' = Proposed EISA per trench = Z< 5 ft' I A=30 ft (typical) Finished Grade niched 8 eespao) Topsoil Cover (min, t foot) 'fikrzlbn spd4ce � y';5�.z= S�' eisA cur+r_ EZ1203H Bundle _ 17t43 (typical) (mfd by Infiltrator Systems, Inc.) 15"6 Install pursuant to manufacturer's Instructions. ��;� 3'xL-0 "f1;EnYxt�s Required Infiltration Area = 857.15 ft, Distribution Method: x q trenches = Proposed Total EISA = 900 ft' branched manifold ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) RL.Apz- S ' G�vSKy A. N)AKiO4 This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) SOS PP AnK )E LR 01 located at: SL 'A, qL%I—'/4, Section Z( . Town z�N, Range 9 W, Town of }hut , 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) appear(s) 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 minutes Tank Capacity: 10 -61Au.aa> Construction: Prefab Concrete _�_ Steel Other Manufacturer (if known): L�irF.�r Age of Tank (if known): Permit numb (if own) �. 3 .' /�'� lCtiH� �'OC7E.Ltit><1LI7 ice sed Plumber Signature) (Print Name) PL V)Vl (Title) ( te) �3135`1 (License Number) i41I'/MPRS Form to be completed by licensed plumber (Dept of Safety and Professional Scrvices Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 In -ground Gravity Management Plan IMPORTANT: PAGE 4 OF 4 The owner of this in -ground gravity system shall be responsible for Its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wise. 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 Malntalner in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = 660 gpd; BODs S 220 mgL"'; TSS 5150 mgL"'; FOG 5 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 I 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, float 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(sl 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 filters) 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: MIKE RODEWALD Phone: 715-425-6200 Local government unit: ST. CROIX COUNTY COMMUNITY DEVELOPMENT phone: Local government unit address.. COURTHOUSE, HUDSON, WI 715-386-4680 ZIP: 54016 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. ST CRO6 LINTY SANITARY SYSTEM File #. ""` A ce Use OWNERSHIP/ADDRESS FORM �edaimzinly Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the Pmoerty Files Scanned weblink. OWNER/BUYER INFORMATION OwnerfiWyer ?kNWtY A- /V�KI Mailing Address l'6 YRrUr2L City/State/Zip i'at';;Cm k YiUlto Phone Number (required) % i S ' 3 7-17 Email Address (required}. !r1 e.+NBrfoni.SQ, I Le, , C,),.t Parcel Identification Number 0;, (found on the property tax tilll) NEW SYSTEM: LEGAL DESCRIPTION Property Location �'A , NN 14, Sec. Z! , T 2'1 N RAW, Town of ) 6D2N Subdivision Plat: VNZW--• FArdl Lot # �. Certified Survey Map # Nfl Volume NA Page # NvAt Warranty Deed # 6 9 �AID � n (before 2006)Volume Ntc Page # At, Number of bedrooms —,!� Spec house 0 yes)6 no Lot lines identifiable N yes 0 no New Property Nerfriaaaon (Staff Initials) (Date) OFFICE USE ONLY from Community Develapmmt Department tar new cons cilonj This form must be submitted with all Private Onsite Water Treatment System (POINTS) applications. New System: include with this form a recorded warranty deed from the Register of Deeds O(ice and a copy of the certified survey mop if reference is made in the warranty deed Community Development Department- Land Use Division 715-386-4680 St. Croix County Govemment Center 715-245-4250 Fax 1101 Carmichael Road, Hudson, WI 54016 / m , 110,311 Square Feet / m :o / 8 ff 05 aJ'p afe�B3 ti ' RADNS-80 2.53 Acre. /' a / o / 1 ,0 76'q ' E ` I rybn=/ p12 I19,662 2.75 6creauare Feetet 17p./�: 92,015 Square F /ry / 2.11 Aczea 120,348 Square Feet 2.76 Acre• 13 neon y 128,219 aFee! io / 2.94 Acre. ea4- s DT Qp0£; Cm-e, I]> 2J44o Dsai— -[Went — _---_—_— ]o — —_— \ 342.00' I 66 0' Sea 10' IE2 00' �i 66100® N 00.49'04'M 2471.10' 10631:0 z J a FUTURE SUBDIVISION i k h � 1ry�y ..; } t�. ',. §A al9eluu —� a�°r ..svf A,�j > a:� -•� ot ' ,> � 0£ Bz BZ V > t R L I 9l .. .7 iit nu��ndrp�ih� i�� 7 q� el 01 g #- •-- 7y,.�'stnti 'dr. � it 'l is �i�niin����i^ i I�ii�� � £ 0 '� IN ol .� ffi� a A r a � �� �� •.Y 4 a� k �{ r F'•: j to r ' A v IM-540 General Specifications and Illustrations The IM-540 is an injection molded two piece mid -seam plastic tank. The IM-540 injection molded plastic design allows for a mid -seam joint that has precise dimensions for accepting an engineered EPOM gasket. Infiltrator's gasket design utilizes technology from the water Industry to deliver proven means of maintaining a watertight seal. The two-piece design is permanently fastened using a series of non -corrosive plastic alignment dowels and locking seam clips. The IM-540 is assembled and sold through a network of certified Infiltrator distributors. Must be backfilled and installed in accordance with Infiltrator Water Technologies, Infiltrator IM-Series Septic Tank General Installation Instructions and for shallow ground water conditions reference the Infiltrator IM- Series Tank Buoyancy Control Guidance. Please visit www.infiltratorwater.comAmages/pdf/ ManualsGuides[TANK01.pdf for the latest Information. Tote! Capacity _ 552 gal (2390 U _ Length 64.9" (15548 mm) 61.7", (1567 mm) -_ j Height 54.6" (1387 mm) _ Maximum Burial Depth _ — — 48" (1219 mm) Minimum Burial Depth 6" (152 mm) Maximum Pipe Diameter 4" If 00 mm) I Weigh ._l._ 169 Ihs (77 kg) J d euelraae Pwk Fined 8 P.O.9oarw qd 5k, CT 475 INFILTRATOR 77-70 II i00t ;Z M3a.5T] _ _ _ .. _ wvW.IMII[ffLOtwalM.iom NNNEcnoN TOP VIEW MR.) END VIEW SECTION A -A' CONTINUOUS G Ku FNNN TOP 14 S Yw cup 7MK EFIIX t GNMTN D K TMINFOT'OM Half MID-HECKT SFAM SECTION DETAIL �ENve W rn �owno.Ic US Pa:aMa 4759,E61; 5,017,041; S156 d50, 5�36,017, 5,901,116.5401,a5B; 5,l� L2W; 5718,163: 6.SBB,ne: S,BOP.8a4 Caraden Patann l,aP9,B5P,;OaL55a UN-palmbperdrg.ln(Illm<n, Eaaa'iTer, Oulticd, aM SdeW+tler eA regu:Iand tretlerM!"s d InN1mNr Wafer TeeA+tloyw InfiAretar s a RN-lyatl badrrNrk.r Fre.ca.INMamr Were iecr+Wopiea N e rpWao� beoanerkM Mew Cd W, Miatlaediq• PdyI O TberSom,M,,I,PW. PaI Out". QAr4 lW.4npLarllvM Sba17M1aGt aetradeRera of Infta Wale TedNNbOI®, PdyL kNalraderneMMPdylok, Ina TUF-T1TEis amgloWWlredem,*o(TEIF-TITr, INC, IIMm-R:b lea rademadta(IPEJ( Inc. B ¢013 6 IIIaCin Weca TeGtn]Y,pee, 11G Nldplru �Onv.G Mnlad n U.SA IMII 1' le Dntact Infiltrator Water Technologies' Technical Services Department for assistance at 1-800-221-443t PL-525 EFFLUENT FILTER Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters.The PL-525 is rated for over 10,000 GPD (gallons per day) making it one of the largest commercial filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the new Polylok PL-525 has an automatic shut off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent won't leave the tank. No other filter on the market can make that claim! PL-525 Maintenance The PL-525 Effluent Filter should operate efficiently for several years under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. 1. Locate the outlet of the septic tank. 2. Remove tank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. 4. Pull PL-525 out of the housing. 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank. 6. Insert the filter cartridge back into the housing making sure the filter is properly aligned and completely inserted. 7. Replace septic tank cover. i Alarm ,*Ir; _ accessibility —�— Ideal for residential and com- mercial waste flows up to 10,000 Gallons Per Day (GPD) Accepts PVC extension handle Rated for over 10,000 GPD Gas deflector Automatic shut-off ball when filter is removed 1. Locate the outlet of the septic tank. 2. Remove the tank cover and pump tank if necessary. 3. Glue the filter housing to the 4" or 6" outlet pipe. If the filter is not centered under the access opening use a Polylok Extend & Lok or piece of pipe to center filter. 4. Insert the PL-525 filter into its housing. 5. Replace the septic tank cover. 1QCi►'(sTQl pat Q�ut7y7 .29.19W ATE SE1T�R(7E�iS M TATION Labor and Human Relations INSPECTION REPORT Safety and Bwldings Division GENERAL INFORMATION (ATTACH TO PERMIT) Permit Holder's Name: Crity-0 Village L1 Town of: 7i Insp BM Elev.; BM Description; TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic - _qe- Cole Dosingr Aeration Hol TANK SETBACK INFORMATION TANKTO P/L WELL BLDG- ventto Air Mtak e ROAD Septic >�� 7 )s�' ' NA Dosing NA Aeration A Holding PUMP/ SIPHON INFORMATION Manuf Demand Model Number TDH Lift vstem t Forcemain Length Dia. H D�scTowell SOIL ABSORPTION SYSTEM ELEVATION DATA A9300292 t//n 3 /5 R STATION 65 HI FS ELEV. Benchmark ' fiL- 4 m, Bldg Sewer 0-611 StV Inlet 9167 9f, 17 St/pf Outlet Dt Inlet Dt Bottom 7477 Header/3Al �D•3G' 9%�f' Dist- Pipe �29' Sot. System Final Grade — TF BED/TRENCH width N_, Length �� No Ot Trenches PIT No. of Pits Inside Dia. Liquid Depth IDIMEN IONS E SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHIN Manuactu INFORMATION TypeO ew j�; � x Model Num System: i 37 '>76 OR UNIT DISTRIBUTION SYSTEM Header/ y I Distribution Pip�e�s r r I x Hole Size I x Hole Spaaog I Vent To Airinta e Length � Dia. length L Dia. � spaang SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over .. N Depth Over rr n xx Depth Of xx Seeded i Sodded xx Mulched I Bed /Trench Center -l.lb Bed/Trench Edges — Topsoil ❑Yes ❑No ❑Yes ❑No COMMENTS: (include code discrepancies, persons present, etc.) LOCATION. HUDSON,T21.29.19W (LOT 13 WELLS FARGO STATION -zo,.otot^df�a� ar��rtao� Plan revision required? ❑ Yes O No Use other side for additional information SRO-6710(R DS191) p6/ ozi Inspector's Signature Cert No SANITARV PFRUIT APPI IC_ATIAN — - — - ---------- In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE A TAjiY T# -Attach complete plans (to the county copy only) for the system, on paper not less than 8%x 11 inches in size. ❑ cr�C rev alon evlous application -See reverse Side for Instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION T_29,N,R /�/ E a-rJ . SE%Ned %,S2/ (oilfW PROPERTY OWNER'S MAILING ADDRESS LOT# BLOCK# a X WZ£rz /3 CITY, 3T ZIPCODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 4 Zs or (rJl sg'D /�o �X z 7619 L.Js //5 �✓ o Sf47 0 If. TYPE OF BUILDING: (Check one State Owned CITY NEARESTROAD VILLAGE � ra,i Lam II�� u�se�, Q. H ❑ Public i 2 Fam. Dwelling�j bedrooms tp or of L Ill. BUILDING USE: (it building type is public, check all that apply) O Z O — Z lFe 3O 1 ❑ Apt/Condo 2 ❑ Assembly Hall 8 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Ott ice/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line Bit applicable) A) 1. 5" New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # Date Issued V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In -Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 14. LOADING RATE 5. PERCRATE 8. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION L' 7 SCD � 1.5 Feet Fast VIL TANK INFORMATION CAPACITY in allons Total Gallons #of Tanks Manufacturer's Name ac Prefab. oncret site Steel Fiber- glass Plastic Exper. App. New istin Tanks Tanks strudel tic Tank or Holding Tank OPO Lift Pump Tank/Siphon Chamber Vpl. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for Installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MPIMPRSW No.: Business Phone Number: Dok S r�oti6aa n /Q z1/7 3L33 Plumber'a ddress City, State, Zip Cade): ((Street, /� O L �co /.G�.1"6v IX. LINTY/DEPARTMENT USE ONLY Disapproved Perm Fee(Imludupe He)wsler eeau issuing Approved ❑ Owner Given Initial Sotary itsl Det rmina - C X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBDeage (formerly Plb$7) (A. 11rea) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER S/1 Al Alf ( L L E 2 / ADDRESS FOX '287- SOS t�YLC[nti° �Z�I� �- Hy/ sch !,yl �5- kfltidSm SUBDIVISION / CSM# LOT # L-? SECTION z/ T z 9 N-R /�W, Town of NcJD SO/✓ I q D'I ST. CROIX COUNTY, WISCONSIN g.M �'rup ez"P.'p--ArIV— cre',n., PLAN VIEW f E'= /010'00' SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM Q-- P2�2I �p NE a- d 5/,oe i 6 Sc<fd- l!y'; to 3 31, f-/t7v Sf LA�FGE 20x SO .' $1 �'/xa9 v, iK-wELL A}oc I(-1-13 IN A INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. �5 BENCHMARK: ToP of 2" tei �Iff N l A(WCov v E (_ /Do or) - -7 Z ALTERNATE BM: SEPTIC TAN / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer:_ (tip sa / Liquid Capacity: Setback from: Well 82 House 191 Pump: Manufacturer i e Other Model# Size Float seperation Gallons/cycle: — Alarm Location — SOIL ABSORPTION SYSTEM Width: IZ' Length <)o" Number of trenches — Distance & Direction to nearest prop. line: 4/ A 7-- / y Setback from: well: '3 z Housed Other ) z ELEVATIONS M< n A,/e 2 Q: y S , 7S- Building Sewer ST Inlet. 9.Oy = I YW/ ST outlet 9, 3(- r=7? y�' PC inlet - PC bottom — Pump Off Header/Manifold Bottom of system (�. 5 5-- Existing Grade Final grade 6-,1 DATE OF INSTALLATION::� tt � PLUMBER ON JOB:��T�r�}�% LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT 0,�, Page of S Labor "Human Relabione Attach complete site plan on paper not less than 8 112 x 11 inches in size Plan must include, but PARCEL I.D. # not hmned to vertical and horizontal reference point (BM), direction and N of slope, scale or dimensioned, north arrow, and location and distance to nearest road. REVIEWED BY DATE APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION PROPERTY OWNER: S,a Cyr PROPERTY LOCATION Q Q GOVT. LOT SE 1/4 tj 014,S2 ) T Z 7 ,N,R / E (or) W PROPERTY OWNER':S�plLINGo01� ADDR LOT t BLOCK • SUBD. NAME DRCSM r T' yr tS W SLIs R( p CITY, STAT ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE T OWN N EST ROAD '"LA, juuagw k� New Construction Use [-y Residential / Number of bedrooms 3 (] Action to existing building [ 1 Replacement [ ) Public or commercial describe Code derived daily flow ASC) gpd Reannmended design loading rate Q . 7 bed. gpdMt2Q.trench, gpdM2 Absorption arm required 6AS bed, ft2 5CS; trench, 112 Maximum design loading rate Q .7 b>ed, gpd/tt20 g trench. gpd4t2 Recommnended Phflltratiol surface elevation(s) 4-,wCO i61Xt AJA 76,E H (as referred to site plan benchmark) Ad6tional design 1 site corisidi rations Parent material Flood pMin elevation, if applicable ft U Urtstlil�te foSuitable fOr VENTIONX ❑ UU A�UN E.i S D ❑ ESSURE &S T�� = r stemtern U ®'$ ❑ U 0 U NI S ❑ U ❑ SDI] U Boring # " Ground elev. jcg- Oft. D"to Writing >�z Boring # I Ground elev. j" It Depth Io C IirraMng e _ > a tin T Name pact' SOIL DESCRIPTION REPORT ® �. .. a •r. =. •• ®®®©® IMMMA ��_. MORE Remarks: Phone: � !_ N L1>J %R' Late: / 0/// /9% ; w i Number-MT-4 PROPEOTY OWNER SOIL DESCRIPTION REPORT Page 2 3 PAiCaID.: Lov !3 WAua ��a —a— Ground elev. loz-)—M It. Depth to imi#ng 7 Ground elev. 1QI.76ft Depth to irtuGng � 9�3 Ground el er. 1013 /ft Depth to irribng for 7 .56 Ground elev. fL Depto smiting few Remarks: nm�ll MM©<M-0109MMO Remarks: Is 1.4 Remarks: 680-e330(R OW92) k r P-cf laccw�.v-�- �.LswX couNTr NO. 633869 STATE SANITARY PERMIT Dyci�s sos pmeie tK PREVIOUS NO. Ig1884 OWNER 151ai M PLUMBER Ah TOWN OF A SEC Z 1 9T 2!I N9 AND/QR LOT 13 a THIS PERMIT EXPIRES POS LIC.# R3179 q Rjj BLOCK SUBDIVISION "ZONE X CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. to) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. ISSUING OFFICER - DATE 8 UNLESS RENEWED h/Z1 AIN VIEW THAT DATE VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (R11/20)