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HomeMy WebLinkAbout645433 006-1065-50-000 (2)WsconsNn Department of Cramorffrte PRIVATE SEWAGE SYSTEM Safety and suddvog Dwmwn INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Persofiall rnformabon ycxk pr�ovAe may be u%ed for fw000dary pwPoses EP"vacy Law, s 15 04 INKmj P,ermft lHd,det's Name ;e Township Four Corners Farm LLC TOWN O,F CYLON CST 8M EWv lnap RM E4 B'M DOSCI'Rp�*n TANK INFORMATION ELEVATION DATA TYPE /,,,=FACTUR? CAIPA(,-,ITY STA110N B! W7 IIIIIIIIIIIIIIIIIIIII PUMPISIPHON INFORMATION RPTION SYSTEM S01 Ouffef 5-Inlel DI Bottom Header/Man Dist, Pipe BoG System Final Grade St Cover M I �KOIIWII St. Croix &W,1140(y Per"liit Nci 645433 Suce P�an 0 No Parce@ 'Tax No 006-1065'-50-000 Sed*WTOwr/Rargo/Map No 2931A6,453 HI FS ELEV q, LAKEISTREAM LEACHING Manufach CHAMBER OR UNfT [m--o� DISTRIBLIT ON SYSTEM Headerl?Jandoldi ID XJfte sue '010 spacvlg PPZ� Length,___.. Ois a _ DO SOIL COVER xPressure Systems Only xx Mound Or At -Grade Systems Depth Ovee -T!,Pth Over XX Depth of xx Seadedll 0 r � � eAWT rene an or renc Edges I OPWI, r �es l No nMfiAr-NT m i m 4, 4 V?X if u,, - code iscrepences, persons present, etc.( Inspecuon #ii x ocatlor 2t 4 WY 63164 e, I Alt BM IDescrlptlen 2 Bldg sewer length r aniount of cover 31 4"n 103 �IAIQ 7t �d P 4-4 c Plan revision Required? Yes No Q1 /2. 2 Use, other side for addifional Informalron, M� �o MAE= S 1301-67 10 (R 3(97) &K W.IA6e45f r 4A 2 ent of Safety Depalltm & Professional Service,s, OCI 11, 2022 Industry.Servi Di io pi X, �1110 L77 .P , colsia,*0 g�PNETjt!jAppli cation In accordance with SPS 383 21(2), Wis. Adrn 'Code, submismon of this Form Whe appropriate governmental unit iis required pnin to obtaining a sanitary penrul Note Application forms for state-owned ]POWTS are submitted to the Department of Safety and Professional Service.% Personal information you provide may be used for secondary 1), purposes in accordance ws, worth the Privacy Law, 15 04(l)(nif, Stats, _ Property Ovvtier's Name 'FOUR CORNERS FARMS ILL ProWrty Owner's Mailing Address 2173 CY RD H City, Sure DEER PARK Wit 01 1 or 2 Family Dwellit - Number of Bedr(x)ms 0 Pubbc/Commercud - Describe IJw 0 h Owned - Describe Use A NevaIlk ral eplacenwSyrnsteyllm InIfspowNwry 801 IVI Capacity ^ 44 Tank Inforination Gallons 160100M -ttz, Phone Number Lot tl Block 0 `SM Number County ST CROIX Sanitary Perma Number (to be filled in by Cri 6 IS-1 3 � Parcel # 006-1065-50-000 Govt Lot S__E SE 9 31 R _16111" Subdivisom Name 0 City of ................ CJ Village of liz To. of CYLON Other Modification to Fxisting System kxpbun) Additional pretreatment Unit ("plain) El Other Type (explam) El Z �frsdC D Mound lndividuap Site lks5gn D Change of Number I n Tiari to New T�,V-i Area Acquired (sif) Doqi Area Propomil 'Systern Elevation ;;l Afta Acquned ifd) 'INsp, A I's SIPre PAUL R KOEHLER 000 Plumber's Address (Strect, City, State, Zip Code) 321 WISCONSIN DR NEW RICHMOND WWI 0 Disapproved n 0 O� 7tondlitho—ni 6-1: A�prov SYS M OWNER `,eptic tank, effluent filter and dispersal cell must be serviced / maintained as per ianagement plan provided by plumiber, � setback requirements must be, maintain MP/MPRS Number 225410 MH J, �g tk r -Z : -117 LIM �12,y �7jj w L,L rn)rr. 7tv am, J-67h \,A 3 S \_Ulj v4 50 --o" j 0 \,A 3 S \_Ulj v4 50 --o" j 0 CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: FOUR CORNERS FARMS Owners Name, DAVE GOODRICH Owner's Address: 2173 COUNTY RD H DEER PARK W1 540017 Legal Description: SE 1/4 SEI/4 SEC 29T 31 N R 16W Township: CYLON County: SJ'CROIX Subdivision Name: Lot Number: Parcel ID Number 006-1065-50-000 Page I Index and We Page 2 Plot Plan Page 3 System Sizing & Crosis-Sectilon Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSIVI or Plot 111pilim!J, fillilillill� '!!C�1!11��Clllii I ; r-1111111", #1 ziz' I I Designer/Plumber: PAUL, R KOEHLER License Number: 225410 DaW 10/07/2022 Phone Number (715) 246-26,60:A Signature Designed pursuant to the in -Ground Soil Absorption Componerd Manual for POINTS Version 2.0 BD-10705-P (W01101), Page 1 "IT ME 0 LmN I 40 47 CFO -T -piolwj NJ- IPI v4 5-1 -0"-k 0 D SOIL ASSORPTION SYSTEM DETAIL I GRAVELLESS LEACHING UNIT Pagm�l of-i 3 No. of 3 ft Cell Width 80 t Call Lon l 3 cl ft Coll Spa 8 Per Coll 24 Total No of 10 50 sq ft EJSA Per Celli 1200 sq ft Total EISA GravelLeaching Unit Manufacturer EZ FLOW travel less Leaching Unit Model: Finished Grade fit EZ 1203H - 10 Typical Cross Section approved cap or vent Soil kfill in �X X• x Gootextile Fabric Infiltrative Surface 12 in 4irrrrrrrurrrrrrsrrr L -fl Limiting Factor in Slotted and Anchored Vent/ ------ Observation Pipe vAth Cap go *IN" poll's Plumber/Designer Signature: ,Z Uteri 225410 Date: OCT 7 2022 I GRAVITY -DOSED SEPTIC / PUMP TANK SPECIFICATIONS 1.1r1­_­_. (No Scale) 11 4 . R—AA 'CAPACITIES @ 600 galfin *Pumip Tank Liquid Level = 16,.12 in Force Main Diameter = 2 in Force Main Length 40 ft 0 [C] TO I Dose V 11 olurne (TDV) 80 gal/dose L(< 0.2X desigin flow + forre main void volume) �W INSIDE BOTTOM' ELEVATION = 8T9 ft "T A Pump weep Hble t__ Alarm —On —Off :;oncirele 1340clk Extend manhole dw as neoessa y. Appmved Locking Manhole with Warning Label Altadvbd (typi-1) 4" Min, at 2.0 ft above E wablisbo d Flood Elevation 1) al ca c yoilly Quwk Disconnect I a" Min, (typi-0 A AWrDved Joints vAlh Approved Pipe 3 1 onto Solid Ground (typica,l) PUMP -OFF ELEVATION 88,65 ft r 3* Approved Radding Malod,,A Beneath Tank Force Main Void Volume 5 gal i Vertical Lift = 525 ft PUMP TANK: Volume 600 gal I Manufacturer WIESER Pump Manufacturer: GOULDS Pump Model: EP04 YwTXw7V_.F Controls/Alarm Manufacturer: SJ ROMBLIS Nowns"w"Nown Controls/Alarm Model* PS PATROL Fjg@t switchgs containing ringrgury are prohibited. Fledneat most comply V41h SPS 316 and NEC 300 rproof 1 j ;ttlllen pox SEPTIC TANK(Q. Total Volume = - - ---------_ 2000 gal Manufacturer(s): jamull Filter Manufacturer: POLYLOCK Filter Model: 525 Force Main Diameter = 2 in Force Main Length 40 ft 0 [C] TO I Dose V 11 olurne (TDV) 80 gal/dose L(< 0.2X desigin flow + forre main void volume) �W INSIDE BOTTOM' ELEVATION = 8T9 ft "T A Pump weep Hble t__ Alarm —On —Off :;oncirele 1340clk Extend manhole dw as neoessa y. Appmved Locking Manhole with Warning Label Altadvbd (typi-1) 4" Min, at 2.0 ft above E wablisbo d Flood Elevation 1) al ca c yoilly Quwk Disconnect I a" Min, (typi-0 A AWrDved Joints vAlh Approved Pipe 3 1 onto Solid Ground (typica,l) PUMP -OFF ELEVATION 88,65 ft r 3* Approved Radding Malod,,A Beneath Tank Force Main Void Volume 5 gal i Vertical Lift = 525 ft PUMP TANK: Volume 600 gal I Manufacturer WIESER Pump Manufacturer: GOULDS Pump Model: EP04 YwTXw7V_.F Controls/Alarm Manufacturer: SJ ROMBLIS Nowns"w"Nown Controls/Alarm Model* PS PATROL Fjg@t switchgs containing ringrgury are prohibited. Fledneat most comply V41h SPS 316 and NEC 300 rproof 1 j ;ttlllen pox SEPTIC TANK(Q. Total Volume = - - ---------_ 2000 gal Manufacturer(s): jamull Filter Manufacturer: POLYLOCK Filter Model: 525 I Order Number H' Vofts Amps Minimum Circuit Brooker Phase Float Switch style Cord Length ­ FDischargo Connedion I-... . — Minimum On LevA r----- 1-11,11-1-1-1.111.1-1 um Off Level ........... Minimum Basin Diameter ..... ............ . . Maximum solids Six:* Shipping Weight Ilbskg EP0411 Plug No Switch 10, Manual mw,wal 20/91 IEP041 1 A 1 Piggyback Wnde.Anqle 10, 12- 6' .... ........ 21/95, L--- 115 12 20 -- EP041 1 F 11uq�tch,/ No SW 20�, Mancial Manual 20 19.1 A. . ....... I . . .... . ... EP041 1 AC Piggyback / 20' 12- 6" 21 f 9,5 Pete Angle EP0412 1 Plug / No Switch 10, 1 h" Manuall tAarKdall 15' 1/4, 20/91 23,0 6 10 EP0412F Hug No Switch 20, mdnual Mamwl 20/9 1 EP051 IF Plug No Switch 20' Manual Manual 22�'I() 115 13 20 . ... ... ....... E 110511 AC 5 Piggyback / Wide.Angie 20' 12" 6' 23/104 EP0512F 230 6.5 PlSMtch ug, No 2'0' Manual Manual 22110 PAGE 3 :OX Inc kknorafions in Nast, Dramage 4 Zabel' PL-55 Effluent Filter & WooOwner ProdurrsV A DWAY4 0 PoWabex, PL-525 Filter The I'L-525 Filter is rated for 10,000 GPD (gallons per day) making it one, of the largest filters, in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the 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. Features • Rated for 10,000 GPD (gallons per day), • 525 linear feet of 1/16" filtration. • Accepts 4" and 6" SCHI) 40 pipe. • Built in ,as deflector, • Automatic shut-off ball when filter is removed, • Alarm accessibility. • Accepts PVC extension handle, PL-525 Installation:! Ideal for residential and commercial waste flows up to 10,000 gallons per day (G PD) 1. Locate the outlet of the septic tank, 2. Remove, the tank cover and purnp tank if nec"sary, 3. (;Inc the filter housing to the 4" or 6" outlet pipe, If the filter is not centered under the access opening use a Polylok Lxtend & Lok or piece of pipe to center filter. 4. insert the PL-525 filter into its housing. 5, Replace and, secure the septic tank cover, PL-525 Maintenance: The'11,525 Effluent Filters will operate efficiently for several years under nornial conditions before requiring cleaning, It is recommended 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,,',-' 5ervicing should be (lone by, a certified septic tank pumper or installer, 1. Locate the outlet of the septic tank, 2. Remove tank cover and purnp tank if necessary. 3. Do not use, plumbing when filter is removed, 4, Pull PL-525 cartridge out of'the .r. Ho�se off filterover theseptic tankMake satire all solids fall back into septic tank, 6. Insert the filter carffidpre back into the housing making sure the filter is properly aligned and completely iriscruxi, 7. Replace and seure septic tank cover. Outdoor Smaiffilter`k Alarm Polylok, Zabel k Best filter% accept the `ant artFflteOPswitch and alarin. Alarm Switch (Optional) Accepts Y' PVC Extension HAndle Rated for 10,M)GPE) 525 Unear Ft. of 1/ 16" F -iltr- ation $lots MW Certified to NISFIANSI Standard 46 Gas E)efli:Kjor Automatic Shut -Off ball U"xiend & Lok I �` Easily instaUs into existing tariks, Polylok,, Inc. 3 Fairfield Blvd, Wallingford,, cr 06492 'Foil Free: 877.765.9565 Fax: 203,284.8514 www.polylok,coni I 4' CAST —A —SEAL 4' CAST —A —SEAL tr H11 CL 7:& FILTER OR BAFFLE im I IL _4 ------ f 00 ko m� a h t I I musm��� DIMENSIONS: WALL_ 2 BOTTOM: 3' COVER: 6* MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT. 66' LENGTH: 12*-11* WIDTH: 7-2* BELOW INLET- 53* LIQUID LEVEL- 48' WEIGHT. 14,860 LBS. INLET AND OUTLET- 4* CAST -A -SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN. SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY. 27.66 GAL/IN (SEPTIC) 16.12 GAL/IN (PUMP) LOADING DESIGN: 8'-0' UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC/SEPTIC. SEPTIC/SIPHON, OR SEPTIC/StPHON COVER. MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #10 (STRUCTURAL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE REVIEWED BY REVIEW DATE iDRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY' t I I am m a <,D 0 Ld lNLET lilt a- ol a WLP 1000— MR GREASE INTERCEPTOR TANK SPECIFICATIONS 4® CAST -A - SEAL DIMENSIONS- WALL- 2 1/2' BOTTOM: 3" COVER: 5* MANHOLE. 24" I.D. PRECAST CONCRETE RISER HEIGHT. .53 1/4- LENGTH: 8-8' WIDTH: 7'-2" BELOW INLET, *2' LIQUID LEVEL.• 36' WEIGHT. 6,790 LBS. INLET AND OUTLET: 4' CAST -A -SEAL BOOT OR ECIUAL GASKET INLET AND OUTLET BAFFLE: AS SHOWN LIQUID CAPACITY. 27.83 GAL AN LOADING DESIGN: 8'-0" UNSATURATED SOIL TANK CAN BE USED AS: GREASE INTERCEPTOR COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN I (STRUCTURAL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE Zwl= . 112Pw-u a! - Fm W302M !DRAWINGS SUBMITTEElf FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: RE .9 SHEET NO. OF ST. SANITARY SYSTEM File Office Use Only OWNERSHIP/ADDRESS FORM cimw2l2o2l 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 heialth, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and ecluicational infoion will be sent to you by email, If you would like to view your issued sanitary permit online, you can do so by using thie R=g-rjy_ELOt� �iqgd weblink, It W1q 4 Mailing Address 2173 CTY RD H City/State/Zip DEER PARK Wl 54007 Phone Number (required) 715-781-1500 Email Address (required) Parcel Identification Number 006-10615-50-000 (found on the property tax bill) MKION Property Location SE 1/4 , SE 1/4 , Sec. 29 T 31 IN R 16 Subdivision Plat: q, 0 + —W, Town of CYLON !!a4L!i . . . ........... . . ... . Lot#_. Certifiedl Survey Map # Volume Paige # Warranty Deed # 103C'!J�.Jbefore 2006)Volume Page # Number of bedroon"i —5, 1 SP7 house 0 yes N no Lot lines identifiableNes 0 no i I rai .......... t for new comtruction 1-5-5--y—o- D �rnmunity Deveiopment epa;4% New �j-stern: Include with this form a r- - SurveY MaPi if reference is mode in the worronty deed Community Development Department — Land Use Division 715-386-4680 St. Croix County Government Center 715-24-425,0 Fax !;.dd@5.Cg)yLgQy 1101 Carmichael Road, Hudson:, W1 540,16 WMICC&MY °yw.. -�_7 7am"" rafE�' t�egle 1 Of 3 ional eEVALUATION REPORT fn a�rdance vwith SPS 3 5, Ws. m. Code County Attach corn eta st s than 8 112 x'11 Incfi s qnsize. Plan m BrvcllST� CRC)l� st to nearest roaVert not Iced 40ll� poq 'BIj, d�lilan +,: Parccal q.C. scage or dimersio s�r l iti5-.(fig ._._ Personal information you rovride matel a used fair %Arcommta rv apu o Gar"l�ww. 1 .tY d Date g1j{rrrpg. Property Owner Property Location n FOUR CORNERS FARMS LLC Govt. Lot SE ,Y. SE S 29 T 31 N R 16 E (or) W Properly Owner's Mailing Address Site Address or CSM and Lot it: 2'173 CTY RD H .._ ........_. LP�horie _ ... _.__._ City State, ;dip Nlumder ® City n Village ® Town ttearest Road NEW '' RICHMOND N CYLCJN New C (ruction Use:[] Resl fiat l Nurr b;of m�s _._.. design rate 1.2i f; PG ❑ Replacement ❑ Public or commercial _ Describe _._..._ .-..._.... Flood Plan elevation it applicable ff. Parent material GLACIOFLUVIAL DEPOSITS GRAVELY OUITt/1lA,SH Gene rail comments and recommendslions. w 1 Boring # 0 Boring Pit Ground surface efev.97.Ep y �. Depth to 4umnAkrsg factor 76ln, stew. .' ft, __ _ Soil Application Rate Horizon Depth Dominant Color Redox Clescription Tmexlure Structure Consistence Boundary Roots GPRfFt' In. Munseill Gu. Az. Cont. Color Gr. Sz. Sh. Etf*1 "Effft2 MML 2F 7 1.6 S -1 , 7. vYR4/44 --__� ._ . ......,'L 2IC MFR...._.._, 1 wF6 1 tJ ....... B1 iS-311 7'.5 4/4 _ ____., __ F SG MFR CS 11 VF 1.0 C 1-35 7.5YR41 _..__ -..______.__ - SL 2 M SSK MIL CS _ - .5 1.0 -- -__ __�- SIL _...2 MSI3 MVF.R ....._. 6 C1 _�R _" C2 YR �3 ---- __--��,__ FSG 0 F SG ML y; -:... _..- Bo eadnde., rt .BQ _-_ 1Q__:_ ._._...... OPR 2� Bwmq � yBoring surface elev. ff. Depth to lrmrtrng factor in. (ell ff. _ ...... Soil Application Rate Horizon Depth Dominant Color Redlox l tescrtpbon Texture Structure Consistence Boundary Roots GPD/Ftr' ._ In, fwlunselq Ctu. AZ, Cont, Color Gr. Sz Sh. "Efl"ff1 "Eff*2 _,... 10Yfi 3/3 _ _ ___ .,___ .. LS OMSG ML CW 1.5 27 2? 10 `f R 41/6 .._ _ ._____ SL 2 M GR' MFR CS E1 �34 7.5YR4/�i.ww_ ....._...�....�_�-____ .�_ ..._.._....__.w. ��.... ....._.._. �.�........w.___�.__ �_ SL 2 M S'K �MF CS 1�S2 10 YR4/5 .-��..____.,.___ G 0 I -SG I Cli"i/' 2 F 5 =B4- _ _____ SG C F SC ML CVO 2 F 1. 7.5YR4/4 ____ _ SIL 2 ABK MFR 2 F 6 CST Name (Please Print) Signet CSTNumber PAUL R KOEHLER _ � � 225410 ISC IPdSN rl DRIVE NEb'tt R'NCHMCIIV �e Evaluation Conducted 2ii22 T-.4e ho Number _ 7'15-246-2660 Effluent #1 - BOD > 30s 220 m9k and T'SS > 30 5 150 mg.fL ' Effluent #2 - BOO, s 30 mg//L and T"SS s 30 mgJL SBD-8330 (R03122) Page 2 of 3 Boring Pit Groundsurface elev,.W9 n, Depth to limiting factor, 96 in, / elev. 8 ft. 71 o lin Redox Descripi n �Qftq Muin:sell Ou. AL Cent. Color 10 YR 3/3 0 SG C d4-11 f (0,41 EBoring # C] Boring 1pdt Ground surface elev.­­tt. Depth to firniting factor._ ­ —in,. / e1ev.—ft. Sod Application Rate ols GPDIFt2 —'Eff#1 F -Eft#2 E] Boring 0 E] Boring Pit Ground surface elev.—ft, Depth to limiting factor in. / elev. ft, MMm — — — — — — — — — — — — Structure, foots Soil Application Rate onzoiT�D�h GPD(Fe I epI7�omin; Color Redo. Destrip6io. Texture Structure Unwstnce ] BoundaryT nsellr, Sz Sh, 'It Qu. Az, Cont. Color Gr, Sz, Sh, In. M �n, QU , Cont.Corrt� Color j -Eff#17-Eff#2 ' Effluent #1 = BOD > 30 9 220 mg/L and TSS > 30,s 150 mg/L * Effluent #2 = BOO,, s 30 mg/L and TSS S 30 mg& J CPO nis- _Q P ''q c i s �� W n!y Ati fit r, r efdv 4 v, A - Z ANI 10/1 BM22, 9:59:53 AM 1:4,514 Lot Tax Parcels SmoftW Overlay DMict 0 0.03 0.06 0.11 rri EM _ L 5 . 75 0 0.04 0.09 0.17 km Li oKIL. LAqL �o r YL.m SEC�_,T_To_LN, AND/OI'LOT op ow as -air hka A a NO.. 645� qpaw-vww wn WW JNr�r Q A XTTT A DV DIUDAi t nu