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HomeMy WebLinkAbout014-1020-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division County: St. Croix INSPECTION REPORT sanitary PEN GENERAL INFORMATION (ATTACH TO PERMIT) 579066 Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. State Plan Permit Hold er's Name: 256374$ Kyle & Shari Overby City Village Township Parcel Tax No: CST BM Elev: TOWN OF FOREST 014-1020-50-000 Insp. BM Elev: BM Description: / ./1 A 1 ~C Section/Town/Range/Map No: TANK INFORMATION / A & J 09.31.15.133 TYPE ELEVATION DATA MANUFACTURER .~-y5 CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing t ®Z5o , 2 °J ~.7 5 /Z116 GO rh b 7 •~5d Alt. BM E. 1 J-4. 2.7-6 4?7L5 Bldg. Sewer 07 ( L, Holding 9. 11" 76.5? St/Ht Inlet 19 7 _157 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/ WELL BLDG. ent o Air Intake ROAD Dt Inlet tit Septic T /6d ~!9 73 Dt Bottom Dosing 1 Z. y 5'.5.5 7 /ap / /sc~ Header/Man. Aeration Z. l l p 97. S °j Dist. Pipe Holding got. System Z ~CI~~ 9/7 s~ Final Grade r D 3 PUMP/SIPHON INFORMATION Manufacturer ~j , Demand St CoverC 2 J~ \ GPM LpJ LA_ Z• Z S 27-5 ~ Model Number 5 Z EForcem!ain Friction Loss System Head TDH/~ O✓~~O v r Zj . S fLeenn,,gth 38 3~ZSDia. Dist. to Well l5 Z ~sg SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenc III s DIMENSIONS G` Z~ / PIT D ENSIGNS No. Of Pita_ Inside Liquid Depth SETBACK SYSTEM TO INFORMATION P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: Type Of ystem: ~ /66 /6Z CHAMBER OR 44 -7 A) UNIT Model Number: DISTRIBUTION SYSTEM J%6 JV Header/Manifold ! ( Distribution Z Pipe(s) 3 4 2 ~ x Hole Size 11 x Hole Spacing Ve I Air Intake Length Dia Length r Dia 3 I Spacing 3 SOIL COVER x Pressure Systems Onl Depth Over Only xx Mound Or At-Grade Systems Only a ~ Depth Over Center Depth Over ` xx Depth of I xx Seeded/ odded T ;d ~ IA Bed/Trench Edges Topsoil xx Mulched Yes ® No Yes ® No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: mil/ 44115 Inspect' n #2: Location: 2843 230TH AVE a,A,I[,,, b~~ Q ~M • , 1.) Alt BM Description = I ✓D f6 iS P/ot,j T I~ 2.) Bldg sewer length = 33 V -amount of cover = / !5,'W- ✓Ka~J~ 6 W--- OVA e, Plan revision Required? 0 Yes No Use other side for additional informati n. I I ✓ I SBD-6710 (R.3/97) Date Insepctor's gnature ~v Cert. No. NEW ~}Gt, YE County i AUG b 2015 . iBfG IvIS n ' eo i Y ~t ? 0 ` U 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) ` P$ rl Madison, WI 53707-7162 ~T. CROIX COUNTY ~/c/c '~'~MUNITY DEVELOPM Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. ry(~ '7 x a , I. Application Information - Please Print All Inform V G CJ /7v Property Owner's Name / Parcel # C - 10, at - 156 etc, Property Owner's Mailing Address Property Location / t tQ,T M Aut, Govt. Lot ' / 35 City/, ~Statl-I ! e y f Zip Code Phone Number Av~ N i•1J/. Section (circle one) ~[x LA W l C~ ' H. Type of Building (check all that apply) Lot # T N; R, E or W 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name I ock # [I Public/Commercial - Describe Use ti ~e+ w` ❑ City of 1 El State Owned -Describe Use CSM Number ❑ Village of Ifs r/ 0 ✓ /~O~ V-e& .Town of 7,P4 1III. Type of Permit: (Check only one box on line A. Complete line B if applicable) 2AA~~ X' A. ❑ New System [ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS S stem/Com nent/Device: Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil 0 Mound < 24 in. of suitable soil , ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) ` / / V. Dis rsaVrma ent Area Information: 1 Design Flow (gpd) Design Soil Application fate(gpdsf) Dispersal Area Required Dispersal Area Pro d (sl)l System Elevation b ► toc9~ ~b~ 1vC~J 3'S 5 70. VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o v New Tanks Existing Tanks w c $ v ^y " vx 1 0 C Y L~ t~ J9 m w c7 a, Septic or Holding Tank 17-5 e p Dosing Chamber ~44. I VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Si MP/MPRS Number Business Phone Numbcr,-:? le Plumber's Address (Street, City, State, Zip Code) FP:P1-1 Counartment Use Only 9 If ----4Z Issuing nt Signature ed ❑ D' ppove Permit Fee Dilate ued L/5 en Reason for De ~Z IX. Conditef3t1 fqr Disapproval f~' ~ptie lank, effluer>E 3) L Al ,twLh, (r~ n, ~f~ dc~Q e rlisrsal cell must ae 4srv e I n I ~►ain t ~ D'z~-v P aS per management plan provided by plumper. art, ~q±d!et ter nnlil>tsifl / as PK applidll~a ~ / Attach to complete plans for the system and submit to the County only onpapernot less than 8 in s 11 inches in size SBD-6398 (R. 11/11) HARDINA SEPTIC SYSTEMS MPRS/CST 824825 Z, ,o 14 Z•: -Y C_t.l-i 1 _ - L1 111 'a _ _ as -a t rte- ~ ' r~ z f a x Q! ~,h d ell r y 93 7s - - 9tiyART.4fE,~_ DIVISION OF INDUSTRY SERVICES ~ti%~ fog 10541N RANCH ROAD q/ \`9P HAYWARD WI 54843 Contact Through Relay 9 `ti V P S http://dsps.wi.gov/programs/industry-services G www.wisconsin.gov ~O'ssror~ti5w Scott Walker, Governor Dave Ross, Secretary June 30, 2015 CUST ID No. 824825 ATTN: POWTS Inspector BOB J HARDINA ZONING OFFICE HARDINA SEPTIC SYSTEMS ST CROIX COUNTY SPIA 477 170TH AVE 1101 CARMIC14AEL RD TURTLE LAKE WI 54889-9187 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/30/2017 Identification Numbers Transaction ID No. 2563748 SITE: Site ID No. 814159 Kyle Overby Please refer to both identification numbers, 2843 230TH Ave above, in all correspondence with the agency. Town of Forest St Croix County NE 1/4, NWI/4, S9, T3 IN, RI 5W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1542474 Maintenance required; Replacement system; 600 GPD Flow rate; 20 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12), SSWMP Pub. 9.6; Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Any increase to the TDH will result in a larger pump selection. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. BOB J HARDINA Page 2 6/30/2015 , Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Carl J Lipp Wastewater Specialist, Division of Industry Services WiSMART code: 7633 (715)634-5035, M-f 7AM - 12PM carl.lippert@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm t a MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: OVERBY Owner's Name: KYLE OVERBY Owner's Address: 2843 230TH AVE CLEAR LAKE Legal Description: NE,NW,S.9,T.31N-R15W Township: FOREST County: ST CROIX Subdivision Name: NA Lot Number: NA Block Number: NA CONDITIONALLY Parcel I.D. Number: 014-1020-50-000 API2R Vr- Plan Transaction No.: DEPT OF SAFETY AND SERVICES PROFESSIONAL Page 1 Index and title DIVISION OF INDUSTRY SERVICES Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintena PONDENCE Page 6 Management and continge Page 7 Pump curve and specifications Page 8 Site plan 1" = 40' Page 9 Filter maint. Page 10 Att. Soil test Designer: Robert Hardina License Number: MPRS 824825 Date: 06/15/15 Phone Number: 715-986-2508 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SBD-10691-P (N. 01/01, R. 10/12), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01, R. 10/12) Version 7.0 (R. 11/12) Pagel of 10 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 383-44-3 in-situ soil treatment for 1.50 Peaking Factor (e.g. 1.5 = 150%) fecal coliform of - 36 inches. 600.00 Design Flow (gpd) 4.00 Site Slope 95.50 Contour Line Elevation (ft) 20.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 65.00 Dispersal Cell Length Along Contour (ft) = 9.24 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution y Pressure Disribution Information network? Enter Y or N (C or E) a Center or End Manifold 3.08 Lateral Spacing (ft) If N above, enter the elevation (ft 3 Number of Laterals of the highest point. 0.188 Orifice Diameter (in) 3.00 Estimated Orifice Spacing (ft) = 9.10 ft2/orifice 2.00 Forcemain Diameter (in) 100.00 Forcemain Length (ft) Does the forcemain drain back? Y 80.00 Pump Tank Elevation (ft) Enter Y or N 3.25 System Head (ft) x 1.3 16.31 Forcemain Drainback (gal) 16.46 Vertical Lift (ft) 87.28 5x Void Volume (gal) 3.81 Friction Loss (ft) 103.60 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 43.25 System Demand (gpm) 23.52 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 1.00 1.50 1.25 2.00 x x 1.50 x x 3.00 2.00 x 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information 750.00 Total Tank Capacity (gal) 1250.00 Septic Tank Capacity (gal) 45.00 Total Working Liquid Depth (in) HUFFCUTT Manufacturer 16.67 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 750.00 Dose Tank Capacity (gal) LIFETIME Filter Manufacturer 14.93 Dose Tank Volume (gal/in) LT 18 Filter Model Number huffcutt Manufacturer Project: OVERBY Page 2 of 10 Mound Plan and Cross Section Views T . J Observation Pipe FK .77, 7.77777. U / A W B . i L Mound Component Dimensions Down slope toe extension made. ft B ft F 9.50 in z ft L ft A A16.00 ft E 20.44 in H Aft ft K [jift D in G 0.50 ft J W 600.60 (ft2) Dispersal Cell Area 1500.00 (ftz) Basal Area Available 923 (gpd/ft) Linear Loading Rate 6.50 (ft) 1/10 B Obs. Pipe Placement • Mound Cross Section View Aggregate Dispersal Area Finished Grade 98.63 (ft) G t H 'I ,iiii/fnnfff/ff/f/ftJ`i'/f//fffffff/ff/f/f I F Dispersal Cell 97.33 (ft) Lateral 96.83 (ft)--► - r Invert Dispersal Cell v Elevation; E L a . r1-1 95.50 (ft) Contour Elevation 4.0 % Site Slope Geotextile Fabric Cover Shading Key c. T Dispersal Cell See lateral details on l0 Topsoil Cap o 1.5 ft ,f. Page 4 for number, size, ❑ Subsoil Cap N j and spacing of laterals. Laterals are equally ©0 ASTM C33 Sand a t 10 - F spaced from the Tilled Layer y 0.5 ft Typical Lateral distribution cell's © Aggregate o centerline in the - A distribution cell (AxB). Project: OVERBY Page 3 of 10. End Connection Lateral Layout Diagram Center the laterals over the A & B dimension Turn-up v Vball valva or m1aenout plug P wl All laterals are identical 1<- X I Holes drilled on the bottom of the lateral equally spaced Laterals &forcemain Sch 40 PVC per SPS Table 384.30-6 S Foroe main ocnneotion via tee orr, cross to manifold at any point.. Number of Laterals 3 Orifice Diameter 0.188 in Lateral Diameter 1.50 in Orifice Spacing (X) 3.02 ft Lateral Length (P) 63.42 ft Orifices per Lateral 22 Lateral Spacing (S) 3.08 ft Orifice Density 9.10 ftz/orifice Lateral Flow Rate 14.42 gpm Manifold Length 6.16 ft System Flow Rate 43.25 gpm Manifold Diameter 2.00 in Total Dynamic Head 23.52 ft Forcemain Velocity 4.42 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and SPS 316.300 WAC 4 in. min. Disconnect Tank component is properly vented E Alternate outlet location Forcemain diameter huffcutt Manufacturer 2 in. Ca acit 750.00 Gallons Volume 14.93 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 30.80 459.78 B 2.00 29.86 C Pump off elevation (ft) C 6.94 103.60 80.88 D 10.50 156.77 D Total 50.23 750.00 Dom se tank elevation (ft) 3' Bedding under tank. 80.00 Alarm Manuafacturer SJE RHOMBUS Note: Switches Alarm Model Number tank alert containing mercury may not be used in Pump Manufacturer zoeller this system. Pump Model Number bn 'lid /,.5- Pump Must Deliver 43.25 gpm at 23.52 ft TDH Project: OVERBY Page 4 of 10 Mound System Maintenance and Operation Specifications Service Provider's Name Robert Hardina Phone 15-986-2508 POWTS Regulator's Name ST CROIX ZONING I Phoney System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1250 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600.6 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Should inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 3 ears Mound Inspect for ondin and seepage once eve 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished• • • • • • • • • • • • • • • • • • . Grade vl 6-8" Diameter Lawn - Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lon Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: OVERBY Page 5 of 10 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01, R. 10/12), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706-P (N. 01/01, R. 10/12)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continaencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 10 HEAD = MET l fE ' a ; x-4 6' a c ,71 L ell 16 m COO { 6 ~ 4 i~: lot I.Mmom HARDINA SEP'T'IC SYSTEMS MFRS/CST 824825 _ x L~J P ; LJ l ~lj ,a t 1 4-2- "?;i; 7 S-6 ILI i r { i S/fit ~ b Y 0 n F f O , t . ~3 s • 0 • if t f It I e i Installation and Maintenance Instructions Installation Step l Dry fit the filter case onto the outlet pipe going to the drain field. Ensure it is centered directly under the access opening. (if outlet pipe is already in a fixed position, additional pipe may need to be added) Step 2 If utilizing the additional single side support and the two bottom supports: While the case is still dry fit to the outlet pipe, measure and cut 1" schedule 40 pvc pipe to the length needed to extend from the hubs that are pre-molded into the case to the side wall and the inside floor of tank. solvent weld pipe into the hubs that are pre-molded onto the case. Step 3 Solvent weld the case to the outlet pipe. Insert the filter cartridge into the case pressing down on the cartridge until it locks into place at the bottom of case. Step 4 if utilizing a vertical read switch: Insert switch into the hole pre-molded into the top of the filter. Press straight down until it locks into place Maintenance 1) Remove the access lid of the tank. Note: To ensure undesirable solids do not exit the tank and into the drain field, the tank should be pumped out until the level of effluent is below the outlet level of the tank. 2) To remove the filter cartridge from the filter case, pull up firmly on the handle of the cartridge dislodging it from the case. (if utilizing a vertical read switch, removal of switch is optional) 3) Using an ordinary garden hose, rinse the filter cartridge ensuring all visible septage °material is removed. 4) Place the filter cartridge back into the filter case pressing down on the cartridge until it locks into place. 5) Place the access lid back onto the tank ensuring it is secure. Lifetime fitter has a lifetime limited warranty: Lifetime filter LLC warrants the filter will be free of manufacturing and workmanship defects during normal use for the period of time the original purchaser owns the product. Lifetime fitter will provide a replacement fitter in the event that the original fitter was not damaged during the installation or maintenance process. Damage to this product caused by accident, misuse or abuse will not be covered under this warranty. Improper care or malfunctions resulting from product not being installed, operated or maintained property will void this warranty. Lifetime filter assumes no responsibility for labor charges, removal charges, installation or other incidental or consequential costs. Contact: mike@lifetimefilteriic.com Phone: 502-7242231 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer K . L.e 511041t, ®UCe Mailing Address 3 M 1- E, E qQ_ L A L F t.J I~ oo Property Address 4?~avM 2 c- (Verification required from Planning & Zo ' Department for new construction.) City/State P ZC-,off. L L!4,1 Parcel Identification Number LEGAL DESCRIPTION Property Location & K , A t d r/4 , Sec. T-,31 N R /LW, Town of 3 Subdivision Plat: Lot # Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house n yes n no Lot lines identifiable n yes n 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 §Comm. 83.52(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. Uwe, 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 Commerce 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 t)fis form are true to the best of my/our knowledge. Itwe am/are the owner(s) of the property described above, by virtue of a 7ranty deed recorded in Register of Deeds Office. Number of bedrooms `f A 61 SSIGNAD;KE OF APPLICANT(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. 09/07 EE~V E P-A-L-P AI~G Z~ 2 01 S 141 S q Wisconsin Department of Com SOIL A-TI RREPORT Page of Division of txyRC"1 0 NITY [)C LOPM041 accordance with Comm 85, Wis. Adm. Code County ST.CROIX Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must 14-1020-50-000 include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. ;/Z-K/~ Rev ed by Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location ■ KYLE & SHARI OVERBY Govt. Lot NE 1/4 NW 1/4 S T 31 N R 15 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Na or CSM# 2843 230TH AVE city State Zip Code Phone Number City [Village ■ Town Nearest Road CLEAR LAKE WI 54005 ( 71 5-491-3079 `SOREST 230TH AVE New Construction Use Residential / Number of bedrooms Code derived design flow rate 4bU GPD Replacement Public or commercial - Describe: OUTWASH Flood Plain elevation if applicable ft Parent material General comments RECOMMENDED SYS. MOUND and recommendations: Zo ~ J~ F1 Boring # 11 Boring 20 Pit Ground surface elev. 95.5 ft. Depth to limiting factor in Soil A licetion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 0-10 10YR3/3 SIL 2MSBK MFR CW 2M .6 .8 2 10-207 10YR5/3 SIL 2MSBK MFR GW IF .6 .8 3 MFR N/A N/A .4 .8 20-50 7.5YR4/6 5YR6/6 SL 1 MSBK Boring 95.16 25 Boring # Pit Ground surface elev. ft. Depth to limiting factor in. Soil A licatton Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff 11 *Eff#2 1 0_9 10YR3/3 -0- SIL 2MSBK MFR CW 2M .6 .8 2 - 10YR4/6 -0- SIL 2MSBK MFR CW 1 F .6 .8 3 - 7.5YR4/6 -0- SL 2MSBK MFR CW N/A .6 1.0 4 10YR5/3 C2D5YR6/6 SL 2MSBK MFR N/A N/A .6 1.0 5 44-55 10YR5/3 F2D10YR6/8 SCL 2MSBK MFR N/A N/A N/A N/A * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si CST Number ROBERT HARDINA 1W - 824825 Address ate valuation Conducted Telephone Number 477 170TH AVE. TURTLE LAKE WI 54889 5-3-13 715-986-2508 OVERBY 014-1020-50-000 Property Owner Parcel ID # / Page of ❑ Boring # 0 pit Boring 95.33 25 Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-11 10YR3/3 -0- SIL 2MSBK MFR CW 2M .6 .8 2 - 10YR4/6 -0- SIL 2MSBK MFR CW 1 F .6 .8 3 254 7.5YR4/6 C2D10YR6/8 SL 1 MSBK MFR N/A N/A 4 6 Boring # Boring 93.75 24 • pit Ground surface elev. ft. Depth to limiting factor in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10YR3/3 -0- SIL 2MSBK MFR GW 2M .6 .8 2 10-24 10YR4/6 -0- SIL 2MSBK MFR CW IF 6 8 3 24-49 7.5YR4/6 C2D5YR6/6 SL 1 MSBK MFR N/A N/A .4 .6 Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. Pit =Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L 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. SBD-8330Te t (R.07/00) Y ° HARDINA SEPTIC SYSTEMS MPRS/CST 824825 .(I Do Lj JAIL i VV" ~ t Cr a z . E .7 s 13