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HomeMy WebLinkAbout020-1133-00-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 592147 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: Richard & Jodi Nelson TOWN OF HUDSON 020-1133-00-000 CST BM Elev Insp. BM Elev: BM Description: SectionlTown/Range/Map No. i 715L-1 6-6-C 18.29.19.642 i - TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. .5 Io7' oa Septic Benchmark /r 75 V , /6s' /f - Dosing as• ✓ Alt. BM / t J". r AQrall Bldg. Sewer I OK, -3 i! Holding St/Ht Inlet r G , / TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic t Dt Bottom Dosing , r r Header/Man. Aeration Dist. Pipe _ 415 Holding Bot. System 7 5 Final Gr e /4 3 PUMP/SIPHON INFORMATION r i Manufacturer D emand Stppver GPM 5 (J / Model Number 19 TDH Lid Friction L ss~ System Hea TDH7 Ft _9cf, -7 Forcemain Length Dia. f Dist, to Well z 75 SOIL ABSORPTION SYSTEM BED/TRENCH Width Lengt No. Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 5I--- 1,441 , rem` f \ o' SETBACK SYSTEM TO P/L / BLDG WELILL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of System: A CHAMBER OR L a t~ O~ed1~"O 5 /t ~y~ UNIT Model Numlt)~J,J 14 DISTRIBUTION SYSTEM, 7 a W c7 A II Header/Manrfoll 1 Distribution x Hole Si e Ix Hole Spacing Vent a Air I a` Pipe(s) ` V Length- Dia ILength ` Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only V w~~l¢1 Depth Over Depth Over xx Depth of xx Seeded/Sodded 1xx Mulched Bed/Trench Center Bed/Trench Edge Topsoil No Yes I No I ~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~ Inspection #2: Location: 920 WILLOW RI E RD ` 1.) Alt BM Description 2.) Bldg sewer length = Jr 1 G 6 ~C.I~i 5 - amount of cover = Plan revision Required? I; Yes No I Use other side for additional information. ~I.7 V~ SBD-6710 (R.3197) Date /rlnSig a Cert. No. rr,- County Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be Shed in by Co.) / Madison. WI 53707-7162 ' thi tary Permit Application StateTransatxl Number In accordance with SPS X8321(2}, Wis. Adm. Code, submission of this form tb the appropriate governmental unit /NV is required prior to obt~ir invi. sanitary permit. Note: Psppticanon forms for state-owned POWTS are submitted to Project Address (if different than marling addra the Department of Shfory and Pirofessional Servies. Personal information you provide may be used for second ses in accordance with the Privacy Law, s. 15.04 i m), Stats. L Application Information - Please Print All Information u GAL Property Owner's Name _ Parcel 4 Property; Owner's Mailing Address S Property Location , G ~ 7 Z. C> C)6 ? J -7 41 o t ~ Govt. Lot City, Stale pp Zip Code Phone Number Yr`, L 1/" Section 16 T N; R~Eor~ II. Type of Building (check all that apply) ,mss' Lf ? f or 2 Family Dwelling -Number of Bedrooms Subdivision Name 3, J 13 Public/Commercial - Describe Use n ❑ City of 13 State Owned- Describe Use C CSM Number ❑"I,, Village of ~ l 3 4-tj i i+- 7~ G P.r of `f7 U G 0, L\1 III. Type of Permit: (Check only one Replacement a on line A. Complete line B if applicable) AIew System acement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explu . B. ❑ Permit Renewal etmrt Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued BeforvExpiration Owner 'lam ~j G 1 4 - J I IV. Type of POWTS S stem)Com men evic (Check all that a )Ion-Pressurized in-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound 2:24 in. of suitable soil ❑ Mound < 24 in. of suitable soil at i-Le ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)V. Dis ersai/Trea ent Area Information: Design Flow (gpd) Design Soil App l' on Rate Dispersal Area Required (s Dispersal Area Pro f) System Elevation VL Tank Info Capacity in Total # of Msat:fadurer o Gallons Gallons Units Now Tanks Existing Tanks j.~ U m o, rn w U Septic or Holding Tank i¢` Er C Dosing Chamber ) VII. Responsibility Statement- L the undersigned, assume responsibility for in taltation of the POFi7S shown on the attached plans. a MP RS N ber Business Phone Number Plumber's Name (Print) Plumber's Si Aur T0Fw 70 2L12 CIS `i i Plumber's Address (Street, City, State, Zip Code) oun artment Use Oni ❑ Permit ee Date Issuing t S' ❑ O%mwMvcn Reason for Denial /1{ l 7 01 1"711 DL Con ' W Reasous for Disapproval ` ! -s 1. 8*ir, ark, eir lmnriiltwend 3 7 011 AMA Zb !3 disper ti cell must dll be senile s ! rm tnJg,rfc as per rrtarlgement plan pro eider! byby plumber. 2. Aq ee(b** r at,i*, 9mAnts musk J4v r itdr h7ed as per txt} coda I crdimmaa. Attach to complete plans for the system and submit to the County only on paper not less than 8 in 111 inches in size SBD-6398 (R. 11/11) a uc. i r - CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: V p1 LS e) i~ Owner's Name: _ 7E A_1A Owner's Address: _ K C,,~ E 7 ~ )S h "V 66b WUCD $ukf AAVJ - ,55`i Z s' Legal Description: SC' ` C J ti i,p l`'t tom' Township: U I County:'? I Subdivision Name: MI-Lo ►v I '`f O ADO Lot Number: 33 Parcel ID Number: 0Z6-- S3 -pd . e500 Page 1 Index and title Page 2 Plot Plan Page 3 _ System Sizing & Cross-Section 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 CSM or Plat Attach~meents: Soil Test & House Plans Designer/Piumber. - E' f=4 ► y~ License Number: LZS Z `y Date: 7 Phone Number `I s e Signatur Designed pursuant to the fn-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 Y I f ; . i ~ ~ ~ 1 ' 4 A~ ~ _ 1 , ~ °t ~ ~ ~ s~ ~3~~ i ~ ~ / ~~`Y ~'o- ~ ~ i a'• , ~s~ ~ /d \d ~~~f,. ✓ .p ~ ~~5 f S211 Ab --rod Svs1!em Cross Section -o n Final Grade 4°Sdmkde 4© PVC Vent Pipe bL .1/ ft With Vent Cap Leaching Chamber ILI -.7-ft Syslem Elevation f l- ft Soil A„bsoeyfln Srrstem Rio V1ew - `7b ft ft Trends 1 Leaching / 7Verndt0r(ObservatlonP'PO Chwnbers IV Dia. Trench 2 Header eachlnQ Ohember S2ecificlMons Manufacturer And Model 1 N1- l ~Tl~ 1 i~' 1~ 7 EISA Rating 0 sq ft per chamber Soil Application Rate gpd/sq ft bC~ gpd Design Flow t Soil Application Rate EISA Chambers 3 rows of L l chambers each. Page of u~✓{JLty tiva.>v aaa.ui vivvv vwwa.~.va: i a..i~.s. a ~ j.. Tank Manufacturer Pump Manufacturer ZOC-LLEi2 Tank Model Number W Pump Model Number N I S Total Tank Capacity Alarm Manufacturer Q `(A I1 QS Max. Bury Depth Alarm Model Number J G 1/-- Switch Type y} t-1'u VC Filter Manufacturer Ll C Total Dynamic Head (TDH) - Feet Filter Model Number Elevation Head Distal Pressure - Network Loss - Minimum Pump Performance Required Force Main Loss Y &Z: GPM @ 16. Ft TDH Total t Outlet Manhole Min. 4" Above Grade With Locking Device. Inlet Manhole Manhole Min. 4" Above Grade < 6" Below Grade Sealed Watertight Securely Mounted With Locking Device Weather-proof ~l• Junction Box " - - Finished Grade a.a ® Depth of T Cover Vent Min. 12" Disconnect Ft Above Grade Means With Vent Cap S { S S<{{ S S{{ C S S S< S S S S;< S f{ S{ i S S t let Outlet Filter - ~y { let 4 Inlet Baffle - - In a ' oUt <t A { 2 5 G irU {y Switch Settings and Reserve Capacity =;s 's V417 >r} Tank Volume = GPI ts{ Weep { Hole >is Dimension Inches Volume Gal. B < (reserve) A `i -a ra{ _ (alarm) B 2 y . `yt Off Elevation - C sip (dose) C S ' 1 Zr_ t>1 Ft (dead) D 1(),. 2. Bottom Total =t= D ?i Elevation Ft s s s> r a a s r a s r a r a a> r r a s a r s s> a r a a~ r> > > : > > s> > s= t= t s= t r= t< t t t s= t t s t t t t< t r t r e s c r r e t t t t s s s r t s s t t t t t t t t t s e t s s s s s s s s a a s s s s s s a> s> s a> a a s s s> a a>> s s> a a a s s s s a>> a>> a s s s s a a> s GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 1628 WAC. 02/05 LJ Page of PUMP PERFORMANCE CURVE w PUMP PERFORMANCE CURVE PUMP PERFORMANCE CURVE SUMP / EFFLUENT MODELS LL EFFLUENT MODELS 140 318",1/2"&314" SOLID PASSING CAPACITY 318", 112" & 314" SOLIDS PASSING CAPACITY 42- 53155 13 MODEL 48 57159 72 76 98 1311139 14014140 151 152 153 4 130 191 Feet Meters Gal. Liters Gal. Liters Gal. Liters Gal. Liters Gal. Liters Gal. Liters Gal. Liters Gal. Liters Gal. Liters Gal. Liters 5 1.5 29 110 43 163 38 144 50 189 72 273 93 352 86 326 50 189 69 261 77 291 10 3.1 22 83 34 129 30 114 40 151 61 231 79 299 80 303 45 170 61 231 70 265 3 12 15 4,6 10 38 19 72 14 53 30 114 45 170 64 242 13 276 38 144 53 201 61 231 12 20 6.1 - - - _ _ _ p 64 25 95 36 136 66 250 29 110 44 167 52 197 3 11 486fi 30 9.6 8 30 59 223 16 fit 34 129 42 159 3 40 12.2 - - - - - - - - - - 49 185 - - 23 87 33 125 11 50 15.2 - - - - - - - - - - 28 106 11 42 fi0 18.3 _ - - - - - - - - - - - _ - - - 32 105 70 21.3 - - - - - - - - - - - - - - - - 80 24.4 3 10 90 27.4 s5 100 30.5 - - - - - - - - - - - - - - - - - - - 110 33.5 2 120 36.6 - - - - - - - - - - - - so - 130 39.6 2 85 Shut-off Head: 181. 5.Sm 19.25 ft. 5.9m 18 ft. 5.5m 25 ft. 7.6m 23 ft. Tom 26 ft. 7.9m 50 ft. 15.2m 30 ft. 9.1 m1 38 ft. 11.5m 44 ft. 13.4m 0 2 8o 165 4165 75 22 a 70 163 16114161 16314163 165/4165 18514185 18614186 188/4188 189/4189 191 ~ 63 2 65 41 Gal. Liters Gal. Liters Gal. Liters Gal. Liters Gal. Liters Gal. Liters Gal. Lifers Gal. Liters 100 379 61 231 61 231 - - 58 220 145 549 145 549 45 170 1 60 161 93 352 61 231 61 231 - - 58 220 140 530 189 1.1 530 45 170 4161 85 322 60 227 fit 231 - - 58 220 134 507 135 511 45 170 55 4789 79 299 59 223 fi0 227 - - 58 220 128 484 131 496 45 170 1 140 70 265 57 216 59 223 SB 220 122 4fi2 125 473 45 170 50 4140 62 235 55 2176 58 220 85 322 58 220 116 439 120 454 45 170 188 45 170 4fi 172 55 206 70 285 SB 220 104 394 109 d13 45 170 14 45 4788 20 7fi 33 125 50 189 51 193 58 220 90 341 97 367 45 170 - - 15 57 39 148 32 121 58 220 71 269 85 322 45 170 12 4 152 - - - - 23 87 9 34 52 197 51 193 69 261 45 170 35 153 - - - - 10 38 - - 45 170 26 106 51 193 45 170 - - - - - - 31 117 2 8 34 129 45 170 i - - 30 157 - - - - - - - - 16 80 17 64 40 151 8 185 - - - - - - - - 4 15 - - - - 30 114 38 1 25 4185 - - - - - - - - - - 20 76 10 99 56 ft.....m) fib u.(20.1m) 89 iL(28.4m) 73 ft.(22.3m) 114 fLp-,n) 91 T(27.7m) 1101(1 i b,n) 137 ft.(41.8m) 20 4 1 009922 2 5 A CAUTION Model 185/4185 should not be subjected to 48 72 53,55 s 139 less than 30 feet TDH. 0 57,59 NOTE: For Pump Performance on Model 112, Industrial column GALLONS 10 20 40 50 60 70 80 90 100 110 120 130 140 150 explosion proof pump, see FM0219. LITERS 0 80 160 240 320 d00 480 560 FLOW PER MINUTE SEWAGE AND ~w MODEL 211 264 266 267 268 27014270 28214282 284/4264 292/4292 293/4293 29414294 295/4295 DEWATERING 211 1, 17 11 "1 8G 241 75 19 1 lo 22 70 - e I z 20-{ 6 - - - - - - - - - - - - - - - - 5 R 15.l 1 - - n - z, s l's . z, snb ,m 60 8 0 ne 009904 ~ 55 U J 16 a 50 Z 14 45 I 2931 O 12 40 0 35 PUMP PERFORMANCE CURVE 30 SEWAGE MODELS i 25 26 282 2 o, 70 SOLIDS PASSING 61 ~ 20 267, 12 I CAPACITY 4,1 5 10- 5- 21 I I ~ 12'1 264 0 ~ I 1292 284 29411 295 A CAUTION Model 293/4293 should not be 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 1 50 170 180 1 90 200 210 220 23 subjected to less than 15 feet 7DH. GALLONS Lli RS 1 1 0 80 760 240 320 40C 48C 560 640 720 800 FLOW PER MINUTE © Copyright 2003 Zoeller Co. All rights reserved. 6 'S T" is. ep' rety and Professional Services °8OIL EVALUATION REPORT Page of 13 ivisi r ety and Buildings ST CROIX COUNTY in ac►i iY~ll~(A~11f Code County P omplete site plan on paper not less than 8 112 x 11 inches in size. Plan must j e, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. ant slope, scale or dimensions, north arrow, and location and distance to nearest road. ` A J/ Please print all information. Revi d by Date Personal informarion you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 7r f 7 -'ropertY-P wner Property Location r' Govt. 1)`I7- )Z' 114 T4,2 N R E( W Property Owner's Mailing Addr s Lot # Block # Subd. Na a or C§M# -7 4e' City State Zip Code Phone Number ❑ City Village own Neatest ~oad ~n ( ) r ' New Construction Use:Z! Residential / Number of bedrooms Code derived design flow rate 2 i GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material _ ~C fti Flood Plain elevation if applicable ft. General comments and recommendations: 7~L Boring Boring # F-/1 pit Ground surface elev._ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 02 r, Al '1( FA A)Z L2 7~ t,7- Boring # 0 Boring Pit Ground surface elev. ft. Depth to limiting factor _ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture structure onsistence Boundary Roots GPD/ft s in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 *42 ZZ7 Z- - 00 110 V E uent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ffluent #2 = BO < 30 mg/L and TSS 30 mg/L CST Na lea Pam- C Signature % i CST Number OPP Address Q Date Evaluation Conducted Telephone Number SBD-8330 (RI l/111 Property Owner / Parcel ID # y~ 111-~51- -ZY-- Page of d F1 Boring Baring # p;t Ground surface elev. ft Depth to limiting factor ~ in. EE tot Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft Z in. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 02 2-1 'V ~7 l~ ❑ Boring ❑ Boring # ❑ pit Ground surface elev. ft. Depth to limiting factor in. Boil Application Rate Horizon Depth Dominant Color Redox Description Texture structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ` f 'l + --f W2 ❑ Boring ❑ Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots tl#1 GPD 02 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Effluent #1 = BOD 5 > 30:5 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD s < 30 mg/L and TSS 30 mglL The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBD-8330 (R) 1/11) Property Owner o ' Parcel ID # - %%3f Page --0of F-F] Boring # ❑ Boring pit Ground surface elev. 16,~<l ft. Depth to limiting factor > in. Solt Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft T in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ` 02 J j~ o~ 1 E Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture structure onsistence 'Boundary Roots GPD/ft s in. Munseit Qu. Sz. Cont. Color Gr. Sz. Sh. ` ff#1 r ff#2 Boring a Boring # Ground surface elev. ft. Depth to limiting factor in. F-1 ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 *W2 Effluent #1 = BOD e > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD < 30 mglL and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBD-8330 (RI 1/11) I 7/f, i 7-7 p :sue a 1-7 ca'Q'~r ` i A 1 I ~ County . ' s 4. ! Safety and BtllkIngs [ iv ion r 201 W. Washington Ave P.O. Box 7162 Saintary Permit Number (to be filled in by Co.) 11, P ( 1 r, Madison, Wi 537Q,7-7162 01 av wT. CaROI X . „State Transaction Number -art Applicat- In accordance with SPS 38321(2), Wis. Adm. Code, submission of this form t PYBYXYN KS88RJ is required prior to obtaining a sanitary permit Now Application fortes for stawo wncu miw . a arc buuuluMu w Project Address (if different than mailing addre the Depanment of Safety and Professional Servics. Personal informabon you provide may be used for secondary purRM in accordance with the Pnvacy Laws. 15.04 1 m , Slats. IL. Lo VA/ P-( b(:, C r) L A lication Information - Please Print All Information Property Owner's Name Parcel 0 ~asynti LAC' - l l,33 Cc' Property Owner's Mailing Address Property Location I K 7 w cc,() I f Govt Lot_ City, Stwe 1~ Zip S5 j -5 11-1 Code Phone Number Section _ YV 0 h w s I\j G (C It one EL Type of Building (check all that apply) f i Lot # T -L N; R ~ E ort~ or 2 Family Dwelling -Number of Bedrooms Subdivision Name - ~ , n. v y~~?IM11 l Block 4 VJ jLte) (1,/ t~ (fix 2 ❑ Public/Commercial - Describe Use ~5 I ❑ City of Village of ❑ State Owned - Describe Use CSM Nmmt'h ❑ 64,-Town or IIL Type of Pe (Check only one box o line A. Complete tine B if app New System ❑ Replacemetn System 4rZVentNoldiV INqwerrient Only ❑ Other Modifcstion to Existing System (explt B. ❑ Permit Renewal ❑ Permit Revision ❑ Chant of r ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before•Expiradon owner 1V Com nent/Device C Il that apply) on-Pressurized In Gr ❑ Pressurized Ili-Ground de ❑ Mound 124 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Talk ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis al/Trea ent Area Information: 1 Design Flow (sydf Design Soil lic ation Jkte(gpdsf) Dispersal Area Required,(at) Dispersal Area Proposed (sf) System Elcti anon 1,/ _ f t l5 z-o 11 9 Cr s. s may. a 50 VL Tank Info Capacity in Total k of Maau£acur a Gallons Gallons Churl I G New Tanks Emsting Turks it ✓ + u l~ G I~, y (l p L- CL U v~ A v~ V S Septic or Holding Tank 1V` OXR. Dosing C haciba aJ VII. Responsibility Statement- I, the undersigned, aasame responsibility for installatlon of the PORTS sbows on the attached plans. Phhmber's Name (Prim) Plumber's Signature RS ben Business Phone Number :;~Z.3 07t 2- 1715% 441 31676 Plumber's Address (Street, City, State, Zip Code) PV- AK 56s- D "5E i-< tV VIII. Conn r'tmant Use Only Permit Fa Date Issued Issuing Agent S 0 Given Reasoofoi s 5 { IX. Conditions of Appro : sans for Disapproval SYSTEM OWNER: INX I W) fV\ Z)~~~-~ ~e 416) u ~/0~'~1D~ J i. Septic tank, effluent filter and dep+h, t'D dispersal cell must be serviced maim line - ii 1 as per management plan provided by plumber. ~IJ 2. All setback requirements must be maintain ° VV4WAft the systes and sub'it the Coen only on paper am Ices than 8 1 11 inches site r SBD-6398 (R. 11/11) W)~-- iq w Lvr ~j(LLaij 21U/) Abo To v~l;U ~ r ~-l~'f~So; J Mss X2, a SOUL gc~e1IJL S SCAI.C-. ~ ~D ~ i t vu I ESfa2 I f 13 { ~~uC'rl-A(~(a1cK ~3 BF1.'C~Ii~r1t1KIL~2 ELF = ~?3 5 (-I G Z7 ' A(3W i i ~ ~ to 91 C ~6v i CONVENTIONAL COMPONENT DESIGN Residential Applicat;on INDEX AND TITLE PAGE Project Name Owner's Name: Owner's Address: A ii wo a T\0 =4+ 6q W06 Q K-1 A 14 SS/L5- Legal Description: _'/ly J/`/ Township: ioS6IJ County: Subdivision Name: yy k) Z k o Lot Number: 33 Parcel ID Number: nZl ^ b - ~o i Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Paoe 6 Management Plan Page ; St. Croix Cty Septic Tank Maintenance Form Page 8 Warrant Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber. 'f- f NX License Number. M zz32`t .z Date: / Phone Number 7I 5- -3456 Signature J/ f/ Designed pursuant tc the In-Ground Soil Absorption Component Manua for P01hrTS Version 2C SBD-1 C7C5-P (N 01/01; Page 1 IL~IL~Z 1~ 4 -TL` L) I ~~LS L) I V' 'Ai S iA --M- T Z.--i AJj K j q W Z..L~ ~~5 blvl~LL;~J ~c /1~~. 21UY~ l~nl) T; Vui~' v f~ ijG J-Sc; M~~S 2Z3 Lys '"y~~r Sb(L i~~ialjL S t 3 !f ~ . Z ~ t~-.1.)ttt~ /,(til~Ll~- I~~►J( -tl/Y'1~1KIL 14 Z7 "Nik • i ~Qal~eurrl.~ rNvadow f, sin CLLIL It ft -qs Is Aldo Elm Dw ft ' T~snch Low" ChmrJww i r OIL Trsach 2 toodw Vur~t ar ~ I I Twuh 9 i Mnrgddeoanrr And MedW -T i'31\4C j (MC IC IC Wd Dubn Rows • W APP&M M ~ 4,, esn R Ga3 cn~m a 8 rows nfcl-dwanbsn slob. Pap of . INSTALLATION INSTRUCTIONS PL-5251PL-625- FILTER ifraBrsdae6 ~1'J~dP~+1t~ i25/M-626 FEATURES & BENEFUSS 1 _ r Features & Benefits: tmr r a Rated for 10,000 GPD _ PL-625 = 526 Linear Feet of 1 /18° Ftttraton PL-625 = 625 Linear Feet of 1132° Filtration i PLC PL-M aAccepts 47 and T SCM. 40 pipe PL-6251625 Effluent Filter should operele effidently o Built in Gas Deflector ;evera,l years under normal conditions before aAutomatic Shut-Off Bag when FIW is Removed h ing-dwartng. It is recommended that the Mar be led every time the tank is pumped or at least every a Alarm Accessibility years. if the installed fitter contains an optional -athe owner vAll be notified by an alarm when the eAt is PVC Extension Hardie needs servicing. Servicing should be done by a fled septic tank pumper or installer. . Pdlyiok PVC FOW Exftnslan ale ° " f x e ► ::-~`«~_l ~ iii ai=' =1F t 4h r - h- i y x - Wwl~ Y r-. fo - _ 6. - t - - Ili OW b-ng yaw PoMok Ex~d & Ldc7m Polyiok sue/ ~ E~u[IDOI be tank OMM to ode- is 8 sue. GMY m use ants po{ybk fax alarm pmeis a vSauei s agog" lamming and sakdk) t that can extend ~8 "N easder ow tNet or pElSet pipe and and ~ fiding 1D open ou d aSwwM udible no w Of 1 funs savtag by make Mar and/or badiie septic tank 01- Mnpenaft MN and tank ing dWWQ to *w tank n a snip. - Fora full Fist of Poiyiok products pime visk Our web ske at www.poWok.COM