HomeMy WebLinkAbout020-1374-10-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 592247
GENERAL INFORMATION State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village Township Parcel Tax No:
Brent & Kristin Carlson TOWN OF HUDSON 020-1374-10-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
iQ - 1 G5 ( 12.29.20.2243
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURE CAPACITY STATION BS HI FS ELEV.
Septic W -0 / I , A^ Benchmark / r4R72, ce 9~ '
l~cn.~ • 7 /
Dosing Alt. BM
t G ~ 1d~[ p
J _5 Bldg. Sewer . /7 / ? •
Holding ( St/Ht Inlet J
z5
TANK SETBACK INFORMATION St/Ht Outlet
~
TANK TO P/L WELL BLDG. Vent t it Intake ROAD Dt Inlet
SaJA,,
Septic Dt Bottom
606 0 ~•6 scr,
Dosing (lot) (00 Header/Man. Z /
Aeration Dist. Pipe
Z 9(0.
Holding Bot. System W .4
t
PUMP/SIPHON INFORMATION Final Grade S 9 q.
Manufacturer GP and St Cover ,7
Model Number
TDH I i , 46 Fricti~ ZS System He c~ TDH t
7 7'
Lent, Dia. 11 Dist. to well /
Forcemain
1 7-
SOIL ABSORPION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 51 3 'If 4467 ® I
SETBACK SYSTEM TO P/L BLDG WELL If LAKE/STREAM LEACHING Manufacturer:
INFORMATION P /
INFORMATION CHAMBER OR -1- 1X
Type Of System t 26~ 7 X -7g UNIT Model Numbep~ _ C~~
DISTRIBUTION SYSTEM S G7,, o $e C0,~.(W 1 f ~/7 /~~~5
Header/Manifold) / Distribution x Hole Size IX Hole Spacing Vent Air I Jr
ake
4 Pipe(s) edl LDia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges \ Topsoil . U No es [ ] No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 222 STARR WOQp'~
1.) Alt BM Description
2.) Bldg sewer length
- amount of cover ( J
Plan revision Required? Yes >rNo 17 Q
Use other side for additional information. 1 c/
Date Insepctor's Sig lure Cert. No.
SBD-6710 (R.3/97)
L.j CL
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133! - ~ - _ o o a oo m n ~o .n 9i . . r .-s H _ o n INS
Ov311 -*"W W101
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cty
Safety' atnd BulidkW Wtslon { J QC
e 4 e ' sr ~Q 1~ 201 W. Washington Ave., P.O. Box 7162 Solitary Permit Number (to be fired in by Co)
_ - BAR `l Madison, Wi 63707-7162
cROUC CCV 72 41 7
Permit 14pp3Tt ttelrarrxiala
,CAM
tarY
In accordance with SPS 38321(2), Wis. Adm. Code, submission of this fo.... r..,.. a ..,,....,a o. a~~
a required prior to obtaining a military permit Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing addta
the Department of Safety and Professional Servies. Personal information you provide may be used for "condwA,
pMgnm in rdauce with aria Privacy Law, s. 15,
11)(m). stars. -zz ~2
I. A licabas Isforrnation - Tease Print All Information
Property Owner's Name Parcel
Bid -4 5 i i\1. ~{A1~ QJ 19 - to -COCA
Property Owners Manna Address P"oIetty t ocarra" y C. a y 3
2 j 1'~ ~ZtiVI j Govt Lot
City, Soft Tip Code Phone Number F y~ V~-' y,; nation i Z
V r~ ~ 9 0t (circle one
Z
I. T L` f N; R -C' E a~
I Type of Building (check all that apply) Lot #
Xkor2FamilyDwelling-NumberofBedroorns l-- j1 Subdivision Name
❑ PubliclCommercial - Dkscrlbe Use ❑ City of
Stz~e Owned - Describe Use CSM Number D Village of i
❑
'ti
Ink- .16 ` w W-7,4-7,t_ t Town of
Ild. Type of Permit (Check only ne box on line A. Complete tine B if applicable) a
A. New System ❑ Repiaremem System ❑ Trestrowt(Holding Tank Replacanent Only ❑ 06= Momcation to Existing Sys= (C*
mit Transfix to New List Previous Permit Number and Date Issued
B. ❑ Permit Renewal ❑ Permit Revision ❑ C Mange of Plumber FO.P="
Baf =r Expksdon IV. Type of POVffS Svstem/Com onentlDevice Check all that a 1
Noe-Pressurized In-Ground ❑ Pressurized Lt-Ground ❑ At-Grade ❑ Mound 24 in. of suitable soil ❑ Mouud a 24 in. of suitable soil
❑ Holding Tank ❑ Dispersal Component (txplain) ❑ ant Device (explain)
V. Drs 1Cfrea eat Area Information: , t ( } y l
A
Design Flow (gpd) Design Soil A77 pplication Dispersal Area Required (sf) ].,-867
ru Progoy~d (y~ System Elevation
CS! ✓
J (l.~ CCCIL'J
VL Task Info coacicy in Total # of 14taar ter v t. cp 6L'iZ"JK
Gallons Gallons Units
New Tealm Exisms Teaks t ,
W ~+1 K. r a c,1 m~ to w v
Septic or Bolding Task r `
Dosing chamber -
VII. Responsibility Statement- L the uudemB ped, assume responsibility for insmlistion of the POWTS shovm_Antke attached plans.
Plumber's Name (print)_ Plumber's Si a MP RS bar Business Phone Number
qC/
Plumb's Address (Street, City, State, Zip Code)
ono ertment Use Only
APPS - Pex~ffi(it Fee De7'z Sigstedue
en ILea3on far Decrial s J ~ °D 3 c3/ 7
UL Candi q Reasons for Disapproval 1 l
1..'Sepliotark, erflt%nt !liter rnii f Q~-• _ Q , y~ ~i (
d stet-:.:,i cell must all be vices i'~++ +rt - rrr"`^^^r`rr
as per marasement plan p! o rioeh by plumbef.
2. =All wfbork re!gt, ,f- ,er s mrrst,,ye maim: ir"E%I
as per Appilcitbl:4 c:nd!: I crdinannv.
ArIsch is complete pines for the system and submit to the Colmty aniy on paper rmt less thaa 8 to 111 inches in amts
SBD-5398 (R 11111)
CY~
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CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: ~R~STI ty AP, LS iii
Owner's Name: AN~F, t
Owner's Address: 2ZZ `,fir a
v <,o y~l
Legal Description: _ j -Z(--" V_,t
Township:
County: -j
Subdivision Name: j H K x 0, ri
Lot Number: r t)
Parcel ID Number: 02P 7LI
Page 1 index and title
Page 2 Plot Plan
Page 3 System Sizing & Crass-Section
Page 4 Filter Specs
Page 5 Maintenance Information
Page 6 Management Plan
Page 7 St. Croix Cty Septic Tank Maintenance Form
Page 8 Warrant Deed
Page 9 CSM or Plat
Attachments: Soil Test & House Plans
Designer/Plumber: - License Number:
1 ~PPS 22r3~`1 z
Date: Z I `1 Phone Number L p
Signature
Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01).
Page 1
Z -
y =
J J cJ 1 .l i
fJ
N
r
N
~ r
L
;L
- - t t
211 ~ ~ifl jg-tm Cross on
ft
Final {grade
4° Sdieduie 40
PVC Vent Pipe rI ft
Pent cap ~ System EWadon
Chamber
ft
S®t! A 0n Svstm FU Vd
- r7 ft
Trench 9
ft Vent Or Observation Pipe Ch~nws
im.
Trench 7271 Header
Wnhinc OhgMhK $effiiftciggN
Manufacturer And Model i t~~ , L[ ~ a--,~ ~ ci ► ~ I~ LJ
ElSA Rating ,Z sq ft per dumber Soli Application Rate glsq
(~%G gpd Design Flow f Soil AppficaWn Rate _ F- ElSA = 47-) Chambers
2 roves of Z chambers each.
Page of
-
p4STALLATION t
125 F L ER
P"251PL-625 FILTER
1
t a Rated far 10,000 GPI
PL-525 = 525 Linear Feet of 111 8° Fftz#On
PL-626 = 625 Linear Feet of 1iW F'tt tr4on
sAt epic - and fr SOW. 40 pipe
PL4a5
s Built in Gas lam
~l
averal years under normal conditions before 0 mac Shui-f Bag when F1W LS AWwv8d
ring-clear". it ed tl d the filler be
gad every time the tank is pumped or at least every o Alarm AccessibWW
Yom. if the filled falter contains an optiOnsi sA PVC Extension Hare
a, the owner will be ~ by an stann when the
needs servicing- Serving should be done by a
rod septic tw* purr or In ier
:j Fn
-OpApAEMED PRODUCTS
WIM
M~V.7 71 47Z
• .e~- r mss. "Tim r?'a
Exww t' • = _
{F iaOIK- [S7av'
T PO S
b &W Y is s dMpK SW ~ toppgr*Q by dAdMn and swww P~ ° fat
wft open
t won that can 0404 OW P~ fan a
V8 WO t wag and us*
3 a ow its auk p
~[dta ~ mans w r ~dlor t
tenure by e- ftmtoeffon a .
to ~rr9 i s Fb r w-wd F P4)P-
rave• ok.~~
of Pw& prodtxZ 010 web ~e at
~afu11
Septic-Dose Tank Cross Section And Pump Performance Specifications
Tank Manufacturer Pump Manufacturer Z n G L(,E R
Tank Model Number ~1? L j 2 j L~ C C. Pump Model Number j IV 5_7
Total Tank Capacity Z 1r~S Alarm Manufacturer NL 1' \t ?.S
Max. Bury Depth Alarm Model Number i-LV C.E C,
\ \ D~
Type r-
Switch
Filter Manufacturer I f= ►-1 lv~ E' Total Dynamic Head (TDH) - Feet
Filter Model Number 1 Elevation Head
Distal Pressure ` t--
Network Loss
Minimum Pump Performance Re uired Force Main Loss 5
j6 3n M @ 1.ti Ft TDH GP Total `
Outlet Manhole Min. 4' Above Grade With Manhole Min. 4" Above Grade
Locking Device. Inlet Manhole With Locking Device
< 6" Below Grade Sealed Watertight Securely Mounted
Weather-proof
Junction Box
- Finished Grade
Depth of
Cover Vent Min. 12" Disconnect
Ft Above Grade Means
With Vent Cap
{ S t<<{< S S i S<< S G S S t S t{ S S S S S S S S S
t `
> > ! Outlet
i
Outlet Filter
Inlet Inlet Baffle `S{ - - Ell
t>< }
< { t
> >S
< < A 3 177
} Y Switch Settings and Reserve Capacity 4
Tank Volume = GPI weep
S
< >
{ Hole
Dimension Inches Volume Gal. B
(reserve) A 1
(alarm) B 2 L) Li, Off Elevation C i
t
>{Y (dose) C (a ~3 LT< Ft Bottom
>s> (dead) D D ~t Elevation
> Total( SFt
{ <t
s s s s} s s s s>>>>}>> s r>>}: s s a s r s> s> r r r r
S{ i{ S< S i S i t i;{ i{ i i t t<{ i< t t i S i S t< t i f>iri'i>t t{ t>{>t`< t{>i>{S< ;>{>i't><YSr< {
3} S> Y S Y} Y f S S S S> 3> S S} S!>! 3> 3! 3} 3 3> S Y S S>>> S>!>}>> S 1} Y> Y!>> Y
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 16.28 WAC.
02/05 LJ Page of
Page 6 of 11
TOTAL DYNAMIC HEAD/FLOW
® PER MINUTE
PUMP PERFORMANCE CURVE EFFLUENTAND DEWATERING
MODELS 57/152/153 MODEL 57 152 153
4,5 Feet Waters Gd. Lun Gal. tiers Gs. L"
5 1.5 43 163 69 261 77 291
10 3.0 34 129 51 231 70 265
40 12 15 4.6 19 72 53 201 61 231
20 6.1 44 167 52 197
35 25 7.6 - - 34 t2i 42 1S9
10 30 9.1 - - 23 97 53 125
55 10.7 22 63
30- 40 12.2 - - - 11 - 42
6 SW-ofi Head: 19.25 It (51 m) 36 h (11.6 m 44 ft (13.4 m)
25
016368
0 6 21
15 3 )!8 ~ 6 3Y16
4
4 we
30
i
t
2 3lie
5
5
~1 ) t52 753
0
10 20 40 SD 60 70 Fb 3115
GALLONS IF - -is-
LERS 0 40 ,t0 120 160 200 240 260 + L- 112'NPT
FLOW PER MINUTE 1 1
1
CONSULT FACTORY FOR SPECIAL APPLICATIONS j--^ ~
These systems are not designed for Explosion Proof Environments. j `
; I
Please consult factory for special options and requirements. 101116
Maximum operating temperature range:
36
Pump: 130° (54°C) ~rr~•~ 332
LL1`.~ SK1015
Switch: 17V (76°C)
CHOOSE A PREPACKAGED SYSTEM:
Includes Pump, 10-1526 and 10-1528 (see below)
940-0005 N57 Pump .3 HP
940-0006 N152 Pump .4 HP 327112 4Ye
940-0007 N153 Pump 5HP
327W
BUILD YOUR OWN SYSTEM:
N57 Pump .3 HP 3ur32
N152 Pump .4 HP
N153 Pump .5 HP t
10-1527 Oil Smart@ Pump Switch -10 ft cord with Relay.
10-1528 Oil Smar* Pump Switch - 20 ft. cord with Relay. ,
10-1676 Oil Smart@ Pump Switch - 20 ft. cord without Relay (requires Control Panel).
10-1526 Oil Smart@Alarm System with Lights, Audible Alarms and Dry Contacts.
12 116 I
5116
A CAUTtON~J
Ail instal):ltior of controls, prote ctiondevicesand wiring should be done b y a qualified Licensed
electrician. AlI electr,ca! and safety cones mould be followed including the most recent National sKZO~
E:ectnc Code (NEC) and the Occupational Safety and Health Act (OSHA).
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
19) Copyright 2005 Zoeller Co. All rights reserved.
- POWTS OW M g MA jUAL AND MANAGEIaNT PLAN
I.E IlilaOltitRA'rTON SYSTEM SPRCEF'iCATIOI+IS ' NA
owner - R "I
Tank
_7~ Feamit # SPwV t Faber ~ / M NA
DMGN PA>E 19[I TIr1#!8 t FMuriel i NA
Nwt * of Badrooms 1 'T~lc >C~ DNA
?Fbngm of Con$mrciet Ups AM ftM TQ ank Msaubaum L,-;l 63 NA
gad now (ate)' IC O Uda Mamtr << u c f NA
. flow (Peaj, ratirnme . x 1.5" L-) C) da Model _ 1 NA Sail Rate ptW ea new Unit NA
Q Pont
FMW
(NA D) t4Eonthiy Avatage°'+ C1 Sand/Gravel FAM
Fats. CM & O mm (FOCI) 5 30 mg/L D Mccbmiad Aaadw D Wa had
BkcbmicW D*rsm Deunrd MMS) 5 220 mg►L 0 Disint~an D Odwr:
ToW Sugmded Solids (TSS) s 250 factner Modak wIL iaispern1 Cams)
p Egkwm Q~ D wiOnmy AYaa~"" 'Ifound (gravity) D Ta-gt+aoml OmmiWO
B owkg oxygen Deund MODO s 30 mg/L 13tzrada D M,v®d
Total SaW coded Solids ('T SS) Odra:
Fwd cwiftm (g ttic mean) 5 30 =SIL
<_20 cfisl10to0ianl
c d ][jjjjjjjtjjjf4M in
L
Msxiamm Efl3arrtt Particle Sisal 118 inch dianoeW Soil Amu PO9, t-7~~
"Wasbewom Flow' Va'ificatlon and Cakubitiom (char than bedroom based) &Mtmgve SwfawXbwAa-ESIA i
Mkdm m Number of L an a
Q Fbw Raters man
rrilLt WI Adis.
velum types fix amnowe (noatcamsin~ist wask"M r Materis r all mm nrials mm aamw
and septic hick afBaanL COMM84 mud bra inesIIad pornmadomm 9►O piOt
**sV fm tvasbewd►ter. and MEM!
D'
MW CICITEK_ _A , ( en ,i99~
D MWiaccaaaia AL-grade Sail ~ System Sstiab Dew & Maa~C' t7ommarse, 3.G. and B.i. T~tler.
D -"wbcomk Mound Soul ~ System Siting, Design dr Cansumtkm
X15.22
C P*bcBbOw 96
D "DmpofPreaneDisfirMahmNetwokfor SpcTan-Srn7Absm S y
® -Daaign of Co "Aionel Soil AbsotomThmbes and Beds". R.T. Otis - ASAE Pubes 5-77 and "DeWP Maanat. -
Onsita Waatewaw 'rreata M and Disposal SYst EPA 62511-80-012 October 1980
Q SBD -105j►0_p (IL609) "At_Cbatle CAmpamW MAMW Using Pr ss rra Disu ft W
C3 SBD -10567-P (8.6199) "In Ground Ab mazxAm C Vu**" x a
D -10705-~P (N.01101) -In Ground SWt
QSB SBD - Ig628-P (14.6194) nta*adaft Saari Filter Systeat C,asnpoaent Ms"r
D SBD -10655-P (N-6199) "Split Bad Reci~ Sand Fifes Syd m .
D SBD -10572-P (8.6199) "Mound Component sm'Or 2.0
0 SBD -10691,P (N.01101) - Mawd C~omat M Vetsi~
Cl SBD -10595 P (R.f") `die Pass Sand Mar C h
D Sly -10657-P (8.6199) uDo -1w
D SBD -10573 P (R 6149) `pressure Damtion CompanaW Mund'
D SBD - i0T06-P (NAItCi) D*Mudm C=Vancw Man"vain2.0
13 Drip-lime Effluent Diagemal CMPMMA Maul Im Muitrflo tan" Wastawder T Units
MAW MANCE AND MANAGEMENT
MAIN-L MANCE M01 rrMORING 9Cl~.nULE Service
Service Eeeat D moat a 3
caaditiosl aP a At least ommce I st'~
oat cotm~s of a Wla Iii Oft#MC voitmse
3
At least am a
s s
a ~
Ck~n effloaat BSar At lastomco 41 ® eon
u~ros dE alarm At lead once M nmmadW NA
Atleast anae s
Funk stela add tmsit At r n u ®vea{s) 13 NA
mwa