HomeMy WebLinkAbout161-1060-70-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 5173- 1
GENERAL INFORMATION State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy La 4 (1)(m ,
Pe` ' Holder's Name City Vill Parcel Tax No:
~h ~
CST BM Elev:
Insp. M Elev: BM Description: Section/Town/Range/Map No:
ll ; 4 -.1 ,
'17.%Il " ~2,'I-
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark g
Alt. BM 16d 7
.Y >y l ~O c.p Ow
A°• i Bldg. Sewer r
~ e Inn.Q_ .ts~-r
Holding St/Ht Inlet f
St/Ht Outlet V~
TANK SETBACK INFORMATION S (p.4 r17
TANK TO P/L WELL BLDG. Vent to r Intake ROAD QIRiet° 9-7- by
o r4-.
uj 7`$ 14 '57 t 14100 a . $ 1 T -77
Dosing Header/Man.
_ _ ~.~.llfo 017~~3
Aeration Dist. Pipe 7/ E 7• r
Holding Bot. System I to
Final Grade
PUMP/SIPHON INFORMATION
Manufacturer D
GPM emand St Cover
1~ r
Model Number _ - `T' Va 40
T Lift Friction Loss System He TDH Ftu b
Forcemain ` Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
~ 9 ~ L
DIMENSIONS °VV
SETBACK SYSTEM TO P/L / BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR cr (4-r.
Ty~D System,
/ UNIT Model u~ ear:
DISTRIBUTION SYSTEM 6 11, `7
A54
117 : 3 Header/Manifoll Distribution ` x Hole Size x Hole Spacing Vent to Air,~ptake
t Length ~P 9 5 G~
1Length___ Dia Len Dia acin
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx M Iched
Bed/Trench Center Bed/Trench Ed es Topsoil
g Yes ❑ No Yes ❑ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: w/ C-41/~w 5 ~
1.) Alt BM Description = "y,b~` 661 S• ~,s Ce n~L+ C,6 2.) Bldg sewer length = t 4` 111 t~-J,/I , ►1 i 6 1 _ _ J it
l 60
- amount of cover = 15w s
Plan revision Required? ❑ Yes ~No
Use other side for additional information. ~Q Y✓
SBD-6710 (R.3/97) Date ICert. No.
A N -Do 17 - /Y,S
`Kyxrit~
~Q
IndusbY Smi Lei
to CwIty
WashinOo
Y; ` ! "SAY 2 2017 ~ n Ave 716 ~P_..6 Alf, ~
S-n Permit N too be fined in ~ C
G.)
16
CROK COUNTY 73
it Appfication Number
L
is required " With SPS 383 7](2) , Wis. Adm. submissim ubm
• of €hIs farm to the zPPrPij,
'
gfim to abMining a sx~ L NOW "le DqwftneW tat
Of rims fair s f st~C ate to rrul= lxw= ( [bars
)
lion you prOv~& may be used for secundaq
in Privarv i- a ]IZ I ea -
1. A tie rMn
ej A A" \4
P-perty s Itag Address
4/ ;r Prate 14 a It. 14
city, f Zip Cede Govt. Lot SmIt / Type oiPB ( t uP y) et
-MC
] or2 Faruity y Img-Numberrf ~ 0 T N, R
- i Subdivs`sitaa x:mse
b f - Btmk #i
C1 L~ city of
~s CSM Number
_ Va3laof. ~ Ft2-fist f-{~t173~%~
Q 2de,u 5}stefls s~ 3, ti ~._rL,y S~~ ~
wG- gTa astsett AtodxfiiauptoE~ristingS {i].^:s} A-
rr~sau taer~.-vas txeY;s of 3~um ~
Expiration - h a +
t3efare it Transfer tai New dV `I' of P0 Own"
i~ I S s
vaa ]n { €aefrati ❑ ad s D At-Grade 0
offoidmgTank - > 24 in, of MU 11 Maud < 24 in, of Wund V.
Lis' Q -,'i (d t~
[design A t P 1' - ) r
r gn Ste] scatraal'ate
,i' Area Kdquard fs#3 s 1 Mars
Tank Info
ly, ri
low ~ of
ram T = r r Czat]rms unit ~ L
4. v vs ri, --i,-~ C7 of
i L'v i u t: v ,Y P t ?-fr,A L'
VrL Peg
Mumbez's s Si of
13usin= Phone Number
]']mnber's Address (5 City, Stu, zip Cbdc)
7 q'
~
VIII. an
3b 1-7 6
} ovec] 4-1_h=777V~rc;I ]ta'ulit Fee D issuisag A east S
S 41 -F.5 .
.M lNippA.]d uald;uawa5ejet: gad sF
3~ ~r
i'~i X144 tUta '>fue~ .:~adaS ' t /
443N An w3j.sxs
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' PLC! rl_rm) y
OWNER J~gi~A+gz y SEC. T N-% W
ADDRESS
ST. CROIX COUNTY, WISCONSIN
SUSt724TSION--- LOT
- LOT SIZE? 'ILI
PLAN VIEW
Distances and dimensions to meet requirements of
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
J
lit` w! Y
1
INDICATE NORTH ARROW
%✓C ,:~CALC
BENCHMARK: Describe the vertical reference point used -
Elevation of vertical reference point:
Proposed slope at site: ;
SEPTIC TANK: Manufacturer: Liquid Capacity:
Number of rings used: J Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
Number of feet from nearest Road: Front ,oSide 0Bear, feet
From nearest property line : Front, Side ,~Rear, O
~.7 feet
Humber of feet from. sell , building:
(Include this information of the above plot plan)( 2 -reference dimensions to septic tank)
SEE REVERSE SIDE
PAGE 1 OF 4
In-Ground n
Index & Cover Sheet
Versa ' 1.0, St O-i M&P 11 1, R. 10112)
i of Index Comer Sheet
9
P of 4 Plot Flan
of Dispersal Area Cross-Section & Plan View
P 4 el III, Management Plan
Attachments:
POWTS Application for Review
Soil Evaluation Report Site Map
Project Name i Description
ow.ner
A (TP) F~ ter` ":1 Phone:
- -
OwnerAddress: 't? P qi# t`~th >r n i:. Zip: 0 tc7
Project Address: 1 (rte A+i A ( Kf,"Q N+
Govt. Lot: - 114 of Section__- _~j__, TZ,,L_N-R f0 E F1 or WP1
Township: -1 ~LL~ U
Project Parcel ll3
Designer Information,
DL-signer am Phone: ?1-5 - 142 - t?7~5"
Designer Address: Z1;?LJ17-J WT 23p:
l1; _ _ tit ( 4eY-,~ e-,51 6,) v I to K e 6 vA 5 sga r"~s x ec ~ sta .
License Number. ~3q - 06 -7
Remarks: ~ ~ ~g~, My c gs `
R ii0 ff 5.~~i {C •9
%ry
f
1its~'''{'h+~°tffasl~$#i
Signature:
L,
date. _ r - >
care an su ed copy,
OWNER
SEC. W
rwDxESS
1 STa CR011 COUNTY, vISCONSI:14
SUBDIVIISTON LOT LOT SIZE PLAN VIEW
Distances and dimensions to meet requirements of
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
t
1
4 /
ll
Vt,v
3.4
:a
.s
INDICATE NORTH ARROW
BENCHMARK: Describe the vertical reference paint used -
Elevation of vertical reference point ,'y i
roposed slope at site. ~
SEPTIC TANK; Manufacturer: ~
Ziquid Capacity:
Number of rings used: j' Tank manhole cover elevation:
Tank Inlet Elevation:
Tank Outlet Elevation;
Number of feet from nearest Road: Front
Side Rear, f/ feet
From nearest property line Front, Side, Rear, 0
feet
Number of feet from: well building:
(include this information of the above plot plan)( -reference dimensions ddimensions to septic tank)
SEE REVERSE SIDE
s
C ~ z
- ~ v ~ a,. "~n4 -`.~2~a3';~c~3 t i ~"°;a :rig-,~ 4 i ~ 1
T re
- ~2d=tf~4L
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• ~ rti4e iYLl~s-~
i~y~`~ \L L •.rt~ `--'`~-.1 ~`ly .:y~ (mot 'a+ ` - ~ i r_. C'`''' .
•ta lij'_t ~~"i' - - c. ! i ~~j~ -::i-~ i :i~?
f7 T,
PAGE 4 OF 4
r
2v ty Management Flan
IMPORTANT:
l i-E ru%'r'"r'tTFF C`'ItES it+rc%_+i+.i Frt~4i; yste,n Sh, rLS erns: is for itc ; ~r~ t+` a.? or
c:sEvE? and F:lc rtt~r~arEwu Pursuant to
requirements of SPs 382-384, Wisc. Admin. Corte. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall
he considered a human health hazard if not maintained in accordance with this approved management plan.
`a~fth~°r*ttra~ 2El n ar+d rrain#enc'n^e ^~tivctES a r
r s ShSl! ? parform. ed by a regist~fe..d ~ AFTS M'aintaniner In
accordance with SPS 333.52 (3), Wisc. Admin. Corte.
inf{ DiceaE Arb einn i irrst:
Design Flow = t ` q d, 005; 224 rng 1
16() ML , FOGS 30 mtgLR
"
lr a :ti r Chi INSF CT FRY 3 "EAR'S
o type of use
0 age of system
r r i~r fa- Eor= (t.. +tL? S. I-~; cc's zl"+
o mechanical malfunction (i.e., trumps, valves, svAtches, floats, etc.)
aterai fatiru-~ rf.L., lu l s braalts, corros?.ten, etc.)
o solids volume in an obit treatment tank(s) and any distribution appurtenance(s) (i.e., distributicn t dre , n•~
o neglect or improper use (ie,, exceeding design capacities, prohibited activities, etc,
c, extent of ponding ;n fttnbuticn 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,
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
11ainteriance, Checklist
NTAtN EVERY 3 YEARS (err when necessary)
° pc and dose tankis3 shall be pumped b a certified
by septage servicing operator licensed under s. 2$1.4$ this.
Stats. when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tame(s) or
as r sired by l al nr narsce. Disposal of con, ents shall be pursuant to NR 113, Misc. Admin. Code.
e fFluert$ filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids according to manufacturers specifications. A servicing period will always be greater than 12
nnorths.
System maintenance reports shall be submitted to the proper local government unit in accordance verith
SIBS 38-33.65 Wi mac. Ad-min. Crde mss,
art ay co3nporer t ta?lu or malfunction .o.
Name of individual or company: V ~:i7 "Tl s 11, Phone:
Local government unit: ` t a 7) 51
Local government snit address: ~
zl t~ _ . - zlp. I _
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), l!►dlsG. Admin.
Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Cade.
No product for chemical or physical restoration of the POW TS may be used unless approved by the department in
accordance with SPS 384, Wisc. Admin. Code.
Ct3ntingRfl a!M
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
abandon and replaced by a code- xornpl'} r ing dispe
ai c-C?r1`?pi1E'te`?b in :.z pJ"^-t et 'r??3!Y?eL'• area of 5:.,';t?.b;'=:.".C1FS.
S4+s#~rat !'9Cl4~YtrYlPng
i £ 5v' of this P{} is L'wCur`$;1,
,U_-'C, ff shall be eba rdonedi in a,:= oran-.e with v~'S
I'h 0nlY Septic Tank, Filter Yo 'll Ever Need
air
Home
Our i lit nr
The lifetime filter
T t'
The lifetime filter is the most efficient, low maintenance effluent filter on the market, rated
3500 GPD. With nearly trice the filtering capacity of other filters, lifetime filter is the best
value Thor your dollar. The unique plate design eliminates the collection of solids inside the car Fridge virtually eliminating maintenance. Cleaning is made easy through the elimination
of
solids trapped between plates, making the time to clean and replace minimal. Our unique, durable construction and patented design insures the ultimate protection of the drain field.
'
he lifetime filter is available in 1/8",1./16",1/32" and i/64" filtration sizes.
in ad{dFil in~Oi~r dIStr€ ~'tQrs b,~ f5n direct#y €lill the mane OCMer al'o,,;vs them to g°t ou,
!iru.~iLCi. t t t ens ijSor t 4-;j
rrn rt hlY v.; Pie ~ tit°fi {It ; t:rt' f , JC I!
J.
Single-Piece FIil
- se
Fade of high quality materials, this single-piece filter case provides
Our u{ni,,ue!tr designed sinal-p-ole(p
filter ease contains nc n lr ~
ti _ glue or s(
r,r n P
m
(!4.t:~t'?: ~f~i 7.~'~.,I?~._'.~~t'r~e•zif''., C'. q.^,•~'-. -=.t ,¢.A'`.. ?;v,~~,_-'r"~P~~~ v'S
!i
--g sX yrt
~'Psk
A Won
yy
4,4
The Quick4u Standard Charnber fits in a 36" pride trench
and is ideal for curved or straight systems. It features the
patent-pending Contour Swivel Connection- which permits
turns up to 15°, right x left. The MultiPortn* endcap allows
multiple piping options and eliminates pipe fittings. The
chamber's farm-foot length provides optimal installation - ,
flexibility.
• Advanced contouring connections swivel up to 15°,
right or left
Latching mechanism allows for quick installation -
• Four-foot chambers are easy to handle and install
`tom
The Quick Standard Chamber supports wheel loads of
16,000 lbslaxle with only 12" of cover'
Certified by the international Association=
of Plumbing and,%Aechanicai Officials (lAP O)
• Tear-out seals on inlet ports provide a tight fit to the pipe _
• Fight molded-in in€etsloutiets allow
for maximum piping flexibility
Eliminates pipe fittings -
Fits on either end of the Quick4 Standard Chamber
APPROVED in
QuicM Standard Chamber
= =
V, 77
f 11
3 t" - t- - 48'
(EFFECTIVE LENGTH)
FRONT VIEW SIDE VIRIJ TOP VIEW
Typical Trench Lew iN-FILTft'iTOR HATER TECHNo-cca STAN=RD u r W a -
(a) The structural integrity at each chamfer. endcap and other accessary manifzi #cred by
Infiltrator ( Units"(. when installed and c;perated in a teacttlield of an onsite septic system
TMATWE BACKRU TO MIL accordance with'Infttrdtor's mstn-^tEtm is rarrahlad to ore Oi~ pxchesff (-Honer,) Fjg
defccut a mate:ias grad v.,o unernsh' for one year from the date that the '-yea- .x_---~------ Rs septic ¢mrtitis issjr,dthe septic system contaitog
the Units provided. howeasr. that if a septic permit is not required b
' COVER BY'~ ? apgrGcaiye Law. the v.arr, ty 3
period u begsr t l the date ttrat a dlaiitar of the septic system
U£SIGhI commences, To exercise Hs warranty rkpts. Holder must notify inatrator in vmtirrg at its Corporate
Headquarters in Old Saybrook, Ccnt:ecfowt ailhin fifteen (151 days of the alleged defect. Infiltrator
12" v.41 supply rep aca Lkwts for emits daternimed by tntr3tralor to be curled by this United
A a- trivERT waranty. f"Strator's liability specifrcagy excludes the cost of removal and- r installation
of Gee Lklits.
~-34--- - - SPAO PER CC?D 31 d6) THE LIMITED WA€?RANTY AND ft&AMES W St113PA H (at AFE EXCLUSNE
tx-tra lcrtt::.+te THERE ARE NO OTHER WARRANTIES WITH RESPECT TO THE UNITS. INCLUDING NO
IMPLIED WARRANTIES OF VERCKWABILRY OR FITNESS FOR A PARTICULAR PURPOSE
Cc} This Cure-ted Warrrnly stag be void if any part of the chamb r system is rnartuf ctured by
anyorie caw than Infiiltrator. The LvWed Warranty does nK extend to maderual. ccnsequent t.
speeciai or indieci damages. Infiltrator shatf not be liable for penalties or liquidated damages.
Size 34"W x 53"L x 12r1H ockidog lass of production arxt omits. labor and materr%aK merhwd rocs. or other losses or
(864 mm x 1346 mm x 305 mm) expenses m cared by the Holder or any third party. SpecificaVy excluded trait Loved Warranty
coverage are damage to the Units due to orci Lary wear and tear. alteration, accident misuse.
Effective Length 48" (1219 mm) abuse or ner if sect of the Units: the Urns t suh ected to veftide traft~ or other aartdit ions which
are not perrnritted by the insratia# r instructions: tadwe to maintain the nt n mum ground covers
Louver Height 8" (243 mm) set forth it the ins r instructions; the placement of improper mater.&I. info the system
ccrdainog me Ulits, fau"re of the units or the septic system to wpoper siting or improper
Storage Capacity 43 gal (163 Q sing. excessive cater usage. improper grease dispos;itl, or improper operaucri: or any other
event rKA Ca d try tnliihator. Tres Lented Warranty Shad be Vow if the HOW" IZU to candy
Invert Height 8" (2 ~ ff36T7) vAth alt of the terms set faith in this Limited Warranty. Fi.Cher. in no event trtlittrator be
" L for any tt>ss or damage to the Hodder, the, Ururs or oily third party re" tram
41staitatio or shunt. or train arty predict liability cGairrts of Hauer or any third party. For this
_;If AW Warsar+ty to amity. „ M Units r=ust be instil ltd in a^uxr,}a a wdh as sire c..rdi!iorS
ref b,ed by state and focal nodes; a4 otter IyeiN anal atf~r~w's insallation irstnuctiors.
(di No representative of Infiltrator has the auGtaity to change or edend this Limited Warranty.
iG~ .:rarramy app-- to any party other Char; the ar +ar Heider.
The above represents the Standard Limited Wan only, offered by Inf>ttrator. A Gnsited ntanber of
4 Bush-. Park Road stales and counter have different %7. arranty regcnrerrrenis Any pt ahZSW of UrA5 shotdd cortect
Box 768
Old trrFJbator's Corporate Headquartfas in Cad Saybrook Conciseicut, pry to uxh piochase, to
cxa s~y3goah cr os 17s obtain a copy of tre a reabte- vv
isc0-~-7t'31i0 -Fax tires-~-1001 p}' r~Pt a^':z"tY, aril snovki r.araE[tay oaf Uri n2ty prior to the
2-840-222-4436 purchase at Unity
-uttiltratorlmaterrwrtt
U.S.P 4XO-661:5.017.011:5.156,488:5.3JY17:5,401.116: 5.401.359! 5.511.9c3: 5.716,163: 5.5E$-775:5.839,&31C.n-1aUisn i3a2ejus: 1.3*.9.Vys: Z004.564 pittcv pa;mts {kver4rg.
tn{estata. EgLot ter- Qtva'i"- and aVsuYr xa recsteied uadernwlz of Witvziar t*r Techni:iw~ Infiltrator is a remstered in fiance. 1tadtr-.ttor water T is a req.tered at
klexim.
c.or::cna. M-. . PdyTutf, error,-'> . t Positack,. O=kcuL - , gri t-a# ant are uawnans of Lihmrator water T
PoiyLok is a trademark of Pc.1yLolt. Inc. TUF-TTfE is a teyestered trademark of TUF-T(TE. INC. Uttia-Rib is a traziernark of MEX Inc.
21313 W.Uria s Wmer Tear -:--z. LLC, Ad rig~t= res rled. P cit d M U.Ss% 0250813
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----i luaulrockuo~-~'ruuluotoJ(Ti01v.Vllyl:!uolpap;o•;l~olpe;~l/s>,voUslanpa~{SP•Y.N~+~P:=3»nus~6W~;~u~aI:C7
tanks IM-1060
• Strong injection molded
polypropylene construction
Lightweight plastic construction
and inboard lifting lugs allow for
! easy delivery and handling
'
"Ji Integral heavy-duty green lids that
interconnect with TWTM risers and
pipe riser solutions
Structurally reinforced access
t ~ ports eliminate distortion during
, r installation and pump-outs
Reinforced structural ribbing
and fiberglass bulkheads offer
additional strength
• Can be installed with 6" to 48"
of cover
The Infiltrator IM-1060 is a lightweight strong and durable septic tank. Can be pumped dry during
This watertight tank design is offered with Infiltrator's line of custom-fit pump-outs
risers and heavy-duty lids. Infiltrator injection molded tanks provide a • Suitable for use as a septic
revolutionary improvement in plastic septic tank design, offering long-term pump tank, or rainwater
exceptional strength and watertightness. (non-potable) tank
Inlet Side No special installation, backfill or
TANK CUTAWAY Infiltrator. water filling procedures are required
TW Riser -
System r x HEAVY DUTY LID
CUTAWAY
r. Reinforced
Partition 24" structural
baffle wali' access port
A,
Structural
. bulkheads
MID-SEAM CUTAWAY
Reinforced water tight mid-seam
gasketed connection