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HomeMy WebLinkAbout022-1067-90-005 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No (ATTACH TO PERMIT) 600250 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: DAVE & ALISA FEYEREISEN TOWN OF KINNICKINNIC 022-1067-90-005 CST BM Elev: Insp. BM Elev: BM Description: r Section/Town/Range/Map No: /Gb 24.28.18.376A-05 TANK INFORMATION ELEVATIO DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark O .6 /C6 Alt. BM a ~1~ 2, 5 16Z.71 Aeration Bldg. Sewer 14.7$ /0 41 Holding St/Ht Inlet l ZS ! -c TANK SETBACK INFORMATION St/Ht outlet '19-71 TANK TO P/L WELL BLDG Vent to Air Intake ROAD Dt Inlet , • Septic Ito f A4_ Dt Bottom I Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System Final Grade 17- PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number 7,.-7 I /o,4z 792- O TDH Lift Friction Loss Sys ad T~ Ft Forcemain Length Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 1 SETBACK SYSTEM TO P L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of SYstem: ~/L UNIT Model Number: DISTRIBUTION SYSTEM ~7~ Header/Manifold Distribution Ix Hole Size Ix Hole Spacing Vent to Air Intake Pipe(s) Length Dia 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 L Yes ❑ No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1430 OAK DR(ti 4/`1 6b"A-, A 56 fe~S 1.) Alt BM Description = /~c.ov~r.~c~ 2.) Bldg sewer length = IZJ ✓ - amount of cover ~O v'~+~ j ~ ✓ 3 Plan revision Required? Yes No Use other side for additional information. //71 Date Insepct Signat Cert. No. SBD-6710 (R.3/97) f --.RE EIVED County p Safety and Buildings Division f S r 201 W. Washington Ave., P.O. Box 7162 Sav S t C2tly ~c pS s OCT 2 201 Madison, uvl 53707-7162 Pernut Number {to be filled in by Co.) counlTY ioMMUNITSY •t Apt 8 State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission oft 9 W4x'2C 41A is required prior to obtaining a sanitary permit Note: Application forms for state-owns the Department of Safety and Professional Servies. Personal information you provide may be used for secc,u roject Address (if different than mailing address) ses in accordance with the Priv Law, s. 15. 1 in , Stats. u I. Application Information - Please Print All Information k_/~D ~Gl f~- Ct J(L, Property Owner's Name Parcel # . D Rvf Property Owner's Mailing Address Property Location City, State Zi Code Govt Lot / P Phone Number /z ~ S (~1 s~ V4, Section 715) Q1 -3 705 circle one) 1 Type of Building (check all that apply) Lot # T aLg N, R 14C 1 E or W or 2 Family Dwelling- Number of Bedrooms£ • Subdivision Name Block # ❑ Public/Commercial - Describe Use ❑ City of ❑ State wned - Descctbe Use CSM /Number 13 Village of I ^ z6- 6Oz7 XTownof krggivy- Ck-,4Wir~W-- ype of Permit: (Check only one box on line A. Complete line B if applicable) A. Nz x" ❑ New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only Other Modification to Existing System ( lain) ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner n . e of POWYS S stem/Com onent/Device: Check all that a (Q '7 D Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound <24 in, of suitable soil ❑ Holding Tank ❑ er Dispersal Component (explain) I V. Dis ersaYrrea ent Area Information: ❑ Pretreatment Device (explain) Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area R uired ~ (6A 60 eq Dispersal Area Proposed (sf) System Elevation VI. Tank Info capacity in Total # of Manufacturer Gallons Gallons Units ' 4 U I New Tanks Existing Tanks U septic or Holding Tank U Cn y rn r. Z7 G, Dosing Chamber /Zoo a ` e~IZ-r ..Lal JCr ~ Ae' ~ f VII. Responsibility Statement- 1, the undersigned, assume responsibility for i ati of the PORTS shown on the attached plans umber's Name (Print) Pl r' i MP/MPRS Number Business Phone Number Plum er's Address (St{eet City, State, Zip Code) V11I. `un /De artment Use OnGD i Approved ❑ sappLQyed Permit Fee Date sued Issuing nt Signature d [2wr Pr ~e eason for Dem $ 256 • 4b© /t5 1-7 A . ConditIM561! seasons for Disapproval i. Scot - tank, elfiwnt flfter vrid 3> ~ ~ I 64New. li cell must,all belic:Ps ! r+. Fit ec - aqper Mar:agement plan n+o /iderf by plumber. - ` 2. 'Alf xI ems mint be ma rdzir:Ed ~ _ as per opFktlbttt crxsf 1 wMinanref, than t~~ I Attach to complete plans for the system and submit the Coun o on a 2 ~ P Per Aot en ~11Cmch- in size SBD-6398 (R 11/11) pg of ~ Private On-Site Wastewater Treatment System (POWTS) PLOT PLAN . FILE INFORMATION PROPERTY LOCATION Owner 1/<, 1/d , Section czPlrsaL TN, R_E or W DCity, Ovillage, PTown of PIN ountyl WI Q - a~ -~o .C 4 r X f (.iiif4Pr' Df W F i ) 1 ( ! ' 7L c~ FrC t~ yv `x 1 MOO o~ PIN f Lu~ 1 + 3X a fao~ r1 f~ k.. Pg of Private On-Site Wastewater Treatment System (POWTS) PLOT FLAN FILE INFORMATION PROPERTY LOCATION Owner Section T& N, R_ZLE or W PIN # [City, OVillage, PTown of agmCounty, WI 0 ,4 cq - 0, Io, 3 ('dcuS d ~z A'de reaC4 ~31 3' Yr L (f vc, Vx ~ ~ 1 SHE Q f t ~Y I ~I I 300 /t 6 D dad 109 )A00 *an k- o~ y~ ~ ~l `~,oFP-'~T'''F=tTG DIVISION OF INDUSTRY SERVICES PO BOX 7162 MADISON WI 53707-7162 .S Contact Through Relay P s http://dsps.wi.gov/programs/industry-services www,wisconsin.gov A~ss~cN'vF~ Scott Walker, Governor Dave Ross, Secretary Identification Numbers October 08, 2015 Transaction ID No. 2602108 Site ID No. Please refer to both identification numbers, above, in all correspondence with the a enc . CUST ID No. 1316956 DAVID LENTZ GOVT AFFAIRS DEPT INFILTRATOR WATER TECHNOLOGIES LLC 4 BUSINESS PARK RD PO BOX 768 OLD SAYBROOK CT 06475 PLAN APPROVAL EXPIRES: 10/31/2020 Re: Description: SEWAGE TANKS, THERMOPLASTIC Manufacturer: INFILTRATOR WATER TECHNOLOGIES LLC Product Name: SEPTIC, SEPTIC/SEPTIC, SEPTIC/PUMP, PUMP OR HOLDING (trans id 2602108) Model Number(s): IM-1060 (1060 GAL. ONE- OR 2-COMPARTMENT THERMOPLASTIC SEWAGE TANK; 1247 GAL. ACTUAL CAPACITY WHEN USED AS A HOLDING TANK; 713.3/356.7 GALS.; INJECTION MOLDED POLYETHYLENE OR POLYPROPYLENE RESIN, 2- SECTION TANK WITH MID-LEVEL SEAM) [44.0 IN. L.L., 6 IN. MIN. AND 48 IN. MAX. DEPTH OF BURY; 507.6 G.P.D. WHEN USED AS A SEPTIC TANK; 341.6 G.P.D WHEN USED AS SEPTIC/PUMP TANK BASED ON A 3 YR. SERVICE INTERVAL FOR RESIDENTIAL WASTEWATER; SEE TABLE I FOR TANK CAPACITY IN ONE-INCH INCREMENTS; TANK DIMENSIONS (OD) = 127 IN. L X 62.2 IN. W X 54.7 IN. H] Product File No: 20150226 The specifications and/or plans for this plumbing product have been reviewed and determined to be in compliance with chapters SPS 382 through 384, Wisconsin Administrative Code, and Chapters 145 and 160, Wisconsin Statutes. The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative Code. This approval is valid until the end of October 2020. This approval supersedes the approval issued on 4/10/2012 under product file number 20120143. This approval is contingent upon compliance with the following stipulation(s): • This tank must be designed to withstand the pressures to which it will be subjected. • The manufacturer must keep at the manufacturing plant a set of plans and specifications bearing the department's stamp of approval. The plans and specifications must be open to inspection by an authorized representative of the department. • Installation and servicing of this product must be in accordance with the manufacturer's instructions. A copy of the manufacturer's installation and servicing instructions must be given to the owner of the system. 2602108 DAVID LENTZ Page 2 10/8/2015 • When this product receives wastewater from dwellings and is used as a septic tank, it will produce an effluent quality with a maximum monthly average value for BOD5 greater than 30 mg/L but less than or equal to 220 mg/L, TSS greater than 30 mg/L but less than or equal to 150 mg/L and F.O.G. less than or equal to 30 mg/L. • Before this product is installed a warning label meeting the requirement of SPS s. 384.25 (8) (b), Wis. Admin. Code must be securely attached to the manhole cover. • This tank is approved to use the following: . The tank is provided with 3 ports on each end (one from each side, one for the tank end) used for inlet and outlet piping, depending on site configuration(s); Four-inch diameter inlet and outlet piping, Schedule 40 or SDR 35. Department-approved effluent filter installed in accordance with the product approval for the filter including a properly sized and located access opening for service and maintenance. . Inlet/outlet pipe water tightness is provided through the use of a rubber gasket, Serco Septic-Tite gasket. See tank wall penetration detail in attached document(s). . Mechanisms for pump electrical connections from riser lid or other locations in riser must be completed in conformance with the riser manufacturer's instillation instructions. . Compatible risers include 24-inch-diameter riser products-Infiltrator TW Riser, EZset by Infiltrator, Polylok@, Inc., and Tuf-Tite© Corporation; other state-approved risers recommended by Infiltrator. Maximum riser height is as per the state-approval and riser manufacturer's installation instructions. • BEDDING: Tank bedding consisting of native soil (without rocks or protrusions) or 4-inch depth of granular material-pea stone, sand or gravel. Anti-buoyancy control measures may be required if the IM-1060 tank is to be installed with less than 16 inches of soil backfill cover and the seasonal high groundwater table has the potential to rise above the elevation of the tank bottom. Otherwise, no control measures are required. If the seasonal high groundwater is higher than the elevation of the tank bottom at the time of installation, coverage with at least 16 inches of soil backfill cover will eliminate the need for anti-buoyancy control measures. For backfill depths of less than 16 inches, the need for anti-buoyancy control measures must be determined based on backfill cover depth and height of groundwater above the tank bottom. If the groundwater table has the potential to rise above the elevation of the tank bottom, see the attached document(s) for information on the types of controls and applicable backfill and groundwater conditions. • BACKFILL: Backfill with suitable native soil. If native soil is unsuitable, replace unsuitable fraction with suitable soil. Suitable soil includes soil textural classes defined in the United States Department of Agriculture soil triangle. Suitable soil textural classes are based on the tank installation depth, as measured from finished grade to the top of tank. See detailed information on backfill suitability in the attached document(s). • Additional information is included as attachment(s) to this letter; see attachment A, B and C. The department is in no way endorsing this product or any advertising, and is not responsible for any situation which may result from its use. Sincerely, Glen Jones, M.S. POWTS Product Reviewer phone: (608) 267-5265 fax: (608) 267-9723 email: glen.jones@wi.gov The DSPS is committed to service excellence. Visit our survey at: www.surveymonkey.con-ds/dspsiscustomersatisfaction INFILTRAT l~ no, • Strong injection molded polypropylene construction • Lightweight plastic construction and inboard lifting lugs allow for easy ! delivery and handling Integral heavy-duty green lids that i interconnect with T m risers and pipe p~~t p riser solutions Structurally reinforced access ports eliminate distortion during installation ii ' j and pump-outs Reinforced structural ribbing and ti 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 tank, pump revolutionary improvement in plastic septic tank design, offering long-term tank, or rainwater (non-potable) tank exceptional strength and watertightness. No special water filling requirements Inlet Side are necessary • The tank may be backfilled with suitable TANK CUTAWAY Infiltrator TW Riser native soil. See installation instructions System for guidance. h 100 Partition Y s baffle wall E° HEAVY DUTY LID F j CUTAWAY i Reinforced 24" structural ~ f access port Structural r bulkheads MID-SEAM CUTAWAY Reinforced water tight mid-seam gasketed connection ft~~ Prolec.0 q 1111( i' !lvil1,l11ii ril viiil i Innovative Wastewater Treatment Solutions IM-1060 General Specifications and Illustrations t LIFTING LUG RISER CONNECTION (4 TOTAL) (TYPICAL) The IM-1060 is an injection molded two piece mid-seam plastic tank. The IM-1060 injection molded plastic design allows for a mid-seam joint that has precise dimensions A for accepting an engineered EPDM gasket. Infiltrator's gasket design utilizes technology from the water industry 662 Q 5801 to deliver proven means of maintaining a watertight seal. EXTERIOR The two-piece design is permanently fastened using a WIDTH series of non-corrosive plastic alignment dowels and locking seam clips. The IM-1060 is assembled and sold through a network of certified Infiltrator distributors. 127.0[3226] EXTERIOR LENGTH Must be backfilled and installed in accordance with TOP VIEW Infiltrator Water Technologies, Infiltrator IM-Series Septic OUTLET Tank General Installation Instructions and for shallow ground water conditions reference the Infiltrator IM- Series Tank Buoyancy Control Guidance. A~ T, Please visit www.infiltratorwater.com/images/pdf/ LzIEHIOR ManualsGuides/TANK01.pdf for the latest information. HEIGHT SEAM CLIP (TYPICAL) y1094 gal (4141 L) (TYPICAL) 7Capacity LIFTING STRAP 1287 gal (4872 L) END VIEW Airspace 16.5% Length 127" (3226 mm) 04 [102] 0 24 [610] ACCESS OPENINGS WITH LOCKING LIDS (2) PVC OR ABS Width 62.2" (1580 mm) INLETTEE 0.2 [260]FREEBOARD OABS[OUTLET TEE Length-to-Width Ratio 2.3 to 1 wLET 16 S% AIR SPACE OUTLET Height 54.7" (1389 mm) PER 3 ) CODE [76] , PER CODE Liquid Level 44" (1118 mm) ~ 44.0 11- Invert Drop 3" (76 mm) SUPPORT SS_ 8] FIBERGLASS LIQUID SUPPORT FIBERGLA (TYPICAL) DEPTH (TYPICAL) WITH Fiberglass Supports BAFFLE 2 WALL WHERE REQUIRED Compartments 1 or 2 Maximum Burial Depth 48" (1219 mm) SIDE VIEW Minimum Burial Depth 6" (152 mm) Maximum Pipe Diameter 6" (152 mm) TANKTOP CONTINUOUS Weight 320 Ibs (145 kg) HALF GASKET TANK , INTERIOR SEAM CLIP ALIGNMENT DOWEL TANK BOTTOM HALF 4 Business Park Road P.O. Box 768 Old Saybrook, CT 06475 p~ 860-577-7000 • Fax 860-577-7001 MID-HEIGHT SEAM SECTION I I L..M1F R A 6 0 1-800-221-4436 www.infiltratorswater.com U.S. Patents: 4,759,661; 5,017,041; 5,156,468; 5,336,017; 5,401,116; 5,401,459; 5,511,903; 5,716,163; 5,588,778; 5,839,844 Canadian Patents: 1,329,959; 2,004,564 Other patents pending. Infiltrator, Equalizer, Quick4, and SideWinder are registered trademarks of Infiltrator Water Technologies. Infiltrator is a registered trademark in France. Infiltrator Water Technologies is a registered trademark in Mexico. Contour, MicroLeaching, PoiyTuff, ChamberSpacer, MultiPort, Posil-ock, QuickCut, QuickPiay, SnapLock and StraightLock are trademarks of Infiltrator Water Technologies. PolyLok is a trademark of PoiyLok, Inc. TUF-TITE is a registered trademark of TUF-TITE, INC. Ultra-Rib is a trademark of IPEX Inc. © 2016 Infiltrator Water Technologies, LLC. All rights reserved. Printed in U.S.A. IM02 1116 • • • • :11 Parcel 022-1067-90-005 10/25/2017 02:44 PM PAGE 1 OF 1 Alt. Parcel 24.28.18.376A-05 022 - TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 06/25/2014 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner DAVID S & ALISA L FEYEREISEN 0 - FEYEREISEN, DAVID S & ALISA L 1430 OAK DR RIVER FALLS WI 54022 Property Address(es): Primary Districts: SC = School SP = Special 1430 OAK DR Type Dist # Description SC 4893 SCH DIST RIVER FALLS SP 0100 CHIP VALLEY VOTECH Notes: NEW FOR 2015. RETIRED 022-1067-90-000 (376A) FOR LOT 4 AS 022-1067-90-005 (376A-05) & RETIRED 022-1067-90-100 Legal Description: Acres: 16.741 (3766) FOR LOT 5 AS 022-1067-90-105 SEC 24 T28N R18W PT SE NW FKA LOT 1 CSM (3766-05) OF CSM 26-6027 14/3857 BEING CSM 26-6027 LOT 4 Parcel History: Date Doc # Vol/Page Type 06/26/2014 997755 26/6027 CSM 06/25/2014 997726 WD 11/17/2004 780202 2697/471 WD 08/06/2001 653062 1694/318 EZ more... Plat: = Primary Tract: (S-T-R 40% 160'/. GL) Block/Condo Bldg: * 6027-CSM 26-6027 022-014 24-28N-18W SE NW LOT 04 3857-CSM 14-3857 022-2000 24-28N-18W SE NW LOT 1 2017 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/10/2016 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 6.600 90,000 242,700 332,700 NO UNDEVELOPED G5 10.141 15,000 0 15,000 NO Totals for 2017: General Property 16.741 105,000 242,700 347,700 Woodland 0.000 0 0 Totals for 2016: General Property 16.741 105,000 242,700 347,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 09/24/2015 Batch 15-03 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer D AUE e- A L-l Sa ~r-c1 s P n Mailing Address / 0 1 3U l r~s ierty Andress rtnc (Verification jrequired from Planning Department for new construction) C ity/State _ /CTvc ,S Parcel Identi cation Number 6aa /aG -gym„: LEGAL DESCRIPTION property Location .5 C` %4,000 '%4, Sec., TiE1-R_Vt~, Town ofI Subdivision Lot # Certified Survey Map # . Volume Page # 3957 Yarnauty,Deed. # Volur"Iel Page 1-2 Spec house 11 yes no Lot es idendflable 0 yes G no SYSTEM MAIlyFT°IiENANCE Improper use and maintenance of your septic system could result in its pcematum failure to handle wastes. Proper maintenance oIIS'sts 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 e ra : , : a1 syste-n. The property, owner agrees to submit to St. Croix Zonhig D, -,art---.Z t a ceitifa.cation form, signed by the owner and by a asterplumber, journeyman plumber, restrictedplumber or a Ecensed;'umpe erif-{~aa that (1) the on-site wastewater disposal system as is proper operating condition and/or (2) aver inspection and pun~pwg necessaiy), the septic tank is less than 1/3 full of sludge. 7*e' the. undersigned have read the above requiremen',s dad agree to aL _ch, private: sewage disposal system with the standards set forth, herein, as set by the Department of Commerce aad the Depict ~n -.t of ~ s.tural Resources, State of Wisconsin. Certification stating that your septic system' has been maintaLad cotnpie ~ ? ._:.a od to t :e St. Croix County Zoning Office within 30 davs of the three year expiration date. A6~~ to l26i l SIGNATURE OF LICANT DATE OWNER CERTMCATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) o" me property described above, by virtue of a warranty deal recorded in Register of Deeds Office. 1~~ (0 /26/ l SIGNATURE OF A.°Pl CANT DATE .,~my information Shat is mis-represented may rzsn t iL tho sanitaa•y p ;rmit being revoked by the Zoning Department. Include with this application: a stamped warranty dwed from the Register of Deeds office a copy of the certifwd survey map if reference is made in the warranty deed ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 144 3 © ~ftK p R zv~- located at: 5 F- 1/4, jut; 1/4, Section Town a$ N, Range I? W, Town of St. Croix County Wisconsin. Upon inspection, 1 certify that 1 have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or servicez4Z&Z~zz Did flow back occur from absorption system? Yes NoX (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: I °f ~0 Construction: Prefab Concrete aC Steel Other Manufacturer (if known): Lj'F' r- Age of Tank (if known): Permit number (if known) 54~ I? S$3 (License Plumber Signature) (Print Name) jz/~7' 2 (Title) (License Number) MP/MPRS v 0/- (D te) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 569583 0 GENERAL INFORMATION (ATTACH TO PERMIT) 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 X Township Parcel Tax No: Fe ereisen, David & Alisa Kinnickinnic, Town of 022-1067-90-000 CST BM Elev: Insp. BM Elev: SM Description: M I Section/Town/Range/Map No: vNC,J t' l 1 24.28.18.376A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS Hl FS ELEV. Septic Benchmark 1266 Dosing 4- "It 6 4-7 3' Aefe0arr ` , ( (1 A Bldg. Sewer q0,b Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P!L WELL BLDG. en Air Intake ROAD Dt Inlet Septic 7 5aottofi 7 1K, Dosing -756 1 7 .fib Z 3C~ / Header/Man. O 7 •t; Aeration Dist. Pipe 4.5 Holding sot. System q PUMP/SIPHON INFORMATION Final Grade 3 c, ` Manufacturer Demand St Cover ` Zo GPM 4- EsG. 1 Model Number ~ U 4b - 5. )t logs V. C?-7..3 TDH L-7 Q l Friction Lo ~ System Hea VV TD H' 7 O , ' ~kA- I 76. Forcemain Len th Dia~tDisttoWell 7 5b _ SOIL ABSORPTION SYSTEM 11-7 BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid 1P-Z DIMENSIONS 3 $ d J~ _ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: 1!57Z INFORMATION Ty Of System-rr CHAMBER OR UNIT Model Number: ;5 ~4~.. DISTRIBUTION SYSTEM I, Jg 8 -1- 8t = Z Dia Header/Manifold / Distribution x Hole Size Length Dia x Hole Spacing Vent,C~ Air Inttt~~~III~~~e length /l• S Z Pipe(s) \ \ - ) Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only a N- Depth Over Depth Over xx Depth of xx Seeded/S ddedd xx Mul ed Bed/Trench Center QS Bedrrrench Edges Topsoil \ ~ es No es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1430 Oak Drive ver Falls, WI 54022 SE/4 NW 1/4 24 T28N R18W) NA Lot 1 Parcel No* 4.28.18.376A 1.) Alt BM Description 2Fla c 5 Bldg sewer length = G / 5 ` e t tj ' L j - amount of cover = J ~ ~ i Z• I t ~ J t..-. 14 Plan revision Required? ®Yes No 7 I F3 1`,/ ~ Use other side for additional information. C• ! _ _ _ SBD-6710 (R.3/97) Date Insepctor Sign Cert. No. I _ L l_ _ I f'. r. _ ter. . _ _ ~.,1 _