HomeMy WebLinkAbout020-1374-02-000 (3)
wiscensln DepanmerlofComm¢-r:p PRIVATE SEWAGE SYSTEM .,curry St. Croix
Safely a•,d Bui dir3 . D,iSlen
INSPECTION REPORT ;an,:ayPer-tNO
(ATTACH TO PCRNI17) 606918
GENERAL INFORMATION slate Plan ID NO.
Persona Nc•maae•~ you pwvicu may Ce Iwo 1011 secOnd.ar; p.rpoSeS lPn'.acy l a,v, s IS.pa (!j~rgtt
Pelmd 1c 1,1$ Warne Ci:y vi age Townlsn,p Parc -a, No.
Curtis & Julie Ann Schmidt TOWN OF HUDSON 020-1374-02-000
Cu BM E'u:' N`.p Btu] Ele'o. Brut JevJip:ion SatmrrlOaN=(angc^dap Vc
12.29.20.2235
TANK INFORMATION ELEVATION DATA
TYPE IIIANU`ACTURER CAPACITY STATION HS Itil FS CLEV.
Septic Benchmark
Dosing All. BM
Aeration G cg Sewer
lidding St/Ht In et
SUI It Outlet
TANK SETBACK INFORMATION
TANK TO PiL 1'VELL BLDG. Vev :c Air I•ital<e ROAD Dt Inlet
Sectic DI 80111111
Dosing Heade0i;lan.
Aeration Dis: Pine
Hold rg Bot. System
F.ral Grade
PUMPISIPHON INFORMATION
NlanufaotLrer Demand S Cc'le'
GPN1
Model Ntxibe(
-UH l-dl F•ictcn Less Syren` Head I DI I Ft
Forcel I ergn Dia n~zt :e ,veu
SOIL ABSORPTION SYSTEM
BEDjRENCH :'uidt•i . engm No. GI -'urn PIT DIMENSIONS No O. 1 Insmp, Do I icw0 Depth
DIMENSIONS
SETBACK SYSTEM TO P'_ BLDG VVFI I LAKE:STREAM LEACHING tulam.fa ot_re-:
INFORMATION CHAMBER OR
Type Of System UNIT Ml dcl Nowt r
DISTRIBUTION SYSTEM
Icecet'P.1,[n tGle I;M-it..bpr x Hulc Srte 11 ''.c a Soarirg Vent 11 im IOla<.
P. oe'
I e-g:h Din _ I engr- J~a spar. rg
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Cepth Over Depth C',-f xx Dept'. of xx Seecec:SOOded xx Wu cheo
BIATrench Center BecGTrcncl- Ides TupsoJ vps Nc Yes _ Nc
COMMENTS: tlnb Lce code disc'epercies, pe'sons present. etc.) Inspection at- Inspecpon #2.
Location: 136 STARR WOOD
1 1 A 1 BIv1 Description =
2.:: Bldg sewer engtn =
- arnourt of cover =
Plan rev son HequircV Yes _I No
Use othe' side for aedticnal in'ormation
Datc. Insemu-s Sigrmwe Ced No
SBC-~i 1J tl< irvi',
i , ladwoy Stavicea Division ca.ty
1400 E Waslamoon Ave 7T, !X
{d
. \=r= P.O. Box 7162
• ' •,'j Sraivry P®il Ntapban (m be filled in by Ca)
Mdifon, WI 53707-7162 ~
Sanitary Permit Application SeaeTrannacnanNUnber
In aordaoe with SPS.I93142).Wi3. Adam Cadg mtbmimipr of this fmm to the approq>ae unit -4JA
is rryuvod pier b aiainirg • stWany pfiemt Nae Apphatiee meeaa mr afa0eowaed 3M. suliantiod m ptgcx Address (c differ
eal than~rraliog oddem)
tlt Depomnnl of Safely and frokaarral Servvx Ptxvanml infametimo ya It ased foe Smondwy purpost:s inaccadete o ft Pfryacy - lAw, s. 15. I m Staec C.YlME/1
GbC{(/
1. Appmemmaim Imtaraadem - Plsae Prime As Infer>vfw
Property Uvaner's Name
UelIs fie, t JtLUE AA)N 5cHMl,)-r 3Y-OZ-DO0
Property Owner's Mailing Addrae
ij's' .)7WWoen Pmpen„Incaion 1~. Y. ac. a3
(Ity,stye aoa
7wPCode Phaaar Nrrmier Z73 W V, )Z
H u LzzoN Wl sq""l tt
11. type of Bmidia6 (e►ee4 a6"apply) tats T ~cl N, R ZCI
I or 2 Family Dwelling- Nrmlierofgedtomnn _ $r8di yinn Name
Hied` a STA 1ZJ-, W 00b
❑ PtailirlCaeeereinl - [?CaTrbe Us
4&14,0 lmtJ-
- ❑ City of_-
❑ Stele Owned- Dmenbe _ CSM Nrmaher ❑ vdhw of
K>Lfy,~-/ - _ Tow, OfL~Ok4- so - _
III.Type erf Pcrimmq: (C1eek r!y bex oa 10e A. (:oaplefe line B if rWPHeable)
A ❑ Ncw S
Yam Symm TeaaerrerWlWdmg Tmdc Replao®mt Only ❑ ()tiw iLdifratiar an Gvenng Sywen (mpLam)
H• ❑ Ferret Remmal ❑ Pvmt Revnia ❑ Claaaw Ofphaaier ❑ Pe nun T a. W New ► Iheviam 1-1 Nraier and Date Lsnm l
Hcfere l3pdation
owe
rv• Itc C1ac1t aB Hat `17~ 7 bf aE - ~ G,7
Rearmed hKirmsd i.Gaxd ❑ M-Cmade ❑ Mound > 24 et of suitable soil ❑ Maad < 24 m. of aoanbk
Tie, Caller Ihtgaml CmPuR+a(-Wbm ❑Preoaaanml Devaee (ezpiin)___ Z•if Na+'"~
V. Area
1 Fier (gpd) Omp Soil Appliance Dupe mil Am Required (at) Dispersal Area Pngmrd (sin Syw® Mevar.m
VL Took lots Capacity in Tad a of Maaeidaaer
C.nma Calleem Uerib /s p
Nev Taney Easva Troia &C~ 59yt V 3
8rx'5r1NL LRt(iclC, ~-i8cn 6 V m x p,
Sepae aralardap~rra ! '"=5 l L~U ! W Iti~ X
VII. Respeammilmilky 9Weaemt- 1, era aadwdgaN, aaaaae Imhlla lam of tk POWES aaoma a at sawbod panaa §qr Pimrier'a Nsat (Pr/io~~) Phmtbgr'x t ~ ~ Tl.~}FZ~•t 1G S
~ N ~
Z.Z4D Hr~nra Phmc N.nhc
Phan •a M)diea (Stier,, city. sera" 71p C-&)
S_ 579' 2856
105 E. H! 2k6 ST C,AC7T W 54'72
vn1 rtmcw Use On
n triter Fee Due:
U err $
~87 tb /d R
inc. C as fir Diappraval - -
1. Sep('e tarn, rr..'. ~iltr- rr 1
Obi: to ~c~•i ~_-l alhe_'._ir s'. 11~_2C
+s per star 3yen~en'. a'zn - o ~i0:: a Lv plwnce..
2. AN m~,k rPc;4inren5 m'jst Le;-.e ,cL it e i
pY.-O I :rdl-Amin.
AebA Y cmptrm plama for ria rywtmal aaimues taa Ct aj aab t.
Pyr ar Ir a►s a 1A a 11 iaim i ie
SBD,6398 (IL 09(14)
Plot Plan Page 3~#
PROPERTY OWNER: (f U9TIS C-- I"== 40 FT.
{ercept where noted)
N>va L'run~
I egal Description: Lt Z0 S~ f kS~ W COD 1ti c t `i. ~f T1~ Sn /L4 SEC. M. ZM._ ~ - baekhQa-~+
Tx l~_ DV + ~Cu /v Ct It U~SChr ,T. CFW)( C-GU Iy7 _ ~SCGA _>1
:ITAK9 WC)?9 OZC- f 3L 'Uz ~OG~1 /SS><1CF'E
North
1
J J C
n Fes- - ,n I ^ t ~ .a. - ~ir'.nc=
~r .
Site location:
1
+ r
PAGE 1 OF 4
In-Ground Gravity Plan
Index & Cover Sheet
CornnWent UMW D=W Relbrenoas:
Version 2.0, SBD-10706-P (N.Oim, R. 10112)
Pg 1 of 4 Index & Cover Sheet
Pg 2 of 4 Plot Plan
Pg 3 of 4 Dispersal Area Cross-Section & Plan View
Pg 4 of 4 Management Plan
Attachments: res:
ZNF1(-T0TrR SPECS POWTS Application for Review _
Soil Evaluation Report & Site Ma
>EPTrc TAuK /}f4c7r--meA77
Project Name / Description
Owner Mme(s): LA RT 1s u Li F ANN Sc t+ti~ I Phone:
OwnerAddress:N-5 :,1,A1,X WCCD IAuv r ZIp• '57/0Y (0
Project Address: -:>A.WE~
GovL Lot: Ni= 1/4 of SvJ_1/4, Section_ . T Z9 N -R zl} EQor W
Township: _P u p ov County: 5T c KoiX
Project Parcel ID L
Designer Information
Designer Name: -iL~,i~:/ 10 fluePLKrr Phone:
7t5__~
Designer Address. 28 197//KINbrQv:TFIu L°f 1 ua ~re~/+ S'IB~t
E4r18i1: hoi(,ST1CYi2Il /~n,~-/ ~Owl
stamp.
q'' y
License Number. 18 -^^W ! `YV Q}aJ
Remarks: L,t` ' r. cu=ti / AgAi?'t,r~ '
= NUPpCRT ' N
D 1ri39 s
fALLSp'
Signature: ; llti JL' 2 nu,
Date: 3 ev / g
--r -rbi
oow. -
Plot Plan Page Hof ,
PROPERTYOWNER: Cages C• ~ JuuF-ANA] Scim r 1 40 FT.
(except where noted)
1 W i//Iy SEC. a ~-f-~~ P IxINCs
Legal Description: LZf Z ST.VUZ Iw,' COD E ot: THE S
, >VIz, _ beatcltme,a
T23'A1; RZOWi TOWA) CF kL(McP r -W CftQ( CGUATY WisCM-no 4 P" V,
I~ STAgrc--tvc~D / ozc-1324.02 -Qgp - 2. /SS~LP_E-`'
North
II
r I
~ ~'l N~ i CS II
o ~zl -~.-v ~ ~ ~NJK
'1 o AGO ~ >AV9~~ ~,r•.T,N= ~ _ r. <
- 3 ftzsXuF _ _ P~~ Win, ° Oµ~~c r✓r`L 99 ; q y . L' • _i,:
Itµ,-
.,JoOD T
yT^M1F.
1
Site location:
~~^IL
I
CuKrl ; ` Ur ANA; 'r,a IJ)T rte: 3 y
Ex1 I
IN-GROUND GRAVITY DISPERSAL AREAu
Uniform Elevation Trenches with Quick4 Standard-W Chambers
s oerT.a,lw.e.tm
3-111 rench (down-sizing credit) go -go _9M -or
OL 7T14''-EAovF a Umftwla
tJr.vrwrnare f(15~C~
1r. rr
ti(X. COVER nltlaO
,T
ruea
Inaoo TYPICAL TRENCH
CROSS SECTION VIEW
rlorao _ - (No Scale)
Hwila m L,.n 3 tt
sym" f3ava8on = R sepvr.&M W W w trer.*..
(HPI+q
o,arsi Star d-W
(N tl (Show la®tm a wet I ouNd Pkx mvacdon w pbn view.) TYPICAL TRENCH
dr~GP
mw0.dt+.1n PLAN VIEW
(No Scale)
T i - TAm3.010
1
s z> R m
(nom m
stamnrd-w tTvn,ue, w
INSTALL PER TRENCR 0 "M by MW~.S~
? r` 0Lirt4SW-Wd)20fl E6NS1WrbWa SL(.,. fe ~~nnlsl nnvw.uwr.wma A
t PaFrs dend~®BIY BSNpYi'w a1
= Prooo d EISA;s trench = 1/75 K RetL/red YWilkaden Ma = i577 K
D[slribullnn AACUtad:
3 trenches = Proposed ToW EISA= $ J~ fe
ui2E u
(Ja' cf f'-t'~ - O] LK' > 5:'57.)4 zAI IA'i `A"M RE4
`557 /~f .2 i LC ~fS t/JAN,T 4f 3 llN, i
CU C4) 15 "Nrtsti yt c 1~- G 1
(AWrTs X 4t - 5(-
S
177
(Z~~~ 5 x
IMPORTANT- 1n-ground Gravity Management Plan PAGE 4 OF 4
The owner of this in-ground gm"* system shall be responsible for its Perpetual operation and maintenance pursuant to
oaR qui considerere=dar ofaSPShuman h382-ea313lt4h, thWazardisc Adif not mamin. Cointade. in Pu rsuant to SPS 383.52 (2). Wisc. Admin. (,ode, this system shall
d ed in accordance with this approved management p
ies.
Furthermore, all inspection and maintenance activities shell be performed by a registered mPOWTS anagement p Maintainer in
accordance with SPS 383.52 (3), Wisc. Admin. Code_
Maximtan OfsoersO Area gMMO _ u
ahw mtts:
Design Flow in ✓ gPd; BODs 5 220 mgL"'; TSS S 150 m'1; gL FOGS 30 mgL-r
inspection Checklist INSPECT EVERY 3 YEARS
11 type of use
age of system
o nuisance factors (i.e. odors, user complaints, etc.)
o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.)
° material fatigue (i.e., leaks, breaks, corrosion, etc.)
11 solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribuVon / drop boxes)
e extent of~Ixoper use (i.e., exceeding design capacities, prohibited activities, etc.)
do" ponding in distribution cell prior dosing
elec irregularities ties - If if applicable (i.e., t pump re-cyding. float swftch settings, etc.)
electtwtion lateral or lateral plica le (i.e., wiring, connections, Switches, controls, timers, alarms, etc.)
shsface discharge of effluent or sewage (measure lateral distal pressure - compare to design specification)
9e back-up into structure served
Aftaintenance Checklist
MAINTAIN EVERY 3 YEARS (w when necessary)
when the all be pumped by a certified septege servicing operator licensed under s. 281.48 Wis.
Stata. soNds In the tank(s) exceeds onadhird (1/3) the liquid vokane of the tank(s) or
as required by lord ordnance, Disposal of contents shall be pursuant to NR 113, Wise Admin. Code.
Effluent fltteds) shall be inspected every 3 years and shall be deaned when rNmassary to
accumulated solids according to manufacturer's y the g ~Y
month:. specifications A servicing period wig always be gre reeter than 12
System maintenance reports shalt be submitted to the proper local government unit In accordance with
SPS 383.55 Wisc. Admin. Code. Report any component faNum or matfuncpgt to:
Name of Individual or company:
Phone:
Local government unit -ST. Ofp K CO MM tAA; i ry D'c \)t lopm E N-t- Phone: 7 f S- 3 gUa50
Local government unit address: H u Lx,01.; V)1
ZIP:. ScJ.` Ej/( Any defective part of this system shah be repaired, reptacad, Or Mmoveed Wwr-
Lode. Repair or replacement of failed or malfunctioning shah to SPS 383.51 (1), . dm Admire
No Product for c henrical or PhYs" restoration of it* PPOWr ~ y unless with SPS 383, Wisc. Antm,- Cade.
in. accordance with SPS 384, Wisc. Admin. Code. approved by department in
Continger" Plan any I Wan sevent that ubmitted to thailled appropriate treatment comPonerd of this POWTS cannot be repaired, it shall be replaced pursuant to
abandoned agency for review and e
and replaced by a code-complying dispersal component in pre-ddeterirm dined ssui itable soils. ay
Svstern A endonnient
If use of this POWTS Is discontinued. It shah be abandoned in accordance with SPS 383.33, Wisc. Admin. Code.
01isconsn Department of Safety and Professional Servu;e
D:wsan of Indushy Scrv:ms
SOIL EVALUATION REPORT Page 1 of
n _xamlanre silk tiPS 383, Wis. Adm. Code
Attach Carrl>letr.:i;C plan on , apnr riot Icati Lhan A 112 x 11 inches in sVr. Plan must County S7, env
include, but not limited to. vertical and honzontal reference point (BM), direction and Parcol ID.
percent slope, scale or dimenvons, north avow, and location and distance to nearest road. £ 32z} - D2 COY`
Please print all Information. Reviewed by - Dyal~l
Pmw:ml information yiv pmvidc may ho uxrd Inn sctgrNary RrrPnSCS (f'nvacy Law, s. 15,04 (I) (m)). I V IZ
Pr:,pefly Owner Property Location ❑ o
IS C. ' JLIU., AW X+l1A1 - GrM Lot 9r 114 -5 114 S Iz T z7 R w E(or)w
P-l W rty Owneir s Mailing Address Lot p Block At Salad. Name or CSW
2 '4A90( ttkLA
Gty Sbde Zip (:ode Prloner Number rty Viflago • own Nearest Road
MuD,c ti w-i ~yCIW 1 ) l+lt1~ tA+ ~TAOX wca[3
F] Nrw Construction Use® Resident" ! Number of bedmnms 14 Corm derived design Ik1w rate GPD
Replacement LJ Public or commercial - Describe.- - - - -
Paron: matenal _ jA/, J)y Flood Plain elovabon it applic ale
rlool 00nmr015
l,,rr;f remmmendabons- LLwV~'. N'![:N/AG- JN-e-r<G UNr~ c 7 z~
A 1~D1TtCNgL Px": wl tiE-- Cc~~...cT[•_D .C: N\Dvc fZFf~rACE/tiIEN~ All ~-#k
1.l NE
C!^1 CF WF%TE-RWAyl H((tHxkA'1Ef`f
Bonny p Boring
Pit Ground surface elev. - /C/ : 2 It. Depth to limiting factor >45 in.
SCtd _Applca Rate
Hourin Depth Dominant Color Rodox Description Texture SUuclure Cnnsistamoo Bamdnry Roofs GPD/fF
:n. Munsell_ Qu. Sz. Cons Cold, (3r. S4 SK 'Eff#l E1192
On 1() 3/ 3 6 &r. 7
t k- itY y _ S I - - 0.7 Glv
I _
L---JJJI any ri Boring
Rl Ground surface olev. _ -ft Depth to limiting factor - in
Soil Atiolication Ra!c
Honzon Depth Dominant Color Redox Description Textum structum Corsislence Boundary Rents GPDl1P
1n. MunsMi on Sz. Cent Cola Go Sz Sh. •Eff!!i •EHp2
_r
Elllue it pi = BODE > 30:j 220 rrxyL ;rid TSS y70 < 150 myrL r ' Effluent #2 - BOD, < 30 mi and TSS < 30 mgfL
CST Name (Pleaso Pont) Sr n CST Number
MARL"JO_IIUPPCRT(fiollistersSol] '1-esling&Design) z_ C ` ~7 . 224X32
Addrdss Date Eva{lua:i snducted Telephone Number
28497 King Arthur's Court, Danbury, W1 54830 2-VO - 715-426-1775 -
WD-x3+uiR07 l_;i
r d•s ' o f n
Iri
4
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I-~, .y 11 r~)t tr ltli 1 _'O,
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y c x x
a
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Plot Plan Page 3of?3
PROPERTY OWNER: (vttzl is e- Z JuiiE Scntij!aT 1" 40 FT.
(except where noted)
Legal Description: Lot z, S`AI wCGD, JJ6Vy Cr THE 5w,& SEC Iz, 1~ VD_1 C21Nlo
..T`K(.ur I~ZLV.:t TGwti Lh 1+QL6LA) 5T. CRCQt C'CU~CIY L.t,tSICN_~J'~ j
I`~~_ ,r.~~k _~.rv-u ! c2.c •i_3z4-cz-~, Y 2../SSAC/265
North
L
i
A..•~of r tYJ S7tN•'" i
6 /iv' ~'fLt'( EL i
m
Site location:
- s
Quick4
INFILTRATOR' The QuicW PIL._:
St1ndnrr± r'h~n1h'; Plusw Series
Ouick,il
The Quick4 Plus Standard Chamber ~
offers maximum strength through
its two center structural columns.
This chamber can be installed in
a 36-inch-wide trench. Like the
original line of Quick4 chambers,
' it offers advanced contouring
1
capability with its Contour Swivel ' y
Connection- which permits turns
up to 15-degrees, right or left. It is
also available in four-foot lengths to
provide optimal installation flexibility.
The Quick4 Plus All-in-One 12u Benetifs:
Endcap, and the Quick4 Periscope Two center structural columns offer increased stability and superior strength
are available with this chamber, Advanced contouring connections
providing increased flexibility in
system cons ?u a*rr s Latching mechanism allows for quick installation
Four-foot chamber lengths are easy to handle and install
o..
Supports wheel loads of 16,000 Ibs/axle with 12" of cover
Maximum Strength
- - - - ~ as
Size Quick4 Plus i-A-i 1- :;le _i dcap Quick4 Pius All-in-One Periscope
34'vu x 53"L x 12"H Benefits: Benefits:
(864 mm x 1346 mm x 305 mm)
May be used at the end of chamber • Allows for raised invert installations
Effective Length row for an inletloutlet or can be 180' directional inletting
48" (1219 mm) installed mid-trench
12" raised invert is ideal for serial
Mid trench connection feature allows applications
Louver Height construction of chamber rows with
e" (203 mm) center feed, as an alternative to
inletting at the ends of chamber rows
Storage Capacity - • Center-feed connection allows for
ai gal (178 L) easy installation of serial distribution
systems
Invert Haight Certified by the International
0.6" (15 mm), 5.3" (135 mm), Pipe connection options include Association of Plumbing
8.0" (203 mm), 12.7' (323 mm) sides, ends or top and Mechanical f
Officials (IAPMO) F R
APPROVED In -
282'
~ N
~ p )
~l
w V
80.900 90 FT
2.156 ACRES
o'I
84.857 SO FT
b'S +~~a
1.948 ACRES
a~
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Q►• ~ 92"19 ~J
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d QU/C*4
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IPHONIm W.31m TechnOFlgYrs, l I f. 5T1NOrND LIMITED DIaIMkq WAliRANTY
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INFILTRATOR ""~'`~r A;y~l.mrml;~ I~aYAPrhll;~a4~«tpa „r„r:>r=xP„Alelh~,r,:,
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0IVISK)N OF INDUSTRY SERVICES
PO BOX 7162
_ \1 MADISON Wi 53707.7162
`gyp I'I Cuorxl Thro,.9h Re"y
` i hla>/dapa.w.0wror0BramsrtM~+rY-Semrns
\'A~ - ~ Pawt.P~acarkilrl,IOv
Scott waMUr, Doi em"
May U8, 2U l $ - oave Rose, Secretary
CUST 1D Nu. 1316956
DAVID I T•.NT7
COVT AFFAIRS DEPT INFILTRATOR SYSTEMS INC.
4 BUSINESS PARK RD PO BOX 768
OLD SAYBROOK Cr oo475
1denti rication Numbs
Site ID No.
He: Darcnption: L FACHING CHAMBER Pieaae rrfer Io txlh idcMefnesnon nutiAcm
Manufacturer: INFILTRATOR SYSTFMS INC. abon, in all Tr"' nnrlrr of with thr a~erc
Product Name: Q
LEACHING CHAMBLHS UICK4 PLUS STANDARD, QUICK4 PLUS STANDARD LOW PROFILE (LP)
Model Nurnber(s). QLI CK4 PLUS STANDARD (INCLUDING (I LND CAPS (trans. id 2534224)
QUICK PLUS ALL-IN-ONE 12 ENDCAP
WITH TOP, END, OR SIDE PIPE INLET CONNECTIONS USED SINGLY OR IN
PAIRS Al ENDS OF CHAMBER LINE, OR AS A MID-CHAMBER LINE
CONNECTOR) AND QUICK4 PLUS STANDARD LOW PROFILE (LP), (INCLUDING
QUICK4 PL US 8 ENDCAP WIT14 END PIPE INLET CONNECTION USED SINGLY
OR IN PAIRS AT ENDS OF LINE: AND QUICK4 PLUS ALL-IN-ONE 8 ENDCAP
WITH TOP, END, OR SIDE PIPE INLET CONNECTIONS USFD SINGLY OR IN
PAIRS AT ENDS OF CHAMBER LINE, OR AS MID-CHAMBER LINE
CONNECTOR)
QUIIIK 4 PLUS STANDARD, DIMLNSIONS: 53.0 IN L. X 34.0 IN. W X 12,0 IN H.
MAX. DEPTH OF BURY= 8 ft.
JEISA for chambers with of without fabric . 20.0 sq. }Llchamber, EISA for Quick4
Plus All-in-One 12 Endcap installed at the ends of a chamber raw = 2.6 sq, ftJend
cap, EISA for Quick4 Plus Aft-in-One 12 Endcap Installed in-lino within a chamber
row - 3.6 sq. Adend cap; Laying length of chamber - 4.0 fl.. Laying length of Quick4
Plus All-in-One 12 Endcap Installed at the end of a chamber row 1.5 h., Laying
length of Quick4 Plus Aft-in-One 12 Endcap installed in-line within a chamber row -
0.9 ft., OUICK4 Plus Standard Open Bottom area - 9.72 Sq. flJchamber, Quick4
Plus AA-in-One 12 Endcap installed at the end of a chamber row
3.1 sq. It./end can. QtAck4 Plus All-in-Ono 12 Endcao installed i04 Open
within a
chamber row Open Bottom area 22 sq. fLJend cap; SEE ALSO ATTACHMENTS(.
QUICK 4 PLUS STANDARD LOW PROFIT-E (I P), DIMENSIONS: 52.0 IN L. X34.0
IN. W X 8.0 IN H; MAX. DEPTH OF BURY= 8 it.
IEISA Iw chambers with or withotll fabric _ 20.0 sq. mJchamber; L.tSA for QUtek4
Plus All-in-One 8 Endcap Installed at the end of a Chamber row = 2 3 Sq. 11Jend cap,
FI.SA for Quick4 Plus All-in-One 8 Endcap instaaed in km within a chamber row =
2.0 sq. filend cap, EISA for Quii*4 Phis 8 Endcap installed at the encl of a chamber
row - 0.7 sq. ft./ell cap; Laying length of chambers . 4.0 N.; La
Quick4 Plus All-in-One 8 Endcap instated at the pint a chamber r Laying r mod' of
Laying length of Oulck4 Plus A B Endcap ainstatiled ow = t.1 h ;
row 0.9 ft.; Laying length of Quick4 Plus 8 EEndcap, installed atttthe ennd of a air
chamber row= 0.4 ft.; Qulck4 Plus Standard Low Profile Open Bottom area = 9.77
sq It /chamber QuiCk4 Pitts Atin One 8 Endcap installed at the end of a Chamber
row Open Bottom area _ 1.4 sq. lUend cap: Quack 4 Plus All-et-One 8 Endcap
instaW d in Nine warn a c hambor row Open Bottom Area - 1.2 Sq. ttJend cap; Quick
4 Plus 8 Er dcap installed at the end of a chamber row Open Bottan Area - 0.4 Sq.
ftJond cap SEE, ALSO ATTACHMENTS)
Product Fiile No: 20150111
534:23 1 I ;-vin J,--, l_.,.
1 he spc:v:riiG of logs androi pLms for Iha: plumbutg p,oduct have been reviewed and datarmuted to txa in
unIfAa„cc with chapters Wb 382 through 384, Wisconsin Admimilrafive Code, and Chaptors 145 and 160,
LV 'u-Onsin Slalules
Lhe Department hereby issues an approval based on the Wisconsin statutes and the Wisconsin
flA ninistrative Code. This approval is valid urttfl the end of May 2020.
- )i. approval supersedes the approval Issued on 1111112014 under product file number 20120137.
Ns approval is contingent upon compliance wim the followtrtg stiputlation(s).
This product must be installed in accordance with the manufacturer's printed instructions, podu~l
approval. and plant alpproval. K tftere is a conflict between the manufacturer's instructions and :j approval andror plan approval, the product approval an (Vor plant approval
wig take precedence.
When this product is installed in a dispersal cell that is sized based on the EISA rating stated in ti-,z
; egarding flock of the product approval letter, this product must receive Wastewater havirq a 6OI):,
less than Of equal to 220 frw - a TSS value less than or equal to 150 mg/L and a roc v;:uc toss tl-.,,,
ngual to 30 mg/L on a monthly average. -
When this promet is installed in a distribution cell Mat is sized based on the EISA Milne staLn :r :no
regarding block of the product approval letter, this product most be installed in axfivfdual ezar;adions that
create a row of chambers that are horizontally separated from other row. in other excavations by at Ica,
-t feet The 3-foot measurement is measured between the closest outside edges of the teaching
chambers.
When this product is installed in a distribution cell that is sized based on the EISA rating stated in the
'egarding block of the product approval letter, the distribution cell design must allow at lea,i six inches r
txxxfirg in the chambers without badcilow of wastewater into the drainpipe that ,-i;~:,
chambers.
When this product is installed in a distribution cell that is sized based a, the E ISr : an„~; ~:a+:~rf u, :t,v
regarding bkr k of the product approval totter, this product must be installed in a fist,i;.,uor, svstonn
which has the top of the distribution cell at or below erfgintal grade.
lVnon this product Is installed with geotextile fabric on the sides of this product in a distribution cell the ;
rJeed based on thv NSA rating stated in the regarding block of the prorluci approval letter, the EISA
rating with fabric must be used to size the system.
When this product is installed next to each other in a distribution toll that is NOT sized based on the EIS.
rating stated in the regarding block of the product approval letter, me effluent distribution area is equal to
the length times the width of the chambered area. The use of geotextile fabric in this type of installation
is optional.
INtien this product is installed with geotexlile fabric on the sides of this product in a distribution cell tbar i-.
sized based on the EISA rating stated in the regarding block of the product approval !Pt'.er. th« ~t~otea n;F
,;tbn(; must (neck all of the fallowing specificaibns:
. Geotextife. shall be non-woven
- Wool shag be 0.35 oz/sq yd to 1.5 oz/sq yd
. Apparent opening we (AOS) shall be 20-30 U.S. Sieve (A 1 ) ..4; ti I,.
or mound designs, see the manufacturer's propYtely mound compwient ma:uad for !flit p, kxlk.ct Ix,,:.
I:i .x mnunr+c; mound propriety comfxinenl m.:run Ii r., tlh-
: ~.iu.:: !J❑c--.
Z-934224 Dgva>1Jluri Pa,. _.&201I
The cepariment is in no way endorsing this product o: any advortising, and is not responsible for any situation
which may reaufl Iro its use
Glen Jones, M.S.
F-C), STS Product Reviewer
phone: (608) 267-5265
f-w (606) 267-9723
email: gioniones@W.gov
irc DSPS Is committed to service excepwice. Visit our survey at:
~wr. survc ym orkey. cnm/^idspsi;cuslrmersalisfa~.[:un
.
3
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23
24
22
25
i
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~a.e6 Z
ST'. CROIX COUNTY ZONING OFFICF:
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)_., l 3 srAv*,- v, ;c cs~ located
at: A;E_'/,, -a Section iz Town 2,f N, Range zc-) W,
Town of HUz-f % St. Croix County Wisconsin.
Upon inspection, I certify that I 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 service io - e-s s 5
Did flow back occur from absorption system? Yes_---- No
(if no, skip next line.)
Approximate volume or length of time: ! gallons minutes
Tank Capacity: r2 -sc'
Construction: Prefab Concrete X Steel Other
Manufacturer (if known):
Abe of Tank (if known):
Permit number (if known) --i y? 'c-. i
(tic sed Plu~ r Signatu ) (Print Name)
(Title)
(License Number) Ml PRS _ -
(Date)
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
ST. C:ROIX COUNTY
SF,PTIC TANK MAINTI NANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Mailing Address
Property Address _ ! X117.' 'L, L , _1
(Vari6ration requimd from Planning & Zoning Department for new construction-)
City/State _ H hlb -'0v ci Parcel Identification Number (/c -C,_ - C C G
LEGAL DESCRIPTION
Property Location Nc , Sex,. i T l N R- _W, Town of iA, - -
Subdivision Plat: 7AhK WC '1.7 _ Lot#
Certified Survey Map # Volume _ , Page#
Warranty Deed # LL 317 (before 2007)Volumc 277C Page #
t c
Spa house Oyes Iot lines identifiablellesc]no
SYSTEM MAINTENANCE AND OVVNFR CERTIF ATION
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
imponsibilities am specified in §SPS. 393.52(1) and in Chapter 12 - St Croix County Sant
ray Ordinance.
The property owner agrees in submit to St Croix County Planning & Zoning Department a certification fort, signed by the
owner and by a matter plumber. journeyman plumber, restricted plumber w a licensed pumper verifying that (1) the on-sile
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tink is
less than 113 full of sludge.
Vwe, 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 Safety And Prof=onal Services and the Department of Natural Resources,
State of Wisconsin. Certification staring that your septic system has been maintimed must be completed and retuned to the St. Croix
County Planning & Toning Department within 30 of the three year cxpuation date.
11we certify that all statements on this rm are true to the bast of my/our knowledge. Uwe am/ere the owner(s) of the
property described above, by virhre of a y decd recorded in Register OC Deeds Office.
Nnmb7 of beds oonu
SIGNATURE F APPLICANT(S) DATE
"'Any information that is misreprasamod may resuk in the sanitary permit being revoked by the Planning & Zoning Deparleaent
1Klude with this application a recorded warranty deed faom the Register of Deck Office and a copy of the certified survey map if
reference is made in the warranty deed.
(RP.V. 84/12)
;ocurr•.rrcr_,- PRIVATE SEWAGE SYSTEM S,I ern <
Jd!vtr antl Bmbmy ~'r.upVr
INSPECTION REPORT Snn'tar' Nn 479261 0
GENERAL INFORMATION (ATTACH TO PERMIT) Ste* Plan ro No
carnal mhrmar^ Y^-u prw:se Tat' x 11.cd f,',,wman purposes IPm'acy Law. s i5 04 1 %1!)
P,vTq Folder's Nawe Cdy Vd(agc X 7ovnshrp Parcel Tilt,, No
Ludw' ,Peter Hudson. Town of 020-1374-02-000
~STBMEev Insp BM Ebv BM Oesrrow $edgMwnritangdMap No
'N\ 1 GST 12.29.20.2235
TANK INFORMATION ELEVATION DATA
r TYPE MANUFACTURER CAPACITY STATICN BS HI FS ELEV.
~;epbe Wlffi(il~ 7' Ali- ~z 5v Bercnmark y.77 /M.77 /cc
All eM
tK I J- /qoo w; e J
%mra6on Bldg Sewer f
Holding SVHt Inlet
!5 9,7.
TANK SETBACK INFORMATION SUHtOutlet 5-IM Z9 1
TANK TO Pit- WELL BLDG. Ve•n to Av ibnake ROAD Ot Intel \
tt ldl)L 7:5Z)' Dt Bolcom \
~Ikxang (L HeadenMan.
Aeratlon Dist. PDe 2 sd
'r!iNding Bat Syste•n
O
Final Grade
PUMP/SIPHON INFORMATION rtiZt- 5•1T9 4 3k,'
j Vanufacturer Demand St Cover
GPM ivl I.OJ J. Z 413 -:51
'.'dndel Number
- T, 7.51 97'Z<~
^.H I Lift FricSOn Loss System Head TDH CI T2_
R;fpfmatn '.ecgt On! to N01
ally OJk- fag lAl •l09
SOIL ABSORPTION SYSTEM
'6EWTRENCH 'R,dth d LengtIt / W Of Tnlnchm PIT DIMENSIONS •fo Of "as Insure O'a L OU4Oepm
DIMENSIONS
~2 S7,5 r7 \ \
r SETBACK SYSTEN1T0 PIL BLDG WELL LAKEiSTREAM LEACHING Manure"Ver ~%((s~ \
I!dFORMATION CKAMSEROR ~Atl 11y
lY,xi p Syatem UNIT Igptle! RUrnpor
DISTRIBUTION SYSTEM } /~I v-/`f _z hfn
.:ronr.MaruMl.^. Disinb eon i Hue Sec s HuM Spaarq Vent to M.~uy,
SOIL COVER It Pressure Systems Only e■ Mound Or At-Grado Systems OMy
iJapet 0m, i Oeplh Or, .+Depm ! vScOdeaf$tg0e0 •x Mukheo
iF,r]Trmm (:on4•. '7 Q(j esM«mU, ESyr!s Tops ar
L U r Yet NO Yay NO
COMMENTS: (Inciude code dlscrepencres. persons present. etc.) tnspecwNI ut _ _I_ inspection M2:_ _I_
Location: 188 Starr Wood Hudson, WI 54016 (NE 114 SW V4 12 T29N R20W I Starr Wool Lo! 2 Parcel No: 12 29.20 2235
TIM Desaipum =
sewer length - IS
'fount of cover = J I - -
:vsion Requ-red? Yes X"0 " r J _Q / / Z
i._~arbur sde to, rot ad adollrona: Infpnna!ror. I z tj ✓6 lJ (J ~J'7 of
i.... ti S,rn Cer. No
Il