HomeMy WebLinkAbout040-1269-70-000 (2)
Y6sccnsu, Deparlmert of Comm',, PRIVATE SEWAGE SYSTEM Curl'
Sa'ety and a diking l)isk St. Croix
INSPECTION REPORT S:ndary Per, 1440
GENERAL INFORMATION (ATTACH TO PERMIT) 606917
Stato P an D No Pe'SOnaI iniunnat un yc., erev tle may oc used to suconeary pJrpc5es Ivr va'y Law. S 15.91 r • Ir...
l
Permit F+o tle%s Name City tillage Taarsh Parcel Tax Nc
Steven & Pamela StOtmeister TOWN OF TROY 040-1269-70-000
CST BIA L e:. Insp /A Llc.•. UM Deu'rp:ion
KNJ~ I , 1 ~ r Seetm^,Tnn~ntKa~rne~Pdap Ao
n `0 17.28.19.1484
Al
TANK INFORMATION ELEVATION DATA
W4jjj[/g ITY STATION BS HI FS ELEV.
Benchmark
7-
61 nit BM Hldg. Sewe r St,-Flt Irlet
TANK SETBACK Eft StiFt Outlet
Ti1NK TO P,'L ROAD Ut Irlet
Septic y
le,
atror , 16
/03. 2
No ;:mg r
s-s /4i:)
PUMPISIPHON INFORMATION Rg5j.a', Demand GPM
_ Tii rt
to t^lell
SOIL ABSORPTION SYSTEM
BEWTRENCII veil I :nigi NC C:I Irenches PIT DIMENSIONS No OI Pits Insde D a. Lry;id Death
DIMENSIONS
3 q ro(~ Z
SETBACK SYSTEM TO I?+L BLDG 4^.rELL LAKF+STRFJ'IP.1 LEACHING Ma^n'ac:u; cr r~
INFORMATION
S. st~r ~ J Z~ CHAMBER OR y~j /1 h I l p.T-v 1 //J
/`/a_y1J C ~O UNIT Motlel Ny{jJ.c.it.
44 DISTRIBUTION SYSTEM Z Z(o = O
Ilracenbf.:n'lot Dlsl'In~lprt ` x Hale Si
y, Pipe;si xNc.'SG:3- c'r•.J Ve^I+~,'Airl taV~y;.~
Lciigl- Cia- Ca SFannq- ` 7
SOIL COVER x Pressure Systems Only xx mound or At-Grade Systems Only
O'er CeF:h P:e'
Dca+Trencr rCC• - xx Depth of 11x See did+Scdtled xx Mdlencd
BeaTrens'r Egges ~ lepsoil
Vc `Yes Nc
COMMENTS: ilrclude code oiscrepercies. Pesons present. etc.i Inspi /N: I pect.or #2
Location: 44p CROCUS HILL RID V ~~L r r _
1 1 Ad BIv1 Descsetion = ~r ~1. _ L_O J ~ ~ ' `4•~~~~~~!!!ll/~~ y-
/ J f
2.? Bldg sewer eo = ` '.5 I tc~ctt5 e3
E r' ed i x.~ r/^
- amcuart of of cover = if It
Plan revision Requred? ;Yes No la 31
L7
Use other site `or adoitional information IQ O _ Y3 ii~
S3C G-t I+ Date - -Irsepot s Sigra:~ - 7317
CC'[ N'c
, - t'•aany C ~!x- - -
I1400EEWashialA,n
= 1 e.0. lime 7162
` Q g 10~~ Modisot Wt 53707-7162 m Y t~.tnt Nom bw (m Ee 6Bed n by (o.)
Sanitary Per Application , Im-rw Ntm 6w
In acwmrce wilh SPs 387 21(2). W, AAn_l:r@.
r rryuacd pipr n awe amdeery psniit Np~. Al issim of dtia run in the appWtiyo b'wanmmOl wi
t
limoo,in
50 fuo t fa co`*`otwaai POW IS arc wbmittcd n Wopod , , mliog M of
the Dcpnbnnt of Softly 'ad.Pn£e:9una suvices Appi
u in accordance with the Ibawel information you pmrde may he mad fw tacadaty , G\I) ddIj: Jrl~
I Law & IS I XT Scala
' IWam.ff.s-PavaePrslABlaicasa,~. MIME j
F'rolfetty Ow3rw'z None Rryan
JTCvc>J ' P4AAF-LA S7DtiVlElsfE~ PM 0 11
""Pety fl w-M Ift Addrwa - I7L --let
I
.
y410 fllt'L RD RnpetyIACOrn
17,
, `Y. so"
yip Cade Phone l,wbor GOVI. Ixa
l IAbSCti t u~ .h -531- 3C-34~ $76 I~ Ii.sm i 7
IL 7 ype.f Baldis (Deck./ LLat apply) !xu a 'i N: R_1-L_- E e
I w2 randy DwdhIS - N.mbw OfBabowy3
Suhliveian Nm
❑ wNicx-.on ..W -Dacnboun_ Block IN - .7-ko v W cob
❑ City d_
❑silo Ommod- DwuiboVw__ CSMNumbw ❑ Vily9e of
Alr-7'ype.tP.xaif: (11ech Coa.pk7e ll.e Bif.pOlia6ie) -
❑NewSyatrw RcyFaoraby Sy,,, ❑ inkling TNC Repimaw, .
may ❑ carom Modi6ntioa to Fsm:rg S)"~O (eaDlaio)
R ❑ptmd Rraewl it evtnon ❑C7ageofR-Obw ❑ptrnitTms6nNM lita Reviwn Ramu Number Dale Wtad 1
Before F~aaom
rv 45.3~(cC L Z_ 0'j~
C1eek d 6af ~Ir) - -
bfGaaud htcmu'md ar(,rw7d ❑ At{3ade ❑ Mw.d >
24 it.
Olhc Ofaehbloyoil ❑Mwmd<2Aio. ofrooWaoU+Af-•
Diapwaat COmpw.a (ewpiait) - ❑geyamaal lbviw
Am ( Iii
Lf.n..tio.: - cawli
D-P Fbia (SPA Dcup Soil App .M.
al) C; . & °ar0°al Ara Rg~med (g~ pal Am PYOpnxd (%1) sYUem E]evnion
/cc 4
YI. Took fade Capraly in Total a ofr
N.w rrs Cellos GaOua I)mti MaatrVoO.a U o
Fuming Ton. o _
smr. ~.wdd raa.a _ /aJ 1 1 / v 3 8 j
m a a
Ra.KC7t~ L7U ) (il) rE5 ~ ~
VII. SWeaw.,_4the aw.me
Pkm6w's Now (Rua) far l -d is of tae 4 omi tow.. w Me aabeaea paua
y/ hw s Stgtaauc M9MPILS Numbs
BUSISICSM Nrnnw
Addm(s6ow•c". ,7vCode) zO- "37 wa:;_ 7y-2856
CS
vuc H! Ek/ ST Cth717T ( 5 t j'72
u.e
m aplno llt~m/.eRae` p,e lenni
fp
~ IX. Condit, r O1 Raa • fw tknid ~ S 7 Q J • ~ /o l1
a h or Deb pptov.f _
1. beptrctack,ernt.f^jiPo=rn1
Oh :,.cell nudt all pm} _r s •
ds pe.mr3gill pltn
_ . roe s Lv ~9umoe.
2. AY atNbark rf•cl.iror::ams tnool ou cr. r.:, u E
Amts m..~ae aem. /w a.e,3..a. a.a M~ab~~c t' _ -
°~b wrf r Pam •rt is rfs a •n . ri4M 1..r.i
SBD-6399 (R. OR/14)
Plot Plan Page - Of
PROPERTY OWNER: Iit F_Vcn: !~AMr;~J. ~Tr_, MG;__T_ ?Z = 40 FT.
{e~rr'pt rripR mtEdj
tee LrT K. IL CY WCDI~, A, D
R 9 iy :-a = 3a iBc
CP.CUY WKLY 'ut}t=~CCN:~i%%--- _
+cf?r_S
~T ~4 cue +I t 1- a i~. -q_ y
- 7-U -
N rth
2
41
iAt
Site location:
k-
In-Ground Gravity Plan PAGE 1 OF 4
Index & Cover Sheet
CMWonerrtAfWWdDesW Retrenoes:
Version 2A, S13 04 07 0 5-P (N.01I01, R. 10/12)
Pg 9 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
Attachmerits: E osures:
7NFit TwTeR sPEcs POW TS Avolication for Review
Soul Evaluation Report & Site Ma
5EP71C 7Au< Aax_Gr-_AeAl7
Project Name / Description
owner Name(s): P Phone:
Owner Address: 0 G'~zccus i~ AJ 1A,1 Zip:moo/(p
Project Address: (-r1M c-)
Govt. Lot: 1/4 of st^1 114, Section 17 , T z8' N-R 1~L EQor WEfl
Township: _ -11201 County: 57-- C RarX
Project Parrei ID C4c f L C ('r _ 70 _ CC C
Designer Information
Designer Name..,) JJ atz~,\/ Jc I1 u r~r LK-T Phone:
D"ner"dress:28L19t KwAtArmuKs C+y lmRvE wx zip: 6qe
EinBp: ti01(i 5~'~Ic(e5~dn n„+l„nK ,Y.•v
e0rvx This spgjrtR~t➢4~stamp
License Number: 185y - 00 Az:~
Remarks: V
f 6"..AIRY
D1899
1 I Oi ,P\~~``ti
Signature: / / I / 1L "Maun,a,w►""
Date: JD.-7 ZV
aftniked ovy.
~
Plot Plan Page z of PROPERTYOWNER: (;Vr-oJ 4` 1~~1N\ D~ M~;Sl r2 1' = 40 FT.
(Pwew where noted)
Legal pesat,borD- ,
Lrrt S IKCY WDDL~ -57---e . r7. "tzSiJ, Rr9 Wl A 1 D
u a~_ e kt ras Nr,L t~ 1:~ ..7I:- GOO
North
L-^
~j ~kMcD /00-GC c
r--IRr
Site location:
3 ck y
c1,41~IST&
v---
IN-GROUND GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with Quic,k4 Standard-W Chambers swk Tarege>Neeeetek
3-ft Trench (down-sizing credit) Iz~Da„ -w -o+ -ar
E,.~ FVW ame.. x+ i~~a
w0 e
ti LCOVER
TYPICAL TRENCH
CROSS SECTION VIEW
t---mew (No Scale)
Piwhe ""Liman 3 a
System Elevelk)n R eapaabon beh een benO.-,
l7Pla) Jn r.-~.'
O.h-k4 Sur.WdW
w/ Fm rap I !
MWn4 - - (Slwn location of inltl / outlet ppe armcUorr on pan view.) Mre~ TYPICAL TRENCH
PLAN VIEW
(No Scale)
r - ;f --------f/`---------__ -
---T
::::I:::"
B
- m
(
sbaWar~W CbarOer w
thwicaff
INSTALLpERTREN n+ra
s~=m O
7 QirJ~~ SM-W Q 208 E6llhiambers (1' rraawer+e,~.m.a ks...~ p
+ _ ~J Pwrs or end • W. Q 6 R' EISNpd, J6 k
- Proposed EISAaw bench. LLit' L. M Ropied Inflkrfon Mee: LL a' Distribution Method:
.S benches =Proposed Total EISA = a' A n0. C , L i->
i r J ~j00 i _ 006;
/t I n; I'll u vA 7z C~ u t t, i~
ccc~}? = bl; IykA.vIT SO uw Ts
50 x'l ' . ZUD ~
In-ground Gravity Management Plan PAGE 4 OF 4
MPORTAN4
me owner of (his in-ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to
requirements of SPS 382-384, Wi3C, Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admirer. Code, this system shall
ire considered a human health hazard if not maintained in accordance wI this approved management pan.
Furthermore, all inspection and maintenance activities shag be pertorrned by a registered POINTS Maintainer in
accordance with SPS 383.52 (3), Wisc. Admin. Code.
AmimUm Dispersal Am& Ope►tttkt LI its:
Design Flow )0 0
ON; B006 5 220 mgL"; TSS < 150 mgL"; FOG 30 mgL-'
insneCtion Checklist INSPECT EVERY 3 YEARS
type of use
age of system
Q nuisance factors (i.e. odors, user complaints, efe.)
mechanical malfunction (i.e., pumps, valves, switches, floats, etc.)
o material fatigue (i.e., leaks, breaks, corrosion, etc.)
solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution t drop boxes)
o neglect or improper use (i.e., exceeding design capaci6as, prohibited activities, etc.
extent of pending in distribution cell prior to dosing )
dosing irregularities - if applicable (i.e., pump recycling, float switch settings, etc.)
U electrical components - if applicable (i.e., wiring, connections, switches, controls, fimers, alarms, etc.)
o distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification)
surface discharge of effluent or sewage bark-up into structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
2 and dose farrkfat shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis.
stets wnen the volturrs of solids In the tank(s) exceed. one-third (1r3) dw liquid volume of the tank(:) or
as required by local ordinance. Disposal of contents shall be pursuant to NR 113. Wisc. Admin. Code.
n Effluent fiftWe) shall be inspected every 3 years and shall be cleaned when necessary to remove arty
accumulated solids according to manufacturers specificaiions A servo
months. ng period will always be greater than 12
System maintenance reports slurp be submitted to the proper local government unit in accontance with
SPS 383.55 Wisc. Admin. Code. Report any component fatgue or maHunction to:
Name of individual or company:
Phone:
Local goverrvnent unit 5T. C'i2DIX C0 n,.M .i v i 7 De QIELp
Y P v\t= N-T Phone: 716'-
Local l(;,YC
government unit address: H U txou 1A1 -
ZIP: _ S~01G:
Any defective part of this system shag be repaired, replaced, or removed rsuaril to -
Code. Repair or replacemam of failed or malfu ~ y SPS 383.51 (1), Wise n. Co
No product for chemical or physical restoration of the pp components shall comply with SPS 383, Wisc. parable. Code.
accordance with SPS 384, Wisc. Admin. Code .Y be used unless approved by the rtepeArnent in
Conti gncy Plan
In the event that any failed treatment component of this POWTS cannot be repaired it shall be replaced pursuant to
a lam submitted
and rap aced byancodeagen for review and approval. A failed in-grou di dispersai component may be
plying dispersal component in a pre-determined area of suitable sons.
$Yr3SMn Aibandomrrard
If use of this POWTS is disoentinued, It shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Coda.
.n.-. - a,axeiv:wiL.N+' ..~msn a.uw .:.ee. •r: ~a:a m. r.w~
Quick4.
ZATOW The Quick4'° Plus
Stang -irk I'hnmber
The Quick4 Plus Standard Chamber
offers maximum strength through
its two center structural columns. 1.
This chamber can be installed in
a 36-inch-wide trench. Like the
original line of Quick4 chambers,
it offers advanced contouring
capability with its Contour Swivel -
Connectiori which permits tums a±'
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 12 Ciuiu : Benefif:=:
Endcap, and the Quick4 Penscope Two center structural columns offer increasec sc :o it, r.nc superior strength
are available with this chamber, Advanced contouring connections
providing increased flexibility in Latching mechanism allows for quick installati:r.
system rnr'~qur,~ro•ts
Four-foot chamber lengths are easy to hande :,rd nsc;r,
Supports wheel loads of 16.CD0 Ibsraxle voi'I' 2' of cover
~w
w1i
Size Quick4 Plus a =nucap Uuick4 Plus All in C I
as^w x s3"L x 12"H Benefits: Benefits:
(864 mm x 1346 corn x 305 mm)
- May be used at the end of chamber Allows for raised invert installations
Efleetlve Length row for an inlet/outlet or can be 180° directional inletting
48" (1219 mm) installed mid-trench
Mid trench connection feature allows 12" raised in er, s'ce..,:. f(-.r ser'ai
applicatiors
Louver Height construction of chamber rows with
8" (203 mm) center feed, as an alternative to
inletting at the ends of chamber rows
Storage Capacity • Center-feed connection allows for
47 gal (178 Q easy installation of serial distribution
systems
Invert Height r r, tn, r
0.6" (15 mm), 5.3" (135 rnm), ' Pipe connection options include Pssoc,nor of N u . Li r, ;
8.0" (203 mm), 12.7" (323 rnm) sides, ends or top and Mechanical
- - Officials (IAPMO) (lA
RNT
APPROVEDin
yFf y
w1j
RVMN, it
I~rno 9
Ai is
w4WRT
HONT V11 W SIDF: VIFW
WkMATM WATER TECHNOLOCIU. LLC ivtnawoa
!St;ope afilli-V~ Waley Ye~o"a,%. UC STANDMD MMIrED Dramn,*ld WAARAFF"
(111. tim,
atx- W ;.Ali ardt,""A"lor laxiow ol an
Cult;9" I'l us
At( -11111ZL 1-1,111no, Ifi-I oww rHi*P,"-j 'watt rrwoa,"~d ~'a-a rsluro. em, tsma vw
.
by VP&AN. ft. flt -I ~'m haFF. "Ae, Im- dm~ ot'l ~IA'
To I,wcact 93 "larlb, ghts llzl~ ~1 mo, Mab,.I.
-m oa,"~'ao At "Pity 11"XI'A'd ur~' 1, 'ary~ ok~.~.j by kvrm'~". 1. N!
WI by In,$ L"iIJ VIWWIY W10112t06 & 12b&Y fiWiliCallY WjCtdK ft CW or asN
.111allat"". I I'Ie U101.
P,, IMF I 11,11H) W/yRRAWY AM, RI 1AVOU S IN.S1 RPAMi"'M (al APP MIFFIF
ALN I Art Noorml-PwARRAmms virth rtrwCTT0 MIF
%ill~Cl~J'AIML"YOPri-wssroPAP~rnV~nflWOf
~Jdim
I IT k.'", 1c,t lm,Woes o, himuialcl llvaag. anu<;tc~ ~ Of
. .,W by
ft it It. H. all 1~1. 11,111, ."It"la,; it.'. ald."W" 11;
auawl
it. am.m .1 IyA I Wt~
-,ynan d~ I- atcyr~' shyn N anpy,'q~' n,,'. vyv.
-Y~le ca'i,,tsal 'I, V~' xxtoo,vi w Xly ~ not ~.w by Ir"1111'any. IN% 1'(41141
W~'W'y ~,av LA, !..I I llu~ IkiF. Al, *'ornov in 2A ; vy, K."as sel IvIn tn:NS Unlialil
tiWLJrah,..I wq Hard parlyottift" ton ~ailalmro N ghapowvyl, In ylvaq tamw hablity
vl~, ~t y ,y mrd ,aly rot tits LjjT5jcd j-,&j,,ntt ay apply ,A (w% mio Aslajw If,
'T ~'.P 'h aI M Ita, '-'k.lAy laty'. "d
w I,, " 'Ijlpmt' * ~Iwyvp ~ obaaf. :hay unnaedwal,ant, Flit
4P 0 P.. ?m
anaclL01.,
INFILTRATOR (AdSapyocaa to3b1&n8cooVcfip*,wptc"wafrv#v mA
0,31 lulhavvna~ dlk*$
4i5".ft, 0.A.G,, ~,I') ll~ 141114% 1111"1. 116;1.1 I129~7pial'"
F"'A" I ria"y
M-6 P -A,11.
it, M~tlty~,. PLUS05 0016
n-TI - 7-r7& 11! !110111joll, IT611,641'.Pi ~01 1~ I
ti~Fjnariy\ \ DIVISION OF IPAUSTRY SERVICES
~t PO BOX 7162
,yt MADISON WI 53707-7162
®=p Caman TF,dvh PeL y
~r:,. 1 S n; falp//d7p0.at.pnvrpr00remsnrX~Irys~,s
'"''"'0mm`mn~ ,.,va.~iscu,M+n.,,♦tn,
sovu waNiar, eowemor
'Li ate 0ti, 2U 120 t 5 Dave ROB` lacy
LST ID No. 1316956
AVID ITNT7
=II ;VT AFFAIRS Di?I'F INFILTRATOP. SYSTP_.MS IN,
iJS(i{F`:~ Phk!: 121I P:I f:0 1A 76
k
_ Identification Numhms
I i ivrtswifts LD No. 25.14224
Sitt 1U No.
',esc'phen_ >(-ACI IING t;-ANVHL•-, Please refer to both identification nuzi*Km
iVlarufar:turer. INFit. fHATOR SYSTFMS INC. above. in all corrccPrlndrnce with the aptCM
Product Name: QUICK4 PLUS ST ANDARD, QUICK4 PLUS STANDARD LOW PROFILE (LP)
LEACHING CHAMBERS AND END CAPS (trans. id 2534224)
Model Nurn1wr(s)_ QUICK4 PLUS STANDARD (INCLUDING QUICK4 PLUS ALL-IN-ONE 12 ENDCAP
WI rH TOP, END, OR SIDE PIPE INLET CONNECTIONS USED SINGLY OR IN
PAIRS AT ENDS OF CHAMBER LINE, OR AS A MID-CHAMBER LINE
CONNECTOR) AND QUICK4 PLUS STANDARD LOW PROFILE (LP), (INCLUDING
QUICK4 PLUS 8 ENDCAP WfTH FND 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 USED SINGLY OR IN
PAIRS AT rNDS OF CHAMF3FR LINE, OR AS MID-CHAMBER LINE
CONNECTOR)
QUICK 4 PLUS STANDARD, DIMLNSIONS. $3.0 IN L. X 34.0 IN. W X 12.0 IN H.
MAX. DEPTH OF BURY- 8 ft.
)EISA for chambers with or wtlt to fabric = 20.0 sq ft./chamber, EISA for Quick4
Pkrs AN-in-One 12 Endcap installed at the eras of a chamber row = 2.6 s% f fend
cap, EISA for OAuick4 Plus All-in-One 12 Fndcap installed 'a1-line within a chamber
row 3.6 sq. (bend cap; Laying length of chamber - 4.0 fl., Laying length d Quick,$
Pius AN-in-One 12 Endcap installed at the end of a chamber row , 1.5 f1., Laying
length of Quidc4 Pitts AN-in-One 12 Endcap installed 0.9 R, OUICK4 Plus Standard Open Bottoom area . 9.72 .n-~. ft Jch a chamber row =
Plus Awls-One 12 chamber r bee, tom a
Fsdcap installed at the and of a cFtamber row ow Open Bottom area
- 3.1 eq. ft./end cap. Ouidc4 Plus AFn•Orle 12 Endcap Installed in-line within a
chamber row Open Bottom area 2.2 sq. ftJend cap; SEE ALSO ATTACHMENTS.
QUICK 4 PLUS STANDARD LOW PROFII F (I P), DIMENSIONS: 52.0 IN L X 34.0
tN- W X 8.0 IN H; MAX. DEPTH OF BURY= 8 IL
(EISA for chwnhArs with or without fabric - 20.0 sq. ItJcharnber; VISA tot Qulcke
I'lus Wei-One 8 Enecap vistaiii at the end of a chamber row - 23 sq. ft./and cap;
EISA for Qurde4 I'lus All-in-One 8 Endcap Installed In-line within a chamber row -
2.0 sq. 11 /end cap, EISA for Quick4 Plus 8 Endcap installed at the end of a chamber
row - 0.7 sq. ttJera cap; Laying length of chambers - 4.0 N.; Laying kwigth of
Quick4 Plus AN-in One 8 Endcap installed at the end of a chamber row _ 1.1 ft.;
Layig length of Quick4 Plus AN-in-One 8 Endcap installed in-line within a chamber
row _ 0.9 R; Laying length of Ouick4 Plus 8 Endcap installed at the end of a
chamber row = 0.4 ft.; Quick4 Pkrs Standard Low Profile Open Bottom area = 9.77
sq. itJcharrlber: Qtidc4 Pius AN in-One 8 Endrap installed at the era of a chamber
r
aw Opern Bottom area = 1.4 sq. fUend cap; Ou1ck 4 Plus AIF-in•One 8 Eracap
installed
4 P E Ante within a chamber row Open Bottom Area = 1.2 sq. ftJoM cap; Quick
recap installed at the and of a chamber row Qpon Bottom Area = 0.4 sq.
tIJetld cap SEF ALSO ATTACHMENTS]
Producl File No: 20150111
I hr. specdrealions andror plans lor this ixunitxrg product have been reviewed and deiam,," d to bra in
co,nTA,dnoc will, chapters bp.5 M2 through 394, Wisconsin Admrnistrahve Cade, and Chapters 145 and 160,
Wisconsin Statuleti.
the Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin
Ac4ninisti alive Code. This approval Is valid until the end of May 2020.
This approval supersedes the approval issued on f IM 112014 under product rile number 20120137.
This approval is contingent upon compliance with the following stipulation(s)
• This product must be installed in accordance with tee manufacturer's printed instructions, product
approval, and plan approval. If Owe Is a conflict between the manufacturer's instrmtions and the product
approval andfor plan approval, the product approval ancilor plan approval will take precedence.
• When this Woduct is installed in a dispersal cell that is sized based on the EISA rating stated in the
regarding block of the product approval letter, this product mist recoive wastewater having a BODY value
less than w equal to 2?0 o9/L- a TSS value less than ur equal to 150 mglL and a FOG value less than or
inlual to 30 mg/L on a monthly average.
• When this produv:t is installed to a distribution cell that is sized based on the LISA rating stated in the
regarding block of Itm product approval letter, this product must be installed in individual excavations that
create a row of chambers that are horizontally separated from other rows in other excavations by at least
3 loel. The 3-toot measurement is measured between the closest outside edges of the leaching
chambers.
• When this product is installed in a distribution co* that is sized based on the EISA rating stated in the
regarding block of the product approval fatter, the distribution cell design must allow at least six Incites of
ponding in the chambers without badctow of wastewater into the drainpipe that dachargesa into the
chambers.
• When this product is installed in a distribuliun cell that is sized based on the EISA rating slated in the
regarding block of the product approval letter, this product must be installed in a distribution system,
which has the top of the distribution cell at or below orlginal grade,
• When this product is instated with geotextile fabric on the sides of this product in a distribution cat that is
stied based on the EISA rating stated in the regarding !Mock of the product approval letter, the EISA
rating with fabric must be used to size the system.
• When this product is instated next to each other in a c&stribution cell that is NOT sized based on the EISA
rating stated in the regarding block of the product approval letter, the effluent distribution area is equal to
ft Length limes the width of the chambered area. The use of geotexibe fabric in this type of installation
is optional-
• When this product is installed with geotextte fabric on the sides of ills product in a distribution cot that is
sized based on the EISA rating stated in the regarding block of the product approval letter, the geotextife
fabric must meet at of the following specificatiwrs:
. Geotaxtile shall be non-woven
. Weight shat be 0.35 oz/sq yd to 1.5 oz/sq yd
Apparent opening size (AOS) shat be 20-30 U.S. Sieve (ASTM L')-4751).
• For mound designs, seethe manufacturer's propriety mound component manual for this product true.
• For mound designs, see the manufackuer'a propriety mound component manual for this product Ono.
it
the e*atirt+cnl is u] no wa} erxiorstna) this prtyJucl er „y advertising, and s r~ t re_cPaz;ib!e lur any situation
:Al CI1 r I, US:-
R']Fr OI,I
Glar .lone Y;,S.
POWTS Product Reviewer
phone: (608) 267-5265
f+,x- (608) 267-9723
ern-A: 9W.ioms@vW.gov
DSPS Is committed to service excellence. Visit our survey at:
~.,nv,v_ rurve,~n nnkey.rt,oils, ii sw,iscust^m2rss:i fep,tiaa
Hyo WOCU-5 Hib- KID
qa, E 566.85
Ng2-33.mJ , mow
,az!Z C" _ - 10 1 11.51 ACRE
a - \ 1.60 ACRES y 659963 80.
N1 \ \69,563 SO. FTi 1
~ X11 \ 1 1
wl \ 1 $1
- -
\I 1.69 ACRES
73,717 60. FT.\ ,h\\ 1 i
i
day/ /
\ 1. 6 AC ES r
80.9 0. FT.
,A~ \ \
9x0.6
\ \ 1.87 ACRES \ \ / /
881,450 60. FT. 1
\ \ 1 2.00 ACRES
. \ I l 1 87,083 SO. FT.
+a c \ o t~ ~20 DRAINAGE
1.95 ACRES ` g $ EASEMENT
\\85.133 SO. FT. 1 $ i 13
\ 1 I 2.00 ACRE
\ \ ! ) )
)9ACRES 87,027 SO.
Al 60. FT.
AGE EJS~%EM
~ , • ~_a2/ ~ ~ ryO _
ST. CROW COUNTY
SEPTIC'rANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
(hvnrr!Ruy'cr ~C ~ hv. _~~~L--~t-y~ v~1 c;-f-P~ _
Mailing Address
Property 1 1d r~. a f1i tti1t
(Veril ication required from Planning & Zoning Department for new construction.)
ity Srtte 1 ~1~ ! C • ti' l Parcel Identification Numher ZVI- -/I'-
LEGAL DESCRIPTION
Property Location See. 17 . T 216 N R r W. Town of
S,IhdivisionPlat: T-Ko`( Vium-) 0gC-_C1
_ Lo[ti ~S
Certified Survey Map # Volume - Page #
Narranty Deed 4 (beibre 2007)Volumc Page #
Spec house❑yestAinl Lot lines identifiable 'yes❑no
SFS1EM MAIN I ENANCE AND OWNER CERTIFICATION
Improper use and mamlcnance of your septic sy>lcm could Iesuh in its picnntlure failure to handle wastes. Proper
;I nGlCnance CouN 45 of pumping out the septic lank evcr,Y three yens or sooner, it needed, by a licensed pumper- What you put into
thr %sucto can affect the function of the septic tank as a treatment stage oI the waste disposal satern. Owner maintenance
Ic sponsibilihcs are specified in §SPS 383.52111 and In Chapter 12 - St. C'reux County Sanitary Ordinance.
The property oxvnet agrees to submit to St. Croix County PLmning & /oning Department a certification form, signed by the
owner and by a master plumber, journcyman plumber, rest ictcd plumber It a licensed pumper verifying that ( I ) the on-site
sk;nfe•w:ner disposal system Is in proper operating condition and'or (2) after inspection and pumping (if necessary), the septic lank is
less than 1!3 full of'sludge.
Uwe, 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 Salely And Prolesmonal Services and the Department of Natural Resources,
Stale or Wisconsin Ceni fical ion slating lint Your septic system has been mai otained must he completed and returned to the St. Croix
Comity Planning & /oning Department within 3o days of the three year expir;Ifi(in date.
Uwe certify that all statements on t s form are true to the best of myr our knowledge. I; "cant are the ownerls) of the
property described aboxc, by virnic of a w' panty deed recorded in Register of Deal: Ofliec.
Number of bedroom``s /
SIGNATURE OF APPLICANT(S) DATE
-**Any information that is misrepresented may result m the sanitary permit being rcvokcd by lire planning & Zoning Department.
Include with this application a recorded warranty decd Wont the Register of Deeds Office and a copy of the certified survey map if
reference a made in the warranty deal.
(REV. (W712)
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR U'T'ILIZATION 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) 1 CK0 cus N, « RO,H L>
located
_qib at: _ ! Section i7Town ~2S N, Range 11f W,
Town of -rAcy _ , 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
Did flow back occur from absorption system? Yes No
(if no, skip next line.)
Approximate volume or length of time: _ gallons minutes
Tank Capacity:
Construction: Prefab Concrete 12SZ, Steel Other
Manufacturer (if known): Age of Tank (if known):
Permit number (if known)
KoTff
(Licen cd PI er Signa re) (Print Name)
LLA.M zzLrc-3~
S
(Tit e) (License Number) KV/MPRS
!U'
(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
/ WiSCOOMDeNnimentofCommerce PRIVATE SEWAGE SYSTEM County. St. Croix
Sably and Building Division
INSPECTION REPORT Sanitary Permit NO: 453260 0
GENERAL INFORMATION (ATTAdHTO PERMIT) SwisPlan roNo:
Personal information you provide may be used for secondary purposes (Privacy Law• x.15,04 It Km)}.
Permit Holders Name: City Veep X Township Parcel Tax No:
Da Farm Investors Troy Township 040-1269-70-000
CST BM F lei Insp. BM Elev: BM De Lion' SatioNrowNRangaaAap No
q). 3 . 3 / Ya1 Z- rWI~ 17.26.19.1464
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchm Z/rI„I_ 2- L~ , I tool • - 3
Dosing AR. BM ~n y 9G • 59
ABldgSewer Ilnlel 7
9 -30
TANK SETBACK INFORMATION SUHI Outlet . `fy L71
~
TANK TO PIL WELL BLDG. Vom to A,r Intake ROAD Dl Inlet f-
Of Bottom
Septic 7 tJ
r'
Dosing Header/Man. la 7
Aeration Dist Pip
13.3
Holding - r Bot. System IS , t 1
T 6 /
Final Grade
PUMP/SIPHON INFORMATION dS Z• 3 3 5~
Manufacturer fh emand St Cover L/ G
GPM Yl s T 3 1 `
Model Number
TOH LIK FrIL-ti s Head TDH Ft
Forcemain eno Dia. Dist. to Well -
SOIL ABSORPTION SYSTEM j Z?• Z-
BEDRRENCH Width Length No Treh PR DIMENSIONS No. Of Pits Insido De. Ligvd Depth
DIMENSIONS f Lf L/ I'll
SETBACK SYSTEM TO / P/L WELL LAKE/STREAM ACHING Ma r/ P
INFORMATION NAMBER OR /
T Of Syalpm "r , 3D l~ UN Modul Number
DISTRIBUTION SYSTEM i1 K" ,20a 64AM,~W~ Head EM,dn Digtdiwtion / x Hob Size x Hole Spaong Vent b Ar Inrekg - r
I / 3b IJ.t.
b V Pipe(s) 3
kff7~A a---
Length_ -Da _ Lengm_ cis- -Y_ SPaa~_-- ~J
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx SeededtSodded for M ld ed
SedRrench Center BtWrrcrx:h Edges Topsoil Yes lai No L; Yes (af No
i COMMENTS: (Include cafe discrepancies, persons present, etc.) Inspection rYi: 3 I l3 _I!~ Inspection
l?5T1t
I Location: 440 Crocus Hill Rd Unknown (Unknown 17 T28N R19w) Tro y/~'wod Lot 8 Parcel No: 17.28.19.1434
1.) Alt 8M Description = ST . a ~,JJ{ A-1, ~d 4- W/
2.) Bldg sourer length = /2. v CGLl,Q ~2p'L(~'..ft L'CY/ trDC'-dam -Z.
amount of cover , . Sys ~~Ucl7 ~C"~ r ~6C~f f(w u ~ ?c7 ,
36
Plan revision Required? Yes i No
Use other side for additional information. I
Dete Insepclo/s tuts - Cert. No.
S6D$7101R.3197)
i-;
k- ~y
57 - °?C% j
nrl•, 1+~., sees 'I~ ~N
5OI L EVRT 1 4
r pQ ~nt'~p Page of
l O M azffdW -
ante wihh SPS 383- Wis. Adm. Code
County ST CKOfX
iV:ad~ cmnplete site plan on paper not less than 81/2 x 111 inches in size. Plan must
9,14ide. but not limited to, veritcal and hpnz6ntm're(erenc point (BM). direction and Parcel I.D. 040 - 1269 - 70 - 0(H)
I~ercent slope, scale or-dimrsh~ohs•.na ~ah~i~d16G8pon and distance to nearest road.
Please print aff information. Reweave y Date
ersona! Infoime!ion you P'Cvide maybe used for wwwary pugwsos (Pnvacv taw, s. 15 a4 (1) (m)).
F , r,, erty Owner Property Location ❑
STEVEN & PAMELA STO'I':M SISTER Govt, Lot 114 SN' 114 S f T 2R N R I9 E (or) W
Property Owner's Mailing Address Lot it Block S Sued, Name Ma
440 C(UCUS Hill Road 8 Trdy Wood 040-01
Ciry Stale Zip Code Phone Number iry ❑ Village I-ITown Nearest Road
I ludson. NI 51016 ( 719) 531 -3036 Crocus Ilill Road
❑ New Construction UseQ Residential I Number of bedrooms 4 Code derived design Sow rate 60O GPD
Replacement ❑ Public or commercial - Describe:
Parent material silty alluvium _ Flood Plain elevator, if applicable NA- ft.
General comments
nd recommendations. New, test rcyuired as there is no room tFuni the original test due to location of dwelling and sysictn. Conventional
a
In-ground trenches 0.6 loading rate system cl at .0011.
Boring
Boring X O
Pit Ground surface elev- 101.72 ft. Depth to limiting factor 64 in.
Sod Applicabon Rate
Honzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD,'lf
in. Munsell Qu. Sz, Cont. Color Gr. Sz, Sh. •EH01 'Ef(R2
1 0-5 10YR212 1 2',.
f.bk nil cs 2c t.f 0.6 0.8
2 5-12 I0YR3r:3 Is (Isg ad cs 2%,f-m 0.7 1.6
3 12-48 IOYRZ~ I I 2fabk mvfi 0.8
es Ivf•f Q6
48-64 IOYR3!3 A Ifsbk mvfr as 0.4 0.7
5 64-68 I0YR3i3 minuvR4:r, sl Om mfr 0.2 0.6
1 /1
it
BoringO El Boring 101 62 13' fit
❑ pit Ground surface elev. ft- Depth to limiting factor in.
Soil Application Rate
Horizon Depth Deminent Color Redox Description Texture Structure Consistence Boundary Roots GPD/R
in. Munsol1 Ou- Sz Cont. Color Gr. Sz SIN •Eft11 'Eff62
1 0-8 I0YK2r'2 - I Ifsbk ml 0.4 0.6
2 8-14 IOYR3r'2 - Is Ilsg n11 0.7 5.6
3 14-50 IOYRI-11 1 2fabk mvfr 0.6 0.8
4 90-62 I0Y'R33 - sl Ifsbk mvfr OA 0.7
5 63- n
(A 10YR3i3 mid10YR4:MIONtir,sl 0111
it 0... O.G
Effluent 01 = BOD, > 30 < 220 mg(L and TSS >30 < 1 nxltL • Effluent rig - BOD 130 mg(L and TSS < 30 mg/L
CST Name (Please Print) Si r CST Number
MARY JO IIUPPLRT Hollister's Soil Testin &Design) 114831
Address - Date EvakiAb6n Conducted Telephone Number
28497 King Arthur's Court, Danbury, Wi 54830 10 - 03. 2018 715-426-1775
tiBU ~ i an ! Ki r(;' l i!
-"'ropeny Crvner - Pa:cee lP# Pays ul
El Borin # Boring
g Pit Ground surface elev. I02'57 fl. Depth to limiting factor 60 in.
Sal Appitizibon Rate
Horizon Depth Dominant Color Redox Description Textue Structure Consistence Boundary Roots GPD/fI`
in. Munsell Qu. Si. Cont. Color Gr. Sz. Sh. 'Ef1#1 -E-W2
1 0-10 10YR2r2 1 2fsbk nn•fr 0.6 O.8
2 10-55 10YR2, 1 1 2fabk m%di 0.6 0.8
3 55.60 IOYR3r6 sl Ifsbk mvfr 0.4 0.7
d 60-(A IOYR3i3 in Id I ON R416R. IOYR6+1 s1 Om mfi 02 0.6
i
r
41-
Boring# I_1 Boring /1
Pit Ground surface elev. ft. Depvtn to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Descnption Texture Structure Consistence Boundary Rooms GPDlfF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sid. •Eff#I 'Eff#2
11
J
I Boring # H Boring
Pit Ground surface elev. ft Depth to limiting factor in.
L._1 Soil Application Rai,'.
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
m. Munsell Qu. Sz. Conl. Color Gr. Sz. Sh. 'Elf#I 'Elf#2
i
i
i
' Effluent #1 = BOD. > 30 < 720 mg+L and TSS >30 < 150 mg!L ' Enuent #2 = OOD 30 mg~'_ and 1SS 30 mgL
y4 t
e „s-• ~e
r °
-11 OP, .
o
~ 1 i ~ 0 1 0 ~~x
1. co
1
CO n
J 4 ti x
,~.T V ' _ 7f
I.. L • H
y N a
i' 4 y-Vn: C 4 <
iLLA
e~ x x
-N, A
~t x x $
~.ti r+l-,~ t~sbr '7 '~1`~~• n ~ ' e~ ~ at F n i Z = $g~ a
y5 rN O
/ i <g N S U
Plot Plan paw z of
+ +
PROPERTY OWNER :5FEQPJ -PAPjN(;4* Sip7'MG1SZ-Lg 1' = 40 FT.
/ (ewept wheem noted)
legal oesmvtion-_La1" fxoY woof-~, I,t r I7 TysiJ R 91~~ A~you'repit
ID" DE 19LV ST CRQUK 40 WI1TY4 W\.5CbN SU9
N40 Caocus ~e~ ~n ~.SbO ~M~
~L__ / oqo-)~-7o-Lb0
North
f
SJ o
~ 99
rN
\ 63 rj2 <4W
1 ~ r
t~~Z+ Q 51- ~~_'95rM
lo~ _ YD `lt__ t~ a~~t-IE
i
i ok,7r+N~.:fa+c 7
~}ssuM~ /cb.0o
QiM> 1DP ~ PFT+~ ptpeKS ~ oor`r
FIRF ,
p+f
Site location:
Qo1 s;
19
}1 !J~( \R
GR~eaSHl~~ ~~~i
I