HomeMy WebLinkAbout020-1374-02-000 (4)
%Vsspr•s n Dena-,en: c' Cc^n•erce PRIVATE SEWAGE SYSTEM want'. St. Croix
Safer-, and B..nn n9 9 pr
INSPECTION REPORT San Lary Permit No
GENERAL INFORMATION (ATTACH TO PERMIT) Stale Plan ID No 606918
PersCna nrc.nraavr you P12oce may Ce sec Ior secerdrf purroses:Pn.'act' Lase, s.1 f :d r; I:imp1
Pe•ml: Hc.de' t 41^'e City Village Tc•n-shin Parcel Tax Nc
Curtis & Julie Ann Schmidt TOWN OF HUDSON 020-1374-02-000
'aT RM i e> Insp 81.1 Eiev Bt: cesunpt 7r' OJ So_fe
n~ Lowr'rRany urtJ ap Nn,
y , z ~ ¢-a L 4 ~ 12.29.20.2235
TANK INFORMATION ELEVATION DATA
TYPE ` MANU'FAC IURFRI CAPACITY STATION BS
(-rHI' FS E LEV.
Sept,- El(1 iJ~ ti 1A/r ~/t. !<~SV` Qenc'1 rk re- 604 IUI''J"_A) / p!, zG
DtDei•Nl- F, Ir At 11 - ,t Co 85 /GS, 3
Aeration 6-a. Sewer
Iloldr,g SaH:lrlet 4
TANK SETBACK INFORMATION FtrlI:Ou:et
99.29
IANK 10 i•iL WELL BLDG. re^1:Clm ',n:a.e ROAD DtInlet
rr /I S eke"
Sup: c tO V -76 7 I D! Bo:ICrn
' I qag w
Aerali; r D St. Pipe SX145
/ •iom r9
Bat S'stFinal Grade
PUMP/SIPHON INFORMATION Demanc SI Cover
PAm:el NuTDH Friction Loss SysTDH Ft Fofcen'ain D si I... oVe - _
SOIL ABSORPTION SYSTEM
BED!TRLNCH WJI~ IF _enet' No. Of -'erv_res PI I UIM~NSIONS No Pis inwdv Dia Uzue Dep:lt
DIMENSIONS 3 y 1
SETBACK SYSTFP41 TO 7D PAL BLDG WFLL LAKE+STRFAPA LEACHING Iearu`acu n /t 1
INFORMATION CHAMBER OR 1 tT
Ty c CI Sys:
y UNIT h•ocel N c'
27 '-.7166 1
DISTRIBUTION SYSTEM 4, r4 141 xo0A&,,- CA)oI
leace::FAan fop T l;Swit:,Ior Hole °ve x Hn e Spacing '•"..I :c Air Intake /
_enyrn5 D a le^~pt0 Pe"I'll ~ Ce nLc,~
_ Did_ Scanr~
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
, , to COer DEp:h Ovor zx Depth r, Ax Seedel'Sccded rx rvL lchcd
Doc'I vm:r cw'V N Z Bec T'errr Eaves lug, ,it
COMMENTS: ,I•cluaecode dis-repences.persons presei: etc; Inspection I Inspection #7
Location: '88 STARR,;vCO~DD J O
I.j AL Bf•.1 Descr poec= F;Iwo wJ~/~' 1
2 i Bldg sewer lerg!h = ; b~~ / _ ^ r G~a: y S /ti L• To
-amcurt of cover= GaJ~-
Plan revision Required? Yes > Jo ~d fg I?` j•{ r,8 72,
Use omer side lo, addi: ona infern•ation.
Ce-t No
SBP6'taiRJ+~') Date Irsrp_: Sig- a:,
-1
V.
Industry Scrvisxs Ihvisem
sa~6Ave :5-,
t\=I i• 1400EW
P.O. Box k~IX
; - 03 tip~~ \ Madison, W153707-7162 Nuut-Y Feam't Nmrhe (m be 61bd in by Cn)
anitaty it Application `-,Ta~aoan
fn necardanoe wit A SPS 393 21(2). W j, Adw Code aibar"Sperma im of roa form to the aLtpropstee util ~A'
is rcquiad prior b obmnbg ainuAmy. Nor Appicmon forms for 0e6eow~ PO ore awhmioed be the lkpethtrntl of Safrfy and PYpfessrmW Causes Paaooa) f" Mm Yoe Pte' be used As
mooo7aly Project Addles (\ddilfamn the smiling addrm)
u in ocmdga* VJO Mc Law, l I5. 1 m 51m f~ / ~ In 6&ff
1. Appgeaeie lafirtaafioe _ Plox Prhe M la6areeha UitAtE In G,~~((
Property OwneF S Name
U!, r 1 s Patcd 9
Cr. t' JuuENAI ScHtitlt)i ~)zG -l5 `1-C~-y
property Ownv'a Mailer to
Addres
6'1~ rropen''laaboo ,•a.aY. ~c. aa3
CM. Stem Zip Code N Govtla -
h{uI1°>UI~' i.i Saxon )Z
IL Type a omming (ek«k an shore apply) LAN T L`1 N; )t 7`,dc:t
Iar2 Pami7y Dwdtirtg-Nuerba MRedroa(/n/~+ srrodiviiion Name
o POMMUC"nsoo mod - De o LAa Bmdl a - STAR!'. U,10t D
❑ Stwe Owned - Dacabe IWS~Y~~~AA esm Nup6a
❑
_ O village of _
}!•y}/ Town of_-J LAW-5 :v f
IIL TyPe et Pere: (Creek oaay he, sa lie A. C~pleee the B ilappl(earie)
A. ❑ Now Sy k-, RoplOeraterl S
ypen TromrarUFiodinB Tard Replmtem GdY ❑ Oroer a4adifiolim to Fs'ym6 Sys, (eWlyo)
g• ❑ Pined Reavrnl ❑ F.Mit Revos O Clonga of Plumb. ❑ Penn., 7lmafR b Nar t d L+c^'146 A e Numha and D're tined
Before Expiration
t'i,rrra
rv. (cc creek ag tree ! r~ l l ! /
-
pYemffmd hfcLra,.ad ❑ A"kade ❑ Mm W > 7A i ofaaahk 3W ❑ Magid < 2A m, of.A*k
T-k Oros Damp" W Camponaa (eap4it _ O Rehemm Oevim (r,~lem) ~it ! N
V. Am Iebraaatisa- -
Deep Flop (Bpd) Design Sad Applkabim f) Depead Am Regded (sf) D"pema Area Psoplaaed (aq Syseom Lhvattiorr
&Iov C, 11 VL Teak ids o min 7~• /S
Tend rd yCkffa
Gdlmn Ilnis g 9
Ne~TavYa Farina Taub P't 9
G.o (//I f~ p/yam E
s St II Nay et..a T/ Os.r✓ V :n x O y
VIL 9hteaeaa- 4Ae s.~
Plumber's Name (PM) kaftned" or ow PONTS Awry M at sawbee pea '
r Plum ' Sr a Ill7MpR5 Nundw &Mom Pane Nanber
(1 6 S r
M Addrasa (SUae, cay, sm~ ~ipimai 2Z46:37 :5'7z?-Zs
5
S E. Nl E!!/ ST CiF(~TJ 547z
Vil ltA
haro7IWQTl
Omc ix. con`
for Dmmppewd
As as per otar3yemeI. c cn w f uv plu 2. A9 aeRsank fKW"t ens m t ue . srt, _ >r Oaf S10cikfbh oxr l 'MI'1Aitctl.
Ar mrmvkaa etrslw~+7+~aM aeamunrwc~.,yewPerr>.naarn,ll l.a.. ;w.la
SHD-6399 (R. 09/I4)
Plot Plan Pte
PROPERTYOWNER: CicjZrls CJulcr.,ti,~ I°-- 40 FT.
(except where noted)
Legal Description: L& Z, STA1 ~UCC_ 1J NEtJy Or T}1EStti'/y~
P~
T2q A; > pfh
-I_~~ TotuA CF f+tiDSCti n 5t. C~olx truAT -
v k. ~ secH~ ~
Z, ~S»4CP
IS$ 5TAlZR DD ozp- f Z4 000
/ North
L ~
4w Ong ,ynr<T G- ~ L
R'
`N
y1
4 r
- `\NE
Site location:
1 14
In-Ground Gravity Plan PAGE 1 OF 4
Index & Cover Sheet
version 2 sea-10 (N.01)01, P- 12)
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
I
Attachments:
j Tn1F1th0r0R ACS POWTS Application for Review
Soil Evaluation Report & Site Ma
ScP7ic TAn rC fF e7L-AkeA7T
Ds~~
Project Name / Description
Owner Name(s): A IZTI S r Li E A vii'ti 11 I j Phone:
Owner Address: _ I S 5 ~T x wCcD { 1 ~i D°xri 1 Zjp. X2101(,
Project Address:
Govt Lot Nr 1/4 of svJ 1/4, Section-~
T Z Q
I N-R zL Eor W~
Township: - P u r-~,S(,,J County: 5T. C' RDrX
i
Project Parcel ID # P J C I S z0 - o z- c c,
Designer Information
i
Designer Name: Ar, LipV `b A, , wt ,*-r
Phone. 7i5 __I 175
Desl9nerAddress: Z8~197 Krnla rQreTHUrzs C+. llaua .psi TM zip• -5M50
E-Mail: h011ts rtes gn r~ vLJ 1 QoM
License Number. 185q - co 7 77ua s qt stamp
Remarks: MA do
R~
i dUPPCFrr .
D ion
t~IV+sR FAt.LSi,;i
Signature: -44(r G '~9iiM,H„u,~aw~w•F`
i
Date: 8"
I WOr•
!
i
Plot Plan Page 30 q
PROPERTY OWNER: C Lt12Tl5 C• J k LIE -AW SCI%m r I'
(except where rated)
Legal Description: L-4 Z, bTAKR V;COD, Al & j, OF 7H6 Swy±j 5EC IZ d _ =DKW&
= Prt r-r•na P?K'z vI
Txt~1~ RZDwF TOvt:a OF IfR Si' Cgoo( CtuxiT LL i%(M-S) 4.
1_-?TKR. WocP_~ozC-r3_G~-Qz-oG~--- Z. /55,4CP6~
North
i:.
qty} ,gin II ~ I
I- -
srrN6
C -
, (,~F to ! ~i,` .F-:
Site location:
I
l
C'uKn>f'-TduEAt~V ~'rvtInT rte: ~oFy
(,.,CUD
tx, )71'(l- ae
IN-GROUND GRAVITY DISPERSAL AREA ws'_
Uniform Elevation Trenches with Qtacc4 Standard-W Chambers SOWTetilalhbbnh2
3-ft Trench (downsizing credit) t L-x! _ ar _ ay _ I.
at 65
SOI. WWR 111Uk+e
P
~eVbW
' TYPICAL TRENCH
\ CROSS SECTION VIEW
(No Scale)
system FJevatlm '.l`~ x sepen•+krl ImrrJw-.
(typo--v)
OukkAt
SdnAarO-W
, FM (I.,
(Stow lo®ttrxt d /owlet pipe amtnectlm m plan view.) TYPICAL TRENCH
sret~
k.~.ps.a~f.kM PLAN VIEW
(No Scale)
r_-.-.~- -------~f----_
'II 'I1' IJ A=3A~
T
i PndO -u
m
B It
m
staridwo-wCmmeer w
IG (INSTALL PER TRENCH: K~ TO
W N... b..eq~lwfa Iimvubm,
? i' QNt4 SW-W Q 2e K EMAMwnbW - A
t' 7 Pairs of end raps Q6NF1SA0*- It,
= Pror>osed EISAyr lmrh = - 8 rk Repired 146aft Arr. 57,14 A' DLSWDudon Method:
?r trWdM = Proposed TOW EISA = v5 74 r
Lam' _`l ~ = U,7 ~ ,5':~% ly~q. zivU.Nl •NU•Ji RECi u(REi~
gSR/q~4.11 Z.C6lSt~u,urT> 4Zfi'L O/h ~Iy uN•T=
r -
(I) Lv IS NN<YSA c ~--L' 72 :11 ti, v,wf~
5
17
(11 ~X G C
fNRP012TAtd": In-ground Gravity Management Plan PAGE 4 OF 4
The owner of this in-ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to
requoniresidered ments ofaSPShuman382-384health, WisehazardAdffmnot nt, Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall
c maintained an accordance with this approved management piss.
FFurthemiore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in
accordance with SPS 383.52 (3), Wier, Admin. Code.
Maxi rtttt n Disoemel Area Oueratinn Utnks:
Design Flow= ✓
gpd; BODr 220 rngU'; TSS 5150 mgL-'; FOGS 30 mgL"'
Insgecti n Checklist INSPECT EVERY 3 YEARS
type of use
U age of system
nuisance factors (i.e. odors, user complaints, etc.)
mechanical malfunction (i.e., pumps, valves, switches, floats, etc.
material fatigue (i.e., leaks, breaks, corrosion, etc.) )
solids volume in anaerobic irestment tank(s) and any distribution appurtenance(s) (i.e., distribution /drop boxes)
neglect Or improper use (i.e., exceeding design capacities,
prohibited bited activities, )
extent of ponding in distribution cep
dosing Irregularities - if applicable (i.e., pump pto dosing
electrical oom recycling, float switch settings, etc.)
Ponents - if applicable (i.e., wiring, connections, switches, controls, inters, alarms, etc.)
distribution lateral or lateral orifice plugging (measure lateral distal pressure - con
cspecification)
surface discharge of effluent or sewage back-up into structure served pare to design
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o SFp and does tank(a) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis.
Stets. when the volume of solids in the tank(s) exceads one-third (1/3) the Nquld volume of the tank(s) or
as required by local ordnance. Disposal of contents strew be pursuant to NR 113. Wises Admin. Code.
Effluent filter(s) shall be inspected ovary 3 years and shall be cleaned when necessary to remove arty
accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12
months.
SPS 38 mm l WWII be Report to the proper local government unit In accordance wish
spat any component failure or malfunction to:
Name of IrWivklual or company: ,
Phone: _
Localgovemrnent unit _STC12D(K COMM.ttic Ci N7- Phone: _716- 3 510 -
Local gOVervoert tacit address: fa a USON tA,:
ZIP: S~1lJ---~--
Any defective part of this system shall be repaired, replaced, or removed Pursuant
Code. Repair or replacement of failed or malfunctioning components shall °Dfy SPS 3383, (1), Wier Admin. Wisc. Ad No product for chemical or physical restoration of the
POWTS Y he used unless with SIPS approved 3 by 83. the department he Code.
accordance with SPS 384, Wisc. Admin. Code.in
ConUPtan
Into event that any failed Ireatment 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 (aged in-ground dispersal
abandoned and replaced by a Code-complying dispersal component in a
W canpon may be
e-determirted area of suitable soils.
j"twn Abandons t
If use of this POWTS is discontinued, it shall be abandoned In accordance with SPS 383.33, Wisc. Admin. i;
Wisconsin Department of Safety and Professional Services
Dnrisien of Industry Services
SOIL EVALUATION REPORT page I of
in accordance mth SPS 3a3, Wis. Adin. Cone
il. C"ROtff
Attach complete site pan on paper not less than R 1r2 x 11 inNl»s in size Man must County
include. but not hrmted to. vertmA and horizontal reference point (BM), direction and Parcel 10
percent slope,style or dimensions, north avow, and location and distance to nearest mad. 324-CL-CAL`
Please print all information. Rcvicwnd by Dfattt 2
Pciwrml inlurrnalbn ynu,xwddn may M e lw secondary iu,w:e: (P .v y Law, z. 15. N4 1) (m)). ' V I
Pmpeny Dwne.r Property Location ❑
n
-1 1 S ° jkl l E ~1 y~1 --x4i(1 - G cwt Lot Attica . vn s 1 T 2-17 R ul E (or) W
Property Owner's Mailing Address Lot # Block # Sutxl- Name or CSM#
L :/fAaR lcn:GU
City state Zip LkW- Phone Nuinher ity Village • Town Newest Roac
HuDs<N, " ~YDib ( ) 74 uUtn1 '.A ARA LtitCb
New Construclion Use® Residential ! Number of badrooms _ H Conn derived design Row rate &Cj) GPD
Replacement LJ Public or cortxnemial - Des, Mw:
Parent material Flood Plain elevation d applicable NA - it-
Ci ml axrxnernS ~yKp~/c +~rrr [:rVAL JN-G~f<t i,rND TIr:FJ.ILkIE-'+ - 0.7 L-12-
and rec»mmmdations.
A~oinc:vA~ Px1 uUc• Ct.vDvcT(D 7U A~brE IZSI-i..FMAAJEN' A~
tt.t CF l,J'itEf2Wh`J/HICTH ls7i4'f Ef= (~INt
Boring # Bering
Pit Gnx,nd surface dev- It Depth to limiting factor y in.
Soil Application Rate
Horizon Depth Dominant Color Red it Desrrpum Texture Structure Consistence Boundary Roots GPD#F
in. Munsell Du. Sz. Cont Cob( _ Gr. Sz. Sh, 'E##1 'Eff#2
0- 4 111 Ylc -3/3 _ e 5q 11 _ 0.7 /.(o /
Z• zL, lC iC y q/ S - 0.7 /6
J
Nc.rfy~ z hiA-; xms 'r:
Bo ng # Sonny
1E Pd Gnwnd surface elev- _ I! Depth to limiting factor in
Sal rralxxl Rate
l lonzon Depth Donetant Color Redox Description T'exlure Structure Consisterlw BounoLVy Ronls GPD#e
in Munsell Qu S/ Conl Color Gr Sz. Sh. 'Eff#1 'ER#2
Effluent #1 = BOD > 30 _ 210 nxyt arxt TSS >30 < 150 mWL r ' Effluent #2 = BOD < 30 axyl. arid TSS < 30 mql.
(ST Name (Please Pont) CST Writ"
MARY JOIIl1PP6RT(I lollislersSoil'I'cslinlt&D~sipn) ~{C _ 'N 224X12
A, mss Date Evalualio Waned Telephone Number
int -!1i-326-1775
1 1444
Jp~ I+asl y~f q {6
1.2 t6
1 11s~ lr ti
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Plot Plan Page akof 5
PROPERTY OWNER: 14f2r is e Jul(E -\(,l~ SCJJAIi )T 1" 40 FT.
(except where noted)
I Ul;dl Description: , h1- 0 Y~ rzINC-
Lot Z, Si:atCR ln)COD, Nc y Cr SEA rHESw , IL, v
1
TO," CF "gb5ca ST CFwj, ccu~Tyl w~5cc s
I -
-~5 _ rT•4kk. I t _D o2C -_~-3G'~-Cz-L'C[' - - 2. /S5ACfZES
North
,
,
,
tf..
r+, .
rr;IT
'3
,f?U4 L~~' 'Gp ~F pp~1C6; y 'rC~
VC - W,
' f..-v''i1Pr- vl.P a=lil
~ J aryR
Site location:
i
Quick4.
IN F i LT R ATO R' The Quick4 Pius
Standard r'hamber
QUIM Plus, Series
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, r r
it offers advanced contouring m
capability with its Contour Swivel
Connection- which permits turns 4
Y',p
up to 15 degrees, right or left. It is t y}.1 - -
! also available in four-foot lengths to y, -
Provide optimal installation flexibility.
~
The Quick4 Plus All-in-One 12 ul e:; : Benefits:
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 configurations. Latching mechanism allows for quick installation
Four-foot chamber lengths are easy to handle and install
Supports wheel loads of 16,000 Ibs/axle with 12" of cover
fraxlmum Stri ngzil
a
74 Quick4 Plus =r!jca F: uuick4 Pius Ail-in-One Periscope
x 53"L x 12"H Benefits: Benefits:
m x 1346 mm x 305 mm)
May be used at the end of chamber - Allows for raised invert installations
Effective Length row for an inlet/outlet 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
8" (203 m1n) center feed, as an alternative to
inletting at the ends of chamber rows
Storage Capacity Center feed connection allows for
47 gal (118 Q easy installation of serial distribution
systems
Invert Heigh Certified by the International
0.6" (15 mm), 5-3" (135 mm), Pipe connection options include Amcciation of Plumbing
8.0" (203 mm), 12.7" (323 mm) sides, ends or top and Mechanical \
Officials (IAPMO)
APPpOYEOin
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262.90'
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90,avo SO FT
2. t 56 ACRES
84,957 SO FTC's s J
1.948 ACRES
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eO N ~•r1536 co
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lilt-
OUickd Plus Standard Charnber
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li It. ~~II illll~'~~I/~( 11'?~~11i!!91!~!
F1r@O,IVE LLHGOr
Ouick4 Plus All-in-One 12 Endcap
m2: dStailtEU ruv rural.
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41
DIVISION 4X INDUSTRY SERVICES
PO OOX 7162
MADISON WI 53707-7162
~S( \EP )-I Oorva[1Th'"hRetar
,Y~'` ` _ Ci Nplrtl9pa.M.pov/gpOramsarW~abY-Servicr_s
\'~~qq~~`_ _ NwM.Mt5oar151f1.~v
~~'Al1NA~%
swir Wskrer, Govan,"
May 3015 . Osvs Ross, seveh"
CU.ST 11) No. 1316956
DAVID I.EN'I'7
GOVT AFFAIRS DEPT INFILTRATOR SYSTEMS INC
4 BUSINESS PARK RD PO ROX 76R
OLD SAYBROOK CT Ory475
Iduadicadon Numben
Labovc, wUm tD Na 25}4224
He: Description: I FACHING CHAMBER ManUfacttXer INFILTRATOR SYSTEMS INC. in all comspn0drncc with the avers. .
Product Nam: QUICK4 PLUS' TANDARD, OUICK4 PLUS STANDARD LOW PROFILC (LP)
C CHAMBI-HS AND Modal Number(s). QUICK4 PLUS STANDARD (INC~LUO NG QUfCK4 PLUS ALLAN-ONE 12 ENDCAP
WITH 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 OUICK4 PLUS STANDARD LOW PROFILE (LP), (INCLUDING
QUICK4 Pl lIS 8 CNDCAP WITH END PIPE INLET CONNECTION USED SINGLY
OR IN PAIRS AT CNDS OF LINE: AND QUICK4 PLUS ALLAN-ONE 8 ENDCAP
WITH TOP, END, OR SIDE PIPE INLET CONNECTIONS USED SINGLY OR IN
PAIRS AT ENDS OF CHAMBER LINE, OR AS MID-CHAMBER LINE
CONNECTOR)
OUK:K 4 PLUS STANDARD, DIMLNSIONS: 53,0 IN L. X 34.0 IN. W X 12.0 IN H.
MAX. DEPTH OF BURY:. 8 fl.
(E)SA for chambers with or wtf1t0ut fabric n 20.0 sq- fl./chamber, PISA for Quick4
Plus AWin-One 12 Endcap Installed at the ends of a chamber row = 2,8 5% ffJend
cap, EISA for Quick4 Plus All in-One 12 Endcap Installed in-lino within a chamber
rew - 3.6 sq. ft./end cap; Laying length of chamber = 4.0 fl., Laying length of Qurck4
Plus All-in-One 12 Endcap installed at the end of a chamber row 1.5 ft., Laying
lorgh of Quick4 Plus All-in-One 12 Endcap )Installed in-kne within a chamber row
0.9 R., QUICK4 Plus Standard Open Bottom area - 9.72 sq. ft./chamber, Ouick4
Plus Alf-in-One 12 Endcap installed at the end of a chamber row
'1 1 sq. ft lend cap. Otick4 Plus All.-m-One 12 Endcao nstailarl Open Bottom area
chamber row Open Bottom area 22 s q- in-line within a
q- cap; SEE ALSO LSO ATTACH1hAENTS1,
QUICK 4 PLUS STANDARD LOW PROFILF (L P), DIMENSIONS: 52.0 IN L. X 34.0
IN. W X 8.0 IN H: MAX. DEPTH OF BURY= 8 It.
IEI,4A for chambers with m wierout fabric _ 20.0 sq. RJchamber; LISA for Qulck4
Pkis All-in-One 8 Fndcap installed at the end of a chamber row = 2 3 sq. lUend cap;
I-ISA for Quldc4 Plus Al-in-One 8 Endcap Installed in-line within a chamber row -
2 0 aq. filend cap; EISA for Otdde4 Plus 8 Endcap installed at the end of a chamber
row - 0.7 sq. flJend cap; laying length of chambers _ 4.0 fl.; Laying kmgth of
Quick4 Plus All-in-One 8 Endcap installed at the end of a chamber row 1.1 It.;
Laying length of Quick4 PIUS AII-Ih-One 8 Endcap installed in-line within a chamber
rrm _ 0.9 ft.; Laying length of Oulck4 Plus 8 Endcap installed at the end of a
Chamber row = 0.4 ft.; Ou6da4 Pkis Standard Lots Profile Cow Bottom area - 9.77
sq- ft /chamber, Uuick4 Plus All-in-One 8 Erdcap installed at the end of a chamt»r
row Open Bonorrl area = 1.4 sq. Vend cap: Ourck 4 Plus All-in-One 8 E.ndcap
;nstallM In line within a Chamber row Open Bottom Area = 1.2 sq. ftJend cap; Quick
4 Plus 8 Lndcap installed at the end of a chamber row Open 6oltari Aif:a = 0 4 5q
ft lend C:,p SEF AL cC AT T ACi~i! ~fn'7S1
Roducl Fii2 No: 20ta9111
-53 42Z4 vr,' r:..,
tic s;r cihcatlC~is -Indot plans lof this plumbing p+Oducl have been fev1ewe<9 anal detarmin?d In tm ei
comfAjoc(; with chapters bf'S 382 through 384, Wisconsin Administrative Code, and Chaptore 145 and 160.
Wisconsin Stalules
The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin
Administrative Code. This approval is veld until tlhe end of lofty 2020.
This approve) supersedes the approval issued on i ill 1/2014 under product fife number 20t20137.
This approval is contingent upon comptianca with the following stipulation(s)
• This product must be installed in accordance with the manufacturers printed instructions, product
approval, and plan approval M More is a conflict between the manufadurer's instructions and the product
approval and/of plan approval, the product approval artdlor plan approval will take precedence.
• When this product 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 must receive wastewater having a BOD5 value
less than or ecp.rat to 290 mg /L. d TSS valueless than or equal to 150 mg/L and a COG value Icss than or
ri(lual to 30 mglL On a monthly average.
• W non this proarrt is installed in a distribution coil that is sized based on the EISA rating stated in the
regarding block of the 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
z feet The 3-foot measurement is measured between the closest outside edges of the leaching
chambers
;When this product is installed in a distribution cep 0tal is sized based on the EISA rating stated in the
regarding block of the product approval fetter, the distribution coil design must allow at least six inches of
rrc.ndirwj in the chambers wtl ,o l backnow of wastewater into the drainpipe that r6sr:harges ir»n the
chambers.
'✓vhen 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, this product must be installed in a distribution system,
.vrich has the lop of the distribution cell at or below, original grade.
W bon this product is installed with gaotex de fabric on the sides of this product in a distribution cep that is
::-sized based on the EISA raing stated in the regarding block 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 distribution toll that is NOT slued based on the EISA
rang slated in the regarding block of the product approval letter, the effluent distribution area is equal to
the length times the width of the chambered area. The use of geotextife fabric in this type of installation
ophonal.
• ''Vhen this product is installed with geolexide fabric on the sides of this product in a distribution cell that Is
cued based on the EISA rating stated in the regarding block of the product approval letter, the gectextile
r,nbric must rreet rill of the following specifications:
GeotaxW shat be non-woven
Wool stall be 0.35 oz/sq yd to 1.5 oz/sq yd
Apparent opening size (AOS) shall be 20-30 U .S. Sieve (ASTM D-4751).
I or mound designs, see the manufacture('s pxrpriety mound component manual for this product line.
F.>r -:n,frki ssun:,. =.,a 1`e a~;;r,.;taciur~r'•; prurincty mound component manual for thus product 0e.
Z';34224 Onvu>U V1t r 'Srellp~s
Trle department is in no way endorsing this product or any adverosing, and ns not responsitye for any situation
tyhich may result from its use.
;rir~-rrl; i
I
Gle"t.JOncs, M.S.
^c W.!7S Prooucl Rbvicwor
phone: (606) 267-5265
fnx (608) 267-9723
email: glen4onest9yvi.gov
-hp DSPS Is committed to service excellence. Visit our survey at:
r.+w. survcym onkcy-camlsldspsiscustomer_slisfacR:r.,
2 ~ - A a A 5 6.
A
23
24
1A 'A; llf f 25 r 22 - _ 7i
rye:;.. . ~ - w
'J / r. ~
JI ` zl l
I
IT U
~V
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)~_,3 srn w c cz located
at: n;c._'/., _,o Section iz Town 2!1 N, Range zc~-_,-_W,
Town of NuUscti' 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 1L 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: LZ
Construction: Prel'ab Concrete ~C Steel Other
Manufacturer (if known): kj ,erg
Age of Tank (if known): - -
Permit number (if known) y -71
K&(M 14A.1,v-5
(L4cs ed'P /1%u r Signatu ) Print Name
(Title) (License Number) M PR
-
/D D~~ ,Zli/SS
(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. CROIX COUNTY
SF,PTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/RuAr - ( i. /;1l , j+ f
Mailing Address
Property Address l~
(Verification required from Marring & Zommg Department for new construction.)
City/State _ l l l~ n oc:: Parcel Identification Number C /C - 1 31 ( -OZ - DO (7
LEGAL DESCR ON
Property Location _NE Y- , stn y. Sec. I2-T 2--l N R 2U W, Town of Nr (Y~Cti
Subdivision Plat: TAhK LA-;,- L',::>
- Lot # Z
Certified Survey Map # Volume - Page #
Warranty Deed # 7 9C > 17 (before 2007)Volume 2.77C Page # 04--1-
Spec home IIye~0o Lot lines idmtifiablepfiesono
SYSTEM MAINTENANCE AND OWNFR (var Iu '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 rrwntenance
responsibilities an specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The Property owner agrees to submit to St Croix County Planning & T.onmg Department a certification fordo, signed by the
owner and by a master plumber, jo rmyman plumber. restricted plumber or a licensed pumper verifying that (1) the on-site
Iwastewater dissposalals~ is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic link is
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 Safety And Professional Services and the Department of Natural Rasou ces,
Sane of Wisconsin. Certification slating that your septic system has been maintained must be coCounty planning & 7 mpicied and reburied to the St Croix
oning Department within 30 days of the three year expiration date.
Uwe certify that all staterrrnts this m are true to the bast of
1/vte arn/ero the owner(s) of the
paperty described above, my/our
w<, by virtu~e/of aon y dead recorded in Register of f Deeds ()Rice.
Office.
Numb,7of bedroom
SIGNATURL• F APPLICANT(S) DATE
-L
^'My infi - nation that is
misrepresented may umdt in the sanilary Permit being revoked by the Planning & Zoning Dryarlmeat
Include with reference ethise application warranty ~ty deed
warranty deed fain We Pepstri of Decals Office and a copy of the certified survey map if in the
(RLV- M/12)
PRIVATE SEWAGE SYSTEM Cro z
INSPECTION REPORT ',"!;n P.,l NO
479261 0
GENERAL INFORMATION (ATTACH 70 PERMIT) Safe Plan rO No
:'e: cnal mfermala- Y-'u press de may o^_ r> sexnda~ purposes ;Pnv,n La,,. s , 5 ^r tom;;
P.y,rn Hdders Narne P!y Wlagc X TQ nSlvp Parcel Taz No
i udwiPeter Hudson, Town of 020-1374-02-000
11 T pM E er rasp 0%1 Eler 01A Desrnphon SeceoNioon'Ra W&P No
/60 1 ^J yy\ GST 12.29.20.2235
TANK INFORMATION ELEVATION DATA
! TYPE I.IANUFACTURER CAPACITY STATION BS HI FS ELEV.
SCpUt 1
(A.) i e4,,( ~ Benchmark y. 77 A W-77
/Qp
~L IC /mod Alt. BM o jb!5, 77
-Aeration Bldg Sewer
q.VT /DD, f 3!
Holding SVHt Inlet
~oZ
IS 97.
TANK SETBACK INFORMATION SVHt Outlet
s, yg `j1p~, 29
-ANK TO P4 WFLL BLDG. Vent fo A, iMa,n ROAD Dt Inlet
.;cyLC I _~r 7 5Z)` DI Botts„
'posing lU Header/Man
- (o• S 9S,sz
Aeration Usl. Rpe
ZZo 17, SI
801. System 7
O
Final Grade
PUMP/SIPHON INFORMATION Ck-_ 5.1 ` C~ f 3
!',lanufacturer Demand St Cover
GPM n~ J Z /63
. S
F.i;xlel Number
JH GM FdCJO.. Loss System Heatl z TDH Ft f TI 7. 5 f ?
~L g.ze 9
'orcemaln Lergt On! fu'.vn~ 1 '
tU o,I lz CIA- SOH IiSI •fo i
SOIL ABSORPTION SYSTEM
PEORRENCH VJ,dlh ) Len<ath t Nc Ot irondws PIT DIMENSIONS No p Pas !nr de Dm` l,gual (09th
7e ` \
OMENSIONS $7-t -Z
SETBACK SYSTEM TO PIL BLDG t! WELL LAKEISTREAM LEAACHING Manrdxlurer
INFORMATION qQ CHMBER OR .LAt-r ~y
'_V\f- Model Nlmeef
Ty~ IC re.~l'r0 ^ (L l /Ll A ` 1 1 / Ill UNIT
DISTRIBUTION SYSTEM W
' -.,9,Y.'Nd,vIO(r! r~ Dstrovlm t riWC $,ZC r WYC $GaGng VK, 10 F,r 1M
SOIL COVER x Pressure Systems Only :e Mound Or At-Grsde Systems Only
"csn U.vr . CepnJ 0..+ Dap1h c. sc<den'ScrkMd ,a, Mwcn.d
Ili~1'f,e t(n (.II,G!! ~,Q// oBlirf nnKn F,NfJS\ TOp$]J ,
OT \ res No wee
COMMENTS: (Inaude cone dlscrepenctos, persons Mesert e:c) Ifspe Gaq ut In Spoat,on p2'.
Location: 188 Stan Wood Hluds11o1n+ WI 54C , I r . ; 1. i. No iF . . L . J
t.) All BM Desarptwn =
2)Bldg sower length = g5 y
- amount of cover c J
Pion revlvan Required? Yes YNO r 'i/ / z~
Use other side for adddional 1MOrmaton. I Z~/ O
SeG 6'! 1 U IR Sv) I Da!.
W w"tam Dbpartatent of Comr"emo Z
Givleionot Salary and BuOdtngs SOIL AND SITE EVALUATION Page / 1 of 3--
Bureau of Integrated services ;n accordance with Comm 83.09. Ws Adm Code
Attach complete site plan on paper not less than a t,"2 x i l inches in size. Plan roust "h
krokrde. W not limited to: vertical and honor" reference point (BM). dirocbon and ~7 Cif x
percent elope, scale or dimensions, north arrow, and location and distance to nearest road. Pa"I I.O. a
za3
OZO-(37(/-U2 -Coo/
APPLICANT INFORMATION - Please print all into atlon. gevaw Date
Perw,,al inbrmanw+ you p ovge may x used for sncondwy 4PA,* Law's. a 11I (m11. .,r . yL'Y•.. l O~
Property OrTrer rty Location
hr~ ~ .,r f'l Goa, Lot i/+-6w1/4.S /z T29 N,R uj E (e) W
Properly Owners Mmli Address "
n9 let a Blocks-T$ued Name of CSMe
i z ~SMA R+2Lr.166d
0tv Stata Zip Code Phone N~umtw i C~y village Town Nearest
s ab ) v 'SI 3S
'
New ConstrucEon Use ® Residential Number of bedrgo s,! Addition to efostng building
Replacement ❑ Pubec or conuneTOw - esentie.
Code derived daily Mow ~?p.. 9Pd Recommended design loading rate -11 2-bed, gpd/fF_-O e- trench. gpdM=
Absorption area required R28- sad. h2 7.:Q _troncn, h2 Maximnxnt design loading rate -.(Zl._bed . gpdMlz Q_ .f irendn, gprl/Ftz
Recommended mNbetwn suAaca elava(o'w(s) 9 _h (a9 referred to site plan benU9naral
Additional Oas+pNSit convtleretions yd~Uat~IO.J _pQ(Z ~Ld7 APPR~ 41
Parent matorum L AU AL / L C
-Flood plain elevation, it epplrable _ h
IS = Suitable for system Conventional Mound In Ground Pressure AT-Grade System in F4 Holding
u- unsurU"e for system s ED u ~`i s❑ u les ❑ u s u u o s U u S U
SOIL DESCRIPTION REPORT
Boring a Rodzm Depth Domnant Color Mottles Texture Stiucturo Consistence Boundary Roots GPDA12
in. Munsell Ou. Sz. Cont Color Gr. Sz, Sh. Bad Trench
2, A_ -lo DYR3(?- - L rr --M CS.._ Znl 09O.?
o-_ 4 ~oY~4~4 Sc nI~ Cs 7M 10.1 o.0
Ground
S A - O, ti c
Depth to
- - S
linating r.11 - ~Se^ -
tagof - -
>cK _in.
Remarks:
Boring s
L I1►icr m 2 O O.S
8 .l oYg3 SG ^T r s ! o.-7 _0 it
n 1~ 444 G s_ r+rn _cs_ - 0~ it
Gound O /h .,T
- - -
00 97J 4
1~1o S~ C'!
Inn.
> n. Remarks:
CST ~N(PMasa P nt) Signal ) e Telephone No
N4R~EY w4e.6v ~$6 ~a
resa^}L(S~S1 TIT/)uASo~ s4oI Dale CST Number
,0
1 x ~I 6.12 66 2275
SOIL DESCRIPTION REPORT 7
PROPERTY OWMERPage __°~ot
PARCEL I.D.e
Boring It hbrron Depth Domnant Cc or Menthe Texture Structure Ccnvstonco FixrWarv Roots z
GPD
in Munseil Qu. Sx Call. C,,,, G, Sz Sh esa Treat,
J L Q "Cr m f5 ~h 04 S
43 Ir '76
y'd 8-z S4
Depth to _
ruling
In.
Remarks.
- D S jp~ IQ3 2 L ~/nc~ GS g O.S
Qve
3roun0 - _
)ePth to
Remarks:
Hanzorl Deptn Dominant Color Mottles Structure pp
in. Munsoll Qd Sz, Cont Cohf Tenlwe G, Sz Sh. Convstence Boundary Roots 0ed _ -
Ly I li'•,
g. -z i~ tR_4L3 - 5G Ms T cs e,~ o D
- TV—
gz 4 4 - SG - 5
7 7 it
Depth to
Lmieng Ll 1
-'-141 n' Remarks:
Boring A
Ground
elev. - }
- I - -
Depth to
limiting
factor
.
- in Remarks:
SRD-8330 rR 5198,
43a~1 o
c • - OL~
a
03
,
Wes-, boot ri.NE fPO~ofEb 4-uu,4orw,-A
PLOT • Chou ucrwM PLAN
&vm orm. gxc^vATw& MM
RLU~ uw
O%iCQ ioo" ro Sod PRO
vl - 470 r "-v&
1 ~r a..,o LoT 4
~.(cN RESIOFNtf i- rLQo/X L.srNf
~ I~Ew ry <N
Arr. &Acmoww
S~lCE iN OMc fialC EIN.98.54' - J
` 5r/4 ~ 6Jwfr 4,N[
eil ~ .~,r o /RSoG.cc.. w,+set Se~nc T~
_ 87-5°" g~ l.~l,+l~neet/►lSvoFrain i
!O'E`~Ba - _ _ S,,•ttr Fit*ER AtwF~.t 3
y` PdC ErFKCtWr L..Ni i
~E,ur/~ar+lleeTrow O,/K ~u 7NiPO L~M>,rd[P a
A95
~PoM E~w ENO N o ,
/tcr. /tp~~f
♦br BS •
If;+f' LrNf
&Igf rflK- SIlltf OAJ Cyt*l*g/ SnkfE~'O'p ~o M .S
/OO_ au
ur 41P uq: 2t x/757
0jq dkTr~1
A.416 "aE OATf: S /J oS
A~Q+trmww 5iG•/~b.Jf ac i;rM~eO~A[
clMr►wbst ;~aaTfsTr+pw:
The Sber
~oiJ>v sul
I -T '~eca►cN SowbmAiova„ou Aw 50,c'asT
1r
L EJ. ~ . ~S
~SrOE Vlfw
7Y
En.crw l.nprr