HomeMy WebLinkAbout032-1054-10-100
„ ~:.on :In •Ime^.1 Jt GJ'nm;:rr:r.
PRIVATE SEWAGE SYSTEM St. Croix
~cMri ;,nd Rw :AI 1I c'IV 5 Or INSPECTION REPORT aui::n,-eI.,INo
Hr IACH TC PLRMiI) 606914
GENERAL INFORMATION t 771-7.:r rL
Fr.'.. InIJIIDa:I:m yuu 5f..1De Tay pr o•:nC for rri"-0ar: Dur(:p;! ICrv:aGC Lava. 5. ?d IL roti
Fei n`n'. -leucrs \arne CIh 'ar.'ane. tuwla^ar' 1'arrr•I Tar hu '
Ross & Lacey Webber TOWN OF SOMERSET 032-1054-10-100
- HV Elr in~0 °L1 f Irv bN L=trip' ` $rs:Nnu! I:mo=:anG C! 6,:uw N~
i n `'_r' 21.31.19.269
Qp /ua~ A-40
TANK INFORMATION ELEVATION DATA
?'YPE CSAW* AC I JRLP ~ ;;A~r1':.7'Y STAI I )N HS HI k $ =I LV.
5eril;: Ctenchmd,,
j / r S / SD
J ! v,
G4 oa.~oo it kA- d r ~i( 8.
r,eravor l F'}; ( X109. Sewe' del 1
I lolang SUR Inlet a
TANK SETBACK INFORMATION
ANK !'i P;L *"ql-. _ 9, DG .!;Ike R';7ALI Cl; Inlet
4 \
1
-epllc d (A Bottom
6
C1S.e1(1 / -7 I / '7eaCeUAAan
Sc ,7
i 7
i.erallnn C)iG( Pine d 7b 97
--.oldinq - Dol. Syst=.:n 7. L IF0 1-7
(Ina l ~ :aAe J
PUMP/SIPHON INFORMATION 3.8 '?4. 37
Manlllaclufvf / 1 -.ernaf) L~ S; Cover
F'M
M noel NUMDE' t L/~
Syslenl 'u aA I:)HA
-IU- Gft FIUWO LOSS
fr (I t
-un:;emaln I ernl(p / U:a .1 C..: r': cell -
)6 1 'z
SOIL ABSORPTION SYSTEM
DED/TRENCH A.d:r' ff ` IONS I',a Y Prs. . DIMENSIONS 'x
`
SEIBACK SYS ILLN' T.'-P;L RI D::'o'.U.~ LEACHING blan. anlin• r
INFORMATION CHAMBER OR -ra
UNIT !ACnr~ 0"*,*e' ,I
L.F
DISTRIBUTION SYSTEM 44 7 7- = 1' -V4 U~
1 lrancRMa-RCe 1I JISt-DUtnri x Hmc Sparer '•:'nn/'. is Art ntakv
:iUei ~1 r~
LSOIL COVER x Pressure Systems Only rade Systems Only ~:rrrlrvl':.:,udeC LIUI(11e(:
COMMENTS: (Include code d•scieperipe:s person:- preserr e'c Inspection *2
Location: 4el 21CI7H AVE -I At 91.d 7escnptlon _ +IJ4t/JC-. 4p
Dldq sevmt length 1 = Z.
amount of cove,
Pear rev,ior Require-0 Yes >(/N0 5 '
JSe 01h0" Sr]c IJf additional mfornla,lgrl. I - -
Gat' P:faUCtO's' nature on No
Count)
Safety and Buildings Division
X ' OS ss 201 W. Washington Ave.. P.O. BOX 7162 ' sanitam i'ermll Number Ih+hc lillai m by t'o.l
P i
$ ' Madison, WI 53707-7162
~Samtar~y ~O(O l
Permit Ap'lca 1 State Ilan i++l Number -
In s ord.mu wnh SPS X. J d 0I 15 is 1dm ( Js, sul n....n + I du, tin appropriate > anal unit
1(~.
i. :quocd prior to obtiininsit u+p. unl \141 nppll,m Ill m±l tar stale-ow V, IN aresohnullcd to Protect Addicss(ifdill-etenl than mailing addtsssl
the Ihl+uv1An111I Sa[s tr anJ Ih .ioual Su+iu I': nonal mtunn vuon sou pnx'idc nl.n hr 'r secondan' purpow, ) I l )-swl
1. Application Information Please PrinAlllnfo ion - G-l U AV6
19opcny Uwncr s Natnc Parcel 0
3 LGLY 1J~159e~ 632 ' (054 (0 - IOb
I`apcnv (Avncl's flailing Address Propcny I oval on
431 IZce l 1 4
tlly Slate /ip Code Phone Numhcr Section
scyh" uV 1 _ 540 as cndcon
I1. type a13u:tiling (check all that apply) Lwu H-~- Po - - -
I of P:nanily Uwdliug Nwnher cl Ikdnn+lnz tSulxirv islnn Nnnlc
ok- Illoek •Y
Puhhat'nmmcraal - I kscrihc Use jC> C " V s I I Cdy of
r' 1 ; Vfllu~u ul /y~~
Stu~~t^^c\\Owned Dc<:n//iyybc~'ll~~.c I l'SVt Number V61 17
Z CQ1DC.o L'.%!.7.2 ~'zZ C. s T5ZZ V1*nw» nl Sc Mt(5 L___ _
III. Type of Permit: (Check only oile box ml line A. Complete line Ii if applicable _ Zo-r-0-
A ~NCSV 'o' all RcpI. - ncnI S"ital1 -
❑1 realllKnfllnl JlllgI will Replacement l)nIV' -1 UIIKr blUditililliurl lU I'.SiShlle SYSICIII (explain)
I
It. Permit Itcnew: Pern»t Rt s,lhrl ❑ Chaawc of Number Pemal I ianster to New List Picuinus Permit Number ;old Date Issued
6c6;rc I_spilaliol - Owner
IV. Type of POWTS Sys componenVUey ice: (Check all that apply) O T
u-;',s•~wiicJ loo-Gtuund Pressllr¢,l [it-(ground ❑Al4oadc UNlound-2.1 in. ol'suil:ddc 111.1 L~Nlound-?1 in ofodude soil
!Icldlll' Olher UwPCnal Conlpuncnl!c\plaio3 ❑ I'mhcamlonl lhvicelesplainl..
DispeesalA reapshenl Area Information: / - 2 G6•)9
A. •n 11' ,v I '1,, r~ I)cagn Soil :\ppliusu11n Kaki pdsfi Uisperxa , a HeymrcJ (cI' Dkpcmd Amer Prop. • Isq Yvslc I!levaliun
i I Xk l
VI. Tank Info Capaun ut total It of Ntmul'"tuicr
lns Gallons hulls ~1aaQ~- v p Y
Ball axluiylank: ,.,/z
New laakl e' 3 _ to •Z ij
pp 1ZSoJ 7So e r r ~ ~
5rp1i.: ,n Ilul.hor. lank
rl,:: r"r 75Z~
H. Responsibility Statement- L the undcrsiancd, asstlmc rcvponsibilite for installation of the POW IS shown on the attachrA plans.
N iaihc, N;une II'rin:i I lumhcr s Sirnalntc NIP NIPHS Numhcr Ituancss Phnnc Nnmhcr
7,4 -5-11 Y_
Pil;m1111 \Jdms_[Sliect. Cil)'. Slate. Zip Codc) -
\•111. 'owltyi Ucpartmult Use Only
pp Yen) Signal c
lrv ted IO,M~p 14rmil Pee URIC ssugcA C~ Ixcuim'
CM.
_(Ty^U ('i+ o IL nun liar Denial S 0C)
Z) / _
IX, CondilllHYfMjq'rI*easone fur Disapproval 3\ I f SQL )
1. ~f*^• (1l1'lt, eft tdk:6m le V' lKt ) ,lGi_Ifn' w•tQ.. ~d•it0..-
(Jy►vr:~~l crll -,tut all bLIln•:IC•*a ' r.rz iMS ?i
ere per alaragenlen. pten ro noen by ~Iwono .
• per ppi)knb I u1 L!1,1 I .rr;rc).
411ad1 n. ronplrte plan% for the system and sobmil to the ('nunry only on paper not leer, than X 1.2 x 11 incla• in o" -
SBU-6198 1 It. I I r' I I I
CYFr;h bf U; f.- i:::4'. C.If{:H iux AS A4f,14Ai-.
SOIL EVALUATION f 5;-' 20' sc ^ E:] SYSTEM PAGE 2 OF
SITE MAP 4 PLOT PLAN
PROJECT NAIAF: EG / s u-sl:;n Ftnv,:,
n ybd',
Attach dasian floe: 31-uwt,Ons for wmmercar plans.
Pipe. iV.al=.rial : ASTA1 Stan9arc i !tables 334.303 8 384.3D.5)
N s ,may ewer,
we sfrnav $ ert ei.:vs~, 10~ =r Form u:,,.
era rzs:imloc: _
Gratlicm ('z) iaiic.-.e n:rth b: IMOORTANT.:
c- Trs:c:f Arc:: Wrt 3Vmbu'. In aPVlcabb; O c3,.~: ~r 5huw orouna wavahon contours at sui mNe intorvds.
on trc:vmova:c hs.
~ _ I GSb/'75D ~i: o
I
I -
44
I
I
I r
z~~ zz I
I
i`1~~Jir
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name
Owners Name
Owner's Address: t{ ( L(L e,
F I
c
~crn er,e,{ W-3
Legal Description: Ne Y# t Sri 3 L1~1 I`"
Townsh!p. .50 4,y-) e r
Count' ,CQyrX
Subdivision Name: _
Lot Number:
Parcel ID Number r C_,o
Page 1 Index and title
Page 2 Plot Plan
Page 3 System Sizing &Cross-Section
Page 4 Filter Specs
Page 5 _ Maintenance Information
Page 6 Management Plan
Page l St. Croix Cty Septic Tank Maintenance Form
Page 8 Warranty Deed
Page 9 CSM or Plat
Attachments: Soil Test & House Plans
Designer/Plumber: )y , f~'I u~ hr License Number. 2c(T73
Date: Phone Number
Signature
Designed pursuant to the In-Ground Soil Absorption component Manual for POWTS Ve-sion 2.0 SOD- 10%05-P (N.01101).
Page t
FC:'.<HO(Ag> FFUCeELC- CNH:K BOX AS An JCAB..
U SOIL EVALUATION o s 1e 20 20' 30 40 0 SYSTEM PAGE 2 OF
SITE MAP PLOT PLAN
PROJECT NAME: r a, m u~slcrl rr:rx. r;w
Attach design flow calculations tot commercial plans.
PROJECT AD0RESS: OD OD Pipe Material l ASTM 13!andird (rablor 384.30-3 & 384 ,,WS)
_ SaBllery Sexrr-_-_ /
BNS/mOnl: + 91A hnre:ninn: too` hr /
F<rzce nlaln'
aM IMxdPlLxe _ _
sbpe Grad~em ('4) b~dkete roM ty IMPORTANT:
,J Tccltd Arta Weii.Tymod (itapplUCle): O the av eeWlvWunxrrx • Show ground Blow w I con lot vs at suitable Intervals.
- on lha
We)5er fi4L
LT Yj,
44 QuILk 4 I~116
~ wail
I
•f
i L) l
I
2 rv0 22
Gttitck y ~h•;mlw
•
iI
I .
r
Septic-Dose Tank Cross Section And Pump Performance Specifications
Tank Manufacturer j ~!y l Pump Manufacturer e1
Tank Model Number Pump Model Number Pi
Total Tank Capacity Alarm Manufacturer 6 <
Max. Bury Depth Alarm Model Number T6✓ !o/
Switch Type f~ ~i lC v f
~ Filter Manufacturer
Total Dynamic Head ("I'DH) - Feet
Filter Model Number Elevation Head
Distal Pressure
Network Loss _
Pu-mpPerfo-rmance Required
Minimum Pump Pertbo-rmance Required rForce Main boss
2S GPM ~ FtTDH Total
Outlet Manhole Min. 4" Above Grade With 3 So
Locking Device. Inlet ;Manhole Manhole Min. 4" Above t . e
`
< 6" Below Grade Sealed Watertight Securely Mounted With Locking Device
♦ Weather-proof /\l
Junction Box o
Finished Grade
Depth of
Cover Vent Min. 12" Discormcct
rt Above Grade Means
With Vent Cap
L :U
Outlet
Outlet Filter
Inlet Inlet Baffle
A
Switch Settings and Reserve Capacity
Tank Volume _ G_PI Weep
Hole
Dimension Inches Volume Gal. 13
(reserve) A 31i l
2 L,
(alarm) B 2 3Z . z / Off Elevation C
(dose) C Ft
(dead _D / Bottom
D Elevation
Totals ~7,5f1 Ft
>
GENERAL. INSTALLA'I'lON: The septic/dose tank is bedded and back filled in accordance with the
manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not
be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock)
installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and
laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank
excavation and the sleeve is sealed watertight. Electrical service complies with NF,C 300 and Comm 16.28 WAC.
02105 LJ Page- of
en rc,Ci,r.Z.N 373 ~j Ci J;S - -l L - (jQ47 0 \
'anOd -1>Oe '31':0 DJ 00/p0 '~~0 GSL4S N 'HJCd N30,'e V1 0, AMH W MEM `
31388808 ~~S~~m ,vnNVw OuJ3s
-flCe add 0-,.=,.Y I '3 N;ti d:1H, 'AE 4Mtl60 = \
aw-osL/osaIM N
w
z
a z >
a ° coo
W W K
7. O m
U ¢ U E, N w w d
w l/1
o d°~ as p m w d m
(n o k w a s to Q o
p ~a a a W
O
~ m
e~ O a a °m 0%< zz w~ a FZ-I 0O o <
G U N O¢ ¢JU J j < U mj z 31l
I Q Q. 0 mN wHw U¢7 z d O~ OU a n
_ m w pN w z Z ~
O1^1~ U p O h00 Q¢Q bN o NN0 Y 0 v c
u/ I..L -900~1]<0 N 1 mwW ^<p ¢ V d mo
¢
\U - y p.. U ~INFNH N~ UO 0FVI x <
N. N ~yy~,, ao W¢¢w a W0. z v~
Oa \M pL~N(0p ~1!U~NN ~ V ONF NU z0
w D \
Lnu) NN ~'O~F 3 0 ~ 0¢ 00W ¢ W CD L) N 0 p ~
N O
U
ZZ-J l zo -0- ZU Y Q ZNp ¢ 0 Za- xX W7
Y Naoo¢ww woW-t~ ¢ao¢~ U v ¢N0 0:
Z W Sm C) mZi F ° zp V 1.~1 2O
Q w Iii 0 ¢ z > Y Z N
F.._ O Z Z J J < UO < U
r~
-1 W _ O
w a
y Q. N
1 - - 1...... - - - - z
O \ 2
Ii
~ I I N
' I N
I
/ I W I I Q
u
III Y iW ~ ~ I W
J
L
\ ~ w
i / _ F to
D
¢
w
N Q
J Z
Z ¢
f
aFS W
x
OO M- ¢
0
Nastewater
METERS FEET
1 i!
MODELS:
PES1 PE31, PE4,, PFS1
HP:.33-40, 50
3
13 0 -4- 2 GPM
30 PE41 1FT
Q
2 25 PE31
~ u
Z 20
c
J
O~ 15
1
5
0 0 0 10 2 30 40 50 60 70 GPM
' i
0 5 0 15 m3/h
CAPACITY
PERFORMANCE RATINGS
PE31 PE41 PE51
Total Head GPM Total Head GPM Total Head GPM
(feet of water) (feet of water) (feet of water)
1 , J. - 57
)9 Z6
20 1n 20 33 I 25 -
16
-J
' I
f
Wastewate
APPLICATIONS MOTOR
Sperlaily cesicned for tite folloeving l.ses: General:
• Moxid Systems - • Single phase
• E*I,tent7Dosing Systems • 50 -ieriz
•'_cW Pressure Pipe Systems • 115 and 230 vole.
• Basemer•t Draining • Built-in thermal o','t rto c oro-.mtion .with auto"',
• I leavy Duty Sump/Dewatering reset.
• Class B insulation
SPECIFICATIONS • Oil filled design
Pump - General: • Hign st7ength carbc -c' ° ''.._'t
• Discharce: 11/i" NPT PE31 Motor:
• Temperature: 104°F (40"C) maximum, continuous • .33 HP, 3000 RPha'
when fully submerged. • 11 S volts
• Solids handling: 112" maximum sphere. • Shaded pole desic_ n
• Automatic models include a float switch.
• Manual models available. Pc41 Motor:
• Pumping ranye: see performance :.halt or curie • .40 HP, 3400 RPM
• 115 and 230 volts.
PE31 Purn>:
f • 'Sc rdesign
• Maximum Capacity: 53 GPM
• Maximum head: 25' -DH PIES', Motor:
• .50 HP, 3400 RPM
PE41 Pump: a 115 and 230 volts
• Maximum capacity 61 GPN • PSC design
• .Maximum head: 29' 1 DI'
PE51 Pump: AGENCYLISTINGS
Tested to UL 778 and CSA 22.2 108 Stanca--s
• Maximum capacity: 70 GPfM
1 Rt Canadian Standards AssuuaGOn
I • Maximum head: 37' TDH GO _s r I~ #LR38549
I
1
I
PUMP INFORMATION
T- Minimum I Minimum Maximum ShipP-9
NO. HP Volts Am Circuit Phase Float Switch Cord Discharge Basin Solids we-,-
Order Ps style i Length Connection Diameter Size lbs. ag
Breaker
I-91 G1 - u L< vile PPP4li`S 7.5 15 11.nu Na Suit n
PEa1 P1 04 P_9bt pact.lo..r 1
Pf•421v1 blan~al!No S.`:iti ',.5" 18'
r
42P1 23~ 3.7 0 1 P~99Ybac<tiu:a Svritdt 2G•
PEi1P,•1 PAa~~:al; Nc Sv:itch
115 9.5 p
PES? P' Pigyy6ack PCar Sw,tch
05
PE:B; Ilan ij No Sndch
TECHNICAL BROCHURE
FEATURES
Corrosion resistant lUn)?rUltlVn
r
Cast iron body
Thermoplastic impeller and cover.
Upper :sleeve and lower heavy duty Tall bearing construction.
frOULDS Ilocor ,s permarentfy lubricated for extended service life.
E1paF"t Pump Powered for continuous operation.
G4 ~
Ali ratings are within the working limits of the motor,
Quick disconnect power cord, 20' standard length, heavy duty
. 16/3 SJTW with 115 or 230 volt grounding plug.
Complete unit is
heavy duty, portable and compact.
<°`jr y ! Mechanical seal is carbon, ceramic, BUNA and stainless steel.
Stainless steel fasteners
~ r
1
1
PE
5J3MERSIBLE EFFLUENTPUMP
~r j GOULDS
a xylem brand
-'1F'+ 1 w .R Sr'6 „ q~ .A!~'"l,,*,~-t' ' • w„ pm. b.I~~ .
.gyp ! ~ r !I 1~y ~~Y! < l +
a. ,
a r
V . ;~i. ..1, * .y dCT,~ r 't'.- Vii.
~ ~ ~r1~g•,~ ,P~ + mss{,
i
AAW
^ya r r iy s y,,~`t v ~y'y ~Y..
t r } i. `-rte At,
? ti r _ .,"[~iA"'`f,.` .~b ~5k • 'Y
I It
LL.,. Jai' k'Ya`A.
g. ±4id.. w 'k S.i S' 'mo t
Sq $ v` 1k xk~' hEt';•. yity `j r $ i~. r a n: It 4.
r V d , € 77FAWYYYf , r + ? '
`xS-yQ+' 'l. ~ c 'Y+, ~ y'r~{♦ ~ }yam C 't .
a"+k ''T' Lam'}.( •SyL L A• M,.,IA A ~ ~J
•4 f T f I ~1 . ~ j'
I6~{ ♦ r f pas
.g - L Y t .
Y~ w y
A Ala
?yyy^dd1~ ~ F 1
L t 9a
kk ~ t'
~AVV -au,c3a
OCT 05 20~~ industry Services Division Jar (
~a X
t,, r U 1400 E Washington Ave SaniLiy 1'nm.it w•nL.. {to he fillcA in *Y C")
P P.O.Box7162 I
r'1 : iY4adison, Wt 53707-7162 &b(_ 7/A/
1-0
BfI211t .f~.~lpIlCat10 a slat:. rra.sn<vn umhe:
a 1
, :corAt 5i .S 387yJ anita1_.+^ f Fir
Code. s-bnuss+oo of this for to the appropctatc yo+ernmcnral
r:.'{uitu7 _e eSLi.vo vsx irv -m~ Nofe: App nation fmm~for«3te-cYn xaUniRCdt~ ,:r : , ..i:,..:;q,,, :+dd:cns)
c~~. sn S+`cty and i e ? c cr. f r.,`erna -ar. rvu pro', to -n y I,:. used f,• soma: ^.,y
Asa nac+ i.'roe w,tl t7 i .A/{1)(m) SLrIS, Tg 10~' ve
\nDi a ron7nfm'rontton- , ntA!linfmm+tion S b /7 l-
Z~ - - -~e1o~c - _ -
' 's hnmc I i _1 S:
l 03 lOS`(- (D-lots
• `:lnili 1c Pmp,rty l< n
'7
L
I
~J awwt(~i¢'^
1r
- - ~,-31 l
n check ➢ Jtat a 1 I,.t M1 i
!.'.in. U .r c.I 11 ..ors - -
"b:itl.nmm<rdal-llcscnb tTsr
~M~ I a
cil) if-
' scri t Sc _ _ 1
Z DYY61 ~ , w ~a-22 d. 17~ lea 't"JZZ U ro•.T: _ rrrt
- -
I i. _m`t: lLheak aril, onefinx an lm e. 1 'IF „r ,cA, I
❑Rcntzcement SYn:cm I T.._,. i .:_i1r P: [~Olher k4Aif7ica'•nn to ttxistinQ S581rm (expir:.i _
I
n ncwa. list Prcvinu. Pc nu. N,tmI a d Dxte Isar
L1 k i-.it'7 ! ( oc i L Permit Transfer to Ncr, 9
a ent,(_na onen e,!'IC.f,
s;u•:v:x; ln-GttSUnd :i 'n.. d. 11sh.r snit^" (t:u„I f „faL c;o-:i
f„'-sit n_ '-1
c tenth •lnfnin ,I "f `f" GL[LlL
s
C' row r:: „ ^ I r
~c I .ixisti RAn i ~ ~It/ { 1-"~ ~ _ r I
r ,
i_ I I
f t
s:'JIiiR'Statecn c;;(-e.fh<nnderslgneA, ossonfr rexyonsthilin: Lr:: a:mn:+f;hc PO\1'TS shown or~tlle attached plans.
_ml - - `Plumxr's $ivnarnre \1^.bf;'[Z~'Q+: r.T ?tusl - PfncNr
i~6, (LIB - _ 716-SY,$ w _ i. s n Jicapp , f
1. Sep lark e'itu'G.n: flow cr.1 3, oC4.
ahpe' cell ^.ust all be ;;•r_k `s a:_-` ei
sper 1
nar 3yemen. p n c i~ea by ylu n0e"'
Wl ~N( ' 1 r
2. "per Pi 4)
r-
p P rdh ux'n/ M11aiv' a rt ,rEt
, _ I..r... , _
I
..=-::w rR'1%AS A?~,X;4+lE CIICCKib~m:;; 0.~u, i::aHIE
SOIL EVALUATION 'c:'' -20' .SYSTEM PAGE 2 OF
SITE MAP n
PLOT PLAN
PROJEC- NAME:
;B r1 gtltl, OF-3IFN =1 ^.VL 3PD
At:arh oesgn floc' catculalions for commeram plans.
PR(:Jr'CT ACORM:. Pipe Material; ASTM Stanrlald i Hm 384.3'G-3 A 384 30.51
Icf' - R N 5aalimy anwnr
RU :.yn0.-t -dy RM EIBV8002 - - `I -
RY Dc,-i~rrc 1 ✓ ! r1 r Tr/
Fi:rtm G-atlml('&) meiomv roanh IMPORTANT:
WOIt $ynIDO'lit npDicablo): Q aawq:n ama Shr:'A'
rt'cclaf Md^: yrocnd e7Rration cor,[ouas al sui7ahiC inlenraL.
.x. mn aPDrcMT:e iFe. _
n
i
i - irk l s~
I _ /,SSv v
I ~ `7~^Qut ~G y ~'iq.n~i5 I
i ~
I
47
I
I
~ I
- - - II yc:ry tlr nG `frCG
I-
--or
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name.
Owners Name Q5nr1 _ILL
za beL~~_
Owner's Address:
4At We
ovt t~^_ S`f01b
Legal Description. NiC t N`t /`f S 2 t j I I~ jQ ~J
lownshm C'
Jor~c rSe:T'
County T. 4 Q t
Subdivision Name:
Lot Number if
Parcel ID Number: ~ 2 • I DS'i j 0 00!5
Page 1 _ Index and title
Page 2 Plot Plan
Page 3 System Sizin,q & -Cross-Section
Page 4 Rter Specs _ _ -
Page 5 Maintenance Information
Page 6 , Management Plan
Page 7 St. Croix Cty Septic Tank Maintenance Form
Page 6 Warranty Deed
Page g CSM or Plat
Attachments. Soil Test & House Plans
Designer/Plumber: >/J /(~r-5 C it License Number: 9d Vc J~
Date O ZO Phone Number
Signature
Designed pursuant to the in-Ground Soil Absorption component manual for POVVrS Version 2A Sul) 10705-P iN 01101).
Page 1
CHECK uux A' A++'. K:PHI L CHECK nC%A` AF:T_I°AaIL
❑ SOIL EVALUATION s k:: r zo n <n FA SYSTEM PAGE 2 OF
SITE MAP PLOT PLAN
~rZZI
PROJECT NAME:
(5 ngod) 5' UFSIGNI IU11 _~nW
Attach design flow calculations for Cbmmereia) plans.
P4OJECT ADDRESS: Pipe Material; ASTM St'and'ard ( fables 384.30-3 8 38445)
f 1, I BD N ; a,IWrY Semr ;
aVS'rrbol: BM rt
el~~stm~~: l F«.:z t.I:,ln: )
sm DeBMpaw'. I~-N 'Pine- ree--___- _
haiwtn iw~u, i; IMPORTANT:
Lf Te^sWlcd Am.'[ a a,(%) Well ,y=N(if8pP4=W.): 0 ~bwi~van aiw Show 9e-na nd efewition crmtours at suitable into
~I Tc M U4 epprOpllB be. Wis.
sc,~/L l s
/Zi
-4~ 1-7 at IG V 0/4,2 5
I-
I
I I
I ~ ~aA
I 1e- a r ~
taa t-ree ~I, ~ W, fl~ ~
I ~
600 nt free
i ! i 4 /b7 ~
i
I
Soil Absorption System Cross Section
ft
Final Grade
440
pe
p Leaching
Chamberf- System Elevation
ftft
Soil Absorotion System Plan View
ft
ft rL _
3 ft Leaching Trench 17
Vent Or Observation Pipe Chambers
mutow R
\ 4' Dia.
Trench 2 Header
Leachina Chamber Saeciflcatiions f
Manufacturer And Model ffr (~IjOr- La'ki~~ C~ i r>
FISA Rating sq ft per chamber Soil Application Rate 7 gpd/sq ft
G EU gpd Design Flow _ Soil Application Rate + ?-Q EISA Chambers
2 rows of chambers each.
Page of
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2
FILE INFORMATION SYSTEM SPECIFICATIONS
lwner
Septic Tank Capacity 145-3o gal C NA
?ermc A Septic Tank Manufacturer ~ r (ff~'~-n r^ J NA
DESIGN PARAMETERS _ffluent Filter Manufacturer C NA
Number of Bedrooms C NA Effluent Filter Model (-F ❑ N.4
Number of Public Facility Units tX NA PUn1D Tank Capacity gal NA
Estimated flow iaverage) 1 l~pfJ gaUday Pump Tank Manufacturer J? NA
Design flow (peak), (Estimated x 1.5) 6Gp' gal!day Pump Manufacturer C NA
Soil Application Rate 7 galidaylfr Pump Model NA
Stancard Influont!Effluent Quality Monthly aver age,• Pretreatment Unit ~ NA
Fats, Oil & Grease !FOG) •330 mg!l. C Sand!Gravel Filter C Peat Filter
Binc:hemical Oxygen Demand IBOD,) 5220 mg!L NA C Mechanical Aeration C Wetland
Total Suspended Solids (TSS) 5150 mq/L O Disinfection O Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) C NA
Biochemical Oxygen Demand !BOD,) v:30 mg!L g in Ground Igravityl 1-1 In-Ground (pressurized)
Total Suspended Solids ITSS) _'30 mg!L NA C At-Grade Ll Mound
Fecal Coliform (geometric mean) 51 C` cfui100ml C Drip-Line C Other:
Maximum Effluent Particle Size Y, in dia. Q NA Other: NA
O;her:] NA Other: NA
` p 'eptic tank gtfiuent. :)The:: ~ NA
Vahm ty ica; for doreevti- wastewater and s
MAINTENANCE SCHEDULE
Service Event Service Frequency
(Maximum 3 years) C NA
inspect condition of tank!sl At least pace every: moniniyear(s)si
Pump out contents of tank(s) yNhgn combined sludge and scum equals one-third 0,;) of tank volume C NA
Inspect dispersal cell!sl At least once everv: ❑ month(s) (Maximum 3 years) C NA
._3 0 year(g)
C month(s) ^
Clean effluent filter At least once every: NA
- /.J year(s)
Insosct pump, pump controls & alarm I At least once eve F n'; ❑ monthis) NA
C year(s) K'
Rush laterals and pressure test At least once every: C month(s) NA
C year(s)
Other: At least once every: M month(s) NA
C year(s)
Oche:: ANA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the 'allowing licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer: PDWTS Inspector: POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank!st tc identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any bacx up or pending of offluont an the ground surface.
The dispersal cellist shall be visually inspected to check the effluent love's in the observatior pipes and to chock for any pending
u` 'fluent on the ground surface. The pending of effluent on thf ground surface they indicate a failing condition and requires the
immediate notification of the, local regulatory authority.
%Vhen the combinno accumulation of sludge and scum in any tank equals one-third ('r',} or more of the tank volume, the entire
contents of the rank shall be, removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative, Code.
All other seR~ices, including but not limited to the se vicing of offiuent fitters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of <-12 months, snail be periormod by a certified POVvTS Maintainer.
sorvice report, shall be provided to the Iota! regulatory authority, within 10 days of completion of any service event.
^aoe y of
START UP AND OPERATION
For new construction, prior to use of the PO%V T S check treatment tank(sl for the presence of painting products or other chemicals
that may impede the treatment process andior damage the dispersal celllsl. If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System Start up shall not occur when soil conditions are frozen at the infiltrative surface.
Donna power outages pump tanks may fill -above normal highwater levels. When power is restored the excess wastewater will be
discharged to the, dispersa, ceil(sl in one large dose, ovenoading the cellis) and may result in the backup or surface discharge or
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or coruacl a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Dc not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or al-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics: baby wines; cigarette butts: condoms; cation swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump purnpi wafer; fruit and vegetable peelings: gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails andior is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• AI! piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• -he contents o' all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. l'he replacement area should be protected from disturbance and compaction and should not be infringed upon by
required soabacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need far a new soil and site evaluation ro establish a suitable replacement area. Replacement systems must
comply with the rules ir. effect at that time.
❑ A suitable replacement area is not availabin due to setback andior soil limitations. Barring advances in P01ti71S
technology a holding tank may be installed as a last resort to replace the failed POWTS.
~r Q~ Thu_site-4as-r zralnated'1'o-id=*rtif s " . `-et t4e
S w,l /r ~alua i e ~ a noidmg tank
bei 'e area '~f2D1-/11~1T~ re R'/.1 ~hlS7R (IGTID~
❑ Mound and at-grade soil absorption systems may be reconstructed in place fohowing removal of the biomat at the
infiltrative surface. Reconstructions of such SyStelnS must compy with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name Name
Phone - ?none
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name
Phone Phone '7/s- 41
I hit, uocument velar araltod it comp:ian;e Witt. chapter mom:r. E3.22(2)(bH1)Idi&u, and 83.54ff I, Z R (31, Wisconsin Administrative Cade.
DIVISION OF INDUSTRY SERVICES
Plumbing Product Review
P.O. Box 2658
( d Madison Wlsrnns!n 53701-2658
P ; TTY: Contact Through Relay
Scott Walker, Governor
Dave Ross. Secretary
March 12, 2014
LIFETIME FILI'ER LLC
MIKE HORNBACK
146 CLIFTON HALL COURT
SHEPHERDSVILL KY 40165
Re. Description: SEWAGE TREATMENT APPARATUS, EFFLUENT FILTER
Manufacturer: LIFFTIMF FILTER LLC
Product Name: UFFTIME EFFLUENT FILTERS
Model Number(s): LT 1,8. L' 1/16, LT 1/32 AND L~ l!64
[SEE ATTACHED TABLE OUTLINING: FILTRATION SIZE AND RATINGS IN GPD]
Product File No: 20140048
The specifications and/or plans for this plumbing product have been reviewed and determined to be in compliance
with chapters SPS 382 through 384, Wisconsin Administrative Code, and Chapters 145 and 160, Wisconsin
Statutes.
The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative
Code. This approval is valid until the end of March 2019.
This approval is contingent upon compliance with the following stipulation(s):
• Installation and servicing of this product must be in accordance with the manufacturer's instructions. A copy of
the manufacturer's installation and servicing instructions must be given to the owner of the system.
• Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filler will
be necessary.
• A manhole extending to grade must be provided over the filter.
• MAINTENANCE: Clean filter at inspection/pumping interval.
• Additional information is included as attachment(s) to this letter; see attachment A.
I he department is in no way endorsing this product or any advertising, and is not responsible for any situation which
fray result from its use.
Sincerely,
e'h
'OWTS Product Reviewer
p•ione: (608) 267-5265
=ax: (608) 267-9723
1!7T `!'J. v en joncs;czwi.gov
=;-ir 1::fiA-f- (V.1 u+v; 'r Fla P.c` 14GU4801__~..
?0 14() 048
Other than single family -I - Primary
Product Lid Single T_
number Color Family applications in GDP Filtration Size
Code Application
In GDP <300 300.600 601
CBOD' CBOUJ CBOD' I
LT-1/8 BLACK 3500 3000 2500 2000 /18"
LT-1116 GREY 3350 2750 2000 1500 1/16"
`LT-1/32 GREEN 3000 2500 1875 1500 1/32"
"1_T-64 WHITE 2500 2000 1750 1500 1164"
-TO BE USED IN CONIMLRCIAL APPI.ICATIONS. DUE TO EXTREME LEVEL OF
`7111 RATION, AUDIO VISUAL ALARM IS RECOMMENDED DUE TO SHORT
-RVICF INTFRVALS. INSPECT AS NFFDFD.
c N
O
V
\ r'1
Z :e~ A
\
D ~ o ]5
1 \ ` ID
\ I
, F.1
I ~
c`'
r m -.J
w l -
P
L
I
i t
Oil
;1 ( Ro l\ cut N 11
AND
t \I RSHIP cI-RTIFI(•.A IION F(IR\1
,.:IingAtWtcss `J ``'~sf. ~ ~ i-r I i tc~," "f••i' i•
rely Addre<S';t j~
Pxw:,vi required fmm plann~ng k Tanin CA.ponmrnl fur new iumtrui:ron.l
r. J.c Par Idcncflcallor Nuithc: i '
1.1-Amill. DESCRIPTION
pcm L,iapttn . k. I \ K , 1A. I oWr +,l
`r ~
((rtified Surt,ev Map st LI Villutnc P c p .26f0
N arrunn lice(I ; Ibieforc 2007)Vuluttw . Page I:_
Mw,c Ov:,~ I --t ru.:dcnhfable❑yc,0n.,
,l SEEM >IAINT ENANCE AND (yN NI•:R CERTIFICATION
Inp•:, i..,,a c:d a:awsw:• c n; our ,c^i,: uld %su" m n> p:cnvtutc tat ire t:+ h,rinl,, wades Proper
. r.r. a ,',xr,nta of i•untping nut tl::wit, r,rn 'itn yeas or ,oona.:f no,atcd, by a ;untevl punilm What you pill mut
atiat the iWwta.n r,f the vepn< Will, a. a lrcaattC I! ,rage In the bate dupu,al system Owner nutmtetrltre
,.,,,c, arc spcafial in ¢SPS ?N1,52+: i nnJ m l'haptcr I' - S(l n»s County Suutary (kMttaice.
pmpcny .•w ncr ulertr, to wbn:n lu St Cnd. l mmry Planning & Znrtmg lX✓drtttuol a ,:erallaatiw loin:, styteJ by tM
I. III matter plumper. p.u rte r toll plumper, r:,tnctctl plwnbct am lwcnscd pumper v tyinr that t ))the ttr.,ttr
. :or J.•poul cy,tem is to proper opernuttp nmJiion aril'+a 1 ]r offer ,ttspe%non acit laanptna cea-ra,ar. i, the xprc tank to
;nai I :till of..lt,Jgc
I wv. dw u:tderstytasl have rcaJ love, ab+xc : equtrcmcnts and agtcc tilt nuintaul :h; prr,'atr scwag: disposal .ygem with tdtc
Lill, cl forth, Iwni as wt by the lkpannt,vtt :•f Saba, Aril Pmfca.urtul ri rvvwc anal -.hc Dcparttncru of Nattuai lkc uwea,
%ta.,mnrr C'ctt:ficaunn uanryt :hat yow wo tic syurn ha, It= matrimmott :nest he enttrpicf0 anti rchtrtwtid to the St. ('tint
Planning & Zoning Dcpartntom wtUun Ur ,fay,if he three }ear c.prmnan date
I w: rcnh that .ti Utcnw•nu a/th
in.e v
PJC beu o1 mym knowtcdgc IAc airarc the uwner(st of the
p,ty'. rn tk:. a(,ce h. ,:rtuc of a weJ recwJeJ in KrFtstrt ai Dccds Office
\ mlx•r of bcdmoms
SIG\AT(RI nl APPLICANT(S) DATL
. • • A,p m6„LIUkI,:,. ihdt t, 1e,, r.rrptcacntot: nvy rewh in thc• ,arrganI permu being mvokM by ifa• Planning k /onmg IkpwlrrwN
h•, lode with w„ appiianon a r,;uukd wmraniy Decd titan Lite Kcdtucr of Ilccli, UNia• and it copy of 1M cc" 11-,.4 rune, map d
rct,+ c it made to the aanatAN deed
INE\. 64121
< 9 ° l ~ti8 it
.ly ~ ' .s v m ~ O r
J 5E e5 ~ Q
..1 ;371• {13),j (~~I,j f S I... S I }
,11 I I If
mI it l~~ IT
Ali III ~ IL. P. '11 ~'~I 1 1 I ~ i
W
II q1 II'l II Jill
I
!u ~u~~Inu14 ~ ~ -
r 1
1 V1V1V1414141
f u iltilii~~ 7U!ph•
, p
L Ei
l~
R-•x-•71 U I
i
1
I ICI
~I Jill
I'
I:., h 8
1 171 , t 41~ +,I I ~ \ I
;1111 8
,I
S
5. 9y 4., + v o `
+ n
+
J ~ ~ ~x q-~! ~ r I~. i n ~t N
I n v t z 5E y,~ r tb J Q
e,
<w >f~i ~
!R~ I
I •
I i f l
f...r...f /
c I 3
,p
L L
j+; 1.
1, eX
I I
{ II I
SSg s4 .x
ar ji
f F't I
t
i
e 11
53 ~ ~ ~ S t - ~ W -
~~5 0o t ~ d ~ M ~
of 3 a Q
h
. ~ - ..iilrl S~S~:i ?5~7:i ti~tei f ±'.i lti.• .I ~ ' "Ill' ;
zr,~ Y
d ~ II
I J~i din
%rf NN
Wlil.•i. v7
U
paj ,
' I
I
I
I _
I
I
I
_ IL
i
J~
I
z - a
i pp
1,2y
~~1
19
~ MpYi t71
V I I I
I
4
^ - '.t I 44 4
i
^I
3
i
t e ++EtBZE
Ri i i. <SS ~ q)~P: is
..i 4seer£a
s 1`
t L44 tL4
jqp
a f..
3
g 9
3 3~ ''E iF 3. i i
tn
j'8 b1 ii :`fgqif i i,'l~i> 33ia s35 11
3Q<i. r.. fiv
1J t 3, µ~t ,,3~, lost'-10 -ICo
9z3
yvrowa~D~breelaConarleQ SOIL EVALUATION papa I d!
Owfaim d Sefeq and slid hpa in aacadWM w1h Comm 85, ACE- Sol & sea EvaaaOar
Afloch onp4e me l*M m ppw r4l hw M 8%x l l .let n ece P n ERECE St_ Cro& Foci". bId rd bled b heand hd®tN Mimepd (1 . dr ecbD... nor6 s and bW d W - %D
Mod
03z-1 os4-i
Phew pr*lt a1 Ardbreadon. APR _ 4 By
147 Q
Properly Owns Jason & Ekwbeth Moe 1M S 21 T 31 N R 19 W
properly Owrrds aadklp Address LAt / 8adl t Sr6Q Nrro a CSIA! _ -
_
1803 Fairway Dr. 4 I _ _C_SM Vd. 1_7, Pp. 4522
Cat' Sorb ZIP Cade Phew Nuber J Cay _f Wepe 06 Town tku Rod
Hudson WI 540tH (715) 377-0119 Somerset 210Th Ave.
y New Corneehdbr the h Rerorm / 1enOw of beeaure 4 _ Coda dwAed a..Ig law raas 600. GPD
Rrpawwwt I PLLMc or caerarrarall-Oesabe:
Pe IF eeW W Gledd ouhvash Flood pfaah efsvrlon, a sppleabb no _
General oormws
• and reocnrars biftwo. Instal corvenlonel POWTS using two benches w M combned E.1 . S.A = 857.15 eq. Met elev. 91.00'.
Belay l Wong
> 1-04' a_ Set kph Rob
Pl Orpnrd Surface eyv. _ 94.98 0. Deed, to cacao lecsa
lawn Orplr Daeewt Cale Redo De 0= Ta&m STa1ao Caroslwo Bwdsy Race ~E GPDW
'EJTf~ -
n Mind Ur Sr Gait Color tr St SA
0,z 1OK" oars s 2fabk mvh ca 2fM 0.8 0.8
2 12-23 1Oyr4/4 none aI 2fsbk mvfr ps lfmc 0.6 10
3 2337 10yr4l4 I none al 2nfabic mvb 9w lfm 0.0 1.0
4 - 3750 - 10yr408 - - none - IS 0 ap d fp tvf 0.7 18
5 50-71 1Oyr4T8 none a Ogg a 1p tvl 0.7 1.8
6 71-104 t0yr5* mar r~ a 0sp d - - 0.7 1.6
- h
Bc" 0 -1 soft
16 Ph Grand surface slew 94.79 a Deph b l nik lector in id Arpraim Ras
lbran Dryer Omwhst Ctia Redw Deeopa Tasn ' Sbuvn Cuewlsrm Bandry Rah GPOW
n Munn CAL Sr Cat Cds I tr 5< 9r i •EfMt •EIl2
1 418 IOyr" none I 2fabk mvk ON 2tmc 0.6 0.8
2 18-32 10yr414 none - - Is _ -21sbk nrvb P -ttmc 0.7 1.6
3 32-40 t Dyr4J6 - - - none b 2mebk rtMy 9w 11m 0.7 1.6
4 40-52 lO r4,O nor s 0 tp a go Al 5 52-08 ,Oyr5i8 --none s- Dap a 11• 10yr814
log d 4-t /41
• Eflarwa f1 = 80D; ]o < ZSD mprl TSS >]D < f kmt 92 = BOO 30 not and TliS -_X rrg2
CST Nero (Plnaea PrYt) CST Number
- 3602
James K Thompson
Adbsaa AC E Sol a 5-b Evaerlons - / Dab Evamdioe Cor 6 Tal phmw NunOar
30 pabon U60 IJtns v1n 540M By132005 715-248-7787
P h oanar Jason & Fpa6dh Moe Patael ID a 032-1054-10-000 _ Paps of , 3 -
F Pt [Lana SwtL elev. - 97.07 R Depth tU brfty facia > I W h. j-ci iym Rar
Ha Do* Dmcwt Color Redw Dai p Tsdtn f.Ytrmre Caaalwo Bnatdwy Raab l3PDff
n MM A ou Sz Cart calm a Sz Sh 'E1M7 'E192
1 OA 10yrm na I 2fabk mvR co 2Mx 0.9 0.9
2 8-15 10yr4J4 none ft I mubk mvfr Oa 11mc 0.5 1.0
3 15-26 7.5yr48 none w 211 mvft 9w tfm 0.7 1.9
4 2&36 7.5yr48 none • 0 e0 d ya ttm 0.7 1.6
5 38-86 10yr4tB none e 0 ag Co ya tvf,f 0.7 1.6
6 66-116 1oyrw nom fa 6 lra 0 sg d - - 0.5 1.0
I
❑ B°'i'° • J Pis Crane Surf=* R OWM to MYip Mor _ Yt Scd Afpieebm Rmb
H.. O.PM OantrA(:olu Roam()mdpim Isows Sirciae Caaatatae ftoday Rom
w Wnwj or Sz Cat. Color Or sz 1% 'Em 'Em
i
t
❑ H ft a _j Beriy
J Pt Cratatl Sahoa ow 2 b UrtaYtp I@C*N h Sd AMkoim Rrb
Hn otpn [Last Cads React Deaopim Tale Siumn Caestav OmEdwy Rmb WOE__
M"d W Sz Carl. Cdor Q U Sh •E1M1 •EfIP2
• EJ%md 61 e ODD 30 -220 myL and TSS 130 < 150 ffq& • EnLat n BOD,- 30 nmyL and TSS --9D MWL
The lleputment of Cwrmc n m cqud oppodunity ~provda and anplo)v. Uym rw.al arafatm 4 enact -v m
nood nnlaW in an dkn ate fo naL, riot contact the do mun t at 60&266-3151 m TTY 6094261-8777.
■ So,Y e4la4r66 es, pi f 6y
T 5<h..,. Ef 1•2109102
I
. /otn![d /o roye. Sfa.PC
N ~rlv
~c to. 4 B/, ~a6ctt Moc /("-w
/oL ~ C5..1 /7~ySU,
H -e
J 1 b
J i t
1 O-
1
1
Bi
r
garage r e~ ■ es
Pio poled ~;.o
_ fK%dinuL ' '
.A Li -zo
GLXErCC C/.v ~ /oY.o7' ~c.o'co~u~r
Bl n
i
CA
o' 91, E
In 6.0',
T 95,0 Asso..,rd
J1 I
y 1~ ~
9Lo' ~tl i i t
,
3
7 `~~o~ 411 1,J 1, bPS sGaw, Of lA
Qt ~ P%ac P/a~6a'b'o ~ v Jl 4re ~ Y
1 ry
~ Y 1
1
z `
3of 3
en ,r mmrre PRIVATE SEWAGE SYSTEM St- Croix
INi' 9F M':gE i I,.
r -iri,; re-mit No INSPECTION REPORT .
488119 (.i
GENERAL INFORMATION ` rTO PERI:dITi
ti:a1e ;>lar DN
Persrn31 'Abrnl-.tan v Li; - 9.' h- .~1lot E TJrfdar': 9W:9SL•S IPnti BCV I3 I ?E I1 i(""I
P-r it tic de s Na°, cry V'I ~q, X --,,I hrt; Parcel IJ.: t.^ ~
Aloe Jason & Elizabeth Somerset, romm of ? 1054-1p ~OD
~Sf BIuI FIev h^o S6~fle'u H`.1 Dcicuof Un .:ed ~i I k=vie. =_:1.''air 'Ji_
21.31.19 269A4-
TANK INFORMATION ELEVATION DATA
I"PF MANJFACTORER '::APACITi S?i:-C`1, 35 FS E-E'•J.
I
Septic Ftenrnma~k
C^sr,g Alt 610
A.era6ur Bldg. Sewer
olding Su r-11 Well
r 11 Outlet
TANK SETBACK INFORMATION
, . _ - w`Ilt tc I r li t met
oeatu. 1 wlon•
I I -)osing lrleaoe,, Mal.
'!era 101 Dist Fwv
acing o a•is erl
flat ""ade
PUMP/SIPHON INFORMATION
7,757d .urcr Genie,: „over
Gr),a
J OP. Jfn le•
ILIR uc roc oss ~vs.em eas
aICiArt In _errg III I .I,
DIMENSIONS
J J ♦ M . c...
INI ORLIATION CHAMBER OR
UNIT
7. 71"
Pi__iyi
ngIL_ ;Pr- l e-7th _ Jia acin+d _
x Pressure Systems Only xx Mound Or At-Grade Systems Only
-I; Vc Yes No
Crdlfr r^Os¢c 9ec;Tr•:nch l.;.3e5 L:,--d YY
I I
COMMENTS: ;.nC ude cad= ds2'0eenn eS, pe5or.5 Present, e!C : Inspection #1 Inspecton #2._-._
Location: 4812 10th Avenue. SorrI V41 54025 iNVJ'.:4 NE 114 21 rE'97d: NA Lot 4 Parcel No: 1 3' 1'i 26S'40
I I Alt HLd Cescrictlon =
R::y sev:er length =
- an•o:mt of cover =
F ar revision Requued'y Yes No
L.se other Side for additional m'orrintior. Cert No
Date (nsepctors frgnakrc
SGU Ei 1r.(, r, W: