HomeMy WebLinkAbout042-1076-80-010
n Ue Pa. P-.01 CI GO trmerr v_ PRIVATE SEWAGE SYSTEM ry St. Croix
Satyr; a-.tl Bai di-g ri:ismm INSPECTION REPORT San tar, Pe-rnit No.
606974,
GENERAL INFORMATION (ATTACH TO PLRMIT) state Par ID No
PCT+anal irfornali ao vc.i pros IJ, -,q oe used fc, seocrdary Purposes ;Priracy Lava. s t5 C4 (T; pn;q
Pc'n,rt Halcers Na-e City village Iovnsh.P Parce Tax No.
Robby & Janice Narlock TOWN OF WARREN 042-1076-80-010
CST 9t.' LIEV l')SP UNI Flev 7777 ipticn rk rJCCapn!TEWef Range-%lap No.
n [>m I 28.29.18.436A-01
TANK INFORMATION ffDATA c>TYPE MANUFACTURER CAPACITY S HI FS
Sept ELEV
ic ~ '32 1,a Dosing .4~ w0. ~•"l
Aeration .(Holding 105•
SOIt outlet
TANK SETBACK INFORMATION
TANK TO WELL BLDG. Vent to Air lrraae ROAD D; Irlet
septic 'O,> I Dt BoCO•r
4 P
Dcsrg Heade•+Ivlan. ICS
Aeration Dist. Pipe
lea-6U
Holding Bot System
1'
L DG -W C, rtt"i. Final Grade
PUMP/SIPHON INFORMATION /o`f b(e
Man,dacsurer Demand St Cover
GPM
Model Number ?
1DH Lift F.n ctsm_css System Head f FI
t crcer in Length
J
SOIL ABSORPTION SYSTEM
BED!TRENCH `Moir ' f engtn i No. Of ',crones PIT DIMENSIONS NC O' P 7s _ Insice Dia Liqud Depti-
DIMENSIONS ik
SETBACK SYSTEM TO PtL BLDG WELL LAKEiSTREAM CLEACHII OR L''tr utacturer~ ' 4
INFORMATION v ~c DI ,ivs; en'.' i t / - UNIT IvIcoe N'..mLcf
DISTRIBUTION SYSTEM
`Ir,vpertMandold is st-ih~t or• 1x Hotc Srze x he e SPacrg Vent to i,:.~+
Pr: cla, r /
Le'gIJ, u. rl Lcugt' Spa'_ng-
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth C, Ceptf• Dvor 'xx Depth of zx Seeded+Sodeud - xx f.~ule^etl
>rNt-pr.'.n Cc "tC'r BCdTferch Edges MpSC f- J YES NC Yes I ' No
COMMENTS: ilncluce code discrepenues. persons present etc.( Inspection AT InspeU:oc u2.
t \
Location: 1127 82TH AVE I' 7
D
1 ) Alt BM Deser ptior = t-U E1.. - V.ci~ iwSto_U.c ~A s~ T ~eR.OC l-gee l:4si~^
( ¢ to cL 17 V'K
2.) Bldg sewer length = SUS L10
- amount of cover = r
>Li~°cov<.t
Plan rev s.on Rent.oc(P Yes No
Use other side for additioral information. ~/J/7I. - clots signature cert No
p.
SBD-5 t n fR 5197i
ItM(UCry SCnkcs Division TI cii .(T
1400 F. WasFumgtoa Ave
Cb )
j > 2 2618 P.U. Box 7 t62 Sanitary Pe®it'Mrnber (6u be filled m by
s PdG ` Madison, WI 53707 -7 2 I
lo6b 97L
co.,,_ ' Jn_ Application stag Tiamadion Ntnber
in 3=r ditnee wi . 7.1(2), Wt4 Adm CM, sibm. lion ofthis form m Ihr:.pla G dal unit
ig rtsN prior to nbtauting saat:oy puoul Not,. Appliuuumfxnarwsta[Lam eWPOWTSaresubmittedm Pmjact Addfm(ifddEEr lthmmatlmgaddrea)
the Depntnient ofSakty and Proti csmn d Stsvtcae P.i YW iniomuUmt you "xic may be used for auamdwy
tnxalNuaz with tlw lhivacY low. s_I )fm~,Stt1s__-- t" .f, ,~yTs
L A_pPSntion (ttforwlion-Please Print All lebrma ~ ~
plopetty Oswtr `s Name Panel A
1lritnceyCHncrs Matting Address PropcCtY [udim
; z 0 1~,' f_ r4ATr'2Y t~ Nc ~~.t Int
City. State Zip Code Phms Ntarft-, Suction Z`5
/Vul cmleone
f Ark ~ - D 7L'
.~11. Type of 8nildiM (cheek all tkal apply) Int 9 'I' _ l`~ N; R F a V~ `
A IV 2pmtily DwAhng-Nwobcv of Bedrounn_ ! S1Mivisim Name
1d a.p ` Rlorl W ~
[)PahEiea['txnmerusl-Ile' axike____ ^ i I
❑ Coy M
❑Statt Ovnted-Uesrribe USe----- CSM Nua~ O ❑VIDW of
own of - ttf ft:CrC/
III. type otpy...tL (e:keek ooly boa on lice A. (:otapiete disc B irappktable)
f5-A~
.1
bl Ncw Syale:n ❑Rgt4aznaan S)start OTmanrmJHoWing Tusk Replxaot'nt (key ❑Ckltar Modtficatteat in l;xiatmR Sysitm (ezplaut)
B. 0 Pernik Renewal 0 Perm! Rrvisiun f1 (]suet N'Pftantxr ❑ 1'trmit "Itar_.rtr to Ncw Lt:f ReviMts Perth NSmtber and Dale hn=J
[iufi it 6plrwum 11 Ihvecr 1) IV. Vet.eC%1 Sryslem(C'omlme~ut/Devtec (GTleok aR tkat a.PPI.Y)
No Pre ized M-Graunl / In-GmW U A4frffit 0 Mound?2A m ofatihdrkslwl 0 Motlyd<2J m ofanahksnil
r.)Pioid,-S Tauk Omv'D15peia7l Cotnpwau(rxptam)-... f~PtWrmnen ikvia (etplun)_
V D6~serstlfl'reat t Arco deformation:
Dcm.v Flaw ((6pd) rkstyn Snit AppltcaMn Wnn(t 3,1111 tk•Iposnl Anm Required (sl) t% p-ul Arch Ii.7 i yo- I 6'kvam
f
~C? (G r ee C l v~^ ,'I ce , c~ CCU t
Vt. Tank Info fapaxt ot ao 'V Mane
C:.dklm (ialldloos units
t s n I: ° Pi R
W..'1's~. pum~Ttokz ~ u " ~ g ~ t
SCp1X-jMlAg4;ank
V71_Responaikiiity S1>omeraenf- 1. Nr?adnap,oed aasnmr rrspoav_bilip ter imilaft m a Ila POW'75 A.. ew dw attsthed ph.
Pltmha's Name(Print) rphmhn' tiy.1n:,u,'~" ~q~.y MPNeIMf.R Then+ba Ruvrcss Phone NUUba
'INI~LI;1~rl I-AKL.`l i JD4'%C ~rr/CJ . 13,3 ~Oy '/J 7
j-Member-s Addtm(Sexl Coy. Stoic, Lip Codr) 4Ut1.5r l /~,y`.i ✓E_Nri,~, }t.f--- _t'f'i~7, w ---1
f Vlll. 'onety/Drrhen!
I Apprrntaf ~ Prr~m/u lcx DaleJ~`''~~ Q~ 1 8nu S" urr ~
i. m-_ 1 Ivrn Rc.va, (x Urn+al 5 7 • Ct>
i IX. Condiltar+g~ for IXcapproval
1. Sep(: k. cr 66t . t vn•1 P, it ~,r.~C kH fOt~~ L25G~ :j
ubuen-nccu- bf_jj -ics'rr-nt ,2L
1i , as p^r rnartyement plan erj W r:u,noe:.
2. AN nrtha!k rect r: 'enlffn,rA t.c -,,.^1. v ! i t
as per 'ppi~ rbf'. c.:ht /:M.rar;c.e
•rrrn u.~.o.rr-.nt..,.ro.,m.>w...-..,.i.~i..u:. in w. c....r :si.
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SfiU-h i92i i t;- 1811 i )
N of man Page Z of y
PROPERTY OWNER: _ 'iDU1 .7 i~CE 1" 40 FT.
(except where notecl)
Legal Description! L17-,' [1, backhoe pit
7'-C.,•q_ I.1!€"y' CtJ,' C? N 1.21E'C:U S7. C'k01g . L`t UjVTV L-CS Al
t
North
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Site location: r: P,n,
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PAUL 1 VF 4
In-Ground Gravity Plan
Index & Cover Sheet
Compw*M Manual Design References:
Version 2.0, SBD-10705-P(N.Oti01, R. 10/12)
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
Attachments: E
POWTS Application for Review
Soil Evaluation Report & Site Map
Project Name / Description
-zS3_ 7
- - 0
Owner Name(s): l~'1? v Ec-(- Phone'
Owner Address: i z% L: ^ rz f c,1. E, rI Nr t t1 t f y /14 , Zip: s t X~ _
Project Address: 11-1 7 :W t :trui
Govt. Lot: 114 of i-U 114, Section T~"1 N-R ! s~ E D or W Z
Township: ,~r°r+;• County:
Project Parcel ID ~L' / _ f ; G C i _
Designer Information
Designer Name: /U~ a,z --1o I Ju r r't r: f Phone: 7)5
Designer Address: ZcS~f97 Krti& ',z_rNu c C-_q_. t+Ki . Wi: Zip: 5919JC _
E-mail: ~l O l l i S~~rc~~~Y ( OL 110r~ _ COry~ I1tis apc "q.♦♦~rrrc.MpgiG9Wl stamp
y `
License Number_ Ik-A - 00 7
f• Ail.i0
Remarks: y t EiUpr-MRT
is RiV&R1,Fq6LtSy'
, 0i
%
Signature: Date: I fir:/f'
o-,f,~rl , ",Wad m each I ed mpy. ~
Plot Nian Page " of y
PROPERTY OWNER: ck)r,y :J±w~ r,L?:LVCK! 40 Ff.
(except where not(-d)
Legal Description: _LL7 I ~ 5'rt L$.u~-~~ ~Jv W 'Ci Cr i'kG ,;UJ%i uT_c'..=a batkhoe pit
North
~i'n xafr-~L,
, 0 ( 51j
°I`~ ,7JYV6N1 SC?'riC
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tl'~.R eft.
t`A
T-I \1
63
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Site location: P
:f LOT (
>V ay r '
^ J
z PAGE 3 OF 4
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PAGE 4OF4
In-ground Gravity Management Plan
IMPORTANT:
The owner of this in-ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to
requirements of SPS 382-384, Wisc Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall
be considered a human health hazard if not maintained in accordance with this approved management plan.
Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS ltlaimtainer in
accordance with SPS 383.52 (3), Misc. Admin. Code.
Maximum Dispersal Area Operating Lam ifs:
Design Flow = J' GC, gpd; BODE 220 mgC; TSS S 150 mgL-'; FOG 5 30 mgL-'
Inspection Checklist INSPECT EVERY 3 YEARS
type of use
u age of system
0 nuisance factors (i.e. odors, user complaints, etc.)
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 / drop boxes)
neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.)
extent of ponding in distribution cell prior to dosing
o dosing irregularities - it applicable (i.e., pump re-cycling, float switch settings, etc.)
r; electrical components - if applicable (i. e , wiring, connections, switches, controls, timers, alarms, etc.)
c 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)
o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis.
Stats. when the volume of solids in the tank(s) exceeds one4Nrd (113) the liquid volume of the tank(s) or
as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code.
c Effluent fides) shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12
mordhs-
System maintenance reports shall be submitted to the proper local government unit In accordance with
SPS 383.55 Wisc. Admin- Code. Report any component failure or malfunction to:
r~
!flame of individual or company: 1jr L_ CriV__Ly F'Ll, 1A%Pm) Phone:
Local government unit. t . P KU 1 X cu 4•,71 r'QaT udu u;,; t Dcef hone: 71 . ;33!, •i;O
oral government unit address✓ L,,u f<,-twLi_5b ---ZIPS
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin.
Code Repair or replacement of tailed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code.
No product for chemical or physical restoration of the POWTS may be used unless approved by the depattrnerd in
accordance with SPS 384, Wisc. Admin. Code.
g20#n9ency Plan
In the event that any failed treatment 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 failed in-ground dispersal component may be
abandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soils.
System Abandonment
lt use of this POWiS is discontinued, a shall be abandoned in accordance with SPS 383.33, Misc. Admin. Code.
l INSTALLATION INSTRUCTIONS
PL-122/PL-5251PL-625 FILTER
IIYMeme~hoA.t ~ Atr-s Hiv/N M: l
INSTALLATION INSTRUCTIONS
t
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W1 n;;CNtaK{,
x, t Step 2: Step 3:
~;le nutlet of lht ecpdc innk (A; Before installation. pace me IA) Glue the filter hou ny on the
r.v. crvnr and z r'.,~,•,) filter f casing oa to the, nutlel Pipe. outlet pipe.
,•.e f-- (Bj i. akd rwre that t40 hoasing (6) Insert the triter cartndge ill itte
I~ st>.~+ra4s is i,o,mor ed so trw OrC r can N, housing, making curt the filter
remove' Irom tits; tank or cartcrdae Iz prouerly aligned atm
ntau±ie„ance anal ixm'ptetcly inservd to the housing.
S'sSr' KI` ENANCE INSTRUCTIONS
~ 1 I
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ltA4aYtii®I
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S•~:, Step 1: Step 3:
i-e . r I• , iA; Remr:••~ tank oeC in i per-p (A; Inserir tite Eller =11rid1je back
n Y._ -nl~ into the Ih9 hous mg making sure
y ,
P I t ld' the Gf?er out of the housing. the filter is property I ,IIrated
:rs :mil complotn y i r3r3rt6`d.
+ • - f 1 rjecE rfi tart A.'!xr over the sei>tic hank.
sure at! solids fall bark into the (B1 Replace "p( w. tank cover
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7 SEPTIC MANUAL pi
_ W."6 US HWY 10 UAK" ROCK M -,47Y7 W.ii. OD /00 OAM. Ilm, 'POUG
\ ° 800-325-8456 xr rwzu~
'A=ETV AND SUILDiN 110Si'N
1';umGinn F: odor,( F.eme•,v
P.O. Box 2558
~f i: k0disar, Wisconsin 5370:-26511
S. TTY: Contact Through Relay
Scott walkor, Governor
Davy Ross, Secretary
October f I, ;'U13
INFILTRATOR SYSTCMS INC.
GOVUINMENT AFFAIRS DEPARTMENT
- 31USiNESS PARK RD
Pi) BOX 766
0' i0SAYBROOK CT 06475
Rte. ifescr¢~:ion: LEACHING SYSTEM, POL YS"I YRENE AGGREGATF
Manufacturer INFILTRATOR SYSTEMS INC.
Product Namc: EZFLOW DRAINAGE SYSTEMS
V oriel NuriLer(s). LZ12031-1 (3-12" bundles with pipe in center bundle in 5 ft. or 10 ft. length).
F71203HP (3-12" bundles with pipe in each bundle in 51t. or 10't. length).
LZ1201 P (1- 12` bundle with pipe in 5 ft. or 10 f:, lengths). F.Zt201A 1112" bundle
containing aggregate only).
LZO701 A (1 7^ bundle containing polystyrene aggregate only in 5 ft. or 10 ft. lengths,,.
EZ1203H CEO (1-12" bundle with non-woven georextile fabric installed at 180 degrees on
the upper side of the bundle, pipe in 5 ft. or 10 ft. lengths).
i FISA of EZ1203 H. F71203H-3110 o, EZ' 203Hf' ,n 5 ft. lengths = 25.0 sq. ft.iprodud.
EISA of EZ1203 H. FZI20,^.H-GAO; E712,32HP in 10 ft. lengths = 50.0 sq. ftiproduct,
Width = 36 inches, Heignt = 2 'riches, Max. depth of bury= 8 ft. l.
P~cd:h:T r No 20130145
to :uccifications andior plans for this plumbing product have beer, reviewed and determined to be in compliance
l:h chapters SIPS 382 through 384, Wisconsin Administrative Code, and Chapters 145 and 160, Wisconsin
S''.atutes.
[lie Department hereby issues an alternate approval to s. SPS 383.44(4?(a)1.a.; 384.30(6)(k) basec cn the
Wtsccnsir Statutes and the Wisconsin Administrative Code. This alternate approval is valid until the end of
October 2018.
This alternate approval supersedes the approval issued on 4'10:2012 urder product file number 20120139.
his a,ternate approval letter shall be incorporated with your previously approved plans andior specificatons
tpproved under produc- file number 20120139.
This alternate approval is contingent upon compliance with the fel!owing stipulation(s):
• This product must be instal;ed in accordance with the manufacturer's printed instructions, product approval, and
plan approval. It there is a conflict between the rr'anufachrrer's instructions and the product approval andior plan
approval, the product approval and/or plan approval will take precedence.
• When -his product is Installed in a dispersal cell that is sized based an the EISA rating stated r the regarding
block of the product approval letter, this product must receive wastewater having a 3OD5 valueess Than or
equal to 220 m, ;L. a TSS value lass than or equal lo 150 mq'L and a FOG value less than or equal to 30 mg%
or a monthly average.
• When this product is installed in a dispersal ce!1 Thal 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
dispersal cell tha' is horizontally separated f-om other dispersal cells in other excavations by a? least 3 feet. The
3-foot measurement is measured betwee the closest outside edges of the procuct listed in the regarding block
of the product approval letter.
Son-1654 ( AW r -ilc Ret 13014502.DOC;
-1Y INFILTRATOR
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Y~~. Itic ~'1' y^J' »:.qa 4< -IIC s -la r< < ,7. n
..ri.~ j, ~l.,.~ 1... ii r ~ ♦ 1• ~ r^o.'Ri'.T ,ll ~"rr ~tmJ a~ ly t
y • • 'F,. ti. ,r:. A ~y )rr K .,:k' r zrrS,j,~l. ~y~~ r ::_.t t/y ~ ~
` 3 ~f x ♦ y'r• 7 J! ,rte, tt♦Ca~`M1•~r~YOYK'iC~k,t: ~a'f e'~ri c `Er `2
_w. " }'~'C HY e• it-r~~~'/a,~Ar rn, Ly~ 'tyyz'~
~ ~>f'±1 K v ,F_ ~ ;+r '~:?:~::;tt$~r „~'d2 r; $.:~5-.s?'d
• Hund es an,, quick to install. a. aving costs cr heav l machlnel., and labor
• M061W construction a!i;.ws con':yxivnns ,o ma-Ch trench dimensi;ns for most _ys!em shapes and sizes
• P-no'lleerec fo: opiima: s°.or:a-0e unci absorptio'. r fidenries
;u)114 to t.unwur along aicjpod si ps arai around ilees of :ar,c::.c:.ilpny
• '..iontyvciont s, ;tem is ;,erfef far rec,&in. n(i tic it slf:
• Easily hc;nc-cawev In*,O position re:9ucr,g tlrfit-, arc lak:'cr
• fi' or 1c` lengths with simple snssp. internal Couplers
Easier cleanup at iiie job siie'roiii-I Jle ci'rr:nabon of scxfr.;
• M;:rn.'yf.hlred frorn tecy je rTi`.':lahi 'Rtt ei rhran :e Oiln!:rl rla,ilt;tl if-:o{)rce
• A .N ''.CIE V2YIF'tl' Of f11d1 .'1P_t°rS d1~G CCflfl•~f ir-Arica to fncc: i-I- allatlon prole-sonal's IIC0KI3
• Hri Coved S'1 many j:lflz.Ci^_; ors with Lin InGlea5e(1 effclCrr./ rata q, i-zx;ucnS3 drainfield s~zc
° L;aCKC:. e; ine leader i;i ate cr"5: to tndusuv
i
EZ
INFILTRATOR
Fcr technical assistance, installation instructions or customer service, call infiltrator Systems at 800.689.7Y59.
NI-il_TRATOR SYSTEMS IN(,
Page 2
October 11. 2013
Product File Noy 2012014`•
• `When this product's instahed in dispersa1 ce I that is sized oasad on the PSA ratuu, stated !n I-w rcyardmg
block cf trte product approval letter. this product mus' be instalied in a dispersal system, which has the in ;;t tine
dispersal cell at or below original grade of insitu soil.
Th s product must have geotextile fabrc that meets requirements of s. SPS :384.30 (6) (g), Wis. Aden. Core.
nstalled directly on top of the product and extending down along the sides of the product to a point at least
'r, inches from the bottern of the product.
T1-'.fi producr may be installed in dispersal cells in place of stone aggregate specified in approved POVAlTS
Component Manuals or Department approved systems. When the distrihution cell is not sized based or he.
--I;:.A rating, the dispersal cell area must be equal to or greater than the area required for stone aggregate.
his oraduct may be installed at a depth that exceeds the maximum depth stated in the regarding bless, of ,Its
;,"evoval. when the manufacturer provides in uriiing that the proposec installation depth is acceptable for the
[-Ovidual installation.
The ollowing slipuArons apply only to the EZ 1203-1 QA 1-12 ~n and 3-12 in. bundles with non wov;n
gc utaxtilc fabric installed at 180 degrees on the upper side of ;he bindle, pipe in 5 ft. or 10 ft- lengths:
When installing EZ1203H GEO in 5 ft. or 10 ft. lengths, the product must be instated with the geotextie fabric
r rri upward.
1V"en installing the, 3-12 in. bundles, trenches must be excavated no wider than 42 in., with a 36 to 40 in.
terc:h width preferred. (Although EZ1203H GFO is not, to date, recognized in the EZFLOW Mound Component
"'anual.l
Geotextile fabric meeting the requirements of s. SIPS 384.30 (6) (g). nstaVed directly on top of the product
and extending down along the sides of the product to a point al least 6 inches from the bottom of the product.
aVhen installing :nodes EZ I20314-GEO, the fabric width shall be at least 5 ft.. wide.
4. When installing the 3-':2 in. bundles, bands used in transport must remain intact during installation.
5 Pipe connectors are necessary for the trarsitior between differing pipe materials (e.g.. polyethylene
(!:?rrigated piping and PVC pipe), meeting s. SPS 384.40, and must be used to assure piping does not separate
dur.rg construction and backfiIhng. (Exampie; Include pipe connector such as AC-VCOUPLER 4 for both
s,:hedule 40 and 3034 PVC 4 in. pipe.)
For gravity distribution of wastewater, line distribution cell piping shall inset the following conditions'.
I 1 he cell Lulls ;bundles) shall be 12 inches in diameter r!- I inch,
2 The cell units ;bundles) shall be manu!actured m 5 and 10 foot leng[r ser-ticns, 2 inches
Tho 4inch pipe within tho bundle shall be rerhfisd as complying with ASTM F 405. Standard Specifications
l i (;ornlgated Polyelhyiene (PE) Tubing anc linings.
q_. T ho 4 inch pipe steal; be offset from the center towards the lop of the bundle whereby 5 to 6 inches of
aggregate is located betweoc the bottom of 11•e pipe and the bottom of the bundle, and 2 inches of aggregate is
lea zted between the, top of the pipe and the top of the bundle.
5 me 1-inch pipe shall be connected by ar internal coupling device, to allow rontinuo~_is connection from one
Ladle section to the next.
1 Thin end-to end gap distance between pipe containing bundle sectiocs, as measured from the straps fixing
:h-, meting to the pipe or from the face edges of aggregate on adjoining bond es. shall be no greater than
S Fiches.
The header or manifold pipe connected to the 4-Inch pipe within the bundle shall be at least 6 inches above
the infiltrative surface of the distribution deli- or the 4 inch pipe within the bundle shall be connected to the
header or manifold pipe using an adapter that raises the irver to at least 6 inches above the infiltrative surface.
• The E.SA rating reduction may be used in disper; al cells less than 35 inches in width.
1. The maxirn(.rn excavation width of the dispersal csll is 42 Inches for z 21 to :3o inch bundle
INFIIIRAIOR SYSTEMS ING
Page 3
October 11, 2013
Pn,duct Fire No 20130145
Otherwise as permined in th!s Al~crrate Approval, ;h:: stipulations ci the In Ground Sod Absorption Gcrnpone.nt
Manuai for Private Onsite Wastewater Trea:ment Systcrns (Versior 2.0j October 2012, fSBD 10705-P (N. 01:01;
N. 012:1 apply.
?.:ropy of the manufacturers' installation instructions shall be onsite and available at the time of instatlancn.
A copy of this aiterna:e approval shall be onsite and available at the time of insrat:atnn.
Additional information is included as attachments; to this letter; see attachment A.
granting Ihs alternale approval the Division of Industry Services eseves the right tc• r6qu r i changes or adci'ions
told conditions arise making necessary for code compliance. Nothing in this review shall relieve the manufacturer
of t❑e responsiburty for designing a safe component into the built environment.
The department is in no way endorsing this prodt,d ;u any advertising and is not responsible to, any s tuadon wh:ct,
may result from its use.
Sincerely,
r_..en A. Jones, M.S.
POWTS Product Reviewer
phone.;608j267-5265
fax. (6081267-9723
rmai!- g, r. r..joncsC4~wi.go,
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INFILTRATOR
4'v l . J J.' ♦ 1 . . . . a vV~wl C JV', P IT'
r . , „ 800.689.7759
www.ezflowlp.com
www.intiltratorsystems.com
For technical assistance, installation instructions or customer service, call Infiltrator Svstems at SOQ.689.7759.
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
1 AOW ^'NNERSHIPCER,TIIFICA'T'ION FORM
Owner/Buyer I o0 61 aA pl ! AVl1 G@ IV a- ock
Mailing Address. 12 0 3 Cr avAn, L QAP- UAV e N S S I Z L
Property Address
(Verification required from Planning & Zoning I e rtment for new construction.)
City/Statelowr. J W ode k Parcel Identification Number 0'42--)0
7
LEGAL DESCRIPTION
PropertyLocation OW
Sea ZP , T, Z9 N R I g W, Town of _ (1a~✓CV1 -
Subdivision Plat: 0 ?_4 _ 6S M Z S- 014 ~ ~ 2 ' Z D ► ] Lot #
Certified Survey Map # Volume - Page #
Warranty Deed # (before 2007)Volume Page #
Spec house0yesao Lot lines idcntifiableNyes❑no
SYSTEM MAINTENANCE AND OWNF,R CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance
responsibilities are 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 & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (t) the on-site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than In fill ol'sludgc.
I/wc, 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 Deparonent of Safety And Professional Services and the Department of Natural Resources,
State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the SL Croix
County Planning & Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this form are true to the best of my/our knowledge. I/wc am/are die owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
3 Y ~ ~a,~h.~~:tom
Number of be rooms
ALL
SIGNA OF APPLICANT(S) DA'I'S
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the cemified survey map if
reference is made in the warranty deed.
(REV. 04/12)
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Wisconsin Department of Safety and Professional Services% t 1 Page 1 of 3
Division of Industry $erNicea
SOIL EVALUATION REPO 96H7FVEF40AM8
J,J,,,,,•,,i ~r~. C;-. .1,--.-'L. `r In accordance with SPS 385, Wis. Adm. Cidc (:numy
Attach complete site plan on paper not less than 8 112 x 11 inches in sae. Plan must include, St Croix -
but not limited to vertical and horizontal reference point (BM), direction and percent slope, Parcel I D n
scale or dimensions. north arrow. and location and distance to nearest road tJ (0
Please print all information. Revie d by Dat
Personal inforrialio_nyouu provide may be used for secondary purix)ses (Piiv, I aw. s 15,04(1)(m)) / j2
perty Owner Property Location El
Dave Coyer Govl. Lot NW NW S 2 T 29 N 18 - (or) W
Property Owners Mailing Address Lot # Block If Subd. Name or CSKV r
712276 th_Av _ - 1 _._--I.. i_.-._..~$/ . 1 b-3Z4
City Slate Zip Code Phone Number ❑ City ❑ Village ® Town j Nearest Road
Roberts WI 154023 ___L(651) 399 4023 Warren _ t 1 W4Av
New Construction Use. L] Resdenbal / Number of bedrooms 3 Code derived design flow rate 450 GPD
❑ Replacement ❑ Public or commercial - Describe iJ~„y,
Parent material sandstone Flood Plan elevation if applicable G"- ft
.
General comments and recommendations.
QX~z ~ s
I 1 Boring # Boring
L= o pit Ground surface elev. 100 ft- Depth to limiting factor 70 in.
Soil A_ ppl¢ation Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft`
In. Munsoll Ou. Az Cont Color Gr. Sz. Sh. •Eff#1 Eff#2
1 0-4 IOYR313 SL 3 M BK MVFI C S 2 M 0.6 1.0
2 4-36 1OYR516 SL 2 M BK MFI C S 1 F 0.6 1.0
3 36- 70 10YR 416 S 0 SG MFR 0.7 1 6
I
I 2 Boring # ❑ Boring
L! ® Pit Ground surface elev. 98 ft- Depth to limiting factor 72 in.
_ Soil Application Rate
Horizon Depth Dominant ant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft`
e - l . Ou Az . Cont. Color Gr Sz Sh - o E##1
-Eff#2
1 05 10YR212 SL 3 M BK MVFI CS 2F 0.6 1-0
2 5-36 10YR518 ! COSL 2 M BK Mf I C S 1 F 0.6 1.0
3 36-72 7.5YR516 COS 0 SG MVFR 0.7 1 6
i
Effluent #i BOD. > 30 s 220 mglL and TSS > 305. 150 _ > 30 s 220 mg1L 75S > 30 s 150 m !L
CST Name (Please Print) l Signature CST Number
Dale R. Stewart 220879
Address Date Evaluation Conducted Telephone Number
757 107" Roberts, W154023 11 /01/2016 71549/-9996
SBD-8330 (R041151
Boring # ❑ Boring
111 ! ® Pd Ground surface elev. 104 ft Depth to landing factor 70.n.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture I Structure I Consistence I Boundary Roots GPD/Fe
In. Munsell Ou A7 Cont. Color ! Gr- Sz. Sh- I •Eff#1 •Etf#2
1 0-7 10YR4/3 SL 2M BK MFR . CS 2F 0.6 1 0
2 7-24 7.SYR416 COSL 2 M BK MFR C S 1 F 0.6 1.0
3 27-70 / 5YR416 COS O SG ML 0.7 1.6
+Z -
L Boring # ❑ Boring -
❑ Pd Ground surface elev. ft. Depth to limiting factor- in.
_Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfW
In. Munsell Oa Az. Cor Color Gr. Sz. Sh •EH#1 •Eff#2
I
I Boring # ❑ Boring -
❑ Pd Ground surface ebv. ft. Depth to limiting factor _ on.
Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft'
In. Munsell- Ou Az Cont. Color Gr Sz. Sh. •Eff#1 •Eff#2
_ i
Effluent #1 = BOD. > 30:5 220 mg1L and TSS > 30 5 150 mg/1- ' Effluent 02 = SOD. > 30 220 mgA. and TSS > 30:5 150 mg4.
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