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HomeMy WebLinkAbout032-2023-60-100 (2) wiisconsin Depanmonlof Commerm. PRIVATE SEWAGE SYSTEM Con St. Croix Safely and Building Division sanitary Permit No. INSPECTION REPORT 606980 GENERAL INFORMATION (A I I ACH TO PERMIT) Slate Plan ID No Personal iufmmanon you nrovide may to used for secrmeaq pr.(r.i lPrivacy Law. s.1 s ae 0 jintll Permit Holdei§ Name. City VII age Township Parcel Tux No Craig Latourneau TOWN OF SOMERSET 032-2023-60-100 CSI BM Flee Imp RM Elev 131.1 OcsenpUon 1 Seclion.TrrxrvRan ,eaAap No- 160 13 y✓~ i lva 06.30.19.562D-10 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS III FS ELEV. Septic PO ~e I- Benchrrlark XAA !ee All. fBM - b~ F11M G Cw 3 Aeration Bldg Sewer Holding SVHt Inlet I SVHI Cutlet TANK SETBACK INFORMATION CL - a r 95.71 TANK TO Pit WELL BLDG Vero fo Air lotake ROAD H G Q ffwr- Yr1 1, T, /5• i-7V Septic ~ S. ZL / J 14.1-25 Dosing _ Header/Man. 5 3 Aeration - - - / Dist Pipe ai 03 ( . 05 Holding - - - Hot System 7 qg .o'S .O PUMPISIPHON INFORMATION Final Grade 3 C, tit Manufacturer Demecd St Cover GPM G.l [Q `I IG' Model Number TDH 1 itt Friction Loss Syslenr ycad--- TDH Ft ! % - Forcemaiff- t_engill ia. Ost to svel SOIL ABSORPTION SYSTEM BED/TRENCH Prutm I enni- I No. 01 lic~•nches PIT DIMENSIONS No. Of Pits Im a Der Liquid Oepm DIMENSIONS 3 Z 11 - _ SETBACK SYSTEM TO P+L BLDG WELL t AKF,STREAM LEACHING Iinntattur~reir. INFORMATION CHAMBER OR!I dL_ Type Of Sv`tem 51 I zo I UNIT Mo el Nu ter Ib•5 7 A ,,C dv~ / DISTRIBUTION SYSTEM t^A-- ~j~p Z 2Z oti C ✓S I Icadofil i i 1 U. sir moron x Hole Size x Holo Spacing Verl to An Inlay vipe(s) _ L,3Q~-- 1(L+.A• Length, J Da 61-11.eNtl ` Dia SFadng - SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Ilepth Over / Depth Oye, xx Oe.Pth of xx Sc do •soduua xx Mulwwd Bearlrnrch Center 3,27 Belntench Edges 1OPF."i Nc A• ~ yes No COMMENTS: (include code d.screpencies• persons present etc.) Inspection #1 inspection #2. Location: 1721 38TH ST 1 )ALL BM Description = /Fr L- //''6 o " C. 2.) Bldg sewer length= GXiS~~G - amount of cover - I J Plan revision Required' Vies No 12 1 1$ 6 3 " Use other side for additional information. Date Insep of s S~ "no Cert. No SBDaiT t n lR 1s,5!j ~~ar ;'t51J _ Riok ` I Industry SeMca.sDWAIon S or+p I c -r` Nu..ib:v '1L-:I in I ; r _r r ` y P$`+ _ 19 2 ~i 1400 E Wash ington Ave t1G 4 P.O. Boa 7162 Madison. WID 53707-7162 S. 7' 1 ~ t .?3x1ftarS7-'Pcrmit Application c na>rdJncc tif: SP538f[t Iw 4dm. Crnlc, submission ofLhls formtr Jl r yvir_d pro to obtaining a£.nJ: pe i[ \mc A plnationmms fU SLtlc-:,t aIVV lS r J.r t r,,,~rN ~1u -li: ,ilf:,c tLr_ v: nli.;. n<'d*css) lt~ P pcnm n-aCJzlcts and nts=,nn rlc-. Icn>n n.n:nntion ynr pro de q ( t acs In nccc-dauc ivt 4.. tncr L w s. l~.(1 r i l n-IiC-ary _ ~jy. I -7 . ApTilicatun Tn formation- Pleas, Print Alfa t ition Z 777YYY GJ ~0-+DUrqea LA. 2 2f Z3~ r-only0 V:rarlinQ A,:drse Po Le tran~ 1 Pc~l' C,,1 Lot I Z'p ode 7`boo<Rumber 0G ~ vDM~f?5 iS n2~7 ar~~ TD n oQ \i Tl•pt of 5 6<ling (check all that apply) 'v'a d - . i,. ^ r rr y h...roUin_-Numb- o Dcdreons _ l Sub Uvisiol "c 4CQtwl ~ IicC.omr.+crcixl- Urscri`e Use i C ay of Sis[c O,,:rcd Urscribc Us C$\iL;uhy;,7. 1 1i~la~c a[ - 4 J~Omi°( SST w 2 2 k 2L - «~o 4,74 3( i - --i- .'C~pc of Permit: (Check Quin on hos on line A. Complete line fi If J,IJ iisiv.r. 7~n .l~n Sy sicm. F.,-.Ia:ement $yaem lrc.=.!nv etHoldin7 i.,k Hc,rt.'r I; n•, <,:.~:;icannr ;o Lr <i fS.~n /.,1..:. E- '+nc7dJ Li'crnr Rcu<iitn I'C'ha, ccfl iur ncr IrPc r,il7rnn fc-fn Kam. ` nt'nIIrrl.`y[k~~jT`ytil rd " em!Component.rDevicc (Checknllthatx n zr :nL Sand Pressu,17edh:-0round ❑At Grade ❑btonnd>2~i in. efsuitablc sna ~r J. r+, r 'snc-seI Cnminxmn: (expln'nl. _ - rctrastn•cn ~ (u.; la nj _ ; ^r+ d:7rest eat Area lnfottna0nn: x /rl _ 0 1:4r t t~rnP kt3s1] ~Ua 7S~- r (~fj C1-~..I:1 _u - ased( i) Sao •.L r.. -/~t}lL/~V7) ~ dj D c t S V 1 ' info l (spz-rtj in ` , t C' „S I C c.- i t s T1l{cY- (HN+.4 tr p- i L !n, ns _'xSxEnp Txtia ~ o I 1000 low I nhh'St'1temCn(-t,th( -..,dcrsignedm. res rc sjbilify fur n+r HA,,n of fh, POk TS shown no the anncbrd pions. ' ' '1 P~ mh S: ..r - ;,SP Axi 7 S Ym:. r ! llustress Phox Numb el ihicrat1 L))prut4er col ~ 73 17/5 748-L5 /X `u`s ~.,~Yyr. ^c: so ,fur 1'•isapprn\al 1. Septic tank, CItIGGn: fiRe'rn•t osprrs call rust all be.: -cj_ s'r •-'th:_ S: as per .nar.3yemen' plan p c. inF by ~lu,noe:. 2. All aePo+rk rcct,iwaen's must Lu iar(r.L ir.6 a as per r{>cau'bls fwd'! ; .Mlaxwr-t, E!, V U FUHECI(6UX As A»:~Ae~ C!ICC{ dOX 55 AIPtICAYI E ❑ SOIL EVALUATION S QSYSTEM PAGE20F SIl'E MAP r) zC 30 40 PLOT PLAN PROJECT NAME; -a fiftpCa; q: nFS GUrr_ow. 1. J _cPn Attach design tbw ca'culattans for commeroal plans. PROJECr aCJ ess: ,I v % .30G r~' •T G r - ~ Pipo Material / ASTM Standard f 1 aDles 384.30.3 $ 3g,7 j au S,m: u j ^ N ,SanRdry Srwe- f•' y~ , 0.5 BIA [hvanort Fr SM Desc6ptim: _ n! ! v. ( 7 - _ / J,,-• r' . . Forc,z Mic_. L J j, 5'npe G:mlcnl t-41 Y/n!b}•mna'in sypirplAe): IMPORTANT: vrrw-ma wen: O +a•:rse,6i~o.• Inn+fq%Mmc im. Show ground elewa nn contours at suilHNeintervals. IJII en i / r ; hoc 1 t; ~Yprr ~ weir ! _ ~ I _ t ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXIS'T'ING SEPTIC TANK(S) 'this is to certify that I have inspected the existing septic and/or dose tank presently serving the lollow ing residence: (Street address) 70, 7 loc, d at: iti'e`_ 'A, ~c 'A. Section 0& Town 3v N. Range_ fC ~ 'Town of Y,x; f . St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. %lost recent date of inspection or service Did How back occur from absorption system'? Yes_ No (if no, skip next line.) Approximate Volume or length of time: _ gallons minutes Tank Capacity: > Construction: Pretab Concrete X11- Steel _ Other Manufacturer Of known): - Age ofTank (if known): Pu-mit number (if kno/wn) ~~1 ~7 _ (I:icensed Plumber Signature) (Print Name) V57 73 - - (Title) (License Number) MPAMPRS (Date) Norm 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. 21?01' D ~a7t ^f Safe'rp anrd profesc!anst E~Js9 2018 '-)cJl y\rkVI-i_Ii; ~ PAL ':n0?'Indtl5llYS°."V!CeS rf.j:o„~._c4 In z=rdenca 'DYn Adm ^ct;e °t~s,,,:•, oornp!oto ells p!zn en pgye I v taxcli>lNtt}9 9"?1lcnes Ins 7a, r'ia:r tuat rr r 'r'V l In9t;uo oJtr•ot<h TUWAo'eergcalan ,rUOntc~tro'oran,.e,aO~att(~w~,Ol~ctlona7d I o °'~`~~^^_°°w-^~ ;.ercentslonc, scan of di narsian, ro to Nrre••v, end Ia06Y0q and ti'sfanc < o to n^cr%a94 raad s ~ " . ~ - ~J _ l ~ hlr3gh(e 'afd~2 aY1 f41a`4f Ae 9F7S~alxd Rey?v.On ' Cata~ fewael nFwmetlonyauArn laun~a to bzdtu8. f 7ei:.J'14nor s ialnda.;p_tnnosos tadvsd•au:,s@C9l1)U'~'i -.s t~l':iparlf l-OCfl!I,y l - :t?Z" Yrolrsr{'y'Gam0-el ingA._ e,; U~Y ~h Co ~~Gi_.tiS£1sy 4.... I1 Iti \G c( to a.it c 11 nd." C^; ,'ls,~ tCi ~~'n Od@ Ph umber s - ~ ~ Jed Ora iC ~ '~B'•l0vnMOrLLCtl0l1 U60', 12651,9!7.~lUlYtaei:.Ci ~ndrCCiY'v _ C'003 eOl;s•Cd dUlgr'10'vl ~~ac!easmen'. G) '-''to!'r. or or coin, aarc ln!•Cascrfgs; % ~ ^-r---~'`' P'arer.Fnlia4yda! Y~ O dpi - - _ - r ~:lofr~!ala9io:etcnifapp!I ac'a ;srs-f cOmmona 4r3 it ommsrdavona: , ~ COt'n c P C' aurri su tsce avi, O f ao'h Yo m tlrg °'ecio°>-731n, SO11 fiA 'caita7 Rt 1e r. tzan ge~tn blh'na ' Gota Rudor~-- pes+rt drr, e• ra si t.c:c,ro orl yF=r,co Ornlyds _ telunso!I t i 6z. 0". C for 1 ! Roofs EI Cir...l. fW2 -3- 31..7 _•s 3 ~i ..~._~tr _ Boltng i Pit t?ro I ,d snffaue t a r -L-.~._ ft L' Yn h, to l!ralnE SOOmr ~ -241 tn. Fiodzon I:OAHt Gom4lart Co'cr Za9o gescrl' Inn fsxlo c tll~lg1~ Rnte Coon. Color 04rlC we nhslO4a>n ftOUrdo od "1 'oi' . GPDM %n Vunenti emu. Sz. try yi yn 3 1~ S t _T_ I J ~ 9.'~i , Yik {l~ Y L ~ I ~ { • ~ ~7 434r.` rvabl--~ m~F~ - 1L J ~ ~ _ ~H,Gerti?Yn3q'J ,>80<1.20, vii;, tl'1'ES>3^, 156{rlgi- I CBTNenO`,Ptcese K:t;' R>lusnix.2=POC~<_3oMg.rLTnd S at d r;S7tv'vm'~a'rrl'rL Abdrass _ ov r~t~b~~ ~~7~~ 5l ~ ` UatawaluaH :Cor~u:2e„ ro!onn Ie(\urr nsr o-1ng t+ I J E.crlne h ` - - - Pags ~ - of , } Rrt uroundeurbaede~ 97 .tl ~e f ;u! m Crgta ter 7 J g.• hnrrnn Derv aa,n:tsn;COiO^ Retto,t s >ta,ion r Spl A I~p '""1 u, l oi+lc'9,Irc ^ C8 ,?t.;,o. J In aunee:i (•c!c ~I vz:, o:isis;etl t'soan ay ,moots GNDM W4, z Coit. p - _ J II ` I •--'•-.z i it .w I Uodttg;¢ saNN l' f-it t, out Pis rfew m, K, De~1,tn 4c ~R IN tq Y o u ~ ent COlot t ut@oxDC.n- taPoo ~Texiuta y r .Cat'01lJr•.,: _ sal vOn,i tla v'u c9r 4o~nt. o Q~ r stonca • %r Rocs OP.7hla~ 0.1 I ^1 t3orrc,• ` P , ~rott::u smfiaCe cis'e. _ ~,g, Ccu;htc aming factor cr4Gn 3n,'i lattci r?,Col -r f ly ct' Rcdc:ti:3sCt;nt!ot. i Te:dwv + CkIcr " m011A,t;o!IOrtlonf~aTI rtat,oe•' @uurdarY Rests s Gu, Sr. Outf • OF Pc `sfti',terta~9wEgD.a:•30<220mg~L:xr9.1'SSa3gg1ERmg1L "cf6datl tX2xE7^,C 4 3o rv r.L , all nd 1'ss L,;io m91ti Clue. TJep:: of SakiS j .nd,P.;okBxs?pral sorvlce,3 Ss•cn ogtaai opltorraui y oorvlco yaovtcor and emplo'rer.. if you nred assfsPancO to ac O9st arrvloos of nr Q Pcria: Ut eel alta aate fCenat corrzci the, &parlrnerc at 60S 2b5-3:51 0; T'.t ti r uoi zap,,.. Pt urca,oauraaer 97, Jrit C`~ Woazvn Ce 1t~ '~w a try c : i ~ IU S fyrl ~ I, . F m snt Cvior _ F.ec w ~~asr h 5ar Y,. I"'_"tl ' tlan P'Ye'_.j -F,~... !r~ hILb6£ r~U , r1R. S}U L:rt 0~11918t©.1~' at:'I;dB ROD,$ QADi' A ~ C17.. Gaa _ 1 I L ~nnp,k I., ~a~ro ~ r' P ft' cur surfa u Modzo. ~ ~sI N ' '!tom ,nsl w51vi ~ ~sF+r c h~~t9'i~. to r.,~'•~_ f o: > r of ml Sral vaNnh Rato I ; f u~1~+o1 Ci ox r'o7i iar Torttu ~ ^„r ~c^I r wi slat•n::a f63uad50' 4oo:e PC1F ""•BwmxR+ I {9o~r~ pt, v"aaadtr,r'ac8+te~ _ >;z.0;r Wen+n ~~:7amrtir~ticic'• F:£c:o>'.re~ V~tlffly ft 9an ~ " _ r r~ ux wonarwia' urda:Y Roos ~allAmq'I e i I ( i z _ 2.,ro .Lent"G p to lyf(resrr>42 n 0 a ~ 9,^,tn~u': nr,@ TS~• w 5@mpri: n.~,( rl'.+aCQ„rO.a31a~A01 3B: C1u..5 'SoG.r rIF10 ,)~;'S.tllth 4t.i 1L' it •:...c ~ _ ` ii Q J e7 ~ ~ J r,1 v r3 re\ r C IN J t \ X lb i h : ~Z' ~ o s JO M n ? Safely and Buildings Division 0 201 W. Washington Ave. -P.O. Box 7162 S;utiinly I'cmul Kumlwr im he tilled in t+y Co.j ` SpS Madison, WI 53707 7162 -S nftary Permit Application 0q State Tmncachon ♦umh r In use Nance with SP S IXI NO). P'I, Asia, ( de whnurul•n al sou, imm hl the appwt,n d i omcrnmcntal/and _ ' Is rtym eJ poor to bt.unine a s umarv IS'mm Non' l pphc.umn Ibnns Inr sync-ou ncJ IY)i1 iS arc suhnuucd h+ Protect Adti drecx dddtircnl than mailing address) dm h4,vUnrn: of tialch and Pros tonal Sen I :'ennnal ud~mnau:m you plnr iJc nail tic used f+r v rnndarv ~ L !m ul scanlm,t wllh lhclmlcy Law, IdyllU:mi Slats. _ ~/'z7 3p 0~ ~e° 1. Applicalion Information - Please Print All Inlogi7maltion Pared s C I'uy soft uwn:r 1ulmp :Wdress lropcnyl"canon O(v. 30• l9. a IQ l7L? J i at State - /q) Code phone Number se tian . of Building (cheek all that apply) I Im r ~ ❑ I ur ' famA IA+slhng \WnN'n+t IicJnronu Sulxhy loon \mle 6f L 131ock a _ I'uhhc ( ornai ml:a - I h-,anhc I I>c I _ 1 n t IN or ( SM VunlL+ct ~ _'col - Smtc Ownal- Ilcnerihc l he 30~-7- U Vdla n'loxnofy'./~~1r e~ Cep w 113 ~Z3 C~.v ~~rs fe I P 3 17~~ I I I.'rypeof Permit (Chh one box online ,A (:omplcte lint BifaliiP Ie) ❑ Ve,e Syslent - It 'placenlem 1'\, ICI" to I :ooant 1I rIJin" Tank Rc ' ))cut Only Other Modification to 1-sl+lmn, System IeyplainI tIt. I'innit kol wal . Permit Rcsishm lit], r vio per ran Number and Dale Isslgl ❑ Ch, nv .I 1a, I'emul l ranstir to New Z$-,} /7l Rulcrc F~p:num^. Uwact 11~J'Tpc rrt PH~F-1~~astem7Com unenUDevice: Check a at a) tar) _ _ a Ihi .u vc 1 t. I m^d~ Prc,,w ed In-anamd AI-0r.lda I Mound _ 24 h1. of suitable soil ❑ Mound - 24 in. of sunah1cf oil~q,y.~pQ.f~ IIG tart- 7 Inhcr ITpr,Ii; :p.n II1j~lain. ❑ Pnlrcunx.nl Dcsac Icsplaini V. Dls oral I'ICltment Area Information pCC~n LL(t%l1G2 ~i l Z rV: L✓~ - - I>:. n e Igpd Ik'vr' A it A, ph. ul: k:J(i pd l Di,per al Ag'I ltupumd {s1) 11"Put d 4lca Prop, I I St stem .:Icy uhun VI. Tank Into tapa m in 'I sal kol Nhumlaclura (Ial.,m Ilalhnts I.[Ills O v Neu 1.. I,, I cslmF l.mk+ F o y y r~ M111. Responsibility tit a tvinen t- I, the undersigned, assomr rrsfantsihilily far iimallation of the 110N 1 S shown sort (he allached plans. I'ImnlSl m: , Trion I'hlmhcr SI •namrc Nil' NII'RS \umhcr liusirtcs: Phww Number ~tf5'7~ 7i5 7~b' Si(s_ I'Iumbcrs Addres, iSnevl ns State ,/Ip(7"ki l VII 1. County/Department IIse _ C- - uree Date ssucal lsslllrtL:M1 tSignature pprrvcJ pp~n+ytd ~l Tel 7i: R \,lu h,I Dcoull ~1,~ l ConcJ "6TrW.V0&"rltea%ons for Disapproval 1. Sepli~lark. eiflt.cn: IBIor VlV 3) ~a,.y.~ t✓C~~'t ' oy~ ~r 1( J oiFa^ cell oUsl all pgy^r_IC:_s't.u tire ieo -asp),,nar ayemen'. plen ~•(,:iae'I LV Vlumoe:. 2. AN selllar:k recuir.'rens mast ue ~ a-,M;➢f ¢ T1 ~\,N.?~jJ PCB J K 1i1 u pM itpFi~csbls c.ht i :M'^a.ri.! 4M ~Q ~ %tach to «o splete phm, her the eyaeln cold whlnil to Ilse ('Quit, unh on paper not Iran than : c I I inebn in we SBD 631)8 1 R. I III I I OHc^.1\Li G:i Rte.\vpJ:145-._ Ch JK GOI Ai..WFI ICOHI F. ❑ SOIL EVALUATION s te: r=za SYSTEM PAGE 2 of i SITE MAP ` 2`. 30 40 PLOT PLAN ?ROJECI NAME. If grid, F1 Mv Attach design flow calculations for Commercial titans arz'vJFCT AD~P.FSS J = ~'e.,%~ . { + Plnr: Material : ASTP.r Standard fables 3863..^.-3 A 384 30.5) RL. ,:yn:.ct {~F 6Ae Ercunlioc y I Sav3cy sexCC Y Force Nnin L:m:,,le r~no- m IIdF'URTAN7: $IiM. G:'virnt (l'.) i+Jc'-L~/mb:9 (i'npilifAblol: 0 c: rcnVq ~:~anuv C Sam, y.. uurA HIPVdhtrl enninors at Suitable intervals. _stca:aee: smc:.nnr.,nnw ire. + i I 1 + I fff 1 ~ T I t f' C j'j~.•,~~ I I I t I . CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name Owner's Name -_d"`✓~A I~(L~ 11illg Owner's Address ( 70 C~61R1~ t' f 6tir~ 5 ~ ~ 7 Legal Description. Township County Subdivision Name: Lot Number: Parcel ID Number ( D L- 2-o L-~) - (pQ - (C(/) Page 1 Index and title Page 2 Plot Plan Page 3 System Szing & Cross-Section Page 4 Fii;er Specs _ Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments Soil Test & House Plans / Designer/Plumber: ense Number: L~~ Y 73 Date: Phone Number 2167 765i - ~ /LS Signature Designed cursuanf to :he In-oroand Son Absorption Component Manual for POWI S Version 2.0 SUD-10705-P iN.0v01). Page 1 ::.•SC411 U:f fs fP]upLLL ~ Pn Y. AS W'n.ICADIL ❑ SOIL EVALUATION D S le: an 20' 30 n SYSTEM PAGE 2 OF SITE MAP PLOT PLAN PROJECT NAME: rsnarm DFMN FLOW ) 5' Attach design flow calculations for commerdal pals. PQ0JF(.T ADDFECS: 1,72 ?87:, 4;,n.1-.-.1- /'z Pipe Malcrial i ASTM Standard (Tables 384.30-3& 384,30-5) N San Wry Sewer:___/ BM SyrrCCl'. + did Elewlliar: _ FI lei L L?~~~ Four Llal¢ BM Descdpuon: j ;tape Braetm C%) mapme nom, Ey IMPORTANT: m ?esB.H Arras, Well *mw (d aPPrcaGCl: O aruni~zr arwi SMUw ground elevation contours at suitatile intonrals. x tae sOCwprTC IM. I_ I I I i I I I 54~rtr c tnH Ic- I I I d I : sell Y f ~ Soil Absorption System Cross Section Final Grae I/ ~(J 4' Schedule 4o I ~ Gov" PVC Vent Pipe 1i With Vent Cap ft J Leaching `f~ OIy Chamber f--- Sy m A vation r _ ft -3 ft Soil Absorption System Plan View ft ft { j ft Leaching Trench 1 Vent Or Observation Pipe Chambers R' = 4` Dia. Trench 2 Header y `Leaching Chamber Specifications Manufacturer And Model ' 1-,/r,Lcla; l~'tat r k EISA Rating _A) - sq ft per chamber Soil Application Rate gpolsq It gpd Design Flow 3 Soil Application Rate i 2()_ FISA = D Chambers 2 rows of L7~ chambers each. Page of Y~ _ II ~ j. I \ I ,I~ I JV \ - - ` ~ IINN d 'If O F v 'c l °n p ✓l n \'r♦ `I V c K o ♦ u ' CeD u \ vjw ` c \ i' i F>,~drvy.y DIVISION Of INDUSTRY SERVICES }0- Pltmbing Product Review \r\, P.0. Pox 26511 Matll-on, Wisconsin 53701-265Y. {i SP . TTY: Contact Through Relay Scott Walker, Governor Dave Ross, Secretary March 12, 2014 1 IFETIME FILTER LLC MIKE HORNBACK 146 CLIFTON HAl_i COURT SHEPHERDSVILLE KY 40165 Re Description: SEWAGE IREATMENTAPPARATUS, EFFI l1ENT FILTER Manufacturer. L!FETIML FILTER LLC Product Name: LIFIL I IME EFFLUENT FILTERS Mocel Number(s;: -T 1/8, LT 1/16, LT 1/3? AND LT 1164 [SEE ATTACHED TABLE OUTLINING: FILTRATION SIZE AND RATINGS IN GPD] P-oduct ~ilc No: 20140048 1 he 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. T•is approval is contingent upon compliance with the following stipulation(s): • Installation and servicing of this product roust 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 lank explaining that periodic cleaning of the filter 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. The department is in no way endorsing this product or any advertising, and is not responsible for any situation which may result from its use. Sincerely, Gler, Jori.b .S. DOWTS Pioducl Reviewer phone: (608) 267-5260 tax: (608} 267-9723 email: glen .ones(?w'i.go:' rl li',l ^bhG+_rh_'e+u; 1 ila Rot: 141P)4911t EA)7: POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity la gal C NA Pzrmrt T_ Septic Tank Manufacturer fr- O NA DESIGN PARAMETERS Effluent Filter Manufacturer Li to ~tML _ NA Nurnue• of Bedrooms J C NA tfiuent Filter Model C NA - V - Number of Public Facility Units V NA Pump Tank Capacity gal NA Estimated flow laveragel galiday Pump Tank Manufacturer - ANA Design flow (peak), (Estimated x 1.50 4-50 gal%day Pump Manufacturer 37 NA Soif Application Rate r •j gaUdav!ft' Pump Model - JZ NA S:nneard Influent!Lffluent Quality Monthly average' Pretreatment Unit C NA Fats, Oil & Grease IFOG) 530 mgtL ❑ Sand?Gravel Filter C Peat Filter 136r:hemical Oxygen Demand IBODS) _220 mg.1 r~ NA ❑ Mechanical Aeration C Wetland Total Suspended Solids (TSS) 5150 mg7L C Disinfection O Other: ?retreated Effluent Quality Monthly average Dispersal Collis) ❑ NA Biochemical Oxygen Demand (BOD;) _'30 mgrL 0ln-Ground (gravity) C In-Ground (pressurized; Total Suspended Solids (TSS) x20 mg1L X NA C At Grade C Mound Fecal Coliform {geometric mean) .10` ofw l OOm:' C Drip-line C Other: Maximum Effluent Particle Size ?P in dia. C NA Other. ^ NA Jthgr: : _ NA Otner: C NA JIhF': r :values -yp:w for dom_srir, wastewater and SP.ptIL :aek P.tfIUP.n:. ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tankls) At least once eve y: 3 A' yearmonitshi)sl (Maximum 3 years) C NA Pump out contents of tankisl When combined sludge and scum equals one-third I?j) of tank volume C NA Inspect dispersal cells) At leas, once every: ❑ months) (Maximum 3 years) ❑ NA a year(s) C monthisl Clean effluent filter - _ ! At least once every: I NA ~ yearis; inspect pump, pump controls & alarm I At least once every: U monthisl 'NA C yoar(s1 Flush laterals and pressure test At least once every: C monthly! C yearlsl JW NA r,,her' At least once every: C months) ja NA yearis! MAINTENANCE INSTRUCTIONS inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POVf?S Inspector; POyf?S Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, oieasure the volume of c ombinod sludge and scurr. and to check for any back up or pending of effluent on the ground surface. -he dispersal cellls; shall be visually inspected to check the effluent levels in the observation pipes and to check for any pending of effluen- on the ground surface. The ponding of effluent on the ground surface may indicate a faiiing condition and reouires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (l) or more of the tank volume, the entire contents of the tank shall be removed by a Soptage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units. and any servicing at intervals o`: -:12 months, shall be performed bv a certified POWTS Maintainer. .4 se.wi- report shall be provided to the local regulatory authority within 10 days of completion of any service event. PaneZ__ u} 7/ START UP AND OPERATION For new construction. prior to use of me POWfS check treatment tank(sl for the presence of painting products or othor chemicals that may impedo the treatment process andior damage the dispersal cellls). If high concentrations are detected have the contents of the tanklsl removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages purnD tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cells) in one large close, overloading the cell;sl and may result in the backup or surface discharge of ®ffluont. To avoid this situation nave the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plurnber 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. De not drive or park over, or othonvise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POV\7S: antibiotics; baby wipes; cigarette, butts; noncoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump] water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications, oil; painting products; pesticides: sanitary napkins: tarnpons; and water softener brine. ABANDONMENT :Nhen the P OWTS fails andior is permanontly 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: • Ali piping to tanks and pits shalt Lie disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Sep-age Servicing Operator. • Aiter 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 It inn POWTS fails and cannot be repaired the following ;treasures have been, or.must be taken, to provide a code compliant replaCemom system: L A su:•taolc replacement area has been evaluated and may be utilized for tile location of a replacement soil absorption system. The repiacement area should be protected from disturbance and compaction and should not be infringed upon by unojurio sorbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will --suit in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems roust comply with the rules in effect at that time. L A suitable replacement area is not available due to setback and!or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POW'TS. / " T ^to-~entify-3-sUtl3bt tailer~--e=- . an r. ii, a io mg ar;k aaec r,\ v '~92 Di-l I'B Ti~D21.i~W Wti577zU Jtp L Mound and at-grade soi; absorption systems may be reconstructed in plane following removal of the biornat at the infiltrative surface. Reconstructions of soon systems must comply with the rules in o3ect ac that time. <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANWOR 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 Nlk-2 ~LCr _ Name Poona SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name :~:c Te- 7] Name C ( t/ J Af.~/ 27tif ! (J Phone _ S Phone -7l this uueumure weF araheC io eompiian^a vnrn chapter Cunun c322i2.llbp;t li d; Sl@ and 83.54!71. 121 fi (31. Wisconsin Admineamlivc Cjee. STC-105 SEPTIC TANK MAINTENANCE AGREEMENT nnSt. Croix Cluuury OWNEI2/BUYER I 1To, (>~To Li P ,v E+A MAILING ADDRESS 1 3 14 S PROPERTY ADDRESS (location of septic system) Please obtain from the Planning Dept. CITY/STATE a .h !f'j L T ~t _qD L)- PROPERTY LOCATION -1/4, 7&7 1/4, Section T . ~N-R(9 W -TOWN OF ~~oasft-, ST. CROIX COUNTY, WI SUBDIVISION eS-4, LOT NUMBER _L CERTIFIEDSURVEY MAP~y7 , VOLUME . PAGE Za, LOT NUMBER 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 lank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification torn, signed by the owner mid by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wnstewamr disposal system is in proper operating cundinon and (2) after urspcenon and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum UWc, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and ruumed to the St. Croix County Zoning Officer within 30 days of the three year cxpiratiun data SIGNED: DATE: /)0 St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 ✓sr~ STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER AiC7~L ADDRESS SUBDIVISION / CSM LOT # SECTION- N-R.Ig W, Town of .`T. CROIX COUNTY, WISCONSIN - PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ls':laR y y %C~ /1(AI f L dib /ust• f l`'~'rKa IND ATE NORTH ARROW Provide setback and elevation informa ion on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARRm J f n ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Liquid Capacity: -Izm Setback from: Well_ House Other Pump: Manufacturer_ - Model# Size Float seperation Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width: _ 2 Length_Z,,/ Number of trenches Distance & Direction to nearest prop. line: Setback from: well: House-_72' _ Other ELEVATIONS Building Sewer_ ST Inlet: ST outlet: PC inlet_ - PC bottom_ - Pump Off Header/Manifold_ 9211e~e_ Bottom of system? Existing Grade_ _ Final grade' DATE OF INSTALLA'T'ION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt I, / - r -I - 'i k. - / I i - wiscofsinDepanmentof lndiutry, PRIVATE SEWAGE SYSTEM 'ounty: Labor ano Human Relations ST. CROIX Safety and Buddings Division INSPECTION REPORT (ATTACH TO PERMIT) Sanitary Permit No GENERAL INFORMATION 284177 Permit Holder's Name: ❑ City ❑ Village Town o State P an ID No.: LETOURNEAU, CRAIG SOMERSET CST SM E ley.: Insp BM 7e-. I BM Destnptmn. Parcel Tax No.: / L U , a, !L11. r s~ t_5 /`~TO'~ f7CL4n TANK INFORMATION ELEVATION DATA A960 428 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic t f~; r Benchmark a y~ ~Q Dosing ~ r Aeration u~ Cc„c EGG Bldg. Sewer (.c o 7 1 4. Holding St/ Inlet 110¢ LA"C r` TANK SETBACK INFORMATION St/ Outlet TANKTO P/L WELL BLDG. Ae, Ito ntake ROAD Dt Inlet ~ - -7 Av Septic ~oTS -r} NA Dt Bottom Dosing NA Header/ Man. Aeration _ _)NA Dist. Pipe Holdin Bot System 9d,G~ PUMP/ SIPHON INFORMATION Final Grade c ra3r 7?Sr ManylacFUCac_ rTDH m nd Model Number PM I Loss Friction System Ft TDH L K Fo rcemain Length Dia. i unt rower SOIL ABSORPTION SYSTEM BED / TRENCH Width , I ength / No O! renches PIT No Of:'ns Inside Da Liquid Depth I 7 MEN%QNS 41 IM SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACUW Manuactur r. SETBACK er:~___ INFORMATION rypcOf P A IT System-2,t f11.~`%~C, v 114 OR CHAMPIT DISTRIBUTION SYSTEM Header r Distribution Pipe(+ r / x Hole x Hole Spacing Vent To Alr Intake r 5/ length ~O Die Length Dia CJ Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade ems On Depth Over Depth Over xx Depth Of xx Seeded r Sooded xx MultTRd.--- RedlTrenchCenter Bed /Trench Fdges Topsoil D Yes ❑ Nn 0 Yes n No COMMENTS: (Include code discrepancies, persons present, etc.) Su~ LOCATION: SOMERSET.6.30.19W, NE, S/EA LOT 1., 36TH STREET C.://. ..~.~r_.,r` tc~ /L-t~-<-<.r'l ~~•a/~.~-vkc.IC % ~ .~iyX[-cCU' - - Plan revision required Yes E]-go Use other side for addi tional information. 7(.~ SBD-6110(R 0591) Date nipelor's Signature Cert. No Selety and Buildings Umsion ia~HR SANITARY PERMIT APPLICATION BureauofBuilding War" System 201 E. In accord with ILHR 83 05. Wis. Adm Code P O. Box Wash Ave. Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less county than 81o x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number The information you provide maybe used by other government agency programs Ion to prnvnus applicerinn [Privacy Law, s. 15.04 (1) (m)I. State Plan I.U. Number 1. APPLICATION INFORMATION - PLEA PRINT ALL INFORMATION Prop • y Owner N me Property I oration i/4',5,- 114, 5 T 'N , R E (or)® Proper y0 er's MadirrpA refs Lot Number / Block Number Ci late ^ Zip Code Phone Number Subdivision Name or CSM u r 1 ( a II. TYPE BUILDING: (check one) ❑ State Owned D Citr a Nearest Road L1 V-1 Public 10 1 or 2 Family Dwelling - No of bedrooms , Town OF r III. BUILDINGUSE: (If budding type is public. check all that apply) Parcel lax Number(s) 1 Q Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 Q Campground 7 ❑ Merchandise: Sales/ Repairs 11 Q Restaurant/Bar/Dining 4 ❑ Church / School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 M Hotel / Motel 9 ❑ Office / Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. Q New 2. Replacement 3. Q Replacement of 4. Q Reconnection of 5. Q Repair of an System System - - Tank Only Existln(gSLstem - Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution Experimental Other 1 1 Seepage Bed 21 n Mound 30 ❑ Speci fy Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 [ ] Seepage Pit 43 ❑ Vault Privy 14L]System-In Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S Perc Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft) (Min / (h) Elevati n Feet SFeet Ca ut VII. TANK in gallons Total # Of prelob Site Fiber Plastic Exper INFORMATION Gallons Tanks Manufacturer's Name concrete Con- Steel lass A New Existing strutted 9 pp Tanks Tanks Septic Tank or Holding Tank ® CI ❑ Q El 11 Lift Pump Tank /Sgihon Chember El Ej 101 ❑ El ❑ Vlll. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for i stallation of onsite sewage system shown on the attached plans. Plu sNe (P Plum erh S oat m MP/MPft$W NO.. Business Phone Number: i P tuber's ddrress (Sire ,City, Sta Zip Cod - 15-eel 11)"! J O - IX. COUNTY DEPARTMENT USE ONLY ,^1[( QDisapproved sane ryPermrtfee I" "enww"a dr« ate ssue Issuing Agent Signature (NoStamps) ❑ Owner Given Initial P IAAPProved Adverse Determination 1540 X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: r G let- sou r.lee osval rxsrxiaunom : awM+l.o ro"u,. n.e.orw to. t~r~^rs n"yrnn n..,,."".n»"«.w"Tw. I ys~ ~✓r y sE~if spa C T. bw X Ypj 3,V! 8 4c ~,~o.~,aAO.f ~aA . r ~ prdu✓.rJr Wisconsin Department of Industry, SOIL AND SITE EVALUATION ? Labor and Human Relations Page of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and J ( - percent slope. scale or dimensions, north arrow, and location and distance to nearest road. Parcel LD. # APPLICANT INFORMATION - Please print all information. Reviewed by Date Pomwal information you provide may be used tot secondary purposes (Prwacy Lew, s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot 1/4~ 6 1/45 T N,R /q Z(or& Property Owner's ailing dress Lot # B # Su . Name or CSL" City Ste Zip Code Phone Number Nearest ?oV ( ( ` ❑ City Village Town ❑ New Construction Use: Residontial / Number of bedrooms Addition to existing building - Replacement ❑ Pudic or commercial - Describe: - Code derived daily flow gpd Recommended design loading rate 6- bed, gpd4t2- / trench, gpolifz Absorption area required _,Qgq____bed, h2 7 l~7dn, -trench, k2 Maximum design loading rate 5 bed, gpd/f12-,-,. trench, gpdAta Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/ske considerations Parent material 2Ep & - L- Flood plain Wevadon, if applicable --tt 1S = Suitable for system Conventional Mound In-Grouts Pressure AT-Grade system in Fill Holding TaNc u = Unsuitable for system ®s ❑ u 21S ❑ u ®S ❑ u ®s ❑ u ❑ s ©u ❑ s ® u SOIL DESCRIPTION REPORT Structure Consistence Boundary Roots GPD/it2 Boring # Horizon Dopth DominaMNoTexture in. MuGr. Sz. Sh. Bed Trencfr U fGrouW Depth to limiting factor Q A 6, 6 1.4 r1% Rem arks: Boring # 41 - Z r Ground _ elev. Depth to Iimifing factor j>IkLin. RB arks: CST Name PI P ' ) signature TelePhono No. Address 1 Date CST Number SOIL DESCRIPTION REPORT PROPERTY OWNER Page of PARCEL I.0.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roos GCDjft2 2 in. Munsell Oe. Sz. Cont. Color Gr. Sz. Sh. Bed Trench l7 I Ground C/9ievp _ ...4r 1. I i Depth to limiting - hl factor - - - ,lLlLin. i Remarks: Boring # Ground- - - elev. -ft. Depth tc, limiting factor in. Remarks: Horizon Depth Dominant Color Monies Texture Structure Consistence Boundary Roots PD in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring Ground elev. _n. Depth to limiting factor _in. Remarks: Boring If ~ss':yr Ground _ elev. n. Depth to limning factor _in. Remarks: SODW-8330 (R. 08195) C AthwtNrl4 N~ SK ~S~ -54 G 7,feAl u~ .1 1w Gr ~ i i I L ~.ZZ bodr 1•ZS ~A geo,r,L S 3 ~U I ,l 96 e-IL L r"s /a. S Webd- Q~~ o C~ r ~d ev~c~ GcpS of d1 co,,.~ 1 VQS arc. O~ 4„ Ca 3 I