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HomeMy WebLinkAbout032-1056-90-000 PRIVATE SEWAGE SYSTEM St. Croix Safety a•ic IW rl -g L?ieis p^ SanCay Per- 1140 ' INSPECTION REPORT 607074 GENERAL INFORMATION ;ATTACI 110 PFRPd.1T? Aare Plan ID No .ersonal in'cunel on yc.. prcr;.de ^'ay Du u_00 '.y gerr,-iarY pi IF, I ojcy Laa, S I "erm 1 -i0tlef'S Narnu• Gy Vi last` - bao S-jp Pe•oel Tax No Sylvia Dalzell TOWN OF SOMERSET 032-1056-90-000 -ST BM Ele, C9:. tie? Fsv. BNI Des:•rpton &•cl o,'J Nn;Ra^ge.lIv1.=.p No 1/0 0 ~/CJJ(~, 21.31.19.282D TANK INFORMATION ELEVATION DATA I YPE afANUFACTURF.R CAPACI IY STATION HS Fri FS ELEV. Scptic^~ BenchrlarlY1 O.US /cN.dS /dC) Alt .BM 7. 9 X12. /5 Aeration Bldg. Si 7 CZ 7 Holding SUN Inlet /d. J ,Ht Outlc: 1Z I`vOY7 1 TANK SETBACK INFORMATION 5 J TANK TU l Vuft.l BLDv. v-rr. r~ ntarc: ROAD Of In el Septic r Dt Boaom~ Dosing HeadcOvlan 1-3 I T 9S Aerator Dist. Pipe 1-3 1 vl/o 16ald ing Bot Sysl"m PT I GO `CJ _ t FinalGraae PUMPISIPHON INFORMATION er - MarufacLner Demanc SI Cox, PNI 7 /z r G /t~.n X Model NJrl T DII I--tenon Loss System Hea H. Ft - i o•cal-la, ~ Bie. to ; eE SOIL ABSORPTION SYSTEM BEDrTRENCH '.NJJT J LenglP Ne. CI "X i4' PIT DIMENSIONS No Oi P is Ins 7e D 1 LiQ"A Depth DIMILNSIONS SETBACK SYSTEM TO l B_DG WELL lAKEfSTREAtu1 LEACHING hear'ar,pert INFORMATION 40 - CHAMBER OR 'f~ - vne Cf Sys:em. _ 7 ) r c~ 93 UNIT I&d - n,ner ..Y DISTRIBUTION SYSTEM Z;3 I - q4g, t-e_Jcr+Ma..i'apl L'sr~rn..l,ar f:,ae Sze xlmie Spacir•g Ventlo Air nla,e ~y P~:oat ~nal{~-CJ~c I en;to ~ D a / Le•,gY ~ D t+ ~.',pzcmG V SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only ~~X> r !9, Depth O.e, z Jcp:lr ".r rjn; of &_ecoa SacicJ xx iich,_d R l TIerch Cco,u- i ftea'- e. E:ges 'opsc \ Yw No YES Nu COMMENTS: (Incude code ciscrepencias. persons p•esent etc } Inspection kt Inspection 02' Location: 469 208TH AVE~ L 1 / nJ 1 y Alt 1310 Des Descr pTor p~c~ A•'•iz 2 i Bldg sewer length - amount of ccs•er - r O A ~y -7I 42- P an revision Reclined, 7 Ye No I' - h ~y y"' /I Use other side for acditional information. T 1 - - - - 1- D'a:u inseprbr " iIr a-n. Cen. No. "'8D.1717 I~ `~,,4N -mot o -7 count) Industry Services Division St. Croix _ 1400 E Washington Ave Similar, Perms Numbcr (lu be tilled in by Co S P tip 0 Box 7162 Madison, WI 1707 162 c / D - /76 7/~ / Sanitary Permit Application state ilns elms Number \,:m (sic ,ui,m su.m rl thi, limn x, the appmprege pn•eminent .1 ana All+ _ i. up..ircJ ~iioie ,h:Ynmp..e :'nit.v~pcrru h',n::1lq.hc,m on Yours lit stare-o•.+nai YOW'fSare submiuni to Pn[I\cdrcss lit di0'ercrv than madings;ldrncl f? rrrrnt t ~ li t n ~ f t rm;d Ss i , I'crsnnal ml' rrwcon you provide may be uad for secondary ~ ~ ^ [ uu:.. tuov ,cif. I nv Lav. I LJI I'pnl-cots `Same k, Ll,w _ i.-'k .pph(ali' lufornlation 1~Prlnt %it Information____- Nnpn',r lnsn.^ sNa:nr _ PNCrI (51-19) Sylvia Dalzell 032-1056-90-000 - _-iY 11"tc Owner's Mmhng Addtcss Plopertv I 'eauon ~ ) } 469 208th ave Somerset WI 54025 n„ 1 m 1 ( I Cil). axne Z 1• ende Phone Nundvl NW 4a, SE e4. Section 21 Somerset 54025 715-247-3476 r 31 N: R 1s W fI~aII. Iy PC of Building (check all that apply) f) - L k XI or 2lamdy Dwdliog- Number of ardronms-~K[~I4 (,Q~ 2 S'..bdn I,- !SEUne I 131cr:k 1! ❑YubliuCommereml - Desenbe Use - _ _ ❑Gny of CSM Numbcr V u l ❑ Village of ❑11a1C ,),ynld- Dcsc:l'tbc LIt[ - P -~.73 ®io.vr. of Somerset ;Ir _ Z3 a-z3 Gle beI I - Fit.'I)pe of Permit: Wficeekk~~ onh one on line A. ('omplctl• Inc lB il'applicahle R, la,eviou Svs;cm IftdlmenUll Idwg Tani Rmlattmcnl Only ❑(hhur ..\kalillcuuon to Fixlsbng System IcsplauU A ❑ New S)stem Ly B. Yttmd Kenrwal r '1 List I'resuous Ycnnit Number and Datc Issue . I ❑ Permu Revsion ❑c'ha:'ce :d Plam!rr f~l'cnnn l'ransfur- New Psf xc f ytlrltton Ow el L~ ( i L ~al Ql. r~ T r IrI~~AIIp of Pl - hm/Component/l[ice: heck all that apply) Non f mosurracd In-Ground ~Pa>su!ssd In Ground ❑At-Urlde ❑MOO t i in of Cmwble wit ❑Mou- d 24 n,. of swiahlc soil( IJ I Iola ng Tank (ahcr ]ialNrsal C a npousu! Kspk: in l_ - . - ❑1'retrealment Dcy ice (ccplam) Dispersal/Treat,,(ent Area Information _ De"Fn lbw icpol /y.-U[stul ♦ d ;\pt,l.rm-n Rracl Id I T Dlspcrsal Area Kegaiml lsfl~Thspcrsal Ater Pmptscd (sl)/ System 8lcvaann 450 5 7 900 J ~22~ ~o • 7 86.7 3 Tank Info Cipucnc ir. Total : of Manufacturer 3 Gallons Gallons ends R, ,eprcer noldmv. Tank X /D/oo _ 1060 1 Infiltrator Uosng Chamber 11 Res or lbilitc Statement- L the under <dl nssum< res ills( II ion of W< P011'TS shown on the aneched plans. _ P Plumber -s Vance fPnntJ Pun Lure V1P'\I f12S NanttMt Bushell l hnnc N -mher Lewis Bork 253W6 715-231-7375 ISUrtdrcr's Addrrtis iSlnNf, Cllr. State L ip(n.tc if i E7818 County E. Menomonie WI 54751 .f VIII. Count; Uep_urtmcnt Lsc Onh _ Approrcd ~n'[J~ - Pamlt lcc Date awed Isswn gent signal S C ---r--- - . ljbD Op I ✓ /f _ Ue c•.. Ih:r, an Tv Dauol z I\-Condi call for isapproval 3> a( 5yOJL , a cad ttiay uW eM Mist all pl1.MS123 L[ M "at L !s Ptr rMWAQltfnerl- Wan pott natal W vluinbe.. (~LQ_ 2. AN tttAlraMt nK+ie'n+rtn mat w r-ontr l.e 1 \ M IM+Irf ptltad /cnl:rvut. Ma.! bat 5, T~ 16 . I coach to cnmplerr pins. !nr the system and submit to the <'uunry a y nn pa ool less n fl I : a I t rnrhea in cite N111)413,98(Rll313) !:4-CA N;)X AS AV~JCaELE `NrL, Y.~ /'7 ~~f ::HE:.I. BGY AS ae>.I(:•19.F.. F SOIL EVALUATIONV, C s~a1":1" =1Q' q ~ 0 SYSTEM PAG` 209P > SITE MAP 3 ° 3 ~ PLOT PLAN P JJECT NOME: Q)NkFSj rl~~ ;.s' ~ ueslGN.=l.a+r: - 456 cao {I~ _ (51-19) Sylvia Ualael; - Attacn design flow calculations for mmmeraal plans. J PROJECT ADDRESS 469 206th ave Sarnerscl W: 54025 Pipe. Mwoda' :.ASTM Standam [Tables 384.3.^.3 8 384.30.5; - ''A. 4•' ASTMJ26651 ~ Sanro7 ~v.•• U Shp Symbd. av E nZiun ,eo r r Nay 2 ASTM [)2655; Firce ' { RN De%criplwn'. top Of water welt I Slone Gradwt:',5) b,Jk:n~nornU P7~sR.1 : Wall Syrcr..el (if apoll.aaeP. Q arn•arg n~~ mw Show ground elevat tion contours at xulUiole Intervals ur,as!ad ANa'. ? ~r tr. al,iccX4 lr ~ sy I~~„a` s•{~l+S-zy7-3yY ,,:'~~w~s~~ou~~-^' 0 DF5V/ N C*we%T ✓ Pod (flej/Z `7 lam, n 1 V y f 5 loAdl r SS lI C) I :5 loe r-4-#i4r-r^ 6,9 ~ f %5 IL CJ / v f l,,Ii! ;~Lt r L l~ f, lili ~i 4(L<~ V ~•~l% 7 ll~t ~,_1D ) -t -Lt PAGE 1 OF 4 In-Ground Gravity Plan Index & Cover Sheet Component Manual Design References: Version 2.0, SBD-10705-P (N.01/01, 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: I Enclosures: 'rank approval I Bio tube cut sheet POWTS Application for Review - Infiltrator chamber cut sheet Soil Evaluation Report & Site Map Project Name / Description (51-19) Sylvia Dalzell Owner Name(s): Sylvia Dalzell _ Phone: 715: 247 - 3476 Owner Address: 469 208th ave Somerset WI 54025 Zip: 54025 Project Address: same Govt. Lot: 1 NW 1/4 of SE 1/4, Section 21 T31 N-R 19 _E❑or W Township: Somerset County: St. Croix Project Parcel ID 032-1056-90-000 _ _ _ _ Designer Information Designer Name: Lewis Bjork Phone: 715 _231 -7375 Designer Address: E7818 County E Menomonie WI Zip: 54751 E-mail: lewisbjork@yahoo.com License Number: 253976 Remarks: Signature: 1 L" Date: 4-12-2019 _ O7n mal signature required on each submitted copy. CN[r;•aU?'. A9 AV+IICNIIE. `NEtJ. V ~t CMECK BC%A9 ~oRCN1.t. © SOIL EVALUATION "r 30 60 e`a"'' 30' 46 © SYSTEM PAGE 2W SITE MAP _ PLOT PLAN 30, PROJECT NAME: l)Nlj<'Y F-10E~ 7.1r DESIGN FLOW: 450 rpp (551-19) Sylvia Dalzell _-g - Attach design flow calculations for commercial plans. V PROJECT ADDRESS: 469 208th eve Somerset WI 54025 Pipe M"rud / ASTM Standard (Tables 380.303 8 384.30.6) _ q•• ASTM D2665: BM Sym6a: am E:evallar _ 100 Fr N Sanaery Sewer F. MYm ASTM D2665: BM Oeecnotbn, t°~Ot wateF well ~ SmSloIm GrWWq twbiwvp a ncnn fry pQ T: ..v//\\ ( 2 wall ;ym6a !x eopucaae>: p u,.exrm. Show ground elavatlon contours at suitable intervals. W Tested Area'. on ~ asCrexaa ar. I S I~,At 5 7 5-25'7-35/7 - \ f---~'lwis i3J 4Z is?9ig Z7 \ ~s r c. wl p ,o, I Fit fs " \ t = r2od `trq\% o p J V s ~c \ \ 0 T 0=✓ r2 eel ~ .5 Ion~ti Dr~ t Gj C21CE~~s pE`'`~~ S ~l ~ nn \ ~ cFta 2c~ ~ gazebo ~~bDSP'.5 SS=T ~~ccc .1~sS~:~.E ~ /r ~ 1n1~ 151~n,~n J A,2~ ~ ~~111' m = PAGE 3 OF 4 Z o U ~ WWy M (D 'o t N: i J Z co C 2 m Q M` ~gO O C Z m CL c 23 E s a s N CL -O En a) 00 9 O E" C Zip f U F- m H F I..L Z O b ~n v L a O ~ V o s g€ u < n D O C U> p C) O Z Z O w ~ O y IE'n~l E O ~ F- U I+ + C7 ~ it II b + + ° Q fn _U Z W (D }a U) y, o ~ U o I o I- U r- I I I a ° ~ W ` co ~ f ~ tZ y rl II ~ C 9 Q O Q I a~ N co Q a CD W -8. ' E Z' O I I C C C Y ui (n 2 w v d Y U ~ o I 3 ~r a I I V-ICOI(0I NI 0 N a I` u x } PY o I I II L C. C Q 3 O - in I m L, Cu V U H$va I I U @~ v C C o Z. ? o m W Z O N e n `I IY Ud 10 c O cU m I 3 c a O (D c a W 2 , II !nn O_ M J x w + a m Z C7 ` ~_''S QJ a E ~•J N t 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 38152 (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 Maintainer in accordance with SPS 38152 (3), Wisc. Admin. Code Maximum Dispersal Area Operating Limits: Design Flow = 450 gpd; BODS 5 220 mgL"'; TSS 150 mgL"; FOG 30 mgL"' Inspection Checklist INSPECT EVERY 3 YEARS o type of use age of system n nuisance factors (i. e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc) material fatigue (te , leaks, breaks, corrosion, etc.) solids volume in anaerobic treatment tank(s) and any distribut on 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 - if applicable (i.e., pump re-cycling, float switch settings. etc.) electrical components - if applicable (i. e., wiring, connections. switches. controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification) n surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tanks 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 one-third (1/3) 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. o Effluent filter(s) 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 months. 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: Name of individual or company. Lewis Bjork Family Septic Service Phone: 715-231-7375 Local government unit. St. Croix County Phone: 715-386-4680 Local government unit address 1101 Carmicheal , Hudson WI _ Zip 54016 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 failed 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 department in accordance with SPS 384, Wisc Admin Code Contingency 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 If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33. Wisc. Admin Code c n ,v w.~5. ~ i ~°r" i #a CA,4, INFILTRATOR` The Quick4"' Plu$ syst.,1 Standard Low Profile (LP) Chamber Quick4 Plus Series The Quick4 Plus Standard Low Profile (LP) offers maximum strength through its four center structural columns. This chamber can be installed in a 36-inch-wide r i trench. It is shorter in height than aK s y Inflltrator's other Standard model t ~ ~1 chambers, allowing for shallower t r +~"f , installation. Like the original line M of Quick4 chambers, it offers advanced contouring capability with its Contour Swivel Connection" which permits turns up to 15`, right Quick4 Plus Quick4 Plus g, or left. The Quick4 Plus All-in-One Standard Low Profile (LP) All-in-One 8 and Quick4 Plus Endcaps provide Chamber Benefits: 8 Endcap Benefits: increased flexibility in system design i and cei f p r,. it r, • Low profile design makes this • May be used at the end of chamber chamber ideal for shallow row for an inlet/outlet or can be y * applications installed mid-trench ' • Reduces imported fill needed • Mid-trench connection feature allows for cap and fill systems center feed inletting of chamber rows • Four center structural columns • Center-feed connection allows for Maxitlttlnl Strength offer superior strength easy installation of serial distribution _ • Advanced contouring connections systems . Latching mechanism allows • Variable pipe connection options for quick installation allow for side, end or top inletting Four-foot chamber lengths • Piping drill points are set for Size are easy to handle and install gravity or pressure pipe 34"W x 53"L x 8" li • Supports wheel loads of (864 mm x 1346 min x 203 mm) 16,000 Ibs/axle with 12" of cover Effective Length Quick4 Plus 48^ (1219 mm) Endcap Benefits: Quick4 Plus • Simple, flat design Louver Height All-in-One 6.3" (160 mm) Periscope Benefits: • Allows installation of a pipe from the end only • Allows for raised invert Storage Capacity • Piping drill points are set for :32 gal (121 L) installations gravity or pressure pipe _I • 180' directional inletting Invert Height • 12" raised invert is ideal Certified by the Intemat onni 3.3" (84 mm), 9.6" (244 mm) I for serial applications Association of Plumb nci J and Mechanical officials (IAPMC) APPROVED in \ / . Quickil Plus" Q Quick4 Plus Standard Low Profile Chamber J - a ~ '1 t 1 !EFFECTIVE LENOTHI Quick4 Plus All-in-One 8 Endcap Quick4 Plus Endca 10,4" EFFECTIVE I' LENGTH' VJnen installed EFFECTIVE betn EFFECTIVE wee I 2 chambers, 8, LENGTH' Sl ~ 13.3" ~ 1~ te" EFFECTIVE 3-3' LENGTH' INVERT s. IN'✓FEtT 'I~- When installed INVERT at the and of a trench. Quick4 Plus All-in-One Periscope - ---.~_w_-_ INFILTRATOR SYSTEMS, INC. SIANDARD LIMITED WARRANTY lal Tl a stn¢IOral area y Ll esCh J _ ::xIV aln (nr r,l'rn.,; n„ In lltralo 1"i1,1 when -dated a^.l rlpeato]ir Alrl✓tf I1 ¢ ;)ayr., - - ac-orda•ce with Irf n,filor's re:u..a- IH ~5 wdno,fe i tome c.ignal pu'Ji Her l fIW3e. I , :efdo HB mlewels am War.•naRt Ip la we yYar bom me ddl01nd1 the SW K ren it r4 i - the 5ept4 s)'b1Wn Catlfirmng the Dia Nori,leQ I•.'W o4w Itlnt B a Si pain d Is n0: •e t') INVERT - 1:411 "law. Ile we•ranly Pi willholl".Pi fly darn sat inelM4tm •l vie stlDtir. S( 1: "non:es %,oi Kt wsrM ty nghhB udder •rl,k nobly IMRralli in wr mg Al nB cu, 9 6• I I, _ nPlado.ra•tms n Ood Sat^.rcq , CC~ -ul within alien (151 de of Cie r,'s ee Oelxl htlcal.,• will auDdy replar:tt`unl Um:B to llnrts daie•rmned h)' bIIIVL'a h• be rowed vj tY! Ihs UnntW 'I•yM'e•ny. I" *rer;r S Ter J!y FpeoSCNIy excli the:Nt of •e•nanl andla naMlallo" 01 Ite U'lls. Ibi THE LIMITED -Aii VY AND NEMEWE$ IN SUIPARAGR PH lal ARE EXCLUSIVE. IHI HE ARE liO 0tH(R WA iTIFS Vitt H RESPEET TO [HE UNITS. INL;.UDINC NO IMPIIED)rARRANnESO; HF.RCII;NTA&tCYORFIINFSSFORAPAN I„ULAR WfIPDSE 1 I 1 - :,I P•t s I te7 d'nn5n1Y : ai be vatl m) Dert 01 the chYnLW sYetttr s ne ulaY nd by u I I a':yc, a tMil hsn h Blt db the L mllad Wgnenty tlces n01 0x10+010 n il'en y y er•• i lo0r teal, spxlal IOVrJ:' 0anagns. l 511re'0• sMl: nx N liablb for punRHea or 10u0afed damages. - 5' "JiAlrtg lcm he 1}ud,clron and prutds lot" and maNinale. OsMtead 0001H, a other Io45e5 ^,p:¢raaB lncur•M by the holder cr any lhi•d PtttY. SpxlfvylY excluded r•om Ulnite: Y1an,;••; 'i'vA a are dal' 3 9111' to 1ne- - Unls all IJ "rdirMry'A'aB and I<M Ntmgtm, d:tI09n1• mguse +se 01 ni or !Fa Until we Un;S Lill 19 sabinolal to VBetGe Inslfc Or 01h& CMdi to'is +r, -1 not permRMt c) the insulation ASIt s; Llhlle 10 m inlAn the minmLm gi. c0", se: hill'e+ Me WSlM,4101 '"IeNdlorle, Ina plaurent of AVioder mabr.A• elto IM l iH1M ,intoning Ire Ii+ite; lallure of the Lines a tre septic bri due to rmp•OIJe• adirg or h•gi•Jpcr nny, exoe5rNit wale I.Hape, urg0oer grease deDoul. or n',proper operates or any OPe.+ =cent rrt cOUB<O D) InbIIrM01. Ptls Lhntr• Wari slid DB SO,I n the II011, lolls t0 ecnfdr al y m>!m^ts SCI trml n the Lmiled 143nwtly. runrm. i•' rp even' shallInfIllratOr Ia {'^rSWe Ic q y lobe or gorcaa to too H -1 r, the Uvdli ra Pry Inir6 {Nny r¢5oltily fi',.m -+;tala:~oo :e snipmenl or texq ar:r pr^d✓.'I IIaGi6q dd•cs a' NJ,far a any Ihrd pony. f cr i.-~ t m ltml WBnanly IC aPPIy. fIM Drub mist 5a mstnllod'n accordAlce wro eg &le cOnddinrs -c .ro; to stale and IaN oyarg at olhm grmtcable IAWI, and IrM atcra Iretalgion nsl,,, on s <f Np ruprlaril•Ta!roe of hlllralor has Ihs eulhon:y 10 Congo or e:dend the ii ri Walla, ^e. / Ni'watra•ty apptl4 t0 any alai Other tra•t the o•.gotal f10I0m. I Wwi,oi a Park Read The-vosy repleii IN SlandBlO wnibd W rholl)' coed Dy htur8ror A h1 iled rumbel nl / P D eo[ Z138 413103 and WUnte9 Aa.•e dltlMent w'Aearllp requrremmrs M) OJ•tliasm of UndS gri r;'.r it I (Nd Slri xa Ca Di hldlOla'S DO'pbate lbad4uanMS in D11 $aJDlOpk. EV+nec':.: pr su LUrPatn t r INFILTRATOR' P6USP-71-re. Sw Sn.nxn obtain a copy of rte applheae wers,t), and. Should clr9tn'-, ,.trl!'ia: a r',yil, Ihl, f-eoo-zx I-use Wrcrale M Uroh, y 1 C fn 5 www.inflltratorayaterrni US PeIw-tx d]591M1 pt Ut 1.'y.JAN,SIV,01;,•rJ01,tt11,SJ;q,J5q 5111 afA.5,]le,ta't5.50B.]1a15.W9Ndd(:nad~A, Pa4ntl 1,3?Q.B59, 2,PL,50A Cntol ,I, Inlnralb, Ee.ItlriN.U J J:'1 '/.iMn Vn gaatiol hp':avnanf 011^anra16Sy11Yry Irb.Ir•nIIWMr rb.: m~Y6lbed lraWmaM1 In RNCa. 1•IIVY}$yrµre hC. IHJrq 1 •1 '.1''}~r.a'•-i (:o•ihur, lApolaMiimn P , Y ,;1 .rrimSlJarrv, 1.IJLPw., .'nxCO:. UK4L111, QO(fr{yy ytept Opi w'C $IrNartLeck we LildgrnMge pt lr•gllralb 6rylems lrc. ~c POlylraa ill a VademarF rot rrolyl n4. TUE 111F e a r0onµec han!mmr. nl TUFTnr, INC. Ulne.n.a,I Ilroli of IPEY In.. wrJ.e 1,1A PLU "Jlt OB'3 H • talon .11 i„ 6 e~ T1 T 1y1~ T lYl 1,1 p { U :1 a L7 C. ~ f 3 ij N :U Y.1 ~ c: Ile MII a+ !L :.r. Ix J _ N = r •`f it ~ ~ y A h Qr k Y r Rey e ST. CROIX COUNTY SEPTIC] ANK ti9AfNTENANCE AGREEMENT AND OWNERS( DIP CERTIFICATION DORM U1'i OwnerrRuvel. Sylvia Dalzell Mailing Address 469 208th Ave. Property Address 469 208th Ave. d i JIfication required from Planning & Zoning Department for new construction.) Citydstate Somerset, Wl Parcel Identification Number 032-1056-90-000 LEGAL DESCRIPTION Property Location NW SE Sec. 21 T31 N R19 W. Town ofSomerset Subdivision Plat - T-- _ Lot 2 Certified Survey Map q _ Volume Page u Warranty Deed 4 (before 2007)Volumc Page # Spec house ON esdto Imt ImeY idenn liable wes[] no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could recut in its premature failure to handle wastes. Proper maintenance consists of pumping oul 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 lank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(( ) 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 (I ) the on-site wuutewater disposal system is in proper operating condition and!or (2j after inspection and pumping (if necessary). the septic tank is Icss than 1': full of sludge. Iwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safely 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 St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I!we certify that all statements this form are titre to the best of my; our knowledge. Uwe am~are the owner(s) of the propem, described above, by virtue of warranty deed recorded in Register of Deeds Office. Number of bedrooms 3 J Z c LURE OF APPLICANT(S) DATE •"'Any information Ural is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty decd from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warramy deed. (REV. 04112) C S' Wisconsin Department of Commerce SOIL ORT Page I of Division of Safety and Buildings in accordance with Comm 85. Wis. Adm. Code County St. Croix Attach complete site plan on paper not *ss that 8 V2 x 11 inches in size Plan must include. but not limned to. vertical anc honzontal reference point (BM), dnection and Parcel I D. 0.'2-1056 90-000 percent slope, scale or dimensions northarrow and location and 1lstance to nearest roatl. Please print all information. Rev by Date PeniMal informabon you p•ovr.de ray be used to se nary pu,poses i ~nvacy ta, s 15 C4.1 imp / ZS 1~ Property Owner Property Location 0 (51-19) Sy hia Dalzell Govt Lot NW 114 SE i, S ~I T 31 N R 19 E(or)W Property Owners Mailing Address Lot# Block# Subd.N 1e or CSM# 469 2208th a%e Somerset W 1 54024 - Part of 10 acres %ool 3!7.313 City State Lp Code Phone Number dy FlVillage • Town Nearest Road Sunlerset WI 547U25 715-247-347 208th Ave ❑ New Construction UseQ Residential ! Number of bedrooms ' Code derived design flow rate 450 GPD 0 Replacement Public or commercial - Describe. N Parent material Out wash till Flood Plain elevation if applicable General comments The first pit I did contained much higher Icvel of FS r' with redox . we will avoid this pit the others contained and recommendations: higher le%uls of courser materials . Ask me for more details .Lewis X- l l3-I Boring# ❑ Boring ❑ 0 Pit Ground surfaceelev.R7. 'I_It . Depth to limiting factor in, Soil Application Rate IIA Horizon Depth Dominant Color Redox Desenption Texture Structure Consistence Boundary Roots GPD#h in. Mansell Ru. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 -Eff#2 i - 1. Y5 3 7- 741,r lM 5 z F 4 C3 Z., 10-18 (014 ply ciI~l ~ s f- L 6 s 19 0 S`fiZ s Ae c 41,4 Le f - ail - - H--2 Boring # ❑ Boring Q Pit Ground surface elev. Pe Z- . Depth to limiting factor is. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rcols GPDM in. Mansell Ou. Sz. Cont Color Gr. Sz Sh. 'Ef##t 'Eff#2 rgC i b8 atz313 1 s o~_ cg 2r'» 1 C3F 2 8-IS lo,-i 51, ry%JL- L Z~ h 6 t 0 g Br -3 3 lv' VY '54 z M A 7j" 41 Y 32-7 t c /s b° 1 C /m . -7 s c q2- vy CaPSy~ s F , - Effluent #1 = BUD, > 30 < 220 mglL antl TSS >30 < wgrL__ , ' Ef9 ent = D, < 0 mg'L and TSS < 30 mgrL CST Name (Please Print) Si n CST Number Lewis 13jork 253976 Address Da)e Evaluation Conducted Telephone. Number F7818 Count}' F. Menanonie N'1 54751 ~~D~7019 715-231-7375 Property Owner Dal/ell Parcel ID # 072-1056A0-0110 2 i Page _,of._ r 1 f U-? Boring Boring ~ pit Ground surface elev 39-7 ftDepth to limiting factor / in. Sod Application Rate Horizon Depth Dominant Color Redox Descnphon Texture Structure Consistence Boundary Roots GPD19t in. Mursell Qu Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 2 - Sy y~1 < ?n ~I G Q -7 t 5/ o s M l - w. S- I. c7 FS b Boring # Borng 7 it • Pit Ground surface elev ` ft. Depth to limiting factor75 - in. Soil Application Rate H ion Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1@ In Munsell Qu Sz Cont. Color Gr. Sz. Sh. 'Etf#1 -Etf#2 0-6 104L 24 MOLL S ZF 6 It )q 4~j Z I t bL 7. L 2r 61 +c _75 'ii1 `i _ i r 5 0'~ L e- !S 7 M f. 6 C- y07 10 V 5 is wi .-I -6 L s s/ F) P 0 6 2- F - - - - i ~ lv^ T. ~ ~c t Boring # S Borirg Pit Grcund surface elev. A. Depth to limiting factor in. • Soil A licahon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = SOD, > 30 9 220 mgr- and TSS >30 < 150 mgiL ' Effluent #2 = BOD, < 30 r i and TSS < 30 mg/L fhe Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access serv ices or need material in an alternate format, please contact the department at 603 ?66-311 or TTY 608.264-8777. 1117. j ~9VJ i~`~l^~~ rr~F.l2 7-5i T ~"FC1 BOX IV, APP. N; AaIE. `~(`!F WVJN rp• L '7 7-5- 1 C.-CKHCxA.5-AFRKMIF- SOIL EVALUATION ~yC SCale:1"=30' SYSTEM PAGE FOP SITE MAP (°30 A rl/A 80 PLOT PLAN 3 3 Its PROJECT NAMf_:~J' I~N~E 75r DESIGHFICTI' 450 GPD (51-19) Sylvia Ualzeil Attach des gn flow calculations for commercial plans. I "'Z0 J PROJECT AODRFSS 469 208th ave Somerset WE 54_025 Pipe Wedal ! ASTM Standard (Tables 384.343 8 384,305) N 4" V - 'I Saottary Sewer.I ASTM D2665, aM 9/men. AM Flwatlenr 100 _ f T Frr<eMan I aM IX-Wlptw toP of w_aler well _ 2" ,ASTM 02665, Inakats ;roan r Scope Gradient IMPORTANT: or Tested Area. 2 Well Sy~ibU 111 applioihle); arnW;p a, um. Show ground elevation contours at suiwW. intervals. J~ m!ne aopopma Inw t Sy I~„a' S #$-I1S-2 7-3y 7; cwis i uc zs?p~6~~ s ~ wtp so I ht+s j e r ~ pt SzGN GnTOvv'~ ~ O O } = Inc! (e~ G/ X 4 ~xFrs V -,M r 10 e ° 5 loaati OW SE 8$'~t O 2 ~ gazebo ~~1~>~ 5 ~1. 113j~ClC J~SSL Cr G A4 .~I~iL~n J Ad Dr 7 1 MA"