HomeMy WebLinkAbout040-1326-14-000= PRIVATE SEWAGE SYSTEM
s.xp and auei.e as:A. INSPECTION REPORT
GENERALINFORMATION (ATTACH TO PERMIT)
040-1326-14-000
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17.28.19.2206
TANK SETBACK INFORMATION
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PUMPISIPHON INFORMATION
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Sanitary Permit Application
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PolyLock 525
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Countryside Plumbing 8 Heati g �I (Hgy13 7162<6-2660
Imt..r nmw.tmwcry.a.wapnm,
321 Wemnsin Drive New Richmond Wi W1]
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CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name:
Derrick Coma / Logan & Megan Cwswnsen
Owners Name'.
Logan & Megan Carsrensen
owners Admess:
410 Meadow Valley Trail, Hudson WI
Legal Description:
NWI/4, NW 1/4, S 17, T28N, R19W
Township:
Town of Troy
County:
St Croix
Subdivision Name. Meadow Valley of Troy
Lot Number: 14
Parcel ID Number, 040-1326-14-000
Page
Index and%la
Pagel
Plat Plan
Page
System Slzirg&Cross-Sermon
Page
Filter Specs
Page
Maintenance Information
Page
Management Plan
Pager
St. Cara Cty Septic Tank Maintenance Form
Page
Warranty Deed
page
CSM or Plat
Attachments,
Soil Test & House Plena
DesignarNlumbes Country side P&H
License Number'. 664713
Data 05/03/2019
Phone Number (715)246-2660
Signaure
au9nM Punuanr b the lmGM" Se mry ,colwed Wnual mr POWla Vanlnn S 0 San4 mal-P,Pa1011.
Pagel
So1LAMSOMPTI0N SYSTEM OETAILIGMVELLESSLFACHING UNIT Fyr_v_
Protect Name: Derrick consll Logan & Megan Carstensen
2
No. a Its
9
For Cell
3
* Call "m
18
Total sort E2120�
90
*Call Length
50
wn Blur per Lail
3
*Call Spening
900
p*Trust EISA
cancer,
so
i
Gravedlap Leaching Unit Manufacturer: EZFIOw
Gravellna Leaching Unit MOUBC EZ 1203H-11
Typical ones Section
Finished Gntle_fl
ObaemUon Pipe viM
approved cap or vent
••••68 •.
�Soil
BaaMlg
a
v
Geetmele Fabric
n InnlfnlHe $mfau
12M
_* Limping Factor
y6%In
Sdden end Anchored Vent!
Obaervadon pipe with Cap
Plumbormagner Signature: Countryside Plumbing and Heating
License 9: 04713 beds: 5/3/2019
PDLdOC,`M
3 PL-525 Effluent Filter
PL-525 Filter
The PL-525 Filler is rated for 10,030 GPD (gallons per day) making it one of the largest filters in ins does. Ithas
5251mearfeet of l/I6" ldkafion slots. like tM Polylok Iff lM the Polylok 14525 bas an autemade s artoHball
metalled with every filter . Whom the filter is removed for cleaning, the ball w01 flwt up and temporarily shut off
the system so the effluent wour t leave the Bank.
Features: 1/16•• Filtration Slots
• Rated for10,003 GPD worts per day) (removal
• 525 br,em feet f 1/16" lEmtim. 10,A11000 GPD
• Acrep , 4" and 6" SCHD 40 P'Fe- eeae..an.1Bandfle
• Built in gas deFlmor.
• Auromatie shut- of ball when Most is removed.
• Alamn accessibility. Rated fic,
low Men
• Accepts PVC extrovert, handle.
1L525 Installation:
Ideal for residential and commercial waste Flows up to of mess It.
10,000 gallons per day (GP B euu.nmslot
1. Locale the outlet of the septic here
2. Remove in, true cover and Rome bank necessary.
3. Glue me filler housing to the 4" or 6"outlet pipe. If qp Bap6 _
the craft is hot centered under theaccess eterusea ie
Polylok GmM & Lok or piece
ece of pipe incenmerfilter
.
4. Been the PL525 filter into its housing.
S. Replace and secure the septic tone rnvec ® w
Visaed to
PL525 Maintenance:
The PL525 Effluent Filters will operate efficiently fee
second years under normal conclusions Before requiring
cleaning. It is recommended Nat the filter be cleaned
every time me took u pumped, or at least every Wee
years. If the Installed filter contains an optional alarm,
in, owner will be notified by an alarm when th, filter G"mefltt
needs servicing. Servicing should he done by a urtfied
septic tam pumper or installer.
1. Leanne the culler of the septic hN. 4mt (sceall
2. Remove tau: cover and pump laty if necessary.
3.Do not oce plummet when Me, is removed
4. Pull PL 25 cartridge out ofN housing,
5. Hose off filter r the septic mark Make care all
solid f fi k' 1 he sez k.
6. inert tMfilrer caradte back mm the housing making
surethe Ron kcomedy offered and mmplaely m,med. Outdonwinurolvlok fecal mnoannrenecort inetch
]. Replace and seem septic lank cover uusmifflufmswnmenaabov meow pimguNs.
politick, Inc, 3 Bunch Blvd. W'ellirrgord, CT 05492 1011 Free. 899.765.9565 For: 233,28485M wwwyceffok.core
W1250-MR
TANK SPECIFICATIONS
aMF
XNAU5 1
W
104'
TT
BOTTOM: HFPTC 3'
XOL➢IXC 5' (.ND 1bO 1B.)
N4
MANHOLE 4I.D. D. PRELASi CONCRETE RISER
HET. 13IV O.D.
_
NGT: O.D.
BOTH'e'O.D.
AL CPS-
BELOWIXI-ET. 5300
F2U 47'
aLOVE)D
R�c
\\1
MIGHT. u3S
P44
/
AND OUTLET.
IHI£i AND AST£i:
M/
(
4' Tn L WT OR
ggg
CASKET. CSTA L LIGHT OR EW0.
BRSE
:
INLET AND OUTLET GAME AND FlLIER
i
MA 1, SET DETAIL CO
(OTHER STATES GTE
---'
uWlo uPAaTx ae.m cupN
R`
HOLDING TANK
F n
WRE! ROLE RUGGED
W
TOP M
ACTUANL CAPACITY. 1.2,M1 GALLONS
3
8�
LORDING LE9a1: BO' UNSATURATED SCIL
C g
�zm
voN
n
TANK CAN BE USED AS
W e
SEPTIC/ HOLDING/ RUMP ON 4PXd1
OD
TANK
W W
_
_
MOVEW IX DESIGN D (s CCNFAL FINER)
-
IN1xT
—
— _ TIF
0„
WSTNa
G
FOR C SlµC TANKS --.RC. w.SER cox.REEE
AX
z
ZE
i
DRAWINGS SUBMITTED
In
FOR APPROVAL
SIDE ME tl
ABBASID By -
SHEET OAPPROVAL
DATH
TANKS ARE MANUFACT RED TO MEET OR EXCEED ASEM C-437 FSWIREMENb
/ 1
POWTS OWNER'S MANUAL& MANAGEMENT PLAN Pare I of �
RILE
own., Logan & Megan Clustering
Sapac Tank CannM 1250 ing 0 NA
Fwmir B
Shall Tank Manufacturer Wieser 0 NA
DESIGN PANAMEI S
EXIUM FlXw Mmoamw Poll 525 0 NA
Number M Beeroomc
4 DNA
EX MPhil Model UNA
Number of PuNc FUAiry, Unit,
NNA
Wmp Tank Ch,c'ny w A?MA
EeBr few lave l
450 ylea
Pump Tank ManufaMrn IIN4
Now Pow 1pwkl lEmmttN:tb1
600 ,Nee
Pump Manufacturer MN4
Soil Ate, t Re,
7 quallgail
Pump Model XWNA
MmeaN lnflumVEXlunt OuaNy
Fare, 01 & Grearo IFOG)
BbWwnical Cyi Dmne(SODA
Tom Surgical Ready USS)
F ly"Weara'
00 mil
420 mph PNA
5150MMIL
Aebee tat king UNA
0 SeM4f,,W Rarer G Peer Rher
0Numereml Ameam 0Walmd
DCAmfection 0Crth"
Pm"Me Effluent flutllly
9mmurnical Oxygm Oemne l8DDr1
T,nd S,mamiee Sous ITSS1
Fecal Cemwm lgmmedic"n)
MontAM college
AO rl
Sit ml UNA
510'c1W IDDYI
DYemael Cal xi4 NA
0NGmune 1pmlryl 0In Gmwe lWewvWl
0A1-GrWe 0Mound
OMe- M 00Nx:
Mesimum Effil peeler Us
$ In dim Xp NA
"Year' MONA
0,her
A(j NA
Wen xN NA
'chose mind to, anmuue wamwan, ubnprc tank ni
lixn NA
SCHEDULE
SwNw Eeem
swil ReWnq
molmneMln oltmklel
At bwt once every:
OrtwnNj sl 0.f,mr,m Sfeesl
UNA
Pump tun contents of unklel
Winn combliee abuse and eaum small nrefdke I r Of Ink voenro
0 NF
Inv=biwwael "hall
At Ism chew rvmy:
O mmMlel iMm]rium 9 Ysers1
0 NA
Cbne ao flew
At Yin once eery:
0=051
I
0NA
Leaped sump, Wmp control, & of
At beM once every:
p my she
X.'LI N4
Rest lereMe and pmmre tact
At bar once MAY
0 mIN
,1, NA
At ban once svry:
O m:MS)
NA
thn'
xw NA
MAWnE CE IMMCnONS
linspecom, of tanks and ebgrttl Was shill M made by an Inch ownen0 does M the followed; Ilene or err aGna:
Matter Plumber: Mutes Plumber RwWcW Sewer: PoWR Ie ammat mmAl Mamall, Septpe SeMdng Op mul Tank
mvmtames a vise,[ aom n of due tannel W IeenMy any mlulnp or bokan beNwma. Mmlfy any cracks or lards,
ume of mmbmee sludge and scm ear n check far the back no or pon of exwem car Ter kini mmod.
Tare a Wwx.l marls) shall be vbuaIW mepNW to check are lothent IanN In ma nbmvatin name and to Check for'MY MMmg
of anem on One ground woom, The painting of strum; on the pm mel All may argued, a fettles amdmcn and reculru me
immmae nmmeatim of Me beet r uin auMoriry.
When he combined xcumulttlon of sludge and scum In my tank Move errthird I%) or Imn of the tank v,ume, the engine
n of One
tank shall Ma reed by a Societe Mari transfer and Model of b ccoldance won attitude' MR 111,
We nan Aem'vivamm Code
All tang wrvicea. NdW kg but not Imbed to th wMCing of effluent nhen, rmhani m or r umM componn4, prNeaNwnt
muu, ear any worming u mal of 512 months, shag be isummi by a celtlfW POWTS MCNtener.
A wrvke sport shell be provldN to the Ideal rpull euthomen will 10 coca of mmgMpn of ny mil e
Fw?Mv
START UP AND OPERATN]N
Far new mnminua . perm to we of Ne POWTB mOe ben MITICE) fir Me prennce of painunp Products m OMw cnmri1Al
fiber may immune The tray process eN/w tlemaoa fin poo l Oil If bipb cmcv "ona en dfle was the mmmta
of MB mrsklel removM by a wptape MMcmB DpmTm prow to uea.
"am rtut up shall not occur win OUT condmi and happen rt Me F90 , surface.
Dame Favors oAdm a pump twks may fill above national MPbwarr wary. Man power Ie rMmod Ne.racome wmanpower will bap
mwharyea W The aispe l von sl in one lure, acne. wrloNing no cNll.) and may result in Ma backup or surface pia me W
afflumt To "Old this swet'mr bare The oriental OF The pump tank reproved av a Gwmml Swlchm Operator prim to marailq
pcww M Ne aMuem pump or cmtM a Plumir or wail Manuel W rttlrt In manually mmmi Me Pump wnnob [c
• a nmmel Santa wiam, Me pump tint
Do wit all or park recall ow Tanks and Awarded cols. Do not fire or was over m oM W dWr w compact Me w
within 16 now down alga Many mwnd or rtgrela MII NmrPWn arcs
Franchise m,Gninanan of The following from Ma wa.rcwMrs N may Improve the Pa ommtt ala golmp the Ufa of the
PDWTS: mtl it As; baby Turman: buns: Tumors mtM, ewtle; awr..mn: amM flee.: Camera: disinfectants: fa4
muMeYm and, jump Turner Witter, now, and v top ie peelings: ape®Tee: arenas: harbianee: inert wraps: mm"It"Is Ill:
nrNnp Taipei remaitlm: wnhary napkins: morpou: and water sohmer dome.
ABANDONMF
when he FONTS take maker W Fo'mnenny taken out W afvdce Me famwmg arms sitar M bkn To malls Mat Me ayaum 11
properly and all aMndoned In compliance wise dmprr Comm 53.33, W'mmein AdminiNeMo Cards:
I All eipinm W tanks and now Mall M diwnpour and Me mandored Temporal Im 1.
I no announce of all now and par atoll be mmwW and propwh ddspou of by a Saptame 3mi ing Oprawr.
I After pumping, el tmko and The eem be ..... aril and romwM Or Mar coven renewed ash the eased .pace fiIM with
soil, grata or mends man wile mMerm.
CONTIN3wcY PLAN
U The PIC)i fins and cannot W deal The following musical hie main, W.mm be teamm poyide a was wmpnurl
f] A suitable real ... mnt arm his ben aranrt.e and may be uM'Da] for Ma b On M a Remainder sou Wwrpin
systam. The mlac Tut was should be Prompted from diMmmce pled cam atb and dmu s net be indrmgaa ramp Try
mil .,Macke may wool end p•oposea eoucri Ion IT... and wish. Failure to Preen the mPlattmmt was will
result In mile ,apt W a mew
wU and . eW iaum a ,ttehlhn, Tumble seasonal we,. Replacement swapped m nmrn
amply wish Me name 'meNen st Om time.
❑ A marble operations,' n area vtlbon mMn ble dun k =door call IimlteGma. Peal mvnoeh a'POWTS
er
norms a hokiltank man ad em i as a last wort to mplaca the broad FOWTS
r orN/f w " ens tt
. 'ficDHlo elm PoRN (gA/$TRU�TONank
0 Mound and Tenpins, mu medical "mul may be re wpm . In Maw a mw'nm removal of Me buyer at Me
lvu norms Ounce. Racw.mctions of such iwm court wpoi lea with Me mom in ebM1m at That [tone
«WARNING»
SBIIC, PUMP AND OTNER TREATMENT TANKS MAY CONTAIN LENUrL GAMES ANDNR IN6UFFICIFM OXYGEN. 00 NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT, RESCUE OF A
PMON FROM THE INTERIOR DF ATANK MAY BE DIFFICULT OR IMPoBSIBU.
PI IMTALIER
POWR MYNTAWER
hem.
Name Paul Koehler
Phone
]15-246-2660
Phone 715-246-2660
6FPTAm 6ERVIC'No OPERATOR (PUMPER)
LOCAL REQUTATORY AUTHORITY
Name
Name 5/ . G 1 201JI
Pena
]15�25-1025
Phone —1cl 3810- a(/o 81D
The rmumm war soil in emphasis With mover amen 9anl2paten l4l) ash e3540 h m NI d). Waml>,n Aerneel ism 4.,.
ST. CROU COUNTY
SEPTIC TANS MA INTENANCE AGREEMENT
AND
OWNERSIf y CERTD'ICATION FORM
11i
MailingAddress; PO Box 445, New Richmond Wl
Pmpetty Addre:a 410 Meadow Valley Trail
(Veel6uhm rtgoirtA fens, Plmiog<]<e' haw'miNaam.)
City/Smre Hudson.WI 54016 PvwlldentiDeation Numbs, N4 1326-14-000
LEGAL DESCRIPTION
Property Locmion_ V,,_ Y., Sm. J I28 NR 19 W, Town of Troy
Subdivision Plat: Meadow Valley of Troy Lot# 14
Certified SurveY Stop ,Volume Page#
Wamnly Dead (before 200'nVhllsoc Page#
Bpecmwel3yeslZ,, Iq lhiu imntlfiableDYesOm
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Impmpv uu mA maiolaneom of your upi[ syalmi m Wd euuli i n ili Pum[mu 5ilurt m hmtlle wu¢s. looly
aof pampiog om Ne vepticbMevvythrteyemmvwmc, ifnatlei, by eliameetl Pw^p� wAatyou Pm irro
leesyakme®nelfim lM1e fuu'.lion oflAe upn[Yvkuatreammnt Hege in llu. xvk Aary�W ayMm. 0µurmnitMwu'a
mponnLilifiea art vpeciBM io 48P5. 383 R(I)eM w Qapo-v II-4 Croix Counry SwNry Qtlmwa.
The pmperlyowreragaab enbmNb at Cmix Cawly PlawingB ]mining Oryarlmmla ceNfiolion form, sipiel byM[
m,,t bYemnYv,wo,u,luuneymeoting modules and PAun'cerocalia'uum soy nnvenfyifBlWllll lb ji, jor
I",ansaru Jispoul IWF. irmpmperrpmlmgmMifian W/mQ)elbiwpectiooaM punpin8fifmcsivyj, We rcptic nor is
luv Nen I/3 (Wla(aIWIX�
aWtludiVxwel.6tbMeumueni..0Suby de Tenements
loefSonteAnd
WPma(pevttsiobruml5tlmmtii[nos enpEmmeuwegeauposelarslmrwimroc
1M1elkpmhnemofNapvel Rauw[ee,
S=VPlrrose J. ceni! 'omat lAal, 30 siearvumcesbsnm®nninmmnn be mmpleb]ave rcmmeEmMe Sl peix
c[untrel.imingc mn;neuapenuem wtlM1#t3h eofwe an«remewitnuenme.
Vxe aNly Set Jl Ymmma on giyfr/�fmryme nue m lM1e beY of my/ow lowwlmge. l/we mNart tM awnak) of the
peowm eeaznhm aIwq Ar iMe[(aw (nry EtttlrecgEm in RegaM nrorok OfEtt.
Numberoflaximumg 4 J
SIGNATURE OF APPWCANf(S) DATE
...Any inNmWiw day umiuegesenM{ say mull m So saaWy resit Miss uwked by the PWmng d ZmmB esp lmod, [ea
hoWtlewhb ft"Ansowra nwtlm wvnnly tlem fees, the aegiou of hum Omce W a mpy of he mtifed unrey map V
re ere ee is one, In Is, w,,o tytlem.
(RRY. wna)
Randall 0: 040-1326-14.000 05m Emig 1231 PM
PAGE OF
AIL Rome t%: 1728.182206 MO -TOWN OF TROY
current x ST. CROIX COUNTY, WISCONSIN
creation Date Historical Due Map# Sales Area Applies%,,# Permit# Permit Type Xof Units
02MO015 W 0
Tax Adareu: Canaria): 0 - Cunen Owner G - Came C,,O ner
OCCI INVESTMENTS LLC 0- DCCI INVESTMENTS HUD
PO BOX MS
NEW RICHMOND WI 64017
PropeMAJtlmafea): -Femur
pietricb: SO=School SP = Spatial
Type Diet# Description
SC 2611 SON DIST OF HUDSON
SP 1700 WITC
LLgal Description: Acres:
SEC 12 LOAN R19W MEADOW VALLEY OF TROY
LOT 14
xp
VOVPaBe
Type
1056026
OC
1032407
LC
1007400
11153
PLAT
80B846
1OM85
PLAT
1 1-053-MFADOW VALLEY OF TROY 0002015 1738N49W NWNW LOT 14
2019 ajUMM(1R1- No#'. Fair Mahe[ Value: Aarsutl with:
O
Valuations: East Changed: 08I2912017
Cnctlptlon Class Acres Land Improwa Total Stab Reason
RESIDENTIAL G1 1680 80000 O 80000 NO
Tattle for 2019
General Pmyany
1.680
80 W3
0 80, OOO
War, land
0000
O
o
TMeb for NIB
General Pro eny
1 "0
80000
0 ROOM
Wee Band
0,000
0
0
Lottery Credit Claim Count 0 Coeducation Date: Batch#:
Specials:
User Special Cade Oabecry Amount
Special Asssaements Special Chage OeleNwrt Cha ge
Total 000 0.00 0.GO
C
LOCAL _..__
O O O NISH
3 SO T SPORT
sa ; SPORT
95ro'RAGs
1747 =e FT TOTAL
-0-
I
°
¢4Sre
I
P
P
G
1f14704 SqP o
UPPER LEVEL P�
141
9 SQ FT
/'=Eb
5-6
El
�•:
_
s/rnaxXa
/\ sea narvPp �,
RECEIVED PAID
a's I oepamlremm SOILE UiA MIUMPORT "1T�
a" Saleb mCvAUG 1120ign amomea®.en co,nre'an-ws nem. Coe. Plan 1 + 3
PNIA'sion0-.lm...., ..._ U mm sal Twtln9Im
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Page 3 of
SamlSoil
Thomas Schnell, Inc.ST_. Nams__ IK5 Hwy ICI Lend Nemen
ThmreS J. Schnell, CST 227429 Nity State,
him Hwy 65
New Richn 5t Ciry, $1e(e. Dip: -Nm:Aiehmoed; Wl5,a1'!
Wwe 715onµ WI500i]
Phope:]15-060-1 978 Lot hocelon'. Mnao14 Valley OfTroy
14
_.el,P—SZJn/✓� Laval hip. Co(ty W114TmyT W1Ve61]Cmi RI9W
Bench P11 Township.Countypip Trvy Toworhip,StCroiv Counry
Bench Milk 1 E1. 100.00' Top o11"Seen PIP.. NW of wmap li =(B6L66')
Bench Maple R El. 100.00' TopoF1" Bb.l Pipe. NE Lot eopnsnplps. • (Ni
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Scale l"=40' g
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LEGEND
0=NpOOHUB$ETATlV
OFFSET. IS OFFSET, MON
BALDING EUTEN$ION
PIA EXTERIOR BUILDING CORNERS
MARKED NTH PIN FAGS.
FOUND IRON PIPE PER PUT OR PS NOTED
TOR- TOP Or NOOD HUB ELEVATION
TOP OF IRON PIPE ELEVATION
\ - - - - $ETBADK LINE
\ DRAINAGE AND UTILNY
EASEMENT
\ / MANAGE EPSEMEN!
\ _
+9G\ \ NOTE'.
SHrkk OW AND 510E SETROVE ARE
SHO4 \ RECORDED
PER
THEPLOT APPROVED AND
RECORDED PLAT OF MEADOW
VALLEY.
A �
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or,or
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4 as
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osoa V
It
/ SS, ELEVTIONS SHAVN ARE Nai 198E CARM,
w yi
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v t OH'-'BW.—f72.80 v
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"10 Plnwy ,pos mnl Yum this Stake -out
gym' or ral or hi
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04/30i19 kmwe9e and Lean.
DERRICK CONSTRUCTION
LOT 14, MEADOW VALLEY (CGrstensm) ® Z .. .. _.'a
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BM it\ B; szs a4 % 4 cal.
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