HomeMy WebLinkAbout020-1395-19-000 (2)
PRIVATE SEWAGE SYSTEM St- CfOIX
INSPECTION REPORT "n" "efn"' ND
607096
GENERAL INFORMATION uAI IACH 10 PER6A1 I t
Sa:c Ptan 'c •+c
°c, c:Jnal v c n'a fil- a r'.r ,d., Tay pp d..., c st•cJncd,y cirposes I=nva:Y -au' _C4 umil
r'e"ni'-HOiae'sNa^tc p, 'u'IIId:C ir.a'-s'i0 Pa-CC ie. Nc
Sean & Shannon Sargent TOWN OF HUDSON 020-1395 19-000
IS,A I Iev In:v: ill., I lev Bb, r :r.<: ni..r rcr,nu: Iaa :fa°aN1.1er Nc
~p0 lOir S*Lk-e N 25.29.19.2413
TANK INFORMATION ELEVATION DATA
IYPL I,IANJi AC'UKL ,;APACJI AIIDN WS iii E =_-U
pwo woo cv,\. ftenchrnarY I 1%3 J ,M
~ IVv
~7C pt
vncM,f. i Q> /r < L r117% l rl ~C~ I O .9
1 O ~ 31d9. Sewe~ ~ ~ l `
-.nldin~ _ SL'I it inlet `Tl ^
V
TANK SETBACK INFORMATION SI" it Outlet
(r,Z2. O-7.S(o
-ANK I pq 'A" I HI D.n: It. An honk, ROAn primlir
vJ (-4 cv, 75a 107
. ,h
K, - 1 / pt-Ronom
(000 S~ Z Z eCSer 756
I1-riq e2 1~LI1 r Headerrlan _n` 103.93
Aerau Us: °rp!: 1 O
Ho:dfng Rol. System
2, Q O
Fula C3radc
PUMPISIPHON INFORMATION 1. S
lefanutaclurer Dem. Sl;;ovcO;Ak~to
Modc. macr
T io.~5 104,23,
TDH I_h FnpNOn LOSS ad IUII FI
ror~en,aln engtn Ga. di wcu
T I?.5 o►.ZS
SOIL ABSORPTION SYSTEM
BLD:TRLNCH NVdt- _crptn '.c or ire - PIT DIMENSIONS Vc Dt't, 1;d, ❑-a: ImLntl ❑eepn
DIMENSIONS -is
3
SL18ACK YST--Nl 7.'1 P^L E- 3_Ur, ','•ot__ LAKFJ IgLAV LEACHING rJ:um'acsnc
INFORMATION _ r CHAMBER OR
-w,wwZr' Sv;tcn' 1 f ~l I UNIT
C v A 1~fyt h pn. Q~ ^1 c _ I }`j/ ' M:,,Ir.: YUrrILc Q wf
DISTRIBUTION SYSTEM L D ~I 5 ~y ~j cf--7- S = ZZ• 5
wunnlL!nn,cl It I: c:uh..bo x-nlr. 5:= ~tla6pc p vent to 41- Intant
_.natn ?ia~ LenOfh sp:,wnq `
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
'rr•r: r r.<:n'r ec,n ct •nc~r-„.:,-~i Mwcnec
Bo:1 , .r .:cr.le 1 , r.~ R,:<: 7r xr Eoa> c.~::r -
.l LL Nc VCg Np
COMMENTS: iPraun one disrrrt>enrres persons present etc i Inspection at ImivvAlun 92. /
Location: h4;:, PHAIRIF M:-AIT,)VVS- rDR~~
.~tb~"•~Alew \ /ay,/~, Ins C
1.:; 41', Wlvt 1)cs:aiplrun = -256
2 1 Bldg sevmr Iengll, = C1~I 1 V
- amount Of ::over
s
Plan revision Regoned? Ycs No L I5
Use otne- site for additional information. 7
Jate 'n:cp~t."=. nanrc GCrt. NC
SBC-6710 iR 3:871
~-dot - /00
Industry Services Division M Croix
' 0 S _ U I 1400 Washington Ave
P1.0 _ BO 2 Scanlan 14nnn Number it. Ec~~hllul in by (o_)
Madison, WI 7- 2 o7 -1
h r
%Ialc l r:meachun manha
S lbj *t" - ~~ni Application
lu a unJ w" woh S~ .l..i+1CI S *uhall n! nI flog hxul to 111C appnpna0. nvoumenlal 4
r yr r ;f fr• r t 1 r n nn: rr. p. -n \k 'PPIIffi na I(xms I'll -IaM.+wned M)IA ti are subnuncd to
Ih. P,mmcm ~;4n ant r I;.:rv r.i Iorv.rn'J nncmalnmvm roo Wo,oa) be used for ae<wrdar Pmiucl•\Jdre.~ lddinerenl Ihm mating xdd¢w)
I urE r.e.'n :reo'.Wau;e "J 'J" I'r...r.'.:.r., . IS odi I nnq. til:nv 943 Pmure McaJuw Lhnr
I lpplicatiun lnfunnali 'Icux•Print,%Il Information
r I r.'. !o uu'. Na... P'u:cl
V l St,.! N:v~cn1 O~1)-1791.19~:x1n
as.a9.19,aN~3
Puyli:as 011 ct', Mailing %ddre,,
84; I'ra'.nc Vu:dos. Droe
Govt. Lot
l a., %uae Zip( !dc Phonc Numhcr N w I,-. NA Sea r, .11
I l uJson. 141 541116 (amle onc)
'I' 2Y N It 14 1 no
11 type of Building (check all that apply) Iola
U I n Luui . D clhrg \a r b❑ of Hdr am . 71, (
A~D I q~ Subohl,mon Name selo." 110%
❑I'uhnornnunueial-fkanhe
❑ I it) nl
❑ tihne flwueJ I k.cnhc l .c ❑ village al
j L 5 ('JA1 Aumtkr
Ll ~jCJ~~ 17 C-Z ~GwS ~ 1®l u+... ui I ludvm
III. Type of Permit: enly oat 1w line A. Complete line B if applicable) _ Ze
❑t.c+. \v.ICm ❑IA:pl.vc<m IAUCn~ ❑Irc:umvnlufksWmr.lanA ltephwenrem unP ❑DUO NkWdnaula us ExIsling System (explain)
It. I'ennn pcn..ud ❑ I'cnnit li<.i, ienl ❑ Change nl ❑ I'rnnil I,nn li`r Io New I to, Terms Number and Dale Issued
Ilehae I vprtauun Plumba I'I'm, 4120546, 11'18'21.102
I~a_yym-~f1'~\4'jy ~.stem ~CornponenuDevice: (Check all that applcl _
Q \nr-I'rc+.n:vu: In-(frvvm ❑ I,ev.anma hrlinnuxl C Al(ira.k ❑ NtuunJ_'4 In rd.nnwsk veil L %L.ond, 24 in ofs.lUbk wit
49-1 in_ unL Iilhcr Uulxr.;:I Gvnpnum!cvplami ❑ I-tenualmcnl Devi". 1cwhun)
_
5 - aLi
V. Dis InrsalrTrcatm t Arca Information, ~ ~ -
Uc:.}•a f I•.wrepel Uv:;p•n 1o Apphcahnn UispcMot Area Itcyui d (:q Di pcrvrl Arca I'm .,.1 (4) 5)slem Idlevfltiun
'Sn It;r,ei l=i*-sli III'1 lI25 1112. 85. 111048. 98 II
OT _
N'1.'1 link Info iapacil).n
f inl Ions total not' s U
Nlanul4a1urcr
Gulluus 1'nifi D ~G 2. ~•7L o _ $ a
4c.. Imrks Luernrp Inds C Y .7 y ~ ;r, j I 1
Ngrtie:n Hulling l'anA ?yJ it llks0 1 ?n0 I?ill- ? IN'cek'.. \I rc,er ur lnlihminr _ff'~'II ^^❑'II
r Ia.arrG :hmIDrr y- _ - ❑ -Ll_--a y-1
Hrvpnnsibilih' Statement- I, the undemiltied, a. unsr rnponsrlnlln For imlalMUon of the 1 (IN I S shns.n m the attached plans.
`Plumb r'•, \arne •:1`ri-rn Ilom'pr ➢r rWore ~ kill NIPRN \univl Buslness Phone Nummer
Ju1uI S;htr.lll _ _ _ L( -2 /L //Ca I `i7N~ TI<-7h0.1i186
I lumtwr'.:WJrew>fNl:Cel.111 S.cre. /Ip Culcl ~ I
NNb II alle+ Vie,, Trnil. Smnanel. U1 54025
N'Ill. County'Department Ise Only
r luui r\grnl Signal c -
K\ ppr.ncd h.;;pp v. ` l'omil Icc 1) 1 d
r 1' :non lur Ucmal N 560 1
IV Condi4r ~ S?4.'YMAJiIF ~ifappraal - -
oispe!rsrcell^-lilt ell pe- l fr s':_•- Az_rr
93 per marlyement piin 9 1:12' ::v ;au•noe'.
2 /1Y il!!1av)k 191~1.k7'.^art.1 munt w r::.:.r.L,t t
0 Pf IIgknb19 aril /;Kr'.nmcf.
\Ilath to curs Ulele Ulam fur Ihr Yslrm ant .ninon to IM' (ounl. ooh an paper nut 1, than a Ir: a 11 in<bea in siae
SBU-b i98112!UId)
SYSTEM PLOT ELAN A
Prciect Na-ie. Sargent
N -H*
idla:h dCSlsf fJW i.alCllallOn2. tUf `rt
'r alecl k10,F..s Y4;, Frer.e Menuae~'n u'n GC^Iri;9r(J91 pla'IS /
F,M'. Svnrau'. A Ole Elevdfien. 1np Cp' T4Ce t•late'ials + aS7IJ S:andaa Scale. 1" = EO'
Hod 7escnplion rrr. W WI Stage TaDies 384.3(• 3 & 954.3[,5
a eC so 120
EI,12 Symbol jL BW Lleva:ion 4" s-- 46=:4 AST III D?ecs
91J DBJGnp1Nr' Ese - 4$TIJ L 034 777,77,77/22" ;.nue Gradrenl s Tested Area '3'a'
:JOI symbol i'aJPli;.ablel
NJ:PS. SFF nnxt pailr''.~r mYe c_npleF ^lap
RW Pracie Meaz:uws D'lv?
B: ~r r,~i it r
I II I ~ r~r it I~ r
r 1 I 1" r~
1 1 llr rirr ii
~ I it Il ri rl lli'i ~ I
D iveway II li'iiyy qo~i
-p.' ~zishny'000 III
;a'' SeDtic 6
gray`-~ Tank j .y'
\^--`7104
ose
W opse:l -'1D6
o Ih!-+Ct6C seDhc tank ' Ca
D
's I PoC'..
0
L
!J
EXisung zSE 75 B otl'~`f:ae':-en.^~ E -1.-4 43.
5
Czis:mD °'z.C2 SC' BiOtli'fas?' :'enU E.. =1C255' ~ i
-3 Pro DOSec 3 a'5 =_Z F DN' tre3ch F' = "C2 0'
74- PropOSee 3'x75 cZ F Dw !r?rh E = •CC 46
T5- ProDD:ac EZ : Dw hench EI. = 96.' 1
I
P~o:~rU nrle
CONVENTIONAL COMPONENT DESIGN
INDEX AND TITLE PAGE
P•oject'4rne: Sargent 5 Bedroom Replacement Septic System
Jwners Name: Sean & Shannon Sa•gcnt
Owner's Address 843 P airie .Meadow Drive
Hudson, Wi5401C
Legal Description: N'W1/4, NW1/4, S25, T29N, R19W
Township Hudson
County: St. Croix
S.rbdivision Name: Scenic Hills
Lot Number: 19 Bloc. Number
Parcel I.D. Number 020-1395-19-000
Flan Transaction No.
Page 1 Index and title
Page 2 Plot Plan
Page 3 WLP750-MR Specifications
Page 4 IM-1060 Specifications
Page S Effluent Filter Information
Page 6 System Sizing & Cross Section
Page 7 EZ Flow Information
Page 8 Management and contingency plan
Page 9 Septic Tank Maintenance Ag-eernent
Page 10 Warranty Deed
Page 11 CSM or Plat
Attachment 1 Soil Evaluation Repo-t
Designer: Jonn Schmitt L cnese Numoer. MPRS 223760
Date: 5/5/2019
f p/ P,ione Nurnbe,: 715-760-0486
Signature:
In-Ground Soil Absorption Compose,i: Vanua 'dersior 2.0 SBC10705-P jN. J1/01)
Page 1
SYSTEM PLOT PLAN A
Project Name. Sargent Design -low 'SC;. D,s"„
Pt OIcGI AUN t'SS . E43 Ptam e Neaa:ms pnvx Attacn desigr tow calculaucn5 lot
CU'TmerCia! plans.
E1,I01 Sympcr. A, 1311 Elevation 100 CO* Pipe Materials I A.STIA Standard
80 Descnplion Tco or t- tot sta.o Scale. 1" = E9'
I Tables 334 303 d 364 3G5 ~ 50 90 120
R1A2 Symbol A W. Elevation. 4" SCr 4c PVC 4S'N C2665
0M DesGipltor 4" 3034 PLC gSTM 03034
Slope Grad*,,l o' Tested Area I'3,.o
NO Syr i u' aopliuiblei
Notes SEE tart page Mr rora Complete ^tap
RAV Prairie Meadows Drive
4 BM1
B2 1T
~ III ,I ~IlJ titl~ll 1
_ J~r~ I I ~ Illl I l1i
I I
I~Dri'aeway l 83~
~~'Jtpll ExisG,ng'000
Garage gal Septic t'\
Tank
B 1 B4 10
5
Bedroom _ 1 104
House I \
P'cposed \ X106
WLP750-MR or~_
IM-1060 sostic lark 108
Fool
o'
TI Existing 3x6875 Bicdlff; ser trench El. =104.43
T2- Existing 3'x6°4 50' Blodiffuser trench El =102 85 n
T3- Proposed 3'x75' EZ F ow ttelch EI. = 102 85'
T4- proposed 3'x75' EZ F ow tre%h El = 100 46'
T5 Proposed 3'x75' EZ Row• trench E. - 58. 11
j ~
I
Prope.'1v I ne
Page 2
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Page 3
IM-1060 General Specifications and Illustrations
VT FAT
It e IM-1060 is an rjoct on molded two piece mid earl
~~r j rr' r r. -
r
plastic tank. The IM-1050 injection molded plastic design
r r F
nIlows for amid-seam joint that has precise dimensions
accepting an engineered CPDM gasket. Infiltrator's r}••J' X,i, , I u a
rrasket design utilizes technology from the water industry =I - )011 1
to coliver proven means of maintainirg a watertight seal.
I he hvc-Piece design is permanently fastened using a
Y 1 {
Series of non-corrosive plastic alignment dowels and
C.cking seam clips. The Ii'l is assembled and sold - -
t'xough a network o' certified InfiL+rator distributors.
Must be backfilled and installed in accordance with TOP VIEW
Infiltrator Water Technologies, Infiltrator IM-Series Septic
Tank General Installation Instructions and for shallow
ground water conditions reference the Infiltrator IM- IQ
Series Tank Buoyancy Control Guidance. II
Please visit www.infiltratorwater.com,limages/pdf/ rr. Iyl•y~U1
a~ r'rln '1" ill:Pr:P
ManualsGuides/TANKOt.pdf for the latest information. II I
7~-=:~faatPl.xXA1 it ,,n:- rcw I
8.';•k qg Capacry tU94 Dal (4141 Lj
Trr :I -aaac,ly 1287 gal (4872 Lj END VIEW
a,I l]A1:e l ss'/o
_r .,,fin 127" (3226 -mi ~,.I.,..r.. "r
62.2. 11580 IV r 11
_e q'h ;o-wlalh Rato 2.3 to 1 •T`~`~`t '~~1
dr'' S7.T 11389 mini I
I Id Level 34" 11118 rnir; ~ I' aI a~~ri Drop 3" (,76 mm)
~Ir;en7186s SuUWrts 2 -1 I'
- ',pa!i'11en:6 1or2
6' 9 v ur Lm Burial Death 18" 11219 m m; SIDE VIEW
r IrI •n Burial Depth 6' 1152 -url
'.tt mum Pipe Diameter ti 1152 '-nrU _ i Irdaous
32p ItN (145 k,g;
Aro
I`.II:.:I.P r St iaN [L IT
/ F
au~n.•_r~ ~1.___-l
I/ - ~a.rr. ter^~v
= FL.r~r a.c Fy.: YOat I A
Y . 759
`.r> . ry r' ' ` rr' MID-HEIGHT SEAM SECTION
INFILTRATOR 1-880-211.4436
www.lnrlitral mli water com
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Page 4
P! 1 i!!e)
'I he PL-525 Filler is tah•;I I.,i 1 o,ow GI'D (gallons per day) making it ono of the largest filters in its class. It has
525 linear feet of I; It,' filtration slots. Like the Pulylok If - 122. the Polvlok IT-525 has an automatic shut-off hall
installed with every tiller. l\ hen the filler is removed for cleaning, the ball will flat up and temporarily shut ,it
the s) stem so the el lhtvnt won't leave the tank.
<a - Alarm s,vrtd,
• Fated for I11,000GPI) (gallons perdav). C~YllI lpPliunat)
•525linear feet cfI1'In•filtration .
\c,vple
•Accepts 4" and ti'ti<..I-Ifl-l01'tIx•. t'.xlrn.rm llaed:e
• Built in gas da Hector. Cn~y'
• Aut ,made shut-oft hall when filter is remove,)
ah¢I hrt
• Mann ar. e,si6Jity W.LNIU GNU
. Accepts I'4C c\tension handle. Is Idea; for residential and con crJa. %%(15te HUN'S lip tC t -yy -J 2, Lme s, Ft.
ni 1116'
10,000 gallons por LIM I;GPDI) ~ -rte Flitiati mslots
1. Lccate the outlet of the septic tank.
K, move the tank aver and pump lark if necessary.
Gbre the fillet housing to tho 4" or n utlrl fill,, It su 11:1 41, Pr,:-
the litter s not ccntmd under the accc,s opening use a
PA%Iok F.\tead & ' ok or pfecv, of pipe to ocnter filter.
4, Insert the PL-525 filter into its hou,m)l -
Grrlirlea fo
i i pielxlace and S,Y ItfP the tiepllc Llilk , U\er. NSFIAN51 Sta O11114 46
L
I It., I'1 -525 L.ftloenl Filters will oporate viii, ivnlly for
V%oral years under normal conditions before rcyuinng
cleaning It is w, onnnrndrd that Ihv litter bv, It., ned
everv time the tank is pumped, or at !east everg three
years. If the installed filter contains an optional alarm,
Iho o%%ner ccill ho notified by an alarm when lire filter _
Gas Drdlrcinr
nerds servi( ing. `x•rx•irurg should Ix, door by a certified
septic tank pumper or installer. Automatic
Shul{)II Ball
I. Lccate• the outlet of the septic lank.
2. Kamove tank cover and pump tank it necessary. _
3. 1)o not use plumbing whom fillor is romoved. . ~1
4. Pull PI: 5525 cartridge out of the housing-
5. I lose off filter over the septic :ank. %takc sure .,11 ~►j `
solids tall balk into septic lank
6 Insert the filter cartridge hack 111!11 file h:nlsing makm}
sum the fit<r`r is prnlx•rly alignal and a~mpletrly melt", i,..f 40,1 1 I facers a,,ePl Extly installs,
Rc•plarv and s,,, m v septic tails covvi 'Iu Sa,,,!Fihce'": 4w dchaoj alarm. into exiMm; lank,
Polylok, Inc , F,iii lilye. W.illinglurd. CT M492 Toll Free: 87 .70i .956 Fax _113-284,S~ 14 wwvv'.pulpluR.com
Page 5
PAGE 3 OF 4
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Page 6
Installation Instructions for i~E ZOZU"
EZ r ; 'Systems in Wisconsin uyINFILTRATOR
, in P. .r.,,.r I h~ind.:: hr_ .'.r ,u< t ii i I C. -lisp
- .-I-re based or rr ns rwrn c-11, oroagc fr:w oral
U%is c•..._,. A -t! (n, II: c'iifica. c : ,.n~1 Cr Nl.r^ ; for
piocuct anc det_rrni^cd t :a be n compliance with chapter- :h: ^rrmeabiidy V :hc s1-. If ccilain crtera is rrcl, the
;;r•nm t32 t^re..yh~ t3:, 4:5seanmt Admin. Code, and Chapter. l ISA r, zing ca^ be used in Vii>con siri, re>ulling in a 40%
145 and 160 .,,ccr5 n Statutes. Al s to,, must meet the $;tr ; •,-nallcr drain='.eld.
& Sod Corddlonl: & I ocatons & Isclat•o° distances as notes ;
local regulation;. 5 Plate EZ,lovr ound:e() in the EZflow conficuration ap-
pr,^.ded by sys!er' design permd specifies for Iho partieu-
The approved p•+.cu:;s a•e '20311 (3-12' bundles ::rtfi c)ipe ia• site. The top or ce^ter-most bundles containing pipe
center buncle in 5 or 1G' lengths) and 12)31 IP (3-''1 nu- de-: are lanec end to end voth an nlemal p pe co.:pler. Any
•w& pipe in each b_ri in 5' or C' engths. : adcitren3l aggregate only bard es that may be requred,
,-r.J:: tie busted against the other aggregate-only bun-
A single pipe buncle coma ns a fe„ r inch perforated pips' F.w : ,rc de not requ re any type of connection.
roundeC ty EPS agg•egax arc s held togetl e• w t•1 p~
I 1=mP ^e h':I 4 v,trl: gu Ie I u ,•I, rI Ord r t r ,t : -it t:p c` each GEO cylinder contains a after fabric pre-
III- act~l in between the nell-no and aggregate. The
'._l.Iir. is inserted to prevent soI ntru,,on, The installer
Materials and Equipment Needed -f -d I rake sure the the GEO is posr,ioned upward and is
• I,~fl~ :w r9 it ~ -It ir1 v :h- [he fabric rontalned in the adjacent cylin-
• f-i fl::v::;~•idi•r 6. F,d ~ . ; d•r hr'orc bat<hSllinr).
• LZffnw iryrna; u::
• "ce for Heads irk I I h 10vw Grainfield Systems should be installed n a
I.•I 'y5nrh in all duectione. ('both across and along the
h , bo1cm) anJ sroulc follow tic ~ontourof the ground
Installation Instructions u•taee elevation (uniform depth), with all continuous
T'1r h1rrr, for rr_ ,ljI- I_t h 10-foot cylindrical bundles placed end to end.
lr ,A IT,I, h 711.1 mu. tic ir malted it a;:co•dnn e •.vitr shat ; "Er central bundle distribution pipe Interconnected.
I r I. i n.,J i.- ,-hapbrs CDrir+ 1;2 nrougn r.34, W.'r ongn Air ..'°c.,t any dam;, stcpdowns or other water nlopn.
utc, o- r I',_ i~rnc'• lop shall be graded such that'salet wIl not
merit:il 1 r,:, (3a-kfill should be seeded or soI mmeuatel.;
.v _:m•phetron to reduce eresUri,
'iia:•: LOS bundles are fexiblo and can fi; in cuNed
nltrk :itii us ` r o of trLr'.i., T's as maybe necessary tc a+ord trees boulders, a
.-awful to set ze••ect tank. i-veil pout. Header line 01 cr.- =.-I obstacles.
tnbulon trot and trend, U'Ti elrvaoon; before msh l-
I9tion of pipe bundle:;. 1 °S aagregate is lighter inan water, therefore. it mignt
ire ~'Kuected anal nalulal buuyancy forces wo-ld lend to
Relro.C plastic FZfloe: shpcany gags puo• to p4'v::ru, ._aos,I FZfla:v assemh!ies to float cwl of ground when
bindles i- the trencn(es). Re-loco any plastic bags n th- nondTg OCCUi,, Field experience has shoran, noweve,
trenc, oeive syslcrn I4 cgveree th:;f this: iS not a p•onlenr wnen systems have a minirnom
• n(ti" '.d sod rov;•i apt rer:cmmcndcd by marnafacrrr rcr_
This prwud mss'. have gectextile iabrc that meets •e-
gairemenis o` s. Comm 84 Vi P,;In irstalled directly on top et .i.,, ~L...-:I -r I 12031hi
down along C•C :ides n( the II fr
i"rhee floe the hnHrm C. n,r,`.
4. Whet- r,`'alled n a bench, it i s r _I r, :.i
a:t^illh ,•f ?6 rnr^c-.. 1'"i5 n' it r. i'i_'••:
tl -•.kt d nr "sinI :aarr -'c-t;
Page 7
PAGE 4 OF 4
In-ground Gravity Management Plan
IMPORTANT:
The owner of this in-ground crav ty system shall be respons.ble for is perpetual cperatibc and maintenance pursuant to
requirements of SPS 382-384 Wsc Admin. Code Pursuant to SPS 383 52 (2}, Wise Admin, Code, this system shall
be consicered a human health hazard if not maintained n accordance with this approved management plan
Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in
accordance with SPS 383 52 (3), Wisc Admen Code
Maximum Dispersal Area Operating Limits:
Design Flow= 750 gpd; BODS 5 220 mgL-'; TSS 150 mgL-'; FOG 30 mgL-'
Inspection Checklist INSPECT EVERY 3 YEARS
type of use
age of system
nuisance factors (i a odors use, complaints etc) ,mechanical malfunction (i. e., pumps, valves, switches. floats, etc.)
material fatque (i e. leaks, breaks. corrosion. etc I
solids volume in anaerobic treatment tanks) arc any distribution appurenance(si ire.. distnbutcn i drop boxes)
•reglect or improper use (i a exceeding cesign capacities, prohioited activities etc 1
extent of pending n distribution eel prior to dosing
dosing irregularnaes - if applicable is e purrp re-cycling float switch settings, efc.I
electrical components - if applicable ire wiring, connections, switches controls. timers, ala•ms. etc)
distrbution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification)
surface discharge of effluent or selvage back up rite s:roc:ure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
Septic and dose tank(s) shall be pumped by a certdiec septage servicirg operator licensed under s 281 48 Wis.
Scats. when the volume of solids in the tank(s) exceeds one-third (1f3) the liquid volume of the tank(s) or
as requved oy ocal ordnance D.sposal of contents shall be cursuar: to NR 113 `Misc. Admin Code.
Effluent filteris) small ce nspec:ec every 3 years and sral I be cleared when necessary to remove any
ac. ~--Mated solids ar_cordm~ to manufacturer s speaf tatro-s A se'%' crng pe-iod v: II a:ways be greater than 12
mo'iths
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 ind4v dual or bomparv. John Schmitt _ Phone 715-760-0486
Local goverment unit. St. Croix County Community Developement Phone- 715-386-4680
Local government unit address 1101 Carmichael Road. Hudson, WI ZIP 54016
Anv defective part of this system shall be repaired, replaced or removed pursuant to SPS 383 51 (1), Wisc Admin.
Ccde Repair or replacement of fa led or malfunctioning components shal' comply with SPS 383 blrisc Admin, Code.
No product for chemical or physical restcraiior of tie POW`rS may be used unless approved by the department in
accordance wish SPS 384. Wisc Admir Code
Contingency Plan
In the event :hat acv faded treatment cernporent of :his PONJ7 S cannot be repaired, it shall be. replaced pursuant to
a plan subrritted to the appropriate agency for review and approval A failed in-ground dispersal component may be
abandoned anc replaced by a code-complying dispersal compene-It in a pre-determined a-ea of suilaole soils,
System Abandonment
If !se of this Po•vbTS is diaeuitirued. it shd b^ abandored i', a_"rt:arce A vi SIPS 383 33, '!Viso. Admin, Code.
Page 8
ST. CROL\ COUNTY
SEPTIC TANK NL11NI LNANCE AGRYrATENT
AN-T)
OWNERSHIP C°RTIFICATION FOI NI
,,t1e BLit, Sean & Shannon Sargent
MaFiria addrt, s 843 Prairie Meadow Drive
Properr;.AddreSS 843 Prairie Meadow Drive
(Vcc Scarier required from Planning & Zoning Department for new construction. )
ChSrate Hudson, WI Parce' Identification Numher 020-1395-19-000
LFGAL. DESCRIPTION
Prostrty Lr_~car.or, NE S.r , NW S4 . Sec. 25 , T29 _N R 19 Hudson
Town. o!
Su'DdjvisionPlat.Scenic Hills Lot= 19
Certified Survey Map » Volume Page #
Warranty Deed 9 (bc]erc 3007)Volurne . Page P_
pet h~.ise❑ya['jto Lot iinc. identifiable0yesE]no
SYSTFNI NIAIVTENA-NCE AND OWNER CERTIFICATION
Improper :ue and maintenance of your septic system could result in its premature .`ai!urc to handle wastes, Proper
maintenance cnncicu ofpumpim~,out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the funct!on of the scribe ran'c as a treatment stage in the waste dispos i! system. Owner maintenance
responsibilities are specified in §SPS. 3'83.5211) anc in Chapter 12 - St. Croix County Sarilary Ordinance.
The prepcrc, o•w:icr agrees to submit :u St. Cron County Planning & Zoning Depaiuneu: a certification !form, signed by the
owner and by a master plumber, journeyman p;utnber, rewicted plumber or a li;.enscd pumper veriN icP that the on-site
wastewater disposal system is in proper operating cordinon and. or after inspection and pumping (if necessary), the septic tank is
less :bun 1 r3 full of sladge.
we. the under igoed hace read the above requirements and agree to ataintain the private selvage disposal system with the
standards set fbtt`r. ?t-re r, as, set by me Deparvnent of Safer; And Pmfessioncl Stn ixs and the Deparlancnt u`Netural Resumccs.
State of R'iszovir. ~rification stating that your septic sys:cm has Tucr maintained must be eoinpletcd anal returned to the St. Croix
Counts* Planning &loni ng Department within 33 days of the three year expiration date.
•nc ccei h::` :n a'I <raramc^ts on nix form arc tmc to the best of"myoar kno•w!eJge. I!we an, are the owner( s) of the
propcr:r Jcszribcd abc•. by v:m:c of s t rani deed recorded in Regster of Deeds Offce.
Number of bedrooms 5
SI(JK'I,LCR6 OF APPLICANT(S) DATE
-Any informat:on that is misrepresented may resuit in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this apph .ton a recorded warranty decd from the Register of Deeds Office and a copy of the certified survey map if
referen.c is made in :hc ,=-tuity decd.
(REV. 04A21
Page 9
/ ~ nx.~-ati s1
i ;
7 a 10
o-73soFs 6 9 r I,soceson r
9?.WAIF 95, 019 so 2Ac. is
W 210 AERE$ 2198ACPES
,
l /S . .
rac /
--Prairie Meadows Drive- - - e r~
:rux~rv, xu.w ~ wrvcwwmv - ~
. -!Iwo-AH5
yy
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178.75 FT rJ}~ 272rAU%S ; 19 i /a k
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2W4CRIs
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20
111.125 SC F\\ L
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17
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1 71 iT i'GZ[t]
aua
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Page 11
1144
'Alsconsm Dees,-!enl d:orrrxVrn SOIL EVALUATION REPORT Page I of 1
Divs4 ul Safety anc Buildnlys in accordance with Con, 35 Wes Adm. Code Tom Scrlmin
COUntV
'JW M y m alto: on i less eat &Y: n t 1 cad. Par want St. Croix
nduca
, i bat My krYtd to: ven[a and l:a¢m181 re'gn)nx Doill DDIr1 IB1Ai, dueabr and Parce I r-i
Di.tiM. boPe. Nw'Ib G dhrimszvc, na•V•. Cl:M, 9nd V('P.'O^ 9ro e'a9rtt IC rcdrosl rM1a(:
Pfosse print ail information' Rlwewed By Gate
+~eama nrmnr~ryrnn~n~ry M.nMbuasas~:..VUK ;r+vay lavrtpp;;lrl, P II~I-SIOL
P,ooen/ Owner Property Location '
Grande Di Gov. Lot NW 1A NW 1A S '-!T 29 _N R. 19 W
Propery Owners Malting Address Lot N Block a Sued. Name or CSMN
131 CGesMew Drive So_. 19 Scenic Pills _
::ay 3tste Lip Coda Phone Number Ciry wuage ✓ -own Nearest Hoad
Sairl oaui MN 55119 Hudson Plains Meadow Onve
✓ New Construction use ✓ Resdemal' Num ier of bedrooms 3 Code dorivod desgn flow late 4S0 _ GPO
ReDlaconi PAI,c or commercial - Describe
Parent malt is Oulw_ash flood darn elexalion• a applicable - - na
Gere,el comments
and recommendalor s'. Area :s suitable for a conventional system with a 0.7 gpolsgft rating Possible system elevation for Area I
is 104.50• (high Iranch; 103.0" (low trench) based on a 13'b slope
Boring a Sot ng
✓ RI Ourd SuAace ekv 106 15 9. DED(n to :midnq lector 1 14 _ ..N APPicaoan Rale
l i- n [)W, Ocm-, ' l io• Rolm C•osm)(lor Texture S',rudu!e Consistence 801.ndary , Roots G-pr _
In M. W a Sx. Cart. Cab, Gr. Si Sh 'Effrl 'EW
1 0-13 10yr3f2 none I 2tsbk my cs 2f 5 .8
2 13-'8 10yr513 none sit --2fsbk mfr gw 2f 5 8
3 18-29 10/r4i4 none sd 2msbk mfr g - .4 6
4 29-02 10yr5/4 none gels lrnsbk 1 mvfr _ gw .7 1.2
5 42.1141 10-{15/6 i none grls Imsbk mvfr - .7 1.2
- - Jam- IrY'{'SO
~~II 43-d
L ✓ Pn 310u1W Surface elev 10810 n. Dooth to IimRmg factor >110 m jyi ADix.U": Rato
Honza! De il, Dori oor Radox Destrxcon Texture I Strjclura Comislr:ce fJoundary Rams GPOW
klcxeal Ou. Sz. Carl Caa C.. Cr Sn 'Ef l l 'E1111e2
1 0-9 1 Oyr311 none sd 211gr mfr cs 2f .5 8
: T-
2 9-19 15yr4/6 none sic: 2tsbk rnfr gw if A 6
-3 T19-30 - 75yr414 ncne Is Imsbk mvfr gi .7 1.2
4 130-1 10 10yr5.'6 niche 1s lmsbk mvIr 7 12
*E-Muentfl=BODS>30,220,ggLand TSS>30<-50 mgr- 'Effluent a2=600,<30 mg4. end TSS<30 mgIL
CSl Nome iuket" Pnm; Syrurr m, / A , CST Number
Thurnas J Si ,-a>t,aa , 227428
Address Tom Srnm:h / Date Evaluation Conducted TebDhone Number
1595 72nd St New R,ch, no V: 51.01' 11 715247.2941
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