HomeMy WebLinkAbout020-1345-30-000 (2)
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PRIVATE SEWAGE SYSTEM °'nN St. Croix
INSPECTION REPORT &anl:arr 'e mrt No
iA77AC I DERMITI 607097
GENERAL INFORMATION 1.1111.1111 1L Nc
'ersona -tormatc-r vc. F"ou'ce may be used fm w-cc-dar ou¢ov_= IFnvxy Lax s 1it'= t:; :1
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Dan & Jodi Brunzel TOWN OF HUDSON 020-1345-30-000 1
IC:S 81.1 Flee Im;: RN i iev aAl ;.e+e,ybou "n~;lrm7own: R:n.;y:: rd:9: Nn
ipl. VLn~ o~1~Q~ 1129.19.1853
TANK INFORMATION ELEVATION DATA
Ty=,- P.IANU=ACTJRFR CAPAC:IT' flL=.1104 C!S HI t~ FS ~yF1 FV
Sep.6E7 -a Rvnr.Nrtr ~l.Olf~ w ,y IQ~.V Vl.~p
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Rl:fy 9ewt:r I dol. liq
I D:mJU@ b:UHt Inlet tot L
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TANK SETBACK INFORMATION SUHI Juliet I ol.l,
I P.NK -Ci Flt_ 'vVELL RI W! vI'. Ic k b:akc R:"_2AD D! Inlet
.I'ieplK ~ .O 1 I D $ I ~ ~ I n r RYRol,om t0 VQ . "1
Hon LSD II 1 SS it IG Header:Mar 1. ~s
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PUMP/SIPHON INFORMATION Q OJT 35
Idanataclurcr CKmand SI Cover t ~f6
CiHM IA' I Cd ~
Mode Inner Tk 20
TDH ifl Fn: Bnn osr. sn Heaa TRH N
_ 'r- 10.09 7.9 Z
I orccrnal
SOIL ABSORPTION SYSTEM
t~}s P►t-
BED:TRENCH •%artlcr R Lrn;tr n Flrv 'r,ncnr PR nIMFNSIONS N_ C !•v• 1-s,ec G:a c/mc 7nP'h
DIMENSIONS
SETBACK SL1,11U -U F':L GLL* 'VA-LL LAKE:STRFAM FACIIING Manufact..mr t^~11 ~'/blc'v'l
INFORMATION CHAIAB FR OR
'ype ':!'ter stem 1 / UNIT tdonel Number CT
~~~cn11d 0.I btu 9' I Z Qtl J
DISTRIBUTION SYSTEM FL4 f IL{ L5 Ip~~
He3oe^Yta eno: Jst ma..w, / / x l,nle fd:~ x H'vte spacing 'Jerq lo An lmnke
"InelS ~ ~U~
rencr ~ C:= -mm~ ~ G.: Sn:~:,nnl
SOIL COVER X Pressure Systems Only xx Mound Or At-Grade Systems Only
I,pt r pent. xx ".cpth rn xx Smo-d'SCCCe xx Nulehed
(dctcesv
Ertl 7r.n l :.n.:.: Gmti 111.111:1,
A _ v1.:. Plc c No
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COMMENTS: ('Maude coot discreocnaes persons present. etc.: Inspection Bt Insucchor 2.
Location: 717 PACKFR DR p
~a J~I ~CM SuC~{1~1 t^ ol(
AltRh.A ~rs<:n;lhnr= V
1 Ride sewer rength = 1 c T'
amount nt novel = ~iclk
Dien revision Required? Yes Nc J 5
use other stile for addthurial Infounahurt.
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Madam WI 33707-7162 1 y Pamit N.
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Andex & Cover Sheet
-xrrpon OtA*MafCesignReferences:
,'Cr'oat 2.0: SEA-10705-P (N.01/01, R. 10/12)
Index & Cover Sheet
Pq 2 of d Plot Plan
" of ! Dispersal Area Cross-Section & Plan View
-;,iis: I -ieinent Plan
"u POWT'S APplicabon for Review
Soil Evaluation Re
port 8 Site pqa
f-oiect Name ! Description:
cin2rG.ame(s): i~r,y 1v f : JcDI .F"-,Li ~c Phone:
_.,narAddress:
Zip: _-5,;VU%~
>iect Address:
Lot - '=114 of 1/4, Section T z`; N-R~E~er W
~atrship: - f i . c,• ; County: :~T C RCr y,
Designer information
a?-sSCne'Sf•. .~+vi:7 L: i'J __a_'t-~U. #~r7~~'T
Phone: 7/S t
Designer Address: 19-i YI,UbJlrTH KS Zip:b9&50
Thusp~eAresszR4d93n~ iatamai.
v_icenee Number: _r . s~1 00 7 ffy
Remarkn:
X n ;c
Sigruftre: ~r 4 _ n rNNraSilfaW@~
c , - Date: z-VI
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IN-GROUND GRAVITY DISPERSAL AREA ~`'r°"',I rl -
Uniform Elevation Trenches with Quick4 Standard-W Chambers 3"&r-*talvo-n Oe
3-ft Trench (downsizing credit) 1' gw _9d _iw
Al D
G'.I1J4Ei ~(NL:A~:Ek MY-W
~z
TYPICAL TRENCH
CROSS SECTION VIEW
Provide mini tm, 3 R
system Eh~uUal ft a:Paratun beMeen trmxher.
(typical)
O~tk4 $~Ma s-:V
W [rid
(tYPle:a!) (Slaw btal{cn rN ir4M / elWlet PNn irnneceon nn fin .i~+.) ?wta
T.. TYPICAL TRENCH
PLAN VIEW
l'.° se
-1f- (No Scale)
D
a = 11L'R m
(bpkzll -Qukk4 slmldue.W tFgmbor w
INSTALL 45 TRENCH: IrYgc~1 0
- - 0d24 St6W ® 70 fe EMAkhambora W k~+o.+.+l e.~...a.o..n A
+ 21 Pairs of and I .1
~ 0 s fl EISNpab= M
• Propr4ee0 EISA Per tmnc h. ft
Rx qA dWer uanAlea= DLstrbudwMethod
trenches = Plo osed Total EISA•
P R' 1 iA.l,k'flE L
57/4.q. - : 6; Ff~~u lT- 1 SG, el q ir1 ITS
1~ I r..
x 41 7_ Ccz- 7 ~ '
r IM-540
tanks
Features & Benefits
• Strcng injection molded
` pclypropylene construction
Lightwe gnt plastic construction
i ano irboard lifting lugs allow for
f i -4•:.•'~ easy delivery and handling
..r integral heavy-duty green lids that
;k; intercorr.ect with M, rse,a and
pipe rsersol'itons
Structurally reirforced access
~ ports eliminate distortion during
installation and pump outs
r$ Reinforced structural ribbing
$offe^s addit oral strenoth
Fl a ~d' Sv`-V Gan be inotaltod with 6" to
F -
y~ 48" of cover
Can be pumped dry during
pump-outs
Suitable for use as a pump tank
or rainwater (non-potable) tank
The Infiltrator IM-540 is a lightweight strong and durable septicipump tank, No special installatior, bac011
This watertight lank design is c` erec with nfiltrator's ins of custom-'it or water filling procedures
risers and heavy-duty !ids. mfilirator injection moldec tanks provide a are required
No special water fillirg
revolutionary improvemeni in plastic tank design, offering long-term requirements are necessary
exceptional strenq!h and watertightness. The tank may be backfilled wirh
suitable rative soil. See installation
nstructio^s for guidance.
n Z.
MIME,
Reinforced c , cus!om fit
{Z. SlrvChn ll TN' Riser
access nnt' r
Rei~forceo
watertgl-t
t,. w. I tom,- ccrnecton r
ProtecCrc: ti. E. r.irorn _It a rl Innovative WastewaterTreatment Solutions ! N F ! LT R ATO R
JM-540 General Specifications and Illustrations P
` a
a - a
he IM-540 s an injection melded two piece •nid-seam
D as'ic tank. The IM-540 injection molded p astic design
s ows for a `nid-seam loin; that has precise dimensions
r5u, accepting an engineered l gasket. Intiitraror's "WrITlH
4esket desicn utilizes technology from.. the water r
dus'ry
_o celiver proven means of maintaining a watertight seal.
he two-piece design is permanently fastened using a -
acries of non-cor•osrve plastic a!ignmunt dov+els aril
ncc tng seam clips. The IM-540 is assemblM and sold
[o.v::raN TOPVIEw
-I-rough a network of certified Infiltrator distributors. n:
1`iT(~VN[CTON
f)4ust be backfillod and installed in accordance with 'Trvf
Infiltrator Water Technologies, Infiltrator IM-Series Septic
'Tank General Installation Instructions and for shallow
eround water conditions reference the Infiltrator IM- i ;';j III 'i I' 11~
Series Tank Buoyancy Control Guidance.
?!ease visit www.infiltratorwater.com/images/pdf/ rHE M
a anualsGuldes/TANK01 pdf for the latest information, 1 I III ' i
YAv'1
r, C END VIEW
apeGty_ 552 gal (2090 Q
64.9'1'548 mm)
:ih 6L7 it 5bi mm: t
(73c71r-n:_ INLET
I I
^ _<iroum 3t.riel Depth _ 48"-f 1219 mr j J I
LJ
.~nrnum burial Depth 6";t 52 mr+y IjPy
uzlmum P pe Diane ter 4- {7 JG ^3rrl
ft 1ai@ I"
~_`.tirl AA'
- -Dei1Y CU4
..fK-
RIM all
1
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G:z_rrx Pux Am: MID-HEIGHT SEAM
O. ?50
CL. C, Ci'A SECTION DETAIL
sa,c•cec
IICIF•:L1QATOR +s'507223413Lewa.rDOf
www.in' "Wompte'.com
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LiRATOR The Quick4" Plus
Standard !;hamber
ie Cvick4 Plus Standa"d Chambe" , S
ffers maxi, -.r-, strength thro-gh
t
is inro center structural ;elumns. j ,
chambe' ca's oe wslahed it
inch-wide trend' L,xe the
~y nal lire of Gwck4 chambers,
of c, s advanced cowwrinq
rpability wi, 'ts Contour Sw vet
rnection* l which permits turns ~ T fl. as~~
p t5 degree--, right or left. It is
•u ava table in four-foot lengths is wh ? V~•: 4 _
d,de optimal 6nstailaftr- ftexibltit''
vuiok4 Plus Al-in-One 12 rt4
'1 *icap, and the Quick4 Perisccpe I ~o certor s,ructt-ra. columns offer ,ncieascd 5 ablliry ,:nd -uper?3 s'r ngth
a avai'doie with this chamber, Advarced con.oLt--g connections
ir,g increased rexibi!ity in
Latd~inq me--honism al'o:vs for gaic.k Instal atlo
coifzturations
Fo.:r-foot chamberIe-ngths aye s_:La t-
131
h>l
r ~
''Aac (1Li',11
c
J:ze MifCk4 Plus At! :.,ii.Cap Gtlick4 -Pills s Ad-:n-Gt-
_ .a mm x ! 3zE :-'m x 305 mmJ
• felay be used at the enc of cnamber Allows for raised invert (nstallat!oes
Cffective Length rOW for an irdeL'outict or can he
14 dir'...tcr,.l.
(12'9 mrnj trench
fo1;d-irerch connection feature alfc:vs
Louver Het M a
9 construction of chamber roses e:ith
,2U3 mmi center feed as an altemative 1:?
- -i nletting a: the ends of chambe; rr
Storage Capacity Center-feed --Drnec'.ion G lows f:,r
47 gad (I' S U easy ir,stal,ation of serial distr.'bL,C.I.••
Invert Height systems
0.6- (15 rnmi. r135 nnn). P'oe cdnnec!ion options 'nClude or p,ur ,bin
8.0` i203 mil'; 12," 1323 mm; sees, ends or top
ano FAe:hanTa _
r
APPPOVED in C~Yloial n,=,F4'Cr ' I4P; r
u;:
U!ic;;v Pius SianCSrli Chamber -
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In-ground Gravity Management Plan PAGE 4 OF 4
INPC}RTANT:
the owner of thin krgotaM Wavdy systn shag be nesponall" for its perpehral operation and maintenance pursuant to
reouienoortt of SPS 982384, Wisc. Amin. Code, Ptrsuarrt to SPS U3.52(2), Whc. Admit. Code, ttbs system shah
be cortsideced a human heath hazard if root maintained in accordance w o this approved menagament plan.
FufMremare, all irspectim aunt rtmi0.mience activi m shall be part tared by a roPWerad PONRS Yamta6 W in
accordance with SPS 383.52 (31 Wisc. Admin. Code.
tAaxhtMen Diswrsal Atee 0oending irwt►c
Design Flow= _ r gpd; 80N 5 220 nigV: TSS 950 rn W''; FOG 530 "L't
won Cbecirlist INSPECT EVERY 3 YEARS
o type of use
u age of system
o nuisance factors (f a. odors, user complaints, dm)
r mechanical malfunction (/-a-. Pampa, valves, switches, flow, elk.)
o material fatigue (i.e., teaks, breaks, corrosion, eta)
o solids volume in anaerobic trwAnheet tank(s) and any distribution appurtenance(s) (Le., disbisuaen / drop boxes)
o neglect or imp Ww use (Le., exceeding desW S, protatted aWAbes, eft.)
o extent of pending in distrbution cell pripe to doff
dosing Wrugul8rWaS - it applicable (i.e., Pump rs-cydin9, float switch settings, etc.)
efeekic:al mrrrporrants - If applicable (Le., wiring, connecGoins, switches, controls, timers, alarms, etc.)
o distribution lateral or lateral ordlice plugging (measure lateral distal pressure - compare ID desgrh speafica*M)
o surface discharge of eftinent or sewage bark-tom wft structure served
Maintanancce Checkfist NAWAIN EVERY 3 YEARS (or when necessary)
~ and do" 11106441 shall be pumped by a cutfred septege seevi" operator licensed under s. 281.48 Wis.
Stets when the vokeee of solids in the tank(s) exceeds ora.thkd (1/S) the @er+fd vokxnq of the tank(s) or
es roq'*'ad by lodes ordinadree- DISP " of contexts OW be Pursuant to NR 113. Wise A6rin. Code.
12 is WIM
be bA'JW ad every 3 years and shag be deaned arlhee nsessMy to reprove any
solids aw"dkV
mondne, to p WKgaohaer's moons. A servicing period wit always be greebw than 12
system WaLrbenemoe reports shad be subadt ed to the proper local Davernment unit in asoordanc& with
SPS 38155 WtsC. Admgi Code. Repwt any component UNm or sglfurWUW to:
Name or in&Aduel or crornpany r r . i lr i Rhprre: S- -
g°"eRrtWrt Gf?:n(). CON~MU.ViU M\)eLORvteNT Puente: 715-3R✓o-qk;ff0
Local govenvewnt unit address i u D Sou W zp 0
Any defective part of this system Shag be repaied, rePlaCed, or teMWW
Code. Repairer repiecament of flayed a P to SPS 383.51 (1~ Wisc. Admin.
rnaffundimft
No W10dUct For dhernk:al or phygirai rsstora SW cor ply watt SPS 983, Mr- Admin. Code.
accordance with SPS 384, Wisc. Admire. Code. POWTS may be used unless appealed by the deparWa# in
Corrtlnnencv Plan
Intl r t 3ed treatrnent component of this POW{S cannot be repaired, it shall be replecW Pursuant to
a plan s br old to tit n9placed agetiq nor 'view and approval. A (aged it-grocrrd disparsel compact may be
p rig dispersai component in a Pre_deteem area of a &WAV svgs.
%mbm /1ha-i°nrne rt
if use of this POWTS Is d ued, it SW be abandoned in accordance with SPS 363.33. WW
Adneie. Coda.
i. [.'.ti°.(JIA 'CC1Ul`: 1,4` l`l1 `4i1g C.* t_fi•k+iE,:~
-'C.RTIFICATTON STATEMENT
.`ION OF EXISTING SEPTIC TANK(S)
i,is is to certify that I have inspected the existing septic and/or dose tank
cscntly serving the followin4 residence:
Strxt address)- ' L l vb located
Section Town x', Range ~r W,
n of St. Croix County Wisconsin.
L Lon inspection, I certify that l have found the tank(s), to the best of my
r.owledge, will conform to the requirements of SPS. 384.35, and it (they)
-Pp:ar(s) to be functioning properly.
`:ost recent date of inspection or service
flow back occur from absorption system? Yes_ No.__.-
i no, skip next line.)
1 pproximate volume or length of time: gallons minutes
ilk Capacity: -~C t?
nstruction: Prefab Concrete _ Steel _ Other
i -arufacturer (if known):
ol'Tunk(,ifkncwri):
;ait number (if known)
r-
-X
1 c n,. Y umber Sit rr~ a; c) _ (Print Nall
(Title) « r:,:• tin P_ S -
(Date)
Form to be. completed by licensed plumber :'roi'I-`tiion_l
Services Chapter 305 and s. 145.06, Wisconsin Si:-: } cr Jccnsed ~iisp~~se-r
(NR P" I i~c:insin A~3u~inis(r.-rtive Code;
S'T. CKii~0, O'vY9~ Is
Si?PT'1C TAYK MAWrENANCE AGREEMENT
AND
OWNERSHTF CERTIFICATION FORM
i✓aihng Address - ii i r"' CAC",
i--
k'topvay Addtcss '•~F 1_ _
{Vcrification rcgwred from Planning & Zoning Department for new construction.)
Parcel Identification Number
LEG.kL DESCRIPTMON
T%r N R iW, Toun of
Subdivision Plat: _yct~f Lot#
Certified Survey Map # Voiurnc Page k
Warranty Deed if !bc"f
9 /~_O 5 ore 200Vohmte µlz z~
Spec housel7yo EC o Lot :6e:a-Lat!_S~L;c t~)cr~ro
YaTP:M MA7!r^iENANC:E AND OWNBR CF.RTiFiCATltf;t
tnmmper an and maintrnanee ofyom septic system eowd resGltin i- -re t a isr o :dR• v es P, ri,::
:-j Utenan =cag4ists ofpuspinq out dta optic tank every three years o Snar it o - 1 1. us d purrs, . - vin ; trz ict ~
- . j stem can affect the hnetion of the septic tank ffi a tre3imeat stage in die wade .dispasal,~jskm (loner m.•nntens=cc
,ponsibilities are .specified in §SPS. 383.52(1) and in Chapter 12 - St - Croix County Sanitary Ordinance.
The pruptaty owner agrees to submit to SL Croix County Planing & Zoning Department a certifirwinn form, siga~d by
.>dr:ter and by a rnaster plumber, journeyman pluambar, restricted plumbrs or a licensed psis verifying that (1) the on-
~_ctcwaler disposal system is in proper onorating condition and/or (2) after inspection and pumping (if necenary), the septic tank
than V3 fill arsIud c-
UWe, the undersigned have read the show requiremonh and agtae to nwatrdn the private sevage disposal system with th-
cards set forth, herein, m set by the Department of Safety And Professional Servdces and the Departmentof Natnral Rtsourcvi,
~;Z,t of Wrsconsia Certihcarion .staring dui vourseptid; system has been maintained must be completed and returned to 11•x. St Croix
cc.imty Planning & Zoning Depsartt t within 30 day of the three year expiration date.
Uwe certify that :dl statements on this to are trim to dte bit of myiour knmw xij_c. Fwr arn/ero •1-a o•nne:(s; of du:
l,: •_;xrty described abov:, by mrtm of a vaamt decd recorded in Register of Deed< Off,
;%nrr of bedrooms
I
4lr,~rATUxL or L AX
L) AIe
-Any information that is aisreprestotcci rosy result in the sanitary permit htyoo naked by the Planning $ Zoniry Dernraarnt
inrpdr with thL. i-- fnr• r L 1 .r- aI«F..
. ._cf} t, of U:,,d_OT ~Capy n'1,1!t
rei
sftmCe is n>ti1. lo. Lh:. u^trnnd, -cq