HomeMy WebLinkAbout030-1050-50-000 (3)PRIVATE SEWAGE SYSTEM
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INSPECTION REPORT
GENERAL INFORMATION (ATTACK TO1XIIIPERMIT)
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TANK INFORMATION n I ELEVATION DATA
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ttPE
NUFPCNNEF
CAPACITY
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TANK SETBACK INFORMATION
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PUMP/SIPHON INFORMATION
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Model Number
IOR LIT
FI
FOnmeln L&I DI.
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SOIL ABSORPTION SYSTEM
65YRTEM
LO
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RI➢G
75
I `
LY'S" FW
A
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DISTRIBUTION SYSTEM
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SOIL COVER IPmeuMS.wrrewrl. xx Mound OrAua.ed, RYMNm. OnN '''
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COMMENTS, pnvum code oleo+oenNea PenOne PPRI eml
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ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC TANK(S)
This is to comfy that 1 have inspected the existing septic and/or dose tank
presently serving the following residence
(Strew address) /J2 `i Co v u r y .cva T located
at S io 114,5E /, Section 2 2 Town 3 0 N, Range I LW,
Town of 57. 7oSc h/i , 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 footnoting property.
Most recent date of inspection or service f- 2 — /9
Did now back occur from absorption system° Yes x No
(if no, skip next line )
Approximate volume or length of time: gallons minutes
Tank Capacity 1000
Construction. Prefab Concrete s< Steel Other
Manufacturer(ifknown)- WEE s
Age of Tank (if known) /y87
Permit number (if known)
(Lice ed Plumber Signature) (Print Name)
yL(#)RS 3a 3 76 0
(Title) (License Number) MP/MPRS
5-;2'15
(Date)
Form 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 Admmistrative Code)
Rev 2/2012
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lt� JUL 18 2019
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�nitary Permit A�nYcati
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SYSTEM PLOT PLAN
PmjeC Name Wells 5 Beaman Septic
w�
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wis ed A
sere r -av
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am
•le
�
! 4opeGMMm.rimeeM.
n R wti�ml
525
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5P9Grmm ��
T' 5'e57 P.q 6 Piw Tmncf
T55+SC Mrte Pme Tre+cn
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is )Yi5' EZ Fiow L.+n -352]
TS ]a-S EZ Fl.w Tre"m E-4S 20 1�
W"I
CONVENTIONAL COMPONENT DESIGN
INDEX AND TITLE PAGE
Protect Name,
Wadi Bedroom Sidi System
Owrrers Name
Scott&"ran Wells
Owner s Address
1424 County Road i
Semerse[ WI Sil
legal Description:
Ssi SE1/4, S22, T30N, R19W
Township
St Joseph
County
St Cron
Subdivision Name
NA
Lot Number
1 Block Number
Parcel I o. Number 030-1050�46D00
Plan Transaction No.
Page 1 Index and title
Page 2 Pint Plan
Page Existing Septic ank Spapfitatlons
Page Bull Run Valve lnkrmrtmn
Page New Septic Tank Specifications
Page Effluent Filter Information
Page] System Suing&Cross 51
Page EZ Flow Informal
Page Management and connngenry plan
Page 30 Septic Tank Maintenance Agmemem
Pagell Warranty Deed
Page 12 CSM or Pbl
Attachment) Soil Evaluation Report
Designer John Schmitt Llcnese Number MPR52237N
Date 7/18/2019 Phone Number. 7154600486
Signature.
In Ground Sall Absorption Component Manual Version 2 0 SBO-30Z05-P IN 01/011
Pap l
SYSTEM PLOT PLAN
PmjE4 Name WelkS Betlropm Septic
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SAFETY ANC BUILIONIry o6gN
Puynq as
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February IB 2010
WEEKS CONCRETE PRODUCTS
RAYWEEKS
1632 215TH STREET
NEW RICHMOND WI Sa017
Re General SEWAGE TANKS CONCRETE
Manufacturer WEEKS CONCRETE PRODUCTS
Pni Name SEPTIC HOLDING. OR PUMP
MCMI Numbers) Key
(491N L 1., 21 TB GAI/IN 3e IN MAX DEPTH OF BURY 511 G P 0. WHEN USED AS A
SEPTIC TANK BASED ON A 3 YR, SERVICE INTERVAL FOR RESIDENTIAL
WASTEWATER I TANK DIMENSIONS. 661N L% IN W %691N H)
Product F16 No snagge0
The speclllcaeons pact plans for this plumbing product have been reviewed and determined to Le In mmpLancer win
charier Comm 82 through 64, Wisconsin Administrative Code, and Channels 145 and 160, Wadi statute$.
The Opamenl hmecy issurds
an appoval based ant" Wisconsin SUWles and Me Wisconsin MminisMOve Code This
M approval Is valid path line and JUNE 2015,
Tom asperm hs contingent upon computers wins the milowig populationlsl'
This lack mush As awarded w wr1h9and Me pressures tons en web aubPcW
The manufacturer must Meer at the maNlepumg Jeff a sal of plans aid seerenc eons Nanng he departments a
sespohaas oval Thep airs aid spenemuone must be carry tolnq»ctem by an sumomed representative of the
deparinenl
When this product receives waslewtlet from dwellings ands used as a septic lank, t will prowl en e1tluml quality
war a maximum monthly average value for 0005 of greater than 30 mk- and less than or equal to 220 mgr TSS, of
greater than 30 mi or less than or equal to 150 mil TSS, and F O G 0 tau than 30 Mg
Approval he issued for true product as WIN equivalent to a Ibor ought water closet when the from dean is mounted
in Me vertical position The design meets the Inland of s Comm I12.32 (5) (c) and fie.20 (5) (a), W m Add Code, which
'applies water c10ndes to discharge through a minimum diameter 3' dram pee or IiMng and the WM to conform to ANSI
SMndard A112192M The intent of the code is met area this product provides Oe same functional performance an water
cbsots that meet ANSI Standard At 1219 2M
BEMNG: Bedding Pane l 0all be cheap to provide a unsurm Wring embct. Amin. of eAnch base of
wand or Wanuhr red on top of a loam and uni owners recommended. The lank should nd Wr on rocks. Sites
sled high ground wax tables Should have %equally designed! Michael. Sails should Ee composed under the Mi
TTs approval supersedes Me appmvat cued on 4121 2TC5 und, pal 11e nuni 2coli 06 This approval leper a iX
ee mcoryorated with your prenouMy approved plans and or spedicationa Approved under pretreat the number 20050106
As of May 15, 20M a copy of a suttessful water tightness And report for this product must be AVAILABLE FOR
INSPECTION AT THE MANUFACTURER'S PLANT Poor to here product Mlng dead as a POV U S holding or Uaatment
tank In Wisconsin.
The depar mein ism no way endorsing this product or any advertising, sale not responsible for any situation which may
result from its use
Sincerely
Jaen M MazCubtal CST
Framework Consulhan-Plumoug Product Rewawer
Command, Safety 6 Buildings Do, PO Eoa 2656 201 W Washington Ave Matlleon W I S3203 26H
Phone 6062Am09G Fat 603253-7456 Finatl Jean MacCu[dn@wnconern gov
98 rl M.Ehtluml Fmhis t CC
Page 3
ate
a.e.mCNI P,dumeo..ae.. woaa.araa.
1, v M
PARTIES
qa
nWPTER
NOT
+euaol�cr�o.
wro
The Bull
or Runsystems.
vale•^ is designedtot m dva fi°ws m septic
Ifeas or aster installation
In addition
ion It i to end advantages al longer t \^ Pd�^
ale and caner lvice abon R le [M1e meat wpublicastewater
healthdispose
[ale Ord P! •T
alternating device available d wanno d ai with \
wastewater. use use has e'soweep no and exi elm
operating cue to me r Thee change o/ and ene.nel
drainage [naoanother The mange over Ircm ° _—> I IN POW
a mince field m another can be a<we without
in less m:r
mnnee by simply mmmg me valve wlmnot elggmq a.
eeRwith w.[uwatar. and IN s Run VaII is sutabe vanreava peptic ma^sal 40 Sir:
systems
andIN
A, wMremdepotdisposal systems
p pp xa - m <anmo-<,el, inau%na. em
II I rtsaenmlapprcatans
lii`IIw- II�LII µII- OPE"nNG THE VaLLVE
neA i,ae The aireRiy t rnnbol effltSi be the EM
of El stand fields
emeamroIN ameome.
at two to pM<eeles niter removing me spew cap
at to top ur me user teed• me vane handle Can
oe.. �) ,l pol be wmea with the value key mmlanea.
Fbavon d X PO°�I°nt° BULL RUN VALVE
rvc
di Complete Valve Kit
oie v,a„ poT Elm,va, Contains
ii� T,,' 1. nun Run valve body
i. le^ Vawe Key
i Riser Cap "spier
RW Rtggd®qR a waterdgnt Access Gp
MR, REAL RUN VALVE 4
Al FULL RUN VALVE A Kiff ONLY
IRICLAISMAK BELL RUN VALVE USES No PAST wrta RRVCIRISER - a^
ADJUSTABLE M III HIGH
vase 4
XP1000-MR
TANK SPECIFICATIONS
Vx'
Cr
FOR AVVFWAL
POLILOW
PL-525 Effluent Filter
rl -a2a1 ler
Ill, pL5n Filter n..a d let m.noc ern Igi per day) making it ono of Ow Lrgeaf raters on it, dills It hi
5Z I mear feet of I/16' Hold In 111 rikr the Poly Ink PL 1M, da Mylok PI,Sl5 him an aufouabcrill ft ball
xfalled x eF every filter VVi the filter u rmmifordeanmy the hall will flat up and wlmpi shut off
tM1 t, th fFl t if to tsh
eryr man to men won call e
L.nuw.
Rated! to, 10,1100 GPu league per day)
- 5M ltrcar for of l/ l6" domain
• 4mpn J" AM6XFltlitllxpe
• Built in pas deflator
Automatic Ali WII when filter As trimmed
Alai amyni
A... p6. PVL eaeromn handle
',tdLn
ltio
Ideal residential and commercial wall, flows up to
to," dLmm per day IG1'D)
1 Lmate the Audi the wpm took
] Pemwe the tank, cower and rump lank d nadoyyrary
l Glue the film housing to Ne d"nr 6 mutict %µ if
myhlte reM runder the a ssopening we,
1'nlvinkrF end k Lek or p¢m of pgrc to emile Lire,
f Ilea out PL 52 met into m bi
5 parlay and s,m, fly sadly tank.....
19 '{1{If 1,111.11,11
Phe PL S S Ffouem Fibers will operate effiorently for
,ove,al year, under nannual mndthom before "inuring
.Iranmp It recommended that the fiber Ad traded
,wy tape the fork rs p,mr,"I it at lam very three
n it the rwddled 61tw condom An.pnnnot All
that rill the tita alarm when the fill,
n Js w ,im, Smelting sMUW hInrw-0y a .nWrd
Peptic tank pumper or ueWler.
1 4xae the outlet of the wime tank.
$ 1 tank mva and pump ank if mvawy
5 14 not ore plumbing when filer m mrmwd
A 11u 11 l'I 525 cartridge bet of Me hearing
5 I lure tiff file, tell the aepnc tank. Make lure all
sold, fall back lino pooh, tank
n. lnssn the mile caandif it kmin IMF houamg making
will by Nm A pr.p Afraid and nmpkaiynmrN
Repm, ail snore seph, took rover
1/16- YilluLnn Wnla arse.m
]0,000 GPD l�l
Amout, t eve
Fmwel4Nk
¢anJ6v
lauxi
5]3s im
ruwaa,.wn
All
aavwc �Hin An cow
0"
A
hheiY .net a r.+rmentmra
Paillnk. lrc 3FrfidJ field WJlmpin.itl (Mk,'_ Tall Free 87761 VSM FAA !(P`p1 Rod •wa'rtdltl.k "I'm
Page 6
IN -GROUND GRAVITY DISPERSAL AREA
Uniform Elevation Trenches with EZ1203HP Bundles
3-ft Trench (down -sizing credit)
ILL!�m
• Il�l
i
s TWA(1)TWA(1) uv.ecur
crete Weeks ConPmCucSEweser Conch
re src T"(Q V,* m..r.
1000 w 1I" p•I —a
w..,W.,.�
_y
PONIak,.E.v se. u
,v Wr a 525
I. GROSS SECTION VIEW
(No ScDle)
TYPICAL TRENCH
PLAN VIEW
(No Scale) CO
Pmlonb0 "*Ml
(Ndral)
5 fl
MmI
INSTALL PER TRENCH.
7 MR Lu,tlla®W flEISAUvd 5U fl'
♦ 1 in eumin®xsn Elswu,sl•25 k
10
OBSERVATDNPIPE DETAIL
ftW
n
oe,.n,rmrp mpwl
Irvamn
L
(hPwl
m
-- —J
W
E21203H Buntlk
0
0vPEaI)
A
l�,mM"Xsb SryMa, hl
=Pmp E IDA pe'bMy,. 375 M RFFAAW InAhmmm A,ee= 1071 W Dbc i i aon McMw:
A 3 trenches = Proposed Tolal EISA 1125 EranN manNold
RESET
Installation Instructions for
EZyr,N'Systems in Wisconsin
...........................................
Wuc r Oep"bur of Ca,,M Salely act lanat
Div,,, has wed the soolfic tuna ledcm pant far the
teaser and dezir it be 11 LIMploollwee cfiaptar
Comm 89 enough 04, Nts..nm Ahmm Cede, and Chapters
lay and I M wisdonsn SUITAI At sdea most mod we $
d soil fuseddialss is L boms R roe nn balances as noted in
lcoal regulations
The agpra ed proI are 1Weld g5 1 R' bundles stuff pipe in
shelf dndk it 5' no 10' bankers) and 1 issi (31T III
wlh ppe in each bundle in 5or 10' kngtns
A angle ype truck, ...tare a foe I associated sea sur-
of by EPS ggruzz and is head aril of pile
smokes nali A single aggregate bundic col ass aggregate
mN and rs hand IojestAv mlh spherical net Ing
Miami and Eptipment Nestled
• Mae, Bundles
• Eznw Guerrilla Force
• Had, in nine Couple,
• Roe for 4eader and Intel
• 6alkess conrelss
The Inslmctms for ns3laLm of 2fldv ptN[4 ne gres
ash« This bee uC. moor 4 insWkd in accordance anti sUte
chus defined rn chapters seen K through As, Wisconsin Ad -
burned
rc Cade and Chaise 145 and )6'l, wiscanan Star-
Lwal as The legal health report v cc half dosser
mmunl lAe he local houto dear bah eNvmmed sizing,
carte aLon used hycat to this EMow 5 dens stake
n In,o , of Lencha and lines Be
ar,fUl W bi Christ ank�meso ppe bes us or his
-
I'idubon she or, hi Colors elevations was nslaF
lab..0 At bundles
P houses post, bonds ships, logs Pe' to poi
Mlles rn the lie ch eel Bemdrc"praalc Wgs.n To
tench before rystem is of
a. Iha pmdua mist Tare presents feel; In meets ro-
staoomof s Comm 94 30 (6) (9), Ass; son Code,
ts lled daectly on top or the product and eNend,y
own soup the saes of the product a a derl at meet su
inches ram fine bosom el product
4 afew,galMn a branch the of ShEWd be dug to
a wET of.,G inches This not only saves bass,
m but vs, Inches of of Mary dpSMy shore
ba>rnlrg rs cartel
AEZf lowwbulletproof
5 iM PbsoryLm area (51F) ncxcwy If a goal site"
he ... add dried on early sewage Thus GM) aad
Me Poimeadlny bm na Iff c n ,lee met The
FIFA wag an be u ed WSCM n, resulong a a40%
aeon dramrrela
6 Race Mae, bundkls) rn To EZflw m.thoughm a -
praxd by system design lommt speoffed for IM "the, -
Is, ate: The lop or xntervnast oui cmao-ng ape
are IanM end of And wM an nzmL spin coulder Any
add,bma ggrint mN Ms> MM may be mOueM.
Cwtl he Word yar¢t line of aggmgatcmy bum
again art cc rot spole any or of mme f
9 IDe try of eact, GEO zoanaer cog ui a Nler fells Asks
wulaclured in forki to netad and aggregate The
foals or rnmae to nations soil ..truss, The ideal
chat) meee sure The the GET is posdlldret uprvna and is
contact wYh the table outlined n the adjacent sells.
der before breaking.
a The EZMm Carlos Sy9ems donna be installed or A
au bushels zonesana amp the
bunch at food fI pu�wv G thegaload
surface ebau ream lead And a meeuw
adowel 1(zg h surpluseshurdles ral eM once to oe
arts owed hinds d'SO A PR interconnected.
rmnoul any tams, Qepacvms a other water two
9 The her led shill be graded such Mat voter ell ml
If &cN01 should be mnced or coof mmructions
after eurt Lm breduce assess,
1C Ezew EPS faced, are feasible me can m a caused
t slay be n,oci To wad tmea, pasta or
notes n I� ltat
11 Ep5 wgregate a fighter than ✓act, MerelmC It ..sect
Ix ncG[1M oral Island agony Icicn wwltl lend to
,zoo, EZMs as ernal to giant out of great wfen
III baser,fiord eymms has sedum. +west
m, MS a prmem m system
of a of sal carer as recmrmmdess by real turn.
1203H-OEO
e Ina
ai— M
sage 8
In -ground Gravity Management Plan
IMPORTANT:
PAGE 4 OF 4
The owner of on -ground III system shall be responsible for its perpetual operation and conference punuem to
requirements of SPS 332-381,'Ni¢Annual Code Pursuant to SPS 3113.52(2) Well Adman CWe, this system shall
be considered a human health harand J not maintained in se omence with this approved management plan
Furthermore all Inspection and maPmtr nm acti shall be Pedo."rnea by a registered POWTS Maintainer in
accordance with SPS 383 52 (3) Wei Admen Code
Mealmum DWmmel Area Concert L m en
Design Flow= 750 gpE, BODsS220mgL', TSS5150mgL'; FOG 530 mgL"
Inspection Checklist INSPECT EVERY 3 YEARS
Type of use
ape of system
nice factors IF a am cards user mplents, eve)
echan!ca' maHuncnon (10. pumpsvalves swubeft nitrate it
11 maternal begun IF e, leaks. threatar. corroson etc
edids volume in anaerobic 4eeMem tans and any platen m a{qunmanegs) o e. control f dray Mtl)
leg ed Overhaul use IF e. wraparmg depgn capacities. comma WnNn. eve )
anent Of pommng!1 d troaam ban proof to aurq
dos!eg,rrejulanbe6. if applicable IF a pump orowdlengnaer winch sorrel etc)
elemrlcal component;- if implosion p a wrong, connectionscnchas. controls amenalarms. etc )
o detnburim lateral or lateral ounce plugging (measure lateral distal pressure— compare to design spedcal
o surfaced!xharge of effluent or sewage back-up Into Involves served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necaevary)
o Septic and does poi shall the pampa W a carded xpiage securing operator licensed under s 281 aS W!s
Slatswhen the volume of needs In Me usual expands penman (lq) Me hall volume of Me Iarkte) or
as repu!rM by !oral morance n!spxi ofwnl;ms Nall ber Wral to NR 113 W!Y Admn Cab
o EMuentflNedel nM1Ml be anepxil every Jyasn eM lWl to dearrS whin nacaasary ro fences any
mulalN wlm9 according lOmanWacNrera epecrnuhons Aaervloiq peno]vnll yweys be 9raele iMnl2
m Wu1M1s
System maintenance reports shall be submina M the proper local government unit In accordance with
SPS Ned 55 What Adman Code Report any component failure or malfunction to
Name aalwiaual or company John Schmitt phony. 715-760-0486
Lam! government unit St Croix County Communi Developement phone 715-3884680
toa government unit address 1101 Carmichael Road, Hudson, WI zip 54016
Any detective pan of this seem shall be Federal happened or removed pursuant W SIPS 353 st (1). Wsc Aomnn
Cale Repair or replacement of fellM Or malfuncoonirp components shall comply way SPS 363, Vil Admen Code
No oaucf for chemical or physical restoration of the POWTS may be used unless approved by the department in
accordance with SPS 360. Wuc Adman Code
Godshal cv Plan
anthe event Met any fall treatment component of the PONRS commoncommonbe Federal itshalt be MP18c pursuant io
p!an submittal to the doNsfale agency for Feweveand approval A Full aeymund dspmsal commuent maybe
abaMonM and replaceo by a code- bymg Modenul compo nem m a prede'ermmed area of suitable spite
System Abandonment
If may of this POWTS is discontinued, it shall be abandoned in accordance with SPS 363 33, Vbm. All Code
Vagc 9
Si CROFY COIINI'Y
SEP`HC TANK MAR TENANCE' A iREEM[NT
AND
OWNERSHIP CERTIFICATION FORM
Qftft,a,yu Scott & Karen Wells
Madhg Ammo, 14.24 County Road I, So met, WI 54025
m PmPy Ancmm 1424 County Road I
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anrsmm Somerset, WI P.ml wm„rw.�m Nemem 030-1050-40-000
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