HomeMy WebLinkAbout020-1129-50-010S.nu.m e.uei.o owls N PRIVATE SEWAGE SYSTEM $1 Cr01%
INSPECTION REPORT urP'"Na
GENERAL INFORMATION (ATTACH TO PERMIp Puemxo 61]]34
Rnn MI
James F�& Patricia A Humphrey M1 �m N �TONM OF HUDSON �N 020-112930-010
tleGO f 'b�l� 1]N2819. 610A
TANK INFORMATION
TYPE
M4IUFACTVREP
CM4iry
STATCH
a5
III
IS
EIEV
Ar"M
em
/.$IAn
leis
1
cp
W;ew
�zp
es
99 S1
525
asps se,,,
momong
w e,el
TANK SETBACK
INFORMATION
SVH1Ouest
%Tc
Acial-I
WELL,
I amc.
ROAD
Dn IN't 3
C,
4.6
94. 49
9:m
3a
S
3
31a o
1„�8
945
11b
21 I
8'
enI"•"
7.I.
93 be
All,l
an Rce
7,4
q3.�B
npamR
_
am solem
$ All
PUMPISIPHON INFORMATION
Icreez
4.
9 —j
Manu9qum
Z e
99 31
WRORRAAT�JSYSBLDG
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in
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.=F=eV
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3 g-7a"
sells
LVMMtte I] ImGWe cWo el.u.PrcL.. persons P,eeenl sly m,V.DQ, or Mon F]
o .,.dpe� IASM. oLRil- ACu
_, PRO s.".,.Nm- E>,t>it �N
em"5
ox a .r
;o,,,e;;:;o.enex.nxlp, Xe
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC TANKS)
This is to certify that I have inspected the existing sepuc and/or dose tank
presently serving the following residence:
(Street address) its Pars ure located
at, NE y., NW y. Section Ir ,Town ra N, Range 19 W,
Town of N" wit , St. Croix County Wisconsin
Upon inspection. 1 certify that I have found the tank(s), to the beat of my
knowledge, will conform to the requirements of SPS. 384.25, and it (they)
appear(s) to be functioning properly
Most recent date of inspection or
Did flow back occur from absorption system? Yes_ No_
(if no, skip next line )
Approximate volume or length of time gallons _ minutes
Tank Capacity: I000
Construction: Prefab Concrete=Steel Other.
Manufacturer (if known)
Age of Tank (if known).
Permit number (if known) (L�
L�N4r inn smmm
(LiSv sed Plumber Signature) (Print Name)
MPRS W760
(Title) (License Number) MP/MPRS
0-7`d�i9
(Date)
Form to be completed by licensed plumber (Dept of Safety and Professional
Services Chapter 305 and a. 145 06, Wisconsin Statutes) or licensed disposer
(NR 113 Wisconsin Administrative Code)
Rev. 2/2012
Page 9
I1E OFAve
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am
RSanitary
Pemit Application
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9BD 398(ROLI4)
SYSTEM PLOT PLAN
WI By Il A BM E�Itw
w wmnp io W2B,w BM
nem n> .wcpo
.wma.xew„miabeo,.a
Pen
pipe Mebeela I19iM euNeq
T1- 3'x65' EZ Flow Trench El. = 93 50'
T2. 3'x65' EZ Flow Trench El = 93 00'
B�sdo9d�\n/
e
IIB3 Garage
Slope >30% I � I \ Be Drrvewal
III I
11 1 1 3 Bedroom
House
� eel
1 \
I\\
aA
U
RAN Park Lane
Proposed 320 gel.
septic tank
w/Polylok 525
.xieang 1000 gel
RasidenLel AppLceOon
INDE%AND TITLE PAGE
Protect Name
Humphrey 3 Bedroom Replacement Septic System
Owners Name
lames & Patricia Humphrey
Owner's Address
435 Park lane
Full At 54016
Legal Description
NEl/O, NW1/0, 517, T29N, R19W
Township
Hudson
County
5t Croix
Subdivision Name
Park New Estates
Lot Number
29 Block Number
Parcel I D Number 030.1329-50-010
Plan Transaction No
Page 1 Index and title
Page 2 Plot Plan
Page 3 Septic Tank Speafiotrons
Page Effluent Filter Information
Page 5 Valve Informal
Page System Being & Gross Section
Page Z EZ Flow Information
Page Management and conceal pan
Page Existing Tank Certfication
Page 10 Septic Tank Maintenance Agreement
Page 11 Warranty Deed
Page 12 CSM or Plat
Attachment) Soil Evaluation Report
Designer John Schmitt Iicnese Number MPR5223760
Date 10/13/2019 //JJ Phone Number 715-760-0486
0/
Signature: /A2 xCL
In -Ground SDII Absorption Component Co��mponent Manual Version 2 D SBD-10705 PIN. 01/01)
vage 1
SYSTEM PLOT PLAN
Project Name Humphrey Septc System
°e°9""'"4'M6°°
Ao-,,,,.ea
o,amwa�..r.
a..
aa�srron.� ee a..m. rm
ro. a..mr�sruswma
ea o.sae� rwan.o.�.u.4��
rsr v.xvsx.aoe
er.z�.aa
mo.mmaar.we.u.. mi
vensnmam.ecure.i
Ti- 3'x55' EZ Flow Trench El = 93 50'
T2- 3'x55' EZ Flow Trench
El. = 93 00'
pu Ace\0/
�\\ 1 I 1
\\ 1183 Garage
Sbpe>30% 1 I 1 \ Dnveway
I / I 1 ax
it t l 3 Bedroom
r House
well
I I 1
U
320 gal
w/Polylok 525
Existing 1000 gal
septc tank
s CAST -A -SEAL
---, '(� oCAST-A-SEAL
I
L— J—J
NLTER ON BA.
Imo. NEW
'"LET
_ - n£T
s
SICIF MEW
ME MMOEACNRD TO MEET M EMCEED ASHY C-IYP
W320—MR
TANK SPECIFICATIONS
nM YMDN
wDTTa:
s'
coE C
MANHOLE, sM' 0 PPECAST CONCRETE RISER
HEIGHT SB' O..D
LENGTH. W OD..
mom s0'BD
BELOW INLET 0 1/2' 0D
OWmL u'
MEIMT zWO LE&
INLET MO OUTLET
r CMi-A-MAL BWi CR EQUAL
GASNEI. CAST -A -SEAL BOOT ON EQUAL
x1£i AMOD
SCfxSH. SEE LEiM 00 lEA
(OTHER STATES SE CHMT)
UQUO CMAaW BO GALAN
LOADING DOWN. 00' ONSATIRATEO SOL
TANK CM EE USED As,
41,nc/ HOLDING/ wMP tl BPNCN
ccL Mx DESGN p (N0 Mu)
TANK. MIX XSGN 00 (sMCTNRAL iLET()
Ws OMlZED TANKS.
FOR Ws1CY TANKS CONTACT M£SR C TE
FOR APPROVAL
MNvm 0.
mx s WOODS) x:
PCLVROK
PL-525 Effluent Filter
PL-525 Filter
The PI.-525 File, s, All for 10.000 epD (ganotu per day) maWng n one of We largera filters in declass. Blow
sec lnrw rat W 1/1ti nlhannn altrb. Like Nil Pulylok PL-la We Pulylok PL-sss lw an automaee ilrntuxlun
msu11M wiW every (lue, wMn We fete„s ,mrovea roraruting tM1e Lall will neat uv ana mmpo anry axut me
the rysmn so We effluent won'I leave the rant -
I all," 1/16" Filtration Slnle
Rated for IBM GPD rgdlm,a per day) 30.000 GPD (orkil O
reEM
*5' bar fat of l/16"fetraeoa Acorn, ,'PVC
• Accept 4' and fi' 5CHD 4o pipe Fau.w.,wrvn.
• Built in gas colors r
Automatic sM1uroff ball when filter a removed
•Alarm accessibility lepvew
• Accept PVC nMumn hanele
PI.;2s1 eWFinnn
Ideal fin residential and mmmemral wool flows up W Nu Lirwr If
10,M gallons per day (ePD) POmarow aw
he nutlet
i Levee Remove
edue tank or We wpoand tank _
2 Remove We tank cover and pump tank ilnxessary
3 Glue fee filter housing to We 4- or C outlet pope if 6c�ttp�pmrv�
Me filter is rctcmured under We argil obscure wee a
Pulylok Extend 6 Los or Pun of OWe to center filter
5 bent the Id2s tom rk housing
Replace and wrote rise xPb'coal simulcast Stamood ass
TM1e PL-55 Effluent Filters will operate efficiently for
serval years under nomul mtW niom More,ryumng
cleaning to recommended chat We 6lte, be downed
every time the tank is pumped, or at least every W re
years If We installed filter n lours an ogieral alarm,
need, w owner tr ronree by an alarm when We effil w Wll
Ns eemrml tc, mbrng should h torehe a rectified �• Pfla+.
aepec rank pwmper or installer
1 Lu'aR We under of thesepec tank
2 Remove tank cover and Pump tank dn¢essary
3 Do not use plumbing when filter is removed Z�
ho"Ifi
4 I'vlIHose of525 enev r the s of
the
tank N
5 Hose off Flierback over the septic [ark Make sure all
am,a, rail back mm.Wpne lark t
6 invert We filler c,rtr,dW lv:k into the housing ma6rg
sure the fileI,r properly nbpncl and mmpl��
y nml wha nw a . 6 e61ursi4.nydeule
Replare and acc'us aeptu cook over w sm.,ocome rekhana ausrrr ft.ewfiguaw,
PolyloLlne 3FaReld Blvd Wallongford,(T WW Ton Freei8T1]659Wi P=2102S414514 ww Wlylti.com
Pal
�RitMp 70urdarinw E papa um.
9 Q - ACCESS
A6E99 CAP
ASERCAP
kk DI
nwmRt
RISER
TIRE
VPLVEDIFECTION
N(ro�
The Bull Run Valve" is ae mad to split area to aeptm
fields or systems In addition to the advantages of longer 4 OIrt POT
life and easier mstallatron it is the most public health safe A ORA POT
alternating device available far wastewater disposal
applications The use has Vita ly no contact with
wastewater due to the valve'A leak -proof and ertemal
Spending charactenrtl¢. The change over from one A`IN FORT field to another can be accomplished In less than
"minute by simply fuming the valve without digging or
contact with wastewater. The Bull Run Valve is available in 9" sA 40 pvc
and Is wltable wherever Septic disposal systems
residused - In Commercial industrial, and
ential applications.
OPERATING THE VALVE
u1E Fultl FUEL bold The direction contiml handle mould be notated
Cut
No No I Ned penodltally to direct effluent to one or the other
of two septet fields. After removing the screw cap
at the top of the riser tube, the valve handle inn
Value ® Valve be turned with the valve key fomishetl.
tl On No Ion No Produces
BULL RUN VALVE
Na
dwng any Complete Valve Kit
Odd Years n°o0 Task Evm Yem I Bull Run
ns
TWC Task L 28-Run Valve hotly
i 20"ap Key
3. Burgerr Cap Adapter
11111 DESCM�ON O. watertight ACCess Cap
Mi BUTFUR VALVE sRoyal all RUN VALVE a MEY ONLY
FUSERWNCIROSEER BUT RUN VALVE At CAST COVER
INLIMENVES BULL RUN VALVE NE( 28 6RVCIRISER-T'
ADNSTAWR TD 28" MGH
Page 5
IN -GROUND GRAVITY DISPERSAL AREA
9ep1T,,,o)
Unknown I Wieser Comets
Stepped Elevation Trenches with F21203HP Bundles
3-R Trench (down -sizing credit)
a °"T'ne"'y
l000 te 320 w —,Pw —m
ENuW File, M, sidusC
Polylok
T.nMFbrM°eele 525
rwrw
sdr coca
J-7T,
TPICAL TRENCH Provide minimum 3B1
. CROSYS SECTION VIEW wismai neneeen tremiho
(No Scale)
Highe3r Trenoli LoM9ITrea(im;a%I1Cab1e)
OBSERVATION PIPE DETAIL
System Elevations = 93 5 q 910 q n. fl, n
sa MOP»
rr nro.
Imupr«a.I
TYPICAL TRENCH (show lOAtlm of see i ovmi vice MxwMEI" os Pan ukwl ""'°°"•"""'°0"°'
PLAN VIEW 4-0 oe.''"
10
(NO SMIe) Perforated L ora1alenl " OMerveun Y n i
(lyg i) I10II Iew"O
..—.—.. _—.—..
rA=10n
_--_—_—.—_------ — — — IryWI
0
B=_n
En
MOMII
W
INSTALL PER TRENCH: Ez1203H Bundle
OT
ropkep
6 ito-et huMl®® Sof EISNunB=300 fl Wi^n°Mid snM.. IrcI
osl^ro
n W.._wnruhaue'enmma
p
4 1 Sfl WMIn �2BM E154Wt=25 k
= Proposed EISA per tremor• 325 W Required Intention AI®=643 k Diiy Didion WrItiod:
x 2 trenches = Proposed Total EISA= 65 M branched manifold
Installation Instructions for
EZ
flOZU"
EZJtow Systems in Wisconsin
to J me
.........................................................................................
Voismnsm Department of Commerce Sately and young,
B. the Manhattan area(BFj necessary fen a groan site shad
Basic has percent the spetlfiatnm and/or plans for the
be sued broad on annul aady sewage fre,BPD)and
pleaded and de@imbed it to be in compliance with rumors
the Pompom ty for the are If ceRan came is met the
Comm 82 mmngh 84, Nfiaronsin Admen Cade, and CJtaplers
EIS4 stung an be oak in wiawsm, resulting in a 40%
t 45 and 160, Wisconsin Stations At sides tuned meet the 5
small aranfitld
&Bo rndrat8 I ocations,2ngli means as noted in
Iaal regulations
5d founder EZ(low bundla(s) in the EZPow arrfiguremon ap-
pured by system design Pamir managed f« Me gratim
The appmvaj products are 12()3H (3-12' WMI¢ wN roe in
der site The tap or center ended Wndes carromng qpe
center der le in 50r 10' foal and 1203HP(9-12' trundles;
are Imad end to mtl with an Internal pipe wurler Any
wM pipe in each bundle in 5' or 10' Iml
addicnal aggregate only burden that may be regwreq
should be butted against the other aggregate -only bun -
A surge pipe hunts contains a four inch perforated qpe sur-
des and do rot require and type of connection.
mounded by EPS aggregate and Is hold together with pnly-
malerreremngAsingleaggregate,bundlecontainssggral
9 The tap of each GEO gdinder anbns a I fabric pre
my aN vc held together who patyethelene netting
manufactured in between the nothing and aggregate The
more no nnerled to prevad soil Informal The instaled
N col aM Equipment Needed
send make sure Me the GEO is entered upward aria a
• FSfiow Bundles
in contact who the fabric contained in the adjacent c)4m-
• QBpx Cenci 111e Fams
oar before batlrfilmg
• Ully, Informal hope Couplers
• Pipe far Header and Inlet
8 The Uflou Drawl Systems should the installed in a
Bndurpo/E.avamr
Ierel trained in al husband (both across and hung the
trmchWtmm)wdahaulafdla Mecantwr 0f theigmuna
Installation Instructions
surface Boos n (undo" dcpU), val at announce
The instructions for installation of Bylaw appeal are gHen
ad)amrg 10-ford mindnal bundes good end be am.
below This product must be Installed m azco dance with state
Mh central bundle tantrum glee iMereanneckd.
mks tlefiretlm Teeters Comm 82 through 84, measured Ad
without any items, shredders or other water smpa
minance" RAe, and Traders 145 and IW, Wlmonsln Stai
cup, as wed as the local hould department's arrant design
9 The tench top shun be graded such that water sell not
current
psM Suit should be sceded or so]ded Immediately
after complained to feature emaon.
1 After the deal health department has determined song.
configurabm, and layout for the E]pm, systems, stake
10 EZflow EPS handles are Image and con fit in awed
or math wit good the Indoor 0f beaches and tins Be
tantldes as miss be recessary to avad trees, boulders, or
small to set oned tank, driven pipe, header line of us-
abler clacadesn
mail has and tenon bottom frerztona before insper-
star of age buntlles,
11 EPS aggregate is lighter than water, therefore. It might
h spectral that natural buo/ancy forces would trod b
2, Remove plastic EZAox shipping bags poor b placing
form Esters mourn es to float W of ground when
fumes in the tmN(w) Radical any paste trtis In me
pending omrs. Field experience has shown, removal
tench before bee em is w+ered
Mat the is not a prcbbn when systems have a minimum
of 10 sal corer as recommended by manufacturer
3 The product must have geWe'ne taboo that meets re-
gwremenk of s Ccmm M SO (5) (g), di Aden Code,
in dated drecty on cup of me product and famishing
1203H-GEO
d0 dcngmesidesoftheproductt0amntatim su
inches fresh me bottom of pmdud
= — ---- 0atcAe
Bannerman,]
4 W ran irort in a trenchn the though should m dug to
a wtlM of Minorco Thrs not on"Pow labor in eeare-
17
ban, M also prowaes bettor Iw64»nng capacity after
haMtllmg is wmplethe
as
..........................................................................................
lone
PAGE 4 OF 4
In -ground Gravity Management Plan
IMPORTANT:
The owner of this In -ground gramty system shall be impossible for Its perpetual cpera00n and maintenance pursuant to
regmraments 0 SPS 382-381 Wise Admen. Code Pursuant to SPS Me 52(2), Wise Admen Code, this system shall
be considered a human health hazard if not mentioned In dccordance with this approved management plan
Furthermore, all inspecton and maintenance acnl shall be performed by a regtabred POWTS Remember In
accordance with SPS 383 52 (3), Wsc Admen Code
Maximum DispemiA Operating Uni
Design Flow, 450 gpd; SODa5230nl TSS5150ml FOG 530 mi
Inspection Checklist INSPECT EVERY 3 YEARS
type d use
age cedsystem
factors (I a Worry user complaints, ale )
o mechanical malfunction (I e, pumps, valves, svnmhea, floats. etc)
mbrial all V e, head Weaka corrosion, eM)
oaWide volume In anaerobic treatment tanks) and any mstribWon appunererlce(e)(i e. di&dbudon r drop bmres)
e happens or Improper use (I a ceeding dealcapecihes, prohibited adlviPes, etc)
o extent ofpending In disinbutmncall pint to dmmg
o dosing Irregularities - fit applicable g a. pump re -cycling, float switch smiings, ate)
o electrical components- J applicable (I is Aided, corrections switches, contras, timers, alarms, etc)
o distribution lel lw lateral orrice plugging (measure lateral distal pressure —compare to design specifical
in surface discharge of effluent or sewage betic-up into structure arved
Maintenance Checklst MAINTAIN EVERY 3 YEARS (or when necessary)
o SeoCn and doves Minimal shall be pumped by a deal septage serviang opemtor licemed under s 28148 Ws
Slats. when Me scheme of mlids in Me teream exceeds on"hird firs) the liquid volume of Me tanpa) or
as required by boat neural ise posal of contents shall be pursuant 10 NR 113, Wsc Admin Code
o EPoumt 0twist shall be embedded every 3 ywm and shall pas deaned when necessary to remwe any
accumulWbd idsa oNmgtomandacmrer'sspecifiwtions A servicing period will always be greater Man 12
months
System maintenance repaN shall be submitted m the proper local govemment unit In accordance with
SPS 383.55 All Admin. Code Region any Component failum or Manue lon to
Name of individual or company
John Schmitt Phone 715-760-0486
Local government unu St Croix County Community Developement Phone 715-386-4680
Lome gwemment unit address 1101 Carmichael Road, Hudson, Wl zip 54016
Any defective pad of Ibis system shall be repaired, replaced cr renewed pursuant to SPS 38351(1), Wise Admen
Cade Repair or replacement of fared or malfunctioning components shall comply with SPS 383, Also Admin Code
No product for chemlrel or physical restoration of the POUI may be used unless approved by the depar8nent in
accordance with SPS 3" Wind Admen. Code
Oommaencv Plan
In the event that any feed treatment component of Mis POYTS wend be repaired it shall be replaced pursuant to
a plan submitted to the appropriate agenryfor review and approval Afailedingmunddiepmsalcdnponentmaybe
abandoned! and replaced by a code-comprying dispersal mmporent in a predetermined area of suitable I
System Abandonment
If use dints PONTS a discontinued, it shall be abandoned in dependence with SPS We 33, Wed. Admen. Code
Page 8
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
owycrrsuyer James & Patricia Humphrey
Mnlltng Address 435 Pad Lane, Hudson, WI 54016
Property Adnirce6 435 Park Lane
(Vmficnam rtquirw fmm Planning A Eyeing Department fm new aeatNNion)
coyrsmleHudson, W1 Parcel ldemingDgnNumw020-1129-50-010
LEGALD SCRIPT[ON
Pyi lcycnigNn NE y, NW y. 17 ,T29 NRt9 W, rnw„nr Hudson
s„AA,„icon PIN. Park View Estates tat Addition LW # 29
Cemined survey Map# Vulume .Peon#
Warranty Deed# Neerufe t#W)Volome� Pagep
Sp[t Nis QpOn Co Aw N[N,rude ayNoM
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Im W0µCf W No rteitleroze ofpwatplie ayntmmua rt km,N pr[nvlurt I"I'm to NMI[ wauea Prayer
mnvs olpwryNg om llessple un4ercrytMe Yean N�mm,ilmhd, ,mte (suynvrnLlittwt¢a[lrtR[utrN n ntNumt„"w[AIyaayNli[[mtmnp,, uNftmrcll
Nimbi in NOS 18152(l)+M in CAapff 12
St GOuCQMIY NNNry ONinrce
pm tea
lte p,op[nyowzragrtevo fubmtuaS Cmu CwntY Plann,neA2[r„ng Rpmmenuamfunwn foie, vgrwd by lte
w¢r W AYamnn plomnu.loumeYmm plwWgrtnnnad pl,mdn or IN[ved pv,rgermfY,ng tM,(IPM trvnN
to EVPmI sYvem tort proprcFemtgattdtuan arNo� Qj Aenmaecl,enanJ pumy,n6 (dneoemryl. merzptw t+d n
Ia+tSn l/)(u11 ofLWge
of
Con bgmjo gvd A.rc on pa,Ni ofSMay"li bnou !n,,x thonvapuwagcm ofNaYat[mmovi
MMWass, fasinM Ifl asstl AY IPe IXpnment o(Sa(e,Y NNPnfm,onN Rrv,m aMtAt Utpmmem of NeNN 0.awtaCr
ComfySolcowissmvn MmgI)OOrOmat Von Y3Ndi of In,
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one No,y IN all SUNNIua knn ue weatMkeat afmy/om WtowleEge IlwtaMNINo,,n: ,Ae
property Eei ok", by I mnlY dad rttwtltl,n Regime of Dome Office
beydrebons 3
SIGN ATEOF PPLII T(s) /U DATE 5
y m1ornilAm,mmoreorbeca myne n,tAm,flogpnmv bmgrtvoWbY ft Phnn,ni Zoning Debi..
IncUle one the peniou, nxo,dW warranty deed frontlM Reywer ofMeda ORxe and a copy of If, "a,fiM m,rty No II
rtrmno, Is made,n IN wu[entY deed
(REV.NJ12)
Page 10
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