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HomeMy WebLinkAbout026-1135-07-000 T sconsin [department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Satsty and Mjilding Division INSPECTION REPORT Sanitary Permit No: %3.q9i38. Aemm GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: P.C. Collova Builders, Inc. I Richmond Township 026- 1135 -07 -000 CST BM Elev: f Insp. BM Elev: BM Description: q- 4+ • 30 a•••, ,� �S. QN�I rr TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark (� Z 98 Z, 1 3 t Dosing Alt. BM O •(Gg Q }.g , 4 r Aeration Bldg. Sewer J 6 g2.89 Holding St/Ht Inlet r (a O q 2.12 TANK SETBACK INFORMATION St/Ht Outlet �P�6Z 9 9a r TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > 20 1 Dt Bottom Dosing Header /Man. O fo CID .s L Aeration Dist. Pipe --t" SGG L` _ 0 l Holding Bot. System O Rile •9a �� PUMP /SIPHON INFORMATION Final Grade �. / 514 4f Manufacturer Demand St Cover Model Num TDH Lift ricti!n!J! stem Head I TDV Ft Forcemain Length Dia. I T SOIL SYSTEM -il- RENCH i th Length No. 9f Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM 3 fog •Sb SETBACK S TO P/L 6LDG WELL LAKE/STREAM LEACHING of yrer: INFORMATION CHAMBER OR 'F Type Of System: , C � ZQ J NIT el Nuer. a DISTRIB,U I SYSTEM 14 4D SoA P L ant to Air Intake Head Distribution x Hole Size x Hole Spacing V ZI G Pipe(s) Length Dia Length Dia pacing 7 _:� SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of x xx Mulched Be dlrrench Center frrench Edges Topsoil Fla] Yes � No Fill Yes � No � CO Fal E N S; (I cell a de di c(epencie rson present, etc.) Inspection #1: 1 / � ! �� Inspection #2: LOCn: 1417 144th Street New Richmond, WI 54017 (SE 1/4 SW 114 24 T30N R18W) Ever ree O _n l„f parc g l No 24.30.1 o l -o•%•, o.,j . s ewer• = T °� cwor� S Est ' 1.) Alt BM Description =� (� 9 1 2 . t o ipv 2.) Bldg sewer length = z A 4 8 amount of cover = It 1 C t Plan revision Required? Lol Yes No fllle her ide fora ition i formpf n. n M -6 3/87} Date Insepctor's ginature Cart. No —;I► t,►-«.S Iou�r+aR �. '+* I I I I I I I I � J_ / J �,1� ; h� i h�' � � � �I � `� 1 �� J Safety and Buildings Division County 9 l 201 W. Washington Ave., P.O. Box 7162 �' , / ' 1* Madison, WI 53707 - 7162 Site Address - � Department of Commerce ermit Number Sanitary Permit Application Sa nitary P 3 "- W' . Adm. Code personal information you provide In accord with Comm 83.21, is Pe Y P Check if Revision S 7`i�, tg may be used for secondary purposes Privacy Law, sl5. 1 m ` I. Application Information - Please Print All Information State Plan Number Property Owner's Name Parcel Number � 9.3 d aC!._ D // S -U7 -L Property Owner's Mailing Address Property Location �) ���� �� � ...rte -- ',4Sw 14; T 6 N, A E City, State Zip Code Phone Number Lot Number Block Number Subdivision Name CSM Number H. Type of Building (check all that apply) V ❑City or 2 Family Dwelling - Number of Bedrooms []village ❑ Public /Commercial - Describe Use j d Township (i r ❑ State Owned r c, � ` s 7/d M. Type of Permit: (Check only one box on line A (n a sch ti ot ' ). C4 mplete line B if applicable) A. 2 ❑ Replacement System 3 ❑ Replaceme �t ,, ` 6 Add C2 For C#unty use System Tank Only ° Ais ' B. k if ani Permit Previously Issued Permit Number fj Date Is s ���3� !! 2 0 1 IV. of Permit: (Check all that apply)(numbering scheme is for mteImid use) - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 11 Constructed Wetland 22 C1 Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 11 At-Grade 46 ❑ Aerobic Treatment Unit 49 11 ReciatAa!!gg 30 11 Other V. Dispersal/Treatment Area Information: Z Design now (gpd) Dispersal Area Dispersal Area it AppdWatioli Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals./Days /Sq.Ft.) (Min./Ineh) ! J Elevation VI. Tank Info Capacity in LZUons Number Manufacturer Prefab Site Steel Fiber plastic Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank � Dosing Chamber VII. Responsibility Statement- I, the undersigned a responsibility r installation of the POW" shown on the attached plans. Plumber's Name (Print) 7mr,S' cure MP/MPRS Number Business Phone Number _ Plumber's Address (Street, City, Stan, Zip e) 5� / i� /e zv) _ Yo VIII. County elDnrtment Use Onl Approved El Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge ) f ❑ Owner Given Initial Adverse �Q 0 7 1 Determination IX. Conditions of Approval/Reasous for Disapp val ue _ ee Attach complete plans (to the C only) for the system on per not ess than SM x 11 Inches In size SBD -6398 (R. 05101) O GU,wt >Gt2 w 17 KC 0 - h - Safety and Buildings Division County /1 l 201 W. Washington Ave., P.O. Box 7162 Y FN Madison WI 53707 - 7162 Six Address /-? Department of Commerce Sanitary Permit Number Sanitary Permit Application 3 9 In accord with Comm 83.21, Wis. Adm. Code, personal information you provide Check if Revision may be used for secondary Privacy Law, s15.04(1 m SAO►. I ! / I. Application Information - Please Print All Information State Plan 111 . Number Property Owner's Name Parcel Nttmbe ra 3� • / • 93 GGi D / 7 —OpC) Property Owner's Mailing Address Property Location ��� G ' �� f ✓L awl/ -X; SpC T3 O N, R IZ E City, State Zip Code Phone Number Lot Number Block Number Sub "vision Name CSM Number f' c-- ��� 5r7 C ✓6- 04 H. 'lope of Building (check all that apply) j ❑City or 2 Family Dwelling - Number of Bedrooms ❑Village ❑ Public/Commercial - Describe Use ow (i ❑ State Owned'�rt'�h� ogres opd M. Type of Permit: (Check only one box on line A (n sch �# or ' ): /C6mplete line B if applicable) A. 2 ❑Replacement System 3 ❑ Replacetne 6 yAdAdi For,Ceunty use stem ` Tank Only %'axis ' Permit Number ' Date Is S B. � P ermit Previously Issued !/ 1 ,Z;, <` IV. Type of Permit: (Check all that apply)(numbering scheme is for interiiil use) %[ - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In -Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑Aerobic Treatment U it 49 ❑ Rec' 30 Other V. rsalffreatment Area Information: z Design Flow (gpd) Dispersal Area Dispersal Area it App do Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals./Days/Sq.Ft) (Min./inch) �� .'� Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Talcs Tanks Septic or Holding Tank � _ Dosing Chamber VII. Responsibility Statement- I, the undersigneddassme responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Pri P MP/MPRS Number Business Phone Number _ Plumber's Address (Street, City, St Zip e) VIII. Count /De artment Use Onl Approved C1 Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge ) ❑ Owner Given Initial Adverse So � � �G>� /p � Determination IX. Conditions of Approval/Reasons for Disappyoval Jb r Attach complete plans (to the Comity only) for the system on vow not than 8112 x 11 inches in size SBD -6398 (R. 05101) PLOT PLAN PROJECT Collova Builders Inc. ADDRESS 70 v Rd E Hudson Wi 54016 SE 1/4 SW 1/4S 24 /T 30 N/R 18 OWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 11/28/01 BEDROOM 3 CONVENTIONAL XXX IN- GROUND PRESSUW CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .9 ABSORPTION AREA 514 # of chambers 30 IL BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE (DWELL - H.R.P. Same as Benchmark SYSTEM ELEVATION 91.5/91.3/91.1 Alt. BM Top of Telephone Box @ 97.3' Plans Designed Using Conventional Powts Manual Version 2.0 Vent > 12" Sidewinder High of Cover Capacity Leaching Chamber 6, Long 1699 34 Grade at System Elevation " Pro 3 Bedroom Vents House 2% Slope 30' � 40' B-3 30' 5 3 -3' X 63' Cells with > 3' Spacing B -1 Alt 8' * B.M. Vents 2 292' Property Line PLOT PLAN ,PROJECT Collova Builders Inc. ADDRESS 70 tv Rd E Hudson Wi 54016 SE 1/4 SW 1 /4S 24 /T 30 N/R 18 y+v OWN Richmond COUNTY ST. CROIX �. MPRS Shaun Bird 226900 DATE 11/28/01 BEDROOM 3 CONVENTIONAL X)OC IN- GROUND PRESSU CONVENTIONAL LIFT HOLDING TANK ; MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .9 ABSORPTION AREA 514 # of chambers 30 BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 91.5/91.3/91.1 Alt. BM Top of Telephone Box @ 97.3' Plans Designed Using Conventional Powts Manual Version 2.0 Vent A6'Long Sidewinder High Capacity Leaching Chamber " 34" Grade at System Elevation Pro 3 .-• Bedroom Vents House B- 2% Slope 30 , 30' 30' 40' B-3 T 30' 5 ' 3 -3' X 63' Cells with > 3' Spacing B -1 Alt $ ' * B. Vents M. 2 292' Property Line 4 AWisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code � � County < - � 1 _ ��� J Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information iewad by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 12/.j Property Owner Property Location Govt. Lot " ,( 1/4 s(�4 S � T / N R E (o W Property Owner's Mailing Addres Lot # Block # Subd. Name or CSM# le City State Zip Code / Phone Number ❑ City ❑ Village j;4Tc5wn Nearest R " 1 0 , ew Construction Use 3nesidential / Number of bedrooms 2 � Code derived design flow rate GPD ❑ Replacement �) ❑ Public or commercial - Describe: Parent material Flood Plain elevation if app' at21 ,> ft. General comments and recommendations: n ^ J ' S ST Al 0i= Boring M Boring # Pit Ground surface elev. ft. Depth to limiting factor in oil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bouii " Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 �t(la P1 1 'Vie Boring # ❑ Boring Ground surface elev,I L r ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Iv T__1 } 2 � * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 _< 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) � � Signature !�C$T�um�r Address Date Evaluation Conducted Telephone Number E _ SBD -8330 (R07 /00) vropct Name Collova Builders Inc. t Lwt- t -tau � Address 705 cty rd E Shaun Bi d Hudson Wi 54016 Lot 7 - CS Evergreen "'I #226900 SE 1/4 S W 1 /4S 2 T 30 Date 11/28/01 N /R18 W Township Richmond F1 Boring 0 Well PL Property Line County ST. CROIX B o RP Assume Elevation 100 ft. Top of Steel Fence Post Sys em Elevation 91 .5/91.3/91.1 HRPSame as Benchmark ( Alt. BM 4Top of Telephone Box @ 97,3° � d 1 V) 'T f vs Pro 3 95' Bedroom 2% B- 96' House Slope 30' 30' 30' 0 B -3 30' -1 B.M. 2 292' Property Line r, Property Owner Parcel ID # Page of 3 Boring # ❑ Boring -� Pit Ground surface elev � 3 ft. Depth to limiting factor - Z- 7elb in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Muns ell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 LZ , , ` L / ❑ Boring # ❑ Boring 0 pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F] Boring # ❑ Boring El pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L _ --he Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715 - 246 -4516 51. 6 1 1 J Shaun Bird #2 6900 SAECnj 200 1�Ir', Wa�tOn Av , P.C i►Kad{refs, WI S9y0'7 - lc j 4 n f O 1� ! ► Pertn�t App�c�tio� cbmk tf ZIVWOZ� D, Nuc ((II Oz --;. TOE �- x xWow � i ar 3 l iot of vidm ni s...5n ✓ 7 C p P T �� ..,.+.w�rw.+ j �l P�btm�:e • DrfA� Uw Type► a edfM aaan box c2 A (otismbo3au for i�lataral urt)r C lira• rppUon b) 3 © mot od 6 G Addidaa 0 i • so 0 Cou"a W w'land � N O 44UN W 124NOWd Q m Wrd �� D l au d Ftrar r at D Nold4 To k 44 � daft. psu s S 0 Dr* Lisa no � aoCt ' m,.ac u ulroui Ats� ,r dysa+m 8�lsvt TL *mot R4mul"1DWS/kA.) 1 QKWri 11IevRrian Mr l ift oS Pitrox , P1esUc (law of Tom G oMrieM Cooateuaa4 Q! i tat e1 "W" stud Boom 4 yn ra � l s7d -5 WAq Amt JIM&M t<mpt} 1�i YN SNOW Q 4WWt Ob�adtat Adwt++ Z 2 0 0 ( 7-10( ,, 1 i / p ;nom161,41aJ perfvtaw ��v ��c�rP� tre. U MW, rGiLs. I • ; """'' ; Sefety v►d Buildir•�s � ;•• :1 +C:f �1. •�' GYM � � 20: � w. wast+lalton Ave• . P.c. Boy. 9:62 , AsaO". wl l390� -'1� :s s , lscrisl� t NA t cadolt 3 9 9s� j 8�!#�ry Perms APP a ck t� taessesdwo asirGJA. W A aa., t• lba swill a, x i T` Of G C to U pL� i f Now sba NUMM CIq spas C5 7 6 m r a g �L p -- 1 t 00fts -11itlr an d tlsdroesne 1 Q WCOi�fARO�' DWO uN Q taw Oaw! it sous bme as A �m t'bs fetf Wu� C t or 1 ! p 3 D aaaeat.t ! G AddldeA ss !I. Q C A A It s ta+ + WWAM or IwAd "' r of Tm IWO Rebepte ae We) 1 dA Nda - ?tWwtyMld 12401M Z:� mum dz D sw Filar !0 D Cor�trnsesd Welland it D Ile10 m Tonic 41 Q liWtr P&V !1 i1 D* L� i 11 G ?stud 10 d � tsnn+c u • u 7teei:vusasn � lyeatR t vt s a Grade app/ 1Ws(tWti.tatydli4•Ft•) Odle,JSbe� ,, ; �levaaon TOM l�mear ,corn aau ; Piusic � ofT �b � Comer lb Siftol far a! iovv�'tt �aswM Num t ��4 14, I era" � �P NOW Q owurY diva AWMW • Z z 0 c f I go ., per Iota n etac� �e a M . tilt�ll � ntMf1 , . r v � � � - �. � � �' ���r ���.BF�y�y�� • .� Q e :O.rj�, Q ��9 a � �C '�as zy� %r �v�i e � 3 �� N v �� 3 t � 3 a ,; �, � 0 v �� .� v �� �_� � � .� � � s �- ��� � a � 9�• ,��a �r�� °� a � � �� �. '� �� '� ��,� a 3 `� � � o - v v e VOAUJ t L x M X I.C3 lift � s U r N C Q� EL D om'= Fh:ON1 Lo o x � c�' c G U! 31 0 � J R R t d? M N �" M . LL un 0 411 i Wisconsin Department of commerce SOIL AND SITE EVALUATION 2 Divisior) of Safety and Buildings Page -- of –.J Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County 1 / include, but not limited to: vertical and horizontal reference point (BM), direction and S . percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. # APPLICANT INFORMATION - Please pr*'Ol� intnrr►r�tian ' Rev ed b Date Personal information you provide may be used for seconpl I pyliposes (Pi ssy La , s. , *04 (1) (m)). Z lr� Property Owner I J Prop ty Location �? llp Govt: Lot S� 1/ 1 /4,S T 3U ,N,R �� E (or)voLJ Property Owner's Mailing Address ° LVU11 Lot Block# Subd. Name or C M# -` cF 04 A - l0 C : >; ,-Y I f I EVE rfen 0 y ef loo k IN City State Zip Code Phone ► (; QF Cf Nearest Road ty ❑ Village [� Town D New Construction Use: residential / Number of bedrooms �3 _ Addition to existing building [3 Replacement Public or commercial - Describe: Code derived daily flow -600 gpd Recommended design loading rate -bed, gpd/fl trench, gpd/ft Absorption area required 24 bed, ft 2 -/= trench, ft Maximum design loading rate bed, gpd /ft . C o trench, gpd/ft Recommended infiltration surface elevation(s) I1 t `(S-ZO Gn cam, -e, Q Y Ld ft (as referred to site plan benchmark) Additional design /site considerations v I'Ot-✓ 7 9,5 Parent material UU - 1 ! w Q 5 1 Flood plain elevation, if applicable S = Suitable for system Conventional Mound In- Ground Pressure I AT -Grade System in Fill Holding Tank U = Unsuitable for system [� S❑ U S E] U S❑ U v El U ❑ S U ❑ S SOIL DESCRIPTION REPORT Borin g # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 r.e IV s in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench e L i m LJ l2- 0 k� — s;1 Z r->�k rn � 5 _ , s Ground 3 /P16 ( vr t--' LS � � � �r C5 ._ � �- elev. C 21C, 4 j q6_V f (D -- LS c-S Depth to limiting factor Iin. Remarks: Boring # i 0-1 3) L S; 1 rrr✓3b� ► G r S ., W .Z La Ground elev. vu " Depth to limiting factor R in. Remarks: CST Name (Please Print) Signature Telephone No. mak r Address Date CST Number 2 th A. ?)6ax tLLLL -I - e5 31369 SOIL DESCRIPTION REPORT PROPERTY OWNER / Page of PARCEL I.D.# /� O Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 h in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed .Trench Ground elev. Depth to limiting factor 96 in. Remarks: Boring # 5 Its 312, — si I aybk -fir e_6 I v-� `#15 0 `{ mS rrmkr �s Ground elev. 9_�o ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench Boring # I _�$ I Z � r c I S ' o Co Ground elev. Depth to limiting f for - Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) PAGE_,�__OF NAME O ( to t 1G. LOT# 7 LEGAL DESCRIPTIONSC. ' /5c -Y4,S 7 lfT, So ,N,R a E (or) 10 SCALE: 1 "= Coo BM 1 ELEVATION <CO BM I DESCRIPTION p&4 I z Q�c �, P e �✓� /a �y BM 2 ELEVATION � 6 7 S BM 2 DESCWPTION („P iaGbg� p w(/afAl SYSTEM ELEVATION r ! `jf 57 ZO Co..•r f �j! ALTERNATE ELEVATION cuAp <rgyr•7ylp�,r -,� CONTOUR ELEVATION I I I ,S o M �n IQ 1 O 0 � SIGNATURE le DATE F RCM F C CZ1 I.DUA BLLRS, INC PHL) NC. ; 7!5 545 5= i i F eb. 0? 2001 07: _ZMAP•M PI ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FOR,\vf Owne.fBuyer '� • �� i VA ' -1 n s Mailing Address r C� n - ri ' roperty Address (� (Vc:ii; ;cation :cqui;ed :iorr Plzrming Der:arlment fcr new cons vc:ienj -s /h'1 C, City/Slate LEGAL DE-SCI'UPTION ?r :pe�'I Loca ti0t1 � f.. /• "' CC a' � �f' �V _: i' n ')I Ki a"',& Subdivisica V L^'t .. . r t r_ Scer j LcuS.^ �'?S C �C '?' ' :r!:;1C1C ,2C� '• _ ... II = "SJQG' C 3nG II3I : tCa aL ; l: :r^t .. " t CL` a " e.^ .tlt cr. t .....1t. T c :. P: 0 ^.1....:_ c:Zazists of pumping out the septic - -r cvc ^ t1: , tar- or sec: e: ii �c-' '.v a ,_aid ;tL�_c -. '4 czt you put i:o '!1c . caa uf. - '•f= fllmea= of t,..e it—,dc :Z� u a r -Neat Wgc in 'r. "- -vas.; ci#o =ai r The prcpe ty o xmer avecs to ar=t to SL Cma Z zning De.a. —_c 1 C?r'1i C1t10R :CIT. =iyC2 'c;� t z ovo= and i T 1 .. :zrplts>r�es, ja:.me}^.s^.pii:alcer, r�:e pllr.:.irr or 3 'dcensed �t17'w" er ?e�� r ti:.3 �Li (!` ;he en -sue N'S�tc'vatG :ystcr s Il grc^ eperati:g e xditiot a:,cJec lam) sf e..rs-.ec Sr;d ! ^r ia� :i �_w. - - ,:`e : tic 'ex :s !ew :La ewe, the uadc:sir_xd :'.ave r=d ::le rbove requim=c=;s sad ig._c to =aiauia ;i:. private :tzr;c d: ^osai systrar aridh ;'ac sraadar S set forth. hertia, as set Icy die of C_ammerce sad the Dc,artmcat Bute of Wiscarsin_ Ccrtif:caaon stating that your septr.c 31atcar hss bees maintzincd: ust be cc=lc:cu..ad mrt:r_3 to '', S.. Cmi. Cou:t-, Zenirg Cf5ce :pit ;lia I0 days,'•Rrf - y ar = -, :irs 'cn ;'ate. r � ATn Ci TG'R�. CF APP... C.�, +: oLv:v�zz c�ziTlFZ��ti dui all statcm=Ls on this term ir_ tr..e to !lie of nv ,err) :L:owlccg wc) an, (?.m) dte owrc: ;5 :he property de- above, by vivue of a varan'F decd rccorceli in 3rsi� er of Vie- is CITIm S a E AP °L' ;G1�ti. i D„T. A+7 inror= that S .=m- .revresentad ma y resuit to am muiwry :xmnit bcin; re vo ked by tlic ZJnisig ic7 " Cnciude with this aprileatien: x ;, amocrd warrant,, decd rrom the R- ristor of Ceeds cfftce a :nvy of the caroled survey man if referencc is made in t2rc wammy (iced Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: S stem Desi n Specifications Sanitary Permit Number Number of Bedrooms 3 Desi n Flow - Peak (gpd) y� Estimated Flow - Average ( pd) 3� Septic Tank Capacity (gal) Soil Absorption Component Size (ft Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak ( pd) Maximum Influent Particle Size (in) 1/8 Maximum BOO (m 220 Maximum TSS (m /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once eve 3 ears Outlet Filter Ins ect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 ears Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management plan for a Septic Tan and Soil, Absorption Component filter Is equipped with an storm, the filter shall be serviced if th *!arm is act ivated Co Intermittent filter alarm may Indicats surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge In the tank exceeds 113 the liquid volume, of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be Inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, detective, or subject to failure must be replaced. , Exposed access openings greater than 8- Inches in diameter shall be secured by an effective loddnq device to prevent accidental or unauthorized entry into the tank. No one should sntar as septic or other tnstmont or holding tank for any reason without being in full cornpilaan0e with o8W s6ndorde for el'twring` a confined *so*. The attmosph$ff w ith in the $000 Or O ther ttIs"Snt of heoN tank may caotttin letha i gas" and rosaue of as person hm the InWior of the tank may bt difficult ar intpoasibla. Tank abandonment shall be in accordance with Coma 83.33, Vyls. Adm. Code when the tank is no longer used as a IOWTS component. �QII Abeo�ioas, �orrctsan The Soil absorption component serving this structure is designed to accept domestic i ration of this compo are shown in f a ci lit y . The, i mlts aF wastewater from a residential � Table 2. The longevity of a soil absorption component depends greatly an proper and timely maintenance, and system use within or below the limits of reliable operaation, Oaod water conservation practices by all occupants and the installation of water conserving plumbing; fixtures are key avors In extending the useful life of this component. Y The sail absorption cornponenrs operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, If any, In the observation pipes, and a visuai inspection for any evidence of surreos seepage or discharge from the component. On steeply sloping sites, areas of erosion should be Identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system Is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months, The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but Is difficult or Impossible to repair until weather conditions improve. In general, $oli compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 Managernsnt Plan for a Septic Tank and Soil Absorption Component Plantings of deep-rooted trees and shrubs directly over of within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. Contingency Plan In the event of system failure, a new system could be installed in an altWYWO area. With the Installation of a diverter valve, the existing system could also be reused after a period of three to four years. It Is the property owners responsibility to maintain the alternate area free from any planting of trees, shrubs, etc. in case of failurs of the original system, the sitsmate area will be needed. If any trees, shrubs, etc. have been planted an the altemste area, they will have to be removed at property owners expense. If alternate arse Is destroyed, there are other alternative systems that can be used, in which, could result in added expense to the property owner, Any tank abandonment shall be done in accordance with Wisc. Code 83.33. Any questions rsgarding this cods, piesjse contact your local Zoning Office or contact the installing plumber. 20g0%M % 'C�s3 JCL \01 ( S ) L4 to % 0 FF�OM P C COLLOVA BURS, INC PHONE NO. : 715 549 5911 Jul. 21 2001 01 :54PM P1 02,'C5100 TUE U;33 FAT 713 38d 4687 RE41STER OF DEEDS Q001 ix 151VZE242 tm tYn'I't eAR OP WrbMSDIFOawI.. Dewu Mawr �W� aERD . �0�V c� IU Deed4 mcdo bdman itm sir rfe�c _ t, to j GgWar. nad P Calbara galiwtae, (saa., x Nlkleaot. 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