HomeMy WebLinkAbout040-1254-40-000 (2)WIN>^e Sell Dal
•"• PRIVATE SEWAGE SYSTEM D0°"r St. Croix
INSPECTION REPORT My pul xn.
GENERAL INFORMATION (ATTACH TO PERMIT) SAM Plan D rm_ 617799
wlPe MDImo4
PRlooartlo%"&Tara Alboresm BM g�l�npn r7" 0WN OF TROV040-1254-06-000
eu Dw :o,mno. •/onnvnwmw„ e E65 a �'l♦w em... X 1My
9.21119.1345
TANK INFORMATION ELEVATION DATA
TYPE
MANUFACTURER
CAPACITY
STATION
U s
NI
Fs
ELEV.
septic
iii ai:• L.�:eser
2
Ber,NlmeM
F11a+A
3.72
Aal•z
/oo.'s
ll Zed" A
I
An. eM
i.7
/Ay.S
Aeneon
Bltlg. sewer
49.41
svxum.,
44 .17
TANK SETBACK INFORMATION
svHlowat
97 11
iAHNTO
$OJ
WELL
all
BLDG
zi
Vent All
uy,
ROAD
WNbr
`
Septic
3
5t7
M
x
pl Boeom
J.
Still
al
ems
5
.rmbn.
9. Cas
IS gS.a2
aarzLcn
lust ww
Nnlams
_
easr•bm
la,z
PUNIRSIPNON INFORMATION
Bel
a sa
4$
uami
Camel
low
sl DONE,
F.11.,. 4al
3.7
Tee. sr
pull Number
iDH
Gfl Ian Lose
tl
Forcem•In LOOM DIe
Betb WO
—
-
EM
BEINTRENCH
n�3
enSM
190
Q BTrenune
" z TT
BID\
IoNO
xn or PM
`
eDM`
Liquid Blom
RUNS
Bx
sysTem TO
WPeor Svsbm /I
Gob.T.Q.
P/L sLDc
le ble
w UL
153
urcFJSTNFAM
,
UNIT
'Oe w' fZ Fo..J
A
DISTRIBUTION SYSTEM (. .jF�L E1Di- Q dz�/V
Bud,Bum mP
D,a
el
�
palatal
qe(e]
�R
ale\
esoame
NVI\
very
diXle
rRA7,.nM,
Dieu
n
•�
M.�
Mn"La.�nM,
�.95
EXX.e
.•
xn
COMMENTS. (I'll wee decrepenae•, peann• pre»nt etc
Localon: 276ST ANDREWS DR
,. ) All BM Deeumeon- i
2) Dleg•ewer I- E
iii
Plnn,eminn REg mree4 3Yes Np
Use mne, nee rontlaleonel lnk,ms n
SOD DION"l one
Insulation #1 mepeaonaz
66 ytal aal
—Im� 3Nx7
sm+l -aUlq- NaC)
' �"9
safety and MId'InBIOiNelM
zo1 W.Na in nAre., PC xTt az
w
M
ryJY Nc/ed
dd
eermn iwu I ml°ey G.l
=.""-7
.i't,
1a DEC 902919
Z'
eu.
Ssaft „axi t Application
° °m
dSce sx2N di. ra am„xm.
Sao
kam�.o amd.,
IAddxm(adw.mldu°�II. )
""ty7�
sr�RLR lI fdaryfarm"
m gerv�..y °y°. �.m.y ee °.d rn.
mtvlknrl°m lmado�
64. A lCo+S
^
nl fnrmafion'*Pkvu erintfNlNb
"00..�. Na.
�.Id
yfl9L.ILII
17tccs.Jd r.. I(>o.
-4o-oao
p..pmywM,.,.11l�a..ddm,.
o<m ��.nn g.
.276 s.-./ p dt.�s �a
DA
�So-1 y.. NRI R, de �9_
h 3se>✓ wr
5C0/6
�,r° 4a-7ia5
T v3 d: R iv„"`=
IL T7p of BM,g (,h,,k AN fl"t IPM Jy
�1wx snm)y IMS,11' N.Rede
9y
Wm
9rro
B
A,
ryx
0 dxy or
❑ Plbae °mm..m;°I-B..mx dz
❑Sud w°.d-Iwndd. u.
❑vnl.g.If
�� pt TndZ
S, MISS
Z b.% F Cell 9r1 EL w
I. Type N hrmi4 (CNe4 Iint A. CnmPIed IInPRIfnPPtindle)
Al
❑xw sy �R°pl0mrcnsyxm
0Tmnmmvx°Img mpkwmm Ony
❑0 mmlfi.1.1En6dR9SYe Mdb4 e)
❑R ❑y..„tN,,..°
❑canpInMuewr
❑ye„mmrd.1N
„m„di�� uaMn Bo
yoggS s .z
rv.Ye Chtkell Wet•
8xM....a . m° oA.-ume ❑w°..d- mn, ...l .° .,....r,mmemil
m
odd odp.a.tcm,pnnmtwminv ❑MInednm.o..Imd.N")
arm
V.o neN'u tat Ana mfmm.nnn:
mwyN..uem
kl ap' to
°"go.'-Ij°.d°
a md¢
'nn+'�:2°p�.,ltg
smm^a
00
g57R`p
Z'VL
Wnk affa
Gp...Y
MawOnmvJ...
z
myun
l
V11.PnnYMll suleme.F i. dkunMN e t
mR%3
wmne N.m.ddnn Idn�H..an a°,�kr.Pdm.N.mx.
..cAMR Ze.dO4n /3B'/ 7iS-yes-6mo
PARR.. tgunt CM. sr.m, zmma
Si C'a Ra 55 'R ✓P2r4A :Ai oL'r-
� on
,ppmm
g5az.00
12 5t 19
,t..„,
f%. Cnndc°ne If APoen.nvRot m. UlIppmnJ
SYSTEM OWNER.
1. Septa tank, eMdent fitler and
dbpetvl ceu mdal tfRdtt iwd I malmain d
SS per meneaeltem plan ptwmed by Plunder.
u per r�pioUiPt9bs° vyJM2prcRk'
SBP6J98(R tl T I)
®J2b "Ic
hasres .svev o, .-=aax .y, ,
� s'£b a s.Ari zi . w/ y 1,•
L 'r3sc•hb 3 sr!yfZa,vS/�^ yid�v t �l� "'s'�'va a^
1
wr"-low
� s y
it
if
I It
5a%
vvd-Oh-b9 -ahp
oh `>/ohS SM r°fin/r
sa8°87U vvul ¢ °P•vni�
z
EMOW IN -GROUND SOIL ABSORPTION COMPONENT DESIGN
FOR A
FOUR BEDROOM RESIDENCE
Owner's Name Riccardo & Tara Album
276 Saint Andrews Be
Hudson, W154016
Located in the SW% of the NWY. of Section 19, T28N, R19W.
TOWN OF TROY
ST CROIX COUNTY WI
Parcel 040-1254-40-000
Lot k 94 Troy Village 2xa Addition
INDEX
Page 1 Index & Title
Paget Project Summery
Page Plot Phu
Page Soil Absorption Svsnew Detail
Page 5-6 Manual and Management plan
Page] Septic Maintenance agreement
Page Existing Septic Tank Certification
Page NDS Diverter Valve Detail
Attachments: Worksheets, Soil test, W arranty deed
Prepared By Michael Rodewald
285 County Road SS
River Falls WI, M022
915-821-6229
�PRS pd1384
Signature
Design Pursuant to In -Ground Soil Absorption Component Manual Version 2.0
SBU-10905-P(N.01101; R. 10112)
Vat""
EXCAVATING
PRIM Wao� 715-425-6200 �EA'
71� FM-:- z
PROJECT SUMMERY
RE: ALBORES, 276 ST. Andrews Dr., Town of Troy, 040-1254-40-000
Existing Conditions: 2 trenches 93J5ft each of Biodlffm(T 11"Chambers.
Trench I is 100 o ponded
Trench is filled full with sand by gophers
Project Plan: I: Install a NDS diverter valve at inlet to Trench 1. Shut off TI and
allow to dry.
2: Remove Chambws from Trench 2 and replace with 90ft
F9.flow's at 025ft deeper (approx. 94.75) hard Existing T2
infiltrative surface. 4""7 ne" �s 4if srs k-z
3- Install Trench 3 using 9011 Ezflow's. Trench will be off contour.
System EL 93.5
phie 7 dq
A c
- Soil it �5°. pl.o,.i Sys! Da/y;4�In�e✓sCLeu' LeFJ� uel�.. -
"£ncL_J. �x•�4y__`f3 'rS6"�..�c,..r b' I6a- yf6
9_-xo'.a�.dry
77e4,k 3. `f - /o' 8"Pois 25V% 3N @. S°
9778Pr
in
----�,
( M,cu �, -->l
Qny< 44 9
... _.1
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pena S of
FILE INFORMATION SYSTEM SPECIFICATDN3
Owner Rick d -rA
S
Septic Tank Capacity Oki il ad
U NA
mrind N
Sam, Tank Manufacturer
µJ IF
0NA
DESIGN PANAMETFA6
EHIuWF,hrMena,e err �at! Zdfi�L
MNA
Numbw of Searoome
0 NA
Effluent Fiber Moats
A-Q,)
0 NA
real of Public Fai Units
0 NA
Pump Tank Carol
did
0 NA
Removal flow loveless)
mildays
Pump Tank Manufacturer
CNA
Deapn flow (peak), inimMd a I.St
600 tissues,
Pump Manufacturer
0 NA
Soil Appllcmion Rush
cps lea
Pump Model
0 NA
Slender lnfluemlENuesi Came
Fern. Oil & Greau IFOGI
Prow ice) Osyser Demand Ull
Total Saimmtled Solitla III
Mmi,.arms'
00 mi
430 mph 0 NA
sl60 or
Phenomena Una
0 SamdWaravd RI[er
0 Mammal A"r
0 Dbinfecaon
0 Peat FM1w
0 Abd l
0 Othe,'.
CNA
Rebound Effluent Ouallty
Blooven tl Oat Demand (000a1
Total Suspended Solids ITSSI
Fecal Downs, Innocent mean)
Monthly avenge
Si0 at
90 mslL
flat PN/100m1
0 NA
Dispersal DOW
0 in Ground )amnia)
0 ADGi
ODal
C NA
C In Grouts lactea izWl
0 Mound
0Oth"
Maximum ENlumt I'll S'¢e
a In die.
0 NA
Omen
0 NA
Other
0 NA
bay,0
NA
Vnusnpwellmoammec wawwmu entl my,urkeham.
Upon
0NA
SeMce Event
Sella Rachel
Ingpim,mmas of tanklal
At l..rt mcee
3
6rlawas 0%,mmm3.oared
0 NA
Pump out mMema of tenklal
Wban oombinea sludge
and scum Wu ds memind 1$1 of ask volume
0 NA
I'll aim del hall
At least
3
IYyae3s IMWmum 3 years)
E NA
Clean mus t Nhm
an
At leono, wan
3
o mbnmm)
.erl.l
C NA
Inepxt pump, pump controls & alarm
At least once every'.
_
0 lllal
o all
Grp
Rum Imnls and p
0 inha l
�A
Other.
At arm 1108 all
o=re ninfal
v rd
0NA
mayo
^
o NA
M TENANCE INSTRUCTIONS
of make and dispersal cell¢ mall be made by an mdivieeal comma one of Na fil Hall or emNlcatlm¢I
Manor Plumbi Means Plumbs, bemicM town, Poi Insiti, P Yi Montreal Sptase Servicing Coal Tank
Inspect elude lees insurance, of the to lsl to ready any shall" n n hardware ideal a ec as e
err, m..mum, of combined sludge and mum and m check err ew ack m or formal of effluent m me ground .p ace
oM dig rt Calllal shalt be visually m¢pemm to gram the gNam[ levels m me amwanan on,, and to aback bar any pcnaing
1 effluent on the ground mi no pending at meant on me around surface may infante a Ivan car dam and require¢ min
Immedlm nmmmem, of me lack) rRusu mn vermin.
When the Conni wourrulgram of sludge entl scum m my took equals wentimund 1 lI or main o1 the tank vm re
v of the trek shall be removed by a Range m iy Operator and dmai of in acconamm, with chapter MR 113e.
Welcome, rem Cotle.
All beer � aervion, Ince
uding bar at anl[ep to Ne servicing of affluenl pipes, machanaal or preuud¢ed eomement proneaMent
aorta, wd any printing at Innervate M S4 mcmha shall be instant by a coupled POi Maintailwr.
A eavYvde raper Nall be prwiaN to me 1=11 rmuleary moray Whole 10 bey¢ of wmun iw of any got went
s AND OPERATION paws -6M�
ov, new For ,, ¢Sol hory ilia en use pp the ni damage h eeNam tankll for life h concert psi am protlutta or oN® chemicals
met may mp.ea had treatment weceaa0nng aerate¢ pileaio nine
p¢mn, If high annaenv¢nnna.re aneYee rove the pmtnn
o the , yet p shall tl by a ¢agape SoUcnp operate, we
b um.
symm yet up man net occur when a.n pona'mm: taw fm:en at ma mno-atroe,anme.
During power outage, pump tank, may fill above normal niebwate, le When Power'u rei tea uc.aa wexewxa SHE be
discharges to me dispersal "Ills) in one large eoe.overcall rho milt ,it may pawn in me backup or surface dunnage of
potank composed e a s a 8ery OPONfor Pool
power Thns e eM.. tpum n ntv c contact aa Plumber POWTS Maimadder to away conceptain concept opmg em'me pump tcontontrols
re normal levels within the pomp tank.
Dram drive ark anlde¢ vnks Seed akpa,al c Co not doveor So we, or ome ise disturb a [mind. the area
within 16 foot down a hope of anyinunit or an Sol soil abaorytion area
Reduction sera p of the 1O1,wlne from toe a the pylmm ma prolong the lib of the
POWTS: an iblm baby wipm: sphere bui wnEo c abs tlep easere rental non; diseases amity,, onte: fat:
foundation drain leurep pi water; hot and vegetable earnings; kfaaolme; gra his barbmmea: most acrapr mtmcxionC dal;
painting Ydaatts: pesticides: Smo-vy hall tampnna; and water mnenar brine.
ABANDONMENT
When the PONT5 fail, anchor la permanency taken out o1 cal me following Step, Snell be taken to Insure Nat the a"i Is
propepy ,it vbry abandoned m [coolant, with chapter Comm 83.33. Wisconsin Altura Me Code:
e All piping to tank, and pea Nall be diamnnected and the ebmamM pipe openirars e,am.
e me ... there or al tanker ma Pit, ffixl be removed and propeply borrowed of by a Cadets swicing Cheaper,
After pumping, all tank. and On, anal be exprvyed ,it p,m i nr their eoar; removed and me vow apace snail wed
real, gravel or another ireft and material.
COMINGENCY PLAN
If the PoWTS fail, and cannot be repaired the following meeauhad have been, on must be taken, to Wovid a [cats canpllM
mplxement a Yet":
0 A sellable replacement area Los heel evaluate¢ Sena may be Still for Me location of a replacement doll Absorption
Return . The replacement area NouM as domestic from S,,obanm and campenion and emulb not be infirl upon by
and
lot mos and wolfs
ure to protect the
dresun edin theb,oks from need for a newSolll and epee evaluation toaconsist a ual rrimim, mum area. Colonacemlen ryes area
mustt
amply who tos has in effort at that time.
0 A Sol Ilsble cue setback anhlor I Ihmonym Bamng advances in POWTS
Mh,,I,gY a holding tank may be installed So a an resort treplace the tailed PCWTS�
(Jislut- e dine g``ask
rrdbkb�bYRDNI8 TIE1or fTR-/J CONST2JC-TLpN
0 Mound and at trade soil absorption systems may be rhadn mat in place following removal or dine cannot at Us
mrmmaive sort.... Reso of ,on byname more comply wife me need in alien x than time
«WARNINGca
sEPI'IC. PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL BASSES ANDIOR INSUFFICIENT O)YGEN. DO NOT
ENTER A SEPIIC. Pal OR OTNFA TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESWE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITONAL CO
n / a
J —to / ! Wound yi { 'FF T a Wev
J Zi de aro t te- aLabel Jii K-r i�� Sold lit'
WIS MSTALLER Pi MNMAIXEA
Name REGULATORY AUTHORITY r.� Lk<
Pnpne rS— zS-62oG
Name
eke (a&WXyR SeAe,BerLeara
Phone
_ yzr- Gzan
1 Nam
1 arc
prepne
rs- zr-ro�S
The
Prime
-Ifs-38(o-
m
a
mp�m wet er.rvem. aompl.npe wmx m.prer Croon ea.zzlnlmlvred old e3.E401, al A Ira. wiw..an Aemlrvmanw. ease,
STM UP AND OPERATION Page 0c1f
Far new cenaWetion, prior to use of me POINTS check Peatmem tanklxl for the pwaenc¢ of painting products or most chemicals
that ben lmpMe M. merchant indor per the also eel maild If high cowdknmmona we detemW nave me cereals
of the tenklsl removed by a edp�age ervm'clg operator prior o use.
Syemm start up shall not occur when mil contlmona am frozen at the informally wrimew
During sewer outages pump tanks ally fill above nomulh on level,. Mai cower is re¢tmN the excess wartewrtm wi6 be
dhchaged to the duldi tl celllsl In no large does cosh ering me celllsl and may result in He backup or surtxe discharge of
effluent To avoid They aim I have the contents of me pump tank removed by a Septeri Smldng Operator prior to r,tt ng
power to the sfRuemt pump or behavior a Plumbu or POINTS Mum aalnw fen aedxt in manually operating the pump sunsets to
reolm nonml levels within the Pump tank.
Do let drive or park vehicles over talks and command cells. Do not live or park name, or oMawim damn, or ownt"i me sea
within 15 feel down slope of any mound or various soil movement, area.
Perm on or ohnsi egon of the modeling from she wastewater etteam may improve for performance and prolong the life of me
POINTS: m[ibloticx: baby Wipes; ciDor o buts: condoms, cotton ameba; degreasers: rental Rosa: museum disinfectants M:
retai don dran (sump pump) water: front and vegetable reside gewene; gmaxq both not": meat scraps; metl'mmionG oil:
painting Thermal; produces; sanitary napkin¢: tampon,, and weer schemer balm.
ANANDONMENT
When the POINTS fails and/or a permanently rokm om of arviae the following steps shall be taken m insure than the xyztan is
pmperH and Smay, ai ..ii In compliance wan chapter Comm im 3G allocation Adminiseadve CWe:
e All piping m tanks and one Nall be disconnecud ,it the abaldomed pipe cpmlingo maetl.
e The ... term, of ell tanks and pill shall be nmo wd and not disposed Of by a 3mmpa Sand ing Operim,
After pumping, 41 tanks and pill shall be molecW and ramwed or their ceverm removed and the vold apse@ flied with
revel or another Net solid material
f/JMINGENCY PLAN
If the PCWTS feib and e,n,w be nepagetl the knowing measures base and, or mart be taken, m relay, a code complaint
replacement system.
0 A a replacementn
a has been Y be noised fart oof a replan evil Absorption
system. The replacement area should bay pro ewIn from disturbance and Composition and should not he IMrinoed union by
etailer aafbalk, tram ,living and purposes n and while Faiwre m moment me replacement area Ago
result, the and and a valuated ro e¢teonm a ¢uhbi mpla,i area. Petrucc t system; must
comply with me rule mneNan rt that tend.
O A xunable replacement
area is
vailable due nobodyhalm 1e11 Imitation Serum dividends in POINTS
technology a fodingthus may be as aIa n mi to replace the failed POV 6
T a
tub a eie F#plAln rffn HRN Conl^Ixu4togr3alk
o Mound and around, sail absorption xymama may be re used m pl sae foili removal of the blame be me
informative surface. R....atmmels of anon SWtad¢ mustwomanmm the miss In emitR ma Time.
«WMNING>>
Si PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFRCIEM O%YGEN. DO NOT
ENTER A Si PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. NFbC11E OF A
PERSON FROM THE INTENDR OF A TANK MAY BE DIFFICULT DR IMPOMIBIE.
ADDITIONAL CONIMENTY Djymlurye4/kii'd ii VC9
tea0 _w_ Orlin / Te. rl_ is ,A 2ez i S,I e6E T GAr A sd' 5 we
ft �'44 3Lbiduch, 11if-liallyQ.R3y 'Aftlty— k
POINTS INSTALLER POWTG MAIMAINEA
Name rg erXc
Phone 15— 'Z—(o2o0
Name
,R 2a¢.im-A aerk.BwLexn
mono_
aJzt- 62Gn
SEPTAGE SERVICING OPERATOR(PUMPER) LOCAL REGULATORY AUTHOMY
theme S. C&I 20Ajw
PM1me
�r—
ST. CROL\ AONCE \'
SEPTIC iAVK W1INTFSnNCH A(iR! LNFN 1
Il
NI
ow']29IIP CRI I:'ll'IC'dT10Y FORM
ow„orllu.'cr Riccardo & Tara Albores
276 Saint Andrews Dr
P.Te., Add...Same
nmnw mrmolmnenmN mne max nnpmo'.'nl e. -(
N .Hudson, WI P ldcri,I;J4I,onNumaA40-1254-40-000
LEGAL DESCRIPTION
Propcm Lrcmimn NW NW ,.. sr. 19.(28 NR19 W.T.,,n mr Troy
uUNd ;,,,,np,,,107-018-Troy Village 2nd Addn 98 94
(-Mired smn-er MOP Volwne .PaC4
Iaarr.np lk„d# /850424 ,lbetow 20071voll,um_—rap==.
sxo.:�.rc Ov<npw tm lmnukmfmk. 8>110m
ST STEM MAINIFINkN('L AN D O"NERCKKrI FICATI A
Imylq...t' ,muml[wn[eu[}u' ,,1cay 'u mwlGr, In In ryf u,' r 6ilxrc la wu9mwu. MaN
m<`Mi<uN atnmrtml< rvxnnrr Im, mel.. 0v w wu c pw imn
I Lr"bfl�.�l�fi�[� dl.'u in
nol�ln[)52(an m vm 1 fup[ In"xaxrdi,p,nai.,.aedn. n.nmmvlmnu�[e
,mpw,�tJ;me urc.pR,ree m sPs 3m3s1 r mm m empm r_- sr. e,m. emnrz emilm, nak,m,a.
1Mpup<n,. ux:e, 44 lu wnm,I wSl Irv,. Coum, Ylannms A]nnmp a[um. 11F bme
1.ua vW ln u=SW pwmM. rvurc.man ph ,rmiaul pl=m u. lianud Mollw (r;h'mv nm„ I I Ill, In 11ty
am dlW l...ucnu m gx, r F+Imc (u a,m mdw I_I aNn ir.Na'lioo W NmpmgIil�a�e.wn, iF<,M:,anl in
m, dw, I I lull ul,lum-e.
I: ue.J Imhrtlgrm N,e real Nc r C mlulrtnxnu ml agl((,n mainuin,M pivale,exay.Ji"u;J'vu<m, m N[
wdJ xl tU . hmum'um0) Ne Ikpa lof U(m'AmlP fimu,rul um ICC, W Me 1Kpennwnl xl Ylwal fta 11,
Su IfAss(mmrt Cemnau(wn 5minnJw `m xpi(s„sum ills Can muntWW naa h vwurla,W ma mw wIEe S. tw"
t m. Ylww,F a L,'mF L4pmm¢nl v nu, s _a w lne uun,w npmim&M,
Cve,Mih Oulall Nolen MF all dml of JW m Ceualms aw 4mxl C I: xx Nome Xe rnngalnOb
pnaenl9ncrlEeJ:IW,e.h ruwe 1 n'Jenl rta'wdW v.0.e&c4norha6 (HR(e
Nu IlerefbMrooma 4_
2; 30: 14
SIG\ A I I IRI o[ nYPl.l(-A\ I I9 DnTF
inrnmw;m mrt 11 mmm` mm,, rue m mr,anm,. rum" trine m'n M Jm I'Immne¢��'Ikpwm,rt ••
Indwe WO01, appli(mm a emnEM xar,ann UvI Imm qC R(P''rra nr Mao l,ITice aml a uqa .,flFeamiflN yun'n vup,l
rtcrcna isn mn xanam d((d.
lRFN."131
-PA�e47
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC TANK(S)
This is to certify that I have inspected the existing septic and/or dose tank
presently serving the following residence:
(Street address) 76 "4 Nnbe=.as 0� located
at: �5 Ya, P `/a, Section /I Town_,L2_N, Range__LL__W,
Town of 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 functioning properly.
Most recent date of inspection or service ADD SVzv
Did flow back occur from absorption system? Yes_ No
(if no, skip next line.)
Approximate volume or length of time: gallons minutes
Tank Capacity: nSd
Construction: Prefab Concrete X Steel Other
Manufacturer (if known)
:
Age ofTank (if known): .b arc
Permitnumber(if own) yDH4es'
( e se umber Signamue) (Print Name)
`2/ /
(Title) (License Number) MP/MPRS
l Zf3o�zm4y
(Date)
Form in be completed by licensed plumber (Dept of Safety and Ptofessional
Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer
(NR 113 Wisconsin Administrative Code)
Rev.212012
Z
0
pxunser Cn0 Be
Repeorv' R edf 4
Dp Noi OP.ra1� W%l%
Pla yv� iv C/ossn indC
'Remas�/pfm,pe 1�ia..aG.z
u,r
R 14(, Y'�anyrr se 6/asZ2
B/oaks Ae ? n./. coflfl
✓•o- iAk fa 34.6 aff
Gmuntl
elevation
t
Proposed
Sysem
Elevation
system loading
itaan@ rate at
boring in. dep
Bonngi
I'
95.38
9 0.7
Boring2
994
95.38
D.J
Boring3
9891
9538
0.7
�Lbo/CPs WalksAee}
Determining Lowest Allowable System Elevation
Boring Kl Ground Elevation 96.3)k
Limiting Factor = 132 inches
Limiting Factor= 11.00 feet (inches convertetltofeet)
Ground Elev 96.1]fit -LFEft) L Limiting Factore(evation
Limiting Factor EL 85.11+3ft= 88.1] Lowest system elevation at this boring
Boring B2 Ground Elevation 994k
Limiting Factor = 1 132 inches
Limiting Factor= 1 1100 Fact (inches convened to kM)
Ground Elev 996 k LF(k) 11.Oo = SBAO Limiting Factor elevation
Limiting Factor L g8.00+3k= 91.GO Lowest system elevation at this boring
Boring#3 Ground Elevation 9g.9k
Limiting Factor= 133 'inches
Limiting Factor= ELM feet (inches converted to feet)
Ground Ell 98.9 ft-LF Lfd I Limiting Factor elevation
Limiting Factor EL 8].9o+3k= 90.90 towertsyrtem elevation at this boring
Lowest Allowable System Elevation Mween all 3 Social- 91.G0 it
Designers Proposed System Elevation= 95.30ft. (must be higher than Lowest allowable)
oXiti�^'� Ti
0
ys pa9
Maximum loading rate of 3 borings= OJ lowest of
ri��of✓s , lcu4ef
Determining Lowest Allowable System Elevation
Boring Bl Ground Elevation 96.17ft
Limiting Factor = 13E inches
Limiting Factor= 1100feet(inches converted to feet)
Ground Hey 96.17h LF i11) 11.00 85.11 fimking Factor elevation
Limhing Factor EL BSll+3h= BB.1J Lowest system elevation at this boring
Bmingp2 Ground Elevation 9974f1
Limiting Factor = L 132 inches
Limiting Factor= 1100 feet (inches convened tofeet)
Ground Elev 99L ft -LF(R) 11.00 = 88AO Limiting Factor elevation
Limiting Factor EL 00.60+3ft= 91.00 Lowest system elevation at this boring
Boring#3 Ground Elevation 9g.9ft
Limiting Factor = 1 132 inches
Limiting Factor= I 11,W teet(inches converted to feet)
Ground Plus 98.9 ft- LF(ft) S1.W g].90 Limiting Factor elevation
Limiting Factor EL 8]90+3ft= 90.90 Lowest system elevation at this boring
Lowest Allowable System Elevation between all 38orings= 91.A0 It,
Designers Proposed System Elevation= 9L.]5ft. (must be higher than Lowest allowable)
.(
Ground
elevation
Ft
Proposed
System
Elevation
system
depth@
boring in.
loading
rate at
depth
Boring
96.17
90.75
S]
0.7
Boring
990
94.75
56
0.7
Bodng3
98.9
94.]5
50
O7
Maximum loading race of 3 borings= DJ lowest of
�lbnn ro woks a
Determining Lowest Allowable system Elevation
Boring Bl Ground Elevationf
96.1]h.
Limiting FSRor = 13s
Limiting Factor= 11.WilncBes mnvertetl to feet)
Grountl Elev 961F)ft) 11W = BS.11 Limiting Factor elevation
Limiting Factor EL BS.11+aft= gB.11 Lowest system elevation at this boring
Boring p2 Ground Elevation 994h
Binding Factor = 1 132 inches
Limiting Factor= 1 11.DO feet (inches converted to feet)
Ground Elea 99Ah-LF(ft) 11.W = g8A0 Limiting Factor elevation
Limiting Factor EL 88.40+3ft= 93AU Lowest system elevation at boring
Boring 93 Ground Elevation 98.9fl
Limiting Factor = 132 inches
Limiting Factor= 11.00 feet (inches converted harder)
Ground pies 98.9ft-LF pill 1100 = 8>90 Limiting Factor elevation
Limiting Factor EL 8].90 e3h= 9o.90 Lowest system elevation at this boring
Lowest Allowable System Elevation between all 3 Borings- 91.G0 ft.
Designers Proposed System kimurtion ftmost be higher than Lowest allowable)
Ground
elevation
F[
Proposed
System
Elevation
system
tlepih@
boring in.
loading
rate at
depth
Boring
96.17
93.5
32
0.7
Boring
99,41
93.5
Jl
BJ
Boring
9891
93.5
65
0.7
Maximum loading rate of 3 borings= o.]lowest of
T3
59 $- aao40 S.F.
ca - 1.011 AGkES /
om' ^ S/
Af
'` z r 2o�2H• w O .//•!�� / 465
1.01
------- �— W % I N7$.5p
214.Op•
r o 93� 1 1
443971 S.F.
e= 1.019 IACRESI I J
z r- 72
foaH•. I Q1 I48117 ST
p' 00" E 295.52' Hroo' 00„ W 8.40• 1 I1.105 ACR
I' 00„ W 297.76' 0.20'
S H7.00' 00^ E 2 .4H' 1(: z l
UN IW56. 00^ .
61 ' ry 94 m s 4 233.61,
0 4 SF. i HI � I� 1
1.009 ACRES m u 1 71
s
H7.00'00^ W 312. 7' a a �Nlu I44304
I tsa4o• 1 154.47• z w 11.017 A'
I 1. 6�•N Im'm 1
1 I S w"I ^ W is
1 '•
63 1 64 1 I1n1 4
I 65 W11
I 1 ICI wl� 68
TROY I VILLAGE Q1 �I
_ -7;.
1
L — — — 1 — — —
ST. ANNES PARKWAY — lNII L—
Au e.0w0oi....oi.p PRIVATE SEWAGE SYSTEM
or:�,w
INSPECTION REPORT
GENERACINVORMATION (ATTACH TO PERMIT)
TANM70 FM1 WELL I BLDGnoun
septet )75;
�Ing
HolGing
PUMPISIPHON INFORMATION
Did aP ,
And
roH LxB.
et two BPW Ft
rCorny
St Croix
L=
.Ln w.alZ �a
PITUMENS
I«. ree
..
wHn
3
M To
uHEsrREun
—
SDt
6NII
.l, wr
`ISO)
DISTRIBUTION SYSTEM Y Y
Hill alee6WJm HD Both a mw
repin ol,l I ` 950
SOIL COVER A WM 9ymme onyW— lifil or AlGraee Syareme any
nzmm�w edrtx ynr 1 mesa
COMMENTS: OnuuaemwHl.nepenew.6elzorc pm+ent ea.l remeceawnnl -1w-1l "spinuollyl
Lxa00n: 96EIAM"SWWH1U1ln.Wl Wie(SWV<NWIIN9TMR19MTm VIIIa9e LW90 P Y: I1190.19,1660
Q1. I AI10M D®orobn'�
2) Bldg serer Mn9ln= LD1R �5
Nmrer= 1$ .
i„L,,,lu4.,.4nr�—bvs ir.1,.Iw..aQn B..Qs r
Pnm,ImH 6Iw, U #41SzG
Too«e IN.9,V aaelwwi alarmnl ��91 �°`�' .�1A9+a+
rd�
�������r
AI �. Mr,y .�2.l.Q Yl16
lYYY1 v1 9IJ1-llr
p
r.Wr
(�
l
wt o. .aa
ferlaYX�Y
Y.r .{oy
91s
rir. r..r
�rMee w.ri.-erwwuvrr
M1l.r x�
o-i ` _
on-
r� .r
St "
•r.s�e
3 IjTan
Y f
aear
M1.O�s
!tars
aeries
5
a nl.Mrrrrrrrwalm
pA
Olra
yy . M1r.r.r-M1rar.�—
rov
❑wr.a
3
m'rylr.rwr lorsa;�ra r PWti.l�r4rw.tl. oarrr
rrarr.ey
e
•Ow.sear
•Orl�a a°.ru.
M1rlr
O orvrrsM1e M1.n.yrr !'�r'r^
rYe°
I1.11rilaiC IOr1iYa/lA�aYld�rrr�aatl
a R(ra��Yr row aOar n°v
a°t✓erryr
a°rvrar�r a°werYM1. r°rr.r
n°vryu.
n°wmr r°nrYn�r a°
a°rr
v-
wwwlao rear relmYr mYyaa. rae.r 4rr,sY. coot
Yn++ M1� rearmaarni mna
r.r
vl.vwr
qsy
'Ir nYr
a.ra
M1m
r
w
er
lr.er
m
m
r..r
� 1
vv. er.rr- r rrra.arwwer..�r�r..
'^
14 l U cilmo
S
vm r
YWsa OrtiAa fop M1MM1IaM,Om�lYaiArrMQNBRY
r4rM
° o.�o,aeMM.e
Z8
-
.�c
r 1" m mmll
mmosoPa^�wl® g� Pa9.,p,
p SOIL EVALUATION REPORT
SEp lm au Inam nowllM1SP5505, W¢. Aam. Code
County
Atlwnwm�ele¢Ile
oa dame, ro110a "m V2 11Imra In eae. Plen
do ml roaapn GIP' ',flood,od mknW.
aC^a4r,
euMaalmemlan
wool road
PIN'e,InYII
WRundel 011RI➢.
<
heated IMamaYan.
�g
/2 8/
w roree m. Mu
KFmceMLo
PraceM Gxne
um.
u B w x
d>edv wrrr.n pemng nedme¢
ale
Bade
eacsma
274
of
2na Maize
city
sum 21d Came xNum
❑cad ❑vulege MTo,, Neaml Read
Raamn
wi 1 Raou;
216 B.Im Mows Dr
❑ NevcoMruwon
Cold Reameakerrnamaeldommil 4 Cade denwtl aemad now MIG ON GM
® Repaaemem
❑vary rdal—Beaanm.
—friele,ow
Minoan Hamden ad Xappmane rv_e.
cer.ral avr.n.ma.ne
r.mmmewm,..wm.,,.�.IPowra.r.,,.,,,.aenew=era.roe..l,lbl®.a�.al,,.d,so>mamlro�.r.
Boom;
1❑ SRI
pit O PII Gmwnd wroce now 0.17 fl. GepNNIMryIrp Mor l=ln
Sol n Rate
Hew
M
Ceps
In
Gammoof
Monier
RRICO,Connotationo.ConnotationIConnotationW P
Ca.k COM. COIw
3tlure
eu
Cmel'm
nary
name
DmF
'i
'EM2
1
01
7BYR 313
vI
2unmk
mk
06
One
OB
1.0
2
9.25
75YR a9
is
Beg
Imee
OR
1V
0]e
1.Sa
3
3Sg
10YR40
0¢g
<
9 32
10YR 514
add05g
Iwae
OZa
iN
mu�Bi
ro
F2 B.dIn061.5
PX GWOORN,,mmmi P. ageblmXlnplaGor 132 1n
Be, Hobo ,Wre
HIMOO
Cedm
Comment Gm
Redo. Gezoµm
W. PE. Cook Odor
Tetlure
4tJoni
GC OZ No
C'MiNme
Bwndary
moment
GPNW
.oM1
made
pa
10YR 313
R
2m-N
08
10
BRO
ICYR and
am
0a
0.8
3
2(1
10YR M0
9w
OTe
1N
a
0&132
10YR B13
OWlame
I","
0To
18e
.a,sd�
not In
1;w1lonm
LOUN anno
d "00)
dsgreWmBv
L E
BOB
.We mm alwm
m CBTNun r
1330032
Ryan NodhalB[G�4.epa
CST Name (Memo Pat)
3nomCenaoavlew CR, Ree aloe. MN 55oB5
CorduvaN
Tekunone Nunbr
I6511327 0074
❑3 liana°e pro - Gwow,heaeale..36eo n Gmuwlmmrer n"r' In
�r
"m
Legh
In
M iIr Cnoar
lCeeanpM1S"
pu�PZ CTM. Color
tl
vrvmw
GZBz 6R
GFleepol
Carl
Ross
GFOIN
1
07
t0YR 312
sl
2hy
It
as
vw
0.5
10
2
7-14
10YR 32
4
2
mk
as
lw
06
10
3
14-%
t0YR0/6
0apk
Iwae
°w
0]e
1as
p
3042
10YR 514
6
Csg
Iwae
0w
0]a
the
02-132
CYR 5/3
pool
DID
Iwae
07a
16,
mall
7,157zi--
°❑lima°s ❑se"° Grw"e aanaw se._n. Denmmn ❑ mnimraw_m.
OP2n"9e Epp l"° Gmama"nap Ner._ft Depth ro her laps,_ b.
-Effil$1-60D.> 3062D) It eM The n JD a 150 19M1 arrears he-B00,>301220 Mes- can That 30 5 160 it
�Bafin6
3 Bonnp6 ❑PM Grol of Nrv. pow ft OeplMolYnPorg(Mor l=in.
6oIIPed
3
14�
--1OYR All
I
Ogg
kaw
INN
070
1 16a
Mal
Oil . °❑P�'t Gl.mlew G�wPw,mpinpbBnr_In.
mm�pwI
®®
❑5 Bompr ❑ ogling
❑ Groom wnm ae.._n. Orwn to lir lry lanor_In.
E ffll$1• BOO, I N 9 M milL and Ting 3o 5160 nwM1 - Ell Q. BOO, 130 1 goo mglend i55>30z 150 mB1
�44 ADVANCED aN o, ;r� � oeess,,f s,�m ' a"instama sSais ,uzew-, eare. '""
SCALL
TrInch2t
o � e areran>a�oenn,�ee
ri
LOT 60 LOT 93
T®t
a — aT.:
....
Imo,". ,r.- _T erhm unary ,r. _ _,n.-_
7
B96a) Trail � Im"m"n"ry
i
(Fully Funded) sq.= 'and
tp A qe6'` r __ I
_ ,l'� o venaY V �-- - .mu
11 1
I VH�je W
0 D
i / Z
,annex nve xn .
Bar =IDOW / B ial e Q
91 _ Tank Cover T T/U01Ne
70
ID I
.,.
Hirsh Edge/
ra� •n ,rv., vrn
Mow line BM2 = 100.65 •n
Bottom siding Tranchons:
0 Trench l Free,
95.34 3
Isting 1250gal Gnk J muse SW Corner Trench 1 Flea Grace - 97.781
7.
Trench 2 key== .03Hkent
LOT 64 i LOT 65 276 Saint Audi D,
mzB =es.o3
s ,.9. Let 44 Tray Ali end