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HomeMy WebLinkAbout032-2167-37-000R Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT ATTACH TO PERMIT GENERAL INFORMATION i ) Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)] Permit Holders Name I City Village Township D Sargent TANK INFORMATION TOWN OF SOMERSET A Description: ^ Nr- SI-A ^ � / tat V•A LAI ELEVATION DATA TYPE TYPE MANUFACTURE MANUFACTURE Septic al Dosing A_ / I Aeretiorr Ij91da9 F) M1, L j f l 1. TANK SETBACK INFORMATION P h(WO I OLK mmmm® ••• Mmlm l �= PUMP/SIPHON INFORMATION "all i Manufacturer I Demand GPM Model Number 'LA� TDH Li �� Friction o s i System Heal TDH Ft Forcemain L rlgth ,`) ia. Z rl I Dist. to Well SOIL ABSORPTION SYSTEM 5 STATION BS HI FS ELEV. Benchmark V r^O O / 0' T v Alt. BM 3- r� J / • uJ I U •� JWJ 3 Bldg. Sewer (6 9Z St/ t Inlet / SUHt Outlet Dt Inlet Dt Bottom / J Header/Man. Dist. Pipe Bot. System 'r / ry 10 Fin ade St Cover _ -Z 12, 2 � r 11,141l n IJ BED/TRENCH DIMENSIONS Width I Le th� I No. Of Trenches ,r L IT DIM SIONS No. Of Pi Inside D Liquid Dep� SETBACK SYSTEM TO P/L BLDG WELL LAKEISTREA LEACHING Manufacturer: • INFORMATION CHAMBER OR I fY Ty e Of System: r r UNIT Model Num DISTRIBUTION SYSTEM Header/Manifo�Dia �I Length LDistribution Pipeength (s) is Spacng Hole Spacing Vent to Air Intake 1\1J�l f4h SOIL COVER x Pressure Systems Only xit Mound Or At -Grade Systems Only Depth Over �1 A Bed/Trench Center P ' 1. / r Depth Over Bed/Trench Edges I r f m Depth of Topsoilyes xz Seeded/Sodded No n Mulched ]A Yes �I Na an COMMENTS: (Include code dis pencies, persons present, etc.) Inspection #1: Inspection #2: - Location: 672196TH AVE Q(� S 1 �„�{� �U .� �" NR - 1Nt11 11bA'mtulli d 1.) Alt BM Descriptionli4w (,bV9% - "1 n ink JW�,"DA 1A,, i c�.S @ ' NY�tr'�1 2.) Bldg sewer length = \ r C rig` - amount of cover = /�n 6^� Wilt (�e Plan revision Required? as N' Use other side for additional ormatiorA `01 ( (N1 tt��`M'�_C(.. Date Insep>� ignature SBD-6710 (R.3/97) J� \` ` Ay �, Q Lzm � Cart. No. 5AW doao — 055 Comity `X .�, Safety and Widingx Division r pawn amen, (m be filled in by Co.) Swmry, fill 201 W.yJ ashingtonl4ve.; P.O. Box 1162 08 JUN Radison 53707-7162 x a (4f(hf St. CroiCounty nt Commu ermit Aftlica SMCT InaccordwwwtSPS3832l(2),Wts. Adm. Code, submission urtohe RPmPgt is [egoi,d prior m obtaining a senitmy permit Note: Application Sams fm s=-owned POWTS ate s; b= ed to N Project Address (if dillesem dial mmlmg address) the Dcpathnaa of Safety and Professional Servies. Fotsocal mformalioa you provide may be used for scoondmy in sccordma with the Law, S. 15.OM1 m Stan, 7� L 'onlnformation-PI formation Property Owner's Name _ D Is U —^^ lJ{J n owsces moiling� Property 6 ZProperty v .l7y/�`l loot i��C �'A Section 71 Cuy, Shoe Zip Code P1toon Number TN; R E W pe of Building (check all that apply) Lot Y Subdt on Name 2 Family Dwdbn- Numbs ofBcdroams — L� Block 0 City of ❑ publirlCommacim-Desaibe Use ❑Stave Oward-Desm'be Use ❑ VY'MW of! CSMNumbu I !- / Town Vf Gl2.rP , X IIL Type ofPchisit (Check only one box bat line A. Complete tine B if Wiiubk) `+' Sy:uem ❑Replacement System ❑m Tresmusold'mgTmh Replacement Ody ❑Oom Modification m Bslnog System(expw.) B. ❑ Pinto Renewal etrnil Revuioo 0 Change of Plumber ❑ Pc mitTramferm New Owoa I.ist Previous Permhfgmnher and Deftbrand Bcfae ExpmuiM d IV. Coon onentMevice: Check all that apply) -ptmsmmed in-Cmound ❑ Prasmved In -Ormond ❑ At -Grade 0 Mamd> 24 m. of suitable Soil O Mound <24 n. of mitable soil ❑ No Component (atplan) ❑ Pnaamnem Device (explain) V. Dispercalfrreetancit Area Information: ' Flow (gplill Deny Soil App�on R&*Wdst) Disprad AM Required (sp Dis (st) SY� Shuman l VLTanklafo Collects, it Gallons Taal Galloon %of Units ManufWadir $ h$ W' Lai s a•'" � � � °d Piw'Tads F ie Tarn 6� y 2 AE nl 6O 1 SW=w Bddiaa Tack l2� Doing Owalba, 3 6 VII. nsibitity Stafema -I, the mdetSigaed, m"Wity foruumWfim afthePOWTSebownwthcatlxhedplam. 'a Name ) PI rgnenve MrIMPRS Number Bnsm a PhmeN A mY� Zip ) `v L'Z i VIR CovortYADepartatill Use lILPIKIFY 0 PmmitFee O Done Issued luting Si S e 9 0 I Zo o .. forDen sl . pp pPr nit t Wu for Disc tier 1. Septic Wank, a Ul dispersal Cell must be se itetl/maimaiNd , as per management plan provided by phwdw. . 2. All setback requ),en•ents must be maintained U pat oppledbte sodeiordinances. Attica b eompime plum for tM apwem son saomv m me wavy very w paper v.. vs wu = u.+.. �^—•-- — SBD-6348 (R. I1/I1) t I'm r Septic -Dose Tank Cross Section And Pump Performance Specifications IMMMM1. a"111 1 1 .. • 1.1 . • LI . ..:_�_� ; it i� 1 Outlet Manhole Min. 4" Above Grade with Locking Device. Inlet Manhole < 6" Below Crrnde Sealed watertight Finished Grade - Outlet Filter inlet Baffle Switch and Reserve Capacity Tank Vohmre = GPI Dimension: Inches volume Gal. (reserve) A 3 (alarm) B : 2 3 J (dose) C —7 l p (dead) D / Toms -ti 6 11 • < 11 . Total Dynamic Head (TDM - Feet Elevation Head Distal Pressure Network Loss Force Main Loss /. Total O Manhole Min. 4" Above Grade Securely Mounted With Locking Device Weather-proof I i Junction Box Vent Min. 12" Disconnect Above Grade Means With Vent Cap A Weep Hole B Off Elevation C r ti Bottom D Elevation Ft GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the manufacdner's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved wi& 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 1628. 02/OS IJ Page of N 280-SER/ES 112 hp Submersible Effluent/Sump Pumps The Liberty 280Series provides a cost effective "mid- range" pump for on -site waste water systems, liquid waste transfer and commercial heavy-duty sump pump applications that require higher head or more flow. Designed around Liberty's unique "Uni-Body" casting, the 280-Series will provide years of reliable performance. All Models Feature: LL • Vortex style impeller permitting passage of solids i y up to %" 4. • 416 stainless steel rotor shaft • Permanently lubricated upper and lower ball bearing • Epoxy powder coat finish • All fasteners - corrosion -resistant stainless steel • 1%" Discharge • Stainless steel bottom screen - easily removable • Maximum fluid temperature: 140'F. 280-Series Cord Lengths Model 10' 25'(-2) 35'(S) 50'(-5) 280 Standard Optional Optional Optional 281 Standard Optional Optional Optional 283 Standard Optional Optional WA 287 Standard Optional WA WA 10' cord length standard on all models. For optional lengths, add "-2, -3 or-5" suffix to model number. Example: for model 280 with 35' cord, order 280-3 Motor Specifications hp 60 Hz 34W RPM Oil filled, thermally protected (PSC) Permanent Split Capacitor 8.0 amps (115V) 4.0 amps (208/230V) Performance Curve: 280-Series ' llllllll n1111111 �1111►\1111 �1�1�11�1�1�11�111111111��1�■ �1�1�111�11�11�1111111�111►\■ ' U.S. Gallons Per Minute 38 78 114 156 192 228 270 Liters Per Minute Dimensional Data: Weight: 29 Ibs. Height:13" Major Width:10" (model 287) Minimum Sump Diameters: Model 281, 283... 14" Model 287 VMF... 10" Factory switch Model 281, 283 Model 287 settings VMF Turn on level 13" 9.5" Turn off level 7" 4.0" The Model 283 features a fully adjustable wide-angle float Di fe tial adjustments can be made easily by tetfhering the float to the dis- charge pipe or other mounting point Vertical float model 287 is not adjustable. J ' Wide angle Wide angle tz_mnmz� ` switch floatwith switch quick -/float Itno I I�I disconr M I ... .- alplug Cn� sA® C us Certified s�ffi ��.ubIW Wrl��ut�. Model 287 VMF-Senes Vertical mag- netic float for smaller pits - will operate in a 10" diameter sump Liberty Pumps • 7000 Apple Tree Avenue • Bergen, New York 14416 • Phone 800-543-2550 Fax (585) 494 1839 wvnv.bbertypumps.com Copyright® Uberty Pumps, lnc 2017 Ninghtsreserved. LLR200a PMA7 SfiVv - -o SS L� Industry Services Division Cmasw 1 e- X ' \�!/ • 1400 E Washington Ave T Isl AR 13 2020 P.O. Box 7162 Madison, W153 7-716z Sanitary Permit Number (to be filled in by Co.) 11, 4P I- —L sc. Cfolx ermit Applicat' date Transaction Number in ec Ifrmah t m. ode, submission of this form to the appropn unit �— is requ prior to obtaining a sanitary permit. Note: Application Brea fors WTS are submitted to Department Project Address (if different than mailing address) the of Safety and Professional Services. Personal information you provide ---yTIM111111111witimairidary Purposes in accordance with the Privacy Law, s. 15.0 i Xmj Slats. a L Avolication Information - Pleaw Print All Information - Property Owner's Name S I'm" 10 b cal # Property Owner's Mailing Address w �V l�nPrPoperty Location ZQ- 31. 11. f Ll J C Govt. L _/'�1A Sectio n Ctry, to Zi Code P Phone Number 553 I _3L TN; RE W ype of wilding (eheck all that apply) AS ding Fondly Dwelling- # 3 So iv ions NamenF Number of Bedrooms n�f Plock ❑ Public/Cornmercial - Describe Use # ❑City of ❑ State Owned - Dwcnbe Use ❑ illage a( CSM Number of lIL Ty of Permit: (Check only one box on line A. Complete line B i e) A' ew System ❑ Replacement System ❑ TreatmenUHoldirig. ernent y r Modi ioto ng System(explain) ik B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ it Trans; m List Previous and Date Issued Before Expiration Owner I . Type of POWTS S stem/Com onent/Device: Check IN that a I on -Pressurized In -Ground ❑ Pressurized In -Ground ❑ de ❑ Mound in of suite a soil ❑ Mound < - . of suitable sail Holding Tank ❑Other Dispersal Component (ez lain) Pretreatment Device (explain) qzw V. Dis rsalfri estment Ara Information: µ, Design Flow (gpd) I Design Soil Application Rat ispersal Area aired (sf) Dis rsal Pr oposed (sf) SyEleva'on stem - 391 VI. Tank Info Capacity To Gallons Gall is M ufacturer�[/f. a U rn is w iL 0 a Septic m Holding Tank Dining Chamber VII. Responsibility Statement- he undenigoed, assaLQ responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum sjignature MP/MPRS Number Business Phone N Plfimher j Address St[xt, City, State, Zip Cod VIIII. Coon /De ■rtment Use Onl � (Appmved ❑Disapproved Permit Fee I E .�� Date Issued ss o g Agent Si ❑ Owner Given Reason far Denifll *9 IX. Conditions of A proval/Ressons for Disapproval 3 is t S • SYSTEM OWNER:Ne�(�tAa►Q�(- 1. Septic tank, effluent filter and �!^�_ K .� ► �� a�4• , dispersal cell must be serviced /maintained as2. All per management plan provided by plumber. 44 N,v, 4 �;� `p,�Q� yk�,p�-4AC K as per applica191isaL'1 8MF,41h~ thesystem and submit to she; oyny y u an paper not lea an 8 is a II ncyn In ai S SBD-6398 (R 08114) 10 I ✓ r recQ t' PROJECT Mike Saraent SW 1/4 NE 1/4s 26 System PLOT PLAN ADDRESS 672 196th Ave Somerset Wi 54025 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 98.0/97.5 4' belowgrade 3/11/20 BEDROOM 3 DATE CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P�e .ArE I-+Om-� SS� ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H,R.P, same as benchma k 196th Ave B.M.* Vent >6" of Cover 4' Lon2112 Gop�' Scale = 1 /4" = 10' Pro 3 Bedroom House Quick4 Standard Leaching Chamber with 20.0 ft2 of Area \5.6ft^2/pair of end caps .LGrrade at System Elevation All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 0 B-1 I -IN 100, M um 102' Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 3/11 /20 Owner:Mke Sargent Location: SW1/4 NE1/4 S26 T31 N,R19W 672 196th Ave Somerset Manuals Used: In -ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintance an Contigency Plan 7. Filter Cross and Signatu License r#226900 System PLOT PLAN PROJECT Mike Saraent ADDRESS 672 196th Ave Somerset Wi 54025 SW 1/4 NE 1/4s 26 /T 31 N/R 19 W TOWN Somerset COUNTY ST.CROIX SYSTEM ELEVATION 98.0/97.5 4' below grade 3/11/20 3 DATE BEDROOM CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 , � BENCHMARK V.R.P�e �AfE I-�-S�f� .CAL ASSUME ELEVATION too' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchma k 196th Ave B.M.* ,Vent >6" of Cover 4' LonQi12 Scale = 1 /4" = 10' Pro 3 Bedroom House Quick4 Standard Leaching Chamber with 20.0 ft2 of Area \5.6ftA2/pair of end caps .-Grade at System Elevation 8% Slope 0 B-1 M -z 40'. All piping shall be ASTM SDR 30/34, within 100, 10' of tank, piping shall be ASTM F891 15 102' Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates •/ Typical Installation Vent At Grade _.A/30/34 Septic Tank 5' Spacing 5' System elevations: A 98.0' B 97.5' 5' at System Elevation E To be >1' above grade Finish grade elevation 102' Went t" at System Elevation 2-3' X 66' Cells Same on other end Observation tubeNent At end of cell A B 16 chambers per cell POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page iof_ yr 1LE INFORMATION Owner S Permit #q-g�57-2- DESIGN PARAMETERS Number of Bedrooms ❑ NA Number of Public Facility Units $ NA Estimated flow (average) al/da i Design flow (peak), (Estimated x 1.5) !K77 gaVday Soil Application Rate allda /fe Standard Influent/Effluent Quality Monthly average" Fats, Oil & Grease (FOG) S30 mg/L Biochemical Oxygen Demand (BODs) s220 mg/L ❑ NA Total Suspended Solids (TSS) s150 mg/L !Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) 530 mglL Total Suspended Solids (TSS) 530 mg/L 754,4A Fecal Colifoml (geometric mean) 510° cUio0m1 .Maximum Effluent Particle Size 'Ya in dia. Cl NA (Other. NA 'Values typical for domestic wastewater and septic tank effluent MAINTFNANf`F Ar WFnttt F SYSTEM SPECIFICATIONS Septic Tank Capacity roo get ❑ NA Septic Tank Manufacturer ❑ NA Effluent Fitter Manufacturer ❑ NA Effluent Filter Model ❑ NA Pump Tank Capacity l ❑ NA Pump Tank Manufacturer 11 NA Pump Manufacturer NA Pump Model I NA Pretreatment Unit ❑ Sand/Gravel Filter CI Mechanical Aeration ❑ Disinfection 0 Peat Filter ❑ Wetland 0 Other. NA Dis areal Cells) n-Ground (gravity) 0 At- ride ❑ Drip -Line ❑ NA ❑ In -Ground (pressurized) ❑Mound ❑ Other. Other. 0 NA Other: ❑ NA Other ❑ NA Service Event Service Frequency (inspect condition of tank(s) At least once every: a(s) (Maximum 3 years) ❑ NA �iPump out contents of tank(Q When combined sludge and scum equals one-third (')S) of tank volume ❑ NA inspect dispersal oek(s) At least once every: ❑ 3month(s) (Maximum 3 years) ❑ NA � year(s) Clean effluent filter At least once every: -month(s) ❑ NA / nspect pump, pump controls & alarm At least once every: 0 month(s) yearW NA Flush laterals and pressure test At least once every: 0 month(s) NA )mer. At least once every: ❑ month(s) ❑ yews) NA Yther: L NA MAINTENANCE INSTRUCTIONS (inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer, Septage Servicing Operator. Tank Inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of ,wmbined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visualty Inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. 'rhe ponding of effluent on the ground surface may indicate a failing oonditlon and requires the immediate notification of the local I-agulatory authority. Ww the combined accumulation of sludge and scum in any tank equals one-third (S) or more of the tank volume, the entire contents of !'he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. IOJI other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, end any servicing at intervals of 512 months, shall be performed by a certified POVhfrS Maintainer. Ik service report shag be provided to the local regulatory authority within 10 days of completion of any service event. Page _ of START UP AND OPERATION ucs x other chemicals thelt For new construction, prior to use of the POWTS check treatment tank(s) for the presence of Painting detailed have the contents of the may impede the treatment process and/or damage the dispersal cell(s). If high concentrations tank(s) reproved by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may till above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal oell(s) in one large dose, overloading the cell(s) and may result In the backup or surface dischSn rge�r to int. of To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator Prior to effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park Vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong time life of the POWT$' antibiotics; baby wipes; cigarette butts; condoms; cotton swabs: degreasers; dental floss; diapers; d sr%darts; fat foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; Og; painting products; pesticides; sanitary napkins: tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permaneritiy taken out of service the following steps shall be taken to insure that the system is ProPe' iY and safety abandoned in compliance with chapter Comm 113.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shag be excavated and removed or their covers removed and the void space fifled with soil, gravel or another inert solid material. CONTINGENCY PLAN If time POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant repi_aac mYerrt system: suitable replacement area has been evaluated and may be utilized for the location of a replacement sod absorption systern. The replacarnerit area should be Protected from disturbance and compaction and should not be infringed upon by requ10ed setbacks from existing and proposed structure, lot lines and wells. Failure to prated the replacement area will result for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must ccmpty with the rules effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Bailing advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure Of the POWTS a sal and site evaluafon must be pertnpned to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place foitowing removal of the biomat at the infiltrative surface Reconstructions of such systems must Comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TAN ' UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O� A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POYUTS INSTALLER POYYTS MAINTAINER a_i Name Name ,5- / c Phone - — ( Phone a SEPTAGE SERVICING OPERATOR PU PER LOCAL REGULATORY /WTNC Name Name Phone ` --IVC Phone I i/J — 7? This document vm drafted in conpliance with chapter SPS 38&22(2)(b)(1)(d)&(fl and 383.Wl), (a) & (3), Wisconsin AdmhMsh Coda. 20140048A 04S200 19.8000 18.0000 I i w 1.1921 r _ 9.846d 9.37591 9A356 .01 Gap between Cose and Serpentine o l -�1 C S.A,Fti vs:—BLnLDIIY�.7v SECTION A -A =-• Warranty Deed # ST. CROIX COUNTt( SEPTIC TANK MAINNI NANCT .t(iRF.F:MI :NT ANI) O W Milt SII IP C1.iRTt FICA'ni-1N IOR M Owner/Buyer._►►`�ce�_.S•e(yQ/At� Mailing Adrh-ess.. Property Address 2 . (Verilicatiou ruquired From Planting 8•- "zoning Dopatt.nela fir new construction City/State_-_-- - - -------- — Parcel Iduntiftcation Number ®j Z--dl b7^7 7—Nrg LEGAL DESCRIP'I'ION Property l.t)eation36d .''/., , N'E--.''A t Subdivision , SCe. Z 6 , .r 3 / 2 N It JQ W, Town of SL9 ��/�� ✓ _. _._.-1 f l-1, i_ _/7 _----------- _ . __._.., Lot Certified Survey Map # 0_� by .. Slier house yes m Voluutc _., Page ot Lot liter identifiable is no SYSTEM MAINTENANCE AND OWNER CERTINCATION Improper use and inainuaance ol'your septic system could result in its pn-matme failure to handle wastes. Proper tuaintetauao consists of'pumpuip out tlm septic tank every three yclnx or sooner, ii needed, by a licensed pumper. What you put mto the system can sfloot the function of the septic tank as it trcaunent surge in the waste disposal system. Owner Maintenance responsibilities are specified in §Conn. 83.52(1) still at Cbaplei 12 Nt- cmix County Sauttary Ordinance The property owner agrees to submit to St. O'toix County Planning & Z,onmr, Department a certification foun, signed by the owner anti by a master plumber, joumeyrtan plumber, reshnaed plumber or a licensed pumper vedlynrg that (1) the on -site wastewater disposal system is in proper operating condition andilm (2) after inspection laid purgiurg (it necessary), the septic tank is less than 1 /3 fill of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sowage disposal system with the standards sg bath, herein, us act by the Dupurnironl of Connncux. and the Department W'Naluod Resonims, State of Wisconsin. Certification stating that your septic system has been inaintainod must he' complettul and rct tined to the tit. Croix County Planting & Zoning Department within 30 days o1'tlie throe year expini ion dale. Ywe certify that all satcounts mr dlis forth ate tnu: to la! hest of my/our litwwlcdge. I/we ati✓are ttm owtielfs) ol'Ihe property described above, by virtue of a warranty deed recorded in Register of Demis Office. Number of bedrooms Sl(iNATGRIs' DATE .. ***Any intimmalion $list is misrepicsontud unity result in fire sanitary permit being nwoked by the Planning & 71011ing Dcpuuru:m. '•* Include with this application a recoided warranty deed from tile. Register of Deeds C duce and a copy of the corlilied amvey nap if reference is nade in the wairanly deed. (PJ,V.08/05) FOR BIDDING ONLY NOT FOR CONSTRUCTION mrifI f6 u re+NYYAlax�r rae: � T. i x:r wiiii�i{iu�i%oruu d�'x yy yy — � wni n"we'"7iT3ii�i11Y �:'"iiY�i NIIA16 ICI gag ouln m a ow In i 0 FOR BIDDING ONLY E NOT FOR CON5TRUCTION s ------------ j --------------- Ll ----------------------------------- L��II I----------------- �mMb +�abe�mwu eem�i.�w ww� a y.nm erssi� a un uwn r� LOWERI EL PLAN 1/4'= I'-O WPOURED CONC FOUNDATION RI&101 m 12 o FOR BIDDING ONLY NOT FOR CONSTRUCTION W QC M1` -.P nv n6 1 1 WJ.G ' I ed a QL' owmv+W { Ose 6 ! .any , tZ --------------- ra' vmn a� Dm 1 FOR BIDDING ONLY NOT FOR CON5TRUCTION ROOF RAN lw—I wm.¢zwmsneo Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of .J Division of Safety and Buildings 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 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Personal information y you provide nta De used for seconPurpo� ses (Privacy Law. s. 15.04 (t) (m)). County n di Parcel I.D. / ot�t0 ?� 3 7- Rev' wed by Date \ �(t,( Oz Prope,qy)Owner - U E-9 V E P4,-/' e� h rope Location / Govt. of S 1I41YC 114 S •s " T N R a (or)(S Property er's Mailing Address u :„a ,, l;^ 9 5 GO � o. .90 x -7/ Lot # 3 Block # Subd. Name or CSM# ' i ne c 1r`tc{ City State Zip Code PhPne Number - , /-4 Pf0 wz K616 1 ( v �' s- ❑ y ❑ Village ® Town Nearest Road orh 6 2 s71- W New Construction Use: 0 Residential / Number of bedrooms _� Code derived design flow rate K, 6 O GPD ❑ Replacement ❑ Public or mefctal -Describe: ,Af � // Parent material ft I l� 2 �� e eCii F r P3, / 8 Flood Plain elevation if applicable R General comments EL, 9Y. /� S„ ��,'�.ir a,ea and recommendations: i Boring # ❑ Boring ® pit Ground surface elev. O /S-?fL Depth to limiting factor � � QL in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/112 •Eff#1 •Eff#2 I 6-/1 /0r/1 ;2 L 2m /r CW Z rn 0.5 0,7 2 /l-11 7.sr< �Ve IVA SL ^s-,dk r, z�- O.S O, 7 3/- 74 7.siR S/a 4 QaZ l • ,,plL ge,13/ 3 yo.U�3 &° k� Z ZBoring # ❑ Boring 0 Pit Ground surface elev. 160.9 3 ft. Depth to limiting factor 74s in. Sal Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz. Cont. Color Texture Structure c- Sz. Sh. Consistence Boundary Roots GPD/ftz 'Eff#1 I •Eff#2 I o-/o OiRi �� 2Ms O ,S a,9 z io /Y OrR s s-t O, s 09 3 !9 37, 7•SYR i S w rn&,42 S O I s D• 9 2-95- 7,5 1'f Mf s irm4- 0 7 1.2 S.O/ 9 . 3s4 t. q1•r` 77 1� ' Effluent #1 = BODS > 30 < 220 mg/L and T55 >30 < 150 mg/L ' Emuenl #2 = BOD, < 30 ❑ g/L and T55 < 3C mgA. CST N e (Please Print Sture CST Number a#Aell U2 C.�LGC 23Q3 K Address Date Evaluation Conducted Telephone Number 3 i-* - 1y Z { - Zo_ o z 71 r- z r/7-3203 M JBu-835U (KU//W) LOa'3 � Property Owner EI.1c'cl"I �4%fin <�Jb.r Parcel ID# Boring # ❑Boring ? 3 ® pit ' Ground surface-�Z ace elev. ft. Depth to limiting factor % 9 6 in. Page _2 of 3 Rnil Annl� irate Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDRP 'EfHi1 'Ef#i2 o o/i NA L naf, CI, 2n O,S 0, 9 y- zr /Orx i AIA s L 2"5"k M'f' G 41 21 O s O. 9 3 Lt 33 ?,sYR /-x A14 L/ 3- ?6 7, 6/� N4- 1(4- 0,7 1,2 — 75? NA yu"o;.J 1�s44- ntr f. U 7 1, Z sa ,Vr 48i3 STsG 7n.i _ r r. w."tfc- t--c ❑ Boring # ❑ Boring 7 or o 7 ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Appliption Rate Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDlft' •Eff#1 'Eff#2 ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Anol� ication Rate I Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD1W 'Eff#1 -Eff#2 Effluent #1 = BODS > 30 < 220 rrg1L and TSS >30 < 150 mgtL ' Effluent #2 = BODS < 30 mglL and TSS < 30 nVL The 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 30(R.07M) Property Owner 1'1BG/" ParoelID# Page _? of Boring # ❑ Boring ... _ ® Pit Ground'surface elev. ®.2• ft. Depth to limiting factor >' q 6 in. Sal Application Rate Horizon Depth in. - Dominant Color Munsell Redox Description Qu. Sz. ConL Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/W 'Eff#1 •Ett#2 o- o/i N/4 L 2rlg,r rut/ Crr 2++ 0,S p 0. / 9- 2 r( /0Y' % IVA rH xi", e d f G at. Z,• Of S ©. 9 3 V-3 7,5-9 % kA .S /nsi/r m 4-1 1, 0.7 i.;Z Y 3- Y6 7, rY o s y r, I — 14- 10,7 1,2 yVimv 1�h54z. rites, 0 7 % • Z �1 S i r1r. W. ng �in6 To/07 pit Ground surface elev, it Depth to limiting factor in. Sal Application Rate Horizon Depth Z�-'n. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture - Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ftz 'Eff#1 'Eff#2 I e- j i ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting (actor in. Sal Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft' 'Eff#1 'Eff#2 Effluent #1 = BOD,> 30 < 220 mg/L and TSS >30 < 150 mg/L If Effluent #2 = ROD, < 30 mg/L and TSS < 30 mg/L The 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 = 608-264-8777. SRD X W tx.anmxr7 OVYx, ?, 1V:1ri12 r/r'nC Address ZQ 8cw 72/ enchtnark 1 Tc e 6-p Yflo -,,&- S3�6,fe Az, /M 0 A enclunark 2 TOR Soil Boring 1_ _ Suitable Area 1" = 40' Scale Page 3 of 3 Brian Parnell CST 231314 Date 6-20-oZ- .T-._i--__Y.__ i gm2{ 1 1 1 I i sr —rT---T�-T—' NI l I I ��_ 1��� II : ' T I l jI j I 1 I , 1 I _T�-.'y- T�T1�,�•� I-�- I -I"- --t----�----- I I IT i I i I I I 1 i I I �--•- -•- .�--t_-�--�--I _�� �y