Loading...
HomeMy WebLinkAbout042-1087-70-112 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] Tainter INFORMATION TYPE MANUFACTURER CAPACITY Septic OaC,r Dosing Aeration Holding TANK SETBACK INFORMATION PUMPISIPHON INFORMATION Manufacturer Demand GPM Model Num r TDH Lift Fripil6rt Loss System Head TD Ft Force main eIt th Dia. Dist. to Wen SOIL ABSORPTION SYSTEM TOWN OF WARREN ELEVATION DATA St. Croix x9imit No: i ID No: x No: 042-1087-70-112 owrdRange/Map No: 31.29.18.486E-05 STATION BS HI FS ELEV. Benchmark .SO 9r. �•00 AIL BM g. ewer St/HI Inlet StlHt Outlet Dt Inlet Ot Bottom Header/Man. Dist. Pipe Bat. System .2D &0 O / Final Grade -t 3.10 I ! L St Cover t2..ls D.Zp / A �� swI r. �— irX=rj 3r�ZAF%-1 rtRENC Width L gth / No. Of Trenches PIT DIMENSIONS No. f Pits Inside Dla. Liquid Depth DIM S t "f� r 21 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Mangfecayer INFORMATION CHAMBER OR —L1i1'h Type Of System: i4fDI 1ZL / -, i�301 �_'� UNR Model ber G DISTRIBUTION SYSTEM SOIL COVER Hod rlManifoltl '� tl LengM Dia Distnbution Pipes) Length Dia Spacing x Hole Size x Hole Spacing vent to Air Intake I 7 t �b x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/Sodded Mulched Bedrtrench Center Bedrrrench Edges Topsoil 0 VeYea,xx Q No A Yes � No COMMENTSG Include coplds iscre a es, persons resckntLetc. In' LCdigln.. CTY�RD' rN�Q ` "� •� `` - 5;�0 ^f°'rI c 's4s r 1.) Alt BM Description = (�r'IA-) 2.) Bldg sewer length = \ A14i - amount of cover = > v _ /I• 3)0� Irmian e-ej -%-e Q Plan revision Required? 0 Yes No Use other side for additional information. SBD-6710 (R.3I97) Da InsepCtoYs Signature Cart. No. Ea 2. 0< II r o D �"' '� 5111-aoX-1414 ' Industry Se ices Divisiop 14MEW hingionAve County 5T. CR01Y °s J U N 01 20 0 P.O. Box 716 Sanitary Permit Number (Ea be filled in by Co.) In ' 8 - MadimnrW1537 62 St. Croix Couf ty Ttatsacdoa Nt ber rl plicarion In accordance with SPS 383.21(2), Wm. Adm. Code, submission of this form to the appropriate govorucental tmi[ �� is required prior to obtaining a sanitary permit. No.. Application forms for swte-oumed POWTS are submatetlto Project ¢ddress (if different than mailing address) the Department of Safety and Pmfrsaiomal Sonic¢ Pvsoual information you provide may be used for a¢ondary u oses in accordance with the Privacyisw, s. 15.04(1 Hm Stars (/Jl(,{1 �� T. Application Information- Please Print All Information Property Oumer's Name E pared STEPNEN i miar .E 7'AtN7ER OW -1087-70-!la Property Owner's Mailing Address Property Location 909 (O. Rd. N - Govt. Lot Sw k $ W 31 h Scoion City, State Zip Code Phone Number AVASOM• 141 54016 7/5-497.3097 T N; R_l�em.) 11. Type of Building (check all that apply) Lot a a Zwsd I or 2 Family Dwelling Number ofBedrmars 3 pjsita. amt. i�imn Hooter J S Black ❑ PubHe/Commereial—Describe Use ❑ a, ❑State Owned —Describe We ❑Vdiarc of SM Number a .37SS ®Town of WARRFN M. Type of Permit: (Check oniv one box on line A. Complete tine B if appHnxb e) A ❑ New System Kftepiacement System ❑Treatmeu6Tloldiug Tank Replacement Only ❑Other Modification to Existing System(explain) a. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Pemrit Transfer to Neu Lin Previous Permit Number and Date Issued Before Expiration ouner U (23 Of IV. Type ofPOWI'S temlCom onendllevlce: Check a0 that apply) Non-Pstssuriad In -Ground ❑ Pressxmzed In -Ground ❑ At -Grade ❑ Mound> 24 ire of suitable sal ❑ Mound <24 in of suitable snit ❑ Holding Tank ❑ Other Disposal Component explain) ❑ Pr"Mj,t Dcvic ( ain V. Dis 1/Treatment Area Information: fmct Iyaign Flow (gpd) Design Sal Application RatKP-pdsfJ Disposal Area Required (sf) Disposal Area Proposed (st) System Eleval filSO q00 I 9P9..7 is.b 88.0 VI. Tank Info Capacity in Total 4 of Manu liver Gallons Crallons Utti ty�Ql a 'a o y New Tanks 6 dnung Tarts 1 u z aU rem y iV � Septic or Belding Tank 1000 1000 t W/GSER LONG. 7C Dosing Clamber VII. Responsibility Statement- I, the undersigned, assame rest o tsibili • for installation of the POWTS showa on the attached plans. Plumber's Name (Print) Plumber m MP&HW Number Number Phone Number Dp io#v >-E[KE -3 7/S 67]-,`�L6 Plumber's Address (Street, City, State Tip Cude) /V 6?98 r. WI 3-1136 VTTI. Coo rtmet t Use Unly YjApp.,,ed ❑ Disa nerd Permit Fee $ �o Date Issual 1 - g Agent Sign ❑ for Donal p IL tI IE Conditions afApprovaUReasms forI)isapprovai 3` /tQ2-al, o• GPo R-Z% . ) t' r f TEM OWNERS a f�rlt'cdtt�n w �t ptic tank, effluent filter and d spersal cell must 1tE rViced / maintaingd �, P� t,H Prpu f�f M to v�ArtC¢ t'�✓�^�^ aA per management plan provided by plumber. - t9brtevr. "'%l1aMYd mtlprtnPpfdrls for the s)xre 5 Tr0m Coa`h only It, 46 as per applicable code/ordinances. tl/�t-�_ SBD-6398 (IL 08/14)Lr �} "�"( a'Q"� 1L� 06 &,-,e etaxtls I / O OS rI STOWN ? MICHELLE' TAINTER SW- SW. 31, a29rd. I8w T of WARREN , 5T Mix L.. - q6q La, RJ. Ai Srr79 — C o. Rd.�l�% PLOr PLAN 11 = yp' l r ❑=PITS ,'A.L ACRE Lel —3 ALL SPS 383.H3 SMSACxS MET E) rY I lvr Ix� 14 — - -- - - P/L * R/w - —1• ' � GRAVEL ajar DAIVEWgy �.JQW • . i'awr MPrts 4 NoVSE LAWN 0 3 IQb 15M. T•Pof'/Oo,O 2 MaNN•�g CafA v � w I;P,Ass o , r-Iao ' F Is+;a, wlfsaA « r 1000 BASIrf9_IITEgI 88.Gc88.o I DIVERTS r °O AtiawE a... .� 4 l` •\ I:SE /'/ffLT.Lat'a< Qurct �/ �Nr/.+AE�i ��a xJY•57� Oq(ii 61V14,+6a.1 IFACNlN) t 'a"m4e. fY au.oi7': 900.0 Fra M/J. A,Ep. n y.S•C i .S= Sao fri %09.$ frL (�) FIxD TIGHT ca45 GF =91.b SAo OArxFx,. >KPP. Ilk. i i 4r N"PIDf EA B.fk;. $q.or NAIL IN WORD Prr" POST t(8'AB°wE I &KA I I fL F , lonrc .3 3' ew re It-- Ir-1"PVC 5 PLAN ,i W eNo Sipj4 80.6 SB,o Mtm Tas+all DeaTH 3.6' below GMDF S.eL s—E� t-- 3 —1— 3 -1- 3' —1 Ci 055 SECTION <N°scmii 214 PLOT PLAN 5TOWN ?MIC19FLLF TAINTER-g6gco. PJ.At !"= Y0, SW. -5W. is, a9N, 18w �N q0 I T. of WARREN 5T Mix La. yo9 ❑=PITS , 3.6 ACRE LOT �-- C 0: RJ-rN II •—! ALL 5PS -AS3.Nj SETb1CK6 MET IAZ FT P,i * Alw _ PV. 6RAyEC � NAIVE WAY ®E LL � 3-Bbrfi � NoUSF s i Q LAWN o° Pj.M. ToP OF - /Oo,e MANXe�( CovpR J j 4! 6A5uv FILTE J Div ATER VALVE )00*401 Iz F II fI 4 d1E �A/flLfii/YDA. 4ura,cY z9,4,f44As%7,a.Ti'5.'� g7ii LNri,Nel.s�raft.,cN�.Y��gA,.gnSr?e.efrs 900.0/r a�.3 rr II 7' E.JI GAASV 1.3 93 0 /r/,J, • -*Q. = YSOr .S> yaoFri 909.1,0Y roris. (i.) Hx() TIGHT CAPS VirNT eAps(i.) C.0 =91.6 sAo i ILL >n•Ma sA:4o �� ✓ N"NDE I S.eC S.FL 3' --I CK05S 5EGTION (Nogcit) Mnx TAs+FII upTH 3.6' Below GmDu I I 3 % ❑�&8 GIlA95 r-ItLo I,S. EC. -I 88.G/ 88.e (5.M. d a9.01 NAIL In NDDO FCNCi POST �IE�AEOVF 1 �RAOF) I i 1 �p4F fp 96 --i 3' O a r T PiPFs i 3' . PoP8 Ca 0 4"PVC 3034 PLAN VIEW (NO66" Page I of 7 Private Onsite Wastewater Treatment System Index and Title Page Project Name: STEPile-N g mirmcieE TAiNtfR- 38drm Sn-erorne) Powrs(Repl><a.vnt-) Owner's Name: Owner's Address: 90 9 C o. Rd /V Hvww, tell , 54016 Legal Description: 5w, 5W, 31If ;L9 1v.1 18.v Municipality: Town, 'p'tila, City of WARREN County: 51' GROIX Lot Number. $ Block Number: CSM Number: 37SS Subdivision Name: Parcel I.D. Number: 0H2- /087 - 70 - /t."l Page I Index and Title Page Page 2 Plot Plan with Cross -Section & Plan View Page 3 Filter Basin Information Page 4 Diverter Valve Information Page 5 Filter Information Page 6 POWTS Owner's Manual & Management Plan Page 7 POWTS Owner's Manual & Management Plan Name of Designer: TOtkN PaME License #: MP- a313H6 Signature: 244 I-Q'Ie Date: 5'I20I2020 SBD-10705-P (N.01/01, R.10/12) "In -ground Soil Absorption Component Manual" Version 2.0 Attachment: Soil Evaluation Report 18-inch External Effluent Filter Basin Applications The 18-inch (450-mm) External Effluent Filter Basin prairies an ideal solution for retrofitting Mating residential septic systems. External Filter Basins eliminate the need to make costly, and often hazardous, modifica- tions to existing septic tanks with reshictive access openings or to unus- able outlet baffles or tees. Grade ring insert - - ,y}Y Handle assembly Vault — -- --- -- _...<- BiWube 9tte cartridge,,,���. -•—. Materials of Construction: Filter Eason: abed PVC Pipe Filter Basin Base: Fiberglass Reinforced Polyester Biotube Enclosure: PVC General Exterrral Effluent Filter Basins are composed of an 18•inch (450-mm) diameter section of ribbed PVC pipe with a fiberglass base, and an 8-inch (200-mm) diameter Biotube® Effluent Finer (U.S. Patents No. 4439323 and 5492635). Orenco Bfotube Effluent Filters are used to improve the quality of effluent exiting a septic tank. The Bionrbe cartridge has an extenftle handle for easy removal. The FT81824 is designed to connect to 4-inch (100-mm) diameter schedule 40 PVC pipe, using a 4-inch (100-mm) diameter grom- met on the inlet side, and a 4-inch (100-mm) diameter Schedule 40 PVC fitting that is solvent -welded to the abed pipe for the discharge side. Call Oren for a custom configuration when connecting the External Effluent Filter Basin to a 4-inch (100-mm) diameter 3034 type pipe. An 18-inch (450-mm) diameter grade ring is supplied, but the riser and a fiberglass lid should be ordered separately to bring the basin Ip to grade. Standard Models RE11824-0812 Product Code Diagram FT818 24 0812 TFRWr WnWO WOW 12 = 12 Miss (300 m ) tFRar damler 08 = 8 inCws 1200-mm) ( Basnheghl: 24 = 24 inches (BW-run) Basin dwreler: 18= IeuMrs(450-mm) Biotube CarVidge: Polypropylene and Polyefl)4ene I &tube' AM mler basin ftt be Handle Components: Sch. 40 PVC, starless SW Inlet Groniel FPDM Rubber Discharge Fining: PVC Specifications Biotube Mesh Openings: Nominal 1(8-inch (3-mm) diameter, nominal 30%open area Orenco Systems* Inc. , 814 Airway Ave., Setherllx, OR 97479 USA • NO-349.M v 541-09-JA49 • www-orenco.com nrO+TB-F'rF1 Real *Mn7 Pena 1 of 1 DIVERTER AND BACKWATER VALVES A 41 o.r 7 Here's the simplest, strongest, and most economical diverter valve ever invented for septic tank leach fields. It is made of tough molded plastic that will not shatter, bend, rust or corrode. It is lighter in weight, easier to handle and less expensive to ship. ract6eYsua3rzs The diverter valve stem flow may be controlled to individual or multiple fields (up to three) in any combination. With a three-way valve stem, flow may be diverted to any two outlets. To allow flow through all outlets, the valve stem may be removed from the assembly. Conned 4" plastic sewer and drain pipe to inlets and outlets on the four way distribution box. (Unwanted outlets may be sealed by installing caps). The Diverter shield whi& houses the diverter stem may be cut to desired length. 4.125' O pkg. Wt. Ea. product port w. it"m tien Color MY.. (la.) am 575P 4- PVC Diverter Valve White 4 9.50 35Py ... 575 4" ABS Diverter valve Blade 4 7.50 35AB close) 1 2 3 0 0� 0 TANK TANK TANK 4 5 6 TURN TO 'IAPMO listed 00 00 ss oa na TANK TANK REMOVE sausmii TANK x The NDS gravity flow Backwater Valve is designed to protect low areas or basements from the backflow of waste from street sewers. It is available in 2", 3", 4" and 6" sizes PVC material. 8 is a cost effective and a chemically resistant alternative to cast iron valves. The quick action flapper allows unrestricted uni-directional flow. Elastomeric gasket in the flapper ensures a watertight seal. Flapper can be easily removed and replaced if required. Threaded access cap is designed for hand tightening. Access cap neoprene gasket provides a positive seal. Valve hub outlets fit 2", 3", 4", or 6" DWV pipe and may be adapted to 2", 3", 4", or 6" sewer and drain pipe with NDS DWV to Sewer & Drain Adapters. Lightweight, easy to install. Horizontal installation required, with arrows on top of the valve hub pointing in the direction of the flow of water. Access riser with cover offers a simple, economical assess to the valve for inspection and maintenance. The riser may be cut to the desired length. A C Item Number A B C Riser Height Riser Die. 275P, 275 2AS 5.03 3.53 16 4 275PR 218 5.03 3.53 16 4 375P, 375 3.51 756 6.10 16 6 375PR, 375R 3.51 7.56 6.10 16 6 475P, 475 4.47 11.18 7.18 16 8 475PR, 475R 4.47 11.18 7.18 16 8 675P.675 5.50 15.25 9.90 16 10 IE�4 Y Ir Approvals applicable W valve oMy. B v No - All dimauions are nam"wl. AA weight, are 6 snipping purposes only. AwJoloil4y it wbiwi b clw ge. .. _ For customer service, ptaose send your fox to: 1400-726.1998 or call 1-800-726-1994. -- 8-in. to 15-in. Dia, Bin -tube Effluent Filters A ica ns Orenco® B-mch to 15-" Batube Effluent Filters are designed to remove solids from effluent leaving ranmercal septic tanks They can be used in new and existing tanks - General Grano® 9-inch to 15-inch Biotube° Effluent Rlters' are used to improve the quality of effluent exiting a commercial septic tardc TheBfotube cartridge fits snugly in the vault and is removable for maintenance, the handle assembly snaps into the notches in the tup of the vault, and the tee handle can he extended for easy removal of the cartridge. A "base inlet" model (see p. 2) is available for low-lxoh7e tardis. M optional sidle rail system• available (in larger models, simplifies installation and provides tank access for servidng. Cutaway mew - - Side view 0,a -F tW Ffgj FA* wmW w,L,-.0ts US a d#bru9>,ed Pwb 1 1 717 FTBB54-3X171`1254�,FT1554-86,FT082P141%17171254-21W Product Code Diagrams t a� -� P �lriLf.Y.a` P evras.waa: a = %9tN.meae resuv�r,e(yov x. s+eirn w. wosza �s = arnas.ma rib rmeeLYp®L 12 pRlq n= npq tsa ism 9vitlCeplbt Bhu = v4i:paaste TA P � OManEsn9eb �mh i �'NaaeKFib t:.samsrY zmazelaSPmam :B:nit3nadha"vgbe9ld Desi gi0.tiBxnl sa--s,nuNmPod;q:. MLaa mi.niyc-Iwowq w�tinssea�b ru ar, ra. nixo-asa®o BaltbT agamgbr8laTinzevRtsSZHSenp •Fa 12 mI1z�Gfi"hmFaSMn%P'<�rd 0.`P� �aprsa�krrabllb blFirGW �r(� a-geeT❑ +` taexmmmuFaav�ar+�o�:u t3ak . wa¢¢¢seab A = Aew8A6oh6FY0 tarPavlmv ontyFtgracl� u = ta[a9nama Fnceegkabv# , 2a EaedK2�k P6= BRve n � npeb BSY = tMa4;eml�� Materials of Construction Vault PUG Pipe cwOM PVC Handle callpolents PVC sjw WIp" ana Maclaet PVC BMWs Cartidge Pdyprapylere MW llelytlhylene xdrsguan+ou�w+y aa>•va'zrmar¢rae sa;�a✓e a, rz-bmane rsaer emus wF Now SyShMSP Inc., ON Airway Are., Sldharfin, OR 97479 USA - 899-348-9M - 541-059-WS • 1vmw.aranm.egm Stg- 7 2 Rev. ZA ® W7 Pipe 1 of 2 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) 909 Cty Rd N located at: _SW_'/a, _SW_'/a, Section _31_, Town_29_N, Range_18_W, Town of Warren , 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 _5/7/2020 Did flow back occur from absorption system? Yes No_x_ (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 1000 Construction: Prefab Concrete _x_ Steel Other Manufacturer (if known): _Wieser Age of Tank (if known): Permit number (if known) 74968 (Licensed Plumber Signature) (Title) (Date) v � (Print Name) -+ _ (License Number) MP/MPRS Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 Page ri of 7 POWTS OWNER'S MANUAL AND MANAGEMENT PLAN FILE INFORMATION Owner SrF f-P11641 ewlL7 Permit 1i DESIGN PARAMETERS Number of Bedrooms (100 gpdtedroom) 3 Number of Commercial Units — Estimated flow (average) ,bp 1/der Design flow (DWF) = estimated x 1.5 f/S0gal/day Soil Application Rate gal/dayle Influmt/Effluent Quality (O NA) Monthly Average Fats. Oil & Grease (FOG) 530mg0L Biochemical Oxygen Demand (BODs) 5220 mg/L Total Suspended Solids (TSS) < 150 mg/L Pretreated Effluent Quality (Z NA) Monthly Average Biochemical Oxygen Demand (BODs) :530 mg/L, Total Suspended Solids (TSS) Fecal COlifmrm (geometric mean) S 30 mg/L 510 cfu/IOOmL Maximum Effluent Particle Size 118 inch diameter SYSTEM SPECIFICATIONS Septic Tank Capacity 1460 Rai O N Septic Tank Manufacturer Wld'sFt O N Effluent Filter Manufacturer 0A&wK40 ❑ N Effluent Filter Model ,9 Jr# #J2 - IfIA ONA Pump Tank Capacity DNA Pump Tank Manufacturer DNA Pump Manufacturer O N Pump Model DNA Pretreatment Unit (51 NA) O Sand/Gravel Filar • Mechanical Aeration O Disinfection Manufacturer. O PeatFilar O Wetland O Other. Model: Soil Absorption Component (Cl NA) I ® In-ground(gravity) O In-ground(press trized) O At -grade O Mound O Drip -line O Other: i Vertical Distance TankBottom to Service Pad: Horizontal Distance T s to Service Pad: /Od R Dispersal Unit MfgJModel Number: �w/fK rA 0 rdA 12WAX 4l 9N404F4Ea S ❑ NA Cakulatioas: Soil Dispersal End Cap (Dispersal Unit EISA) DWF - Application Rate Area Required - EISA - or(TrenchWidth) - #Units or Tow LengthofTrench(s) e" 7oZ< <F O "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publication 9.6 O "[CC Flowtech Mound Component Manual" Version 1.2 O "EZ Flow Mound Component Manual" Version 820P_007 13 SBD- 10854-P (R.1/12) "At -Grade Component Manual Using Pressure Distribution" Version 2.0 19 SBD-10705-P (N.01/01)"In Ground Soil Absorption Component Manual" Version 2.0 O SBD - 10691-P (N.01/01) "Mound Component Manual" Version 2.0 O SBD - 10657-P (R_6199) "Drip -line Effluent Disposal Component Manual" O SBD - 10706-P (N.01 /01) "Pressure Distribution Component Manual" Version 2.0 MAINTENANCE MONITORING SCHEDULE - MAINTF.NANVF ANn MANAr-FMRNT Sertice Event Service F ueoc Pum t rsal cell(s), clean fitter At least once : ® 13 onths ®3 ears O Other. I & p controls, alarm, pretreatment uunitAt least once 3 mmouths 113 ears B NA Flush and pressure test laterals I At least once every: Cl months O 3 years ® NA START UP AND OPERATION: For new construction., prior to using the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). if high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall notoceur when soil conditions are frozen at the infiltrative surface. The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality or the wastewater stream will affect the performance and longevity of your POWTS. The installation of water -saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste. showers, dishwater, etc. This system is designed to handle domestic strength wastewater; however, the disposal of food based greases, oils, vegetable/fruit peels, seeds. bones, and food solids, such as those produced by a garbage disposal should be minimized. Toilet tissuc is the only paper that should be discharged into the system. Other non -biodegradable items, such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs, should not enter the system. Chemicals, such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system b*mm they can seriously damage your POWTS and contaminate your waters Page 7 of drinking supply. Maintain a regular steady Flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all systmn components. Compaction ofsnow over the dispersal unit may cause it to fi=ze up. INSPECTIONS & MAINTENANCE: Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer. POWTS Maintainer, or SeptRge Servicing Operator (per the attached Maintenance Schedule). Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and check for any backup or ponding of effluent to the ground surface and test all electrical equipment such as pumps and alarms_ Any defects shall be promptly corrected. Exposed o penings greater than g inches in diameter shall he secured with effective locking devices to prevent accidental or unauthorized entry the tanks. When the combination of sludge and scum in any tank exceeds one-third (1 /3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Ch_ NR 113. Wisconsin Admin. Code. Specific servicing mechanics must be provided if vertical is>15 feet or ifhorizomal is>150 feet and instructions to be provided below. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Solids washed from the filter shall be retained in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service p OWTS There is normally a I day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. ABANDONMENT: When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch_ SPS 393.33, Wisconsin Admin. 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 properly disposed of by a Septage Servicing Operator. • After pumping., all tanks and piss shall be excavated and removed or their covers removed and the void space filled with soil, gravel, or other inert solid material. CONTINGENCY PLAN: If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: Or A suicablc replacement area has Wen evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks firm existing and proposed structure, lot lines and wells. Failure to protect the replacement area renders it unusable. Replacement systems must comply with the rules in effect at the time of replacement. O A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. 0 The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed 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. a Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions ofsuch systems must comply with the rules in effectat that time. \YARNING!!!! SEPTIC, PUMP, A_XD OTHER TREATMENT LANKS N14Y CONMAN LETHAL GASSES AND/OR INSUFFICIE-NT OXYGEN. DO NOT ENTER A SEPTIC, PUMP, OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OFA PERSON FROM THEI.NTERIIOR OFATANK MAYBEDIFnCULT OR IMPOSSIBLE. ADDITIONAL COMMENTS RE/L/GfML.aT ,7YtYly i0 ,{E_�,Jsrtr[r.GO .✓�f/L>7.t /ASjj " .//YE.erC4 U,/Lflf POWTS INSTALLER POWTS MAINTAINER Name: faHN_111XiK,f Al/- T3/3Y4 Name: ELK! 64 / i Phone: 7Y.S I Phone: j/s L77- 1 e SEPTACE SERVICING OPERATOR (Pumper) 7 LOCAL REGULATORY AUTHORITY Name- Name: /6,t[[ 4e. 24.rnd4 1 Phone: I Phone: ;9S .773- 31121 Wisconsin Department of Safety and Professional Services Division of Industry Services SOIL EVALUATION REPORT Page/of 3 Attach Om'PWe site plan on paper not less than 8 12 x 11 incites in sas. Plan rtws[ County T ��d/X include, but not limited to: vertical and horizontal referencepaint (BM), direction and Parcel I.D. percent slope, scale or dimensions, north aravv, and location and distance to nearest road. O ya _ 4 g 7-74 Please Print all information. Reviewed by Date Personal infmmstion You pmvide may be used for secondary proposes (Pdvacy LaW, S. 15.04 (1) (m)). Properly Owner Property Location ! J TE/N!d f/'y/[Wi-tiC r41,jTlrt Gout Lot S4/ 114 S&1k S ,3/ T W7 N R /8 !(4w Property Owner's Mailing Address Lot# Block# Subd. name or CSWW J755- 90 9 Le. Fe. N 8 I Gry Stage Zip p Code Phone Numb 9a Tavn Neareat Road /-acres I41I SYo/L I (%/S ) 1/97- aF7 4,44,exEN o � 1 '74 le. A. ❑ New Construction Use1Z Residential / Number of bedrooms 3 Code derived design Sow rate +Y Fd GpD ® Replacement Public or commercial - Describe: Geyer material Flood Plain elevation if applicable ^14 It. cormmerds and recommendations:IAA&da r+.ue //� awry .J (,/�� /e 7e SGe/E/ O/41 [Ae 1S f/F[e i�FG O.+d�'JO 1-YOr r4 F✓CrYrS - � � 4YJE4 UOYL/ L,xa r4cJG/r1 CENT 98.0� OJ Q/.a, rl GLeJF re <lea+/14A.Aw Boringr Boring # Q f • I pt, Ground surface elw 9/ L 1. na.ar, i- li—ifi,.., r.,..... on u. Solt Applicallon Rate Horizon Depth in- Dominant Color l unsei Redox Description Qu- Sz. Cont. Cam Texture Structure & Cr. Sz. Sh. Consistenoe Boundary Roots GpD11F 'EfF#1 -Eft12 / O 47 /orc t - ,re / ar , c -4 /.d .? .?-.7 or4 3/C — Sri n e 8 - `/ Le -go er4 Y/3 _ Nrnr s - �I Baring # ❑ Boning r i - Q Pit Ground surface alev. 89L ft. Depth tolimiting factor > a in. SON Apollicabon Rate . Horizon Drh in. Dominant Color Monad Radox Description pu. Sz. Cont Color Texture Stucture Gr. Sz/ Sh. Consistence Boundary Roots GPDlfF 'Ef1#1 'EWW .frl H 1Plk LS bf Za .3 Jax& Y/9 - S/ I Yi / i Sfk Gs Y .7 YJ- o /errs S/S/ — e/lee/ .11 re p S — . S . a / f1 / R 3.1 A/ C11OWnL f1= ovv, � JU a(U mglL ena 1 S >Ju n I mgrl-Clrivem SZ-ow JV mat... wo a.wn ' CST Nams (Please Print) Michael J. Hassett aigrwun // a ' / . C9T mLxrkw Address Eau Claire, WI 54701 Date E11dIuellon Conducted Telephone Number (H) 715-834-8610 (C) 715-577-4383 S-/S 1no Property Owner Sri- E I A/.+ r-'A Parcel ID # u swing soft ® pit Ground surface elm. 88.8 ft. Depth to gmiting rector >4 In. Page d of 3 Sol]A..HrAmn Horizon Depth in. Dpminant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Dr. Sz. Sh. Consistence I Boundary I Rools GPDM `EMI 'Eff#2 O /1 /dra3/a - SI jw R'O cS j"O L /d ,t .19 /ora y/3 - S.! ,t P j k gwb cJ /d4' 6 .8 3 .19-YB /arc y/L - s S .r.'. as .7 1.4 Y Yt-st ara Y - s/ Fso rr A, S 58-76 /a rc S/Sr - s �a� S ron A, ❑ Boring # Boring Pit Ground surface elev. ft. Depth to limitng factor in. Sol Away— ica�n Re a Be" # Bong Pit Ground surface elmft Depth to limiting factor In. Sal APpllcefipn Refs Effluent #1=8DO5> 30< 220 mgrL and TSS>30<150 mg/L- Effluent #2=BDQs< 30 rrgft. and TSS`30 Ma& Tlx: Department of Commerce is an equal opportunity service provider and employer. If you necd assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. S1104IM a (A07A M rlwvi. rbliw PROJGCT MARE: 'ruwm i /LN6'LLE (,t/.r1f•C, PROJECT LOCATION- 54j�„StJ,s_..3/,_-- CST LICEMSe U •dtayp�Y-��i'1i�c/rp�� T. SIGNATURE: p p u n pp,y6,.dY X err ,LA 41sd N d ! D ,te! YA Z= Orrs/ 3.G 44Ar 4.r Atc Si3 383, 93 .5rrb/cd1 l rr 00'9$ fll pa y,15s'ft t$ �Dlldfl✓E/ 1 I l.L IpNA ! of inp�/Ia« cows �xrs rwc +dirsu � � 66 I �SrsrEn /rsrrlt.A/9fs) FF[ri /,C, 3er3 I 1 89.0 b/I.' ODD p,D�t w�Ayf P� �Apss a/u fl[dp 3 � e 1. (woos cnnm %PPM 7A.AC NAQ.'}!t! ANh µYtLUtNT V.p r"491"iP CMTRKAUDN KRM �r.�SN Tq/AlTE� _ "llawill Ad*M �p�gMt Y QeA N _ ► u"i IL" _-.`•a.rw wP+rw.►�.:�i+.�Mr�+wlio.rrw, •_._..____, ca' m liltQSOAi t- .°--4a[i lreof uua. N.�Yw_EfN•.YJ7.7W •qJ LAG l Or-SCRI TION PAT yLW&ta $L�..j��.lW[„j(_,*.11 NRIJLW.Too ef_j SN._._. yr rrr µ I bmArrYb w. Y Rlwttll MAdR01AM L.A.\C OM DLb [ *14tatic AlKIN (y.. b�r�W./Mrr)If1).�sJrfrrbYY�IYYr./Rt.Y�R. rI�. her a ...�r.w.rl/Y��w.r. q..rrwr!RY. �.w.�r /.rrh.Arrtp+Y Mrl+r+� jsE r qrY W.lYYl1YYIliY.IY, r�r rr r. r.rrrrlY rre r4..rsr� «r rr ih ■l.V.�r+i.rar[r ft 4.w t'wn /l�r• i�w+U7r�.rlr�a r�...w•Ar r .r W h • �� 1'W, rr*1�IIrYr. rlseryr.Aa..iM�rw+lr�rU.r �r tit..l!. iirri y� • rl..�r � rYrr rw fB�eYrrOY W rr�lsllw.rFt ♦raMr rY Y1.A � Mtge. rar�el Yr rr..iw. raMs� W rw. r rwr.�r rr rr.r ��rr r.rgY��4 D.rwrwYnrfY Wisconsin d� AinalServi Division of}SOIL R PORT Page of Attach cc plate sit@@ppI�rPOtWlaOtf�rl 99R n B 112 x 11 inches in s¢e. Plan must V _ include, b not Iimit� itvpm n al reference point (BM), direction and percent slo e, f& nsions, north arrow, and location and distance to nearest road. Please print all intiorMatlon. Personal information you provide maybe used for secondary purposes (Privaq I.M. s. 15.06 (1) (m)). County P� I.D. Re 'awed by , /, Date / 207� Property Owner S)7 EfNll "/0i/cNE[LF YA/r TF�c Property Location GovLLot _f4/ 1/4 ,f,4/114 S J/ T,79 N El R /B ; (ore Property Owner's Mailing Address 90 9 fa. Qo. N Lot# 8 Block# Subd. Name or CS%W �j 7J,i city State Zip Code Phone Number unsex 14)11 SYd/L (7/5' ) 1/?7-3d87 6=pty [3wftge LfiqTown ACASW Nearest Road rt N I '?d le. Ai IV Q New Construction Use(Z Residential / Number of bedrooms ®Replacement Public or commercial - Describe: Parent material ''. General comments and recommendations: /<IG/ke W4.4 //e rJr r OYJL< UO•r�I LrK< rM1CJL/LS C!/T 3 Code derived design Bow rate Flood Plain elevation if applicable /./A ,/ /e% .fce/6 d%.i c<4ss F/FLD 88eI OJ 9/.e, � f/5_0 GPD ft / `Z,_ . E Boring # Boring r ® Pit Ground surface elev. 9/. G B. Depth to limiting factor 90 _ in. Sol Application Rate Horizon Depth in. I Dominant Color Munsell Redox Description pu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD#P 'Effftl •Eff#2 or& J/C - Sr/ w silk e..5 3 dI-Co /ore 5-1,1 A4 QS - s I �i S 8a-8a oYe s/i e d /erM1 Boring # © Boring Pit Ground surface elev. 89.4C B. Depth to limiting factor > 86 in. Sal Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Du. Sz. Cont Color Texture I Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ff 'Eff#1 'Eff#2 /d Ye 312 — s /N 7a .? .+ es eT G .O d.7 /oY< Y/3 - dr / er -4 l k 4.s /N lP o° 3 72 3 1474 MY - s/ .10 c s - Y .7 Y3-8o /dYR TAI — d/Jd+a J - it mlyx 3 3 q/ vurucrn m i - w✓ + w �_ Lcv mgr� ano i a> >au � rou mgr� � - nuem eL = ova � .w n,yr� anu , _ nxy� CST Name (Please Print) Michael J. Hassett CST Number Address Eau Claire, WI 54701 Date EvAluil"O inducted Telephone Number (H) 715-834-8610 (C) 715-577-4383 S'/WElaao Property Owner SfEUE /A/ Parcel ID# Page d of 3 Boring 4 Boring G: ® pit Ground surface 88. 8 ft. Depth to limiting factor > U In. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redoz Pt Qu. Sz. Co t. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/fF 'Eff#1 'Eff#2 /c)w 34? SI M ? fo G5 .jut L /.0 /ara y/3 - S,l ,2 s 3 d 9- y8 /d»c y/4 Ard -Pr a s - .7 /. G y Yr-s8 arm /9 - s/ FSo rfP as - Al .7 S S8-71 /6r: 5-I9 - 6s s n��� ❑ Boring # Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil A pp8cation Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/W 'EfI#1 I 'Eff#2 ❑ Boring # 1H Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Cu. Sz. Cant. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/fF 'Eff#1 I `Eff#2 Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODr < 30 mg/L and TSS < 30 mg1L 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. BBD.8330Ta1(PIO/ 1 110JJFrr N a [ O ,7.' v. Q' '41r5. 3.4 .44Ar car ArL. 5/3 393. y3 Serb/c,rs ivrr MLvx rbna PROJECT NA]-JL: SrCA#rw f /y/cNsuc rA/./rf< PROJECT LOCATION,_ ,fa $rJ &?9N /84 CST LICENSE 1! SIGNATURE: DATE! 1031 s futo A/, 3 .,c3 J b''1 PAa rgl "p66r�r1 /,f AM 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 (Street ad located at: Sw 1/4, S W114, Section .3 1 , Town Za) N, Range 1 8' W, Town of IZ&7Y-re-v-\ , 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 Did flow back occur from absorption system? Yes_ No K (if no, skip next line.) Approximate volume or length of time: Tank Capacity: IDU-) Construction: Prefab Concrete k Steel Manufacturer (if known): -r Age of Tank (if known): Permit number (if known 1 1 (Li sea Plumber Signature) (Print Name) (Title) 12- ?-iD2D (Date) gallons Other minutes 23)3y� (License Numbe PRS Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012