HomeMy WebLinkAbout014-1071-70-002Saint Hi Green PRI SEWAGE SYSTEM
INSPECTION REPORT
GENERALIHFORMATKIN (ATTACH TO PERMR)
tv�YF•m� PriLaw. um Bmml
courts St Crol%
fi30310
F�pm
users Hear N'.
Roger Ludtke
cm ww TOWN OF FOREST
rareness, 014-1071-70-002
Pm0•
KnP
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33.3115 331E
TANK INFORMATION
ELEVATIOI DATA
TYPE
MM'BFFCTVNEF
STATION
SS
W
FS
ELEV
NCAFACI�
M pM
B11p Bern
WI w
SYHIIntel
9oTANK
SETBACK INFORMATION triii .F.MY,i
Si MIet
TANK TO
WELL
I SLOG
I PartIArin
gpAp
OdtrIH
rare,
GSNnn
�19
Hardest
Ae 1
RIre
Poland
%S
IOJe
20�
ZSe
E°1 sv.mm
POMPISIPHON INFORMATION
Phil
turned trader,
p n rcm
SOIL ABSORPTION SYSTEM
Caluilli
Plan
OISTKISO
harassers
1. Lure are
I Has, turns)
Vast
Length
1
400uim
bi
Bernardi
Ndhai Emu
COMMENTS: (Ini me discrepancies , Persan Pant ii InepMwn al Inspa'9an At
Leareum xMsrmY s, 1
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Plan rassKd required? >L, Y" �Nn Ito �'.�tbLWL. f1� /S OD�iGP
Printan
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riI
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NE'/.NW i3,T31WR15W
Forest ro nscouhy eP�W 3L CPm J
z
Legend' leD"
Scale IIIAO,
T
ExceP[whero in ivdicered
No DSPS 383
s back problems
L': - �v.•ra crow
32&m
{Ao use
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page 3 of l
REC VWED
OCT 12 2020
st Cron comely CONCRF,TE HOLDING TANK DESIGN (pOWTB)
Community Development Replacement
Index and Title Sheet
PR0JEOTNA11E LUDTKE
OWNER Roger Liplike
N11131 14&Sl
peyccvdle, 9!1 54725
LOCATION: Street Addles 282 1 H LN CINYood t'i WI
cl'1Tj IIER15W
Lc gel Descnptmn —ry,
TnwrahrdcountY roc=
CONTENTS, Angel tide page
Met holding ten speciricatmon
page 3
site Plan
page 4
commermrcc WO contingency Plan
page 5
lank details
DII 14,
'evGgN�a¢\�.IS,.. .
par
servicing contract
2
page 7
ag¢emcnt wlmwnship
pf
Ana'hmenu
`19`
//111111\\\\\`
Deslypere name and llcenac no: Lumha larebw #1872-007
Address. N2099 CLY. Rd Y
Menomonie, WI 54751
715/664-8184 ph
715/505-1629 cell
Plumber Sl®mt1Re: September I(io, 2020
Lus
iBnod submdted these Plans urWn my auWonry
midinglWrwmppmmtmomecl 0.10855-P(No3M,R01/12) page l of
rvial 1)
CONCRETE HOLDING TANK DESIGN (POWTS)
Replacement
Inds and Tithe Sheet
PROIECTNAME. LUDTKE
OWNER: Roger Ludtke
NI1131 140St
Boys wile, WI
LOCATION. Street Address
page I
page 5
m: Losettalarmbee 1
ssN2089 Cty. Rd Y
Menomonie, Wt
715/664-8184 ph.
715/505-1628 cell
Date September 16, 2020
n under my authority
sin (NO3ro1) Imp Iof7
HOLDING TANK SITE
W%.,SSS,T7IN/RISW
Foram
Form
St Cmix ix county
r
Legend:
`(9
Scale 1"-10'
��w
Except wtwc mdi=cd
No DSPS 383
DSHewomblems
a
3c&r
35V 4' iA
iP.k
u��� v
bry
1
pm]ect: LUDTEE pagc 3 otl
e' /
WADQ-MR
TANK SDECIFlCATIONS
DRFNwws
WO ; I/a'
BOTTOM Y TC r
CNER: B'
"HUE: 24' I.O. PRECPEI UNCRETE RISER
INGWIN' O.D.
worn: BO. O.a
e¢oN ,wn: Sr aD
INXIB IE�FL' w
(FLIT' 12.M0 16 SEPW
cowl 4xo IBE.
MFI m ojT T
r W T-A-SEY BOOT CR EEM L
aAWEt CIS-A-S B M EWAL
MEi W ajR T SARIF ONO MhR
MEMSMN. SEE MUG
(OTREF S A= M
IIWD CAPAIIW YBA OAL/:N
wmw O1:5W v w LNSAIWAIED SM
HU NO TON:
%= HaE PWOfD
ACIUN G 41W C MS
TANK CAN BE USED A4
BMW/ NDI➢IND/ PUMP OR 9%IDN
COHA: WX D5O1/J O BBEA)
TONN: MN OE9(N(N f6EA)
CI ZED iM
MR WSM I"S COMTACT wESER 4Yg2w
IilP£_bEN 11 FOR
SEPTIC or HOLDING TANK SERVICING CONTRACT
r n.e Dana
9 !� jp;1�J
Tire mmredle mace heNvem tle
Te1N1 fameNe) Nantals) and Pumpefa Name
A
LlLtJ
We navledpe Me melelabon of a) sephdlwbing bntsf Me Mhoneffiro pleperty
pmuide el deem IfP Y 533 TN 91 RtS Ico�-ip,
w�
u ad�u6 r..e.�mA fs�a.+Yn
_____________________________________________
1 Theawnvegrmblleetopy of lt,utmnM w,Ml6e leak gaveml,cnYl unn ($L CYola CauMy
mvin¢,urce byv«mfiM sepmgeswtnogapvamrr
PWmnggnZoning OA1XeT2
Igmrttl,n $P$lgl5$Ixc)2 Wig Adm Code aM tM appmvetl Cnngaunt Mamul.
India
3 The ormr aglen to Wve Mew.pncl,1dmg taBB)sermel by the urdereped pumper and guuvntmgo
gamut Me pnrmer in have seess and or room area Me progeny for Me pwp„e of servicing the
xq,tAoldiug ankle) The Omer egrtes I, managing nor access m d or dove so that Me purger can
mw kee wurcMc
mcM1lar6ges [inIw
amnyvlup,plmMenngLuT^Nheo
pmnm key at uncowmuellsentencingMrvOcR,ng Ole mrmfiaut�11Y aagreedagreed�d Wbna, M1Y Me
ownamdpug�
The Pumper attars b eubmM1 b Men local Bovanmen41=1($L Cm,x Comsy) a rtpnit fw Me S m ai of
Me olding lmk(a)memmMlybeus TTCpumper laMve®m bwJude Me follgwlW In Me
mon re
MonthlyBport
a. ersontcegoneible fm[m,emg Me sepneMNMngwM,
a. The name and alkaline
e, of Me m't:
h The urge of We ownaortIn
wonmoletng
c The lw,ily peri property In won III Be eryticlmldmg lank u,mWiW,
Mk(,fkoowo),
d. The swlery permit numbs lu,W for look
e The doges on Me wi serviced,
lmtwssrom
raftibuch
of Me, Me, eatfw«hsm,cag.
r The volume meal1,aems ong,
ml6erepuuMank
Pum,m
a onge the aglding
8. TFe dlSpovl ntura whicM1 tlw. conlmos fmmth<uPllcAloldmg bank were tleliveM
ltir agtcmcm wll tv®,nmeRxl mod tM owmmpun,permmlwe WswntracL In Js v+mlofe
eMnge,g this wvtsw, Me ovum agrees m fle a copy of my chmge[ b Mrs mee mohacl or s tqy afe
twm Me lark xo,.emntenul non mmM aMve wiMw tm (lo) bus,tess a.n fmm Me
dam OfM mMe, x..,w mnnael.
Ormer(e) Nmtns) lPntrt
anB(vE R 2 ,I U D A-
Qvsel55glwwq� , .e
•LOy_, I y //(^
s awam elN mwlnmmam MN aer
fb✓d_Cp/J.�, seV
202 c
.7K'e-
7 C< r'-..nLY�1 v-.
,
1 Tot Deb
^.
Pumper. Name (NM)
Pumpers SlpnaWm
N Pudb $proWle
t � ulll �3er�ks
�A- �G'ela—
..,+F?±�+ue''�•
b 712�
Pumpers Ryleha4wl Number are, -qe '= a^EeFa°Ila'
abco '� g• ,'__
St. Croix County
Holding Tank Agnwnmf
xum-1
1 Heil Ai
aD) L f1
amivenTw wn m.m...nurvnm��me......nuxuo-a�tl�wnmw�w+e
W rd� ximXel0.n. NY
�.in mu:u wiv 0m.m„Mti
..nw,d...wer.....,.m m..w.e.�u�na.�aw. �m w� nw.mw~pm.'m n:.
SEPTIC or HOLDING TANK SERVICING CONTRACT
Conbacl Dale
''��^^
9 %� pry %
Tu la wnlract lamade Calween me
Tank Dwner(s) Name s) tl�l Pu/�mmp�,et,,s.,Name
t� �� ))��
�Lti./ C.. frAW u-i. Z30nL/vr/.Y
We Ietlge Melt Wilahonaf alsepbclhddinglank(s)the fdlowngpmp Ry
(Romtle legal0esonaWn) CIEs 11W a ssy, T3) ei/4 i5 hJ a.re,% {o4m c)t P
and
mire aP 9 m�tv4 d/eewmA "'s rarvsln
-------------------------
I Tire owner agrees b file copy ofNie comntl with the land governmental nmt(6t Chou County
PWningn opemmras
spent
regmmd in 9P9 9g9 R[II(e)E Wis Adm. Code and tl¢ eppmved Component Manuel
SPS 38l52(l)Nem)bdodin CoeainunarmebyadComp Maetral
2 The owner agrees to have the sryvclholdmg trusts) sourced by the undemtgnd pumper and mannhesto
minor the pumper b have seems and to inner open thn forestry for me purpose of xmcmg Me
ngmemol TTe can
tpmammmpmeme
orner
serviceMe ssh chargldm With)with ice .The
th memberbe pay
ashchdo t The owner fwM1er agrms bony
g the smmping
pumps fresh charges inartetl in servicing the sepuclholNng w4(s) use mmually, agrted Donn by 1Fc
invented y t
owner and pumper
l The lumber agrees m submit o the local governmental unn(St Croo County) a repair for the servmmg of
the seloommoldmg fares) on a monthly basis The pmvpa further shows to include the milow^gm the
monthly then.
The name mdadawss of the person responsible for servicing the see belandmg and,
, TM1c name of me owner of the deptmNoldtng arks,
Thc Iowbon of the property on which the weneNaldmg airs is erea Icl,
d The sssnazy pemvt number issued for the boom holding; uses pfknows),
TFe erase ran which Me upvGFolding tank: was nerviced,
f The vol=c m gallons of me contents pumped man the sepoMmldmg tans for each swmmg,
g The disposal s,tea to wNch the contents from the sepuNwldnig inns were deliver ad
a TNs agcevceot will rcmam in egu.t wink the ownerorwmper teiwiaks Wsconnaa In the evem era
change mNc mike a wpyof changes ro to o: a copy ofa
5 the owner agove
armed, (10) bcomas
conked out the cocalgovemmenal unit mined aMvewthin ¢n (10)buavessdayx Gam the
contractn
anus
Of change to non service wnaant.
(h.merhm Name(s)(Print
J,
rs&gnalur e
Su acrlbetl antl auroM to me an that date.
Re&F ,IVDiiet'
QGriy G. K'�-
TodaYs Data
Pumpers Name term)
Pumpers SigneWre
asubhc Sigmture
Jwi� 3ereweks
;Esues,
,wo�i
1b zazC
Pumpers Registration Number wet ". p =, m ^Sion Expiration
�erzrda l C `a</C
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fhclkry I Serery uM Prvf iarel Sm cos if m e0atl oppprrumrysi pro% i and cmployec lfyaunml ns�Wna ro
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The Dept It emery wdpm(evlexxl Servmesm umeRmxl opportunity acre... pror,der.nd employer Iryounrmxviswam
euusurvmerornud muenel m xn xOvnnm 6rmet, vonmel IFe Jcprnmenl e� 60W3661151 or RY �FmugM1 Reley
w. o.a wsrme.e P,eeamas.m. SOIL EVALUATION REPORT v.tle 3-al
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TM1e rlep u18e1[ly mtl Pruloslunal ti[rvrtn is m equal apponwrry ssrmce pmntler wtl employer Ifyou need remittance to
rc'.en xrnme or n'M en¢ml in m eltemtle fromµ mntm the tl[pronmt et 6438-2663I3I or MIt Relq
Soil Evaluation Site Plan
BRIG:en _
Roger Ludtke
NE'/. NWri,S33TINB15 W
Foresttownstup
St Ctmx county
CST 24588 ` J
a `!'
ss :.
LEGEND
% -biis; cepits
No SPS 393 set b ,k
pmblems y'
Scale f'- I� o" ✓ �' ` rrn
b
ExC pt.vkere
indicated 4
N'Se
s*
-8� 18h
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