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HomeMy WebLinkAbout038-1046-10-000 (2)Si1111 Di OOa e:uene o..me •,` GENERAL I= PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) Co" ryrMmum St Croix 630344 PSOR To. No SO Ploal038-10i16-10.000 Iwrmmn.npw.rNO 71 318.197A2 PUMPISIPHON INFORIMTON PMawiqurer OxnM SON", 0 99. BO SOIL ABSORPTION SYSTEM 3 a G Immi rY^ OnT1a..,) SYSTEM TO r=MT i >so SLOG is' KELL yo' WffJbTPFM1 — CHAMBER OR f rc - r wo E e oi y„ p N. �,p � ^r SOIL OOVER un9 wne001y NWMOr AI-0nJeS pn•Cn Nonam Ni Topi mInepObnlF2 COMMENTS: pnC"ee wee dsoSopean, mnme ppi Nm1 iSeoi01 Lo[e1bn. 1288 CTY RO H A 'gcNls On All LChdr I I +)An em Lleanpbn• NI [icf 2)BNp CovK iMi�'FiY(� 1;•yv e,CN ' tT,s fivy wN,Nr meth- ..mo"mmme, ". EYoCOAV) ^i�Iw�g6J m,i�eJ I e At, !IwI GHA+, L•e- 10i �Yr�LCLL �VW 1 11,11, Reo"Le.1t SHy" IN No Ip� Um other S40 br2eeAbmllnbrmeDo II SBOa,m OR vaq e -Inmi9 Sir", Cm no 'r �'1W a Wetim�Ave rr.r br bmml OCT 07.j02 ms3rwr-nv .a Ca3o LI pplication .r�ewb•e.�..rr......0 •me=+. e.r®�roWrs...e..wb s.uvrPr-.rasanana�a� iml..�.�...r:®rk�r.arr ..s=.e.e. ca.srr.n..+ba .®r:.... r mK ✓ L Yirrrl�-t�frYN4i..tlL Y N O's'•1� av1• AAbU�Y. 17/.Ya rr9^y �V L 'KWIIVaYs�11� a1�L e.dv Iq'IAz Lll.fYii(dLLYlYlyjr) I,Aa [�r mLPgbpaVa-1IUAIBsbs_f � ✓ 9bh.o Ns ❑Sue(Mnel-Ib�ba We Wlbaa 61.11Amlc - hl � Hof' ter i°14✓ a� SoilApsomyo ��--pl Vjm Illllllr'IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIllll6r,llllll'.I IIIIII:{IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�IIIIII paanay-,fir. can aa. soa roak.ew, r+m�,va'pn wa o.y„rcn «._�swnarvwa aem. J�, gyp. -L�c�emnd. z mw.a�_ yea eae. kr r POWTS OWNER'S MANUAL & MANAGEMENT PLAN pNa a_ On+2r Teak MnuleNa... a,(.'JJ . t,fi .h W SR.ec g Ow g xogrq VOMmH o1N Ma9 Pxm DESIGN PARNIETERS Talk Lb¢Iaever )LI/e%Li 44. ❑Np bum tv a BwYmne, o IU sNl¢ o IX e o 1MAelg sKma bq NunpaaPupScietlilylMb ®FH VaHSldaerce sank& m(S)bakN2 Na®16I1%lays Tmiga)to 3eNm Pee lMpoMma as Iq Ea4nam bro ago)Flea E. Ipatlan 451gn (pmk)Fbx=(pIYr161x15j. Mkyryl f.( sly®ays ym ygaY kc, as, on tweak. In 9W 6alIpn RY[ -J IpnueyMl EIAm11 Fib MHeta9ea )%a n EmI87n Folsom¢. ❑Ms swravd(oomwpcl lmusllranuea MvmN am Ol aGruw, (FW) SlnOl FimpManubryra laC0.1 ma^V'L ❑N4 01N Tptl A�impsiwY poop AkAtl Nigh aYHgth lduaNEMuers MwMy sleep¢ RNmpnml Unl IFWt '30 nga Manubcpaer le<`A1 �1�nryi ®NA ❑M lM ❑pan Fpa mkki, ❑rmakem Owed" R¢IrmIM EMuem MUININ e+a'me ❑s.wcr..x Fm. ❑anr Ias 1 mp�M1 $al PlapptlOn s)'B19n ®NA FSWCWmm .vneYumwn o' OlrrowuN leaf aa�dmumftwwml ❑Gryun. ❑kk ❑M n1®mran dnuem pemaesln kmma. ❑bun olpx ❑NA ❑Na WHEWLE Sw Fame Servkv Prepwrity PunpW mllsYeabrlk�al ® ❑Ytvrdb bph�HS��ta�M�W ewlrnM(h)d WkrGnle Inapmmretm dbrNsl NlroMmaemy 3 ®v t IMaxlnwn myval ❑NG Ir¢gf es¢aeg pl(s) g""'I8)) (YWnun ST�aI abut CImn NAlaXrla Nle®I pv6 Hqy -1 u�al ❑Np IrrsP Wnp. PanpmkcYdelYrn NNenmme 0 m ke GI IU Flusp lends sCpewlaeW Nbaam eaeY' onne(el �Nt NI�m»esaY g f ❑IN aN MAINTENLAWE INSTRUCTON3 Inspecsons of talau and wl eWiTtlon atom¢ aM1W W made W aI ine,dae prying me it, than Mlwnng Ilmaw w mNflmpm2 Maaw PIanW Mann Plumps ReaMae] Sena, PQNI$ legetwIVM3 ManlHms an seame 3er,dN Opmew (puneseq Tank nimmavns must Irc um 8 wead In(pmon dthe lenkb) to I]2mtlly arty misang o' broken larM2re, 1Om11ty any aaGs rc Imka. mDOw Un¢ dlpgende eNad WBf WMupa WndiNcleMuentontlmgroundsurfam Thesal apmrglon VOW sheik W Nsmlly InyMM b yla1t111eeMlvsl lMs Intho OFexuapon time and lochwhlon any Wading of efl4g11 On the grwnd slslem iM Ix,rdlrg of dPuent on Ih¢ grewld aOrfam maj IMksb a billy mMtlm eM rmukp be Immalele nofifiMpndMalOcd regulaleyeulMrlly contents Swum ul rmcofn udge a awnInanypmhnmt unkequalsddkSmaloro ammthelankv amt IM mtlm Wammid IM leek yShiam Ce remove] by a SgABge $wNcng Operator (IyenFetl entl tll6mc9d Of in BmtlenM MN dlepler NR 113, w sin Pnmldaalyacmm Al Mer ¢Maps, IItlItlIy and W IImI1W t0 to aevldrre 0Mass them, m cldnml Or praslnm] mmpnna b, mareatmaM matt, and any S¢Noyyimaybe W tt13 moms, mail W pelwnM by a Geri P SINanenef A mevim A mn that be maiMi to be lea r gulawy aut artys tart 30 days mpipham d any, MrN¢eaml aNNA0510105l UP NO OPERATION .y� ✓m• Lot — START ¢naWmm. poor muse d eK Poi dr k bMmeat Texts) W may prWma' m pa.�y peed eds, mNmb « ends For ry sallmak NW may mutation the 4®Mml «osc[ wave ro'rlaga Ire sal aNa)A«I Mein It no wmmea«a in glom now ire symorm of The mays) Lambert M a sglan, Serviare Operator loan et for to uM. P«nvrwaedsy al.d«.a rrorma r.q..aer la,tia «or ln.eTnw «enemp.np r.Iue. smrt lm «reatolauonapu.a iced ma.a weameral.ru rammm.m.:ule�:.asra..ra well ee nae�.geemmewr piton sy5ran �n ore rye cede ®leala an Wag" IN Try rY11 in M Lv]ap rt slulan ti5dlytp dl sMUMI a'N eBrnge b VC Syden To araE tlM eMmNn Iqp tlp NMamad NB pmp Wx ginmCYabyaajenevia term rain Ipmy)plus err labgpanemXegmp«matlaery or PONISMCYearsm commnmar®lygcers rreamp thenudll Ik'nna tlPIm1IMsaerMlvalwl0il tle Pump dery DMan riveain w AralOr pi incommonersover del ¢rows are rover a o mnuDon tanax W Hartdrive 15Met clMtlms of ON mount or toor argaowry summer Da not anveawrh are.',«araHw alemN«amp". tlM ®wenln t5maeoan adpedanympnrntire latla Mlaeseennmarm Woducturn or nwalWIS troyhevion m ereraloMng,s VRwm, ever abismaY Ifteb maroad anreaM praonamaINS or meVNeed Tnb aN gal eion. IN ayean Yea. ahem pit p) NYpM, apa'me ise «neom a cartoon creation auLn, egr•Yse. eenml Han meet drame, MN UO da d, p wrmdon sae bddm M a'unnge, Tun and vagarabm parm gvolme, Whed Ira2ltleae, meet p, mmlabbdro, aN. priming pWutls, pmnae®, mdWy mpann, am«m, tenpoln, N ant« Nmer erne a.a.g•. ABANDOIMEM Wean this PoNT$ rats are'« is rpnnaraNv ati M d serves the mnWrq ape shall betaken to insuR but the ayaan IS prya'ry am addr sLaro«Iel in aamplarme wP a fmnr SO M. Vanscommi bnlnlaretiM Cape • Nl ppkq to raps, plsaadM Ylabatna�ryaena MalWamlrefM ere tleabnrM JPLe Mee'vyp aeabf. • 1Mmdse•d Mmasua lVSaMlCe mlpateM popaly depMeedrye5eaaga servinrg Opa'ely lwmea) • Nb p•ntin4 e• Tnb atl able ale• d e¢watef am ranawe « Wr ergs rrnwel are Ire wa spa-e nllee are sal. gRwMaawdsleat.ae mdaW COMMOEMCY RAM It Me RTYTS taN are raeM M roar" the "lasing mns,m may [an. or mud W Was m INdpke a dean o]npWn �aa srden * A sunade mplasneM des tabs Lan evaluated are may as Aides ra the IoaM he a Rp ormand WI abmpMl sya9n The replacement area anode Her rydeaN tran erswNaM end attention ale ahead not M alleged aprl nr expor t sa ksnomanstngaMprcpdserlsbuaure, ldllres'andw la FNIURmg Cher«lwmmtam WYrmunlninane We nmwlnna via aauamto Yahuah a sulmae replaesmmr arm Reaamneasraens mud YngrwA"tMwMln dmd d the time or roar permit lasueneve ❑ A suitable replamne t arm as and avaimatle ere to MPKh areas not IlmXelloee. IT thin soli a0wrytlon a s above Ee rMmlleam and tomno aNances In PoIMSixIAMury, aMlerg Ark any M Manned as lad next TM aids hit not rem evalleted to itlandyaeWde rgeamnmina Upon /sluRdrM P0.M5eedleM am evYuaM mite Ee aaldmee ldl�l¢B vtiYde repmaned am Itrorelaanmt area ie awaltlMe 6lMfArq anhmNda �roWled Me Y rearm rglac Me haled MAYI$ p Murtl a9 ayepe eoJ ePupnm synans may be ramsrrvaei In pmz ttllwtng renw6 of Me tland a the lnMratrn summ RemvmNaodaW Mensmutmmgy won lee rvlM In enenatmabme W MW TREATMENT TANKS, PUMP TANKS, AND rpL W TAWS MAY CONTAIN PpSONOUS GASSES OR LACK aF�\��tjrSUFFICIENT O%YGEN TO SUSTNN LEE NEVER ENTER AM TANK UNDER AM CIRCUMSTANCE. DEATH WY RESULT ESCAPEORRWUEFMM EIMERIOROFATANKMAYWTDEPOSSIME PONTSINS A ER POWTSMAIMAINER NM0 )_ Nene PITY — Perrone sEPTAGE 9ERNOMp OpEgATOR PUMPER tIX:AL RHiUuroRr AunwRRT Noe Nana Hit z Fr is,— athave Perm , wawa ay.ro daN n.. corm P«.Yrs mad.m W.ea m �P..o... Mn.w CmmmsyaKSNtMdWR.nmwrt.we rn. a�w v,nas0e•man�. cww� ST. CROOK COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANR(S) This is to certify that I have inspected the existing septic and/or dose ta>$ presently serving the following residence (Streetaddress)Id89 CI; ?J H '�I I >L located at. SC A, yI,'/1, Section II . Town__a_N, Range I I W. Town of 97*41 Pzorar , Se Croix County Wisconsin. Lipon inspected, I eemfy that 1 have found the tank(s), to the best of m) knowledge, will conform to the requirements of Comm 84 25, and it (they) appear(s) to be functioning properly - Most recent dam of mspecuorl or service 8/ I I/ Did flow back occur from absorption systems Yes_ No A (if no, skip nett line ) Approx macon volume or length of tune. ff (�gallons _ immune' Tank Capacity Pcpo Construction Prefab Concrete A Steel Other Mavuufactura (tf knowo)'�- M/ Age of Tank (if known) 3P. Permit number (if known) )161sl Sm u: zyme klAiSernoed Plumber Signature) (Print Name) 1a . rv, a aY59G'.2 (Tale) (Liaase Number) MP/MPRS m - 9 aoao (Date) Form on be urmpleted by licensed plumber (Dept of Concise Chapter 5 and s. 145 06, Wisconsin Studies) or Licensed disposer (NR 113 Wisimmm Adm m rnanve Code) Rev 9/2008 n. CROMc UNTY SRPnC TAN% MADJTFNANCE AGRE� Am o� cmr>FSAnoN Forst PrvpertyA l4C (' ? IlJ sva31 N.mmm s®P�er®u�rmwromw gym.) cLLy/Sak",z �a+ e IJT em ll4mcfi�mN®br �. TS' i^9/.-m nGr I ALDESCRDMON Propety t, mon Al Y., SecJ1�T NR1�W, Town of :Jf�z �znnxrf Subdinsim Plaz Lot N Certi edsorve➢ PN vobme 3 P.R.N Gam. War tf Deea0 4N3247 (xfoTe zoonvolume JP.NeN sy.e hma.aym om y«mt.mme.uleamom mfny3M ANCSANDOWNF.RCERnFI MN �0a ma m.�m®..=c�from aaPdt.mmm mwa,a.snmmP�eam.m�me,.,,m.� iNofP�Pm¢om Le sepec mkewYthrte Sro.ua'arn.drcn'1u115'ehcmal pmoPs PTtl n. Po mio the sY b sm sHe¢eh5dm4SPS383�cLl)mE meQaPv l3�Qoa (mmry5 �Qdmercc auum¢ovee pu¢ i.me ve spx. �eTW+nY=waepenmmkoa to St Ooa CmOY pl® Aby me wrs mG by a meet PI®MJmmrymn Plo �P�ue4mWpi�¢V�mtl (p6e m-IDe �jgpwry ummcr ZIdP®Pm6 (dv>arvYl me Ae ®ku leu ehav IA!vll of amye. WS Ne uvdm��mhewtMlLe eM.ss nNo®� mi e9am w®mde P¢"°m e'^e6. bW>°I sY®w�Poe ®tlptl[wtuQ hvem.uMby Le Dgie�m�of 5efay Autl PvhmamlSm�mE the Rqa �ofNamJ Aecute; Sme o[Wumnrm Cmnfiunoos®ethv Ymv�afLe� apuro®dmm.nbe wmPlro]w0 ed+m-aim &eAQm Co�yPl®mg&) 4DePeumw�m Ihrc mbfr�all spmmpry mLu 6m ce PxmY bS ofmY/om'mowlmge Uue mY,e eheowu(s)ofiH µpppty daamDN eWre, by vad[ ofe vme6y EmlrsmLnlm 0.egM oflba4 D&u Numb fb rvgme� DATE �, SIQNAT[R2E OFAPPLICANT(S) u•MY mfmmaCou Nn u mlvalemmmimeY rsuCm Ne �imayP�dbemgfewkeC by the Plm^m8 & lumo6 DWu®me ••• iocLdc wd Lit aPPhuMetmaW` wm®H hd Som Le RepM oflhle D a nd esvpy dU uc6nl mrvrymepJ ,efm,,,, b mw m dIo mama csT-,CQo— 3aa www amqic#+ wu _; Doan sonE ALUATM NEPo T a' i w .U.. 2 ( ro X R E Io'1 W PnoMVOmWeNYYyA� PNo4R Sb]fbne (5W 8'l 97PION"I" ❑, ❑Wye ' am NevW Rm] 7 Lv�m.� ❑w. ®N.m�m,n�X�ro.,aeee�P.. cXa.aXneee+wwAn �Re{eaaiwY ❑NCYw -Cmtr —Xm1P1e,.Yrmm.ypRZM,�R 1. �. � �Xp. ❑Ns,.p BH fivq uYaM �R hMYMahm//S p 08���000 Wuaw✓ "? BNV SR AnN��loM�b YYV ilik u1 •R�.v.+-eoo.>.n.�wswrss>»siw�m •emenn-eoo.>ns as �.aiss>sos�moy, rS/N-X/al 9 PLB-67 Permit AeC only Carry, Po,mn and County Coonry, Wr for Pow a Domesh, SawAN Systems Comi 'DENOTES STATE APPROVAL REWIRED Dam App,w,1 Rear IRA State if Rrymsee Site Plan ID a IL OWNER OF PROPERTY MaArg Addi iAJ- c�bi7 9. LOthead, Seen t �. T ry m-0 YL Lota _Gry suWrviuon Neme, nearest ,n.e Imo or nrtam.,x elkx Vol townsla O TYPE OF OCCUPANCY Commercial_ Indosvaal Omer Ispenlyl Variance_ single hardly y Coale, No of Betlmoms Q No of Pevon.� D SEPTIC TANK CAPACITY /OM Total gallon No o ranks HOLDING TANK CAPACITY Tmal Wisdom No of t,nke Prefab ronvete X m orm piaod _ Seel pdWgpss_ Omer [no enFail New Installation _Re ixem Lh Pomp Twkor Siphon Cbamb, Tomlyllone Prel<ronvate_PwreMmRax_OIMrISpeerfyl— E EFFLUEN DISPOSAL SYSTEM Rtmlallon flareaiaa.yt[_.TolalAmwE New�Repacement pltemarcl5putyl 5eepge Teen No of lI N 11r�b_s, le Eepllr lto9 of A of TreJJ��Net� Swasig,AW, DM L.ngN em Oepm me aprlr Ihd —No of lr ofThe Samete PIP ranee a r U mtl Depm o of Seepg Ph Percent slow of lam _2 a Distance from concil.mce WATER SUPPLY Powder 9 Joint 0 Commons 'I Monc a ❑ (family name as listed n Fit 115 it r Than present 1, the nne,o IN rife owner I netl mrO win NationH62 iO Wisdom,Aesm bCodee and that that too sized atbe ettloem enposal systemfrom the EH115prepared by ICJ�t r^nso, of NAMl T of E C'a.S CST .R iiii and add information obruned And fawner ewldiI _ P=s SrgnaNre MP/MPHSWa /fG3 from i - S/4S RomMr' A - - - PLAN VIEW Proerh AetN Wow of system bzwde hemacan of sloodeas aM at c,WrWWm a®rd wish Ki]O Well lw w Nall be inedualkincl on theAeteh sentence or smooth lmson of all Polls on the p,ownY or rciglrMrt propene It well ltm not trash dnllee Team mdmate - / f�/ / .100 / N AS BUILT SANITARY SYSTEM REPORT OWNER ST. ISCON IN. 1UNNSHIPSx�-GSEC. II TN, R�w ADDRES ,� GROI SUBDIVIS N LOT LOT SIZE PLAN VIEW Distances 6 dimensions to meet requirements of H62.20 SEPTIC TANK(S) / MFGR. I' ,. /! _ �ney (=gMCRETE�_S f7�E Inge on cover i U.pth PUMPING CHAFER SIZE PUMP WOE. --RWL NO TRENCHES NO. of BED NO. of line Paoli tal pit area AS BUILT /. 4/� , Disclaimer. The inspection of this system by St. Croix County does not imply complete compliance with State Administ+anive Codes. There are other areas that it is not possible to inspect at this paint of cpnstruction. St. Croix County assumes no liability for system operation. However, if are inoted the ue e County will make every effort to determine ca ilure GREASES AND OILS SHOULD NOT BE DISPOSED THROUG' SISYTfRi� INSPE DATED 7-/L-AD ER ON SOB I CENSE NUMBER /�/P REPORT Of INSPECTION INDIVIDUAL SEWAGE SYSTEM o Sanitaay Pe4m4 State Sepue NAME ..K i) fowaah44i.. Pil. i. a. S{. Crta44 CoantV Location_ Section SEPTIC, TANK Size aaltona. Number o6 Compaatmanto Din Lance Fnomt Weil ozz(�'' it. 121 On Dneaten 4tope=6t BMitdin0 6t• wetlanaA _6t• DISPOSAL SYSTEM N4Bhwater-62. Distance Roes Wett 6t. Ill as greaten elope=6t. Building C` 6t. WetLande -- F2. Niglaaater_GSt. FIELD DIMENSIONS: _ Ninth of t4ench_/�4 6;. Depth o6 rock below, tile14in. S 1-ienath o6 each line 4 6t• Depth 06 rack aver tale a' in. Number 06 unea Depth 06 tiie below 9rade-:1L44. Totat length a6 "A" it. Scope 06 44cach is Per 100 it. Distance between tbnea G Qt. Depth to•bedrack it. Total abe anb Lion artea C2 6tY Depth to 94aundwate4 6t. , Required area /.,� 6.2Y Type 06 Caaen: ¢pen n Straw PIT DIMENSIONS: Number a6 Pita_ avet around pi" 9440 Outside thane{�ae 6t• Qepth betaw inte.t_St. To;at abaonbte¢ 6;Y Area reRMine 6;I INSPECTED R' Apr ,DATE 1g7Od REJECTED ,DATE I97 EH 115 WVISIONIO HEALTH, BUREAU OF HEALTH AND SOCIAL LSERVICES DIVISION OF HEALTH, B ED ROOF ENVIRONMENTAL HEALTH O 9SCONS X SIDE MPOI SO N, WISCONSIN 53101 LOCATION SL'AALF. Senion/1,T_,iN,PLiQbrlW Townsbpor Monlcllml,tY—,�Tsr /Xi(Eti Lot Fb . 8I06 Na Ah"A"n CnumY a �- - - Ow,w,Name Li Ajvc. /y - TYPE OF OCCUPANCY NnrEena X- _ Pb al OWrooms_(.�S 00x - - — EFFLUENTDISPOSALSYSTEM NEW 4 ADDITION _REPLACEMENT — DATES OBSERVATIONS MADE/ SOIL BORINGS iLF-Vr —PERCOLATION TESTS L- LZ-��— SOILMAPSHEET —— 'l SOIL TYPE (v - LtMA.4 '4E' -- — PERCOLATION TESTS -------- 7- —Ho OR S__rW AT _ER I N TESTTIME DROP INWATER LEVEL INCHES RATE SINCE HOLE TEST HI xx I SMELLING IN MINUTES PERIOD I PERIOD 2 PERIOD 3 M"WN SOIL BORING TESTS TEST NUMBER TOTAL DEPTH INCHES DEPTH TO GROUNDWATER INCHES CHARACTER OF III THICKNESS INCHES DEPTH TO BEDROCK IF OGMRVEOI OBSERVED JESTIMAILD HIGHEST It f�FAVL CTIE t PLAN VIEW ILomre PermY4omapawll Lon Min aM wNaMe 111'FEE ImI.. Mp nrlle WOODIMID gwrelM of sllhblluev INI®re numEer oNyxelM olegorgo reeErtl br LUIIEIrg peMo WnpL15 __ IMrmemle It, eLrenm. Q. nnrrmml M lenrml,.lm,,, Come Indicate IT Elm INN ME