Loading...
HomeMy WebLinkAbout008-1041-80-000 (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 IPnvacy Law, s.15 04 (1)(m)l Permit Holder's Name CityVillage Township Scott & Katy Peavey TOWN OF EAU GALLE CST BM Elev Insp BM Elevv BM Descrip/tion r IDO �10 &Af S,dr TANK INFORMATION ELEVATION DATA TYPE MANUFACTURT a,r5s CAPACITY Septic IAJ LJ, C-xr L\ v Z d l tr v(y 16I< 57-6; Ai Holding TANK SETBACK INFORMATION Lrr_1=S .1- C. a f xu If TANKTO P/L� WELL BLDG. Vent to Air Intake ROAD Septic .�lJ 1 —] 1 Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand Model Tiber T TDH Lift F ctio oss Sy em atl T H Ft Forct4ain Length Dia. Dist to Well SOIL ABSORPTION SYSTEM STATION BS HI FS ELEV. Benchmark o 88 too Alt BM •J (o Bldg Sewer 3.q5 lv,y3 St/i Inlet 9 G SUHt Outlet / Dt Inlet Ot Bottom Header/Man. 7.67 C13 Z Dist. Pipe &IA� Bot. System X SJ-i Final Grade St Cover No (aws i' �^; s DrsA Q; cs T1 7 -7 TZ 8// yZ. Z 1 '� '(i Z /'r 2_ BED(TRENCH DIMENSIONS Width J Y Length t Y ` l" No Of Trenches PIT DIME Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM I LEACHING HAMBER OR UNIT Manufacturer Type Of System S Cat\ 41. I , — Model Numbe DISTRIBUTION SYSTEM . N� 1, JaA _1 }A-nt lv Header/Manifold t t Length 2 I Dia Distribution Pipe(s) Length Dia Spacing x Hole Size x Hole Spacing Vent to Air Intake �' xl ✓� J 7' SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only \/�ex ll Depth Over Sed/Trench Center y.1!,. Deplh Over Bad/Tranch xx Depth of aps xx Seeded/Sodded Yes xx Mulched as Na COMMENTS: (Include code discrepancies, persons present, etc.) Inspection 41: Location: 2582 CTY RD IN 11 1.) Alt BM Description -TO ri 'w Fov1�tlA�+Ow 2.) Bldg sewer length -amount of cover = '%bO p70 �/ y ,i �LO�o)iNC Plan revision Required? ❑ Yes No / )'1 2� Use other side for additional informati n, to G� SBD-6710 (R.3/97) EA,3 )-I +, }N O 040— Date KC) 1- 40-mi wall ro+f Inspection #2 i not- Comewj Y.V. Zop ) 1 00 3�5 Insepor's SignaturS ht Cent No pOL-LIA-1I i/1<�[r i5 r,Z COO LJ"^ h."z" it re.Kowd gpAafAf p� >•�' _ - r) F �/ I1 F �' r-', I� � Safety and Buildings Division County St. Croix 3 s 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co ) > APR 02 2021 Madison, WI 53707-7162 togs clm,,Sallit Pe t Application State Transaction Number In accordance with SPS 383 21(2), Wis Adm. Code, submission ofthis forth to e. Oo ental not Na is required prior to obtaining a sanitary permit. Note Application forms for statcowned POINTS are ski Inmed to the Department of Safety and Professional Sera ices Personal information you provide may be used for secondar0 Project Address (if different than marling address) purposes in accordance with the Privacy Law' s 15.04 1)(m), Stars 2582 CO. Rd. N, Woodville, WI 4028 1. Application Information- Please Print All Information Property Owner's Name Parcel 4 �C Scott & Katy Peavey 008-1041-80-000 Property Owner's Mailing Address v 299 250" St. City, State Zip Code Phone Number Woodville WI 54028 715 707-1890 11. Type of Building (check all that apply) Lot 4 ® I or 2 Family Dwelling —Number of Brooms 4 Na i Subdivision Name Block 4 ❑ Public/Commercial — Describe Use Na Na ❑ City of ❑ State Owned — Describe Use ❑ Village of CSM Number Na ® Town of Eau Galle 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ❑ New System Y ❑ Replacement System p y ❑ Treatment/Holding Tank Replacement Only ®Other Modification to Existing System (explain) Reconnection/ New ST/Effluent'Filter B. ❑ Permit Renewal ® Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Daze lss ed Before Expiration Owner 199922 issued 11/03/93 630366 issued I1/12/20 IV. Type of POWTS System/Component/Device: (Check all that apply) ® Non-Pressunzcd In -Ground ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound <24 in of suitable sort ❑ Holding Tank ❑ Other Dispersal Component (e plain) ❑ Pretreatment Device (explain) V' Di ersal/Treatmenl Area Information: Design Flow (gpd) Design Soil Application R its Di sal Area Required (at) Dispersal Area Proposed (sf) System Elevation 600.0 Gpd 0.5 Gpd/Sq. Ft. 1,200.00 sq. ft. Exist'g 1,216.80 sq. ft. 9233', 91.32' & 90.32' VI. Tank Info l apacity in To 4 of Manufacturer Gallons Gallons Units 1r(�'')1� [•�11— a G o f u New Tanks Existing Tanks —\ `� y-Rt� •1` ICY /1 U a c: rn rn C7 cl. Septic or Holding Tank 1,250 I 1,250 1 Wieser Concrete X Dosing Chamber X i VII. Responsibility Statement- I, the on ersigned, ass me responsibility for mist Ila1 of the POINTS shown on the attached lans Plumber's Name (Print) Plumber s Signamr MPIMPRS Number Phone Number James K. Thompson I Cl— — MPRS 30021 L11"5)48-7767' Plumber's Address (Street, City, State, Zip Code) _. 340 Paulson Lake Lane, Osceola. WI 54020 Vill. County/Department Use Onl Approved ❑ Disapproved Pe rt Fee S/V Date Issued Issui g Agent Signat re yyy /t Elt �1,3�02. an far Denial IX. Conditions Approva ' p��� SYSTEM OWNS 3' 1`�' I&'N t$-4b C7l "L SP-Q � Ili` r�Q&"xr­ 1 Septic tank filter � � effluent and f1 ¢ ic dispersal cell must - I serviced / maintained N� �� � e iT-t nC t as per management plan provided by plumber C , /n� , IISSUU �� 2. All setback requirements mist be maintained � AJ!Ier 6' A*r s��llll7lll � gyx Q,vik j .�-no re I ' `^` �- w' pfam tnr me sysrem ages mmm t ounty only oa pa pernot II., t an 8 11. N i lies in size (� r - e �pq�� I,rol s ff tt RECEIVED -APR 022021 ST. CROIX COUNTY CDD EXiJb`n� Wed �(,JCp pY Proposes 46tdroo� ,?e5,alencL ♦ 4,436-v ?nade I ites/. ®I Scott /�ea✓r '' 2582 Ce..Pd•�1 40ood✓,71e, Lo1. rIOVS6i4/, See, y r2*4. /P/lou1.,T.oF kC,./lc, -CW D be, 38.cn a li d ,�'-rv�i.•tinttcrvtett✓, oF6w(dny 9B.eb.' grade r 5,Ec. �rof�osca(u� eserC•m �p6'c `+,KW/Polyl A' tzsO IQ -4zSCFI' �2Ebu,% � �IEVaE e�.flo-�. '/"saki e/0 G1. ✓,C; � 93Cr�Z4' /I s7•M p • /745 ,, e o cut o so• �---- /(tw � "Asrn 303 y p.✓. S. kea�G.: E.w��/G d;�ocrsa/ee/% 1- reeW L`�ti,csiJ a � S "X/Ct9'G++S ,.Ypa�k.-q,Eedppe4 pia.', . et 1J4-or/�s'-r _5y964M //a441 in5,4ee ROn r'6 a 9 �M� gist's 9.z.a3� C7ri'�aa�y Ex,1f r e(kn �, 5ya6-c fX,,kf '� _/�' Fnblabandw , Ee tie Qaed L.. L.dQcr ep6* .._ .. ✓ a6aads ,f� toner Sep 2 STrltan4 le 61 v M/7' .. 2n✓afEoFS,?.or,�Elt{ " C= 95.55' K ESt. �n�er£ elt✓. oFS,T. /n/a-E�O,'�OE � 15,E �. 41. (pCp pY RECEIVED APR 0 2 2021 ST. CROIX COUNTY CDD 0aray< Gam,,,,." x-VA;'li"A �.a af6w�d„5 Pro o5Q-d JeWWRtta ".aoX;1 �Fb�roor, = 9B.eo: kis Jens[ 99.10' A: 2mde E,Yi36.h j (,)cll—\ �ara9e EXi3�.�q QeS.cdMrG Eo 6e QaGed (Z— Ul►C\ll�._. AY-ti-_ ep. 6- bu id;n 91 3 we'be ✓ QkAdAn4d as V-J pv core. n ♦ Evs5 r� grade elle% f.cale: / _ AO sc4tt Aa✓y 256z Co. Ad- 11 uiced✓,lle, L01. I r?Ei'�SEi%1, Sec,!l4 Y.18rL /P/6W-,7h—a uCark l,,E.Cro tX 15,, cJi. dig_✓o*//- -coo 0 bQ- 38.co ages 11 preposEd u7 esw Cd 0- io "-A 504'cA-L,K0110,1 Loy SzScF< 4sYMQ Gw cJ"A9rM 3o3yp.✓e�Ah aoGr: c, d"W,5a/W1. reeCi tr��Yrat 5"xicn'e:.,s eft i.ypr.(ore.beefppe6 �rxi✓e.Q �nF. /tiabvt SwrGee e!e✓ate' `� lJic�or �3y.S�m lrisdo//a• inSroe bn ,� & 90, Sz ' ef 9isz's y2.33 611 9ha�y ins ertro^ 6X s6,' 6xa/d, q5e ci repw£, S4'6-efd�'fkeaf� /o•Fes =/A9.tD. fn bz26rtndcv,..� es,gv'.cad[- E,Y.3d: a D P u7rrse+�j u,'((� a foo,.�enadQ I eaner Sep L off/b,raA?.: S.T/Han,(a/eCe✓v E/Qf = 98.r7' Qo.u� -*T,✓erEeFs,T.&Aklc{ Am 95.65� 0�0. k0cl. "n " x Est. ,nv&-£ ok✓, oFs t;n/e f 0 pe = eo.,afz r— r nr=nr\ n �! .5gV -24ZA- qoa Ir `/`L7 count}, �1 I Safety and Buildings Division St. Croix OCT 2 9 2026 2011 W Washington Ave, P.O. Box 7162 Sanitary Permit Number (to be filled in by Co ) i Madison, WI 53707-7162 and awry farm) pplication 7 Oa State Transaction Number In accordance with SPS 383 21(2), W is. Adm Code, submission of this form to the appropriate governmental unit Na is required prior to obtaining a sanitary permit Note Application forms for statcowned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services Personal information you provide may he used for secondary purposes in accordance with the Privacy Law, s 15 04 I m Slats 2582 Co. Rd. N, Woodville, W 154028 I. Application Information — Please Print All Information Propeny Owner's Name Parcel # Scott & Katy Peavey 008-1041-80-000 ✓ Property Owner's Mailing Address 'q' 27 299 250" St. City. State Zip Code Phone Number Woodville, WI 54028 715 707-1890 It. Type of Building (check all that apply) Lot# Subdivision Narne ® I or 2 Famih Dwelling- Number of Bedrooms 40� Na Pl re q ise.1 i'1GUSe. Na Bloc ElPublic/Commercial - Describe Use lam_ GC1S �� N ❑ City of ❑ Stale Owned - Describe Use ❑ Village of CS . Number �,� t� d izj l o^ k - virlil&4 i 4-� � I WAIL issuey Na ® Town of Eau Galle Ill. Type of Permit: (Check only one box on line A. Comple ine B if applicable lorqfi6r, f..f-t 1 A New System lacement System ❑Treat tMolding Tank IRplacely C Other Modification to Fxisting Sy (e xJtpl / ST/Filter canister evlous Permit Number and Date Issued B. El Permit Renewal El Permit Revi ❑ C ge bar ❑ Pc t fe w Before Expiration 199922 issued 11/03/93 IV. Type of POWTS Componenb`Devie . k all t a ly) ® on -Pressurized In -Ground ❑ Pressurized In-Grou t-G e > 241of s le soil ❑ Mound <24 in of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (exp n) P mment Device (explain) V. Dis ersaVFreatment Area Information: 6 nfiltrator" -4 dard P s I in chambers 'Flow (gpd) Design Soil Application Ra sf) Dispersal equired Is Dispersal Area Proposed (sf) System Elevation �i 1f00.0 Gpd 0.5 Gpd Sq. F 1,200.0%q. ft. 1,216.80 sq. ft. 92.33', 91.32' & 90.32' VI. Tank Info Capacittri Total # Manufacturer Gall s Gallons Umts •� ` L �+-� ff)1U �D((a.. = ,�, y u y New Tanks Existing Tanks �7LS v y y a is rn r7i c= J i1. Septet or Holding r ank 320 1,000 1,320 1 Wieser Concrete X Dosing Chamber IX VII. Responsibility Statement- , the uncle signed, assume responsibility for finsingtheition of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber'& Signatu MplM '5 Number Business Phone Number lames K. Thom son 5--- MPRS 30021 715 248-7767 Plumber's Address (Street, City, State, Zip Code 340 Paulson Lake Lane, Osceola, WI 54020 Ville Coun /De artmentUseOnl Approved roved Permit Fee Date Issued Issui ant Sign ure w _ iven a on for Dental b ZSo • •, 1 �1Z, 20 r IX. C6ifiam gYptl( ons for Disapproval �" ' 1.Sept�ctai)<. �- 3�3 -yp. P109i A LA*,0WA&e- iUj A4*.'A4 AMct. t cedlmzrtaned d spersal reP me<t lumber manager.ant o'ar, prondcd uy p Clue 1`'i� ise per mainta•ned ! l U 2. All setbatk, cilor ullents dmarb as paht r apP I ht \ SBD-6398 (R. I I/I1) Attach to complete plans for the system and submit to the County only on paper not less than 8 in x I I inches in sae 4 Bedroom Conventional POWTS Reconnection Index & Title Sheet Project Name: Peavey Conventional Reconnection Owners Name: Scott & Katy Peavey Owners address: 1299 250th St., Woodville, WI 54028 Site address: 2582 Co. Rd. N, Woodville, WI 54028 Project Location: Subdivision: Legal Description: NEl/4SE1/4, Sec. 14, T.28N., R. 16W., Tn. of Eau Galle, St. Croix Co., WI. Parcel ID #: 008-1041-80-000 Mater PI er Restricted Service: Signature: Page 1 Index and Title Sheet Page 2 Site Plan Page 3 Existing Dispersal Cell Sizing Calculations Page 4 Septic/Filter Tank Cross Section Page 5 Effluent Filter Specifications Page 6 Certification Statement for Utilization of an Existing Septic Tank Page 7 Septic Tank Maintenance Agreement Page 8 System Management Plan Page 9 Warranty Deed Attachments: Soil Evaluation Report House Plans James K. Thompson, DSPS Credential #30021 Date: Cct . l /, .WZD Paee I Of 9 Design pursuant to In -Ground Sod .Absorption Component Manual for POWTS, version 2 0 SBD-10705-P (N 01/01) Peavey Existtfig Dispersal Cell Sizing Calculations 1. (4 bedroom)(100 gallons)(1.5 design factor) = 600.00 Gpd design flow 2. Infiltrative capacity of native soil = Odd sq. ft. 3. Absorption area required: 1200.00 so. ft. 4 Absorption area as constructed: 1,500.00 sq. ft. (3 gravel trenches at 5' x 100') / J Pg. 3 of 9 a Ignl" TOP VIEW 4" CAST -A -SEAL TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS WLP1250— MR TANK SPECIFICATIONS DIMENSIONS: WALL: 2 1/2" BOTTOM: SEPTIC 3" COVER: 5" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 52 1/2" O.D. LENGTH: 120 1/4" O.D. WIDTH: 84" O.D. BELOW INLET: 41" O.D. LIQUID LEVEL: 36" WEIGHT: 8,810 LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET, CAST -A -SEAL B00T OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 34.81 GAL/IN HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 1,323 GALLONS LOADING DESIGN: 8' 0" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC/ HOLDING/ PUMP OR SIPHON COVER: MIX DESIGN #8 NO FIBER) TANK: MIX DESIGN #10 STRUCTURAL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE m o c `W r N W C � ca U C LO o � m z 00 a I V7 � N LM H DO W�00 M 3 r ci DRAWINGS SUBMITTEDII rn FOR APPROVAL APPROVED BY: SHEET NO APPROVAL DATE: 1 PRODUCTS NEEDED BY: EEJ 0—MR 50" 4" CAST -A -SEAL a 0 FILTER OR BAFFLE J TOP VIEW a INLET - OUTLET ` I Sin a SIDE VIEW 4" CAST -A -SEAL TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS DIMENSIONS: WALL: 3" BOTTOM: 3" COVER: 4" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 58" O.D. LENGTH: 50" O.D. WIDTH: 50" O.D. BELOW INLET: 46 1/2" O.D. LIQUID LEVEL: 43" WEIGHT: 3.880 LBS. INLET AND OUTLET: 4" CAST -A- BOOT OR EQUAL GASKET T-A-SEAL BOOT OR EQUAL INLET OUTLET BAFFLE AND FILTER: SCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 8.0 GAL/IN LOADING DESIGN: 8' 0" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC/ HOLDING/ PUMP OR SIPHON COVER: MIX DESIGN #8 NO FIBER) TANK: MIX DESIGN #10 STRUCTURAL FIBER) CUSTOMIZED TANKS: kk FOR CUSTOM TANKS CONTACT WIESER CONCRETE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: W a N W � �Q00 u� N LM =�O W=cc N 3 YCO X Inc Mnorationsm Prewsi, Oramago Zabel' 81WastewaferProdusl5 A Dmsion or PoMok Inc. PL-525 Effluent Filter PL-7 Filter The L-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the Polylok PL-525 has an automatic shut-off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent won't leave the tank. 0 Features: • Rated for 10,000 GPD (gallons per day). • 525 linear feet of 1/16" filtration. • Accepts 4" and 6" SCHD 40 pipe. • Built in gas deflector. • Automatic shut-off ball when filter is removed. • Alarm accessibility. • Accepts PVC extension handle. PL-525 Installation: Ideal for residential and commercial waste flows up to 10,000 gallons per day (GPD). 1. Locate the outlet of the septic tank. 1/16" Filtration Slots W l 1t1 M1N 2. Remove the tank cover and pump tank if necessary. . Accepts 4" & o" 3. Glue the filter housing to the 4" or 6" outlet pipe. If 1 SCHD 40 pipe the filter is not centered under the access opening use a Polylok Extend & Lok or piece of pipe to center filter. 4. Insert the FL-525 filter into its housing. 5. Replace and secure the septic tank cover. PI.-525 Maintenance: The PL 525 Effluent Filters will operate efficiently for several years under normal conditions before requiring i cleaning. It is recommended that the filter be cleaned every time the tank is pumped, or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. 1. Locate the outlet of the septic tank. 2. Remove tank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. 4. Pull PL-525 cartridge out of the housing. 5. Hose off filter over the septic tank. Make sure all ! solids fall back into septic tank. 6. Insert the filter cartridge back into the housing making sure the filter is properly aligned and completely inserted. 7. Replace and secure septic tank cover. Outdoor SrnartFilteilP Alarm Polytok, Zabel & Best filters accept the SmartFilterO switch and alarm. Alarm Switch (Optional) Accepts I" PVC Extension Handle Rated for 10,000 GPD 525 Linear Ft. of 1/16" Filtration Slots Certified to NSF/ANSI Standard 46 Gas Deflector Automatic Shut -Off Ball Extend & Lok'TM Easily installs into existing tanks. Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com Pg. sQ�9 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT J 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) 2582 Co. Rd. N, Woodville, WI 54028 located at: NE '/4, SE 'A, Section 14 Town 28 N, Range 18 W, Town of Eau Galls 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 Na Did flow back occur from absorption system? (if no, skip next line.) Approximate volume or length of time: Na Tank Capacity: 1,000 gallon Construction: Prefab Concrete x Steel Manufacturer (if known): Wieser concrete Age of Tank (if known): 27 Years, installed November 5, 1993 P(rmit number (if known) 199922 Yes No x gallons Na Other James K Thompson Plumber Signature) (Print Name) MPRS MPRS #30021 minutes (Title) (License Number) MP/MPRS September 24, 2020 (Date) 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 0 �'00 Owner/Buyer Mailing Address Property City/State ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Scott Peavey 1299 250th St., Woodville, WI 54028 P2582 Co. Rd. N, Woodville, WI 54028 (Verification required from Planning & Zoning Department for new construction.) LEGAL DESCRIPTION Property Location N E ,/ SE Subdivision Plat: Na Certified Survey Map # Warranty Deed # Parcel Identification Number 008-1041-80-000 ,, , sec. 14 T 28 N R 16 Spec house Dyes Elno W, Town of Eau Galle Volume , Page # (before 2007)Volume Na Page Lot lines identifiable OyesE]no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Lot # Na Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1 /3 full of sludge. Live, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I!we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office wi--------da•--- - • / ATLJ9t OF APPLICANT(S) 09/24/20 DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) Conventional Septic System Managementan Pursuant to SPS 383.54, Wis. Adm, Code General The conventional septic system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10705-P (N.01 /01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715) 248-7767 or the St. Croix County Zoning Department at (715)386-4680. Septic Tank Septic tank servicing mechanics comply with SPS 383.54(1)(e). Septic tank to be located within 150' of service pad, with bottom of tank to be <_ 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1 /3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Slats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1 /3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used, they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October -March) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent pending. Pending levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Contineency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Pg. 8 of 9 � .�bcdrao� �sva�s Qts%dcncL I � i 3o3YJn3,+/sK/ Ex.3E:,q QeS.da,cc Q¢dtd b Sewv� b e � abnndti.ed as Gov Code. =/w._. 1 .0.if proposed u.� cpf%o tr-�W F; � Evat Ou. Ex,Sb-vr yade clt✓. • ri f(O ,le,Lot. AE SEJ'1 Sec. is/, 7..18rt; a'CA aC, Ile, �ce8-Joy/-ao-cr,� b¢,� 3d.m ¢ores Epsb- dA*t-Sa/Cal/.7XrYc(J) Ef�nc4iSaf 5'XJQ7fsnSEn, c4c[/ yPrr/wa Ecdppeif aiu✓oQ fm¢�fiabvr5�A ¢�✓ 4- ,Av or �a/3y3F�m ,'nsda J/aria. lnsPrxis, ,..ya»^� - 9o.31, 9/.J1.'L 92.33" �3tD-mQ / 98.17' Qi�.(.J, ySn✓arQoF s, t.oµfl:{ Ape K55: -e ESE. ;nowt nitY, e/S,T. ;n/ei ar^ r S po..2 a f 9 yyo,orwn Department of Industry. Labor and Human Relations Drvisan of Safety & Buildings SOIL AND SITE EVALUATION REPORT Page of 3 COUNTY Attach complete site plan on paper not less than 6 1/2 x 11 inches in size. Plan must include, but ST. C(2A L K PARCEL I.D. # O o 1j - not tended to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road REVIEWED BY DATE APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION PROPERTY OWNER: R V t= f X-t� }} L.1 CC- Zii�T�Z S l) N PROPERTY LOCATION GOVT. LOT N N 1/4 SF 114,S t Y T Z8 ,N,R I a E (an�Y PROPERTY OWNER'S MAILING ADDRESS LOT# BLOCK# SUBD NAMEORCSM# Z S 0 L Cx�-JAJ rLf " W - I - I - CITY, STATE ZIPCODE PHONE NUMBER ❑CRY ❑VILLAGE ®TOWN NEARESTROAD 1.Jbo�\H L_LL lvl SVUZZ i�ls)b98-7-SLS fN Gkt-\. T a7)1-N` l I New Construction Use pC] Residential / Number o1 bedrooms t/ (] Add bpn lo e)dst V buNng N I'l lacemerit [ ] Public or cwmmeiW describe Code derived daily low loll J god Recomumoded design loaft rail - bed, gpdAl2 ° 5 trech, gpd1t2 Absorption area required - bed, ft2 \u\o trench, (t2 MMM design loading rate ° 1 bed, gpdAt2 ° • S trench, gptw Recommended nfdtration surface eleva60n(s) StnZ Nub Unu PAac 3 R (as relented to site plan berchnark) Ad6iixlal design / site consideralons 1vj c \ YcSW (S 1Z21t*vCFk LeyLS`Ttt FtaLv+ Yo do tau" \ S R�ee htteU D � a , Parent materiel Roodplinelevatron,dawiic" N �• ft S =Suitable IDr SPIS 1 U.11rtsuilditlebT Bem CONVENTIONAL offs ❑U Marto IRIS ❑U WOOM M PRESM ®S ❑U I AT -GRADE ILLS ❑U SY5THA N FILL ZS ❑U HOLM TANK ❑S 0'U Ground elev. ct3.0 It Depth to limiting factor > -)6" Ground ew. 93.51L De"lo limiting factor a 7 -)8 SOIL DESCRIPTION REPORT Horizon Depth in. Dominant Color Munsell Mottles (kL Sz. Cont Collor Texture Structure Gr. Sz. Sh. Consistence EwxWy Roots GPD/ft Bed rant o-a sp `1.1Z 3 / 3 - 3j Z)rm wt'QL- 4-S °- S U. I. R 3 /y _ �a 2 �Sbk kt �t CkS % 3 18-3$ Lo`+R YA - 7s LCabh h1U-fH cg D.s o'6 3�_'lb to `t l2 S�8 - Tz o.,., M v'Ft, u•Y'o.S ��L/ N S`tR Y IVMU S 't S Remarks: o-to 1b1�313 S1� Z Fabk t"t'% as - o•S °_6 Z \oib tuYR31y sli Z�ssk V11 CL — ,.S o•l 3 z6-41 �`t�Y/l �S \�sltt yr vFt CS - ° yl=7g t04i:Z S/g - A \A - o•LiD.S StM ND-m ri S P58°ve. Pomvr4e- STName .-ReasaPrint Arthur L. Wegerer Phone:715-425-0165 e 0rer Soil Testing & Design Service-P.O. Box 74 River FallS,WI 54022 gnaGxe: A�/ Date CST Number � ad_: i+ °J?- ZYi M00576 Page. Z.of 3 PROPERfYOWNER B"--A�TCL.SUti SOIL DESCRIPTION REPORT PARCEL I.D. # Boning ft ,3 Ground oleo. 9S_OIL Depth to imiing motor ? —?" Gmud elev. It Depth ID Writing factor Boring ft X Ground elev. it Depth ID imiting factor Ground elev. It. Depth to irrpWlg faclor Horizon Depth in. Dominant Color Munsell Motdes Ou. Sz. Cord. Color Texture Structure Gr. Sz. Sh. Consisiertce Bwxlery Roots GPD/ft g� rerrh — Z 10 ZY >�7Q 3,/ - 3 u-39 t0y2 YA - - 51 39=17 10YR S - StM wo7'C 61 HeMarkS: SBD-8330(R OS921 PLOT PLAN Page "3 of 3 SCALE V= 3D vC1ZLPy L.bc/}�i-1U1V �� DITA`jN e1.935 n2tU�Z rp Cmvj STV-U GT7uA3. e.z LlU Wu .O 6w3 rwr� mM o r bef\Zrt sF s �p,ru 6 x GR2k0e �L 9DQ_Y1 %Z!4 W-�avtE k ¢' 01M I N J. s, No`t-E= 94 r-��+�5nun goy Lu'..G� 3Z� D�eF kT �FE �'P$W\F ��t 0�i�liMlNt it �+Cbl �--LL-Ur wus S)T i�nt OF eNuST4�c1�UN. q3-24-7 (715 ) 425-01 Fs M00576 CST Signature Date Signed Telephone No. CST# NOTES m. w.o�ro e+cwm.c.w �aox ,o lIT Hw Y T.—TH m 11 m� 1. orz e m m[ ca TTRI IT .. ,, ,w.x ATE .. � T ,. a. T. II III.. IT u ILI I'll" �ry �"1 ��TV '1P<I"ITEER E ExTEPCP O1 —1 — ITTBx E TER IT.' 1 xo s ry wi 1^.1 NOTE CONTRACTOR TU LULAIE HVAC TINT` AND WATER HEATER AT SITE L—�CJF FEL".� ....,:: F R . DECI �It \g -� HATx J ... .. a. al S'ET _ CLOSET 1 �J y IAIINDRY` j'RFj£in . — vt TI=EE -ANTRY J IT p F s rvI F 'I TRLNT m Houc 0V. LET'S' SELECT DS .1 IS "IT- I -IF E5 LESIBID �Efl BEEN DD 114 FBI I'll 1' 11 El IEIELIL LF "IF IlTt I EEILLTBII Ell FEET LESS III, IT ILL ZE IF ISCE I' ELL FEEL, lESCIIT TIE I I I SITE FILE � BIBLE IN- I LEI I BE I _J r, FLU—If-i� ]::LE t, i" - - -_ - -------- 1•--- Rr�esPgn H F:I.'''`'IT -FF F!�` J ---------------- -------- 1, � li lj 11 , I p. III '.;wNl I'il IIII IIII II',•,Y`I' IIII, II i. IIII i II-` III ��II II II Iit Ildl�l'll ��I I�I�uII��III11ullll6� II�hVll6�lu''I�II,I ,'r., III III ildil I L, it I 11-I FF- I'_ f 1 --- ---- A3.0 LQ:aM;AVlpanFi"o44W 14.28.1C b TE SEWAGE SYSTEM Lahor and human Relations Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Permit Holder's Name I r.t. n V.11 , n T,.,.,- /00. I / ,_ o, I o TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic o--r Dosing Aeration Holding TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. gvnt lntake ROAD Septic 76' 3C) >_go NA Dosing NA Aeration NA Holding PUMP/ SIPHON INFORMATION Manufacturer Demand Model Number GPM TDH Lift Friction SystemLoss TDH Ft Forcemain Length Dia. Dist To Well SOIL ABSORPTION SYSTEM ELE%ATION DATA A9300330 STATION BS HI FS ELEV. Benchmark Bldg. Sewer `j7.7,'1' St/Ht Inlet 5.87 q y9 St/Ht Outlet Dt Inlet Dt Bottom Header/Man. q,s s 93x Dist. Pipe a :' 0,7 e Bot. System q.S3 i i.ry NT 33 o.3i Final Grade RED/TRENCH Width„_ 7 Length No Of Trenches PIT No Of Pits Inside Dia Liquid Depth DIMENSI /DO DI SETBACK SYSTEMTO P/L BLDG WELL LAKE/STREAM LEACHING manufacturer: INFORMATION CHAMBER TypeUT r 70 r Model Num er: System rT /p0 i� /✓�� OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Sae x Hole Spaong Vent TO Airintake Length Dia Length _ Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded! Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENT$ (jlddXe code discrepancies, persons present, etc.) T.00ATION:,)� GALL�14.28.16.2 3 / TI Lai I v^ Plan revision required? ❑ Yes ❑ No G Ise other side for additional information. 5 3 b 80-6710(R OSNI) Date Inspector's Signature Cent No SI'LE l.'J-------------------------- 1-i� RE _L TI _'f'1 ,i 11E I,4' ____-----------'_ ---_- 1 A3.1 Published under s. 35 93. Wis. Stats , by the Legislative Reference Bureau. 33 SAFETY AND PROFESSIONAL SERVICES SPS 382.30 Table 382.30-5 Minimum Thickness of Insulation Frost Protection Zone Extruded Polystyrene Foam (in inches) Insulating Concrete (in inches) A 10 6 B 15 9 C 10 12 D 2.5 15 Table 382.30-6 Predicted Depth of Frost in Various Types of Backfill Soil (in feel) Soil Type Frnst Protection Zone A B C D Clay, Clay Loam 2.5 30 3.5 40 Silt Loam, Silty Clay Loam 35 4.0 45 5.5 Sandy Clay Loam 40 4.5 5.5 60 Sandy Loam, Loamy Sand 4.5 5.0 6.0 65 Sand 5 0 5.5 65 7.5 Gravelly Sand 6.0 7.5 9.0 100 Table 382.30-7 Minimum Width of Extruded Polystyrene Foam Insulation (in feet) Predicted Depth of Frost (Tee[) Depth of Sewer (in feet) 2.0 2.5 3.0 3.5 4.0 4.5 2.5 2 NR 30 3 2 NR 3.5 4 3 2 NR 4.0 5 4 3 2 NR 4.5 6 5 4 3 2 NR 50 7 6 5 4 3 2 5.5 8 7 6 5 4 3 60 9 8 7 6 5 4 6.5 10 9 8 7 6 5 7.0 10 10 9 8 7 6 7.5 10 10 10 9 8 7 8.0 10 10 10 10 9 8 8.5 10 10 10 10 10 9 90 10 10 10 10 10 10 10.0 10 to 10 10 10 10 (it) Location limitations. Building drams, budding sewers or private interceptor main sewers shall be separated from water wells by the applicable separation distances contained in chs. NR 811 and 812 or as otherwise approved by the department of natural resources. Note: See s SPS 382 40 for provivons regarding the separation of water supply piping, building sewers and pm ate interceptor main sewers Note: See ch SPS 392 Append, for further explen.dorc ni Section NR 81208 mev require u!da,.,d setbacks (e) Irutallatwn of budding drains and budding sewers I. 'Trenching.' All excavations for building drains and building sewers shall be open trench work, unless otherwise permitted by local ordinance or accepted by the local inspector. 2. 'Stable bottom' Where the bottom of the trench can be maintained in a stable condition and free of water during the time of installation the budding dram and the building sewer shall be bedded and initially backfilled to comply with all the following requirements. a Where the trench bottom does not contain stone larger than one inch in size or where bedrock is not encountered, the trench may be excavated to grade b Where stone larger than one inch size or when bedrock is encountered, the trench shall he excavated to a depth at least 3 mches below the grade elevation and shall be brought back to Published under s. 35,93, Stars. Updated on the first day of each month. Entire code is always current. The Register date on each page is the date the chapter was last published. Regater May 2016 No 729 SCC ArcGIS Web Map E ..... .........::..... ............... F. S«1s.1,±a1.-M.. .. . •. . eiN'i4F., 11/11/2020, 2:32:52 PM 1:1,128 Public ROW Umlteo Common Eleriwd © ZONE AE - FLOODWAV 0 0.01 002 0 04 m Lot and UNts General Common Element ZONE %- 0.2 PCT ANNUAL CHANCE FLOOD HAZARD 0 0.01 0.03 0 08 km Wool Tax Parro a—e Base Flood Elwatm Um SCC C0D Esg*a srxl SCC CDD, FEW SCC COD Flood! Hararo Areas Park ZONE A Lot © ZONE AE We A,,aw lib A m SCC CM I MW. SGC COD I SCC CM aml SCC Hgs M DW I FEW. SCC CM I CM aM NPS Ntl l Deosesse-IMWtf Pasecy (NDA), Dells Srale u+rvaeM'. Eel I Esglexew a SCC CDD I