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HomeMy WebLinkAbout020-1289-20-000 (2)PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) tlPWAKV UW nsCal 111l'M Wolske PUMPISIPHON INFORMATION SOIL ABSORPTION SYSTEM Gnumv St Cron S.nrwry P,�i,m 630393 T..xn 020-1289-20-000 imrramm.,ml 26 29.19.1416 110 MOUTRIONCH mal m3, L..� 9U 2 r <w "c NpDfbkP. BLW LL LN(EISTFEMI Va��-�� A/ r .e,,...'"$ SYSTEM l.n Di.4 On(r ap•nm. < W3_5, r..m,e., > COMMENTSIlnc meeme ....e. pram, peaem e, t mpdpn#1 Ineperticn X] Lncexon 745N MEAOOw OR —Ve^45 co all IveveI 104-c( eanjS; ))AU EM Omml-3Zo 4w Cover _ Z.(} rize� n✓ole✓ orn aC3f:r3 s$w I� z)eia9cewarie,gat k)tot . m,,,- F�c�si-ice - valln iL.s/w/4//F/e� I)ie dX;047 /ra')r,'lc< Plan rates d Re,adda n w. .Nemle eq^e�n ,. ,�e,mr,aen�nnaPM�" Xxn IZ 10 Zo seo Sn0(R Val in )5003 G5 ..,.,,OF 1- 5ir Con, Industry BPMcw Wallin slcmN '.u{P= 2�j11\I�D NOOao BmI eR An smomy w�m,xunae,msmumMml 1� z110 .. oazozo mlindm,""a' "°' (o3o-3 [Application_ Sec SlmTmmrmxrq a Pss 41 II^M^ea Mow. min Gmm� l Ivi¢au'rcJ 1Ta13`4�t'%�W Cryuun mofF ,ry enJ Yrol:eiorel eirs= R m,o nn eu rmNe mryhuxE l•n r<v semtAW InYdilRma Pm yllnttlhrl invewEun,nNN: Pnrm l� mYSuureu ✓✓ L Appini lnformi- PIUM Prlel All lefom.(oo Kinston A Levels WWIe 0635WDY50 sense, AM; ulbm' ^on^rlmmZ4 Z+ 14 14\ Ia^Swin min Ciry.Som LKCOY Mr, xleMr N Vrs nSeam ]6Jp�a'k IIWve, Wl 51016 ml N R19SeQ! IL IrM of Building b L.n msbpi I Iv. SvN r•Mdi ® I w 2 FmniN Denning- N•nlnM ,d xM n,P a ❑wxnCmni-Coin Cm 041a ❑ City ❑ See send -union ❑ vluraf 2om—z X �m Wmm ®Tnrnr Nine III.T ofNmft RULm r.Mn.epx A. l:w W.Yrt. mY O s.nen onto gc5,nm ❑Tw�etgbmmTq PM®nM ❑aewnmrYmmamm5>®Immrl � O eMn ar.em � ✓ p.linuni e�em rmmr Ann rer T ofPo viXrue L1w1 sII lEs ®NmM®m1 ❑wemnMlnGlwtl DA,! ❑MVM ay mMCYYp ❑gCW <N warYWeW XdE Tint Cm:pslmplrl ❑M.Mr Alaprl V. rr M A4Y.m.We: been, eiio.Ipm�u pW Mm�u y MmelxrRwrslN oaaml A�.Rwmal,n spa, now 07 VL Task wb cpnrye GYba nY endu yy5e Y yy y Ng eYYm a e"MYIW ✓.� A uo C sevml TW pun Ino nIS a M 2 w1®d corroe DninB CTwW VIL Ridponstnift 9tllmrM1 I. as, Me aWI ne4emume bImYYMIWIOMlY9mea we assi 111i I NilPuq Plumba'is L C / WNIFRS"orbr BurFam PM eNull IOM Sebwn �.✓( (. (/ W70 IIS1Wp56 A4e® Iraq CO. ruse z4 udel 595VaJl View Trod. =wM W1N(N . Coua /p sn's 'Or OnI Apnerol ❑beba{pmwf Pmmllpm uulnpAyu om,cwmamm m,Dmw 5485.rw 12 9 20 ed�Yn 1 • s I F!"T PllAPpm'.VIWMmwwDmPPnMl 3\i Iv. h4 J septic :, Pill, nrfile p+ke- � eAo/of KAT. a S1 upersall wll muq be serviced I Rajcm000 Lbtuh� SGni YwiC Syl rzM M9�✓1Pest vrk ee permenagmnem plan Flmwbo'l Nv Nw b, i 'N 2A sNhg ow as nn.+:�.,.. pryn4nnlMerunrerrtmuamaelurnvryryeprmr yemrnlaamud s)Bn� zf c e is<,� IzsoJ,II,Ak. s9P6l9e OlnanAl SYSTEM PLOT PLAN Wolske4 Bedroom Septic System 0e1pnFox °0°GP° Bnbanaaem MveM ^^ aroKntww ®bl.u".a 4am N BMI6ymWl i -� PA1 FbveKn'ima� min alellelel P8lM s4mvN BM°®olNam TWdfaMMM iaEbe9&lW 6de1.BM SWe'1-=AO' LY Q BMEIeveYon 06 rp nzye BM Wplgbn TopW vaod mfnNY mm WLryv MLM9fBM ie' Bbpe WaLeN"IiMe]Mv nn%I Wee,SM Nob: 6"e PIA map b� eanObM M PIlepp4ftr xbting V KennExiting BW l4 Beare mMewey�Y9BDeck \Existing l k septotiBM2 Pnoposetlelseptic lafi T1B3 ---- ___--B?� S ------------- e_ se", T1- Existing 3x88 75' IintuVetor SgeMncertrendi El =87 W T2-Existing axes 75' IMlhalor Sklewmtlerirencin El =860'' T3-PmpomE 3Y90' EZ Flow Vents EI=8515' Ta-Pmposetl 3'x90' EZ Flow Vance EI=84 35' Kay Road RM CONVENTIONAL COMPONENT DESIGN Hesieenual Application INDEX AND TITLE PAGE Project Name: Wolske 4 Bedroom Replacement septic s ymem Owners Name: Krlrtine III Lyman Wastes Owner's Address 245 N Meadow Drive Hudson, Yin W25 Legal Description: NWl/4, SEl/4,526, T2911, R19W Township Hudson County. St. Crate Subdivision Name High Meadows and Addition Lot Number 29 Block Number Parcel I D. Number 020-1289-20-000 Plan Transaction No Page 1 Index and title Pap 2 Plot Plan Page EtlsMg Septic Tank SpeUllations Page Westing Tank Cerofiatlon Page Proposed SeptlC Tank specifications Page Effluent Fiber Information Page) Valve diagram Page System Sizing &Cross Section Page 9 EZ Flow Information Page 10 Management and centingena plan Page 11 Settle Tank Maintenance Agreement Page 12 Warranty Deed Page 13 CSM or Plat Attachment] Soil Evaluation Report Designer: John Schmitt ❑cnese Number MPRS 223760 Dare: 32/4/2020 Phone Number. 715-960-0466 Signature: In -Ground Soil Absorption Component Manual Version 2.0 SBD-10705-PIN 01/01) SYSTEM PLOT PLAN WDIBke0 mSeptlD System nBYpn F1o'r °°°e°° N T4rH Rohn 4441W. fMIWnOM .VIeN M4F 0.w opleMb m L M- Wn amia A eu�: roj1 Rxxm%14 � W WoxN� Tware°m. iwneB4� 6]&3M raxi 9tae1'=MI Owl 0 Ell p]} 0 b W M 4vMb'.. iNa w44 Vamar6 M+ lei Fowl NNsmxa jAWTxW.W m repgoirYl Mgee.Sm>W noMmr4YYp ErleOng Wa4. GnnN Ex isting EllBedro m Drlwwry Garage House Deck 2 Existing Weab 1250 gel sepfic bank BM2 proposed NSessr 320 gN al lank w/PdyIGk 525 T1 vane T2 112 ------------ T1. Existing 3'48 75Infiltrator Sidewroxer trench El =87 W T2- Existing 3'x88 75' Infiltrator SNerender trash El =89 W T}Proposed 3'x90' EZ Flaw eexn El =6515' T4-PMPSW 3'r90' EZ Flaw trercM1 El =54 35' NNy Road Rhv W1250—MR TANK SPECIFICATIONS ow wawa Wu : r CA51-n-SnL BOTaI: ]" CWER: S Y.WIpE ].' I.D. PPEGS! CIXIlAE2 PoYA IEllilT. M s' mw. r-z ow wan Ds" Yam .r Iwrar7,� T.zm us NUT un Donn .' c. sT-n-s D M Ea r a¢r MUT wnn GTTW w nsx wsc . sc DLTn ro �� YDLm cwnam ze w Dung ; MQW m V. HO nDTuu czrnam Daiwa e . LWWO MMM O' T L AWAnn IDL V ' W77 sync / x c / rwr w svnw mLmrcsuL A (xo rew) Y 41 Lu T" DE901 ro (51RUCRM.LL RSA) mw amo m Taws: -. vow WMW Tnrws ra,rncr w®+ cawwcrz aoLCTs wmm w. ST. CROIX COUNTY TONING 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 addrese)7<s R Meadow Drive located at: Rw 7. se ,/, Section 2e , Town 29 N, Range 19 W, Town of Rvacoa , St. Croix County Wisconsin. Upon inspection, I certify that I have found the mnk(s), in the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly Most resent date of inspection or service / Z- I l9 2-0 Did Flow back occur from absorption system? Yes_ No_ (if no, skip next line.) Approximate volume or length of time: gallon minutes Tank Capacity 12W Construction: Prefab Concrete Steel _ Other Manufacturer (if known). welsh concha Age of Tank (if known): wtWH8 Permit number (if known) 315e47 t Z tr. 1� sa., xanm (Li reed Plumber Signature) (Print Name) MPRS 2237M (Title) (License Number) MPIMPRS (Date Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Semmes) or licensed disposer (NR It 3 Wisconsin Admunistmtive Cade) Rev. 22012 s' z' CAST-A-YK P' CAST -A-%& 0 MRS CF 8U W320—MR TANK SPECIFICATIONS IxY gcmm W r eoTmY r CO" A' x.AWa ' RE zA' Lo PRECAST TF RSw owT W A n r-Y woTx .-r mow xAcr w Vz. o M]LEw. Ar raT»T: zeao ins RAT AND W TLET CAST-A-KAL n T OR Eau sra¢r MCT AND wT T 8M Aw iR1FR RscaRSA. m wTA no (owww STATES 5 CHART) u a Wcm woo P+ I@J1EC LO G oE9OP e'-o' MSAMATfO $qL Ci f TANK W1 E V As O C sn9c / IlgteM / PLw OR SP ea; asTA (Ro �l iMY.: YX LE9Gt1 POo (SIRVCTIRK i8n) T" W CVSI m TARS FOR OISIOI TARS C TACT RE911 LOYAEIE LU REaTwn aT ^ rrcTr CATc 3 FOR APPROVAL uuxTs RYm er ane.'r�+awa PL-525 Effluent Filter PL-525 Filter The PL525 Filter is rated for lO,OW GPD (gallom per day(makmg m one of the Imgest filters m its class Ithas 525 hneufeat of l/16" fdtradon slots. ❑ke the Polylok Polk Ne Polylok PL-525 has an automatic shut-off ball installed with every filter When the filter s removed for cleaning, the ball will float up and temporarily shut off the system so the effluent won't leave dw fork. Features f 1/16" Filtration Slats •atm10,000GPD (gallons per day) [fN'�A� � 10e000 GPD firework) •5251meer feet of l/16"than bon Aeaepn I- PVC •Accepts 4"and 6"5CE1D e)pipe Em A11 Hol • Built in W deflector • Automatic shut-off ball when filter Is removed • Alarm accesxality Ranh, - "Is PVC extension handle f9,dpePo PL-525 Wtallahon. Ideal for residential and rommercW waste flows up to an tors. Fe 10,000 gallons per day (GPD) on/m' fl/16-Pumssm yW I Loose the Dollar of the septic fork. 2 Remove the bank cover and dump time 9necessary. 3 Glue Me biter focusing to the 4"or 6"all flat Rural if scxo ao pipe fire filar is not centered under the access opening use a Polylok Extend 4 Lok or place of pipe to center filter' -- 4 Wert the PL525 fills into its housing S Replace and xture the septic tame evvry ® e xef Wumsuadrata PL-525 Maintenance The PLAZ Effluent Filters will operate efficiently for sever [ year; under normal contracts Note requmng cleaning It is recommended that the filter M cleaned every dine me tame is pumped, or at least every three years. Iffire installed filtercrosauu an optional aarm, the owner will be notified by an alarm when the filter omeem needs sarong. Servicing should be done by a cerWied ° allow cork pumper or msaaer. mm.nr 1 Iacare the outlet of the sepba 1tic nk ant tal 2 Remove bank cover and pump cute if necessary 3 Do not use plumbing when filar s removed 4 pull 3 cerendge out of the housing 5 Hex off filter over the septic tank Make sure all solids fall back Into Spot tank ,_ L 6, lnxrt the filter cm mudge back mm IN Musing making auretlefdhrspmpertyalignedanammpletr3yn rerkd. pyym4ubaeeIt, iuAl. a<..P •sour oon, 7. Replace and metal septic tank cover. aeseunFamArviW aN.wm. mmmumiI. Rollick, Inc 3Fainfield Bud Wallingford. Cf 06492 Tall Free RA]65950 Fax 203264.8514 www.poly[ok tom Page 6 n "a ,—�—— n.wn u.wl. In.eULv pewy..w body aws.w /suevuTeE.nowr .t �S ACCESS GP RffRCM Mvt9t RISER RBE vKVE01REC110H MDF The Bull Run Valve" 1s ECIpnM ro dva Haws M uqK fiNEa or systems In addition I to Me most public health al bnpa (OIrtPMf alt rna rosier Ins a avail R Is Me moat tewat rdis Rateoral f gIIPCQf alternating aTim available for dly no wastewater disposal war applications. Tee the eei es Mak-p n mnbtt venal wastewater rlUe to Me value's Mang o r from el eperage fired toanrirtlrc The Mange over hcss an a Min a flab to anodesen be valve Mw In ten Men f IRNMI ft a by almgy diming Me valve NXMw[ alppMp or conlnR wM wastewaer p�W Ase NoNo Nel No] Valve VNI Poskm Y ai g Oro S ee E Timeas TW (T L w1aR BULL RUN VALK Pod my EAST COVER BULL RUN VALVE KEY 22- SRVKMS wIL RUN VALVE Ken 3E- nVidi auu RUN VALVE KEY AR^ The RUN Run Valve Is available In a- Each e0 pvc and Is sultda a wherever septic blapmal ryrtems rt usM - In wmmvdal, Industrial, and residential applicators OPERATING THE VALVE The direction control handle Sai be M[ pMMlcally W direct eTuent to one or Me other Of OND Seel ONds. After removing Me screw cap at Me top of Me tlwr tube, the valve handle can be tumM with the valve key NrnIMM. BULL RUN VALVE Cofnpiate Valve Kit Contains t. Bull Ron Valve body 3. ]B' Valve Key 3. Riser Cep Adapter <. WeteMpht Access Cap BRVCIRISER -d" ADJUSTABLE TO IN" HIGH IN -GROUND GRAVITY DISPERSAL AREA Stepped Elevation Trenches with EZ1203HP Bundles wleaer conereia 3-ft Trench (down -sizing credit) 1250 py 320 �I y � nno.n Ene, u..Ko.o- Polvlok I 1"wI®'n am.,m fsm.tmaec 525 war go -` TVPI CALTRENCH Prnvweminlmum3ft t�� — — ..�• CROSS SECTION VIEW separahm between he, ' (No Scale) Highest Trench L est Trench (m app&mbs) OBSERVATION PII£ OETAs System Oevaw - 85 15 ft, 84.35 fl, ft, ft, ft srd�t 1 �.en�I m� TYPICAL TRENCH Islwx loslbn WlNMlnWat lxps cmmmonmgla•gexl ..,..,-....._,.. PLAN VIEW 4.0 e_..a w..+...,..a n (No Scale) Penoratetl Lateral Pom,grc 10 ft o.re l(m�w0 Ib q — _. ::=:—,_ _ _:_::—_ rA=30A 11 --- ----- --f — — — — — (Womb 0 9 90 m w INSTALL PER TRENCH: EZ12ftp Bundle) w eaap O 9 16fl WMIea�Spff EISNuit=450 q= I�Mlreeuor Sssmme lrct D1 uWlpwamnmm.rcrwirzlmnimu.. i 2.— Sft bundles @35ff E�nx=D M I A =PrtgpeE ass .460 ft Regmrre perM nfiltamAran=MT fl' D6bibulon Mebotl: x 2 trenches = Proposed Total EISA = 900 fl, branched r anilold 0 Installation Instructions for EZlowSystems In Wisconsin ............................. 6................. Wrsmnsn Oepdment a Cp+oastrce, safety and Buamgs omsm, To renenxtl the agetifrc.ucns and/or p4ns In this product and delemonetl it to be In canpo5a+ce arty itapays Comm 82 Mragh 84, YAscaan Adman. Corfu, and Congress 145 art ISO, Wrsc n 3rlri NI soles must mad tle $ge, 8 So"Il e b 1 cocall 6Jsa6Tbw defenses as ro1W n kW regulahns The a[pared poducls are I2OSIH (31 WMks hen pope in coder borode in 5or 10' lengMO any I^.0,14P (b 17 WrMa hen urban each bundle on 5' for t0' Wool. A single pope bundle contains a bur vch pMorded pope sur- muMd by EPS aggregate and is neltl together vnM poa'y- Shithene rei A single aggregaN bundle counters aggregate a* fora Is ho together with payelnykne natural Matadala and Egulluna d Needed • EZnow Sunda, • EZllow Geotexnle Fabric • Uflow Internal pipe Couplers Pope our Hader and Inlet Bscklue/Excavator mMnstron lns for inns The mxwdmns tut must pep of Utldin praauns are limn blow This product must a In 82 through m azcortlanu into slate rules dennM m e and C Comm B4 and n &, isconsi.un Act my IS w soda. and lung m 145 aria 169. Wscent cuton tits,. ss well as Me dory eealM dpdmnl's eurren145gn maraud I After the fiscal treats deparlmryA hasdelermval smog, cmfrguralan, and Iaprd for He EZNox systemsslake or mats mlh talent the localm of trenches and Ines. Be carets to set correct only Imed ptae, Meer Ire Or F6- bWLM Ipr and bench Mtlwn dNilens LFlore msto IeWn of ptae Wrdles - 2 Rennie plash, EZNow shiµrg Wgs qwv S poll Sunday In the threshold) R<mom any plastic begs in Me trench before system b covered 3 This product must have geutexhle Fabric Met meets re, quremente of s. Gahm 8d 30 (6) (g), so Ader Cade, instaod directly on by of the product and eAendng down along the sides of the product to a paint at least six inches from the Whom of product a When Installed In a trench, the trench should he dug to a val of 36 inches Thrsnotonlysaveslabormesceve - any, but Was proses bather Md-beanrg capacity after heckfillmg Is Ounces t%EZf ,ow - 5 The Absppdon area SF) necessary 10r a grain site shad he sod baud on ma.rmum daffy sewage Now, (GPD) ad the Permeadllly for the uty It cedmn pitere 6 mN, Me Oil smog can W us r m Wrscommn, resulting in a 40% snadar dranM1dd 6 Woe EZbw bumkfs) in the Ullow wn6gun4on ap Pond by system desgn permit specfied Iw the prlcu- Hr sod The Ion or cenlerrnosl buNks cmraneg to are jarred and to and wM an mtem pope sager Aay additional agyregate my IauMes Ibat may be reguwN. should be noted fill the and, eggrgate-aYy bun- dles and do not salmis any for of carccfm 9 The has o1 each GEO cylinder contains a tiller tapm p e- marnfacturdrnbe entheneH1hgandaggmgete The tabor as msedN to premnt sotl arsonist The mstader seal make sure the the GED is posnlioned upward and Is dcontact wild the fabrc Ehercd n the adaount cyen- d er nature backNllmg. B The EZnow Oroa rrold Systems should be installed in a howel trench in all directions (both across and along the bench harem) areshould follow the conmm pulse grwnd surface colossi (uniform depth), min ad continuous adpmng 10.1wt ryf nducal Wndks Closed end to end, wM central buMea distnWWn qpe inlerconnetled, vnmout any dams, slepdovms or other wale. xlqu 9 The hence top shall [e praise! smh Ihat water Fall not plea do®r sho be medN or ,added rmmMiatey, after compehm t0 rMUw eropon. 10. EZnov. EPS species are bade sod sari fit in cursed 4enrM as may be who ssary to and trees. W.iders, or often Mstcks I I EFTS aggregate is lighter than wale, NtteM4 it might de a becal that natural bucyarry forces would lend to use Uflow Assemblies to Moat our of ground Hren pxMrg ¢ins Field erpenence sus shown, however Me this a not a forr Ones systems nave a minimum of 6- o1 not cover as recommended by manuladmo 120311 (firs k " Jan � Eller MartelXyl ............................................................... 4..... F . . . . . . . . . . . . . . . . . . . . page 9 PAGE 4 OF In -ground Gravity Management Plan IMPORTANT: The comer M the ingmund erectly symam shall be responable for its perpetual ap rral and maintenance pursuant to requirements of SPS 302-384, Wsc. Mmin. Code Pursuart to SPS 383.52 (2), Mac. Admin. Cede, retardant shall be considered a human heaM1 haseN If not maintained In accordance Mth Mis aVemvM management plan Furthermore, all inspection and maintenance acbveiea shall be performed by a re llwared POINTS Maintainer In accordance with SPS 383 52 (3). Wil Admin. Code Maximum Dispersal Area Obberal Limits: Design flaw= 600 gpd; BOD55220mgL''; TSS5150mgL''; FOG 530 Mi4 Inspection Checklist INSPECT EVERY 3 YEARS 0 type M use age of system • nmaance factors (is Odors, user complaints, etc ) • mechanlcel MNmnI (I e, pumps, val satchel floats, etc) • material fal h a, tomes, breeb, corrosion , etc) o scilds volume In aneemb¢treaenmrt timus) and any dgnbution appurtenance(s)(I a, distribution I drop above) neglect or Improper use (I e, exmeding design cawcides, prohibited agates, etc ) o anent of wnding in Eidribudon call prior to dosing o dosing lrtegulerllles - if applicable (ie, pump recycling, float switch social etc) • ethical components - g applicable(Ie., wring ,connections. switches, commit. timers, slams. etc) o ditlbbudon lateral slatarel odece plugging (measure lateral fund pressure—wmpereto design specdwllpn7 o surface dlscharpe W affluent or awards back-uo Into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Smi atl dose tanxla shell be pumped by a canted"age annual opermor licensed under s. 281.48 Wis. Stetll when the volume of wilds In Me lank(s) exceeds ons4hlyd (113) Me liquid volume of Me tankp) or s required by ImN ordinance. Olapwal of contents shall be pursuant to NR 113, When. Admin. Code. o Effluent glterlal shall be Irrelevant every 3 years and shall be Leaned when necessary to remove any momulatetl an wilds according to manufacturers speclllcatins A serviurg pwlod wil Masys be greeter Man 12 ths System maintenance reports shall be submitted to Me proper local government unit In accordance with SPS 383.55 Wise. Admin Conte. Report any component failure or malfunction to: Name 0Indradull or company Schmifl& Sons Excavating, Inc. Phone. 715-760-0486 Loral government unit St. Croix County Community Cevelopement Phone 715-386-4680 Low gmemmem unit address, 1101 Carmichael Road, Hudson zip: 54016 My resolve pan of mis system shall be rental replaced or removed pursuant to SPS 383.51 (1L Was Admin. Code Repalr or replacement of failM or maMunoonmg wmnn nts sball wmply wit SPS 383, Wlsc Mmin Cede No product for chemical or royairal restormon of the POWTS may be used unless approved by the department In accordance with SPS 384, Wisc. Admin. Conte. Contim encv Plan M the evert mat any filled sea m component ofthle POWTS cannot be repwred, it shall W replaced rural to a plan amended the appropriate agency for review and approval. Abland lrr.ground dlepemal component may be abandoned and replaced by a code-coml drspereal component In a pmdetemrined area of Unable soils System Abandonment If use ofthis POWTS Is diewer med, It shall be abandoned In accordance with SPS 303.33, Mac. Admin. Code. Page 10 MC C TANK MAuTrEmANCS AOSSSMSNP AND OWNPRSI(B CERIl7CATlON POSM Meiling Add= Pmpuly Ad&= % YS )1✓ Neff da df el.�t pyrmy m'a mmwmq atyf a /2o W- A 41 .'v Poredm=aogrm N®4c o 2O • / ;I p %r o LWAL OSSCUMON hwaty cocatiwt u/ w. SAY. sm?6 T JNa—)6-w.To mo( ✓J c mw . SeAvidm I: S%i.'N'I d Wt!- CatGrd Sv[vey Mep 6 Vol®e . Pew 8 wu=dy nada.SS-ao z3 voi®e ���6. P+p#.�/S, sPwbomeoymgw Pd lmaw EgAc(A ym 0w mar•--�..=wx.,x .Peidr: rm.Smddecp4bi�� `v+ �x�da.u,msewb�. wm�reae�.m,m.w� vb�arowmm.gmm m mm,a m se cmn�ea�mm.im<d yabmmemdbr e at.�o-,�e�a.vaca..r��ae�a.eo.�acc.�wc;, �a�rneadx.� v.e ab�da.R,vdardm. ma.mxm�;m;.ebrimw--+�d�=.s�•,(��me� «t64buam,sscs6yde'igamvadp®u¢mlhlkpYmm[d1LmlFawomr;Swe dwo�omm- RMgom �tdrtr�'.4d�.)d�ha6am®erm�ima[4ayiedmLe�edb6eSCaviQmM1f LmbLOGmvimm]0 dr. � !/5lQrP LiTUBE B+ARfICV\T pA�p OV��It'iTFTGTTO\' [(wdaaeCy dm m.em®emaa.mmmexmm.emd.y (wdlmwb4e I(.m).m(bm)aboom(dd Y mly devbbd.6wgbr AOr: d.wwdrydmtsmfdmgce4tadDrofe OPT¢ utinaoaArecevxr y,� "w'Aroamemmamwm.ebrrcwii.aaaava�baoc�+aPmnya.zo.et•••«• ••fvd¢Ee wtW WIC vpN� mammy Wamwreme6 &Rcgtl aUmdca • r^PY d.nmdGM m.aY mg6nlermck mWc in 3c v.mny GeL SANITARY PERMIT APPLICATION mM w m D+Penmem Wona/n m Commerce I ..... rd ads RNR 83 05, Con ADD seeks IMMAge �.AWN • Attach complete plans(to the county copy only) for me system, on paper not last they�.� than B la x Ft nin cap ✓��� ®! • See reverse side for instructions me completing this application st "t, P5li - p(� �he 'ar ,aA rm Thomfoates, We amide maybe used brother overhead agency mourams �� Ivrivaaylvv.: rsm(ferlu Plan 10NumberStatle I P F R -PL L .?f T 11 ,N,R E(or)Q yr eme d R/6Jtu jF Itn,S ` m th Imm p: e Work Number Cn. zip cMks F N t Odge Or gillnmbm r8! Su bo union Name or cdd N am ber . ofag F.R—L%�' 11. 1 yet Last :(Check one) ❑Slate Owd n xeVa�7—A �l J viar,0F Public . I or 2 familyOwelbn No of bedrooms lJ"I/ti5I OW tntappbl a eksml III. BUILDING USE: (Itb„na,ngty i,p^,bi.,ch rkzP rr©ua Q&. a]. /9./v/sC /.;t8 —2,O 1 ❑Ap.rtm<nt/CwAu 3 Cl Assembly Hall 6❑Medical Faahty/Nursing Home 10❑ Outdoor Re[reaUmal Facility 3❑Campground 70 MerchaMrse. Salesi Repam It❑Restaurant/Bar/fining 40Church/School 8❑Mobile Home Park 12 ❑Service Station/Car Wash 5 ❑Holel/Motel 9❑Office/Factory 130OtM1er.ei IV. TYPEOFPERMIT: (Cheahonlymalloxcri Checkboxpnlme9,Happhadole) A) I ptev 2 ❑Replacement 3 ❑R<placemmtof a. l] ReconnMlon of 5 QRapsrof an - _ --system kst<m Tank Only - ExisNngSyslem Exi Ling SZS M 6) ❑ ASamtary Permetwaspr<vously issued PermRNumber Dat¢Issued V. TYPE OF SYSTEM (Check only we) NM-RNunaeddshrbu M1on sunrtd dsMbbon FNerw"od Other 11❑Seepage Bed 210 Mound 3l ❑Specify Type at❑Holding Tank 12,0Seepage Trench 22❑ In -Ground Pressure @I]%t Pnvy 13 ❑Seepage of 43(]Vault Privy to❑System In Fill VI. ABSORPTION SYSTEM INFORMATION: I Gallons Per Day 2 Aburp Area 3 Abwrp Area 9 Loafing Rate S.Perc Pate 6 System Elev 2. Final Grade Req netl liq hl Proposetl lsq fiJ (Gal9tlayJls .h) (MinnncM1) Elastic n bOo %6D 8) 88 VZ-Vj' 1�• S' ez-eAt Feet Feet VII. TANK gam, Srnu biaea fr aea INFORMATION an New, ExxM1n Total Gallons Rof Tanks Manufacturers Name P (.e so oreu rn,e steel Nbksr. you her, Abu Talks Tank Tank oexoN, 1200 I✓(5SR [� I ❑ ❑ ❑ ankm Iwn Cbember ❑ ❑I Li I❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume respondbeiter for installation of the create sewage system shown on the attached plane Numbers Wme (PIRA CARS LaoKn F 1 natur aumbee,5i (No mall Reverse unessA her P69 >a6 nn6OY 3J3a ass Pb,ref AeNessl2tm uy caks "/—.i3mb Rw"rr Om2 .11i IX. COUNTY/OEPARTMENTUSE ONLY ❑Oisapprov¢tl s rtf �n�nr w.m Ri a a gAgemsrenamrelwstamprl plumed ❑Ativeer GOetermmaaon j X. CONDITIONS OFAPPROVAL/REAS NS FOR DISAPPROVAL: Year andDawmm, D'sim mama PRIVATE SEWAGE SYSTEM Be" Buuampi0imabn INSPECTION REPORT GENERALINFONMATION fA"ACH TO PERMIT) Perwnar IMomvlbn yw prMce troy W used breemnMry gxpmJac Prn'auy taq a 111 (IIImIf OLSKIee KRISTINE ERJ N ace , N P)DO I T TANK INFORMATION ELEVATION DAT/ clout ST. CROIX nay Pi 15847 ,r<020-1289-20-000 R9p00219 TYPE MANUFARURER CAPACITY STATION as HI FS I ePtie W mE.vit 125-o Bench 2 36 IO1 ICrp OOPn9 AL _ Sm "(.O 101 Aeration Bldg $"at 11-51 9e.9 Holding &N}Inlet II. rj0-71 TANK SETBACK INFORMATION (vii Outlet IL 90 SL TANKTO P/L WELL BLDG 'V. n�i:I < 0.0Aro Dt Inlet ptia 1 ti y' NA Dt Bottom Donal NA Harder/Man ly of Aeration NA Dot Pipe K d Holding Rot System I5w♦F Q PUMP/ SIPHON INFORMATION Final Glade LDj 9f 3j Manufacturer rel GPM gl.W"La4 a 9 FY 93 L Model tuber TOR Fnction S st m TDH Ft Forcernesin ng0 but flour SOIL ABSORPTION SYSTEM BED x n 3e 8,1 0Omm�i Pep nP/L PIT 1 Dubai x Olt mole as nrao,mn SYSTEM TO BLDG WELL LAKE/STREAM LEACHING Manu atturer SETBACK INFORMATION ype CHAMBER xum e. sane a' 0. ORUNIT DISTRIBUTION SYSTEM P¢nnTn era a �an, bi eyme 31 Spacing 11 1nfiI I �rYp vin°'rrr�a at SOILCOVER K Pressure systems only ru Mou"Or At-GradesyttemFOnly cepmo.<, r ea<msoea<a mad �o.<a ❑vea oam ox, COMMENTS(include code discrepancies. persons present, etc) LOCATION: WDSON 26.29.16,NN, SE T 5 N. M AWN DRIVE (� W, A iI NoF y ata e Q A3f�R-i�v Plan ter F^w.l 710 if f s gmredi ❑ Yee MTV Use other title for additional m(ormaUon SM1,6710f1fa t ' -;'T ST. CROIX COUNTY ZONING DEPARTMFNf AS BUILT SANITARY REPORT Owner LIiA� /� - 'F0 —C—�—�,lY-S31K. r Address AXX cT RO N City/State .M�OYg t'tlo/b INC, c Legal Description: (-1,elq,g raam.v� � `xF Lol� pluck Su division/CSM 9 Y, /Lw'A AL, Sec 2A-, Ta4 N-RAW, Town of }iJvan PIN k 7n 1 >YX 9- SEPTIC TANK — DOE CHAMBER HOLDING TANK INFORMATION: Tank manuf ene r W / C.f , � Siu ST/PC 12vVO Setback fmm. House * Well /.9iL Pump manufacturer an/ is Alarm locelion (HOLDMG TANKS OMY) Setbacks: 60 � Service road 4 Vent to fresh an mothe Water Line Meta location Alarm location SOIL ABSOR�yiEM: Type of system: �,nDac Width —3 Length .�87}jjvmber of Trench« Setback from: House Well _ P/L —_ vat to f wh a"n intake ELEVATIONS: Description of beoehmark Xco.. P L, Elevation 10� 36 Description Of etnmate benchmoth 3 c ,3 Elevation 100 S I Building Sewer ST/HT Wet 90 76 ST outlet, 10Sf PC laic[ PC Bottom Header/Matmoldbq NI Top of ST/PC Manhole Cover Distribution Lines ( ) 89 1/ / O ( ) Bottom Of System () TO it () ( ) Final Gmde O ISO O ( ) Date of installation §crnnttt''nJuJfber / /� '3/ S Qte number Plumber's signature f�4 �plan �e numb¢¢ //tJ��+fu(.Aate l I faspeetor tTnnlne pW pkn a NOTICE: Please provide (lie following: A plan vices sketch showing cvcrythmg within IUD feel of the system Two horizontal reference points to center of septic Wik manhole cover Show alterratte benchmark, if applicable Bv�e .a4JO� $0 INDXC 111 NORTH ARROW I 11,^a �fI 13 be7 too t7/ DD0� EVALUATION N REPORT PI'm W__s Cs-r.49, -38a 02069 page _ I as 3 SNmin BtllTulnq Inc Fnem mnpRnepolen npePoo WG{W! 6Mr nine 0 Counry 6y Cr01[ "Not aN ndlmNMb nq im IBMl bnmuard NIsecape mI or El en w 'N lou0 1104III b wei mad rtal I OxPIxB&30.000 Plape 1II Information. - r ay ee^ �am.p sw. �� !2 9 Zo nnoenv� RmPom La.Imn WobM, Lyman 6 Kni too lol 1 SEv.. sM.npY RIM Rcgnr Cori MI asomis I BIM: -SI I orCSM - ]<5111 MYOOw Drrve - - -- -buu 29 High MYEMn III ary zO Coal Gnme Norm, Cry III Trim rair Rou Hudson WI Sa016 71S41P0026 HlgSom ..I WMOn.-- e uamu lbw rewcInni Ou u r a CosFees, nle 6W VO ammo.mere Ior nmmeaelotq parmtaoNwes &I eM1(6aLoam) FWnswaMno IFHP Camara mmnnln 4enolwe n.naunaele raatasirelllmrsyvbd.mlaarpldgm lr wseae saslsm NnamnblMlWR-�Mm 'ara^me^dni .Oast/ HOouan 61.351a free ,rou eraNmmmemldva Mwam Saademan ty. 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BOD..]n nwa and IN c3i CST Name (PI ... a Fnml CIT Humid iTOMBI s<AJ smmlil �eu� Sxvxv uamea -mmul NJI III Ire ase 0111 neeneo o TINNIII Ni 1595 721 St NV Rlrnmcna, wl3.on 12h1 p 715.780.I97a III One" WOlzkq Lymen & Knood" _ _ ftml tD# 020-12892CAMN _ _ page _2.. o1 3 37 E¢anm.a e°nng .... .un.m... - � rem' w>+_ b SdI Rml a ndmlRem o.dn u^ �G Renm Mrongnn Te.1or. blmuun �rrg m av4nBouMery pods In Ou ba Cod Cabr Or as 56 _GPbfl' seer 1 O15 1W-3/3 none 9 2mgr Inner az M 0,6 1.0 P 15-3510yr</9 none d 21nedt Mir PAW Inn 0.6 LD _3 _ 3545 10Vr5/6 clone gns Osg ml One- -- 07 16 q 45-105 10yrn/1 none grs ON ml --. ...... 02 16 41, ❑ BofiryP Bonn PIn GrnuM emlve Yev a Down to amine lader _. n BOAP{ =M, Re on Cannot Command Color PMueOmcryllm enure SWnun comm ru RounMq Rrols Marvell Ou Sz Conl Cobr Or Ba. Sn-- _ _Gorm. ❑ added Pil Olound amlem she _ fl PopintallmlIndfig m $pl bmosson Rai XBaaon Cepin Gdnlnenl CaN RedoR Iplon Tetlun 6l I Conmsdw Boundary Rings GPOIM Munxll on as Col Cdnr Gr So Se _ Effle 'EMuen1Y1= 0130 5220mgrL and T55 ab else "I •E1gueM1 "OD. R SO myLagri. 30 mqL TAe Degnmrml eum oneNrnl opechu W prmrnd end cenpim r Kin tiUaz ices ry 110 mulenal In an game, denied douse mms'I d'di'mm 'd OMX 266.3111 nrll'Y 61gi61 X"' dT St Croix County, Wl BM 1 100.0' Top of NE lot Corner BM 2 100.31' Top of house foundation at upper Levei (Not walkout) Outlet Pipe 90.58' Legend Septic tank manhole cover 93.22' (1 riser) O WELL K NNEE •vvrvouv X015E O Rhv B1 88.35' gve.n B3 8.3T — SLOPE 10% B3' RTH ME SYS EL DRIVE HIGH TRENCH 8515' 08'� � LOW TRENCH 8C.35' _._. BI E4 N 42 5T 1)J' Ir l % w 151' i6 R/W KALV RD