HomeMy WebLinkAbout038-1194-00-000 Wisconsin Department, c;orrxnerce PRIVATE SEWAGE SYSTEM Co y
' ` safely and
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INSPECTION REPORT ��• Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Sa 38 891 itNo.:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)).
Permit Holders Name: ❑ City a Villa a Town of: State Plan ID No.:
C Collova, 5tar�raine Township
CST BM Elev.: Insp. BM Elev.: BM Description: '` Parcel Tax No.:
O r �' 2 PU� 038- 1194 -00 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark 2 41"q- p2 . . b
Dosing It. BM rf "
Aeration Bldg. Sewer 'd (03 �'S ( q
Holding St / Ht Inlet ' (° •�� �b
TANK SETBACK INFORMATION St/ Ht Outle
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic 5 $ $ NA Dt Bottom
Dosing NA Header / Man.
NA Dist. Pi S'
Aeration Pe ro. S•.SS��
Holding Sys • l 0 3
Bot.
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand ove 2 •,�� I ov ,a r
Model tuber GPM
TDH Lift;. =- Friction System TD Ft
Forcemain Length Dia. Fi Dist. To Well 1 :1
SOIL ABSORPTION SYSTEM
I ENCH Wdt h Len�gth N O Trenches PIT Of Pits Inside Dia. Liquid Depth
I IME N
Man ure
SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING _ S
SETBACK CHAMBER M Num b e r:
INFORMATION Type O f OR UNIT 'e
System: V, - 45 , 1
�
DISTRIBUTION SYSTEM U4.5w
Header /Mani pl K Distribution Pipes x Hole Size x Hole Spacing Vent To Air Intake
Length a� Dia. Length Dia. Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Oepth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes C] No
/ COMMENTS: (Include code discrepancies, persons present, n ec ion : l l oZ I o Inspection #2: --
Location: 1350 218th Avenue, New Richmond, WI 54017 (NE 1/4 NW 1/4 13 T31 R1 8W) - 1331181005
Pine Acres -Lot 10
1.) Alt BM Description = j e� t w-k4o.. o
2.) Bldg sewer length= Ig
- amount of cover = > 3C a S oT
�1•er. �- .;,vva�,e,Y�,p•
L> � css•.S \
P n revision required? No 1 FiU
Use other side for addition ° I ZroD J
SBD -6710 (R.3/97) Da a in Signature Cert No.
Sanitary Permit Application Safety & Buildings Division
lVi In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave.
See reverse side for instructions for completing this application PO Box 7302
sc onsin Personal information you provide may be used for secondary purposes Madison, to 7302
Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to cocoununty ty if not
state owned.)
Attach comp p lans (t t h e c ounty copy o fort stem, on paper not less than 8 -1/2 x 11 inches in size.
County State Sanitary Permit tuber heck if vision to revious application State Plan I. D. Number
1 lC
I. Application Information - Please Print all Information 7 7 Location:
Property Owner Name Property Location ? ;�
0 • c D I / 1 `b yr'G � ts_.� � ��j � � * � /4 /V�l/4, l r T / ,N, R/ (or
Property Owner's Mailing Address Lot Number Block Number
s a � o --
City, State Zip CodeP urpbgr4; Subdivision Name or CSM Number
I1. Type of Building: (check one) . r' tt ❑ City
or 2 Family Dwelling - No. of Bedrooms : ❑ Village
wn of
❑ Public /Commercial (describe use): nt1R
❑ State -Owned
\ Nearest Road
7 Parcel Tax Number(s)
1I1. Type of Permit: (Check only one box on line A. Check box ' 011", lin B if plicable)
A) 1 ew 2. ❑ Replacement 3. ❑ Replacement of 4:- 5. 6. ❑ Addition to
System System Tank Only Existing System
B) T Permit Number Date Issued
)ELA Sanitary Permit was previously issued
!Y,eType of POWT System: (Check all that apply)
Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V. Dispersal/Treatment Area Information:
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed Ra %(Gals /day /sq. ft.) (Min. /inch) Elevation
v �/ '
VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
❑ ❑ ❑ ❑ ❑
VIII. Responsibility Statement
I, the undersig as sume responsibility for installation of the POWTS shown on the attached plans.
Plumber's N e (print) =s): MP/MPRS No. Business Phone Number
Plumber's Address (Street, City, State, Zip Cod
e"�2:)e 192- �., i &e&VA-4,Al
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signa re (No stamps)
Approved ❑ Owner Given Initial Adverse Surcharge Fee) CID
Determination Q , �s� , 2 -, 2 cro l
X. Conditions of Approval /Reasons for Disapproval:
-� `r P
SBD -6398 (R. 07/00)
j31/R T PLAN
PROJECT P.C. Collova Builders InADDRESS 705 Countv Road E Hudson Wi 54016
NW '1/4 NW 1/4S 13 / 18 W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 10/24/01 BEDROOM 3
CONVENTIONAL >00( IN -GRO D PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22
BENCHMARK V.R.P. Top of 2" PVC Pipe ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL »H, R. P. Same as Benchmark
SYSTEM ELEVATION 95.5
B.M. 201' Property Line
jL Sidewinder High Plans Designed Using
Capacity Leaching Conventional Powts
Chamber Manual Version 2.0
100'
34 Grade at System Elevation
Ve
a C
60' B -3 5 ' 1 -4 <<n J ¢
a
M 60' B-
0 '
B -1Ven -
10'
10'
Pro 3
Bedroom
House
218th Ave
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of
the cells.
4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
5. The owner agrees to save this plan.
6. Do not plant trees nor park nor drive over system.
7. Watershed is to be diverted away from system.
8. Discharge into system is not exceed those required as per Comm. 83
Contingency Plan
1. If system fails, determine cause of failure, use alternate area and install new system or
install system at a lower elevation.
2. Replace any other failing components as needed.
Plumber: Shaun Bird 715- 246 -4516
Shaun Bird #226900
Sanitary Permit Application Safety & Buildings Division
Y In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave.
VA See reverse side for instructions for completing this application PO Box 7302
`�COnS� Madison, WI 53707 -7302
Depar 'ment of Commerce Personal information you provide may be used for secondary purposes (Submit completed form to county if not
[Privacy Law, s. 15.04(1)(m)J state owned.)
Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size.
County _� State Sanitary Permit Number ❑ Check if revision to previous application \State Plan I. D. Number
I. Application Information - Please Print all Information ;' cation:
Property Owner Name rty Location
114 1/4, S 13 T3 I N, KZor
Property Owner's Mailing Address Lot Number Block Number
City, State Zip Code Phone Number Subdivision Name or CSM Number
II. Type of Building: (chec one) �� El city
I or 2 Family Dwelling Bedrooms : ❑Village
❑ Public/Commercial (describe use):_ ` - w - Town of
❑ State -Owned � cS
Nearest Road
/+V
�do P um
III. Type of Permit: (Check only one box on lin A. Check box on line B if applicable) 19.31. 1 4 , 100
A) 1. WNew 2. ❑ Replacement 3. eplacement of 4. 5. 6. ❑ Addition to
System System Tan my Existing System
B) Permit Number Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
1 I`{ t/ �
V. Dispersal/Treatment Area Information:
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application , 5. Percolation Rate 6. System Elevati al Grade
/ Required Proposed Rate (Gals. /day /sq. , (Min. /inch) / El vatio
/�o :� �5 / Cr ay f . c� 7
VII. Tank Capacity in Total # of ManufacturerP fab Site Stee er- Plastic
Information Gallons Gallons Tanks on- Con- glass
New Existing cr stptcted
Tanks Tanks
VIII. Responsibility Statement
I, the undersigned, assume responsibility for installation oftheFQWT shown on the a ched lan
Plumber's Name nnt) Plumber's Sig a (n stamps . P PRS No. Business P e Number
do
Plumber's Address (Street, City, State, Zip Code)
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued I nt Signature (No stamps)
proved 0 Owner Given Initial Adverse Surcharge Fee)
Determination 3 a
X. Conditions of Approval /Reasons for Disapproval- /
yl�b is b�sti i ( � � J Soi� Q �°OYt�c�h (c/ I�wJj�$f�crsc�h +vs 30
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SBD -6398 (R. 07/00) CC0 /i
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I isconsin- Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3
Division 4Safety and Buildings in accord with COrt'tM 83.06, Wis. Adm. Code
- Attach complete site plan on paper not less than 8 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference p 'on and • �� o K
percent slope, scale or dimemstons, north arrow, and lod�nnto rarest road. parcel LD.#
APPLICANT INFORMATION - Please 1 `a // infWpal dn. Pendin
Personal information you provide may be used for seco q rrraer 15.04 (1) ( )). wed y Da�
�Grposes
e
Property Owner . property! ion
Lakes & Hills Development - r c , . 4 t. Vt. 1/4 NW 1I4,S 13 T 31 N,R 18 W
Pro Owner's Makin Address Subd. me or CSM#
Property 9 Lot # Block # Na
� � �
X e k. /& State la1 -- Pine Acres
Ci
State Zip Code Y ,PhoneNurl4M)n dime Town Nearest Road
Z fr- �ta,� A A ll Vol e L I 218 TH. Ave
New Construction Use: Residential / Nunn ms 3 DAddition to existing building — ---------
❑ Replacement Public or commercial describe
Code Derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd/fF .8 trench, gpdfftz
Absorption area required 643 bed, fF 562 trench, T Maximum design loading rate .7 bed, gpd/ftz .8 tr ench, gpd/fF
Recommended infiltration surface elevation(s) 95.7 ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material ------------------- - - - - -- Flood plain elevation, if applicable ---- - --- ft
S= Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank
U= Unsuitable for system ®S ❑ U N S❑ u ® S❑ U Z S❑ U ❑ S ®u ❑ S® U
SOIL DESCRIPTION REPORT
Bonin Horizon Depth Dominant Color Mottles Texture Structure Consistent Boundary Roots PD FA 6 11
g# in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. h
1 1 0 -11 10YR /3 ------------ - - - - -- 1 lmsbk mvfr as if A tp
2 11 -21 10YR4/3 ---- - - - - -- 1 lmsbk mvfr gw lvf .4
Ground
3 21 -40 10YR4/4 ------------------ --- __ -_ -_- 1 lmsbk mvfr as - - -- 4
elev - - — — —
99.7 ft 4 40 -60 7.5YR4/4 ------------ - - - - -- cs osg ml gw - - -- .7 (,
Depth to
5 60 -89 10YR5/6 ------------ - - - - -- cs osg ml - - -- - - -- 7 ! 8
limiting
factor
>891 fv s'� .ead¢Nelo
Remarks: 1 1 kv +� - --�_ t 9, e x
•-�o twt • -�v So • (t 44- 4,`k, r 3 s�k an, .va#�1vs
2 1 0 -11 l 0YR3 /3 --- ------- -- - - - - -- 1 1 msbk mvfr as 1 f .4
2 11 -24 10YR4/3 --------------- --
1 lmsbk mvfr gw lvf .4
Ground 3 24 -40 10YR4 /4 - - - - -- 1 imsbk mvfr as - - -- 4
elev
99.7 ft. 4 40 -67 7.5YR4/4 - - - -- cs osg ml gw .7 .8
5 67 -90 10YR5 /6 --- - - - - -- cs osg ml - - -- 7 8 �,
Depth to --- - - - - -- - - --
limiting
factor
Remarks:
CST Name (Please Print) Signature: Telephone No.
Jacque Hawkins QAAt .gL_ , - �� I - e" y Y
Add ss a l Date CST Number Ref#
�' 4/8/00 7 382
l
:0koPERTY OWNER: Lakes & Hills Develop —t SOIL DESCRIPTION REPORT Page 2 0 3
PARCEL LDJ Pig
Horizon Depth Dominant Color Mottles Texture Structure nsistence Boundary Roots GPDtft=
in. Munseil Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
3 0 -12 10YR3/3 - - - -- 1 1 msbk mvfr as I f .4
F2 12-24 10YR4 /3 ------------ - - - - -- I l msbk mvfr gw l of .4 b
Ground
elev 3 24 -39 10YR4/4 ------------------ 1 lmsbk mvfr as - - -- 4
99.3 ft. 4 39 -60 75YR4/4 cs osg ml gw .7
Depth to 5 60 -84 10YR5 /6 -------- - --- - --- cs osg ml -- -- ---- ?
limiting -
factor
>8411 03 — - — - -- - -- -
Remarks:
4 1 0 -12 10YR3 /3 ------------ - - - - -- 1 l msbk mvfr as 1 f 4
2 12 -26 10YR4/3 ------------ - - - - -- 1 lmsbk mvfr as lvf .4 ' .5'
Ground
elev
3 26 -39 I0YR4 /4 --------- - - - - -- 1 lmsbk mvfr gw - - -- . 4 .5 w
100.O 4 39 -61 7.5YR4/4 -- ---------- - - - - -- cs osg - ml gw - - -- . 7
Depth t0 5 61 -94 IOY R5/6 ------------------ cs osg ml b
limiting - - - --- - -
factor
>94
Remarks: _ - -- - -_ --
5 1 0 -11 10YR3/3 ----- ------- - - - - -- 1 1 msbk mvfr as 1 f .4
2 11 -21 10YR4/3 ------------ - - - - -- 1 l msbk mvfr gw l of .4
Ground - - - - - - -- 1 lmsbk mvfr as 4 (o
etev 3 21 -39 10YR4/4 -- - - - - -- -- - - --
99.7 ft. 4 39 -59 7.5 YR4/4 - cs osg ml gw - - -- . 7
Depth to 5 59 -89 10YR5/6 - C s osg mt - - -- - - -- 7 r.
limiting — - -------------- --
-- —
factor
X89° -
Remarks:
Ground
elev
ft.
Depth to
limiting - --
factor
Remarks:
l
7 /c3
� a
A -I , A,
lop vl .
J4,1 6) 11�p N Olb
fj
I
I �
ti
— ( oo
C � 7 Z,
Wisoonsin`Depe tmentof Cammeroe SOIL AND SITE EVALUATION Page 1 of -�
Division of Safety and Buildings in accord with Comm 83.05, W IS. Adm. Code
Attach complete site plan on paper not leas than 8% Y 11 inches in size. Plan must County J �(
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimenislons, north arrow, and location and distance t0 nearest toad. — -
Parcel
APPLICANT INFORMATION - Please print all information.
Personal information you pro-ide inay be used for secondary purposes (Privacy Law, s. 16.04 (1) "A Reviewed By Date
Property pwner Property Location
Lakes & Hills Develop Govt, Lot 1/4 NW 1 14, 13 T
Properly O rs Me Address Lot # Block ty Subd. Name or CSW
P 9
_
7 - � 1 I -- Pbic Ac=s.
City State Zip Code PhoneNumber City _ illaue Town Nasmat Road
! i �ft,�t �Ji .✓ Jam' /ut Y� i' SJ `�'�K. - �+ , i' t. 218 7T.1. Ave
4`
New Construction g---=-
) Residential / Number of bedrooms 3 17Addition to existing building- _i Use:
Replacement l Public or commercial describe
Code Derived daily flow 450 gpd Recommended design loading rate _.....,? _ —bed, gpd/fe $ trench, gpdr
Absorption area required . 643 bed, tr 562__- trench, fe Maximum design loading rate .7 bed, gpdW .8 t rench, gpd/fl?
Recommended infiltration surface elevation(s) .. 95.7. _ _ ft (as referred to site plan benchmark)
Additional design / site considerations
Parent material-------------- --- - -- Flood plain elevation, if applicable - - ----- ft
S= Suftable for system Conventional Mound In -Ground Pressure AT -Grade Sytdem in Fill (
Holding Tank
U= Unsuitable for system 0 g r] U T-1 S❑ U I2 S U G S I I U , n S 1]V U I L_I S �! U
SOIL DESC RIPTION REPORT
Boring# Horizon Depth Dominant C01or I Mottles Texture Structure i �nsistenci� Boundary Roots GP --
in. MunSe11 Qu. Sz. Cont Color Gr. Sz. Sh. I Bed Trench
1 1 ...... 0 -11 .. _....... /3 _._- .. - - - -- --... -- Iambic _ . mvfr - - -• as .... lr . ..E......:4_.
I
2 11 -21 10YR4 13 ----------- - ----- l lmsbk mvfr gw lvf 4 5
Ground 3 2 -4 0 10YR4/4 ---------- - ----- l J tnsb k tn vfr as - -- .4 5
elev _..- - - -- _ .................. _.
99.7 it 4 40 -60 7.5YR4/4 es osg rnl gw .7 .8
Depth to 5 60 -89 1 UYR5 /G lid - -- - - -- .8 8
limning 6 2� 4 1 ' 1 6 �X
factor.
Z l 0 -11 lOYlii/3 ------------ --- --- 1 lrrtsbk rnvrr R.4 If - - - .4 .5
_._._.._. ..;...
2 11-24 1 OYR4 /3 ------- - --- -- 1 I msbk tnvfr gw 1 of .4 .5
Ground 3 24 - 40 I OYI(4 /4 ----- - - - - -- I I rtisbk mvfr as -- 4 5
elev_........ .. _........_._ ...... , .... .
x)'1.7 fl. 4 40.67 75YR4/4 -- -- - - - --- cs ass ml gw ---+ ,7 8
Depth to —_ 5 67 -90 I OYR5 /6 cs osg Inl - -- - -- 7 _8
limiting
factor
>90 11 1
Remarks: ...... .........
CST Name (Please Print) Signature: Teiephom No. /
Jaccluc Hawkins y�7 - J �� Y
Add 1 Date CST Numbei Ref #
/ L� 4/8/00 - <:f 382
Td WdBE::LO i00Z SZ 'heW TZVZZZb 'ON Xb WOHJ
Private Onsite Wastewater Treatment System Management Plan
Septic Tank And Gravity In- Ground Soil Absorption Component
Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment
System (POWTS) shall include information and procedures for maintaining the system within
the parameters of Comm 83 and 84, and the conditions of approval by the department, agent,
or governmental unit. The approved plans and permits for system are on file at the county
zoning or health department.
This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground
Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD-
10567-P (R.6/99).
Table 1: System Design Specifications
Sanitary Permit Number Z,
Number of Bedrooms
Design Flow - Peak (gpd) G
Estimated Flow - Average (gpd) �O
Septic Tank Capacity (gal)
Soil Absorption Component Size (W) 3
Type of Wastewater Domestic
Table 2: Soil Absorption Compone - Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow - Peak (gpd)
Maximum Influent Particle Size (in) 1/8
Maximum BOD (mg /L) 220
Maximum TSS (mg /L) 150
Table 3: Maintenance Schedule
Septic Tank Inspect and /or service once every 3 years
Outlet Filter Inspect once a year and clean at least once every 3 years
Soil Absorption Component Inspect once every 3 years
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks
under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with
NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease
Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable
Restrooms).
The operating condition of the septic tank and outlet filter shall be assessed at least
once every 3 years by inspection. 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
a �
Management Plan for a Septic Tank and Soil Absorption Component
filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously.
Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall have its contents removed when the volume of scum and sludge in the tank
exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the
time of an assessment, maintenance personnel shall advise the owner of when the next service
needs to be performed to maintain less than maximum scum and sludge accumulation in the
tank.
Manhole 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 one should enter a septic or other treatment or holding tank for
any reason without being in full compliance with OSHA standards for
entering a confined space. The atmosphere within the septic or other
treatment of holding tank may contain lethal gases, and rescue of a
person from the interior of the tank may be difficult or impossible.
Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the
tank is no longer used as a POWTS component.
Soil Absorption Component
The soil absorption component serving this structure is designed to accept domestic
wastewater from a residential facility. The limits of operation of this component are shown in
Table 2.
The longevity of a soil absorption component depends greatly on proper and timely
maintenance, and system use within or below the limits of reliable operation. Good water
conservation practices by all occupants and the installation of water conserving plumbing
fixtures are key factors in extending the useful life of this component.
The soil absorption component's operation must be assessed by inspection at least
once every three years: The inspection shall include recording the levels of ponding, if any, in
the observation pipes, and a visual inspection for any evidence of surface seepage or discharge
from the component. On steeply sloping sites, areas of erosion should be identified and
reported to the owner for repair. The surface discharge of domestic wastewater or sewage
from the system is prohibited and considered a human health hazard.
Traffic around or over the soil absorption component should be avoided particularly
during winter months. The compaction or removal of snow cover over the component may lead
to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or
impossible to repair until weather conditions improve. In general, soil compaction over this
component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to
more intense, and earlier, organic clogging of the soil.
2
w
' . Management Plan for a Septic Tank and Soil Absorption Component
Plantings of deep - rooted trees and shrubs directly over or within ten feet of the
component should be avoided since root intrusion into the component may obstruct wastewater
flow.
A
67 1 5)
� 3g
3
ST CRO1X COUNTY
SHPTIC TANK MAINTENANCE AGRP.P_MP_N'I'
AND
n OWNERSHIP CERTIFICATION FORM
Owner /13 fryer 1 b 1 o VA 6 1 A tt S -V- nj <—
Mailing Address - 70 w . p d C /X - (v Z
Properly Address
(Verification required from Planning Department for new conslnrclion)
City/State nn
Ctt `
Y /vtii� lC'if/nu -�- Parcel Identification Number 63 $ - //
�' O t7 - co o
LitQAL DESCRIPTION
Properly Location Al �r / 4 , / V 1 y � , Scc. N_1z �� W, 'Town of ! A
Subdivision _ /NF XC7 le-E.-5 Lot It
Certified Survey Map 11 Volume Page 11
Wsu rainy Decd It L3 Volume Page 1/
Spec Mouse; yes ❑ no Lot lines identifiable ' X yes ❑ no
SYSTEM MAINTENANCE
Inrpvoper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper nrain(cuancc
consists of pumping out lire septic lank every three years or sooner, if needed by a licensed pumper. What you put into lire system
can affect lire function of the septic lank as a treatment stage in lire waste disposal systcrn.
The property owner agrees to submit to St. Croix Zoning Dcpartntcut a certification furru, signed by the owner And by a
nrastcrplunrber, jourucyuranplunrber, restrictedplunrberor a liccnsedpumperverifying (bat (1) the on -site wastewa(crdisposal systcrn
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.
Uwe, (lie undersigned have read the above requirements Bud agree to maintain (lie private sewage disposal systcrn with the slandards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, Stale of Wisconsin. Certification
stating that your septic systcrn has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
day to a year exp' ation dale.
. IGNATURR Or APPLICAUF DATE
OWNER CEliT1r1CATION
I (we) certify that all stalcnrcuts on this form arc true to lire best of my (our) knowledge. I (we) ant (are) (lie owncl(s) of
the t described above, by virtue of a warranty decd recorded in Registcr of Deeds Office.
� DAT E
* * * * ** Any information that is mis rcpresen led may result in the sanitary permit being revoked by (lie Zoning Dcparhncnl. *• * *••
** Include %vith this applicnttou: a s(nnrpcd warranty decd fiont (lie Register of Deeds office
a copy of the certified survey map if reference is made in the warranty decd
I
RIVER VHLLEY RBSTRNCT Fax : 715 - 381 -5053 Rpr 2 2001 10:28 P.04
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Soto of Wiscmi .
IRTURN TO
Lot 10, Pine ACM, SL Croix County, W isc i& P.C. Collovs Bumrs, be.
705 couM RDad B.
HodrmL WI 54016
Tax Patel No. 039-1 OW
Ila$ is not 4omeslead property,
Date �ay
93e1 c wtzetettoe, kx. � �—
Artt4entkostl�n pclwatkiEwaset
9 (s ) STATH OF MINNsS TA ) ss
COUNL'X OF kostRo
audtetni this da of „ 20_ pwwmally aeae bd M me thin ' A dsy of
1'011 %dw sbov/ earned ��' + — + —” "r. critrtiuc. the ■ r� Ma y
71tk Mtyttbst, Stag zw of w6a win
to me k twmft ate peesea(a) who executed the fnrepoing
- rHJs INSTRUMENT WA6 DRAFM BY: wit the the unto
a As 4tea. PA
612D bcea Arseus,?!^*� - -- —
ScDtwatcr_ h4s 5 062 notary tic County, MCI.
P 1J Any ten u peanaasnL pf nttt, trnte espiretioo date: ,
Sipaturta may be sut wittkaated or aCYtfowlehvi. � 20M
� tt1
w
polaasnsu taet°a
oc_
NOTIC E TO ALL UTILITY COMPANIES:
To preserve all Lot Corner Monumentation (ALL UTILITY COMPANIES SHALL MAINTAIN
A 5 F00T DISTANCE FROM ALL LOT CORNERS AND BENDS IN THE RIGHT —OF —WAY)
Any monumentation being disturbed will bbe to remonumentation fees.
t1Cc3�
3 80' RADIUS RIGHT—OF—WAY
ound ` J TEMPORARY CUL —DE —SAC TO BEj
East line of NW 1/4 AUTOMATICALLY VACATED WITH >
of Sec. 13, T31N, R18W ROAD EXTENSION TO THE EAST.-
R18W. , bD-
470.26 S0o°16'55 "W 326.24' 66
i
10
°
65,791 sq. ft.
1
c 1.51 acres N
pj 1
OI NI
OI co 1 * l
NI z I. rl
`oi i Cf) . 32 &36' 3
' F,
ad zi d' S00'16'57'W
w . f. co
C 00 >i UJI '�� O' U� tC I a
z. 11 g Z .
�l o_I W Q
zl °I 5i 0
W; °'; w' 65,776 sq. ft.
w al
l' �' �' �' ° 1.51 acres oo' -T
XI O I OI I UI W ,
X JI UI QI QI N 33
aJl OI OI WI I
U1 >1 01 QI Zj �C
31 OI V
st line of NJ
C.S.M. 9/2494. S � 6 — - -'E
500 17" W 335.69' 1
470.24' °
328.00 109.24 12 �\
- 437.24'-
70, 634 sq. ft.
Wi