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HomeMy WebLinkAbout002-1091-60-050 (2)1Adseonsm Department of Commerce Safety and Busdng Dnism PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Pam"' ntornWgrt you provde may be used for secondary purposes IPnvacy Law. a 15.04 (I Hm)I 1 Chad H. and Christine Stafford I Cdy Veapa Township CST BM Elav r Inap BM Elev _ BM DescroTOWN OF BALDWINtxrr '1 M L-AA, TANK INFORMATION TION DATA DNMN NCH W�dtn i 1 l I No Tr ncnas PI DIMENSIONS No. Of Pr!S Inside da Lquie 0"01 SETBACK INFORMATION SYSTEM TO Prl BLDG JVVELL LAKE/STREAM LEACHING N Manactu TypeDf Sysbm I t�Qr V CHAMBER OR uNrr DiSTRIRI11rInM svf-TCU HeeeerMan 11 DtaaiEueon PI x Hob Size x Hole Sperrp Vent b Air Itstasa Lsngttt",� Dia Langtn Dla Spwng Snll CnuCO _ _ Depth Cw - -.- - - -•••. DePlh Over -- .-....... v. na Fwue oyswms unry BedlTrench Center BedTranch Edges a Depth of Topsoil u Setood'Sodded xs Mulched (� Yes I No D Yes No COn<lyde Eodedsaaespro t. etc1� ton PW� 7111,46 Locatlon: 2840 60TH AVE 1.) AR BM Description 2.) Bap sewer length = O �e n } �!1 "- P - amount of cover - > Z fC� � 1wL�. 3) 4.01 6&oedv, Ssk4 . 4 2d> L jV.g0' 10. Q0 %.40 Plan revisionRequtred? Yes yNo Use other side for adddional Information. I ijp Z i SOD-6710(R."7) Dab - — - — Insapctofs Srgnatum --- - Cart F y) PII . be-j,- 45 . , "v;� 12 sa. s� 2 •o' r--v" SOW% trvLe.., *6, -� w .`i(� b1A aVts e•` ►� ed'C. rt-*" ^� 4t%w ,1A.,Lt„�ad � bo-iit c.ILnbitiid �At, ked T _� S end.I:h jrctt -1)a0 —1�1 savig Divipoa Cartnry rvjIadtutty 49n Madiaoa Yards Way r.. . CAo/)( Saaisty Petmu li mtbei (lobe e filled in by Cn.) Madbm WI 53705 P.O. Box 7162 Madison, W153707-7 62 (40 5` ermit Application m. TrocdonNmba In etutdaaoe IM Wis. Adrn. Code. n6mution of this Amps b tln ualt is rapdrod ptior Obbhsisg a mibry permit Noe, Appikauion forms Aar de%:,*wii;Wj00Www eehtminod to Aojoa A&Irc= (f di (fact dm aoAhiadhma) the Deponent of Safety and Profmional Service. Paso" inforwatm you pra.iwadda any be wad 1br siewdy mom inw owoordance with the ' law• s. I SbLL I t Yo LG r-� L A l- -- lahrmadva- Pkue P4iac AM l Propwy ownces Nam Parcel a Z11AD JrAf4COA,0 k4/RISTiAIE c ON-/o9/-Go-aso Property Owners Mailinj A 11 t- hey laatim 3.25-0 Y.7 -r"�' Sr. Gorr. Lot 5E, City, side Zip Code Phone Number Arov,w.-I- E 1.11 SY7,T/ 7/S 79- d0.t7 T a9 N 0. 11. Type of RoAding (eked all that apply) lot x �I a 2 Family Dwelling- Number of M-- ` a y 1 sbdi Ssrisiae Name Block A ublirlComroereial- DocnbeUse J DCUY Of E]Stue Owned -DesoribeUse 7Ly IV R=cof tr/N of /JAOI, ILL Type Of POWFS Perak (Ch eMher'T111 ' K ' coomw and odw appile" as Ilan A. Che& one has M Ban lit Campleae Use C a •`. System I Pteplananem Syaett ClAer Modiranno w Fsiu:b Syem (axp4m) harwommt licit (edam) S• E]NoldingTank In -Ground �t-Grade OINarad Individual Sim Design Type (c�Wt) (canvmtiao,► C. Renewal Before 0RevioM a of PlOalber Ornwaft ie 14W Ppsvioae Parnit limbo and Der hmd Explra4on IV. D mat Ana and Tank Iafarnsod" Design Flow (gpd) Design Sal Appiirarion R-W(gpd(sn 13UPWoW Ara 26;d (sf) D•gwral Arc ropesd (>t) IS Gno .5 1 /07040 A"t s 90.,Y 97.71 97ar Tank lefortranrn Cap=ty m TOW Gallen Gallons 117=6 oaf Uab t+tw Fiudax Taeln I � 6 U i7S r7i 1ye i swig wiWYsat>,ak /I.To 1 Wit sf't L..+... 7 Dosing Claw" 7-To - 7S0 1 eovAo r- V. Rattp0411alb8ity SWOaNnt-1. dw ats�i nWwd, asame impeadbYhy 1M of an POWYS Hwn eas tie al z pYu� en Plot beta Naa (Print) PI MIRAO !7 Nibar liuiaee Pbote Nmbcr N.V ArL J .i.W & Plumber's ArYhm (Sheet City, Star. Zip Code) N 4C,7 98 Sr. 4,y s e lJ S Sf7i C" rtamt Uw 010 Appoved ❑ Di Penidt Fee DMWpod S ❑ for DCREI Conditions I �J� J 2D It YSM 3 J afU1 Septic tank, effluent filter and ��►+as' WAihf•� °"r dispersal ce8 must be serviced I mainly_ In e- ,,,,, ^ ��0. as per management plan provided by r v( A8 setback requirements must be mainlaitied � maintained � *s as per applicable codelo dlnances CQezt Pv-4vr SBD-6398 (IL 03/21) f07 o rklrys N ;t 370l rXro� ri T.r//f o•oo/ - 7/'�' ( �'rr7f Gfv� n3/n NI'7/ ,r (£)t7/1/'pass Goo r h[vf v/,,h e /t8 /!rs' 10071P1 or =rfl7p •rlrftrv/ Xr,✓ �fr/1%C/ (you spj) Tf/opel .j 009 j"PIP,0.7r 'r'i/✓ .'/PN to IT rarW 910.7 9 r,/ODpC/ r,pip p•o!•rrvrrvvW7 pi s�Q)Ms�)rl�tr7i�I�,w9 O2' fv1o'"A'7 /j ,F ,h •n S / ozb IV jr �y•71 1!41 .i 7R/asr / (c)srv;p f100 Oft, ry • Srn6/ x 77 ah7r .�M�n/vd n7n rgMp �sN •+yam pXto/ore Ph -:�7 p•F6) t�.xirr'� on/orr/ n r/►.✓ Xsro� °A •117f �d r o� � tb •iir7 ryrvo or _ v s x7 „w sW7roaJ2f CA TOT sIS' 77r 1v7 3rvr /•8l' /s1f/ : a tr o of j M7/'IV 6r /7r'M.F /(9N:5S) �n*vRj07 ob7C -prol!tu,5 0kv)�2 Page I of 7 Private Onsite Wastewater Treatment System Index and Title Page Project Name: CHRO Sr.1.o*Ae - Y- AA. eA rAJ) Owner's Name: Owner's Address: N 3l5-,o Y.Yl a� ,fr 4) I YY73*1 71S ,t79-�os7 Legal Description: r Sr wr).F Jc1, 3_T0 /L Ad Municipality: Town, Wlege, Gky of +6At4A01.1 County: Lot Number. ,T Block Number: CSM Number: S7�y Subdivision Name: d6Y,0 GO & Aix Parcel I.D. Number: Oo 2- /o f/- Lo - o So Page I Index and Title Page Page 2 Plot Plan with Cross -Section & Plan View Page 3 Septic Tank / Pump Chamber Cross -Section & Speci ications Page 4 Pump Performance Curve Page 5 POWTS Owner's Manual & Management Plan Page 6 POWTS Owner's Manual & Management Plan Page 7 Filter Information Name of Designer Toyv Alxr License ll: /V/- .73134 Signature: ' Date: _ Y-.To -,?0.72 r .q..nt the foLlowitng POWTS Component Manual and DSPS 381-�: BCD-10705-P (\.01101, R.10;12) `In -ground Soil Absorption Component Manual" Version 2.0 Attachment: Soil Evaluation Report e&OE!A et7 C//AO ST4"OAO- .Uro Lo Aw SW, 341 .7fN, /l W p, AF /f ,ILoutJ, Sr (wetX Lo. f r /N / ,ICAe Lo r A« S�'S JJJ. Y3 sera/cKJ ,ov[r „ gal" 97.i a /60.e oe.� Nto rurr d4vr Lwn(a) � ttr►Ca) 4 eets/rt f-� Yr it/r 1 N "e i S. [c. s. a J: u. �tcoeJ- Selri..+ emoo suLr) r else 1^irurwero, Qriaw ✓ Wo (,0 CMA►N•1 r Jo•0 /r + /J47.0 /r• M/.J. .l[iwsrer Leo=.S, /,roerr` eror,#4 trwX. /A"rwtt, o[/ri: .JO"4tle� Lam//r1 OAK s a.. W fOwtr / lAf.J (/W )l 9t.a G%/Es[.c /.Jso/lfo CeAAe rw.K ii,wo., r Ol o PL 0 wli pee "=N,1 ® Ptee.tti uru Aw�urw► ad f4o yi I d,d J[<de. /../[aC3) J` Ew ZArS PLIV u1rW l„ ae sLtc/) lc) t ' Ax - /Oo.o Page 3 of 7 FINIAL GRADE MANHOLE RISER & COVER rA0Pa aa.b au4c..mq from (par Vs me.xsm t (4 appmvd ate.) tar P UW *W"" a) Oalloa, a = Ale seed; Edw asaapla dawas naoaaaay.) 4 a4. &k 40 PVC Tads Vaet BUILDING SEWER 4- iin- edt se avc Twat V.N ELECTRICAL . � Ri�ieoe�. (PwWe38zmo1)) gee . Ir.eonyradearw JUNCTIONBDX RoW aawYOn fool vr, sps ale and NIX 30M I -......_.._. ............ ............ FORCE s*: MAIN "T , �• OPTIONS ssmw +3-ait Msatotc FORM /Xl raw aormuOF*LET a ,.1 RMTme ! I I auF_ 3' WISP I �r .9Esr I ' w e c �aaarara ran...aGatrsre.. , on Flea •gyp,,•,rtaqw6d onOAN a orrrar A pry Q^=a MINIMUM OF 3- OF SUITABLE BEDDING BENEATH TANK a MAXIMl1l11 BURY OEPTH OF 96' AnCgryey at exrt may be requYed par SPS 3614XBM Tank Manufacturer Sri/ES ER �o.�c.c�rE Sepwpump SI /.?So /7 O �galbns Alarm Manufacftrnw ST. E. /�it�o.rsos Model Number. r4A4K A[fRr Switch Type- M<<.✓��iais Effluent Pump Manufacturer: oLtttt Model Number /S/ Minimum Discharge Rate: _ 10.0 GPM Vertical lilt (pump off to Lateral invert)............ /.1. a ft Systehead (distal pressure x 1.3 ft): — ft m 00 R Force maim x /. 0 YI00 friction factory ft Filter friction lose ............ .......................... — ft Total Dynamic Head (TDH): /3.0 ft Daly Wak mter Flow (DWF): _ GOO GPD Number of daily doses: S. 3 f! /1.1 f.) Force main volume: /Oa ft x _ /l7 iiaW = /l 3 9M Aerial dose voluna /J ! gel - /l J gel = & 7 fl� (iota) does volume -volume of force magi 746E TANK CAPACMES• Reserve above alarm _ J in - 3113.4 gal (D) Alarm float above on float 0_ in = 31.1 get► (C) On/Off float measurement a in = /11 gal (B) Of above tank bottom _4 in = /; 9 gal (A) DOSE TANK DIUMBIONS- Length /SS In Outlet height 3W in Width 84 In GaIIonenixh /.Z I PUMP PERFORMANCE CURVE MODEL 151II152/153 r .J4 L 1d' � +9 Ta a A n r x • ✓i 1c .0 n er 7U to art0at __ � r— i a o ,ia .r 7m 7tl rx >M tec FLOW PER tMrTr V1�A CONSULT FACTORY FOR SPECIAL APpuCATIONS • Timed dosing panels available. EWCOMI afternatorS, for duplex systems, are avai able and supplied with an alarm. • lhriable level Control switches are available for controlytp *4e Abase systems. Dade piggyback variable ievei float switches are available for variable level"and Mort cyde controls. ' Sealed Ow -60, available for outdoor installations. See FM11420. • Over 130'F (54'C) spKW quotsbon required. 15['';; enes 151r1M53 YDDELS Comm Mydw NodY_�YMtrl YotY _ _ Mys N,51 HS 1 rliai 6.0 511151 11s 1 flub 6D ad+dad 2a3 Eii1 230 1 Nm 32 -- t - 2a3 DE151 239 N1S2 ttb 1 Aufo '1 Non i 32 LMwrii 65 t 2a3 2_a7 aN1Si I1S 1 Atao b t1S 11rA6d 2a3 1321 ice' 3 hio�-; 1 t 3 httltge0 a M1 ?1 - 1 ►10t 1 2a3 dItS3 S1S t Ak& 1 2a3 E163 230 1 flee -.. ... Sl 1 - 2 or 3 -_ 1631 1 2af TOTAL DYNAMIC HEADlFLOW 1114 Y aF PER MINUTE EFFLUENT AND DEWATERING MODEL 1 L5 IL 152 153 ran or I'M b is Sa 1M a at 7? Tat 'C _ 7.1 A 61 Tit 70 !!e 76 _IA al >t tN a 201 61 w 61 b 7p 1" 161 62 tR is a 0 It s. 1a al 1 im 35 TO.T T7 87 T3 iTs _ _ _ n tl al 12 T 11 a atuartrt 31L 1n SIl 1 Nl tlr Model 151 • - aper 179 ... —7- a 1 +nvr atvu. 1. fto P(WTaadk vanads level nor a7rakit or WOW "p tiaok vanable Mvel Ior 7twAkI ROw kt FMO477. 2. See FM DT121ar Doer- ngdet of D eWcal Anemator E-Pak. 3. WriaW levelcone skw& 1D-0743 urad as a coMrd aelvabr, spoil- tlkpMs (3) or (4) Foal "am a CA�jI Models 152 If 153 . r.n f 6 I �p 1 4- _ •L ssa t I _I altar .� i assww 7fd+rbeppe i � \ PUMP STAND PIN 16-221' Redutxs polenlial Cbppklp by dabrf6. Replaces coda or bricks under the pump. Made of durable, nonmrroaive AaS. Raises pump 2' off bottom of basin. Provides the abily to raise intake by adding sections of I%, or 2' PVC piping. Attaches securely to pump. Accornrlodales stamp. ditalering and effluent applicabons- NOTE: Make sue float is hoe front dxstruakin. ?' �FRL'E :'r:�WFkEh r�rSIGN For unusual oondttions a reserve safety factor is englnoered irtto the design of every Zoeller pump. 0 Copyright 20013 Zoeber Co. All rights reserved. POWTS OWNER'S MANUAL AND MANAGEMENT PLANT Estimated flow (average) Design flow (DWF) estimated z 1S Sod Avoliation Rate mtuenurmuent Quality (❑ NA) Fats. Oil & Grease (FO(j-) Biochemical Oxygen Demand (BODJ) Total Suspended Solids (TSS) 'retreated Effluent Quality (® NA) Biochemical Oxygen Demand (BOD5) Tote! Suspended Solids OW) Fecal Coliform (geometric mean) Soil D F T 9ilA tiou rate = Monthly Average 5 30 mg/L 5 220 mg/L 5 150 M91L Monthly Average 5 30 mg;1L 5 30 mg/L s tais-r m bmCI- -CATIONS Septic Tank i NA Septic Tank Manufacturer iJ E NA Effluent Filter Manufacturer £6 Y 171 NA Effluent Filter Model f- d E3 NA Pump Tank Capacity SO NA Pump Tank Manufacturer L%iEsaa Le.Ka. NA P Manufacturer Zoit«t r7i NA Pump Model / NA Pretreatment Unit (® NA) ❑ Sand/Gravel Filter p Peat Filter Cl Mechanical Aeration M Ways ❑ Disin&txioo ❑ Other; Manufacturer. Model: Soil Absorption Component (❑ NA) M ln-grourod (gravity) ❑ In -ground (pressurized) ❑ Al-Bndc ❑ Mound Drip -line Other. 0 Dispersal Units — Mwu&carer /.I//c resr" ❑ Aggregate Ced(s) Model aw" b Dispersal End Cap (Dispersal Unit E1SA) or AISO.&QUi[ffi - EISA - (Trench Width) /,7a6- 6 43) T lac fr' /!.0 Fr, = N Units or Total LenglLQLjMRdlW ❑ "Design of Pressure Distnbution Networks for Septic Tad* -Soil Absorption Systems^ Publication 9.6 (SSWMP ❑ "ICC Flowtoch Mound Component Manual" Version 1.2 ❑ "EzFlow Mound Component Manual" Version 12115n017 17 SBD - 10954-P (&1/12) "At -Grade Component Manual Using Pressure Distribution" Version 2.0 0 SBD - 10705-P (N.01/01) "In Ground Soil Absorption Component Manual- Version 10 O SBD - 10691-P (N.01/01) "Mound Component Manual" Version 2.0 ❑ SBD - 10657-P (R.6199) "Drip -line Effluent Disposal Component Manual" ❑ SBD - 10706-P (N.01101) "Pressure Distribution Component Maud" Version 2.0 " rums_ MAINTENANCE MONITOR NG SCHEDULE - MAINTENANCE AND MANAGEMENT Service Event Service Frapency 1111Ws cells clean filter I At least oroa evety, 0 13 months R 3 Otber - Inspecti puny & mm tors t unit I At km once months R ; years 13 NA Flush and pressure test Writs At least once mantle 3 NA START UP AND OPERATION: For new construction, prior to use of the POWTS check treatment tautk(s) for the presence of � PainB products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the Um4s) removed by a septage servicing operator prior to use. Systan start utp shall rat occur when soil conditions are frozen at Otc infiltrative surface. The property owner is responsible for the operation arid maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The instillation of water -saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the grand surface whenever possible. Note: this does not include laundry water, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit peels and mods. bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non -biodegradable items such as baby wipes, tampons, sanitarynapkins condoms, cigarette butts, dental floss, and cotton swabs should not eater the system. Cberllicalg Butch as petroleum products, paint, Page 5 of disinfectants, pesticides, antibiotics, solvents, e1c., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it um freeze up. INSPECTIONS & AINTENAN['F: Inspection shall be made by an individual ca rrying one of the following licenses or artrlieauons: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scam and check for any backup or ponding of effluent to the ground stuface and test all electrical equipment such as pumps and alarms. Any defects shall be promptly corrected. Exposed openings greater than g inches in diameter shall be secured with effective locking devices to prevent accidental or unauthorized entry the tanks. When the combination of sludge and scum in any tank exceeds one-third (1 /3) or more of the tank volume, the entire contents of the Codshall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NR 113, Wisconsin Administrative The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufactmu's specification. Solids washed from the filter shall be retained in the Lank. Filter cleaning maybe necessary at more frequent intervals than sated in the maintenance schedule to keep the system operating. Alarms should be tested on a regular basis by the home owner_ If an alarm sounds, contact an individual licensed to service POWTS, Therm: is normally a I day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. Ate: When the POWTS fails and/or is permanently taken out of service the following steps shall be Laken to ensure that the system is properly and safely abandoned in compliance with CIL SPS 393.33, Wisconsin Administrative Code. - All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. - The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. - After pumping, all tanks and pits shall be excavated and removed or their covert; removed and the void space filled with soil, gravel or other inert solid material. CONTINGENCY PLAN: If the POWTS fails and cannot be repaired the following mcasures have been, or must be taken, to provide a code compliant replacement system: Ili A suitable replacement area has been evaluated and may be utilized for time location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure,lot lines and wells. Failure to protect the replacement area render it unusable. Replacement systems must comply with the rules in effect at the time of replacement. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soi I absorption systems may be reconstructed in place following removal of the biomm at the infiltrative surface. Reconstructions of such systems mast comply with the rules in effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER j Name .TOArM Elmt'E .NP-�3/3y[ Name EtlrF LuirbtdC j Phone 7/S 672 Suof i Plnme 7/T L7�-Sj[mt SEPTAGE SERVICING OPERATOR Pumper) LOCAL REGULATORY AUTHORITY Nate ,fl r Phone I •Agt:oey Sr hair �owrrm.tirr' !/ft✓.va r Phone 7/J JJ,( lld Page - _ of -7- Installation Instructions for the GF10 Filter Maintenance of the GF10 Filter v Stop 1: Locate sod ramose the septic cank mover, on the outlet tide of tank. .rtww © I' 1r Step 4: Glue the filter case onto the outlet pipe. Inset the filter cartridge Into the can. (Mate sue the filter is completely inserted Into the case) F! -J, REST Step Before Installation, Place the Aker case onto the outlet pipe. Make u,re the rase Is positioned so the inter can be rwntoved from the tank for mafnw nanceandswvke 0 S1ap3: ForkWallationsthm require or desire additional suppport. Of additional support is not needed,go to Step 4) Gkrta section of 1' Sdn. 40 pipe to the Iwo hubs located an the bottom of the case and the hub located on the side of the case. YfWIN 0 'r Step S: FV Installations Where It "I be AfficWt to reach the handle, place i' Sdnednsie 40 pipe Into the tee on the harsde and extend it to height that will make 4 easy to remove the filter. o �r rat i:r :..r I, t'v •, r ry ua vat r , e : r- :. ..i r.n rr r r-. --, r•:� u Installation of an 5a11M,1e1M1t,,,,�r� A existing system, sss�h.M.ttp.+I,rie.t.htrttoltlWee „ f(' cu ro rr vs w r:: r. v•, ,c_ ru ..� A tune haunt In eteds septic tart n W lead b set by Mete and local codes Although they nray bt dilfarwe, roar ragulMory agencies suggest ewe to five Years. We wOnernend the GF10 After be dwwd when the septic tank Is nornnih, clamed and ptarnI . a as mailed. WARNING: If the liquid level in the tank is above the top of the fiher, pump the tank prior to removing the filter cartridge. OCAUTION: USE RUBBER GLOVES WHEN HANDLING FILTERSI Step 1: tternove the septic tank cover end pump rite tardt If necessary to Prevent any solids from escapkV to the Reid when the (deeds m1 noved. C7—= fi t 0 Stop 2: NO the Attar handle and side the Neer out of the caee. Stop S: While holding the filter cartridge over the aaess opening of the tank, rinse dia cartridge oil with fresh water. Take care to make stet all "Id material fah back Into the tank ;-�-� e;ew- For.�cl►ano�oor 2247d94 514 trraar9 0 Stop nwt the cartridge back Into the can mW" acre that it Is property aligned and completely instated Into the case. y(p�f.R.Lt z F 4i� 4i .S t•�`l Sy. 7 7• wsmncatDepartrrwdofCornmerce SOIL EVALUP.T^''' REPORT papa I of 3 Dvsbrl of so" and Butidings in eoco-danm wnn Comm 85 Ab Adn � Adrlr mnpfatla/644enOd Gaper oN11gt Mt81r1 ■ I' In insrze Plan mutt CT.Croax MiLde, but not liimiINa to varbCal and hoMonta' reference port (BM), drednn and Parcel 1.0 Perm Slope, WAIN or dmensioru, north arrow. and location and dictanoe to nearest road _ Morin prink all information. f'YfOW cram ke" Re �+ed by / � or. P nC, nNY rxr.a rY uco . Pdrp " PINw • L" s '! 14 111 rmlr Pmp" Owner Property Location Jason Larson Gout .a SE 114 SW 1�5 3a T 29 N R 16 (or) W ProPany DwrrersMalrgAdOreaa Lot a Block a Slbd or CSMV 2774 Counonly Nvp N City Soo Zip Code Phone Nurnbe' Veiepe jKlTown Hammed Road Woodville 1 wi W26 1 715.928-1447 01.111..':.. i 60rh eve I O` New CorobreYon llea0 Rea denual r Numoer of Bedrooms Code wined design flow rate 430 GPD Reveimm rlt Pubk or oon menial - Describe. Parent M318" fill ` - Flood Porn elevion d apo►rabk. �JK it Gent" Lnnrrrorlro and rerommefdNJprs. Lst 7onng a i -: for -% consenuonal drain field iyzt, c1. sluxild hC S or higher ( n r ; 0 ACa go"a L-1 Pd Ground surface elev 100 R Daptn to Vncng tads 60 In Sib Applicalkii Rate Horn Daph Dornwra Cobr Redox Decrnption Tenure Strucbre Consistence Houndery Roar EK2 n Mtrree C!u. Sz Coin Color G• SZ Sr,-EIMt A 0-10 IOyT). cl Igr ml gs If 04 07 B 10-30 IOsT4i6 Its osg, pit gs - 05 1.0 C 30_60 lcyr5-g Its rxcg nil as 0 5 1.0 D h0.72 I IOyro.B s,r8ref,ptach•+ SICl I r in 0.: 01 r .>r Bonn%0 —1Oil f u El Pit Ground etw n Depth iolm6 Horizon Depth M. Donwnant Cobr Recoa Deserpt,on murwo Cu. 3z. Con. Cob' '"emlre Structure G' Sz Sh CGnsisrenoe Boundary' Roofs GPC 'EMI A 0.9 10yr3'= i sl Ig1 ml gc If 0� 13 Q-18 IOvr46 Si. c^E rrl gs 05 C 2J-64 It}yr5.8 1(. oig nil ti 0.5 D 64-76 10yr64 S..iSfi`,rlu[che era Igr mfi i0.2 � t�1 _ Efkwd 01 = SM. > 3C c_ 220 rrgl and W5 >3(3 < 1,%: yL CST mom (Prone Print) . _ - _. —. sgnaltre Drvid C. LaiH Ad&",N - cnueni r� = l c .:: a I.Pir - 20163 h%N 7 Cumcil 'A 1 5473: 6 9 1 r1 715-239.6194 i Jason Larson 2 3 Prop" Owner Parcel ID a Pape -of El Borm i ❑ BOMQ a a pn Grourta wAaoe ekv. 100 ft oepm to vno ng factor n 1 n - r-- 5011 AGO�on hormn Dttpth in Dtanetan: Color Munwa Redo' Desatphor, th.Sz COm COer Taruure Structure Gr.Sz Sh Cordstante Boundary Roots GPDW 'EfMt -EID2 A 0-10 10yr3.3 sl 1w MI gs If 0.4 0.7 B 10-20 I 4'6 Its Osit nil gs 0.5 1.0 C 20-61 10v175.119 It, us¢ ml as 0.5 1.0 D 61 f+6 10yr68 7.5yr5 S °lf splotches SO Igr urea 0.1 0.3 I LJ Pit Ground surface ekv h Deolh to WrAwn }actor n '� Rao horizon Dapth it Domcw t Color Munw Rec-ox Descriptor. Ou. Sz Corr Color Tutors Structum Gr St Sh Concwtano 13otxedory ROM GPON 'EMI 'E111112 0-10 ItryT3.3 sl IgT ml g> If Ua 0.- B IU-25 I OvT4i6 Its 051Z ml gs 10 C 25-58 IOvbS if Its os ml as 10 p SS 65 I b 7.5ti75 8 11 i s lotches stcl Igr M !0. 0.3 I o IP . a 080" _ 47.-z _ . _ X) L_J u P.l ., . ,,.� oz r ._.._. , . _ SW Rafe Honren Depth in Domnant Color Murtsea Ream rlesrnptkm Ou Sz Com Color Tertrre Structure Gr Sz. Sh Consweri a Boundary Roos GPOAF 'EMI 'EMY A 0-10 1OyT3'3 51 Igr ml �� If 04 07 fi 10-220 10yW6 Its 05F nor gs 0.5 1.t1 C >t156 luyrs/� 1(s us ml as 0.5 Ili D 51 '71 10 ,F ' 3c-5 8 11 f solotches I tor Igr frill U.: 0.3 EM uwt tf • 3W. > 30 a 220 mp'L and -SS >30 < 150 rno'L EfI uam it, = ROD, _< 30 mp4 and TSS a 30 mp L I The llq+artment of L.�mmtt�c I: an e.t::af ✓ypnnw+ir. ;rr. ua• pr?� ids: anJ ercyir. rr. II j Uu need :uscistrnce W access sen ices or :Iced material it. an x1cmur he"na: Meant :Cfim the Jcpann eTtt at alil-21x,-3151 or Ill' <,+1E-:oY8777. sFC "IMW da1N+ C <l� 1 Y PropertyONOW Jason LAson 4 11 3 3 / — Groundsrfameiev 93.72 h •n. ❑� Ptl � b iraYry �� 40 on. Sd Ralf FlMfmn Daph Ooobbo. RadonDaaalpmn Texture Stntthaa Cormolfnce Boundry Reob GPDff n. Rr" Ov. Ss. Cord Calor Gr. Sz Sh 10101 'Ellltt A 010 IDyr312 sl lgr ml Qa if 04 0.7 B 10-20 IOYT412It w ml BS 0.5 1.0 C 2040 1"14 Ifs OSS ml as 0.5 1.0 D 40.51 IOyr6/6 7.5yr5i6f1[ spkxchcs sicl IPI mfi 0.0 0.0 ■ 0 a . 'P1�'7 i■ � r T7 i■ � r T7 wwMc!==Mff*9qrMff r ._ ® r� E1bwM /1 • BOO, > 30 < 220 ntp7L and TSS >30 < 150 npl - Efllrera 02 < BOD, < 30 mplL and TSB < 30 nWL The Department ofCommeroe is an equal opportunity service provider and employer. If you need swiswm to access scrvices or need mMuiel in an agematc format, please oontad the departtrtent at 608-266-311511 or TiY 609-264-17P. aonsrr.tsruaq .P� �e C O / C r— I 0cjA)Cp,! JASo,J 4AASdAJ L.Oc•A-rr4w)•. . .t 77tl CouAPTV W y N 5r- jvJ 36 - a'✓-14 ai (')ooa r,A-[cr Of 5•y0018 co; WoeROI)( 7/5-- 4)d.6t• t44V7 TA•. 6AL4W( l I 4)f Sr Ap tj a? a-9 L 9�t� 9b 1 qi 9.�t is p O-"* AdE Sot& TESTER .=IAS3 010/46.5' Nwy z CefIdre•1L W/ 56/003.Z 7i5-,2-3 1 G scA�F ►'`= yo' vk —'p AS � F !I ME O 1� 'Ply 2022 File 8: ST. CR SANITARY SYSTEM O//tte use Only S e'�"E1oD ERSHIP/ADDRESS FORM CroaW21mal Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. OWNER/BUYER INFORMATION Owner/Buyer ClraA -4 ,} cY\i15��y�Q -!(lwofk Mailing Address bc,,SD - `k5-)k1l C City/State/Zip N'kNXrCyVtf �_ CA,)Cj I Phone Number (reouired) Its. 2,701 - MZ Email Address M Parcel Identification Number DOC3\ I Ln k " 6D- DSO (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION 5� + ``.-�p� Property LocationNE 1/451rJ +/. , Sec. � T 2 I N Ri (9W, Town of _1"W\4\� S ivision Plat: , Lot * �. CeftlRed Survey Map M NM &E -51f2� P ge # Warranty Deed # � (before 2006)Volume . Page AF Number of bedrooms L_ Spec house 0 yes IN no lot lines identifiable 10 yes O no / 1 / `,OFFICE USE ONLY New Property dress z6 f 0 l� — , , (,GS ) (Vedfica ' n of new address required from Community lopment Department for new constniction.) (s ff Initials) (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. Now System: include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey mop if reference is made in the warranty deed. Community Development Department - Land Use Division 715-386-4680 St. Croix County Government Center 71S-245-42S0 Fax cdd@sccwi.yov 1101 Carmichael Road, Hudson, WI 54016 IywwsccwiQQv '131►�] -3M C7 6 n S A 7 lw , ,I II 11 II „ 11 „ 11 11 11 11 11 /1 1 11 II 11 11 11 .I 11 11 11 11 5" 11 11 11 11 11 11 11 i co ! CO s j- - - - - - - - - - ----- - ----- - - - - - - - - - - - •--------------'' NO ___ ------------ - 1 I 1 1 I 1 1 ' 1 1 1 I I 1 1■■■ I 1 I 1 1 1 1 1 I 1 1 I . 1 1 1 • 1 1 I 1 1 I I I 1 ' �YE■® � 1 1 Ps�'y'yi0{ � I 1 I 1 1 I 1 Haul � 1 1 1 - - •N 1 1 I '1 1 1 w o!1 1 ' !d d 1 1 1 1 1 1 I I 1 1 I 1 I I 1 1 I 1 1 . I 1 I 1 1 1 I 1 1 1 1 1 � 1 IF 1 ' 1 1 I 1 I I 1 1 1 J 1 1;2 111'711 IL .94 '1 es 3 z T '�000 coo mono ROPIL C01'N F", Chad and Christine Stafford N3250 457th St. Menomonie WI. 54751 N64060thAve. mfi,allu, -I.q :i e,1 City Slat.- Woodville. W1 002-1091-60-050 36 29 16 -own Baldwin Subdivision Lot = 2- Certifled Surve) flap r CSM 25-5764.002/20111­ Page t Warrant-,- Deed SYSTEM NA-',k! i ""'AINCY 1-1 AL.p's I: L - - 1:, 1 1.1d, I r. .!, , . . I .... . ... .. ., I.,,, 'i.!): ;.I Is . 1: . - ;11-, 11,;*. I' It < .",:.I C Alw yr.0 the system C-In %fleL-; :ip_ t:,c In..... N'z-, v, �i.r. .s ic c!l _,o-ncr momien i "Ice, :csixitisibilitics arc S: 1-ouvi, Orlvnr.,^ — I IM and tiv a %uiiv plun.1-ct, jum,,,-vn, al rr a hccji�cai vmfyng that 4 11 ffic ou-si:-- c%4"Jill C15j)M a 5aOCII- i5 11. r., -0" :T 17e' 1 2, a!',r ir.spc:nr:, and IiIan t;,:; rf .0 v. :t P nju I, 4 418 2022 r- L Wkcomn Department of Division of Safety and Bu u L j I J CST Q614-- a33 SOIL EVALLIAT'" REP , Pape I a1 3 ST.CROIXCOUFjf "w"..... ''''"• "' Attach oonp1I0WM W4* /2 x 11 inches in size. Plan meal Include, but rlol l' ", lo: vertical and Igdzonta re rernce poinl (BM), direction and percent slope, aatb ordimenaiona, norlh arrow, and location and distance to nearest road. PM" print all kd nnaBon. FM10 l Irllb milbn you provM may a used for teary PrrP«e (Privacy tar, s. 15.01(1) (m)). ST.Crou Puaoel I.D. , 0 IZe M / sty owrw Jason Larson Pr w" Louhon Govt.Lot SE 1/4SW Ij 36 T 29 N R 16 Ida Properly Ownses Maitirq Address 2774 Couoonty Hwy. N Lot 0 Block a %W. Nerrid or CSMte city State Zip Code Phone Number Woodville wi 1 54028 l 715-928-1447 Ly;*y Vdeps ElTown Nearest Road 60th ave Q NOW Cowhictim UsaQ Residential / Nuruber of bedrooms 3 Coda derived design now ram 450 GPD O Replecantant [3Pudic or commerual - Desabe: Parent nl AwW till Flood Plan elevation if applicable 1L General art MAXI JIA 40mm0r�Use boring Al 1-5 for A conventional drain field Systbe . el. should bhigher l /I I G �jCJ ✓ a ',�`� a 1] Borings 13 B01I'rp a if Ground surfaceebv. 100 . Depth to 6nutinp 6t) a :2_ in. P„ ff. sa Application Rase Horizon Depth in. Domirant Color MLMSM Redox Desaipflon Do Sz. Cont. Color Twhws Structure Gr. Sz Sh Corastenca Boundary Root GpDM -Er i 'ElM2 A 0-10 10yr3/3 sl Igr ml gs If 0.4 0.7 B 10-30 1 6 Ifs osg ml a 0.5 1.0 C 30_b0 1Oyr5/8 Ifs osg ml as 0.5 1.0 D 60-72 IOyr16J8 7.5yrs/anfsplacha sic, Igr mfi 0.2 0.3 t 2 a ❑ Borinp &wig Q Pit Ground surface emv. 100 ft. Depth to limiting factor 64 in- Sd Applicabon Role Horow Depth In. Dornwwrl Color M1rla 1 Redox Description Qu. Sz. Cont Color Text" Structure Gr. Sz. Sh. Coraialence Boundary Rods GPCW 'E901 'EM2 A 0.9 10yr3f3 $l Igr ml gs If 0.4 0.7 B 9-28 1 Oyr4/6 Ifs osg mil 86 0.5 1.0 C 28-64 10yr5/8 Ifs osg ml as 0.5 1.0 D 6476 10yr6/8 7,5yu3/6n(aplotohes sicl ]Br mft 0.2 0.3 t ' t r=m sr " otnr � .1u _ ceu mprL anti t SS a3p 1150 rrVA. ' EflWrnt 02 BOO < 30 nV& and TSS < 30 MgIL CST Name (Phase Print) Slprnttse CST Number David C. Laird 221253 Addrea' Dam Evaluation Conducted Telephone Nranber 20165 hwy Z Cornell WI 54732 8-9-16 715-239-6194 ftpedY Owner _ Jason Larson Parcel ID 4 ❑ /Paps Q pig Ground surface elev. i R Depth to lm&g factor 00 61 in. ,// 2 3 Of Hortzon Depth In. Dornlnrrt COW Murrell Redox Description Ou. Sz. Cont. Color Tex4ae Stricture Gr. Sz. Sh. C*r"W os Boundary Rods GPDIN *001 TM A 0-10 1Oyr3/3 sl Igr ml gs If 0.4 0.7 B 10-20 I 4/6 IS OS9 ml gs 0.5 1.0 C 20-61 10yr5/8 ifs osg ml as OS 1.0 D 61-66 10yr6/8 7.5yr5/8 f7fsplotches sicl Igr mfi 0.2 0.3 Bor BD& ❑ g S p� Gmund surface elev. 97.91 ft. Depth to MWV factor in- in Sod Awlicabon Rem Horizon Depth in. I Dominant Color Murssl Red= Description Ou. Sr-Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Root GPDAf 2EW1 'Ell1112 A 0-10 10yr3r3 sl Igr ml gs If 0.4 0.7 B 10-25 10vrV6 Ifs oSx ml gs 0.5 1.0 C 25-58 I /8 ifs os ml as 0.5 1.0 D 58-65 IOyr&8 7.5yr5/8 fl f splotches sicl I mfi 0 22 0.3 J M Boring !S rg Grand surface ebv. 97.75 ft Depth to ft" factor 56 in. Horizon Depth in. Dominant Color Murrell Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Rook 'EW1 TOW A 0-10 1Oyr313 sl Igr ml gs If 0.4 0.7 B 10-20 Ifs osg ml 99 0.5 1.0 C 0-56 1 /8 Ifs 039 ml as 0.5 1.0 D 5 l 1 8 7.5 5/8 flf splotches sicl Igr mfi 0.2 0.3 ' Eflluent #1 - BODS > 30 < 220 mg& and TSS >30 < 150 mgA- ' Effluent 82 = BODr < 30 mg& and TSS < 30 nV& The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to socess services or need material in an alternate format, please contaot the department at 608-266-3151 or TTY 608-264-8?77. SBD c m laouol CBS Property Owner Jason Larson Parcel 1paY / Pape Boring a� r/ 93.72 0 Pit Ground surface ebv A. Depth to lmitnp factor 40 in. 3 3 Of Flonron Depth in. Dominant Color Munsell Redox Description Ou. Sz Cont. Color Texture Stricture Gr Sz. Sh Consistence I Boundary Roots GPDAP •EfW1 •Efl►2 A 0-10 10yr3'2 sl Igr ml gs If 0.4 0.7 B 10-20 l0yr412 Ifs osg ml gs 0.5 1.0 C 20-40 10yr4r4 Its osg ml as 0.5 1.0 D 40-51 10yr6/6 7.5yr5/6flfsplotches sicl IPI mfi 0.0 0.0 E Boring 0 Boring • Pit Ground surface elev. A Depth to limiting factor in Boring a Boring Pit Pit Ground surface elev A. Depth to limiting lector in ' Etffueril i1 = BOOt > 30 1220 mg L and TSS >30 < 150 mgA- . Effluent 02 = BOD, < 30 mg& and TSS < 30 rig L The Department of Commerce is an equal opportunity service provider and employer. Ifyou need assistance to access sen ices or need material in an alternate format. please contact the department at 608-266-3151 or TTY 608-264-8777. S6Dl]JPrr lR 0l.LOi ! � P O� � �� 1 � l OtJUER• _jhSoA) I.ARSoA/ L,OC�'11ro�c% 27711 COOA^y KeJi N sr-5-036 -a9r✓- IG cJ w ooD r/ �c F u/ sq o a1Q Co.. OY c ko/x 7/t- 9d-Ei- I4/47 TN•. S, LZCd/AJ fl2op l /4/4r I e 7 9p 38 L-OV& q�r xI p I.� -P f I!a' hO�" ACE Bolt ?ESTER/as3 7/5-0s9—�/9�1. M� ado' 4a' ---. SCAL F rM = yo \Iqy, !o/yam IA) 9a� i I O cJ NEB ' J h S o AJ 1, .* A S O A) L.o cA-r t oA) -. 2 77(/ COJAJT y Wy N Sr- SrJ- 34- - a 9a-14 cJ Woos ri+-(Q Of j'yode Co.. 9r.coolA 7/S- °)a_e- ,Vq, TAP. $,jIZWfA/ I I q \�1 �0 �o` -PF (�O 1 .r AJE .pcv�►e�R �vas3 0AP16 rYw y L COOT A)& tl- cvr SY73� 7/.r- a 3 9- Zr r q ° do$ 40' i SCALF !'` = a/O' c r• ' 0 i �> > • No, 641970 STAT SANITARY PERMIT n ��k 2Lyo bo Ave.) 61k�'75F6�IQEW'�7. PREVIOUS NO. S�I2L/at OWNER CAM �GNtISTjllitr AAFnlb PLUMBEblit" LIC12343� TOWN OF Qdiwwl•w/ EXPIRES BLOCK ="- SUBDIVISION CHAPTER 145.135 (2) WMCONSIN STATUTES (a) The purpose of the sanlary permit Is to &Dow Installation of the private sewage eyetem deaerlbed In the permit. (b) The approval of the mniary permit Is based on reguletbu lo force am the date of approval. (e) The unitary permit Is valid sod may he sees for ■ (d) changed regulations will sot impair the valkilty, of a unitary permit. (a) Renewal of the anal" permit wig be baetd on regulation In fora at the time renewal Is sought, mad that changed regulations may hapwe rmewaL (f) . The sooitary permit is transferable. Nlsterr. 19" c.168; 19" e. 34,221; 1981 e. 314 Note: If you with to roaew the permit, or transfer ownerahip of the permit, phase contact the too" authority. ISSUING OFFICER - DATE UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION sBn-064" (x) )rzo) 40