Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
008-1083-80-000
Wisconsir ~)epartment of Commerce PRIVATE SEWAGE SYSTEM Sty an~~Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 'ermit Holder's Name: City Village X Township Krause, Edward Eau Galle, Town of :ST BM Elev: Insp. BM Elev: BM Descript' n,~ ^ ~` /OD `(LU TANK INFORMATION ~, TYPE MANUFACTURER ~`, ;. ~', ~'~ ~ ~ ` CAPACITY Septic f ~~;' *~ ! . ti _ Dosing }} ~ r .~, C. ~rx+lion (;~ ~ ~;~ . " ~ 1 .. Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD t Septic ,• / / ~$ Dosing ~ '` ~~~ `~ i .~$. ~ ..._ Aeration Holding PUMP/SIPHON INFORMATION r 1 _ Manufacturer ~ t ~ "" ~` Demand °- j ,+. ,~,, .; GPM Model Number ..~ ~ Zo ~l03 b 7DH Ljj$„ Frictio~L ~ System Head ~ TDH ,.,ft • /l ~ S~ 2 • / Forcemain Len t / Dia. ~~ Dist. to Well ~ ~Z ~ ~ /~ SOIL ABSORPTION SYSTEM county: St. Croix Sanitary Permit No: 506289 0 State Plan ID No: Parcel Tax No: 008-1083-80-000 Section/Town/Range/Map No: 29.28.16.4446 ELEVATION DATAf ~. S'S /0.3.55 /P.~ STATION BS z HI ia~, FS ELEV. i a7 Benchmark - ~ ~~ u~ ~ ~ ~j' / ~ ~ d q Bldg. ewer ~~~ ~ ~/ r $~ SUHt Inlet ~ / 5 St/Ht Outlet ~ Dt Inlet ~~ Dt Bottom ~ y 7 ~/_ J~ R ~, Header/Man. ~ 5 ~'1 ~~.Or - Dist. Pipe ~ 1 1 ~ 9s. ~b Bot. System ~~ ~~ ~, $ ~~• Final Grade ~~ ~~ ', / `O~ 1 0 St er / / ~ (~ g T! 9 5 • ~l I .:, ~-r..,.~~ ~ .~ ~3 , ~ BED/TRENCH Width / Length ! No. Of enc s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid De th DIMENSIONS ~~ /3 4S `~ e ~., _ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ORMATION CHAMBER OR INF T e tem: YP Ys L G 3 ~ ~A,~ CJv UNIT Model Number: Z } / / DISTRIBUTION SYSTEM /_JeStl- Header/Manifold ~ i i + Length ~~ ~ Dia / '~ Distribution // / ! Pipe(s) ~j Length (v3 • "' Dia ~~ 5 Spacing 3 '~ x Hole Size/ ~! ~ '7 ~L.~ x Hole Spacing / ~ b Z 3 Ve o Air Intake ~t~J SOIL COVER Y Praesurw Systems only YY Mnr:nd Or At.Grade SvStems Only U A. Depth Over Depth Over xx Depth of i xx Seeded/Sodded xx Mulched Bed/Trench Center ~ ~~ ~ BedlTrench Edges \ Topso l f ,~ es ~ No ~; No ~"P~es Ia 9 COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: y~•~ /~_/ ~~ <~ 'i Inspection #2: / / ti dam'',-~ Location: 2240 10th Av~Baldwin, WI 54002 (SW 1/4 SW 1/4 29 T28N R16W) NA Lot ;:,, .~;,.i..::.~., ~ ~ ,..Pardo: 29.28.16.4448 1.) Alt BM Description - ~ 1! ~OJ~~~ , t' ~M''~- 2.) Bldg sewer length = / ~ a~ / f (y `~ u ~~- `~" i'~ A - amount of cover = ~~r ~ ~~ aJ,- v ~ Imo JS~, Z . `~~~ n ,~,~~~ ~ ~ ~ ~ d~4 ~~ Plan revision Required? ^ Yes No / ~ ~ -~~ I - - - - - ~T~~ e{~< Use other side for additional information. ~~ / ~ L__ ~_ _~ SBD-6710 (R.3/97) Date Insepctor's ignature Cert. No. ~-ta-igov Safety and Butldingg Ihviston C, ~~~ ~ 20I W. Washington Ave., P.O. Box 7162 / ~ scores ~ n IKadison, WI 5370-7162 Smi1a<y Permit N~ber (eo be filled ie by Co.) Hof coaraneroe SO Cv 2 ~' ~ Saaitary Permit Application ~ ~` T`~"'°° I'"~" I ` ~ ~TS ~ / r ~ ~C d to with s. Coerm. 83.2!(2), W~ Adm. Code; snbon~on of this form to die aantal unit is required prior m obmining a sanitary pernet. Nose Apptiotion forma for Povrrs are submined to the Departnrdrt of Cormnerce. Personal infomption you provide an Project AddressGfdiffera~tthmmtu'Cogaddress) Z ~6 ~Q ,/~ in ac~rdarrce wah the Law, s. 1 S 1 m Stars. V " ~~, ~i ~ ~ Z L tine Information -Please Print AR Info n ~~ ~ Properly owners Name R E C E l ~'~ i,,f~-2cf ~r'~cps'~ ~' ~ ~ ~~ ao ~'d~- 1~~~ Property Owner 31~ing Aaaras A U G 1 0 20 0 7 2 "~ h Iy2~`L~- ~y Locaxiwt ~. ~~}~ ~ , ~ ~0 Govt Lot ctty s~ ~ ~ Y ~~ ~ ~~ G2 ~5~- ~ ~s~ ~( ~~`~c) R 'E W T `~ H II. Type of Baitdia fi (check alt ffiat apply) p Ic, r..~ Lot ~ ~ or ; Faminr~g~Aiew - Ntm.irr of ~~~ ~e - _ - ~~b~,~tk- ~ P sloat~ [3 ~ - Describe use ~ City ~ ^ State Owned - (Jesaibe use /r~ ~ ~ / CSM Number ^ Village of ~ Town of ~ ~' 4 ~ ~ (~ 5 / ' / ~ w~ ' ~~ III.- Type of Permit; (Check one box on lice A. Comptebe ifs B J ap~ble) `~ ~ ReplaoeAra-t System LJ Tre~ne~Oldiag Talc Repmoe~0afy 0 Otberl+~or5fiatiat to Facisttag Systrm faP~) . B- ©Permit Renewal ^ Pettnit R ^ Change of Plmnber ^ Permit Traosfffto New Lat Pteviota Piamit Number and Dsae hatmd ~ - Before tacpiration Owner IV of POWTS GlDevtt:GG C_ Itecic a>t that a O J; . ^ Non-Primed Irt-Cuound a Pre~urited dfGronnd ^ At-Grade ~ Momtd> 24 io. ofsnpable sod ~ Motmd <24 is of a: le safi xx / ~ - U ' ^ Holdmg Tactic ^ Other Dispersal Caaposatt (explain) ^ A Devine (atplaia)- , V. reatmeat Area Informattots: Design//~y~p{y ) ~( /~ Design Appiieadwc ~ ~ ~IL't'~ pisppUsat Area~r, sf) / l ~' V ~N ./ pig/ /a/ l Ar/eat ts'B VI SrV '7~~~~ (/ Syasea~/t/~tXevatioa L -l! fir Vi. Tattk Info Capaaty in Total # of )t~aOUFacaav Gales Gagons tJni15 a t' U ~ Aleea Tasks Fs~Tada +~' jj~~ jj~~ ~ `Q~' sq F53 ~ ~ ~ B a . ~ Z4 ~ Ut„J c, V o, r ao w o . S~orFlpldnpT~ Q~ r* ~ ~ ! C6sartrer ~ ~ _. VQ. Ons~ity S`tatem~ti I,11x siadersigoed, o[tire PpW1S oa the attached plans. Plurctber's Name') s Sigmwtte /~ ~/ N Bcuto~ss Phan~Njateber PI s Address (Street, City. // ~~~ Cork ~ vnL .n v~ ved D ved Permit Fee s ~ ~0 ~ Dace Issued Luwos a Ressoa ~ $ ~3 ~~ DC. Co for 1>isapprovat 1. Septic tank,- effluent filter and 1,. „ /~ dis ersal cell must all he services /maintained ~ Q ~ O ~ ~ ~ ~ ~ 4'/~-~ a' '-'"' ` `' -~ U V-~ a' as per management plan provided by plumber . 2. AN seffiack tements must be mt~ltained Gn ~ _ I __ svalem and ssbrsk to ~Coa~r asiy on papa'sot lessNaa S t/t z t1 idles is sbx ssu-63~s tie. ot~vaiia tt~ olro~ ~ ~ ~ ~b ~'~ ~ ~ ~~~ ~~ ~~ f~~ ~ 6 ti a {r A _.~p _ - _ ~_F ~ ._ .._ ~~6Et G~~~ ~ ~ Y ~ ~~~~4~'` ~~~ g ~,~JJJ~r ~ ryC i~1~~~~ ~~~~` __ ~ _____ ___. __. ~_ __ .__ ____ _, _ ~ ~~; --- ~..-. - I ~rG e ~ a6 ~, 3 ~ ,~=~ t.. ~ 3 R ~~~~ ~~ s 8~- ~' •°r,;; a; ~ i ~ ~~ ~ ~~ ~''`~ "~` ~c v: g ~ -. ~ . ~$ a ~ ~ ~ yy'~., ~ ~ 3 ~~~- ~ ~~} ~ ~, - ~~ ~ 1 `,~- ~ ~ r _ . ~~ i ~ i ' ~ ~' 1 ~ ~ ~ ald ~ ~ I `~ ~~ I /qq~ ~; k ~. .~ ._~~,. ___.__. a_.___~.___ ------ - ._. _ _ ~ _. _ .. _.~__ _ _~._,~ °`'°~- $ 9 4 T 2 "v ~ ~ ~~ ~s~t ~ A ~ - s-c~ ~ ~ ~ ~ a,~ q ~ ~_. •~, d °' y$ ~ ~ ~,a ~ f r 0 ~ (~:Wt, tv~ v ~ow~~~`~mt ~a~ ~L7 ~°'~ ~l~ L ~ ~~~~ ~. ~. / ° ~° ~:~~ aciz~> ~ _, ~` ~~ ~ b~ ,,~ ~~ I , ,.... ~.~«_.~ w _ .~~..~~ ~~ti.a . ~ ~ j ::' L ~~ ` ~.~ ~- ~ ~ ..~y ~ ~ ~°~~ Cl~ .r~ 1 ?~ e t 4 ~ ~~` + ' 1 i ~~ .. ~ ~ ~ ~. ~ ~, r, c ~i I ~ } t ~ ~ ~ ~ ., ~ ~ ~ ~- ~~ -~ - ~ ~ 1 ~ ~ C ald ~ SGh~~~ ~ 1 ~ ,~ s~ ~~ ~"!~ ~. c. _., _,. __.r ~ Vw a___ ..._ .____-._ ._. _. _ .~ .,_ ~. __. _. ~`"~ ~v ~ ~~ .. ~~ .~ commerce.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi. govlsb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary August 06, 2007 CUST ID No. 223475 JOE STANG STANG PLUMBING & ELECTRIC PO BOX 263 WOODVILLE WI 54028 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/06/2009 SITE: Edward Krause 2240 10th Avenue Town of Eau Galle St Croix County SW1/4, SW1/4, S29, T28N, R16W ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Identification Numbers Transaction ID No. 1425571 Site ID No. 728577 Please refer to both identification. numbers, above, in all corres ondence with the a enc. . FOR: Description: Three Bedroom Mound System /New construction Object Type: POWTS Component Manual Regulated Object ID No.: 1145031 Maintenance required; 450 GPD Flow rate; 38 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the effluent filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • Comm 83.22(7) - A copy of the approved plans specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department which mawinclude local inspectors. P.Q.~~I.T.~. Cnnct'itorral~y l~G ncaau7MEN7 OF COMME JOE STANG Owner Responsibilities: Page 2 8/6/2007 • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) -The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, ~f,~ Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon -Fri, 7:15 am - 4:00 pm j erry.swim@wisconsin.gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WSMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN ,J(f( ~ ~ 2007 Residential Application INDEX AND TITLE PAGE SAFELY & BUILDINGS Project Name: Owner's Name: Owner's Address: Legal Description: Township: Krause Mound Edward Krause 2240 10th Ave. Baldwin, Wisc. 54002 SW1/4, SW1/4, S29, T28N, R16W Eau Galle County: St. Croix Subdivision Name: Lot Number. Block Number: Parcel I.D. Number: 008-1083-80-000 Plan Transaction No.: Designer: Date: Signature: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan Page 9 Soil Evaluation Report License Number. 223475 Phone Number: (715) 684-5166 Des~ned-~rsuant to the Mound Component Manual for POWTS Version 2.0 SD&10691-P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) Version 4.01 (R. 09/04) P e 1 of 9 OIVlS-UN OF SNttIY AhU bU~Lu~~.~~ ~ SEE CORRE ONDENCE Mound and Pressure Distribution Component Design Design Worksheet Site Inform ation (r or c) R Residential or Commercial Design 300.00 Estimated Wastewater Flow (gpd) 1.50 Peaking Factor (e.g. 1.5 = 150%) 450.00 Design Flow (gpd) 5.00 Site Slope (%) 93.70 Contour Line Elevation (ft) 38.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpd/ftz) Distribution Cell Information 65.00 Dispersal Cell Length Along Contour (ft) _ 1.00 Dispersal Cell Design Loading Rate (gpd/ftZ) 1 Influent Wastewater Quality (1 or 2) Pressure Disribution Information (c or e) a Center or End Manifold 3.47 Lateral Spacing (ft) 2 Number of Laterals 0.156 Orifice Diameter (in) (e.g. 0.25) 3.00 Estimated Orifice Spacing (ft) _ 2.00 Forcemain Diameter (in) 170.00 Forcemain Length (ft) 80.00 Pump Tank Elevation (ft) ~~ 4.55 System Head (ft) x 1.3 Z . 13.95 Vertical Lift (ft) 2.13 Friction Loss (ft) / ~~1 20.63 Total Dynamic Head (ft) ,~Z /~ o,h Lateral Diameter Selection in. dia. o tions choice 0.75 1.00 1.25 1.50 x x 2.00 x 3.00 x Note: Sand fill (D) calculations assume a Table 83-44-3 in-situ soil treatment for fecal coliform of <= 36 inches. 6.93 Cell Width (ft) Are the laterals the highest oint in the distribution Y network? Enter Y or N If N above, enter the elevation ft of the highest point. 10.24 ftZ/orifice Does the forcemain drain back? Y Enter Y or N 27.73 Forcemain Drainback (gal) 58.19 5x Void Volume (gal) 85.92 Minimum Dose Volume (gal) 23.69 System Demand (gpm) Manifold Diameter Selection in. dia. o tions choice 1.25 x 1.50 x x 2.00 3.00 Gallons/Inch Calculator (optional) Treatment Tank Information 600.00 Total Tank Capacity (gal) 1000.00 Se tic Tank Capacity (gal) 36.00 Total Working Liquid Depth (in) Wieser Manufacturer 16.67 gal/in (enter result in cell 649) Dose Tank Information Effluent Filter Information 600.00 Dose Tank Capacity (gal) Zabel Filter Manufacturer 16.76 Dose Tank Volume (gal/in) A100 Filter Model Number Wieser Manufacturer Project: Krause Mound Page 2 of 9 Mound Plan View 1_ 1/10 B • ~ ~ • •Observation Pipe 'Q' :~' K ,5. :t.~ .~.~~.... ... ............... . ... ...............B ........... .. ~. I i L Mound Component Dimensions Down slope toe extension made. A 6.93 ft E 10.16 in H 1.00 ft K 7.39 ft B 65.00 ft F 9.50 in z 10.38 ft L 79.79 ft D 6.00 in G 0.50 ft J 4.67 ft W 21.98 ft 450.45 (ft2) Dispersal Cell Area 1125.00 (ft2) Basal Area Available 6.92 (gpd/ft) Linear Loading Rate 6.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 95.99 (ft) .f,,,,. F 94.20 (ft) ~ - = • = Dispersal Cell :~ Elevation Shading Key 1~ _ Topsoil Cap © '~'~~' Subsoil Cap ASTM C33 Sand Tilled Layer ^5 r:r:r:, Aggregate ~I H Dispersal Cell . ~ 94.70 (ft) Lateral Invert E D ~ ~ ,, 5.0 % Site Slope '~ a ~ .Q ~ Dispersal Celt ~ 1.5 ft 5• ~-}~ ~ m c 0.5 ft '':'Typical Lateral •'•:;^:' F . .. .. .. .. .. .. .. {. ~ti.• ~ I . . . . . . . . . : ~ ~-- A ~ 70 (ft) Contour Elevation Geotextile Fabric Cover See lateral details on Page 4 for number, size, and spacing of laterals. Laterals are equally spaced from the distribution cell's centerline in the distribution cell (Ax6). -r -~ _I -1 Project: Krause Mound Page 3 of 9 End Connection Lateral Layout Diagram Laterals centered over the P All laterals are identical IE X--~I Holes drilled on the bottom of the lateral equally spaced Farce main connection via tee a cross to manifold at any point. Laterals & Force main of PVC Sch 40 (per COkAM Table 84.30-5] Number of Laterals 2 Orifice Diameter 0.156 in Lateral Diameter 1.50 in Orifice Spacing (X) 3.02 ft Lateral Length (P) 63.42 ft Orifices per Lateral 22 Lateral Spacing (S) 3.47 ft Orifice Density 10.24 ft` Lateral Flow Rate 11.85 gpm Manifold Length 3.47 ft System Flow Rate 23.69 gpm Manifold Diameter 1.50 in Total Dynamic Head 20.63 ft Forcemain Velocity 2.42 ft/ Dose Tank Information Electrical as per NEC 300 and -- _ Comm 16.28 WAC (L, ~---- ~ I Disconnect • =Turn-up wi'ball valve or cleanoutplug Locking cover with warning label and locking device and sealed watertight 4 in. min. Tank component is properly vented Wieser Ca aci 600.00 Volume 16.76 Manufacturer Gallons gal/inch -~ A B C D Dimension Inches Gallons A 19.67 329.72 B 2.00 33.52 C 5.13 85.92 D 9.00 150.84 Total 35.80 600.00 ~ 3" Bedding under tank. Alarm Manuafacturer SJE-Rhombus Controls Alarm Model Number Tank Alert 1 Pump Manufacturer Goulds Pump Model Number 3871 EP05 Pump Must Deliver 23.69 gpm at 20.63 ft TDH ~ Alternate outlet location Forcemain diameter ~ 2 in. Weep hole or anti- siphon device P~P off elevation (ft) 80.75 Do• se tank elevation (ft) 80.00 Project: Krause Mound Page 4 of 9 Mound System Maintenance and Ot~eration Saecifications Service Provider's Name Joe Stan Phone 1-715-684-5166 POWTS Regulator's Name St. Croix Coun Zonin Phone 1-715-386-4680 System Flow and Load Parameters Design Flow -Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow -Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450.45 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Freauencv Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Ins ect and/or service once eve 3 ears Should ins ect and clean at least once eve 3 ears Test once eve 3 ears Should test month) Laterals should be flushed and ressure tested eve 1.5 ears Ins ect for ondin and see a e once eve 3 ears Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished ...~~.......•. ............... Grade ~~ 6-8" Diameter Lawn _~ Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral ~`i Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Krause Mound Page 5 of 9 Mound System Management Ptan Pursuant to Comm 83.54, Wis. Adm. Code rat This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in acxordance with its' component manuals [SBD-10691-P (N.01/01) and SSWMP Publication 9.6 (01/81)) and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers ahouki 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 sut~ect to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective kx*ing device to prevent acadental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stets. The contents of the septic tank shall be disposed of in acxordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall Ne assessed at least once every 3 years by inspection. The outbt filter shall tie leaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retaM solids ~ the tank that may sough off the filter when removed from its enclosure. ff the filter is equipped with an alarm, the filter shall lie serviced if the alarm is activated c~rrtinuousty. Intermittent filter alarms may indicate surge tknMS or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum 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 a triennial assessment, maintenance personnel shad advise the owner of when the next service needs to be performed to maintain less than maximum swim and sludge accumubtion in the tank. The addition of biological or chemical additnrea to enhance septic tank perforrnanoe ~ generelty not required. However, ff such products are used they shall be approved for septic tank use by the Department of Commerce. Pumn Tank The pump (dosing) tank shall be inspected at bast once every 3 years. All switches, alarms, and pumps shad be tested to verHy proper operation. Han effluent fiker is installed within the tank it shall be inspected and serviced as necessary. Mound and. Pressure Distribution Svsbem No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mcwnd shall be seeded and muk~ed as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound b not recxrmmended since sod compaction may hinder aeration of the surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dilate that the mound be heavity mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODs, 150 mg/L TSS, and 30 mgiL FOG for septic tank effluent or 30 mg/L BODS, 30 mg/t. TSS, 10 mg/L FOG, and 10, du/100 mL for highty treated effluent. IntiueM flow may not exceed maxunum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and k is recommended that each lateral be flushed of axumulated solids at bast once every 18 months. When a pressure rest is performed it should be compared to the initial test when the syst~n was instaNed to determine if orifice hogging has ocx;ureed and if orifice leaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal ced shad be chedred fir effluent pooling. Pooling bwets shah be reported to the owner. and any levels above 6 inches considered as an appending hydraulic fafiure requiring additional, more frequent monkoring. Corrtinaencv Plan If the septic tank or any ~ its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. if the dosing taMc, Pump, pump contrds, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a ccmponent of the same or squat performance. If the mound ccmponent fails to accept wastewater or begins to discharge wastewater to the ground surface, it wfll be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically dogged absorption and dispersal media, and telated per, and neplacarg said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your kx;al POWTS regulator and service provider. Project: Krause Mound Page 6 of 9 tBd - 9t9;T885i~s~iO~ii . ~~ ~6ou~as BPS ,, :~ 38'71 ,s` 'area . ~ a ~,~ • tope ap b~t,P~t ~ lieed~ ~ b St teat ;~ ptecfiaep~sr~1~*I~f. ~~ • Med~iarseal: artbon- Blrlr~llte4eeioee~rs. • 7eAeper~ • i~r~ ~ ~, caaevorra~ riles • CPM1~tS~gMtpilre~~41P, its,r?.~O = S8 r1~ ~!f ~+*~t ~ ~ s i ii1Yj i~h Or-~oaAwip ~ wwvs~ ~saS~ftMianlh • e drat aeatt~ier. ~E!!i1^~~'t~rno~ A ~ ~C~fiet slr ileac lipped ~~~~ oar~ios~a~noe. iNr11rM~C~tbq ~R~f, al~~f- er eieiMt Germs l~eeeeapie~c cwer~t iere~nHppdeea~e~ ~ a~ewt ^!Mw'~iic8a~ndnq- piedda~s~rerteeb~nt ^ !lpp~rarrd to~wr AiersMN~e~lTet~l t~ !lNtiNt~~iar ~*~~ ~~ w~1 ~dtlp tNt1I~06tOf MeeC~eetp r^~re_..___.... . ~__^ ~ sune6rr~ irli~~ee>itll _j -~-• - . -- ---~---. - - - -_. - -r ~-- - = •- -- - t - ~~ -- a ~ ~ .. ~ r. ..r..~_ ~ ~ +.~..._...._.... _ ...... ~.. ._.~.. ~D JO ~ . r0 . bQ _ .tit a 2 a 6 S-- to tst w~ Ca ~ M ~, b9 ~~ ~ ~ Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 4 Division of Safety and Buildings m atx:oroanoe w¢n ~,omm tsa, vvis. ram. t,vae County - St. Croix er not less than 8112 x 11 inches in size Plan must Att h m l it l n on t . p pap ac co e e s e p a inGude, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 008-1083-80-000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location ~ ~ Edward Krause Govt. Lot SW 1 /4 SW 1 /4 S 29 T 28 N R 16 r) Property Owner's Mailing Address Lot # Blodc # Subd. Name or CSM# 2240 10th Ave. City State Zip Code Phone Number iN ^vllage own Nearest Road Baldwin Wisc. 54002 ( 7~5-684-3852 10th Ave. New Construction Use Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement ~ Public or commercial -Describe: Parent material Outwash Flood Plain elevationrf applicable ~t-r~ ft. General comments 6" Mound @ Contour of 93.7 and recommendations: 1~ Boring # ^ Boring D pit Ground surface elev. 93.7 ft. Depth to limiting factor 48 in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Dltt'- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *EfF#1 "Eff#2 1 0-10 10YR5/3 --- sil Ifsbk dvf cw 3co 0.4c 0.6 2 10-21 IOYR3/6 ---- sil 2msbk dvf cam, 2m 0.6 0.8 3 21-31 10YR4/6 ---- sl lmsbk mvf gw if 0.4 0.6 4 31-48 7.SYR5/6 -~- s 0 m ml --- - 0.7a 1.6a thin band of scl @ 48" 2 Boring # U Boring 42 91.4 a pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10YR5/3 --- sil lfsbk dvf cw 3co 04.c 0.6 2 10-23 10YR3/6 -- sil 2msbk dvf c"~' 2m 0.6 0.8 3 23-42 10YR4/6 --- sl lmsbk mvf >;~' if 0.4 0.6 41 42-60 7.SYR5/6 fI5YR5/8 SPOTS s 0 mgr ml -- --- 0.7a 1.6a thin band of scl @ 42" * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mglL and TSS < 30 mg/L CST Name (Please Print) ignature CST Number Thomas W. Gedatus 962178 Address Date Evaluation Condu Telephone Number Stang Plumbing & Electric P.O. Box 263 Woodville, Wisc. 54028 7/25/2007 715-684-5166 Property Owner Edward Krause Parcel ID # 008-1083-80-000 2 4 Page of _ 3 Boring # V Bonng 93.7 38 pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fi? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *EfT#1 *Etf#2 1 0-8 10YR5/3 ---- sil lfsbk dvf cw 3co 0.4c 0.6 2 8-19 l0Ylt3/6 ---- sil 2msbk dvf cw 2m 0.6 0.8 3 19-30 10YR4/6 ---- sl 1 msbk mvf ~' 1 f 0.4 0.6 4 30-38 7.5y~/6 fl5YR5/8 SPOTS s Orngi' ml --- --- 0.7a 1.6a thin band of scl @ 38" ^ Boring # ~ Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil licatan Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/if in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Etf#1 *Eff#2 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. Pit Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DffF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mgll * Effluent is = BOD, < 30 mgll. and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330Test(R.O~/00) EQ G/a-R ~ k R ~h S ~ 2^~~v /Ut~ a/ 6~ ~' ~ w ~/yam S w ~ /y, 5 Z `i , "'+" za ~/, 1Z !`~ ~ ~~ -~ 00.8- ~oi~~r-g~"o°° ~, ~, .~~~V2. 9l: ~f ~ ~-~~ ~ ~ , ~. o -}- ~ , ~,. ~. ~~~~ i ~~ ~ ~ ~~~~` ti F t t - ~_~. ~_ 9~ _ r t ~ ~ e l .{ d ~ ~~~ ~ .~ s ~ .~ ~° ~ ~' ~ r ~ _ ~~ ~~ i f ~ ,;; ~ I ~ , SST ~~=fo2i~g ,. ~~ ~~ ~, xM ~~ . S'i~~~ f t" 0.~ c ~- ~ ~.~_ ~~ ; ~~ !,l ~\ ~ ~P' ~. old s~~~~~ 3 a~ y lO ~~ ~~ Wisconsin Department of Comm ~ ~ „SOIL EVALUATION REPORT page 1 of 4 Division of Safety and Buildings m acwraance wr[n ~,omm aa, vvis. ream. ~.vue County St. Croix Attach complete site plan on paper no ss 1 inches in size Plan must . inctude, but not limited to: vertical and horizontal reference point (BM), direction and pares I.p, 008-1083-80-000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Revie by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ` ~~ Property Owner C E I V E ~ ro rty Location ~ ^ Edward Krause ' Govt Lot ~~ 1/4 SW 1/4 S 29 T 28 N R 16 E (or) W Property Owner's Mailing Address JUL 3 0 2007 tot Btodc# Subd. ~ ~ 2240 10th Ave. ~ . ~" ~~~ City State Zip Code honr~lul~1X COUNTY ~ ^v0age own Nearest Road Baldwin Wisc. 54002 7 5-684-3852 10th Ave. New Construction Use Residential / Number of bedrooms 3 Code derived desgn flow rate 450 GPD Replacement ~ Public or commercial -Describe: Parent material Outwash Flood Plain elevationlf applicable ~ i n ft. General comments 6" Mound @ Contour of 93.7 and recommendations: ~~//)'t,(~/1J -1~'~'~-~ ~- ~u~ ~~a~~~-~/a~'aA'~ , .o~ li.~ ~_ t,;.,,~a - U~`r.-mil ~~ ~~ ~~s ~2~~ (~~=~~, c~~ ,fie ~.~~o! Boring # ^ Boring Q pit Ground surface elev. 93.7 ft. Depth to limiting factor 48 in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 1 0-10 IOYRS/3 ---- sil lfsbk dvf cw 3co 0.4c 0.6 2 10-21 10YR3/6 ---- sil 2msbk dvf c~,~, 2m 0.6 0.8 3 21-31 10YR4/6 ---- sl lmsbk mvf gw if 0.4 0.6 4 31-48 7.SYR5/6 ---- s 0 m ml -- -- 0.7a 1.6a thin band of scl @ 48" 2 ^ Boring # ^ Boring 91.4 42 ~ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/tf2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10YR5/3 --- sil lfsbk dvf cw 3co 04.c 0.6 2 10-23 10YR3/6 -- sil 2msbk dvf cw Zm 0.6 0.8 3 23-42 10YR4/6 --- si lmsbk mvf gw if 0.4 0.6 41 42-60 7.SYR5/6 f15YR5/8 SPOTS s 0 mgr ml --- --- 0.7a 1.6a thin band of scl @ 42" tmuent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mg/L * Effl nt #2 = BOD < 30 mglL and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Thomas W. Gedatus ~ 962178 Address Date Evaluation Conducted Telephone Number Stang Plumbing & Electric P.O. Box 263 Woodville, Wisc. 54028 7/25/2007 715-684-5166 Property Owner Edward Krause Parcel ID # 008-1083-80-000 2 4 Page of 3 Borin # ~ Boring g ~ pit Ground surface elev. 93.7 ft. Depth to limiting factor 38 in. Soil lication Rate Hortzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f>? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 1 0-8 10YR5/3 --- sil lfsbk dvf cw 3co 0.4c 0.6 2 8-19 10YR3/6 ---- sil 2msbk dvf cw 2m 0.6 0.8 3 19-30 l OYR4/6 ---- sl 1 msbk mvf ~' 1 f 0.4 0.6 4 30-38 7.SYR5/6 fl5Y]t5/8 SPOTS s Orr-gr ml --- --- 0.7a 1.6a thin band of scl @ 38" Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fi? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Etf#1 "Eff#2 ^ Boring # ~ Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 *Eff#2 * Effluent #1 =GODS > 30 < 220 rr-g/L and TSS >30 < 150 mglL * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/l. The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330Tost (R07/00) •. ,E',pGl~R~ k~e~ys~ ~ yJ ,/yam ,S ,,,~ 1 /y~ s Z 1., T 2a ~, 1Z l,~ ~ j ~:~ ~~~_ ~~ X30 t~. ~~~ ~y~ q~; ~~ ~~3-~ 3.` --~-. r o ~,,,~ t,`, . G ~ ~ ~, ~-~ s CST ~~-~2i~_8 ~fn (,v ~~~a ~~~ `~f ~a L. o '}' L 9 •~. ~ ~--- _-.~ "~ ~~,~~a i~ f t i +' a ~~~ ' ,~ ~ , ~ _ } - '~ ,. ~~ I s f. ~ ~~ I ,3 1 f ~ ~ ~' ~ ~ ~ ~~ s ~ V O ~.1 4~'",' ~9 ~ +~''' ~- , ~~~~~ ,, ~~~ ~ 3 a ~ ~ ~~ '~ ,~ ~~ e._ ~ .F~ .a~ std s~~~~~ N~ o ' Parcel #: 008-1083-80-000 08/02/2007 09:58 AM PAGE10F1 Alt. Parcel #: 29.28.16.4446 008 -TOWN OF EAU GALLE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O - KRAUSE, EDWARD R EDWARD R KRAUSE 2240 10TH AVE BALDWIN WI 54002 Districts: SC =School SP =Special Property Address(es): " =Primary Type Dist # Description '` 2240 10TH AVE SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC G~~~, , „ /j t'c.v~- ` j ~(jl f.~j h ~ .~ ~ G jyt , ~(~ ~~ Legal Description: Acres: 2.000 Plat: N/A-NOT AVAILABLE ~ SEC 29 T28N R16W 2A IN SE SW COM 31 RDS Block/Condo Bldg: ~ W OF SE COR, TH W 18 RDS, N 18 RDS, E 18 RDS TH S TO POB Tract(s): (Sec-Twn-Rng 4 1/4 160 1/4) 29-28N-16W Notes: Parcel History: Date Doc # Vol/Page Type 11/09/1998 442992 827/92 QC 07/23/1997 493/164 07/15/1987 428124 785/271 LC 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/11/2000 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 16,900 11,100 28,000 NO Totals for 2007: General Property 2.000 16,900 11,100 28,000 Woodland 0.000 0 0 Totals for 2006: General Property 2.000 16,900 11,100 28,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch #: 513 Specials: User Special Code Category Amount ~x/~ i~zlt-UU ~~. 2~ Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 T T I D~~S,IMENT NO. . TM16 !S'AG! RCBSRVID FOA ARGORDIWO DA=A Bws or- `waa~vPio>a ~ansYe O -' ~~ I 1! ST ~I fI ~i n€C~ E fI_ ., ._ - E ~ ~~~ ~ i E ~I ~4 . i E!30K .~. ~- --- --~- - --. - . Ii i~~i~'~ ~FF~~ E j ~1 s Debra R. Sikora ~~,d f~ R~~ (` . ~ ~ NOV 4 ~ I! • Edward: Ft Rrau-`se---• --- .. gait-claims to --------- ---• -- If 1 ~ 8:30 A.M , Il i{ -- --- - ----- ---- ..- -- ---.-. ' ~ ~~ ~ i I~ the followln descrsbed real estate in St.~_ .S:rnac .:......... ........ L`onaty, of Wtsconam: te St ----•---------- - . - II a I4 - .. RLTUR tl N TO 11 1 I - .. _ - I Tax Parcel No: --• -• ---.._ .. ++II ...-------•-- 1~ ~;~ Past of tY:.< -:ioutheasaa Quarter o€ the_ Southwest .Quarter. (Sly} SW}) I~. - - Of SeCtiOTI 29,. .township-,2o ivori:.ii, raia~c 'c '.f_•-. •-. i~ --- ... .... o ~ , + (' described as follows: Commencing3l rods West of the SE ccrner of +~ .. _•--- -~....«s•.. e,.,..a.4.woat Maart[aTi. thence uleSt ` 1~ s81U .wu~uccav .. .~ .._- -- _ ~ 18 rods; thence North iF3 rods; thence saat '° _-~-;-rhanca Sa4t:; le Lp LV4b ~l to the place of. beginning... ~S!!I~ ~'~ ~~ ~_~ II _ BEEF I~ 1 - Chas deed is far the p+~rpose of relinquishing; any .and all inerest ~~ 1 grantor has in the land contract between Kurt ,James Buetow and Jody Slocum, as vendor, .and Edward R. ILrause and Debra R. Sikora l as purchaser, dated June 25, 1987 and recorded with t!ae St. Croix Couray Register of Deeds on July 15, 1987 in volume 755, pagQ.271, as document number 42$124.) I I _ _ ~~ 2`his __....is..nat.......... ho.+rtestead property. (is) (is not) I~ Dated. this ~s_i< ........................ day of --- .................................................................... (SEAL) 0 --.._...---••-• ......................................................(SEAL) I AUTHENTICATION I authenticated this ..).~t.day of•._IZRYe~r.._..._.~ 39._$~ II `~ s Keith Rodli --• ~~ .TITLE: MEMBER STATE BAP, OF RiIJCONSi;v y (If not. --•---••-•--------------•-•--- --- -- - ---•---........ t authorized by § ?06.~J6, Wis. Stats.) .... ~ ..__ ..... ..rc.~sr.:---...._ .... (SEAL) ....Debra R....Sikora ..................... ........ ...._..,....._ ............. .....------...-- .----(SEAL) ACHNOWLEDCiMEFYT STAT1sJ vi' S:'.SCL)NSIAI ss. •----•- •-------•--------•--------County. ) ...da Personally came betorc me this ............. y of •------------------------•--------•-----... =°...----- the above named to me known to be the person ....._._..._ who executed the. -,,, ~~~;-G .rsf_l,..e.,t _.t:l an&nnwletlee the same. II THIS 11•tSTRLLM EAT WAS.~JR AFTER BY :i i. --..i wi. - - t - .__--...-e~. ......:......--- a~ ....... .._. i ~ i oat _ _ .. ._.......-. .- !; 214 N .,TR~_.t R-0..ur Fall 0 :.-..::, ...:.~..c>---~__-'::_~:._WZ 2 .. .._.._.. .._..-...._ Sall _ ~,;;• ~ .tl.lf. ::- •- P ...._ ..................... .Wis. .County `t lCis»a_4»_eu ..an , 1.- > ntn•~ erL rn _ --_.-_. ___- • _ -_ .-_ - ' . _ ... ~:etlcs.:?. ~nt1e tit!.' Cottt t)11~510n is i,L7- _- - ii ni._ ti.u'.._ L`..:•:--~:''^ ....~..... - __.. Ii . nC `ac a'V.) fire not : d ::r : . nit . ...... ....._. - . Ii .. . . li I~ 1 aal....r ~~ ~~__..... .:~..:..e __.., _.., ..._.. !.^. in.. .., ..~.:,v .1...~_l.i ha - - ~~a e.~e. n.l nr nrinlyd 1)nl.'.cr ttl^i, aiR r>\t . L,_, _..~ _.. _...-.._._.. _- . ~~ ~ ~~4«'+bl.~ ~~ - -- ~T.\T t: B.\n OH• µ•ISt-[)\~11 Stocic No 1$00's _ ,.-os.. .. , _ ,y8, . ~r. cxon~ couriTY SEPTIC TANg CE A AND O CEItTIFICATiON FORM . eyes ~b .,~ ~. ~ K ~ ,A- v ~~ ~.. Mailing A,ddmss , z z 1}- ~ t ®~ 1.~-1~-~ Y Address ~~~°,~ w 4~~ L dt Zoaosng De~ctmeast for nesw caeasnuc6oeo.) ,.. G"ity/State 3,c~-~~t..~ ~ N ~w S Paz~cei Idartifi~an Nmnbea i.~, Dxsc;~riox p~ Property I.oc~ation ~ ~-~ %s , ~ ~`"`%4 , Sea. ~ f , T ~ ~AT RAW, Town of ~~/~i ~~/` - Subdivision- - ~ -- - -- - ~-- - -- --- - ---- - - - - - - - - - ; tot #- - - Certl~d Sarvcy Mttp # ~j , Vole ,Page ~ Wttrr~utty Deed # ~ L ~ ~ G ~ ~ , Vow ~ ~ ~ , Pie # ~ ~.. Spec homse yes no Lot 1~ idmtif~sble yea na uee and maintes>snoa oaf year septic system oe:old nit iet ~ ~e to banelie ~vas0es. Pi+oper msia6manx oo~ls +~paeopieg a~ the s~C ts~ a+reary thee yeas a sooae:; ifneeded, bl a BoeASed p~anpaG Wleat you pa# inlo the aystam caa affect the fm~ of the septic feat m a ti+eatmeat stage ffi the waste disposal system. Owner msiate~snce: . tespensa'bilitie~ sex apecifiod in ~Caemm. 83SZ(1) sod in C 12 - ~ G~+onc tao~y SatMaty Orrlimnce. The pe{oparty owner age+xs ~ sabmit to St: ~ t:o~aeaty Plaezning dt Z,aeu~ De~artaoemt a onion form, sigoexl by the oa-ner and by a master phmobe~ joemreyamn phmsbe~ reatrkted Plomtber or s >i~ed pamper veniFy~g pmt (1) the aee~ite wmtewaier disposal system is in proper a aoadition aod/ac (Z) a&r mspectron and P~P~B fff Y), the septic taudc is kes them 3~3 faIl of sludge. ~R the nadexsipaod lanne uad the sberr~e and agcea to the private aewaga disposal system with 8u stmdaz~ set foectb, hendia, as setbytha Depalms~o~fClomotnoe and~Desp~tmea^t ofNatasdBaaoat~oey 91sRa of Wila~aos+ia. - ~ : GatiBeaaiaa tmttin~ that yeiar ~ iyeemLet teas maiab~ mtatbe oaseptated and re~rit~ad to the 9t C~oivc (~aeasty ~'!~ ~ Zo~ng Dep~amrt wiibin 30 days e,~the three: ynaraaopirationdiMe. 1fwa; oe~rthat sg stalpnea~ as thi ioeova are imo to 16e beat of a~foear 1o^oMlae~ t/wa ses~lases the oe~et(a) of ie Property dese~bod aberre; b~rv~e: eda wseaaatyeleed taoo[dad isB,e~stara[Uaeds nltioa. x.~bealrot~ms ~ r i i SICi~tA OF A-PPZ,ICANT(S~ DATE '`Any isdormatton>t~ie yaaiat+spoeaented~rrasdtistha smiMtcy paeeitLaieltsavoioedb7-~s P~oa~s ~ Zoei~ Dom. "' fodode with this won a rdoatdmd qty deed it+om the xegialer afDaeda Offioa snit a Dopy eiifther oectiBred aaney meq~ if re~ceoe is moot iu the: waromly deed. (iRBV. rBIbS)