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HomeMy WebLinkAbout018-1096-03-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village x Township Bonte, Ron Hammond Townshi :ST BM Elev: Insp. BM Elev: BM D scdptio . o X06 - G ~~ ~.. TANK INFORMATION TYPE MANUFACTURER C ~ /4CITSY Septic ~ / O ~ d . Dosing n f1 ~ ~ ~~~ Aeration Holding TANK SETBACK INFORMATION TANK TO /L WELL 1.10'0 BLDG. Vent to Air Intake ROAD Septic ~~~ t / I rs Dosing Pr Aeration Holding PUMP/SIPHON INFORMATION Number Loss SOIL ABSORPTION SYSTEM / BED/TRENCH Width / Length / DIMENSIONS ~ SETBACK SYSTEM TO INFORMATION Type„Of System: Head TD Ft ._-= t. to Well No. O~ ch~e~~a~ ' ~ . DG WELL DISTRIBUTION SYSTEM ELEVATION DATA c°"n~~ St. Croix Sanitary Permit No: 429937 0 State Plan ID No: Parcel Tax No: 018-1096-03-000 Section/Town/Range/Map No: 09.29.17.778 STATION BS HI FS ELEV. Benchmark rf . fl /off. b /b D ~ v Alt. BM - ~T Co 3` ~ ~3- d a Bldg. Sewer / - • V O ~ ` St/Ht Inlet ~~~'~~ ~U r /bb- ~ SUHt ~ ~e~~ Dt Inlet / ~ Dt Bot i ~~ Header/ aq.~ ,~. ~~ 1 1 a -~ •,~ / Dis~t. P' e l) o~C f ~' ~. ~. ~1 Bot. System I ~ v: ~ ~` ~ Final Grade -n ,~ s s b• ~ Zi ~ o- St Cover f C~ ~ ,Z / 0~ CHAMBER Dia. Liquid Depth Number/: \ MAIM Y[1.O Header/Manifold 1 ti Length~Dia J~- Distribution ` Pipe(s) / a~~k'! ~ ~ Length Dia_~ pac+ing x Hole Size /~ x Hole Spacing ~ Vent to Air Intake ~~ SOIL COVER x Pressure Svstems Onlv xx Mound Or At-Grade Svstems Only ~" ~ ~J' Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bedlrrench Center Bed/Trench Edges Topsoil L Yes [~ No r--~ i : J Yes `; No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: ~O ~/Y1/ / / 0 3' Inspection #2: ! / Location: 1086 174th Street Hamm-oyn~d, WI 54015 (NW 1/4 NW 1/4 9 T29N R17W) Pheasant Rid g Lot 3' / Parcel No: 09.29.17.778 1.) Alt BM Description = ST' ~y G t`"~ `~'~` ~ t,~~ ~ii~ .~-p e1~.7'N S ' ~i'Q.( ~Q~ ( Z b` 2J Bldg sewer length = 2~ '~ U ~_ (Sf~ ~ s (uIG~~~~G~ q(o•~ -amount of cover = `71 ~ Plan revision Re u+red? ~', Yes ~%No (-----T---~ ----- _.-_.------- ------ - i I ~ S i q ~ //~~ II - Use other s+de for add+t+onal +nformation. i_._~ ~_~ ~ __is/~'~ i_. ___-____ ~ . _ .__~_~ L _____1._ SBD-6710 (R.3/97) Date Insepctor's Signatu Cert. No. R~ G ~- Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 Cormty =~ ~ ~ ~seons~n Madison, Wl 53707 - 7162 (608) 266-3151 Sanitary Permit Number (to be filled in by Co.) L~Zq 3 Department of Commerce ..--~ ,~ t~N Sanitary Permit Applica ions-~~~.~~ ~ / k ` S to Plan LD. Number ersonal info anon you provide Code 21 Wi Ad i h C 83 , p m , s. t omm . !n accord w may be used for seco~ary purposes Privacy Law, sl 04(1xm) , '~ D ~ ~ ~ ~ed Address (if different ling address) ~ '~' :~ ~ ~ r i~ ~ ~T ~ ~G 1 ?'~i 1. Application Information -Please Print All Information i ~_ ~!/rld r~ ])~ ~! ~ ~ ~ ~ ~~-'~'_., Prope Owner's Name ~_~ P el # Lot # Blook aY " l Property Owner's Mailing Address Property Location /~ `~ ~ / S/ ~ ~ %., Ire" '/., Section City, State Zip Code Phone Number ( 9~1 ~7 „/ ( ~ ! 1 /y~ /// ~~~ '~ ~~~/ 0 p M T ~ I N; R,~E otatiy/ t t l / Q V app y) , t 0~ , i Il. Type of Building (check all tha ~V I `w" Subdivision Name CSM Number ~ ~r 2 Family Dwelling - Number of Bedrooms ~ Oh/I'~0 ~~ Q~ /~/ ^ Pubhc(Cotnmereial -Describe Use / / ,, / ~~ l'~t /~~ ~ ~ ~ T ~~ ~ ^Viilage~Township of ^City ZZ ^ State Owned -Describe Use / i J _ 111. Type of Permit: (Check only ane bos on line A. Complete line B if applicable) A' New System ^ Replacement System ^ TreatmenUHolding Tank Replacement Only ^ Other ModiScation to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New list Previous Permit Number and Dade Issued Before Expiration Plumber Owner IV. T e of POW'I'S S stem: Check all that a l Non -Pressurized ln-Ground ^ Mound >_ 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sam Filter ^ Constnucted Wetland ^ Pressurized - lding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Fiber ^ Recirculating S thetic Media Fitter Leaching Chaatber ^ Drip ~ vel-less P~ ^ Other (explain) V. Dis ersal/Treatment Area Inf h / - Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispetsal Area Required (sf) ispersal Area Proposed (sf) yttem 9 ' Elevation 9 z' ~ 8~ ~a •~ • Vl. Tank Info Capacity ~ Total Ntnnber Manufacttuer Prefab Site ~(,/6v Concrete Constructed Gallons Gallons of Units I ~ Steel Fiber Plastic Glass / Ncw Existing N Tanks Tanka Septic orb" ~) ~wv .~,. ~~ / Aerobic Ttcatmcnt Unit Dosing Chamber Vll. Responsibility Statement- 1, the under d, ass r nslbillty for installation of the POWTS shown on the attached plans. Plumber's Name (Prux 7 ~ S~ Plum Si MP/MPIt5 Number P~3~~~ v' Business Phone Number ~~ Z~s= ~~~ ~0 ' av Plumber's Address (Street, City, State, b09 dap ~~ ~i/ !~/~ ~l~7.~ Vll Count /De artment Use Oal Approved ^ Disapproved ~m~Y Penntt F~ (includes Groundwater S h F Date Issued !s g Ag Signature ( s) urc arge ee) 7~ ? ~ ~ ' l ^ Ow~r Given Reason for Denier r"' ~` Q nn,A, ~/ / Conditio~~rovons fo~ v~/ ! ~ ~~l~iJ7T /rl~'f / L/ O ~ ~~~ ,/~ ~ G~Gc~Gh!/h . ~~~~ C vn~l ~ ~ ~ ~ C-o- G _`~1in.dS t~ ,,,t,o.¢,~j~;c,~,~,,f sarc.~ Gn~~ ~1~~~--~° ~ /~ (~ fo~jlkte pleas (to the Couuty only) (nr the system on paper oor rasRnau epic z „ meow .u sue ) t ~ GiE.t w: a~?r+tie~~,a..eoc~rr~,OG_LTL~I ,fi~v'L(, Q 3. to d ~~~2- v+.~ ~~~a~F~~d r~•~ cl~,~c~.e- rte' ~ ~n . 8e ~'~h~~u-~ on 6~lt.~o . ~~ ` SB - 398 (R. O1/0 ) PAGE~OF NAME: ~ n ~ ~/J LOT#~_LEGAL DESCRIPTION:~1/4 l4i I/4,S~T~N,R, 13'E(or~ SCALE: I"= yD ~ ELEVATION: l(,27 , d ~ ,~- BM I DESCRIPTION:~~ p n. ~ ~ ~ ~-- -1- BM 2 ELEVATION: ~~~ ld ~~ ? i eC ~ BM 2 DESCRIPTION: ¢o ~ d ~ ~ ~ ;~ K.0-'~ P ~ ~ e SYSTEM ELEVATION: dr~Q ~(y .~O L~wcr ~(p. 5d SYSTEM TYPE: ~o ,~,~e n,~(--,,~a yam( Apo. a3 ,~ ~ ~, -~~ ~~ ~ ~ ~ A, ~ ~ 2 ~ ~a ,~e ~~_ ~ o ~~ ~~ B~ .~ ~~ v ~~S ~~,~c~ ~ ~~ ~ ~ ~~ ~~°~~ ~`'`' ~ ~ ` N~' ~ gnz ~~ 4 ~ ~ , ~ 8-~ SIGNA N .~ o ~~ ~ ~ ~T ~ ~a W ~ d 0 O Z\ `~ ~• r~ ~ ~ W Z ~ ~ Q N Z R~ ,.fl e ~ N ,, ~ ?O ~. m O n 0 i N .,p o l ~~ ~ _ v O ~ ~ '~ O ~ b _1 c ~ ~ Z ~ ` Q ~ O ~ ~ ~ N ~ ~ ~ e ~ 1 N ~ ~ J ~~ ~ r o m .~ ~, m anon wd!- comet ~. ~ Attach cortrpl~e see ~ on paper not lass than 8112 x 11 tnctres in alas. Plan must ,de. but rat d 10: v~Cal and tg~~ r~tlorr and ~ ~- a l~ ' /vq ~ - a 3 -ao~ percent scope. scale or dimensions, m nearest road. Date ~resse - `~3d 6~ Perswsd tntamaNon rov prartds ~r ta-+!' (P^r~Y . ~• 15.W (7) (m)). ~ PropertyOwner propertylocatiorr Govt Lot ,~(f 1/4 w1l4 S T N R E (or Property Owners Mairng Address ZONING O F F I L F_ Lot ~ Bbdc ~ Subd Name ar C ~ o ~ ~-~ ~ . r - 3 . ~if a q ~, ~y ~a Zip Code Phone Number ^ ~y ^ V~lage L~j'~ Nearest R~ ~~rnmoMA Wl (~iSr) 7 ~ - liZCo ~ a/~ lC)x- !~ New cor~udior- ties: [~ Residentlai ~ Nrmrrber of bs~o~ -.~-~-- ~ derived design flow rate ~ Ca ~CV GPD ^ Replacement ^ PubBc or cwmrrterr~ai - Desaibe: .~ /.~ ft. Parent material _ Tr ~ ~ Food Piaht elevation T app6cabie Ger>eral oomrnerds S ~~.~ e'''1 ~ ~ P j J, f°~ ~' Co . q U L o w r r fCo, ~ C~ and recornmendati~ons: ~ G ~'Ye~C VC ~ ~ dea S2~Y3w ism ,~,t ~ SOIL EVALUATION REPORT Pace _...~ ~ voisafetyarrdBu 8s vtr Adm code ~~ ~9 GJ ~9 # ®-Pit Graxrd surface elev. OI ~ R Depth m 8migng faaor--[= ~+• Sot Rye d ots R D/ttr tiaiaon I DephF+ in. ~~ -ri Domit~rt Cdor MutseII p ~3 Redox Descaipdon (lu. Sz Cont Color - Texture S ~ Structure Gr. Sz Sh. B b l Consistience m ~' Boun ary C -s o - v~ "E.if#1 r S 'EtT#2 Z to -'~6 I~' s 3/C~ Sc k~ k ~~ ~. (..~ ~ ~ (o y y~- a ~ - S o S rr. ~ -- ~ ~ Z ~~ ~ ,~ 3 1 I ISM ri ! ~ $~ ~ 3 ~ r -l-Se ~ 9ot~tg fl~-t got~g ~ f~ ~ t1i Pit. Grorxxl eur(ece e~ev.1 ~. S y ft. Depth to ~rrp~ng iactor~1111- m- ~ i9orimn. Oepth. DominantCdor .- Rec~xDescription ~. AArrlrseM Qu. Sz Cunt Color Texture Strurftrne Cansi Boundary Gr. Sz. Sh. :Roots GPDlltz 'E1NF'I 'Etf#2 6~~ le 3/ `_ SL ~s~Ic r c 5 ~~ ,~ _ --~ L ~-~sb k m~~ c w - , ~ S "Z ~~ Z `~ • C-12rrefrt ~Ft = BOQ ~> 30 ~ 220 ngA: and TSS >30 t 1 50 rwgl[. • Eflk+ent fR2.= BOU <_ 30.mglL.and TSS <_ 30 mglL CST Name Prig a CST Number ~~" 3~ ~~ Date EvaNmfion Candu~d" Telephone Number •, - - ~a~nY ~~ ~~ ~ ~~ Pamei iD # 13aing ~ ~ 6amg ~ 1t. Dapnr b tiring rector __l_L-_- ~' Sd Rol Pit Ground sudaoe elev. Dotranarn R~daoc D Textue Stnw~ure Conefelerroe Y Roots 'Et~2 Florizon Depth Gr. Sz Sh. rn. MumeY Qu. Sc. Corn. Cobr (' a `I Z x313 ,~ msblc r ~ S l U-1- - ~ ~ D B«~s ^ PtPn~c r~iaon ~ ~,. rFace elev. ~- ~ to Rrr~'r-9 ~' $p/ Re Redorc Dssrxlptbrr Texture Sprx~rae Corrstaterrce eawdary Roots GPOY~ Gtu. sz Corn. Color Gr. Sz. 3h. 'EI~9 'E1gt2 a ~ ^ Grovnd > dsv. R. Depth b in. ^ Pit Soi Rye Fiorvarr Deptlr Qomifar+t Color Redox Deealp~ Texlue ~w~ure Ca-sieienos Bo~dary Res in. trlunseY Au. Sz. Corn. Color Gr. Sz. 3h. 'Ef~1 'Ettl12 ' Ettixud #1= t3OD5> 30 <_ 220 mgll and TSS >30 < 150 mgfL " Elikrent ~k2 =GODS <_ 30 mg1L and TSS <_ 30 mglL The Department of Commerce is an equal oppommity senrice provider and employer. If you need assistance to access services or need matexial in an alternate fomnat, Please contact the department ~ b08-266-3151 or 7TY 60&-264-8777. ssnas3ots.grree~ PAGE~OF NAME: ~~~--~ LOT#~LEGALDESCRIPTION:~1/4 /w l/4,S~T~,N,R, I~'E(or~ /J i SCALE: 1"= l~ ELEVATION: ~~~ , ~ BM 1 DESCRIPTION: ~ p ~~- ~ ~~~p rt Q~,D ~ ~- '+' BM 2 ELEVATION: ~~ ~ ld p ~ ' ~~, R BM 2 DESCRIPTION: ¢cs ~ O ~ 1 ~ ;~ ~0~ P e~p e SYSTEM ELEVATION: ~Q 9~ •~D j~,er gl~•5a SYSTEM TYPE: ~o ,~,~e~,-(-~7zs yam. !~ tb , "d B n ~- SIGNATURE: DATE: / ~" /y -' D "Wisconsin Deparhnent of Commerce SOIL EVALUATION REPORT ~ Page ~ of Division of Safety and Buildings ~_ _____~____ .__ll. •+___ nC \~/__ w.a_ P.~J~ 111 OWlA Y011{.r ~IIIYI 1+V11Y11 VJ, X11.7. l~VI11. vwc County Attach complete site plan on paper not less than 81/2 x 1i inches in size. Plan must indude, but not limited to: vertical and horizontal n:ference point (BM), direction and Parcel I.D. p ' ®~ ~o ~ -' Q ~ ~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 6 (~ j Please p-i Re 'ewed b Date Personal information you provide may be u for lPw~Vs$~oy . s. 15.04 (1) (m)). ~-/ Property Owner Property Location JUN 1 p 2 p Govt. Lot N E 114 N~ 1 /4 S 9 T Z 9 N R/ "~ E (or 1N Property Owner's Mailing Address ^ ST CROIX C " Lot # Block # bd. Name or CSM# ~ ~ y~ { I ~® 4 - OUNTY V 1 City State Zip ^ City ^ Vllage Town Near t Road ~( v~~ (15)7 ~~~2tp () ~ _-- -_ - - ~-New Construction Use: ®. Residential / Number of bedrooms _.~_ Code derived design flow rate ~S Co ~d GPD ^ Replacement ^ Public or commeraal -Describe: Parent material 1 Flood Plain elevation if applipbie ~~~ ft. General comments ~( P vYl and recommendations: CG ~ ~ ~ ~ t? ~ .er / r ~ ~~ 5-p `~~% l~vc~°' d'Z' Q.~~1Cc G~.....- (/(,`~Z~ 'G~it'+:~ .~ an d so,1 --e~T°~~~- y/,z~aV3 - ~~, ~ tom. ~-- .~.~s ? ~ ° y,~~~3 ~W- w( 'B 1 1~ 3 • !~ ~ h% la r ~ ~ ~.~'~~~C S:G~cGtrS~ ~U~ ~lc- I BOrin ~ 1 vc~+~+ w ~~ i . Boring # g ~ Pit Ground surface elev. ~7• /U ft. Depth to limiting factor ~ in. Soil Application Rate Horizon Depth Dominant Color Rector Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 Z c~ -2 10 ~ ------~ • ~I 2vr~~bk ~ s - . ~ z {c~ ~ .~ 5 ~S -- ~ --1 r. z ~ -~ ~ C~ P~1.5 ~ m 5 1 _ - . ~ i . 2 ~ s~ - - ~- s - "~ Boring # ^ Boring / ~ ®- pit Ground surface elev. ~ 7.9o fL Depth to limiting factor ~V in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture SWcture Consistence Boundary Roots GPD/ft2 in. Munsell (2u. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Et[#2 3 ~ 10 $ 3 t~,s C~ ~S -~ 1.z `Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 =GODS < 30 mg/L and 7SS _< 30 mg/L CST Name (Please Print) 'nature CST Number c ~ _- _ _ -~-~ zj Address Date Evaluation Conducted Telephone Number ~ ~r»-e-r~ric1L ~yDZS _ _ .~~ ~Sr-O Z C7r5~zY7-y~0 8' z%~~~- ~1 Property Owner ~~ Parcel ID # / T ~ Page ~ Z of Boring # ^ Boring (n~~, . ~- pit Ground surface elev. 7~ ft. Depth to limiting factor ~_ in. Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Strudure Consistence Boundary Roots GPD/ftz in. Mansell Qu. Sz Cont. Color Gr. Sz Sh. 'EN#1 'Eff#2 i c~-~o ~ 31~ ~ c I .5 . B 2 I©- l~. ~ S~ 2 c -- . ~[ - ~ 3 3~- 0 813 mS DS I c - . ~ ~ - Z 4 Sl (~ ~ .5 v~,5 ,m l -- - . ~ ~ . Z ~~,~~~ s I ^ Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Soli Application Rate Horizon Depth Dominant Color - Redouc Descrfption Texture ,,.Structure Consistence Boundary Roots GPD/ft2 in. Mansell Qu. Sz Cont. Color Gr. Sz Sh. 'Eff#1 'Eff#2 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Appliption Rate Horizon Depth Dominant Color Redox Description Textun: Structure Consistence Boundary Roots GPD/ft2 in. Mansell Qu. Sz. Cont. Color Gr. Sz Sh. 'Eff#1 'Eff#2 • Effluent #1 = BODS > 30 < 220 mglL and TSS >30 < 150 mglL ` Effluent #2 = BODs < 30 mg/!_ 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 608-2648777. SBD-8330 (R07Po0) PAGE 3 OF~ 7~T A AdF ~c~ n `~ e LOT# ~ r EGAT DESCRIPTION /ll F ~ NW i4 ,S ~ T Z `l ,N.R. ~ ~ Elorl(6l) SCALE: 1"= Yo ~ ~ BM 1 ELEVATION I00. O BM 1 DESCRIPTION -Iap ~' f "Q ~y~, P~. P ~ + BM 2 ELEVATION 99,30 BM 2 DESCRIPTION f o (~ o ~_~ v~ ,~; P e ~ S ~C ~ `~ SYSTEM ELEVATION ~~. ~ ~ SYSTEM TYPE {~- ~- (~- rac(. ~e- I CONTOUR ELEVATION ~ ~ d ,; ;ua ; ~"~~ ~~\ v o ~ D ~. o' ~ ~ ~i u 1 ~ ~~_3 ' V I ~ ~ ~ r ~v -,-! ~ ~ ~~ u° ~~ q`~' ~~ SIGNATURE ~- G ~)8!28,`O1 TLTE 15:11 Ft1JL 715 886 4686 ST CRX CO ZONING 01001 P~WTS OWryEIt;'S MAN1dAl, r3~L t"YAi'1Hy~1`'A~{~i r~+rv ~°x~ °J---- FiLS 1NFQRMATtO1M ,Owner i/ r' ~! Permit # Z ..~.•..w nse~eutrT~lt! Number of Bedrooms ~lj ^ NA, Number of Commerdat Units ~~ Estimated flaw (average} gaVday Design flow (peak), (Estimated X 1,5) gat/day Soil Applicasion Rate ,s ~ ¢aVdaylft inlluentl5fl~uent Quality 1Hvnttrly average" Fats, Oil St Grease (FOG) X30 mg/L Biochemical Oxygen Demand {BOI)s) X220 mglL Towi Suspended 5oi(ds (TSS) s i 50 mg/L Pretreated Effluent Quality ' ^ NA Monthty average* Biochemical Oxygen Demand (130t7s) X30 mgJL Total Suspended Solids (TSS) X30 mg/L Fecal Conform (eometric mean 10' civ! I OOmi Maximum Effluent Particle Size ib chdiameter SYSTErt s~ECSric~+-r><vna Septic Tank Capadty mD0 t ^ NA Septic Tank Manufacturer ^ NA &fffuent Filter Manufacturer ^ NA Etftuent Fitter Model ^ NA Pump Tank Capacity gat Pump lank Manufacturer ~QA Pump Manufacturer R Pump Modal Pretreatment Unit /0'NA ^ Sartd/Gravel Filter ^ Peat kilter ^ Mechantcal Aeration ^ Wetland ^ t)isinfectlon ^ Uther: Manufacturer Dispersal Cell(s) n-;round (graviry) Q {n-ground (pressurized} ^ At-grade ^ Mound ^ Drt -line ^ 4ti,er: * Valuer ryRlca! for domestic (non-commercial) w~tewater and septic tank effluent. *+ Values typical for pretreated wastewa ter. Service Fregsaeaty ~j ^ monttos ear(s) (Maximum 3 yrs. ) i$e and scum equals one-third (Ys} of tank volume © months ~rl Year(s) (Maxr<r~num 3 yYS.) ^ months ~year(s} Q /1`S ^ months ^ Year(s) ^ NA Q months A year(s) ^ NA © months ^ Year(s) C] NA ^ months ^ year(s) ^ NA MAfNT;ENANc>r sLncsruL~ Service Evtnt irupect condition of tank(s) At feast once every Pump out contents of tank(s) When combined slue inspect dispersal cell{s) At least once every Clean effluent fitter At least ante every inspect pump, pump controls at:aiarm At least once every Flush laterals and pressure test At least once every tees: At least once every over: ,~.t least once every MAINTENANCE 1NISTR~1CT10NS (nspectlorLS of ranks and dispersal cells chair- POWT5lnsaector~ POaW7 M intatnerf Septage Servicing t~perator L1Tank lnspectla plumber; Master Plumber Restricted Sewe , must include a visual lrupettlon of me nd t )ch ckfor an b k uP or pond3n& of efftu ration the grow d su~rfaceedThe dispera f volume of combined 5tctdge and s cell(s) shall be visually Inspected of efflu rat on~the~ground surface may ratite e~ aefaili ~tco Fitton and ~undln~e immediaten the ground surface. The ponding nadflcadon of the iota[ regulatory authority. When the combined accumulation of sludge and scum in any wnkratotiand d plosed o)f in a<tordaa etwith ch.tNR 1 ~3, Wtsconsi contents of the tank shall be removed by a Sep~~ Servidng Ope Administrative Code. The servicing of etnuent filters, 4eN ~ ocel 2rmo~ a~~essOshwalri be performed by a certttied POWTS Ma stainer ray other maintenance or moNtaring at In A service report shall be provided to rile local regulatory audtoKtY with[n t 0 days of completion of any service event. S'CART UP AND OPffRAT10N For new construction, prior to use of the PC)WTS check treatment tank(s) for the presence of painting products or other cherrltc. that may impede the treatment process and/or damage the dispersal cell(s). if hfgh concentrations are detected have the conten' „r rhP ranirfs'D removed by a tent~'rt servicsn}~ operator pcioe to use, .(',13!28%0l T'[JE 15:11 Fox 715 ~$6 4686 ST CRY CO ZONING ~ ooz gac~ .._~,..~ System ;tart up shall not ocptr when sdi COndtilons art fPOZtt1 it t~ Inf~uaR{vt iurface• Dur~n~ ppWer au~taeM pump tanks may ~!! above rtamtai t,ighwater levels. When pvwtr ~ testot+ed dN ~~ wastewater wi}i tie dischargr4 to tht disaersa! erA(t} 1n one lase lose, overlaidlrs~ ti>t ell(s) and mry result to the badcep o+'surtaee dJtehar~ ui etTluent. `Co avoid this situation hdvr the crrrcents of cite Rump tank rortJCVtd by • Sep>as~ ServktnE Openior,prlor to restaCtnx power to the elEiuent pump or contact a Plumber or pQVt+'fs Ma{ntalnei to assist {n manudlh oparitlni the purnA controls to rvstare ncrmai levels within the pump tank. Do not drive or park vehicles over tsnics ind dispr•rsai cells. lSo not drtve or puk vvrr, Or otherwlst disWrb or compact, the area wtthln 15 (eel dawn starve at arty mound or at-Grade salt si~satptlon uea. Reducdan ar ellminaclon of the following tr4M cite wstitewater atnarrt maY tmptow ~ perFortnance and pr°loaa ~ life of the PC1WT5; antibiotic; buoy wipes; tl~artt~t butts( tondbtm; touoty ttwab~ d+s;reasrra; dented Aost; dtaptrs; dWnlettanu; tat; toun6at;an drain lsump pump) water; fruit and v+~etabie pettlrtest s:ss~trei tt~~l herbiClQisi meat scrips; medications; v~1, aalntlnR croGuru: aestfcldes: saniwrv naukins, tamuons: and watp- SafLlAtr brine. A~ANlaOtdEM EN7 When tha PQWTS fails and~or is ptrrnantr+tty taken out o~seMce the foliowlnE slaps shat! loo taken t4 irtsurt that tht system is properly artd safety abandoned to canalince with ch. Comm tl~.33, trNiscotts{n NdmtnJstrstlvs Code: ,g1I plptn~ to vnks arad pits (hail bt 4lscar-rracted anei the abandorssd RtW e~nln~s sstakd. • The contents of alt tanJts and pits sttal4 be removed crud prc+Rtriy: did of by a S:ptaec StrvitJn; Operator. . ,4her isvrnpinst, ai- tanks and pits shall ba excavated and removed or thtlr coven removed ar-d the void space filled with sail, Cravat or another inert solid matrrial. CoIVTiNG>ENGIf Piraw Jf the PQ lie xntt cannot be repalreQ the followttt~ rrteasurcsr hiW b+tsn, or mc+st be taken, tv provide a coat Eompitint rtrstxt nt system; ,4 svltablc repfacerrsenc area has betn evaluated and may bt utsilxcd for the {ocattass of a nplaeemsrtt suit ibsorptior~ system. Ttx rep[acemmt arcs should be protx~4 Irani dJsasrbante and CornpaCtlon and shou{d not be Infrtnetd upon by required setbacks from ext:tlr-E and proposeQ str•+ct~ur'e, Ivt t{ttta rnd wells. l'aiivra uo protrCt the rsplacement ar*a wii~ r soft to tAt nctd for + new sou 311d site evalt~atlan tC ascibltstl i lttttatltE replac4rrsent utra. Repiactmttnt systtrns rnwt mpiy with the rules {n effect at ti+ai qme. p u1taDlc repiac nt aria not coat! due tie ~ d/or katla . lSarrt Pt74YTS tachnviv~~ h in= ak is be Ins t:s a W rep! thr a . e !te n t bee a (site tJfy a~ p1iC ~ arc. n fat{ f t~se a f d' evaluatlvn st bt sarr?vnmeef to locaae o wlv acemesrt sfrea~ If n0 ttplxtRitltnC area ii ova lea dine tank may ba lnstaiiad s a fart resort W replace ttte failed POMt'1'3. >~iound and argrade sa14 absorption sYsurtu t1Wy be reconsm+aed to plate fatiowtnE removal c+f ti'-e biomat at the InAluat}ve wrface. R,ecanswcttons of such systems rtsvst.comDly wJth iM coke in sffrct u that dyne. < < WA~tN1NG > > SEt-'rlC, IaUMP AND (xTKER TREATMENT TANKS MAY Ct3NTI-~N IGETH/4L GASSlES AND10R 1NSt;EF>F{GIENT OXYGEN, 00 NOT ENTER A SEPTIC, PlJ?iP Olt OTHER TREATMENT TA1~IK t1HDrER A]~tY CIRCClMi7ANCE5. DEA'ik! MJlY RESULT, RESGUt OF A p6R;ON FROM 71E~ IPiTri.KICJR OIL A YA?~iK MAY ii DI~FIGti,1tT 4R ssapr~«iat c. Apf717lONAL COMMRNTS POWTS INSTALLS Tlame ---. _..._ . ,...,,..,.~..., ...w Photse TEPTAGE >:ERVIC{NG UPERATOR P MprtR Noma Phnn~ _ i•OWT3 MAi .None ---. _..._ . _ ............. .....,. ~~~ Mt=1~nM~lii~E~t ~~,~, itp G TORY AUTH ~koencY /k' ~ ST CROIX COUNTY SEPTIC TANK NSAIN'TENANCS AGREEIvIENT AND OWNBRSHIP CERTIFICATION FORM erBu er ~1~' @t'~S ~a~ ~'\ ~~1~'~S ~ own y ~~ ~ ~~i ®~ I ~ ~~` ~-f cam Mailing Address ~ ca l Y7 r-! `~~ ~`f Property Address ~ a (Verification toquired from Planning Department for new constructioal rr City/State _ ~~' ~ ~J~'~ Parcel Identification Number LEGAL DESCRIPTION t \ property Location 1_.~.~.._'/.,~~ Subdivision _ ~ W, Town of _.1~ `! ' 'fir. '/,, Sec. ~ . T N ~~'t~~~- Lot # .,~• Volume ..Page # Certified Survey Map # ~ # ~ ~ ~ ~ Volume Page # Wa~aty ~ _ Spec house ^ yes ^ no Lot lines identifiable '~. yes ^ ao SYSTEM M AtNTENANC~ rematun failure to handle wastes. Proper maintenance use and inaiatenanceof your septic system could result in its b a lioensed P~r• What you put into the system mists of pumping out the septic tank every three years or sooner, if needod Y can affect the function of the septic tank as a treatment stage in the waste disposal system- eat a cecti5catioa form, signed by the owner and by a The property owner agrees to submit to St. Croix Zoning verifying that (1) the on sine wastewaterdisposal system mast~crplumbor, journeY~aPl~r+ restrictodplumbex or a licensed ~)~ ~ septic tank is less than 113 full of sludge. is in proper operating condition and/or (2) aRer inspoction and pumPinB (~ the vate sewage disposal system with the standards ~, the aadcrsign~ have head the above requirements and agree to maintain Pri State of Wisconsin- Certification eat of Natural Resources. Office ~~ 30 set forth, herein, as set by the Department of Commerce and the Deparim stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning of the year exp' 'on da ~ f /Q Jam, DATE-, /~ SIGNATURE OF APPLICAN'T' OWI~jIi R CER'I~IFTCATIO~I our knowlodga I (we) am (are) the ownct{s) of I (we) certify that all statements on this forma med~ecorod~ ~ ~°g~tmr of I?~eds Office pmpetty descn'bcd a e, by ictue of a warranty ~ 1 CJ ,~^~~ DATE ~.J SIGNATURE OF APPLICANT s.s««« Any information that is mis-represented may result in the sanitary pcnntt being revoked by the Zoning Department. «««««~ «« licatioa: a stamped warranty decd from the Register of Deeds office Include vrith this app map if nfe~a ~ made is the warranty deed a copy of the certified survey _~ ~ _.._ _ - ~ n urt t rf t ~ N E OF 1 St33 ° 41' 53" E 2621. 77' ~ ._ w ~` -- -`- .~ _ ` 5s" E .A,VEIVU;~ w _a______ ..____.. 2v~o.26 THE pUBL ~~, 25'3. o t'. 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