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HomeMy WebLinkAbout018-1083-36-000/* Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM • 'Safety and Buildings Division INSPECTION REPORT GENERI~L INFORMATION (ATTACH TO PERMIT) Personal information you provice may oe used for secondary purposes (Privacy Lav~s.15.04 (1)(m)]. CS0~1i~o~~1~ Name: ^ City ^ ~~~jr>~w~"I~1nrnSllli CST BM Elev.:- ' Insp. BM Elev.: BM Description: 017 . o (°~O •~ r ~ rave ~ C5'i- ~ rw ( TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ,~- catro~6~ Dosing ~ ~ ~~9-~.~.,IOp Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Airlntake ROAD Septic S'~,i- Z~, I .-. NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION Manufacturer ~ ~-~ ~~ Model Number ~ ~ TDH Lift~°~9 Lriction,,p Syst~ Forcemain Length -~ (~~ Dia. Zf f SOIL ABSORPTlO YS7~71 Demand GPM .-- TDH $, t Dist. To Well ~ .I ELEVATION DATA roix n ID No.: fl83-36-000 l,~. ~9. t7. (o STATION BS HI FS ELEV. Benchmark .~ p ~~ ~ • a ~ 3.2~ cm.Sar BIdg.Sewer (2,,2d 9(.~Or St/Ht Inlet 'Z,ap q~.2(ji St/ Ht Outlet ----~ Dt Inlet - Dt Bottom . (00 ~. O ~ Header /Man. Bot. System to , to O ; D q .Or i Grade $, ~„p - p / t . Gsue:~ BED /TRENCH Width ..- Length No. f Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N 3' ~- DIMEN I N SYSTEM TO P / L BLD WELL LAKE /STREAM LEACHING Manufacturer: ? SETBACK INFORMATION Type O , f ~ ! ~ ~ ~ - CHAMBER OR UNIT Mo a Num er. System: (b i']ISTR1611T10N SYSTEM Header / Mani old tt Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Le Dia. Spacing i ~ ~'S SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over ' xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges f Topsoil InStlPC11Ar1 #1 ^ Ye No No a /COMMENTS: (Include code discrepancies, persons present, etc.) ~ll4'la/ Location: 972 172nd Street, Hammond, WI 54015 (SW 1/4 NW 1/l4 16 T29N R1n7W~)~1Q6~2~917608 Phea ant H i I Is -Lot 36 A~~~_Q ~ an C ~ E _ ~ a,.s~e. ~~y,ttrJ `t~ eaxx.sa~c ~"" ' [""""' C~4-s-~.e" ~~' t~ 1.) Alt BM Description = ~°I' ~; Sri ( ~~ ea.~we~ Koe~~ 2. Bld sewer len th = a"} .o ~ ~~ J 9 S •~ ~ lam-. c,~•-+~.e~ ~w s.r `~~+-. -amount of cover = 7 3`" ~1 C,~rcl ~ S~i~ o~oa- ~ 7U A' loa ~, ~ C:ST" L-t~wCS ~saA.~ 2535~6~ ~~~-- -(lam ~ t~SL ~ ~ ~~.. Plan revision required? N (~ ~ „!~ Use other side for addiY r ~ n t SBD-6710 (Fi.3/97) ~ ~ t ate `'' s e r s g r~j ~/ Cert. No. C~~ _ _~li rett.~W~.~ a-. r/23~ / -~-~ ' dNisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT Page of IIIawV1ua111R WIUI VVI11111 O:l, YYIJ. MUI11. IJVUtl 1 County S.T C ~ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size Plan must ~ . ~ . include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north an-ow, and location and distance to nearest road. Please pr/nt all Information. Re 'ewed by Date Personal information ou rovide ma ba used for seconda ( y () ( )) y p y ry purposes Privac Lew, s. 15.04 1 m. ~ Property Owner ~~ ~,IV Property LocaGtion~ Govt. Lot .T'~ 114 Ivt~/4 S ~ ~T o~ N R 11 E (or W~ Property Owner's Mailing Address Lot # Block # Subd. Name or CS City State Zip Code Phone Number ^ City ^ Village (Town Nearest Road (7~5") -mil /7D~ ^ New Construction Use: ^ Residential / Number of bedrooms _ Code derived design flow rate _ GPD ^ Replacement ^ Public or commercial -Describe: Parent material Flood Plain elevation if applicable ft. General comments and recommendations: ? II /I l /S /~ /.~N GG(0 ~ ~ion~ l ~~ ~r~-~. I~l l Boring # ^ Boring ^ LI[LJ ~ Pit Ground surface elev. ~~ ~ ft. Depth to limiting factor ~ ~ in. ~ A ~ - ^ Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Rc t`,'I v~ t „ - y ?, 1 ~ti sl GS I ~ ~pr r `~ -~2 s~ s l e I -~ y s l /hvf CAS I SOY ~ 5 Os I I-I :~ ~~ 1 ~ S/ ~ S - ,--~ ~4~0 ^ Boring # ^ Boring ^ pit Ground surface elev. _~ ft. Depth to limiting factor in• 'Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 _. ~ t. ~.. _ .- ~ i ;.:~ ~~ Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si n ture ~~ ~u~ ~r f Address Date valuati n Conducted Telephone Number T.L. Sinz Plumbing Inc. 1. ~- _~1. ' ,~ 4'Jr/// 4 l / V ,...1 •r° E5609 708th Ave. Menomonie, WI 54751 ~~ ~ ~~~~ ~~ q ~~~=~o~ ~~ Phone: (715) 235-2644 Fax: (715) 235-2592 ~Y' 3 ~ ~-l-ea~ ~t-u,T !-~, (I s ~~ ~ u~ -b 2 9 I ~I ~ ' " " ~ ~; ~~. 1 c~` D . ~s, ~~ ~ / 4 ~~ ~t ~6t~,v~ ~a~e. ~~ ~~ T \~v ,~ i~~ ~-~ " ~ \\~. ,~ AS - ~~ ~~ ~ ~~ s i~ ~ =-~ Z~uti ~~P~ ,+ + 7'.L. Sinz Plumbing Inc. ^-,,,. w-----~-,`~ ~(J ~ y ~t ~-- E5609 708th Ave. Menomonie, WI 54751 2 ~~~ ~~P n `~~. ~~ ~r 0 l`' =~ J~~- ~~1 ~o vl. ~ 14., ~~ DT ~L,,~,) ~bt ~~ %~ 3~~ Q Phone: (715) 235-2644 Fax: (715) 235-2592 ~tt~ u ~ t b 29 I -1 ~ ~e~~,u ~ ~~ o0 ~~~t ~eC~~~~pop/!' I ~'"'a ~e U' ~.-1v° ~'~~ ~~c ~p S s~~ \~v r ~..~ ~ ~ 3- ~`,~ . ~~ ,'1} ~r~ y ~ n,~ ~- f ~,~ ~,.~ <~; ,~ ~,, ~~o ~~`= ~ECE ~ . . . ~~~' ~ ~ x j `~ sue, o ,~~ .~4-~. ~ z~`~G ,: A` ~~ ~: ,- ,: e ` . .... ~_-'- _ ~" ~Qu~ ~~~E • pun~u Charact~risHts 1as f M9tM Udt SubtmxtM~ Aaeu;tolk Modol~ SNlF30lt1 Hac.p~wor .S0 hN Lead Ao~s t1.0 ltNtor Bladed Pdo {4 l R.l'.M. 1350 1'Sme g 1 y 115 Hertz b0 lolpperotote 140'F At~tent NErKA Weilo A ils~latlon Cieefl A picchm' Si>h 1-I/~' N17 G5iNw1 Solids HudinO !/4~ {IVrw1 war vaet0~t so Its. hover Cord iB/A„ SJ'fl~ x0' >jN. Materials of Construction 1~w..iZrrMt~sANl~A ~fA ~ ~ 6 ~ p t ~w 0' ' t to to m a 5r uw~~5«o~a e t r iot~l NNtti hN 0 i 14 10 ZO 44 DitFtn~n~cienal Data „~ pA t'~ ~, AE I~WIYMR k11iI1K. (niwW ar iw~atlanl n.. ~ ;.3 z t dln+e.roir mp ~: lA ~~ pon •.~n i Na fa anehaPan p~ !~ wb c~t7'ied =r~r on~~oe ~ N+ S. on/oR ant ar>ju~Ohl. a• wr~»a.~tan~. a~~~~ ,e,allmrrm.tttour t>.tln rl. ~.. ~~~K ~1~ ~~ ~~~ s~ye 'ros'> ~~~:~- '~ N~ Staiolees Stool ~.~ pR oirl.rtri<; 01 NbroF ll+a csa ko. car Gust Moo NlodteMwi Stroh Bed Seol locos: Gtriott/G>n~ Sod ~ Awe~od st.ei 5priog Striltlot:a StNi 1elowss heo~N E tk Gs1 iro+l Sleow Lower Rew MN {+tton Il~b >k ~ ~ tlalk Fattetl0fts Stoilott Stttol I~ HYDR~MATIC • ~ ~ 1840 Benrr Rwd Addend, Ohe 44505 Tel: 419.1M•304Z hx, 414~781.4pp Weh Site: rrrw.penidrrunµtom SAYS CIFFKES IM A!l MW4R CfTIfS A8~ COUNTRIES Rem N: W-U2.8350 X208 6M Q 1999 Nydrortiatic' Pumpe, Ashlarn~, Oh~o• Al! Rig -Your Authorized Lord Disrciburor - ~ ~ n ~'" `, n. _x t ./ ,, Sanftary ~ermft Appli ation S7 ~AQI W;, Safety & Bntldings Division In accord with Comm 63.7.1, Wis. A '. Code ; / 201 W , WashinEtoa Avo, ~~~~ See reverse aide for instructions for eomplety is CpUN' PO Hox T3o2 Dapartne•rtt ar•CQmm~ Pcrsanal information you prorndc may be usod for ~ n~ s~F ~ Madison, •Wi 53707.7302 • (Privacy I,aw, s, 15.04 1 ra `: ! ( t corn lctcd form to ccan if ( )( )] p ty not /-._...~,_ state owned. Atcaclt coax late tans (to the coon co von for the stern, on er i l inches in size. ~~~' ' Ls~1~U1 Ste P O it Ntutsber l7 Cheek if rcvtaion la Provious nppbwWOn S Cate Plan i. D. Nuritbor 1, A li0ation xnforaiation - ]?lease print all Information Location: Proporty O r NemeJ~ _/ -~ Property l.dP•81i0II r`'V'r) V~~ t Z ~~ ° ~.JC:il'/l:~i(t'1 .(..11f4~o~t+11/4, S~ T~~N,~ or PropcrtyCwnnG'sMaiiistgAddr ~~~ ~ LatNQumber 137ac7cNttmlxt Gity, taro Zip Codc Phone Nun~bpr (~i Subdivision Namo or CSM bet Y'1, Type of Building: (check one) ^ Ct ~~ J or 2 Fatally lhvelling - No. of Hedroams : ~ ~ ^ Vi7lryage ~Yv1/1'1 ~n ji ^ PublicJCorruntxcial (describe uso)~ ~Townof D State-Owned Nearost Road ~ ~~ 3 ~ 8'S ~ ~-*P-K.c.Q ~s Par~olrnXN~ TTI. 'l' a of Perirtit: Check only ane box on Iute A. Cheok box on line ~ if a IfC~ble ~ / -~' - DO ~ A) 1. Ncw 2. O Aoplacement 3. ^ 12tn18aement of 4, 5, + 6. ^ Addition w SYSOem 5 stern Tank Onl (o , ,7 9 . 7 . 6 Lxisoi S H) l'ctutit Num r Datc Isatted d A Bonita permit was rcviousl izasucd ri/, Typt; of POWT Systeiati: (Check all that apply) Non-prossurizcd Trt-ground ©Motutd O Sand Filter (~ Constructed Wetland ~ Pressurized In-gourd ^ Holding Tank ^ Single Fars ^ Arip Lint Q At• ^ Aerobic Treatment Unit ^ lZeeirculatin O tither: V. 171s ersalllYeatment At-ea TnformatioA: 1. I?es7gn low (gpd} 2. Dispersal Ana 3. ieperSal A;ca 4, Soil App~caaon .Percolation Rate 6. System, ovation 7. Fatal Grade ReQuircd ropored Rate (GaJ9Jdny/sq. fR.) (M?nTnoh) L'lcvation 'VII. Tank Capacity in Tota] # of Manufacturer Fr+cfab Sitc Stec] Fibtr- Plastic Information t3a11ons Gallons Tanks Can- Con- g7oS6 New P.Xtsting crate strutted Tanks T'anky Q ^ ^ D ^ ~'Il7i. Responsibility Staroment l the unt[crsi assttme nsibili ins on he POWTS shown on the attached lens, Plan, s Name (punt} P s starttps): tv1PRv}:P o, J3usiturs ao Number ` E~ ~ -° ' " ~ ~~~ ~- ~! =ASS= Z~~ Flutnbefip Address (9trrot, City, State, Zi ~`7 I7.. County/Depat-[nteut Use Oaly D Disapproved Sanitary 1'emliCFee (]nciudes Ground+vator Datclssued ~ s Agcat Signaam lNo starnpa) ~Apprvvcd1".~ Owner Given Initial Advtrsc Sur Bo F~~s ~ ~ 7Jvterminatian ~ ~ z~ X. Conditions of Approval /seasons for Disapproval: (~ _ - `~ /~,h a .",s,`'~`.c. a1lo~ Sol ~ ~ ~'t•C'~ ~t. irµp~t.tl~,~ ~°'' ~Q~,~pLCt.Wl2s~ SIfS~ S t'fZ t>r U ~rw.. oleo: ( ~•c--~ w~.v.~- s~s w ~ t.Q. ~Se -~~....r,, f~..w~e.r,~e~ ~.utiq, sYS 5ED-~~6~~3~~98 R~~O~~~/00 L ~ I ~t ~ e ~ tt_~,g't`Q`' v~u6~--.r¢.~.ot~R-,'{'~~'~.. "T ~- '~ ~ ~1~e~ l i G~,t oMQB wt ot,c~'W, t~ aG -_-~"_ t -t'~'~ u,,,n„~-~,c, a.~s re.c~.a~e~s . p U ~ ~- ~..~-~.,,w,,.. ~ iz`t so-t~ ce~is re o,,,ers . v~~ ~- sYS~- t~s~- ~ T.L. Sinz Plumbing Inc. E5609 708th Ave. ~o,.t ~ (4_ ~. P~~T ~/~ Phone: ('715) 235-2644 Menomonie, WI 54'751 _ Fax: (715) 235-2592 I,~r- 3~ ~-4.~-t-u,-t- ~a s ~~ u~ ~a ~9 i-~ ~ ~b~ ~ ~ ~ ro ~ u Gct ~1 I`` -~o' ,vo~r~ ~- 3 _ ~ ? ~J" . l~~sn S~P~~~. ~ Le ~~ W`~ ~~ M Q~ r JJ~`S `~v X09 ~z~ ,~a~~ L~~ ~~(~E T.L. Sinz Plumbing' Inc. E5609 708th Ave. ~ K ~ l ~ ~. ~t oT p/~ Menomonie, WI 54751 ~~, ~ ~ S t~ ~^ ~ ~~ ,~gS ~ T 3~ ~° ~ ~~~~~ eP 0 l`` _~ ~~ ~- ~~ ~~, o. ~~s~ 4~~ Iov L~~ ~~~~ ~`~' Phone: (715) 235-2644 Fax: ('715) 235-2592 ~~ u ~J ~ ~ 29 I'1 ~ ~ }~tv~.c ,~. iD e ro ~ ,c Ga „,~ ~~~~~ ~ Wist;onsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 ., '~ Division of Safety and Buildings ORIGII~s~i: With Comm 83.05, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not less than 8'/z x 11 inches in size. Plan must COUnt y include, but not limited to: vertical and horizontal referens~point (BM), direction and Croix St ercent slo e scale or dimemsions north arro i n I tance t n arest road di . p p , , q~ . ~ ~ s o e r - p ~ Parcel LD.# APPLICANT INFORMATION - P ~•prmtl mfokri~a~ipn . Personal information you provide may be use s~~e¢onda per ~i e~, rrvacq LaW~. 15.04 (1) (m)). IewQd By ate , Z ~ t Property Owner property Location Bonte, Ron ~ r ^ ~ , ~ Govt. Lot SW 1/4 NW 1/4 S 16 T 29 N,R 17 W Property Owner's Mailing Address ~ F, - 4~ot # Block # Subd. Name or CSM# 1011 170th St. 36 Pheasant Hills City State `~,Zi Code:-~-tieNilrftbeF ': H d WI x 4 5 7 96 '' ^ City n Village ®Town Nearest Road 170Th S ammon 15-7 -5240 , . 01 ammond t. ~ Residential.LNumberof bedrooms 3 ^Addition to existing building ^ New Construction Use: ___ Replacement ~ ^ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate •3 bed, gpd/ftz .4 trench, gpolftz Absorption area required 1500 bed, ftz 1125 trench, ftz Maximum design loading rate •5 bed, gpd/ftz •6 trench, gpolftz Recommended infiltration surface elevation(s) 24" below contours ft (as referred to site plan benchmar Additional design /site considerations Install 2 - 5' x 1.12.5' shallow trenches for 3 br Parent material till Flood lain elevation, if a licable NA ft S=Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U=Unsuitable for system g ^ U ®S ^ U ®S ^ U ®S ^ U ^ S ®U ^ S ® U JVIL UCJ1.rRlr 1 IVIY RCPVR I A'le.. ~ ('...Un ~i`S. 4" 1 "7ix~n ~ f=1 Boring# Ground elev 96.1 ft Depth to limiting factor > 72" 2 Ground elev 96.0 ft Depth to limiting factor > 70" Horizon Depth Dominant Color Mottles Textur Structure Consisten Bounda Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color e Gr. Sz. Sh. ry Bed ~ Trench 1 0-5 7.SYR 2.5/1 - sl 2 m gr mvfr cs if .5 .6 2 5-11 7.SYR 2.5/1 - sl 2 m sbk mvfr cs if .5 .6 3 11-38 10YR4/4 - sl 2 m sbk mvfr cs if .5 .6 4 38-46 lOYR 4/4 - sl 1 m sbk mvfr cw - .4 .5 5 46-61 7.SYR 4/6 - Is 1 m sbk ds cs - .7 .8 6 61-72 lOYR 4/6 - s 0 sg dl - - .7 .8 Remarks: Z S. z/ t¢ t- z 1 0-3 7.SYR 2.5/1 - sl 2 m gr ds cs if .5 .6 2 3-13 7.SYR 2.5/1 - sl 2 m sbk mvfr cs if .5 .6 3 13-40 lOYR 4/4 - sl 2 m sbk mvfr cw lm .5 .6 4 40-70 7.SYR 4/4 - sl 0 m mfr - - .3 .4 zy o Remarks: SST Name (Please Print) Signature: Telephone No. Henry F. Grote ~ ~ 715-665-2681 4ddress ertt to of esttng D t CST Number Ref # P.O Box 57, Knapp, WI 54749 4~1~/2000 222774 1047 PROPERTY OWNER: some, Ron PARCEL I.D.# 3 Ground elev 96.7 ft Depth to limiting factor > 67" 4 Ground elev 96.6 ft Depth to limiting factor > 70" 5 Grountl elev 96.4 ft Depth to limiting factor > 64" SOIL DESCRIPTION REPORT ~ page 2 of ~ 3 ' `?. Certified Soil. eT stm~' Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots , GPD/ft2 Bed Trench 1 0-5 7.SYR 2.5/1 - sl 2 m gr ds cs if .5 .6 2 5-13 7.SYR 2.5/1 - sl 2 m sbk mvfr cs if .5 .6 3 13-43 7.SYR 4/4 - sl 2 m sbk mvfr cs Im .5 .6 4 43-67 IOYR 5/6 - s/ls 0 sg dl - - .7 .8 KemarKs: ~,.,~,~~~, Y ~,~ ~,.~~u~~..«, ., ~ n Y,Y ,. ~. ,,, ,~~, .....,, I 0-5 7.SYR 2.5/1 - sl 2 m gr ds cs if .5 .6 2 5-11 7.SYR 2.5/1 - sl 2 m sbk mvfr cs if .5 .6 3 11-26 l OYR 4/4 - sl 2 m sbk mvfr gs 1 m .5 .6 4 26-37 7.SYR 4/4 - sl 1 m sbk mvfr cs if .5 .6 5 37-70 l OYR 4/6 - s/Is 0 sg dl - - ,7 .8 31. Z io . Kematxs:..,,..~.,..., ..,~ ......,.,. ., ... ~, ~ ~. ~..~, ~„ ~.., 1 0-4 7.SYR 2.5/1 - sl 2 m gr ds cs if .5 .6 2 4-10 7.SYR 2.5/1 - sl 2 m sbk mvfr cs if .5 .6 3 10-36 lOYR 4/4 - sl 2 m sbk mvfr cs lm .5 .6 4 36-43 lOYR 4/3 - is 1 m sbk ds cs If .7 .8 5 43-59 l OYR 4/4 - s 0 sg dl as - .7 .8 6 59-64 SYR 4/4 - sl 0 m •- mfi - - .3 .4 ~•~/~Y• r<ei i iar ~5: Ground efev Depth to limiting factor ,~ N ..~~ J i (T o ~ -~ a ~ ; --t g/ 3 ~ 4 ~,- ~ ~- o ,n J __n~ ~ ~e 4 s G 0 G d ~ .~' ~ o (`~~ s 0 _ • ~ Q ^ Q 9 ~ ~.1 r Y 0 1 ~~ ~ ~ a ~ ,.~ d' r d ~,\~ u :s ,a, ~ ~ -~ J ° 9 / ~1 ~ ~ y ~~~ ~-j `' c~ n~d a ~~~ ~~ 0 ~ ~ ~i ~ ~ ~- d a J ~ ...-N ~ ~~ c 1 ~ ~~ ~n (J~ b ~~ Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Design Specifications Sanitary Permit Number Number of Bedrooms Design Flow -Peak (gpd) S" Estimated Flow -Average (gpd) U Septic Tank Capacity (gal) ~~>~ Soil Absorption Component Size (ft2) /,~~~ ° GT Type of Wastewater Domestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soif Absorption Component Design Flow -Peak (gpd) ~` ~p /$~~ Maximum Influent Particle Size (in) ~ 1/8 Maximum BODS (mg/L) NA 220 Maximum TSS (mg/L) NA 150 Maximum FOG NA 30 Table 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Should inspect once a year and clean once every 3 years . Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic Management Plan for a Septic Tank and Soil Absorption Component tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank maybe difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Ws. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing. fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recordi~ig the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. 2 Address L Address ST CROIX COUN'T'Y SEPTIC TANK MAINTIBNANCB A4REEMENT AND OWNERSHIP CERTIFICATION FORM ~ C ~o r~-~ C W3raY.~, ~© ~b~ h S~ _ I~U~rrnmo~ l~~ ~a ~ ~~~ S {Verification required from planning I3epartmcnt far new ~C~.YY~In`6Y`l}. ~ ~/`~'-~-- Parcel Identification Number , ~~ ~ - Jd~?~ ' ~ ~~~ Location ,~ '/., ~_ '/4, Sec. ~, nn ~~C C~J~~~ ~' ( ~ I J N-R 1 ~ W Town of ~d` m 1~`~ Y~~. T~ rAt# 3~. -_ Sntrvey Map # ~ a a 5 7 / .Volume ~ .Page # ~ `~-' Deed # .Volume .Page # Spec h~use ~,l Yes ^ no Lot lines identifiable' yes D no Improper use and maintenance of your septic system could result is its premature failure to handle wastes. Proper maintenance consists of pumping out die septic tank every thrrx years or sooner, if needed by a licensed Puml~cr• What You put into the system can off din function of the septic. tank as a treatment stage. in the waste disposal system. The propeiRy owner agrees to submit to St. Croix Zoning Department a ccartification form, signed by the owner and by a master lumber. jcnuaeynuur plumber, resirictedplumb~ ar a licensedpumper verifying that (1) the on-site wastewaterdisgQSal system is is operating condition and/or (2) after inspection and pumping (if nY), the septic tank is leas than 1/3 full of sludge. Uwe, undersigned have road the above requirements and. agree to maintain the private sewage disposal system with the standards set. lrnrein, as set by the Departmart of C`ommeme and the Depattment of Natural Resources, State of Wisconsin. Certification statil~ t your septic system has been manatained must ire completed and retwrned m the St. Croix C.atmty Zoning Officx within 30 days o the throe year expiration to. C. ~ ,9,© I Si OF APPLICANT DATE _~___ !,, I (we) certify that all. statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owncr(s} of the pro erty described above, by virtue of a warranty deed recorded in Register of Deeds Office. C~ 11 ~I SI OF APPLICANT DATE *f••'~ Any information that is mis-represented may result is the sanitary permit being revoked by the Zoning Department. ««ts+~~ '~~` ode rvitlr this appilcatlon: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed Dine M. Honte, as Trustee and Ronald C. Bonte, first alternative Trustee of the Karf M. Ulferts and Katnarina G. Uiferts Family KHTHLEEH H. kRISH REGISTER OF DEEDS 5T. CkOIX CO., MI RECEI4EB FOR REIXlRD 04-10-2000 10:38 (MI ~ -~ w a t--~ ~ r 1 \ a,, t ~ n . ~ ~ ...-- S N21 266.62 ~'. Q ,~` ~ `~ ~ to r ~ ~ a ~ S '.z ~ i : '• pit `~ ~ ~ ~ ~ ~ -~i ~ ~ ~ • C ~ i ' O ~ ,1 W `. ~ tt Ud ~. N ~ ~ i ~ ~('~ vV W O ~ t ' ~ 'rl' t ~ ` !' ~ 3zo. \ sE - ~ 3• ~- ~'~ ~ l~q' -.: `, •~ ,',x[31 s0' .IyA ` ® ~ 9S• 51g r,/'' tg3,70 , ~~tNE w ~ \ ``~ ------ - - p [J ~; •-'~ NA •~. .~ . .. ti, M 5 ~ ~ • 40' ~~, E ,'ate ~`rd f ~ a ~_ u; U M v~ ~ Q ~ Q O q qN w N ~ ~ {{ ~ A 1 ~ 4 1 ~08. 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