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HomeMy WebLinkAbout020-1128-30-000 o y ~ c ~ ~' 301 ° c d ~1 ~ ~ o I ~ ~ ~ m ~ ~ 9 ~ "~'~ ~1. ~ .~ ~ ~ I ~ ~ ~ c C7 b \ 1 I I .. ,.. ~ O 3 N a ~ O ° N O A ~~ Q V N ~ { `C ~• i O ~ ~ N C ~ ~ ~ ~T +~ ~ Z n m ° fA ' ~ ~ N M O0 3 N N p Q ^ ~ O ~ ~ Vt \ 1 - ~ -~~ t ~ ~ I AI w ° ~o G3 O ~ o ~~ ~ ~ __~ ~ o ° ~ ~ H A ~ 7 H ~ I C O ~ 1 ~ v I ~ m (n v D ? N ~ ~ A a v v I cn ~ ~ D N ~ N 7Z' ! ~o a r a m; l~ - o .v t ~ co = ~ lop a ~ I = m y W m ~ I n ~ m o c a° r o ~ I o o° a c o c° n ~ i V ~ A Z ~ m 0 ~ ~ ~~ N N C o o ' c~rtn umi coo 0 0 N I ~ - ~~ i o o~ o e ~+ c ~ I ~ 3~ ~ ~ ~' cn j ~~ '~ • o Z O O O ~ I O O O g rn', ~ I a° o ~ v 3 ~~~~ ~'0 ~~ N l V I l I S~ i ~ o A p' ° m _ ~ ~ ~ ~ ? ~ d g _ ~ ~ I e o I ~ ° ,~ _ v [ ~ I a .. I d N r. v, - ~~ ~ ~1 o D~ o O I ~w ~ ~ y M I ~ O a = I I ~ w ~ I g ~ ~ ~ ~ ~ ~• I '' ~ N I c ~ m N ~ c t~l m N m ~ N S t0 ~ m S m m I w m n a I ~ a a I Z 3 m = m 5 ~~ I 3 m = 5 ~ ~ -~ N A ? ° n 0 ~ O ~ n d A ~ ~ .. I ~ am I I. n~D m~ ~ z 1 ~ ~ ~ A I 0 M I 3 O M i 9 Z m I I ' H ~ tll ~ Z A I v I ~ w w I ~ a ~ I ~ a I .. ° a ~~ I a s r. ~ ~ g I ~' m c I ~ v c m~ a I ~ o a m N ~ N - ~ N I ~ ~ 'O ~C n I b I ~ I I ~ I oo- v v I ~ c~ ~° I o I y n ~ I ~' N ~ I I ~ I o I o w I m I m °ro ~ I ~' O I cry ~ m ~, ~ o g ° i I o of o ,~, Wisconsin 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)]. Permit Holder's Name: City Village X Township Robe ,Richard Hudson Townshi CST BM Elev: ( Insp. BM Elev: BM Description: TAAItr IAICnDAAATIf'1AI EL TION DATA TYPE MANUFACTURER CAPACITY Septic CTC~ Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~ ~ ~ rat Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufact rer Demand M Model Nu er TDH lift oss System Head TDH Ft Forcem ' Length Dia. Dist. to well Cnu A QCf1DDT1AA1 CVCTR 1 [" iR _ _ / county: St. Croix Sanitary Permit No: 395254 State Plan ID No~ J~ Parcel Tax No: 020-1128-30-000 STATION BS HI FS ELEV. Benchmark Z " 25-~ ~ ~ • Gtr Alt. BM /, (~ ~ 3•$ 1or~C t Bldg. Sewer SUHt Inlet SUHt Outlet Dt Iniet Dt Bottom Header/Man. $.sZ q ~•~3t Dist. Pipe ,D"$'a 9~•~s r Bot. System ~ ~ • s ~O "$(~ f Final Grade '~. St Cover BED/TRENCH Width K Length r.•,,...^ .- . . . No. Of Tr nches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ 3 r ~'(3"~ Q0. Z SETBACK SYSTEM TO P/L BL G WELL LAKE/STREAM LEACHING CHAMBER OR nu a t rer: INFORMATION / Type Of System: ~ ~ ( ~ t ~ ~a `~ UNIT Model Number: nrcTOrnr rTrnAr cvcT~ne i ~ _ ~. r~ ~~ nii ~ -•-••--------- Header/Man' Id ~~ v- .... . -- Distribution Pipe( x Hole Size x Hole Spacing Vent to Air Intake ~ ((~~ th ~ Dia L Length Dia Spacing eng cnn rrniw .. ~_..........., c..~•e...~ n..i., .... ne.,"~.,r~ nr nr.[:rane wstems ~nw Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~ Yes ~ No ~] Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:,~0 _/ ZS~/ al ~~ory~tiglj: 68 Perk L~~Hudson, WI 54016 (NE 1i4 NE 1/417 T29N R19W) Parkview Estates Lot 17 71.) tA,~kt--B~~'M Descrip`ti-orn = ~ `b t 2.) Bldg sewer length = 2 ~/a9. - amount of cover = " Plan revision Required? ~] Yes No Use other side for additional informati6n. d ?_J' ~ L Date Insepctor's Signature SBD-6710 (R.3/97) Inspection #2: Parcel No: 17.29.19.598 Cert. No. r - ~ ~sa~ Sanitary Permit Application Safety & Buildings Division 201 W. Washington Ave. [n accord with Comm 83.21, Wis. Adm. Code PO Box 7302 fseansfirt See reverse side for instructions for completing this application Madison, WI 53707-7302 Personal inforniation you provide may be used for secondary purposes (Submit completed form to county if not Department of Commerce [Privacy Law, s. 15.04(l)(m)) state owned. • Attach com late lans to the coun co onl for the stem, on a er not less than 8-1/2 x I 1 inches in size. / State Sanitary Permit Number ^ Check if revision to previous application State Plan 1. D. Number CounryJT C ~ S Z Location: I. A lication Information -Please Print all In ormation pro~ny Location ' PropeRy Owner(N~ame ;~ !- N C +'C .+~ ' ~.. G ~G,! 0 IC •s ~1 ~3 Q. ~ •L 1 ~-, IvLt/4, S ~ / T Z~ N, R' ~E o property Ovme~s Matlrng Address Lot Number Block Number / w~"'°° Zi Code Phone Number d ~j Subdivision Name or CSM Number city. State ;'~D 14a ('~-'r 3~`- DSd ~ SFr /~ S1~I t~ S 4 ~ ~ ` ^ city II. Type of Building: (check one) ~ ^ village O t or 2 Family Dwelling - No. of Bedroom Town of ^ pubGc/Commercial (describe use):_ ~ U s ~ ^ State-0wned Nearest oad ~; .~ ~.. Fem.- y Q ~v Roc~l Gov ~.r=~~ k~ ~= t /1-r~" ~~/~J~ld~. Pr L. Pazcel Tax Number(s) OZ~. Z ~. ppp III. T e of Permit: Check onl one box on line A. Check box on line B if a licable 5 Z Q ~ 6. ^ Addition to ,~ 1. ^ New 2. Replacement 3. ^ Replacement of 4. Existin S stem S stem stem Tank Onl Date Issued 13) Permit Number ~ ~ „ O ,. ~~ A Sanita Permit was reviousl issued ~~ ~ C ~ _y, r ~ ~/ ~~ N T pe of POWT System: (Check all that apply) ~ 5'~+~ ~'~ /`~ M'~ Q'~~ ^ Sand Filter '] I^~.Constructed Wetland ~lon- ressurized In-ground ^ Mound "p p ~.~~.~ ^ Sind;..".ass ^ Drip Line Pressurized In•ground G Holding Tank ^ At- , de ^ Aerobic Treatment Unit ^ Recirculatin ^ Other: V. Disllersal/Treatment Area Information: 1. Desilm Flow (gpd) 2. Dispersal Area 3. Dispersal Atra 4. Soi4 Application 5. Percolation Rate 6. System Elev~lion Elevation e Required Proposed Rate (GalsJday/sq. ftJ (MinJinch) ~~'~ Q /I ~G ' ~~ yso r ~~s,~ s3i ~ ~~~/,z ~ VII. Tank Capacity in Total # of Manufac rer Prefab Sitc Steel Fiba s Plastic Gallons Gallons Tanks Con- Con- g Infurtnation Crete structed New Existing Tanks Tanks ^ ^ p ^ VIII. Responsibility Statement I, the undersi ed, assume res onsibilit for installation of the POWTS shown on the attached tans. [3usiness Phone Number Plumbers Name (print} Plu~ber's Signatur no sta MP,w11'RS No. t ~ ~ s~r~ ~ ~ 3 g~ - gc 1 Z.-. Ul ~ ~ ka.- ~ - Dam.. l ,r ,~ ~.. Plumber's Address (Street, City, Slate, Zip Code) ~~ f 1X. County/Department Use Only cure ostamps) '~~ Issut - ilk (1'I .~~.__ ^ Disapproved Sanitary Permit Fce (includes Groundwater Date Issued I Approved ^ Owner Given Initial Adverse Surcharge Fec) ~ ~ Z~ ©v p 3 ~ ~. ,, = ~ ,~;% , ~. Determination 0 ~'` X. Conditions of Approval /Reasons for DisapprovaL• ~ (/Y~ ~p "~ ~S ~y~~~r~`~°~ ~ ~; cow.. 'ate ~ `~ ,~ tN~oi rG~ ~,~ re Qasd ~~~ S ~ - ,~ , I "k ~ d~/kPh,T Ji-I1ltcr 7'~ k!e fh~TR~~Pct~ Gad < -..Qo l'` ~ ~ ;,,~,a ,..-~ U C CO i.~ N, G.+~ a~ l i t7~ S. ~ "~y ~ 8~ 4 C; f' n '~gW1 t.r aF 5~~~' ~ d.~ k s, f/,=43.7$''" Z ~~ BZ ~ ~ ~ 3 b ~ ~--'f~~1~tH~ S ~ B-3 ~ ~~ i `ii ~I tHatb ~+f iTk Robey L4t"~~ a !s~' ~~~ to ~~rk 1(i~,W ~f~`'~fa-S y~8 ~a~ k Ca „n_.. S~(STa,~EI.: ~d~Sa~ S~~ Ia. ~iy~~ ~~. ~~.c lrbl ~~~-,~,,~,I ~2.ZS03 (. ~,,, -'~I M3') _. ~i - ;; d I ~ ~~ ~ ~N ~!, ~'1 i sta. ~~.. ~ ~ z'~US /~/~ ~/~ s 9. ~.~ o. ~- ~'~toc,v~ t-~~~s~ ,'~ '~ ;, k ,~ 1' ', ,, ~' ', ~~ ~~ ~~~~ L~N~ 8. M • ~3ot1 o rti e~ s,,',~S FI - Ioa,oo' ~W~ i t ZQ /, .~ I . ~Z~ ~ ~ BioDiffuser Specifications ~ .`. ~ ~ Z y s~ 3~ F , -~ ~6• ~o 00 00 00 00 ~o 00 00 00 00 =o coo coo coo 00 ~© Dl~ O DO ~C] =O 00 O p0 ~G~ 00 Q~ ~o ~~ ~~ 00 ChunbK ~k ~~ ~ 4' Knockout Universal End Cap DS-Ci-3.0 DS-GT~L.O Grommets RB-BAS-20x38 RB-BAS-22x38 RB-BAS-26x38 All Basin Assemblies includes 38" basin, lid and your choice of two grommets 'specify grommet size when ordering ~~,r ZABEL ENGINEERED UNIFIED SYSTEM e Basin & Basin Assemblies • Perfect for installing an effluent filter outside of the tank • May also be used as a lift station for pumping effluent or sewage • Six different sizes are available to meet all your applications • Each basin may also be fitted with extension risers for your custom depth • Basin assemblies include appropriately sized lid, two rubber grommets, security screws, special fastening tool, and neoprene gasket • ~ • • 1 1 1 RB-B-20x12 1 • ' ~ 20" x 12" Basin 39.95 34.00 33.50 33.25 33.00 RB-B-20x38 20" x 38" Basin 93.95 74.00 73.50 73.25 73.00 RB-BAS-20x38 20" x 38" Basin Assembly' 133.95 114.00 113.50 113.25 113.00 RB-B-22x12 22" x 12" Basin 39.95 34.00 33.50 33.25 33.00 RB-B-22x38 22" x 38" Basin 93.95 74.00 73.50 73.25 73.00 RB-BAS-22x38 22" x 38" Basin Assembly" 133.95 114.00 113.50 113.25 113.00 RB-B-26x12 • 26" x 12" Basin 41.95 36.00 35.50 35.25 35.00 RB-B-26x38 26" x 38" Basin 95.95 76.00 75.50 75.25 75.00 RB-BAS-26x38 26" x 38" Basin Assembl 135.95 116.00 115.50 115.25 115.00 • 1 1 • DS-GT-3.0 3.0" Grommet 9.00 6.25 6.00 5.75 DS-GT-4.0-35 4.0" SDR 35 Grommet 9.00 6.25 6.00 5.75 DS-GT-4.0-40 4.0" SCH 40 Grommet 9.00 6.25 6.00 5.75 411 7CI IC hocin ~ceam hliac inrlnria a AR" hasin annrnhriately sized lid. and two gromm ets. Reque st the grommet size of your choice. • 0 0 ,, 22 RB-B-20x12 RB-B-22x12 RB-B-26x12 __.__ t. . , fa„~ ~ ,5 `~- ZABEL ENGINEERED UNIFIED SYSTEM • Constructed of high quality polyethylene • All access system components interlock with a patented twist and lock design • Tested to withstand up to 3,300 Ib. wheel load • All Zabel Riser's and Lids are UV Protected • May be cast in or retrofit to the tank • Available in a variety of sizes to meet any depth requirement LID ~~~ ~ .t-~i~ MADE IN USA `i Risers & Lids TANK ADAPTER ~~-"~ N a c~`, e~ . ~ ~,i: POLY TANK ADAPTER ~ Neoprene gasket Designed to adapt Zabel Risers directly _ : ~;~x and tamper resistant to Norwesco and AK Poly tanks. t,. ~'` fasteners included ~J~y~~ ~~~~~ RB-L-20 20" Lid 42.95 38.00 37.50 3725 37.00 RB-RTA-20x2 20" x 2" Retrofit Tank Adapter 39.95 34.00 33.50 33.25 33.00 RB-R-20x6 20" x 6" Riser 34.95 29.00 28.50 28.25 28.00 RB-R-20x12 20" x 12" Riser 39.95 34.00 33.50 33.25 33.00 Qn_Q_~n..~n ~n~~ v RR° Riaar ~ 93.95 74.00 73.50 73.25 73.00 RB-L-22 22" Lid 42.95 ~ 38.00 37.50 37.25 37.00 RB-RTA-22x2 22" x 2" Retrofit Tank Adapter 39.95 34.00 33.50 33.25 33.00 RB-R-22x6 22" x 6" Riser 34.95 29.00 28.50 28.25 28.00 RB-R-22x12 22" x 12" Riser 39.95 34.00 33.50 33.25 33.00 RB-L-26 26" Lid 46.95 40.00 39.50 39.25 39.00 RB-RTA-26x2 26" x 2" Retrofit Tank Adapter 41.95 36.00 35.50 35.25 35:00 RB-CTA-26x6 26" x 6" Cast-in Tank Adapter 36.95 31.00 30.50 30.25 30.00 RB-R-26x6 26" x 6" Riser 36.95 31.00 30.50 .30.25 30.00 (~ ~ ~ RB-R-26x12 26" x 12" Riser 41.95 36.00 35.50 35.25 35.00 `~~ B-R-26x38 26" x 38" Riser 95.95 76.00 75.50 75.25 75.00 . - RB-PTA-26x2 ~ 26" x 2" Poly Tank Adapter 44.95' 139.00 38.50.: 38.25 38:00 20 .~ Wisconsin Departrrrent of Commerr~ Division of Safety and Buildings Attach complae site plan on paper not less than 8~ x 11 inches in s¢e. Plan must ~~ St. Crobr include, but not IimRed to: vertical and horizonW reference pant (BM), direction and Parcel I D percent slope, scale or dimemsiars, north arrow, and kcation and distance to nearest road. . . 020-1128-30-000, ID#17.29.19.598 Please print aff information. Personal intortnaBori you provide maybe used for secondary' purposes (Privet)' Law, s. 15.04 (1) (m)). Z Pr~Y Owner Property Location Richard & Rita Robey Govt. Lot NE 1/4 NE 1/4 S 17 T 29 N R 19 W Property Owners Mailing Address Lot # Block # Subd. Name ar CSM# 468 Park Lane 17 Park View Estates 1 St Additron City State Zip Code Ptv~ Number ~ City ~ Village ~ Town Nearest Road Hudson ~ WI 54016 715-386-8588 Hudson Park.Lane SOIL EVALUATIOPI REPORT in ~rrrvrl~nro with (`rvnm R~, 1Mic Arlm C`.rl[~a 1444 page 1 of 3 AC.E. Sal & Site Evaluations ~ , ~ _ __ fig'` ~~~~ ~' New Constriction Use: ~ Residential / Number of bedrooms 3 Code derived des. , n~ '.,-~~ 450 .- - _ " GPD -l Replacement ,~ Public or corrurrerci~ -Describe: ~ ~ _ _ ~ ~ Parent material Glacial outwash ~ Flood plain , ff na General cptnrrents and recommendations: Install 2 trenches at 3' x 81.25', 26 High capacity BioDiffuser infiltrator ~' ~ ~? bers~!!~O.~t}P *""' `- ` ~ ' :><~. `-? Sn E - ,. ,,,~ 1 ~n9 # ~ ~~ .~- ~, ~ .~ ~`' ~ Pit Ground surface elev. 95.93 ft. Depth to limiting factor il°I-~ ,.... ~ Sots uc~i a- Rate Horizon Depth Dominant Color Redox Description Texiure Structure Cons~tence Boun '.YR GP DI(tY "Eff#1 1 0-11 10yr3J3 none sl 2fsbk ds cs 2fm,1c 0.5 •~ 0.9 / 2 11-18 10yr4J4 none gr. sl 2msbk dsh cs 2fm,1c 0.5 / 0.9 / --- --- --- --------- -------- ---- -~13j ~ --- ----- --- - - ----------- ----- - ----- --- ------ 3 ~ 18-44 10yr5J4 none vfils lmsbk ds CW 2f,1mc 0.7 1.2 / 4 ~ 44-52 10yr5/4 ' f2d 7.5yr5/8 vfsl ~sl 1 msbk dsh aw 1 f 0.4 0.6 ~ 5 ~ 52-112 10yr6/4 none s & gr 0 sg dl - --- - .07 / 1.2 / ~ 9 - ~s -,- / Q Comm. 85.30(3)2 applied to dist~unt the presence o ~ redact conceMmkions described in H#4. ^ J B«~ng Z ~'m9 # ~ Pit Ground Surface elev. 96.89 R pepth to lirrritirrg factor ~ ~ 123" in. Sod ApptiCation Rate Horizon Depth Dominant Cokx Redox Description Texfiue Structure Corusatence Boundary Roots GPI ?ift' *EtT#1 *E 1 - 0-14 10yr4/2 none ~ 1fsbk ds cs 2fm 0.7 y 1.2 / 2 14-26 10yr4/4 none Is 1 msbk ds gs 2fm,1 c 0.7 ~ 1.2 ~ 3 . 26-41 10yr5/4 none Is lmsbk ds cw 1fmc 0.7 ~ 1.2 r 4 41-53 10yr5/4 none ffs 2msbk ds cw 1f 0.5 ~ 0.9 / 5 - 53-66 10yr514 t'22d 7.5yr5/8 vial ~S 1 csbk dsh aw - 0.4 ,, 0.6 / 6 66-123 10yr6/4 none s & gr _ 0 sg dl - - .07 ~ 1.2-/ alb .gyp .5 ~ 6, ~ u amm. 85.30(3)2 dis the presence of relax. concentrations ascribed in I-F#5. ~i~ , ~ ~ _--- - * Effluent #1 = BOD ~ 30 <_ 220 mglL and TSS 30 < 150 E #2 = BOD <_30 mglL and TSS <~0 rrrglL CST Name (Please Print) S' CST Number James K. Thompson _ .^. ~- 3602 Address AC.E. Sal 8 Site Evaluations Date Evaluation Coryducted Telephone Number 340 Paulson Lake Lame, Osceaa, WI 20 7/27101 715-248-7767 /~ ~Lr ~M.vLYSM•~sv- ~l~ ~~~- ~~~ /" Si+-. ~~~ -f ply O,Mrer ,,.Richard. & Rita Robey _________________ Paro~ ID # 020-1128-30-000, ID# 17.29.19.598 Page 2 of 3 ~~~ L. Bonng # ~ ~~~ n !~ PR Ground Surface elev. 96.73 ft. Depth to limiting factor ` > 120 in. ~ APPS Rate Horizon Depth Dominant Cola Redwc Desciptionn Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 1 ~ 0-13 10yr3/3 none sl 2isbk ds a 2fm,1c 0.5 0.9 / 2 ~ 3 ~ 13-28 28-38 10yr5/4 10yr5/6 none none Is sl lmsbk 2msbk ds ds cs cw 2fm,1c 2f,1mc 0.7 ~ 0.5 / 1.2 ~ 0.9 ~ 4 - 38-42 10yr5/6 f2d 7.5yr5/8 vfsl Sl ~ 1 msbk dsh aw 1 f,vf 0.4 0.6 5 42-120 10yr6/4 none s & gr 0 sg dl - - .07 1.2 / Carron. 85.30(3)2 applied to discount the presence of rr3dox. concerttrdtior>s described in H#4. r i r i. ~ i_ Cg ~,~ t3oring # ---J eoring ~{ -~-. `1 ~' P ~~ C on ~ 2r 5 atlt ~ v.. w t 1~'!^ 7 i •.., , ....w~, . ~_ I~ Pit Ground Surface elev. _~~ ft Depth to limiting factor ' >98° in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consbterrce Boundary Roofs "Eff#1 •Effiy2 1 0-13 10yr3/3 none sl - - - - - - 2 13-25 10yr5/4 none ~ - - - - - - 3 25-32 10yr5/6 none sl - - - - - - 4 ~ 32-40 10yr5/6 f2d 7.5yr5/8 vfsl - - - - - - 5 ~ 40-98 10yr6/4 none s & gr - - - - - - Corrvn. 85.30(3)2 applied to discount the presence of redox. conc~rrtrations described in Ft#4. Boring # ~ ~~ ;:~ Pit Ground Surface elev. ft. Depth to limiting factor in. Soli Applic~on Rate Haizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#'I *Eff#2 ~~z 5 * Effluent #1= BOD S> ~ < 220 mglL and TSS >30 < 150 rnglL * EffhteM #2 =GODS <30 rrrgfL and TSS <30 rr1glL The Departmertt of Commerce is an equal opportunity service provides and employer. if you need assistance to aacess services or steed rttatetial m an alternate fob, ttlease contact the de~ertt at 608 266r-3251 or TTY 608-264-8777.. 8 ~~ ~ (~. B.,rf. ~ Top S~oBp o.t dec.X Ede v' :. 93.78.' 00. ~' Qe ~' '~ / S~yZ • 5oi/ ¢daLua6i~ t ct u~r' ~ri n~ Q z ~ ~~ ~ e JQ /UQ'~i CM ~~ ~ ~ ~~Q ~Q ~r'Ol7 • /ocnx~.ed /Onop. Spa Seaye. / ,_ ~, ^ a~ `~ Bel %. r ~ /off /7, / ~e,¢dc/. ~, • Q e~ ~'~~ ,~~~ !~; e~ ~s des, 0 Ews~n~ so;/ a6soi~f.'ar~ 5e~. /9 ~ o,c,~~(san • ~- S~ste,,,. s~rsE. eke' = 9,2.8/. S~• C.~oix Cc., ~/. 8/ Sep ~%c fan ~. EsE%rna~•e d elegy n,E ou.~lef = qsl, Std. . ~~av - i EX%,S~rn ~¢,i1e-~1 aPI~* yc~0~'om O~ ~ 6.tdr~:h ,5 ~ d - SS u.ye ed e 1. = ~ pp.~ r't5,'derree "~' -Well 0 ~ off' Is r '~~ ~~ Pa,~ ,~a~e ~' {~ , 3 0~3 ~`~ ~~~~ ~ ~ -• ~- ~ ~ ~~ ~.~ ~~~~ 1~~ ~`~ .mss-f~~~5 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 Soli 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) +~1 S° Estimated Flow -Average (gpd) 'f-s Septic Tank Capacity (gal) o0 Soil Absorption Component Size (ft2) 1 Type of Wastewater Domestic Table 2' Snil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) Maximum Influent Particle Size (in) ap 1/8 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 Tab le 3: Maintenance Scneawe Septic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the ~` Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from fhe interior of the tank maybe difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 ' `~ Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. ~~s- 3 y~ -~ ~6 9' Z / ,~ 7 ~ J'- 3 ~'~- ~~~ ~~ 3 ~ ~ .~~ ~ ~, ~_ _ ~~'~ -`" ST CROIX COUN ~~ SEPTIC TANK MAINTENRNOE~ AGREEMENT, AND OWNERSHIP CERTIFICATION FORM OwnerBuyer R'c~.a~~ ~ ~~ '~ Mailing Address , 'y ~ ~ 1~ a ~ k Lai ~ ~. Property Address `{ ~~ ~ Q ~ k Lt ~~,--- (Verificationrequired from Planning Department for new construction) City/State ~ u ~ S e ~ W I Parcel Identification NumberD ~~'• i l L~-3G - aaQ_- i.F(sAL DESCRIPTION Property Location ~_ '/,, .~ '/•, S~• / Z , T ~ ~ N-R ~ W, own of~~~ ~ ~ ~1,division ~,42k VIE cu GST~ T~'.~ _, Lot #~ Certified Survey Map # ,Volume ,Page # Warranty Deed # 3 ~ ~ ~0 3 r ,Volume ~ Page # Spec house ~~ yes i~no Lot lines identifiable O yesno SYSTEM MAINTENANCE Impr+ope:• use and maintenance of your septic system could result in its premature failure to handle wastes, Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeymanplumber, restrictedplumber or a licensedpumperverifyingthat (l) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, hereiq as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to•the St. Croix County Zoning Office within 30 da the three year expire •on date. ~ / ~5/ U SIGNATURE OF APPLICANT DATE '. •~:~WNER CERTIFICATION ~i; i'(we) certify that aii statements on, this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of die ;described above, by virtue of a: warranty deed recorded in Register of Deeds Office. ~ ~~5~ ~I GNA Ole ' 'I.YCANT ~ DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. **'*" •* Include with this application: a stamped warranty decd from the Register of Deeds office .a copy of the certified survey map if reference is made in the warranty deed OOCUIMENT NO. '~~~ ~ ~~~ r~rf ~O~ - -- .~ the follo«rin6 described real estate in _L~'~__rlr0 1 ~C County, State of Wisconsin: (SEAL) t c ~t it >• a~ 0 6~- (SEAL) Tax Key No. - Lo'F" ~ ~ ~ ~~ r~C U /~w ~S'~~r7 Ps ~vf ~ ~ old i`~~ o h e C U l' ~ r h ct -fa ~~i z P ~~f Z~ ~ Li e /"-~ u'7'~ A S f e C o v- a e c~ ~~ ~/ .J lH `~ ~~ ~l~fs ~ P~5 ~ ~~ • ~~~° 1 t be t!P cY ~ s ~ rr ~ b.e c~ ~--- EXEMPT This ' S homestead property. (is) (is not) _ Dated this ~ - - d y of - (SEAL) (SEAL} AUTHENTICATION Signatures authenticated this day of 19_ s TTTLE: IfEMBER STATE BAR OF WISCONSIN -X (jt not. wised by 4706.06, Nis. Stets.) This iasinrment was drafted by ~G /! /r /!-cl v t >'~ '~ ~. STATE BAR OF NISCONSIH-FORM 3 QUIT CtA14M GEED THIS SPACE RESERVED FOR RECORDING DATA REG~SFE3tS OFFKE ST. C1lUIX CEO., W~ R~c'r.. for Record Ms 17th day of lrar /L D. 19 82 TO ACKNOWLEDGMENT STATE OF WISCONSIN tt l• ss. _ St. Croix County. Personally came before me, this 17th day of J(Sj( the above named Richard Robey ~. ~. to me known to b~ ~i,~atSA ,.~ ~rb6, executed the fore- going instrmge~ 3r~r~l~w~~ge~~~+me. ',f_ Jt ba arrtheMicated or ~kaowledged. Both UNotary Public _ ,; ~_ ~e~ssarlr.j My Commission C 0 r ilTl • a •~ • County, Wis. ~~~,.• ~tgK';'state expiration ..~~_~. D Q L~ cn W Q W W V w Z N !- w w Z ~_ U W ti.. O Z W i- LL O J~ ~ Z~ Z ~E p W 0 W Z Z o v :~ ~ W } W W Z w ~ _ Z ~' w w o w Q = N ~"'~ Q 2 W 0 = ~, S F- Z i- w z - ~ f= w 3 3 _., ° o .. z . O • ~ N w v 0 !- W ~ N a? W M ~ . 0 3 ~ ~ z V ~ ~ ~ •w ww x Z W z ,'~ 3 ° 0 U w p X o ~ ~ W ~ p o g = U W Z Z ~t H N = W M w U o = Z ~ ~ _ ~ ~ N o LL _ ~ ~ 0 O Z •~ W V o 3 T ~ ~ ~ ~ N M w Z J _ ~ Z W ~ } W > ~ ~ = N o Z Q ~ ~ cn Q ~ p Z o ~ z ~ W p Q ~ O w ~ c~ w 3 ~ -- z p Q O CD n Q W a = Q J > W a W ~ W ~ Z ~ In > m z_ N U Z Z _~ 3 0 = c~ ~-- Z lL } O W ~ ~ N N ac Z W _ a r 0 0 z ~'ti'ER .~ ~`t ~ ~ .I ` " /'' ~ TO~~TNSHIP ~ u ~ S c ,~ •.SEC. v"` T ~ N, R ~ W . .0. ADDRESS ~ u.. •~,,~ , ST. CROIX COUNTY, WISCONS/ N• ~ ~ ' t . 'BDIVISION ; .<• ~ LOT~LLOT SIZE ' ~ PLAN VIEW •Distances ~ dimensions to meet requirements of H62.20 _ SOW EVERYTHING WITHIN 100 FEET OF SYSTEM - { , r • !' -~ J~/` ~L1 )- . .- d4 ~ _ .----.__.._.a ~_ _-----~- . TIC TANK S} I ~ ~' ~' ~MFGR. ~r ^ ~ ~ • ~ ,:,~' ~ ~ ~ 7 CONCRfF. TE STEEL NO. of rings on cover ( Depth ~ DRY WELL .>NCHES N0. o€ width length .area 3 no. of lines____~ width Iength~ area~~~- depth to top of pipe _ ~, ~ '' rREGATE :u~C RATE , ~ AREA REQUIRED L 1 ~_ AREA AS BUILT ~ ~'~ :claimer: The inspection of this system by St. Croix County does not imply complete % .pliance with State Administrative Codes. There are other areas that it is not possible inspect at this point of construction. St. Croix County assumes no liabi:ity for ~ :tem operation. However, if failure is noted the County will make every effort to ermine cause of failure. ~ - • ASES AND OILS SHOULD NO. BE DISPOSED THROUGH THIS SYSTEM. ~ ' -z..-- .y,.-.--•..~.. • _ "INSPECTOR _~*' ~~._~_~_.. ., . • • ~--- a DATED ~ PLUI•iBER ON JOB <:~~~ •~u{ ._~[~~~ . LICENSE NUMBER - `f.. ~` ~ z? ._ ~; ._ . ,T . RRPOP.T OF IPISP~CTIOTJ--I~JDYJIDUAL SL'T,)l1GE DISPOSAL SYSTEt~i • .. S ~~ anitary Permit ~ ~' •• Sate Septic • Croi;; County ~~ •..~ize -~~''Z~ gallons. 'Dumber of Compartments ~ ~= Distance Frors: Y•~ell ~ ft. - 12% or greater slope --- fi. Building `_-L.~1_._.._f t . Wetlands -- f • Iiigticaater --- .ft. DISPOSAL •SYSTF,:1 ~ _Tile Field or SeePa~e Pit(s) Distance From; ?fell __ ~ ft. 12%.or greater slope ft Suilcinr ~3 ft, Wetlands ~ f; FIB r;ighwater ~_ ft, ~ . Total length of lines c.'{~ ft. i~luraber of lines ~. Length of each line ~~ ft, Distance between lines ~ft. Width of file trench. ft. ~ Total absorption area ~~; 5: sq, ft. Depth _ ` ~ of rock below file - in. Depth of rock over the •'~- in., Cover :. .. ~nver .rock ; t. Depth of the below grade ~n. Slope of ~ - t trench "'~~ in p er 1C~1 ft. Death to Bedrock --- ft, Depth to groundwater - ft. . PITS ~ • _____ Number of pits Outside i et ft, Depth below inlet ________ft. Gravel around pit . e no. .Total absorption area ,. sq. ft. Square feet of seep `:quarQ feet of see~a~.e~nit Inspected tiy: Approved ~~ Rejected h bottom area required ~. re required '~ Title ~' , .Date ~! ~~• 19 ~_._____ . 7~. Date 197 , ~, ,~~ ~~~ PL667 t LOCATION: IV Subdivision Name, *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required A. OWNER OF PROPERTY r'llk~ ~~ B ~~~w D State and County Permit Application for Private Domestic Sewage Systems State Plan I.D. # Mailing Address: c T= E '/4, Section '1 T N, R E (or) nearest road, lake or landmark Blk# S~~-~~ State Permit # ~L~ County Permit # -?,~ County sTi~l~~~~ ~.~psoiJ w Lot# J_Zcity Village Township U p$ d ~'YPE OF OCCUPANCY: *Commercial *Industrial "Other (specify) Single family / Duplex No. of Bedrooms 3 No. of Persons TYPE OF APPLIANCES: Dishwasher t/ YES NO Food Waste Grinder (-~YESNO # of Bathrooms z- Automatic Washer ~/ YES IVO Other (specify) E. SEPTIC TANK CAPACITY ~ D 0 O Total gallons No. of tanks _ 1 *Holding tank capacity Total gallons No. of tanks t.~ New Installation / Addition _ Replacement _ Prefab Concrete *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1)! 2) < 3-~ Total Absorb Area 1 sq. ft. New / Addition Replacement *Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches _ Seepage Bed: Length _~~idth l L ~ Depth Tile Depth ~~ No. of Lines Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land 2 `7. Distance from critical slope I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from . the EH-115 prepared by the Certified Soi! Tester, ' ~ ~ 3 NAME I~ /~~ D ~ ~ b and k ~N S C.S.T. # other information obtained from , t, ~ ~ ~ 2 ~ (owner/build ' _ ~ ~ 3 ~ Phone #1 }' ~ - ,Z 3 3 Plumber s Signature ~ P/MPRSW# ~ 7 Plumber's Address ^ u- ~~ i c .n u ~ PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). ~. WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS LOCATION: ~'/o, ~•'~'/4, Section ~L, T~N, R ~~ (or) W, Township or Municipality .~/ t' ~' / ~ ~'' l~ , Lot No. ~, Block No. ~~ ~ ~ tt~ County ~r~' ~rP ~ ,~- ~, subdivision Name Owner's Name: Mailing Address: ,~ [' ~ /~ ~? ~I/ TYPE OF OCCUPANCY: Residence ~~ No. of Bedrooms ~~ Other EFFLUENT DISPOSAL SYSTEM: NEW f- ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOG~IL BORINGS "~ ~ ~" ~ ~ PERCOLATION TESTS ~ ~ °~~ ~ ~ SOIL MAP SHEET .~`~/ SOIL TYPE ~ PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS H LE WATER IN HOLE AFTER TEST TIME INTERVAL DROP IN WATER LEVEL, INCHES RATE NUM- BER INCHES THICKNESS IN INCHES SINCE O 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P- l 3~ S~ ~ no ~ ~ °?~ 3 ~ ~ S rms: ~ ~ ; , SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) ~Z ~ ~ h 5 .' ~ ~/ ~~ ~~ ~. -s ~ i 1 [, /i t ~ ~ ~~ Jar B-s ~2 '~ 7~ '' ~5 c"- I "- ~,-' ~ ~~ 3'' 7' S d' : i 1 ~ ~° r PLAN VIEW (Locate percolationtests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable area . umb f squa a feet of needed for building type and occupancy. ~ ~ ~ or distances. Give horizontal and vertical reference points. I ica a slope. t (I EH 115