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030-2016-20-100
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 578931 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: Smith, Joel St. Joseph, Town of 030-2016-20-100 CST BM Elev: Insp. Elev: BM Description: Section/Town/Range/Map No: 36.30.19.418610 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER L CAPACITY STATION BS HI FS ELEV. Septic r n, Z Benchmark 5.35 I K •3 /04!~N Alt. BM Aeration Bldg. Sewer 4. z Holding St/Ht Inlet ?ASS 97•'5 TANK SETBACK INFORMATION St/Ht Outlet g •ZS °f 7 TANK TO P/L WELL BLDG. Vent Air Intake tROAD Dt Inlet N o GS4^ V v Septic 57 Dt Bottom O Dosing Header/Man. ' 9C, , z5 Aeration Dist. Pipe 9, 65 1-5--71 Holding Bot. System PUMP/SIPHON INFORMATION Final Grade cl -7' Manufacturer Demand St Cover GPM Model Number lo~ TDH Li Friction Loss System Head TDH Ft Forcemain nth D' Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside 4 Z re _ Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: / INFORMATION CHAMBER OR /r ltd . Type Of System: UNIT Cd nJ~w ~Dw Model Number: DISTRIBUTION SYSTEM a< (Q+ I LP - 3 Z Header/Manifolo jo/ Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) t~e~ Length S Dia Length Dia Spacing ^ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over 7-Depth of xx Seeded/Sodded xx Mulched Bed/Trench Over Center q/ Bed/Trench Edges Topsoil Depth Over s [0 No `-_1Ca F] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 887 Willow River !Driye Houlton, WI 54082 (SW 1/4 SE 1/4 36 T30N R1 9W) NA Lot 1p Parcel No: 36.30.19.418B10 1.) Alt BM Description = 1" ) L>YG/L, o 2.) Bldg sewer length = Z7 - amount of cover ~iWature > 3 ern a..x-X_,, Pcc~ a .c~~ Plan rev ision Required? Fo, Yes o Use other side for additional information. SBD-6710 (R.3/97) Date InseCert. No. l V V Ho _ 0 e a ~ a Q n ~ T < < W v ~v 2 y _ ~ r ~ V ` Z o b ~ n ~ d o o Q 2 ~ ' o n r C i Q 44 ~ e as ~ V C n O ~`c r e 1 ta~0 v h h y. Q♦ ~ J. a ex ~ rr u~ C C v r M \ v k k W~ r ~ 1y 4 ~N 7~v v~ ea Z r v a o• o .l v v o ~ Q ♦ W 1, r ~ V N V d -1 ? ~ ~ ~M V N♦ ~ V ♦ ~ ~ V. ~ M `Li ~ Ir v - - 44 3` ~ ~ ~ 0"00 l(' Ac ~~a Y R'u~ ir 111 - :~,r111 . ' ° 1 ivision County ,r 8 1400 E Washington Ave Sr. 6to/X Cttt7C COUNTY P.O. flaxlti 2 Sanitary Permit Number (to be filled in by Co.) UNITY DeJEL4PMENT Madison, WI 53707-7162 3 t S~ Sanitary Permit Application State Transaction, Number In accordance with SPS 38321(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services- Personal information you provide may be used for secondary purposes in accordance with the Priva Law, s. 15. t m , Slats. 1. Application Information - Please Prin1Information 8197 411LLow X/uER ,Ae,vg- Property Owner's Name 1 Parcel # -.I O EL r// 030 - as/G -.7,0 - loo e' 5'188 ~o Property Owner's Mailing Address Property Location 7,11 A4414 ,6t4AeoY aoaE City, State Zip Code Phone Number GOVt. Lot' 1 SCe1 Section .310 L(OSo.J circle one .'Sya/G 7/S 8l - ~o/7 T 30 N; R &o~ H. Type of Building (check all that apply) Lot # I or 2 Family Dwelling -Number of Bedrooms Subdivision Name 6k wa- ac.S~ lock# ❑ Public/Commercial -Describe Use Q-C-iEy~ of ❑ State Owned - Describe Use CSM Number / Q "ittage of ff~ ~yO? y.5~ ® Town of .Sr. osEPN III. Type of Permit: (Check only o box online A. Complete Pent: B if applicable) A New System ❑ Replacement System 0 Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B• ❑ PermitRene ❑ Permit Transfer to New Permit Revision Changa of Plumber Before Expirati Owner yG 3 /L 7 /6 a78-doo 5/ IV. Type of PO~VTS Svstem/Com onent/Device: heck all that apply) gNon-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound - 24 in- of suitable soil ❑ Mound <24 in. of suitable soil Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersai/Trea ent Area Information: Design Flow (gpd) Design Soil Application Rate(gpds Dispersal Area Required (sf) Dispersal Area Proposed System Elevatio P t X50 .7 6 y3 Ly9 a 9S. o t Ae. VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units ~ 578 o Now Tanks Existing Tanks a ° s e U rn y rn r U C. t'6~- 14 Septic or 4lelding Tmtk ~DOO /QGO ` L✓/E SE.Q <:fo. 1 C A rrE ✓ Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the PO'WTS shown on the attached plans. Plumber's Name (Print) Plumber's re MP/WA*S Number Business Phone Number OIY", Al/ze x313 f/1. 7/.S' /0 7.7-.S07G6 - 7 Plumber's Address (Street, City, State, Zip Code) x.298 .Sr. wY aS" fut. ,0,0 LJI yT36 VIII un /De rtment Use Only Approved irl Disapprov Permit Fee Date ued Issuing A Signature $ .6:5. ZX 61L~~n weer Given Reason for Denial IX. Ill- L~ e s r, tsappraval it Condit, 1Septic n, e t8annn& V. 3 (',3 l L..~ i J dispersal cell must all be selicle@s 1 tatptalttQd. Z , l r1t as per management plat provided py p(y KJ ,61,E 2. Aft sefl X30 regtllrarlj" must ~ J11{~d Iv TZ r as per applic" a0tt -i a1d11111 IN " U ; /iC , 1 t Atit Attach to complete plans for the system and submit to the County only o aper not less than 8 t2 x It inches in size SBD-6398 (R. 08/14) wets ntsite Wastewater Treatment System Iuc e and Title Page Proje3vame: _ 'roar'- sro/TN - .3- /.St ~.✓tted„lo l~owr5 4vgnws Name: OwnWs .Address: '7.7 "~Iut ~4/L G.s~ ~A/deb T- ____Z~s' 38/ - 00/ 7 Legal Descapi on: -St/, SE 6, 30N 19W VMRM Uumipaiity: Town, ~ of _ .ST. Jo SE/iy _ County: Sr. ~iroix "divfsiua Name: Lot Number. //J Block Number. Parcel LD. Number: pap I Page Z .Cora. Pap Page ar, Gs~a~-.~ `s r~~.✓u~i.~.~~~~~~ ~~~.at_ Page td tf tt at tt Pap 6 Alz- rx.L 1s 1.d F'~°.~Aa c ~~J o Pap 7 Page $ ,i°Y "M4il1€N7'S d &W 110W /i®Lr~ord f' Page 9 Nano ofDesig xr: Toy. Ak4&C License Number. /%0- ~31~yG Date: Desigascl to the P`ollowing PCB CGMPonent ual and sPS 8I-85: £a-Crouud Soil Ahwag n 99=0nem Mm-at far POVM (ter. 2 2-0) SBD-10705 P (N Oyon VI 0 ~i a v a t Z Irk O R 2 .o Q IZ, olz n T p v .0V 21 f--N v IN Li Z H ~ V v ~ t o 41 c ~ Z ~ v $ +vu v ti R e v 3 1♦ o hd ~ ~ A V b ~ 3` v w ® M♦ o ~ O ~ v M v p h ? ~ ~~r~ v o 14 P y ? c Wisconsin DepartmentSe of Safety and Professional Services SOIL EVALUATION REPORT Pap of in accordance with SPS 383, Wis. Adm_ Cade County Attach complete site plan on paper not less than 81/2 x 11 inches In size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Party I.D. -QV o •aoi - o- 6o L. 5'ia8- 05 Please print all Information. R by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). PropertyOwner Property Location 00 -7_6 xi. -S/vi r,,v, GovL Lot _W 114 s-114 S G 1&2,0 N R a Property Owner's Mailing Address Lot # Block # Subd. Nance or CRY / 444[ ~aa eW ,0l1 / vE /o S ya 7 K!r o . 3 /av Zqs Code Phone Number Elvftg g opt Aea rest Road 104COJ lJ~j .SY-014 1 Z15- f ) 38/-0617. -Sr Jas 87y!✓/tcovQidcr: tGy New n Used Residential / Number of bedrooms 3 Code derived design flow rate -'/So GPD Replacement Public or commercisi - Describe: Parent material Flood Plain elevation if applicable n/A fL General comments DEEP Ji✓6a e u r0 IZOAd r. / .r and recommendations: G ~BEta~✓ 6aAOLr 7 Q/ Fr 9P / ~eqo~~~ ~srE GRASS 4'1E'1 D .1 _ / y~o sla/E F/_1 Boring # ❑ Boring Pit Ground surface elev. ld/ °f t > Depth to limiting factor /,?S in, MApplication Rate Horizon Depth Dominant Color Redox Description Texture Str mb" Corisis(snoe in. Munseli Qu. Sz. Cont Color Boundary Roots GPD/fE Gr. Sz. Sh. *Eff#1 *Eff#2 2. 14.4 'Q's .7d 1,6 a - a orti - s l `k aY y - sc/ 044 r►~ G IM, k 114 IPA Cu/ - / AeJ A /'r O uwr O Boring # Boring F;1 / © Pit Ground surface elev. ~a/. O fL t limiting factor y dd miting _ in. Horizon Depth Dominant color Redox Description Texture Structure Consistence Boundary Roots ~ GPDAF Rate in. Munsell Qtr. Sz. Cont. Color Gr. Sz- Sh. *Eff#1 *Eff#2 d o Yit - S v n .7v~ G R/-37 0 - / n 3 37-GO o r.~ sG 3 ya s s E a 3 ;og ~4 w / aC4 44 Am? sJA NCO re itr ^)do ` Effluent #1 = BOO > 30 < 220 mg& and TSS >30:5 15o mg& = gpp < 30 m9n- CST Name (Please Print) Michael J. Hassett Signature CST Numlber e call - * By St Address Eau Claire, WI 54701 Datte Eva Telephone Number 4-8610 715-577-4383 CST, WRS-224974, D-1152 SBD-8330(R07/13) Property Owner- ~7~6f i Parcel ID # Page a of 3 3 F Ig Boring # iU Boring Pit Ground surface elev. /40,0 ft. Depth to fimiting factor >130 in. s~ ' Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsefl Qu. Sz. Cont Comer Gr. Sz. Sh. "Eff#1 'Eff#2 / 6-.73 o 3,47 - v n s ~u~ /.o 3- a Ya. 3 - l nt s n r✓ • o 3 o /aYn. / 3 Syr t s 6 ac / / k u - 3 y o• ao a s S s rv l Boring a Boni # Pit Ground surface elev.. /6 a O It Depth to limiting factor > 36 in. Sol! Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff° in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 -Eff#2 l / 6- /S 14 A 31.? r /S- o +/3-L .s l /o Y L S - Se o /o Y.t S - S ff wv,r f! # ring ❑ Bang BPoit Ground surface elev. ft pth to limiting factor in. 5a1 Rabe Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rants OW in. Munseil Qu. Sz. CDM. COW Gr. Sz. Sh. `Eff#1 'EflQ • Effluent #1 = BOD, > 30:5 220 mg& ar►d TSS >30:5 150 mg& ' Effluent #2 = BOOS < 30 r%& and TSS 30 m%l_ Property Owner 46f l Parcel ID # Page o? of 3 3 Boring # Bonng F pit Ground surface elev. 14-0,o R Depth to limiting factor >130 in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots . GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Etf#1 *Ef#2 .2 -.73-111 anti 3 v slk ~ - AO 3 o 14Ya. 5-16 X200 s t r J4 sc , .7 . 3 y 40 /Jo 16Yn. 5/y s S Y - G .7 A Boring # Boring a Pit Ground surface elev. 16,7, 0 ft Depth to limiting factor > aQ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eft#1 'Etfi#2 d - /S 6 a 3 / S l e Ya 1//3 l 3 /o Ya c x e Al - o i6 yC r - s rt .7 tl~ ❑ Boring # Boring IH Pit Ground surface elev. ft. to flmiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Ef#1 *Eff42 * Effluent #1 = BODr, > 30 < 220 mg/L and TSS >30:5 150 mgA- Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/- 1Z ;i S8b4M310(R077t3) ` a Cy ,Z y O O o .~°c 9' r' ~ to c 0 a a H b y oho o N0 n ~ t Rai l p ti a r' h ~ o ~l a ~ ° 7 k• O L p °ht ~ y d a ~ ~nC` u " i K ~ ~ o n o \ tC = q v F- O A h Q -c ~ ~ Ley ~ 01 O M h O a so i ` N ~Z g t a o a 1 I ~ v Lv l Industry Services Divt County } l 1404 E Washin~ln A' TR S f ~i10 /X i p R 9 2 015 P.O. Box 7 6,t Sanitary Permit Number (to be filled in by Co.) ~7•Madison, WI 5370 7I62 t ~ 1~C COUNTY 5 anltary Permit Application State Transaction Numbg In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit N//A is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary _purposes in accordance with the Priva Law, s. 15. ! m , Slats. 1. A lication Information-Please Print All Information G✓/Ltow .~/dER ~,¢,~,c Property Owner's Name Parcel # _J 6 EL X v., rN 026 - a4i4/. - ad - /oo &*AA!9-~ Property Owner's Mailing Address Q nn Property Location ~ l 8B- ' 0) 7a/ boL A6c, Ae v ,f~A~dE Govt. Lot City, State Zip Code Phone Number T SW .SE Section .3G Ud s,.) V 1 Sy0//P 7/,S Od/ ] circle one H. T of Buildin T 30 N; R / ~ro Type g (check all that apply) Lot # I or 2 Family Dwelling -Number of Bedrooms 3 SQ ~O Subdivision Name r Block # ❑ Public/Commercial - Describe Use of ❑ State Owned - Describe Use - CSM Number ( iitage of Alt rtJv7 Sya 7 ys Town of j J oSEPN Uat. Q~. y III. Type of Permit: (Check only one box on line A. Complete line B if applicable) n e A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement On Other Modification to Existing System (explain) tat ew Previous Permit Number and Date Issued B. ❑ Permit Renewal Permit Revision 11 Change of Plumber ❑ Permit T fe Vi Before Expiration Owner yG 3 /L 7 1-6 ;J8-,7o0 N. Type of POWTS Svstem/Com onent/Device: Check all at a t 9Non-Pressnrized In-Ground ❑ Pressurized In-Ground ❑ At-G in. of suitable soil ❑ Mound < 24 in. of suitable soil 2 w 1 _ i A%J ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) t,T1Q-Tat` V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Appiicati Rate(gpdsf) Dispersal Area R iryd'(st) Dispersal Area Propos sf) System Elevation ~l60 .77 Z 013 Ly9. a 98.s ~ VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units c T New Tanks Existing Tanks U ; Yv/ ✓ + l7 ( - J ~ 0.V Vi ~ V] w C7 0. Septic orl101dif g+anlc C it6TE Y Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' at MPIMWS Number Business Phone Number oN~ ;4E~KE t4, 1 22/3 y4 7/-f G 7.7-SA766 Plumber's Address (Street, City, State, Zip Code 4d a 48 Sr. 4Y- VIM. ~i/,4.O.~o Gt1l Sy736 County/Department Use Only Approved Disapprov Permit Fee Date Issued Issuing Age i re g,, b ' er Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval SYSTEM 0 -14-_ 2 ~7r~ 66 4 1. Septic tank, effluent filter and 'i Pe r ly dispersal cell must lle serviced / maintained W/t S h oee /G`-' c/ as per management plan provided by plumber. Pl' S-y J 't 2. All setback requirements must be maintained 0 ve rla as erapplicable '2 Attach to complete plans for the system and submit to the County only on paper not less than 8 W x 1I iuches;h s / ~~S~vrbun~e w.l( y-egvyre__ SBD-6348 (R_ 08/14) I aF Private Onsi aetewat l"re ent stem hidexx and Tide page o~c .s rig - .~•,l~,¢, /.✓daoavo down's ' Ownes Name Qwnfes Aftac: 7a! ~A4c ~lu,~«r D~~~E 7/S - 0o/ 7 Leggy. Desauption: .St✓ SE .3 ,ego / 9 Gl 1 m pa Y= T~ N - Y Of Sr. To s`PN ConaT; X~T 1A- I- "dav doa 1N8M: Srt sy.2 7s'S ~1a_ Pc ~3i3 y Lot Numb= /0 BlockNumber Parcel LD• Number. Page 1~~ Pap. 2 Aar lr-d.A.. Gflot3- .~~'G~'la.J ¢ dr,~.4rJ f)/,6W Pap 3 &Xk~rle *f IF-Iola s PPage 4 s.~.~z~Jr~lEr».~r Page ti if Tt :r Page 6 A14 nex 1` lei7ia! '~~T~P.✓c€ Afro Pap 7 Page 8~"~ctlgrs Page 9 Name ofD esigaen. oH.v E«E _ T icavseNiu-rtber: d/3f4 Sig Date: Y- Des e 7to the liollowing POWT'S ComponentMsxl. amd SPS 81-85: In--Ground SCE Abso gM P&MOM MIMI for POV ~or 2.01SBI)-IQ2Q -P (N t31/0I) VI 0 ~I MW 0h ~ ~a ~ V a C e v a a ~ ~ 4i ~ "s h 3 14 n v Cl% v v~ O no C V ~ W nt t~ j ~ ~`w Z V V v m Q k k r~ It h ! ~ :a _ t Af~~ v k t~ v o Z 4, 0 e ti j p W ~ 1• 1 W V) J 40 3 ~ y ~ o 3 ` tKN ` 14 M vilw ~ ~ -s a z X W m z 61" 86" C C) 42" z X r O nIla O m 2 UP ~ 4" GAS X fA*1 D 0 3" 36" cn j cn -n a o Rj r cn P a) rn m m n UP 38" V~~ > r 4" CAS ~rrn ~ N N V I 4 c C m m- m m D O O~ p ° 39" m ° a z ` -i OrD n rn~ r -n o rn a ~0 Fom 0 m a mm r x;o a z 0 m z z p cn Z< Z z O 0'o -qp -i o c Fn ~n 0? n D ro z z m Jum XK Cl) z F-N O D ^OND ADD A Am~r1 trnK0 Oaf z 0 C: C) pD NM \m r- D N D--i-Iz 0 ;oz mD0 Z-! zl0'Om ~z o- C F- < C) n=X -i VlC -4(nC i<<r*11z0o v D v 1tn z r0D DO "DUO { yZm yDm V11+ r" 3 r-0..~=tn~ -0 v v D D p C A Oo a M N -i 1 i co C:: O -Di 3" O N m .s o a m z O D 1*i m -02-0 V rVI O M M --1 O O m` C O A z Oas Ln in CnZ O -i C< [C CD Nmy DA WoN 0 C:) O 000- 20 n r m m Oz \ 2Tf W Np - s- a Op O v m z 0 O z a ° m m to W ?7 O Z D HAD` 'v z L c0i~ 3: Z r~ c0,a m n > O ~ ~M `n D D Z O 0 ~O AP -q vp O m M M Z v~ o 1m Apo z D m m = 0 m O z Z o Cn n " z -1 O r 0 O H o r m r FD O O D r 0 ;D Z m r m m A \ = WLP1000-MR \ m MIENER concAETE SAWN BY. SME CALE pRE-POUR: O o SEPTIC MANUAL REv. "o W3716 US HWY 10 MAIDEN ROCK, NA 54750 DATE: JANUARY 20l70:[ DATE:. POST-POUR: REVISED JAN. 2010 800-325-8456 FILE Yl AOM-162 -~11 F4 ).l c ~..}~4 li 2-1 ~u l is rc k iZ 4- 8 s a r ~-r Olt -DR, .INiw,z.:,_ V3o,2-ouo-,? -ioo LEGAL DES-CRIP-rioN P- St,~ S S 3 (el 10 Certified Survey -Nlap XL arrantDeed ST'sTE-!l NLAINTF .tN("F ,.AND C} NN TR C:LRLlF krIrIC)-N , i "llic G iC r ter. R l 08 : 0 5M POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page V of 4 FILE INFORMATION SYSTEM -SPECIFICATIONS Owner ~/OE~ SwlrN Tank Manufacturer AJ/ESER Lo,uc.cErr DNA Permit W Septic D Dose ❑ Holding Volume: / 070 (gal) DESIGN PARAMETERS Tank Manufacturer. Eff NA Number of Bedrooms: 0 NA D Septic 17 Dose D Holding Volume. (gal) Number of Public Facility Units: JK NA Vertical Distance Tank Bottom(s) to Service Pad: 7 {r~} Estimated (average) Flow : d bD (gallday) Horizontal Distance Tank(s) to Service Pad: /ao (ft) Design (peak) Flow = (estimated x 1.5}: 5pectfc servicing mechanics must be provided if vertical is >15 feet or y5-6 (gal/day) if horizontal is >150 feet. Specific instructions to be provided on back. In Situ Soil Application Rate: .7 (gavdaylff) Effluent Filter Manufacturer. QE's r DNA Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model: G F /o Fats, Oil & Grease (FOG) <_30 ma1L Pump Manufacturer: Biochemical Oxygen Demand (BODS) 5220 mg/L DNA ❑ NA Total Suspended Solids (TSS) -<_150 mg/L Pump Model: . High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mgtL - Manufacturer. (BODs) >220 mg1L ❑ NA 19 NA {TSS) >150 mglL ❑ Mechanical Aeration ❑ Peat Filter ❑ Disinfection D Wetland Pretreated Effluent Monthly average ❑ SandlGravel Filter D Other. (BOOS) <_30 mg1L Soil Absorption System (TSS) 530 mg/L ❑ NA Fecal Coli€orm (geometric mean) 510` - In-Ground (gravity) ❑ In-Ground (pressure) ❑ NA Maximum Effluent Particle Sin ' in dia. [I NA D At-Grade ❑ Mound ❑ Drip-Une D Other. Other: D NA Other. D NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) 5rWhen combined ;fudge and scum equals one-third of tank volume p When the high water alarm i5 activated Inspect condition of tank(s) -At least once every: D month(s) (Maximum 3 years) 0 NA 3 ® year(s) Inspect dispersal cell(s) 11 At least once every: month(s) (Maximum 3 years) ❑ NA 3 f~7 year(s) Clean effluent filter , At least once every: 13 lei' month(s) ❑ NA D year(s) Inspect pump, pump controls & alarm At least once every: 17 month(s) 0 NA Q year(s) Flush laterals and pressure test ~'At least once every: - D month(s) )ff NA D year(s) Other At least once every: D month(s) ❑ NA ❑ year(s) Other. D NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The soil absorption system shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one-third (3~) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code: All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <_12 months, shall be performed by a certified POWTS Maintainer. A Service report shall be proviaea to the local regulatory authority within 30 days of completion of any service event Page 5 of _ START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process-and/or damagw the soil absorption system. If high concentrations are detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will be: discharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the Infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the treatment tanks and soil absorption system: acids, antibiotics, baby wipes, -cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge. ABANDONMENT When the POWi'S fails and/or is permanently taken out of service the fbiloving steps shall be taken to insure that the system is properly and safely abandoned in compliance with s. SPS383.33, Wisconsin AdMinistrative Code: e All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. e The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator (pumper). o After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable repiagernent area. Replacement systems must comply with the rules in effect at the time of their permit issuance. * A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort p The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a sod and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed.as a last resort to replace the failed POWTS. * Mound and at-grade soil absorption systems ,rimy be reconstructed in place following removal of the biornat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POisONOUS GASSES OR LACK kl~ S UFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE DEATH MAY ~ RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: POWTS INSTALLER POWTS MAINTAINER. Name ox.) E< KE-o13/3y6 Name .,/6,y~ ~EtrE C~E4t'E tu~r,6~~c ,?4 6 Phone 1s C 7.2 - S.?L L Phone 7715 7,2 SEPTAGE SERVICING OPERATOR PUMPER ~rwJ J LOCAL REGULATORY AUTHORITY Name Name Sr Phone Phone 716' 386 - y6 8? START UP AND OPERATION Pape 5 of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process -and/or damage-the sail absorption system. If high concentrations are detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will be: discharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent. and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the treatment tanks and soil absorption system: acids, antibiotics, baby wipes, -cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons,'and water softener brine discharge. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shalt be taken to insure that the system is properly and safely abandoned in compliance with s. SPS383.33, Wisconsin AdMiriistradve Code- : o All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings seated. The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator (pumper). Q After pumping, all tanks and pits shall be excavated and removed or their coven; removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. 'Replacement systems must comply with the rules in effect at the time of their permit issuance. 0 A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and baring advances in POWTS technology, a holding tank may be installed as a last resort. 0 T he site has not been evaluated to identify a suitable replacement area. Upon faildre of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. 0 Mound and at-grade soil absorption systems 'may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POi50NOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY ' RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE ADDITIONAL INSTRUCTIONS: POWrS INSTALLER POWPS MAINTAINER. Marie J o~y,~ ELKE 1W ?3 Name -✓6,y,✓ ~El/CE L"~- t'E Lu~v~6l.~L Phone 7/5 L7,7 - 5-;746 Phone 7is ~7.2 -say ~ SEPTAGE SERVICING OPERATOR (PUMPER) - t/~w~ .rXSW,J LOCAL REGULATORY AUTHORITY Name - Name ~J- ~iloix zo.rJiat DFFicE Phone Phone - 71„5' 38C- yG,?o rr~a z~ ►~°o¢ i 7 ~o m m m 0 - m m AM rx r. m a O i m° n a L7 J io =1 O A o ~ i• iI J 3 ~3+Dmm W m } ~ c 3m k oam~ !1 Qs` 3 ~~aN n Q m'+m n m 3 0~ rs 'C ~ ~ ~ y m 2 It 3 a m O.. n g~ G m U t~ 03? y0=n fD c..°=a a a m Q 3 a o A a m 'a 1w' 4 3 m O O < 5? O O O 7 N p~~sd A S p p C P7 5- rv N 3 `L O= lod eD Z- IV CD =1 'D 'D c~ IR D m m rn p Q T a° jj }will P o° 3 v I j, n m Q Q to O a. C 'O !D y 2: O Er v L- N Q m m ^ O o L G e p m = 3 rrD t°J SJ N N Q 7 N AML Q< Q ro a n G D m m 'a ~av aN°-m m 99 z .6 z +'o n 7E l:L M x (D m 3 m mn N . s., m v G L: J ~h J ~ » CJ rt ry O" 0 0< (D u N i d < , n c m T ~ ~ \ ~ r iD r fnl ~ A ~ J ~ m G ~ `~m0' { -,,1 C off, o n w m _ w`P• to ca ~ 3 e, m = GL O• C ~ a rn~ o--l~~~h !D 0 5z- to o 0 N Z m `u m s cQ ® CD n u"' a w o m 3 (D G o ,~1 ^i pqq • ? O m3 O rr ~ 0 0 m ~ Li T i~ aY` ~ N t~ P°° oc C 3 O O r^ m V.t a Yi a °i = ~ N G CD ~ ~ M..r ;~''F~ a 35 < m ~ j A ~ r=t (D I QN s~ n M (13 m 3 0° a m m 0 21 = I~ A N d Q i.a -I tD .-r r ' r` (D Il~~ 9 i I{I II. a N r 22 s ~ ;a ~N c Z P O y b 2 III ~'3 I 6". gN j m~ E, og i i Ily ~ ~a I ~h~~ . f3 I'E',' ,gb LH Ca IPA S N D DRAWINGS PROVIDEDDY: PROLE OESCR11TION: m McCormack Classic smith House NO. OEK~~DN DATE TMESE ORAW3MCd ARE T1F PROPR3ETMYwo.,NopuRµD -i Construction POTHE PRMR,r..PM~CORtMCK CLASSIC CONMUCTION, DEVEWPED OM S72128 h Avg MON.IVE USE OF NcCORMACK QA55R: L, Mudfen, WI So [gVSTRUCEION USE DP TMESF DMWINGS AND CONCEPTS (715 760.3233. McCORMACR CIA55IC C7p THE NppOMN PERMISSION OF SuMECT YOU TO A CLAIM POR DAMAOES. CO "'BrrEO AND O MAY L i arb ea,N• zs ,u„r_~zs E +4~~ q r '4 n 4 / sb P ra g 4 a riFF®pp® p ' ~ I w~ ~M m a A 4 tl i ,~e~ b ~ ' A a ao~ ~ ,r,aR• v zau• b as + CC r,r 4i P cE i ~ - 4 xab ~ '0 li b ~~a ~ ~ mras a,a ea,w ~ • ,z.z nne' a. I ~p 4 m 'q a 4 z.b I ub ePb N O DRAWINGS %tOVIDED BY: PRO]ECT DESCRIMON: m o McCormack Classic Smith House NO. DESCRIPIiON BY DATE THESEDRAVaNGSARE7NEPROPRIETUNSTRUeYWDRKPROpUCi,WD •-I N Construction PROPERTY OF McCORMACK CLASSIC COCAON, DEVELOPED N " Yo w, POR TXE EKCLUSIVE USE OF MKORMACK C A55K e72 310th Aw CONSTRUCr.. VSE OP TNESE .,,K S AND CONCEPTS V1 Xudaon, W] SW.. CONTAINED TXERQN WITaIOVI'TXE WRITTEN PERMISSION OP ()15) )fiLL]231 • McCORMAyO CTAS5IC CONSTRUCTION I PROHIBITED AND MAY SUB]ECf YOV 7O A OATH POR OA."Es. COPYRIGHT 0 XOyyO m<vtr- ~ F 0, P.w+K j.-o.w ,a~wr~I zr m~ ~1S :w II e 3 gy • ~ Y~ ~ ~ ; II 5 b anoi I D~ n~D 1 I xaar Q 1 { I r q€ A I ~ < ~i I zr I I g I iii 4 no• dty ~ vn wr g § ~ m. ~ F A b I I < I zP~ I ~ ~ 0 O i j~ LL~ a UT 0 DRAWOpS pROWDEO ay.- PROJECT DESCRTPRON ' m \ McCormack Classic Smith Hous; e No. oESCRtvnD" BY DATE 'THESE DRawDNGS ARE TIE PROPRTEdRY WORN PRODUCT A Construction PROPERTY OF NeCpRNgq(CIASSlC cONSTRUCIION DEW COND PED W H WI FOR THE IXC1uSNE USE OF CVSSIc N MCCORMACN 572 , Ave CONSTRUCTION. USE OF THESE DRAWINGS AND CONCEPTS WI ~oj (71S) 760-2221 - COMAlNED THEREIN WITHOUTTHE WRITTEN PERMISSION OF (715) MA wSIC CONSTRURTON IS pNOMiSITED AND MAY SUSIECT YOU TO A CIAIM PoR DAMAGES. COPYRWHT O P t R O y bf z O 8 T 2 SY O y m wa Xr ~ r c c +r i ~ Pa 5 Egg It z ~m to Sp 5 oN pp T by rm Ox ~ 5y m O zm A o~ O 9 C VO1 IA r y o E z m z z ~ Om cm 0 z 0 U1 DRAWINGS PROVIDED BY: PROM? DESCRYnON: ' m McCormack Classic Smith House NO. DESCRIMON W DATE TPROPERTY OF MIESE DMWlNGS ARE TIECPROPRIU3ETARr WgU(ONr DEPRODUCf AND PCORMAOC 5IC CgI51RUCTI C Construction W[ MR TIE VELOPED g,,USM USEOP MecORMACK CLASSIC 572 128th A. CONSTRU. USE OF TIESE Nudson, M W3E WITNO... WRI DRAWINGS AND CONCEPTS N CONI'AfNED TIEREIX PERM15 PI (]3 760.2211- TTEN OF McCORMACK CLASSIC CONTtUCTON LS PRONMMD AND MAY SUBIECT YOU TO A CLAIM PO0. DAMAGES. COPYRIGN] O FF r------------------ L 1 ~ i I to' 6 ~F -7 I s0i m~ I . 6 1 I n' ~ 1 I e ~ C I I I I R I I I I I , I I I I I I I I I I I I I I I I I ~ I I r I 1 I ~ I I z I I , I I I .p I I I I I Sf~' I-- I P I I 1 I > I I I §rn I I I I I I ~ I I I I I ~ 1 I I I i I 1 I I I I ~ I I I I , ~ I I I I I • L I I IT• I t' I a I , I i , I I I I , I < I ' - - - _ _ F 1d-6'~zd'~r-~tg-0„~~2.6•.1.---.t0.b,-_-_ J . Ia p Tfi• 0 ~ ~ I O o ~ S C::3 EM Ll I o z GO~ o0 000 1=3 1::3 taa trr i a~ P I d I ~a B i N O DRAWINGS PROVIDED BY: PR0)ECTDESCRIMON: NO. DESCRUTION ' m o McCormack Classic Smith House BY DATE THESE DRAwmrs ARE THE PROPRIETARY WORKPRODUCTAND N PROPERTY OF NOCORMpCK ClA55IC CONSTRUCTION, DEVELOPED o Construction WI FOR THEIXCWSNEUBEOFNeCORNAq CLASSIC 572 128M Ave CONSTRUCTION. USE OF THESE DRAWINGS AND CONCEPTS H Hu0W, WI 51016 CONTNNED THEREIN SUBTEC WTIHDUTTHE WRITTEN PERMISSION OF JSS) 760.2211 • SUMEC AON CIASSic CONSTRUCTION IS PROHIBITED AND MAY TYW 70 A CIAiM PoR DAMAGES. COPYNGHT O Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 !tabor :~rd Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis., Adm. Code COUNTY 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 % of slope, scale or PAnR7',) dimensioned, north arrow, and location and distance to nearest road. d i r` APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION R ED BY DAT 11„ aiAG, PROPERTY OWNER: PROPERTY LOCATION Dave Anderson GOVT. LOT SW 1/4 SE 1 6T C' 19 PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAM 0 OFFtCE F ~ 706 19th. St. S. 10 na CSM e CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE (MOWN A Hudson., WI. 54016 (715) 386-8207 St. Joseph r~Dr. ] New Construction Use i ] Residential /Number of bedrooms 'I [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft2 Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 98.35 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem Z~S ❑ U EtS ❑ U 12S ❑ U ® S ❑ U Ej S ❑ U ❑ S O U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench .;.::;1._.;.•1 0-9 10 r2 2 none cs 2f .5 .6 2 9-27 10 r4none sici lfsbk Mfr C139 if .2 .3 Ground 3 27-33 7.5 r4 4 none sl 2m r mvfr na .5 .6 elev. 102.08 ft. 4 33-84 7.5 r4 6 none s os mvfr na na .7 .8 Depth to limiting I factor eat-- +84 Remarks: Boring # 1 0-10 10 r2 2 none 1 2csbk mfr cs if .5': .6 2 10-21 10 r4/4 none sici 2msbk mfr if .4 .5 Ground 3 21-82 7.5 r4/6 none s os ml na na .7' .8 elev. 102.2 ft. Depth to limiting factor +82" Remarks: CST Name:-Please Print Gar L. STeel Phone: 715-246-6200 Address: 1554 2 t . , Ave. Ne Richmond, WI. 54017 m 02298 Signature: Date: CST Number: 7-5-96 PROPERTY OWNER Dave Anderson SOIL DESCRIPTION REPORT Page 2 Qf 3 ' r PARCEL IA # pendintt Lot #10 Depth Dominant Color Mottles Texture Structure Consistence Bourclary Roots GPD/ft Boring # Horizon in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed Tmend7 1 0-12 10 r2 7 none 1 2msbk mfr cs 2f .5 .6 L..---...- 2 12-28 10yr4/4 none sicl 2msbk mfr gw if .4 .5 Ground 3 28-34 7.5 r4 4 none sl 2m r mvfr na .5 .6 elev. 101.35t. 4 34-82 7.5 r4/6 none s os ml na na .7 .8 Depth to limiting S factor 2 2 +82" Remarks: Boring # 1 0-10 10 r2 2 none 1 2msbk mfr cs if .5 .6 4.< 2 10-27 10 r4 4 none sicl f r mfr if .2 .3 3 27-33 7.5 r4/4 none sl 2mgr mvfr gw na .5 .6 Ground elev. 4 33-80 7.5 r4/6 none s os mvfr na na .7 `:.8 102.1 ft. Depth to limiting factor +80'" ~3~Z z Remarks: Boring # 1 0-12 10yr2/2 none 1 2msbk mfr cs 2f .5 `.6 r72 12-23 10yr4/4 none sicl 2msbk mfr gw if .4 .5 3 23-30 7.5 r4 4 none sl 2m r mvfr na .5 .6 Ground elev. 4 30-80 7.5 r4 6 none s os ml na na .7 .8 101.25 ft. Depth to limiting f+80'. Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) PROPERTY OWNER Dave Anderson SOIL DESCRIPTION REPORT Page-2 of 3 PARCEL I.D. # pending Lot #10 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baxxl3y Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trend? 1 0-12 10 r2 7 none 1 2msbk mfr cs 2f .5 .6 3 2 12-28 10yr4/4 none sicl 2msbk mfr gw if .4 .5 Ground 3 28-34 7.5 r4 4 none sl 2m r mvfr na .5 .6 elev. 101.35t. 4 34-82 7.5 r4none s os ml na na .71 .8 Depth to limiting S factor +82" 2- Remarks: Boring # 1 0-10 10 r2 2 none 1 2msbk mfr cs if .5 .6 4 2 10-27 10 r4 4 none sicl if r mfr if .2 `:..3 Ground 3 27-33 7.5 r4/4 none sl 2mgr mvfr gw na .5 .6 elev. 4 133-80 7.5 r4/6 none s 02.1 ft. os mvfr na na .7 .8 - Depth to limiting factor +8011 X312 2 Remarks: Boring # 1 0-12 10yr2/2 none 1 2msbk mfr cs 2f .5 .6 52 12-23 10yr4/4 none sicl 2msbk mfr gw if .4 .5 Ground 3 23-30 7.5 r4 4 none sl 2m r mvfr na .5 .6 elev. a, 130-80 7.5 r4 6 none .01 .25 ft. S os ml na na .7 .8 Depth to limiting factor +80" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-6330(R.05/92) PROPERTY OWNER Dave Anderson SOIL DESCRIPTION REPORT Page-2 of 3 PARCEL I.D. # pendinu Lot #10 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed Trench 1 0-12 10 r2 7 none 1 2msbk mfr cs 2f .5 .6 3 2 12-28 10 r4/4 none sici 2msbk mfr gw if .4 .5 Ground 3 28-34 7.5 r4 4 none sl 2m r mvfr na .5 .6 elev. 101.33t. 4 134-82 7.5 r4/6 none s os ml na na .7:: .8 Depth to limiting S i factor z Z l +82" Remarks: Boring # 1 0-10 10 r2 2 none 1 2msbk mfr cs if .5 .6 ....4,< 2 10-27 10 r4 4 none sici if r mfr if .2 .3 Ground 3 27-33 7.5 r4/4 none sl 2mgr mvfr gw na .5 .6 elev. 4 133-80 7.5 r4/6 none s os vfr na. na .7 .8 02.1 ft. m Depth to limiting factor +80" ~f 3~Z Z Remarks: Boring # 1 0-12 10yr2/2 none i 2msbk mfr cs 2f .5 .6 2 12-23 10yr4/4 none sicl 2msbk mfr gw if .4 .5 Ground 3 23-30 7.5 r4 4 none sl 2m r mvfr Cfw na .5 .6 elev. 01 .25 ft. 4 30-80 7.5 r4 6 none s os ml na na .7 .8 Depth to limiting factor +80" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Dave Anderson 1554 200th Ave. CSTM2298 SW4SE4 S36-T30N-R19W - New Richmond, WI 54017 MPRSW 3254 town of St. Joseph (715) 246-6200 lot #10-CSM N 1"=40' BM.= top of NW to C el. 100' c 5`5~g ~P `o Gary L. Steel 7-5-96 Wisconsin Department of Commerce PRIVATE SEWAGt SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 463167 0 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 Parcel Tax No: Houle, Timothy St. Joseph Township 030-2016-20-100 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 36.30.19.418610 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI S LEV. Septic Benchm _ 9t Dosing Alt. M 1 Aeration Bldg. Sewer / Holding SUHt let N let ` TANK SETBACK INFORMATION St/Ht TANK TO P/L WELL BLDG. Vent to it Intake R AD Dt Inlet Septic Dt Botto Dosing Neader/MAn. Aeration Dist. Pipe r Holding Bot. Sys PUMP/SIPHON INFORMATION nal Grade Manufacturer Deman St Cover GPM Model Number TDH Lift Friction Loss System Head H Ft Forcemain Length Dia. Dist. well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits I de Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number. DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of red/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Z Yes ffj No ~ Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 887 Willow River Drive Houlton, WI 54082 (SW 1/4 SE 1/4 36 T30N R19W) NA Lot 10 Parcel No: 36.30.19.4181310 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes [ No Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. Safety and Buildings Division County VA 201 W. Washington Ave., P.O. Box 7162 scons n Madison, WI 53707 - 7162 Sanitary Permit Number (to a filled in by Co.) --Department of Commerce T (608) 266-3151 l / ~ 2J// (PY- Sanitary Permit Applicati i~ State Plan I.D. Number In accord with Comm 83.2 1, Wis. Adm. Code, personal inform yo n may be used for secondary purposes Privacy Law, 1 IJ Project Address (if different than mailing address) I. Application Information - Please Print All Information # oO o \ Property Owner's Name 0 C T 2 7 Parcel # )Lot # / Block - T Q 2004 Property Owner' ail ng Address IX COUNTY Property Location ZONING OFFICE ST. CRO_ City, tate R ' Zip Code Phone Number Section crrc L ////)A/ T - x~ N, R90 I. T pe of Buildi g (check all that apply) 1 or 2 Family Dwelling - Number of Bedrooms 3 Somme CSM Number ❑ Public/Commercial - Describe Use ❑ State Owned - Describe Use ❑City ❑Village o ship of 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type ofPOWTS System: Check all that apply) 3 Z Non -Pressurized In-Ground ❑ Mound 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At-Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In-Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculatin ' Sand AFilter ❑ L.- A Recirculating Synthetic Media Filter Leaching Chamber ❑ Drip Line ❑ Gravel-less Pipe ❑ Other (explain) ~F +-moo , ( V. Dis ersaUTreatm t Area Information: e3 Design Flow (gpd) Design Soil Application Rate(gpdaf) ispersal Area Required (sf) ispersal Area Proposed (sf) Syst4 Elevation g t ,S~ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units W1-7 f~4-/CD Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank / Aerobic Treatment Unit 7 Dosing Chamber VII. Respo sibility Statement- 1, the undersigned, a me responsibility for installation of the POWTS shown on the attached plans. Plumb 's 7amni Plumbe Si e k MP/MPRS Number Business Phone Number Plumber's dress (Street, City, tate, Zip C ti Ip S S VIII. Coon /De artment use On Approved ❑ Disapproved SFee includes Groundwater Date IssueIssui Agent Signature o Stamps) F) ❑ Owner Given Reason for Denial 2 so - og-, 2F, zod IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Attach complete plans (to the County only) for the system on paper not less than SU2 x 11 inches in size SBD-6398 (R. 01/03) I i I I I t : r , d I I I I 1 i i I VO I i : I I I_. I ! I I i _ I ' I , I I Y 1 , I ~ I I I I I t , j f : I I ,2 _ I I ~ I I I I I, I i j I I ~ ~ I I I j~, I I I I i~ j i I ' r ' I I d i l l I ~ j ~ I I ~ T I I ~ i I I , I ~ i I I I I _I a m Qb AA C6~ r e ~ O b 0 WiscoiisinDepartment ofIndustry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 abor :end Human Relations Division of Safety & Buildings in accord with ILHR 83.65, Wis. Adm. Code COLIN Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PAR `h~ , dr dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION R ~DBY DAT r 4 ~ ? I~ ~ ( i,' l PROPERTY OWNER: PROPERTY LOCATION , Dave Anderson GOVT. LOT SW 1/4 SE 1 35T 4 u1 19 PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUED. NAM .'0 MWliflG-O :R ~ 706 19th. St. S. 10 na CSM CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [MOWN 'IN A Hudson., WI. 54016 (715) 386-8207 St. Joseph 3 ° r Dr. k ] New Construction Use*. J Residential / Number of bedrooms [ ] Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd$ . B trench, gpd1ft2 Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 98.35 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem IMS ❑ U 125 ❑ U CAS ❑ u ®S ❑ U K IS ❑ U CIS O U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmnch n 1 0-9 10 r2 2 cs 1 -Mfr __2f .6 2 9-27 10 r4/4 none if .2 .3 Ground 3 27-33 7.5 r4 4 none sl 2m r mvfr na .5 .6 elev. 102.08 ft. 4 33-84 7.5 r4 6 none s os mvfr na na .7 .8 Depth to limiting factor +84'° Remarks: Boring # ;<X t 1 0-10 10 r2/2 none 1 2csbk mfr cs if .5 .6 2 2 10-21 10 r4/4 none sici 2msbk mfr if .4 .5 Ground 3 21-82 7.5 r4/6 none s os mi na na .7 .8 elev. 102.2 ft. Depth to limiting factor +821, Remarks: CST Name:-Please Print Phone: Gary L. STeel 715-246-6200 Address: 1554 2 t . , Ave. Ne Richmond, WI. 54017 m02298 Signature: Date: CST Number: 7-5-96 PROPERTY OWNER Dave Anderson SOIL DESCRIPTION REPORT Page=? of 3 PARCEL I.D. # -pending Lot #10 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/ft in. Munsell Ou. Sz. con t. Color Gr. Sz. Sh. Bed Tench 3 1 0-12 10 r2 none 1 2msbk mfr cs 2f .5 .6 2 12-28 1 r4/4 none sici 2msbk mfr gw if .4 .5 Ground 3 28-34 7.5 r4 4 none sl 2 mar mvfr na .5 .6 elev. 101.35t. 4 34-82 7.5 r4/6 none s os ml na na .7 .8 Depth to limiting S factor Z Z +82" Remarks: Boring # F 1 0-10 10 r2 2 none 1 2msbk mfr es if .5 i.6 2 10-27 10 r4 4 none sici if r mfr if .2 .3 3 27-33. 7.5 r4/4 none sl 2m r mvfr 9w na .5 .6 Ground elev. 4 33-80 7.5 r4/6 none s os mvfr na. na .7 ' .8 02.-1 ft. Depth to limiting 4 factor +80', ~3~z z Remarks: Boring # 1 0-12 10yr2/2 none 1 2msbk mfr cs 2f .5 .6 > "IM 5 2 12-23 10 r4/4 none sici 2msbk mfr 9w if .4 .5 Ground 3 23-30 7.5 r4 4 none sl 2m r mvfr Crw na .5 .6 elev. 4 30-80 7.5 r4 6 none s os mi na na .7 .8 01.25 ft Depth to limiting f+ err Remarks- Boring # iii. Ground elev. ft Depth to limiting factor Remarks: SBD-8330(R.05192) STEEL'S SOIL SERVICE Gary L. Steel Dave Anderson 1554 200th Ave. CSTM2298 SW4SE4 S36-T30N-R19w New Richmond, WI 54017 MPRSW 3254 town of St. Joseph (715) 246-6200 lot #10-CSM N 1"=40' BM.= top of NW to C el. 100, f f` a C S~ - 1~ ~ A f'17r Gary L. Steel 7-5-96 POWTS OWNER'S MANUAL & MANAGEMENT PLAN., Paged of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity al O Ni, permit # Septic Tank Manufacturer >R r a N;, l DESIGN PARAMETERS Effluent Filter Manufacturer ti O NA Number of Bedrooms ❑ NA Effluent Filter Model © NA i Number of Public Facility Units 91 NA Pump Tank Capacity al ANA' Estimated flow (average) al/day Pump Tank Manufacturer Nt 90 g Design flow (peak), (Estimated x 1,5) al/day Pump Manufacturer NA Soil Application Rate al/da /fts Pump Model ja NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit 6Nk Fats, Oil & Grease (FOG) 530 mg/L O Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODE) 5220 mg/L Jd NA 0 Mechanical Aeration O Wetland Total Suspended Solids (TSS) 5150 mg/L 17 Disinfection O Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) O N! _i Biochemical Oxygen Demand (BOD6) 530 mg/L _dIn-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L Q NA O At-Grade ❑ Mound Fecal Coliform (geometric mean) S10° cfu/1001711 Q Drip-Lino Q Other; Maximum Effluent Particle Size Yd in dia. O NA Other; 0 NA Other 11 NA Other: Cl NA *Values typical for domestic wastewater and septic tank effluent. Other. N MAINTENANCE SCHEDULE y Service Event Service Frequency D month(s) Inspect condition of tank(s) At least once every: (Maximum 3 years) © NA [ lK ear s) , Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,) of tank volume O NA O month(s), " ) (Maximum 3 Years) O NA Inspect dispersal cell(s), At least once every year(sj I O month(s) . Q Nt Clean effluent filter At least once every: year(s) 0 month(s) Nl. Inspect pump, pump controls & alarm At least once every: Q ear(s) ffNF, Flush laterals and pressure test At feast once every: Q month(s) r O year(s) Other: At least once every: 13 year(a) (Q Q NA 13 Other. O NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. TanK inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surfacE, The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires thu immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 1134 Wisconsin Administrative Code. „ All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at Intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. ()MW IQ/O 1' Art Page of START UP AND OPERATION' For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or, other phemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents' of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(o) In one large dose, overloading the cell(s) and may result-In-the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator pronto restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist In manually-operating the pump' controls to restore normal levels within the pump tank; Do not drive or park vehicles over tanks and dispersal cells, Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides,;meat-scraps;. medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the systorn is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed, • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a.code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems rnusL comply with the rules in effect at that time. 0 A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS.-----. - ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area.. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. 0 Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLS POWTS MAINTAINER Name Name 6 Phone _ Phone SEPTAGE SERVICING OPERATW (PUMPER) LOCAL REGULATORY AUTHORITY S Name Name Phone Phone .:.r.. "his document was d in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Page 0 f START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) In one large dose, overloading the cell(s) and may result In-the backup or surfeoe discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior-to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually-operating ths'pump'controls to restore normal levels within the pump tank; Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise. disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; ;,Meat-scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. 4BANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the systern i> properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: e All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed, ,r + The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. :ONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken,.,,to provide a.code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. 0 A suitable replacement area is not available due to setback and/or soil limitations, Barring advances in POWTS technology a holding tank.may be Installed as a last resort to replace the failed POWTS.-7 O The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be, performed to locate a suitable replacement area.. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. C) Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL (SASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES" DEATH MAY RESULT, RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ,DDITIoNAL COMMENTS OWTS INSTALLS POWTS MAINTAINER Name Name `5 p, Phony _ Phone EPTAGE SERVICING OPER (PUMPER) LOCAL REGULATORY AUTHORITY Name Name > Phone Phone Nr...,. . its aocument was d In compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST CROIX Ct YUNTY SEPTIC TANK MAINTEMA NCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer -Ct o-r (i~ Mailing Address N6', EL~12 l ~t~.L A L l`u~O Property Address _ Lo T ~b IitJ r l tlUuJ ~If/C~YL 3 7 2rv (Verification required from Planning Department for new construction Sl- J o s~ l 'Iw kcq G p City/State W LSC4 r~ Parcel Identificat.on Number LEGAL DESCRIPTION C Property Location S (AJ L y, Sec. T 30 1` '-R~W, Town of. a4 sa P~.-( Subdivision Lot # Certified Survey Map # 5-q 7 Z. q~;- , Volume 313 Page # Warranty Deed # Volur. ie l Z3 q , Page # lo q Spec house [P yes ❑ no Lot lines identifiable l,cT yes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof 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 n coded 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 Dep: irtment a certification form, signed by the owner and b a master plumber, journeyman plumber, restricted plumber or a licensed pun tper verifying that (1) the on-site wastewater disposal 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. I/we, the undersigned have read the above requirements and agree to mai Ytain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Departm ont of Natural Resources, stating that your septic system has been maintained must be completed an i returned to the St. Croix CState of . Certif days of the three year expiration date. ounty ZoningsOfftce withinication 30 ~i SIGNATURE O PPLICANT ~b D~ DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the bes of my (our) knowle the property described above, by virtue of a warranty deed recorded in R sgister of Deeds Office e. I (we) am (are) the owner(s) of SIGNATUR F APPLI ANT `b / (Z/ CS ~f DATE / Any information that is mis-represented may result in the sanitar; permit being revoked by the Zoning Department. +*s*•s Include with this application: a stamped warranty deed from the Rel ister of Deeds office ' a copy of the certified survey map if r.,ference is made in the warranty deed