HomeMy WebLinkAbout030-1030-50-000
V.'scorsir Depaitment of Commerce PRIVATE SEWAGE SYSTEM County: St.
Safety and Buy ding Division St. Croix
INSPECTION REPORT San tary Permit No
GENERAL INFORMATION ;ATTACH TO PERMIT] 584706
State Plan ID No
I
Persoral information you provide may be used for secondary purposes (Privacy Law, s '!5 C4 ; I )fm)) h~
Permit Holder's Name C ty Village Towrship Parcel Tax No
Steven & Stacy Mael TOWN OF SAINT JOSEPH 030-1030-50-000
CST SM Elev: Insp. BM Elea BM Description 5mAion.7owniRangei.+Aap No:
07.29.19.109G
TANK INFORMATION ELEVATION DATA
TYPE MANUFAC x CAPAC',TY STATION BS HI FS ELEV.
Septic Benchmark -
Dosing
AIt- BM
Aeration Bldg. Sewer
Holding
Vfdt Inlet -
I ;
TANK SETBACK INFORMATION S~'Ht Outlet
TANK TO PIL V1FLL BLDG. Vent to Air Intake ROAD Dt Inlet r
K f,
Septic t Dt Bottom
k
Dcliti Headerlh4an
Aeration Dist. Pipe
Holding
Hot. System -
Final
PUMP/SIPHON INFORMATION Grade % I
c.•1Manufacturer Remand St Cover
Model Number
TDH Lift r Friction Loss + System Head T DH , rt
/ ,2 a
Fnrcemam Length' lDia 7 Ditit to b'.'en
SOIL ABSORPTION SYSTEM rx t
BED/TRENCH Vddth~ Lergm N• C' Trenches PIT DIMENSIONS No. Of Pits n6; e. C a Lieu 'd Depth
DIMENSIONS
_1 I i
SETBACK SYSTEM TO J P! , f BLDG WELL LAKEiSTR A%1 LEACHING Manufa jtwer
INFORMATION
Type Of System CHAMBER OR 1 r
r~, I T UNIT Mode Numt:er
r
DISTRIBUTION SYSTEM
Header+Manitold Ur<_tnbuti°n x HCIe size x Hole Spacing Vent to A r 'make
.~.-i PipelSl--
Length- Dia Lenglh Dia Spacing - - ---7
SOIL COVER j x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over broth Over xx Depth of xx ScededtSodeed Iched
Re.&Trcncn Cevef 9ed(Trench Edges _t Topsoil
_ n
r~ Key No Yes No
COMMENTS:: (lnclude cod discrepencies, persons present. etc) Inspection #1: Inspection #2:
Location' 4W+14~$ A~Uk I DA~S lJlb~ +I 7H /
'"1'lX'
1.) Alt BM Description It tt Cbve~
= l , C oc;w fi 2.) Bldg sewer length 6
nb,~(Obf ~tj~'Ic r
- amount of cover Fj
l r 2.1.
Plan revision Required? L I Yes No - I ti ~1 f
Use other side for additional information. L 1 1 j
S130-6710 IR 319?) Date Yhsepctor'z-Signautre Cert. No. L
All
r
/cr
MOVED -County
Safety and Build. gs Elms J I i, 1
u 201 W Washinciton .4v Bcx rarv Permit Number (to be filled to by Co.)
/t. D S ~a! 0 ,1 Z011'
1 P ' l APR 't Madison. b'Jl 537 ~-7. rY' t
ST. caouc COUNTY OPMENT
ii ~ • Stan Trmsaeaon Number
arutary Permit Application
:n accordaocc aidt SPS A3 'I;2), Wis. Adn Code, submission of this fo m to the zpprop late gcvcmmcLEal unit
is required pror to ohtaining a sanitary pe='L 'Dote: Application forMS for sate-ovmed IN'-, -S are submitted w Proje: t Address cif different ttt a rwii in_• address)
the Department of Safety and Professional Se vies. Ptsonai it ormation yaa prcvik may be used for sewndan• 1
,.urp.xes in acoordanue w;th die Priva:y La w, s. 15.t14;1'l m', S•,z:s. f / 1
1. Application Information Please Pri t Afl Information ` 1 7 7 L~ 7 ~1
Yrvptx:F Cwna's Name j t FPar.el +t U 00 V
„ C7.~.i9.lo9G
f Proper y Owecr's Mailing •kddms ~ j Property Lacatix
CrtY. S (~q lip Cade Phunn Nu® er Section
r ~ N- R
IT. Type of Building (check all that apply) ?got
" r i Family Uwctliug '~uutbcr of Bcdtoc ~ Sulniivisus, ~Katne
J ?uh[ i;iC.>um: a rcia! - Describe Use rJk twal B.nek „
_ ❑ city of
P 4~ _
J
~ Sa th.-dai - Describe Use CSM N .rtber Village of
ZL[~ / Town of
2,2-k
U Type of Permit: (Cbeck only on box on line A. Complete line B if applicab
A
ew Sysrcm U Repla;eraert System Treannestl Iold n¢ "ank P.cplacement Only Q .ttfrcr Modifica:ioa ti Existing System (expta n)
B• D Permit Renewal ❑ Pcrrmt Revision D Changc of:'Jumber Ll Permit Trar_~fer to New L:r Prtviotts Yerroit Number and Dare ssucd
Before Expiration Owma
IV. v of POW" rS SystemlCom onen6gD vice: (Check all that apply)
n-Prazstuize l ln-Cmuric C Pressurized In-Ground n Al-(rade C Mound 24 in. of suitable soil U Mound < 24 in. of suitabic soil
T- ltim~ mkk Q atber Dupersal Connpooent (explain)-_- ❑ Preacatttteat Devi.e (explain]
4 V. Dis ersal7reat ent Area Information:
ign Flew (gpd) Destgt Soil .Apphca ion Ratefgp I Dispe:,al e:; Rcyuirec e:f Dspe*sal Ara FLoposed (4 System Elevatin
,
VI_ Tani: Info ~ - Ceoacity m ~'otal # of lvtanufa",-t-
GaAlnos Gailon Units = "'"~1[
New Tads Eximag Tanks 1 s m ? •in
Seruc or Holding Tank Xc~
f ! l
Dosing 'uaaber I -
%M. Responsibility Statemen the undersigned, ass r pomibility for iustallatioo of the POWTS shows ou the attached plans.
Plumber /:5 Namc riot) I Ph tLbe• i anre - - MPlWRS Number Rttsiness Phone Number
P1umbep's.A.ygr.ss iSt;ee:, City, 'S'tate, Jtp
VIII. 'ounty/Department Use Onh. _
Permit cep ' D Issu Issuic^ : rt S: attar
Apprn••ed r app: v S p
er tv Reason for ial S5 •
A Condi ~ J?0approvW A
uis):~ei-..~+ cell must all be setvhcas ! nLai- to r,e~ -3)
as per maragemen! plan provided by plumber. 11
2. All 5603 t k requirerlents must 00 r i&nU ined
M per awNcras coda / ;rdiMIMS.
A aaU :u ctmplvtr places for the stv m and submit to the County only on paper not less that 5 , rz r 1 t inchL~ in sue - - -
SBD-6348 (R 1 I 1 i
PLOT PLAN
PROJECT Steven Mael ADDRI?s~ 416 River Wood Bend De Forest Wi 53,532
NE 114 NW 1/4S 7 /T 29 N/R 19 tip' TOWN St. Joseph COUNTY ST. CROIX
SYS'1EN1 ELEVATION QF..B 96-~ 45 below grade DAT E 4i1/16 BEDROOM 4
CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT XXX HOLDING TANK
N90L-ND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765
HOLDING TANK til'/,E L0.4ll KA'T'E 7 ABSORPTION AREA 691 h of chambers 44
BENCHMARK F.R.P. Top of 1" pipe ASSUME ELEVATION 100' Filter ifetime Filter
7 BOREHOLE O R ELL -11. R. p. same as benchmark
44
Property Line
All piping shall be ASTM SDR 30;34. within To Golden Oaks Drive
10' of hank. piping shall be ASTNI F891
Pro 4 I
Bedroom
House
Huffcutt Comno Tank 2-3. X 90' cells with >3' spacing
B-2 1
Scale is F = 40' 50' ~T
unless otherwise
noted
85B. Ni.
1
X50,
4W
8`"o Slope
60'
50
B-1
ent 102'
>6 Quick4 Standard 100'
of Cover Leac.hin- Chamber
with 20.0 ft2 of Area
' S.6ft^2r'pair of and caps
4 Long 1
Grade at System Elevation
34" Properly Line
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 4/1/16
Owner: Steven Mael
Location: NE 1/4 NW 1/4 S 7 T29 N,R19W 1096 Golden Oaks Drive St. Joseph
System type: In-ground absorbtion system(conventional)
Manuals Used: In-ground absorbtion system (version 2.0)
Pressure Distribution Manual (version 2.0)
Pageff
1. Cover Paqe
2. Plot Plan
3. Chamber Cross Section
4-6. Maintanance and Contingency Plan
7. Filter Specifications Sheet
8. Dose Tank Cross Sectio
9. Pump Curve
10.-12. Soil Test r'
Signature
License numbed` 26900
PLOT PLAN
PROJECT Steven Mael ADDRESS 416 River Wood Bend De Forest Wi 53532
NE 114 NW 11'4S 7 /T 29 N/R 19 W TOWN St. Joseph COUNTY ST. CROIX
SYSTEM ELEVATION 96.81196.0 4.5' below grade DATE 4/1/16 BEDROOM 4
CONVENTIONAL. IN-GROUND PRESSURE CONVENTIONAL, LIFT XXX HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE 'L'ANK SIZF. 765
HOLDING'IANK SIZE LOAD RATE .7 ABSORPTION' AREA 891 # of chambers 44
BENCHMARK Y.R.P. Top of 1" pipe ASSUME ELEVATION 100' Filter ifetime filter
❑ BOREHOLE O WELL -11.14.11. same as benchmark
44
Property Line
All piping shall be ASTIVI SDR 30,134, within To Golden Oaks Drive
10' of tank, piping shall be ASTM F891
Pro 4
Bedroom
House
Hul'fcutt Combo Tank 2-3' X 90' cells with >3' spacing
B-2 15'
Scale is 1" = 40' 50'
unless otherwise
noted
8s'
B.141 " I
250'
40'
8% slope
60'
so
B-1
Vent 102'
' Quick4 Standard 100'
of Cover Leaching Chamber
with 20.0 ft2 of Area
5.6ft^2%pair of end caps
r'L g 12 „
Grade at System Elevation
34" Property Line
Cross Section of Infiltrator Quick 4 Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 ft2 of Area per Chamber
5.6ft^2 pair of end plates To be >1' above grade
Finish grade elevation
Typical Installation 102.3
J3' nt Grade Vent
4„ 3,
f,30/34 Septic Tank
5 5' Lon a
1
Grade at Systern Elevation
36" (=►rade at System Elevation
Spacing 5'
2-3' X 90' Cells
Same on other end Observation tube/Vent
At end of cell
A
B
22 chambers per cell
System elevations:
A 96.8'
B-96.0'
POINTS OWNER'S MANUAL $ MANAGEMENT PLAN Pap of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner
-
I Septic Tank Capacity 74('-1;'/F[3 NA
Permit # Septic Tank Manufacturer /'r"t ' ❑ OVA
GN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of &Weaoms 0 NA Effluent Filter Model 10 NA
Number of Public Facility Units Pump Tank Capacity l ❑ NA
j Estimated flow (average) Pump Tank Manufacturer r _ C C NA
i----
I Design flow (peak), (Estimated x 1.5) Pump Manufacturer) O NA
Soil Application Rate !R~ Pump Model / 71
❑ NA
Standard Influent/Effluent Quality Monthly average' Pretreatment Unit ❑ NA
Fats, 01 & Grease (FOG) 530 mglL ❑ Send/Gravel Filter ❑ Peat Fitter
Biochemical Oxygen Demand (BODs) 420 mglL ❑ NA 0 Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) x150 mg/L ❑ Disinfection D Other.
Preheated Effluent Quality Monthly average Dispersal Cell(s)
Biochemical Oxygen Demand (BOAS) 530 mg/L ❑ In-Ground (gravity) 0 In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mglLNA Q At-Grade ❑ Mound
Fecal Cofdorm (geometric mean) 5104 cfull 00m1 ❑ D*Line ❑ Other:
,Ma;dmum Effluent Particle Sine )6 in dia. ❑ NA Other: ❑ NA
Other - Other - 0 NA
Nakm typical for domesfiC wastawaJ r and septic tank eftluenL ~ 0 NA
NTENANCE SCHEDULE
Service Event Servioe Frequency
Ynspect condition of tank(s) At least once every: ❑ month (s) ( 3 yem) ❑ NA
(Pump out contents of tank(s) When combined sludge and scum equals one4hird ()S) of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
~-y~r(s)
Clean effluent fitter At least once every: ( a month(s) 0 NA
i
Inspect pump, pump controis & alarm At least once every, Q month(s) 0 NA
s
Flush laterals and pressure test At least once every❑ month(s) ❑ NA
❑ year(s)
At least once every, ❑ month(s)
13 NA
13 ye(s)
r.
❑ 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
kxkjde a visual inspection of the tank(s) to identify any missing or broker, hardware, identify any cracks or leaks, measure the volume of
combined sludge and scum and to check for any back up or pondmg 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 pending of effluent on the ground surface may indicate a fading Condition and requires the immediate notification of the local
regulatory authority.
Mm the combined acrzurnuAtion of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of
)he tank shad be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin
Administrative Code.
Ail other services. including but not limited to the servicing of effluent filters, mechanical or pressurized components, Pretreatment units,
trrd any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report strait be provided to the local regulatory authority within 10 days of completion of any service event
Page of
START UP AND OPERATION other chemicals thin
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of Painting products or
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. will btu
During power outages pump tanks may fit above normal highwater levels. When power is restored ft excess wastewater astewateter effluent.
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in thebackup or surfacerestodrig tnL
To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to power to
effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal leve s
within the pump tank. the area within
Do not drive or parts vehicles over tanks and dispersal ceps. Do not drive or park over, or otherwise disturb or compact,
15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the followirng from the wastewater stream may improve the performance and prolong the We of the POWT-$:
butts; condoms; artton swabs; degreasers; dental floss diapers: dis'urfectants: fat: foundation drain
antibiotics; baby wipes: cigarette
(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 POWfS fails MUM is permanently taken out of service the following steps shall be taken to insure that the system is properly
and safety abandoned in compliance with chapter Comm 133.33. 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 property 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 fined with soil,
gravel or another inert solid material.
CONTINGENCY PLAN code compliant
If titre POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a
replacement system:
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 requirled
setbacks from existing and proposed structure, lot lines and wells. Failure to proted the replacement area will result in the rued
for a new soll and site eveluation to establish a suitable replacement area. Replacement system must comply with the rule:) in
~ at that time.
❑ 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 ftm POWTS a sail 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 may be reconstructed in place following removal of the tuernat at the infiltrative
surface. Reconstructions of such systems must comply with the rules in effed at that time.
<<{ARNING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER ASEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O7 A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDinoNAL CoMmENTS - - - - -
POWTS INSTALLER r POWTS MAINTAINER
Name Name
Phone 7/ Phone 'r 21
SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATO Y AUTHORITY
Name > ~i r=~,~[T > Name_
Phone Phone
This downent was drafted in ownpliance with chapter SPS 383.22(2xb)(')(d)&(f) and 383.54{1): (2) S (3), Wisconsin Administrative Code.
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Septic-Dose Wank Cross Section And Pump Performance Specifications
rank Manufacturer 'um Manufacturer 7
17'a_nlc Model Number 1 j 1 Pump Model Number )A
Total Tank Capacity : TI- Alarm Manufacturer ~C Q~~
Max. Bury Depth ~ Alarm Model Number ~ L/ I
SwitchType rX0
Filter Manufacturer Total Dynamic Head ('I'DH) - Feet _
j Fiber Model Number J,7 _ J Elevation Head v
Distal Pressure _
Network Loss
Minimum Pump Performance Required Force Main Loss
~Ft TDH I Total 1L.
Outlet Manhole Min. 4" Above Grade With
Locking Device. Inlet Manhole Manhole Min. 4" Above Grade
With Locking Devine
< b" Below Grade Sealed Watertight Securely Mounted
Weather-proof
Junction Box _
♦ finished Grade r . i.. `
Vent Min, 12" Disconnect
Above Cimde Means
With Vent Cap
' Outlet Filter i-
Inlet = Inlet Baffle
w
'twitch Settings and Reserve Capacil.y TA 1/4»
---Tank Volume =
Weep
40
-Dimension Inches Volume Gal. B Hole
(reserve) A J
(alarm) B 2 T_,Elevation c
(dose) C ht
D Bottom
Total - D Elevation
fJ S ,
GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the
manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not
be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock)
installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and
laid on stable sail to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank
excavation aid the sleeve is sealed watertight. Electrical service complies with NEC 300 and C;onun 16.211.
021051,1 Page of
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-77
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Variable level float switches available.
Variable level long cycle systems available.
Available with special cord lengths of 15' 25', 35' and 50'. -j
i;
Alarm systems available.
Duplex systems available,
- I ~j-._ s
Single Seal Control Selection LisCngs -
Model Volta Phase Mode Amps Simpiex Duplex CSA uL 1 Integral float cperated me&arical switch, no ex:ernal cm :rol rraquired.
us K3 MM5n59 115 1 Ano 4.7 t 41,Y 2. Single ~gbac, variable level Iloat switch or cl%ble Pi9• ack ,arat e 'eve
'453 K18-,"59 173 1 Non 9' 2 30'49Yb~
s`i float switch. Refer to FMC4?7. 53 RNS, 115 f alto ; c; 3 Mechanical alternator 111' 10-0072 er'0-0075
8F5?.67 230 1 Auto a.8 4. See FMCi 12 `or corrt?ct moc el of Electrical .A female
D5,55 D5 ,,59 ;W Auto 4.e 5. Variable lave' control switch 10-0225 used as a Intro activatc with Eler_irica
c335 E5-,,54 230 Nor 4.E 2 3or485 Y et
emator (3) or (4) float system.
Smg.e picgy Lactic switch ncluced.
a caunor+
F,,rmforrnabononaddibonafZcelerprocuc„referlccataoganFggyback'vanabieLc.e FioatSQche5,R.1W77;
Fi=dncal A,tomator, FMW46: Mechan.cal Nlemtor =h1Gi95; Sump'Sewage Basins, FWA87: and Single Phase .r...:_.. _ ccz~ sr
3
oex Pump ' o•+COGAharn Sgserns. Ft 73Z
For unusual conditions a reserve safety factor is engineered into the design o every Zoeller pump.
HealL rO.- P.O. BOX
77 ~ousv+Ve KY 4025ti-.,-,
~11~i'1.,iaCfLrLYS C.
SNIP 10: 3645 Csne Rvn Read
a„SY;r e KY 4u2+ r 196 i Qvaurr PI,uvs ,SNCf /999
50~ T8-2:31 • ; iPOJ) 928 PU.b1,°
htipJlwww.zoeNer.com ZA11W TQ FAX (50 1 774 WN
O Copyrignt 2002 Zoeller Co. All rights reserve,.
ST. CROIX COUNT°Y
SEPTIC TANK MAINTENANCE AGRELM ENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer----
Mailing Address
Property Add
(Verification required from Planning & 7oniug Department for new constractLon.)
City/State Parcel Identification Number ~3b L - r
LEGAL DESCRIPTION
L
N R4_W, Town of --r~ -~U
Property Location t/4 1/a , Sec. , 'I'
Subdivi;siioa , Lot #
Certified Survey Map # V(Almle , Page # ! ( - -
Warranty Deed # o ll Volume Page # - giw Spec house y n Lot line` identifiable (yes) no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and U0=W== of your septic system could result in its premature failure to handle wastes. Proper
u:aaatenauce consists of pumping out the septic tank every three years or sooner. if needed, by a licensed pumper- What you put mto
the system can affect the fanction of the septic tank as a treatment stage in the waste disposal systen owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St Croix County Sanitary Ordinance.
The property owner agrees to submit to St Croix County Planning & Zoning Department a rectification fa= signed by the
owner and by a roaster plumber, journeyman plumber, restricted plumber or a licensed pun4= vcrifymg 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 fill/ of sludge.
Uwe, the undemignesd bavc read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as act by the Deparonemt of Commerce and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been oaait =ed must be completed and returned to the St. Croix County Plaaniug &
expiration date.
Zoning Depattmout within 30 days of the threZo
true to the best of my/ourr knowledge. Uwe am/are the owner(s) of the
I/we certify that alt statements on are
property described above, by virtne f a ed recorded in Register of Deeds Office.
L
Number' edrooms /
,t
J, JA/tv
S1G~ F APP CANT(S) DATE
***Any information that is misrepresented may result in the sanitary pernut being rHVoked by the Planning & Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds G ffuce and a copy of the certified surrey map if
refCrenc a is made in the warranty deed.
(REV. 08/05
U. S 8 8° 55' 30"W FOOT.
0
660.6 1' otp CENTERLINE OF EXISTING
w o.. SOUTHWESTERLY ` TOWN RO A D
z m IGHT-0 F-WAY LINE ,
_
U.
0 U 31 z rn 5.05 ACRES
co a ~6 ' m
~ co o 0 0 ~ ~ 119' 09 4b„
N N 8 6 55' 30" E h
3 476.07'
3 w W
0 _ C o
32 't 33
v a~ 34
o 5.05 ACRES M
5.05 ACRES
`r 0 - h
N `t 0 2 TRUE BEARING
z
SCALE
476.25' 333.47' ~ air
N 89° 47° E 809.72' 0' 200' 400'
SOUTH LINEOFNE I/4 OF THE NW 1/4
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wscans+n Depa o(Cdfnmerce SOIL EVALUATION REPOR 7L tl age of
Division of Safety bad'touA ngs
OIX ~NT)( in accordance with Comm 85, Wis. Adm. Code f
tic 5T Piww county ci I f
Atta b~(}t~'1'. ~T an~ rm'ffyss than 8 112 x inches in size Plan must
includ@' not imiteo to. vertical and horizontal reference point (BM), direction and Parcel I.C
Percent slope, scale or dimensions, north anrow, and location and distance to nearest road.
Please print all information. Re ' ed by Date Lj::~ Personal -reformation you provide may be used for secondary purposes (Privacy Law• s. 15.04 (1) Iml)
Property Owner Property Location
f Govt. Lot / i_ 1/4 1(4 5 L,L" N R t E f w
1~~ / / ZJ(J~ 1
Property Owners Mailing Address Lott # Block # Subd. Name or M#
S to Zip Code Phone Number ❑ City ❑ Village Town Nearest oad
'^•i~~s
New Construction Use,1 Residential / Number of bedrooms Code derived design flow rate ' GPD
❑ Replacement ❑ Public or commercial - Describe: Parent material ri;~/a/,~?✓ Flood Plain elevation if applicable rt/ ! ft.
General oornrnents
and recornmendabons:
f
Svstem Tvcc System Flevaation
/
F 7, Boring # Boring
fQg. pit Ground surface eiev, ft. Depth to Umiting factor in.
Soil ication Rate
Horizon Depth Dominant Color Redox Description Texture StruCure Consistence Boundary Roots GPDlff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'E'f#1 'Eff#2
J kmx
Boring # ❑ Boring r
pit Ground surface elev j ft. Depth to limiting factor Z )in. Soil ligation 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 -Eff#2
1
Effluent 91 = BOO. > 30 < 220 mg1L and TSS >30 < 150 Effluent 92 = BOD. < 30 mg/L and TSS < 30 mqA-
CST Name (Please Print) CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Adcress Date Evaluation /n diic*r.i Telephone Number
1432 120th St, New Richmond. WI 540 715-246-4516