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HomeMy WebLinkAbout040-1126-30-000 . Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St Safety and Building Division Sanitary Permit No INSPECTION REPORT 589776 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: ~r Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)] ~C Permit Holder's Name: City Village Township Parcel Tax No: Dwight & Mary Jo Nelson TOWN OF TROY 040-1126-30-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 33.28.19.526A TANK INFORMATION ELEVATION D A TYPE MANUFACTURER CAPACITY STATION BS FS ELEV. Septic ` Be hmark S 25 ~a✓.Z. F1c4+ S ~DDO Dosing tO Alt. BM 017" % Aeration Bldg. Sewer 7t 9• /Z ct Z ' Z Holding St/Ht Inlet St/Ht Outlet ~ TANK SETBACK INFORMATION TANK TO / WELL BLDG./ Vent t it Intake ROAD Dt Inlet Septic Dt Bottom t$ Qom' ~ /~YS Z/d Dosing / / Header/Man. 3,8 '3 Aeration Dist. Pipe 3. 7 /4011 Holding Bot. System l Final Grade /46Z. PUMP/SIPHON INFORMATIO Manufacturer Demand St Cover * 3,44 97, 9 OJ .5 GPM Model Number f✓7 i Am 10 TDH Lift Friction Psi rj System Head I+ I TDH4 ~,F rl ~T , .7 -Lr7 Forcemain V T / Dia. w Dist. to Well /O J. 1 1 ~O S Z AAX, 11 SOIL ABSORPTION SYSTEM 6 0 V Kul BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits In a Dia~r Liquid` DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHLEACHING AMBER OR Manufacturer:~A INFORMATION Typ f System: 7~0p N UNIT Model Number:/'1 - ~~7 D 0.4 16 't DISTRIBUTION SYSTEM 4-/ 4''/ _ x Hole Size x Hole Spacing VenAir Intake Header/Manifold 5 Distribution I/•sr44~ if Pipe(s) S g a> _ Lengt Dia pacing Length 77 Dia f~i GL ~MJ SOIL COVER /x Pressure Systems Only xx Mound Or At-Grade Systems Only De th Over Depth Over Ex-xDepth of xx Seeded/Sodded p il Bed/Trench Center ges J NCOMMENTS: (Incl ude code discrepencies, persons present, etc.) 0 Inspection #1Al\ tt Inspection #2: Location: 548 OLD CTY RD M O~ ~t f vTe4A^, dill d&~ 1.) Alt BM Description = • ' 4J 2.) Bldg sewer length - amount of cover = D Q ~ Plan revision Required? ❑ Yes p o Q' II Use other side for additional information. p Insepc r' Signa Cert. No. Date SBD-6710 (R.3/97) PAGE 4OF5 GRAVITY-DOSED J\I&LsoNI SEPTIC / PUMP TANK SPECIFICATIONS pW(~ rT 4"0 Vent Pipe (No Scale) >10 ft from Building Electrical must comply with 12" Min. or 2.0 ft above SPS 316 and NEC 300 Established Flood Elevation Weatherproof Extend manhole riser as necessary. (typical) Junction Box Approved Approved Locking Manhole IMPORTANT: Vent Cap with Warning Label Attached Anchor tank(s) as necessary (typical) pursuant to SPS 383.43(8)(g) conduit 4" Min. or 2.0 ft above Established Flood Elevation (typical) Airtight Seal q \L/ - \1/ Finished Grade Quick Disconnect CAPACITIES @ gal/in (ty Min. pical) Depth (in) Volume (gal) T A Z5. C 2-5:5-,00 * I Weep Approved Joints with B"O Hole Approved Pipe 3 ft onto A Solid Ground (typical) [C] 2 /yJ't..' ~ i -Alarm D 9iL 1.3t" li B ~ _On [c] Pump PUMP-OFF Pump Tank Liquid Level = 1'7,~Q in _off ELEVATION qz. ft T = Force Main Diameter = in ° Block INSIDE BOTTOM ELEVATION= z , ft Force Main Length = ft 3" Approved Bedding Material Beneath Tank ° Force Main Void Volume= 2,~ ~2.`~ gal r too 47 [C] Total Dose Volume TDV = B,S 0~ gal/dose ( < 0.2X design flow + force main void volume) _ t7z -t t z. Z2S IDS .ZZ i Vertical Lift = ~f D ft To if 75/)< . 13 , 10.425 r4cW 6ACK i 6 PUMP TANK: CD• Ed SEPTIC TANK(S): Volume = 050 gal Total Volume 0 G~ gal Manufacturer. _ W1Et)EA Manufacturer(s): (k)IE'ttk Pump Manufacturer. C--_-Ct.llrD Install approved effluent filter at the septic tank outlet Pump Model: le •31 (See attached pump curve.) immediately uPstream of the PumP tank inlet. Controls/Alarm Manufacturer. s 3E R}I0,NAPV,5 Filter Manufacturer. Pmf 1-D K Controls/Alarm Model: :,A6 Ate Filter Model: 525 Float switches containing mercury are prohibited NGOULDS PUMPS Submersible a Effluent Pump MODEL 3871 EP05 EP04 & = Series APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermo- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for plastic enclosed design for heavy duty ball bearing con- following uses: lubrication and efficient improved performance. struction. • Effluent systems heat transfer. ■ Casing and Base: Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms superior strength and corrosion Canadian Standards • Heavy duty sump manual operation. Automatic resistance. Association • Water transfer models include Mechanical E Motor Housing: Cast iron for Op 15 File # LR38549 • Dewatering Float Switch assembled and efficient heat transfer, strength, preset at the factory. and durability. Goulds Pumps is lso Soot Registered. SPECIFICATIONS FEATURES ■ Motor Cover: Thermoplastic • Solids handling capability: ■ EP04 Impeller: cover with integral handle and 1/4' maximum. -oilen design Thermo- float switch attachment points. • Capacities: up to 60 GPM. plastic semi-op with N Power Cable: Severe duty • Total heads: up to 31 feet. pump out vanes for mechanical rated oil and water resistant. • Discharge size: 11/2' NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: METERS FEET - 1040 F (400 C) continuous 10- 1400 F (601 Q intermittent. • Fasteners: 300 series 9 30i- - - - ►~-4-5GPM stainless steel. • Capable of running 8 - dry IT dry without damage to 25; components. °a 7- 6- 20 Motor: • EP04 Single phase: 0.4 HP, z 5 115 or 230 V, 60 Hz, 1550 - - - - - 0 15r- RPM, built in overload with a a EPOS automatic reset. o • EP05 Single phase: 0.5 HP, 3 10 - 115 V or 230V, 60 Hz, 1550 EP04 2 RPM, built in overload with automatic reset. 5 • Power cord: 10 foot 1 standard length, 16/3 0 0- SJTW with three prong to zo 30 ao 50 GPM grounding plug. Optional 20 1 foot length, 16/3 SJTW with 0 2 4 6 8 10 12 m'/h three prong grounding plug CAPACITY (standard on EP05). Goulds Pumps c2o05ITTWater Technology, Inc. ITT Industries Effective January, 2005 \w~ 83871 A%tPhW Peg*; of. , ' Jmawr --jAr . ice=. note* • 33 T2sN R IqW -AWN pwt nos, a- . mot, mss- h° I1~6-30-d61,' Ndr& Q Jj o r~f'PKD J Zoo ` W UL) Es c TO R . 11 1. z;~NL 'cR+J`~ EJp ~S c j' ~ 54q'~ '6+a►~l= BortwN~h To ~ ~33 V~~p`. Aiuwf= A) LE" SQ5 3 d 3 B*-*Z-~roP of Wimww JILL a\~ jw c. Kwup S q-LQ.s (3EDRO~M u} Q4~ S&e M:H. AItJqI S-A county • Safety and Build ' ion CR0/ 1 ~ a.. J U L 7 W 6 201 W. Washington A .O. x 7 2 Sanitary Permit Number (to be filled in by co-) Madison, WI .~'4 ID (COUNTY P FO Z~g way DMLOPME Sanitary Permit Application 6,q>NgR state Transaction Number In accordance with SPS 383.2](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 Servies. Personal infxination you provide may be used for secondary - - purposes in accordance with the P#yacy Law, s. 15.04(1 Xi n), 1. Application Inforration - Please Print All Information 2 ~r 1 Qn d al e Tyr i ve Property Owner's Name Parcel # Property Owner's Mailing Address Property Location _ . 1 6 50g 6LD e.T14. - Govt Lot City, state ~1 Zip Code Phone Number Section 50 2'I, vv, F-A _S~ ut. '540t Z 5 /s /ti (circle o T N; R~-Eorr IL Type of Bailding (check all that apply) 2 Lot # "91 or 2 Family Dwelling -Number of Bedrooms J Subdivision Name 1 ❑ H e6 Block # Public/Commercial - Descnbe Use ❑ City of ❑ State Owned - Describe ~U~se/~ CSM Number ❑ Village of p n _ ~J~~V IIUtV li~t+W ' ` + t hP.Townof III. Type of Permit: (Ch n Complete Use B if ailpplicable) A' ❑ New System Replaoemart S TreatmentIMIding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. T of POW Is S Cam t/Device: Check aB that a urizH; ound ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound <24 in. o J /eI /1/~j ❑ Holding Tank ther Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis rsalf][ tment Area Information: Design Flow Design Soil Applicatio Dispersal Area R (sf) Dispersal Area Proposed ( System Elevation Co' _ CIO q541 VI. Tank Info ity in Total # of Manufacturer Gallons Gallons Units °o New Tanks EdstiagTaks tw p t!y~o~ 52s' Fi p~ ~~a a U rn m w t7 rs. Septic or Holding Talc 1~ fo DosiagChamber VII. Responsibility Statement- I. the undersigned, respoesribr'tity forAmstallaboa of the POWTS shaver an the attadued plans. Plumber's Name (Print) PI Q P umber Business Phone Number Plumber's Address (Street, City, State, Zip Code) W ql, r 170 G. f N ON Er, FA- WT '5W 2(k, VIII. Conn rtment Use On vet ❑ Permit Feet Date Issued Issuing Agent Si ❑ iven Reason for Denial Ito 0 D IX. Conditions of ApprovaltReasons for Disapproval yv{ V SYSTEMOWNFR; 3) deed be sohtnkMed to 1. Septic tank, effluent filter and ~N& dispersal cell must lie serviced I maintained o as per management plan provided by plumber. as per appllC Co o net ce thesy a, a '°~tto k'w"a I SBD-6398 (R• 11/11) PAGE 1 OF 5 In-Ground Dosed-Gravity Plan Index & Cover Sheet Component Manual Design References: Version 2.0, SBD-10705-P (N.01/01, R. 10/12) Pg 1 of 5 Index & Cover Sheet Pg 2 of 5 Plot Plan Pg 3 of 5 Dispersal Area Cross-Section & Plan View Pg 4 of 5 Pump Tank Specifications Pg 5 of 5 Management Plan Attachments: Enclosures: Pump Curve POWTS Application for Review Filter Specs Soil Evaluation Report & Site Map 5 ~'S Project Name / Description l~W►r✓+1-r ,MAlzy It ~J C.L_~e Owner Name(s): f:f-LIAME) Phone: 7/5 - q5N z- Owner Address: 5141' oc.b &rfl. M , Rlvsl~ FAUN _S, W! Zip: ~y°zz Project Address:? r,4_EJ~0A1_E D1ZIV& Govt. Lot: wA :5W.1 /4 of 5e 1/4, Section 33 , T zy N-RAE ❑or W hJ Township: 2U0 County: 5tj c~.c~X Project Parcel ID ~~ID i 12~ 30 -UO~ Designer Information Designer Name: MAtQ Y --It' ttuP~'~I~ I Phone: 11-5-- LIZ - 1176- Designer Address: /-V4m7 X w& AK-muk!, CT L AAiP) KY,, Zip: 5~ 16 E-mail: haft►sterd~s~c,n c~ `~~`~~amutmun,,,i OWL-mK., c c ,tit iyi License Number: - t ~~~`®~y! Remarks: [I AFlY JO Hupp7qt i Lf ! ~ w ~ • • • ~if/flfff ###ff B~~N'~~ Signature: 1 Date: S-Z~-ZOII~ Original signature required n each submitted copy. T2YN R "W f ~ ~ Qs (,vow IPASS) ZAiD o wIV-qrove R L 3 ¢qr" IMAA6 i~1~ *nlow , D ski ~ aeZ~sP w W,pyr Mu- jw cw*m-m 4? de t~ - Tull R lw lll of -tom .b ~ d= 22, X bit, moo C4 -a") r ~o 'a _ v~ ~ ° sao~eo~ ~ez•~.P W v,r ,stet. gimtcoar. cRrwa-= 4x.4S' a • - 9 = PAGE 3 OF 5 U o W W N M> o =W CV)m ~gZ cu U> a.. E W Z ~ d L c N N i O U E (D - cl C N W o m N c~ Z_ s cu U to Z Ia 4 U E U) a '2 LLJ m U a s m g m o 49 ?C L.L O m a E 2 a 2~ m W r E Q U o y I; I T o E 7 Y 7 O Q 'TTVVVL'TS I Q a I E 7 a) 0) CD 14 _ I~I Q 11 II U) cu o sl c Q ~ 3 Ic ~c~~ Q cn ~ / N \ y1 J, N W (n N c° I a o U) U 'm m a I I U it I 06 U w i CL o I aai vi _ I m I a a~ s n .N v,v C: r~~+ w m 0 - r^X I V o :3 c p N j I ♦w~~ ~ I I 75 O o I a O M D I I 04 2:1 M o F- iv d J C)l 001 001 cnl O v I JI 11 II 11 11 X O a Z. 0 co C.) (D 0 CL CO < a) o I I = w w W U) I v a 1 z E '2 I Z N a cn ~O v ro leI a ~ Is - 'I ' cnc LIJ W o cn F s ~I J v CY Ie , Q CL Cl Id a cn e) Z M r PAGE 4OF5 GRAVITY-DOSED SEPTIC / PUMP TANK SPECIFICATIONS Dt~T 4"0 Vent Pipe (No Scale) >10 ft from Building Electrical must comply with 12" Min. or 2.0 ft above SPS 316 and NEC 300 Established Flood Elevation Weatherproof Extend manhole riser as necessary. (typical) Junction Box Approved Approved Locking Manhole IMPORTANT: Vent ICap with Warning Label Attached Anchor tank(s) as necessary r (typical) pursuant to SPS 383.43(8)(g) Conduit 4" Min. or 2.0 ft above Established Flood Elevation (typical) Airtight Seal Finished Grade 1 Quick Disconnect 1 18" Min. CAPACITIES @ gal/in , (typical) Depth (in) Volume (gal) A Z5. C _26_'x, 00 * T Weep Approved Joints with Hole Approved Pipe 3 ft onto B 2.0 A Solid Ground (typical) 10 5, D <,3,:5-. IL / -Alarm 910 131 'r 00 B -On I} [C] PUMP-OFF Pump Pump Tank Liquid Level = 1'7,C© in _Oft _-a-ELEVATION= qz-.(,,7 ft T- ( Force Main Diameter = in ° _Ble INSIDE BOTTOM ELEVATION= Z , ft Force Main Length ft 3"Approved Bedding Material Beneath Tank . Force Main Void Volume= 1 2,. Z_2.' gal r too 4"T [C] Total Dose Volume TDV = 8 00 gal/dose 0.2X design flow + force main void volume) ~1 LT'+ ~l -t )2. idy.~ Vertical Lift = d ft IC,rO 75/)(./31 rZ_ow6AV< PUMP TANK: Ca. 5 SEPTIC TANK(S): Volume = 050 gal Total Volume 0 Ge gal Manufacturer. lx%1E Manufacturer(s): Pump Manufacturer: C-.-Ct.Lt_b Install approved effluent filter at the septic tank outlet Pump Model: M •31 immediately uPstream of the pump tank inlet. (See attached pump curve.) Controls/Alarm Manufacturer. S3E R}Io,IvIFAAS Filter Manufacturer. PeLyCA/< Controls/Alarm Model: ;A6 A Filter Model: X25 Float switches containing mercury are prohibited. PAGE-910FA' In-ground Dosed-Gravity Management Plan IMPORTANT: The owner of this in-ground dosed-gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = gpd; BODS 220 mgL-'; TSS 150 mgL-1; FOG 30 mgL" Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (i.e., pump re-cycling, float switch settings, etc.) o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: T0{M..4-_S Phone: Local government unit: _ ST CR.OI.. CO" 1/ Phone: -715--356 - ~SU Local government unit address: t`'DltY1.TnOasE {4f,(1J~ ZIP: Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in-ground dispersal component may be abandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. Wastewater METERS FEET 1- .7771 PE31, PE41, PE51' _l H , P:.33 .40-50 y 10- LL_- - - - - -1► 2 GPM I - 30 PE41.- r x ^ 1 Fr w 3 PE31 q - P - - x 25, t ~ s - r z 20 i L- L- L -Y---.- -r - 8 la- 15 0 _ :---I 7 10 r { - 5 r s t a 4 i { 0 0 10 20 30 40 5~0 60 ~0 GPM 80 0 5 10 15 m3/h CAPACITY PERFORMANCE RATINGS PE31 PE41 PES1 Total Head Total Head (feet of water) GPM GPM Total Head (feet of water) (feet of water) GPM 5 52 8 61 10 67 10 42 10 57 15 59 15 29 15 46 20 50 20 16 20 33 25 39 25 0 25 16 30 26 35 8 I si ® Filters PL 5 EFFLUENT FILTER Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters.The PL-525 is rated for over 10,000 GPD Alarm (gallons per day) making it one of ability Accepts PVC the largest commercial filters in its wdension handle class. It has 525 linear feet of 1/16' filtration slots. Like the Polylok PL-122, the new Polylok PL-525 has an automatic shut off ball installed US linear feet with every filter. When the filter is of 111r removed for cleaning, the ball will filtration slots Rated for over float up and temporarily shut off IOAOO GPD the system so the effluent won't K leave the tank. No other filter on the market can make that claim! Accepts 4- & 6~ SCHD. 40 Pipe , 'L--525 Maintenance: The PL-525 Effluent Filter should operate efficiently for several years under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or at least every three years. If the installed filter contains an optional alarm, the owner will be notified' by an alarm when the filter needs servicing. Servicing should be ' Gas deflector done by a certified septic tank s ♦ Automatic shut-off pumper or installer. , ball when filter 1. Locate the outlet of the U.S. Patent No# 6,015,488 is removed septic tank. 5,871,640 2. Remove tank cover and pump tank if necessary. PL-525 Installation: 1. Locate the outlet of the 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and com- 2. Remove the tank cover and 4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the tank. Make sure all solids fall 4" or 6" outlet pipe. If the back into septic tank. filter is not centered under the access opening use a Polylok 6. Insert the filter cartridge balk Extend & Lok or piece of pipe into the housing making sure to center filter. the filter is properly aligned and 4. Insert the PL-525 filter into completely inserted. its housing. 7. Replace septic tank cover. 5. Replace the septic tank cover. 3N3'61dOUIDd- WRRIV M 9MM -'ONIWd 3JOQ W3 M III WMd )1OUIOd a o _ riu ZOEI jl~ 4 i Cil WL 9r1t3a0 OUHHWWTn roD SLd3~0t313M:1OS -85B- nD --t _ r S1073MIAO CS- HOI IM33MWHWA Hot OF - OIHX.;&dMK3- Ent T 1. ~t Ho1MS1Yffund 131m1~OS- NOW TV8S'9 3N'31tdQW7dd - OWf qN - -WRMYN SZS•ZtWC-'ONIWd JNHH5f10HalluSZS•ld Kit ao'a Ol9 aHOsiloO 184 - 516370(30MHM13M sit NOHH31)Cj13MH6i SCYI aoH6asld3al3 - XaOTN9A19--. U3171:1 1N nU-43 5Z5-7d suoipoil pads jeowy~al 54j" AS 84 REQD m K 43" D Z z m c D C C) p I o I III II ~ If D m I U) I. 0 3" I 46j" I 5., I) ~ y I CC) I ;o I II > I II m 38° ~I mo \ iI. W I II al If m I < C I I II II: N I i II II' a ~ r m r. L-- I I iI. III- _ T- IT! C 41 " -Z+ n D m D o N I D 1 N m D r > J0 z~ z ° c Fri fn Fri m D s m n z p D o -s6 > 0ou A>oo> Z5 ~ OT- X- ~m z O D O-~NZ D 'z orp-z1 rO nN mp mn m m D r=*IOp mD0 rp*.2-CIO 0rN O c0 (AN -per n ~ZC -4 ~C 1<*irZOD Ll V) c -ly Zo om cn z `"i?m C)ym :Ar~*►mA M O r- x :kz Ln=j v CID ~N >En I or~O~~? mac) ~rn mm -I Cy) „irn ~N- 0-5 D o O cn m y m o w p p I Oo W a. TI Z Z O U9 In a 0" (n p' r s a p 0 0 (J1 o v n v 580 z m Z Dc~ m-mim m~ o v~ D O c: U) °c o --a n n~ n D rr of=> rp m I LA r- ° T1 zz ~ z z Z D~k 00 W 0 D O m H D Dv C y IOC O~ -N1 z m ~ m 70 Z 0 r- r c m O m C) M m< p FFI m-u M OUC Z D V) co D C) N z O .ni m r V) m ;u r O m X C m 000 00 r D F~-I Z N r~ m v \ <n WLP1000/650-MR S fDATE: WN BY: WCP SCALE: 1/4"-l'-O" PRE-POUR: m MIEBER oeillETE REV. m SEPTIC MANUAL W3716 US HWY 10 MAIDEN ROCK, WI 54750 00 00 00 DATE: POST-POUR: 800-325-8456 : IMPi000/&%-AIR ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT .'AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Lo -~)i. Property Address' (Verification required from Planning & Zoning Depa - nt for new construction,) CitylState Parcel Identification plumber 4,~11-)'1~~~ e4aD LEGAL DESCRUTION Property Locations lu Sec. T N R,r' 2; Town of T I iyr' Subdivision , Lot -Y Ceirtlf>led Survey Map # , Volume , Page # Warranty Deed # Volume Page # Spec house yes no Lot lines identifiable Va ito SYS'I`EM 1 A IYT)ENANCE AIM OWNER OERLMQATION ~ Improper use and maintenance of your septic systen7 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. Owner maintenance responsibilities are specified in §Comrn. 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 certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper 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 Rill of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards ict forth, herein, 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 Planning & Zoning D --part-meat witYn 30 days of the t'hme year erpira ion date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of numty deed recorded in Register of Deeds Office- Number q' r mns c 1! 1 SI OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey nutp if reference is made in the warranty deed. (REV. 08/05) Wisconsin Department of Safety and Pr iDEJ sED CST o i 4 - (>3 Y ilk iff it, Division of Industry Services , - JUN O 2 J IL EVALUATION REPO I ? Page I of 3 in a~ n"TYS 383, Wis. Adm. Code S-(, ,;r~Vtl~~~~ [~pMEM. County ST. CROIX Attach complete site plan on pap¢¢~~ WA 8q9~°~t'r1'i~ldfies m size. Plan must include, but not limited to: vertical`s o~%ntal reference point (BM), direction and Parcel I.D. 040 - 1126 - 30 - 000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Re y , Date Personal information you provide may be used for secondary purposes (Privacy Law. s. 15.04 (1) (m)). ✓ 3 r I W Property Owner Property Location DWIGHT E. & MARY JO NELSON Govt. Lot SW 1/4 SE 1/4 S 33 T 28 N R 19 E❑(or) W Property Owner's Mailing Address Lot # Block # Subd. ;Naame:or CSM# 548 Old C.T.H. M city State Zip Code Phone Number ity Village own rest Road River Falls, WI 54022 ( ) -0- Glendale rive New Construction UseE] Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Q Replacement Public or commercial - Describe: Parent material loess over till Flood Plain elevation if applicable N ft. General comments and recommendations: Conventional in-ground trenches 0.5 loading rate Property address: trGe~n riv Boring # Boring Pit Ground surface elev. 98.95 ft. Depth to limiting factor 80 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 1 0-20 7.5YR4.5/1 sil 2f-mabk mfr cs 2vf-m 0.6 0.8 2 20-35 7.5YR4/4 sil 3fabk mfr cs lvf-m 0.6 0.8 3 35-46 7.5YR3/4 sl l fsbk mvfr cs l of-m 0.4 0.7 4 46-80 7.5YR4/6 s Os nil 0.7 1.6 hA/ 2 ] Boring # ❑ ❑ Boring 102.65 60 • Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-20 7.5YR2.5/1 I 2f-msbk mvfr cs 2vf-m 0.6 0.8 2 20-28 7.5YR3/3 sil 2fabk mfr cs lvf-m 0.6 0.8 3 28-43 7.5YR3/4 sl 2f-msbk mvfr cs lvf-m 0.6 1.0 4 43-60 7.5YR4/6 s Osg nil 0.7 1.6 Effluent #1 = BOD > 30:< 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number MARY JO HUPPERT Hollister's Soil Testing&Design) 224832 Address Da Evaluation Con ted Telephone Number 28497 King Arthur's Court, Danbury, WI 54830 04 - 14 & 21 - 2016 715-426-1775 SBD-8330 (R07 13) Property Owner NELSON. Dwight E. & Mary Jo Parcel ID # 040 - 1126 - 30 - 000 Page 2 of 3 F11 Boring # Boring Pit Ground surface elev. 102.00 ft. Depth to limiting factor 76 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftl in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-20 7.5YR2.5/ 1 1 2f-msbk mvfr cs 3vf-co 0.6 0.8 2 20-27 7.5YR4/4 sil 2fabk mfr CS 2vf-co 0.6 0.8 3 27-45 7.5YR3/4 sl 2fsbk mvfr cs lvf-m 0.6 1.0 4 45-70 7.5YR4/6 s Osg ml cs Ivf-f 0.7 1.6 5 70-76 7.5YR4/6 s Osg MI 0.7 1.6 orizon 5 has some I OYR-3/4 bands of sl. ❑4 Boring # Boring 98.75 ■ H in. Pit Ground surface elev, ft. Depth to limiting factor 69 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -Eff#2 1 0-24 7.5YR2.5/1 1 2f-msbk mvfr - 0.6 0.8 2 24-28 7 3 3 sil 2fabk mfr 0.6 0.8 3 28-39 7.5YR4/4 sl 2fsbk mvfr 0.6 1.0 4 39-69 7.5YR4/6 s Osg ml 0.7 1.6 c~ Boring ❑ Boring # Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -Eff#2 ` Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L SBD-83 ±0 tR07 13) 1 Plot Plea Page 3of,- Owner '~r'+a~erly IJW t zt+fi x Io llJ&l-.Sant Legollksarotwn sWY D>= T T (fit Wk" not4 SE,~ 33~TZ~S1J~ R 19vJ-MWA) Dr 'i-RAS~ .5`r. C'RD1X t - a = 8O lAp CDRIJT , Wl5f M5)A~, 32S~C~~S ~1Zb-' wed North 1 S &L&&ALE bR- CQ ~ 17B1 . lD2Aa, CYINE 'fK-E'~~ T5 f ZOO -3 00 sm-*i=5aMVA& W Z~•cv ~5p5*-bgsl V~ ABOVE C RouN b ~D 1'57 100.00 l 3 ~B~~tZ =TOP OF WIMIWw SILL (3EDROot- 14ti GRau~D .q5' Abli 8 ~i8.'rs ti~J Q4 Q Site ton: CTH• C CFr9~"i^ ' O N p YA? x n . v ~r =m Qlm ro ti ~Al t , ilk MIN @~ ra i _ ~ ~~Arv Y5x ~c a e O V Or CERNOHOUS, DAVID E MORROW, MORROW, MORROW, TIMOTHY P 50 GL DALE DR TIMOTHY P TIMOTHY P & CHERYLA V" 040112490000 1yf+u112440000 0 040112450000 04011281000 SWEDISH MISSION RD. CLAY, AARON & SHELLY JO 040131403050 -SW NW-SE NE-SE MORROW, NELSON, DWIGHT TIMOTHY P E & MARY JO .`040112590000 d04W12 ER, 040112580000 4 RJ 0000 LENDALE DR FEYE ISEN, GR GORY J & *32 ENDALE DR C RYL A ( RS) 040 1404 00 26 GLENDAL ILLS D-CHT E, !AR* jE) ff 0401121i91000 n pp M U HOLLAM, CHAD a I1J UA NELSON, DWIGHT & PAULA B (I E & MARY JO 40131403010 k 040112630000 NE OPI, DWIGHT E a ARY JO n _ SW 40112660CJO -,W - SE 5 X18 LENDALE DqE - SE~~ ~A SERENI WS 1~6e •548 OLD CSM VOL 7 PG 2099 AeG ----H-0 O ERS LOT, NELSON, DWIGHT T2 ION INC, s~JO~ HIGHWAY M E & MARY JO ~ r r F7 040112670000 04999 542 OLD - w_ OLD >t H I G -Ni4QIHWAY M 530 CTY C uNTY PIE D PT, c~LO<3p0 8p~ RD M X561 60 LL-,' FiE [L.t O LNTY 04 1 7010 TILL, JENNIFER HI M HWY EHILLTO L & DAVID R Ld& 040112 0100 E COUNTY PARTNERSHI L '040112640000 HWY DEPT 04 11.~5 . . _._.__M M & LORI ANN 040112680000