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040-1254-20-000
PRIVATE SEWAGE SYSTEM County: St. Croix Wisconsin Department of Commerce Safety and Building Division Sanitary Permit No: INSPECTION REPORT 592125 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 Township Parcel Tax No: Justin & Sara Wurzer TOWN OF TROY 040-1254-20-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: -tyanNirow 19.28.19.1343 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER 9, fv66 CAPACITY STATION BS HI FS ELEV. + Septic in / ' Benchmark l 0q. 100 Dosing fWAP: Alt. BM Aw2tien Bldg. Sewer H !)Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/ WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic /r. II A' ' 4 Dt Bottom , T8! Do r L- T (V ~2 1 ea /Man. $ a MJ& Aeration Dist. Pipe Holdi ~t - Bot. System L Final Grade PUMP/SIPHON INFORMATION 71 1 Manufacturer Demand St Cover O ri 2 GPM • V J Model Number 1~J A l I I TDH Lit Friction Lost, 3 System Head__ TDHq•^ Ft A, Forcemain Len ) Dia.21( Dist. to Well 'v SOIL ABSORPTION SYSTEM BED/TRENCH Width fj,Le 7h~ No. Of Trenches PIT DIMENSIONS No. Inside Dia.~ Liquid Dep DIMENSIONS D I---- / SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR T e Of System: t Gnqi / UNIT Model Number: )A1 I DI T IBUTION SYS\~1ITEM der/ anifold N Distribution x ole Size x Hole Spacing Air Intake Pipe(s) Length Din Length Dia Spacing , 9-4, SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Dept r Depth Over ^ _TT Depth of xx Seeded/So xx Mulched Bed enc Center Bed/Trench Edges / t 1 psoil Yes ❑ No ~ L CO ENTS: Include code dis repencies, persons prgsent, etc.) Inspection #1: Inspection #2: ')P W ell nw IMANV 1 @ nsyecfi a'\,- Hex 6( Location: 2g2 ST ANDREWS D~RY~1 1.) Alt BM Description = ~)L~ cL C6"- 2.) Bldg sewer length = ,t1 C - amount of cover = V J 7 UIt lYT C m t CN Plan revision Required? ❑ Yes ,No D I w)'J Use other side for additional information. 1~J Cert. N _ Signature Cert. No. I Date SBD-6710 (R.3/97) SON Q04 f~,d = SEP 2 12016 i t,, ~ Sr. Crca.x ~C:% Ac- Sams arv PeTi3,i i~t UI110er (io Jz! i;fled 3I1 Co--, i wiac3 c- 5('7 +J f ST. CROIX COUNTY % ✓ / (r r c)MMUNL_TY DEVELOPMENT 0/( OJ t ] ilt 7~_i:Gl68rR:~ ii:!.~: \ _i,_ 1~. 1. t 1. _.U~. ~t@P ..:S,C:.. ~ ..L... l: _ 7XV 6 ~ f7 'CtIN1! ^.(CtbC• 11 , i Obi.: i I. _ T73 _ .YOii 3D1- .3Ci3i i0uR5 10 i CO\`.i000{_CCi~_ i'• litirl:d .1.°• i83•.lli=v00; _jS! J2 r.1~;3C Of Jv..'.lf O! nLP 0 z 530"1:31 $i:R'ECdS n OI u.:!)`OiiT18i.0.. - : CC!,°;'r!r= L ..t '1CC' R:?ii7 lilt ~,t -,.G. ? 3 i t411i) C!2L. G pl?c•1 a n;o-fz?ar?on ilea=e , ini t 02/r!E 1! i;GF _ 1 vOR u S - QI Q 1 _ odC) W ~q. X02 COW 'iC i ri tOu~ 1 rhGil^y::4Fii?.: 40 tf~ if ao 74-74- 8 a Pow - 7 7 x- ht:C^ _ _ ^l3L~ mac.. ,.a _:C,tQiiY _ . ~DlF~.:.,,Lai tj tl J :it_ =•tC\3'.iFLCii11C ii': =.liji:; _ :iCli: L.ii A all 64.1..: _ l:i-.'. (..7 ~1~ -C (:.•.1!C?i•. ,,.5~.,.i.~c^ ._ti - _i _._._'Lt l~ r~F! ~ , _ !i f i?~cSt C4tl :ipnllCz -3: S'', i DI: uiir 5.;C2 .CC:{:i1i Ji: "i! S~f.~.ti! 't,-C~ ~:•5uOS2^_ r o._ /o7,z //oa 95 y _ A90,5- .6-0A) 6A.Arl- Siilil Ec •.`.:ai:)iG F__?t- iitC UIIL"~:'S:~IILG .^.5 :??itC- 57011 ~t!};:;'~ _ "I't>e'-di urin 0i "he i~01A;'_ 5 shuv.u OlI ~°~Y.J _~~c'~ _ 02.3/3YG 7/S 67fl?-S.7d1 - / 1 -r- e-! Y v ~ LeJ J'B• r ~~s'rG (-li..L- i - f~ to - nz- n 1 ,Sbppr• tank, a fllxnt rdte* ~~nd ispemw cell must all be spiv es! rnainWnes m pw management plan provided by plumber. requirements mus t e malWiried M per #pp1=W code / ordinanm. V ~X 7 ~ r n i 14 0 s ; u v4 M l v `z ~ Z r k w L V ~ i ~ I ~'51 V „ ~y ! k 14, hQ Q }~V ~ ~ I ~ of { c0M, z l 10 - zo~ 0_ O_qC:I.7 7 7 -1 7 7 •l Q 1X V) ti w o ,^t n @ 30 i ` L I~j j Vt m Z ` h v kli INS S 2 k C' a, 1 w I~ v I N1 - - - 1 { ~ ~ Ira o H a Z ~r q 1 r I~ U N W "ti v a v o 0~ ~ v I o M \ ~ o 141) (4i ao 1 w 14, C C a VIIII G t'iD. -tomKA! • QS 4Cound sur aCw a'viaf mm, > nsr 3 33 na 3U!L vilI!G S'EVVER f' f per 'S !=-,S 89-30 (11)1) zLm-pd Lac~*;rla =Li,'~1Ciit - .?th L,,anfnr ae[c 'UN SCI's C0 I a:YfLG L j f'i r3 \l• i ~~i l±~~ ~LL 3 . - ~ Iii ~ q MANHOLE :.j _ 1 ~ !--'r _ : rf.l> /i~i~/ ,i/,f..~ Jfi/r~j ,~i~; ~!/ll Vii, ; : l /~F S I" /1!/dI/f%lj~fitiiffff~/lrfi% f M&Z-,, ri 3 Z, /0 7i; TERED flRIJEMPE _n_ 73u ~C17 -'l f±~Lll. yt Y -__{.3tfiti.-... - REQUIPSC Oil, OUTLET 0 l ~iL _ Qn/L R ~ if ',•}ltti 'daily- was!ewa ° {~G ✓ a I~:;[';"1beroi Q8i(~7..-JOsas eCillai dose vclu lB,l ,!air m mtani!iCCiurOr S.T. 4t NOS ~rsS_ iai ; ~lO4e' i,Um?°; TANJ< .4LZ'-,- i t Jrse' l i ?L;41= /Y 7 _ 9d X .IG 3 i 7~Bi V" itch N/-,AZ ~iu.;a dose ilciume /.s'S, 3 =f~iel dose `Joiume - voiumie o i-OFCwmai -`41;2 ?i UUtT,! itrrlU GP IM Zr? G-:- 1" DUMP pump mUQa; 1UMbe /S/ it71, ?ol CAP '1 C1! a`E~ra 8{30\ 2{ctr c>? { lC!1c5 = SSDgallons J! nlcEiia iloai above on ioai nZ ilCitcH = JO i;allG 1S t~ i f(liftltlrl ~u!Ti0 j1SCilSFc iBTc ("J, WO Gn1G oazmeasL.sna-: i Moizas - !Sd c5ei[01 ;a) li Oi tiGwl l?!'ttf lily OF IDISiflsUilGiS 6aBF2i` 7 u iii `IOPt 0'ra i2ii: JGIIOs i c ?1Ct,8v = ,1G6a!i0{;s I ~zvs;em `reaVdisiaOreSSure _,D i28iJ DIMENSION'S ~o S, ocr,, ANA; DIMEN'S . ni11.},o CM.,IBt„ ICfi RUNS . 7 n nc a., 1 78; OiiS }Ci inch S, Q TOTAL DYNAi HC HEAD: F' 01"d `'J/ PILIMP PERFORMANCE CURVE PER MINUTE MODEL 151,11521153 EFFLUENT AND DEWATERING MODEL 151 1 152 53 ar, - 632 tlrr- a ~t r4eter Gat _ ` i 89 l F9 29- 50 231 _ 70 ~ m c - - 6! 2`1 4 6 6r - ...._._;_y I 52 u P 2' . 5' 1 t 0 6. e - 29 '29 _12 i 2g ? ~ 16 n5 3d ~ 'ii 1~ -i 1 tG _ 5 35 ' 40 Z._ l 12.2 - i _Ti-11 :938 ftl1 tem) 54 n.(114m, Model 151 Models 152 ~ 15 r S. ~ J~ t t~ o r t Imed dosing panels available. Electrical alternators.. for duplex systems, are available and supplied with an alarm. Vgriable level control switches are available for controlling single phase systems. Double piggyback variable level float switches are available for variable level long and short cycle controls. Seared Owik-Box available for outdoor installations. See ' 1 '14120. 0.er ~,r1 r 7. ~ . - t 1 ^'Sl?'i i ca SK-1064 151,1152153 MODELS Control Selection Model Volts-Ph Mode Amps Simplex Duplex 151 115 No,i 0.0 2 or 3 ` .151 ? a u;c 5.0 Included 20,3 su 1 Nor 2 2 or 3 ~,..5i zsu 1 Auto 3.2 mcuded_ 2or3 ~ , Easy assembly" 4 152 ` 15 Non a.5 1 or 3 A Icr mn a disrr.aroe pipe 52 ' 1 Aura 8.5 fir,iuded ' 1 an;idea.; E 52 230 1 Nor 4.3 2 or I - 13 n luded t or a FEE 52 230 1 Auto 3 Ott l: 1 ;3 tic i vot 0 2 of ' N 53 11, 1 u c rriclur!ed 2 or 3 Try 17,3 2:30 1 N or 3 6E .53 230 Auto _ 1..... . 2_r3 Single piggyback -variable level float switch or double piggyback variable level Reduces potential clogging by debris. j stoat sarttch. P.efer to FN10477 Replaces rocks or bricks under the pump. See _M0712 for correct model of Electrical Alternator E -Pak. Made of durable, noncorrosive ABS. drdable level control switch 10-0743 used as a control activator, specify duple: Raises pump 2" off bottom of basin. Dr '4-! float svstem. Provides the ability to raise intake by adding sections of 1112' or 2" PVC piping. kNil w_caurioAttaches securely to pump. Accommodates sump. dewatering and effluent applications. NOTE: Make sure float is free from obstruction. Or unusual colidlti0!is a re'se, rve Sa-ct; hero! Is engineered i!i1 , Ct siiljrl of t v` v Zj-iiil pU111j. rights re~erved- r,q n 2008, = ueller Co- W! 1,, Ccmy ~;n IA ~i L v i id;`ORTI~t ATSC}1'vv S;STEI?I'SPEGtFiGAT!QN,5 CDvviner j Tank l:4anuaciurer: LrJlESEft C c>n~GeEtE r et 2k _ crmil Cea;iC "i,osE Holding `i0!U:i14. - t Tank ~itanu,ac{~!rer: ~✓/ESE'2 ~o~+GRCrE ❑ IS.A `Si; t PA..AMETERS i I~lUmber of ScdrdClT'S: l! I`ti: A L! `septic PC' Dose Ho!ding boiuna: 9,j U~ (C I, Numb--F cif, '~f]blic FnCill?\! .lnF.S: NA t ; ~`pit4Cc! ltct?nCC T2n;: Bp. pn.,(Sl td C-eriiCe Pct: /a? 1 Hcr;Zontal Distance Tank(s;; io SennGe ?ac: //O if ? `=siimated (average) Flog:.` : 'gyp s ~tda,} s st 0c provide.. - MICal f D .2c ' CparliiG 5$^`lGitIQ 1-,tech a n CS mu i _ Qal,^Y. r n i i' >1 ` ~iD 5 Vi~ > 0 Q= 7 ;u11d'a}9,_ j Efiluent Flier jVianuiacturer: A. !n Sib-, SC11 11D11Cyildn Rate: !e1 ~S r~ andarG (CJCm~5i1C1 fnilu8ni~~riU::nt Wtorithiy averaa° is+tl~t)2l: ~ - j 1 ~Lmr) i'aanuf-curer: L 0 Lze 4 at- Oil c`= CrcaSU (FOG) <3vl Inc" oic ne l'CcD,-i-?n Dcrnand (SOD;) _2( and L hi,y Dial su,~5i),_-ndt;d ^Iids ss~j _ SQL rn7 .;L . iiq*1 J'!'t'n0ih lnifuc^ni/Eilu2iti - i?rldii[ll" -v =r ^g@ Yr2rre2.t.7fScr:t t}r!t _ cLr. vp _ .,r- .y ,8tlul cC UreE 1BOD i GU f aiL iVr. 4 i,aeCt=n,Cai Aeration L -1 Pe t Fsi?=s f . SS, >150 :mL ! S - :;•reaa - fist rectt Freireated Effluent i'Iio,-Ahl,.1 :average .Stand/Gravel Filter -Other: iµvOs) 30 ma/L ! Soil -=bso,ption S',ist°m f gcl <3C, m /L 2£ 1 ln-3rounc igr-rt;'j r'• in-Groun? fpressure} „ . =ec'of ioliform ioFQme±ric mean] 00---- i -f ~~,_G<zd- ❑ ound a..?r7iUt1: Ei'zlUen[ , ~r'tiCic SiZa~ miner' 0 tier. ;~A { Other ~Z FLa~✓ /~6~7ir~ eau a v«s ❑ . - - - AV%.I TENANCE SCHEDU_c Service Event i sea-viGe Frequency -E a?hen combined sludge and scum equals one-third o tank vgiumi ?amg out contents p tank(,; _ tiihe;, the ;tan ter alts r is GGUvatei 1' i 1 n 5, (lSiarimtSm .5 years) i nsPect condW Cf iar:K(s) !ea5i. Once every: j J Je3r(..) t i - - - ❑ mdntn(j (Maximum, 3 years) 'O° ! n nam dSper521 Cell S) AIL leas' omGs tver y: Dea l aff-'uem Ifltcr A;, .a7s, o . e .t. ~ CGr!5l inspect Dur o, 6L'rno conirais r ajam) _I i?c=_t once fBcr'ol Flush iarera(s aria urc55Ure test f-o iea_~t once eveiv: Jih°r: rit icast once ever]): - :!5) ilt! i ENANC i!L1S I RUC t IONS BCiiutls of °ant S and sGii 2DS`ai~ii0i', S;S--a s si a!i be mars 8% indi,,Adufl! -ariNT-, One ^ diawinp lfc't srz- ^r sera _ G- c. 4 r~r^1.,1i r1s ect I rovv 5 miatmainer or Sewage SerLi in C --+uc O (ou- .i-^Star. "!Umbe,, itiiastnr P;,umber Pes ic-te p crk inSnecTions must 1nciu Qe a visual insDedion of t•le .cnl rs) to idem an; m' ssina or broken hardware, ide rlt ant. cC o„' ...~U 'hd ',loiuTic of Gomibin5d siUdg 8 o zcU+' ant a C!. f - -nor a3nv back uo Jr pOnvlml rm Filue- l op. -Lhe orou ; cL _ 1'' V tsoro?ion s`isiem shall be visually; inspected io Ched, the eilluen !eV.:t., in the aC,58r`JaClan plpZS and to Ci1@CF: fdr any ,r,, in e around Suri2ce. The pondinq di effluent on. the ground surface rncl indiCaia 2 iclllnp Cai OltlGn and, iulr iG iorl Ui the lanai reguiatoFv c f O 1`- - r_' more lien ne combined accumulation of Sludge and scum in an,/ Ireatment tank equals on; -third i.';.,l or mpre of the Vii:; Ot)-m4 r ipurno ant QIsooSed of in Fccordance eri .._:.:_..i> p? ,.,G ;ank h21( be remove. by _ jcptage entiC!ntJ. . iSConsin t~dmini5ir ive Code. jl o-,h=r services, including but not limited tp the serviGina of ei;iu=nt ~.it~rs, mechanical or pressurized components, pretreatment units, n Coi'liiet Dr,DV%ITS Ivlairo.aine- - ri ,nr !i?.ePJ:;[S 4' 12 mCrths -.,all 1Jc p°1."iom'.-- b, nor new construction, prior Eo use of the P0V TS check treatment tank(s) for the presence of painting products, solvents or om chemicals or sediment that may impede the treatment process anti/or damage-the soil absorption system. If high concentrations are :Jeteced have the contents of the tank(s),removed ',by c Sep age Servicinu Operamr't,iJumper) prior io use. P L'tni) tanks ma-,, till above normal highvfater levels orior to startup or due to pump failures. Stari up or restoration of power under ihes: conditions is not recommended. as the excess wastewater `."'fill b&discharged io the =nil absorption, system in one large dose causing are OJerlOad that may result in the backup or surface discharge- of effluerit and damage to the system. TO avoid this situation hat? contents of the pump tank removed by a Sepiage Servicing Operator (pumper) prior to restoring po+rfer to the pump or contact a ?lurn0er or POW T S Maintainer to assi5i in manually operating the pump consols until normal a luent levels are, r?SiOr?C 'Alltrlin Me puma Svsterri staff up shall not occur when soil conditions are iroZen at the inilitrative surface. Do not drive or park vehicles over tanks or the soil absorption: sys-iem. Do not drive on, iiFrk over oiher.' ise dimiu'r„ ^r cOmoF= [ area w~,hin 5 feat down. Slope of any imounq or cl grade soil absorption area. :.yciucUon or elimination of the following from the .vas;awater stream may improve the performance and prolong the life of the ireaimen-, . : S and soil absorpiion system: acidsi antibiorics. baby wipes, cicaretie butts, condoms, coiion swabs, degreasers, denial diapers, disinfectants, fats, foundation drain !sump pump) discharge, 7, uii and vegetable peelings, gasoline, greases, herbicides, _r^os, medications, oils, painting prod+uctts, pesticides; sanitary napkins, solvents, tampons; and'JJater softener brine discharge. `JNI JO'\!ri FN! T the POW TS fails and/or is permanently taken out of service the following steps shall be taker to insure that the sysiem is prep r -~ei'sly abandoned in compliance with s. SPa`383.33, Wisconsin Administrative Code: ii iptng to tanks, pits and other SOit 3b50 iJtion systems shall be disconnected and the abandoned pipe openings seai&t. The contents of all tanks and pits shall be r eT+gved and pi p}7ci+j' tiisposi-d of by a SeDtage Servicing Operator {pumper;;. After pumping, all tanks and pits Shad be excavated and removed or their covers removed and the void space -filled :viih SCi!, gravei or another inert solid material. Ei ICY PLAN . tides`",QVVTS faits and cannot be repaired ine following measures have been, or must be taker:, to provide a code comoli2n . epiacemen`: system- A suitable replacement area has been evaluated and may be uliliZed for the location o7 a repiacement soil absorption svsiealm. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required etbacl:S tom existing and J. ropeseL 5tructure, iot lines and vial Is. Failu. _ to proiect the 'placement area .vili result :n the nac- c 'Or a new soil a;'id site evaluation to establish 2 suitable replacement area. Replacement system pis must compiy with ehe rules : . ; c-ct at ire time of their permit issuance. Sul`labli reoiaCeniBni area 1s not a'JaiiaGic due io _eiback and/of SDli {imrtaiiOnS. ff 'he soil absorpi rehabilitated and barring advances in POV4 T S technoiogy, a holding tank may be installed as a last resort. he site has not been evaluated to idenff i a suitable replacement area. UCon failure of the POW T S a soil and Site `i'usi be cer;ormed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as last resort to replace the failed POINTS. i~OiJnd and a--grade soil absorption systems may be reconstnjcted in place !olimAJnC .:v:2: -a sur Lace. Reconstructions of such systems must comply with the rules in of ec"t at that time. ~r~ilitlG TREAiMi ,°-N TANKS. PUMP TANKS. AND `OLLtti\IC iFiNKS rtiiA`( CrJi\i,TAIr~ ..ASS; ..s.. -3i SUFFICIENT OXYGEN TO SUSTAIN LIFE. i\IEVEP ENTER AIdY TANK IJNiDErI ~'IRCUCLiiST;Ai,!C=. P.ESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A T Ai\l il+1AY NOT u:E POSSIBLE. ADDITIONIAL INSTRUCTION& 'O` 07S INISTr,'L ER pot;+„y iii 4II i i =4!U=I?~/ Name dNJ EZ1CE 312Yt~ i Name 11-5° G 7,7 - S~c:L ~.7,2 -.;.ziIG hone SEPTAGH SERViCii\iG OPERATOR {PUMPERI ° +`sa 0 3e; LOCAL REGULATORY AUTHDRITY Name Name _jj. LIt'IX Zo.."" Gff/CE _ Phone ( Phone ~jJr ,3~~ YGcP~ e _ c CL - L c V QI G"~ ° n F 9 :v s ra' fk- G c J u '_l call - emi ~ a = o > ;u - - .2 2 vt fl'~ ~ u V ~ N :J L Q V° V L r- J ~ Vf S~ a m u c: - - - ° _ u o o a x _ _ a ° ~ a ev ~ - ~ rv RECEIVE ST. CROIX COUNTY SU g 2~~6 SEPTIC TANK MAINTENANCE AGREEMENT c0UN't`~ AND ST. CRp1p~ppMENT OWNERSHIP CERTIFICATION FORM J~MMUNIN Owner/Buyer ` jlusz~ Mailing Address (7 ~ I F ~ ~f{~ ~U~ f✓~~ -174' Property Address (Verification required from Planning & Zoning Department for new constru tio& City/State Uf Sal fJv Parcel Identification Number _ LEGAL DESCRIPTION Property Location '/4 , Sec. , T N R j l W, Town of Subdivision L c4 _C ( T o ~-j t ir1#{ C } h - ,Lot # Certified Survey Map # Volume , Page # Warranty Deed # , Volume Spec house yes no Lot lines identifiable yes 110 SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §C.omm. 83.52(l) 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 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set 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 Department within 30 days of the three year expiration date. I/we certify that all statements on this SQ~m are true to the best of my/our knowledge. Uwe am/arc the owner(s) of the property described above, by virtue of a w71ty deed recorded in Register of Deeds Office. Numb!g"fbedrooms L SIGN A4tkE OF APPLICANT(S) DATE *~*~atymforrnation 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 map if reference is made in the warranty deed. 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