HomeMy WebLinkAbout036-1081-60-410
Weconsln Depanrrlent of Corcmes' PRIVATE SEWAGE SYSTEM I"dO°t' SI. C.fOIX
Haler, a1c Bu ding D,mslun
INSPECTION REPORT SalA fy Pe•ma No
GENERAL INFORMATION (A-TACH `C 'ERMI t) 597363
Sole Plan I: Nc
Pmstuu n'Crmahon you P*101 may be usee in' - a 'dart Cannnxet Il'nmsa I au' v 15. lu r t I m1I
Fermi Hddees Name C. TV Vll'.aun T:w^S"Ip °ardo lax No
GARY COOK TOWN OF STANTON 036-1081-60-410
CST RM Elev Insp SM hex' RM Desmpton
i Sect orv I ewn'lianga•Map No
_ 32.31.17.501 E-04
A l.lr- ~ n.. . i
TANK INFORMATION ELEVATION DATA
TYPE MANUFAC TURLR CAPACITY STATION BS HI FS F-FV
Septic lt; 1 r{,I r.~ t r'' 1`~ . Rencnman , j
BldgSewer
7Holdinq Ali BM
7 ,;VHI Inlet
TANK SETBACK INFORMATION
TANK TO PIL WELL BLDG Vent it A1. Intake ROAD Dl Inlet
~ r r
Sephc_ f _1 Dt Bottom
ILI i
Dosng Header/Man /
ABratrue Dist Prue _ J
HDOing - - Rol. System ) `
'I v 7, . i / x
PUMP/SIPHON INFORMATION Final Grade f
Manufacturer Dernanc S Cover -
GIPM
Model Number
TDH Ldt Ericson Lass System Head TDH R
For=main Length DO Dnt I1%Veil
SOIL ABSORPTION SYSTEM
DED(TRCNCH Wdlt _ I mote No O' Oonches PIT DIMENSIONS NC Of Pas Irwe Da _qop Ueuth
DIMENSIONS
SETBACK SYSTEM TO PIL f: r BLDG VJEtt IAKF;STRFAM LEACHING Nanu'aaww
INFORMATION
Type Cy Srylem CHAMBFR OR
it
iINIT Model Wainer _
DISTRIBUTION SYSTEM
I k•ader,Mlanrnid D¢L•~DCto^ x Hof , ride Spannc Vern lu An Intake
' V6!'i11
Length pia Slaann
SOIL COVER K Pre m Systems only cz MoOnd Or At-Grade Systems Only
Jenth Over C)entn On' x. Oeplh or n'. SeedeWSaddec >x Mulched
9ed:l rencn fAlller ik:d+Ircrlch Etloes iocsn
es ND Yr NCB
COMMENTS: Ilneude code dLscrepenctos. Persans present, etc I Inwecson Rt. Inspe:dron k)
LoceNon: 1615 HNY M
1.1 Alt BM Descnpno n -
2 ) 8169 :Ewer length L aU:
-amount of cover- f., 1..,,' ts'1_1?.r Et T. L:' i., ,I ,L L. ivl ~r
I
Plan revision Recurred? Yes - No
Use other side fui audniunalmMrmalion. ~ I i5 I It IJ<o
5130 6?10 (k Cert NC
i
i. lp+ - count)
RECEIVE-.; Industry Services Di vision Si (HUIC
0S = 1400 E Washington Ave Mnmtan Tamil Number (1, he lit cd in by Co. i
P.O- Box 1162 {
Macisofl, WI 937077162 J 7 3 (O
s
Sanitanr Permit Applic~imrelran,aal~ialNm,tcr
In uc"acuicc with, SI'S tRJ'll_i. \b)s AJoi L v,!, v~Ilnni,vor nI :'u, Ib:m m the afpmpn:nc [uvcrnmcnl:d ant Nr,
n "yuoad I nor In rbl (i ninr. a vat u) Iemol la \ppl c an ,n t nu.: hr I.a, o rned IN) 1'IJ are ohn' lied I:,
the U parinw n,t N itch and Pr Rani mat Scr i u.on.Il ml tiox,, n a punide ma) he riled tin x„ndar, Vrojml AJdtass Ii(di0crcntlthan minhne address
ml..,rs maeeordun.c,thths mac,.. iw.. I 111 lllmj Mira
1 Application lnforrlrja\turn Ylease Print All Information
1'ropcil ' Oliver'; Name \ ) - parcel 4
(;ARN'('(x)A ~w~ U36-I OSI fiAI-41k1 '~11:
P,opcnv Owner's Meiling:ddresa Pn+pcny Lucaliou 1 >I 17 1:'fLC
! 1,1511} 61
fin\I i.Vl
Cit). State 7..p Code Phme Number N1\` 4:. NN' Scction P_
NI-W RIC'HNIOND. AI 51017 (curds one)
1 11N ]1 171. or\V
11, Type of Building icheck all that apply) A I A v - - -
❑Ior2l:unAlDolollbtg NwnhMr of Bcdrrwxm i• '1 tiubdnr>mn Namc
6tc t+a _ _
❑ Vahhc('ommcrml Wxribc t.sc III(S:k f:
❑Mlae Oa'neJ Ikx(ilx l!x 1 - - ❑ Vdinpc of
t' Numhrr
MM
f ®Inwnnt tir:\Nr()v
Z pe e (Check - lc ~pnQ.
III. Type of Permit: (('heck onl oII/ t bov on line .1. Complete line- B if applicahle)
A ❑wv, S+slon ❑ Replacement Sy,tcn ❑ wa1mcnClloldiig talk RLJ)IacCIIIC11110111%
13. Pcnnit Hencw al ❑ I'amd Rcvi smn ]Change of ❑ I min 7mnal Pravious crnul Number and Date I-ned
I'lumhrr ~c' -
Bel-re „\puall n Owns
n N[LII
I\ 11pa or POW I S S„tun.' Component. Device: iCheck all that apply) -
urv A In-i rtoun 1 r P%I,unnC In-Uound L At Grata [I Vt and 'J in o1'wllabl: sod o Mowd 21 m. of suitable vod -5VA.~
N f n<:
lloldmp'r'ank 'Jdic ~iN.. .:dl on.ryesm psplmnl HVlccc.to,c, iwise lc\plainl P1JS
\ Dispersal/ I rent myntkeen l n fortratio n
Ip' 13., tpl'J! It Sod A.pl l tan Di, "at 1~ia Required I.1) 1P_a7>'al 1r~C sed "t) System Cler:.leu~
AC II t 1,1xtl V C~ )1 1 19i<V
/ur( 1
),I. Tank Into Capauly nl
J 9
Cain n' _ lulal duf M1moluoutcl
(.:dlons JnYS~~ '
Nero I:rrAa ( i
NcIa wor l loldmg'1'ark I(Ri() _I11111~I lit111 C1II ® _ ❑
I1ti ing Chamber
❑ ❑ ❑ ❑ - ❑
V 11 Responsibility Statement- I, the undersigned, assume rtrponn.ihilin' for installation of the POM I S shown on the attached plans. -
I 1 mler , N:unr i l'nn1l lu uhu:{ tii n \tl' %1VR% Numhrr Itu<inec, Mac Number
• ROBI KI II\RDINA _ / _r l?:~ . ~'1'-ag-'S T•.avl-y0.19 -
I'loinim', Nddrts, Wuccc Cn\. time. /.p (lA,l
F- 170111 AV I. I IIK I LE IAKI[ \\'I 54889
~sV-'l~ll. Countylllepartment Use Only
gear Sip, low
(~lppmsal t~'Dl+appn,eJ :r I'en'nlitI ee Dar Issuer I,so
/ l ~~❑y "o,,'rwa 12c:n,~n toi:h:a,I ~'?D 6Z ~ I C
1\. Ccndrpt) JIM I`RR' as fo Disapproval j--,.n
tiq
11 DDaaWw~n 73,.. w rL`
o:Sper..•.~rxa au.l ail b_151r_k11'rra')i4'4S 1 dQ0
ss per ,narayeman• pt.n p'o,bdM W JIwnLl.. /.,.,-C'S}- ry (s Al ;-r ~t+ _ G r
2. All Iterowlit recur.-An s Muut w mutt: ire I
w par IiWilc lble c r,& I cnfaanre?. -
uoery ,.nlv an pntw nni In. dun a ra er f I erne, to w,r
MLrM1 ro e.,nyarm ~an~n r.w.h.."l-, cwt .bmb (.,he'
NI3O41]98 (Roll! I l l
i I
I
I
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name GOOK
Owner's Name GARY COOK
Owner's Address: 1515 11 W Y 64
NEW RICHMOND WI 54017
Legal Description. NW,NW,32,31N-R17W
Township STANTON
County* ST,CROIX
Subdivision Name
Lot Number 4
Parcel ID Number: 036-1081-60-40&/n
Page 1 Index and title
Page 2 Plot Plan
Page 3 _ System Sizing & Cross-Section
Page 4 Filter Specs
Page 5 Maintenance Information
Page 6 Management Plan
Page 7 St. Croix Cly Septic Tank Maintenance Form
Page 8 Warranty Deed
Page 9 CSM or Plat
Attachments. Soil Test & House Plans
Designer/Plumber: ROBERT HARDINA License Number. 824825
Date' 02/07/2017 Phone Number (715) 491-5039
Signature ~7 I
L)"nea pursuant to Me in-Grcund Sou Absorption Component Manual for POWiS Version 2 0 SBD-10705-P ON 01101).
Page 1
HARDINA SEPTIC SYSTEMS
MPRS/CST 824825
Cgtg I e-<- l-.;Jd iL is ;a ~
y
t - Ic`c`c Cµ L 'Tsl..; K.'
13 it(:
0
~ X
/ bd
/ 100
onk t
I b t Fac2~yjrw e W
r 1
f ; ?
24
oar - - '
q~ 9Z z p
3 96 70 I"
• ~1
bq tc
Soil Abaorvtlon 8»tem Croaa Ssctlon
96.9-1
R
.4* Sdmduk 40 Final Grade
PVC: VeM Pipe 94.59
With Vent Cap R
Leib -fir o\ 93,i9
Chamber U 1lll 4 ft
Q 949 R System Elevation
Soil Absormtion Svstam Plan View
ft
3 00
ft
i.00
-R Z===
4' Die.
French 2 He
ader
r- - ~ Loachlna Chamber Soeciflcatiom
Manufacturer And Model INFII.TR [OR QUIK 4
T)y EISA Rafing '0'00 sq R - - 0.50
per chamber Soil Application Rate gpols ft
f no (f t
_ gpd Design Flow + 0' S0 Soil Application Rate + 30 FISA = F~ ((0 Chambers
(i0 IS
2 rows of chambers each.
Page of
[31ifeti
Installation and Maintenance Instructions
w.:a Labon
Stvp I Dry fit the filter case onto tires outlet pipe going to the drair field. Cnsure it Is cantered dursOis undfa
nutty. upeoing. (If outlet pipe is already in a fixed post tion, additional pipe norry need to be added;
itep 2 11 utilizing the additional single side support and the two botturn supports. `Nhile th" :.e'•"
:s :till dry fie to the outlet pipe, measure and curt 1-schedule 40 pvc pipe to the length needed to extend from the
cues that are pre molded into the case to the side wall and Uie inside floor or tank. solvent welt) pipe into the
hubs that are iye-molded onto the eau.
Rep i So Went weld the case to the outlet pope. Insert the filter caetndge Into the case pressing down or Irk
cartndgc until it locks Into pldce dt the butIO"I OI case.
Step 4 If utilizing a vertical read switch- In•.crt switr!• into the hole pre nloltled into the ter," of OW I ft" Plc-:.
straight down until it locks Into place
Matntcnancc
1+ Remove the access lid of the tank Notc' It, ensurr undesirable solids do not exit the tank and m1c. me
nfa:n field, the tank should bs' pumped out until lire level of effluent rs helow the outlet )eves of tfie tank.
J) to remove the filter cartridge from the filter case, pull up firmly on the handle of the carindge dislodgtrig
i; fio[n the case. (rf utilizing a vertical read switch, rerno mil (rt switch is optional)
i) Using an ordinary garden hose, rinse the finer cartridge ensuring all visible septage material is remoy,Nd
41 Place the filter cartndge back into the filter case pressing dnwr or. the artfidge until is lock' rn-c pl.,,
tj Place the access lid back onto the tank ereunnp, it r..ecurv
tar•hnm hhct h.,% a RR•bnm Innm•d w"...I,
GiNlmP flher llC warrants iRP fihrr wiN be hie of manufadunn,; :mV wwkman;alp drl.vL Juhng r»rmai us.•'o~ the PC~aC Ct
firer Mr nryinal VurcRaser uwu ttr prWU0. lffehme fthr wi6 prince a rePlarcrrrenl IJter in MC to zit Ihat tRe wVT41 Gav w.u
r,ot ifan.ap.W dun... the an~lal4hm• u. mwuar-nance prkr¢•a. Oarrunn tv rhn nmrfun u~ tc0 M aOhn•nL mnau or eWSt w I; m'
:.e mvrred u,Wer ttus wananh. Inrprope~ care us malfurxtxxn IrSUIUnI; from pruJoU rain bcmr. In,,"I d• opstat.a m ma•rnm••a
Oropufy will vqJ Mrs wananh- lifetime fitter asumvs nu I rsponslbllhv for Lflxu [narCes, mnrrval <Rarre•5. 'muslin W n c' niy~nndmlal w [onseeouenRal east:
Rmeu~: nuRrWOlrhnrrRit[•dh_•own Vfwm'A1 :!a till
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page_ d
FILE INFORMATION SYSTEM SPECIFICATIONS
Qwne` F;Flr
Pcrmil Y ~ LL'i K. Tang Manufacturer N 1.* y,•<'„t T ❑ NA
OdSeietic U Dose -1 Hnlrfirng vol_ !t> _ NA
DESIGN PARAMETERS Tank Manufacturer 49-NA
FDk r of Bedrooms ❑ NA U Septic D Dose D Holding vol. al
r of Ouol c Facility Units - - - 9
NA Fflluent Flter Manufadufor L I C C T r m C (I NA
yd (eve+- flow V+" , _ yaUaa Effluent Filter Model L i
(poakl flow = (Estimated x 1.5) DI c
- gavd~ Pump Manufacturer f1 NA
al Application Rate
1aVdayift, Pump model
d InrluenVFffluent Quality Monthly average' Pretreatment Unit Fats . Oil & Grease (FOG) 530 m L Ll NA
g' O Sand.'Gravel Filter ❑ Ncat Rller
henicei Oxygen Demand (BOD,) .220 mcpl ❑ NA rl Mechanical Aeration
Total Suspended Solids jTSS) <750 •n L O Wellantl
B` O Disirfoctlcn U Other.
ed Effluent Quality TtAorlhty average
Manufacturer
hemical Oxygen Demand (BODs) 30 mgrL Dispersal Coll(s) Tota Suspended Solids RSS ) S30 mg'L [I NA 121r-Ground (gravity) U In NA
-Ground (pressurized)
Fecal Caiform (geometric mean) 510` cli o0 ml ❑ Al-Grade
Effluent Particle Slze -O NA n Fl Mound
in olio. Dr me
- - p . U Other
17) NA OiFc
NA
'Values lyrical for eanuatic waclewate' a+d stet tank cll'uenl. OIhN
❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank (s) I At east once every: n'c'n'rO>)
- - - 1 Lit years (Maximum 3 years) U NA
Pump out conterl5 of tank(s) - -G When combined 'Judge and scum equals one-thi-d ('6) of tank volume
- F3 When the high water alarm is activated Fl NA
Inspect dispersal colt{sl
_ _ At least once every: O
aycar(sl monthlsl (Maximum 3 years) ❑ NA
Clean effluent filter -
At t OnCC Cve•y: ❑ e•onlltf sl
W yew(s) / 3)%S ❑ NA
inspect pump, pump controls & alarm At least once every: ❑ month(s) -
_ _ f-i year(s) F NA
Flush late•als and pressure test ~At least once every: U moot {s)
(?Viq: - ❑ year(s) 4C NA
_ A- least once every. U month (s) -
orhe-- - U fear(s) ❑ NA
Fl NA
MAINTENANCE INSTRUCTIONS
Inspectiors of links and cispersal cell; shall be made by an individual carrying one of the following licenses or certifications: Master
Plumber; Master Plumber Restridezl Sewer; POWTS Inspector POWTS Mantamur; septage Servicirg Operator (pumperl. Tank
inspections must InplLde a visual inspection of the lank(s) to identify any missing or broken hardware, identity any cracks or leaks,
measure the volume of combined sludge and scum and a check for any back up or Doodling of o'llaent on the ground smlace. The
dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pending of effluent
on the ground surface. The pord,ng 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 lark equals one-third or more of the tank volume, the entire
contents of the tank shall be removed by a Seplage Servicing Operator and disposed of in accordance with chaplet NR 113, Wisconsin
Administrative Code.
All other services. including but not limited to the servicirg of effluent filters, mechanical or pressurinaf components, p.etrealmen f ends.
and any servicing at intervals of -12 months. shall be performed by a certified POWTS Maintanor.
A service rupon shalt be provided to the beat regulatory authority within 10 cays of completion of any service event.
OMW (12x02)
START UP AND OPERATION
For now construction, prior to use Of the POWTS p'k1B- or_
chemicals that may impede the lreatmonl chock treatment lark(s) to the presence OI paintin
cuntarts of the tank(s) removed posers andeor damage the soil dispersal cell(s). II nigh Concentrations uare dejected have the
LY a sOptage servicing ng ng operator pre louse.
System start up shal' VOl Occur whec sal conditions are frozen at the mfllrative surface.
Junng extended power outages pump lanks may fili above ronml hignwatw levels, When Le discharged to the dispersal cell{sl in one large dOSn and may When
To avoid this situation have ;he contents of fire it' the t Power is up Orod the excess wastewater will
ovOrloatl thorn resulting backup or surface cess r fi M eller wit
effluent pump or contact a Piumber or POW7 pump taenrk removal by a Seota
w,thn the pump lank. 5 Maintain to assist in macUally Operating lh i tho pump Operator prior controls lO tor rrestore estore ronnal power to th
levels the
Do net dove or
15 slope of "'Od or at-9 soil abscrp D feet down or park aehhicles Ovm tanks and dispersal cells. Do not drive or park over, or otherwise datwb or c
ompact, the area within
Reduction or elimination of hetfa ow mgr front he wastewater saeam may ho
sUmiolice, baby wipes: -garere buns; condoms; cotton swabs, d , Y Preve he performance and prolong the life of the
p puny) discharge: Crud and vegetable peNin eg easdrs; dental Boss. diapers; disinfectants; fat; foundation dram
PeSIl.ides: sanitary napkins, !W)POls: and water softener brrine.e• grease; hcrbeides; meat se raps; mrMicat~ons: aC Painting Products.
ABANDONMENT
Wher, the POWTS fails and'or is permanently taken out Of service the following steps shall be taken to insure that the system is properly
and saMly abandoned in oompllancu with chapter Comm 83.33. Wiseensin Admmistrative Code
• All pping to tanks and pits shall be 65ccrrecled and the abardoned pipe ooenirgs seated,
• The rontents of all larks and pits shall be rameved and Oroperly disposed of by a Septage Servicing operator pit • Atrer pooping, all tanks arm s hall be excavated
and removed Or their covers removed and pre v
grovel or another inert solid material.
CONTINGENCY PLAN Old space filled with sad,
If the POVJTS fails are cannot be repaired the following
mpiacerri sysh_m measures navy peen,
or must be taken, to provide a code comoharf
L A sone. ere The f0l)ta replanon!cement area has been
systtem. evaluated and may be utilired for the, location of a r
area should be potee ed Iron, disturbance and com
required
ed setbacks Ir m eplacemenl sot absorption
in thensold for r ewsting and proposed stmCiure, lot lines and wells. mPa Ou and should no infringed luo
a new sal and site evaluation to establish asuitabler. Failure 10 project
Ca-nPiY with the rulOS in effect at that time, will
area . Replacement sys upon by
L A antahlo rap;acemenl area is not available cue to setback arid/, soil limitations. amng advark :es r POWiS trcrnroingy
a holding lank may be rnstallM as a last resort to replace the faded FoW-TS B
❑ The site has no[ been evaluated to Idoubly a s.utablo replacement area
be installed . Upon 'ailwe of the POYJTS a soil and rim
must Le performOd to Ideate a suitable replacementarea, If no replacement area s available hold :r
be insf as a last resort to replace the failed POWTS,
1-) Mcow acd at-grade soil ab g 1a•lx may
mfil!ralivc surace R sorption systems may be reconstrucretl in place followirq) removal of the laomal al th
econstructluns of such systems must comply muh the rules in efle;l at that lime e
«WARNING»
.
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANWOR 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 INSTALLER
Name''IPOWTS MAINTAINER -
-
Phone LNamo
tdnr: - - - -
SEPTAGE SERVICING OPERATOR PUMPER
Name - LOCAL REGULATORY AUTHORITY
Phone Name ,
7h~A000nPhone :a- •J V R I QO -
Cwnm s3 2212{ b)if "tl RM ono eg Sq fjs vY the Gram Lake, Mmyueae ar,d Wauxhar~ O
O (2) R (al. Wlsmr~tin AA^,inisbab.e Code, Courly Zonng and Sa^itafon aSle~d~ .n complancc m1h thapla
ST. CROIX COCN'1'Y
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Huver
L GARY COOK
Mailing Address r
L _1515 HWY 64 NEW RICHMOND 1M 54 17
Property Address v?-' '-5-H6✓s -
(1'cnficalinu reyuircd fmn Vlunning & /oninp, Ihpcurmenl f,r new cvrnarreayion,) - -
CitviState L _
WI-- Parcel Identification Number
LEGAL DESCRIPTION
~r - 16) 6
(yo etc
Property Location NW y NW I,. Sec. 32 I 31
- - - - N R 17 W. 'town of STANTON
Subdivision Plat: - - - - - -
- - - - - - - - - - - - - - - . n
Certified Survev Map t! Lot 4
-
- - - - - Volume _ Page#
N`nrrauh' Dcai p - - _ - - -
(before 2007)Volumc . Pa9C n
Spec 11111141 yes no
lot line. idcmifiaM, Vos nn
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Inlpmpcr use and rear nlcmmcc nfyuur saphv system eou!d
on sisLS ofpmn rruth in its prcnr:nure funk"'. I" ba"di, Wray,
maultcnunce eping.... 1 Ihr septic hole every lb", years uw nrt . rllu'aJaJ, M1
Ihr. .vstcm can k17ia the limction ortbc 1'mpcr
scpnc lank as a trealluent slag, or in the Wa41c dis ) a hcrascJ pumper W hat you put inh
resprnuihilitics :vc sltcciliad in $Cornm. 83.52(1) and of .
C'hnplcr Ii _ SL C'mis Couul ~ sal sVSlcnt. Owner ma nrlen:atcc
y mitary OrJtnanec
'I he pn,pcnv owner agrees to snbmlt to St ('rorx C'oumv 1'Lnmmg & lolling Depanmcnl a -enilicmion loon. signcJ h} Ilrr
owner and b i a mash r VInther, pmrneynum plumber. rsibrclcd plumber ur a liccascrl pumper seri6 Poll lerl that (I l the on-site
w,ts than dupns:d ysIrm a in proper operating mndihon andror 12) slier inspccGorr and .
Ip Ihn L 1:3 lull of aludgr pumpin~, (il'nrcessary)• the w1nic tank is
Uwe, the undersigned have read the above reyuircrttcnls and agrcc to
smrldarJs set forth. harun as scl by the I )epanmenl mmntnin 1111 ens
t ale suvags drspusal syslan with the
of('onmmrce anJ the Depunnrcm !!s;nur;J Kex urxes. Stala
Ccrtiliartion stating that your septic lystettl has horn mainutrncd nor t he cum
Zoning Ihp,trtmeni within 30 davs of the three year expir nn nidate ^f
nly Marron
)IT L.IcIrJan d rUumad to the SI. ('mix County bg A
We certify that all statements on Y1h,,Prnj arc tnrc ar the best of nr
pmpcrtv Ile` "I"d above. by virte ory: or lliege Uwe :un:tr the ownrr(s) of 1111
' JecJ recorded in Kegister "If Deed, Ufticr
Number of ii,-Pa) rooms
SIGNATLREOF_APPIIC I7 (S) t %L(
-
DATE
•••Anv intonation That is misrepresemeJ may result in the sanitary pcmril Nil?, revoked by the planning & Zoning Depart nt
Inc tilde with this application a recorded wananly decd
rrlerence ismade IT the warr fiom the Register of Uents Ullicr anal a n,
mry' decd py of the crnilicJ wrv'e1' map it
(REV. 09!117)
, t u i I 300) \ t,./! ° UII:': /Ol .ft.4AOltd./ {
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onpanm#d~f c SOIL EVALUATION REPORT Page M j
JIN Stun o! Safety and (3ui dlngd \OI_ ly~,Pt in a`romance w th Comm 85, WS . Adm. Code
CaufryST CROIX
Attach trim aNe Ion on per rot lass than 8 1,T x 11 Inches m size Plan must
ilUWe per rtot llmaeo to verbal and horizontal rolerence puim iBM), direction and Parcel ID 036-1081$0-050
p cent slops, scale or dimensions. north arrow, and location and distance to nearest road j
Please pent all in/ormation. RevMwed tiv
i Data 1
-sonal minrmaLVn YmrpMnde rr..yn. coy nor xnan~Lry uumoxn lnn~ncy l.ex. s. t5 Ml1'Jml i ~U
~opertY CMUYer PrOpeny Location
(GARY COOK
NW
Grnn. LUl v4 NW 114 532 131 N Rt7 L (Of) vv
anperrrytyowngs Madrg A4rLUSS
' 515 H1/V1' 64 Lot If Block d S1bd. Norm or CSN# N\ 1 5-/A / all
Sb1ie ➢p GLX* P1Ypne Nunwer
'tY Town Nearest Road
~N~&RICHMON(b WI 54017 617-4638848 Waage ST HWY
-1 I l . 84
New Can" tise❑• Residen4at I Number of bedrooms Code dern¢d desyn flow rara _ GPD
Re'plam r4 O Public Or COO'a "al Describe
l'artml malerwl <z c ~..SrJL~c r /Ik Hood Plain
erW cururYpM _ ekwabon f apNcabill,i~/s~ It
Con I S RECOMMENDED SYS'EM ELEV 93 59 11
"
lird recompmendations J
I~Jb'~ .-c ?l~q Y• ~ 1 l~~/f%~w~O ~ I ~ ~Cl_J ~~iJ ~(2 ~'lC~ ~iG ~C~'YgL~il-
1 ~w] 2~ y! L d l r 1v( It, ofecLC_c/ l(( )
I I 1 Bor"IY 4 ❑ Boring l /
J
Pit Ground surface alev. - 9692
6. Depth to linating facto 196 _ In
&A A ication Rate
YWnion Depth DonYinanl Cola Redux Descnptan Texture S:nrcture Conslstpnce Boundary Roots Gf'a1Y
rn MunsdG
O.9 Qu. St. CoM. Cuor Gr. S2. Sh.
'Ef#1 •E##7
MYR? i " SII. 2MSbK \II R C\\
-1 10YR416 - - 1
.u- L '_\KIiK MFR (:W 2f 4~
1 19-36 10Y R4(4 - - i
.n. U ?N1SNK 1•Ilk 11' !
3696 - - -
7 SYRi:6 -n.
Is IJSh MI V;A NA 7 Lo
t--- Dairg# El Boring 97.25 >96
J -it Ground surface ale, it Depth to im Ing factor n
- Soil Iiralim Rao-
rRln]m Depth PomrtYaM Color Rcdox Doscnptnr. Texture Structure Consstence Boundary Roos GPM _
_n Munsea Gu. Sz. Con. Cdur Gr S2 Sh. 'Eff#1 'EM#2
I 0-10 101'R ifl n.
till- 2MSBK MiR lW' 2M 6 X
lul'RL SII. 'MS11K \II li GW 'I-- _b 8
BIN R4 6 .n. LS SG ML GW I I' .7 1.6
11 7 S)'RS 6 .o. SL MSBK MFR NrA NrA 6 1 0
~ T
' Effluent All = BOD• > 30, 270 rYg4 and TSS >3U 150 nL
_ N' ' C16ur:n1 #2 = BOD, c 30rngrL and TSS 1130 mg4
CST Name (FYkase Prud% gr CST Nurnber
kLIR1:R4 HAR1)INA~~~i~i 824x25
Address -T- Dato Evaluation Conducted Telephone Number
477171Nh AVf. 11 1RTLF LAKI. W'1 548x9 7-18-14 715.9x6.2508
.?JUK U36-1081 ti0-OSi 2, of
~
hrogxry (M~,cl
P.Wco ID P. 0
&nrg F ❑ Rarny. 965 Pit Ground surface h,, it Depth to Imutrxi radar '98 _ in
~zon D u Sa Caunn Rate
D na Redox Desarpton
in Mun Texture Smrfure Ca sconce Bourdary Roots GPD* _
m. PAsetl W. Sz. Cant Color Gr. Sz. Sh
'EfMt 'Etta?
U-In lu\'12+3 .a sit 'M AlK Y11R LN' ;,\I x. j
0YR4+6 SCL - 1
-u- _MSlI1K MPH ('\1' Ibl a
i SVR4:4
if I, q
4 5YR4;6
- .p. t rs IA56K J MFR NiA WA 5 7
~Nil,7i7 ~
c 7 //J
r~ Ebnrg # n Doriny
iL~J Pit Grojod surface ekv Depth to holding facor
IR,r zon Depth Domina,n Cola Rexx,x De!__-_ Seb Apphc lxi, Rate
sngoon Texture Sbuctu: r. Cunsistenx Boundary Routs GrD4t"
in Idunual Ou. Sz Cent Cdor C'. St. Sh 'EII#1 •Lf #2
Boring st ~J Bonny
❑ p,t (;,wrdsolaceek-w fr Depm to limiting factor n.
I4oomn Depth Dominant Cdcr Ronox Des,i Spit viraton Rar
srtion Texture Soudum COns'ste-riCe Boundary Routs GPDnf'
in Mansell Ou. Sz. Cori. Color
Gr. Sz. Sh. •E##1 'Eft#1
FlOuent #1 = BOD,. 30. 220 mgA and TSS -30, 1511 m
9r- ' FMuent #2 = BOO, ~ 30,rcyi and T,y'S = S0 mql.
I he Dcpa rUr,an nl ('nrmnercc ',;it' cyunl opportuniq' xn ice pr»uder and cmploccr. I (you nccJ nn+istuuC lu 111 C11 1011 iio or
need matec:d rt as :d lenrate tonnnl, plcsr :oaWcI Ihv -h p:ulrnonl at sis 1_6x, I1 I ar I I l' 6f_18 264 1-77
{"c7ok Parcel G36-1 E81-60-050
PrnperlY Uyr~.r D tl
Page o1
1 E-- - 9s.5 . - -
Boring # ❑ Sourly
>gA
Pit GfUOrid sudacn elev. If Oep:h to limi0ng factor_ in
Hor2on Depth - Sail ohcaGOn Ralc
Dominanl Colcp Re dnir Descnpinn Te¢wc Structure Cunsislenre 8ouncary kook GFD7t _
r in. Mu, x11 Do. Sz. Cont. Color_ Gr Sz- Sh. •E M#1 'Eeu.
I !1111 illl'R1 1 -it- _ <!1. 'MARK All R C'W ?lt r,
r OVRd:6 SCL -
.tl- _?;11114f: \tl R 6W 4 g
j - 4 SYR4/4 -11- II b
]AISltK Nil R Gll'
4 SYR416 -0 LFS MSBK MFR WA W 5 7
I ~ I
Boring # Bonnq
pn Gruund Surrace Nev. _ L I Z y Deype to Imlting factor IF m. -
SdI r licatore R;&
.lonzon Depth Orrntranl Color lr RCW>t Des Fxlore Tev[ure SLVdure Cons sterice Douldary RUMS GPDm'
ue. feunsch I Qu. Sz. Cwt. Col" Gr. 5z Sh.
0"~I L 111 _ - _ 'EET#1 'Etl
~T i ~ F ('_ct 9
z 9 Iti sic 73~ _r1C C w i
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u s N~ 1
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9
Bonn( #
I~ Pit Ground surface Nev - - _ h. De1Mh to Innung factnr n
d cation Rale
Horizon Depth Domnant war Retlox ::osrnption So Teuwre Slmrkno Cons,stericu Boumlmy Roots GPD.A
in. Munsell Del Sz. Colo. CNor Gr. Sz. Sn •Effdl 'EH#7
r
Effluent 41 = BDD, > 3C < 220 "'qL and TSS >30 < 150 m
U'L ' ErfWBM #2 -BOO < 3C mg4 arn' 1 SS < 30 mg9
The Department of Conn..... r. an canal opfnatunnY sen ica' prnv:dc, m"I amplnyer. 11'yuu need ueistanee to j"r s:n le.] i,,
need neaterial nl'm Jlcmat, Inrmeu. please conl.tcl the tlrytmhncnl ,i hi IN-e ee :U 1 or I I Y W" 2h4-%!',
HARDINA SEPTIC SYSTEMS
MPRS/CST 824825
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