HomeMy WebLinkAbout042-1101-60-050
Yl u:onvn U=ea4rcn'. u' _:o-imciu' PRIVATE SEWAGE SYSTEM St. Croix
`aten' ana Bwldrg Omrs.on
INSPECTION REPORT Sanaarv +-ev n N
A-TACI+ o PCRMITli 600206
GENERAL INFORMATION stale war ID Np
P fwgal information you pmvim nay re used Ia sec, ndan' Pu pn•xS lYndacv 1 aw s 11 LA 11 hm),
-ermd Hoioer's Hame Cly VIaIM trrvr'rn~l` Parcel w Nc O
DORWES FARMS TOWN OF WARREN 042 1 101 60-W(@-
CS- BM Eer Insp. BM Etw BM Description twr'mxv I nwrvRarXle'k4ap No
/no aM 65T 36.29.18.561A
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACI'Y STATION BS HI FS ELEV
tis0 1.7
/03. /Gtp
Septic s.~ 1 Benchawk
I J; G I 5 OHO `.72- 44'7 /dQ
F•I QD )o IC AI: BM -Z u4 S, ,L'f G9r4.'18
Aeratior Bldg Sewe /
L- / / p 3
noldlnq suH; Inlet Y ,7f 9S• 97
TANK SETBACK INFORMATION SUH:Outet 9 /4 w 'SS
-TANK TG Pfl WFLI_ BI DG en cA, vae ROAD Dl lnle'
S
'"epic 1 P5 Dr Bottom
J;r1nq 1 G HeaOeoTAnn /Q-s$
IkcratlDn V J - Dist. Pive
HO,oinq BO System ~O T
Z(j, 7q yz-~a
Final Grade D
PUMPISIPHON INFORMATION 5 -fp3
Nlanofacturer Demand St Cover
GPM Lo 5, z~ `~q '~8
cr
INtodcl Nur,
1
TDH Cdl no Loss e.ad J\I Fl
I orcemaln I ength .-Aa Uea in YNi
SOIL ABSORPTION SYSTEM
RF"'TRENCH WIoID , T Ne Ln I rerrw_s PI I OIMENSIONS N, ;)I msitlr C=: I inwc Dec!n
DIMENSIONS Z 1( ~C, I is ~
SETBACK SYSILM IC Ill. BLDG WELL x~] :AKUSTRLAM I FACHING Manulad...er -
CHAMBER
INFORMATION Type Of Sy:ue+: I n AA-
UNIT OR Mucel Numper 4
CDiAJZv ~D 1 i
DISTRIBUTION SYSTEM 1
I zarle"Md/p~~icit♦ D'Slnnution x Hov Silt' i. HCIE Spa C:nV qt~I Vcn tc 'Inw,,e
I BnGiC t/ Dia 7 lPnQat _ Jru Spa PnO
SOIL COVER A Pressure Systems Only xx Mound Or At-Grade Systems Only l0
C,TTr :)ver Dcplr Dx xx Ccptr of xx *,eneglSmiled ax Muichetl
itea'l ren<n Center Redtticnch Edpc, Topsoil
~•~yec Nn ~CS NO
COMMENTS: (Include code ci screpencies, persons present etc I Inspection St Inspection #2
Location. No Address Available
1 At BM uescriplion - GwQ,
~ d
'win 42- S
2 i Ran sewer ienall, - d'win (~faJQ : O V~
arnouat 0,=over- f/ P-8 A& e-Npk L ~ `py1r~
Plan revision Reguired7 Yes )(No IQ 4 ! -7
Use other side for adddional mfarmalion _
aair Inaepcb,s ,Jtu.(. Ce1 NO
::iili-6'IO IR.3.'97,
- go-
1 I
p cunnl. Of X
v + RECEIVED Safely and Buildings Division Sf C R 1
U S 201 VV Washinglon Ave. N.O. Box 7162
. tiam:an VCnu Cmuhcrut by i9cJmhr(o.I
P s SEP 2 0 i , Mad son 'An 53707-/162
OIX COUNTY AJLD V(J
:oMMUNITY~ F ~Q unit J 63MRTEXONE2VE `1uaIt'l°„ :<,n\..... he'
lu I curJeucr wash NP ti ?1 1., \J n l ohm „r. I nn : In. ,grpu nuk team nr-1 oast
I: r yulrA pI I hitlni.l, I emrrv. /\nl,l Ih'n t wu,. 1 t nls uclxd I U\Y I *S n: wbmili 'd to Ih i .:I \AAn<.' 1 till a: n1 J. c
the iL%mlJrr>sl I~ r
"rma: S d Iv :mJ I nl ,nnLi. Ana I n.m II I'.: nr.n.rrr 'Oil NMI& In.i\ he .,,it Im .uvntderc eI - ~Z T
luny in a. trot eW:O Inta,SIn IuJ'.Innu \Ia:. Int' T u tooi
I \pphcabr n Information Please Print II Inform aion
I r p n Ih nu A,nm 1 :I~ ~ I
cH~y~ Print 11
~lLV~S 000
19op.II. I la ncr ; \la inn•. 1JJre++
~ )p Plopcl:~ Lui aluru
/3 87__,7a l4V~ _
till \t.m /g.('.do Plunr,'Nnnm, W Nf'V lr.u,,n
n6 e-te 7-5 uj ! N_-
II spr of RuilJin); (rhrrk all that apph) I nl a
~I nr, I'mn:h IMell iuL' Nun,ha of I1cJrnmm Nnblhsl~ne: \:.na Vol , y-6-- { i
o 7- CSM 1053371 G3S5
JI'LhLu:'^mm~sncr:d Unrnh~l'or / I 1Ok/~ - 1..
C Coy ,d
~~VI:Jr UUncJ Ib>urLrln, I I Kun h;, vo \ face Pl
I11. "fspa of I'crmit: (Ch[rk ooh onnnnnx-u\ u94 n line A. ('nm title line If if applicithlcl
\ )(\cn \,.I: m I R, rla:.9II or N.';em T { L I rcallnrnr l lAdn:t, l nu{, k4l.", ncnt I nh ❑ t nhcr Mlji aline to l".Ialml• S,.h'nl lt'tplain!
Ii I .non he a~e al I ~ Pn nJ I:c i I;m i J l hun_: uiI'rl i :nnf. I Iunekr lu Nett -bl I7i vunls I'a nul \lln,hal ❑nJ >elv laual
It`1 re I\pn:,lo nl I U.t net
IN I vp[ of PO{\ 7 S Sy[cm ( bmp0nc"I1 Cl'ic[ (C'hcck all that apph') -
V I I Io..n i f I. l ~uuJ I I n 1 I t eel L nl-t n.ule I Mrvm 'J m. ul'sunahle ...d J \I runt un u: xnha?le unl r
I H.Ihnr ink ❑In.ha Dr yr I(on
1 r P n n sp nor 1 feu nnkm Drcr . Lrplainn
Unprr.alftna rot %res Inform
alrnn
` I) i u, I ~o f fM~t I>, .n.n b d 1ppL:u1 rn Il,n gpd.11 Ili..p rsal ,1¢a K<yur J nil Ih Ia r.;J :\ICa IYuixo (,Ii %%'Icm I ILL ulLm
2.5 S64F P1,4 AJ
VI. Tank Info [l Ia1c in
1 :1 - I Inl .ul A,an,ll~ -
I' Y
l lions liabons Iqul. r -
N.•w fan[; I\Ianr Ln4.
~ (I Il dJing I:mA /~D ~ QQO ! CC.~rn.¢ !
IL n CI"I nha _ _
VII. Rcsponsibiiip Statement- L the unJrni~nrJ, assnnv rr.pnn..hili_n Inr inaulla.ion ul Ihr I'tl\1l G shoo n an the attached plain. -
I lumhrr'. Nan I I bmkcr - -sun :nwr NII', MPR'i ]undnn lin'w.. PI a V.uuhIt
WRL 1 r`2 Nr:r.nvLcci Ll r• ix.,l~zc_k-llk.' I3z'r ~Lc- I 5 7`rY 33~
Plnmhcrl \J:1n•.. I Nircd. I` 1t N!:uc Ap CnJcl -
`rte t ri~,~A`_r:.r sY~t~.3
VIII. (jwnty Ilr tar lrncnl l!x Ilnls
I pe a .apph , Pcnnn I'a Dal L.u:J Iwmn :cent Snaww
~!5 oO L
-J rn I k •..n Irrr Dcnm
I\ Cundi Reasons for Disapproval-
t. ,alksrr leer :•n1
[lhper: rxs aunt all oe a.~~,k>s '~~er ~'ot¢ ~ ~r ~25e(✓P
as per awagenwn! plan y u ncet by pkimbe,.
2. Al eeRtsr:k recui«~erhs mrx..9 m- r.,ant: it f
sF Pr Awhcr"A viedi I:rd uxill.
4rarh ro nunplrro Plum lu. Ihr a. •Irn aul vrhml w Iho l bnnh anti nn pant r nm h,• Ilan P r:. I I inrhr. in.i.r
"BIM'MIR 11 It
PLOT PLA(J
We. L-OT L. I V
- ~ O 1
3 < ~ n
- 13 ~n2M ' 2
r- W E ,.t U HoHr ~ r F
I O I
j - NEB wcESER lOoo ~aP
A S.T. puT 45.0
r 13ox
r laLF_.' ,
( ( i i 1 i; 1 49y
a5
61
S (o Pc 5 (33 I I m
r I hi I
13H a 5E;r
l °N of I y ~U/ I I rn ! ° ~ o! I
o r L yA. , e,
r \ g2-
sGALE _ I =30' 99 ~i .
II rj`
C • = ~A~KNoE PITS ~~0
5 ET: TO or
Q = 5og.9hcC;7 (Dx)todRS `
I ! I
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name CO W LE S NEU) 3 ~~RjY 0,6A; SEP.[
/ ~ ,fsy,iA ,
Owner's Name ~OQW~S f4l?lys C~ .~~/Lr CetylES
Owrcl s Address O
6 -7 Q A✓z r
I egai Desc-iption. 2 -9 ACW S mow, N~ SEC. 3G 7-2 yN (2 ~p uj
Township Wf}RREN
County sfi• CRDI c ~e3g/
Subdivision Name GO7 1 CSti1 7p~AlQ/N(y iD5337 Z VoJ 29r
Lot Number LOT
aZ-i/%~ -Olab
Farce IU Number.
O`VS
Page Index and tttie
Page 2 Plot Plan = ULIS~~ ~ $ ~
Page 3 System Sizing 8 Cross-Section 01164 _r ~ -
Page 4 Filter SpecS HUDSON, W1 Page 5 Maintenance Intormatiorl
IGN
Page 6 Management Plan •"'-,,,,rimnurot""a`+
Page 7 St. Croix Ctv Septic 1 ank Mainle-ance Form
Page 8 - Warranty Deed
GSM or Plat _
Page 5 -
Attac:hrnents. Soil Test & House Plans
DesignerlPlumbei License Numbe•.
Date Phone Number
Signature
t fined porsuani te.. the In-Ground Soil /Wsorption Component Ala nuai for POVIT,' Ve:a:un <.c SBO-i 07o", (N.01101;
Panr i rit S
J
1
FLoT PLAt,I
rJe. L-oi- I97
-
jjEOKM
Nov
WELL CO, ONE r
53 ~ w
k ~48o ,
-3 J3co~ Se11 eiZ 5~•~ 2~
o NEW w`ESCI`_ 1000 ~&k .
pRrcAsT S.T
L7 L lol I 041
I
s. T. poY SET q5.0
3 ~ r `~4• lsi.
r`f I (fOK
1 Gr INLEI ,
I I , 1 , ; 1
I 6~1 r 15.1 ~ I
-I I I -1 I
I X I , X 1 1
C L. ~
! a`~
5(eFcs 63 ! a; I I T I
I r T} I ~ ' .I I
ml<' 1 I...It
t hI I 7 1
I S,AI , I I I
TOP Of !ypo" I rn p IoI
.t
~ r.~'15 I ~ t I
LOT
SCALE : 1 30 99.o a
I a = /3AcKNoE QITi op
O' (3.M.'S SF_r Top or
bF5
su(t$PrcE Co~tovRS
r a I
iN G9-0VNp 501L Afi 50izlp ioa .5ysrEm cRos5 SEct,•ous
S 9. p -
T PAR 4" scti. 4v
MJO Ti2E~cl~
/}(3Rlt SLOTT"EU I~~JC.~+ORED yg i,ispEcr1oo Pi Pits. Low T2E~ch"~
0-• y' Scti. 17-19 PEftFE►2nTiEo 3>is i; P i PE
LEVEL DOT7omS ~3• {{i TRENGk
sysrEM -
EIEVhT10N5 -NIO TREock
P-CAje
PEP- COPE- MANUAL M~rJ• G" A~gRErRTE 9 -.1 . - o--- low T
-uuvER FIST. Pi PE, M4J.Z° AC3&UC PERFE'RATED Pi PEE
I -
SoiL AGSoRPrioN 5YST. PLAO VI•Ew
TYPICAL Rock
CELL 191HeI-)cIf0 ;
i
Li=NyI.T` Top of IRENL~ g3.8j "A
y ,
for of Low r12ENcMP r yd.83
13i-ow U~ [ALA VIEW
Rock coif 60vE
- I
1~ O.w T S• pEer. D~'sr p j i I
CALGULAT-ioK) pI - - ctiIl
~ EDGE
y C -DRil.y D.w.F•
y scl, .4~ Iuspe _T PIPES
5OiL hpP1I CAT(U Arc hoRED s Lorrt PER
RATE = PowTS MA"JUAL I sEr %s io
1125 5pAi. REQvIREv? '/p t~,E LE-;jlkT- of CELL
CELL AREA- FROM TEIZAIWAL FO(rff6
-corAL
Pg 5
POWTS OWNER'S MANUAL & MANAGEMENT PLAN P-
FILE INFORMATION SY51 EM SPECIFICATIONS
Owner C Elp L
CoW /E5 Septic tank Capacry cal e
F'rrrnna -
Septic Iank Manufacture [VI".Q J-e/L NA
DNuoiLu r PARAMETERS
oons - - - 3 FI NA Effluent Filter Model 'rt.trer .00 _(-?G~i -U -1 NA
NA
:4 PuLlic ty Urns io. A Pump T ark Capacity I Nk oal
Estimated flow (average) 300 gah,j ay Purnp Tark Manufacturer dS N
Des:gn flaw (peak), (Estimated 1.5) ' - T~0 Pump Manufacturer L?Vv."•.
aL ra
od Application Rate d ay ft' Pump Model :"1CN~•.
tmdald lnfluenVFffluenl Quality Monthly avr-ricp Pretreatment Unit tf4,NA.
I-ats• Of & Grease (FOG) 30 mgrL U SandfGravel Filter ❑ Peat Filter
Biochernical Oxygen Demand (RODr:J <220.ng,`- 7- NA L1 Mechanical Aeration ❑ Welland
Total Suspended Solids (TSSS) <_160 mg1L U Disinfection P Other.
Pretreated Eftluenl Duality M Iy average Dispersal Cefl(s; U M"•.
Biochemical Oxygen Demand (BOD- <30 mgrL Yin-Ground (gravity) Fl inGround (pressurized)
Tidal Suspended Soh d•' SS) - *30 mgil- . NA G At Grade U Mound
Fecal Colifcor (gee nine mean) r 10" cf', 113oml U Drip-Line ❑ Other:
Maximum I Ifluent Particle Site rk in ura. [ I r,A other - - - ❑ NA
U NA Other ❑ NA
'Va1ue-. 1yp11a1 fCr, d0raestu- wastewater and septic tank effluent Otrer- r'. NA
MAINTENANCE SCHEDULE - !
Service Event Service Frequency
In pad condition of tanks) Al Lust once every 1 • (Maximum 3 years) L J NA
ump out ronlcnfs of tank(s) fA hen Cote bind sludge aid scum uqua~ on Year
llnrd i',) of jok volume U NA
'ns ect dispersal cell(s) urmih(s)
P _ lr.=ist nnre every .1
3 (Maximum 3 years) I) NA
Clean e9lueni filter I monthfs)
least once every: NA
Inspect pump, pum controls & alarm
p east once every ❑ monthts)
U year i j - NA
- - -
Flush laterals and nresswe lest ❑ mcnthis)
At east once every: PkNA
_ _ year
- s) El NA
At least once every- r~ nunrl'
I I NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dspersal cells shall bt- mace by an individual carrying one of thr_ following licenses or certif•cations Master
1'.umtxr; Master H.jrnh.et Res:ric:ed Sewer, po' %'f.`-. !nspectw: POVVII S `daintamer, Septage Servicing Operator Tank inspections m-isl
nclude a visua inspection of Vie tankis) to alent.ty any musing or broken hardware, dQri0y any uacks or leaks, measure :he volume of
combined sludge and scum and to check for any back up or ponding of effluent on t°.e grouts surface. The dispersal toll(s) shall be
v:sually Inspected to check the effluent levels in the ohsev~fion pines and to check for aa•iy pondwq of effluent on the ground surface.
The ponding of effluent on the ground surface may incicate it loili•Ig condition and requires the romediade notification of the kcal
regulatory authority.
When the combines accumulaliun of sludge and srun in any tank egaals one-third or more of the tank volume, the entire contents of
the lank shall be removed by a Septage Sevocng Operator and disposed of in accordance with chapter NR 113. Wisconsin
Adminlstralive Code.
All altos services, including bcl not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units,
and any servicing at inlelvals of 12 months, shall be performed by a certified POW lS Maintainer.
A service report shall be Provided to the local tegulatory authority wdhin 10 days of completion ul any service event.
1
- of
F START UP AND OPERATION Page
or new constriction, prior to use of the POW) S check treatment tank(s) for the presence of painting products Cr other chemicals that
may impede the bealment process and/or damage the dispersal cell(s). It high concentrations are detected have the contents of trite
tank(s) removed by a septage saroeing operator prior to use.
System start up shall not occur when soil conditions are fnveo at the mGllralive surface.
Dudrg power artages pump tanks may fill above normal highwater levels. When power is restnred the excess wastewater will he
discharged to the dispersal cell(s) in one large dcse, overloacing the cell(s) and may result in the backup or surface discharge of effluent.
To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the
effluent pimp or contact a Plumber or POW 1 S Mairtainer to assist in manually operating the pump controls In restore normal levels
within the pump tank.
Do not drive or park venide.s ever larks and dispersal cells. Do not drive ce park over, or otherwise disturb or onmpac( the area within
15 fee! down slope, of any mound or at grade soil absorption area.
Reduction or clrminehon of the following from the waste•watei stream may improve the performarce anJ piuioug the life of the POWTS
antibiotics; baby wipes; cigarette befts, condoms, cotton swabs: degreasers; dental floss; diapers. disinfeclarts; fat; foundation drain
{sump purnp) water- fruit and vegetable peelings, gasoline; greasy, herbicides, meat scraps. medications: oil; painting products:
pesticides, sanilary napkins, tampons, and water softener brine.
ABANDONMENT
:"then he P06"Ii S fails anaflpr is permanently taken out of service the following steps shall be taken to insuro that the system is properiv
and safely aLdiloned in compliance with chapter SPS 383.33, Wisconsin Administrative Code
• All prying to tanks and pits shall be. disconnected and the abandoned pipe openings sealed
• Thy contents of all lacks and pits shall be removed and pioper!y disposed of by a Septage. Servrclrg Operator.
• After pumoin(j, all lams and pits shall he exravated and reproved or their covers removed and the void spans filled with soil,
gravel cr another inert sord material.
CONTINGENCY PLAN
II the PC).V F fails grid can, of be repaired the following measures have been. or must be Taken, to provide a code compliant
replacement system.
A suea Dle replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system.
Th-s rplacement area should be protected from disturbance and compaction and should not be infringed upon by required
se:backs from exisbrg and proposed structure, lot lines and wells. Failure 1o protect the replacement area will result m the need
fora new soil and site evaluation to establish a surtaole roplacement area. Replacement systems must comply with the riles in
e`.hs:f at that lime.
n A sortable reptarenrenl area is not available due to setback and;or soil limitations. Parnng advances in POWTS technology a
holding tank may be installed as a last resort to replace the failed POWs -S.
I I I he site has not been evaluated to icentify a suitable. ntplacernect area. Upon failure of the POWTS a sad and site evaluation
mast be performed to locate a suitable replacement area. If no replacement area is available a holding fork may be installed as
a last resort to replace the failed POV TS
El Mound and a!-grade scil absorption svstems way be reconstructed in state following removal of the biomat at the mhlira!ive
surface. Kern^strucaons cf such sys;erns roust comply with the :•ules in effect at that time
<<WARNING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN t ETHAL GASSES AND/OR INSUrFICIFNT OXYGEN. DO NOT
ENDER 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 IMPOSS181 F.
ADDITIONAL COMMENTS
POINTS INSTALLER POWTS MAINTAINER
Narnr_lUhG7EK /vEva V1,1i5 - - - Nam, A)5CCi V;.,`5 _
Phore 715 ' 7q -33 2-2- ~f.one 715• 7!{~~ 33~Z
SFPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY _
Name /uEyE~25 PV/tf,/ Naln~!5 t. ("[1.r~ZONINPhu. 1!S 3 a (D q6 tpo
This dorumecl was 8rafieti in eompC::cce w•Yb chapter SPS 383 22(2)Ibi(1)(d)&;Q aid 383 54(1j. (2) 8 (3) 1NSCOnsn Adrnn:utraLvc Code Rcwsed 3r7 .:13
J L
START UP AND OPERATION
For new ccnstrucl'm ,[,or to use o` Inc P7NuT5 checK treatmen :-nk(a1 for the pros -rice F_t r b r r.,d ci t t ca ter r _.,Is t at
may impede b 1c, r a,ment process and,cr damage the dispe.,.al cell(s). If high coneen.raticns i iav+ th.. ~~~tr rrr
tank(s) removed by .ri ssptage servicing operator prior to use.
System start up shall not occui wrier, suit conditions are frozen : the m iltrative. Surface.
Luring power o.riaocs pumo tanks may ,ill above normal highwater towels, When LTe t:e xu Ysre v t w~l i:.-:
discharged to the dispersal[ cell(s) m one large dose, overloadrnq the cell(s) and may r: inn • i- to- su ace ..i_:-hall r ~f9u-rlt
To avord this sfluatron Lave the contents of the pump tank removed ty a Septage Serv•cinq ClDewtp: pnnr to re;tcnng power In riz•
effluent pump or conteca a ?'umber or POWTS Maintainer Ic assist in manually operating the pump controls to restore normal levo',_
within the,)unit) tank.
DO not drive or park veftlces over :anks and dispersal eels Do not drive or park over, or otherwise disturb or compacl. the area willri,
15 trot down slope cf any mound o• at-grade set[ ahsorptcn area
Reduction or elimination o` the follovnng horn lne wastewater stream may improve the cerformance and prolong the life Of the POV,
antioirl baby viper, ogarella butts; cori cotton swabs: degreasers; dental floss, diape:s, disinfectants: fat, foundatioc oraw
(sumo pump) water. trot and vegetaLle peelings. _7asoime: grease; rierbicides. meal scraps. medications, or, painting prcduUs,
pesticides, sanitary rapki^s, tampons. and water softener brine.
ABANDONMENT
Lbnen the POA`i ; 'ails andi D•. is permanently taker out of service the fchowng steps shall De taker tin insure that t:rie system is prom-:Iv
and sorely abandoned in ccmpliance with chapter SPS 383.33, Wisconsin Administrative Code:
• All piping to t3lKs anc pits snail be disconnected and the abandoned pipe openings realed.
• The c:umants of al. tanks i,id pits _.h-14 tl• r T. v-d arrf Prrserly d - risecf cf t !y a 4ptap•_ rvi in. Ope•:;•n
• After pumping. all tanks and pits shall be x_av,tcrl d . f " I cv. I r r:~,Ir r. ,r-, : -e».e,ec d^d the b t .::.:c t 1 r. •h
grave: or another leer' solid matena.
CONTINGENCY PLAN
If the, P'°,^!1S `arts and cannot be repairpc t`rn f,,1rrvnnq r. -iscr, i.n b.•r:~. .r. r,.t_t tk-n, t, ij•,v.t__ 1
rtfrlai.emenl syS:er:
A suitable repl.icerrent area has been evaluated and may be utilized for the loutbon ct a r-.-placcmcm soil absxPbcn syste-,,.
The repla:zmeril area shou;d be protected from cisturbance and compaction and shoodd not be infringed upon by recurea
setbacks frar.r existing and proposed structure. lot I.nes and wells. Failure to Drotect the replacement area will r=esult in the need
for a now soil an:'. site eva.uation to establi.-h a suitable replacement area. Replacemenl systems must comply w;Pr the afes 6•
eNect at that bnic.
U A suitable reolacement area is not avai,abie due to setback ardiar soil lindalicns 5w-ing, aevances in POWTS technology
F;aoing tank may, be installed as a last resod, to replace trie faded POW 1 S.
U 7hE site has not beery evalcated to icentify a su,tacle rep ac-men: a'ea. Upon failure of the POVvTS a soil and site evawa:ron
must be performed tr kx:ale a suitable replacerrenl area If no repla;xm=.nl area is available a holding tank may be inslaliee a..
a lad resort to replace the failed PO'.NTS.
I I Mound and abgrade scil aitsorpbnr systo.rs tray Le reca-sL'ueted in place fobomnq -e-r l of the bton:al a: the irfll-alive
sw f:f::e. Recrxrs;ructions of Surd -r ;,Y:;: erns TIJBt vmm'y with the rules in efiecf Hl ITIat 11:11e
<<WARNING>>
Si--?TIC. PUMP AND OTHER TREATMENT TANKS MAY CON IAIN LEI HAL GASSES ANLNOR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMFNT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMEN-S
POYYTs INSTALLER POWTS MAINTAINER
Name 94G7_4~P- _A15614'.V y 1C Name
Phone 1/5 - 7 !z7 3 ZZ- - - ---i~honr 715- 71ff/- 33~Z
I J
ScPIAGE SERVICING OPERATOR (PJMPEK) LOCAL REGULAIORY AUTHORITY
Narne e 1_~Je 5 ~(~/L1 iU~- - va:r,e 17 t. C_n0/1( ~pON/N~f`
_Phone I - Phone 7~S ' 3 ~lD 7CD 6 L
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01A7NT.RSF2 CERTMCATION FORtiI
Q,vn::r;Bever e*EP.Y L 600 le s -
Mai:ing Address 13 87 764t- A V e- ROGER T A I. S y o
new e,nl n,eron l
('v'c: _ficaton -eyu!red tram Planning Z:ht; icpamnent or
C;1,, "Tate ~D(3ERTf • Parcel Idenn `ca:iOrNumber
LEGAL.D1•SCRIPTION
:,xm L x:at rn NW . N(,()'':. ,cc. 3 ~a I ! R l6 'x. 'o•.AT. f W/f R R E N
Certified Sut-sey Mart 3'' -7 2- Volume 7-9 Page 4~ &3 g S
'Warranrv Deed i1 (befor::200:)Volurne Pag..---
Secs house ❑ yes no Lot lines idennfiabic . C nn
Sl SITNI NLALNTRI ANCE AND OWNER CERTIFICATION
imlxonc; cst avd maintrn mce ofyotc septic ~y~[er-, <.~,uld re,ai ir. its premature fai.urc to handle wastes. Trope:
-r.aintenancc coat rs of puMpm8 nu: the .epos t:mk cvejy :1:: _e ycaa cr sooner. if needed, by, a i:ccused pumper. That vou put into
he system can a.f_e: the function *,I rrc sc-,ri;:::wk as a :rearnien: augc L*t Lit was e disposal system. Ownte maintenance
isibili:irs arc spec!(ied i:, §SPS 383.52(1) and it.. Chapter 2 - SL Croix Co:mri Sartr.v-y Ordinance
7,n ptopem• owner agrees to submit to St. Croix County, Planning K Zoning =tepartmen: a ce-fication forth, sipcd S} tht
an,: by a master phumber. Iourvcvman pia-nbcr. restricted plum cr or.a licensed pumper vcrifj•i~g that (1) the on-sae
w ,r:water disposal svstem is ir. proper op-raring condition and-or (2) after mspec-ior. and pimping Lf necessary), the septic tarn is
ices than t 3 hull of Mudge.
Uwe, the undersigned have read the above : eqm;ement and agree io ntamL u) -he private sewage dupesal system with the
;undarde see filth, iicrem, as scr by the Deparim, w r,.` SafA% And P-n6:ssional Se.ices anc the Departmen: of Natural Resource::,
titate of R°sconsm. Ceniftcatiou stating :hat your septic system has been maintained must be ztun:,ieted and retuned to the St. C: oix
County P.anning F: Zotutl, Department within 30 days of the three Yea: expiration date.
1'we t tt ,:tar at --ments on this Orin are true to the :.rest of mviour lmmviedoe. ,:'wc ata'arc the ownterjs of the
tY :.esa ..d a.:.e. 6Y vvm. of a wartn• decd recorded ie Register of Deed.• Oftice,
Number of bedrooms 3 J
t
S)G 47?rtiE OP APPLIC.AN Y(S) DA I F.
"'Any in ornatior. that is tnisrepresen:ed may resul: in die sanitary pc.=t being revoked M' the Planning R Zoning Dep arunent.
Include with this apnlicatiou a recorded warranty decd Gom the Reeisrer of Deus Office and P. copy of the certifies survey map if
-c:erence is made r :he wzrranty decd.
.'REV. 0412)
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Wisconsin Dept.-Va t.af 8afsly6yld Professional Servrces Paco 1 of 3
' Division of lndusny Sernces
f J Ii SOIL EVALUATION REPORT
T C:F (nn COUNTY In accordanue with SPS 385, W s Adm. Cale I Courty
Attach ~u c~ n O RMSt. Croix
pyrtl~fl~Q~pran 8 112 x 11 inches in size Plan must ,nr•'
but not a6 vertical and horaonta reference point (13W direction and oetr•e•~-*SQO Parcel 1
scale or dmenswns , will arrow, and eca4on and drslarct: to rx:amsf rum' OV Ref #2419
Jpalee J
Please print all information e5,v ` Rew d bAorCSM#
_ Punorial mfonrwbunya,mvide may be used tai seamday p ` "nary i-aw s 1y 04(V( inn Properly O
wner Property Location Dorwes Farms;Cheryl Cowles) Govt Lot nw Y. nw S T 29 r, W
Property Owner's Mailing Address Lot # Block # Subd 138/ /O' Ave _ na na na
City Slate zip Code Phone Number Gly ❑ Village ® Town Nearest Road
Roberts WI 54023 Warren _ 70'° Ave.
New Corstruchor Use: N Rcsldentiat/Number-of iblidwnms 3 CaJe dewed design flow rate 44N GPD
[Replacement El Public or commercial - Describe
ZpT'`
Parert material Glacial Drill Flocif Plan elevation 4 applicable na 4
General comments and recommendations Site suitable for seep Inground POWTS with mOlt•ative surface 92 00 8 93 DO' with 0.4 gpd/sq. ft leading rate. 6.
mound system recommended to overcome extreme system depth and resluctrve soil application rate. Mound system lobe placed on 99.00' contour.
i Boring If ❑ Boring
Opt Ground surface elev 99.'0511 ' 2J Depth to I miung facto, 1110- in
Sod Apphcanon Rale
Horizon Depth Dominant Color Redox Description Texture Struclure Consistelf ce ouna ry Roots GPD%Ft' _
In Munsell Ou Az Com Color Cr Sz Sh A _ p(y/I _l .FH#2
1 0-11 10yr3/3 none sl 2fgr mfi A7 cs 20 f 06 1.0
2 11.16 7 5yr4,4 none sl 2msbk nut - rw lvf fm 06 1.0 ,
3 16-28 7 5y 4,A none cost I msbk mfr cw 1 v1 f 0.4 0 7
4 1 28-36 75yi4;6 none - sl Imsbk ds cvv - lof 0.4 0.1
5 3649 75yr416 I none WIS. Osg ml cw IN 05 1.0
6 49-110 10yr416 none banded
Ivfsifs Osg ml 04 D.6 j
~ _ - _ -J
Boring is ❑ Boring
111 ®Pn Ground surface elev 99_08 It Depth to funding faclor > 112" in.
Sod Application Rate
Horizon Depth Dominant Colo: Redox Descnption • texture S.ruclure Consistence Houndary Roots _ GPDIn'
In Munsell Do Az. Conl Color Gr Sz Sn
'E1W1 10#2 _
1 012 10yr31- s 2fgr ! mfr cs 1hr 06 1 0
2 12-28 7 5yr4t4 4 none sicl 2msbk mfi cw 1 vl l tm 04 U to
3 28_b2 7 5y,4:6 none _ SIAS/s I msbk7USg mfr/ml - - W 1 of 1 04 0 67 '
4 62-73 10yr515 }h none s8gr Osg dl gw lvf 0.7 1 6
5 73-112 10yr5/4 none s Osg ml - - 0.7
d1SS>30s 150 mglL
_ • EHluenl # 1 =130D. >305220 mig and TSS Y 30s 150 mg1L Effluent #2Z011. s 20 mg/L an
CST Name (Please Print) Sgnefuie S Number
James K Thompson / 1 J 5" 30021
Address ale Evaluation Condu Telephone Number
340 Paulson Lake Lane, Osceola, Will 540.20-5413 July 5. 2017 _(715) 24.8_-7767
SBD-8330 tRO4/15)
3 Boring # ❑ Boring .
® Pit Ground surface elev 97 R2 It rleptn to limiting factor > 109" jr
_T Soil Applicabon Rate
Horizon Depth Dominant Co or Redox Descrip!0n II lexlure Structure Consistence Boundary Roots GNU/Fl'
In. Mursc~l ! Ou Az Cont Colo l G[ Sz. Sh •Eft#t 'Cff#2
011 t0yr3f3 none SI 2fgr mvfr es 2fin n6 i0
2 11-27 t0yr4/4 - none sU Itrsbk m6 fav 2fm 0.2 03
3-- 2?-51 75yr4!6 none Is cemented dsh cvv Ivf•f 0.2 06
i
4 5160 75yr4!6 none gr is Osg di cw - 0.7 16
5 60109 10vr614 none s 0s ml - - 0.7 1.6
I
4 Boring # ❑ Boring
Pit Ground surface elev 99.74 ft Depth to limitng factor 1122' in.
Soil Application Rate
Horizon Deptn Dominant Color Redox Uescnptro - ToKtwe Slmdure Consistence Boundary Roots GPU/Ff
In. Munsell On A7 Cent Color f Cr Sz. Sh. •Eff#1 `EfMi2
--i 011 10yrU3 [wile s 12fgr mvfr cs 2vf,f 06 1.0
2 11-32 7 5y-414 none s. 2msbk mfi cs M J 06 1.0
3 32-56 75y414 none Cost tmshk mfr _ -..M 1vf,f 04 0.1
4 5669 7 5y4/6 none I Isifs 0 s
- ~ ml aw 1vf.f 0 5 10
5 69-122 10yr4/6 none fvvfs g dl I - 0 4 0 6
I Ruling # ❑ Bonne
Pn Ground surface elev. 95 72 fl. Depth to limiting factor y;i in
Sod Application Rate
Horizon Cepth Dominant Corn RcWox Uescripnon Texture Structure Consistence Boundary Roots GPDIFt'
In M•msell Ou Az Ccn: Color Gr. Sz So F
'Eff#1 'F.ff#2
1 011 10yr3,7 none s[I 2fgr mvlr rs 2vff 0.6 06
2 11-25 10vr414 none scl Imsbk rnf- cw 1vf•f 0.2 0.3
r
3 2536 7 5yr414 f2d f. Syrbii sl lmsbk mf• Lw - 0.4 0.7
4 35-56 Z5yr4 f2o 2d7~ oyr6.n scd tcsak rnf gw 0.2 03
5 55-72 7 5y1416 f2f 7.5yr414 15 cemented Ash 0.2 03
I I
Effluent #1 - BOD > 30 5 220 mg1L and TSS > 30 s I56 mq I ' Ett uent 02 - BOD > 30 s 220 mg:L and TSS 1 30 < 150 mg,L
E-3 Bonng p L3 Boring
® D1 Ground surface elev 97 B2 R Depth to limiting factor JLj n
fff Sod Applirauun Rale
Horizon Depth Dominant Caoi Redox Descrlplicn Texture Structure Consrstence Boundary Roofs . - G_PD: T
In Munsell On Az Cont Cola Sz. Sh
~Fffp1 I 'ERp2
1 0-11 1Cyr3t3 none sl 2fgr mvfr cs zfm 06 110
2 11-27 ICyW4 none Sol Ini mfi cw 2fm 02 03
3 2751 Syr416 Mile I ,s cemented nsh cw ivfr 02 _ 06-_--
4 51-60 { 51`06 none 9,15 I Osg al cw - 07 16
5 60109 l0yr614 none s Osg mi 07 I E
4. _J Boring A ❑ Boring
Pit Grourd surface elev. 99 74 h Depth :0limdinq facto, 1122 in
_ S_nll Applicatia•i Kale
moron Depth Dominant Color Reoox Description Texture Structure. Consisterce Boundary Roots GPDh:
In I Munx.l Qu Az Com Color Gr. Sz Sh. •rffpl 'ERR2
' COI lOyQT3 rone sl 2fg• mvfr es ~2vf f C. 6 1 0 II
2 11-32 7.5yMA rone sl 2msbk mfi cs 1I of f C.6 1 0
3 32-56 15yW4 none cos, Imsbk mtr cw lvi.f 04 07
4 56-69 75yr4t6 none Isrs Osc_ ml aw IVU 0.5 IU
5 - 69-22 l Oyr4rS none fslvfs Osg dl - 0.4 06
5 Boring Of ❑ Boring 0 1 '
M Pd Ground surface eev. 95_72 R Depth to limiting factor 2.5 in
Soil Appiicat on Ral~
Horizon Depth Dominant COia Redox UexnpWri Texture Strncturc Consislence I Boundary Roofs _ GPD*t' _ In Mansell Qd-Az. Cori. Color G,
Sz Sn L- •F"#l •ERp2
1 0.11 1 _
Oyr312 none 5il 21gr mv'r cs 2vl.l Ofi 06 ~2 11-25 13yr414 none srl imsbk mfr cw ivf.f 01_ 03
3 25-36 75yA14_ f2d 7.5yr57? _fsl 1msbk mfr - rW 0.4 07 ~
8 _
t 36-56 7 5yr474 c2d 7 5yr576 f2c I0yr6t2 sr. 1csLk 1W 0 2 0.3
r5 56-72 7.5yr476 f2' 5yr4:4 Is cemented dsh - 02 0.3 i
Effluent p1 - ROD > so s 220 mg11 and TSS > 30 s 150 TN1 ' Eff uent 02 = BOD. > 30 220 mg +I and TSS 1 30 5 150 mg1E
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