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HomeMy WebLinkAbout026-1306-00-019 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No (ATTACH TO PERMIT) 600231 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] NA Permit Holder's Name: City Village Township Parcel Tax No: Josh & Alicia Traynor TOWN OF RICHMOND 026-1306-00-019 CST BM Elev: Insp. BM Elev: BM Description: P Section/Town/Range/Map No 6t- 121 18.30.18.1626 .I I-Aj TANK INFORMATION ELEVA ION D T TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 1+.!SQ Iii II►~►d ' Alt. BM ' ft GUQ .0 S 104.(15 Bldg. Sewer . H SUHt inlet TANK SETBACK INFORMATION St1Fltet►tl~`_ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD DLjaet Septic Dt Bottom 111- Q ?2 -6 9 Dosing Header/Man. -16 (?-7, Rg Aeration Dist. Pipe pp •IS 3Z IS 5 Holding Bot. System -r (p • 4t~. Final Grade PUMP/SIPHON INFORMATION W-1/5 Manufacturer Demand St Cover GPM .0 VO•(A Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Lenggtthhk` Dia U Dist. to Well , SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSI NS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 1 SETBACK SYSTEM TO f P/L BLDG ll~~WEELL LAK STREAM LEACHING Manufactur t INFORMATION CHAMBER ORK~~I ~~+t Type Of System: tw I 4 ` ( I / UNIT CHAMBER G{J, T R+ L~q DISTRIBUTION SYSTEM t4--;L,5 ir Intake Header/Manifold Distribution x Hole Size x Hole Spacing to A I ! Pipe(s) Length~_ Dia Length / Dia ~l Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over t Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed Trench Center 4 Bed Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1528 96TH ST ,r 1.) Alt BM Description U "~s Q V 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑ Yes ❑ No C, Use other side for additional information. SBD-671 0 (R. 3/97) Date Insepctor's STgh tur / Cert. No. RECEIVED 3V6 • ~ ~ I is aich~ ; . t ~ s G:T ~ ~nnt}< OCT 0 9 rl.!] 11 sT, Sanitwi Fermi Number (to he filled in by Co.) PS ST. CROIX COUNTY SMMUNITY DEVELO MEN~T P`172GE28RE TO 3 Sanitary Permit ALPP iCa i4t1 tateT ansatact,on Aumber accordance wiih SPS 33'.21(2), e Nis. 3m. Code, submission of this loin to Ule app:nFna~c- s;o~ertut:enta{ wut Al c retluircd prior to obtaining a s.initary i e miL -Note AnplicVtion forms fix tt7te-ou-nei} Pelt ,-S ore aabmiueei :o Pruitt! .ld ires (i: ditFerert that. mailing address) DtTartntent of Satei*,• and Prote-Wonal Services Personal information you Provide may lac used for secondary os ^ in xco;d nee tcitiA the Privacu i:sNv, s. IS -04 1 t ?tnry. Stag. 1 -0- 21 'tip}r icatiorr Information - Please Print -`tl! Information' _ . t} f3:vner's huae f'atcel - _ t 026 ~3d6 QD O/ 9 rci(crryi~+oncr's•1"rilingArldtess 1 vropcrtyLocatior +(3 ~~1 i~' 'X~ i ~r181 /1419277A! t;UAY f i.... t Sl:ltl• 1 7.Ej JYf. L.OI Zip _odv i Phone Number AAd - SAC-- ~'o m2 sE7 , u12 II ~~d.~..s ( circ~e one t Type uF~3uilciiug {checA alt that tlsl~l~t~} i toort or2FatnilpDrsellinLt-.\umLer~.AtT3erir.,3ms Sutrt3trtstGn,:ame I C~t~Ns of tuow iPiucX Nubile/Commeictal - Dc:cribc State Gvne.:. Describe Us. . • ' o se ql ct' v ! r,w 4 s.ur cat t.. _ H_ d try vfidn cells w 2 5 i Town af ~ 2S chain bets o _ -1)'p, _ Check onlN one box m lint Complete line I3 if tpplicsbic} t fir-:~•Sr;tem 7 4piacrmeltSy^>i zn tnaunanilCloldittx Can Re 33acment(nCti t; ~ Gi.. t i oSttic.aion iG t:, u S:stc~u te~pia:r? 13- P~*tnit Renemal l-1 ?r rmt Revision ~ 1 a 1 , [ i~t'rrviuus Yrnn it 'Jgmbcrand r?atc fssucd Ch nn: timer ❑ Permit Sranst t e BLAnc E:`Pitltron -it•.7ler D Safi ic.l~ y !'Q 'ottenuDevice: (Check all that apply} - - }t s;-Prtasurici IsrGroucd Pry riled In-Ground At-Grade { Mound 1 - t m. of sutiable soil hlo nil 24 t,r- rn iuitst i ~i wr ES e^al Coin onaw (ex laia f P F • ) beri{:e'Lsplofii V M^A• rl'si~et s sh'"T-rc rtrneni ,arc:! Information. ~n £fa (epdl Dtois-,n tie>i1 Application ( 0~.at ast) r D.~fe sal .tr~n Require; Dispersal tre,_ t'roposea (sf) Syst u! tttvatron - tnio Capacil"to Total of Mwutacturcr - - 6alions 1 _ - Gallons Units i Ct_:c l-u+}.y S;xiciinL!Tan:.c tI- _ ' r~ E •i , I s` tt>t t ti tt 1 hoG ra:,.. j25 /ril/ ~ /2513 I ~ I ~{J/ES~r _~lyt:;~.~`~ ! I _ 1 i 750 _ . _ __L_7SV G~mBa ~ ✓ i i I'll. Responsibility St:ttcrnent-- I, the undersigned, ac;stime res1wrtsibitits• seer installation of the C'C)WTS shown on theatuictled plruts. A Piuutb r N tin (Pont} I Humbcr' tort vIi'!t##"r~~ \umber Business l hone umber - !lS 7.ir - 5a7G6 Plumber s Address {Street, City, State, Zip t_odc; l /VaI~c f' r S' V%,j !P l'7T C;ntttlty/lic~artnrcnt t'cc t3nlr' - - - - - t 1 permit Fee, ~ RtL7' ;J L cr e G en Ri or }or D rn it / ~ l~ C'unttjt.an± nt Appritt:tC/ldcrtsuns for Disapproval SYSTEM OWNER: ~ MWC. SI.~S~M ~ VN f/ J T• 1. Septic tank effluent filter and ~i pM~,(~~i be%n,l dispersal coil rltl:st be serviced /maintained as per marlar0ment plan provided by plumber. - ---2-AU "\iG`.•.Tu1-fitcarl}'., ar..t ,.:.m t.... C. ~aa,:. , „ i,_ ? as per applicable code/ordinances. S131'4239;~. (1". 0804) If Y% Uf,insF it as Y:LL~eInrf .L'C'D oTjeci ?c: 11eGK06/N49 fid4d;r per's Name: " ' ` ~/Pump Ch'~rnBbd~ _ E L -i:u t r _ SF 18 301v, lain ',riu ic? aTii~f. T Rl ~tf ~ ©AJ I'f3L~7~iiCiQt~ ~fCLn/tip ! 17~LC (TLews of /GCO(cJ /~/UE>~ -2:mtl ID. Number OzL~ ~3D6 _ o o o aae. e Z j~L 6T '~,Z J /j G- 16,f$ r 7"iv ✓ ~ ~i'r~r.✓ CIr~~J j age 3 ~E fJ r/6 X.19 t dour r~ ~t~',~.v ~~E•e Tito ss - 5 c s /o,~ age 4 rc.c. 1''~'♦~~X3 r~.tl/}.J~~ /A/A*0 ~ rr~Gtf-rrt E7t~'T : S~ ~ ` TFST ) Ja rt,✓ f~ c _ 'License -Nuniber: MoO- Z3 t3 ~r Date: 10-el-2417 siaacd Pwml try tie i ollowi~zg PO-\7,'S Com-pontAt Ma -u31 and V s n s 81-85: IN6G1COa440 s6/Z gAsa~ePri,OA1 60M,-o.II-dr /?lOit/&44- Fot faulTS ( E`,e5lf~rJ s'~. Q 1 .SBA /07r.S- I I u r , Zli ~ y ~ 4 p ~ ~ { i C -3 Z„ L5t p ~ `a 3 w o0 a' R Q n a 1 V r p n 1 Q r Z ,o y a 1 ~ > n Xi IN 114 A C C ~ a n A + ~ r Z y L i c) a Al h G` `,~i ~ 4a ~ ~ d + 't e ro .A O i (c n { L 'f u n 3 a ~ Z i ` ~ W 10 h . j a w o f D ~ hl la ~ xe~ o a ~ p N I t ANVPUMP CHAMBER X-SECTION 7 !DRAWING NOT TO SCALE) , MANHOLE: R1SER & COIF-R NA ~r~k „tihl'i_ (Per 's P.S84.25 (7) & (8)J - 4rovenLPipe iMPOP,?AN? i ~rtd surface away from / >TO 8 irOm for proper drainage) f ; - auk'Ing Anchor tank(s) as necessary 12"Nlin_ ,r 2.0 A alSQ a PurSL , Z i0 SPS 383.43(8)(g) ESIChashed Food Eiavat;On (6jFir±!} Approved t:den,i manhoie r', as ne,xssary. BUILDING SEWER ~ dent I _-p ?f¢Bt S PS 32.30 it ELECTRICAL _ i Appfoved Laddig F1anFtnte I J ! ~JU~lL71ON 30{ I 1'4Ih tAraning Label Ahached { Eecw,c111 m;tsl . ;rnpiy VA91 `I (Lypicc)) r ! S°S''31Z and NEG 34G 0 W. - - _ - I-y` itshe or 20 d ahnve a t ` bGsned=aad Ptav2;6cn 'AANHOLE MANHOLE I i AlAINHOILE _7 T rwJy cu-:d i ©OTT0M. Or it`LcT(roverleles ' anon) - FY t........ ............t..........- 1 __.t r i///,lam!%ii%l1~//::'~i//% i/l//. ~'f`,-/// ~ ~ -ALARM FLOAT { Fit rG C 0`i FLOAT 4` U;LEr YIF~ FILTERED 3 ^ OFF FLOAT (lea arGaGiQ) APPROVF0 FFFI_UENT TITER EFFLUE01 REIRED 'W UU I'LL i elev CCU f I`"wiMUM OF 3" OF SUITABLE BEDDING BENEATH TANK ~ untr~no i I C U i-'U s t OR EQUIVALENT COMPONENT ~ I i -~r, i.«u,i~iacturer /E!E C ~a ut.tE rF DWF (daily wastewater flow) _.!d4 bPD •.'iC1Pulnp tank modem 617 so Ilumber of dally doses _ S.3 (I 9 °Jo~ i manufacturer am n r e I tlurni'ar -7-1 .t/. agar / Forremain volume _ 5.2- Actual 3 dose volume (gallons) j fi,l "i t;n? f lec ;i ;lnoCr _ _/S/ PUMP TANK CAPACITIES Reserve above alarm inches = yp3•?Vallons Alar float above on float ~ inches 3.1,E gallon, (Cl m On/Off fi0at rneasurment _ y_ Inches = 11 jallons (8) j 'Vortical f Off float above tank bottom - Inches /a gallons A" lifl. ({pump of: to distribution lateral) -rte system head (distal pressure X 1.3 feet) TANK Dr}rlENSIONS & PU14P CHMADER SPECIFIC' TIONS Friction loss in the forcemain 92 -ioo x32'__;. Total dynamic head (T0H) Length Width Liquid depth V8 Gallons per inch ! I i TOTAL DYNAMIC HEAD1FL OW / -7 PUMP PERFORMANCE CURVE PER MINUTE / G OF? LL MODEL 151,152/153 EFFLUENT AND DEWATERING 153 I MODEL 15 152 153 40. , I - Peet ' rdeters G-- Bets I Ga!_ Liters Gal. Le." _ a ` - - 35 Y-- 5 1.~ SU 159 fig 261 77 _ _29'. - U2 170 61 231 70 65 30- 5 46 38 144 53~ 201 61 j 231 25 - ' 20 6.7 29 110 i 44 157 52 197 , 16 67 34 29 42 159 2 Zfi ` 1.s_.... _ _ 23 - 87 i 33 125 ' 3D T ! 35 tQ 7 j - _ - - C e2 85 I I i 40 122 11 j2 Shut-off Head: 30 P (9.1 m) 38 ft. t11.6mj ( 41$- (134mt _ ! _ _ 014SQR5 Model 151 Models 1521153 iv) 30 tG 50 60 10 Al W 100 L . 57.32 T _e 373 3 7'E - SB rte, i I 3 7i& Ir ' t i a a 's 7.5 O T:5 y, 1 1 1~,£G dCSinr N n8,5 aV~ll20i@. _ lecincai alternators, for duplex systems, are available and supplied with an alarm. Variable level control switches are available for controlling r-_ single phase systems. ° Double piggyback variable level float switches are available J. r' for variable level long and short cycle controls. • Sealed Qwik-Box available for outdoor installations. See e 12 va I E _ } FM1420. t i - I • Over 130°F (54°C) special quotation required. _ - 5,5 I ' It' 51'E SK2344 S92g64 1511152/153 MODELS Control Selection Model Volts Ph Mode Amps Simplex Duplex N151 115 1 Non 6-0- 1 2 or 3 ~ SN151 115 1 Au o ❑ 0 included 2 or 3 E151 230 1 y Non 2 1 2 or 3 8E151 230 ; Auto 3.2 included 10 3 "Easy ass$mblyn - - - N152 115 1 Non 8 5 i 2 or 3 imp dis0arge Dipe 8N152 115 1 Auto 8 5 nauded 2 or 3 riot ncluded.) E 152 230 1 Non 4 1 2 or 3 3 G w o - or BE152 230 1- -Auto 4.3 Included 2 or 3 ) J' N153 115 1 Non 10.5 2or3 BN153; 115 1 Auto 10.5 Included 2or3 E 153 230 1 Non 5.3 2 or 3 6E153 230 1 Auto 5.3 Included 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level Reduces potential dogging by debris. float switch. Refer to FM0477. 2. See FM0712 for correct model of Electrical Alternator E-Pak. Replaces rocks or bricks under the pump. Made of durable, noncorrosive ABS. 3. Variable level control switch 10-0743 used as a control activator, specify duplex Raises pump 2" off bottom of basin. (3) or (4) float system. Provides the ability to raise intake by adding sections of 1 Y2" CAUTION or 2° PVC piping. Attaches securely to pump. Accommodates sump, dewatering and effluent applications. NOTE: Make sure float is free from obstruction. For unusual ~ondltlOns a reserve S 3fety factor is engineered lnio 0 e desigi". of eVer,, 7 e' Plli;1N- .;o 7rltlrl; 200S5 _4eile CO. All t IGr i,^~ r ;Sef VP.C. PJh I S O'WNER'S MANUAL AND Mr1NAGENIENT PLAN FILE INFO RMA'I10N' _SYSTENI T SPECIFICATIONS tuner sN S4 f}i.~,v - ~ ~ i Sep tic, Tank Capacity _ i /2SO gal C1 NA ermtt Tank Sic Manufacturer_ _ Cp G, 171 NA t)F3IGN` PAR.~'v 1,TERS - 33- [fluent Fitter Mauufaeturer NA B ±dtunber of Bcdroours (l 00~pd.heiira PI) f lucnt Filter Model~ ~F C1 NA Nwnber of Corn ucriial Units _ Pump Tank Capacity f 750 g=al ON f1 Estimated flolr (avctage) ~p11 v Pump Tani Manufacturer t3es-aa tloty WW F), astirnated x 1.5 ~ - - ;a Ha } 'r mp i4lanufacturer u 6,9,9 aLda[~ NA od flppiicatiott R rye Pump lvludei ,al%a} - - - -----L ©NA (nflucrtt/I,t'tluent t7uttlity (r] NA) { ivlonthly,lvcraa Pretreatment Unit ( jgNA) Fats. oil AV- Grease (FOG) ❑ Sand/Crave( Kilter ❑ Peat Filter Biochemical Oxygen Demand (BODs) = 30 m°'L 0 Mechanical Aeration 0 Welland ~ Total Suspended Solids (TSS) 220 rnglL ©Disinhction p Other. E40 m !L rbtan rtrcturer: Model: Soil Absorption Component NA Pretreated E-filucnt Quality 1vA) htontlily F ve age ) _ S I1,' round (gravity) /Pump O In-ground (pressurized) Biochemical Ox,Fgcn Dcmand (-BOD5) t Total Suspended Solids ("TSS) 1 _ 30 nt2.ft, C:1 At-grade CHIW ao Mound Focal Colifoiru (c=cometric nrcanj 30 mg1f, Dr p line-- M_ Other-: 10 cfidl00m1 Vertical Distance Tank Bottom to Service Pad 7.S' -j hYnnr.im Effluent Particle Size 1 1 inch diameter Horizontal Distance Tank(s) to Sef,iice Pad:/Z5-1' Dispersal I11,tit Nlfg,/1blutlel Number: ::"'alculutinns: _1~YF/4LR-Lo2 "C~-disk L,t~ CftflA?BEX'S ❑ NA Soil Dispersal End Cap (Dispersal Unit I:ISA) or Q 1G` - Auplicatiou rate Area _Y tired - EISA _ t`s rer)4h d 1h,) _ Units or Total Lent~ih of Tretrchtsl O~ _ = /Oeo - a -3 20, b c T z = 5D Ct/~rnl3ERS 7~ S~EivY~ Gh'fS i)EatGN CRITERIA 'Deli-n of Pressure Distribution Networks tier Septic Tank-Soil Absorption Systems" Publication 9.6 (SSWMP Manual) © "ICC Flo-moch Mound Component Manual" Version 12 0 `EzFlow ivlound Component Manual' Version 8/20121107 a SBD - 10854-P (R.l `f "At-Grade Component Manual Using Pressure Distribution" Version 2.0 OK SBD - 10704-p (tV.01lO1) "In Ground Soil Absorption C:omponcnt Manual" Version 2.0 I i ❑ SBD - 10691 P (N.01/01) "Mound Component Manual" Version 2.0 CI SUD - 10657-P (R.6199) "Drip--line Effluent Disposal Component Manual" El S13D - 10706--P (N.01i01) "Pressure Distribution Component-Mamral" Version 2.0 L.1 Other - i)~I ATt+ITENA +iCT MONITORING SCHEDt LF -1LUNTNIAntCE AND lIIANAGEVII 1`l' - Service ;sent _ Service FtcEluencv Fump/inspeet tank(s), stec,t cisu,rsai cell(s) c,lcan filter At least once every: 9 13 months m-- l - 3 cars aspect puttrp pttmp controls tlartrr, pretreatment unit At least. once every © month, IM 3 years M NA T lush and r~sure test laterals - __C' At Fast ones cvery.- pnfcnt>=us ❑ 3 etas Del NA x"FART L1P r~ D tIPE(2 A7 ION; For new construction, prior to use ufthe Pf1WTS ehctk tr~.rtuicat tank(;) for the presence oc pcrtntingproducts or other chc._nicals that way impede the treatment process and/or datnsge the dispersal red( s). If high concentrations ` r detected have the contents of the tuft (s! ` rcinw-d by a sel 'ia5c • sLr;'i1,, ng t ~ UpMltor prior to use. System start tip shall ttot occur i ;vhen soil conditions arc. frozen at the infiltrative surface. I i fic propcrtt owner is responsibic, for the operation and maintenance of the POTS and submission of required reports.'Flce quantity and quality of the wastewater stream will at;cc.t the performance and longevity of your POWTS. The installation of waster-saving appliances and fixtures alon); with prompt repair of is aks reduces the wastewater voluaw. Also the brine or waste fron, water sulicucrs, 11,01: removal units, other clear water treatment dcvicra and foundalion drains should be discharged to the ground surface whenever possible. Notc: ibis does not include laundry waste, showers, dishwater, etc. This sytitum is i-lcsi`r~ned to handle domestic atrcttgth wastrNvater, however the disposal of food based greases and oils, ve"ctablcltruit peets and seeds, bones, and food solids such as these produced by a garbagc disposal should be tninimired. Toilet tSscue is the Only taper that should be discharged into the, system, Jtlrer non 'Mode=radaole ironssuch a ; bah wipes, tamT'ens sanitary ~ y n~-.,pki,1s , e0ndoma, cigarette butts, dental doss, and cotton swabs should not enter the system. Chc:micais such as petroleum products, paint, page S 0 f I SCi;~:,rl eUt ~f. 3 iuzlhed irt~ tic sysrcrn as Lic;y can scilorlaty daulaFC yQ UI' Pi15,_tIT S ' d contaminate your d n via- water supply. Vlaintain a rel,,War steady flaw by spreading laundry -washing throw*hout fhe week Avoid vehicle tr"J r c o ier ail system components. 'ompaction of snow ovcr die elispemalt unit may cause it to freeze up. i SPECT It3t l,ri ti MAV T ZINIAtNCI : inspection shalt be made by an individual carrying one of the following licenses or cs'rtifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Sepiage Servicing Operator (per the attached )[t ,intenance Sehednlej. Tank inspections must include a visual inspection of the tank to identify an, missing or broken hardware, rdeutiiy any cracks or leaks, measure the volume of combined sludge and scum and check for any backup or poaching of effluent to the fund surface and test all electrical equipraGnt such as pumps and alums. Any defects shall be promptly corrected. Exposed openings -eater than u inches in diameter shall be secured M d., effective lockcing devices to prevent accidental or unauthor led entry the tanks. `.'•.'hen the can;binatiou of sludgt, and scum in auy t2alt exceeds one-!bird t;U3} or more of the tank volume, die entire contents of itle :.ll, sllali be removed by a Septagc Servicing Gptir« tar and disposed of in accorctarlce tviitll ChapterNT 133, Wisconsin t'Administrat' e i ti:, malei tlltel•(s) sbztl be ii,+.ipec'tt:d and cicaned to rcrulo-'c arty acc+anul:_+ted solids according to manu lcivier's specIaications. Solids :shed f gan the It, r ahall be retainer in the, tang. H ter cleanin ri ay be necessary at more Ct'cqucnt intervals ihiui skated in the r fir. intenaace schedule to i:eep tlar :,ystetn operating. !amts should be tested on a regular Lasis by the home owner. Tf an alarm sounds, contact an individuai liecitsed to service POWTS, :ere is normally a 1 day reserve under rec;ular operating conditions, however avatar aboard be conserved until any problems with the. system are corrected to prevent back-up of se-wage mto flie dwcliing or surfacing. s'!l' OIFt t~1T: YNgien the PO WTS fails and/or is.permane ally t.ai~en our o_ service the foilovvingsteps shall be taken to ensure ; Iat the system is properly and sa.My abandoned in compliance with Ch. SPS'S3.33,Wisconsin. Adin;wstrative Code- - All piping to tanks and pits shall be disconnected and the abandoned pipe operti:-tas sealed. - bt: conic"Its of all. t2aI_C.`s and ;)iw shall t)e removed and prcpcHy disposed of by a Septage Servicing Dpc;ra'ton ' After Lain 7ILI aIi tanks P t g, and pats shall be excavated and removed or their rovers removed and the void space filled with soil. gravel or other inert solid material. f ~^[a a :tdi M,7 PL fir: If the Pt)WTS fails and cannot be repaired the i'ollowina measu-es have been, or raust fie taken, to ptrividi . a code compliant replacement svsteln_ i$ A suitable replacement area ha.; been evaluated and may }e, uti li-+. l ;or (lie location of a rep)acenitnt soil absorption systern. The replacement area should be protected from disturbance and compaction and should not bu infringed upon by required sctbacks from ('X%Sting and proposed ructuie, iot Imes arc, l vIcHs. Failure to protect the replacement area render it unuslblc. Replacement syslervis must comply with the rules in eFfect at the time of rcplacetnent 0 A suitable replace-merit area is not available due to setback audlor soil ihnitatioys. Bi:aing advances in POWTS technnlow a holding tanhc may be installed as a last resort to replace the failed POW"TS. 1-1 The site has not be-11 evaluated to identify a suitable replacement area. Upon failatre of the PO' VTS a soil and site evaluation must be performed to locate a suitable, replacement area. If no rcplaC°ment area is available a holding tArils may be Installed 'is a ;ast resort to solace the failed POWTS. M Mound and at-grade soil absorption syskcins ma,r be- reconstrlrcted in place follov,,in; removal of the biomat at t zz infiltrative surface. Reconstrl?i:tlons of such syst°ius mLSi. comply with the 711es ill efrEct at that time- a'r?''a F ~sa 3 ^ .7y ~y .t i C. _ UNPI A`l)3 OT"H4' .i~ ;.r.. T" V11 P iT'f -~-NIKS MA- CC`,INTIs d l E"I'HAL .:ASSES Ai` DK 1INS FF CsE7°.'f Y N. 00 NOT 'FI A-EC . r- SEPTIC, PUMP OR OT-K7,l'i Rr,,A a N1jCjC ,TT TAINK t.1L II . ER ANY CfRCUhk.S i'A_NCE. . DEATH 11AI RESULT. RESCUE OF A PERSON 1'?349M THE INTERIOR OF A TANK i+fiA _13r D1FF1f_'7 t OR 31YSz"Q.X+SSMI E. AD IT'IONA , £ ~tlYll3 `3 S {14ST AL 1.1L' _ z r/4~i. f~J I~+IE?lI'l rti if ens ame Tf1 fI iii ASE L I<G1~. c 1 1i' 1 ~l lame _ llGr~i lr!/.fG - ---C65 w, V PI?arte Ei {gi n 3i s Jlt N {}s'r'i LT ttlal ev)~ LOCAL I?EGrJLisj OiVY E"JE-110-1,11+'" Name Atf~nc~r - Phone Phone 715 - 386 ' ~p J Page 6 of,-7- . cn lb ~ a ~JG ~ n m 5 F d .f-t.• Z N n N O 7 - n ~1 CJ O < fL rp y 7 0 M~F ti f3 N rp _ .o._. U1 7 3 7" r '7 N R' _ = O N N T y ~ ~ N r. T 3. Or 9 ~ ~ 7 N N' % ~ ~ C J r s - a3 aN !'P 3 ? y N pq a o N v ID y !J m? L7 O Q. N 7 v N m 0 rc ° O 7 G Q. m E O V ? O 3 - N o°Y C N N _ C L r ~ T !8 N Q N N ~ 9 m ~ ~ - N d j 7 m v cL o "u3 0 .°i+ pv N C ka < C, N p v O C`. 7 C C~ A 3 N rD :3 3 3 - + fD A -o z m ~ O io m N ' O r vNi n 3 1- C G O O N (p 4 A C l < m (D w n c y j C m rp f %o a _ ? r ;'3 n roc 2 a~ G ~~~JJJ O yl T - 2 D ,g "f RN n c e d O D a rD :T g = I.a 3 ra y' A G O F C C rt ".J O~ a m 0 m lQ N. 3 Z cu CD cr n 0 o. v o r ® rD .--r G v " 07 r.} .E 5 ~V a m ~1 ST. C:ROIX COUNTY SEPTIC TANK MAINTENANCF AGREEMENT AND OWNERSHIP CERTIFICATION DORM Owner/Buyer IUQ ' 7Ur Mailing Address 047, Nc~ - - Property Address t`7 2 ' %'V 5t (Verification required froze Plauning & Zoning Department for new construction.) City/State Parcel Identification Number Lo 17 CT`s ' ~ ~%'_C~ f LEGAL DESCRIPTION', Property Location A `/4 , ~5 'T N R W, Town of a ►'XJ_ 'e ire Subdivision 1 ~l - Ll.-;` I y of r' Lot# Certified Survey Map # Volume , Page # Warranty Deed # 3 Volumc , Page # Spec house yes z1o - Lot lines identifiable yes no 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 §Comm. 83.52(1) and in Chapter 12 - St, Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a masterplumber, 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 tack 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 form are true to the best of my/our knowledge, Uwe am/are the owner(s) of the property described above, by virtue of varranty deed recorded in Register of Deeds Office. Number of bedrooms z ~IdNATTJO 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 map if reference is made in the warranty deed, (REV. 08/05) i i® I~ r ~I 77 nn ~LJ ~I ~u n m m 0 o ,a m~ a y g lap NOTE, W:OAMAMN RROYIOEO W STRUCTURAL ORAWWGS BY 'a 9 a~ tl P 1a71~E IaE E°E~IY y I g m F 1-4124-S oRYnA ux ARCHJ CT TARE PRESONCE OVER ANY STRUCTURAL T $j ~i~77a 3~,p S C r 1m s EAx . 4 % 11 i p };Cfa1d 1 0 PLAN REPRODUCTION AND LICENSING NOTICE > LAS PALMAS MODEL ° i ' SINGLE FAMILY HOME LICENSE« xxx=xz