HomeMy WebLinkAbout020-1341-10-010.-= Nisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Buildings Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holdcr's Name: ❑ City ❑ Village ❑ 7fown of:
Kingsborough Homes, Hudson Township
CST BM Elev.; Insp. BM Elev.: BM Description:
U 4
PI FVATInN DATA
TANK INI
aM
TYPE M
MANUFACTURER C
CAPACITY
Septic �
�J or Z
Z66
Dosing v
vU
AeFatLoa-
ti NK SETBACK INFORMATION
a
TANK TO P / L WELL BLDG. Ventto ROAD
p Air Intake
Septic 5 S/� -,- S d �-- NA
Dosing , .} r �'� ► 30 ` NA
A
H
PUMP / SIPHON INFORMATION
Manufacturer ff er Demand
Model Number GPM
TDH Lift/ Friction System TDH Ft
oss Force main Length k g r Dia. F 2 i " 1 Dist. To Well
r%nill ARcnRPTinm SYtTFM
County:
St. Croix
Sanitary Permit No.:
383824
State Plan ID No.:
Parcel Tax No.:
020- 1343_,10 -010
STATION BS HI. FS ELEV.
Benchmark S S. U
Alt. BM h ( 93. fo
Bldg. Sewer jv g,2 Z
Q/ Ht Inlet I Z J Z 4- 5 ;Z 2 9 e 4 2-
Ht Outlet 13.0(, y , 17 17 Z ��• 3 3
Dt Inlet
Dt Bottom
Header / Man. g
Dist. Pipe
Bot. System
Final Grade LK
St cover JP( 12.
0 93
BED/ ENC Width / Lengt _ No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
p 3 DIMENSION
Manuf acturer:
SETBACK SYSTEM TO P / L I BLDG WELL LAKE / STREAM
LEA
INFORMATION Type O / r _ AMB R Mod Num r
System: Cm
nItTRIR1ITInKI SYSTFM
1
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes [] No El Yes [] No
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
M old f Distribution Pip s.. x Hole Size x Hole Spacing Vent To Air I take
Header �AA� Length Dia. L I Length Dia. _M Spacing I &A I IV A
COMMENTS: (Include code discrepancies, persons present, etc.) -7-Z,
Inspection #1: d'' /L //a /Inspection #2:
Location: 450 Carriage Lan , Hudson, WI 54016 (NW 1/4 NW 1/4 32 29N R19W) - 3229191817 Windsor Hei hts -Lot 1
1.) Alt BM Description = b df s; ,� over 0/4 Sewoy '1�� Atedl �qr�,.,.� k - Sc 0`aL � e%trV� I�
2.) Bldg sewer length = z1'
- amount of cover = > Y 6 4 kft_.eAe4 (tie,- e fk spa, Ied y 2�i
3 ) i t , S 6e�w «w 5 be /-a w t6l!dk --kcW c hk,.- 4pte s.
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD -6710 (R.3/97) Date Inspector's Signature Cert. No.
�') S < < hpfies bv, 4alk
PUMP / SIPHON INFORMATION
Manufacturer ff er Demand
Model Number GPM
TDH Lift/ Friction System TDH Ft
oss Force main Length k g r Dia. F 2 i " 1 Dist. To Well
r%nill ARcnRPTinm SYtTFM
County:
St. Croix
Sanitary Permit No.:
383824
State Plan ID No.:
Parcel Tax No.:
020- 1343_,10 -010
STATION BS HI. FS ELEV.
Benchmark S S. U
Alt. BM h ( 93. fo
Bldg. Sewer jv g,2 Z
Q/ Ht Inlet I Z J Z 4- 5 ;Z 2 9 e 4 2-
Ht Outlet 13.0(, y , 17 17 Z ��• 3 3
Dt Inlet
Dt Bottom
Header / Man. g
Dist. Pipe
Bot. System
Final Grade LK
St cover JP( 12.
0 93
BED/ ENC Width / Lengt _ No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
p 3 DIMENSION
Manuf acturer:
SETBACK SYSTEM TO P / L I BLDG WELL LAKE / STREAM
LEA
INFORMATION Type O / r _ AMB R Mod Num r
System: Cm
nItTRIR1ITInKI SYSTFM
1
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes [] No El Yes [] No
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
M old f Distribution Pip s.. x Hole Size x Hole Spacing Vent To Air I take
Header �AA� Length Dia. L I Length Dia. _M Spacing I &A I IV A
COMMENTS: (Include code discrepancies, persons present, etc.) -7-Z,
Inspection #1: d'' /L //a /Inspection #2:
Location: 450 Carriage Lan , Hudson, WI 54016 (NW 1/4 NW 1/4 32 29N R19W) - 3229191817 Windsor Hei hts -Lot 1
1.) Alt BM Description = b df s; ,� over 0/4 Sewoy '1�� Atedl �qr�,.,.� k - Sc 0`aL � e%trV� I�
2.) Bldg sewer length = z1'
- amount of cover = > Y 6 4 kft_.eAe4 (tie,- e fk spa, Ied y 2�i
3 ) i t , S 6e�w «w 5 be /-a w t6l!dk --kcW c hk,.- 4pte s.
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD -6710 (R.3/97) Date Inspector's Signature Cert. No.
�') S < < hpfies bv, 4alk
BED/ ENC Width / Lengt _ No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
p 3 DIMENSION
Manuf acturer:
SETBACK SYSTEM TO P / L I BLDG WELL LAKE / STREAM
LEA
INFORMATION Type O / r _ AMB R Mod Num r
System: Cm
nItTRIR1ITInKI SYSTFM
1
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes [] No El Yes [] No
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
M old f Distribution Pip s.. x Hole Size x Hole Spacing Vent To Air I take
Header �AA� Length Dia. L I Length Dia. _M Spacing I &A I IV A
COMMENTS: (Include code discrepancies, persons present, etc.) -7-Z,
Inspection #1: d'' /L //a /Inspection #2:
Location: 450 Carriage Lan , Hudson, WI 54016 (NW 1/4 NW 1/4 32 29N R19W) - 3229191817 Windsor Hei hts -Lot 1
1.) Alt BM Description = b df s; ,� over 0/4 Sewoy '1�� Atedl �qr�,.,.� k - Sc 0`aL � e%trV� I�
2.) Bldg sewer length = z1'
- amount of cover = > Y 6 4 kft_.eAe4 (tie,- e fk spa, Ied y 2�i
3 ) i t , S 6e�w «w 5 be /-a w t6l!dk --kcW c hk,.- 4pte s.
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD -6710 (R.3/97) Date Inspector's Signature Cert. No.
�') S < < hpfies bv, 4alk
nItTRIR1ITInKI SYSTFM
1
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes [] No El Yes [] No
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
M old f Distribution Pip s.. x Hole Size x Hole Spacing Vent To Air I take
Header �AA� Length Dia. L I Length Dia. _M Spacing I &A I IV A
COMMENTS: (Include code discrepancies, persons present, etc.) -7-Z,
Inspection #1: d'' /L //a /Inspection #2:
Location: 450 Carriage Lan , Hudson, WI 54016 (NW 1/4 NW 1/4 32 29N R19W) - 3229191817 Windsor Hei hts -Lot 1
1.) Alt BM Description = b df s; ,� over 0/4 Sewoy '1�� Atedl �qr�,.,.� k - Sc 0`aL � e%trV� I�
2.) Bldg sewer length = z1'
- amount of cover = > Y 6 4 kft_.eAe4 (tie,- e fk spa, Ied y 2�i
3 ) i t , S 6e�w «w 5 be /-a w t6l!dk --kcW c hk,.- 4pte s.
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD -6710 (R.3/97) Date Inspector's Signature Cert. No.
�') S < < hpfies bv, 4alk
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
M old f Distribution Pip s.. x Hole Size x Hole Spacing Vent To Air I take
Header �AA� Length Dia. L I Length Dia. _M Spacing I &A I IV A
COMMENTS: (Include code discrepancies, persons present, etc.) -7-Z,
Inspection #1: d'' /L //a /Inspection #2:
Location: 450 Carriage Lan , Hudson, WI 54016 (NW 1/4 NW 1/4 32 29N R19W) - 3229191817 Windsor Hei hts -Lot 1
1.) Alt BM Description = b df s; ,� over 0/4 Sewoy '1�� Atedl �qr�,.,.� k - Sc 0`aL � e%trV� I�
2.) Bldg sewer length = z1'
- amount of cover = > Y 6 4 kft_.eAe4 (tie,- e fk spa, Ied y 2�i
3 ) i t , S 6e�w «w 5 be /-a w t6l!dk --kcW c hk,.- 4pte s.
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD -6710 (R.3/97) Date Inspector's Signature Cert. No.
�') S < < hpfies bv, 4alk
COMMENTS: (Include code discrepancies, persons present, etc.) -7-Z,
Inspection #1: d'' /L //a /Inspection #2:
Location: 450 Carriage Lan , Hudson, WI 54016 (NW 1/4 NW 1/4 32 29N R19W) - 3229191817 Windsor Hei hts -Lot 1
1.) Alt BM Description = b df s; ,� over 0/4 Sewoy '1�� Atedl �qr�,.,.� k - Sc 0`aL � e%trV� I�
2.) Bldg sewer length = z1'
- amount of cover = > Y 6 4 kft_.eAe4 (tie,- e fk spa, Ied y 2�i
3 ) i t , S 6e�w «w 5 be /-a w t6l!dk --kcW c hk,.- 4pte s.
Plan revision required? ❑ Yes ❑ No
Use other side for additional information.
SBD -6710 (R.3/97) Date Inspector's Signature Cert. No.
�') S < < hpfies bv, 4alk
arif" *L(
qrkAe
(4,S)
fl•O&
WIESER CONCRETE PRODUCTS, INC. SEPTIC, HOLDING, PUMP OR
SIPHON W1200 -MR 189, 251, 252,06/10
(38.5" L.L., 31.16 GAL.IN., 96" MAX. DEPTH OF 1114
BURY 575 G.P.D. WHEN USED AS A SEPTIC TANK
BASED ON A 3 YR. SERVICE INTERVAL FOR
RESIDENTIAL WASTEWATER)
WIESER CONCRETE PRODUCTS, INC. SEPTIC,HOLDING,GREASE W1200-
FDL 227, 251, 252, 03/06
INTERCEPTOR,SIPHON OR PUMP (49.75" L.L., 24.33 GAL /IN., 96" MAX.
DEPTH OF 1114
BURY, 580 G.P.D. WHEN USED AS A SEPTIC TANK
BASED ON A 3 YR. SERVICE INTERVAL FOR
RESIDENTIAL WASTEWATER)
/4 A 6--
-- Sanitary Permit Application
Safety & Buildings Division
. *r.
In accord with Comm 83.21, Wis. Adm. Code
201 W. Washington Ave.
N visc
See reverse side for instructions for completing this application
PO Box 7302
Madison, WI 53707 -7302
Department of commerce
Personal information you provide may be used for secondary purposes
[Privacy Law, s. 15.04(1)(m)]
(Submit completed form to county if not
state owned.)
Attach complete plans (to the county copy only) for the system n paper not less than 8
-1/2 x 11 inches in size.
County
State Sanitary Permi Number Check i revision previous application
State Plan I. D. Number
/"0' t *#--
I. Application Information - Please Print all Information,
Location:
Property Owner Name
Pro eig Locatio
Al
n , yam
*T Vr 4 X&I /4, S ZLTa) ,N, RAE (orb
Prop *ID ees Mafling Address
Lot Number Block Number
$ _ ci �l
City, State
Zip Cod e
Phone Number
Subdivision Name or CSM
, /J
d�
"ILType6t
/
J S �rc
( )
6� 1
(check one) ✓
❑ City
* 1 or 2 Family Dwelling - No. of Bedrooms: 7
❑ Village
❑Public /Commercial (describe use):_
.Town of
❑ State -Owned
0*
L i
Nearest oad
Parcel T umbet(s)
III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) O — 13 T 2 • to
A)
1. WKNew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only Existing System
B)
Permit Number
Date Issued
X A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade � ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
/ p , Bo s.., c ,1
V. Dispersal/Treatment A rea Inf ormation:
1. Design Flow (gpd)
2. Dispersal Area
3. Dispersal Area
4. Soil Application
5. Percolation Rate
6. System Elevation
7. Final Grade
Required
Proposed
Rate (Gals day /sq. ft.
(Min. /inch)
(
Elevation
�c�
D-c �
9 �Pa �
3
VII. Tank
Capacity in
Total
# of
an actur
Prefab
Site
Steel
Fiber-
Plastic
Information
Gallons
Gallons
Tanks
Con-
Con-
glass
New
Existing
crete
strutted
Tanks
Tanks
L17
ti �
c�
❑
❑
❑
❑
v
fvGr/
�vtc S -�
❑
❑
❑
❑
VIII. Responsibility Statement
I, the undersigned, assum responsibility for installation of the POWTS shown on the attached plans.
Plum es Name (print)
Plumber's Signature (no stamps):
MP/MPRS No.
Business Phone Number /
64&nE44
� 9��
umber's Address (Street, City, State, Zip Code)
O` t7 cl4 fc --� O
IX. County/Department Use Only
❑ Disapproved
Sanitary Permit Fee (Includes Groundwater
Date Issued
Issui g Agent Signature (No stamps)
X Approved
❑ Owner Given Initial Adverse
SWharge Fee)
-22"t
`
Determination
. OD
X. Condition L - s of� Approval - /Reasons D'sapproval� C*-,o '
e-- cover 36 " �-v�Q,
.fi cam¢- �-�
s 5 -e �ula A [A - C6.QJ-
SBD -6398 (R. 07/00)
IENERioneRm
Maiden Rock. WI 1 -325 -8456
Portage, WI 1
Fond du lac, WI 18004841
Vebsite: www.wieserconcrete.cor
Prqjcrllamc: � C��mfiul:uiomsQ\:Daic:
Location: / (�c�f�►� ✓� � — (hcrkCd Q\: Date:
Tnldlt�m: shut:: OI':
IESER eenei�
i- X800-325-8456
1-800- 3627220
14800 - 6416937
Project Name: By: Date:
Location: � Checkcd By: Date:
Talc /Ilcm: /
meet or:
Maiden Rock. WI
Portage, WI
Fond du lac, WI
�3
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer �� ' r
Mailing Address
Property Address L a," `c- �s
(Verification required from Planning Department for new
City /State Parcel Identification Number
LEGAL DESCRIPTION
Property Location N ` ` / <, Sec. 3 . T a 9 N -RZ, Town of lea, I S2 4)
Subdivision r l ' . so y / (* 71 , Lot # ./_
Certified Survey Map # . Volume , Page #
Warranty Deed # % a 70 /a Volume /S If Page #
Spec house Z�( yes ❑ no
Lot lines identifiable 9 yes ❑ no
SYSTEM MAINTENANCE
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.
The property owner agrees to submit to St. Croix 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.
Uwe, 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 Zoning Office within 30
days of the year expiration date.
!I 12 c7
SIGNATURE OF APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of
the property des Abed above, by virtue of a warranty deed recorded in Register of Deeds Office.
1) / Z2/ O
SIGNATURE OF APPLICANT DATE
« « « « «« Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.
** Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
Wisconsin Department of Commerce M EVALUAMON REPORT
Division of Safely and Buildings
in accordance Comm-85, Ws. Adm. Code.
County
Attach complete site plan on paper not less than 812 size. Plan must
Include, but not limited to: vertical and horizontal r edion and Parcel I.D.
percent slope, scale or dimensions, north a a nearest road.
Please Print a
Personal information you provide may be used to ndary �. h) (m))•
f r H_
P����� �r74� ��� �_ � 7 20 01 1�,� 1/4 /4 s
cT Izbf V
Property Owner's Mailing Addrefis Block # Subd. Name or
WP;; t C
rr State Zip Cods
city OM axin
Ne9i C6h9WMn Use: ° Residential I Number of bedrooms Code derived design flow rate
❑ Replacement Q Pubic or al - Describe:
Parent material l P_S�s O'l�� �,� Flood Plain elevation if applicable
General corrimenIs
and recommend
Boft F/I # 1 nS Ground surface elev. R� Depth to limiting Fedor 7 in.
Page I of
Date
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FOR
FI # O
E Pit Ground surface elev. / •�ta fL Depth to limiting facdo in. Scut AnrAr--Am MAP
Effluent #1 = BOD > 30 < 220 rng& and TSS >30 < 150 mg& " Effluent #2 = BOD < 30 mg& and TSS < 30 mg/L
CST Name (Please Point) Sig a CST Number
TV
Addu�ss
1q.3 � � � � -(A or, 6 Date Evakiation�Conducted �!� ��
f'
• \ n \ \
1��Illllltll[�
+,.
FOR
Effluent #1 = BOD > 30 < 220 rng& and TSS >30 < 150 mg& " Effluent #2 = BOD < 30 mg& and TSS < 30 mg/L
CST Name (Please Point) Sig a CST Number
TV
Addu�ss
1q.3 � � � � -(A or, 6 Date Evakiation�Conducted �!� ��
f'
Property Owner Parcel ID #
M Boring # E] Boring 91 '2 0 PR Ground surface elev. IL Depth to llmA g tact+ in.
Page a of J
19
Pit Ground surfaoo E{ev. + W tt. Depth to irnitsrrg factor ">6'0 in. I c.,a a pro
Redox Description
'l
MMM
, i
�!►>t'
1, l�
ill
MIN"
M WW
19
Pit Ground surfaoo E{ev. + W tt. Depth to irnitsrrg factor ">6'0 in. I c.,a a pro
Boring #ng Ground surface elev. ff. Depth to limiting factor in.
Pit
car n �r_,eP
Redox Description
'l
MMM
�!►>t'
1, l�
ill
MIN"
M WW
Boring #ng Ground surface elev. ff. Depth to limiting factor in.
Pit
car n �r_,eP
Effluent #1 = BOD, > 30 < 220 mg& and TSS >30 < mglL . Effluent 82 = BOD < 30 mg& and TSS < 30 mg&
The Department of Commerce is an equal opportunity service provider and employer_ If you need assistance to access services or
need material in an alternate format, please contact the department at 508 - 255-3151 or TTY 508 -264 -8777,
SBD-V 0 M071Dp)
Redox Description
Effluent #1 = BOD, > 30 < 220 mg& and TSS >30 < mglL . Effluent 82 = BOD < 30 mg& and TSS < 30 mg&
The Department of Commerce is an equal opportunity service provider and employer_ If you need assistance to access services or
need material in an alternate format, please contact the department at 508 - 255-3151 or TTY 508 -264 -8777,
SBD-V 0 M071Dp)
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WiscotlsE 'Department of commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page of
Bureau of Integrated Seryices in ac ith s. ILHR 83.09, Wis. Adm. Code
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Attach complete site plan on paper not less th "i '1 inch in si must County
include, but not limited to: vertical and hod r dir ti6n `
percent slope, scale or dimensions, north a ;a/id kmca ' t road.
f Parcel I.D. #
BE
APPLICANT INFORMATION - rinta�ir�`drnr�l�r. r__ Reviewed by Data
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Personal information you provide maybe used for selcondary purpose L.aw, s. 1 .07�( (m)). 19 . xfA
% L'i --- — Property er OFFICE Location
�o Lot U 1!4 1 /4,S T ,N,R E (or
P Owner's Mating Address Lot # I Blodc# Subd. Na or CSM#
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City State Zip Code Phone Number ❑ City Village 129 Town Nearest R
.M New Construction Use: Residential / Number of bedrooms Addition to existing building
❑ Replacement Public or commercial - Describe:
Code derived daily flow 24Z — gpd Recommended design loading rate _5- - bed, gpd/1t .g:� _ trench, gpd*
Absorption area required _ bed, ft 2 fQ.0� 1 trench, n Maximum design loading rate gy bed, gpd/tF � trench, gpd*
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design/site considerations
Parent material / Flood plain elevation, if applicable ft
S = Suitable for system Conventional Mound In -Ground Pressure I AT -Grade System in Fill Holding Tank
U= Unsuitable for system 1 (0 S ❑ U 0 S ❑ U ®S ❑ U 119 s ❑ u ❑ S M U ❑ S ED U
SOIL DESCRIPTION REPORT
Boring #
13
Ground
elev.
1
Depth to
limiting
factor
�>S,2
on
Dominant Color
Mottles
=Mom==
-
/�
1
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II���J1irra
M'
riWAMA®
MEW
c
mm
Remarks:
Boring #
Ll
Ground
elev.
/eft.
Depth to
Address
Signatur Telephone No.
�b Date CST Number
ik
II���J1irra
M'
MEW
c
Signatur Telephone No.
�b Date CST Number
SOIL DESCRIPTION REPORT
PROPERTY OWNER Page of
PARCEL I.D.#
Boring #
,E3
Ground
PL —ft-
Depth to
limiting
factor
in.
Boring #
0
Ground
elev.
ft.
Depth to
limiting
factor
>-4—
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
,-,?6 in.
Boring #
13
Ground
elev.
ft.
Remarks:
Remarks:
Horizon
Depth
in.
Dominant Color
Mottles Col
Texture
Structure
-,=Mow
Consistence
Boundary
Roots
PD /ft2
Bed , Trench
1� t�
��'�
� e
—
�-
Remarks:
Remarks:
Horizon
Depth
in.
Dominant Color
Munsell
Mottles
Clu. Sz. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
PD /ft2
Bed , Trench
}
� e
—
�-
Remarks:
Depth to 1�
limiting
factor
in. Remarks:
SBD -8330 (R. 07/96)
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Private Onsite Wastewater Treatment System Management Plan
Septic Tank And Gravity In- Ground Soil Absorption Component
Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment
System (POWTS) shall include information and procedures for maintaining the system within
the parameters of Comm 83 and 84, and the conditions of approval by the department, agent,
or governmental unit. The approved plans and permits for system are on file at the county
zoning or health department.
This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground
Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD-
10567-P (R.6/99).
Table 1: Svstem Design Specifications
Sanitary Permit Number
3
Number of Bedrooms
Design Flow - Peak (gpd)
Design Flow - Peak (gpd)
00
Estimated Flow - Average (gpd)
4M
Septic Tank Capacity (gal)
I 2.8D
Soil Absorption Component Size (ft)
3- '-
Type of Wastewater
D mestic
150
Table 2: Soil Absorption Component - Limits of Reliable Operation
Table 3: Maintenance Schedule iq M,
Septic Tank
Septic Tank Component
Soil Absorption Component
Design Flow - Peak (gpd)
Soil Absorption Component
- :�
Maximum Influent Particle Size (in)
1/8
Maximum BOD (mg /L)
220
Maximum TSS (mg /L)
150
Table 3: Maintenance Schedule iq M,
Septic Tank
Inspect and /or service once every ears
Outlet Filter
Inspect once a year and clean at least once every 3 years
Soil Absorption Component
Inspect once every 3 years
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks
under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with
NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease
Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable
Restrooms).
r
The operating condition of the se and outlet filter shall be assessed at least
once every 3 years by inspection. The outlet filter hall be cleaned as necessary to ensure
proper operation. The filter cartridge shou no be removed unless provisions are ma — e to
retain solids in the tank that may slough off the filter when removed from its enclosure. If the
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Management Plan for a Septic Tank and Soil Absorption Component
filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously.
Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall have its contents removed when the volume of scum and sludge in the tank
exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the
time of an assessment, maintenance personnel shall advise the owner of when the next service
needs to be performed to maintain less than maximum scum and sludge accumulation in the
tank.
Manhole risers, access risers and covers should be inspected for water tightness and
soundness. Access openings used for service and assessment shall be sealed watertight upon
the completion of service. Any opening deemed unsound, defective, or subject to failure must
be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by
an effective locking device to prevent accidental or unauthorized entry into the tank.
No one should enter a septic or other treatment or holding tank for
any reason without being in full compliance with OSHA standards for
entering a confined space. The atmosphere within the septic or other
treatment of holding tank may contain lethal gases, and rescue of a
person from the interior of the tank may be difficult or impossible.
Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the
tank is no longer used as a POWTS component.
Soil Absorption Component
The soil absorption component serving this structure is designed to accept domestic
wastewater from a residential facility. The limits of operation of this component are shown in
Table 2.
The longevity of a soil absorption component depends greatly on proper and timely
maintenance, and system use within or below the limits of reliable operation. Good water
conservation practices by all occupants and the installation of water conserving plumbing
fixtures are key factors in extending the useful life of this component.
The soil absorption component's operation must be assessed by inspection at least
once every three years. The inspection shall include recording the levels of ponding, if any, in
the observation pipes, and a visual inspection for any evidence of surface seepage or discharge
from the component. On steeply sloping sites, areas of erosion should be identified and
reported to the owner for repair. The surface discharge of domestic wastewater or sewage
from the system is prohibited and considered a human health hazard.
Traffic around or over the soil absorption component should be avoided particularly
during winter months. The compaction or removal of snow cover over the component may lead
to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or
impossible to repair until weather conditions improve. In general, soil compaction over this
component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to
more intense, and earlier, organic clogging of the soil.
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