HomeMy WebLinkAbout042-1017-50-200
w sconsm Deoan-erl c'Cc--erce PRIVATE SEWAGE SYSTEM County. St. Croix
Safely an] Building D vlsi l
INSPECTION REPORT SannaryPermitNO
600392
GENERAL INFORMATION (ATTACIITOPI M111) Stale Plat, 11) No
Pu-sunal irlp+malor, :JU p'n.ire- may ne r.xed'er secerda"i purposes IPti'ra+.✓ I s 1S :M It+im11
Per- it ihicur's NJ^'c Cry Vil age Tzvnyhp ParCfI tax NO
Dustin T. Garden TOWN OF WARREN 042-1017-50-200
CST Btvl Elev iriG I46a i' a;' Rlvl Descrpric Semen+I ev.n Range 'II No.
07.29.18.104A20
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV
Septic Benchmark 1 D 1V .co
Alt. BM
'Bril LACY Aeration Bldg. Sewer
I I.
HoLjing - SVHt Inlet
SVHI O 1S
TANK SETBACK INFORMATION
TANK TO PR_ *ELL BLDG. `+e-nJ Alf 'take. ROAD DI nlet -
Septic ! Of Bottom 3,O
Dosing Header: Man.
Ae•ahon Dis: Pipe
Holding - Bot System T 19t03.(0
Final Grade
PUMP/SIPHON INFORMATION 60 G
arW St Cover
Manufacturer ~k GPnPd
U S /6
Model Neel
_O
TDH Lift J FncGon Loss System Head JT H H a r,
,?Q lo. 1 J
F-orranlain en: t? Dla Y ulst'n."0 oil
SOIL ABSORPIITION SYSTEM
BED:TRENCH naa" 1 '_enct•i _ _r NO Ot Trerrnes~ PIT DIMENSIONS Nc Of Pds Irsidde U Liau_id DC .Ii
DIMENSIONS C6~fvT -
SETBACK SYSTEM TO PR. BLDG WELL LAKE!STRFAIyt LEACHING Lfa-urac'nrer
INFORMATION CHAMBER OR F
nypCOri LP UNIT RI N-Thee
DISTRIBUTION SYSTEM 1 oV oAri f- lT~'0i
1Header8vnawtyd;l Cstrlh~lnrr >:fcc Sm xIlMe ~payine Var ^An P+UXa
r r•ioesi - - -
Lrnctn_a0__. 11 t u 1 e"TtF fha Spac ng
SOIL COVER + x Pressure Systems only xx Mound Or At-Grade Systems Only
D-7 J':C" r, pill OVer tx De Ulll Ui xN SCC~C~~u:Une~ - Mk ~!Ub~L'U
Bed'T-e-..ch Center C~ Bee'Irce:r I does - Ire&''IF - Yes Nc ZS--'-NC
COMMENTS: llnclude code discrepancies , persons present, etc.; Inspection #1 Inspection #2
Location: 1C." 93RD ST
1.; Alt BM Description = 1 G KJ OX.
2.; Bldg sewer length = sr,7b
- amount of cover = )
Plan revison Reguiredn Yes No p 1rY) /~.Ir _ ` D (/71,,//O
Use othe• side for additional information.
Dare InsePetor•553r, lure Cerl No
SI!G F. Ki fR &37r e
r No P -L County
Safety an gs mis,on • / X
-'•O Q~`~ 201 'A! Washington Ave, -7BOx 7162 tianilary!'ctml; ,umhr(to i:a lill,:i
s _inky CI)
t p $ , i0 ivladisnn, WI 537073707-7162
(o~39Z
S Iwli ermlt Application Sidle I N' b%:~
7a ax.nrdar: , arGl 3Sp,AQO W Ct'~ y'r.:' n ts: mot. p: ~,rnt nee .L 't I'- r
>r un Ip , + t.: , , i..I PUI TS. 'l „
c I SD [3 rd
~ i +t l t tluadmtt i A Ol ta,,
t ,alum llcmcl rri ',it
-
Gardten - - - 0/7-o-a0 0
f! 77-
f2J~ ~ ~ru?ooc~ 84- VD 2
- - --,'S~ Nw ~7
1
r{S 71S a -x273 z9
1 p -
11 P, a
U of Nwld/ng (check nil Ih-tt-npPl
Cs m
I_:•,.iplo-C'onPrr%crak 17:ar:L•_t1~ - _
-~aY✓'~-
\ V`a~ pl~~. ~Z15tZC)~Z6G•~{a_-'S~~y3 Q Ac Al
i 111. TpPc of pet and (Check onNo hos on line A. (anlPletc line) dapphrulde) - _ X,
T- -I
j St'.'.... ' ~Krp:.c.n_.-t S,.,un .,.''~Cr.• I~~(1:+<r ,.o..il`ta i~P•,sb,, ,>.nic~!~~ahU
I yIIy\ lype o(PO\\7S Sc5lemlCotnnonnNUerue_:_(Chec1. all lhai apph)
pv 14.• . ,!a-G.a: -ci i.. I' ..>tn _ ..:v'. 2., ,i. al v-rL 4.:-n.i
,
1 fTtp Nf'rt al 't tlulm'tnaltm -
boo . /Roe) iaoo yo„~,~
L'. r r - - ,
w/~a ink S25
\11 RespomrhdtN Slalenranl- 1._ the undla%iyned,•t time rJan"il Hit,W,in}rdlatiup oC the VIM lS ~hron an fix atlachxd plane.
1 }o 7v c~ ~ l ` ' ~b o~ lJ 3L~'7 7~5-760
."S
_Idx_`~~3 Amery _r, 1 - - -
\!!I purl ,btL,R,:c rt (
7 0-"
I`C fondit - !M;u- fww'jpprutal
MIRFIQ~IIM1M1 3) ~~ac ~~.e 6
+rvK,T0r•>IGMrkn•Plu+p!orac+tw,rJUrnlxr.
2. All afm* r9gjr :ism MU t Lin -xt:t( irea
as per rppilCr'EIS cars: !
_..-.\,16it1VCU{~y. tellLn lutr: )-N~.•.I,u.. ~•1tuN.C.4JLaL{~eLIJrB. YV{I~ 1'umhLt•.N u1~n>iee
~r N,
~ , yo
~/ate a= T~`r
rP.
13 _a = 9,93
13~ 3 0 /o0.-2o
31 /a50 / 76-0
s ~ \c
r, b-l
3a~
x
k ~3
coin
aad3s7
CONVEN ION,1L COMPONEN` DESIGN
ReSgen;ia AppilCat,or
INDEX AND TITLE PAGE
t V8rc~2e
>wners Name c,-si'~ Y-, ayje-yN
vner's Address l )?l-c7 i r (dC9o Ct aL
Wo b of fs Wl _
_e?ai Descnction ~LZ^PJtJ S7/ 7-a4 N/~i9&)
TownsniF
S-+ Cvc-- -j
c Sin
Lot N:,m:je,
Farce: iC Nur-~b~ Q~a - /0/7 - J`-D -~06
r^^aae 1 I^ae, an:: tlt~e
Pape G :3kOT P;ar
Page ? Svster Sung &Cross-Section
Page c Filter S. ec
Page _ Maintenance ir.for-.an-
Page S Manapernen: P,ar
Page' S: C:orz Crv Seot:c Tank Maintenance For-
Paoe E Nda^anty Deed
Paoe S CSM o- Pia'
tittacrr,ents. Soil -es! 6 House ~ ans
6esrgneo'?r~ inner nn-0.~ Lk r roe tse Nur,aer '9C2035 7
Cate I. Y. ~9 ~rj/8 core N; roe 7 / S - '~LSt~G
Sjorati-e 44
IY_e --e.: 1, :n_ r, - 1nG S, /4L, =[1''0~. . _ $3G ~...5? T
P3~8 '
! 0. 3 ( fT- u~. o~
93
i3r1 a 7-1
/a50 / 75-0 % C16
.9
g.l
3a~ X
k ~3
a-~
aao3s7
Soil Absorption SVStem Cross Section
ft
_44 ft
4' Schedule 40 Final Grade
PVC Vent Pipe
With Vent Cap ft
~ 7 Q K
Leaching y
Chamber ft
System Elevation
3 ft ft ( ft
Soil Absorption System Plan View
ft
3-ft
~ 1~1~ h
( ft j Leaching Trench 1
Chambers
4" Dia.
Trench 2 Header
Vent Or Observation Pipe
Trench 3
Leaching Chamber Specifications
Manufacturer And Model 7 ~ 7^/
EISA Rating ~ 20 sq ft per chamber Soil Application Rate • Sgpd/s4 ft
-60p_ gpd Design Flows i S Soil Application Rate + Q0 EISA = _60 Chambers
j 3 rows of 0 chambers each.
boo , s . iaov ao - ~o = 3 do ,o~ ~
Page of
- 1
I IL
~ArJ'r
s 1
D iNvERT
IN%ERr
Pb,la Standard Chamber Specifications
iFRATOR
2 1 .4436
z ~
u =
vZ~
Out 4 a
2~
`
~JZ
tL U
Z o z
r- -
U a
W O
a~ A
f J o 0
O o~
J
Q /N Y I
o
m .
M
uj V\'
Q U.._..i
>
Y w ~J `
U w
d ~
J
m
Q
H
W
f
r+ i
C? lL _ V) Q Q
C7 Ul f C
J/ lyl LL LL ; TTTTJ"'' ! LLJ
\ CD~~~ Z~~
f' A o - gym
o LO
_ ~ ~ Co L 1
N 1- LLI
~L 'I
_zr
Septic-Dose 'l'ank Cross Section And Pump Performance Specifications
I ank Manufacture- Pump Manufacturer &0 ~
I ank Model Number /aS p / 75 0 Pump Model Number 'L
6~S
T
otal Tank ('apawty Alarm Manufacturer
Max. Bury Depth Alarm m ~ - -
' _ ~ ~ - - Model Number Q 6, ~
Switch Type
Filter Manufacwrer l ntal Dynamic Head (TDI1) - Feet
Filter Model Number P 3 a
-J----- Elevation Head
a Distal Pressure
Network Loss
Minimum Pump Performance Required oZ cj
_ T Force fain Loss ~G
O GPM (a)
2 - - / Ft TllH Total l_.
Outlet Manhole Min. 4" Above Grade With
Locking Device. Inlet Manhole Manhole Min. 4" Above Grade
6" Below Grade Scaled Watertight ~ Sceurel y Ntounted With Locking Device
Weather-proof
Junction Box D J
Finished Grade
r Depth of ~
Cover Vent Min. 12" Disconnect
Ft ( Above Grade Means
With Vent Cap
Outlet
Outlet Filter
Inlet---- Inlet Baffle Lf
Switch Settings and Reserve Capacity A
Tank Volume- GPI Weep
Dmicnsion Inches Volume Gal B Hole
.
i (reserve) A
C (alarm) B 2 Off Elevation C
♦
_ <,< Ft
(dose) C iv
Bottom
(dead) D S g~- D Elevation
Total
_ Ft
GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the
manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not
be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock)
installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and
laid on stable soil to prevent settling or sagging. 'I he force main is sleeved with 4" Sch. 40 PVC to bridge the tank
excavation and the sleeve is sealed watertight. Electrical service complies with NIX 300 and Comm 16.28 WAC.
A„nc < r Paae of
ra.eteeYii/t ["M111~7
EP04 & EP05
Series
A►►UCATIONS •;yedlanw In lq~S • EPOS Inpeller:'hermoplas ■ 9aS.Upper And
IIAMIW br t;( eixlosed design for h" dutq be 'I beaon
Spec"-CAy Aes" for the
i^y,rH.nq sps tsAAM%ae laid few I mp!oyed pedoamante 'instt'u(tior,
• EM.rept system; Am Mallky. ■ Casing and Me. Rugged
•':orrs ArailallelMaAMlertaad thermopsasti(design provides AGENCYLISTINC.
F?'TS superiorstrengshand (corrosion
raanal epva*m- AN► resistar.(e e/WaVn su^a.'a: .weo..:.
Neaq duty sr,mP "Wk Mook kwilode 6 r+e f t4sssas
• "eater transler Medsankal►seaeSorlRh ■ Motor Housing: Cast Ow,
•Ot++dterifg assnllMk ampreslllatthe tol Olont heal Iran[ GOWS Pw"p, nnU 90ol ~egM..c
t", strength. moo duratMity.
SPECIFICATIONS ■ Motor Cover. therr!sopla K
•'rntrdshandnngfapabrlny FEATURES cover with lnteyralh&fXk nd
md}rmUm E float Swnth aeachment pOiniS
• :dw !;ts: up to 60 GPM ticS"*"w# r • power Cabe: 5ewt duty
Told: heads: up to 31 feet. Pa~PahRgst~ Y ~adwKSi rated cnl and water repstanl
• Dwhsrge suer t rli V7!_ seat
•Mefnanuat seal carbon'
c•a^Y: ,,'scat onary.
HL NA h e'a9pmerS.
"r a ",walu•e
ca s (Wo (onunuous
160Y.? wrterrmtttrS{. M[e~ ftai _ - - ,
• AkIpilers: 300 series
A'.ITOV! damage to
~;mpene~ts a[ ~t •
4
• i F04 SLlgIt phase 0 4 HP.
V~ ,
,.aumavf fewt
• Fp!:5 S.ngle phase 0 r Hp. 7 aF 14,
I ,S
.,rV0'..0'': 60,411SS0 ~NPa Gr:,q :n cve•rnad w7~ _
e~.ca:ataresel 1C ~ j ~p,'~(Q1~' roa
•GCwr•:Ord 191x1 _._.1.. _ '
xrern]arn •e!Igln. lFj3 .F -t-"`__."'-
i'rw wnh !brae ;:.ronq ! j II
;Pdmq plug. Optvai lU _..~i_.... I
,1?A^1V
. ~ ~ J~ CsOt1Il1; PU lp5
I
`VU TS Ob'%rNER'.S NIiA•,i. tL NiANACztMENr PLAN
-!_i: IrJ RF"::11D!c SYS"IEM SPECIFICANDrJS
S,.p,:c (a tk tail:! E V,
r, a
Wieser J N
DESIGN °APAMP TFRS Etfluari =dtur Mai ,o NA
'Juinbe >uUroorr._ _J _L{ Eflwen Filter Mace
1 'dumoe o' 'u hho Fadlity Links p( r% Rrnp Tank Crn arrtc ~J!'-~. ~.J., - NA
-„amazed floe: leveraget _oump an+: NA
I sign tio' ipeik• IEhtmored X 1.5 • umc IJan •'a-,
. 604 r','
1..5 ~0 Appiiavur Rai lump M c C po 6 'c.
G
'-andard n`tuecir_fflinnt Quality
i
Fats. Oil a Grease iF00r ;30'T Sa,,r _i ' 2:•I r:ne-
Biachenical Oxygen Demand 130:;,1 _22' Fn,; P:;: ~'Je::ar nical Aers.ur, -',.ellund
-xa suSnended SUildS _ _^s_r e_tI°n..-- 7 Otner.
atreated E",,uent Quafrtp• Mon,,hiv a.wage 7coan:hi Crllls: N4
.
Jxyger. _ emana IBDD.; -30 rng:.. :3•uund igravi;y. In-Ground tProssuriraa
?xuSusaanded Solids iTSS; <_3O mg yc: r" . A--u`ade ❑ Mound
°cca :.oliiorra igaaaietriC meant ~7-
CILl'J.~ C D:;p-Lme Ober.
LidxinlJT. Effluen'. Particae S2e---....-_- Ir dl: _ •6„
o' RA irw- `
'i 81LLf.'•JpICFI ('J'riCS[IG C: Y.`s1tl V: aICI bl1U :CCkG l'J'1!: :.'I:JO ] - ~
h1AINTENANCE SCHEDULE
Samoa Event Service Frequency
r n
cspeot conditio- of 'acvis! At t::as: ors.. _:;vur' month's! (Maximum 3 years)
2 a vea-rs'...
'ump ota contcn:; o' :w kisl aVhan cimninee s r --zi , ~.r~s ,r -nird ri;l of rank volume
Inn Peet di pe et del si At leas an a sve (Maximum 3 yearsl
iJan effluco fad. A iezz:~ on
=putt im tp.:)ur•a controls & alarm-__ wt leas unc
~C
ush laterais and pressure ieiit loast on~a L m n pis Q
Yeaf S',
A. :Cas once r.v.
SAINTENANCE INSTRUCTIONS
r,spsct,oas a' taros anr.. dxpnfsal enas char ne made ey an i^dlvidua carrying ore of t'te io!lowing ucenses or ce-titicat x:c:
Master Piurnbw. Master Plumber 3est-icted Sevre-: z"W-is inspector, ?CWT) Pfairta:ne,: Santade Se•vicing Operator. Tcnr;
'sue:a unn must ehcvude a visua, inspectior of the tanks! is idemifh• any miss'.ng or aroker hardware, identify any Cracks o. "cL.
n'.uasure the volume a' comoired sludge and S: um ar,c tc ciiucK fu! any back uc or oonding of effwent or -ne ground svi.....
he dispersal celitsl shale be visuaby inspeotec to cheek th^_ f fflucn::ovo.s in the nbsarvation dines and to cneck tar arn- nor i'.
s iusn; on ;ne ground surface. The pending cf affiusn: or: the ground surface may indicate a felling condition and reauires
I'~nea-ate notifir-midn u` the iu::al reguiarory alit OT1.
ien the comoiaec ac;.jnu:avon of s:udge dud sear In any :ank rdcals one-Third 3i or more of the ;ank volume, the
:'.:h:•.ter•;s o.' IDe ranK sna!'. ba removed nv R Seotage Seri•icing Operator and disposed of in acuurderice with r• taps, NR
...~_::s.n .4cirranlstrat`v6 Code.
'u' o:na- se-v)ces. mCludr^g but not limited to the sa• icing o' nffiu¢:n fitters, mecharicat or pressu:;cec carnponana, d•e-rewm,
L;nas, and any servicing W. inwvals of 512 mdnms, shah, be perforrnrd by a certified ?C%1%7S Maintainer.
vice epor sl-ni'. u- c-rSJ e_ .h : ire • :.ul nrc• . Ir.-~~ Yc _ _
2
UP AND irj;',
➢l az:i;o pr,llr t-. C, t:
-:r IT:av imp-do the treatment proceSS and:or damage tha dispersal pelt Sl. If high iC,!r
o' :-.e lands! removed by a sentage servicing oporator prix- tc use.
.'stem start up snai: vn: occur when snit pendlti O.^s a'C frc30n a, 1:19 irailtrat!ve sirfar'
I-.p power outages ournp :auks mac ill. above ,ur•-ta, nfn-v. ator levca. Sdtltiu t.rt•, :I , 1_ a;: r.;
-il ;cI" ',grd is 7ha d:spe:sa pellis! in one ;wge dcso. ove•ioarfing rha ce!Is; and map -eau : ir, t -!D ❑S::ku~)) U:: 1 I~ oe.> uur.
u' "T. -c' avoic this sitnanon nave t•1e Cuntelas of tiro Uwnp tank ramaved by a Sep-ape Sareici-g Opurawr p- o• to ra5tct'-;~'-:
to the eifiuene Pump or contact a ?luftlber or POINTS Maintairer to assist in manually operating the pump ccntros
aorma' levei5 within the pu-np tank.
,nt drive a park venues over tams and dispersal ;:elis. Gc' no. cni a o• park over, or otherwise disturb or gompac;, the
78 teat down slope ui any lnpuod a- at-a-ade soil absorption area.
ration or elimination of the following from the wamcwator strearr Inlay rn:novn'he oa~ormance and n,o!ong the He or -r,
-...:-S: antiointics; haby viines; cigaretTe burs: condoms: cotton swans: .._c ~Lr.L;I r -~,D
7iatiin drain. !sump ;:unnW v:ace-; fruit and vuuc;ar,:u pea6ags; gasoL1e ,
...-'.nac3 produg-s': aesti_ines; Sanitary naokins::alnpOna: am tauter S :Ye•le- n- -
AEANDONMENT
tna °014"S fans arln:or is permanontly taker r, c.' service the
or srly and safely abanoonod ir. compliance with .^.l;ap;er Carom 8x.33, v`: s..pnsl4
• AI' Dining to tanks ana pits shalt be disconnected arc the apannoncl D :pc op::ninys ::r.
• -ne !,.lien's Ot al Tanks ano Pits steal, be ran,Ovoc and p•npe"y diSCpSEp of be
• Aite: pur.)ping, all tanks and pi's steal! bE Oxcavatcd ana removed Or trial, covers ryrnuva-~ anc tea Vol. space ti!Iccl
soli, grave' Dr anotri inert so!'d matera'.
!-:DN''TINGENCY PLAN
P.I -a raiis and cannot on lepairr.: t;le (oilnvaing :naasu:es nave pee',, o- thust ne taken. is provioe c ac-dc compl;-.i-i:
_:'eme'C sV5t01)::
J;caole repta_e nant area has been pvah.ateti gad may; tie utirizex: for the location of a replacement sot? absprptin
c: stem. The roOlaceinent wen shoukf be Drmected tram disturoance and compaction and socuid not be infringed upon. b,
':'-%wod ser)doks from i xis'ing and proposed structure, sat tines an, wells. Failure to OrXect The replacement area wil
c..l I: ir t45' nucd fJl" p now soi; anc ::its ( :'aluatcon'r. ei'a U1:5:: a saCanla 'en:a•:e Ten; area. R9nle Cemnnt SCSte'nS mds'.
-..mly %t is-1 the I Was it. etteci at boat 'ima.
;;Jnanle replaclament area :s not aV3aab10 !)JO TO 5`•'>Fn:k are :Y till: 1.[rtliail:It15. Barting advances in ?OWTIa
iP.Chnnlnn)' a roNling :anK may' be i:)sial L•L as a 135! 'a5 r"t tJ 'Lpiace the mired ?O1''.7S.
, J ~-t a}'al,la' ~y^~•i)_L" ^ ~ .l,c '~CT;~rET"'it-' a J ^.n _
h1 :OI{Ot•. r:q , _.ro-' - -
rnrd anc d:-g-adE 5n1 anSD'ptlOn 5)•STC:':S' 'hat' be 4:..,ns .,riled in :)lace :emnc.,
In'iG'nl'ie su-ia Ce. Raco15trc110ns of S"_^. ,VSICMS' 2' 9: ^,pl•j '::i"1 e`a'l;:es i^ ef8:ci a: ind:
l4•AKNING> >
SEPTIC. PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NC'
°NTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE :7P u
PERSON FRONT THE INI ERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
.DDITIONAL COMMENTS
P D\ArTS INSTAt1EF POINTS MAINTAINER
Name - E Name
Pn one 'L/L7 - Lj f~'yClj .Dne
SEPTAGE SERVICING OPERATOR (PIIMPERI LOCAL REGULATORY AUTHORITY
41 1
!'none t ° ;one j -7 r S ice. r q-7)
ST'. CROLX COUNTY
SEPTIC TANK !VLkLN'fE\ANCL AGRFP 1=N7
AN-D
OWNERSPAP CERTIFICA'FION FORM
(rjlterT3u.cr_ ~~r f
' LIL-ac Address/V?// _Ya;rwood L-a lobez,-)z _Syoa3-
# /v58 n?~
Proltet'.v Address ~ C/ - sl~ee~
- - -
(frerifica'ron rcaviced from ?fanning - Zoning, Department for ncucorstrrcuon:j
City?State ~O~Fa P reelIdentificaaonNu:riber
LEd;A1 DESCRIPTION
T'ro-)cny Location SE ' N W , Sec. T AL? T R A VV,'I oNvn of (t b~► refit/ -
Sabcivisiun Plar. //1 p_-_ Lot 47?
Vo,umc Pa«e 4
Certified Sun-ey Map 4 95_ll 13 .
Warranty Deed # (before 2GQ;)Volumr - Pale n
_105
Spec bouse f vcs fC r:o Lo: line iticn:iaa:+le R>'es _ no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Irny,: raper use and ms:iuteua c of yoc septic t~ sc:n could resLlt in its a e:raturc failure io ht;:itclle wzstcs. roper
maintenance consists of ptunping out the septic ; d everv thr c• wars or sooner, if needed, by a lic.nsed pamper. What yoL put it:to
the system can aliect the f.mctiot of'~1. septic ::nix as a treatment stage in the waste disposal system. Owner rriaint.nancc
resnonsibili:ies a-e spocificd in § PS. 383.52(1) and in Chapter 12 - St. C. oix County Sanita y Ordnance,
fie property Owner ar_rees Vc Submit to St. Croix County Pletmin° & Zoning Deparment a certification forn. signed by the -
owner and by a master plumber, jou:neyrnan plumber, res:rctcd plumber or a lieeused pumper verifying' that (1 i :he on-site
wastewater uspusal system is ir. prup.r operating condition an.for (2) after inspcc:ion and pumping S If neccssaryl, the septic tank is
;.ss :pan l;3 full of sludne.
i; wc, the uodersiencd have read the above regLiremeats and agree :o maintain the private sewage dispcsal system with the
standards set forth, herein, as set by :he Deparment of Safety Azle. Profession-al Services and the Dcpancne:rt of Natural Resources,
State of Wisconsin. Certification sratir.g d&, your s.ptie system has been mam-mined must be complctcd and returned to the St Croix
Comity Planning & Zoning Department within days o: the three year expira-ion date.
L'we ce:-u fy that all statemer:ts on r fora1 are true to the best uC rny%our knowicdgc. lime andare the owner(s) of :he
property described above, by virnre of a uayfan N d,,--,!d recorded it Rceister of Decds Office.
Number of bedrooms J•Jl
'SIGINA'III.RE Or PLICANN,S) DATE
""Any information tha: is misrepresented may resLit in the sanitar'y permit being r.vuked by the Planning & Zoning Department.
lndude with :his application a retarded war an:v decd from t Register of Dccd-s Office and a copy of the ceri.5ed survey ma is
reference is.T.ade in the warranty deed.
(REV. 04 !12)
17
C 5-~ik - ooh
CI
JAN 0 4 2018 puce I_ bt~_
t r r'tq son Ise,°nt s SOIi_ EVALUATION REPORT-
Ode
r, rtl 4:~i1~~'B r I. ~ggeFJfdba. ce tvdh SPS 3&n, _
~L':u.r t:onp=.•.e sRe plat ^n Pape' r of less lran 8 1:2 x 11 inches in vze. i'lan IX1'.u^t 07 a _ / 17 - D , '1D O
p'A r -.r #r 0 _t f~i~d a Z¢ nir er:'. P r r%r t„1a'e A en of ntng~ ~rnevlto aatlesl rnao ?evin LO Daalee`
Refire bi 7 / S
ail information.
D1WB6DHBV9NP4
'ILI
nn, p
ornpert't I. ocahor r 7 N R F to ''1'V'
ect. oc aNtJ'a
1 1~ 1 • IJGI a: u u1ccM A cod ^.arneo S1Ap
a C5m a5- b4~ 901a
`ornpurty Owner h9adirc A.d9re_s
iage [$Tcwn Nearest R03A ,,..1
k LV
(;i y
Cl
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NJrnber
a - Stale Lp Chic P (v
1lv~t~_ LiSy°a3 1; 7)5 ? -`GPD
4 770c ernltr de5'ar pov; rate
fI~ N ^rr r,[hon J< ~ P. sines ial Wittier f eJ -orn.: _ _
I r•'I n r t L} F url r mr T'1e':aa C .5 ih.' _ - - fl
1 BxU Fic:u, 1 _1- _
IPa ntmateial~lJl 3 T.C•
t.ereral cowmen's ZSo, Best 3-tr~-tn ehx$ L.5'F~r ~r r"a'y r . Y.~ 91~3s'r
l a,d'ecoinr•,Cndx'ons.. T r C 9 Y. 8e ~ \ ~7 L: L-1'w'r 11 S Z ,
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go•nlg 9 f ':.eptl tr. lirntirg fadrr ~ ~ - ir' So I F heat_°n ate
_ PJ t
R°o'` ff1t1 Y;F<
r tr'iz::n Ceps Gar,ir air °cdox Degcnptinn ~ex :r.° o •ucture on Sz Sir,
(;f+ S>.fSir--
rc Piunsell3 t . Con! COlrr ~`rt .
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a Pit -:oJ 1_tra .e clr
G_t fft_
_ nrmdary Routs
F' ,zor Depth Do linar Crln Fedcx Ce-_r,(ip[ion rr -cxtu~e ~Irr urc .Onsi aonre 1-. fp2
t ^rr scp ~Ou Sz. nt coins
c:.
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nurnrzr
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Prnpefy Owner -al -sf l1-:7
4nenq *f3o•inq
I p Crrt r- s.lface elev. IRP-70 - Gfpll- tc F1,11 rnQ tact I r'~ O n. .
- Sole " lice mmial+:
Horzor, Depth r1roYand a'..• RenozUescna'cn T=..xtr.re Stnu.It, ..Insistence 'or,roarp Ncr_t<. GPDr@
C. `.Lnsfll :]u. Sz- Cent Colcr Sz SI. ffki ff,72
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a i a-75YQYly FSL 1 F r C~ iF
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I] Ennrp
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L_1 ❑ RI Grnund surfs:e elev Dep+h to L'nAir faHOr
_ _ _ Sotl R~ I ^aUUn Ralu
Cn pepli. on indr.t C;:Ior R2UOx Descri .lion
f^_--_ er..ve , wjrc om!tenre oxidar~ Foots 1IDU
r r Ln- j Qu. Sz. n; CJor_ (;F z_ Sfr ' tfCi ifa2
1
F-h.^r,:#• urr'• _ In „i_2rtl c: ~3C :^SG rt•gi_ '64Inen1 i:1=RCa _?a li and TSS _ 30 mgI
! f !Sal;- rn l f -oll-' ml S:-v :n oppmi .:rci.. prrr•. idcr ;-nd cntplm or - I f ,ou nccd av.,:uc:c to
a.rav.._rviics or rrcJnrnrialu n:G;crn.c lnrrmv.:. r':rrt the a:•(•;rnm:•m :dl `_~:,6..;IC1 r•r Tl }'Ihruuah Kcla,.
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I`lo^aor C,onnan; i. ICrI kptlpy ~y rti2.:nn 7_x-t' Soil A* Iica;ton Rate
i . ~'ucRr- orssie•rce -amtlari kooC• GHG+FI
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D .i1 - ~J a~56 m JZ1'
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to ?i: i;rnur.a st.rac= Elc•: I DO .g°r r, Cec11: h^^. Jmihnn'actor 1
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WoconsinDepsrtmehofCommerce SOIL EVALUATION R€PORT Papa! of
3
Division of Safety and 6taldings 1
in axortpncbypih Comm 85, Wis. Adm. Code i'
Attach complete site plan on paper not less man 812 x 11 inches in sae. Ptan must -
include, but not IlmNed to vertical and horizontal reference point (BW) direction and percd I.D.
percent slope, scale or dirnensions, north avow, and location and distance to nearest road. 47 -1C,1 7- x1-
Please pdnt all Wonnatlon. Reviewed by Dale
Personal informtxm you provide my to used for seconAary wrp m (PrMry law. S. 15.01(1) (m)).
Property Ovmer Properly Location
❑ ❑
KAREN GARDEN Govt. Lot SE 114 NW 1/4 S 7 T 2S N R 18 E(01)W
Property Owner's Maflhg Address Lot a_ Block M Subd. Name or CSMIF
947 107th Avenue ' 2 -BmetnB
City State Zip Code Phone Number CNy VlNage Town Nei rest Road
Roberts, WI 54023 ( 715) 749 - 3571 A. i j93rd Street Wnixen New Construction U" E] Residential / Number of bedrooms NK Code derived design
flow rate GPD
❑ Replacement Public or commercial - Describe:
Parent material sandy outwasb Flood Plain ekwdon if applicable N,q N.
General co"rnorts Mound System 0.50 ft sand fill 0.6 loading rate
and recommendations:
1
Furtber investigation can be conducted after the location of the dwelling in esL,blishcd.
❑ Bormg a ❑ Booing
Q Pit Ground surface clov. 98.32 ft. Depth to limiting factor 55 in.
Sol Application Rata
Horizon Depth Dominant Color Redox Description T®rhne Structure Coneizbsna Boundary Roos GPD/R
in. Mussed Qu. Sz. cent color Gr. Sz. Sh. 'EIW1 'EfIM2
I 0-15 7-5YR3/2 - sl 3f-msbk mvfr cw 2vi f 0.6 1.0
2 15-20 7.5YR3/4 - sl 2f--msbk mvfr cw 2vf=m 0.6 1.0
3 20-30 IOYR4/4 - sl 2&bk ds cs 2vf f 0.6 1.0
4 30-55 I OYR4/4 sl 1 fsbk ds cw 1 of IF 0.4 0.7
5 55-60 IOYR4/4 n f IOYR4/6& IOYR62 sl Ifsbk mvfr 0.4 0.7
Horizon I t,.s Mme 51
2 Borkg a 100.22 39
0 Ph Ground surface elov. ft. Depth to lim" factor in. Sol Application Rate
Horzon Depth Don4 ant Color Redox Description Texture Structure Consistence Boundary Roc a GPD/r
in MuneeN Qu. Sz. Cont. Color Gr. Sz. Sh. 'EftM1 •EfW2
1 0-19 10YR2/2 sl 2f-mrbk mvfr ab 2vf f 0.6 0.8
2 19-26 IOYR3/3 - fsl If-msbk mvfr cs 2vf-a1 0.4 0.7
3 26-39 I0YR5/6_ - Is Itmsbk mvfr as Ivf m 0.4 0.7
4 39-43 10YR5/6 nfIOYR5/&&IOYR6/2 Is 1rmgbk mvfr as Ivf IF 0.4 0.7
5 43A8 10YR5/6 m2p7-VALV4dIOYR62 Is Imsbk mvfr 0.4 0.7
EAued 01 = BOD > 30.,E 220 mg& and TSS >30 1150 myL ' Effluent C2 = BOD, < 30 myL and 7 3S 130 mg/L
CST Name (Please Prtd) Slgnfttlne C ST Nuttier
Mary Jo [4ur*crt Hollister's Soil Testin & Desi ? n 224832
Address _ Date Eva Conducted telephone Number
W9875 690th Avenue, River Palls, WI 54022 12 - IN - 11 (715) 426 - 1775
Property Omer GARDEN. Karen (l,ot 2) Parcel ID N (Pending) Pal e 2 of 3
Borring L.J I;ng
❑ S. Q Pit Ground surface elev. 99.22 It. Depth to limiting factor 42 in. Soli katbn Rate
Horzon Depth Dominant Color Redox Description Texture Shucafre Considerxe Boundary Rocs GPDNR
in. Monaca Qu. Sz. Cont. Color Gr. Sz. SK •EfW1 •E11102
1 0-32 10YR2/2 1 2f-msbk mvfr cb 1 of m 0.6 0.8
2 32-42 _ l0Y sl IEsbk mvfr as I of IF 0.4 0.7
3 42-50 IOYR3/4 fIf10YR4/6 sl If--msbk mvfr 0.4 0.7
❑ Boring K H Boring
Pit Grand surface elev. R. Depth to limiting odor in. Spit Application Rafe
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rools GPD/IF
in. Munsell Qu Sz. Cont. Color Gr. Sz. Sh. T1fIB1 •Ef l#2
4
❑ Boring a Boring
Pit Ground aurlace elev. R. Depth to limiting factor in.
Soli Application Rate
Horizon Depth Dominant Color Redox Description Texture Strua4ae Cormstence Boundary Roos GPDO
In. Munsoll Qu. Sz. Cont Color Gr. Sz. Sh. 'Efla1 •ERR2
• Effluent 07 • BOD, > 30 1220 mg/L and TSS >30 < 15D myL • Effluent 02 = BODr < 30 mpIL and r. s 130 myL
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance I) access .services or
need materiel in an alteruste format, please contact the ekparuncnt at 608-266-3151 or TIY 608-2r4-8777.
51%D43Mfen(R.07e0)
P t~' i nr;S> a rt~~ 1"F ~z P-064reJ Of:3
r+x~ertiV Owner KA+rC~.v G~rv~ f--~
=.ditft.
Y' r Ica tewe, 4t .w%tere -noted)
QF THE AMI' f?,136Ni rc,.4'ti f-.: , d 'Fiakiive_pit
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