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HomeMy WebLinkAbout036-1078-50-120 connr= , Croix v;isro~'s-•~ ne>a~: -cot L:om'^"-~~= PRIVATE SEWAGE SYSTEM St INSPECTION REPORT sani:ay r°er~+n NC 600387 GENERAL INFORMATION rAIT CIITOI>ERL4IT? SlatcP'an:rNj Personal Wennation you croe~ne map he J$UC for,eCC-dary l ;privacy l > IS.e< r,pn'I Por°•e H.Ad I',Name crcv vill Tlmnship Parrnl Tax Nc Scott~Tamara Schmidt TOWN OF STANTON 036-1078-50-120 CST dr.1 Llre -rnp. W Rev l Dexrnption Sect¢mTownA23nge hlap Nn E L . C~ r vet I kr k r• : rl ;d 31.31.17.487A-20 TANK INFORMATION ELL :VA I *I A A I YpE MANUFACTURER CAPACI Ty STATION HS HI FS ELEV. Sepho BCr Cnn'8r6 6il t-V tL C~ ~vLt Desiny Alt LIM Aeration Bldg Sever ~c5 Q ZS I lelding I/ St:Ht Inlet ! ~JS 25- Still Ouue: y zy TANK SETBACK INFORMATION I ANK TO P'L :"JELL BLDG '•.•'=n: to A r Intakr ROAD D, Inlet - Seplic q Dt Holtom I1vsil•.g n l Haaoer7pAan C7 5Y [y~ / Aeration Des' Pipe Holding Hot System I - L'' 3 ` ) ^ Vtl7~ PUMP/SIPHON INFORMATION Final Grade f - Dcorarc S: cm.. + ~J r IolanufacLUCr G Ai1u~L C lc:"l 1 'I7 PIA Po1coc.Nwnczr ;.i c, -~t. is cwih FUH I dt I' lion Lox, System Head TUI I N Forcerla I,. Lerglh D sl to SOIL ABSORPTION SYSTEM ~-s , nck BED7TRt NCH n'h Le•^I!hr Nn f Tre Ures PIT DIMENSIONS Nc Of P,1= see J.1 Lgwo Depfi DIMENSIONS r (v 4 Y y~f~ ~ SETBACK SY STEM TO l BLDG WELL I AKEtSTRFA" LEACHING N.ar ufac !p I ~ CHAMBER OR INFORMATION - / UNIT tvlufcN..mheI L4 DISTRIBUTION SYSTEM ~--7`~wE'~` PI Ve Di n~arric'r _ I I ie fi ze r rick Spar ny n1 tc i.n Intake bet~.1 ilty is-/ if >p.itti~ .ercJ 5 y I: L Len 1t0_ Cu _ SUJ...nQ_ SOIL COVER x pressure Systems Only xx Mound Or At-Grade Systems Only De t J _i ,n Dcy'n ct xx Scecea. ouoeo F' hd"eJ DCpI O er P as r Jen,fr nit' Ed,es L;psn' Yes NG Vr _ Ko __dTicn~.^. Cer.c i 1' g ~ g COMMENTS: ;Includeceded'scrzpendes. persons present eta) incpetllo9 # Inspearon #2 Location: 1864 143RD STI f 1 } Alt Blvt Description 2.i Bldg sewer Iength - q2 f amount of r'cver -)2 i Plan revs,on Required' Yes No Use.. other side for additional information.V- I•,xep~~ler*.. SVign^a'c_~cll Cer. No. Daly SBDc i f 0 i R a's?'~ `atY County t - y-._---_. etacT 41 L J ` I - : Industry Services Division - 1400 E Washington Ave, Sanitary Pit Number (to be filled in by Co.) S P.O. Box 71 1s t ^ "s kK ~,'Iar 2 s zoos Madisuti 70=2362 " /a /l EvMGN Tp rmit , KGWV569 -State Transaction Number In accordance with SPS 383]1(2), U'is, Adm. Code. suhmizi( ~,a rorm to the appropn t _;os'ematcnml writ is required prior to obtaining a saaitan penni[ Nnle: Application (giros for sue-owned L'OW 15 arc submitted W Pmlecl AddreSti (if different than mailing addles) the Dcpanmrnt n Safety and Professional Services. Prnonal inhmuation you provide may fx used for secondary u uses in accnrd:wcc with the Privacy Lao:, s. 13.040)(m). State. 1. A licati n Information-Please Print All Informs • - POxncr's Narne > Parcel if Property Location 7A - aC Property Uxner's Mailing Address Got. I A City. Suite Lip Code Phone Number -t Y';" Section ~~1 f N R//7 f u/W II. Type of Building (check all that apply) Lut k 1 or 2 Family' Dx'elling - Number of Bedrooms Subdivision Name - ❑ Public/Commercial - lescribc l-~sc~ I BIncA0 C] i City' of L] Smac Owned Lescribe Use _ ❑ Village of Town of onnonc ~CSM Number Ill. e of Permit: (Check box online A. Complete line B if applicable) A. ® New System 1 ❑ Replacement System ❑ Treatment/I loldmg Tank Replacement thdy ❑ OOrcr 1oditrr.a[ion F..,fare System (explain) L Permit Ntnnbcr and Date Issued QJt~ B. El Permit Renen'al ❑ Fermi[ Recision El C'hanee of El Permit Transfer to New Before Expiration Plumber Chsnrr ~e r C IV. Type of POW'TS Sy'stemrCornponenuDevice: (Check all that apply)_ ~l • _ rs (M Non-Pressurized In-Ground ❑ Pressunmd In-Ground ❑ At-Grade ❑ 11ound _ 24 in, of suitable suit ❑ Mound . 24 in. of suitable wit ❑ Holding lank other spersal Component (explain) ❑ PnNrCa[ntcnt Device (explain) V. Dis ersal/Freatmen res Information: lesi m Flow (apo) Desicn Soil Apphcatiat Dispersal 4rca Required (so Dispersal Area Proposed (s System Elevation / RatefgPdsQ / _ 1'I. Tank Info Capacity in u c Gallons I Total a o C Ions f t U ao 1 darer - T c Units M c 8 2 Neo' Tanks Existing 1:uas l ~1j e- V i7 u' SepticorHoldingTanki❑ Dosing Cham bu ! _ - ❑ ❑ 1 ❑ -Q- VI 1Responsibility Statement I the undersigned. assume respnmOpldy In,, installation of the PONT'S shuxn on the attached plae-c PlunitJwo'skame ((Print) Plumber 4s.cnarurc / IMNIPRS Number t R, sines Phone Number Number S Address ea, City. State, ! Zip Code) I County/De )artment Use Only _ - - r 4tiprmed ❑ cd Permit Lece UatG,l ued X~" Issni -cro Sig u nsr.c cen Iteawn for Denial S 1 J t f~ I IU _ r)` _ IX. Condi"TftjQ*Y Reasons for Disapproval 3a D r S I, I , ate t4 1. '.Beplr Tark, cAkxrr. rNto-rn'f ( ,t-/1/'tcI ~I ,)s P?0i7 c~rwal.~✓~s/~►'~C~frv~ o:xPe^"•~ cell must all ¢g rr_IC^s f ro lnh ! e4 `Y as per Saar ayemerC Dian n'r,,iue : Vv ytu. ~ 2. All stthY.k rertksr.^ens m-Alt w n.noe t : aapM apF'{Ip1611 Cr>r•si :rA;,a M:[. s. r' - torah to complete plan for the system r sub t o the Caunn on h' nn paper not kss thou a M., a 11 inches to sue O /sue r S ~eyDired do, pccusS FT(= I I 1 1 I r u Y! , 1 1 o•, CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE project Name: - -t- - - Owners Name: _ n, Owner's Address: - Legal Description: Township: - County: Subdivision Name: J' Lot Number: - Parcel ID Number. Page 1 Index and htle Pdye 7 Plot _Plan _ Page 3 _ System Sizing & Gross-Section Page 4 f=ilter Specs Page 5 Maintenance Information Page 6 - Management Plan Page 7 St Croix Ct( Septic Tank Maintenance Form Page 8 Warranty Deed Page g _ CSM or Plat Attachments: Soil Test & House Plans 1 i)csigner/Plumber.1.~ L.irense Number: Phone Number Date: Signature c. Designed pursuant to the In-Ground Soil Absorption Component Manual for Povvrs Version 2.0 SBD 10705-P (N.01101) Page I 1 f I -_31 gin. v;?. ~ / x ✓ _ ~:1 ~ ~ ~ ~s:u.ej/ e.JS).lrv i'!il.C,C' 1 i rl< ~ k ~ f _ _ _ X lVr`~~•.Y/iiON[: AJ_~ I ' I a ,'f r ~l /r ''.5-r 3 PrC iii ~sss►~sa~f ~ ss a®at Sa~rkfA t I FAfG Vert Pipe VLTJJ V--,t cap dr- ing ft Chain 11 ii Chamber 1 t ~fsori ft--Tt sxGtem Platt Mew il}! ~r f~~t~ ~fT~i1I1 { mF,.!u HIM Z Veni Or 0bsenrabon Pipe Chambers ftt IVV~ g° Dr_ Trench 2 Header i~_ar`FFtFf~t GF°.3s3'~.6P.P ~.€re t~~RZS l ' Manufacturer.Aard Model E(SA Raring sq it per chamber Sail Appft3tbn Rafe gpd/w Chambers gpd Design Flow . Sul APPUcaflon Rafe s EiSA = - t 2 rows of drambers each- Page - = oe V PLG5 EFFLUENT FILTER ( Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters. The Pt, 525 is rated for over 10,000 GPD ? Alarm " Accepts pvo (gallons per day) making it one of accessibility extension handle the largest commercial filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the new Polylok PL-525 has an automatic shut off ball installed 525 linear feet with every filter. When the filter is of 1/1e' , removed for cleaning, the ball will fittration slots Rated for over 7Q000 GPD float up and temporarily shut off ii the system so the effl uent won't leave the tank. No other filter on the market can make that claim! Accepts 4° & e" - SCHD.40 Pipe-'\ P1 525 M?-interc-inc©: ► s The PL-525 Effluent Filter should operate efficiantly for several years under normal conditions before requiring cleaning. It is recom- - t mended that the filter be cleaned ` l avert' time the tank is pumped or at least every three years. If the installed filter contains an optional p, alarm, the owner will be notified 1 by an alarm when the filter needs r. i servicing. Servicing should be Gas deflector N...~.~:1 4f f done by a certified septic tank 1i Automatic shut-off pumper or installer. k... hall when fitter r is removed 1. Locate the outlet of the u.s. t'atent Nag s015.4av septic tank.i s.a7t.wo j 2. Remove tank cover and pump tank if necessary. I? ~~ti ii"S a^E!c1$fC*f 1. Locate the outlet of the 3. Do not use plumbing when septic tank filter is removed. Ideal for residential and com- 2. Remove the tank cover and 4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose off filter over the septic 10.000 Gallons Per Day (GPD). 3. Glue the filter housing to the 4' or 6' outlet pipe. If the tank. Make sure all solids fall filter is not centered under the back into septic tank. access opening use a Polylok 6. Insert the filter cartridge back Extend & Lok or piece of pipe into the housing making sure to center filter. the filter is properly aligned and 4. Insert the PL-525 filter into completely inserted, its housing. 7. Replace septic tank cover. 5. Replace the septic tank cover. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Paco cf_ FILE INFORMATION SYSTEM SPECIFICATIONS On~rcr i Tank tolanufadurer: - ' I I NA Pemlit j Septic ❑ Dose O Ho'ding Volume (gap DESIGN PARAMETERS Tank Manufacturer L4 NA Number of Bodroorls rl NA ❑ Septic ❑ Dose L7 I lolding Volume- real) Number of Public Faci ity Urits. Y-1 NA Vemcal Distance 1 ank Bottom(s) to Service Pad. (it) Est mated (average) F:o:v: - C'~ (OaI'dayl Porizontal Distance lank(s) to Service Pad' (ft) Ues p=rifir, se:vring mechanics must be provided if vertical is>15 feet or l/ :yn (peak) Flow = (esti:haled x 1$1 (gal .day) f horizontal is %150 feet Specific,nstrucllcns to be provided on back, In Situ Soil Appl cation Rate: 1 (ga';daylt'i Effluent Filter hlarufecturer L.1 NA Stenca,d (Domestic) InflUCnUf-thuenl felonthly average I ffluent Filter fe1odel. . ; Fals. O.I & G,easo (FOG; _30 mg1L Pc:np Polan~jficturer Riorhemical Oxycen Demand (HOD.; <220 rnril ❑ NA 1,4 NA 7o6a1 Suspecded Solids (755; 50 mrlL Pu•lip Model H'gh Strength Influent,'Effluent Monthly averaqe Pretreatment Unit i-OGi >30 m;fA- Manufacturer: (30D,) >220 mgiL NA ❑ Pd ff NA (I SS) >150 mgiL echanical aeraGOn L] Peal Filter ❑ Dis.nfcction ❑ Welland Pretreated 1 ffluent A4cnthly average ❑ ;suNi::ravol Filer ❑ Other. tson,) 30 mgil Sn l Ahsnrpticn System JSSi s3U mgrL NA =veal Colilorm ire rashic ~nr:ani <10` n In Grourd (gravty) ❑ InGround (pressure) ❑ NA I I ?4 -Grace I.1 Mould N11aximum. Ef iuert Particle Size in cia. I NA I D-ip-I -ne r_1 Ctrcr Other: - - - - I I NA Oti•rr. - ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pjmo o..t contents o'tank(s; - Vhcn combined sludge anal scum aquas orlcC.iul (l;i of tank volume ❑ When the high water alarm is activated Inspect condition of lank;s, Al least orce every : - ❑ Inong:fsi (Maximum 3 years) ❑ NA ❑ ycai (s) Inspect dispersal cell(s) At least orce every - - ❑ u:urifi(s) (Maximum 3 years) Ll NA _ >f I yearis; Clean effluent filter At least orce every- - f I lrcnthisS II NA ❑ yearis? Inspect pump, pump controls & alarm At least orce every: - I mcmthfa'. _ - f<1 NA U nears; _ Flash laterals and pressure test At least once every. ❑ rouvltjs` E~ NA Other. mcnlhs) - At Ic<-s once every : I I ccanls; G NA (2her - ❑ NA MAINTENANCE INSTRUCTIONS Pispediuns of t5rks aid Soil absorption Systen'S shat oe made by an mdividual ra•ry,ng cne o' l'ie follc•:',cng iccrses or certifications: Master Plumber, Master Plumb- Restrctec Si/Juer POV-JIS• Insoectc-, PO:VIS 61aintainer or Scpmgo Senacrg Operator (pumper,, tank inspections must include a visual inspection of the tank(s) to elanOfy any missing or broke•I hardveare, identity any cracks or leafs, measure the volume of combined sludge and scull ant a check for any bask up or ponding of effluent on the ground sulfate. The soil absorption system shall be visually inspc,-tod to check the cllaent levzls it the observation pipes and to check for ary pending of effluent on the gmurd surfacC. The ponding of ettluant on the ground surface rnay indicate a failing condition and requi,es the immediate notification Of the local requlalory authorily- 'idher the ccrnLried accumuatior Of sludge and scum in any treatment tank equals ere-third (S) or more of the :ank volume., the entire contents of the lark soaa be removed by a Septage Servicing Oprratrr (purrpr) anc di=posed o` in accordance with chapter NR 113. 'i'lisconsin Administra=vie Codes All other services, Including tuA not landed to the servicing of effluent filters. mechanical or pressurized components, pretreatment units, and any servicing at nteara.s of 12 months, shall be performed by a ccrtned POW1 S Pela retainer. A service report shall be provided to the local regulatory authoc¢y wctnin 30 days of c orlp. PI on of any service even:. CAA'-005 (02105) Page _ L- nt _ _ START UP AND OPERATION For new ccnstruatian, prim to use of ti-c PO'WIS c-ic.:* treatment tanks) for the preserec of painting products, solvents or other chemicals or sed.ii that may :mpede the treatment process andfcr damage the soli absorption system. If high concentrators; are detected have the contents of the tank(s) rcmovOd by a Septacc Sati•irdng On orator (pumper) prior to use. Pump :inks may fill above normal highwatei levels prier to startup or due to pump failures. Start up or restoration of power under these cnncitions is not recommended. as the excess wastewater vgll be dis,uharged to the sod absorption system in one large dose causing an overload that may resua ii the backup or surface discha,ge of effluent and damage to the system. To avoid this situation have the conterts of the pump tank removed by a Septage Servic'rig Operator (pumps) prior to restoring power to the pump or contact a Plumbe• or PCLAITS Mainta--nor to assist in manual:y opc-ring the pump cortrols until normal off Licit levels are restored within the pump tank. System start Up shall not Oxusw'hen soil conditions art, frozen at the infiltrative. sur`ace. Dj not drive or park vehides over tanks o• the so i absorption system Do not drive or park over, or otherimse disturb or compact, the a'ea w~ thin 15 feet down slope o- any mound or at grace so] absorption area. Reduction or otm:nntion of the follownrg fro'n the w•astemale• stream may impioee the perfoaran00 and prolong the life of the treatment Tanks and soil absorpton system' acids, arlibiot,cs, baby •.wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss, (tapers dis rtartants, fats toundahcn dran (sump pump] disenarge, fruit and vegetable, peelings gasoline, greases- herbicides, meat scraps., medlaations, ols, painting products. pesti6des, sanitary nap'kins. solvents, :ampOns, and watr softener brine disehargo. ABANDONMENT =!en the POVVTS fails ardrer is permanently taken out of service the follow•ng steps shall be taken to insure that the system is properly and safely abandoned in compliance with s. Comm 83 33, Wisconsin Adminlstrai Code • A I piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. • 1no contents of all tams and pas shall be removed and properly d soused of by a Septage. Servicing Operator (pumper). • Ater pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filed with soil, gravel or anofre, inert solid mateAal CONTINGENCY PLAN If the PO%NTS Is 's and cannot be repaired ;he followicg measures have been, o- most be taken, to provide a code compliant replacement system [?r( A suitable replacement area has been evah_aleJ and may be utilized for the Ic:;ation of a replacement soil absorption system. the rchdaramont area su:ulci be protected from distu,bance and compaction and should not be infringed upon by required s.-tbnck, from existing and proposed structue, lot lines a^.d wells. Failu'e to protect the replacement area will result in the need fo- a ne'd✓ soil and site Ova cation to estahd:sh a sutable replacemert area Replacement systems must comply v;rW. the rules in cure: at the time of their perm' issuance. F1 A suitable replacement area is not availabe due to setback and+or sci'.. limitations. If the sal absorption system cannot be rchabil tated and bav:ng advances in POWTS technology. a hold -9 tank may be installed as a last reso-t. I I Tic site has not been evaluates to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation rn.st be performed to Ic:;ate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resorl'a rep.ace the .`ailed POS°.?S ❑ Mound and at-grade soil aosorptio-. systems may be re:;onstnrcted in hire follo•:;ing removal of the b:ornet at the inhtrative s ,_race. Recorstruclions ct such syste rs must corn ply with the !Li les in efteA a- that arrc WARNING ~i TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: POWTS INSTALLER POWTS MAINTAINER Name ! _ Narie Phone - r'honiv SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY N?ru~ Nam(. i - Phan( Phone 7. Th -1 ds,.m=:r via; d wit :l l I t..: -,r;a of tre GreCn I nk : Ir1om!ioro. and':; ai_.'I lra t_:ran:y PCIVCTS r-gLlaUr/ ng=aneE. 'n oomo'iAi ce v.i'h re::rions C, rtnL'o <3i" L I Pl$'i,' 0 r'I'J. t,r 7~ ~2i 4,, 1% 6lrncrii'n r G'zCcAi% tl , III I I~I~_ i ~ , - - I L /:I f II ~ i l ' i ,t 0 fCOTT & TAMA_fCHMIDT >m Tll ~''t~~0~~` Ins ISlsrfr. new alcuMOn~, W1,5401/ j II ~ _ 1 11 ` I I \ I ~ Ali ~ \l a n I I I I I , I I I IT FPIZ II I- I III !I r \J oin's Droumq doorr. fCOTT & TAMAJCHMIDT 14:5.5 181sr./t, ArW R'C.HMO/VU. WI .M017 ?tt afFlt r ~ li sh. I I i Il ~ I i i I _I ~ l ll ' I i I I v i I i I i III ~ ~ i I I o ~ i I I I p LN - Iain'%Drawlrg Room fCOTT & TAMAfC HMIDT Id351A1sT,/t,lVLW k1C_bM0/VD,WI5d017 ~t~C`'~~~~ ~ v» ' ® t I u I I II I I1. J' i z li i v Fl- . I T, - r I f COTT & TAMA-rCHMIDT ;U fl' bra ing zoom: I I ~ c _ I I I . I I J Ai4 I I I, n I y i I:. I - I I i 4 4 4- - i I I I i T, 1,1 1 f COTT & TAMAfCHMIDT ton's Urrw r g koorrn 1x331£31st./'t,/VPWliIGfiMJ/1U,'•,JI5.1017 ~t~~~~~, ~ al d» - - - - - - - - - - - - I I , III I I II I I I I ~ I I I J , I _ I I I i I I I I O II I II i ' I 1 I I I i-- I II II L I II ~ I' ~ I I I , I I I I I i I I I I I I I I I L. I I I I I I I I L I I I i I , lain'.^. Drru:rg Room ./'COTT & TAMA-fCHMIDT 1455181alf1./s.tW 21CHMOAD, WI 5401i ~,md» 3 I r S I I 1 i I i 1 1 u r I. fCOTT & TAMAfCHMIDT O 143.3 18151ft, /iLW WCIMO ID, WI 5401 Jtt~Sta~~ m i ~I ii ii. I~ i I L~ - W la:n's Drc uir 9 Room fCOTT & TAMAJC.bMiDT 1455 181,1 f t, /Vt4.- RICHMO/9D, %,/15 4011 'u~ & onYtQi ~ - _ I mlr4 I , I I', ~ y i loin's Drawing Mourn -fC-OTT & TAMAfGHMIDT c~ 1433 is 5ff , nFw a cpn; nv. wl 54017 r p-mrk Gf i nc{ Ecrm : G' - -Mill i j. i llj -r i j - 1`i I i fCOTT & TAMAfCHMIDT loin's Droving Room ~tY5~r C~ 1455 181st ft, nt=W R:C,MMO/iD, WI 54017 - f 1 1T - I_ r a: .fC.OTT & TAMA ROOM 433 lfitst.l /VF W kICpM J/iV. W1 54017ct myu' ST. CROIX COUINT'Y Si TTC ~-K -7 viAL!'I~_A.NCE ACsR ENEZ AND 0 WNTRSHUP CERT=CAT10N FORM /4l !11'V,;i G'l. r nerB rVW nil Yerificaaon r°quued from Planamg & Zo=,%Depamnent for new consWcoon.) Ct,:/State j ; Parcel Identification Number - EG L DESCRIFTIQ ?ropefty Loca don. i/< N R_LLW; Town o~ ~U Subdivision Plat: tot Certified Survey Map i Volume k' _ Page # Warraett Dead t I- J (before 2007)Vo1•arie Page g Spec house C yes i no Lot Imes ideirtifi" 0 yes 0 no SYSTEM MAINTENANCE ARID OWNER CERTMCATION, improper use and maintenance of your septic system could result in its premature failure to handle waves. 1'ropK maintenance consists of pumpng out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into ue Systeat can aaect the ibnction of the Septic tank u a tre=e= srs-a in ate waste disposal system Ownermainteaance remonsfnilides are specified is §SPS. 383.:2(1) and in Cbapter 12 - St_ Croix County Sanitary Ordinance. I"he property owner agrees to submit to St Croix County Planninz & Zoning Department a ca i6cation form, signed by ere owner and by a master plumber, journeyman plumber, restricted plumb-: or a boensed pumper vc.ffyto, that (I) the en-sibs wrstavn= disposal system is in proper operating condition and/or (2) after inspection and pumping (If necessary), the septic tank is less than 7/3 lull of sludge. Uv;u, tae unaersizred have read 6c above requirements and agres to maintain the nrivat.°, sewage (.isposai system wit2h the standards set A e4 berm, as set by the Deparw=t of Sa_-.ay And Profeemoaal Services and the Department ofNata al Resources, Stare of w-zconsm CctiSmuon staa;g that your septic system has bee- mambuned m= be completed and returned to the St. Croix Cottmv PlP2.lT mg & Zoe= Depar3m t w-rhm 30 dal s of he three year cViza ioa dax. Uwe certify that all statements o ' ' Strm are nue to the best of my/our knowledge. I/we am/ure the owner(s) of the propwty described above; by verve of a arrstaty deed recorded in Repster of Deeds Office. Number of bedrooms S -ATA't R„ OF A~oPLICANI ; (S) DATE -"A zy information that is misreumseated may result m tae samitary perm; being revoked by the Planning & Zoffn¢ DepwliaML include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the cer¢oed survey map if reference is made in the warranty de,' fR ti.04/1Z) ILxauncnt Nuni:m: Document I ills ' , 4 0 6 :44a1f;A St. Croix County 1062725 c BETH PABST Affidavit for a single POWTS REGISTER OF DEEDS ser.•iell 22 '1'w~ Struetures via Private Intereeptor Main ST. CROIX CO.. WI RECEIVED FOR RECORD C,7 JJ 03/27/201802:44 PM Name-(Owner) Typed or printed EXEMPT a. heing duly sworn, stales, under oath, that: Ree FEE 30.00 PAOES:I llcr'shc is the owneiico-owner oflhc lullowing parcel of land located in St. Croix Counts-, Wisconsin, recorded in Vrftmn: ,PzfFe_ Document Number ' >O. 1 SL Croix County Re)~islcr of Deeds oflicz: ;t.. order ..,Tea Name and Return Address A parcel of Is d located in IhCs~ Ofthe jr✓t of Secliurl. i / , T~N,RjIN'. ~(Cr+~ GM(1/[^ ~C h/rf t own of, ,•;~A',✓ -S& Croix Cuunty Wisconsin, hemp, (duly described as C1,7 rr~,P L follows (include lot number and subdivision. CS\1 or detailed Ic~al description): q "A r IUf 5L&X C-cif CSI'% Vol, b Pie al~6& ~f r to flared Idanrdi;.alion Manbn l ls,p a owned' of 11+c BhnbL deSCflbctl propcnv. I acknow le h,e that a Priva(c On site % aslewaler l reaunenl System IPOINTS) sem-ing the plinlaly residence is sized for 3 bcdroo nisi waW I design wastewater flow otr~- pall mrday l D~1 F iv based on 150 gpd bedroom ail persons per bedroom). A maximum of E. occupants are permitted, if the nom I>f OCCIlpanls CWTC(IS the maximum for P014 I S design, Ihe• system will be undersized to 2cconnnodale increased wastewater flows all(] or contaminant load, and may be subject to prernature failure. An accessory structure NOT to be used as adwelling has been connected to the POWTS via Private Interceptor Hain Sewc:r (PIMS) in compliance with SPS 782 ±Oi 12). 1 wlderstand that disclosure of this infuriation will be made to any panics ictere>led in purchasing this properly in tile finare Dated this day of Att'I HENTICATION ACKNOWLEDGMENT ' Si ature SfA'll: OF WISCONSIN ) <plgn1°nrn Try )Sa. 4.C<n _ ' - - WILSO N• Croix County' 1 1i. mahemic riz his c o day of <C_, C!- Person:div came h Ire me thi< _,,4l day of ~ e ~l year9 G G'(A R year the above named f ~ SY'c-> ~ _t hm is n v'.cP 1 p !I'!a /cc Ali M rd' ~ - pU HILL ME,NIBER STATE BAR OF WISCONSfIp 0 to me knowm c he the (If not, sT'' _e yvnlsl who executed the lixtgomr mnnunm and qTE OF jdeknnwledge the sane. Tana muaPS A lllnrlLed by V 700.06, Nis Scats.) 'PHIS INSTRUMENT WAS DRAFI 1:1) BY • ~ s,~Ir1ji~~ga,{l~ ~1fUE~~11'lEil~ ~~~O~t/111941"i~ (Signalures nlav be aI thenheatc or acknow ed -cd Both are oars,Public Slate of Wisconsin not rwces'atp i My ( nnunlssam is pernlanenL Ifnut. stale expiration date Date:. Ally a 7 L-OI<~ "THIS PAGF. IS PAR I (IF I IHS I.F.GAL DOCt %o:NI DO S(Tf ICFARA F:" An m6rnrarion inum h: r ur!•irnsd hT aubmiff r :h,ton.,n1jgk. lame & reI1mI a 4, ;-red P(!: / 'r<:rutre.ii ~ f1n- i„'b. rr:a r s... 5:es lAr eranlin}; elawes• legal desc Follon. e(. mqv be placed on llus fern parr q,' the dnrunu,nl nr +n... c, r.,aa ed a+ rr T ,a.~ d Jr iu•r rs h~:f. ce n' fhi.v emvr mxge aide one pace n;l our decanien!and J211fi In ltie rcrnrdure IVis. ~nnr t;mm~c, )rl Ji S. Cron Oou~ty'06L12S I'aGe 1 Of 1 CST-dole -0 33 Wis. Dept of Safety and Professional Serviil:#i, ? 6 '?'U§OIL EVALUATION REPORT Pa Division of Safety and BuiMings - of in accordance with.SPS 385, Wis. Adm. Code Auad1 complete site plan on paper not ktiss than 8 V2 x f1 inches in size. Plan must County , V include, but not limited to: vertical and horizontal reference point (BM), difecligq d Parcel I.D. _ percent slope, state or dimensions, north arrow, and localign ag4distatY~Jr~ Jst road. Please print all informatia~-- EvMGNM Revie by Date Personal Information you provide may be used rw L` 69 s. 15.04 (1) (m)1. Property Owner _ _ KGW i7 Property location o % - Govt. Lot r:- 114--.-} ! 1/4 S i T N R E (orj~V Property Owner's Mailing Address Lot # / Block # Subd. Name or CSM# city Stab Zip Code Plane Number ❑ city ❑ Village OTown Near oad New Construction User Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial -Describe: Parent material Flood Plain elevation if applicable ,/1' -ft. General convnents and recommendations: F 71 Boring # ❑ Boring ® pit Ground surface elev. fl. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure nsistence oundary Roots GPD/ft ' in. Munsell Ou. Sz Com. Color Gr. Sz. Sh. ff#1 It#2 Y, A 1 ❑ Boring # Boring L - ® Pit Ground surfara elev. i , ft. Depth to limiting factor in. _ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure sistence uodary Roots GPr) in. Munsell Ou. Sz. Cunt. Color Gr. Sz. Sh. IBe f1#1 ff#2 r / _ Effluent #1 = BOO > 30 f 220 nglL and I SS >30 < 150 mg/L uerd #2 = BOO 30 ingit and TSS < 30 mg4 FAdd (Pleas e nt SignatureCST Mu w Date Evaluation Conducted Telephone Number SBD~8330 00 i i Property Owner < - ate; f<'.' _ .1./ Parcel ID If i Page of Boring ❑ Boring # ❑ : - ®pit Ground surface elev. ; , .~.1 fl Depth to limiting faClOf in. Soft GcaSon Rate Horizon Depth Dominant Color Redox Description Texture Structure nsistence Boundary Roots GPORt in. Munsell Ou. Sz. Cant Color Gr. Sz. Sh. itiF1 f(#2 ❑ Boring If Boring Rao ❑ pit Ground surface elev.. fL Depth to limiting factor in. Soil Aply GPD/R Horizon Depth Dominant Color Redox Description Texture Structure nsis[ence Boundary Roots ft#1 ff#2 in. Murrell Qu. Sz Cont. Color Gr. Sz. Sh. - ❑ Boring # Borng C] Pit Ground surface elev. ft. Depth to limiting factor. in. Soil Application Rate tex GPDIft zon Depth Dominant Color Redox Description 'ture -Structure z. Sh nsisrertce undary Roots if#1 , B#2 Hori ' in. Munsell Qu. Sz. Cont, Color Gr. S. Slt. Effluent #1 BOD > 30< 220 rr4k and TSS>30 < 150 mgIL - Effluent #2 = SOD < 30 mglL and TSS < 30 molt = s _ The Dept. Of Safety and Professional Scrvices is an equal opportunity service provider and employer. If you need assistance to access services or need material in an altemate fomtat, contact the department at 608-266-3151 or TTY through Relay. SUUE)yn tRUn n Property Owner. Parcel ID# ?age --o0 ' Boring # r❑t7n~ Boring 13i Pit Ground surface elev. ft. Depth to "ling factor in. Sob ADObcabon Rate Horizon Depth Dominant Colar Redox Description Texture structure onsistence undary I Roots GPD/ft ' in. Munsell Ou. Sz. Oast Cnfor Gr. Sz. Sh. H#1 ff#2 ',L , a s~~ lW' i - F / I ~ I ❑ Boring t Boring pit Ground sudace elev. --_fl. Depth to limiting factor iri_ Soil A,nnlica6on Rase DM Horizon Depth Dominant Colnr Redox Description Texture Structure nsstence Boundary Roots GPD/h , in. Munselt Cu. S± Com Cola Gr. Sr, Sh. t;¥#T ftfk t iiOring _ ❑ Boring # 0 Pit Ground surface elev. , fl. Depth to lirtutirg factor ir,. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture structure onsistence Boundary Roofs GPDIR ' in. Munself Qu. Sz. Cont. Odor Gr. Sz Sh. R#1 ffX2 I i Effluent #1 = SOD e > 30 f 220 mgt and TSS>30 1150 mg/L ' Effluent #2 = BOD 30 mglL and TSS < 30 mg1L 7'hc Dept. of Safety and Professional Services is an equal opportunity Service provider and employer, if you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. sao-arw reran o QA"l ' I 11133 1 I I ;gym ~ l I 'Tel rkx ~ % II I 1 I I f~usL i~C7;a6r."v w,;. N I I I I I I I 7#) . 3, - - - Lund i:.rr ST C~UO-l,UiV1 Y I',arrnrn,pd Iirrrcl hilorniatron P. esour-ce Manntlemenf C'onnmunity Development Department 5,14/2018 Scott and Tamara Schmidt 975 E 410 Street New Richmond, W'I 54014 RE: Conditional Approval: File# LUP-2018-018 Project Location: 31.31.17.487A-20; Town of Stanton Projec Address: 1433 181` Ave Dear Scott and Tamara Schmidt, Community Development staff have reviewed the Land Use Permit application for construction of a new single family residence and land disturbance within the Shoreland Overlay District, Chapter 1730. The request has been conditionally approved based on the application submission and the following findings. Please see the enclosed site plan to reference the general erosion control and oradinc notes. • All setbacks and height requirements have been met. • Erosion and Sediment Control plans have been submitted that meet Wisconsin Department of Natural Resources Technical Standards. Best Management Practices will be incorporated. • Impervious Surface (1S) calculation is not required pursuant to Admin. Code NR 115.05 (1)(e)l.b. • The P-ivate Onsite Wastewater Treatment System installation is approved under State Sanitary Permit x600387. • There is an existing driveway and address from 181'-' Avenue, approval for access off 143i0 Street will require Town of Stanton approval. Please see condition #7 regarding driveway access fo.- residential lots. Based on these findings, approval of the Land Use Permit is subject to the following conditions: 1. A pre-construction inspection is required to discuss the construction timeline and verify the silt fence has been installed downslope of construction activities and the vehicular tracking pad installed pe- Wis DNR Standard 1057 prior to any land disturbance activity. Please call me at (715) 386-4683 to schedule this inspection. 2. St. Croix County reserves the right to require additional sediment and erosion control measures to be installed if found necessary due to site-specific concerns. 3. Permanent vegetation shall be established once final grade is reached or as soon as applicable. 4. A temporary cover crop such as oats, winter wheat or rye, OR, mulching will be necessary if the site is not stabilized by September 15, 2018; please reference Wisconsin DNR Standard 1058 and 1059. Phone 715386.4680 Governmen! Center, 1101 Carmichael Rood, Hudson, W! 54016 Fox 715.386.4686 Laud Csc ST. C R 01X 1 z U NTY ~'Innnin A. Land Information KctiouacAlunngenrrnl Community Development Department 5. Al; temporary erosion contro! measures shall be left in place ane maintained until the site has reached a point o` at least 7001c permanent vegetation. 6. A post-construction inspection is required prior to removing the temporary sediment and erosio- control measures and to verify only one driveway exists. Please call the inspector at (715) 386-4683 to schedule this inspection.. 7. Once construction has finalized, this residential lot shall have one driveway access. 8. It is the applicant's responsibility to secure any other required local, state or federal permit(s) and approval(s) prior to land disturbance activity. 9. Failure to comply with the terms or conditions above may result in the revocation of this permit by the Zoning Administrator according to Chapter 17.30 (13). This approval is subject to the conditions listed above; it does not allow for any additional construction, structures, or buildings beyond the limits of this request. Your information will remain on file at the St. Croix County Community Development Department suite. It is your responsibility to ensure compliance with any othe- local, state, or federa! permitting or regulations, including contacting the Town of Stanton and the Department of Natural Resources to inquire if additional permissions are required. This permit is valid for one year, with the possibility of up to two (2) six- month extensions if the applicant submits the appropriate permit extension fee and documentation to the Zoning Administrator. A copy of the Land Use Permit placard should be submitted to the local B,iilding Inspector for the town upon application for the building permit. The orange placard must be posted on the job-site and visible from public view. Please feel free to contact me wish any questions or concerns; I am typically available Monday- Friday from 8:00 a.m. - 5:00 p.m. Respectfully, J J4, ,i Sarah Droner Land Use Technician 11 File er__ o veins:oo;~~idc :_a>nr Contractor/went wr,otst[+ r', rr ,+~~fro c~^ net ,F~, Town of Stanton Land Use Technician enclosure Site Plan and Erosion Control Notes Phone 715.186.4680 Government Cewpr, 1101 Cormrcnaet Road, Nudsor, IA/154016 Fox 715386.4686