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HomeMy WebLinkAbout042-1076-80-030 Wi,cul-s'.n DCPanrient of Commerce PRIVATE SEWAGE SYSTEM county St. Croix SI,t'i and Bile ing Div s or INSPECTION REPORT San 11 Permit No'. GENERAL INFORMATION IATTA,^,I TO PERMIT) stale Plan 10 No 600397 .r'er5•:JnaI in'GlmS i on y:nl F.flIoce III L',•_' .60U uCGU ".da ly' PWPGFG_s [PIwAr., 1 a'A 5 •h 04 :111 Pei t Her ills NJnle Civ V Mace TPwnsr'ip Pal To. 1I Matt Skoviera TOWN OF WARREN 042-1076-80-030 f.SI H I I~~ h.4p. Bll Elcv RI.! fieapnpl an Sc9 I r, Hange II NO' /ell 'ST 28.29.18.436A-03 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS FI.FV Septic / ` Y 1 r I r ~I /(ftr Benchmark Uosirg K w (~.L V Aqh . Ct/ l /I-)[ 0[ 0• p l Aeration L F Bldg. Sever Holding SL'Ht Inlet q TANK SETBACK INFORMATION St tjLL) Col _ TANK TO 111 WELL BLDG >Ar ma.e ROAD Ut Inlet Septc i , 1lJ 1~~ Dt Bottom Dcs m; HeaoerAlar, ._A•'t Aeralicn Dist. PToo 2 `/~W I~JJ Haldro Bot. System T PUMP/SIPHON INFORMATION Final Grace Ir~~tt 4 1-'5 a1.35 Manuarlurer r.r ~r Demand St Cover tf4A <-PM + PAndel Number 1194 DH LItt Friction Loss System He TDH T or Cf:'1'AI'I wic 11T I Da hi 1: 'uYRll y r{ SOIL ABSORPTION SYSTEM 0-T LX O ' o• BEUn HENCH Yvi ]t^~ t engl•~ Ne is Ir,•m;tcs PIT DIM1tE IONS IN'; 01P Ir; Insice Dia Lieuic Del DIMENSIONS r r l SETBACK SYSTLN•I 10 Pit BLDG FILL UlKEiSTRIE LI RING L'la ru'aclu-er INFORMATION CHAMBER OR Z Pe Ct ;y:.r-11. ~Ot UNIT Mpcel Nu^'Oc' DISTRIBUTION SYSTEM c IIL ;I$r11,''al ~Ino: Ui,PiL_t,w xyoleSz? x'L'IC ~-pa+rSn Veil to Air In'.ake P°cll - l: Le•,gln ~ Dia,___ Lerg:r• Dia `:I:acm; ~K'-~_ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Dup'P' 0,e' DVF'tl' User o: Dept', NC JCCrFJ'JOJ JUC %%LIIItiI'en BcJ 7, I Ccnrv, Bc,17- -h Eecos TIp 5, it Ye N., Yes Nn COMMENTS: i1rclude code discierencies. persons oresen:. etc i Inspection dt Inspecton H2. Location: 191 112TI I ST I.'I AR BIA Description - f ~C~ l' 1 2 1 Bldg sever length = L~,~II - amount of cover = Plan revision Requred? )(/Sres No ~S q~ 1 oe y1 Use other side for addNOr inWmation / Datc P'sepicr Sul nCr.• - CcI No. SBID 6 11atR 3 SUMP PUMPS 6EC SERIES -1/3 HP ''3C4g Sw?1Yu ii-~ nXi>aK-: 6' I ii!I Ol i i~ Ail Il &l it I d t 1`r ~ r qfb ii oca F.('~. l f. L-?Fa', Inr „r it,, r Iii F i. 1 J, 6 C JA iil r I I,'. ,F -I I 11, 11 n'. j[, H rS fp;ili va111 ' 6tC-CA rVS ._'ulporoovl~f iifi tiErj ni•r; If..Pi'VJ0Amrp1 G•IS'i2153 rv; -at -I cEC{IS Ff e'gyroa>a It s (.61 5 19 & 3 (223 rmi I AMY (2,5 Sr ou) Iv 1 6K {IM I'y)PrWi ere I It 06 t261>r N eN LHmn',1 1 a<a (21 no) i r n ti r. tvN Cover --I Epoxy Celted Cast Iron Motor Housing I 1 J -sI Irc*t -71 -Impeller Material Nylon Volute t;r.n, at:. ~»t rr- Mechanical Shaft Seal Nitrile with Carbon and ceramic laces Fasteners SldI - '-s'slvI Shah Cold rolled steel - Bearings Uer nd Ic rr ~dll F i i a: Power Cob _ _ [SJRVSJTOW(506B5a) ` iLI earm-04 400 Franklin Electric I I yr !14' LittleGMT L ME r rrliriiitiffi~~iiiifii► 6E( SERIES -1/3 HP q PLAw BASE H:;('mtntsur ps_ ceaatc l vz;ater In islet I vt 1(Ltell i (AST IAOX BASE I r ■ Heas, dut,'ssl Ycr construction ■ Permarell* sphl (apa(br (PS) nlolor With therms! %erlradp lleborl • [I?si9)etlfrr0anlinueusduP! wiiiiiiwiiiiii ■ erqv-5& llr, Imamp draw - `II N nr ■ 1=.r F!IPT1is:har)c38v-v yf n ■ Handlesup'oli)"p)./mmi>olid< ~ ■ Rulliplemu:11oplUeusfor aulon-ahcopera'In ■ 140 `=(6Q °Q liquid lemperalu e rating ar 3 f; S4 IR I<.! J 1. `#A53 I EEC-:IA-Rr l'3 I'S (as1>ul Piaaybeck+!xhankd rbal 5'--~ 6'-Ir 10 33.51Et _ (SU o Xl cn) ('sI tm 70.cfit) (am) (•u Kq) 6 8 I N' SS$ l ca8858 6rc CL173 1 113 16 (rl Imn "NW(k MttMr cal rlwt is 15 1( 1 2 m 1 L ` - m_) tl$2 on ZOSa_n) ` Ibl m) (161 I - I S I '15 tilun Ir }-,:i I I IT tl• _ 11 I' TI 15 T1 1 5••6007 16EC C.A SFS 1 1-3 IIS PMyprary7lene II rgrd SnIP A(6m Flad a Y s 10 is lbs t (x a s an 2,z 9 uN (Stan 121 M) (3 m) dz' n kSF' I'i ~•rr Irt i ,r ~t F rl:at 9 I 5 II` 506000 (•F. a-NS I 113 i ns l lbpyropyi~i, Mlegal Snao-Man } O(tsm Z79cmi : (S.l an 12.7_(m) (6-r0_ SAO) rn' I1 506801 tiEGCIM Uf IIS P(lypmpyler4 Mamal - _ ( 10' ~2651M (3 m) t (12 Kg) 50[•372 6E(f1M--- 113 i ns PoNPlowiam Mnr - _ (bmlm) (S t7s its 4 Kg) 506854 6kC{IM (xtlron Manl.al _ _ VS 251 34 IM n$ (16m) ' (154 Ky,~ a :;p rl i_-(~ - LI },Ilw' Ln N n ~ 04 ,T r~ N N O c0 O N O O a0 Cp v LO m O Ca~Ln w i ~ C I S o= u r o m a F LL W I W ~ r - i Fes- ~ c O ~ a j Z 47 O -I .~A I fC. O~ L .I III a E QS ' I ~ ~ V Y C N ` S / ry _ O` W W J a VI W k to w - d r Ci co ~ r> ~ f z `O r s 3 - - u i `t ct: u w r p Z O J O 9 O ? p <'n r;- ti °z Y i D in Q v; ti I 111 ~ ~ t ~ (p v~ j w O"'E n W '1 O a N 7 s a w Ytr c Tt9- N 7 m c > t^ c~ C ~ ~i WED l 0 2018 1 r V1'ashmgmn :Ave °sP MAY ' g 5annnr) Pcrau. Ni11MCr I,to 1x'jn o o. by Cn.) ntJ Madison 1VI 53'07-7162 I c. ..Melt 'a 606 Cl 4n}tdnf Permit Apphcat>.on 1 uxoNuue w th SpS W-'42) . 1l is. 1 L A/tA s ode,ub flsiml ol'th;, film to he appwpriuL-gnvau:nanul mn ! rcyuirpf poor to obt ml ly xa ICny ~crm - Norc' App i aliJn fonus bn amlocuml POWTS ntc ubmiaCd to _ i the D;um Ien IC Sa cry t Id I ru cc,l a I St,,;,,, 1-,Hood u...... n~n vcu unv~k ruy h. I,v:ri t Projce[.\ t tIM11 than ImgadJrees, r: .,u.rlJ,w J'// f X75/ 11: rpc v i 1 wrdanc. 'Ith LR i uy l.la' < I5.0$r pmt taLS- fl 7 DV _ \ hcihmt inform?non Pltasc Pnnt All i nmtion r/ Pucd 0 C) /A rr JK16__ c _ 0 Y.7 - /0 7~ SO Propan Q,vncr s .f AJdrcas _ A-- - p (j ~rltl.n `IIAWImn 0' L _ /SY L Y A-014 xlf ~aE /o/ ~✓4! d ' ; ss r9 a8 ~LpCId< I Phwm Number 1. tcitctc mtcl E _ U~ttEY/ /'1/✓ SS/J/ 957 ,7~Y- (7e .1. Type of y) T N. R 1$ _S.uQ AuRding (check all that aPPf ya l m'l CunilY Dadlinv \uniucr of Lc.Lwra: - I J 5,!OEitdAM Kamc ~ J pk F31.nk Pahlidt LA 444 P a of - I Stale O,vaw Oescnu a 1, cc I t-Ski ivurnhtn i.}WII 12~~ ~_4t9 EL_~/e(,~ t~Dj28-~/p32~r~,~.. ~fI i (t. 9}pe of PermiL• (Cheek only w has ml Zinc 4. Complete iine S if applicable) ? W k-o-\vstrnl Rcj,4mcmr_•n Systrnl J'Cresbl ulF'l1ulLng Tank Rc)lacaman Only ! `k7 Other Nf(diht mean to Exrsbng Syslmt Icxpiam) Pcnnit Ra,a,•aV 17 Pcnuil RMsion (-1 '-I List Prcuiaos Pcmn NWtll>cr and Dsm lsmed lJ (:hinge al )'lumber I C l salt I tansfa to New Hclon Fsrynitwn 1 Oo•rrr . V. T,pc of 1'OtV-fS Svstena/Compaocnt/Dcvkt Check all that a ~NO:LI rn unreel In (irzrunJ i, F'rrsanuA !n Grwrld ❑ At-Grwde ❑ Mwu¢I _ 1; in. of wnablc tiwl Mnund m nC snitabie wd - - tluld- r 1. 1 L OU Di-Puss. C np vcw (ocinwn) _ - 11^nuu luu Ikvlrc laxptain} i Dispenal/Treat cnr Area 1 15 el_ Y 1 n Fl, s , ~p l) UrsiQn Soil .{pp1 emit n ILntc r - - - rq,tncd Sys rn, l.ir.:nlon GpJs Dicpcrsal:1rwRc.pllyd,sl }@sp,„ rvl.•\rca 90O__ 990 '1- k Tank Info fapaclty in IotJ 'oTj--- Manulrgtacr -Y T' I Gal.... 6all(xly tInit i t o a_ I \f, TN{:, r.C411116 Caltx _ C- rr % v _-1_--. _ _ - - I - , 711 liespOnxtbthry SWlnment•• 1, Wt undcrsiGnrd ssuluc 1 oFl lnnbinly for Instnilanoo of th I OP 15 zhvwn on the allachcd Plant, 'Imnhvra Namclt:rli Tharb rsS ttu• _ - - t r' 1 <fIMPRS Numtxl qusmv Phmw Numbe, &s s»-~~oo I'Iamixr s Addrtts f.SFred (,itv. State, hp Codeq O. vor 1163 SAw l19/~ !./r _3S 7o i - - t - - lll.Caunh /DCpartmuat lice_On/ i\ _ pF•v t.i _ M 11 n T,a- )zrc/~'%ml~f Wrong nn Signmarc ~ ` 111 k-n [ i 71Vt~ n ! fondlt • ' CXAN h IRI'rif~approvvl 3 ~ 04itil..'ai CA rxitt dill y oil IIIpFBolble coo)/:flf SaH.• '•.a rye tm:. I,. n. f. rh npa, ml.v!h.nx .II :¢Oru n sia tiRi1-6?98 (R. CRF -1, l ~ ~ ~ J q ~K 4 Y -I .y, ~ Q`I •4 h ~ ~ 1 l at ~ ~M J \ :~Y~ i •hl ti W O C -S," a °O 3 v O Cf Q ~ V ti ~ ~ 2 rl \ J h ~ h 2\ "l bN ( ~~t 13 i R r I t o K~ ~ \ I n ~ y~ -a°..:.• j o o k I h t 0 3 rt 'a ; \ e J v ON - C O r N (D N a N N p 61 I~ (D p N m c. r-L ^ 00 (O m N u) N L C LL V O - X L O m a LL CIO 0 Q 7 v W w Q a n G F. Y~ t O L o K Q v U1 $ N O :n r; r 1 ~ o 0 1 c { O ~ cti O t rn i 1 U O f- tx "n O W ~ v O O " c J O F. ~ v> W y V co d> v, S Page I or _(o Private Onsite !Wastewater Treatment System Index and'ritle Sheet ae-. t Name_ / A r _ Sro uie tq - 3- 6c _~NtRe wA ors Owner's Name: Uwncr's Address: /SYG Y G 1[Axi£ A~c~141 . Lcgai D::scriptton: Municipality: Town, kiflage, "y of County: Lnox - L.ol:Number: Block Number: CSMNumber: Subdivision Name: Pa: cel I.D. Ntunbcr: O k--, --1,07. 80 - ~+So Page 1 /,fax + fi rcE S,y£Er Pa,cw 2 LoT ` LAiJ cJ~ C/toSS- C JIe,J f ;-~A,J -fJje£'LJ _ Page 3 EP714 A,Jer SdEC,, • _ _ . Palge4 _~t✓TS_ QiIJER S A~upt ~pwlAC6iveaT `LAJ Page S " P:~ge 6 Fib rE2__ P Page 9 Pa,c 9 Nameoi'Designer: E.O n3E.rc.t! License Number: ~?/BA9 Signature: Date: Designed pursuant [n tc foI(owing POWTS Component Manual and DSPS 381-393: GRou.~p ~oMfo/w/E.'Y /~F.✓uAL - UA_a_,_.ZO S[i0-/o 7oS_Q_C!V.aiLo~ ~Q, /o//a~ ArrAU/«EwYs: Sa/t-. Euotueriov_ E~oar v a _ \ N a` ~I V ^V~~ 'V Q `Pl 1~ `~f J ~ a~ G '1 1 R V ~v ~ ~ W~ v o° h \v a; M ~ ~ •)t of \ \ ~ ~ Y Iv •~V r_... L ti~ 6~ y o A o x \ ~v h ~ ~ y W !I T , ~ ° a a I V , 1 ~I ~ l h o \ a L ti M1 J hr Y t W \ ~ 1 , Y 4 x Vq y j u\ \ W I -a, ~ V i q ~ N IVl 1\ Q \ * I ~ . lO ~ 1 U `I 1 \ ~ I ^7 \ Q v Lo CV v~ r-- o 4 N N n e r- ~ 0 (D o Cv f- C? b Q i v Lf) H_ ~ r i ~ N J 1__ r LU ~ `i O - X 'L LL LL ° O ' f s u ' O U Q g N o N -n N O r o jr, N V H b ~ M1) Y u1 ` Y cl- s i ( IJ :J O W 15 i J4 i 41 N j!j 2 C~ E- w LL. 4 U ; ~ 4 m o W W J W j O Q <5 I z n_ R, o z a, w ~ v,~ x o \ 4 -I ' I O co O ~ \ O ti o N !n W 2 J ~ v W n ~ ti `~wF r 2 ~ a m ° a) ~ POWTS OWNER'S MANUAL AND MANAGEMENT PLAN - H LE INFORAICI ION SYSTEM SPt(IMIL_ ATIONS Septic 1 rkt rats _ P /000 gal fl NA noon septa lankrvimmfacturcr Ad {/tEG#tY ONA% 1'Vum b.rln(ll'N''vcr akc ~lna dhedrmmj I'urrp lanAl (`r ~IoJcl, lion r([r[.e g1®N.\I Effl o is I stunafcd flow Punlp Lank ManuteUUret /!f e j/~~- 0 \A f)cslgn flow WW Ty - estimated x 1.5 yS0 gal: da Pump Manutaaarer Soil Application Rate - - _T aVd k' 7 Pomp Model O 1catFl' ..---ltcr --_n NAJ InllucrtuEftluent Quality (r1 NA) iYlonthly Average pretreatment ' Filter er 14A) FWS. Di'. & Gre.uo IF(HPi 30 mf/L 0 Mechanical Aeration O Wetland Biochemical Ox, gen Demand (BOD) < 20 m yl, '1 Ui total Sus coded Solids f I SS I smlcetion O Other: P I 5 1 s0 mgd- Menuitcturcr Model: Pretreated I Dlucml Quality 00 NA) Monthly Average Sod Absorption Component (Q NA) Biochemical Oxygen Remand (BOD,) f 30 mb'7, lid In-ground(gravity) O In ground(pressurizcd) ! Tolul Suspe n eit Solids (TSe) mgt. j ' At-g~ltk O Mound heal Cobtnrnn(s e•oraetricm dl•I [7 [)rip-line .'1 Other; - 0c1i1'I(70n11, - Vortical Diriancs, Tank Bottom In Sonar Pad:_--11-' Maximmn Y.ITluent p article Sue I'g inch dlatnctcr i I (onzont:d Distance l';vlk(s) oScmcc Pad: - GO_.-r _0 I Dispersal Unit Mfg./Model Number: E`Z fLaa1 "_/~p3 d4.d4[ES 0'SA ('.JCUlalions: Soil Dispersal End Cap (Dispersal Unit i)W_F Applicmiun Rate - ,Area Requircd - PISA - of Trench Width) - k t niti ur l stall 1xnf1h t,(I rcnch sl Y,£o_ S 900 - So.O fr' /d d..do[Es DESIGN CRI Fk RI.A - rl 'Design of Prccsure Di:;oit" :ion Network:; to. Septic Fa nk Soil :Absorption Systems" Publication 9.6 (SS W MP Manual) O "!CC I ouaech Mound Componcnt Manual" Version I 13 "11, Flow Mound Component Manual" Vow on &.W2007 O SUL) - 10954-P (R.1 r'12) "At-G adc Component Manual Using Ncssute M.grihut(on" Version 2.0 XSBD 10"?(IS-P (N.011(II)"In Crreund Soil Ab,oipoon Component Manual' Vcrsion2.0 O SBD 10691-P (N.01'01) "Mound C'(nnponent Manual" VCNiOI1 3.0 O SLID - 1065"+-P (R.6'99) "Digrlinc Ff-lhn•m Disposal Component Manual" 7 Slit) - 1070e-P (N nL01) "Pres,um Distribution Component hlanuaV Version 2.0 O Other- N1\lN fl NANCE MONITORING SCUEDUI 1 - MAIN rENAN( V AND NIANAGCMENJ S•rviccl.ent ~ Sen ice Pn4nenel' i I rm(i torts cl di pe :;al cell(s) cleml Idler -A Icas once c rc s a I l n onlh R) Yt us 7 Otht r 11,Fso pump l pump s muals alarm_ r aimen[ until A lea. once cecre O month 71 3 sons 2 N \ j [ lu h:md pr., sir.. ICS latent - - !l Icast on v av n me nth 7 3 tan VA S"T'ART' UP AND OPERA ]ION: For new construction. prior to using lite 1'0W7S check Ircamiz t tanki(s lx the ptcs_ucc of pa)nnng producl : or other ehenricak that ma) impede the armament pmecss and,or dnmmgc the. eiispcrsi cell(s) II kith eunCCnlrauon; arc detected rlusC the con(ents of the tank(s) removed by a septage servicing operator prior to use Syslem stall up shall notoccur when sot[ conditions are frozen at the infiltrative surface. I h: propcr,% owner is responsible for the operation and maintenance of the POW] S and submission of rcquinai reports. 'Ihe quantity and oualflo of the wastewater stream wiil aflec( the performance and longevity of \our POW'1"S. "fate installation of water-saving appliances and lixiurcs along with pmmpL repair of tcnks rcducus the wastc'.vator volume. Also Ihe firine or waste `rom .racer solienen, iron gamuvul units. ..then clef water Irralmrn: do vices and foundation drains should b,: discharged to the ground surface whenever po~iblc. Note: this does not include laundry waste, showers. dislnsaier, ester. this system is designed to handle domcstit' strength wastcssraiv, however, the dispo%W of lo-id based gicuse-c, oils, vet;ctahic+0uit peek. seeds, hones, and food solids. such as tho;c produced by a gurbage disposal should be minomicd. Toilet ticeuc is the only patwr that should he discharged into the symem. Ctrher non-biodegradable itcuu, such as baby wipes, tampons, saniotry napkins condoms, cigarette butts. dental foss, and cotton swabs, should not enter the system. Cliemicais, such as petroleum products, paint, disinfectants, pesticide anubioltes, solvents, etc.. should not be flushed into the system ba ttwilicy can seriously damavc your POW TS and contagninate your "aq` S of antibiotics, solver, Is, etc., shouid not be slushed into the sysrcm 17CCal Ic tlic-y car, seriously damage your PONVI'S and contaminate your drinking water supply. Maintain a rcgularsteady Dow by spreading laundry washing throughout the week. Avoid vehicle traffic over ail system componcott,. Compaction ofsnow aver lite dispersal unit may cause it to Ifeeze m,. INSPECTIONS Sts MAINTENANCE,: Inspection shall be made by an individual carrying one of the following licenses or certifications: Mnsrer Plumber, Master Plumber Restricted Sewer, POWTS Maintainer. or Scprage Servicing Operator (per the attached Maintenance Schedule) 'tank inspections must include a visual inspection of the tank to identify any missing of bnoken hardware, teem fy any clacks or leaks, measure the volume of combined sludge and scum and cheek for any backup no pouding of effluent to the ;.,round suifi ce and tut all elecuteal equipment such as pumps and alarms. Any defects shaii be promptly corrected. Exposed openings ~:re3ter than S Inches in diarmen:r shall be secured with effective locking devices to prevent accidental or unauthorized entry the tanks. When des: rombinaron uf'sludge and scum in any ;auk exceeds one-third ( 1!3) or more of the tank volume, the care contents of Lho tank shall be removed bye Scp(age Servicing Oreralorauddisposedofinaaordance with Ch. NR I I:, Wisconsin Admin. Corte. Il'e ou(lcr ti fool s) shall tat; inspected and cleaned to emove any accumulated solids as;oniing to manufacturer s spcei tications. Solids ,+ashcd from the filter shall be retained in the tank. Filter cleaning may tic necessary at more frequent intervals than stilled tit dtc m nintemocc schedule to keep the systcut Operating. Alarms should be tested on a regular basis by the home owner. if un alarm: sounds, contact an indoviduai licensed to service PI S, 'I here is ironically u I day reserve under regular operating conditions, however water should ha conserved until any problems with the system are cornxaed to prevent bacl:-up of sewage into lite dwelling or surfacing. Ai ANDONMENT: When the POINTS ;oils and/or is pcnuanenrly taken out of Servvice the following steps Shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. ST'S 383.33, Wisconsin Admin. Code: All piping to tanks and pits shrill be discotmccted and the abandoned pipe openings sealed. lire contents cl'ail tanks ants pits shall he removed wad properly disposed of by a Seplagc Semcing Operator. After pumping, ill[ tanks and pits shall be Cteuvau;d and removed or their covers removed and the void space filled with soli, grave:, or tither merr snhd material. CONTINGENT y MAN; If ~hc POWTs fails and cannot be repaired the following measures have been, or most be taken, to provide a code compliant replacement system, A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption sysrcm. The replacement area %hould be protected front disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, tut lines and wells. Failure to protect the rrplaccntcni area renders it unusable. Replacement SySteots must Comply with the Hiles in effect at the time of replacement. 7 A suitable replacement area is not available due to setback Indoor soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the. trailed POWTS. O The site has not been evaluated to identity a suitable replacement area. Upon ti dome of the PO WTS a soil and site evaluation ;rust br perfirrned to locale a suitable replacctocnt area. If no replaccuent area is available a ]toiling tank may be installed as a has; resurt to replace the failed POWTS. i Mound and al -glade. still absorption systems may he rcronstr cIrml in placr following removal of the biomat at the infilimb r snrFace. Reconstnnchonxnfxuch Systems must comply with ihr rules in eiT'ect at that time. WARNING!!!! SEPTIC. PUMP, AND OTHER TREATMENT TANKS MAY CON771AN LETUAL (.ASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP. OR OTHER "I REATMF_NT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON F ROMTHE INTERIOR UFA TANK MAY REUIFFICUL OR IMPOSSIBLE. d DDITIONAL CO:4IMEN7"S POWTS INSTALLER PUWTS MAINTAINER Name EO~EilCN. /Y1iQS-7~/8YY Name ~l6 U S6iric _J r Phone SEPTAGE SERVIC ------IN( OPERATOR {PumPcr LOCAL RE,.( ULA'i'URY" AUTHORITY Name r a Pi:nc Phone %/S ,386-Y'/8o.. _ v l'• 6 eF 6 Li nff. 90:•.,:h. ':.r 1,'a'.: :In <va~':!•r(]s~: 'Lo'':,: ne ~1..•j•~e):(C 9'Ynua:.p.^w Imii i.,.:,.. i~ r,,.} ~.ara :.!do. t.:a... +y i _r:>x (<•.V. IFr.'~ur:Z.[n,:t 1°Sifnca- nl f!v^.ri:rC.x ul;ci•» ,:'i•.n~•!a bR.'•,U 1f,-PA:If,.iq :.p, ilCbl n.~, ..-.Fdc,. I: ef(::24'0( Itt 4'PUA: trei~it~: dftr.3e°lfPl! tr lifz!rn.;r rile i.~.;p, l'3=a"71~ tt;ls~.:as. LIL : );'J... ~fl ,r•., 1 ..i:u.. Li.t. ,u..~'L:u l7 ft"r'Pidpiily. pl : }::i o..,i~zk >i f7., jaA:B .~.[~,lu!"nr Tt[n_. p:. f'.: yCbwl^drlC•l(~"Y?p rflI:,PRI!.S it5E.:63:dd;.v1! p A -D,'ty Outlet [ ~.tt cifr 1 u ~ r~.:•.:.c znA^Cr.:rv'n; ST. CROIX COUNTY Sf P 11C TANK MAINTI-NANCI: AGREEMENT AND ! OWNERSHIP C•1 wnrIC'ATION FORM Ownen'Buyer rv\ut) _P~vy ~q - ✓rn Mailing Address ..I _6 u Iu h e~~/~ 'lD( APPk vii (I c V -SSi zY Property Address 1\'crific'aimn rcyunc(t trail l`lalnliny. /mint Dcpannlcnl lilntcty cunstruru0n.) - - City/Slate _ Palccl Idenlifcalion Numhci - l I.EOAL DESCRIPTION Property Location W-_. i4 , Sec. Z-8- . T Zc ._N It lLD W.'I'otc•n of 1-o , n Subdivision Plat: - Certified Survev Map q 1~.- Volume Page if Lo Warranty Deed N (betbre 2007)Volume - - Pa)>e P Spec house❑vesolo Lot lines identilsah1c, pyesono SYSTFNII MAIN 1•IEN ANCT AND OWNER CL••RTIF'ICA-r10N lnlplnpcr ow nod muinlc laorv Ilrvow vpdr svocm could rcwh in it, prcmnlurc frilllrc In hlnlle agi.Wr f9vprr nlainlentlltce consists of pumping 0111 the septic lank cvorv nhlee years or sooner, if ixeded. by it licensed pumper. Wleti you put into (tit' ri•slclll can anCCt the rill A'lioll of the Jepllc lank Its a livalment Slake ill the Waite ilispUSal S)yll`Ill. Owliar lllaill chance rc.;punsihdilics :11c specflied in §SPS. lJij.520) will it, ( hapler 12 - St. t'roix County Suoua)' Onh uiuts The property owner agrees to submit to St. Croix County I'lanninv & Zolltnp Drpanmrnl :I eJnifio ninil form, swovil by' the owner and by a master plunllmr, journeyman plumber. restricted plumber or 11 licensed puroper vcrifviny than (1) the ou-site tctslelvu(c'r disposal stS1c'm Is ill proper upclabuy cuudinoo :nld oI (.t) alter i0spection and ponlpiu)• Ill uxrssap•t. 1be wjnIL tank is Ics, (ban 13 full of sludge I,vc. the lmdeisi; ucd boyc read mc.Ibovc inµlirenlenls :unl agree to nlai0ulin lite privwe sewage disposal system will) the sbuul;u Js set 141(11 hercill, as set by the Deparunent ol'Salety And Prol'esslonal Services and Ibe Depainnent al Natural Resoarcas, sunc or Nlscon,in. cvi I. fiva, ill sI;IIin y IlIa1 Saul sopllc sysivol has been ma uxained Into be completed and Murnctt It, lite St. Cl ois Cuum}' f'I:wniug & Zoning f)eparlntcnl within lU dnvs ofthc Ihmr ecar cspiratimt d:rtc. I we re1Ill) (11,11 all sunc•ntcuns on this li nll arc utle to the best (if toy. our knowledge. f we a11llare the OWne'rl sl of the pioporl)' dcv:ribr1l above, by viuue of uuJ,uun';nlty Bred Iccntded in Itegisto of Deeds Olliyc. Nun r If b rooms 3 7-7 t B S$1 1RE OF APPLICANT(S) - ° - - Dr\1'l) •o"Any information that is inisivpresenled may result in the svdtary permit being revoked by the Plannintr A Zoning Department. b:cludr wilb this apphexion a ircorded nvtroaydeed from the Register of Deeds office and a copy of (hc ecrtihed survey pulp I( ro'crenc'e is nlaoe iu the onrrinly dcvd (R(il'. 04112) tin a~ o ~ o I LL.l C ~ _ III IIIi WI II . L l J 111 III :n Ili r I l o C I© o ~-o - - M Q 1:5 a. 49 I I r °gh N o I b~ U „ o - EU I P ~ - lll! ~a 4 ~ 000 I 0 0 O Ir ~ f - lj I , i ~F I I I IO O O ' 00 0 Vi - T7 C7CTCI~ I ,iTCTCIn= T 11 lI❑ QQ ~ I ' 'rr''' ~ f 1l O~CT J]' I' I I I f'IQ n 111M H I, C7 [ I IT U III! 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