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HomeMy WebLinkAbout042-1098-60-001 stiscc-slnDepani-erlefCCmer:-=. PRIVATE SEWAGE SYSTEM ty St. Croix Sa'ef. a'tl awnpi••) I:.abie.'i INSPECTION REPORT Sancary Peirz,d No 605050 GENERAL INFORMATION ,ATTACH TO PERL:IIT ,t) f pia I~ yr 6 a-1o9a-co- Persoral r.for-ancr you F-ovide may be sseC `e• seco-.ia r~ pn •ncr..'s. ;rrrr:ac: I d'a. s.15 t4 i l limn Pe'-itHlaer5 143-'e City Village Tcw"shin P~[E.e' IJxJYp' -(r ce Scott & Lou Anne Turner TOWN OF WARREN l " 042-1098-60-000 'CSI GP,I Jc, nsp. 3Vllev. BM Descnalmr. SeelorTC'r:•,: Rwn vklan No d K I GS j 35.29.18.545 TANK INFORMATION ELEVATION DATA TYPE f,'ANUFACTURER CAI CAPACITY STATION BS HI FS ELEV. Septic /r 0 DQnchM2rK zs ~ 1. ~ ia' ioo Dosing All Blvt 1 0 75Z> /1r7 4?2'7 A;wIfiRM1' I , Bldg. Sevier G'1 hr ryJt~ ZZ.71 -749. 69 Ho oing Sl.Ht Iniet Z3. Z 71 - Z SVHt Outlet TANK SETBACK INFORMATION TANK TO 4Ilt WELL BLDG. '•ieritc rI)tiTc ROAD Of In.et Septic 1661 Dt Bottom z7. 7 '7J.7 Uas.nL• x'/ HoaderiMar, !O' cl' 90 ' e Acralier Dist Pipe Held Fig - Bot. System /3. 7- p Final Grade J 92 PUMPISIPHON INFORMATION q, 7 1011- btanufecturer Demand St Cove /I Model Number f» v w TDH Lr Fnchon I oss S;slcrn tl, on TDH t IG.S 3.a ~ , lei- Force-rain Leng(F / Da . if 1ao 2 SOIL ABSORPTION SYSTEM BED; TRENCH V. d:h Lc"gth Nu+O' If, 0,- PIT DIMENSIONS Nb O' f'te. Invde 7ia I old Depv- DIMENSIONS I'LL Z Y iyQ"LLA SETBACK SYSTEM TO P+L BLOG WFII LAKE:STREAIA LEACHING l'14TJ INFORMATION / CHAMBER OR UNIT D,IrAe Numte rA DISTRIBUTION SYSTEM .30+-325 = (06 JS 11; Mani',) GsrnW-n xHole Sze H'de Sfarino 'rert'~ArhtaAe L+nytn Up ~ ^i'II ~ f.ia Spannc_ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only ,.n•n Deptr' 0.~. x lop h of v Sccdcd'L1xlCed .x r.t noel r,!t. is Ce°I-( Be d'T-e '.cn E"nes' t',_:nl Nl~ es No res Ne COMMENTS: Ilnciude code disciepencies poisons prexenL etc. i Inspect or #1 Inspection #2. .J s: c 1e,...~ i-) • u I e Location: 695 1?OTH ST 5 ~ /1y I Alt Btvt Description 2 } Bldg sewer Inng:h = 27 1 amount of cove, _ , 1 Plan rewson Required ,Yes)<ONc pg3g74 Use other side for add,honal infounalion. U 'I Uate Inse Ions 5' we r No. - q' - n - Safety and Buildings Divisor Iei t * $ ` 'I \ 1 A Y 'sp18 201 W. Wasnington Ave.. P.O. Box 7162 Sannay Porn ^lumm (to be filled m by Co.) - L 4t 1^ r, t~T a Madison, VJI 53707-7152 fs ~mt~ erm~t Appfi( - s ar TriaxsaNop N mba-~S 1304` L^ acrardu xis STS ,dm Cori. suh n ; wn of thie form m the appnrniare gmanmenul lad I- Is Icgoirrdprior to :b:,o,,mg sanitary pride Nute..'1ppLalto'.or:ua fur -!a c-owxdA Vk TS are%w.miecdw oluea.Address(if di8aea: mar: nia:lireG addlas w )ry,mwz ! Safer. ax Processional smlcc . ?z s maj i llom nnn n proviot me, be used for s:canday DtTj..itCS m an.ordanoc w:m trc Pm'sy Iaw 5. 1U rgfl', m) Stats. 1. A IPPlcadonlnformanon- Please Prigt All_ In[marion _ Property Oxncrs Nane, - J- L- b r7 n fi,Jr CL. - -r - Oil- ~Ptopert}' Owar's A:ailmg.Udress Pntlwrty I.awioe G 4a j oCi 8 -(-oa 1 ~ -e~^ _ CsycLnt ss.ay.lssys,~l City, Sts:r/1 IL Type of Bmldinr (check a 1 that app I l.ot 1 :-0r'_ Eacndy Dwdlmg Numhcr of " ms S ~bdlu Na'>< U iVbi:uComma:ia:-IMrtx.'x I _ _ r of ❑Staitnwncd-IksmM Gse CSbf Nun:irn V^ ViiIs" of Z ►J; tr w[ bfi36 C cr /0 76 e~f.r~Q,~✓ 11f. Ty of Permit: (Check only one box an line A. Complete line B if applicable) A. S vcm .7E-?Meat. y. ❑ Repia: cmo: Sys;rn T>tanont+:{oid;np.'rani; Replarcm<y: :TdV ❑ (hhv hLodtticw:x 1:, i xfctitt, S7'-'~+fenlvmj R- 1Ferloit Renewal f)V' tRev_uoc i~ C_t:aigc, (.1 i'rnua Lansfa Z': SCw Ist Previous Pcrmn Numbs and Dare _ssucd Bcf:r<F.zpira!i,xi Chxer Tl~.~' 1 ¢ w..Tvpe of POW'I'S Syrierw'ComponenuDevice: tCheck all that apply) GGaa[[.... -fin !'rastautd lo.taro n f . 114rssJnl4e In-Ground r'Atdnaoe i_Mrnmd 24 ic. of sui'abl- soil M xmd' 74 m of amable wit U Fioldu:x T~aNc (N er Lns;^c sa: a~ met irxptnn) - 14areumae Drvrue t xplaiol__ - V Dispersa1?reat of Area Informalmnr - _ - - ~ ~ / ksiPn fl~'yp'_' i. Dcst~ Soil 'yFLCan:a Rdtf, Dispa.al ;.red Require` tl Dispersal Asra Proposed Q System Eles a:loo i IL /e VL Tank Info Ca;=m, is lutal %of Mmwfaaua I~ 'i+allons ~ -s] ons Uultt : ~ c a \cw iao6-s `=1ueo6= _ 0 2 u a m _ t n~ xEtotlu :aza n i 111, Re;poncrbllicy Statement- L the uodent >;nrA r rcspuo>Ibihr}' for insraltaom: of (Ise POR7N shown as the attached piam P wttxr' Nznte Prinii P:uf ^ . i;' u:e 4fls;'M? Nwnba Baseness Phone Numbs Z Pl 'S Adaress (lncd, t..uv. 3me, Gr Cud ; - - -"1 + r VTR CouotylDepartment Use O_ my _ Fawn Fee D Issued "sswaS n; Sigratme provw1 .~(~h•a~Prv S iX. Condi owwv.wus for Disapproval 1 n _ 1. Septh hck, cllcsm dNtr td1 roy rye,,,G~ x uia W.'s.r cell oust all yi'M3dSL as per,nar3cjemen! plan yo tided by ylwTIbO:: 2. Al mfWck regW wnen'.i rntut to rraaiitiraQ M pu Perdcn "i ro"! 1 :rtFnemsr. L------ - - Aua~to amMrn Daminr Poe cyam, and cuhfurtaebe COUOty Olt oaWP'r vof lr+. fhao Al.: rl::w'Ln u: vt. JRUc3YM :R. I ;i i 1 I System PLOT PL:,kN PROJN07 Scot: Turw ADDRESS 83,5 Bradlee Dr. Hudsor A4r1 5.1^-16 NW 1:4 NW I;as 3,5 :'1' 25 N`R 18 AA -rONN Warren COCN7.1' ST. CROIX SYSTEM ELEVATION 83.7'92.0 4.5 beiow graae DATE 6" 3:18 BEDROOM 4 CONVENTIONAL CONVENTIONAL LIFT XXX I10I.I1ING *I'ANK MOUND SEt''I'IC 'f :UK SIZE 1255 GahonS LIFT 'DANK slZEi 65 DOSE. "LANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION ARL-k '212 k of chambers60 Iti;NC1I At:A ItK V'.It.l'. Top, Of survey iron ASSUME eLE\ATION 100' Filter Lifetime I'-Im ❑ BOREHOLE ~ WELL "I1.R.P, carne as benchmark -0th Ave n vent ~a~ >6" Quick4 Standard 378' Propclty Linc of Cov Leachm Chamber - with 20.0 ft_ of Area j.6ft^2;pmr of end caps I Pro 4' L. n~ n roam / Ilou~e Z7 To k ; t 13_' Cell with :S'spa 30' ' Huffcut Combo Tank 90' 91• IF, 15• Ak- i0' 96' 98' q 'C 00, tl, All piping shall he ASTM SDK 30!34, within 10' of lw& pipil) Shall he AS*[ 'M FS91 B.M.% ? Property Lme Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 6/12/18 Owner: Scott Turner Location: NW 1/4 NW 1/4 S 35 T25 N,R18W 70th Ave Warren System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Pressure Distribution Manual (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications Sheet 8. Dose Tanlq Cross Section 9. Pump Cu e' Signatur License a ber #226900 System PLOT PLAN PROJECT Scott Turner ADDRESS 835 Bradlov Dr. Hudson Wi 54016 NW 1/4 NW 1/4S 35 /r 25 N/R 18 W TOWN Warren COUNTY ST. CROIX SYSTEM ELEVATION 93.5/92.0 4.5' below grade 6.13/ 18 BEDROOM 4 DATE. CONVENTIONAL CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK s1cE 1255 Gallons LIFT TANK SIZE765 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1212 # of chambers 60 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime Filter• ❑ BOREHOLE M:LI- * 11. R. P. same as benchmark 70th Ave Scale = 1/4" = 10' Vent A.ona Quick-1, Slandard 378' PRoperty Line Leaching Chamber with 20.0 ft2 of Area S.6ft^2/pair of end caps Pro .1 Grade at System Elevation Bedroom 34 1lousc To be >5' 2-3' X 122' cells with >3'spacing 30' 5'B-2 Ifuffcutt Combo Tank 154 Slope 35' R-I 90' 94' 15' 50' 96' B-3 60' 98' All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be AS'['h4 F891 I~s B.N4.* 378' Property Line Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates To be >1' above grade / Finish grade elevation Typical Installation 98.0' Vcm Grade Vent 3 X30/34 Septic Tank 3 5' I.OnP t 5' 5' Lone I " Grade at System Elevation 36" <irade al System Elevation Spacing 5' 2-3' X 122' Cells Same on other end Observation tubeNent At end of cell A B 30 chambers per cell System elevations: A-93.5' B-92.0' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _of_ FILE INFORMATION SYSTEM SPECIFICATIONS Owner ✓ Septic Tank Capacity - 11 NA "1 17 47 Permit # 9a1 Septic Tank Manufacturer A'vlr G NA ESIGN PARAMETERS Effluent Fitter Manufacturer 13 NA Number of Bedrooms - ❑ NA Effluent Filter Model 0 NA Number of Public Facility Units - -NA Pump Tank Capacity al ❑ NA Estimated flow (average) L Pump Tank Manufacturer ❑ NA gaVday i Design flow (peak), (Estimated x 1.5) gaVda Pump Manufacturer ~r /jam ❑ NA Soil Application Rate gaidda /P.Z Pump Model O NA Standard InfluenUEffluent Quality Monthly average" Pretreatment Unit Fats, Oil & Grease (FOG) 530 mg/L. C Sand/Gravel Filter O Peal Filter Biochemical Oxygen Demand (BODII) 15220 mgrL C NA n Mechanical Aeration C Welland Total Suspended Solids (TSS) j 5150 mg/L C Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODY) 1 530 nI / Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 1 530 rrgfL 'NA ❑ At-Grade C Mound Fecal Colifomn (geometric mean) 1 510° efull00ml L Drip-Line ❑ Other. Maximum Effluent Particle Size ;k in dia. NA Other. - CJ NA fJther: '/-Q -114A Other ❑ NA 'Values typical for domestic wastewater and septic tank effluent Other C NA AINTENANCE SCHEDULE Service Event Service Frequency 7 month(s) inspect condition of tack(s) At least once eveiy. (Maximum 3 years) ❑ %A - - - ,~-Yeaf(5) Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume ❑ NA Inspect dispersal toll(s) El month(s) At least once every: v7 year(s) (Maximum 3 years) C NA Glean effluent filter At least once every: ~l year(s) ❑ NA nsped pump, pump controls & alarm At feast once every: month(s) ❑ NA - - - - - ' ~ Year(s) - - ~Iush laterals and pressure test At least once every : C month(s) ❑ year(s) tither. - :1 month(s) At least once every: ❑ gar(s) C A Jther: Ll P. MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: aster Plumber; Master Plumber Restricted Sewer, POWTS Inspector; POWTS Maintainer, Septage Servicing Operator. Tank inspecbo - nwst include a visual inspection of the tank(s) to identify any mssing or broken hardware, identify any cracks or leaks, measdre the vol me of combined sludge and scum and to check for any back up or pending of effluent on the ground surface. The dispersal cell(s) shad be -visually inspected to cheek the effluent levels in the observation pipes and to check for any pending of effluent on the ground surface. the pending of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. ✓vhen the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <_12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory autnonty within 10 days of completion of any service event. page _ of START UP AND OPERATION Or 'it' ch~v~ >t ei of the For new construction, Prior to use of the POWTS check treatment tank(s) for the presence of painting detected hue the contents may impede the treatment process and/or damage the dispersal cell(s). If high concentrations tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are from at the infiltrative surface. is restored the excess wastewater will be During power outages pump tanks may fill above normal highwater levels. When Power the restored surface discharge of effluent. discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may rest* Fill to restoring POW to the To avoid this situation have the contents of the pump tank removed by a Septage Servicing OPeratorce to restore rgrmel Ieves effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump within the pump tank disturb or compact the area within Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise 15 feet down slope of any mound or at-grade soil absorption area. of the POW": Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the We foundation dreF antibiotics; baby wipes: dgerede buts condoms: cotton swabs: degreasers: dental foss drapers: eel fat water: fruit and vegetable peelings; gasoi grease; herbicides: meat scraps; medications, oil; painting product; pump) pesticides: sanitary napkins; tampons; and water softener brine. ABANDONMENT shall be taken to insure that the system is ProPa'ly When the POWTS falls and/or is permanently taken out of service the following steps and safely abandoned in compliance with chapter Comm 83.33. Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed Or their covers removed and the void space filled with sell, gravel or another inert solid material. CONTINGENCY PLAN code compliant If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a rep system' all absorption sYsteKm• !table replacement area has been evaluated and may be utilized for the location of a replacement The replacement area should be protected from disturbance and compaction and stiould not be infringed Vier by re4ui(ed setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new ski and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effed at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Boning advances in POWTS technology a holding tank may be installed as a last resort to replace the tailed POWTS. ~area. meUpon frs re of the ❑ The site has not been evaluated to identify a suitable replacement e aPCWTng tank maybe installed as must be performed to to ate a suitable reptilcomeM e a lest resort to replace the failed POWTS. ❑ Mound and at-grade sal absorption systems may be reconstnrcted in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in elfed at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POW rS INSTALLER POWTS MAINTAINER Name Name- Phone / r l`, Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY 77 Name r1 _e Phone Phone d d 393.54(1), (2) 6 (3)• Wisconsin Administrative Code. This document was drafted in corthp9ance we draper SPS 393.22(2xbxt)( )b(fl en N ` I M \ - I - f I I'I ~jeL;~'. P , Pg g I01 XII VK < S~ Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer h < C Ptmmp anufactamr Ni- Ta_r Model Number / ; J 7 > U r Pump Model Number _ Tots! Tank Capacity ] Alarm Manufacturer c r P. Max. Bury Depth t Alarm Model Number Switch Type Head i Filter Manufacturer , r - Total Dynamic (TDH) - Feet 1 Filter Model Number Elevation Head i Distal Pressure - Network Loss Minimum Pump Performance Required Force Main Loss ~T^GPM a) j 7FtTDH Total Outlet manhole Min. 4" Above Grade With b Manhole Min. 4" Above Glade Locking Device. inlet Manhole / With Locking Device < 6" Below Grade Sealed Watertight Securely Mounted Weather-proof 1 Junction Box Finished Grade - - - - - - - - - Vent Min. 12" Disconnect Above Grade Means With Veal Cap - outlet Filter inlet It--~ inlet Bale - and Reserve Capacity A Switch Settings Weep Tank Volume Hole Dimension Inches Volume Gal. B (reserve) A (alarm) B 2 J Off Elevation C Ft Bottom (dose) C 3 (dead) D % D Elevation Total S~ Ft GENERAL INSTALLATION: The septic/dose tank is bedded and bacfied led in manufac accordanc turere the as b ft may not manufacturer's product approval specifications. Maximum depth of bury have awn ffective locking device (padlock) be exceeded without prior approval. Manhole covers exposed to grad fittin and ith installed. Piping at the inlet and outlet is of approved material, main is connecteded wto the ith 4~h 40 PVC tight ridge the tank laid on stable soil to prevent settling or sagging. The excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28. Page of 02105 U 280-SERIES 112 hp Submersible EffluentlSump Pumps The Liberty 280-Series provides a cost effective "mid- Performance Curve 28 ties range" pump for on-site waste water systems, liquid 40 12 waste transfer and commercial heavy-duty sump pump applications that require higher head or more flow. 35 11 Designed around Liberty's unique "Uni-Body" casting, 30 9 the 280-Series will provide years of reliable performance. 25 r 8 All Models Feature: LL 2 6 • Vortex style impeller permitting passage of solids 15 5 uptOY" = 10 3 • 416 stainless steel rotor shaft - 2 • Permanently lubricated upper and lower ball bearing 5 HER •Epoxy powder coat finish o 0 • All fasteners- corrosion-resistant stainless steel 0 5 10 15 2 25 30 35 40 45 50 55 60 65 70 " Discharge U.S. Gallons Per Minute • 1 Y • Stainless steel bottom screen - easily removable 0 38 78 114 156 192 228 270 • Maximum fluid temperature: 140'F. Liters Per Minute 280-Series Coro Lengths Dimensional Data. Model 10' 251-2) 35'(-3~ 50'(-5) Weight: 291bs. 280 Standard_ Optional Optional Optional Height: 13" 281 Standard Optional Optional Optional Major Width: 10" (model 287) 283 standard Optional Optional N/A Minimum Sump Diameters: 287 Standard Optional WA N/A - Model 281, 283-..14' 10' cord length standard on all models. For optional lengths, Model 287 VMF...10" add --2,-3 or -5" suffix to model number. Example: for model 280 with 35' cord, order 280-3 Factory switch Model 281, 283 Model 287 settings VNIF Motor Specifications Turin on level 13" 9.5" hp 60 Hz 3450 RPM Turin off level 7" 4.0" Oil filled, thermally protected (PSC) Permanent Split Capacitor The Model 283 features a fully adjustable wide-angle float Differential 8.0 amps (115V) adjustments can be made easily by tethering the float to the dis- charge pipe or other mounting point Vertical float model 287 is riot adjustable. Model 280 Model 281 i~ Model 283 'v Model 287 Manual, Wide angle ' Wide angle VMF-Series „ no switch float switch - float switch t Vertical mag- with quick- with series netic float for disconnect (piggy-back) smaller pits - plug will operate in ' i a 10" diameter sump C~nt'EJ s A z \ C us Certified SpeCMfaM1O,r..',m suLih:l [V clu„JC wiL•wVt raOCe. Liberty Pumps • 7000 Apple Tree Avenue • Bergen, New York 14416 • Phone 800-543-2550 Fax (585) 494-1839 www.libertypumps.com Copyright m tibcrty PLIFTIM W. 2017 Ail rims reiservod. urn 2000 805717 tit'.. CROIX COUNTY SFY11('I t\-NK 1RAIn"fFNAACE :c(IRFFMlSN"f AND OWNERSHIP CFRT]Fi(:A"CR_.N FORM Qwnerll3uyer _ h_F~ - 1 ~ ~ ~ Maihn Address Property Address 13ZS_1 O'{6 S,{ (Verification required i=um PL•tnniug _ Zoning Depath:wn( lout new- constlvcti011 CityiStateParcel hientificatiouNor Iber LEGAL DESCRIPTION Property I-,ocation& Scc. V RL W, Town oh y c - Subdiisiou [,of # Certified Survey Map # lime . Page #6: Warranty Deed # Vo(utue Page # Spec house yes 11 l.pt lu>':_ identifiable yes no SYS'T'EM MAINTENANCE AND OWNER CERTIFICATION Itopnrpcr use and niamwEiance of your septic system could texult in its pr.:mafine failure to handle wastes. Propel nuimetwnce consists ot'pumping out the septic tank cvcn• three ycars or sooner, i1 uecded, by a licensed pumper. What you put into the system can affect the function of the septic tank as a trcarNwid. stage in the waste disposal system. OWller tnaiutenatice iesponsibilities are specified in §Cbtmn. 83. i2(1) and in Chapter 12 St. Croix County Sanitary Chditauce. The property owner agrees to Submit to St. Ciolx C.:our"ty Planning & Zori ng Dopartment a certification form, signed by the owner and by a roaster plumber. iourneyman ptr:urbet. rrshicted plumbet or a licensed pumpet verityine that (1) the on-stte wastewater disposal system is in propel opera:ng condition author (2) after inspection and pumping, (ii necessary), the septic tank is less than 1:3 full of sludge. Iiwe, the undersigned leave read the above icc uncincl is aad a}pe.c to maintain the private sewage disposal system with the standards set forth, heroin, as set by the Dcpar :rent of (onenetcc and the DaTartm.cml of Natural Resomccs, Sratc of Wisconsin. Certification stating that your septic. system has been maintained wu%t''re conplehxl and icttuned to the St. Croix County Platmme & Zoning Departmcnt within 30 days of fire three year oxviratio.1 date 1/we certify that all slaicmcnis on dies nrrn art, true to the. best of ui}None k nowledge. Iiwc am/are the ownci(s) of the property described above, by virtue of a wa my ticrd uecaded u: Regnstar of llcci is Office. - Cf bar bedrooms SI('rNATURF OF APPLIC.ANT(S) DATE ***Auy imormation that is uristepresented i my iesuh in the sanitary permit hemp r:voked by the Pianturig & Zoning Depairment. Include with this application a recorded wutatuy deed '.rpm he Re-gisici of I )earls 1-:ffucc and a copy of the certified survey nuip if reference is made in the warranty deed. (REV. 08/05) 3~t~3C193 J 5 I) i I z ) y II _J W Jv LL I _ I J f, II ' 3Cn3CIS324 y I . t~ AuI! vl . _ \ 4 ` ~I a !c Ljuuu ' p 1 I ~1~ ~ _ _ ~ `i II I . 1 i a - - - - - - - - - - - - - - - - - - - - - - - - W ly V LL V Z ~.r F'F-CENED Si - - P`l 6SI 30W 1 Wisconsin Department of me ~OUWpY SOIL EV A' T _ Page _ of Division of Safety and E wVpTo.(1D tiA3 Me1`IT _ O(: n~MM ccordance wRh Co.. 85*II- - 3Q County Attach complele'si a plan on paper not less than 8 1t2 x I r v., st ` include, but not limited to: vertical and horizontal reference 01"t , p~ -.,eor and Parcel I D Percent slope, scale or dimensions. north arrow, and locate, .,stance to nearest road oTZ " ~a ! ' Please print all information. Revie d by Dat Personal infomueon ya wovMe may oe uae4 to aecandary a* aes (Pnvacy Lew s 15 04 (1) tmll Property Own Property Location J Lt Govt. Lot 114 ,_~14 T 2, N R E io' W Property Owner's Mailing Address Lot fr Block # Slbd. or CSMp Cjty State Zip Code P &e Number ❑ city ❑ village own Nearest Rd IP' New Construction Use,©Rosidenlial / Number of bedrooms Code derived design flow rate GPO I ❑ Replacement ❑ Punic or commercial - Describe: Parent malenal~ ,(1 ~2/1}C1 J _ - _ Flood Plain elevaUUn if ayyll<a ne ft. General wrtrrxnts y '~~p f n and recormbnciabms: I r ~iys!e. Type 1. L, /1~~(~yt~ ~~_I :iytilrln Fle•.;itinn I ~ ~ ~~-xl~ Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting facto in. - - - - - Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD.MF in. ~~))Munsell Qu. Sz. Cont. Color Gr, Sz Sh. •ERU1 •EMtt2 419 C ( / Being a 0 Boring Lam. Pit Ground surface elev. R. Depth to Iunihrlg factor /i in Soil : iratlon Rate Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPDMF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh, •Effk1 •Efftt2 sC) • E81uent #1 = BOD. > 30 < 220 ri and TSS >30 < 150 • Effluent #2 = BOD, < 30 mc-L and TSS < 30 rng1L CST Name (Please Print) g re CST Number Bird Plumbing. Inc. Shaun Bird 226900 Adtlross pale Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 7 715-246-4516 Property Owner Parcel lD # Page of Bonrig D Bonny ( ®•p;t Ground surface ele/y~ v.9 n. Depth to limiting factor m. Sal lication Rale Horizon Depth Dominant Col or Redo. Desafption Texture Structure Wislen ~ Boundary Roots GPOfff it) Munsell Ou $7, Cunt. Cold Gr. Sz. Sh. 'r"i 'Eff#2 i Q-) of J f1 L S nY )4 Nor < I 2 i Bonng # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil 'icetgn Rate, Horizon Deptl+ Dominant Gda Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'EN#1 'Eff#2 ❑ Bong Boring # Ground surfaceelev. _ fl. Depth to limiting factor in. F-I ❑ Pit Sal Application Rate Hmzon 'topth Dominant Color Redox Description. Texture Stnrchxe Consistence Boundary Roots GPD,Mf in. Munsell Ou. Sz Cont. Color Gr Sz- Sh. 'E"'I 'Eff#2 ' E`fluonl #1 = BOD, > 30 < 220 mryt and TSS 130 1150 mq'L ' Effluent #2 = BOO, < 30 mWL and TSS < 30 m91- The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an altcmate fonnat, please contact the department at 608-266-3151 or TTY 608-264-8777. seu non M rProperty Owner Parcel ID k Pace _ 01 Boring ft Er^l~ Boring !/,7) I CTPit Ground surface elev.? 1S ft Depth to 4rtWng factor % . in. • Sol: Ap(tilcatucn Rate Honznn Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roos GPDfff in Munsell Du Sz Cont Color Gr Sz Sh. •Eff#t •Eff#2 0- i D J r31 L < !r L' St. cry v /rV i I t , I'. 9i I Boring # ❑ Boring l l ❑ Pit Ground surface elev. It Depth to limibng factor in. Soil AooiipUOn Rate Horizon Depth Dominant Coin, Redox Description Texture Structure Consistence Boundary Roots GPDlff in. Munsell Du Sz Con;. Colo ' Gr. Sz. Sh. •Eff#i 'Efl#2 i I i Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in Soil Aoplra6on Rate Horzon '7epth Dominant Odlor Redox Doscnpaon. Texture structure Consistence Boundary ' Roos GPD/ff m Munsel: Ou. Sz. Cont. Color Gr Sz. Sh •EB#t •Eff#2 i I I ! 1 I Effluent #1 = BODr > 30 < 220 mry1 and TSS >30 < 150 mg-4 • Effluent #2 = BODr < 30 rtxyti and TSS < 30 m9;L The Department of Commerce is an equal opportunity service provider and emplover. If you need assistance to access services or need material to an alternate format, please contact the department at 60k ?66-)! 51 or T N* 60€-264-€-71 $IIU IM M. 4M, Soil Test Plot Pla Project Name ScottTurner Shyt Bird Address 835 Bradley Drive Hudson Wi 54016 ATM #226900 Lot 1 Subdivision Date 8/28/17 N W 1/4 N W 1/4S 35 T 25 N/R18 W Township Warren Boring Q Well P1, Properly Line County ST. CROIX BA1 or VRP Assume Elevation 100 ft. Top of survey iron System Elevation TBD *HRpSameas; Benchmark 70th Ave Scale is 1" = 40' unless otherwise noted 378' Property Line 15S Slope 35* B-1 94' 15' 50' S096' 133 0' 98' B.M.* 378' Pro erty Line 2 Q' J N 'u Nu Y ~v C ~ y U U - ~ o v ~ i i F d c i f Z ~ Ol ~ u ~ o- .n , L, rc n a ¢ i U ❑ I to 4 r 9' t 5- P ~y e ca y~ \ a~ p Q : f T" y i y> s 7 z s ilk " f ti" t ~ fit' r ,a ago .s~:atr•ars.....: •,.i 'iii