HomeMy WebLinkAbout026-1121-24-000
PRIVATE SEWAGE SYSTEM aan" St. Croix
`dfP.^j AO.9 IU, i~J'n(j IJi A' i J,
INSPECTION REPORT Sanitary Perr'4Nn
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No 605109
Pctscnu nfcma:ieo you ntc"Ce map ti< see for se.:rnttaty proposes IPri',AC;. Lax, s 16 oa )f },roil
Permit Hr, 1P,, N.=.me City Village Talnsh.D Parre~ TAx Nr
Halle Builders TOWN OF RICHMOND 026-1121-24-000
CSI BM Lie, Insp RM Flew 1160 (lost pLUr. SCtUan+l ev,' I!5n,'I 1v1aD No'
a fA 1 05.30.18.739
TANK INFORMATION ELEVATION DATA
TYPE MANUFACIURER,6 CAPACITY STATION BS HI FS FLFV
Septic /O 1z5p Benchmark
z °19,8
Dosing Alt. BPA
Coy J 3• ~ilj, D I
?er~ren ( - Bldg. Sewer `1.S D r7~ . L
Holding SUHt Inlet
/~.5 $9 3
TANK SETBACK INFORMATION St-Ht OWUet
TANK TO Pi 'HELL aVe- ROAD Dt Inlet
5septic 36 AA Df Rottcm 13 •-7 1
Dosing IleaderWa,t. 3.
Ae'ahon D.st. P pe ry
r Ff ✓Q.~
Holding ( Bot. system
~ Q~o crJ
Real Grade
PUMP/SIPHON INFORMATION
fdarr.dacturer i GFIm(ta~xnd'fy, St Cover r, I L , d 93
t^
Model Nurrhe: Zz D U M) ~ r7, -11 -7A
TDH Lik 7 Freon oss System Heq~ TDH Ft - 7
1
XD
Forcemain Lerg:n + Dial Dial.
P J
SOIL ABSORPTION SYSTEM
BEDtTRENCH Wictr I ength INC renohe< PIT DIMENSIONS Nit C Pits Irsde U'a. I Iq,iin Depth
DIMENSIONS QJx J! J J~ 1~
SETBACK SYSTEM TO /U P:L B -IQ~ `WIEELLL'V LAKEiSIRFAM LEACHING rdallAaclr y ~Q~
INFORMATION 7• CHAMBER OR
4Y O' Systc~• UNIT Daonet Numt:er
44.n Iz 5~.t r
DISTRIBUTION SYSTEM ) of 16 a yd = ILL,
1IlCadcl ManCOIJ 11st14ufeo xllofcSte Hole sp.=.oin- Ven A, l~~prka
Plpci'ei
LengPi Dia.. Lergth Dia Sparinc 1
SOIL COVER 1 ) x Pressure Systems Only xx Mound Or At-Grade Systems Only
Den th Over s I:%I'h O er .x :1en7, o' rx P>eededSrodrd .x lol,.loherl
Nenrlrn r::en!r lierir..r.rl rbpea IcF:<nl
x'cs No Ye'. No
COMMENTS: (Include code discrepencies, persons orese-ii etc t Inspection #1 Inspection #2
Location: tlr}g 10/THSI GI/~+x.1 ~S~ ■I ~ d~
G{rjl+~+ C.~tDJ.an lJp-
1.j All BM Description - 1 ~J 1 LO~fs Ov\ nf„~ I,
2.) Bldg sever IengU• = Z~ nn t 1 ~-'w
-amount of cover- /gy NR ~~l 1r117f~~tGlL'~ `
> L) 12-11
Plan revision Required? Yes X N, /e ~Q li- l 7'5
Use other side for additional information. I1VJ _ 1V___. if
-
SBD-G'Ni :R.3 'Ay nDale cpcet Sgrature Con No.
04444 d~ 0 . z ~o ; el r~~ Joe o m
i~ Ii iC-. 'i I Q'miy~
~Szfety anc 3uiidins Givi;ion
. p + t U 201 W. Plasninglon Ave ' 0. BO 7162 I [a:u4ary r amt: Vunioer (to tK 61cd a by Co.}
Madison, 'Jill 537,7-71152
S; niwn Fcnitt Appli6&i0'H - S)mcTrmnawo ~umbe
rtal~rt -
is rcau'red imnrt'v ~+.aiv;r ,.utti ..crrm J '.e.:krp lion .orr5 tm ttattcwveC 1 ;iy\-1'S are >ub;nwed {p Figen 4 -if ddlerea: tlm madinF addtas;
i< h4~"~ S.,icrv ma Pr f coral yr e. i c°.:nal i (on:a:wu "IL prov:dc rnzY be uc.-d for x.:.mdary I 6, 1
~T ~ rs i xdana wrta me °nu a'y' L. w 4 a{ I em' Stets. -7 ( l 0 -
f Application Infom2rion Rlease Print 411 lnformenon
.ryorv :)wna4 Vavc ll '9 Parcel A~ r
'rm, col pwu'S Maili A.ldt=55 i ?inpen} Lx::n+~m
-3o, F, 7 3 11
Ill i . l
ci v. Sratc I p Ccddcc -i Ph" Vutabtt $ectim
f I t n: k a
If Type of Building (cheek all that apply ~~.oi"
$tiaii sitm N.
fmnily fhsdlins - FtwrDun; E3edmos//~~/j////~J ,J
lam'. I31oci .~1!
_ A~Dbc:'armcrcial- Ilcscnk't cc I/~OJ'St~ _
t'SMVert xr 'd:aye of
' -'$'nlr [)wn<d-Drcri'x JSc
11 III. Ty : (Cheek only one ox oa line \ Complete line R if applicable)
4 Syaem ~Rcpiu.A+e¢n; Systcn i Tr..ruv:ne?i~l.f~^.g lank kcpla:er eut Jni}• -Orba ModtimrJ+on Lo F.xisnng S,Sttto fexp:=,
Pvotit!:tarber znd _ _
'J Ltr Pr viooi Dale ).surd
Pint Reo.I . Pami: Res IS= i I hviac nt'umar- ❑ °errsit Transfer to Nm
B Itc rc Exp:rar:un ` rJwvet Ez Goo,,,,
em Cornpc nw1T,Devi,e heck alt that app IV[
-AUrm' 1 h: (n wad i-. Iles it+a U n: r ~ :V ♦2 we 1!nund :-.0 m. of mirabie wtl l lI Nound 24 v 7f st+rtMn. w+d
lioicwg cic i.l f>tYer l'w~as C apuo'ti I~xpir r~ ~F~etrealmcvt ^cs:cr icxpixmi _ 1~~ (y{,4~
\ Ui pt-mRlreat nt Air-" Informatiop.
r~Q n;)w is d? ,r{1}xy Sol .4pDL:.an nm(yrds^ Lispe+nal Nw Rrgvye9 isf~ I) gv"~al rea Ropoxd J). 5.stcm t'.levauno
Iota k of A.a,plaaurr. y
rN1. Tank Info I Awn vin
i - iiaLLem ~ia.Ons 1'nitt - = 1
117. Respuusibility titatemen - 1, the undersigned. u responsibility for iacrsllanon of the I UN IS sbowe oa the attached plans.
P'tanprr s r mre Printi 7't::oti -..r azor< Ffp,%IPPS Vomb ~0sUaSS iLune um r /
' I Yhanb+a oasts lStrc^t r S'n:-. Zi k1d1 ~f J
1
VI.L - riDepartmeot Use Only -
Ft . D:.I &saiaf. • t Sim a:w
i 1
I IX. Cnodi ns5pey' easons fVrl+PProsal
]S pmr
i 2. AU
w abw k ec, fO''~'1 ~IL 7S / _fAA~i~
- per "pFifcab1 c,>r
-nrmrh W oompkm stiam fur m garm ants ~uaiwr t Count. ovh oo su pc voans due a t t iveba w me
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 7/5/18
Owner: Halle Builders
Location: SW 1/4 SE 1/4 S5 T30 N,R18W Lot 24 Partridge Run Richmond
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. EZ-Flow Cross Section
4-6. Maintanance and Contingency Plan
7. Filter Specifications Sheet
8. Dose Tank Cros Section
9. Pump Curve,'/
Signature',
Licensesnumber #226900
System PLOT PLAN
PttoJEc'T Halle Builde,s ADDRESS 1113 Hwv 64 New Richmond `oVi 54017
SW 1/4 SE 114S 5 /T 30 N It 18 w TOWN Richmond COUN'l•y ST. CROIX
SYSTEM ELEVATION 4' bolo`:.' Qrade DATE 7/5. 18 BEDROOM 4
CONY ENTI ONA 1. AT-GRADE CONVENTIONAL LIFT XXX HOLDING TANK
MOUND S 1255 gallons LIFT 'T'ANK 517.1:765 DOSE 'TANK SIZE
F.I'TIC "TANK SIZE HOLDING TANK SIZE LOAD RA'Z'E ..2 ABSORPTION ARtiA 300 it of LZ-Plows60
RENCHNIARK V.R.I'. Top of mark steel post ASSUME ELEVATION I0W Filter Lifetime Filter
❑ BOREHOLE O WELL •11. R. P. same as benchmark
16' I roperty Line 5p,
Cells are to be >5' from property lines B-1
-)0"
6-3' X 100' cells with 3' spacing
Vents
80'
3% Slope T3 X10
3 50
B -2
21
Pro 'l
Bedroom
House
246' Property Line
17" 0 t h St.
Q U OC
a L m
L 1 a
N
10 ~ ~ W
_ (7 > x E
~ d N N
w, C T
y/ 11 0 (7
LL
lu (-D
Q GV::: (U
O
{(v~ boa
{ cr II \
f tI :3 O a ° LL
O l~~ f ao0 w ~O
IL > U
> N y N -0
LL E o a g at g
.'.N'. In o O d d f0
W
Q~ ) 2 E ~ c
V m Co w ii
/w♦ - 9 C
WWW .a s'.'. 01 N
v~ .
a m m ~
-AL
v I ~ ^ li
O T o Cpl
is = c 'l
cr
0
E U w
y.,. w (9
t/1 U'
L ~
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _ of
NILE INFORMATION SYSTEM SPECIFICATIONS
l T
Owner Septic'"ank Capacity / / j al Cl NA
Pennii Septic Tank Manufacture ❑ NA
'DESIGN PARAMETERS Effluent Filer Manufacturer C NA
Number of Bedrooms U NA Effluert Fitter Model ❑ NA
Number of Public Facility units jl?-NA Pump Tank Capacity
ai C NA
Estimated flow (average)
_ _ J Q-~aUday_ Pump Tank Manufacturer , fyf NA
Design flow (peak), (Estimated 1.5) aUdav Pump Manufacturer n t`1 C-NA
Soil Application Rate
gal/day/ft? Pump Model ❑ NA
J
Standard IntluenUEtfluent Qual- ity Monthly average' P etreatment Unit NA
Fats, Oil & Grease (FOG) 530 mgiL C Sand/Gravel Filter 0 Peat Filter
Biochemical Oxygen Demand (SOD,) <220 mg/L O NA 0 Mechanical Aeration C Wetland
Total Suspended Solids (TSS) <150 mglL = Disinfection O Other.
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ Nd
Biochemical Oxygen Demand (SODO 530 mg/L / -Ground (gravity) 0 In-Ground (pressurized) i
Total Suspended Solids (TSS) <30 mg/L ~.NA At-Grade ❑ Mound
Fecal Colifomt (geometric mean) 510° efu/100ml C Drip-Line C Other: fff
Maximum Effluent Particle Size , Other:
-Other. - - - - A Other. - - ❑ NA
'Values typical for domestic wastewater and septic tank efguenL Other ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Ilnspect condition of tank(s) At least once every: ,.'3 month(s) (imurn 3 years) 1.7 NA
'Pump out contents of tank(s) When combined sludge and scum equals one-third (h) of tank volume C NA
.nsoect disperse! celf At least once eve month(s)
O every: ' ' ears (Maximum 3 years) ❑ NA
Mean effluent filter At least once every: C month(s) 0 NA
- ar(s)
n ect um C month(s)
_ _sp p p, pump controls 8 alarm - At least once every: ear(s) - - ❑ NA
(s)
=lush laterals and pressure test ❑ month
Al least once every: 0 NA
❑ year(s)
i5ther 0 month(s) r
At least once every NP.
year(s)
NA
MAINTENANCE INSTRUCTIONS
inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master
Plumber, Master Plumber Restricted Sewer: POWTS ~rspector, POW-$ Maintainer; Septage Servicing Operator. Tank inspections must
include a visual inspection of the tank(s) to identify any missing or brokers hardware, identify any cracks or leaks, measure the volume of
combined sludge and scum and to check for any bane up or pending of effluent on the ground surface. The dispersal cell(s) shall be
visdally inspected to check the effluent levels in the observatipn 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 regwres the immediate notification of the local
regulatory authority.
INhen the combined accumulation of sludge and scum in any tank equals one-Wrd ('h) or more of the tank volume, the entire contents of
he tank shah be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisccnsn
Administrative Code,
Ail other services, including but not limited to the servicing of effluent filters. mechanical or pressurized components, pretreatment unr.s,
and any servicing at intervals of X12 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory autrionty within 10 days of completion of any service event.
Page of -
START UP AND OPERATION nth ucts or other chemicals that
For new construction, prior to use of the pOWTS check treatment tank(s) for the P are celeriac have the contents of the
may impede the treatment process and/or damage the dispersal cell(s).
tank(s) removed by a septage servicing operator prior to use.
System start up shall not occtu when soil conditions are frozen at the infiltrative surface. is restored the access wastewater will be
During power outages pump tanks may fill above normal highwater levels. When power
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or Surface Power
To avoid this the
situation have the contents of the pump operating the pump controls to restore
efficient pump or canted a Plumber r or rde pOWTS Maintainer tank to assist removed in by a manually Septa" Servicing Operator Poor normal levels
o
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.
Reduction or e(iminabon of the following from the wastewater stream may improve the performance and prolong the life of the POWT a'
( fat toundation drain
butts; condoms; cotton swabs: degreasers; dental floss; capers: disinfectants.
(sump water; trod and vegetable peelings; gasoline; grease: herbicides: meat scraps; medications; oil; Painting Products:
sump pump) baby wipes: a
pesticides; santary napkins: tampons; and water softener brute.
ABANDONMENT
When the POWTS fails and/or is per ane m en out of service the following steps shall be taken to insure that the system is propel y
and safety abandoned in comPU 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 property 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 fifled with soil,
gravel or another inert solid material.
CONTINGENCY PLAN must be taken, to provide a code compliant
If the POWTS falls and cannot be repaired the following measures have been, or
replacement system:
m.
~A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system.
The replacement area should be protected from disturbance and compaction and should not be infringed upon loll required
setbacks from e4stinrg and proposed structure, lot lines and wells. Failure to protect the replacement a will result in the r*,ed
y with rule-1
for a new soil and site evaluation to establish a suitable replacement area. Repleoement systems must effect at that time.
❑ A suitable replacement area is not available due to setback and/or sal limitations. Barring advances in POWTS technology a
holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation
area. If no replacement area is available a holding tank may be installed as
moat be performed to locate a suitable replacement
a last resort to replace the failed POWTS.
in effect at lodud wi time removal of the biomat at the infirawive
❑ Mound and at-grade sal absorption systems may be reconstructed
surface. Reconstructions of such systems must comply with the rules «WARNING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT
CSTDEATH MAY RESULT. RESCUE O"r A
MANY BE TDIFFICULT ANK UNDER O IMPOSSIBLE. CIRCUMSTANCES.
ENTER A ROM THE INTERIOR OF A TREATMENT
PERSON
ADDITIONAL COMMENTS - -
POM/TS INSTALLER i POWTS MAINTAINER
J
Name _ i- Name
Phone i Phone -
SEPTAGE SERVICING OPERATOR PER LOCAL REGULATOR AUTHORITY _
Name Name Cc Phone i /
Adminmtrob." Code.
This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 3113.54(1), (2) & (3). Wisoorrem
i _
I -
" i~:'
~
1 i;
ji~7JC ;
,f_,y
~ i - jjtli.~,~r
\ r
I r
~ ~ ~I.
t j .nom ~1 it i
E / ' ~I
! r ; ~
,
~-~~G
{ ~
_ i~ a
i ~ _ - - - p
_ o
r-- o
~a
~ ~ ( u
_ _ \ , ~ "o
C - ~ - ~ti -
a
R c
U ~ / << l
4A\ x
T4 1 Z~ ~ t J C;\
l0 s: ~ u~ A Q
3 ~ F ~
y 3~ ~.k( C ' Y 1
♦xy4 C
Cr \4: ~ 2+c
- ---------r_
Septic-Dose Tank Cross Section And Pump Performance Specifications
- - ~ - f t ump Manulacttuer t
r _
I ank `
Manufacturer IL L t~ L - - - - -
1ank Model Vp her ` Pump Model N_umber_ U -
- -7} L
I cHa1 "Tank rr.a aci Alarm Manufacturer
t ~ _t~~.~--. - - - - -~-Y.t•?11?---~'~ 1
Max Depth Alarm Model Nttmber r I
L. Bury _ - J l
-i
Switch Type t l + /c I I (-tc --I
t F~Iter Nlanufftcttfrer z { < - -1'otai Dynamic Head ('n - Feet
Fitter Model Number Elevation Head j
Distal Pressure
Network Loss
Minimum Pufup Performance Required Force Main Loss
(iPM' a.) j Ft "fDH Total
-1--/
Outlet Manhole Min. 4" Above Grade With Manhole Min. 4" Above Grade
I:o o Device. Inlet Manhole With Locking Device \
< (i" Below Grade Sealed Watertight I Securely Mounted J\l
_ Weather-proof
unction Box y _
1 r + Finished Grade r + + r . . ` _
Vent Min. 12" Oiscomtect
Above Grade Means
With Vent Cap
Outlet Filter ~y
Inlet inlet Baffle
Switch Settings and Reserve Capacity -1 TA Via"
F'r}
r Tank Volume Weep
- - CrPT _
Dimension Inches Volume Gal_ B Hole
(reserve) A
(alarm) R 2 - - ,yff Elevation C
(dose) C l 7 Ft.
2 a - - Bottorn
dead) n 1~ 1 D Elevation
Total ! Ur; L, Ft
•LLLll1y l.YY~- Y.. 1.1111 •
GENERAL. INSTALLATION: The septictdose 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 effartive 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. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank
cxcavatiuu and the sleeve is sealed watertight. Electrical service complies with NEC: 300 and Comm 46.28.
02105 1.J Page of
250=SERIES
113 hp Sump/Effluent Pumps for Professionals!
ALL MODELS FEATURE: MOTOR SPECIFICATIONS:
• Rugged 1/3 hp motor, oil filled with 1/3 hp 115V 5.2 amps 60Hz
thermal overload protection. Thermally Protected & Permanently Lubricated
• 1 /2" solids handling. (PSC) Permanent Split Capacitor
Maximum Fluid Temperature: 140"F
• 1-1/2" discharge.
• Hermetically sealed motor and switch cavities, DIMENSIONAL DATA:
and permanently lubricated bearings. Weight: Model 257:20 lbs.
• Liberty's UNI-BODY casting - a solid, one- Height: 10.5"
piece housing that eliminates the lower motor
seal ring found on other pumps. Major Width: 9.6" (manual model 250)
it Epoxy powder coat finish PERFORMANCE CURVE
• Vortex style impeller for superior PFRFORMANCE CURVE
solids-handling. Made of high temperature 25
engineering polymer.
• Fasteners - all non-corrosive stainless steel. 20 6
• 416 stainless steel rotor shaft. & v
C 15 5 2
m
250-series Cord Lengths ° -
= 10 3
Model 10' 25'(-2) 351(-3) 50'(-5)
Standard Optional Optional Optional 5 2 a
250
251 Standard Optional Optional Optional
253 Standard Optional Optional N/A 0 0
257 Standard Optional N/A N/A 0 10 20 30 40 50
U.S. Gallons Per Minute
10' cord length standard on all models. For optional lengths, b _ _ I t
add "-2.-3 or 5" suffix to model number. sa ra nn 156 192
Example.: for model 250 with 3v cord. order 250-3 I-aers Per Mmutc
EFFLUENTMODELS
tt
i
Y~
Model 250 ` Model 251+L Mod=ell 25311/ Model 257 VMF
Manual, no switch. Quirk-disconnect Wide-angle float with VMF switch. magnetically
wide-angle float, series (piggy-back) operated vertical float -
mercury-free. plug, allows manual operates in a 10"
operation of pump. diameter sump.
S 1• ° Dual vilely certification br
cernrrc s CCrtIflCd the United States and Canada.
$p,xifvf:i.•,s el,. SUO.K1 tC C~3ryle'rvMlOi^ mY-re.
Liberty Pumps • 7000 Apple Tree Avenue • Bergen, New York 14416 • Phone 800-543-2550 Fax (585) 494-1839
www.liben'ypumps.com Copyright C Ubcvly Pumps, Inc. Prl
Alinghlsreserved. UJT2500-RSrti
ST. CROtX (,'0CN1"'e
SEPTFC TANK'v1AINTLNANCL: AGRFFNIFNIT
AND
~n OWNFRSHIP CERTIF)CA-1'It'N FORM
Owiiel-431ycr 4n _ _ _
Mailing Atidress
Property Address
(Venfieatiou reouireel From plaaamg & Zoning L)cparment for new construction) - -
Cily;State Parcel Identification Number
-
LEGAL, DESCRIPTION
Property I ocattiou ,Sec - 7' L R J i! i •foWn of- f _ 1 _ -
Subdivision ,-c Lot #
Certified Survey Njap # - - V4111 10 Pa c #
Zl-
Warranty Deed # volume Page #
- Spec ;rouse ye' no Lot linr- idenhhahle yes no
SYSTEM MAUNTENANCE AND OWNER ('ERTIFR ATION
Improper use and maintenance of your scrruc: system could result in its pntinamre fathtrr. to handle wastes. Proper
rrnainterraucc consisis (if pumping out the septic tan), evcn~ flied vcam or sooner, ii uc .ded, by a Itcensrd purnjim% What you put into
the system can af3isof'he function of the septic tank as a trenhnent stage n the, waste. disposal system Owner maintenance
responsibilities are specified in §C onnn. K 52(1) and to Chapter 12 - St. Croix Co inty Sanitary Otdirtance
The property owner agrees to subunit to St Ctotx County Planning & zoa my, Dopartmrnt a eel tificauon foul:, :signed b_v the
owner and by a :vaster phnnher,.leurneyrn2n ptuniocr. resntcled plumber or a licensed pumper ventymg that (1) the oil Site
wastewater &posal system is in proper operating ccnd.tron attdlor (2) after msper.oon and pumping (d -necessary), the septic tank
less than 1:3 full of sludge.
iiwe, the undersigned have read the ahov, rcywremerds and agree to maintain the prnale srwage disposal system with the
standards set fonh, herein, as set by the DepaCnnent of Conunctcc and the Deparrr.cut of Nature] Resomccs, Slate of Wisconsin.
Certification stating that Your septic system fras been uaintaried must he coniplewd and returtu:d to the S!. Croix County Planning k
Zoning Department within 30 bays of the three :year expiration date.
live certify that all statements /dr
form arc true, co Cie best of rny.our knowledge. Iiwe am'arc the ov; net(s) of the
property described above, by n: of a ty de
ed recorded nr Roister of Der is Office.
' el _
Num4er of bedrgom
SIC AT Ol` APPLICANT(N) DATE
***Anv information that is misrepresented may result in the sanitary permit being ovoked by the Planning Zoning Department.
Inciuae with this application a recorded warranty deed from the Regisret of Deeds Office and a copy of the certified survey map it
reference is made in the warranty dta-d.
(REV. 08#05)
N F- N I LJ 0)
FT Ld l am N 3
I W LI 3 N
a, a, - 1.025 ACRES 00
Icc
N 44,P66 SQ. FT. r
I ~
i o o I
j I f-- I- -'-t o q;
2 0.20 Q I S89-51 31"W 246.53'
j I t I
Z
L._.-._.-._I NI
j_._._._._.J There a
i I
i
i 24 N W Secs. 2:
w Wis. St.
1101
Code w
T.. ; 1.005 ACRES
43,789 SQ. FT.
Certifj
26b.20' I I S89'55'31 "W 249.38' i
I I I
-~-i 00' I I 100'
i I ; t
I j 25
ES;
1.015 ACRES NOTE: LOTS 1 1
l I 44,221 SQ. FT.
tlgi'~I td~•,n•
K 4o1JF-~wy
NOIS'AN3®
C~i
Ki.]rtW[M]4WKI'T
LL
O
z O
J
a LL.
iJ
Z (n
1
LL 1 I ~
• t w.s w.n I .mrs.•w• ~ it ~ °
[4 Y
{A t O•
•t
q qa1°
- q , qq q .i. ~s E
Al;
b
i YP h i u qt 3
y • ~ ~_!_J '~_y ni
t
p s e Y `L` E If ~3, q r a
v 1 wi~~ > i i
7 =
s 3 8' d v+'3s asrs~3=~3s~tk 1~kkB
Y g n ~ S s y aAd r;k fk }s +s 'p4~+da
W~ ~5f C ~ Y 3 5 e s 5 N H~ I ~ . C~
K ~~y' t- I ~1 W at SW
wi
W q
® X
ED 4 J
k M'
NOISiAN3® _ ajri
~...boJ .l
W
z
5I UJ'.
Q L
Z ~ LU
LL f O
PL -
Y a a d. - ~
~ ` ice- • ~ f- y~ ~E I7
- a , lk
` ~ 1•..I . T FJ ei~ :I'•-_. Ill d~
r
r L
I
IM
GLL C'
D'5, E Y b C ~ yp3b 'b ~ ~ I '.i ; wz"a:H AS S _
h F G A 6 13 3 5 q ? iN X33 Put,
~2157~54 S~ 9$ 3t
Z 5 } Y 555 .P t i 'ky k~ k' e,~ p
MM W
Q J ...yyam~ . ad
J'i ~ S
NOIS:AN3* QI
I Z
5 a
a o
Z z
O
5 ~ ~ 6 M s
r t
i ~ p r
ii
i@I , t G{ ~ it
~p R
#9 Ig PI ~
op ,
~ i
I ~L
t
NOIS9AN3~
<...a nov a wzm. I
1 1
I.I Ili
Li'JI~ I.I 4
I ' t J
El Q; Eli El
❑ ❑ ❑,❑i
❑'❑'i❑ ❑
0 \ 1 IL' II -
1~! ❑ ❑ ❑I❑
W 1~~; ❑I❑~❑I❑'~'
U ~U i
a" ^ l ❑ ❑
w' E U ❑I
I❑, 1
Z a ~ o
W _j o
Q w u
S
_ wN
W R
TI
i
I '
'I 1
,III
r;
a'
s l a d!,
w s c 4 r NO dh i~ f ~MS W $ ~{i/ (
F- R 4 R y R t~+a ~ .11' a O 'S14 I ~l f~~E
O fM 3g d -iEU I ♦ Ii 0., U' 2 ~4 f. I~il
M t 5 3 Z' V 11 i 1 ♦f ' t 17'41 t [ ° O b9~~ c♦~ E} II
z ivt' me yw I I 1 Faf t 3 P.E J
Z
wU' ~F~hieP ado i>fi wsylsh II'_JLt 7{ ~s~ yEQs x_ 4 b ~f
Mu 0 IL w
RECEIVED—-,
:^;isconsin Department of Connie e rL r, - SON EVALUATION REPORT Page ~ 01 3
.or,;;ion of Safety and Buildings ' 1n~1
n a ror ancc 1Vi(FI Cc m 85. Wis. Adm. Code
Co:mly
Attach complete site plan on p r fml"( r than S 1l7`k'41 inc Is in size. Plan must
include. but not limited to: v'erlica! aad firr^..niatfe~ei2[ice Poi (861), direction and Parcel I.D. ~I
prrcenl slope, scale er dimensions. nr:-h ,+.rnW, :anft loca. et distance to nearest mad.
Please print all information. R owed Date
PnrSOna:nrormationyrupmoidema;o hp:SU ~ -o'dd')f ~4 •-.'.'u' i L•.vg51°r;i(1;ina;- - '(,(itilriM 6:
Properly Owner I'•operly I or;alion•--'
f nI k (:)'.`a lU r'C" GO-A. Lot '.?W 14 ~C 114 5 j T 30 N R IS E(~11
Properly Owner's Mailing Addrens ' vl U Block # Solid, Name or CSMC
1113 u. , l E,. ! :3Lj _ (a: ~t: v p
city Slate Zip Code Phone Number City Village (~Tovrn Nearest Re `d
•I JA b`~ )3 K.Ch wlO ~lv 107 4 Now Construction Use: Residential r Number of bedrooms Cade dw.vef design flow rate q 5 0 GPD
Replacement ~J Public or commercial Describe:
y -T 1
Parent material 1 r I % Ly Flood Plain elevation it applicable _ ft.
Coneral comments-- - 7-rhet~ . y 5,~C g 1-5'1 ,rf a~-•a5' i-oi - •rl,e ,•t,Ir',1t S Sv....,3e
-ndrecommondabons: !-$!•75'4_,& 1-$7.5nu1-•.
a-81.a5'ah<C~-75.o'TRa-r-•..1...5 , T.q C93 QA,)
T,1 (9r,HT') r.s a.to3'~ ~$7 l;F} to ll be
7.3 C 90 ~49'> ~ 1 Nr_c,~~erG ~n-(~l~ f
. r ~ _ -n 7~C~tiJ wrt~!'n~ ~n ~Q Yhlr~ J~ D ~ -R7'1
Ronng # ❑ Boring
❑ 13 Pit Owand su^ace elov- ft. Depth to I:miting factor I I D in.
Soil ApplicaGOn Rate
Horizon Depth Dom-nanl Color Redox Description Texture Structure Consistence Boundary Hoots GPDMP
in, Munsell Ou. Sz. Cool. Color Gr. Sz. Sh. •Eff#1 •Eff#2
1 o-S 10` k la - L IF1SR -1s as a r-
y
8-(`{ 'o°1R3/4 - - - L I~PL lc!-. Cut IF
3 a4 io Ak s/. L aySaK CW IMF S e
t7 3 IU `Ik `h+b ~y ~msf3K ? :4. (=1J 1vF 5
❑ Do:iny I rI IS j - l~ 0~lY17A,P
Boring k C/
~ Pit Ground soda elev. %~0.5~$ ft. ~beLdDepth to limitirg factor f 117 in.
Soil Application Rate
H or zvn Ueplh Dominant Color Rrdez Descripf.on Texture Structure Consistence Boundary RvOts GPDift'
in. M•unsell Oa. Sz- Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2
0-8 ~oyR'!a _ L aFGR cis as aF s
"SL' ams835 CU) I F 5
3 »-no Ts acs aFSB% cis - - 5
f t t rr' ~zA ¢c b
31
kets svRula SL (9p S8
'Effluent#1=BOD, >30<220 mg Laad TSS >'W _<150 ring;L •Eff1jent#2=ROD, <2. m;;Larc'SS<3U nryL
r'ST Name (Please Print) Sigratur CS! Number
ikon,44 7. s+~ k ;~a I v~
Ard!hess Hale Eva.ual.on Corductind Telephone Number
t~ln.
a
Properly Owner Pam:IJ ID f _ Paga
❑ Boring
Boring #
M
-3 ~ pit Ground surface elev. (,/,31 11. Depth to limiting (actor
Soil App!icalicn Rite
Horizon Depth Dorninanl Color Redox Description Texture Structure Consistence Boundary Roots GPD+`t'
in. Munsell O.r. $z. Cont- Color Gr Sz. Sh. •Efl 'Eff#2
I o-5 loN!k 21A - - - L IF cis QS 4
a toxa '1K - L. FPS ,)s~, (~VI ,r y 6
3 as -7.5yn sLy 1?rv1sGK ~s ~rtnf F 5
y as 45 l.5 `IQ " b - - c rr G's~K ,_;Sh ;aLJ - . 4
i5-95 yR - - 5~ ! F58Y ci'~U f r
'ID
l/Boring # ❑ Boringq r f .V:r-O- P•/C1 I
0 pit Ground surface elev. 5 L9 I Depth to limiting factor D$ in.
Soil Application Rate
Honzon Depth Dominant Color Redox DestIophen Texture Structure Consistence Boundary Roots GPDrll=
in. Munsell an. Sz. Cons color Gr. Sz. Sh. 'EII#t 'effl:2
0-7 1c) yR 31a - - L IF&g as o,s aF y 6
a 7- 6 lOR 31 L IFPL c"j y 6
3 iS-iS ioq sly L arg ds C~ Ivy 5 8
!S'yfO ~,SYR yob _ Heap 5 dr~is3k d5 ~~F ~u
-46 7.5 vR ql arsk d
❑ Boring
F] Boring # El pit Ground surface elov ft
. _ . Depth to hauling factor _ ]/G o
Soil Application Kate
dcrtzoo Depth Wounanl Co.ur Redox Description Texture Stricture Consistence Boundary Roots GPM,
in. Munsclt Ou. Sz. Con:. Color G•. Sz. Sh. 'EtV11 'E"2
' Flfluent Wt - BUII. > :M a 220 mgrL and TSS >30 < 150 mg;L ' Ltfluent 02 - BOD. 30 mgn, and TSS _ 30 mgrL
The Department nt'Cunmtcrce is on equal oppnrtunily service ptocider and employer. If you uccd assista:lce to access services or
nrr,i material in an ultcru_.te fonm..t. plc.rsc coal -t :hc ccpurhncnt at 608-106-z 1 I or TI l' 60S'-26 4 S""
.,u i;.x ,.,e..r ..i
ri
E J a ° 2 CL ~
`S `z rev)
(X
oa
ca Ca
\ \ N
j
i~. \ \ Y o. r.sp.,1
43
p J
v ~
V1 \ D
S y
r
~ u1 0
~ `3 ~ ,o~9cr
+a~ :5- J -
I
9 1 26C 2C' ' \ \ -2 .6C \
\ \ \ \
1.061 AG \ \
~x('9WtAC)~i
/ 1 1 I I ,
.j, co ` 1.009 AC
o \ (1.009 AC) 1.625 AC [o
(.0 5 AC)
204,54 7 _ i - I j N ,
50 W
\ l ~ i O '
\ 26 20 I f 746.5 \
10 \ l -i 1 i r__ l
1f 1.00 C w jl ~1 X 999.4
(1.005 1 24
-w I
- 1t - 1.005 AC
J4
34 AC
(1.)734 A(-) 1.005
x 918 9 x
200-s4. ec x;'
013 AC \ V
a (1.013 AC) 13 10C,' 'I \ ° 10 '
\ 1038 AC 015 Cj
'.1,038 AC)
i
X _ - ` \ -
d7, I 1~ I\\\\\~. x ~
AEG 2:: 98.8
\ ` 252
1 I I
~ 9 2 - 1 1~`2 AC ~ I
o I
O_00 AC
I 1
82
J30&. 7 I _
9P,G.0
,D 991.6 Y
! \ x
~x
~ 993.2
Y Y
I
.GRICULTURAL