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HomeMy WebLinkAbout032-1081-80-250 PRIVATE SEWAGE SYSTEM Counr. St. Croix Sa'et; and B.iilc ing D.v s nr INSPECTION REPORT Sa^dar; Permit No GENERAL INFORMATION (ATTACI I TO PERMIT) Slate P'an ID No 605141 Pe•v anal infomralion you :novice r he ..sea `o• serorda•y Durposes IP( v. Cy Law. S 15x04 (1 hnI]. Per- t Homer's Nain¢ C I,, Vi aqe T ohgt h D Parael Tax No Meyer Revocable Living Trust TOWN OF SOMERSET 032-1081-80,2W CST IWM Err Insp BY El" 8%1 Desr•ip ipn Socbc•VToan,Rarye:M,-_p Np 28.31.19.393A-20 TANK INFORMATION ELEVATION DATA I YPE MANUFACTURE S CAPACITY STATION HS HI FS ELEV. Septic Lvi e9.e,Y' ~ VA i Benchmark ) 35 (r Dosing A I BM Aeration Hag Sewer i(oldir- S'HtIF'let T--i TANK SETBACK INFORMATION $,H1 Outlet DD 79 {b 1 IANK'C p:L ,l V•:LL_ BLDG. r1l Artl-Lake ROAD DI If, tt y Sup' u Dos rig N Hea der: L•lan. Q'y/e .Q Aerelmr Dist Pipe ,l ,tio Hcldmg Hot. System PUMP/SIPHON INFORMATION Final Cade gLiftF-icifor Demard St Cover L, GPM Loss System Head TDH Ft th Da. 7is:. to v:er. - SOIL ABSORPTION SYSTEM BED:TRENCH v`:d:h Lie-In y No.Utgene -es PITDIMENS SND ),r IrsrdeC~a Liq:.idDepl- DIMENSIONS SETBACK SYSTEM TO P:L BLDG WELL LAKE' M LEACHING t: arutacturer. INFORMATION CHAMBER OR I'. O' Syslem UNIT 1, i9f Mail N'mn per S --r ,el 1, A L DISTRIBUTION SYSTEM C-il 11_ac C-; lawn loll Ll y:1 UU:On x iInlu 5 [f- _ x HGIe SDaCi--y 'ern'.? A r I'La Ae/~ u Pic=(si l e';gth_ 0 C a 7 Lencth_~ D.a f Soaci-y / W SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Cep It, O'Je' Jeeth User xx a¢Dth c' xx Seeced'Sodduc j •:x PA.ilch¢d 6ed,•T.e-oh Cu ")4_i :cclfn•nd: Edyus / Tcosod / Yuv No yes J Nc COMMENTS: (Include code disaepenc es. persons p•esent etc.) Inspection #1'. Irscect or #2 Location: 410 192NC AVE I ) Alt SM Desviotion 2 i Bldg sewer onglh - ~W) , - amount of cover = y1-~~-v I I` J Plan revision Required? Yes 1 No / 3~~~ - - - jL~Q l ~lX /I Use other s ae b• additi oral information. L lS`/iltn' Da'e Insepcbr's Car, No. <BD d"' 0 (R 3r`l L-/ d IlT County ! Industry Services Division B 1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.) 5 SP ; F.O.Box7,62 ~S ~ - Madison,Wl 707-7162 ~sm:rA`fi` - Sanitary Permit Application Sate TTetior Nanbu in accordance with SITS 383.21(2). Wis. Adm. Code• submission of this form to the app c vcmmerdbi unit is required prior to obtaining a sanitary permit. Note Application forms for state-owucd PO WTS are submitted to Pmjeer Address (if different tlmri mailing address) the Department of Safely and Professional Services. Personal information you provide may be used for secondary purito ses in accordance with the Privacy Low, s. 15.07(1)(m)• Scats. 1. Application lnformation-PlewPrintAOtnformation Property thvner's Name n n J Pared p -1.;~7~n'r1f'Y.. a 0, 3 I 3 13 A c Property Owner's Mailing Address Property Location 01 CoVL Lot City. $mm Zip Code Phone Number Y.r L. Section. ~i (circle oaq T'' I N - R Eon W_ 11 Type of Building (check all that apply) • 1 j 1."t H /J - I or 2 Family Dwelling - Number of Bedrooms Subdivision Name ❑ PublidCommarcial - Describe Usc Block 4 ❑ City of ❑Stite Owned-Describe Use_..- _ ❑Village of CSM Number ` 2 ~.b,~ _~ZZ~ZZ ~D~ 2`1 P Town of - IQ_. T Cheek onl one ox on fine A. Complete line B if applicable) TO _ New System Replaccmrni Systan ❑ 3 reamwnt/Hutding Tank Replacement Only Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Doc Issued Before Expiration Plumber Owner e/ •~•4rr' WMF mlcoa onent(Dcvice: (Check all that apply) Non-Pressurized In mxmd LYFrasurizrilln4kound ❑ At-Gradc ❑ Mottnd ? 24 in. of suitable soil ❑ Mound <24 in. of suitable soil -46 Hot mg al Component (--plain) ❑ Pretreatment Device (explain) V. Dispemallfreatment Area Information: _ Design Flow (gpd) j Design Soil Application /r Urspasal Arcs Required (st) Disposal Area/Proposed ( Sysma Ekvation Ratc(gp&O _ c"- ~ rye VI. Tank Info CapeCrty m Gallons _ l"otal p of Manufacturer u ° B o Gallons Units 52 IT 2 ,°•t a tl New 7'aeez tinting Tanks G a t-1 T N rn 4 V L Septic or Holding Tank d ❑ ❑ Dosing Chamber ❑ ❑ ❑ Vll. Respon#bilily Statement- 1, the underaigaed, assume responsibility for iust*atiou of the POW IS shown on the attached plans. ITlumbcfa None (P Plumbers 9 , j MP/MPtLS' Numbs Biuinas Phoce Number --r noO ~ Plumbe•s Address (Sued, City, State, Zip Cock) Vfll. •oun /De artment Use Only Approved isaptxoved- Permit Fee Date Tied Bsitin tSign rvrn Rexson Poe Dehial S !J" •Q~ $ IX. Condift&V~A.¢pVMBtI'.(tasoos for Disapproval 1, tioptk lark, ettk sm Oter en-1 I 1[Llj! wit-.A.~ e nhper:^.u cell must ell be s^.r_k~s ~r._r ec- n par ;rnW.3remeM. plant 7o rinro Irv nduroe.'. 2- M r** Wet 7'Kn frar.wi ; mgt tw mark u.(,i r Oaf ahCya~lg coat I •rrf mils.[ Abt► to coupkte pram for He Must ad wbmit to the Cnnnty only on paper not ks Has a In a 11 inches in she SBD-6398 (R03114) y Y =OPT - - - - ~1 CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: yL - - Owner's Name: Owner's Address: - Legal Description: Township: i County - - Subdivision Name: I-ot Number Parcel ID Number. Page 1 Index and title Page 2 Plot Plan_ Page 3 System 3099 A Cross-Section Page 4 Fitter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St Cron: Cty Septic Tank Man6PJranx~e Forth Page 8 Warranty Deed Page 9 CSM or Plat Attachments: SoB Test $ House Plans Designer/Plumber (kense Number: - Date: Phone Number Signature ~ r designed pd nt to the Ink;Wund Sol Absorpfbn canponent Manual rur POINTS Version 20 Sed-10706-P (Kolmi Pane t glg i/ 9G ~U , I. Gs ~ I ~k 1 97 Soil Absorption System Cross Section _ ft - 4' SdieWL 40 Final Grade PVC Vent Pipe wAh Vent Cap ft Leaching Chamber - -Y" System Elevation _ ft it Soil Absorption System Plan View tt ft ~ 1~11I~1f - --ft < Vent Or Observation Pipe Leaching ( irench~ I` Chambers _J 1~11®III~III[~[IL®I~l 4' Dia Trench 2~ I leader - Leaching Chamber Specifications Manufacturer And Model- -~..-'-1-...4.~1~~ --fir:, EISA Rating, sq ft per chamber Soil Application Rate 1-, gpd/sq ft gpd Design Flow : Soil Application Rate FISA = -It / _Chambers 2 rows of , chamberseach. Page of FL-525 EFFLUENT FILTER Polylok, Inc is pleased to add it,; r - E new commercial filter to its existinq line of quality effluent filters. The PL-525 is rated for over 10,000 GPU Alann Accepts vve 5 it (gallons per dayii making it one of accessibility extension handle the largest commercial filters in its class. It has 525 linear feet of t. t filtration slots. Like tile Palyiok t- PL 122, the new Polylok PL-525 has an automatic shut off ball installed - 52,5 linear feet wAth every filter. k~5/han the filter is 'i of 1116° I. filtration slots q fated for over r 10,000 GPD removed for cleaning, the ball will goat up and temporarily shut off the system So the effluent won`t leave the tank. !Vo other filter on t Accepts 4" & _ \ , the rnarketcan nlake that Bairn.i 6 scflD 40 Pipe' The PL-525 Effluent Filter should' operate efficiently for several years under normal conditions hefore requiring cleaning. It is recnrn- mended that the filter be cleaned ,:vary time the tank is pumped or at (east every three years. If the installed filter contains an optional t alarm, the owner will be notified by all alarm when tile- filter needs y. Gas deflector servicing. Servicing should be 1 RMA «t"'~~ done by a certified septic tank „Automatic shut-off ball whet' or installer. >`r filter S is removed I 1. Locate the outlet of the 1J. ..Pstenr DleC s•01s, a ° sr-.otic tank. 5.6:1,640 2. Remove tank cover and pump - - _ 1. Locate the outlet of the tank if necessary. i3f _t;L~ r f 3. Do rlotusr: plumbing when _ septic tank. filter is removed. idaai for residential and com- 2. Remove the tank cover and 4. Pull PL-525 out of the housing. rnercial waste flows up to pump tank it necessary. 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the 5. Hose off filter over the septic 4" or G" outlet pipe. If the tank. Make sure all solids 1,111 filter is not centered under the hack 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. th-I filter is properly aligned and 4. Insert the PL-525 filter into its housing. Inserted. ng. ~ 5. Replace the septic tank cover. Replace t;:optic tank cover. ~ Ciy} POWTS OWNER'S MANUAL & MANAGEMENT PLAN rItp: _ J FILE INFORMADON SYS-I'EM SPECIFICATIONS O net rkMnn!jf rtt re•: ❑ NA i-rn ii c ;ic 17 1 c: e. D HO nc Vn un : qa:) DESIGN PARAMETERS +~ink 7~7anufactaror: G~NA Nrc7tc:^r of Redroorc;: ❑ NA ❑ Septic I I Dose I I Hofeiny Vc!ane: (5-:0 NXILb i of Puh!iC Facility I Inns: - NA Vcrfcal Distance Tank Bcttom(s) to Smvice Pad: I:) Estimated favoragn) I bnv:: {yaVday) Horizontal Distanca:. Tank(s) to Service Pad: ;1t) S , +'lu ,+-rd.riny ~7rcL`aCt a mu. t t e Iroviat•d .f :roftlCa' 15 feel cr Desiy7(ueart7 Hu"", -(e lln°ta;lxl it-.I r- if!rarzont.l 150 eef..Ircific ir.l~hopato tNnn bar, L. Situ ;,oil App Iic.7.ion Rate. `J - (ga_Inptt C`flucnt Filter P:tan Antilu ei.:~, 1 ! J NA CLiiida:d (Dvinest:C) In:lien::=clam; Nlwthhy averacc- Fhi.rnt I ilter Nlodel: Fats. 014 G+eas: (I-OG) s301rg11. P,.nlp Manw.ricturer -,imtT=m4:al Oxygen :7emand iul;[ + 220 mg:L _ PJi: 1X1 NA m~a. Pump haode;: T=1 sll_r'en~irJ Sol`a_. (TSS} 1150 H'n1: Smyth Iafluert-Efluent - Monl:nly average llmkmatmanl Unit .FOG) >30 ctgrt !v,I n:,tnctu,'ec >2iQ mgl:i. N;': _f'1-N.A i-r5;::) >I57 zonal I Pdechaniral r.=.lation f ( Peat Filter ❑ Us:nlccfnn ❑'vtc and Frn=rr,,T.n.6 I-floc.nt Nlont1y avcir:ye _ ❑ 5an9:G11vcl l Cte_r ❑ olher: .ar., m_1: (iss) ~c'c mind. NA cil!ibsurption Systel:7 : L9 Fecal ColJorm (gec':nehic nwan7 :10` - i 11:-Gocrc (gravity) D In-Ground (pressure) I I NA - I lAtGr=de 11I,'loI f.9aximu:n Efflaent Palticle Size k.: in dia I 1 NA 1 ! Drip -I in= I El NA Other Other: ----El NA MAINTENANCE SCI iEDULE Service Event Service Frequency Pump nu contents of tank(:; L L"Jhen combined sAmge and BOLOn e+.µlals nnn-th-rd i cf ;-Srlk -AUM~! E'::hrn t~-n hia't:vatcr 41411 isv adivateci rrorfl:(ai ' cars Im:pecl ::audition of tank(s) A. least once e`tery: (Maximum 3 / f-j PIA E n nu;_i Inspect rt!+'7strn :rn _ (Maximum 3 years) IJNA U1yca+.l Ciuallef'ucnttJter A Irestonccr;ry Lj" I I NA Ld !spec: pump. pump contrcls & alarm At least Ono ever,.. I mct,hr. 'L}'NA yc8risi - I n-.cn•.thfc) - - - flugh latcra' rnd ?rrssurn test A- lnnst or.re criery! I l ynan;,n NA cr}c 1-1 NA -tra: - E N,' MAINTENANCE INSTROCTIONS Inspeoticns nt tanks 4111 Sril ah ,rrpt!._. c.~:.t:.n-s ;1111 ho =.r mcivieual carrying une of trr. roI O•:n'J h: n ~ > a .r •tific:utin•rs: f,`ant::r I'i,.mber, l1L `o, 1111imi;er He:Iric ec Seae , 1'0'4'15 Ir Epect*~l, POV-fTS WaI' •al:tr;r Or ° r ta:g ° i• r I' Tr;nk i:!Spections must include a visual 57specUon of lhs tart<fs) to idenLFy any m'ssinU broken haidwrare. idenlI cracks crleaks, nleas.re the v :ume of ccr wined s't:rge and sc an arrl a cheok frr n y b.ao< up Or pondiny Of effluent On the groucd :;u!face. Tho soil ilsog7fion system shsC F.^ •disualq~ insncacd to cha;<the ett!::en; L^.•ee!:; in the: obsc !vai.-or, pipes and to rah^ck fcr any puriding rf effluent can the grounc surface. I:tn pcmliny Of effluent cal the guvrld surface :nay indicate a failing condition and requires the immediate n ot'tiraton of :he loc-11 regula=or y authcl ity. 7, I J ^e comnined ecz:urnwatio. Of sludge anal Scvnl in any treafn!ent tank equals ore-third ( ) or more Of the lank volume, the entire _nnten's of the tank shalt be renruved by a Septaye Servicing Operator fp!+!luer) and disposrnd o` in accuidarce. with chapter NR 113, L^dieCOnsin Administrative Code. Ali ethrr sowims, :-)nlud:-q but net ~imi'nd to tho st~rricing a' ctt'uent filters, mechanical cr pressWzr..•' rOmponeats, pretroetment units, and any sen:iri y at lrlelva!5 of - V mcilths, s,,,all ee per.'orme9 b7 a r_ertitiec PO'c^J I S Paaintaine.. A. ! ILA e,:c I a9 be Plr Ia-,i 1 t11 : ~.I r;.,:ul.il 1' .:11 . iIf I rl .^:a I _r.; r,f r-on ' !-111?' of aII - , eo P+ lit 1'20.0 of _ START UP AND OPERATION 1 0- nxv> c.rasttwtics, prix lO use of tide POCifS cre.. ,reaincn-. -a@nk,s, to 1 -:e ie.:r;r ' ct pair.tn;a piod.:cl:, solvents or other chamioels or sodment that may impede: the treatment process: and of daa:ag-n ino soil abscrption system. I` ^igh corcentrations are detected have the ccntc-;s of the tan(s) removed by a Septage Servicing Operator (pumper) prio,to use Pump tanks may fit above normal h:ghwator levels prinr to startup or due to pump failures. Start up or restoration of power under these co:adilicns Is rot recommended, as the excrs tvaste.•n~ater v:ill bo dischargcd'O the soil absorption system in one large dose causing an overload ;rat may result in trr backup or swfinw. cis: charge of ef0uenl and damage to the System. to atiroid -this s:tuation have the c0nterts of t. e pump tank romov(A by a Sertace Servicing? Operator (pum.per) oric: to reStovng power to lire pump cr contact a Plumber cr PC%*:V I S Un rt<-Jncr to ass s: in manually cperaling ti're pump cordrols until ncr,nal e`Ilugnt levels are restored wilhin the pump tank. Sy<tem st':ri 0.n ,hnli act occur when soil oonddumr[ o'o frozen at the :r.filtrativ- surom. Lo rot dri:;: or park vetic'es over tanks or ll-,e su.1 absorption system. Do riot drive cr park over, or othen>vise disturb or compact, the :aea v:ilnin 15 feet down slope rif any moo-1 nr at-grade sc:l absorption arr:.a. Reduction or clminaticn of the follcvang flea the waslelvatei slrearn :nay improve trg perfomaance and prolong the life of the treatment tanks and so*.[ absorption system: acids, antibiotic;;, baby wipes, cigarette h..utts, condoms, cotton s:;abs, degreasers, dental floss, :rapers, dis nfectants, fats, foundation dra'n (sump pump) discharge, fruit and vegetable peolings, gasoline, greases, herbicides, meat scraps. Ir r"i catiens• ciis, painting nrcducas, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge. ABANDONMENT fJnen tire I'0':,^J FS fails and!cr is permanently taken cut of nnivicn the foilo%ving steps sca'd betaken to insure that the system is properly snd sa`cly auandoned in compliance ,,'Jill s. Comr, 83.33,'rViscpnsin Administrative Code. • All piping to tacks, p.ts and other soil absorption systems shall be disconnected sad the abandoned pipe open:ngs sealed • 11-e contents or as tanks acd pats shall be remo'vud and properly d'sposed of by a Septage Servicing Operator (pumper). • Afie' pumping. all tanks and pats shall he mrinvatgd emd removed or `heir covers removed and the void space tiled mth soil, - grm:el or another Irc-t solid material. CONTINGENCY PLAN If the PO"N I S foils ant cannot be repaired the licLowng measures cave been, c. must be. take. to provide a code core iant replacement system. t4 A ;;viable replacrrnert area has been eva'catod and may be utii:ed for the location of a replacement soil absorption system. The iep'acement area should be p-xncted Porn disturbance and compaction and sho-.Id nct be nfrinecd upon by reA-,iced z.etbacks flora existing and nrepo sc:d s7:10ure, ,et I:nes and wells. Fziiurg to protect the replacement area hill result in the need a neN soil acd S 'e evaluation to estab:ish a suitable replacement ar,^a. Replacement sy:;tcrrs must temp?y with the rules in effect at l::e tinn e of their perm.' issuance:. C A suitable replacement area is not a:•ailatdc dug to sotback n-dicr sc'! limitations. If the soil absorption System. cannot be ie'iabilltated and barring advances in 1104:r1S te>:hrology, a holding tank may, be insto led as a last resort ❑ The site has not been eva!uatcd to identify a suitable repla:>nment area. Orion failare of the PO -1I S a soa and site evaluatlwi :must he, . or, corm ed g locate a suitable replacern enl area. If no replacement area is avadahig a hciding tank may be irstallad as a last resod. to replace the failed PO:'-ITS. ❑ 'found and a`-g-ade soil absnrn=on systems rimy be recasrshucl:>.d in nano ro!Iov;rng nc3-.oval of the bior:rat r, t-e icfl!ia' ;e st.rface. Recons:ntc,'ions or such s~stcm:v rnusi rrmnly •,vt~ foe r.~Ics in ct=rzt r that Fore. WARNING .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 .jt RESULT. ESCAPE. OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: POWTS INSTALL?=R POWTS MAINTAINER I arrlo Phone - PIT°,ne SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL. RFGUTA I CRY AUTHORITY n;me r lore ,,s F. Phore p me Z/z -Iris rorzjnl nt aa.. Jul,::i by Ill,. s al`: -f 11.- Grtlcl tdarlu tte 11i" a'im* -"z rr.6r hr POW S n.4u. alp yin rr. ~rl.Iian .'wrfry ser.'i:,rs . mil N3 2?1 1 trjS ;f) .r !1 41 `A:1l F. , a r:' n A-ill: r r' r~rrf. C,',. r'an- START UP AND OPERATION ref acre: corsf-~ci cu, pfior t' 'se. Ct tree PO:^;TS ch2c% tr^..-:-nerd ttn.c(si fc' the presence of painting nrirlad<:, solde:YS or o'-. nr chemicals or sr,; meat Wit may impede the treahnent urocess and/or damage the soil absorption system. 1` high con:rnirations ar- detected have lie contents of the tanK :.:j I--InLw d by a Septage ier'dll::nq Operator (oumpe;) prior to use. P.Imp tanK may rill above ncrmat nigh-r:a`c levels oriof k, stani m o- cue to pcmn fa':ures Star. LIP or restoration cf ocvrer under t'ie=r condiions :-s act recommended, a:; the excess wastrnnntr.- vrll be dischargsC to the ::oi' absorption systcm :n a'e lai:fe dose caul ra are. overload ttra: may I'esuR it tie ba;l;cp ur surface cischarce of of:scent and d,-!m,;;ge to tte sysmrr:. fo avoid title situation nave tht f'i_r-1t ; conte:us of tnc pump tank removed by a Sontacr Smvloin_ Ouerator r:atmpe'i prig' to resior.n; fmwe- to the pump o' contact .1 or Pole'-,ITS PJ,%1nr:aster to assist in manualiv oper:ttir._y the pump oantrnls anti normal etlurn: levee ate restored vritnr the purnu to :L. System Smn up ::hall 'tot cc::u: When soil Condih.or-z aie frozen at the infittratwe suifaec. Do not drive or park vehic;es c'•rer tankF o- me soil absoiptior c,ystcm. Uo not drvc or park ovef, o' otheroisc disturb o. obmpect. ' . arena e;rhir 1- feel doter orc• of any meend c: at-grade soil absctrrtion area. Reduction e' elfin n?tiori of the rgl'cwlnU from the m<stron<:-.C Stre_im r.Iay Iml.rrv • the oe. fonnance and noon- th;r life of the fnatn tanks and soil abserntior svs:em. aci_'., an::bf a ns wpe,. cgerctt. 'Cutts; u:noo:ns, onttr s,&abc, a- rease's diaf+e•s. d-s.nfsctants, 'as ic_ii: dtion clam (sump pumot i cnarce f. --I:, ann vea=tdole peelings. aa::Olin greases nerh ^i t.-: -i~~ ? I f:ainiuty prcducts, nesticida::; sdnitarv napki-s, solvent:, tampons. and. water softener brine:) 3^e-g,.;. ABANDONMENT NJ.-.;:r. the PO'vVTS fails andror is peu:Iare::lly taken Cu` r servi:;e the fCli01Nng steps shall be taken to insu-e that lane system is :;nc s iaiv nrn':c.n noc in c:unuitarn wish s. Come 8 .a, Vviseunsin Adnwr :native Cud`e. • All ofp.ng tc t:lnks pis and where sc.1 abso•plicn systems shale be dsconneciec and the abandoned pine op-n ngs • to cunte~ts of all tanks and pits shall be removed in J rroperly disposed of by a Seutage Se-%,tang Operatof (p-jmp~i • After parcpinc, all tart<s anc pits shah. h^ excavated and removed or thai: covers removed and the void spacc Nr c.. vvr-- aravcl g anctner irer. solid materin CONTINGENCY PLAN I` tie PO': i~~S Leila anal cannot be repaired he to:lanfnq measure:' have be.-.n, or must ba takon, to p-ovide a :aide comnlian: : e~;aoelrient svstcm .A snitanle replacement a: oa ties o^cr eva:uuted and may tin u-i:izee for Cne location 'n a reotdcefnen' soil absorption syste r. i':' cptacemeni ale: should be p-ak:rtec from disturbar..e n-d c:rnpactior and snould not be intrincec upo- by recuired toacKfi: trcm exis:.ng anti p-opaxc stn::tune, lot I.:ies anc; webs. =aauie tc r'otonY the reuiacemeni area will result i:t the need M- ne•,v soil arc site eeaiuat'.on to estab:ish a su!tiblc replacement area. Replacement systems rrest Comply moth the rules in tfecl e'. fhe ti•n^ of-hoir oc-mit issuance. s_¢Lable replaceTfent ns;_ r ncz available cue to setback andror soy Iimttations. 1` 4`10 sail adsorption system cannot be ^~ffabiiitated anc hamnc advance,' it ?0114V -l S technology. a haci^.g tane rr:ay be ins:a'led as a last resort. Tree site has not -cer eva'uated to identify a rm"FIAe ieo ecemen: area Upon failure of the PO'v;`TS a soil anc site ovaluation rrt:s: be pc to-^iod to iodate a st:itaNc remacemen: area. If ro repia:^^mont area is available a nolding, tank may b^ installed as a lastr ug to replace the failed PCY-PVIS. Vuund and st-aracc so11 rFOrpEc: s, stems rray x: -..,:Cnsuuctec in rlam_ foliowine reTnvni o' the tiornat a+. t^e infiltrative s!:ra Ri:^ar. a-fans o j.1_f mist cnm~l., velth b a cs in cHc~;t st tt:dt fil WARNING 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 R-SCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: POINTS INSTALLER POINTS MAINTAINER SEPTAG= SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHOR;TY r• ;h: ;.:.,nL ••r: is r. c.,ac^; =r.~n r~ conmi anc: 'with s,~rhr.~f~ l Wort 'Pf Yf 'rd'. =(Y. r dJir ~-r, F.dntm I i L:c:b= ST. CROIX COUNTTY SEPTIC TANK I~FALN Eh'ANC~ AGR]~AIT AND 0Vk \TRSHIPCERTTFICATIONFORIM Owner•-BLyer / GL •t f- J ~11) / / ~f L _ l~ C 'IIrGD'.^ti':Y :]dI?SS ,Verification m1aiind from Plt®mg & Zoning Department far new otmstructim) Pity/State Parcel Identification N=ber , r L ' a LEG_e DESCRIPTIO Property capon 1/4, Sec. T NR W, Town of cs f Subdivision Plat: Lot # Certified Survey Map # Volume Page i `i'arraW Dead n ('before 20(a'7)Voluroe . Page a Spec hotuo 0 yes Z no Lot lion idle ayes ono SYSTEM MAINTENANCE AND OWNER CERTIFICATION improper use and maintenance of your septic system cor ld result in its premairre t;Wure to handle wastes. Proper maintenance consists of pampiae ont • he septic tank every three years or sooner, if needed, by a licensed pamper. Wbat you put into Lire system can affect the function of the septic tw! as a treatment step in the waste disposal system Owner maintenance responsibilities are specified in §SPS. 38352(1) and is Chapter 12 - St Croix County Sanitary Ordiiancm The property owner agrees to submit to St Croix Comity Plating & Zo=g Department a certification form, signed by the ow= and by a master phtmbar; journeyman phli nbe , restricted plumber or a licensed pumps vm*ing that (1) the ou-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (ifnecessary), the septic tank is Less tha*i 13 fall of sludge. Uwe, the undersis t d have read the above requirements and as ea to inainrzia rite private sewage disposal system with the samdards sin ft* here , as set by the Departai= of Safely And Profcsmoxal Scxvices and the Depwtmem ofNamral Resouroes, Std of &*scoRS*a Cerancanun scene chat Yaw septic.sisoem has beeam mini med must be completed and rammed to the St Crotx C.aaoey ai,m & Zoning Depertmtemt within 30 daps of the rhnoe y e©sarhon date. liwe certiry that aD statement; on form are ime to the best ofmy/ota knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a y deed recorded in R~ of Deeds Office. Number of bedrooms c SIGN L;W OF APPLICAN 1(S)• DATE Any inmrrnation that is misrepresented may result in the sanitary permit be* revoked by the planning & Z.onmg Department fnchlde with t'nis application a recorded wartaaty deed from the Register of Deeds Office and a copy of the catified s<avey map if refer-atce is made in the Aurrawy deed (REV.+ns,22) . 1 wis. D<aL fir cfffe:y and PrufesslcIaI be 1,el SOIL EVALUATIO~L NORT T _ or Div-son of Safety and 6dilmngs 1~1 3 n n a ce-dance v itI SPS 385 Wis Adm. Code - County Attach complete site {Uw, er paper i1o[la thalr8!L!-X~ 11 inches i r size. Plan must - include, lint riot Iln;led~to:!veRla,4lir liFwncniai`reference point iBkll, direction and Pared I.D. . pcrccnt slope. scale ubAirnTfhsTons rorth arro-.v, and for-.ahon and d.-;lance to nearest road. Please print all information. Rc;i,red by Dato P: y:arral rlormaL:,n y:., provide ^r~y oo a^,ea Inn se<xmd:ny p.. q,ses (I'r „c, LJ A, s. 'S 44111 tr jt Property Owner Ps:porly Location b"y -`1 - a, - Govt. Lot / 14 ~z T N R E (:,r) Prope^y (Tuner's Mailing Adcross Lot # Hlockll .`>ubd. Name yr GSIAI" C.ty _ slab 71p Coca Phone Ndmber ❑city ❑Village [3Ton•n NNa•est Rcrd New Cons!rnclinr Use.: ® Resident al i Numuer of bedrooms % Code derived dmign flow; rate GPD ~J Replacement ❑ Public or commercial Describe Pa•ent matenal Flood Plain elevallon if appli:.able . _ h General comments _ and recommendations. .:/-i,. ` %Y~ / ❑ Da !'9 Do4rc # ® pit Geunrl surface elev. fl. L'epth to Urnn:nU factor il' Soil Ao IlcaUOn .Rafe -ienzon Depth Dommant Cole Redox Descriptnn Texture Structure .onsislence otmdar; Rants GPDift ' in. Munsell Oki. Sz. Con:. Cola Gr Sz. Sh. ff41 ff?2 Il , ❑ Hn i•r Baring LJ ® Pit Grourd sulace elev. fl. Dep:h to limiting racx:r~/ r. Soil Fan lication Rate Hc,izon Depth Domiran: Color Redox Descxipt.an Texture Structure :on sistaice oundaly Roots GP(Yf@ ' in. M irsell Qu. Sz. Cons Color Gr. 3z. Sh 100 ' ffx2 i -r - -A _ - 4 ~i /i r - I I ,1 - F ffluefrt 41 -DOD > 30 < 220 mg:L and I SS >3C 50 nx{;L Effluent 42 - _DOD < 30 rug l and TSS 39 mgrl_ CST Name (Pik ace Prr :i!g•rahrc / ^ CST Nunrbu, A!cress _ /Date Fvaloalrtm Conducted l Telephone Nr.mher Vt) 1 I Prope^•y Owner I'dr_cl ID K " L PnJe ~ u' ~i Boring t❑~tt Borings - - 1'~I Pit Ground surface clout %'i7 fl. Depth to limitin factor -_zL:., _ in. Sc I ;locdia~:~on Ratr. Hc:nm•i Depth Dominant Color Rctlnx Desc•iplion Iextare Stvcture -:onsistenee oundary Roots GI°DNt ut P.141•1sell flu. Sz. Cont. Color G• S[. Sh. ry {{p2 1 _ ❑ Rcnng 6uri•r, lr ❑ Pit Ground ur(are elev. f;. Dcplh fu hrtuting factor soil; olicotion Ra:c Hnrizon Deptn Don'inarl Cobi Redox Des::opli m Texture Struclun, Jcis steno: ocndary Rcols GPDrII irI. t lunsell Ou. 5z. Cont. Color ..^,r :;i sl'. ff41 ff42 Ronny - Boring N F-1 F1 ❑ Pit iornurd surface e-lev. Drnth to lint ling laolof n. Soil Application Rate Benton Depfi Denlinant Golor Redox Desari:aion -e.grru S:ruclurc, •c+rs'slence Boundary tCots GPD•18 in_ Wunsch p.r. 8z. Gonl C.,*., Gr Sy F.P. ' -Iltlt PN2 EfI 19' - RCD ; - 30 »n rng;L and 1 SS >30 150 mI L°I,rert *2 - BCD : 30 mg:L and TSS 3n In( Lj The Dept, of Safety and 1'rofessionel lien w. -s is an equal oppoiwIi:y vi proem ^r 111d r Iopluccr. II Noll nead .u<islanec to access services or need m.ltcr i._I in an altern:nr ILun:rl. ermtac' fre dgrartn'rnl .n P0' ?66 ? . s 1 m 1'TY tiu:nleh Relay I''ct 'rtr J'.c•'er ~/_'~~/`X'~ ~3t'.I ID ~ _ - %f-''. --/;%Y; I'ag2 ~I _ i El ~iorng EZ ® -.it ;Trnu:rl surface elev. 4. )O.:qh !n lirn:hn<~ factor r_ $eiI AG DIiC300r Effie ~c^zen Depth Cormran;Cclor Rzcox Gz~.:.npticn 1zz;urz Saucture bnsisience nmd?ry F.cots :;PG`. in. "Ll)-ndl Sz. ::::nt. Cider Gr Sh. TBi• ff#2 I j ❑ f'wxinq L~ quv.nd :wfaserv. C!p[h lin:mq'gr ;c:j,"~ in. 5cl,ap li ,=lion Hate! -icrzcr Depth Com:naot ~ulcr, R .i~x ,c,.p[i<r U:c-r= t e n ite°.ce 'currary R:tnt:t GP7:Yt in. MI,nsell i Fonng C Ccr na 4 Grounc scrfacr. elev ft Cepth to limitinq factor f n. ❑ Pt _ C=oil .a cllcaticn Rat= Hcrzcr Uep:h I Scmnant Color Redox Cescrptor I ex!:.re 1 :;mirure Jcnss!erce ~ic~ncar~r Roors GPID it ' ir.. FAUnsell !7n :i Corr <,clnr Gr. ffI1 I ,11 t -H'_ _..,r L~LPrhI -Ilh:ei -?Pm,~L3 1 The Dept. of Sa,lcrv an.i ~cr: IC ix Jn equal rl+nortcritv +cr✓ice pt•.>id.:r tad sec: iU, of r.cec mares iul in ill alternate 5tnnar..,onf:wt the cepa:'trtenr ar ho, I it TTY time in Relav sn^ n;,o: n i i n -T nCSF:<' ~ Si j-r > >L9 o? ? -bi+rr/'-+ y-'f I G~:! x`44 ✓<J ~.t r o o o - - m THE U•FST LINE OF THE SN'I/4 OF SECLON 28 NEARS S00'21'25"F BASED UPON THE ST. (ROIE TULIN IT o COORDINATE SYSTEM o Ty m c c4oc~ cmv^ c m 1 _ IVFST LINE OF THE AVI/4 lir-1 {}(~~S,~F`- `f FyCp~ P^p^ N.~~ 500'2:'2S'E SW'1]'25"F ~JI v t .l •Z m 5 y T 1313.9 13$394' 1; _ ti T , m (1 a•L ti~ 2 pm ~r L / j VI r e < Iw LOT 1, C.S.M. b'OLF'8~?G,f.•i'31, I' m; r o - D r N00'21'25 i 70UAO' i \ _ 31 670.72 r r~ - 29.26' a 4 W ? I~ F~ r A c I I / \ x; LAI 00 1~n 00 X401 61'- _ - 270 06 I i 00 6,w I^ i "I N00'21'25"SV ]WIA~.' x m 4 P o FNS S c. O P Wzy i z f'~:~-~ i Im F L Y r O I Y i O z ►I ` ► EJ s iv a~ > ~ II!--• m n g ' v a<. "erg p` no z m z 3 Ian I 2 _ $ $ ? 5 o lit. 3 - $ x o m v lD y^M r~ F w Dig CO < t Obi p O I M1y F C Z 6 OpG c S ° v Z 1,7 n m " fQ 07 N - / S Zy O i n f: ID 442ND STREET w w O S J 667 63 L _ LOT - rt_06'24cIFVARY GRACIE UNPLATTt_D_LAND ESTATF4- ~II r- ~Ict IOVOGRAVHY. SOIL BORINGS