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HomeMy WebLinkAbout034-1044-50-000 v ai"c nsin Depan-en: e'Cc°°-•erce PRIVATE SEWAGE SYSTEM Ccunr, Sl. CfOIX SXcly and B.Iilcing D vaor INSPECTION REPORT Sanitary P,I- t N: GENERAL INFORMATION (AI IACH TO PERMIT) s;a:e ?la- ID No 605140 Persona 'nrc'mr.IC you Pu.ide ma'/ de ~see'r secondary purposes IPr vacy ! awy s 15 9: n'~~ml) 3146915 Verna: l u de, s 44-e Cry vl age Tv.nsh o Pa'xI Taa No Larry Rickard TOWN OF SPRINGFIELD 034-1044-50-000 ':ST Bral F.ey I Insp BM Elev. BM Descr pto ~ Sec:icn,To;s~m'Ha1~gr.'blap Nu b~' 19.29.15.301 TANK INFORMATION ELEVATION DATA TYPE N%NUFACTUREIR CAPACITY STAIION BS HI FS ELEV. ScPUC Berchmark ~ I L;UU ( IQJ.O(p ~~~,7n Cosing Alt. QN1 0 d A22tron B.cg. Sewer IT S',-Ht Irlet I ? 7 St H: Ou: et TANK SETBACK INFORMATION TANK TO t':L, 1,61CLL QLOG Ven:t,Ai iia•m ROAD D! Inlet Sep: C Ut Qatar Dosng Ileadcrifslan I i I J Aeration D st. Pipe r I tif-;~ Hold. ng Bol System N I bo-~ 5 PUMPISIPHON INFORMATION ^inal Grade b. y0 P.9anu`acWrer ',,n I 1 Demand SI Cover r - f~C-~~;•~., rrks GPM ll (p I .QO f hlotlel Number - I TDH Lift, Friction Loss System Head I F: Porcemain Length 1 01a CIS, "Veil SOIL ABSORPTION SYSTEM BED:TRENCH saicP i I englrr No C' benches PIT DIMENSJONS N5. Vrs Psiee I a Liq.id DeN•+ DIMENSIONS SETBACK SYS[I TO P!L ~ QL DG WFLL IAKEISTREAM LEACHING aanutacturer. - INFORMATION _ CHAMBER OR 9De MOO UNIT J ~ `.foJ!•I NumCcl 191 f C_ ~ DISTRIBUTION SYSTEM Il.acc ' ci-LILd C-t f Dslrbulon xllclC Sitc %I ale ,.'.omg b'en]tO A':ela4e_ r Tipe;si C 1 -.r3•.h_v+_1..C3.-i% Ien.th__~_~ Ua O Spa: ng A, LM SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only - J!'(:;II':j': p! del Cs=r scc deb Tronc, Cm9er 3cc!Trer& Edges tupsni - - Yc'S NV Yee NO COMMENTS: ilncluce code discrepencies• persons presert etc; Inspection #1 LIO4,( Inspection 42: Location: NO Acdress A•:aarila,ble ~PIV-l 4 1.) All W Descript or = x.{~o-{ Cc~~-r-{ ~6 - c h-, - 1. J.,•.' 2.1 Bldg sewer length = r - an,oun: of cove = LJ~ J (l xxk~ w1an rev s on Requred) _ Yes No I^ tt,er side for adcitional informator O C _ ii - Inseoclor's Sign .ae / er. No. --A" - 3'>`l _ can,,:,, - Safety and Buildings Division s$- ,~p 201 W. Washington Ave., P O. Box 7162 Sr, Perini: NuRib.:, (,o be filled in by Co ) P F'JL Z 1 ~IJl8 1 Madison, WI 53707-7162 -SaiiiUry!P-&mit Application s a!c Tran u: n:. 'rn accordance u it§ SPS 383.2t(2), Wrs. Arlin Cude w'sm:ssion of this form to ! ^ e merits unit is ,gsrr(mred print to obtaining a cum.u} permit . Note Application tomes f'or scare mwitd POW IS are submamd to proj«t AJd•, s td,if r t i.m :nmiing address) the Dscs in in cot ydamety' and polfess;onal Serves. 4(Pers~pnjl l Xmy. information you provide ma} be used for se p co::dury - uoses aecnrdan:e uvdt the e Priv Pavac\ n' Isuys. IS Rt .Scats 1. Application Information - Please Print ormation Prcxny Omncr's Ntmr / Parcr'>: Pnipetn Owner's A1aibnc A,;d:c.s i C x Prupcn, Location Smtr !Zm Code hone Nurnba N./C ".~f6~ Section ll~~ - c We (.~~//lei cut Ss~aaB 7is-GS 9 ~y z9 u Ilrlyy. Type of Building (check all that appi') - wt - - - gs~ l or 2 Fart Dwelling - Number of Bcd,-Optns Subdn isiun Name - OIL a Black k Public,C'ontmeuriA - Describe Use _ O G;} of_. ~ /d v11l4c of ' L] S[atc Chsned - Describe Usti CSM Numbei ~ - r----r-- _ _ X50 ~e JtI Tcun o 4 _ "YY 1 Z ill. Type of Permit: (Check only one box on lint A. Complete line R if applicable) 'l New System , Replaccmcn: System L: 7rcarnsntMo:dme lank Replacemer:t Only ❑ other nfodificaiu.n to Existing Sts;an iexplain) B• ^ Perms Renewal [ Penns Revision mbs L Pennil Transfer to New :.,St Prcv,ocs Pernut Number and Date Issy d Ch;+nge of Plu Belore Expiration Owner - ~j 1V. Type of PONL'TS System/Component/Device: Check all that apply) - Non-Preswracd lo-Ground Prcesur.vcd 4,Gmund J At-Grade [ Muund> 24 in ofs::uabie x Slound 21, in of:,tu c cane: Bolding Yank L her D'spc754i Cm,pmicni (exPiad'j _ _ ❑ Prellraburu: V. Dix enal/frea ent Area Information: _ s Design Plo%(gpd) Design Soil APPicahon Ratc(gp f Dispersa: Area Regm,ed ts11 Dnlxr vl Aic: it Systcri Elc,a:iun .400 I • G joe4t coo v./ Yl. Tank Info Capa:.ity,n --l 0of MSCactu:cr V i 6a11ons Oallum limn } \ewTan::s i'visona "anti A1/'I lale- :26-ti, I y J c: pica BoldmS lank v' _.i OHO . n,.cng Cham'oet i 1'll. RnponsihiTj Statement- 1, the undersigned, assume responelbilin fur installation of the POR"1 IN shown on the coached plans. i'lumbcr's Same (feint ( Plum s Somitture ` 1AP MlPRS Number Pion Nwmt et ---I', /1<tnF.~/ yI~T 1 26, 7985 7~s ass its "lumber's Adness (Strcct, ell\, S uc, Zip Code) j till ouan•/De artment Ilse Only Apprnvrd !S!plwr - Permit tee Dait sued 1 locum ant Signature Tar ~nro Reason for 5 ~ ~ ~ ~ ~ 1.C. Condi*1#tffY" canons for Disapproval 1. tS60: tank, eftX-m. IiRs L"I ur,per.•s, CO Host all be -A" rox i ~c as per Yiarayemen- plzn p•o naed by plunbe:. 2 All albfrAt reSl.wr^erns rnuut us:'a,M: iY.e^. e pv vppiorlble c1aY: r crrl:u•wra. Atuoh m comP4tc plans fm die camas ..d ,.hr t to the Cpunb oil, on pvper not lest than a in a r 1 mahra m sire SBD-6398 (R- 11;1 I .._F(:Y. aC%A, A'"Ftl::A3 c 1t'0 -0 Q WALL SOIL EVALUATION Scan: 1' -20 SYSTEM PAGE 2 OF SITE MAP PLOT PLAN Lary Rickat ' - n to h os~yn 11uw catculOL U•ts br cornrnt.r 'ta plans r t JJv t n.;tn. Dmatono AS-M S anew" Mmo 3R4 3 , S 384 MY _ oVz 4S7DA M054 £a,ita s~„« N4- l . b Trn J `Y.jc n:e Jaen _ _ dA L?s:.cevo^. Qf Oe FO ar 7r- c ' Vf IIC:u fIb90't . t t 11 snu oy "ma tit amhame'. t y M, vrc., 's G n v. a~::uro ere dour ....o.a d. sditabte in,wdw. r 1 3e t ~ ~s\.:a~''( I o, r--. 'L thrJ 3 z . 99' ~a n1'~, ~ II i ~Oo~' i I `l i I I ' VSlope I 1 ~ IDO,D ' ~ I i t t I i ill 1 i I ` .r `ae~,)~etsn,j UIVISION OF INDUSTRY SERVICES 1054' N RANCH RD HAYWARD WI 54843-6462 SContact Through Relay P ~ hllp:Asps. Nt.,ov!prograTsiindus!IY-Services Scott Walker, Governor Laura Guli6rrez. Secretary A mqust 14.3018 CLISI IDNu. 267985 .111% POIVT.SM.;peclor \11CHAEL. J .\1YERS ZONING 01 :1 ICI. NORTHLAND 131.11\1BING IN(' Sl CROI.X COON FY SPIA 413 1 ±0111 AVI, 1101 ( ARMICHALL RD GLEMMOD CH Y \k'1 54013 HUDSON WI 54016-7708 CONDITIONAL. APPROVAL PLAN APPROVAL LXPIRLS: 08A 412020 Identification Numbers 'I iansaction ID No. 314691n SI' AF: site 11) No. 852815 Larry Richard Please refer to both identification numbers, 280111 St above, in all correspondence with the ageney. 1 uwu of Springfield St Croix County NF:I!4, SEI!4, S19. T29N, RI5\V FOR: Object t ype: PO" I S Component Manual Regulated Object ID No.: 179'061 Nlainte:latlee required: 300 GPD I low rate: System(s): Mound Component Manual - Ver. 2.0, SIM -10691-P (N.01 01, R. 10!12). Pressure Distribution Component Manual - Ver. 2.0. S13D-10706-P (N.01!01, R. 10`12): Efllucnt I'ilte•r The submittal described above has been reviewed for con`irrmanee with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submilial has been CONDITIONALLY APPROM). 'Ibis system is to be comtruclcd and located in accordance with the encluacd approved plans and with any component manual(s) re[crot•,ced above. The owner, as defined in chapter 101,(11(10), iscunsin Statutes, is responsible for compliance with all code requirements. A copy of the approved plans, spcci!ications and this letter shall be on-site during construction and open to inspection by authorized represcncrives of the Department. which may include local inspectors. All pernnits required by the slate or the local municipality shall be obtained prior to c,nnmcoc•cntcnt of construction/instal installation opciation. In Inrantinp. this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise makim- them necessary' for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for de-i J in:; a safe buildinh., structure, or component. 1,-r J)- =L hv ~ Inquiries concerning this correspondence may be made to me at the telephone number listed bcloss', or at the addresfi"SION OF II on this letterhead. I he above left addressee shall provide a copy of this letter and the POW TS management plan to the owner and any i~ others "Ito are responsible for the installation. operation or maintenance of the POWTS. Sincere I cc Rcquir'ed $ 250.00 t Fee ReccivedS 250.00 R Balance Due S 0.00 Ldwin A Wastewater Specialist , Division of Industry Services WiSMART code: 7633 (715)634-3:733 . Mon-fri, 8:00 a.m. - 4:30 p.nn. cdwin.taylor:uv\ i.gov PAGE 1 OF 6 Mound Plan o" Index & Cover Sheet Component Manual Design References: Version 2.0. SBD-10691-P (N 01/01, R. 10/12) & Version 2.0, SBD-10706-P (N 01101, R. 10112) Pg 1 of 6 Index & Cover Page Pg 2 of 6 Plot Plan Pg 3 of 6 Mound Cross-Section & Plan View Pg 4 of 6 Distribution Network Specifications Pg 5 of 6 Pump Tank Specifications Pg 6 of 6 Management Plan Attachments: Enclosures: Pump Curve POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description Owner Name(s): Larry Rickard Phone: Owner Address: 826 280th St,Woodville,Wl Zip: 54028 Project Address: Govt. Lot: NE 1/4 of SE 1/4. Section 19 T 29 N-R 15 E ❑ or W Township: Springfield County: St Croix Project Parcel ID Designer Information Designer Name: Michael Myers _ Phone: 715 -265 -4115 Designer Address: 2943 130th Ave. Glenwood City, WI Zip: 54013; E-mail: mcmyers@centurytel.net License Number: 267985 Remarks: D Signature: I^ --Date: -S 2of8 Onginal signature requi an each submitted mrv. [,H ICK FOX AS APr AP Ih SOIL EVALUATION Seal(,: I" 20' SYSTEM PAGE 2 OF P2C 30 SITE MAP PLOT PLAN f'RUJECT NAF:f_: ❑:.;.r,N a-:::r .',UC :;vu Larry Rickard APacn eesigi, llmv C Iculalion< to, commercial plans ?,'q4 280th S!, Woodirilie WI Pipe Mwerial l ASTM Standard (Tahles 384.30-38 384-305; PRO.IFCT ADDRESS. Samar: Sewer PVC ASTM 03034 RM Syacd 11, RN Eie::+9on. 100.0 1 t N ~o•cn v,' PVC ASTM D2665 skluesvp0o-. grace a Poplar Tree with yellow riboon IMPORTANT. since GraoeM i"~i 3% Well sy.bot (f ao- wb'e; 0 Shuv ylound elevatior coutamrs al su Wblc inter+als. i of Testecl Noa' o,+m ice om.:e ix. I I I oSCU ?rQ 06- 3° r 5~s ~o ~-2_ gz:99.&q $3:9s'.8~ ~ ' ~or <<- M>A qD II i8~ih~ 0 loc.I 3'/ I N ~Sfopa ~ L Ioo s' I : If 17 DISTRIBUTION NETWORK SPECIFICATIONS (No Scale) 2 'O tgcdi 40 I.Wpe to pdmp Mal. F_USH VALVE DETAIL ' nisei olpes r'Pl erabLackl U 14, SCA-Ie; OPtiona or-ice Ir - _ '_3'^•JI SPPfIOp 3 'IF Cen:a- of T`:reaArxl Cap Insulation optional) S - Ie head lust...1 'U SCnAl iO VIM OrllCe ioPlincAll 1 \ PVf. M; rral ltypirall I \ SriNC ano.".. r I's B plit,rall 1 \ / ~~St~ JJ Ld[Ndla L aVP inpliurall SrhAl AD PVC Lateral 1 V2 i l AIPfAI Length iP i = 45 'I Number of Orifices per La4u-dl = 28 iq tl1,11 .Y \ Olifica Cischar5le Rate. - 42 9pni c-nom nIumul Ftiixh V., OLnny hA..aom h of 1810,atornl aal LilcnG Cp o'la'aral 4a5ortnlj ~ -1 NV MpP p Lae Ic 2 n y Ih h'a h~i 'fl-see J-1811, ,u..g d".. I, 7 ~atoral D.-:Nua.Itnte SJ gpm Last OfYY.o (lypi::ull Oifs SPd(A ig !XI- 2".7$ Ir 1 A t PRAL INVER7 ELEVA7l0N = 413t,64 a -o-nl D senaieet uAl t = 23.06 caul QyDio31 ow,, Uin^•Plrr- 125 in ;Ij i1Ga } ORSFRVATION PIPE DETAIL ;w snlrel Xr ~ FND MANIFOLD U CONNECTION Sncs-l Yci or a~ 3~~?~ Finished gran- Check up. applicable box. rl m.l •{'n PVC Pll 7q:.~Pa t'rl'N'f NfSI n111i1Y: IIF 1 { II t pti:ndll V I .P of p Pe to wrimhatC C rNa 1 rnnll ityPlCdl'I - D at of ato e ,w, dWd -_ur~ f71 Inl lr<'-v)>, P :gym., ~-'-x X,2 x--~ r ,p $ atan IOCIU+' 4 11 k - CENTER MANIFOLD -n Ar: 1,mng 01•trn ` _..-°f~ Intlta En L1 r0ol: CONNECTION rn (riser .¢,o ";.:v+ran SINGLE-CELL MOUND DISPERSAL AREA Iczs•vaasr-E~ncr~aFCAfF c= 20 it n.r.a'eene.,lh7*1en,.a,l,i:q,n.ll:n.zc• tnn r:r.ofT^=sal. CoVe i E= 22.2 it o mr disaiu:ion rpo ;mc .rive.. :d vRl` ap, mved sjn~M:k IatrM..l mn. r c n Sy::erc Elevation = 100 95 it _ sleral invert Elevator = 101'SC- t, A5 1 61 5ANC l'_L _ CROSS SEC] ION VIEW 'IAI L ~ I- a= 6 It- ~ (No Scale) E ,ere c„novel 3 sh., .,,•:,~w,= 99.18 n •S-ow fame main, nHr loo ara t sn varve iowiors on D'nr V.+wC PLAN VIEW (No Scale) l 1112'0 SAmu% i 82 8-33 e A PVC La119e1 ft "'t A Avnwal) u o!,co-vaxe _ _ P -:null _ - it 6 it ~ R= 50 ,I ( 7~9t, 10 4 it Recd as necessary in fol ctrlour j G) 1 ~ C0,1, VR ' O PF TOF IT 71A OT Cc Pre vcrc ns:urtar and..eh d", tmrcir: wit-1'1, 15 feel oF.1nwnf*tpe Tito Reset Page PAGE 5OF6 SEPTIC / PUMP TANK SPECIFICATIONS 4'fl ! Pi;):, (No Scale) ' 101 mr, Budding I ;,.i ld,. , .-I an:'Vly tdt~ 12' Min. 01 .C fi a^evp SPS 31C and NEC 300 Eslabl:sned Flood Elesalior Fxla'd manhole n;+~r :n: nn~xn:::::•y. ,lyplav I Pra!nenpux.! nign:nxvl ,:unr.Ln^ Ho} bra d I rm 1•Ienlmtle IMPOHTANI : I ein nn Wa Vaaming ge Lapel AOarhni hyn1411 Anchor lank(sl as necessary mut pursuant to SPS 363.41(fl)(fl: I I 4' Min v 20 - Eslaolnnx! Fqo:! rlmmli,u' \ I / i ~ 1lypireli Ailiqt \J/ Finis°ac Crada Wia Uisoonner:I IR" Mr' CAPACITIES @ 17 gallin 4 C 1 Depth (in) Volume (gal) * a A 20.9 354.7 ( srz. ~Aoo'na.:t..nl^I.w1I, e Ann::,'. Pines n onto B . 2.0 34 A scud c;:eu:x ' ~ IIVIII. [C] 5-4 91.3 o- Ala, D l 10 170 ;3 t>-on I Icl PUMP-OFF * Pump Tank Liquid Level 38.2 in e P,-,p b_olf ELEVATION = 92.7 ft = D - INSIDE BOTTOM Force Main Diameter = 2 in c blijk I nI°~ ELEVATION = 91.9 ft Force Main Length = 80 ft Vertical Head = 9.18 ft Force Main Void Volume = 13.9 gal + Min. Supply Head = 6.5 ft [C] Total Dose Volume (TDV) = 52 gal/dose + FM Friction Loss = .95 ft L (SX total lateral void volume S 1 UV s 02X design low) +(ron e main drainhack volume] + Fitting LOSS' = ft a(min, supply head x 0.31 FMIN. PUMP DISCHARGE RATE _ -23,1 gpm = TOTAL DYNAMIC HEAD = 16.63 ft PUMP TANK: SF_ PTIC TANK(S): Volume = 650 gal Total Volume = 1000 gal I Manufacturer: Wieser Conctrete Manufacturer(s): Wieser Concrete Pump Manufacturer: l G" n' Install approved eff luent filter at the septic tank outlet Purnp Model: e P! immediately upstream of the pump tank inlet. Controls/Alarm Manufacturer: SJE Rhombus Filter Manufacturer: Polylok Controls.!Alarm Model: PSP120V6H150P17A Filter Model: 525 Float switches containing-mercuryare prohibited. PAGE 6OF6 Mound Management Plan IMPORTANT: The owner of this mound system. shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384. Wisc. Admin. Code Pursuant to SPS 383.52 (2). Wisc Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code Maximum Dispersal Area Operating Limits: Design Flow = 300 gpd; BOD5 220 mgL-'; TSS 150 mgL"'; FOG 30 mgL'' Inspection Checklist INSPECT EVERY 3 YEARS type of use age of system nuisance factors (i.e. odors, user complaints. etc ) mechanical malfunction (i.e., pumps, valves, switches, floats, etc) material fatigue (r. v., teaks, breaks. corrosion. etc.) solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i e , distribution / drop boxes) neglect or improper use (i e . exceeding design capacities, prohibited activities, etc) extent of ponding in distribution cell prior to dosing dosing irregularities (re-. pump re-cycling. float switch settings. etc j electrical components (re w ring connections, switches, controls. timers. alarms. etc ) distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification) surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) c Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s- 281.48 Wis Slats when the volume of solids in the tank(s) exceeds one-third (113) the liquid volume of the tank(s) or as required by local ordinance Disposal of contents shall be pursuant to NR 113, Wisc Admin. Code. Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. Distribution laterals shall be flushed once every 3 years or when necessary. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company Northland Plumbing Inc Phone- 715-265-4115 Local goverment unit St Croix County Phone 715-386-4680 Local government unit address: 1101 Carmichael Road, Hudson, WI ZIP 54016 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code Repair or replacement of failed or malfunctioning components shall comply with SPS 383. Wisc- Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384 Wisc. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant !o a plan submitted to the appropriate agency for review and approval A failed mound dispersal component may be re-constructed within the originally approved area after removal of all failed components. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383 Wiisc Admin Code ITT GOULDS PUMPS Residential Water Systems APPLICATIONS MOTOR Sueaally designed for the followirg uses. General: • Mound Systems • Single phase • EffluenUDosing Systems • 60 Hertz • I ow Pressure Pipe Systems • 115 and 230 volts • Basement Draining • Built-in thermal overload protection with automatic reset. • Heavy Duty Sumpt • Class 8 insulation. 7ev.aterirg • Oil-filled design. • High strength carbon steel shaft. SPECIFICATIONS PE31 Motor: Pump - General: • .33 HP, 3000 RPM • Discharge. 1':S NPT • 115 volts • Temperature: 1041 (40'C) maximum, continuous when • Shaded pole design fully submerged. PE41 Motor: • Solids handling: k maximum sphere. • .40 HP 3400 RPM • ;automatic models include a float switch • 115 and 230 volts • Manual models available. • PSC design • Pumping range: see performance chart or curve. PE51 Motor: PE31 Pump: • .50 HP, 3400 RPM • Maximum capacity: 53 GPM • 115 and 230 volts • %laximum head: 25' TDH • PSC design PE41 Pump: • Maxim:im capacity: 61 GPIA AGENCY LISTINGS • Maximum head 29 TDH PE51 Pump: • fv'aximum capacity: 70 GPM • Maximum head: 371 Dii ` s Tested to UL 778 and CSA 22.2 108 Standards By Canadian Standards Association vt ital ;EtT File #008549 4:: •~r:ot. a ri u. nm. r, PIS: ' u~; nc. '.c u i t_ GP!., Goulds Pumps is ISO 9001 Registered. ! Qa4l Itr _ 0 c 2S i z ' i 20 H :(1 U nU ID 20 I 3D 40 SD 6 0 70 GP1,1 f. 5 CC is r^4n CAPACITY i 4 ° i i v a P r L \a 1 mod. ~ QCV r ST. CROIX COUNTY SEPTIC TANK.NlA, TFNANCEACF_E_-.VE T ! NT) 0WNTR-S:ITP CHERTI.FICATION FORM Ovvner'Buver M'sitng address gZ G 2 qO to .S'£ P_Ope-ty Address 0 ur acacion requf:ed z om Nanning & Zoning Deparrneat for neN consu'ac:ion, i C:_v,'St3tc aooa~yl4r W/ Parcel Tdent:8cadonNw-nbcr LFCAL DESCRIPTION Pronery' Lclca:ion ^(4- ± . , Scc. .5-e _/?,T T 2g-N R /S C7, Town of -S Sujd:vision Piat:_ Lot F Certified Sun e)• Map K ~'olna e Page Warranty Decd r _ (before 2007'Nolumc Page Spec hots- C j'e= sn i.ut !ties ident-.15ab;c .yes ore SYSTEM MAINTEN-kNCF. AND OWNT:R CERTIFICATION . L C2 1'id 7nL1Li 1;-'.11.. of your cr]t:C 5\'Stem C:)'.::: Ic$U~: i-3 it: :)7ciaallL"e ' .I 11172 hLldle N'a5t 5. :'-:C?er ...eztcuance consists or punplns vat the septic tank cvey threz yeas or sooner, if ncedcd, by a keen;2d n. =por. %1=1 yuC put into --:c suit: can aTtct the `an. ion of the septic tank as a :rcatnent static in LLe wasie disposal system. Owner maintenance oorsibiiires de specified in gSPS. = S_ .f'_(1; ant m Chapter I2 - St Croi- County Sanitary Ordinance. The prop crty' ouver agrees :c Submit to St. Cro:x County Plarn:ng Zoning Depatme1: a certification form, signed by ac oN ncr and by a music. plumber, journeyman p;urn''ner. restricted plumber o: a licensed pamper %er:~lnr *.he. (1 L:'ie on-site ,tai avater disposal systems in proper 0*~,e: ating condition andor (21 sfic: inspectiomand pumping necessan_ 1, the septic task is Icss than 1 -0 of sludge. i".;e. the undersigrcd have read Cie above requirement and ag tie to maintain the private sewaue disposal system with the : ,3a ds set 176-tii, herein, as set by the Department of Safety And Profcssionai Se-, viccs and the Department of'Natural Resit c:s, cf ~Nscons:n. Cern5zauon staring that ycra: scv:ic s\'ste has beta mainmined must be comp;eted and return-d ba the St. Croix i~srnq' Plarming & Zomug Depa-ment Nithin 3B davs of the three year c+:niradou date. '.ewe rtifv that all catcmcus oc his fo^n are true to the belt of m.dour imowiecge. Iwe am are the oNVerrsj of the nr.,N7ty descr bed above, by virtue of a warranty deed recorded in Register of Deeds Ofncc. Number of bedrooms <0*1NATURE OF APPLIC:'Lti'I(S) DAT'n .tiny information :hat is inisrcprecented may retina it.. the sa-ita-y permit being :evoked by the Planning & Zriug Dcpa-¢acnt. u,_-hide wig :Pis application a recorded Na-anty deed f om the Register u: lleeds O:uce and a cop}' of die cer,,fiec survey map if -cference is made in the wa„dt y deed. (REV. 04 ;171 "16 1 i ')S®IL EVALUATION. REPORT- #100 Department of Safety andP•oiessiora Services Page 1 of 3 S Divisior cf Safety arc, Buildings Northland Plumbing, Inc. - in accordance with Comm 85. Wis. AdmX-A County Attach complete site plan on paper not less than BY.x 1' inches in size Plan must St. Croix include, but not limited to vertical and horizontal reference point iBMI. direction and percent slope, scale or dimensions, porn arrow, and loca4on and distance to nearest road. Parcel I D D 3,f- /~.rt<, Please print all information. Revie By ( fla •/rA/ Persona irforma-wr yin. provide may be r.setl to, S,> nOJry p✓pewra (P,,vacy Lae. s 1504:1jjmii Propery Owner Property l ocation V Larry Rickard Govt Lo: E114. 114. S19, T29N. R15W Property Owrer's Maiiing Aadress Lot # BIOCK # Subd. Name CSM# 826 280th St Cily Slate Zip Code Phone Number City Village Town Nearest Road Woodville WI 54028 Springfield 280Th St New Construction Use Residential.' Number of bedrooms 2 Code Derived design flow rate 300 GPD Replacement Public or commercial - Describe: Parent material Glacial Till Flooa plain elevation. if applicable ft. General comments and recommendations tionnq # Boring Pi; Ground surface elev. 99.18 fl. Depth to limiting fac;or 17 in. Sod Application Rate Horizon Depth Dominant Color Redox Description texture Structure Consistence Boundary Roots GPDW in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'En41 -F"2 1 0-10 10YR3/5 sit 3sbk rnvfr Cs 2f .6 .8 2 10-17 10YR4,14 sit 3abk mvtr c5 if .6 I .8 3 17-24 10YR5/4 7,5YR5/8fld spots sicl 2abk nlfr gs if .4 .6 4 2442 10YR6, 8 7.5YR5/8fld spots sic tdbk mfi Cs .2 .3 i I 2] Boring# Boring Pit Ground surface elev. 99.69 ft. Depth to I•mdmg factor 16 m Soil Application Rate' Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMI ff in Munsell Ou. Sz. Cont. Color Gr. Sz Sh. V191 •EH#2 1 0-9 10YR3JS sil 3sbk mvfr cs 2f .6 J3 i 7 9-16 10YR4/4 sil 3abk mvir' Cs 1f .6 .8 3 16-25 10YR514 1.5YR5/8fld spots sicl 2abk mfr gs if .4 .6 4 25-39 10YR6/8 7.5YR5/8fld spots sic labk mfi (5 .2 .3 Ef iuent #1 = 90r).,> 3C 220 ai,tL and TSS >30 < '.50 mg?L ' Effluent #2 - 6OD, < 3U r•rgiL and TSS jL30 mg'. CST Name jPeease P•inti + Sa"re/: CST Number Michael J. Myers 1 1~ C `1 ~cr- - 267985 Address Northland Plumbing. inc. Dale Evaluation Conducted Telephone Number 2943 130th Ave Glenwood City W' 54C13 711812018 715-265-4115 Propecy0wr•er LanyRiCkard Parcel ID# Page 2 of 3 Bunng F Borng # =it Ground surface elev. 98.87 ff. Depth to limiting factor 16 in. Sod .Apptcahon Rate Horizon Depth Dominant Color Redox Descrption Texture Structure Consistence Boundary Rcots GPDrff ` ir. Munsell Ou. Sz Cont. Co:or Gr. Sz. Sr. •EIIx{ •flfa] r 1 0-10 10YR3/5 sli 3sbx mvfr cS 21' .6 .8 2 10-16 10YR4/4 sit 3abk mvfr cs if 6 8 11AK,"y1p 3 16-20 10YR5r'4 7.SYR5,r8f1d spots sicl 2abk mfr gs if .4 .6 4 20-44 10YR6,r8 7.5YP.5/8f1a snots sic labk mfl Cs .2 .3 i Bonn3 Boring # Pit Ground surface elev. IT Depth to limiting factor ,n. - Sal Application Rat Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDm' A. Munsell Qu Sz. Cont Color Gr. Sz Sh •Erf#1 •F"2 Boring Borrg # Pit Grocnd surface etev ft Depth to landing factor in. - Soil Application Rate Horizon Depth Dominant Goior Redox Descriptor. Texture Structure Consistence Boundary Roots GPDlfil in. Munsell Cu. Sz. Cont. Color Gr. Sz Sh. •[~i •Eff#2 I i Effluert _ BCD, _1 30 5 220 mgiL and TSS -,30 150 mg:- ' Effluent #2 = BCD< 30 mgrL and TSS <_30 mgrL Ilie Department of Sall N and Proles,iunal Sere icese is in equal oppununiry service prnv ider and employer. If voU need 1ss131anCC to access sers ices or need material in an alternate ldrmai, contact tiro denartmenl at 608-266-3151 or I'IY Through Reim SnD B; T!ro:IR IP"'N;rtr+.,M I+IUmPrp, in:. F,-ope-tl :,wne, La'tN Rl_sarG 'ape 2 rn 3 BUnng I_J Boring k _ ?it vrcune sur`a::e exec 9517 ft. Ceu1L' a Iin;itine tacly lE :n. Soil ADOncat,on Rate •nnzon Depth Dominant Color Re-ox Descrintton Texture Stracture Ccrsistence 3ourcarv Roots GDD.NY In Nimsell Ga Sz. Cont color G. Sz. Sr _ "E •c_frv± l C.-10 10YRy-' sil 3sbw rlvfr c2' _0 .6 ? 10-15 ;CYR4.,L sii 3abk rnvfr c< if .S ? 15-2C 10YR5r4 7.5YR5,.8f1d spots sid 2aot, tnfr gs If .o 4 20-44 lOYRoiS 7.5YR5 8f1d spo5 sic laok mf ;,s .3 I i I r 9gnttc Ll Boring C -Y Game Waco elov. ft. NOW 4 I:mdtnc 'attar Soul An .an - 'r. nhcabon We Ho-;zoo Depth -Cominant : o!or Re= DF.Srrni,on Teave Siradure 'Corsislent e 9ounoa v Roots C=:ilY n C1,ms91 0'.: S.- Con: Color ;z St •F'fa' -_M: i I Boring Boring # pi: 3mwc sdr,'an e,ev f!. Centh W Wing factor in 15pt': hPPucaaon Rate Hoqzon Declh ~'ornn+nt::ainr =eoozl:esgnrnon Texture Stra-tore 'f:rrsi tents 9::unaer: R:mts Cr.-)r r. leluf SP.' u. l.On: '.OIO:' -Hit. i I -`(loch: N = 90D.1 30 t222 rng l and-SS >30 150 mgO ' Mijem R2 = BOC 30 mg& arc TSS 30 mg!_ --nc Department of Saicru ant Prnic >,onal srmwnv is an cOaa' orpnnucln' scruce p ,ulacr :md crmioucr. uric nccd assiuancc to access se.mcec or race material !n a% alternate tonaa_ contact tric deranr'.cnl at 6lil:-2ii6 ! 51 or -i-l-Y wrough Relal >e::>•Y u!Qrs, T.. f.: boM1nNrO ,1yT;m;. tn;. -~s o9Z I ' I ~ I I ~ r 1 ~ P' f- ti I I 1 3 a ~ + o nL 'O a- L 0 0 ~ ~ 11[ ° o oo o0 (Y w 4' ~ " ~ ~ Q' ~ v- _ a- a ~l 7 Ll M