HomeMy WebLinkAbout022-1028-10-100
'uN=.rp"sin UcOJn°rrI GI C! n nne'T
PRIVATE SEWAGE SYSTEM Coert, St. Croix
Sa'ely n' J 7uJ'm!; f.iwyinn
INSPECTION REPORT Sa,.itarr Permt Nr
GENERAL INFORMATION (ATTACH TO PERNIII) 605187
State P 'in U NC
Pev,ral irlorrc POr, you p rtitle rray he n.sed `o secr- rlari purposes lPnvacq La.v. s 1531;'ltrl
Per-t Harmer s %a-e Ciy Vil age To,vnship Parcel Tax No.
Jean M. (Nonexemp Marital) Pearson TOWN OF KINNICKINNIC 022-1028-10-100
CSI 13,10 l_ ad Insp BY Llev BM Descr. otlrr. _ Sec-iom?osvn:Range+l.'ap W.
10.28.18.145A
TANK INFORMATION ELEVATION DATA
TYPE NIANUFACTUR-r . CAPACITY SiAIION BS HI FS ELEV.
Septic 1 . Hencnn•ara ~(J,i Y-'>
A ~
Dosing All BM
Aeration Bldg Sewer >
Ho ding SUHt Inlet
y
TANK SETBACK INFORMATION SUHt Uulle:
y' '~ti fy
TANK TO PA '.I L LUG Vent 10Ai- eta..e ROAD DI Inlet
Septic Ut Bottom
Dosing HeadeutWan
~d I ) . C J r-
Aeraticr Dist Pioe
Holding 6-1. System 9j
Final GGrrade
PUMPISIPHONINFORMATION r) ti r, r~~, Q dr
falarufa-turer Demand St Cover
CPPA
PWodel Number
TDH LM Frabn Loss System Head TDH F:
Foroemain Length Did. ass; to over
SOIL ABSORPTION SYSTEM
BED:TRENCH loch _ _erv_~th_ N, Or Trenches PIT DIMENSIONS Vo Ct Pcs P'siJe Goa t rvauc Dertr
DIMENSIONS /
SETBACK SYS [EPA 10 P:L H1 OG VVEL.L LAKEiSTREM,' LEACHING R1aru'actorer ~
INFORMATION CHAMBER OR ~v_ I i{C ✓
UNIT L:eeClNu-'be'
DISTRIBUTION SYSTEM
ileac VPlop I Distrit.ricr x Hole Site x HC 9 Soacirg 'v'ent 103,x' :n13ke^
1:a UP Sparing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth ?ve t Depth C'er xx Depth CI sx Secded,8odcee ,
Ita7 "e';:n r,,-. r,rer Ser.Hrencr Pons Tic,, -
Yes Nu Yes Nc
COMMENTS: Incl.rde cede discrepencaes, persons present, etc . Inspection N1 Inspection a2'.
Location: 452 OLD CFPAETERY RD
1.) Alt BM Uescnplion = - ~
2.; Bldg sewer lengtn = r'• ',`L y c"f`J'"'
y~1J5t MLO~- ~,~t F4 r3 I t'r^'L' P
-amount of cover= cir r
Plan revision Yes _ No lV J u/ I 11 :+x' I~
Use other s ca `or or a ad-Tj ditional information lJl 75 / lJ 25(•p~_ -
Dale Insepacr's ig~d crC Cer. No.
SBO E~:' o i R 3. S?j
, r
Industry scrvias Dividon cwtty
I:.-
4 1400 E Wa36emgq n Ave ST. C`iC'C? 1
• Y.U. Box 7162
\ t~ c. 2018 Sanilmy Pane Numba(to be filled in by Ca)
Mad" 5 7 2 Iff (.005 iv •7
- rmit Application Settle Transaction Numba
In ecaomdercc+war 7.21(2). Win Adm. Code, .mission ofAis form to dw apprwiae govamnprtyl ure VA
A
u ragrered prior W Obtaommg a saarlary permit Noes Application forms for subawnea POWIS m mAmMed b
rd la 3eocdary Aaleot Adam (tM6msrt Mao roatmg addrem)
ere IAWrenua of Safixy wed PmofessiaW Swiees, Persaad infametim
you pnwde may be ue
in accandi x web the Privary law, s is 2!(I)(m), sub.
L6rantioa - Tease'Print AM L#e.s,6.a qS Z O LO r- EMf=7-F-XY {ZP
~oR*tY OM+Kr's Noma - pill cd a
S +N M ti'c., Ex yr /tIiiKl7at FF"f Orz - 1041K - iL~ -too
Property tTumer's Mail Property Uo m m
I'ro9 c r~iEtiJ
city, Slew cm,. lit
Zip Code Rion: Nimbler Y, A/C Sectim
Lod (prck H. Type of BaabBax Lot IF (tiatk all tba! S .35~ - SLSS T Z~ N; R ~
apPb')
~1 or 2 Fa.nry!Melling - Nurrba of Bad Subdrvoiaa Name -
Hoek #
❑ PuNwicamnecd - D'Wil,' use ❑ city of_-____
❑ o"nod- Desvmbe CSM Number ❑ Viow of
x' t ZS t./ ! j 4'-y l f 11 1p( T~ of _ IL ,l V rc/<r,4 q C`
HL Type a Pent it ( A. C.a.plate lisle B if applicable) X
A. ❑ New S
epranmeot SysY.m Tut Replsr3xoaml Only ❑ Olber Madificalion W Exiiemg S (e+g)lmo)
H- ❑ Ptrme Renewal Pe®i1 Rensrm ❑ Champ of Ptmr6a ❑ P1mt Transfer to NevK• .m Pmious PYmt Number and Dab I.,
Herne rapastion FO owner JJ 27
IV Cbsek d LLat t V i
,:2 D
r<cd bfOroud Pt- d bi-Crarnd ❑ AWrade ❑ Maimed 24 is of sin bk soil ❑ Maud < 24 in. of suirbb sell
ied
C'aO~a (Wrem)_ _ ❑ Plwcmnart flcvioc (e~Isio)
V. Din Ain Lir~eWr -
Daw Plow wee) Desw Soil Appt~im Raham" Dispersal Mm Required (so Ditperml Am Plapmcd Sys1® F7akeman
VI. Tack We Caprraly in Turd s Of M>mf>cn=
GIIm3 Callao Units a
New Tests Faris 7m6 / € 0 r9 w$ B
w O lad wee
VR- rSlat m nt- L dw Werdpei,,aue rtslmdWb 4e 4 *ommd. aflbe POVYf$aMw.« Iae aMaebeef prat
Rusmber's l4amc (Frio[) Pkmdmer's
CORY T..7,teKMAI ~~Zl~ f - ber 7H fiPbm - ""~2-4 y
Pkmba'3 Address (Street City, Stain, Zip Cade)
93oE t~~K w~ssrg 3~~1 a~
vlil. ltse
Went Pee AgoraS'
Reasm for Deemed
sue{ " zs O
tX. C. t.., .k, e. cent l p~i•n•i T'---- .~aa 111 1I r
irk{7ar:rte a•II cost all ~:;_irs `t!_ -ac k1, /k~0 awl"' O~ `yy ~ r ~
an per ook rK men! pt-s mss :drt L,V NIt„nbc:. ''/(ll U /
2 AM aet PpF rart.iRnenis muut w
w V
per + c06e .:rA:,w.V;cd. 1
Acorn r e«rksr Ia~• a•. ~ .inns r .+mkr r Cammb airyr. b 7141
a l reM
1( eke./r o0 1a PBJ/~/~I
sBD-6398 (R. 08114) J VU v
'7 1't!/K VCS aLIa ,x b' ~/~)~Y~.~/
1
Plot Plan Page a0f I
PROPERTY MNER:__ JAI nA. /Navy uor Mf►strra i Y 40 FT.
(except where rated)
Legal Desoiptia_St /14 OrT}FE- NE'S~ 10, 7z9fj,Bl ~.l, TOWA G =backhoepit
17q, y~o ~ae~s
North
J
!If
\R
I \
1 `
<,44
13 V
JLGZi4
`t~ S~F q zv ~ ~i-~ ;h
-NEw w1E3~~/oo0 ~~w Q8f
_ _ _ 'rMK w( F-r L*EIZ J
It,
77- C)
T1 qV 4
'yam /
~pJ Jet 3F
K 56u~rr ply T
Site location:
yliII -i. X (iA7 y/r
ZEEkE rrb
J
In-Ground Gravity Plan PAGE 1 OF 4
Index & Cover Sheet
~ponsntMrrwrDes~rR.lf~~ences
Vbrsian Z% SOD-10706P "X", R imz
Pg 1 Off 4 kwim & Coww Sheet
Pg 2 of 4 Pict Plan
Pg 3 of 4 Difpersai Area Cross-Sec,•tion S Plan View
Pg 4 of 4 lAl bnagernent Plan
u e K Fcf- POW S kq*cabm for Rw*isw
T) cT ` &C-5 Sod Evekmrmon PtepW & Site
7f{ SV~C-5 S J'Thf T.A.vK f46~,4LFAEV7
w~rz~N i>~U
Project iM01r1e / Description
xfiN N) I~~Arnl Prrone: 7~5 _ _ 'zss
ONrwer Addrsm f (y °sr V , Lw D 5 c 'J
21p: 's'/°iL
Projed 9 1IMC 1152 OLD CCAkE-tE&Y r<G D
GwiL Lmt SE 1Ftof~E 1/4, Sscion /c' T z X N~2 l 8 EQor wiffl
Tow m**c - f-1NNic,<f Vjc 5T. C ~f X
Prs}et Parai d` 7_Z - I Czs- i C- Lc 0
DsdWw Wanrfrrion
Ds@Ww N =w Ad ~Y ~I uPP~xr Phowr -
DsdgsrAddtass 2844r Ku~~lcn,.a~ Cf~ t]~wrz~rey~,~
e-+wnt hour destan r ~-.+r~,~ gem
Lb~ Mmober. R*q Ob -1 nN
talrrgrirs:
C a via"
6t,D TAXK -M BE A r5AA DO.AILD
Sri 3~3. ~J~ flQH\, CGl7E
Plot Plan Page aof -y
PROPERTY OWNER:-_}F ~ • , ~x yr A~~Rt ~ acrv~ 1" = 40 F F.
(except where noted)
Legal Desviptiorc St~~f of rti~ A1E~~4~ 5ia? 10 TzBrJ RjxLjf To /J L =bad&MPit
I7q• ~t7e
North
•1
ED a v r .
Coles R°' ~ r
j ;
G 7
t<1
-NEW wl F.r ocp <.-~~oa pg1
~R I,
Tear` w, r! CrEr•` J
r Ems- _a
\ a V C
~Y,at , r
Site location:
cw~~
S~~ ~
FZ,
rrr~: 3 C~ y
Sept Taaga)
IN-GROUND GRAVITY DISPERSAL AREA W't ss
Uniform Elevation Trenches with Quick4 Standard-W Chambers ,^f'~'1 SOOC Twwfs>VJVaaa¢
3-ftTrench (down-sizing credit) ~v+ -go -.9w -aw
F.ar uw.siwa.~
acv ~cY~
-C, tzz
e!a ~ seal. c
vweo
soL covet _
sw~w.p _ TYPICAI. TRENCH
CROSS SECTION VIEW
I-- No Scale)
a• • C between trxhs
System Eievatlm=~L ~ R s~'~°"
pYWaw)
(MIArA (Snow ksoslbn of Wet ! a" pipe oanetllors m piers Mew.) PLAN VIEW 11
be.%L (NO Scale)
-7 ---1A - --------f---------
-
T 5----I-:- _
O
e=aft m
(WGFA - ouicks Starsdm6W Ctsarnber w
tin O
INSTALL PER TRENCH: trnpyaswsaw STmiw arJ -n
~~jJ~ Waww~a bawwYr~-HS YYw~w
IQ' 10 ick4 Si6W @ 2O W ESNtlmmberw fl
+ Pairs of erW caps @66'EMVpetr-ft'
- Propa~d ESA per bench - e' Requksd trse(aa" Arm - 750 fe DLSVIIxA on Med)O&
z - trenches = Proposed Total ESA = 7 7Z rt (Afl N t - L-D
L-fzjla = L.l, LK > >s -fe/ 'f 2,-zeQU1gT--b
750 = Zc E = 3'75 C)K 38 tMl 1 T S
3S= 2 = l / 1,LNrrS &A. TREwW1+
1gx~ls 7(0 ,
L z) 3' k 7t, '7AF/JCH--S
~ ,~Af
PAGE 4OF4
In-ground Gravity Management Plan
IMPORTANT:
The owner of this in-ground gravity 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 Link:
Design Flow = Kj) gpd; BOD6 5 220 mgL-'; TSS 5150 mgL'; FOG 5 30 mgL-'
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors (i.e. odors, user complaints, etc.)
o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.)
o material fatigue (i.e., leaks, breaks, corrosion, etc.)
o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution i drop boxes)
o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.)
o extent of ponding in distribution cell prior to dosing
o dosing irregularities - if applicable (i.e., pump recycling, float switch settings, etc.)
o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.)
o distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification)
o surface discharge of effluent or sewage back-up into structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o 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.
o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids according to manufacturers specifications. A servicing period will always be greater than 12
months.
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: 1-/KY -Jr t'./C~Ai IAA4 PJ Phone: I» b u '
Local government unit .>7. O'NU X 00 1A'j / C'0_0kU W I a bE V61- Phone: 7i.5- 3s& - ~l t, Y6
Local government unit address: -p o 11sC:tii zip. `fold.
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 38151 (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.
Continciencv Plan
In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to
a plan submitted to the appropriate agency for review and approval. A failed in-ground dispersal component may be
abandoned and replaced by a code-comptying dispersal component in a predetermined area of suitable soils.
System Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code.
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INSTALLATION INSTRUCTIONS
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MAINTENANCE INSTRUCTIONS
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ST. CROIx COUNTY
SEPTIC TANK MAINTENANCE AGREEMENI'
AND IJ D
OWNERSHIP CERTIFICATION FORM 1 SEP 14 2018
(hvner/SdYeA JCS /~'1. NC4G7.cMP~ iUlnr~~rflt~ 4J~1F2'~.Cn1 f Sr -
Mailing Address I t l CrZE~>l V l EiV 1 JtA D"O ( e °~"ens
Ptopcity Address ' 45~ o~n cEtits i-t_Fiy keR1~
e~catihxl rcquitsd Gem %mming & 7nmriog Deparmteat for IteW cortshticLOn.)
City/State tt2sv /i Parcel Identification Number r2Z-az1.5-ID -/Co
LEGAL DESCRIPTI N
Property Location jE h/., NF-'/.,Sec. CI T Z%NR 1'_ W,Townof KI,U1'e[:KWt IC
Subdivision Plan k Lot #
Certified Survey Map _ Volume - - Page it
-
Warranty Deed # zyZp (before 2007)Volume Page #
Spec housecly Lot lines idcntifiableiyesono
SYSTEM MAINTENANCE AN OWNER CERTIFI(:AT ON /
Improper use and mairnbensurce of your septic system could trsull in its premature fadtae to handle wasam Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you pm into
the system cam affect the fundtion of the septic tank as a treatment stage in the waste disposal system (hearer maintenance
responsibilities are speci5ed' §SPS. 383.52(1) and in Umphcr 12-SL Cmix Co mi
•SLary Ordinance
The property owner itirrees to submit to St Cmix (:omty Planning & Zoning Department a certification form, signed by the
cr v and by a matter plumb • journeyman plumber. restricted plumber or a licensed pumper verifying that (1) the on :its
wassewatet disposal systi n in Proper operating condition amdror (2) after ration and pumping (if necessary), the septic trink is
less than 113 full of sludge.
i/we. the tmdersm have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth hemp as t by the Department of Saf 2y And Profesional Services and the Department of Natural Resourrms,
State of Wisconsin. Certifiraion stating that your septic system has been maintained mutt be completed and rMrmhed to dm St Croix
County Ptarru g & Zoning D armhcoh within - days of the wren year upuatou date.
Uwe cetiy that all is on s form are true to the best of rW/om knowledge Uwe am twe the owner(s) of the
property described above, by ue of a deed mwrdmd in Register of llud5 Office.
Number of bedrooms
-SI(iNATLIRE 91; AP ) DATE
•••My infwnmUon that rs mimcpicsonecd may result Im the sam ay permit bung revoked by the Plain, rrg & Znrnnp, Deparlmmt ~
include with this application a warranty deed fiom the Regime of Deodc Office and a copy of the certified survey map if recorded refutace is made in the deed
(REV. "12)
Wisconsin Department of Safety and Professional Serwres ` J) 'o~U kg ` ?)6
Divisio
rp F[f -N-F~ l''`'.,+'?f SOIL EVALUATION REPORT Pago, of 4
I~ J
in accordance with SPS 383, Ws. Adm. Code -
C 2018 County ST. CROIX
s than 8 112 x 11 inches in size. Plan most
Attac comp ~srte p anon paper not
met , but not Irmted to. vedu al and h ozontal reference point (BM), direction and parcel LD. 022 -1028 - 10 - 100
Perm tslope,i9calobirdimehHon5 nor iarrow, and location and distance to nearest road.
Ccr rijn'; i Reviewed by ate
-tease pnnf all information.
Personal informationroj p- ode ney tc mod for Secondary purposeslP C~w~3'19 Yt7t!T77. I
Pioperty Owner
JEAN M. (NON[XFMPT MARITAL) PfARSON Govt. Lot SF va NF 14 S 10 28 N R IS E (ors
Pioperty Owners Mailing Address Lot# Block# Sulad Nam or CSM;V
1109 ('rest View
City State Zip Code Phone Number ry ❑ Village • Town Nearest Road
Hudson, W1 54016 ( 715 ) 386 - 8255 Old Cemetery Road
New Construction UseE] Residential f Number of bedrooms _ _3 _ Code derived design flow rate 450 GPD
Q Replacement E] Pubic or commercial - Describe:
Parent material silly alluvium Flood Plain elevation if applicable n,Ti e - It fic General comments 4' and recommendations: (omcntional In-ground Trenches
--11.6 loading rate system cl It.
' #52- OiZ -!E.NT=T
rl f I Boring # n Boring -
LLL_~~~ ❑ pit Ground surface elev. 96.06 ft. Depth to smiting lector 7 y in.
Soil A fication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMr _
in- Munsell On Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 0-22 IOYR22 sit 2Isbk nrvfr cs 0.6 0.8
2 22-41 IOYR3/2 SI 21+bk nrvfr 0.6 1.0
3 44-75 7.5YR•V4 s Osg nil 0.7 1.6
dil~
El Boring # ❑ Boring 93.98 78
u 0 pit Ground surhace elev. It, Depth to limiting factor- in. Sall Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/lt
in. Munsell On Sz, Cont Color Gr. Sz, Sh. 'Eff#1 -Eff#2
I 0-38 7.5YR2.5;2 sit 2fabk nrvfr cs lvf-ni 0.6 0.9
2 38-50 7.5YR2.52 sil Ifabk mfr cs I%f-m 0.4 0.7
3 50-78 IOYR312 sic] Ifabk mfr Ivf-f 0.2 0.3
one boulder
' Effluent #1 = BOD, > 30 < 220 mg& and TSS < 1 0 nig1L ' Effluent #2 = BOO, < 30 rrg1 and TSS < 30 mg/L
CST Name (Please Print) ~~7e CST Number
MARY JO HUPPItR'I' (Ilmllistcrs Soil TcstinK&DcsKrr) 22,1832
Address Dale Evalu i n Conducted Telephone Number
28497 Kine_. Arthur's Court- Danbury, WI 54830 09-06 & 09-12, 21118 715-.126-1775
Property Owner PFARSON, Richard & Jean Parcel ID # 022 - 1028 - 10 - 100 Page of 4
❑ Bonng# 0 Prt ring 95.18 69
Ground surface elev. R. Depth to irriting factor in. Shc A cation Rate
Horizon Depth Domnant Color Redox Description Texture Structure Consistence Boundary Roots GPD/R
in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. 'EtW1 'Eff#2
1 0-20 7.5YR2.51 A 2f-msbk mvfr cs 2vf'co 0.6 1.0
2 20.38 7.5YR14 sl 2fsbk imfr Cs Ivf-co 0.6 1.0
3 38-69 7.5YR4,14 s Osg nil Ivf-f 0.7 1.6
Some cobs
1 ,
El Boring # ❑ Boring
Pit Ground surface elev. R. Depth to 6mting halo In. Soil Application Rate
Horizon DepM Dormant Color Redox Description Texture Structure Consistence Boundary Rods GPD/W
in. Munsell Ou. Sz- Cont. Color Gr. Sz. Sh. 'ER#1 'Eff#2
Boring # Boring
Ground surface elev. ft- Depth to fmiling factor
Pit Snil A ~fication Rate
H
Horizon Depth Dormant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tt _
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh- 'Eff#t 'Eff#2
Effluent #1 - BOD. > 30 - 220 nxIA. anrd TSS =-30 < 150 ux rL ' Effluent #2 = BOD. 30 rrgL and TSS 30 ngrL
Plot Plan Page 3 of I
PROPERTY OWNER: .J-F-A I A11 ,wnmr%FLQT AIAR(TA MARSM I" = 40 FT.
(except where noted)
Legal Description: St14 OF ThE- IQF-Yq. SFC. 10. TZ%M RAW TOW-4 badthoe pit
L+F IUNNr~' ~,.UrCG, Cyu>VTy v: srcrznlXi ~nYON~N•~
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