HomeMy WebLinkAbout040-1269-20-000
a:,eo•snOem3n°en c'Cc°°'eree PRIVATE SEWAGE SYSTEM Courlr St. Croix
Sa'ely a"J 3uiIC ir•g D is un
INSPECTION REPORT sa-itary Perrni: No
A I I ACH TO f'ElIT; 605176
GENERAL INFORMATION stave P an D Nu
Perscrel i-fCr-ahcr- you p'c:iJc roay oc uscJ'c' sCcunJa'y ou ocscs ;Pn^acy La'r: c • @ c4 ;11;m ~J
Pe'-it Hake, s Na Ciy Village Twe snip Px:zI Tax No
Chad & Cassandra Howard TOWN OF TROY 040-1269-20-000
CSI UM Lie, nsp RL' Flew BM DescripLOn SecvonlTcwi-yRangdMap No
Wpb ~~bd 17.28.19.1479
TANK INFORMATION E VATION DATA
TYPE f•AANUFACTURCR CAPACITY STAT'.CN BS HI FS LLEV.
Septic 37A_ lv; Benchmark
/Z50 7 $ Jd417$
"AJ I 'l 11 /cil
strtg
cI I L 5G Au BM
o, /Q .i3
Aeration Bldg. Sene• S • 3b 99 • SyL
Hold rg SVHt Inlet s•" pq 0
I
TANK SETBACK INFORMATION SUhtOl 4.9 -7
Vert tour Irca•:e ROAD Dt Inle:
TANK ICI ~i~ Vu[LL JBLDG
Dt Bottom
Dosing Reader7,dan
•T9
4-79 97
Aeratlpn - Dist Pipe cr1 7f,
Hold rg Bct. S'ysterc
S,o 9G•7
~6 J
PUMP/SIPHON INFORMATION Final Grace LoI.J S; Z •g
Ixtanufaaurer Demand St Cover /I ( Du r r_C /Qyr 3
TCH Lit( Fnc4on I. oss Sys eac TOR FI
Forcen'ain LengiF Din 7r. to VAel
SOIL ABSORPTION SYSTEM
BED;TRENCH Le-u:h No O•lrr chr. PIT DIMENSIONS No Is nsiCe Dia Lqua l:epl^
DIMENSIONS 3 1x _tA
.xmffa
SETBACK SYSIkM TO CJ P+L BLDG WELL tAKE:STRFAtJ LEACHING Mill
INFORMATION CHAMBER OR yarn f~l
Ti ;!e
O' Syster• 3~ N4 UNIT D.li,n I Numt q
nJt a
K4 1
DISTRIBUTION SYSTEM d ZZ+ZZ=
Hracelolc If Litt 11. _L .-1r eHOIe. Size xF'n e. Spaeirg '•!P. Int' 4z 4
r r Drd~ 39acr~ -
l e'3'.h__ SCrd `h L~...;.I:
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
CcpR• O'.e' C "Lit., O'C' xx Depth of Secnen+Sodcuc rx %I Ulc'ud
SedT'e"mh Ccutoi S•IZ BeAlLench Bd9es -ops~~ `7-fti -1 NC
COMMENTS: ;Include cone d suepences, persons p'esent etc Inspection 41: Inspection 42.
Location: 335 DAY FARVI RD I L".ll 6 r~
i All BM Descnp:or = r"I LOJ'Clti q Q. ROO..
2. i Bldg sewer length - t
- amou It of Ccver = Zµ y / 10V till ti I' N Oil ~ " d~~~
7 /g °r` urc~. 7 ADO
Plan revision Requ.red? es JC /b l~Q ~g I4E?!~
Use other side for additional T
Date in bail igna%.re Cc-[ No
SRC~e't J iH yr^.?j
I. All 4T-6
r
t ~ ~ InJu I, ~u ,-c. IA. nio't ( r I'
L, J 2018 1+1 0 I \1 h..t_ w \ec
~ C P.0 Il v?Ir,? S,nl.a, I'cnmt NnnlL :r (lu in by ('0.7
Sarutarv Permit AlIl ic...l041 s r h .wr ou In.L
I
Ina rl'n.ca t51 s. ri. .I 11.-:1 :m ( I
t-- Aj:A. ~ .c
a r:: p i.. b... n..e a u.. u, ba:n t` w • tit, ir.l. trL qu
L n,::T-TI?-53T1'•^' f .:ucd ro 1'nn1ri \,LIw., ii(Adl Crcn; rasa.. -r l.n hlr, :JJra. y
I'
r_ 11ei !u'-: rot. l..L_y :ltd l +v.a.::' Il~t,on. .lnm:n:.tm,n u mn:J. n..y l ~r.:?' G•r .Ynnlar.
lrl : o a -P. w'th(b 1. - ~ I. ulll pN.e- -
\1ihtJhon Inlormalion I -lease P rill A11111111rmalio~ _ - •i[
I opu l;,tm. N. I'n
Iv% rY. ~/,F
I'In110 rlvltwuu4 AtuiLnr, :\.k:..:.+ 1'mpray leratn,r. • /11 7q
01 MaU 7q>C<dc PI ,nc Ncnth' S J . Sacri n
airCIc. r . I
-f:e•,~ LC!F_ r~ I Z~ R~ but \'G_i
1 epr of ISuJding (ehrek JI that apple) I
F1- _Fun.l I1 :~IIrp N ml. ....Hal rout... ? SebJl tj n\alnc
d~ p'O Hloek r; Jj~~a 7dr'ai7
❑
` F7 M~~fl( r IO ❑ (iri' of
Ll .-d P l . ~ CSM N:.mh r - \ lagc of
7 Y\M' .er Y7I of 2 per. Cen} t..i~lZen~.1.. slo(.x-` _
III. l\pe of Perm_ il_. ((:heck ally one ho\ 4111 line A. Complete line It if applicable) 2
\,w ti;:,tcm L I l, u; .:unar >v'aom C L.::m,.:n:Af ~LfL,I. 11nR I _f¢cm:nt Dnly ~ Other MAW" :Ion to kei>ling $yen'm icsplainl
R ❑ I'rr: r. 1 r. r nvt Foe c.n t (1 .lye nt I'lomilcl' ❑ II tit l:. Nz.c P."ioae PCnnn \cafucl m-i D:er I....... lcnalir
LI Lncly .b r - _ Den. -_.?~(-1t~a
ll lye oflUNlS \ssrcn[C ontpun(nl Ur\u.( W heck all lhel epplvl _I_ el 5
\ . I 1".0" .nn 1 L I ...u r I I n. J in nl'.'astable wil 31 wuab1c
(~(\w CIS
II Lh _ tau U Il us 111. I'..-r, u n ,pl.a. ❑Pro mAisnov Ik'ui . {..plain.
\ Dupusitt'I T eat meet \lct Informalron
It li. r pJ. Ik hJ \ 1 I. kl igrl Dl p.nallA 11(y ocd i:'r Uslx d A., Pn(ase istjn aNk ; l'.Iel ...n
C i rZ~v-- 9~ 96 7,0
\ I. Tank [tit,, (..::p u m i ,1a 1 A.a11 ..u.l ..u _
(c:Ilun, Unit, c
D~~z E.~ v, ~ ✓ -rJ c
4
\ II I(esporlslb.htp Stateuu nl- I, the under.. ne J. assume lesponabdit or 14N(Jla41un f Ibe I (1\1 I S shown m .h nuacb J plans.
i n 1 FI ,t V1, VPIh\ Pb n Murtha
r 'b"*' AJ.I .\IUCI.Ch, tit/Ij:. dip (.I i •
\II1. Counts llqVa9 ..4141. Ik. (Illy
en:rture
n... l ee. D:11e l»uCC I: si.... • 104.
vouJ I .J _ q
tt ~ui:J.. r a.. nt 11 n 1 _:r.ll I , /0 06 iZ Z/ / O
IR. ('41nr1i1B)SCbE11E)QWM6dtcasum for Disapproval
P I A
1. Septic tack. eAlccn:'ilta-[vtii D")V O D
r
uispel: s. Celt be d^~i~c ~s' n,zlntn <'t eer If I
Os per mar Jyemer^ plan p c nee : by plume.. (sa, „a e.G~i.Q, Y~,ti7rr
2 AU aWbvk lecu%. ^arrs moot ur -airh'i1.[':
u per rppdabl\ (,r'.'r ;
n.a Ir.. n::m I I I love. m.v.
\ua.u ,........pl.... p:a.., Gm n.. .y.e rn:nut .ubmil o.'K t unn.. only on pap'.
S!111 r,)o~;R i1Nn•It
HUDSON, ~ _ 9~SCF1 a5 /
2510
j - ~-c,eoG' - 'rte„fi=.~~.•~ ~-.`..c.ae
CONTOURS SH01VN.4RE
' \ ST. CROIX COUNTY
ELEVATIONS
\ 1988 DATUM.
908
I six ~ _
T-O.H. = 912.29
o \
a
Lmn
PROPOSED DRIVE WAY -
j PROPOSE:)---
&
GARAGE
j 91A i
50''
' T.O.H.. /
910.48 F j
p,` V
o ~i
/ N >
r '
- _ :i§z?s - - - - -
- 1 _ 539.25' _ - -
l_
-
HOWARD H= -
it NATTSTOCK ffSTAKEOUT - -
IM OF VM
PLAN ti. r
I em
W;SCOnsin Ce 3h•r rl oSa~ ion3l Se fires ~ Page of
Divisor, of Indu by So 'A"
-
SOIL FVALLIATION REPORI
In accordarce with SPS 385.:^ v, Adm. C<xie County
Attach comnlete site plan on paper no le. +s than 8 V2 x 11 irchcs in size . Pla'r must nclude. `--l -
but not limited to vertical arr, hanrnnlal rele era poin: (H611 drecl.<un and P: 'xin: s'.ope. Parcel I.D.
scale or dimensions. north ancv_ and ICCaton arc distance to rearesl road.
Please pant all information Kevi •ed by -
Personal nlurn:aUen you PIUy:dG r aY ..sen I r 'InvI t p : q: ; jt r 1" s I n i :Im1I. 1Z 7-7)1 0
Propony 0-wrier Pr_:ie.rl inr.ir •i ❑
' F~ r lr//:5 S/+!il7 +f/9- G+!lvrf-~.O Vu,:. ~ )tl:/7
Property Oevner's W1ailhAddress # Block # Subr.. Name or CSf.I#
c<)t1X
City Sl~lo lip Coye Phone V.imber ❑ City Vilage ®luwn Newest Road
M, I~AA
Nev: Cutc;:ruchcn Uso.,KCSidenlial: Numberolbodrrwms ✓ Ccde cem:nd oesi ,n flr.•.v raleh."/ uPD ~z X
❑ Roplacement ❑ Public or commercial Describe*
Parent material 'C.. f-..%¢';~/ Flood Ran elevation if applicaL•le A ft.
Gereral comments and weororacodalions. -
Hcrin 4 ❑ Uuuny /
9 ® Pi: Gourd surface elev. ~'t Depth :o lialraTq faclt~;~ in.
Soil Applicatior Rate
Horizon Depth Dominant Color Redox Dosorip:on TCxlure Sir.iclure Consistence Boundary Hoots GPD!FI`
In. Mansell Cu. Az. Cont. Color Gr S>. 3h. 'Lff41 'Eff42
9
X, ~7
- -
Al 7
I Honny 4 ❑ But vc ,
Pit Ground sa•lece ele"LIII 4 Depth to limitn•g faelotL in.
Soil Application Rate
Hnvon Depth Dominant C'Aut 'iccux Dewuut un Texture Structure Consistence Boundary Roots GPD4' _
In. bl.msell Ow Az. Cont Coot Gr. Sz. Sh. 11,01141 'Lff#2
/ Lx l
_ 'Effluent 41 - HUD• >30S 220 •ne 'l and Msf Effluent 42 BOD - 3:: 220 riel- and TSS > 30 s 150 rngtL
CST me In., rig S yn rt`r / CSI Number
j, `
Add eSs Date Lvaluat or Conduct' Telephone Number
SBD-8330 (R04;151
r
,J Bering iJ ❑ acring J
_ got Ground su?acc clc/4k2 9. Depth to limiting fac:or,r!=~
Sol ApphcaGca Rate
Horizon Depth Dominant Color RrCOx Description Texture Stntctu'o Consistence Boundary Roots GPUtFt" _
In. If resell Qu A/. Cant Color Or S/. Sh. _ 'NIg1 'EII:12
24-
/ 1
ICf .5 ~,/rrZ~' ~ f r~ ~ 4
E--7 CIO
"I, v
Boring N ❑ Boo -
n Pit ourd sudw.. elev. fl. Oopth to liirnhre [actor _ V.
Soil Application Rate
Horizon Depth Dominant Color Redcz Descrip:io"r Texlure Structure cors:sterce Boundary Roofs GPUfFt'
In. ^dunscll Qa. A- Cnnt. COlcr Gr. Sz. Sh. - •F.ffk1 'Effk2
-
❑ Bnnng
ROrirr 5
❑ PR Ground v:rtace elev h. Depth to limi::nq factor _ m.
Soil A licalion are
Horizon Depth Donm',arl Color Redox Description Texture Struclme Consistence Bouncary Roots GPOTt'
In. Mursell Qa. Az. Cont. Color Gr. Sz. Sh. 'EyYI 'Effv
i _
-^~uenl kl=6UU,~....=770 rr<t+L and iSS'~3(1<~Sr:nyiL J':.ert;r7=60D,>3.^..S l20 rngfL arC IS5 ~3(1_'Sp m~+L
t
Ctainr r [ 3oring
r
~ -'d r~rc sn1u.icyl!q~~ Depth to lunitn.g tdUOr~:~~ie.
Soil A hcation Rare
Had_om Ueot•I Darr-dill Color RGdux Do2u Cl ou Twaxe ' Srv :err 2ons:xtence ' boundary Roots GPD+FI2 '
In Mensal! Qu. A.. Co.r CtAo+ Gr S z. Sh. •Eff#l '=ff#2
'-X~ / ~~~k F~~ 1 -~j 1 / - it ~
- of t'
Baring;
r ' t i~rourc Surface tier. 7ePth 1A 1=111¢.4 factu• _ W.
Sail Apply ation P:ae
Homo= DupU+ Dum,nam Color I Redox Descrol'on Tenure Stvcn,ra Consistent- Boundary Roc:_ GPDIFt'
In. I-Aunscli Qu..Az. Cun:. Caor Gr Sr. St .Effrt,, •ETti
aorinc A ❑ Baring
❑ Pit Gfound surface 6P., f: Dca7 lc limiting factor _ ir..
_ Soil Ap I aticn Rate
H:,r;znn De3dli Dominan: Color RC.'.,x Descr+ptior, Texloro Stn+crdre C wAilence T BDUncArx Soots GPD F_
In hAxisel Qu. A-,. Cunl. Color Gr. Sz Sh. •E`f41 'Eff"
- - - III - - ---t
'i-tlluen'. 9'=90D>30 <220 mciL and 7SS`39 150 mutL 'E$iuer'tiJ-9::7D~vj Arid TSS>3C'<150riq;_
. ~ :HUUSON,
sr~l A$n /
j
i
It CONTOURS SHC,':*..==E
\ ST. CROIX COLJN7Y -
ELEVATIONS SHC.'.-,
1988OA1UM
/ r
I y,2
T.O.H. 912.29 • -
o
m
PROPOSED DRIVfWAY,\
PROPOSE7ri`;__-
/ - & GARAGE
I 914 i/
50'
/
---~=ia 910.48
0
- = 539.2.S' - - -
-
WITTSTOCK BUILDERS -
HOWARD HOME
TAM or mar - -
STAKEOUT PLAN
- S~IU ~ - c27
IUI~r- ~ i -,1t Indu uro ~enlx<Ih I r,:n ~ Cuurv
0 tt ~V Is Ro[ II 1tuMl,.✓mi: nl Im be hlleJ,l l,
(t l ~ E PE ! , L NF. i r'r {Q 51 r? 71v'
jLjlo (e 65
!7(0
sa llitar- t Applicatio 4 c Tra.uac r. Numb r
1 u: ol, trc xnkMC7c;.I , 6r ,._b;u Ir.,l lLis lnl ll'IL[,I. or•}ul ~um^v:ntal
uI Im 11 I I ,r: It perII Vt Ill A 11Illet aco.vt.J IUI IN Ate,chme0.d m YI ~I %JJu-ss(I'nT; enl t^sn rulgxxddr:<j
the t I , t c t y I l I: 11 . I rAlin-I I .r ll.o 1. c ma.' c u cd Inr u.mdars•
i If. "I t1-1 1,,nh :t I I_ si14111,1 <II._.
1 \pphsati'o Inlor'ntano I hear.l d %it Infarriati_ TTT~~~ ✓ j 46- 1~~~7 ^nIl
..,.i, Pallet -
I upu[, 0*.n I Il4du,_:1. A.:&.,,
C :(N, S'ailu - Zip Codc I ?hone Number I Nx.ll j
L N: P. F
III. 11pe nl Ifuddlne'(thrcl all that apply)
1 F:nul I n., b.o" f M Bi , uc:u _a C~) - A IhJI Isnn S:u'
46 iifsck
o/c
I uhhs'1_'a::m r r I faes; L1. I_b;,: -
44 . it.
_41 I u :ber L xilhllcof
--v-SIC- F~-'1'mwt af'
I 11. Type of IleIil: (Cf -I only one box on line A. Iatp II Iitie applicable)
Uif
Mw S ttcm LJ R<pl.mrnrI: Cy.:.:In ~i Trcalmcnt l3 n~ . I rccr,t lir..y ❑ Od cr \4od!licst .i :a lixatine System (cxplaEn)
li L Pem rw::.l - _ _ - - I.I,[ Pleura. I'con:t Numhrrm. D. t, lsur<1
J l:. it Il,..v,r, hall,:6 New
q .,c I :I t r:r Oss u,.l T_ Al (4-f- -Aid I1 I lcm (nuytonuu Ueatsc: l(. •el d ~ppitil _ t - 1o
x
N 1' I I 1 n: r. I I s. I/ 1 t a.ud ] blaa^ 1 `4,, ul n hl suit ,1 %I cl J.2-I .n 2 sm:able s ,I n
val
h:IJi y L.n. I Ioil cn,l Ix ;.ml.
❑ Yret cVnau [Xd
1 Dlspusal ItetUoenl Area lnfoemanon
D t I u _JI Itca;n-t Sell lpplieall r Ra ti". fT. p sal : I Z I,.irJ )1 I anal .area Y op'neJ la' \ss'rm flcva[i nn
N 1.'Fanl<Info Ca:p,ci'y in btau:tae[urcr
f Tm (fell I» Cam; u
N.:u ilk, x _ ic¢-tAs o ° ^a '
_ t
\ IL li punprhddx Statement I the undersigned, asatnm rests lj7lnl h In msndlahon c 1 the I 10V, I bossu In life attached plain.
I I n I I /'~N--, I I Ph ni x ~.naNr: ~1 / I `,t t u,.i cr iu.rl Y t e lsitmbe:
117
I11 1 : AA:_I s I<ne'~ C:I < « /rz C,dc)
\111 onnly Ihpu-I mrln l t IInIF~ - ,
tI, I }et : it Far. I)a1 ss:l:a1 4n~::![ S141- I
a
i i u'> nzmt fh r>;nia: OV _
IY. Cut~idil. ~ ~~Il~(fj~~11}r I<onyy for Ih<.tpprln N
. $I' Fta^t'. f l Ilitf' nl w` ~f
A. p:r yerter plan wl dv t. r•.be,-
2 AN se per P k r llpF'NCeWecur _n mlful.alr
w a r \ eY 4t~h° I/Ofi C/JI
per i rIY I m:rr l
t ,.L,,.:cnl. hu. pl:m.lix rile Ill:nrla,hmil la lh. Cnunty ud, an yal•aln tle<jtlun ♦1l inahns in.ia
S 14,
-\s
'\l .d M~/ Fix 'y-' . ? ~.c/ !:-G~ y.~.! _
fir" 'fI _
a ,k
1_~'~ !yam I
t it ~ l
\
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CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name:
Owners Name:
Owners Address:
Legal Description:
Township:
County .
s,
Subdivision Name:
I of Number
Parcel lD Number
Page 1 _ Index and We
Page 2 Plot Playa
Page '3 hem S¢urg & CiossSedton
Page 4 Filter Specs
Page b _ Maintenance Informa56n
Page 6 Managernent Plan
Page 7 St Crab: Cty Septic 'rank IYRaertenance Form
Page 8 Warranty Deed
Page 9 CSU1 or Plat
Attachments. Soil Test & Hasse Plans
DesignerlPlumber License Number
Date: _ Phone Number -
Signature
p„s."teo the Ma c m nd soanbsorplim Compmo6 Yammd for POVVrs vasbn 20 seo-10105-p pLalsu,r.
Page 1
\ ,V
,y
-
soil Absorvl5on System cross Section
1 ft
4' Sdwinr 4o F[tei Grade
PVC ved Fpe
wM Vert Cap .1 _ ft
LOadlr~g ~
Chamber
ft
2~L,,
System Elevation
It
ft
Soil Absolution System Plan view
'ice.' tt
ft
ft Vert Or Obsrvzdon Pipe - Clratctinng - L Trench
`arJ F..bs = / ~
EMWffEKZWMc 4' DFa
Trends 7 Header
Leaching Chamber ~ ons
- J
ManufactmerAnd Model J
EISA Rating , sq ftPer chamber Sal AR*cafion Rate
gPd/sq It
gPd Design Flow: Soo
Application Rate r ~ _ EISA = _ - Chambers
2 rows of chambers each.
page of
T o Filters
PL 525 EFFLUENT FILTER (-ice.
Polylok, Inc is pleased to add its -Y
new commercial filter to its existing
line of quality effluent filters. The
PL-525 is rated for over 10,000 GPD plum
(gallons per day) making it one of t accesubmw ` Accepts PVC
the largest commercial filters in its exirnsioahatralte i
class. It has 525 linear feet of 1610
filtration skits. Like the Polylok f i
PL-122, the new Pblylok PL-525 has
an automatic shut of ball installed 52S raear feet
with every filter. When the filter is of 1116' , i
removed for cleaning, the ball will fdtariaoslots._~ .:a Rated for over p
float up and temporarily shut off r ti 3 to 00o GPD
the system so the effluent won't
leave the tank No other titer on
itle rrlaflikef can maters that darlR! 7 9CHO, 40 Pipe -R- g
PL-525 Maintenance: ~ s
The PL-525 Effluent Filter should - - e
operate efficiently for several years i
under normal conditions before
requiring cleaning. It is recom-
mended that the filter be cleaned F
every time the tank is pumped or I
at least every three years. If the
installed filter contains an optional
alarm, the owner will be notified
by an alarm when the filter needs -
servicing_ Servicing should be - ~<e--" Gas deflector
done by a certified septic tank g Automatic shut-aft
pumper or irtstatler, t t ' ball viben twer
f is removed
1. Locate the outlet of the gg usPntenrtVemti,4se
septic tank. 4 sancao
Z.`Remove tank cover and pump
tank if necessary. PL-525 Installation: 1. Locate the outlet of the
3. Do not use plumbing when septictenk.
fitter is removed. Ideal for residential and com- 2- Remove the tank cover and
4. pull PL-525 out of the housing. mercial waste flews up to pump tank if necessary.
5. Hose off fitter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the
tank. Make sure all solids fall 4' or 6 outlet pipe. If the
back into septic tank. filter is not centered under the
access opening use a Polylok
6_ Insert the fitter cartridge back Extend & Lok or piece of pipe
into the housing making sure to center filter.
the fitter is property aligned and 4_ Insert the PL-625 fitter into
=nplewly inserted. its housing.
7_ Raplana septic tank cover. 5 Replace the septic tank cover.
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Fageu!
FILE INFORMATION SYSTEM SPECIFICATIONS
:lnef
fan<PAaruf2~'r.rer: ❑ NA
Pr mi; It ,
Xsep6c ❑ Onsc I I Ifolding Volumr.- - trap
DESIGN PARAMETERS Tang P:lanufac'urer. J NA
Number of Be:lrooms: ❑ NA ❑ Septio ❑ Dose ❑ Holding Volume: !!14
_Number cf Publc racliby Units: 1 NA Vert: cal Distance Tack Bottom(s) to Si Pad: :,n)
Estimnh d iavetaye) How: e „ rg;;l;da•;, I',orizontal Cistfe :r lank(s) to Service Pad: ie
Descin (peak) FIOw - (esllmaterJ x 1 fnnl:da Sf.e die 5er i )y ru chanin must be p o ided (vcrLcal is >75 feet or
4 horizerin is , ` 1 -O feet. Spe r'c inslruc 77
r he provided on back.
In Si(u Soil Rppliralion Rate: (ya-dvr Yt'i Cticent Fi er f.lanufartur ❑ NA
Standard (Games6c) Influen 'Effluent Nlont ly average Effluent Filter J~oa
Fats. Od R Grease (rOG) :30 ni Pump Manufac'urer.
n:o::P.nnica! Oxy;en DC^land (601 X220 mcr, ❑ NA r gNA
- i c!a: Si Solar (TSS) -:150 mp;L PUMP Pa Ode):
f iijh St-cngth Icfieen Einuen N"onthly ave•agc Pretreatment Unit
f~OG) :•30 mu+L C4arm'aGUrci
a<m;) =220 mart [!J Nr^, SNA
(TSS) >1:3C mI I Pdedcan!cal Psralion H real tiller
❑ Dissirfection ❑ 'Ali
Pretreated I-fflucnt I:lonthly average _ i : Sand!Gravcl ❑ O_ iher.
inoDr) •so matt Sod Absnrpticn System
(Nisi 3un1g::. LYA NA ,~.J
Fecal coliform (gvcnwiift; m=anj sii 1~5 In-Ground (,raofly) L~ ho-Giound (pressure) ❑ NA
❑ At Gi ❑ PAr.umi
).6dxlnlanl Etfuent Pai:icle S¢:~ ;h. in (lid- NA ❑ Drip-I- re ❑ titter
Carer. - ❑ NA Olher. - - -
❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
7u Pump nut come-.IS Ut:an~sl ❑ -,,Vncn aclbirec s;udge and scam eq.d's Una Third (;3) of t-ink vUiurie
VJhcn the high water alarm is ati•,eated
Intip: nt ccndilon of t anR(s) At ieas' once every: ❑ nn nuosi - -
(Maximum 3 years) El NA
l~ sr iii
I sp..c - ❑ rxx th(s)
At least once every
drspcrsal cells)aximum 3 years) ❑ NA
F y7 }c is)
Clean effluent films _ A. Ii I - rl .nc nhis) -
- once ever
y 7~ y iris) rl NA
Inspoct pump, puarp controls & a;ann At ieas; onnA: every: ❑ mnnt,,s) tai NA
- ❑ yeagsj
Flush laterals and pressure test Al least On^.c every. ~ monthts)
- 0 NA
014ec I. _ - - -
r77 Icdsl Ct (.':'Cry'. L] mrehi Fl :1 ❑ NA
^4hcr- _ Y x.
❑ N,^,
MAINTENANCE INSTRUCTIONS
Inspections of wks acd soil absorp r n rstr:niE .;L,..I be made by a•i it l-viluzl Ua" u:: I r *e; ct -.h.- fr Inn'nq or certificatlcns-
%laster Piuiiber, Mas:er P'umher Res ri te:-1 Srr e. fS I ~ -I ec'ur, 11Ct:'u' I S f.hmfainet Uf Sep/nge Sr-vi-in3 Operator (pumped.
r rk inspections m.rs: ino tree a visual rn p ct'on of the, to-ks , to i 1r.aiay a ny i li.;s:r g or nrcker hardware, ide:di'y any cracks nr lcn<s,
riea„ure rho VIume of cOml.l cd slud' e nr1 sc,in and a chrnl< for day Lank up er uon i- x; of efluent or the Ground Si Tile still
nhcorption system shefl c Asa =Cy Inspected to chr ^k the effluent levels in the ubserv tion pipes and to ureca for ary pondicg of effm_nt
car Inc. grrucd surface t he pondi::q o` effluent On the ground surface may indicate a failure corrt on and requires the immeoint ,
no`.fication Oi Inc loci, regu:atory authority.
When the combrad accumulation o` .=•IUdoe and scam in any treatment tank equals ore-third f~) or more of the tank volume.. tee entire
contests cf li:e tank shell to rei by a SeptacO Servicrg Operator (pumper) and dsposcJ of in accordance Yrth chapter Nit 113,
'idsconsin Administrative Code-
AII other services, including but not :trailed to G-le servicing of e'fiuent fixers, mechanical or pressurized components, pre:read lent wits,
and any sen,)cing at m'rn'aa of>72 months. shad be xrfonned ray a ce.'titicd POb^JTS PAaintainer.
A service re.nort shall Le provided to the Icunl rcgu!atcly nutttoray •n-!thin 30 days of comp'etion or any service e'ven'..
i'agu of -
START UP AND OPERATION
For r(!ar cunstrt:ction, prior to use of .he POb^JTS cl,cck treat•nent tanVS) for the preserce of paintirg prod.ms, solvents or other
chn-lima s or seciment teal may impede thn treatrcent process anclor damage the sci: absorption system. I' high concerlratons are
detected have We contents of the tank(s) removed by a Septage SeM0119 Operator (pumper) prior to us(-.
P.rtp tanks may fill above narma h ghwaler levels prior to start:tp or due to pump failures. Start up or restoration of poa:er under these
c _I'ditions is riot recorrmanded, as the, excess v;astmvatei will be cis:alarec-d -.o the soil absorption sysleni in one large core causing an
overload that array result in tte backup or surface discharge of effluent aid damage to the system. To avoid this situation have the
cortents Of file p:nap tank remcved by a Sepbsge Servicing Operator fpcnper) prior to restoring powor to the pump or contact a Plumber
or f'Or;YTS f:lmntainer to assist in marua'ly o0era'.ing the pump eonLeis :tntd normal of"cent lc OIS ara ms`,aad within the pump tark.
Syste•n s`.a. t up shall not occur when soil conditons arc frozen at l''°e inhl:rati:•e sue."ace.
Do rot drive or park vehicles over tanks or the soil absorption system Uo not drive or park over, rr cthcrvise disturb or coni the
area 15 feet doval slope of any mound or at-grade soil absorption area.
ro.l.jctiun or nlimination of the to lowing from She w•astowa'er stream may improve :he performance and prolong the life of the treatment
tanks and so" absorption system: acids, antibiotics, baby wipes. cignrede bulls, condoms cotton s•.;abs degreasers, dental floss,
f _rs, dlnn. -cants. fats, foundation drain (sump pump, discharge, fru t and veyelab c pealings. gasoline, greases hrrnicides, meat
raps, nr dica -ors of-s: painting products. ocsticces, san'!-cnry napkins solvent, tampons: and •a.aler softener h•inri discharge.
ABANDONMENT
V,Jhen the I'O'%PvTS fails andlur is permanently taken out of service the fellov.ing strips shall be taken to insu'e that the system is properly
and safely aba'doned in eomplinfice•,aith s. Conlin 83.33,'.Visconsin A.dmnistrtli:e Code -
• Ali pipng to tanks. pis and other soil absorpticn systems shall be discunrected and the abanconed pipe cpenings sealed.
• The contents of all tarks arc pits shall be removed and properly disposed of by a Septage Semarig Operator (pumperi.
• After pu•nping. all tanks and p.'s shall be excavated and removed or their rovers removed and the void span: flied wiih soli, -
grnve or another merl solid material
CONTINGENCY PLAN
If the I'OV•JTS ails and canncf be iepairc.•d the following measures have been. Or must be taken, to provide a code compliant
reolacenler`. sv5(uin:
'w A suitable 'O.Piacerne^.t area has been evaluated and may be :.Pfizer inr the Ic of ore of a replacemea*. Soil absorption system.
're replacement area sl-culd be prctc--:fed 'rZirn disturbance and ccmp::cl on and s.'letdd not be infringed upon by required
ectt>ac:ks from exist ❑c and proposed stri :ture.:ot linos and wells. Fa line to protect the replacement area will result in the need
''or a new soil and site evalia:for to estaulish =.udable replacement area. Replacemert systems must cv.Xmply Vdth the rules 'r
eflect it We lime of their perm:; issuance.
❑ A soifab:e replacement mea no' available due to setback a-d!er soil lirutators. If tte soil absorplion system cannot be
.
rohab0ilated and baniny ao`varces in POW I S technology n holding lank may be insta[e, as a last resort
The site has not been. evaluated to :denty a st.I:able rep:ecrime•it area. Upon failure. of the PO'd'JTS a soil and site evaluaF:cn
must be performed to locate a s:,ilable replacement area. If no replacement area is available a holding tank may be installed is a
last resort to renla;:e the failed POV•1TS.
F-1 AGcuad area at crade Solt ai~serptron systems may Le iecons-st:;ted place follcvvirg removal o` the biomat at he infiltra,,ve
sur'::cc. R"";IIsUt:niiens cf sunh sys,erns rttr;t comply wish thin rules fr: erred at that fimri
WARNING
TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK
1 • SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY
RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE.
ADDITIONAL INSTRUCTIONS: - - - - - -
POWTS INSTALLER POWTS MAINTAINER
~l ilia Na•ue - -
Phurc- r f hone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGU TORY AUTHORITY
Isis fir:-.r.rt',ecI 'al- ..tv1=.: by the stalls :4 11: f'reeu Lake. Marge k..r ei Vtc JSI'.;•v !:in.ri. LO J r fit, Anry ager:c.~. ire :anr.phance rdth z.%.hc,c
C 'M71 .3.251111 Ird):='('r-ur'g;0:41;1 I 1'.(:i,'dlr:'ursr;4cr-rn-.i-'hl^Gare
-ages of_
START UP AND OPERATION
For new conz.t.ucli;m pnor to use of the PO',--.'TS check treatment tank(s) for the presence of paining produozs, solvents or nt^er
ch.^.mlcas u, sedi-tient t-a: may irn)ede the treatment pr^.^^ss and?or damage- the soil absorptior system. If nigh concentrations are
detected have tnc ccnferrs of the ta::k;s; romovcc ova Septage Servioing Operator (pumper; priorto use-
Pump tanks may H. above normal highvvater love -s prior to staer ,n or one to Durnp failures Star. u or restoration of pore- order :here
conditions is riot recommend-nd, as; re ex.Cess Wastc•Aninr will oe, discharged to fie soil absorptio" system in ore large dose causi-ri a-
overload ilia: may result it tic beck..p or surface discharge of effiuent and damage t=.) lire system, lc avoid this sit.;ation have the
contents: of ore pump tank rcm over, oy a Septage Servicing Operator (pumper; pror to restoring power to the pump or conta- a Plum scr
br POVdTS Maintainer :o assist in maiually ope-at'ro the pump controls cntil norrcal effluent levels are restored Witnin the pump tangy;
Syskm_tart up sL•af net oxurmme- soil COndilians are frozen a` fro in`ILalive Surface
Do rot drive or park venic'es over ta:iks cr the soil ahsorpticn syslern. Dc not crive or park eve', otherwise disturb ar compact, the
area Wit'^in 15 feet davn slope of any mount ill r-grade soil absorption area.
Reductio- b- e!irrisiatior, of he toloring f-on the wastemaler stcarr may improve the pcrorrancx and Droong the iffe of the treatment
tanks and sot absorpf:on system. acids, antibiotic;, Laov vv:Des, C-Marnte hefts, cxidoris, cefton svrabs, degreases, dental fie;=s,
diaoers, ci s~nfactanis, fats, fou:rda-ion dry in ;sump pump; discha'go, fruit a-d vegetabrc peelings, gasoline, greases. nerb.ddes, n. eat
wraps, nre .ca'.ions. oils, painting amdu:7.s, oesliades, sanitary rabkins scivents tampons, anc rater so-err brine cisoharge.
ABANDONMENT
L^Jhe ~ life ?")VIe'-S fails andror is permananty taker, out of service the to! owing ssteps sha' be taker fo insure that the system' iF ;rt°-ell,
snit safely abandorcd in eorrp:iance with s. Comm 8:i.33 `ifisconsin Administrative Code:
sn I.-:d
• !',II piping 'to tan%s, pas and other soil ahsorption sy'sterns sl-all be disoonnected and the abardy)ed pipe coaling
• The contorts of all tanks and pats shall be removed a'td properly disposed of by a Septage ServicioC Operator (purr.pe-S
• After purnuing, all tanks ana r:s shall be excavated and r:noved or their covers removed and the void space filler! 'alit 5ei
wave: o' anotner inert solid natecal.
CONTINGENCY PLAN
It the PO'%^.TS Pails and cannot be repaired the follox4np neasu-es have basin, or must be taken, to provide a code compliant
-~pa,xment system:
,'fJ A scitable ;eplacrmeci area has beer evaluatec and racy' b utilized for the Iocatror. of a repiaeeme-c soil absorption svsten'.
'.re rep:acement area should Le p-o.ected tom di:hrba ice and corrpac:i0 and snood net be infringed upon by rca:;ired
scSsacks from ex sing ar.d proposed szachm:, ht Imes a~(d vaei!s Failure tD protect the replacement area will result in tre need
Y a now soi and site eval:,a: on to est7.h!,sh a scitable replacement area. Rep:aoerrrent systems must comply with the rd.es in
uffec- at the lime of tier permit issua-,.'c.
❑ "t s-fable rapia=ent area is no: a'vaiaLc cuc to setback and'b- soil Innitat,ons. If the sol atsDrption system ;amOt be
reha:i ilia:rd and barrinc advances in P)-A'TS to^hnoiogy, a Fcldinc rn% may hr• installer; as a'a=.t nnsort.
❑ The sate has no- beer eval ated io ioent}y a stranle rep.acement area Upon `ail.ire o`. the PO0JTS a soil and site cvakration
mus: be oerforrneo to ~ocatc n suitable replacement area. If no replacenent area is evaiiaale a nooing tank 'illy be ir.stalled as a
last resort to -epiece the fa.leri PO':'vTS.
❑ Mound ar ; at-grade sci: absc-0-on sys-ms may be reconst%cted in p a:.-- fc-,cm4rg rmova: of the aicma: at the i-l tratve
of _.r._ tystc:ms must =rp y vvt'° th5 r I . in elect et th t tine
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 RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE.
ADDITIONAL INSTRUCTIONS:
POINTS WSTA ER POW7S MAINTAINER
Nrm - -vi-l", i ' r' N+r.e
Fh r_ - Flone~
SEPTAGF SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
' Y
)'none P-n.-;nc
Ti ce.:wr_•q: cis drafted .•r :lr.: c- 'c :r ri V.- ".r. 'a -j at. lu. ::rnrci ,1, i~ rnn.t to.v n,,em,es in ecmaraq_..::iii «:anrs
ST. CROIX COD--N-Ty
SEPTIC TAY -VJWN ' ' CE AGIR--NONT
_4_N
O'VVINERSHIP CERTIMCATION FORM
r
Ovruznr~Rziyer C✓ vACtCireSS ~~'L- 'i2 ✓ r L-u i~lvtiY:
Fa~It S L_;t 5C/c Z Z-
P v Adtaess r
(Veri5canon teq fired f3tm Plrmmmg & Zoamg Departomatt for new ccmstrQCjj=)
City, Staxe Parcel Identification Nwnber r ` .4j 1/: / - - --/~i
LEGAL DRSCRIPTI()1~
Psoperiy I,ocatian 1/~ , L _ y ,Sec. % i' , T. t R Town of
Subdivision Plat Lot #
Certified Survey Map ^ Volume . Page #
W RrT r,(y Deed n 1 (before 2007)Volume Page
Spec }louse O yes 0~ao Lot linter iderrti&bk *yo. Ono
SYSTEM MAIlVTF~NA_NCE AM OWNER CERTM ATION
Improper use and maintenance of your septic system could result in its preroanre failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
rte system can aTx,-t the AMOdpm of ma septic tank as a t:-z tmont stave in the waste disposal sus Owner maititenance
responsibllides are specified in §SPS. 383S2(1) and in Claprer 12 - St. Croix County Sanitary Ordiaamce.
The property owner agrees to submit to SC C Tort County Plamtm g & Zoahtg Depw1menr a cerr25mon form, siwed by the
owner and by a master pkmhber, journeyman ptumubec restricted pltm2ber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is iD proper operating condition and/or (2) at= inspection and pmpina Ctf neeessaty), the septic tank is
lass man 15 fnL of sludge.
Uwe, the undersigned have read the above requirements and agree w maintpi , the private sewage disposal system with the
sandz-ds sex im dk hers, as set by the Depxtmemt of Safety And Proiessiomal Services and the Depmtm m ofNatmai Resources,
State of'Miiscams m. Cartfio m sitting that your muc svstcm has becamammm d must be completed sad rewtmed to the St Croix
C rszy Planning & Zoning Depatuez vFZdrm 30 day, of the three yea; a p,irrtion date.
Uwe certify that all s ateme= on thi form are mre to the best of toy/our knowledge.. Uwe am/am the ov mer(s) of the
property described above, by virrue of a vy deed recorded in Register of Deeds Office.
Number of bedrooms
~IGTM T Ai PLICAN7.9). DATE
s A-oy information tar is may result in the . bake revoked by the Piatmut &
~~3' permit ~ g Zimiog DeparGnenz
include with this application a recorded v ==,y deed tom the Register of Denis Office and s copy oftbe cer ided survey map if
reference is made in the warranty deed
xtEV. 4)4/LZ)
l \ I I io
l•t I I
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O
70.09 ACRES I N
•'I ' I 439,404 SO. Fr.
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of ' N82"33'00'E
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1.60A
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m s 1.69 ACRES\\
\ CY \ 10. ORES 73,717 SO. Fi.\ w`
Na, ( \ 451,909 $O. FT.
\ NoT fUNINCI ° \ \
\ UVBOM9iON Oa 1N'S tai
O l \ wPNONIaneN e°6/ \ \ Y
1r \ \ ao \ /
\ 20'DRAINAGE EASEMENT
1.66 ACRES \
80,971 SO. FT. \
L% ( 1.67 ACRES Ory
44 \ .w 81.450 SO. FT. y
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\1.77 ACRES /°y ; \^~Y° ~ i I 'flO V 77,274 SO.
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0. Ff. $ l,o II Hr71
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1321
Oiisc I Department of Commerce SOIL EVALUATION REPORT page I of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Ada,. Code Gustum Septic Sernw
County
Attach canplcle rile Nan en palxr rat I¢s3lt.va AY, x 11 noi~ it s¢e Plac m.lst St Croix
;ndade, tw not limited to: vertcal and hoyzorO referix" pool lBiA), direction and
pcexpislope, scale T dimemsluo>r north arrow,end.lecjrti4n;lrl Sistrgce tc nemat road Parcel 1. D. O(1b.-~,1y _,)0-C6q'j41)
Please print ItfirddrmaNon. H By peYTdl~ Date 9_ l u
PC¢.Mnlnlrrn:2cr tcu r.cvea tr3. to All I- w,gna fyQ~tf+x5~(Prvxy t.»s I^.P7 ;'j ('nD j.-. / (l
Property 0,in& property location
Humbird Land Ccrporation r. GUY-Jot n!a 1!4 SW IA S 17 1 :R h H 19 W
Property Owners Ma(irg Address l•l. Lot if Block # Subd. Name cr CSNV
332 Minnesota Street, East 1404'' - 3 Wa Troy Wood
City Slate Zip Code Wrorr,ilbet. City' Vd:a9e ✓ Town Nearest Road
1 65 222-5555. - I roy E Cove Rd 1 Day Farm Road
Saint Paul MN 5540
✓ Nrw Construction Use* V Residential / ~ oL1>Ld Wns .i Code derived design flow rate 450 GPD
. Replacement P„L•'x or commercial - Describe:
Parentmaterial outwashplains Fkxxl plan eleIr-01, 4a1 n/a
General 0omrmar4s
and recornrnendations: Part of 10 37 acres. BM #1=100.0'. BM #2= 93(3'. Recommend system elevation of 96.8'. P33 and P43
from preliminary boring work done 5 5 00.
P33 Boring# I Llonn9 >75 in Sa7ryg6 aten Rate
✓e Pd Ground Surface elev. 100.2 It. De" to Imitlrg factor
Hovur Depth Ocminant Covx Redox Desmiplxn Texture Stricture Corsis'ence Bandary Rms 'ER#1 FD4rEfnr'2
1 0.12 10yr212 none sit 2msbk mvfr as if 0.5 08
2 12-23 10yr3/4 dune sit 2msbk mvfr cw j 1f 1 0.5 08
3 23-30 10yr4/4 none it 2msbk mvfr cw - 0.5 08
4 30-53 10yr516 none I gr. s 0 sg ml cw ~O 7 1.2
5 - 53-75 10yr616 none s.. gr-s 0 sg ml - - I 0,7 1.2
P43 t3+# Boring
Pit Ground Surface elev. 96.5 9_ fx~th to limtmg ta1a >75 m. I Sol Apprra"lo~ Rate
oa Depth Dwrnanl Color Redox Umonetion Texture S'JLM(e Consistence BwndaryRools Eff# GPD,1t-EtW2
1 0-8 10y2/2 none sit 2mp1 mvfr as 2'.tm 00 00
2 819 10y.B14 none sit 2msbk mvfr rw if 0.5 0.8
3 19-28 ?Oyr414 none sit 2msbk I ..vtr cw- - 0.5 0.8
4 2843 1l none sit -21*ysbk mfr cw i - 0.5 0.8
- - 05 0.9
5 ' 43-75 10yr416 none sl 21.1sbk mvfr 05
Effluent #1 = BOO 5> 30 < 220 nxyl and TSS >30 < 150 nxyl. ' Effluf en'. 10 = BOD,<_30 mry'L aid TSS <_30 nV1-
CST Nano (Please Print) Signature`s CST Number
Tom Gustunl 227618
Address Gustum Septic Sanrce Date Pvaluallen Conducted 7elephme Number
N 134,1,0 9171h St New Auburn . WI 54757 11!'. SrOp 715-658-1344