HomeMy WebLinkAbout022-1044-10-400
'a :'iscorsn 6eCatl^em c'Or:°-'srce PRIVATE SEWAGE SYSTEM :0Okwt' St. Croix
Sxery ar d It.,tlc m9 U ~ w ^
INSPECTION REPORT Sar O.ary Permit Na
606934
GENERAL INFORMATION iAIIACH10PERib91T) State Ran ID No
Personal in`,rmai on int. Ito, de mJy CU ."I 10' Sc:nncar'. p/rp'DSes (Pr vary law 5 I i VG ^p;-"
Permit He d-r',. Name Cdy V loge -ovnship Parcel Tax No.
David & Ardie Peterson TOWN OF KINNICKINNIC 022-1044-10-400
CSI 1! UC. P sa. 6M E ev: W Descnr'w"r _ Sectiov73wwRange;Map Sic.
00 l CS 15.28.18-.-2-37A-40-1
TANK INFORMATION ELEVATION DATA
TYPE t.1ANUFACTURER CAPACITY STATION BS HI FS ELFV
Septic 3 i Benci r•ark S /
Cil
alt er~t~ JL.t :.r 7S
Aeration Bldg Sei.e
He oo-g - _ - StrHt In et
1 s `l 7
Strl a owlet
TANK SETBACK INFORMATION _ oLG .5 S
TANK TO i E^:ELL BLDG rn%k A r nta6e ROAM Of nlet
Septic Dt 3ottom
~
Dosing Header:MarAeration Dist Piao /x•45
Holdnrg 6 :1. System IZ 45 IS-7 7.
FI9al Grade e' '-11 / -
PUMPISIPHON INFORMATION 4s > I C~- `fG `
tlanufacturer Doman- St Cover
Gi Ill 41
Model Number en.
r'lo Ear _ w-r\ 73 TDH Lift Friction Loss SysterTt.Heati" H F: t t C .
f' I~. 5 z
Forcennain Length D'.a o ft t, vac I
SOIL ABSORPTION SYSTEM
BEDtTRENCIi Th 1 1 e-q7e M1n 01 4"Chea PIT Dlh~E:NSION$ N, Of =its Ins de 1) Liquid Dect•r
DIMENSIONS
3 1 ) L. i LL \
e.
SET13ACK SVSIEM To Ptl. Hi 44FL1. LAKF:STREAM LEACHING Man.~rers
INFORMATION CHAMBER OR
I'r'pe,Ol System. - r t~ UNIT Mod 9 Nemher
L' rT
c/'=:- i.~ Ins `iL ~J,.,:IC•..ti_
DISTRIBUTION SYSTEM • 1~~
Fc•A I r •r 1(G "
I•cadcr+I,ta'n'p ;1 /I Jsa Vu: cn x hole S ro x Wile Spacing .ontpl I.4aF.r.;
i Pi •efs1 ~
LenQl- )I.-. t1L er,in_ c a 'cn~
_
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Decl" Oam / 7cp:b O•:er xx bath o` xx CiCC7C.rSCC n-d xx P.tachcd
Be9lTre rod Oc..n.c. .y 3.ec~Tremr Edees \ Tnpsail ~ s No NJ
COMMENTS: include code discrepenc es, persons present etc. i Inspection#I Inspection #2
Location: 12g9 CTY RD J(r_ /
1 )AR BM Descf ptior = C 1144",
2 i Bldg sever lerglh = I t
/r r 1 F-t t,~.\x~c 1 I c.., ti S•te.~L-c S
- amcurt of cove, _ It
Plan revis on Rea• Lvedri Yes o -
IZ Gi:: t s ( fv a 3y ~ _21
Use other side for addlional rfo'mahon
121e 1~-sePC r s Siyrat e' Ccd Nu
SBD-fi? 1 C ';R.?r2';
Imla'L. SC.r;icts l)is isi;:n t. t.t,
14t11- %V -.$in-rtn^ A',c
r'U Mix 162 L TI Putt-tN mha'r iW La fill ii a11 CO)
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Sanlt~u-~ Ycrrmt .lpplicatu)n
't11'µ1
In. r.,rdancc Sill IS 1. I, I V:1: A.In suhcLS. T11 IhidI t-1 to Ikc arprtpriac 6oYQ]nt t at11,11:
nyur: ;'I~:il .,mci~-in_.str.t:ny Error N6tC 4pAli-trut'a>utt,tl e.,„•xn:d PJVISalcsu9n.ncJ1o Pruiecl Adiress III aa.mrt llr.ul vli-tneddicsc)
tl e 1 )111, - r t t %1 I t t '1 ? I'. .,n I t cr a i. provide Ir t l -w,! 1Jr seconda,
it T-10-AT ` n t Ila iir I ♦ t
ill. 11IS11 1 Apj lieuli n Infnnnahon 1 la+_c print 411 Information P"nlt; iD ~:Ls;rt \snrc
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I pl,~)'•str IAJIi,.I't:a Pop.lj[ncaltm+ ISNG~ I~f. d37H-
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( ail('. 7i}+.od.: PforcAnns.r i/~ ♦aun
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Iy A'.Ibdrvumn
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r ILh i Y'ommar I I A-s. (I : I Is,; IIYY~~ f l/
❑Ltv of /~S, Vim t ❑Villreo:
T,u1, At 111. 1 ap• 41 _i'ilit; -1 'ck mdr one bl v an line A. (.umple« line If it apph dd-I r - -
V~ N,:n s U F` 7 ..:m t •.cm J r ui n I I li l.vd: p v ncn p;I Ct,h hiodirc I .io -w -in S\ I a(explain)
'rat D b
t Ll ( h of -1.i. F1 P..Il master to Lu I'rrslons 2cmn Nw+ r:. tsst:d
IS. [ P:. n~a h...tua:J L u t Pi::n
f~lpx ol'YDR'TS i~xi~7t Y'mtlllcmen llrsrc: (Check :dltlmt apply)
I~ t I.._a v,d Ifnn:n, 7It.:,.:u.. Itlrrn.l I1t(Ir.,Ir ❑\4ounv nu:sni:,I:Ic.oil Ui%L'oI'.
F Idtcp len_ ❑9fst Dt :-I G:,nl ai M1.:-iloini ❑Pmlmvmcn[U:.m :cxglsm:.
A/S
: Ihsltrrsal Inaln art .4nllnfmmuutn -
J v n H .-w pil Ik~,'• z x d spplie: n n Rat.' Asll Sal.-1w lllspenJ Alca P'nposcd is[' v t m Jc•:zu~oyn
,'1. I'•ank Info leF t ily iu `i la q u! Marmlac'rdrrr >
c .
It A, Unit
]:^.v P/ /O~ UZ - o y u s'.- n
\ I I Its spulplbllils tilatentr nt t. the undcly ned, :u um. r •spnnyrLll « fm mv+allalion of the I UR'I'4 shover n Olr Inachsd plans.
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Ilml I m IPUUII Pl nnh.tE tlJmr _-1VP \1F Iit\u ISts xss lhn Vunhcr
Iln 1 ~ii. ,A.hn IS ,Cn vt I,~ipC ~cl '
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\ I,II/ton Ilx Ur tacnl 11sc Only
UiI er.. .I P:,nv fcc _ I Ltek ks xa I uv AScu I,:I mm
up::>St>,1 El
~v ` yes o~ ~o/zS/i~
IX. ConJilimu of V pprocal!Ftcasons for Ilixapproval ~(.1,t -LUP
2U, `v V CV
is 01 0
SYS r V '?'A^ h
1 S t !-n ftl cry. Sltc n ~1 AA
II tr._ Ilan: U.:= tt rrln+nla n°d -I T510-f4ai/~ f vw~ _
- I UaAnati tb Iarf ~rdAl'IAA e k111GIT-'A +C;L nmduufnunr. on papa I.., 1q,I an x 12 x l l Inr Les in ix.
t!p f )t d_ II hl- nnl tamed fl .t ntAy 1,`„ AIMT/1\`~ I
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CONVENTIONAL COMPONENT DESIGN
Residential Application
Np" AND TM-E PAGE
Project Name_
owners Name ,/r'' ;
Owners Address:
Legal Description-
j.
Townstup.
County T V
SubdWisron Name
Lot Number.
Parcel ID Number
Page ] Index and We _
page 2 Plot Plan .
Page 3 Sysiian Sb:bw & Cross-SecGon
Page 4 FiR Specs
Page 5 hkinbenance 1
Page 6 IYtaragearrent Plan
Page 7 SL Cron: Cty Septic Tank MmrMrnanoe Faun
Page 8 Warranty Deed
Page 9 _ CSM or Plat
Attadxreflls: Soil Tess[ & Hause Pkns
j
DesigneriPpanber lease Number
Dam Ptwne Number
Signature /
Ocsijmd poaratro the r.ciasd sbaMsolr~ Gwapmm* Ibewl for POWF3 %%Ed= ZO SBa10706-P acolAn}
Pew 7
I
`l
- fir/ TmuJF C
i
1~ i
IhO~~A ~~-if=
SY
i
/wo
~Ma b7 ~
f~ov 11.
A~l
l ~11cT 7
®~es____oio~ ~xstesea ~eoss
~ F7rt8 ~e
4`Sc~'~le4U ( ,
PVC Verb Pipe a
ihlitfrveni c-~o
L_-aching c~- `mfr
Chamber Syswn Bteva bon
R
IL
'•..i9 :50 f[ott ~fSf'.@ltg Q~BR Irww
17
r liirlq iremh
---r --3 Vent or Obs. vakon Pipe Cumbers
t. i Header
YIunGh `z
~~fnelr6 ~°-h3tTtut' ~ya~.~~asf~FS +
Man ifacfurer And Mode!
BSA Rating-LLL sq ft Per chamber I Sol Application Rafe„ I go" ft
gpd Design Flow _ Soil Application Rate- ESA = Ghambers
? rows of /L chmnbers each.
'Page 07
:~~`T r 11
f tom. i~ '.tom
_ PL-525 EFFLUENT FILTER (,_M: : 1- T Zak ~ '[~3• uv~es"Sin ee.`e...
Polylok, Inc is pleased to add its 7-,-
new c:ornmercial filter to its existing
line of quality effluent filters. The
PL-525 is rated for over 10,000 GPD Alann -4 Accepts PVC
gallons per day) making it one of <
accessibility ° extensimi handle
the largest commercial filters in its k
class. It has 525 linear feet of 1:16 k k
filtration slots. Like the Polylok
PL-122, the new Polylok PL-525 has 3 i
an automatic shut off ball installed 525 lineal feet
with every filter. When the filter is of 71/16°
filtration slots Rated for over
removed for cleaning, the ball will ' 710,000 GPD
float up and temporarily shut off 3
the system so the effluent won't
leave the tank. No other filter on "
Accepts & t _
the t»arket can make that claim! t 4•' 6"
SCHD 40 Pipe _ y!
PL-5525 6YE6[n24-".i±a. e.
1 ~
The PL-525 Effluent Filter should
operate efficiently for several years
under normal conditions before It requiring cleaning. It is recom-
mended dlat the filter be cleaned
every time the tank is pumped or
at least every three years. If theme` F
installed filter contains an optional n r
: L 6
alarm, the owner will be notified
by an alarm when the filter needs q
1.. ^ Gas deflectmservicing. Servicing should be
clone by a certified septic tank i Automatic shutoff
Dumoer or Installer ball when filter
- is removed E
1. Locate the outlet of the u.s. Parent Nuc 6.015,466
septic Lank. a sa 1,640
2. Remove tank cover and pump
tank if necessary. t>- t. _=-.f S 1. Locate the outlet of the
3. Do not use plumbing when J23 1zs Zdf-d$ G:- septic tank.
filter is removed. ideal for residential and com- 2. Remove the tank cover and
4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary.
10,000 Gallons Per Day IGPD). 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 fall fitter is not centered under the
back 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.
the fitter is property aligned and 4. Insert the PL-525 filter into
completely inserted. its housing.
„ 5. Replace the septic tank cover.
7. Peplaca septic tank cover.
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa_r
FILE INFORMATION SYSTEM SPECIFICATIONS
O'd.ner ! 1 •1•;
~ lark : nu(aclurer. JL
I'ern5t :~Scgrtr; U Dose U l lo:cing Vnl.xie: /;n, r, geli
DESIGN PARAMETERS Tank Mpriutactwor-
AfLnlvcl' x Rerirnorn I I NA ❑ Septic: U Dose U I Inldiny Volume:
N.irr:' r of I'utiic Faci:itJ Units. KA Vertical Distance I an:< Buttom(s) to Service Pad: (n)
Eslir.luled faverwce' Flcar : _ se„ (3avday) - In izont 1: Distance Tank(s) to Service Pad: (ip
- - - ',r Gifu, sr.iv tiny mcchan` mist be pr,e:dcd d vtirtical Is =-15 f~ut cr
u- -iy!1 (peak) FIU:v - (b511itlateCl x 1.~): fnai r+- :j honzo: tat is >150 feel pectic inStU tmps o be pr uviaa.l ~ i butt;.
I- Stn Snip Ap,:iication Rate: J (~a~ dep::'i ~f0uenl Filtcf Pdanrfactur r
I I NA
S'.anria.d(DemeS:c)In9uen::E'fluent Month:y average Fft!:!en IiltcrNlcdel:
vat:. oil N ur:aac (ro3) s30 r""i :L Purtp.' "Inufacturer:
3ic•ahemical oxygen demand (801:;) -.220 r=r1(I ❑ ?lA _ iNA
ib:al Su5pan,,cd Solids (TSS) 2150 mQ;L . Lnlp Model:
Hiyi, S`"eryth IrfluenYEfluent Itlunth:'y average pretrcatrs rt Uril
(I -US) ~3f1 mc;L r"l Inufaoturo-
!80D;) %220 mgiL N,1 NA XNA
r I SS) >'Ic0 n1y;L C' aac.nacicai Aeration ❑ Ycsl Pier
- ..i Ms!clori:ri I -I'Piethird
're'.rea!ec Ef0uenl 6•Jonthiy average I I SarW"-duel =.Ifo U Ctf.cr _
BODt) S30 ir.y;L ;oil A.hsorplm- System
Fecal Conform (yoomoxic meant --10" .,-In rCreuad (uravity) F i Irl-Gruurc (arca3r.rc•) U NA
- - - ❑ At-:ir-ice ❑ mcuntl
Paaximum 1,91uent I'article Size 1'6 in cia. ❑ NA ❑ 1) q) Lra U cn ;:i.
Ott- i, Nip C)r-e.- U DLi
MAINTENANCE SCI IFDULE
Service Event Service Frequency
P: 1'10 out eonto'ts cf ;anlos %h n Inl u,n -u L:r. nrd scim. a:u:1i ; er"ediiil •i l :,f tzn< vc L-me
thel igll'netel alaflll Isactl'eated
I:,spect condition of tan:<(s) At least cnco ever,: _ ❑/.10 Itl (Maximum 3 years) I I NA
Insnert dispersal cell(n) At least orce cvery: - I I n.urth(s) (Maximum 3 years) ❑ NA
Jd ye::ry)
I.
Qear effluent filer I Al ;east cote every: uanlh( sl
- _ - -I I :
ycariai
n:ucth(c)
In:;pe! poop, pump cunYOts & a'ann At least once every: ❑
❑ NA
CJ .~1~nq:rs1 N:"~
Plush laterals and ores^,urr. test ALc+nst core every: ! I ycarisl
OfiFS' _rtMs)
At 1-ura ur:.r ^ rv: 7j NA
- -
MAINTENANCE INSTRUCTIONS
I:'spmicns or -n-ks and . cl z:.., ,rptirn cyst:•rts s°a.l co radn by anr.1.vi1i:,.i ::u. y ,._:1 mane ix in. tr.lrvrn.9 I. ,arses o c c,-.csf ors:
f:9aster I':ctnbel, fo".ast:-r I':umber Ksetixtei Sumer, IVA.11S Inspectci. FGVVTS I:Inintain^r or Sept.m Servicing Oncrator !p ropeli_
Tart; insputi:lns mast irGUde s visual irspectioc o° the tank(s) to identrh a,y mi. . .ing or broken harrLvare, :denh`y any c1'aczs or leaks:
measure t:.-e vc'.:me of o-mhined *--.In e and :;cum and a (;I- any tack up of pomklg Of o:~l;ect on the ground sedate. the suit
a:,;nrpt:on syatecl shall t)e vlsca.ly inspected ;o ::hock lice a"fluant ~erals it Lite ubsel'vaticn pi0os and to check for any ponding of erfluen'
~.ul the gluund surface. TLe pui-Aing o° effluent on :he gro.nd surtare lrz<y :ndi::ntc ;1 fair- xnditicri and requires the i.nlmedinto
r cdificanon of iho lo!n! mgu'atcryauthority.
'o':'ilen the, combined arcumnirtron oi!: edge and scum in any trea-:nerl lank equals cne-third (4) or mere of the lank volume, the entire
coctents o` that t::r.k shall be removed by a Sepu:yo Servicing opfatur (pumper) and disposed cf :n accordance with ch. Ater NR 113,
Wisconmr) Administrativo Clndc
All other services. inracdiny nut not lirnile'd'a the servicicy of effluent filers, mechan:c2l or pressurized components, pretreatment un.ts,
aid any sorting at !rter'vels of -'2 most:-s, shall be portormcc by it el F OV-., I S Iu';einl:=nor.
A ;:.rc, rt.,-nl: bop_, o.cJ`^ t=_ J '::Ire-p.!.,-n-; n.ttt.. t ,:!'.in_0 il-; :ofc~°iI mot, itoi
C'N Jjz,:1 ;'95.
( apo' l.:
STAR] UP AND OPERATION
For nee: cors!r,rr :rn, peer to use of tee PO':dTS cheat '.reatrnert tacks; fc thrt pres:-:nce of parting pro6ur3s, solvents or other
chewicals or sediment that may impede t-o trcatrnoit prceoss and or dr:nago tie soil absoraCon system If high concentratcns are
dctorma have the cont^rts of the tank(s) le•nc•red by a Seplage Servi~~ ^y Opercar (pumper) prior to use,
Pomp tanks may fill ahove m mtal highwaler levels prior to slartuP Or due to pump failures. Start up of restoratirn of poser under these
cc141tibn5 is not reecmnuended, as lt'.e excess wasleteater will be disoharged to the soil absorption system in one large dose causing an
„verload that may result in the bad<up or surface discharge of eftluont and damage to tine system. To a'vold this site ation have the
intents air the p;rmp tank rcmce•ed by a S- loge Sera ciny Operator (pumper) pror to rostoring power to the punp nr contact a I'Inrlber
or P(AV I-5 I•dnintainer to assist 'n marualy opcrati:;g the pump rcn'm's until nnrmal etf:uent levels are rostorcd within tine pcnp tank.
Syslen start up shall not Ccxu"when Sri] rxndition s in, fr17cn at lro inti trat;ve surface.
Do net drvo or park vehicles ever tanks or the soil absorption syst(m. Do not drive, or park over, or othomise distwi) nr ron-.po:;-, ^o
ai-a within Iii feet do•.vn slope of any mu;md or at-grade soil absorption area.
2rducticn or of r vnet'or of the; `ollowiny front the . aste*ater stio-in may inxnc,.•r, tho per`ormance and prolong the life of the, treatment
tan'<s and soil atsrrpticn sye;bnm: acids, antibiotic ,baby s;ipes, cigarette limits, condoms, cotton swat degrcasrrs, dental floss,
diapers. disintcctarts, fats, ronndaticn drain (s irnn pump) discharge„ fruit a::d vogetablo peelings, yas;;!ine, creases, norb'cidcs, moat
~rrx.;, medic>:7ors, oils, paining products. pestioiden, sanitary napkins, solve:,ts, tampons, and water softener brino discharge.
ABANDONMENT
t::thm the PO::' 15 fails andror i s pc: manently taken out of service the following steps shall be taken to insure that the system is properly
a,ci safely ahandoned in ccmplin. sv th t'.. Cc:nin 133.33, Wisconsin Administrativo Corte:
• Al piping to tanks. pits and other soil anscrp !on systnirs shall be discrnrected and the abandoned pipe openings sealed,
• The contents of all tanks and pits shall be removed and propcriy disposed of by a Septaga Servicing Operator (pumper).
• After burtpirg, all tanks a.^.d pits shall he excavated and removed or their covers removed and the void space filed with soil, -
yrave; or another inert said rnate:ial-
CONTINGENCY PLAN
F the PO6"•1TS fails and cannot he ropnirrd Inc. tollmOng measures have bricn, or must be taken, to provide a code compliant
LI ement Sys to- m:
V , A sui°ahlo replacement area has been e aluead and may ire uti;ized for tI'.e :oration of a replacement soil absorption system.
lhr, replacement area should be pluteoled fi'cm disturbance add curnsction and should not be inbinged upon by required
setbaess from existny and proposed stntc'ure, ICt linen and 'Nelis. Fa lure to protect tee replacerttent area wal result in the need
for a now Sol and site evalueton to ostahlis i a sui`.able rcnla:rrr.ent area. Replacement systems must nomp y with the rules in
effect at the time of their permit issuane;e_
r. scital::e replacement area is ne5 : vailrnl:'o due. In setback and!or soil 'imitations. If the ;coil absorptor, system cannot tie
rehabilitated and barring acvarces I:, POL^fl S technology, a holding tank may be instal'ed as a last resort.
F-1 The site has not been oval,:ated to identity a snlable replacement area Upon failure Of [lie PO.':rIS a soil and si'c evaluation
must he perfomind tc lo•:ate a suitab:e rep'ace•nen: area. If no rep:acerront area is available a holding tank may be instal'ed as a
last resell to replace the failed P(Y,,- TS.
❑ Mound end at-g'ade soil a'sr-ptii,n systems cony be re^a-)s'na;teti +r place follc'd:inq removal or the hiomat at the milil•ative
surface. Reoons'ruciors o` such, systems muss. comp'y with the ru'e; in : meet a' that 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
' t RESULT. ESCAPE OR RESCUE FROM THE IN I'ERIOR OF A TANK MAY NOT BE POSSIBLE.
ADDITIONAL INSTRUCTIONS:
POWTs INSTALLER POWTS MAINTAINER
^1-!;Ie / 1 Il Ns:mc
Fnorc J Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL. RFGULATORY AUTHORITY
Fp'a-ne t•;ame - , -
I I u _..1r 1.mt ' n, r!raft~r t, th.it f the (:n:;• I 'a Kt?, M-11 :I ti 1(~ a ,r. 'N;,:IA: .1 a (;rn.rty PQ::'? . r ~jr. atory ayor..tc:; in cr•npl :.n..e w tit s:,el,uns
ern i x31v,i i t 11 ,,r l~lil) n, 1 .54(1} L ..:I. ddi-r r-'n.1^ml r- r~.tr:~(.~tlc.
START UP AND OPERATION
=cr ne•:: cons:-a..iirn-. prier to arse of the PO'u1+(S cneck lreatmen::ankfsj to- the presence o` painting produces, solvents or other
~ln:'.c.ais c- srd meat tint ma'a innede m- t,eatment oracess andro, carnage the soil abscroGO:: systex... If high conce•rtrations are
c: t o:md nave t*rc. c::rtenis Of the fsj removed by a Septage Servicing Operator r;pumpe-) prior to use.
FT.m n talks rnay'LI above normal hl*nvater leveis prior to s:arium n• dac to purr? failures. Star: up or restoration of power finder these
.:ct:d~iiuns is nc: re::ommended. as the excess wastnwater w'it be Jischar,.ed to th- soi~ ahsorptio:r system i.- one ;arge dose causing an
e; trric that may rasult in the backup or scan- des::hams of effluent anc damijo to tn,c ys:ern. rc avci this sitcatlon nave tar.
contents r,'th- pump tank rernovec by a Septage SeiviJil.,j Ctr';:rntn- ;nurncri otter to restoring ocv:er m t.^.e pair. or oorl a Plumber
JJUTS r:lainlail:er lc assist in t..n.al,;r opeTairg the p:rnr, c:rirol until :icr:nal effb.:cnt Icvci: are rector c witft:r G-:e pump:ank-
f+'v tOm stalt uo Shall nut c:zlL when soil oonditioas arc tiomn at the ir.nltratnve surface.
I;r rot d. ve or nark wehiaas ^ e- tans or the soi~. absorption system. Do not drive a park over. o- other:ri se disturb or compa=, t^.e
witFi-. 1;i fee: do.rn :lope o~ any n:ou::G or at-grade soil aosomtion area.
:^unhoc o- a:i•ninr;tor of It;e ''-1 10 ':g from G:e wastewater strca-n nay inpro:re the performance and nrc'ogg the life Of the treatment
~rks and absorption ssterr- acids, antibiotics, baby* wip^s, ciga rette bults condoms, cottoc sd,<,bs, crgreasers, dental loss.
cr<, a. f:,.:.nt,:. fats fcLnda:cn J- n i,sumo p;.mp) disoho-:c fr.. end veeetabie peelings, gasoline areses nerblcides, meat
rr. aci :;tiecn, oils, pain:rn; prodLKZS. Posit--JoS, Snr~itay napkins, sehieniz; tampons, and water sofnsner brine discharge.
ABANDONMENT
"Jain the I'CY:^v I (ais an:Ue• is gem-ane^Iiy [akgr n:.t of se^rine tr:e fol:c:viny sAeps shall bc• taken tc rs::re loot the system is propariy
::uu saelp acrar.^o-rad in comp'ianro sith s. Conan Y's.S?; 1;:'iscen3:c Acrtinistrsti:° Lace: I,
i
• :+.li p ,.r.p'L ; tanks, pats arid elhe'seil absorption sv_-,nrrs shah b^ discocnectec and Lire ara^dna:d pipe noenings sea.ec.
• The consents of ail tanks anc pits shah: t.n re.-n Daed and woperly idsOosed of by n Scma e Ser'vici m Operator (,'JUrnpe.').
• e- pariping, al. tanks are. nits shall nc ex::nva-ec :rid removed or their -.avers removed and the void space filled with soil, - I
i e, 1 or another Vie solid irate.al.
CONTINGENCY PLAN
1- :h PO'47S fails and cannot b^ rcpeimd thc:- fellcveing r»asres have been, c• must be taken, to prc•Ade a code comp'.Iant
r-j- 'I.cme vsteol
A suitable replaoernent area it"s hewn evaluated an 1 n- oe Lni:izec for the- ic•:R',or o. a reaaoement soil absorpton system,
rehired
The pia r en: sires shcui h ra,e e f-on li u :J nc end co-n a-rbn and shout not be infringed uaon by
setuac s from existing arc pr nsnd R--lure, lo[ h e j. s R iU a t- pr•) e t the replay=men: area will resit in the need
ter a new !,,-I and site evalu..tier. t- astabiish a scdaLi_ I .Tr: nt area. Replacement systems crust co•npy with t.e rues in
effect a: the Line of lne:r perm-,r issua-:^r:
A suitable replacamcnt e-^a is mr,, : vadaok: due to setback anJor soil iimitabo^s. If the ail a_so'pUcn systcT cannot be
iehab)!Aatec and barring nc:'an cs in 'iRr:' I S techvc:ocy, F.:dd:na tank r.ny b^ inmaled as a last cosec.
me sate has not been waC;aiec io idea G s-.:i:sib;e replaceme-~t n-ea. Uco° failure o'thc °(Ati'`S a soil and site evaluation
most be perfolmec tc lam,:c F. s.;ita-le ri,oiacetrent area:. If vc replacement area is ae'aij:l- c- a hexi- g rank may be i•rstaled as n
Last recor to reolace t^c tailed PC':"JI c:.
❑ hlaunc nod at-g-acc sci as")-xOI sys'eru :nay be :ecVlstructed i^ place fDlIev'Irle !err oval cf t^e ["oOrvt at tte ~ntltrat•;e
aorta Rc^~,t . u^ti ns a Il h ; ,;:!e r s IT. act w,.P}..:lilt the fules. in air.:t a' ll.at ti:ue.
WARNING
TREATMENTfANY.S. 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 FROTh 't HE INTERIOR OF A TANK MAY NOT BE POSSIBLE.
G'' v
ADDITIONAL INSTRUCTIONS:
r.
POWTS INSTALL4R / POWTS MAINTAINER
(carne
SEPTAGE SERVICING OPERATOR (PUMPERI LOCAL REGULATORY AUTHORITY
(,:er'e
PPc,ns Phone - - o i
-his d;: cr ear v:as drafted by the staffs Y the :G*Cln _ .k r.:i 'Joao: tr CoLrtJ r':,:;'F ra~r Ar-v acenr ill cor'.plianct•• mitt se-ticn
Cuu:r. SS22(2r.;bfalfAJ&(f; a"d 82.541). 12: &(3i. Ni.seu:ran iv7~wri:~l: aE:•c C:per
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ST. CR.OLK COIPTy
SE.1' 111C TAYK IvLALAUI 12NT-AN cE AGREl:% T
UWitiERSHIP CERTEICATTON FORM
Own.°.rlSuyer
I,ailing Aoaress 1 1`( X~/ J 7 i' ` c
?-opw:yAdcaess
(Verification reqaireil fn;m P & Z6mffig Department for new o mstruraion.)
/ 1
City/State Parcel Identification Number
LEGAL DESMTTQ
Property location a : - I/< ,Sec. - f N R W, Town of
Subdivision Plat: Lot #
Certified Survey Map Volume Page #
Warranty Deed r (before 2007)Volume Page
Spec horse Oyes Xno Lot lines identifiabl O yea to no
SYSTEM I`k~TTAh?CE AND OWNER CERTIRICATION
Improper use and maintenance of your septic system could result in its Premature failure to handle wastes. ?roper
maintenance cons= of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic teak as a troatmeat smge in the waste disposal system owner maintenance
r espottstbiFrties are specified in $SPS. 38352(1) and is Chapter I2 - Soi1c Comity ganitmy Ord"nnmce
The property owner agrees to submit to St C1,oie County Platmb & yo=g Dqmt= a cembcaocn form sietted by the
owner and by a master plumber, joumeyman phimber, restricted plumber or a licensed pumper veri fyiag that (1) the am-site
wastewater disposal systecm is in proper operating condition and/or (2) Mltr inspection and pumping (tfuecessary), die septic taper is
Less than I13 full of sludge.
Uwe, t1he undersigned have read the above,egmaeman's and agree to main air the private sewage, disposal system with the
st
andards set ft-th, btu, as set by the Department of Safety And Pra`ess l Services and the
State of
C~~ P'tsco~ Cron sang dAt yow septic sysOnm bas been maintained must be weep returned to the St Croix
larmmg Zoning Deivartment vcddtin 30 days of the dupe year ev raaon dace.
I/we certify that all statements on this form are true to the best ofmy/our lmowiedge. I/we am/are the owner(s) ofdte
nropw-ty described above, by virtue of a Harr Y. deed recorded in Register of Deeds Office.
?Member of bedrooms
_ h
SIGNATURE OFAPPLIC_q~ S) DA
~-/A
r
'"Any information that is misrepresented may result in time srnirmy permit being revoked by the planning & Zoning Department
Include with this application a recorded warranty deed from the Ragister of Deeds Office and a copy of the certified wvey neap if
rebereac a is made in file warranty deed.
(R£4. (Mx?)
RECEIVED r~si~tlCa~Ll'4L
WiscornsinDepartment of t(' t O 20%11- EVALUATION REPORT 1 3
, - paw 400-~-
Division of Safety and Builortgs 0
ifop[prdericoWithCom 85. Wis. Adm. Code p1~'
Attach complete site plan m pa r ; F in size. Plan must county 5T G ~ O% x
include, but not limited to: vertical and horizontal reference point (BM)• direction and Parcel f p
Percent slope, scale or dimensions. north arrow. and location and distance to nearest road.
Please print all information. _ Date
PerW YMorrnrUOn yov GmcvrOe rney W use4 br secargmy purposeriPlh'KY law, s. 15. t) (mJl. 3
Properly ormer Property l Lion ~f
DAUtD t /1QD1E ?ET-ER5bP3 Govt. lf W MG 1145 114 S/5- TZY N R/ {(of)w
Property ownoes Mailing Address 2 Lot If Block # Subd Name or CSW
33/ cry. 720• -TJ IA-IT Ilk , , P'35W06v6- C- M /'44 ' )L:
city Slate Zip Code Phone Number ❑ city ❑ Vi" 5a Town Nearest Road j
IztuEl; f~l(5 4Ul' Svo2 ( ~yzra•5533 k)A/A/iGK/NV%G ~~y Hwy. S -r
New Construction Ilse: ® Residential / Number of bedrooms Code derived design Mow rate S/.5'O O-CJ _ _ GPD
❑ Replacement ❑ Public or cormtercial - Doscnbe:
Parenmaterial SgVp~yQU'Cw~4SG Flood Platelea(ioni(appicable ALL SITES ARE n.
General comments hA),P D0/0 Af r'TE• f~CiOUE SvRV~yOiP'
and recommendations:
A•ke,+7ZSTEU iS SO/r4.&1LE tote A- ,t F/cod ~/~1r'u
COOLMzOT10OhL Houx0 L) SyST-Em`•1 cawiV-%- of -12 LiuE.
SAOD
a# oBorinq 95.30 .27 Ss.s.
1E. Pit Ground surface elev. ft. Depth ro 6nitirg factor in.
Sal Applicatbn Rate
Hontron Depth Dmt6tartt Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
In. Munsell Ou. Sz. con. color Gr. Sz Sh. •EM#1 •Eff#2
o' 7 /a yR / 51 2fS hlk n."f lZ s 2r .5 . y
z 7•l(0 /oy,?s/ GS /f ceJ 2.f .7 I•L
3 6 1 /o 9G L5 /fi AMA acs f-
7. 5 v k S c2~ r+ors SlcL lfshk r~i 4s Z 3
S f G" Z I:AfES7`P.vE Oho ; T o ccv S_
a Bai,g # 0 Baring 1530 29 .5-S-5
R1 Pit Ground surface elev. h. Depth to fim&Q /actor _ ! in. Soi Application Rate
Horizon Depth Dominant Color Redox Description Texture S1nxWre Consistence Boundary Roots GPDW
in. Munsell Qu. Sz. Con. Color Gr. Sz. Sh. 'Etf#1 •EtT#2
0 .-7 0Y/(.' yiY sc 2f.shk fR 5 2.,-, . s
7.15 /o Vk 6,L5 /f n«k w z.f .-2 Z
3 15•2/0 2S G5 /F cS - - -7 t•Z
7.-- cieLHOrs 51CL /f5bK 0-5 - z .3
S d rr L/~J S u l0 E
Effluent 91 = BOD > 30 < 220 rr*t and TSS >30 < 150 nv& ' Effluent #2 = BOD < 30 nv& and TSS < 30 nVL
CST Name (Please Print) Signature + r CST Number
Ijz01?>eFT' 24 LS3RictiT Z243 7s
Address Date Evakiation Conducted Telephone Number
wov.2o-.1oo,3 7IS.77a•3442-
Ulbricht & Associates ~S/> t
Private Sewage Consultants
2812 10th Ave.
Spring Valley. WI 54767 1
I
(property C>\vnrr--- Parcr.!ID# Got„_---- Page c.
(w~~ 11()141 ` S•S.
L Pie Ground surtax etev. 2 '84n. Depth to Mminng tacta xn. Solt AppacaEon Rate
HMzon tle~th DorninarN Cole Redo, Description Texture Savctrue Consistrex;e Boundary] Roots GPDff
in. Mun;atl Qu Sz. Cont. Color Gl. Sz. Sh. •E M#1 'EfM2
-Y IA,
x[6A2- 7.5 2 SL_g2 wtfR' a,~ Y _ 4
fir, v2 ~ 1-5 l moTS SL _!Oa All__ _hx f f S
ill vR se
- ~ Bairg # ❑ 13o"119 .
u ❑ Pit Gro u d srefaceelev. ft_ Depth b funding factor . in. Sony ipNat Role
Flaizon Depth Dominant Cola Redo, Description Texture Structure (;rx6iatr)nx Botendary Roots GPORf
In, Mansell Qrr- Sr. cont. t;clor (u. Sz Sh. Tff#t 'Elt#2
Boring# ❑ e-wg _
❑ pit Ground surfaceelev. ---fl. pth to tlrnNng factor in.
Sod Application Rate
Flonzon Depth Dominant Color Redo, Descriptor Te a SUucture Cancistence Boundary Roots GPDRt __4
in. Munsed Qu. Sz ConL Colof Gf. Sz. Sh. 'EMI 1 'Eff#2
r f
1 r
Rating # ❑ Boring
❑ Pit Gload surface lev Depth to Writing factor in.
Sad iiwtion Rate ~
Hereon Depth Daninam Color R Descriplar, Texture Struc"e Corsi o boundary Roots GPORF
in. Mnnsel 0 ,1. Sz. COOL Color Gr. Sz. Sh. 'Eff#t 'EM
Effluent #1 = BDD, > 3o < 220 mgrs and TSS >30 < 150 mgl- ' Effluent #2 -1300,:E 30 trgR. and TSS 130 nVI
t
The Department of Cornmerce is an equal opportunity service provider and employer. It you need assistance to access sentces or
need material in an alternate formal, please contact the department at 608-266-3151 or TTY 608-264-8777.
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Parcel 022-1044-10-400 0_23278 Q1 C?PM
PAGE 1 OF 1
Alt. Parcel 15 28.'8.237A-40 022 - TOb:'N 0- KINN "KINNIC
Current X S CROIX COON I Y, :'uISCONSA
Creation Dale Historical Date Map # Sales Area Application # Permit # Permit Type
07,02~20C7 UO 0
Tax Address: Owner(s): O - C~rre~l u'.v,er, - C,nrervt Uo-Usvn=•
0 - PETERSON. DAVID P & ARDEN D
DAVID P & ARDEN D PETERSON
331 CTY RD J
RIVER i-AL_S Vii! 54022
Districts: SC; = SChool SP = Special Property Address(es): ' = Pnn-ar•/
Type Dist # Description 1299 CTY RD J
SC 4893 RIVER FAl.l S
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 2.5.10 Plat: 5426-CSNI 22-5420 022-07
SEC '.b T28N R-18'e^r NE SE CS?A 18 4/62 LC 74 B{ocklCondo Bldg: LOT 04
NICA CSM 22-5420 LOT 7 12 540ACj - -
Tract(s): (Sec-I•,an-Rng 401:'4 1601:4)
1b 28N-18V4 NE SE
Notes: Parcel History:
Date Doc # Vol/Page Type
05 22 r2X". 7643'2 le'4762 CSM
12x'1121C-3 ?494.9 2-:7t; i,:)6 'AD
115 1.9,2'100 822747 1')09424 OC
07723+1997 1218+442 Nlll
2008 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07123?2007
Description Class Acres Land Improve Total State Reason
Totals for 2008:
Genera{ Property C.~iiiCi C 0
Woodland C 000 C 0
Lottery Credit: Claim Count: o Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total f ii0 (i-:DJ 0 n0
CERTIFIED SURVEY MAP
LOCATED IN THE NE1/4 OF THE SE1/4 OF SECTION
15, T28N, R1 8W, TOWN OF KINNICKINNIC,
N ST. CROIX COUNTY, WISCONSIN.
LEGEND
ALUM NUM COUNTY SFCfICN
COH?J_H MONUMENT FOUND - -
O > OWNER
15!16' 0.U IRON PIPE FOUND
_ DAVID & AHDIF PFTFRSON I LOT 4 AREA
c w 331COJNTY HOAO'JJ°
u' Q 1• X 18' IRON PIPE SET WEIGHING HNEH FAL55. WI 54072 7.54 AC- INC. RW
o 1.13 LBS. PER LINEAR FOOT 110.477 SO. FT
rOO, _
(D SECPON CORNER POSITIONED FROM 2.30 AC. IXC. RW
WITNESS MONUMENTS OF RECORD SURVEYOR 100.311 SO. IT.
t❑ EDWIN C FLANUM
z NORTHLAND SURVEYING, INC.
d 100ROALriVAY SEIBACKLINE "0
0 0 856 A HWY '65'/ P.O. BOX 14 im
0 0 HOBLfi 1S . YJI 54023
IIT'
x . X-X-- EXISTING FENCE I-a I
n II~
x c.~ FLOODPIAIN ELEV. = 940.0 I 1
Io
NBT'S62TE I°
~071.4P
- - c_r.H_~• - _o S87°58'27'W 1333.28' 230.16
. t 6' 381 a0'
--a 491.56 VAHIABU: fi;W
Ill -1 461.'./- 0' 381.28' u.
i S88'28'03'tiV 13CZ.Ei:S w f p ` ".I
5
o f LOT 2 ~i w n
V " N V A t.i
~a .1:11 O $ 2.54 AC. INC. R4V o in
0 110,477 S0. Ff.
1 ~ rn v o
m
jO n w 2.33 AC. DCC. RW LOT 4
m ~ I
H
101,665 SO. Fr. Z
LOT 1 •a,`'1 24.OOAC. ING RW ' O
CNO~" 1,04$,28650 FI. N81`$62TF230.16
N8 r562 PF 230.16 j
N
Ip ELD: 2220 AC. EXC. HW
M
O oHlvt 967,241 so. Ft. y LOT 3 W
Itp 11 26 AC. Inc. MY N
1tN0 400,319SO.F'. 9)
5 F m
5
m o OJ~~ 10.90 AC. E)(C. RsV ~
•2`~jP 474,64450. FI.
i~ I O I Oar rZ
fll m ~ W / D
1N NG"~ r~
133 4$' 1 _..pP - \ o 'p
t5C'0. J S'v iD
% ?A ZZ
y
-
15
ICU
v~-
~ x•1258.74' I'
i 68.64' 1327.28' cf)
N88°25
y~1hNfGK h~ hCHNtiR ;,;~L
UNPLATTED LANDS OWNED BY OTHERS
SCALE IN FEET 1" = 200' SE CORNER
SECTION 16 Cl
ao SHEET 1 OF 2 SHEETS
Kevin Grabau
From: kevir 0- raDau
Sent: tnursday, July 26 2018::13 Prvl
To: davepetr 10ctpurnail ( om
Subject: inquiry regarding Lo: 7 - CSM 2?-5420
Attachments: Veterson - Mapped Wetlands.pdf Peterson - Soil Fval Report 022 1044-10-40,').pdf.
'-tenon Contour anti Shoreland Overlay map.pdf Peterson - Floodplain map.pdf
Hello Dave.
RE: Lot 7 of CSM ??-S4?C PI D#: C22-1044-1G-400
This email is in follow up to our meeting last week, on July 19, 2018. You had requested information regarding
Floodplain, Soil Evaluation Report I.soil test for septic system). arid a map showing _iDAR contours, I also said that I
would check the DNR Surface Water Data Viewer to determine if there are any wetands identifiec or• your property.
I have attached the reaps in pDF format for you
I did check the DNR Surface Water Data Viewer. and it appears that there are no known mapped wetlands on this
lot.
All structures rnust located outside the Floodplain boundary of 940.0, unless proper permits are issued, such as for
filling and grading within the Floodf6nge, etc, You stated that yo'., wil have a surveyor flag the 940.0 elevation on
the property so that you know where that boundary exists,
The entire propery is located within the Sihoreland Overlay District, and as suer will require at minimum, a Lanc Use
Permit for arty structure(s!. 1 here may be other permits under Shoreland that tray be required, depending on the
location of structure, total square feet of filling and grading that would be necessa,y ;such as filling and grading of
1 D,000 square feet or morel for a dwelling site. accessory structures. driveway, septic system. etc.
There do not appear to be any steep sloped areas on the site that would prohibit filling and grading, or placing of
structures.
I hope that this helps. If you need anything additional, please comae: me.
Thanks- Have a great day'
Km.n Gra6au
Land t se Administrator
St. Croix County Community Development Dept.
1101 Carmichael Road
Hudson, WI 54016
715.386.4680
" Note new email address:
kevin.gra bau@sccwi.go
' i4ihrr = verytmnq seems to be aoinc ogmm ! ooL., _,~amgcr that The airorm;e .axes -`,`against fhe wind, nor with it,
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