HomeMy WebLinkAbout026-1066-95-200 (2)
nv's-sinPRIVATE SEWAGE SYSTEM „a°rty St. Croix
Sa'cty a-d 3uJ cirg L'~cisw•~
INSPECTION REPORT Sansi Permit No
606959
GENERAL INFORMATION (ATTACH TO PERMIT) u•,e la° ID No
Pws$ r-,,l r'lorrr&l on yo,, p'ovid:• may ue used 'e- secur 7a'y aa'DC *Pnvaey Lava, s.'5 C4 (Mimi)
Per...it Ilolcers Na°c Gly village Icwrsniu Parcel Tax Nc
Laurel Lorfield TOWN OF RICHMOND 026-1066-95-200
CST SM E ev Iri W,l Etea RN. Gscr;A on sector,, Irw-~R3nr;eRdaa No.
/ VLF 011 Lod 5 22.30.18.342D
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic E1/r'J) wile ~zl~~ Benchmark
rI Z L..all ~G All WA
i`
Aii on Bldg. Sowell
Holding S:.I It Irlel
S:'HI Outlet
TANK SETBACK INFORMATION
TANK TO '?L WlELL BLDG er oA✓ vaxe ROAD Ill Inlet `
Septic DI Bcllonl 60 25 1 /16 f Dosing HeaderAldr
Aeration Dist Pipe °J • 1 97?
Holding Bcl Systen•
inalGrade
7f
PUMPISIPHON INFORMATION F S.~ /D6
Maru`actwer Demard St Cover
GPM E : / 02.8
Mooel Numder
TDH L.It System Heatl TDH Ft
Fo,cemar r"c",ui
rin Dia ;fell
SOIL ABSORPTION SYSTEM
BEO;TRENCH m`ac'h 1 engtrQ~.~ Nc Cf Trencr= t~ PIT DIMENSIONS 40 Of Pits Inside Dia Liquid Jcpth
DIMENSIONS VC! 2R~~t.a 1
SETBACK SYS I FPA 10 RL (BLDG LVELL LAKEiSTREAPA LEACHING MarufacureEL F/~r--1
INFORMATION CHAMBER OR
T•r_ O ..ys'e^' ! 267 4 UNIT I:.pCBI Nu^'ne•. / '
N.V O h S + -L I DISTRIBUTION SYSTEM Y? $1 $ Z
Hcace!Ala"to /I U51'iC_bar xHole Size xHc1a Saacnij vi6nttly1 In to
Y P.,ols ~ ~ t / drW
:.ergth Ca T Le,)g:lF Dia SJuo^g
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Ccp:h J c i O,e• x Ceph of xx Seedetl:SOtldno x.. Eau nnr.
Bra-er.n Cento, 4.41 .41 6:J'Ilca;lr Ldgcs :-psn ` Nc Y-s - INC
COMMENTS: ilrclude code discrepencles. persons present, e:c) Inspection #1: AA Inspection 42
Location: 1258140TH AVE f •r'V eo dr Sr,,
1.) Alt BM Description =
2 ) Bldg sewer crgtn = X14
- amourt of cover = 1 P J
Plan revision Required'? Yes ANo ll q q /ry 513 /r7
Use other side'of adoilional informal: on Date Inse tars gnalure Con Na
SBO 6:'e lR 3r97i
Ir
Mail txl~ Vf2 5RW-J01 F -330
-
- r `J InrW [I. l
tM1 Jn C wlr.ty
I- I IIII I 't hun it(tun Ave
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P.0 Box 7162 b!mia-: Vmmr. 1 r I::r tx IcJ ,n h•. Cr.
PS or" T 3 0 201B
1 Madison, Nl 5;70 7161
-
6D(o 55"~
"ICK
antt•,~dI1AtE1 ]tApplicatlon state linmhcr
In accordancC I,t \'ia. 1d n ',r1q ..chit I sml of hi, f r Ir,~l sit
i, eq.t cd pool t t,4u ung a aniwrv .>v,oal %.to: Apph atior. . me atc-owned -I, whm ttntµr Molq., \ddraa Td:l krcm Ih;m m,ilinp ndJres)
tl a Ucranincnl M Sa1cty and 1 mlcsoonal Services- Personal mlimnatwii •'ou provide. ma% Tot .<natJar)
O.wplr in.suxdanec with [be Pnvac Law IS 0411)Iml S:,a+ _ _ - ' l as8 s"Pe
1 A licatioo lnfor_maImn- Please Print All Informs' _ "«ff l Jo /J'
Pmccl f _ - -
L 4uaEC ~O lF/F(D 0.76- 16.'e 9s ?oo
- - - -
1'o_>).crty Owner's M:nbng Add: as Pmpcny I canon aa '~O. 19. 34 ~70
S8 /'Yo ruE rrsa I r,l _
(rp'. State Zr [('W~------rPlwl Nwnasr 3rJ✓ SE s, .7.7
NEu ?iG// tie. a/ LJ r - SYo /7 _ . r r 3o N; k /8
~Tl/. T) pr of Ruildutk (cbeck all that apply)
pSj 4 Lex F
l or P.tmilY Dwelling - Numbs of RMroms Subd,,mon Nana
C' Public C'ommcrcral - Describe Uw
_ ~ FSlrrV Or _
I'u•.1 Vv a l' u!
LSIaIC lhvne I
U. /j lei. 3Y11
111. Type of Permit: (Check an one box on line A. Complete line R if applicable)
\ I LJ Nov $yshmlkcIHuccmcnlSplem) (1 frcaunm:la lokiu,•.___ - P.
I 4. lank R I col chili D OIFrr YhiJilia! n [ F. i.ou \v iuu Icx 1
B. ❑ Pc'mit Ramtval ❑ 1'crmu kcci:ia• t P moss Pcm w Nwnlaz and Uvc IsNai
U (Lwrgt nl Piumbo Q Pamil Ttaasler to Nrw INiI6L NO /7-/!-e.t
Fncforc Lxpualrwi Owns
t I y.~o3B5- 9
-/t-a~e~
IIV Type of PONNTS SystemtCn_mponenl/Dcsice: (Ch[rk all (hat apply) ~7
f/
Jp \'uo-PressurveA n [u.nn I n uressmIId i UroUnd ❑ At-(hide n Mamd > 24 ai of smlal Ic - l \f mrnl 2a m, or.unal+l_ S
I Iolding Tu rk L f4her Dispersal Conqurn..m Iezplaod _ ❑ Pit[ v-atmeut I Iovl . 1 zplainl 720A.
V. Ohs Cnal l teat' it \res Information
D"apn I OO~IeA Dcx a 9n t Nrl iLv!d LsQ Drcpavl. uimd s) - -_-r CT.vpcrwl Amur
dO 1'myuscJ lnlcm I:kvannn l
\'I. Tank Info Cup, m, in - foal % of M:annacnim i _
` Gallm (,allow l)nile
1 ~~i r ] I 3 s
Vr T Ik i f,i<nllp Tmgc G7n
ass p r 1WFFw-LY<:l I - L
- I.~SO
/dSO IZ') 'C
Sf.JCS.
VII. Respolvilhility Siatement- 1• the undersigned, •sznmr responsibility for installation of the POIATS shorn on the attached plans-
' b mb r a K, m (Film) _ - Plcmhcr I St~ma1 MP:9R6Ab' ]wnhr flusin>s Nana Number
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Plmla'•AdJrvlSlraY, Cnv Si 0.. 7.rp1.. Icj '
' a7 98 Sr. arr. d S~ k~uR.f•JO, W S SY736
' nunh Depxrhncnt i u (1n IS - CAI
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I ~ I tt/n~itpF-t Ua« Isuc JJJQ Is u i n.
` t. p i I T I )II cal ` -7 D 5• ~i 7 O n
I\. Conditleaso s for f~uapprn, .tl - ` t - ( I - -
7. Septihark, Erftc~, it en•1 3 ~ _ IQpS[•
ahper. Orll ruse ab he s•'~ _Ic.>s'!rt'"t_eC
is per roarayemen. pl n ,.'weft tiv PIWW f~ 5 a`
2 M MftW* fK FN SMI Mont 1R. I a,rL WA
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Y pw PpFAplblt Caldr) M M1D'Irt3.
4 .n .vvnpl trpun.1 It•.clan and rabmttto r4 Cwnt-eah an yaPur nw lm lbanN
SDD-6398 (R. 0$,14)
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Page I of 7
Private Onsite Wastewater Treatment System
Index and Title Page
Yrojce[ Name: _Z2uRE4~aaF/ECD - 5 6e,.~rt ¢.~ao l~o~TS _ itE/~L/LF rE✓r~
Owner's Name:
Owner's Address: /a SB /ye r=~ ,Qar
NE., ~1,_~NNe✓B LI~ sYv77
Legal Description: Sw SEfsld*,eN,. /6✓,
Municipality: Town, `ri4age, C=ikpof e,v r., 0 -
County: Sr, Leer!
Lot Number: 13 _ Block Number: CSM Number: S7" F2
Subdivision Name: - - /,~t8 /yo /{✓c.
Parcel I.D. Number O,J(, -/oGG-_jS=a_oo
Page I Index and Title Page
Page 2 Plot Plan with Cross-Section & Plan View
Page 3 Septic Tank Specifications
Page 4 Divcner Valve Information
Page 5 Filter Information
Page 6 PObbTS Owner's Manual & Management Plan
Pap
,c 7 POW17S Owner's Manual & Management Plan
Name of Designer: j-,C" p E4XC License 8: _/y~- a73/3yG
Signature: ¢ Datc: /d -07s--07018
DesiHned )ursoatit to the followint, POWTS Component Manual an_d DSP'S 361-_385:
SBD-10705-1) (N.01 i01, 8.10/12) An-ground Soil Absorption Component Manual' Version 2.0
Attachment: Soil Evaluation Report
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1J05L, ar II -i li -J -isl 3C i ii ,l tough Inoicied plastic that will not snail bared, rust or corrode, it is lighter in weight, easier to handle and less
escensive to ship.
diverer valve stem bow may be controlled to individual or mulFplo fields (up to three) in any combination. With a
--may valve stem, flow may be divered to any tao outlets. To allovi tiow through al! ri leis, the valve stem may be
rlc ed from the assembly.
a meet 4" plastic sewer and drain pipe to inlets and cu'Tlets on the tour way distribution box. (Unwanted outlets may be
aled by installing caps). The Diverter shield which houses the diverter stem may be but to desired length.
6.305 ( r-ky. @R. %a. pro3na
port No. Description C°Ior l (ii) "Ims
t` - 5-161, 4- -VC e:verler Vah•e Wnha 4 9.50 35PV
--~1 5r; r'APsl::erlerval"e abck 4 7.50 35A6
m aosu ,°~2 3
TANK TANK TANK
a 5 6
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a
a
?1 lAPN.O Listed ~f
REMOVE
TANK TANK eMEaSrFAS TANK
The NDS gravity flow Backwater Valve is designed to profect !ow areas or basements from the backflow of waste from
street sewers. It is available in 2". 3", 4" and 6" sizes PVC material. It is a cost effective and a chemically resistant
alternative to cast iron valves.
The quick action flapper allows unrestricted uni-directional fiow. Elastomeric gasket in the flapper ensures a watertight
seal. Flappo: oan be easily removed and replaced if required
Threaded access cap is designed for hand tightening. Access car; neoprene gasket provides a positive seal. Valve hub
outil fit 2". 3", 4", or S" DWV pipe and may be adapted to 2", 3•., 4-, or 6" sewer and drain pipe with NDS DWV to
Sewer & Drain Adapters
Lightweight, easy to instal. Horizontal installation required, with arrows or. top of the valve hub pointing in the direction
of the flow of water. Access riser with
cover offers a simple. economical :7~ 1 , Number A 3 C Riser Heigh- Riser Di°l
assess to the valve for inspection and crt.F, 275 2.18 5A3 i 3.53 16 ! 4
maintenance. The riser may be cut to ~276PR 2.18 5A3 3.63 16 4
the desired !engtfl. ! 575P, 375 3.51 7.56 6.10 16 6
l 375PR, 375R 3.51 7.56 6.1o 16 5
1 I i 475R 4S 4.47 11.18 718 16 8 {
"~~^^FFI 475PR. 475fi ` 4.47 11.18 7.18 16 8
A~ 675(',6?5 5.50 1525 8.'!0 15 ~ 10_1
ml S q Approvals appncatue I° valve oru)•.
? a t.
B uaC.:
NDIe: AA Jlnwn.wn. are snm!nol. Aa v igke ore far Mill pUTOW 0*. Awalnlpllly I. W111ac1 W dwnps, _ . , .
For cisterns: service, Plane rend your fox 's-; 1-800-?26.1998 or call 1.800-726.1994.
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A1 007m/300T"-8 Series Filter
The interval for servicing septic tanks is set by state and local code. Throughout the United States there is a wide difference of opiraon
on what this interval should be, but most regulatory agencies suggest two to five years. The Zabel' filter, which does not increase the
frequency of servicing for the tank, should be cleaned when the septic tank is normally inspected and pumped. However, our filler is
virtually self-cleaning The continued action of the anaerobic organisms on the Zabel filter causes lodged particles to disintegrate and I
fall to the bottom of the tank. If your filter contains a SmartFilter' alarm, you will be notified by an alarm when the filter needs servicing. +
To service the filter.
Servicing any Zabel Filter should only be done bya carded septic tank PWWrorinstMer
Locate the i
S ouNatotihe
septic tank $iEP
i
-PI
- Remove the tank cover
ALI , and pump the tank if 4w •1: Firmly pull the ~
I i necessary to prevent Wrhandle and ! f4
f" fe solids field from
when slide !
j
to I tie titer cand
L a y`, the e out of
1 x removed.
case
I
f
STEP I I WWI
f
While holding the cartridge over the access
opening nose off the cartridge with fresh Insert the filter cartridge back in
water, being careful to rinse all soptage r'- the case making sure dre filter y
material back Into the tank. cartridge is mperly a" and
Before replacing cartridge be sure to chect completely PrwdBd in the case. i'
-
for and dean If necessary the outlet screen
within the case Lr" Replace the sepUC tank cover. I' . v+
'NWe:Nand nams,.•yrodcwn Nre fnYer •spao'ass - ~.k~~~= yL
ThBArm!litt5ro rgw,' mthofdsreidesn7npEfreetrnoW
p+orasssds'w!d96a lyF.e
ratridgo maybe dStasckmerMrkW Air w tlowmrrti Ya
9.)
Raamea
The Product(s) shown are cov~ by the followling patents:
U.S. 4,710,295, 5,593,584 Other Patents Pending
Call for a free ZABEL ZONE' • 1-800-221-5742.Or Ordor Online: www.aabolzone.com
OEI1~2t7
.'r_i-::~ 'viitii i. r.-. itiv:j AkAINA(:h:17EN-I PLAN
IIIi INl t)R\i\17(1\ S1S1 EM SPL(11-IC,4 IONS
I PcmlitnL - Scp:c -lankCa acits - aS _aIONAI
- Sc*, ti7 i u Manufacturer r(/ E w ~e.04A., [ NA
DESIGN N P112
7 3I:RS
Nuntlxr of Bcdui rtes i li 10(r s t: - I lluuu f ilter.Ianufacturer 2 L r, NA
Number of (r nr crcial lJnits ~ : Illucnt I'iftel Model
Pump lankCtp:ctty _ - ISgNA
t sum;ncd Ouw _
(avcmgc) yoo aVday Pump Tank Islanulacmrer
Dest n [low (D\1 f) - estimated x 1.$ --y-- O N X
_ Gdo a -day Pump Manulauwer O NA
Coil Applic t1:mt Rite GaiidaWft? I Pum Model - -
htflucntiEffluent Quality N) Mont Preirealmcm Unit (OfNA) -
hly Average O SmdGrascl filter
Pals.. Oil Od & (ireasc (F(K) ~ 30 mg(L ❑ PcatFiltcr
Biochemical Oxygen Demand 1130Dr) <220 mg/I I rl Mechanical Aeration O Wetland
Total Su; >endcd Solids ('I SS .'_l Disinfection O Other:
I 1 150 meet. Manufacttm'r: Model: I
Pretreated Lflluent Quality iXNAI tMonthiv Average i Soil Absorption Compement NA) -
BiochemicalOxvgenDemand BOD) ;Qfl-t \t-gerround (gravity) OIn-ground(pressurized)
>0 mW'L 'o d Suspended Sol ids i1NS) `-30 med. 'i O ode O Mound
Feral (oh form fgeomcbic mean) O Drip-line O Other
10 Iu+IOOna
_
L
V u llcal Distance Tank Bon m io Sc:vice Pad: _ fi
"Maximum kllluQnd Particle Size UR mch diaruder Lllonzontal Distance Tank_I,i to scn.cc f ad: /JO ft
Dispersal Unit MfgJModel Number: Ei fLe✓ /aag QoJ/tn O NA
Calculations:
Soil Dispersal End Cap OAspesal ["nit UISAI
DWI* . - Aoulica(ion Rah- Ana Ra7ut h T
red LISA - or (Trench t \Vid1h)
l '
. _nit+u.!I'nta: f.cnut of rench
DESI(-N C Ril ER1.4
O "llc's: n of Pressure Distribution Ncncak !or Septic Tank-Soil Absorption Systems" Publication 9.6 (SSW MI Manua))
O "ICC hlovicch Mound Component Manual Version 1.2
I O "FZ f-Imc Mound Component Manual" Version 820-2((17
O SBD- 10854-P (R. V 12) "At-Grade Contutntent Manual Usu1g Pressure Distribution" Version 2.0
g SBD • 10705-P (N.0 V01)"In Ground Soil Absorption Componcnt Manual" Version 20
O SBD - 10691-P (N.01, !01) "Mound Component Manual" Version 2.0
i rl SBD - 10657-11 (R6.,'99) "Drip-line Fftlucut Disposal Component Manual"
O SBD - 1070(1-P INdf I%01) "p:assurc Distribution Component Manual" Version 2.0
O Other
.MAf N'I'F-NAN'('E D70N1'1'VILINC S(:HEDCLF, - MAIVTFVANCfi AND M1LCNAGEMI:NT
Sdnuc Lsrnl _ _ See ru D nym.nev -
PumP'nisTfcU di cer I cJ4vl lean filter \t icast m c even. Li mot us OF i years O Other'
InspecipumpKpnmp controls alarm pretreatment unit Ate: mt ec crv:O rtwnlhs O;}etrs RNA
lush lend prtssurt test Iaicr 1, At Iea.t once CVC v; ❑ months o 3 year, RrNA
START BP AND 011ERA'IION: For new construcliom prior to using the POW"IS check Ireauncnt tank(s) for the presence or painting
products or other chemicals that may impede the treatment process an&or damage the dispcnul celf(s), Which concentrations are detected have
the convents of the tank(s) removed by a septage servicing operator prior to use. Syslem start upshallnot occur when soil conditions are frozen
at the infiltrative surface.
The property owner is responsible for the operation and maintenance of the POW'TS am subm -esiou of royuired reports. The quantity and
quality of the wastcw:aer stream will affect the performance and longevity of your POW FS. 'f he installation of water-saving appliances and
f iuares along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners. iron removal units.
other clear water uratmem devices and foundation drains should he discharged to the Kround surface: whenever possible Note- this does not
include iacrdn' wtlste, showers. disMvater. etc.
This system is designed to handle domestic strength wastewater; however. the disposal of titod based greases, oils. vegetable/tivlt peels.
seeds. bones, and food solids, such as those produced by a garbage disposul should be minimized. Toilet tissue is the only paper that should
he discharged into the system. Other non-biodegradable items. such as baby wiles, tampons, snnimry napkins condoms, eiguralte butts,
dental floss, and cotton swabs, should not enter the system. Chemicals. such as petroleum products. paint, disinfectants. pesticides.
antibiotics, solvents, etc., should not be flushed into the system Ixuaaethey can seriously damage your POWTS and contain inate your
Irinkin~• wetcr supply. , tin 3.la e -c; stead, lhr,y i,i pr m ini ! n 7 asil all systeut components. Coompacton ul snow over the dispers,1l unit maj~rcau+etn
tolog till up lout the week. Avoid vehicle 11,11lic over fr.
INSPE Lions 'S & D4AINTENANCF.: lasPection shall be made by an individual carrying one of the following license,
ccrtifcalons' Muster Plumber. ,rlastcr Plumber Restricted Sewer, p011r or
Maintenance Schedule). T5 Maimaincr. or Scplagc Servicing Operator (pm the attached
Tank inspections the must include a visual inspection of the tank to identify any missing or broken hardware.
groun l'y any cracks or Icaks, measure lb volume of comba ted sludge and scum and check tttr any backup or pmrJing ofef0ucut to t he
grouJ solace and test all electrical cquipmem such as pumps and alarms. Any defects stall he promptly Corrected.
Expo,cd openings
greater than 8 inches in diameter shat) be secured with effective locking- devices to prevent accidental or unauthoti/ed entry the tanks,
When the combination of,iudge and scum many tank exceed. one-third I I/; I or more of the tank volume, the entire contents of the
tenk shall be o nnoved by it Septage Servicing Operator and disposed of in accordance with Ch. NR 113. Wisconsin Admin. Code.
Saccilic servicing mechanics rnus't 1x provided if vcrtiial is> IS feet cr if horizontal is,150 lect and instructions tube provided below.
I lie outlet Mien:S)shal l be inspected and cleaned to remove any accun a fated solids accorl ing to manu fact urce spccilications.Solids
washed tionr the tiler shall be rcmincd in the tank. Filter cleaning may be neecssaty at more frequent intervals than ,rated in the
ntainicnancc;chcdule to keep the system opeati reg.
Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service P O W FS,
'I here is normally a I day reserve under regular opcmting conditions, hmv<vcr water should be conserved until any problems with lire
.system arc corrected to prevent back-up ol'sewagc into the dwcfling or surfacing,.
ABANDONMENT: When the PO WTS tails and/or is permanently taken out of service tic hollowing steps shall be taken to ensure that
the system rs properly and sally abandoned in compliance with (:it. SPS 383.33, Wisconsin Admin. Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all ranks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• Alicr pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with suil.
gravel. or outer inert solid nnaerial.
CON FINGF.'NCY PLAN: Ifthe POWTS fails and cannot be. repai.cd the following measures have been, or must he taken, to provide a
code compliant teplacentent sysrem.
A suitable replacement area has been evaluated and muy 1,u utilized tot the location ofa replacement soil absorption system. I he
replacement area should be protected lima disturowtce and compaction and should not be infringed upon by required setbacks
noun existing and proposed slmuure, Ins lines and wells. Failure; to protect the replacement area renders it unusable. Replacement
systennx must comply, with the rules in effect at the time of replacement.
O A suitable replacemcnr area is not available due to setback and/or soil limitations. Barring advances in POW'TS technology a
holding lank may Ile installed as a last reson to replace the failed POW'I'S.
O The ,ilc has not hcen evaluated to identify a suitable replacement area, Upon Iailurre of the POW'I"S a soil and site evaluation moist
be perlormcd to locate a suitable replacement area. If in replaccnneot area is availnble a holding tank stay be installed a, a last
resort io replace we failed POWTS,
O Mound and at gads soil absorption systems may be reconstructed in place lulowing removal of the hionat at the infiltrative
sui lace. Reconstructionsofsuch systems must comply with the rules inettectat that time.
\V_112NI1G!!!I SEPTIC, Pt: )Ir. AND OTHER lRLA-UNIEN'TTANKS !1M CON"PIAN LETHAL GASSES AND/OR INSUFFICIENT
OXIC1,'N. UU NOT ENTER A SEPTIC, PIMP, OR OTHER TREATMf:NT TANK UNDER AM CIRCIIMSI'ANCES. DF.A'1'FI
VIA1' RI.SCCI'-RESCUEOFA PERSON FROM I HEINTERIOR OFATANK?11AY BEDIFFICULTOR IMPOSSIBLL.
\DDII IONALC OMiM F.14 I-S: ~cE/LAlErFaY .Sysrzy ro Qi /,✓S Y,I196f4 W1,0/pf1711t UAI✓d
POW1S INSTALLER POW'TS MAINTAINER -
--r
I Nanicl TLLNN Name: llz~,r A/
I hr>nc: _Z/r - -~I
hone: 71S__L7.7-~.7G6 _
SEPIACESERVICING OPERA_POR(Pumpery ? _ LOCAL REGULATORt'AUTHORITY
Name: i
- ~ kNa m e: M.hone: 7/S •38G-•YLdc
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer ' Gc r _ L~oc-ICS
Mailing Address 462:5L L/ p Ri G nr~ f3 = t/ ( r
Property Address 1?'S)' tf C) 'A
vl
Pte, y J Yr r int9 tJ1 (/U
(Verification required from Planning & Zoning Department for new construction.)
City/State j~- aJ vy1Lt2,QL Parcel Identification Number - O(o - ~s -aOG
LEGAL DESCRIPTION 7 fJorhuP St I(1 4 Stu J/y
Property Location
SU) y,7/Sec.~ T N R__ff_W, Town of
Subdivision
Lot #
Certified Survey Map # 5 y (~~l a Volume Page I
Warranty Deed # Volume Page
Spec house yes no Lot lines identifiable yes no
SYSTEM MAINTENANCE AND OWNER CE-----'----
Improper use and maintenance of your septic system could result in its premature 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
the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance
responsibilities are specified in §Comm 83.52(1) and in Chapter 12 . St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Pluming & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and retuned to the St. Croix County Planning &
Zoning Department within 30 days of the tbree year expiration date.
Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the
property described above, by virtue of a warranty dad recorded in Register of Deeds Office.
Numt~ r of bedrooms
SIGNAT OF APPLICANT(S) ~DATE~
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Departmiem.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is nude in the warranty dad,
(REV. 08/05)
I. CROI\ Cal \T7 zo\I\G oFEU I-
CUR77L ft 4, 1ION %TAI LNL NT
FOR UTILIZATION OF EXISTING SEPTIC TAN6151
lhls is wo cmk that I ha,c nspc.lM the cct<uny_ ,no, and or ;Inc lane
p:c :nt is scn'Ina the tollnwu:F :eslacn__.
(SV.c: addtes+I - ul Ltcd
at Scer.,n Inwn ` Ranee N.
l"Ar I .St.(Tom C oxoA 'jmi,
Up rtl ....peel wnl. I :cos, In,. I htnr louml the tank)cl. to the l v'1 w
k:IUw ledge. will cor.lomt to nc mgoi7 mcnls of WS and II ttae.
uppcatlsl :c M lunctiocing prmcrl.,
Mvot m.-ato date.: irmvo!_, 1.-:
Ihd row hack oicur Inn.. ahxrp:ior clclan:' Ps p,
('a na. srip next lint 1
\lnrox mate volume or langin of lime: gallon, minute,
lank (ap ol`
Cun'hurtiou. Plcl:fb( l:'oele steer Otinc,
Mam.i.:mrcn. I knroeni
Ace of Tank t : knawn
Penn: numher(it known-_.
tllecrlsed Plumber Si;•nature- (Prim \arrlel
(I rIcli tl.,ccnsc Nuwl zr(NfP VPRS
I om In be conplctcd n ficei5cd PIunIMr (Dent of SLtcrn and P^o-cs,onal
SersI Chapter SO` mIG laj.ub. N ixocsin SlatutesI or hccnscd daroscr
(\R I3 N'iscorsir, Adm.cicra;isc Cnd:I
Rev _ 20
Wiscehsin DepertnhmtaCommerce PRIVATE SEWAGE SYSTEM County St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary PB"'"tNO 420385 0
GENERAL. INFORMATION (ATTACH TO PERMIT) State Plan lD No:
Personal information you provide may ce used for secondary purposes tPrivacy law, s. is o4 (t xm)j ' - l),'
Permit Holler's Name city Vnage Township Parch Tax No
Lorfeld, David E. Richmond Township 026-1066-85-200
CST BM Ele , Insp. BM E., 0 Deauiptiwh'
OD- o /DD,v f~lnW-/
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION 8S HI FS ELEV.
Septic Benchmark
6F. 14 /0'--L( 00 O
Dosing w/ I AIt. SM e
Aeration 7v Bldg. Sewer
z. /
y, 0114 M
Holding SVHI Inlet SA
TANK SETBACK INFORMATION SUHt Outlet (4 3 OL
TANK TO w~k WELL BLDG. Vent to ke ROAD DI Inlet
Septic (W/ f 1 -2`1 Est DI BO
Dosing N J HeaderlMan. y,p
9 7, ~
Aeration Dist. Pipe
9'7.3
Holding Bot. Syste
I - E~r----l /„,e/ 4 ~z ya ~Y
✓
PUMP/SIPHON INFORMATION Final Grade SP /ODn
Manufacturer Demand St over J
GPM 1z,L, G~IU•.; Z 6
Model Num r
TDH Lilt Friction Loss Syslem Head DH 1 Ft
I 1
Forcemain ength ia.. Dist to Well
SOIL ABSORPTION SYSTEM q 13
BF01TRENCH Width 1 Length No. a Trenches PIT DIMENSIONS No, Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO 88 PIL BLDG LL LAKE/STREA LEACHING Manufacturer ifi INFORMATION CHAMBER OR
T CN SYVr~nA r 36 UNIT Model Number:
DISTRIBUTION SYSTEM ZIt Sul ~f/,
Haader/Manifold Dietrbubon~r r x Hole Size tide Spy ad to Air Intake
r Pica(s) yr ..L1r 1 / / f
Length Die Ir L"t h u , Dia _ SpflrJng
SOIL COVER It Pressure Systems Only m Mound Or At•Grade Syst s my 4&, fir-I I✓rcJfpri
Depth Over Depth Over u Dr;ah a >a SeexfeNSoddcd
Bedrrmnrh Center BeNtrench Edges Topsoil
as ■I No [01 Yasn~f No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1:124L V1t-~-6 Inspection #2:
Location: 1258 140th Avg New Richmond, WI 54017 (SW 114 SE 114 22 T30N RIB" NA Lot 3 pa Parcel No: 22.30.18.3420
WiconsinDepartment of Indus". SOIL AND SITE EVALUATI,9)DI-itEpORT Page 1 of 3
Labor and Human Relaaoro
DivMion of Safety a Buildings in accord with I LHR 83.05 4 Adm. Cbde ,
COUNTY
Attach complete site plan on paper not less than 8112 x 11 inches in sizo. Plan must k 4tlde, but St . Croix
not limited to vertical and horizontal reference point (BM), direction and~,& of slope, scale or P CEL I.D. a
dimensioned, north arrow. and location and distance to nearest road I 026-1066-95-200
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION 7 FE IEWEDBY DATE
J k t iy ~s9
PROPERTYOWNER: . PR `,RATION y
Tim _Gj ov_iR f5t7VT. LOT SIV'' 1r4 $V 1/4.S 22 T 30 N,R 18 24Dr) W
PROPERTY OWNERS MAILING ADDRESS 7( fi ~Ko 5 NAME OR CSMN
1757 144th. St._ 3 csm
CITY. STATE ZIP CODE PHONE NUMBER ❑CITY I❑vILLAGE GWWN NEAREST ROAD
New Richmond, WI. 54017(715 246-4347 140th, Ave.
[XI New Construction Use I z¢ Residential 1 Number of bedrooms 4 [ I Addition to existing building _
L I Replacement I I Public or commercial describe
Code derived day flow 450 gpd Recormterded design loading rate • 5 bed, gptldt2 - 6 trench, gpMt2
Absorption area required 900 bed, ft2 7.50 trench, n2 Maximum design "ingrate .5 bed, gpolft2 .6 trench, gpd4t2
Recommended infiltration surface elevation(s) 96.40 -ft (as refened to site plan benchmark)
Additional design l site considerations na
Parent material outwash Flood plan elevation, if applicable na ft
S= Suitable for system I CONVENTIONAL MOUND IN GROUND PRESSURE ATGRADE SYSTEM IN FILL HOLDING'AW
U - Unsuitable fors stem ® S ❑ U ®S ❑ U ®S ❑ U ®S ❑ U SRS ❑ U ❑ S [NU
SOIL DESCRIPTION REPORT
Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence BouindEry Roots GPD/ft
in. Munsell Gu.Sz.Cont. Color Gr. Sz. Sh. Bed Tmndt
b
1 0-13 10yr4/3 none I sl 2csbk mfr yw 2f •@ i.5
2 13-26 10yr4/4 none sl lcsbk mfr gw if .4 .5
Ground 3 26-84 7.5yr4/6 none is Osg mvfr na na .7 .8
elev. -
1oD.4 ff.
Depth to limiting
f4 _ - q} t L-
Remarks: -
Boring #
1 0-12 10yr4/4 none s1 2mgr _ mvfr gw gF .5 ! .6
2 x 2 12-31 7.5yr4/4 none scl lcsbk mfr yw if 2 ! .3
3 31-54 7.5yr4/6 none co s Osg ml 9w na 7 .8
Ground
elev. 4 54-84 7.5yr5/4 none fs Osg mvfr na na .5 .6
1gQ, qft. -
- I I -
Depth ID
limiting
~'l1 2 1
Remarks:
CST Name:--Please Print Gary L. Steel Phrmc: 715-246-6200
Addnmss: 1554 2(Inth. ew Richmo 154 7
Signature: Datc: 4-18-99 CST Number: m02298
r
PIIOPERTyowNER Tim Gjovik SOIL DESCRIPTION REPORT Page2--of. 3
PARCEL I.D.8 026-1066-95-200
Boring # Horizonl Depth Dominant Color Mottles Texture Structure COnSisterice Bmrrhy Roots GPD/ft
in. Munsell du. Sz. Cont Color Gr. Sz. Sh. Bed Trench
Mq, 1 i0-12 10yr3/3 none sl lcsbk mfr GW 2f .4 .5
3
r3l26-84I ; 7.5yr4/4 none sl lcsbk mfr gw if 9 5
eGlround 7.5yr4/6 none fs Osg mvfr na na .7 .8
100.1tt
Depth to
limiting
factor
+8411
July { .
Boring # 1 0-13 10yr3/3 none sl lcsbk mfr gw 2f .4 .5
4. 2 13-30 7.5yr4/4 none sl lcsbk mfr gw if 4 .5
3 30-801 7.5yr4/6 none fs Osg mvfr na na j .5 .6
Ground
elev.
100.0n.
Depth to - - - - -
limiting.r f 4G. ~o
facto - - - - -
+801,
L Z
Remarks:--_
Boring #
1 0-15 10yr3/3 none sl lcsbk mfr yw 2f .4 .5
? 2 15-34 10yr4/4 none sl lcsbk mfr gw if .4 .5
# - -
3 34-82 7.5yr4/6 none is Osg my fr na na .7 .8
Ground -
dev. ~
99.7 ft. - -
i
Depth to - -
fimiting . 6 / -
factor - - 39
/ - - - -
Boring #
Ground - -
elev.
Will ID -
Wiling
factor
Remarks:
S8DA330(R.o5192)
STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave.
Tim Gjovik New Richmond, WI 54017
MPRSW-3254 town o of S22-T30N- Richmond R18W (715) 246-6200
t
I lot #3-csm
N
1"=40'
BM.= top of NW lot stake @ el. 100.001
Alt. BM.= nail in Pine tree @ el. 100.30'
PI ~ a^~ 33~i'
1Z~ ~ b~Z s}~~ 5
k
38
1118 ~1qV e
Gary L. S'Beel
4-18-99
- 1