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HomeMy WebLinkAbout032-2176-22-000 ssorsn Deoa~rnen; c'Cc.'^-en:e PRIVATE SEWAGE SYSTEM Ceirpy. St. Croix Sarer; and H.. ilo ng D'v sar INSPECTION REPORT Sanitary Perr t No 606968 GENERAL INFORMATION (ATTACH 1,) P1 RM11 i State Plan ID N., Personal in'crmaVi,n y'% IM, le may r-'Aed IOr Secondary P~IPQSCS lprwa y : aw• s 15 i"":l Perm I Hn.der's Name Cry Vil age Tannsh p Page e' To. No. Will Johnston TOWN OF SOMERSET 032-2176-22-000 CSI L1.' Llev Irse. BNI L e': Bfvl Descr ptlu- Sect on:Town;Rangelfdap Np 12.30.19.1507 TANK INFORMATION ELEVATION DATA TYPE PdANt1rACTURER +•A- CAPACI IY STATION BS HI FS ELEV. Septic Z .I Benchmark At BNI Aeration _ Bing. Sewer J7-S 1/6z' (.0 He ding St-Ht Inlet TANK SETBACK INFORMATION SVHt 0.ltlet ~•S /OJ . LANK TC P;L *ELL Ei57 air) In A•Irtake ROAD Dl Inlet Cr.J~ ''fL'.. Septic 30, Ut Bottom ~ Dosing HeaderMar `7,5 -7 /-Tr -3 Aeration Dist Pine Holdrg H:;I. System ) PUMPISIPHON INFORMATION Final Grade Mali Demard St Cover GPPA I - r 2 /6(,./ Ninde Numrer - T g• a 9F"3 TUH Lut rfi.I-0n Loss Sys:em. He-ad TDH rt z - F.(calma P Lel`gin [)to Dist:c 1^ICII o 12•a 9~i. ~ SOIL ABSORPTION SYSTEM BEDITRENCH b:mlr Lcngt~ No Cl 1 rr~n-cheS I , PIT DIMENSIONS No CI Pds Ire. de C a. Liq-id DCeth DIMENSIONS /1 ^J If e~ Lam} ~ ` \ SETBACK SYS I EPA TO ?+l. JBLUG WELL :AKEiSTREAM LEACHING 'dan~r, j • we r INFORMATION _ CHAMBER OR •L H h cy s:e m y voe Of t ~f UNIT r,toeel Nylnber F' 1 /1 ) GJ✓v' DISTRIBUTION SYSTEM LA3,111- zb e + L✓ Hearn' Map fTtp I DI,=ht..tinr X Hote Sizc x -n a Spacirg Vert Air Iptake n I 'L jI I* Lergth C a I P-r7i- Dia Saar.I-g _ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Dep'h Ozer 11 L`epR' O'oe- xx Dcrlh el xx Seeded~SNcud xx Mulcted Sec ? rerc Ce-ter " Bed:Tre.-ch ECges TOD501 - COMMENTS: ilrclude code discrepancies. persons present, etc.) Inspection #1 Inspection 42. Location: 82e 16CTH AVE~` I de-Ar-6 l1i 1. i A9 BM Description = r--~✓~y~ 1 2.; B Cg sevre• Iength = - armo.lnt of cover = P Z P I O OLD- / Plan revision Require.? f _ Yes ~~o Il 6 S f/ / 'r 3 Use other side for additional infonna otf n. 1 1. SBO 6713 (R 3297~ Dale - - _--i~se07ors SigAat.:re Cert. No nnnn~ i>~~> t, ch' a~~ Blildings Clvlsio~ ~ ~ iL f 1 7L ~s r•~ 201 Inv I ngtOn AVE.. P 0 Ftnx'1..? Ssmta, Y.-mi: V umnet 'lu he L led is b) o j . ~ 1 PS !C~ 4 24~~ ` n Lladis~n VM ~3'07-71e2 Sanitary-PL.mlt Application sT-a av:no'nmin V acurrlef:Gttl7i S'C _ ° > ar l I. I -f.h tpn .ICtw a A _ is regmred 11110(t h ia;re a ulcutmv xma V a f pj a n -.a M, lot ~.alc-euncd PIN C arc cubminc r PRI to AdN - Qi if aid- of f6 anhnL [tress) inc ~cpaaw ~a S~rtn ar Pr le i. ral Se^.IC pns:elal I t,,m.auon yvu inayide nal I _ mod tv stt ma:a r O 7/ _ ~ t. oxs is a.w'tan:.e ai-t he L t ncv ..:K t 4 I _ _ 1 L Appheaton Informunon Please Print AII,Irolm Information atiou All/co Prop _--.S C.'aar/ s Maki Md-_ s _ i [tope n Lx:aticn e /La 7 K _ [7 o Ge"I ] _ 7 7 Cir Six e 7ir Ce Aorte Nmbel ugmn T~0 V R w 11. Type of Buildint: (check all that applsy( OK, Yanulp''h, <lhu= ♦w Ibn :.t R:un.m; Subdivion//~~JoLmc _ - - pj'tct~ r•~L 3:II,:t rµrs - }11:an:t:onmrui - llas<nbe le J e, m IISmmUwvC-Desuhlisc__ -1 . r_ a_.l ,s 2b ~~diak Ilf. Type f Permit: / 'heck only one z on fine A. Complete line R ifapplicablel A. L . esv Vsrcn .r. Rcpl:u<er n $~.em ❑ Tfcx o, r. i I:_ u„ T,-u. d 7.. e_. Isnl A r i Oth v hfa'iiticatior to ExieTn~ )Klr~ lexptam; It 2-.vr'//Lys ti*nu urinm nqi ks -.I'. uq} i:.m flm L' a w ~'IlI tt1.II 'i=a. an ,rLC a~'~D~L hc.orc f•x~ Im::nl k t >wnn R. 7vpn.rfYUq'fV~y~y~'<_.ompnnerm Dcvire: (C heck all ilia[ apphl tiuq F- ~yv.-coi h:-i.taun.I~'~ 14c.::'~ i ::corral _l At'-d, I . s(uuod _i u, of suitable soa Motmd - l: sr, A rrvzabi, sail ' I - I -i r z i.xplan _ Anmilmcrl :XVSZ~a I In \ UrspersalTrea treat InfurntaLgn j Y>.r.I FI. T) .,-IDun k~P ^•CSII ).::pc. ;a: _a licyml¢ I PsF~-d.l(ea "noF~... :yslcm6 B` q-Lyy6` o _1x1 E \9. T anA Ltfo i.::y ns-.q Ii T tv X o." t bfvms-mrcr I I 1 '.ilia 0tit; I II Avw Lwks ams TZ. u I r N711, flespunstbilin 7tlttl t- 1, the uuderu nod, a> res(lonsibdiry for u xlabatiua of the PUNTS sbowo 0o the Attached plans. y~tl '.Vm. krq; i F:Itm S.gnatu:e .726r ~ Bunn thane V~yr~r~/ I/t .'s 1 s~ctt,: v itnle, Li^ odes \'fTl. Countv.Depariment Use Div _ Y ~"ml' : C'-~ U:dr li ued 11sU 0. . t S.~nattire 5^ I C15 ~ Z /a ~ ~ ~ ~ t rwl rn Rca:'n. f n )trial V _ ~C LX Coo itlo`ns0 Approval'Rea ousiorrDDisapproval r f - I~ 14L~wsQ ./a /mil a~ 2, Sy6~er. ~a W,4t_ ' CJ b N <6 -Z- - `(~c•cJC6'// Y- Atla<b w oempleu pleu> IoI IL.>pleu: uue mUmn Io Nr Cown only eu yayrr wn kv ILao M r 1 i uv LF m vu ~Bli'6398 (R, f t ll l l Soil Test and Svslem PLOT PLAN PROJECT Will Johnston ADDRESS 826 160th Ave Somerset Wi 54025 SW 114 SW Uas 12 r 30 N/R 19 W''1'OWN Somerset COUNTY ST. CROIX 5YS'LE11 EI.EI+ATION 99.0.97.5196.0 3' below rtrado 12110118 BEDROOM 4 UA'fE CONVENTIONAL XXX CO,NVFNLIONAI. I,I1-1 HOLDING TANK MUIiNp SEPTIC TANK SI%JS 1255 gallons LIFT TANK SIZE DOSE. 'TANK SIZE IIOLDINC TANK SIZE. LOAD RATE: .7 ABSORPTION AREA 1216 # of chambers60 Rb;NCnVL1RK %r .R.11. Top of survey iron ASSUME ELEVATION lou' Filter Lifetime Filter ❑ROREHOLF: O WEI.1. "11.12. P, sameasbenchmark Vent Quick-l Standard Scale = 1/4" = 10' a.. 01 Cowl- Leachin,2 Chamber with 201) 112 of Area fl^2/pair of end Caps 4' Long 12" Grade at System Elevation ,34.. B.M.''' l All piping shall he AS1 M SDR 30/34. within 21 10' of tank, piping shall be AS'l'VI F891 B-3 30' 100' 18'%r. Slop' 20' 15' 3-3' X 82' cells with >V spacing 132 10 10. "I' 13-1 60' 350' Property Line Pro 4 ors Bedroom House 1601h avc _ I _ Srt-a u i g_ 30 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page _ of Division of Safety and Buildings ' in accordance with Comm 115. Wis. Adm. Code county c J Attach complete site plan on paper not less than 8 t'2 x 11 inches in size. Plan must include. but not limited to* vertical and honzonta! reference pant (BM), direction and Parcel I.D percent slope. scale or dimensions. north arrow . and location and distance to nearest mad. j 00L Vs" Please print all information. Review by Datt AA PlnpH+mlpminon yW poman maY Oe ve<G for secon0a7 perpMeslwrvacy Law, s. l5.da(1;(m};, V=:;~& , /V Property Own or property Location 4v f _ r r ( 11, C- r ~ , - L + ~ i~Govt. Lot S 1r4 :4 S ,_T 3 ~~N R C E (or W Property Owner's Mailing Address Lot b Slork # Subd. Name a 'h City State Zip Code Phone Number O city ❑ Village Town Nearest Road (20 91 LA~ New Construction Use;g.Residental I Number of bedrooms _ Code derived design ffrnv rate GPD C] Replacement ❑ P rc or commercial - Desontie Parent material fJ qj- da4 ~v! Flood Plain elevation if applicable N R General torments and rsoonwrondabons- System Typo Gti?~ S ;c"tom Elovalw 7_ a-- Bonng# Boning y(7~,y / / D Ra Pit Ground surface elev. Efltj _ ft. Depth to Wring factor in. Soil Application Rate Horizon Depth Dominant Cola Redox Description Texture Si ucture Consistence Boundary Roots GPDRF in. Munset old Sz. Cont. Color G(. Si Sh. 'E"l 'Eff#2 ~ - ~ i - n~ 11, 69 1? al~ LLYL v S N'1' n Boring # O Boring r pit Ground surface efev(t7y~. ft Depth to limiting factor in. Sal )>Ircatah Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary, Roots GPD1ff' in. Munsell Qu Sz. Cent- Color Gr. Sz. Sh. 'Eff#1 'Eff#2 s i! ' Ethl t #1 = BOD. > 30 < 220 mp4-and TSS >30 c 150,phyL ' Effluent 92 = BOD. < 30 mgIL and TSS < 30 mry'L CST Name (Please Print) ygnature CST Number Bird Plumbing, Inc. Shaun Bird 226900 pddroy; ' D.110 Fvaluafion Conduct.„I luluphone Numher 1432 120th St, New Richmond, WI 54017 - r - 715-246-4516 Property Owner Parcel ID# Page Of FS] Boring Of ❑ Boring Q O (r ~r Pit Ground surface elov. ft. Depth to limiting factor n. Soil iralion Rata Horizon Depth Dominant Color Redox Descrption Texture Structure Consistence Boundary Roots GPDAP in Munsell Ou. Sz Cont. Color Gr. Sz. Sh. •Sf #l •Eff#2 Boring # ❑ Boring - ❑ pit Ground surface. elev. ft. Depth to limiting facto in. Soil Application Rate Fkxizon Depth Dominant Coo Redox Description Texture Structure Consistence Boundary Roots GPD1ff in. Munsell Ou Sz. Cont. Colo Gr. Sz. Sh. 'Eft#1 'Eff#2 Boring # ❑ Boring ` - ❑ Pit Ground surface elov. _ ft. Depth to limiting tailor in. Soil Application Rate Flonzon 'lepth Dominant Colo Redox Description. Texture Structure Consistence Boundary Roots GPDMf on. Munsell Ou. Sz. COnt- Color Gr. Sz. Sh. 'EB#1 •Eff#2 Effluent #1 = BOD, > 30 < 220 mgrL and TSS >30 < 150 mgt • Effluent #2 = 800, < 30 m44 and TSS < 30 rngq- The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need matenal in an alternate format, please contact the department at 608-266-3151 or TfY 608-264-9777. wo WO m ewl - ```~,1 ;»f:'y Bnc 3uilAings Drdlslon I . ~ I ~ x Q S Y ~J: At VV3 h ngYa Ave.. P.- Bcx T iEz I Samlx}' permit Numbc (le be f.U d in by Co. i I PS i I n,; MHJ YJr 1^J 53707-71(112 q CI,,I:: ~iml\8l'ti 11' Numba Satutacti Permit Appllc,a.uan- s -.c rtdw < nrth ]F J i0. 1 7 '4~ Adm 1< I hn l ,r f l ,is itQ. t- .Ec ;IPprpnat. gm•actn.utal Zvi y.tiR.l ar rhaacros.4 m1u" Pcur tc _u;L au fccat,1 swle~wned?NTam =unmi¢c~ AJd:ess:il:Lllescm eEao mauLn~.;::ress) ih L~,P VCn.Ll 1 Saiacv and Pr I 'Ui mr (l r Pr, : n V.tol nanl ,Ou P J'idc maj k umd t]r S mdarp 1 , Application Lrformanon Pletsa Pnnl All lntormatioo F-:.pct}': amc t \acul: f'm cl . t~, ~ L) P. fit--~ eJ~ f ~ nl `Ci't~iJ . Y opeaty_Qwoers Miulme Aeeteas P114- v t.ncaawn 0,30 J9 `SO ",wait 'iy,.itxlr 7.Ip Cnde fT.,me NZb: ( ) J 11.1 vial of ButldmiehuA all [beta 1 ly ~ _ ~.1:•17.flia Dw<lliug Vmbcr of?iW;nc L Su`rdwrcmu Kane I BIr<k e J P % - Pabhe' . a I a .uJ - Dk mbe Cse State Oa,,)-d- IlesrnM.6s. - ~wn~rn-PTS - Z_(J;ad Cel~_ ZL~ ZZ~,~oe u < < M. Type of P uric !Check only ne boc on line A. (bmplere liue R if applicabl s _ - 'bnr C stem ~ R p h ti n[ C t .r. - f ^atmcut R;a.lin_ Tar:k P ~U: ,rn 'mlv ~ VMr+ biaLG' n:;,m W Enz[ing S •Stem lapsir. i If R. List T m.lnus Perms Noniber =d Liar Fame Reucwa. 17 uut n-silo, - b ,e of Inti 1.=,fa :u Few Be rcr.Pru n ' w R-. vpcaf PO«'T~!Actan.(ompoocn Ucvice: IC ck Olhat a} I \4,4EYr c L-' , r n:. d fr ou d l:. a[ ` M,.,o i : iR of 9 itvlo Bevil -1 Xlo,Md < N w. of ntL:ilole ,,it i .:I.J.m mea _apk ml V ❑ YratcS:ncvt !}etim jexpWnJ _ -T D V Uts fir, _ t saYTrcal tAreal tu(ormation _ pje ~Ci r IY~t I_!T:a, rtl~ Crn`nS tl vpli auc 'o;gp~51..~u,¢L:: t., HrgacrJ Uupers. al A:w Pr p11 5slag %irrnl -7 VI. Tank Info - CTacay in i Total -i =of f:iiolts iixlhm, Iamb Ye taLLS Eu;ine7nL• e ° d -t' < x lluli or-. I I ~ ~ h3 VD Rcspomlbl ltri Staten I rlle undemT,.cled, nc respuoslbihry frr Ixsralladon of [Le Pt1N' I $ shown on the atu -lml Plans I Il.mh^ s S vae rm I I'hl 51^nmu:e RNILP S N=ocr B.nlnec: A>,rc t#=b I _ ~ ]Zr /y 'I' 6c5 U1 elc SQeel n} al~'.l I ' ~ ~ ~ ~ ~'II . ouxts De larimcu[ Use Cloly ' Aypr:nw j.c Permit^cc Rare h.-_ lial¢;<m Si3ulutt L4 Condtt ions 0 iy~~nPprov al - - 1. tar'lc, a t.on: t r o;11>e•'. cell ali be .,~.Ic s - M~ _ 3 7y~'~rl. ~o tr`W4.J~ V Z 11 par sal ayeman' pl n j-- I, rim ~ll , 1 i" n s m w.T - - . M it 2- All xeth3 k ect r, rt it c : (_~11~C.rel ~ ` L I asP(Y'PF,c:blrcn'' 0 -tr% ~!.'.cQFys'ye-•^-'C aTec, 1Ya:L a u,my4ea ylaaf (ur dw s}:rem anA zohm& v. t Coynry ..d. ne W yrr not lew Wee a t^. z ] 1 wuho w vu - V - 'i$i}b?95 .;R 11:111 System PLOT PLAN PIt O,I 1?CT Will Jonnston J ADDRESS 826'601n Ave Somerset Wi 54025 SW I 4 SW 1!4S 12 fT 30 WR 19 vv TOWN Somerset COUNTI ST CROIX SYSTEM ELEVATION 95.6.'95.2 4.4' bcioev grade 10111'18 BEDROOM 4 I1ATE C'ONVL%r1ON,V. XXX CONVENTIONAL LILT HOLDING TANK '1255 tiallons MOUND SEPTIC TANK SIZE LII'1"LANK SIZE POSE TANK SIZE HOLDING 'I'ANF SIZE. LOAD R,:%TE .7 k B.SORYLION AREA 891 7 of chamhem 44 BENCHMARK N.R.11. Top of 1:2" steel pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑BOREHOLE O WELL H.R.P. sameasbTchmark Vents Scale = 1/411 = 10' 8', slope X 90' cells with sp;wing Q-3 30' B-1 6( I 10 71' 82 Vent 6 QuieW Standard All piping shall be ASTIM SDR X0/34, Within of Cover 1 with 20eachin2 .0 ft2 Chamber Area 1(1' of tank, piping shall be AS"1'~9 P891 S l 5.6ftn2Jpair of end caps 4' Lops, 12" Grade at System Elevation 4 >0' 50' Pmperl. Line Pro 4 Bedroom 6.1 house 100th avc Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 10/11/18 Owner:Will Johnston Location: SW1/4 SW114 S 12 T30N,R19W 826 160th Ave Somerset Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross ection 4.6. Maintance a ontigency Plan 7. Filter Cross ion Signature _ License num e tt226900 System PLOT PLAN PROJECT Will Johnston ADDRESS 826 160th Ave Somerset Wi 54025 SW 114 SW 1/45 12 rT 30 NrR 19 tY TowN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 95.6195.2 4.4' below (Trade 10.. 11/18 4 D:1'f E IS ED ROl Mt CONVENTIONAL XXX CONVENHONAL LIFT HOLDING 'TANK ,YIOIAD SEPTIC TANK SIZE 1255 gallons LIFT 'IANK SIZE. DOSE TANK SIZE: HOLDING TANK SIZE LOAD RATE •7 ABSORPTION ARFA 891 # of ehambers44 BENCHMARK V.R.11. Top of V2° steel pipe AsscntE: t:1.E:vArutN uul' Filter Lifetime Filter ❑ ROREDOLE O NVELL same as b nchmark vents Scale = 1/4" = 10' 6"c Slope 71 2-3' X 90' cells (with >3' spacing B-3 30' B-I 60' lS' 101' 100' -0• Vent >6° Quick-4 Standard All piping shall be ASIlN'I SDR 30/34, within of Cover Leaching Chamber with 20.0 Q of Area S7 10' of tank. piping shall he ASTM F891 4' Luny 12" 5.6ft"/pair of cnd caps ;4„ Grade at SNsten) Llcvalion 30' 350' Property Line Pro 4 Bedroom 1 louse 1601h avc Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber wish 20.0 ft2 of area per Chamber >.6ft^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 100.0' vrnt Grade ~`cnt 3 I~30134 Septic Tank 3 5' 1_.01)0 1 5 I.on0 1 Grade at System Elevation Z 6" Grade al System Elevation Spacing_53 24 X 90' Cells Same on other end Observation tubeNent At end of cell A B 22 chambers per cell System elevations: A-95.6' B 95.2' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _-ct_- FILE INFORMATION Owner SYSTEM SPECIFICATIONS Sep.ic'ankCapacity - 17 NA Septic Tank Manufacturer _ C NA DESIGN PARAMETERS Efrluent Filter Manufacturer C NA LMuent Filter Model ❑ NA FEstimatedflow oms L' NA Facility UnQS-ANA Pump Tank Capacity NA erage) ~ yIl aday PumpTank Manufacturer NA (Estimatedd 1.5) - / - - - S' IN QaVdav PurnP..Manufacturer NA Soil Application Rate - - Pump Standard Infiuent/EfFluen!Quality Monthly average' Pretreatment Unit Fats, Oi: & Grease (FOG) s30 mg/l. ' Biochemical i C Sand/Gravel Fitter O Peal Filter Oxygen Dernand [BOD.,) <220 mg/L LI NA C1 Mechanical Aeration C Welland _ Total Suspended Solids (TSS) x.150 m L _ ❑ Disinfection O Other Pretreated Effiuent Quality - +MonthlY average ( - - - Dispersal Cells) O NA Biochemical Oxygen Demand (SOD,) s30 mg/L In-Ground (gravity) ❑ In-Ground (Pressurized) Total Suspended Solids (TSS) 130 m gfl1 90m1 L' At-grade 13 Mound Fecal Cohform (geometric mean) C Drip-Line C Other- Maximum EHiuen: Particle Size J ¢ 1 m 0° dice cfiu _ !A~ Otnec - - aner - - - `a~~`~c.~ ❑.vA O.NA Utter--_ - J NA Values typical for domestic wastewater and septic lank efFluem O[ne%: - - _ - - - L NA I MAINTENANCE SCHEDULE - Sorvice Event Service Frequency Inspect condition of tark(s) At least onr i every. '-l month(s) (maximum 3 years) NA Pump out contents of tank(s) When combinea sludge and scum equals one-third _ (Y~) of tank volume ❑ NA iInspect dispersal cell(s) At yeast once every: C munth(s) - 6$year(s) (Maximum 3 years) 7 NA JIean effluent filter - - ~At least once every: - I ( C month(s) - _ year(s) J NA rsPect pump, pump controls & alarar - _ At least once every: t ' month(s) - year(s) AN !-lush laterals and pressure test At least once every C month(s) - ❑ year(s) I At least very C month(s) iff--- year(s) MAINTENANCE INSTRUCTIONS Inspectons of tanks and dispersal cells soall bu mace by an individual canying one of the following licenses or rertificauors: Master Plumber: Masser Plumber Restricted Sewer; PO'WTS irspectior POINTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to Identity any missing or broken hardware, idemify any cracks or leaks, measure the volume of cembined sludge and scum and to check for any back uD or posing of effluent on the gourd surface. The dispersal cell(s) sha!I oe visually inspected to check the eMuent evels in the observator pipes and to check for any ponding of effluent on tie ground surface. 'he ponding of effluent on the ground surfacei may indicaie a failing condition and requires the immediate notificatioc of the local '.'ogulatory authority. When the combined accumu'atron of sludge and scum in any lank equals ono-tnird (f) or more of the tank volume, the entire contents of he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wiscons:e Administrative Code, All other services, including out not limited to the servicing of effk.ent filters, mechanical or pressurized components, pretreatment unes, and any servicing at intervals of •:.12 months, shay' be performed h; a cenified POb'✓TS Maintainer. ~ service repot shall be provided to the local regulatory auroonty •mthin 10 days of wmpletion of any service event. Page of_. START UP AND OPERATION For new constriction, prior to use of the POW's check treatment tank(s) for the presence of painting products or other chemicals thEt may impede the treatment Process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will by discharged to the dispersal cep(s) in one large dose, overloading the cell(s) and may re" in the backup or surface discharge of affluenlt To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and oispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within i5 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POINTS' antibiotics; baby wipes: cigarette butts: condoms: cotton webs; degreasers; dental floss; diapers: disinfectants; fat: foundation drain (sump pump) water, fruit and vegetable peelings; gasotinc; grease; herbicides; meat scraps; medicatlons; oil: Ping Products; pesticides; santary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS falls and/or is permanently taken out of service the following steps shall be taken to insure that the system is prope,ly and safety, abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shag be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and Cannot be repaired the following measures have been, or must be taken, to provide a code compliant replac7nent system: suitable replacement area has been evaluated and may be utlized for the location of a replacement soli absorption systelm. The replacement area should be protected from disbabance and compaction and should not be infringed upon by requlrled setbacks from existing and proposod structure, lot lines and wells. Failure to protect the replacement area will result in the nmeed for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rule_i in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a homing tank may be installed as a last resort to replace the failed POINTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a sal and site evaluailion must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in pieta following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name 1-;,-/ Phone Phone _r.- d_ l .f SEPTAGE SERVICING OPERATOR MPER LOCAL REGULATORY AUTHORITY , Name / Name l ,';7 i-t 7 r - Phone 3 Plane -i This docu neru was drafted in compliance with chapter SPS 383.22(2Hb)(')(d)&(f, and 383.54(1), (2) 8 (3), Wllsoorwn Adrniniii a Code. I. I r~ L w i i . ~ L ~ C tt 4C „7 t ~ ` J Y yy~ hi rj t ST' C'ROIY COUNT" i SEP'1'1C TANK MAIN''I'l-,NAN'('F tiGR}-"EV(1.NT AND / J OWNIFW4141P CFR'1 II'1('A' l(.N FORM Owner Buyer - ' 1! - 3 14~.~~y✓ - - ?yladinr> Addrt ss - - ~ ~ C41 t CA_) Property Address (Vrrilicalion rraILL d Rnm planaiug & %oning Uepaltncni lot new construction.) - - - Parcel Itlcfitification Nut iber Lh;GAI. DESCRII~"TIO/N Property Location 5 cd `ia , Sec. 1' J L' /C~ l N R l l W, Town Suhdivision G,u J L(_ Certified Survey' map # V( ;11111C Page's - - - - Warranty Deed ) Page f, Spec; house yes no :.ar run ider:ntiablu yc:; nu SY'STTM NUUNTF.NANC'> AND OWNER CERTIFICATION Improper use and maintenance o' vour septic "stau _ould ieradt rm its pre;mafure failure to handle wastes. Proper urtinlc»auc< to ntiist.. of pumpir:~ ant the sep Gc tack ecrry Ih[ years or saonm% ii ueedrd. by a licensed pumpet- what you :,of into the. sysnau can affra;t the function of dic septic tank as a bcauncnt. dace iu dr• waste disposal sVsleni, Owner =Intcnaucc iesponsibililics are specified is §i omm. 83.52(i) and in Gh:rurr I-) - Sr Cmix County Sanitary r -"mane. The property owner a gees to submit to Sr Cnrx Counr, Planning & Zoning Deparunrnt a cerdtical1011 forul, signed by Ihr owner and by a master plumber, jownevmmn plumber, reatrwicc piumbel or a licensed pumper willyinv that (1) the on-site wastewater disposal system is in proper operating coudition an +'or (2) aftei inspcc:ion and pumping (itncussa.y), the septic tank is less than I%3 full of sludge. ihv,:, the undersigned nave read tits :tn c rr:autcnu'r:IS and agree to rnanltain rb.. puvaue wwage disposal sys(cin with the standards set furrh, Iterrin, an .,rt by the Dcpart:,rrnt of Co:nmela' and die DcPartmgnt of 'xiah:ral R.csoimcrs. Stair of wisconsim. Certification statuul: that yore septic system has bccri niaintal;:Cd mast he rompletal and retamcd to the St. C.unx Count) Plamuug & Zorrmg Department wititin 30 days oI the three pear exprrahoat date. - Yw'e Certify that all sl rternents on tilt, form are u uc a tie ^eia of myilrn A uow ledge. Ir'ive arrrarc the, owutcu(s) of file property tlescribai above, by virtu- of a all ntx deed rcco[ded u- Rcf!wte[ of Dee Is Offices Number ;1ion um T RE OF APPLIC_ ANT(S) DATE Any, irir t is rrusrcpresented ri resin; in the sanita, y peanut being r,-yoked by tire Planning & Zoning Dep:utnicul. lnef idt with this application a recorded warranty Iced fioul me kc•oistrr of Deeds Ohio and a Copy of dtr ccrtiited survey malt if reference is made. n the wairanrv deed. - (REV. 08105) / LOT I* 3.04 ACRES V r 132.300 SQ Fr. LBO -3184 ^ tl! ~ na NW1911irw 507.71• 40 ar w Sag A SM 241.27 ~a LOT 20 &01 ACJIFS 131.218 90. Ff L.B.O. - 9704 301.05 71.49 iW 4'47"W/ 372.54' LOT 3 04 ACRES q C 172,313 30 Fr ~J r n ~~OO 57 9 ~ c~c rya na 160TH AVENUE - - 88901 WOWW 223.79 - _ SOUNH L Mf OF P-E SNPt * 14 CMIN 12 7 - - - •x N s - •fd I : x 570.18 c~ ( l N LOT 9 W a W 0 0 b pai /v LOT 16 0 0 x l7 ...c W N x X N - 575.47 ~ 1 t: I 2/• f N A n a N x N u LOT 17 O O n ~642.67' / rya` p - 380.95' LOT 18 N W O m N 0a / LOT 19 O N W N N f0 N 0 a S ~ 1a rc 563.71' / 291.23' f LOT 20 w C1 N OD 71.48 336.96' S89`3N47'W 372.54' N LOT 22 e n ~ W LOT 21 O V) W w ; 0 N a 0 0 0 0 N Z 224.03' - 371.61' t__-= 160TH AVENUE X589 1408'W 223.78' NERS: DEVELOPERS: Parcel 032-2176-22-000 s,z e ;:..a-ra PAGE 1 OF 1 Alt. Parcel '2.3C. 19.1507 032 'U':^JN OF SOPaEr25ET Current X ST. CROIX COI,\TY. '-,VISCONSI.N Creation Date Historical Dale Map # Sales Area Application # Permit # Permit Type J1r'ZHQOC" co U Tax Address: Owner(s): U - CLrfvni O,v•ier. C = C.w i c ic- TI f,tAG\USON ENT INC O I' MAGNUSON cN( I\C '638 83RD ST NE4'! RICHN OND :NI 54017 Districts: SC - School SI-' = SpeClal Property Address(es): Primary Type Dist # Description ' 826 1601 H AVE SC 3962 NhN; RICHMOND SP 17Cr, TC Legal Description: Acres: 3040 PIaC 09-099 LAKESIDE ESTATES 1.22 C32-04 SEC 12 T3GN 8194; ?T I.AKESID) Block/Condo Bldg: LOT 22 ESTATFS'C4 LOT 12 i3 04ACI - Tract(s): (Sec-Twn-Rny 40':4 1601!4) 12-:30N-19''v' SVe' S'c^i Notes: Parcel History: Date Doc # Vol/Page Type 111(7+2CC.^ 811724 2925+080 VJD 01i28i2CU4 752613 9:99 °LAT 08,2212003 !36985 2335i2ti:5 %N'D C9;27,2:;W 69201! 1951/540 QC moro 2008 SUMMARY Bill Fair Market Value: Assessed with: c Valuations: Last Changed: 08, 102005 Description Class Acres Land Improve Total State Reason RFSIUI N`IAL G1 3.04J 60.20:) (1 60.200 NO Totals for 2008: General Property 3 !;,1J 6(: 200 0 u?) 2(C Woodland 0-J:~O ii 0 Totals for 2007: General Property 3.(40 60.200 0 60,100 Woodland O.OII'J 0 0 Lottery Credit: claim count: 0 Certification Dale: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total JX0 aiiC' JACI fsie J a lll~ 1 t f•V' t y I ~ C< J i / \i 7 i y ii i JI} ` I I t ~I I l`` ~ FBI Y t I ~ W < Jl p~ v Ii ! V t`, i 5' S j y, SS! ~ ~ 1 Il IS /.Y ~ ~ ~ _ r E 1 h ` 5 tF~; # J 5 U i.f i i;5# I;d i!i~ J` ~r Ra 1Y~''ts p n ~ + G : { p a I ,Fh R S N t a ~ ~ . s ~YSCa i ~ ~ i 4.I~ 'r.l nai)i f. t g, V !k. Yi. . +is 'i ~>~vE~op~~e//_3t~~e%PS ~ ~D PAR ~~rr~~oo~,~,7- a,/o Toni HANSE.V ¢o(o W4i.✓ S7- 651. 3618 - /Coots wronnslnDPparbnentofCorrenorr:e SOIL EVALUATION REPORT Page/ of 3 DMsion of safety and Buildings In ecPmdanoe with Canrn 85• Wis. Adrn, Code ST c~Poi x c-rty Attach . bill a In site plan von pnrvi e ical not less Ihan a 112 x 11 lorii.•s In Plan Most IU(jlldn bill al limited tOl VPr{Cal and hUfVnrllal relPr PrenfC (%,Inl (RM f.1), dire Cola, and 1 l l/pemont slope. scale or dimensions. noal, anew, and location and r1mlance to nearest mad rira!I Id)G' Please print all Information. Reviewed by Date nnntnal InftrmAlgn ytr provide mAy Ae use4la alron4ary Or%t%+~ex (nr:vaq hv. is e•I (i) ImJ) ~ ~ f~G y'✓7~ • h - f Prcl(peny^fTmer _ - - Prnpeny locaGon S G//7i~~Je FF) TjoARDMi9.~ (;n%l Iof 114 114 S ~.•Z T30 N R 19 (p)W Prt,Pgrty (M•t,er's Al:rilit,gddress - F Dlodc p .M Nairn or CSA4# , L; -2 Z 167b 7'K z/~ ' _ 14 (may /FW Slate 7n, i,o Phaw Ntmbrr t, City ❑ Uilage Le Town Nearest Road - Ric[,. OwP i w/ 15yo/71( 7/5) iYiG S384 Sa ~,EiPSET- 1 -411,2 . Nevi Constnrdion Ust,M Residential / Nlxnba of brMrnMlS 1 1 Code derived design flow rate ❑ Repla(mmnnt I I Puhhc or a%nmercial - Describe: PflmM mMPdfll_ _ fIt(%I f~UiU elCVnI.YI II a($)af:atllP. ~~T fl. Gonnal cornmerds and rocar,rmMal;orls- 40064 TESr&/> SUlTil le FdR A ~ovzl~.UT7O.uryL i.~ yYt o vv0 Po w rs - ~3; ° A'; FFvs ~ ~ //s • Poring # U Boring /0 p Pit Gmind suface Plev, / If De"i M Nettling facia - in. - > _ Sal ,licatia, Raft FiaAZOn l DepM Dordnant Cdor Rodox Description Texture Sh,rch%e Consistence Boundary Roots GPDi1F In. Mta,sefl W, Sz. Corot. Color Gr. Sz. Sb. _ T"I 'ERif2 l 0-So MW 313 sL Z,►e1 SAe S iii -f . S 9 SG Z-fshk sti c~v / ~ . s . 9 3 6 1 /oyrr LS %.et7/K Bodng U ' Pd Ground surface elev. fi Do;)", to limiting factor 7O In. - Sod Application Rate f lod)nn Depth DmInant (Am Redox rksaiption Texhre Shurh,re Consistence Boundary Roots GP_D/_ff In. Mansell Cu. Sz- Cont. Color _ Gr. Sz. Sh. 'Effk1 'E"2 / 0.7 i0YR 313 SL Z4"'f' d,, f4 3 f . 5' . 9 2 /1 &L y s/L z sh 4„~ , s .3- 4 3 11-21 7s Y/R ~I Sz- 2 -f ccs - s r ' Ef t;ont 01 _ DODO > 30 < 220 nxA and S >30 < 150 rrgrL • Effluent 112 - BODE < 30 mg4 and TSS <.30 ff9l l1 [U . It CST Nama (Phla" Print) Signature CST W ber R 0/3e'/? r 2-116 /i'il,~T •2 z co 3 7.5 AddersA Dale Evalmlion Conducted TebpMxn Number Ulbrich- & Associates rivate Sewags GORsaltar" )s,_, /G DeD 3 77S 77~ ~3y4{Z 2812 10th Ave. Spring Valley, WI 54767 i or issuance of permits and uesq-irg Conlact: Ulhdchl & Associates /Z Reg stered privale wastewmer consultant and plumbers 2819 10th Ave. yLIJ/S/~ SEe• /Z Spring Valley Wl 54767 715-7723442 ORIGINAL T30 giPD.y.4~✓ L.0 T" 2 Z rmpertyOwner Page of e !.'7.3 _ X Depth to Ilmiling fader 7 Rate ~3 1 rg a ❑ noting / 494-A-AA&Mm /7' 3 pit Gmund surface o tov. anl Color do. [).!sc tpt. Te.tUle r' Sz. S slstBdn+dary RoRe a2 In6lunsed Ou. SzCont. COllx Gr. Szh3 9 _ Hndg a Soriig v facto, in . _ Pth to Xndli1 Soil liwtion Rate ❑ pit Grolmd 5urtaceelev De horizon Depth tkxn111.t Cokx RoMx Description Toxlura Stnxdure consistence [foraxtary Roofs _GP[MP Gf- Sz. Sh 'Efla1 'Effa2 In. Munsed Ou. Sz. Cont. Color LJ poring - F1 BOdag It surfaca olOV fl. Depth to IerrM fader in. 1 Pit Ground Sod I'rcatiat Rate GPC)flf t4 d7M (),pill tbnnnnnl Color Redox Description Texture S e Consistence Fkxnxlary Roots TIM *Efla2 In. Munsed Ou. Sz. Cont. Color Gt. S Sh. L ~1I poring a U Boring GmundslnMceelev. it Depth M Howling fads In. Soil plication Role _I pit GPDIff i Texhne S6uchne Constxlence Botxxlary Roofs Ilodzon popNr pterr nt Cdn Red;, DesOd Gr. SL Sh. 'Efla1 ~Rq2 In. Munsell Ou. Sz. (:onl. or -r- and TSS >8(I < 150 -.It ' EtXrnfrd a2 = DOD, < 30 mgiL and TSS < 30 ngll • Effuerd a1 = ©OD+> 3< 220 rtg'l. r Department of Commerce is an equal epporlunity service provider and employer. If you need assistance to access services or The D need material in an altemate format, please contact the department at 60R-2G6-1151 or TTY 60R-264-8777. ten rIM IR Rret Z Z Pmpnoy(hvnnr Pamo.f ID M, raga nmingf/ rUA nodnq 7-5-20 3 KI MI :mun+l surfnrn Bleu ft. Devil, to limlinq lador> it, I l k d znn Uepnf Icnlion Rare - Urxnlnanl C:nla Red' x Uesrripfinn Tnxkne Stnnnfina Consisler" Suraxlary Rants _GPDM In. Mmanll Uu. Ss cont. OqA GI. Sz. Sh. 'nttpl 'EIfg2 0•9 goy, ?A zfs& =eesl 7 ~w 3 7a s -s c ftndny M Rnliny - - - - - Pil C+rnund surlarn elnv -n . DePdr to limilirg lector _ Fr - Soil P p'lic+flinn Rate lkdzm Ueplh f_krOe'll Color Rerinx Dnsnfpfiuo Tnxtum Sfnxiure Cmsistorx;n_ flrxlydary --RwL% GPDdf In. Munson On. Sz. Cont. Color Gi- Sz. Sh. 'EIItl1 'En42 DofirgM ff~ Rodnq I_ Pit Gnanxi slnlann nlnv. _ n. 1?eplh In IFnili fade, In Soil loafix Rate Ikxbcnn f)npnr Donrlonol Cola Rednx Desalptlon Inxhne Sir a Consistence Boundary Roots _ G_PUIff In. Munsell On. Sz. Cont. Color Gr. S . Sit. 'Ettpt 'Elfll2 flndrgp U &'tinp U Rif Gruund surface elev. _ n. Depttr In limiting fads In. - Sell Application Rate Hnrizrxf Doplh fRrminnnt Cnlor Rw1nx [Msnipl' xn Texture Shur9um Cmslstre" ft(xrn drug Roars GPILIN In. Munsell Ou. Sz. Gxd. ,drx Gr. Sz. Sh. 'ERNI 'ERN2 rmom l frI - ftOU, > -V < 220 nx;?L and T SS >30 < ISO uWA) ' FiMunot p2 - n00, < :u1 nW. and TSR <30 null- The Deparlmrnt of Connnrrce is an equal oppoilunily srrvicr provider and rmployrr. If you need assistance to access services or nerd material in an nltenralr formal. please confacl the department of 609 266 3151 nr I-I Y 609-264-R777. son Wren time z 7"' cf r J c 15 \y y ~ APK' Sri `e l 2 75 e /3~fC/~~at ~s 3. v. - • S, c"F c/Pnik SST, 13 ,y / 0 F TOP or 5 )/ea2 I P1% /Od, p/ ~ ~ M ~ ZZ C5 G