HomeMy WebLinkAbout040-1227-50-000
Prisconsrn Deparlnmrtof Commerce PRIVATE SEWAGE SYSTEM `a" ty. St. Croix
Wety a-d Buildinc i
INSPECTION REPORT Sa•utary Permit No
P.I IACI+ TO PERF,IIT, 606976
GENERAL INFORMATION t ~ slate P an lD No
r'ersonal m'ennudan y'm. art,, ae may M usej rx seroncti pit poses IPr aaay ! av,, s 1534 r'
Pennrl I'o dc•'s Name Ciy V. are Toxnship Parcel-ax Ne.
Johan & Brianna Persson TOWN OF TROY 040-1227-50-000
CSI UPA Elea nsp 3M Fie, BM Descn Dlior SeclrneTaavRargeMap No
~•Ob 13.28.20.1113
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER STATION BS HI FS ELEV
scplic Benchmark n *7^
Dosing All. BM
Q Cvl~ -1-W
Aerator - Bldg. Sewer
Holding St-'Ht Inlet Wg;
V
TANK SETBACK INFORMATION SVHt Outlet .75 Ct T
TANK TO P1 WELL BLDG 'dentb Ar Intake ROAD D et ti
Septic t
, Dt Bydsey-U ~i-
i
PA_
Dosing Hcaccr.'i -16
' -1 l tt . O
Aeration Ds!. Pico
Holding act. Systen' (
• O. O
PUMP/SIPHON INFORMATION Final Grade
9.~v
Man,dacwrer Demand st Cover\Lll
'Plat Yv Vf
Mcde Numb r
T DH t. fl for Loss System Head E ilH Ft
-
Forceh'aih ength D a U st b S've /
SOIL ABSORPTION SYSTEM
BED; IRENCH rV,Ct, -engtr No. Of T•encney~ PIT 0 ME St10NS Ni Of Pris Ins o Uja Liouic Dul
DIMENSIONS V/`I '1
SETBACK SYSTEM TO P;L J BLOC WELL LAKEiSI REAb1 LEACHING I:arufacturey-. 1
INFORMATION CHAMBER OR
` ♦~X`~ src.,[
T'ip^ O' `i)>lc"' - •-a r UNIT Manor Number
O Cam[
C
DISTRIBUTION SYSTEM at -
Headerl6na' fu d Dism ouap" x Hole Size - x hole Spacing Ve/y'toA r lr ke.
I C F 01" 11, Io
p
LCrg:O O Dia_ lengl" Da spat ng
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
i O,w xx Ceptr of xx svoilval SOdae xx MW ~rec
i;a:; r~er'cr Ce'tc t,~+ BedTrerch hopes TopsG Yey No - a% - No
COMMENTS: IInCIL7de code discrepancies pawls present, etc.i Inspection pt Inspect on #2
Location: 288 SALISHANN ORt,,.~ (/t^~'yti✓ 1 1
1 ; Alt BM Desorption
2.:: Bldg sewer :rirgtn =
amount of cover = g tl
Plan revision Repwred? - Yes No rX 1 1 A' ~/}NyV~ 1 u '
Use other side for and:lional informalion. ~V l~/~y U \O l l~~ O
'l 5-C rR.?!i'r DatF.' ins ctowSig" r-~~.~~ ('.nn ND
Safety and 6ji.dings Division SfcL J
sr Bs 'r - Ii 1 201Nt^ras.ungton Ave., P.D. Cox 7162
>amta: Pcani: Von na;ta b<EIIcL ra h. Co
'y~ PS/P F I. 1 7J1 h^altz n 1J S3 0 '162
t (~0~97(0
Sanitary P~rlnlt Application ~L vrr miri unh mbs
I,:a. d..: .c wvhC g_c . tY-tq„ t~ -.n,ssr r-f.fi•.I;cr tc lhc.ppr-pn <c. camc~tul tmtt
u rcqu:rrin rf :...umrr t,erite: pout ttrt \ppU a 'n fame for sale„wn:11 rg arc subl`I-.Jn
i
.nc n r.n 5 or: &A 5 n e 1w "M amauuu p;uvrJc ma, Ad'!: r,., i>: Jrffaem thou mwun; az'r~s
ikpa. t ~t..nsn:n .:.rs nr . uxJ :or c mian ,}}r' t~ I
trn~xs n s.. n.l.m... w Ih tic Yn.a:. Let 4,.1 m ,u:s. I 'r' f~ p SLa g t~l a✓x-.
I tpphcsuun Information - P urtPn_
~ _ion
j-0 n_f All Inform_ ar
f pcttt xnQ tl~amc _ ~~.~r%✓V
C r_»r.~~ I Ifs
r->~c'y r'unc .Mailer; Add[cu 2-~xtv.o-
///3
o' i~8 S 1, zt~ //~J o~.
I SMW G p .1,dr P>.unr Numbs
V: IFS/ o- Rr
fl, ype of Building (check all that appl
_
lo,: nrcly liwr':nr• - 7vranl.:a ~f Ncuo. $cid ivisr.:or N.
nQc
'r'chli:.i'..:nn<rilJ- ^cscriM Cr Ot ~ • /sar.J'e-~ ~,`°--~-i~
_ Cir; of _
Statr C xn a Detnl lh.. I : i< t. `A N,"w' - - ~ I Village of
xu.r,
z Ceps ..J 1z 1 Z2 ct_5
.1L'1'ypF-uYPermitC (Check only a h' nn line a. Complctr line R ifapplicable) - ~f - ---1
etr WsRn: ~'~Ift :p,arr .n S: a:r _7rcaLnrnl•11 Idin~.m.k Replaremcn::mly r7.ru n.hLCa: o4. ..x:+lm~. System ex my
t r~
R Par 4 t. ai: k un s: t -anyr o` Poor bcrT ~ I ntrz Trumt_a t 4ewi / tr`. r` 'T"'m/tt \wnira nnr/. L)at. tsu
I ::rttrn rt rrn ,r. - --_1 =h.2 r _ bl/ / V
I1,Tspiruf U _ m.C'omponctn•Dev;criWheck all that ai,L1111_- /
? re . V, :,rua.n~ C . n:. -y + , : -r ~md-.:1I<;nic MiacrJ w. of sat roe n: w : 70 in rt
T7131a1f ~ ~)'trr n_prrs.,.:I. r spl:At _ _ '1'rcncatrn nt Lk i¢ xrrl`r.u ~ Q
(f~~~tN4
\ Drcpersai beat,q°e/ot Area lofurmaUuu [fu .c u
C 1n E'i` /i 1 qpp-ri n i r y~r~s t Pcyuard nx a M1 ra a •,;It ' St:ncn: Iarv~jh
I V L'Lnk lolo ~eI r 6~ ~ , I I I ~ ~ i vf,, e - ~ V ~y~
\rw I.. t. rxi~<g 7z:r.
~M afro Lrµ : av: ~.x fl:x-oba ` -~~J
11ktespumlblht Stat nt L the undersiene me respousibilin• lbr inamllation of for PO"IS sbowo on the attached plain
I w N= '9n t - - I ?I SraalWC - Mf !\¢WKS vumb t
a f J,wcst pbpo' I ur9b.:
l? S~ ~Ju 511_
~ 111. alv.Dr artnten f 1 tr Doh
Y' F'crn'n:Ct L:IIe'~SLC IS$ela Scro S1gwa - -
~ .pp: o.rd ,r...-++rsepf-»'r`~ - e
J ,•r er f -end . ~ IZ /l~/ ~ ///"''III
I\. Coodtl 1 enson
s for Pisapprot'tl
)Inv VM1
uisl.`e': c II r.t-.1 r p c s' nn(~c
2 FJI Setfsa k reCl ens fall t Lt r t r c \ 2S
as f'pprc b r v' rd v> O u 6
as per .na lr^ c ~trrra r m.v 1lu nbe..cl,m: „1n<<„~ r arr~, t• i,.. / ~
Soil Test and System PLOT PLAN
1,RoJF,C"1' Johan Persson ADDRESS 288 Salishan Ur. Hudson Wi 54016
Ira U4S 13 /T 28 NIR 20 w rn1VN Troy CoCN'rY ST. CROIX
SYSTEM ELEVATION 94.3/942' 4.5' 12/11/18 BEDROOM 4
DATE
CONVENTIONAL. XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC 517.1? 1255 gallons LIFT TANK SIZE DOSE 'TANK SIZE;
HOLDING '1"ANK SIZE LOAD RATE. .7 ABSORPTION AREA 891 # of chambers 44
RENCIIMARK V.R.P. Base of survey stake ASSUME ELEVATION 100.0' Filter Lifetime Filter
❑ BOREHOLE O EI,L x 11. R.1', same as benchmark
476' Properly Line
Scale = 1/4" = 10'
jL, Quick,l Standard
eaching Chamber
ith 20.0 I12 of Area
.6ft^2/pair of end caps
Grade at Svstem Hle.vat ion
T 4Pro I
Bedroom
Ilouse
i
2-3' X 90' cells with >3' spacing 20''
B'; B.N1.
'
>251!i slope 4~ 15'
.S
O1rt Slop. 2
l o'
Vents
20'
B-2 120'
All piping shall he ASIM SDR 30/34, within ar24 30'
10' of tank, piping shall be ASTNt 1`891 Salishan Drive.
130'
L r '
I -
Cs-*-ae1~ -3cG
Wsconsin Department of Commerce - S - ` V MLNATION REPORT Page -of
_
Dvisinn of Safety and Buildings
in accordance with Comm 85, Ws. Adm.. Code
County.-~
Attach complete site plan on paper not less than a 112 x 11 inches in size. Plan must
include. but not limited to. vertical and horizontal reference point (8M), directon and Parcel ID
percent slope, scale or dimensions. north arrow, and location and distance to neares! road. 0 C)
Please print all information. Revie by Date Q
Parsons) omormsuon you provMe may oe used tot secondary purooses (Pnvecy uw, s 15.04 (1) pn))
Property Owner Property Location
~ o A- P r Govt Lot 1/4 1.4 S T N R~ j ( W
Property Ownor's Mailing Address LoLt# . /pr M#
n Blod# Sb
1~ 1917, City ,State Lp Code/I Phone Number 0 City 0 Village ;@;-TQwn Nearest R0
Q ad
k1 1 f r
egAkw Construction Useesidemial 1 Number of bedrooms _ Code tlen design flow rate 6GPD
❑Replacement 0 P or wmmercial-Describe:
Parent material X11 ;-/chA-Kilo Flood Plain elev n i` applicab N.
General comments
and rearm!endatwns:
L
System Type( System k-levaluui 19 c/
1 Boon g # ❑ Boring y^
® pit Ground surface elev/ f _Q R. Depth to limiting factor in.
Sal rabon Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsea Qu. Sz. Cunt Color Gr. Sz. Sh. 'Eff#1 'Eff#2
)Z
Z /1-3b s" ~ C c
1
X4 f 1, . A,
Boring # ❑ Boring 9-1 U
0-pi! Ground surface elev ft Depth to limiting factor f _ u1.
Stiff Application Rate
Horizon Depth Dominant Color Redox Description Texture Sbwure Consistence Boundary Roots GP04F
in. Munsell Do. Sz. Cont Color Gr. Sz. Sh. 'EA#1 'Eff#2
? 1
17
(
Z
4tn 7""
• Effluent #1 = 800. > 30-< 220 n WL anh TSS >30 < 1jrjture ' Effluent tr2 = BOD, < 30 ngrL and TSS < 30 m(DL
CST Name (Please Print) CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Lv W -eeon Condudod Tnlophnnn Nnmmr
1432 120th St, New Richmond, WI 54017 ~,t - ~~1 715-246-4516
Property Owner_ Parcel IDY__ Page _ol___
a Boring # Bonng 0
,
- pit Ground surface elev. a. Depth to limiting factor- in,
Sal Application Rate
Horizon Depth Dominant Color Redox Descnplion Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr Sr. Sh. 'Eff#1 'E##2
L t , c r
i
0
3 g ~-Fsc~
C Bon N Boring
Pit Ground surface elev. tt. Depth to limiting tailor in.
Soil Application Rate
Honzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPON
in Munsell Qu. Sz- Cont. Color Gr. Sz. Sh. 'Etf#1 'Eft#2
F1 Boring # ❑ Boring r
❑ Pit Groundsurfaceelevft. Depth to limiting factor n.
Soil ication Rate
Horizon ')epth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfff
m. Atunsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 _ BOO, > 30 < 220 mg/L and TSS >30 < 150 rri ' Effluent 92 = BOO, < 30 mg/l, and TSS < 30 mgL
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or Try 608-264-8777.
1B L' \I CiR 0?q
Property Owner Parcel ID # Page of
a Boring # ❑ Boring
pit Ground surface elev. r~ h Depth to linutlrg factor n
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Stnuhre Consistence Boundary Roots GPDlff
in. Munsell Ou. Sz. Cent Color Gr. Sz Sh. 'EB#1 'Eff#2
r cJ
i
r-T
Ong # ❑ Boring
❑ pit Ground surface elev. ft Depth to hmihrnG lactor in
Soil Application Rate
Ho nn Danth I tkvrvnant GoInd Rednx rkc - intion Texhue Stmchre Consistence Boundary Roots t;PDtW
in. Munsell Ou. Sz. Con:_ Color + Gr. Sz. Sh. 'Eff#1 •Eff#2
I
Boring # ❑ Boring
❑ Pit Ground surface elev. tt. Depth to limiting factor n.
Soil ftoication Rate
Honzm ')epth Dominant Color Redox Description Texture Structure Comistence Boundary Roots GPDA'
in. Munsell Ou. Sz. Cont. Color Gr. Sz Sh, 'Efl#1 'E8#2
' Effluent #1 = BODr > 30 < 220 mgn. and 'SS >30 150 mglL ' Effluent #2 = BOD, 130 mg/L and TSS < 30 mgt
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, plcase contact the department at 608-266-3151 or TTY 608.264-8'77.
sanxiw re snq,
Soil 'l'est and Svstern PLOT PI AN
PRO,IE 'T Johan Persson At)m ss 288 Sahshan Dr_ Hudson W 54016
Ir4 li4s 13 rr 28 N!R 20 w TowN Troy COUNTY ST. CROIX
SYSTEM ELEVATION 94.3'94.2' 4.5 ,e M~ - 12i'1'18 4
DATE BEDROOM
CONVENTIONAL. XXX CONVENTIONAL LIFT HOLDING TANK
1L55 gallons LIP°r TANK SIZE DOSE TANK SIZE
MOUND SEPTIC 'I ANi'SI/.E;
HOLDING TANK SIZE LOAD RATE: .7 ABSORPTION AREA 891 # of chambers 44
BLNCIIMARK Base o-survey stake ASSUME ELEVATION too,o' Filter LifelinIC Filler
-❑BOREHOLE O %%*LLL -1I.R.P, sameasbenchmarK
476' Propcrtq Line
~'cnt
Scale = 1/4" = 10'
C)uick4 Standard
of Cover Leaching Chamber
with 20.0 ft2 of Area
5.6ftA2/pair of end caps
1 2"
4' Long
Grade at S%-stem Elevation
34'
Pro 4
Bedroom
House
2- X 90- cells with >3' spacing
B_; NB. M.
I5'
E1.4 ~4 >25% slope ST
0%1 Slope
10'
Vents
20'
B 1
B-2 120'
All piping shall be ASTM SDR 30,r34, within 30
10' or tank, piping shall he ASTM F891 Salishm Drivc
1 30'
s®4w a o 1& _ ~f o a
_ Srtety rlnc 6u;1'iings ~mislcn /r ~
0 , 201 .1'. J:'a h ngWr Ave P.O. Box 7172 units: PrnIn near Ar :r filed m by [ai
$ Y q 7~ Idad m +'J' S 0 f7
PS 1•
Sanitary Pormit Applic,cila n.. $;ru 7-cuaa oo nmhs
.n aeund:m < u, 11 tT$ is I , "V:-, w , . ..:'1'i , .i A II is f u r n c :n _.rcq , 9e ',ovrtvcntal MII
n mgvimd pro. t<,b'.:inl., 4..tL yeau. '!.e pM .,....u .mas um _.al. oonv.C(i N
'.'S uesubmmed a:, %Aaonz ",ddd;u:u' Me,:mviiug add.-ml
thr D-P.Amtw - f Said, r Prd ional Sr t s i'rs nsl i dmrrwouL 1>u , %.^c mn 1 used tt.'se:aucsz' ~p
Ln,¢ly i,u<pn-u.l l..i,
' s.:d,l iimi
tTJO:KSmS.-nr p~
L A licati n Informam hplease P{!ui 411 Infonuatiun ~ ~ 1•~ Y
sI-
?rapctty ndS Name
PL 04/o
•1ropeRy jUwaci sC'~5at2mK ~t J~dwss / l4op..u .._ti.u. (F3. a$.aO. (tl3
7.ir k-mL c Phon: Nun.ba
_ r LAlJ \ _ Z p r.. Cam(, w
17 'Type o(- y v Building (check all that apply
Paiua A)<4wg Nc:nbcr ofSrd:ox < Sind.,auu N:a:,c.
6)c_
~ ~Arh(idC;annrerc:al ">=srtbe.i'r _ _ ~ 1
-~n e 3~~ t7 ~ ~ 1
J Stae~*anni 0.-,:4`•e ~ic _
wry a: _
llI. Type _(C•hick uul one box on line 4 Complete line B It appl I
A' - ~r+ ¢..r.-t Rgtacc, leap Sy..,.,:, 1 ~ Trcm:MUOI Lf,.:_ Tau -.n.. t t,5fic.az, r m si.Iiu;: $r mm iezplam'
J~ - I -
It. ;a. I 1 'vam n 7 r , , .r. i'~:rrnu t:+vr.Mr and Date issuee
Fctwt r2eM ,v,
wa - ru: Kc ,
D<A cc t vxtOn
W. ufPONTS l-ompnncnc Uamc. t( heck )
ry _ Presser's.: T"ror nu •',c b , _ nmA _ <l m of nmah,. r S earl 24 m nn-ark ,,j
I :yO1C1 ^ 194, f ~5-cSM,t C 1 ,(t I *.^pI St _ _ ❑ heUr4urimt LKNU '%blJ i
S Dislwrs( al beat t Area lutormauou _ - _ OGL
Fx ea „n S I b am Rnle; Ss , Lu,ML. 1 Atc, Rgw-cd r, ✓ Dts cr,aa A G. px n(. "It' I-l " C
_6O ~I.:
l>pwih it f _sl is S._ ufa emu.. _ tT _
VI. Tank Into
C't')-r s zllous mu,
u o a`
fin.. xi7nlii'4.
1TL Responsibility' Statement the uodi m.Xcuvl. aI u r e,ponubdny for Innmllation of the MINIS showe on the amchrd plans _
Y rnnicr _ Vso •'rlat' T'.") x- :;:n:surr MP:' IPF Numhr k:nwr i11ne Numb
11 ne> t4lrcr' C" Sl'te. Ltp
W. ount_vrD_ cpartmcnt l se dryly _T
Approt cd ~j-_. --a:ntt Pcc 2rte su ?•I y
S T5 4q
1, lo ir
IX. CouAl n ~i r'r~~F uona for Di a nval - -
a ark e1 t;r.
1nt tt r
ll tnt pp 3j 1 f llzce V-C
6hper ,cell r~ucl ell be ~ :IC _'S `y!= 1 • ~1}' '
es per mar 3yemen' pl n o tae-1 by plu,nhe.. I I S~ (~l5 ZS /a
2. AN P,k tactile!^err., rwPot be r. .m II.(: !^VD d b~r~~cl.n J I/
as per A Kk4)Ww c.,x'is i :rrCuIru
- _ atneb to a,mptrar Dlam la rM garv..uA>uUmn rt,r Cnw+n omv ea V+1^ um less were F r;•: t 1 iurhee m vrc _ _
Stitt-C,.19R tR. 11!I1 V
System PLOT PLAN
PROJECT Johan Persson :NDDRE.Ss 288 Salishan Dr. Hudson Wi 54016
1/4 1145 13 /'1' 28 N/R 20 W TOWN Troy COUNTY ST. CROIX
SYS'IliNI ELEVAII ION 836.1:836.0,1835.9' 4.4' below 11x'18/18 4
DATE BISU ROOM
CON VRN TIONA I, XXX CONNTNTIONAL LIFT HOLDING TANK
NIOUND SEPTIC TANK SIZE. 1255 gallons LIFT 'DANK SIZE DOSE, TANK SIZE
IIOI,DING TANK SIZE LOAD RA FE .5 ABSORPTION ARE:% 1216 k of chambers60
BFNCIINIARK v.R.P. Top of 3/4" rebar ASSUME B:LEV %TION 842.51' Filler Lifetime Filter
❑ BOREHOLE O VI.L x 1I.It. P. same as benchmark
Q-5 10' }3 _3
111110.
476' Properly Lino 10 100'
Scale = 1/4" = 10' B 2 80 3-3' X 82' cells wilh >3' spacing
vents
10'
ST
R-4 B-1
' 10'
80
Pro 4
_ 13edroo ,
House.
T r
Vent
>6" Quick4 Standard
of Cover Leaching Chamber
with 30.0 ft2 of Area
All piping shall be ASTNI SDR .-30/34, within 5.6102/pair of end caps
M' of tank, piping shall he ASTM F891 4' Long 12"
34 Grade at System Elevation
'
Salishan Drive.
Cover Page
Shaun Bird
` Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 11/18/18
Owner:Johan Persson
Location: Govt Lot 2 S 13 T28N,R20W 288 Salishan Drive Troy
Manuals Used: In-ground absorbtion system (version 2.0)
Page4
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4. 6. Maintance and Contigency Plan
7. Filter CrosSignatureLicense num 'l-
L1226900
it
j~ -
F
rein TU7w 7lu ::U' _
Ti. I cP
v
~ F 1" 1 0 J 4.;µJ"
- 6 1 r Q ~
i ~ 7 , }i ,rtes?"
~F
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care ,r
System PLOT PLAN
PROJECT Johan Persson ADDR6:SS 288 Sai:shan Dr. Hudson W1 54016
114 I i 4 s 13 !-t' 28 VR 20 W TOWN Troy COUNTY ST. CROIX
SYSTEM E_LEF'A'1'10\ 836.1!836.0'835.9' 4.4' ')Clow 11/18!18 4
DATE. BEDROOM C ONVEN110NAL XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 galions LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1216 # of chamhers 60
BENCHMARK Top o` 3i4" rebar kSSC NIE F1.VVA'1'I0\ 842.51'
Fihcr Lifctirnc Filter
❑BORE110I,E 0 %5ELL "H.R.P. sameasbe'1Chmark
B 5 B_3
476' Property Line 10' 100'
Scale = 1 /4° = 10' B 80' 3-3" X C cells tNith >3' -1 -pacing
Vent
10'
S'
B -4 B-1
$0' 10
Pro 4
Bedroom
I louse
Vent
>6- Quick4 Standard
of Cover Leachinc Ciunher
with 20.0 ft2 of Arca
all nipino shall be AS TM SDR 30134, within 5.6ftA2Jpair of end caps
t!' o; tank. piping shall be .1S 1'vl P891 4' Lono I
Grade at System Elevation
1..
Salishan Drive
Cross Section of Quick 4 Standard Leaching Chamber
Typical cross section for 2 of 3 cells
Quick 4 Standard
Leachin Chamber with
20.0 ft2 of Area per
Chamber 5.6ft^2 pair of end plates To be >1' above grade
/ Finish grade elevation
Typical Installation i 840.5'
Vcnt Grade Vent
4 A/30/34 Septic Tank 4
1' Lone I > 5 T
T' Long,
Grade at System Elevation
31" Grade at Systcrn Elevation 34"
Spacing 5'
3-3' X 82 Cells
Observation tube/Vent
Same on other end To be located on end of Cells
20 chambers per cell
A
- B
System elevations: C
A836.1 '
B 836.0'
C 835.9'
POWTS OWNER'S MANUAL & MANAGEMENT PLAN rave!of_
FILE INFORMATION /
SYSTEM SPECIFICATIONS ~
Owner _
Septic . ark Capacity a; G NA
Permit# -
Septic 7 ark Manufacturer NA
)ESIGN PARAMETERS Effluent Filter Manufacturer 0 NA
Number of Bedrooms 0 NA t fluent Filter Model 0 NA
Number of Public Facility Units -$4NA Purnp Tank Capacity al NA
- - - - -
jEstimated flow (average)
_ q
gaUday Pump Tank Manufacturer NA
I Design flow (peak), (Estimated x 1 5) Pump Manufacturer _ NA
u auda
Soil Application Rate - - dal/daylrt` Pump Model - - - NA
Standard Influent/Effluent Quality Monthly average' Pretreatment Unit NA
Fats, Oil & Grease (FOG) 30 mgrt. ❑ Sand/Gravel Fitter 0 Peat Filter
Biochemical Oxygen Demand (6005) X20 mgl :i NA 0 Mechanical Aeration 0 Welland
Total Suspended Solids (TSS) <150 mg/l. 0 Disinfection O Other.
Pretreated Effluent Quality Monthly average Dispersal Cell(s) 0 NA
Biochemical Oxygen Demand (BOOS) 530 mg/1 to-Ground (gravity) 0 In-Ground (pressurized)
Total Suspended Solids I, <30 rrg!! ` LJ At-Grade 0 Mound
Fecal Coliform (geometric mean) <10` cfu/100m1 ❑ Drip-Line 0 Other.-
-
Maximum Effluent Particle Size Y6 in dia. C: NA Other. ❑ NA
IOthnr. NA Other. - 17 NA
'Values typical for domestic wastewater and septic lank ef9uen-_ a'1e' 0 NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tark(s) At least ova every: ❑ month(s) 'ears (Maximum 3 years) ❑ VA
)Pump out contents of tank(s) When combined s.udge and scum equals one-third (36) of tank volume 0 NA
❑ month(s)
inspect dispersal cell(s) At !east once every `j '~,(s) (Maximum 3 years) 0 NA
lean effluent filter At least once eve I month(s) r
every. _ year(s) 7 NA
inspect pump, pump controls & alarm Al least once every: ❑ month(s) 0 NA
- _ _ _ 0 year(s)
1=lush laterals and pressure test At least once every: 0 month(s) NA
0 year(s)
-:they
. E: month(s) At ;east once every E: VA
Other------ - year(s)
- NA S
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shat) be made by an individual carrying one of the following licenses or certifications: ast&v
!Plummer; Master Plumber Restricted Sewer; POV`!1 S Inspector POWTS Ma.nlaner, Septage Servicing Operator. Tank inspection must
!include a visual inspection of the tank(s) to identify any m ssmg or broken hardware, identify any cracks or leaks. measure the volume of
xmbined sludge and scum and to check for ary back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be
visually inspected to check the effluent evels in the observation oipos and to check for any pondiny of effluent on die ground surface.
The ponding of effluent on the ground surface may indicaie a failing condition and requires the immediate notificaton of the local
Pegulatory authority.
When the combined accumulation of sludge and scum in any lank equals one-tnlyd ('!a) or more of the tank volume, ;he entire contents of
he tank shall be removed by a Septage Servicing Operator and disposed of in acccadance with chapter NR 113, Wisconsin
Administrative Code.
AJI other services, inducing but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units.
and any servicing at intervals of •-:12 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the boat regulatory autnonty within 10 days of completion of any service event.
Page -of
START UP AND OPERATION ducts or other chemicals tt*t en of painti For new construction. Prior to use of thePP OWTSc ec dispersal ce (s)s) If filth concentrations
are detected have the contents of the
may impede the treatment process
servicing operator Prior to use.
tank(s) removed by a septag
System start up shall not occur when soil conditions are frozen at the infihrafive surface.
During power outages pump tanks may fit above normal hlgtwvater levels. When power is restored the excess wastewater effluent will be
discharged to the dispersal calls) in one large dose, overloading the cell(s) and may re" in the backup or surface ischar9e fl the
To avoid this situation have the contends of the pump tank removed by a Septage Servicing Operator Prior
effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal leve s
within the pump tank. the area within
Do not drive or parts yehides over tanks and dispersal cells. Do not drive or park over, or otherwise disturb of compact
15 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 POV\(TS-
antibiotics: baby w4m; cigarette Mme: Condoms; cotton swabs: degreasers; dental floss; diapers; disiinfedarts; fat foundation drain
(sump pump) water; fruit and vegetable peelings: gasoline: grease; herbicides; meal scraps; medications, oil; painting products;
pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out Of service the following steps shall be taken to insure that the system is prope' y
and safety abandoned in compliance with chapter Comm x3.33, 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 properly 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 code compliant
if the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a
replacement system:
--3d--$. suitable replacement area has been evaluated and may be utilized for the location
shoof a uld placement soil absorption upon by 'eQukied
The replacement area should be protected from distwbance and compaction
setbacks from existing and proposed structure, tot lines and wells. Failure to protect the replacement area will result in the neled
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules/ 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
holding tank may be installed as a last resort to replace the failed POWTS.
❑ The she has not been evaluated to identify a sufteNe replacement area. Upon failure of the POWTS a sal and site evaluation
roust be performed to locale 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 place falowing removal of the biomat at the infittraiive
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 pONlTS MAINTAINER
/ Name ~J`t_!5
Name
Phone Phone j -
SEPTAGE SERVICING OPERATOR P PER LOCAL REGULATORY AUTHORITY
n
Name /,y.,✓~11.1 Name
Phone L, j Phone 3
This document was drafted in compliance with chapter SPS 38322(2)(b)('~)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code.
7
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CROIX COI T k
SIT'IIC TANK NIAINT13NANCI tGREFMVNT
i%ND
OWNFRS1111) CFRTIVICATICN FORM
Ntailinr; Address
1'repcrtY Address
07erificatiou required froth I'lennrng A•- Zunrnp L)cpa:t.nenl for new ronsuzlction.j -
('1tY'Statt? P'eTTc! IT•rtitication N:rrahc:r 0''46 - f , - L -7 560
LEG-M. DESCRIPTION
v-,, r ~c r L _
PropertyLA)Calaon Scn _ _C kk.Townof
Sul)dl' miorl jJ'. N~
71 Ot r..-
Certifiers Survey Map # - - Vc dime ~ Page #
Warranty Deed Vohune page rt
tipa; lions, •,:c.. uo Loh line Acntiffal;lr v~ i - - - - -
SVSTFM M.AINTFNANC,F, AND OWNER CERTIFICATION
Improper use and Inaintettance. of ynm comic system could Ie moult In & pmmature failure to handle waste Yroprr
nrairricnauce wnsists of-Punrpine out file scpnc rani, eveiy Luce pear.: oI snonm, a nccd,'d, by a hcensed Punrpch. What you trat nun
the syslenr can affect Ise tunctioo of the septic Lank as a treatment. stage. in the waste thsposaE svswfll. Owner maintenance
rrsponsibi~ties are specified iu Ot :omit. 83 `:2t l) and ci Chaptca ;'1 - `7 t. Croix Couuh`smiiuy Utdinaucc.
The property owner agrees aI sabwit to 5r. Cu,is (.ourty Pfrnwing Bc /err..ng Dcna rrrnrnl a csndPeation Ibrm, signed b~the
o•nncr and by a nwstet plumber, lounwyman plumber naurc'ed plus bvt c; a hcenscci purlrpet vorifyuil; Ilia, (1) tlrc on-site
n-smewater dispma! sy:steat is in proper opet aang couditim: audlor {2) after inshrcuun and puniprne. (I! twccssary), the septic tank i;
icr,s than R3 full of Sludge.
Uwe. the undersinrmd have read the above reuuircmeub: and agree to Irian.lam the private sewage disposal systent with th'a
standards:<et torch, herein as set by the Depat lain of Cormimcr;ar(i the !)vpzrtrr.em of Natural Resources, Starr of Wi"'ImIa.
Certification seating that yotu septic system fuLS been rrainta)r.cd nm%i he cor pleted and retulned to file tit. Croix Counhc Planning r
Zoning Dcpamneat within 30 riays of the threc year expiration 4atc-
L''we certify that all statemer.ls of rhrs form sic. irI to III(- bet of :uy/ow kr owlud,-e. Ifwe aturarc the owner(s) ofttho
propetrv describe([ above, by yirh ofa <tud ly fired tec.otdad III Rc.el to of Dec, Is Oflwc
fl
Number of bedroixL-i-
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*~1 ny infomration that is rmsrepreserrtcd roay veswt in the sans .
tat,c n.rral h;_mi, n+voked 19 thu I arming 8c 7_onmg Depatriuau_
in i rdc with this application a n;corded warratw, died hint) d :e
zne a clgry of the rerlflicd sax c`r chap it
reference rs made in the'.varranov dred-
(R t'. V. 08/05)
3.29 ACAFS \ - -
i 1A3<29 0, FT,
9 _I O:
b rn
Y ^ LI D acres N 616 •
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3~ o \ BUIt Ol NO SET9ACK.("-may L
CO:)' urn I(NF
100 W .
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z- aes 83 a-
( !22,329 sc g M.
EXI ;TI);5 3D W'DF :NCNESS I * .
-AND EGRESS EASEMEN-. 1
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Ysecors<n Deru•trnent of ndu;ay• SOIL AND SITE EVALUATION REPORT Page t of-3
pr and Human Relation.
i r4 -ision of Safety & HuMinas f
In accord with ILI IEi E13.OS. Wis. Adm. Code COUN^
r
Y• C'"D 1X
Attach complete site plan on paper not less than II 112 x 11 inches in size Plan must include, but
not limited to vertical and horizontal reference point (BM), direction and % of slope, stale or PARCELLD. #
dimensioned, north arrow, and loranon and distance to nearest road. 4~ ~ - S3 ceb
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PPOPFR7Y'CW'NIH \ARCC', %3,t,3 ; ~.vDD 9 PROP::I'YLOCA'ION
c-)o S-TtV 1-tJ c.upp cC':7. LOT 14 va.S NF 2A EI w
PROPERTY OWNER S 1.0A!I INC ADDRESS ' 01 R I B'JOCK4 SUBD NNAF OR CSMft
N\-c.o Ott ~tp6L ~_~_-!ut - IY t'~_AT OF s'AIISNAtJ
CITY, S-ATE 211 100-1 PHONE NCMBER ❑C TY ❑ViLLAGE IUOW.V NEAREST ROAD
~~~vC12 Fn~~S.,i S4oz2f)IS) qZS_ z)S7 T2n f t'RST' Cal ut_ RAFlt~~
New Construction Use 1k1 Residential; Number of bedrooms U I Addition to exsting building
L) Replacement ; I Public or commercial describe r - 1 (
Code derived daily flow b o O gpd Recommended design loading fate s bed, gpdrft2 C- _trench, gpd'ft2
Absorption area required C,10c3 bed, ft2 N1300 trench, ff2 Ma nmum design loading rate bed, gpdM,2 0 t> trench, gpd'ft2
Recommended infiltration surface elevation(s) S e'II PAGG 3 of S It (as referred to site plan benchmark)
Additional design/ site considerations DoS~D ZTYEUCI}r;S ARC 1Z~-CO'IwIC~~~D .
Parentmaterial 5i'_?tit Sftfinewr ~~~R SAwD a <i-VAuGt- Flood piainelevation. ifappkable v-/~. ft
S =Suitable for System CONVENT`CNAL MOUND INGROUND PRESSURE ATGRADE SYSTEM IN FIL HOLOM TAN(
U= Unsuitable for system MS ❑Ll ES ❑U WS ❑U IRS ❑U IRIS ❑U ❑S ®U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Cortsstence iBOLrldOry Roots GPD/ft
I in. Munsell Du. Sz. Cunt Color Gr. Sz. Sh. ; Bed rte
114 Zy I~vR 3,4,
- 1 z (s'SK tr _ U.L
Ground 3 1zy-3u to 1t2 3/e - s 1 ~sbk mv'<v c, 0.~1 0.5
elev.
f_ft y ~0 60i~•S`/R y/6 I ~SflTS O S~ 7l cS o•5 o.l~
Depth to dD_R0r,O`92 y/y - S v s9 1 - • J.~ o.
limiting - i - - -
factor
Remarks: _
Boring #
z 3 Lf lotitz 3/b 5t_~~ L z ~'shk m F a1 ^,so•l
~ c o S
Ground 3 21-2; 10 `1 R _-7N ,107 1 1 C Shbc itl 0i
elev. y C. is S b Q y Ir~t! ~s o c S o o. L
(j 7
Depth to - 6 G I D/ R 4;_ 5~ 5 S y to c S o S 'a
limiting v 66-/3 ! u `rrz i y ~l~h1a i] i 7 1 u 0
factor .•e O Sy J
3 6.
Remarks: Lo , r
T Name:-Please Prin; Plane
Arthur L. Weperer 715-425- 0165
_
egerer Soil Testing & Design Service-P.O. Box 74 River Falls,WT 54022
Signature. , Date- CST Number:
✓JLcvz-'vJ~ t 9 3-03 r 9-93 M00576
1
3
PRCPERTYOWNER tlA4t J" ,wOp acwo SOIL DESCRIPTION REPORT Page, 2- of
PARCEL I.D.
Boring# Horizon Dewh Dominant Color Mottles Texture Structure ConsistenceBorrxzuy Roots GPD/ft
n Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed 'Trench
'INA
-c- 0 -IV Z_ 3
1O-f2 3/L - L L~ 5h'ti >n FI- S L
Ground e)- 28 113 `1 R 31L - ~ ~ ~ C S Uk m v'F t•- C S o `-I . o -
elev.
8`to.5 ft. 2$-q7 "~.54R ',V6 - ~5 5'~S 5- vh 1 CS 0-S Depth to S w- z N(342 y j(/ - 5 ~f FS Q) S) wj 1 c
S o• S o b
limiting
factor z_ l !O yiz yly - S ~y J ° i o.
!
Remarks: _
Boring # l
z l Z - l- l U~^~ ~t -r S u . L
41 z w.ty. 1t3 \M 3/b - L z Sbk to<r s ~•r
g iq-2y 1078 3/L sl ~,c5uk MU'E1-~. CS ~•~!!o•~
Ground
elev. ZQ-y6 -.5 ~2 vl6 - Isms r~ s M~ cs Sio-h
S U6-b8 l0 12 v/y S ~I FS v Scf wh 1 c ; ° S 0,6
Depth to - - -
mitrg b$.ao lo`>G `//y - S O Sq wt 1 p. U•Y
factor -
17
i
Remarks: _
Bor: g # L 5h t v-
5 ~~-zl lOye 3/ice - L Z~ sblc to O:S o- S ° ~
3 zl-z9 IOMR - s\ 1 `sbk InU Fy e s I o S
Gromd - -
e'ev. Zq-4y v/6 - 1 ; a 4S S5 w ) e s o
- 5 4$.65 l OLle. 415/ - FS O S9 ir7 ° S 0.5 u.'e
-
Dep h to
~imiting b-d9 07~ y// - 5 s~ ~n 1 °.~u•'$
factor
Remarks:
Dor ng If
Ground - -
e ev.
- - 1t.
i
Depth to - -
limiting
'aclor -
Remarks:
=RC> Cl'7NEp.''Ak.F-,_:~r',:=iv\ a SU SOIL DESCRIPTION REPORT
PARCEL-D
DE-Dv- Dominaw.:;olor hhoItes Structure GPD:ft
3ur:ng ft Horizon) Texture Qt: Sz. Corr_ Gr. Sz S n. onssxncx- Sourrla} Roos lamed iTrend-
n 4:ucse; Color . yyn.
1J iSZ 31. - ~Dr
'arDUnd
l; zE-~:; dr 16 - srt; o sj
ucalr :o 1O"¢ y'y C-
limitin^
,actor ~ -'t` - ~ j J'=• n-'--
I
Remarks- - - - -
Boring
ft. -'4 ! 9 1 O "2^ air 1 j5j,r` h^, Y~r w J p. ~ Oc
Found - ~ 1- 1,
01 ~v
5 hre-h.J iD"j2 y,ip• ~ ":.`-S V C4 M I i p.S a <
Cl-clt. tc 7 - .
Remarks:
3o'irr
J H- ~ L-_. I 'i ~ `1 Q ~ / c ~ ~ C. Z c tJti 1rI S• U- 7 .0
3 Z9 i~Lh i;_ 51 1 _s'o~c mu*'~ cs
elev. y ?9.ajl! -S.Syiz V/r - S Eti
-
Depth t0 - - - - i
I c
Remarks:
3o•irg k
.
,
Groinc - Depth to cn!hng F-j - - -
PLOT PLAN Page of-
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SCALE 1 tl
`..O C_J~TI D fJ
St~cTCN 'U
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0
O 1II ` 3/V" ZE-gN2 w/Lh TN
R.D. wi r*t, 840 6 ~
ANtctui Rn, iw~ B-$ B-3
5' ~L"Z%pJT laT
j t-tom 5u I~KDI-t ' 1 Fo1Z
f I ei bvo ~ I tTl HL 1~>J~
~,~I .I I ,~~TL~~lJn1E SySTEns
17 80 I 1So'
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b.y _BA J
tt.bYO 3 80, ~'t 5Y0 3 n
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\1~uSt TO Qt RT l-l`~'A 1`1' ZS• FiZuN ~RA'tn~F~~LDS.
'vJ LPL w Sp'
'-jOTT~1'iO`- X45 ~'✓I 1~, C..,._ 't~T _Z FN. -a 6..,
715 ) 119,5-01,1,9 1400576
CST Signature Date Signed Telephone No. CST #