HomeMy WebLinkAbout016-1070-50-050
V; saxrsn Depacreent,r rnrnrn:•"° PRIVATE SEWAGE SYSTEM Go~ntr. St. Croix
S=fety and Bt, id g ovas on
INSPECTION REPORT Sanitary Permit No
GENERAL INFORMATION to T TAC1 I TO PERruT) State Plan ID NC 606977
Pefs,ral rfoc-Mier ve:, r'nvme r* 'ay he used 'C' sertrdwy aaraeses [rwacy l aw da :11:,,, 11
3162699
per-.t Holder's Name. C t V.la;e Tdwn9rrp parcel Tax No.
Laurie Goetz TOWN OF GLENWOOD 016-1070-50-050
l'S'BM ELV. ^so. Blvl Elev. BM Description So,tn- 7,-.1 No
33.30.15.4938
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS FS ELEV.
Septic Henchma•k
Dos rg Alt BM
Aeration B cg Sevier
Hoiomg SUI It Inlet
Outlet
TANK SETBACK INFORMATION SUI O
TANK TO Pit :`JELL BLDG `Je-I :c Air Make ROAD Of Inlet
Septic Dt Bottom
Dosing Headerlotan.
Aeration Dist. Pipe
Hcldinq Bot System
Final Grace
PUMP/SIPHON INFORMATION
Maru'azt-re' Derl Sl Cover
GPna
Model Nonoci
rDH Lih Friction Loss System Head TDH Ft
Fcrcemain Length DIa. Dir.. tc lr.-ell
SOIL ABSORPTION SYSTEM
BED/TRENCH Nmo' LenStr Nc. Cf Trenches PIT DIMENSIONS NC Of rfits Ins de l:e 1-
DIMENSIONS
SETBACK SYSTEM TO PrL BLDG li LAKEiSTREAl,d LEACHING fvlanl.la ct..~er
INFORMATION CHAMBER OR
T'ipe 01 STSIem UNIT
Wean. V„mher
DISTRIBUTION SYSTEM
Heade Nl,ra-Jni~" De,-Ti`,'en xlrue.S,4C n-iCeSpa,i-g Vert if Air ldtake
P pets',
Le-gth_ _ lira Lengir__ JA Snac.^g _
SOIL COVER x Pressure Systems only xx Mound or At-Grade Systems Only
Depth over Deptr Orer xx Uewh el xx Sec dcdSCddcd •a. t Cheri
13edvTrenc Cer Ief BeC,-P. cr II lCOSOn No ve5 No
COMMENTS: Jncluce code discrepences, persons present etc; Inspection #1 Inspection 02.
Location: 125C 31 ST
1) Alt BM Description
2.; Bldg sewer engtn =
. amoam of cover =
Plan revision Required? Yes No
'I
Use other side for add Ideal In'ormahon
Dale Inse9elOr5 $ g08W u: GCU. N0.
SBD,'1C (R ~;y;;
' ~ - <'~~1,._ I ~f:' - Industry Scrvicea Division ! Counry
;
• r 14(N) E W millisgtnn Ave
~7 f ~izoiX
S f , P 0, F3ox 7162 SariiWry Ptnm l Nonitw (!o be lillctii rn by Co
1 1 J
. I.! sonua, WI'c3107 7 162
s _ (o o (P 977
U >
ApYplicatlon -^J State Trans celron N"NM r
I;r,t~ C ~ ~l k'Mrc it / Qq
In sreordanm . vitr
v.. a m o abmn,u m f th's km i rMra.ppc nale... ,vu mmuil unit
s r pZ;d prxv it% obtvnmg a svntory pcrcmt N, 'n: !lpplioatiul Timms lu
Dc r slaic-owned POW aicSMnnl(cd to Pnjca Addrecs (d diffornt than mailing addtcss)
lb: patL:tcnl of S lily and P:nfcssionul Scrvicca. Pemmnl mfamfanun you pmwde ocly be used for smondary
P reuses to accordance n 18t rh . Privacy l our s I s ,in gin) SL%
T Application Information Please Print All Inf Bon 7 <?00 r~ ST,
. Yr,Pany 11 mcr s N_rnr - - -
.nad9 I
~ -1
LAjWX1.C_- 4/704 1 4 GIB- 1074-,58.057a
Un(r<dy Ovmcr bladinp. AJJress - -----1 1•ropcny Lcuior; 33 •'3Q•~s. ll~J
/a7 G.7 30o T'' Sr
Govt. t r I
lnv Sielr - -
/.i talc Phone NunPrG
_
T '7 p --5,67 -NiC- '4- Sects on 3 3
11GLf/rld ing `/TY Ul _ J~yO/~ /4.s /,18 1'
07✓er -i=irclc aneL
7 eorlduil in N.
)T g (check all tidal apply) q Lot a - -
ry ! :.I+umily Dw.:on5 Nnnrh<r oPHcdrm+ms J SukxliJsion Nmuc
1.9
r a p r vck ~ - - -
F, ok fl
i'ubhyCvnmae'ial-DSav;bc
I VV6J ~rll-
Swtc Owned / Uesctilw Usf f'SK Vnm~a ~-41Hap of
~Tuun of G[rt1_tloo/_
d~r~ I
X 75 _ -vOl Zcl_ L _
I III I Tvpe of P n (Check only Ime hox on line A. Complete line R if applicable) J Z~ X "I
; P:ew S rs0.m 1 R!plucnnGU SystGn t TrcaOUadrflola.inµ 7 u:k Kq»nwnvnl Only V Olho Modlfcauun In l u ung System (explain)
H. ! f Pc Iw R n<aal i] Velma Revision l hange of Pluna," Last Previous 1'crma Nttmbcr auJ Dx4 IssuG1 _
iJ P<md1 Trarufa to N<•w
Piratim db. Tvpe of Pt1WT_S SysteMCom onrnt9)rstce:• Check all that apphy
N n Pr .v.mircd In tiround r I rrssurf Y: In 6nwnd ❑ At ('mute ❑ mound - 24 is ofwitahle a0; Mamd 224 in, ufsuJablc soil ` j
_ Lk Idi. Turk ❑ Othm. D;spv, t. tip n t aplain) ❑ Prcavaanod Device (explain) /
_i Dtspersal/Tre ttm'nl Area Tnformanon - _ - ~ i~
If Ur o n 1 low (g(aSl f Pn S ul .lpplic:a ilxt ft gpals ? Disprnal 4ma Raluimi (s ~T f Tap anal .4ra1 Prof Isf) I S vinn O 4u,c f
'fays°nk ' - C'J.cit.• m 6 • l olal ull if 1 25 S'Se 144 _ /6i_ 7 ~a /60 '
l L info :gw ~ of - --A'lmofacturus -
(Talk is [mllou, t!nn.< c
r ff
Vcw Tank. Fuane ',ra, - - ! ' ~ ~ (r c !
A.v;c v W14oµ,yyrk - _ I -i-. - !//"11((__1111 _
- i 000 i. _I 060 I ~ JKAtJ P EC.~T' ✓
a--GOO
Pll RCSpOItSlblhh SGtentent 1 the uaderstgacd, assume resporrsi t;~Xor installation of
~ We POW73 shown on the attached plans.
' YLunbc-r's Nume (1 nnll Ylawl+G'v Sry nvlu¢ hW/h1PRS Nmnkaz fluslness Phonr. Nrmlh!rc --_i
~IL f
EA ~',cc,v ~da~8a 9 ~s 5 77__-sago
Phunh<r a Addwm (Sln:ct, ('it),
L. A. _"V Lm:c1
C
-E,or4 tA/Rd Cil j . S`/763
\lfl ountvrD~arrmtnt use only ~
-
t -
Apprm cd -<-L}(3)~ --nsr~✓ f rnml Frc Il t (.curd Isxw
gent Signatis
R
6,115 I
11fw'1; .i tan ur F<x r aUClial 7//"~-
IX. Condt6llie RA/j'i~t~6 M~rasnos for Disapproval / -
t. 5ept~s tark, eYlLC~'itta•L»7 r 3) ~a J,.IL ke.si-~...
u 1l`2r.'i'pl• +I I)l pallt:_S. fOF ~rlte. nC
a4 per,:idr:t~em P" :!Ln p'4 sUerl bV NIHmbP . OA.O_ ,t
2 C.t'Yt'C.JT
AS ~NWI< rec. !Ms must w nt, it c .
Y per +ppi'etibie <.>r'.I ; :M'vlrr.).
aria<h In <aaplrl<plaru dw Ibe ayanm nmt subma m tin Qnnnr wh nn papa nM doe than a UI < 11 le<hn Ia ihrc - - - '
SAD-6398 (It. 08'141
`MARTMEt'\ DIVISION OF INDUSTRY SFRVICFS
3824 CRFFKSIDF LN
HOLMEN WI 54636-9466
S 'I Contact 1 hrough Relay
P S http:lldsps.wi.govlprograms/industry-services
rr!~~ruw` Scott Walker, Governor
Laura Gutierrez, Secretary
October 14, .>.018
C'l ISI ID No, ?.'1889
AfT,V: PUH'7:S /n.cpraor
EDWARD J BL'RGI I ZONING 0I-'11CL
(TLAR\VA I FR SF.PI'ICS ST CROIX COUNTY SPI.A
PO 130X 103 1101 CARMIC14ALL RU
FAU CLAIRE WI 54702-0103 HUDSON NVI 14016-7708
CONDITIONAL APPROVAL.
PLAN APPROVAL EXPIRES: 1(1/14/2020 Identification Numbers
Transaction ID No. 3162699
SI'I'R: Site ID No. 8$4129
Laurie (,oct/ Please refer to both identification numbers,
i00T1 l S[ shove, in all conespondcnce with the agent
Tuwm ol'Glcnwood - -
St Croix CounIN
S L I 4, NF I!4, S:i:i, I'.i(1N, R I Situ'
FOR:
Object Tppc: POW I S Component Manual Rceulated Object II) No-: 1798437
Maintenance required; 450 GPD Flow rate; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-13 (N.01 01,
R. 10!12), Pressure Distribution Component Manual - Vet. 2A. SBD-10706-1' (N.01i01, R. 10!12); Effluent Filter
the submittal described above has been reviewed Ibr cunlurniance with applicable Wisconsin Adntinistraliae Codes
and Wisconsin Statutes. The submittal has been CONDI ZONALLY APPROVED. 'I his svslem is to be constructed
and located in accordance with the enclosed approved plans and with any component manual(s) referenced above.
1 he owner. as defined in chapter 101.01(10), Wisconsin Statutes. is responsible lift compliance with all code
requirements.
No person may etwage in or work at plumbing in the state unless licensed to do so by the Department per x.145,06,
stall.
The lidlowine conditions shall he met durinlt construction o installation and prior to occupanev or use:
• This sy:slem is to be constnteted and located in accordance with the approved plans and with the "Pressure
Distribution Component Manual for Private Onsile Wastewater Treatment Systems Version 2.0" SI3D-10700-1'
(N.01i01).
• This system is to he constructed and located in accordance with the approved plans. and the "Mound Component
Manual lbr Private Onsilc Wastewater Systems Version 2.0" SBD-10691-P(N.0I 01).
• The pressure network is to be constructed in accordance with publications SBD-10706-P(NOI M) "Pressure
Distribution Component Manual f'nr Private Onsite Wastewater I reatntent Systems - Version 2.0" andr'or the
sizing methods of publication "SSWVIP Publication 9.6 Design of Pressure Distribution \etlvorks for ST-SAS
(01,81)".
A copy of the approved plans, specifications and (his letter shall be on-site during construction and open to
inspection by authorized representatives of (hc Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction s'installation +operal ion.
In granting this approval the Division of Industry Services reserves the right to require changes or additions should
conditions arise staking them necessary ['or code compliance. As per state stals 101. 12(2), nothing in this review
shall relieve the designer of the responsibility [or designing a sale building, structure, or component.
I I Xt ARD I III Will Pnµc' 1, 14!20,:S
Inquiries cOnccrnine this correspondence may he made to me at the Iclcphonc number listed belo\+. or at the address
on this letterhead,
I he above lefl addressee shall provide ;t copy of this letter and the POWTS management plan to the owner and any
others who are responsible Ibr the installation, operation of maintenance of the POWTS.
Sincerely, ]:cc Required S 250.00
Fee Received S 250.(1(1
Balance Due $ 0.00
Matthew :Allen Janzen
Wastewater Specialist. Division of Industry Services W'iSMART code: 7631
( 715 )3340-0107
matthewjanzcn:&%~ i.mw
Pagc I of p
Private Onsite Wastewater Treatment System
Index and Title Page
Project Name. -_44axiE_ Goer2- 3_A,_Cletwo ours ~ntew~_
n n
Owmer's Naute:
~6TVDITIO ~J n,~lY
(hvner`sAdrtrrss: _--_----1,~6a2_ joOsr:
6iPi IRy7jy[ '.T_---
DEPT QF
DIVISION OF IN15US'Y SERVICES
----7i S 9.Z 8 - 0 7sS
Legal Description: 5E ~}E ,331 30N /SW SEE.CO.RRESPOi1Lt]E&CE.
Municipality: Town, V41aKc, k-;wy o 6441-i JO-00-
Cotmty: .,~,to,x
L~It Number: 13 lock Number: CSIN Number:
Subdivision Name: Sao ot Sr
f',I -ci ! D. NUn16eC
rage I Index and Title Page
Plot Plan
Pa--,c 3 Cross-Section & Plan View of Mounts
Page 4 Pipe Lateral Layout
Page S Septic Tank I Putnp Charnbt r Cross-Suction & Specifications
Page 6 Pump Performance Information
Page 7 POWTS Owucr's Manual &'Management Plan
I'age 8 POWTS Owner's Manual & Management Plan
Page 9 filter Information
N.inrx of Designer: - h-'o16E /lLicense 17: /PPS-?-71829 Signature: < Date:
Ucsivncd L ant to tilt; ; ; rull(mirgPOWTS Component Manual and DSPs 38J-3K:
S13D-10691-1' (1`.01+01) "Mound Component Manual" Version 2.0
SRD-10706-P 1x.01r011 "Pressurr Disrribution Component Manual" Version '.G
Anarhmcnt: Soil rvalumion Wpor:
RLGFIVFD
Qtf 20-; A
INDUSTRY S-ERVI ;ES
p ~n v ~ I
V ~ ti ~ n I
J i
a o o
I \V ® O ~Ol~ ~ V ~ ~ V ~ \ I
I ~ v ~ Y
al y h~ v~ Vv y~+
e ~ ~ e4 ^ x ~ i
o r
o ~ ~ a 7 4 ~ G i
o-
y~.
1. `
Q a ° w
V \ ~ w
Y `l s
3 r ~ h ~ a a
ff ~
q4 1 71
IV)
l V II V
h
°
' _ •r
- nI I U u
e oI \I \ ~ ~ ~ z
J
U ( w
> it It It
! Q w w w
CL
rn Q Im F - - 1n 1
0 U n } N O ~n ~I
EL U> 03
C C7 al N p 1 t:
w ~ \ O
o w ti w d !
LI I- U S J J al f,'aa . IO «
w
fr' y
w
p n a h
f a J j3. I s'
r I L f fL ~Jj~
~I ~ p G rf 1 ~r~
ONI
n L CP
o! }I i a ~m
L) a
5 ry
41 J l Y~ e' c w s, .M1 Y m
NO /~Y W L m w \
L H r 7pn Ya ~ ~ U ~ vN
~~tl `I i/ }LL a' X d T C Q o
F_ 1 I 3- 9 Ql ~ 7~ L ^I
a 'V X a x,
c? o
o l Q.
40
Q. V
M
W r
J v Q
a `1 v
LD
'v. 4 W W t w w w 4, w 4! w
Q ^ a n~
y N
11 II II U If If A II 11 If 'v ,ec. ,o
1a50~0 IaleA•,pn e(1:d
Q !r U' w ~ H ~7 ~-l ~ iailofs'l;A .a~aa,
1i~
~i
rn z u
N > y
c_
w u 3 0
o o >
o w
f ` ~rY ~ O W Q
X SJ fn Rl ~
N
o o'
a Ci ~ . p a' fi
~ F
aQ O
d ` ~o % y al II V S'
F} / N V ry
LL -F ~ N S
Y
^ T -
J I s~ v X
v G
40
Q P~ r p X i o u{
` ~m Xa = 1w II X IJ
Imo' w , A L ° ~ YR ~ ~ of
LLA
S 1
X z U ~ DO
on }T U:y ~ N N
p % ' C w C_
X
C C C
`Y O4s ~ 1.
`
06N
NL N
LL
Z `U N
I I ~Ia S C
!1 n It w II . _ W
ai ai si Vv~l~ a
k w w w w
A CL
Fl ~ ~
d v CI y)
f.
u T Qa
d ~ w !
~ H~ a n n a u
Page S_ Df
COMBINATION SEPTIC/DOSE TANK CROSS-SECTION
lDRAMW3 NOT TO SCALE)
. MANHOLE RI.SFR. & COVER
FINAL GRADE (pat s?s aaa 75rt a ta).,ROai -
(sWpe ground Su faw away Inm kj&ng d im. R warning YIM. F.,Tond 1
mWW0 (w) ria nn>r„r rininage) manl - nkr as ncrsssvey.J
< Afv: Sch a ru: f. il
a' nen- Sch. • 0 PVC Tank VM1 ELECTRiGAI werr Rio" 1 ' i /.1,,,
BUILDING SEINER tocacd lz•aho. Aatle or _ 1It1NCTION BOX 1 (por 5?53e2.3a(1 f)j above Royon«Fbou ElevaWn
nail weh$ rr)
J
ra3 NF.C :1xl
i i FORCE
' MAIN
OPTIONS
1 vFYtvi I I ~ -`1 f
I r I ` 1 T
NOt W-M OF 111LF ,'1, t
r i • I 1
1
~t
1 i ~iF /O I ~ _ y ,,Iam.lem
<IVyT flk[ A:fFbh Cl^.~»I Fwc. ~ F ~I
z.. e: c.. ran al .an _~y 1 j
Re~u ec 6 OuUm Ce f kul
'LA
VM MJM GF OF SUfFABLF HFIII:IN(i L1HNt AiH t'ANK & MAXIML•Id BURY DEPTH OF 96'
AnchonN at;ank may be recluiind pct SE'S 363.43(6)(R)
7a,k't9an iacu::cr J1~f~EGAST _ Daily WaslewalerFlow (DWF) GPD
Sr.ptiClPump size: /OOe /6010 gallons Number of daily doses- P
Alanr Manufacturer f.. scNo.+6as
Model Number: A.J.rc L Ex r ! Form main volume: 90 fix . /6 3 gautt = _ /3.0 gal
Actual dose voturne. gal /30 gal SS8 gal
Switch Type: (total dose volume - volume of force main)
Lf`luent Pump Manufacturer, Li zzer 47eewi DOSE TANK CAPACITIES:
Model Number: 9EN LM
~Reserve above atamT _ t3 in = 378._8 gal (D)
klingnum Discharge Rate: __Q15 08 GPM Alarm float above on float in = dJ. 9 gal (C)
OnfOff float measurement 4. in - gal (B)
Vertical lift (pump off to lateral invert)........... 11..7 A Off above tank bottom in 8 gal (A)
System head (distal pressure d.s x 1.3 ft): .3,3 ft
--&400-ft Force main x/10[) fnction factor /.1 ft DOSE TANK DIMENSIONS:
Filter friction inss._. - IT Length._,__ 1-5-Y -_In Width .__77 in
Total Dynamic Flead (TDH). /S, 4 _ ft O:rtlat height 39 _ in Gellonsfinch__/6. `17 _
EFFLUENT PUMPS
~ EF 9
9EN SERIES - 4/10 HP
II i ' { r Y I``~~
I~ --I l Ltd.
ricnvux j
Ilk
/,I-; on
9fN-9a SES { X USd AW'
77333 3 rm _ 26.54 an_ _ M29 (rv
3Ett(16 Nf 9AS Vfi 69'
23;4c" Taso cm _ un cn _
'JkN CU1 24 ' 9% _ 6.0•
~.1_. 2SN 4m I )n 30 tm I 01(m
to no AD ro Cover Epoxy o..aty l Cast ❑ont
~tiv 1 { - C Motor Housing fpc xY_ rnar d cat Iron -
I Impeller Male)iai The mop Aic r astomei !
- - - { L impeller Type t or Uou _ I
9oluM t p ryvca ea ~ ~l nw
's Motor shalt
Mechanical Shari Seal f 4Rnlewitb cubonancimank
f 4 Fute_mvs I >ta Ness steel
upper d sleeve and bwe~
IBearings It Ibearsnnng_
1 Power Cord 1 Nt °C1T
I(f s ear 3
A n to 40 W Us
1: Po
UXgrY-®11
Franklin Electric -,..;n,',tj7c,i
'7
9
POVVTS O'WNER'S tiIANUAL AND :MANAGEMENT PLAN ~ - PILE iN(•"ORR1A r10A SYS1 IM SPEC.II IC A•I'IONS
of r LAu ct~ . Gorr rz r~'-
; Septic 1 ink C Ip, crty I lQ~ i l fl 11
um t i - ~ Sepuc ant L nut ictulcr- ~,CA/~ ~EGIJT O l
DESIGN i 1R 4 U}. (r RS Effluent I-ihir M.mulacturer
VI u' r of -_sons(100 eptUbedlnort) Gf:iucnl Filter Modcl _ MN,
\ ml+.. oI, r uacr rill Uniis I +nl C-_[l iaty GOO ,a ❑ \11
i Rm vl d [ nt Ieq) ~OQ Y .!fly Pun fmrl Mnnnferrun;r. _,~KAu ,,1*'i ,A,r O iNA'
)c n fro, rD4 f) csal and x 15 V50 I tl day Prur Uanl IacRuvi - L! rT J- ~s/Nor D NA
it d Application Rate /o t'day ft !'cm' U, cl 9 N C_/n 'J IV ti_
11, uc11 I'll lent Quid ity (1`71 NA Mulullk
T 7 Sandf6lavei Filter O Peat!r Ii "r -
Fats. Oil F_ Grease (FOG) I :3•i 7 Vtc•:hunirul :4cration O 44'nlaod
ilioahemicol 0%y-cu DclI%lnd iBODs) <220 m~i t. -
Total Suspeade.d Solics (I SS) 1 220 MviL ! fl D;sintealon fl Other-. mgli~ Manutaceo r. ,bfodo:
'nua,ed t l dt ent Quality (fig NA; ~4onthly Aye a;:: { I Soil Absorption Component rl N,\ T---- - - i
31ocllumlc I Ox.gen D_ullwlMOD;) '-30em-1. i ❑ In-21 ound. glavity) f-i In-ground(pressuni-d)
lotai 5usprndcd Solids OSS1 : 30 D U aJc LIT Mound
Feral Coll loran (gcomzuie Inean) I < ; 11:1 Drip i rc D Othr
Vctlical Di<lairce'fank Bottom to Scn•icc Par
::ain:um B111ucnt Panicle Size l'S mch dlamctor I I-loriiot u l Orsancc'rank(sl to Set vice l3ad: 001 +
Dispersal Unit 'Mg./Model Number. _WNA
Ac a ialions:
Soil Dispcna` End Cal) (Dispersal tinit IiISA)
'pp!ication,Zulc Area 8oyuirol LISA or rilench Width1 9 Units or Total Lennt'ryof Trench(s) 7 %PS sicri of Pressure D:sir tbution Kcsnrrks fr.. Scplie Tank-Soil A`aautpliou
Systems" Publication 9.6 (SSWIMP manual)
i D "W(C F`oss^.cch Vlou lc Component \;attuaf' Vcrsicu 1.2
! Cl "2/ Flow Mound Comvonem Manuel' Version ii.-M12i',M
7`I S BD- ! 03:1'4-P (I'i.l i l "G) ":1t-irmdc C:oa:ponent ,Llanu:,t l is in4 P~ iasu-c i)istrbutio0" Version 2 0
' ❑SRD-16705-Pi\.O1;Ut)'ir, Ground Soil>hsurrtion Component ivlanua;"Vm'sion'1..V
'3(SFD - 11691- P (N.0!,'01) "Mound Component ildauuai" Version 2.0
;f 3R!) - 10657-P (RV99) "Drip-line Ettlueat Disposal Component Manual"
XSBCr - 111706 P (\,01/Ol) "Pnsswrc Distribution Componenl Mznual" Version 2.0
7 Othcr
49 ~INTFNANCR N10NIIORiNG SCHEDULE,-MAINTEN.AN(i::AVl) MANAGEMENT
suntcci sent _ _ Sc_nrct rtct,ucuc+
-
u o m~xu d spc rsnl cell( s), [ :c t au Cc r 19 3 months Qf Derr, _
r > ~ f )then
perm pamn cunt u xima. prcTre; unenl mot 1 Ica crcu ON rl months 1~ +cros _ fl NA
u n and ores t c ra ahr .ts i Icas I m,c c.en i 7 amnth vcar. _ O N_s. _
ST tRT UP AND OPERATION: For neyy consuucbuu. prior to acing the POWI:S check ovalnun' tnk.(s,'• '.tar the prewnc:; of purilin
products or other :hcmicaIs that may nril:ede the treatment process andlar dama_e the dispersal cell( s). 11 high concenlmlions am detected have
dry contents of the tank(s) narawcd by a sepuuc servicing operator ptior to use System stnrt up shall not occu r when soil conditions are frul
at tic infiltrative. surface.
1-i1c. proper nwm.r is :cspnrslble for 1110 operation u:rd muinwilanc:: of the POWTS and submission of required moons. )'lie quami;c and
uualItV of the waste•.valer ctrram will nlrtct the peribrmance and longevity of your I'OWTS. Tic installation of water-suvingg appliances and
her lures along with vromut Ivpair of iruks reducer: the aa:;tcyvatr volume- Also th:; brine or ,vast- trum yvatcr solo ners. iron removal units,
other clear water uealnicnt devices rind !oundation draini should he drschilreed to the ground surface, r:hencver possible. Note- this does not
,.lddde !aundll waste. showerb. disinvaler ctc.
hoc c Qem is designed to handle domestic strc igth svostcycaua however, tine disposal of fiord basal cases, oily vegctablu•'truit peels.
::cods, bones, and final solids, sachas those produced by a ~;arhnoc disposal should beminimizcd. "foilct tissue is the only paper that shnu!d
Sv. discharged into the sysrr.m Other non-biodegradable items, such as baby wipes, limpons, sanitary nopkirrs cundorns, cigarcee buns.
dcN;Il fins<, and coil+n: swabs, should not enter the sysaan. Chemicals, such as petr'olctuo products, pain!, dismlectantc pesticides,
rev ihiotias, soi, a it-,, ctc„ shrmld not he I)us!md into, Ih: v)^:rcm brt z. th,_v an: scnously darner<<„r your !'OW1'S and cnr.tam inatr. vile?
drinking. water supply. Maintain a regular steady t!ow by spreading iaundry wadi iug thruughoul the week. Avoid vehic In Ina i'lic :r•cr
it It system components. Compaction o fsnow over the dispersa. unit may cause it to 1'meye up.
INSPEC:TIONS_& b9ALN"rENAN(Ji Inspection ::Ball he made by an individual carrying our of file tollosving licenses or
certifications: \dasice Plumber, Master Plumber Restricted Sewer. PUIVTS Maintainer. or Suptage Servicing Openitor fpcr the a:tacbed
Maintenance Schedule) 1"ark inspections muss include a visual i:+spection of the tank to identill .my missing 0r broken hardwanc.
identify any clacks or Icaks, mcasun: the volumc of combined sludge and scum and check for any backup or pending of effluent to the
ground surface and test cdl electrical equipment Such as pumps and Aatais. Any defects small loo promody corrected. Exposed openings
^ieatei than F. inches in diameter shall be secured whit Jfeetive locking devices to prevent acc!demal or unauthorized entry the tanks.
tvhcn the combination of Sludge and scum in any tank exceeds one-third (1/33) or mom of the tank volume. the entire. coalrms of the
tank shat! be removed by a Septage Servicing (.)perahN and disposed of in accordance xvith Ch. NR 113, Wisconsin Admin. Code.
Specuie servicing, merlianics must he provided i fvertical is %IS rest or il'horizoniat is>I50 feet and instructions to he provided befo'w.
ILaoutletfilet(s)Shullbeinsp cedandcicanrdtoremoveartyacctnnulalcdsolidsaccordingtdmanefacimier'sspecilications.do!iels
washed horn the liltci shall he retained in the tank Filter ricaning may Ile necessary at more frequent inecrvais than stated in the
mai ntcnance sched u le to keep the system opera irg.
levee >huuld ii- teslcd nr. a regular basis by the home owner If-, Aimn sounds, contain it,, individual licensed to sci vies POW I'S.
hole is naturally a I day reserve under regular operating conditions, 'low•ever witcr should be consen•cd until any problems with the
+iem are currccred to pieteut back-un ofsewu-c into the dwelling or soriacing.
'L uANDONMEN'T: hen the POW-fti fails sushi, k pcarnanent!y la'..en silt of scrvicc the fuiluwing Steps shall be taken to ensure the:
Inc syslam is property and saltily abandoned to compliance with ('h. SPS 38?33, W is:onsin Adnur) C;odc:
A.li pipit, to tanks and pits Shall be discvnm-cred told the ahandom:d pipe openings st"eled-
' The cotent5 e f al l ranks mid pits shall be removcd and properly disposed of by a Seprage Servicing Operator.
k Per pumping, all lams and pits shill Ix cNcavaird and renmycd or their covers removed and the void space filled with soil.
vravel, or other incnt saint material.
i-'QN'j' NGF.NCV PLAN: If the POWTS fails and cannon 1Y repaired the 110flowing measures h;;vu been. or must he takcu, to pro,idc it
o de compliant rrplacenietd system:
rl A tuiiable replaczment area has been evaiuutcd and may he utiliyed for the location o" a replacement soil ainorption system. -file
replacement area should be protected font disturhance and compaGiau and should not he infringed upon by ,:quired sutnnck.,
from existing and proposed structure, lot lines and wells. Failure to protect the rcplaccmenl area renders it unusable. Rrplacemeui
systems muq 09mpiy with file PJICS in effect at Vie lime of replacement.
O A SUitab!C Mplaccment an:a is 1101. availahie due to whack andioe soil limitations. Bsmng advances in POW'IS irchnoloav it
s,../ holding tank may he. instedcd as a last recut W rcplac:: dnc failed POWTS. -
'5 ?•he site Ica. not beet evaluated to identity a suitab!e replacemem zrca. (-!poll failure of the POWTS a soil and site evaluation must
be perlbcned to locate a suitable repinamcm arco. L'tic replacement area is available a holding lank hiay be instailad as a !act
remin to replace ehc tuilcd POkk"f5.
Pv;ound and tit-gmd^ 5oii absorption systems may be tc::onstrueted in place following re ndval of the biemat at the infiltrative
.;u: fsec. Reconstructions ofSiiCh systems an US! comply with the rules in efli:ct a; that time.
SEPTIC, ITNIP, AND OPR.HR TREATMENT TANKS AIA;' CONTIAN LETHAL GASSES kNIVOR INSITFICIEN'T
OXYGEN. DO NOT ENTER A SEPTIC, PUMP. OR U"rllltR TREATMEN 't TANK UNDER ANY (.IRCUMSTANCES. I)EATI'I
NIA Y It F;SL LT.RESCUE OI'A PERSON FROM 1'111•: IN"fgRtOR OFA T NNK MAY REDIFFICULT OR IMPOSSIBLE:.
41 ni)fflt_MAL CONINILNTS:
!10WTS INSTALLER POWTS MAINTAINER
I iv:unc_- EO_-,B~>tCfL_- -/Y/°RS-.7.7/889-~; rams: ~Ldf4lJw~cc S~ric_s
7/S 577--Slog--.. S S71?-SAoo
SEP7AC1 SERVICING OPERATOR (Pumkcr)-7 _ LOCAL REGLL.ATORYAUTHORIT'i-
- 'y
,Name:
Name: Jar ~•reyX ~q. ~~~fn4✓>t .06uFtoPr/caY
- - 7LS-38G-_yGBo
jx<h N
~ -y V i{n { t
{ Q ~ J
H 2
W
y° -
0
WZ
y E W SY S
a C O i ~ ~ e ~ p y - W
r+ y O OC - ~ L `
i w •1
4r r 'O x 9 m 1 r L i:.. r r
U _ ? s
U ~ ~ vn
axwe~
® a
le-
as -
~ t -
N 6637A
Y T p
`L i i Y u~ m N
a
- Y l 4
:I7
~ x FU i p
a
y G G l
n+ c xO
U
4:.CROIX( M-1'1
SEPTIC f ANK MAIN ''i `4ANC:3- AGRI-I'h7 'f
AN 1)
,)ANFRSAIPCgFTI-!C~,'i' ON FOR\,•f
Uvueri Buyer
MailingAddres` _ r o\ - - - - - -
P.'0%rl; Addfcss
IVcril 4 h~t,io.r'I mmgA /mmn•, DcpaY ,astnclionJ
Ci:aSta[ Pere: ldenvfrattt;n Nurnher C- _ - /C ? 70
LEGAI._D£SCRD') oN -
I'(.PC!., Localior, V, Sec. ` _•l'_.. NR
S'*L•divi ion Plat:- Lot
Cer^?red Survey \lap N Vo;!•.... r,
Pl_nn
\':an'antyLacdN_ - Coefnc.t.:'07)Vui'r- Page
- -
Nccchotr,: Lot ii: t: 41enitfiableQye:.f Irv-
6 1S-1L1MAi 1 NAiNCr-.ANDOWVI•:ltcF,8,77)CATIC
imomper as.• and maintenance of ww r,: •IC system -mad rcsui! in ao ptcrfat.nu faibtrt• to l:.mdlc• .Yasll>.
otnEl t na-rte conuots -f n . ..Ing oUt die sepUC e.nk c. N•ter }cart. r cov^ ,f. r..:~. by a li•-...^.' pwu . - What . ou ;ul iet.:,
the ,yscom can iffe t the function, of ae Sept,, tack as a tr..r,n t aa..r a :ho watiR d s0osal sigkm. Owm•r n.iotenan.,
pons)hdatrv are spccifiw in .N 111, ih) ~'!(I t at:C m Chapter - $i. C roix ,%,nty SSndaty Ordiranca.
:he rmpc,ty r,• :r irr.m to ubmiz o et. Croix( ounly Platmim:,v Zoning Vcoarlment a ecn,ficafnon d,- signed ny the
rv,.er and by a r plu v`. r, Joulnc, mmt platnhcl a n sad pi.u^bt r or a licer •d pcmpet verifginq that , i; the on-sits
:'.ta: .vaic' dupawl ~ystern is ut ; r^;u~r n; cr nin_ wuaitmn tine of 1'7 after ir.,pcctiun and pttmpln,(tfncce+cury), the ;erne tank is
..':tar. P., fo'l ef , 4-,c.
'Ave, Vlli undersign: d have •c rr <h, abeva n q"n - n :nts a,,:: ;.et..' .o 11-!t win the p. lute caveat d° „tar •.v.,.an will1 ••n:.
. t n ]s :ei 1 th, h 'n, a, t by t:R Dal etlmcnt of Safety Ind I :•nf:•s,ionrl Services a d the O parnn a a; Nnt Ual >o r. •r,
>i cc or Wisfonrn. Certificatmo stati,: teat your >cptic system has t:en :intainA mu a b,- cnmplerre and - hn,wd to the St. t'•oi•
•ucty :1imun & /onitig Department within 10 days of tic rh^c y,.ar espilation date.
Uwe cd,I:R, that all otat(!W:/n;,,lotin al c true to the best of my, our knowledgeFwe amlate the owrxits) o O:e
lopcrty desrri}xd abUVC, t,y ry deco recorded in Res iao•: , f i)cen• Ctl lio:.
N'aniber of becirooms
tiICrNATI W t ] i `;`,T(S) - 1 t
DA'I}
^ ny Ulan is mis:c,xcsented may resuit in the ,.,r--n -y 1• mrt hems ,--voked ht tit, Plenni.ig & 7-n. r!r Dydrimrnt. • "
Inc I with Ihi aPalicatinn a r.,,,&.1 ...-,,ley r.«I f" the R.;, rar of Deed. r.lrtcc and o ~ y ,riJv caninc-i swvc~ matt if
rcicrcncc is Iaade in the warran)• decd.
(Rrv. o4:12)
R
oQ
EPA
r' i V L 3> I t~ `
DOW
y n i
Y U C) II V 1-,1 '
~Inj N ~ ~utt[lnOlnltlln!/iniun(//Z!(mn/Ofll!® rminmim O u
O. N U~.
4 0 'u
'CS
o~i
7 v w ¢$I
fn Q
tl ~ ~ ~ ~~•o O I .U N~ N 1-- N yr.
J W " °e ' /1 1~ Y I r a Jai nr n ,Pi .mil
o X
W
W 6p
If I^ N 1n a m m
C ' L 1
N "C °e I
moo- _ ~ils 1
o. - m J~ gq
l6 U - la$~ I ~ '-D
ooE~
0
~ ) C N U I „
N = N ~ rv
U Ty. A >ssx N8~ v
) Mks °25fRL, g ~ I N u~ t~
N .2 0 n ~6.y!
C N 0
0 Lam' m a ^ zV edg
d, ~ _ ,a rtH
PO - I '
O~
$LP I p N b~~~
1 ~i~ ~4, TWZ V<<FOZ 2
.Y "'111 t~ iV ~VLio
Z I i nEz
`v N Q ! " ~l WtnZ w~~U
Q O 3 ~~e- YY~9 ~ p ~ <4~uu0
Cr m f v iv.J' ool?.~~
tlJ Q m ~I i♦ ~ n o ~i~3
VIZ~yy,
u' ~smv O aw~~u\~~ncscin2\\\ccti~c~m I" ' N
a f-( r .i J-}i ~ r' N 1 iJ Iii u
n~, 1
pal
lily o' s l~~
' R ia~ v
!N e a
~o
I
I I
em - 1 I
H~1111 tz
o I I ~ I ~ '
Q N L a F
CL.
m - r it r Q 6 ce ' y.
b X
d 3
N ti .P o w O 9' I• sMOrs;nxa mj
d C N i; v, I Q U V I~ 4t'~n 9i ~I
rn n m r,~
tq Q° I i i d
t i l4 L I I I X ~ Y , i `r~ VI YIN N
k i b I I n I e~ I 5 -
I I w~ li ' on- .I mmi--.
I-t~ I ; ~~opE
I__ M1Y'_-__ I Ia U
IIT
9NIN. T3%W IS
I .~E E~
I i i✓.Wl u ails
I I 'n rr.~ I I ,~~V b'rJ N9
I I I t l I I C c c ° ~ g 4 ao
C-D
I i I I i NI ~ C 6 t y t•4
p O U I; I l l d o°Oo
L,J
d p .1-.I I L~ n C j .mo
( e M
1 .63:
C v ~ o I ; .I I~ ~ 5 B2[
ry Tp p r~l ill o.5
T ~ I V-. d yq O L
Y Y -J U i W FI Q S ~ F
er $S
OCCR~ 9 ~ Qap s4 ~ y.>,
6 14 J 4 V ~
N CiNY: Z...N .n V'n
r~ I
-doig-
Wis Drip!. of Safety and Professional §ptvicai SOIL EU~ ~ RT I.
Division of Safely and Buildings tt" Page
n accorJance vnth SPS 385, Wis. Adm. Code
County <-t L
Anach camp le r sS then a 112 x 11 inches in size. Plan most E. ~ - rc, I X
include, by1I~~p r it k`F1pd honzbn4al reference pumt (RML direction and
ri♦r~~ Parcel I.D.
pen:rnl sl agnsions, nonh anow. and location and distance to nearest road. 0 1670 - Sri - ('$Sa
Please print all information. Rted by [)ate
Personal mfoonation you provide may be ua:C for secun4ary, puwusex (Pnvacy Law.:. 15.04 (1) (m)).
Property (Tuner Property Location 10
1, 1 c --l l t
Gov. Lot jp: 1l4NC 114 .`,.3 IF ?f N R 15 (or VVl
Properly Owner's Mailing Address Lot # Block # Subd. Name r CSM#
city_ Slate Zip Code Phone Number -
❑ city ❑ Village T own Nearest Road
L`-'IC.{1LJOCr~._ IWI IS-1ct- ( ) kM
New Construction Use: Residential I Number of bedrooms Cade. derived design flow rate_ ~(`.">Q pp
L] Replacement J Public or commercial - Describe: ---1~
Parent material `x'411 , Hood Plain elevation if applicable ft.
General comments " Y - V ~7- .a
andrecommendations: Lr np y' ~c
i
Afi ri lc 1 n,Lilo -;n, r` •l.a~_:r. 25 r µ C - - -
I Roving # u-1 Boning
L_.__._I SK°lr Pit Ground surface elev. it. Depth to limiting factor- i in.
Soil Npplication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Fce oundary Roots GP_D7fl '
in. Munsell pu. Sz. Cont. Color Gr. Sz. Sri. '.:tt#1 -.It#2
-ii C;
7 6+4
T-
Donny # Boring
Pit Ground surface elev. z ~ p n
, Depth to limiting factor in.
Soil_A lieation Rate
Horizon Depth Dominant Color Redox Description Texture Structure 'onsistence oundaiy Roots GPD!# '
in. Munsell OU. Sz. Coal, Color Gr. Sz. Sh. 1f#1 f(#2
'i. s`i Q7 f
-
14-L qS5'- n r ` -
_ - I I-- Yy Air ^r _`-1' lam'
Effluent #1 = BOD > 30 < 220 mg/. and TSS >30 150 nigIL ' EPouenl #2 = BOD , < 30 mglL and TSS < 30 mgr.
CST Name (Please Print) Signature r CST Number
TM .4t, jl,~jso
Address Dale Evaluation Conducted I ei
ephone Number
r j~
_ Kafls4 ~-c U.AFc~ ~(~F-Il ~m",rv.va ,ctb
r _ ~ ~_L st'ISv _ t~yne G.> _~_L'•k~ ''rts IC 4,4 t,'+ lbI
SRD.xtth IRI I!I i 9
~ C
f 1
Property Owner Parcel ID pact -1 - of
Bonny C'~/
c. Bonny #
Pit Ground surface elev. / to, 3 tt. Depth to limiting factor in.
Soil Apoliulion Rite
Horizon Depth Dominant Color Red°z Description Texture Structure onsistenre oundary Roots G_PD/g '
in. _ Munsell Ou. Sz. Cont. Color _ Gr. Sz. Sh. _ _ IIK7 ' .ff#2 _
r
I. ; 1 : tCi 3/ _ l } cL,K -ht~r c• ' f1?.
41
3. 11 l i' t 4 C rs A y ~A.~
n
).7.t''n
Boring # ❑ Boring
L ❑ pit Ground surface elev. ft. Depth to limiting factor in. _ Soil A lirdtion Rate
undary Roots GPD/D
onsistence o
Horizon Depth Dominant Colnr Redox Description Texture StrJh
in. Munsell Qu SzCon. Color Gr. S_ "ffN1- ff#2
Boring
eon"g * Ground surface elev. ft. Depth to limiting factor in.
IVp iCalinn Rale
❑ pit jRoolsGP0/1I
rHOnzon Depth Dominant Color Redox Description Texture Structure onsislence oundary in. Munsell
Ou. Sz. Cont. Color Gr. Sz. Sh. tfri2
Effluent #1 _ BOO , > 30 < 22D mg/L and TSS >30 < 150 m91L ' Effluent #2 = BOO > 30 mg/L and TSS < 30 mg/t.
1 iic Dept. of SaIct) and Pro lcssional Services is an equal upportun ity service provider and cmploycr. II'yuu need assistance to
access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay.
Property Owner ~_'~~~-f'i E. I ~•n ~~7 ParcetID ~ Page
r Bonne J
I ~~~IBoring y
~ M. Depth to limiting factor in,
J i Pjl Ground surface elev. p / 6.~'i
$pil AuFI~ icalion Rafe
Horizon Depth I Dominant Color Redox Description Texture Slmdurc ~onsislence oUndary Routs GPD1h
in. Mansell Qu, Sz. Cont. Color 1Gr. Sz. Sc. 'tR81 'Fff#2
-2 q,
If, AV
t;k. tc-07 t' . -j~ _ c • r.4 wit r ..w I 1 vC - t tit-~
c Z4 --3o l.s `I'vy- Ic- a l.a o'Ik r1 1'~'^t^ -Y •~G
❑ Bonna
Boring
Ground surface elev. ft . Depth to bmitrrty factor--.- in.
❑ Pit _ Soil Application Ralc
tlnnzon Depth Oomirant Color Redox Ilesrnplipn 7euhrteT GUre 'onsistenr,e oundary ' Roots GPDM ' -
m. Pdunsell Qu. Sz. Cont, Color Gi. Sz. Sh. -ff#2
7
-
- _ I
i
tl ~~~I
r-
aonng m C Bonny
❑ pit Ground surface eiev. ft. Uepih to limiting factor_._ in.
Soil AUOlicalion Rate
_ J
Horizon :Depth nant Color Redox Uesvrplion 7exlme Slnndure onsistencc Boundary oots GPDNt
•Eff#1 'Effp2
ur.sell Qu. Sz. Cont. Color { G;. Sz. Sh.
i I
i
Effluent 81 = BOO 30 < 220 mgfL and TSS >30 < 150 mgfL ' Effluent 92 = 30D , < 30 mgll. and TSS < 30 mylL
The Dept. ol-Safety and Professional Services is an equal opportunity service pvvider and employer. I('you need assistance to
access services or need material in an alternate format- contact the department at 608-266-3151 or 1'Y through ILeiec.
ouc~..a,ru u n i i
i
y_i_ y S~11. EVALUATION SITE PLAN
page 3 of 3
~
j
o,- `l
Laurie Goetz
SG'4,NF'./4,S33) l iONiRl5W
Glenwood tov%atship 1
St. Croix count} \
Loretta Larrabee CSTM224j80 Q \
Ml .1 0 11 t"T „I a~aau \ A 11
,u steel pu.~L V
c;
.1MI: 100,o top ol
,,I ACCT post
?f - hack hoe pits \ \ \ q
• - grade elevation \
contotu• V A
No SPS 383 set back \
problems
\ \
Scale I" - 40' except 7 a
where indicated
Parl of'iA.C. (r
\ r
r ~
V"