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HomeMy WebLinkAbout016-1074-20-000 ~ Cowry - An,ncn5irD,p,cn1P,t~fCjRIrN9Ce PRIVATE SEWAGE SYSTEM Cow St. CrOiX Salcbr -in C. Flu id ny Dr. .:.or Saaran, Pe'mA No. INSPECTION REPORT 606989 GENERAL INFORMATION (ATI ACH TO PE RPdI T) 51ate P ar ID Nc 3162 741 Personal irlnr^'ativ' you F'o'ome may be sac for secondary WrpOSes IPrivaoy '_aaa 5 15 C4 !•;o-;°I. P61nnr Hclje's Name C ty V Rage Tnwrs-ip Perce'l Tax No. David Ess TOWN OF GLENWOOD 016-1074-20-000 CS' 369 E c¢ Insp 89d Elev BtA Descl:ll Secbc :lawn:Range: 'aF No. !00 34.30.15.514 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURE CAPACITY STATION BS HI FS ELEV ;H S ]•I Septic Ben-warK 9 O /6 6 lip Dosing ,~„_,p 6~ AL•. BM _ Ce 1 Bag. Sewer 7-5- Pa j . t szs Iiclding SUIlt Inlet Stnii Outlet TANK SETBACK INFORMATION TANK TO p I WELL BLDG Ven: to A' Intake ROAD Dt In et Septic I I I l%C;' I vl ill F ~Z(x7 I Dt Bottom 3, of 1- g J Dos n- - tleader.'Il H,70 UZ, G Aerator) I).at. Ppe Hold ro _ Bot. Sys!en' ~1 1 l Final G'ade Z PUMPISIPHON INFORMATION 3,~5 UJ g Demand S: Cover In ~ GPPA 13,35 170 2.66 IOy.3 r Loss Sys:eT Head i1_ FI ~~uoDla. I I D,s:fo SOIL ABSORPTION SYSTEM Y, y 5 BMTRENCH V.4 Ienal- t PIT DIMENSIONS N. UI PIS ns de DLig•nd OWN DIMENSIONS SETBACK SYSTFIo1 TO P+L ELL L1KE;STREAM LEACHING Ma%ladu'er INFORtAATION I,Fe O` 7 ) \ ~ ' UNIT rJOdel Nwntzr lL 6~ DISTRIBUTION SYSTEM ; WC f HeJ7cr Afa' x Rote Size x -role Spa: n9 VCO O A, Ir•lake li'oy s:r UafiJn I I Pip7 e,;9 I l It . (V-I IV Z I,~ ....•1~ tt~~ I engt'J a I e-3th~~ a-1 Did S'aaC n(I_ w SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only .x Dep:h c1 x Seeded+SOdcee xx 69u one? CeFll' O':e• JeF:h Cscf _ _ - _ eedTenuh Ccn'e- 1 ~ I iiea°-ercr E.aes _ _ - Tcol COMMENTS: ,;Include rr•de d screpencies. persons present . }}etc > Inspection #I Irspearon #2: . J JJg1L t,O I~ '!h1 Location: 3U2!! CTY RD DU 6i J USfp'.~ 1 1 Alt LIM Descripiton - ' VDU 1.. nx 1~Y'P _ 2.) Bldg sewe' length = BO r It15)dl' P~°"' •~tY' ~4i, _,cca/+~al~ cA_° ms~~'o' IrCPPe' dsr arnourl of cover = (A~ h vr4, Plan revlsron Retired? F- Yes I- No Use other side for addnional informal on. Cen No. Oro- dolk~ 366 67, (CJ ~t ti ,7'L`-'tt \ sa,ety and Bw!d nys Ln sion 1'~ S 1 201 !f4_ 4N.7Sh~I1glOY1 Ave F' O. BOX 7162 tt 7 "rr'i, Ar (;o he t6L1 in by Co -I hradson,'Aa 53707 7162. 666~~ 3Ps . a 71 r Permit Applua t 7 V r~~' 1, ','fb ttaun n i t _ a.J 1 dJ" a, ttr't" a ~ ra A A, a , Air ht•I:..: r.~ . tIU tiT~ I n tt I' Icaaa Print. -{~{Imnatiun 1 (pplicettuninfnnnettun V:•1 1, 4 _ - ao -oao f.'- - - - - - - - 6 1k 34 .3o.►5.y 36t _ - - d; Snmc\umh:r Lk i/ G ~~c >>s ass -7yo„ 3 O. It t 5" L _ G ~ 1 y 1. tI l'ype of RuJdine Nhark all that app ~ Fes' ~ I I ,-gin i:rvk - OCQ, r. r t , t covlwc7o c.at N, :n h:: 75 III. Typa of PcrnuL IC hcaio~lN nna a-on Ime 1 (nmplrLL line R if appitcehle) _ -_~SR~~~Jal:. _ _ 7 ,:.,i t I.c_ Ltti It ,•.e ttt CAI -14 k4 1, t -A06z - (.-a N ( -Pp ?t 1 V. 1.p. of 1 OK'Y~ tiaslem Conljw•tanL'Ucatcc hcck all that \tv .I in .,t viiL j/~~^ N 't Ite , 1 1 ( Vu .I J n,. rtnNt "~„1~ \ ( 4` I ,muntU uJ.anl. Iq d.` t Uiapcrel-l real ant iirea l nfnl maliun ,r Itsnal A, '.ryat 12v t.._~ .u~.d7 I .ipr.X ,,:r.n.! IJ'' Z iJSO oyG' I 1'L lank Iota I r. p ~ s - ova GL° L _ - rA P{~j `rl, c\i~,ib;• --Q/,i 11. RtapunctbtGlt slatenlenl- I. Ilu• und",noi:tln+/unw, rnpun>ihilitr ftrimlalaliun ut the LON 1a hF~;,nd1 \'c attath n L 11[- y L1Tlp1k~1 y`~ 5 \'Ill~muh'Ue~rluunl 1. ac( 111% X,• P. ,,ltfd: •,I , ~u $ - O ate. 1\.(unAl 711rN~vttcaw~a for lllaappnra al , u;tipa.. r:I' , t~II De ;^r_ir s IA ,,s per ;..jar 3yemen F - n Q ,o oY I plwnbe stns muut La r1. it 2. All Ikf1WM re4u1'et ff(:MYI' aspujWclx 4i F - - - 11t•chmu~mplrlc Man.. Lrlhc.vtrm ad whmilluthc (--'~u~^nrt~unb mr polar nnck , n C// ^ v~ , / ,N for d 13-/= iol, ya yv 13 - %3i = ino ` r470, ff3io u- 7.sct'7<r /ooo ✓ GOD (l flA- I'v - x l ~ j I -I -3ria t- t+ d 8 ~~tc,nt srriy„ DIVISION OF INDUSTRY SERVICES 10541 N RANCH RD HAYWARD WI 64843-6462 S Contact lhrocgh Relay P S, http:iidsos %w'.goy+programstlneustrpservices t, vvvv.w,sconsin. gov ~k r pion P-t~ Scott Walker, Governor Laura Gutierrez, Secretary September 26, 2018 CES'1'It)\o. 220357 :1T7X POWTSbtv.pe<tor BRADY J Ii TGARD ZONING 01 :1 IC1. L:TGARD PI IIMBING R IIFATING ST CROIX COLN I Y SPIA PO BOX 413 1 101 CARMICtIAFL RD AMLRY WI 5:001 Iltll)SON W'I 54016-7108 CONDITIONAL APPROVAL PLAN APPROVAL LXPIRLS: 0912W2020 Identification Numbers 'I ransaction 11) No. 3162741 SITE: Site IL) No. 854130 David Fss Please reter to both identification numbers, 30.0 Cth Dd _above, in all correspondence with the agency. Town of Glernvood St Croix County SWI.1.SWI%4,53.1. f=ON.RI5W FOR: Ottjecl T)pe: POW IS Component Manual Rceulatcil Object II) No.: 1798418 Maintenance required; 450 611) Flow rate; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01!01, R.1012); FfiluentFilter CorvPITIG 'fhe submittal describe) above has been revirwc•d for conformance with applicable Wisconsin Administrative Code; APFRD and Wisconsin Statutes. The submittal has been COMA FIONALLY APPROVED. This system is tb tnppagpiIFETY AND PR( and located in accordance with the enclosed approved plans and with any component manual( s) reference atrVISION OF INDL The owner, as defined in chapter 101.01(10). Wisconsin Statutes, is responsible lur compliance with all code requirements. A copy of the approved plats. specifications and this letter shall be on-site durin^ construction and open to , inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to cornmencenlent of RES Coll struetioninstallation operation. In granting [his approval the Division of Industry Serv ices reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state slats 101.1201, nothitw in this review shall relieve the designer of the responsibility for deli-ning a safe building, structure. or component. Inquiries eoncerninlp this correspondence ntay be made tome at the telephone number listed below, or at the address on this letterhead. The above lell addressee shall provide a copy of this letter and the POW TS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely. Fee Required $ 250.00 - - "-N 1'ee Received S 250.00 Balance Due S 0.00 l:dwt avlor Wastewater Specialist , Division of Industry Services 17-- ART code: 7633 (715)63.1-3.78.1 , Nion-fri. 8:00 a.m. -•1:30 p.m. edwin.tay lord wi.gov MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: ESS Owner's Name: DAVID ESS Owner's Address: 3020 CO. RD. DD GLENWOOD CITY WI. 55014 3020 CO. RD. DD GLENWOOD CITY WI. 55014 n Legal Description: SW / SW / 834 / T30 / R15W Township: GLENWOOD I V~~sTQ 9 ~201B County: ST. CROIX Subdivision Name: Lot Number: Block Number: Parcel I.D. Number. 016-1074-20-000 t', f LLY ,'ED Plan Transaction No.: ~FSSIONAL SERVICES T lY SERVICES Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan p DENCE Page 7 Pump curve and specifications Page 8 PLOT PLAN Page 9 SOIL EVALUATION Designer: BRADY UTGARD License Number: 220357 Date: 08 2/18 Phone Number: 715-760-0946 Signature' Desitined Purs to the Mound Component nual for Powirs Version 2.0 SOB 10691-P (N. 01101), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) Version 3.11 (R. 06101) Page 1 of 9 Mound and Pressure Distribution Component Design Site Information R Residential or Commercial Design Note Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 83-44-3 in-situ soil treatment for fecal 1.50 Peaking Factor (e.g 1.5 = 150%) col form of 36 inches 450.00 Design Flow (gpd) 9.70 Site Slope 101.42 Contour Line Elevation (ft) 32.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpd(W) Distribution Cell Information 75.00 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpde) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Distribution Information network? E Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation (ft) 2 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 3.00 Orifice Spacing (ft) = 9.00 ftZ/orifice 2.00 Forcemain Diameter (in) ~O 100.00 Forcemain Length (ft) Does the forcemain drain back? Y I 90.00 Pump Tank Elevation (ft) T a 6.50 System Head (ft) x 1.3 A46. Forcemain Drainback (gal) J 11.92 Vertical Lift (ft) 5x Void Volume (gaq 0.97 Friction Loss (ft) Minimum Dose Volume (gal) 19.39 Total Dynamic Head (ft) System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1 25 x x O~ 1.00 1 50 1.25 x x 2.00 1.50 x 3.00 2.00 x 3.00 x Gallons/inch Calculator Treatment Tank Information Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in) weiser Manufacturer L~ gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 600.00 Dose Tank Capacity (gal) POLYLOK Filter Manufacturer 11.82 Dose Tank Volume (gal/in) 525 Filter Model Number weiser Manufacturer Project: ESS Page 2 of 9 Mound Plan View J 1/10 B ODServa6on Pipe 33 - . K - C 0 A B. . - I 3 . - L Mound Component Dimensions A 6.00 ft E 12.98 in H 1.00 ft K 7.69 ft B 75.00 ft F 9.25 in 9.96 ft L 90.37 It D 6.001m G 0 50 ft J 4 12 ft W 20.07 ft 450.00 (ft) Dispersal Cell Area 1196.67 (fe) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 103 69 (ft) - . G H 1 r/rr//rrrrrrrr lLLJ1///i//1 ♦1 F Dispersal Cell 102.42 (ft) Lateral 101.92 (ft) - Invert Dispersal Cellc Elevation E 1. o 4 i4l 101.42 (ft) Contour Elevation 97 % Site Slope Geotextile Fabric Cover Shading Key m c - Dispersal Cell See lateral details on 1❑ Topsoil Cap o n 1.5 It Page 4 for number, size, c R2 / Subsoil Cap o ❑ o ~-1y and spacing of laterals. © ] ASTM C33 Sand 2 I / E Laterals are equally F= Tilled Layer m 0.5 ft Typical Lateral spaced from the N L~ Aggregate e o Q5 distribution cell's centerline in the A distribution cell (AxB). Project ESS Page 3 of 9 End Connection Lateral Layout Diagram Laterals ceutervd over the A&B dimer),on •=Turn-upra'holl valve or oleanoutplug _ p. - =11110 FF'0,ep als are We,itical I<- X--)I doles drilled on the bottom of the lateral .F equally spaced S makr eon tl ok)n via tee of Cross to maniFold at ang point Laterals & lorco main of PVC Sch 40 (per COMM Table 84.30-b) Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.25 in Orifice Spacing (X) 3.06 ft Lateral Length (P) 7344 It Orifices per Lateral 25 Lateral Spacing (S) 3.00 ft Orifice Density 9.00 ftZ/orifice Lateral Flow Rate 10.30 gpm Manifold Length 3.00 ft System Flow Rate 20.60 gpm Manifold Diameter 1.25 in Total Dynamic Head 19.39 ft Forcemain Velocity 2.10 ft/sec Dose Tank Information Locking cover with gaming label and locking device and sealed watertight Electrical as par NEC 300 and -10 - Comm 16.28 WAC -_-"4 is min. Disconnect Tank component is properly vented _ E Altemate outlet location Forcemain diameter welser Manufacturer 2 in. Capacityl 600.00 Gallons Volume 11.82 gal/inch A Weep hole or anti- Dimension Inches Gallons _ B siphon device A 37.42 442.33 C B 2.00 23 64 Pump off elevation (n) C 5.34 63.11 90.50 D 6.00 70.92 D Total 50.76 600.00 _ Dose lank elevation (k) Bedding un er tank. 90.00 Alarm Manuafaclurer LEVEL / Alarm Model Number DLV IJf Pump Manufacturer GOULDS Pump Model Number EP05 Pump Must Deliver 20.60 gpm at 19 39 ft TDH Project ESS Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name UTGARD Phone 715-760-0946 POWTS Regulator's Name ST. CROIX Phone 715-386-4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ftZ Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu1100 mL Service Frequency Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Should inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Inspect for ponding and seepage once every 3 years INSPECT FILTER ONCE A YEAR Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a waterfight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm, Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turin-up Detail Finished Grade \ 6-8" Diameter Lawn . ` Threaded Cieanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: ESS Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10601-P (N 01/01) and SSWMP Publication 9 6 (01181)) and local or state rules pertaining to system maintenance and maintenance reporting No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83 33, Wis Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281 Slats The contents of the septic tank shall be disposed of in accordance with NR 113 Wis. Adm. Code. The operating condition of the septic tank and outlet filer shall be assessed at least once every 3 years by inspection. The outlet fitter shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent fitter alarms may indicate surge flows of an impending continuous alarm The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment. maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, it such products are used they shall be approved for septic tank use by the Department of Commerce . Pump Tank The pump (dosing) lank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation If an effluent fitter is installed within the tank it shall be inspected and serviced as necessary . Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-Febmary) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODs. 150 mg/l. TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD.,, 30 mg/L TSS, 10 mg/L FOG, and 104cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months- When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell Observation pipes within the dispersal cell shall be checked for effluent pending Pending levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition If the dosing tank; pump, pump controls. alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance it the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider Project- ESS Page 6 of 9 ITT GOULDS PUMPS Wastewater PERFORMANCE RATINGS COMPONENTS Total Head Ga lims Per Hem Ih of waled AEinute No. OesoiPL' - EP04 EPOS 1 Impeller 5 53 - 2 Base 10 46 62 10 ~t 1 - / 6 3 Pump Caving & \ 20 36 55 S Mechanical Seal - 20 0 46 5 Ball Bearings _ t 21 r 25 0 33 6 04bngs 6 -30 - 17 7 Povrer Cord 8 Oil Filled MOtor 4 - y' w Atator Housing! 3 - - '1 g Staror AczemNy ~ -~Rcxtr to Motor Cover ' - f fvlF fERS fCET _ 10 9 30i i--►SGfM B 2SR 25r-- - 1 - I n y - r 151 a - - EPOS 3 10, 2 EP04 5 i 0 r 3 40 so (;PM. 0 2 a 6 8 10 12 mr/h CAPACITY 3 j 1 l Jove ()C) _S 0 13 -a = /~i, ya v yon Y 13 - /1 a ~La~ 13^ = %00 T~p 61 75D 7-L FuL- 0 Joao )3-3 300 / - - ST. CROIX COUNTY SEPTIC TANK NLAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner;Buyer A~t -failing Address 3 d 20 S C tf fr Property Address (Verification required from Planning & Zoning Department for new construction.) City::%State C~~~''^ C~Or1Z C L j Parcel Identification Number e_)CmC_) LEGAL DF,SCRIPTION Property Location LLt , Sec. 5 T C N R SW, Town of Subdivision Plat:_ Lot k Certified Survey Map # Volume cc~~ Page # AA'arranty Deed # _ L (before 2007 )Volume . Page #_~l Spec house C yes Ano Lot lines identifiable L yes Xno SYSTEM NLALNTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years- or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 38352(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. T'he property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, joumeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition an&or (2) after inspection and pumping (if necessary), the septic tank is less than 113 5mil of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safery And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwc certi5~ that all statements on this f/rm are true to the best of my/ otu knowledge. Iiwe am.'are the owner(s) of the property described above, by virtue of a wat toy deed recorded in Register of Deeds Office. JJJJ Nu er of be4rooms SIGN TORE OF APPLICANT(S) DATE "'Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warrant decd. (REV. 04112) l~'~~ 4r ~ST'~IFl ~o~~a~t)rrgyaq't QCj 2 9 2p~p t ~ 'lap: of safety an>Plc'crllartnal ....-'C)N hP~}~I Page.-~ol- SJteS >O~6'7+I7ptly,`--n?'e" ~1 If n a-. ant rcounty s Q b 7~ ncl ...te sl.e ptar on naper not kss har. 8 V/ x I : rnr.,9r, u, .I_< Plan :rl,., u I le n.I: not I n N:c to. ver cal And'1:III nnal ra'e rye onmt IIW8 rirrr1:,v and Parcel 11) r~ _.:r[ ;tope.: tale r.! d mens ^rs nnr )-I^+v an In Sinn ar.n i_r- a .e to nearest ma", 1 7 ^Q Q Please print all rntormation P.evte .d ny Date O~N F_ s ' o! 51.,) 1'as 11A S y7 b N R/S E(o `N v1 5---...-- - anpeAy Ow)ors f•Aalt.nq +ddress. I n; ° I;Inck # SuUA. Name CSLA# 30_0 4Q,_._f~t - L-!,71;y n4dlaoe rg:'nwn NeareSl Rln~arl ~1~~21JWDoL~C:"f~! ~J~~SJVIY_I. 7~~!a~s`7yo'~ ---~]-e►_~~~naS.__L_Cp K8_~~7_, C'.onstrur Ix ..1-demved rkSign I1'w rate YSn .-._GPD Faiertmatenal Q _pU,gy--j 1(t -.~s'G-~C1.N riit7.~~A'v'G -i _levahxi('appli!:atrla _ - JA,4~ 3-~ se->F a.t w+y'd 0- - L nonnat I Pit h•mtu'.t,, tactor in. iii,,, Soil. ,ioalion Rale ~ '-Ion7on nvpth (Dom:rant t;clor~ F• r 1 i 1,1' nn nru le L: rsisfance ~3oundary Rootx GPD/H ' m LSm __II v , ..nl r,l, Sh. I ' :H#1 11#2 9 w a $(L it-~Sbt fSb 1-lie~- ay2sl - S ~ I I ~ n)nnq ^ F >rmn'7 1 r ( n.t C'rrnlna r la -le`: D/, ...y In , r Lt e'un) ~r, ~.e. - Sail AppLCation P, rr~. I h n r Uepll C) rtrdnart t.ovv ; x Dosr Ire a r ur- unsrstenx oundary ku GPD.1t ' m_ NunseL ( Uu r:al r t uln S'1. ~f`#1 11 H#7 - 0 --'_L71~___ aM_` kS ;~-53 r~.t qW I F _ -Z__ 1, (o 3 74o~IC>-f lyi FiF?,sY241xl51c -tFSbK r>F' _ - • .,1a.i ' I-111wnt 11 = 6ULt 11 ~ mgtL ant I o F ,6.wn' 99 - ROD 30 mgd. and TSS < 30 TW, c. NJm°,p4.ase Y•inr_-___..-_---___- . __I Ir_ t - - - --CST NIxntlel c).:D 17 Y (a Adrl ss ta■-'r-~s~lt. >ate Fvalu n:u'I GcnduUetl Tekphone Number m r O r~ re_ la,~S_S 7 -17-~o/g 10 51-a1r3$ - (o► rr:cl~ If t>,P ^rn{,Orly tl5vner_{ 5 Page . nZ of Rnnnc # ?chug 9 - LJ r d Grrr:nr. . -:e airv _ 9p V8 ilt-jtn to 6mrting factor_J in. _ SadApplication Rate Hormm fkmth Lomnant Cow Jex lnsa!p,i:~ , u = i - mauve :onsistence oundary knots GPDM r r if 7JUns~il ) Con. Color YY.2 .l, cFs eK w a - - S L _ FS b ~l _t d 0 !n a ke-N ~SR r~-f-a-ale J i I- J ~I Bnrirtg Ronnn# ~ p,: ~r~un. : ac _ elev l { ;h io ion sir r~ faclnr _ in 4atF Howon Depth ifk:minaai CrkT R.dns Cesrnntion ur rutiurc Doss _:i"= -oundury P - ' -G _ " r. ~z. SI'). ff#t i7t2 I i + { 1 I i , 1 ❑r Rnr,~. _ t7oivl[J3 t f.~. r-h;o hnoimg fsrtnr - Snd 4 {Irafinn Rate -Wn2on~ fie, th IGcmean: i:nln- r:;osf lpCon :n:-' Imr,%ire `ons•stence oundary Pools GP)@t' Wrisell r ° _:nn r'ab, S11 _ ff4I ff#2 ' Ffnuent #i = P,OC aU c 220 n7. rL and T:>5 o-30 I5': ,.ra_ E lfliwnt #2 = CiOD < 30 mgA. and TSS < 30 r ,y'L fc. 7.; f rct.:;+,..1 lFiC(' l.~•...;Icr :,n.l rmplovcr. If rnu r;_cd .1111 t,.- of I1~ thioki 'i Rcu ~~v~+~ ass _ ~~3a 3 Sw, S lJ~ See. 3 yJ) T,3aNf) '/o .~a11►~ 14 -r RCS w ! acre. S:ale;lug ~(c~' FGtsrGet- Cst aai-7q r e1'~ lOJ, of vec.'~ . + hor f~ tr' tip. K~un,,v~w,. Wa• L e.ie-~s.~.+•,otis $i (ni,`la' a3 g9,+18 } C4 r~ + 3 3 t , ~ 33 zz h O M 300 ;rey ~ r I~ t ~ y j~ 24* 7' t. 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