Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
020-1162-40-000 (2)
N1srcnsin Dcpa•Mcnt pf CcmmE2c county' s:411, and B., ding Cvs;o1 PRIVATE SEWAGE SYSTEM St. Croix INSPECTION REPORT samlary f'e(mn No GENERAL INFORMATION (ATTACH TO PERMIT) Suite Pla• ID vc , 597425 =rlmonal invinittoal you provide may he used for secnocaly p,posos (Pnvacy; sa s M 041.1;•,)I. Pe rn1J Holds Na."'. (;rty V.llsye Tnwn:hr, I Ta. No Michael Brueske TOWN OF HUDSON 020-116240-000 "ST RU Flcv Insp. BM Llev nm nnso ptien SxipmTn.Y^Ranpd/Mao No 17 0/ -krs ST- c +-t2- 29.29.19.931 ~ TANK INFORMATION ELEVATION DATA TYPF MANUFACTURER CAPACI IY STATION RS HI FS CLLV. - - Septir. ~DOO Bcnchntark ~'Z p O .~3f Uusing All. BId *t AwaGpt (J _/J Bldg. Sewer SO if Intel / TANK SETBACK INFORMATION SUHI f lullet ~ -39 9 /G ^6 3 TANK TO PIL :441 I HI DG. Vonuo Air Intake ROAD Runlet Sc I , G ( > 5-6 / l 1 ' Dt Bottom Z > 30 r Sb / Q I HeaderlMar Aeration U U'st. Pipe C .'fS / G -Sb Holding Vol. System r py L> 2 3C1 - 4-y?e-- Fi I Grade PUMP/SIPHON INFORMATION i o . 3 Manufacturer Demand St Cover crM Model Numlxr 1t~ U~4t~ 6-~l 9G o ' TDH Lift Frict )LOSS System Head l ul l Ff ~~,4 . sr l (-.3r Forcemain Lergttt Ula. Dlsl to ttirll - ~ 1~3•0l SOIL ABSORPTION SYSTEM I a- PA~ t,r rIM REN %N 'dt^ 7 7 11 No. Trenches I ENSIONS No 01 Pcs Inside ow t idmd Ueplh OI NS ( SETBACK SYSIL.IN1 10 P7L SLUG WFI L LAKCtSTRLAId LEACHING Ida^Na_tu•er. INFORMATION CHAMBER OR Type S& V. (bf 2 e / Sd f UNIT Model Wntw G S~ ~S DISTRIBUTI N S TEM IleadpCklnnifpl Distnculoc H.oeSin• Itocspacing Vent to Airlmake r Ppels` _ 33r myth :)in LnnpN 71a ^v{vnrn+g _ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Dnp11, Oenr Depth Oa:1 xx Ueplh.9 xx S.md,diSoodcd 1 xx Vulched Rrc9tlercn Crnb:r BedlTrench I dyes 'opsoll Yes No Vr.: N'n COMMENTS: (Include code discrepences. persons pwO..nl, eh:) Inspection Inspector #2: Location: 724 GRCENBRIAR RD A ` Sr) s n _ 1 tQ r,' CCC "'OOP"''^^`^^^ x^^ac- L)Alt BM Description = ST AAO. 1tlt- CAV`~ (0 CrPrr l 4 2.) Bldg sewer length= _ >15/CeV~i~C S-S'-~s~.••..5~'~°a~cto•r„1( - amount of cover Plan side Required? Vey No sy r`- SS Use other ther for atltlilronal udomtat nt~ 7/1`0 IIR.3:91) Insepctor's Sgn a rr CenNo Loki, Industry Services Division SI. Cmn N a d ? - YO D $ G p .r 11. 1 1400 E Washington Ave - ' PS f.'-•, ' Smul:ml'cunu \umtkrlln be tilled nl by ('u.) N U box 7162 CROIX COUNTY tvladlson.ih~ 53797 7j$2 . Z `r K ere a( nFVELOPMENT r!~% - N Sd111iiit) Permit F76y ! B8 VZZG St:+tc Irancacnn Kumlkr In t rdmce ss uh SPS tS S'II N Will ( d s h... o I till, "q11 . al und, i. ICywni rnurh tbtami ea.nul trcr non pli o1r anti fin ale TCd 1. Pl.% i. ullJdI" :hc !k annxnt t Slllh ,nJ I uRs r I'.I Srn - I ro)ea[ Addre.r f if ddterem than mailine addre>s) P t I coon tl mbtmnn mn ~ u Fn.: it.c m.l, n_ us.: n1 „mtF,mPu o 'c' in accnrdtmce "till th I c h 1! 1.11w. Sul'. Same T~~ T•P¢,n6Y(Cil" 1. Application Information - Please Print :All Infrrrnalion vol 1) tic:' N .2111C Parcel :druc A Nhchacl N II :ahah f+-I lb_'-1U-100 - - aq.aq.ly.vsl I'1; p « r ONIIla 1 Nlading Addres` >r'NrN : off, l:on 24 IreenbnnrRoad (n. I I t 1 in Sta0.' Zip (ode Phone Nunlhcr NU S41' ; Se.uon 24 IluJsan,lVl Is I It. I vpe of RuildmK (check all that apply) l or X I I fanlils:A, ilmr N'.,mlm of lUt,xmtc s~- Llb - _ Subdnision \,unc / - 1 Comm Bill U I uhh;i('nmmuu'll Ik•.enh; I hr Block El ~ Slfnc Uwncd Dae:Ihc l sc - _ ❑ A \'illa_C of nmhcr /I•an of IInJu,n Ill. '1\_ pr of Permit: (Check onh' one I'm on line A. Cumplele line R if applicable) ❑ Nets Spm111 ❑ Rcflacenlcnl Seacn) ❑ I Ica( erc I {olding lank Repluzemcm l!nle ❑ (hhu 111,41t nk o to (:arson sNitem lecplam: El Pei Tait Ruie,%41 Pt m.+t Iiclnn!n i ❑ I'cnnit'iransfcr lu \cw I w r. cious Punul , u. U.tlr La1e;l lief"re I(srlranon Plumber U..ner 128666 10:25r 1989 IV I% peo1 PUN IS System Component Device (Check all that apply? _ N n I us+ur.i J In (i n11d I Ic,.urvcJ hi (7ounJ ❑ \Wwi 1c ❑ %lound 4 in ul ail thlc sod ❑ %lound 1 in. ul ruilablc soil ,_I IAIJm.I:c:A [!!I ;er l hp.r'nI I cminl..u.i.eplaml ❑ Pretreatment U.eLLC itsl.l.tint - ` Dlspers9. Neal menI Area Information: _ _ n Ipxc I_.re :J. I u i.. 1rP~x al nn D"pera: Arcs i(eyuired !sP. DiiN d Area I ,t po>cd '.,O Sy>Icm He%atiun Sa.:_pJst1 ~ti;3 65n 44.14' \'I. Tank Info t armcl- s of r v ~ ( all r° of z J v T otal d l~lnits N4amlfacturcr - e• - Gallon. Sd he [ I fdJm= 13-1, ?20 H I P 111 I }20 a \lFc'.'. N i.~ c Q ❑ ❑ Q i ❑ ❑ ::AI m l h mhr C: El El A'll. Responsibility Statement- I. The undrrcigned, as,umc rr%pnncibilits for installalton of the PIl\\'I'S xhnnn on the amtchcd plans. Plumnr.\vmc 1'runt 1'Imulicr /u/ydlure n.ll':WIRS\uulhcl It .vlcs Phone Number John S hmill y. / r AzZ~Ci 6~I ';J. JS%b I'lu itm AJdre. IStreet, C it,,. Slatc. Ap(fidet 610150";Ave. Somersul. Al 54025 \111 County/Department( a Only _ \PI n.'cJ IIl - IX. Condition DI cr~a.r'1 - - - Permit I cc Datc Issued 711-1111 \ecnt wnauuc - C~ } alsait:LLssYn L , a :br Ilcnl.tl' p O ~ i s of Approval Reasons for Disapproval SYSTEM OWNER: -~[Awkr Ci.flt4rtskio~ Q° cfQ 1 Septic lank, effluent filter and )T No~c Lax r-~ ~FL( i S r{. 1 ) dispersal cer must be serviced I mai_ntalned ~1i 6 0l1 s1.~tJC. ao~;Gho f I d as per man;y- 'r plan Px provided by plumber. mR 1S QAPurr~_ 2 it selbacY. ~i7S~$d "tell 1 Imrlrh Plan> fm Ibe al<m and nhmil m the t aeg17C!dxip~,lvtlt'€rg~c})e4?~f' Rlari(;e$ Ic SIiU-(u'98 1 RQli I ~I I CONVENTIONAL COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Brueske 3 Bedroom Replacement Septic System Owners Name: Michael & Eliiabeth Brueske Owner's Address 724 Greenbriar Road Hudson, WI 54016 ega! Desc-iption: NW1/4, SW1/4, 529, T29N, R18W Township Hudson County: St. Croix Subdivision Name: Country Hill Lot Number: 2 Block Number Parcel I.D. Number 020 1162-40 000 Plan Transaction No. Page 1 Index and titie Pare 2 P of Plar. Page 3 Existing Septic Tank Specifications Page 4 Proposed Septic Tank Specifications Page 5 Effluent Filter Information Page 6 System Sizing & Cross Section Page 7 E2 Flow Information Page 8 & 9 Managernent and contingency plan Page 10 Existing Tank Certification Page 11 Septic Tank Maintenance Agreement Page 12 Warranty Deed Page 13 CSM or Plat Attachment 1 Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 8/7/2017 Phone Number: 715-760-0486 Signature: In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 Protect Narre PLOT PLAN : Brueske 3 -Bedroom Replacement Septic System J a yes; ipticr `NW1,4, SWIW 529, T29N. R18W P D 020-1162-40.0_00_ ' Suhriv,aron Name. Country Hill _ I Lot AL 2 'uwnsnip. Hudson ~i Parcel Site. 1.030 Acres SCALE 1"=40' Caur'ty St Croix - Syslerr Elevivrr T1= 94.10 Pro osed 90.00' EZ Flow Trench Slope. 6%. T2= 94.10 Proposed 90.00' EZ Flow Trench A Bld? Flevation 96.54' Top of Culvert - BPA2 Eleval on 9670' (Tank _outlet Exlstm Tanks s Concrete Products 1000Gallon Bac,noo Pils Proro n' Tenk~ Wieser Concrete W320-MR Ic_- ,-It-.-Polylok 52_5___ See Plat Map for complete view of parcel I •i li', rh<e -AS'let n7r.i, S h 3034 - AS7M1^ D3034I I q L Ll 3 ~rZ r2' ~~M \ ~ ~ - 4 `4 >4T-11' Alt IJ ~Lr1(L`4 l i r}BlJ KLI IN I HGLiSF J ~r. ) LI:N i~lil(rll Nt< 'u )at~LAt r•'L }tcc4luN ScJ;lc. rrFNP~ _ - v CIL ~ c H Ll t x, D2AIN FIt I: L13 gt X94 i 1 IL ~3~ Il15An'u~,~,=p r 1 Page 2 SAr 61 Y AND 4U!_D!NGo UI'JISICN ?urobinp Prod.::' ~ievie+v commerce.Wi.gov N.O. Box 2658 Vamscn, Wisconsin 5!701-2658 i sco n s i n TTY: Contact Through Relay Department of Commerce Jim Doyle, Governor Richard, J. Lemenkugel, Secretary Feb,uafy 16. 2010 WEEKS CONCRETE PRODUCTS RAY WEEKS 1832 215T1l STREET NEW RICHMOND Vet 54017 Rut Description: SFNlAGETANKS, CONCREiE Manufacturer: WEEKS CONCRETE PRODUCTS Product Name- SEPTIC. HOLDING. OR PUMP Model Numbcris) 1000 (49 IN. L.L., 21.76 GAL-IN., 84 IN.MAX. DEPTH OF BURY 511 G.P.D WHEN USED AS A SEPTIC TANK BASED ON A 3 YR. SERVICE INTERVAL FOR RESIDENTIAL WASTEWATER:. TANK DIMENSIONS = 84 IN. L X IN. W X 49 IN. H) Product File No: 20100040 The specifications and or plans for this plumbing product nave been reviewed and determined to be in compliance with chapters Comm 82 through 84, Wiscorsin Administrative Code, and Chapters 145 and 160. Wisconsin Statutes. The Department hereby issues an approva' based on the Wisconsin Statutes and the Wisconsin Admir.Istratwe Code. This approval is valid until the end of JUNE 2015. Th,s approva: is contingent upon compliance with the following stipulation(s): • This tank must Do designed to withstand the pressures to which r wnl be sub•ected. • The manufacture must weep a the manufacturing part a se- of plans and speci'ioaticlns bearirg the depart nenf's stamp of approval. The plans and speciticalions must be open to inspection by an authorlied representative o1 ire department. • When this product receives wastewater from dwellings and is used as a septic lank, it will produce an effluent quality with a maximum month .:y average value for BOD5 of greater than 30 mg. L and less thar or equal to 220 mgt TSS, or greater than 30 mg/L or less than or equal to 150 -gil- TSS, and F.O.G. of less than 30 inglL. • Approval is issued for this product as being equivalent to a Boor ouwt water closet when the fixture drain is installed in the vertica't position. The design meets the intent of s. Comm 82.32 (5) (c) and 84.20 (51 i;iu. Wis. Adm. Code, which recuires water closets to Cischarge througf• a miri-rem d'ameter 3" Crain pipe or liftng and the oowc' ro conform to ANSI Staedard A112, 192M. The inter.! of t,re code is mel s.nce this product prov.d:.s Inc same funcficoa, perrorrl.arce as wale, closets that meet ANSI S:ahoard At 12.19.2M- • BEDDING: Bedding material shall be used to provide a uniform bearing surface. A min. of 4-inch base of sand or granular bed on top of a form and uniform base is recommended. The tank should not bear on rocks. Sites with high ground water tables should have specially designed bedding. Soils should be compacted under the tank. I his apivova supersedes the approval issued on 4;71 i2005 under product file number 20050106. This approvai fetter sha!' he incorporated with your previously approved plans anrilor specifications approved under product file number 20050106. As of May 15, 2008. a copy of a successful water tightness test report for this product must be AVAILABLE FOR INSPECTION AT THE MANUFACTURER'S PLANT prior to this product being used as a POWTS holding or treatment tank in Wisconsin. The department is in ro way erdcrsing ,his product or any advertisng. a,1d is not responsible for a iy situat,oc which may result from its use. Sincerely, Jean M. MacCubbin. CST Engineering Consultant--Plumbing Product Reviewer Commerce: Safety 8 Buildings Div.; PO Box 2658: 201 W Washing'on Ave : fvladison WI 53703-2658 Phone. 608-266-0955; Fax' 608-283-7456: E-maii_ Jean. MacCubbingwscons:n.gov snD.tese r tra the;, Fee Heft IM04eos Dom: Page 3 0-:07.0 31 O:L>S .11 Z a^o~-is~d rt-cr r _3 ra cr~~r,.. x ❑IVa 'mo'o; rr,ulvA a. A.vl+, -IVONVYV DLLd3S „ t{ .3~ 3l~~aaoa w ...nD,l dHd ~~-,l- 4/I {INB± .;.N -AH tYl b'?IiJ V3331M a{"'"_0NM \ O W K ~ w ~ J N w H Q D J z co 0 z w ° Z:) a s = N a a w cnl o w © a l/{ Q Z KO V. pF- ¢ n J z m w Q Om Oil fi V H Q c c i F- U F J Z J Z ` w Q LL - N c` ~jW <<'.U :.1 G d`C3 Z < c j~ d VI W H W J Z W U Q Q n [v U Q Vi J I 4ww < p O~ U o mMm << W v zz N a LL- -°ooaaJ w ~ mwN p p ¢ z x OU <0 o.. pm rMN ink ad ] p z N Lit i•i m w<v wz¢ m m 7 N na- n o » -s 7 In ..O 1Y 0,m 3:n O<y pOw < w m F pw 1<-'0 2' >702 ~07U Z. ~V) Q O 7 V _Kp 0U Y SO O< w wOw G~V `¢SO U < V x 0 Z Z Z 3m U~LJ s m.~3 O U Q w J 5 a x d1.{ i ou p 2 Z ° OJ ¢ >z r OF V 'I rn z - w ~ J 1 ~ 1 S p W _ H T V%. U - _ L W C ~ ¢ W yi V 1 I < 2 w N Y Z 2 H Page 4 °t I he 1'; Filter i~ rated for 10,1100 GI'D (gallons per day) making it one of the largest filter. in its class. It has 25 linear hrt of I!-16" filtration slots. Like file Polylok PL: 122, the Polylok P1.-525 has an automatic shut-off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off dw vsteni so the effluent won't leave the lank. - Alarm Switch Itatod for 10,(M GPD (gallons per day). 10 " GPD (optional) ",_2-`, linear Icct o(1; 16"" filtration. r A'.efvts and 6" SC1 ID 40 1riPf'. Exte tte Accept, I" PVC nsion Handle ,'U'It in gas deflector. Automatic shut-off ball when filter is removed. - ' vT - [.It ill accessibility' Rated for uLtxw)GPU epls PVC extension handle. I Ideal for residential and commercial waste flows up to 525 Linear Pt IW~ utlne 10,000 gallons per tidy (GPD). L Locale the outlet of the septic tank. Z. Remove the tank cover and pump tank if necessary. Glue the filter housing to the 4" or 6" outlet pipe. If „ ; ;14, the filter is not centered under Hie access opening use a Polylok Extend R Lok or piece of pipe to cena•r f lh•r. J. Insert the P1.-525 filter into its housing; Replace and secure the septic tank cover. the PI.-525 Effluent Filters will operate efficiently tot veveral years under normal conditions before mrjuirm leaning. It is recommended that the filter he cloanvd every time the tank is pumped, or at least every thrr+' wars. If the installed IiItor con(ains an optional alarm, the owner "rill be notified by an alarm when the filter nerds servicing. Servicing should be done by a certified .optic tank pumper or installer. gnh,u+. i "hut-oil I,,,; I I . Locate the outlet of the septic tank. Remove tank cover and pump tank if necessary. 3. Do not use plumbing; when filter is removed. 4. Putt PI -525 cartridge out of the housing. 5. 1 lose off filter over the septic tank. Make sure all Mir solids fall back into septic tank. 6. Insert the filter cart Mgt- back into the housing makin>; sure the filter is profx•rh• aligned and completely inserted, 1,,I% 1,,k Label k It wt hlter, aeee•Pt Fail a„tau. 7. Replace and secure septic tank cover, IN,Smartfiuerkswitchand Alarm . Into e•xishnt;Wne, Pohdok, Inc. 3 Fairfield Blvd. W;dlingford, CF 06493 'I611 Free: 877.765.9565 Far: 203.284.8514 ww%,.polylok.cont Pale 5 SOIL ABSORPTION SYSTEM DETAIL I GRAVELLESS LEACHING UNIT Project Name: 6rueske 3 Bedroom Replacement Septic System Grave6ess Leaching Unit Specifications Manulachirer Model Laying Length EISA Rating 'it yn' 23 C. matro•,rn _ F7 1: System Sizing EISA Rating per Foo:: f F7 Flcm• 5 Sci Appl catior Rate 0.7 gp-tt 450.0 gpd Design F:ow . 0.7 Sail Aop Ica: on Rate e EISA = 126.6 Feet of EZ rlon• =trenches 65 Meet long each 2 No. of Cells 6 5 Per Cell 3 it Cell Width 13 Total No of 1203H 65 n Cell Length 325 sq R EISA Per Cell 3 n Cell Spacing 650 sq ft Total EISA Typical Cross Section Finished Grade P`. H Observation Pipe with _ _--SP Sol! j Baod cap or vent Backfill ll 36 inch- - Geotextile Fabric 12 inch O II fl Stoned and Anchored VentlObservatan Pipe ti i_ _ with Cap 94.10 k Infiltrative Surbu >36 inch Plumber/Designer Signature: License MFRS 223760 Date: 08/07/17 Page6 Installation Instructions for d*EZf rowN EZ/Ann, Systems in Wisconsin by INFILTRATOR 'vb'ir:rc•rsin Department of Commerce, Safety and Huiidirg; 5, The Absoria~ area (SF) nor-essary for a giver site shall ..Sion:, has teview•ed the spccit:cations and., or plans lot the be stzcd based on maximum daily sewage flow (GPD) 1 and roduct and determined it to be in compliance with chapters the Permeability for the site, If certain criteria is met, the c:rmm 82 through 84, Wsconsm Admin. Cafe, and Chapters USA sizing can be used in Wisconsin. resulting in a 404% 145 and 160• Wisconsin Statutes. All si`,es must meet 'the Site smaller drainfield. Sod Conditions & Locations & Isolaiwn distances as noted in dal regulations. 6 Pace LZRow, bundle(s) in the Uf3ow, configuration ap- [-in,ed by system design permit specified for the parlicu- I he approved products are 1203H (3 12" bundles with Ppe in far site. The top or center-I. bundles contairing pipe enter bundle in b' or 10' Icngihs) and 1203HP (3-12' bundles a•c joined end to end with air internal pipe cou,oler. Any :oath ,too in Cadt1 bundle it 5' or 10' lengtns. additional aggreoate only bundles that may he required, • sitoulc be bated against the other aggregate-oniy bur- single pipe burdle contains a four irch perforated Pipe SI6 : dies and do rot require any type of connection. ot,ndee by CPS aggregate and is held together with Poly- _4 ene net:irg. A single aggrega'e bund!C contains aggregate 7. the top of each GEO cylinder contains a finer fabric pre- r I r,c he6 f tt:aelhrr h pChrtr, I rg rr• ing. arUfactured in between the rotting and zggregatc. The fabric is nserted to prevent soil intrusion. The installer Materials and Equipment Needed steal make sure the the GEO rs positiioncd upward and is • E/flan Bundle, in contact with the fabric contaired it the acjacent cvlin- • EZ11ow GcotexSe f-abric der before backfilling. • CZfloc: Inte;ra' Pine C•:o..plets • Pipe for deader an,-' Inlet 8_ the EZfiow Drainfield Systems should be installed in a • !iackroe%~xca.2tci level trench in all directions (both across and along the trench bottom) and should -chow the contour Y the gIounc Installation Instructions surface elevation (uniform depth), with all con'iroC.a Th,: m;l n,ctiors for irstallah,n of -_Z fu,,, prier :are. given adjoining 10 foot cylindrical bundles placed end to rrcl, oelow.. This proouc: must be instated in accordance vatn sta:c with central bundle distribution pipe interconnected, Iles defined in chapters Comm 82 through 84, Wiscunsm Ad- without any cans, siepdowns or other water stops. dristeat:vo Code, and Chapter 145 anti 160, Wisconsin Stat- _tes, as well as the local health departrient's currer' 6 csigr 9, 'r c trench top shall be graded such that water write -~rs.ru_.I, ❑end. Backfill should be seeded or sodded immecist~ aer completion to reduce erosion. i ;Vter the local health deparlmew has determired wiry, sanfiguiatior, and layout for the F71low systeris ;tug:, : 10 FZfil )w EPS bundles are Ilexible and can fit in curve-. I -r mark :with pair' trio location o` trenches and linos. Uu 'rendres as maybe necessary to avoid trees, bou!det.; ireful to set correct ,ark, i'ivert p,po. header line or dirt- ether obstacles. ribution box and trench bot.o n elevations be*ore instal- lation of pipe bundles. I. LPS aggregate i5 lighter than water: therefore, It mi;,l: I:e expected that natural buoyar(. forces would tern Remove plastic FZflow shipping bags prior to placing cause FZflow assemblies to float out of ground .v)I !:;,,rdies -.he trerch(cs). Remove any plastic bags in the pordirg occurs. Field experience has shown, h;veCv t-erch before system is covered. that this is not a problem when systems have a mC irurr of 6' of soil cover as ccommeroed by manufac:.ir,r. This procuc; must have geotextile fabric trial mees re- cv-irements of s. Comm 84.30 (6) (g), Wis. Adm. Code, nscilled directly en ?.^,p r:' the prdd'uct and exter•uir•e 1203H-GEO (town aigng the sines of the product to a pain: at least sx Inches from the ho-.om of product 4. Wher installed In a trencn, the -orch should be dug to flay a width of 36 incne5 -Fit n; t oniy saves IaLor i excava- ',ion, but also provideb better load-bearing : opacity after backf1fing is complete. Page 7 POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Gll. M1S¢: I X Flvaheth Hrueske Tank Manufacturer: Willer Con-rctc _ NA Fallon it J SvIl [Uric [rlo:ding "A lurnc. 320 DESIGN PARAMETERS Tank Manufacturer: Wieser Concrete [ NA Ncmber of Bedrooms: ,I NA -,Septic [Dose [-,to ding Volume. 320 Nunrher of I'ubic facility Units: NA Vertical D stance Tank Bottomisi to Service Pad: h Islanaled laverage) Ho••v 300 gahlay lHorvgn;al 1) stance Iall to Seniv ad fl Desicr Flov:=est.malen. x15 450 ga.day ~,I-:a n' t.ff vilt'l is-151vI::. In S Ill. Soil Application Rate. 0 70 gal.4dayifl2 r:nzo^:al.r 1~. •eer ~ceonl rso-r _ues lt. be C,Ove d nn eau. Standard Domestic InfluentlEffluent Monthly average Effluent Filter Manufacturer: POLYLOK [ NA =as, hits & crease tFOGi sac mrr, tirthient Filter Model: It odrr° ~a Orygun Dr-4"d ISOD:t stzumgl. [I I Pump Manufacturer: Irlal Sasperduc Soots (TSSI 'i50mc!I ump o e: High Strength InfluonUEHluont Monthly average Petreatment Unit NA Fans, O Is & 3re.as¢ IFOCI s3a marl Mant.facurer S shell ;,al Oxygen Demand (I S220l L [ NA J r,mm.-.~~r.,l4r: nu~•~ .J p,:.n = :r.r TDWl Suspended Solids JSSI s150mgil J I;i::mL:~narv ~ toml:rw Petreatod Effluent Monthly average [ tana Ir a,tl -a., 7 (l BochefrrJl O rspen Otero ds UUD,i s3r)hl _ of son tlonl1ysterrrl',c.,_vvy -1-77A :TSSI 5^,amftft NA [ O, aro.mc Or'_,": eFal COilbr^• goemctr C rtreant Piu~fu! I JUmI At Giane hl lVdxrnurn Effluent Particle Size: 7. r dia JA ❑ric I r. r,. er. 01.1c• u• [ NA MAINTENANCE SCHEDULE Service Event Service Frequency ','Chen combines With S I and Stunt equals one-third j'G} of lark w:lume Pump out conxnts nl lankr;st When the high water alarm is activated At least once every . 3 r""' "I (Maxi mun 3 Years Inspect condition qt tanki si v~:rrl.l ) L NA ar'sl (Maximun 3 Years) L NA Insperl dispersal cellist At leas! once every 1 S CrraDr:"I v • l Clean effluent filler At least once every 1 5 NA Inspect Dump, pump ool is 8 a arm At least once every NA 'vcarl=l :I coon-'',I FT NA F-, NA ;I MAINTENANCE INSTRUCTIONS Ir_reet Ins I'tank. III mst`n,1l eel . shr ne mace Dy er i-dhadual Iamymg ere M th¢ otitis rig hr,¢r ge° rr ae'( L,: a'Ir'i?. kA.95ter pl,:mbe•I hAashL P ,nuCe' Resirctec Sewer PC'i lTS Insc.DP.rlor PONl1$ Rk9m'm ^er. Septaya ServCng ODCratC' I~umF'-'Q Tank inspe0l -ust iro ude A visual nspcrno- of the tankisj to identify any missing o~ broker raottl, identify any cracks or eaks, rr njsure lie volv-v of ccnroined s udge and scum and a crere'of any Dark up Cr ponding of efluent on gro.md sur!acd The dispersal celgsi shall be visual y inspected to Chl lire effluent level it the corke-n;atirn p ties and to check for any band rift r,• eff-en: In the ground su•lax. The Donding of effuent on the ground swil, may indr,:!ilud a failing condi it and requires the Inn-:ediate •iurficabon of I local regulatory ar-tronry• Ill the combined agG.mualion If st..dge and v,,m in any treat-em tank equals one :hi 'd i G) or ^xe of Ere tank volume tee ertlre ecrtents of toe tank shall be •emove'<d by a Serfage Seling Operator and 0ispcsec of in accordance with ~ rgtlkr NR 113. y^Os»nslr 4d-inin1stranve col All other Seeffoll, ool but nd1 hm:ec :9I servicing of e9vert Eli met-anca' o• pressurized Cem Donfel pelreal°enl units, and any ser farg at intervals of 512 mi snag. be Ier•rr^ed by a cwn•mc RU'.^!TS Mainta.ner A irate report stall ee provided to me teal •eg,IatDly author. ty wi:hi- ao Jays cf rnmplefon If any service event i Rev 2X5: I_ START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may Impede the treatment process andior damage the soi: dispersal cell i. If high concentrations are detected nave the contents of the tankis) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frmen at the infiltrative surface During extended pourer outages pump tanks may fill above normal li ghwater [eve's. When power is restored the excess wastewater will be discharged to the mspersal vial in one large dose and may overload them •esultlrg in ibe backup or surface discharge of effluent. I o avoid this situation have the contents of the pump tank removed oy a Septagd Serv cirg Operator prior to restoring pourer to the eN uent pump or contact a Plumber or POVdf8 Mania rer to ass s: r clanual y operating the pump controls to restore normal levels lvithr. the pump tank. Ito not drive or park vehicles over tanks arc dspersal coils. Do not dive or park over or otherwise disturb or compact, the area within 1f> feet down slope of any mound or at-grape soil absorption area Reduction or elimina!ion of the following from the wastewater stream may imorove the performance and prolong the life of the POWTS. antibiotics, baby wipes. cigarette butts condoms, cotton swabs degreasers dental floss, drapers dsmfectarts, fat foundation drain (sump pump) discharge: fruit and vegetable peelings: gasoline. grease. herbicides: meat sc,apsi medications, oil, painting products: pest c'des: sanitary napkinsi tampons: and water softener brine ABANDONMENT When the POWTS fans and-or is permanently taker o,rt of service the fndnvnng steps shal be taken to insure that the system. is properly and safely abandored Ir compliance will- chapter Comm 83 33, Wisconsin Administrative Code • Ali piping :o tanks pits arc other sod adsorption systems shall oe dlsconrectec and the abandoned pipe openings sealed • The contents of all tanks and all shall be removed and properly disposed of by a Septage Serv crag Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil gavel or another inert solid material. CONTINGENCY PLAN If the POV)i fans and carnot be reoaired!he following measures have been of must ne taken, to provide the opportunity to obtain a sanitary permit for a code comoliant replacement system U A suitable replacement area has been evaluated and may be uh.Iled for the 'location of a replacement soil absorption system. Tic roplacement area should be protected from disturbance and compact. or and should not be irfringed upon by required setbacks from existwo and proposed structure. lot lines and wells Farufe to protect the Ieplacrimen: area will result 'n the need for a new sell and site evaluator to establish a suitable replacement area. Replacement systems must coh•ply with the rules in effect at the time of their uerrnit issuance - ❑ A s,utable replacement area is not avai able due to setback andior soil limitations If the sod absorption system cannot be -ehabddated and oarring advances in POWTS technology, a holding tank may be installed as a last resort The size Las not been evaluated to,denhfy a suitab a replacement area. Upon f6ure of the POWTS a soil and site evaluaflon m,rst be performed to locate a suitable reblacernent area. F no replacement area is available a holding tank may be installed as a last resort :o replace the failed POWTS Mound and a-grade soi aLsoTaCon systems may be reccns! uclod l-1 place followi emeva' o`fhe biomat at the inidbanve surface. Reconstruconrs of such systems must comp y with the rues r effect x that bme WARNING: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT - OXYGEN TO SUPPORT LIFE. NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY 4ri1 CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT. ADDITIONAL INFORMATION: POWTS INSTALLER POWTS MAINTAINER Name. Juan Seh._t Aam: "i'n Schm I: Phone. ! i'l 041I8 VI•vnC "5 ?GI: 04 YG SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Na^e fywncrs C'ruiv= -4a-e. St Crc x Cc.rmy /onrq Vhpne. - - - Panne r1S 388.458C This document B Intended to meet mini•Tdn1 rel cements o' Ch Comm 83 22i2?ib;if' p(d)&ifl and 83 5a(1 i i2: & i3? Wisconsin Administrative Code. Use of Ibis document does not guarantee :he performance or the PObVTS hr ''I ST. C'ROIX COUNTI' ZONING OFFICE CER'T'IFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existin« septic andior dose tank presently serving the following residence: (Street address) 724 Greenbriar Road located at: Nom' SW Section 29 - , Town 29 N, Range 18 W. Town of Hudson . St. Croix County Wisconsin. Upon inspection, I certify that I have 10und the tank(s), to the best ofmy knowledge. will conform to the ruluirements of SPS. 354.25, and it (they) appear(s) to be functioning properly. Nlost recent date of inspection or service Did Ilow back occur from absorption system? Yes No (ifno, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 1000 Construction: Prefab Concrete X Steel Other _ Manufacture' (it 'known): Week's Concrete Products Age of Tank (if known): 1,0;25+1989 I'enmit r Whet (if known) 128606 John Schmitt I.ic sed Plumber Sif/ - ( i tenure) (Prot Marne) AMRS 223760 (Title) - - (License Number) NIPi'IVIPRS - I l- 17 (Date) Form to be completed by licensed plumber ( Dept of Safety and Professional Services Chapter 305 and s. 145.06. Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) ltev. 2?2012 ,t~ io r Z H • a ST C- 105 r a H SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z v a OWNER/BUYER MkC."P&(- ~ ~AWET~E A SK t^ ROUTE/BOX NUMBER Fire Number CITY/STATE Z.IP=j40k(o PROPERTY LOCATION: RRA k, SyJ k, Section. , T ~29 N, R--1q W, Town of_ISpS~N St. Croix County, SubdivisfonCaUt3~i11 Nkll Lot number _ Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix County residents May be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, Journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. o F. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with m tite standards set forth, herein, as set by the Wisconsin Depart- v ment of Natural Resources. Certification form most be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED DATE a•~ St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 715-796-2239 or 715-425-8363 Sign, date and return to above address. ',i ~~.-11 N C) ~o ~ ,or rn w z C) wo _0 0 2 6F co > F-- a o a f a w N~ U h Ci N o,E,'L J J W N N W J V) w "i\ HI N O N. a (1 ~ O ~ Fml o o Q Fz o LO 0 IQ 9LZ U1 d' OI 0~90N zo ~oa__O \ 0] U R N M .SOS , z D: 0 of s w O 3 al 'r OH \ IV 3d~ i JI pU \ ~ OI WI F .O~<,i FI a WN pp OW 3 ~I O ~ N 0 jI I,.I C; O n a m OI Ol N J w O M v- 9 a yL (V (\j 0) f vi o ? O NW W m p U N d F 4 z o m n O b ^p 1' FI O mW .4 F LLN LL N NI O W O Z Z NS n1 N:Y I VI W 0 N 0. O mN O On I <rI M Ir Z= m % 1` J o v J vi o O 0 N 2 w o ° e_ v_ a u:i W n~ o o uI m m OD N o H a H V .00 bZZ ,00'SOZ m ~ 0 D \ N w I ,00'6 Zb - M„II,00000N 1 ai = Z Z a r 0 I N y U p = W N z ~ m j O }cr w< U n 0 J Z H m U a 3 f O N W w N 0a NK U a W e, vu n _a ~ v) ir]I SANITARY PERMIT APPLICATION 170 _LHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY 1. STATE SANIT RY PE MITk -Attach complete plans (to the county copy only) for the system, on paper not less than /A 8% x 11 inches in size. ❑ Chetaevlao0w tan application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION /y' + - / 1;W %5_a J'k, S 2 ~ T ZS, N, R / o PROPERTY OWNER'S MAILING ADDRESS LOT# BLOCK# 724 CITY STATE / ZIP CODE PHONE NUM FA SUBDM~ 1014 NAME OR CSM NUMBER 7'~ C . / It. TYPE OF BUILDING: Check one CI NEAREST ROAD ( ) ❑ State Owned VILLAGE ❑ Public jX/11 or 2 Fam. Dwellings of bedrooms 3 V d/ /4 h III. BUILDING USE: (If building type is public, check all that apply) / 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in It" A. Check line B if applicable) A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 U Mound 30 ❑ SpeciyType 41 ❑ Holding Tank 12 aSeepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2, ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. T FINAL GRADE REQUIRED (sq. h.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./Inch) / CELEVATION - 3 y~•f~ Feat /7. Feet i VII. TANK CAPACITY In gallons Total #of Prefab. Site Fiber- Exper. INFORMATION New Existing Gallons Tanks Manufacturer's Name ncret Con- Steel glass Plastic App _ Tanks Tanks strutted Septic Tank or Holding Tank a PLk. 4 C. '=1 F1 Lth Pum Tank/SI hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsits sewage system shown on the attached plans. Plumber' Name(Prinq: Plumber's SiiggnnaWre:(No Stamps) ` MP/MPRSW No.: Business Phone Number: ar°Pr r. /(ri 3'LZ 715- 72 321 Plumber's ddr (street. City, state, Zip Code): /J al IX. COUNTY/DEPARTMENT USE ONLY d~I~ Disapproved nitary Permit Fee(ImIudaa Groundwater easu lasuing Agent Ipnaturo(NO tamps) k Approved I ❑ Owner Given Initial aG S,r sraa Fw) Adverse Determ nation /,q Y' X. CONDMONS OF APPROVALIREASONS FOR DISAPPROVAL: SBD-M (formerly PlbA7) (R. 11188) DISTRIBUTION: Original to County, One Copy To: Safety 8 Buildings Division, Owner, Plumber APPLICATION FOR SANITARY PERMIT S T C- 100 his application form is to be completed in full and signed by the owner(s) of the roperty being developed. Any inadequacies will only result In delays of the permit ssuence. Should this development be intended for resale by owner/contractor, ("spec Ouse"), then a second form should be retained and completed when the property is old and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property M\C.F-14~EL E(,,,IZA2£C!{ SRUES`G•E Location of Property NW k SV~ k, Section 29 , T~N-RN Township F-10osr~c.1 Melling Address _ 550 S A3rm -ex. Address of site =724 Saar. 2p • UQCAA P4 - w\ • sm\6 Subdivision some _ CDUtA-VP-11 k\\t.L .p.~D\'C10t~1 Lot Rueber -Two Previous Owner of Property SYJfw G`~ItSC\A\A ItORV\C1F Total Siae of Parcel 1.0',A QL.Rfcs Date Parcel was Created Fig \4 • \584-- Ara all cornets and lot lines identifiable? X Yee No Is this property being developed for resale (epee house) ? Yes X No toloma 16E and Pogo Number 3l5 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A warrenty Deed which Includes a Document number, volume and nape number, and the Seal of the Register of Deeds. In addition, a certified survey, if available, would be helpful so me to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY (XVNER CERTf T)CAT)ON I IWe) rtAV6y that aft btatemen(, un this 60nm ate tAue to the beat a6 my lawuw) h-. W.qe; that I Iwe) am We) the cwneA la) o6 the ptopeAty deacAdbed in tk a tn,{o`lmdt.ion 60tm, by virtue u6 a WaA an.t deed Aecoaded in tie U6 ice o6 the Connfgg RegtbteA o6 Oeedeae Oucwsent No. h(-~'jQ- ; and that f jW non IJwt ptopose.d Ai.te 6oA .Owe eeuage dla;oe el papa entry ern event, to tun with the above deeca,i.bed wto a t,em lot f Iwo) have obtn.ined an syet", and the, same has been duty AecoAded to the O66<eeh06ctU a CountynRegiatelt o6 Oreda, as Doeament No. ) SIGNATURE Of OWNER SIGNAT OF CO-OWNER (IF APPLICABLE) 940 - 9 DAIS SIGNED DATE SIGNED i ~ • H 'L N H a ' r ST C- 105 r' a N SEPTIC TANK MAINTENANCE ACRE:F.MENT p St. Croix County y 0 a OWNER/BUYER Mk-c4AP -1- fr E1.~2J~ irk SQ~}ES rn ROUTE/BOX NUMBER Fire Number CITY/STATE ~UO~ly W~ 7.11' PROPERTY LOCATION: Rw 14, sW It, Section 2 T_~29- N, R W, Town of µ'105c~fV St. Croix County, Subdivision4f.OUMNVA ~~u Lot number J~ Improper use and maintenance of your septic system could result In I its premature failure to handle wastes. Proper maintenance con- II sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of it fail[ng system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. yo F I/WE, the undersigned, have read the above requirements and agree N to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- Iro ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning, Office within 30 days of the three year expiration date. SICNED_~/J'I~fEJ=---- DATE__•~ 1 St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 y 715-796-2239 or 715-425-8363 Sign, date and return to above address. 1 DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY A BUILDINGS • LABOF7S1 HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, NI 53707 NW%SW%,,Sec.29, s T29N-R19W L 1CONVENTIONAL C. ALTERNATIVE s•^•^• Hu Mn• N nl NNnat Town of Hudson O Holding Tank U In-Ground Pressure I Mound Greenbriar Rd. A Li N AMF OF°ERMIT HOLDEN pll'JIIf tiS U. l'\RMI'NUI.Ut11 IHSPfCT~ NOnTF 724 CrEj,,nhriAr Rd Hilt] On till 511 01 Michael Br s - 3a bf NCN MARK Ie. r^.. ..~i^.)OISCRI lIr R01-'T HI'ROM>LAV IF II iLfY .1t 1111 P~ flfV L,~, r L t t _ - - nlne n114Amn.. T•nP MINS'M /r. G:un• L•`IU. P.'me NU•R•.• Ro er Tinn _J 322_4.. S pro; Y 198666 SEPTIC TANK/HOLDING TANK: MPnVfgCTVRf9 LII)V R.'.iCAC'11V Anr:IV'.[ IV TANKOVTLErfLEY WINHIN 'LIRE LM.KINVCOVEH l r ( Gy R01 IU PNQ .Ofo w,r I o 0 li;i'6 -7L/ ~1 0 YES .JNO EYES;__ xf DpmG i•FV1 urP 7f-,t MnrL r t NUMBER OF nOAO ROPERrv WEL.. /.NOmr, HIr ro FR N N:.. (i _ LrNf ~1 qrR NL E--~1-It n pL RN _ FEET FROM 7 v ET ~~U 7 ) r t _ L_YES r O E6 f_NO _ NEA_RE_S_T _ _ _ V DOSING CHAMBER: _ u.f eC I,IPE N'-rFOf rNU :'corn Ar TCnV rnq. M<rrJll ru MwSrrr.nv Mwhb~tc 1. rRfq ,wiuNW4. ABEL LoCKMG COVEM rRCVIp[O IROVIOED f C YES LINO I'IYES ENO IJYES LINO GALLONS PER CYCLE. ruMP AVU CI RT7tdi: wLiipi ritinL NUMBER OF vRiirl u'. wtu - 111L" 1. v NI n f N (DIFFERENCE OFT'7vEEN - FEET FROM uNE AAI PUMP ON AND OF F) IJYES AND NEAREST A.tanL AnC UAHr nr. S0ILABSORPTION SYSTEM, Check The soil moistureat the depth of Dlowing .'f~~ .I+MT Ur. 7 o, eKcavxlon. 11! soil can be rolled into a Wire, constmct.n.'shall cease U,.1.1 FORCE Ih. soil " ally enough to con:R.l MAIN ON V ENTIONAL SYSTEM:__ nr V IS -R IIVE SI'nCl•I• r. rY31VE G1A - eiiS LIOVIp WC.rr`- INr. NV FFk BED/TRENCH IR. wts n)n am PIT I _ trtr lq i DIMENSIONS ~j / rL j' II;Nnt-- L Flu n o a 1 I:.vaaF'Mnzu1 A L._. NUMBER OF •H TGrr WI:L euH Ornl: v nF Int "Is" PI nr rl rEC neoYE :oYLR IF rd Si. I 'rE LrNE nIH 1uL• /y+~ L~ A it 1 ^f FEET FROM ~1 q 1 V W 9 NEAREST MOUND SYSTEM: U _ Mound site plowed perpendicular to slope TCheck.the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- he criteria fur medium sand. TIONS MEASURED. .AYES ]NO VEtt • •Ir'Hf MI•...An1..I xnHKr lr. CPSfNV err(IN NFIIS OYES _ _ ENO DYES ❑NO- cFV1uFYli.rrrNUmp (IEF O.r•oFn mlVrrr 1 n Ctl r.•r.n nn n.u uVl l: nV.O uCNtU fEYir I:([ i Ir DYES LINO L i_1 YES JNO EYES ENO PRESSURIZED DISTRIBUTION SYSTEM: W LIT.. LtNIIH 00 rLnikaAl3PgC'N: b4nYFL OEPrH dkLfIW 11DE _ - Ill Mp OVF fpVfN BEO)TRENCH nrtwrnfs I DIMENSIONS W.-47' OEU "'Plat Mewl CLU ~plsnl P.ef MAN"OLD Mn ant M[I Ur$-frl` urS• 1 w51H. un Nn LMnI V.~'AL ae wnul:NG Fl rv + fI V ••PE$ 1mn ~ ELEVATIONA EIEV E DISTRIBUTION INFVR7LMTION r.uLE SIrE "Hoff SPdo»li cunu_-•coHRLC •:v covfR MnrEHrnT'.._ o~wyraLUn coPRf s•ONOS IO nvPHOVfn -]YES LINO EVES IJND COMMENTS: fRMANFN R EAS Ub3E NV4r104 WFLL5 NUMBER OF rxovn"rr wfl.l ewLl)- : FEET FROM LINt F. S-INNO_ ~YES_ LINO NEAREST /J ^ L4 i ~1Q FO Sketch System on Retain in county file for audit. Reverse Side. TIT I DILHRSBD67101R.011821\(Aa I.D~~.J hat y% (.I_ _ •C vy'l!/7 49L't,4 ;x1- Form - S T C - 104 j AS BUILT SAN1;ARY SYSTEM REPORT i OWNER Kr 7CI7NSHLP _ '✓'.-v cv: SEC. Y T N-R ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION ~GR.'~n1 (I LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of 11HR 83 SNOW EVER):;R YC WITHIN 100 FEET OF SYSTEM • f./~efr c( ~JC r ~ r Fes . j Y r.,., v5 r. , .5 ..r,. 1V ~d i I1I{` INDICATE NORTH ARROW BENCHMARK: Describe the vertieal reference point used _ aI';',.x Elevation of vertical reference i•= point: Proposed elope at site: ~ SEPTIC TANK: Manufacturer: Lt/ k $ L1,uld Capacity: ~GL•O Number of rings used: 'I Tank manhu:c cover elevation: Tank Inlet Elevation: >174 Tank Outlet Elevation: ' 1J Number of feet from nearc. Road: Fron t,O Side O Rear, feet From nenrest Prupo'iy line Front,O Side 0 Rear,O Sf~ feet i Number of feet from: c,•II building: (Include this information i 'n Above "lot "la"' ( 7 refer en,e dimensions to sentle tank) PUMP CHAMBER Manufacturer: Liquid Capacity: ' Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlay: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear,O Ft.~ Number of feet from well:- Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: Length:- So Number of Linea: Z Area Built: Fill depth to top of pipe: ✓ t Number of feet from nearest property line: Prone, OS1de,©' Rear, Olt 2 Number of feet from well: ex Number of feet from building: 2?6 (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: - Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box 0 or distribution box O been used on any of the above wil absorbtion sytema4 (Check one). HOLDING TANK r I Manufacturer:Capacity: Number of rings used: Elevation of bottom of tank: Elevation of Inlet; Number of feet from nearest property line: Front, O Side, O Rear, OFt._ Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job ~L O: License Number: /i'7~ ` SL LY 3184:mJ PATu A A ~ A L) 71. TN~F •LL IAING TANK I•hCOMMENpfp vSiFM.l:ptlnmryn- u s u 'ns -Y{ilTIpNAL 1 ❑ Rble'Lgyen dFE JOY en'~f )jtt ~0 1 O5N AT 11 vp v^I n I I ! n Ine n rHfta en,;rl t ; .ra^ C4SS Lt I%raw nnn uFlPOpdean n_wevu .on -L~C< _ PROFILE DFSCIIIPTIONS BORING' TEAL - r - - gTFR-r CII - I :L I THICKNESS. rL TEXTURE,- AN EH EA OF MIhBHi q(ELEVni15N BS TQ BEDROCK IF OBSERVED (SEE ABBRV ON BACK.) B /4.33 /0/.34' 1 w >/0.33 1 /34AL$LTS /91son SL q_." S sZ oa r`o6~. N,~ _'`>io.oo /z~gcs~= ls'~aNS1 93"&aNMS f } 7y 7~'So ~4 g.6 5 gcSIL75 3i"BRN4r$euMS 3 -7' s )"7 5 10" L TS n Qt L 7S" ge St'CttY, s a" :9.SO / &LIS 2i-gelvL 7sB Scc,* ' rr~ ~•`p'.,~, PERCOLATION TESTS OEPTR• wnILk U. rIpL i TES TIIAE > r , a M S RA MI UTE lAAW1.15a Ah•FR SYFL-IN±9 INTERVALIAIN- f ' • k' .y;A ~ _ 1..__ - __72 PER INCH PLOT PLAN: Slow 1o tipm of pnoorytlnn tarp, W11 Wr:npt .1 IM dimtndont nl muabin ma -..m- Inr6da rCa, m yypnper. U.. wh., nm .1" li, lentil wry Patti" eprwden ref w. ce Finial. aril reeve their bul:n, Pn the ..In, Pion. Snow I- udnrn wnWNea nt n11 lxrrbMp Pml !AP ylrtcor.r .rul imrrnn~ n11.1d nom, SYSTEM ELEVATION _ 'x4.10 kp. OEEM.L PA,Wr - . oN TeP dP CuLJ[R'r 51TC Loc,%TloN e•N REYECSf ELEV' ~OC' djA LL C . .T,e. P3 Q.. ALTS kN ATC yf it' ~1 2r' _ • 1Y, Sv TEM El£V4T ON 4 F~ N I r-~ 94.10 ° ° SWLt h«.F rt v~ 1 _ Ya• pp, j, 9Z•- ' 't To LOT f - /oz'-'~ ~wca N004ATY LINE I, the unMrppaeli, (wrPpy tertify I", the wil Intrt rnVPrlnd Cn ILII In•m w^rp in" UY IM in ahn01 wlnr Inrt ILOOwLrlnr nP1 u.~l enh "'c inwl 11q 1TpIxMTn AdmininleBN Cyye, end then the yen rennrd eml the Marlon of mt tol, era corrart tV Irrn txyl o! -v Enowind} am, IwI of. _ A pI nl~~-~ - - I ES11 V(bRF CUMPI F I tD_>N J"~1 Gyat--~QLruad.itnlc, NC Mn_v.3o 1987 so ~ A 4 ~ I ~ ENIIFII %IrON NUMNIN NIONk NI1MNER4ry•a•n.dl~ ~~S4EQN.4_-•~z -.h1S/~~/!1. .o'lt nIUHF I -"a g J 016TR LIUI:O!1-..p I, a ..v.l..l rbnr•.nv.... Y. j r- ~+OS)NNIY l .PGIX f> a ~ fz $ •c a ~~qEc ~ o t I - ♦ E r 4r~d~ ~j N.~i~♦ °o Y tl f f i rr L I RE ~ i i~ ? n n a i t. rc~ rc° a i Z -~1 Ctry~ o d y r s E a? t ~MOM cEn 07 ~ 0 3- v. 0 3 a rc¢ S i a.- U c.. cn - PP" Ado Ja_ 0 .'a 'e A 8 3 yRY t Cob, ~j V i n l i , l Cn ` ~ ~ ~ ~ -3°~ / /_Z_ ~ ~