HomeMy WebLinkAbout040-1308-00-155
^lso:xs n Deoanment o• Commerce PRIVATE SEWAGE SYSTEM County St. CroiX
Safe:y and Building Dr.• 3 dr
INSPECTION REPORT Sanitary Perrot Nc
GENERAL INFORMATION (ATTACH TO PFRIJ11) 607020
State Pan U Nu I
perscna nre-nraae'r you proaice ma': ne ..&PC tof sece'rJari Pu•PCSes ;Pn:dCp I BN. s C4 H;;mjl
Pemu:I c de-. Nan'.e Cit9 ?Tillage TewnSnip Pa'cel Tax NO
Ryan and Shelby Kuphal TOWN OF TROY 040-1308-00-155
cSl BM eev nsp HV Llzv BY CPsonpt on Sectlo,+TavwRangerMap Nc
24.28.20.1974
TANK INFORMATION ELEVATION DATA
TYPE NIANUFACURER CAPACITY STATION BS HI FS ELEV.
Sep' C Bencnmart
~os~ng At. Blv1
Aefalicn B.o^y. Sevier
Ho om; SvH: Inlet
SL'Ht Ou: Pit
TANK SETBACK INFORMATION
TANK TO P;L L°lELL B'-DG. 'dent to A, wa," ROAD Dt Inlet
Sectic Dt Bo:trtr
Dosing Header P.1an
Twat on U st. Pipe
I lolding got Syslem
Final Grace
PUMPISIPHON INFORMATION
Manafa 'wel De•rard SI Cover
GPM
Model Number
TDH LiR Fria on ~-ss Systor I lead TDH R
Forc¢ma r Lergth Do Csl tc vae I
SOIL ABSORPTION SYSTEM
BEDlTRENCH 0.fdth Iz•gth No O'Tte%hes r DIMENSIONS N>. O'PCS I•rsJU Do HCUre UZP[h
DIMENSIONS
SETBACK SYSTEIJ TO PrL BLDG :"JELL LAKE+STREAA4 LEACHING Ma-u`ac:urer
INFORMATION CHAMBER OR
type Of Syslem UNIT Vocel NUm Per.
DISTRIBUTION SYSTEM
Headw arifaltl DAtnbut.i Hole Size x HPie Spacing Vert to Art I-Aake
P self:
le^;qth Dia _ LCnV:r Dia_ Snacra
SOIL COVER x Pressure Systems Only xx Mound Or Al-Grade Systems Only
Ilzf'e 'Jve" DeptrOoe' xxXPthcl xx Sezdcd~Seoded rx lvlJr,dea
Ucc'' cr di Cc ncr Bed+TTe rrn Lcaas Teusoil I Yes No Yes Ve
COMMENTS: dr-clude code discrepercies. Ti present, etc i Inspection 01 lnspechon 4
2
Location: 318 LINDSAY RD OR
1 ) All BPA Descnpdon =
2. t Bldg sever length =
- amount of cover =
Plan revs on Required') Yes No
Use other side fcr additional rfonna:.on
Oale . hrs~ ictoYS &ynal.w CPQ NC
SBD-37'C (R 2 4,-1
- =.J - - !ti' ' X11 ~ 1
nd11 Is Su via. T)k mo'1 ( 1111
140 0 l 11:1shu ton iv. _f
~ 2019 I it Ih1>•Ilfa
L 14 ~n ISan Ialr Pei: to
SP: tie 1['o y; fill"I by Gu.)
* l b zo
t-}II-t jctLIO Sat IlarlLn Icr -
1 I rlmlc a l SI 1 %3 1 I V t + u I I,i I thi I n d 'c I' I id u I A
p( ;I pII Il hr-min I nl 1. a it ♦1 ,Ih ant i.r, 1 Ii ar.I1/11t IS hnttkd r? Pill-,
nan mail:nC adJlrs).
it IY;nuonul t 1. .ry. 10.,n I1AI l .ir.: 11x. I u .I 1 " _ 1` I,ic Il I, h. I ed im au Ldav
1 Tl' ICI - , n I I ; 1eh1 II l _a l,.1!.)111II \e.
tpphultion Infermallon Please 1 rinl 111 Inlnrma _ nl 3 -FJ:
1 lyn:.l
I I'arccl k
I h t txl 1 I u,, a l hu. / - - ~ Cp'~ \~~\p
Il pi,y l.O-:III I a `III
1, ~').,~1/,►I,7
it %il>Ccdu P.uIrI N,mbcr ,'SC i.. `~F Jocnen, a_✓~
one)--
II fspr (If Ruildin;; (chrakall that apply)
La * ry/-✓/~ _ f ~7,) N: k
I zl ] al:'ll•I IIWCIIII." \11 :11.Vl o f ltrJrou V _ /✓J Sulkts aon Nanl.:
7
Irk Ca }yLll -
n I'u)1is !i'nnnurraa.- M-116 l..c C*C 04 Is ~
❑ Sla:c Owned - U:vadl.• tt,• (\\I \usbcr ❑ \'illa~c ul'
III,'1'spe of Permit: (Check a 1% one has on line \ ( (Implele lee It if apple lhlel Zff1'SQ~
~V: n'4 :I-m ❑It,~Gcclr llti .I^'1 A flan':: 1'I JiL IuIlk R
- J ~ I1 t'. II On.y U (1G1tt A1a`ii ti.>uun lu htulln So>:cnl iecplainl
It. I'a'n 1 I ....:.LJ Pcnnil Itc.la. I'ennil
. r n>ICnu NOV LI, I I •s iou.. \m nhaand Datc 1-wd
' n l'f a ul I InnL-r ~ F. Ill's n
kt~ :I .'c I PI I u (k a r-~
_-~11r1 a P(IR1`4MStun (nugmnurt Ihsice: hul dl lhal appls')
C \ Ilr n hill un ~Ir<:-, I 'I+r. 11,rw L.I AI-Ga J110I.1 Tin. of aft dY.c s?II ❑111Ir1 . u au Ihk soil /'1. _ 1__~
n I'll . I: { Ft U dConI I:., 1'hnnl _ 3 Prorlsncn: Devi Ivpl.e -q l.i~~+lW~sss+~"
V. Dispersal Ilea lenl UI11nIo1 Ill lean _
Il I I i 1 II h;.ti I \p ,-n I I I.l ui.-? Ilupcrsal 1. N ;1uhcJ 1st) Dill I J 1rt'I Prot
u.cd I) I S 1 aI I I...rc L.:n
%I. l ant. lino - - t_`, Ilan Tl l I ' V.I odauwu 1
< dl I GJlns Un:t as
2
\ 11 Re'llivi lht\ Statement- 1, div unA r. IGncJ, a sum Icspan.ihJH\' lot imiallalinn of the 1 UR IS shoes till III atladwd pram.
I I I.I ~(`cm ofy' tumor Sip o,rc•/~ / VI hit Itv V/I lu- B~In ss Ph I. A/uIII~VTt
xj~
\ III (uuoh Drp nuncnl 1 hr (lnl~'_ - L ~ ~,r -
.d 1 I i::il ll cc
f1.r ••1lssu t m
Iucrl 5icnams
1 ~:P I b11~1i ;1111.111..17 SW w 2115/ I -
IX. (nndi6){6 (gt{Ilfl~t2{tr Lnns Sur llissppnls II
pe! r ,C rll nJISt ull l ell be s3 be li•1IC:'s ~t«~t-~--
oiSpt P1
~ r,+' nt•~es;
as per mar ayemen' plzn , o riaet W plumbs:.
2 N eeRgrk reair.'cen's m'r.,t he . <..rh iiei
as per Witrtsk C,)e-r rd, -.a v:r r.
Urlch u. rnugJaa platy nrt lhr ganm vW .ulunil to the C'ouutc ..uh tin paprr nm Inss IhauR IQ x I I in. bl. in •ir.
V 4D (:Tog I'L, ti& I I I
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CONVENTIONAL COMPONENT DESIGN
Residenliai APpk2kV m
MDEX AND TITLE PAGE
PraiectName_
Ownees Address:
- -
Legal °n-
Township _ i
Gountlr
Subdue Nam
Lot Nurnber -
Parcel 10 N /
Page 1 IrMaxand MD
Page 2 Plot Plan .
Page 3 _ 4-jkm Slug & Qos&Zecgm
Page4 F-illerspecs.
Pages MainWsrdmeirnkrmadon
Page 6 MarragenrerK Plan
Page 7 SL Cmor!ASeptic Tank lAfwftnaome Farm
Page 8 Wenanty Deed
Page 9 CSM or Pbt
A Sol Test & House Plans
D Dense Al nirer -
Dar~ Phone Aiinher - z .
Signall~e /
oesiVad PosMr14080 6W ~Sa/Msa~im m.oa.mdbl=mdfmwwrs Msd=zasao-mMSP(KxnmX
Pa t
- ~ ~ , ~ J / s-! -
/Ici.E:ti j~cts~il!/ f~. ~ i'~irn.
~ ~
~ ~ ~ o
I ~ ~
- . , ~-s
i, b~
~ j ;d
- - ~ / - +
- q i~ ~ 7.~,
A
Y P ~ ~ ii
\
~ .
' ~
~
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7 i
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h.
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J
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i~f~l y
~
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'Oy
~
Soil Absorption System Cross Section
tt
_7 ft
k4" 40 Grade
pe p ft
Leaching ~
Chamber ft
System Elevation
ft fr ' ft
Soil Absorption System Plan View
ft
ft U[I11fiM(ff(fffiilNli>Tiff(>lifi(llfffillll(11II[~I!
ft r Leaching 1 Trench 1
Chambers
~(ffnf ~ EM [MITI
t1.LJ1147.Lt1.ll1IJ1Ll-ll~J 4°Dia.
Irench 2 Header
Vent Or Observation Pipe
Trench 3
Leaching Chamber Specifications {
I T ;
Manufacturer And Model
EISA Rating sq ftper chamber Soil Application Rate gpd/sq ft f
j--; gpd Design Flow 1L Soil Application Rata EISA Chambers
L-_ 3 roves of chambers each.
_J
Page of___
yq
y Q Fib
PL425 EJFUlENT FILTER r z , r F. ~J
Pblytok, lnc is pleased to add its ; -
rmvv commercial filtw- m ics e>dsting
fine of quality effluent f ber& The E
PL-525 is rated for over 10,000 GIRD Ahm
[gaNats; per day) making it one of aaces - _,_K, pr+Otost?fre 9
the largest commercial fitters in its f i- emerrioofiaodle P
dam It has 525 fenear feet of 1.16
5ltratior sluts. Like the Pdylok a L
PL 12Z the new Fblylok PL-525 has 1
an automatic shut off bell installed 325 rnerfeet t u
with every filter When the filter is
removed for deaning, the ball Miff itlaariaas'~a s _ Rama far over float up and tzatporarity shut off to ete a+o
the system so the effluent Won't
~ E
leave the tar& No off" Slhr an
ffteBta~rtcasetaliethatclailtLt ' B asPrpe, ,
C
3
PL-52 l ask mrtare _ % ;
The PL-625 Effluent Filter shoulder s
operate of csontly for several years i f
render normal conditions before
requiring It is recom-
mended that the filter be cleaned f
avert' time the tank is purnped or n
at least every three years. If the t
installed fifer contains an optional
atamn, the owner will be ratified
by an alarm whim the filter needs .
servicing Servicing should be sasdefector
done by a certified sepfic tank mania fic bal-alt
pumper or installer. 3 as b;A v &m fib i
1. Locate the oude of the errs PasearNoe6a~4a6 isremO1ed k
septrc tartlc ~ ssrrero
7-Remove tank cower and pump i _
tank if necessary. PE 525 EnsWiatloft: 1. Locate the outlet of the
3- Do not tmc plumbing when septic tank
filter is removed. Ideal for residential and com- 2 Remove the lank corer and
4. Pull PLC out of the horsing. mereial waste flows up to pump tank if necessary-
S- Fierce off filter over the septic 10.000 Gallons Per Day (GPD). 3. Glue the fitter horsing to the
tank. Make sate an softie fall 4' or G outlet pipe. If the
back into septic tank. fitter is not centered under the
access opening use a Polylok
6. Insert the filter cartridge back Extend & Lok or piece of pipe
into the housing making sure to center filter.
the fitter is property aligned and 4 Insert the PL-525 filter into
Compl wtlr ifs. ifs horsing-
T. Replace Mark cover 5 Replace the septic tank cover.
11~<
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pane - of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Septic Tank Capacity gal U NA
Permit p Septic. Tank Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Filler Manufacturer ❑ NA
Number of Bedrooms - - 0 NA Effluent riper Model 0 NA
Number of Public Facility Units )41 NA Pump Iank Capacity gal 0 NA
Fstimated flow (average) - .aliday Pump Tank Manufacturer 0 NA
Design flow (poakl, (Estimated x 1.51 Pump Manufacturer NA
gal1day Soil Application Rate galidayrft- Purap Model U NA
Standard InfluentiEffluent Quality Monthly average' Pretreatment Unit t O, NA
rats, oil & Grcaso IFOG) **30 mgiL 0 SandiGravul Filter 0 Peat Filter
Biochemical Oxygen Demand (BOD,) -:220 mg~L 0 NA 0 Mechanical Aeration 0 Wetland
Total Suspended Solids ITSS) x:150 mg?L 0 Disinfection 0 Other:
Pretreated Effluent Oualily Monthly averago Dispersal Coll(s) 0 NA
Biochemical Oxygen Demand (BOD,) ?30 mgiL It)Ground (gravity) 0 In-Ground Ipressuriz.edl
Total Suspended Solids ITSS) °-30 mgiL PiNA U At-Grade 0 Mound
Fecal Coliform (geometric mean) `-104 rfui I o0ml U Drip Line 0 Other:
Maximum Effluent Particle Size in dia [7 NA Other: 0 NA
Other: - ❑ NA Other: - - 0 NA
'Values typical let domestic w3stev.ater and septic tank effluent. Othtr. 0 NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank{sl At least once e~Jrry: rl month(s) (Maxinunn 3 years) 0 NA
Inspect 0 year(s) _
Pump out contents of tank(s) When combined sludge and scum equals one-third IK,,) of tank volume 0 NA
Inspect dispersal cell(s) Al least once every: year(s) s) (Maxirnurn 3 years) 0 NA
Clean effluent filter At least once every: - U, month(s) 0 NA
- 0 year(sl
Inspect pump, pump controls & alarm At least once every: i -1 inont yearls)h(s) 0 NA
Flush laterals and pressure test At least once every: 0 month(s) gj NA
0 year(s)
Other: - - - - I.I month(s) I.I NA
At least once every: 0 year(s)
Other: - - - - - 0 NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying une of tho following licenses or certifications:
Master Plumber; Mastor Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer, Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identity any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or pending of effluent on the ground surface.
The dispersal relll s) shall be visually inspected to check the effluent levels in the Observation pipes and to check for any pending
of effluent on the ground surface. The pending of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of tho local regulatory authority.
When the combined accumulation Of sludge and scum in any tank equals ono -third I/-) or more of the. tank volume., the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
WOW (401)
Page K- of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chernicals
that may impede the treatment process andior damage the dispersal celllsl. If high concentrations are detected have the contents
of the tank(sd removed by a septage servicing operator prior to use.
System start up shall not Occur when soil conditions are frozen at the infiltrative surface..
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cellist in one large dose, overloading the cellist and may result in the backup or surface discharge of
effluent. To avoid this situation have the. contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive, or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance aril prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condorns; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (surnp puropi water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails andior is permanently taken out of service the, following steps shall be taken to insure that the systern is
properly arid safely abandoned in compliance with chapter Conlin 83.33. Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Soptage Servicing Operator.
• After pumping, all tanks and pits shall be, excavated and removed or their covers removed and the, void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired tho following measuros have been, m must be taken, to provide a code compliant
replacement system:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacoment area should be protected from disturbance and compaction arid should riot be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable, replacement area. Replacement systems must
comply with the rnlo in effect at that time.
❑ A suitable replacement area is riot available due to setback andior soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POINTS a soil and site
evaluation must be performed to locato a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound arid at-grade soil absorption systems may be reconstructed in place following removal of the biontat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANWOR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL. COMMENTS
POWTS INSTALLER POINTS MAINTAINER
Name Nance
Phone - - Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY.AUTHORITY
Name (Janie _
Phone Phone
This document was drafted in rompliance v:ch chapter Cenim 83.2212i0b1(Wd;&(II and 83.54(1), 12) & 131. Wisconsin Administrative Code.
page 4 of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tanklsl for the presence of painting products or other chemicals
that may impede the treatment process andior damage the dispersal celllsl. If high concentrations are detected have the contents
of the tanklsl removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cellist in one large dose, overloading the cells) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluont pump or contact a F lumbor or POINTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or a:-grade soil absorption area.
Reduction o: elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POW'TS: antibiotics; baby wipes; cigarette butts; condoms; coYon swabs: degreasers; dental floss; diapers; disinfectants: fat:
foundation drain (sump purnp water; hunt ane vegetahle peelings; gasoline: grease; herbicides; mea- scraps: medications; oil;
painting products; pesticides; sanitary napkins; :ampons: and water softener brine.
ABANDONMENT
When the POW IS :ails andior is permanently taken out of service the foliov:ing steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• Al! Diping to tanks and pits shall be disconnected and the aoandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
11 . the POWTS fails and cannot be repaired the following measures have been, or roust be taken, to provide a corle compliant
replacement system::
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and propcscd structure, lot lines and wells. Failure to protect the replacement area will
result in oho need fur a new soil and site evatuanor. to establish a suitable replacement area. Replacement systerns must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available cue to set;;ack andior soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last taste: to replace, the failed POW-5.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
[J Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biornat at the
infiltrative s;v`.ace. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND;OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name Name
Phone Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name -
Phone Phone
Thi; document was draflod in compliance with chapter i;;r¢m 83.2212)(brt 1 and 83.54(1). (2) & (3i. Wisconsin Admavst:aeve Code.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address - -
Property Address
(Verification required from Planning & Zoning Departme for new construction.)
City/State _ Parcel Identification Number r
LEGAL DESCRIPTION
Property Location ,-~'/e , Sec. - , T--- N R-~ __W, Town of
Subdivision Plat: Lot#'
7`
Certified Survey Map # Volume Page #
Warranty Deed # (before 2007)Volume Page #
Spec house [I yes O!no Lot lines identifiable 6' yes O no
SYSTEM MAINTENANCE 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. 383.52(1) and in Chapter 12 - St Croix County Sanitary Ordinance.
The property owner agrees to submit to St Croix County Planning & Zoning De artnent a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full 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 Safety 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-
Uwe certify that all statements th"rm are true to the best of my/our knowledge. Uwe am/are the owner(s) of the
property described above, by virtue of a waryfinty deed recorded in Register of Deeds Office.
/
NnmbeT of bed 0111s
-SIGN 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 it
reference is made in the warranty deed.
incp nit/191
Dose Tank Cross Section And Pump Performance Specifications
Tank Manufacturer Minimum Pump Performance Required
Tank Model Number (iPM@fl / FtTDH
"lbtal Tank Capacity
N4ax. Bury Depth > - - -
Total Dynamic Head (TDH)_Feet
Pump Manufacturer ,T r Elevation Ilead
Pump Model Number Distal Pressure
Alarm Manufacturer J !F 1,41" Network Pressure Lacs
Alarm Nlodel Number Force Main Pressure Loss I r
SwitchTNTC Total
Manhole Min. 4" Above Grade
With Locking Device
Vent Min. Grade _ Weather-proof
Above Grade I
I Junction Box
o
With Cap
Finished Grade
Depth of Cover L Ft Disconnect
Means
I
>
Outlet
L - tf Settings an d Reserve Capacity Inlet k Vol tune GPI
on I Inches Volume Gal. A
- a„
(reserve) A>/ _ ' '
Weep
(alarm) B 2 B Hole
(dose) C Offfilcv.
C
(dead) D -5, <f Ft
- G-C L
Total - -
D
Y Bottom or Tank Elev. 1'Y Fl -
GENERAL tNSTALLATfON: The dose tank is bedded and back filled in accordance with the
manufacturer's product approval specifications. Maximum depth of bury as specified by the
manufacturer may not be excocded without prior approval. Manhole covers exposed to grade have
an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved
material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or
sagging. The force main is sleeved with 4" Sell. 40 PVC to bridge the excavation and is scaled
watertight. Electrical service complies with NEC 300 and Comm 16.28 Wis. Adm. Code.
03./05Igj Page of
[qGOULDS PUMPS Submersible
Effluent Pump
Y PE
4~~ rte'
JF Vllf (p»AiV
SPECIFICATIONS MOTOR FEATURES
Pump - General: General: ■ Corrosion resistant
• Discharge: 1'H' NPT • Single phase construction.
AV! • Temperature: 1040F (4000 • 60 Hertz ■ Cast iron body.
maximum, continuous when • 115 volts ■ Thermoplastic impeller and
fully submerged. • Buik4n thermal overload pro- cover.
• Solids handling: 'h' tection with automatic reset ■ Upper sleeve and lower
maximum sphere. • Class B insulation. heavy duty hall bearing
• Automatic models include a • Oil-filled design. construction.
APPLICATIONS float switch. • High strength carbon steel ■ Motor is permanently
Specially designed for the • Manual models available. shaft. lubricated for extended following uses: • Pumping range: see PE31 Motor. service fife.
• Mound Systems performance chart or curve. • .33 HP, 3000 RPM ■ Powered for continuous
operation.
• EffluentfDosing Systems PE31 Pump: • 12.0 Maximum amps • Low Pressure Pipe Systems • Maximum opacity: 50 GPM • Shaded pole design ■ All ratings are within
the • Basement Draining • Maximum head: 25' TDH PE41 Motor. working limits of the motor.
• .40 HP, 3400 RPM W Quick disconnect power
• Heavy Duty Sump/ - MaximPump: cord, 20' standard length,
Dewaterin
g • Mum he: 60 GPM • 7S5 Maximum amps heavy duty 16/3 S1 1W with
• Maximum head: tyd: 29' TDH • PSC design NEMA 5 15P, three prong,
PE51 Pump: PE51 Motor. 115 volt grounding plug.
• Maximum opacity: 70 GPM • .50 HP, 3400 RPM ■ Complete unit i5 heavy duty,
• Maximum head: 37' TDH • 9.5 Maximum amps portable and compact.
• PSC design ■ Mechanical seal is carbon,
METERS FEET ceramic. BUNA and stainless
40 PE51 MODFLS: PE31, PE41, PE5P Steel.
HP; .31.40, .w ■ Stainless steel fasteners.
35 10 2 GPM
J AGENCY LISTINGS
30 PE41-- Qpu%
2!, PE31
a I Tested to UL 778 and
} 20 - CSA 22.2 109 Standards
0
By Canadian Standards Assnretion
Fie #11,38549
O
Goulds Pumps is 1509001 Registered.
10
5 h/
0 00--- 10 ._....-30... 40 50 60 /0 GPM 80
0 5 10 15 m3m Goulds Pumps
CAPACRY -
h JMJ l.n, rlA<O,mn< . ,
ibor and H Hummuaan n fiee'aCOnatons Sdostry,
L OIL AND SITE EVALUATION REPORT Pa;c- I of '-I
Libor
Division of'Satey S Duildinqs in accorC will ILHH 93.05, ws. Adm. CoJ:
- cGLrrrY
Attach complete site plan cn paper not less than 5 tit x I I inches in size. Plan must Include, but ~1' • C" Zo LY,
not limited to vertical and horizontal reference point (6.'.1), direction and % of slope, scale er PARCEL I.D. If AAR di mensioned, north arrow, anal location and distance
to nearest road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION E4' DY PROPERTYOWNa: PROpERt'f _CCA;.C': 1~/T_ e,jRp6.t4TG{ SE ~ 1;.32y T'20 E:o1 W
PRCnE !CYJ'JEn,C.SMAILING AJCP.ESS. LOT. 6L'CC{; SJBD NAMEOR M:
L o t eEIJCIZ lCt juE rJ. t . 2 1.
p j
- "TLL 'J r" PGc i! 1zf ~tD$-
C:Tri S\_ is TCCDE PFC`JEr;JM6ER ❑i;liY i.!.:A E L~fGW'N REI'.RES-ROAD
~rtti>J~ , r-t tv >'•Itiy ~`G-O`f '~:.u~ Sfrt R-o+\n
(,<j Nae e uCL.ton USe (~Q Residential; Nx-ber o'tedror=s O Ad ' iQn tc e~xs5ng
bu~ll~ing
( ( Fepl x Wert Publ`c Of Co-mer6af desaibe_- LA / ~
Cede der;afd daty flew boo gpd Rxcmmer:ded design Toad nc rate- _b d, epC ftz_8 tench, gpd ft2
Absor"ton aearaquired bS~ bed,n'_%O bench,12 f&xL-Lmdu:gnloacirgta:e= _V-d gpdi`Zberch.cpd'2
P,eoommend¢d iniaraiicn Surface elevatiorisi=OL: Q V_ -t (Es re'cued tc Site plan benctmrux)
Additional design. i si:e considera5cns ~E)Z r-JuTiiZ- -Tj f N SM LLtR C" ( 4
Parent r. ataf: L O mss, o vk'R C ~u A~ Ov t\ S 1{ Flood plain elevntcn, it app, tic _ v PA - Il
S= SCI:ab~e`or 57Sfcm CONVEWICN;.1 Ih:L".C IN UNo F.3 SUF.E AT^.v:CE SY -Y IN E'! HOLDINu TAN't
U=L'rscilao'aroisrsem I as ❑U i nU I [TS Uu .J?S UJ I ®S UU ❑S Qu
SOIL DESCRIPTION REPORT
Boring ;9 Horizcn DCp:h !Dominant Color rVott'es T Structure i
ex, re GPDrft
C(i-5'~i'e."CC ~~•Bwt77rY ROWS o in. j Mucsc11 Cu. Sz. GnL Color 3r. Sz. S'..
g i o`f~ 10 ` Vt 3 ( Z - Bed Two
Z h l8 )0`-12 3!6 i- ~l I ~~'sbk -
i_ ^~S~t ~ cg •5 •b
Grourd 3 18-tlo rvS iR 31y - ( I S I d1 .E
~a6r a
Nev. - - I}-
g92.ofL ~-r I -I I
Depth to
limiting - ,
factor I'
>tto'_-I
F-1 -1
Remarks:
Born x
I o-LZ 10 `-t 2L 3l2
s3_aL SyQ 91
IT
Ground' ISZGH~ OSy
elev. t 9o-too t6`1lZy/~
NP I.vp
298_8 ft O S9 ht ( -
Depth to S o<°~ \U La LIt 1 L GM 1~v14 ~~~~ctc
limitng
factor ~ ~ I
q6~ I I I ~ ~ ~ - - -
I I I
Remmarks:. _
CST P;ame: Please Ptirt Phcra:
Arthur L. I+e`.erer 715-425-0165
dress:
Gegerer Soil Testing & Design Service-P.O. Box 74 ivLr Falls,i,'I 54C)22
SrnaCrr -~`]_~.?7 I~)Q Date: CST Number.
2 2 54
PR0PERTY0WNER LZ0KM 1:ZKJTKt U~- SOIL DESCRIPTION REPORT Page _Z01-L
PARCELI.D.o. 1°L )I G
Borinc R Horimrt Depth Dominant Color b7oltles Structure
~d in. Munsell Qu.Sz.Cont.Color Texturo Consistence Bourrkay Roots GPD/ft
(3r
S7.. Sh. Bed Terrh
L ~~_7_V lO`tR 316 :ail (h Cg - S .6
blIz
~ -
Gro.rw 3 Z6-lo$ ~.S-ciz fly - S G) Q Sg >h - 9
$l I.3 t;. - I--
Depth to
I]C:er
71 C18
i
I
Flomarks _
,W mg #
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q-LS t*~. 'I IL 316 - -
- - - s i I z Msbh wt~r r '3 s ,1
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t .8
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lim:tiag - - -
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I
Rorr.arks:
pto~~g Ir I - -
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10-Z
Z 1O-fa 3/6
3 2 _~lO -1--s YR 3!y et 6V, U S9 Vh
Ground - - - , .y
elev.
M-11 fl.
Dcp:h to - - - I 1
lirni:ing I f
factor
Remarks: _
Wring N
"Io:.. I 'zy t t R 3 c z
i 1 2{ s bk _I'H - 5
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';/D
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0 M~ ?w l i.~
= - - _
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k( Ct to M I NP IjP
614ing ,/actor l7 _ ``"v_iuS < Son Ltr IESTOJJ F H~~✓7 S
1u&' 7 S °/o w E3EOao k6
Remarks
PARCPARCEL LD AELI.# tJER w1.1T11,.J~'U~YCI Q~li_ SOIL DESCRIPTION REPORT
Page
?-ol -`i
_ SQL tibJ Iv L:- -
Lo`itic~# Horizon Depth Dominant Color Mol Toxturo Structure GPD/It
in. Munsell Qu. Sz. Cont. Color Gr. Sz. ShConsistence BourrUy Roots
.
• C'? o_`i lt;'-{t? 3/~Z Sil Sbl'C ~ Cr Bed Tmdr
Z <C to `lR 316 - - - --Sh- -S - •e
;urc,d 3 L6-ID$IS`tR- 3(y~- -~S x.61- O S3 V-1
gel-Jtt
r,%l rig
Remarks:-
aG4I}Jg t! - - -
I o_<) lr:`iR 3lz st I=Fsb~C c~S~ eta _ `
q LS ff to H2 3l6~ c g S i.l
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3 1S-110 ~.S `IR 3/
Grund - - y - S G6 _ O S3 Yh
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S9S.S IL - - J
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remarks:
} o-ID to 2~E5b'n. cfcsh c-w
Z I~ z IU `t2 316 -
- - s r 1 { ab1L 11 f> zy - S 1.6
3 Z 110 ~.S LfR 3!
Ground SEC 6h O <39 1vl 1 _ .'1 .8
elev. I - -
Depth to - - I
limiting
factor -
Remarks:- -
1~...- 1 _zY ttz 3 IZ _ - i 1 Z isbh w. l - -
F Z ZJ_by ;o~fa 316 - c-`" "s ~ .6
;round
;Iev. 4 c4-lo (I I.S Y2 31y I - -.--S -I - - &,)b p it. 1 _ O 31 M W l
)ep:h to 099 - ra
imiling I N1 tip
der uS < So°lo ~IM?STUA/ F ~r a/TS
Lt> i✓ ~5 7 $ °~o w CL3lOR0 I'L~
Wscns`n CH-.3rtrrAnto t[IdLStry, SOIL AND SITE EVALUATION REPORT P;:^a Lab" are Homan Rclaior iof
J
Ctcsicn or5a'er(S Builr.:rv„ In accord vyi fn I_HR " DG w is.
COUP,-Y
Mach ' Mach ccmp!ete site p,an on paper not less than 8 1;2 x 11 inches in c:ze. P:ar, mw; mduda, t'a
not Iirrited to vertical and horizontal refe:erce point (EP.1), direction and %ol s'ope, scale or P%••RCEL LD. tz~>v0 N r -
dimensioned, north arrow, and location and distance to nearast road.
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION PEVIEWED BY _r(i f - TE
ll
?FOP=RT'VOt4P,ER: PRGPERiILCCA'C`; -
CO>J K E t 7~; In T Ca>zC~. 5E Se. 1:a,S2Y T Zb ,`::l E(c W
=ROPERTYOIN 7':S 44,1. GACDR,;a- LCi CCM. 'SJB) .91n!1ECRCSti1#
-l JL'~LftGS I ~'tiYtr~-.~
CITf, STATE Z p COCE ~!iCNe \JYE❑ r I:l_L4 _ Ik'~R~, IV=AFEST FCAC
rt .rv~ , r i v 4oy ) Tt~u t.~7 Src t >zoAp
[XI New CcnBCLCEor. Use (:t~ Re id?oriel f Nu-ter of t?drec.ms u _ I P.cC:,^'~n lo ex:;iry b:flcine _
[ I Fep'axmerl I I Futlic or commern] desGibe _
Cod? decaed d&Y few 600 gpd R comme ed dE~icrt !.Firg ra: - be , gpol112_ ' Uench, gpdif12
Absc;pGon a ea requ:r>] $S$ bed. „2 DSO :rends ft2 Nax:mum d ;,n teadinn rat? b d, g di`2B tench. apd fl2
new^m-ended i fil7ator. S L r WL e:evation;s; ;StZ' _ PRbE:- V refer?d :c safe plan tenchm. kj
AdCi7orrr' desgn! SIN ccnaderatiors -EiF . N T%Z I I iv Sn OLtzF 1 n CC.
Paertmateriel, Lo ma 0 ve2 C\~`tgt_ CO~rneµ_Flocdp!ainetveGCn,itapplcatle_ !-~A-f;
Ji,aJl_.,'S'+st?m L J.`.C IJ:,
U ❑iJ ~y$ r_I _ t=AF Soic!d 'V PILL i!u'CUd"i ""K
JrSL tadld for 5" ~Cn ❑
J Bs L-ju KlS ❑u [IS kiu
SOIL DESCRIPTION REPORT
Bering # Cup:h Dominant Color PAcf?s Structure
g . ilcrizcr. Cxtur? Can s,once'xu irvl'HCOSj GPD.fI'
ir. N.Cnse11 C"J. Sz. Ccnt. Cc C' G. Sz. S:-. Bed T;:-
:v-R
z 8-18 Io~riz 311, - ~ g;l ~ ~'isbk ~ G~S}1 cg - .s .•'o
Grand ~ 18-\l0 ':•S'-tt2 9/y- eaur
Depth to f i
limiting
freer
>tlo" 'I I ~ !
Remarks: _
Z '.vV'ifZ31Z I I I -"f3b4t 'r1~'r I Cyv I - I •5 i.~,
~ 6 Z I2Z-S> tC`-t2 3l6 ( I Sif ! r+1S~oe I yl`r eS l - 5 -G
S3 ST(. -7.34p_tLy - I`.6~I QS9 MI C3 1
Ground - -
elev.CZ~ S 7 SjO`6' \O'ta 6/3 I Lt+~NSvUC PzA!Gw~-fs
iimiony^
factor -
H?marks:
CST N'ame:-Please Prat Phone:
Artltur_L. Wegerer 715-425-0165
dress:-
egerer Soil Testing & Design Service-?.C. Bcx 74 River.Falls,Wl 54022
Signaturz - O""- .>13-Z47 - I,-iO C'" 4'°1 "S %L ber---)
22O~5~r
J
PROPRUYOWNER C61',MtJ~V~'td Qom, SOIL UC-SCRIPTION REPORT
PARCEL I.D.A - PC,L>~1ly L, Page 3 pl.-L,
t J k Horizon] Depth Dominant Color Mottles
t2 o P.tucsep Texture Structure
Cu.Sz.Co .Cc'or Gr. Sz. Sh. Consi fence BourXLay Roots GPD/it
C. I Z- Bed
~bk' g 1~ _ _ s ,6
- - S1I f Z tSb1t I tt{L Lc~ - 5 •l
bound 3 3d-1121 l.Syt 3lyl - ~S d6l- U %I
84D.$
Ge~1h to - -I I- - --(-~,4-~ I l I I
limiting -I
IttelOt I- I-- - -I- - ^ ~ '
Flemarks:_ - ~
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FL 1 _ ~-!o I toHti 3i Z I---_ ; 1 2 fsbh _~Qsh I_ r' ` - s .h
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3 ~33 S3 to4FL 3/6 srl -FrrSbk ,
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PLOT PLAN Page. of .
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CST Signature Date Signed Telephone No. CST
PLOT PLAN Face 1 of
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CST Siana2ure Dz;e Sig.^,ed Telephone No. CST =i
?n0?RTY C°iNER ~L'`~1l IJkUStcl. UtV. SOIL DESCRIPTION REPORT
_3 ot~
?AfiCGU.D.k- PL,~~Ia,C:- page,
B Ielirq # Honzon Depth Dominant Color I P,1cICes Structure
b' in. A,lunsell Qu.;;z.Cor.LColtx iexfure Consistence: Ba Roots GPD/fl
Gr. Sz. Sh. °rkaY
B Travi
6 ~ r,._1 c_' `•p IR 3l2 _ ed
cA :>bk ash ~w s 1.6
Z ~t_36 roylz 3/6 - sit z~ sb~ f~ es
Ground 3 36-tt2 1,S`irL Sly f I -~--1 1
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Wt),t It.
Dc~t'1 t, I -
ra~hr I - -
i
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H
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10-2 s, I o`f R 1lte - i I---
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3 2S-/oq~ S!a Sty S d64 h2
GrarJ - - O S9 .S
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factor - -
09
I
Hemarks -
L ~~-3>!O`1k j2y II( Sll 3~i'SbK M~CF CS i'~
3 ~3 `S~tO `!IZ j/6 I ~-III -i--
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a,lev. `I S3 -90 'tS tili 3!y r _ S 6h p 39
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Remarks:-
3 ,rnr rr - -
~IA'.. I t-$ IU~1lL j 1 L S 1 Z-CSDIa;
S ? I$ y Y ! u `t ti 31 t-l-_-. - s 1 1 ~ 1~ ~'t- c S . s b.
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h:o 1012 6Ij LIS 6k
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Him„rks - - - -
Nlscoosn Gaoarmant o::,:.mmolce SOIL EVALUATICN REPORT Page..
U''.as;on JI $AION dnd L'Old rx;S - ~i
'm accorCar -;h. Ccmrn as. 'Me. Adrn, Gab
'Ay
t c
t '.-:)T. C'
~'ps~ ~~~pQ/ E D
anacnUJmG:UIO she D-an on Gaper not Iels than 8 't2 x 11 .n: US A J M ano
ixluutl.:rat not Ilrnlod 'a ..tlniral end IuX WW rolmmnra 7otr :11 !ed P I t O r~(/~y(pte~ G
Ilefcarll SlODa, SGaI' Ot d.'OnllbnS. Own avow, am 10=ion - O Imtanw to naareslroad.
I 13 tiaytewed ty~ Dare/
Please print all !n/ormaflon.
vmanxl LVOr+•uon.pu mw•sx may e•vreo tnruw^CW OwI>aaax v.vxc _r+ t SG Il mII I ' I ~~l j~~Yr I f/ A j
PropeM (hurter - ~'nowwacegon
2b z ?J ~'rr
LLC.VTIn Ent1~ L OEt~ELCPutE~ T Cnf P.
ProDem! ()wner s Mel:lny AComas _DI d i BlorJC a SIUO. Vamp w i,SMa
II<j_i_OU A ERD 6T. E gu1~g IOG ASS - TROY Uj L~AGE L4- JJ4
G,ri :;:ate ' D CuOU 'none Numoer C:y 'r `i,llaya .}~'ow+ Vaares: Fides
G oSr~Y KD~ .
:75'7-7 T D"
5449 ~765
;No
NawC Stmaton ~~se:~l7eaberlJSll4um.Der>r0Wrwms 'Jolla cenvod doelan row :ate_ CQ_-.- t i
Rooacumara '~.WC or ralvneranl Oesutbo. '
I VlP FIpW rladt a:avadon d 660~GalAn ___N 'r'
•Parum rnatmtal.!?S~Tided`hs~5~~
General com-ants i
ant mcanmendatlors: C.Oa+urc/% AL IrJ-r.v 2DV.Nt;7 ~KEUCM6~ t
p.7 LUAMtN6 KALE
~I ri ~L
J Bonny
a 1 36r.ry P rII rrcund wr!a;d elev. g`~5 _ [:ep:n to Iknafny , acr L'_'-_n
ur
-J I a01 p?hGt date
Ux1ta9 skmcltre Consistence) BOUnc Ur( '~Wt'
7066%Da1cn DOOn
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