HomeMy WebLinkAbout022-1072-30-000 (2)
ccnsm Dco3'h• Ir o't:nnun r PRIVATE SEWAGE SYSTEM St. Croix
S:aery a°.d 3uilcnlc D vs or
INSPECTION REPORT "eR
597389
GENERAL INFORMATION A rill "G PERI'AITI S40f "I'll,, ID ur.
Persc'/al "d:n m,+lulp yo.. ntOP,Oe may Le uscc IQ, onC49dUr•/ Pu'P~.`r` nl Lax' &'J C4 f1',Im1,
Fermi'. HPlc Hr' Nu Tic CA VIII:IJP Taa--,F Parer. Taz Nc
CARRIE STATZ TOWN OF KINNICKINNIC 022-1072-30-000
(:>:1 HIM E,e'J. IrSP R(d E. BM Dl•SCIIJIWII ` :iE•f.R'1G'Tfm91R3r",j,I P N?
- - 9 26.28.18.403A1
TANK INFORMATION ELEVATION DATA
TYPE MANLIFAC T IIRFR C.APA"'iIY STATION BS III FS FLEV
SepU(: ?I' 4 Bwlchl
F1fr+n4 Al. BM qo , r
a(;TrL_ 1> r is ti, tl (QJ
AeraPO'1 RIOC Sewer .~j
C) 1. l- 4 q
-O/J w
Homing SUHt Inlet
J. I
:;VIII O.,Ilet q
TANK SETBACK INFORMATION
TANK ?O P:L WELL HI J:; \+e-l tc An I"lakc ROAD DI Tm!I
_ .k
SePllc
Heatl=riMan , I IJ lO15
Acratlor rDistcPip. S, "Y- , t0 191. 4b~]J
Hodrlg Boot 'wrer, / 1
~YIA N U 1~, i~+
- _ _
Flna. Gratlc•---
PUMPISIPHON INFORMATION
Manc,arlulel 1Demand S: Cover
C1PM T-Akii 'l 1' I -~lT
Mooel Numb ~5v-✓k l li
TDH L tt Friction Loss Svsrerr Head \TDH F f l . I r '7- / ID O
Force.l Lcnglh Dia Dis .e '~:'JI
SOIL ABSORPTION SYSTEM
BEMTRENCH C7101i' _ Ne l-)I T- nl--s PI B7 I S N[ U' l:AS - 'rise:" IA.: L,emc depth
DIMENSIONS `\On ~ -
SETBACK -YS I LPA TO P:-. RL DG WELL LAKES ^AM LEACHING hfan_'zcl ~u~, T 1 /
INFORMATION Ivne Ot Svs;err I T CHAMBER OR ~'l. 1 -1JY
LINIf D,4•nel NUmhe!
41 1~ l ~s y a~
DISTRIBUTION SYSTEM
He.cC f1-...Li. ':I UI4r1h0hC' , .In,t S.., •1 b:+ryra x~~,tl FE O
- I pe n- li.Y
L • a'n D,a~ L.myU. Dia _3cir..
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Derll' O:•u, DcoUi OAT ra DcpR' oI a: eeauc'Suc ar;;. x,. LAnlc~ea
Bet Tc";-,b Cc'1e! 3eG-T.Q'.& : nn2:. Topsc Yes. Nu Y'e:- Nr
COMMENTS: pnclude code dlsc,epencr s. cersons present ei:. ; Inspection, f'. Inspection 92:
Location: 1y5 PONDEROSA RD j::wSlk U 01A iUOCQ~4h^
1 i AI! BM Description I"C' i... LAC.L1A:j Lo C0..iWtn
2. i Bldg sewer length - ``L;-F(~ rlljrt ~w~tT'
- arnoun: of cove- - v.
;an trevision rier side Repwred~ _ Yes - No
,J,;, -Q~ f _J`- ( J , , t-•(~~~In
c otner sid° for additional mlmmahon.~ UJ v J\~ _r V Il (iI/~ 1, f'
Oatc Ine~.p-r.e. SlOratnr~ Gen Ne
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SS
- comme 'elwl ov s1 fiely and It - Culil
c/► 1 ps) g018'pI W.JWasly tun 4\r.. P.O. Box ~y.R-fAl~+ 5 crI jC
W'scons'~ V p7adn ?If>? Savilar+rlcr~milWm+hcrlcobctilledmbyC'a.)
Uoparement of Commoreo J / 7
- --Sdil liHi'y' Sute`I'r_nsaclion Number
Per~-v~ilication -
+ n, ( I`, •.,.I I or it",torn.:" lheapprop'latc b'ovcnlnt<nlal
uno i. uy'ftul + -r In u o' F, i s'. t. p r I Ni n: 11.I h nnun Inrms lia state-owned POUTS are Project Address (i1 i iff-rent than mailing address)
Unmmlt t: rlu 1 p t r,I it f +s« f I rl n l Loon you pro,,dc may be ir,cd for sc,.mla°>•
ttlposrm actordan-< ll: th I I a I ts-It 1)LV Sb. /S
i
I Application Information I-lease Print/A'y,1 formation
I I I gien y(twnnl \-,ar r/ / I'a <I ❑
Property Ownsts Slalint::\d drcss Location:zE. aj,../h. ~G
$2 AV
Y/
c~drrc- rf OouLlo -
Cny, state - Zip t. ode Phone Numher t CL -
Section
S1~1s. Type of Building (checkall that apply) Lot k T S: k / ttra~ J
I or 2 ram:ly Dwelling `h:mba of Itrdrooms((//J/~~ ~~J 1 Sulxirc+snm Na.".
A l~L,/J~GCb--_- Block /vr'g
I~ i'uhbaCumm«riai Ucun M: Ilse /Mi7
- JJ(( I _ - -
~ L Sl:n< O,+ ncJ U tinbc I 1`.I Mom tiage of
I 1 -
+ lownof ip.2_rC^-•~j 11i
111. Type of Permit: (Check only one box on line A. Complete line B if applicable)
i] New Sy. n.m X Replacement SyIral L l reatmenVHoldntg tank Het P .meta (h+s ' ^ Other Ahxiifiration to Fixisnng Sysle m
I'cm I Kt<al R" n L) Chao;e. ut Viaml< r List Pl vwa. Pelmi N'amhct and Uale lucid
~ I{rnn,t
ri:n f r ❑ Pcnni Transfer s New
B•terc 1 . v1'al'o,n O•sncr
IN Tvpc of (OR IS by xlcnrJConlponenN_Urviee: (Check all lha~tply) - j? p~V ~
19,:..unr<d 11,61-111d 1~Pn: v.lim.1 In -Ground ❑At Glaue [\h>cnJ-[ 24,n. of sndablcsou [I Ninucd 24 in. ofsuoabIc suh C S
IL,LI: q: Ihn'. _'Ulhr, Dispcisal C'ulnp.rccol ,;rvpiaie) ❑ Prctrcatmcnl Device (e,,p;A1n)
N Un icrl sal Ina(~~[,'(cnl Area Information:
D t I1 p_ ,i / 11cs.gn App6ca;lo1 ICa iirpiwI Uiapelsal Arut Required ( I Dlspcrcal Area Proposed (s System Elevation
75 c~ I n ~r _/5 oc / J' r ' 0 J-1 37
Vl. Tank Info Ca pi I. ^ Total kof 1 Nfanutaaurcr
6su r. Gallons Units f o
I Nc.. tank. - - - glm,l: ~ ~ .x~- ~ ~ -
vu.• = w i~ t-.
\ It II :Ai.; T:ni
~ I tic. ,¢."r1, ..C/•7
Ntl1. Responsibility Statement- 1, Ihr undersigned, assume responsibility for installation of the POSVTS shown on the attached plans.
-
h m u - Na tic II nett PI 11 s SI n:UUre NIPAWRS Number Ru. mess Phone Number
I lumiser's Address (Stan, ('.nv State. Zip( ode)
7 Zc't
bIl -uwth Q)cpanment Use Only _
-I
Apprm. sd I r-•--•-•..:rt -_T-rm0. Fer Dal Issu• lwnl' gent signal 'e
t t IuTt Hue n In ❑rn.ul • C0
IR. Condit' anun~lor Ujsapproval----" C
MIItYf'1 J~ F. 5
NyfM:a oA frwet aq It£Y~?1Sotf~4~lS. ~ ~ b~ G
an per +mwiigerri plan pro Aden Irv Niu,rbe! r,
2. Al Mftw t rttl¢.irV `iftMs Mont w Milli I:.f : Ro ocY P 0.,
Mpllrlp~il:tlEM « Iht !:M'vlrf= /
:Wash In <nmplrtr plan+ tar th<a.:Irm and xubmil to the fount, onh' un paper not lit, than 8 n2 a 11 hmLts In strt
SBD-639X (R. 02'09) Valid Ihru OUi I
Pg of -
Private On-Site Wastewater Treatment System (POWTS)
Index and Title Sheet
Owner: , . `
PrMeet- a and System Type: j `P h~ .h
I ucatton: r 2 o•-, V'.. ; L u I "~C~
S1reer Addravs
i gal beucnpdun _ ✓
T,,.whip,Counr>
y
inntcnts: Page 1: e
Page 2:
Page 3: !,o t,~, / > C<, i
Page 4: - r .fie t z ,
Page J:
Page 6:
Page 7: _
Page 8:
Page 9: Ly
Attachments: t,<_ w . NQ. • r rte.,,, i - ~ -5
Plumber7)esigner: - Signed:
Credential Number.
• ` Date:
- y o-
Y 5' j 7 c
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!n-ground Gravity Management Plan PAGE 50F 5
I~_ •tt_
I he owner of this jn-ground gn" system Shay be reeponadWe for
re rements of SPS 382384, ~d Code PtrSUWt to SPS 45 3W 52 (2). wtac AQtrWi
~vf1D,~r1,S.,1,d~8`f, ♦ a ed a turrterl heeflft and maintertanCe twratrant :c
^••~nnrre Code, th18 System shat;
accordance with SPAS 3833 52 (3) x °t~ ~Tnad by a rog py miner n;
Ifn
Dtittners~t /L~ r
J"n Flow
tp C 9Pd; BODY 5 220 aagL^; T35 5 160 mgL-'; FOG 5 36 mgL
insoec ftecklist
type of use (ACT EERY 3 YEARS
age at system
nuisance factors (i -e. odors, USM comPlarKs, sk)
Matm enal kw*r PUMPS. vahrea, etc_) es ryoats eh )
satds vdume in anaerobic ttO0Rpd0f ~ eM
tar*,(s) and extent wW'Oper use (i.e., ~y aa07btbon ~ptaiprtar~(s) (ie.. oisinouW+~ ; ur
;ioxo
dosing P min thabtbuaon cam WW to do" • PrOfvbled aCbviae6, etc)
*~Won Werst or (r a cure Iw rw aayCfigg owdMis ' ) aett,
surfacE discharge of ef0uertt eat stnrdtae Orebue totode&gn spe"wawn~ WIWW
~lLltetia~~~
K",IiAIN EVERY 3 YEARS (or wh&n wry)
n of so be by a oar~ swv=(113) #w
9 OParator bcwued under S. 28- 48 : ;
shatt required by local ordnance OiepCad Of tx
. Cm*wtr shea be pua lwmdaertt to b NR 113. . VVI vohwrtu of the tank(sl a
Wrsc Admin. Code
sfwY be irupetywt e-guy ;Yours arx7 snail
accumulated ~itdb
months °OC°'rdv~9 to ntertutacturers specfjCatiorr&e aeYrted wig Period will alleys be greater than
~ystam Inav wnance rePorb ehaw be submitted to the proper iocai ouventwma unit b
';PS 383.55 Wmc_ Admin. Code. Repot any cowtppWWK kilum or i14 bn b.
accordartee wren
lame of ,ndrviduai or c«ripary_
govenrrier,t urvt. i r, ~ ~ Pt'°"°
p~~..bt
Phone-
~1V6IT1mf.Ylt Ur1d 8ddre8S' I ~ i~ ~ .Yi a~ '-Y ry detective Part of tttu system sttaM be ZIP=
tr,
removed Purvt+eru to SPS 363.51 383' Wi(1), Adff , c
, lode P or rePieoernant of failed cw rib Q'Portents 8W co 1r/tt gPS 3g3
y
NO Product for with Schemical or
lai restoration of the POWT may b ,
PhA~ S may be uaad rrry~ rdw aPPrOved by the dsc.epaartmertment t r ie
aAdm. Co".
02t7inae- nc-`n_
,wn s'nxnrtted to the ePDrOPrit riPOnerY of on POyyrS cannot be raP aired, it .:.arKbned and 'Placed by a nyrtYfor review 8w approval A fasted jn,~b ~l be
comp o p nt maw;
_ode-co' pdytV dmperaal Mff*Gr m in 8 d~PrMSa! suitable sot may,: r
PleitetBwrarled of SOI1S
e j! t- n Abandon t
' ~se of the PpWTS rs dMoOrRxltred, R
ShaU be abandoned n aocordanC& with SPS 383 33, Wise Admir. "~oae.
ST. (.ROIX COI INTY
ii~PFIC TANK MAINTENANCE AGREEMENT
ANT)
JWNaSHIP CERTWICATION FORM
vlailing Address
- "T = Kl_-`dfl f) River Falls. 1M 54022
f verification Icgtitrtd from
11VZ~$ TSB ucpattment for ttew mitsirotliot>_) - - - -
- ! "t t ✓V"L Parcel Identification Number F z
lopcrty [.0C M00 Scc. T _t N R Ik_W, Town of
❑bdiviston Plat, - ' _ -
crtified Survey - - - L02 `f 1
Map#
Volume _ -Z Page It S Z
-Z~ (before 2U07)Volume _,Ly7G r~ a
es Iut lines idcnlitiahle
)j7. Ycs[in~
:y']'F~:'ati i'viAIbTEI\ANY„ti
O ER 'EK T )N
l wri use and ,iwntnutlGC of yu,a septic rystem txwld restO[ ,,t,rrwwe
> tut ntenance ce runsisys of PwnPi in it, ng out d,e sepne tank every throe
handle~:res
alicct the fw,ep,r, of dy: Y~ of soonv, if,xcda:, by a li ~ I
.-:.:,asibihties uc - [.cvacd pttmper What VUO tit;: ;nv,
spec,fioo fn §JpS. 3gs 52(I) ~ -the wx disxsa! srstem,
and in Chapter i 7 (hurwr nntintaante
Croix County SattitarY Ordinance.
-she PmPeny ownor agrees to s,wn u to St. Crax Cotnry pliinoiag & 7nnia
~-~d ay a inns[, Plumber, iotaneyn,ta P)frnber, ,ostrrttcd pr,amhet or a iitxoaegil Dopacttnait a
- -»ata dispusal system is in Propel certification forte sj by r}:,
as that(,) the G,an i/i fill of sludgc- fWemirng condtion ardor (2) after inn MW pinro g (if necessary), the ~bL t~,f
!I- the "Odeistgned have react etc above no wrens m and agree to mwru&in the Private ..,.suds set forth. hetan, w set by be Departinau of Safety And Pto
-r~ of wus enn Corirficanon scat wg that l tom[ Servieea and gte epee tit r ak sYSaem infs. ;i.,
r'tY planning & Zoning D¢patn~ your teppc system has be rueintaiuodrtanY tbtnp entof Nan"
Reaxnucc._
I within 30 dayx of the Ovec year txpirauoa date. letedand
returned to tk,e- e_ tut.:
i/we certify char al! ,tat
emeots vu this form are Irtm a> fhe
desenbod above. by virtue of a %ananly deed tewrdud bi~~t of orvio,n kmowledgc iiw.- . nrarc ',,fc ~,:.tfc rt vt ;n,
i fn p •u.r,ISter [lt +~i'.(t$ t)(5:::
Number of bedrooms A i
SIGNATUgEIYFAPPi IC'ANT(S? ti ; 5 t r"
"'Arty adorrpabon Out u mtQelxeaeofrit IiA; is
nuY ~
lnckude w,th it" appk,cotu,n a recorded e a ,n the ® War)` petit bong revoked by the plwwng & Zoning (kpartm,,, t
`efrJmcc i5 made to the wa ry decd w'+rranty deed From the Rtyster of Dcu}a t'Nfice
rren and a Copy of
Ik,e cP✓n11uf au'rYey •n»r, f l
z
__-~I
''i ' °'L1 r ti rcpt SOIL EVALUATION REPORT
, -.n t - lely anc 6.,ad nq ~7 q(t, Q Page
ocC{}dYynfk"A•Yh C191r,I 85, NAs- Adm. Code -
a7srt. complete site plan on pyper no[ ICSS Than b 7 A 4,1 } menL - 1 size. Flan must County 1-t
u r acts. bast not mimed to. vcnl~gl and hprvdntal pule rekr:,poumld Q, direCouu and Parcel I U
octal slope. scale or dimensiposepe{jparrow and distance to nearest road ) l J. it
Please print all information. Review Dy pa
- .u.,.u informa:wn yaa Vr~•i0o may vo wcJ (w aecmwa~ y yw Voncs (r uea~y laws 190011, lru)) 5 T ~O
°oF c^y6,vner N1 FOPeny LOCaDaI
~ 7'<Z7 E Govt Lot -5w 7!4/~~ t!4 S _f T Q N H
E lopeny Owner s Alailing Atltlress - - Lol &rxk # Sutx1. Narrle CSOkt _
_ny State Cw Code Phone Number ❑ City ❑ Village Nearest Road
{ins / ~ - / ~S:hsl,-r ~ f'
1' 1 ~•-:JII/ I'T-__._ FrrJHi t ~.i r~"r. c_ n /j':y'
J New Construction Llsu' - `
Hesidenuai i NumDUt of bedrooms S _ Code dr;nved design flow rate GpU '
Replacement U Public a r-omrnerclal - Descibe.
'..,riot material % Firm Plain elevation if applicable /°0-2 - 36/✓-374
d (L
nd recommendations:
r
f. • 1 ¢ < vc t, o., -i s wx
L] Owing
Boring #
Pit Ground surface.elev. 7C ft. Depth to limiting factor " •f^ in.
Shc - Zion Rate
nanzunT, Ueplh Dominant Color Red ox Descnppon Texture Structure Consistence Bourxfary Roots GPUlfF ~
m Idufself I Q,. Sz. Coral. Color GC Sz. Sh.
p;•_1 - i rr, , i6 f' -1 + <L f,- y fi' - 1, -
I
_ 1 I
ly
L] Bonn.,
Boring
pill Ground surtace elev. / ft- Depth [0 IirnNng factor 4__ m.
Sal - Apphcaljon Rate
°,.'imn Ceoth Dominant Color Rrdoz Description Texture Structure Consistence Bowldaiy Harts GPDrff
hluns_eil.__ Qu. Sz. Cant Cola Gr. Sz. Sh. 'EB#l 'F tt#7
-IL
I- 7~
1 16
1
' Filluent #l = BOD. > 30 < 220, -Lanc I S 0 1 SO rt>grl. • Effluent #2 = BOQ < 30 nig/1 and TSS < 30 MOIL
-oT Name (Please Pnnt) Signature CST Number
'AAdress Date Evaluation Calducted Telephone Briber
Parcel IDN -jo-0007 Page t, W_ L
i3G~ng9 r.~ Boring
Pit Grourd surfs eelev- ~j T b ry_ DCplh to limOny lacta 1~` in
- _ Sal GCal on Rate
: bdzon `DOPih Dominant Cul, Redux Descripp- Description , Texture Stmaurc Consistenue Boundary Roots UPG/R -
m.~_ MunseU Qu Sz- Cont Color
Cx Si. Sri
EUNt 'EUN2
6K s C S > „rr
"7 J' l a 9 2, r
- _-I Bonny N ❑ Boring
pit Gioundsirraceeiev. --ft
Depth b GmiUng laubr in,
_ Sal ieauon Raie
~orizon Depti, Dominant Golori Redox DesmpUon Texture Strudrue Consistence Boundary Roots SPDJfF
rnunsel: Qu. sz Conl-`:olor Gr Sz. Sri
-I-11ttt •Elrxz.
r
Boring N U Hunng -
J Ground surface elev
Pit ft- Ueplh to limiting factor n.
_ Soil i G]UOn R:IC _,I
c;nron Depth Dominant Color Hedox Deseaiption exexture ~Saucture Consistence Duundary Routs GPOIR
- -~-In. _ tdunw. I Qu. Sz. Cont. Color Gi- Sz Sh. •EftN1 'Etta.
_ r
T
Effluent P I = HOD, > 30 < 120 mgrL and TSS >30 < 150 m L • Effluent 95 - BCC_' - ac n -
_ ty'I and TS..,
Thr: Depa:nnew at t_bnunc:cc a an equal OppO1tu2m., sera ice Pn.v ider and cmpioyvr It ul. uaul nss: sta'i,: u., uci u.r-I;,e:: c:
new m er;a. ❑i jr, rl r.r'c [or at, ;Ic,e -mr::,, .hc departmer,; at nU!~ 2w,-~ I i
Air l E . TA TF
,.a c/Sinn, T.
i
r -/c don[ 6 T A..r. y¢ s~4 - I
•ca"~e-. /Tn ~Ur7 -CX cp~T. ~~r rf ~,fr~/
ALK 3-
r KcrC G. - f
F# prc
ri
i7 31
I all
r f/rs 1vo7.7S-
Iln ~M SL~
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State of Wisconsin Scott Walker, Governor -
DEPARTMENT OF NATURAL RESOURCES Daniel L. Meyer, Secretary s
West Central Region l ocpnc•v_• 715-839-3';::. - - -
1300 W. Clairemont Ave Tot "ve 1-&A&i?3ri-74 F:c; A
Eau Claire, WI 54701 TTY Ac ass via •elav - 7'1
March 16, 2018 FAD ID: 20151
Sarah Droher
St. Croix County Community Development
1101 Carmichael Road, Suite 1101
Hudson, WI 54016
Subject: Unnamed Tributary to Nye Creek Regional I lood Elevation (RFE) Determination, Town of
Kinnickinnic, St. Croix County, Wisconsin - Floodplain Analysis Approval
Dear Ms. Droher,
The Department of Natural Resources has reviewed the floodplain analysis prepared by Steven Voigt,
P.E., of Johnson & Scofield, Inc., to determine the Regional Flood Elevation (RFE) for an Unnamed Tributary to
Nye Creek. The analysis was completed on behalf of Ms. Carle Statz, located in Section 26, Township 28 North,
Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin.
The analysis utilized a HydroCAD model and TR-S5 to calculate the 100-year flow rate (regional flood discharge)
of 102.5 cfs. The study implemented HEC-RAS 5.0.1 to establish the Regional Flood Elevation (RFE) for each
corresponding river station. Based on the assumptions applied by Johnson & Scofield, Inc., the RFE for each
river station is presented in the final floodway data table in the report. The property of interest is between RS
950 and RS 1075.
The final floodplain analysis and report titled "Carle Statz Flood Elevation Determination" was submitted to the
Department on March 14, 2018. The Department will consider the assumptions applied in the analysis sufficient,
therefore approving the study as complying with Wisconsin Administrative Code NR 116 technical standards for
application of St. Croix County's Floodplain Zoning Ordinance.
If you have any questions or concerns about this approval, please feel free to contact me at
Mirhael.RocnevCu wisconsin.gov or 71S-839-3735.
Sincerely,
j
Michael Rogney
Water Management Engineer
Eau Claire Service Center
Cc: Steven Voigt, P.E., Johnson & Scofield, Inc.
Jake Perrine, EIT, Johnson & Scofield, Inc.
Carle Statz, Property Owner
dnl
wsconsin.gov Nattlndiv WISCONSIN ~~j "
Summary and Recommendation:
The FEMA LOMA determined that the 1% (100 year) floor) elevation is 998.9 feet. However, the
calculated flood elevations for the flow path on the west side of the property are greater. It is possible
that FEMA did not analyze this flow path since it also does not appear on the StreamStats program.
Based upon this analysis, the existing ground cover over the drain field is just above the 0o-year flood
elevation which ranges between 1000.16 and 1002.361across the drain field area. The surface of the
drain field area itself ranges in elevation between 1002 and 1004. Therefore, it appears that during a
100-year flood event, the water will not inundate the drain field area. The landowner's plan to reconnect
to the existing drain field would therefore be in compliance with the County ordinance.
I HEREBY CERTIFY 1 HAT THIS PLAN, SPECIFICAT ION OR REPORT WAS PREPARED BY ME OR UNDER MY
DIRECT SUPERVISION AND THAT I AM A DULY LICENSED PROFESSIONAL ENGINEER UNDER THE LAWS OF
THE STATE OF MINNESOTA.
Date: Lic. No. 20034
Page 3
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' )I~a ECEw~ Safely and Buildings Division s'y w~ X
R 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number po be filled in by co. i
Madison. WI .53707-7162
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Index and Title Sheet
Owner:
Proleet4: and System Type:
Location: e ; a e c'
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,Street Address - -
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Legal Description _ 7-
lun'.ul~ipi County
Contents: Page 1: " e X ~r h e e~
Page 2:
Page 3: Cq.
Page 4: f- ] - 7L L ,
Page 5: /V/., 7t ~'w C
7
Page 6:
Page 7:
Page 8:
Page 9:
:Attachments: t'c i~~, t rn /g
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Credential Number: Date: :7
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INPr~ T ANT In-ground Gravity Management Plan PAGE,'OF 5
he owner of eta [n- 3U-3 ~Y 3YAwn Adr shall be
requirements w SPS 38238A, w. responable Tor t5 PwPebuat OPembon and rrraswwnance
~
Pwsuan; ;c
Ft1e cortnsrdured a ttunran health hazard if tq(. P~ 10 ~ _ ~ ~ R). Wfec. Adrnin. Code. this system snal;
#WMOfe. all ruPsdbon and ) Maintenance acbvews shah be Performed by a re p t P
accordance with SPS r finer
mMUM DeSOersal a -
Design Flow
9Pd: BODs 5220 nbgL': TSS 5160 ntgL'; FOG 5 30 MQL
v We Ot use M'SPECT EVERY 3 YEARS
age of system
° '"sane factors (f e. odors, user, compfa rb(s, etc )
o app (r 1806.. setc_) floats etc.)
st" ohrna in anaerobic
' mprOM use (i: d0eign~~~ mss) 0-e., dutnbutiai ;drop t~ces;
Pondsg n dabfbobon A°1tNtlsd arb~ etc. Call plor to do"
)
0
it appk
1cal
" G e'er "er8 Not arilrA
o Outran la or (r.e.. Grp. dortlBCtions,
M*Oj
amts. eh'
urface onljoe Pam (rbreanae lateral
s .
Ors harge of alNtrerr( or aeeerps baby up ft, W pr~s+e - compare to desW speaticaaan,
NlfikterL'tnc._ G►~
o MA"iAW EVERY S YEARS (or wdeatr rY)
in!'- ro=lb w al" be Wnped by a OerOW 8"" Operator Ircertcerl urKlst s. 28, 48 W,_ in #0 as requuea by Local ordinance- UWO@W of d ~or lanle d,.r 130 we;rrt to ~NR 1R1
s Wear- Aorn, at si or
Merle' shall be RNPOclOd every Yews and shall be ned
a mcgth std sokla °~rdrq to ""AVMKW 3 clee On neca vary to nerrrove any
',C9 WW "I alleys be greeter than ;
System manterLat" r'gaorts ab.N be subrat(pd b the SPS 383.55 Wisc. A.* l Cods. Repwt aay ~ R %Wjm to t mince wrtn
or
a mdrvmdual or - _i
company: ' Q•-: -
Phone
- 9arenmerx unr. . ~'r i T <'0 I u i
'-'Y;81 9a'ernment and address , L , i Phone. _ 71, L' -
.
"'y dive Part Of d'" system shall be _ ZtP: __rao8wed
-ode. Repay or rep rwN d (ailed or ' fSPlsood, or removed Porwartt tb WS 383.51 1
no P dud for dmm'C l or Physicvj ~ aorr"ntettts *w oott" WO SPS 383. Wisc. Adnrn Coo,
,x;cardarxe w6h SPS 394. Wisc. Ado r"Wrabon dths PpWiS be used trdsss apProved by the daPartrttent m
=~L-!faancv Plan
plan sub"
the event that any faded treabnent ~roonreett Of do POU S cannot be repaired, It shall be
= s" sut-d and to th ai pprolonabe a agency for mvww sM VProvet. A faded Iyrgyd or-~ Pursuant to
d*mrsd oamponar,, m a pea-d&srtnyted 't may c,,
area Of Suitable soils
j.sbam Abark+....
use of tn~ PpkYTS 6
. R shag be
ebartdptad in aocoMsnce with SPS 383.33, 1Misc. Adnmr- (;OM
.