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032-2124-10-000
1• PRIVATE SEWAGE SYSTEM St. Croix sai,-r; .auJ t~u.mno c„wsor. INSPECTION REPORT `'anal" Form No iAI TACH TO PFRMI-I 607057 GENERAL INFORMATION sn:~, vino c No "e,oOa -t.wnt Jw yr>4 bCrVIJr rn:rr tR' a+eC. v s.Wnoary p-mcse51Fnvacy LaN 5 1$.C4: iirn i] pam'.it H.1d L:. Name ;;Il `diltarr iown::n,p nWoo Tax. Nr. Christopher and Corissa Hermsen TOWN OF SOMERSET 032-2124-10-000 CSI BM .IM' Irner nM Llev Bbt l:exnpbor. Se;iical uxntY,anpa Nap N., a / 05.30.19.1109 TANK INFORMATION ELEVATION DATA TYPL MANJFACTURER~ CA?A(II-y STATION GS HI FS CLC\' SeoiiG - u..r ~i \ Bcncomark L~ > 1 r i ! o Dosing AII. BM Aeration Bldg. :icv.±•- / -ioldmtt S1r'it tulcl >tMt Odnet _ TANK SETBACK INFORMATION ~F i ANK To F} WELL kl D(: 'der'. tc=.i: ma.e kJAC' DI Inlet Dt Gonern gephr. 1 / ` I f I 1 r I L,osing -waoc-04an ".eration Dist. Pipe - Holoetg Got. System . Ina Grade PUMP/SIPHON INFORMATION ` ~f~ 7 `l l•_T Istanutaauic• LB:ilyrro St Cover Grit IMooel Nu ber - %oo STD- I ift _ _ Eamon Luss =YoleRi Hea tl T-tr Ft pI V I-ur u:ma~n Len;7tn /o ~L~ SOIL ABSORPTION SYSTEM PIT DIM NSJONS Nn °.tr. nsiJC C,ia I icmJ (.`ept^ BED'TRENCH 9nt•, 7 l T,-h-, DIMENSIONS K L / SETBACK S"S'F%l hG P4L 1G-:)G lWLL LAK65TRE: LEACHING ,da-Lda,n,-,^ yr_ ~)t1u) INFORMATION _ CHAMBER OR - / / UNIT Elrxoc~ N ,,oer: 1aY'. l i I ~v~ Tf a DISTRIBUTION SYSTEM' ~6--riQ 5. /O ' Heal r lanrfod C uTUJ Or x Ila e `,:.-r H (-,an5 t$n'to Art m: t I ~L' P tC SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only r/ dQ ':vIItlh Gin Ja DN Cvv- xr Uep:n pt xx Semnd'SUJCe9 I xx Mutcnea CcJ" rend ..m..1\ r-~ neHTeuvb I Jue:, To,^;eP _ / COMMENTS: (Inrlu<le rodt: dms tepencws persons present etc.; tiispectron #1 InspeJuon a? Location: cln 172NC AVF ! 1.i /UI RN F:es_ipunc= c.;, ?lor, sewer i-mglh = amount of morel •I °;ar r=vision kwcared? yes No ,Ise- m•ie' side (or addnronal Information C' n In:H:Ddtn~r{ uf!u >-eM1 No. >~!J 1 a L ?n Seery and oui:oings D -sion p+ 1 dt. r'J3hhington Ave., V.a Box 7162 'Sawa? 'ccnn; Vv:nrer itr be Ii;.eJ u. by Cu i - - ~ itv,sacY - - tom- stag i Sanitar, 1 enilit Apl-f1cati ere 7,d-', hm t t tf J f:[r i s apptmmaL .,-v.n I wrt I - Pair. Address i if dificrea: t!un whin,., a:~l:-s In a.c udao.e atll[ tit $ t'+ t t - - -,at;;,d , '+v. tV ate bu u ~ to - eauirri nor « tat u r w::t.t e: n t e Pp -+u fo-ru :u tae ~ c kap.amrat ~ cf ' n I r 2 is nsl -r : vn:::: ;tv ta9rac v.J rnnidc ¢a Lc ,,ea lot :.wrdan' / sir>.:ntam_•wmth L1: __y Cav I lwl_~nt tn. j/'1'a r /_I l application Info, matinn_ Yleasc Prinl_AII innu_innn__ i , n t: t.~:nt ,r )•ropr:t) (Tvrct 5 N.adtnK •t- f ~2 3ii/+. tiecvuo N i I 'a IT, S-vpe of Bwldmg ichtr all t 1hat apply i~`.11- --_i ti.da'.v'tuo KPm ~.,?Fartih 11 r.:ia, -1`ti tbrr a[IKmoo:r_ _ 1*xbho anvnrn:ial -[h:'ibr 4 -_~a 5. - -1 in .,f ~I I] ~::uc t an<A :kt,,,he t. Sr. lit. I Pn'm1`: it Duly one bus on lint A Complete line B if tpphcabl-1 x - - 'rha h.?dohca.,•m r Emsan; ~tten (cxp_-a. ~ea S •stnx Repta,, en[ Si:eea . Trrsm:n '.o„ 1>r.r. t.c r. ,uc... _ady _ - t~: Y;rvi~uS Yernit FUmbc vue Da= 'suet - - :'amtRrn.h>u \:TnIPC o:Picmbct I Jrrt ; Iro-fcrt\ca' AS /-Z~ N. Fcn Re a: - t~aTa C/' i- ' -um oneniTevice ((.heck all that n LY1 - - IV. Tv e o ' V:m. +i e:;mna ,n C r.:nJ f-e. ur.nw tr:-Cr. ound ❑ '+t. n.._, I 1=iom,a = -24m . rd sunaldc sut7 J ?1owtd . v d vtrz:iu sa:f r', I] YM r:nln0.nl \De cy, ~c/;tlanu / '~rp Hold s^2 U3 cr +i-I crsJ nt, :amt ;e>p1alJ. 1)iapenaV7reat nt A, ca informaUUn- f t- 7~s,_K,as; A+ca --:/~xv~';[rm +tv 2 p, , L+ctt.J S~.il .)opb ati m Rate; , i D:.p al R<yum t " 7 v la G V V1. Tank Info I:mt: _ v Il.:as i Ncw ~mkx ~ Faiak[TvaJ~ ~f ~ a I cr-0t+= m i:'mnk Taal .vvtc '':,r!r Lam- . ReSpnnlibiliri StalcVuu&,tgnCd.:1 pt nsinilily fnr ioxedSatiuu d the ! r1R' I'sb~wn ou [br attached plau< DTI 1tt:nas Ptmn"-nn - ~ _ e:mll Ya 7a1e Jef.~ 11-s]t19 rail )i9'.aatlr rw•r< t_epf S ,pP ~ ~ ga . ~ i ~~zg ~9 L Cuudrti w[ oc fnr Disapproval r I ;tiM.'er: 5t crA Host all be ~i 35 pet Tor3gement v,2n '•~'IOr7 LV JIU:nbl? 2. Atl nt~M'•k r(~GUwr en;s mtr t ..rt, iI J iM pet ppknblt (.xi etucn u. <umpmx p:aa, lu+ tim nttcm run anhmn tr. the o• N t - au 8 a I1 iwha m ain ''/`/~\\'1 z z J 44ur,3/~~ K/Dff Pn. I Soil T-st and S\ stfm PLO I PI. PROJECI Chic Harshma-1 ADDRESS K3 Hars-Imar Dave Hucsor A" 54 15 SN 1±4 SeM 1i4S NiR 1a' TOWN SOmer9et (otm) S- "HOIX SYSTEM ELF%ATIOS SuQEZ4-low cross Seclior DA rF 6i20r19 BEDROOM Z COAA'EV'11ONAL >XK A7-GRADF. C010ENTIONAL LIFT HOLDING 'lANk ".27 naliols 1.111 TASK SIZI- DUSt. 'LANK SIZ.F. NTOI. ND SEPTIC 'I A\K SIZL HOLDIM; '[AAK SIZE LOAD RATE -Z 4BSORPTIOX 4REA 3000 # of EZ,-Flo))'s60 BESCII~Q:~RK ).R.P. 101: of 34" conduit ASST Nil. ELEYATI()A 100' Filter Lilc:itn Fillor ROREHOLI'. 1M1'ELL Same aS -)enC-1MarK ly;' Propec} Line - X 100 Ccl;; Pic i h-~ I Sop,: f \enL <al cnd ni the cea ~0 ~O~ 1; I B, M.. ;t . I i\' ~tV` 14Y~7 T~ flr % i 1 a. V u a ~ m N C ~ N `0 m N m N O vi W LL o 9 I O O h 0 m Q. m cn1 0 U:. ~ v T N E u a- Q a O N ¢=a (7 c~ ° o N m ~ 3 ¢ N O II W 0 > N c - : p n c # 00 N co C5 N N ;,1 ~ ry W ' ~ r~ , -I. N N L Z U N m I ~ J ~ ~ C N V _ O w Cc Ct 0 1 n =p C i 5 3 o 7 o V rn d m ° m' E y y v... ` c V 3 - ~ T O . (n r L) Property Owner Parcel ID # Page of _ © Boring If 0 B-onng 0-pit Ground surface elev! S.' R Depth to limiting fades _ n. Soil icalion Rate Horizon Depth Door pant Color Redox Description Texture Sbudure Consrslence Boundary Roots GPDMf in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh 'Etf#1 'Eff#2 Z 10 /77 1 Boring If ❑ Boring ❑ pit Ground surface elev. If. Depth to lioutirg factor in. _ Soil Ap Ilca;ion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMf in. Munselt Ou. Sz. Cont. Color Gr. Sz. Sh. 'E##1 'E1102 ❑ Boning F-I Boring # Ground surfaceelev- If Dopth to limiting factor in. ❑ Pit Soil Applicallon Rate Hnnzon 'lepth Dominant Color Redox Descipton. Texture Structure Consistence Boundary Roots GPDMf m. Munsell Ou. Sz. Cont. Color Gr- Sz. Sh. 'E"l 'E##2 Effluent #1 _ BOD, > 30 < 220 mgvt and TSS >30 < 150 mgR ' EfIluent #2 = BODE < 30 rn%L and TSS < 30 mxy'L "I -he Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate formal, please contact the department at 608-266-3151 or'[-1'Y 609-264-9777. suU ! llU i R etiG Property Owner _ Parcel ID k Page of_ I I Bonny 0 111 Bonny C- / L- "JJ S-Pit Ground surface e4eofL _ t. Depth to limiting fags in. Soll ication Rate horizon Depth Dominant Color Ream Desmpton Texture StrurNe I C Istence Boundary Roots GPD#f in. Mansel Ou. Sz Cant. Gaon G:. Sz Sh I l 'Effkt i 'Ef1#2 l 12, 1 Boring k ❑ Boring I ❑ Pit Ground surtace elev. Depth to limiting factor in. Soil AnplraLon Rate ( horizon I Depth Dominant Color Redox Description ! Texture Structure Cons,sience Boundary Roots GPD.nf in. Mansell Qc. Sz Cont. Coic, Gr. Sz. Sh. i ~ 'Et#1 •ER#2 I I i l i 1 Bodng # Q Bonny ❑ Pit Ground surface e,ev ft. Depth to limiting factor n. Sal Application Rafe Horizon ')epth Dominant Color Redox Description + Textue Structure Consrslence Boundary Roots GPD/tf in. Munsell Qu. Sz. Cont. Color I Gr. Sz. Sh. 'Ef#' 'Efr#2 ' I i ~ ' Effluent #1 = BODE > 3C < 22C my and TSS >3C < 150 mg& • Effluent #2 = BOO, < 30 nxA and TSS < 30 ng'L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material to an alternate format. please contact the department at 00b-266-3:51 or TTY 608-265-8777 . sao-x~w R sm. Soil'Fest and Svstcm PLOT PLAN FRo.)ECr Chan Har0r,ian 11)DR4:SS 303 I larshman Drive Hudson Wi 5,1016 S';r I It 4 SW l i -15 5 ; 1' 30 N. R 19 w 1011N Somerset COUNT' ST. CROIX 5\ STEM ELEN1,1110S See EZ-Flow cross senor. 6:20119 BFDROOM 4 DATE C0NVD:N'1'1ONA1. XXX Al-GRADE ~CONNI-ATIONAL LIFT HOLDING TANK (VIOC NU 54; 1255 gallons LIFT 'TANK SIZE, DOSE 'TANK SIZE PTIC 'T'ANK SIZE HOLDING 'TANK SIZE LO:1D ILYI'4; .4 ABSORPTION ARF.,1 3000 q of EZ.-4lows60 ~I HFNCIINIARK ',.R.P. top of 3!4" conch ASSUML ELEVATION 11111' Filter Lltehme Filter ❑ BOREHOLE O N'lil.l, same as benchmark 193' Property Line 3 3' X 100' Crlls wish >3' spacing, Pro 4 10' liedroom 5'l I louse 11~~\ H% y 35 ?If' s R-2 0 1"i Slope Vents on end of the cell 50' 00Y R_1 Ci..' 10' 1 388' Property Line 0' 40' 1?-Ind Ave. Safely and llui pings D~ision 201 W. ;at:mng on .4ve box ? ]6z Smvmy Prn of N . be, no be Ulc4 is b} Co OS `I Pdadlson VJ ?ur ~G2 X6765 7 .1, 0 a;xucset[cdidsSc`~~, Suurll li<A,e- C,,d, l .yl~~f p1~Q1!f hewn pe pr, 7- arc sub m incj~ I'r~1e,..tn 4L:est i. olll rni thae :oadm~ add:ess'~i s rc;1rrl minrt ia d,c Depam esd cr Sa«rs and 14 f io,.: l ~c t r.:. I 1 :f,1.nao.,n ,nu p:m idc ma+:a acrd :o: soconda: ' li wspnscs to a [IL.c vt.G 1r a u) I l Apphcahon Informah n Please Print All Information r,tlxn tK. tc,Nam. e ~~OnW~ C.0C `P. c],H 1 ` 4 14 ~ If 95,2 •ropcrt5 (Mw .'sM P 4dmos F:, ><n :neaaro r1 j0. ly , Tory i IN ray late / a j i t -[:de 'how Vrmha s~ Mi. on ll U. I ype of Ruilding (check all that apply N, R / 7 _ d j KL or Z Family Uu•<Ihoe_ \wubc::r."Rc.imon• 'iL-~~~'/S'Ir1) S/a.'d/»'ision t;.am: . ~ ~-IruM.oY,unmlrein 1kra.Ue (ISe ❑cm f - I V dLa@c of, "SM V:nrx Date(~Guar'- Drsmhr Use ❑ (...)ab~-_W r~/O FtZ {~/Or-YS ~c.Y1 I/I..Cj~aam~ ~>i?!t• /t~~_ _ Af. ypw.(P rmt- Check only one ox on line 4 Complete line B ifapphcal,1 Ir -4 N S lo-zt J Rep:au sy".n :~mrvn I:: nom, I u:>. p':uoni li J 'Jtl Modi:rcat x: 4rxts[mc S, stem texpla.,: l[. J Pc lent ene,J 1I !'r,trn Rrv:noe C'aanxr of F' Fcr , TraaSta le Nex LS Prwiatrs Permit Nwnbc a,a Dale lssuc: IN. I of 1-E)4~-1i-f»af~~:ovl uentDeucr 1liCbtt► all th e :_T VT,r~.hcs -rt . it, n I T*'-T~ : ro 1 "n1141.1: I I :.t-ii::a,. t.to:ai : m of s:.iaa,lc s(0 ~ M-,;. *4 :n n, mtink y>o . dtmrTan7, - '~<::t1c Tspe• -,I t>F ~ u. ,cxpl.u:: _ _ _ ?rctratmert liesace sple:nl _ q--,t. Dis mat Ircat ent4re lofm mati.n: Q l"~ T j FRaien Plou L.cs foil ,ppLr aboo AatN dsA lrspemal 4rea ~equi:cd isf~ D¢pczal .•ca Ptoposad s t - Fiaaa c , y rvu 7 VI. Tank Info Vny to Toth aof Maoc`.haurm .aa(lms i;ailum Ume. II~_ hew :aa6 - I t.:wcF I,.,>=. •l c.~' Fr,~` I I ` - j /,/a~ t r r v F'„u:d(.Tamba VII. Reeponsibihh titate nt- L the oadersirned, ."A, esponvbrhh for iuslallahun of the POUTS showa ou the attached plans -:Le's \ame :T : _ >lm:i. s5' narmc Ytrt}nS tiumbc kuvnesa ?aotK her ' I.unhc'n to.4-ess i J!rM 1 \G:c, 1ap CnC.[~ ~ J ~ 1 (c c rN1lunh Drpartmrut f cc Only i Ycmi Fee j Date L> d l Ia -e ' u Slguaffi:e y : y~ r F..:s...a rt D-nial_ .4f7 0/91 LxCoodmn[[ {st cnus flit Disa~pros•al - ~ Ar(( f v wit ark k e 1 t- . 11 i` n. 3 1 l ✓Wr~. - uhyxn~s, cell Duet ell be, !s per our 3yemen! pltn p.. ~j V.Ct!\IOtJ I ' r I 2. M lael6lrR WLjw y1r ,s In1nt w ~prpF7oroaecwi!i.M'..atcf?. : ~ J a ~2 w.C~ /~'IQa ~X.r_~~~. Atuc1 to rnmpletr Plam for tW s}:sme. a:ul seb:.a m else ['nunp o Iv pq yr ont Ices rose a z 11 ieeSln in vn 'f oC Cage t✓ I~Oc- 17- tiiiD-r: icS lR Illli J OA N 1K 419 System PLOT PLAN PROJECT Chi- Hershman ADDRESS 303 Harshman Drive Hudso-i W'. 54016 - 6W 114 SW 1145 5 J 30 N!R 19 R TORN Somerset COUNTS ST. CROIX SYSTEM ELI:%ATION 93,7!936!93.5 3' below grade 4%g'1 g 4 DA'I'S BEDROOM CONVENTIONAL A'I-GR;vDI: CONVENTIONAL LIFE XXX HOLDING TANK MOUND SEPTIC TANK SI/.I: 12,55 gallons LIFT TANK SIZI1:765 gallons DOSE TANK SI7.I: HOLDING TANK Sizv LOAD RATE .4 ABSORPTION AREA 1500 0 of EZ-Flows80 BENCHMARK N.R.P. top o- nali in -.P.nCf' post AssultE ELEVATION 100• Filter Lifetime Filter BOREHOLJ O 'WLI-1, 111.R.11. same as benchmark s B. M. 193 Property Line Vents 0 C> B_5 H-4 V-(-Slope SO' 1; I w\ B-1 B-? 40. r Huficutt ho Tank Pro 4 Bedroom.. House "SSF Property Line I I Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 4/8/19 Owner: Chip Harshman Location: SW 1/4 SW 1/4 S5 T30 N,R19W 410 172nd Ave Somerset System type: In-ground absorbtion system (conventional) Manuals Used: In-ground absorbtion system (version 2.0) Pressure Distribution Manual (version 2.0) Page4 1. Cover Page 2. Plot Plan 3. EZ-Flow Cross Section I 4-6. Maintanance and Contingency Plan 7. Filter Specifications Sheet 8. Dose Tank Cr6~ Section i 9. Pump Curve; i Signature License 'm t I I System PLOT PLAN PROJECT ChiD Harshman ADDREss 303 Harshman Drive Hudson Wi 54016 SW 1/4 SW 1/4s 5 /T 30 N/R 19 1{' TOWN Somerset - COUNTY ST. CROIX SYSTEM ELEVATION 93.7/93.6/93.5 3' below grade 4/8/19 BEDROOM 4 DATE CONVENTIONAL- AT-GRADE -CONVENTIONAL LIFT XXX IIOI,DING TANK MOUND SF,PTIC TANK SIZE. 1255 gallons LIFT TANK sIZI.:765 gallons DOSE 'L'ANK SI7.F: IIOLDING TANK Sr/.F, LOAD RATE .4 ABSORPTION' AKKA 1500 BI:NCILMARK Y.R.P. p in fence post nssuME ELEVATION 100' filler Lifetime Filter ❑BOREHOLE If. R.1', same as benchmark '5' B.M.* 193' Property Line 3-3' X 100' Cells with >3' spacing 25• Vents 13-5 B-4 30' 1% Slope 80' 15' Hwv 35 B 1 B-Z 4 0' HUITCUtt Combo Tank 25' Pro 4 Bedroom [louse 388' Property Line Q U L D. - U m n a LL ~ m w _ CD 2 E C ° N j` V 1 Q~ U- O U n a ~ _ ~ eo II ta,d 6 N E m m v Lim o . CL U p ()'a y- CA 2 V ~ ~ ~ Q LL 3 ¢ ~l w ~o~ N cli. I o E n o - o o CL CD (D '0 W U 0 Z U '.d' > w C7 1 v`0L ` 7iE E o m c o E T LL c ..U. y a) 0 ~ VI Q LL N _ o ~ i O " M 7 ~ Q~~• U m n > N ~ H ~ a~ c T POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pays _.of - 'FILE INFORMATION SYSTEM SPECIFICATIONS Owner ---i~'/.,I._.-/-^'-Y19-a;?•'-`~ Septic ark Capacity gal LlNA Penmt# Septic lank Manufacturer 1 ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 0 NA Number of Bedrooms i n NA Effluent Fitter Model y ~1 ❑ NA I- - - - - Number of Public Facility Units - Z NA Pump Tank Capacity al C NA Estimated flow (average) CC) gal/day Pump Tank Manufacturer O NA I Design flow (peak). (Estimated x 1.5) i c r i-G gauda Pump Manufacturer ~Z - ❑ NA Sell Application Rate f adday/ftz Pump Model fly ❑ NA Standard Influentleffluent Quality Monthly average' Pretreatment Unit NA Fats, Oil & Grease (FOG) X30 mgiL C Sand/Gravel sifter C Peat Filter Biochemical Oxygen Demand MOD,,) c220 mgiL Cl NA 7 Mechanical Aeration El Wetland 1 Total Suspended Solids (TSS} 150 mg/1 C Disinfection _7 Other. Pretreated Effluent Quality Monthly average Dispersal Cell(s) C NA Biochemical Oxygen Demand (BOD;) 1530 mg/L n-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) .530 mg/L NA ❑ At-Grade ❑ Mound Fecal Colifonn (geometric mean) 51 0° cUl00ml ❑ Dnp-Line ❑ Other Maximum Effluent Particle Size )6 in dia. C NA Other O NA Over: A Other ❑ NA 'Values typical for domestic wastewater and septic tank efrluent. Other L NA MAINTENANCE SCHEDULE Service Event Service Frequency 'J month(s) inspect condition of tank(s) At leas! once every: year(s) (Maximum 3 years) ❑ NA --s?.-'~- Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA inspect dispersal cell(s) At least once every: month(s) (Maximum 3 years) O NA year(s) .,lean effluent filter Al least once every I month(s) years ❑ NA 1 nsoect pump, pump controls 8 alarm At least once overy ❑ monfi(s) ❑ NA 4:1-Year(s) flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other ❑ month(s) A: ieasl once every ' 7 NA. ❑ year(s) Ll NA.~ MAINTENANCE INSTRUCTIONS Inspect.ons of tanks and dispersal cells shall be made by an ilowdual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWiS Irspectnr, PO4V7S 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 ponding of efflueni on the ground surface. The dispersal cell(s) shall be disually inspected to check the effluent evels in the observation pipes and to check for any pending of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local -ogulatory authority. When the combined accumulation of sludge and scurn in any tank equals one-third (%i) or more of the tank volume. *.he entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of fn accordance with chapter NR 113, Wisconsin 4dmmistrative Code. Ail other services, including but rot limited to the servicing of effluent filters, meGnanical or pressurized components, pretreatment units, Itnd any servicing at intervals of <12 months. shall be. performed b; a certified POVV'TS Maintainer. a service report shall be provided to the local regulate y autn]ntj rriihBt 10 uays of completion of any service event page of START UP AND OPERATION thEit For new construction, Prior to use of the POWTS check treatment tank(s) for the Presence of painting products or other chemicals may impede the treatment process andlor damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. will be During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will the discharged to the dispersal cell(s) in one Large dose, overloading the cell(s) and may result ong Old r or prior to drestoring e a of power to the To avoid this situation have the contents of the pump tank removed by a Septage effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal laves within the pump tank. disturb or compact, the area within Do not drive or park Vehicles over tanks and oispersal oe4ls. Do not drive or park over, or otherwise 15 feet down slope of any mound or at-grade soil absorption area. the life of the POWT~~' Reduction or elimination of the following from the wastewater stream may improve the performance and prolong antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat foundation drain water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting produclls; (sump pump) Pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS faits and/or is permanently taken out of service the following steps shall be taken to insure that the system is propel y and safety abandoned in compliance with chapter Comm 83.33, Usconsin Administrative Code: All piping to tanks and pits shall be disconnected and the abandoned pipe openings seated. • The contents of all tanks and pits shall be removed and property disposed of by a Septage SerwCUng 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 the following measures have been, or must be taken, to provide a code compliant rep system: I=itable 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 requhled setbacks from existing and proposed sure, lot lines and wells. Failure to prated the replacement area will result in the rued for a new soil and site evaluation to establish a suitable replacertnent area. Replacement systems must comply with the ruW in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Baring advances in POWTS technologN 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 POWTS a sal 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 fast resat to replace the failed POWTS. ❑ Mound and at-grade 30 absorption systems may be reconstructed in piece following removal of the biornst 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 AND/OR INSUFFICIENT OXYGEN. DO T 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 POVYfS MAINTAINER Name ; , - Name Phone Phone " n - - SEPTAGE SERVICING OPERATOR ( UMPER LOCAL REGULATORY A,T =TY Name Phone This doaaneM ores drafted in comptiance with chapter SPS 383.22(2)(b)(1)(d)8,(f) and 383.54(1). (2) & (3). Vvlsoonsin Atrnin'rslrefive Code. L I I ' N 1 41 N 1 i a ~ U r Septic-Dose Tank Cross Section And Pump Performance Specifications Tar l lvlamrl rclurer Pump Manufacturer ~Yump Model Number rank Model dumber />v Total Tank Capacity _7Alarm Manufacturer 1%9ax_ BUrN' Depth Alarm Model Number switch "hype /V'P{~ H Nlter %lanul teturer ~ total Dynamic Head (17)H) -Fee[ filter Model Number Llevation Head / C~ llisrd Pressure ict-,vork Loss ivlimmurn Ptmtp Performance Required Force Main Loss ~p GPN Pt H)lI Total Outlet Manhole Min. 4" Above Grade \k ith Locking Device. Inlet Manhole Manhole Min. 4" Above Grade 6' Below Grade sealed Watertight n securely Mounted With Locking Device \ I--_ Wcathcr-proof -s Junction Box - - '7- Finished Gradc - - - - t _ r T Vent Min. 12" Disconnect Above (irade Means With Vent Cap Outlet Filter Inlet Inlet Raffle - A switch Settings and Reserve Capacity Dank Volume- I (il'I _ Weep Hole Dimension Inches VOILUne Gal. B (reserve) A A o _ Off Elevation' (alarm) R y (dose) Ft _ Bottom (dead] D (y 1) Elevation 1 otal Ft GENER•AI, INSTALLATION: The septicJdose tank is bedded and back tilled in accordance with the manuf'acturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not he exceeded without prior approval. Manhole covers exposed to grade have an eftcctive 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. I he force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is scaled watertight, Electrical scrxice complies with NEC 300 and Comm 16.28. 02+0 L.I Page of 250-SERIES 113 hp Sump/Effluent Pumps for Professionals! ALL MODELS FEATURE: MOTOR SPECIFICATIONS: • Rugged 1 /3 hp motor, oil filled with 1 /3 hp 115V 5.2 amps 60Hz thermal overload protection. Thermally Protected & Permanently Lubricated 1/2" solids handling. (PSC) Permanent Split Capacitor • g• Maximum Fluid Temperature: 140'F • 1-1/2" discharge. • Hermetically sealed motor and switch cavities, DIMENSIONAL DATA. and permanently lubricated bearings. Weight: Model 257: 201bs. • Liberty's UNI-BODY casting - a solid, one- Height: 10.5" piece housing that eliminates the lower motor seal ring found on other pumps. Major Width: 9.6" (manual model 250) • Epoxy powder coat finish PERFORMANCE CURVE • Vortex style impeller for superior PLRI ORMANCE CURVL solids-handling. Made of high temperature 25 engineering polymer. • Fasteners - all non-corrosive stainless steel. 20 - - c • 416 stainless steel rotor shaft. LL 250-series Cord Lengths = Model 10' 25'(-2) 35'(-3) 50'(-5) ry 10 1 m a 250 Standard Optional Optional Optional S _ _ z 251 _ Standard Optional Optional _ Optional 253Standard Optional _ Optional _ N/A 0 tt 257 Standard Optional N/A N/A o 10 0 30 40 50 - U.S. Gallons Per Minute 10' cord length standard on all models. For optional lengths, I I 1-~ add "-2-3 or -5" suffix to model number. sn 18 na lye 192 Example: for model 250 with 35' cord, order 250-3 I aers Per Minute EFFLUENTMODELS t'` r ` tf~i~ Yr~ i l yf Model 250 Model 251 Model 253 Model 257 VMF Manual, no switch. Quick-disronneet Wide-angle float with VMF switch, magnetically wide-angle, float, series (piggy-back) of)(,. rated vertical float - mercury-free. plug, allows manual operates in a 10" - no operation of purnp, diameter sump. r S I' ° - Uuai ;ateq u~ aiflctainu _LNrr eo Certified In. !h~•Uuikr;f States and Can d,,. Liberty Pumps • 7000 Apple Tree Avenue • Bergen, New York 14416 • Phone 800-543-2550 Fax (585) 494-1839 www.iit>ertypumps.com Ccovn,w Liberty Pumps, Inc. 201i All rghtsms 1-! LL111y00-R5:17 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE r4LGREEMENT ANA OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address r IL p Lac - Property Addresf~ (Vetification required from Platting & Zoning Department for new cousbr 11 City/State Parcel Identification Number - )a ~ 071l LEGAL DESCRIPTION r r4-2( '/a , Sec. N R W, Town of Property Location ~ b Subdivision r ZJ - Lot # _ Certified Survey Map # Vclurne = Page # Warranty Deed volume Page # Spec house yes no l.ot line identifiable Ss 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, u- needed by a licensed pumper. What you put into the system can affect the fuxction of the septic tank as a treatment stage in the wasec disposal system. Owner maintenance responsibilities are specified in §Co>ffi 83.52(1) and in Chapter 12 -St_ Croix County Sanitary Ordinance. The property owner agrees to submit to St Croix County Planning & Zou irg Department a certification form, signed by the owner and by a raster plumber, journeyman plumber, restricted plumber or a licensed puruper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspecdon and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Vwe, the undersigxwd have read the above requirements and agree to rnaintam the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification staring that your septic system has been maintained must be completed and returned to the St. Crnix County Plamung & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on is form are true Lo the best of mpbur k.uowledge. I/we am/are the owner(s) of the property described above, by virtue of a rranty deed recorded to Register of Deeds Office. Number of bedrooms --J _ C~ ylg E IGNATiIItE OF APPLICANT(S) DATE ***Any inforrrhadon that is misrepresented may result in the sanitary pctrnit being revoked by the Planning & Zoning Department. a*» Include with this application a recorded warranty deed from the Register of Deeds Gffhce and a copy of the certified survey map if reference is made in the warranty destl. (REV. 08/05) w Q 62 5 4 aa UJ 0) LL w 9l Stf MALCIAON dB fiS 0ry'ryOry/ \ ti \ _ P CV) y. 19 Z Z a\ \ CY) U W N O slb / a 0010 J CO) ~ ~ .001 m \ y •to•av__ y ~i J Q h\ I u 3 _`I~ ~,~0P4a DOI Z Z s ;4 J o~.d1 6^ I ~ ~ UHI~ Fes: ::1 ~m P o \ W t Q Z \ n / C wt Q X_ ~a a. o Q$ N.mo r 2 ~I rs~b~4^ 4LP r I \ 25 ~ \ ZZ'ZZ8 Alb 6 a8 .l/l tl-.ll 6lq) tt ~M.MYt Mi OrM ' ,Z/t 19. 0C S 'Q CIO .J one-. t~ i ~ t7b JL Y~•F' ~ u I n_: _ eeaeam •Hf z- y iw .L-.C li AS ~ &n- 5 ~i. r ~ G T-21 vnlx e ~h_ x& IW~,f ~ a , c - ~ Y I tZ a, p i rK _ i I ~ C abzc VZNZ G.L. NO t i . Iasi 1 ' l `r~• l b f-.9 cad I <<. y V ~ co V1 ` I i i -I G T'l ~ k M ~ I M ~ v Wisc&Mrr Department of Commerce SOI-....✓ SITE EVALUATION Page of 3 ' Division of S~ifery and Buildings 5ureau of Integrater• Services in accordance with Comm 83 09, Wis. Adm. Code Attach complete site plan on paper riot less than 8 112 x 11 inches in size. Plan must County include. Put not limited to: vertical and horizontal reference Point (BM), direction and A percent slope, scale or dimensions, north arrow. and location and distance to nearest road. parcehLD. u APPLICANT INFORMATION - Please print all ip/ormation. Rca-,,xid by Date Personahnfu"alanMu4rovi a ma bn .rsetl fur s! -Dodd, c9rs v y Law 15040s... i 1. r (2) Property Owner O / l ^ Prolainy Location Govt. Lot SCN• 114~J 1i4,SS T50 ,N,R I Q E tor) Property Owner's Mailing Address Lot # Block# Subd. Name or CSMN C'_-j// !a'-r•+'-~i.".- City State Zip Code Phone umber ❑ City ❑ village town Nearos d a ~t~ 1\- D ,c l., wS rrC,l(-,(1i5 )s/y ,6T'Sr C;Me_0. I 't\ New Construction Use: ReS:denial i Number of bedrooms - `i Addition to existing buildi g ❑ Replacement ❑ Public or cornrnercial Describe: Co r S °G{ G l9Ll Code derived daily flow (y w gad Recommended design4dading rate gpdflt2 _ f ~nen. gpd/ft2 Absorption area required bed, ft2-7 Gtrench, f12 Maximum design loading rate _"ad-gpWN2_" treneh, gpdAt2 Recommended infiltration surface elevation(s) i/ • k (as referred to site plan benchmark) Additional design/site considerations-4'c4- ele-0, Parent material f'; I ( Flood plain elevation. if applicable 1S = Suitable for system Conventional Mound InGround Pressure AT-Grade System in Fill Holding Tank u- Unsuitable for system S❑ u ~ S n u [Y7 S o u Lt's ❑ u LJ s O u ❑ s R u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Moules Texture Structure Consistence Boundary Roots GPD1ft2 gyn. Munsell Ou. Sz Cont. Color Gr. Sz. Sh. Bed'. Taenctt Ground elev. q-f A. fl. . r _ Depth l0 limiting factor _ `1, - - - - I`S in. Remarks: Boring # c S - le Ground elev. Depth to limiting factor ~ in. - Remarks: CST Name (Please Print) Si nnnture Telephone No. Dor~ - GluY~v~r_ Z F .5 / C'l ~c 8 Address _ Date CST Number yc l r - - SI ~r SOIL DESCRIPTION REPORT PROPERTY OWNER S - Page -Z- of ~ PARCEL I.D.# - Boring 11 Horizon Depth Dominant Color Monies Texture Structure Consistence Boundary Roots r z in Munson Ou. St. Cont. Color Gr. St. Sh. TjenCh 1 Cy Ic f 3 ~.~+r1hYt .~1 FQ c5 ~i [-t i 6 Ground - - - alOV. Depth to limiting 3LZ~/ L' factor 5`{ 'in. Remarks: Boring If f C, Er rcY _y' I tv~t~6Y ti~ ~2 ;f Z!~ y 7 (2ti' [c. k i `t / - , I Z. r~ra)~I< wl Q c -5 lC~, 9 3 1% '[O 3/ I C S Growxf elev r,:e Depth to - limiting factor , 4 Y in. Remarks: Horizon Depth Domini nl Color Mottles Texture Structure Consistence Boundary Roots GPDIft2 in. Munsell Ou. St. Cont. Color Or. St. Sh. wed ? Boringk p-13 1oyiz SZ_ Irby~nv1 w rrL c- `f ✓ ~ 1 - Ground - - - - Plow ft. Depth to limlfing - factor 1CI -in' Remarks: Boring ft _ yy ,._SYiy~~ sZ- ~M x4c Ground `-i 0111 4:A n. Depth to _ O / - - limiting factor g 3-in. T Remarks: S om C co n'i 1` 1 ~ -7/ r SRI) 8330 iR.9;giil PROPERTY OWNER ~'II2J SOIL DESCRIPTION REPORT Page of PARCEL I.D.# Boring # Horizon DiMottles Structure Munsell Qu. Si Cont. Color exlure Consstence Boundary Roots ' Gr- Sz. Sh. Tyr 3 1 - (S _ - I..,.,abrl tt C> Y 1= ct i 6 Ground - - elev, _ 4H 2~ ft. ~ Depth to -Al limiting 3!, z" r7- - - 18C1of •in. `p Remarks: Boring # Ci -6' i, A~ Fps , - I Z rat>s~lc t~ ro C s ✓CC, Ground "J - - - elev. Depth to limiting factor cf k, in. Remarks: Horizon Depth Donunant Color Mottles Structure in. Munsell Qu Sz. Cont Color Texture Gr. Sz °h Con^,:xlence Boundary Hoots •PDRt' Boring # 1 -Bed T~ G 13 I-°Yk 3r1~ - _`~L ~r~^+19 v -t rZ c v; S I~Ict 'lot f - - _F CS-_ - - - Ground elev. - - 9,Lx it. Deplh to - ? limitiny - - factor /oLm' Remarks: Boring # U/- Ground aa- - - elqv Depth to limiting - - factor 83~in Remarks „ °'1 ,r~.>•. i ' SBD 8330 (R 9198) d~ J Depanmont of Commorce SOIL AND SITE EVALUATION mon of Safety and Buildings Pago of ...'eau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County J include. but not limited lo: vertical and horizontal reference point (6M), direction and percentslope, scale or dimensions, north avow, and la:ation and distance to nearest road. Parcel I.D. # or - Si t. ~y -'44 4'C r Z., 30- Pori APPLICANT INFORMATION -Please print all information. A2rr1 / r"kdY Reviewed by Date Personal irformatirn you provide may to usoo for secondary purposes (P-wacy Law, s. 15 04 ri) imji. Property Owner II Property Location Govt. Lot 5 (A) 1A 5 V I:4,S S T 30 N.R E (or) W Pug)erty Owners Mailing Address Lot # Blocks Subd.. Name or CSM# ( City state Zip Code Phone Number n City ❑ Viilage ❑ Town Nearest Road ( ) ~n ars 4 ❑ New Construction Use: L] Residential1 Number of bedrooms Addition to existing building - ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gl)i Recommended design loafing rate bed, gpolft trench, gpdAt2 Absorption area required __bed, n2 trench, n2 Maximum design loading rate -bed, gpdift2 --trench, gpdift2 Recommended infiltration surface elevation(s) _ n (as retested to site plan henichmark) Additional design/site considerations Parent material Flood plain elevation, it applicable - It S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system n S ❑ U ❑ S ❑ U n s C U n s ❑ U ❑ S ❑ U ❑ S ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD+fM= he cI 4o in. Munsell Qu. Sz, Cont. Color Gr. Sz- Sh. Bed Trench QZ- 1 04 l4 Yk y~3 2 (pl rr e~n~r Ground 3 2042 SYR 4/ S L ! c a / ~r elev. -n. ! z-P Sfi2 y - SL l Cie - Depth to limiting _ factor r Remarks: 30"4n'), 1AZ1,t10k2fAA~j,i' Boring # Ground - elev. Depth to - - - - - - limiting factor in. Remarks: CST Name (Please Print)) Sig/nature Telephone No. le Jey Jon if veyr/ao Address Dale CST Number SSG l PAGE. 3 OF NA%11' }y-f LUI- l LCGAI-DESCRIP'I'I0NS&.1' S4'+.S S 'I.30.N,R19G(ur)C-) SC'ALF: I" ~Ud RM I FLFVAI'ION R\I I DFSCRIPFION.Vq,'(;n(,"r L, Pqp{- Ld/flue R.\1 2 1:1TVATION 00.0 - C R\I_2DFSCRIPTION Va;I,'A I$>Im rIu; ( W/I4. ) SYSIIMII.IfVAIION t ALLRRNATF FLEVATION 3~ K C ONI OUR IU.FVA I ION - - - % / 5~ ?y 3,L .D„ 6l 3T S16\AIURF / DATT: