HomeMy WebLinkAbout032-1043-60-000
„erl ' PRIVATE SEWAGE SYSTEM St. Croix
i~rlcl: uurl Gw dmG Jwrcgn _
INSPECTION REPORT -w" it N'
iATTACH TO PERMI I I 607059
GENERAL INFORMATION 'gate I'lar I: NC
r'eNona 9formabbn vau In:r:I:Ir nuri n. _5cJ lc~ seGOncep ovrpO5C5 Orroar_': L,rw.:..5 ?d 111(mil
Timothy Larson and Linda Senn TOWN OF SOMERSET 032-1043-60-000
C3T BM 6nc nsp Bhr E r: 31.1 Cry-c`,atnrl °eann ~rrnnlR:nrudNac 'ac
.~U n' M in OC Al L* cp~ A3C- 15.31.19.217
TANK INFORMATION ELEVATION DATA
'YF'C MANU-AC I-REP .,,1r ACIT" S-r,TF-,N lr H'. L'__'v.
SCE wywv
S-plic i rn!:a,u:an. 04 o
~(Str ou4 val ~Z D n bo Kf3• lob,oa
1111 BY
Arrxion Lndc. Si 25 35
J
Plo,dlno v K/_ Sul It i%el ~'60 I&DO
g(;HI !h,llct
TANK SETBACK INFORMATION
T nNK I-1 o. L tNF 31 rn An o-~«, i04D rr Lnlet
? IVev
:Septic I~O t t 1 Dt Hollum
jUU;ng Neade:;P:tin. 9.95 (L./C?
lac: allow DIM pipe 15 q4, .P5
'+DIdiO~ do: JVsteR zR5
[yam
uU I L 1~1J "I J
I/ V
' Inal C-rade .O
PUMPISIPHON INFORMATION T 10 710.5
Manufacturer - anc sl -.uv<r (rt~n „ I ~.r C
;~h y VJ
Mode Nu r
m
TDH J1 :c. SVSten' Head -DH ~ 1 Q~L ~ ~jT 1.~
Forcem n eny:h U,a. cr7 00 k r,.(.
SOIL ABSORPTION SYSTEM h SIB{' b f ,
BEDfTRENCH .Nat- vrgln ~OI Nc Cf' encnes PIT DIMENSIO no UPix_ L'.a .:iy Contn
DIMENSIONS
SETBACK SYF_T_W Ti} PL BLUE u^VLLL IAK='S*RLAN LEACHING Nan,'arwm- I~r
INFORMATION _ N CHAMBER OR ` 1Ct
rr ~IIV` ID W 6/ 1 UNIT f~tuee Nu•n M'. 1 G4
DISTRIBUTION SYSTEM a Z fU~~
rlc3r_N.a^'rn. r.,~1 - nt ::fio' Irte a.. IIr ;uacw9 `.w1, rin::rkc
\T `q
~cn R I' 41Yi Jig Sr.ar rv _
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
I:c{ t er v ' n:;oll % Crp 11 - ee..^tl: z. tl ix Nulcn s:
Gee Ire -r•mc- ~aA r ~r cuues Tnr•:ril
Nc
COMMENTS: Include cod, d:6,vepenoeE. pemor Tesen( 0%. Inspection at Ins( .hon tt2.
Location: Nc AUalc:ss AV1141r h~i 2 ` bl 1 V 1 1 rt1 1 7 4- I:/hat n 5 - ~
ar Hbl nes::r 1l,tlu:I = l ~ 0 ~ (N%Q\, , SQarJ C { On f I I<r c ems` `
LI rldp sevB leapth- M
IN 1 W~7 JNS
Plan•ev!sIlw R(!qulrcd• Yc's .e' b 14 71 "1 65-
.Im ulhui side for addit"a In'.orn' hnF.
::ete `-acv.; bi."ntwc .x❑ Nr.
9IiC L 1i. ri 's.9..
cy-rr aCO - County ~ - "RE,
Safely and Buildings Division s I ~IY-
t- DS rl 201 W. Washington Ave., P 0. Box 7162 Sanit.ny Permit Number(n be filled in by Co.)
PS •i Madison, WI 53707-7162
7Q~;G
1 1
Sanitary Permit Application -7 .1 1 State l'ramsction Number j
In accordance wadi SPS 383.21i2 r'b'is.:Adm. C'edc. submission of this total to IhC apprcpcalg uvcrnnie lt'lilil
is required prior toobtaining a anit<us ptrmu. Nan Application f6this list slack ,ned P( AA' I S are submitted to ]'reject Address (if different than mailing /address)
the Mparli cat of SatclN and I mli•~u net Scrv,cs Pcrs real ml tnnaunn you pr'n We may be used for sucdndaiy' ,J /
u ones in acuodancc N+ah the Pti, uy La,. s. 15.C-4i 1 roll. Slat,,7/Jf' 12a
L_Lpplication Information - Please Print All Information _
Property Owner's Name C Parcel q
'1.3 ~0 a^
(~~Cl ►I`1 LFA tZSL` d 1 JPAJa ,-_AV% 32 lD
Propcny Owner's Mailing Addremv~l Properly Location ,L q'r Z~
I 7 ✓
City, State Zip Gale Phone Number NFL y. CVXii Section 1,
~f~N~~i~'_S~ ZS 7 C(circle one
,,1~1./.. Type of Building (check all that apply) Lot n _
IJi~l or 2 family D%%elfing Numbci of licdr•omss Subdivision Name
PubliKommercial - Describe 1 , sc_ r-~
~1 LSI M^s _CnY Of
LI Stale Owned- Describe I sc J I CSNI Numtxr U Village of
1 f3 rownof_S(z~E~2 T
2- L~~__ _ b 2Z
lll.'Iype of Permit: (Check only one box on line A. Complete line Rif applicable)
y. U lYCamenUHoldmg lank Replaeemenl Only Other Modification to Gxtsting System (explain)
New S stem ❑ Replacement System
- u - ' -._hanecof Pl ---if P1 m - List Previous Permit Number and Dale Issued
R. i Pcnul Kencsv- _ crritil Revi>ion [ t:uber I'emul I rmsler to New
Refire HNpimtio owner ( ~C .-/d _ ~c f
IV._'type of POWTS System/Con pnnentiDevice:_(Check all that apply)
$Non-Prrsvni>crl In-linwml ! I Presuoeed In 6ruunJ i At" Bade . Mound 21 in of suitable soil C Mound,- 24 in. of Suitable soil
LI Holding lank ❑ litho Drspcl'al Component lcxrlaini Prtuenuncnl Derv ac lecplaini
V Dis ersalf 'rent I Area lnfm•motion•. _ _ 'L L4 L.;('1 +1 f~ "I tom=
Dispersal Area proposed Ist) System Glev align
Design Fk igr,f) 1), a~n Snil +I.phestion hat epdsfi Dispersal Area Required (st)
5 57 9y.5' w~
V1. Tank Info CupaCity in Total a of Manufacture
(iallnns Wilons hairs y R o
w u ^y
Is'cw Tacks I.xisang :Ark. ` ~ y ~ v
I Septic. „r Inldiur T.rnk IV, it T ~E~G'f~
VII. Responsibility Statement- 1, the undersigned, assurne responsibility for t istallation of the PON% I'S shown on a attached plans.
Plunder's Nanic illont) Uuiatxr s Slamre--- - _F Nip S Xt lbCr Rnsincss Ph:nc Number,
~F1' z 115 L I
Plumber's Address (Street. City. State. Zip Code)
s~ ! 1 /~-Lt
V Ill. County. Department Ilse Only
ppnrrcd r Permit I cc Date ssned Issuing For Signani -
5 qd , o0 7 u r
srncr cn Ih•ason tor Dnnxl
IX. Condi Q"teilBi ,Reasons for Disapproval 1 /J 1 r n f
1. tank, ernun: imw MM 3) eie.L„tak¢a,. - PA. ►at.- /(i '
ialVVszr.^_•. Coll'ust all pg Ike- ^s 0f;
qtr per mar ayement plan yr, aacl uv ,AUrnbe:.
2 M aetbe+:k rectmrens mir~1 t.u _:rtra e i
a perrwikxblot C'),1, M', nrtt
- Aliach iu nom Vlrlc alone (ot ILr r~,irm enA submit to thr (:nmu...:dy un yaps not 1, than s I x l l mdtr, in liar
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Wi.,con.:. r. f)cpa9nv;n; of Solely Ard Prolcasionnl SaviCC, ~ Page of
Division of hdj-WyServ cer;
SOIL EVALUATION REPORT
I. _
h acw,dunce with SP53S5. bVic. Adrn. Code County /I •
Attach complete sde plan on pape~ not lesti Than 8 112 x . 1 inches rn size. Plan must include.
bul not hint •d lo: ver,ical an9 hoci<enlal rcforonw oeml (Bkt). dncelion and pureunt Cie;. c, Parcel LD-
scale or d mansions, noRr anon, ar,u loarion arc cislance Ic newest roan -A[(-\#* 3
Please print all information. Re, wed by D~aat
Personal information you p'ovide may be used for Secondary purpuses (P'rvp i' Lan•, a. 1 S <i r )m i). / ~
Property Owner Prupcrly Location
GCVI Lint o T N R E (or) W
Property O vner'r Madi i • Address Lot x Block # Sub . Name or C.SMe
City Stale Ap C<::fe Phone Numher ❑ City ❑ Vil age ?g Io•wn L Nearest Road
® Newconstru<Aren Use* Resident at r Nomberof bedrooms Code derived deugn flow rate' . ) GPD
❑ Replacerr'ent F1 Public c• conlmorcral - Describe.
Parent malenal FIorxI Plan elevation i' applicable _ ft.
General comments and recommenda: ons'
Haring ,t ❑ Boring
® Pit Ground surface efew II Depth to limiting factor] in,
Sod AppLrabtar Rate
Horizon Oepth i Dominant Color Rodox Descrip;lcn Texture Structure Consistence Boumlary Roots GPDrfl'
In. ldunsell Ou. Av. C:nnl. Odor Gr. Sz. Sh. '1-IIf!1 'tff62
r--,? I BOfp1g E] Raring
C - O P I Grour.<i surlaCe. olev. r fL Depth to liintirc factor in.
Soil Application Rate
Horizon Deptn Davnmanl Ciolor Rodox DescrlptiI Texture Slr.whao cor.sislonce Boundary Roots GPOtFt`
In Mkirsell Qu. A7. Cent. C010' Cr. S7. Sh. 'Effp1 'Eff1t2
' Effluent pt = ROD.. > 30 220 m fL and TSS > 30 150 mgiL ' Effluent Y2 = HOD. > :if) 220 rtI and TSS > 30 s 150 m !L
CST Name (Please Print) Signq re \ CSI Numher -
r
Address - ' Uale F.alaal or'C[.u clack r. Telephore Numhe
- -
' - SDD-8330 fR04i15i
IJ ci ~ J
❑ Barmy
® Pd Gmurd solace clc Dcpll. In limiting fac'or in
SoilAppheaaor Ratc
I torizon Depth Dominanti Redox Descr ption Texture Structure Consstrince Ruuncary Roots GPU:FI`
In. PAUrse!I Ou. Az. Cunt. Color Gr. Sz Sh •Eff#1 'Eff#2
49
3
Boring u ❑ Banny
J ❑ Pit Gre.lnd sur`ace clrv. fl Deptll to limilirg actor in.
Soil nppl caticn Rate _
Honzon UupIn Uurnmunt Color Redcx DeSerIe110n Texture Structure Consiz:ence, Boundary Roots GPL)&r
In P.funsell Ua. Az. Cunt. Color Cit. 3z. Sh.
'FIIWt 'Fff#2
Boring # ❑ Boring
❑ Pit Cris ind surfarn r ev ft nepth to limiting factor _ in
Soil Applira:icr Rate
Hnnzon Deptn norninem Cotm Redax Up.scri::hor Ioxhue Stnr.:ture.. Consistence Uounrary Roots GRDtFt
In. 6lunsell U.i. A> Cant Cr;lor Cr. S> Sri 'FI1111 'F`f!t2
• Cfflucrl i11 - UOD. 30 < 220 mg:L and TSS 30 c: 150 mg:l ' Fffuert 82 -ROD, 30 220 mg+L aid T8S 31.1 5 ISO mg:L
i
L~ Ground surface eiev i t. Depth to. limiting facto* i a2i in
i
_ Soil A,rpLa for Rate li
Hpmor Deptr Dominant Calor Rcaox Des np run ; exlure Structure Consislenue Boundary I Roots I r
GP
In. I1u.nsell j Du Az. Cont Color G &z. Sn. EILt 'Eff#2
2 y fin. C' , ' -
I
I
r
1 'l
Bonnc A ❑ B:zny
❑ F.t Gs>wd surfars eiev- _ C. Depth to limi5ng faclo• _ in
Sill Aoslicabor Rate
Honzon Depth Dpmmant color Redox UesciuUOn lexni.e S:ru cure Consistence Suaidary Roots GPD?Ft'
In. Morsel Ui Az. Cool. Goio• Gr S z. Sh. •E9ti1 'Efftr2
:
II
Bonng
l .J °rt Groma surface elec. R. Dep9i to hinting factor in
Soil Application Rate
Honzon D:Fn Dominant G::ra Re:i;;x Descroficr Texture Struci,re Cons:stence Boundary Roo'-- GPD!F~'
In Id.insell Gr. Ss Sh 'Efflrl 'EIfp2
Effiuert'#1 = BOD, 301 220 mg7L and "SS ? 30 s 11,90 mgtl ' Fffwem S: - BOG, > 3". s 121 mga air TSS > 3G 5 150 mgtl
3 3 I i PA LAf.SoN
i
3~- f oy3-Ga -cX%<,
C5 {?2~3~Ig3 ~
7/ 2
- x 62
6
x ~ moo; 1 ~a~'~ N ~s
14 Q
VC-RF, A-i- 3M AT 100' T'op ar FaCL 1.I PRTr4~(
59N-aG~9-oS~
- County Safety and Builds Ss Division
e 0 ~s 201 W. Wasnington Ave.. P.O. Box 7162 Sanirnq Punnt Number Ito M filled in by Co.)
t F
Madison, WI 53707 162
PS Coo70:5
- - ,.1 - Sate Transaction Nurnbec
Sanitay Permit APPIZCa ri-
b: r -sn a with Cr C IS. 2:(:1, Wis. Adm. C< is :.him~cinn of th_ a I -opnatc a vetnmm~a~ unit
is rcyuiu.d 1. nor u: of 'rnurf. sani[sy permit. Note. Appov.nnn forms for sYatr-rnvna Wi1}pc snbr.Atled tO Ihuie a Address 6"diffe cm than milling addles::'
:h ) p, trnont of Caicq and Prufesci mad Scrvi s Perwna: infuunanoa voo provide may INC used for sew. 'W"
uu r.s r ac<uul u+x wath theYis¢y Law-s 04.:)Iin 1. Sate. 21 SI GT~F~~
1. Application Information- Please Print All lnfomotion
Propcrh:Jwrr-:'s Name
"NIV
`TfM THy LfIiKSCJ '4- i.;Jo. Serer .X32 iC113-66-C06
.
~q • ~l -
Prope.-n owne's Mailing Addax= _ H 1 r r Property Location I C .11
; z3 /(4(, 1 ~ V G f io,vtI Lul W
City, Suite Zip Code Prone Number '4• Section
_ r LJ~
PP ,0 ric{E'o
C- rZSC Ic
Lt I h
11. Type of Building (check all that a 13
,,.~,yy~~ Cuivi"'Sion Name
'tat or: Fwniiv Dwelling Nucioer of Bedr*.
Block
6 jab P4-4- - ~D
I .J Puh iuconuncrc:al - Describe Use
-~a,tSCr-~ u c:r, of
-
_ ('SM Numl+er ❑Village of
_ State Ow'rcd- lhxuF+e Use e-
Unav`•sbef5 /r%~nNT.Of J(11`'~E IZ ~G'1"
cablcl 7 6 X
111. Ty [haul: (Check onh' of box on line 4. Complete line R if
New System ❑ Kcpiaaenwm Sv:slxm rcztmcavNoldmg?'mernen: Only ] Other Modification W Lxisting System (explari:
I
Lis: Previnos Permn Numhar and Date Issue;:
R. Pcrnit Rcra•wal ❑ Pertar. Revision n Cnanpc d Pmmt'r P 'I r'e, to Nt,
Before Fxpiratioa
1111 lv° fvne nfPUYN" emr/C1 in onenNllie%ic_e: (Check all that a r
~ Non-Prc9sm-e In G:oand ❑ '..rived in-Cimmtd 'tack and - :4 m of eoiablc soil ❑ Mound 24 o of suiablc soil
TCo `
,.I Flo+dmc Tarls khcr hspcaa: ComponentlC>}ia1C1-_ tiArrlenl Dn'lalCxDlaln;
Dt% crsabT lea rot Area Information: _ i L E
IN.
i SvssCm Eicvaunn -
Demur I '-S di Ili.:in+C i~ a>hrtiun Kate gnsfl D:. r_r Ara RCgairec (s k Instil Ama proposal Lt
\T. Tank Info C'a v+cav :u low *Of rafa:.mrer m y
Gallons Cullom Units
_ K1 r V
Nea Tvrc- Fx+mAe / ~ ~ ~ c = C ~ t :d
Sctmc «HoidroElNiNl C-( Jr-:, - _ l u VL ~E F r~
Jo%mr C nvmlr - ~ '
NTL ResponsihiliQ' Statement- 1, the undersigned, assume responsibthts for'nsallati of the PORTS shown on the attached ph NuL
k'I~urnl.er's Name lI trait ' Ir r s supeawc NO! 'RC N rber Bmm~es% Phone Numlwr
Z3 C`IZ 'IS. q1-3q S~
Prnmir_'r t .addle (Suet., ('m Sate. Zip Code) e
ICU.
VltI a .ounly/Dc rartment Ilse oub,
Para':Foe avr suc issumg MISignalme
Approved n 1 Wow $
rtvon Reason fn: Denial 566 • 00 y jL ! 9
DC. Condit fa easons for Disapproval '
1. 3 Sepik tank, nd t, line- ltti I `tl'1 C aC. F~` "`~r✓ `
u;y4~eC'h+ pest ns1131 all CQ~i°ryic ..5 ' r t(~.~ Cl /
is per nV 3Semek pl+n 7o'rari Lv ylu.nbe .
2. N eetlver;k IvtS ^eras "VAA Lu'-e:r.L•A.t
r per lrpFaerN~ c.x:^ ; :rA': anse.
.4r1A:I+ rV (V IAnleo ,to. IYr the 6)%. still %abuto IY the C... Onh VC tNpFl IrOr IfJF nrln a t.1 I I md.ra in %bo
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L''COPY
- -
CONVENTIONAL COMPONENT DESIGN
Residentiai Application
INDEX AND TITLE PAGE
Project, Name* Z-01. 'S
Owner's Name-
Owner's Address -
ti'~U75
-egal Description _ L l,y 11`/ s vv (Ay S,/,s Lit ^ / 1 ✓
rownship• ~nMt _R ,~Y
,ounty: -f 01,201 Y.
>ubdivision Name:
.ot Number:
'arcel ID Number: /C lf3 - 6,0 Cr,,(~
Page 1 Index and title
Page 2 Plot Plan
Page 3 _ System Sizing & ,Cross-Section
Page 4 _ Filter Specs
Page 5 Maintenance Information
Page 6 Management Dlan
Page 7 St Croix Cty Septic Tank Maintenance Form
Page E Warranty Deed
Page 9 CSM, or Plat
Attachments: Soil Test & House Plans
asigner[Plumber: License Number
ate 1 I Phone Number
gnature - L,
;ianed pursuant t, the In-Grouid So: ASsorpnoi, Z: omv;nent Ma9uai for Pr=-S rsior 20 SBD-1670clp rN.01101)
Page i
L12 '
S 17 3
1 ,
I /Y
v
i'
I ~n k l
Cf
+ Z,)c p
i
V
<7 - 7'~~
Soil Absorption System Cross Section
- 4 SScheaule Fha. Grad-
?VC Ver,; Pipe 'it 3 y
Vddh'Vent Cap . fl
Leachi,c
C amber - ►il LI
Y f;
System Beva'Mn
~ft _~tt
Soil Absorption System Plan View
fl'£p ft
J t ~~~~I'I I ~b J
_
Leaciin2 Trexh 1
yen; Or Ubse~ ativn Pipe
Ct;ambe ,
L TA I L
tiV Dia.
Tree: 2 HeaJe-
Leaching Chamber Soecifica`ions
hfan rfactu er And hAodal I~ I ~j~~ 4? I L
EISA Ra ing aL-L Sq 4 per chanb,r Soil Appfca:ion Rate 7 gpd, sq ft
~e'C ( opd Desigr. Fiiw i • 7 Soil Appiicatior Ra`e Z C
EIg4 Chambers
2rnvsr fi,z_Z_
L---- o ~ _ char-nbers ~aoh-- - - -
?age of
INSTALLMSOM INS'TRAJC'~Ns
Wim! =91001WIM ss
ML-025 FEATURS6 a SWARM
Features &
Pbod for IIXOW GM
q-~-- Zr F~
Forsion
p- on
s tender np.mef MWWorr befo.ro r b MmfAd
yeer
Cc.eab+W
ad Glowy smtt lo*inpUnVgdorSCjMWtanery .AMEMA
I yeem If the kotAw INK aor hdno an °pwmd .A+ooeile PVC 6dendw Hmdle
o. the oom vA be noVW by sn delta "be' the
.reds serve mj;. Swvk ft mhos d be dcw by s
Nes m;ooh moww ,,aloi w
owww p1 towcTs P-ql III
b s'
] .rte }
~ ~ God
wry- r CanrB MUM eiosn~f a totem _ pp1~0~ !!*A pe~r+s ei r,e
i~o~e~lllpp~~0~
blsitaowr Dr"'*' tir! apse oai~
baft stt~.nt+swaas~3ts
ap&
rodp~Lotadc°" $'~p+Pa
1WNAOL
FaraftibtofP*Iokp OMNO'*'*Ou'viebMOat1+ m
POWTS OWNER'S MANUAL & MANAGEMENT PLAN P age _ a_
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner _f (11r hl t ~k~ h- Tank Manufacturer ON
Permit # - .Septic ❑ Dose E~Holdinc Volume. { Z.C., (qr
DESIGN PARAMETERS Tani; Manufacturer. E~N
Nurnbe- of Bedroc.ms j U NA ❑ Septc 0 Dose G Holding voigme: (gr
umber of Public °aciiih Un' NA Vertical Distance Tank Boftom(s) to Service Pad: If
Estimated ;average; Flow . y (gaiiday,i Horizorta' Distance Tankl,s•',, tc Service Pad: if
Design Specific. servicatg mechanic:, most be provided 1* vertical is >16 feet n
(peak) Flow = (estimated r. 1.5): 6, C~ ;gagday~ y( (,wizontal 15 =•150 fee;. Spoc'hc Insirudio s to be provided on back
in Situ Sal Application Rafe: (gavdayie) Effluent Filter Marnrfacturer. L('[--j W) C
Standard (Domestic) InflueriUEffluent Monthly average Effluent Filter Model. I N
Fats, Oil & Grease (r-OG) s:30 mglL Purro Manufacturer: - -
Riochemical Oxygen Demand (Ei0Ds1 522U mglL ❑ NA
Tots! Suspended Solids (1SSi <150 mg!L Pump Model
High Strength InfluentrEffluent Mantra), average Pretreatment Un0
(FOG) >3C mq!L Manufacturer
(ROD,, >22.0 mg!- (5,(,iA
iTSSi 50 mg& C Mechanical Aeratior DPea: Pliter
Pretreated Effluen' - - Disinfection ❑ Welland
Monthly average ❑ SanWGYavei Fiker _ Other.
50Ds; 530 mgiL Soil Absvntin-, 5ivetcvn
, bSj c3U mgf wNH.
!-ecai C'cJarm (geometric mean) E10' 'Y` ~)n-GroUnU tgra'viyj ~I in -Ground (pressutei ^ Ni
Maximum Effluent Particle Size 'y in dra. O NA 0 At-Grade O Mound
- - 0 Drip-Line ❑ other.
Other he,
❑ Ot
MAINTENANCE SCHEDULE
Service Event Service Frequency
Pump ( out contents of tank's; Eg:!irtlher ccrlbined sludge and scum equals one-ttNrC
o` tank volume
_ -r At the hear: vrater alarm rs activated
Inspect conditla of tank(s) At beast once every. 3 ~ nuntris;
_ yearly; (Maximum 3 years)
p NF
Inspect dispersal cell(s) At least once eve ❑ rnontn{si - -
(Maximum 3 years) ❑ Nf
slcan effluent filter I A; least once every ❑ NF
Inspect pump, pump controls & alarm I At least once every: ❑ month(s) - -
yca (s) ❑ w
Flush laterals and pressure lest A! least ory e evrnyc ❑ month(s) -
0 NA
At least once every: ❑ month(st
O•.Ivar - - - _ ❑ yearn? 0 tea
L NA
MAINTENANCE INSTRUCTIONS
Insvections of tanks anc sod absorption systems s'-iF0 oe made by an indmdua' carying one of the f:;lowing licenses or certification
Master Plumber Master Plurri'e- RestnatcN Sewer. l1 Wv7S inspector, wv:'TS Maintain, or Septage Servicing Operator (Dumper
sank inspections must Eric e a v.saaa. inspec:rDn of the tank(sl to identify any missing or broker. hardware, identify any cracks or leak
measure the volume of combned stodge and scurr and a check for any back up or ponoinc o` effluent on the ground surface. The sc
aDscretior systern steal! be visually Inspected to cheGt the effluent ievets in the DDser,atioh P.Des anC to c ecr for any ponding of effiue:
on the ground surface. The ponding of ef.uant on the ground surface may indicate a failing conddior any requires the immedia)
notification of the Iota' regulatory autrwnh,
When the combined accumulation of sludge and scum in any treatment tank equals one-third ()y) or more of the tank volume, the enibr
contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 11:
Wisconsin Artministrative Cork.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment unit!
and any servicing at intervals of <.12 months, shall be performed by a certified POWTS Maintainer.
A servia: report shall be provided to the local regulatory autrlonly within 3Q days of compistion of any service event
,lino-ors (02x1:
Page _ of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents a
chemicals or sediment that may impede the treatment process andfor damage the soil absorption system. If high oonrsentratlo
detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use.
Pump tanks may fill above normal h ighwater levels prior to startup or due to pump failures. Start tip or restoration of power under
conditions is not recommended, as the excess wastewater will be discharged to the soil absorption system in one large dose cau:
overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation he
contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a P
or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tat
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
Do not drive or park vehicles over tanks or the soil absorption system. Do not drive or park over, or otherwise disturb or compy
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 and prolong the life of the tree
tanks and soil absorption system: adds, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers. denta
diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides
scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge.
ABANDONMENT
When the POWTS fails andror is permanently taken out of service the following steps shall be taken to insure that the system is pt
and safely abandoned in compliance with s. Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks, pits and other soil absorption systems 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 Septage Servicing Operator (pumper).
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled wi
gravel or another inert solid material.
CONTINGENCY PLAN
If the POWfS fails and cannot be repaired the following measures have bean, or must be taken, to provide a code con
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption s
The replacement area should be protected from disturbance and compaction and should not be infringed upon by re
setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in thn
for a new soil and site evaluation to establish a suitable replacement arcs, Replacement systems must comply with the r
effect at the time of their permit issuance.
❑ A suitable replacement area is not available due to setback and/or sal limitations. If the soil absorption system can
rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site eve
must be performed to locate a suitable replacement area If no replacement area is available a holding tank may be installs
last resort to replace the failed POWTS.
Cl Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infi
surface. Reconstructions of such systems must comply with the riles in effect at that time.
WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTA:4 POISONOUS GASSES OR L
J~: SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE DEATH
RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE
ADDITIONAL INSTRUCTIONS:
POWTS INSTALLER POWTS MAINTAINER _
Name F x
? Name
Phone -
Phone 1191 Jz1:'~/"
SEPTAGE SERVICINGI OPERATOR PUMPER LOCAL REGULATORY AUTHORITY
LNamne Name Te Phone 715- 3V,- ~ 6 ~ O
This document was drafted by the staffs of the Green Lake. Marquette and Waushara County POWrS rogtrlatory agencies in cornpganee wig, w
Comm 63.22(2)(b)(1Hd)&(f) and 83,54(l),(2) & (3), WisoonaM Administrative Code.
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ST. CROIX COUNI'Y
SLPTIC" LANK MAIN-VE.NANCE AGREEMENT'
or: ANT)
OWNER SHIP CERTIFICATION FORM
Owner/Buyer Tim & Dawn Larson
nI Mailing Address 1787 46th street, Somerset, W1 540.25
Property :lddress21 " County Road I
Z I S I C_ '1^y,
(vc'wication requited front Planning & Zoning Deparnneot for new conctr action.) -
~ie Cit Somerset WI 032-1043-60-000
ylState ParcelldcmlificatiouNumbur LEGAL DESCRIPTION
aT 15 31 19 Somerset
Property Location /q , y, ,Sec. Y N R W, 'l'oan of
IS _ u Subdivision Plat- - - - - Lot 11
e Certified Survey NMap Volume Page a
r \Varrauty Deed # before 2007 Volume Page 4
r P;pcc house ❑ycs[❑w Lot liecs identifiable ❑yes❑no
SYS'I'F.1\I NIAIINTFNANC E, AND OWNER C'FR'I'llFICATION
hr.proper use. and tit at it te,r:mec of yo;n scpI ic..rystcIII :oulcf nsnh in its prcntahue failwe to handle wastes. Proper
ilia intena rice. consists ofptunpinl; wo the septic lank rvery three years or sooner, ifeccded, by a licensed pumper. What you put into
the sys:c;n can affect the finiction of !Ile septic tank as a ocatntmrl stage in the waste disposal system. Owner ntaintenacce
responsibilities are specified in 9Sl'S. 383.52(1) and in Chaple: 12 - St. Croix County Sanitary Ordinance.
The pnmerty owner agrees to submit to St Croix County planning & Zoning Dcpariment a certification form, signed by the
owner anti by a rtax'.er plumber, journeyman plumber, restricted plumber or a licensed pcmper verifying that (1) file on-site
wastewater disposal system is in proper nitrating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than fi3 lull of sludge.
Uwe, the undersigned have refit the above requirements and agree to ntzintain the private sewage disposal system with the
standards set forth, herein, as set by the Dcpartutcnl of Safety And I'tafessional Set vices and the I)eparuncut of Natural Resources,
State u"wiscon.sin. Certification stating that your septic system has been maintained nisi the completed and returocd to the St. Croix
County Planning & Zoning Departurcnt within 30 days of the three year expiration date,
1/we terrify that all statements on t us tornt are true to the best of ntylour knowledge. IAve anVarc the owner(s) of the
propeuy described above, by viraw e[ a "%aIlanty deed recorded in Register of Deeds Office.
Number of bedrooms _ Lj
SIGNATURE OF APPLIC;AN r;S) DATE
'+*Any intbrntation that is misrepresented may result in the sanitary permit being revoked by (lie Planning & Zoning Depernrtent.
Include wish this application a :ccordcd warranty decd from Ibe Rcgistct of Dccds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(it fl v. 04,111) _ ,
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.;rsia Uepartmenlof Safety arid Professional Services Pare _ of _
Dials or of Irdusty Services .,I
ISOIL EVALUWIONRFP'ORT
:
In acrordancu •.m11: SPS 38S.:^.'is. Adm. Code Courtly
A::ad' con•ptetc s 1c plan or. paper not !ess Man 8 1:2 x 11 inches in size, r Ian crust rcludc. -'Xfnr 'z -
hu(not lmitOO lo: vorf:al and hornOnlal reference pert (Btd) , cireclion and percent cope, Parcel LD. r
sGaIc or dirr'ensvris, rTGnh arrn'nt i.rc IoGabon rind dlslance b newest road.
Please print all information. RO•newad hate / q
oorsvial nluroauun ycu prcvide may he used to wwaday pr.rposes wrivae t.a•e•, 1!)C4t1 i+ n/L
Property Owner Property Lcr ation ❑
f•->/i:-{ 7_iCd✓ (,o•.A lot f/~. )ifs r. S~ ,t N R ~'~i C {crl LV
Pr,~ arty ('Nn{er P In Loy Address, I of Y Block # Subc. N"O c SPA#
City Slate 7ip Codc Phone Number ❑ City ❑ Village ❑ Town Nearest Road
,.r
Nov, Cunstuaion llse'Residential: Numhor el hedrtx0r7s Code derivoc design flow (3pL)
❑ R Iplacerrenl Public c~ commercia - Descobc. _
'areal malenal y'. plocd Plan elevalion i applicable N/c fl ~J
C_:enerel comments and recommendations-
% rig; Lti. •F-, a : ~ L.:~ %C •
Borwg # ❑ Bcdng
~~JJ m Pt Ground surface OIOV. Ucpth to lani!wq larkv- j%[ - ir.
Soil Application Rule_
I k:von I Depth Doirman: Colcr Redrx Deseriot'on Texture Strticlure Consistence Boundary Roots GPOT
In. I I ravel Ou. Az. Cont. Color Gr. Sz. Sh. •Erf4i 'Effv
17 /
J
Being 4 ❑ Bnnng
LLI____ Pit Grourd swfaco olez'!-L. rl. Ueplh to lirndiny ractar~~~? in
Soil Application Rate
Hori>on Lne,)p, Dome ant Color Redox Doses cowl lextwo !ilr inure ~ Consistence Boundary Roots _ GPDiF1`
Mor sell Ou Az. Cc it Cola- 'Lff#1 '611#2
~ i9"
ENluent 71 = BOD. > 30 < 220 rn(1:1 and TSS > 30 150 :nyiL. ' EI(luent R2 = BOD, > 30 s 220 m fg L and TSS > 30s 150 mWL
~ r -
CS, l M ro (Plea, Pjki) Sinnnture . -
CST Number
Address Dale EvalJton Conducloc Telephou -NKumber
l'
sm A31^.' jQfA'5)