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HomeMy WebLinkAbout040-1260-10-000 (2) :':r:' r: r.»mc tot,rt::rrc PRIVATE SEWAGE SYSTEM St. CfOIX S:ael'i vnd Frnln ~p Div v.e• INSPECTION REPORT =c« nrm iAT;Ai;H 70 P[RPA:TI 607093 GENERAL INFORMATION sate -Ian w N~ ,,c-al na,,ston you otnAjc may La usnc •nr sroontla'v Purpo:.x:: lcnvacv Law, 5 ^8 91 11 N,: nll t'crm:t 1.1d,-Name ;;.fi Villapr I_-.1," xamnl'a,. Ne'. Randy and Jean Strong TOWN OF TROY 040-1260-10-000 L:, 91.1 I Icr ur., RM HIM I;Into- n - I N,, 91 1 dF OLd! £ s~ ao oMn:I:a:, wr,118.28.19.1390 TANK INFORMATION ELEVATION DA A -YPE !AINUFACI URFR 717 SiA-IDN o.~ HI FS LLLV. SeptlC Gene :lard. 7 3 IN-1 9 . s u~.«.. An Hr.I i I oL :5 r,-4 Go /e L .s ke:aNOn L;Idg Se)wr 97.7 I lul3l:¢7 Jtil It Vint TANK SETBACK INFORMATION Jul c 0.111et 9l~•~ 1ANKT;I n.L V'VT-.__ D-Dr; Jnm Alrln:ake R!']AD Ollmcl / U7 4attnm ` SepUC 7 50 71- Dosing J t Icadclftvlan b.I 951' Aerallon Lind. Pipe n riokiing Ga. Syslern n S X32 Irlal ::ride PUMP/SIPHON INFORMATION l,p ,J r,'J 3•'/-1 tig• 3 klanufami-er ; . / -~I:mand ° . ..nverF/IL 6 /pZ • S °rv1 ldnnel !vumDer 7.1 9 - 1:)H I in ' nctlun ! cn:. 5"vslem •tcac TUI I =1 Forccn:aln lend fin.t Icl^:eil 9 r 93 3 SOIL ABSORPTION SYSTEM BED, TRENCH tb'min Lc'Itr Nn C` Tmncne_ PIr DIMENSIONS N,: .'If = i6 nsvre La ly.rd 7~~ath DIMENSIONS !G / 4 -:M 1 SETBACK SYS-LNI TG' r7D WI BLU~ I Vv=! / _gY:Lr51 R6 At., IFACHING Ware, a ru(5 INFORMATION _ CH AMBER ON,/~~-r•~ ~VI y/pe ~G Sysmrt -'V VNII I.trvol Nut .4 ;4_^ n C/or~JPF O Z7 7Z AAA- DISTRIBUTION SYSTEM /I y J_ _ y WS ,d!:crtlddnRnltl r Ca:nC,Lia r. Hale 6i•e~ a Gr $papmQ +•.Il:lt'ta,, ...;#tt L'ta T _ nnntn FlpC1`_~ _ E/~Otr)S SOIL COVER x Pressure Systems only xx Mound Or At-Grade Systems Only C=nr ' L:e em !.va- x' lrph C. .:neoml4nc-c^ xx rAu Kne[I FndrTt.nch ~rntc- C cse'irenor i:Lle-. al Vn Yes. COMMENTS: ilncuar• code dlscr ap=n s. per. ons present. elc t Irspection a' ape is q Location: ;;GC D-G. VALLEY DR / ~I '..i.Alt BN IY.:scnpllnn- ~I G.6 ~Q/` 1- i-acir, dl^ 2.? 91dg sewer length = - amount of cover = Plan revooon Rec ueed7 Use other side 1o additional) mforyes mattoli. SBD f.-. IC iR.3N, Dare - I^ser:or< S:'_vnalu'^ .,r'. Nr ST. CROIX COUNTY ZONING OFFICE: CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the followi/n~g reside jtc : (Street address) 395 K~~e1 V QP;~L located at: A)E /a, /U ''/a, Section VT , 'tow Z$ N, Range / S W, Town of Teo St. Croix County Wisconsin. Upon inspection, lV erti ly that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service _ Did flow back occur from absorption system? Yes No (ifno, ship next line.) Approximate volume or length of time: gallons minutes Tank Capacity: Construction: Prefrb Concrete Steel Other Manufacturer (if known): Wt&5e-C Age ol`fank (if known): Jew ✓J Permit number (if kno n) S/y9o'7 _ (Licensee tuber Signature) (Print Name) w w Ort 1✓1 P tiZ~ ZZ,3 Z ("title) (License Number) MP/MPRS (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 A jab aot4- oqP dd.di.ora wl esmT -TiOZ Sanitary Permit Application b Mund. WM SPa sa21C2).Wht MUL code, amt 10®40 w mpkad p[arm obaiedeg a tekey pomk Nave: Appbavm fmmr for anda.awaad pOA''IS we wAwA d m Ins me Dopvama of sdmr rd Pradrai=d soviet Pasaml vdDOOMm yM tao+Vda am be road is eecoufty iaw z 15. Satc X15` l r'.~e.,i ftas Prim AN bbo*kfwa r10~'h °M°~'' N°°1e 1 ev- V\- ~i ~1 O G- iZ~U ~C OGh 1A Propepa0anr'a rfaIlgAddoo s(5 pFcjz V RILL-- Y Offt l.at . swa zip Oak now"Ndw ^,[.y,, lam, C K Z -C" 8er~. a Typo a(!lullftg(dlai aim d" apply) i m 1or2FaeijDaeillog-Numbcrof ~I SubdMske ?Is ` 0 ❑ A6idOoaatneohl-Dsa3e llae C Cky of C 9~Owaad- Vie ~ ~ d Z l C (l : ) 4-Z-T ( Toee d C,y ULTYMorP.~le wIP Cw41r arappiuMa A ❑NwrSpim 8yt4 '1lealeanadiditTa*PAOMMAVAOdy ❑OteModFrbuaaeee(er~s pqr L ❑ PeraicBAMM ❑ earicRavioioa C C~needNvY~r ClPaatTreodermNwr 1'1t Pwo Pe>~ oww - l'1 ci 0-7 b8 fv creak alt Piaeonsd 1a-0looel O A14ab C Mamd 22d kL ofwuoble wd O Mond t 21 a o(sWM* poi C HdieS Teak ❑ OOr Diapsad Cmpamt (mlptah) ❑ AaoeamaotDsvioe (aepiaia1 V Ana Soma 1 r'1 s DIAP rim (WO 34~Y AppEart4oa RaM(ipdeff Dhoa!!1 A7aa KOOMM (20 bMpma~ei Atrj M" I ~ fElwlm T1aYclai Toed d r Ti Dian Ilan f oTi ' uft ti/ ! o jc~ 5Z DoebgCbodM r Tat 1 L5 j ZS C i W f 77 VII slaYaart- cm uwkrwav4 uue far laeea0aa►a orere !•Oie" Mon "rimarbour ao. a Nas Tibst) =~-41 b1P Ybo" Nombu r6 X zz 5 zIL 1177ci/-,31 1 T'hwim'S A66M (sued. Cb. StOk Zip C4Ddte) `7f f - 7S5 ' 7-14 1 c Bt)K 5rs5 Vv S`1C ~ Q"MRMwwtw U" Ont f/ cn rt S q J ~ ~OworOCe~saeraaicDwf .OC - 1. Sep a La*11'!T ,w Imr Phopp"Pol rk, 11 nat. 1l k C. 1 ^ { 3 n.G-UlJ] ~o ,7el~Ov~ u per aarayeman! p4n 7.. a I l ~ 2. AI aerberlk n~c,U.wrea7 meal ~c r n, I as per p%*rble C4)& 1 ad:rn.iatt, Re wibotr fr4o4ea~oY raw oaay oa pape tw lr:wita■1 tL SBD fi39i (A 11!11, . 1 \J l l l.. I f l T l 1 / i / V i i CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name Owner's Name: Pr1[ Owner's Address: Legal Description _1yE l k) NC JJ`I s I~ -T Z-A, i~~ f\ I ! N/ Township: :ounty S? 1 l~ I subdivision Name l~ (-_i= t,~ UA -ot Number: I 'arcelIDNumber. C, (YjC Page 1 Index and btle Page 2 Plot Plan Page 3 System Sizm & Cross-Sectron Page 4 Filter Specs Page 5 Maintenance Information Page c Management Plar Page i S; Croix C:v Septic Tank Maintenance Form Page a Warrar. •d Dead Page S CSIV or Plat -r Attachments Soil Test & House Plans esigner/Plumber License Number ilt,"\ V~ZJ %:2L ate: Phone Number 21 j - ~ Cr ~ _ J ~ S CJ gnature - G~ Cl atoned pursuant to the In-orouna Soil Abs3rolion Component Ma•tuat for POvv rS venior 2.C SBD•10M5-P fk 0110^,. Page ' Soil Absorption System Cross Section c C( >i i N--- a' schcvule as I I Fnn! Grade PVC Ve d Pipe With Vent Cap I~.•-- ~ ft Leachino ! Chamber LIIt- J ft j=/ n S~'ste:n EJetiafinn Soil Absor tion System Plan View ft j ft II ~7717~r ObsearefiPie P 1-~L~I1I1~~ i.fii~ili (I)~11TIII Ilfl?T~ I ~T~~)R L Trench 2 a` Dia Header - I Leachin_amber Spea~ati_ns I I Mantra- urar A is (rAodel 1 (,t=1L~-} ~i E(SA Rating ZC) s ftPa 4 -rchambar Soil Application Rate o7 I 9pd C't ood Design Flow t i7 ~.%sq ft Soil A,op!ica;ion Rafe e ~ EtS.A = I J Chambe,-s I i - 2.^ows of ZI Z~ I chambers each. --age of T i r a y~ -_r i Aftrr J' \ I/ ~~t 1 t\L1'~: _ is I',£~~:C'tl)r1~tz1~ li1H\ DF 'iRF1JCt~ ILI .15 "`1111 , POWTS OWNER'S MANUAL $ MANAGEMENT PLAN Page _of_ FILE INFORMATION SYSTEM SPECIFICATIONS Owner ~ FHo Manufacturer: LLI~[Sb 'lam ❑ N Prt # eptic ❑ Dose ❑ Holding Volume: I ~(yE DESIGN PARAMETERS Manufacturer: FF umber of Bedrooms: ❑ Nq eptic C7 Dose ❑ Holding Volume: (gE um ber of Pubic Facili Units _ _ ty ❑ NA cal Distance Tank Bottom(s) to Service Pad: (f Estimated (average) Flow: ontal Distance Tanks to Service Pad: ak) Flow = (eSbmated x 1.5): (yaUday) lr_ servlprsg mechanics must be provided if vertical is 115 feet o _ zontal is >150 feet. Specific instructions to be provided on back In Situ Soil Application Rate. (gaVday/fF) nt Filter Manufacturer f L t;~ Domestic) Influent/Effluent Monthly average nt Filter Model: x.15 rats, Oil R Grease (FOG) s30 mg/L mir.:d Oxygen Demand (80Ds) 42U mgrL ❑ Nq Manufacturer: Total SuspendW Solids (TSS) x150 mglL Model. th Influsn"E fluant Monthly average atment Unit (FOG) 130 mgiL facturer: (ROD,) 1220 mg!L VNA (TSS) >750 mWL ❑ Mechanical Aeration ❑ Peat Filter ~Nl Efflucn Monthly average ❑ Dis ❑tecuon ❑ w'e'nd ❑ SanrL'Gravel Piker _ ❑ 0thec (BODs) :.30 mg ~ bsorpticn System _ (T.S) s30 mg.L NA „ai Colifc;m (gaometrk mean) s10' [-In-Ground (gravity ) ❑ In-Ground (pressure) ❑ Nl ffluent Particle Size k, In ia. NA At-Grade Mound _ ❑ UrpLine ❑ Other: ❑ A Other ❑ NF MAINTENANCE SCHEDULE contents of tank(s) When combined sludge 3 and scuin equals one-third (Y) of tank volume 13 When the high water alarm is activated [laterFAs ervice Event Service Frequency condition of tank(s) _ At least once every: ❑'nnnth(s) fdJycar!s} (Maximum 3 years) ❑ NF spersal cell(s) At least once eve (s) ( - - ry❑ mcntr' Maximum 3 year s) years) CI N! ent filler L - - - least once every. m -cnar(s) m p ❑ Nf p, punt cont rols & alarm At least once every: _ p y owh(s) NF rals and pressure test At least once every; ❑ month(s) -LI ear(s) NA At least once every: ❑ P ❑ P MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems sha±l be made by an mdividua: carrying one of the fokomrig licenses or cerli0cetion Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector. PO'WTS raintainer or Septage Servicing Operator (pumper Tank inspections must include a visual inspection of the tank(s) to identity any missing or broken hardware, identify any cracks or leak measure the volume of comb red sludge and scum and a check for any backup or ponding of effluent on the ground surface. The sc absorption system shall be visually inspected to check the effluent levels in the obseivaton pipes and to check for any pending of effiuel on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immemat notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one-third (4) or more of the tank volume, the enbr contents of the tank shall be removed by a Septage Servicing Operator (pumper) and dispaed of in accordance with chapter NR 11: Wisconsin Administrative Code All ogler services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment unit: and any servicing at intervals of 512 months, shall be performed by a certified POW I S Maintainer. A service report shall be provided to the local regulatory authority within 30 days of oompledon of any service event. GMw-005 (02iof 'epoo ~IWASIu!wPV u!eums!M to v (Z)'(LPm (l)9(PXL)1q)(Z)ZZ'£e wwo0 ps (AIM wAwW wa ul 990L*6e AioleM6w S1MOd A3umo emgs M pue oWnbmVl 'alai ueejo wA p Vets ail! 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Aue;o adols umop 1aal 9L u!4l!m Sale 3dwoo io ginls!p 0S."L to JO 'iano Nied io anPP IOU op uraisAs uolldiosge 1!OS all io sNUe1 JOAO S9PllaA Nied io SAPP IOU oO aoepns an!1e gu! a41 1e uazoi; ale suogipuoo lps ualm inooo Iou Neils do liels uialsAS iei dwnd 841 utL4 m paiolsei On slanal luan!ya leuaou /tun sloiluoo dwnd all 6ugeiedo Allenmew u1 is!sse of iaulelu!eW S1MOd io Id a peluoo io dwnd Sill of ismod 6upoisei of loud (iadwnd) ioleiedo Bup.weS 96eldeS a Ag panouiai Nuel dwnd ell p slueluoo ail uogergp sl41 p*Aq of uialsAs e41 of 96ewep pus 3L=Wa to a6ieloslp eoeyns io dn>peq 943 ui unsai Aew Ie41 peopano >neo asop o6iel auo ui walsAs uogdiosge Nos a41 of p©6ielosp aq IlL m ialemalsem ssaoxa ell se 'papuawwai8i pu s1 suogpuoo i9pun iamod to uogsiolsai io do lrelg -soinle; dwnd of anp io dnlie3e of Loud slenal ialenu46n4 leuuou 9AOge 119 Aew sNuel dund esn of bud (iodwnd) ioleiado 6uawaS a6eldaS a Aq penou ai (s))luel 0411° sluelUOO 841 ane4 Pepelep 04eiluao!roo 4614 11 uLalsAs uogdiosge 1!os an a6ewep iolpue sseooid )ueugeeil a41 8pedua Aew 1e43 luaw!pos io seoluiaLp a sluanps 'spnpoid &3qu!ed W 83uesaid 941 pl (s)Nue1 IWLL4eaA ipe!1o SLWd OW 10 asn of loud 'uogonilsuoo meu iod NOLLVil3dO ONV do iHvis p `abed START UP AND OPERATION Page - of 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 andlor damage the soil absorption system. If high concentratie detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use. Pump tanks may fill above normal Nghwater levels prior to startup or due to pump failures. Start tip or restoration of power Linda conditions is not recommended, as the excess wastewater will be discharged to the soil absorption system in one large dose puss overload that may result in the bacl or surface discharge of effluent and damage to the systan. To avoid this situation he contents of the pump tank removed by a Septage Servicing Operator (p;.muer) prior to restoring power to the pump or contact a P or POWTS Maintainer to assist in maruaily operating the pump controls unfit normal effluent levels are restored within the pump ta! System start up shall not occur when soil cond5ons are frozen at the iniiltrative surface . Do not drive or park vehicles over tanks or the soil absorption system. Do no: drive or park ever, or otherwise disturb or comp area w?thir 15 feet down slope o' any mound or at-orade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the fife of the tre: tanks and soil absorption system: acids, andbiotids, baby wipes, cigarette budts, condoms, cotton swabs, degreases, dents chapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herb icides scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tamports, and water softener brute discharge. ABANDONMENT When the POW FS fails andlor is oennanentty taken nut of service tha following steps shall be taken to i.^.sure that the system is P. and safely abandoned in compliance with s. Comm 83.33, Wisconsin Administrative Code: • AI: piping to tanks, pits and other soil absortton 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 pis shell be excavated and removed or their covers removed and the void space filled wi nruq_I nr anMhm ir~cA e~Ii_' m-»erioi CONTINGENCY PLAN If the POWTS fails and cannot be repaired the fllowing measures have been, or must be taken, to provide a code cor replacement system: ❑ A suitable replaceinent 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 mr for a new soil and site evaluation to establish a suitable replacement area. 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 soil limitations. If the soil absorption system can rehabilitated and barring advances in POVUTS technolcgy.. a holding tank may be installed as a las`. resort ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of me POWTS a soil and site eve' mus! be performed to locate a suitable replacement area. If nc replacement area is available a molding tank may be installs: last resort to replace the failed POWTS. 0 Mound and at-graoe 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 rules in effect at that time WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTF.t4 POISONOUS GASSES OR L 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-7 ~ =Nane Phone - SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY None ame Phone Phone 7/5 - aSto - S'(~ - This docunion! was drafted by the staffs of the Green Lake, Marquette and Waushaha Count POWTg Comm e3.22(2)(b)(1Xd)8(t) and 113 64(11, (2) & (3). Wisconsin Administrative Code. y regulatory a9enCrc:s in compliance with 4ZT. CROT-k COUNTY NCZ MAY 06 2019 St. Croix cou,7,y Ma" lin? Addr--ss 3 9 !Z vrm t_[--e- 11,LZ7 ,',gin. mar reT~~ i;orn r iann;g 6z ?nring :iep;I-:W:;n: F1r nea ;:or..rnl: for..-s C i:;,.taic f~ U DS O ~J tnl y _ _ C>`I C'1 l ~2 (c C~ - / p LEGAL DF~-C WTIO\' ?is__ - p,E,E'R ✓/k L L~ - _ - ,t--- _ Ceit:Sed Cnrc'er ngap n Fo'::me y.F~. Warranty Deed = LZ0 e `L`e: li01S': vC:1 :..T. G➢e?. iIi»L;af`iE.-''... ~J _ ST~'I'E:M NLaTN-fT- --tNCE AND OWNER ("TREFICATION :.nsiq--~ or nLL.._7:ni D4'. :e:,aC :;1r1 vt i tli:: _✓n--5 J7 Lyn.".1 i' L IiL_^.5=1 ~llal G'GL "iIP S ..it :'"Se= ::'"_1T ales. frn iLU 1 11- J LI '^n-1as L C93 1 n.Lt•, :;1 .CI. we-qt ^`:sm.-sa} R'A `Cf! VHIC7 ~'1C _'^10,_;l L'll7LieS a7e .ij )9DJc7 L CS' = V- G--I, j aLd i7 ::Iant% SL 1-7,1 :.01:11' $&~7"d'1' C,rU1L?Jia. , _ ~ropCr>' Cu Je" i:` rf%..b t_ sib-, it LO _L C7"x n~:::1TV P:dlL]L' fi a C - ^uJ- `I am-- ' - - c -mT,pan :.l I - `i 5T.2 T1P.'S1bt=. IVLZC~T.LI -plumb= ]T [ JCC1st~ 7L"l~+e' V~-^ L L.ffi I U *-a:-mu.-I dis~asal S steTL 75 it U'v,^'i`:LC 1 _ - 1L:z,eC.]DIl iln= ni.,31' ',;i 19G9SSar: I, uE : st e-nC '3IIT is i~We.:Je 171-:St_„e= have rt.aC J: 3?Jve • :T1'-: i-1`~a an- is 7c: Lr .T.alr.mi m- =m-- S:'u'a_t 1:5:103- }1•17-°.TIl u7i): ;:)L c=nc s ss, =0-L as set b)"ae = tnazen: a o: Szlb-: d Pr~Rssio7~ S° ~ e . r ' ~ - ..r\-1::.- aid IDE 7L•pc.,llcnt a~ Di Leoolsi Ccrin~~D~ ..tL vot Se,1 Fv3ter.1'1a3 1x-•z Lna°ntan-- mus: be. cl=p;r._d an. - '-C,L11:\'?'iannini: k ZoL:ice uilhrm?.^ d°v1 if -J: t,R-Ce. vvL e._rdJ Or..^:at_. •v 'a C ^3T a 3-a'-n1:.n-. TJ.T 7 h I oz } , 'a : ' i' -art a1'Le: 1_S..na a~) ovt. h\ \i'-uc J: c J .L:.l ..._at- 7 f. or \vmber of oo , Y - - 6 i9 Sir- :.T rc` GF AP?7iC_'~~ • _ninr7r.~i;1La Lr;_::nroscnte c >va_ res::lt =the ;1e72L7 revni:e .in nda:i; \Z7Li Les appiicaix a : ordad wa; a7, d c'_ ;'oa- 3: Rtds'ca.7 0: --ie 1e and a CD?v of -Lhe c :tee= s1 W r..?9I~7OC `S )^31e 3 TS_ Wa.:.Lnlc 1..~_. _ tT.E%r. 64'1'I Wisconsr, Depamncnl of Commerce LSlaIe y r Sr,l-tvXBO.Id:ngDlvauon PRIVATE SEWAGE SYSTEM St. Croix INSPECTION REPORT Sad,tary Peoria No GENERAL INFORMATION (ATl'ACI I TO PERMIT) Plan ID No 514907 0 Persa,al infwmaacn >vu p•ovde may cv; used fair secondary purposes [Privacy Law, S15 Oa (1)(mp Permit Holders Name. City V.IIaOe X Township Tax No- Baribeau. Mark Tro , Town of 040-1260-10-000 CST BM Elov. rasp Uxl Elov RM Descdpuonn Sedion/Tov,nlRangatMap No: Its M t GS 18.28.19.1390 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER 1A CAPACITY STATION BS HI FS ELEV. i Septic n Benchmark a $Z Alt. M P6 lop 6P ~b 7. 73 Aeration Wild. Sever Holding St/H1 Inlet ~ 417-7 I(. b(p . ) TANK SETBACK INFORMATION SUHI Cutlet (o • b TANK TO P!L WELL BLDG. `Ven'. :u At, Intskp ROAD of Inlet Septic > 50 ~J(}-- 33 Ot Bottom ` Dosing Header/Mari Aerauw, rz.bg 95 • z~ Dist. Pipe Z7 Holding act. System 1 PUMPISIPHON INFORMATION Final Grade Jo.I~ 97.8 Manufacturer Demand SI Cu er GPM Model Num TDH Li% Fnct:on Loss Syst ad I UH rl Fwcemain Long Dia. Disk. to Well SOIL ABSORPTION SYSTEM BEDITRENCH W IUb, t.e',11 NO Cr Trenches PIT DIMENSIONS Nn G Pits Insde Dia L,quia Ueplh DIMENSIONS 96 Z I (t.•.. SETBACK SYSTEM TO PA BLDG WELL LAKUSIREAN4 LEACHING t6MmdaclUrer~~ INFORMATION T A CHAMBER OR 1~ C yp~ 01 System 10 UNIT Model Number DISTRIBUTION SYSTEM i`T +-9 - Heaoer1k1amloi~ C,smbuoin x I Me S ze x t»lo S vablo r Intake n-~l p Pipe(s) \ 1F~Je-Length O _ Cu._ 1 ength , is $puung_) \ S2 OIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only E z- ii~ L.Jes Uepm Ovw Cops, Ovw u Depth of u SeededrSodded u Mulchetl r Beefroynch Cenle• '3 Bed/Tro„U, Ldges \ TupwJ yes I I No Ns-'Yes U No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection 111: Inspection 02: Location: 395 User Valle riv Hudson, WI 54016 NE 114 NB 1!4 18 2 N R19W Deec Valle ( of 11 rcel No: 1 28.19.1390 1-) All BM Descdpuorl= y 1~ I nr 1 //ASU / ( S 2.) Bldg sewer length = 33 ~Ca 1 ) s/` r q V-1 aL ~O u - amowd of cover = / U J Plan revision Required? _ Yes ~No / t314 j5' Use other s:de for additional information. ~O (p v ~I{' SBD-07101R.Ora7) D`do InseWI ' S,g'atu Cert. No. Wi;co"sin p"ePartmentofIndustry. SOIL AND SITE EVALUATION REPORT P .Labor and Rumen Rotation Page 1 Of - 3 _ Division of safety 8 Bindings in accord with ILHR 83.05. Wis. Adm. Code COUNTY Attach complete site plan on paper not less than a 1/2 x 11 inches in size Plan must include, but Croix not limited to vertical and horizontal reference point (B nd % of slope, scale or PARCEL I.D. x1260 n, dimensioned, north arrow. and location and distanp4 ne risJ road, ' X40 611`0 APPLICANT INFORMATION-PLEASE P Nf ALI INFr 1RMAT1'0 R VIEWE0BY DATE PROPERTYOWNER r. + P PERTVLOCATION _Uerrick Construction, InnnJ~ _ J(~ LOT NE IM NE V4,S 18 T 2 NR (or)W PROPERTYOWA'ER'~SMALINGADDRESS {-r~9g - -t0 x BLOCKx-TSUBD NAME ORCSMx 1505 H-yw #65 ST r-Rox 1 na I Deer Vall ~.STA?E e C TV ZIP CODE 40 CITY IIIAGE [SOWN -,+-NEAREST ROAD New Richmond, WI. 54017 h7r2 ' Troy E. Cove Rd. ()d New Construction Use Residential ! Nu dl d _ q ( ) Addition to existing building _ J Replacement I J Public or commercial describe Code derived daily low 600 - gpd Recommended design loading rate 7 bed, gpdM2_ , Q-trench, gpdM1 Absorption area required 858 bed, 112 _ 7SO trends tt2 Maximum design loading rate 7 bed, gpd;ft2~R trench, gpi Recommended infiltration surface elevation(s) area A= 94.50-B=93.65 It (as referred to site plan benchmark) Additional design? site considerations _ na_ _ Parent material _ outwash Flood plain elevatron. it appl:cab,e _ na It _ SUitable fDr System CONVENT,.044 MOUND IN-GRC'_NDPAESSURE AlGRADE SYSTEM IN FILL HCLDM:G TANK U• unsuitable for s stem ®S ❑ U ®S O U ®S U U IN S0 U M S ❑ U O S r X, SOIL DESCRIPTION REPORT Boring # Horizon Depth I Dominant Color Mottles Structure GPD/ft in. Munsell (lu. Sz.Cont Color Texture Gr. Sz- Sh. Consistence BarxHy Roots Bed Trerdl 1 1 0-18 10yr 3/3_ none- 1 _2msbk mfr } 2f .5 .6 2 18_32 10 r 4/4 none sil 2msbk mfr w if .5 .6^ Ground 3 32-90 7.5 r 4 4 Jtone cos osy 1n1 na na_ .7 :.8 elev. 99. Oft. _--L-_ - - I - Depth to fading - - - - - facto 9y +90" - - - - - - r - - - s-`t o Remarks: Boring# - - - - D-9-- 10yr none 2ms tEZ ,6 s 2 2 9-20 10yr 4/4 none Lsil 2msbk mfr gw if 5 .6 - - - - - - Ground 3 20-90 75yr 4/4 I none cos ; ml_ na na .7 .8 elev. 99.0 h. Depth to - - - - _ tirmting factor Remarks: CST Name:--Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th. Av New Richmon WI 54017 Signature: Datc: 6-4-99 CST Number nri PROPERTYOWNER Derrick Construction SOIL DESCRIPTION REPORT IPage i` of.,3 PARCEL I.D. # Boring# Horizon Depth Dominant Color Mottles Texture Structure ConsistwwBourd y Roots GPD/ft in. Munsell Ou. Sz. Cortt Color Gr. Sz. Sh. Bed :Tmndi A, 3 1 -19 10yr 13 __Lnone +sil Zmsbk mfr 2f 5 .6 2 9-34 0 r 4 4 none- 2msbk mfr w if .5 .6 Ground 3 -96 7 YgL4 none cos elev. na na 7 ! .8 _ 98.2 it Depth to Iifttng - - - - facto 9! 3 _Y "1-` _ 44.4 40.1( 54.o/9p•f. Remarks: Boring r~~, 1 0-20 ~ I-Oyt 2/2 _ -none _ 1 _ 2msbk • 5 ' s% 2- 2039 10 r 4 4 none I 4 . Y -1 - sil 2csbk -mfr lf_ I .5 .6 gvw Ground none 7 elev. I _ 97.9 ft. - - - - - - Depth to - ( - limiting 1 facto- - s/B~ - - - t Remarks 1 Boring l0yr 2 2 _ none- _ bk _ mfr cly jf. 5 --.6 $ I7I " V 2 23_-45 lOyY 4~- _ none- sil 2csbk mfr 5 - 6 Ground 3 45-90 7.5 r 4/6 none cos C g mi na Ina 7 .8 elev. - Y - 97. -A-- ft Depth N ` - Ys RL t - - miting factor +90"_ - Remarks: - - - - - - - Boring # Ground - - - - elev. TT Depth to - - Writing facfdr --i - - - - - Remarks: - . - _ _ L SOD-e330(FLOW92) STEEL'S SOIL SERVICE Gary L. Steel Derrick Construction, INC. 1554 200th Ave. CSTM2298 NEkNE~ S18-T28N-R19W New Richmond, WI 54017 MPRSW-3254 town of Troy (715) 246-6200 lot #11-Deer Valley This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. 1"=40' top of 1" pvcpipe @ el.100.00' -Alt. BM.= top fo 1" pvcp ipe C el. 97.80' v D~ ~ N P 122 ~ ~ AGa Steel 6-4-99