HomeMy WebLinkAbout030-2011-90-110
' - PRIVATE SEWAGE SYSTEM St Croix
near; =crmil ~r 615313
INSPECTION REPORT
GENERAL INFORMATION 4TTAC•i TC' ERtd't Sule Plar e, Nc
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Knstopher & Kelly Newman TOWN"OF SAINT JOSEPH 030-2011-90-110
HN Emv nsy BL1 Lev NV D-,11-11- SPQOn'-nxmAan9e+I,ta: ~c
I V'I 35.30.19.396A-11
TANK INFORMATION ELEVATION DATA
TvZ'L IAANA=ACIUR P, STA-0N H. L 'v. (tags Septic 6cnctl. larx ~ - 11
E~ fx I
^`Inc 7C-~,~ 07 4 z toy 5 ;,It. R~, -`llr~ .2a 101-21
Aerauor Al 5 B11.4.Sevrer
Iliming :ifl'II Isle: ~S
TANK SETBACK INFORMATION SUHt outlet W t, fa 6!~ ¢,.J4
EANK nq :"aFl l 3_JG 'de cc 411 11: a11 R, )A7, DI Inict
7 II to
Iluatlor9vlan V'im`,
Dist Pipe GM. Systz
I q4.S
Final Grade '
PUMPISIPHON INFORMATION .4c) WbA
Ivtanutaclulel Uanand St Cover to 7.
Iv1:T•IP. NJIIIJI'f 8.5
TJH _dl n S\51en! "eac I Ft v
~Folcemam _onq,h Dia. „e
SOIL ABSORPTION SYSTEM
BED(7KENCH :,I enutn t •,c :H Trenches v PIT DIMENSIONS V: DT=I" ms~nr C. 4erL'-'-
DIMENSIONS
SETBACK SYST=10) 1vV p^ _ BLDG 'vv-LL Kb'S;R-AM LEACHING Nan-tacuv:
INFORMATION Tfp,'-:- s:em CHAMBER OR In Gl~t,~
UNII AICCe Nunn
DISTRIBUTION SYSTEM Il Iv r U
HoauC M. Ac I I :L1t%0U!0r Hale Sire HD, SpaanG +en: rc toKr
rlµn ~yn IpB'a
Lnna 1 v _ G - '1 _enp:ri 'na / .`,nscnTy (,C,r <
SOIL COVER z Pressure Systems Only xx Mound Or At-Grade Systems Only
fiep r Ceptn , / x _•cElfi c _ ond/Bc.'oe0 ` O MwU - - _ _ _
gcn T J: ~e cei 6vo Tr h F,,r,
f
COMMENTS: tvlcooc woe DISCrepennie.S. p e-.(,rv o esenl ,Ik Inspecilor Kt i'vim>::nor, 92
Location: • 7Ar, BAti _4KL RD +1 r 7 1 1--
1.1 All 3M Desm phorl
2.j Bldg sever length=
amount of arvcl =✓l t ---777 III^^^---7l ~ V
Plan revision Requiretl" yes s N:: /1
UsE oiler side for additional ininrmali:xl /
Lalf - _ msopcrx;. ogm me ~ C:cn f~~ dr1
~j
fL~ ?
r
Safety and Buildings Division S-j
tYC 201 W. Washington Ave- P.O. Box 7162 Sanitary Permit Number (lo be tilled in by t o i
c ~SPS..I j y fl1- Madison, l 3707-7162 X53 r 3
t State TfaflSaelign Number
~ary Permit App icati
In accordance with SPS 383 21(2), Wis. Adm C "c, submission of this form to the appropriate govcmnx
is required prior to obtaining a sanitary' permit Note. Applicahon forms fm state-owned POW I S arc submitted Io• Project Address (if dtffbmnl Nan mailing address)
the fkpanmcnt of Safety and Ptofcssional Scrvies. Personal mfummuon you provide may be used for see, urv Z u q 6;Ai S L 1A K( K
` )C +AI
pufWSCx in accordance will( the I'nvaev Law. s. 7 SaW(I )pit!. Slats- _ I f "
1. A t lication Information - Please Print All Information
Property Owner's Natnc Parcel f
~'1STONf~E_l + E.ILJ Ewi\\Ati- Ciao dell -`i0 IQIU
Pmpcity Owner's Mailing Address Property Location 5: 3 I _ ~'y(, /I ' t
1 t I
'X ly Sri,cV►p, L N Govt.Iot__
C'ity, Slate 1 2ip('ncfe r plu me Numbcr E 'r,~ . SeUwn l.~
U ~~S17 f\) I"" S`IU1 (cireleonc)
-tj It. Type of Building (check all that apply) ^ to a -
Xi or 2 Family Dwdlint. - Numbcr of Hedaus _ Subdivision Nam
ock k -
0 PublidCormncrclal - Describe Use
❑ City of
Numbcr vCL $
l_1 Slate Owned Describe Use CSM D Village of
L aI
---I D f r- O ~r 0 `)(>LE' J4-✓ f ~ 3b &-rowrlof SI -aCF
IIt. Type 7oL-2 L• (Checkonly e box on line .A. Complete line R if applicable) A' em ❑ Itcplacement System TreatmcntlHolding Took Replacerm:nt Onit ❑ Other Modification
to Existing System (explain)
-
_ List Previous Permit Number acrd Dale Issued 1
H. ❑ Permit Renewal U Permit Revision ❑ Change of Plumber ❑ Permit tanster to New
Hcl'mc Expiration ! (),oner '
IV. r UrPOWY'S nt/Com mnenUUevice: (Check all that aDPly)
Non -Pressurized In-Cimund ] Picssunud In-Ground Lam.' AI-Grade ❑ Mound > 24 in. ursonahlc soil ❑ Mound m 24 in. tit suita6lc and C.~a
Icsplainl - ' encabnent Device (explain)- _
❑ He t ui29
lv~
V. Dix )et Area Information: I
Design Fld) esign Soil Application letglvki Dispersal Area Required t) Dispersal Area Pro sed (sl) System FI<v Lion
~s~%~ 7L;~I> l~; ~li,a°~to ~t; 45.`l
'(oral N of fvlanufactuicr
VI. Tank Info Capacirv in
Gallons (iallons Units
l ina tank:
Ncw Tanis bxts rte L+ .~j ,+Lj Y
1 ~ Y r v v: v a
SCM¢n Hddmg Twrk 1 C9ci 5 ' ► S ' V ( Sit--
Doeinr Chamho _
`VII. Responsibility Statement- 1, the undersigned. assume respon%ibrht) for installation of the POWTS shown on the attached plans.
Number's Name (Pony -W Cr nalor f1TSincss F'hmre Number
Pl-T. ~9Plumbers Address 1Sneet, il) Slate. Lip Coe)
J) R'IrC C- 6 k' 0C,
in2~ W! 59
NAIL ounlvlUe artmenl Use Only -
ovcd Uisa~ Permit Fee Dal Issue yf Issuing nt Signature/ /
Cr, ppr Reason no Ducal ^ 1
Ile. ConditllfGi'614%*WId7Reasons for Disapproval 3) el
1. Sep1i^• tack, edlr.em tine- ~ rv1
,isptc's, CA Wl all be'ACC ' -t
ss per -,-w3yemenO plir ?'o ioel ,umber. i
2. AN NO CalligU lie's nm'XAwt:r. t'nti
W per VFyu!bb cu9t I ;Knanrsat.
- - Annch to complete (dam for the igstem and.ubmit to tae (:nunty only on Paper not Ieo than a t : s 11 inches in she
SBD-6398 (R. 11! 11)
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E.L(' qZ
z SCIL YSCL2'AA;'~
COPY
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name KQ
AF"6~NiPA Owner's Name
Owner's Address: L
5~/ Ol
'_egal Descnptrort _ 'tin /y S wy ley a"7", 7" 3i` L l1' 1"t township: T _j SLY II
:ounty: 5 Lt IZ01 X
subdivision Name:
.ot Number:
'arcel ID Number:
Page 1 Index and title
page 2 Plot Plan
Page 3 System Sizing & Cross-Section
Page c Fitter Specs
Page 5 Maintenance Information:
Page 6 Management Plar
Page 7 St Croix Cty Seoti^ Tank Maintenance Form
Page 8 Warranty Deed
Page S CSM or Plat
Attachments Soil Test & House plans
signer/Plumber License Number
/~`11)5 Z z :S 1 ( 1
~ ~ c
te:
Phone Number JI ~C/~' iSj
nature
Vned pursuant to the In Ground Soil Absorouon Component Manua[ for PoviTS Version 2.0 SBD-10705-F ;1`1,01101;.
Rags i
KKI,~1L'iijcii J k--_LL\l t) lam,\\~,
f'~Lr ` L t
LUT I CSrvL ilot 21
I1\301 5w Vq s zs -r-5r ~ I ti I I ti✓
S.~ SpCSV+I T~~`~ t'
>✓~PiZS ~ 3Z`11~
r
I W
i
I
V1
i
i~E.►k41/~lt\K{( 2 TO r' oP- 1 if Sic -L LLic P6r,.ri Lo7 Ci'2nJE9 FiPl.
EU'v qZ
SCiL Rc~l~~hs
S C ,-AL C - C
Soll Absorption SVStgm Cross Section
/L1 2- ft
.4
- ,61 ft
i Finai Grade
4' Satiedufe 4G
PVC Ve7 Pipe C~ L~ o
//J I WV7 Vert CaD ( ft C/ .j o
Leaching 5' te ft
Chamber System Elevation
~I J it J P
fl
5
Soil Absorption System Plan View
7Z ft
7T~
,3 ft
Ir g Lr
5 ft Chambers
~ i
Trench 2 Header
Vent O: Observation Pipe I
r Trench
Leaching Chamber Specifications
Manufacturer And Made!
EISA Rating L sq ft per chamber Soli Application Rate 7 gpd/sq ft
Chambers
gpd Design Flow a . ~ Soil Application Rate a LO EISA =
I
3 rows of chambers each. ~
Pale _Of-
- -
E INSTAL,L,ATWH IN~uCT10Ns
--.mLTER
&mpL,02S FEA3UM & SENEF s
Feaftaus a Belwwm
coo
.rpL-= ,t.inBar Fed of Iner Porabn
~f pL.M a M Lkm F04 .0f IIW tN
' fAampIF 4- and 9' SCW-'40 PIP.
PL4= PIAM
k 8Mmd Frmf dwWtPlt~ • "y,.In,~G'Jy B. Bi1~0MctQ
~w Yam UrAw noTmw ommorm bwbre . ` hup 1 EIM wmen FOW
r aow* p. it ft mooBmmWed gig the aw be
ied4worytlmethe/o+ bpuMpedoratIn* WMV eAlraAOosssMW
e ypma. tf lfw tntds/ed Iti w un.AROBp~ E7 Fierde
o. jw Gwwvd1 bs noWsd by sn dw v w the
reds swvi*g. so mickV dwLfd be dons by a
pod sep9o tank punWw or kmWw
D PRODUCTS
r 'a
IO.raibl .r.. ~OOMM
p~sl s g~IMtldnLAk" s PpdylCkfdl/0~_ ONE& _
iatdcaora;lu ts~~~d fatrpgw~Obf^ e~deMdi*Pa1d
s db.s~ sllt aA nam okm d ~q ap4n .ed..dtd•.o~~
ywowolow br ~ - eairflrsiA(arhi~ ssicer~wouw s~a1~r
nQ dW O 10 d w*
~
WAIL
Foraid btafP*IokP pigMvbaowvrebAga mm"
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of_
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner (S-_~ E,wi)lWl(>✓'_ _ Tank Manufacturer: U N
Permit # p~-Septic ❑ Dose 71 Holding Volume:
DESIGN PARAMETERS Tank Manufacturer: f, N
Number of Bedrooms `J ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: W
Number of Publ'c Facility Units ❑ NA Vertical Distance Tank Bottom(s) to Service Pad: ! it
Estimated (average) Flaw : sffC (gavday) Horizontal Distance Tank(s) to Service Pad: j if
Design n Specffic sezvkdng mechanics mull be provided if vertical is >15 fret o
(peak) Flew = (estimated x 1.5): j l r (gauday) 0 horizontal is >150 feet. Specific instrucliars to be provided on back
In Situ Soil Application Rate: , (gaiiday)tt') Effluent Filter Manufacturer: L) F- &'V V 1 4,1
❑ hL
Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model_
Fats, Oil & Grease (FOG) e30 mgA. Pump Manufacturer.
Biochemical Oxygen Demand (BODs) 420 mg)L ❑ NA ,Iti! Nr
Total Suspended Solids SS 6150 mg)L Pump Model:
High Strength Influent/Effluent Monthly average Pretreatment Unit
(FOG) >n mg'L Manufacturer:
ISOD4 >220 mglL NA G >•l l~Nr
ucnanical Aeration ❑ Peat r!aer
rTSS) >t50 M91
❑Disinfection ❑Welland
Pretreated Effluent Monthly average Li SandlGrave.l Filter _ ❑ Other:
(BODs) s30 mg;L Soil Absorption System
(TSS) s30 mg;L UNA y//
Fecal Colircrm (guornetric mean) s10' l~n-Giuund (gravity) ❑ In-Ground (pressure) ❑ N/
At-
Maximum Effluent Particle Size in dia. U NA El riGrade ❑ Mound
❑ Drip-Line Grade otM,+:
Other: Other.---- NJ
MAINTENANCE SCHEDULE
Service Event Service Frequency
Pump out contents of tank(s) When combined sludge and scum equals one-third (A) of tank volume
U When the high ureter alarm is activated
Inspect condition of tank(s) At least once every: 1 ❑ man0i(s) (Maximum 3 years) ❑ NJ
U yearns)
inspect dispersal cell(s) At least once every: Z U '"sot"(s) (Maximum 3 years) ❑ NJ
❑ yenrts)
every' II ❑ mn".h(am J NF
Clean effluent filter Al least once
r 1 ❑_yeaiis)
Inspect pump, pump controls & alarm At least once every: ❑ rrwith(s) ❑ W
Uyear(s)
Flush laterals and pressure test At least once every: ❑ month(s) ❑ W
❑ rear(s)
At least once every: ❑ month(s) - - ❑ Me
❑ yeai(sm _
Ora: - U NP
MAINTENANCE INSTRUCTIONS
Inspections of tanks and soil absorptlor systems shat: be made by an individual cam:ing one of the following licenses or certification
Master Plumber, Master Plumber Restncted Saver, PO'NTS Inspector. PO'AITS Maintainer or Septage Servicing Operator (pumper
Tank inspections must include a visual inspection of the tank(s) to identify any massing or broker, hardware, identify any cracks or leak
measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. 'I he sc
absorption system shall be visually inspected to check the effuent levels in the observation pipes and to check for any pending of effluei
on the ground surface, The ponding of effluent on the around surface may indicate a failing condition and requires the immediat
notification of the local regulatory authorty
When the combined accumulation of sludge and scum in any treatment tank equals one-third (S) or more of the tank volume, the entir
contents of the tank shall be removed by a Septage Servicing Operator (pumper) and dispoaed of in accordance with chapter NR 11:
Wisconsin Administrative Code.
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 S12 months, shall be performed by a certified POWfS Maintainer.
A service report shall be provided to the local regulatory authority within 30 days of completion of any service Gwent.
GMW-005 (02/0.
HI rANm a~ueildwm of saaue6e ArolelnQer S1MOd Aluno~ e~e4aneJ,q pwe a1lanWeW O*n uwJE) 041 (m slyl IS ayl Aq Pa4erp( sem)lluewnoop sail
0uO4d
query - ~o4d
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- :sNouonuaN IVNoIJ.IJ oOV
3I81SSOd 38 ION AVW HNVI V d0 HOPJ31Nl 3H1 Woad 3n3s3S a0 3dVOS3 '1InS3a
HIY3O 3oNYIsmnoalo ANY a3awi HNVI ANY s3. N3 a3A3N '3dll NR/ISns 01 N30AXO 1N31oLddnS
I a0 s3ssve snONosiod h;ylNOo AYW sxNVl oNIOIoH ONY 'SKNVI dwnd 'SXNVI 1N31-----
DNNaYM
-awy Ie44 le pop ui solni e4l 41gm Alduao Ism sweps,(s 40ns to suogpnllsuOOea aoepns
gu! a41 le leum!q a4l JO leAOwal 64)lMOlpl a-eld ui poprulswow aq Aew suialsds uogdjosge pos apok-1e pue punopy ❑
SIMOd Pella; a41 eoepdal of posal Ise!
3l!elsu! eq Aew duel 6u!pp4 a epel!ene s! eeie lueuaoeldal ou lI -ease luouaoeldaj algei!ns a aleool of pauuoped eq Isnw
ens aps pue I!os a SIMOd 04i to ejn!!eJ uodn ears lueweoeldej algepns a AJ4u9p! of pelenjeAO U9aq low se4 el!s e41 p
posai lsel a se pellelsw aq Am Iual 6u!p14 a 'A6olou4o91 SIMOd ul se0ueAPe 6uu1eq pue palelllpNel
ueo walsAs uogdlosge pos 94111 suotM.w!I i!os jo/pue Ioeglas of anp algepene Iou sl ewe luaua0elde; algel!ns v p
'Bouenss! l!uuad nayl to ewq eta le pale
m A M_
Isnw sualsAs luawaoeldaa eaae 1uawooeldej e!gelps a 4s!pgels9 of uogenlene Opp PUB 1109 mau a ml
Wlull lueuaoeld9l a4l palod of aniled 'sham pue sawl )oi 'anpruls pesodod pue 6ugs!xa uaq slpegps
al Aq uodn peBuyyu! aq low plno4s PUB uorpedwoo pue eauegnlslp uaq pepalad ag pra4s ease luauumldal NI
s uopolo9ge pas Waureoelft a to uogeool a41,ol Paz!pln aq Aew pue pGwnlen9 uaaq se4 eae luouaoeldel olggns V ❑
:walBAs lWunoBldai
um 9poo a ep!AOd of 'ue)pel eq Isnw a 'ueeq 9AN senseow 6uIvAonq e4l paj!Bdai aq Iouueo PUB q!Bl SIMod 041 P
NVId AON3DNIJ.NOO
'leualew pips p9u! la44oue to laAel6
!m POilg a0eds PIOA a4l pue P9AOwaJ slanOO n941 to PanowaJ PUB paleABOxa aq IIe4s sl!d pue sNuel Ile '6udwnd la$V e
(ladwnd) loJerado 6uioru*S s6eldeS a Aq to pasods!p Aladoid PUB panouaj aq pe4s spd PUB sMuel Ile to slualuoo a4I
pole" s6up9do ad!d peuopuege 241 pue pepswoos!p eq Ilegs suielsAs uogdjosge I!os je41o PUB spid 'sMuel of 6uldld pV
apoo aAgeAs!u!wpd uisuoosM'CEeB wuao 's 41w, eoue!Iduao w peuopuege Aleps pue
d sl walsAs a4l ImA ensut of UG4el aq lRgs sdals 6(j!MolloJ eta Bowes Jo 1no ue)M Apusumiad s! Jo pue 414 S1MOd 841 U04M
1N3NNOONVBV
'a6iBips!1D auuq >auayos JOWM PuB 'suoduel 'sluanpos 'suiMdeu Aelues 'sappgsad 'spnpod 6uguled 'sIlo 'suogeolpew 'sdems
sappggla4 'seseek 'aulpse6 '96UIW alge*BOA PUB lm9 'oftWs!p (dwnd duns) uleip uogepunol 'slel 'sluepalwmp 'ssdegr
.Mwp 'siesealBap 'sgams uolloo 'suapuoo 's4ng 9lleie6p 'sad!m Aqeq 'a0gopgglue 'sppe :ualsAs uopdio$w 1102 Pull 9*Ml
i0A mgjo Bill 0416wpd PUB ao(jewlopad NJ anodw! Aew ueafls alemalsem a41 uro4 6umollol aw to uogeuiusle to uo!pnpaa
-eam uogd,osge pos opei6•le ,o punow Aue Jo ado!s UMOP 100141 U!41!M Me
du= m gnlsgP asgmle410 JO 'JOAO fled to anpP low o(] walsAs uogdlosge ups N) JO s>luel JOAO sep tleA )fled 1O anup IOU op
aoepns OA!lelllyu! 9411e uazwJ OJE suog!puoO Ilos ua4m inooo IOU pe4s do pals ualsAS
jai dwnd 941 ulgl!m palolsal ale slanal luanWa Iewlou pur. slorlu00 dwnd a416ugeledo Apenuew u! Ismse of laugelu!eW S1MOd 10
ld a pelum m dwnd a41 op,amod 6uuolsei o1 mud (jadwnd) lolwed0 6up1AJ9S e6eidaS a Aq Panou>er>luel dwnd 941 to sluBluoO
a4 uogery!s sWl p!ona of 'ualsAs a41 of o6ewep pue lLangla to a6iNoelp 9oepne io cimpeg 041 u! 4nsau Aew le4l peopano
>neo asop o6jel quo ul ualsAs uogdjosge I!os 04101 p96je4os!p aq Ilm Jalemalsevm ssaoxe 941 se 'POPuawwooel pu si suoglpuo0
repun aMod to uoge olsai to do ps1S sompeJ dund of anp m dnpels of mud slanal ralem46!4 leuuou enoge lly Aew "uel dund
asn of joud (iadwnd) }oleiod0 6upwaS 06B1daS a Aq PanOUeU (s)NUOI e41 W 64UGPMYj N4 ane4 P8p9lep
Ogenueou00 4614 11 'UalsAs Uogdlosge pos 941 96euep Jo/pue sswcd luewgo-q a4l opadun Aew le41 Rawipae a speo!u p
a sluanlos 'spnPwd 6ugluled Jo 93u9sad 841 lo) (s)W8l luaugeall )10040 SbWd OW to esn of joud 'uo!pngsuoo mau lod
p 08Rd NOI1Va3dO ONY do laYls
_ of
START UP AND OPF~RATK]N Page
Fa• new construction, prior to use of the PO VTS check treatment tank(s) for the presence of painting products, solverds a
chemicals or sediment that may impede the treatment process andior damage the soil absorption system. If high concerdraffo
detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use.
Pump tanks may fill above normal' highwater levels prior to startup or due to pump failurm. Start up or restoration of power under
conditions is not recommended, as the excess wastewater will be disohargee to the soN absorption system in one large dose caul
overload that may result it the backup or surface discharge of effluent and damage to the system. To avoid this situation tie
contents of the pump tank remove: by a Septage Servicing ODerato" (pumper',, prior to restoring power to the pump or contact a P~
or ?OWES Maintainer to assist in manually operating the Dump ccM,ols until normal effluent levels are restored within the pump ta,
System start up shall not occur when soli conditions are frozen a! the infiltrative surface
Dc no! drive or park vehicles over tanks or the soli absorption system. Do not drive or park over, or otherwise disturt or comps
area within 15 feet down slope of any mound or a<.-grade soil absorptior area.
Reduction or elimination of the followfnig from the wastewater stream may improve the performance and prolong the life of the tre
tanks and soil absorption system: acids, antibiotics, berry wipes, cigarette butts, condoms, cation swabs, degrteasers, dada'
diapers, disinfectants, fats, foundation drain (sump pump) discharge, flit and vegetable peelings, gasoline, greases, herbicides
scraps, medications, oils. painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge.
ABANDONMENT
When the POINTS fails andor is permanently taken out of service tha following steps shall be taken to insure that the system is p
and safety abandoned in compliance with s. Comm 83.33. Wisconsin Administrative Code'
• All piping to tanks, pins and other soi: absorptior systems shall be disconne;ted and the abandoned pipe openings seated.
• Tne comens of al! tanks and pis shall be r ernoved and oropeeriy disposed of by a Septage Servicing Operator (pumper').
• After pump ng, all tanks and pits shall be excavated and removed of their covers removed and the void space filled W.
.n . .J. J
ol , v. OiIV\il>i IIOrt J'J.i•J .1161e 1G1.
CONTINGENCY PLAN
It the PONTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code cor
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the toration of a replacement sod absorption s
The replacement area should be protected from distubance 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 tt8
for a new sail and site evaluation to establish a suitable replacement area. Replacement systems must comply with the r
effect at the time of their permit issuance.
0 A sultabie replacement area is not available due to setback and'or soli limitations. If the soil absorption system can
re`,abMated and barring advances in POVJTS technology, a holding tank may be installed as a last resort,
0 The site has not been evaduatec to identify a suitable replacement area, Upon failure of the POV%?S a soil and site eve
must be performed to locate a suitable replacement area. If -1o reoiacernerh area is available a holding tank may be instathe
last resort to replace the failed PONTS.
❑ Mound and at-graoe soil absorption systems may be reeonstruced in place follo.wne removal of the biomat at the infi
surface. Reaonstructons of such systems must comply with the rules in effect at that time
WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTA!4 POISONOUS GASSES OR L
_ SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK LINDER ANY CIRCUMSTANCE. DEATH
RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE
ADDITIONAL INSTRUCTIONS:
PONTS INSTALLER POINTS MAINTAINER
Name 'TL_ i ~ r K Name
Phoned
SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY
Marne F Name KI.?N
Pmone Phone
This document was drafted by are stags of the Green Lake. Marquefte and Wmshara Ceeray POWTS regrAidwy ag•ndcs in ewrioance with L
Comm B322(2)(bX1Nk)&(f) and 83...4(1), (2) & (3). Wises w&Adrrknistrative Coke,
ST. C'ROIX COUNTY
SEPTIC'rANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
OwneriBuyer W GojOhe.y $ 1,w4
Mailing Address 2/Z q ISM \0 LV► r OMAtif)Y) VNl lX -
PropertyAddrke 2 _~-1y1_~_y
(Vet'fica%on icquacd from Planning & Zoning I>zparana:[ [or new co~s[ruttinr..)
City/State Parcel ldentiCrcation Nmrrber 1 ^ ~lt'
LEGAL DESCRIPTION
TN R~W, Town of
Property Location NC 1A,
Subdivision Plat; Lot #
Certified Survey Map # Volume Page #
Warranty Deed # (before 2007)l%olume , Page
Spec house ❑yes❑no Lot lines idrr•.ufiable ❑yes❑no
SYSTEM ]MAINTENANCE AND OWNER CERTIFICA'T'ION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Props'
:nainmriance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 St Croix County Sanitary Ordinance.
The property owner agrees to submit, to St. Croix County Planning & Zoning Defuumseat a certification form, signed by the
ouret and by a master plumber, loumeyman plumber, restricted plumber ore licensed pumper verifying that (I) the nn-site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pimping (if necessary), the septic tank is
lrss than 13 full of sludge.
Ilwe, the undersigned hive :ead the above requirement and agree to maintain the private sewage disposal system with the
Standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources,
State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. r'mtx
County Planning & ~mrmg Department within 30 days of the three year expiration daft.
Vwe ceryfy that all statements on this 6 nr are true to the best of my/mu knowledge. Vwc anti arc the ourer(s) of the
property descn d above, by virmc. of a Warr Iv decd recur in Register of Deeds OfLce-
Number fbedf6mm
L:RE O PLICANT(S) DATE
• • ny information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.'**
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey nap if
rctcr ice is urade in Itse waeuuq deal.
(REV. 04/12)
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RECEIVED i tT
Department of SOIL EVALUATION REPORT___; #1840
S S ► Safety and CC I ~ 60rdanoe with Comm a5, 1A'is. _Page - 1 _ of 4
= Professional Services Schmiff Soil Testing, Inc.
F~ 369HDF4DNKPNW
ST. CROIX COUNTY
Attach complete site plan on Mica ij},Fn~-rt ,tt~fr@g n size. Plan must - fit. Uroix
include. but nor limited to- vend horizontal reference point (BM). direction and . I 1 r
percent slope. scale or dimensions, north arrow, and location and distance to nearest road parcel I D
.
Part of; 4(041 1-90-Sa nq
Please print all information. Rev, d By Date J
Personal information yo.r provide may x used for secondary pwposes (Privacy Last S. 15 . nn (1) (ml) . l2 Z7
Property Owner Property Location / C T
Steward, Frank & Michelle Govt. Lot E1/4, W1 . S35, T30N. R19W
Property Owners Mailing Address Lot # Block # Subd. Nam or CSM#
1224 Bass Lake Rd ~i CSM Pending Approval
City Stale Zip Code Phone Number City Village Town Nearest Road
Hudson WI 54016 715-441-0541 St.Joseph ass Lake Rd
New Construction Use. Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
Replacement Public or commercial - Describe*
Parent material O_u_tw_ ash Sand (Burkhardt Series) Flood plain elevation, if applicable _ NA_ If
General comments Area,s suitable for it oonvemidna' system wiht a 0 7 gpdisgfl vale- Possible system elevation for Area 1 Is 96.38' Slope e' area is
and recommendations g~.
~x
Boring
1 Boring #
Pit Ground surface elev. 101.38 ff. Depth to Inviting (actor _ 98+ in. [Soil Application Rare,
Horizon Depth Dominant Color Redox Description Texture Structure Consistent Boundary Roots GPD,h_'
in. Munsell Ou Sz. Cont Color Gr. Sz. Sh. •efat 'E##2
1 0-8 10yr3/3 none sit 2mgr mfr as 2vf 0.6 0.8
2 8-17 1 r4/4 none sit 2msbk I mfr gw ' lvf 0.6 0.8
I -
3 17-24 7.5yr4/6 none grts 0s9 ml gw ! lvf 0.7 1.6
q 24-98 i 10yr5/6 none grs Osg inl 0.7 1.6
---r - -
tl
F Boring
Pit Ground surface elev. 101.38 II. Depth to limiting factor 110+ in. 'Soil Application Rate
Honzon Depth Dominant Color Redox Desenplion Texture Structure Consistence Boundary Roots GPD111'
in. Munsell Ou. Sz. Conl Color Gr Sz. Sh. 'Fff#1 'Ee#2
1 0-9 1 3/3 none sil 2mgr mfr as 2vf 0.6 0.8
t
2 9-14 10r5/3 none sil 2msbk mfr - 2vf 0.6 I 0.8
Y gw
3 14-41 10yr4/4 none sit I 2msbk mfr gw 2vf 0.6 0.8
4 41-48 7.5yr4/4 none grsl 2msbk mfr gw Ivf 0.6 1.0
.'S 48-86 7.5yr5/4 noe grs Osg ml cs 0.7 1.6
I- - i
6 86-110
10yr6/4 none s Osg ml 0.7 1.6
' Effluent #1 = BOD,> 30 < 220 mga and TSS >30 < 150 mgrL ' Effluent #2 = 6013 30 mg1L and TSS 5.30 mgrL #I t,
CST Name (Please Pont) Signature. _ CST Number
Thomas J. Schmitt 227429
Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number
159572nd St. New Richmond. W154017 10/14/2016 715-760-1978
I
Properly Owner Steward, Frank & Michelle Parcel ID # Parto_f_: 030-2011-90-100 Page 2 of 4
Boring
F Boring # pit Ground surface elev. 99.88 ft. Depth to limiting factor 96+ in. -
- - Soil Application Rate
Horizon Depth Dominant Color 1 Redox Description Texture Structure (Consistence Boundary Roots GP_D_ .+tf'
in. Mansell Ou. Sz. Cont. Color Gf Sz. Sh. T111#1 - 'En#2
1 0-8 10yr3/3 none sil 2fsbk mfr as 2vf 0.6 0.8
I -
2 8-24 10Yr4/4 none sil 2msbk mfr gw 2vf 0.6 0.8
3 24-30 7.5yr4/6 none grsl 2msbk mfr gw 2vf 0.6 1.0
4 30-36 7.5yr4/6 none grls Osq ml cs lvf 0.7 1.6
i
5 i 36-46 7.5yr5/6 noe grcos Osg ml cs 0.7 1.6
I ` r
0_.7 1.6
6 96-96 I I0Yr6/4 none qf5 O~ MI I 011 U Boring IS fa
❑ Boring # Pit Ground surface elev.
141 Depth to limiting facto y~ in.
Soil Application Ralel
Horizon Depth Dominant Color Redox Description Ta are Structure Consistence 136undary Roots GPD/fl'
in. Mansell Ou Sz. Cont. Color GL Sz. Sh 'EII#1 'En#2
I
I!
I
Boring
Boring # Pit Ground surface elev ft Depth to limning factor in
Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence BoundaryRoots GPDM _
m. Munsel Du. Sz. Cont. Color Gr. Sz. Sh. T"i Eff#2
Effluent #1 = BOD 30 220 mg)l and TSS -30 - 19,O rngr; ' Effluent #2 = BOD, 30 rngiL and TSS - 30 mgt
fhe Oglp urtment of Commerce is an equal opportunity service pro%ider and employer. If you need a,si,lanec to access sera ices or
need material in mn alternate tirrnr.;l. plcusc Contact the dep:Ulmenl al 608-266-31 i I it Ill'
liel -I.11 71-1, 9lunln `+aiTr:.V, :
Page 3 of 4
Conducted by: Conducted For:
Schmitt & Sons Excavating. Inc.. Name: Frank & Michelle Steward
Thomas J. Schmitt. CST 227429 Address: 1224 Bass Lake Rd
586 Valley View Trail City, State, Zip: Iludson, W'1 54016
Somerset, W 154025
Phone: 715-76D-1978 PID. Part of: 030-2011-90-100
`g'v uro Lot No : Q CSM Pending Approval
Date _'r7y- 91 yll~_ Legal Description: NEli4 SR'1/4 S35 T30N R19%'
Backhoe Pit Township, County: St-Joseph, St. Croix County
A Bench Mark 1 El. 100.00' Top of 2" PVC Pipe
A Bench Mark 2 El. V-01VTop of 1 114" Steel Line Point/Lot corner Pipe
Slope= 8%
Scale 1"= 60'
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amp- 1,= aMt
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63.7 ?9. eb,
5,79.97
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