HomeMy WebLinkAbout042-1076-80-040
m+><as- Dqc-mrne:,Ia::on-ire'ce PRIVATE SEWAGE SYSTEM n' $t Croix'
Saf2h and Buieinlg :)I\'F I'Jq
INSPECTION REPORT ;an rr.vn,,.cv 615312
GENERAL INFORMATION ;ATTA: R I C' PERMIT,' ,.L,, an iC r+,
Pc s.nN nd:n nrabai you grc'.adr' mr: o. ...c:_,u .ecgng3•V F. mcSC ''-rar.9 :u~ f. 15 C., I'.Lmi-. ;
Gregory & Angela Plahn ma;r TOWN r. Is. NF
N OF WARREN 042-1076-80-040
3V Ed,, ms4 EiN E cc .?.1 Ce~:.~r of $cr'.um'IvwWF,anpe.'MaP N,,
28.29,18.436A 04
TANK INFORMATION ELEVATION DATA
TYPE MANUrkC:.'LIRLFI CAPAC;I iv ,,S 4,I1 I~'IN BS d ~ FL HA
Sept" r bcnchinare I ,~O ! vl. 5
Dosm.9 AI: 3141 - ,
r~ Y ;tr/ V < 170
Ae:ano;I Rldq ii!•In•i ,O 17 J0
MO!11nC Mt Inlc: O I Z 11
U 0 /
JV-lt l_i,li i!!
TANK SETBACK INFORMATION
i Tr,NK I':' FV. VA [ I [3_DG. J 11 A.n lg13ke HuAc. Dt trt`e' - - -
i I
D'3Ohum
15 JL0 I
I leadertFdar'
~craG9o Dix. Pipe
HOligx; j HO'l bvslem
Final C;IaeC .OQ -f
PUMP/SIPHON INFORMATION
%Ianufacture' Demand 81 '.OS,.
aP1v, ~ ~.l E_• ' )D
` ouvi Nu er -
?E,H t W FIL lom-r OSS Sr51s n ieil I7 i r
rorcernac,
SOIL ABSORPTION SYSTEM
BED?RENCH ,igtn -l / enq:n br. lu r - PIT DIMEN, 0N$ 'A - 1, read" ly LrOw xPP
DIMENSIONS f / - /
SETBACK SYSTLNITC1 1P, FL r,3LX 'aN-I I ill"F SIR=AM LEACHING bla-.utn:.nrr:
INFORMATION CHAMBFR OR --1->/-
',•pc y •,nrn f,-/ 1 UNIT f.lnnix N.", o_r
DISTRIBUTION SYSTEM
: tU:u told ❑ nL:tor - r~cle vie r1-~Ir r d-IF qr h,me
Lvv ngrj
/
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systoms Only
Gout :eC' -,cull we rv G.: at''v / rearo'_' , 1 Ixr: 1.1~..'eG
tiea1 ch r.'OI Iied. i emt Eq4 ! T+p :nil ( yu vr> - Nc
COMMENTS: include cone dlsneixencros, persons present el:. t lnspI a nsoecnor K2
Location. -12111
t> i+Jt RNt Desulpllon - I
3iu4 sewer length= J
- a,nourn O' cwcl = 7
Pidh fcvtS10n r<elUlfe:1ti r~cs rr NO
U5- other slue Iur ddnnal iniortnalluh
ao
gate insury,rnrs 5xwawr~ ;.en No.
10 in. 3. ,
Safety ano Buildings Division -
B f t^: :201 YJ,VJashin on AvP `-y - _
P 9t - Box ' . t.9 9vl 1. p pcmi- Nllvi•IC UC x ri7 n
va\ S lvlalls9NWI 53 v j'2
vn i I~ III L .1 i_ ,
- -
j Sanitan YurmIt Ar1b licat1On S"~eT rSaGr:i tm n -j
't. a ~tdan a ann `W' I ll1 i aS ry , I .F.:. r Ic ,the n ~ / f..}-
IS renuiredn xf+ tn..l z zrrt t a}e •p'iav ownacutal ul: LtL .f _ _
P~ .ut \ to z;, h y 2'Rmy tP, ue-uWrn:C pl!N' 'ti are mbm u : [o PmjaK rWdress If d:.lc¢m tEm Irsilin~ atj
the Mpavl nY Sate} and T f i..,,a! le I t
r.d 1 i;lmalon nu p pride aa, x u.d :m Lc~ ni x-s
ItAJr$.t anlan_..rtl'If T t s\_I~A cy!i ¢I
( vat,' licabon Ltfurm noo Mews rmt Inlol merian - / X--~ J/~A S / _
rIwo s1.:cnc y sI %I
~1 _L!l_'T7_II
L81 I 1
C mpem--[lW''n''dr , blaihul,
N1V FhOKA l~~:arl+r. T
0i ~l Lot
- ) zip" .de
$m"m L rj
Ii '1'.I,c of Building (check all tbat apply f;; P,
' 5Chd YL!04 Nacre
_ I:''fer~~\\)wne] Ucsu'il>•.I _ _ _ MA VW:;ir/r(//~~ _Village of _
s I _
aWn of
11IrPParmiC t('beck uolh cloxnnc a, (f-'o-nt lete lm UT
A- L b!C~__ -Sd~VL~- cli lfap3yh-nblrl _ _T.-Q~
rw Yr.:cm Rcplacn. y.-nct I.j 1rr vrll'I-.king'. 9,k hylacanuel .
. I 'mh (i;irht.!„ilA.ItlldbnL !f. xisiiag $VStC1il l:expizinj~
k -TL P Illl. FC(IC r. 7
I kt,v,swc I - - -l
. - U f Ily.. cf' I 1 u'r ; ?enna ITarsfn (c 4w I = err az Pcam:'.wnh:z zed ::ak ILwrd
k Tc Fapr
_ Cher
R' TtTr of P(]tA i - I C.. / 3.__L .ALL
- _Pe+retR7lrvice: !(haA ali that aJ!ph i 7`
Vv ressu er Ir- nr•uad PC^i;LGI 1 Lz m-.,m~ _ -
~i 4Krack r. ]-sta a. :f nitaMr wd IIRlaUnd v.. ofsn,labi,'dfl II}(-' Iy
11 las , lny Y•hcl 1 PCr)el :.tn f t 7L~ +..r! { V .R 4V, _ P m _ _ Hemvarnrnl L4 i mlainl
t Thu m kri rearm t Alm Informanuo - - - t - -
s1~ Flow +pd Da N
L
s,c hegmrrd <(1 fh; ctsal ~.a
P :S^~.ca i>Il Svstar Elm'souo
- LT _ ~ 1c' L 7
t1.'I'2uk info _ Cap m.U I Total `I i t::mUfa.:min
how lacks Gaheas 1_mts J
arse-.r Taub \ AAA'
N tl RespnnRlhAm' Sta[eme - L the aoalrm; nr a mr res umvDibl hn Itutallamm of Utn PoW- 1'c
la fw s Ra rn 1 : - - - shown oa the uttacbed place
1 t SilJxrluc 11P, b1I'i;$Vartcer klsuus, I'bpne VmoSer
i
Y ul hr✓ mom ss n u Stain - tp!:odc'--f
t 111 (ruorv bepanment I sr On_fy` ~ ~ -
'+PP s"~- cape-, 1 "tMI re: I Date i ac2
Lsaiur: n: $icla:urc
f e. r. f; l ra!~ I Sid 91 i
IX. C.unditi htuns jjUr U1R
il~ Lank ata%kr to?pproval
1.-
05yter:¢o cell !duet all be
aJa parmar.3yement plan ?-unan -11, u,nbe. 3~ ~Cp~Jk4r-Nett
-Z. Al Mt[ .k rKt.h£C^",S nnl>I Ll. - .1:61. 1
IM per>yt kfbl'• olrl•r; ;PI -r. e jG/✓
nnacn ru mleylr!c platy fur rD<>)-ors and aahmil m lhr tin~p uolr nw Vvpcr nm le> thou R tL s i i mrLw iv :ae - -
adU-0 y8 S R. ;1 r°i
_+il i`cs' ',rnd S\ t ni PL( ?T N-
PRO,R=.t_'.I Grua PlL;'rl :1IlUR1;S> 45'; 3weoird D-- hu^v;!ar. t^J 54,'"i;
4 fVl^I 1 i 4 S 28 2G V!R 1F 11' 'IT IbY\ War -ir
('(lUN'I'l.ciL ,')B'JfX
SYSTEM 1 L4'I AT'IO\ 4' beim orano --4 ' Q
It411 REDROON1
CONI'EMIONAL X*,, CON%UNI]ONAL 1IE'1 HOILDIAC: TINA
MU( ]h SCP 1006 CiAlons 1,11"1 'I,1Nh S(Z1. POSE TANK SIZ1.
'1( T ; 1\li Sl/.1
I IOLDIA(;'f AN6 SIZE 1_0ki) RATE %RSORPT1Oy Altt.el 651 t; of chambers 3~
AENC'HNIARL I.R.P. vJ.91KOU! Ibun;ation N4S(-Mr El UN,I'r1ON loo' Filter _,ifctiire Fihc-T.
❑ RORI:IIOLF ~ \I'HA Il.lt. P. same aS bC'IL'h'n a'i:
prone- v l,ine
t+ • Quick SCUxi,i;
wnl"'G ) elf AreL
"G t^'_rp(tn of cnd caps
4' Lops
- - 4.. 'ivCdCii a: ;~Iiien. Flc%'aiR1❑
Scale = 1i4" = 10'
s-~
60
s~ SIoDc
\ ,ave
6-1
Qp 4
13 .
(r
66' ccl:; with r. 'Spacing
WC
1(Y'
1T
?3 Prilaert_I Linc
,0 H.\1
Pro .
Bcdrr,r>1 t s
L a ~ir.< <lall n- AST M SDR IQ '4. within
I i?I lal nipino shat h, AS I'M '91
1 'inY
Property Oorner--__ Parorr.100-- Page ---of
Pit Ground surface elev. h. OCpM to lirtdting factor in. Srxl Application Rate
Noncom Depth Donawnt Color Rodox Description Texture Structure Consistence Boundary Roots GPD/If
in. Munsue Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Z
r~ Boringa Boring !n~ l Y -
U ❑ pit Ground surface elev. _ It. Depth to limiting factor in. Soil lio~tion Ra's-i
Horizon Depth Dominant Color Rodox Desmpeon Torture Structure Consistence Boundary Roots GPD/lf
in. Munsell Qu. Sz. Cent Color Gr. Sz. Sh. 'EB#1 'Eff#2
i
[ Bourg # E] Boring
U ❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil ication Rate
Honzon Iepth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPO/ff
m. Munsell Oki. Sz. Cont. Color Gr. S7 Sh. 'E"I 'Eff#2
I
Effluent #1 = BODr > 30 < 220 mg-1- arxl TSS >30 < 150 m91L ' Effluent #2 = BOD, < 30 rng+L and TSS < 30 mgt
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need matenal in an alternate formal, please contact the department at 609-266-1151 or Try 608-261-9777.
SOD r pt. x A^,I.
property Cwne, _ parcel ID Page _ of
# ❑ Boring c/y~
P,: Grtxrne surface elev. YI-~_ h Depth to limiting tacta in.
Soil 7-tlwl Rate
HOnzon Depth Dominant Ca Ream Des Dtfor Texture Structure ( Consistence Boundary Roots GPD&
m.. Muriel Ou Sz Cont. Caa Gr Sz Sh. 'Ef•#'1 'Etf#2
- J
1 +UIl2
J 1
C Boring # Boring
LJ pit Ground surtace elev Y, Depth to irmltmg factw in.
Soi~. kpplicaiior. Rate
Horizon Depth Dominant Cola' Redox Desatpbon Texture Shupture Consistence Boundary Roots GPD/N'
I in Munsell OL Sz. Cont. Color G. Sz. Sh. 'Eff#' 'Efr#2
i I
I
❑ Boring # C Boring
pi, Ground surface elev. it Depth to limiting tactor n.
Soil Katun Rate
Honmr. -lepth Dominant Caa Redox De p4<r. Texture Structure I Consistence Boundary Roots GPD&
m.. Muriel' Ou. Sz. Cont. Color Gr. Sz. Sn. 'EB#1 ) 'E1f#2
I I i ~
I
i
Effluent #1 = BOZ, > 30 < 220 ngr- and TSS >30 < !5G mgrl ' Muent #2 = BOD, < 30 rngfL and TSS c 30 rng,'L
7 rte Department of Commerce is an equal opportunity service provider and employer, If you need assistance to access services or
need material in an alternate iitrmat, please contact the department at 608.266.3151 or TTY 608-264-8177.
sanxitura a,m,
Soil Test and Svstem PLOT PLAN
PRO,fEcT Grea Plahn ADDReSS 4,96 Bluebird Dr. Hudson Wi 54016
NW 1l4 NW 1146 28 IT 29 N;R 18 W TOWN Warren COLN'fv SI.CROIX
SYSTEM ELEVATION 95.0' :94.8' 4' below urade 714!19 BEDROOM 3
DATE CONVENTIONAL XXX CONNENfIONAL LIFT HOLDING TANK
1000 gallons IAFf I'ANK SIZE DOSE TANK SIZE
MOUND tiI?I''lIC '1':UK tit%li
IIOLDINC TANK SIZE LOAD RAl F .7 A65ORI9ION AREA 651 # of chambers 32
BENCHMARK walkout foundation ASSUME ELLVATION Ills' Filter Lifetime. Filter
❑RORFIIOLE. OWE1-1, same as benchmark
A No pl'opcily Line
Vent
>6" Quick4 Standard
of Cover Leachin; Chamber
with 20.0 R2 of Area
5O' S.6ft^2!pair of end caps
12 4' Lone
74„ Gradr at System Elevation Scale = 1/4" = 10'
B-2
60'
5~'; Slope
35' Vents
B I
90' L15
-31
B
30'
2-3' X 66' cells with >3' Spacing
(io'
10'
324' property Line
?0 R.M.
I'ro 3
Bedroom
House
111 pipin, shall be ASTM SDR 30/34, within
10' of tank, piping shall he ASTN7 F891
1 I _th St.
I~ ~~l ` Iv ~OU l~ I 1
~amor" - i'nunts
i~~ \
x e,eh ar O Z
f Ks 201 'u Washington Ave.. P J) Sox ' 162 ,r¢;rtman' Permit Number eta A rilkd i • (A. i
'r~ PS ' lionY 21 N4 h9a~is04 5?'L'-i132 .
a o ,
C )pile' t1011 Stmt TranceqItI Numbs
n a- ,mdm ulm s15 W. in .c
n .~b'nt ico ~f tl;is t II. W We ~,ytcp i a erzvcran<nhil cant Il.~ AA ~1
r. trau.mdo art ai,wtpasA`tta1, P-..ut Note. bw totms fostate-oanW POW:N aresubmmcdm
s Uvx u -tt i sm-'}'^td 'r dcssl>nu $e'alc ! anal n,t t(mv1 Pn?jxC ddR ress :5snan @au trading addresj
'Ttic'~tOS :r ~~tcrwth 111C 1 tiseta C vu s s L-[ i s , loo , ou Prs:dc ma}' oe Escd for srcvnaa
J AP hcahon Information -Please Friwt All IpfurmatDo
r.. pan Jwos s Namc - j>97e
rtoperty(G~wnel's-ssgaiimg .9ddresc O rIJ r4 " V
/ ~ ~L.ei Fs I ~ / ~ ?4upEiy I,.auen
-/-~.,-✓~.e G-vt lot
71P t'_•xfe f?.noc Number ~ ~ ~ / ~~[t Sm. ion
r I (ciccic
r
T'pt uf Building (check all that apply] Z'
L Namba ,M Sylnmsjca Nam_
D k Ao J -y
Nablic•'Cunlutaa~l- Uec-rbr s:
S[.k ilwnd Yy:rix r _ _ II.• !t i-S f-Z"9 ❑ tillage of
-
Z 1 6YYY312>wn r i
IIL'Fv bmk only un box on fine A Complete line A if ap - ilel
' to c s1ESl I Rqu en
air:n
ro: it rr '.:•a!v --r- iJdln 17ruliti:xian to Fxirmg SysL•-n Iexpla;n;
~n ~7-_I yen:.1 n -new:r'
+rF C :l: _ Pr-nl_ ::rasfa n hew' Lisa P ViNtt Pemit Numba and Dave Issue!
~iorci < ost m I l_f~{< 1~p l _ ~nJ!~/ ,der'
tug r -l ! V=~
C-4 T~ rum ul.Desm.v l it ' dmsd V .Duna -f u111 w1d--,eta ref susiablq xi'.c Ur Pc Q:.:rpw-n i xeivl I _ ~ S
_ _ teuc:mnrnt:~es•:ce ieaplalal_
S Un~rxalTrea ent
4rea Informer - - -
P.) IkncS d..oyG:::m ~r zp.lsf' U~,crsal y /'.ice/
J ~ - ~ ~ f~ +tra Rcyuue~, rspc.yl sea d (1f) ~ g}slem E)cs;un o
t5e
t 1 1 abk Info Ce a II ir_
s ~l rs fou. I eof raudacwo T-
_ :ia.l ra lini6
1 rv~ wis ~wtTsl n ~ I Y _
al s Hnl'L-_.x,. I. _ IW M,.f`-~'/'- OU I r I v L AI
- - - _
V
II. Statemee/nt-the undersigned, axx a ponsib1bt,, for imlananon of the PON'TS s1wwo on the attached plane
,,I Ni
hfP:'41PRS Van.';a Flstw-cc PLUne Number. .
2z~~~
~Irm•ha's.4daess lS7ec ear Sta,c 'ly •L, .IC's - ,
6'III. ' -only rl)epartment l sr Only_
4pptmrd ] ynPf'+cr Permi: Pec i Date sued Lssai'l grnl Siva-set -
x:I:41S 5_~ • Sid l~
IX. t oodi0 asnus m
' Di ypproval
-
4c' i n.
uisr.ef: cell rust all be gh_.ir•8 " _ 'it~ f~ Y,2. ~L~JC~J~ .
:ts per ,ear ayement pizn rc ,Ioeq W ,;IWn00-
'
2. AN Mltwk re."i"P.^en.4 1lYEit hu r-. C.P.. a.( :
M PW l *XUS ale!! i :R(1Jk10H.
- .urnen u, coral•Lte playa fee rAe pre ,ea mb r,: nv r_v o°) aul. a I,yrt uo[ In> n:an S to c 1 ] iv:>tn w v¢ - -
S3U-6398 ;;t ::i l :l
System PLOT PLAN
PROJECT Greg Plater ADDRESS 450 BW:wc Dr. Humor Wt 54016
NW 1 .'.1 M 1 i s 2E 'T 29 NIR 18 N- TOWN 1ti'3rrOr
coo!:T} S-. CROIX
SYSTEM E.LE% AT'fON 94.C '9 S.8 3' below Prude 5'20!19 3
BEDROOM
DATE
CONVENTIONAL ))O: CONVENTIONAL LIF'C HOLDING 'CANE
MOUND SEPTIC 'LANK ti['LE 1000 UEdbr.s LEFT TANK SIZE DOSE TANK SIZE.
.
HOLDING TANK SIZE LOAD RATE .6 ABSORPTION AREA 771 k of chambers 38
RENC'IINIARK A'. R. P. NF lot cx.-ier
.ASSt'MF. Fa.t:NA'IION 100' Filter Lifetime Filter
❑BOREHOLE O WELL -II.R.P. Sameasbenchmark
B.?\1.*
60'
1 tr
L'-;
_ . ' V -S' Cell: Nk.th sna':ine
>0' Vew;
B
10' Scale = 1/411 = 10'
13 ' 90' 3 0'
ST t
'0'
Pro 3
BedrOOM
110use
ent
Qui 24* Properiv Tine
t,. ck4 Standard
of'C-ovor LeachinoCharnbc-
with 20.0 fC Of Arca
~.Ozt^2lnair of end cans
4' Lone
Grade at Svstem Elevation
i
7 AI' piping shall be ASTb4 SDR '10'14, within
O F 10' of tank, aip+.n- shall. be A.STM F891
112th St.
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 5/20/19
Owner:Greg Plahn
Location: NW1/4 NW1/4 S28 T29N,R18W 785 112th st. Warren
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4-6. Maintance Contigency Plan
7. Filter Cross e ion
i
Signature _
License n mber #226900
System PLOTPLAN
Plto,ibx°I' Gron Plahn ADDRESS 450 Bluebird Dr. Hudson Wi 54016
NW 114 NW 1/4s 28 /•r 29 NIR 18 W TOWN Warren COUNTY ST. CROIX
s YsTE.N1 ELEVATION 94.01193.8 3• below c1rado 5.'20119 It 3
UnrE EDROON
CONVENTIONAL XXX CONVENTIONAL LIFT ITOLDING TANK
NOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
IIOLDING TANK SIZE LOAD RATE .6 ABSORPTwN, AREA 771 # of chambers 38
kk BENCHMARK V.R.P. NE lot corner ASSUME ELEVATION 100• Filter Lifetime Filter
BOREHOLE O )17?LI. «11. R. 11. same as benchmark
60' B.M.*
10'
R-3
2-3' X ?8' Cells wilh >3' spacing
50' Vents
B-2
10' Scale = 1/4" = 10'
20' B-1 90' 30'
ST
30
Pro 3
Bedroom
House
324' Property Line.
ji Ouick4 Standard
Lcachin, Chamber
with 20.0 F12 of Area
5.6ft^2/pair of end caps
Grade at System Ele
vation
3 4All piping shall he ASfM SDR 30134, within
1 12t1) S!. 10' of tank, piping shall be AS'I NI 1891
.
Cross Section of Infiltrator Quick 4 Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
` with 20.0 ft2 of Area per Chamber
5.6f1^2 pair of end plates To be >1' above grade
/ Finish grade elevation
Typical Installation 97,0•
Vent Grade Vent
3 X30/34 Septic Tank 3
S Lone t 5 I
Long
44 3 Grade at System F-levation
G' Grade at System Elevation
Spacing 5'
2-3' X 78' Cells
Same on other end Observation tube/Vent
At end of cell
A
B
19 chambers per cell
System elevations:
A 94.0'
B_93.8'
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page __of_-
FILE INFORMATION
t Omer FILE IN SYSTEM SPECIFICATIONS
(
C Permit # - - -r Septic Tank Capacity i ❑ NA
Septic Tank Manufacturer' "
DESIGN PARAMETERS Effluent Filter Manufacturer •Lfl0 NA
Number of Bedrooms - C NA
_)0 NA Effluent °ilter Moilel
Number of Public Facility Units - - - - - C NA
_ _.1' NA Pump Tank Capacity
f NA
Estimated flow (average) - -
sS kal/da Pump Tank _Manufacturer NA
Design flow (peak), (Estimated x L5) - -
! J
Sou Application Rate R2 da Pump Manufacturer NA
-
yaJdaytFt` Model
Standard IMluenf/Effluent Quality tMonthly average' Pump Pretreatment Unit C A
Fats, Oil S Grease (FOG) 530 Mg/L, C Sanu/Gravef Filter U Peal Filter
Biochemical Oxygen Demand (BOD,) <270 mg/,L C7 NP. U Mechanical Aeration U Wetland
1 Olaf Suspended Solids (t5S) <150 mgiL _
Pretreated Effluent Quality _ Disinfection
Biochemical Monthly average Dispersal Cell(s) 11 Other:
s) `'30 rng/t C NA
Total aOxygen Demand (BOO
Suspended Solids (TSS) -Ground (gravity) ❑ in-Ground (pressurized)
; -3 0 m g/L
G
Fecal Colifotm (geometric mean) CJ At-Grade Mound
X10^ cfuli DOml
Maximum Effluent Particle Size C Drip1ine ❑ Other:
+k in dia. C NH Other:- - - - -
lOther O NA
Other: - 0 -
`Values typical for domestic wastewater and NA
sepF.c tank effluent NA
- Other -
C NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
inspect condition of tank(s) _ At least once every. 11 month(s)
_ ears
Pump out contents of tank(s) (Maximum 3 years) U NA
When combined sludge and scum equals one-third (Y3) of tank volume C NA
I:rsped dispersal cell(s) month(s)
At feast once every:
S_year(s) (Maximum 3 years) O NA
lean affluent filter
- - Al least once every. C month(s)
_ _ ~
nspect pump, pump controls year(s)
L) ritorth(s) NA
& alarm At least once every.
I°lush laterals and pressure test t7 year(s) NA
At least once every: C month(s) -
_IL year(s) _ ❑
- J month(s) - - - -
At least once every
❑ year(s) C NA
MAINTENANCE INSTRUCTIONS f•1P.
'inspections of tanks and d estrict cells snall be made by an individual carrying one of the following licenses or cenifx;ations: aster
in include ; Master inspection • Restricted Sewer; POW i S :nspectur: POW-S Maintainer, Septago Servicing Operator. Tank inspections must
include a visual inspection of the tank(s) to Identify any m ssing or broker hardware, dentity any sacks or leaks, measure the volume of
Jombined sludge and scum and to check for any back up or ponding of afflue"l on the ground surface. The dispersal cell(s) shall be
visually inspected to check the effluent evels in the obse olification on of of the
rvation pipes and to chec:ik for any ponding of effluent on the surface.
The pondng of effluent on the ground surface may indicate a `ailing coed bor. and requires the immediate n fecal ground
regulatory authority.
Nher the combined accumulation of sludge and scum in any tank equals one-third (h) or more of the tank volume, the entire contents of
the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wiscons,n
1administrative Code.
Nil other services, including but rot limited to the serv,ang of effluent filters, meutarncal or pressurized components, pretreatment um N
acid any servicing at intervals of -*12 months, shale be performed oy a certified POWTS Maintainer.
:a service report shall be provided to the local regulatory authcnty mthm W days of completion of any service event.
Page of
START UP AND OPERATION other
cais For new construction, prior to use of the POWTS check treatments(s) for hthis presence are products or
have the d*micontents of ih1e
may impede the treatment process and/or damage the disperse I i9
tank(s) removed by a septage servicing operator prior to use.
System start up shall not oocur when soil conditions are frozen at the inftrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluend.
To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the
ef6uert pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels
within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact the area wrWri
15 feet down slope of any mound or al-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWT$:
antibiotics; baby wipes: cigarette butts; condoms; cotton swabs; degreasers; dental foes; drapers: d'sin ectenis; fat: foundation drain
(sump pump) water, fruit and vegetable peelings: gasdine; grease; herbicides; meat scraps: meditations; og; painting products;
pesticides; sanitary napkins: tampons; and water softener brine.
ABANDONMENT
When the POWTS fags and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly
and safely abandoned in compliance with chapter Comm 63.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shag 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
replacement system:
suitable replacement area has been evaluated and may be ut hzed for the location of a replacement sod absorption systelm.
The replacement area should be protected from disturbance and compaction and should not be infringed upon by requited
setbacks from existing and proposed structure. lot lines and wells. Failure to protect the replacement area will result in it* nod
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must con" with the ruled in
enact at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Baring advances in POWTS technology a
holding tank may be installed as a past resort to replace the tailed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. upon failure of the POWTS a soil and site evaluation
rtnrst be performed to locate a suitable replacement area. If no replacement area is available a holding taNc may be installed) as
a last resort to replace the failed POWTS.
❑ Mound and at-grade soft absorption systems may be reconstructed in place foilowing removal of the biormat at the infiltrative
surface. Reconstructions of such systems must comply with the rules in effect at that time.
<<WARNIN
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OP A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name Name
Phone = i_ r Phone L
SEPTAGE SERVICING OPERATOR (PAMPER) LOCAL REGULATORY AUTHORITY
Name 1 L i/I ` rr On Name rp
Phone - iT L Phone 71 - j b - b---
This document was dialled in oorpliance with chapter SOPS 383.22(2)(b)(')(d)8,(f; and 383.54(1), (2) & (3), Wisconsin Administrative Code.
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ST. CROIX COUNTY
SEPTIC 'TANK MAINTENANCE t iGREEm ENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer b Qi f r~
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Mailing Address _qY~ Dr~~J_,C
Property Addre-
(Verification required from Planning & Zoom Ra nt for new constriction )
Cin'/State. ion /
_ Parcel Identification Number f ~ /C7 i 0'
LEGAL DESCRIPTION
Property Location/ IJ'/< ,~%i , So . c' 7 , T Q T NR / ZW, Town of p
Subdivision Lot # .
Certified Survey Map # Vrltune C__ Page # t:?J
Warranty Deed # ) S J Volume Page #
Spec house yes no Lot line identifiable lsy no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
nmaintenance consists of pumping out the septic tank every three years or sooner, d- 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 systtmm. Owner maintenance
responsibilities are specified in §Cormn. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zootimg Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition and/or (2) alter inspection and pumping (if necessary), the septic tank is
less than 113 full of sludge.
Uwe, the undersigned have read the above reluircmmnds and agice to maintain the private sewage disposal system with the
standards set forum, herein, as set by the Department of Commerce and the Depar rant of Naturai Resomues, State of Wisconsin.
Certification stating that your septic system has been maintamed mnust bc completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statements on orm are true to the best of my/our knowledge. I/we am/am the owner(s) of the
property described above, by virtue of a deed recorded in Register of Dorms Office.
N er of bedrooms--
.s
S NATURE OF APPLICANT(S)' DATE
***Any information that is misrepresented may result in the sanitary permit being tevoked 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 map if
reference is made in the warmly deed.
(REV. 08105)
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Wisconsin DepaAF IE sional Services b = rl L r - - Page 1 of 3
Division of Industry $ ices
COs, r, , SOIL EVALUATION REPORT
96H7FV"40AM8
In accordance with SPS 385, V✓is Adm. Code Coun
Attach complet S CROIX CO T e g 1/2 x 11 inches in size. Plan must include. St Croix - -
but not limited to- I A20M f~' xomt (BM), direction and percent slope, Parcel 11)
6616
~scale or dimensions. north arrow. and location and distance to nearest road 4#Z- ~ (O Please print all information. Reese by Date
Personal information you Provide rt be used for seconds purposes Pfiva Law, s- 15.040)(m - Z
Property Owner Property Location
Dave Coyer Govt. Lot NW % NW % S 28 T 29 R 18 E (or) W
Property Owner's Mailing Address Lot # Block # Subd- Name or CSM#
1122 76 lh Av 4
City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road
Roberts _ I VA 54023 651)3991023 Warren__ $ 1121°ST
® New Construction Use- ® Residenbal / Numberof bedrooms 3 Code derived design flow rate 450 GPD
❑ Replacement ❑ Public or commercial - Describe* _
Parent material sandstone Flood Plan elevation if applicable v ft.
General comments and recommendations:
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Bonn9 # ❑ Boring
I _1J ® pit Ground surface elev. 97 ft. Depth to limiting factor 74. in.
11 Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure i Consistence Boundary Roots _ GPD/Fe
In. Munsell Ou. Az. Cam. Color Gr. Sz- Sh. -E(f#1 -E #2
1 0-18 10YR2/2 SL 2 M BK MFR C S 1 F 0.6 1.0
2 18-46 10YR518 ! SI 2 M BK MFR CS IF 0.6 1.0
3 46-74 5YR516 i COS 0SG 1 MVFR 0.7 1.6
r,
2 ~ Boring #t' ❑ Boring _ - _ - _
® Pit Ground surface elev. 97 ft. Depth to Inviting fads 77 in.
Soil_ _ ration Rate_
Horizon Depth Dominant Color i Redox Description Texture Structure i Consistence Boundary Roots GPD/Ft'
In. Munsell Qu. Az Cant Color Gr Sz Sh 'E##i 'Eff#2
1 0-29 10YR2/2 SL 2M BK MFR C S 2 F 0.6 1.0
2 29-54 10YR316 SL 2 M BK MFR CS 1 F 0.6 1.0
3 54-77 5YR416 COS I oSG MVFR 0.7 1.6
i
3 -
' Efnuent #1 =SOD. > 30 s 220 antl TSS > 30 s 150 m fflueM #2 = BOD. > 30:5 220 mg/L and TSS > 30 s 150 m
CST Name (Please Pont) Signature CST Number
Dale R. Stewart _ 220879
Address Date Evaluation Conducted Telephone Number
/5r 107° Roberts WI 54023 11 /0112016 715 497-9996
SBD-8330 ! R()14,151
E Boring # U Boring
EI ❑ Pit Ground surface elev. 965- ft. Depth to limiting factor 74 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft`
In. Munsell Ou. Az. Cont. Color Gr Sz SR •Eff#1 'Eff#2
1 0-27 10YR2/2 SL 2 M BK MFR C S 1 F 0.6 1.0
2 27-50 10YR4/4 SL 2 M SK MFR C S 1 F 0.6 10
3 50-74 5YR4/6 COS O SG MVFR 0.7 1.6
l
Boring # U Boring
_ ❑ P4 Ground surface elev. _ ft. Depth to limiting factor rn.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft'
In Munsell Ou. Az Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2
Bourg # U Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
_ Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft'
In. Munsell Ou Az. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
i
Effluent #1 = BOD, > 30:5 220 mg+L and TSS > 305 150 mg/L. ' Effluent #2 = BOD, > 30S 220 ng/L and TSS > 30!5 150 mg/L
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