HomeMy WebLinkAbout030-1077-80-100
:^:is;onsin Cepar:men! of ^cmwvrce PRIVATE SEWAGE SYSTEM e„..r. y St. Croix l
Sa!e!y a`4 hLLle ^ y C v sii ^
INSPECTION REPORT Sane-yPc°nhNo
GENERAL INFORMATION ;ATTACtI TO PCRI•AITi 615336
s:atc Plan ID No
~.ersa net mkrni a Ii C^ - u G"ovnrq be used for sacm,c ary J-rpesus [P' vd%'i _ rx s ti De iy g - n,I
Pe•r+111oIda; Narc: ~,:y Maya Township Pate Tact Nc
Mike Gleason TOWN OF SAINT JOSEPH 030-1077-80-100
CS7 71.1 F Izc '.n:p hK f r, FIM Cescrot 0" Sac6onlTo,, :a11 enMas Ne
27.30.19.275D-01
TANK INFORMATION ELEVATION DATA
TYPE VAWFACTURFR CA'ACTY SIA.ION BS HI FS ELEV.
Septic PwTA-e'ark
Dosing A.It. Li:'
Aeration Bldg. Sevvr
Holding Std IT In cl
i;l.llcl
TANK SETBACK INFORMATION SI:Ht
TANK fO t=d. :NEq! :K; a-te:,::.r rroke RCnD DT nIel
sep:':c Dt H;:!harn
lox ry I leaderlMan.
Aeratiu'I O.s:. r, pe
Holdinc Got. svstem
I ral Gracc
PUMP/SIPHON INFORMATION
Manulactuier I )ernan:: : Cover
;Pon
Model Number
TRH I fl °rc7::n I oss Sys!:nl Head 1 11 f 1
Forcev,m-T Length ala. Dist. to We
SOIL ABSORPTION SYSTEM
BEDITRENCH Aid% Lc-;[- No. C' `cnche5 PIT DIMENSIONS r.> !1' Prs P ::::c Un _ paid Cept-
DIMENSIONS
SETBACK SYSTEA'TO P:L DLCG WELL AK^iSl^iFAV LEACHING V: fact_fer
INFORMATION 3,ule CHAMBER OR
i,: z '-,I UNIT Model Number
DISTRIBUTION SYSTEM
londcrl`.fanilo:f 1U.y,ribulu:a s-tda 52e x1•ula :pae^~ 'Jan!ICAI lnske
Flpc;,l
l ar yl Cva Leng!h -ha Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Uep:h Over Dcpth C".rr .x ❑cr'r" ..zzdadr SC: dcd xx Mulched
Svc°r.••.~ Ce-1r.' rw; Tie 11,h F,: es NC Y" NC
COMMENTS: winiude code clscrrpen°u:s, persons present. rlc i Inspection #1: Inspection #2'
Location: 661 132ND AVF
1.; All U10 Desorption =
2.; Bldg sr w-r length =
- amount of cover =
Plan revision Required? "es 1'0
Use other sire for addil cral informal or. _
Oa:c I^sipptc~s SrgnaNre Cc9 No
SSD.67 10 ZR 197:
Industry Services Division a;,,ny
1400 L Washington Ave ST. ~.to<K_
O P.O. Box 716- SP.+nut Number On I- tilled in by Co.)
°s s ti Z 19
Madison, \VI i:707-7 Ih? ~P ~ 533(
r^.eni Slt [ r¢nsa+;,nn Nunshef
rri Application I
1 r, ~
,Lc wdance wi1 ~ 1lr. AID+ C , c ubmmrm [1116. Gmltn the aPpnt in nn~i IF N _ _ -
r yuirw pr u. t , htauor) muary Perm t \ n. l t l u rt t nns i )r sLnc void I r r ,r ❑ A 4s I I orject Address it{ d.1 frcnl than mmhng addfess)
ih~ ):Pamuent d lvfov n t I P f x )Pal S 'n e l n' lnnrctifn y,' Pnwide I. u :1 I r udary
t in xwrd¢nw unh it Ir..u1L I ).Illil 4r'• _ _ a[NX•
1 Application Inform non- Please Print All to arion /32~L"" AUf•~
{ n}' Uwna's Narnc l ~ / G aFsI 1••~-- Pan<l Y
/K~ GLEASoe) JJ 030 - /o 77 -8o-/aa J,,yyf~
iIg1 Owner' s M¢ihng Addms> Prupcny I4w^aunn 0-,19_a-1 SD W
I L", Smtc ,I. 7-p Cr.lc I Phone Number SE _ )4, Section 7
V (circle one)
" /GN/YO NQ CI~ SYO/7 I T ~O Y R /Y _le otQ
I I. Type of Building (check all that zpply) I-"/ -
Sulxlivist A
X or L Family Dwelling - Number o(14alnnnm on Namc
: I
ok C Bloc t• -
..badCommemial - Uesenhe I 'se ~x•OJ Rl C#A~ [~-FNY of _---p Vumb.nJb1U llayc of - CSNI
' Store Owncd - Dcw.bc LYc _ - - p
a7 /-/i.s~•Z [~•Tovw)nf~T JOSE/ _
2- c"APA-6e.1.5
i11. Tv mit: (C heck onl one box in line 1 Complete line B if applicable)
Replauu cn[ 1}stcm J 'i :nnlam HoldinE T:u+k k placrnmnt Unly I l Nb c \1oddreatl)n [e Lxisbng \yucm Icxplain)
Nc . \vs0.t r
Lut I nc us ? n 4 n s~. ~,d U c Imua1
It I_', P r v i[ R newal .J Pe met Rev no rI C'wnrc al I lumber i i ] f omit Truusttt to Neu
'IICN(e Ilxpr u : Clucn ^..yye
IN Item C. ompuncou'Deviee_ (Check all that apply)
XNnoTtMsunZCU In-(around Pr.-.-, nicd In-Ground U Al-Unlle ❑ Mound %23 in. of suitable sni: i~ Mound' 24o . u! surtah!c timI C.
I b dung lbnk r ) , iqx 'd f rl n n [ ley) inl__ - ~ t rcucat _nt Ck 1 "plaint-
\ Uts •rsab?reat nt Area Information _
t, agn Fiow lhpd! Ikv~n \ rii .1p, 6 tiro Rat gpJsl) D!spc al % Requird(51 D spcrsul tr a Pa al is \ clan Clcvunm
o
Goo .7 ass 989 931
ul Y. of SP nubmlcrcr
Tank Info C ,pacrty in
Cnlions (-tllo~ I:n.tx <
N- Tank. f-suunv_ rai,A: r ° r S y p l7 L I
l✓ E~csEa Id
s`P"`orHaNia,ark .700 /]do ~ / ~ /ESE.t C,~c
I Arsine Cb=bcr ...r ff
If. Responsibility' Statement- 11 the undersigned, auum responsib ' for installation of the POWTS shown on the attached plans.
Plomtxa's NantC (P ,nit) Plumtxr'> r.eta' MP.•S Numlxr Buvn~s Yhunc Nombtt
ddyi99 715 9~7 yrsS
~ E'a1T
Plumber's Ad~ddm,, (Smst. City, Slate. Zip CuJel
~Ap, uunn!Dcpanmrnl l'x Only ne .nut I ec Ua[ Issue Mtn tent Siruannc
yIL a. r for Dcnlal
IS. C~~ndrl iT~As~. h h utz or i)~sapprm al
1 Sel tark r l it ulµsar eed, all lie' 5!I IL
SS Der 7WrayemeM pl n r pluv::~ .
2 A/atllbfrk n14UW'stws mo:,t ou rardtk • .
t♦III PM frpFialDb ax5) i cM ^.n ro:ca.
SHD-6398 (R_ p5+1 I
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''~'.1~CL ~idi:]C /v~E-i7CEAS o,~/_7~-/JR._/.~JGgou"D POL11'f /Puay LNANQEK
1'.`. ner's Namr-
r..l l)caCtlpLli7;1. - - -SEA .77}3a N 19_t.)
niripal[ty: T'on, C-+t o Sr. Tose/N
,unty. _ Sr. C4aX
Number: Block Number. CSfvi Number Y-45.7.2
,I,;tivisiun Name: /3a "O AE ' Lc, 4._-r 48/
D. Number. 030- /o77 - 80 -100
Page I Index and Title Page
P;:,re = Plot Plan With Goss-Section & Plan View
Pilo 3 Septic Tank / Pwnp Chamber Cross-Section & Specifications
Pao c 4 Pump Performance Curve
Pagc POWTS Owner's Manual & Management Plan
e<,_,e 6 POWTS Owocrs Manual &'Mana,cment Platt
Nate 7 ; fltcr Information
Name of Desimicc /~_E_ of -/roKE _ _ License r: IW- o?.?YI ? 9 _
Signature- /
Daze: S-3o-?oi9
~esi_ncd_pwwant_u, tl,e Rillu~n-i g POI 1'S Component i\ '111ua[ and DS!'S i8I-355:
SR7-III ; , p I iy'.']1 1,1 k.-(! I I 4i n. ed Swl Al',[ T11 11:1 i'.~nnnonccl A7enua' V'CTNNIUI13.i'
a
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1.5
P-ge 3 of 7
OMBINA.TIONSEPTICIDOSE YANK CROSS-SECTIOiN
(DRAIMNG NOT TO SCALE)
~(perVSPS0794 226(7) R5ISER(8& COVER
-iNAL GRADE
pe grouno sunace avray Item kicking dovioe, & warning label; Emend
manhole(s) for proper dra:naga} manhole riser as necessary} d' Min. SU. 40 PVC Tank Vent
ELECTRICAL bcalod t2'above oracle or 2e
uirt scn. ao PVC rank vent JUNCTION BOX above Regional Flood Clevalion
BUILDING SEINER leut2•awvc grade or 24'
(per SPS 387 30(11)) above Regional Flooa Elevaadn foomply ,in
and NEC PS 316
and INE300}
FORCE
MAIN
12- OPTIONS
~,l i II \,I
V/ 6-cove:
1e• 41aN101= i -
1 II I _ rnenl
- - I Gam
eOrrOIt OF INLET (nan Neva.) I ~ I ,I
MET-
r
~ ~ ~ ( r ~PI¢cM-vk4
O/(f.JCO rnenml we
I-Alarm Floel
i,. -On Plnal
l a-iNLTTna Mpm,m Em MFnmr ;
_Y.. P.We Sae 3
I'~ ettw4a4r Hclured Ungnel Op FIOX
i' A Clev. - /
MINIMUM OF 3' CF SUITABLE BEDDING BENEATI I TANK & MAXIMUM BURY DEPTH OF 96"
Anchoring of lank may be required per SPS 383 43(8)(g)
Tank Manufacturer: Wasce LO. e serf Daily Wastewater Flow (DWF): 600 GPD
Septic/Pump Size: 4700 /goo gallons Number of daily doses, S. 3 ( /87, ?--%T
Alarm Manufacturer: S. X. z-- 40,y dos
Model Number. D'•A.✓K _.4z rcr / orce main volume. SS _ it . /G3 gaUit = 9.0 gal
Switch Type: /YEC 114.11 .1.44 I µdual dose volume /??.3 gal - 90 gal= 113.3 gal
Jf (total dose volume - volume of force main)
Effluent Pump Manufacturer. L/ rriE /sio+T
Model Number: 9EN- ellDOSE TANK CAPACITIES:
Reserve above alarm , ?O. S in= ySG gal (D)
Minimum Discharge Rate: Wo. 0 GPM Alalm float above on float a in = S/Y. S gal (C)
On/Off float measurement S.S in F: /t1.3 gal (B)
Vertical lift (pump off to lateral invert)............ G.1 Q Off above tank bottom 8 in = 177 9 gal (A)
System head (distal pressure x 1.3 ft): IT
SS ;L Force main x /o /100 friction factor it DOSE TANK DIMENSIONS:
Filter friction loss........ - IT Length 14Y in Width 9G in
Total Dynamic Head (TDH): G. 8 ft Outlet height 34 in Gallonsfinrh
EFFLUENT PUMPS
P~. y of 7
9EN SERIES - 4/10 HP
' I'd'16i R.RL
llsvwftuG
9dt{~-jq 9EN-OA RE
IIi70a Raf
-B I
r r Q
9En cal
9FN{Asrs I Ia'( - 10S 8Ur
I__... 173}on 7651 tn' I 1049tma17
_
9EN CIA-R' 9Js' r 9a' r 2174en 14.38
~FN - 915LL~~~L9 2314un 74MCm 1°a ( Epcpr -coaled cast won/
-
A o w INI 80 ,n; a1 ID) i Cover -1 'Thermoplastic
a ! Motor Housing _ Epoxy-coated cast iron
L ' a Impeller Material Thermoplastic elastomer
b t ~ - ~ - i ---"1 ImpeOer Type Non-clog -
1 ' Y
6 olute_ - Epoxy-coatedcasllron
m - T-- _MotorShaft Steel i
(
wilh carbon and ce2m
Mechantwl5batt[Seat alas
i - I I I E~astenors - - stainrm Steel
upper entered ileere and lower
Hearings
ball beariinq_
r i Power Cotd _ MY -5110W _
~ _ _ i__ l N ~cn dUw'NAFf a:a abl{91rtn1c!
9 to m s~ e] n w ro
urRan-Fex
o f F R (R .e; ri:i
(=r-anklin Elan ic aR4e;1Umm I .5145~
5 r 7-
PULL"f'S (>W'tiii}2'ti MANUAL ANN ViA?iAS:;:MENT PLAN
FILL' IN PORM.% IrION SYSTEM SPGCIFICATIONS
_ /KE G
_LEASa
! beptic tank Capacity ~p gal O-NA
paned- Se tic fink Manufa - - -
DESIGN PAR,1d1F.TF:12S ~RE.JCa NA'
t torn I ) - _ _i Gflrien[ I rtilodltacturcr _ F-_ YB• 0
Number of Bcdivom• (100 andlbedruom r lcr i 8 NA,
i Number of Commercial [inks Putt I 'I ink Canaciiy I Bop - _ gal ❑ NA,
Csiimored flow tat cage) I '/oo 'alidey I1 Pump I ank Ivomufa_chver _L !✓/ESEe ~e.uct• 71 \AI
Design Ilow (DWFt- estimatedx 1.5 boo dal./day I Plump. 7lanufacturu__- -1 L/rret G/e~r ❑ N.ti
Sml Application Rate. _ - "al/day/ Pump ro dei j, 9EN- G/r/ ❑ NA'
- - ' _ Pretreatment Unu (VI NA,) i InRucndElfluent Qualitt (n NA) INdonthl- r\vcrasr. O Sand!(iravel Filter O Pead-titer I
Fats, Oil R C rcase (POG) < ib pool. Q Mechaorcal Aviation Q Welland
Biochemical Oxygen Demand (ROD;) I <220 m?, L p Disinizetion O Other:
Total Suspended Solids (I SS) 150 m-0.
- MnnWnrnuzr: Model:
Preu'calQuality iM NA) Monthly Average Soil Absorption Component (III NA)
Bioc'lemicai Oxygen Demand(BOD,) X30 m,•l. ~a~in-gn>uad (gravity) 0 In-ground(pressurized)
r Total SuspcnJcd Solids ITSS) S 30 nts~L i 1 \t-?race rl ~inund
Pocai Colilomt (geomcuic mean) 10 afa'IOOmI. r Drip-line O Oth: _
Vertical Distance Tank Bottom to Service Pad:
Maxintamllilueut Particle Size I I18 inch diameter I Horizontal Distance Tank(s) toService Pad
Dispersal Unit Yifg./Niodel Number: A;'C/LrtdrsA (jdtcK '}r L.0 GNAn'dLoS " O N.l
Calculations:
Soil Dispersal Find Crap (Dispersal Unit !i[S'.%i
D\NP fication Rate = Area ReUuircd - ;'_'.S A - or( wench Width)_, - Units of "Ibtat I,:nnth of Ticnchisr
1nl
/e 0'0 - , 7 - ass's - y/73~_ - aO.d iY - 4!/A,r6ftS
DESIGN CRITERIA 9l - 989.7 fr'
(.l "Resign of Pressure Distribution Nctliorki lie Septic "tank-Soil Absorption Sy,eat " Publication 96 (SSwMI' Manual)
i71 "ICC Flowtech Mound Component Manual" Version 1.2
G `EZ Flow Mound Component Manual" Version &3012007
r -I SFID- 10954-1' (R 1112) "At-Grade Cumtponent Martini Usin Pressure Distnetuion" Version 2.0
' I S B D - 10705-P I N.U I?Ol)"ln Grounki Soil Absorption Component Manual" `version 10
G SBD - 10691-P (N.Uli01) "NIound Component :viaiiual" Vcriion 2.0
M SBD - 10657 P (Rein'),)) "Drip-line Effiucat Disposal Commoncnt Nfanual"
O SBD - 10706-P (N.0U0t) "Pressure Dislrihutiun Component MaormP" Va:'siot 2.0
L_G Other:
MAINTENANCE MONIT01UNG SCHEDULE _MAINTTENANCE AND YIANAGEMEN1-
Service Fvent -c. nice l'regaeaet
Pump?inspect dispersal cell(s) clean filter At least one clcn- X 13 months 95 3 years O Other:
Inspect pump Q pump tonuols nlann, paueatrnzni unit At a. t o icc etcn ❑ - months 91 years V NA
l Flus) and pressure lest iawnds i A. leest opt: zv..n: G nomlis --I 3 ve`rs K NA 1
START. UP AND OPERATION: For new construction. prior to using the P O\4'IS mock tnatment tank(s) for the presence of painting
products or other chemicals that may impede the treatment process and/or damaee the dispersal veil(s). ll' hish concentrations are detected have
the coaicut> of the tank(s) removed by a scpweC servicing operator prior to use. System start up shall not occur when soil conditions are frozen
at the infiltrative surface.
The properly owner is responsible fur the operation and nuumcnanw. of the POWTS and submission of required reports- The qumuhi and
quality of the wastewater stream will affect the performance and longevity of your POW CS. The installation of lwawa saw me, appliances and
(ixhRes alone with prompt repair of leaks reduces the wastewater volume. Also the brim: or waste from water soficners. iron removal units.
other clear water treatment devices and tbundation drains should be discharecd to the ground surface whenever possible. Note. this does not
include laundry waste. showers. dishwater. cic.
This sysictu is designed w handle domestic slrcupill \wast'veinCG howeV"' the disposal of food based greases. oils, vcgetaltlelfntit peels.
seeds, bones, and food solids. such asihose produced by a garbage disposal should be minimized. Toilet tissue is the only paper than should
be dischnrg:d into the sYStcm. Vthwt non-bind: grudabic item::; ::ucl. as baby wirumc, tampnnc, sanitary napkins conthtms, ei_arCrte bulls,
dental floss. and cotton swabs, should not enter the system. Chemicals, such as petroleum products, paint, disinlWanls, pesticides:
antibiotics, solvents. etc., should not be hushed into thesystem 1X®1sc they can seriously damage your POW T S and enntaminateyonr
G ]
drmkin,watet supply. Maintain a regular SLCady flow by spi Cadutg iaundry washing throughout the vreck. Avoid vehicle uatTs over
al I system com ponents. Compaction o rsnosv over the dispersa I on it may cause it to freeze up.
INSPECTIONS g MAINTENANCE*. Inspection shall be made by an individual carrying one of the following licenses or
certifications: Master Plumber- lvlastcr Plumber Restricted Sewer. POWTS Maintainer, or Septage Scrvicint, Operator (per die attached
Maintenance Schedule). 'lank inspections must include a visual inspection of the tank to identify any missing or broken hardware.
identify any cracks or leaks, measure the volatile of combined sludge and scum and check fix any backup or ponding ul effluent to the
ground surface and test all electrical equipment inch as pumps and alarms. Any defects shall be promptly corrected. Exposed openings
greater duo S inches in diameter shall be secured with effective locking devices in prevent accidental or unauthorized entry the tanks.
When the combination ol'sludge and scum in any tank exceeds one third (In) ormore of the tank volume, the entire contents of the
tanl, shall be icntoved by a Septagu Servicing Operator and disposed of ill accordance with Ch. NR 113. Wisconsin Admin. Code.
Specific scrvlcine mechanics must be provided if vertical is 15 feet of ifhurizontai is -~I50 I'cer and insituctions to be provided below.
Tlnc uudct filter(s) shall be insocctcd and cicaned to remove any accumulated solids accoidingto manulaeturcr s specifications. Solids
washed Isom the filler shall be retained in the tank. Filter cleaning may be necessary at more frequent inteivals than stated in the
maintenance schedule to keep the system operating.
Alarms should be tested or. a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS,
There is normally a 1 day reserve under regular operating conditions, Itotvever water should be conserved until any problems with the
system are corrected to prevent back-up of sewagz into the dwelling or surfaaino;
BANDON LiEN1': When the VOW I'S tails and/or is pzunanendy taken out (it'sservice the tollowing steps shall be taken to ensure that
the system is properly and sa rely abandoned in compliance with Ch SPS 353.3:. Wisconsin Admin. Code:
All piping to tanks and pits shall be disconnected and the abandoned pipe openings scaled.
The contents of all arks and pits shall he removed and properly disooscd of by a Septasr: Servicing Operator.
After pumpm-, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil,
gravel. or cnhcr inctt solid material.
CONTINGENCY PLAN: If the POtV-t-S fails anti cannot be repaired the following measures have been, or must be taken. to Provide a
code compliant replacement sy'stenc
A suitable replacement area has heen evaluated and may be utilized for the location of a replacement soil absorption system. 'I he
replacement area should be protected from disurrbauce and compaction and should not be infringed upon by required setbacks
from existing and proposed structure:, lot lines and wells. Failure to protect the replacement area renders it unusable. Replacement
systems must comply with the rules in effect ai the lime of replacement.
O A suitable rcplaccmcm area is not available dtrc to setback andlL, soil limitations. Barring advances in POWTS technology
holding tank may be installed as a last resort to replace the thiled PO W TS.
fJ The site has not been c%alteucd ro identify a suitable rcplaccmcm area. I lpun failure of the POWTS a soil and site evaluation must
be performed to locate a suitable replacement area. tf no replacement area is available a holding tank may be installed as a last
resort to replace the lulled POW IS.
Q Mound and at-grade soil absorption systems may be reconstructed hl place following removal of the biontat at the infiltrative
surface. Reconsuuctions of such systems must comply with the rules in cffeclal that time.
q'ARNING!I!! SEPTIC, PUMP, AND OTHER TREATMENT TANKS MAY CON1140 LETRAL GASSES ANDJOR INSUFFICIENT
OXYGEN. DO NOT ENTER A SEPTIC. PUMP. OR OTHER TREATMENT' TANK UNDER ANY CIRCUMSTANCES. DEATH
NIAYRESULT. RFSCUF.OFAPFRSON FROM TUEANTERIOR OFATANKNIA-V B613I1"'rICULT OR 11IPOSSIBLF..
ADDITIONAL COMMENTS: - -
POWTS INSTALLER POWTS 1%tA1Vl'AINER _
KE,,r1o/LE /YIN-?Y/99 aurae:
Name: _
P hone: )/jr 967- Y/S~_- Phonc: 71,E_7-L7--y(SS
SEPTAGESERVICING OPERATOR(Pumner) !,OCAL RE(`;LJL4T0RY AU HORCi
Names I Name: ~j T.. 4.,e [~i7nu,rrr7 /IENIL.~
Phone: - LPhone: 715- 3A.1- Y.80 _
8-in. to 15-in. Wag, Biotube Effluent Filters
Applications Standard Models
I,ra 8-indi to 15-inch Biotuhe- ffffuent rivers are designed to FT0854-36, F1125436, F11554-36, FT0822-14B, FT 1254-36AR
c solids from effluent leaving commercial septic tanks. Thee ra_n be
i n new and exisMrig tanks. Product Code Diagrams
General FT [I L ~J - 36 I
g-irtcu ICI 15-Ir;,h 31u1cee"' FWueal EI[ers` arr. eyed io impro':e
I_lLi ly of effluent exihng a cammatciel septic tank. fho Biotube „ -
.r !rJg~ tits snugly in the vault and is removable for maintenance, the ! rmpi.U..:r o-
i nr5.l; assembly snaps into the notches in the top of the vault, and the b' Moll"""""
•n,Pwiern w,xro
I,r Cle can be extended for easy remordl of the carhidye. A "base .e MI z a
rI f r.-n p, 21 a I+ailaNn for to" profile tanks. An oooanal side
M :I-rl
I ~a.laOle on larger mcde[s 'impliligs installaiiwl dnc tiro'+id.-s u c rsn n,r.
£ervlcing. 'nwsennn:. ><m
as - G nna
e - 2=
i- :SaiQ
1 Gb'me96s'
ru~!le as;2mbly' w,:.. •e., a-N•a~
'I 7M#~MV:glfp
i
A'arm goal assembly
f (ordered separalery} m li vimmmiw. tr nr Uini' I~r~~~~~
~ d"r-~ a6n!is~5 n4 my nln ~_nr5vz: fc~S2:-9 ,,.i~ rp lb li}n JY WII 1~'. kra r,Mn
u, q n iim a m: rra r-an...
FT 148E j
Pipe coupling
~ 9certrl'n
; III ii II-_ _ &olubes
1 rm rw
1 Vaull i I n
( r:lYgMiM(^:
I ii I Or - eTL.
12 _ ,yrvY.i
I
Inlet hales - ® O Ierv aa+mm
4:.r: y. oCVe
&rpvort coUPIN
M
aterials of Construction
P: y
W
-
~ Pipe WIPI'liq PVC
a bracket - Ranale Owpori PVC
Cutaway view Side vew
SuppoA couphog and bracket PVC
Biotube" canridge Polypropykinie and polynth f,,
Oreneo Syetenie Inc., 814 Airway Ave., Sutherlrn, OR 97479 USA • 800.348-9843 • 541-459-4449 • vww.mnco.cw 17 7-c7 1
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Page 1 of 2
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Ownerl3uyet Michael Gleason and Kelley Forsythe
Mailing Address W4410 750th Avenue Spring Valley, WI 54767
PropertyAddrki681 132nd Avenue Hudson, WI 54016
-
-
(Verification required loon Plano ntg & /onmg Uepurtrnenl for r.ew• constraction.)
030-1077-80-1 0
City/StateHudson, WI parcel Identification Number
LEGAL DESCRIPTION
Property Location S E , SE,/, Sec. 27 , r 30 N R 19 W, Town o f St. Joseph
Subdivision PIatCSM 29-6522 030-2018 Lot # 1
29
Certified Survey Map # 1 _068421 Volume _ Page .76522
Warranty Deed # 1069088
_ (before 2007)Volume Page # _
Spec house 0yesow Lot lines identifiable E]yes❑no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
fmproper use and maintenance of your septic sy.iteni could result in u.s premature failure to handle wastes. Proper
ma imenance consists of prrrnpi ug nut the septic came every three years or sooner, if needed, by a licensed pumper. W hat you pur into
the ystem can affect the function of the septic tank as it treatment stage in the waste disposal system. Owner maintenance
rrspansihilitics are specified nr sSPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
7 he property owner agrees to submit to Si. Croix Colony Planning & "Zoning, Dcpartment a certification firm, signed by the
owner and by a master plumher, loorneyrnan plumher, restricted plumher or a licensed pumper verifying that (1) the on-site
•,vaslcwNawr disposal system is in proper'Te.a4ng condition and/or (2) aflet Inspection and pumping (if necessary'), dw septic tank is
less than I3 till of sludge.
hwe, the undersigned have read the above rcauremenls and agree to n ijitimu the private sewage dapesal system won he
stanrtards set forth, herein, as set by !tic Department of S.ifcry ynd Professional se" ices and tnc Dcpartment o1 N:uural Resources,
State of Wisconsin. Certification stating that your septic system has been wamtained roust be completed and returned to the St. Croix
County Planning & Zoning Dcpartment within 3n days of the ttuec year expiration date.
Uwe certify that all stafcments o this firm are true to the hest of mytour knowledge- bwe anu'are the ownerts) ol'the
property descrihcd ahuve, by viirrtlue of a urranty decd mun-ded in Register of Dceds Office.
Number of bedrooms 1
y
SIGNATURL; OF APPLICANT(S) DATE
***Any infonvation that is misrepresented may result in the ..mii.iry permit being revoked by the planning & Zoning Deparlutent.
Inchtde with this application a recorded •.varranty deed burn the Register nl'Decds OfTrcc and a copy of the certitied survey map if
reterence Is made to the warranty decd.
(REV. 04712)
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Wis. Dept. of Safety and Professiona151ervi, b 9 ` SOIL EVALUATION REPORT of _
Division of Safety and Buildings
in apwfdana with $P$ 385. VMS. Adm. Code
County -
Attach complete site plan onpaver nor less-than 9-1rZ x 11 inches in size. Plan must -
include, but not limited to. vern caland horizontal reference peml (6M), dneclion and Parcel W,
percent slope, scale or dimensions. north arrow, and location and distance to nearest road. -
Please print all information. Revi of by Date/
personal infcrnatio• you proo.de nay be used fc- secondary yu'puses (Privacy Law. s. 15.04 (1) (m)). 6 Prop" Owner Property Location
Govt. Lot_- E 114 _ 14 S - TN R E (ori
4 (W
Property Owner's Mailing Address . Lot Block # Subd. Name of C$W,
! yy?/ ii >r / .s .
city/ r State Zip Code Phone Number ❑ city ❑ Village r~]Tawn Nearest Road
New Construction User Residential! Number of bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - Describe _
Parent material i rlood Plain elevation if applicable h
General comments ! - ' -
and recommendations:
E I E] Boring # Boring
-
pit Ground surface elev. s- 7 fl. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Descrinhon Texture Structure ons.stence Boundary Roots GPD41 '
in. Munsell Ou. Sz. Cent. Color Gr. Sz. Sh. H#1 ' ff#2
~i ?C
tl
❑ Borng # ❑ Bonng
® pit Ground surface elev. 4 Depth to limiting factor i in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPDdt =
in, Mursell Ou- Sz. Cont. Color Gr. Sz. Sh. ff#1 'lItf#2
- EPouent #1 = BOD , > 30 < 270 mga and SS >3 < 150 mgr. EJ'tient #2 = BOP 30 mgrL and TSS < 30 rng7L
CST Name ease Prin Signature CST Number
Address - / ate valuation Conducted Telephone Number
917
SBD-83301 R I I! I I I
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Property Owner Parcel ID# Page Of
Boring # C] Boring _
la pit Ground surface elev. ` - - it Depth to fmiling factor i in-
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPDIft '
in. Munsell Qu. Sz. Cent- Color Gr. Sz. Sh. ' "1101 *1#2
❑ Boring # ❑ Bonnu
❑ pit Gound surface elev- ft. Depth to limiting factor in.
SOMApplication Rate
Horzon DeRth Dominant Color Redox Descrpron Texture Structure onsistence Boundary Roots GPOAI '
In. Munsell Qu. Sz. Cont. Color G. Sz. Sh. ff#1 *f#2
Borina
❑ Boring # ❑ pd Ground surface elev. ft. Depth to limiting fader in.
SoilA lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD+h '
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ff#1 ff#2
' Effluent #1 = SOD . > 30 < 220 mg.-l- and TSS >30 < 150 mqA- ' Effluent #2 = BOD , < 30 mgrt and TSS < 30 mgrl
The Dept. of Safety and Pi ot'cssiunal tiers ices is an equal uppurton ity scn ice provider and employer. If you need assistance to
access scrv ices of need material in an alternate lormal, contact the department at 6(18-266-3151 or Vl Y through Relay.
SUWllO(RI I III
Property Owner Parcel IDM r~ C 7% P~ ~ol_
Boring C Boring Ground surface elev. 7,5'`x. 7 It Depth to innng factor I i in.
Sol Application Rafe
Horizon Depth Domnard Cola Redox Description Texture Structure ns'slance Boundary Ruda GPDAI r
n. Munsog Qu. Sz. Cont. colon Gr. Sz. Sh. 10 fw..
r ~
At Id cr /19
- , i
n H
~/16
BoringN ❑ Boring
F-1 ❑ Pit Ground surlece elev. A. Depth to hma rg fads in. Soil Yon Rate
Horizon Depth DwdnaM Collor Redox Description I Wdure Structure - teraz Boundary Rods GPDrA '
1fC1 11112
in. Munseli Ou. Sz. Cont. Color Gr. Sz. Sh.
❑ Boring C ❑ Boring
pd Ground surface ekv, ft. Depth to limiting factor in.
❑
_ Soil Application Rafe
Horizon Depth Dominant Color Redox Description Texture Structure ;onsaieirce 3oundary Roots GPDAI r
in. Munsea Qu. Sz. Coot Color Gr. Sz. Sh. 1 Aft
•EfAred Rt=BOO 30<220 mg1L and TSS>30 <150 mA 'Minn #2=BOD 30 mg2 and TSS <30 mWt
he Uept. of Safety and Professional Serviu.~s is an equal opportunity service provider and employer. If you need assistance to
access services or recd material in an alternate format, eontwA the department at 608-266-3151 or TIY through Relay.
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