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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 " •h X ~ t J \h • A h V' ~ M 4 N G `1 •O~ ~ J L T^ ~ I S ~ I ^ ~ o °C a W y o ~ v -t t~ I r v°1 ~ b ~ M n 4 i W H N II L~ I i i O G j i 4 I, I C r 0.'1 M ~ 1 Omer vsier~T 1111c i'tt-c ''~'.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 M ~1 V V 't ° i H 1{t I\ Z p h ` = n 4 J a + W o- ~ w~ h ~ V isli \ L 71 =1 w v V 1 - \~I ti ~ ~Mt Z a \ v° Vi V ,a h ~ M I e ti v j nQ o 1 't i a. h o V~ IV Vi h o I~ ~e I N `n ! a y 03. oti® W o: fn V o 14 W o a ~ a a° d tz 1, ~ 41~ o V `C b 7~ 4, ~ J Z. M 0 2 u 00 M 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 M 2n. c n.1 ] 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. 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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 li I r - i 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. sauoretzunn /r I !ss--y 75/'