HomeMy WebLinkAbout040-1041-40-000 (2)PRIVATE SEWAGE SYSTEM Sf. Ol01%
se.n°"e x°ilaing(A m" INSPECTION REPORT Op`re"a N° 615368
GENERAL INFORMATION (ATTACH TO PERMIT) pl."mxo.
PPGPAaI mvwINed %m)4
Town^eof Troy pR cm WN OF TROY .L�x 040-1041-00-000
IN
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PUMPISIPHON INFORMATION
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ManNamre, 0.manEGPM
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System Heetl
L'ident
SOIL WV[x Cnry
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COMMENTS: Plcode d,,GA "'Will ' inepedpnet'. In,
LUNPARNIN 426N GLOVER // ��- GI/M1 '+•� �" 6,.�
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Smitary Permit Application
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AjBN GLOVER ROAD
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%TOWN CLERK OF TROY 'Ip1.Jn oC f
040-10041MXD
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AR.n�mw
GLOVER ROAD
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9ORING
WRING 197 82
SOPIN52995
PORING39845
SYSTEM ELEVRPON 95.25 _,
IS 125 PER DAY 05-R3Z.5 GPM%I5=65625/6=5�0�50-2 ZE[Z ROWS
DOMED
1
656,X3 M91320985ERIC TMWK ROUND TO AlM/WR
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June 27, 2019
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 2021-0622 L JI
Plan Review: PWTS-061900909-C
PAUL R ROEH LER DOn'S.utJ Ue lni Ill-t ny S::. VICES
321 Wisconsin 0r p� � �����
New Richmond WI 54017 I �
s c�uinrloe0c.
SITE:
Glover Park Restmoms
428 N Clever Read
SL Croix County
Town of Troy
SW % - SW % - 59 -T28N - R19E
MR:
Object Type: Public Use Gravity Conventional In -Ground Soil Absorption Component Manual
System serving 125 patrons per day -Public Park for POW6 Version 2.0 SET-10205-P IN. 01/01)
-Toilet waste only -657 GPO - New -
Effluent
Filter - Maintenance required
The submittal described above has Irten reviewed for conformance with applicable Wisconsin
Administrative Codes and Wisconsin Statutes. The submittal has been MNDITIONALLY"PROVED. The
system is to be constructed and located In accordance with the enclosed apparent plans and with any
omponent manualls) referenced above. The owner, as doomed! in chapter 101.0i Wisconsin
Statut¢,is responsible for compliance with all code requirements.
No person may engage in or work atplumbing'in the state unless licensed to d0 so by the Department
per S.105.06, stets.
The following conditions shall be met during production or installation and prior to occupancy or use:
Reminders
e A sanitary permit must more fmthe county where this project is located In accordance with
the requirements of and 145.19, Wis. Stets.
Inspection of the private sewage system installation is required. Arrangements for inspectlan shall
be made wRM1 the designated county official in accordance with the provisions of Sec 145,201
Ms. hats.
A state approved effluent filter Is required Maim enance Information must be given to the owner of
the tank explaining that periodic cleaning of the filter Is required
A runs of the auuroved Plans modifications and this letter shall be on 5Re during [nnstruc inn and
open to ins Indian by authorized representsfiely of the meant, which may Include loyal
Owner Responsibilities
• The current owner, and each subsequent owner, shall revive a copy of this letter. Owners shall also
receive a copy of the appropriate operation and maintenance manuall and be responsible for
ensuring that POWR is operated and maintained in accordance with this chapter and the approved
management plan under z. SIPS 383.54(1(.
In the event this soil absorption system or any of its component parts trapunttlers so as to create a
health hazard, the property owner must follow the contingency plan as classified in the approved
plans.
The owner Is responsible for submitting a maintenance verlflwtlon report acceptable to the county
for maintenance tracking purposes. Remains shall be submitted at Intervals appropriate for the
components) utilized in the POsi
In framing this approval the Division of Industry Servants reserves the right to require changes
r additions should conditions arise making them necessary for code compliance. As per state seets
101.II(31. nothing In this review shall relieve the designer of the responsibility for designing a safe
holding, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number fisted below, or
at the address on this letterhead.
The above left addressee shall provide a copy of letter and the POWrs management plan to the
owner and any others who are responsible for the Installation, operation or maintenance of the POWi
Shansi
&% Rmi
Deck 1El'oabetxl Rudnick)
Wastewater SpecialiA/POW6 Plan Reviewer, Division of IndustryServices
(608)400d186
e zabethrudn cki(awiscons n env
PbajaNt Name:
Ounals Nearer
awneh Nuros
CONVENTIONAL COMPONENT DESIGN
RM4emel AµTutlon
INDUANDTMEPAGE
GWA PARKRESTROOMS
%TOWNCLERKOFTROY
654 GWVER ROAD
ADDSON Vol
Legal Description:
SWI/4SWI/4SEC9T28R19W
Townsho
TROY
Govair
STCROM
Fr r
SuWNlabn Nam.
r
..:r..
W Number:
Paml 1D Numbet:
04041041-0 000
Pagel
rndsx and title
Paget
PMPNn
Pepe3
Sre m Song B CrcaeSectlon
Page
Fiber Spume
Noe
Memnanoe inroimatran
Page
Management Plan
Pagel
RCmMCMSepflc Tank Mafty mm Form
page
warranty
Noe
CM cr Plat
AtlxkmerN: Sol Tplfl House Pens
Drlgmr/Pwmber:
PAGLRKOEFLL
lkmae Number.
22 10
Dam
ONM019
Phone Number
(715)446-3660
Slgneture
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r
BM 11W MANOR OF makX101'
,Or ,,N GIDVEP PAPA RISUDGMS
NUEV=Q1SCA
Q=aM eM1=InG PM 2=9805
_WRING
O
g9PIMG 19)82
POPING299.5
QOPING398.45
SOUTH FIELD
125 PER W ®3 -< 7.5 GPM X1.5=65625/.( IOAA/5p#1 aP OP 22U FLOWS
656 fi%1 �B13)D.% SFP11G TKNX ROUND TO A 1DX WGON'00'
125 patrons per day
656 25 GPD Design Flow
BgLAB80RPTON BYBTFM DEINLIeMVEL1EBB LFACMNO UMR �_
pnopd�:
GLOVER PARK RESTROOMS
4
w.eecxp
5.5
Pwwl
3
nCellwMm
5.5
fetal pod EZ FLO
55
ncen Loul
275
wn B"Par wl
3
nwl BpNre
110p
wn Total
Gnvallo LpecM1Np UnpE4nuMdnr. INFILTRATOR
onwll.n Leeching Unit wax: EZ1203H 10FTAN05FT
ryplm cmos«aon
FlnbM1e00Ms_fl
......... .... ..
Sail OvcMlll
wo 16 FnN¢
95.25
121
T Th aYw SuMm
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3 P n Sloped and AncM1wWVxN
y _ _ ObpamOon Pipe Gp
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umneee 225410 ceta:JUNEIUH2O19
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MARPoN.-ICPE
POLYLOK PL- 525 - 625 CUTAWAY
WLP ROD
SECTION AA-�
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ANTFAW. FIUEDFVLYPROPYIENE
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OPIIommsNING
ilRN MRPE01111Ef
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PA NO. mlI
OR CFTOWFR TS}NTCH
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PART NO. wlaR A
POWTS OWNER'S MANUAL& MANAGEMENT PLAN Pea ) a �
Dwnw %TOWMCLERKOFTROY
S CTnkC,mn'ny
100MIX M
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YEAR
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At least none many:
YEAR(�'1
.ervi al
ONA
Inmm Amp, punk omen', a Mmm
At Amor mot evw:
Ll 0Mm IN
lack,
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NA
CahwN
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MANTWAIICE INSIIili Tli
mmmmOill of ton" me Newmn =ebe mall M mete by an ineXMual mmWq me W the 1OHmaten mama of urMkNnu'.
Mi Foun er: Mud Plamhu Rammed Smv: POWIS Inspanw: POWIS Mamu m, Sbnme Samry Opmmr. Tom
mim0ms mains midu n of Met vi to lOmMfy, any meaep =r ammh"i money any maks o, IIIw tin thena,I m, M c,mbinM akda, mn emm and to ,peek far my back m or pondit of orMnt nn Me Pound =1,O,,a
The tlbpml men) Into be vemly a dam to m ak Ne ullum level, in the obeervnlon plow me to meok im any among
of Intent on Ne paled emla¢. The po p of weumt on the around auTe=e may InE✓+u a talent mndNnn end mmla the
mr,mm, myti W th, local,wmnarY mmmity.
When, tlrt ,mbim l av„umuhoon o1 ab dte and Imp In my tank put =oohed I$) or ewe of me tank mmm, !M army
an,am, of N, nmk Mall de remove by a Saptape mrvmW Operator vd dbpaeM W In e¢=gm=e wmh mmur No 113,
WJ conun arm nem, Cod,
Alr m.
�abmbut not tmlmd to Me Ite ylelnt Mi lei mwbtu't lFamemim COMAIM MS teeeeew.t
units, Am any m
eirmi n intmwh of 1131romN. IhN be pMtmn dy a ,WIMd POW73 Whinny.
Aarm may mN he peaidm to the Into Momoy euti wMF 10 deye If owmkimn Many er e"M
F.P. zt 2
SOMPT UP MID OFENpTIOM
F=r mw mnamwrmn, elm he ob of 61 FOWISCheck A om Mobw fw Na proven of Meaning p rem w aided, eAmJoIF
MF may roped¢ be i=xMwnt process ndkor earnape the eleperW FIRM. If MR wSUMeuma me demented Ina One ambnts
Or Me tenon rune by a npnpe vNCNn opelM MR, W uu.
Stwa ¢ t up anM not omur was, W cmanMu Far fio=n at Pro MftNM,, nvreca.
Dumop power outpes pure fi mry fll above nolmM Wirehair Iowa. Man powm LAM be, exam& wactewarr WYW
alrcra,Pee m me dId,,lw Canal In me WP• don, we,[,W,W Um cepin and mi w t m ire Iodine or uRxe chich"a of
Mlumt. To awW Me Mellon Move the mntmu of the pomp tart iwnwN Per a SMPMI Sxvl=Inp Opvam PIMP to nvWry
on~ to Ne &MUM tame or =mitt a Pat or PoV✓1'S Maimamor x eNa an m.... IN ending one pump m N, V,
nomW Irvd, wwn One hump M1nk
0=nd dI or prk whiny wd took, and dimmi POP, DO mdime or vK ova, or otlwrudse enter, oranwa Me ,of
,,vi 16 feet dew, slope of ny mound P wgrade Per ebmrpdon are&.
NMudion or HmMRbn of Me folmwinP her, the wawwvav, mam nay Imdwe fie periwmi and amimP the 100 W Me
POWTs: ne: baby w va better ... d,me amr aii dap , denttl Po®: OIWI: hake ei fare
M,eJI MI II MINI with lrvk na "went, RMI,ge PmolPe: pew: harloa a trod w,qe: malk 11I PIT:
Panama vma„n pmethwe al@aYMpil ; twnpa,a: me Went, zwer Wires.
ABANDONMENT
men R, POVRS fait aM/m in pemmently tote one Of emin Ne MlbwinP Map, ahal M to W Inaom onto Me aye i h
properly and aftly sh"I In organ=& with taph, Comm ea.]$ W"Form AtlminWeWe C,de:
uI plume m tans ma irk, n&w b. dv„ma,rad.na m. dmm,t don. npnlnR¢ mWd.
m.amreNd a.nWk¢me pwdndealMWd.na deem atWmdt W.sepafle s.Wdro opw.m,.
• MR, Peed!0, edtl WnLanm.tlWpnwmmor tbe. mcwwW mtl rmwvei or Nd mvv¢ reme.N PIE M vde rode flIM xM
CONTINGENCY P0Al
U tla PI RON and n.nw be mpaW one MIFFIns meavre¢ nw& b , Meant be taM, u North o wall mre9a¢
w xt ot n:
reo o A 11MIN, raPKMi vex nm ben W.IUM6 add my be UVI IF, Me boom of a npltrmn< mtl eF®rpun
ryWem. The replrtvnmt mee&new r,"NoNA fen dinewbnn ne mnd,,nMaA NwN net N MITIelaa lWn by
returned Ioeaw fin, e¢i.t,u tow woWne Muum, etFor area wane. Ft'Inm to PrWm the,glewmmt and wMll
„mNe doe fm.nawmd VMFftv.mxlmnad.Wen..,Nebk apldemmr.,e.. SNJ.,uast wwaoe w,a
O ta'Wr tra o,a& n of a, n mt wee.
o A a,Mele m hoofing
. vanebla a,. to ,to hat drat, ... nmiredwu.. BPMP ayem> in POINTS
tdnmlDPv d n,MI.P and ma
s. mwlW n.It„mat m rode,. as nxda Powns.
�� mk
. Me . 'PROMS Fn✓M, fd.2.J If beeal-eiLp+
o M,ana n ,Fend" M alma fn wJ of tla annul t me
InNmaNe ¢urtxemflem1nsw oo,ss of auMmryatmu muaraoanpty wM Me rvle¢ In dhtt at that Xme.
a GWN RaF,>
METRIC, PUMP AND GIVER TREATMENT TANKS MAY CONTAIN 1£TNAL GASSES MPADR INSUFFICIEM OXYGEN. OR NOT
INTER A SEPTIC. PUMP OR OTHER REPAYMENT TANK UNDER MY CIRCUMSTANCES. DFATN MAY RESULT. Ali OF A
0.MON ROM THE INIEXIOR OF ATMK MAY 6E DIFFICULT OR IMFOSSIM£.
ADOrt GwA cGMMENK PUMP THE TANK AND Gi EAN Ell MR FVFRY APli
POWIS INSvLLId PoWTS MMM m
dame COUNTRYSIDE PLUMBING AND HEA IN NmPro,•a PAUL R KOEHLER
FnpM ]i&248-2660 ]1&24&2860
S AGE SERVICdD OPBLLTOR INIMPELp LOCAL REGULATORY AUENORITY
Nome
Bartels sa 'c selwce
Pane
1 715 426 1025
N&md
C I
2WI
Rend
-]Is- 381e-
N
a
ml.amama Peerlit. mmPpaa..w lhd M, OF. b3Mho0)DAdFQl I SI II,Pit 6 or,
we.uP ms.mYene PmMwrl Servwloa SOIL EVALUATION REPORT Ppe I or
GNe�mmsmerv.a auraose
u mNen®..u5P51x. w.. eem tma
�b
STCROtt
PaWID.
MGIM1J0.tW
FN
toleanamxienenwwplrebren.,PunmllnMAae em
Pa�nl eupe.eale orelmenenna, mMmw,melo®len enJesnnmm msaam�
lOomo
PNua plot alllnbrmatlon.
Rerleaen eY
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em wuP�+e. m.vwuwenruwmv ��0'mMw�.ad w I�IMII.
PragMommr
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VTOWNCLERKOFPROY
9W SWIM 9T
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654 GLOVHRRO
a qm
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NGLCVER PD
Q Nm C0roo s UwQ RwN ?Nmwof Ne �We d~e^Wn So, Mr
ORD
13 WppanwA Qry RPSMOOMS FOR GLOVER PARK
mnmemtwlLOAMYDADT µ
Tll INSTALBE
S THENDYGRAVT A 6 LEA' LEADINGRHELOW iIIE
9IZETHE SYSTEM ATA 6LOAORlG
BHORIZON.
mX �l°^�'°� 9Y1ffiA ELHVAilON 9525
BVA 0N95,2
NOTE: AFTER 86 CrCHE4 PDS WI[�EHANO DUG.
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aMmYmmiNnvwr_ 6
O6Bmma cwneaelenew. 99.5 86 m c .
PAUL R KOEHLER /i�l/���- 225410
fµWS{ IVi}pnnre5. J.
WISCONSIN DRIVENEW RICHNOMl WI5e01] �E�NE Il2019 ]15�2A6JH
wroam cl.enKOF'rxnv B00.1a1J0-0W � 3
R4^e'b Mne� PoMNX ✓eP _M_
- ppnippU�g 98.15 130
•EPVYp1=BOP •>99 <Yatl rtg0.atl1S9 a9951®.qM1 'EMvaHW=BW �.Nmpl mf i�<tlpmyt
tTe Dept. of 5elery eM VraRavionel Sarvien is eo eq�el aryoeNniry eerviw pmvitln mtl <mplaytt. If yw nzE avawlvlenve to
xan wneev wvwEme¢r41 in ao ellem@ Iwmet Ponpp N<tlel�Wcmin(AS�363�3151 mTIY WwgF Relry.
ftm plANG PR>ARC RESMOMS
BM 11W DORMER
NROPING 299.5
OF BIMRTOp
Q-BM SM I•JMBM2=91IA5 \\\
�-ROPING
BORING 197.82
9OGNG299.5
BORING399.15
SOUTH FIELD
BM 2 "JIS
nn.
Private Onslte
/ RPPIIsannOaxR FOR REVIEW
Wastewater Treatment
PPwN.mmmm,eemnmvmmms
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Berenlmun0®neveb¢en wltyambuwneulllMym miexvlvum lxu or GN¢knq mdcMsmm. Eaasvn WdM
n entlmelrtlm altndixkourµeb¢tletl
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/buyer
Mailing Address (0Si I)SCEL
pon, CL
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Property Addn ra 4a.R N G1 Qn d F! A - W—
(Ventilation nqi from Planning Z" pnd=ntmrmmEFmton)
City/Some NbA edDi .)Z Pamendeotificallnn Number 040-1041-40-000
LEGALDESCRIPTION
Property lboation,Cj, ''A,jam_ A., Sm. _�_, T_aqR_d_W, Town of-Tfnq
Subdivision Plat Lot#
Certified Survey Map# volui Page#
Warranty Dced #
(bOfrm 2009)Volume ,Pap 0.
Span house Usti ON l ire[ id entifinbk D yesi
SYSTEM MAINTENANCE AND OWNER CER'PIFICATION
Improper use eM meinlmanaofyoursspac [y[tem cou10 result in ibprcmnwrefiilure m IieMle wrex Pi
,maintenance consists of pumping Out me, septic tank every three yew rAir ci f needed,bynliunttdawar Whrtyouput nto
We rysleeen,Red the bmo i m of he MAi, Mk in a banned stage I, the waste shipment system. OWnaivinmm,x
maim, blaieswe epediied im 4SPS. Sff.SR(p and In Chaise 12-9t Cmie Counry 9anituy ONinmeu
The Property ux a egrtte to submit In SL Cmia County Pleating& Z,nina PopaMen a adiLet ion him" ri pad by the
owed and by ems s ptumber,jomnrymenplumber, Mounded ptumbetora hommaid pumper vniying that (1)lM ones
W disgust l system ie in proper Operating Aviation and/m (2) at inspection and pi(If Invest de naic tank is
Im an In alnfnndp
none, the ternamgrei have rted the dove Nowremems and Aram, to Mai Ma the private sswage disposal system him the
standards tp form hurm, a ad by the Cepnmenl o f Softly And Pmfesionel Shansi me mid the IX"Nwnt of Natural ph vvq
Sett ofrainb n. Cedi4u dug that par ethnic Annem has brc"retained mn be conplNM and Moving b the SL CnAX
County Pannign& Zmmit Depamment within 30 days of the three yew mutation di
am, rsnify that allm ,this term AMINO no tire ban of my/our knowledge.)/we Debate nor ownn(r) Of the
p prorty aetuibed Anse, by Vimn of wmrydml Mai in RcMSE, of DI ogre.
�lLl
SIGNATURE OF APPLICANTS) DATE
^Any habitaon that is m erepeexmea iAny rmu It in the sanitary Penn it being revoi by no Planning& Lniing @pamnenn.
Itmlude one this ship IdbnnrtMM mwemmay deadyear lbe RegiewofateOnce ad Ontad, Ap) of the ads fete survey map if
refema'm made m the wan.nny teas.
(REV. MID)
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