HomeMy WebLinkAbout038-1010-50-000
IV152_ Tin in per-ennnrr tre-r.-~ PRIVATE SEWAGE SYSTEM `anIT St. Croix ~
2we:r a I!uld-;p nvision
INSPECTION REPORT San Iary Perma vc
ATTACH TO PE:R%11T} 615375
GENERAL INFORMATION 5rale Plan. a No
ncrsna.a -fcnr'atoncn^.ay be
USed lar sr:wbary:nnposrs-.riyarylnw x15A41
rlie sTer PRAIRIE ar el ,r.ratr 038-1010-50-000
J essie & Terena Stewart TOWN OF STAR
~5- fiN 1 lei ',nsP. EI.1 Elan I GA Ucs"'PO° _ .<.~,.mTar. -!-an,e:Liao •Jc
02.31.18.308
TANK INFORMATION ELEVATION DATA
TYPL VAWFACTURCR STAT b_`N G'S H FS ELL`S'.
Septic Den, Vit ark
Dosing M. BM
Aeratlo-l Bidy. Slaver
Holdirvq Sul II In. el
TANK SETBACK INFORMATION SUR O;dlet
TANI, '0 P!_ 'vVFI I BLDG. Vnn t. Air l-ta<o RCWA Gt trier
Septic LA Bolle•n
Dosing I IcaderDdan
Aeration Drst Pipe
Ho ding Sot Sy'stelr
PUMP/SIPHON INFORMATION FinalGrac e
h'anu'rc•..rrer _irarar'd St rCVCI
t,q
Mo.^.e1 Number
T'?H L fl °nr,•.ion Loss System -eac T-)H 1
Goroerrain LcryV. Dia :me 1,1Ns.
SOIL ABSORPTION SYSTEM
nF.D~TRENCH , -11, _ongm `,o CA Irenchr.. PIT DIMENSIONS `JC Df n t5 nsiea Lis 1 iquJ DePib
DIMENSIONS 1^
SETBACK .`is'S
INFORMALIUN 1FM T`I P;L BI 1:: WELL ~AKF~STREisA! LEACHING Tanwact_rer
')G!' r~ t:i::nrrr CHAta BER OR
UNIT Idctlol N""'r.
DISTRIBUTION SYSTEM
Fcdcenl.lnirtolJ Cibdr..l.<" T77777- t"
Pipr,sl
Lena^_ Cla tenq:h ~ia_ £PaGn
9-_
SOIL COVER x Pressure Systems only xx Mound Or At-Grade Systems Only
L :nn o c' uamn c r,
Ilc:1n-vnch Center ue . eph ar vx SoadedlSooced xx 1.6:.' ed
_-Dl lrenC- [ones cPSc
Yr;i VC Yei f.p
COMMENTS: 0-Idude code to"Cm{-r:•rrIes, persons o•es(ant etC I Inspedltrr) bt: Irspcr.'io-t a9
Location: 129° 01V RU H
I.j A t Bf.' Uescriplicn -
2.i Ef.cg sewer Iei¢n -
a-nounb of cover -
?Ian revision Rega red? Yes Nc
,.SC U1he' side for addiba'Ial infcrma7on.
aeu-i'N; f-i Sr., C4, ~nsep<:rva'a S 3na'urc ,r.,
_ i~dJ tr S'. iCC4 lvJ1'.
14, _ h
$ aS r• - nit n i'e1 ~~i l h_n: - 'c Lr Iill I In'... a~,•
?162
r I* Box
Ps J L oeel _71c2
15 375
~ - _ - m I t' u1S'I A T rl Nutrhr.
}
Application
put ks Permit
r ar-a anb r~r a .oi I: ui I th a-:pr. rr a unr Int I un.t V __J
ul.luuvl l.n I t n. Ir l it I oi- I \ +I I n 111,1 tat n .A IN 1 11 arc Ul-mtu to ?r. UC1 A Q, I d..l...'.l llrtr I: It In i.css;
II 1 I a Irtcnt I I x d I 1 al > I I r un t 1 0 TI: : I n-i . Id. -ua u.d 01 a, 7ar~ -
I q. _.I_L: IJn ,n:d1II Il.x•_a. u,7Lm.ath - _ ,~~Z2~
I apphe•+unIt Information - Please Print All Information
I t~' i \ i n:' r l
~/t SSi! / ~•^-fl~:a. ~'t£w,~L~ 63 U -,f0 - pn()O
ff u_.-Ie .1•..n .a:.:ug 'c J,.:a; _ ?r uhI ,,xon
1731 3-T- IJL:~ ~~kc ~,at~t In: -
(.Ite. S:utc. - - JIp Code ('horn: N'..clhet S%A~ Ia Se• '.,I Sen:ion v
St. ~N,; R ~l/s s v(~ y c s!- z o~ rasa -13 I . R / 09 L
11 ~I) pe of Bulldmr Icheel: all that apph
I _ Fa:nll, f1 L. -'su¢hcr ci l4cd o,.rn, _I~L~_ Z Suhdnv¢ u•: NIT.. e
OIL RI-''. IT ❑P li Commu 1 Ilea Lh.:lF.^ Ll\ L I\ I
~~u
r ❑ -
❑S to s-. I, Usc - d 37 7b ❑Vilh tit
111. Check only one i on line A. Complete line Ilif applicah-- _ , iK ij ..4_ A-
P
o
I T
v S rerr I__I Rc:,tl v....... i ; rn ❑ Ir.:v:: cn; I J. l:ri. :.In.cv.cnl Only 01 rm t :od:5c rt ur I:, fs s:c.c S<q In ara
li. l"c•. w~> Perm t tiumic: sr L1 1< L+.::.'.
~j In n ❑I'cunit R;•, a•," ~I l u_I~f n,n ircnsl:r to Box, _y + u
Cin I ,
1
I\ YItT(SR'TC~1 C_ omponant Daa ice: IChul all that apph')
Nc I'.::>In r_Ir G:a_nd 'rc :n II ❑As-Iiradc ❑%I b..... :n ofwI.abh ❑ Inucd -:-14 u1. swu1,I: so,.
\ DIIti . ❑ h I mi u I d.r, _ ❑P: ctrcin ..I U^~ 111`.1_
t 1 r' I•I -Ln rt vat lrae Information V
~ J - F [gyp IT °'f`' N•C J
ns
ev_ IIv. _,pr11 Des'. _'ra I .I I PI _.9s, Us.._rsul nr kylnrc,ll iiI fsr_a.A:a c 1.[i CG Z/~ f4
y`J~ Svc 9c>(~ 9 9 0 " 9s 1
~r
NT Tank Info f + d•. in ra cl t' nut. '..re1 c ~~,yl. /
u. lu, . f_-.nni'I eras a(/ _
yu~,v x -
\'ll Itesponsdnlne Statement- [,it.. unJ rai neA, assume respominihty Sur n,I;.Ibnfw of the I O\\"I S shnsrn on the nttad.ed planx
I y,~ d ♦.;r t I r 1191?. ~I nl art, I :I ''`I n~ha: Bat : ] Ph tic Vunipcr
l
llama .t[ c:w15,n _ a ~Q ZL7-371-_ 71S- sile8
\ill -.hunt lIc It tmcnl l w0111i
li a. ad 9 - - F "ma Pec Dale Icmin en: S. Mat rc
Iv( } aasupi Sur Disapprrn'aI 3 1. ~..r.~\ I/a. U ~ZQ/ (J (r L~
1. Sept.. ck, a art. I r• en•1 I.AIM~~~•°°'' _•aLl
uispar.'s. cell must till b~rse_k.'•s ' I'r 'tt -tL ' t° 4// ~CIY`tia•~• /
+as per awrnement plan yo aden by ylwnoe.. Cc,TL r
2. AN eeR rX nNrerpn:s rtarat 1N. I rt n
pereplll
u>ti: M'rwxa: 7 {f e
ea
ar i o. un.gl lIfaun lo. IL s Ina .ma •nfn ul1'd,c Gr ns nnM1 rr pu prr not hs+ti yrfi lvll inchas m>i.e
s
1
1
~..J Q~ j •a 1 L
a
j
m f-1 L)
a 1 V
v ~
3
t ~ rJ
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CONA'ENITCN!AL Mfv TOCNiEN T DESIG,\4
F.esioenti2~ A~„lica"c.
INDEX ANJ TITLE PAGE
•Pr;3ct t~ar~e
D.,"ners Name IL
O%,,ne's Adoress. l 7 3 /
Legal Doscratior.: 5w £ nnS Z TJ j c I,L -
TOwns'# 74 1
St•bdiASion IAErre: v
Lot Num;,er-
farce! ICNjmt,:,r: C) J)' Page " Irdex and Me
Pagel Plot Plan
'age- 3 Knum Swo & C-css-sec:.67
Page Y _ ;71113: Soecs
Page S
Page 3 MaraOBmen: ME-
age' Croix CW Selz -Elk Mahtena%e Form
'age 8 oya7ant,1 De3y
Hag; a CSM or a 21
~.tt3O.ments: Soil Test & Hojse Plans
Dos;?ror'PIu°,or C~4c, 4f 7Y~iw/S t 3 Ji erseNLmb:r: 2-L2- 072
7 / Phase N::mber t /T' ~f 3C-, 138p
Fvs! An • ~~.,T r 2 733 10%&F PA :vmo
Gig= 1
J O
I)
T
e
4
a ~
Jam- _ ~
\ Y
v v
F-7 ® 3
\ 1 ~C u 1 r1
V 1
V
1, J
~ h h
Soil Absorption System Cross Section
n f- - - _ rl n
ft
I~ 4' Schedule 40 Final Grade
PVC Vent Pipe X17. L i - yb o
With Vent Cap it
.1
//~a ~L.LI'~~.GC- iJ•
Leaching _p,//
Chamber -
I!( 11 ~ ft
-y System Elevation
it it S It
Soil Absorption System Plan View
ft
_ it
{ [[IIIIIIIIIIIIIIIIII[Illllll(I(iallllllll[[[ll[11111
ft J Leaching Trek nch 1
Chambers
[fffll!Iffflllllllllllllllllllllllllllll(IIIiIIIIIIIIIIIIIIIIIIIIIIIIIIIIIiIIi~lliiill 4^Dia.
Irench 2 Header
Vent Or Observation Pipe
t
l.,. II
Trench 3
Leaching Chamber Specifications
Manufacturer And Model c; , C k Y.7
EISA RatingLd sq it per chamber Soil Application Rate gpd/sq it
7 >T gpd Design Flow; -7 Soil Application Rate-, Z_0_-_ EISA = _YS Chambers
3 rows of /.f- chambers each.
Page of
Y-
~rl t e r!.^^. V=i
I ~ c1Ci.~
r
...__s qJ II _ l; :u
?r_ 1i ULIi::.'I;'.-h BGwilA1315' S.c .+Lle ~J]pe -
' IM1~ 7IY i~t LO the I : D'^~. I'1 _S' C.. _ v
its are pre-mnl 9 mzc th- 'he SiJe sell?r.
c' et are pre-malded enro the c,..
-r So!•✓ertv:_Idtle:a;c,oshe :?'•L oiy
dge uriil iL lows inx plz:? acne 5:7Lo r c s
p cu-i1 - o Ye;Ll:el re;:
mt
i,i;.intenance
c-air.fi?lo,ih: ,nh:•h.Jla .u1•I_~ ~ _ t
~t
_G "i'•110,'e the °l•:?i i ]ririic- •i!"-', :!•e !i~L..r _i. n I I La y
-r . n e he d
' I!~ T L9e: IJ_ _ C:51 .i'
-fie :sse Tilling avc~i-33d sw'rC l,`EtiT10L„ Of S 4117„ h._ C7 cnalI
!>Ir:p an o'dinal pr)?ilnbo -^5 :he f,--,2r C3,ri3c "SU'I
r. L., " fll J_r:a-r'-fie oa ; ~u c~,e i-t_ _h. -s.
5I i.a:cl c back U. "I1
lid .,arl: an 'h ;.rv:l.
I t
' r .f 11 t'J frb']? ,1'IJo_.. L1`: TE i,!;t l pt in c d,i - -
r❑ (1 I S'I L t r' I ❑ n C f Qn^ J '1 11. Jr" t Ot Y 1 1 G J J _
^ ~ ~ r I t rr;n~ 1-10 ^ rcJt: ,rraftn 0n, ¢zu 1 rtr., pt cu_. •1,.1 ...n n ~I, d, c;l r t .r••~-.~
Av v., Itit..i; La:ix,
PUMP CHAMEEP CROSS HCAIG?J n:n.'<' cnt pc~-c•'aaa
'i 't 1D sc f-or. dear, v.+ntnw j
hr:2G IGG'•:.rl.J t':3r1^C'C Or sr~c- f
'i •--::t:f~.. = \ _ ~ I Imo/ ~
I !vr.Tr C' Cv'[
L' • r ii _ _-~_I I~, III i~'~i I I~ I I I`~ ~ ~ .I~
.I _
fl ~J I d. .1CV~'✓ELI
I I :I i J r - ,t
' LED
10 i-
7- I'1/ll,l'M ) )!.I I.i _=ice
ilt;
Ic i
+Oi-. I'_rii wrtC' a)87"7 arE s=_-a.'iiiE I ~~JI?7:1:°i ci CscS: _ _ / Z 'er •n.•-
<ir-_IV s -.t IL: R' <.,.:r. r'c~e "o-'n_ ayf
Tank V(;; uI-t s
nla:71 )f~f UTcC rSf / Vt i 7~O~ 2-0 •/3Ir..=es c- 4 ~al n^s
M0Co1 hJiMiber Inche-5 Or 3_,_-1`l
Y•37 -:r:,s or 7J• 33 Gall r:
Piu, Man:;' ar-_j, C?0-ti' S i (L :^Gh25 v'~`)7.~✓.:atlp^s t
IN
li NJ! OCeI (l_illC I - i - 33 IrCLFC ~r VVJ l'-I lr'c
%i O:izr.m~-cie Rate:
=.I ~e,e r_- ret:.e r. rump C'r` rl?t::ir,r pipe -
,I rr-, it F.c-c If-r' ~~:U DIY r?ess ~ _ _ _ L- / '
r' _
.9i :1.31 I't!^l:?_cnlt VIriC(1sICr1'_: i.?r~G:i,
I-
Effluent Pump
k
3871 EPG-
,05
Stan A?PLICkTIONS
n ~ l in Ems:?.. Imp: her: "h. n ~ tai- IE 6 a n t : rc lrc,~;
'~-d t,e''U-'a.icr vr:du uPl
IfICHI I[,JQ ^.1 i_i C9 I Ld 0^'. l'I ev r. vo.' c
• Efflu~n' sast_•c s Czsnq and Us-c:
• -inre, "rn rr:';de a2 rr;iyr' ;n;::v:r s an:: AGENCY NAM
.4vailatle .Dr au:arn;:i;
,aprnD• J2^y:h Co'r ;i. ri
•urns any
franua o' eralian. ,Gala- r
:8:'S:]IEE. a~rrw:invQ::~uracai
• `tE2Yy tlu1' 9rn'p matic ma-leK include
• V6::n-;r M." Vnr. ;acica: Fowl Scr,:~ a r✓.ota Houskq Cast i:a: k:ism r:dei n.. rt';ws e't9
assr:ctblcd cei:. not scat tranSIC9, ri ,r"r
Jn:va tennp Ire
rn:.:;reset a'. L e
Iactory. :trt:r;h, an- nxati.icy.
SPECIFICATIONS KIA:)tor Cover; Theerroplaric ,ail ru:i~v K tv Axe "imd
FEATURES rove' ~7n ii:>yra! harJIe and
• Solis h~-Idl:no cacsbiO,Y - 'to]: >cia~i =[::ar•rtrent
ra>,i nt• H FIN Impeller. Ih=_,cq'a:- It AM Cable: Slow My
~npncitiriz u:: :u 6G ::Pht. x'4rr.i-open ccl;l:r v:irl
csrotl Di' '11C vrztar r_.i,.]n,
'naI heads. '_c !e iP.c;. pump o;:: -;anes ix ntrthavWi
• ~i>;: IarOn S.:e' 'dam Leal pr0:&.,,v1
l✓enaniral •-,az CaDa-r
EUN4d•1 eC~stom's;.
nro: MAY
1l1{'} :4,.',,: Csiti..l?L'S
:4p`F (SO`Cl trtiacMETERS FEET
•Fa-Pnzrs:3v~, smrs
sr."ST NNI
Macy _ ~hrsMacy p! N7=-, is
~
rrco ponenrs.
Motor'
•:1oa M VCO H:, H50
RP.'.•:, bulb in
autDet2CC re>et. °
t
• _FOS Singe V'tasti: ^.5 t'F S t Pp,~
t1t or t' r01'• 1a5C ,
RP' At a O E lOc %11*0 L
Boom!= f L L : Pry \
r v CA IT= -
star~;-- ~ngh. 15:3
_T~J,V .mi!f. tvice proau
Twjwmgpay jtioial;:0 ° cs ] It NA
!3 ~l°.h' wilt
Oman d WPM
v,r:.ctrr
GOUidS Pumps
ITT Indu5l,rle>
fiitr W
POWTS OWNER'S MANUAL & MANAGEMENT PLAN
FILE INFORMATION SYSTEM SPECIFICATIONS
mnr I 11' f lams to nr 3-' ff a E NA
f rrcit+t r 16cIIOo:eEVolding V,Icme: /Do_? rcali
DESIGN PARAMETERS Tan, fclanufactumr 3 %f4 w ❑ NA
h lm he: uiCncree-v'. E NA S.^yfr.se I_I Ifolding Volume: (y00 (call
tvumbrr of Pui>fr. =acility U'l t_. i. '•'er;ical D stance Tank Bottomis) to Service Pad: /D ir:i
Es--mr:tcd(average)F:o.v: 3~a :da;daya I(eri7ontiUietenceTank(s)to ServirePad: ~p (ft)
mneJv,rs i bep 4d.d if'ecrtialt 1 cot
~i gel l;oeakl Few (estimatedx i.bj: y,t ~'✓J iralt.Iay; if hr, vr:r,al 's>150 feet. $per. fie lnslru~IlonS ;n he p. n.i,.~cr. La.'<.
In Sin: Soi' °•.pol:caticn Rate: T> (gaVday.M I Eftlunnt Filter PAacufaclurer: , fG 4^'* ! F NA
ardard (Domes'ic) Iniucnt:Effluenl NVt ti by ave, age c'(lue9. Filter Model: ff
a's, Cil S Gra=sr: (FOG) s:T7 n;9i- Purip Man-,factureC
Cioclerical Oxygen Dema:ld (CODs) =2201nI -;:2~1 NA
Total Suspene.ed SAics tl SSi - iou mgiL 'vtlp haadd: _ G U',{ _ 3
High Strength Int uenJE;;,uent hlon6ily average I mr reatrrent Unit
{FCG) >30 r3C- ' F.1snUf7C'llfer:
rpti:i,1 >2'LJ mciL g'fI•.r""•. IJi~
i-.5;_ >750 ryi: I fvi °a::~,: al::erztion I ]Pea: Filte:
- - - - ❑ Disi:.rcrotlcc ❑ :"ICtl2nd
s'mtreated Ef"Ment B•tonthly avsraGe I J Sanri'Glrr•I Fll:-r ❑ Omer.
F / 3c mg:1. L4,(/ cIl ZbsO'D;bn System
- ' - -
, ti ^ r-,:q .A
Fe - t 9o1n1 ; u_ nicri cI'Y n Grcand (gran Iyi ir :ind (preecuaa) MJ ;~A.
%]9:x.imum Efllu~n;FartidL Six rlla. [ nc❑-~Ine ❑
JItIeI: ;1,. Vthel.
( t:r.
MAINTENANCE SCHEDULE
Service Event Service Frequency
n-i!I- r.I.nnnd mr ut9-d r.'1 IJ volume
out t
ont 1 f'rkl~:
Puri I
r
Cuhl ~~-•r alarm C _
IruDe , rcn:9i:IOn C` ,c-.k:.,, Ai leant oncc e e- (Maximum 3 years) t.1 NI
inspect dispersal cel:'(s) Al :east cnx Cvi.nJ (Maximum 3 years) E! NA
cl. rfi'uen: liker At least cnne nverv: l I~ T' ,u :I ❑ fcP.
Insnec? Fa.mp, pfnp controls & alarm At least onr'e every- I~ Incnt~!si - - ❑ NA
~ ~zrf2i _ - NA
Hush laterals and pressure lest At leas'. Lce ever;: J year,'e.; _ _ _
OI❑t~: - I nunhrsj -
l k.e_>t rn z r-vnry- ❑ I I ,4a psi I I KA.
MAINTENANCE INSTRUCTIONS
I"spentlnns o. t,nr d I s,rp t^ h II r- I diI r J: dAM Carry g u II '.I n 1 ~I 1 rtrfl i_iors:
hAastr:• I'Ium~..r L7.--..L:I I I bar Ra,tn t I I , . il., tr ..L FJ, • S Mn ntaln..r I,c..clp~:;-
1 ank 'rsoecl m's must il'. drir •.ISI.n in.:ne. Ji:_n of fee talr,~'1 U: i,:! ntiry a^,y missc'g or brekci iJ -ntfy any r-i.ka c' leaks,
nleasre lhe. BrdUme rt annb:red sludge a-u scurn aril a creek ter ^ry crack up or pordVng of oftue:it on the ground <;wface. The soil
absorption system shall be •ns'!a6y inspected to check -,he efdcenf levels in C:e ubse.'vnann pines a:id to cne.ok fCrary ponding of effluent
on the gru.~nd surface. Tlh~e pi-ding of eE:uent on the grouha s.:,lone may indicate a fa!tiro nn"d.,un and rewires the immediate
not fCation of the Iona1
regulatory :;utto•::y.
o'ren the ccT,bined accunr.dafon of sludge end scum :n any treatment tank equals one-third (h) crrore of the tank volume, the entire
crn'ei:ts o` the tank shall be removed by a Septage Servicing Operaior rpumperi and disposers of in acoordar.ce ✓,•ith chaptar NR 193,
..ISCO^sin Administrative Code.
;~'I oihr:r services, indLding out not flr`~ed in the ssr.'i:9ng u(ef(.tera fi!tera, rr echani~a or press~.ri~~=:d components, preimahn2nt uNts.
and ary somrfing nt ~rter•v;aIs of <_12 mmxhs sIr.l: be ne.Iorrrcd by a cer:i`ed PO'o" Ii S to:a.'nta:nee
-'J'C m Ir °I : ea'..I; r1, Ct n-; ~e cr; ent.
STARTUP AND OPERAT ION
_n of
~ "f c on a `lion l_r rr to
cirr'iiC:a or sc Ym Ise c he r'Ci'i/fS cher r i eatmer rcr !re p'aseT:cc o -
ant t at ma/ nned^ tile treatment voce ani, n Paird4tg prooudc, Solvents ,.~taCfed 1 : - or other
e t`.e co.t,ems oft' damn c the
suit acsnrp,ron systern !f hi or, Concentrations are
t..rti,,, raro'ded gy a Sentage, Se:vie^g Ouera'or fpurn9er; prior to use.
ondil ohs , :n not rf,, ebIna ngxnsl hiyir.v;aicr levels prior to sta•lup or due be purcp failures. Start • c ^
evert ions is not raCOmmer.;fed, as the ex0ess vm zerrater v,ill be g
P or e_loa+
.ion of Power under these
0ad that may ro -it in l - discharg rf to me soil abcctption system n ore Large dose causing an
Y s rte backup or e dci O er of+laent and damage tg Skrh. To P.vc; this silua'lon have the
conte,nis ct the pump fa.;k remo:red gy a Santa. e Ser viaicing pe;a'.or the Sy
(pumper} prig-o;estori•:g pc•,ver to the pump Or cartact a Plunger
or PO /'/TS M-isn!ainer f0 assist in me1ua'Iy operating t. "o pimp cor1:ois .eltil normal efrl'!ent levels are restored wlthi.n the pump tank.
System start up shal, not cc~ ,.-.e.!hea self ixmditlms are frozen at the aGv,~. surface.
Do net dive or park vehiczes ova; to^ks or the soil atsorptiort s'os!em. Do pct drive or park over, or otherwise, tiislurb or compact, the
area :violin Z feet down slope of any mr )d or at-grade So,! aLrc,l !ion area.
Redjctinn or elfrn4raf'on o` fho folio•,aing from the evastc:vater stream may improve Vie performance add prolong the lire of the treatment
tanks and so .,xorr ~cn c: gt.n a rite an+.unhcs, bah, 4tf s, +-y.t.nfte Butts, co:iocn:s. cc9on sin+ab,, uegreasers, dental `oss,
d.apors, d sinfcc mts, fa feu ,ca.'on drat : (cu np pump d.sc:)-tce, fuw and veGetable peelings, gasorne, greases, herbicides, meat
scraps, oilo pan ung prrdoc6S, pest) 4 cs San' ni y r lp"ins su :+eras :arnpors, arld mafgf SO$E :e' Cfine CisCharge.
ABANDONMENT
,Aloen the PC'v'vTS tails ardror is pemanenlly taken o,.t o.` scroicc the; fella:;~in~ steps shall betaken to insure that the system is property
and Ssfe.y a;,andcngd in cc.-npliance with s. Ccrm 83.33,'Alisoo:isin Ao-ni!
ristrative Code:
• Ali Fa ping to tanks, pits and other soil abso. ption systems sbali he disconnected and the aba::dnned pipe npenings sealed -
• Tne con;cnts of a'i tanks and nits shall be removed aed properly, d'sposed of by a Septage Ser'iCnc Opora;or (pumper).
• .vft'r p.:mpirg, all tanks and pits shall be. excavated and remcvc:f or their covers removed and the void space fined wQth soil,
g•a del or another inert solid material.
CONTINGENCY PLAN
;foie P011'1TS faits a:,d cannot be repaired the fc.Io.ang measures have been, or must be taken, to provide a code compliant
replacement syst(r:
G A suitable replacement i -ea ;Pas beer evaluated and may be i.4i;izad for ti,e Iocalio^ Cf a replaceT.ant soil abso-plion systan.
The r placeinent n, sho:ld be pro'eci c iron. dis'u-bancg and ccnpaccion and show d not be it {r'nyed uuon by required
seibac ks rom ox S 4 ]nd piou:)sed strut of , ;0! lines anti •+~,:e11:;, Failure !c pxtnU rite replaGfm arlt a(ea w*l res7R In the need
for a fr, soil and site evat::a'.for to establish a suitaKe rcpia :went area ;Rcplacr.ent
ef.eCt at the time of [;:(,T
.r permit issuance r systems must comply moth the rules in
C A suitable replacement area is not ava%ih!e due to sotba:k a, arrr soil limitations. If the sc'i agsorptton sysmr cannot be
rehabilitated and barring advances in P01Ag8 tochnolcgy, a holding tan; may tie instailed as a last rescrt.
sly The site has not been evaluated to id:-•rtii'y a su'sabfn repacement area. Upon failure of o:e POWTS
,roux', be p.^.rforrne~-1 to Ir.,:a!e a saitatda : en;acrm err; area. Ii no r~ Jace 2 soil and si!e
_p pent area is ava,...Ble a ^adirg tank m g'e2luatiun
tae`s [as--:[ to replace the faSed PO4':il"S- may bnrnsta~.ed as a
❑ P:lcurld and at-grade coil absorption systems nay be rrgonstructcd in place 'O!low,*n,g rent^v-i: of ;!,e b;o•nat a' 'ho i::rJtre:ive
surface. Reconstruc',iors o'such systems must cornnlywhit Inc lutes in erf=c`: at tratr .e.
WARNING
TREATMENT TANKS, PUMP TANKS. AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK
SUFFICIENT OXYGEN 70 SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY
RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE.
ADDITIONAL INSTRUCTIONS:
POWTS INSTALLER
tia:ne .1 POWTS MAINTAINER
Phone i - - - - - -
~ _ 7UV Ple - -
SEPTAGE SERVICING OPERATOR (PUMPER)
LOCAL REGUL AT'0RY AU'iHORITY
r:ame
CfiPJ (horse
7his da u~l d was cn~f d 7v lr-w 1. , - I ;~r / S 3f3b - TC, f3O
r , r :I 1 IJ:harp [ °tL^T. ,n ul5~ar, <7t:f tie,. it rc
fe.{i'r.ce vi'Ih rec[icna
SI.CRO`,~ CO AT1 1
-a'\T
C VN=RSHIP CE1:17FIi_. TTON FORA;
t;~ter; 7u}`er- ~/3~, £ z'vw S~lw s - -
,<.t_:r_g.Ad;iress 173/ 5 i7t~ -l~r tiCli. Sf.
---1 -i t7~ -C'ti , k/lr , W, T voz L/
Properry Address 3f~ J r, 1 _V160A_ 3RR - -
~I'v eA icaJot: requires it lhmnir.c & Zoring D_:,arnnent for n-w consnwtion. i
T11
i,F.G IT DF.SCRIPTIGN
YropB L\' I OC3{:OC 5'f_ ` T I 1 ~l_ . 1 OtitT: J Tc l ti i L
Subdivisior. Plat:
- - - - Lot
Cerra ced Survey Map n - dolcm` - Pa«,
\'arrattn Deed - tbefore?(ii)'•jVolutne ?•a_c.{
Spcc horse - yesla ro i.n• t i r i,icatii; '.,Ic "
b-
SI'ST PtF :`rI.4_P'FEN
ANCF AND 01'v'. T CER'fIFIC.4TI0ti'
lmpropcr use a,d maintenance of your scn t cvster.. our r_aua it < n a v < ail
h i~c:.c a st ~.n:
matntenaacc consiss of- roving = the septic tank et thre:.e,ms n: so;me.. T n_eocd "'N a licensed . n:
Pumper, tn:,
Elie ;VSteS CaL af.Ct LIiC function o' the Et_Dtl[ tarp as a L'caT,ren: SL^e m tic ii'a;ir disposal <t'stCm. 0q9?e7 TalC:et: a.'t_e
responsibiiities are specified ir, SPS. 393.52(1 ,1 and in Chapter 12 - St. Croix Cotes z,
ty Saes;;. ay Urdinavac.
1 nc pmpert) • curer agrees to submit to S'. Cyan: CouupPlashing E_ Zonic_ J°
_pat menl a irg t a.: L r ~_c he ,e
a•r.vHr and h}' a ataster pitcnbe-, ga~tcyznan phrmbc:, rtstric:ec ntumber 07 2 h nscd pumper t eriryu:_ that ;1 t ¢..r site
vast e a er d sposal sty rem s a proper operating cnndinoe zn 'or i attcr mspe: iqe znd p unpat_ (tf necessa'y), the septic ;arl: i;
less than L''3 -W1 o`sludgc_
`we. tae undeaigne9 have read the above requirements and agree to main:zio the private setvae° disposal system.. with'he
siruidardc set forth, he,-ein, as set w :he D-mai „Went of Safbty Arad Professional Services and the Department of Xatural Resources,
Sr- to n`Wisconsin. Cen::icatioa s:a5inc hat your septic system has been maintained must be cornpletec and returned to the S . Croic
Cotmh Pl,=Ig & 2a11ing JEpartnenr within 30 days of the :hrec yea: espi.-ation date.
1,we cerify that aL statements on tats are rut to the best of my!ou: knowiedge. L %ve w ware the owner(;) of the
^roperr, described above, by virrae of a tn1 my deed recorded to Rcgisler cfDcods G
Number-of bedrooms
SIG A 1 OF APPLICANT(S)
DATE
`A:'.) inGirn:ation 6-- is raisre.,
r:•conted may resulf is :he sanitary pe^nit beh?g revolted by tltt Planning. & Zi)riZg Department.
lnclude wid'. fihis anpiication a reco:dcd wassnm deed from the R• seer of Deeds 0mcc and a -on :^f the cani-d surve_a map if
rc tb_ ence is na;ie in the warrwity deed.
(BFt~. 04!Li
PARI OF E 12 OF THF: S'JJI;~ r~ c ~UKVL Y MAP _CCArFD IN
A:; PRAIRIE F1:4 OF ECI:G W, TGW.V
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WEI H. NSi 1.618 1.65 /1_!N.
I X 3' RON PIPE SFl
r. F C'
WF,F IN> '
LRR L3S.i L,N. °T
A=
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o G Lo C C i NEiG4C:G 3.65 LAS./ L.N F7
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n- ~
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h -vOD 'u ,C
v ` u• 1,;, -MFANDFR _INE
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OWNER Ei PLATTER
tI l 11~ ';1=v'<L'LR :.INF 8 I ROSE7TA M. 4IL SON
f t L.h ^-SFt•-'I.NT . RO,y'F /
kc !i'r1;hiD, '.4=~ON 31Pi
APPRCZ VED I s4o1;
NOV 09 1981
':J 4 ° S CRvX C
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