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HomeMy WebLinkAbout016-1070-50-050 (2) Vo,ccnsir Department of Commerce PRIVATE SEWAGE SYSTEM County St. Croix Safety ane Bu dig Drms.on INSPECTION REPORT Sarxary Permd Nc GENERAL INFORMATION (A I I ACH TO PERM IT) Slate Pair ID Nc 606977 Pe•soral °abcr eou p,aeine may he seo for seconearr p.rrposes 6"~':eCy Lav: s.' 5 C4 I I':miij 3162699 Pew, I l loldels \a-P n,, p: VIlage TC»^shie Parcel Tax No Laurie Goetz TOWN OF GLENWOOD 016-1070-50-050 CST BM CC,.- Insp BY E Blvf D,, s<, p•i0 SCOtiC'ti io.vn!KangC'4'ap No. 61IY ! Gs- 33.30.15.493B TANK INFORMATION ELEVATION DATA O 1c,7i TYPE MANUFACTUHcR CAPACITY STATION BS HI FS ELEV. Septic - Benchmark T. •3 t 163.1 /6L Ucsing At . BM - Ae•at on / - g. Sewer Holding S(:.H: Irlet C ~r~ar r StiHt OW et TANK SETBACK INFORMATION TANK TO P:L WELL BI DG '✓pn: U A - Irlake ROAD Dt Inlet Septic _ Dt Bottom Dosing Header,'Man. Aera:ion - Dlst Pi:e - I. iy I I~yl, /yI Tickling Bot System - iOI, Final Grade PUMPISIPHON INFORMATION Man,daraurer Demand St Ccver Mode': Number 17 1 , Cs , 3 . 1 /0 ` f DH II ift Fr c on L s Syslcrn Head TDH Ft 4 Irv; 1 f' Z I(Q-~~1 - - Fo,cemair Lergcn Dla IO VJeI - - SOIL ABSORPTION SYSTEM BED(TRENCH V.-Vh Lengl- No 01'•erchcs PITDIMfir ~ NS No.OfPis Ir,iaeC;a_ LipuitDept- DIMENSIONS / - SETBACK SYSTENI TO PiL BLDG :4441- IAKti$IRFAtA LEACHING Var a'actwer r^ t". INFORMATION CHAMBER OR"/ l• Ii PC Of S'yste... UNIT '.1oCel KUrr DO'. ;~'.,l DISTRIBUTION SYSTEM Heade. !L, .~rdp,tl D i auk .n ,l x I' c Sim x ll it yl Vdrl Ic Air In:a<e Lcrg:h_ZDia ?entrl Dm_~~ Soacirg_~. SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only 7:-pth 0':e• ) D,;,:h Over - xa L'eptr Of I..: S"r,FCiJOr OC9 xx Wchcd Hec heron Cerler I iiuc Treccr ECges / 1005ri yes 14C I- vcs No COMMENTS: (Include cede discrepenaes, persons present, etc.) Inspection X. "J zr3 ~4Q In ection-12: Location: 1250 3COTH ST 1 i Alt BPA Description C 2.i Bldg sewer length = ~ =ccc- - amount of cover = 1 ?I Pit, I' 4 -1 Plan revision Requ red? I.. Yes No ~~i1 4 _ /n r y Use other side for addltioral inferrat;or. Date Insepctors Sgna1~ e rrn No a61 367 < ~ i... y,', I >1 I Industry Services DivISUM Cuunry - - - - - c 1400 b Washington Ave J sP= { J_ A B P.O 130X.16_ ' Sanitary Pctmit Nurnlwr(to behlk;inbf Co.) f 4adisot, W1 '13707, 716- C Applicati6i-ti {Slate lYansarliwi Yumlxy - In xcordanee a x m axe wbmi i of this hmr t rnft►apx N isr uvern.1 o"A !s r-ymrai pnx l[ obtmnm a s rotary permit. N<Ir. Appli[.almn linen; lur Sta4 uvn[xi FOW f or ed to -oy c(ifdl 'f~ muilmc addrrv) tla b[ wt .!un v f calm) xnd I n f rci;xud S[nnc 1'erso:rnl mbmwnon you Ptmadc nary 1 v uscJ fnr smondary Ipulposa in ac[unLmce wa), - c Privacy IAW. t u40 )un) A'3: L Application Information Please Print All Inf ation_ rd ST FutpLny Owner . N;,rtx 4~u.c{E - Goe-rz 1070- 5.4-05c) i PmpenYlhvna"Nlmbnt!Addmss_ nJ 11'mpcrty' Gn:.~~ut ;7✓ • 3 1 S• ~ ~f✓-!J - /a :.z 3oa S. Govt. Lot Lip Cudr Pharr Num!xa _ ~s.wE.'i, w-tier 33 GLf/sldonD CITY~ ~~/•5' -9.t8-~7ss .1. curie onc- - 11.Type of B mlding (check all that app1Y) to[ 3 x 0 . N; H .L -A- ! /v I ur) Family fl;cuing l% wn bm 4 Ih!drnNns - - q Sulliixion Nm:r_-- - - I, 1 Chuck d 1 - PtBli<'Comm.ncial- fhsribe use OK ,rl - SNIe Ownod Uescnbe L!sy CSM !s'wnlur 15C7W7- W-"age of ~Tow'n of l!~LNwoal Ili. Type of P ft: (Check only one box on line A Contour tine B if upplicabl - Nv`w. Svslsm 1 [i Repiacmu t J)sten! C frea m .rb".lnidmH Taiile RcpIac mLm lk!!yMer Mudifical,on to [xialin System (CXplain) - B• ❑ Pernnt R mcwal ❑ Pcmrit ReVLtar f h i cc of Number 17 Perm t Tiarrhr to N ,a, s[ nvious amd Nom rand Uale I I• P ' F be ssucd 1 More IApraom I V. Type of PO W I S Svstrm/C omponenUlleOce: Cbeck :[Il thnt n A - - - C Yon P ca urittd In (;round [j Pmssun?p! InOmmnd n .At-Uadc ❑ Mound ?a ro o!'sui1ah11- M f ~ uuml 24in of surWble soil _ 14011t,"1 1,111k I ' Othc[ D pin.. I L ;np n¢nl (explain) _ _ , )art Prcu 'nn an. [)evicc (explxm) ' Dtspcrs , reatmPnt Ana infarmuhoa fi r fi- ,f i ik•v ! r Fr w U,pd[ ~i)[xigu Sri,l Ap hvalum It gpd [ D;sperzrI Area Reluirrd (s ID,fxna! Arct Pmp (sl) J afion 1 v ° y5tO- ~ o / 6 • yso 125 _ yso ' ` ''T ; - ! 1 /6 o /~a VI. Tani, Info Capaun in Taal 1 Y, of btunalacuuu Cialluns [;allrns lJ!UL; = o - ~eaat k_.._ FxFhngT.M< yr: ev=' MMrlrania+J; I w~~V-~L__✓ _ - n u 1 rn n I n iv~l i /oeo - I/oeo, 1 1 SKwar w£c~r v l'ii Responxlbility Slatement l the under>t oi.•d, assmm responv ip'orim[allavonof the PUWrSshownan lheanachedplane Flumber s Nnmcfl rntl i L bM:MFRS Numhrr f3u<inesa Phone N[rmber E°-~3E.c~ v as/8a 9 -77 saoo ! Ivntbsb Addreva llh ..I, City. swe• Lip Cmtei I OaX /~_Giyu C.l•4iRE ctJ1 SYTe] l_liL 'ounwT)vPartmenl Ilse Onh -I _ Approved }F'bl>eppmoe - Permit }re I Uat I>su I Iwo gent Signmu - - - -o/ X 4~ <!•iPie; O liar ha n. !ar Uca IC C.ondi6~l~S~i~sSij ca5ons fnr nisapproval 1. Seplh lark. a 31f.c Ate- M 3~ J0.11 /1 1e _ U 41e2~'.S [p d ~1f"' iC S ~ t,ri i~(t'" a_ (~OC~d~ JP's i- as p?r.;,ar s~er+er' pltn n•o ~icm1 by Nlwnbe.. J i A - f)f~ t w~ µ r AN ac(hs.-k W L l i n:5 mU t U[• J,rlt. Irf N-t-tC.'LA' 2 . - - Mpar W4;crbl r :i:fA ^AY[F. \Irach in romplek Iq., m for Ilrc rtatrm nnA >ulrmit m ~h. Gnm ty and) an Vxyrr rat Ins tha 88111 s 11 is r1, -m, P~r - - - %BD-6398 lli_ Obi 14'1 ~~raar~is-, DIVISION OF INDUSTRY SERVICFS 3694 CREEKSIDF I N HOLMFN WI 54636-9466 Contact Through Relay `•l .S P w hnP:) ldsP' wi 9 . ov!Pr~rarnsrmdustry-services ' s wvnv.wisconsin gov Aa'!?s,rrr~nc Scott Walker, Governor Laura Guti6rrez, Secretary October 14. 2013 ('(IS'[ ID No. 221339 POWISLr.,'peclnr ED\\'ARD.I BERGH /LINING OITKT.. CLFAR\1'A I LR SEPTICS S'I' C'ROIX COC\ FY SPIA PO BOX 101 1101 CARMICI IAEL RD EAU Cl..A1RL WI 54702-0103 IlUDSON WI 54016-7708 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 10114/2020 't'ransaction ID No. 3162699 Site 11) No. 354129 SITE: Please refer to both identification numbers. Laurie Goetz 100"1'H St above, in all core, or ace with the agency. 'town of Glcnwood St Croix Counts, SLI'4, NF1 4, S33.'f 30N, R15W FOR: Object Typc: POWTS Component Manual Re ulatcd Object ID No.. 1 798417 Maintenance required: •150 GPD Flow rate: System(s): Mound Component Manual - Vei. 2.0. SBD -10691-P (N.01 01. R, 10 12). Pressure Distribution Component Manual - Ver. 2.0, S13D-10706-11 (N.01,01, R. 10 12): Effluent Filter the submittal described above has been reviewed for confornr<mce: with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The;ubmittal has been CONDI FIONALLY APPROVI-D. ']'his system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. t he owner, as defined in chapter 101 .01(10), Akrisconsin Sfatfles, is responsible for compliance with all code rcqu iremcnts. No person may engage in or work at plumbing in the slate unless licensed to do so by the Department per s.145.06. ,tats. 'I he followin,, conditions shall be met during construction or installation and prior to occupancy or use: • This svslcm is to be constructed and located in accordance with the approved plans and with the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems Version 2.0" Sill)-10706-P (N.01!01). • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for Private Onsite W;tslcwalcr Systems Version 2.0" SBD-10691-P(N.0F0I). • The pressure network is to be constricted in accordance with publications SBD-10706-P(N01 r'01) "Pressure Distribution Component Manual for Private Onsite Wastewater I reatment Systems - Version 2.0" and or the siting methods of publication "SSWMP Publication 9.0 Design of Pressure Distribution Networks for S f-SAS (01!81)". A copy of file approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of coast ivction'insta Ilationr'opcrat ion. In granting, this approval the Division of Industry' Services reserves the right to require chatwes or additions should condition, arise making them necessary for code compliance. As per state. tats 101.1'_(2 nothing in this review shall relieve the desirtncr of the responsibilih for dcu Ming. a ,ate huildin)~„ strrucmre, or component. I_IAkAIt:)J III Rl0l Po-,O3 P,I1'1018 Inquiries concerning this correspondence ntay be made to me at the telephone number listed belo\\, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and :wy others who are responsible for the installation, operation or maintenance of the POWIS. Sincerely. fee Required $ 250.00 Fee Received $ 250.00 Balance Due S 0.00 Mattlim Allen lann:n \4'asic\aatcr Specialist . Division of Industry Services 77R I code: 7633 (715)340-0407 , matthew.Ian~em;il;wi.eov Pav~• or() Private Onsite Wastewater Treatment System Index and Title Pale Pn;cctNamc: _L~9Ur</E GOET2- 3-,6c. /~JowrO I06,Jrf ~nftw~ n n U,,vners Name: - - '~R_ ~6NDITIO~ Y (!toner's Adr.ress: -/a?G n? - 300_P~ Sr _ /DEPT DF $AE f t - - DIVISION OF IN(SUSTRY SERVICES 9.28 Lc2al I)c,criptiun: _ ,SE .?3~ ,U 4J SEF-(;[i ti3[-tiPC1Nhf-icC'E,_.- Municipality; Town, V46gc' L;i:Y o! GGEwawoe0 Connty: $r, ~izoix L;x Number: Block Number: CSM Number: SuhdivisronName: - - jao rd- Sr- P.uccl ; D. Number- Page I Index and Title Page Pnge 2 Plot Plan Page 3 Cross-Scction & Plan View of Mound ]'ate 4 Pipe Lateral Layout Pap 'c 5 Septic Tank r• rump Chamber Cross-Section & Specifications Page 6 Pump Performance Inli,rmation Page 7 POWTS Owner's Manual & Management Plan Page s POWTS Owner's Manual & Management Plan Page 9 Filter Information Namcof Desikner. LicenscH: _^0,CS-_ 2,7/889_ signature: Date. Dcsinc4Vvrsga_n( tn.th( 'W11ow1,ng PUWTS Comnnnent Manual and DSPS_;SI SRD-10(91-1'(N.0101 "MoundCounon~t usual"Vcrsion'.0 SRD 10706-P (N.01i01 )"Pressure Uisini~u0_;n t..nnporrnt tvlannu:i" Version ? f,; Anachmcnl Soil Pv:Juatitat Rc(wr RECEIVE-r-) QLP 2 4 INDUSTRY SERVI ,ES p W j 1 l( L 'Y 'O M C 'Q O O W v ° ~ V Q T R I r ~ c ,Q a o t 'OaW® ~ M~ \ o 0 0 Q a`V I I i t z` ~ ~ ^ x L' Wj ~J b1 A V ~ ~f ~ ~ S~7 r o ~ Y w ~ ~a M i T N O a` O ~ ~ N M o ~ W ~ w I 1 W O V it n h It 0 h v p 1 r r :r- P h U c ri \ o n c>uj GY Q 11 it II 1 `Q W W W e 4 In ~ y v N o I q. 1 ;5, x 2 - " O 0° 0 ( U i ~ ~J w LU w m Q~ ' J w c - y 11 `n` ° O ? m ~ E ~ N r y v a r,~ kt N.o V z to to m LL ll -1- 1 X Q ^ CJ N m u J 101 / 1( j Cr ~ try: _ -qmn o 0 a ,!)I J i' pia; y n •A, r0 t I1 n Z 'n m N V +o m U7 2 I1 w e( C] i"o N W J - 1 01 ili m t. a o ~i a. a 0 [ J G N K x c !r t~ ti O O < I I N o v J I' 0. w ' w a ,i `lt w o, 4J 1 11 V y 1+ J YI .u y .0 11 W 41 w W W W W 44 4i W 42 W u' ~I u ~~<--~IEG Sal n I ~ a s- N 0i', .9 II II It II 11 it !I II 11 11 11 If O Je IJ501~ OIP lBJI%~tf)£M/M 0GIP A G: L•e C7 .'!r >r :A H y x t7 pauois 'll>,,voii/-~ I ~I . ai J W cm (13 2 Lll aG a G w u 3 O y o O O > R ® F V T -1 W -b c p n) O - r- O tL G x U) m ri o ai S p cZ_ 4: 6 a a c a O R > " d V U- 9 N n ~I fi m v i r x O a°•sv v h' } 2 Q ~ ;p m,O I L J 0 yNm'U G w 3~ " ?x s H ~R Q > 3 / ~R T } O O O y W 4~ C S~ \ R T y ~ Z X X Opt ° r QG / r` a- R T w d p, O o u c m J ~ iv y- G C: ❑ 5 \1 Opb d 11 w ~I LL O N R w c it 11 It n > Q~I w N a v W a+ " F Q `wM II `4~ C d U Q M ( q r_i a a I v~ 1 w n E~ a n n n n S~ x~ °w w m x r Page 5 of COMBINATION SEPTIC/DOSE TANK CROSS-SECTION (DRAWIIW9 NOT TO SCALE) MANHOLE RISER & COVER H NAL 3RADF (pp] SPS 384.25(7 i s (a)..pprnrnl (dope gmuna surface away Iran locking OM - 6 WarNlq bbai, FMand /mannGeSa) ba mrn drainage) manhole Beer as nr..essary ) J( 4' A]ir: Sch 60 PVC Tank Vent ELECTRICAL. '~laup..aaew24- 4' MW Sch. 40 PVC rank von! :zk", Repionai Flood tlavataul BUILDING SEWER klca1e012'ahove goAe w 24' JUNCTION BOX i (pal SPS 302.30(11)) mhnws Roplonal Mad El r lkw.. (comply -.nth SPS 316 1 and NEC 300) /f - _ FORCE ! If i./ : L MAIN `12 4- OPTIONS 7 I56'cwer I .23-TM. ~B M1'P •.PIOIF I l I ~Fwca ualn III ~!.r, I I eorroN 7 I LLil trrvm r4aun~1' ~ I r v I 71- ~ (waxiwpacl ewlh L - - 1 /S~sr f 'f°f ~PP...ya..M yy I io : kam rwP All I'.1 IM.a: flPk Lperibl'P r(I Few - I Jaou NY.q :Oil].JC ~~]9 I ' G II''~,+ Rnnu: ai On Owe: Y I 1 ._J OR n" 'J EIPV .k4lNIMUM C:'r 3' OF SU. (ABLE BEDDING SENFATH TANK & MAXIMUM BURY DEPTH OF g6* Ands nng of tank may be mquirud per SPS 383 43(8)(g) Tank Manufacturer: -5L'~Aw fit£ sr,_ Daily Wastewater Flow fDWF): DSO _Gf]U Septic[Pump Size 1006 /600 gallons Dumber of daily doses: Alarm Manufacturer: S J. E. LG.Vg r,¢us Model Number: q.,1.c force main volume RO fl x . /L 3_ gautt = /.i.0_ gal _...--_9L£'f_r . Switch Type: 1%e -4661 dycrc Acual dose volume: 98 8 gat /3.0 gal - 8 S_8 aal _ ' - (total dose volurne - votume of fome main) Effluent Pump Manufaclurel. 1,17- r DOSE TANK CAPACITIES: Model Number - Reserve above alarm W-3 in = 37A.8 gal (D) c~ - Minimum Discharge Rate __?S OS GPM Alarm float above on float in = 32 9 gal (C) On/Off float measurement 4„_ in = _ ?9.9-gal(B) Vertical IiPt (pump off to lateral invert) - /Z.-7 ft Off above tank bottom 8 in 8 gal (A) System head (distal pressure l x 1.3 ft). .-j,3 ft ft Force main x --ft~±/'100 friction factor A / ft DOSE TANK DIMENSIONS: Fitter friction loss It Length _ - in Width 77 in Total Dynamic Head (TDH): , IS. L ft Outlet height 3`) _ in Gallonslnch 6.Y EFFLUENT PUMPS fi. Gdf9 9FrN SERIES - 4/10 HP V,' M Ill4 I" MIT xt4 r -l@` PtS-Cla 4hL' 9EN{I~'eF - tsA,AK 9 , 5£N Gk i 5FM00.-SG5_ cm M _ :__cM 17.T3 o 41 9FN:M 2LTam~ )a ra ret 6.8• 9 110 rA m( AD 307 cover r~uxy-wetCU (a5t lf0tl,! - r`-- 'r 9 1 the m.Oplx is _ Motor NOUSIn9 _ Cpoxl-rMHed tier non _ _ Lp Impeller Natenw ~TtammjdaAtcrJaslomu - impeller Type _ Nun-(109 :u ~EPOXY _r_uateO rdst tron_ _ ---LLL r IYoOtnr Sh ft 'T llrct - _ ~(v-_ - I q `Io lmi(al Shaft Seal frtrile rlth (aibon and ceiy;jn - - f- - bores _ a Fasteners _ Sai .rSS StmI Bearings tipper si ieren sleeve and Awcr tall h(rtrlrtg _ Power(ord ,TOW- ~ warm-r9n Franklin Electric - ro:1:e:2WALZ94 I a'ra0hYtn"m •.c: +.'0iM1'TS (lam'N[,Jk'S ~7AEIUAL AND MAISACF,MF.NT PLAN I, t ~ 1 0Ri'7 i. f 3t~N SYS fLN1 1;I1I:t'17.1('+1'f,f0 NS 1 n v rScpt a 1 n6 C rm•city .l4 al .rl NAI i Scpn Tan1. 0. anulacturcr - Dt __N PAR Sirq ELtJT 7 P. Al via f e1` of Rwnrn m (In)n yd bc_droom) ~ •'•:Ih rnt dtcr 19anul'achircl - t 5111 ant' ; Ice t l soul r " n na.tai boils rdcl i umn ,nb t.ipaut} t~_`00 al 1`l Nr\! Esum trd tix ;avers e1` i-J60 '31/c a) Pump t nn>t Manufartur c1` jcty, ~Cr.gsr '7 NN n oral ae ID\+ ) eadntaled x t s _ YSO , il day Pr •n : rvlan nactwu Li rrEE bi9or O ~A L nl npphaatmn Rate _ /O 3Ih;ny'ttt I Pcnr1 Model ~941V Cn+ C7 NA! runi EtNuenl , PretrcmmcntUmt .4) - II „n Quality f7 . ' A; 1 h•l Innth y JlA. ,c:zgc I Y, I in Sand+Ciravei Fiber C3 Pcatl•rltcr Fats . Oil k Grmec (FOG) ,1) m i !3;oahenricai 0xy¢cn Dcm:,nd (ROI'i;) 15230 in _e`l a .Muchtmical :\Clalion O Wetland T0I01 Suspended Solids SS) t DisinFe lion r, Othe-: mg/l, l ;blanut outer. N- odci: I t catedLtlluuu Qutird ISO Nr IMonthty Ave:agc ~ Sntt AJtiC Tpuon Component +n Dl!\'i------ ---1"v-' FS dahcm cai 0 •ecn Demand (110D) -.i0 mn,•L C I o ground t,giavity) ❑ !n-vround (pressurized) -olai Suspended Solids I ISS) ! ' 30 mrlL. r7 At grade Mr Mound Fad ('olitlnm (geouxuic ratan) <incGt IOihn(_ : I n Drip-line i] Other 1 Vertical Distance TankBMton to Service Pad: _.~~r It I:ezinvnn ;'Rlncm Par; cic Sigr !.'S inch dr•metel i linrizomal D stance Tauk(s) to Servicc Pad: p r - llispcrsal Iin it ltlo/RN'I oalcl Number. yaNrr atill A,: Soil Dispera! L;,nd Cap (Dispersal Unit LISA) I7tV t: _ pplirrtior Ralc = Area P,gquircd - EISA 0114 hench Wid;h)- Inns or -Pnta.111 ngth of Trc, ct L't)_ y~ ° o r . 7)F:10CN CRITERIA 7s - :7 "Des 1`r of Pnsst It Distribution he[ 1`n, :le a-Swiic Tank-Soil Abxorpiion Syslcu;s" Publicaliun 9-6 (tiSW:bll' Manual? O "1<:C I wetech ;Mound C'on;pdn_n. \Ianuai dcrsion O 137 Flow Monad Crn;ronem N!arual" vcrsicn Y+31J'1U07 0 SAD - t 05 4-1' t R. I ! 17) "A[-grade Component Manual Lsiue Presso r_ Disnthution- Version C SBD- 10705-Pt:N.01101)^!n Gnnind Soil .,\bsorptron CUhnp Clreltl M.11111.11" Version I) (~ISBD - 10691-P (N.f71f01) "tilound Compmtenr Manual' \'crsion 2.0 Q SBD 10657-1(R.6.+99) "Drip-line Ullucnt Urspuul Cmncatrem Manual" ' SISRD - i0706.P (N-01/01) "Pns5ucc Disc tbu?ior: CO%trpOr ieili bi'.n~,raP' Version 3)i 1(.a IS'I'F'.h;\NCl•: MONI"TO121NG S(:IiEU7f1,C1 - -MAI11'JN.ANCP: AND Ni.ANAGr.ME.N-1 Scn 1`a I calm nrv r p-u1`-(c u spe~sN c~ll(sl 6 can hlit. a land n rd; ;tJ a month P~ 3 ve; r. '7 t Ithci. in C 6!n R r ; I p 1 n rap cnnru a. ;r_ n, prurcaunent unit _ I At least nn a ,wcr O mor[h, vrnr. CI N:\ - - - 'lush and pressure lest latat..b - i - - - - - - -----97 ..iAt IcTiEl ac- c clan .:namh t fl Ni A _I SS_f,17:1' UP AND OPERA 11(),; R>' ucx cun.aaWou. prior to UsEna, Iha P(.)W t checb. [matnlcn !nil.; s, 71: the n cs„-c:: iJ paiminy products or other chemicals uaat may i;npcde tile treatment prods antL'rr damage The dispersal cell(s). Il' 1401: WneentnaBons age defected hat e at the the conwn infiltrative l of the the surfatank(s) removed by a s'ptt,gu servicing operator prior m use. System %1'1`1 up shall"morcar when soil conditions are frozen cr_ the propene r.e'ncr is respnnstbfc for the n;.~rrtinn eo'l nwimnrancc of dte POWi'S :wd submissnon of n:quircd reports. )hc qukuriit;% and duality of the wastewater Stream ,vih ajr"q the pertonnance and longuvit, of your PO N'7S- The initailmimn of a'aln-sas•iny appliances and !istmns along will: ptoa:pt repair of leaks redm:es the u;LSica:mler vctume:. Also the lain: or waste from water softener.,. iron removal ?mice, other clear r: alcr treatmcat devices and tourtdatinn drains should be diseh,ugrd to the ground surface ivhencver pussible. Note- this does not include laundry Waste. showers. disim;rtei. cic. '!his system is designed to handle domestic nrcligth waslcwarcr; however, the disposal or food hosed grrscs, oils, veg cla thldfruil peels. seeds, bones, and hood solids. such as those produced by a garbaoc disposal should be minimizcd.1 oilet tissue is the only paper that should be discharged into the vystcia+ Other non-biodcgmdable items, such as baby wiprs, l:unpons, sanitary napkins random s, cigarette buns. dental (loss, and cotton swabs, should not emcr the svs;ein. Cheiuiuais, such as pc!roluum products, paint, disinfectants, pesticides. antibiotics, soi vents- cw., should not be nnsbed into;he:ysTem I>.•c -c ,-;hcy c,ti xriovsty riarnu~u your POW "I S and cnniamma,o vow driTA q,,g satur supply. Maintain u "l-,fl, srr Cv tlow try Spr,:.Idwg laundg waSl•'inl_ ihroug~hou .hr week Avoid vrh•t lc traDic ovrr z h system components. Compact ion of snow over the disfxrsa: unit may cause it to freeze up. l NSPP:CCInNS d'c MATNl'ENANCE: Inspection shall be made by at,. individual carrying one of the Ibllowing license: or -rte )cation: Master Plumber. \faster Plumber Restricted Sewer, POWTS Maintainer. w Septage Servicing Operator (per the atiacbcd Maintem ice Schedule). Teak inspecifom must include a ldaual inspection of die lank to identih, any missing or broken hardevarc. ;dc-uifv atrv cracks or leaks, nicasure the volume of combined sludge and scum and check [or any backup or ponding of eff Utah to the ,n:uud surface and test all electrical uquipinent such as pumps and :draws. Any drieris shall be Ixomptly COITected. Fzposed epenings -watcr than 8 inches in disuneta shall be,. secured with effective loekaut devices to prevent accidental or unauthorized entry the tanks. Vr hen thecombinmion of slud:,c mid scum in any tank exceeds one-third (1/3) or more of the tank volume. the entire contents of the tank shall be removed by it Septagu Scrvicint; Operalnr and disposed of in accordance with Ch. NR 113, Wisconsin Admin. Code. 511C-citic• servirine mechanics must he provided irvetticak is 115 feet to+f horizontal is >1 ill fee; and instructions to he provided below. :a:u outlet 114c:01 shall be ir:spceted andcleaned to removeany acctrmulated sohdsaccotdiogta itmnulbctwet'aspucifications. Solids : ;hcd from the filter shall be irfrined in tilt: tank Filler rlcaning tray be necessary at more lieyuwmt intervals than stated in file tr a ntenaocc sehedu Ic to keep tic system opera fag. 'l last., should ite teitcd on a regular basis by the home owner. !fan alarm sounds, eornact an individual licensed to sane" 2OW1S- i here is uoerrally a I day reserve under regular opcwtin_g conditions, however water should be eonser'cd until any ptobkems ",fill the cram arc conrcled to picvcnt back-up ofscwagc into the dwciling or surlacini.. BANDONuNIENT: When :he POW` 'C fails anAlor is pcrmancntl~ raker out Ofse:-Vii :c the I: flowing steps shall be tail en to ensure that T,tC ,vstenl is properly sad safely abandoned in compliance with Ch. SPS 3V-i 3, \Viseonsm Admin. Cade: " All piping to tanks and pits shall be discouuec ed and the abandoned pipe openings sealed. The contents of all racks wed pits snap be.. removed and properly disposed of by a Seprage Servicing Operator, After pumping, all hick; and pits skraki be excavated and removed or their covers removed and the void space filled with soil. Cruvcl, or other inc!i solid material. CONTINGENCY PLAN': if Ilia POINTS fails and cannot lie repaired the fIlHow•iny measures have beer., or must be taken, to provide a code compliant rephicautent system: rl A suitable replacement area has been evaluated and may be uldizcd for the Itx:ation of a replacement ::oil absorption system. file trpla crneni area should be protected from disrurbancc and conrpariion and should not Lie infringed upon by required setbucks lion: csistiny and proposed structure, lot lines and wells. Failure to protect the mplaccricnt area renders it unusable. Replacement systums must comply with the ndcs in effect at tile, rime or replacement. O :1 suitable replacement a:ca is not available due a> setback andior soil limitations. Barring advances in POW TS tcrbuoloay holding lank mar hr, inshli ed as n last resort W rcp:ace dic tallied POW"f S. yQ Th:; site ha. not iv:cn cvahnne: al it allify it suitable replncenitum area t Ipml failure of the POWT a soil and site evaluation must be performed to locate a suitable repincYmcnt ar•.a. If no f_p lacuclent area is available it holding tank May or installed its a )act reson re, replace rte failed POP TS. triu lad and ut-grade soil absotpt ion systems :nay be rcconsrnr; tad in plane ionowing removal or the biomat at the in 1-0trativc .;urlauc. Rcconsh'uclicnsofsuch cy5lCIa%auts5 comply evil it the rules in efrecwi that time. 1__,RNING!"' SAP'riC, PUMP, AND OTHER TREATNll-Nf I-i,NKS NIAV CONTIAS LL•'TIIA), ;ASSES %iNl)/CR INSUFFICIENT OXYGEN. DO NOT FN TER A SETTIC, PUMP, OR O'T'HER 'IREATiVIEN'T TANK FINDER ANV CIRCLIMSTANCES. D!*-kI'll VIA Y RESIA. T. RVSCUECOl'A PERSON FRO•LI 11M INTERIOR OPAL ANI(N)AY RE DIFFICULT OR IMPOSSIBLE. MIT: IONAi_ COMMENTS: POWTS INSTALLER POWTS MAINTAINER Name: .Names - - Lc E,~,c~.« Sf~ric s Phone: 7/S.._ S77-.Se?o,q Phone: /S _ 577- S7oo SEPTAGP:SERVICINCOPERAI'OR(Putnper)?--- LOCAL REGULA-fORI'All'IHORIT\' _ t Narn 7~amw: Ihonc: - 7L-38L- yG80 Y c" h K 1, ~ H J ~ ~ ~1 _ o~ d +1 W ,,~ww ) Y v v E W W= _ u L~ ~ ~ o E W V C O ~ `rnu°~ ~F - `o ~iti o a Y ap o f u y = c~ u It F k- © _ . r = m y z F- e C~ F-1 1, 1 Z a sF ~ _ ~ ® t u Q 9 `o F a N L L rr rl~ M: F a~ J .j q - 33r { n" I Y` j oo I © t _ _ ` "E i C { H J { ! 11 c Y V~° { ~ C c ' { I N { L v w w ns r I% 4 . CROIx ( 01.\ I-SEPTIC TANK MAVJ `~AND- AGRI-PNtrT AND OWNf RNMP C17F`t- C'1'1'70N F0,2.%vt !.)N7?LCil3tlyCC Mailing Address,_ - - - - {Venl -t6. c.Ir n, 1 role i ,n~nmg a /.nnin•• D..pac r ; tu'ruci On.) Cii_ttSlatt P-':!IdeJllficattu;t'VUmher L,EG_AL DF;SCRIYf tON Propc Location J., `ec.._ _ I._.._ NR _W.Tot>,nci SuLdivi:.lan Plat: LOT 9 Cet-tilled Survey Uaa k ` 1\'arrnnry Dee<i P_-_ ('+efn-c 2i'07)Vot,7 .1c > Page ' - - - >rrchou `_7..,•ti! !.o: li:•r.:,~aatifiabie Oye;l Inc J1 S CE.LI MAP , I-EN1NCE AND P-it C_7_RT. 1CAT10 :moroper us,-and maintenance orvotu .::•,c sys:am: nt id rtSt dt lit ds pmrc,a4rte faibvt• to':.mdic wastes. Pr.,-e- nmi,t-n~.,., consxw rr.:-:~,. nnKouttieseptic❑nkr•. t`re }crsc urcw...: ,f--•n byallr' "A.pumn- wbat ouloutim.:, the sys m can .ffect the fwtctior. of tote segt., ;a op as a M. *MnJ u^ .::'v the waste dc.1xill syslcin. Owner maimenti r.r• pell0i!iucs are specified in ,w`, i87 ~1(() ar.C m Chapter Si. Croix :.:,,nty Sarataty Ordinance, he rrnpr.ry cw.-r.,r to ubmit,o cl. Croix r ouity Pl anon; a Ltmin¢ Deoartment a cort,fieation G r: signed tit the r,:,,cr mid try a e:rr: r.-~ p1un~P:.r, jotancttnan plwuber rc r.': and ptaatb<r or a lia•rv •d pc.mper verifi•inn :bar , i) ffie cn-sit. r.:: t:atr dopasal system is in prnit•r o?r r., tia'•'Jrlaition nm: of i J aria inspc.!iun and ptrmpinMifncce~sary), the :ep:;c tank ,s :.!:fan!Ji fn'I c`<. ad^c - V 4vc• tut unders,g-n.d have rate th above !t qt is a..:! a t o ,n^.maill ;he P.,Wte l.OVayt di a an with m: t n._. is - t 1:l- tit, h n, a..cl by G¢ 7~I ,rim r: of }afu.~ mind "rof. ,i,wrl San•ices srd!he Dµtanm. t . Nm,aa:.:ao,uc ata:,; of Wtsc unli t. Certificatrnu stati,:, d ac yolu. P'le syst m has baen :.t',ntt7nA rrn•,1 b~ cimpien'r ,tad o:r.:.:d to t!w S;. t loi,- r' .tml_ Plz:nin_ /onus4 I Dcrv"',nxnu Within ; T, C days of ffi.: . ),,ar exp:.annn (!.lie. Ilw'c :ettifv [ua! ell ~tatemcn~flnl s f ;:l oprny described above, by vi•errany Aerti Ircornd, in is •,~Iste: • f Ucco• Ctllin ';;umber of fivorooms DA' I } .nv in5~','tor. War ill mis:c,resented may result u: the sao •.n-y permit hcrng r:.,,ked ht tit, Plamting &7-r in:; Uq>anmrat. ;,c it, do wilh thi noplicutinn „ty ,+.....I fm - the R.-., mr of Dced•~ r,tfcc m,d a ,:y of lac ecnirrd sewn) ;nap if re;crence is mad: in the vartanq' d ed. (RCV. oa, f z) IVV~s AI N ~ °O II I I~ m Y F ,n ~ 11 O N L t f y :n ~ I ~ o < Y v .II}U ;'r YII lmllltllOZlID ~l ~I!/I/n ~ V U ~ U N rv CL aL a io m ° F ~ cn Q ~~y 6.rc' I.~.j p..a N,nN~~~v:n ~y~ Ln. 1'l l^ 4'1 n N'N YI Y) Y) S - t f0 L O - Q G~~ O ~ O N , ` U U I N ~ O N o CO T A U ~ ~_l~-jyL~(~ Ys I °u~ V ' ~A ns U r Q) CL 0 (U C7 c From ~ ' z F H i~ Wyk d Nb 40. W J~ aNOW e i I t~x`I I ~ r a naz b r Q rZ~-+ I iH Wz Z i I I 1 i I Y V``-no ~1 N^^` ^y ~V23W Q L I 1 ~z<~c ~YOt Q. Q: 'E6 jxri €~',~T IR I`I• W 32..,JR v SY2V Y ~ Ob(t O~F~~ ul Q m % S SnV ~6~i y V `t V ti 1 •II .1 a1 ./F~L~ia U. NYWN <j,VW C• ~ N R 2 V N w ~y D.; © 1musss~v""`(h""`~ ,-k o n n. L l ~VVI U. 41 ~B Qslola 33 y x.e LLLL n` m' q 1 HO M C- 11 u.- ~ I x o 1O E I I O Z I I ~ ~ o y. a ' u I 4" r l i v1 I I a f 0 21 ~ i I • SN d d C ~ I I V a V O I I'- 1 In I I LL i I I R N N N !1 ~ I ~ II ~ 1 I - rj, c "Gs k ' I h S _ JwLdO T3401;S it rj h ~ J LI. ,Ilr Ih~ F o I - r i it P a o I I I I w~ ~ 6-., 11 i ' X351 ~ i i 9q~3~ qr~ I I I m~9 O' M i ' I r ".'~f G C N ltD I I I § o q~ f, 5 O LEp 0 w Ll I I I I I I 1'4' J o V c S a E su rv r -I I I Z 4L ri .1 m E O 3i i .I-.1" I 1'll. l P I y 0 0 L 0- O I I y ` I f. p E Q m i I i N Q y w I - I i L_J i Q i w l v ~d E S c v lo- I ~ ! I °gg06z~. jZa 85B U U I. :.col I II Y9'`e' 86 °u N O O I _ 1. I I P r~1}-1 i i 3.y L al x N 5 (D I I I I J it l S m~ x ~'asrl d~ T i F In x .-I x Ad ° 35 8 o I c) ' cv pp C7 ~ T N ,i I I ,o v e 6 fe F-I - kc O 4 4 G f0 .7 J V V T~ C i6 c - o, HUN(J ZI N e.IVN M JI r~ -a°►~5- rr Ws. Depl, of Safety and Professional Se(yic~t S0' 1 L EV OPT. page of -i Division of Safely and Buildings , ' - in accordanre with UPS 385, Wis. Adm. Code c IAttach comple#Nid ia ss then8 1/Z x 11 inches in size. Plan must County include. bu/~ /da lr horizontal refernce pole (BM), direction and Parcel I.D. ~ percent 51'n n~ionsnorth arrow, and uc:alinn and distance to nr-aresl roatl. 7~ jsj Please print all information. Rev and by Dale mlormallon . Z 7 Per5nna, you provde may t,e o>cd (Or sewndery 1.1..11 ('reary Law, c15 04 (1) (m)) Property Owner - Property Location 10 r'\ <a Y• 1P Y~ C~ Govt. Lola. 1/4 N E 114 ~%.3 T f` N R l,`> (or VJ J Properly Owner's Mailing Address Lot # Block # Subd. Name r CSM# cilyy Stale Zip Code Phone Number p city ❑ Ullage Town Nearest Road fie,\k; or, ~ I V) I I S-tc.13 I ( > C >ler wc~d r~ I II'I~ New~Constr-uc-tion Use: Residential I Number of bedrooms Code derived design flow rate._ O GPD ❑ Replacement ❑ Public nr commercial - Describe: Parent material Flood Plain elevation if applicable Genulal celnnlcnts - e Li, -11 and recommendations . f Ems- / a.t Do,ing Boring Pa Ground surface elev. JO .V ft. Depth to limiting lactor I(,) in. Soil 3 A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPDIft I in. Munsell Qu. Sz.__C_ont. Color Gr. Sz. Sh. • :11#1 f(#2 i y " cil 1( r 1n `4Y1"S Y' 5 ~ V V) (G lb--2-4 ,syr~"%~i _d'r~ s%y s~ i,C -_r~ cA.~i Q:fo y1 Boring # Boring... l • ~ l~'L'1 Pit Ground surface: ele..v. 7~ II, Depth to limiting lagrv in, Soil Application Rate Horizon Depth Dominant Colu1 Redox Description Texture Structure -.Onsistence oundary Pools GPD!# ' in. Munsell Qu. Sz. Cont. Color Gr. Sz- Sh. - TI#t ff#2 i a 1) 0 '19 ~44 --AIL 3 I4 - 2 7.5 Ile YA 14 . L, Effluent #1 = ROD 30:< 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOO < 30 mglL and TSS <30 mgtl CST Nmne (Please Print) Signature CSl Nwnber N\I, 1~~~c. 1~CCnS+re \tii,zCt. lam- '1~¢r Address Dal Conducted Telephone Number ~h r4 ._~dOk'~ C,ur.f•y ~1 .e.-Rohn Grua, V.;i 97 'i>1 ~~~he 3j1 'i~ ';IS ~L (t.y-'1~~ slii"130 (101(111 Ptaperty Owner .Ms. L_P~ r I P. Parcel ID # Page of - -I Boring Boring # c ~J Pit Ground surface elev. / 6. rs fl. Depth to limiting facto, ~i in, _ Sod A liwtion Rate Horizon Depth Dominant Color Redax Description Texture Suuclum onsislence oundary Roals _GPDIft ia. Munsell Ou. Sz. Cont. Color Gf. Sz. Sh. ff#1 ' .02 C" le \tK '1/4 r I- _ .S _7 $J°~/ Borng# ❑-7 Boring L 1 Pit Ground surface elev. ft. Depth to limiting factor in. _ Soil liw"0" Rate rlo(izon Depot Dominant Color Redox Desorption Texture Stmrlure onsislence oundary Pools glf)lfl ' _ in. Munsell Du. Sz Gonl. Color Gr. Sz. Sh. -ffNl 'off#2 n Boring ❑ Borg # El Pit Ground surface elev. ft. Depth to limiting factor in. _ Sod A t >licalion Rate Horizon Depth Dominant Color Redox Uesaiphon Texture Structure onsislence oundary Roots - GPOIfl ' in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 Effluent #1 = BOO 30:5 220 mg1L and TSS >30 c 150 mg[L ' Effluent #2 = BOD < 30 mg/L and TSS :E 30 mgrL The Dcpt. ol'SaI ul\ and Pro less ional Services is an equal opporlun ity service provider and employer. II you need ass islan cc to access services or need nmlerial in an altermuc Ibrinat. contact the dcparlma:u :n 608-266-3 151 o; T I Y through Relay. Sri,-•n r+~i n~ Property Owner- Parcel IDC Page - of . Buring S Burins r, pi; Ground surface elev. Cl~ a ft. Depth to limiting facto) 1 7 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onslstence boundary I Roots GPOn: in. Munsef Qu. Sz. C^.ont. t;olor Gr. Sz_._Sh. •EftA'1 'EIiP2 1. ~ - I ~ tCl ~,f' 3/z c° ~ l t c~K •-Ysrcr j G ~ ~ t~- - ~ 7 IR_22 a i t 7. ~tl` "/r' l I : •;nyr r:5 .--r. ' 5 li-, -SL, -1 :`t..0 1C -Ski b~r•,4>~ O c~ iY1=_r -v •--t' I C Boring Boring „ U ❑ pit Ground surface elev. ft. Depln to limiting factor in. SoiS A r rlicalion F.ale Horizon Depth Dominant Color Ready Deschrihnn Texhue Shnclure Consislence " ounoary I Roots GFD!f. ' i in. Munsell Qu. S!. Can!- Color_Gr Sz Sh "I T I,,2 I.1T- I ~I l J Boring Bonny u r PII Ground surface elev. h. Depth to iimitiny iarlor io. u R u _ Soil ASoiI IiealinnRaieRate- Roots GPD!fl Horizon Depth Dominant Color Redox Oescriplion Texture Structure onslsience I".,oundary in. Munsell Qu. Sz. Cont. Color I Gr Sz. Sh. _ _ ffY.1 fYt2 1 i j -i - Effluent #1 = BOD 30:5 220 mg1L and TSS >30 < 150 mg1L ' Effluent 92 = BOD s < 30 mg!L and TSS < 30 morL The Dept. of Safety and Pro lessional Services is an equal oppo:t inity scrvi;:e p: ov idcr and employ cr. Ilyou need assistance w access services or need material in an alternate RlrmaL contact the department at 608-266-31 i 1 or TTY through iteley. SUOannlalwn