HomeMy WebLinkAbout042-1012-80-397 (2)PRIVATE SEWAGE SYSTEMM05161877C-72
St. Crow
srcrv,nd awama Cedno
INSPECTION REPORT
615430
GENERAL INFORMATION
(ATTACH TO PERMIT(
k�IPn I1PAN
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TOWN OF WARREN2-80-38T
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TANK INFORMATION
ELEVATION DATA
TYPE
MANUFAcrvaER
Opol
STATION
HI
ELEV
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Holding
/
TANK SETBACK INFORMATION
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PUMPISIPHON INFORMATION
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or Guru LA._ 6GPM
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un �enLe„
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DISTRIBUTION SYSTEM
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15
COMMENTS (Include wee emOada lee pemone pmenl eD) mAndepo as mppacal
feel ASIAN
Heado, #.�
Wntlen 1132109TH ST
IIAdNDS,e.�phon. E>digmpllrl
xi slag All angm•10
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uels
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1117)
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AUG 0920191 ' Y,�,a, --roz'+e'
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6BD6399( 11,11)
System PLOT PLAN
PROJECT Erik Me ADDRESS 1132 men at New Richmond WI W17
HE Ira SE 114S 5 /T 29 N/R 18 M TOWN Warren COUNTY ST. CROIX
SYSTEM ELEVATION 965961 S5725onew grade 8/8119 �EDROOM4
DATE
CONVENTIONAL XXX AT -GRADE CONVENTIONAL LIEF HOLDING TANK
MOL50 SEIFO C TANK SIZE 1255 pfirana LOT TANK SUE DOSE TANK 52E
HOLDING TANK $VF LOAD EATS .5 4BSORIPTION- AREA 1200 B of EZ.Flowe24
, BENCHMARK \'.RT, Too 013/a' mkc pipe ASSUME ELEVATION IN' FdDr Ldcumc Fdux
❑ BOREHOLE (DWELL - IT R P. SEGg AS thesch' mihr
if Line BA-•/1,,
Vegas3-3' x 80 cells with>3' spai /
system is to be placed between existing Henches J/
0, System was never used it filled! wIN goers phIn less than
years time
Ii
IM
OWNINji
.4440 50 ST
40'
BM'
4
BWmom
House
41 Or Property Lme /C()
46. Maintance an I ontigency Plan
Filter Cross S i n
SignaWr
LlMnsB e Oer 42M9W
System PLOT PLAN
PROJECT Enk Aho ADDRESS 1132109N st New Riehmond WI 54017
NE 114 SE IHS 5 /T 29 SIR 18 W TOWN Wotan COUNTY STCROIX
SYSTEM ELEVATION 96. SAID 115725below trade 8/8/19 Bf.DR0fIN4
DATE
CONVENTIONAL AKK Al'-LRADf. CONVENTIONAL LIFT HOLDING TANK
MOUND_ SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD KATE 5 ABSORPTION AREA 1200 X of EZ.FDOO24
BENCHMARK V.R P. TOp 0134' VV pipe ASSUME ELEVATION IN' Filler Llfebme Filler
❑ BORF.HOLF (DWELL 'It R P same a9 bearchmark
lk-3' x 00' cells wlth>3' spacing, /
Vents system is to be placed between existing trenches 1
q 0, System was never used, it filled with gophers in less than
/F'b 2year_�nme
e3d
us
001JUNIAEUM
BM*
410' Properly Line
ST
4
Bedroom
House
Cross Section of a Three Cell EZ Flow In -Ground Dispersal Component
3' . -.. 3. `1
R
Final Grade
NWIPM
1OEM
Design Flow 664 Loading Rate - S = Required dispersal areal Sq Ft
Required dispersal are� // J e 50 EISA
Y� ( 1=ol(number of ands)
GeoteNih horn to meet Comm se 306)I9l We Adm Code
Minimum of tY of offer over lop of Cerl
five oLaervalroNvent pipes to Ce prrnMed Por cell
Not to wale
Cell an 96,E Cann 96, / C.IIn 95.7
system f3evaoolrJQ q� Ft system Elevaeppn Ft r/ zsystem Elevate n
Fill Grade / /r ✓ Ft FmalGrar Fit (%(j t
Final Gr D `F
POWTS OWNER'S MANUAL B MANAGEMENT PLAN ry._a_
Ovmc
SgYc Tents Capacity ❑N.
sg4cTN A4nulwNrer OtU
Pamn/
NF816X PMNIEI£RB
0NF
EIMa9Flw kOvalrtesrL4=42
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Esam9W floa'(awPepq
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Design Ime book) (Eeten.ta. l 5)
A rK. Malay
Pump Manufacturer NA
SON Pypllaam Rate
wavowi
PumpM NA
SYMWItmuenVElAwm OualN
Monthly Pribi
Peraplmem One Ni
rule Gil B Ground (FOG)
oW mi
❑SeMTiIrveI Filter ❑PM Fiber
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mutant ,,dl,, ofai
Al lewd man, wary
mom
e) IkyaMun a new
❑RR
Vunpo mmenYMYnk(el
urban moral.futile and added egipe msthdrel Nof unit Whim.
❑NA
lnapent divwYn Rude)
At "at onaewiy
's) BFeaYtium Syaenl
0NA
:ben sough fllM
meal own awn
/I moM'al
❑Ni
renal W" Road mmW 6 awn,
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In.wNm. illar Rai
a ant Restrict Sa WII Ee meteex ao i Pndi arryln0 ma N Ne Mbmtq Ibemp r anMaWn. Meals
Plumae,Ma.iw pwmlx,N.ehe har Sawe'PowranawWg PGWTE, tomwa FEWWNa ymalq opertlm Tenknape VPUadWuq
pnWtle. muralandw m the tank(a)mor am any upon or memo, muMmin oI the pound ntacket or Ivek.11iNee its Brad nl
a be
deim].Wlp..ntl amm he m arlt tot any r er r prn iu m.Roam on for anyw wrong
of Top, dan Me Rllle) Mel e
pro padog0 leent on Megroun l sarmitaft In Me may
a ptuna Prnd mcon Ftutana rera MW nd mMade mNsmn Of .bon
11n Wnalna pd .dfluMn non Ma ground aWaa lrcry indicate a I.Inlre mnamm and lepun« in. hnmMYla utlflatlnn m In. Ircal
yepulep r.WwaN
IMe pits" WMeaunulan niNWea Wawmin any drink par n onab�m If iormreaIna lank vaume Its n0YParents
hournl
Me lets alyY ap lmmal an a Septa}+ selWHna ow9mt .M eYpoeM M m ecrn�Wna MBi mvpYt No tls. wiwam
AdMaraw Radiative.
Cape,allnant.Fvy.InaWma bad
Of net ImaMmaa ymwp of Oya Nmle. nPi Miami
or pleRutuaa WnWlanl.. PaYaaamunb.
it vry.wamnpakmrv.Na p, monad.a an UPRria eya Rmn may, of
no..mainnmr
4 aervlm neon WA a pnvErl b Ire b`.el Rpulelcry aulMnp wmn 10 naya olmrnoonion N any aervm avert
FW _«_,
STAR!UPA OP[MTON
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ISbmxmb exec bmn mo«b w mq.R• wu mntl« mb.
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mx , YGY rOm: wAm• dme. mrbnr nobs wGt u0wemc bIW mrmn dapw: teYIM•nY.1b blaWlM eleln
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ABAXOONIIXf
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eM eext/abm4xnf b cml[Yma'e •MNeW Lmm p P. Y/�mMMbblm Cale:
• NlpWgbbNu mm pb WYb Wmm•Otl eM tlx ebnewlM We WmlePuule].
• TMmMub dmI WM1J VW pb NYI G•roRtty tltl pl«Nly deyay Wbyef✓e4�Serva'q Opvab.
• Allr punpNp. aM bob eb pN aNNGbuvabe uM rmbapwlWr cvnn�enlweewnepU Rmi Rw Mx M.
V aaN «maaEw iwl eNt me W.
CMTIXOIXCY PLAN
n n gTVfS ffi Ytl aM M IapeYeE Ox kbhq mwaee Me bn. v mut Fe bM. b pwYe a mb mnpem
ropomR eYmRn'
Prourn
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b pob9sE ton asbNa vm m�PHw N eMtl rtl b Ymw ,, � o IR
eemebi Yan eid•n Ym ppvb N9�n.lw llrm MvdY. FY•ebp«YSN npbnse tls •m ntltlb NrFe
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el1•im Nm tllm.
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Rabb pmmu�� m vb a auluW repxarunl wa. II ro �eW«mml «ee a areYYMe B KWlgbrk mry b IrMeMf m
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w�ln. RMpubFYwm M wyi ryabms mwl wnplYmin na n W m •M1m tl N« time.
P N.P
IEPIIL, PUMP AND UPORYRMTIEIRTANRa TAN UNDER NN MLGAIeEI.WbUfl WBUFFIY MLT. R .00 FA
fN1G A IEYIIC, RIW OR OTNER TRMTYENi TANK UNDER ANV CMCV WTANCE6. OFAIN MAY RUULT. RIJOUE OF
PERtOx FROX TX! IMOip11pF ATYtIWY BE tlFFlC11LT OR IYPoWYE
AUplpNRL 00191pB
POYIIm X/! 6l pOWIX WJXfRWER
Ilene —A'c mil _
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YYJI GP 1011 IWP IgCLLRMINAIORY WIIMIMY
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREPIMEN'f
AND
OWNERSHIP CERTRICATION FORM
OwneRBuyve r_.i
Mailing Alss4 Ali=
PmPenY Address // 3� //i11d t'f
rvmnmiw reeu„m fmn rl.nnmrfl mmnaoy n�rn.,1w,.�lenn.n..wl
C,DSwe 1'xel lJenei(wlon NumbafyAY ��%fli �J.'S/a�
LEGAL DESCRIPTION
limPany Laeelinm •.r Y. •Su A. Sax 1 1N RAW, Torn of �L e(?PFn
Subd,vemin Pull . La o
Cer4fied Survey Map x
Warramy Dada
Volume qy Pgear S�L,
Ref RO>IVolume .Pager
Silk b"WEli"fr>&I, In ene. a.narmleDn.Ow
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
we aM MImmeorpw wlwe.rurn, omit rewu in iup.mu„m nJv..mb,al..vu, Pn
WmD�Mum Ne uprc mt nery min rem,vwm,.!„vaeeJ. hi,k,,Wwmpr NFw pad pm,nw
rr mluwM,un+rtwipennee ""fek uSi-ru x me Ilk a,wul.ru. nn .Ameiww e..
D 11Iutlun Chapw i' 4(mi. Cwmy Nmury IMwrce
O,r pmDeq n,.m..yaem.,Jm„nNC n,ngfl y..n,ne nw.^<n,.rmmmrwn rwm..g,me MrM
uHe^eer'un ^yMryeeeelin IS M iwwuprtnrampwenaolnuem aEnaMr rtnwxnn.vit,be moluInl„lh.nhu naa hpueeonmmi .wwmNanking
mnwmnery�^g uw II ryml. eNgar.Mwe,a kill, minf,wge va, 11 unan,p,N bra IM Ih eMve ttyn„amanD end yne w mnu in rM pmau u"S, e,awatl,ruem.,* in,
smmdswlfmnn hyrMMwmmnlofwlnA rrnm...,mlt,.r.a,.ne rM l><w•n-,nrrv.n,,a Re.n,,,a.,.
nnnrx„wn„n i.�va,,nm,mrmg rbr row.vn= `rmm nn na.n m.,m.ma nm„ or mpmkd..d rnumm w lM a ow.
Cwny Monona a IDmnp Dapeumne.nhm 34 dp„n Ilk thew you r,om. ewe
wmym.nl,..mm.wm, n.m.eumwrb M., nrmr�uwlm.ladar .r.m..arMn.nm•Inrma
pmDenre�Me.M.r. Ey r,nne nr..m.,n�Ieaaa,een.Jea,n ReP,u nr�m, Dina
NulanerafnmwDme
6X116
ONATORE OF APPLICANT(S) DATE:
^AnYofwmnon On is m,uepeu ADW my makinin, e,up imrkt being rewkN by ib Phmngl 7xining Depmm,enr
InClute wnh I"WIW9,on n ruvdN kniom doi rm,n the Reaol[I offHIM, ORoe eM a uqr nfi1, kmfi,d mn<Y one if
,mire a a made in me wm.nn dam
(REV wnq
ST CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
rnis is to certify that I4 have inspected the septic tank presently
^� ing the Fr�Ci {I h'1 Zes'denc�(PP( located at. Section �� T�N, A�IM. Town of
Wry.„✓ Upon inspection, I certify that I have founa
the tank and baffles to be in good condition, and it appears to be
functioning properly.
Lro flow back occur from absorption system,
Yes a\ No (If no, skip next line)
u Oproxlmate volume or length of time: gallons nutes
Gapacrty. ID-ugC7
Construction: Prefab Concret Steel Other
Manufacturer: (If known)
Age of nk (If known): 5�[wlm'
f o /aatuure) (Name) 6Plealse rent
ld/i (S ZZ /nl
(Title) (License Number)
d . &- i q
Term to be c ompleted by licensed plumber (s.145 06, Wisconsin
Statutes) rLicensed Disposer (MR 113 Wisconsin Administrative
Code)
Plumber (applying for sanitary permit) Certification:
IF, accept:rg the above statement regarding existing septic tank
condition, 3 coralfy that the tank t the best of my knowledge will
confovm to the requirements of III
J, Win. Adm. Code (except for
inspection openl over outlet ba ). /�
Nama� [ Sign MP/MPRs
PRIVATE SEWAGE SYSTEM SLQ
BtlpNa+syn.sen r.maN
mAP REPORT $gg735
EIG GENLIXFORMA(ATTACH
TO
TOX L"LIG,rsaERMIT)
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TANKINFONNAT ELEVATON DATA
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