HomeMy WebLinkAbout018-2009-37-000 (2)mm aarnemdco,"em.
PRIVATE SEWAGE SYSTEM
ROSS ne e.ileiy olruu"
INSPECTION REPORT
°rmmw. 5921U9
GENERAL INFORMATION
(ATTACH TO PERMIT)
plmlo
mwOIl Lw. •r.wO (`))
uxeN.r.ON,
TOWN OF HAMMOND
TAT ON R...
eNBN..
p"# m
Mre04.29.1]1021
_........_��... _.....I
IRLI
x or"&TlnxnATA
NA I>FACTURER
CARAC
STATION
.o
o'
. 6
Pod
Aqt
st
2
99.
Bl , &ON, rarA
TANKSETBACKINFO ATION
SORT ONI.I
TANKTO
WL
LL
BIT G.
POPO
ql^M
Septic
Owning
Mr
5,
IRA SI
Hold";
PUMPIBIPHON MFO TION
IGna.
M.nuM1Olrer O.IIn
GFM "a
SlCwer
SOON Nuru
TOM L
INap
FIrall Po SOIL ABSORPTION SYSTEM nvxL r LpwoeaJ
ANSI I HIM 31 L.191bD, 3 NNM oK,
PORACK BIEMTO PIT No LGG` WtFISTR '
INFORMATION "OfsymwB
y'
b,
_ 1
IBUTION SYSTEM
MINN. IPO
.PA 0Y�PbGNIIPo
SNAN�
�p
UI
SOIL DOWN Sy my S,
o.ou.� ER. •Only _
`7 it "
COMMENTS: ill euoepwPOOR"an. P.m PNI xc) b x
LW.nO.,,,,,,BTHA*Iklchbors Wtll r�DL
W
I)Alt IW OavlAtim-IbB+roM If N. pj� Marko per plum
i)BMe....r elNm �^avu s'Q'� -�. QjI- MAVkRA '�J W.l a
DS ile-Caa-lam
SRA1 zo i,-48 -
v.
Imu rges omslan
IZ -
\ P
a III
fame n'gan
P QIE®
N.m� °: I
Annm
I able
Sanitary Permit Application
mIALL
'D
�mM
cmui
;
tl
Indian Awl A, t, I di .n an..f
� /715 //9 k
P,,IIf1wIdI APill"PiAll
k n IfI:inall
Pn
BY&CONSIAvr
w,ra,
Boom,.IAmp.
(Awl I At
bit Slow
ex,/_. Powarat
M1�x�
".Oil
nr els_la i x
® 2an .n x Mrn T
lid I will In I
❑r.mec,.nn.,.M11—I,n:ma u>o 6 +e I..�ar
❑ Ckf nr
N
®.,m.of11Ol,,.Ir
uLr o(Pe.mm ICnrt4n.Aln. (:um len ex.
❑N .r:.:
®w
O.-.m
.Wnn•. I.,ne x.,nm deal
°r;F�,��.e.nM
❑�,mn x„mm
If
CeennulTaBILLIONIII
Aaaahk and law Pound
0Cpage
IF
IS. r vnr POWrs s.I
CN,kellmern 1'
®BI nne ❑nlaa.r,.am.mn.nu ❑m ❑rvx M1mn mm�na�f rm
M1nxoxr�::n
lo'Gl,nl>«Wmlr,�.mtim
❑1����r`„�;;,N
ln.mnly em.m
a. i.(....iff,,
Alan L ON)in
man Sol
Am elm
Fe aon
all 5C)o
r1_r.nunrn
_ 4
.rrr
y
Oul n
k
:
IIM1W
w / 24:u11v7.n
Im
-
pmOLI.Badnelwe
IAO
1111YIIx IIoi
SIR 4
Ilnpark llrY SWw... r- I theuWavknNnmmranrymlUlllly par lmn .ell pm. palled
PlInnar . met Alin
mmrrAen I
nmMr
niMr
OnAl
Pool lJa u.rNot, a, Slow ZIP CAW
ADVAN( LI3 S APIT It INSIAI Ink ION -10511 CI I IIPI %%A INillExM1 CM1OOl I. N 1547`7
%1 Ib
eA
5°
avgreaf�rerilae fileeimep..,l 4J, No/th East ➢�opei ne
eo°dRoA
wild; MUS be ner„nenlxlnlsM1n a�' inSyerha�!5V5393 Sr1b�+.r3 Must br nut
znil Sident al...ba �emesreMl mne'd IZ bf lVf2't
I / Gd U51"
•=wi wxn=.n.CmwnwLnw.....mrn,,.n
and :.emn
one , ow, ..I"'An..-n...m....,.
1
.1l. n.11Wnhh
chain root
Snwv)4x
IPWl1u1
,�iue0 Soil Testing, Septic Designs & Inspections
eeh Serving North Western Wisconsin since 1994
71S) 577-609 WastewaferProszant
Client
NON -PRESSURIZED IN -GROUND SOIL ABSORPTION COMPONENT— USING LEACHING
CHAMBERS
Reference Component Manual
In -ground Absorption Component Manual (VERSION 2.0)
Location
Sec-.T N, RW
County:
Designer's information: William J. Bergh (License No. 1577-007)
1 the undersigned state that these plans were dessl?axi
and sub ed under my aulBori(y v
Designer's signature:
-poi
BERGH "_
opn�y an E nr is,
�K
o vn =
/��SStnNAL OEeo ..
Page 1 of 10
Contents
Page 1 cover sheet
Page 2 site plan
Page 3 Distribution cells (leaching chamber z-section)
Page 4 leaching chamber manufacturer specifications
Pages Treatment tank cross-section
Page Effluent filter manufacturer
Page Effluent filter maintenance specifications
Page a Dose pump specifications
Page9 O&M
Page 10 0&M
11041130" Airships - Chippewa Falls, WI 64729 "' o ly@wasiewaterpros com "' Fax (S88) 466-9S73
11041130" Airships - Chippewa Falls, WI 64729 "' o ly@wasiewaterpros com "' Fax (S88) 466-9S73
� NO LDAIGi SEWER MUST ff71MLY I
WIiTISPISM.WWACIII) I
I LMATIE N OF WELL MIST CEIYLY
L }viTN,kOxRyyR,N5n1 sOx �
6 eExcrluAan ELEVAT e0.1T —�
BOTTCMCF GGV K
10 LOCATION OF
B Gel
I D LCCAiIMOFSULPI334 I
1 (D NOCRIBEDN(XaGOR.OF LOT LINE I
j1® DESCRIBED OF RATIONCi LOT LINE I
® CE HTEGNGFF DgLFWAY I
L® CEMERLINEGFDEfCP1SEGROAD JI
N
W+E
S
SCALE
WI AYJ NON
�0JOLOS �5 30
(<NON -PRESSURIZED OISTRIBUTICN CELLS
ATOtAL OF t'OEZBow I203H1EPSSU NS
ARE REQUIRED WHEN MPLWNG AN
EISA RATING = 50 PER SECTpN
TIEM ELEVAT ON=9I8A'
EXISTING
y\QI
Exr3TING
ABSORPTION AREA SIZING CALCULATIONS
I BEDROOMS • 100' 1.5= III GPD
6
00104
=1500,0 W
EISA rating per gnvelless unit= SOLD M ^
1500 0150= 30 0 UNRS
Instill 30 EZ flow motlel 403H -00'
gnvelless Pipe un0a
AD d,
PI NON -PRESSURIZED DRTP.IBUTN3N CELLS
A TOTAL OF (SO) Ebbw 1303H 10' SECTIONS
ARE REQUIRED WHEN MPLYING AN
EISA RAZING= W PER RUIN
SYSTEM ELEVATION =JpI��M
IV�53
1 Y��
INSTALL SCH 40 PVC
BUTTERFLY VALYFS TO DIVERT
FLOW BETWEEN NEW SOLD
GE111ECx. uC
I IEn PC I K AVENUE
ggpns lxf[YM1
,µNA
PGWi4
_
NH@PEWA FILLS, m man
......... a
:,elm I ad ,Fox imx
.. 0,M. 5
_LET
Im+..s.xa.�
�.F IV
NON -PRESSURIZED CELL(S) - EZFLOW DISTRIBUTION UNITS
TYPICALLAYOUT(Dr WJNGNor TOSCALEI
She may require addhonal varpence act them M - palPaws Pun stand
OBSERVATION PIPE
hon1eC at opposite enCsI to III
the length of the cell
meal from the end of cal
f COVER MPTER`l
GEOTMILE RAW hat to pontone plant anent) R�
ISPS WK(6)Oh
SYSTEM ELEVATION = 9w
(BOTTOM OF DISTRIBUTION CELL(S)
30 10' - EZ1203H DISTRIBUTION UNITS
4" OBSERVATION PIPE DETAIL
(TYPICALNOTTO SCALE)
MIN. (E) PER TRENCH A EITHER END
In(mPORE nOR S"P
an"OVEDM
R"`Haa
�xvarvlsoe
XaLONGO
.TS
GNT
MQ 3GMIPTRERAMeE
4TenPact
Iw e
AenOmq Mpg)
5' - EZ1203H EZFLOW DISTRIBUTION UNIT - OPEN BOTTOM AREA = 25 SQFT
10' - EZ1203H EZFLOW DISTRIBUTION UNIT BASED ON EISA RATING = 59 FT
ALL MATERIAL S PIPING SPECIFICATIONS AS PER THE IN GROUND SOIL
ABSORPTION COMPONENT S PRESSURE DISTRIBUTION COMPONENT MANUALS
S
DRAWNKl
GNOTTOSI 4pf
EZ1203H
::•: 1
'.... +„
a :.
2' i
..: .......
4.625"
BILI
36"
12-12"D1A.(tYp.)
.,...".. I.,L— wVqii ea
HILL
�. [( In 011,E Ann,-" �-
["4
i.11J�
EPS Aggregate
Trench System
:y
'trr' I)/fie
aln5
Mrs I"H c.ou4
l WOOial
es Ill WOO PoK aa.
ookiaI M aeosa
.'f 16
COMBINATION SEPTIC TAN KIPOMP CHAMBER X-SECTION
(CPPwING NOT To SCALE)
FINAL 6PPD<' MANHOLE FrsER a COVER
(pmuna Bo SM6 SAN Tom/ te0r 6P6 Ba125 (1)8 (B)
SION
m nfrou ls) In propel O veneal (wlaPpmuee b[4P9^ed¢
BUILDING SEWER
Mi
SIT 11TEK tr
Vj WJ
OFF
3
r
PLIMP WAKE
MINIMUM OF 3' OF SUITABLE BEDDING BENEATH TANK �rUMrrW
EFFLUENT FILTER
^ OR EQUIVALENT COMPONENT
Tank ManNac mr
- [ONE (daily wastewater flow)
SepdGPump lank model
Number of daily doses
(OWFJeNual&smlunef
Alarm manufacturer
Alarm model number
Fortal Blume
Actual dose Blume(gallons)
lolaldo»Blume- volume ouoimmaml
Effluent pump manufacturer
EXIuent pump model number
PUMP TANK CAPACITIES
Reserve above alarm Inches= gallons
Minimum pump discharge rate (GPM)
Alarm float abore on float rmoved z: gallons(C)
Veri lift (pump off to distribution lateral) 01 float measmment .Inches= gallons(B)
system head(tletal pressure K 13feet)
Off Mat above tank bottom ii = gallons (A)
Fdp-ion loan In the krteemaln
TANK ol MENSIONS& PUMP CHAMBER SPECFICTUN4
Total dynamic head(TOH)
R
Length 164- Width 96.
GquiddepM 36' Gallons per inch 2224
e
New System inumallatlon: A100ran add A300l
\\`
Ittaxu`ub
SPED )V *
met
I
Y I—
Y e e p
AIWI/3001-8 Series Filter
palate Mutual
th, hadelPIP In¢M
IwwYelplPe,p
m3'e.wre Pxithe
Pal wareennif
turned pl(9 mtle
ill.
PaOear
woutmarl
utpa.r.lrrr •••-_ __
S[BOut
Real
paret .b NuO'xntlx uae0mry5mpMn
aaww4.
�.�.
appon
plea
aad"un , ,s,mrem.a,
6uYrel Xald(gl'ue) the r r10 to Dal e)Ne
iddietmldphe,B�rm�
In�vWTep
Me�lae.Tllen end a0mpmpipe, an l0v0h0
and an0an01he�0npp0Nplp0lnmexwwn at the
Poermmege In the ands
vat sure Me lilll
age, Pwa the num, deaf, and the slpmn pile
mlmd90' pOpelNLp ml
r Kkn
me out in pine Ndneet the sup Pa'I posalwas
own
�Btomeyl00elyir3e�10
Spann
an lure on the mnk flenMce ctl al
and %W V he nam Fp to datlpm In N¢ eygM
P@e.
Sdru93ydem lnptallaW n
.smapevxvwsxan,wwtwwrwanemplwpwd.ummvuwapnduaxa,.
�Ilyu Mnpurtroead ez cer Smvl jon' GYlOi¢meWyOw IM'ONbnetan Mlwn¢Nu.smrXtllelnaimsryun Wq. • m. maun.sen: w m+p m u. wa,0am wsl, um armn.0mum. ma.m a s Imn la' h nwnwo auw.lo- out Iral a me relay mmPoa • A o u ip pmh war Pe wlNl e0vv PoBnlry Y ammme V ¢a ud mry M mpral In mdjn Mee
. IPetlrermn m�ml,umll0a:,rreearrgmul.emneeral.umunna.Lureulnspm Panel naxmsymnuremmeoommwsaewle.�ee¢
Tyre gradual mown are w.s ed by it rollnwal midnal
U.S.4,710,295,5,593,5M4 rpatentspendiig
Call for a bee D BEL ZONE•• 1 -800-221 -5742 • Or Order Online: www.xabelzonroom
At OW/300"i-El Series Filter
TIM IMPNBIIwaervkig s0:p IeNs IR oydeb andla1:4 ThrnlgM1oplrhemUb!,, Slafa Nem5 Red on
on what Nis iMnv0l aM1wBbe bNmwlreguMoryegentlessugpealkrolnfN y¢are.The ZabePfilfer, rAlkll doa laf lrcteaze tlls
irequerlry of sen9dnglorllerink ebould be cleenedwbanr pdc fankls normaYy inspatletl pad penpetl. Howewn mriiXeris
vNeally salWrarvng. Th¢mAli cr lknol NeereeraGcorygn eonlM 3aballdrer rauseslodge0 pemdes N dleimeryare an0
felNNeperg oUnk MynurfiXerembirea9mulFlll#'Mean, ymt will be norified ty an arms when Ne fiX&nee&e¢rvicinp.
i0eeays filler:
•.rAWarq enYZebnAFMa'sdoerVmtyb¢dmebYacw@4a16Wd.'feM AffeWaMelks
nyl
be ��
�
1
wearare
Nb Wks
'—I
-
PamaeMmrm¢r
vdpuPpe lenki
�
ry prmwn
flwr�MnPbeuW
IMrysi9lmmeMe
sFtle Ne
biw XtltlM iXm
I
mdndno�ulN _
im ,y,
IFF me.
l
While Wldq re camera mer Uz wm
Rene
g nm'a Off Me World weh lrevh Imae re nX& Mini bWm
Mere, ENng wMNlo nrsealle¢p�¢ became mekFlsumfla(iXer
mmera'ownwaNe Otrfl, Card 8P lehyallq�were
Spin beed grei W anre m M+k com ep�reenedmft
apple
fm Wakanllne�srytlmaNlNeeem Rep" the ayiper rubber
wm'mlXem.
need, riee, red
LS-FM
The ereddake) Armem ere covered by the Inlbeing pe10i
U.S. 4.71 OZ5, S M,5940Mer Patients Pending
Call for a Idea ZOBEL ZONP s 1-800-221-5742.Or Order Online: www.zabelzone.com
CONSULT FACTORY FOR
SPECIAL APPLICATIONS
• • MINI II m 9Dv+ WQMRNmM, aeercI Wd
• Tene,mMM v MIMI
• U PryEak w'Roe b® icM miMnrt&I
m eM UVI
Mr,JD &'Mak W wMuuWtrnse. SM
420
.0.✓i.or. E) sau quvbn Mwv.
Jh
_
NJ
lf
Mim
ME
[
r®
iu++uv.0 aw.wp[[Iwnocwaamvraxvu al[wl
TOTuovNW+w NEsnIaDW
PER MINUTE
EFFLUENT IND DEWRENIIK
Model 151
Models 152/153
SELIMIJIN PRIDE
LwM R mvvelw bvllra svvnvmse[gu+vvuw wwivci
vrevvn1u w m rmmwi¢¢wb dp%I
vlelrm'Mm
RESERVE POWERED DESIGN
For wI t�m9 aM�e mama sm6 wyleemE rx M, mmon A"IN zmllx pmp.
��P ® �Mrpm mom M,Mr w u.mw MI
<t in
6samnuMent a IJWWmn: ROBBY& CONSTANT ING JOHNSON -nes 119"AVE NGE
POV?S FAjnYimn Gp Tech ask a Site Eveloalkn_ Cnipp Fall¢, WI]155]2E838
Lout Rpuletery AWlgity', ST CROIX Coune) 20nrng OeMrb t-NUEaonWl]I5.396 p680
PO'MBlneryllec RWarcgG Septic lrralelYOon._CaOOX. WI]190,froze
DESIGN PARAMETERS
InnL WE%enl pualiy(e¢ ryk I valupfor domestic (me MWuel xreelewelar and woe lank effluent)
Fet¢, OH mq Mall (FOG) e3O hil Bb emtml oxygen Dement IBODS e220 MA Total So Whorled Some
(BS) n1 W ME- Sol Loading Rate (SLR)-0 d Noun'.
SYSTEM SPECIFICATIONS
mmTMponentepmmKmcWeof mm¢epic&Oe ere 'mentionm an" a Mur-0Mr (S00-GPO) Nrple.mmp rea imence. The
IMan peering Wieser 12001800.MR walla/dose tank IwZbel mush filter) and anus m
I�mrMs, In¢IaH a salve Wx 8 (3I lPA1 ¢¢unwed Anbpufim tell¢ using gravelem Be ing gembery SAE
raLng M 50 o ash speti by SP53alMal
z-Flow 1301rv-t0 praxlkaa aye unity are rpulred Mrtn eppMrg an EISA
inslallM Par mmodusider apesifrcatJona Ma aOf the � kM¢enk or comply tan WE Arm. Code SPE 384 and So
DESIGN CRITERIA
In Mend Soil MOrMSgn con ant Manual VERSION 2.0
MAINTENANCE& MANAGEMENT
nns d life Mrgikin of the treatment basis)and diapersal corks) a Manual ofevery three years. TneseplkkM
comerus mull be removerin e6ordarce Moo Coupler MR 113,WI Moo. COW¢tha, the combined seem and scum
nausea Mal On) the tank wWme. The Wouenl Neer Should be Impected annually to Weak maximum
petformarce. At a minimum the fiber must be cleaned every Ibrke yeah Mien me lank is rympke. Immediakly
WM1blegmeans 60 MPIMP-no
anvlamN mot fiibler ahe000 me eXx moo pages and thoroughly Samoa won a has or earlier
of all b¢rgn maker Maple¢ the irked n that it Is properly removed. Upon wccesaful removal
finer mane um, ¢PodficNnna fonddltimral t Is prAPeW`sabout wsuficme filler housing sell Refer to individual
pane s
STARTUP
For new mmtu on prkr to use M the POWTS Check mumnmt hands) der prrtc of paring Mdr BY other
chemicals that may imPoee me Vestment prar¢ ended damage Hre elsgrvl wilts). n are like mntenik of the AWARE rermvM by a updegaummy cperaWrpdwto Regain dearromemi ere
OPERATION
The Mal owner N FnPon¢tbk der IN Ofe resch and nuiMenence of me POgTS 80 sub ssmn M r limd
ra Ins
m The boundary add puallly of Waeleymu will Bad me pertwmenp and Imgcvily of par P AME This,
s - of wabrvaaking coamliaimanmn
s and fidums d ppl Other da age rNrras malewaler wlume. Asiaaloman Wake soMn many and older wader Sol derreeSshould too d'scFWd to life ground
sea Mrmevm mornme. Nak: this don not itcum aundry twsb,¢Maeda, diarmaler, No
The system Ia hoaprred to handle domestic TwWh wastrel however Me disposal of food bawd g1Mns and
oft be minimized
tpe1ells Issuehois m�e oo ens and food full Bad as thou =dUU be a garbage d madvi ¢hodi
eema artch as Why Mcea. Mrramns YsRoper Other should Ed dt argerl mho me Water. Omer non Mocks a]aW
okm rem mien me W any napkle. condoms ti arebe bugs, mi bra, and Loryon avail¢
(mkiwm ns). solvents a . should not bile Pushed into Me spde are they on Wdex zesty dram yurManual m bbiode
mnmMnage You, mrkmg wate...May sae your POWTs and
Avoid vahmel poor all system moo enl¢. Composed M ama Over the unit may uuu b HE "us up,
INSPECnONS
Shei be mad, try one M the fromeng: Master PlumEer, Master Pombx Restntled Denver
,
POWTS Meintyner or
tage Semcing oparamr
Sepik Tank Gang t
Tank inmileses MUW Shall a visual lnapecyon o1 the WE to MM any mining or broken hmmare, ell a no mas"leaks, measure Will M di
me WimbenM sludge end ant M crick for any barkup w surface
dal mharga M effluent Peel openings used der Weeklydf w sSm ( shell be seal" argil WE upon
der"�w a Ides may ushe aaM wild ffem Mall Manual looking PPHYp Equde d meanings greater Ilan 8'Ma Manual in
an ce prevent arJ hf M WoUthebaed entry n the pi
=a8e(5''oe9�
ofID
emdem St. huts any am,mmmm w as ao al to
e b a Us mspached Stab meaeed Io
aanuraWm(s specPusdmybUses attached ¢Mmo Pmerent talthebe de Noted an Trlds 11eme the lanknuwing
eanmg. isyst m oiler may be necessary at inpre nequam lalemale Ina, elated m the malmmanm acnMma
b keep IM ryelem operating property
nGkAmd Gravity Ccmpir diseases Calls
The InpMion anal) Include recording Me level¢ of pending, it any In Me observation Ideas and a visual
on for
any enhance of sedan sectors, or discharge. Any discharge tithe second must be promptly
MN"M to the regulatory aNmaNly. PoMsng greMw Man 75% or the height of the wmlwnenl may infidel¢
ovedoading or lmpmding mall failure noes da ing cocoa frequent me,romme.
Valve Roe
The valve box a l be evAtlgd to serve the Nepal disam mn component every three year:(Wzn the septic
tank is due for O regular mam,nmed Threaten, X pending is observed In the ob¢ervamnNenl pipe R any cell,
the droolor valor snarl be corm to the opposing component EMM,mwe pdnaMa greater than 75% of The
heghe of IS, component may lndimte Idenea6ng or iMounding hydraulic failure nece¢sleldle more Bepuem
maniKKmg
REPORTS
Rpnd¢lor maintenance, InapMgl and monitors shall be submlbed in accordance an SPS 28355 Val
ABANWNMENT
WTan Me PONTS dds anNor is permanently taken out If Stavin the lollwing sHope anell m taken to ensure that
tax system is property am assay ebanmeo In madawnce with Ch. SP53e333. Wiswnsin Adminl5tralive Code.
All piping to tank, and pits shall Be dlscmredM and SO a lmdoned pipe Opening sealed.
The mnlents of all tank¢ and pits save be Nuall and properly dlefened of be a Septage Serviong
Operator
After pumping, acause and pits shall be eecavalM and remwM or their covers removed and the read
spare@kd with are gravel of other wild matedM.
CONTINGENCY PLAN
If the POWS NII¢ and cannot be repanM the bllowing measures Wye been, e, must be lake, to Provide a clock
nt re ,exmenl system.
p is subs¢ replaumemt sea Ins been evaluated- -
um absorption system me annual area sIlePueded home EislRhaooe and oompentloaxndA ldIN
be merged Upon by r ul(eb Setbacks team exempt and Prope¢ed stmcurenllot lines and deal Fagure to
orate the MOammem area wis mark in the b the Mixed fora near soil and see waason to establish a suitable
eaplawrm nt ema. Redarement systems most mi ,in the ml,s m anon at that time.
WARNING
SEPTIC PUMPAND OTHER TREATMENT LINKS MAY CONTAIN LETHAL GASES ANOgR INSUFFICIENT OXYGEN.
DO NOTENTER ASEPTIC, PUMP OF OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES BEATH MAY
RESCUE ESCUE OF A PERSON FRCM THE INTERIOR OF A TANK MAYBE DIFFICULT OR IMPoS$fazE
Ma'or coundrandurplants
The telecoms a a list Of the major components recampid to complete the installation of the POINTS. Tin
list Eces not Include an allowance for brings, glue & cleaner and may at Include all pans and malelwls
U
ST. CROIX COUNTY
SEPTIC TANK MarNTENANCE.AGREEMENT
IND
OWNERSHIP CERTIFICATION FORM
Otmer'But�p<r :y h ('
Meiling.4ddreslli 1 O S 4�IL
kfYlMnhSle
PropenN pu dress yp 11�4. 0.5 F� ('Jc � A. 11 -A f� - I�� S.�c1 ca�
�I('riFlcmffan«Quvetl from PlarsmgS Zonm¢Oepemmenl fm/1n conxw�ni�any)�
CiMSlate'1 0.%Z Parcel ldmeifiratlon Nvmba (l�fi''��/�.3�-GGO
LEGAL DESCR]PTION
Proper,' Lobuion5 il, V(_L '/e, SecT Jc NR/�Z-W, Toxn of
Subdiv'imin Plat:" �IS iia e bts
Certified Survq Map # , Volume n , Page %
11 arremty Deed S /(e 3 � C( 7 (before z0p7)volmmeT�, Page PAL.
Spec M1omeyvesAm hat linesimitiffablKes- oo
SYSTEM M4INTENA.NCE A.\D OW?'ER CERTIFICATION
Improper use said maintenance of your sort, symem ,,to each in as peemnme&,me to bards, w,,w, Paper
tresults of pump'Ing or, nve Na septic nk er, Mee yeers or sconce if needed, by a license member. Sethi you Pm into
thes3xm accan al be famine of me septic had, as a neament sage in the waste despond system. Prose main¢narr e
rexpachounim me specified in §SPS. 3835E(I) and in Chapter Il- St Croix C inn Summer ONmwa.
The prapem north agrees to submit o St Come come, Parna g ir Zoning Depanmem a craffiatiin form, signed by the
either cad by a mazta plumber, journeyman plumber. hmai ued plumber or a licomed pumper verifying chat(1) its means
w disposal system is in proper operating continuumand'or (2) after wommon and pumping (if nearer,, thecash, made is
less 13 Nu of sludge.
L we, the undersipmd mva mad me ¢bore ranchormno and ago, to mamain me pectin seunge diryaeN yu m with the
0ncm b It risen Herein as Sir or the @paaanem of Sin&laMa Pieeaamnal SIMI,, and me Depmment of NamM Resources,
Sate of vaconsin Cenifiueansating that yourseptic system has been, mounted must be competed and«tmnad a din St Cam
Coanp' Placing & Zoning Department widen 30 days ofrne Mee year expiration data
J,we cenifi chat xli su hasfmm ere nee to Ne best ofirwowtnowledge. l'we em'ert tM1e ownet(s)of Ne
treater, described above, by vitwe of a o nn' JW reorde! in Regilar of Discus Caes
.Number of bedrooms
SIGN:4 URE OF.4PPLIC.4Xi(Sj DATE
^Any mahmario t that is miueprtaenim me ramYI me ¢aeon' permit being rtaoked by me Plmmmg & Zoning Diameter ..
cude with this apphaarian a recorded xa' deed boa the Resume of Net, Office and a cop) ofindifirvry e eed aumap if
oncerns is made'Inme wanann-deed.
(R£v,sul
ST, CROIX COUNTSZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXIST NG SEPTIC TANK(S)
This is to certify that I have inspected the existing septic and,or dose tank
presently sen'ino the follotcino_¢sidegce.
(Street address) located
at�$� ;.. }s, Section /- ,Town / S, Ranoe WE 1i
sown of 4 llci . St, Croix County Wisconsin.
Upon inspection, I certify that I have found the tank(s), to the best of my
knowledge, Hill conform to the requirements of Comm. 84.25, and it (they)
appear(s) to be hmetionine properh.
Most recent date of inspection or service
Did floc+' back occur from absorption ssiem^ es l� No
(if no, skip next line.)
Approximate volume or length of time gallows minutes
Tank Capacity: [2Cl2 — S -
Construction'. Prefab Concrete Steel Other___
Manufacturer (if known): `_o_S.r--
Age ofTank (if lmown): I)y9-5
Permit number(if knotrn) N�12T1(I
<i4 kF
(Licevsed Plumber Signem� (Print Neme
�-bfS K-' xe'mkr QaL4CY7
(Title) (License Number) MPMPRS
(Date)
Form to be completed by licensed plumber (Dept of Commerce Chapter 5
and s. 145,06. it Statures) or licensed disposer (NR 113 Wisconsin
Adminisaatice Code)
Re.. 9:2008
I'
37 .
\
`, 31
65716 6.F.1
m
66516
1.61 Ac. /
r(a eczw fz
1,.50
/ NA. e1,
Na i.d A..
�/
MA. 1,
38\1.
I� 65499 S.F. \\I \Q\11
/
+I 65393 5.r. /
)I 1.54 A@ I I
u.e. ewsre.a/
1 xe. JxlAe.l _L.
�'70744 S.F. I \,
1.62 Ac. Il gi,
9894'S.Er
1.83 Ayr I
/ x0. ]Owe SF.
\ /
I N.G. vw Au
1.
/ \ I
'1792 P F. 1
/ e6S. 1
1.56 /Ac.
1.501 % yy,501 Ac
IF. xal eSeWl'a11. a
I K4 1 Ae j I Kr I.wlI I<
1 �. '
1�9. `0�th 6L9 \\
RECEIVED 16 -(70
xBpap"""tM oIL EVALUATION REPOR �1 i D u16za
waaalsmnaSno Snowed
JEP 087 mrpMorWon COMM 05,We.AAs P,p. a„s__
tt g0.01XCOUNT'
lASEH56JW06B1 Monsan"OsTeav ma.
AeaT mopes almwae�-mq�MAEYk49YN56k'm dr. Monona
"_...,
Sl.cmv
indoor. normal xlfxi4end Nreoam ...0 polo lsm) ry
. e n ax
onx, o anw v erosion
pemnladx.awMui �maaxi a aamalXamarore.nunew .
----___ - _-
paMx 1G.
1 b20_R_ 3]LO_]
Plx¢e lrrbr
_
Rxbw Oe
womvaemw Ones, pe"I
mnMnn
uum
JaMson,RRLyB Canalanw
Ro
nor Lot TipN. R1T4
W1* SEIM,
CEW64,
- emea CBW InIX PMFX
IM511WxeMamq
1ner Ave
37 X d HdphjS
City - - --- fiWl E54CWe PMre HuniM
No
CM I sewn NxnX POM
HcmrmM WI 54015 fi51�200-9023
mono
HemmoM 119TIAw.
--ue.eonaudlon Use Rxdennell Xumbrd Mbooma _4 caeaernwe Eeron lsw ra. e00 _Gw
.-
RxMameo ` Pofillaarmmmad a-COOMMO, _
hdalhl JeµeRSALwmNwaon.ppal Par,mmmumal GkazM_ NA E.
an d o
Geronlwmmeme Flml ya'6 Convxkna mea,Imlllsysmm a0<aea195.<B'IPreaenErtilgniFPoblnylmb]0k0161. 6H.
wgmmenEauene'.yxC'.Mwa aea lrvslall munUMSystl99.fi]'GxeJaHamaNurllrce5letllehNd96P.
eOnry X I BrnR
._Pk Gmuwsunasekr. __98.0]_ 4 wprw fmaiiglaaor 60. in 6oYPttllmlkn Rise
Xdym
Casa
Rm'nam Caor
McWm Cwulpnon
Twom
Season
Caovenrem 8oenoary Roe6
Gpm-
In.
menial
Gn.4 .Cent Cotr
Gr. Sa. Sn.
her
'urz
1
tr17
10/r313
rare
ad
2mMr
mh as _ 2H
0.6
0.8
_
2
SJM
].SyNl9
_
pM
Em4k
ink
qw
TN
0.6
L0
3
2942 ].SM/9
p
grls
1
mvh
6__
IH
03
1.6
AME
N
Om
mh
9a
-
—
0.2
05
4
42i 1Pry616
5
Wn 10y 6
mEo lga6R
and
9
0m
mfi
—
0.2
0.6
j
1�2_
_
_.
I
Fxp6artsnM
m
9B.07 fl. Gegnb FmAinglader 35 _ eN Appeaser
�nOn.
Im
T 6lndon
WmWry
_
1,
mummew
Rasa con car
Gin6a. sn.
1
0-ll 10yr3/3
rcne
Or
r*
as
lM"o`
O.fi
OB
2
11-24
10yN/4
rl a
Sol
2mabk
sellspx
lrtw
09
0.6
3
N35
10yN16
a
/MM6 N
lm�k
k
ON
0.9
OJ
3566
10/rt/p
Om
Mir
4
pr.
'EMwMPI=e00 y>30<]10 mryLanp T55 =30=150 ry4 2=BCGay]OmyLano TOS-- m;M1
pyi Mona"am Rlnl) 61anNu�m CBi Xunb
TMmae J.STmM
- �pq EvvlP eMUva TebMma XunW
RCNnm6N15a01] BYa012018 ]1S]6PipR
EmPoMOwne. Johnson, Ross" sdM¢ va,,Va R 0162M 370]0-3 Bonn
9712 Deals e P' I
Page 2 0l 5
cmnm am.m aw. .:_.... n. oimm�ne .owr 2e
seu.nwrnlon Rai
Iasi
Gewn
MunuY
0eevbtion
Ou as COM. Color
T G¢6x.5fi.
_ _
harz
]
0.1l
lOyYil3
re
gl
2mBr
mh
5
IN
06 0.8
2
1120
IWy Pl
se
0
2 cM
h
gw
If IM
04
0.6
3
20.28
IM4/6
Plane
g
SmsM
mh
mh
9w
—
1M
—
04
0.]
4
2472
25M14
shlI�6
gy
Om
0.2
0.6
Lw j g Bonng in.
PoPq GwmeurM1u eee._ 97.56 R w7:M ioim4rg kaw -�fi1__
1 152015 lOyr3/3 n(ne g 2"r raft IN 0.6
2 5 ]TyM/9 O 2msEk m! gw 3N 09
3 253J5M/fi g�- 0.6
4 3W3 JS /6 gw _0.2
note i 91G Ron fi -
s 4352 I0p5/6 wie fg Om mf - 02
fi 5296 165m5/6 Planes 9� Om IV - 03
0.pifi an YmtiPB lepoi
10yr3/3 iwre 91 Imp mh a Sm,]N Ob O.B
10yIel none I 2m4k 6 gry If IN Ofi OB
IOM/6 none W 2msbF mfir gw -- 04 0
6
lq*5/6 rcn¢ y loaft mh — — 04 0.7
Effluent 01-B00a>30.220 RA. aN i33»O< 150 n,j EIIIoem X1- 000y< 50 myy no 155<_70m
me omonmenmfewnnne.lenn.ywi u0pttunlnau�+avmdeermennn�nYe1-usun neeu mhunafu.vev x.......
neNmmenei m an auamefo io mw, ohuttaonl.olmed,Wmem ui 60e 26o-vm urm GCP.264.P]a.
nro.mo.,., AMn�lbp&Gnsb,vs svmioa9lbzwaJ>.w0 ___ vw 3m s—
�umeaPd
mneml,.Oem, 97.62n MgAlo lm4ryr.m _lz soe�umm� Ane
11
onmi1'rwoo , rs.ao. c.,.eum' swan ..
x.moil ,. u. sn.
umm. win, �
coam
�en. -
—
-•em
1
o-]z
1U p
I
2n9,
mh
X
vN
06
o.e
E
122E
1Oyr3/4
Moo lot?
grit
11
Ems)(
mh
ew
1N
O6
0.6
3
9
iE 31
31 R
IOyM/3
IW/6
mE SyrsA
)ems
ire
gl
g
lne[k
pn
mh
mft
_..._
ga
—
09
0.E
0.6
0.6
ela.nitr,- . o. no me..nans.m.,w men E11mnia-600,< alwrit&,,erss.,nmy.
M Mw,unmmreummma lien tualoplonu ly mo;m enn;ea,me omVlarm. Iryoumcdt,, iAmnvluncnetoneso,
.m �.m.n.... nn al¢mo 1flomm Ploerc ¢mixuM am�m.will " Yi-o sns.zsasm.
C'"w0d er:
a. i. conaa<w.e.
Fape aa O•S
mN85ma Eat T Inc NaeRob 8Jonoeo
Thomas JSolvent CS22i429 CORaal7le1PLO AA
SValley Vew i2ll City Stare lipNammonJ. WIifp15
Oelal WI5COR5
eM it&:IWB Pot. Wlf of. 37 ROOM,11pill
5'T'mv Lot No J]NI ROOM, St T7
M Bench MSil Tmrscover liP.Cwnry'. Hammond, St. Coati County
♦finch MaM 1 El. 9].BP Top MR' Fllb<manlla t cover.
0$10" MoakR EL BIATbp Brountl olwaYon of SE comafpwlof dog fen"
Blopa= a%
_1, ' L Sc¢ale 1'=80'
—I' CO L/NE B
1 " Eema7// 90'
NOTE: Fo<fullWw Ml
Neyf9F%
1"a
3V/w'fZ
\l /
poG �
FfNGF
yc
e
\
v/ �y hp t t„pR- =�
Lau-�ro.� RrFeaa/64. 55' -
TNSTNL(j7 o N
N
/ 226.00
3 N
4° 401,80
� n
to #1
N
PRIVATE SEWAGE SYSTEM
9mn.reememeoxi
'
INSPECTION REPORT
GENERAL INFORMATION
(FTTPCR TO PERMIT)
m )
TANK SETBACK INFORMATION
TANUTo
PL
wELLBLDI3
N�4
5'
i5
_
n
Z1,
�n
N
Isi
5
1=19
PIIMPRMPNON INFORMATION
MxnNemm
z�l
f
el NumN
�
°i 68 Fna6`,23
em re
j 41 Ft
425
o�.z I
m
A-
C�x
MSt.
lk
ala �.�n
n.IT.�
ww+omn
3,
Z ffe
_
_
HMO
DISTRIBUTION SYSTEM
H.I
AL—aeA— ;P' N� .Si.
SVk
OIL COVER ure6 I¢ onN� a+M¢em¢
^mau , DW�l.55 .EUp. � Twq oaU.
V a Lro
COMMENTS: pncwe edea¢uewnuee, [emare peemt e¢.I inwemonet_ mepozn¢_
we.mn. nR511nA= C �S(SSIANEann M)NnViee N¢gna �knrel xo. wrznna021
e.lulNreo.¢mPllu,=f'1 G�p.,�
2,)BIdI /5