HomeMy WebLinkAbout008-1056-20-300 (2)PA"', epent erq efed mn PRIVATE SEWAGE SYSTEM
ill I'd BINSPECTION
Couni
St. Croix
nP•mrnxd.
REPORT
GENERAL INFORMATION (ATTACH TO PERMT)
B17719
pr.ao xo.
Pormonendernaten au p 04 1dmlt
Joan (Larson
nr unpTOWN OF EAU GALLE
,I T..N 008-1056-20-300
e. EI..
Ird, ENl,
Sdre.aa„n®.noe.+a9x26.16.21RB
TANKINFORMATION ELEVATION DATA
TTPEmPHUFACrvPEP
CAPAGry
STAnOry
BS
HI
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u
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TANK SETBACK INFORMATION
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PUMPISIPHON INFORMATION
eualaaee
Manufacturer
GPM
Atom,
Nepal Number
LmFri Laaa
Syria,Rene
maIrani
mmeu
SOIL ABSORPTION SYSTEM
SETBACK
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SOILCOVER
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Plan ramor, u¢a Baton Sae Feel
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CBa a,.w _ RR u
Safety and Buildings Brvisiuen
St. Croix
OCT 08
0J�01 W.Washington Ave., PA. Box]162
Samar, pompNummlmgo, ww in by Co)
Madim, ; y 5 ] I62 -
�+ mN
(iCi77/9
Sanitary Permit Applicanon —
fiunmmmiruumn,
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201 W Washington a . PO. Box ns
Madison, WI W707-71M
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Baltlwin, W1
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SEE CORRESPONDENCE
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6RciirK[-MgN 3 B�Rm.v.J
Mound POWTS Index & Title Sheet
suspect Name_ Larson 3 BedNom Replacement Mound
OwnenNnme, lean Larson
owne(taddi 2149301h Ave.. Boudoir, Wl 54000
Site address: Same
Project Location'.
Subdivision: Na
Legal Descripdom NWHN5M,See 19,T3gN.,R.16W., Town of Eau OaIIC St Cmix Co., WI.
PrmellDp'. 009 051fi0000
Page I
Index and Talc Sheet
Pont 2
Sae Api Mound Design
Page
9Wtic Tank Maintenance Agreement
Page
Septic 'I anWPump Clamber Cross section
Pasts
Flitart:uss shot",
Page
Canned Survey Map
Page]
Warrat Deed
Attachments None
Meter Pln"erke
ch d Service lames K. Thompson DSPS Credential 93W21
Slgnamre: L Dats `Jd�✓���%
Page 1 of
Di puoumtw x u,1.1d ruh Adwpnw ComFunaa ntawll 11 POWTi vmlonl A 990.uses RMeVO I)
enjorbay, DFUSIONOF INDUSTRYSERVICES
CREEKSIDE ITS
N
•1w) C d w
pwlgcW rygesSo
..W lk G
August 23. 2019
CUSTIDNo. 30021 ATINr POMS)nspea l
IAhRS R THOMPSON
ZONMO OFFICE
ACE SOMas SITE EVALUATIONS
ST Cli COUNTY SPIA
Ed PAULSEN LAKE LN
110 I CARMICHAEL RD
OSCEOLA WI 5402U 5413
HIIDSON W1540162209
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: HS1312019
SUE: Ideoti Catiou Numbers
IDan Larson Transaction lD No. 2986465
214930TH Ave STRED No. 841463
Town of Bodwin Pleaze afutobolhidutificetlanuumbers,
St Croix Ccunry above, m all mrtas ondaocewlW Na s m
NW I14, 6P1/q S L Mae, RI6W
FOR:
Description'. rivers BeAOom EZFIow Momd Syaei Slapfng she
Offed Tyr,e POWTS Component Manual Regulated Object lD No: 1721414
NNST.... ceregnhed', Repincemenlrysom, 450(rPDPIowmm; 301n Soil mmlmum depth to limiang factor
from onguri gmd4 Sseeni EZtiowMomd Component Manner, (R7112), Pressure Dlshibation Compomn[
Manuel - Vu.2.0, SBD 10706P D 0 110 1, R 10/12); blBnmtFan,
The mbmlval described a I hest bem reviewed for Caf enee with eppil"Ime WIComfa Administrative CWu
and Wisconsin Summs. The submibal has been COTTJITIONALLY APPROVED. Thissysmn re to be camnuded
and lomrd in accordance with the enclooed approved plans and writ, any component mennal(s)mfer Iabove. coNDITI
Free owner, as definedv:chapter 101.01(10),Wiesner, Smmes, IF respotuime for wmpnaom with all ode APPR
ropmements DEPT OF S
No person may engage in or work at plumbing in the Stan. unless licensed to do 10 by the Department per a 14506, PROFESSION
aorta. DIVISION OF IND
The following conditions shall be met during commission or installation and prior on canpancy or Ise_
Reminders
• A compary permit mint be obtained dom the cowry wham flits projut'Is located In accord cewi tt,cype 5 R
requhemeo6 of Sec 145.19, Wis. Slats.
InspeWon of the pnvam sewage system moulationfa required. Anemmm r s for contraction shall be and, aim
the designated county official in mcm dancewith the prwram s of5ea 145.20(2)(d), Wis. Bran.
• Adate approved fli filter is requned. Muntmma information most be given to the owner of08 mN
explaining that periodic clamting of the filter is mmmod.
• The existing POWTS shall be abandoned put 5PS 383.33, Wu, Adm. Code.
The area within 15m,m,I pcof the dispersal cell shul remarn undisturbed Vehicular natfic. excavanon or
soil Compaction is prcNbited in this erect
A Cow of the AS Of laao eefimfoo mdthls ester shell bconiadonn^consrcucfmo and 'Pen to
inspection by radicals 1,Cmsma vas ofNe Daoartm vndudo on mso s
3AM6t K TACINFSON Pagv2 Mists
Caresser l2esponsibififies
The curter[ owner, and such subsequent wshall receive a copy of this letter including instructions relating
to proper ou and maintewnce of the Vseve Owners shall receive a copy of the appropriate operation and
mainterame manual andow owner a normal forme POWTS described m this approval
• The owner of a POWTS shall be responsible for ensmmg that the operation and muetenanw of one POWTS
occurs in cumulative with this chapter end the approved management plan order, SPS 383.whl).
1n the event this soil admiration system 0, my of its component parts rialPoremew"o do to create a health
hoary the pmpmty Ownu must follow the commgeney plan as described In the apprwW plane
The owner is rsponslbla for mbdommorammmaer rnw verification report acceptable to the county for
mceroac migpwposes Reports shall be submitted at intervals appropriate for the cmuprpon(s) milled
mdue POWT9_
In gmntmg this approval the Division of Industry 9eoces Parents the right to require chmtga or sa iom aboard
,amfidom arse mahang them weessary W code compliance. As par state word 101 I2Qd nothing inthis review
shall dove me wooper of me responsibility 6r designing a safe building, muctme, or component_
Inquiries vonwmhgmls correspondence may he made to meat the telephone number listed below, or at to adhess
on this letterhead.
The above left aerospace shall provide a copy of this letter and the POWTS management plan to the owner and any
others who we responsible forme installation, operation or ma atmence of the POWTS,
6lnwrelg Pee Aequued$ 250.W
Fee 250.30
Balancence D e Due S 000
ed M Sir
POWTS Them Reviewer, Apawegldv 15am 4:0rny5erviu5
(60y)oven rtwo Mond gov ].IS ear -0:OO pm Wi9MART cotla: 9633
jeuryswMQwiscoopingov
ad Edvom A Taylor, Waatewamr Spebmfst,(715)634-3484, Monday- Friday 800 am To 430 pm
JAhG6 x ToMresox FW2 aaarzott
Owner Responsibilities
• The cwreut owner, and men subsegomt owner, small receive a copy of �mmooyer meaning
PP �sopereuon and
m proper use and mamtmsuce of the solo. Owners amen twelve aw ftbea
mamr mce musical anNor owner's tuanual fm the POINTS described in this approval
• The owns of a POINTS shall be smaradble for Comes& that the operetion and may ==U of the POINTS
seems as azamdame with lots chapter and the approved arrangementplan under s. SPS 30.54(t).
• In bit event this soil absorytiw systo or any of to WimPonmt Paris malfwcdos so at; N vxffie amwlid
yCdI are Property owner must follow Ne cwMgeng plan as desmbed in Ne approved Plans.
TOO owner s napomblefor wCommnb a mamtenmce veridcanon report acceptable to the munry far
• mamteomce Corking pwposxi. Reports mall be mb®ued at intervals amon,aiew for We corepowt(s) malted
us me POINTS.
PC morning may appmail TO Instant Of Indian" Services reserves We right to aegalre cbmgm or additions 601111
As per $late
folding h din
small relieve the d'sperofthe responsibility for dempNmoa safe buildvgs, Monitors, or Instalment
rcvlew
sera scary for
gmngas
mqulnesc=nceremb dus wrtesprsdermmay be made to me at the monism, madou listed below, or at me address
on dris lmmhead
The abuse left addressee shall Provide a copyof this (eater and me POINTS mmagoem plan to the owns no any
mhes who we responsible for the mslsllatioq opuntloas Ormamtmavce of the POWTS.
S, Fee nom me $ 300.00
FMReoelvedS 450W
sal®=ewes aoo
mrartlM Swim
POINTS PIav Renews, Olvtnw oflCdurtry Bervims WiSMAATcom 9633
(608)789 7892, Mon -FR 715 am-4 00 pm
jen3'.swwL¢'wlxnwio.91,
or: Edwin A Taylor, Wasmwao+ SIOCCIC t, (115) 634 3484. Monday -Friday 890 an To 4,30 pm
REiipd
-
EZiIDwNMOUNDANDP ESSURE DISTRIBUTION-CgMPONENT DESIGN
Resin BIArp cabcn
INDEX AND TITLE PAGE
INDU 91
Project Name: Larson 3 bedroom replacement mcund
Owners Name: Joan Larson
Owners Address'. 2149 30th Ave.
Baldwin, Wl 54002
Property Address'. Same
Legal Description NW114 NE114 Sec. 19, T.28N. R. 16W.
Township Eau Salle
County: But Croix
Subdivision Name. Na
Lot Number: Na Block Number: No WALLY
IVED
Parcel I o. Number: 008-1057SOL00 .FETYAND
Plan Transaction No %L SERVICES
ISTRY SERVICES
Page 1 Index and title
Page 2 Data entry
Page EZGxv mound drawings
Page Lateral and dose tank DENCE
Page Distribution media
Page System maintenance specl4patloms
Pager Management and contingency plan
Page Pump curve and specifications
Page Site Plan
Page 10 Attachad Soil Evaluation Report
Designer: J K Thompson License Number: 30021
Date: —6/133B17 Phone Number: (715)248-7767
Signature/ p
Desgneupwauamlo0e
Uflow Mound Component Manual Vac August 20 20D7,
DBWMP Publication 96 Design of Pressure Distribution Networks for ST SAS nee ll and
Pressure Distribulipn Component Manual Ver.2 D SBD-1 0706-P (N. 01101, R. f01121
EZllow Mound Version 3.0 (R. 311 it 2) Page 1 o1 10
Mound and Pressure Distribution Component Design
Design woMsheer
Site Information
(r or c)
R
Residential or Commercial Design
]00 00
Estimated Wastewater Flow (great
9S0
Peaking Factor (a g_ 15=150%)
O600o
Design Flow(gptl)
1 J.00
Site Slope
(.A)
10a.00
Installation
Contour Line Elevation nn
106.00 Contour Length Available nn
30.00
Depth to Limiting Factor (in)
4d0
In situ Soil Application Rate(gp!/Xr)
Distribution Cell Information
Cell Whom (H) 3 6 5 6 ] 8 9 or 10 Cpbl0°)all
00.00 = Dispersal Cell Length (H)
A6.00
0.95
Dispersal Cell Design Loading Rate (g
t
Influent Wastewater CualTy(1 or2)
Are the lse215 the highest part
In the distribution
Pressure
Elimination Information
nerst i Enter or
(c w e)
E
Cents r or Eno Manifold
3
Lateral Spacing (fl
If above, enter the elevation d)
of Latemala
of the highest point O
Crlllcd Clameter (in) es9 0.26)
ANumber
Estimated Office Spacing (f) = B 20 fle/mlfca
Forcemaln Diameter (in)
Forcemaln Length(ft) Does the
horseman drain 0ack? r-I
Inside Pump Tank Elavatii0n(H)
Enter or
m Head (fl) x 1.3
at Lift u)
1n Loss gh
Dynamic Head by
Ion.
Diameter 5elec0on
Options cM1010e 0 odla.
75
1 00
125
1 SC
0.16
Forcemaln Dralnback
6x Void Volume (gal)
Minimum Dose Vowmr
system Demand learn
]193
6o.os
J123
Mammm Diametsr selection
da.
o [ions
ehoce
125
50
2.00
3 00
M
(gal)
it 00
00
Gallormi Calculator (optional)
Treatment Tank Information 602.02 Total Tank Cam" (gal)
1000.60 Septic Tank Capacity (gal) 1 51 001 Total Working Llqukl Depth fm
Wieser Concrete Manufacturer 11.02 gallm(enter result In cell Bag)
Dose Tank Information Effluent Filter Information
602 02 Dose Tank Capacity (gal) Pollak Filter Manufacturer
11.82 Dose Tank Volume(gal/In) IFL525 Firer Model Number
Wieser Concrete Manufacturer
Project'. Lareon 3 bedroom replacement mound Page 2 of 10
Mound Plan View
Mound Component Dimensions
BI D B6.06 in to bah J 49h W 1 24.44X
480.00(fls) Dispersal Cell Area 161345 (Xa) Basal Area Available
5 63 Basin) Linear Loading Rate I a 00 an ilia B obs. rope Placement
Mound Cross Section View
EZflow Cour al Area
Finished Grade tWs0(M1)
H
F begin 105 60 (a) Lateral
104.50(fi)��— 6 Inven Elevation
o p rsalc u Q
Etc tp D 0
5-- 10400H)Correct Elevation
135 %Site Slope
TypicalDispersal
Page
5 Cell
Shading Topped y u 2 T Be P 9 5
®Cap
Approved Deposits Fabric Cover
ASTM C33 Sand a 20k +ry
4 ®T lied Layer v [
Ube" Media } FJ Y
Jo Csn
�A--{
See details on page for number sale, and spacing or lateral¢.
Laterals are lasted In the 4" gravity distributor pipes asah,,n on page 5
Project Lrrean 3 bedroom replacement mound Page3ot 10
End Connection Lateral Layout Diagram
Plew Appmpnefe Lateral
Ote near From Right Below
P
an wtpup
—91
z mmvlw btlMaL lex—+�
dotes pm W eaeaeruvem s
a me evxn ry Operates. y
fawmAnq�rgam WrN A ei0S4 M rturldl L CryrearsIwr YAp
AIWv@e addressern xiren RiiW AMMea
pe aDR; NO.IM
Number of Laterals 2
0 useiemeter 0]56 In
Diametr
Lateral Diameter L50
Ofifice Spectate%) 289 fl
A
Lateral g0.20in
On4ceaper Lateral 29
Lateral End ( 0.80 R
Orifice Den" 8 26 hrlattice
Lateral Spacing(8) 300 X
Menlfald Length 3.00 ft
Lateral Flow Rate 15.62 gem
Mannold Diameter 1.50 m
System Flow Rate 3L23 gpm
Fcroemein Velocity 3.19 fascia
Dose Tank Information
aan119
is e Might and
m9M seal Ontl
Elect Ber NEWPoa on, — 4e
any3 CO
6 ) n
n6 1nee
Tank min ponem ie patenteamed
" flee
lo..ran
Wieser Camels Manufacturer
Ce soli 602.82 Gallon
Volume 11.82 gal9ncb A
Dimension Incdes Gallons
A 3122 369.OT
B
0
B 200 2364
C 6➢0 00.09
D
130-02
Tatar
_1t00
51 DO
602-82
�m m career
case are an art,
"hot di
�1 lank Calder2
l l
9enam9 Ana eaam�a enmemoier 925
Alarm Marm acturer SJ Rhambps
Alarm Mocel Number SJE ia11421
Pump Manufacturer Zoeller
Pump Model Number BN151
Pump Must Delver 31.23 dean at 12 d3 ftTDH
Note 6wnrk.as containing m cure may not be used In this system
m.
Protect Larom3 : a he am rapleceanl mound Page of 10
EZ/low® Distribution Cell Media Layout
6.00 Call Width lop 150 Sidewall to Lateral (H)
Distribution Cell Gross -section Arrangements
SR1-7A Bundle-6 ff or 10 X lengths
SR1-l2A or EZ 120lA In 5 ff cr 10 tt lengths
SR3.12Hor EZ120tPor SR3-12H In 5 nor 10 ff lens
a^ centered Distribution Pipe With Pressure Lateral Inside
• Trump Enclosure - - - -- Pressure Lateral
Bundles are covered with approved ge idend le fabric as per the their product approval.
Distribution Cell Plan View Layout -Typical
8.00 Call Width - A flit 8000 Cell Length -B ho
Center Conneotion Lateral Layout Oie9rzm
Force Main
Eno
Man old
Pmjxc[ rarser 3 deoetm replacement mound Page 5of 10
Mound System Maintenance and Operation Specifications
Service Providers Name Jmaes K Thompson Phone pl5) 2487767
POWTS Regulators Name St Crew Ooun Zonin Lapt Pbone(l15)396-0660
System Flow and Load Parameters
Design Flow - Peak 450 go Maximum Influent FaNCle Size 1/6 In
Retention Flow-Ave29e 30o gy Maximum BOD5 220 mg/L
Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L
Sot Absorption Component Goal 460 W Maximum FOG 30 mill
Type Of Wdst¢wal¢r Domestic Maximum Foos lcoli(orm >IDE4 aft mL
Septic and Pump Tan I
Effluent Hasr
Pump and Controls
Alarm
Pressure System
Mound
Other
Service Frequenc
Intranet and/or service once every
3 years
marked and wean as necessary
at least once eve a e
Test once eve 3 years
test
LarriSboultl
lsShouldbeflushed
ReelaitUretested every 3 years
Inspect for pendingandseepageonce
9 years
Miscellaneous Construction and Materials standards
1. Observation pipes are slotted and materials confirm to Table BPS 364.30-1. have a watertight cap
and are secured In as shown In the EZflow Mound Component Manual Ver. August 20. 2007
2. Dispersal cell media conforms to EZflow products approved for use with the EZflow Mound Component
Manual Ver August 20, 2007. Media is covered with an approved geotextAe satiric.
3. All gravity and pressure piping materials conform t0 the requirements In BPS 364, Wis. ALL, Ccde.
4. ➢liege of the basal area Is accomplished with a mold sward or chisel plow.
5. The mound strumure and other disturbed areas will be seeded and mulched to prevent mu emsor
and help reduce frost penetration.
Lateral Turn -up Detail
Finished Good -........ ................
6 6 O'ama[er Lawn ThreadHI
Plug or tl Qeandut
lve
Sprinkler Va ve Bm Plug or BeII Valve
Yr. N, Be g ..0`Ig-1 Long Sweep 90 or Two
45 Degree Bends Same
iic Mede Diameter as Lateral
11 Fees
Lateral Lateral Cleanout —�
Project Larson 3 bedroom replacement mount Page 6 of 10
Mound System Management Plan
Inclusion to 5P5383,5<, aft Area Code
The vote, I hill be Opel, v accordance wlP SEE 38280 WE hex Guide and
End
01011 aI155WMP Protection door yand localund Cow press M fiorrslate in leg patterningst Pressure tosSsleispersalm maoennancsent ae r o me al miens ce 10,11119Pl
Sept c and pimp tank abandonment s a s h as 11 a=Nanw with SPS 39333 W. a Aom. Oooe when the to Ike are nc longer
Sept c or pump am manhole risers access andwuenShield be mwenm for water tighrealand soundless A unless
openings used fifir sell c, and assessment Fill be dllgJ u night upon the mmpartan of space Any awaran daemoemoved
email.I nIlct todemeefMIIZto prevent ac[pepnlaro wauuthodxed entry mo a stank or component e ,laced Exosed across onins search than 8 ,cn saps mUerahill ceaeu eo oy or
Te ,pro tank Shall 00 me abash do me ... coal course to mrso, septic Links t cast 33
Sept,. Tell
of on y 810 Aom. Code. The operne end ton at the Sir tank sin ouun Mlle:
8 Sued, The coi of Me
11111 be 11111mor It pactevery Syeals by wpetlon VaThe IfIll trust tsCep to ch snail me
All Atlgez
noff ln pmppe
� tn an alarm the filter Shal ad ehara 11 lire sllalm is aehated Clammily elnlefmhlen1 file, same an indicate laulge fens or an
,,lending mmundus again
The opla, talk chal have I s cinemas rearmi Inuffin the volume of udge and am in in file lank ewxoe IT the hung rd we of
fork
t the currents of the tank are aw removed 11 the time of a Fall a ... sonfil maintenance papi fif adi the
se os to be performed to main arm less than maximum scum and sludge accumulation in tn@ ang
The a�c b� mo of bolo9 gl m e ed Xowe:sr 0 sun wire
prams are field Cray mad be Of al for e n, tank use by the w�.Poh;eno performance of comlm. ieevu
The sngparalM 3�yman fills arty
proper operation IF an effluent Ion IS Lns�IIQJ & thin Me
+d ng Pump 11
could Shall
be are Illnebrre man has
keep file It lifilad be noted if it is Functional
and if nor it For be comed
No one sould ever enter upi Mal aw alpha or dose lank since Wngxoue gases may 0e pl ,,Ed e dseO.
d Mou e0'nufon ibSus
No peak or shrubs should Lee I on the Found engines unit IAem the nowild mall ad
Seeded suit m (,the than far
sual cel on oaf [he lnf,g
the Mau to and Carl 'On the ry ter ,If p ak rant penetrationColdAtinsRrlafmns TCamber�ff dipole that
[he Mound be heavily led aSp
o lmgi nt Islao101 In,ssnlno lobeinmay not lasted OO IT mf1 150of ISs.and Son;aa FOG for eeatm tank aklaenl or
highly lbeadeflues. Intent w may OF exceed Mal Mal
design Mae specified in the proper for !his irstal can
soltlsea sperorlmed a fir lane= flat nepreefira. ereeoswae end s
e syeta tame If used olggemg neomred and I en groamgla fiewhould to maintain equal
hall 11 muffin the it Spi all
Ordered ion pipes Stan the dispersal Air an be teen[ for enu ent pending rusladma lauela nallhe nooned to the ownsand
any loveIlaoves inches cone Nefed as at impending had gel feire,h along edokienal more frequent monitoring
Controls.. Plan
f the Sept, c tank or at � of its
ompenenn cefarm eceledoor lire talk oearn Psnlve the wool wmponem(sf eh of nbe �amount, a
, the losing tank pump pimp force a All, or to fee facing becomes
,gi I di with a Adult of the ,Me or
If it, slipped the amunO for It e'
iual peaceful
fall
by.. ea.ngmsaraeedme leakage ecasoram commerce Oiolagiva ky dogged absorption End
our, and re aced pipngand replacing sate comparable as deemed necessary' a ma the system no, proper operating
See Page of tns p s n to if a name a n c to she ee h um bar of yen or,l POWTS again ter a a o s Lane pro or
protect Larson 3 Lerfroom replacement moo nit Page 7 or 10
. Eski P.+ae.timle.
�EI[wiw NnOOS, col ¢r¢b*¢......Iml.sa
�rlmwnne.ln.
aRle P�eeY¢
• Lbile m9YAhA Ml e.meey
vs:mle core EN We short cycle Needs
�6WYpvk%[eiel¢WelooNJm'ma611aDooa See,
a.noF lsan4Pm+wNw°^rwMm.
151115Li53Evi¢
PUMPPEPFOPALWCECURVE
WDEL151115V150
CONSNL7FACTORY FOR
SPECIAL APPLICATIONS
.„
I he
I J_
70TaDYNAMIC nEPDIFLOW
PERMINUIE
EFFLUENT AND DEN'ATERING
FWL
OF
es
Is
Model 151 Models 1521153
26w Ra01@ W aim mocaml FYbW hi loEPon
s W,&,"lmaeolµ41I 5 uW az¢ wmrN.einly, i Cyayag6l
o 111 MNgbeu.
For unusual oaol a reelsifh El is signal like Me tlaior of coil Z(aller pomp.
41
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SEE CORRESPONDENCE
aw..,
nam � 9 8E
RHUL r/�HonE
i0 �>, Ge6rrx[lH9nf 3 SEDRmn,.f
So.i aea/u4Lo.,,a;e
E,rss��.ad. �aY
sc.✓e:.: eta.
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pi dmr. Kel-uo-o�n'
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aie Laa mbe�iotrcb�d
40 �a
OwneriEnyer
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMI
AND
OWNERSHIP CERTIFICATION FORM
Joan Larson
2149 30th Ave., Baldwin, WI 54002
Property Add.. Same �r
(veriftaalion required For, PWning&IDrvng Department for new mnmucM1on) (JJ
City/smm Pared Identification Number 008-16a_A-60-9800—
LEGAL DESCRIPTION
Property Location NE a NE y See. 24 , T 28 N R 16 W, Town of
Subdivision Plat'. Na
Certified Survey Map 0 Na
Warranty Deed id
vomme Na
Eau Galle
LOta Na
Paged Na
(before 2009)Volume ,Pagea
are Tom, OyesOm Lot lines identifiable eyeapno
Improper use and maintenance of yam abuse eysem mull result in itr premature. failure m handle xaetez. Plana
Maduounhani Consists
ref PIMP IS I It the optic Unit every .. three years or soon:[ named, by, licensed pumper. What you put Into
the ryemm canafhq the 5ncl noft' ss in etas' the wad chip ... I rynem_ Own mm...n nto,
aspon burin ea ryco4ad n§SPS 19C s2t I and In Chi is -Sr cm, C...0 Sanitary Compete e
The property owncrasmcs m abmitro it Come County Planning & Zoning Department a anifcation form, signet by the
www,,nd erplumbeSfommyman p1mimtt.ed plmfli,licensed pump e.....Fine that theoaz.be
rdory Im is in proper meersirymion ng condition wil(2) Car, nand pumping PC wom uryi, the septic tank.a
lass Thand.ryal 1/3 full of slui.
bond, the and .siOUR! have read the above requirements and agree m maimuin the prone sewage disposal sysum wit the
standard, set foth hi fie set by to Depan I of Safely AM Pmhs.onal 4mAsa and the Drpwri of Namml loci,
State of �teondn. Cenlficalon aoiug that your epticrystom 1 beenma.ntented uwII M complemd and ram"d m the St Coca
Caunry Plenning&Zoning Deparvnemw Mn' days ofthe tree year vpimuian dart.
1/we cenlfy that all sere is ont. farm we coca Up to best of mCour km IC1ge liwe am/are Pe ownegs) of the
property demrlbM above. by spun, x in deed m,orded In Register f Deeds Office.
Number of bMraoma
z
SIGNATURE OF APPLICANTS) MATE
" Any in mr,C not rsm repro med may result In the eeimry warm, being r,v,krd by the Planning H sloping Debarment.
Include with tieeppnce to,,,vux anry deed from the Regmar of Deeds Office and a copy of to eerifM survey map if
mfwmce a made m the wmem, deed.
(REV. and)
P5, 3 <F7
W1000/60 MR
TANK SP (CATIONS
,,,b.
_..
—
ME
OM 80 JE
BOTTF.
COVER s
M
11/ L0. PRECAST CONCRETE RISER
_ —
GAL 6
LENGTH uai/z' oG
-
i� Ilil \\
1lnGnc %eP O.D.
/
WELL: 933. AN
-
6" CAST SE2 (III
T/
\
1" CAST A -SEAL
BELOW IN 5Y OD,
OWEDill WID IIYFL A.
024
)WDGHT.
12.38O US,
TYi'/
INLET AND OUPTES
V CAST A -SEAL BOOT OR EQUAL
i
HLIER OR\
/
GASKET. CAST -A-SEAL BOOT OR EQUAL
\� BAEFIE �/
WEFT AND wRlr BAR(£ AND FILTER :
m
a
'MYONSPA SEE DETNL N10
=T
_
(OTHER STATES SEE CRART)
i
LIQUID CAPAOM 19.61 GAL/IN (SEATS)
1163 GALAN (PUMP)TOP
W
ANEW
~
LOADING BMW: 80' UNSATURATED SAID
W
CE
C AD
e�m
VENT
TANK CAN BE USED ASDE
alrc
SVTC/SEPTC. BEPnc/PDMP
F n
OR SmTC/SIPHON
LY 2 1
00
COVER: MEX LESSON H �NO BERR
Y NIL
— — —
AI
TANK. WE SUCH D SlaOtry AL NEAR)IIIIIIIIIE
xL£r
—
OUGET
CUSTOMIZEDFOR S TANK
CUSTOM TANKS CONTACT WESER CONCRETE
E(.
EA
S
PUMP PAD
DRAWINGS SUBMITTED
FOR APPROVAL
SIDE NEW
LSET NG.
S
A DATE/
PRON US NEEDED By.-
Dr
/ 1
TANKS ARE MANUFACTURE)
TO MEET OR a vi REQUIREMENTS
d�J
Technical Specifications
PL 525 EFFLUENT FILTER (COMMERCIAL)
IL
AL
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reE
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f&
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WoodmanGepaSrv�SN bawnal Seem Page l oll>
ioiain n¢ ry�,p1uLl SOIL EVALUATION RIPEST
GRO1%Oa'rOW .n¢.nSP conmy
Anon pom�a>ne^la�n oe,q' F61na nrz aeinaaea ln,ma ems, sLcmu
Rental rekren¢Pobt( } >n
sub5rd mansons, nonX arryy, Mbm115n an00151anu to nee �OG 005-1 )60A00 PA RaBS
Pleas* pXM all lnbrma0an. �'4 as by Gaff
io 1Y
Nn1mm>bdn w a
n�5
A�R
vmpeNv owrtr
mP.roy to - ❑
Joan lemon
Lonm NE Y. s 10 T O N E (11) W
PrtgeTy Culal Melling Addmea
LMX
Rbdtl .Name WCSMtl
2149 30"Ave.
Coy Sleb 21p Coal Phone Number
❑Giry ❑vessel ®Town lea nA Road
Beldam W1 or(W 22OBBM
Eau Gala, 220 s=
❑Nave CSnderWbn doll Z Rea dental Nunderd Wlrwm na Nnrel trsgnPw re&LSJ(GPG
0 Reparosal ❑ Pubm or dommelmlal—Gewebe:a3 7,
Plant materiel Glaolal Tlll Flool plan ekraton M appllwble l4
Cartel wmmema and re¢mmendauom Coe ou Idea For mound Pmrrs PeoSmmelKKd IMlXmlw aorhro ales.m he 104.59 as 6^ above I Go amour.
❑
1❑ Eonn9p
on Gmund ® auRe¢eleu.IW 02fl 4pin 1p llm olnp M1tlor 30'In.
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Boundary
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