HomeMy WebLinkAbout040-1009-95-000 (2)smry and III Dmnen R. PRIVATE SEWAGE SYSTEM
$1. Croix
INSPECTION REPORT
tiry Pool No
GENERAL INFORMATION (ATTACH TO PERMIT)
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617766
SIM Plan In No.
John 18 Temi Seibel
a„ V11a0a aPW TOWN OF TROY
P ..aa 040-1009.95-000
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TANK INFORMATION I ELEVATION FIAT&
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TANK SETBACK
INFORMATION
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Plot Plan PW2oty
PROPERTY OWNER: JOHN F€TAM AA. 5=1BEL 1e=40 Ff.
(., ptv we�nea)
Legal flescriplian: Lm 'roD sEADF TH*NI/3Yz8n) flxl I]RMckbe Prt
Twn or Tmv s. erswx �,e*r a 11-haedco"+J-
5, iV ae a e5
North
Site location:
11
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fm.nu.Te� O�N�IS
In -Ground Gravity Plan PAGE i OF 4
Index & Cover Sheet
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P91 of4
Index &Ca SnW
P920f4
Plot Plan
Dbpareal Are° CroseSecbM & Plan View
P94 of 4
IAenegemmat Plan
Aaachrmr�:
/L
-
..11oa6on
POWIS for Review
Mar EveWet an Reams & Mile Map
4i 5 5
,}EpnC TANK iS42n1i
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Plot Plan
PROPERTY OWNER: _ wF.i-FA nrtA S:BEj.- —�
1• _= 40 Ff.
Beni oexn ''// 1••,:anc.nerenoem7
Pin: Im 4oD sE�y OF NWY 3 0 RflW 1]=6ackAoe prt
Town ov Tsv R. ccniX Eve... w,sc+.s,a. �-hanJdinS
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North
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Site location
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In -ground Gravity Management Plan PAGE 4 OF 4
IMPORTANT.
The dery almis nyroud greuirayabm Mall W reauOrm a(m to wppedual opaR4P1 ant mumarmanwpursuant to
reWmme=OSPb382-3M,YNss.AEmin. CWa. Pursuant b SP5383Wn), WW Admin. Code, Niasywmatgll
byCustoMEa human IPaM rleaBm If nM meintaned In aeNrdanw sim this immye dmana.ement plan.
FU mme, ell Mrpa(tire ant meinbnance ardwas Mail Oe Pmlwmed by a reyle l POWTS Panmtlnx in
ecmNW.y wth SPS 383.52 0)WM Admin. Code.
Maxlmum DMw I Adda 0marafting unifinal
M Igry Plows 600 gtd; B0Ds53ZOmli TSSS150mSL'; FOG S 30 mgL4
IabMctlw CMcklst INSPECT EVERY 3 YEARS
a hype dux
• ape m system
hire talon be. Gears, ter a mmm. WC)
aneUcaamralmaHunmm(/ e. qunp,vgvµ eaitglea, flaetemi
materiel impart (i.e., leek& Creaks, wrtmloR Mr)
o a didsvduneinmevvaGCLealmdnlaMt(s)aMawdmdbAonapput nw(s)(I.e., dlehibulim/draboxas)
nedleadmimPmyer um(l.e.,mblesi deagn Capani panated somebodyMi
o added a running in dg1dbutim On pMr b massing
o barbardminummin - if SPPlir aUe., Wmp reeding fload peread eminds, roc.)
• o dlstrinhadclmponnts- 0lapplicable (I e., dump, cf x s, saildma conm's Omen, Warner ai
a &New dreitmwN effluent or sewer�bacriavelalereldlMel Prexure-mmtarem Mtigri spetlnCetim)
9 +.p iMOMwtun mrvM
Wino an Che klbt MAINTAIN EVERY 3 YEARS(Or when nweeeary)
HM boll be Pumpdry ed a Obtain sepdaw stations operator dia
meter ri s. 28148 Al
G Seal worth vd a OF rollW In me ten4s)escaetla One-third re (in) llwdd volume orate wpe)o-
mounted by bod wammad Dimsmalao»,tmla diNl be Isesuam to NR 113, Wlec. Admin. Castle.
shill be In mbaod sorry ] yeem and &tall to deaned whin naeeasalW remora any
mtmMed Wr&mnNiCq to Manufactures; ewdlkLions. A mrvidyMW pWII always oa glWx Nan 12
Months
SMam mmmanaxe mpods sMll W ubm d to the Itroper Intel sovemmem unit In accordance read
8P$]B].BS VAsc,Mmin. Cew. Repmtar Coml nammllummmanN onto:
Naneaindraidualwmmpany: ADVANCED SEPTIC INSTALLATPhurn. 715-703-8337
Qom gwmnmrn we ST. CROIX COMMUNITY DEVELOPMI,ddw 715-3864680
Lwalgwemmmfl una eaeresa NUDSON, WI ZIP 54016
Any Mmdw Pan a [maeyahm atoll M repaired, repla den orremowll standard M SPS 3b3.51(1), Wie,. Admin.
Cont. RepairM f�'awrnefd Mmigd ormelfunaloning xmlgnenb atoll Cgnpy tnlM1 SPS 38.i, Kfx Admin. CMe.
No sdenp wchemical
SP dal an phxsid Admin. WMbM of the POWs may M rant lnlett impri by Me depemnem in
aboOrCGMinwnw Plan
In the ersnl Val any hilm tmM wmp]nam of this POWaS cannot M repaired, It nor be entered pursuant to
plan vuustad made appaplie egmuybr Wand approval. Afalled InpmutpdspemelmmPo MmayM
alwdomi Md nobawdIrva mgeagnwrltg dsprdur compounds in a Pm eM herd order mwaits said
Mm AMndpnment
II Mae of to POWTS is i`MdmwW II Me" M aMddoned In amadetwu ar SPS 303.W Nas. Admin Code
QO%Bk4
INFILTRATORThe QUICk4° Plus
Standard Chamber
The Waif Plua 5lantlerd CM1amher
affela nexenum strength maough
IN Mo center aWctutal cdumna.
The chaMner can M bight in
aa&inch-wmetrench, ukethe
odginul line of 0ulck4 chambers,
h o(fm eManm] contouring
aapabllitr with Its Console, swivel
Cannecuon•-which perm en turns
uP to 15-degrees, right or left. It is
also available in far -fad Ingthe to
provele optimal Installation flvibiliy.
TM Oumka Has AlNn-0ne 12
Endcap, and the Gulaot Periscope
are evallable with this chamber,
unearthing increeead Pexibiliy in
aptan configurations.
Maximum SVemith
1
fm.txygm
mPmoveom
Will Plus Signs tl Chamber Benefits:
• Two center mudunl calunre Ofte increased stall and superior strength
• Pdvanced mntoullry connections
latcMng machaniem all for quite imtalll
Four -toot chamber IengtM are easy to handle and insmll
Slgpwfe whe9local of 16,0001tha/axk wlth 12- of cover
4&
Ouicki Plus All -in -One 12 Endcap
Beneflif
• Mar as used at and of cMmber
cow far an ImeVoutud or can Ice
Install N and-trandl
• Mm-trencM1 rnoo.•.x•.,
as an aterndie, to
Center -fend connection allows for
easy irafellation of sdial Oiatribulmn
systems
Pipe connection rill include
sides, emis or as
OulckA Plus All-Ini Periscope
Benefits:
Allows for raised Insert iremnauans
• IW(staffers iNetting
12" mrsed lmert a meal («serial
appitcatiolta
C I hwe oy thelaennel
As Iuim of Plum
aCi�rg���)
� A11aliAl \^J/
ucAe
Qj QuICkE Plus' Series
NIEMEN
IN
Nana All
o�
FFONi NEW SIDE NEW
Qaick4
OitlN PMU Y41n-0n Pofismp9 MrJIN
uNI 'Unan I anal mTMw�wk nrpiuwn%u�o,�°
M1weal xc�i Nallam.t& AIMD�t�,THENE
h
WINILINNNIS
If Mew -HI m m m nw rw nr.� l wmty
WI
e
Na
.nnme.,i.nnurii.uimu,. n°NNN
mow mmaM°ihuemxnay IN, ?na�°Mvtln
x°
INFILTRATOR' ""'°'
,II
V-b NwLL gs
V 400^v LOZ
024.60
z7V2 1
SECTION A -A
I2500 ---�1 ERMANENTFOAMED-IN 0---��11 POLYURETHANE GASKET
THIS AREA MAY BE FILLED WITH
CONCRETE FOR ADDITIONAL WEIGHT
SECTION A -A
Drainage and Septic Products
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19m Ph CwM TqL mFf: iO.YY.flgp
M~ml: Cop*mar Polyprepyl n
Color: Gr s
24 X 12 RISER
24 X 12 - RIS - GREEN
ST. CROIX COUNTY ZONING OFFICE
CERTMCATION STATEMENT
FOR UTHAZATION OF EXISTING SEPTIC TANK(S)
-loHV 4 TAW S
This is m canifythat I have inspected dre existing septic and/or dose tank
Presently serving the following residence:
(Street address)_ 570 bm r DAK 0 'E located
at: 5E Y, NW Y., Section �� Town d N,EB
Town of -rROV zOga /= �'•
St Cmix County Wisconnim
Upon inalaserM 1 certify that I have found the mak(s), to the beat of my
knowledge, will cartoon to the requirements of SPS. 384Z, and It (they)
Wear(s) an be functioning pmPmly.
Most recent date of inspection or service
Did Sow back occur from absmpaen syahm? Yes
(ifm, skip meet: lice.) NO—
. Approximate when, or length of time:__galloay_mfo°ma
Tank Capacity : /49
Cnaatmction: Prefab Conasaw % Steel Other
Age of
Tank(ifk omse):
AgeafTank (ififlaro : z4 yrz=
Permi[numba (ifknowa) 2egY/
_ �(FJ%ii iiA.CNfos
N lumber ) (Prtm Name)
�xyU37
T tle)
(Licewe Mmber) MFR.7PR5
(Dune
Form to be completed by licensed plumber (Dept of Safety and Professional
Servmea Chapter 305 sad s. 145A6, Wisconsin Statutes) or hcamoxi disposer
(NR 113 Wi. Deaf¢ Admioishative Cade)
Rev. =012
ST. CROIX COUNTY
SEPTIC TANK MAMTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
John Seibel
576 White Oak Lane
Property Address
(Verifcaw, mquirN all plus ning& Slurry Department for new submi ion.)
CRY/StamHudson Wl ParedIdentification Number040-1009-95-000
LEGAL DESCRIPTION
property Lneatmn SE ,A
NW ,e
Sae.3
,T28
NR19 W,
mWn of Hudson
Volume ,Page
Warranty Deed4 (before266])Volume , Page N
Spec house Dmst7lio Lot lines id"ifable Oyeapno
Improperum and mmaenunee ofyouraepill system cmid result in its prear are Daimler, handle once, Proper
consistsmarmormce ofpumpimg oar the alone tank every three years,reSVheaded, by a licensed pumper. What you put into
the system
affect
he boner gas of septic k as a treatment negein the wary, disposal system. Owner instrument
mammals ldied arc specific! in 4SPS.NOTE )and In CFepur IE-4[ From Cowry SanSury Ord ounce,
The properry, owner agrees to submit to St Ooix County forms &Zonng Department a conalmlon Sea, signed by the
and by a master plumber, formation plumb¢, tumbled plumber or Ike,wd former veribing Nan L)Ne or -site
wom,am, trimmed system is m proion,imtatmg making mder(2) after Inspection and pumping ofneuessary), the septic Wait is
less than Ib At of sludge
Lose, the undersigned have read the above begircmenn end agree re main the private sewage disposal Amin with the
standards sn 6nh, hern'n, as set by the Department of Safety And Proffni nal Smvlces and the Department Ofluninl Pemmcm,
SWe of W,,m,m. Connecting stating that your septic system has been announced must be wmplered and learnM to be St Dium
County Planning & Zoning Depemnent Within 30 days of the Nrce year expiration date.
I/we sanity that ell suwmen6 on thiyf mr arc true to the best of my/ourkwwlalg, D m aimareNe owners),Rite
property described grovel by vline ofe ws✓9 deed rcemdedin Register of Deeds Office.
Numbers[ bedrooms 4 1
l/�� 11/121nil
gIGNATURE OF AP y- CANT(S) DATE
"'Any unusuanon duals m gamma ny,d may result in the sanitary rimat being revoked by the Owning & Zoning Debarment
Iwlude with this applicants, a theory warnnry dad from the abbler of Deeds Office and a copy of me eenifed survey map If
reference is made in the wamnry deed.
(REV. DID)
S TC- 105
SEPTIC TANK MAIRTSNANCE AGRSm M
-at. Croix county
ONNCR/NUYER �OHNlfljEt-
annecss .Sib Wwlm; 6f?I. eIRE NumE
CITY/STATE--I--I Ail gip rn4Olb
PROPERTY IA�Ca'TwI'ON: � 1/<, •(W 1/<, SECfIDnj, T1r6J1-R IQ M
TaNN Ol 11 , at. CrOlx_�Coount�y,
UN
SUMDIVISION , LOT NB¢ry.
eels i prntsperuse end maintenance of your septic system could
premature failure to handle wastes. Proper
maintenance cousists of pumping out the Septic tank every three
years
or sooner,
if needed by a licensed Septic tank pumper. (fiat
Yoe pu Into ersystem can affect Ne function of the septic teen
as a treatment stage in the waste disposal System.
St. Croix County residents may be eligible to receive a grant
for a maximum of 60% of the cost of replacement of a failing
system, which was in Operation prior to duly 1, 1979. at. Croix
County accepted this program in August of I9a0, with the
requirement that owners of all new systems agree to keep their
system properly maintained.
The property Owner agrees to submit to st. Croix zoning a
ertification form, signed by the n and by a meter plumber,
jOwner
plumber, restricted plusher or a licensed peeper
verifying that (1} the on -site wastewater disposal system is in
proper operating condition and (Y) after inspection and Pumping (if
necessary), the septic tank is less than 1/1 full of sludge and
SCUM.
I/Ne, the undersigned have read "a above requirements and
q e to maintain the private sewage disposal system in accordance
with the standards get forth, herein, as act by the Wisconsin DNR.
Certification stating completed that your Septic has been maintained lust he
co and returned
too the St. Croix Co. Eoniaq Of floor within
o[eezpiratimn at .
STORED:
DATE: q-lq-YS
St. Croix Co. zoning office
911 Ith St.
Hudson, NI 54016
Peow�eVj'
�axw.mmw.
NRVATE SEWAGE SYSTEM
&SIM ad e11s.5101
INSPECTION REPORT
GENERALINFORMATION
(ATTACH TO PERMIT)
N SEIM,NJOHN
cm
fm(OU
ermom.: Y
r
H
L J
TANKWFORMATION
u
&EVATION
TYPE
MAIUFAS IURER
Oippgryj1d
ION
SePb<
ark
OR g
AmaHon
Bldg.wer
Ndalrg
$IN
TANKSETBACKINFORMATION
utletTANKTO
P/L
WELL
BLW
MDtINN
Omn9
IM
IlwlamAeration
eHolding
(emPUMP/SN110NWFORMAIRON
WMenWMurerORmNµ
Matlel Number
OFM
TON
Nh
fl On
5 em
TpN
ft
FanemaiO
Lergtb
OiA
Te NN
SOIL ABSORPTION SYSTEM
RD/THI
Nn
renpu
M
YT a
RT
5•
♦oP/t
3
eereem
S15TEMTO
iunn
wci
•.ve........
II*oNN— D--1 L.ngug.
SOILCOVER aResuRSyeYmf OrYy uMoynld OrAKrNe3ysYme ONy
uenw.. 2'� Ovp4ia.. Lee.+ &'"aN' aaeomor .. srN seea.e o%
e.nrtr n Ta+al O rnN ONO o nee NO M
COMMENTS: (Indudem dimampAga Pertom NN tecl
LOCATIOR: TYOV.3.28.19R, BE, HIS, ahite Oak raI
Y6w)-0/a�h J� Sy(d-4)
RenrMlsiwrrtyuiny? ❑ym S(Ny
Use
s a Ner See ;u eMtitiuxil oormatio,
Sao
mvm
f ,.__ .__:_
�eee
v\
BTC - SYSTEM
Y
AS BUILT SANITARY SYSS TEM REPORT r i
ONNBR JO\n Ssl et'
ADDRESS _-YD g
rvc/%
SUBDIVISION / SeMl k
LOT A p
SECTION -3 T_iZ-N-FtI / w, Tovn of �w
ST. CROIX COORTY, WISCONSIN '
PLAR VIEW
SNOW EVERYTHING NITEIN 100 FEET OF SYSTEM
I 3 I
sC"f=r�
INDICATE NORTH ARRO
Provide setback and ale va[ion information on reverse of Ybis f0[m.
Provide 2 dimenslOns to center of septic tank m Covet
manhole
BENCHMARK- /aP T P 4./ IMAP
ALTERKWIS
SEPTIC TANK / EMIH MjmmmmER-/ BOLOIRt-TRIK'IMPOBHmTIbK
manufacturer: Iw)V�. Liquid Capacity: /4 S-0
Setback from: Well House /9 Other.
Pump: Manufacturer q/M Notleli= Size
Float separation Gallons/cycle:
Alarm Location
BOIL ABSORPTION SYSTEM
Width: s LaNth SO Number of trenches
Distance S Direction to nearest prop. line:_ IS30� E✓'
5etback from: we1L 4 House� Other
EIHENTIOMS
Building Sewer. ST Inlet_$}'ST Outlet 8�
PC inlet — PC bottom - Pump Off '-'
Header/Manifold 9,5" Bottom of system % ,9
O
Esistinq Grade dA. Final grade Pe
SATE OF INSTALLATION: Z(f/- (9�'- J
PLUMBER ON SOB: L'JC(�e
LICENSE NUMBER: 1 S 6 3
]/9]:jt
29 \
29 ^,zo•
390
W NIE
OqR
1
enez 39 C
30
9N/5i7
1114
39 E
39 8
--&F t
2`
C9CI(f49
311CS7>� �
IS '9rt.
40 C
SE 4 -NW 114
26 14
a2m
pp40 G
I 40 E I
�y ti^y�MSOIL AND SITE EVALUATION REPORT MLtl3
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b/fA,q �y
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v° A3 9fgo 3 F/ivr >a
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b. s�Ubesrev-TReAwL, sysreys � �` W
NSE 3 TEFNe(�5 CAc4 3 X�0
o 14f6k TPEOZ4, 94r.0 2
$� meD Te eN d. SH.o • NEE I{NSE H_S'r !2
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NOV 14 2�19 IL EVALUATION REPORT 3
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InWy.wmNpuJm^a:�n'ulanewimmy reknnupam RDlMoa%'b
Sean atce,wbrcemen.wm,ne naipewmwmmp
Plisse psin(ad mfamsBllpll.
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pµ ly —SE IN tIMS 3 T 28 N R 19 EImIW
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INDSON, WI I 5WI6 715 222-9332
p
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NrGamNiNn UWQ ImM6N/Xunoe�mMema 4 CeMCMMeaWn Avx ab �' GGD
Rpm m ❑ tl wm wu.�p
PmMrtiYl Ittuutttsmda lmm till FpNFMebrebn YeppiobN plp
Min mis coovMboal lu-eiewd bmnc�—P]aWmg nu—a,IJmgdiveueaudfilreeuownea.-
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