HomeMy WebLinkAbout022-1018-30-028Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes (Privacy Law, s.15,04 (1)(m)J
Permit Holder's Name. City Village Township
Royce & Lisa Opsal TOWN OF KINNICKINNIC
CST BM Elev: Insn. SM Flev I RM
TANK INFORMA
TYPE
MANUFACTUREf r 5
1
CAPACITY
Septic
Dosing
Aeration
7cr
o/ 525
TANK SETBA(CK INFORMATION
TANK TO
P/
WELL
BLDG.
Ventto Airintake
ROAD
Septic
qO '
!!qL
78 \
� 1
Dosing
1
/O
t)Llt
CJ
f _1�
7
721
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer/
r
,Model Number 1151
TDH . Friction Loss Syst
t,V,
Forcemain Le th , DiaV1 D
SOIL ABSORPTION SYSTEM
BED/TRENCH Wdty Length
DIMENSIONS U\ I 1 � •5
SETBACK SYSTEM TO 1
INFORMATION
Type OfSystem:
DISTRIBUTION SYSTEM/pt; r)).
-T3G
ELEVATION DATA
STATION
BS
9.1
HI
FS
ELEV
Benchmark
75. ZZ
Alt. TJnjto
-3
Bldg. Sewer
SVHt Inlet
•L{
T�
j.
SVHt Outlet
Dt Inlet
Dt Bottom
O�
Iv V u
`107
Header/Man.
n
L
! 7-
Dist. Pipe
Q
/�O
Bot. System
Final Grade
CoH f*�w—Lt.
7 7
sae./
OR
Header/Manifold
Length
`
Plse(s) tionL
5
`'�
x Hole Is
.1
$
x Hole Spac/iinngg
�'
V�P][�.t tto Air Intake
'"Ui.t
Di
Length
Dia
Spacing
rCd
A V IL l U V CR x Pressure Svstams only yv Mnr A n. Q. .e...= n-I.. _. .J✓
Depth Over
Bed/Trench Center
1r
2�
O w
Depth Over
BedfTrench Edges
g
,r ?
7 1 �
xx Depth of
Topsoil —�
1 `) U
xx Seeded/Sodded
xx Mulched
� Yes
�,,j No
Yes
COMMENTS: (Include code discrepancies, persons' present, etc.) Inspection #1: P &cj f T6Lr, Inspection #2:
Location: 461 90TH ST Lc�t,,Il (/s/ Zo (5)
1.) Alt SM Description =/('�V AAP _ 1 LA•__ � f y �P(� t „ .
2.) Bldg sewer length =1lJs , l r•vl^ �7y(�
-amount of cover= (pWxt#,iJI}
Plan revision Required? Yes ;,�[; No -7 t ��J_� J O
Use other side for additional information. !�
SBD-6710 (R.3197) Date Insepctor' ignature Cert. No.
fi"L
St3N-�a� -0.
�✓
��_ �
Safer and Buildings Division
County
St. Croix
i
i�
Sanitary Permit Number to be filled in by Co.
LI
201 W. Washin ve., P.O. Box 7162
Madison, 7 71
—1 Z
N 312020
V
ter., ,�>�,- ,1A
•
rmit Application'
State Transaction Number^ p vra.k
7`
In accord nce � SRtiY Wis. Adm. Code, submission of form to the appropriate
prior
w • � " IZODOO 3l - e.
Project Address ('rf different than mailing
govemme I quired to obtaining a sanitary permit Note I' s for state-
owned PO S are submitted to the Department of Safety find Prof onal
address)
'
information you provide may be used for secondary purposestn accordance w , S.
15.04 1 m Slats. n A
461 90th St.
I. Application Information — Please Print All Information
Property Owners Name
Parcel #
Royce 8 Lisa O sal % =
664
022-1018-30-028
Property Owners Mailing Address
Property Location 07
Govt. Lot
1901 Lillian Dr.
$W Y., NW ' Section 07
City, State
Zip Code
Phone Number
drde one)
(circle
Hudson, WI
54016
T 28 N; R 18 E or W
11. Type of Building (check all that apply)
Lot #
Subdivision Name
® 1 or 2 Fam.l ,Dwelling - Number of Bedrooms
04
3
Vol.23, P . 5528
Block
Na
Public/Commercial - Describe Use
City of
CSM Number
875357
Village of
State Owned - Describe Use
® Town of_
Kinnickinnic
Ill. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A
® New System
Replacement
Tmatment/Hoiding Tank Replacement Only
Other Modification to Existing System
System
(explain)
List Previous Permit Number and Date Issued
B.
Permit
Permit Revision
Change of
Permit Transfer to
Renewal Before
Plumber
New Owner
Expiration
W. Type of POWTS S tem/Com nt/Device: Check all that apply)
Non -Pressurized In -Ground Pressurized In -Ground At -Grade Mound > 24 in. of suitable soil ® Mound < 24 in. of suitable soil
Holding Tank Other Dispersal Component (explain) Pretreatinent Device (explain)
V. Dis rsallTreatment
Area Information: Pol ok PL-525 effluent filter at ST outlet
Design Flow (gpd)
ign Soil Application
Dispersal Area Required (sf)
Dis I Area P
System Elevation
Rate(gpdsf)
(st) ( (Z'feo,
01.82' at 20" above
450.00 Gpd
1.0 gpd/sq.ft. ASTMC-
1,125.00 sq. ft.
I f�
33sand 0.4 gpd/sq.ft.
1,533.41 Sq. Ft.
rOO.15'contour
native soil
. Tank Info
Ca ' in
Gallons
Total
Gallon
# of
Units
Man4facturer
w/Pp �O '� j2,
fv �_'
m
m
New Tanks
Existing Tanks
s
F
@ c
m e
mU
o
y
a
ii U'
Q.
P
aU
Septic m Holding
1,000
0
1,00
1
Wieser Concrete
X
Tank
0
WLP1000/600-MR
Treatment
Dosing chamber
600
0
600
1
Wieser Concrete
X
VII. Responsibility Statement- I the undMigned, ass responsibility for installation of the POWTS shown on the attached plans.
Plumbers Name (Print)
Plum s Si ature MPIMPRS Number
Business Phone Number
Jim BoumE
I I Ile
86 20
Plumbers Address (Street, City, State, Zip Code)
< 2 y
1070 Hwy. 35, Hudson, WI 54016
2DZt7
Vlll. County/Department Use On
SYSTEM O R.
1. Septic tank, effluent filter and rL0S.
dispersal cell must be serviced I maintained e
SBD-6398 (R. 11111) as per management plan provided by plumber. `�) P w•�•,�
2. All setback requirements must be maintained tL
as per applicable code/ordinances.
e t!
Approved Disapproved Permit Fee Date Issued Issuing Agent Signature
Owner Given Reason for
Denial
IX. Conditions of Approval/Reasons for Disapproval
Attach to complete plans for the system and submit to the County only on paper not less than a 1R x 11 inches in size
SBD-6398 (R. 11111)
Residential Mound POWTS
Index & Title Sheet
Project Name: Opsal 3 Bedroom Residential Mound
Owners Name: Royce & Lisa Opsal
Owner's address: 1901 Lillian Dr., Hudson, WI 54016
Site address: 461 90th St., Hudson, WI 54016
Project Location:
Subdivision: Lot 04, CSM Vol. 23, Pg. 5528, Doc. #875357
Legal Description: SWt/4 NWi/4, Sec. 07, T.28N., RA 8W., Town of Kinnickinnic, St. Croix Co., WI.
Parcel ID #: 022-1018-30-028
Page I
Index and Title Sheet
Page 2
State Approved System Design
Page 3
Septic/Pump Tank Cross Section
Page 4
Effluent Filter Specifications
Page 5
Septic Tank Maintenance Agreement
Page 6
Parcel map
Page 7
Deed
Maier Plumber Restricted Service: Jim Boumeester, DSPS Credential #222904
Signature: Date: n l h
Page 1 of 7
Mound and Pressure Distribution Component Design
Design Worksheet
(R or C)
Site Information
Residential or Commercial Design
Estimated Wastewater Flow (gpd)
Peaking Factor (e.g. 1.5 =150%)
Design Flow (gpd)
Site Slope (%)
Contour Line Elevation (ft)
Depth to Limiting Factor (in)
In -situ Soil Application Rate (gpd/fe)
R
300.00
1.50
450.00
2.00
100.15
16.00
OAO
(C or E)
Dhdribution Cell information
112.501 Dispersal Cell Length A" Contour (ft) _
1.00 Dispersal Cell Design Loading Rate (gpd/fe)
1 Influent Wastewater Quality (1 or 2)
sure Derlbutkon Information
C
Center or End Manifold
0.00
Lateral Spacing (ft)
2
Number of Laterals
0.156
Orifice Diameter (in)
2.00
Estimated Orifice Spacing (ft) _
2.00
Forcemain Diameter (in)
Length (ft)
UForcemain
Pump Tank Elevation (ft)
Nob: Sand fig (D) calculations assune a
- Table 383-44 3 in -situ sal ireaiment for
feral colifonn of o- 36 inches.
4.00 Cell Width (ft)
Are the laterals the highest int
in the distribution
network? Enter or N
If N above, enter the elevation (ft)
of the highest point. 0
8.04 ftz/orifice
Does the forcemain drain back? 0
Enter Y or N
4.55 System Head (ft) x 1.3 6.52 Forcemain Drainback (gal)
0.40 Vertical Lift (ft) 50.97 5x Void Volume (gal)
0.78 Friction Loss (ft) 57.49 Minimum Dose Volume (gal)
0.00 In-ine Filter Loss (ft) 30.16 System Demand (gpm)
13.73 Total Dynamic Head (ft)
Lateral
Diameter Selection
in. dia
options
choice
0.75
1.00
1.26
1.50
x
x
2.00
x
3V
ac
Treatment Tank Information
1000.00 Septic Tank Capacity (gal)
Wieser WLP10D0/6 Manufacturer
Does Tank Information
603.36 Dose Tank Capacity (gal)
116161 Dose Tank Volume (gaVin)
Weiser Concrete Manufacturer
Manifold. Diameter
Selection
in. dia opfions
' choice
1.25
1.50
2.00
3.00
GaOonsllnch Calculator (optional)
603.36 Total Tank Capacity (gal)
36.DOI Total Working Liquid Depth (in)
16:76 gal (enter result in cell B49)
Effluent fiiter information
Pol Lok Fitter Manufacturer
PL-525 Fier Model Number
Project: Opsal 3 bedroom residential mound Page 2 of 9
f
to
T LO
o T
edld uoge&uecgo
Penols'SIP •ul Y
73
0
M
rn
a
Center Connection Lateral Layout Diagram
P i
J*-x— r21 Lds.r Manceaisin itch 40 P=
- par, SPS TYbte 354.30.6
tiaMsaaUe ontMeo0lpn 00e1010ft"L •. Tam.apwtbolfwww aleaaoutplug
agn`apwW
Number of Laterals
Lateral Diameter
Lateral Length (P)
Lateral Spacing (S)
Lateral Flow Rate
System Flow Rate
Total Dynamic Head
Orifice Diameter
Orifice Spacing (X)
Orifices per Lateral
Orifice Density
Manifold Length
Manifold Diameter
Forcemain Velocity
Done Tank Information
Electrical as per NEC 300 and — 0
SPS 316.300 WAC
Tank component is properly vented
Weiser Concrete
Capackyj
663.36
Volume
1 16.76
Manufacturer
Gallons
gallinch
Dimension
Inches
Gallons
A
19.57
327.99
B -
2.00
33.52
C
3.43
57.49
D
11.00
184,36
Total
36.00
603.36
_ I
A
i B
CC
Disconnect
Alarm Manuafacturer
I SJE Rhombus
Alarm Model Number
JJB Plugger XL
Pump Manufacturer
lZoefter
Pump Model Number
IBN 151�1511
Pump Must Deliver 30.16 gpm at 13.73 It TDH
Project: Opsal 3 bedroom residential mound
Locking corer vdth warning
label and locking device and
sealed vratertight
4 in. min.
Abornale outlet
location
Facerdain diameter
2 in.
Weep hole or afAv
siphon device
4 Purnp dr elevation tt
93.92
Dose tank elavallon
93 00
Note: Switches
containing mercury
may not be used in
this system.
Page 4 of 9
Mound System Maintenance and Operation Specifications
Service Providers Name F Jim Boumeester Phone 715 388-9020
POWTS Regulators Name I St. Croix County Zoning Dept. Phone 715 3864660
System Flow and Load Parameters
Design Flow - Peak 450 gpd Maximum Influent Partite Size 1/8 in
Estimated Flow -Average 300 gpd Maximum BODS 220 mglL
Septic Tank Capacity 1000 gal Maximtsn TSS 150 mg/L
Soil Absorption Component Size 450 fe Maximum FOG 30 mg/L
Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu1100 mL
Septic and Pump Tank
Effluent Filter
Pump and Controls
Alarm
Pressure System
Mound
Other
Service Frequency
Inspect and/or service once every3years
Should inspect and clean at least once eviry 3 years
Test once every 3 years
Should test month)
Laterals should be flushed and pressure tested every 1.5 years
Inspect for ponding and seepage once every 3 years
1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap,
and are secured in as shown in the mound component manual.
2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code_
3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code.
4. Tillage of the basal area is accomplished with a mold board or, chisel plow.
5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion
and help reduce frost penetration.
Finished .•..���...
Grade \ f
6-8" Diameter Lawn
Sprinkler Valve Box
1
Laftml Tum-up Debi
...............
Threaded Cleanout
Plug or Ball Valve
Long Sweep 90 or Two
45 Degree Bends Same
Diameter as Lateral
Project: Opsal 3 bedroom residential mound Page 5 of 9
Mound System Management Plan
Pu uiantto SPS 383.54, Wis. Adm. Code
Genera!
This system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' oomponent
manuals [SOD-10691-P (N.01101, R 11112). SSWMP Pubbcebon 9.6 (01/81), and Pressure DWrihufion Component Manuel Ver. 2.0 SBD-
10706-P (N. 01101, R 10/12)] and local or state rules Pertaining to system meinsna ce and maintenance reporting.
No one should ever enter a septic or pump tank ski dangerous gases may be present that could cause death.
Septic and pump tank abandonment shall be In accordance with SPS 383.33, Wis, Adm. Code when the tanks are no longer used es
POWIFS components. - - - -
Septic or pump tank manhole risers. access risers and covers should be inspected for water tightness and soundness. Access openings
used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or
sublectto /elknne must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking
device to prevent acciderital or unauthorized entry into atank or component
Septic Tank
The septic tank shall he maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic
tank shall be disposed of In accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shag be
assessed at least once every 3 years by inspection.
The outlet filter shall be cleaned as necessary to ensure proper operation. The Triter cartridge should not be removed unless provisions
are made to retain sefxfa tin the tank that may slough off the filter when removed from its enclosure.. If the filter is equipped with an alarm, the
filter shag be serviced If the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous
alarm.
The septic tank shag have Its contents removed when the volume of sludge and scum in the tank exceeds 113 the liquid volume of the
tank. if the cdr0ents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of
when the nerd service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank.
The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, If such products
are used they shall be appmuad for septic tank use by the Department of Commerce.
Pump Tank
The pump (dosing) tadt"be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper
operation. If an effluent AAgirlalnstalled W Min the tank N shall. be inspected and serviced as necessary.
Mound and Pressure, Distribution System
No bees or Shrubs should -be planted on the mound. Plantings maybe made around the mound's perimeter, and the mound shall be
seeded and mulched as nleollesery, to prevent erosion and to provide some protection from Frost penetration. Traffic (other than for
vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the nOkrslMe surface within the
mound and snow compaction In the winter will promote frost penetration, Cold weather installations (October -February) dictate that the
mound be heavily mulched as protection from freezing.
Influent quality into the mound system may not exceed 220 mg/L BOO.. 150 mg/L TSS, and 30 nqA FOG for septic tank effluent of 30
mg/L. BODs, 30 mg/L TSS, 10 m91L FOG, and lop cfu/10C ml for highly treated effluent, Inftueat tow may not exceed maximum design flow
specified in the permit for this Installation.
The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recorrmanded that each lateral be
flushed of accumulated solids at least once every 18 months. When a pressure test is performed itshoukl be compared to the initial test
when the system was installed to detenm rs if orifice dogging has occurred and if orifice cleaning is required to maintain equal distribution
within the dispersal cell, -
Observation pipes within the dispersal cell shall be checked for effluent pondng. Ponding levels shall be reported to the owner, and any
levels above 6 ncbeaeenadered as an Impending hydraulic failure requiring additional, more frequent monitoring.
.. - Contirmencv Plan
If the septictannk onanlr of He components become defective the tank or component shall be repaired or replaced to keep the system in
proper operating condition. -
If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component($) shall be immediately
repaired or replaced with a component of the same or equal performance.
H the mound component falls to accept wastewater or begins to discharge wastewater to the ground surface, it vdN be repaired or
replaced In its' present location by increasing basal area H be leakage occurs or by removing biologically dogged absorption and dispersal
media, and related piping, and replacing said components as deemednecessaryto bring the system Into proper operating condition.
See Page 5 of this plan for the name and telephone number of your local POWfS regulator and service provider.
Pretreatment Units
The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection
units are attached as separate documents and are considered part of the overall management plan for this system.
Project: Page 6 of 9
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January 8, 2020
CONDITIONAL APPROVAL
PL S: 2022-01-08
Plain Review: PWTS-012000031-
JAMES W BOUMEESTER
BOUMEESTER EXCAVATING
1070 HWY 35HUDSON, WL 54016
SITE:
Royce & Lisa Opsal
461 90m Street
Town of Kinnickinnic
Saint Croix County }
SW, NW, S7, T28N, RIAW
Total Amount: $250.00
DIVISION OF INDUSTRY SERVICES
2850 MIDWEST DR STE 104
ONALASKA WI 54650
Contact Through Relay
hap://dsps.YA.g(N/prograff /Defautt.aspx
www.wsconsin.gw
Tony Evers - Governor
Daum Crim -Secretary
Conditionally
APPROVED
DEPT. OF SAFETY AND PROFESSIONAL
SERVICES
DIVISION OF INDUSTRY SERVICES
SEE CORRESPONDENCE
FOR:
Description: Three Bedroom Mound System \ Sloping site
Mound Component Manual — Ver. 2.0, SBD-10691-P (N.01/01, R 10/12), Pressure Distribution Component
Manual — Ver. 2.0, SBD- 10706-P(N.0 1/01, R.0/12), 450 GPD, 16 depth to limiting factor from original grade,
Maintenance required, Effluent filter, New construction
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be
constructed and located in accordance with the enclosed approved plans and with any component manuals)
referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance
with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
Reminders
• A sanitary permit must be obtained from the county where this project is located in accordance with the
requirements of See. 145.19, Wis. Stats.
• Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches.
Proper soil moisture content can be determined by rolling a soil sample between the bands. If it rolls into a 1/4-
inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to
prepare, do not proceed until it dries.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of See. 145.20(2)(d), Wis. Stats.
• A state approved effluent filter is required. Maintenance information must be given to the owner of the tank
explaining that periodic cleaning of the filter is required.
PPrIFIVED
I DEC 26 2019
MOUND AND PRESSURE DISTRIBUTION COMPONItlT$1�i.ES
Residential Application _ - _
INDEX AND TITLE PAGE
Project Name: Opsal 3 bedroom residential mound
Owners Name: Royce 8, Lisa Opsal
Owner's Address: 1901 Lillian Dr., Hudson, WI 54016
Site Address: 461 90th St., Hudson, WI 564016
Legal Description:
SW1/4 N011/4, See. 07, T.28N., RAW
Township.
IOnnidtinnic Conditionally
APPROVED
County:
St. Croix
DEPT. OF SAFETY AND PROFESSIONAL
Subdivision Name:
CSM Vol. 23, Pg. 5528 SERVICES
DIVISION OF INDUSTRY SERVICES
Lot Number:
4 Block Nu
Parce(I.D. Number.
022-1018-30-028
Plan Transaction No.:
SEE CORRESPONDENCE
Page 1 Index and title
Page 2 Data entry
Page 3 Mound drawings
Page 4 Lateral and dose tank
Page 5 System maintenance specifications
Page 6 Management and contingency plan
Page 7 Pump curve and specifications
Page 8 Site Plan
Page 9 Attached Soil Evaluation Report
Design: Jim Bo ter _ License Number. 222904
Dads: 19 Phone Number (715) 386-9020
Signature:
Designed Pursuant to the - -
Mound Component Manual for POWYS Version 2.0 SBD-10891-P (N. 01/01, R..-11/12), and both
SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01181) and,
Pressure Distribution Component. Manual Ver. 2.0 SBD-107WP (N. 01/01, R. 10/12)
Version 7.0 (R. 11112) Page 1- of 9
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150"
4" CAST -A -SEAL III IC 4" CAST -A -SEAL
.I Ilil IP
f° TYP 1 I
FILTER OR U
II BAFFLE III Il
P M W
WLP1000/600-MR
TANK SPECIFICATIONS
DIMENSIONS:
WALL: 3"
BOTTOM: 3"
COVER: 5"
MANHOLE: 24" I.D. PRECAST CONCRETE RISER
HEIGHT: 56" O.D.
LENGTH: 150" O.D.
WIDTH: 84" O.D.
BELOW INLET: 42" O.D.
LIQUID LEVEL: 36"
WEIGHT: 14,970 LBS.
INLET AND OUTLET:
4" CAST -A -SEAL BOOT OR EQUAL
GASKET, CAST -A -SEAL BOOT OR EQUAL
INLET AND OUTLET BAFFLE AND FILTER:
WISCONSIN, SEE DETAIL #10
(OTHER STATES SEE CHART)
LIQUID CAPACITY: 27.88 GAL/IN SEPTIC)
16.76 GALAN (PUMP)
LOADING DESIGN: 8' 0" UNSATURATED SOIL
TANK CAN BE USED AS:
SEPTIC/SEPTIC, SEPTIC/PUMP
4" VENT
OR SEPTIC SIPHON
w�
COVER: MIX DESIGN /8 NO FIBER)
TANK: MIX DESIGN #10 STRUCTURAL FIBER)
CUSTOMIZED TANKS:
FOR CUSTOM TANKS CONTACT WIESER CONCRETE
INLET
UTLET
3"
4--—JL--r.—J
M `PUMP PAD
TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS
FOR APPROVAL
APPROVED BY;
APPROVAL DATE:
PRODUCTS NEEDED BY;
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PL-525 Filter
PL-525 Effluent Filter
The PLS25 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has
525 linear feet of 1/16" filtration slots. Like the Polylok PL-12Z the Polylok PLr525 has an automatic shut-off ball
installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off
the system so the effluent wont leave the tank.
Features:
• Rated for 10,000 GPD (gallons per day).
• 525 linear feet of 1/16" filtration.
• Accepts 4" and 6" SCHD 40 pipe.
• Built in gas deflector.
• Automatic shut-off ball when filter is removed.
• Alarm accessibility.
• Accepts PVC extension handle.
PL-525 Installation
Ideal for residential and commercial waste flows up to
10,000 gallons per day (GPD).
1. Locate the outlet of the septic tank.
1/16" Filtration Slots
2. Remove the tank cover and pump tank if necessary.
Accepts 4" & 6"
3. Glue the filter housing to the 4" or 6" outlet pipe. If SCHD 40 pipe
the filter is not centered under the access opening use a
Polylok Extend & Lok or piece of pipe to center filter.
4. Insert the PL -525 filter into its housing.
5. Replace and secure the septic tank cover.
PL-525 Maintenance:
The PL-525 Effluent Filters will operate efficiently for
several years under normal conditions before requiring
cleaning. It is recommended that the filter be cleaned
every time the tank is pumped, or at least every three
years. If the installed filter contains an optional alarm,
the owner will be notified by an alarm when the filter
needs servicing. Servicing should be done by a certified
septic tank pumper or installer.
1. Locate the outlet of the septic tank.
2. Remove tank cover and pump tank if necessary.
3. Do not use plumbing when filter is removed.
4. Pull PL-525 cartridge out of the housing.
5. Hose off filter over the septic tank. Make sure all
solids fall back into septic tank.
6. Insert the filter cartridge back into the housing making
sure the filter is properly aligned and completely inserted.
7. Replace and secure septic tank cover.
Gas Deflector
matic
-Off Ball
Outdoor SmartFilterO Alarm Extend & LoV-
Polyloir, Zabel & Best filters accept Easily installs
the SmartFilteAD switch and alarm into existing tanks.
Polylok, Inc. 3 Fairfield Blvd. Wallingford, Cr 06492 Toll Free: 877.765.9565 Fax: 203.284.8514 www.polyloLcom
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer Royce $ Lisa Opsal
Mailing Address 1901 Lillian Dr., Hudson WI 54016
Property Address 461 90th St., Hudson, WI 54016
(Verification required from Planning & Zoning Department for new construction.)
City/State
Parcel Identification Number 022-1018-30-028 'or
LEGAL DESCRIPTION
Property Location SW'/4, NW'/4,Sec. 07 ,T 28 NR18 W,Townof Kinnickinnic
Subdivision Plat: Lot # 04
Certified Survey Map # 875357 'Volume 23 'Page # 5528
Warranty Deed #
1089104
Spec house ❑yesElto
(before 2007)Volume Na Page # Na
Lot lines identifiable Oyes❑no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources,
State of Wisconsin. Certification stating that you septic system has been maintained must be completed and returned to the St. Croix
County Planning & Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Numb of be s 3
SiG'I',TA-Tpn OF APPLICANT(S)
1 /3o/tea b
DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. ***
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 04/12)
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WisconsinDepamnentof ree a ZQOB S IL EV. ON REPORT
Division of Safety and Buildings I;,id 1��
paw /« 3
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Attach complete site plan on paper not yt(QG. ]�..i (n siNt,
Include. but not Iknited to: vertical and �Ence point (BM).
percent slope, scale or dimensto,7s,we flaw, and location and dista
Please print all information.
Porto"bdon you erwWe � be Used foreeeaedery purpoeec (Pdvecy (rpj.
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City I State Zip Code Phone Nurnber
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New Carstructiak Use: PdResidential / Number of hedroans Code derived design flow rate O '60 00 - GPD
❑ Replacement ❑ Public or krmvrercial - Describe:
Parent materiel 7" LOESS Gq,J� Flood Plain elevation If applicable R
Gerwalcarmneras FI;uF r`rs . x
and rew"a"eridaeans: Tested suitable for
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Parcel M 022-1018-30-028
01/02/2013 12,55 PM
PAGE 1 OF 1
Alt. Parcel M 07.28.18.103A-12 022 - TOWN OF KINNICKINNIC
Current IX ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
05/23/2008 00 0
Tax Address:
Owner(s): O = Current Owner, C = Current Co -Owner
0 - RAY, JAMES A JR & ELAINE A
JAMES A JR & ELAINE A RAY
471 90TH ST
HUDSON WI 54016
Districts: SC = School SP = Special
Property Address(es): ' = Primary
Type Dist # Description
' 461 90TH ST
SC 4893 SCH DIST RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres:
2.039
Plat: 5528-CSM 23-5528 022-2008
SEC 7 T28N R18W PT SW NW BEING LOT 4 CSM
Block/Condo Bldg: LOT 04
23-5528
Tract(s): (Sec-Twn-Rng 401/4 160114)
07-28N-18W SW NW
Notes:
Parcel History:
Date Doc # Vol/Page
Type
06/03/2008 876014
EZ-DR
05/23/2008 875357 23/5528
CSM
05/30/2003 723667 2257/407
EZ-1
496/102
morn...
2012 SUMMARY Bill M
Fair Market Value:
Assessed with:
197753
Use Value Assessment
Valuations:
Last Changed: 05/14/2009
Description Class
Acres
Land
Improve
Total State Reason
AGRICULTURAL G4
2,039
300
0
300 NO
Totals for 2012:
General Property
2.039
300
0
300
Woodland
0.000
0
0
Totals for 2011:
General Property
2.039
300
0
300
Woodland
0.000
0
0
Lottery Credit: Claim Count:
0 Certification Date:
Batch #:
Specials:
User Special Code
Category
Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 000