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HomeMy WebLinkAbout038-1207-00-000 (2)Wisconsin 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)] TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic Dosing Aeration lrlel"1 �Kis� i Zak 4 ��1or� TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing x\ ` � Aeration Holding PUMP/SIPHON INFORMATION tm STATION BS HI FS ELEV. Benchmark • 3`t j01, yS 1 Alt. BM Bldg. Sewer SVHt Inlet` SUHt Outlet Dt Inlet Dt Bottom Header/Man. 10- o .4 f 8af 7 Dist. Pipe Bot.System 11�15 ��•�� Final Grade y, Z , St Cover VA but 1•n1 114. 95 SOIL ABSORPTION SYSTEM 16 +I L L L.ct u.b& rs 10.v BEDRRENCH DIMENSIONS Width , Lengttr 11O No. Of Trenches Z PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L N BLDG WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacturer f14 T1 Typ mSystem: ohvti: o..« 1 r �' 3 8 r 117kw Model Number. uLl DISTRIBUTION SYSTEM HeaderlManifold 5.8 ` 1 I7 Length Dia Distribution Pipets) Length Dia Spacing x Hole Size x Hole Spacing Vent to Air Intake SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Bedfrrench Center / Depth Over %*% Bed/Trench Edges g � xx Depth of Topsoil p In Seeded/Sodded xx Mulched (Q ! � ■ Na Q Yes � No COMMENTS: (Include code discrepancies, persons present, etc.) Location: 2155126TH ST I l 1.) Alt BM Description =r ` 2.) Bldg sewer length = GICIS•)k f� V(46 R - amount of cover = f7h 'J Plan revision Required? ❑■ Yes [KNo �f Use other side for additional information. ( _. Date SBD-6710 (R.3/97) Inspection #1: Insepctafs Sig ture Inspection #2: s�+nf-2020-!04 MAY 06 2C Sakdy and 0 2oi w ' ' SmihryP�[No♦ber (b be diDed in by (b.) adiiglon Ave., P.O Box 7162 7 Col�io0 C 'el Dill-nt Sanitary Permit Appfi S°"T In sovmaavee wish SPS3e3.2I(2)6VYrm.Ad-Cod<aaEmmiancfit= Eam to the appopiBe govern lmLL m1e9med Rwrbobtssamgasmrypem.a. Nae:Application fog for shbowacd PORTS am nkmncd to the Depeatemmt of Sality ad Adomood Sveies Pemood whrmahm ym paovde mry he mad for mamdmy AojatAdd, (dd;ff+eotd n.1h gaddmn) L 2000rdw= VMh de Prmaty 11!!& , 15,04(IXMX Swra SebN)f G L Appbcffdm labaatomtits-Phase print A®hatermatim Pmpuly Owam's Nmw P.od b . ce - O - Proaaly owme's MdmgAdatm ed Plopmty Latim M.1Y'tE .+4j.section � coyst,b zgCode PbomNmnbv J o 11 S / 7 T N. B 11L /!/s) fL Type d�6(eierYsm thatapply) Lott / subdivisionIf �Iu2Femiy Dweeeg-Iii®bc a'Hcdmoms ,_� ❑Pubba Cameu®1-Desmbe Use _ Blurt■ city ❑ of ❑Stdo Owned-D nb. U. - ❑ VabwOf `D gTownof (SMNambw ' Cawlplete ff e B ifapplitahk) UL Type dPersit (7=`Y�Tll A. ❑New systemTtcatmeollNTaek ReptaeemeosOdy ❑Otlaaa�i6mtimbEaitiig SyNaa (e>plso) TR ❑Farm Renewal ❑Pe®rt It"ism 0(3�aPh b New I.M Pledos ftmat I mbmawl Deb Ismed Bekaa Fspastim Qwv of POW" Ciat d Hat la-('aoeod ❑PnmemdI-Gr ❑AWa& ❑Momd>24mofa*.ticwd 0Maamd<24in.cf=w"c3od ❑NoM gTaok ❑Other Dapusd Cospmm¢( Prtnmbme>♦Devioe (etpdSio) V. teadvat Artm babaesatio�: DaiglFbw(ffd) Des®oSm7AVp imtion%tW,&4 DW-9d geq�ed(at) Dspcml Aaw Ptapmd(at) spdmsl1kden / .3 s VI Took Ubo Capacity m Codkes Tatd Callas oaf Uo tI _Mmdadlm /�- '/(� NarTm Fitb Taks SgfiemDalaagTd , VIL $dannen[-�tle mJmdpe{ao�e Ent wamY'na Soda POWTS - an Me aWebed ; K11%e SNmebc $wiaeePhosNebm � , LL ?, Pl®bce3 Addmss(Shd, Qty, Stft Zip (:ode) y Jf s vm the Only ❑ Poa:tF« s Drabtama Agent ❑ Deowl — ZoZO UL Conditions dAppretaYReasaas tar SYSTEM OWNER: Dei""' ' 4" S t S 1. Septic tank, effluent filter and • %ef! 7D ..twNs.e.Mt �!+ rw: f s.�fQs- S64 �Da-.YJ+at+ s arrv' ��.a��� dispersal cell must ba.� iced / maintained a�tuw tftPP(�`nea/�} , as per management plan provided by plumber. '{) Dj v t( !M1 t4fAeu 6L * r+4. (` Te- aI 2. All se CL a y y� `�fe1+ 04 as per applicabiecodM"Im tj' - atlaw+�an:u rim 4s! (+11+W.Gar sen s3M cx lvl), P _2 �.� .. •:. •.. Tawnsh4X CONVENTIONAL COMPONENT DESIGN ResklerM App k abn ROM AND TITLE PAGE l D �- , , Lioe se Nunbw- DaiE= - Phooe Nisrder 7/.5 Signalise / c 0�1�/n��eu e.e r.Givad saAesal��m Cm� �a®1 t�vUwrs Yrdon 20 s�0.7mosP R�auo.} Pm I ti .: -- . ,- L r. _ i !-Z.: : ... . ^y ft �Se4o Fsvl Q-ade PVC Vaotpipe VMVatCap .-' ft Leaftv ( � � � �♦— C`j5�m �vafion C! ir Vent Or 06aetvafon PQe / Tmnch 7 Tnmrb 2 Y HBada 2 mm of /L> dmmb®s eo dL Pme_ of ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT MAY 19 Q020 AND OWNERSHIP CERTIFICATION FORM ^MSt. Croix county Owner/Buyer Mailing Ad& Property Address (Verification required from Planning & Zoning Department for new construction.) City/Slate �/,k vh '� 1 ,_ Peel Identification Number029- j,7p7_ a6 -t960 LEGAL DESCRIPTION g Property Location V4 , _/ _ Y4 , Sec 4 , T _-j_N R2,g_W, Town of Subdivision Certified Survey Map # Warranty need # J OISq3 -5` Spec house 0 y4no Volume , Page # (before 2007)Volume — , Page # Lot lines identi5abk/dyes 0 no SYSTEM MARMNANCE AND OWNER CERTIFICATION Lot #Ca. 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 fimction 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. Uwe, 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 your septic system has been maintained must be completed and rearmed to the St. Croix CountyPisnnmg & 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 mylour knowledge. Uwe amlare the owner(s) of the properly described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms —� la & �SIGVATURE OF APPLICANTS) DATE '"Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department sss 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- / Vw ndnll POWTS OWNER'S MANUAL K MANAGEMENT PLAN Page_ el MAY 19 2020 sr" sPEaFICATKms DESIGN PARAMETERS Number of Bedrooms )7 NA Nurnher d Pubic FaaLry tlrils ❑ NA Estimated (average) Flow: W,,") Design (pe* Flow = (esfmaled X 1.5)_ (lawn) In Stu Sal Application Rate_ 7 WAUarvlf) Standard (Domestic) Irilluert/Flivart Mori fty average Fats. ON & Greater (FOG) Sio MWL Iadrerncd Oxygen Demand mow s22o ogN- ❑ NA Taal Srap®rded Sords USS) 515o m WL Kgh Strength Irflue t/Efiue t Monthly we age (FOG) >30 m g;& (eOOO >M mglL tj NA (Tss) >15o mglL Pretreated Effluent Monthly average � )�NA Fewer CoBam - mem) rn <_ C MalmnunEffluent particle Sne )bindia El NA Other ❑ NA T Ma ufactuec lLs t ❑ NA [� El Dose ❑ Holding Volume: /rjr, (:ate Tank Manufacturer- NA ❑ Sepic ❑ Dose ❑ Folding Vokm(X (gall Ver6eel Dish Tank BOdOrH(5) to Service Pad pq Hotiaxitat Distance TatQs) to Service Pad pp SpecifiearA*Q mechanics rxrsi be pro dW ff wfeal is >15 reel err ffhwiz W is>15n feA. Syeafc'estiudurs to be prandef m bact Effluent Fier Ma ubct ra ❑ NA Etiuect Filter Model: Pump Marmiaiuner ❑ NA Pump Model: Pretreatment Unit Marnfact rw.. JA NA ❑ Mechimical Aeration ❑ Pry Fiea ❑ O"siiacbm ❑ We#end ❑ SadKkavel Fier ❑ Other SW Absorption 9ysterm db,G errd (grayly) ❑ Imtkard (P> ) ❑ NA ❑ At-(1rade ❑ Maud ❑ D*ume ❑ Omer OQrer ❑ NA Service Event Service Frequenry Pump out cants is of taik(s) When mmbirned sludge and sum equals one-third ()S) ottank volume ❑ Wha n the high water alarm is activated Inspect cmditim of tan k(s) At lead once every j year(s )s) (TINa)amnrn 3 years) ❑ NA Inspect dspersal cell(s) At lead ace every. `�j 11 VI Yn(s)) (Marumun 3years) ❑ NA Clean effluent filter At Icest ace every_ `-3 )) El NA Inspect pumA {gyp controls & alarm At lead once every El �)) m NA Flush laterals and prrssre test At least Once every_ Ll ❑ War(s) ) NA Omer: At least once every_ ❑ MWW) ❑ NA our_ ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and sal absorption systems shall be made by an m3uidual carrying are of the tobwig ties or certifications: Master Plumber. Master Plumber Restricted Sewer. POWTS Inspector, POWTS Mantainer or Septage Servicing Operator (punper)- Tank inspections must include a visual inspection of the tank(s) to kle nfify any missing or broken hardware, Ilffy any cracks or leaks. measure the volume of canbined sludge and sum and a check for any back up or pandrg of etiumd on the grind su lace. The sal absapikn systern shall be visually inspected io check the efiue t levels in the observation pipes and to check for any ponding of effluent on the grand surface_ The ponds ng of evert on the grand surface may indicate a fai inrg condition and reQaes the immediate notification of the local sec tatory audKx tv_ When the comhined ammktatim of sludge and sum in any treatment tank equals one-third (19 or more of the tank voMme, the entire contents of the tank shall be removed by a Se Cage Servicing Opa-alor (pumper) and disposed of'ru accordance with chaplet NR 113. Wisconsin Administrative Code. All Other services, including but not limited to the servicing of e(9uert fullers, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 maths, shall be perfumed bV a cerMW POWTS Mantaner. A service report shag be provided to the local negualabory authority within 30 days of enmplet w of any service evert. GMNr-ao5 (02A)5) Page _ of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon b�- required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area wi. result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. II;Z The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC. PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALL E t Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) Name Phone POWTS MAINTAINER Name Phone LOCAL REGULATORY AUTHORITY Name Phone 7k " _?e - �/,,T� This document was drafted in compliance with chapter Comm 83.22(2l(bl(i)(dl&(f) and 83.54(11, (2) & (3). Wisconsin Administrative Code. �� MAY 19 2020 ST. CROIX COUNTY ZONING OFFICE `^mst. Croix county CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) -,:)/ /�24 �s-74-- located at: -T L'/<, Nc- V., Section /I/ , Town_,ILN, Range_Zf W, Town of ,Are ,�e,St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: _ IAP gallons _� minutes Tank Capacity: Construction: Prefab Concrete-- �V— Steel Other Manufacturer (if known): L4 Age of Tank (if known): Permit number (if known) (Licensed Plumber Signature) A wXee (Title) (Date) (Print Name) (License Number) MP/MPRS Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 i i gg ........... I 7�US ........................:................................................. U°sM+MC T 490 S0-S°C i I owe Xr Esn ROOd, Di---217.84'-—217.84'-- —^----217.84'-- -- i M1 ...................... -----233.39'--- I. N00'00'25"W 886.91' ----------- - - - ---6 TOWN ROAD -- N00'00'25"W 886.97' L---285.75'— `— ----— — — — — 285.75'— — --�--- 315.47'----- I I Z 8o°I I i ZI I C tA:................. ...................... i ti 00 9' >? Na NI v NI g'10()0 �aA 3 c, ^1 I` II ?0 20 00. 1 J L NOO'25'W 887.24' J L_ - -- -N- ----- - - O LG4A/NAl�''�! 283�5 285.75' AQAAVAQE 315.74 � EASEMENT 312.44 a H.WE: -J6Q0 299.76' NW(,- EASEcsr _27504 H.WE. =366.0 jN Z 1p VI ---lA ' Ph IIp V o ��o w a Wiisconsm Depabnent of Caavnerce SOIL EVALUATION REPORT Division of Safety and Buildings p,w I of 3 rn aaaaance wmh Comm ua, Wis. ,won. Cow Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent a".scale ordimenslons. north arrow, and locaymawWij_tance to nearest road. Please print aft Infatmaf/on. -� Pereenel infoneefon y provide nay be wed Im ry papwe (Privaq` .1 f111mU. County S t . Croix Parcel I.D. endin Date nn / 3l Pmpwtyowr»r - •r •� i r `••��, Ewlen Properties. Ltd' L o /�/ S GOCr L SW 114 NE 1/4 S 14 T 31 N R 18 B(or)W Property Ownses Mailing Address :. ` 1 't 1430 220th. Ave. x Lot 2 Block a nor Sbd. Narte ar (SAM' Prairie View Estates CRY State Zip Dade New Richmon Wi. 5401 (zi' am UggfiiE:' ... (y D Yung KI Town Nearest Road / Star Prairie I CTH "C" [R New Constnx don Use: ® Resdera al / NumheT fld o¢nis'�y \T code dwK ed des4n Saw rate _ 600 _ GPD ❑ ReplacertbM ❑ Pubk a comnwdal - Oes77Rre:—'''` Parent malarial outlsash Rood plain General comnanm C �l.tiR- i%'la'GI�T�i� R. and recarrnerdetions: l-� trenches @ el. 95.10' aBonrhg p ❑ p e Ground surface elev. 94.85 R. Depth to NrIftV factor +100 irk® Pit Soi 'Rate Horizon I Depth in. I Dm*warvt Color Munsel Redox Description Ou. Sz Cont. Color Twdure Strucaae Gr. Sz. Sh. Cmsistmca Boundary Roots GPDM TIM TI102 1 0-12 10yr2/2 none L 2msbk mfr cs 1f .5 .8 2 10-247.5yr4/4 none sic1l 2msbk mfr gw 1f .4 .6 3 (24-5i).5yr4/4 none .2 cos osg ml gw na .7 1.2 t Bainl;# ❑ Boring 2 ® PR Ground surface elev. 99.80 R. Doh to lini" factor +100 In. So9 Rate Noriwn Depth In. Dmwmt Color MuhseA Redox Description Ou. Sz. Cant Color TextureCorttsistence BohndarY Roots GPDRF •EflC1 •ERM2 1 2 10-2 1 r5 4 none - mfr 1f 4 .6 3 7 4 �.� ml w nor 1.2 7 5 r5 6 nor w na 0 .2 [a • EM R1 = BOD 30 _< 220 nV1L andTSS >30 < 150 mg4 ' Efiuers 92 = BOD < 30 ngtL and TSS < 30 mglL CST Nana (Please Pdrd) Signathae . CST Number Gar L. Steel 298 Address Delit Evaluation Conducted Telepnro Number 1554 200th. Ave., New Richmond, WI. 54017 11-30-2000 715-246-6200 96 f>ropertyowner Ewlen Propgrties, Ltd. Parow1O# Vending Page 2 of 3 ■ j■im ...- N.M., n ��■ .. r - � � �-► a ir�� ,��■■!�■r.�■�rA m ■_ I aNW . r l:� M �■� '- ;SEE , MIMI ■■� ■��■■■■� ' EfBueM #1 = BUD, > 30 <_ 220 nxA and TSS >30 c 150 rnglL ' Eftw* #2 - SOD, <- 30 mg& and TSS < 30 mg'L The Department of Commerce is an eq I opportunity service provider and employer. If you need assistance to access services or need material in an alternateermat, please contact the department at 608-266-3151 or TIY 608-264-8777. I'm PLOT P )DO2ULT .bbllin lDobnron AD Db ID N R Emrab NI W13 M I14NE IiA/ 14 it Ol N,R ID IOMN Bbl PreMs couI W.01g0( MPRS Sh=BW 22M OAII�� DDODOOr 0 CIXIY[NTNtt1AL XU. IN6WUND IYr 1 CONYDN &L U1 bDCS4. TAN[ MDUND _ B TAN[,,, 1000 DAbr 1 TAm /Ml Don T. tQi DW .I'm M LOAD n AMODIIMN AW 6N / d J 22 DI KAM Y.LI CD c! 1' DVC P1,M ❑DM Apgyyf p,6YA1MIN IN' PNI ZOdA-100 om (D— ,b. D.1. BYMrBMdINrk tlleliM r.YVATtIN W.0 305' Rv lire B' AY. B.M. Tapd 1'PVC Rpe Cdl/ Nnh>)' Sp d.S Vr Vm >6^ Snprd BiDEI1rr d CDtleY Isadti mJ16a�� 6• la2 11' ntler Syfbn Denum eWr a SOIL EVALUATION REPORT n®YO�Da�6vt .VR LVY Vr ADrmA4N•YymTRArYnA �D• �� urbN Nnmr ny�W1YArub.rYw wws,r•weNw Af0.eVn� va �O. ^urrPsys�re� �ewws.nNvrnwlroairrw�a ti�•r�•r�r�r r n.�m�f �.••��niM Rm1tlYUr.�nlyytlaY� n/1� l "�.. y3.o Ia,i+Jf3I/19117�0©� -C..,7�1�%l�iF11J� R�I� ��r.�ap■�r�lrni�rl�s7sJ ROM= iOBG����ooO STEEL'S SOIL SERVICE Gary L Steel 1554 200th Ave. CSTM2298 1�' Pcvperties, Ltd' New Richmond, WI 54017 SW}NE} S74-T31N-R1,w MPRSW-3254 town of Star Prairie (715) 246-6200 lot #20-Prarie view Estates This soil evaluation was conducted to satisfy a zming requirement. it may or say not be suitable for your use. The location of the test may or may not be as sborn as personent lot lines ware root established at the time the test vas canducted- N 1"=40` BM.= top of 1" pvc Pipe @ el. 100.00' Alt. BM.= top of 1" pvc pipe @ el. 100.10' 1 Gary L. Steel 11-30-2000 Wisconsin Deparvnent of Cor rnerce PRIVATE SEWAGE SYSTEM Safety and 9uildng Division j INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide nwy be used for secondary Purposes [Privacy Law, s.16.04 (1 Am)]. Jonathan BM Elev, IBM Desrnpuan: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION ZL' 1dex A IUO fj i {�fi TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing 7 ,'ahon Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number V c` V t u TDH Lift Friction Loss 5ystem Hea TDH Ft Forcemain Length Di Dist. to well nak Ik SOIL ABSORPTION SYSTEM -, C' ,lc r. DATA STATION BS I HI I FS ELEV. Benchmark 1 Y,o AIL BM ILI Bldg. Sew6r ZVc b" c SUHt Inlet St/Ht Outlet .7 psi o Of Inlet of Bottom ` Header/Man. Dist . Pipe 7D 4u 1 / 3 Bot. stem Final Grade St Cover S BEDITRENCH DIMENSIONS Width / Lorgin 4 / No, Of Trenches ll LK Qr+.0 6c Z2 PIT DIMENSIONS No. Of Pgs Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO Type IX System: -�,�errlion IPIL jBLDG G 0 WELL nC, j n LAKE/STREAM I LEACHING CRA► BER OR UNIT Manufacturer: Model Number. DISTRIBUTION SYSTEM HeadenManifold Lon gth� ",/� Dia / Distribution x Hole Sim z Hole Spacing VeM to Ak Intake Lerglh Due Spaung SOIL COVER x Pressure Systems Ontv xx Mound Or At -Grade Systems Only Depth Over Bed/Tie,x3, Center / - % y r77 Depth Over / BedfTench Edges ` xx Depth of Tc soil u Seeded/Sodded _= zx kk, yes _ No COMMENTS: (Indude code discrepencies, persons present, etc.) Inspection #1:Of/ C'310� f j nspec __� Location: 2155 126th Street Star Prairie, WI 54026 (SW 1/4 NE 1/4 14 T31N R18W) Prairie View Estates Lot 20 Parcel No: 14.31.18.1115 1.) Alt SM - Dwriptidn= IoQ♦ wr.�, kbirx(4 dl *3) Netd5r W Safi �a�pril�e, Cl�; er, 2.) Bldg sewer length = JrM f?e{ " � Jibloc�p -amount of Dover = /� r } C 4 y.�vy � It Iry Plan revision Required? nX1,Yes��No D � i r� (���/ Z/1 r I � ��fyjl Fl, Use other side for adtlitlon I�aM1 _ —'_-1— _ �y� _ _ _ j 'w! 5 i o(/ SBD6710 JR. V97) Deft nsepclofs Signature Cart. No. � Y1.E.C,cJ Sgt� „Q,oO•t-w�- Gtt,�'fi (} PROJECT Jonathan Loaterman SW 1/4 NE 1/48 14 !T PLOT PLAN f17�ADDRESS 1853 240th St. Emerald Wi 54013 —s/R 18 W TOWN Star Prairie COUNTY ST.CRCXX MPRS Shaun Bird 226900 / DATE12/10/03 BEDROOM 3 CONVENTIONAL XXX IN.GR D PRESSURE CONVENTIONAL LEff HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 1d of chambers 22 BENCHMARK V.R.P. Top of 1' PVC Pipe ASSUME ELEVATION too, Filter Zabel A-100 ❑ BOREHOLE O WELL •H.R.P. Same as Benchmark SYSTEM ELEVATION 305' Property Line B.M. #1 25' _ N A _ B-1 5� hAtiiz— Vents T >y1L 7 Vent 2-3' X Pro 3 Bedroom House >6, Standard Biodiffuser of Cover Leaching Chamber with 31.1 ft2 of Area 6' Lone 11' at System Elevation 94.6/94.5 5.2' below grade A1L B.M. Top of 1" PVC Pipe 5' N s with >3' Spacing Vents 30 ` T Yu.F cal �� 20' (V IF L A/,11 j46-- 3' ,/ L S/3/1/` Plans Designed Using Conventional Powts Manual Version 2.0 r Safety and Builainy Division 201 W. Wmhiag Ave.. CorurY �/. / X r y fs�i�s/I! oo . Mdiso'n,Wl 537 _70 ECE1 N (In befi inbyCo.) (608) 261- Department of Commerce Sanitary Permit Application DEC 2 2 Store Phu D. Number 003 w/ ft In accord With Canon $321. Wu. Adaa Coke, P0720061 inZo Winn YOU vide my be rued fax aaoordary purporo Privacy LAW, 515.040 Xm) ST. CROI)c (;U proje� aili NTS (ifdiRamr thou m4 L Appileation Information - Please Print All Information �aLd/.6la'1u) Property Owner Name Persil a tot a Blbck e Jo v 3- Property Owaer s B Address Property Loch ooa/ Siam Zip Code Phone Number L� ) T N: E w IL of Building (check athat apply) s 'ritdm Nude CSIA Nowbr � r / 2 Fsmily Dwdlmg-NaobradBakrovms /1//{+'yyt ❑ PuhllU ammCCL1- Dtscnbc l/se QCrty_Dvfl ownwapo / �,- / ❑San OWved-Danbc Use nl$7� /'�ZC,.i GJ cviurr%td IIL Type qf Permit: (Chock only one box on Hot A. Complete Jim B If applicable) A eW ❑ mmtrot RAPIaeer Sys ❑ Timsmmr%iol&oa Took RgRWC Only err M u Exinuts Sysrem R • ❑ Ptxmit Rene.+) ❑ Permit Revision ❑ Change of ❑ Pamir Transfer to New Lan Prtv+out Permit Numb. and Dom hand Before Eap¢adon Ph nber Owner i 1n1imuvd ❑uo Mod > 2a in. of viable aoii ❑ Mmmd c 21 n of tuiahk soil ❑ At['uade ❑Single Pane Saud FWer ❑ WetWd ❑ Prasuriaed to Q Noldmg Tads ❑ Peat Fllw ❑ Aerobic Tramnua Uva ❑ Rocirculaunx Sand Filter ❑ Rac s M." Fi a CLunbar ❑ Dri Line ❑ Gaw-W. Pips Q OWr+ u lain �. �- �Rel v ntr.._._.tTwew..a ♦ .i �_«.._. rn T , rl n .? soil AypGutim R+Yffp°ro DixP.al Alva Reamed sin J D� S 1 VL Tank Info Capedry in frllons Tool Oalloor Nurba of unia Monufamum, Prefab Crones Sim Coost vaw led Fibs Olm "t bhw rska EsYtlaa T U Scone or Fbtlisa TaLL Aeslie Tne,e. Uah Day Choabw VIL Rs ttd Statement- 1, the Kmiervignod, am, respoml for mraDatloee oof,rtthh��eee POWTS(.A." oa the oorYbwAAsap/ Piumb.'x (Prim) ^ Phone Plumbc'a MPfhfPRS N"" t/7 f/ V _ I S On}�j(i[/1 2 � UZ7 X Lam, J o a Rmeat Use Oo Approved ❑Own❑ Diappovad Saoiary Ptamit Fee (' trda Oramd- r Dole h Sueebarae Fen) D . OwenN+sarm for Denial IX. Con=OWNE" nos for Disapproval .93 4 f?O ST3 r �/n effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber 2. T�II setback requirements must�tained cable codelordinances • f-573-/ SBD-6398 (R. 08/02) err - 411- Sys{�iP as pap. 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