HomeMy WebLinkAbout038-1074-70-000
A"sconsrn C--paitment of Cnmmcrcc
PRIVATE SEWAGE SYSTEM t' St. Croix
Safety arc i I INSPECTION REPORT Sanitary Permit No 84777
GENERAL INFORMATION (ATTACH TO PERMIT)
State Plar ID No
Personal information you provide may oe 4sed fc• seconcary PLrpcses [P-ivacy Law s 1504 (1;;ri}j
Permit Holder's Narnr~rty 'village Township Parcel 'ax No:
Don Martin TOWN OF STAR PRAIRIE 038-1074-70-000
CST BM Elea: linsp, BM Elev HM ❑ees.cnpf or SeetiorlrcwnlRangeA0ap l_
160-111 4- (4- A 17.31.18.308D
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STAIION BS III FS l
Septic r r Beenchmark yr IZ lb .Z ~a e
L yl t 4r A L1 et,G I~OD 12D ffa?A S' ) 114
Dosing Alt BM
e c fe- P~ d. a 3, 7S 16C .
~ L Bldg Sewer
ti ,Al, C \ rllo7lding SU'Ht Inlet
r~'' I
Sl Cutlet
TANK SETBACK INFORMATION
TANK TO APl'~ b^;FI I LD v r Intake ROAD Dt Inlet
Septic y 66 / 3 ) Dt Bottom
Dosing 7 11 3D J HeadeNMan g 9S 7C
Aerator Dist Pipe yF ,I 9S 77
Holding - - Rot. System ~`.I 7
Final Grade
,
PUMPlSIPHON INFORMATION ~ 7,Co 9~o•~v
Manufacturer Demand St Uuver
MuclurnUer
TDH Friction Loss System Head - TDH Ft
Forcemain Length D a. D st to'Alell
SOIL ABSORPTION SYSTEM
BEDlTRENCH 1dth Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia IL quid Depth
DIMENSIONS 3 ct 7,_ ■ _
SETBACK SYSTEM T^ ! Pll BLDG / WELL LAKFISTRFAM LEACHING Manufac rer
INFORMATION Type7f S CHAMBER OR T, F ' I a. l
PAX~J~L~,,In Der
ystc n __6 66 , I % f~ UNIT
ill DISTRIBUTION SYSTEM IU~f Z 3 +-Z 3 14 (o d'ti d~Q
HeadedMandad ~t Dstributior x Hoe Size x Hole Spacing Vent I Intake
Length Gra I ength Dia Spacing J
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Dver Depth Over :.:x l of xx Secaed'Sodde:f roc MrlGhed
Bed.,Trench Center Dec:Trerch l Topsc l o Yes No
COMMENTS: (Include code discrepencies, persons present etc) Inspection #1: r Inspection #2: r
Location: 2110 100TH ST I^ 15fi;iiiis [ /C 1 D^^yO~-~
1 ) Alt BM Description t
60- r0.,
2.) Bldg sewer length = 15 Ll C~
- amount of cover = / 1 J I OC
Plan revision Required? Yes No (V ZUse other side for additional intolrnation. ~r V CJV
S9D-v710 (R.3ig7) Date Insepctw' gnatr re Cert. No.
~I
r~l ~S ~Si1~t ES S<1"/- 17 T_~jl}! r
~i~-o SJ2x J~3Xsc ~ _1
LIZ`
f !60`~
t
~i~ ~ Hlvs~ ~
`r t999
I I
I
Eerari~ County
RECEIVED Industry Services Di
N ~\1 1400 E Washington Sanitan• Permit Number (to be filled in by Co.)
P s 1;~ MAY 2 3 2016 P.O. Box 71
s 621-
'r;`• Madison, WI 53707-
ST. cRaix couNrY
VHm~
1415 Ur-Vr-LU 4 anltary
lilt Application tate'Iransaction Number
"Mi
In uccurdance with SPS 333.21(2), Wis Adm Code, submission of this forni In the appropriate governmental unit it V
is required prior to obtamin.o a sanitary permit. Note: Appl:cation forms for state-owned PUNTS are submitted to
the Department of Safets and Professional Sett ices Personal information you provide ma} he used ter sccondan Project Address (ii different than mailing address)
purposes ir. accordance w ith the Privacy Law, s. 1; C4r 1(m), Slats 2 no 10()41,
1. Application Information - Please Print All Information
Property Owner's Name Parcel n
/,-l 7X -~IAI l C - - - t'Y^
Property Owners Mailing Address Property Location
Goal. Lot
Cite, State Zip Code Phone Number Section 7
) 11~~ (circles j D
T V/ N R E oL 3w
II. Type of Building (check all that apply) Lot k
I or2 Tamil} D~tiellin• NUU1110 0fRCdirk1ms ' / SubdivisillRia~
❑ Public,Commercial - Describe Use 00 Block ✓
❑ City ' of
❑ State Owned - Describe t 1sc ❑ i of of
n CSM Number ~1
I
(715W )&77OW C. W 2.3 LW73 own of
L
III. Type of Permit: (Check onlN• a box on line A. ('omplete line H if a IicaKle)
N ❑ New System eplac nien: System ❑ Treatment7lolding Tank Replaeem nl Only ❑ Other NI(Aitication to Existing System (explain-
B ❑ Permit Renewal ❑ Permit Rcvision ❑ Change of ❑ Pcrmil'I ransfer to New List Previous Permit Number and Date Issued
Befew Expiration Plumber Ow'ncr -
IV. Type of ' S S, steni'Coni ponent"Device: (Check all that apply)
❑ PressurZed In-Ground ❑ A--Grade ❑ Rlound > 24 in. of suitable soul ❑ Mound 24 in. of suitah so
❑ Holding lank ❑ Other Dispersal Colnprmenl (explainI ❑ Pretreatment Device'cxp:ain)
V. DispersaFTreatment Area Information: Lrvl L,
rI
Desi •r Him (gpd) Desi' un Soil Appli,ation / Dispersal Area Required ( Dispersal Area Proposed System Elevation
VI. Tank Info Capacity in
Gallons rial r of Manufacturer ; Units New Tan"s Existing Tanks / - " f ! = C
Septic OF Holding Tank ❑ ❑ ❑ ❑
Posing C haniher C=' ~'^/1 i ~C ❑ ❑ ❑ ❑
VII. Responsibility Statement- I, the undersigned. assume responsibility jbr installation oft a PONY I'S sho)vn on the attached plans.
Plumbe 's-Name rig s Plumher', S>>n, NIP,,N1PRS Nurtbc Rusmese Phone Number
!`-~1,
Plomher's Address (Street. City, State. Zip Code)
ldf
V1111. CountviDe partment I se Only
Appn'wedi` ❑ Disal'p- Penimit Pce Date ;suued Issuing Agent Si_n
Owncr Given Reason tc Ii;d S 5/7-7/N
Conditions of Approval' VmAt*eff 1.0% a]
1.8®ptio tank, effluent filter and
di4per5ai cell must k:_e_ac ! d maintaine-d
as per managomant plan provided by plumber,
2. All setback roqu`rements must be maintained
xuaeh 188,pj@rrlZ[{ k h i n u !nllt to the (-ount,- onh on paper not le- than Xi > e I t inches in sije
SRD-6303 iR0Ma)
CONVENTIONAL COMPONENT DESIGN!
Residential apphcatio ~
INDEX AND TITLE L'. -
Pace Index ah Title Project
f
#3a 2 Pfot Pfau. Name:,;
;image ~ Systcrrz Sizlnr~ & C.rcls~-Se£fAOx~`.
Owner's ,
:Palge Filter ;Specs Name:
~a~ ~ i'a,~i~tte~alce nfa~attan
Owner's
i'a~~ ~ ~ia~agemenf Pfau
Address
Page: ? ~ptt~ Tank Maui€enarlGe Fpm;:: _ Page; $ ~•~ti
ttachm nu it T&
st
Legal Description:
Subdivision: Lot #
Town: j< f' - -
County: " . i Irv
Parcel ID#
tDesigner/Plumber- License #
Signature. j
~ Date:
Comments
I
I
Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version Z.u
Index+Trtle 21212012
l
f~cv ~ts~1~s ,f~i-sFl~s~ s,Fc17-
p
f A
~L
LEE ,l
19,99
3 ~~INM~~j~~ ;
1 j I
fit' ~'~C ^t~~~ - . _ - /3~~• / !,'tiiC -
y"/ 1
4' Sdredub 40 FbIW Grade
PVC Vent Pore
nth vent coo
Leaching
Chamber % ' fr
- levabo
so€! Abson3don Slsfism Plan ZfBew
i Learning Trenclr 4
Vent Or Observation Pipe Chatrtber5
4" Dia.
Trench 2 Header
Leaching Ghambeg AQ§GR!cafios S
Manufacturer And Mode(
EtSA Rafing. sq ft per chamber Soil ApphcWbn Rate ~gpd/~q if
gpd Design Flaw : 5 srn'I Appatior~ Rafe f'f5 EISA= Charn6ers
' Y-
2 LOWS of d ambers earl.
Page of
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of _
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Septic Tank Capacity
Permit al O NA
Septic Tank Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms - ? ❑ NA Effluent Filter Model o ❑ NA
Number of Public Facility Units NA Pump Tank Capacity -
of ❑ NA
Estimated flow (average) al/daY Pump Tank Manufacturer ❑ NA
-
Design flow (peak), lEstimated x 1.5) -e gallda Pump Manufacturer NA
Soil Application Rate Pump Model 6NA
Standard Influent/Effluent Quality Monthly average" Pretreatment Unit )ANA '
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODS) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) :5150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BODS) 530 mg/L J In-Ground (gravity) ❑ fn-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L Ed NA ❑ At-Grade ❑ Mound
Fecal Coliform (geometric mean) 5104 cful100m1 ❑ Drip-Line ❑ Other:
Maximurn Effluent Particle Size Y3 in dia. ❑ NA Other: ❑ NA
Other:
❑ NA Other: ❑ NA
"Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: 13 month(s)
0 earls} (Maximum 3 years) ❑ NA
Pump out contents of tank(s) When combined sludge and scum equals one-third (y) of tank volume ❑ NA
Inspect dispersal cell(s) At least once every _ ❑ year( month(s)
(Maximum 3 years) ❑ NA
Clean effluent filter At least once every: ❑ month(s) ❑ NA
7 Oyear(s)
Inspect pump, pump controls & alarm At least once every: > ❑ month(s)
P'year(s) ❑ NA
VFlush aterals and pr essure test At least once every: ❑ month(s) 9 NA
❑ year(s)
At least once every: ❑ month(s) ❑ NA
❑ year(s)
❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or pondfng of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The pending of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume. the entire
contents of the tank shall be removed by a Septage Servicing Opera 'o; c1 -4i_ou c.~ of i I I u,aar.c:_: 'v;ih rh -pe
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent fiiCCrs,
units, and any servicing at intervals of <i 2 months, shall be performed by a certified PU4•vTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
GMW (4lOl)
START UP AND OPERATIUrl Page of---
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
ghat 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.
Uo 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 taker, out of service the following steps shall b2 taken to insure
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, grave) 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 by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
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.
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 INSTALLER-' POWTS MAINTAINER
Name -
- / Name
Phone Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name E Name `
Phone Phone
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(I) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
PRESSURE FILTER INSTALLATION & SERVICE INSTRUCT
tONS
455 Lexamar Drive Tolll,ree 88R-999-3290
Rayne City. M 149712 Office 231 -582-1020
Pax 231-582-7324 Cmailxilrru aae-<imtnh.cnm Web ,%"rx.ga >:mm-Oix-vil
INSTALLATION:
When installing an STF-100, screw filter into discharge port of any pump that has a 2" National Pipe Thread. Pumps with
a smaller discharge port may be adapted to fit. When installing an STF-100A2 a tailpiece and male adapter will need to be
added to the inlet end of the filter to the desired height and a 2" union will need to be added to the outlet end of the filter.
Always install the filters in a position where they can be easily serviced. "Always use caution when starting threads to avoic
cross threading". Plumb force main into the 2" sch 80 PVC union. **We recommend that the union remain together during
gluing to insure that glue or cleaner does not ruin O-ring or sealing surface"
SERVICE:
Service of filter screen is dependent on usage as every system is unique. For most residential systems we recommend
inspecting the filter within the first year to determine the necessary service intervals for the filter. In high volume systems we
recommend inspection within the first 6 months to determine necessary service intervals for the filter. Once the service
interval is determined it should be consistent unless something changes in the system. Always inspect the filter screen for
any damage or corrosion and replace if necessary. If our STF-101 service alarm switch has been installed and adjusted
properly it will alarm when the filter requires service. It should be serviced no less than when periodic pumping of the septic
tank and pump chamber is performed. Servicing will be more frequent if using any one of our optional filter socks (600
micron, 150-190 micron, and 100 micron). Check your local health department for septic system servicing recommendatic
If the screen becomes clogged before the periodic pumping requirements, a high level alarm or light will indicate the ne:
for service. If system is equipped with a "pump on tight" that stays on longer than normal, this also may indicate a need tc
service filter.
To service filter screen, unscrew the 4" cap. Pull filter screen from canister and wash out thoroughly in appropriate
location with proper protection. In some cases an additional filter screen allows quicker service allowing the dirty filter to be
washed later at the shop. Note that in cold conditions the filter cap may be difficult to remove. Keep the filter in a warm area
or pour warm water over the cap before removing. Once the filter is installed in the tank it maintains a stable temperature
and removing the cap will not be a problem.
If the system is equipped with our Service Alarm Switch, the filter screen does not need service until the Service Alarm
Switch activates a light or audio alarm. We still recommend that the filter be inspected once a year for damage or corrosion.
NOTE: The total dynamic head loss of the system must be increased by 0.5 feet of head to overcome friction loss through
the filter.
SERVICE ALARM SWITCH
The alarm switch is available in three pressure ranges, low head, medium head, and high head. Installation is simple, on
SIM/TECH FILTER systems, remove plug from base of filter chamber and connect tube fitting. Next, run the tube up into
the tank riser and connect to service alarm switch. The alarm switch is fastened to the side of the riser via the nylon strap
provided. Run alarm wire to alarm box. The service alarm switch can be wired with its own alarm or with the high water
alarm.
Pressure adjustment is made by removing the end plug, and inserting the 7/32 allen. Clockwise increases pressure. Onf
turn equals approximately 3 PSI. The low head alarm switch comes factory preset at 8 PSI and is completely field adjustabif
within it's range (3 to 24 PSI). We recommend the use of a ball valve when using an alarm switch. Once you have installed
the tiller and alarm switch, the ball valve can be closed off to simulate a plugged filter so that you can make sure the alarm
switch is working correctly.
****TRY OUR LID/SCREEN REMOVAL WRENCH. Our wrench holds filter lid firmly and hooks screen for easy removal and
installation. Made of PVC plastic.
WARRANTY
All products are warranted against defects in material and workmanship for a period of tvvo years from the date of purchase.
In no event shall GAG SIM/TECH FILTER, INC. be liable for any consequential damages or any labor, material, freight or
expenses required to replace, correct or reinstall the product. GAG SIM/TECH FILTER, INC.'s liability is limited to repair c,
replacement of the part. All warranties are void if the product has been improperly modified, applied or installed, subjected
misuse or abuse. Except as stated herein, there are no warranties expressed or implied, including the warranty of
merchantability or warranty of fitness for a specific purpose.
EFFECTIVE September 13 2005
Dose Tank Cross Section And Pump Performance Specifications
Tank Manuf!Number turer Minimum Pump Performance Required
Tank Model GPM Q , Ft TDH~
Total Tank Capacity
Max. Bury Depth '
Total Dynamic Head (TDH) - Feet
Pump Manufacturer Elevation Head c
Pump Model Number 1 i r 41 Distal Pressure
Alarm Manufacturer Network Pressure Loss
Alarm Model Number Force Main Pressure Loss '
Switch Type
z-, - Total
Manhole Min. 4" Above Grade
With Locking Device
Vent Min. 12"
Above Grade Weather-proof
With Cap Junction Box 1
- - - - - Finished Grade -
Depth of Cover ` Ft Disconnect
Means
> L
S
<
' Outlet
Inlet Switch Settings and Reserve Capacity
<
Tank Volume = GPI - _
< Dimension Inches Volume Gal. A
' (reserve) A V "
rT S 4
C < (alarm) B 2 B Weep
t ,
ff t ' Hole
' (dose) C
~}t (dead) D Off Elev. C
< Ft
> <
' Total 10.
<
}C t
D `
Bottom of Tank Elev. Ft
< Y<
< _ 1 < t C ( < t < >
GENERAL INSTALLATION: The dose tank is bedded and back filled in accordance with the
manufacturer's product approval specifications. Maximum depth of bury as specified by the
manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have
an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved
material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling ()r
sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the excavation and is sealed
watertight. Electrical service complies with NEC 300 and Comm 16.28 Wis. Adm. Code.
03/05 ]gj Page of
- tA6E
PUMP CRAMDER CF.055 SECTION A►j0 SPECIFICArI0h1S n/f
- - - - of
ihJLII(~..J97, -7~fsf,tri S
VE UT CAP
VENT PIPE
WEATkfEKPKOOF l _APPROVED LOCKING
? 2Sr FROM DOOR, JUKICTIOA7 box J MAWROLE COVCA WITH
WWOOW OR FRESH 12'MIU. WA"ING LABLL
AIR INTAKE I
GRADE I
MIAJ. r
-7 I
cououlr
I AN
IAJLE T YROV. DE
T AIRTIGI{T SCAL
APPROVED JOIIJT A I' APPROVED JOIU'
W/ PVC f I I W/ , PIPE
EXTENDIUCs 3' ALARM LITEWDILIG
ONTO SOLID SOIL D II 04TO SOLID SOI
~ I
Ow
C
ELEV FT. I ~ •
f~
boFr
PUMP-~ l
0
COAICRETE DLOCJJ-
R15CR EXIT PERMtT(ED OULti IF TAIJK MAUUFACTURCR HAS SUCH APPROVAL
3" APPRVOVED 6[DDING %A-,Atr T-P WK
SCPTIG f 5PECIFICATIOKJ
DOSE )
TAWKS MALJUFACT URCR:---jt/lrf ~ IJLIM.$CR OF DOSCS: PER DAy
TAWK SIZE: GALLOUS 0051 VOLUME _
ALARM MAUUFACTURER; -7 I. ~~~S~n y~• ~v IAJLLUUTAIC, DACXFLOW= / GALLON
MODEL UUMBEK: CAPACITIES: A=JJJCHCSOR ~p GALL Oki!,
SWITCH TYPE: g -IIJCMCS OR GALLOWS
PUMP MAWLIFACTURCK: , c- 9 7, lQCHES OK ALL GALLOUI
MODEL UUMDCR:rP9 INCHES OR L,Z,?1 GALLOUS
5WITCH TVPC: U01-(' PUMP AMD ALARM ARE TO DE
MIKIIA1.1J"1 OISCKA>RGE RATC- 414 GPM INSTALLED O)J SEPARATE CIRCUITS
VERTICAL DIFFERENCE 6ETWEEU PUMP OFF AUD OISTItibUTION PIPC.. FEET
+ IMjIJIMUM MCTWORK SUPPLY PRESSURE, FCET
+ ~ FC ET OF FORCE MAIJJ X ;r FTion rr rRICTIOU FACTpR..--.cl'y FCE T
TOTAL, OyIJAM1C. HEAD = 1(i FCET
ILJTEFLIJAL oIrIEKJSIO L of 1AUK' LE►.IGTH -i1~IDj'li iL14U10 DEPTH
51GuE0: - LICEWSE NUMBER: ~~L3 DATE:,62-
~v~ ~ I Ici1 lG~ ~
Curves Pumps
Men" FEET
00
T_
25 t - , - MODEL 3885
WEISH - - --T- SIZE 1/4" SOlidS
70 + -
20 w{IOH -
60
o - - I
r` WE07M-
50
40 WE0S11 I -
10 WEOJM
S it Wewl ' --i
10 - - ,f
0 0 - - r
0 Io x 30 40 so 60 7 -
b0 w 1 W 110 120 GPM
0 {0 20 Y.~ C 341n+/b
~'LOUIDS PUMPS, JNC.
METEAi FEET
126
u - - MODEL 3885
110 WEISMM r , SIZE 3/+ Solids
1
1 Ov i f r - -
30
t~t
2S -
70 - -
20
60
a -~-f ! -
wEOSMH - - t
15 50
- - --r
•o C- ' -1 r
10 30 - - -
10--~ -
70 ` 1 W 110
i
0 so 12p GYM
V
• IYN CAPACG T Y 30
0964" pumps. PC.--
E~Giw~ 1~
ST. CROIX COL\TY ZO\I- G OFFICE
CERTIFICATION STATUMENT
FOR UTILIZATION OF EXISTI-NG SEPTIC TANK(S)
This is to ccrti ('v that I have inspected the existing septic and,''or dose tank
presently semng the following residence:
( Street address)
located
at: -Sf ; ' Sectio►~ 1 To~~ ►IN, Ranges°.
Town of ~ St, Croix County `Wisconsin.
Upon inspection, I certify that 1 have found the tanks), to the best of my
knowledge. will conform to the requi:-cmerts of Comm. 54.25, and it (trey)
appear(;) to be functikmingr properly.
Mos. recent date o 1nSpCCtI~)il oI' seI-Vice
Did floe hack occur ioIII a-0sorption s~tcn1:' es- N
(i.f no, skip next line.)
Approximate yolurne or length of time: gallons minutes
Tank Capacity:
Constnrction: Prefab Concrete X Steel Other
Manufacturer ("if known): ;T
_1ge of Tank (if kno,,N-n ; c
Permit numb r (if known)
(Licensed kinber immature
(Pant dame) 4
(Titled I Licerlsc Nrul1 he. i ~IP'MPRS
Form to be completed by licensed plurnher (Dept of Commerce Chapter 5
and s. 145.06, NWisconsin Statutes) or licensed disposer (NR 113 NWisconsin
Administratiyc Code)
Rev. 9`2005
}
-11 Wisconsin Department of Commerce
Division d Safety and Buikliings SOIL AND SITE EVALUATION l
bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Page J_ of 3
Attach complete site plan on paper not lass than 8 1/2 x 11 inches in size. Plan must County
include, but not limited to: vertical aril horizontal reference point (BM), direction and
percent slope, scale or dimensions, north avow, and location and distance to nearest road.
~ Parcel I.D.
a C~
APPLICANT INFORMATION - Please gl ~p
Personal infonnetion "°~!:a Ravi ed Owe
you fide may be used for urposes { 'vary tAw, 3.1`1`5.01 (1) (m)).
~J
Props
or
_/'L~1 ern Property Location
VLfYLU ovt. Lot 114 114,S T N,R1 E (or)9
Props e s Mailing Address _ J 7 3/
~ i 1 g X98 Lit r , frock Subd. Name or QSW
sT c 3 L
city Statp Zip r ,
Lv C>FFp~ f", City vi e ~ Town NeareSfrRaad ,
® New Construction Use: Residential / Nun
13 Replacement r be: Addition to existing building
Public or commercial -Describe;
Code derived daily flow gPd Reoorr►rterrded design
Absorption area required _bed, it2 'S'_trench2 tg rate bed gP?~hinch, gpdM'
, tt Maximum design loading rate _-5_bed,
C gPdnc trench, 9P
Recorrmended infiltration surface elevation(s) - ft (as referred to site plan benchmark)
Additional clawgrVsite considerations
Parent material
Flood plain elevation, if applicable _ ft
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System In Fill Holding Tank
u= unsuitable for system S❑ U M S❑ u WS ou WS Ou ❑ S~ u ❑ S U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color monies Structure Texture Boundary Roots GPD1ft2
In. Munsell Ou. Sz. Cont. Color Consistence Gr. Sz. Sh. Bed , Trench
Ground ;
ellQev..~ /
Depth to r
limiting
factor
Remarks:
Boring aY
Ground
elev.
Aft.
Depth to
limiting
factor
- Ain. Remarks:
CST Name (P P Signature r
Telephone No.
Add
y ~a ) I _ / _ Date CST Number
-5- 7
r 33
e
3J
AA011A /e 6:. e..t .iwV
/
ST. CROIX COUNTY
SEPTIC TAI,_k MAINTENANCE AGREEMENT
AND
. nn r rI T~f---r,-. -•7j 1 F"O", Owner/Buyer
Mailing Address
roperty Address • _ ~ _
(Veri ication requir um Planning & Zoning Department for new construction.)
City/State Parcel Identification Number,' / 77/
- j ;
LEGAL DESCRIPTIO.N
Property Location, S ' 4 Sec. T.NR -_W,Town of i~-
-
Subdivision Plat: 2 2 , Lot
Certified Survey Map # Volume / Page #
Warranty Deed # (before 2007)Volume , Page #
Spec house G yes)ano Lot lines identifiable 21 yes ❑ no
SYSTEM ILUNL TENAiNCE 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 iii proper operating condition and/or (3) after inspection and pumping (if necessary), the septic tank is
less than 113 full of sludge.
Uwe, the undersigned bave read the above requirements and agree to tnavitain 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 returned to the St. Croix
County Planning & Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the
property described above, by virtue of a N~ranty deed recorded in Register of Deeds Office.
Number of bedrooms
,t 7"
SIGNATURE OF APPLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning R Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey mi
reference is made in the warranty deed.
rRRV. nJ/111
J r e .
CERTIFIED SURVEY MAP
Located if, port of the Southeast Quorter of ty►o So~iheael quarter of Seclinrn 17, TownslJp 31 North, Range
18 West, biung lot 1 of o Certllled Survey Mop recorded in Volume 3 page 6S2, Town of Star Prowls. 5t.
Croix County, Wleoonsin.
Pr6oored for and at the request of:
OWtiER:
R1 Ft. Matt fA.Sr 1/4 GYagMflt-
21~ih Avenue SFC. fl-J1-!4 `
Somerset. Wt 5402.5
(FNIJ P.Ir i ~
r
prollad 6y. Krjvll A, tylondl I n~
S :4 ft
Scow x W-
s~ t77.Si1' - S.?.p~' x-^r--r. K i--e- ~ ; • I 1
RONAL D f. -----♦73.0~0_-_-- `r I I
,ONA D LOT
O TUTAL AREAS 03,061 SO, M/1.91 ACRES I ~I t
e-t S
10C. EXC
AMErtY r ti AR A r i I f l 1 v
Wis. ~P+ 7i.13s SQ fT. r` I t
. - - • 11.112 ACRES - 22.48'
-4 j 1 I' 1
4N 1) •e• ~ s% ----N 07,45,014 w ~73.t~o'•: ` I Wf
•000 1• 60
~Q?W2 $r LOT 4 1 ,I 1 l =1
LWAL-AGE& 1-11
n$ 348,741 so. ►T. n I 1 f I
YQl 4 p_ASrE§~2 +u 8.01 ACRES ti 1 l
LL 9
316,9" SQ. FT. SSE
7.2b ACRES
It if / II~ ~I
z rri i 01
l,~t 7 SEPTIC -S° I-= ad o
~.J.~S. CAI?~CE iE 1 I 11 II r! ~j
L~~1~lKr +i.Q..~~41194 STIED i i I~! t I t
...ti.... ! E
' ►1 i I
It 1 ~I
R o w. ~fnur t ii
,4 1
M e76.1~- w 932nd' m.~ i 1i :t
- 4
9rse 1 -
w - -
sor,IH !/4 ~ 2618.20'-.._- - ' -
SEC f X1 _A9f It 210 TH ! F--
Uc uu r0, ,tong sovia 10A_ V N U { .xr l
cry >ik _sE
sovrr>I~sT
or rhT
Vb'-'1b .p L p§ (cuu ca AtW..j k.1.rl
NOTE: The parcel(s) shown on thle mop is/ore •uijjuot to 51ate, t:ounty and
Township lows, rules and regulations ( i.e. wetlands. minimum lot size, access contact Croix County Zoning Offlt:•nu rt~ind ho approprateg lown, Raord , for advicr.h•
St.
LEGEbk-
County Section Corner' Womiment
of Record
• Set I' x 24" Iron Pipe weighing
o mirtirnum of 1.13 pnunds per
u
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~ ( 160~St
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Wisconsin Department of Commerce SOIL AND SITE EVALUATION
Division of Safety and Buildings Page of
Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and Y
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel 1. D. u
D~L
APPLICANT INFORMATION - Please rlhfbk4--kon. Revi weed by Date
Personal mformat on you provics may be used 'c sa urpnses (P rvacy Law. 1.04 (1) (m;Q.
Property Owner Property Location _ tttrrr ✓
Q 10vt Lot 1/4 1/4,S1 .7 T -3.v ,N,R) y E (orl Yl cl*z Property-Owner's Mailing Address, fQ tot a Block# Subd. Name or QSM /
{ Cl _s~+f.~ ~ l S 7 (~~l X 1 ~ ~ y YJ ~ _ ~ .'7 / ' r " ( ti~
City Stag Li p Co j r Nea a Road
yvF City Villape Town
= G
® New Construction Use: 6 Residential ! Nu it>32~cf"6edrooms _ Addition to existing building
❑ Replacement Public or commercial - Describe:
Code derived daily flow gpd Recommended design loading rate 5 bed, gpd4? ~'__trench, gpd/112
Absorption area required _ bed, ft2 y; trench, ft 2 Maximum design loading rate bed, gpd/ft2_~t_trench, gpd/ft2
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design/site considerations
Parent material f~ _ Flood plain elevation, if applicable
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
U = Unsuitable for system S❑ U ® S ❑ U MS U U 0 S ❑ U ❑ S U ❑ S I U
SOIL DESCRIPTION REPORT
BCring # Horizon Depth Dorninant Color Mottles Structure GPD/tt2
in Munsell Ou. Sz. Cont. Cuiw Texture Gr. Sz. Sh. Consistence Boundary Roots
Bed Trench
Ground _
elev.
fft.
Depth to -+r t /
imiling
factor -
in. #
Remarks:
Boring 4
Ground
elev.
`!2 ft.
Depth to -
limiting
factor
}in, Remarks:
CST Name (P ase Pr I) Signature Telephone No.
Address Date ! CST Number
SOIL DESCRIPTION REPORT
PROPERTY OWNER ~u - Page of ,
PARCEL I.D.#
Boring # HDepth Dominant Color Mottles Texture Structure Consistence Boundary Roots
m. Munsell cu. sz. Cont. Color Gr. Sz. Sh. Bed Trench
_ L Groun❑ -
tt / _
Deptr to
limiting
factor
J1~.n
Remarks:
Boring #
r
Ground
elev. -
Depth to - -
limiting
factor
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/I 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
Boring # s ! . I
1 'I
Ground
elev.
5 ft. -
Depth to
limiting y
factor
In. Remarks:
Boring #
Ground
e ev.
ft. -
Depth to
limiting
factor
n. Remarks:
SEM-8330 (R. 07/96)
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s ST CROiX COUNTy
PLANNING & ZONING
June 25, 2010
Donald Martin
2110 100"" Street
Somerset, WI 54025
Codc.Administ-niun Re: Property at 038-1074-70-000, Town of Star Prairie
715-386-4680 Parcel #17.31.18379A-10
Land Information S
Planning Dear Mr. Martin:
715-386-4674
A complaint has been brought to the zoning office reporting that you may be in
Real Properrr violation of the St. Croix County Sanitary Ordinance, Chapter 12, Section 12.1(F)
715-386-46;7 (1) (b), which states: "All structures or premises in St. Croix County that are
permanently or intermittently intended for human habitation or occupancy, which
rrPCyCK„g are not serviced b a
71-S-386-4675 Y public sewer, shall have a system for holding or treatment and
dispersal of domestic wastewater which complies with the provisions of this
ordinance." An RV has been parked in the driveway of your home for an extended
period of time and the complainant alleges that someone other than yourself has
been living in it.
This type of use of a recreational vehicle is a violation of the St. Croix County
Zoning Ordinance, Sections 17.15 (1) (c) single family dwelling and 17.70.(3)(c)(2)
Temporary Occupancy permits, which only allows temporary use of an RV if it is
being used during construction of a permanent dwelling on the parcel and with a
permit issued by the county.
Your cooperation in responding to this complaint in a timely manner would be
greatly appreciated. Please contact me within (10) ten days of this date with your
plans to resolve this situation. I can be reached at (715) 386-4680 (8:00 A.M. to
5:00 P.M. weekdays),
Respectfully,
41
Pamela Quinn
Zoning Specialist (/fGi~CiY► V
Cc: Town of Star Prairie
File
ST ;.:.i, Oix Cc u, ITY GO vEH.104EAT C ENTE R
_ _ 1 101 C ARA4ICHAFi_ ROAD. 1luDS^!V, W,, 5.40 E-•41986 r-.ax
ST. CROIX COUNTY ZONING DEPARTMENT ',moo
AS BUILT SANITARY REPORT
Owneri
n~9
Property Address
City/State .s %
Legal Description:
ass r
Lot _ ? Block Subdivision/gNb-##
s~ '/4 ,e '/a, Sec. 17, T_L~N-R1W Town of---, PIN It Si.
17.3/. /6• 3ogD
SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION:
Tank manufacturer = - Size ST/PC f rr Setback from: House Well PJ'
Pump manufacturer Model i/',4
Alarm location
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM:
Type of system: Width Length Number of Trenches
s
Setback from: House ' Well P/L. _ Vent to fresh air intake A-
ELEVATIONS:
Description of benclunark Elevation
Description of alternate benchmark f< r Elevation
Building Sewer STrHT Inlet ST Outlet PC Inlet
PC Bottom Header/Manifold 9`1,Z2 Top of ST/PC Manhole Cover
Distribution Lines O , ice' O / ( )
Bottom of System
Final Grade ( ) i' 7 7 ( ) ( )
Date of installation, ? L Permit number state plan number
l7l
Plumber's signature C / License number Date- 2
Inspector
Complete plul plan a
NOTICE: Please provide the following:
• A plan view sketch showing everything within 100 feet of the system.
• Two horizontal reference points to center of septic tank manhole cover.
• Show alternate benclunark, if applicable.
PLAN VIES`'
;e
i'
~l -
INDICAT1✓ NORTH ARROW'