HomeMy WebLinkAbout028-1027-70-000 (2)1Msconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Budding Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Law, a 15 04 (t)(m))
Permit Holder's Name City Village Township
Littlejohn A 8t Susan D Gailagher TOWN OF RUSH RIVER
CST BM Elev: / Insp BM Elev. BM Description
cs, : D (o O . D [ to ee, Inti4i� t
I ANK II FORMA I ion
TYPE
w� �°� ANUFACTURER
CAPACITY
Septic
[ES 2
IS-S5- 7 o
Dosing
Aerat, n
Hold,
TANK SETBACK INFORMATION
TANK TO
PIL
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
~YRo a1
1z0
I
p
�O
Dosing
tt
tt
1j
r
to
Aer
Holdin
PUMP/SIPHON INFORMATION
Manufacturer
0 E LL,C—
GPM
q q •
Model Number
I 5�
TDH
Lift
Friction Loss
System Head
(�
3.4f)
7FH—Ft!!
Forcemain
Length _I
Dia. /f
D{st. to Well
�5
z
Demand �
SVIL At35UKr I IUN SYSTEM
ELEVATION DATA
County
St. Croix
Sanitary Permit No
645447
State Plan ID No
072201710-c
Parcel Tan No
028-1027-70-000
Seciion/Town/Range/Map No
23.28.17.165E
STATION
BS
HI
FS
ELEV.
Benchmark
/
Alt. SM
Bldg. Sewer
t '�1
StIHI Inlet
SUHt Outlet
I
Dt Inlet
Dt Bottom
�2-"a
93.az
Headertman. A
r
Dist. Pipe 01 6
6
6 ,�
q rr r3i
Sot System 8
. q z
7,3 D
r(qD
ina rade
�t—>
t Cover C
iw,(eT
pjp , � 0
J l(�
DS•
l�. I
BE
EN310N3
Width
7
Length
, 0 gr
No Or Tmnehea
PIT DIMENSIONS
No Of Pits
inside Dta
Llquid Depth
SETBACK
SYSTEM TO
PIL
BLDG
WELL
LAKE/STREAM
LEACHING
Hurst r.
INFORMATION
CHAMBER OR
UNIT
Typo Of System �t
-�
�
III �
I C
/
Model Number.
RA 07`
o WID
>
L1t.7I KILIU I IVN , TS 1 CM
Header/MenHdd !1
I
Distribution l / fir t
r` 3 O
Ix Hole Size %
7�[ �(o r (
r'Hole Spacing
l
Vent to Air IntakPipee
Length 3.50 Dla
Length �z `�D Dia l Z Spacing
3,0
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Sirstems Only
Depth Over
Depth Over
xx Depth of
xx Seeded,Sodded
xx Mulched
Bed(Trench Center
Bed/Trench Edges
Topsoil
Yes No
Ya's No
COMMENTS: (Include code discrepencies, persons present, etc.)
Location: 1967 3DTH AVE
Inspection fi 1 �O(/Z3 Zpzf? Inspection #2 V� �20 3 K
Cev.%�Pleur- 7/,0�202 � k° � FwaQ
3 `i
1.) Alt BM Description
411w t%11.
lit-
2.) Bldg sewer length = clew a`` t.,� �( yv T CE l S i,,vt t (- kejPe�
- amount of cover �}/1
Q V
Plan revision Required? r 1 Yes j No
Use other side for additional ;nformati
Date yepctors Signature Cen No
SBD-6710 (R 3/97)
-;,;
Department of Safety
County s t. Cn a 4
r
�=
& Professional Services,
Industry Services Division
Sanitary Permit Number (to be filled in by Co.)
b `7J y
SS�a Pe it Application
State Transaction Number
Q 7 b —
In accordance th SPSre submission of this form to the a o n
is required pri to ob t ;a le: Application forms for slate -owned PO
Project Address (if different than mailing address)
the pepartmen f ro essional Services. Personal information you provide r secondary
purposes in accordance with the Privacy Law, s. 15.04(I Hm), Slats. ��
1. Application Information — Please Print All Information
Propen Owner's Name
Parcel p
ToHN 6/44L Rcr14C 2
n2$-lp;LT -Ta -dos
Pro y Owner's Mailing Address
PryLocati !lfI 0 %VZ
Z� ��'
l
Gop.L
ovt. Lot
Y., Section 0.3
T 8 N R W
City, State
p.�7t�y..�iiZ.9
Zip Code Phone
Number
11. Type of Building (check all that apply)
Lot s
Subdivision Name
91or2Family Dwelling - Number ofBedrooms 5'
Block a
❑ Public/Commcrcial - Describe Use
❑ City of
❑ State Owned - Describe Use
Q Village of/�
CSM Number
XIra
Town of fl A4A '
III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C If
a Ilcable.
A.
❑ New System
®Replacement System
❑Other Modification to Existing System (explain)
El Additions] Pretreatment Unit (explain)
B'
❑ Holding Tank
❑ In -Ground
❑ At -Grade
Mound
❑Individual Site DesignOther
Type (explain)
(conventional)
C.
❑ Renewal Before
❑ Revision
❑ Change of Plumb
❑ Transfer to New Owner
Date Issued
ist Previous Permit Numb:�v
t r
Expiration
1
0/1
�^q
IV.
Dispersal/Trealpient Area and Tank Informs on: M
Design Flow (gpd
Design Soil Application Rate( SO
Dispersal Area Required (
Dispersal Area Proposed System Elevation
98.
-750
.q
$90
Tank Information
Capacity in
Gallons
Total
Gallons
tt of
Units
Manufacturer
P 'S 2 S
E
`
to
} y
L.
2New
Tanks
Existing Tanks
D ' n y �
o
�
Septic or Holding Tank
! S
(•S S
C;r.r111:1
Dosing Chamber
C)
RgA
V. Responsibility Statement- 1, the undersigned, assume respo as I bit ity for installation of the POWTS shown on the attached plans.
Plumber's Name (Print)
Plumber's Signature
MPIMPRS Number
Business Phone Number
t�RyrFR NF-c14uZi-11-E
C,J
rs-7�►4-33�1
Plumber's Address (Street, City, Stale, Zip Code)
44� 7 N (957 A
Vi County[De artment Use Only
Approved
❑ Disapproved
Permit Fee
Date Is
issuing Agen nature
75.
❑ Owner Given Reason for Denial
U p
Conditions of Approval/Reasons for Disapproval 3 t( ` t �Jb0-t5, lyi -f s ajolom t�
r",
MTFM DINNER:
I. Sptic tuck, efHuertt fiher and
cell must I
�
as ptf
as per management plan pro„ided by plyutbil: (tiyK
2. All setback
vW;,rments trwst be "Wintairod 1 J
M W sgpltGrblr eodu/ordrnanem I K F rn , -1
Attach to complete plans the system and submit to the Cou y only on paper not les than to x 11 Inches in size
SBD-6398 (R. 03122) 4
DIVISION OF INDUSTRY SERVICES
2331 SAN LUIS PL
GREEN BAY WI 54304-5211
Contact Through Relay
http:llds ps . w i , g ovi prog ra msli n d us try -services
www.wisconsin.gov
Tony Evers - Governor
Dawn Crim - Secretary
July 27, 2022
CONDITIONAL APPROVAL
Conditionally
PLAN APPROVAL EXPIRES: 2024-07-27 APPROVED
Plan Review: PWTS-072201710-C DEPT. OF SAFETY AND PROFESSIONAL
SERVICES
RYAN GARY BECHEL DIV SION OF 1_4aUSTRY SERVICES
779 Spring Creek RD S
Red Wing MN 55066 i�j�,
SITE: SEE CORRESPONDFJCE
Joe Shakal
1967 30TH AVE
Town of RUSH RIVER
St. Croix County
Total Amount: $250.00
FOR:
Description: Five Bedroom Mound System 1 Sloped Site
Mound Component Manual — Ver. 2.1 (May 2022-2027), Pressure Distribution Component Manual —
Ver. 2.1 (May 2022-2027); 750 GPD, 31 inches to limiting factor from original grade, Maintenance
required, Effluent filter
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 manual(s) 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 Sec. 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 hands. 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 Sec. 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.
Owner Responsibilities
• The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also
receive a copy of the appropriate operation and maintenance manual(s) and be responsible for
ensuring that POWTS is operated and maintained in accordance with this chapter and the approved
management plan under s. SPS 383.54(1).
• In the event this soil absorption system or any of its component parts malfunctions so as to create a
health hazard, the property owner must follow the contingency plan as described in the approved
plans.
• The owner is responsible for submitting a maintenance verification report acceptable to the county for
maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the
component(s) utilized in the POWTS.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open
to inspection by authorized representatives of the Department, which may include local inspectors.
In granting this approval the Division of Industry Services reserves the right to require changes or
additions should conditions arise making them necessary for code compliance. As per state stats
101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe
building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at
the address on this letterhead.
The above left addressee shall provide a copy of this letter and the POWTS management plan to the
owner and any others who are responsible for the installation, operation or maintenance of the POWTS.
Sincerely,
ra -
POWTS Plan Reviewer — Wastewater Specialist
Department of Safety & Professional Services I Division of Industry Services
email: Katie. Petzel(ar wisconsin.gov
Cell: 608-574-1189
ADVANCED
E N V I R Q N M E N T A L
Property Owner/Client: Joe Shakal PIN: 028-1027-70-000
Site Address: 1967 30TH AVE, Baldwin, WI 54002
INDEX
Pg. 2 SITE PLAN
Pg. 3 SOIL DISPERSAL COMPONENT
Pg. 4 EFFLUENT DISTRIBUTION LATERALS
Pg 5 TANK SPECIFICATIONS
Pg. 6 DOSING AND PUMP SELECTION
Pg. 7 MANAGEMENT PLAN
Pg. 8 MANAGEMENT PLAN
Pg. 9 FILTER MAINTENANCE
County: ST Croix
Pg. 10 MATERIALS ESTIMATE
Pg. 11 SOIL TEST
Pg 12 SOIL TEST
Pg 13 SOIL TEST
DESIGN PARAMETERS
FLOW.' Wastewater Type: Residential
Estimated Wastewater Flow: 500 gpd
Design Flow: 750 gpd
SOIL & SITE
EVALUA 770N.-
POWTS Type: Mound
Limiting Condition Depth: 31"
Maximum System Depth: Above Grade
Contour Elevation: 98.00'
Limiting Condition Elev: 95.42'
Land Slope: 9%
# Bedrooms (residential) : 5
# Occupants (per capita flow) : _
Public Facility Flow: NA
Treatment Level: Effluent 1
Code Required Separation: 36"
Soil Texture: L
In -situ Soil Application Rate: 0.4 gpd/ft2
Dispersal Cell Loading Rate: 1.0 gpd/ft2
POWTS DESIGNED PURSUANT TO: DEPT. OF SAFETY AND PROFESSIONAL
SERVICES
Mound Component Manual (Version 2.1) DIV 5ION Of INftuSTRY SERVICES
Pressure Distribution Component Manual (Version 2.1)
Comments:
----------------------------------- ------------------------------------------------------------------------------
-T
Replacement system for existing 5 bedroom home. No home business. No sewage ; SEE CORRESPOND CE
ejector/grinder um Existin s system to be abandoned per SPS 383.33.
pump, g Ys P 0
a*AN--------------------------------------------------------------------------------------------------------------------SIGNED: 7/19/2022
ADVANCED EN 0NMENTAL LLC X'/��`'O�rs I G NCB
779 Spring Creek RD S, Red Wing, MN 55066 (651) 327-0074 1,rn„1111"0
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MOUND DISPERSAL AREA
Obs. pipes J
i_ _J�B �1 _�1
I
r
L
A
7.0'
F 9.5"
J
4.2'
B
108.0'
G 6.0"
K
7.8'
D
6.0"
H 12.0"
L
123.6'
E
13.6"
1 10.5'
W
21.7'
Observation Pipes (1/10th of B) 10.8' Dispersal Area Required: 1875 ft2
Absorption Width (A+I) 17.5' Dispersal Area Proposed: 1890 ft2
Dispersal Cell Media: 112" - 2-112" Aggregate
Geolextile Fabric 100.29'
99.13'
Topsoil s ^ '
a Seed` 98.50'
/f
2" Aggregate
.� ASTM C-33 SAND J'
1"
Plow 6% 8" deep (min.)
98-W, 9 n prior to placing sand
OBSERVATION PIPES
Screw -type or
slip -top c;
4" SCH 40 PVC pipe
Top of pipe to terminate 8
or above finished grade
}" - }" x 6" slots
spaced 90' apart
Anchoring Device
(Toilet flange)
Finished Grade
(mulched & seeded)
Topsoil cover
(I'minimum)
ifiltrative
surface
Page 3
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TANK SPECIFIC4 TIQNS
• Minimum cover = 6 inches; Maximum cover = 8 feet (unless specified by manufacturer)
• All manhole covers shall extend 4 inches above final grade
• If the tank is within 2 feet of final grade, insulate the lid to an R-Value of 10
• Minimum 18" of cover required over building sewer,• Insulate if greater > 30' long and < 42" from grade or if
< 60" from grade under all high traffic/snow cleared areas (driveways etc.)
• If forcemain will have a J-Hook" assembly, drill a weep hole in the "hook"
• Building sewer., No 90's, keep 3 feet between 45s, maintain 1 inch in 8 feet (1%) slope, install
W+ler'%hl —1 01 b0. Wdh
uaarale pump and alxm urcur9s ��
—107.55' 99.20'
Quick Disconnect
Clean Out
SIIeve tOrCenlalll in 4* WH
+o PVC P.P.ac.o+> t•ro
—105.45' 95.58'
• e.cavatwrr Io preve�l we
4' SCH 40 Bldg, seww
Ie1111n6
Effluent F411er
1'•1 5" PVC Floal Tree
Li
+/- 110' —` ' - 93.58'
_ (PUMP OK)
Weep Hole
92.50' �y I. 4Pump Bloch
-----------------------------------------------------------------------------------------------------------------------------
Tank Manufacturer/Model: Wieser - WLP1585/950
Filter Manufacturer/Model: Polylok - PL-525
------------------------------------------------------------------------------------------------------------------------------
Panel Manufacturer/Model: SJE Rhombus - Tank Alert 1
------------------------------------------------------------------------------------------------------------------------------
+631
-_--------- lilt
II 4' CAST -A -SEAL 11114- CAST -A -SEAL I�
(III
II rILTER OR I I II
BAFFLE IIII
11 IIII U
( TANKS ARE MANUFACTURED TO MEET OR ExCEED ASTd C-1227 REOLIMEMENTS
WLP1585/950
TANK SPECIFICATIONS
DIMENSIONS.
WALL: 3'
BOTTOM-. 3'
COVER 6'
MAN" LC: 24' 1-0 PRECAST CONCRETE RISER
HEIGHT. 53-3/4' O.D.
LENGTH: 1e3-3/16- O.D.
1NOTH: 101-3/16' O.D.
BELOW INLET: 43" O.D.
LIOVID LEVEL: 3a' `y
14EIGHT; TANK 13.010 LBS
WEIGHT: COVER 9.300 LOS
INLET AND OUTLET_
4' CAST -A -SEAL 8001 OR EOUAL
INLET AND OUTLET BArn-C AND FILTER:
WSCONSIN, SEE DETAIL #10
8
(OTHER STATES SEE CHART)
!„
R
LIQUID CAPACITY- 41.67 GAL/IN (SEPTIC)
x
25.00 GALAN (PUMP)
LOADING DESIGN: 6'-0' VNSATURATED SOIL
W
W
TANK CAN BE USED AS:
(�
SEPTIC/SEPTIC. SEPnC/PUMP
OR SEPTIC/SIPWON
COVER: Wilt DESIGN 08 (NO FIBER)
FIBER)
illy n
W $
A- VENT TANK: MIX DESiCN /9 (SMALL
I
CUSTOMIZED TANKS:
O
FOR CUSTOM TANKS CONTACT WIESER CONCRETE
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DRAWINGS SUBMITTED
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FOR APPROVAL
A PPRN D 91:
Sr+F F T NC
APPROVAL DAVI:
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P4001A IS ALLDLD Iv:
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Page 5
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MANAGEMENT PLAN
The owner of this Private Onsite Wastewater Treatment System (POWTS) shall be responsible for its perpetual operation and
maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. This management plan identifies operation and
maintenance activities necessary to ensure long-term system performance. Tasks that should be performed by the homeowner
are identified. Professional management tasks shall be performed by a registered POWTS Maintainer in accordance with SPS
383.52 (3), Wisc. Admin. Code, however, it is the homeowner's responsibility to ensure all tasks get accomplished in a timely
manner. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not
maintained In accordance with this approved management plan.
► Keep this Management Plan with your Septic System Owner's Guide.
► Keep copies of all pumping records, maintenance activities and repair invoices with this document.
► Review this plan with your POWTS Maintainer at each visit; discuss any changes in product use, activities, or water -use.
MANAGEMENT FREQUENCY
Design Parameters
System Specifications
Number of Bedrooms
5
Septic Tank Manufacturer
Wieser
Design Flow (gpd)
750
Septic Tank Capacity (gallons)
1583
Soil Loading Rate (gpd/ft2)
0.4
Effluent Filter Manufacturer
Polylok
Standard Effluent Quality
Effluent 1
Effluent Filter Model
_ PL-525
Biological Oxygen Demand (BOD)
220 mg/1
Pump Tank Manufacturer
Wieser
Total Suspended Solids (TSS)
150 mg/1
Pump Tank Capacity (gallons)
950
Fats, Oils, Greases (FOG)
30 mg/1
Pump Manufacturer
Per Installer
Treated Effluent Quality
Pump Model
Per Installer
Biological Oxygen Demand (BOD)
- mg//
Dispersal Cell Type
Mound
Total Suspended Solids (TSS)
- mg//
Fats, Oils, Greases (FOG)
- m9/1
Pretreatment Unit Description
NA
Max Effluent Particle Size (in)
1/8
Homeowner Management Tasks
Check (listen, look) for leaks in toilets and dripping faucets.
Repair leaks promptly.
Regularly check for wet or spongy soil around your soil
treatment area. Contact service provider if issues arise.
Control burrowing animals (gophers, groundhogs, etc.)
!Seep bikes, vehicles, snowmobiles and other traffic off
treatment area.
Alarms - Contact your service professional if any alarm signals.
Lint Filter- check for lint buildup and clean when necessary. If
you do not have one, add one after washing machine.
Caps - Make sure that all caps and lids are intact and in place.
Inspect for damaged caps often. Fix or replace damaged caps.
Professional Management Tasks
Effluent Screen - Check and clean per manufacturer
recommendations.
Liquid levels - Check sludge/scum/effluent levels in all system
tanks. Recommend if tank(s) should be pumped. Pump all
compartments every 36 months at a minimum.
Inspect tank inlet and outlet baffles (if applicable)
Check drainfield effluent levels (if applicable)
Verify pump and alarm system functions (if applicable)
Inspect wiring for corrosion and function (if applicable)
Clean drainfield laterals (if applicable)
Check event counter/elapsed time meter and evaluate water
usage rate compared to system design flow.
Check dissolved oxygen and effluent temperature in tank.
Check for surfacing of effluent or other signs of problems.
Verify inspection pipes are capped and intact.
Provide homeowner with list of management results and any
action to be taken.
POWTS REGULATOR., ST Croix County Zon/ng Office
ADDRESS. • 1101 Carmichael RD, Sulte 1200, Hudson, WI 54016
PHONE: (715) 386-4680
Page 7
START-UP & OPERATION
For new construction: Prior to system operation, check septic/pump tanks for the presence of painting products or other
chemicals that may impede the treatment process and/or damage the dispersal cells. If high concentrations are detected, have the
contents of the tank removed by a licensed septic professional prior to use.
System start-up shall not occur when soils are frozen at the infiltrative surface.
Duringnower outages: Pump tanks may fill above normal high water levels for system utilizing pumps. When power is restored,
the excess wastewater will be discharged to the dispersal cell in one large dose potentially resulting in overloading of the cells.
Backup or surface discharge of effluent may also result. To avoid this situation, it is highly recommended to have the contents of
the pump tank removed by a licensed septic professional or have a septic professional manually dose the system to return the
pump tank to normal operating levels prior to restoring power.
Do not drive or park vehicles over any septic system components. Do not drive, park over, or otherwise disturb or compact the area
within 15 feet downslope of any mound or at grade system or secondary septic system site.
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an appropriately licensed individual or business. 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 backup or ponding of effluent on the ground surface. Access openings
used for service and assessment shall be sealed watertight upon completion of service activities. Any unsound jefegtive access
ooenings shall be replaced immediately.
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. Ponding of effluent on the ground surface may indicate a failing condition that requires immediate
attention by a licensed septic professional.
Tanks must be pumped when sludge accumulation is within 12 inches of the bottom of the outlet baffle, or whenever the scum
layer is within 3 inches of the bottom of the outlet baffle. In no case shall total sludge and scum volume occupy greater than 25%
of the tank liquid capacity.
The effluent filter shall be cleaned as necessary to ensure proper operation. The filter should not be removed unless provisions are
made to retain solids in the tank that may slough off the filter during removal. If the filter is equipped with an alarm, the filter shall
be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous
alarm and should be evaluated by a licensed septic professional.
Pre-treatment components shall be maintained and serviced by a licensed septic professional according to the manufacturer's
recommendations.
CON7INGENCYPL4NS
If the septic tank, or any of it's components, become defective the tank or component shall be immediately repaired or replaced
according to the original system design specifications.
If a dosing tank, pump, pump controls, alarms, or related wiring becomes defective, they shall be immediately repaired or replaced
with components of equal performance.
If the soil treatment component fails to accept wastewater or discharges wastewater to the ground surface, it shall be repaired or
replaced by; increasing basal area (if toe leakage occurs), rebuilding the component at the secondary system site (if identified), or
removing and replacing biologically clogged absorption and dispersal media and associated piping. If repairs or rebuilding is not
possible, a new soil and site evaluation must be performed to locate a suitable replacement area if one has not already been
identified. If no replacement area is available, a holding tank may be installed as a last resort replacement POWTS.
ABANDONMENT
If the septic system fails and/or is permanently taken out of service, the system shall be abandoned according to SIPS 382-384,
Wisc. Admin. Code abandonment regulations. Requirements include:
All piping to tanks shall be disconnected and abandoned pipe openings sealed.
The contents of all tanks shall be removed and disposed of by a licensed septic professional.
Tanks shall be crushed & filled, or removed.
A septic system abandonment notification shall be submitted to the appropriate local governmental unit.
WARNINGII
SEPTIC, PUMP, AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO
NOT ENTER A SEPTIC TANK, PUMP TANK, OR OTHER TREATMENT COMPONENT UNDER ANY CIRCUMSTANCES.
DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ALWAYS CONSULT A LICENSED SEPTIC PROFESSIONAL BEFORE DOING ANY WORK.
Page 8
P�l�.gK,nc
no MvcrionsinPacRADuirugr Zabel,
A Wnrrwlrn Pwwcn � A dawn of VdybM kic
INSTALLATION INSTRUCTIONS
Step 1:
(A) Locate the outlet of the septic tank.
(B) Remove tank cover and pump tank
if necessary.
c•r1 to
warruwar sc.na..a 46
MAINTENANCE INSTRUCTIONS
Step 1:
Locate the outlet of the septic tank.
as ■• J
WHEN FILTER IS REMOVED
USE RUBBER GLOVES
WHEN CLEANING FILTER
INSTALLATION INSTRUCTIONS
PL-122/PL-525/PL-625 FILTER
Center filler
with opening
W H
J �
e
Additional pipe or
Polylok Extend & Lok-
for centering.
Step 2:
(A) Before installation, place the
filter housing on to the outlet pipe.
(B) Make sure that the housing
is positioned so the filter can be
removed from the tank for
maintenance and service.
Step 2:
(A) Remove tank cover and pump
if necessary.
(B) Pull the filter out of the housing.
(C) Hose off the filter over the septic tank.
Make sure all solids fall back into the
septic tank.
Step 3:
(A) Glue the filter housing on the
outlet pipe.
(B) Insert the filter cartridge in the
housing, making sure the filter
cartridge is properly aligned and
completely inserted in the housing.
Step 3:
(A) Insert the filter cartridge back
into the the housing making sure
the filter is property alighed
and completely inserted.
(B) Replace septic tank cover
Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877.765.9565 Fax: 203,284.8514 www,polylok.� 9e 9
INSTALLER MA TERIAL ESTIMA TES
THE FOLLOWING PARTIAL MA TERL4L LIST IS INTENDED FOR ROUGH BID PURPOSES ONLY.
INSTALLER IS RESPONSIBLEFORALL FINAL MATERIAL CALCULATIONS.
TANK(S):
Tank 1:
Wieser - WLP1585/950
Tank 2:
Effluent Filter 1:
Polylok - PL-525
Effluent Filter 2:
PIPING:
Diameter
Building Sewer:
t 110'
4" SCH 40 PVC
Forcemain:
t 65'
2" SCH 40 PVC
Header:
t 4'
1 1/2" SCH 40 PVC
Laterals:
t 210'
1 1/2" SCH 40 PVC
IMPORTANT, • Piping
estimates are exact. A Material waste allowance
has NOT been added.
FUMES):
Minimum Head Minimum Flow
Effluent Pump 1:
47.2 gpm 12.2 ft TDH
Pump 1 Model:
Zoeller - 152
Minimum Head Minimum Flow
Effluent Pump 2:
- -
Pump 2 Model:
-
SOIL TREATMENT AREA:
YARDS TONS
Washed Rock:
29 ydg 40 TONS
(�12" - 2 112" Aggregate)
103 yd�
144 TONS
Page 10
ST. CRO NTY SANITARY SYSTEM File #:office use o,>,ry
OWNERSHIP/ADDRESS FORM Created212021
Community Development Department will utilize this information to provide the property owner with
information regarding operation and maintenance of your new or replacement sanitary system! This
information will be provided as part of our ongoing efforts to protect public health, your well, groundwater,
surface water, property values, and county resources. Once approved, this completed form and educational
information will be sent to you by email.
OWNER/BUYER INFORMATION
Owner/Buyer
v v
Mailing Address I `T 6 -7 3 0
City/State/Zip 514
Phone Number (required) -71 `i -
Email Address (required) N "-*
Parcel Identification Number 0 2. 8- 10 a —i - Z Q- a o 0
(found on the property tax bill)
NEW SYSTEM: LEGAL DESCRIPTION
Property Location N C 1/4 , Ny0114 , Sec. 03 . T �L t N RLW, Town of
Subdivision Plat: Lot #
Certified Survey Map # Volume Page #
Warranty Deed # 11Z-? % (before 2006)Volume . Page #
Number of bedrooms S Spec house O yes ■ no Lot lines identifiable ■ yes 0 no
OFFICE USE ONLY
New Property Address Seq K-A.-e _
(Verification of new address required from Community Development Department for new construction.)
(Staff initials) (Date)
This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications.
New System: Include with this form a recorded warranty deed from the Register of Deeds Once and a copy of the certified
survey map if reference is made in the warranty deed.
Community Development Department - Land Use Division
715-386-4680 St. Croix County Government Center 715-245-4250 fax
cddl?Dsccwi.gov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.gov
Wisconsin Department of Safety and Professional Services
Division of Industry Services
SOIL EVALUATION REPORT
In accordance with SPS 385, Wis. Adm. Code County
Attach complete site plan on paper not less than 8 1/2 x. 11 inches in size. Plan must include,
ST Croix
but not limited to: vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D.
scale or dimensions, north arrow, and Iocafion and distance to nearest road. 028-1027-70-000
Please print all Information. Reviewed by
Page 1 of 2
Date
Personal information
you provide may be used for secondary punposes Priva
Law, s. 15,04(1 m .
Property Owner
Joe Shekel (Seller)
John Gallagher (Buyer)
Property Location:
Govt. Lot: NE
't. NW Y4 S 23 T 28 N R 17 W
Property Address
1967 30TH AVE
Lot # 71��
k #
Subd. Name or CS M#
City
Baldwin
State Zip Code Phone Number
IWI 154002 1 (715) 410-7496
❑ City ❑ Village
❑■ Town Nearest Road
1 Rush River 30TH AVE
❑ New Construction Use: M Residential /Numberof bedrooms 5 Code derived design flow rate 7550 GPD
Replacement [:]Public or commercial — Describe:
Parent material Loamy drift over sandy/gravelly outwash (Onamia-Antigo) Floodplain elevation if applicable NA ft.
General comments and recommendations: Rewmmsnd minimum s• sand -lift POWTS mound on 9800 contour with 0.49pdm2 loading rate.
LF • 31' (RedomimorphiC features)
1❑ Boring # ElBoring
® Pit
Ground surface elev. 98,00 ft. Depth to limiting factor 42 in.
Soil Aoolication Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft'
•Eff#1
'Eif#2
1
0-9
10YR 314
-
1
1 msbk-1 mpl
ds
cs
1 m-vf
0.4
0.6
2
9-21
1 OYR 316
-
sl
1 mabk
mfr
gw
1 f-vf
0.4
0.7
3
21-42
10YR 616
-
Ifs
Osg
ml
cs
-
0.5
1.0
4
42-61
10YR 616
f2f 10YR 416 6 toYR 6/2
Ifs
Osg
ml
-
-
0.2
0.6
'Horizon 4 h
d 24' thick crtinuous
bands of
5YR 314 sl (0m). Loading
rates redu
for horizon to r
flect banding corrition.
Boring #
❑ Boring
Pit Ground surface elev. 96-00 R. Depth to limiting factor 31 in.
Snit Annlicatinn Rale
Horizon
Depth
In,
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Fe
'Eff#1
•Eff#2
1
0-11
10YR 313
-
1
1 fsbk
mfr
Cs
1 m-vf
0.4
0.6
2
11-31
1OYR 4/4
-
sit
2mabk
mfr
Cs
1vf
0.6
0.8
3
31-44
1 OYR 416
f2d 7.5YR 5/8 3 10YR 6/1
fSl
1 mabk
mfr
c,5
-
0.2
0.6
4
44-60
1OYR 716
11f 10YR 5/8 6 10YR 6/2
Ifs
Osg
ml
CS
-
0.5
1.0
Fmuwnt U1 = FUlrl > 3n S 77n ulna nna TSC > 3n { 1rin mnn ' FttfuAnf n7 = FLUX-] > 3n 5 77n mnn ann 155 > 3n S li9U MCVL
CST Name (Please Print)
Signature
�;P1330832
CST Number
Ryan Bechel
Address
Date Evaluation Conducted
Telephone Number
779 Spring Creek RD S, Red Wing, MN 55066
07/13/22
(651) 327-0074
boLf-a'sau (MU4/lJJ
Page 11
Boring #
❑ Boring
0 Pit Ground surface elev. 97,85 ft. Depth to limiting factor 41 in.
Snil Annlicatinn Rake
Horizon
Depth
in.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft2
'Eff#1
'Eff#2
1
0-15
10YR 3/3
sil
lfsbk-lmpl
mfr
cs
3c-vf
0.4c
0.6
2
15-24
1OYR 5/4
-
sil
2fabk
mfr
gs
2c-vf
0.6
0.8
3
24-41
10YR 4/4
-
sil-I
2mabk
mfr-mfi
cw
1c-vf
0.6
0.8
4
41-56
1 OYR 416
f2f 7.5YR 416 d 10YR 6/1
Ifs-fs1
Osg-Om
ml-mfk
-
1 m-vf
0.2
0.5
❑ Boring #
❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Rnil Annlicatinn Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD1Ft2
'Eff#1
'Eff#2
Boring #
❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Snit Annlicatinn RatA
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft2
'Eff#1
'Eff#2
' Effluent #1 = BOD, > 30 5 220 mg/L and TSS > 30 5 150 mg/L ' Effluent #2 = BOD, > 30 S 220 mg/L and TSS > 30 s 150 mg/L
Page 12
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Wisconsin Depa a "A I ices Page 1 of 2
Division of Indust :
JUL 2 9 2022 SOIL EVALUATION REPORT
In accc rdance with SPS 385. Ws Adm. Code County
ST Croix
Attach complete site plan on g¢pQrWkl�stlhaq 8 112 x 1 inches in size. Plan must include.
but not limited to: ve ic�hdrygrptpj®pgggJClnt BM), direction and percent slope. Parcel LD
scale or dimensions, a to nearest road 028-1027-70-M
Please print all information. Re vl d by J / 1 at 2
Personal information you provide may be used for secondary purpposses Pnvacy Law. s 15 04 t m yL7i1 [I
Property Owner Property Location:
Joe Shakal (Seller) John Gallagher (Buyer) Govt Lot NE I/. NW %. S 23 T 28 N R 17 W
Property Address Lot # T
lock # Subd Name or CSM#
1967 30TH AVE
City State Zip Code Phone Number ❑ City ❑ village ❑■ Town Nearest Road
Baldwin WI 54002 (715) 410-7496 1 Rush River 30TH AVE
❑ New Construction Use M Residential I Number of bedrooms 5 Code derived design flow rate 750 GPD
Q Replacement ❑ Public or commercial - Describe
Parent material Loamy drift over sandy/gravelly outwash (Onamia-Antigo) Floodplain elevation if applicable NA fl.
General comments and recommendations: Recommend minimum 9" sand-kn POWT$ mound on 98 00 contour with 0 4gpdAt2 loading rats
LF • 31- (Redoximorphic features)
1❑ Boring # ❑ Boring
❑■ Pit
Ground surface elev. 98•00 It. Depth to limiting factor 42 in
Soil Aanlication Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu Az Cont. Color
Texture
Structure
Gr Sz. Sh.
Consistence
Boundary
Rools
GPDIFt'
•Eff#1
•Eff#2
1
0-9
10YR 3/4
-
1
1 msbk-1 mpl
cis
cs
1 m-vf
0.4
0.6
2
9-21
1 OYR 3/6
-
sl
1 mabk
mfr
gw
1 f-vf
0.4
0.7
3
1 21-42
1 OYR 616
-
Ifs
Osg
ml
ID
0.5
1.0
4
42-61
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f2f 10YR 4/6 a 10YR 612
Ifs
Osg
ml
-
0.2
0.6
Ho •rizon 4 h
2a4" thick
Ilnuous bands of
5YR 3/4 sl (0m). Loading
rates redo
for horizon to r
cl banding
ttion.
F2 ] Boring #
❑ Boring
0 Pit Ground surface elev 96-00 ft
Depth to limiting fa r 31
Soil Annlicahon Rate
Horizon
Depth
In
Dominant Color
Munsell
Redox Description
Qu. Az. Cont Color
Texture
Structure
Gr Sz Sh
Consistence
Boundary
Roots
GPD/Ft2
-Eff#1
-Eff#2
1
0-11
1OYR 313
1
1fsbk
mfr
as
1m-vf
0.4
0.6
2
11-31
1OYR 4/4
sil
2mabk
mfr
cs
1vf
0.6
0.8
3
4
31- 4
44-60
10YR 416
10YR 7/6
f2d 7.5YR 5/8 3 10YR W
fit 10YR 5/8 & 10YR 612
fsl
Its
1 mabk
Osg
mfr
ml
cs
cs
-
0.2
0.5
0.6
1.0
nnn.--- ....A
TCC � 9A
C 1r1n-11
CST Name (Please Print) _
Signal ure
CST Number
Ryan Becher
5e.4
1330832
Address
Date Evaluation Conducted
Telephone Number
779 Spring Creek RD S, Red Wing, MN 55066
07/13/22
(651) 327-0074
CRr1_R'i'tn lR114I151
❑3 Boring #
❑ Boring
Q Pit Ground surface ele4 97.85 ft
Depth to limiting factor 41 In
Soil Aooiication Rate
Horizon
Depth
In
Dominant Color
Munsell
Redox Description
Qu Az Cont Color
Texture
Structure
Gr Sz. Sh
Consistence
Boundary
Roots
GPD1Ft'
'Eff#1 'Eff#2
1
0-15
1OYR3/3
sil
1fsbk-1mp1
mfr
cs
3c-vf
0.4c
06
2
15-24
10YR 5/4
Sill
2fabk
mfr
gs
2c-vf
0.6
0.8
3
24-41
10YR 4/4
-
sil-I
2mabk
mfr-mfi
cry
1c-vf
0.6
0.8
4
41-56
10YR 416
12175YR 416 & 10YR 611
Ifs-fsl
OsgOM
ml-mfi
1 m-vf
0.2
0.5
4] Boring #
❑ Boring
❑ Pit Ground surface elev. ft Depth to limiting factor in
Soil Anoiication Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu Az Cont Color
Texture
Structure
Gr Sz Sh
Consistence
Boundary
Roots
GPDIFI'
-EB#1
'Eff#2
aBoring #
❑ Boring
❑ Pit Ground surface elev ft. Depth to limiting factor In.
Snfl Annlir-Ahnn Rate
Horizon
Depth
In
Dominant Color
Munsell
Redox Description
Qu Az. Cont Color
Texture
Structure
Gr Sz Sh
Consistence
Boundary
Roots
GPD1Ft'
'Eff#3
'Eff#2
' Effluent #1 = BOD, > 30 s 220 mg/L and TSS > 30 5 150 mg/L • Effluent #2 = BCD, > 30 s 220 mgiL and TSS > 30 5 150 mg/L
r
Bonng # Q■ Pit Ground surface elek. 97.1135 R.
Depth to limiting factor 41 in.
Seil Anntiration Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft'
.ER#1
•Eff#2
1
D-15
10YR3/3
-
sll
lfsbk-lmpl
mfr
cs
3c-vf
0.4c
0.6
2
15-24
10YR 5/4
-
sil
2fabk
mfr
gs
2c-vf
0.6
0.8
3
1 24-41
10YR 4/4
-
sil-I
2mabk
mfr-mfi
cw
1 c-vf
0.6
0.8
4
41-56
10YR 416
rzf r.SYR 416 a 1oYR sr1
Ifs-fsl
Osg-0m
ml-Mfi
-
1 m-vf
0.2
0.5
Boring
❑ Boring
❑ Pit Ground surface elev. ft.
Depth to limiting factor in.
Snit A'nnIirAinn Rate
Redox Description
El Boring #
❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Snil Anoliratim Rate
Dominant Color
Murtsell
Redox Description
Qu- Az. Cont. Color
Effluent 01 = DOD, > 305 220 mg/L and TSS > 30 5 150 mg/L • Effluent 02 = BOD, > 30 5 220 mg/L and TSS > 305 150 mg/L
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