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Home My WebLink About038-1186-50-000 (6)PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) Wisconsin Department of Commerce Safety and Building Division GENERAL INFORMATION TANK INFORMATION TANK SETBACK INFORMATION PUMP/SIPHON INFORMATION SOIL ABSORPTION SYSTEM DISTRIBUTION SYSTEM SOIL COVER COMMENTS: ELEVATION DATA Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: CST BM Elev:Insp. BM Elev:BM Description: County: Sanitary Permit No: State Plan ID No: Parcel Tax No: TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK TO P/L WELL BLDG.Vent to Air Intake ROAD Septic Dosing Aeration Holding Manufacturer Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia.Dist. to Well Demand GPM STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer St/Ht Inlet St/Ht Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover BED/TRENCH DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia.Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL Type Of System: LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacturer: Model Number: Header/Manifold Length________ Dia________ Distribution Pipe(s) Length_________ Dia_________ Spacing_________ x Hole Size x Hole Spacing Vent to Air Intake x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Bed/Trench Center Depth Over Bed/Trench Edges xx Depth of Topsoil xx Seeded/Sodded xx Mulched Yes No NoYes (Include code discrepencies, persons present, etc.) Location: 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Inspection #1: Inspection #2: City Village Township Section/Town/Range/Map No: Plan revision Required?Yes No Use other side for additional information. Date Insepctor's Signature Cert. No.SBD-6710 (R.3/97) 8/31/2023 St Croix County Community Development RE: Request for expedited Sanitary Permit review Owner: Ian & Kati Young 1373 211th Ave Town of Star Prairie Reason: Failing as per 141.245(4). Septic / dose tank is cracked and broken. Liquid in the tank is dropping overnight indicating sewage is leaking from the tank into the ground. Michael Rodewald MPRS 931384 PL-525 Filter The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has 525 linear feet of 1/16 filtration slots. Like the Polylok PL-122, the Polylok PL-525 has an automatic shut-off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent wont leave the tank. Features: Rated for 10,000 GPD (gallons per day). 525 linear feet of 1/16 filtration. Accepts 4 and 6 SCHD 40 pipe. Built in gas deflector. Automatic shut-off ball when filter is removed. Alarm accessibility. Accepts PVC extension handle. PL-525 Installation: Ideal for residential and commercial waste flows up to 10,000 gallons per day (GPD). 1. Locate the outlet of the septic tank. 2. Remove the tank cover and pump tank if necessary. 3. Glue the filter housing to the 4 or 6 outlet pipe. If the filter is not centered under the access opening use a Polylok Extend & Lok or piece of pipe to center filter. 4. Insert the PL-525 filter into its housing. 5. Replace and secure the septic tank cover. PL-525 Maintenance: The PL-525 Effluent Filters will operate efficiently for several years under normal conditions before requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped, or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. 1. Locate the outlet of the septic tank. 2. Remove tank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. 4. Pull PL-525 cartridge out of the housing. 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank. 6. Insert the filter cartridge back into the housing making sure the filter is properly aligned and completely inserted. 7. Replace and secure septic tank cover. PL-525 Effluent Filter Accepts 4 & 6 SCHD 40 pipe 10,000 GPD 1/16 Filtration Slots p p & 6 ipe 00 GPD00 GPD ltration Slots Accepts 1 PVC Extension Handle Alarm Switch (Optional) Rated for 10,000 GPD Gas Deflector Automatic Shut-Off Ball 525 Linear Ft. of 1/16 Filtration Slots Outdoor SmartFilter® Alarm Polylok, Zabel & Best filters accept the SmartFilter® switch and alarm. Extend & Lok Easily installs into existing tanks. E d & L k Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com Septic System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. 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. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Drain Field Effluent quality into the drain may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG. Observation pipes within the dispersal cells shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches is considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective, the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the drain field component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced to bring the system into proper operating condition. Installer -- Mike Rodewald Bettendorf Excavating 715-425-6200 Septic Pumper Darrells Septic 715-425-1025 Regulatory Agency St Croix Cty715-386-4680 Community Development Department Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd@sccwi.gov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.gov SANITARY SYSTEM OWNERSHIP/ADDRESS FORM 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.If you would like to view your issued sanitary permit online, you can do so by using the Property Files Scanned weblink. Owner/Buyer Mailing Address City/State/Zip Phone Number (required) Email Address (required) Parcel Identification Number (found on the property tax bill) Property Location _____ ¼ , _____ ¼ , Sec. _____, T _____N R_____W, Town of . Subdivision Plat: , Lot # _____. Certified Survey Map # , Volume , Page # . Warranty Deed # (before 2006)Volume , Page # . Number of bedrooms Spec house yes no Lot lines identifiable yes no New Property Address (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 Office and a copy of the certified survey map if reference is made in the warranty deed. NEW SYSTEM: LEGAL DESCRIPTION File #: ______________ Office Use Only Created 2/2021 OFFICE USE ONLY OWNER/BUYER INFORMATION Ian C. & Kati CT. Young 1373 211th Ave New Richmond, WI 54017 612-718-3442 kati.young0215@gmail.com 038-1186-50-000 SW SE 13 31 18 Star Prairie Prairie Flats Addn 1998 1126076 3