HomeMy WebLinkAbout182-1026-40-125VOsconsm Depanmem of Commerce PRIVATE SEWAGE SYSTEM
County. St. Croix
Safety and 8m0d.ng D'v—n
INSPECTION REPORT
Sar,%ry Perms No
GENERAL INFORMATION
(ATTACH TO PERMIT)
645489
Femoral ntormstion you provide troy be used br sitoOndary Purposes [Primacy Law. e.1 S.04 (1)(m)I
Slam Plan ID No.
Parma Holds a Name
Donald J 8 Lori J Stephens
City Village Toenallip
Parcel Tax No:
VILLAGE OF STAR PRAIRIE
182-1026-40-125
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Sechon1Tov nrRangefMsp No.
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TANK INFORMATION
ELEVATION DATA
TYPE
MANUFACTURER
CAPACITY
Septic
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TANK SETBACK INFORMATION
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PUMPISIPHON INFORMATION 2 a ' I
Manufacturer
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mand
GP�S,y
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Model Number
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TDH 1-iN55
Friction Loss System Head TDH
FI
2s3
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Foroemain Length Dig. Dial to Vyap
s
10 Z 10 ) mro i�
bVIL AtSbUKV IIVR bYbTEM
STATION
BS
HI
FS
ELEV.
Benchmark
914
QG. s
Alt. BM
Bldg. Sewer
�.I3
9D `i2
SUHI Inlet
ID.4s
�i.2s
StIH1 Outlet
of Inlet
of Bottom
i3o
g(o�
Header/Man.
Sys
92.zs
Dist. Pipe
Bat. System �1 L
r
y
b
Final Grade
9 VF
St Cover
31
9' 4.
znleJ
SED"RENCH
DIMENSIONS
V*fth (
Larger
(Db
No. Of Trenches
'l (*)to.1
PIT IONS
No. Of Pits
Inside IN..
Liquid De
SETBACK
IN
SYSTEM TO
PIL
BLDG
WELL LAKE/STREAM
LEACHIqO.
CHAMBE
anufacturer I
�nIi111dto•/
Type Of System:
�sndhiioval
)25
) J�
I OD
UNIT
odal Number
U10 1 KIGU I IVP/ OTO I CM
HeaderlMene
P,
x HaN SQ.:
Hab S1lecap
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LM D'
Lanpm
Die Spacing
SOIL COVER x Pressure Systems Only
It Mound Or At -Grade Systems Only
Depth Over I
Bsrfrtrerlch Cares" 2.s
C." Over
Be nrA
xs Deptlr of
sos
Ssadedr5odded
xa Mu
'�
Ysa 1
Yes No
COMMENTS: (Include Code discrepancies. persons present. etc.)
Inspection 01: Inspection e2:
Location: 456 HILL AVE
1.) Alt SM Description =
2.) Bldg sewer length = 7(0'1
• amount of cover • 4-
Plan revision Required? ❑ Yea ❑n. No
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I m 2
FILE INFORMATION
Owner Uoal L(ig,\ S
Permit t
DESIGN PARAMETERS
Number of Bedrooms
3 13NA
Number of Public Facility Units
,Is NA
Estimated flow leverage)
3 al/de
Design flow (peak), (Estimated x 1.5)
Lt�gal/day,
Soil Application Rate
--1 galldeytW
Standard Influent/Effluent Quality
Monthly average•
Fats, Oil & Grease IFOG)
SW mg/L
Biochemical Oxygen Demand fBODs)
5220 mg/L ❑ NA
Total Suspended Solids (TSS)
5150 mg/L
Pretreated Effluent Quality
Monthly average
Biochemical Oxygen Demand (BODr)
530 mg/L
Total Suspended Solids (TSS)
530 mg/L ❑ NA
Fecal Collform Igeometric mean)
510' cfu1lOOml
Maximum Effluent Particle Size
Y. it dia. ❑ NA
Other:
❑ NA
•Values typical for domestic wastewater and septic tank etfimM.
SPECIFICATIONS
Septic Tank Capacity
y
❑ NA
Septic Tank Manufacturer
tAfJJZ
O NA
Effluent Filter Manufacturer `, / �./� C
❑ NA
Effluent Filter Model
1 8
❑ NA
Pump Tank Capacity
660al
O NA
Pump Tank Manufacturer
W165 6 K
❑ NA
Pump Manufacturer ZOeLLEi2
O NA
Pump Model
5
O NA
Pretreatment Unit
❑ Sand/Gravel Filter
❑ Mechanical Aeration
❑ Disinfection
❑ Pest Filter
❑ Wetland
❑ Other:
jo
,Diis'persal Cellls)
WIn-Ground (gravity)
❑ At -Grade
❑ Drip -Line
❑ NA
❑ In -Ground (pressurized)
❑ Mound
❑ Other:
❑ NA
Other:
❑ NA
Other:
❑ NA
` Service Event
Service Frequency
Inspect condition of tankls)
At least once every:
monthlsl (Maximum 3 years)
earls)
❑ NA
Pump out contents of to nk(s)
When combined sludge and scum equals one-third p51 of tank volume
❑ NA
Inspect dispersal celllsl
At least once every:
❑ monthlsl (Mulmum 3 years)
!� serial
❑ NA
Clean effluent filter
At bast once every:
❑ monthlsl
serial
❑ NA
Inspect pump, pump controls & alarm
At least once every:
❑ aerial ❑ month(s)
NA
Rush laterals and pressure test
At least once every:
❑ mon 11 -
❑ ea(sl
NA
Other:
At least once every:
❑ month(s)
❑ ear(s)
NA
Other:
❑
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal calls shell be mad+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 ponding of effluent on the ground surface.
The dispersal celllsl 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 ponding 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 IYs) or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filers, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
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....,r,ac.a &ACISS SXlCTION AND SPECIFICATIONS
6' Cl YpR PIPE 12" MIN. ABOVE GRADE t MGM PROOF
2 26' PROM DOOR, MINDOY OR .UMMON SOX APPROVED
FRESH AIR INTAKE WITH CONWIT MANHOLE
FINISHED GRADE Y' CI RISER W/ PAOLO
6" MIN. WARNNING
_ ABOVE G ADC s►" MI
I$" 1fI11. 6" MAX. •�
INLET
,`WATER TIGHT SEALS T GAs- ;
TIGHT-'
Y" BAFFLE A SEAL • APPROVED
Ci Pi PE —�— NA JOINTS W,
3' ONTO B N PIPE 3' i
SOLID T- SOLID So:
C
SOIL PUMP OFF ELEV. FT. RISER
O PERMITrM
IF TANX
MANUFACTL
3" APPROVED BEDDING UNDER TANK HAS APPRN
CONCRETE PAD
SPECIFICATIONS
gcPTIC 1 DOSE
TANK MAMUTACTURERs WIE 5£iZ NUMBER DOSES PER DAY: r
TANK SIiCS: SEPTIC iCoO GAL. DOSE VOLUME INCLUDING QA
DOSE GAL. FLOWBACK: GAL.
ALARM MANIFACTUNER: M �S CAPACITIES: A : MODEL NL_ INCHES
UMBER: SWITCH TYPE: B : 2 .INCHES'` i
PUMP MANUFACTURER: 20C L(G 0 -7G AI- C =
RICHES
MODEL NUM817t : byu us I � G` � n,r �
SWITCH TYPE: D n INCHES = I�7.-71
REQUIRED DISCHARGE RATE 3L GPM PUMP G ALARM WIRING AS PER ILHRz16.23
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . . 'FEET
MINZtQlfl NETWORK SUPPLY PRESSURE . . . . FELT
)_. FEET FORCEMAIN X FTlioo FT. FRICTION FACTOR . 2. FEET
TOTAL DYNAMIC HEAD � FELT
INTERNAL DIMENSIONS OF PUMP TANK: LENGTH IZ� : YIOTH 15
DIAMETER
LIQUID DEPTH -
:IGNED: LICENSE NUMBER:
PULL POiFi0R11111iCE CLIME �
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ST. CR NTY SANITARY SYSTEM Flefk
" 1- OWNERSHIP/ADDRESS FORM oan 21 oaty
rr.oted2/zoat
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 PropeM Files Scanned weblink.
OWNBVBUYER INFORMATION
Owner/Buyer Donald J & Lori J Stephens
Mailing Address 456 Hill Avenue (P.O. Box 280)
City/State/Zip Star Prairie, WI 54026
Phone Number (required) 612.961.6492
Email Address (required) don.stephens@gaderandhighstrom.00m
Parcel Identification Number 182-1026-40-125
(found on the property tax bill)
NEW SYSTENk LEGAL DESCRIPTION
Property Location NE ,�, NW Yi Sec 12 T 31 N R 18 W, Town of Village of Star Prairie
Subdivision Plat: Lot #
Certified Survey Map # tO I Z 5 0 . Volume L 3 Page # 3�53
Warranty Deed # 0 3 �tqx (before 2006)Volume . Page #
Number of bedrooms 3 Spec house O yes ■ no Lot lines identifiable ■ yes O no
OFwc[ USE ONLY
New Property ddress
Nerifi ion of new address required from Community Development Departmen for new construction.)
I�
( aH nitiah)
This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications.
Now 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.
Community Development Department — Land Use Division
715-386-4680 St Croix County Government Center 715-245-4250 Fax
cdd0sccwi.aov 1101 Carmichael Road, Hudson, WI 54016 www.sccwt aov
Kevin Grabau
From:
Doug Avoles
Sent:
Tuesday, December 6, 2022 5:40 PM
To:
clerk@villageofstarprairie.com
Cc:
Kevin Grabau; Linda Geraghty
Subject:
Address question
Attachments:
456 and 474 Hill Ave - Village of Star Prairie.pdf
Follow Up Flag: Follow up
Flag Status: Flagged
Amanda,
Per our phone conversation today, I have moved address 456 Hill Ave to parcel 182-1026-40-125 (the lot the
Stephens are going to be building on) and assigned 474 Hill Ave to parcel 182-1026-40-135 (the lot with the
existing cabin). Attached is a pdf map showing the new address points in our GIS data.
Kevin, you can use 456 Hill Ave for that permit the Stephens have an application in for. Let me know if you
need any other info from me.
Doug
Amanda,
We recently received a Sanitary System Permit application from Donald J & Lori J Stephens for their property
on Hill Ave. They have 2 lots of a Certified Survey Map. They are planning on building on Lot 1 which is the
eastern lot of the two. On Lot 2 they have a smaller home/cabin, not sure if they reside their or if it is just used
as a vacation place. They also have indicated on the application form that 456 Hill Ave and PO Box 280 is their
current mailing address. PO Box 280 is what is listed in our records for the tax bill mailing address. And we
have 456 Hill Ave listed on both of their parcel records (182-1026-40-125/1-ot 1 and 182-1026-40-135/Lot 2)
for the property address in our property assessment system. In our GIS map data we have an address point for
475 Hill Ave that appears it may have been assigned in 2015. It is located on 182-1026-40-125/1-ot 1, but is not
an existing property address listed in the property assessment system. We do not have an address point in our
GIS data and 911 Dispatch system for 456. Therefore, I am working to reconcile all of these discrepancies in
our information and I am hoping you will be able to help shed some light on these issues
Do you know if 4S6 is actually being used? Has the Village assigned an address for 182-1026-40-125/Lot 1
that the Stephen's are planning to build on?
If 475 was assigned for Lot 1 back in 2015, and the home/cabin is 456, then these would be out of sequence. If
that is the case we should look at either flipping 456 and 475 so that 475 is for the existing home/cabin and
456 is for the new home they plan to construct. Or even assign new numbers. I also see that the Village has all
even number addresses on the north side of the road, so I am a little more confused on background of the 457
address point we have in our GIS data.
Thank you for looking into this.
Doug Avoles I Community Development - GIS Analyst II
1101 Carmichael Rd Hudson WI 54016
T:715-381-4934 I F:715-381-4400
DouaAvolesgOsccwi.aov
ST. CR VNTY
srna.ru
Doug Avoles I Community Development - GIS Analyst II
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Wisconsin Department {safety and A '' Page
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N� RR L EVALU �0
• DN'rsbn of Industry 'j V C�16` 4' —�7
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D op ante with SPS 385, Wis. Adm. Code County St C'ro 1 X
Attach complete site plan on p s than 8 112 x 11 inches in sae. Plan must Include,
but not limited to: vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D. u
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scale or dimensions, north arrow, and location and distance to nearest road. I Z
Pease print all Information. R 'awed by
1l�atR �Z
27/7z.
Personal infcanadon u provide may be used for seconds u sea Prive Law 1 s. 15.04 m
Properly Owner
Property Location
NE ''/ '/. S 1 2 T 3 N R
❑
E (or) W
n V\ e S
GovL Lot tQUJ
Prope'fS,vn 's fling Address
Lot #
(
Block #
Subd. Name or CSM#
Cs
3753
a 2
uo I
City State ZI Code Phona Number
eares
❑ ray Village ❑ Town Nt Road
St7+R Pr �v e LA,sTwr
Rq;r,e I R
CT
New Construction Use: GM Residential/Numberof bedrooms _ Code derived design flow rat _ GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material Flood Plan elevation if applicable _ ft.
General comments and recommendations:
c re r
ElBoring �.
Pit Ground surface elev�Z-
Fil Boring # ft. � epth to limiting factor
_ in.
AQ leh!zit- c..a e.,.
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Ou. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft'
'Eff41
'Eff#2
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0-7
7, R
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CS
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2
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2q-15
7-3vek 946
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c,
RAV
Boring # ❑ Boring
�5. 2 7 103
Pit Ground surface elev. —ft. Depth to limiting factor _ in.
Soil A lication Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Ou. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft'
•Eff#1
'Ef#t2
0-7
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' Effluent #1
= BOD, > 30 5 220
/L and TSS > 30 5 150
m /L
' Effluent
#2 = BOD, > 30 s
220 m /L and
TSS > 30
s 150 m
CST a (Please Pri
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Signature
CST Number ^ /!�
L 7
Address
T �P s rtir
Date Evalu Cond ed
/( Zz
Telephone Number
a - s/yo
-5VC&
Q i.�
Boring # ❑ Boring 1 3 • 1 7 7 V
Pit Ground surface elev. ft. Depth to limiting factor _ in.
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Ou. Az. Cont Color
Texture
Structure
G, Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft'
•Eft#1
'Eff#2
q r
rn
115
sq
ml
q
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lu
✓ns
1
—
V!32-
❑ Boring #
❑ Boring
❑ Pit Ground surface elev. -ft. Depth to limiting factor _ In.
Boring #
❑ Boring
❑ Pit Ground surface elev. -R. Depth to limiting factor _ In.
Soil Application Rat.
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Ou. Az. Cont Color
Texture
Structure
Gr. S.Sh.
Consistence
Boundary
Roots
GPD/FP
'Eff#1
'Eff#2
Effluent #1 = BOD, > 30 5 220 mg/L and TSS > 30 s 150 mg/L ' Effluent #2 = BOD, > 30 s 220 mgfL and TSS > 30 s 150 mg/L
P52�{�
Boring El Boring 1 J.q 7 721/
E Pit Ground surface elev. —ft. Depth to limiting factor_ in.
Soil Applicatlon Rate
h.
���1'C!r•3L
���i-111L1�-�����
❑ Boring #
❑ Boring
❑ Ph Ground surface elev. —ft. Depth to limiting factor _ In.
Soil Application Rate
Horizon
Depth ..
.. In:
Dominant Collor
Munsell
Redox Description
Ou: A.F. Cont Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft'
•EfF#1
'Eff#2
7 Boring #
❑ Boring
❑ PR Ground surface elev. _ R Depth to limiting factor _ in.
Soil Application Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Ou. Az. Cont color
Texture
Structure
Gr. Sz. Sh.
consistence
boundary
Roots
GPD/Ft'
•Eff#1
'Eff#2
• Effluent #1 = BOO, > 30 S 220 mg/L and TSS > 30 5 150 mg4 ' Effluent #2 = BOD, > 30 5 220 mg/L and TSS > 30 s 150 mg/L
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