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HomeMy WebLinkAboutSAN-2023-200 038-1186-50-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15-04 {1 ){m)] Permit Holder's Name: City Village Township IAN C YOUNG I TOWN OF STAR PRAIRIE CST BM Elev: Insp. BM Elev: BM Description: 100.00' Top Of lot pin in SE corner TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic 1 f �'�j1e52.0 L.o+^nbo I � DC7O �l Dosing TANK. SETBACK INFORMATION TANK TO PIL WELL BLDG. Vent to Air Intake ROAD septic -- ] 5G Dosing Aeration Holding PUMPISIPHON INFORMATION Manufacturer L, Demand GPM Z,5-4yndikr� Model Number 25,0 (KeL TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM r) County: St. Croix Sanitary Permit No: SAN-2023-200 State Plan ID No: Parcel Tax Na: 038-1186-50-000 SectionlTown/RangeiMap No: 13.31-18.946 STATION BS HI FS ELEV. Benchmark Alt, SM OF Bldg. Sewer St/Ht Inlet St/Ht Outlet Ot Inlet Dt Bottom 11 21 �n l F Header/Man. (From pean.it #353400) 103.2 6.95 95.25 Dist. Pipe Bot. System Final Grade St Cover BED1TRENCH DIMENSIONS .Width Length ❑. Trenches IMENSIONS No Of Pits Insi Liquid Depth SETBACK INFORMATION SYS EM TO PIL BLDG LL LAK STREAM LEAC G CH ER OR UNIT Manufacturer: Typ Of System Model Number: DISTRIBUTION -SYSTEM Header/Manifold - stribution x Hale Size x Hole Spacing Vent to Air Int ipe(s) Length _- Dia Length Dia ._ _--Spacing _.- SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seededi5odded Mulched Bed rich Center d r Edges Topsoil Yes Ne Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Location: 1373 211TH AVE 1.) Alt BM Description = 2.) Bldg sewer length = 25` - amount of cover = Plan revision Required? YesO]N Use other side for additional informa Date SBD-6710 (R.3/87) Inspection #2: gc, i fnsepctor's Signal Cert- No. -COUNTY STATE SANIT [A _E_ _&� 11 I.-P -M _x_j -&,%a JL%Li" -L �E�tAC'�n�nii � 7�IN K (� � OWNER �t3 C. qD SEC I a , 2�_N, RjB _E/W 15 BLOCK. ARY -1-3 �? I t tt_� NO.` r� PREVIOUS SUBDIVISION 34Z . 1539ob CHAPTER 145.135 (2) WI5CONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit- (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c.168; 1979 c. 34,221, 1991 c- 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. ,Ap� Lc%r" AUTHORIZED ISSUING OFFICER - DATE Q.T2� THIS PERMIT EXPIRES I . I • Zq UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (R11120) RECEIVED Industry Service,, t)ivision Cculri[� 4822 Madis,rn Y.u'cEs 1�'ttti' aa�al�zaz S ' C "' x �. Sanitary t t rm.l Nunib�r (to be filled in by Co.) Madtion, W1 - .3705 _ Paid Via Ascent P.O. Box 7162 Madkon, W1 53707-7162 Sanitary Permit Application St roc `fra,caCtsan Nu,nhcr In accordance with SPS 383.2](2), Wis, Adis. Code, submission of this form to the appropriate goventmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POW'l'S are submitted to Project Address (if diflcrent than mailing address) the Department of Safety and Professional Services- Personal ['formation you provide may be used Im secondary Same Purposes in accordance with the Privacy Law, s. 15.04(1)(rn), Scats. I. Application Information - Please Print All Information Property Owner's Name Parcel M Ian C. & Kati CT. Young 038-1186-50-000 Properly Owner's Mailing Address Property Location 1373 211th Ave Gov[. Lot City, State /ip Code Phone Number _ _ New Richmond, Wi 154017 612-718-3442 SW _-y�,SE �4. Section 13 _ 11. Type of Building (check all that apply) Lot 4 _ T31 N R 18 T, ar w f�I or 2 Family Dwelling --Number of Bedrooms _ 15 Subdivisioii Name Block 4 Prairie Flats Addn 1998 ElF'ublic/Commercial - Describe Use - '❑City ❑State Owned- Describe Use CSM Number i�T'owrt of Star Prairie --- Ill. 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 applicable. A. EINew Svstein []Replacement lacement System � iher Modification to Exis[ing Sy: em {c plain) �Addl[IUnaI PTCIrCiltnlem Unit (explain) LLJJ ptto Tank Replacement B. ❑]1oldin rant[ 8 �In-Ground ❑At•Gradc Mound 117dtVld[la1 Site Design Other'I'ype (explain) (conventional] C. FRen,v,.113ef,, hange of Plumbcr �l ransrcr to New Owner List Previous Permit Number and Date Issued Fxpiration �[]Rcvision R 353400 4/17/2000 IV. his ersailTreatment Area and Tank Information: [hsign Flow (gpd) 450 Design Soil Application Rate(gpd'sl) Dispersal Area Requirctl (so Oispersal Arca i570 1'Inlmscrl {st] Sastcm 1:Ie�ation D.8 562 95,18/95.22 Capacity in 'Total # of Manulacturer Tank Inrormation Gallons Gallons Unil, o New Tanks Existing Tanks o u Sepik or Holding Tank 1606 1000 1 1 Wieser Dosing Clwin ber 650 650 LjIF7=11= V. Responsibility Statement- 1, the undersigned, assume responsibility for Installation of the POWTN shown on the attached plans. Plumber's Name (Prou] iSignat Milim, RS Number l3tisiness Phone Nurnim Michael Rodewald Zurti 1931384 715-425-e200 PItLinbcr's Address (Street, City, State, Gip C'ode) 285 County Road SS River Falls WI 54022 Vl. County/Department Use Only Approved El Disapproved Permit l ee Dal, 1, red lss,Inig Agent Signature ❑ C'3wncr Given Reason For Denial 1 Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 1. *lic tank, eFfiuenI filter and dispersal cell must be serviced i maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code i ordinances. Attach to complete plans for the system and submit to the County only nn paper not less thin 8 In .I I inches in sirs SRD-6398 K 03121) 285 COUNTY RIVER FALLS 800-828-3723 715-425-8466 8/31 /2d23 St Croix County Community Development RE: Request for expedited Sanitary Permit review Owner: Ian & Kati Young 1373 2111h 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 SEPTIC/DOSE TANK REPLACEMENT Owner's Name Ian C & Kati CT Young 1373 211th Ave New Richmond WI 54017 Located in the SW 'Ia of th e. SE Y, of Section 13, T 31 N, R 18 W. TOWN OF STAR PRAIRIE ST CROIX COUNTY Parcel # 038-1186-50-000 INI)I,:X Page 1 index & Title Pag,e 2 Plot Plan Page 3 Dose Tank Cross Section Page 4 Pump Performance graph Page 5 Poly-lok PL525 Filter Instructions Page 6 Septic tank specifications Page 7 Management Plan Attachments: Request for Expedited Review Sanitary Ownership form Certification of Drain Field Iced Plot Permit File Prepared By Michael Rodewald 285 Count Road SS Ri% cr• Falls E.N;1, 5=1022 715-821-6229 -MPRS 931384 e1 ,1 2uZ-3 Page 1 of 7 pzo - PZAA1 Its /<- A 0 3S -1186 - -o - 0 o d Q: Septic -Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer W iescr Tank Model Number LP1000/650-MR Total Tank Capacity Max. Bury Depth Filter Manufacturer of -lok Filter Model Number -5 5 Minimum Pump Performance Required 25.00 GPM I g 15.90 Ft TDH Pump Manufacturer Libei-t Pump Model Number 253 Alarm Manufacturer SJ E Rhombus Alarm Model Number 13 Switch Type INlechinical Total Dynamic Head (TDH) - Feet Elevation Head Distal Pressure Network Lass Force Main Loss Total _ - .90 Outlet Manhole Min. 4" Above Grade With Locking Device. inlet Manhole Manhole Min. 4" Above Grade C 6" Below Grade Sealed Watertight Securely Mounted With Locking Device Weather-proof Junction Box Finished Grade — -• ,.� Depth of Cover Vent Min. 12" Disconnect Ft Above Grade Means With Vent Cap t, tF-4: 4 4 i 4 1 4< 44 Outlet Outlet FilterInlet 't' ,,_� Inlet Baffle ___-- _ _ - - - t A 'c }i} Switch Settings and Reserve Capacity .>4 '< '/4" < X Tank Volume = GPI {:{ ;< Weep >{> Dimension Inches Volume Gal. <;< B }< HoIe > [ (reserve) A 19 323 >i }<} (alarm) B 2 34 <}< Off Elevation CFt (dose) C 85 e'< 4'4 Bottom } (dead) D 12 204 .}< D )< Elevation Total 38 646 Ft } ) t �� >4> - ........r 4 4 4 i<< i 4 t t < s > 1 } ! } ! > > y } } Y [ t S i;< 4 4 4 i< 4 4 2< S f[ i 4 i 4< i t s<< ] ] ] > ! > ! s__s._>__>._)_)_Y_>.5.l.1 }.).}.y.}.Y.> ? > > > > 1 } s } ] ) } Y } > Y ) ) > f > T s } y y4 GENERAL INSTALLATION: The septic/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 or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28 WAC. 02/05 LJ Page 3 of 7 ljbel'r'o Flu--s- V, LITERS PER MINUTE s 0 20 40 60 80 100 120 14Q 160 1&0 25 2^0 IN 5.9 0 10 :.0 30 40 GALLONS PER MINUTE 43 i'.I� ii U.t 'u I� Y rb.•i i7 I'uinp. Pnc CIS iidl u: ra�n :J. by+ndi r..a ion4 o-nbjCcl In aha�igo ai16uu1 nin ira. B 6 s 2 1 m"f— Pumps- Page 4 of 7 Page 5 of 7 P40LY.AMW110KjMlnr. Innovations in Precast, Drainage � ' Zabel" & Wastewater Pro6cft A division of Potylok Inc. PL-525 Effluent Filter PL-525 Filter The PL-525 Filter is rated for 10,000 GPD (gallons per dav) making it one of the largest filters in its clay. It has 525 linear feet of ] / 10" filtration slots, like the l'olOok PI.-122 the Polvlok Pl,-525) has an alltoni atic . 111E1-off 11a11 installed with evert filter. � hen the filter i�!, remo\ ed for cleaning, the Lull will float ul) and temporarilt shut off the system so the effluent " ain't Ica v e the tank. If Features: • Rated for 10,000 GPD (gallons per day). linear feet of 1/16" filtration. 1.,c cl, t, V and 6" SCHD 40 pipe. 111� in c;as deflector. 1 ti f o i i iatic shut-off ball when filter is removed. ,Darin 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. 1/16" Filtrath 2. Remove the tank cover and pump tank if necessary. , Accepts 4" & 6" 3. Glue the f i I for housing to the 4 or 6' outlet pipe. If SC HD 40 pipe the filter is not centered tinder the access opening use a Polylok Extend & lark 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 Vears under normal conditions before requiring clean in, It is recnmmc•nLiCLI that the filter be cleaned every tine the tank i-; 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 ta, ; I: cover and pump tank if necessary. 3. Do not use h; t I m h i iI- when filter is removed. 4. Pull PL-525 c a r I r i , e out of the housing. 5. Hose off filter of er 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. in ti�citrh tionalJ -cepts 1" PVC tension Handle Rated for 10,0UU GPD 525 Linear Ft. of 1/16" Filtration Slots Certified to NSF/ANSI Standard 46 (I D_ 7 —Gas DeflectorAutomatic Shut -Off Ball Outdoor SmartFilterO Alarm Extend & Loklnl Polylok, Zabel & Best filters accept Easily installs the Sma rt F i I LUTO switch and alarm. into existing tanks. Polylok, Inc. 3 FairficlJ 131%J. 1lailingford, CT 06492 Toll Free: 871.765.9565 1-av _10). 2�4.S5 14 www.pol%lok.cojii WLP1666/650—MR TANK SPECIFICATIONS 12'-2" DIMENSIONS: WALL: 3" 4" CAST -A -SEAL 4" CAST -A -SEAL BOTTOM: 3" COVER: 5" MANHOLE: 24" I.D. PRECAST CONCRETE RISER -------------� 1------{� HEIGHT: 54 1/2" k i li�l i LENGTH: 12'-2" WIDTH: 7'-0" i BELOW INLET: 43" LIQUID LEVEL: 38" }. + J-1 WEIGHT: 14,940 LBS. II 4 I INLET AND OUTLET: II FILTER OR - illi II 4" CAST -A -SEAL BOOT OR EQUAL GASKET i BAFFLE �I�{ � INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 26.32 GAL/IN (SEPTIC) TOP VIEW 17.00 GAL/IN (PUMP) LOADING DESIGN: 8'-0" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC/SEPTIC, SEPTIC/PUMP, O w OR SEPTIC/SIPHON ry 0 4" VENT COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #10 (STRUCTURAL FIBER) CUSTOMIZED TANKS: ____ FOR CUSTOM TANKS CONTACT WIESER CONCRETE INLET - ---- -- - _ --- —- OUTLET �� v> + Qc -J f t LO aY'] �— 00 d ro U I d 3„ .I rlj���- + REVIEWED BY PUMP PAD REVIEW DATE Page 6 of 7 TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL HATE: PRODUCTS NEEDED BY: LO n ul ul 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, Stalls. 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 i 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 113 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 mgfL TSS, and 30 mglL 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 Darrell's Septic — 715-425-1025 Regulatory Agency — St Croix Cty-715-386-4680 Page 7 of 7 ST. CR9 LJNTY SANITARY SYSTEM File #: Office Use Only OWNERSHIP/ADDRESS FORM Cr'eated212027 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 y .�' would five to vies,., your issued sanitary poi nit online, you can do so by LSHIg the Property Files Scanned weblink. OWNER/BUYER INFORMATION Owner/Buyer Ian C. & Kati CT. Young Mailing Address 1373 211 th Ave City/State/Zip New Richmond, WI 54017 Phone Number (requi Email Address (requi 612-718-3442 kati.young02l5@gmail.com Parcel Identification Number 038-1186-50-000 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location SW '/a SE 1/4 , Sec. 13 T 31 Subdivision Plat: Prairie Flats Addn 1998 Certified Survey Map # Warranty Deed # 1126076 N R 18 W, Town of Star Prairie Volume . Page # (before 2006)Volume , Page # Lot # Number of bedrooms 3 Spec house E3 yes ® no Lot lines identifiable ■ yes E3 no OFFICE USE ONLY New Property Address (Verification of new address required from Community Development Department for new construction.) 1 I (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. 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.sccwt.gov III�I7 6I�9�I�I�2� State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document No, Document Name THIS DEED, made between Philip L. Brand, a single person ("Grantor," whether one or more), and Ian C. Young and Kati C.T. Young, husband and wife as survivorship marital property ("Grantee," whether one or more). Grantor warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property°)(If more space is needed, please attach addendum): 1126076 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI 03/23/2021 09:48 AM EXEMPT#: REC FEE 30.00 TRANS FEE 870.00 175[h *-5ij Recording Area Name and Return Address: Northwest Land Title, Inc. PO Box 520, 105 Central Avenue Milltown, WI 54858 Zt I D !;�)Z_ Parcel Identification Number (PIN) 038-1186-50-000 , This Is homestead property. Lot 15, Prairie Flats Addition, Town of Star Prairie, St. Croix County, Wisconsin. Dated: BY: 'Philip L. Brand (Signatures may be authenticated or acknowledged. Bath are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. QUIT CLAIM DEED 2003 STATE BAR OF WISCONSIN FORM NO. 3-2003 'Type name below signatures St. Croix County 1126076 Page 1 of 2 AUTHENTICATION Signature(s): Philip L. Brand authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stag 706.06) THIS INSTRUMENT DRAFTED BY: Philip L. Brand ACKNOWLEDGMENT STATE OF % I V% Pt • IT' OF �51n�v+►��-o I, ai- s A . SU.- a Notary Public for the County of Whh-v � � and State of IAlir.-QQcin, do hereby certify that hilip L. Brand personally appeared before me this day and acknowledged the due execution of the foregoing instrument. sr - Witness my hand and official seal, this the �! of LLpen r L , 2021. (SEAL) JAMES A SOER wom PUBIx 6 (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM, ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED, QUIT CLAIM DEED 2003 STATE BAR OF WISCONSIN FORM NO. 3-2003 'Type name below signatures St Croix County 1126076 Page 2 of 2 r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) rUFSOFtet tnturtrrauutt YOU prwtC;e stray LAI useu !OF seCUUM 3ry purposes [Privacy Law, 5.1a.04 (1)(rn)1 Permit Holder's Name: ❑ City ❑ iliag C1 O of: .C. Collova Builders, tar ePralrle'�o�vnship CSt 9M Elev.: Insp 13M Elev.: HM Description: � a C�l 0 TANK INFORMATION TYPE MANUFACTURER CAPACITY septic G �daJU Dosing �e �s& TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG_ vent to Airintake ROAD Septic r�i7 y ��' Z t%r L� NA Dosing + ] ; � NA Holiiing PUMP / SIPHON INFORMATION Manufacturer Demand Model Number GPM TDH Lift FLriction System TDH Ft Head Forcemain Length 2,'r Dia. 2 `{ Dist. fo Well SOIL, ABSO"TION SYSTEM L LL VP%I1wiv "Pt iP% count Croix Sanita,r�No State Plan ID No.: Parce6W U6-50-000 STATION BS HI FS ELEV. Benchmark _Z 0 62 0 Alt. BM Bldg. Sewer 9 'op �/ Ht Inlet 7 Q Dt Bottom Header / Man. Dist. Pipe t T 4 f4,/ J' Bot. System y (0 T�7, If fL.2 Z Final Grade; 0 9 Z St corer BED / EN Width r Length r No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM 1 � �� pl SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEQ aria aeturer: INFORMATION CH ER TyPeOf Mae her: System: UNIT DISTRIBUTION SYSTEM Header i Mani old ' Distribution Ptpe(s] �}, x Bole Sire x Hole Spacing o vent roAir Inca e Length r �. Dia. Length _ Dia. Sparing _? 7 2 �7 ] r SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over DeptYi Over xx Depth Of xx Seeded /Sodded xx Mulched Red /'french Center F3ed 1'T Tench Edges Topsail n Yes [ ] ❑Yes ❑ No C-CIMMFNTS' [Inrlrir{arnriariierrrnanriac norcnncnrocant air inspection #1: y % IhQ Inspection :- _ Location: L i i i 1.5mn arreeL, IV2W tcacnmonu, vv l J4V i 1 1,3 vy LI + 7G L!`F E J I. o t:N Rio vv) - ­­1 15 f }Gr aG.rr,.n - r 1.) Alt BM Description =� a %ram Z.) Bldg sewer length = 2- Y � � rt y � s Q �., � y - S e rf=� P cft,- C k r ve 5,'�r P (�,, !-amount of cover —.�ys�4, GHQ 5 4L Plan revision required? 0 Yes E] No Use other side for addition information. h 5BD-6710 (H.3/97) Date inspector's Signature Cert No I' V, V&, * 2,/17- Wiscons n Department of Commerce SANITARY PERMIT APPLICATION In accord with 1LHR 83.05, Wis. Adm Code r• Safety and Buildings Division 201 W. Washington Avenue P O Box 7302 Madison, WI 53707-7302 • Attach complete plans (to the county copy only) for the system, my ��e� than8 112 x 11 inches in size. `.' .S' �G Yo r 1K • See reverse side for instructions for completing this applicati ��cr� <� State 5 itary�P}erm�ijt,N�u�mber Personal information you provide may lae used for secondary purposes ©Checx lVevision to previous application (Privacy Law, s. 15.04 (1) (m)l_ tate Pl I.D. Number I. APP I I � INF RMATI N - PLEASE PRINT ALL INFO MA ' Propert Owner Name P tD lion - r '' S" .. T 3 , N, R E (or) W Property Owner's Mailing Address d; Number_ .....: ` �E Block Number G AOel 4_f City, State Zip Code hone Number Subdivisl or CSM Number tY r TP f)._2 2 5- 7 . TYPE OF BUILDING: (check one) ❑ State Owned ivy Q Village Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms Prbwn OF ° � 111. BUILDING USE: (if building type is public, check all that apply) Parcel Tax Number(s) 0 3F= !r s'aA-aaa 1 ❑ Apartment! Condo • 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor R creational Facility 3 ❑ Campground 7 ❑ Merchandise; Sales Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1, KL New 2. ❑ Replacement 3_ ❑ Replacement of 4 ❑ Reconnection of S. ❑ Repair of an System System Tank Only __ Y _ ______Existing System _ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 aSeepage Trench 22 ❑ In -Ground Pressure 42 [] Pit Privy 13 ❑ Seepage Pit r 43 []Vault Privy 14 ❑ System -In -Fill S VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate f. 5yst m Ele 7. Final Grade { Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft,) (Min./inch) S. ID Elevation q " S�r e r eel Feet llll. TAN({ Capacity INFORMATIONGallons in gallons Total # of Tanks Manufacturer's Name Prefab. Concrete 5rte Con- steel Fiber- glass Plastic Exper. App- New Existirl strutted Tank Tank Septic Tank or Holding Tank N ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Si hon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature (No Stamps) MPRSW No.: Business Phone Number: —f S--_4 f re1 7, �- I -_ -9, Plumber's Address (Street, City, �Sta�te, Zip Code): IX. COUNTY / DEPAfR/T ENT USE ONLY ❑ Disapproved 5 tary Permit Fee (IndudesGroundwater Date Issued Issuing Agent Signature (No Stamps) Pl Approved Y ❑ Owner Given Initial Surcharges-ee) av � p ' Adverse Determination C , T X. CONDITIONS OF_APPR VAL / REASONS FOR DISAPPROVAL: r / _ gy SBD- 6398 (R.11197) DISTRIBUTION: Ohginaf So teunty. Ona copy To: Safety & Buildings DMWOrv, Owner, Plumber �Y g4J �,12 r e— FXe, tr, V/1 Wisco"n Department of Commerce 1 SOIL AND SITE EVALUATION Page y Division of $afety and Buildings in accord with Comm 83-05, this. Adm. Code Gille Trucking & Exc Attach complete site plan on paper not less than 8'f: x t 9 inches in size. Plan must County include, but not limited to: vertical and horizontal refers 8M), direction and St. Croix percent slope, scale or dimensions, north arrow, `lode iqn raf1 % nce to nearest road.al j APPLICANT INFORMATION - PI se firint all " fo�x(at' - Personal Wormation you provide may be used fc error dary p�rivacY L (] fm11 Fev U "led ` By rl ¢ date rr...rva n.. n !�._ tFe1. 01 �4-0'1 Property Owner f ` ' Ptoperty Location Casey, Dan r%' t, tot S W t14 SE tl4,5 13 T 31 f�F,R 18 W Property Owner's Mailing Address c ... _ 11 --- _ _ .. v_ i • • "�# Btadc # Subd. Name or CSM# T CrI .).,� - 323 Sawmill Lane` 15 Prairie Flats _ city State Codefldfidf� 1 City ❑ Village ®Town Nearest Road New Richmond WI 54 17 . 715-246-4 \ Star Prairie I, Hwy 65 New ConstructionReside aril edroams 3 [:]Addition to existing bugling — -:.., Replacement [j' Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate .7 bed, gpdfft'— Absorption area required 643 bed, ftz 562 trench, ft2 Maximum design loading rate 7 bed, gpo1ft2 Recommended infiltration Surface elevation(s) _9,ft (as referred to site plan benchmark) Additional design 1 site considerations ParentmaterialOut-wash Flood plain elevation, if applicable S=Suitable for system Conventional Mound In -Ground Pressure Al -Grade System in Fill U=Unsuitabie for system MS o u U I -' S❑ U i 0 SN U i s U . , SOIL DESCRIPTION REPORT Boring# 1 Ground ele ffl -YY Depth to limiting factor 96 in. 2 Ground ele M19 Depth to limiting factor 96 in. 8 trench, gpdfft2 8 trench, gpolfl? ft Holding Tank i S L"i U Depth Horizon in. I Dominant Color Munsell Mottles Qu, Sz. Cont. Color Structure Texture Gr. Sz. Sh. Consistence Boundary Roots GPDIW � -- - - I Bed ; Trench 1 0-14 7.5YR2.5/1 ---------- SiL IFABK MVFR AW 1VF .2 .3 2 14-34 7.5YR416 -------- CL 1FABK MVFR AS 1VF .2 .3 3 34-96 7.5YR513 ---------- S o-GR NIL ---- ---- .7 ; .8 f , , Remarks: 1 0-14 7.5YR2.5/1 ---------- SIL 1FABK MVFR AW 1VF .2 .3 2 14-26 T5YR4/6 ---------_ CL 1FABK MVFR AS 1VF f .2 ; 3 3 26-46 7.5YR513 ---------- S O-GR ML ---- -- 7 .8 , f , f f 3�4 •sto Remarks: CST Name (Please Print) re: Telephone No. Dennis Grille _ 715-268-6637 Address ❑�# CST Number Ref # 372 140th Street Amery, Wl 54001 T�_. WNW 3409 107 PROPERTY OWNERyCnsev, Dan _ _ SOIL DESCRIPTION REPORT Page 2 -- of -- Gilla Tniekino k l xrnvAfinn lnr 3 s Ground elev cn S Depth to limiting facmr 96 in 4 Ground elev Depth to Tinting factor Ground elev 91 �*, D" to IkWting factor 96 in. Ground elev Depth to liming factor Depth Dominant Color Mottles 1 Structure GPDV Horizon lrl Munsell Qu. Si. Cont, Color Texture Gr. 5x. Sh. Consistencel Boundary Roofs Bed ` Trench 1 0-11 7.5YR2.511-_______ S1L 1 FA 3K MVFR AW 1 V>~ 2 .3 2 11-28 7.5YR41£ ---------- CL 1FABK MVFR AS 1 VF .2 .3 3 28-96 7.5YR5/3 ------- S 0-GR AIL ---- ---- r .7 .9 & Remarks: 1 0-14 7-5YR2.511 _--------- SIL 1FABK MVFR AW 1VF .2 3 2 14-27 7,5YR416 -_------- CL 1FABK MWR AS 1VF .2 .3 3 27-96 7.5YR5/3 --_------ S O-GR NIL ---- --- 7 .S F Remarks: 1 0-12 7.5YR2.5l1 ---------- S1L 1FABK MVFR AW 1VF .2 .3 2 12-31 7.5YR416 ---------- CL 1FABK MVFR AS I VF .2 i .3 3 3 96 7.5YR513 --------- S "R ML — ---- 7 8 4 L LL Remarks: Remarks: t ESQ. FT. _ ` . S94'00'00"E f • ` ;. 4.. 4 o 6 . '� "� N 9D'CD'C 0,0w / to 15 /z- - 1 0 /a°�/ r 1.80 ACRES a :ES / �` ' ' j 78,212 SQ. FT, o 'Q. FT. '' ' • 348.92' ire 14 269.66 `, 1.71 ACRES 74,341 SQ. FT. o - ©o a . c; • to 0) 00 f r ` f '� +.SQ 1. • � i ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING DRAIN FIELD This is to ccrtrfyy that I have inspected the existing septic system presently serving the lc}llowirig residence: ( Street address) 1373 211 TH AVE I ocated at: _S W_ ''/ 4, _SJ�'_ 'fa, Section 13 Town-3 1 N, Range18 W, Toun of —Star Prairie , St. Croix County Wisconsin. Upon inspection, I certify that I have found the dose tank to be damaged and regUire replacement. The mound and piping, to the best of my knowledge, will conforni to the requirements of SPS. 384.25, and they appear to be functioning properly. Date of inspection 8/24/2023 Original Permit _353400 _04/17/2000 Licensed Plumber Signature) (Title) (Date) . Ai kw c (Print Name) (License Nwiiher) MPIMPRS .�W CHAP-1 ER 145.135 (2)'WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and maybe renewed for a specified period. (d) Changed regulations will not impair the Validity of a sanitary permit. (e) Renewat of the sanitary permit will be based on regulations in force at the time renewat is sought, and that changed regulations may impede renewal. (t) -[ he saniiary permit is transferable. llistory: 1977 c. 168; 1979 c. 34,221; 1981 e. 314 tole: if you wish to renew the persnit, or transfer ownership of the permit, please contact the county authority. AUTHORIZED ISSUING OFFICE - DATE_ THIS PERMIT EXPIRES q. UNLESS RENEWED BEFORE THAT DATE -wN PLAIN V1`1W f-1, h Po��i VISIBLE FROM THE ROAD FRONTING THE LOT UINICONSTRUCTION SBD-06499 (R11/20)