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Home My WebLink About038-1061-40-300 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 578976 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Vo elpohl, Rick J. & Theresa Star Prairie, Town of 038-1061-40-300 CST BM Elev: Insp. BM Elev: escription: 6.s-f- Section/Town/Range/Map No: I bb BM D (3 15.31.18.266D TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACI Y STATION BS HI FS ELEV. Septic Benchmark Dosing f Q 6dt~ A{It\ ~oo( 4„1I :551,63.4 . 7Ae~ 6 Bldg. Sewer ' 7. Z7 X62 P . ! Holding St/Ht Inlet 3S 9~. a \ - TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent it Intake ROAD Dt Inlet \ \ I Septic 5Q / ALL' 577 Dt Bottom 9 , Dosing D 7 :57 1 (03 f Header/Man. 7. V c? 7 75 Aeration Dist. Pipe g. 17.3 Holding Bot. System 3 PUMP/SIPHON INFORMATION - Final Grade 13Y A7, 5. Z8 ,Jd . O Manufacturer Demand St Cover 7. o L) GPM r-- ri-. l Ca l l Model Number TDH Lift Friction Loss System Head TDH Ft 3. X ,ilA- Forcemain Length / Dia. it Dist. to Well - 3a 7- > lee, SOIL ABSORPTION SYSTEM /D, z -j 7 BED/TRENCH Width / Length No. Of Trenches /V PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 7x Z ~ ~t ~C1 SETBACK SYSTEM TO 13 P/L BLDG WfE LL LAKE/STREAM LEACHING Manufacturer, INFORMATION Q CHAMBER OR =~/1 r a -7 Model Number, Type i7.^JEo 1 ( /,6 AJl { UNIT U ~ G~, DISTRIBUTION SYSTEM S'a,,\-k~ 1 -7 )ir Z = 3-4 Header/Manifol~ it Distribution ix Hole Size x Hole pacing Ven},to it Intake Pipe(s) 1Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only y` Depth Over Depth Over xx Depth xx Seeded/Sodded F Mulched Bed/Trench Center 3 Bed/Trench Edges Topsoil Yes No Yes L No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 2153 CTY RD QC Newl Richm d, WI 54017 (SW ~/4 NW 1/4 15 T31 N R1 8W) NA Lot 4 Parcel No: 15.31.18.266D 1.) Alt BM Description= CO +1 C~~~ ,I, Lb_ L 2.) Bldg sewer length = 7~ ~-i~ - amount of cover 7 `>t Z 6 c~L'L - - Plan revision Required? es No Use other side for additions i ormation. SBD-6710 (R.3/97) Date Insepctor Signat a Cert. No. ~9 4t rrsrArfvr~ County 1~^ - Industry Services Division ~T f ( D'i►'~° ' 1400E in n A O.r e4 I P Sanitary Permit Number (to be filled in by Co.) I U i0 Madison, WI 53707-7162 n9Of Tsicri 76 578 `:1/ - ST Ki !p CC) I QMt1s t wit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address (if different than mailing address) purposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats. 1. Application Information - Please Print All Information _ a r 3 Property Owner's Name `G Parcel # v3 - -30 Property Owner' Mailing Addres Property Location C7t It 5-3' ~f/• C- Govt. Lot s!.~ City, State r A Zip Code Phone Number SW '/4, A"W14, Section 7 r- (circle e) T 3r/ N fig; R w E or W 11. Type of Building (check all that apply) Lot # 1 or 2 Family Dwelling - Number of edroo Subdivision Name ❑ Public/Commercial -Describe Use Block # City El State Owned -Describe Use ❑ of nn_ ISM Number 64 413S4 ❑ Village of Town of Z. :6~- Gc a W 17 G a,~Lc(i - /a /0_ 3 33 6 .5 1 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. 10 New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. F1 Permit Renewal ❑ Permit Revision El Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner t') a x IV. Type of POWTS System/Component/ Device: (Check all that apply) 1:t q Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treatme Area Information: Design Flow (gpd) Design Soil Application T~l rea Required (sf) Dispersal Area Proposed System Elevation Rate(gpdst) SD Ada VI. Tank Info Capacity in Gallons al # of o Manufacturer U Gallons Units 't ❑ v New Tanks Existing Tanks U Septic or Holding Tank /000 ~t7~a 0 1:1 El Q F1 Dosing Chamber ❑ 1:1 El El VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumbe 2Name (Print , Plumber's nat (O/MPRS Number Business Phone Number t JJJ////l A)003,577 7a0 Plumber's Address (Street, City, State, Zip Code) e6z, 77 VIII. County/ eartment Use Only Approved -~isappreve Permit Fee Dat IssIssuing t Signature caner Given Reason f~rj $ 7 O daD sfl~ter and Disapproval 3> b~wl- IX. Condi I C nk a e ? OU "I 4~~41 06W .Oiso6ml cell must all be services / maintained Gb dC~Q_ ' as per management plan provided by plumber. 3. JAIL s04j6* regWro merN+& must bcmaintainbd as per 11 p11 ablf COde / ord narim. Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x I I inches in size SBD-6398 (R03/14) Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer Minimum Pump Performance Required Tank Model Number 1660 / 6 GPM @ , y ~ Ft TDH Total Tank Capacity 600 Max. Bury Depth Total Dynamic Head (TDH) - Feet Pump Manufacturer Elevation Head / Pump Model Number Distal Pressure Alarm Manufacturer Network Pressure Loss Alarm Model Number Force Main Pressure Loss Switch Type `,2 ~ Total 5 Manhole Min. 4" Above Grade Vent Min. 12" With Locking Device \ Above Grade Weather-proof With Cap Junction Box " - - - - - - Finished Grade - - - - 1 Depth of Cover Ft Disconnect Means > r ) > > > > } ) ) > ) > } > > > > > > } > > > ) > ) > > > > > s > s ) > s ) > > s > s s < { { { { ; i t { { < < < ; i { t i i i t { { { < S ; i { { { { { { t ; S t < S t i' i t { S< S i S S - - S > Outlet Inlet Y` Switch Settings and Reserve Capacity - - ' Tank Volume = GPI { < i Dimension Inches Volume Gal. A > < { (reserve) A (alarm) B 2 S °;t Weep ` l B Hole } (dose) C 1 r ~v Off Elev. C (dead) D 7 S 1 L7 Ft t Total > { ) ) S)i D Bottom of Tank Elev. Ft L); YL~ < { i i L L L L Y } Y > > > > > > > Y Y > } > Y } > > S Y J > J > > > > } > } } Y } Y Y Y > > > > Y S S > > > > > > > > > > } > } LS t C S S S K{ S t t i t{ L<< i L K i S<; C{ t{<< L K S< i t i 4< t{{( S G< C S i t{ K{ S K{<{({ GENERAL INSTALLATION: The dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the excavation and is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28 Wis. Adm. Code. 03/05Igj Page o MGOULDS PUMPS Submersible Effluent Pump MODEL 3871 EP04 & EP05 Series APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermo- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for plastic enclosed design for heavy duty ball bearing con- following uses: lubrication and efficient improved performance. struction. Effluentsystems heat transfer. i Casing and Base: Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms superior strength and corrosion • Heavy du sum manual operation. Automatic Canadian Standards p models include Mechanical resistance. S 0 • Association Water transfer Float Switch assembled and ■ Motor Housing: Cast iron for c us File # LR38549 • Dewatering preset at the factory. efficient heat transfer, strength, and durability. Goulds Pumps is ISO 9001 Registered. SPECIFICATIONS FEATURES ■ Motor Cover: Thermoplastic • Solids handling capability: E EP04 Impeller: Thermo- cover with integral handle and 3/4" maximum. float switch attachment points. • Capacities: up to 60 GPM, Plastic semi-open design with pump out vanes for mechanical 0 Power Cable: Severe duty • Total heads: up to 31 feet. rated oil and water resistant. • Discharge size: 1'/z" NPT. seal protection. • Mechanical seal: carbon- rota ry/ ce ra m i c-sta ti o nary, BUNA-N elastomers. • Temperature: METERS FEET 1040 F (400 C) continuous 10- 14011 F (6011 C) intermittent. i • Fasteners: 300 series 9 30 - E-S GPM stainless steel. • Capable of running a ~-zs rr dry without damage to 25=-- components. °a 7 w = 6 20! Motor. - - • EP04 Single phase: 0.4 HP, Z 5 115 or 230 V, 60 Hz, 1550 } O 15.-- --------r---- - L RPM, built in overload with a 4 automatic reset o EPOS • EP05 Single phase: 0.5 HP 3 10 - -T-_ 115 V or 230V, 60 Hz, 1550 EP04 RPM, built in overload with 2 automatic reset. • Power cord: 10 foot 1 standarSJTWd with length, 1ron --4 613 o 06- i' 0 --zo - - 30 o so GPM g grounding plug. Optional 20 foot length, 16/3 SJTW with 0 1 _L 2 4 6 8 10 12 m3/h three prong grounding plug (standard on EP05). CAPACITY ulds Pumps C20051TTWater Technology, Inc. ITT Industries Effective January, 2005 63871 i~ X-ri rz.~ t:a j~ s f i i y I ~ i CONVENTIONAL COMPONENT DESIGN Residential Application / INDEX AND TITLE PAGE Project Name: V C' Owner's Name: C~ Owner's Address: - C- Legal Description: /U U-ti % 6 /S / T 3 l l /C 0 tq Township: County: Subdivision Name: Lot Number: Parcel ID Number: d 3 ld Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: License Number: Date: Phone Number Signature Designed pursuant to the I Gro nd Soil Absorption Co onent Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). V1,. Page 1 C:kL .4 ~io n b moo/ o !I cs^^Q- C I N Soil Absorption System Cross Section ~f ft 4" Schedule 40 Final Grade i PVC Vent Pipe f G;7~ , With Vent Cap ~7 / , Yd ft Leaching Chamber a q61 ft System Elevation ft ft Soil Absorption Svstem Plan View ft ft { r ft <I Vent Or Observation Pipe Leaching Trench 1 Chambers 4" Dia. Trench 2 Header Leaching Chamber Specifications Manufacturer And Model EISA Rating -D_ sq ft per chamber Soil Application Rate o 1 9pd/sq ft gpd Design"Flow r 7 Soil Application Rate D EISA = SP.IY Chambers 2 rows of chambers each. 3 ~ a0 ~Bo sQ,~ Page of 48" (EFFE(TIVE LEN GTH) - I 12" ~ ~ ~ III - 34" 11 2" 13 8" INS ERTk 8" INVERT 1 I I 5 S' INV H I _ ----III- - - i 18 2" 33" k KT P! I'~ INVERT ouiCK4rws 6" 4 AL, ONF 12 ~1 I' 11/`11 LNUt;nr' Ji(.k4 Pius Standard Chamber Specifications i;V,, It}ti . a. INC-'3LANDARD LIMTE,l tNARRAN T 11Vtea„ i Ili 1I, , .I IV'. ~r1t `1 nR a I ;.17It( INFILTRATE .I f... ,q "~L ICI ° ~ ?K. ~ i, 800.221 .4436 www.infiltratorsystems_com 0 - - I M O M V cl~ co cs~ cz:l i ° FCD co = M ~ w LLI Lu = i / Z cor) F- C-9 LL) a_ co CD = o O L.LJ Z w CC) CD Z~ N O Cl- U cz' Z i Z Z - N O m OCN Cam F- Z O cfl Lli - - u? !a4 < 0-n ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM U Owner/Buyer 9_~Lle_ Mailing Address c-71,5-3 C Property Addres; R/ S5 3 C (Verification required from Planning & Zoning Department for new construction.) City/State `JR",I- Parcel Identification Number D 3 a o o LEGAL DESCRIPTION Property Location 1/4 , W, 1/4 , Sec. 15-, T N RAW, Town of S--'a,~ Subdivision Plat: , Lot # Certified Survey Map # 5-6 y3,5" <p , Volume Page # Warranty Deed (before 2007)Volume Page # j Spec house ❑ yes V no Lot lines identifiable Alyes C no SYSTEM NAI- TENANCE ANTD OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by he owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on s form are true to the best of my/our knowledge. L'we am/are the owner(s) of the property described above, by virtue of a w anty deed recorded in Register of Deeds Office. Number of bedrooms SIGNAAJRf OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application 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. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM^SPECIFICATIONS Owner , f Septic Tank Capacity, /l_'30 0 gal t/ ❑ NA Permit # Septic Tank Manufacturer uj_~ ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms C;? --3 ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ;~NA Pump Tank Capacity gal s~3 NA Estimated flow (average) 0 gal/day Pump Tank Manufacturer A! NA Design flow (peak), (Estimated x 1.5) j gal/day Pump Manufacturer NA Soil Application Rate gal/day/ftz Pump Model NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit A!T NA Fats, Oil & Grease (FOG) <_30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODS) :!=O mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA ; Biochemical Oxygen Demand (BODS) 530 mg/L In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) _<104 cfu/100m1 ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once ever 3 ❑ month(s) (Maximum 3 ears) INA y' year(s) y Pump out contents of tank(s) When combined sludge and scum equals one-third (%3) of tank volume Inspect dispersal cell(s) At least once every: 3 ❑ month(s) (Maximum 3 years) $ year(s) Clean effluent filter At least once every: ;W month(s) ❑ NA ❑ year(s) Inspect pump, pump controls & alarm At least once every: p month Ii~ NA year Flush laterals and pressure test At least once every: ❑ month )(s) NA year(s Other: ❑ month(s) At least once every: El NA ❑ year(s) Other: {1 NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The 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 (%3) 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 filters, 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. Page 2 of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or: must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. T g ~ ank aluati e ai e ~??D ~ 1T~~ 1~l>~ (~N577ZtJG~I. ~ be i i-l l ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name -r6 Name Phone 715 _ - o C7 Yo Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name !!~'j CIW ( ouA/ 2Dll~~~ Phone Phone "7 (S- 3e(P_ (08(D This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. START UP AND OPERATION Page Z of _Z1_ For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POW-S technology a holding tank may be installed as a last resort to replace the failed POWTS. - r T W/91 aluati arvailab a o ding ank be i e ai e FTZD4-ll8 TTi1~ 1~:b 2 A/61^) Car,,jSTR lc,710~ ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone I ~`5 _ c1 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name o / Name Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(4 (2) & (3), Wisconsin Administrative Code. ~(o~Jl ~w aY 4wa~ bL£L (ta) . 0 7 ~5 a.a.. .a .a... 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Of Safety and Professional 4~rQlicflla SOIL\IALUA-' IO REPORT Division of Safety and BuildingsM L nl Page of in n nth SPS 385, Wis. Adrn. Code Attach complete site plan oFe~a RO`tfvq -'09 County C C i an 8 112 x i 1 inches in size. Plan must J nclude, but not limited! nd horizontal reference point (BM) direction and percent slope, scale ~~o ( dh arrow, and loretion nDd , anc~tdnbarest road. Parcel I.D. aJ 638-/v~l- n-3Q ~l Pas print adl erafaxr,l<~4~a~r~ .W Re . we y Date Personal in`en at;oryou provide may be used f^r second Pr la( _aw, s. 4 ; 1 im j, Property Owner •l~ Property Location Govt. Lot 1/4 6' eft. _ N Wl14 S/ S T3/ N R E (or W Dc:~ perty O er's Mailing Address Lot # Block # Subd. Name or CSM# 5 a C t y R fit. CC- ~ 2 P 33 30 State Zip Code one Number City ❑ Village [Town Nearest Road nleW R,Ghw,ar I wr S` /7 ( > a'f -3 S"fGr Ct 11 Nev Co traction Use: Residential / Number of bedrooms (ode derived design flow rate L/ GPD 5 Replacement Public or commercial - Describe: r General comments Iood } atzi 61a-vatico it applicable and recommendations: I 1-1, I H r PRESEK)t 14oose_ to 6e- vh ka,nv-~v ; it" q r'.) Ck o Boring # Boring 1 Pit Ground surface elev. /Ob •?.S ft, Depth to limiting factor a in. Horizon Depth TDominant Color Redox Description Tex are Structure onsistence oundary Roots Soil A lication Rate in._ Munsell Ou. Sz. Cont. Color _ GPU/ft Gr Sz. Sh. ff#1 ff#2 ~ a - oY2yl -7 .5 1 IQ- 1/1 a 614 Jar r Boring # Boring E Pit Grcurd su fgce ere Depth to hl-tin-'a factor ~~Horizon Depth Dominant Color Redox Description _ Texture Structure onsistence _ oundary Roots Soil GPD//ftion Rate _ in. Munsell Ou. Sz_ Cont. Color ' Gr..z. Sh. ff#1 a -I{ i o `izY/ ff 2 5 L 6C L_ 0~ rV1 v'-) It F 3 a7~ , ~,5 rR yl~ L - - -~Je 52, Effluent #1 = BOD = 30 220 rrig/L and TSS `30 < 150 mglL. Effluent #2 = BOG < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) - Signature _ ! 3 ti-! , -yam- CST Number Address + Q~ a r 7 Y V ,n Date Evaluation Conducted Telephone Number ~4 r e ~ T S-S-av1y psi--a3 4/1, !6 SF~D-R?30 (RI 1 /1 1) e ~GIt t t f k~'~CZ page -~of Property Owner O Parcel IQ # _s Boring tt~ "-S {Boring # ~0 ft. Depth to iimiting factor n Soil A lication Rate F i Pi; Ground surface elev. GPD/fk - - Horizon Depth Dominant Color Redox Description I e ure Structure onsistence oundary Roots ~1 ~2 Qu. Sz. Cont. Color Gr. Sz. Sh. in. Munsell S o -fie ~oYyl L i 1b-;t . , iJF t/ LEa-,~~~~ Boring Boring # Ground surface elev. Depth to iimiting factor in. Soil Application Rate pit PD/ft Horizon Depth Dominant Color =Redox cription Texture Structure onsistence oundary Roots~2 Gr. Sz. Sh. in. Munsell nt. Color Boring # Boring Ground surface elev. _ ft. Depth to iimiting factor in Soil A lication Rate Pit Horizoi ~ Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots ff#1 GPD/f2 FG--. Sz Munsell - C1u. Sz. Cori. Color i Effluent #2 = BOD < 30 mg/L. and TSS < 30 mg/L Effluent = BOD 30 < 220 mgIL and TSS >30 1-.50 mglL - The Dchr. 1 ct )nci PI "n i` '1 ;'hn ,rtLill scr'~ pro~,i~lrr and em}~loycr. If'j~ou need assistance to u x.,s. Serl ices u~ _1c°~l n a~u i:;l it, I01n>>t. cont<rct tLc dk.nartnu,li at 608-266-31 51 or i TY through Relay. Srt11-S;SO iRI I.i'' + te~~~ F Property Owner I ! RC, Parcel ID # Page c_ of t_-J Boring # Boring D3 -f f Ground surface elev. U~J 3'✓ ft. Depth to limiting factor in. Pit Soil A Pate j Horizon Depth Dominant Color Pedox Description Texture i Structure onsistence Boundary Roots in. Munsell Qu. S z. Cont. Color Gr. Sz. Sh. ff#1 w -7, NY) I ~ ~ I L I i Boring #❑~--tt Boring Pit Ground surface elev. ; . Depth to limiting factor r. Soil An lication Rate Horizon Depth I Dominant Color L Redox Description I Texture Structure "'onsistence ~oundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Sh. * ff#9 * ff#2 i - 1 Boring # Boring Pit Ground surface elev. i~. Depth to limiting {actor in. Soil Application Rate Horizon Depth 1 Dominant Color) Redox Description Tex ure i Structure onsistence Boundary Roots GPD/f: `f in. I Munseli Qu. Sz. Cont. Color _"j Gr. Sz. Sh. ff#1 ff#2 4 I I 3 i I t ! Effluent #1 = ROD = > 30 < 220 mg/1- and T SS >30 < 150 mo/L ' Effluent #2 = BOD < 30 mg/L and SS < 30 ma/L The Dept. of Safety and Professional Seri ices is ar. cqual «pporttmit~ Som ice provider and employer. U you need assistance to acccss sc,-vices or need material in ar alternate format.. contact the de.par tmeni at 608-266--'~ 1 i I or TTY through Rcla} SBD-Si i0 (RI I/I I ) { Co. ~G5"~' i kA mow, ~Z T CC 0 a o - v- s _ ~ ~ - cry 0 I l~ A 1 j t Spa 4 Ile h _ gi 4 J ~ o w t o (A (A ~ F n i d Parcel 038-1061-40-300 06/11/2014 08 44 Ann PAGE 1 OF 1 Alt. Parcel 15.31.18.266D 038 - TOWN OF STAR PRAIRIE Current X', ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner 0 - VOGELPOHL, RICKY J & THERESA M RICKY J & THERESA M VOGELPOHL 2153 CTY RD CC NEW RICHMOND WI 54017 Property Address(es): = Primary Districts: SC =School SP =Special 2153 CTY RD CC Type Dist # Description SC 3962 SCH DIST NEW RICHMOND SP 1700 WITC Notes: Legal Description: Acres: 12.520 SEC 15 T31 N R18W SW NW BEING LOT 4 CSM 12/3330 EZ-UT-1232/369 Parcel History: Date Doc # Vol/Page Type 07/31/2001 652550 1690/518 WD 09/29/1999 611209 1459/600 WD 07/23/1997 1150/155 TI 07/23/1997 1112/555 QC more... Plat: Primary Tract: (S-T-R 40% 1601/4) Block/Condo Bldg: " 3330-CSM 12-3330 038-97 15-31N-18W LOT 4 2014 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/13/2011 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 12.520 56,600 86,100 142,700 NO Totals for 2014: General Property 12.520 56,600 86,100 142,700 Woodland 0.000 0 0 Totals for 2013: General Property 12.520 56,600 86,100 142,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 504 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00