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HomeMy WebLinkAbout038-1164-10-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 597380 GENERAL INFORMATION 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 Township Parcel Tax No: JOHN MONTPETIT TOWN OF STAR PRAIRIE 038-1164-10-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: I`J/ w 30.31.18.775 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark: 2 Dosing l / Alt. BM „ *efauGn y r Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Ven to Air Intake ROAD Dt Inlet Septic Dt Bottom t U ' 11, 0 Dosing I i Header/Man. Aeration_ Dist. Pipe Holding Bot. System PUMP/SIPHON INFORMATION Final Grade )Cj 76 Manufacturer Demand St c .t I n GPM Model Number TDH Lift Friction Loss System Head TDH Ft a r L4 3- 1Y Forcemain Length / IDia. if Dist. to well 16 Z s~ SOIL ABSORPTION SYSTEM 7 - U?r BED/TRENCH Width Length N . Of Trenches PIT IMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 7. SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEA HING Manufacturer: INFORMATION CHAMBER OR r Type Of System I . r i UNIT Model Number: DISTRIBUTION SYSTEM r + I;' Header/Manifold ^ DiPe9~s~ lion ix Hole$ize ` ix Hole, Spacing Vent to Air Intake Length Dia Len th Dia Spacing , SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Mulched Depth Over Depth Over xx Depth of xx Seeded/Sodded T Bed/Trench Center Bed/Trench Edges Topsoil l~ I G Yes lam', No Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1914 RIVER VIEW LN 1.) Alt BM Description "e- ~ I 2.) Bldg sewer length = < 2.) - amount of cover 41-1., Plan revision Required? ❑ Yes ❑ No Use other side for additional information. / T SBD-6710 (R.3/97) Date Insepctor's lure Cert. No. ~^'°~~~ro~, -i94-i-7--/Y-7-County f 1 Safety and Buildings Division j CYG 201 W. Washington Ave., P.Q. Box 7162 Sanitary Permit Number (to he filled in by Co.) Madison, WI 53707-7162 s 1b State Transaction N ber ermit t 1 In accordance with tPS 383.21(2), Wis. Adm. Code, submiss._ ri ernmental unit is required prior to obtaining a sanitary permit. Note: Application u- ' v e submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information l_ ised for secondary Pi~ u oses in accordance with the Privacy Law s. 15.04(1)(m) Slats. V t1//~ 1. A lication Information - Please Print All Infor on Property Owner's Name / Parcel # Property Owner's Mailing Address Property Location 3 0 3 ? 7 - , Govt. Lot City, state Zip Code Phone Number Section G (circle one? N; R /J E or 6td~ II. Type of Building (check all that apply) Lot f / Subdivision Name 1 or 2 Family Dwelling -Number of Bedrooms 1 Block ~ G~ J^ G Lt,~ :,t d "J ❑ Public/Commercial -Describe Use K a ❑ City of CSM Number ❑ Village of ❑ State Owned -Describe Use Town of : 7"~ I - pr,a +LS er % % 1 ~~Y-Zloop I . Type of Permit: (Check only a bog on line A. Complete line B if applicable) A. ❑ New System Replacement System ❑ Treatment/Fiolding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New ~yY3 yr~D Before Expiration Owner IV. 5- T e of POWTS System/Component/Device: Check all that a 1 XNon-Pressurized in-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank C Other Dispersal Component (ex n ❑ Pretreatment Device (explain) V. Dis ersal/Treat nt Area Information: -7S_ G+ 1 ~7, 3 r Q A.' ~ Design I , (Td) Design Soil Application d ispersal Area Required (sfj Dispersal Area Proposed ( CIO VI. Tank Info Capacity in Total 4 of Manufacturer y Gallons Gallons Units ° New Tanks Existing Tanks c ° tII v iC7 R L) Septic or Holding Tank 42 0 2CS(1 j GS, S- Dosing Chamber Q 7J/ . `es'eo VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the PORTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature RS Number Business Phone Number ~ti' l(;t> rtrt Sc1,CL-W,c lrev ~1'aL~~' ~ - 7 `q7c~f~, G3izI Plumber's Address (Street, City, State, Zip Code) J 7Ga SG e l~ 9A t<< P 5'~~ .d l't) ; 9`~ Cl / VIII. C /Department Use Only Permit Fee Date ued Issuing nt Signature pproved ved iven Reas r Denial V ✓ LZ A. Condi fi easons r ti , or Disapproval 3♦ r►t 1i ei00 'tiisper .sit c0 must all be sfv%tC;i`S ! rrteii)to,_' 1 ` ! y u ~ t1 e~,~ as per m4nagement plan plrr tided by pluinber. 2. 'JW ~Ie nit+ints must>tte r~a~rttr it c i ~l- I r U W f9faWit cod! / cMinam". Attach to complete plans for the system and submit to the County only on paper not less than 8 in z 11 inches in size SBD-6398 (R. 1 1 /11) ~i iN►SL. d~ ~ t ~cJ{`J~ 111 $'cal-~~ =~'Dr ~V /7/J e`Z- /'{1-ctsll~lc~~~ ~du~rlG6~3 f ye- a 4- w 1 :A t ~r I~ CONVENTIONAL COMPONENT DESIGN Residential Application INPEX AND TITLE PAGE Proiect Name: Owner's Name: ' o A,/v j- a / yy~i~s o f Owner's Address: Ida r I_egail f)p5c_ription 5-,-.-3 r.- L~ C3 Ltil (:out7ty. ~ ~ G',t2~ subdivision Name; ~Y' ~ S''< a ~~c of Number 1Y, - i'arcel ID Nunnber: CS j~~ lC4 /D . p~ d Page 1 Index and title page plat Plan Page 3 SYstenl Sizing & Crass-Section - - - - Page 4 T _ - filter Specs Page 5 _.._-Maintenance Information page 6 Management plan Page 7 St. Croix C-ty Septic. Tank Maintenance form page 8 Warrants Deed T page 9 C of, Plat - Attachments: Soil Test & House Plans 1.1es I g Ile r/ t' h x►xt ber; r c_r, ^ SC`. ~7iaryi j r~ i-_JcensF.. Number: 7 r 4; Phone Number e 5 - 11e<ttgr~F[:1 prar:suailt to tlZe In-Grnnnci 3011 Absorption COMpaZent Manua[ for P01ATTS version 2_o SB1a-107Wi-P (N.011f11). F age 1 ~D ~,,n r e [T Yy1 b ~~Pc? 7 ; ` '1 L r v j, uJ 5'7';t e. S'?` C Y n ~'~c ~ ,din! .`'`~~G log ,gn4 z Ihdy6z~~z ~o~erl~~ 3' Az v + W n 4 rn ~n I way ell Soli Absq!ptlon System Gross Section 4" Schedule 40 lne} brad'e PVC Vent Pipe Mth Vent GAP 2 ff leaching, 1 Chamber f l ft System Elevation ft ft 3 ft Soil Absorption System Plsn Via~r ft ~3:LL!!1_~~~LW1J_~~ J- tt Leaching Trench 4 Chamhern ~~JJ1LM1~~11.1-~ 4" Die. - Trench 2 j Header Vent Or Observation Pipe i Drench 3 1 - - - - - L.eachina Chamber Spegt cagons - Mannfactwer And Madel 62u i tsA Rating a7 sq ft per chamber Soll APpllcatian Rate gpd/sq f# Dag qL Design Flaw Soll Application Rate '2-r'- E}5 7 5' pd Chambers 3 town ofr:hambers each. Page of POWTS OWNER'S MANUAL & MANAGEMENT PLAN Papa of _ FILE INFORMATION SYSTEM SPECIFICATIONS Owner, ~Septic Tank Capacity ~ro gal ❑ NA Permit # - Septic rank Manufacturer ❑NA DESIGN PARAMETERS Effluent Filter Manufacturer ' l 0 NA Number of Bedrooms u ❑ NA Effluent Filter Model .e- ❑ NA Number of Public Facility Units 0 NA Pump Tank Capacity ci ) ❑ NA Estimated flow (average) coo al/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) /day Pump Manufacturer ❑ NA C) C~ Soil Application 'Rate - - gal/day/ft' Pump Model - NA Standard Influent/Effluent Quality Monthly average*, Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 1 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (60Dtl 5220 mg/L ❑ NA ❑ Mechanical Aeration O Wetland Total Suspended Solids (TSS) <_150 rng/L n Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) - ~ - p NA Biochemical Oxygen Demand (BOO;) 530 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L © NA a At-Grade ❑ Mound Fecal Coliform (geometric mean) :!~10" cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y$ in dia. Ci NA Other: ❑ NA Other.- Q NA Other; El NA "Values typical for dornestic wastewater and septic tank effluent, Other; 4 u - ❑ NA MAINTENANCE SCHEDULE Service }event Service Frequency Inspect condition of tank(s) At least once ever C3 month(s} y: {Maximum 3 years} CJ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (i;) of tank volume ❑ NA Inspect dispersal cell(s) At least once every; ~ ❑ month(s) _ _ X year(s) (Maximum 3 years) El NA ❑ month(s) Clean effluent filter At least once every: t • ~ ;K Year(s) E] NA Inspect pump, pump controls & alarm At least once every: ❑ month (s) El year(s) El NA Flush laterals and pressure test At least once every: ❑ 0 year(s) month(s) ❑ NA Other: ❑ month(s) At least once every: ❑ year(s) ❑ NA Other: ❑ 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 'l'ank 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 (Y~) 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 NH 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 evert. START UP AND OPERATION Page - of 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 call(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 Maintalner 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; meet 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, caravel 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. 13 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. 11 The site as not en evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site N evaluation be performed to locate a suitable replacement area. If no replacement area is available a holding tank may "_k16' le s a last resort to replace the failed POWTS. © 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 VF POWTS INSTALLER poWTS MAINTAINER Name i lH~ _ w C!~u V_-, Noma Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone S This document was drafted in rompliance with chapter Comm 83.22i2)(bit I )Id)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. v ~ r- cti Qc ti 3c v - O III ~ S y ' 9i v = < r o a M v ,n r v J I ~ j I I _ cr of S <t ~ " J D c7~ P-- i - v~ r s I I J (~~Cr 1 Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer e Mini um Pump Performance Required Tank Model Number GPM @ Ft TDH Total Tank Capacity Max. Bury Depth Total Dynamic Head (TDH) - Feet Pump Manufacturer Z6 to, Elevation Head Pump Model Number Distal Pressure A Alarm Manufacturer Network Pressure Loss A f A Alarm Model Number Force Main Pressure Loss 9L /66 Switch Type Total Manhole Min. 4" Above Grade With Locking Device Vent Min. 12" Above Grade Weather-proof With Cap Junction Box C:z::= Finished Grade - _ - - Depth of Cover Ft Disconnect j Means L i i i{; i i{>L << i L t i{>S {{<{<< S>{ i i i>{ S L{ i i i>L S L i>L i i L{ >L>i } C S Outlet Inlet Switch Settings and Reserve Capacity Tank Volume = GPI Dimension Inches Volume Gal. A>{ (reserve) A } > S i } (alarm) B 2 B t < Weep (dose) C Hole < Off Elev. C }C} Cyi > (dead) D Ft t, } L y Total ► ` y y } M FS D y< \ }~y Bottom of Tank Elev. > `J y > > > > } } > > > > > > } } > > > } Y > > > } > } } } > > > } > > > y > Y y > } } > > } > > } i > } > > } L y t l < L t t i t{ S S{ t t<<{ i t i i t; S; S S t L< L i t i t t i t t t<{ L L L L L S t S{{{ S t S<< t i 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. 03/05lgj Page of T D of HEAD/ CAPACITY CURVE W F. W W LL 100 TOTAL DYNAMIC NEADICAPACITY PER MINUTE EFFLUENT AND DEWATERING 30 95 SERIES r43 -57-59 97 177.139 163 165 p FT -I LTRS GAL LTRS GAL LTRS GAL LTRS GAL LTRS 28 5 152 163 65 248 104 394 61 231 61 231 90 EFFLUENT AND D=WATERING 1D 3.05 129 57 216 79 300 61 231 61 231 15 457 72 43 163 84 242 60 227 60 227 26 85 ♦ SEWAGE AND DEWATERING 20 a 10 27 104 36 736 59 223 80 227 ♦ 25 7 62 6 30 57 216 59 223 55 206 58 220 i 24 80 30 9.14 40 ,2.,9 46 172 55 206 50 15 24 33 125 51 191 75 2 -129 15 57 43 161 22 70 21 34 30 114 11 53 ~ 80 "e4.38 70 MOD EC-- \ MODEL LOCK Vawe 9 24 5 26 66' 87 20 65 1 163 \ 16G 5 TOTAL DYNAMIC NEADiCAPACITY PER MINUTE •7 ` SEWAGE AND DEWATERING \ SERIES 257 266 762 264 297 AL LTRS GAL LTRS GAL LTRS GAL LTRS M GAL LTRS G 1 52 108 408 102 386 1 492 1 687 3.05 50 227 72 273 360 1 598 1 6 4 57 20 76 43 163 238 1 511 18 r2~ 6.10 6 30 125 1 401 50 782 7 288 \ 1 30 9.14 '63 77 2 29 45 \ ` , 35 10.67 60 227 14 ♦ 40 t2.19 16 174 45 13.72 26 106 350 1 15 24 12 45 12 40 \ MODEL LceK Vawe 18 21 26 35 53 10 35 \ 293 8 30 MODELS 25 _ 137 139 6 20 ( MODEL ` 284 4 15 MOD MODEL 10 268 1 282 2 MODELS 5 53, 55, MODEL MODEL 57,59 97 267 U S . GALS. 10 20 30 40 50 60 70 80 90 100 10 120 30 140 150 150 170 180 190 LITERS 80 160 240 320 400 480 560 640 650 FLOW PER MINUTE 3280 Old Millers Lane Manufacturers of . ~ sville, Kentucky 40216 4/{/ ' ZffZZZ-Jff Louisville, I7. Box 16347 (502) 778-2731 QUAL/ry Almag SNCE /,F,7,4 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TAINK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 17 i `7 ),'t j r i C ~ located at: ;4, 1/4, Section K- ; Town 3i N, Range '\V. Town of St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25; and it (they) appear(s) to be lunctioning properly. 1 Most recent date of inspection or service T Did flow back occur from absorption system? Yes Nom (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: A-e Construction: Prefab Concrete Steel Other Manufacturer (if known): Age of Tank (if known): Permit number (if known) k l (Licensed Plumber Signature) (Print Name) (Title) (License Number) MP/MPRS (Date) Form to be completed by licensed plumber (Dept of Commerce Chapter 5 and s. 145.061, Wisconsin Statutes) or licensed disposer (N7R 113 Wisconsin Administrative Code) Rev. 9/2008 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer OA t1 ~ k e 1 l l hi4 f ,67e 7',' 7 - Mailing Address "B v x / Property Address e l v.. tJ (Verification required from Planning & Zoning Department for new construction.) City/State s r~► e rs ~y Parcel Identification Number el 3 ~ LEGAL DESCRIPTION Property Location. %4 '/4, Sec. 3 J_, T -3 N R / i Town of Subdivision Plat: es-rT~, , .e cy , Lot # Certified Survey Map # , Volume , Page # Warranty Deed y/ (before 2007)Volume P # age T~ k Spec house 13yesilio Lot tines identifiable Dyes[]no SYSTEM MAINTENANCE AND 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 Chaster 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the 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. I/we, 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. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Nu drooms 7SIG,1/SIG T URE 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 getace ~s madQ ~nthe warranty r~e~l. (REV. 04/12) (0 6S r - W 17 o&A 1.6 87 AC. .~v ~6° co .~h 22V vs 18 ^ co 1.698 AC. N' o d M N Cl) N N ' till ;Rt1 19 1.707 AC. 0. C-0 OX s ~ 05~ J 1 1 M o 1. AC. W 10 C 1.365 AC. 00* -'0O , cb N on N. 1~ 4~• ~4? 9 1.850 AC. z 1 3 80.00' 130.00 80.00 1275.76' 2668.54' DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDINGS LIV-0.1 & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, ill 53707 c 'CONVENTIONAL L~ALTERNATIVE SI- P,D Nur t- 'L ~ Holding Tank E (n-Ground Pressure L. Mound NAME OF PLHMI I HOLOEH A S Or F'FRFn IT RO: CEP INSPECTION `E Lynn K. Wandel Somerset, WI /r" 7 l EENCH MARK (P,-,.n-, ~IIr,F11-v c,-! DESCRIBE IF DIF FF BENT FROM PE AN REF FIT_ EIEV .SI f2EI ^T E; NE SE, Sec. 30, T31N-R18W, Town of Star Prairie, Lot#11, Crestiview Add. Nam Micahel Wilson 6388 St. Croix 54993 SEPTIC TANK/HOLDING TANK: IMANUF ACTVFiEH i -hl-. :AP:. ITV INK INI ET FIt IANi-li F TEL[Y IA~i JIN- 1R~i C LO(KIN(" (:✓EF 1 k YIUiL FI+UVICt. -YES S -ENO YES _No 7 BEwINO .7LN olA veN MATL rvnr H (NUMBER OF AonD - u >~RT. ~.rl L Bul~lati ✓Er rRESrI ~A IIVM FEET FROM it, INLI -1 - ! :YES _ -NO - - _'YES _NO [NEAREST--01j DOSING CHAMBER: _ IF; 4NIIFAI'TI;FI(H 1{1 ~lf!I. il:^,P.SIPR(]ty "AA"., ~.T1 i IF!? AAR `1111., EAF. F CCKINC FOV EP 11 L PROIiv. )t t) i`HOVIDFD YE NO_.L_ AYES NO YES ;NO LJD LLONSPEHCYCLE. PUMP ND~.E rRULSUPLHAIIONAL - F+,rr B,IEnE~.TTOFPESH I" AI NUMBER OF IFFE RENCE BETWEEN FEET FROM R INLET M_P ON AN_D OFF) YES_ _ NO NEAREST SOIL ABSORPTION SYSTEM. Chack the soil mo stur at t~Te fit pth of plowing FORCE - or excavation ilf soil can be rolled into a wire, construction shall cease until the soil is dry enough to continue } MAIN CONVENTIONAL SYSTEM: l E H LEr FI -.,r 1 r~r P11', ;Prv.INl, J!ER'n ,E BED/TRENCH T1 Ht ~I IFS ~ YATtHIAU PIT DIMENSIONS i 1 I IEP I f {`r TD $-ri PIPE MATER A[ (i AiTH NUMBER OF PR_P-HT-y JCLL Nll;i -J, VENT TO -NE-SH t L V1 P F A~~ vE C~J ~-E6T hl F I I L L P~~- LI NE ',III INLET r: I I" „wuE FEET FROM MOUND SYSTEM:_ Mound site plowed perpendicular to slope Check he texture of the fill material for PROVIDE A DIAGRAM OFSYSTEMMM and furrows thrown upslope mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- II I - meets the criteria for medium sand. TION.S MEASURED. SOIL COVER DYES _.N0 VES _.NO YES ENO tP7 --7H lHt veil BEfl ~)'P I+I]Je.Vi Hf rlr-J El(I' )FFiH l 'F,I ---1 - - LFNIF~* - l S(lf DFII FE 1CFi -T~ ) DiE ti I ~-I f- I - ~i_!YES -J NO _,YES _NO _YES NO I PRESSURIZED IZED DISTRIBUTION SYSTEM: WI!:TI IEVii~l ND OF _A7 F:AL SPAIN{, rRAVFt Of PTH HEI Vi PIPE FILL D-1Tj BED/TRENCH ~__~rRENCHES DIMENSIONS I MANIFU_U PUMP -MANIF 'L ,JISTa pip' MANIFU_D MATE HIA, I'll, lf$T,i D15TH P!P!- LiISf tITI~II ICJ F_E'i :Tf I.I~~i E_E v EI EV OIA DE. FIFES UTA ' ELEVATION AND DISTRIBUTION _ INFORMATION HOLEJI(E CJL,S'ACINC CHILLFDC(IHRECI[Y COVERMAtFH1AL VERTI 41 ilFICgHHFSPnr'(if,Tr,4VPHr1vEC PLANS F-1VES _ L~NO i~YES LlNo COMMENTS: PERMANENT. MARKERS OBSERVATION WEL-$ NUMBER OF PFOPERTV -TWELL 9UIL DING FEET FROM uNe LJYES FL j _ NO C_YES L]NO NEAREST-- - - - 1 r - i Sketch System on Retain in county file for audit. Reverse Side. SI(iNA TURR TITLE DI LHR SBD 6710 (R.61 /82) RECEIVED Wis. Dept of Safety and PrWordafSe~rbics SOIL EVALU N 7RT Page f/ of Division of Safety and B MOLK COU~ce with SPS 38 Wis. ooMMUNITY DEVEL County Attach complete site plan on paper not less than 8 1/2 x 11 i i . P' include, but not limited to: vertical and horizontal reference po , diParcel I.D. percent slope, scale or dimensions, north arrow, and location nd di- .aarest road. v - Please print all information. Revi ed by Date Personal information you provide may be used for secondary purp, Law, s. 15.04 (1) (m)). LZ Z-// 7 Property Owner Property Location o A,, VL A-elI 111 it 110e il't Govt Lot 1/4 /_/'~-1/4 0 T: N R 1 L (or)oV Property Owners Mailing Address Lot # Blodc # Subd. N r CSM# nn X 12- ?p 30 C~PSrU~ew Cec~~,`f,'vz City State Zip Code Phone Number ❑ City ❑ Village ©Town Nearest Road ✓erv,e C'-S~~'f 11+1 Sy~z~ ( ) s~~i ~rr , w L ❑ New Construction Use: ® Residential ! Number of bedrooms Code derived design flow rate GPD ® Replacement ❑ Public or commercial - Describe: Parent material D r{ e.J o u t 1." of Flood Plain elevation if applicable General comments yS f "1 ~ C v f 4 U Y G o 'A- rC and recommendations: Boring # Boring S U ® Pit Ground surface elev. ~ ft. Depth to limiting factor7q ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ff#1 ff#2 y yg 7,IVA SL 'Zrnshj" /h7/~ c w d ~ 6 /o U fti6 0,7 z ® Boring # Boring ~/'l~ 0 Pit Ground surface elev. % / , e ft. Depth to limiting factory in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Y ff#1 ff#2 I 0-1y 104~z 111A SL '2m v fi~~ Cw 2c 01 6 A G Z IV-32 7, s iR % AVA- 2- mf'~/t M,/,/ C&- 1n 0,6 0, 8 s* ~A SL / ms"~ m~" w / y 0,-7 3z- Y~ -71 Effluent #1 = BOD > 30:S 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BOD t < 30 mg/L and TSS < 30 mg/L CST N e (Please Prat) Signa CST Number Address Date Evaluation Conducted Telephone Number 9._ his- z s~~ -3z ~3 SBD-83'0 (RI 1/11) i Property Owner o{]~ % n roc - ~U y- 16 6 0 U D Parce_ Page of ®Boring # ~ Boring ® Pit Ground surface elev. / ft. DepthN limiting factor )'S"? in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Mansell Qu. Sz. Cont Color Gr. Sz. Sh. ff#1 * ff#2 0- l3 /~Y~i SG myr m c G i , 0 Z 13 3U 7, SCR % /VA L a M16 K Me6', C U-- m 0,6 l , D /y /4 y yy-sq 7,1 LJ~s 6, y o,G ❑ Boring # ❑ Boring 0 pit Ground surface elev. ft. Depth to limiting factor T/~b in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 * ff#2 2 8-1 9 -71 msbk c u. ~2 /n 3 ~9 3~ 7% SG lmS;~ cc~ o. y o, 7 I, V 39- 9~ 7, s q% FS D SF /7" L - /u71 0,S Boring ❑ Boring # Pit Ground surface elev. ft. Depth to limiting factor in. ❑ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ` ff#1 * ff#2 ` Effluent #1 = BOD , > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD s < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBD-8330(R11/11) Property Owner 5;, r='c f r pa e o Parcel ID # l 9- Boring # ❑ Boring ® pit Ground surface elev. ft. Depth to limiting factor,~-CY n. ' Soil Application Rate Horizon Depth Dominant Color Redox Description I Texture Structure onsistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 * ff#2 IVA V9 71 S v ❑ ❑ Boring # Boring pit Ground surface elev. ✓ ft. Depth to limiting factor T in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Fonsistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 ff#2 G L C, G ('66, ❑ Boring # Boring F-1 ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 * Effluent #1 = BOD , > 30 < 220 mg/L and TSS >30 < 150 mg/L Effluenl #2 = BOD . < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBD-8330 (RI 11"11) OWNER Page 3 of 3 Name n/ e//ro- tf~~t, r Brian Parnell 1) 0 Address ?6 r36,y 12 CST 231314 / So,-e SYf c~~ Sy°~' l~'1 Date 0 _ ~r ® Benchmark 1 To Jc ~e L_ hCJ. 2 u 1 Benchmark 2 ❑ Soil Boring Suitable Area 1" = 40' Scale ~ O i1 v i I I 1 3 4' 4 ~F 17 1 J ti 5 i~ t f