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HomeMy WebLinkAbout038-1000-10-200 Pdsconsir Cepanmerlof Comnl- PRIVATE SEWAGE SYSTEM County. St. Croix Safety are Bu Id ng Division INSPECTION REPORT SannptyPer^•tNo (ATTACH TO PER'.11T) 605138 GENERAL INFORMATION stale wan ID No. Pe•sonal ie`ermeuor you olcwce may to .Ae, lot secOrdaty' pa'peses ;Privacy I s.'5 04 (1 )pr)) Perm 1 •Iolli K3me City Village Tuwnc-,rp Pa rCCI lax No. David & Erin Koch TOWN OF STAR PRAIRIE 038-1000-10-200 CST Bh1Ee:. I^sp Bfv1 fiev BM Oescr atler. r~ l Secuc JI ownrRarge.blap No a Ap- 01.31.18.1A-10 TANK INFORMATION ELEVATION DATA EA. MANUFACTURER CAPACITY STATION BS HI FS ELEV III .Y ,-QC Benchmark - - - - All E110 Bldg Sevier f b , - - - - SVHI Inlet SVHt Outlet TANK SETBACK INFORMATION (vL{ r TANK TO V:'ELL BLDG Vent to Afr,lwu.c ROAD Dt Inlet - - - Sep! c Dt Bottcm !Y ti- ILD Dosing Header:K4an. Aeration - % Dist Pipe, 799 ?,5. rya Holding - - Bct Syslenr 4 Final Gr oe PUMP/SIPHON INFORMATION tc 70 aU Manufact.ne• Demand St Cover U GPM y) /O ~2 w Model Numcer''.. S r )o O9,~o TDH Li't Fnchon Lcss' System Head TD/ H Ft q O Forcemain 1 engryi Cia. - - - Dist to':uall - _ - - - - SOIL ABSORPTION SYSTEM BEDiTRENCH :^;.am _enotn No. of Ireneres PIT DIMENSIONS No O'P Is Insice O~Ti Lrcwc DIMENSION$ Ii C1 -f SETBACK SYSI E10 TO l Pit. Lk BLDG V-A L ViKEi TREAM LEACHING td an.fa~C/C(..,(1 E.~ INFORMATION CHAMBER OR TYpc O' `y'slern / v ( UNIT Modc: Numter Q „~l~kt i 5. : i , r4C~ DISTRIBUTION SYSTEM 54- Hea.l, falc 1L'isl'itj N, xice Size xFC e:i'iaarn___ Vent to A r lrwe Pmulsl Lcugl` l ~ Dia Lcng:l' _ Ura _ Spacing - ~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grado Systems Only Depth Ocei Deaf Ove• ax Depth o` xx SeecearSid!ce xx Mulcfud Unar franc, ::^n:e• ueo: I rannh Fdges cpsatl Ycs Kn Yes - No 1 I i COMMENTS: ilnclcde code discrepenoes, cersons present. ete.j Inspectional Inspech nag: 1 I n~u. Location: 1325 POLK ST CROIX RD 1/~CA 1, T ~j[,~ 01~ Wit.( g~Caa.~ ✓ l 1 y Alt Brit Desc•ic!ion = 2) Bldg sower lergtn = - amCert of cover Plan rev s on Requved•r C Yes I No ir, Use other side for additional information 0 I C to InSepcWYS S'gnalurC Cert No SBC-0?1G IIR J 97I 1 Industry Services Divisioncowq DS 1400 E Washington Ave2 IF I Sanitary Permit Number (to be filled in by Co.) P.O. Box 7162r P S ] li ? 018 Madison, WI 53707-7162 19, awIN (0 (jy Sanitary Permit Application sla~Trm~elignNami In accordance with SPS 383.21(2). Wis. Adm. Code, submission of this form ro the a~rirt ~ is required prior to obtaining a sanitary permit. Note Application forms for s191eo S are submitted to [ the Department of Safety and Professional Services- Personal informal you provide may be used for secondary Pro)eer Address (in(ndifl or than mailing address) purposes in accordance Ivi the Privacy I.ew, s. 15.04(1 Xm)• Stars. 1. Application Information - Please Print All 1 ation I Properly Owner's Name al Parcel p ' Property Owner's Mailing Address Property Lrcatimr U 1 , 31 . 1 O Ir 1 Govt, Lot i City. State Zip Codc Phunc Number IF, Jll A A. Section (circle 004 T_ N R EorWi' ied, Lot a - 11-,Type of Building (cheek all that 111 a 2 Fatuity Dwelling- Number of Ilcdrouins ~ L/I Subdivision Nana ❑ Public/Comnaaeial - Describe Ilse Bloek a 1/v,il P 4✓~ ~f ❑ City of State Owned - Describe Use . CSM Number / ❑ Village of 3 11 , ~ w 1 ,e5 Q Ibw, of Ill. Check ont a box_on_line A. Complete line B if a icable) -4, 6 New System ❑ Replowi n[ -System 0 Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) R. ❑ Permit Renewal ❑ Pemrit Revision ❑ Change of ❑ Permit Tramfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner - _ Cort neri lkvice: (C6cek all [hat apply) IGI Non-Prcssvrized In-Ground surized In- hound ❑ At-Grade ❑ Mound ? 24 in, of suitable soil ❑ Mou 2- 4 in. of saita le soil ~s rspersel Comporictn (explain) ❑ Pretreatment Device (explain) S V. Dis ersalfrreatment a Information: Design Flow (cod) Design Soil Application Disposal Arca Required (sQ Dispersal Area prope JSystemElevation Rate(gp ' VI. Tank Info Capacity in < u Gallons Total Ii Of o o Man azLt°rcr o g 2 e New Ta,ka Fxisti, Tanks Gallons Units _ l O OM1- SZ e' U ffN7~ m N - LL O M1. Septic or Holding Tank - f %-s Sxl- ❑ Dosing Chamber ❑ ❑ VII. Responsibility Statement- 1, the undersigned, assume respomlbllity for Installation of the POWTS shown on the attached plans. Plumber's Norric!"I/' I Plumber't rc MP/MPILS Number Busbies Phone Number Plumbers Address (Street. City. Seal Zip Code) VIIh unt /De partment Use O I approve Permit Fee Dal ksu Issu tSlgn Approved a~ a _ vcn Reason for Denial S ✓ • O r' ~ _ _ IX. Could ifle Disapproval ,3) n , ~L t I- „ rG /1 .IL (~L1•"(~n dies tG•ar.- _ AWd l oee roast of hlJCRlI(g/,.IM411 C . e pr tlarlwrnatl! plan "laded by slil i- 2 N adbw* r*qI.W nn ml be ner1l •per aff4criWaco&I:rt laxaf Attach to complete pleas for the system and submit to the County only on paper not less than a to x 11 iacbes in size SIID-6398 (1103/14) L' A3 - i ~I ,a 1. ~ _ 0 p - CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TrrLE PAGE Project Name: Owner's Name: Owner's Address: - 7 Legal Description: = f - Township: County- Subdivision Name Lot Number. _ Parcel ID Number " Page 1 Index and We Page 2 Pkrt Plan Page 3 System Srzing & Cross-Section Page 4 Filler Specs Page 5 _ Maintenance Information Page 6 - Managemen! Plan Page 7 SL Croix Cty Septic Tank Maintenance Forth Page 8 warranty Deed Page g _ CSM or Plat Attachments: Soil Test & House Plans License Number Jf=. Designer/Plumber Date: Phone Number Signature / pesmjned pusuard to the krGrourd Sal Absorption CmrgoneW Manual for POwis Versiwr io SW-1o7M v pcoimi} Page 1 N ~ dl i?t li/ l ux- ~ a ~JG ~1ico.o i i 1 K:- i Z\13 l\1 s. t 1 ~j • 3 lee, 4ti Soil Absorption System Cross Section rc 4' Schedule 40 Final Grade PVC Vent Pipe With Vent Cap ft Leaching it Chamber ~ System Elevation ft ft ft Soil Absorption System Plan View ft ft { l i Leaching Trench 1 ft Chambers II~IIIMIII IIII~ 4°Dia. Trench 2 Header Vent Or Observation Pipe f(1111~ffiii1111~(I( Ifflillilllil(~llll]11II~Ili( Trench 3 Leaching Chamber Specifications Manufacturer And Model T , - EISA Rating. - f sq ft per chamber Soil Application Rate gpd/sq ft j ; gpd Design Flow - 7 Soil Application Rate EISA = - Chambers 3 rows of--,~ chambers each. Page \ T of y(, *~v~ 1 PL 525 EFFLUENT FILTER Polylok, Inc is pleased to add its T'= new commercial filter to its existing line of quality effluent filters. The PL-525 is rated for over 10,000 GPD ~lJ Alarm Accepts PVC !gallons per day) making it one Of accessibility ' extension handle tie !argest commercial filters in its - l' class. It has 525 linear feet of 1/16" titration slots. Like the Polylok FL 122, the new Polylok PL-525 has an autornaticshutoff ball installed 525linearferf r ith every lifter. 1NE1en the filter is situatioof 1/16" n slots Riled for over removed for cleaning, the ball will 16,000 GPD float up and temporarily shut off f the system so the effluent won't leave the tank. No other filter on ; - the fyrarket can make that claim? Acmpts 4° sr e•' - Sfx-tD. ao Pipe' _ i PL-525 _ ~/_`."3 1411cif11 c6:utofl s.G: E ~ The PL-525 Effluent Filter should operate efficiently for several years ';i under normal conditions before requiring cleaning. It is recom mended that the filter be cleaned every time the tank is pumped or at least every three years. If the installed filter contains an optional I fl alarm, the owner will be notified by an alarm when the filter needs !j Gas deflector servicing. Servicing should be done by a certified septic tank „Automatic shut-off pumper or installer. ball when filter f f is removed i 1. Locate the outlet of the us.I Vent Nni' 6,01-S,48A septic tank. U 5,371,c40 2. Remove tank cover and pump tank if necessary. 1. Locate the outlet of the 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and com- 2. Remove the tank cover and 4. Full FL 525 out of the housing. mercial waste flows up to pump tank if necessary. 5. l lose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the 4" or 6" outlet pipe. If the tank. Rake sure all solids fall filter is not centered under the back into septic tank. access opening use a Polylok 6. Insert the filter cartridge back Lxte rid & Lok or piece of pipe into the housing makinq sure to center filter, the filter is properly aligned and 4. Insert the PL-525 filter into .:omplet_ly inserted, rts housing. Raplace the septic tank cover. 7. Replace septic tank aver. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page. or FILE INFORMATION SYSI FM SPEL]FICA110N Csvner ank ofanuta tcrc: -1 NA IJ Dose L Hold:nr, V., time: - ;y0 DESIGN PARAMETERS Tank PAanuL;(tur D} NA Numbor u: Bucifcon.s: u, NA U Sept'c ❑ hose Li Holding Voltimr- (ga:) - N.;ru:'el U: Public L ity aNIA V:ni-ncal Dis:<roe Tank flofanm(s) to Service Pact: al) Estimated (evcmign) f-lid: In. i7rntai Distanoo Tank(s) to Service Pad: (e) n r,k .vv'cing mechanics must. be pro•6ded if vertical I, >15 feel or I )~slpn (peak) Flo'.v = (e. irratoii x 1-5): _ ? (t rl i -yi d h n <onlal is >1.50 `vet. of , c 0c ns'm li:n to be pmvided on back. In Situ Sol i,r,pli..<lhon 12.,;n: _ 4. I _ (gaLd,y.u-; I --fl.r.-,r Filter Paanufaclu ~r ~!'v / ! I NP, Stand; rd (Domestic) InfUellUE(ficeltl 10onthly average PLluent F Iter `010deC =a:s, CII s cra.=.xe (FO(-,) s30:ny:L MIMI) F:lanufaCturer: iiu:::Lnni,al Oxygan r,entaad (1300') e220 mgA 1.1 KA •~1 P;r Tctal Suspcrnn:d sa,lbfs (ISS) x150 mgrL Pump Model: i I' r.. Strength Influent:I ftlucnt Monthly aver, ge Pretreatment Unit (FOG) >30 mgA. Manufacturer. +290 rn,IrL NA - _ (rS;i) >150 en :L iJ VoLal xical Aeialixi ❑ Peat 1-1:101 I'a;frcatca Fflh:el:f ?•,1onli:h dvera• I I Usinfect'On I I',Vettand y d° ❑ Sand:Gravcl Fi Icr ❑ Clh_r. s30 n1ga, Scil..6wrplonSystem (I ss) <30 cr..:L NA : Co'irocn (geonletnc mean) •a0" _ ttAln Grcund (gravity) I I In Gro.md (pressure) J NA (:•laximur.I Effiuen; Partide. Si7, in c'ia. A7-Grad= ❑ tAoor:t I_ I NA J Gro-Line L] omor. Other: i- NA J NA MAINTENANCE SCHEDULE Service Event Scriice Frequency Pumpo,-I _ L^ihen ccrebined ::IuCgn and sr.Iir1 ::qu=its nn::-th-rd (F.) r.f `.ani, volume rcx:h,nC; n; tsrk(si _ hen the hich':;a`.rr akrm is I.nspec; co::ditrc:: of tink,•S, mur l At Icast enr every. (Maximum 3 years) I I NA IOSpeCI dispersal cell p- At least Deer. rvr.:y; (Maximum 3 years) J NIA year,.,. Clean of^uent file; At east cnce ovc..ry: I 1 nwnth(a) J Nip I _ _ idY=ar(s) Inspect pump, p'..mp u - ❑ aa:n7i(s) contrds u Lila! -n At I~+asl once every: ❑ NA - ica:(s1 n, St a. ::Is aoe pressure test At least once e >rY* ❑ rr orthf,} NA ❑ er OI: r i r , wrath, s) ,.:I I I NA Cthc, ❑ N;; MAINTENANCE INSTRUCTIONS Inspections of ranks and Soil aLsclplio:) 1,yr:h.r^ 1 tlI Le old i- -y r rrtdi:i.lua' ::^ary'I d ,Jti Of Thu frllr.,,r'ng r -r O o. rt-%-1 ,-ors: :aster Plt.-t,ber Plaster Ob"Iber FtesLiutud d(!, PO'aVI-S I ,pec:ur, PO,N'18 [JAnta ncr or `rnngo Scn:dng Operator (f)ualpciO Tall Fc pnc[ions must include a vir::al insueolicn Of the tank(s) to idc,.!-y any missing ci Lro.kur ha:dsvate, identify any clacks of leaks, mua:Swe tho volumn or ::uinbieed siudgo and scum acd a check for any honk up or pending of clwnlll on the grounc sucacr. 'I "he soil absorption systu(r shll be •dlsdal y r5pec!ed tc rceck th- et' pert love's in Inu 0bsonsa-on Pip^s and to crec'.rt ter any pondlnq 0: effment o:t :tie ground surface. The pu,icing of eft'urlm un the yruur:(1 :;:)dace .ma'y inciicata a railing condition and requires trio immediate notification :)'the Inral re qul aol y authonty- When the combined accumuta6on of 1; 'edge and scum in any trca-mcrt tack equals one-third (k,) or more of the lack volume, the entire contents of the tank shall be removed by n Soptage Servicilm Operator (pumper) and OSPOSed Of in accadal;Ce With chapter NPN 113• V..iscmis:n Administrative Code. A] uthei seivinF. 1, innhiding Lul ncl fi:ni'.ed 10 the servicing Of effluent filters, ,roof anica! or prossari7rd componerts, pretreatment units, and any servic'ng at interva:s of _12 months, shall be por-crmed by a certified 1`011,Wq Paaircairer. A servicO report shell tie providrd to than loea' regulatory auttcriby :vithin 30 ciays Of ccm*letion of any serv.'ce evert. Or,%V-005 (02,-05) Pang cf START UP AND OPERATION For ncdv 1:101 to tier cf lire FOV•ris &V-C: trerr::n 11:. 'ark{sj far 1!'o cresenco of painting products, solvents or u:i:a• uhemicn:: or sod went that may `mhrde file treatment process arc;or cans<ge the soil abspption systun. If high eoncentratiors ale detected have the cunler.ts of thr. t:;nk(st removed by a Septaye Servicing Oprr<aor (p::mper) pricrto use. I'ump tanks may fit abc,,+ti rrmlal cigl,,::n°^r i-ve!s priur to startup or due to pcntp fal.u;es. Start up or reslorttion of pos\;r antler these condtions is rct recorrmenrt:~d, a:; the esxss •d:astes,aler 1h"il b2 dlSCharg:rd to G.e sal ascipFon system in one large dose ceasing an overioad that n:ay r-suit !r. fire L•adap r.' surface discharge of ef? ac-n: and darnaye to the sys;rm. Io avoid This situation have tf:e a piers of the pump tank remcveri by n Septage Servicing Operator fpanper) pror to restoring pcvvvel to the puctp or contact a Plumber or PO4`,?S i'v1ainz-vner to -ssist in manualy operating the pump crn'rr.'s unlit Penn al el'Went love s are Ies'ored within the pump tank. System Stall up shall not exurwhen sell ccndifions aro Go2en at the infil°ratve surfae:, Do not drive or park vehides ever tanks or the soil absorption system. Do ricl drive r:: pa: k over, or oiliervise disturb or compact, the ::lea within 15 feet dova. ,Icpe of any mound or at-grade soil absorption aiea. Reductior nr eliminaliun of thr. tcllcaang "Orr the wnstruater stream may ictp ove the r.nrtcm anne and prclong'he ffe of ti.e treatment larks and not absorption system: acids, antihiofcs, hairy wipes, cigarette braes, rondrms, cotton swabs, degreasers, dental floss, diapers, dis'.•tioctants, fats, fourdetior. drain (sump pump) discharge, frcJt and vegetable. Peelings. gasoline, greases, herbicides, beat me'.icaliCn>, cis, painiiny products, prstidde,, sanitary napkins, sohrenis, tampprrt;, and wafer soft ener brine, discharge. ABANDONMENT b:'hcn t~.e I'UY': I S fa l; aru:lor is permanently taken out of service the frllowmg steps shall be. taken to insure, that the system is prnpor y a'xj safely abancPn;:d in rc:npliancewith s. Ccmm 83.33. Wisconsin Adn:inistra"ve Code: • Ai piping to forks, pits and oilier soil absorption systems shall be disconnecter and the abandoned pipe cpen'ngs sealed. • 1 he contents of all tarks and pits sna ll be removed aid properly dsposed of by a Septage Servicing Operator (punq:ar), After pump:ng, all tanks and pits shall be excavated and removed or :heir covers removed and the void space tilled •.vitit soil, - cravel ur another ir.cd solid i- iai. CONTINGENCY PLAN If tho POVITS fails grief c,-mno`. be repaired the follo'afiag measu-^s have been, -a mu::t be taken, to provide a code compliant rep`t/aantcnt sy:;tem: A suitable ,eplacement area has been o•,valua'rd arid may be trIP17od for the. location of a replecem-nt soil absorption systr.•m. If,(-, :-placement arc-) shou'd be protentod from disturbance and rcripactic•: and should riot be infringe, upon by rc,3::ire snchocks fiom existing and proposed stn;chxc., lot lines and •,aells F:glCxn m protect -tic, reptarnment area will result in the recd fo1 a ncJJ soil and site evaLratinn to establish a s-Atabin. 'nplacement area. Rep'acelte:tt systen'S must comply with the rules ir. effect at the trine of than perm' issu%ric ❑ A suitable n-placement area is rot ; ailabte due to sotbark a::d1o1 soil linlitatlons. If the soil absorption system cannot be rehabil'tati erd oairrng advarre s is PO'eVTS tenhnology, a holding tank may be installed as a last resort. ❑ The sis. has not been evaluated to identify a sutablo rePlac:emecl area. Upon failure of the POWTS a soil and site evaluation must h:: per`orrned to Inrltr. a su::ab!e replacement area. If f.0 replacc•.•nort arcs is availnHo a holding tank may be installed as a last resell to rep'ace the `ailed PO61?S. I I 6,lpucc ag-d at-grade sort abscrplinn systems wsy be reccnMrimted in place fclloming rerTioeal cf lire bio!nat a. the inflitm'ive surface. IZxon,tn r..tio:w cf such sys'errts dust Corfcly with fi`e rulesn effect at tea: time WARNING TREATMENl' TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY r RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: POW']$ INSTALLER POINTS MAINTAINER Phone Fhrrc I SEPTAGF. SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTI IORITY Nzrte Name 11., Fhono Pf'une Pi Cb1';L '.ert ::as di:-riled by Iha staffs c` the racco Like, :^rrq,rc`te ..1:111 :`;,njshxa County f'O':•r5 rppiate:y agei-Jes in cr.-npl anrc with scrfnns Ccriri a3.22(2)(b)t1)ti A)8(h rind 63.:14(1). (2) & (3), bVisrrnain AdniinArati.,u Cede. -'.air tti' ur START UP AND OPERATION For ne•:; construction, pdnr to use o' :Ile PO':^11S rnr:k free.. nt:rt Lrklri fcr rile p'esercc of paintinc products. solvents c, ::Ifl~' or • edirlen: that may finned., t7e- ireaUnent b'-lass a:'d!oi damn9e, the .~i ausorFtion system. h high conDentraficns ai cnen':i~ris _ . - : dotertec have the contents of the tankisl remcv d by a oeptage Servicing Opcra:D. (ptunpeT) pnOrtg use. Pump tanks clay fill above nrrma hi.chvvater levels pr:or tr, Rm-iuo or dje to pump failures. S:a3 up or rcSTnration of power under frost: corditions is not recomme:tded, as tie cxce s maslev;aLel win In discharged tc) the s:.-il ansorptron sy --m it Ore large dose wusinr: r-,ii overl:ad that rnap result it the backup or surface dswargc. of efilue:rt and damage is the system. To avoid this situation hayr: `nI-_ contents of the pump tack retr:oeed by a Seotage Sen;:cng Operator (oumnerl prior Is restoring pc•,ver tc l!:e cu:np cr concac:t a P:u:nun or P0iATS Maim2 mor tc assist in n:autali;v operating Lfte purrrp controls :mti, normal effluent levers ale -estoied.thin the nump :ar:s.. System start uP shalt not oxu: wenen soi: conditions a-e framer, a: the infiltrative surface. Do not drive, or nark veh:cas ever tanks Or the soi. ausoroticn syste.T. Dc not drive or park over, or otnewAse disturb or oompact tlhe area viAhir. 15 feet deny siope of any moune. or at-grade soil absorpton area. rteduction cr climmairor of lt:e 'oilw/rig frcT the toter stream may improve tte ncrforran~e anc prolong the life of fhe tr atcleai ;arias and soi. atsorruor 54'S:em: acid- annDMJ 'ybaU wiDCS -1-arette to:'s ccrdn-ns ccilon soiapS, degrca r coral f10;: diaCers. d::ircectants, fats, ic.lndaTon drain lsurno p-l-lpj discharge, fruit aac ve_IC;a: do peelings, gasofi,^.e ge->sr. herbic.-1-- scraps. mcd:ca'lons, oi:s, painting oducts' pesticides, sanitary' rapkins. soive::s, Tampons, anc'r;_i softe^cr brine discharge. ABANDONMENT Wken fhr: I S fails anr,+or is Permanently taken o.rl of se-vice the fotowinp steps shall be taker. to insure tiat the spste:r r.nd saey :tl:andoricii in c l-nul,ance will,. Come, S .:?5 r: iis;.ol~sln A, r'iinistrnave Coda • A:I ripmg ter rains, pits and otnor soi. absorolior, systems shay he disw::nected and the abandoned pipe cpcnings sealed. • Tire contents of all tanks anri its shall t r--Mc wed and proneriy disposed of by a Se?:aye Servicing Opcraio- (pumper;. • After punpirhg, al' tams a-1 pits shall be excavated anc lemoved or their coders removed and the void space ri l:>. "V17 sot. - yravel or arother ir.cr solid ma`.eial. CONTINGENCY PLAN If tt PJ'+'•u'TS tails oral c:.nnel be repaired the foilov;Ing measures have been, or must be- takers, to provide a goon. con Dlian: re,:;.acemec° svstom A A saitable replacctraen' area has been evaluated a:hc may be tt'I¢ed for the loatior of a replacanent soi! ansomoon systar. -h^ replacement area sfroue he p^a'ected from disturbance. an- coriipac for and snouid not be Infringed upon by recui'eG s?tbacks [turn existi:hg and proposed structure, lo: lines and wells. Failure to n,otect the reaacement are=_ wrl reel: in the non: e rr. dr Solt ana site evalu.atic - In establish a scitaUe replaoomen: area Replacement systers must comply with the r:ae_ in et,-:;t a: the lime of `.heir nermi' issuanoe. A s.lzanie replacelrhad area • •vailable due to sofback sndr'or sel limitations. If vie soil absorption syste.•r ca.nno: -oc rchabihtased and barrinc acvarce% fr. PJ'J•J.-S tec'wi:rogy, a holding map be insfa.led as a las: resor,. -r site nos not beer. evaluated b;, idertifd a suitab.e rep,aceInert area Upcc faituro Of the POIPoTS a soil and site evaluation mast ne Performed w Tonto a str'ablc repiacerverl area. If no cpiacement area is ava_i:able a holding tank may be mstal:ed as a last resaA to replace the fa:[od POW's. Mound arc at-grade. soil absorptio': systems may he reconstructed in place folloeAng, reroval of Gre Moira: at :he Inrhltrative Sur.i „u-:I s„tens must comp: vith b_e r I r e5c t ~it that tin'm. WARNING TREATMENT TANKS. PUTYIP TANKS. AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGFN TO SUSTAIN LIFE. NEVF^r. -,NT--R ANY TANK LINDER ANY CIRCUMSTANCE. DEATH MAY RESULI. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. try' ADDI I IONAL INSTRUCTIONS: PORTS INSTALX•CR PORTS MAINTAINER Nrr .-rf`: / I Namr y - C Phont i SEP"I'AGF SERVICING OPERATOR (PUNIPER) LOCAL REGULATORY AUTHORITY IVw':T' N31 i. :•/-~'~j .t:.'~ci `~B'--!"n h.- :1'•cLltlcd tt..fie„ b, Ito II : -r' r- ak=. Lt'ii ip. I vac agInc irL in :G1pl, t. wiP '•^'19n:. l-iii.. "'il[fll u9 t., Parcel 038-1000-10-200 Valid as of 08.1 61201 8 09.58 AM All. Parcel #:01.31.18.1A-10 TOWN OF S [Ali PRAIRIE ST. CROIX COUNTY. WISCONSIN Owner and Mailing Address: Co-Owner(s): DAVID A KOCH KOCH. ERIN E ERIN E KOCf I 1563 PONDEROSA LN Physical Property NEW RICHMOND W154017 Address(es): Information Not Available Districts: Distif Description Parcel History: 3962 SCH DIST NEW RICHMOND Date Doc* VoUPage Type 1700 WITC 06x'25!2018 io,-,F_.~ I WD 12/06!2011 L'4- OC Legal Description: Acres: 9.210 08;072003 y,s? 2352:421 WD Sf G 1 131 N R18W NW NW BEING LOT I CSM 09,28+2001 1728101 WD 14,4015 more-, Plat Tract (S-T-R 4044 16WA GL) Block:Condo Bldg 4015 GSM 14 4015038 2000 07-31N-18W NW NW 1401 1 2018 Valuations: Values Last Changed on 09:13:2011 Class and Description Acres Land Improvement Total G1-RESIDENTIAL 9.210 44.600.00 0.00 44.600.00 Totals for 2018 General Property 9.210 44,600.00 0.00 44,600.00 Woodland 0.000 0.00 0.00 0.00 Totals for 2011 General Properly 9.210 44,600.00 0.00 44,600.00 Woodland 0.000 0.00 0.00 000 2018 Taxes Taxes have rot yet been ralc0lated Key Primary ST. CROI% COUNTY SEPTICTANKMAINTENANCE ACrREEMENT dI - '•viL- AND G 2 0 2018 ONN~iLRSHIP CRRI'IF'ICAIION FORM A'- Vl~~~- OwneriBuyer Mailing Address ~ 3_©11 U S~ ~ll h (0. I'. t~~\;4AG/7LL& SJ Property Address (Verification required from Plawning& Zoning Department for new construction.) Parcel Identification Nu nbet I .P GA1. DESCRIPTION Property Location d ' _ALL"_ _ , Sea 7'-~ I N Town of )division Plat:- Lot # Certified Survey Map # _ - , Volurne Pa e # i 1 Warranty Deed N (before2007)Volume - Page f,_ Spec house 0 yesxno Lot lines identifiable J yesliXno jl SYSTEM MAINTENANCE AND OWNER CERTIFICATION improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper niaintei=cc consists of pwnpine out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the ~ yxtcrn can affc: t the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(l) and in Chapto: 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & "Zoning Department a certification fort), signed by the owner and by a master plurinei, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site uniewatet disposal system is in proper operating condiuon and/or (2) after inspection and pumping (if necessary'), the septic tank is ',ess thin 113 full of sludse. 1lwe, the undersigned have read the above Fequircinutz 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, Sinte of Wisconsin. Ccitification stating drit your septic system has been maintained must tic completed and returned to the St. Croix Courtly Planning &'lunhig Department within 30 days of the three year expiration date. i'we cent iy that all statements on is form arc true to the best of my/our knowledge+ llwe amlarc the owner(s) of the pro;:cay described above, by virtue of a , iranly deed recorded in Register of Deeds Office. Nuinber of bedroo s S 10 ~ N:\Tt;IZE OF APPLICANT(S) DATE. "."Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Departmcnt+ inolude with this application a recorded warranty decd from the Register of Deeds Office and a copy of the certified survey map it reference is made in the warranty deed. (REV. 04!7 2) ti as 18 Wis.Dept , of Safety and Professionalpgr4ic4sli SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with SPS 385. Wis- Adm. Code ~ Attach complete site plan or paper not less than 8 1/2x 1Tmehes in size. Plan must County - ' include, but not limited to vertical and horizontal reference point (BM). direction and parcel 1.0- _ percent slope, scale or dimensions, north arrow. and location and distance to nearest road. -^i- Please print all information. Rev by Date ==:;~L Personal infmmatsen you provide may bn uses !or secondary pur -w,, iPrv<c/ Law. S, 1S 04 (1) im)). g Property Owner Property Location GoA Lot VC, 1" 1.14 I T )i N R rr{' E (Ort Yv Property Owner's Mailing Address Lot # Bloc" it Subd. Nam o CSM#_ Q ) ^ State Zrp Code Phore Number ❑ City / ❑ Viloge ElTown Nearest Road New Construction Use. CA Residential / Number of bedrooms _ Code derived design flow rate GPD ❑ Replacement Ir~I Public or commercial - Describe: Parent material - N Flood Plain elevation if applicable ft General comments j=. 4 j~/,11 ~~JJ and recommendations Gr?'N2 A E] Boring Bonny ® pit Ground surface elev. r Depth to limiting tailor in. Soil Application Rate Horzon Depth Dominant Color Rodox Description Texture Structure onsistence Boundary Roots GPDM in- Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. ft#1 if#7 60, f~ 0 Borir.c III E] Oonr^_ VI/ pit Ground surface elev.' N Depth to limting factor! _ in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPDrtt ' in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. tt#1 ff#2 v I is r is " all i {I Effluent #1 = BOD ^ 30 < 220 mgR. and SS >30 _ 150 mgA- ' ~ffluent #2 = BOD 30 mgrL and TSS < 30 mgrL / , CST Number CST Nart94 Please P .t) ' Signature ntldress - Date Evaluation Conducted - Telephone Number - - SRI?3t+U1Hl lilll Property Owner Parcel 1D# Page ofi Borng# Boring l J l,g Ground surface elev. k. Depth to limiting factor m. r7 pit ~i Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD,h ' in. Mursell Cu. Sz_ Cent Color Gr. Sz. Sh. k#1 1`1#2 G - v. I/Z ❑ Boring At Bonne ❑ pit Ground surface elev. N. Depth to limning tailor in. Soil Application Rate Horvon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD.1t ' in Munse!I Cu. Sz. Cont Color Gr. Sz Sh. ff#1 ff#2 Boring ❑ Boring # Ground surface elev. k. Depth to limiting raCOr in. ❑ Pit Soil Application Rate Horvon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPDnt in Munsen Cu. Sz- Cont. Color Gr Sz. Sh. ffltl ff#2 Effluent #1 = BOD , > 30 < 220 mgil- and TSS >30 < 150 mgiL ' Effluent #2 = BOO , < 30 rngrL and TSS < 30 mgiL 'the Dept of Safety and Professional Services is an equal oppurtonitY service prooider and employ or. If you need assistance to access services or need material in an alternate linmtat. contact the dcpa tment at 608-266-3151 or TTY through Relay. seb31 in (31 t~! u ?ropery. Owner E of Boring x ❑ Bortng - nit Grourc surface elev. ' t It Depth to hmihne fa.ao Ir- Soi: Ap it abor Rase 4onzon Deptn Dominant Coro, Redox Descnphor Texture Structure 'onstslonce Eounday Roots j GPD31 in. Mursel, Qu. S=. Cont.::olor Gr. Sz. Sn. 'Ertx1 f .z iti I I ❑ 5orinc x Swing ❑ Pit Groand surface ^Iec. ft. Gepln ew limiting favor ~n nil :+ppl!catior. Rate v^wr' I •wN. Tr vg2fE yhll(1(Ille Cnclv?c,:a Fn i ~ i G_,Cr NG'h _ ~ ic. Munseb i~.::~a ::gin: Gotor yr Sc Sn ftkl fY'2 I - i - ~I 3ori0r. Borinq k = Grounc surface ei=_v. _ ft. Depth to limiting factor ir. nit Soil! licavon Rate It- Dominant Colo: Redox Description. Texture Structure onsistence 6ounday RoOt_ ;;PD'F. ' iiodz0o Doe in. Munsell Du S r;oet. -6o , Gt. S= Sn. Ihr1 fi;r2 i I i - I - 77 E-1.i?r: 1 = 5JJ ; 3Q .^?C r-ip+_ acd S >3' ^ 150 rt:p+.. _filaent #2 = BOD . <30 mgr and TSS < 30 mw!_ ~aich an_', Prot es wca: ~-rviccs is ar.:::ua' opponun il, service p! idcr and employ cr. If you need assistance to ;n_xss sen•ices of need ina'.-ia! in an alternate former. contact the departnrnt at 605-266-1151 or TTY though Relax. , s l „ r I _ ~ I i { i lee