HomeMy WebLinkAbout038-1051-70-000 (2)
PRIVATE SEWAGE SYSTEM CDnty St. Croix
Satcly u'ra Buy yr.;t Urasion
INSPECTION REPORT sance•y Per- t Nu
606929
GENERAL INFORMATION (ATTACH TO?ERdIT' Statc•PIanID'k
Perso'a rto oar,°aau p•oaiu::nmy LC'-scc'nl secc-tlary pmPCVSjRF:arr Lan•. s I6 ---I
Pe rcit Hobe-; Va^*e City Village Tc%-shin Pamel Tax Nc
Thomas Savinda TOWN OF STAR PRAIRIE 038-1051-70-000
,:SI ISPd i Icy nsp. al.' Lev. BM Demotion -:e^uunrTr.:.-;RancelMaa N-.
d4,- 12.31.18.218D
TANK INFORMATION ELEVATION DATA
T YPF MANUFACTURFRl CAPACITY STA-11CN QS HI FS ELEV.
Septic t•~ Benchmark 3 /d `/2 06 67 Dom` Alt. 13A'1
I c~.~ /Gt ~
NO.J G S AL vµ-- #
Aerat on Bld,. Sever
Holding SUH: Inlet !
TANK SETBACK INFORMATION SuH;Ou:et
4/
a-am ETANK lo`L'v'iELL 4, t i+i n:u+c ROAD Dt lnle: -7
-7.y3 p
7 /
'n f '57 / _ 1VI Dt Bottorff ' LLL CK
t!+ T J ,7 9,9
HeadeoMan
Dist Pipe ong Rot System q c yg a~
I l
PUMPISIPHON INFORMATION Final Glade
S.' $
Manl.raclurer Demand St Cover
+ y3
GPM
Model Number
TDH Ldt Fnch;:r I oss S•ysnnr I leader FDH II
Forre -rain '_F.ny C st b :'pie
SOIL ABSORPTION SYSTEM
BEDITRENCH 1.' d:h r 19:h Nu O' llc'mhcs PIT DIMENSIONS Nc 01 =is ms pe D ~4uJ DeOPr
DIMENSIONS
SETBACK SYSIEIst TO P:I. RI DG WELL LAK&STREAM LEACHING P.tan,ttrolure,
INFORMATION CHAMBER OR
Type O` ':stew UNIT PApWy Numo°
DISTRIBUTION SYSTEM o✓ k/ 3Z 11
4eadcdlvlando~:1 L' ,Ir I< I x Hole Size x j,,. Spacing Vert to MI Ir4 e
P,pvI- 50a
..cngN~_, D 3 T Ler]Ih Dia S-acirv,
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systerns Only tt:✓
-Prh ( r G Cep:t• O°er xx DeP;h cl x ..eeae9 -.:]asp ` IJII
9::dI NCO ei`1rr "3 U Bed'T'e rn FCgo-s Tcosoll N9 VES- NJ
COMMENTS: rlnc%ude code dlscrecencies Incisors presenl, etc j Inspector Irscec: or #2
Location: 2249CTY HI;CSI~~c, 5 ''NI
1 1 All RP.A Description - ~.LMf l I~
2.1 Bldo sever length -
amount of coverr
Plar revision Requ red? Yes `1y~F/~No 10 Z6 /19 kJ
Use other side for addit ona intorratibn
Date I-sep-.IVr $rCna a Cert. Nc.
Sill) F:'1 a rk '3'5';.
RAC Sf► v d i~ -3%
- ~ F ny fir. 'rt:mr ] e^n I.: -,h- I
mo.'s ry r
OC f 15 big C. B > 7M2
..1ad{so;+, 1, 11 *"7-7 i1C:l~.lc.)Ii SPCIs i- 4tl:n Gxh t , ¢;Sor oftaiueil -rcacSrcdpZOr fcrUll v• p -r, ,r. ~j
d!c Pwjj-(t AAA (:(udYcrcnttnan, ^.:ing :+dd r:
JRV rE r to r ss nt c \ ] v r `o:m , t '::c }ru r. a t 1-.=e-, s,xcnda-„ ^
~r^r ':n- nut t, r s f` 11 'NrSaq_ ~cJQA,,~/•t/Il.~~ ,
rt¢;_ + ilnformettnn rl as~P } Infot mation _
r Naa,c Pamcl K ,
--319 70 Ae.c)
~.lailin., Acd:csa t}ty L, 3
Z _ -
LT
~'~tn ~kr!ill ihnt 1~yd'yc`) ^ N. ctc }O~
1 City -
.,_?7ss6c~L Cat Numhcr ~ r-~Vit7ag of _ pp
(l loan cf
1.: Kficu. . v nqe box on Ifni, h r ,m, to fine B if Yjeplicaale) 01& &
S : x.n. t;,,; 1 r, t System I Il T, Tank ) cCp accnocn r,n'r ❑ Olhcr Modiicalinn m Existing SSt~m tic
List P%,il,",
- _ Pcrmi'. RCncc n7 T'
i c: v inn L2 Chrn c uiPIunLc: l. ) ('cni17rnnsfcr to Neu, rPc-rr: N,ro L13t: Isc~r
~rcl _p abort Owner J ~t y.~y~
t . f - "Z'S Systcm'C.ompment.'Det3ce (Check nD that apply) _ L
k - -d ir.t.mr rd C Pressurind rn-Cr.i.J-~~ V (rr.tl; i1Alxm< ::4'r Su. ~F~.-so,I .'nuttd S.T.-#'.::T
.rcar,t~ .t tnt 1r< ~s; r etlop.~j~!/<J/✓~~~ /L^ f~R /O._~
'~'}1 I...ir r-n 5316 •Ji•"" c~ t,. InrJ t.;j { .,iP (
i
ASV - - 5~~ ! lQy~ qb-5
r ..yin -r !:.nurc t...r.
' zilons s 1 s v: 1
7.00{:- C.sr tom. I i
L~ Ul.
'r4CFn>
-t
P spars ;l i(p ,Statement-;,the rnt,,, nAnsu :rxya'r;ihiliry fnrinsit.Fatlna of the POWTS Shmrn nn the attached plans. -
' -i•al ! ylam r<S'..nzr - ~ n{;'.'1riPP.S Vnmtr.-~(;usit , FF.D1c l,, ;arc Z,plVI lthe~ r 9~ 7
76 5/1
1715
„j--
C~jlr
/Oi,~
rj / rnili. er^aic
On Gi P. Jcniai. !y sG/.l I °~~3~l Sf
rr,APbrnt ul ~iran,'S {nr Disapprn;;.1 a~ cI _
,rE-M Uo'vNEK L0116 r
1 Septic tank. ctflucnt hltt-r alld I0 LKSR- f L
t:lspersal cell must be serve: A , manlt-iro-J 7 '•`T
per r}anagemant plan piowidel f'r 1:,rt'b..SI
selbaCk r sp_~r_vrrrnt . wt;c l he oral !tall as per aopl c:. l , r. jr RVrhn a~ Nes • - - - - - -
ST. CROIX COUNTY ZONING OFF ICV,
CERTIFICATION STATENIENT
FOR UTILIZATION OF EXISTING SEPTIC TANK(S)
This is to certifv that 1 have inspected the existing, septic andlor dose tank
presently serving the following residence-
(Street address) ZZ't ~t 647 rL located
at: Section t . To\tin N, Kane
Town of St. Croix County NVisconsin.
(:poll inspection, I certify that I hays found the tank(s), to the hest of my
knowledge, will conform to the requirements of SPS. 3iti 1?5, and it (they)
appear(s) to be functionim- properly.
Most recent date of inspection or service
Did flow back occur from absorption system? Yes No
(ifno, skip next line.)
Approximate volume or length of'time: _ uallons minutes
Tank Capacity: /O6~ -
Construction: Prefab Concrete Steely Other
Manufacturer (if kno\+n Lie e /cS
Age of' I ank (if known
Permit number (if known)
(Licensed PI tuber Signawrc) (Print Name)
V'~7 7,3
(Title) (License Number) AqP PRS
/D/as~l
( llat ) i-
Form to be completed by licensed plumber (Dept of Safety and Professional
Services Chapter 305 and s. 145.06. Wisconsin Statutes) or licensed disposer
(NR 113 Wisconsin Administrative Code)
Rey. 2 %?01
I
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name:
Owner's Name.
Owner's Address: cj i,
14 CC C
Legal Description: 1 Z.1:, 1 /J ! l}~
Township. J I Cl l
County
Subdivision Name,
Lot Number:
Parcel ID Number.
~
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 n I /
Designer/Plumber - / License Number.
Date. !.S Phone Number 7/ S J~ S l!S!
Signature
Designed pursuant to the in-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-1-`(N.01101).
Pane
'.-;I L•_~ a'.%4:<APnLI::gL L. ..IHLpF CCK AS AP -lICg51 F-
❑ SOIL EVALUATION Scale: 60' ~ SYSTEM PAGE 2 OF
SITE MAP "J
PLOT PLAN i
PRO.l- C:T NAME: - L{Sb
t' n p;aj 1S DESIGN FLOW GPD
Attach design flow calculations (or commercial plans.
I'NUJFC;I ADI)ItI-5^. CT W«- ~r Pipe Material r AS I M Standard (Tables 384.303 8 384-30.5)
1,1 N Sanaap• Sewer j
6h' C\"IIL'GI + BN Elev Mlr.~ ___[✓O I t \ Fcrce rdam. i
tlld Desr:ripriuu _L.Q P~~.. I L I i> (l ;C L J ✓Q I..
5 cre Gradient Z%) r~~iram nn-.r r„ IMPORTANT.
e1 Testea A'ea, 'Bell SymMf Iil ao;olir;aClc;: 0 A:vwp an mr~w Show ground elevation contours at suitable inlervals.
..-i'Iv: aPpnprM Irv:
~ ~-r~IRLC~rx,I'~ 17firICN're(C{I Z- ~rrws Ib(('~ Q>n~c1c ~ ~haalxrs 3
I ~-I YC I nK 4' I I'~G f ~ I
I
Ila }
,40kSc
l
l w1
EJt I.ST Inf. 'Fq.t K
~!s weCKS IPao
~i f'1Pr Chvhr~r
II ~ !.r'~c fl ~ ~ I tt ~ ~
LT %8
I
I
f61litet) It rnb,~~7,
U I
Alta. hl A )th~,-
Soil Absorption System Cross Section
ll.Sft
Final Grade
4' Schedule 40
PVC Vent Pipe
WAh Vent Cap ft
Leaching
Chamber C~.Sft
System Elevation
_ft ^ft
Soil Absorption System Plan View
ft
~ft { -
ft r Vent Or Observation Pie Leaching Trench 1 I
Pipe Chambers R^ Ij
RR 4' Dia.
Tr Tench 2] Header
~L.eachino Chamber Specifications I
Manufacturer And Model lz i, 11"tor
EISA Rating sq ft per chamber Soil Application Rate 7 gpd/sq ft
gpd Design Flow 4 Soil Application Rate a 7 ~ EISA = < Chambers
2 rows of chambers each.
Page of
>"Ta DIVISION OF INDUSTRY SERVICES
- -'-i F; Plumbing Product Review
D P.O. Box 2658
Madison, Wisconsin 53701-2058
TTY: Contact Through Relay
Scott Walker, Governor
-'0--- Dave Ross, Secretary
March 12, 2014
1IFETIME FILTER LLC
FAIKE HORNBACK
146 CLIFTON I IALL COURT
SHEPHERDSVILLE KY 40165
;e. .)es(;fiption: SEWAGE TREATMFNI APPARATUS, EFFLUENT FILTER
. anufacturer: LIFETIME FILTER LLC
'roduct Narne: LIFETIME EFFLUENT FiLI ERS
f:4ode'. Ncrroc';s): L"1 1/13, 1 T 1116, L1 1132 AND LT 1!64
[SEE ATTACHED TABLE OUTLINING: FILTRATION SIZE AND RATINGS IN GPD]
~Jrn&ct File. Na. 20140C4i'.
the specifications and/or plans for this 'urnoing pio(r,ct hsve reo ewed and detemn ned to bu in alinpliancr:
.midi chapters SPS 382 through 384, Wisconsin Administrative Code, and Chapters 145 ar-A 160. Wisconsin
Statutes.
The Department hereby issues an anproval based on the Wisconsin Statutes and the Wisconsin Adminisirai ve
Code. This approval is valid until the end of March 2019.
1 his approval is contingent upon compliance with the following stipulation(s):
• Installation and servicing of this product must be in accordance with the manufacturer's instructions. A copy of
the manufacturer's installation and servicing instructions must be given to the owner of the system.
• Maintenance information must be given to the owner of the tank e;g)Iairing that periodic cleaning of tt e fliter vvlll
be necessary.
• A manhole extending to grade must be provided over the filter.
• MAINTENANCF: Clean filter at inspection/pumping interval.
• Additional information is included as attachment(s) to this letter; see attachment A.
I he department is in no way endorsing this product or ar.y advertising, and is not responsible for aoy situation which
nay 'esult from its use.
Sincerely, 11
GTeri Jon,6s,S.
POWTS Pfoduct Reviewer
phone: (608) 267-526C-
fax: (608)267-9723
canal{: glen.;onesrulwi.gov
',B[)-%o i64 C iN-1 bN.ii i le Ned' 141JU4,901. 130[:
i` 1 4 C 0 48
Product Lid Single Other than single family Primary
nurnber Color Family applications in GDP l Filtration Size
Code Application
In GDP <300 300-600 601
CBOD' CBOD' CBOD'
LT-118 BLACK 3500 3000 12500 2000 1/8"
I L 1'-1/16 J GREY 3350 2750 2000 1500 1/16"
LT-1/32 GREEN 3000 2500 11875 1500 1/32"
LT-64 WHI I E 2500 2000 1750 1500 1/64"
T 0 BE USED IN COMMERCIAL APPLICATIONS. DUE TO EXTRGME LEVEL OF
FILL RATION, AUDIO VISUAL ALAR('v1 IS RFCOIvIMENDED DUE TO SI IORT
SFRVICF INTFRVALS. IVSPL('T AS NFFDED.
N ] i
O
~ A
Z
k,
v u a
n g
m ~
f,V
^1
x
i Ii
2.0140048A
3
to ti t
rr 0
-s•s `t~ s` !
t J 04
Installation and Maintenance Instructions
InsG,llat`on
Step l Dry fit the filter case onto the outlet pipe going to the drain field. Ensure it is centered directly under -he
access opening. (if outlet pipe is already in a fixed position, additional pipe may need to be added)
Stop 2 If utilizing the additional single side support and the two bottom supports: VJhile the case
is still dry fit to the outlet pipe, measure and cut 1"schedule 40 pvc pipe to the length needed to extend front the
hubs that are pre-molded into the case to the side wall and the inside floor of tank. solvent weld pipe into the
hubs that are pre-molded onto the rase.
Step 3 Solvent weld the case to the outlet pipe. Insert the filter cartridge into the case pressing down on the
cartridge until it locks into place at the bottom of case,
step 4 if utilizing a vertical read switch: Insert switch into the hole pre-molded into the top of the filter. Press
straight clown until it locks into place
Maintenance
1) Remove the access lid of the tank. Note: To ensure undesirable solids do not exit the tank and into tFe
drain field, the tank should be pumped out until the level of effluent is beiow the outlet level of the tank.
2) To remove the filter cartridge from the filter case, pull up firmly on the handle of the cartridge dislocig'.ng
it from the case. (if utilizing a vertical read switch, removal of switch is optional)
i) Using an ordinary garden hose, rinse the filter cartridge ensuring all visible septage material is removed.
Place the filter cartridge back into the filter case pressing down on the cartridge until it locks into place.
Si Pace t-^.e access :id back onto the tank ensuring it is secure. L l,,
i Ed fi C:IIS'
-11ez'rrc Ht" bias e lifetime minted •nananbr. )~11~~ r sf hl l J) r_,"~ ,
I frtime hirer I.LC warrants the filter will he free otnranufacruring and workmanship defects during normal use for the period of
t. rre eut original purchaser owns the product. Lifetime filter will omvide a replacement filter in the event that the original filter was
rot damaged during the installation or maintenance process. Oamage to this product caused by accident, misuse or abuse will nnl
m• ce.,eted under this warranty. Impropercare or malfunctions resulting from product not being installed, operated or maintained
properly will void Ihis warranty. Lifetme filter assumes no responsibility for labor rharges, removal charges, installation or nther
r6dental or consetluenuai costs.
contact'. miYPr~nliletimthlY•nc~ cur-. Phoce: SW.. 124-2231
q~
or
I ~
ft{
f ~t S
r 4 y.E
e
~~a rJI V! F~ r
~ V t
(AL
i! /T
R
a
1 w4
~ • ~ , as . O
t _
I _
o
A
co
4' ~ f
k
+
~i
r Air
c z d k= af~b is ~!y 'J-': ti
i5tt
e i g ~ ~y
F 1 KiFa ~ ' f y T j
F 1l x-ri
l
,p t
tiY
y .
a ~ t~ S 4 ~ 11
O
.C,
\N
-c
ST. CROW COUNTY
SFP HC TANK MAIN 11,V (B AGRELML:NT
ANT)
MMERSHIP CERTIFICATION FORM
Mailing Address ~'J.,;x
Properly Address
( Verification required from )Tanning & Zonng Deparmtcnl for new construction.)
Cit),State l/ ✓i'~'~f:Y__w ParcelldcntilicalwnNumber
LEGAL DESCRIPTION
Properly Location /Y !v/'; '4. Sec. , T , I/ N R Town of
Subdivision Plal:_ Lot ;1 .
Certified Survey flap # - - Volwne Page ! J j
Warranty Decd P (before 2007)Volumc Pa"c +
Spec house ❑yes[ }w Lot lines identitiable ❑yes❑no
SYSTENI NLAINTENANCE A.ND OWNER CERTIFICATION
Improper use and mannenanee otyour sepur:.ivAeol could result in its prentatine Iitilure to handle wastes. thole
maintenance consists of pumping out the septic lank every the ec years or sooner. if needed, by a licensed pumper. what von pat into
tae system can affect the function of the septic tank as a trcau:tent stage in the waste disposal system. Owner mair.lcnance
responstbilitiei are specified in sSPS. 163.52( 1) and in Chaplet 12 - St. Goix County Sanitary Ordintuicc.
The property owner agrees to iubmit to St. Croix County Planning & Zoning Department a ecru'icalion Gn ni, Signed by the
owner and by a etas:er plumher,journeynian plumber, restricted plonber or a licensed pumper verifying that ( 1) tac on-site
wastewater disposal wsren is in proper operating condition amd:or (2) after inspection and pumping fif necessary). the septic rank is
less than 1 ~3 till of dodge.
I'we, the undersigned have read the above requiremenec and agree to maintain the private wwage dsposal system with the
standards set lurth, herein, as se: by the Depamnenl of Satcly And Professional Services and the Department of Nutura'. Resources,
State of Wisconsin. Certifiexiun stating that your septic sy:ctern has been ma3irlaincd must be completed and returned to the St. Croix
County Planning & Zoning Deparuncnt within 30 days of the three year expiration date_
I'we certify that all statements on this Ibrni arc true «t the best of my'!our knowledge. 1. \%c and arc the uwncr(sl of the
property described above, by virtue o`a warranty deed rcordcd in Itetnilcr of Ureds office.
Number of bedrooms
3
SIGN'A RF OP AI'PLIC'AN"f(51 DATF.
Nov information that is niweprescnlcd may result in the aanitary permit being revoked by the Planning R Zoning Deparlmenl
Include with This application a recorded warranty decd from the Regina ol'Decd. office and a copy of the cerli6cd surnry map it
reference is made in the warranty deed_
(REV. 04i 1 z)
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Papa of 2
FILE INFORMATION SYSTEM SPECIFICATIONS
U.dner _ Septic Tank Capacity //~~ff~~) p NA
:,oriel; F - - - - - - -1u-. gal
Septic Tank Manufacturer ,~y 1~5 C1 NA
DESIGN PARAMETERS Effluent Filter Manufacturer n NA
Idamhet of Bedrooms NA Effluent Filter Model 0 NA
Number of Public Facility Units R1 NA Pump Tank Capacity gal 5 NA
7stimated flow laverege) 7L~~ gal/day Pump Tank Manufacturer g7 NA
Design flow (peak). (Estimated x 1.5) T5y _ galiciay Pump Manufacturer jQ) NA
Soil Application Rate gal!day!ft' Pump Model NA
Standard Influent/Effluent Quality Monthly average" Pretreatment Unit NA
Fats. Oil & Grease (FOG; •s30 rng!L :1 Sand!Gravel =filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD,I 5220 mgrL NA C Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) I 150 mg IL G Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cellls) ❑ NA
Biochemical Oxygen Demand (BOD,l <_30 mg!L Xln Ground (gravity) ❑ In-Ground (pressurized)
. otal Suspended Solids (TSS) ~,30 mg!L NA ❑ At-Grade ❑ Mound
Fecal Coliform igenmetric mean) _104 C4lr+100rn ❑ Drip-Lint. Other:
Maximum Effluent Particle Size in dia. C NA Other: 17 NA
Diner.- Other: - -
`R NA ❑ NA
'values typical for bomesbc wastewater and Septic tank cllilemi. Ocher. C NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Insne;r. condition of tankls4 At Ieasr once eve } - rnontniw
ry: ;year(s) -(Maximum 3 years) L] NA
Pump out contents of tank(s) When combined sludge and scum equals one-third (y;) of tank volume O NA
13 monthls)
Inspect dispersal collisi _ At least once every: 3 X year(s) (Maximum 3 years) C NA
:dean effluent filter ! At least once every: ' ❑ monlhisl NA
t7Ayear(s)
inspect pump, pump Controls & alarm I At loasl once every: C monthlsi NA
C yearls)
' u month(s)
Hush laterals and pressure tcs- At mast once eve0~: C your(s) WNA
..h" At least once every: f7 rnonthlsl
NA
v - - C yearlsl
0 NA
MAINTENANCE INSTRUCTIONS
Insorctions of tanks and dispnrsal Solis shall be made by an individua: carrying one of the following Iirenses or certifications:
Master Plumber, (duster Plumber Restricted Sewn.,; POWTS Inspector; POVJfS Miaintainer, Septage Servicing Operator. Tank
inspections most include a visua', inspertior, of the ,anklsl to identify any missing or broken hardware. identify any cracks or leaks,
measure the volume of combined sludge and scum and to cheer: for any back up or pending of effluent on the ground s mace.
he dispersal cellls) shat; be visually ir.spw:ted to check the effluent levels )n the obsorvation pipes and to check for any ponding
W effluent on the ground surface. The pending of effluent on the ground surface may indicate a failing condition and requins the
immediate notification of the local regulatory authoritv.
'saner. the combined accumulation of sludge and scorn in any tank equals one-third or more, of the tank volume, the emire.
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 fillers, merhanical or pressurized components, pretreatment
units, and any servicing at intowa; of i 2 months, shall be performed by a certified POW"TS Maintainer.
A service rennet shall be provided to the. Iota: regulatory authority within 10 days of completion of any setvien event.
nape Z Ds 7/
START UP AND OPERATION
t-nr 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 andior damage the dispersal cellist. If high concentrations are detected have the contents
o` the tanklsj removed by a seotage 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(sj in one large dose. overloading the cell;sl and may result in the oackup 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 Maintainor to assist in manually operating the PurnP controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal relis. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at grace soil absorption area.
Reduction or elimination of the following from the wastewater strearn may improve the performance and prolong the life of tnr:
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain ;sump pumol 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 andior is permanently taken out of service the foliowing steps shall be taken to insure that the system is
properly and lately 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 contems of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After oumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled writ
soil, gravel or another inert solid materia!.
CONTINGENCY PLAN
It the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacemenn system:
C 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, int lines and wells. Failure to protect the replacement area will
•esult 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.
L7 A suitable replacement area is not available due to setback andior soil limitations. Barring advances in POWTS
teennology a holding tank may oe installed as a fast resort to replace the failed POWTS.
UI'3ffi2-TL^Jtace ° r
N e•alua io- - a no ng ark
av ae e aie 'PRDf-/I137TE2~~IJ~LJ JCpr~rS77ztJC-1't or~
p IJuund 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 Phone
SEPTAGE SERVICING OPERATOR IPUMPERI LOCAL REGULATORY AUTHORITY
Name Name y- Lo ' ~ 20 /i .
-I 1 Phone '716-- 75L cf f Phone -7/S- 3K!c- ~(Od'O
-cix ooromaw eras draped in cnrnpiianre svit-. -hapto- Cumin-, k;3.Z2i 2l;bl i t t+dl&Ni and 63.54!11, i21 & ;3i, Wis::on%Ir. Anministrative. GDoe.
AS BI1l1,T ?LAN OF '.SANITARY SYSTE'i
C i'/EK COUNTY
SEPTIC TANK PEJRIIT
OWNER ADDRESS f,'-~- L,_ _ ,J ~i a~/io :1_ ✓ ZIP
LOCATION OF SYSTE'I; of Section J Town ->/N, R1NGE ) N'
Gov. Lot r Lot Subdivision
PLAN VIEW
Distances F Dimensions to meet Requirements of 1'.62.2C(1)(d)(2)
SNOW EVEEYTHING WITHIN 100 FEET OF SYSTEM
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
I
v.
I
I !
iL
-I tY
L i - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
SEPTIC Td.?; Concrete Ste l_ '1frr. Depth to manhole
,
SOIL ABSORPTION SYSMI: Drywell-Depth _Inside Dia._Depth Below Inlet
TRENC'114S, No. of Width_ Lenp.th Area Depth to Pipe
RED, No. of Lines _I'!idth_L LenPth 5 ; Area~Depth to Pipe
AGGREGATT-.' Y,_ Inches Area Required /",1•~ f AREA AS BOilt >
DISCLAII4ER: The inspection of this system by Poll: County does not imply complete
compliance with State Administrative Codes. There are other areas that it is not
possible to inspect at this point of construction. Polk County assumes no liabil-
ity for system operation. however, if failure is noted, the county will make
every effort to determine cause of failure. GREASES AND OILS SHOULD NOT RE DIS-
POSED OF THROUGH THIS SYSTE'i! ! ! /
PLUMBER ON J01T- _LICENSE
DATED
N-1ail - mikes pltunbiiil ii:hotmail.com Page 1 of 2
RE- 2249 Cty Rd C - Star Prairie - Christine Savinda
Jeremy J. Moe <jeremymoe@westconsinrealty.com>
the 920 i?:J1e 1-~1 ^.64
- lelernyJ -Moe <jtn.r.t,noe~? E,MOtu;nrtrltgcoml .'IA1 eWaltnel' rrtkes ttntingi'nul.~ailmom
I he Moe' , <themoes-AthemocssclInomm Com>:
Good morning. Just checking to Mdke %We you re(eived this order below?
Thanks!
~l
Jeremy Moe
•''TSTconsin Realty ///lll~~1
Realtors e-,1 1 ~ti
_JFdian r~e.net S ~T~ if
I'1 E Dr
FO Box x 269 an 269
Flew Richmond, WI 54017
ThervloeSellHomes.com
baker License 4 - 700915-91
noent License 7 - 71923-94
Please feel free to call, text or email me any time!
Sellers pay a low 4.8% commission rate on qualifying properties. Contact The Moe's Real Estate Group at
W£STconsin Realty for a free consultation!
1 ou m:rv request that the sender of this entailed message nnl send any future unsolicited advertisements to air email address(s)
hnl situ desivnate. Fo opt out of further email advertisements from this sender, please hit reply, and type in delete in the subject
ine.
.i,into 1 "fiIIr-„rt,I i-i.+r. d r r i+l s o d i+ d r n l-d -oloi,torh ti Lctt'•~ i1.iJzr.r i.y'tjh1 '1ti +•r. add- _,i.
. r, +re wnua.m Lon fid equal info^nah ou.nc a In tenaeJ co r, for Ilru and I, is koI r. rrnnd II', o- +re not Ih? n,i J of feve- - ,no ou to not d s+-urinate,
r.. i,ute or copy this email. Please nouty the sender.uimediu•.rh• it you huvo we:•:ed lh ; r•mad by mistake anc ci(*to tha ernwd iron: your ycem it
rc not the rMeoded rcopient you arc notified thro dsclosmg, copying, diciriouting at takine aoa action o r6onre nn the contentso! this intormauun
From: Jeremy J. Moe <jeremymoe@westconsiit real ty.corn>
Sent: Wednesday, September 19, 2018 17:28 PM
To: Mike Walther' <mikes_plumbing a hotmail.com>
Cc: The Moe's <(lie moes@themoessellhomes.com>
Subject: 2249 Cty Rd C - Star Prairie - Christine Savinda
lellol
hflps:?r'outlook.Ilvc.cony'otsir 7llcmID-_'\QMkADAta A I Y Viii '';A/SI INI).\41,'IcwV I kl... t) 20`21113
T1.1 I
1 - i aD1B- ass
Wisconsin Depadment of Safalyalld er4fes9rwf "services H i I'age 1of 3
DivLsron of Induafr~$ey+iices - - - 'I Ih If\
SOIL EVA RRPORT
k In accorcdance with SPS 385. Wis. Adm. Code County
sST CROIX
Attach complete site plan on paper not less Man,8 1;2 x M17 inches in size. Plan must include,
but not limited to. vertical and hon/ontrll'refelenee Roint-(BPA). direction and percent slope, Parcel I.D.
scale or dimensions, north an uw, and loCabon and distance to nearest road. 038-1051-70-000
Please print all information. I_ . Rewb-y Dale
Personal Wormatini no •ovicl-: nod co ised Ier seconear cmoses ('ran, law. s '104r11mY L
W p
Property Owner Property Location
TI10MAS SAVINDA Govt. Lot SW Y. NW G S 12 T 31 N R 18 E (or) W
Property Owners Mailing Address Lot # Block # Subd. Name or CSIA#
2249 C I Y RD C 1 CSM IN VOL II PAGE 485
City State Zip Code Phone Number City I Village Tom Nearest Road
STAR PRAIRIE WI 54026 (NA) STAR COUNTY RD C
PRA RIE
New Construction Use: Residential f Number of bednunns 3 Code derived design flow rate 450 GPD
. Replacement Public or commercial - Describe. _
Parent material OUYWASH Flood Plan elevation if applicable NA 8.
General comments and recommendations. GOOD FOR CONVENTIONAL SYSTEM ' o,,&x
Boring # Boring
, . Pit Ground surface elev. _99.5_ it Depth to limiting factor 107+ in.
Soil lica[iun Ratc
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIRP
In. Munsell Qu. Az. Cont. Color Gr. Si Sh. •Eff#1 -EI1#2
1 0-8 10YR 212 SL 2"k mfr cs 2m 0.6 1.0
2 8-12 10YR 314---- SL 2kbk mfr n 2m 0.6 1.0
3 12-107+ 10YR 6;6 - S -0- ml 0.7 1.6
-7
Boring # Boring
2 _ Pd Ground surface elev. 98.5 It, Depth to limiting factor 101+ in.
Soil licetion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1Fl
In Munsell Qu. Az. Cont+ color Gr Sz. Sh. •Eff#t 'EII#2
1 0-6 10YR 2i2 SL 2fsbk mfr es 2m 0.6 1.0
2 6 14 10YR 314 SL 2fsbk mtr cs 2m 0.6 1.0
3 14 101- 10YR6;6 S 0 ml - 0.7 1.6
Effluent #1 = BOD > 30 s 220 m 1L and TSS > 3Qtd) 50 ' Effluent #2 = BOD, >305 220 in 'L and TSS > 30 5 150 m L
CST Name (Please Print) gna e/ CST Number
PETER ERICKSON - 1293207
Address D e Evalu Don Conducted Telephone Number
1291 170TH STREET ST. CROIX FALLS WI 10110!18 952 261 1100
SBD-8330 (R04115)
C Boring #
Boring
Pit Ground surface elev. 99.5 ft. Depth to limiting factor 112+ in.
Soil Iicatlon Rate
Horizon Depth Dominant Color Redux Description Texture Structure Consistence Boundary Roots GPD1Ft'
In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh.
1 0-9 10YR 2+2 •Cff#1 •Eff#2
SL 2fsbk mfr cs 2m 0.6 10
2 9-13 10YR 314 SL 2fsbk
m6 cs 2m 0.6 1.0
3 13-112, 10YR 6r6 S 0- ml
07 16
❑ Boring # Boring
Pit Ground surface elev. _ ft. Depth to limding factor in.
Soil hcaYion Rate
Horizon Depth Dominant Color Redox Descrption Texture. Structure Consistence Boundary Roots GPD/FY
In. Munsell Qu, Az. Cont Color Gr. Sz. Sh.
'Eff#1 •Efl#2
El I Boring # Boring
LLL--- l Pit Ground surface elev. 11 Depth to limding factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence. Boundary Roots GPD:Ft=
In. Munsell Qu Az. Cool Color Gr. Sz. Sh
'Eff#1 'Eff#2
' Effluent #1 = BOD, > 30 s 220 mg! L and TSS > 30 5 150 mat. • Effluent #2 = BOD. > 30 s 220 myrL. and TSS > 30 s 150 mgrt.
i
wo-
_
fiV - , -i I - -
44-
x womp
c(q
75 -3
he I
r
I
T T~- -
W 150027 -
1 vuo- u) Y'uW ,wx y~r m.etrutwvwl.oom Y?a1M m Mp I G I t r
~ I
Mailing Address:
TYPE OF OCCUPANCY: Residence No. of Bedrooms _ Other
EFFLUENT DISPOSAL SYSTEM: NEW - ADDITION- _ ---REPLACEMENT DATES OBSERVATIONS MADE: SOILBORINGS. PERCOLATION TESTS
SOIL MAP SHEET SOIL TYPE
_ PERCOLATION TESTS
TEST UEPTH CHARACTER OF SOIL HO IHS WATEFINTERVAL
ME DROP IN WATER LEVEL, INCHES RATE
NUM- INM,HFS THICKNESS IN INCHES SINCE HOLE HOLE ABER FIST WETTED SWELLES PERIOD I PERIOD 2 PERIODS) MIN/IN
P-
P-
P-
SOIL BORING TESTS
TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
NUMBER INCHES OBSERVED ESTIMATED HIGHEST [DEPTH TO BEDROCK IF OBSERVED)
13-
B_
PLANVIEW (Locate percolation tests,sod bore holes anrd sui table soil areas.)
Ir, frate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area
l led for building type and occupancy. _ Indicate scale
m distances. Give reference point. Indicate slope.
i - I - -
- - I lI
- ~E1 t N
777
!r I
i
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures ,
and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct
T6TIN, HIP ti~~ r f ~'c_Zc
' t. CTroi;: Cvunt~
SF°TIC TA.!!'N
gal loll s
Distance From: 'dell ft, 12% or greater slo?e yC fl.
Building _ ft. Wetlands f.
I;ighc•rater. ! ft.
DISPOSAL SYS'1;?=f Tile Field or Seepage Pit(s)
Distance From: Tell ft. 12"4 or greater slope /L ft
Builcillp ft. Wetlands
FIELD
r,ighwater
ft.
Total length of lines ft, Nu;;2,)er of lines _ Length of
each line Distance bet:.,een lines ft. ?lidth of tae
trench /a ft, Total absorption area sq. ft. Depth
of rock below tile in. Depth of rock over tile in. Cover
nver.rock, Depth of tile below grade n `/tn. Slopa of
trench - in ner 100 ft. Depth to Lcdrock
Depth to
ground water ft.
PITS
Number of pits OuC ::e di~m~ter ft. De ptth below inlet
ft. Gravel around t / es no. Total absorption area
sq. ft.
Square feet of seepage trench bottom area required
Square feet of seepar,e pit area required
Inspected 14y / - Title: -l 1
Approved Date 197.
Rejected Date 197
A. OWNER OF PROPERTY Mailing Address.
B. LOCATION: '.G/V4, Section T j~N, R F (m) W Lot# City _
Subdi,tuon Name, nearest road, lake or landmark Blk# Village c
Tuuvnship ✓ JV ~ q,/, c
C, TYPE OF OCCUPANCY : 'Commercial 'Industrial 'Other (specify) 'Variance
Single family v Duplex No. of Bedrooms 3 No. of Persons 3
D. TYPE OF APPLIANCES: Dishwasher J/YES NO Food Waste Grinder YES t,_ ) # of Bathrooms-j_..
Automatic Washer ___-YES c-) Other (specify{
-
E. SEPTIC TANK CAPACITY d )
Total gallons No. of tan:.= c++.-L
'Holdinq tank capacity Total gallons No. of tanks_ _
New Installation Replacement Pi of ~!r Co•,n eke 1/
'Ponied in Place Steel Other (specify)
F. EFFLUE(~Y DISPOSAL SYSTEM: Percolation Ratc I iO -/F 2) c-/G3) o~ /1Tota1 Absorb Area sq. ft.
Neea;/ Addition Replacement 'Fill Svstem
Seepage -french: No. Lin. Fee' Width Depth Tilt- Depth _ No. of Trenches
Seepage Bed: I.ength 9;-•Wodti,~ /R' - Depth 3f-` Tile Depth ;7-No. of Lines :1
Seepage Pit: Inside diameter Liuuid Depth Tile Site
Percent slope of land C a_ Distance from critical slope
i, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20•
Wisconsin Administrative Code, and Ilya I have sized the eiiluent disposal system from the EH-115 prepared
by the Certified Suil Tester,
NAME Wq/re_ r- Ali, C, 6V, k _ C.S.T. # and other information
obtained from (ov+neF,builder).
Plumber's Signatuic,.~6,5 Phone
MPMPRSW#
Plumber's Address A- if.!hGl✓_~Lt~•-L
PLAN VIFIN P e: ;li, skol(h belr,% of sy,rtern (include direction of slope and all distances in accord with
H62.20• including well).
i
2 ~ 105 _ - r
qat 1'ei 4'=
~l4
y
rtgs
T
Mailing Address:
TYPE OF OCCUPANCY: Residence No. of Bedrooms -Other
EFFLUENT DISPOSAL SYSTEM: NEW__ ADDITION- _
REPLACEMENT
DATES OBSERVATIONS MADE: SOILBORINGS
- _-PERCOLATION TESTS
IL MAP SHEET SOIL TYPE__
PERCOLATION TESTS
TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TI h1E DROP IN WgIN (INCHES THICKNESS IN INCHES SINC
E HOLE HOLE AFTER INTERVAL 1ST WETTED SWELLING W b11NUTE5 PERIOD 1 ip_
_ SOIL BORING TESTS
TEST I_TOTAL DEPTH DEPTH TO GROUNDWA fER,INCHES
~Uh:BER INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES
OBSERVED ESTIMATED HIGHEST :DEPTH TO BEDROCK IF OBSERVED)
PLAN VIEW (Locate perm tat ion tests,soi l bore holes and suitable. soil areas.) J
Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area
needed for building type and occupancy.
or distances. Givc reference - - Indicate scale
point Inds pte slope.
I I
_ c ! ? I
t' -
fc11~: % 1 I
-r---I--} r -
TrI
I, the undersigned, hereby certify that the, soil tests reported on this form were made by me in accord with the procedures
and methods specified in the Wisconsin Administrative Code, and that the dau recnrrivrl and In ra....., s r.....,..