HomeMy WebLinkAbout038-1007-20-000 (2)Comm,"
PRIVATE SEWAGE SYSTEM
cweN St Croix
door am e.mme oiheen
INSPECTION REPORT
sown rest No
815380
GENERAL INFORMATION
(ATTACH TO PERMIT)
(ATTACH
wen to No
o.n l.rmy V11m11
cm Maratew
R Tx No
RichardaAGnda
TOWN OF STAR PRAIRIE
038-1007-20-000
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au E..
°eir
Iwru,.nrR.rpu.1.o62311820
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5 Femme �.,,�
TANK INFORMATION
ELEVATION DATA
MANUrACTURERl 7
C.VACnY
STATION
BS
H1FS
ELEV
saw=
Kesel ,
/z
R.nmw.n
13,14
/OR.s
7<.z.
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All FILw6A
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4 L
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only
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qsq
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TANK SETBACK INFORMATION
Sum Ourw
5 s4
t,yJ
TANK TO
WDr.
IELL
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RWO
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POMPISIPNON INFORMATION
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COMMENTS. pnaueeweeeleuewi dewwonwwm ed
Loulbn 12489 CEDAR OR
11 AueM oeeuwlmn• F11..7 6d+ ,
216Iesgee^e,Ief
.e un 0lwver• TI
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plan Dnlara e9 gYee >(No
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remelt•"
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SID-ral
ST. CROIX COUM1 fY
SEPTIC T.4NT MAENPENANCE AOREETr 7
AND
GRNERSFiIP CERTTIC TION FORM
Ow T74 Gyp ne c6Gsz—
Ma]sng A m
(Jc.Scum rt9�from Plmnm6@IDum6 far u onsmmm)
Crv>ae Patel ldm-nuvon N=a 638-too 7-00-w0
LEGAL DESC'AIXITON
Prue-yr ,mom A)L .T34 NRw,70w of Sig(
S;bi.ison Pls Lot M �.
Cer m Surrn . P S
Felmne 5- Pe c n iaa a
R'arraun'Deed'.
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Ia lme i6�or3a+le_�s=m
i�sopv ar and mem.a®:e ofyu seyc rysa wJd evE m rs mmeue fulm<u hose real P,µc
— :usa oiP�m6 o¢aes'Pn=emB e`r)W.ayusm»noa.Jowe16>eL:esa'imme RLx yet Pm mta
� � dm} fmmw ofrle.gtl: ark ea e7uam� cage ¢ m. axm 3:.W� svam. Orov mamamx
Si;n_me sfecdedm iSP6 i6i_'2(:I mtlm Qw�¢S-S trim Cwmry Saory Udmm:e
13e: vpeh owns egret u.vSmuw Roov Co�rP�mealunmeDm+' ear ecc-esmmtma. sad Mee
prom andM nmaaa Phmom,jurnevmm i1¢nem. m+'ncrcd PhmMmeh._... vmmavw.aeear (da mma), m-sa
WDY+oxnmg emhm®mwm a) ffi�cnm.a mwmc aesv>). ee sgocavkb
Is met 15 io0 of slotlge
Gae. ee mdmigoai hoe rtstl ee wve-qu zmtlepxbmmmm ee prrve smsge d. Wryseem wfd ee
s�cards ee fm(q Laem, m sm q the D =of SLLWA dPm'.®ooJ Sc v:s®d e: D-Pamm%ofNu Rgoa
S�se ofWsmm Csh m rmog roar yow zya gsem h b mevumod muc b- WWia:d mi.nm bto R Gom
Cvmn MMMM9& gfY.Tm art 1T is drys Dfebe3 :.w expmo®dear
1hw-omvry eu e0 sa®arm®ess tom aWe hn ofinalaowletlge L'we wa-e eeorov(e)ofee
,mvpm[y deair� above, by woe of eeD
wmavq oatlxmdei m Fepver KDeds Otla
l/m�ber of bedroom11 (s�
9IGNATLRtE OF.9PPLIG4ISL(S) DATE
^"aoy mfmmmonev u mmremumetlmnl resW mee smrmy pvmn bem6 rtvo4ed M ee Plmnme ffi ]um�¢ Dry men �••
In1.,.•arA[ms gn7Lcmmart„o-dsi wmrm:y dee:5om "we Reguss ofDm omoe mtl a Dory of ee cem6N suvry arm1
rfsma.5 mute m We wmmry ucd
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CONVENTIONAL COMPONENT DESION
PmnaEl APa�
9FIE[FIDiIiIE PAGE
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN
hall
owns ol eA.
Silt
i t" b15390
Number M Beroal
INA
Number of PW¢ FackM Units
O NA
Federated Me(ewraae)
Zw
p
Design Task (Pessi(EBrmand. ls)
Mager
Soil Application Rate
_gsgNylnv
Ahmed lnflueMlEMMO QuaIR/
AbnNly werage'
Fats. On Grease (Food
53pmpIL
elaMmlral Qrygen CemeM(Dom)
ehforal
ONr
Total Suspended ShcW (TSS)
still myu
Ptelteated Effluent Sally
kbnWyatetpe
Eventual orygen ostwp(BOUN
Sip myl
Total Suecended save ERA:
ttgl
�NA
Feel Cowotm(gmmetic mean)
9p'wrtrom
Mangum Effluent ParMX Sao
bin One
o NA
rotor
o NA
vaawa ypa g awram.. W...t. w aaoar wA .INMa
Some Tenk Capadly _kili
Sapuc Talk gWer
Effluent Flltar Manufacturer ur
Effluent Flllar Maeel
Pump Tank Capaory
Pump Tank Manufacturer
Pump Manufacturer
Pump Mwel
Pretreatment Use
o Sanacmval Finer
o Peat Finer
O Macham®l Audi Owe w
Error)
Dili
ImotheMmakes)
oIn-Gra Devanagari
o M.orade
o M m
o Drop-0na
Domed
Orde
o Iw
onto
o NA
Ivpetl mnkhn alaing)
At West mx even
3
g'�yj" Magerlraare)
o RA
Fyne op mMnbi ONl n)
when same load sludge
and seem
equa�ls fro of bank volume
0RA
IrKpBa dipNey Cy(a)
IAt least mmavery..
3
pOl�e�lhad
Zyeal sled IMa.lmum 3y l
DNA
Clean effil OW
Al least Once every
1
Ofillnls)
OMA
IriBµy pump, lump vnnds6elerm
At least Dore every
omeryes, its)
o reat(hi
JIB
Nuen lelarys am premrelml
At once every
0 metQyear )
O
par
At level ohm every
To, i(st
oyear9)
o yaares)
MMM EMAMCE INSTRUCTIONS
Ina{stions a! RnFs vM d9laeal mild Bliell Ee male by en IMIWdual urryltp one of 1M blmvXp IgenNe or ttMIrJIMB MBNer
Plumber, Master Plumber Findings Sewer. POWTS Ina Or PONNTS Maintainer. Seplpe Sleeping OpemM Tank Fapx9ons must
theme vlis asFec9an of the tando to identify any missing wbroken hardware. bendy any gal or ,measure NB volume of
wmdned sludge am scum and to Gwck M any bear up or pending of ar t on the ground Bul The diy [ cNI(s) sail M
TiBady be( line g ideck Me MoralMoralmade in de ob malion pleas and to Trans ns for any Sending of an the ground surface
a pending of ending an the around sunaco may Imlreg a failing comfort and requires the Immediate nafi on of the Inoel
regulagryaummmy
wM1Bn Ma ¢mbirrod a¢umuleflci of sludge end gum m any funk equals onethird (A) or mare MPe tank Mul Pe m m mM nh of
the bank shall be remained by a eeptage Smarting operator and disposed of In accordance whir canter NR 110, wmv mnn
A MIA, hatwe col
At most "Moss, vessel but not imited to the Bamang of emuem flare. metlieg®I or pressurized compotwres. pretreatment ones,
and any busidirg at Intervals of s12 mal sag M performed by B attended POATS seasonal
A semre report Mali by provaes To the local regulatory Butnomy wlbm 10 says of wmplar of any Bervlre event
Page —of_
START UP AND OPERATION
For new construction, poor to use of the POIMS creak treatment at for Me pre of palnlmg products or honer cMmuslb Met
may Imcene the trealmmt pmmss anchor damage Me deposal mllp) If high more tms are nefdYen rave the r'mlenb of the
tarts) shut by a step soural operator prior t0 use
System sran up man not name when si Tankers are proud at the erpreted sudden
Cuing down, pull union tanks may fill ache, normal mgMeler Nepal W power Is ratmel the Hass "novel are der
aarlms¢tl to the finis al will in me bye doseowanoadma the firmho add ryea m,ns in Man e Meant, o, nealcuseparged of effl"l
a .
To dead thin vn l Hey me mentems of the pump removed by a Seprage Servong Operator prior m respond ppmr m toe
effluent pump o, comatl a Plumper or PO'di demand, to swat in manually model Me pump rnnmH to msow normal byN
within the pump hank
Do not drive or perk vama es over tanks and disp ll cams On rim i nee ar perk over, or Otherwise disturb or mmpea the area within
15 feet death slope of any mound or m.grede all absoryron area
Reduction Or elimination of Miami Mal Me wenBww, all may Improve Me mr arc add for the He of POl
amiaoncd baby wipes, doseet a W1b, mrisome, when swabs. degreaen, dental flow. dopers, mamretlerne, fat, Mundnlm dram
(sump pump) water, bun am vegetable peelings. gasoline. grease, rebores, meet seeps, me imtlws, oil. pamgrp pmduaa
mention. waniten hoping tampons and water Waver brine
ABANDONMENT
NTen Me PORTS fee whoa Is pmmamntly taken out of bounce the following &few shall be taken p Insure Met the system to PMWY
and safely apparel In WmphbKe nM chapter SIPS W333 Wlemnam Administnfly Code
• All pigop totanks and am slap W fundamental eM the abandoned pipe ww,ge eakd
• The moments of all ranks and plop shall the removed vtl pmpaM diyosel of by a Sepape Servwop OMmW
Ater pumping, al and sn
tanks atenail ad naval aaddm resvenapproveand M Or ther France, mand wads .team fibd from sual,
goyl or another rmnmlln mall
CONTINGENCY PLAN
11 the POW1S New 8M emblem be repanmM the Mowing measures My Lean, by must be taken, to omega a oche arngbm
replacement system
❑ A sunaae dawwment new have been mawaod and may W Alai for Me began of a replacement hod abeppmlen system
The replawm nt area should the pmtaden Nom dmhtuManm add mmoac4on and snout me M Inmtpe] upon by reammi
mtbaGe from analog and pmmsa sfiuchm, IM lines and weue Failure to pmtem Me replamment area will result M the need
for anew sea and sea evaluation of establish a suitable replacement area Replacement ayarema must oper with the miss In
effect at thaulme
❑ A wiNbla feplacement area la not available due o seMack antlror oil limitations Eming advamea In PCI bec nolagy a
aging tank may par mail as a last mean to edam the Need POIMS
The sae has not over amounted Mitsui a sawame measurement area Upon failure of the POWB a ml and NM evea lon
must wommi,metlmo madve subae replacement area If no reoawment area ma avalwar a hi lank may be w wIIed as
lest man to replace the failed POVTS
❑ Mound and al grade soil ebmrplm systems may be recmNruched in place following rermvel N the bCrMm at me Iammflve
surface RemnsbuNons of sutll sYsema must mmpry with cone rulep In enMMmalume
,YMW$W,,
SEMC, PUMP AND OTHER TREATMEM TANKS MAY CONTAIN LETHAL GASSES MMR INSUFFKIENT OXYGEN. DO HOT
ENTER A SEPTIC, PUMP OR OTHER MRF EM TANK UNDER MY CIRCUMSTANCES DEATH MAY RESULT. RESCUE Car
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE
�S MAINTAINER
Nam
(;
Plrom
SEPTAOE SERVICIKKi OPEMT00. PUNPE0. LOCAL REGULATORY AUTHORITY
NBmB Names54% G C %Y
Plan that -715-396-41
ThHdwneMmdnlH]nmM•v wh Nffir S 3W3 MMXIXdN sand MSITU (a) A 0)YFmm®n AJmemal,aMS OM. 1 N 3
x
EE SAWTARY PERMITAPPUCATION witwOawkMR
Aiuenwmgme aMmEuu.awmraapYwNfwtnesmam, en a,P,riwtleu �
tMna r➢ •+t HHlnin au
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a see�wwxRaerw �noamwXew eomgeen9tdseagXnion 5ewein �pYlal"
rn.mm.m.w.p. o-maem.y Oem�MwXr.9em.mmm.e.mrwwxm� Omu. wXa.o-r•rwrm
I.nrglµ... �Sp➢1M11 q.al➢ Xumew
Pmee omw.
X1,xrrXr mxe. 5 T x,R,(Iwl'V
naperry S eyamrmMN11b,
eraxum
.PEaee
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: IcnpLawl ❑Sua owlee
XeX.^
WNi: tw 3 Farnity Owtl.. NO o1
III. BURDWG IISE: wWb9Tw•pw+.m+o tlmXawhl xm.MHe
�tar038
— Im8 — ZO�OOD
+ � APptmFn3(arNo
3 0 AefinNy i s IG O GOutlm Xar.e,Oo W Faaliq
3 (]4ma¢watl 70 MertMrw]Oe W esi Regain 11 O RmYumntl Bar/MmN
a (]pwrAlia g a O Madle Home Gark 120S *State Cf rwaN
50i+ywoIMoW 90GHialfmtwy t30 aner'. �M1
W-TYPE PERMIT: IOwak weYmeewonarc A. OX<k Eo. mnrca. �lapgiwdel
A) 1 Cl 3 0 w i ®BFl,rnnent "MyMIent of a.ORKMYeIFnol 5 QRePsrofar
______ s[➢am____ Syalem ________Tank y__Ewau%SAVwn........ Em"SYYem
B) ❑ASarutivy PeaetnXtxOmima DaN WrE
V. TYPEOESYSTEM: (D konlyorc)
MmRemrnaetl0.a(neulmn peawlaeJp[uiXurun t+per.menW p➢er
11 ®$eepageBM xtOMauM 3005 afy Tyfo 410xgEir9TaAk
1305aeaa9e Trench r301mGmaM wewue Q01111ne
1305eeL'a9e At 430Vwn Try
MOsplem-lmFiB
A. ABSORPTION SYSTEM INF MAMON:
1 Gallon Pw Day 3 gAqubp,�r� Area 3 adwp Area a Lehinq Mte S. Pert RaU E. syStwnEler 3 Firyl fwaYe
M9air w hl AapmeOm h) IGJ1M,ylq h.l IMin. n) Llevaean
M
Al. TMK
INFORMATION
'n gglOnas
Gallons
Taanks
Mww4ewrei.xame
ra
sa.
suX
M
IkX
Rwa
Nw Emnn
Taran, Tiny,
pima+
savor rwk w Hawn+ re.k
All. RESPONSIBIITfYSTATEIRENT
Lute 9neE,auumerakpwgdleyfw� l nondm wwumwpevmMuwwn Onwaluewegm
OL ILUUMITIMPIMIRILffill MbEGNLY
n�ir
❑pLPorerea nthly mnrmion
rvPomtLWuaeMSomW
�Appor9V Owner0nnumma
AtlrereBeier
X. CONDITIONS OF APPROVAL I REAburD, FOR DISAPPROVAL:
°FOipe1LA°NN' PRIVATE SEWAGE SYSTEM
RaML'wNeuwtiww.wen INSPECTIONREPORT
GENERALINFORMAMON (ATTACH TO PERMIT)
lmdM Nmnan lW pebmwNw]brvWry gepreslPnrvy .e,s.M INImR.
n MINI,
RII` TALI PpARS �""
Irsp
o m.
JO d6,
TANKINFORMATION OtEVATION DATA
" I.ST.
CROIN
9
U
-Iooa-20-000
A9800AA0
wPE
MANUFACTURER
( AOTY
3TAPON
M
HI
R
ELEV
Dowry
Matwn
Bldg Sorer
3
HNdinq
SOW"1
3
TANK SETBACK INFORMATION
SOW Outlet
47,2p'
TANKTO
PFL
WELT I
aLOG
ROAD
Dt INn
Sepur
Dmry
A
Header/Man.
/
Aeration
IT
A
OHt Tpe
HoldingBM
Sysum
PUMP/SIPHON INFORMATION
Flwl Grade
J.2S0
maoutoturw
Demand
GPM
�•
S.%
ModN NunEw
mH
Uh
MOH It
Fwoma
L"d,
Du
SON ABSORPTION SYSTEM
IED/1RE
w
rayon
barruvwn
nT
rb aen
r4dlwq,
/d I
SYSTEMTO
P/l
BI➢G
WELL
LAKE/
LEAMNG
°w1°°
SEECAG•
04112PFR
LMOKNATNIM
E,
e/Y/
-SO'
� I44
DRDMT
DISTRIBUTION SYSTEM
�
L�roo
tmNn
sPw.H
SOILCOVER a Prwswn synms Only vREowMOrAt+ SNsW Only
nry,n On,
I%Nnger
nle o,
uswEMrsW0.0
uMNJM
rs
w,,,mrnteges
tone+
O.w ON,
O N" O He
COMMENTS: (lrwlua roM diurepwNiea, pawns preum, eU-1
ILt(:ATION: STAR PRARIB 2.31.18.22I,N8,31 1248 S. CEDAR DRIVE
Danoewwyn mvwwme ❑rw �No
U,e na, de EoraednimN mFwm,4mJS' L
Beom,OlR.>9D w Congo
Jf:r.H�o pf�Ja *ZX Lu4 a,<, Z-1d ,ri1'W
�lz S36/?
w rx'
- �z.C/im.Ga-
ay
31e. are
Sl'. CROCK COUNTY %ANINC Dfl'Alt'1'MHNti'
AS DUILTSANUABY RVNURl'
Owner JA&W
AM= Ze m 6! � SEP 30 gq5
Gty/Stalc tssj, z J.&- nr , s maga
N�mI1Y
w nwKa
Lot I Died
Id � Block _ $ubdlvl6iONLSM g (aaa' ' Z
% yW- V, �.1. See 3,'L�N.R4tW, Town of PINK - O
ga 31. It. »_
SEPTIC TANK — DOE CHAMBER — HOLDINGTANK INFORATION:
Tank marmfa me j4wo/ Sum SRC/� SdmrY from: House Welk=Lz PIL.W
Pump mamufac urer Modol
Alarm location
(aOlDwc TANKS ONLY'
Motor loateOnn E: Sroad_
Miler
Alum lotion
Venl to frmh air intake Water lint
SOIL ABSOR_PnM SYS YM,
Ty of system: R.e Widlh 2+�/%ales'
ScPo Y 6om: HomesJi_ lae to38— orrmbc oC'Cae,Yc _,�r�
� We11 �, PiT. �v
_ mt on fseb for intake
ELEVATIONS:
D ptimofbmehmmk e_4„.re 2kwtioo//l.'A
Dcmiption of alternate baKhmatk T PAwatim
Bummai;Scwer 997.a taw IWe 9D.-Z1 STQtlM� QD>,] PCIoW
INC Bottom Huaa/ALnifiM 97y Top of STRC Mm fafc Cover 5W Y�
Distrihution Lim( ) V= ( ) ( )
Batwn of sy () 9/ 7.? ( )
Rind Cmde O
Date Of installation R� P tayber State plan number
Plumber's signatm n I al, License emmber ,2saj�U r Date q.(�lf�
lospr<mr
1..,w. ary cs. -
..
Lw( Jn«pr �-••• r� V� Al. Nw 6
Mniuremrt, Wu H]).
RAT OF SI/RVEY
nit+nt Mode Mr. kf
1poe6fr. 3671 A
White
wo tanrnora Art
W}) eu6 pert of 00
of
..07 :.
-q-
uc
__
to Ceder
f e101q t
Lake to e
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