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Home My WebLink About030-1093-60-003 (3)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Saiery and Bulldmp Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal mi nudiion You provide may be used for s andary purposes [Privacy I.M. E.18.04 (1)(m)). '.CST BM Ew.. IInsp. BM Elmr tBM Desaryuor_ TANK INFORMATION I IILA / = ®�oI72 ��IMr� TANK SETBACK INFORMATION PUMPISIPHON ManMan�mand PM Modelltuber TDH Friction Loss am Head TDH =t Forcemain Length Dia. Det I° Wen SOIL ABSORPTION SYSTEM TOWN OF re _EVATION D 7A STATION BS HI'�77 FS ELEV. Bench rk I��JBench (?,G�I �. I�. I AIL BM Bldg. Sewer ;rvHt Inlet �• I I �, Ht outlet y� �l 1 1 I [J —i7 -- { �1 Di Inlet DI Bottom HeatlsrfMan. Dist Pipe I 13• U 'j . SOL System Final Grade St Cover i BEDFIRENCH VJidih \ ` No. Q Tr_nr I Prr DIMENSIONS No. Of Pits jinwde=ieJ'// q..- ✓/y DIMENSIONS lixnall,, Z — SETBACK SYSTEM TO P/L BLDG V'F.1 LAI%/STREAM LEAGHWG Manrria�rrec1r/ WFORM0.TIDN CHA - OR t)Nrr Type System { /� r Nooel Num / X) oll I GN ' ck DISTRIBUTION SYSTEM Headerjr0x Hole S¢e x Fide Spacag vent m Re Imale s) L^.ritrth Di Lenpih Spa:xio SOIL COVER z Pressure Systems Only xx Mound or Ad -Grade Systams Onry 7 Death Over 'Over xx Depai of xx Sae0a 6aonm xx ur Berlrrench Canter es �I / i°Psoll ❑ Yes No Yes No COMMENTS: (Include c e disc,. es, persons pr=.sant, etC.) (� Inspection *1: inspection 4z Locarbam 49 Doi ` lyw(% Ia 1.) Aft BM Description =I,'I�12 C01�. Ski �3 . 2) Bldg sawar length -.amotml of cover= Plan revision Required? ❑ Yes J -NO use other side for additional intormabon L5 I ' "" V Dale Insepctors 5 re Car. No. SBD-710(P-3M Safgly and Bulldrgs Division 201 W. Ywlshington Ave., P.O. esx 1102 Sanhay Pamir Nvatber m be fiDed In by Co.) Madison, 370 -7T62 Njv 27 2019 • io 1 '77$ 6 hmrTansactin N®ba st. cr e it App icatio d fo 1Cs68A41iB3?2h'2 ,' , submission of this form to the appropnere govamnc wit is re,pmed yrioito oMaioing a sanitary pe®t Nott: Application forms for sue owncd POWTS are saMnttmd m Project Address (ifdiSmmm mailing addmes) the Department of Safety and Professional Savies. Pasooal iofmmatioa you Provide may for secundaty, Purposes ID se onlanee with the Law, s.'I5.04f1 m Seats. L Application Information- Please Priat All Information Property Owner's Name Pascal �O Property Owner's MuilinkAddtess Property rA °° 3a7, 30 ice, 3H G , Govt. Lot y4 Section Z Zip Code - Pborc Nmnber ^ ? T 3O M. R E W IL of Building (check all that ap L.m N Subdivision Name Dwetliag-Numbar of Ok 4i� alockY ❑ PubliQcommacial- Describe Use ❑ City of --- ❑State Owned -Describe Use ❑Viaw of nfr2 CSM Nmnber 11 %b u-j V 7. III. T (Check only ant btx on line A. Complete lase B if applicable) yatem ❑ Replaccmat System ❑ Trmuncat/Holding Tank Replacement 0* ❑ Otbrr Modification to adsmg System (explain) B• I❑ Pamir Reaewd ❑ Permit Remnot ❑ change ofPimiha ❑ Parent, Tmosfa to New I.bt Aevions P NN—ber aid Date Issued Befae Exp'vstion Owns 1 Of PO nent/Device: Check all that apply) h Nw-P,esamirrd to-G,owd In.Gtamd ❑ At1mde ❑ Mowd> 24 m. of-itable soil ❑ Mowd <26 is ofsoi ble Holding Tarok ❑ Dispersal Component (explain) ❑ Pmtreamnem Device(explain) ^ l• V. Din al/Trea at Area Information: Design Flow (gpd) A Dmp Sol Application Disposal Ares Required ( Disposal Atea . VL Tank Info Capacity in Total 8 of Manufacmer Gallons Gallons Units a e lie. Tads Fxi>eog'faots Septic m Rdk.@ Tavk (� Dmiwg Ch=bc . VII. Responsibility Statement- I, the anderdgned, assum osibility for installation of the POVM shown on the attached plans, 's Namc (Riot) C Plumber's MP/MPRS?imnbar Business Pbooe N ber ,1 3iPI ""' r ZZ / f� S . (stiarL may, state. Zip code) V11ILRORWA3epsatesent Use Only ❑ . Pamh Fce Dal, Issuing. SigwMe ❑ ar Reason far Dmid S fg )Z 3 19 IX Condmam�f AssrovaVReawns for Disapproval 11.. Septic tank, effluent filter and dispersal cell must be ser_viced_I maintained � as p* management plan provided by plumber. 2. All s0olack requiremdnts must be maintained �I� �1'e—�•��---'vim—•��•�... V.+� e.n. un.ru....v ...u.. v.u.] wyeW uu. ,a, Woa,r:z la,OmC5081[[C SB)}6399(3L 11/11) FE 4 System PLOT PLAN PROJECT Heidi Madsen/Huebner ADDRESS 456 Old E. East Hudson Wi 54016 NW 1/4 NE 1/4S 32 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST.CROIX SYSTEM ELEVATION 95.5/94.0 4.5' below grade 11/25/19 BEDROOM 2 DATE CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 800 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 611 # of chambers 30 BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL 7*11.R.1same as ben IMmark Scale411 _ Property Line I - y -i Vent be cotin tincture to >6" nv rteIt. be of Cover sized fo a 2 bedroom house. 4' Lon Lv`vK 40' 140' S 2-3' X 62' cells wi >3' spacing 30' -3 60' ents 40' 20% Slope 40' 10' B.M.* All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 2" Old E East Quick4 Standard Leaching Chamber with 20.0 ft2 of Area 5.6ftA2/pair of end caps Grade at System Elevation 112' 108' 104' 100, B-1 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 11 /28/19 Owner:Heidi Madsen/Huebner Location: NW1/4 NE1/4 S32 T30 N,R19W 456 Old E. East St. Joseph Manuals Used: In -ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintance and igency Plan 7. Filter Cross Sect' n Signature / License numb44226900 PROJECT Heidi Madsen/Huebner Systern PLOT PLAN NW 114 NE I /4S 32 ADDRESS 456 Old E. East Hudson Wi — /T 30 N/R 19 �`4016 SYSTEM ELEVATION g W TOWN St. Joseph .5/94.0 4.5' below grade —COUNTY ST. CR01 CONVENTIONAL X)p( 11/25/19 — _ MOUND DATE — BEDROOM 2 CONVENTIONAL ENTIONgt LIFT SEPTIC � TANK SIZE 800 gallons HOLDING TANK HOLDING TANK SIZE -LIFT TANK SIZE LOAD RATES ABSORPTION AREA 6 DOSE TANK SIZE BENCHMARK V.R.P. Top of 3/4,, pipe _ to of chambers 30 — BOREHOLE O *H R. P. ASSUME ELEVATION 100, WELL same as - benchmark F'It Pro Scale perty Line = 1 /4" = 10 Existing Structure to >6" be converted to be of Cover sized for a 2 bedroom house 140 40' 2-3' X 62' cells with >3' spacing 30' B-3 6W Vents 40' 20% Slope 2 40' 10' B' B.M.* 50' 1 er Lifetime Filter Vent Qufck4 Standard Leaching Chamber with 20.0 ft2 of area 2„ 5 61 ft^2/pair of endcaps at System Elevation 112' 108, 104' 100, FB-1 70 Old E East All Piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6f A2 pair of end plates / Typical Installation Grade 4" A/30/34 Septic Tank 11 5' Spacing 5' System elevations: A 95.5' B 94.5' 5' at System Elevation 5' To be >1' above grade Finish grade elevation 110' Vent 1" at System Elevation 2-3' X 62' Cells Same on other end Observation tubeNent At end of cell A B 15 chambers per cell Owner/Buyer Mailing Address Property Address Ja City/State LEGAL DESCRIPTION ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM required from Planning & Zoning Department for new construction.) Parcel Identification Number Property Loeation/-/L,,1 f/. ,Nit/a , Sec. 34'— , T 30 N R/?- W, Town of 30 Subdivision Lot # -L. Certlfled Survey Map # Volume �U Page # Warranty Deed # , Volume �� , Page # Spec house yea no Lot linc identifiable( 7ros / no SYSTEM MAIIVTENANCE AND OWNER CERTIFICATION �/ Improper use and maintenance of your septic system could reach in its premature faihne to handle wastes. Proper maintenance consists of pumping out the septic tank every throe years or sooner, it 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 aystem. Owner maintenance tesponstbilities are specified in §Comm. 83.52(1) and in Chapter 12 - St Croix County sanitary Ordinance. The property owner agrees to submit to St Croix County Planning & Zoning Department a certification form, signed by chef owner and by a master plumber, journeyman Plumber. restricted plumber or a licensed pumper verifying that (1) the on -site f wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than W full of sludge. I/we, the underaigted 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 Commerce and the Department of Natural Rosances, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and retied to the St Croix County Planning & Zoning Department within 30 days of the three expiration date. Uwe certify that all statements on ' form am true to the beat of my/our knowledge. Uwe am(am the owner(&) of the property described above, by virtue of a deed recorded in Register of Deeds Office. Number of bedrooms o=— SMNA1:0KE OF-APPLICANT(S) DATE ***Any information that is misrepresented nay result in the sanitary permit being revoked by the Planning & Zoning Department **. Include with this application a recorded waaanty deed from the Register of Deeds Gffice and a copy of the certified survey map if reference is made in the warn inty deed (REV. 08105) tr POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page_of_ FILE INFORMATION Owner 1fn Permit # SIGN PARAMETERS Number of Bedrooms d� ❑ NA f Number of Public Facility Units If, z6-NA Estimated flow (average) Lida I Design flow (peak), (Estimated x 1.5) al/da Soil Application Rate gal/day/fie i Standard Influent Effluent Quality Monthly average Fats, Oil & Grease (FOG) 5W mg/L Biochemical Oxygen Demand (BODe) 5220 mg/L ❑ NA Total Suspended Solids (TSS) <150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ❑ NA Fecal Corfomn (geometric mean) 5104 cfu/100ml iMaximum Effluent Particle Size Ya in dia, ❑ NA Other. ❑ NA "Values typical for domestic wastewater and septic tank effluent MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity al ❑ NA Septic Tank Manufacturer ❑ NA Effluent Filter Manufacturer ❑ NA Effluent Filter Model ❑ NA Pump Tank Capacity l ❑ NA Pump Tank Manufacturer NA Pump Manufacturer NA Pump Model NA Pretreatment Unit IJ NA ❑ SandlGravel Filter ❑ Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other. Dis aural Cells) ❑ NA In -Ground (gravity) ❑ In -Ground (pressurized) ❑ A - rode ❑ Mound ❑ Drip -Line ❑ Other. Other. ❑ NA Other. ❑ NA Other. ❑ NA Service Event Service Frequency "pect condition of tank(s) At least once every: -1� O month(s) (Maximum 3 yore) ❑ NA ea s Pump out contents of tank(s) When combined sludge and scum equals one-third (35) of tank volume ❑ NA Ilhspect dispersal cell(s) At least once every: monlh(s) y yearls) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: month(s) l ! I earls raped pump, pump controls & alarm At least once every: D y�(S(s)Mush laterals and pressure test At least once every: ❑ month(a)❑ ear{s)Dther ANA At least once every: months)�7ther.s 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; POINTS inspector; POINTS Maintainer, Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Ya) or more of the tank volume, the entire contents of !:he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. I5JI other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, ar� any servicing at intervals of 512 months, shall be performed by a certified POINTS Maintainer. A service report shag be provided to the local regulatory authority w thin. 10 days of completion of any service event Page _ of _, Phone START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals th>tt 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 fit above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cei(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park Vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or Compact, the area within 15 feet down slope of any mound or at -grade soil absorption arse. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the fife of the POV VT$: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fags and/or is permanently taken out of service the following steps shall be taken to insure that the system is prope0Y and safety 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 property disposed of by a Septage Servicing Operator. • Alter pumping, all tanks and pits shag be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: —Asuliable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. liable The replacement area should be protected from disturbance and compaction and should not be infringed upon by rayui0ed setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the riled 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. O A suitable replacement area is not available due to setback and/or sal limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade SW 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 TAN 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 777,773 T Phone SEPTAGE SERVICING OPERATOR MPER I e Name Phone 11s This doaenent was dratted in compliance with chapter SPS 383.22(2)(1b)(1)(d),(f) and 3111KI), (2) & (3). Wisconsin Administrative Coda 20140048A v M �vil�i:YC;ai SECTION A -A 1721 Second Level Floor Plan h? 1ST LEVE ..,, RcVicw $m W14 ------- Not Fm Construction First Level Floor Plan C[� Vesper eco-WMea.ve �y Damn Noy. e A-2� x 6'5T-ao iq - P ;� 2019 AUG 28 I 1501L EVALUATION REPOF7f Wisconsin Dope of Commerce Division of Safety Buildings -; .,, rn,.n:v Page _ of _ �.. - De:'�f wen wmm aa, vvls. vwm, was Crp,�;n Uniy Attach complete non paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Pa l Innormaoon you pr v' may be used for oaoonoary purpm" (Priv" Low. r. 15.04 (1) (m)1. Co1+uY Parcel I.D. � ^Y17 1.43 "Ab -Irp.3 Re by Date 2. 3 l Property Owner Q. Y Property Location Govt. L.ot a-," 1f4 - — 1/4 ZT C) N R E (or) Property Owner's Mailing Ad ess Lot # Block # I Subd. Name pir CSM# State Zip Phone umbw ❑ City ❑ Village o Nearest Road Construction Usesidential I Number of bedrooms ? Code derived design flow rate �Jt J GPD ❑Replacement ❑ Publi rcommera al -Describe: Parentmaterial ®� Flood Plain elevation if applicable i✓ilY ft. General coirrrlerds Zax� X and recommandabons:: System Type / r9 A/L11' System Elevation I ( j Boring # Bong PMit Ground surface elev. lG .l ? ft. Depth to limiting factor I/ - 1 in. Sal Application Rate Horizon Depth In. Dondnant Color Munsell Redox Destmocn Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDM 'Eff#1 -EB#2 -(z a s a ��- /0 ® Baring # ° Boling ®, pit Ground surface elev. f r.�t`J , Pft. Depth to limiting factor In. Sad Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDIif 'Eft#1 I 'Eft#2 o— 3C L s ,r — 6 , Z — 414 C t% Z Effluent 01 = BOD. > 30 < 220 mWL ant TSS >30 < 1 Effluent Q = eoo. <:A7 mgf- and I b,� < M mgrL CST Name (Please Print) atur CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address ate Evaluat n Conducted Telephone Number 1432 120th St, New Richmond, WI 5401 --1 715-246-4516 Property Owner Parcel ID # Page of FF J � LL 0 MA0IMrM MA Wo� ■E) pit Ground surface elev. ft. Depth to limiting factor - in. Soil Application R ❑ Boring pit # Ground surface elev. ft. Depth to limiting factor in. ' Effluent #1 = BODs > 301 220 nVL and TSS >30 < 150 mglL ' Effluent #2 = BODS < 30 mg& and TSS ! 30 mg1L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. ss"3"nt.b ) Property Ovmer _ Parcel ID # /age _ of Boring ® • Rin. NAMP�� ' _�I� ��1INI ii�� // /. 1 r- 1 �_ZEK- !•MENEENUENVI- A ❑erg# ❑Bering h-j..- i i Lv,—I— %1-'. r ❑ pit Ground surfaceelev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Cola Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD#F 'Eff#1 I 'Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon 'lepth in. Dominant Cola Munsell Redox Description. Qu. Sz. Cont. Cola Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD1ff 'Eff#1 I 'Eff#2 Effluent #1 = BODE > 30 < 220 mgli- and TSS >30 < 150 mglL ' Effluent #2 = BOO, < 30 Trot and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. seo-etro lz.6mot Soil Test Plot Plan Project Name Heidi Huebner Shaun Bird Address 456 Old E East Hudson Wi 54016 -=1 CSTM,#2�-f Lot 6 Subdivision --------- Date 8/2849 NW 1/4 NE 1/4S 32 T 30 N/R19 W Township St. Joseph ❑ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 3/4" pipe System Elevation TBD *HRPSame as Benchmark Property Line 140 L:M' 40' Existing Structure to be converted to be sized for a 2 bedroom house 40' 10' B.M.* 50' Old E East Scale is 1" = 40' unless otherwise noted 112' 104'