HomeMy WebLinkAbout020-1489-00-140Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]
IPennrt Holders Name I City Village Township
TANK INFORMATION
TYPE
MANUFACTURER 5
CAPACITY
Septic
ng
a �
era ion
Holding
TANK SETBACK INFORMATION
TANK TO
P/L
WELL
BLDG.
nt to Air Intake
ROAD
Septic
T
-7
t
Dosing
Aeration
Holding
PUMPISIPHON INFORMATION
Manufacturer
Demand
GPM
Model Number
TD
LiR
Friction Loss
Syste Head
i
i
TDH Ft
or
Fcem
ength
Dia.
Dist. to
SOIL ABSORPTION SYSTEM
TOWN OF HU
ELEVATION DATA
County:
St. Croix
Sanitary Permit No:
631230
State Plan ID No:
Parcel Tax No
020-1489-00-140
SectionlfownlRange/Map NO:
10.29.19.3117
STATION
BS
HI
FS
ELEV.
Benchmark
3. o
J
I ty, • 2-
Vl.l
tIt. BM
�k
Bldg. Sewer
�•
1 1
SUHt Inlet
C
I
SUHt Outlet
[7 •
Inlet
D otto
Header/Man.
We
Btat-Ptpe
q
Bot. System
r 197
Final Grade
3
�06.2
2Z-t 2-2-
BEDrrRENCH
Width
Len th `
No Of TrencJ>a§
PIT DIMENSIONS
NO Of Pits
Inside DaLiquid
Depth
DIMENSIONS
3
O
L
SETBACK
INFORMATION
SYSTEM TO
TSystemOf
(,pe
WII�VCI
P/L
�t
BLDG
WELL
ZOt
LAKE/STREAM
LEACHING
CHAMBEROR
UNIT
Ma ct
ll
Mo um er
DISTRIBUTION SYSTEM
Header/Manifold
nifold
t
Di tribution
Pi e(s)
x Size
x pacing
Vent to Air Intake
li
leAf
Length Dia
Le [h Dia Spacing
t. ��(/L WG V C
SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only
Depth Over 1 / /
Bedrrrench Center 11 6� h,
—1
Depth Over Lt
Bed/Trench Edges 7 1 y
xx h of
Topsoil
xx eded/ dad
No
xx Mu
No
J ✓
s -
I
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: Inspection #2:
Location: 1076 HOPKINS DR
1.) Alt BM Description =
2.) Bldg sewer length - i i��k 5 Q to QJ7U)
- amount of cover = i 4 2U
Plan revision Required? 0 Yes No
Use other side for additional information. J D J
SBD-6710 (R.3797) Date nsepctors Signature Cart. No.
'54ty-aoaI - 0la
County (�
-
Safety and Buildings Division
201 WPWashingbon Ave., P.O. Bex 7162
` r�
Smeary Permit Number to be fined in by Co.)
> 2 2p21
Madison, 707-7162
(p 3 Z 3D
?E
Sam -Permit Applicatio
Star T �a °�n Number
In accordncee u tp_SPS-38321(2), Wis Aden Code, subs i icu of this fors to the appropriare tal unit
Project Address (if different ihm mailing address)
u mquir�phor m obtaining a sanitary permit Note .kppLicabou forms for stm owned POWTS are m
the Department of Safety and Professional Smies Pers:mal information you provide may be used for secondary
r
purrposes m accordance with the Privacy Law, s 15 04(1 m) St;ts.
"7 r
X' 7
L Application Information - Please Print All Information
Property ihnic's Dame
nark q
- Iq 97.00-IL
ez
oa
Property Owner's Mailing Address
.�i�, ,n
Prq�eriy Location
�D 12i. 14.31n
-t S \ c.t� l/[r I
City, S t Zip Code Pbrme Number
Cpvt Lot
�'�•��r/4 .X141on I
Lu .� 1 /%
Ic c)
TN, R W
ype of BuBding (check all that apply) LotB
/
Subdi None
amity Dwelling -Number of Bcerooms !
t n
Blockd
L
j L PubbrXommereial- Describe Use
O Ciry of
L State Owned - Describe Use CSM Ntmibcr
❑ Ytllage of
Z E: v
own of
III. Type of Permit (Check only one box on line A. Complete line B if applicable)
A. Sy
❑ Replacement Syst®
❑ Treatment/Holding Tank Replacanent Only
Other Modi&catmn to Fasting System (explain
B- ❑ Permit Renewal
❑ Permit Rntsion
❑ Change of Plumber
❑ Permit Transfer to New
Lm Prevtous Perms Number and Date lssued
Before Expuahon
Owner
IV Tvne, of PO VY-rS Svste Com onent/Devme: Check a6 that applv
f-'&
-Crround ❑ Presstuved In -Ground ❑ AI-G tide ❑ Mound > 24 m. of suitable soil
.ram' Motmd - 24 m of suitable soil
❑ Holding Tank n Orba Dispersal Component (explam) ❑ Pretreatment Device (ezpiam) -'
V. Dispersal/Treatment Area Information:
Design flow Cod) Design Soil Application dsf)
Dispersal A= Required (sf)
Des Area posed (sf)
�/
System, ev
VL Tank Info Capacrry m
Gallons
Toral
Gallons
N of Manufaawer
Units LI f1'r
=
s u
y
S
o
New rooks Ewang Tanks
.-
F
Z o
5V
d - $
y P Yn
<
'c.0
A
-
Sepnc or Holdmg Tank
j
Dog Cbamba
VIL Responsibility Statement- f, the mdersiga d, m responsibility for installation of the POW n shown on the attached plans.
PI 's Name (Print)
PI 1parme
MP/Iv1PRS Number
Business Phone Nmn
LIZ,
'
Plmber' A.ddress (Sim CurSLAM'
VIII. Coun !De artment Use Only
Approved ❑Disapproved
Permit Fee
s f
Dqu bsueo
zd z l
Issumg Agent Sr _
❑ Owner liven Reason for Denial
52s. o
WVpp provaVReasons for Disapproval 3 NO p4r4 D-- .5 t 54-ek-% t(t/ oH/4 rn /14
/� l i
1 Sephctank, effuentflterand
d'spersal 4) 3;,S'� I�r 1pevt jaaer f t l
� fev i�}.c sysk,,,, �t�+Kkfta�
ceu must be serviced r maintained
f I
a, rr r""Iement piar, provided by plumber. tk'L po yK0.:-f�`^ �r '7 aWKtr.
2 !,U :etha�k, n�p,nrcmc•nfs must be maintained
l
^' Ps"� 9r'3 U'? CO;iadytlltgBtaP Pi. fur the and submit a the County ody a peer not Less than 81rz 111 ix es m sac
75 KC`f �tGKc✓Iif aria Mvs4-- do fre5-cevJ
SBD-6398(R. 11/I1)
4 0.
��4
e-n^fn�
System PLOT PLAN
PROJECT Kernon Bast ADDRESS 948 LaBarge Road Hudson Wi 54016
SW 1/4 NE 1/4S 10 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX
SYSTEM ELEVATION 96.2/96.1 4' below grade DATE 1/12/21 BEDROOM 4
CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44
,,, BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE O WELL-H.R,P, same as benchmark
Scale = 1/4" = 10'
vent
> Quick4 Standard
of Cover ching Chamber
with ft2 of Area
2/pai end caps
4' Lone 12
2-3' X 90' cells with
>3'spacing
0% Slope
124'
MR]
61
434' * Vents B-1
Property B.M.
Line 33' _ 42 -
1 �?
1
T
3
ro 4 Bedroom
1076 Hopkins
All piping shall be ASTM SDR 30/34, within
10' of tank, piping shall be ASTM F891
213' Property Line
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi54017
715-246-4516
Date: 1/12/21
Owner:Kernon Bast
Location:SW1/4 NE 1/4 S 10 T29 N,R 19W 1076 Hopkins Dr. Hudson
Manuals Used: In -ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4-6. Maint4andgency Plan
7. Filter CrSignature
License n0
System PLOT PLAN
PROJECT Kernon Bast ADDRESS 948 LaBaroe Road Hudson Wi 54016
SW 1/4 NE 1/4S 10 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX
SYSTEM ELEVATION 96.2/96.1 4' below grade 1/12/21 BEDROOM 4
DATE
CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT 'TANK SIZE DOSE TANK SIZE
HOLDINNG TANK SIZE LOAD RAPE .7 ABSORPTION AREA 891 # of chambers 44
,,� BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE O WELL "H.R.P. same as benchmark
434'
Property
Line
Scale = 1 /4" = 10'
Vent
Jon
Quick4 Standard
Leaching Chamber
with 20.0 ft2 of Area
�5.6ffNpair of end caps
Grade at System Elevation
2-3' X 90' cells with
>3' spacing
0% Slope
B-3
61'
Vents
R X4 *
33' _ i _ 42
B-2
25' ST �'
24'
Vic1�7
4 Bedroom
1076 Hopkins Dr
All piping shall be ASTM SDR 30/34, within
10' of tank, piping shall be ASTM F891
B-1
7213'Property Line
Cross Section of Infiltrator Quick 4 Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 112 of Area per Chamber
5.6ft^2 pair of end plates
-/ Typical Installation
Vent i Grade
4"
_,A:-'30/34 Septic Tank
5' Long
Spacing 5'
System elevations:
A 96.2'
A
Grade at System Elevation
To be >1' above grade
Vent
5' Long t
Finish grade elevation
100.2'
at System Elevation
2-3' X 90' Cells
Same on other end Observation tubeNent
At end of cell
A
B
22 chambers per cell
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _of_
FILE INFORMATION
Owner )—►%—�
Permit # r C a
DESIGN PARAMETERS
Number of Bedrooms
❑ NA
Number of Public Facility Units
NA
Estimated flow (average)
yd Vgal/day
i Design flow (peak), (Estimated x 1.5)
Utf aVda
Soil Application Rate
ai/da lft2
Standard Influent/Effkient Quality
Monthly average`
Fats, Oil & Grease (FOG)
530 mg/L
Biochemical Oxygen Demand (BOD5)
420 mg/L ❑ NA
Total Suspended Solids (TSS)
<150 mg/L
Pretreated Effluent Quality
Monthly average
Biochemical Oxygen Demand (BOD5)
s30 mg/L
Total Suspended Solids (TSS)
_<30 mgR A(A
Fecal Coliforn (geometric mean)
510' cfu/100ml
Maximum Effluent Particle Size
ik in dia. ❑
(Other.
NA
'Values typical for domestic wastewater and septic tank effluent
A] NTENANCE SCHEDULE
SYSTEM SPECIFICATIONS
Septic Tank Capacity
at NA
Septic Tank Manufacturer
❑ NA
Effluent Fitter Manufacturer
❑ NA
Effluent Fitter Model
A
Pump Tank Capacity
al VNA
Pump Tank Manufacturer
NA
Pump Manufacturer
_t7
NA
Pump Model
NA
Pretreatment Unit
NA
❑ Sand/Gravel Filter
O Peat Fitter
❑ Mechanical Aeration
❑ Watland I
❑ Disinfection
❑ Other.
Dispersal Cells)
❑ NA
❑ In -Ground (gravity)
-7` In -Ground (pressurized)
❑ At -Grade
0 Mound
❑ Drip -Line
❑ Other:
Other.
❑ NA
Other:
❑ NA
Other
❑ MA
Service Event
Service Frequency
Inspect condition of tanks
()
At least once every:months)
a s (Maximum 3 years)
❑ NA
iPump out contents of tank(s)
When combined sludge and scum equals one-third (X) of tank volume
❑ NA
(inspect dispersal cell(s)
At least once every:
asks) (Maximum 3 years)
❑ NA
^-lean effluent filter
At least once every.
/ morr(s)
t
❑ NA
rspect pump, pump controls & alarm
At least once every:
D month(s)
Cl NA
:lush laterals and pressure test
At least once every:
❑ month(s)
❑ year(s)
NA
Other.
At least once every:
El month(s) ❑
year(s)
NA
Xher.
❑ PIP.
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an mdividuat carrying one of the following licenses or certifications: aslsr
Plumber; Master Plumber Restricted Sewer, POWTS Inspector: POWTS Maintainer, Septage Servicing Operator. Tank inspections must
imdude a visual inspection of the tanks) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of
ombined sludge and scum and to check for any back up or ponding of afflueni on the ground surface. The dispersal cells) 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 conditions and requires the immediate notification of the local
Pegulatory authority.
iAten the combined accumulation of sludge and scum in any tank equals on=-thikd ('!,r) or more of the tank volume, the entire contents of
the tank shah 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 filters, mechanical or pressurized components, pretreatment units,
and any servicing at intervals of 512 months, shall be performed by a certified POVv7S Maintainer.
I> service report shall be provided to the local regulatory authority within 40 days of completion of any service event.
pop —of
START UP AND OPERATION or dthef dhemik�is that
For naw construction, Prior to use Of the POWTS Check treatment tank(s) for the presence of painting Products
may impede the heahnent Process ardor damage the dispersal cell(S). If high cionoontratiOns are detected have the konterds of the
tank(s) removed by a septage servicing operator prior to use.
System start up shall not o=ir when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal higher W levels. When Power is restored the excess wastewater will be
discharged to the dispersal cel(s) in One large dose, overk adrig the cells) and may result in the backup or surface discharge of eftluani.
To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator Prim to restoring power to "
effluent pump or conted 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 area.
Reduction or ellminafion of the following from the wastewater stream may improve the Performance and prolong the fife of the POWr$:
antibiotics; baby wipes: dgerolts butts; condoms'. coWn swabs; degreasers; dental floss; diapers: disvmfedants; lat; foundation drain
(sump pump) water; fruit and vegetable peelings; gautfirme; grime; herbtddes; meat scraps; medications; oil; painting producO;
pesticides; sanitery napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permarrerrhy taken out of service the following steps shall be taken to insure that the system is prope(1y
and safety abandoned in compliance with chapter Comm 83.33, W W=sin Administrative code:
• All piping to tanks and Pits shall be disconnected and the abandoned Pipe openings seated.
• The contents of all tanks and pits shall be removed and Properly disposed of by a Septage Servicing operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and fhe void space filed with soil,
gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
rep system:
ifaMe replacemerht area has been evaluated and may be utilized for the location of a replacement sad absorption sysbgm.
The replacement area should be protected from dWwftnoe and compaction and should not be minged upon by requitled
setbecits from existing and proposed structure, lot lines and weft. Failure to Protact the repted>ament area will result in the neled
for a new soli and ails evaluation to establish a suit" replacement area. Replacement systems must comply with the ndeit in
effect at that fine.
0 A suitable replacement area is not available due to setback and/or sow limitations. Baring advances in POWTS technology a
holding tank may be installed as a last resort to replace the failed POVYTS.
❑ The site has rot been ewaluded to identity a suitable replacement srea. Upon failure of the POWTS a sort and site evolualIon
must be performed to locate a suitable reps area. If no replacement area is available a holding tank may be installed as
a lest resort to replace the foiled POWTS.
❑ Mound arid at -grade sow absorption systems may be reconstructed in place fdkvring removal of the biomat at the infiltrative
surface, Reconstructions of such systems must compy with the rules in cited 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 TW UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE Or A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE
ADDITIONAL COMMENTS _
POWTS INSTALLER
Name `
Phone/tea '
POWTS MAINTAINER
Name
rz�
Phorhe !�� ✓ �� �' J
1
SEPTAGE SERVICING,/7OPERAT PUMPER LOCAL REGULATORY AUTHOR
Name L'r i— 1 r� / Name
Phone j �J
Phone
This document was dialled in conpuance with chapter SPS 383.22(2)(bx1)(dWfi 90 393.54(1). (2) & (3), wyhecons®A&nImsftWW code.
?.0140048A
1.1921
SECTION A -A