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Home My WebLink About020-1487-18-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT rn / GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)1 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic '14 ) ZJ50 P, I y i✓�tt Aeration Holding TANK SETBACK INFORMATION I,ov, Ls C-t11U;M' TANK TO P/ I WELL BLDG Vent to Air Intake ROAD Septic , ZS ' (� �V - , Dosing Aeration Holding PUMPISIPHON INFORMATION Manufacturer Demand M Model umber I DH 7171 ift Fric on Los System H d TDH Ft Forcemain Length Dia. I Dist. to County St. Crop( Sanitary Permit No. 633919 Stale Plan ID No: Parcel Tax No 020-1487-18-000 Section/Tom/Range/Map No: 14.29.19.3109 G � .4�� • I i �� JVIL MMQW!'i I IVPI J TO 1 CIyl GQ LU (�—V BED/TRENCH Width DIMENSIONS 3 Length '7 x !� No Of Trenches PIT DIMENSIONS No Of Pits Inside Dia Liquid epth SETBACK SYSTEM TO P/L JG BLDG IWELL LAKE/STREAM LEACHING Manufacturer r INFORMATION CHAMBER OR UNIT �i- Typ9,Of System' a Con ��I ) �r . VV `— Model Number IG i DISTRIBUTION SYSTEM HL rira•nifold Dia on Dn(x Pieqps) LengtDia Spacing Hole Size x He Spacing Vent o Air Intake / p r tm SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Bed/Trench Came5, C^ Depth Over Bedlrrench Edges 7—Topsoil xx Depth of xx Seeded/Sodded xx Mulched es77 o Yes No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: Inspection #2. Location: 896 GAVIN PA,S�Sr).:'LLV 1 ) Alt BM Description = Y"1 / jYr c/OV'ef- 2 ) Bldg sewer length =-7 - amount of cover = Plan revision Required? [Yes I .0 No I Use other side for additional information. SBD-6710 (R 3)97) pate Insepctof�s SSgr ature " / Can No - 14"- /f � � J riS � y1br� y ,, e,)r1A ,/ Ate. r SAn1 a091-3d8 r°2��,xngar� Safety and Buildings Division Cow 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number - (to be tilted in by Co.) 'd X �' TO Madison, WI 53707- 2 �33c(1 � °G �oxeasiounv L (� )L Appl Stint Transaction Number 1n accordance with PS 383.2t),`1r(fs1 Cude, submission of this form to d opria[e governmental unit Project Address (if different than mailing address) is required prior to raining a,�(pit pemut Note Application forms f to -owned POWTS arc submitted to for the Department of S ty essional Servies Persomil information you provide may be used secondary u oses in accordance ' die Privacy law, s. 15 04(I&Sorts. /L y / is 9J L V wCl I. Application Information- Please Print All Information Property Owner's Name Patent W /, o D o - Pfopeny Owoer's Matting Address CP -� Prop Locatio o.Lot �a•31r�1 Lot Govt. _ _ /, /, Section City, State Zip Code Phone Number N 4ntk�i cl c) T N; R orW B T pe of Building (check all that apply) Lot W Subdivision Name Family Dwelling -Number of Bedrooms L Block 0 ❑ PubliUCornmerciai - Descnbe Use 1� ❑ City of ❑ State Owned -- Descnbe Use CSM ❑ Village of Number ZmNc_ If III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' ew, System ❑ Replacement System Q TreatmeridHolding Tank Replacement Only ❑ Other Modification to Existing System (explain) B- ❑ Penn Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Penn Number and Date Issued Before Expiration Owner e of POWTS S stem/Coin onent/Device: Check all that apply) -Pressunud lm-Ground ❑ Pressurized In -Ground ❑ Al -Grade ❑ Mound > 24 in of suitable soil ❑ Mound <24 in. of suitable sod ❑ Holding Tank ❑ Other Dispersal Component exp 'n) ❑ Pretreatment Device (explain) entArea tment AreaInformation- w( Applicati a dson Dispersal Axca Requ' (sf) Disp^Area Pr s sf) System Elev^ation fV.D'kS!ersaVTr ��i] �6�� l^C/nk Info Capacity in Gallons Total Gallons 101 Units arulactmer / 's'rr��. yr e New Tanks Existing Tanks u ei v u b' to A i U rn A 'r b a. Septic or Holdmg Tank nnsrng Chamber VEL Responsibility Statement- 1, thejagdersigned, esponsihshry Iladun of the POWTS shown on the attached plans. Plumber's Name (Print) PI Signature MPfMPRS Number Business Phone Number C� � Plumber's Ad ess (Street, City, State, Zip zz- . Coun /De artment Use Out Approved ❑Disapproved Permi�t7Fe�c �O Sj L� _ Issued Z ]suing Agen atu rn ❑ Owner Given Reason for Denial _ IX. C61tfl1lMlooft#pproval/Reasonsfor Disapproval 3 1. Septic tank, effluent filter and ) el;spenal cell must be se,,cetymaintioned ,rt� r_ t rlS 7"C es per management plan Provided by r plumber s/a�+Ler 2. All Ye1bYCh raymrcments must be maintained K pot Allphteiae tewtudinarice3. /i'l(gr`yW,(,¢.�N j &LJk-t� / Attach to complete plans for the system and submit to the County only on paper nk less Wyn 8 In x 11 Itches in size L!x_ SBD-6398 (R. 11/11) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 8/25/21 Owner:Oevering Homes Location: 1/4 NE1/4 S 23 T29 N,R 19W 896 Gavin Pass Hudson Used: In -ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Sectio 4-6. Maintance and Con e cy Plan 7. Filter Cross Sectio Signature License num r 226900 PROJECT Oeverina Homes 1/4 SE 1/4S 14 System PLOT PLAN ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX SYSTEM ELEVATION 88.0/87.3/86.6 5.5' below arade 8/25/21 CONVENTIONAL XXX DATE CONVENTIONAL LIFT BEDROOM 4 HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1219 # of chambers 60 , 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 is 1" = 40' unless otherwise noted a Co��o>r S J;rrck"".t�y wnaw, use Vent >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 4' Long 12" 6.6ftA2/n-�- 3 caps Elevation AN POO 10, Pro 4 Bedroom House 0 on 150' Gavin Pa; -)(h»1.1 so; *3)n- All piping shall be ASTM SDR 30134, within 10' of tank, piping shall be ASTM F891 J s 3'' z s = a' 8- d'n s � �'�, a IYL wig � E ; k �4;t � i€- � a� � p• ..y` �L SS_ � _' s v�« ru•_ .dn ti t s $ s i HE 31 N11—J __ �' , cW F EP• fr h �1 �gVlq P0.55 � h _ _ �GgVN 4$ �— F (•�� i f � S �� k � ! i f •. per\ 1 Tos mE e r W k'w —� ne ,C99 LHZ 3.2555Ao5 9 9( 6611 M.ESL0.00E - 64'h A3i.+enPl: T'3fi5YW_ —dw A.1,4m =21Lti3'S t -.CH [ L l ikp ® W4 Py •u. - =Rv4_ °_f, AoUI'Consulune/assomatee SkS laud Servurang fr h �1 �gVlq P0.55 � h _ _ �GgVN 4$ �— F (•�� i f � S �� k � ! i f •. per\ 1 Tos mE e r W k'w —� ne ,C99 LHZ 3.2555Ao5 9 9( 6611 M.ESL0.00E - 64'h A3i.+enPl: T'3fi5YW_ —dw A.1,4m =21Lti3'S t -.CH [ L l ikp ® W4 Py •u. - =Rv4_ °_f, AoUI'Consulune/assomatee SkS laud Servurang —� ne ,C99 LHZ 3.2555Ao5 9 9( 6611 M.ESL0.00E - 64'h A3i.+enPl: T'3fi5YW_ —dw A.1,4m =21Lti3'S t -.CH [ L l ikp ® W4 Py •u. - =Rv4_ °_f, AoUI'Consulune/assomatee SkS laud Servurang System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 1/4 SE 1/4S 14 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX SYSTEM ELEVATION 88.0/87.3/86.6 5.5' below cradle 8/25/21 BEDROOM 4 DATE CONVENTIONAL XXX CONVENTIONAL, LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1 21 9 # of chambers 60 hk BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark Gavin Scale is F = 40' unless otherwise noted 3-3' X 82' cells with >3' spacing 90, 92' 94' Vent >6" of Cover 4'Long 12" B-3 4 10% Slope KWOOO Quick4 Standard Leaching Chamber with 20.0 ft2 of Area 6.61't12/pair of end caps Grade at System Elevation 25' I \ B.M.* iglM 110 10, Pro 4 Bedroom House 355' Pronertv Line IV _ 150' All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Cross Section of Quick 4 Standard Leaching Chamber Typical cross section for 2 of 3 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 6.6ft^2 pair of end plates Typical Installation Vent X1 Grade � 30/34 Septic Tank 4LonoY, 5' Grade at System Elevation Spac To be A' above grade Finish grade elevation 93.5' ,Vent 0 4' Lom4s t at System Elevation 3-3' X 82' Cells Observation tubeNent Same on other end To be located on end of Cells 20 chambers per cell %A System elevations: A 88.0' I POWTS OWNER'S MANUAL. & MANAGEMENT PLAN Page of FILE INFORMATION Owner =� f� Permit # bESIGN PARAMETERS Number of Bedrooms --- p NA _ Number of Public Facility Units jd NA Estimated flow (average) iO� al/cla ry Design flow (peak), (Estimated x 1_5) Ggal/day Soil Application Rate J al/da /ftZ !Standard Influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BOO,) 5220 mg/L t1 NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality _ Monthly average Biochemical Oxygen Demand (BODs) != mg/L Total Suspended Solids (TSS) <_30 mg/L /� Fecal Coliform (geometric mean) 510' cfu/10OmI .Maxlmum Effluent Particle Size '% in dia. ❑ NA Other. I A "Values typical for domestic wastewater and septic tank effluent N AINTENANCE SCHEDULE VA SYSTEM SPECIFICATIONS Septic Tank Capacity at ❑ NA Septic Tank Manufacturer O NA Effluent Filter Manufacturer /0 ❑ NA Effluent Filter Model �� ❑ NA Pump Tank Capacity al ❑ NA Pump Tank Manufacturer NA Pump Manufacturer NA Pump Model NA Pretreatment Unit NA ❑ Sand/Gravel Filter O Peat Filter CI Mechanical Aeration ❑ Wetland ❑ Disinfection O Other. Dispersal Cell(s) El NA In -Ground (gravity) ❑ In -Ground (pressurized) ❑ At -Grade ❑ Mound • Drip -Line ❑ Other: Other: ❑ NA Other: O NA Other: ❑ NA Service Event Service Frequency lInspect condition of tank(s) At least once every: ❑ month(s) Xear s) (Maximum 3 years) 0 NA Pump out contents of tank(s) When combined sludge and scum equals one-third ('fa) of tank volume ❑ NA Ilnspect dispersal cell(s) — — At least once eve ry' ❑ month(s) (Maximum 3 ears ear(s) years) O NA Clean effluent filter At least once every: months) ears ❑ NA nspect pump, pump controls & alarm _ At least once every: month(s) ❑ year(s) I O NA 1 I=lush laterals and pressure test At least once every: ❑ month(s) ❑ year(s) ❑ NA I Other. Lnher: — -- At least once every: — -- __ O month(s) ❑ year(s) ❑ NA ❑ NA. -.I MAINTENANCE INSTRUCTIONS (Inspections of tanks and dispersal cells shall be made by an individuni carrying one of the following licenses or certifications: Master IPlumber, Master Plumber Restricted Sewer; POWTS Inspector: POWTS Maintainer, Septage Servicing Operator. Tank inspections niust linclude 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 he ivisually 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 conditio,r and requires the Immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals une-third (�) or more of the tank volume, the entire contents of be 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 eflueM filtrrs, mechanical or pressurized components, pretreatment units, find any servidng at intervals of 512 months, shall be performed by a certified POINTS Maintainer. A service report shall be provided to the local regulatory authority ..vr(Nr, 10 days of c:ornpletion of any service event. Page _, of _, 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 thrt 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 conditlons 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 b)a discharged to the dispersal cell(s) in one large dose, overioading 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 wlthln 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTG: 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 prcdudl ; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to Insure that the system is propeliy 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 properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with suit, 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 ocmpfrint replacement system: Ttl—A uitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systgm. TheSreplacement area should be protected from disturbance and compaction and should not be infringed upon by requkled setbacks from existing and proposed atructure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil acd site evaluation to establish a suitable replacement area. Replacement systems must comply with the ruled In effect at that time. ❑ A suitable replacement area is not available due to setback and/or soli 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 Identity a suitable replacement area. Upon failure of the POWTS a soil and site evaluator must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed ax a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed In place following removal of the biomat at the infiitmOw 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 NOl ENTER ASEPTIC, PUMP OR OTHER TREATMENT TANIii UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O� / PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE ADDITIONAL COMMENTS POWTS INSTALLER n Name Phone n K)' POWTS MAINTAINER Name Phone L �s SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name _ Phone Name - /' / ZV,,j Phone r This document was drafted In compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. 20140048A 1921 SECTION A -A j21a U o w o m n O m O A � N M s 9 . !�| |` - -- ] ,, _ - ` � -- - . oil � !/ ■ t\%� \« ` _ /\(n- ! - / // -�-- @ /§ ) (/§ LOT $ M / mB.o =sss o114 952 SQ. F7 r Ln r� 87,300 SQ. FT, (2.004 AC.) o Co (10) �........ ? 50'SETBACK FROM $$3° NONNAVIGABLEWETLAND 31'23 "E _ 170.00, / z '� 592.78' =N iiE--_-- _ s78 °52'18' � � 313.9s' ,E ,n -� S88.06' -- o LOT 11 - �N78 s2,18 �-' _-- /v 1 / 129,607 SQ. FT. - 21 49,E (2.952 AC_) m 219.66' o U IN N89'48'39"E 629.71' 25• � EASMLW �O EPScA.-N1 7 LOT 12 m > �SPECIAL wEl L 132,878 SQ. FT. ' ^ CONSTRUCTION AREA (3 O50 AC) SECORN N -S89°41'45"W 2605.60'- SE -SE BOUNDARY -- SEC. 14 NE -NE m o '" LOT 18 ` - - — — - - - - — -- — — — - NE SEC COB z3 LOT 19 a ,ye 112,949 SQ. FT. 33' ry 117,821 SQ, FT. y"^, '7 (2.593 AC.) N89'48'39"E 627.16' (2 705 AC.) 5 L.B.O.=924.00 / 5D'SETBAOK FROM ... 00 )5, NON -NAVIGABLE WETLAND.' `\ N LOT 13 ............... i W _ a�i 126,759 SQ FT, o IN S89'04'39"W 355 26' °� VI r. (2.910 AC) o _L p9 ,pp s io }j Q w LB.0=972.0 1 __� N In Ln O N Z '^ SOO`16'46"W 40 17' wF 10 N89'58'30"E 207.78'ZD a LOT 17 al Z 4�� Sp33 BENCHMARK 103,2495Q. FT. (7.370 AC.) ry S89'42'22��W 42d:-2fi`------__—__ uN' � o—LT.0.B=927.8 L.B.O: 93400 Py N LOT ICIO o F9s�1�c� �9r� o LOT 14 L L �J'M(� MAP, z WULILr1HLS P,/�\QF=P -044(o) r S89°04'39'W S00.40' ,28) SEE SHEET 2