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Home My WebLink About020-1487-13-000Wisconsin 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)I Permit Holdefs Name City Village Township Oevering Homes TOWN OF HUDSON CST BM Day Insp 8M Elev BM D iptio +^' Q ' ` TANK INFORMATION ELEVATION DATA TYPE MANUFACTU ER CAPACITY Septic IAJJ Dosing Ae ton Al 14V i Holding TANK SETBACK INFORMATION .% POMP/SIPHON INFORMATION Manufacturer errand G Mo 7 l Number TDH, Lift Fn tion Loss stem He a TDH t Forcer, Len h Dia Dist t Well SOIL ABSORPTION SYSTEM r � OEM mom :. lzM�10 BEDITRENCH DIMENSIONS 'Nidth g f Length No Of Trer>Ghes PIT DIMENSIONS No Of Pits Inside Dia Liquid Depth SETBACK SYSTEM TO P/L Gj IBLDG WELL LAKE/STREAM LEACHING 110,4aufacluppr INFORMATION CHAMBER OR UNIT Type Of System f �l {�' Ai Model mb r t v ' leader;Manifoltl Oistnb i x Hole S x Spacing en o f Pipes) -ength Dia Length D Spacng ��r� �� • �^ x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over / \ Bed/Trench Center / Depth Over Bed/Trench Edges % ' t Gepth of T saA xx e odded xx ched i� it yes No i I COMMENTS: (Include code discrepenc es, persons present, etc) Inspectiiooxn/##1 I 1,��. p�.l G„A Inspection #2 1 Location: 895 GAVIN PASS ' N�/ `�j- `�i"� Y ,r V-ff C/ `1,�VC -/ i 1.) All BM Descnption=F+ 14/covc✓ '�/ f�f�y14 ✓oogh✓ 1A��BI.fL�'lil/h f l 2 ) Bldg sewer length = 16P 1! r lY' f%Gl YVt 'f6 AY q�U Qr�0 4'Tct- t�5 j{��,1 �httt��P -amount of cover = i/7i Plan revision Required? ❑ Yes No other side for additional mformatio Use oth Use tho (R 3/e7) � � \�__ sePors Si _---- --- Can N�� Safety Buildings Division L Cowty51, i and 201 W. Washington Ave., P.O. Box 7162 Samrary Permit Number (to be filled in by Co ) a '...,$p.'•.' DE� Madison, W1 53707-7162 L_�= �riitary Permit Application — 1, SureNnmba In accordance with SPS 393 21(7), Wis Adm. Code, submission of this for., to the appropnau go unit Project Address (if different than mailing address) is required prior to obtaining a sanitary permit Now Application forms for state-owned POWTS are submitted to Professional Servies Persm:J information be for secondary the Dcparment of Safety and you provide may used purposes in accordance with the Privacy Lau, s. 15.04(])(m) .Smts. _ 9 �� ,L'I✓ti 1.A Application Information- Please Print All information Property Owner's Name Parcel p o a-o — H9 oet�� ,` Property Owner's Mailing Ad s — Property Lreation P S Gnv Lot _ /l/,, $ecnon�i Tcic — City, State /) / ��a Lip Code � Phone i Number t t_.G f/LX W //_ L .k T _ N, R C or ype of Building (check all that apply) Lot ii Subdin on NaC 2 Family Dwellmg-Number of Bceroorns Slack 3 11 ❑ Public/Commercial - Describe Use ❑ Cary of ❑ State Owned- Describe Use CSM 611age of Number Town of/p� J III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A w System ❑ Replacement System ❑ Tmatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal Pcrtnn Rennon ❑ Change of Plumber ❑ Permit Transfer to New Lin Previoia Perron Number and Dale Issu d Before Expiration Owner 6 / a0� IV. Type of POW rS S stem/Com onent/Device: Check all that apply) Cl Non -Pressurized In-Cnound ❑ Pressurized In -Gravid ❑ At -Grade ❑ Mound 124 m. of suitable sod ❑ Mound <24 in ofsmtab ❑ Holding Tank ❑ Other Dispersal Component Ion) ❑ Pren a em Device (ex l V. Dis ersit reatment Area Information S Design Flow (gpd) Design Soil Application R sI) Dispersal ea Required (sf) D / al Area Prowled ( [0- rEllea on / ' �� / (� .S vG/ VL Tank Info Capacity in Total 4 of Manufacturer Gallons Gallons Units /L�, I U S u o Tanks Exudas Toads New j�`y/�� 0 zU Vi in 6-3 Sepnc in Holding Tank - , i a j 1Msing Cbambo VII. Responsibility Statement- I, the undersigned, as me esponsibility for installation of the POWTS shown on the attached plans. Plum is Na�(P (tit) r��L Plum giazme MP/Ml'RS Number Business Phone ber Plumber's Address_(Sueet, Cny, State, Zip C_od� /. 1 �i /�Cl `�I . e artmenOnly VIII. Cou70;�E (� Approve❑S Pcrmrt Pee ^D Date Issued _ ]ssmng gent $igna[me I 7r r Denial p 2\ S —t IX. Conditions �� YSTEM OWNER ��,,.._a_� . Septic tank effluent filter and �, t �''�-�r 0"I'�'""'�'� _� a- 11% / Sv-�Q 4�10.4 �GtIT dispersal cell must be serviced mavit-ained ` t'st�+-n Odi.l - as per management plan provided by plumber. All cPthr-4 rP rPmentc m,,0 be maintained (d as r app lCabl CO °d ion Plan for the system n� s li no be fouary only oott lesatbaa A trz x ll'och in svx z-i / 1 �5"^/' P Soil Test and System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 1/4 NE 1/4S 23 /T 29 N/R 19 W TOWN Hudson r,ntTi „f CROIX SYSTEM ELEVATION 95.0/94 4.0 5.5' below grade DATE nFr fig { 12/15/21 OOM 4 CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK EROIX COUNTY CDD — MOUND SEPTIC/NKZE �12ons55 gallLIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1219 # of chambers 60 BENCHMARK V.R.Y. Top of s iron ASSUME ELEVATION too' Filter Lifetime Filter [:]BOREHOLE O WELL +H.R.P, same as benchmark of—� L-3 Scale is 1" = 40' >6„Leaching standard unless otherwise of Covereaching Chamber ith 20.0 ft2 of Area noted .6ft^2/pair of end caps 4' Lon Grade at System Elevation Pro 4 Bedroom House All piping shall be ASTM SDR 30/34, within d c I C Q Y 10' of tank, piping shall be ASTM F891 L 103' -3 Gavin Pass 101' Vents 3-3' x 82' cells with >3' spacing B- 99, 10, 7% Slope 9, 220' roperty Line 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 895 Gavin Pass Hudson Used: In -ground absorbtion system (version 2.0) Page# 1, Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. MaintYandtigency Plan 7. Filter CrSignature License n00 Soil Test and System PLOT PLAN PROJECT Oeverino Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 1/4 NE 1/4S 23 /T 29 N/R 19 W TOWN Hudson �ObrpjVrSS-LCROIX SYSTEM ELEVATION 95.0/94 4.0 5.5' below grade 12/15/21 UU 4 DATE nEC 1 GB�OOM CONVENTIONAL %00C CONVENTIONAL LIFT HOLDING TANK — 6:F. ROIX COUNTY CDD — MOUND SEPTIC NK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ` BENCHMARK V.R.P. Top o_ f8 Iron ABSORPTION AREA 1219 # of chambers 60 ❑ BOREHOLE O WELL *H.R.P. same as benchmark ASSUME ELEVATION 100' Filter Lifetime Filter Vent Scale is 1" = 40' >6., Quick4 Standard unless otherwise of Cover Leaching Chamber with 20.0 ft2 of Area noted 6.6ft^2/pair of end caps 4' Long 12 44 Grade at System Elevation 34" (\J4 eo ' 7 I') Pro 4 Bedroom House All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 20 103' ST B- Gavin Pass 101, 10' Vents 3-3' x 82' cells with >3' spacing Br-? 99' %1e�0 4,, 0 10' 10, 7% Slope 90 B. 220' roperty Line 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 Grade 4' Long 1 Spacing 5' 4" �130/34 Septic Tank 5' at System Elevation 3-3' X 82' Cells 4' To be >1' above grade Finish grade elevation 95.5' Vent t" at System Elevation Observation tubeNent Same on other end To be located on end of Cells 20 chambers per cell A B Syste elevations: C A 9 .0' 9 C 80' I' POWTS OWNER'S MANUAL. & MANAGEMENT PLAN Page of 'FILE INFORMATION Owner �� i ', L Permit # I DESIGN PARAMETERS Number of Bedrooms r 07 ev 0 NA Number of Public Facility Units Estimated flow (average) y�� Design flow (peak), (Estimated x 1.5) _gal/day aUda Soil Application Rate J ai/da /f12 Standard InfluentlEffluent Quality _ Monthly average' Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BOD5) 5220 mg/L D NA Total Suspended Solids (TSS) <150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD5) S30 mg/L Total Suspended Solids (TSS) c30 mg/L ;;.eA Fecal Coliform (geometric mean) 510' cfu/100ml Maximum Effluent Particle Size 'a in dia. ❑ NA 0thec A 'Values typical for domestic wastewater and septic tank effluent IAINTENANCE SCHEDULE r SYSTEM SPECIFICATIONS Septic Tank Capacity al ❑ NA Septic Tank Manufacturer ❑ NA Effluent Filter Manufacturer ,r `Q� ❑ NA Effluent Filter Model �� O NA Pump Tank Capacity al ❑ NA Pump Tank Manufacturer NA Pump Manufacturer NA Pump Model NA Pretreatment Unit NA ❑ Sand/Gravel Filter ❑ Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection D Other. Dispersal Cell(s) 0 NA In -Ground (gravity) ❑ In -Ground (pressurized) ❑ At -Grade ❑ Mound D Drip -Line ❑ Other: Other. D NA Other: D NA Other. ❑ NA Service Event Service Frequency Inspect condition of tank(s) At least once every: (Maximum 3 years) L1 NA j Pump out contents of tank(s) When combined sludge and scum equals one-third ('fi) of tank volume ❑ NA inspect dispersal cell(s) _ At least once eve Y '7 D month(s) (Maximum 3 ears 5 ears) y ) DNA Mean effluent filter At least once every: onth(s) Kear(s) _ DNA !nspect pump, pump controls & alarm _ At least once every: ❑ month(s) ❑ year(s) ❑ NA :lush laterals and pressure test At least once every : ❑ month(s) 0 year(s) ❑ NA ! Other. Other: At least once every: ----- ❑ month(s) ❑ year(s) DNA -- D NA MAINTENANCE INSTRUCTIONS iInspections of tanks and dispersal cells shall be made by an individunt carrying one of the following licenses or certifications: Master (Plumber; Master Plumber Restricted Sewer; POWTS Inspector: POWTS Maintainer, Septage Servicing Operator. Tank inspections mast [include a visual inspection of the tank(s) to identify any missing of broker liardwa,e, identify any cracks or leaks, measure the volurne. of Lombined sludge and scum and to check for any bark up of ponding of effluent 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 surtace. The ponding of effluent on the ground surface may indicate a failing narditio,i and requires the immediate notification of the local I-egulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third ('S) or more of the tank volume, the entire contents of !.he tank shall be removed by a Septage Servicing Opeminr and disposecl of in accordance with chapter NR 113, Wisconsin Administrative Code. IAII other services, including but not limited to the servicing of effluent filter. mechanical or pressurized components, pretreatment units, [and any servicing at intervals of <12 months, shall be performed by a certified P01rJTS Maintainer. IA service report shall be provided to the local regulatory authoi;l; ,vithin 10 days of completion 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 thrit 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 fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of eflluenH. 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 Compaq, the area witNn 15 feet doom 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 POWT$ antibiotics; baby wipes: cigarette butte; 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 fails and/or is permanently taken out of service the following steps shall be taken to Insure that the system is prope�iy and safely abandoned in compliance with chapter Comm 113.33, 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. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with sail, 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: suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelm. The replacement area should be protected from disturbance and compaction and should not be Infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a now soil and 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 soil limitations. Bening 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 evaluaf or must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed; a: a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place foilowing removal of the biomat at the infiltr2liv( 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 TAN UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O� ) PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER In Name I Phone zi--n f POWTS MAINTAINER Name SEPTAGE SERVICING OPERATOR PU ER LOCAL REGULATORY AUTHORITY Name '^ Name Gef:224 / Phone Phone/JG r This document was drafted In compliance with chapter WS 383.22(2)(b)(1)(d)&(f) and 383,54(1), (2) & (3), Wisconsin Administrative Code. 2 4 0 0 4 8 A 00 SECTION A -A IL f