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HomeMy WebLinkAbout020-1489-00-250Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Budding Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may he used for secondary purposes [Privacy Law, s 15 04 (1)(m)] Pert Holders Name I City Village Township Kernon Bast :ST BM Elev TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANKTO P!L WELL BLDG Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMPISIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcem.m Length Dla Dist to Well SOIL ABSORPTION SYSTEM IOWED] amotel 11 01 ELEVATION DATA County. St. Croix Sanitary Permit No. 642236 State Plan ID No: Parcel Tax No. 020-1489-00-250 SectionffowMRange/Map No 10.29.19.3128 STATION BS HI FS ELEV Benchmark Alt. BM Bldg. Sewer St/Ht Inlet St/Ht Outlet Dt Inlet Dt Bottom HeaderlMan Dist. Pipe Bot. System Final Grade St Cover BED/TRENCH DIMENSIONS Width Length No Of Trenches PIT DIMENSIONS No Of Pits Inside is Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacturer Type Of System Model Number DISTRIBUTION SYSTEM HeaderfManifold Distnbution x Hole Size x Hale Spacing Vent tc Air Intake Pipets) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bedfrrench Center Bed/Trench Edges Topsoil —Yes L No Ll Yes 1 No COMMENTS: (Include code discrepenraes, persons present, etc.) Location: 1055 HOPKINS DR 1.) Alt BM Description = 2 ) Bldg sewer length = - amount of cover = Inspection 41: Inspection #2. Plan revision Required? L Yes L No Use other side for additional information. _ SBD-6710 (R 3197) Date Insepctoes Signature Cart No S,qN-aoa I -- V.�") a�.anreyr Countyt— Safety and Buildings Division Washington Ave.,PC.box 11b2 Statuary Permit Number befilled inbyCc) DEC 01 20 1 201� (to Madison, WI 53707-7162 yZ Z36 St. Croix LD n Y ermI ppli-cation _ ry S Stain Transa tion Number in accordance with SPS 383.21 2), Wis. Adm Coda submission of this form to the appropnate governmental unit Project Address (if different than mailing address) is required prior to obmming a sanitary pemut. Note Application forms for state-owned POWfS are submitted to the Department of Safety and Professional Servies Personal information you provide may be used for secondary purposes N accordance with the Privacy Law, s. 15 04(I)M)`Sevis. / za 1. Application Information- Please Print All Information Property Owner's Name Parcel A oLD Property Owner's Marling Address� Pmpcnnv Uoatma `7 i3 A Section C State Zip Code Phone Number , ��/iS/` L �`� II Type Typof Building (check all that apply) Lot q d /&ucle e VW7R//E xW 1 or 2 Family Dwelling -Number of Bedroomsoff 1 Subd vision 2:amej' ' Block tl ❑ CKY of ❑ Public/Commercial -Describe Use �� ❑ State Owned - Describe Use ❑ illage of CSMNumber -Eo e ' � Y`-C a JIL Type Permit: (Check only one box on line A. Complete line B if applicable) A. ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑Permit Renewal ❑ Permit Revision ❑Change of Plumber ❑ Permit Transfer to New Lis[ Previous Permit Number and Dale Issued Before Expuatioa Over . T e zvv I. of POW'tS S stem/Coin onent/Device: Check all that apply) on -Pressurized In -Ground ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound > 24 in of suitable sod ❑ Mound 124 to of suitaole sod ❑ Holding Tank ❑Other Dispersal Component (expl 'n) ❑ Pretreatment Device (explain) V.Dis rsaVIreatment Area Information: gn Flow (gpd) Deslz Soil Application Rate(gp sf) Dispp ssal Area Requucd (sf) Dispersal Area Pre d (s gml , Sy tem Elmauon 0 VI. Tank Info Capacity in Gallons Total Gallons q of Umis MsPumcturer 1 io / .- o U $ f' u o i V u v ° Yn a m n-C _E n New Tasks E usueg Tanks Sepnc or lioldmg Talc S Dssmg Chamber VIL Responsibility Statement- c undersigned, as responsibility for installation of the POWTS shown on the attached plans. Plumbbler's Name (Print) Phmi s attire MP/MPPRRjS Number Busin/ess�Yhone(N/�/J�/bet Plumber's ess- Street, City State, Lip e) c IL County/De artmeat Use On1V _ Approved ❑Disapproved Permit Fee Date Is d Issuing Agent attire $_J o / 2 / ❑Owner Given Reason forDrnml DL Condition f,&"I ?Jolg4MK*A;W 6proval ? � . kr1 T�U- AtrO /s��l+ J �'t� pm,quleua aq lsrnu sa+auianrtio., 8)egws IN n L asWrild Rq papleoad uelci 7ua.ua9nuew tad se 1'�1✓w. "tom B__L ��V! s'�S/_`,,t �L(q/yl �3S3q IsnUi Ilan lesiacis�p - pue AIPJ wanll;a'huat)Ildas,t / _ 'b3Nh10 W31SAS !H �/`Ytluaoy y Ap �/ JJ Attach to complete plans for thesis and suntan tyes otheCounonlyanpaperso sthav ve.11is 6sosn,/ 1)No pt,,. { e�f (rm So;/-5 nb' 4 ltI1S/ So GI`L / % d /�7< /its; 0 60Mr 063U t (R. 1C IV�0.Nt +'cSS I CvLaLtt (�% � Q / [ \T)1 (See 12o%e ol, Scfl J g rvt System PLOT PLAN PROJECT Kernon Bast ADDRESS 948 LaBarge Road Hudson Wi 54016 NW 1/4 SE 1/4S 10 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX SYSTEM ELEVATION 93.0/92.9 5.2' below grade 12/1/21 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 .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P.Top of 3/4" nvc pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL •H.R.P. same as benchmark Vent >6» Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 6.6ftA2/pair of end caps 4' Long 12 Grade at System Elevation 34" B-1 2-3' X 90' cells with >3' spacing 1.5% Slope 93' Property Line m Vents 151' 1 41' d 20' ST 20' Pro 4 Bedroom House B.M.* Property Line Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 11 /28/21 Owner:Kernon Bast Location: NW1/4 SE1/4 S 10 T29 N,R 19W 1055 Hopkins Dr. Hudson Used: In -ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintance an ontigency Plan 7. Filter Cros ion r#226900 System PLOT PLAN PROJECT Kennon Bast ADDRESS 948 LaBarge Road Hudson Wi 54016 NW 1/4 SE 1/4S 10 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX SYSTEM ELEVATION 93.0/92.9 5.2' below grade 12/1/21 4 DATE BEDROOM - 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 BENCITMARK V.R.P. Top of 3/4" pvc pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark Vent >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 4' Long 17,E 6.6ft^2/pair of end caps Grade at System Elevation 34" B-1 2-3' X 90' cells with >3' spacing 1.5% Slope 93' Property Line IC 64 Vents 15V 10' 741' d 20' 20' B.M.* 20' Pro 4 Bedroom House 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 ft2 of Area per Chamber 6.6ft^2 pair of end plates ./ Typical Installation Vent i Grade 4" A/30/34 Septic Tank 5' Long 1 5' Grade at System Elevation Spacing 5' 5' To be >1' above grade Finish grade elevation 98.2 Went 1" at System Elevation 2-3' X 90' Cells Same on other end Observation tube/Vent At end of cell A B 22 chambers per cell System elevations: A 93.0' POWTS OWNER'S MANUAL. & MANAGEMENT PLAN Page _of 'FILE INFORMATION Owner Permit # (DESIGN PARAMETERS Number of Bedrooms _ ❑ NA Number of Public Facility Units -jd NA j Estimated flow (average) lI Design flow (peak), (Estimated : 1.5)_Callda Soil Application Rate % al/da /ftZ Standard Influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODE) s220 mg/L ❑ NA Total Suspended Solids (TSS) <150 mg/L 'Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) Total Suspended Solids (TSS) s30 mg/L 530 mg/L A Fecal Coliform (geometric mean) S104 cfu/100m1 :Maximum Effluent Particle Size in dia. ❑ NA Other NA 'Values typical for domestic wastewater and septic tank effluent. IAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity / aS� al ❑ NA Septic Tank Manufacturer ❑ NA. Effluent Filter Manufacturer ❑ 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 ❑ Peat Filter CJ Mechanical Aeration ❑ Wetland i Disinfection ❑ Other. Dispersal Cell(s) LI NA Ground (gravity) ❑ In -Ground (pressurized) ❑ At -Grade ❑ Mound ❑ Drip -Line ❑ Other: Other. ❑ NA Other: El NA Other. ❑ NIA Service Event Service Frequency 'Inspect condition of tank(s) _ At least once every: nths) —��emoa(Maximum 3 years) [IIVA r(s) iPump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume ❑ NA 1 inspect dispersal cells p p O At least once eve every: -� month(s) ear(s) (Maximum 3 years) ❑ -1 NA _ (Clean effluent filter At least once every: � � onth(s) lr �year(s) NA_ — nspect pump, pump controls & alarm _ — At least once ,very: ❑ month(s) ❑ year(s) NA _ _ I -lush laterals and pressure test At least once every: ❑ month(s) El years) _ NA (Diner At least once every: ❑ month(s) ❑ year(s) N� Inner: _ — --- — N'n. , MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individuni carrying one of the following licenses or certifications: Later IPlumber, Master Plumber Restricted Sewer; POWTS Inspector, POVVTS Maintainer, Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardwaoe, 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 cells) shall be visually inspected to check the effluent levels in the observation piper, .rnd to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicai.; a failing conditlo,l and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-thl;d (') or more of the tank volume, the entire contends of he tank shall be removed by a Septage Servicing Operainr and disposed of In accordance with chapter NR 113, Wisconsin 5dministrative Code. !All other services, including but not limited to the serwang of efrlueot filtr;rs, rrcnanical or pressurized components, pretreatment units, land any servicing at intervals of <12 months, shall be r rforn-�sd by a ^.enifed POtrJl-S Maintainer. A service report shall be provided to the local regulatory authcnt;• ,vithB! C day or 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 thr(t 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 resuft 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 with',n 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 lee of the POW r$ 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 produclls; 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 properly and safety abandoned in compliance with chapter Comm a3.33, Wisconsin 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 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 srpil, 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 repla ent system; table 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 requhled setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the noed for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rule:{ in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Baring advances In POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The she 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 soil 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 MOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT, RESCUE O� A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE ADDITIONAL POWTS INSTALLER Name LS,4, Ph" % O`- / `j—cam/ , —£ASl POWM MAINTAINER Name Aec.✓ Phone I�j/j — Z? S SEPTAGE SERVICING OPERATOR (BUMPER) LOCAL REGULATORY AUTHORITY FNe This document urea drafted in compllance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.64(1), (2) & (3), Wsoonsin Administrative Code. 2014C.,048A 1 J921 SECTION A -A SaWOH a9'd::)OW '3NI'vlosgNNIW ? :803 3:)N3ais3a a N Q 1F Iryr _ _ Z 's �LLLL O m m j g Z W W0 Z ME DO -L, it Io� m eo �g 3C d u Z D N � yy N zz s3 wago i � pz5 I P 115g ZZ m m mo ao :o a'E�4 a; as7��s$ O eT P 11 P Ovi bx crt ------------ I I _ zn �, ____ i 1 r m 1 I I II I m K�U L ----------------- I I UNFINISHED I I y - UNFINISHED In I I / J\ 1f a as IILL ��yy nIN I I _ yid rrc ' F. ., v-e Bo L nm se s m le I v a n I I 1 ¢ U wc" x-5N Lrl r k �- \ II I pie I - rc ve I xe-u'cc {� II1 uPJ--�•^�•'m 1 vs -a"eLa �- I� P cry a II I I e rw oat UNFINISHED 1 L- ------------- --------------- ____________ LrcE MEG" w �x c aLl ^ 11 1 ma rya '�- 1 b'I ____________ UNFINISHED O p I i L I 1 : LmcE I p m 1 R�Dou S i OI 1 UNEXCAVATED a I II I I 1 I ve ae ue I I I I UNEXCAVATED I I I I STEEL 9iRPP91N CONC I 1 I 1 I N91OE JL wdLL iOP WINO 9NEPR _ 101' Itl e' i e -� biEFL BiRdob IN raNc 1 I I aN'vBICE ro we„ 1 b 1 L raR wlN� BNEeR 1 1 BASEMENT PLAN 1/4 = I -0 e' POURED FOUNDATION W/ 2 PLATE 3 9 © Planco MN, Inc. 2021 •21-091 snA Y> i • M 4 _O x r u 'D JO b u F°ati I q" iy �6366Rll 3, W� VO 6nl-i 1:�3 lnl .Ll 6-L a p 4 _ ,[ z p s •s n s �" j � O ��d � R7 D u 'x Pippl o a a N Q� /y % O m LL p] 00 a QGI v°o 9 9 III II 1LLL $� �_ y za aaE zu II II „� ¢ - c 4�' IIP m I�� nlll a AIII II^ ✓L_ 1f a34a9 6 6a3Gla� III 0♦ D[I DES — Dt .Vf 9E q n p cc�a�u�am.fii C ° s I @ a u I I Itl `Cl o I I u Itl a I q nl;s R g 9 qp$ I I YI Itl qJ r i E--63E 6arau I I $ b = I I� la - I� L 9 N Li C Z 9 zE 9n p V a O ------------�--, I I I I I r a o >I w �I ¢I I I I gll C ^^ U a3cw'a. 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