Loading...
HomeMy WebLinkAbout030-2106-70-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No (ATTACH TO PERMIT) 592213 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village Township Parcel Tax No: Mark Weckwerth TOWN OF SAINT JO EPH 030-2106-70-000 CST BM Elev: Insp. BM Elev: BM Des / Tectionrrown/Range/Map No: {e d~ 06.29.19.891 TANK INFORMATION EL VATION DATA TYPE MANUFACTURER •J~ CAPACITY STATION BS HI FS ELEV. Septic Bench ark Ex: y~~ We /Old , ,`o-, l • /ot• 99. Dosing Alt. BM jr4o a (A ,oorztwN• ~a ~a~ Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO 11 WELL BLDG. ent t Air Intake ROAD 7. 45 3 Y(J Tn 7 rj Septic /600 7 6 I .541111" Jr d a(~ 3.7Z ~g i ~t Header/Man. /6,6 J 7 Z7 1, Aeration Dist. Pipe / it 2 , I, /0.4Z Holding Bot. System 3 Q, Final Grade PUMP/SIPHON INFORMATION $ . a 7. z n4, Manufacturer Demand St Cover q Aj- GPM '646 7-321(o Model Number TDH L Friction Loss System Head TDH Ft Forcemain Leng Dist. to Well ti SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of ~rrenc421_ PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 9V L/ e-'` `A SETBACK SYSTEM TO P/L BLDG / WELL LAKE/STREAM LEACHING Manufacturer / /J INFORMATION CHAMBER OR Type Of System: , G a A a wob ~77 UNIT Model Number: tG / ,a v\,S DISTRIBUTION SYSTEM #I L G 9 k Header/Man ifold Distribution x Hole Size x Hole Sacing !i~*# ntake Pipe(s) p~ 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 Mu ched Bed/Trench Center `2 Bed/Trench Edges ` Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 357 117TH AVE ~ 4A,, G I1 1.) Alt BM Description 149> CA V 2.) Bldg sewer length ;No t- amount of cover = c/ Plan revision Required? ❑ Yes Use other side for additional information. J ' Date Insepctor's nature Cert. No. SBD-6710 (R.3/97) __11M& OW AV& IF-" It Or" Pik Safety and Buildings Division J A C /11O.4~ 0 4 2. 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) JAN P Madison, WI 5370-71 ` ST. CROIX COUNTY Q IWON~t LAITY DEVELOPME 5 ! ZZ Sanitary Permit Application 'ansac`i°°~ Number In accordance with SPS 38321(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit A- 's required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal Wormation you provide may be used for secondary ses in accordance with the Privacy Law, s. 15.04(I)tm , Stats, 7 117, ~ jk a e L Application Information - Please Print All Information Property Owner's Name Parcel # 42 Irl" Zoe,' 030 o2/O6- 70-000 Property Owner's Mailing Address Property Location .s-T a 0'e cal; . . ►~l Govt. Lot City, State Zip Code / Phone Number Section < 7 tt ~.j G 6 T N; R 0/ circ1RcI H. Type of Building (check all that apply) Lot # ® 1 or 2 Family Dwelling - Number of Bedroo ( Subdivision Name ❑ Public/Commercial -Describe Use Block # ell /P! J? e ❑ City of ❑ S Owned - Describe Use CSM Number ❑ Village of 1 ® Town of J Ci i~it Y- d ~JPP~j . Type of Permit: (Check only ne bog online A. /Complete line B if applicable) AeQ - A- ❑ New System K Replacement System ❑ Treatment/Holding g Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal' ❑ Permit Revision Changeof Plumber 11 Permit Transfer to New List Previous Permit Number and Date Issued ❑ Before Expiration Owner 3/~9 Y6 1999 IV. Type of POWTS S stem/Com onent/Device: Check all that apply) Ql Non-Pressurized ht Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ ~retreatrncnt Device (explain) 0 J V. Dis ersaUTrea ent Area Information: 15 PAC-1-1 ow III Des' Flow (gpd) Design Soil Application R7o% t) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation OO ~ 0.s 1200 2 /boa Z %O. G VI. Tank Info Capacity Total # of Manufacturer , Gallons Gallons Units ' v 4) t New Tanks Existing Tanks . ~-_2 w 0 y a u ' yw, ~~a lrl®~ ~ U in i- t Septic or Holding Tank SYa~ • / DQ s ~S Z /'I /r IGCC li~ir ~it~r /fsi Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum Signature MP/MPRS Number Business Phone Number CA G Z3/3/`/ 7iS-Zy7-~zo3 Plumber's Address (Street, City, State, Zip Code) 3 ?,f - / 9Z v e Sore t'~rcr w~' _~'Yozr VIII. Coun epartment Use Only __-r pproved ap Permi~Feeate u ~l L Issuing r iven Reason for Denial ~ l~ 1041 DL Condi easgns for.Disapproval 1. ` rk uei ur, iIfter t5nd uispernui cell must all be -v-+_ics?s ! r, a' it~r e5 as pen management plan pio iideri by plumber, 2. AN rt~*talrer:tents mustApe r: aint , it e,i as per apFbcabla axk / wrd;Pwriom. Attach to complete plans for the system and submit to the County only on paper not less than g 1/2x 11 inches in size SBD-6398 (R- 11/11) O=% Wt_C k IvCll- 1 X41 Page 3 of 3 a/k Brian Parnell Andress r 7- / 7 a c CST 231314 Bate 12 - l & (,c/a ~k O u 1' 9• ~8 ® Benchmark 1 ~0 9 O -P Benchmark 2 Soil Boring r_ Suitable Area 1" _ 407 Scale- I f ° I f f € f f 14~1 1 # ~ 1 i ( ttt e € ~ ~ ~ f E j E ! E 1 i r t r LGI ' t I 1 #i f = _ ~ t r f a : t 77 f _ i E { : J 1-4 E r ! 1 A t aii o~ E I F-, a 14- Y a CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE P//AGE Project Name: Act,.,- ~ e ch C~ C/ 4 Owner's Name: Q~ fi✓ w eC,<C 0 elf e, owners Address: Legal Description: Township: SY/. CA /"I r J oJ~ A County: /-d Subdivision Name:/ 17 )C VOPC Lot Number. Parcel ID Number Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing Page 4 System Cross-Section Page 5 Filter Specs Page 6 Maintenance & Management Plan Page 7 Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Designer/Plumber. ~ ~2 P `l Z 3 ~3l Y License Number Date: Phone Number ~~f" Z 7-3ZD3 Signature 0 - Designed pursuant to the in-Ground Soil Absorption Component Manual for POWrS Version 20 SBD-10705-P (N.01101). Page 1 OWNE Page 3 of 3 Name, %Wee- LC. Iyel 1~Lt Brian Parnell Address / / 7 Q -e CST 231314 llate f ~ A Benchmark 1 ro 0 Gt/a A O A Benchmark 2 Soil Boring i__i Suitable Area / 1" = 40' Scale ~6 m f ~2` 7 E I , t i ! li ! N 4 , 1 IT t ¢ i t C t t 71 i ! (I - qI I T- F 8 a - ~-a C74 Do ~ ~ X f 12 fo /L 6 f r 12 zoo z = ~v ~~D SOIL ABSORPTION SYSTEM DETAIL I GRAVELLESS LEACHING UNIT Dage~_of Project Name- //l IQ/ 6" eck lam' e~~-4 No. of Cells q Per Cell 3 ft Cell Width 3 6 • `total No of 20-; tt Cell Length /ys'o sq ft EISA Per Cell 3 it Cell Spacing sq it Total EISA I Manufacturer Model Laying Length EISA Rating I Infiltrator EZ12o3H-5ft SO 25.0 i EZ12MH-10ft 10.0' 50.0 Gravelless Leaching Unit Manufacturer. 7'0 ~ Gravelless Leaching Unit Model: 2. /Z 03 Typical Cross Section Finished Grade ft Observation Pipe with approved cap or vent I Soil Backfill 2~ to •'r::; •:_%r-.■ Geotextile Fabric q0, 6 infiltrative surface 1 1 72 in S61t Limiting Factor ~curio ~0 in Slotted and Anchored Ventf Observation Pipe with Cap Q.A............--- ~G- Piurnber/Deqiq tier Signature.: INSTALLATION INSTRUCTIONS I; Is zwxr PL-525/PL-625 FILTER INSTALLATION INSTRUCTIONS Centerilter YAM Wcrft r- Ste is Step Step 3: (A) Locate the outlet of the septic tank (A) Before installation, place the (A) Glue the fitter housing on the (B) Remove tank cover and pump tank filter housing on to the outlet pipe. outlet pipe- ff necessary. (B) Mahe sure that the housing (B) Insert the filter cartridge in the is positioned so the filter can be housing, making sure the fitter removed from tfie tank for cartridge Is property aligned and maintenance and service- completely inserted in the housing. MAINTENANCE INSTRUCTIONS Step 9: Step 2: Step 3: Locate the outlet of the septic tank (A) Remove tank cover and pump (A) Insert the filter cartridge back it a If necessary. into the the housing making sure • , (B) Pull the fitter out of the housing. the filter is properly aligned (C) Hose off the tier overthe septic tark and completely inserted. USE Ri1BBER GLOVES Make sure all solids fall back into the (8) Replace septic tank cover WNEAi CEARt1lU~G t=IL~ER septic tank. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page o. FILE INFORMATION SYSTEM SPECIFICKnONS Owner / ~l lit K ~iC/ Septic Tank ~G Capacity _5-X6 r. /O O 2• (gal ❑ NA Permit Septic Tank manufacturer t' ~ I to~`r1'lldluo~l~,NA DESIGN PARAMETERS Effluert Rteir Manufacturer o /y l o c 0 NA Number of Bedrooms 13 NA Effluent Fitter Mode( SZ .1' 0 NA Number of Public Facility Unit ❑ NA Pump Tank Capacity al ❑ PIA Estimated flow (average) t1C) d d Pump Tank Manufacturer ❑ NA Design flow (peak). (Estimated x 1.51 6 4 CJ Pump Manufacturer O NA Sort Application Rate O , galldM2 Punch Model ❑ NA Standard influent/Effluent Quality Monthly average` Pion tinent Unit UNA Fats. Oil & Grease (FOG) 530 mg/L. 13 Sand/Gravel Ft7tw 0 Peat Filter Biochemical Oxygen Demand (BOD,) 5220 mg/L 13. NA _ ❑ Mechanics Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection. Ci Other. Pretreated Effluent Quality Monthly average Dispersal Celt(s). NA Biochemical Oxygen Demand (BODJ 530 mg/L 13 in-~ (gravity) a In-Ground (pressur¢ed) Total Suspended Solids (TSS). 530 mg/L E3 NA 0 At-Grade ❑ Mound Fecal Coliform (geometric mean) 510' cfu/100ml 13 Drip-tine 0 Otter: Maximum Effluent Particle Size Ye in dia. Ci NA Other: 0 NA Other_ ❑ NA Other: O NA Other typical for dwostic wastewater and septic tank efflu a NA MAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tank(s) At least once every: 0 mon j(s) (IIIIa 3 years) ❑ NA Pump out concerts of tank(s) When combined sktdge~and scaurm equals one-third (Y of tank volume 0 NA Inspect dispersal cell(s) At least once every: 0 month(s) (Mahornum 3 years) 0 NA s) Clean. effluent fitter At least once every: 3 0 month(s) ❑ NA .C3 year(s) nspect pump, pump controls & alarm At least once every: ❑ month(s) DNA ❑ year(s) Us* Faterais and pressure test At least once.every: 0 month(s) NA ❑ year(s) At least once every: 0 month{s} 13 NA ❑ year(s) Ctner. ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cogs shek be made by an fiviividuat carrying one of the following lrcernses or certifications: Mash Plumber Mash Plumber Resbicted Sewer; POWTS inspector; POWTS 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 bads 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 pondog 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 or more of the tank volume, the entire contents of the tank shaft be removed by a SeptaW Servldmg Operator and disposed of in accordance witty chapter NR 113, Wisconsin Administrative Code. All other services, kxiuding but not lin>;ted to the serving of effluent famrs, rnednanical or pt nzed components, pretreatment units, and any servicing at intervals of 512 months, shag be performed by a certified POWTS Maw. A service report shall be. provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPEu►noN Page of For new constriction, prior to use of the POWTS check tleauTwit tank(s) for the presence of ping products or other chemicals - that may impede the treatment process and/or damage the dispersal ren(s). If high 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 infdtradw 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 oil(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed a power to the effluent pump or contact a Plumber or POWTS Maintakme r to assist manually operating a Servicing Operator prior to restoring 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 sot absorption area. Reduction or elimination of the fallowing from the wastewater stream may improve the peformance and prolong the life of the POWTS: antibiotics, baby wipes; cigarette butts; condoms; cotton swabs; degreasers: dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable pee*rgs; gasoline ; grease: herbicides; meat scraps; medications; oil; painting products; Pests: sanitary napkums; tarnpo ms; and water softww 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 property and safely abandoned in compliance with grapier Comm 83.33, Wisimnsam Ada nishvive Code: • An piping to tanks and pits shall be disconnected and the abandoned pips 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 the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS farts and cannot be repaired the following measures have been, or must be taken. to provide a code compliant replacement system: ❑ A suitable replacement area has boom evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from.exisupg and proposed structure, lot lines and wells. Fare to protect the replacement area wry result in the need for a now soft and site evaluation to establish. a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replaosinant area. Is not available due to setback and/or sod limitations. Barring advances in POWTS technology a holding tank may be installed as a test 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 am. If-no replacement wee is available a holding tank may be installed as a last resort to replace the farted POWTS. ❑ Mound and at-grade soil absorption system may be reconstructed in place hollowing removal of the biomat at the infiltrative surface. Saul of such systems must comply with the rules In effect at that time. < <WARNING> > SEPTIC, PUMP AM OTHER TREATMENT TANKS MAY CONTApN LETHAL GASSES AND/OR MtSUFFICiBIT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CUMUSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON R tom THE ill fERIOR OF A TANK MAY BE D W-RCULT OR IMPOSSIBLE ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAWAWF.R Name of I~GR Piz m e /I Name - 7/s- 2Y7-,~Zo~ SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name G Phone s~ .~t(~~ QPhonepp~.J~ This docur nest was dra:€sw =Ira lane with chapter Corm 53.22(2)tb)(1)(d)&(f) and 83.54(11, & (3), Wisconsin Adrm**aadw Code. Page of START UP AND OPERATION For new construction, prior to use of the POWCS check vestment tank(s). for the presence of painting products or Other chemicals that may impede the treatment process and/or damage the dispersal casts). 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 Ivghwater levels. When power is restored the excess wastewater indli be. discharged to the dispersal Celts) in one large dose, overloading the. cows) and may result in the backup or surface d-charge of effluent To avoid this situation have the contents of the pump tank removed by a Sgatage Servicing Operator prior to restoring power to the effluent pump or contact a Plu riber or POWTS Maantasner 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 drspessai cetts, Do not drive or park over, or otherwise- disturb or compacts the area within 15 feet down slope of any mound or at-grade soil abSarptr 'on area Reduction or elimination of the following from the wastewater stream, nmv improve the performance and prolong the life of the PO WTS: antibiotics; baby wipes; cigarette butts; condoms; notion swabs; degreasers; dental floss: diapers; disirrfectarrts; :fat; foundation -drmn ( ) water; fruit and vegetable- sump pump) peelings; gasolene: grease: herbicides; meat scraps; medications- oil; Pmvbg products: pesticides; sanitary napkins; tampons; and water softener brine. %BANDONMENT ~ v: ~ When he PO VAjTS ~5m"ro 6TiW i'ir i3 l~aFeT)CIY taken out of service the following steps shall be taken to insure.that the system is Properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Adrniriiestrative Code: • AU piping totanks and pits stag 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 the void space filled with soil, gravel or another inert solid material. MNTMENCY PLAN If the POWTS falls and cannot be repaired the following meet have been, or .must be iaken, to provide a code compliant replacement system; Q A suitable replacement area has been evaluated and may be utilized for the location of a replacement soft absorption system. The replacement area should be protected from dmtvibance and compaction and should not be infringed upon by required. setbacks from-existing-and proposed structure,.lot Ines and wells. Favure lo, protect the replacement area will result in. the need for anew sot and site evaluation to establish- a suitable -replacement area. Replacement systems trust comply with the-rules in effect at that time- 13 A suitable. replacement are is not available due to setbaclk and/or sod firnitatiorm -seeming advances in. POWTS technology a.hokrmg tank may be installed as a last resort to replace the failed POWTS. E3 The site has not been evaluated. to "identify a suitable repiacemenfarea. Upon failure of the POWTS a soil and site _ evaluation must be performed to tooate-a suitable replacement are& tYno replacement area is available aholding tank may be installed as a last resort to replace the failed POWTS. 17 Mound and at-grade son absorKm systems may- be reconstructed in place following removal -of the biomat at the infiltrative surface. of such systems must comp V with the rules In effect at that tirm. <WARNING> > SEPTIC, PUMP AND OTHER THE WMENT TANKS -MAY CONTAIN LETHAL GASSES ANDIOR iNS[!Ft-1C19~E i' OXYGEN. DO NOT - ENTER A SEPTIC. PUMP OR OTHER TREATMENT TANK UNDER ANY COMMSTANCES. DEATH MAY RESULT. RESCUE OF A N FROM THE wrmw OF A TANK MAY 8E DMCULT•OR-IMPOWME UXXTIONAL CONOU13 5 'OWI'S INSTALLER POWrS WARVtTAVIER Name a_i ?0"4 a it f~ E Name Phone 7/S Z. Y7 3 ar Phan iEPTAGE SERVICK#16 OPERATOR (PUMPER) LOCAL REGULATORY AUTHOR)TY Name _ Name f C Phone lfione - (e 44446 'his doc unumt was drafta= fiance with chaff Carron 83=20)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) -5-7, 11-7 170-.4 located at: I/4, 5- 1/4, Section , Town q N, Range W, Town of r oSjoA , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service 42 - /0 Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: ~~O gallons minutes Tank Capacity: d © CIE& Construction: Prefab Concrete Steel Other Manufacturer (if known): 9FI-ey-wei 7-.e "-^840' Age of Tank (if known): 1 f l 9' Permit number (if known)-- I (Licensed Plumber Signature) (Print Name) 0~~ ~3131~ (Title) (License Number) MP/MPRS / z (Date) Form to be completed by licensed plumber (Dept of Commerce Chapter 5 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 9/2008