HomeMy WebLinkAbout040-1291-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division _
INSPECTION REPORT Sanitary Permit No:
561053
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)J.
Permit Holder's Name: City Village X Township Parcel Tax No
Peterson, Brian D. &.L nn I Troy, Town of 040-1291-50-000
CST BM Elev: Insp.BM E ev: BM Description: / Sectionlrown/Range/Map No
' I6 r G 24.28.20.1662
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
i
Septic Benchmark
/Z6 �9Z. 7 2.. ggs.
Fe I I a l'C.. �Zs Alt. BM 3,
Aeration Bldg.Sewer
Holding St/Ht Inlet
•$ ,
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO W P/L WE BLDG. ent o Air Intake ROAD Dt Inlet
Septic GIs Dt Bottom `-
Dosing Header/Man.
`-
Aeratio Dist. Pipe
Holding dot.System
9.3 Fs X3 . 7
PUMP/SIPHON INFORMATION Final Grade
�/ � ��rss• 3
Manufacturer GP nand St Cover/
el Number
H Lift Friction Loss System H DH Ft
Forcemain Dist.to Well
SOIL ABSORPTION 9YSTEM /Z-jj S'a'd �zz.
BEDITRENCH Width Lengta No.Of Trenches ' -` PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 7a Z
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacture
INFORMATION CHAMBER OR ff
Type Of System: / ^ -V w /� UNIT
C/.O_ .�.aM. `�'rb�I►.�J[�l+ �' + � SZ �✓ Model�nber: t,
DISTRIBUTION SYSTEM �� �. / �- 4 " 'S
Header/Manifold Distribution ` x Hole Size x Hole Spacing Vent Al r Intake
4+ Pipe(s)\ _\
Length Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Dept f xx Seeded/Sodded xx Mulched
Bed/Trench Center Q� Bed/Trench Edges Topsoil Yes 77, No -' Yes No
COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: /
Location: 323 Lindsay Rd.Hu son,WI/5�4016(SE 1/4 SE 1/4 24 T28N R20W) Troy Village 5th Addition Lot 134 Parcel No: 24.28.20.1662
1.)Alt BM Description= '�°'�"�' G 4-• L � a✓�.
� JJ
2.)Bldg sewer length rte`
-amount of cover= r
Plan revision Required? ❑ Yes ❑ No -
Use other side for additional information.
�10(R.3/97)
Date Insep is ature - Cert No
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oeaNl.l~ov Safety and Buildings Division County -t-
201 W. Washington Ave„ P.O. Box 7162
EC4 t ✓ ~~Q'
9~ Madison, WI 53707-7162 Sanitary Pe umber (to be fitted in by Co.)
l /9-5-3
Sanitary Permit Application State Transaction'tumber
t
in accordance with s. Comm. 93.21(2), Wis. Adm. Code, subinissiori Athi f.... to the oveinme ital
unit is required prior to obtaining a sanitary permit. Note: forms fors WTS are Project Address if different than mailing address)
submitted to the Department of Commerce. Personal i you provide may for ondary '7
in accordance with the Privacy Law s. 15. ts. .~02 ~2NlJS.'OY A0.4-IN -
I. AM&SLfig lot -1"0,/
gragift t ati
Property Owner's Name n Parcel #
Property Owner's Mailing AdUms GEC\1~~. Property Lowhin
GOt4: Lot
city, state Zip Code Phone Number r_ V., -re_ % Section
(circle one
"'t'.;l
vt+~ _
29 T A b N, R 9Q- E
it. Type of Be' ing (check all that apply) Lot #
1 or 2 Family Dwelling Number of 3 Subdivision Name
Block #
Q PublichCommercial- Describe Use
0 City of
a;x,~ P trx,ti
❑ State Owned - Describe Use CSM Number ❑ Village of
Town of Tit0.Y
lli. T fleck enly ane bmr an line A. Campletctine$if appiicaW
X New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ other Modification to Existing system (explain)
❑ Permit Transfer to New List Previous Permit Number and Date Issued
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber
Before Expiration ` OCheek all that
NwPrmuriwd In-Ground in-Ground 11 At-Grade ❑ Mound > 24 in. of suitable soil 0 Mound < 24 in. of suitable soil
er Dispersal Crgnponent (explain) PIA &0 - ❑ Pretreatment De i (explain
V. DbpersaVIrrutnient Area Information,
Design Flow (gpd) Design Soil Application RaWgpdsf) Dispersal Area Required (sf)✓ Dispersal Area Proposed (sf) System Elevation
G s X86.
t/ A. P" -1i,'&
VI. Tank Info Capacity in Total' # of Manufacturer
Gallons Gallons Units
Now Tanks Existing Tanks
wV rn~ A a, a
Septic or Hdl ft Tank
Dosing Chamber
VII. Responsibility Statement- 7, the understmed, assume r esponsibiuty for installation of the POWTS sbawn on the attached plans.
Plumber's-Ntune (Print)- Plumber's Si MP/MPRS Number Business Phone Number
Plumbe Address (Street, City, State, Zip Code)
/V i
"VTn can 11Se rtment Use ow-
I ing A r
( 1 proved 11 Disapproved Permit Fee Date Issued 10.
p
owner Gwen Reason for Denial
IX vaUReasoos for Disapproval ~ / Z; Z u~
p ~ tan , effluent filter and 093 ~J
dispersal cell must be service / d A
as per management plan provided by plumber. j ~~PjyytUG~ C~ Gam`
2. All setback requirements must be maintained Y
as per applicable code/or di
_q IAJ
Aihch te-ceawleb! pWwfar the sysiam And sabak the C~mly only on paW "ma-8rn x N ieehetirraine
SBD-6398 (R. 02/09) Valid thru 02/11
CONVENTIONAL POWTS DESIGN
INDEX AND TITLE SHEET
Project Name: Brian and Lynne Peterson 4 Bedroom Conventional Powts
Owners Name: Brian and Lynne Peterson
Owners Address: 934 Carter Circle, Hudson, WI 54016
Site Address: 323 Lindsay Road, Hudson, WI 54016
Project Location: Town of Troy, St. Croix Co., WI
Subdivision: Lot 134 Troy Village Fifth Addition
Legal Description: SE 1/4 of the SE 1/4, Sec 24, T28N R20N
Parcel ID Number: 040129150000
Plan Transaction Number:
Index and Title Sheet Page 1
Site Plan Page 2
Dispersal Cell Sizing Calculations Page 3
System Cross Section Page 4
System Management Plan Page 5
Filter Specifications Page 6
Treatment &/or Filter Tank Cross Section Page 7
Parcel Map Page 8
Septic Tank Maintenance Agreement Page 9
Warranty Deed Page 10
Attachments:
Designer/Plumber: Gary Zama. Dept. of Comm. Credential #222373
Signature: gmz~ Phone No: (715) 386-2850
Date: o
Page 1 of 10
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DISPERSAL CELL SIZING CALCULATIONS
1. (4 bedrooms) (100 gallons estimated flow)(1.5 design factor) = 600 Gnd design flow
2. Infiltrative capacity of native soil = 0.7 gpd/sq_ft.
3. Absorption area required: 857.15 %ft.
4. Absorption area as proposed- 857.40 NA (42 chambers total)
Infiltrator "Quick 4"=20.00 sq.ft. EISA per chamber, Infiltrator "Quick 4" end cap (pair) = 5.80 sq.ft, EISA
857.40 sq.ft = (2 pair endcaps)(5.80) = 840 sq.ft.
840.00 sq.ft/20.00 = 42 chambers required
Number of trenches: 3 A)14 chambers per trench
Trench Width: 2.83'
Trench Length: 58.67'
Trench Spacing: 7.00' on center
Total system w/4' trench spacing 17.00' x 59.00'
Pg. 3 of 10
Soil Absorption System Cross Section
A. = "A' Yo
A=~Yi 4'
a=9,k,00
C = :P9G so ft /,j_ = 00
C 9a, 6o n
Final Grade
4' Schedule 40 sv
PVC Vent Pipe ,Q M oo
With Vent Cap
A, = 6f~ ho
Leaching p`'
Chamber SysEleva',;` ✓
ft
ft Y,00 ft
Soil Absorption 3vste P n w
ft
~`ooft Leaching Trench 1
Chambers
4" Dia
Trench 2 Header
Vent Or Observation Pipe
. Trench 3
Leaching Chamber Soecificatbons
Manufacturer And Model
l1~L~2oiott
EISA Rating .0~0 o sq ft per chamber Soil Application Rate a" 7 gpd/sq ft
-,~,-2v, n gpd Design Flow.+ Soil
D. Application Rate } EISA = Chambers !
3 rows of chambers each.
Page of fZ2
Convtod6 al ►dt 5ystm MantgetBent Plan
Pursuant to Comm 83.54, Wis. Adm. Code
Gemral
The conventional septic system shall be operated in accordance with Comm 82=84 Wis. Adm. Code, and shall be
maintained in accordance with component manual SBD-10705-P (N.0I/01). All local =&or state rules pertaining to
system maintenance and maintenance reporting shall be compiled with.
Septic Tams
Septic tank servicing mechanics comply with Comm. 83.54(l)(e). Septic tank to be located within ISO' of service
pad, with bottom of tank to be < IS' below service pad elevation. The operating condition of the septic tank shall be
assessed at least once every two years by inspection: The septic tank contents shall be removed when the sludge and
scum in the tame exceed 113 the liquid volume of the tank. The contents of the septic tank shall be disposed of w
accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If
the contents of the tank are not removed at the time of assessment, maintenance personnel shall advise the owner of
when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The operating
condition of the outlet filter shall be assessed every silt months for the first two years of system operation and once
every two years or as needed after that. The outlet filter shall be cleaned as necessary to ensure proper operation.
The fiber cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off
the filter when leaved from its enclosm. If the filter is equipped with ah alarm, die filter shall be serviced if the
alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water tightness and
soundness. Access openings used for service and assessnumt shall be sealed water tight upon the completion of
service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings
greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or
unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present
that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when
the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance
septic tank performance is generally not required. If such products are used they shall be approved for septic tank
use by the Department of Commerce, Safety and Buildings Division.
Soil Absorption Cell
Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system
should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic
(other than for vegetative maintenance) over the system is not recommended. Soil compaction may hinder aeration
of the infiltrative surface within the system and will promote frost penetration doing cold weather months. Cold
weather installations (October-February) dictate that the system be heavily mulched for frost protection.
Influent quality into the system may not exceed 220mg/L BODE, ISO MG/L TSS, and 30 mg/L FOG. Influent flow
may not exceed maximum design flow specified in the permit for the installation.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Pon"g levels shall be reported to
the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent
monitoring.
Contin mcv Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to
keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by
installing a new soil absorption cell to bring the system into proper operating condition.
Questions on the operation or maintenance of the system should be directed to installing plumber, Gary Zappa at
(715) 386-2850, or the St. Croix County Zoning Department.
Sof /o
Page
EFFLUENT
FILTERS Paw% L~DK
"The PL-525 has 525 linear feet of 1/16"
slots. It has an automatic shut off ball. When
Alarm Accap,s PVC
the filter is removed for cleaning, the ball will •«a,alhill,y I<-- <„<n
float up and temporarily shut off the system
so the effluent won't leave the tank. No other
S25 Gnaw (eat
filter on the market can make that claim!" 011118
Ill•ra llnn sluts Ra,eO lu. o.e.
lo.ooo cvo
Acwpn 8 6"
5CH0 a0 Pipa ~
J
t ~ Gas A<Ile•toAutu-ic shut on
- israne.eo
"The PL-122 has over 122 linear feet of 1/16"
slots. Rated for 1500 gallons per day, and a U2 PVC
can be manifolded together with other PL- Al-
Swl,ch
122's to double or triple the GPD. It has an
122 Linaa, h
automatic shut off ball that stops flow when Filw Sl., Slch
FiO,s
the filter cartridge is removed for cleaning.
Comes complete with it's own housing, no Fill,, H. ny
gluing of tee or pipe and no extra parts to s PwnhJ as
ipa AOap,e,
buy.
I I,
G.a O<nann,
Automatic
Shu,OX
• Bail when
Fihac is
R<n a.e0
From Tnnk
Order # Model # Description List Price
PK-525 PL-525 Effluent Filter System 203 50
PK-122 PL-122 Effluent Filter System o
6-10
A 6 ~Fia
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
OMskx+ of Safety and BuNdings
in accordance with Comm 85, Wis. Adm. Code
County 3,T, caolX
Attach Complete she plan on paper not lees then 81/2 x 11 Inches In size. Plan must .
include. but not limited to: vartical and horizontal reference point (Blot), direction and psme( I.D.
percent slope, scale or dimensions, north errow, and location and distance to nearest road. 60 - Q
Please print all lnformstlon. EtW@wed by Date
Persona! Information you provide may be used for secondary purposes (Privacy Low• s. 15.04 (1) (m1). f 11110,11' 13
jo~-
Prop"Oviner property Location
W
(mo0M11K)*P-1,3-T1kL CAE Mi-DPW-.W Co A+. 114-CF- 1/4 S V{ T ,l N R 2,0
Property owner's Meiling Address Lot # Bads # Subd. Name or CSM#
11800 1N$Elqu=.tJ 5T. N. 5txt 100 134 -Ttrzoy \AI-S-414-1,V-7 r1rH -AI)0t
CRY Stale 23P Caft a Number City ❑ %Allege .Town Nearest Road
'b Lfi133!~, iN 65" 1 ('7b3 '757- Sfo sett) I -tn1n~~`'I Vom,
New Construction Use: f9 Residential / Number of bedrooms H Code derived design flow rate (ob GPD
❑ Replacement ❑ Public or commercial . Describe: .f= -p~~~~l.~ra -
Parent material _Ot xz vJfA'-= Fpt~iefrS~~ EE11appli ie N J`
General cornmants e~2. ~-`(J1JZ i S 6r-c~C
and recommendations: t^ QNV ~N't~OrlAt- "CKE~CN~
Q,, LOA01AY6 .ZaIS OCT 1.4 2002 446
ST. CROIX COUNTY Vw~ r G OFFICE
Baring # E] Boring
{aJ Pit Ground surface elev. -T3 9 ft. Depth to limiting factor ~R 2 In. Sol) licatlon Rate
Nodzon Depth Dominant Color RedoxzDescription Texture Structure Consistence Boundary Roots GPD/ff
In. Munsell Ou. Sz. Cont. Color Gr, Sz. Sh. •Eff#1 'Eff#2
} t~-5 {t 149 Z/ Z 5t 1 ,4 ~ ~b 4y- CIO s o,8
Z la `1Kg2 _ 511 rY}Qb mCY- r 0,5 f)
ID K''/~ St I r" ~I rY1 G 5 -rr D, r8
I7yi`~ D14 K t 511 .m mCfr S 4- O.Z 0."3
5 I8 'Z3 (0VR3/LI : ~ y- 1 °ntab(( rh~ttY 0.5 ('►'E~C\ !,Z
7.5 Y►23 b
ry\
25-yD .5 `1K U6 m C 0,7 t,
19/1 2- 0Nr-" 1 A\ -s S21 D,'1
~ O--
Ct 0V_\2WS -7 .AJE IO o
Boring
Pit Ground surface elev. ft. Depth to Hmftlr>fl teclor ?~Q_ in. Soil 'cation Fate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. $z. Cont. Color Gr. Sz. Sh, 'Eff#1 'E"2
1 -10 i~`IKz~I L. _La r C-j -wLrv 01
2 I0-2-'S 10\lk 4Z Y L (-Lo K m r la 5 2±1- f 0.4 (),G
3 2.5- 32 14 `i R. 316o l 1 m 4i G S 11+4 v' Z 01-5
14 .3 it ~e~' s C Imo` f a G5 Ocy► 1.2
S 4z to
1-42- I an y c s m I p, -7 1 r 2-
(NOR.u rJ5 ~ = ~ f4+i~. ~IO~I~, ~fl. j Ev) i!1 '7 u)
Effluent #1 a BOD > 30 220 rng/L and TSS >30 < 150 mg/L ' Effluent #2 G SOD, 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature CST Number
MARY J0 H u STF- ZzLi $3Z-
Addrens Date Evaluation Conducted Telephone Number
1,J9%75 (,90+~A0kr R1vE FAU.S WT 5402 2 09-oZ-oZ. "7tS y2.b--1175
t~
1 /JAG 1.- j \T -L Parcel ID 0 ~ ~ 2--t- --+~O- M- 0 Page Z of
(p' Owner
rop~erly
I I Wny 0 D poring
Ground aurfwa w'. I. g n. Depth to IlmNinp tedor - 7 -q3 in. Soo Rate
H~ Depth Dominant Color Rodox Dasa4pUon Taxltae Gr. St. a Cor►ststance Boundary Roots OPOK!
Horizon l
Qr. St. fih. •FJV1 -Eff*2
In. Munser Qu. St. Cont. Colo qfr Cb 34- m 0.5 O's
7-
658- < s't . M a mfr -
3 ie-~z s w -f o. l.z
1, G~3 D ~ 1 Z
y ?Z 2$ to CS
1,
(H a!o AN S
Boring N ❑ Boring Cr in.
❑ ❑ Pit Ground surface elev. h. Depth to tirniting actor Sol don Rote
Texture Consldanca Boundary Roots GPOM
Horizon Depth Dominant Coto Rodox Description -Structure Sh 'Etfol 'Elfe2
In. Munsell Qu. Sz. Cont. Color Ge. 51. ❑ 9 r1n4 In.
Boring M Ground t;ttrfaceelev. Depth to Ilinitinq odor ~ lion Rs4a
O Pit
Roots G Rt ,
Horizon Depth Dominant Col Redax paaaipdon 7axtun r' St. SK Cort sbtence Boundary 'E TN1 'Ettit2
In. Munseo Qu. St. Cont. Color Gr.
1
~a
l~
1.
• Ef wg ii1 a Boo, > 30: 220 mo►L and TSS 3,30 1150 mgll ' Ef luart N2 -1300,5 30 mflll. and TSS 130 m91L
r
The Departmant of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in on alternate format, please contact the department at 603-266-3151 or TTY 609-264.8777.
sso-l)f►Ix.uool
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ST C:.ROLX COUNTY
SEPTIC 'TANK NIAiYMNANCE AGR.EE;~dIEI~'T
AND
OWfiiERsS lip CERTIFICATION F0n4
OwnerfBitycr_,_
s
Mailing Address 2,.?:14
property Addrtw
(wrxication required from Planning Department tat new eonMru dM)._ _
-CitylState, r f l Parcel Idetatificration Na.ntber lr ~ ~l f ~L'~b
LYRYALDESCRIMQN,
1ss 1/., Sec. c- T -R-2 W, Tgwn Of P~ Locatiar~ /
Subdivision Lot #
CerdMW. Survey Map # Volume . Page #
Wa ranly. Dewed # 5_ ~ Volume Page #
Sa house El yes qno Lot lines identifiableyas ❑ no
USMI MA N,AN
IrVWpcr use and majaWuan accf your scpaa system eou:~ result fa its ?rea>mtu ~ fail- to handlt wastes. Proper mas.~tenance
cmw'ts of pumping out the septic tattle every three years or zooaer, if ea&d by a licensed pwnpes. What you put into the system
=n sffrrt the functon of the septic cunk as a txcatamcnt stage a the craste disposal system
1:at: prapcrty owner agrees to submit to St, Croix Zoning Department a c tcatiou form, signed by the owmr and by a
trusterpbi-mber, jour sclrm=plumbcr,restaictedpluater or a I.icensedpumpervcri4ri-12 that (1) the on-site vrasftwateedisposal system
is in proper operating condition andror ;2) after Wspection and puling Cif necessary), the septic task is less than 113 fall of slt!dge-
Ifsyc the vatclcn' have read the above retNiremcnn =d agate to maintain the private sewage disposal system with the standards
set fwth„ )*min,as et by the Depamnent of Caranexce and tix Depart n=t of Natuml R.amarces, State of Wisconsin. Certification
suaing that y ouT septic system has been m=tainsd trust be completed and tetumed to the St. Croix County Zoning Offim within 30
days of the tlu" Sesr eatpinuon date.
S1GKXn OF APPLICANT DATE
~~.~~Gz 'TIC)N
I (we:) cresfy that all sfateaseam oz this form are trie to the best of ray (out) knowledge. I (wc) am fare) the owner($) of
tL,c propm above, by vdmie of a vtarranry decd ;'rccsrded is Register of ]Deeds Office.
t~~ ~~~ribea t cr 1 13
SIGNAT[1jiN OF APPLICANT DATE
i 111M71 t~
s*«**" fyny irtfarmadon that is :tali-repreicnted may result in the samtxuy permit being revoked by the Zoning Departrncrtt.
$1- iatclwe with this sapplicstion_ a stamped warranty deed from the Register of Deeds office
a copy of the certified surrey map if reference is made in the warranty deed
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ' of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner
r's Septic Tank Capacity Z S-D gal ❑ NA
Permit # ~ O S
Septic Tank Manufacturer W1
67 S~`~ ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms L ❑ NA Effluent Filter Model 5 Z ❑ NA
Number of Public Facility Units NA Pump Tank Capacity al A
Estimated flow (average) gal/day Pump Tank Manufacturer NA
Design flow (peak), (Estimated x 1.5) 61 Qv gal/day Pump Manufacturer NA
Soil Application Rate 0,-7 gal/day/ftz Pump Model NA
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA
Fats, Oil & Grease (FOG) <_30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODS) <_220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) <_150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal s ❑ NA
Biochemical Oxygen Demand (BODS) 530 mg/L Q-K -Ground (gravity) In- roun pressurized)
Total Suspended Solids (TSS) <_30 mg/L ~A ❑ At-Grade ❑ Mound
Fecal Coliform (geometric mean) <104 cfu/100ml ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size Y8 in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
*Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: ❑ [Dfe-ar(s)rrigath(s) (Maximum 3 years) ❑ NA
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA
Inspect dispersal cell(s) At least once every:
-3 ❑ ear(s)(s) (Maximum 3 years) ❑ NA
Clean effluent filter At least once every: ❑ month(s) ❑ NA
Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA
❑ year(s)
Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA
❑ year(s)
Other: At least once every: ❑ month(s) ❑ NA
❑ year(s)
Other:
❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted 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 back 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 ponding 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 (Y3) or more of the tank volume, the entire
contents of the 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 effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
2
START UP AND OPERATION Page 7i of
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that 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
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
within 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
POWTS: 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 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
properly and safely 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
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS ails and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant
replacemen system:
A suitable replacement area has been 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 existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
aluat
l~v T
be a ai F91)4115 T1m fbR- N~ afVS7-9(JCg10 Jank
❑ 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 NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Named Name
Phone -71S-- 316 - Z Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name s5', G ( d N/ 20I~I~
u
Phone Phone -7/f; - 3g(10_
(a O
4/
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&M and 83.5411), (2) & (3), Wisconsin Administrative Code.
MAIN FAX 7153777375 p.2
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Subject to Dec'-orations of Co•:er.a^ t.s, CCndi2icna aad ~d~2'r Cite
Restrictims; for Troy Yrllage, rec.rded in voL. 1241, Nuds~n, it: 5a01o
Page 7.Sn, as acc. 1,10, 559964, and the reciaruticn of
Go!-' Cclirse Czvenants, Conditions end E>°semen.s,
recorded in Yor. 124:, Page 301, as Dcc. 4C. 559955, Pa^t Of 04[-2:51-90-100
a:l as ayaearinc *r t.ne office of the P.EgisLar e? Deeds :ygircury~a~nN7 wr{Afw
.or St. Croix County, Wisconsin, and s= ;'r, other
easen*ntB, restrictiong and resr=rvati,-lls of -eaord, This ie -Ct heresacvdp-oFCrtt. j
or in use, and the 'a".:y'mrl' obi_caticrs contained in 4isi Shrarl
tae PLrdnwm ajrvement for this lot.
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1 04/23/2013 E 1 OF A 1
Parcel 040-1291-50-000 PAGE 10.50
1
Alt. Parcel 24.28.20.1662 040 - TOWN OF TROY
Current ❑X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
00 0
Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner
O - PETERSON, BRIAN D & LYNNE M
BRIAN D & LYNNE M PETERSON
934 CARTER CIR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 323 LINDSAY RD
SC 4893 SCH DIST RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 1.006 Plat: 09-009-TROY VILLAGE 5TH ADDN 130/145 040-02
SEC 24 T28N R20W LOT 134 TROY VILLAGE Block/Condo Bldg: LOT 134
FIFTH ADDITION -
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
24-28N-20W
Notes: Parcel History:
Date Doc # Vol/Page Type
09/18/2003 740476 2413/363 WD
2013 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 11/09/2009
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.006 215,000 0 215,000 NO
Totals for 2013:
General Property 1.006 215,000 0 215,000
Woodland 0.000 0 0
Totals for 2012:
General Property 1.006 215,000 0 215,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: 12/04/1998 Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Wisconsin Departrnent of Industry, SOIL AND SITE E V A L U A.T10 R E R 0 R T Page I of 3
Labor and Human Relations _
Divisidh of Safety & Buildings in accord with ILHR 83.Q51 Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but ST ' ~_0 lk
not limited to vertical and horizontal reference point (BM), direction and of slopp'*-We pr PARCEL I.D. # p L,u G
dimensioned, north arrow, and location and distance to nearest road. '
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION. REVI BY - DATE
PROPERTY OWNER: P. RQPERTY LOCATION
Co ~.i-P t__j wt t)V T- eorLp.- 5 v sz, 1/4,sZ4 ` ;tom
PROPERTY OWNER':S MAILING ADDRESS. I)IOT ; l3COC}C;* SUBD. NAME OR CSM # 0-11
\7Z- 3t, 1 fwii fJ.~ . Z.3v 1~ - TRU`~! 1JLL\_rT6E Z> .
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN ' NEAREST ROAD
eLrn.fv~ ,r-Lfv Ss4~y ( ) ~-Q-opt ~ttios+~t ~t~.
[xi New Construction Use [~Q Residential / Number of bedrooms y [ J AdditiQn to existing building
[ J Replacement [ ] Public or commercial describe
Code derived daily flow bow gpd Recommended design loading rate -1 bed, gpd/ft2 ' trench, gpd/ft2
Absorption area required S~ bed, ft2 So tren , ft2 Maximum design loading rate -1 bed, 9pd/ft2 •6 trench, gpd/ft2
Recommended infiltration surface elevation(s)$204 - 0 `(SuTIF t ~c Sl ft (as referred to site plan benchmark)
Additional design / site considerations SZE ri'o ~0 l >v STfrL.LL2 o00 ;h-G e- 3
Parent material Lo ov~~ G Lf` L ttL- ouTwft sW Flood plain elevation, if applicable IQ A ft
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem f_S ❑ U ®S ❑ U ®S ❑ U I [OS ❑ U ®S ❑ U ❑ S O U
SOIL DESCRIPTION REPORT
B Depth Dominant Color Mottles Texture Structure Consistence Botr GPD/ft
ring # Horizon ( I (r.~ry Roots
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
<w.uat;; p _ N3 l
# ] 0`L~1_ 31Z
sit Z'P a\~lr~ ~5~1 Cw - • 5 .b
Z t3 _ L(o K tZ 3d
. t~ ~ St I zm s6~c oQsh ~s - • s
Ground 3 ►~-\Z.l ~.S~fIZ fly S tG~. U 4g rK 1 .~3
elev.
l39o.S ft
Depth to
limiting
factor
Remarks:
Zrin #
o-~Z Yo~tR 3CZ - s,l Z'Fabh r~S~ ~w
z 1,a-qq- Lo-,tz 4/L _ S o sq V4 -
3 14V-L-LI -a.S~t2 3/y - SsL6v 04g h~ ] -
Ground
elev.
I.o
~°t ft
Depth to
limiting
factor
? mg
Remarks:
CST Name:-Please Print
Phone:
Arthur L. We erer 715-425-0165
e~gerer Soil Testing & Design Service-P.O. Box 74 River.Falls,WI. 54022
Signature: y13-297 - 1Z-3 Date: CSTNumbe220254 -
PROPERTY OWNER COKM lJedVIKL 'Z)P Q .
SOIL DESCRIPTION REPORT Page? of ~
PARCEL I.D. # X'ro) !v G
Borin # Horizon Depth Dominant Color Mottles Texture FSrtructure GPD/ft
\2 in. Munsell Qu. Sz. Cont. Color . Sz. Sh. Consistence Boundary Roots
Bed Trench
0-t0 %13Z `Fabk s CW - .s .6
Z ~~_Z s ~u 2 3 I - s~, Z,wi sb►zf ew • s
Ground 3 ZS 13~ l0 `-t R - S g Gh O %9 hr1~ .1 • fi
elev.
8~,~•y ft.
Depth to
i
limiting
factor
Remarks:
g # ,
1u~1i1-
zlz - st.I z4 CL.bk Js S - s. ,b
Ground 3 y3 -tb'I 1 •SH12- 3l y ~ S t16►- D S9 1M 1 _ ~ ,y
elev.
Depth to
limiting
factor
> l w]'*
`
I
Remarks:
~oring # ,
1 off R 3 l 2 - s, ► 3` -Vk cw
C r"`' Z ~3p l U `1 IZ 3/ L
3 3u-L2~ -)•S`t►z S eLC~►- 09) M
Ground
elev.
as ft. ~
Depth to .
limiting
factor
Remarks:
3oring #
around
alev.
it.
)epth to
imiting
actor
Remarks: -
PLOT PLAN Page -3 of 3
SCALE 1"= So '
a
1 T L/ N_ ~ l1
S C I ~N4 I Sc~~' - .9q~.y~or~l`u1Rt~r~1 PWe
8~' L .9ES.SV oh,
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715 ) 42.5-01 6 5-
CST Signature Date Signed Telephone No. CST #