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HomeMy WebLinkAbout040-1163-40-000 (2) . Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St Safety and Building Division Sanitary Permit No: INSPECTION REPORT 579058 0 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)]. Permit Holder's Name: Village X Township Parcel Tax No: Hauschildt, Todd City Troy, Town of 040-1163-40-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 25.28.20.633A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding 1E St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head T rH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution Ix Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth over 1xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes [E No Fol Yes Fg~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / / Location: 166 Skyline Drive River Falls, WI 54022 (SE 1/4 NE 1/4 25 T28N R20W) NA Lot 2 Parcel No: 25.28.20.633A 1.) Alt BM Description = 2.) Bldg sewer length - amount of cover = Plan revision Required? ❑ Yes F No Use other side for additional information. Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) RECEIVED L.1 Safety and Blli m ivis#on County , r .gau ye ,0. Box 7162 YD 2D ~i~? 162 Sanitary Permit 14,mber (to be filled in by Co.) Ivladi9rnt, wl sus 7 (o State 1Tattsacdon Number Sanitary Permit ,,.ppliication dary prplect Address (if dif#bmnt than tttail'tttg address) in accordance with s. Comm. ga.21(2), VAS, Adm. Cod, subro#sston of Tbts form to the appropriate R°V aTR1E `i unit is required prior to obtaining a sanitary permit Note: Application forms for state owned POVJ f S are submitted to tbo Depertmant of Commerc', Personal information you provide may be used for secon Purposes in accordance with the Privac Law s. 15.04 1 to State I~Yn J r~ l I. A Ncation information Please Print AM IMoretu+tion Ptu+eel # ['roperty Owner's Name a' /1 Q yd Property7Loaation Property owner's Mailing Address y n C}ov/t, Lot ~ t ~ ~ S , G 5~ "Al ~ Section -L.2 45~ - . zip Code phone Number City, State (circle 094-,% Lot # 11. 'Type 0f Shading (ebeek all that altplY) Subdivision Name ki nr Family Dwelling - Number of 13edrootua ~ S1ock # Cl Pk1hlic/Commercial i)t:aeribe Use-- ~ City of CSM Number l3 ❑ village of State. Owned Describe llae - ✓ J Town rxf t,.i ~'l~t l9- 57 Va I1 ~P -6 Ill. Type of Permit; (Check O )MY one tax on line A. Complete line B if aXtplicable O A. f!&ew System ❑ 1Leptacement System ❑ `f['teruin"vH'idins TankReplamment Only ❑ Otltar Modifiaatinn to Bxistfng Systtttn (explain) List Previous permit Nntnber and Date Issued - - ❑ Change of Pl»mber 0 Permit Transfer to New ll. { ] Permit Renewal ❑ Permit Revision Y~ OWMT Before Expiration d X. i. Type of Pow S S tan/Com nentmevIce: Cheek all that "DIVI Mound < 2q in. of ie sail {),talon-Prcasnrized ln-Grrnind EIPressurized ln-Ground ❑ oGrade Q Mound>24 in. of suitable 9011 L-1 Pretreatment Device (explain) ~ Holding Tank ~ Cat r Aispersal Ctnrtponent (explain)_____---- _ Dispersal/Trea niArea 1<nforlnationc S temRlevadon Diapers Area Rega'red (of) / Dispersal Area Prof ys ec w Y Drsifm Flow (gpd) Design Soil Appl#oatlon Irate( st) ✓ ~ ~t kd a / 2s' ll~r { Manufacturer ? -L- I $ of Vi. Tank Xnfo t'ap' neity in Total - ° 'g a Gallons Gallons Units / ~ C~"4 C7 P4 eW Tanks extadn% Tanks U New l,✓ ( Da 3rptlc at Holding Tank 66~ W ! 1 f)osinq Chamber Atta plans. YXI. Res imobillty Statemeab- L the underalgt►ed, aasmne rag nathfHty far instaa+ttl0n of the POINTS ~ Number shed Business Phone Number Pbtmber's Name, (Print) Plumber's Signature ~•i' s~'~- s ~✓e'V,"L eyt se o a.9-7 9`76 {`lumber's A ddress (Street, City, State, Zip Code) ~TIli. Ceun /De ar'tment Use Dal t 81 Perm#t Pee Darr ]~sjlued lssuit►g Br+aturc ppro 15 e-d n Reason for Dpenial -1X. Corm a ~tdlsappmval 31 V n~acA.~^~^~Q 4JP~J di cf#fdritt all ~rvFoaa /maintained as for rd plan pro ad by plumber, 1 rtlaintaind 2 'setback.. , ~ . _ _as_pK appl' t~di / o►dinan0a. x ri ineba in aixe --v Aitaeb to cnmpicle plans for the system and submit in the County anly sn paper not im than Bin 51iD-639A (R. 02/09) „ 'Y a 7 ee ~ t,. 5 s p 0 r-e- ! 151 3 - 3 x ~ ~dfici. P CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: 7_,~5d d Owner's Name: Owner's Address: Z&, 4~ ~p' i y /f , s~ l=am / °f ,~4'6 Legal Description: S L' % Township: ~Yd County: i! NJ t ~X Subdivision Name: Lot Number- Parcel ID Number: G y~ - Page 1 Index and title Page 2 Plot -Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber; License Number: 2 Date: i5~/1z/ lam- Phone Number 7-I Signature Designed pursuant to the in-Ground Soil Absorption Component Manual for POWTS Version 2.0 SSD-10705-P (N.01101). Page 1 7 0 s ~ f{ ~ 13 r" 3-3x7~T~'~,~~hes I I Sol! Absorption System Cross Section --..,..r• f qd ° ft 4" Schedule 40 inal Grade PVC Vent Pipe Nth Vent Cap ft Leaching ? 0 Chamber ft System Elevation _ { J ft ft Soil Absorption System Plan View ft ft i ft Leaching Trench Z Chambers- 7 4" Dia. Trench 2 j Header Vent Or Observation Pipe Trench 3 Leaching Chambgr Sipeemca ons Manufacturer And Model k (-Vs EISA Rating a D sq ft per chamber Soil Application Rate gpd/sq ft gpd Design Flow + , 41 Soil Application Rate : '10 EISA Chambers 3 rows of chambers each. Page of I POWTS OWNER'S MANUAL & MANAGEMEMT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity 16,Tc) al 17 NA Permit # Septic Tank Manufacturer t,L e-r ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer G J k.C C & ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al ❑ NA Pump Tank Manufacturer ❑ NA Estimated flow (average) gal/day Design flow (peak), (Estimated x 1.5) alfda Pump Manufacturer E3 NA Soil Application Rate alfda /fta Pump Model 13 NA Standard Influent/Effluent Quality Monthly average" Pretreatment Unit 13 NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODS) 5220 mg/i, ❑ NA Q Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :150 mg/L ❑ Disinfection ❑ Other: Monthly average Dispersal Cell(s) ❑ NA Pretreated Effluent Quality Biochemical Oxygen Demand (RODJ 530 mg/L IR In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coilform (geometric mean) 5104 cfuf100m1 ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Ye in diia. ❑ 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: ❑ ar{ Q years)(s) (Maxllrnlm 3 yeas) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y9) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 17 month(s) (Mmamum 3 years) ❑ NA ❑ year(s) Clean effluent filter At least once every: 13 month(s) ❑ NA M Year(s) Inspect pump, pump controls & alarm At least once every: 0 month(s) ❑ NA _ © year(s) Flush laterals and pressure test At least once every; month(s) ❑ NA © year(s) Other: At least once every: 0 month(s) El 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(sl 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. ___-of START UP AND OPERATION Page T For new construction, prior to use of the POWTS check treatment tanklsi 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 fails 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 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 sail 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. C7 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 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 NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK CINDER 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 Name Ci1.il% 'a .zip S'c /L AMY Nama Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY C Name Name , 4~'-►ev Phone Phone This document was drafted in compliance with chapter Comm 83.22121(b)0 )jd)&If) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSH P CERTIFICATION FORM ONvner/Buyer ~ w Mailing Address_ Property Address atioxa irequired fro fanning & Zoning Department for neIcnstm ion.) (.',ity/State Parcel Identification Number 64b-11 LEEALDE§CRIPTION Property Location Sf 1/4 , i/4 , Sec, _Z5. T :2,F'N R ad W, Town of Certified Survey Map # Volume Page Warranty Deed # Volume , Page # _ Spec house yes nn Lot lines identifiable ye no SYSTEM MAINTENANCE _ DD OWNER C,E&UHCATION Improper use and maintenance of your septic system could result in its premature failure to handle waste's. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a troatmamt stage in the waste disposal system. Owner maintenance responsibilities are specified in. SComm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tang. is hiss than 113 full of sludge. I/we, the undersigned have road the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning Zoning Department within 30 days of the three year expiration date. l/we certifv that all statements on this form are uve to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. X Number of bedrooms- 3 X ? /a/1_5F SIGNT E 0 APPLICANT(S) ~ DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. 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Pla St. Croix include, but not limited to: vertical and horizontal reference point (BM), directio percent slope, scale or dimemsions, north arrow, and location and distance t( Parcel I. 040- 163-4 000 Please print all information. Revi ed By Dat Personal information you provide may be used for secondary purposes (Privacy Law, s. Z111:5 Property Owner Property Location Todd Hauschildt Govt. lot SE 1/4 NE S 25 T 28 N R 20 W Property Owner's Mailing Address Lot # Block # Subd. Na or CSM# 166 Skyline Dr. 2 na CSM Nol 11, Pg. 302 City State Zip Code Phone Numbei City Village Town Nearest Road River Falls WI 54022 715-222-0928 Troy DeLander Dr. New Constructor Use: Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: Accessory building/future residence Parent material Glacial Outwash Flood plain elevation, if applicable na General comments and recommendations: Soil suitable for conventional POWTS, 0.4 gpd loading rate. Recommended infiltrative surface at approx. 36" below grade at elevs = 98.5', 97.75' & 97.0'. a Boring # Boring Pit Ground Surface elev 99.02 ft. Depth to limiting factor >88" in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structurc Consistence Boundar Roots GPD/W in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 *E f#2 1 0-16 1Oyr3/3 none sl 2fgr ds 9w 2fm1c 0.6 1.0 2 16-23 1 Oyr4/6 none gr sl 2fsbk ds cw 1vf,fm 0.6 1.0 3 23-35 7.5yr4/6 none grsl 2msbk mfr gw 1vf,f 0.6 1.0 4 35-44 7.5yr4/4 none grscl 2msbk mfr cw 1vf 0.4 0.6 5 44-70 1Oyr3/6 none rlcos& Osg ml ci 1vf 0.5 1.0 6 70-88 1Oyr5/4 none s Osg dl - 0.7 1.6 Horizon #5 consists of an undiferentiated mixture of Osg Is & Icos with a high clay content & Osg s. Loading rate pf H#5 adjusted to reflect reduced permia of horizon associated with intermixing of is, Icos & s. / 2 ] Boring# Boring rt ~t F Pit Ground Surface elev 98.37 ft. Depth to limiting factor ~ 82 ~ in. oil App ication Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD/ft2 in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 *Eff#2 1 0-11 1Oyr3/3 none sl 2fgr ds gw 2fm1c 0.6 1.0 2 11-24 1Oyr4/4 none grsl 2fsbk ds cw 1vf,fm 0.6 1.0 3 24-39 7.5yr4/6 none girls 1 msbk mfr gw 1 vf,f 0.7 1.6 4 39-82 1Oyr3/6 none grls 1msbk mfr cw lvf 0.5 1.0 5 72-82 7.5yr5/4 none Ivfs Osg ml - - 0.4 0.6 r Horizon #4 consists Is with a hig77 nt & 1" - 3" irregular bands of 7.5yr 4/4 Ifs. Loading rate of H# a t effect reduced permiabilty of hori associated with clay content and banding. * Effluent #1 = BOD > 30 <-22 mg/L and T S >30 < 150 mg * Effluent #2 = BODS< 30 mg/L and TSS < 30 mg, CST Name (Please Print) Signature: CST Number James K. Thompson 31362 3CO2.1 Address A.C.E. Soil & Site Evaluati s Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 7/30/2015 715-248-7767 Property Owner Todd HausChildt Parcel ID # 040-1163-40-000 Page 2 of 3 3~ F Boring # Boring r' Pit Ground Surface elev 101.84 ft. Depth to limiting factor >88" in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPDff in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 Eff#2 0-10 1Oyr3/3 none Is Osg dl gs 2vf,f1 0.7 1.6 F32 10-28 7.5yr4/4 none gr sl 2fmbk mfr Ci 2vff1 0.6 1.0 28-49 1 Oyr4/6 none gr Ifs Osg dl Ci 1 vf,f 0.5 1.0 4 49-88 1 Oyr6/3 none Is & gr Osg dl - - 0.5 1.0 Horizon #4 consists Is with 1" - 3" irregular bands of 7.5yr 4/4 Ifs. Loading rate of H#4 adjusted to reflect reduced permiabilty of horizon associated bandin ❑ Boring # Boring Pit Ground Surface elev ft. Depth to limiting factor in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots -G-MM in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh 'Eff#1 *Eff#2 ❑ Boring # Boring Pit Ground Surface elev ft. Depth to limiting factor in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD/ft' in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 "Eff#2 Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg x Effluent #2 = BOD 5< 30 mg/L and TSS < 30 mg, The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07J00) A.C.E. Soil & Site Evaluations N soil eda~uo rlE~.~scv'~J f) r.-de elev. z oy .o.c~? a /ut/,ke To6~ h~ausc,~.;~d~oro~. K r'~/u'~C //s r J/, Syo2z /1Cl~/sEyy, 5xc.26; T.',26t(-, Q. 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