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HomeMy WebLinkAbout034-1005-50-000 Wisconsin Deoartrrent of Commerce PRIVATE SEWAGE SYSTEM Coun!y safety and Bjildutg division St. Croix INSPECTION REPORT Sanitary Permit No GENERAL INFORMATION (ATTACH TO PERMIT) 582092 State Plan IL' No Personal information you rimvide may De used `cr s:-uondary pu-poses (Pnvacy Law, s. 15.04 ,1)(m)) -ermit Holder's Name. 1_.Ity Village Township Parcel Tax No. Robert Huber c/o Carol Lindberg TOWN OF SPRINGFIELD 034-1005-50-000 CST BM Elev Insp T.1 F4 BM Descr t i l ` p i r~ i (r ) Seclir_n,Town/Range/Map No ~IUIV 1 ~J 03.29.15.426 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURE CITY STATION BS HI FS ELEV. 'sMA Septic Benchmark Dosin f,_ Alt. BM Aeration' Bldg Sewer Holding f . l St! t Inlet ~-1f lK~ L TANK SETBACK INFORMATION SUHt Outlet TANK TO P!L ' WWI I_ BLDG. Vcnt to Air Intake ROAD Dt Inlet Septic s 6TU3 ;-A cfZ,L- Dosing Hcader;Man. Aeration Dist. Pipe Holding L L r t` i / r ~yy Boll System PUMP/SIPHON INF~1( kIai/,6VA/ ff {`1 Firtal Grade it- Manufacturer Dem d St Cover Model Nu r TDH Lift Friction I oss Systeru ad TDH Ft Forcemain Length Dta Dist- '.c well SOIL ABSORPTION SYSTEM-- BEDlTRENCH t; did )x' Length No .~a PIT DIMENSIONS No. C` Pis Irsice Dia. DIMENSIONS Vwdpept4• SETBACK SYS.IE%I TO P1 13-7 WIFLL IAKE!STREAM LEAC"G Man,rfacture•: INFORMATION Type Of System CHAMBER OR UNIT Model Number DISTRIBUTION SYSTEM Size -i cle Soaing Vert to .Air I Header/Manifold FLe:l'h'tic,) pia Lenglh_~ Dia~`~SD iry_ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only . , r Depth Cver Depth Over xx Cepth of xx Seeced/Sodded r -111- .1u c ed Bed/Trencn Celter BecrTrer h Ecs" Topsoil /elf Yes No ~ Yes ~ No COMMENTS: (Include code discrepenc es persons present, etc.) f lnspepon #1 Inspection #2: Location: 1143 WXY 128 C I (f I J r t I (f C.~, 1.) Alt BM Description = l - ? b~ hT 1 r rn" P 2.) Bldg sewer length = t, amount of cover = JL! Plan revision Required? Yes IN Use other side for additional information - L [T:3te ~'~s/In5" a :or s Si n ure SOD-6710 (R.3197) 9 Cert hJc au• c CG' Industry Services Division County DS 1400 E Washington Ave PS MAR 14 2016 P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, WI 53 707-7 1 62 o sBZa 9z COMMON!+~ wit Application 4Sta actio n Number In accordance with SPS 333.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state oti+med POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary u oses in accordan ce with the Privacy Law, s. I5.04(1)(m), Stars. I. A lication Information - Please Print All Information Property Owners Name /73 LJr ~i~0 ~ Parcel d lCoQ ~6uis uts~-~ Esrar a ©3W- 1etas-5-,) Property -Amer 's Mailing Address O .;,1, 15. q,? J3 Property Location 5'S'y ~uR~s ~vE. City; State Zip Code Govt. Lot Phone Number ~y AuL N W _,S 4.) Section 3 II. G S/ 771-3S-16 (circle one Type of Building check all that apply) Lot T_?N: R /S I or 2 Family Dwelling - Number of Bedrooms Subdil'ision Name Block R El Public/Commercial - Describe Use - o fay, s ❑ State Owned - Describe Use CStvt Number ifia°e of Town of J/~/t/n/LF/ELQ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System Replacement System ❑ Treatment/Ftalding Tank Replacement Oniy ❑ Other Ivtodification to Existing Sy=stem (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration ` Owner IV. T- e of POWTS System/Com onent/Device: Check all that a ly) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound _>24 in. of suitable soil ❑ Mound < 24 in, of suitable soil Holding Tank ❑ Other Dispersal Component (ex-plain) V_ Dis ersal/Treatment Area Information: ❑ Pretreatment Device (explain} Design Flow (gpd) Design Soil Application Rate (-pdst) Dispersal Area Required (st) Dispersal Area Proposed (st) System Elevation A~ _ Tank Info Capacity in Total # of Gallons Manufacturer Gallons Units 21 New Tanks Existing Tanks L c U U ~ U = J v u y s septic or xoldina Tattle / 0- U :n_ ^ Dosing Chamber Od0 - 3400 W ESE/L L6.JC.rEr~ ✓ 1 V11. Responsibility Statement- 1, the unde igned, ume re onsibility for stallation of the POV1'T•S shown on the attached plans. Plumber's Name (Print) Plumbe ' Signatu llMNPRS Number Business Phone Number //V / Y17-rLES7X,0 r 07a7 7 5 Plumber's Address (Street, City, State, Zip Co e) a~8/ 9 /~.t~/lFio Sr. EN~o,tli6 ~ Sy15/ XrIII. CountY/De artment use Oni Approved ❑ Disapproved Permit Fee Date Issued Issuins Agent Signature ❑ Owner Given Reason for Denial $ V sC. o (b I4~e~' O~~ 40 1~74 X. Conditions of Approval/Reasons for Disapproval /QS~ SYSTEM OWNER; A6064NM6~flT 4(l 1. Septic tank, effluent filter and AT iPEG/ST&R° of 7)F /l (*0 dispersal cell must be serviced / maintained Ot,✓ti~sKrP /S , as per management plan provideli by plumber. 2. All setback requirements must be maintained attach to complete plans for the system nod submit to the County onh on as P,f licabie code/ordinances. S~~ GST- Zalt; - D/Z FpQ. ~tO t2E~ T of less than 8 12 c 11 inches in size SBD-6398 (R. 03/14) Private Onsite Wastewater Treatment System Index and Title Page Project Name: WO a Ff r 2601 Yt~~Ea 6"s rgrE - off - /~i oi,~~ ~aK Owner's Name: !,/d CAAo L ZIAJ MEaL, Owner's Address: /5/95 'ea s AvE ,Sy" ~A4t. /~/V SS/oG GS/ 77/- 3S/O Legal Description: /Vt✓~ S4J. 3 o? / /S 4) Municipality: Tom v4mw, - Prof .SP.cI.►~~Fi~r,o County: Subdivision Name: Lot Number: Block Number: Parcel I.D. Number: Page I X.yDt•~C T/ rLE- S~S/EE 1°' Page 2 Page 3 /4`6L Dol!y % ilww 6,toss- Sre-fYo.J ,SAM-5 Page h /'y%Jg f.4c r4aE.c s s Page -5 /T6LD/n16 A•JA Page 6 A4 Page 7 Page 8 Page 9 Name of Des' er: i r L r Ao License Number: Signature Date: o? - 0?3 -.?O/G Design t to Following POWTS Component Manual and a s /J.5 8I-85. 1110LD1414 Pn!/G o v a r AAA)4AL C (fE/[Syo.✓ o~ O) .SBD 0855'-P C 03/07) I --,q I tk ` a y a~ \ ~ G Q 3 r 0 0 14 n~ Q V Zlu '0 ti `'6 yj ~ C~1 ~ v 3 ~ ~ w ku j k J b o ~~1~ e 0~ . 3 of HOLDING TANK SPECIFICATIONS ti Number of bedrooms Non-residential estimated flow (gpd) ©o© Minimum holding tank volume required (gal) I 3 ppp proposed holding tank capacity (gal) Tank Manufacturer &11,4 36,00 Tank model number S. T. E. ~lo,yaas Alarm manufacturer Complete alarm manufacturer's no r.4A rrt LE~t J 1 Alarm model number Complete alarm model number. Tank Dimensions and Data Tank Anchor Calculations (/F lix0co) X for round tank a?S a8o lbs Weight of tank and cover Liquid depth below inlet invert (in) Safety factor Maximum depth of soil cover (ft) 3 8 Sob lbs Weight of anchor required 4/ 12 3 Height (in) Outside 3 in Soil cover req. for anchor or /0 84S/d5li" 8y Length (in) Dimensions 9. G Yd3 Concrete counterweight eoays//d r /oa Width (in) Only Required anchor depth exceeds maximum cover depth. HOLDING TANK CROSS SECTION manhole cover with locking device and finished vent cap junction warning label grade box 4" min. 12" min. 23 in. conduit ~ Manhole and vent locations ' vent pipe 18" min. tether weight - --•-•---~ia a service in. building sewer inlet blind plug alarm on iNot: ll tank joints, to seal and jeointAs between tank outlet openings and piping are Electrical as per 33 in. sealed watertight. All NEC 300 pipe and vent materials and SPS 16 comply with SOS 84. 3 in. bedding under tank. Tank is anchored as necessary to negate buoyancy. Project: Transaction !Number Page of i i Pi . yaf ~ z 60" As 102" > REOD m 48" K rz- zm+ c m D n m UP 47" p/ -P o 4" CAS 0 m > m 4 3" 51 6" N m m n r p to I v N m < ( OD m m I nNi 43" ~ r C W m D vi -n r m ;o UP 45" t rn D z 4" CAS \ m pl 0 c 46" 0 m 0 -4 0 -4 (A z~ m z C O 0 -n o x o rp c m m --1 X 0 -I Om X- "I 0 *m z 0 Occ > o~Z ~Z- -IlD~pzm>O oDN z 0 a C) --I M0 m N >mZ D moo Dp-4ZZp~" ~-10~ 0 N C T` ~zC ~C•• 7c 7C~--~•• r -~'-W C v > o inm Or c G7 r- --I A -ni r~ 0- ) cn Z n=.. Nzr~ i ran i i mr0 ~mrn C> „ m L.1 zo z m >o -a- m >mo AW580 ZW (n r a z m con DN Z \p m Dm DN.I I ~AcmCsr:.4 a D r m m -t z > 0-0 ~o N m m (1) m p C's CA 4. 4. o~ m co m m m N i~ C E V W o -mil t>- to WO Wo (7 0 m< v m a H n KZ C 0 mmr z C) 00 O~ O ll z r>r-M o > uv r- OF> 00 o;= °rn c= -Tl 0 -r D7 ;o A 't- x Z -i r- 0 C7 -ni m~ Ln ~ C) z -i o cn w cDn D D v to i0 O_ D m v z v o r~r D p°' o O (A ;D c H mm o z > W FD O z r CA cn m V) Z Z M m m m DRAWN BY. SME SCALE: 1 4'=1'-O' PRE-POUR: ~ - _ P3000 WIENER ciellETE ~ SEPTIC MANUAL Rte`' W3716 US HWY 10 MAIDEN ROCK, NA 54750 DATE: JANUARY 2010 DATE:. POST-POUR: \ ° REVISED JAN. 2010 800-325-8456 FlLE: wir= Pg S of G Private On-Site Wastewater Treatment System (POWTS) HOLDING TANK SYSTEM - USER'S MANUAL A. SYSTEM OPERATION: The holding tank system serves to contain wastewater on a site until the contents are pumped and hauled to a proper point of disposal by an individual certified under Wisconsin Administrative Code Chapter NR114. Wastewater from your interior plumbing system enters the building sewer that terminates at the inlet of a prefabricated concrete holding tank system. The tank system has a switch that is set to activate when the liquid level reaches a point 12" below the tank inlet- The switch activates a high water alarm located inside a tank alert box that is installed on a pedestal or inside the dwelling. When the tank is full of wastewater, the switch will be activated and cause an audible alarm to sound. A switch located on the tank alert box can turn off the audible alarm. The liquid waster carrier contracted to service the holding tank system should be called immediately after the alarm is switched off. There is only a limited reserve capacity left in the holding tank system after the alarm has been activated. B. DESIGN FLOW: The holding tank system has a total wastewater capacity of 660 gallons. Servicing intervals cannot be predicted, as every household has varying water use habits. Use of water conserving fixtures and water conserving practices will increase the number of days before the tank needs to be serviced by a liquid waste carrier. C. WARNING: Failure to have the holding tanks serviced on a timely basis may cause wastewater to back up into the dwelling and/or discharge from the holding tank's manhole cover. The discharge of sewage to the surface of the ground-is a public health hazard and subject to enforcement action by County. ST. 02.01)( Soil settling around the tank perimeter may occur after it has been backfield. All depressions caused by soil settling should be filled with soil material to prevent surface water collection. Depressions left unfilled may allow surface water to freeze and cause frost damage to the manhole riser ring joints or the other tank components. Do not drive over or near the buried holding tank system with any vehicle or construction equipment. This action may result in a cracked tank(s). This type of damage may allow groundwater to enter the holding tank(s) and increase the frequency of pumping. Many disease-causing viruses, parasites, and bacteria are present in the holding tank's wastewater. Even the slightest exposure to wastewater may adversely affect ones health and increase the risk of serious illness. Please note that the owner of this POWTS must provide the septic servicing operator with reasonable access to the tank(s). This may include (but is not limited to) construction of a designated drive or servicing pad to within 25 horizontal feet and/or to within 15 vertical feet to bottom of the tank(s), foot traffic over and through property, or vehicle traffic over and through property. D. TROUBLE-SHOOTING 1. Wastewater backs-up or overflows manhole cover: a. High water alarm not working. b. Tanks not pumped. 2. High water alarm not working: a. Tank alert box not plugged into electrical outlet. b. Audible alarms switch on silent mode. c. Tank switch installed improperly or defective. d. Tank switch electrical connections faulty. e. Electrical line to switch defective. 3. Groundwater entering tank: a. Tank manhole riser ring joints leaking. b. Tank sidewalls or base cracked. A/. GbfC Holding Tank Management Plan IMPORTANT: The owner of this holding tank(s) shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this holding tank(s) shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Estimated Daily Wastewater Flow = '766 gpd Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o electrical components (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o surface discharge of effluent or sewage back-up into structure served SERVICING FREQUENCY o The tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wisc. Stats. when the wastewater in the tank(s) reaches a level of one foot below the inlet invert of the tank(s). Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. Tank pumping reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wis. Admin. Code. Report any component failure or malfunction to: Name of individual or company: 6A1le4 L/.vOeEat,y Phone: Cs/_ 77/- 3 S/o Local government unit: Sr ~/loix le Zo,vi~yG Phone: 7/s- ?*4 - y~~+o Local government unit address: ~ r ZIP: SS~o/e Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Contingency Plan In the event that any failed component of this holding tank(s) cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agecy for review and approval. System Abandonment If use of this tank(s) is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. SEPTIC or HOLDING TANK SERVICING CONTRACT Contract Date 7- Zol~O This contract is made between the Tank Owner(s) tVame(s) and Pumper's Name t: We acknowledge the installation of (a) septiClholding tank(s) on the following property; (Provide legal description}: lgj~rr 1. The owner agrees to file a copy of this contract with the local govenunental unit (St. Croix County Planning & Zoning Department) to document maintenance by a certified septage servicing operator as required in Comm 83.52(1)(c)2. Wis. Adm. Code and the approved Component Manual. 2. The owner agrees to have the septictholding tank(s) serviced by the undersigned pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the septic/holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the septic/holding tank(s) with the ptunping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the septic4iolding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local governmental unit (St. Croix County) a report for the servicing of the septiclholding tank(s) on a monthly basis. The pumper further agrees to include the following in the monthly report: a. The name and address of the person responsible for servicing the septic/holding tank; b. The name of the owner of the septic/holding tank; c. The location of the property on which the septiclholding tank is installed; d. The sanitary permit number issued for the septic/holding tank (if known); e. The dates on which the septic/holding tank was serviced; _ f. The volume in gallons of the contents pumped from the septic/holding tank for each servicing; g. The disposal sites to which the contents from the septic/holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the local governmental unit named above within ten (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) Owner's Signature(s) Subscribed and sworn to me on this date: Rrav w tools r V E f. C) 01 D- o I of Today's Date Pumper's Name (Print) ; Pump S Si ture Notary P is tgn re Tip 1 m-sr ,)-r 01 3 2-01 Pumpers Registration Numb Com ission Expiration b GINA M JOHNSON MINNESOTA NOTARY PUBUC - i ` ~ IRES 01181118 RECEIVED AN ao Wis. Dept. of SafelMAR ~1 t' AsGiOUServices SOIL EVALUATION REPOR Page~of Division of Safety and Buildings ST. CROIX COUNTY in accordance with SPS 385, Wis. Adm. Code Attach KYSJN12 oV~paLper no ess p PM M C°""~' ST. p than 8 112 x 11 inches in size. Plan must 4461)( include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Q 2 J OS~~~ v Please print a0 information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location rSTiF!'E c~ ~A~e t //,.t06 Govt. Lot /1/1.f 1 /4 SO 1 /4 S 3 T a 9 N R Property Owner's Mailing Address Lot # Block # Subd..AWM or CSM# y1' n~ucds ~i vE, - - City State Zip Code Phone Number Y Q~Filloge ®Town Nearest Road Sr wG W 06 ( GS/ ) 71 -,3.s/G .Sio~~nf~FiOt4 11y3 /z✓wr. /.?8 ❑ New Construction Use: S Residential/ Number of bedrooms .2 Code derived design flow rate 200 GPD IS Replacement ❑ Public or commercial - Describe: Parent material ',z rY .SED/BEN r -oa-rA 3-1L 4 Flood Plain elevation if applicable AW ZAA19- XJ ft General comments and recommendations: /7 6t D~nlL ~.O,rtC SiJ'E ❑ Boring 4)9WEV 4S 4:ZA6~-OA.) S/GT Ca4rft W/#&Wvy St457)097Aiw ❑ Boring # ® pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. f1#1 *01#2 0-8 oYx 3 3 a 8 - /G /O YR S~3 7.~Y.e y/L Si 1 ,K ^ G S - 3 a Boring # © Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor-1- - in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure nsistence Boundary Roots GPDlft z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ffQ 1 0 - R /,0 Y,t 313 2 9-/6 LA s13 /c/ 7. YA- -3 d -Zo 7 YA Vlf( 3 -Ya /4t sa Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 40- Etfluent #2 BOD 30 mg/L and TSS < 30 mg/L CST Name (Please Print) CST Number Michael J. Bassett Address 1503 Fairway St. 54fe Eva nducted Telephone Number Eau Claire, WI 54701 4? _ 30 _ (JU) 715-834-8610 (C) 71 7-43 SBD-8330 (RI 1/11) CST, MFRS-224974, D-1152 l / Parcel ID # Page o7 of Property owner ~o6E~s Louis u.6aa ES TSI rE a Boring # ® Boring ? ❑ Pit Ground surface elev. ft. Depth to limiting factor ~Q in. ate Soil Horizon Depth Dominant Color Redox Description Texture structure ~onsistence Boundary Roots GPD/ft z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 * ff#2 / 6- o QM S,1 1,0-17 At 1/1 c/ 7.TYA 1 L a Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth tD limiting factor in. Soil Application Rate Horizon Depth DominantColor Redox Description Texture Structure nsistence Boundary Roots GPD/ft s in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * tf#2 a Boring # Boring Ground surface elev. ft. Depth to limiting factor in. ❑ pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure ~onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. fl#1 ff#2 * Effluent #1 = BOD 5 > 30,,_ 220 mg/L and TSS >30:5 150 mg/L ' Effluent #2 = BOD r,:5 30 mg/L and TSS 30 mg/L The Dept. of Safety and Professional Services Requ portunity service provider and employer. If you need assistance to access services or need material in format, contact the department at 608-266-3151 TrY through Relay. t. sBD-8330(RI1n1) a~ a ....E f r ' H H n n PC [nil Q n - a t^ H e i r t h i n a o ~N Z y a o r a t a a ~ a o D 14, a a e n LN w .`t ~ a ^ I n