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HomeMy WebLinkAbout020-1089-50-000 Wisconsin Department of Commerce County: PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No. (ATTACH TO PERMIT) 584727 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. ry Permit Holder's Name: City Village Township Parcel Tax No: David & Vicki Datt TOWN OF HUDSON 020-1089-50-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 32.29.19.372G TANK INFORMATION ELEVATION DATA TYPE Af~11 CAPACITY STATION BS HI FS ELEV. Septic nc l o O hm 8 2 Dosing Alt. BM `J ration Bldg. Sewer Holdin S t Inlet ) L - TANK SETBACK INFORMATION S Pt Outlet %'C) TANK TO P/ ELL BLDG. Vent to Air Intake ROAD Dt Inlet Q Septic Dt Bottom Dosing _ eader/ n. / / Aeration Dist. Pipe -1 175"1 41 8•y g~R Holding Bot. System 'rZ S Pl Z T f 14 !?57. to Final Grade PUMP/S N INFORMATION 7 Man cturer emand St Cover / hO GPM Ul V Mo el Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM Z-7 C" hek~ BED/TRENCH Width I Lengtq No. Of Trenches PIT DIMENSI NS No. Of Pits Inside Dia Liquid De DIMENSIONS 1 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION T Of System: r 1 CHAMBER OR N ~2o OU [~4 V o i I R I UNIT Model NU r.. 11 - `I "`iii IBUTION SYSTEM He r/Manif[old /I Distribution x Hole Size Ix Hole Spacing Ver}; to Air Intake Pipe(s) JcJ /U~' S !f1 Length Dia Length Dia Spacing SOIL COVERT \ lipessure Systems Only xx Mound Or At-Grade Systems Only Depth Over I Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 1. 1 4h Bed/Trench Edges -.T Topsoil Yes No Yes E] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspectio(/~`r h /I;I/C ~J L cc I Location: 649 O'NEIL RD ~p w ~ t ~ m ] n I (~L nJ Jj 1.) Alt BM Description = ~ I IX `11 ns ~ e ct o n 2.) Bldg sewer length = q5 I u Ol ,nn[n V L n - amount of cover = l MU1 W 1~ ,0 1 ~qz"Or(owf 00 alb r \eAwan fJL Plan revision Required? ❑ Yes ~&No I I Use other side for additional information. Date t ` e s ignature Cert. No. SBD-6710 (R.3/97) PLOT PLAN PROJECT David Daft ADDRESS 655 O'Neil Road Hudson Wi 54016 SW 1/4 NE 1/4S 32 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX SYSTEM ELEVATION 94.0/93.5 5' below grade DATE 4/23/16 BEDROOM 5 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/630 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1091 # of chambers 54 Ilk BENCHMARK V.R.P. Top of 1" pvc pipe ASSUME ELEVATION 1001 Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark 398' Property Line Scale = 14" = 10' All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Lot Line 4 % Slope B.M.* O'Neil Road B-2 B-1 12' 123' P. L. 51 ' 40' 10 36 2-3'X ' 110' Cells with 98, >3' spacing ents 99' B-3 10' Huffcutt Combo Tank 20' Pro 5 Bedro M House Vent >6" Quick4 Standard Leaching Chamber 276' of Cover with 20.0 ft2 of Area >r 5.6ft^2/pair of end caps A 4' Long 12" ' Canyon Road 34 Grade at System Elevation 11% r-o o% r 2FQ County Q Safety and Buildings Division 4 J I~ 2 7~~ 201 W. Washington Ave., P.O. B 162 Sanitary Permit umber (to be filled in by Co.) Madison, W1 53707-71 ST CROIk opurtt y MMUNI`T°Y [XV91()Pm N°r ~ ! Z? Sanitary Permit Application Trazrsacd N b In accordance With SPS 383.21(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-owned POWTS the Department of are submitted to To'= Address (if different than mailing ess Safety and Professional Servies. Personal information you provide may be used for secondary ) uses in accordance with the Priv Law, s. 15. 1 m), Stars. L Application Information - Please in Informati o Property Owner's Name y # Q Parcel Property Owners Mailing Address Property Location - p 1 I Govt Lot _ City, State Zip Code Phone Number 7 Section irclc U. Type of Building (check all that apply) Lot # T 7 N; R or 2 Family Dwelling -Number of Bedrooms _ Z Subdivision Name ak ab Block ❑ Public/Commercial-Describe Use ❑ City of ❑ State Owved - Describe Use 7 SM Number Village of AL VL^ 1 " V J `Town Of _(~_-•ayl~ 2- 6e M III. Type of Permit_ (Check only on box on line A. Complete fine B if applicable) A stem ❑ Replacement System ❑ TrearmenUHolding Tank Replacement Only I ❑ Other Modification to Existing System (explain) B• ❑ Permit Renewal ❑ Permit Revision Change of Plumber ❑ Permit Transfer List Previous Permit Number and Date issued ❑ to Hew Before Expiration Owner IV. of POWTS S stern/Com onent/Device: Check all that a l _ rl esstuized In-Ground ❑ Pressurized In-Ground ❑ Ai-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank Other Dispersal Component (explain) Pretreatment Device (explain) V. Dis rsaVTrea ent Area Information: Desi Flow ? r? / (gpd) Design Soil Application Rate(gp f) Dispersal Area Required (sf) Dispersal oposed S stem E ev 'n VL Tank Info Capacity in Total # of Gallons Manufacnuer New Tanks Gallons Units Existing Tan} r Septic or Holding Tank Dosing Chamber VIh Responsibility Statement- the undersigned, assu responsibility for installation of the POViTS shown on the attached plans. Plum 's Nano (Print) ~ Plum ignature MP/MPRS Number Business Phone 3uniber lumber's Address (Street, City, State, Zip Code 7/`~~ 71, ountylDe artment Use my pproved ❑ Di Permit Fee Date Is d Issuing Ag t igrature g5 •T/ L~ / ❑ Ot G' R for Dcnial IX Conditi sons.flQr D' approval ar. er t:tn; i~ e t,i-4w _ cell must all be ic s rL nta ^ec ~'S r L~ aGf as per 1F@1,4Bement plan prc,ided by Plumber. 2. ` ~tN` [ { @ytt to ~ tre maint<ined as W WWW f AIRIAPN., Attach to compute pLms £or the system and submit to the County only oa paper not less than R 1rz x I1 inches in size SBD-6398 (8 11/11) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 4/23/16 Owner:David Datt Location: SW1A NE1A S32 T29 N,R19W Lot 2 O' Neil Road Hudson Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and )Con ngency Plan 7. Filter Cross Section Signature- _ License number # 00 PLOT PLAN PROJECT David Datt ADDRESS 655 O'Neil Road Hudson Wi 54016 SW 1/4 NE 1/4S 32 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX SYSTEM ELEVATION 94.0/93.5 5' below grade 4/23/16 BEDROOM 5 DATE CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/630 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1091 # of chambers 54 BENCHMARK V.R.P. Top of 1" pvc pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark 398' Property Line Scale = 1/4" = 10' All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Lot Line 4 % Slope B.M.* - O'Neil Road B 2 51' 40' B-1 12' 123' P.L. .4 hip., 3 6' 2-3' X 110' Cells with 98' >3' spacing Vents 99' B-3 10' Huffcutt Combo Tank 20' Pro 5 Bedroom House Vent >6„ Quick4 Standard Leaching Chamber 276' of Cover with 20.0 ft2 of Area 12 5.6ft^2/pair of end caps 4' Long Canyon Road 3 4„ Grade at System Elevation Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation A(I 99.0 Vent A Grade Vent 3' 3, ~ 30/3:44SS e ptic Tank 5' Long 5' 5' Long 1 3611 Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 110' Cells Same on other end Observation tubeNent At end of cell A B 27 chambers per cell System elevations: A-94.0' B-93.5' POWTS OWNER'S MANUAL & MANAGEMENT PLAN P"e._,,.Of r7Pem* NFORMATION SYSTEM SPECiFt =ONS ^ Septic Tank Capacity ( ❑ NA # Septic Tank Manufacturer NA IGN PARAMETERS Effluent Filter Manufacturer Number of Bedrooms CI NA Effluent Filter Model ~i ❑ D NA NA Number of Public Facility Units )UM 'Pump Tank Capacity t NA. j Estimated flow (age) Cy U Pump Tank Manufacturer NA I Design flow (peak), (Estmrated x 1.5) ~ Pump Manufacturer NA Soil Application Rate qaVdaW Pump Model i Standard Infiuermffluent Quality Monthly av NA erage Pretreatment Unit NA Fats' Oll S Grease (FOG) 530 njWL 11 Sand/Gravel Fitter © Peat Filter Biochemical Oxygen Demand (BON) 5220 mg/L ❑ NA D Mechanical Aeration O Wetland Total Suspended Solids (TSS) 5150 mg/L O Disinfection D Other. !Pretreated Effluent Quality Monthly average Dispersal CeII(s) O BiodiernIcal Oxygen Demand (BODs) ,530 mg/L n-Ground (grew/) 13 In-Ground NA Total (pressurized) Suspended Solids (TSS} q0 mgt p At- rode Fecal Conform ❑ Mound (geometric mean) 5104 Cfu/100m1 ❑ Drip-Line 13 Other. !Maximum Effluerrt Particle Size in olio. p NA Other ❑ NA Other: D NA "Values typical for don wsfic war and septic tank effluent Other. ❑ NA NTENANCE SCHEDULE ~ Service Event Service Frequency inspect condition of tank(s) At !seat one everymot s(s) (Maxhrttarm 3 years) DNA (Pump out contents of tank(s) When combined sludge and scum equals one-third {Y~} of tartlc vdfcsne ❑ NA Inspect dispersal cep(s) At least once every: 17.month(s) ~+~KS) (tlllaxtrnum s years) ❑ NA Olean effluent filter ~At least once every months) O NA Inspect pump, pump controls & alarm At least once every: r 13 month(s) 1=1ush laterals and pressure test Yews) At feast once every- ❑ month(s) ❑ year (s) ANA At list once every: sus) r. MmwrENANCE INSTRUCTIONS !Inspections of tanks and dispersal calls shall be mad"y an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POW7'S Inspector, POWfS Maintainer; Se a Servicing O buAide a visual inspection of the tank(s) to identify any missing or broken hardware i Perator. Tank insthe v u must combined sludge and scum and to check for any back up or ~n any sacks or teaks, measure the volume of P ponding of effluent on the ground surface. The dispersal cell(s) shad be vfsuatiy wed to deck the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The pondkrg of effluent on the ground surface may indicate a failing condition and requires the knnvx ate notification of the total 1 egulatory authority. ! Vhen the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of }fie tank shad be moved try a Septage Adminisbative Code. Senricang Operator and disposed of in accordance with chapter NR 113. Wisconsin All other services, including but not limited to the servicing of effluent filters, mecatiaal or pressurized components, pretreatment units, WA 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 Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals theft may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of thb 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 by 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 situWon 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 13 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 POWT$: antibiotics; baby wipes; cigarette butts; -condoms; cotton swabs; degreasers; dental floss; diapers; dis'rnfeatants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting producos; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:. 0 All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage SeNicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compfont rep system: liable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systeM. The ~replacement area should be protected from disturbance and compaction and should not be infringed upon by requirled setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the neled for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rule$ in effect at that time. 13 A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS teehnologK a holding tank may be installed as a last 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 evaiuaOon must be performed to locate a suitable replacement area. if no replacement area is available a holding tank may be installed/ as a Nast resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be recxxrstructed in place following removal of the biomat at the infftlive 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 TANI~ UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O~ A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name ~,y r Name Phone Phone 7/~ oZ _ LI> SEPTAGE SERVICING OPERATOR (PUPAPER) LOCAL REGULATORY AUTHORITY Name Name Phone _J O?S ~oC Phone E This doarrrrerrt was drafted in compliance with chapter SPS 383.22(2xb)(1)(d)&M and 383.64(1), (2) & (3), WWmnsin Administrative Code. rte.., i P'll! i j v , O d i o -Q- - - O a 1 ! i ; ( l v `l- E i C J ST. CROIX COUNI-y SEPTIC TANK MAINTENANCE AG NT AND OWNERS' CERTIFICATION FORM Owner /Buyer Mailing Address S _ 1 ~r Property Address (C c (Veritication requaed from Playing & Zonui D g epartment f w conshuction.) City/State Parcel Identification Number P'? U -/0 - S~ LEGAL DESCRIPTION - Property Location.&L Y. P - Subdivision R, W, Town of Subdivision T _ Certified Survey Map # Lot # y Warranty Deed # Vc.,lume , Page # _ > Ll Volume t{ , p e # Spec house Yes Lot line, identifiable yes no SYSTEM 1~ZAINTENANCE AND OWNER CERTIFICATION Improper use and oain~ of your septic system could result in its sauce consists of Premature isilux,e to handle wastes. lrumPmg out the septic tank every three needed, by a licensed Noper the system can affect the yew or sooner if Abilities are fanction of the septic tank as a treatment stage in the waste disposal system uo Ownermaintenauce iE~ed in ¢Comm 83.52(1) and in Chapter 12 - St Croix County Sanitary Ordinan ce. owner and dbb property owner agrees to submit to St r Croix County Planning & Zoning Department a certification f wastewater Y disposal master plumber, system is in journeyman plumber, restricted plumber or a licensed pumper verifying signed Proper that (1) the on-site less dean 1 /3 full of sludge. inspection and pumping (if necessary), the septic tank is standards Uwe, the undw~ have read the above requirements and set forth, herein, as set by the Department of Commerce and agree the Dto maintain the private sewage disposal system with the Certification stating that your septic system has been t of Natural liesoiurces, state of W' majutained ZO1Q~ impartment within 30 days of the three year must be completed and retuned to theSt. Croix County Ping & e - an date. Uwe oertify that all its on this are true to the best of my/our knowledge. Property gibed above, by virtue of a,we am/are the owner(s) of the deed recorded in Register of Deeds O$ce. N rof I TCANT(S) DATE ***Any infomatioa that is m1srepreseated may result in the sanit&ry permit being revoked by the Planning & Zoning Department Include with this applic aranta y q tY deed fr dee& reference is made in the w om the Register of Deeds Office and a copy of the certified survey map if (REv. osm) ~E F~a ~ ~ A g as ILm,I'Nosami,.,I a_ Leo aFJ it9 `d 5 ae O P .UV Q P 43~~1e S~~f66a f~~ ~~11 cpp P~.. II ~ P~ _ J z I I I > I II z I I Ilr I I 0 I I Q 'I I I I I I I I Illi~ I F I~ I I I a I 1,9 ; I I I f' : I I I I ' _ I I II I I II _ I ' li I I I ' I I ,II I - T17 jT 1I I 'I'II I! I I ' I I I I I I ~ ' I. i l l I I I I I ' IIII II I!I II Il I I II II I I I I I I, I III I I I I III I I I_ ' ~ II III III ~ I 'I I I I I 11 I L I I I I , I. 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CROIX COUNTY, WISCONSIN Current X Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - DATT, DAVID R & VICKI L DAVID R & VICKI L DATT 655 O'NEIL RD HUDSON WI 54016 Property Address(es): Primary Districts: SC = School SP = Special Type Dist # Description SC 2611 SCH DIST OF HUDSON SP 1700 WITC Notes: Legal Description: Acres: 2.010 SEC 32 T29N R19W SW NE PRT OF LOT 2 CSM 5/1347 NKA LOT 2 CSM 16/4292(2.01AC Parcel History: (2.13 AC INC R/VV) Date Doc # Vol/Page Type 11/21/2003 747217 2460/555 WD 02/28/2003 711718 2158/598 LC Plat: * = Primary Tract: (S-T-R 401/4 160%) Block/Condo Bldg: * 4292-CSM 16-4292 020-2002 32-29N-19W LOT 2 2014 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/17/2012 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.010 53,000 0 53,000 NO Totals for 2014: 53,000 General Property 2.010 53,000 0 0 Woodland 0.000 0 Totals for 2013: 53,000 General Property 2.010 53,000 0 0 Woodland 0.000 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges 00 Delinquent Charges 00 Total 0.00 A UnT to .J Wis. Dept. of Safety and Professional,Ser" COUNISOIL EVALUATIO Page of Division of Safety and Buildings D"VELOPMENT it 2&or76nce with SPS 385, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County 1' s~G X include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. l a percent slope, scale or dimensions, north arrow, and location and distance to nearest road. w-, Please print all information. Re ' wed Date Personal information you provide may be used for secondary purposes (Privacy Law, s. i5.o4 (1) (m)). IN " / I Property Owner Property Location !Je Govt Lot 1 /4 ;lI r 1/4 S r' „ ~ G/ / N R / Y (or) 11l Property Owner's Mailing Address Lgq Block # Subd. Name r CSM# 6 City State Zip Code P4one Number ❑ City ❑ Village VITown Nearest Road V ® New Construction Use: [B Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material `l Flood Plain elevation if applicable 11 ft General comments e c •'1 S / t- L/ u i t /0 f' t Y £f and recommendations: S sr•W ^e /uW r f-I Boring a Boring # v ©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 j~ in. ~Munsell Qu.J~S~z- Cont Color Gr. Sz. Sh. y, • ff#1 ff#2 i V 1 Z ~*U~~ k, / /I'~J Lift //l iJt, C_ r7 G/ r.7. Z 12-2-s 7~ ~ s 3 AC ~ G 2, ;h ~ c w r d, 0, ,2, -s r- > t y 10//'? wf' s 2`'i I~1 S C ?J y l7 L C.~ l , Boring # E] Boring F),] 4I Pit Ground surface elev. 7 ft. Depth to limiting factor Z v in. 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