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HomeMy WebLinkAbout040-1116-80-000 ':Visconsin cepa7oiert of ;:c rim""'e PRIVATE SEWAGE SYSTEM ;curry .St. Croix Safety and Bwlcing Grvis on INSPECTION REPORT Sal Pe-mit No. 584780 GENERAL INFORMATION (ATTACH TO PERN111) State Plan ID No'. =ersnnal vdorn _dior yor. p•nvice may be used for secondary purposes [Privacy Law, s.15 04 (1)(l Permit Holder's Name: City Villag,, Towns•up Parcel Tax No. Brett Olson TOWN OF TROY 040-1116-80-000 CST 9M Elev Irsp GM Clev: BM Description S_ecunnJowrrRaryP..'l Nc. /bb Go►,~ r-locil 30.28.19.475B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION RS HI FS ELEV. Septic Benchmark -PO r; i a ale. J!Z-s Alt. Boat' ae.A G 3.9 9G • (8 Aeration ~ Rldg. Sewer Holding St;Ht Inlet Sil Outlet +l TANK SETBACK INFORMATION 9b 9 3. Z • oNK O PI V,E_L BLDG Vet Air Intake ROAD Dt Inlet J1~c ~ Septic / ~?E -.4-- j Dt Rottom Dosing leaden"tan. Aeration Dist Pipe C1 0 Holding Bot, System /O.o 9p , PUMP/SIPHON INFORMATION =final Grade . Q Manufacturer Demand St Cover GPIV Mo umher TDH Friction Loss System H TPR- zt Forcemain Ler.;th 7111a Dist to lve SOIL ABSORPTION SYSTEM BEDITRENCH 'A' dtn Length No. Of Trenches PIT DI NSIONS `.o Of t nside Dia__ Ligwd Depth DIMENSIONS q _ _ - ~ SETBACK SYSTEM TO I ~D l BLDG WELL LAKEiSTREAV LEACHING Man INFORMATION Type Of S CHAMBER OR u`actur "r Illil 1 o Sao 35 3e 7Z UNIT triode Number 4 DISTRIBUTION SYSTEM C J : -I It 4- J $ 3 Header;Man fold I fj Cisinbuh IA Hole Ste rie Spacirg Ive4o Air Intake Length Dia Length C a Spaurg SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over epih Over xz Depth of xx Seeded'Sodcled xx Mulched Red~'renr.h Ce•rter 3ed,Tr•^rch Edges 'opse Ne COMMENTS: (Include code discfepencies, persons present, etc.) Inspection #11. Inspection #2 v r, Location: 112 CTY RD F /1j4d- /~_oJ ar +'Y ~'vt so 1) All AM Description = v Q r~ ss a Bldg sewer length = 2.9 ~ 5 Or• l.~ p - amount of cover = Tti 1/~[., i~ Plan revision Required-, Yes ~No G Y 31/ Use other side for additional information L _ _ _ Y~ S6D 671 1 ;R !.`17: Date Insepc 's Sic Lire Cert No I 1 VT Safety and Buildin isio f Cos fr ` 0 S P ' `-it - i~AY 25 2016 201 W. Washington Ave., 7162 i Sanitary Permit Number (to be fL•ed in by Cn ) Madison, Wi 5 _-71 y" - 5 ST. CROIX COUNTY ✓ U f [J UNITY P ~I Sanitary Permit Application StateTransactionNumh,.t I In uccordanee with SPS 183.21 2), Wk Adm. Code, submission of this form to the appropriate eovenuurn,a! unit N M _ is required prior to obtaining a sanitan permit Note. Application forms for state-owned POM"S arc submitted to Project Address (if 61,crent than mai!irtp-address; the Depa:trneat of Satety and Professionai Servies. Personal information you provide may be used for secondai% Purposes it, accordance with the Privacy Law, s. 15.0r1(1)(tn). Stats. 1. Application Information - Please Pr' I Information Property ihtincr's'damc ' Parcel' ~t' `~jCi C~ -Yo oc) PrOPertyQwact's Nlailir,_ Address; / / - Property I.a:ation - , v _J J` lJr Govt ity, Stat . Lot - ~ - ~ Zip Cr,de Phone Nun- her S F S LL{ 4; Setiti;ttt 3 U cur - - / 7 .2 3 1 le one) 1 N, R - For II. Type of Building (check all that apply) Lot# I or 2 Family D.vcliin'_ Number of Iledr, ; Subdivision Name - - ' Block # I Pub! ic'Cuntmercia! - Describe Use ❑ City of _ State Owned - Describe Use CSNI Number - n village of - - n / KtTON'n of . CzA~ A wJ ~eboxonlineA. 111. Type of Permit: (Check only Complete line B if applicable) ► - Q ❑ New System = e 'acement System l.~ Trealment4lolding'fank Replacement Orly l Cither Nfcdi i.ati:m t. 'urine S,ctem {ev laiu) L_ - 1 I Li;t Previous Permit Number and Dal,: Issued Peuuit Reacssal L-1 Permit Revision ❑ C han^e of Plumber 11 Permit transter to N,-,A Befctc F:vrtirati.v; l hT.er 1 IType of PONY 1 S Systern!Componeny'Device: (Check all that applr) r ~J p.nn-Pre st:ritcd In-Gr,,:.tna ❑ Pre sun ,:d In-Grvrrtd ❑ At-Grade Nlcund' 24 in of suitable soil _ Mound =2.1 in. of suitable s-,ti AJU Hu stn Tank outer Dispersal Cemp:m, nt t•explain) _ ❑ Pretreatment Device (explain- r - • N Dispcrsah`'f•rcalr t:nt Area Information: .'n 1 1 + `•'r, : r), iT; Soil Application Rare'gp sll Disp.rsal Area Required I i L)i;I er:al Ar..i Propcsed fit)- System Flcvati -ri - y~' 6113 IT , Info Ca~aci ' in h ~ Total R C, ~ ',".tnufrehirer ~ , Gallon; i Callon l ~r.it.s hicw TanES F.ai;ting Tanks w P. ptie or Hclding Tark - - - - - /tJl.~ O fC c u l 1 I tay - r f-71 1 I In l%esptt(msththty tatenteut- I, the undtret,ned, uyumc res onaibility f - - p or installation of the PONN I S shown on the uttachcd plans. t I'i_ni}at •;ire (Pr:ntl mh 7_131 - - hTF,S1PR5 Number Ru"inr" fh•,n, Nurrher - I'b.:mh, ~ lr. i.~t_.• r'irc, tint:. 7ih c'isdcl x ill. ruutyDt. r trtment Use Only - \p; n . J I t I fermi: Lec [late stiue ` is nin -tit bi,natarc Lff4. 66 r.c t,s ~r I. r I)~n~zl I\. Condi y5 irk 1 t i1t1 I)i.;tpltroval aisper ai cell trust all be swblc_as ! inf~ng; Y) 5 i L. 1, < <+l~ j G~1 6 as per management plan provided by plumber. ~ 2 Al tsdbt ck regyMef ►ents must,kre•rlairtt;itfied l ti 66 W WVV YN 0 4N04 I as per mKicable wde , c1r6t,a1%n. 612733 , 1 .1;-.,, L !:r:u-, 6. t,• I-din- f r ,Iti••.,: n: am' ~ul•rnit In t`ir („•infv o•ilc r. +a per mgt li>< th.:❑ ` I I I :,i. Lc. iu ~!~r `.Itii: ;~,•i 11 III r r 'x i _ 15,f er W t CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Owner's Name: Owner's .Address: Loaai Description 53 ~ - Township: d . County Subdivision Name -ot Numbe': Parcel 1:1 Nul~~be 0,/0 (//G - 6~CG C 2y I(17 - y0 -GOF~ Paae 1 Index and title Paae 2 Plot P;an Paae 3 Svstem Sizing & Cross-Section Paae G Filter Specs Page 5 Maintenance Information Page,3 Management Pw Page St. Croix Cty Septic Tank Maintenance Forr- Page 'v%'arran:y Deed Page a CSM or Plat Attachments: Soil Tes' & House Plars DesianeriPlumber`-~ License Number: Date Phor_ Numbcr Sicinatur j Gesignec pursuant to the in-Groan Sni. Acs--rctij - ;,,,mporerr. Manual fn, P0V%7,; `Jemi:)r 2.0 SBD-'x:'705-P (N.01t0% Paae 1 c-~ r4 a ~jl v M 1 'J" e7 J , Soii Absorption System Cross Section 4" S&ed!,,a 40 i i f Final Grade PVC, Vest Pipe i I M1 Vera Cap ~ i 1 Systc,~ rv?eva;;an - ~e r Mc-tn ft i .1~l1Jit~t s ' ~~11~?E 1111M 'T 3 ~t Leach Trev& 1 Chambsrs k--- 7 TT i , ! i ! 1(li (T ] TR??T?,? r, R~ - V Dia. Trench 2 Header ~i 1011 H FILL 1 Tr°nr . 3 l Leaching Chamber Specifications Manufac„ urer And Mooe ciSr'. atin ~ sq ft per charm:::, oil Applicatii)n Hate e .'7 Gp`,3/so it _Z /50 t)Pd Design Plow + r---'`- - ,Soil Anp!ir 3tion !late E!SA - ~ IC(larri ~ r- / i ' +.,vrs of ---L ( charr,bers ,uric 1.~ n g t (Y 4-7 _ oft I i o fC~ r i ~ ~\1,i i V ./,y us i j IL .y f~q r T~ ~ ,t p L1 r I i I ~ 1 1 ' ~I - - j _ - = - 'f { r r UJ Z - ~ ~ ) ~ ',f ~ it ~ 1: ~ss /~icrr LLI ~ tJ.1 LLl •:1J " Y / ~ ~ I ~r.t'~"' 6 ~r ~ Z / ::FPPff /F .t ..1J O ~ Ju _ Cf3 \ C~ CI- f \ \ ` \ O N Cl J LA r---=- - t r_ _ LLJ c~ z O c~ LC) U1j ~,17 i~ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pace 1 of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity QG~Cy qal ❑ NA Permit # Septic Tank Manufacturer 0 NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms - C NA Effluent Filter Model6~ - ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity gal 41 NA Estimated flow (average) 0O galiday Pump Tank Manufacturer kNA Design flow (peak;, (Estimated x 1.5) 62 gal;day Pump (Jlanufacturer NA Soil Application Rate gal,,day,'ft Pump Model NA Standard Influent/Effluent Quality Month y average' Pretreatment Unit Z'NA Fats, Oil & Grease (FOG) 530 mg!L ❑ Sand!Gravel Filter Feat Filter Biochemical Oxygen Demand (BOD,) 5220 mg,'L ❑ NA ❑ l0echanical Aeration Wetlanc Total Suspended Solids (TSS) 5150 mg'L ❑ Disinfection ❑ Other; Pretreated Effluent Quality Monthly average Dispersal Cellist . NA Biochemical Oxygen Demand (BOD,) 530 mg!L KIn-Ground (gravity) ❑ In-Ground (pressurized) i Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade Mound Fecal Coliform (geometric mean) 510° cfu-100m1 ❑ Drip-Line . Other: Maximum Effluent Particle Size in dia. ❑ NA 0the ' NA Othe:: 0tha-: 13 NA NA }Values typical for domestic wastev,•ater anc septic tanK a `luent. ~tnJ E NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspec: conditior of tanks; At least once every: , J month(s) (Maximum 3 years) E: NA Pump out contents of tank(sl When combined sludge and scum equals one-third of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA ear(s1 Clean effluent fitter At least once every: 3 Month ❑ NA year s) Inspect pump, pump controls & alarm At least once every: 13 month(s) NA ❑ year(s) Flush laterals and pressure test At leas. once every: ❑ month(s) N^ ❑ year(s) _ Other: At lea,: once every: ❑ month(s) ❑ NA ❑ year(s) Other ❑ NA MAINTENANCE INSTRUCTIONS l^spections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Mastc~ Plumber Restricted Sewer: POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the :ark(s) tc identify any missing or broken hardware, identify any cracks or ieaks. measure the volums o` comoined 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 ievels in the observation pipes and to check for any ponding of effluent on the ground su-face. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notitication of the local regulatory authority. '.Vhen the combined accumulation of sludge and scum in any tank equals one-thire 0,I) 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, 'Xisconsin .Administ-ative Code. All other services, including but not limited To the servicing of effluent filters, mecnanical or pressurized components, pretreatment units, and any servicing at intervals of_-12 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 Z__ START UP AND OPERATION =or new construction,, prior to use of the POIti'"S check trey-.ment 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 tankisi 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 fil. above norma! highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cellis! in one large nose, overloading the celllsl 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 Plum:Der or POV'VTS IJlaintainer to assist in manually operating the pump controls to restore normal levels within the pump tank, Dc not drive or park vehicles ove, tanks and dispersa! cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down siope 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 pumpi water; fruit and vegetaole peelings; gasoiine; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napKins; tarnpons; and water softener brine. ABANDONMENT ' 'hen the PDV,TS tails andr'or is permanently taken out of service the following steps s ,-.all be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping tc tanks and pits shall be disconnected and the abandoned pipe openings sealed. • T:,ie 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 tails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: C A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. -he replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbaci;s from existing and proposed structure, lot lines and wells. Failure to protect the replacement area vdill result in the need for a new soil and site evaluation tc establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable repracement area is not available due to setback and!or soil limitations, Barring advances in POb'vTS technalogy a hoiding tank may be installed as a last resort to replace the failed POWTS. e aiuati C c a no cing wank N/)~ , a i ca is a v, aii i r , r be i e tar e ti- RD+lif37TF1~ 'FD (Z A16W Cn"S7_RCiC 0~ )Mound and at-grade soil adsorption 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 Name ~t-6r e Lh., e Pho ne e - SEPTAGE SERVICING OPERATOR (PUMPEM LOCAL REGULATORY AUTHORITY Name Name =j C( i ~~j J ZON!/U Phone- - Phone S- 3 l0 U Tr.iF no.nument was draftee in ccr-mliance nntr chapter Comm E5.2212)iul"'.lia!&ifi ric E3.=4!1, i21 & ;3;, W!=nsin Administrative Code. START UP AND OPERATION =0r new" c01:>-rUCTIDn, D-iw tc use vi :llc r'Cvti T : heck treetmem tanvts, Inr the. presence D' painting ora:tucts or ltne- Chemicals tnat may imneoe the treatment process and/or damage the -ispersal eelllsl. If high concentrations are ❑eiected have the content;. pf the tanicisl rernoved Dy a septage servicing operator prior tc rise. System start up shall not occur when soi' : conditions are frozen at the infiltrative surface. =luring cower outages pump tanks may fill above normal nianwate- levers. When power is restored the excess was-ew•ater wail' be discharoec to the dispersal cellis) in one ia-ge lose, overloading the cellist and may result in the oackup or surface discharge of effiuum. To avoid trnis situation nave the contents of the pump TWO. removed by a Sep-ape Servicing Operator prior to restoring power tc the effluent pump x contact a Piumber or P:M7S hRaintaine- to assist in manually operating the pump controls tg restore normal levers within the Dump tank. ]c no: drive or Dark vehicles over tanks and dispersa! --elks. Dc not drive or parr: over, or otherwise disturb or com0act, the area vvithir 15 feet dawn sione of any mound or at-grade soi: abso-ptioc area neouction or elimination of the following from the wastewater st-sam may improve the perform ice arc prniono the fife of the amibiutics; D"a'Jy wines; uigarette bULls: condoms; cotton swabs; degreasers; Dental floss; diapers; disinfectants; tat; foundation drain !sump pump; water, 4-uii and vege-able peelings; gasoline; grease; hemicides: meat scraps; medications; oil; :iaintlnc Droducts; best cldes; sanitary napkins; tam Dons; an-- wa-e- sottener brine. ABANDONMENT 1':':yen the PCI TS fails and-or is permanently taken out of semi--e the following steps shay be taken to i:isure that the system is D, oDeriy and safer- a0anciDnec in compiiancc ivith chapter Comm 83.33, W;sconsin Adminstrative Code: • All piping tc tanks ana flits shall be ms--onnected and the abandoned pipe openinas sealed. • The contents o`. all tanks and prs shall be -emove and probe iy disposed of by a Sep-age Servicing Operator. • After Dumping, all tanr:s and pits shall ne excavated and rem-,)vac or their covers -emnved anc the void spa. -c- filled wits soil. gravel or another inert solid materIB:. CONTINGENCY PLAN f th_ F10*7 fails and cannot be repaired the fuliOw,ing rneasures have beer.. Dr must be takon. to p-ovide a cone compliant repta :ement system: C A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil abso-ption system. The replacement area shoule be protec-ed f-om disturhance and compaction and should not de infringed upon by require-- setDacks front existing and proposed structure, iot lines arid wells. Failure to protect the replacement area will result in the need fo- a new soi! and site evaluation to es-ablish a suitable replacement a,ea. Replacement sys-ems must nmpiy with the rules it effect at that time. ❑ suitable replacement area is not available due, to setback a.idlor soi. Iimitatiam. Barring advances i- POA-S teunnoiogy a nDlding tank may be installed as a last resort -o replace the faiiad PC14 i S. c J I w~ o%ail:en - or c ~~J V r❑ ..~li ~:I ❑iac. fly nl-a I C a 7) idina tank v De _ - - e ta,~ec rv ~fZDi-(I~ lea U/~ r45r1,5T'R() Gr l p;j C Mound and a--arade soil agsorption systems may be -econStructed in pia--e following rem, ova of t:'e biornat at the infiltrative surface. Reconstructions p- sue;: system imps. co -ply with the rules in effect at that time. < < WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN L_THAL GASSES ANDiOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC. PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON =ROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALL ER POWTS MAINTAINER Na ne fume Phone 7~5 _ n G" J Prone SEPTAGE SERVICING OPERATOR (PUMPER; LOCAL REGULATORY AUTHORITY Name Name Phone Phone '1 ; j _ Q,, n:5 (JLK;urM!r)'. ❑aLtlec I.- ::omuicance v,,.-,n C^:agier .o-nm ","(dl&if. and & ;.°i.:, '.'V=xisir AominlstiaiTvE ~GCIe. 13AW 4~2 c-T/ - ~ .a. - l' .llj c~ ~7nlri° Tl~ ~~-?j1'ir',?l~ ri~iy?l~ _ - _ _ ©yc -/ll~ - 4 oc~ Pxcel Identification Numt er-tilted sut"E'er pia#1 ~ ~ ~ l ( i.iiw:~ Fage I arrann Deed ibefore 2007)Vi,1ui-) Pane 4` iN S ! Ell MAUNTENANCE, AND M-8-NER CERTIFICATION ~iCi^Cr !L.:: ':n~ t'"t:11Cr-'G?h~ t'•?ti.F ~rF il: " Stc-n zauiv result w i- ^riaT'' um Ia~_!!1.'!' i~l _1alidle tv31 teS. Proper =_e Cur'sism uFpwUpwg out We .igac tank eves-y three years or sooner, it nccdc:f, b~ a iicenseii pumper What Voll ptit into M o r Wept '}5:` ta'K:! M OAK %ep"C t.lBR:':r 3'TOatr•.nt .a,-Ie in ' ,'.S ( 4 , _ .ht~;;" tc i.:,7i7sat ~•~s'em. n-: l '71 'ne te-lsncti =T ev are ;P ecifiCu in § SP5. 3833.52(11) aril in Claper ^ > a „r 12 • St. %F+,lx tc,1BC S~.r~.ltatti• ~nd .iniltit,._ ho pNrcm: , %ner agre:s to s:!baik to A. Croix C,oL'nri Plamiirig & Zoning De} iIn-m? .-rit a ce;,ificatioll form, signed r'~ the 3 iil i.';ieC ^iUt`1hCT, ji)t1InL 'E11: L1 ntulzlber, ICilr:+ I.t'd E.1lliTlh2r (-F i1CL'Li::fCl 1111?)2: YZFtfti IQ~ tliat (1) the -)n-site 1..:•.. 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