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HomeMy WebLinkAbout038-1021-60-100 St. Croix HARVY JR & REBECCA CHRISTENSEN Municipality: TOWN OF STAR PRAIRIE 1098 CTY RD H Permit Number: 584797 NEW RICHMOND WI 54017 Parcel Number: 038102160100 Alt Parcel Number: 04.31.18.910 Site Address: 1098 CTY RD H Components Component Manufacturer Description Last Next Status Schedule Service Service Conventional Infiltrator Quick 4 Standard Current 36 Drainfield Effluent Filter Polylok 525 Current 36 Septic Tank Wieser 1000 gal Current 36 *No data found for Maintenance History, Notices, Violations, Notes Lp-rd @ 1:50 Wisconsin Department of Cc-rmerce PRIVATE SEWAGE SYSTEM County St. Croix Safety and Builcing Divisior INSPECTION REPORT Sanitary Permit Nc: 584797 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No. Nrrsoral irForrn.ahon you provide may be fr.' secor dary purposes (arit'a--y Law, s.15.04 Perrin Holder'; Nam, City Village Town8hip f a'cel Tax Nu: Harvy & Becky Christensen TOWN OF STAR PRAIRIE 038-1021-60-100 CST 3N1 Eiev Insp. EM Elec. :BN1 Descriptior: Seclion7o-wniRargeAlap No j 04.31.18.91 C TANK INFORMATION ELEVATION DATA TYPE MANJFACTI!RER' CAPACITY STATION BS HI FS ELEV. Septic Benchmark - I J , r Alt. BM a Bldg. Sever _ Holding SUHt Inlet Ly SVHt Outlet p TANK SETBACK INFORMATION TANK TO PiL WELL BLCG, Vert 'c Air I-itake ROAD Dt Inlet Septic 77- t , Dt Bottom Dosing Header/Man. y JS 1, G Aeration Dist. Pipe Holding But. Sys-ern Final Grade J PUMP/SIPHON INFORMATION l S tvlarufacturer Demand ov GPM Model Number TDH Lift Friction Loss System Head T D'i Ft Forcemain Length Dia. Dist to Well SOIL ABSORPTION SYSTEM J BEDJTRENCH ;Vidti l Hngth -t- Nn Of Trenches PIT DIMENSIONS No. Of Pis Inside Dia. I itlwd L'eplh DIMENSIONS SETBACK SYSTEM TO P ,'L B WELL LAKEiSTREANI LEACHING Manufacturer: , INFORMATION CHAMBER OR I 1 Type Of System- ~F UNIT Model Number: ~i v')v '11 DISTRIBUTION SYSTEM / Heade t"anifold Uis'ribution x I lole Size x He'e Spacing Ven. to Air Intake Pipe(s) I~ Lc rllh ?,a I engt•I I: a Sp:ar.,nq r l { ( 1{ „ SOIL COVER ; x Pressure Systems Only xx Mound Or At-Grade Systems Only 1b, r Depth Over Depth Over , 1 1 jxx Depth of 1xx Seeced,Sodded x Milched BedlTrench Center Bed.-rerch Edges Topsoil - / es No Yes No COMMENTS: (Include code discrepenc,es, persons present, etc) Inspect on 41: Inspection #2: Location: 1098 CTY RD ' +1 (x.11 I 1 I N n 1.) Alt BM Description - l-L 2.) Bldg sexier length - i J O ( WL O - amount of cover = t ) Plan rev sion Recuired? Yes rNd No Use other side for additional Information. DV are In§epclofS S'gnahu~ We. SBD-6710 (R.3,'97. county 1 < RECEIVED industry Services Division k' p 1400 E Washington Ave PS Sanitary Permit Number (to be filled in by Co.) P.O. Box ~ JUN 0 3 2116 Madison WI 53707-74A2 ~ 717 iYK1L~SA~' ST . C 0Pwj0*pp1ication i°n Na bar In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this firm to the appropriate governmental unit f is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address (i[ ditTerent than mailing address) purposes in accordance with the Privacy Law, s. 15.1)4(1 Xm), Stats. V L~ 1. Application Information - Please Print All Infor o Property wner's Name I Parcel # j' e Property ner's Mailing Address Property Locatioo [P .3 1.1g C Govt. Lot City, S Zip Code Phone Number N~ %L J E '~ti Section I (circle ) i :/a T_ -7 / N R E ot(l Lot # H. Type of Building (check all that apply) a 1 or 2 Family Duelling - Number of Bedr J ~ Subdivision Name ❑ PublicACommercial - Describe Use Block A ❑ City of ❑ State owned - Describe Use ❑ Village of M Number ❑ q Town of 3 610~, q c 4 " Ill. T of Permit: (Check only le box on line A. Complete lire B if applicable) A. ❑ New System Replacement System ❑ TrearmentMolding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Pcmtit Number and Dale Issued Before Expiration Number Owner L _L IV. Type of POWTS S stem.!Com nertMevice: (Check all that apply) Non-Pressurized In-Ground ❑ Pressurized "round ❑ AI-Grade ❑ Mound 24 in. of suitable soil ❑ Mound < 24 is of suitable soil Q ❑ o ntg Tank r Dispersal Component (explain) ❑ Pretreatment Device (explain) r S V. Dis rsalfi"reatmen Area Information: Design Flow (gpd) Design Soil Application Dispersal Area Required (sf) Dispersal Area Proposed ( System Elevation Rate(gpdsf) L Vl. Tank to Capacity in S Total N 70 Gallons Ga llons Units tanuf~urea ~ ~ ~ t; y ~ s Pkw Tanis Existing Tams ' l O / V ~Z P. U in 2 v~ u. U C_ Septic or Mding Tank E) 0 ❑ ❑ ❑ Dosing Chamber / ❑ ❑ l,omlity for installation of the FONNTS shows on the attarbed pleas VII. Respo ibility Statement- 1, the undersigned, assume pespons Plurn me n j Plumber's MPi`MPRS Number Business Phone Number Plumber's Address (Street. City. State, "Lip Code 'N'IN(Countv/Department Use Only pproved . ppnw Permit Fee Bate Issuin nt Signal RReason for Denial I S • 1/O i1no IX Condi a q~ Disapproval duper-.5i oell must all 1LLIULW! rn, inla'rec as per r *neown nt plan provlded`by plumber. , 2. AN saft*4 t w.k-ba molnttiiiad as par ap able nod. / cn inwim. Attach to complete plane for the system and submit to the County unh on paper not less than 8 u z K 11 inches in sae ;its-~7~/4,'{J,~ i;~.•r_ "7wy"~ - _ ~ ~ ~'~/~C_ _ _ - - ,c_/G,ll'l~ ~C/:'i~r'.'- .~_r,`eWr-, i.: p>.u~ c•a+ c~•'l~ii{.C-~~~ Ic,P ~ - - ` I4-I l ~ - 6 - I , I - 211 ~ I i i CONVENTIONAL COMPONENT DESIGN Residential application INDEX AND TITLE PAGE Far- t~ttie:arr~ =31fe ; Project #~a~e ~pdotPta~ Name: ~~;~y~tsrrf szrig c>5s ~ectson Owner's Page 4: :t Speos Name: , r <<x page 5` Ma4rrfgnanee ;n€arrr~at~an Owner's / gage 6'! Nlzfladerr c_m. Plan Address: Page 7`SePtic Tankr Mau~tertanee i=orrn i?dg~ ~ GSfUi ~jr Pla# ; ~ttaclt~nen~ S;oll Test Legal Description: Subdivision: Lot # Town: County: Parcei ID# L Designer/Plumber: License Signature:%~~" Date: [Comments 1 I Designed pursuant to the In-Ground Soil Absorption Component P/lanual for POWTS Version z.u ,ides=Title ?iii:%lJl~ 6 y f i 1 13~ ti' 4' b 3 /3 - / 'y {iY~1v KYL'4~ 1 ~1 Y f,74d i I 1 1 Soil Absorption System Cross Section ft ~J r ft 4° Sdtedule 40 Final Grade PVC Vent Pipe With Vent Capft Leaching - ,1 t{ Chamber System Elevation ft Soil Absorption System Plan View f 1 ^r ft Leaching Trench 1 Chambers 4' Dia Trench 2 Header Vent Or Observation Pipe Trench 3 Leaching Chamber Specifications Manufacturer And Modef EISA Ratin > sq ft per chamber Soil Application Rate gpd/sq ft gpd Design Flow - Soil Application Rate EISA = .-f Chambers 3 rows of ~r chambers each. Page of L 8 MUTE F-I 81As1~ ``~-~f C.IIONSS { 1 :r - Ffj F - _ to. tR~ r _ Step is stop 2; ksWa#bM ~ the (A) Cie thO tip hOtRsiM on tW (A) Locate ttw audet of ifie G Tank (A) iif hnuft on to to oufiek Tape- nutter P438- P) Remove €antc cover and pump lank (8) midge In the make sure that the hOLMW (B) try tt~ if newly is posifironed so ifiefl€er can be housing, ivaj&g saw ft Mier ama,e3 tam ahe ttk for Gw#kwe is in u~ maintenewe- and setvic e~Y MAINTENANCE NS MA& Wo. v-i; r - - t - _ ` _ - 1 - _ S'f-p L- SAS 3: Garutwe back Step 1: Lacafe the auttef of the septic rank. (A) Remove tar+f4 river and pump (a) $1e spa #a housbV qtr #0 ' is t N aRoed (B) Pug the ' ar ofihe tag- aad W* {G) HMa oftheWter o altle sew Mfr- cover . ~ n F i 1 C _ G { J, male sum a!1 somas fall badc i~ #a POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORM ION SYSTEM SPECIFICATIONS Owner T1 , I Tank Manufacturer. ❑ NA Permit # 0 Septic ❑ Dose ❑ Holding Volume: (gal) DESIGN PARAMETERS Tank Manufacturer. NA Number of Bedrooms: ❑ NA D Septic ❑ Dose O Holding Volume: (gal) Number of Public Facility Units: NA Vertical Distance Tank Bottom(s) to Service Pad: (ft) Estimated (average) Flow : (gal/day) Horizontal Distance Tank(s) to Service Pad. (ft) Specific servicing mechanics must be provided if vertical is >15 feet or Design (peak) Flow = (estimated x 1.5): (gallday) if horizontal is >150 feet. Spectfic instructions t be provided on back. In Situ Soil Application Rate: (galday ft2) Effluent Filter Manufacturer. ❑ NA Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model: Fats, Oil & Grease (FOG) s30 mg/L Pump Manufacturer: Biochemical Oxygen Demand (BOD5) 5220 mg/L ❑ NA O NA Total Suspended Solids (TSS) s150 mg/L Pump Model: High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L Manufacturer. ❑ Mechanical Aeration ❑ Peat Filter (RODS) >150 mg!L NA NA ❑ Disinfection ❑ Wetland Pretreated Effluent Monthly average ❑ Sand/Gravel Filter ❑ Other: (BOD5) s30 mg/L Soil Absorption System (TSS) 530 mg1L Zf NA Fecal Coliform (geometric mean) 5510` f dln-Ground (gravity) ❑ In-Ground (pressure) [3 NA - - - ❑ At-Grade ❑ Mound Maximum Effluent Particle Size in dia. ❑ NA ❑ Drip-Line ❑ Other: Other: ❑ NA Other: p NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume ❑ When the high water alarm is activated Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA year(s) Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA ® year(s) Clean effluent filter At least once every: ? D month(s) ❑ NA 0 year(s) Inspect pump, pump controls & alarm At least once every. ❑ month(s) o NA _ ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) H NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). 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 a check for any back up or ponding of effluent on the ground surface. The soil absorption system 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 treatment tank equals one-third (X) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator (pumper) 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 serviang at intervals of 5_12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. GMW-005 (02/05) 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 that may impede the treatment process and/or damage the dispersal cell(sl. 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 soil and site ovaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. 0 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. The site has not evaluated been eva( at on must he performedto locate atI suitable suitable r placem replacement ent a ea. area. no replacement area l is available 0 a holding tank may be installed as a last resort to replace the failed POWTS. 0 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 INSTALL , POWTS MAINTAINER Name - Name Phone -I ~76'Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone This document was drafted in cumpfiance with chapter Comm 93.22[2)[bl(1)1d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK NLAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM ON nerlBuver '1 i - I c ? ' _ . iviailing Address z,~l f, Property Address (Verification required from Planning & Zoning Department for new construction.) City!State Parcel Identification Number LEGAL DESCRIPTION Property Location _ lr4 , --;Z '/4 , Sec. , T l NR W, Town of A. Ac_ Subdivision Plat: , Lot # Certified Survey Map # Volume Page Warranty Deed # (before 2007)Volume Paze Spec house v yexno Lot lines identifiable ;~ves 7r no SYSTEM MAINTENANCE AND OWNER CERTIFICATI; Improper use and maintenance of your septic system could result i . a t[ L , ,r _ maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed r- - r the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Ou responsibilities are specified in §SPS. 383.52(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 forui, ~:;;ned by u~.- 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 tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services 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. I1we certify that all statements on this fo are true to the best of my/our knowledge. I./we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Ndfn of bedrooms . _T SIGNA 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. ORFV 04121 Wisconsin Department oREQ61M?rtt ervices y Division of Industry Services 11 a JUN 03' r> 0 1 ~ ; SOIL EVALUATION REPORT Pages cf NTY ,ordance with Comm 85, Vt4s. Adm. Code County S r. CROIX CoU , Attach complete c/YdWbhlbNWdDEV X11 inches in size. Plan must r' include, but not limited to: vertca' and ho•izontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions north arrow, and location and distance to nearest road. Please print all information. Revie by Date Personal information you provide may be used for seconday purposes (Privacy Law, E. 15 04 (1) (-Ti)) ~f $ lU Property Owner Property Location T Govt. Lot 1i4 114 S T = N R Q E (or) W Property Owner's Mailing Address Loo # Block # Subd. Name or SM# LZZ/ A' IV City State Zip Code Phone Number ity Village Tavrr Nearest Road New Construction Use Residential I Number of bedrooms _ Code derived design flow rate GPD Replacement Public or commercial - Describe: Parent material _ Flood Plain elevation if applicable General comments C i~ f f-. and recommendations: 11 Boring Boring # a pit Ground surface elev. ft. Depth to limiting factor L;! in Soil Ap: cation Rate Ho•izon Depth Dominant Color Redox Description Texture Structure Consistence Boundary R=s GPLYff in. Munsell Qu Sz Cont Colo- Gr. Sz. Sh. Eft#1 'Eff#2 ~5z' /w Z-1 L. ILI' 24 12A -7 ❑ Boring # © Bar rc x !0 Pit Greurd surface elev. ft. Depth to limiting factor in Soil r, pl cation Rate Horizon Depth Dominant Ce or Redox Description Texture Structure Consistence Boundary Roots GPD,'ff in. Munsell Qu. Sz. Cork. Color Gr. Sz. Sh. "Eff#1 "Ef~#2 C. Eflu(W #1 = BOD, > 35 < 220 mgA_ and TSS >30 < 150 rnn'L _,Lent # D < 30 mg,L and TSS < 30 rr,L CST Nameease P t) Signature CST Number Address ate Evaluation Conducted Telephone Number I l Propery Owner - Parcel ID ii Page of Boring Borira # ® Pit Ground surface elev. ft Depth. to Smiling factor in. Application Rate Horizon Depth Dominant Color Redox Descripticn Texture Structure Consistence Boundary Roots GPDrff in. lvtunsell Gu. Sz. Con:. Color G• Sz. Sh 'Eff#1 'Eff#2 r FYI Boring # Bor rg M p t Ground surface elev. r ft. Depth to limiting factor in. Soil Application Rate I lorizcn Depth Dominan' c6cr Redox Description Texture Structure Consistence Bounda: f Roots GPDJF in Mansell Qu. Sz. Cont. Colo' Gr. Sz. Sh. "Eff#1 'Eff#2 1 n - 42 ;L 7 i4l 00- Il Boring Eorr" # Ground surface e'ev. ft. Depth to limit rig fader in. r Pit Soil Appl cation Rate Hcrizon Depth Dominant Color Redox Description Texture Structure Cors stence Bcundary Reets GPDfft= in. Muns_II Ou. Sz. Cont. Color G•. Sz Sh. 'Eff4i 'Ef#2 Eff uert #1 = ROD > 30 < 220 mq'L erd T S -30 < 150 mg'L E`rluent #2 = BOD. < 30 mgL and TSS < 30 mg'L SEC-ft--_'F.i71?i ope ty :J~.n u r'--- Parcel ID _ Pane - o _ Boring # 'ring lit Ground surface elev.ft. Depth to limiting factor in. C~j Soi'. Ap Gcatior. '.ate i Fianzor Dep`.n Dominant Colo. Pedox Descripf:cn texture Structure Consistence boundary Roots uPD;fF in. tut_nsel Qu Sz. Cont Color Gr Sz. Sh 'E r1 'E`f;~2 r,.. LZL i 21 v boring ~ Cl 3cring Fit Ground su ace elev. ft. Depth to I mitirg factor it Soil ?,cc;ica-ron Rate -lonzor Depti Dominant Coior Pedox Desc~;: ion Texture Structure Consistence Bcunjnry Roos G?Dif~' in Munsell Ou. Sz Cont. Color Gr. Ez Sh. `E T1 `Efih2 ~n- % / 7 ' ~t U boring Boring F]Pli-. ;ror.rr' su-Pace elev.. _ ft. Depth to lim ting factor in. Soli AIpl'~afior la's Horizon Depth I Cc-nirant CoP.edcx Descript en exiure Structure Consistence 3ounda-y Roots Col' in f/ursell Du. Sz. Cont. Colo *Eft, 'Ef-?2 ~ I l I'hl ~ t i y 96 W k 6 /ys I 1- ' 1 Sy; o - G+rirbc J~ ~ g 1 Je I 1 -r-