HomeMy WebLinkAbout040-1326-10-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
584784
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: City Village Township Parcel Tax No:
DCCI Land Planners TOWN OF TROY 040-1326-10-000
CST BM Elev: Insp. M Elev: BM DA t Section/Town/Range/Map No:
17.28.19.2202
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER • CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
+ltj t /ado /3 3 //.fb ins .
Dosing Lr a~0 ` (06 Alt. B 1
Aeration Bldg. Sewer 08
gyp[ j► St/Ht Inlet 4, ~ /i67•
TANK SETBACK INFORMATION St/Ht Outlet 441 167- 6
Q
O
`
TANK TO G P/ WELL BLDG. Vent t Air Intake ROAD Dt Inlet
Septic ! J# Dt Bottom
Dosing Header/Man.
Aeration Dist. Pipe . S
/aS Holding Bot. System fo. s /a S
7. im 1,6 A/. S.3
PUMP/SIPHON INFORMATION Final Grade (O - 7
Manufacturer Demand St Covey ~K 6 . 5
GPM
Model Number
TDH Lift Friction Loss System Head Ft
Forcemain Length Dist. to Well
SOIL ABSORPTION YSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits_ Inside Dia. Liquid Depth
DIMENSIONS
/ Z
,3 1 , AGOIA
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufactur
INFORMATION CHAMBER OR 9•
Type Of System: UNIT Model lb 1r~6
DISTRIBUTION SYSTEM 7- 74- Z 7. S
Header/Manifoly 1! ID istribution x Hole Size re Spacing Vent-too A t e
~j Pipe(s) ` -
Length V Dia T Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over , r Depth Over xx Depth of T Seeded/Sodded xx Iched
Bed/Trench Center y.• Z~ Bed/Trench Edges Topsoil v Yes No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 394MEADOW V L YTRL
1.) Alt BM Description =
2.) Bldg sewer length = 46
- amount of cover = dl « O n
Plan revision Required? Yes -J4:~No JLZ~ Us e other side for additional formation. Date Insepcto Signature Cert. No.
SBD-6710 (R.3/97)
1 - Safety and B gs Division ✓ ( ; 7
{ 9~ t~ ry ft 201 W. Washingto e.; P . Box 7162 San;
r 1 U Madison Wl tary Permit Number (to be filled in by Co.)
5T CROfX CC7U 7 lz~
anitary Permit Application Stale Trmsact~~Nutober
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate gov tai emit Nlfn])~,
is required prior to obtaining a sanitary pernut Note: Application fortes for state-owned POWTS are submitted to Project Address (if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary
oses in accordance with the PriVacy Law, s. 15.04{1) m), Stats. e
1. Application Information - Please Print All Information J~ Lf _ ~~1 ~L
Property Owner's Name
Parcel #
1 ~
4- C ),L,~
Property Owners Mailing A
ddress Property Location
SOS- 17. 9" 111
/_~V Govt. Lot
City, State zip Code Phone Number /i/~[J / l
Section
1 L? j - 7 ircle one
II. Type of Building (check all that apply) L o T N; R E
or 2 Family Dwelling-Number of Bedrooms Subdivision Name
Block
El ) f?Z Gam. dl '
Public/Commercial -Describe Use c~
ev-m- Q City of
11 State Owned - Describe Use , CSM Number Q vwage of
WI {l ~f v'~' 111 w of L
III. Type of Permit: (Check only on of on line A. Complete line B if applicable)
A. d
ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only Q Other Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision Q Change of Plumber List Previous Permit Number and Date lssued
Q Permit Transfer to New
Before Expiration Owner
IV J4
. e of POWTS S stem/Com onent/Device: Check all that apply)
,
Non-Pressurized In-Ground Q Pressurized In-Ground Q At-Grade Q Mound > 24 in. of suitable soil Q Momid < 24 in. of suite so'
Q Holding Tank Other Dispersal Component (exp )
❑ Pretreatment Device (explain)
V. Dispersal/Treat ent Area Information:
E%i Flow (gpd) Desi Soil
J 1 gn Application Rate dsf) Dispersal Area Required (sf) / Dis al Area opose (sf) 5ystcm Ele o
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units ° p
New Tanks Existing Tasks .mow v J „ r
Septic or Holdwg Tank
Dosing ctaM
VII. Responsibility Statem t- I the undersigned, ass e r ponsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumb Si ature MP/MPRS Number Business Phone Number
Plumber's Ad ess (Street, City: State, Zip Co
VIII. ountylDe artment Use Only
Approved rpt Permit Fee Da Issu Issuing ent Signature
en Reason for Den $ 5 '
IX. Conditl&Vfis£Aj)~basons for Disapproval
1. 5epti~ tank, etflufunt filter and 3 o Ar 4, ,
disperv -,i cell must all be sw~lces r tn~ iritaire~
as per rnaragement plan provided by plumber. b fa j h
2 ~Ak lirk requireMents must we r;~Ialnts,in"ed O~
as per. I VpAcable code / ordinances.
AYmcb to complete plans for the system sad sabmit to the County Daly as paper noY less than S is z I1 inches in size
SBD-6398 (R 11/11)
PLOT PLAN
PROJECT DCCI Land Pianners ADDRESS 1505 i-iwv 65 New Richmond Wi 54017
NW 1/4 NW 1/4S 17 /T 28 N/R 19 W TOWN Troy COUNTY ST.CROIX
SYSTEM ELEVATION 106.0/105.0/104.0 5'below 5/27/16 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 1096 # of chambers 54
kk BENCHMARK V.R.P. Top of 1" steel pipe ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE O WELL *H.R.P. same as benchmark
39'
Scale = 1/4'1 = 10'
44' All piping shall be ASTM SDR 301/34, within
106' 10' of tank, piping shall be ASTM F891
117'
41' 108'
143' 110'
70' 12% B-2
Slope
vents
109,
.M.*
B-1 - Property Line
B-3
3-3' X 74' cell it 3.9spacing
15' Combo ST q~
20'
Pros
Bedroom
House G
Property Line
Vent
>6" Quick4 Standard
Leaching Chamber a'
of Cover with 20.0 ft2 of Area J Meadow Valley Trail
5.6ft^2/pair of end caps
4' Long 1
34" Grade at System Elevation
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 5/26/16
Owner:DCCI Land Planners
Location: NW1/4 NW1/4 S17 T28 N,R19W 394 Meadow Valley Trail Troy
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4-6. Maintanance and contingency Plan
7. Filter Cross Section,
Signature
License number #226 00
PLOT PLAN
PROJECT DCCI Land Planners ADDRESS 1505 Hwv 65 New Richmond Wi 54017
NW 1/4 NW 1/4S 17 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX
SYSTEM ELEVATION 106.0/105.0/104.0 5'beloW 5/27/16 5
DATE BEDROOM
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 1096 # of chambers 54
BENCHMARK V.R.P. Top of 1" steel pipe ASSUME ELEVATION loo' Filter Lifetime Filter
❑ BOREHOLE O WELL *H.R.P. sameasbenchmark
39'
Scale = 1/4'1 = 10'
44' All piping shall be ASTM SDR 30/34, within
106' 10' of tank, piping shall be ASTM F891
117'
41' 108'
143' 110' . -
70 12% B-2
Slope
vents
109'
B.M.*
B-1 Property Line
B-3
3-3' X 74' cells with >3' spacing
15'
Combo ST O
20'
Pro 5
Bedroom
House
Property Line
Vent
>6" Quick4 Standard
of Cover Leaching Chamber Meadow Valley Trail
with 20.0 ft2 of Area
12„ 5.6ft^2/pair of end caps
Long
34" Grade at System Elevation
Cross Section of Quick 4 Standard Leaching Chamber
Typical cross section for 2 of 3 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 111'
Vent Grade L4
4' 4" 4'
X30/34 Septic Tank
Long 1 5' 4' LonGrade at System Elevation
3491 Grade at System Elevation 3 Spacing 5'
3-3' X 102' Cells
Observation tubeNent
Same on other end To be located on end of Cells
i
~%A
B
System elevations: C
A-1 06.0'
B-1 05.0'
C 104.0'
18 chambers per cell
POWTS OWNER'S MANUAL $ MANAGEMENT PLAN Page of
ILE INFORMATION SYSTEM SPECIFICATIONS
Owner
bcca- Permit # LO P/r- --Z' Septic Tank Capacity {1 11 NA
Septic Tank Manufacturer C NA
IGN PARAMETERS Effluent Filter Manufacturer
Number of Bedrooms ❑ NA
a NA Effluent Firer Model ❑ NA
Number of Public Facility Units NA Pump Tank Capacity
j Estimated flow (average) NA
l j u Pump Tank Manufacturer NA
i Design flow (peak), (Estimated x 1.5) , ada Pump Manufacturer
NA
Soil Application Rate
' ~ Pump Model
i Standard InfluerrtlEftluent Quality Month aNA
Pretreatment Unit
Fats; Oil & Grease (FOG) p Sand/Grovel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODs) 420 nVIL ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Soi (TSS) 59 0 Disinfection ❑ Other.
Pretreated Effluent Quality Monthly Broc~nerracai Oxygen Demand (BODs) 530 average Dispersal Cell(s) 13 NA
Tote! Suspended Solids (TSS} cap m~ n-Ground (gravity) E3 In-Ground (pressurized
- ❑ At-Grade L3 Mound
Fecal Colibm {geometric mean) 5104 cfu/1 OOml ❑ Drip-Line
❑ Other.
iMaximum Effluent Particle Size 36 in dia. p NA Other.
D
NA
Other.
❑ NA
'Values typical for domestic wastewater and septic taunt effluent Other.
❑ NA
NTENANCE SCHEDULE
Service Event Service Frequency
Vnspect condition of tank(s) At least once every: ❑ month {s)
;,0 s (Maxnttm 3 years] DNA
(Pump out contents of tank(s) When combined sludge and scum equals one-third
Inspect dispersal call(s) of tank vbhnne E3 NA
At least once every: ❑ month(s) (Maximum 3 Years
~fyear(s) ) DNA
Clean effluent filter
At least once every. / ❑ morrth{s)
O
S) NA
Inspect pump, pump controls & alarm At least once every: 0 (s) NA
year(s)
I:lush laterals and pressure test At least once every: 0 year(s) NA
At least once every: ❑ month{s}
r. D years} A
NA
14YAINTENANCE INSTRUCTIONS
llrispec Lions of tanks and dispersal cells shall be madeby an individual carrying one of the following licenses or certi
Plumber; Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer, Sef~9e inspections Master
include a visual inspection of the tank(s) to identify any missing or broken hardware, identify n cracg or le tor. Tank e th must
icombined sludge and scum and to check for arry back u w any or measure the volume of
Visually wed to check the effluent levels in the observation ponding pipes of and to c t onheck the ground surface. The dispersal cell(s) shad e.
'The Po~g of effluent on the ground surface may indicate a felting condition and requires the immediate notification of the local
:Mw the combined accumulation of sludge and scum in any tank equals one-third
or more of the tank volume, the entire conterrts of
floe tank shall be removed by a
Septage
Administrative Code. Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin
All other services, including but not limited to the servicing of effluent filters, mechanical or pressuried components, pr at units,
Ind 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 tt*t
may impede the treatment process and/or damage the .dispersal cell(s). If high concentrations are detected have the contents of tho
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 bie
discharged to the dispersal cep(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 this
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 improver the performance and prolong the life of the POW 7$-
antibiotics; baby wipes; cigarette bunts; -condoms; cotton swabs; degreasers; dental floss; diapers; dts'rnfectants: fat; foundation drajin
(sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products;
pestic les; 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 safety abandoned in compliance with Chapter Comm 133.33, Wisconsin Administrative Code:.
• Ail 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 property 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 cornpliarrt
replacement system:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system.
fie replacement area should be protected from disturbance and conpacfion and should not be infringed upon by requhled
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 evaluation to establish a suitable replacement area. Replacement systems must comply with the rule:i 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.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWT'S 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 instWIW 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 ANDIOR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TAME' 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
Marne r Name `j frL~
r,
Phone - ~Phone
SEPTAGE SERVICING OPERATOR (POMPER) LOCAL REGULATORY AUTHORITY
Name Name ( < D k
Phone Phone ? J ~7
This document was drafted in compliance with chapter SPS 383.22(2)(b)(%d)&(f1 and 383.64(1), (2) & (3), Wisconsin Administrative Code.
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LUATfONEPORT #1749
JV' IL EVA R
` S S P t Safety and ' accordance wiffi omm Adm. Code Page 1 of 3
{ Professional Sgrviceg' Schmitt Soil Testing, Inc.
A(lli f ?014 County
Attach complete site pIA opt{ of less than 8Yz x 11 inches in size. Plan must St. Croix
include, but not limited Iii ic'at'a~d~r erence point (BM), direction and
percent slope, scale of ~d~ fi¢7 ej5, geation and distance to nearest road. Parcel I.D.O VIl
Please print all information. Rev' wed B I//,, DGaJt
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Gry^' / / l
Property Owner Property Location
DCCI Land _Planners _ _ Govt. Lot NW1/4, NW1/4, S17, T28N, R19W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
1505 Hwy 65 P.O. Box 445 1 p Meadow Valley Of Troy
City State Zip Code Phone Number City Village Town Nearest Road
New Richmond WI 54017 Troy East Cove Rd
1 New Construction Use: Residential / Number of bedrooms _ 4 Code derived design flow rate 600 _GPD
j Replacement Public or commercial - Describe:
Parent material Outwash Sand NA ft.
Flood plain elevation, if applicable
General comments Area is suitable for a conventional system with a 0.7 gpd/sgft rate. Possible system elevation for Area 1 (Step trenches) 106.9' &
and recommendations: 1057. Slope is 2%.
0 ht;
Boring # !--F Boring
Pit Ground surface elev. 106.66 ft. Depth to limiting factor 110+ in. Soil Application Rate
Fil j
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 0-20 10yr3/2 none sl 2mgr mvfr gw ivf 0.6 1.0
2 20-29 10yr3/4 none sl 2msbk mfr gw ivf 0.6 1.0
3 29-40 7.5yr5/6 none grs Osg ml cs 0.7 1.6
4 40-110 10yr6/4 none s 05g ml 0.7 1.6
Boring # i Boring
Pit Ground surface elev. 108.63 ft. Depth to limiting factor 115+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/I
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 0-12 10yr3/2 none sl 2mgr mvfr cs 2vf 0.6 1.0
2 12-20 10yr3/4 none grls Osg ml gw ivf 0.7 1.6
3 20-72 10yr5/6 none cos Osg ml as 0.7 1.6
4 72-115 10yr6/4 none s Osg ml 0.7 1.6
' Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 j j30 mg/L and TSS -s30 mg/L
CST Name (Please Print) Signature: CST Number
Thomas J. Schmitt 227429
Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number
1595 72nd Street New Richmond, WI 54017 5/5/2014 715-760-1978
S13D-8330 (R 07/00)
Property Owner DCCI Land Planners _ Parcel ID # Page 2 of 3
Boring
F73 Boring # pit Ground surface elev. 110.98 ft. Depth to limiting factor 112+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-15 10yr3/3 none sl 2fsbk mfr gw 2vf 0.6 1.0
2 15-32 10yr4/4 none sl 2fsbk mfr gw 2m,1vf 0.6 1.0
3 32-56 10yr5/6 none Cos Osg ml as 0.7 1.6
4 56-112 10yr6/4 none s Osg ml 0.7 1.6
F-1 [ J Boring
Boring # pit Ground surface elev. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
I
j Boring
Boring # ,I pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 < 30 mg/L and TSS <30 mg/L
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SBD-8330 (R.07/00) Schmitt Soil Testing, Inc.
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Page 3 of 3
Conducted bv: - Conducted For-
Schmitt Soil Testing. Inc. Name: DCCI Land Planners
Thomas J. Schmitt, CST 227429 Address: 1505 Hwy 65
1595 72nd St. - City, State, Zip: New Richmond, W154017 -
'
New Richmond, WI 54017
Phone: 715-760-1978 Subdivision: Meadow Valley Of Troy
Signature Lot No. 10
Date -S=s of y/ Legal Description: NW1/4 NW1/4 S17 T28N R19W -
■ Backhoe Pit Township, County: Troy Township, St. Croix County
A Bench Mark 1 El. 100.00' Top of 1" Steel Pipe. SW Lot corner pipe. _ (861.25')
Q Bench Mark 2 El. 101 M'Top of 1" Steel Pipe. NW Lot corner pipe. _ (863.03')
Slope= 12% - - -
Scale 1"= 40' ( bm 2
N c i
OUTLor yNl
117' 0100
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s oG, /
cJ
_ Prof 056-Y
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