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HomeMy WebLinkAbout042-1016-10-600 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Building Division St. Croix INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 589792 Personal information you provide may be used for secondary No. purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village Townshi Oevering Homes y g p Parcel Tax No: TOWN OF WARREN 042-1016-10-600 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No TANK INFORMATION 07.29.18.97E ELEVATION DATA TYPE MANUFACTURER n r _ „ A CAPACITY STATION BS HI FS ELEV. Septic t Benchmark Dosin D) 70 Alt. M Bldg. Sew r t Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO tP WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing S ea de an. C Aeration V J ' ~ ~ w • I Dist. Pie I C C1 Hol J ' ' Bot. System Nor ' . 2 T3 ilt PUMP/SIPHON INFORMATION Final Grade Manufacturer I Deman y St Cover GPM Model Number A-~ r S TDH Lift Friction Los System Head TD11 fI Ft Forcemain LP~pt~l. Dia. ~t Dist. to Well N~k SOIL ABSORPTION SYSTEM BED/TRENCH Width ' Lengt I No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS J SETBACK SYSTEM TO P/L BLDG WELL LAKE/STRE LEACHING Manufactu INFORMATION Ty e Of $ystem: I I~ I~) CHAMBER OR re 11 6'v -WDQL UNIT Mode m":"k- Wk)? 215- D BUTION SYSTEM I A~ eader/M ifold Distribution f Pipe(s) x Hole Size x Hole Spacing Vent to it Intake/ ngth Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over n Depth Over xx Depth of 1 it xx Seeded/Sodded xx Mulched Bed/Trench Center I Bed/Trench Edges 7JL Topsoil Yes ❑ No COMM NTSe: (Include cqde di{s_crepenci s, persons present, etc.) Inspection #1: Inspection #2: • / Locatio 084 100TH` (~S ~U11 ~(~~~~jl~.. v►Sion svbm~eC~ / 1.) Alt BM Description = \n ~~~C`1 tDn 4u a^ 2.) Bldg sewer length = 01 H ~c ~a f 4-160' Fl'.11• - amount of cover = ~ i"J 1^, ~Q ~91' f ftU Plan revision Required? "'Yes ❑ No Use other side for addition d information. S LV BD-6710 (R.3/97) Date Ins tor's Signature Cert. No. 2~ R C ty Safety and Buildings Division f'".'°;+ fJ 201 W. Washington Ave., P.O. Box 7162 Sanitar} permit Number (to be filled in by Co.) ®Cj Madison, Wl 53707-7162 OIX COUNT`( NT If VJA 569 ol~ i en nit Application ctionN In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appr„,,.._ A EK1 S G R R 7F3 CA is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are subrpitted to ess (if ' ent than :mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary uses in accordance with the Privac Law, s. 15.04(1) m), Stars. / L A Iication Information - Please Print All Information , 4 f Property Ownff's Name Parcel # r Property s Mailing Ad 1 s Property Location j. 1 t- Govt Lot _ q City State tP Code Phone Number J / r/ Sectio > f 1 t-'' i . %ftc rcle ne) . H. Type of Building (check a at apply) Lot # T f N; Rfi or W or 2 Family Dwelling - Number of Bedrooms Subdivision Name Block. ❑ Public/Commercial -Describe Use ❑ City of ❑ State Owned - Describe Use I I ► CSM Number ❑ Village of ~tTownof~~(/C~ (1 III. Type f Permit: (Check only one box on line A. Complete line S if applicable)/ ' l A. " Replacement System ❑ TreatmenUHolding Tank Replacement Only Q Other Modification to E 'wing System (explain) ❑ Permit Ren -al ennit Revision ❑ Change of Plumber ❑ Permit Transfer to New L Previous Permit 'umber and Date Issued Before Expirat' Owner .T e of PO S System/Component/Device: (Check all that apply) Non-Pressurized In-Gr~' b❑ Pressurized In-Ground El At-Grade ❑ Mound > 24 in, of suitable soil ❑ Mound 24 . o su a soil //77 11 'JH Other Dispersal Component (explain) ❑ Pretreatment Device (explain) (i V. Dis rsal/Treatme t Area Information: Design Flow (gpd) -11 Soil Application ds f) Dispersal Area Req (sf) Dispersal Area Pro osed (fl ystem Elevati VL Tank Info Capacity in Total # of 1S t.~ Manufacturer Gallons Gallons Units New Tacks Existing Tan}5 J m P v~ t C7 Septic or Holding Tank > S ! f 4 _ Dosing Chamber T` VII. Responsibility State nt- I the undersigned, A 6e responsibility for installation of the POW TS shown on the attached plans Plumber's Name (Print) PI s ignanue MP/MPRS Number Business Phone Number Plumber's Address (Street, City. State, Zip Code) VIII. County/De artment Use Only y~ d Permit Fee Date Is ued Issuing Agent Signature $ /V ❑ Own eason for IX. Conditions of A~QpUReasons for Disapproval SYSTEM O'P~ 1 sf / d 1. Septa tarik : t tI C I ~ its, f7~ ~ntYAHVIOf VtVer dispersal Gl1 rr,U.;• C7 rr.@if;?aIf?2d ✓ ~ as per r^. ~~gerrler' o an P iii 1 ci y lumber A /Il~ 1 ~ d f„ 2 All etbac,~ ~~7uirPrnents tr~~i i he n u,ta;ned ~lW 1l.lL~/ _ ...•.b4tsaCh.sa.ca~¢leoc platisrfor the system and submit to the County D only on paper not less than 8 is z 11 inches in sin SBD-6398 (R. 11/11) System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NE 1/4 NE 1/4S 7 /T 29 N/R 18 W TOWN Warren COUNTY ST. CROIX SYSTEM ELEVATION 95.0/94.0/93.0 3' below grade 10/3/16 BEDROOM 4 DATE CONVENTIONAL CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE 765 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 121j L0 of chambers (P - BENCHMARK V.R.P. Top of yellow stake ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark B-3 483' Property Line C l' Scale = 1 /4" = 10' to be >5' from each lot line 0 3-3X 82' cells with >3' spacing . M. 40 B-2 \ 1% Slope Huffcutt Combo Tank 3 0' 180' -1 40' Pro 3 Bedroom House 100th St. Vent >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 12" 5.6ft^2/pair of end caps Long Grade at System Elevation 34" 222.5' Property Line All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Septic-Dose Wank. Cross Section And Pump Performance Specifications 'rank Manufacturer - Pump Manufacturer I 'Wank. Model Number 7 ~ - Pump Model Number p' s F- ~ Total Tank Capacity j r Y Alarm Manufacturer Max. Bury Dcpth Alarrn Model Number Switch Type Filter Manufacturer E? _ Total Dynamic Head (TDfI) -Feet Filter Model Number <I l Elevation Head Distal Pressure Network Loss - Minimtun Pump performance Required Force Main Loss Ft TDH y Total Outlet Manhole Min. 4" Above Grade With Locking Device. Inlet Manhole Manhole Min. 4" Above Grade < 6" Below Grade Sealed Watertight Securely Mounted With Locking Device Weather-proof Fi ished Grade Junction Box Ins Vent Min. 12" Disconnect Above Grade Means With Vent Cap Outlet Filter Inlet Inlet Baffle { 1h Set sand ~iwitc t~ng Reserve Capacity A t Y4'1 _ Tank Volume= GFl Weep Dimension , inches Volume Gal. B Hole (reserve) A, Off Elevation ' (alarm) B+! 2 7.C (dose) \i 7~ 4, { (dead} " D Bottom D Elevation < 1:<yt{. t < I • s • < . • • • :s.1 t { . , . . . . . a < < < . < { ! { . . •{'`1`' t 1 < t11<>{>lal;! {>::<•t•1•t•i•/•t 1.1•:f !•1 a•{•:1•. i GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.2$. 02/05 U Page of TOTAL DYNAMIC HEAD/CAPACITY HEAD CAPACITY CURVE PER MINUTE EFFLUENT AND DEWATERING MODEL 152/153 w w MODEL i52 153 w 50 Feet Meters i Go!. 1 Liters I Gal. Liters 153 5 - 1.5 69 261 77 291 12 40 10 3. 1 61 231 11 70 265 `'152 0 15 4.6 53 I 201 61 231 = 20 -1 6.1 44 167 I 52 197 30 25 I 7.6 34 129 42 I 159 , z 8 rv~ 30 9.1 23 87 33 125 720 35 22 85 40 12.2 i 1 i 42 4 LOCK vcive: 36.0 (111.6x,)144.0 Ft. 3.4n)I 10 o r 4506 0 2 40 60 80 100 GALLONS LITERS 0 8 0 160 240 320 6 1/4 3 27/32 * 5/8-- FLOW PER MINUTE I ~ 3 27/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS a • Timed dosing panels available. 0 3 zi/3z Electrical alternators, for duplex systems, are available and supplied with e ' ; an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. -r--- (I • Sealed Wk-Box available for outdoor installations. See FM1420. I • Over 130°F. (54°C.) special quotation required. j 1522153 Series 12 1 /8 1521153 MODELS Control Selection I 1I I Model Volts-Ph Mode Amps Sim lex Duplex 5 I o N152 115 1 Non 8.5 t 2 or 3 i BN152 115 1 Auto 8.5 Included 2or3 E152 230 1 Non 4.3 1 2 or 3 ( I -L sK2WA SE152 230 Auto 4.3 Inclined 2 or 3 N153 115 1 Non 10.5 1 2or3 BN153 115 1 Auto 10.5 Included 2 or 3 SELECTION GUIDE 3 E153 230 1 Non 5.3 1 -2.0 BE153 230 1 Auto 5.3 Included 2or 3 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. L& CAUTION 2. See FM0712 for correct model of Electrical Alternator E-Pak. All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 Louisville, KY 40256-0347 Manufacturersof.. SNIP TO: 3649 Cane Run Road Zo Louisville, KY 40211-1967 QuauryPa&RY 91,YCf ~99d (502) T78-2731. 1 0 httpJ/www.zoeller.com / LJMP !O_ FAX (502) 7740 PUMP 3624 © Copyright 2000 Zoeller Co. All rights reserved. POWTS OWNER'S MANUAL & MANAGEMENT PLAN ftp of ILE INFORMATION SYSTEM SPECIFICATIONS Owner ~ Septic Tank Capacity I ❑ NA Permit* Septic Tank Manufacturer ❑ NA IGN PARAMETERS Effluent Fitter Manufacturer ~ ❑ NA Number of Bedrooms El NA Effluent Filter Model 13 NA Number of Punic Facirdy Units -0NA 'Pump Tank Capacity 75 S-D tNA Estimated flare (ayerage) U Pump Tank Manufacturer i Design flow (peak), (Estes x 1-5) al/da Pump Manufacturer Soil Application Rate al/to Pump Model Standard Influent/Effuent Quality Monthly average" Pretreatment Unit Fats; Od & Grease (FOG) s3o mg/L ❑ Sand/Gravel Filter © Peat Filter Biochemical Oxygen Demand (BOOS) 420 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 515o mg/L ❑ Disinfection ❑ Other. Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Bioc cal Oxygen Demand (BODs) Sap mgA. n-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) Cap mgll- y~NA ❑ At-Grade ❑ Mound Feral Coflform (geometric mean) 510'' cfui100ml ❑ Drip-Line ❑ Other iMaximum Effluent Particle Size 36 in dia. p NA Other ❑ NA Other Other. DNA 'Values typical for domestic wastewater and septic tank effluent Other. a NA NTENANCE SCHEDULE " Service Event Service Frequency 11nspect condition of tank(s) At least once every: ❑ month(s) (Maxinumn 3 s Years) ❑ NA (Pump out contents of tank(s) When combined sludge and scum equals one-third (Ya) of tank volume ❑ NA inspect dispersal cep(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA I ear(s) I( J Olean effluent filter At least once every: month( s) 13 NA Inspect pump, pump controls & alarm At least once every: month (s(s) NA f=lush laterals and pressure test At least once every: ❑ month(s) NA ❑ ear(s) At least once every: ❑ month(s) 0 year(s) NA [bft. , NA MAINTENANCE INSTRUCTIONS !Inspections of tanks and dispersal cells shall be madeby an individual prying one of the folkrwtng licenses or certifications: Master !Plumber; Master Plumber Restricted Sewer; POVVTS Inspector, POWTS Maintainer; Septage Servicing Operator. Tank inspections must Incilude a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of icombined 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 levels in the observation pipes and to check for any ponding of effluent on the ground surface. The pondng of effluent, on the ground surface may indicate a falling condition and requires the immediate notification of the local hegulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Jfi) or more of the tank volume, the entire contents of }the tank shall be moved by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Adminhdre*%#e Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, WW any servicing at intervals of 512 months, shalt 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 nt tank(s) for the presence of painting products or other chemicals th0t For new construction, prior to use of the POWTS chi treatment I cell(s). 1f high concentrations are detected have the contents of thmay impede the treatment process and/or damage the dispersal 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. the excess wastewater will be red th t. During power outages pump tanks may fill above nomTral highwvater levels. When power is recto discharged to the dispersal cep( in the backup or surface discharge of effluent e, overloading the cell(s) and may result to restoring power to t Servicing Operator prior t large dose, operating the pump controls to restore normal levels of the pump Maintainer tank to assist removed in by a SmanuallS~ Se avoid this pump or situation contact have the s) in contents one large e a Plumber or POWTS Mai within the pump tank. disturb or compact, the area within Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or 15 fret down slope of any mound or at-grade soil absorption area. 4WTfi= Reduction or elimination of the following from the wastewater stream may improve the perforrnance and dis prolong h; the fat; We of foundation the the Pn drake antibiotics; baby wipes; cigarette butts; -condoms; cotton swabs; degreasers; dental floss; diapers; water, fruit and vegetable peelings; gasoline, grease; herbicides; meat scraps; medications; oil; painting Produc~ s; (sump pump) 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 propetlY and safety 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 property disposed of by a Septage Servicing Operator. all tanks and pits shall be excavated and removed or their covers removed and the void space flood with soil, • After pumping, gravel or another inert solid material. CONTINGENCY PLAN code t~mpGant If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelm. requilled The replacement area should be protected from disturbance and compaction and should not~t are a l rupon i bn the aged must comply with in the in setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replace for a new soil and site evaluation to establish a suitable replacement area. Replacement systems effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWfS technologN 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 evaluajon installed as must be performed to locate a suitable replacement area. if no replacement area is available a holding tank may be a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place foltowing 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 O °R Y CINCES. DEATH MAY RESULT. RESCUE O~ A ENTER A SEPTIC, PUMP OR OTHER TREATMENT MAY BE DIFFICULT UNDER IMPOSSIBLE. PERSON FROM THE INTERIOR OF A TA ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name ~w a Phone - J Phone j' SEPTAGE SERVICING OPERATOR U ER LOCAL REGULATORY AUTHORITY Name Name Phone > Phone This doo mentwas drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383,54(1), (2) & (3), Wisconsin Administrative Code. N ! a ~„i 77 P - r ~ r 7H-1 7, i 1 Q~ ! a v O ~ a O O O I I'q 0 CO \ z 3 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Q2ug r1f ~ Mailing Address Property Address 0 ~D t~ (Verification required from Planning & Zoning Dep t for new construction.) City/State _ -Parcel Identification Number LEGAL DESCRIPTION r7 / ~I Property Location Sec. 114 , t ~ T _ la , N R) ~_W, Town of Subdivision Certified Survey Map # Lot # - Warranty Deed # Volume _1 Page - Volume , Page # Spec house yes no Lot lines ident~abl yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION h"ProPer else and maintenance of your septic system could result in its premature failure to handle wastes. P maintenance consists of purapin~ out the s the system can affect the function of thee septic tank every three years or sooner, if needed, b roper responsibilities are specified in Ca tank as a treatment sta a in Y a licensed Owner pumper What you put into § mm. 83-52(1) and in Chapter .12 - St Crloi the to disposal system. Owner maintenance County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning owner and by a master plumber, journe ty lanning & Zoning De wastewater disposal system plumber, r roan plumber, restricted plumber or a licensed mper ver a certification form, signed by the less than wastewater is in p pe operating condition and/or (2) after inspection and pet verifying that the on-site 18 full of sludge. Pumping (if necessary), the septic tank is I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposalsystem standards set forth, herein, as set by the De Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has Departmentof f maintained with the Zoning Department within 30 days of the three year expiration damust be completed and returned to the St_ Croix County Planning & te, I/we certify that all stateme is on thi form are true to the best of my/our knowledge. I/we am/are prot1a ertd7" deed recorded in Register of Deeds Office, the owner(s) of the LICANT(S) 4121/ - **An DATF y 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 surve ma reference is made in the warranty deed, y p if (REV. 08/05) _ N89°39'35"E 483.45' M[p~44CD dLQI[D~ S00°45'54"W 0 66.01rim z LEGEND S89°39'35"W 483.51' _ o ® 450.09' 3.42 Un I = cvn m r ? -PROPOSED m m m DRIVEWAY ® APPROVED I A O SOIL BORING LOT G ST_ CROIX COUNTY I FOUND ALUMINUM zoninnTkmP%'0ft ommittee N N COUNTY SECTION r3 IS N ® 2.470 ACRES JUN 2 3 2004 u, CORNER MONUMENT N (107,602 SQ. FT.) INC. R/W ® M ? Cn 2.299 ACRES FOUND 1" OUTSIDE (100,145 SQ. FT.) EXC. R/W DIAMETER IRON PIPE O If not reooroea witnnin 30 days of G= ° 0 ® approval date approval shall be 8 null vvld SET 1 " OUTSIDE ` ; ° DIAMETER BY 18" co C7 4 . (R Q LONG IRON PIPE, N89°39'35"E 483.70' m WEIGHING 1.13 LBS. 450.09' N 3.61' I Q PER LINEAR FOOT N 6 6, ® A FOUND PK NAIL LOT 5 33' 33' _ ROADWAY 2.221 ACRES ® I SETBACK LINE N N (100' FROM g (96,756 SQ. FT.) INC. R/W S g I RIGHT-OF-WAY) a° 2.067 ACRES (90,018 SQ. FT.) EXC. R/W r m (n co ~ n n