HomeMy WebLinkAbout040-1254-20-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
ATTACH TO PERMIT) 592125
GENERAL INFORMATION 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:
Justin & Sara Wurzer TOWN OF TROY 040-1254-20-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
19.28.19.1343
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
Dosing Header/Man.
Aeration Dist. Pipe
Holding Bot. System
Final Grade
PUMP/SIPHON INFORMATION
Manufacturer Demand St Cover
GPM
Model Number
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dia. Dist. to Well 7_
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System: UNIT Model Number:
DISTRIBUTION SYSTEM
Header/Manifold Distribution ix Hole Size Ix Hole Spacing Vent to Air Intake
Pipe(s)
Length Dia Length Dia Spacing I __J
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded r Mulched
Bed/Trench Center Bed/Trench Edges Topsoil ❑ Yes ❑ No Yes ❑ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 282 ST ANDREWS DR
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
Plan revision Required? U Yes ❑ No
Use other side for additional information. L I-LIJ
Date Insepctor's Signature Cert. No.
SBD-6710 (R.3/97)
_ SE 2 l t I 0. ~o_: Sar.?inn Permit ~~uma" (ie c ;f:eti to he G._.
i C/
ST. CROIX COUNTY
`rnMMUNITY DEVELOPMENT 0KSHNVS
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$t~ptic tank, efflmmt rtlte* and 3 Lug- C
dispersj~1 cell must all be sPVtc-es l r'1. ains
spar management plan provided by plumber.
Z re juiMements Mustbe mainftiried
a pKappuble code / ordinances.
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iii float a ]0`ra iaii: JQtrO c ' Zc ,BS = 100 gai
Mat iiii uHAP Vii
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TOTAL DYNAv,IC HEAD;FLOVv /4 _7
dP
PUMP PERFORn-LANCE CURVE PER MINUTE
MODEL 1511152,153 EFFLUENT AND DEWATERING
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- 1 152 153
- I MODEL 151
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at, Gal it=rs & -
c F.§eter
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' Model 151 Models 152
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Timed dosing panels available.
Electrical alternators.. for duplex systems, are available and
,supplied with an aiarm.
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.
Sealed Qwik-Box available for outdoor installations. See i
Over 130°F (54°C) special quotation required.
SK24-
l ? 5 1QDcl5 Control Selection
Model Volts Ph lode Amps Simplex Duplex I
:4151 o Non 6.0 2 or 3
BN151 ~s = Auto 6.0 tnclidec 2 ar 3
'151 30 Nora 3.2 2 or 3
Included 2 or ' Easy assembly'
BE.51 230 1 Auto 3._ P
t umn a ttisr arae pr e
N1.52 115 1 Non 8.5 2or3
5 1 Auto uded 2or3 a\lF
F El 52 231 NO 4.2, 2 or 3
I BE 152 230 Auto 4.3 induced 2 or 3
P1t!a won "05 20 3 `
BN 153 115 t Auto +0.5 included 2o,3 E153 1 ND, 5.3 1 2 or
BE', Z30 '~`o
rgle piggyhzck variable level float switch or double piggyback va able (eve: Reduces potential clogging by debris. ,
at sNttch. Refer to FM6477. Replaces rocks or bricks under the pump-
ee FM0712 for correct model of Electrical Alternator E-Pak. Made of durable, noncorrosive ABS.
3 '=arable level control switch 16-6743 used as a control activator. specify duplex Raises pump 2" off bottom of basin.
3 Or flot.t svster, Provides the ability to raise intake by adding sections of 1'/"
or 2" PVC piping.
{n =cautor~.__ Attaches securely to pump.
~ Accommodates sump. dewatering and effluent applications.
~
NOTE: Make sure float is free from obstruction.
or unusual conditions a reserve S~3iEly iFGtOf is eilgi'VBC`uU 4w 111 llf iyil U( k;Ve s' 7J' it j)ilrliN.
0 Copyright 2008 Zoeller Co. All rights reserved.
LE i i~Oti!''ir.TI0i'"i SYSTEM SPEG[FiGATlDIiS
~~~SE LaNGeETE
_ C%vrer iani<l:4anufaciurer: fL
Erm.... XS 1G I❑ Do L Holding lolume
( e~`
- Tank Uianufacturer: G✓IE.S£'t Go~GR~r~ iii i
=Sit 6! PAP-ZUYlETERS i
iv ,t l J septic Holding liolume: SSG cif)
idumber of, Bedrooms:
- ?ranicai DistanGS Tani; 80 om(s} ?o Sereic-e Pfd* /d t'1SL,~?i ^ r of Public t'a_iil!?!'✓nli5: - ,
Horizontal Distance Tai k(S ) t0 SePr+ce Pad:
Eciif fated (average) .=10? a b~ (gaud=Y1 ( - >15
{ .C.OECItiG se .'icilQ mieGfianiGS must be or0 fd°l - htCot
~Gl u li r i%0n?2i 15> 5~ ieci. vG6GHiG:f}J I i iIQ1 J O o:a'n g C^ o
- -
cait;1 tpL K! Flow (~SilTc[CGz
7 e~+.fdayii_`i Effluent Filter Svianu acturer: I~ES r
in Situ Soil Application Rate: / J
Z' F-
STanC2`G (CJCi,Iwi;Ch YnilUEi'ii/i=TituanE ivionthiy average j -iui~e::i i it E± t'.'tGG21: -
Oil & G;aase (FOG) <_3D ma!! i ; ?Dmp ivlanu~nc[ur=r- 2o£LGE/~ i ,
!~220 Me-it-
o:cchemicai Oxta~n tJ_mzr,❑ 1130
---Jtet S =p ded_'ids v`t in"Q mei_
J monin(v average i prPtreai-n-n! Unit
:ion S'ieng:n Inttuent/f iuen
iV'anllicCLUr2; d"
>220 m0fi --I i I Pea )-rite
' f31~ { 1 u tvlezl'~ci i:C of f+°P'ai1Cr1
GJj >150 ,q,i_
i,dionlhl.l weraae + 1 : 'i Sar:~IGrSVei Fii4er Other-.
Pretreated Effluent 1--= -
(BGu,) <_30 MOIL Soil Absorption Sysm
530mg/ ❑ in-Ground (pressure) - .
fn-Ground gr--nh;,
s C ajiound
~eal Coliform ,oeorrietric mean) !510- `
i t~~-GSLC7 _
71 iler:
'l"Aa ;Minn Ltguent'Panicl~size leer. i N Other- ELfLa~✓ /cL~~/r~ tg4aJcES -
i1liAINTEi?IAit1CE SCHEDULE
aeit?ice Evens Sei =°ice rrea,uency _
~ }Nhen combines sludge ana scum equals one-third 1 of t=rk ?'ulurre
?urno out conienis a; Tan :(s. `rtrnei1t the high t.ja c-r . mi, is activated
i ~L a ..lEc
) mo;hnsi i1ifia7imum 3 years)
1 -ri iEnSi y: ) -a J 9
f (nsr?ECt GOndiuon of iank(S) oncg every: year(s)
- - - L montn(s)
(Ida-,imum 3 years)
sped disgerai Geli(s Ai leas: ands s: erg: t year+s':
-
-i montn(s)
' car{ s j
-
.can effluent llte ~i.
putT,0: Gt:i z:m; Oa aiaml .=.t iE25C t~('iG_ cieBr',3- 3 iGy eer-
-
-.USft is-erals Hnd pressure tc__ lea5i Once evei(y: - ❑ ;,c2siS1
L -nontars)
At ieas-, once
";;AiNTE,,MIANCE l[+(STRUCTIONS `hc CllOtlitl !ic_ - or
5 H' lp ?f! iTliJividual cat w-"' one DT f Sc
Ui :3115 aiiC1 50i car ifica iGr!
EM3 i118
-'ivIIt❑ any craer VDU.
a[}EC iUll~ c ip iCi 5jij;
S
Plumb=;, rt'iaster Plumber Restricted ~-°Ct"': a~1jJ. ~ ,(lageC J3; Golf?!?~ ivi8inialncr ur cD?aGB Jet
ate:
i crk n50BG?SOWS mus? inGluCe a visual inspection Oi ine tan1C(S) to IdEn"ri a 1 "'t ssing or broken, hardware, ide ii % cn C'cCKS Oi .~C.{
1uani on t'r, cr u, t sLt E
+.t(c the ` oiurnc of Corribinuc sludge and CC3i;'. and E G'.cG-: fora . i7~G U 1 Or OOno! 7' -
a.utiires the _DSurQiion system shall be visU?liy inspected i0 Gheci: ine c1iluent levei. in the Observation Dices and to clecl for ane pOndi'Y7 0 `
a t'iOIdOP, anC
a ,
-n• around surf--c he Dondino of E-ueni On the ground sui8ce may inah,~mtc icllt p CO
,tL ;tan Cif ihelUGai
:'.cif rite combined aCGUmulHtl0n 6i sludge and scum in any treaimeni tank equals one--ihird {"'D or more of ii a iar'z4 valume the of i^e tank all=il be rem OVB~• by c Septa,:
Se^~lcino Operator (Spurnper) and disooSed of in BCCOrdanLE'ojitit GitaPler lqh ,
sconsin dminisire_iv= Cade.: a .T
,:;her servicas, including but not limiteb to the servicing of ei;iu' cr tltiers' Pc~l a rc i` `or pressurized cornpone~.z, u t'
shall be; oerforrnad C C iS-v
} v c:.- . : Of mon th a; n'..
FOr new construction, prior to LSB of the POtni1'S check treatment canlC(S) for the presence CT pSlnting prodtcts> solvents OC gi^
chemicals or sediment that may impede the treatment process and/or damage- the soil absorption system. if nigh concentrations are
• (S) '^n., Cdr t0 use.
'.etec~`eC' ita'.le i1a content= or'.h the tank ,mOI.Ced by a c Sap c t^gc - jerVlCing vpeiHiOr (dUmp,sc,eer) p ~
Pump tanks may ill above normal high mater levels orior to startup or due to purnp failures. Stari up or restoration of power under ihese
cgn.ditions is not recommended, as the excess wastewater will be discharged t0 the soil absorption system in one large dose causing an
,,,,'?rioan iliac may result in the backup Cr surface discharge or effluent and damage to the system. To avoid this situation hav--.
cCnieRcs of the pump tank removed by a Sepiage Servicing Operator (pumper, prior to restoring power toihe pump or contact a Plu:
OF POVi_ iI 5 Maintainer i0 ass=ist in manually operating the pump controls unit/ no nai effluent levels are restored ,,.ittlin the pump tar;.
-in suit u0 shall not occur when soil conditions are frozen at the iR liSait}?E surface.
:y!Q not drive or park vehicles over tanks or the soil absorption system- Do not drive or park over. or otherwise disturb or comc•ac:
c~ 'JriiiliP. "l5 feet down. slope of any Tiound Or at-grade soil absorpion area.
-auclion or elimination of the follovArig Tram the wastewater stream may improve the performance and prolong the life of the ireatmen
t'n ;s and soil absorption system: acids, antibiotics; baby viipes, cicarette butts, condoms, couon swabs, degreasers, dame! f o
clapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herb+.cidc;5.
3_raps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge
:NDOiii E
,en the P0Vt1S rails and/or is permanently taken out of service the foiiovring steps shatl be taken to Insure That the ,
solely abandoned in compliance M~ h s. SPS383.33, VVisconsin Administrative Code:
= .il pioiRg to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings
-.he contents of all tanks and pits shall be re-moved acid yr Openly disposed of bye Sep; qe Servicing iiper ator (pumper'.
after pumping, all tanks and pits shall be excavated and removed or 'their cc'.er= removed a•:._ S?ac-
eravei or another inert solid rnaterial.
GEMCY PLAN'
iii., YL?tJI.JTS fells and C3nno: tS r•2p2ir?O :ire fOllOVJIRG mB3SUra3 have beer, c` USt. tC OFUV!^
-olaeemaM system-
A siiitnhie replacement area has been evaluated and may be utilized for the location of a repiacement sail abso"o':iu^ = r'•
The reolacement area should be protected nom disturbance and compaction and should not be infringed upon by faoureC
•C0iiacks iron' existing and proposes structure, lot lines and walls. Faiiuia to protect the rep! acament area !'Dili result in the
a new soil and site evaluation to establish a suitable replacement area. 'Replacement systems must comply with the rules
;:=eci at he time of their permit issuance.
Suitable replacement area is not available due io ~eiback and/or soil ilmiiations. F the soil abcorpiiOn system canric
rehabilitated and 'oaring advances in POVtiTS technology, a holding tank may be installed as a last resort.
-ne site has not been evaluated tG lgenii a suitabia replacement area. Upon failure of the PaAf T S a sell and site evaluaii-1
'"'Usi be'o+erformeo to locate a suitable replacement area, !r no replacemant area is available a holding tank may be installed as
.as resort to replace the railed POINTS.
. -.ijnd and at-gr'ade soil absorption systems may be reconstructed in olace fc!iovvino `emov2! of the bidmat ai the tnTlltfc.:•:"_:
.ghee. Reconstructions of such systems must comoly tvth the rules in effect at that !me.
°itT T iD T,.~dKS NiAY COitlTAlitl i=Oi50i~,OuS GASSE o!-11
. TI~EfiAf~}K5, PUMP TANKS, AND J ; iv_iitlG
;r n_Ss SUFFICIENT OX GEN TO SUSTAIN LIFE. 14EVER ENTER AiNIY TANK UNDER ANY C!RCUiv"t i'CE. DE T
RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK AMAY NOT BE POSSIBLE.
- - - -
r;DD1TJONAL INSTRUCTIONS:
= lift-S li,,lS T AT LEF POVNITS FOAMITA!MEP
i:Name T6HJ `E1/GE ,x_.73/,3rd Name
, l
hone i Phone ~j~ 7,7' Sc~4G
-
_P"SAGE SERliiCtNG OPERATOR {f'UMPEPl LOCAL REGULATORY ;aU'HDRi7Y
+ i`:ama € # Name j j ~/tcs~1C ZoyiJt l'fflCc~
FPMoni horG 7/~ .3~G - yGBb
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10
ST. CROIX COUNTY
SE? 9 20~~ SEPTIC TANK MAINTENANCE AGREEMENT
o1X CoUNTy AND
~T. CR DEVELOPMENT OWNERSHIP CERTIFICATION FORM
✓OMMUNIT`!
Owner/Buyer u' I l~~> I~r
Mailing Address ,'7 66, dkl_ RD Gil -i'5-17W
Property Address fir/ +v{T fit}
(Verification required from Planning & Zoning Department for new constru tion.
City/State Uf`s~/~l Parcel Identification Number
LEGAL DESCRIPTION
Property Location '14 , Sec. , T c N R C1 W, Town of
Subdivision Lc+ Q2- Mzokl VuA 6(" 4-4-x• Lot #
D
Certified Survey Map # U r0 0 2~3DC~ , Volume , Page #
Warranty Deed # Volume , Page #
Spec house yes no Lot lines identifiable yes' no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Ovrner maintenance
responsibilities are specified in §Comm. 83.52(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 form, signed by the
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.
I/we, 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 Commerce 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.
Uwe certify that all statements on this are true to the best of my/our knowledge. 11we am`are the owner(s) of the
?IT
property described above, by virtue of a warr ty
deed recorded in Register of Deeds Office.
Numbgr-Dfhedrooms
SIGN E OF APPLICANT(S) DATE
`*_*A«aytnformation 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.
(REV. 08/05)
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