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Home My WebLink About018-1096-04-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 592152 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: Bryan & Melanie Kofal TOWN OF HAMMOND 018-1096-04-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: ~l ; 09.29.17.779 TANK INFORMATION ELEVATION DATA TYPE MANUFACTUR sJ CAPACITY STATION BS HI FS ELEV. Septic ' 1 y,t D • , Benchmark ~ ~.nnL.. b'~' ~ Alt. BM 0::-~~•u~ li0 55 7'J Aeration Bldg. Sewer 65 Holding SUHt Inlet 7U 'I Z • 2-7 / TANK SETBACK INFORMATION St/Ht Outlet Jr • a y Z. b S TANK TO P/L WELL BLDG. Vent it Intake ROAD Dt Inlet Dt Bottom Septic 7 J A*- Dosing Header/Man. Aeration Dist. Pipe ` J! 's . CY✓ Holding Bot. System PUMP/SIPHON INFORMATION Final Grade y, k s; ~Q,Q,. Z . s5 • S Manufacturer GPMand St Cover, Ga Jv c. ~'/S 7 Model Numbe TDH Li Friction Loss System He TDH ~r Forcemain Length Dia. Dist. to Well 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 t-;; Type Of System: UNIT Model Number: • DISTRIBUTION SYSTEM le Size Hole Spacing Vent to 'r Intake Header/Manifold Distribution x Ho ix Pipe(s) a~ Length Dia Length Dia Spacing S SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seede odded Ixx Iched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1711 ) Inspection #2: 4 Location: ~ a yrs. 1082 174TH ST OR ~;1 coy I 1.) Alt BM Description = ( G~ -OG O 2.) Bldg sewer length = 2y - amount of cover = $ it 6n 7 elo Plan revision Required? ❑ Yes No L 7, Use other side for additional information. SBD-671 0 (R.3/97) Date Insepctor's Si ture Cert. No. dam" hr . « ~ mG1 .1 / County J r% 3 0 1/ , - l t ~ ` Q Safety and.Bullciings C>vision S T K01 X G~ } (C? 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be Shed in by Co-) Madison, W1 53707-7162 ST. CROIX COUNTY CSZ-- R, VOMMUNITY DEVELOPM T", ZC S1$jV9A ~ s~ateTrazrsa 'onNtlmber Sanitary Permit Applicatiu.. Q844 - AM- is In accordance with SPS 38321(2), Wis. Adm. Code, submission of this form to the appropriate required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are smn..._ Project Address (if different than mailing addra the Department of Safety and Professional Servies. Personal information you provide may be used for second ses in accordance with the Privacy Law, s. 15.04 1 m), Stars- p / 7 J g~ Q L Application Information Pi a Print All Information Ga Property Owner's Name k ant, e, Parcel # T3 R`1 0 ~aF EL 010 1601&__69- 000 Property Owner's Mailing Address property lion Qq F aZ`~ . 17 , 11 5S 5 v N Govt. Lot City, State Zip Code Phone Number y., _hLk/? Section C! ofc Z1_ -S YV / L/ (circle one Z ~ N; R ~ _ E or EL Type of Building (check all that apply) L Lot # T or 2 Family Dwelling- Number of Bedrooms 1 ! Subdivision Name ❑ Public/Commercial - Describe Use t ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of 4 U ; t.✓ 16 4- 26 JZTown of k1 F Type of Permit: (Check on one bog on line A. Complete line B if applicable) A ,System. ❑ Replacement System ❑ Treatme it/Holding Tank Replacement Only ❑ Other Modification to Existing System (expli B. ❑ Permit Renewal ❑ Permit Revisioa ❑ Change of Plumber ❑ Permit Transfer to New Lust Previous Permit Number and Date Issued Before-Expiration Owner IV. Type of POWTS System/Component/Device: (Check all that apply) oNon-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound a 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil _ ❑ Holding Tank ❑ Other Dispersal Component (explain) stment Device (explain} o ( C V. Dis rsal/Trea nt Area Information: +\ti I ` Z Design Flow (gpd) Design Soil Application Rate Dispersal Area Required ( ispersal Area Proposes (so System Elevation VL Tank Info Capacity in Total # Of Manufacturer Gallons Gallons Units New Tents O Existing Tanks ` g d o o iz a U y ii U 17.5 7~ b / 4 Septic or Holding Tank Q i f aZ Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility f installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature N RS bet Business Phone Number V:- F F6 YL 011 Plumber's Address (Street, City, State, Zip Code) If C/ P 0 -9-6 Y_ 16_ls sZI-E!, VVI soy 47 OUR artment Use Only proved D Permit Fee Date r/I ssuin t Signature Lid . $ (U t ~a AeE D Condit~d~7 Reasons for Disapproval • flrCS elUe 1. Septic tank, effluent (vier and 3 disperse:,i cell must all bt be ices! maintajreg, as per management plan provided by plumber. 2. AN setbeck requirements must be maintained as per *piwW cwk.r / .rd;rwmAs. Attach to complete place for the system and submit to the County only on paper not less than 8 is :11 inches in size SBD-6398 (R. 11/11) IN? -4( Ar 01- ZIA_ ~ i CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: [3 I< t OF AL Owner's Name: Owner's Address: 6T t" S by I L4 tA% Legal Description: I%/ ~IAI -T 2-,1 A.) . Township: NFL V3 County: Subdivision Name: "~~F~' Lot Number: Parcel ID Number: Page 1 Index and title Page 2 Plot Plan Page 3 `System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: ~~FF r c License Number: tAJ)1?.s Date: I Phone Number S-f~ Signature (C VJ0 Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 II F~ Q 1 n^ 1 ~ i wAbvw*cop ft 3 ft - Chwdms ~ TtorO 't i t%WW Trsnvh 2 \ftwOrclowwo"1'" TMrAh 3r - 11 ,ular.-hftMAnd ij ~ Co t c V EISA Rte .sq ft pw drr Od Ap*dM Rds.- ~5 F 4 ft gpd D-OV Fbw , S fop AWImdw Rab , _ Z E19A = Lmay! Champ S wm vE dmmbo s eo& Pam of INSTALLATION 1 ' 1 S u pL-525/PL-625 FILTH ~19!lkac3P~#7C9G. ,raj -625 FEATURES BENEFITS Features & Beroft: s a Rated far 10,000 GP® Few of 11'16" Mellon PL-625 = 525 Linea' of I W itra °n w z PL-626 = 625 Ltneer t=eat ` eAccepts 4r and On SOW. 443 P" PLIM5 iii.-M a Built in Gas L~ , ~ FjW d Bag when Fier Is Removed everal years under normal a ondt ions before a Automa be Shu" ci g. it is recommended #l d iii Iffier be ad every time the #ank is pumped or at least everY $ Almm Accesslbft yam, l€#he flied filter con#atns an optional eA PVC Exterojori Handle n, the owner will be no ied by an alarm when Ms needs servlc Ing. Servtcing should be done by a iced septic tank pumper or Installer fi GTS rt31AE1►ILED PRODt3 pcbftk PVC Fftw - ~ 333 2 a L,k F~ 5 L 4r--- FOW & Lok= moor COVWS Extend q!S = E)ftnd 6dW Y'" IS P°aly* M M* m USG pmvwd ~c acddwft plc f&w ats~m D~~s~ HOWAOMWtoWads. sim~e. and soon th~ can W and tom' fagM hio open am aOsvrlTM~p iMONCOM of 5 s trte tc or adlet J1C$~ m ' andf°r befRe and ts* t&m swap. I ftgkv to aid tw* Ffts T WA 47 PPe- ronce• o ,W web sjW at IPOWTS OWNEWS MANUAL AND MANAG1143 T PLAN IWA INFORMATION SYSTLrM SPECIFICATIONS Owner Le Tank 14A Peru # Sepue Tank ManuOtctarax Q % We- Number DESIGN PARAWIWrF S Eftltteat FOter Msnufactunner of Bedrooms 1110 pp, Effluent Fritter Model NA-6 Nmnber of Cartar2 Units NA Pump T"k Est flow (aveage) bb Oda Puny TankMaut£curer DNA NA flora (peak), estimated x 1.5 Oda Pump Model brt~ar Soil Application Rate Model O NA Pmt Unit DNA InfitnndEf Quality (NAD) Manddy Average"* E3 Sand/Gravel Futter 0 Peat Fib= Fats. Ott dt GMW (FUG) 5 30 mg/L 0 Mechanical Aerstion O Wetland Biocl l Oxygen Demand (BODS) S 220 mg1L D Disinfection O Odwr: Total Suspended Solids (TSS) m1un wtta+er. Moack S 250 mo/L Dispersal Cell(s) Pretreated Effluent Quality D Mon*ly AverW"" l Voaul (gravity) © hVumd Omnwimad) Biochemical Oxygen Daasud (BUDS) S 30 mg(L 0 At=grade ® M0=d Total Suspended Solids (TSS) 30 mg/l. a Utltier: Fecal Colifo,int (g;eonnettic mean) 10 X1100011 D Leaching Chamber Mi n ifachm Q)OKK PH 1~2 V rL M dmuu n Effluent Particle Size 1/8 inch diamftr Model Laying Lisngth/Cbvmbac "Wastewahr Flow Verification and Cakulttio= Soil Application Rate Axes Rect. (Other dun bedrooms based) Infilttativo Surface/Cbanber--ESIA Rmim 2- fl Aft uwm Number of Chambem D Fbw Raft min Valnr s typical f W d0fl395dC ( vial wastewater Matnuls: sit materials mr~ c ongdy with WI Adm. Cade and septic tank dftmt COMM84 and bo inaWW per n muhcuu s gem Walues leaf for preprested wastewatar. and letters. DII:SIGN CRITIRIA "wisconsin At-grade Soil Absorption Systern, Siting, Design A construction Manual" (Converse at ium) p "1Nisconsm Maund Soil Absorption System: Siting, Design dt Construction Manual" Converse, ].C. and E.I. Tyler. Publication 15.22 D "Design of Press= Distribution Networks far Septic Tank-Sou Absorption System" Publications 9.6 C3 "Design of Conventional Soil Absorption Trenches and Bede". R.I.Otis - ASAE Publications 597 and "Design Manual - O zitt Wastewater Treatment and Disposal Systems". EPA 625/1-80-012 October 1980 C3 SBD -105704 (R.6M) "At-Gra& Cant Manual Using pressure Distrbution" XSBD -10567-P (8.6/99) "In Ground Absorption, Component Mantuai" -10705-P (N.01101) "In Ground Soil Aborpton Compote Man ual" Venim 2.0 p SBD - I0Q" (N.6/99) "Re:g Saud FilW Systent Component Mamma" ® SBD -10656-P (N."9) "Split Bed Reci,tivlatirtg Sand Filter Systenn Component Manual" D SBD -10572-P (ILW99) "Mound Component Manual" D SBD -10691*-P (14.01101) "Mound Component Manual" Version 2.0 0 SOD - 10595--P (ILO") 'Single Pass Saud Filter Con"ent Mstutal" C3 SBD -10657-P (86/99) "Drip-line Effluent Disposal Com,ponmA Manual" D SBD -10573-P (R 6199) 'Pmssum Distribution Component Mannar' 17 SBD -1070' (N.01031) "Tressure Dfthibuticru Compownt bbumal" Vera on 2.0 D Drip-line Pfflual Dispersal Component Manual for Multi flo Onsite Wastewater Trestoare A Units MAINTZNANCE AND MANAGEMIM MAINTFNANCE MONITORING SCIMDULZ Soda great once ❑ monilm s 3 bwom condition of tanUs) At lean Purnp out contents of a: When combined sludge nand scorn equals one-~itd 113 of tok v0hme yrs. s At least once annals s 3 Clean of sent fib= At least once every r p montlus WPWKS) camtrok & alarm At least once ev D mo b s WA Flab ldi=b and teat At least once every month a r"I NA At 1",0nT"AVPM r-I months t3 vows) 0 NA IP Sys spirt up sfttlt not occur when soil couditions are i at the inf kratz've surface. OPERATION The property owner is responsible for the opezation and mointensuce of the POWTS and submission of required reports. Ilia gmmrity and quality of the wastewater stream will affect the performance and longevity of'yow POWTS. The won of water-savia8 appliances and fixtures along with pronipt repair of lesks reduces the wastewater volume. Also die brine or waste fromwow surface softeners, iron removal emits, othar clear Buster trewnent do"m and foundation drains should be des bgpd to the V=W whenever possible. Note. this does tuft include laundry waste, showers, dishwater, etc. no system is desawd to handle domestic AnwSM wastewater, however the disposal of food based grmses and ails, vep W)L-&W peels and seeds, bones, and food solids such n thane produced by a garbage disposal. should be minimised. Toilet tisane is the only paper tteat should be discharged tmo the systemm Other non biodegradable items such as baby wipes, tampons, sanrtary napkins con durns, cigarette butdt, de ntol floss, and cotton swabs should not enter flee system Chemicals aoch as petmlawn pub, paint, disinfictook peatihckles, andbiotics, solvents. etc., should not be flushed WW the system as they can sarmsly damage your POW TS sad coulamliode your drinking wow sq*y. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traftic over all system eoropononts. Compaction of now over the dispersal mut may cause it to freeze up. p Valves Valves; shalt be operated in the following manner. 0 Alas ms Ali = should be toted on a regular basis by the home owner, If an alarm sounds, contact an individual licensed to aeMM POWTS, There is noru"Y a 1 day reserve endear regular operating conditions, however water should be conserved we sAy problems with the system are dead to prevent back up of sewage mean the dwellmg or s afacing, Il~iPEL~lY& Inspection shalt be made by an individual carrying one of the following licenses or catiftatiaos= muter Plumb x~ Meatier Phmnber Ra=icted Sewer, POWM MttintaMer or Septage Servicing Operator tiler the attached Maiatatanace Schaed194 D Septic Teaks Component Talc inspections must include a visual bspection of the tank to identify any missing or broken hardware, i may cracb or hwks, maeras m the volume of combined sludge and scum and to check for anp bs~ or porduaag of effluent to the ground surfime. Access openings used for service at assessment serail be sealed and/or locked ttpcne completion of see. Any dew shall be promptly mnw*KL Exposed openings greater than 8 inches in diameter shall be secwed with an d i x*ve locking device to prevent accidemi or unauthorized entry into the tank. When the c"ination of sludge and scm in any tank exceeds ow-third (113) or mare of the tank volume, the audio contents of the tank shalt be removed by a Septage Servicing Operator and disposed of in acombuic a with Chapter MU 13, Wisconsk Administrative Code, The outlet filter(s) shall be inspected and cleaned to rernove any accumulated solids according to manuactinces specif radon Provisions are tD be made to raven solids in the tank. Filter cleszong may be necessary at mars Sequent intervals than stated in the maintenance wAedule to keep the system operating. p Pump ChamhertT m me ut Tanks Conaponalut such as pampa, alarms and floats. A visual check mast be The impecdon roast txbwe a test of all electrical esqu4ment of sn fps. made for leaks, backups, surfacing, mrsswg or broken security devecas and other ba; dwore and dm condor y Any service needs or repairs shaft be promptly taken cane of. p U03rou nd Gravity Cou"nout Dispersal Cells The inspection shall Hidude recce ung the levels of ponding, ' if any in the absexvatiaan tether and a visust ittapectioaa for any evidence of surface seepage or disctfmge. Any discharge to the grow id surface meat be prof kVdy reported to the rplotory autiou rity. Poadmg at dapd a greater ttum 75X. of the heW of the comps may indimu ooverloaft of invanifing hydraulic Who nece mg more fief momltodng.