HomeMy WebLinkAbout040-1326-11-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 592150
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 Investments LLC TOWN OF TROY- 1 040-1326-11-000
CST BM Elev: Insp. BM Elev. BM Description: Section/Town/Range/Map No:
17.28.19.2203
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER f CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
1
Wsing Alt. BM Q -
Aeration Bldg. Sewer
".0 /6(, .
Holding St/Ht Inlet j!
163.42
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic ro Dt Bottom
Dosing Header/Man.
Aeration Dist. Piper
A OZ-
Holding Bot. System
tS`•
PUMP/SIPHON INFORMATION Final Grade
4 ~
Manufacturer Demand St Cover
GPM 4 J'513
Model Number
TDH Lift Friction Loss System Head TDH Ft
I
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
Type Of System:
UNIT Model Number: r {
w '5,
DISTRIBUTION SYSTEM k: u -
Header/Manifold Distribution x Hole Size ix Hole Spacing Vent to Air Intake
Pipe(s)
Length / Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over ri Depth Over xx Depth of Ixx Seeded/Sodded Mulched
Bed/Trench Center Bed/Trench Edges Topsoil
Yes E] NIxx
U Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 398 MEADOW VALLEY TRL
1.) Alt BM Description
2.) Bldg sewer length = +r .3
-amount of cover = ~ ~o ~ ~ _ ~n a' ~ ~p Ofd G~.r :,e?f'
Plan revision Required? ❑ Yes r] No
Use other side for additional information.
Date Insepctor' Signature Cert. No.
SBD-6710 (R.3/97) 9
5r~-a~j~ -~3
County i
ings Div ion J
ED
201 W. Washin
K A Sanitary Permit Number (to be filled in by Co.)
Madison, W1 53707-7162
rL ST. CROIX
tats transaction er
co MLiTY DEWELOPI,§_ tary Permit Applicaf _
rdanee with SPS 383.21(2), Wis. Adm_ Code, submission of this form u 99QR4EBKSS8FG
is required prior to obtaining a sanitary permit. Note: Application forms for sta Project Address (if different than mailing address)
the Department of Safety and Professional Servies. Personal information you _
purposes in accordance with the Privacy law, s. 15. 1) m), Stats. j
1. Application Information - Please Print All Information ~G g 4sZ f
Property Owner's Name_,
n Parcel # I ttt~~~~
0Li0 - 1316°-11 ' 00U
Pr Owa~s Mail i>dress ~ pe _
'Pro rty Location
Govt Lot
i City, State Zip Code Phone Number
v 1i~
~ 4 Section
t ircle o
II. Type of Building (check all that apply !Bl t # T N: R E W
r 2 Family Dwelling-Number of Bedroo Subdivision Name
l..R wL
a [ WV_ oc f f~ '(If
❑ Public/Commercial - Describe Use
❑ City of
❑ State Owned - Describe Use CSM Number ❑ Village of
f w ,
Z2, _Z of
III. Type f Permit: (Check only o e box on line A. Complete line B if applicable)
A. System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing S
j }'stem (explain)
- B• D Permit Renewal ❑ Permit Revision ❑ Change of Plumber
❑ Permit Transfer to New List Previous Permit Number and Date Issued
' fore Expiration Owner
t Iv T fPOWTS System/Com onent/Device: Check all that a iv
Non- In-Ground ❑ Pressurized In-Ground ❑ Mound > 24 in. of suitable soil ❑ 11 24 in. of suitable soil/
Hol " ank ❑ Other Dispersal Component (explain) - ❑ Pretreatment Device (explain) `
ersal/Trea ent Area Information: .S "'Design Flow (gpd) Design Soil lication Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Propose sf)
System Elev on
VL Tank Info Capacity in Total # of J
Manufacturer
Gallons Gallons Units
B
New Tanks Existing Taa}a m v U
y C y a~ - in
O ai a m m
Septic or Holding Tank
Dosing Chamber
VII. Responsibility Statemen the undersigned, assu r ponsibility for installation of the POWTS shown on the attached plans.
Pluni 's Name (Print) Plumber' azure MP/MPRS Number Business ono N er
Plumber's Address (Street, City; Stn , 'p Co
VIII. unty/De artment Use Only
pproved ❑J,~Iisa Permit Fee Date ued Issuing rnt Signai
~fg5.ao /o /S
w r iven Reason far Drniai
IX "'V19 lisp ppor Disapproval /J r II
ark, a n* ,lt~t , i 3 1l.~dfa~. dGP~wP.~6 ~b p~t~l
disper-.::i cell l'xlust n rec
as per maragt5lgen jy pkimber.
2. 'M Setback refit nt a rft sd
sswrApF+Qtftoodt / mina :s. t^Or~M •CJ• .
Attacb W complete plans for the system and submit o t CoWEY 1, on paper not less 8 trz z 11 inches to size I
\J\ e ~ ~I
'
SBD-6398 (R 11/11) t e- 4AX.
System PLOT PLAN
PROJECT DCCI Investments ADDRESS PO Box 445 New Ri chmond Wi 54017
NW 1/4 NW 1/4S 17 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX
SYSTEM ELEVATION 105-0/104.5'4' below qrade 10/6/16 4
DATE BEDROOM
CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44
BENCHMARK V.R.P. Top of 1" steel pipe ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE O WELL *H.R.P. same as benchmark
B.M.*1 Property Line
52' Scale = 1/4" = 10'
40'
123'
43' 150' 106'
8% Slope
5 8' Vents
x,108'
110'
'i 115'
I 4''i +
Vent f 1 f
>6„ Quick4 Standard 2.3' X 90' cell Bwith B-3
of Cover Leaching Chamber
with 20.0 ft2 of Area >3 spacing
12" 5.6ft^2/pair of end caps
4' Long
34" Grade at System Elevation
20' }
All piping shall be ASTM SDR 30/34, within
10' of tank, piping shall be ASTM F891 20' Pro 4
Property Line Bedroom
House
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 10/7/16
Owner:DCCI Investments
Location: NW1/4 NW1/4 S17 T28 N,R19W 398 Meadow Valley Trail Troy
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Se ion
4-6. Maintanance and tingency Plan
7.Filter Cross Section
Signature
License numb # 6900
System PLOT PLAN
PROTECT DCCI Investments ADDRESS PO Box 445 New Ri chmond Wi 54017
NW 1/4 NW 1/4S 17 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX
SYSTEM ELEVATION 105.0/104.5' 4' below grade 10/6/16 4
DATE BEDROOM
CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44
BENCHMARK V.R.P. Top of 1" steel pipe ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE O WELL *H.R.P. same as benchmark
B . M. * 1 Property Line bol
52' Scale = 1/4" = 10'
40'
123'
43' 150' 106'
8% Slope
B-1 Vents
58' 108'
115' 110'
Vent
>6" Quick4 Standard 2-3' X 90' cells with
B-3
er Leaching Chamber >3' spacing
with 20.0 ft2 of Area
12" 5.6ft^2/pair of end caps
?4Long
34" Grade at System Elevation
20'
All piping shall be ASTM SDR 30/34, within
10' of tank, piping shall be ASTM F891 20' Pro 4
Property Line Bedroom
House
Cross Section of Infiltrator Quick 4 Leaching Chamber
Typical cross section for 2 of 2 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 ~ 109.0'
Grade Vent
Avent
4" 3'
~~30/34 Septic T:5) 5' L
ong 1
3 6" Grade at System Elevation Grade at System Elevation
Spacing- 5'
2-3' X 90' Cells
Same on other end Observation tube/Vent
At end of cell
A
22 chambers per cell B
System elevations:
A-1 05.0'
B-1 04.5'
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
ILE INFORMATION SYSTEM SPECIFICATIONS
Owner
t_-C~ Septic Tank Capacity ❑ NA
Permit # - al
Septic Tank Manufacturer NA
ESIGN PARAMETERS Effluent Filter Manufacturer j 9, ~,A
~lJ
Number of Bedrooms ❑ NA Effluent Filter Model ~i
❑ NA
Number of Public Facility Units [VA Pump Tank Capacity al ❑ NA
Estimated flow (average) Yo aUda Pump Tank Manufacturer
I Design flow (peak), (Estimated x 1.5) 61 avda Pump Manufacturer Soil Application Rate - ; al a ~z Pump Model 1 Standard Influent/Effluent Quali
tY Monthly average Pretreatment Unit
3NANA
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODs) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 m
9/L ❑ Disinfection ❑ Other.
Pretreated Effluent Quality Monthly average Dispersal Cell(s)
❑ NA
Biochemical Oxygen Demand (BODs) 530 mg/L In-Ground (gravity) 13 In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L NA ❑ At-Grade ❑ Mound
Fecal Colifonn (geometric mean) 5104 cfu/100ml ❑ Drip-Line ❑ Other:
!Maximum Effluent Particle Size Y8 in dia, ❑ NA Other.
Other. ❑ NA
A Other:
❑ NA
'Values typical for domestic wastewater and septic tank effluent Other.
❑ NA
IAINTENANCE SCHEDULE
Service Event Service Frequency
Nnspect condition of tank(s) At least once every: ❑ month(s)
3 ears (Maximum 3 years) 13 NA
(Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume
❑ NA
linspect dispersal cell(s) At least once every: J esr sjs) (Maximum 3 years) El NA
Clean effluent filter At least once every: ear(s)s) ❑ NA
Inspect pump, pump controls & alarm At least once every; ❑ month(s)
❑ year(s ❑ NA
1=lush laterals and pressure test At least once every: p year s)s) NA
ether.
At least once every: 0 year(sjs} NA
ether;
NA
MAINTENANCE INSTRUCTIONS
!Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master
(Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must
linclude a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of
ccembined 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 ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local
I-egulatory authority.
I+Nhen the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume,
the re contents of
ffie tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NRe113, Wisconsin
Administrative Code.
INN other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units,
I nd any servicing at intervals of s12 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 tI*t
may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of th?.
tank(s) removed by a septage servicing operator prior to use.
System start up shall not oath 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 ble
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluenL
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 yehides 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 We of the Powr$:
antibiotics; baby wipes. cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disrnfec WvW, fat: foundation drain
(sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; Ping Producils;
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.
• 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 falls and cannot be repaired the following measures have been, or must be taken, to provide a code compGarrt
replacement system:
/W-`- suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelm.
The replacement area should be protected from disturbance and compaction 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 noW
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rule;l 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 POWTS a sail and site evaluation
must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed 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 AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TAN 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
Name Name cz.- 1S
Phone 7 Phone l/ J
SEPTAGE SERVICING OPERATOR PU ER LOCAL REGULATOR AUTHORITY
Names, Name { ~~71
Phone 1 c r,~ Phone
This doasnentwas drafted in compliance with chapter SPS 383.22(2)(b)(%d)&(f and 383..54(1), (2) & (3). Wisconsin Administrative Code.
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i SOIL°EVr4LU REPORT 417
$ P Safety ano 01,1 in accordance with Comm~S Wis. Adm. Code Page 1 of 3
Professio r cds? !
Schmitt Soil Testing, in.
Attach complete site. q "X 8% x 11 inches in size. Plan must County St. Croix
include, but not limiter 44i:'vd tdat dd ~(~riz6rRVL14JMnce point (BM), direction and -
percent slope, scale or dimensions, north arrow, an location and distance to nearest road. Parcel I.DQ
Please print all information. Revi ed By Dat
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
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~ Meadow Valley Of Troy
City State Zip Code Phone Number it City 11 Village 1 Town Nearest Road
New Richmond WI 54017 Troy East Cove Rd
New Construction Use Residential ! Number of bedrooms _ 4 Code derived design flow rate 600 GPD
_I Replacement Public or commercial - Describe:
Parent material Outwash Sand Flood plain elevation, if applicable NA ft.
General comments Area is suitable for a conventional system with a 0.7 gpd/sgft rate. Possible system elevation for Area 1 is 105.4'. Slope is 6%.
and recommendations:
'Boring
F-11 Boring #
Pit Ground surface elev. 107.17 _ ft. Depth to limiting factor _ 115+_ 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 0-8 10yr3/3 none sl 2mgr mvfr Cs 2vf 0.6 1.0
2 8-15 10yr3/2 none sl 2msbk mfr gw 1vf 0.6 1.0
3 15-25 7.5yr5/6 none Is icsbk mvfr as ivf 0.7 1.6
4 25-43 10yr6/4 none s Osg ml cs 0.7 1.6
5 43-73 10yr5/6 none grs Osg ml as 0.7 1.6
6 73-115 10yr6/4 none s Osg ml 0.7 1.6
Boring
2 Boring # ,
Pit Ground surface elev. 106.76 ft. Depth to limiting factor 115+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2
1 0-6 10yr3/3 none grsl 2mgr mvfr Cs ivf 0.6 1.0
2 6-10 10yr3/1 none grsl 2msbk mfr gw 1vf 0.6 1.0
3 10-15 10yr5/6 none gris Osg ml gw 1vf 0.7 1.6
4 15-115 10yr6/4 none grs Osg ml 0.7 1.6
Effluent #1 = BODS> 30 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 <.30 mg/L and TSS s.30 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 5/6/2014 715-760-1978
SBD-8330 (R.07/00)
Property Owner DCCI Land Planners Parcel ID # Page 2 of 3
Boring
a Boring # pit Ground surface elev. 109.24 ft. Depth to limiting factor 115+ in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I *Eff#1 *Eff#2
1 0-8 10yr3/2 none sl 2msbk mvfr as 1vf 0.6 1.0
2 8-14 10yr4/4 none sl lmsbk mfr gw lvf 0.4 0.7
3 14-20 7.5yr5/6 none sl lmsbk mfr gw lvf 0.4 0.7
4 20-115 10yr6/4 none grs Osg ml 0.7 1.6
102 1(
Boring
Boring # 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/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
Boring
Boring # 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/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you heed assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or FIN 608-264-8777.
SBD-8330 (R.07/00) Schmitt Sal Testing, Inc.
Page 3 of 3
Conducted by: 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, WI 54017
New Richmond, WI 54017
Phone: 715-760-1978 Subdivision: Meadow Valley Of Troy
Signature Lot No.: I I
Date S-- (o v2O/'! Legal Description: NWI/4 NWI/4 S17 T28N R19W
Backhoe Pit Township, County: Troy Township, St. Croix County_
Bench Mark 1 El. 100.00' Top of 1" Steel Pipe. NW Lot corner pipe. _ (864.42')
Bench Mark 2 El. 98.64' Top of 1" Steel Pipe. SW Lot corner pipe. _ (863.03') -
Slope= 6%
Scale 1"= 40'
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