HomeMy WebLinkAbout032-2045-30-300
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 592252
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:
Oevering Homes LLC TOWN OF SOMERSET 032-2045-30-300
CST BM Elev: Insp. BM Elev: BM Description: ~p n'v' ~ PV 0 ~ fp Section/Town/Range/Map No:
M r~- 12.30.19.654D
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 41, Septic ~r f UA Benchmark
l + t fm, TZ I V~.~IJ 1 V J~ ~Ov U
Alt. BM
/XEI~tttR1 _ Bldg. Sewer t02-6 Hulrlirag SUH Inlet
(o. IOD,S
TANK SETBACK INFORMATION SHt Outlet
(Q (f(J
TANK TO P L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic p r / Dt Bottom
Dosin Header/Man. VO. t 9-7, C)
ration Dist. Pipe q
_T Ar
Hol Bot. Sy em P-7 11.2
9~ 7 1. 9
PUMP/SIPHON INFORMATION Final Grade -7, L. 9
Ma rer emand St Cover U
GPM
Model Number
H Lift Friction Loss ystem Head TDH Ft
Forcemain ength Dia. Dist. to Well
SOIL ABSORPTION SYSTEM \ t- Ca
BED/TRENCH Width Lengttj,, t No. Of Trenches n PIT DIMENSIONS No. Of Pits Inside D>> Liquid Depth
DIMENSIONS (V_
i
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer j ~A
INFORMATION CHAMBER OR /
Ty e f System: U " 1 ^ ' 0 D t UNIT Model ber L
IBUTION SYSTEM\~II r/ LQU
Head anifold Distribution ze x Hole Spacing Vent to Air Intake
Pipe(s) /y`
Length Dia Length Dia Spacing -~J I
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only L
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed Trench Center ` Bed Trench Edges ^ Topsoil
L No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspectiion #1: n Inspection #2: /}~1~n
Location: 827165THAVE -4, Nell 1)6+ 'osbRI-A f (~rec`'`~~,
1.) Alt BM Description =
2.) Bldg sewer length = 2~1 ~i ~ ~ ~rVU 1 (/till h 16~ IL U ( wIL~
- amount of cover 41 ll~ l~
~ ~Cow all ~ ~ ~ Plan revision Required? Yes No f
Use other side for additional informa on.
SBD-671 0 (R. 3/97) Date Insepctor' gnature Cert. No.
f
County
< > Safety and Buildings Division
8 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit N=ba (to be fill" in by Co.)
Kj- j t Madison, YY1 537,07-7162
SOU j i . 27,5Z_
MuNr -
axutary Permit A tale Transactitm Number _ ,1.6 e-r i.0 `
m accordance with SPS 36321(2), Wis. Adm Code, submission of this form to the appropriate governmental ,it ; L L-) -71
is required prior to obtaining a sanitary permit Note Appticatoo forms for state-owned POWTS are submitted to i Project Address (if different than mailing address) o
the Department of Safety and Professional Servies. personal infonnahon you provide may_tLpsed for seconda y w
L purposes in accordance with the Pnvac). Law, -S1 5. 1 m), Scats. }
L Application Information - Please Print AlI information rL J
Property Owners Name '
i i Parcel ;i
~ ~ / i ~ r~7,` .l - , ~'t AJY/! ;
Property Owner`s Mailing AdrirpSs
Property Locatr ~ y ~ •
I ((a 4~ iZ i(~ its
'4:? s . •
C'ny, State ~ ~ _ Govt- Lot
Zip Code Phone Number
le OJWT'7
U. Type of Building (check all that apply) Lot A T, 'L 7 N. R 1~
or ~
-c
i nr 2 Family Dwelling -Number of Bedroo Subdivision Name
a~ Block #
LJ Public/Commercial - Describe Use
Li
U Ciry of ~
J
State Owned Describe Use CSM Number ~ a illage or
Li I to H(O
of Type of Permit: (Check only one to on line A. Complete line applicable)
I A
Systerl ❑ Replacement System i L Treaunenthiolding Tanis Replacement Only I ❑ Other Modification to Existing System (cxp;ain r
B- ❑ Permit Renewal ❑ Permit Revtsion Change of Plumber i 1i Perrnir Transfer to New List Previous Permrt Number and Date ssned
Before Expiration e
I Owner
IV. of POVVTS S_ystem/Comnonent/Device- (Check all that apply) -
- -Presstuized In-Ground ❑ Pressurized In-Ground ❑ At-Grade t
C ~Souud = 24 LL of suitable soil ❑ Mound < in. of suitable sell I
L~ Ho M;7- Tank E~ 6ffi r Dispersal Component i explain _ ❑ Pretreaament Device (cxpl !
V. is rsallTre meat Area Information: - ~t~e 4' / V t
Des gn Flow (gpd) Desist Soil Application Rat
f) Dispersal Area Required (sf) !Dispersal Area Pro d (S System El"ationr ( -y
VL Tank info Capacity in Total k of ✓ , rJ ` f s
Manufacturer -r-- t2
I Gallons c>allon~ Units
New Tanks rx.e,,gTanks } l e i l m `_u J
xWo or Holing Talc V~-rl ~i /.w t I n a i n ° L
Dosing Chamber
VII- Responsibility State ent- I; the nnderstgoe me responsibility for instaFlaaon of the PORTS shown on the attached plans
(Pant) - T-
Pltmbex's Name PI Si 7anue MP/MFRS Number Business'hone Number
Phmnber's Address (Strew, City-, Star, Zap Code V !
I fifi / i
i-
v'
VHJ,oCountvA[)e artment Use Only '
I Approved ❑ Permit Fee Date sued Issuing entSignatrre
( ~y 5
Q O yen Reason for D.. Q j 7 '
DL Couditi 1
asons for Disppproval
t. ep tark tt c e i rnu n; lilte t rn
c,is~•e rct, sett r.+ust dil bt se_ic; s - - tt-.. e~
v t ( p '
{f as per onar.ayement plan p!o Eiden by plu,nbe,.
2. AN r4row,lt re,4ww r Me" must Do maatt. itf. -
:
w per PK iatblot cult:1,rd;nan i. L'AAr i A~'
Attach to Cup Lim for the system and submit to the County only o7, paper sot less than 8 it z 11 inches in SUM
S13D-6398 (R_ 11i 11)
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 3/30/17
Owner:Oevering Homes
Location: NE1/4 SW1/4 S12 T30 N,R19W Lot 3 165th Ave Somerset
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4-6. Maintanance and tingency Plan
7. Filter Cross Sectio
Signature
License number 26900
System PLOT PLAN
PROJECT Oeverino Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017
NE 1/4 SW 1/4S 12 /T 30 N/R 19 W TOWN Somerset COUNTY ST. CROIX
SYSTEM ELEVATION 95.3/95.0 4' below grade 3/30/17 BEDROOM 3
DATE
CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32
BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE O WELL *H.R.P. same as benchmark
165th Ave
Vent Scale = 1/4" = 10'
>6" Quick4 Standard
of Cover Leaching Chamber
with 20.0 ft2 of Area Property Line
5.6ft^2/pair of end caps Pro 3
Long Bedroom
Grade at System Elevation House
34"
30'
S .M.*
B-
40'
10'
54'
01
2-3' X 66' cells wi >4' spacing
0'
-3
t
18'
All piping shall be ASTM SDR 30/34, within
10' of tank, piping shall be ASTM F891 90'
100' B-2
98, 4% Slope
72'
W
_,Property Line
t5o~
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 99.3
Vent G rade Vent
3' " 3,
A~=Sepfic 5' Long 1 5' Long 1
Grade at S
ystem Elevation
36" Grade at System Elevation
i
Spacing- 5'
24 X 66' Cells
Same on other end Observation tube/Vent
At end of cell
A
B
16 chambers per cell
System elevations:
A-95.3'
B-95.0'
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner
i4`' Septic Tank Capaci ty Permit # al 11 NA
Septic Tank Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer r
Number of Bedrooms ❑ NA
❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units ,L} NA Pump Tank Capacity
Estimated flow (average) ~ al Q ~
aUda Pump Tank Manufacturer NA
i Design flow (peak), (Estimated x 1.5) ?j
' ~ aUda Pump Manufacturer ❑ NA
Soil Application Rate
al/da / tz Pump Model O NA
Standard InfluentlEffluent Quality Monthl avers e`
y 9 Pretreatment Unit ❑ NA
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODs) 220 mg/L ❑ NA 0 Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) <150 m
g/L ❑ Disinfection ❑ Other.
Pretreated Effluent Quality Monthly average Dispersal Cell(s)
Biochemical Oxygen Demand (BOD5) _<30 mg/L 13 NA
Total Suspended Solids `Ground (gravity) ❑ In-Ground (pressurized)
(TSS) 530 mglL ❑ At-Grade ❑ Mound
Fecal Colifonn (geometric mean) <104 cfu/104m1
❑ Drip-Line ❑ Outer:
Maximum Effluent Particle Size 36 in dia. ❑ NA other.
Other. El NA
A Other:
❑ NA
*Values typical for domestic wastewater and septic tank effluent Other.
❑ NA
IAINTENANCE SCHEDULE
Service Event
Service Frequency
Ilnspect condition of tank(s) At least once every: ❑ month(s)
ears (Maximum 3 years) 11 NA
(Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume
❑ NA
Ilnspect dispersal cell(s) At least once every: month(s)
- year(s) (Maximum 3 years) ❑ NA
Clean effluent filter At least once every: ~ ear(s)s) ❑ NA
1 nspect pump, pump controls & alarm At least once every: ❑ month(s)
CI year(s) NA
1=lush laterals and pressure test At least once every: 13 month(s)
ether. ❑ year(s) NA
At least once every: 11 month(s)
ether: ❑ year(s) NA
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
!include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of
immbined 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.
When the combined accumulation of sludge and scum in any tank equals one-third (X) or more of the tank volume, the entire contents of
I:he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with c
Administrative Code. hapter NR 113, Wisconsin
Ill other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units,
1.3nd 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 rY tY 10 days of completion of any service event.
Page of
START UP AND OPERATION
For new constriction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals thelt
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 by
discharged to the dispersal cell(s) in one large dose, overlong the cell(s) and may result in the backup or surface discharge of effluenit.
To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to ttde
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 yehicles 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 POWT$:
antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat: foundation drain
(sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting productjs;
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:.
e 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 properly disposed of by a Septage Servicing Operate'.
• 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 fags and cannot be repaired the following measures have been, or must be taken, to provide a code comp6ont
replacement system:
.suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system.
The replacement area should be protected from disturbance and compaction and should not be infringed upon by requirled
setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the neled
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rute;i in
effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Bening 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 sal 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 infif live
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
Phone - ' I Phone i7
SEPTAGE SERVICING OPERATOR P PER LOCAL REGULATORY AUTHORITY
Name Name
Phone Phone
Cp,
This document was drafted in compliance with chapter SPS 383.22(2)(b)(%d)&(f and 383.54(1), (2) & (3), WLscor►sin Adminktrative Code.
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ST. CROIX COUNTY
SEPTIC TANK MA XTENANCE AGREEMENT AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address
:Property Address 1 1,
(Verification required from Pi ~~A
arming & honing Department for new construction.)
City/State 1 s
_
- Parcel Identification Number 1132
LEGAL, DESCRIPTION
Property Location Sec.
T N R. W, 's'own of
Subdivision L--
Certified Survey Map D ~q Lot # 3
Warranty Deed # Z - Voltune P - J O 7
~7 c~ age #
Volume Page #
Spec house yes no -
Lot lines ident~ablq✓
SYSTEM MAINTENANCE l Yes no
AND OWNER CERTII+'ICATION
Improper use and maintenance
maintenance consists ofpulnpin of your septic s stem could the system can a#fect ~e~ out the ry three e result in its premalnre failure to handle w
function of optic eve y azs or sooner, if ne astes• Proper
responsibilities are specified in the septtc( ) tannk k and as a in Chtreatment Stage eded, by a licensed
§Comnz. 83.521 n the waste disposals stem, Punpei. What You put into
Chapter ,12 - St.iCroix County Sanitary
p Pena' owner agrees to sub' Ordinance.
owner and by a master plumber, journe mil to St. Croix Coun P
wee R ater di yinan Plumber, restricted p uml ing 6licen' DeParttnent a ce
sposal system is in proper reification
less than l li fujY of sludge. operating condition and/or 2 pnmPe1 verifying that 1 ~ signed by the
after inspection and the on-site
purnPing (if necessary), the septic tank is
T/we, the undersigned have read the above
standards set fort requirements and agree to
h, herein, as set by the D maintain the the
Certification slating that your se ticeParhnent of Cornrnerce private sewage disposals stem
Cerb p system has been and the Department of Natural Resources, State of Wisco sin
g Department within 30 days of the three ina'ntained must be completed and re
Year expiration date. turned to the St. Croix Coon
Uwe certi that County Planning
all
en's on
property described above by statem
s form are true to the best of my/nm knowledge. I/we am/are the o
trtue of a arranty deed recorded in Re
Number of bedrootus~ gister of Deeds Office. wner(s) of the
~T~GNA OF APPLICANTN
**"Any information that is misrepresented HA'Z'E
may result in the sanitary permit being revoked by the Planning 8z `Coning Department
Include with this application a recorded warranty deed from the Register of Deeds Office
reference is made in the wana re deed.
e and a copy of the certified survey map if
(REV. 08/05)
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VVis onsin Department of Safety and Professional Services EC G1 CC, Zd ~5- Q3$
Divi io;, of Industry Services DEC
SOIL E\W"bTJ<MKTVORT Page Of
0,32- -3
in accordance with Com~'in0flJNt~(mDLOPME -ZO</5- C~ -300
County
ach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
to Jude, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
rcent slope, scale or dimensions, north arrow, and location and distance to nearest road. 6 _ zoAl G
Please print all information. Re wed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Z `r
Property Owner Property Location
7 i
Govt. Lot 1/ 1/4 T :j~, N R c E (or) W
Property Owner's Mailing Address Lot # Bloc # Subd. Name r CSM#
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City State Zip Code Phone Number City O village Town Nearest Road
New Construction Usejn Residential / Number of bedrooms ; Code derived design flow rate GPD
Replacement Public or commercial - Describe:
Parent material: 2Flood Plain elevation if applicable ft.
General comments
and recommendations:
Boring #
11 F 71 171 Boring
Pit Ground surface elev. ft. Depth to limiting factor >Z in.
J-Aj Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
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Boring # Borin/Ground pit surface elev. ft. Depth to limiting factor ?f in.
- Soil A lication 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
- i_ 6,
z, Z
f
IV/
ll
Effl nt #1 = B 5 > 30 < 220 mg/L and TS 30 < 1 mg/L - * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L
CST Nam leeasel(l r J Signature-- CST Number
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Address / J Date Evaluation Conducted Telephone Number
SBD-8330 (R07/13)
n /
Property Owner c? Parcel ID # Page of _
Boring # Boring
Cr .
Pit Ground surface elev. 5 . / ft. Depth to limiting factor >4L in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
- - - 0-1
21 _
611 N
1
❑ Boring # Boring
n 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/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
Boring
E Boring # Ground surface elev. ft. Depth to limiting factor in.
Pit 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 = BOD5 < 30 mg/L and TSS < 30 mg/L
SBD-8330 (RO i/13)
Property Owner Parcel ID # Page --;~2- of
Boring
Boring #
F-31 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/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2
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/fE
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2
Boring
❑ Boring # Ground surface elev. ft. Depth to limiting factor in.
17 Pit Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
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
SBD-8330 (807/13)
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