HomeMy WebLinkAbout040-1074-60-000
St. Croix
MELANIE & JASON BERG Municipality: TOWN OF TROY
326 S COVE RD Permit Number: 24105
HUDSON Parcel Number: 040107460000
WI 54016
Alt Parcel Number: 18.28.19.283D
Site Address: 326 S COVE RD
Components
Component Manufacturer Description Last Next Status Schedule
Service Service
Septic Tank Septic Tank 12/08/2016 12/08/2019 Current 36
Conventional Seepage Pit Seepage Pit 12/08/2016 12/08/2019 Current 36
Drainfield
Maintenance History
Service Date Maintenance Name Gallons Pumped
12/08/2016 Darrell's Septic Service 3200
04/18/2016 Darrell's Septic Service 0
10/20/2014 Not Available 0
09/09/2012 Not Available 0
12/01/2009 Not Available 0
Notes
Date Text
7/4/1776 12:00:00 AM ADDITIONAL NOTES: plot plan showed existing 1000 gal. tank to 2 drywells (seepage
pits) and lot soil report shows which parcel POWTS was installed - <1978
MIGRATED ON: 09/04/2015
'No data found for Notices, Violations
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No
(ATTACH TO PERMIT) 592290
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:
Jason Berg TOWN OF TROY 040-1074-60-000
CST BM Elev: Insp. BM Elev: BM Description: ( Section/Town/Range/Map No:
18.28.19.283D
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
S e.~.~ f ~OOd 5 M7, / -00
6"449" Alt. BM 4.16 /6Z.
5
A9MftOTI' i (1 `~i~ w J Bldg. Sewer
Holding i•!• St/Ht Inlet
7.4 49'g
TANK SETBACK INFORMATION St/Ht Outlet 74 S 49
S
TANK TO 0I WELL BLDG. Vent Air Intake ROAD Dt Inlet ~
Septic Dt Bottom
Dosing Header/Man. A , r
Aeration Dist. Pipe I . g's , l'.
v/ 1 ~t Z
Holding Bot. System
PUMP/SIPHON INFORMATION Final Grade
Manufacturer Demand St Cover
Model Number 1(~~ J
~7~ (o
TDH Li Friction Loss System TDH Ft
/6.3 'T7
Forcemain Length Dia. Dist. to well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Li uid Depth
DIMENSIONS 3 oL `14 Z TQ I-ICILb ~ ~
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System:`
~ s I ~0111 ~ M / UNIT Model Num er: 54Cn 1011ts
DISTRIBUTION SYSTEM c ( 41 Z(, (awe,`, 2
Header/Manifold 11 Distribution ~~;Txle Size x Hole Spacing
VAir Intake `
' Pipe(s) Length Dia Length Dia SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded jxx Mulched
Bed/Trench Center -3 • Z Bed/Trench Edges Topsoi es ❑ No Yes n No
ilin It It
60' rrt4%AVAj._
COMMENTS:
Inspection #1: Inspection
(Include code discrepencies, persons present, etc.) 0c,
Location: 326 S COVE RD
1.) Alt BM Description =
2.) Bldg sewer length = ~d %Lb e w~1b4-~tjA_ C~ q,, S h-c~ d
-amount of cover = J ^
7 3 a,ti _0.1X1 Glr
Plan revision Required? Yes WNo Zg 7
Use other side for additional information. I _ 7` V
Date Insepctor's nature Cert. No. I I
SBD-6710 (R.3/97)
county
Sakity and Buldhigs Dvslon RECEIVED
201 W. Washittgtort Ave., P.O. Box 7162 Sfaitary Permit Number (to be filled in by Co.)
r Madison, WI 53707 7162
APR 2,6 201j~~
pplication State Tran ciber
in accordance with SPS 38321(2), Wis. Adm. Code, submission of this firm to the appropriate governmental unit _
Ce- wit a sanitary permit. Note: Application fomu for state-owned POWTS are submitted to T Address (if different than mailing addle
e N of Safety and Professional Servies. Personal information you provide may be used for secondary /
w Si:mmaacgcordavoc prior to obtaining
I C7 with the Privacy Law, s. 15. 1 m Stats. 3z `f' ~o J ~ (moo c~ ~
1WPUcation Information - Please Priest All Information P\
o Owner's Name Parcel # ~C
10110- UW
0
d Owner's Mailarg Address Property Location
N . L, 1--) C ~j 1 C' 'wre ( cwt. Lot
am State Code Phone Number y~
zip K. S V 4, / C.
(circle oone).
II. Type of Bur7tling (check all that apply} I- Lot at T N; R E `'1
❑ 1 or 2 Family Dwelling - Number ofBedroo Subdivision Name22
Block* 1/A~•, ~ 1>
❑ PublkX=mexciel - Descn`be Use
❑ City of
❑ State Owned- Descnbe Use CSM Number ❑ Village of
I i
;e
7 zJ, C tDQh w 274-Z-7 C er5 sk`Townnof
1IL Type of I'ernt it. (Cbeck only o box on line A. Complete line B if applicable)
❑ New System DLReplwement Sysbcm ❑ Treauneat Holdng Tank Replacctnrrtt Only ❑ Other Modification to Ettistmg Systeat (c*t
B. ❑ Permit Renewal Q Permit Revision ❑ Change of Plumbea 0 Permit Transfer to New List io Permit Number Iassmd
Before•Facpiration Owner
f ,a ~Q 9
IV. Type of POWTS System/Component)Deview (Check all that apply)
KNon-Pressurised ln-Ground ❑ Pressurized in-Ground ❑ At Grade ❑ Mound 2:24 in. of suitable soil ❑ Mound < 24 in of suitable soil
❑ Holding Tank - 1pmW Compment (explain) ❑ Pratmetmett Device (explain)
V. Dis alffrea ant Area Information.
Desig~nFlow (gpd) Design Soil Application Rata Dispe/tr/sra~l AlreaJyRequired Dispersal Area Proposed/~(sf) System Eleva0n
56 41 -,7 VI. Tank Info Capacity in Toni # of Mer<rha
New w I
t'3allons ttailaets Units /~bp~z Ta
a]s Exiasog Tacks
Septic or Holding Tank 5 ' S 1
Dosing Chumbar
VII. R oasibllity Statement- 1, the andersiped, assume responsibility for in ration of the PORTS sbowniml.lie attaehed ans.
Phi mber's Nam (Print) IS Si e / W ilmbea Business Phone Nwaber
-JY -,YJ56,
Plumber's Address (Street, City, State, Zip Code)
C - f , Ass ` ti `~l ~3-41 (Y)ei
VIII.Ro-uRYADnartment Use Ofd
Pextait Fee DAC s sure
❑ fix Denial ts 15, 17
Reasou °n ZV
I.X. Con ns for Disnpproval
3) 61 LA~
'u6S}>St:=s erM r:ftl~f do be sit IC?S -~t~ r es; /
os per ,inwalgernent plan pro nded by plumber.
2. tY+gt„iFot"~artntl>it t,N t ~acnta Irf d ~~QC Q~ r
as W 11pp"Wo catdw 1 zrdimaArA..r.
Attach to complete pions for tia and spit to stns County only an paper not less alas 8 W a 11 inctam is via
SBD-6398 (R- 11111)
.
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CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: 1-1 j FA
Owner's Name:
Owner's Address:
~IaSC'I~-~ ~ti~I
Legal Description: c ' 1/4 -.5,V i~ ~Sie T AJj'; / kil
Township: Tk)
County: T ~i-
t`~C ;I
Subdivision Name:
Lot Number:
Parcel ID Number; 7`I
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: rE-T F
License Number: ~l~i:~ Z73z~.,~z
Date:
z Phone Number -715 _ it
Signatur~
Designed pursuant to the In-Ground Soil Absorption Component Manual for PDNTS Version 2.0 SBD-10705-P (N.01l01).
Page 1
v
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f
NI
K: 0
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.s
t1 _
Z-A
.
Ct~ n Wt-em Q on
Final Gracie
4' SdmVfe 40
PVC Vent Pipe r~. n
With Vent Cep
Leaching ft
Chamber
Syetem EWwadon
f$ J~ it
S®tl o MVS fta V
I Cj ~ ft
Trench 9
Vent Or Obeenm ion Pip
Chambers
4" Dim
Trench 2 Header
ChIng rchambff $ eoong
Manufac firer And Model L (0, J60 ,(A ~ K
EISA Hating l sq ft per chamber Soil Application Rate -j gpcVsq It
gpd Design Flow f Soil Application Rate = EISA = Chambers
`
l:~ i
2 rows of _ chambam each.
Page of
_ INSTALLATION INSTRUCTIONS
L-625 FILTER
PL-5251P PER
141,
~1.
~res s && E erg.
fF
a Rated for 10,000 GFD
FL-525 = 5w5 under Feet of 1118° Fft8Wn
PL-GL5 = 625 Ling Feet of 1/32" R Uation
- i° i=~-- _
*Accepts 4- and it sCM 40 P
PLPM5 PL'M
g Built in Gas Der
sveral years under nowt conditions before ca A maft Sheer Bag wtsen FNW is RemoVed
,i,V- . it is reconur"Wed #w the ffter be
led every time the tank is pumped or at least ever ~ Alarm Accessibliity
ym, tf the filled filter contains an optional Accepts FVGron Handle
ri, the amw wilt be rx~t~:d by an alarm when the
needs servicing. sgFvtcing old be done by a
g,ed septic ta* Pumper or lnstaiter. : -
,01AMENDED PRODUCTS
}
Handle
r^ s'~
rd
Fft" s,~a
x. _ g~~lt fir. Gt►11IF~
E & L&TO
e!3 covem
M serts YQW 11D pmverd trams acddwft duldren, poVlak ' 21MM o ponds v%Uel
#st+k to 8 a sc*A can {wag a** ia
3 a tw wet or a VTVenmV
,swessier tfte aSby Sam- sdWVV °i xf Fits g'a-Af P4-
rance- O
she at
~a
rOWTS O
-
synm ca' NS , WA l
r i
F21
~rf 14A NA T=k NA
of Co U T9* NA
now 'jRLs
flow x Yodel NA
SOB Ram y Ave~rsOtao D ® D Wo PwtFMW
Fad On (FOG) RD s 30 WSIL D °ca1. A+e~1i~s OdOr,
Dew 220
~ Sokds~TSS) ~ °l
°i'c~s1 230 D' 1 a1
t~ Wbmfty A
30 mf/L CO At-Smde
LOrk-mChamberldimil
Fecal Co <l0 cull D
1 is k - YOB
118 Am Reeq.~
Facticle Siam
tmeaaa
&M Flto~rY 'ea ~ ESIA .5
m bel N Of .
assxa
D USA
4w Vnlaes: t l fix X84 and be ' MOpiw
sud'ep~ic tssslr a and
* fir.
Dzmw
1
atsi. 9903
Sao caaonrcese, I.C. sand R
C.l U
D -W SW Absorptm • gam, pdffication -modp 15.23 of T - Sysa+eaoos" 9.6 _
D
T cbes and Beds". R.~. Dtk - 5.99 *6 aaa
Dgdp ASAS I
D of 8 EpA, 11.80.1212 Octoba 1980
D DV 10%7-P ~ ) 6W) -At-l C= manor
2.0
D S~ - (R .&W)
-10705-P (1d 01101] "Iat timed ScA usm'
D SBD -100 " (N-6&9) W Ssnd Filtsa< Sys .
Sand vuw 8yrmaan compoemst moor
Q SBD • 10572-P X6M)
1:3 WD -10691•-P (N.01101) Versim 2.0
D SBD mIft" 3 l
D SBD a 10573-F 3 ~Tr~rsaevn 2.0
D • I ~Alot3tj fas I►~ult1- ~
D '
A
g At U" astc~ ? ® C1 s - 3
vow- 3
rs s 1 Oftadc
Of s
$ Atle"t mw ~ GI a
AO" s D a 14A
is At least asses 4A
test At alm NA
At 4"1 fwwp acv _ '
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
OPLP-CnON
The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity
and quality of the wastewater stream will affect the performance and longevity of'your POWTS. The installation of water-saving
appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water
softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface
whenever passible. Note: this does not include laundry waste, showers, dishwater, etc.
This system is 4=ped to hunch domestic strength wastewater, however the disposal of food bused greases and oils, vegetablelfliuit
peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Todet tissme is the only
paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins
condoms, cigarette butts, dental floss, and cotton swabs should not eater the system. Chemicals such as petroleum products, paint,
disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POW'I a
and contaminate your drinking water supply.
Maintain a regular steady flow by spreading laundry washing throughout the week Avoid vehicle traffic over all system components.
Compaction of snow over the dispersal unit may cause it to freeze up.
p Valves
Valves shall be operated in the following manner.
0 Alarms
Alarms should be tested on a regular basis by the home owns, if an alarm sounds, contact an individual licensed to service
POWTS, There is normally a l day reserve under regular operating conditions, however water should be conserved unhi any
problems with the system are cornered to prevent back-up of sewage into the dwelling or surfacing.
IN-PECTIOlctS
Inspection shall be trade by an individual carrying one of the following licenses or certifications: Master Plumber, Neater
Phunber Restricted, Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule).
0 Septic Tanks Component
Tank aupections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks
or l+ ohm measure the volume of combined sludge and scum and to check for any bacimp or pondmg of effluent to the ground
surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service_ Any
defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective
louring device to prevent accidental or unauthorized entry into the tank.
When the combination of sludge and scum in any tank exceeds one-third (113) or more of the tank volume, the entire contents
of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter N1t113, Wisconsin.
Administrative Code.
The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's
specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more
frequent intervals than stated in the maintenance schedule to ]Deep the system operating.
Q Pump Chamber/Treatment Tanks Component
The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be
made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of say filters.
Any service needs or repairs shall be promptly taken care of.
® Infiirounl Gravity Component Dispersal Cells
The inspection shall include recording the levels of ponding, if any in the observatum tubes and a visual inspectim tar any
evidence of surface seepage or discharge. Any discharge to die: ground surface must be promptly reported to the T QTY
authority. Ponding at demos greater than 75% of the height of the comet may indicate overloading or impending
hydraulic failure necessitating more fiegnent monitoring.
Page eti
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
owner/Buyer
01
S v l
Mailing Address
Property Address
(Verification required from Planning & Zoning Department for new construction.)
J l o J, < Parcel Identification Number = l~ % / %r /T
City/State
LEGAL DESCRIPTION
Property Location . ~ 'f4 1/4 = Sec. T._,,, N R_Zy,' W, Town of % i
Subdivision Plat: , Lot #
Certified Survey Map # , Volume . , Page #
Warranty Deed # (before 2007)Volume , Page 4
Spec house D yes A no Lot lines identifiable 0 yes G 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 Owner maintenance
responsibilities are specified in §SPS. 383.52(I) 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 e
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
less than 113 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 Safety And Professional Services 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 wi ' 30 days of the three year expiration date.
Uwe certify that all statements on " form are true to the best of my/our knowledge. I/we am/are the owner(s) of the
property described above, by virtue of a N ty deed recorded in Register of Deeds Office.
Number of bedrooms -
t S NA _APPL CANT(S) DA
r'
***Any 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 survey map if
reference is made in the warranty deed.
m Y~cT (1.(fi7\
RECEIVED
Pa~ of
Wis. Dept of Safety and Professional Services SOIL EVALUATION REPO ZCQYPEOZYG2PR i
Division of Sa"l'
in accordance with SPS 385, Wis. Adm. Code
County
Attah,kj Q1X r not less than 8112 x I I inches in size. Plan must
in aaiaorizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. -
Please print all information. Revie by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 2
prop Owner Property Location
Govt. Lot 11450 1/4 S T - NR E(or
Property Owner's Mailing Address Lot # Block # Subd. Name or M#
City Zip Code hone Number ❑ City Village Town Nearest Road
❑ New Construction User Residential / Number of bedrooms > Code derived design flow rate GPD
j~ Replacement ❑ Public or commercial - Describe:
Parent material Flood Plain elevation if applicable v' ft•
General comments
and recommendations:
F1 Boring # Q Boring
+t Jo•~ Pit Ground surface elev. ft. Depth to limiting factor in. Soli Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure nsistence Boundary Roots GPDtft 2
in. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 *12#2
.2 2
l~
1
Boring # ❑ Boring
Pit Ground surface elev.X~. l ft. Depth to limiting factor) J -._in. Soli Application Rate
2
Horizon Depth Dominant Color Redox Description Texture Structure 3onsistence Boundary Roots GPD/ft
ff#1 ifi#2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
V a
1, W
r 07
• E t#1 = BOD > 30 < 220 mg1L and TS < 50 rng/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Number
CST Nam Pon Signatu~~
Address ` Date Evaluation Conducted Telephone Number
v/ ~l SBD8330(Ri1/11)
Property Owner -)Z< Y . Parcel ID Page of _
❑ Boring
~ Boring #
Pit Ground surface elev. ft Depth to limiting factor in.
Soil Apprication Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ff#1 $02
Boring # ® Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure nsistence Boundary Roots GPD/ft z
in. Munseit Qu. Sz. Cont. Color Gr Sz. Sh. ft~# t * ff#2
Bring* Boring
,
❑ Pit Ground surface elev. R Depth to limiting factor in.
F-1
Soil A licati on Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft :
in. Munsefl Qu. Sz. Cont. Wor Gr. Sz. Sh. * ff#1 ff#2
* Effluent #1 = SOD 6 > 30:< 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = SOD a < 30 mg/L and TSS < 30 mg/L
The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to
access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay.
M-8330 (R 11 /I 1)
Property Owner ~~rr sF~J ~~iC- Parcel !D # Page ::V of _
Boring # ❑ Boring
Pit Ground surface elev. ft. Depth to limiting factor //r7 in.
Sol Application Rate
Horizon Depth Dominant Color Redox Description Texture structure onsistence Boundary Roots GPD/ft z
in. Munsel( Qu. Sz. C/ont Color Gr. Sz. Sh. 01 $02
940
~s
r
.00, 44 1
Boring # ❑ Boring
❑ Pit Ground surface etev. ft Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure rnsistence Boundary Roots GPDIft 2
in. Munseit Qu. Sz. Cont Color Gr. Sz. Sh. ` ft#1 * ff#2
Boring # Boring y
❑ Pit Ground surface elev. ft Depth to limiting factor in. ~
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPDM 2
in. Munsell Qu. Sz Cant color Gr. Sz. Sh. * ff#1 * ff#2
* Effluent #1 = BOD b > 30:5 220 mgiL and TSS >30 < 150 mg/L * Effluent #2 = BOD s < 30 mg/L and TSS < 30 mg/L
The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to
access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay.
M-8330 (AI IJI 1)
,I
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N 4
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