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HomeMy WebLinkAbout012-1028-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 592295 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] 2928366 Permit Holder's Name: City Village Township Parcel Tax No: OEVERING HOMES TOWN OF ERIN PRAIRIE 012-1028-50-000 CST BM Elev: Insp. BM Elev: BM Description: Section Town/Range/Map No: da 11.30.17.1618 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER J2., A-1 CAPACITY STATION BS HI FS ELEV. S , S /0/• /Qd Septic T^ (e , /Z56 Benchmark r~ 16 O Dosing -77 d Alt. BM/'' G ~q Out . Ion Bldg. Sewer 13.6 71 Holding SVHt Inlet /AI . S TANK SETBACK INFORMATION St/Ht Outlet TANK TO /If/4tN WELL BLDG. Vent t Air Intake ROAD Dt Inlet Septic :5 7 7l ' Ir Dt Bottom ~ $ • ~f ~ 2. 5 Dosing Header/Man. 75 /g. z1v 3.7 et-7-1 Aeration J Dist. Pipe 3, 7 97• Q Holding Bot. System AI Final Grade 'Z PUMP/SIPHON INFORMATION Z c 9 06 Manufacturer Demand St Cover L 06CUA~, GPM 54.9 Model Number /53 CVV14t,-r TDH Lift Friction Lo~ System Hea TDH Forcemain Length Dia2 I/ Dist. to Well 75 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. ¢(Trenc PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth R/ JL DIMENSIONS 45 _76 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type O stem: O V CT w l UNIT Model Number. DISTRIBUTION SYSTEM of c~(J ~y Header/ManifolV Distribution Ix Hole Size x Hole Spacing Vent t~►Air Intake Pipe(s) JC /f/'/ Length Al Dia 2 Length /Z Dia Spacing 3Z Z+ .0 I-P SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Ck0 Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges` Topsoil f-~ _ es No No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: totot~ dTk-, l Inspection #2: Location: 1949 170TH AVE oe 44 ~`~►`%~Z 1.) Alt BM Description = - Exa4jI i 2.) Bldg sewer length= Za - amount of cover = 6 _ Q b ~.OS C✓~ Plan revision Required? L] Yes )<No Q •~S 1-7 3 7S Use other side for additional information. t0 SBD-6710 (R.3/97) Date Insepctor's Sig ture Cert. No. 5tV-aa17-6 9,6 C ECEIVe Safety and Buildings Division County r 1 '2s1 K K 201 W. Washington Ave., P.O, Box 7162 Sanitary Permit Number (to be filled in by Co.) rP APR 2 4 201 t Madison, WI 53707-7162 ~~t l IX COUNTY ,©MMUNITY W"Airmit Ar State Transaction Numbeerl - In accordance with SPS 383.21(2), Wis. Aden Code, submission of tnis 2 { ? 3 1p is required prior to obtaining a sanitary permit Note: Application forms for stare-ownea r~ Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for seconaary n pluposes in accordance with the Privacy Law, s. 15. 1 m), Stan. L Application Information - Please Print All Infor. anon l- ► t ~t' Property Owner's Name Parcel # 00 A) MZA - ~77 / -I--- - __7 Property Owner's Mailing Address Property Location IT. 6.17 , Govt Lot City, State Zip Code Phone Numbers Section a l ~L 1 . ,t \ o i i i -f - nett c(ae) 11. Type of Building (check all that apply) Lot # T N; R or W 5 (!~~z 2 Family Dwelling - Number of Bedrooms L Subdivision Name / q Block # ° / 1 T El Public/Commercial - Describe Use VK ❑ City of ~ CSM Number ill ❑ age of ❑ State Owned -Describe Use _ S ~ / ill. T,vpe f Permit: (Check only one box on line A. Complete line B if applicable) 41-1-systern ❑ Replacement System ❑ Treatmenv-olding Tank Replacement Only ❑ Other Modification to Existing System (explain) B- ❑ Permit Renewal ❑ Peanit Revision ❑ Change of Plumber~Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration net / IV. Type of POWTS System/Component/Device: (Check all that a 1 u - i ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade _ and > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treat ent Area Information: 0-1 1 rgn Flow (gpd) Des' Soil Application gpgsf) Dis ersal Area Requir st) Dispersal Area Propo s"-i Seem Elevation C~ ' 1 6 t ~a ~J✓ VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units - a ° d New Tanks Existing Tanks v .N L -N Septic or Holding Tank T rt- Dosing Chamber , VIIr Responsibility Statem nt- I, the undersigned, responsibility for installation of the POWTS shown on the attached plans. J Plumber's Name (Print) Pl imlature MPrNTRS Num~bbeer) Business Phone N ~ Plumber's Address (Street, City; State, Zip 1 County/De artment Use Oniy pproved Permit Fee Date sued y Issuing _ Signature S 4 11A / er Given Reaso`r Denial Z.7 IX Condi p easong for D" approval t. SMAR. ark, etfium 01hr tin 3 (at/ tilspenrui cell must all a sr L; !23's f r+k!nW;es ~i as per ;narigement plan pro ided by plumber. 2. AY >1el4ii~icJt naGser>rs trust k,e l tiaird> lrsd 1 as per rVpWaV9 r4do) I crdi11a11C12. erAA Attach to complete plate for the system and submit to the ounty only on paper not less than S t2 z 11 inches in size SBD-6398 (R. 11/11) System PLOT PLAN PROJECT Jen Brothol ADDRESS 1949 170th Ave New Richmond Wi 4017 NE 1/4 NW 1/4S 11 /T 30 N/R 17 W TOWN Erin Prairie COUNTY ST. CROIX SYSTEM ELEVATION 97.5' DATE 3/31/17 BEDROOM 4 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND X7CX7C SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark 170th Ave v~iic = 1i = i O 3.4 Acre Lot Well is to meet all WDNR setbacks Tank is to be properly bedded and provided with lockdown Property Line covers with approved warning labels Area 15' below system is to remain r W undisturbed 4% Sloe 95, , Pro 4 Bedroom House B-2 B-1 9 6' Huffcutt Combo Tank Grading is to be done to divert run-off away from system B-3 97 400' B.M.* 225' Property Line DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL STE 150 GREEN BAY WI 54304-5211 3 ! < Contact Through Relay ~2$ P S i http://dsps.wi.gov/programs/industry-services www.wisconsin.gov oasroNT~~ Scott Walker, Governor Laura Gutierrez, Secretary April 17, 2017 CUST ID No. 226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RDA NEW RICHMOND WI 54017-6409 HUDSON WI 54016-7708 z, - - Z CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/17/2019 Identification Numbers Transaction ID No. 2928366 SITE: Site ID No. 837127 Jen BrothoI Please refer to both identification numbers, 1949 170TH Ave above, in all correspondence with the agency. Town of Erin Prairie St Croix County NE1/4, NW1/4, SI1, T30N, R17W FOR: Description: Mound System (4 Bedrooms - New Construction) Object Type: POWTS Component Manual Regulated Object 1D No.: 1701194 Maintenance required; 600 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • With new construction; it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall be properly disposed of on-site or off site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. All loose or,,anic material to be removed from mound area. • Divert surface water from POWTS Area. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire, SHAUN R BIRD Page 2 4/17/2017 the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Well setbacks to meet chs. NR 811 & 812 • SPS 383.54(1)(e) The management plan for a POWTS shall specifically address the servicing mechanics of an aerobic or anaerobic treatment tank or a holding tank where either of the following conditions exist: 1. The bottom of the tank is located more than 15 feet below the elevation where the servicing pad is located. 2. The bottom of the tank is located more than 150 feet horizontally from where the servicing pad is located. • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • Pump Floats to be set and verified per approved plan. Any changes may result in pump resizin2 to meet TDH and GPM Specifications. • Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the mound must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required S 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Please Include a Copy With Your Tim Vander Leest Payment Submittal. Private Sewage Plan Reviewer, Division of Industry Services WiSMART code: 7633 (920)492-2214, Monday - Friday 6 am To 3:30 pm tim.vanderleest cr wisconsin.gov r SHAUN R BIRD Page 2 4/17/2017 the site is too wet to prepare If it crumbles site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Well setbacks to meet chs. NR 811 & 812 • SPS 383.54(1)(e) The management plan for a POWTS shall specifically address the servicing mechanics of an aerobic or anaerobic treatment tank or a holding tank where either of the following conditions exist: 1. The bottom of the tank is located more than 15 feet below the elevation where the servicing pad is located. 2. The bottom of the tank is located more than 150 feet horizontals fr in where the servicing pad is located. • Tank Installation to follow all manufacture's recommendations. • Verify property fine(s) prior to installation. • Pump Floats to be set and verified per approved plan Any changes may result in pump resizin2 to meet TDH and GPM Specifications. • Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the mound must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required S 250.00 lzLl This Amount Will Be Invoiced. When You Receive That Invoice, Please Include a Copy With Your Tim Vander Leest Payment Submittal. Private Sewage Plan Reviewer ,Division of Industry Services WiSMART code: 7633 (920)492-2214, Monday - Friday 6 am To 3:30 pm tiin.vaiiderleest@wisconsin.gov Cover Page /ED 'FIR 4 3 2017 Shaun Bird Nif") 1STRY SERVICES Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 AND 715-246-4516 RVICES Date: 3/31/17 Owner:Jen Brothol E Location: NE1/4 NW1/4 S11 T30 N,R17 W 1949 170th Ave Erin Prairie Manuals Used: Mound Component Manual Version 2.0 (N.01/01, R. 10/12) Pressure Distribution Manual Version 2.0 (N.01/01 R. 10/12) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9. Filter Specifications and cross section est AttachmenX,Z'~ Shaun Bird SignatureLicense 60er 226900 Page 1 of 9 System PLOT PLAN PROJECT Jeri Brothol ADDRESS 1949 170th Ave New Richmond Wi 4017 NE 1/4 NW 1/4S 11 /T 30 N/R 17 W TOWN Erin Prairie COUNTY ST. CROIX SYSTEM ELEVATION 97.5' 3/31/17 4 DATE BEDROOM CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark 170th Ave Scale = 1/4" = 10' 3.4 Acre Lot Well is to meet all WDNR setbacks Tank is to be properly bedded and provided with lockdown Property Line covers with approved warning labels Area 15' below system is to remain undisturbed 4% Sloe 95' Pro 4 Bedroom House B-2 B-1 96' Huffcutt Combo Tank Grading is to be done to divert run-off away from system _ B-3 97' 400 B.M. 225' Property Line