HomeMy WebLinkAbout030-2028-70-000 (2)
PRIVATE SEWAGE SYSTEM County: St. Croix
Wisconsin Department of Commerce
Safety and Building Division Sanitary Permit No:
INSPECTION REPORT 597392
GENERAL INFORMATION (ATTACH TO PERMIT) 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:
Justin Gerstner TOWN OF SAINT JOSEPH 030-2028-70-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
/66 Q 6,5 22.30.20.440F3
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER tom` CAPACITY STATION BS HI FS ELEV.
Septic 7 ` L Benchmark /D~ /
•r.~ JJ gal
•t
5
Dosing Z Alt. BM y a T
n Bldg. Sewer , JZ s g3 ~7
Holding St/Ht Inlet ~Q• Q '
J® ~
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO /L WELL LD Vent Air Intake ROAD Dt Inlet
Septic Dt Bottom ~G•5 dG~ S
Dosing G v7 Header/Man. 'r Lt ~Qb~ i
(06Zs To 4
7 7 I
Aeration Dist. Pip
Holding Bot. System it
1 3• /~~I, `~v
PUMP/SIPHON INFORMATION jimitGrade
t
Manufacturer e~ Demand St Cove
G Nj4.-1_ ~b• q
Model Number
IIJ ~~2-
TDH Li / t Frict' n Loss System He
yc( TD ~t /1 _ Z. Z
~ dLO.
r . (PIP
Forcemain Length., Dia.Z Dist. to Well
SOIL ABSORPTION SYSTEM !
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS -3 _Fte., 1~_-
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
ie5tf
INFORMATION t CHAMBER OR
Typ Of System: , UNIT Model Number: qv 5
11.111160a W. I be
DISTRIBUTION SYSTEM 449^0 a
Header/Manifold Distribution 3O O x Hole Spacing Vent Air Intake
Pipe(s) P{/
Length l V Dia Length Dia Spacing ole Size
SOIL COVER «Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center ed/Trench Edges Topsoil 1] 4 Yes No ~es No
4
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: n I Inspection
a - r na r'•C 6Z
Location: 1406 HILLTOP RF1
1.) Alt BM Description -DID
2.) Bldg sewer length= Z41 J
- amount of cover = erlo_54 A (~8'"J•o 1
/A, l/~0)Gt.t,_
Plan revision Required? ❑ Yes No Ll I I-7 ~Use other side for additional information. L --___j
Date Insepctor Signat Cert. No.
SBD-6710 (R.3/97)
Shw , CC q `
It
e w~ r r rvicL-5 County
J. t vt sh a zx r 1.~L ' i
;hr, t rr Penn it Number to be filW it, by. Co.)
162
~x our~r J 9 7 3 1
2
^Q~ Muni ~ ' (Staxa t-a::~saztion number
Sanitary -1:1r gat Application
f
{
n accordan,co vv to SPS 30-21(2), Xis Adm. CMe, submission of -Js fort 10 tho appropriate govern renu I unit
~
is rs jwis, ; pnu, 2 a t-,-- ;,in a ?am4u permit. Note_ Apps cation Coors for ;tat, o~< z d POWTS are :abmittu.l to Project Address (if different uhrai mailing address)
4a'; tic a n: of Sallety and Prol Sao al mice Pe ri , information vc,.i p.maie y he USIA for s ~ErA
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P, 1.
P or Ov ver's ' i n=; Address = r er[y C oc stiast?~ 1 ~o^, ~5 qqo F 3
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f Pub?ic/t ommcne"sal - cei? u Use F 0 City of
LStP Number Jiiiateof
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?ts" P,evious Permit, Nur,U r arid Date l ucd
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;r t. T.,x ~s t .iro t anacity sn i Tata a of i Dvtanufactur_r
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ui pems... Cell rsust all be t~Pc: s ! rm int.L:
~ss-per rnar.4yernent plan p o aiaerl by plunbe~.
2. 'All 4064, recwreclenms must-Le t aintJr:,E•l
a per M*ftnb s cvdti ! rdinancva. r MkA a 0
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In-Ground Dosed-Gravity Plan PAGE 1 of 5
Index & Cover Sheet
2.o sBD-•1D-0706-P~' References-
Version (N.01101, , R. . 10/12)
Pg 1 of 5 Index & Cover Sheet
Pg 2 of 5 Plot Plan
Pg 3 of 5 Dispersal Area Cross-Section & Plan View
Pg 4 of 5 Pump Tank Specifications
Pg 5 of 5 Management Plan
Attachments: Enclosures:
Pump Curve POWTS
Application for Review
Soil Evaluation Report & Site Map
Project Name I Description
Owner Name(s): T(!U L laS i ~U~d
Owner _ Phone:
Address: t { -D 'c
ti' rf k4C +`tikF~i Project Address: Zip:
--1 A
Govt. Lot: __1/4 of 1/4, Section , T ~C N-R
Township: St.. ^ & ----_E ~or W
Project Parcel County:~
Designer Information
Designer Name- . jjup -
Designer Addn~: q 7 Kj ~ AA.*H - Phone:
E-mall: ~ ~ _ j ~fi I-~~uz~/ T.cp:
i t J] I L Sf-ed LF'S~gf'1 u. O i OCJC ° L~CN'i
This space rese
License Number. _ I g~7 n 4 1,
Remarks: 1
'ti aY L.~ Y mac '~A~A
72
✓'4
Signature:
Date:
required on submdEed copy. "1''
~J)
Eljen GSF System WI Design Program
Date: 08 -14. 2017 Client Name: USTHN GEIiSTNER
Site Address: 1405 HILLTOP R DG£, h-0jLTC;J
Designer: P,,RY l^v HUPcERT
System Sfdng (TOW Number of E4en a% Modules Required) Design Notes and Continents
1.1 Site Characteristics:
Total Number of Bedrooms 5
DDF per Bedroom (Daily Design Flow per Bedroom) 150 gpd Effluent #1 Application Rate 0.6 gal/ft'
DDF (Daily Design Flow) 750 gpd Equivalent Effluent #2 Application 0.8-1.0 gal/ft,
Application Rate 1 gal/ftl J
Required Basal Area (DDF _ Application Rate) 750.0 ft'
Unit Used ( Usually B43) 643 V
Unit Install Width 6 ft ~f
Square Footage per Unit
3J
"If - ~ Q 24 W/unit r
1.2 Module Quantity Analysis:
/O G
Minimum Number of Ellen GSF Modules Required
77 `
32 units /z-
Amount of Ellen GSF Modules Used 33 units
1.3 Trench Design:
Number of Trench Rows 3
Trench Width
6 ft
Trench Length 45 ft
Units per Row
11
Total Square Footprint 810 ftz
i
aft
6
45
MIN 12"
CLEAN FILL
L~ NATIVE FILL
12" SPECIFIE Q G3
6 - r.~r 3 ft --a.~
t it a A
e1j,
11-el
~`,Erq~sTat,tr DIVISION OF INDUSTRY SERVICES
I J
y PO SOX 7162
~'1 i S a I MADISON WI 53707-7162
II p Contact Through Relay
http://dsps.M.gov/programs/industry-services
iq 4a` www.wisconsin.gov
U~FS''10" A4 u
Scott Walker, Governor
Dave Ross, Secretary
Identification Numbers
September Ofi, 2016 Tranmetion ID No. 2673851
Site ID No.
Please refer to both identification numbers,
CUST ID No. 1319743 above, in all correspondence with the a c .
JIM KING
EDEN CORPORATION
125 MCKEE ST
EAST HARTFORD CT 06 log
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 08/31/2021
Re: Description: POWTS COMPONENT MANUAL
Manufacturer: ELJEN CORPORATION
Product Name: (trans id 2673851) ELJEN GSF® IN-GROUND COMPONENT MANUAL
Model Number(s): VER. AUGUST 2016; GSF@ MODULES A42 AND 843
SEE ATTACHMENT A
Product File No: 20160056
The specifications and/or plans for this plumbing product have been reviewed and determined to be in
compliance with chapters SPS 382 through 384, Wisconsin Administrative Code, and Chapters 145 and
160, Wisconsin Statutes.
The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin
Administrative Code. This approval is valid until the end of August 2021.
This approval is contingent upon compliance with the following stipulation(s):
• Installation of systems that conform to this POWTS component manual must consist of wastewater
treatment tank(s) approved by the Division of Industry Services that meet the criteria listed in the
manual. Tanks that are approved with options that allow the tank to meet the requirements of this
manual, without further modifications to the tank, are considered approved tank in accordance with
this manual.
• Approval of this POWTS Component Manual is for recognition for designs of systems that are
covered by this manual. Systems that are designed, installed and maintained in accordance with this
manual will provide treatment and dispersal of domestic wastewater in conformance with s. SPS 383,
Wis. Adm. Code.
• Copies of this Component Manual are available through the submitter/manufacturer or downloaded
from the department's webpage; see:
http://dsps.wi.gov/php/sb-ppalopp/prodcode result.php/POWTSM/POWTS_COMPONENT_MANUAL
Approval of this design manual does not constitute approval of individual POWTS designs based on
X., this manual; site-specific designs shall be submitted to the appropriate governmental unit for review
and approval prior to installation.
• Additional information is included as attachment(s) to this letter; see attachment A.
2673851 JIM KING Page 2
9/6/2016
The department is in no way endorsing this product or any advertising, and is not responsible for any
situation which may result from its use.
Sincerely,
Glen Jones, M.S.
POWTS Product Reviewer
phone: (608) 267-5265
fax: (608) 267-9723
email.- glen.iones@wi.gov
The DSPS is committed to service excellence. Visit our surrey at:
www.surveymonkey.com/s/dspsiscustomersatisfaction
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PAGE 4 OP
GRAVITY'-DOSED
SEPTIC / PUMP TANK SPECIFICATIONS
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN page 1 of 2
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner
LAS i 1~ Septic Tank Capacity gal 0 NA
Permit #
Septic Tank Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Miter Manufacturer
lFL-)Jry~ ❑NA
Number of Bedrooms 0 C NA Effluent Filter Model
Number of Public Facility Units ❑ NA Pump Tank Capacity
1 gal ❑ NA
Estimated flow (averagel gal/day Pump Tank Manufacturer
13 NA
Design flow (peak), (Estimated x 1.5) 75 gal/day Pump Manufacturer '7 ❑ NA
Soil Application Rate al/da Pump Model
Standard Influent/Effluent Dual' y ❑ NA
rt1' Monthly average Pretreatment Unit ❑ NA
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODfi) 5220 mg/L )&I NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection
❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s)
❑ NA
Biochemical Oxygen Demand (6005) 530 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) <-30 mg/L 1] NA ❑ At-Grade ❑ Mound
Fecal Conform (geometric mean) <_10` efu/100mi 11 Drip-Line Other: r
Maximum Effluent Particle Size /V)~{
in dia. p NA Other:
Other: ❑ NA
❑ NA Other:
F
❑ NA
Values typical far domestic wastewater and septic tank effluent. Other.
❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: ❑ month(s)
year(s) (Maximum 3 years) DNA
Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: -3 ❑ month(s)
year(s) (Maximum 3 years) ❑ NA
Clean effluent filter I At least once every: ' ❑ month(s)
year(s) ❑ NA
Inspect pump, pump controls & alarm At least once every: ❑ month(s)
I L year(s) ❑ NA
Flush laterals and pressure test At least once every: i ' ❑ month(s)
Other: ~ ~ `G1 year(s) ❑ NA
At least once every: C monthls)
Other: ❑ 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 combined 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 regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third (Y
or more of the tank volume, the entire
contents of the tank shalt be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of <12 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.
START UP AND OPERATION Page of
For new construction, prior to use of the POWTS check treatment tank(s) for the
that may impede the treatment presence of painting products or other chemicals
process and/or damage the dispersal use. ceU(s). It high concentrations are detected have the contents
of the tank(s) removed by a septage servicing icing operator prior t 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 highwatar levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator power to the effluent pump or contact a Plumber or POWTS Maintainer
to assist in manually operating the pump t controls to
restore normal levels within the pump tank.
Do not drive or park vehicles 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 life of the
POWTS: 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 products; 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
property 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 fails and cannot be repaired the following measures have been, or:must be taken, to provide a code compliant
replacement system:
A 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 Jy
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POVVTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
T aluati
be '
e ai a -RD44t5 rte FbR- A/~ ro j~2dG~Lip ank
❑ 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 ANDIOR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. 4
ADDITIONAL COMMENTS
POWTS INSTALLER
N E~~' "t POAT5 MAINTAINER
ame Name S t EVE {~L~~ILf~T L~~( 1
one
Phone
! 7
5- D3- -5SEPTAGE SERVICING OPERATOR (PUMPER)
RE LOCAL REULp7'ORY AUTHORITY
CffT rjt'~IA/L Name t ~j ~,y Phone (aSCD
cument was drafted in compliance with chapter Comm M22(2)(b)it)ld)&(f) and 83.54(1), (2) & (3). Wisconsin Administrative Code.