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HomeMy WebLinkAbout040-1310-00-002 County: St. (;rOIX Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division Sanitary Permit No: INSPECTION REPORT 597313 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: n 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: DAVE & MARY HAVEN TOWN OF TROY 040-1310-00-002 CST BM Elev: Insp. BM Elev: JB Section/Town/Range/Map N. v-P CA , 17.28.19.1989 0,ak)i i TANK INFORMATION ELEVATION DATA TYPE MANUFACTU R CAPACITY STATION BS HI FS ELEV. IN6S Benchmark 2. q / OLn' /bv Septic JowaaL 1ES i Alt. BM Bldg. Sewer vma f~ J va PI-It Inlet Y•~ S t Outlet 97 TANK SETBACK INFORMATION TANK TO P/L~ WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ( Dt Bottom Dosing Heaadeyman. /w a eration Dist. Pipe olding Bot. System V '7 al Grade PUMP/SIPHON INFORMATION Q / o Manufacturer DeP nand St Cov t , _ n L~S Mod Number f~ v TD Liriction Loss System Ft Force h . D ist. to well • tLiquid SOIL ABSORPTION SYSTEM BED/TRENCH Width j_engt~. No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Dept DIMENSIONS 5 Z I'll SETBACK SYSTEM TO P/L BLDG WELL LAKE/S EAM CHLEACHING AMBER OR Manufacturer: INFORMATI N p O S st O' 1932- 1 UNIT Model Number: DISTRIBUTION SYSTEM ( - Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length is Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched 14 1 Bed/Trench Center Bed/Trench Edges Topsoil Yes [ No No COMMENTS: (Include code discrepencies, persons present-, etc.) Inspection #1: Inspection #2: Location: 458 MEADOW RIDGE TRL b?tr. @ 1ns 9-e C,loe i 1 1.) Alt BM Description = ~IQ C,V `w\~~ 1 O 2.) Bldg sewer length = X01 r ~l~Sed amount of cover = v 1 t u G~ Plan revision Required? [ Yes n. Use other side for additional inform n. Cert. No. Date epctor's Sig ure SBD-6710 (R.3/97) -~REACE " _ 1 -7 _ tttdustn~ Sere ices ivisin._.-_-._.. O S C ouni? MAY (i I400 F \1ashingtonAve PS lJ P.O. Box 7162 ✓~r ~/7o/X Madis 4V*l i'707-7x162 Sanitary Perntit Number ST. CROIX COUNTY (to he tilled in by ;OM '5773/ 3 anltary Permit A} stateTran~ti n--urnber ht accordance faith SPS 3$3,2 1(2) 1k is Adm. Crxlc submission of this I- i on'n to the altd s required prior to obtaining a sanitary permit- Vote_ Application titans for state otonu PO WIS are euu-..._ to Project Address (I I'd Department fSaluti and Professional ertitcs Personal information loft provide may be used for sec coda Y purposes in at of dit} lthan mailing address) anue tti the Putacti al S s, let)d(1 1Hm'), Stars L .lpplicatton Information - c~ 1)rOpert) Otoner s Name Ple ise Print :111 formation 5 m f v ~~ou #2:~~ ~ .1 T ~nJ i✓i~~JE +'t /~`,/Q Parcel ?I Property e/ (htncr's [v9ailin Add~-'~--- oca~r' )Uwe - C)o~ ~ ~J~e~ /'~E~,Oo t- Property Location ~ Zip Coda Phone Number Govt. I. of ®.tJ /VW ~~C Section 17 11' Type of~(cheek all that apph.~---- ~•S/ a~G lam- y.~SO (ctrclc one 91 or2 Pamik Dtcellina-NmnberofBedronis~~~ j Lot N: R_~~ ~v O1. Subdivision Narne I ❑Public.C'ommercial-DescribeUse ~ Block y ❑ State Otoned Describe Use CSM Number _ Q-V46ge of 2' -5.X+11. T! ~4~tA~1KJe J Townot tll. Type of Permit: heck only o e boX on line A. (.'omPiet e line B if applicable) ❑ Replacement System - LJ 7re-atmuntillolding Tank Replacement (htl l3. } ❑ Other Modification to Existing System (explain) ❑ Per e m Eit Renewal ❑ fannit Rctision L 1 EJ I' xpiration Chan rc OfPlumher U Permit Transfer to Meta. List Previous Pcrntit Numberand Diate issued Owner 11'. tcjm of YO11"TS Systeml('om onent/De~ ice: (Check all that a h ) gNon-Pressurized In-(.hound - 01 ❑ Pressunzed In-GCOUnd ❑ At-Grade ❑ ❑ I fold i,,L ) ank ti1vuttd -q in. of suitable soil El Mound <24 in of suitable soil ❑ Other Dispersal <'omponant tcxpl rin) -Wirrext _ ❑ Pretreatment Device (explain) V. Dis r n; eat lrea ►nforniatio ~I~sign 1-lotr {gpol ~ Deign Soil Application Rat pdsij Dispersal Area Required sl Q ( Dispersal Area Proposed is System Fletation U. Tank Info 917 9`1! au.. Capacity m Total of r 6 " Gallons I Manufacturer New"Lanka - Gallons (!nits v Existing 1'a"k, 2 7 ~ L i eo- (~/d Dr sag ('hmnb~r , -gyp -`EK r4 ,JG.6ETE Y 1'II. Responsibility Statement- 1, i Plumber's Lame{Print) - the undersif tied, assume responsibility for installation of the POSY"fS show n on the attached plans. Plumber s Srgnahtre ~O/tlv___~F'~~~~e- ~ MP, :Number {3usiness Phone Number Plumber's Address iStrct, Citt. State, fip Code) La-~it~- o~,3J3 ~G 7/S G 71? J;?4G t--------/~ G__-~5~: r✓r. P7.S*__~JcrR.~ao 1711. County/D artment 1 se 0 n1) JY724 Approved ) sapprotc Permit Fee : _ fi L Date ]slued Issuing t S (n en Reason for Denial 1$~7 5 /a !7 t €natort Y\. Condos s rk, r<r tpcnr I ~fo~ approi l t t lsperw~t 001 must all be s?r: Yeas ! rq lnL^e~ b Wr!'►1al"yemen' plan nra ncerl Uv plumber. J a!lhst~c tics roust DN t: t;airt it e d f Or+ v~~ UO VAN p ~ SeJ~ $ ~ ~ ~2w1„ a M► ambit! at>.~t: / :Mlw'ICn, Attach to complete plans roc the scstem anti snbntit to the Cou n onlc own paper not leis thin s in x 11 inches in size i y) lG ce,w~e",A a. to- ~a ~eserv 1 SF3I)-6398 (R. 03 1.O L;COP, . y .j a t t 14 n a ~ ~ IN: f ` f 4i~ 't ~ Q ~ of tie wJ ~ ~ ~ `t• h 1 I V 4„ d ~ M I~1 °j 4• L 4 S. b 1 ~ M tj~ ~ 0 1i 1 ' n~ ' \3 h 'ZI i Ix "t _ ~ ~ ~ ~ _ _ ~ F.:'~r'u't t ~'f,6fZ d' i u t~Jy' - t. - .U~i . G r.:.~ ~ ~ ~ jaD ~a 7"S Ew _ S/ - aC 9 - yaso Gky o -L 74e Y _;_U-~v'~ciL-~i:, rne: ,/~~E.pAoa1 KlOLE of 1t/lo>' iti~ Jv of OCR 1!'nb~ 6rJ! C- fL0 SS- ~F"G ! lO n.~ 4 •Ll•`/ !%1 c lc% 14,4 d G'° _ r r~~~ (j ~f~ J'~i~ ~sc1l~o.2t~ltfPtanJ - e G Ll r-- Z. 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H it I .~I Q ~I I w~ f z~ 98 L9 m ll Uj I~ E ev-r `..cam ..t 1. ~Y iNF, ' ~i ? 3v SYSTEM SPECIFICATIONS ~;vtier vE f ,IRY ipu Septic Tank Capacity __1666 gal ❑ NA Permit Septic Tank Manufacturer /,/jESER Ca.,re ❑ N-A DESIGN PARAMETERS Effluent Filter Falter Manufacturer~ ' dQ- j- _ ❑ NA j Efflu' ent Filter Model Number of Bedrooms (t00gpdibedroom) F-/D [I NA I `'umber of Commercial Units r Pump Tank Capacity _ gal N- -1 Estimated flow (average) ~ Pump Tank ;Manufacturer j ❑ NA 3Od aal, d4_ Design tlo,xx (DWF), estimat a ySo al da: Pum Manufacturer ed x l.j ~ p ❑ NA Soil Application Rate - - Pump Model J NA ` . veraLe' ft- ; ~I Influent/Effluent Quality (M NA) ivlanthi<<AveraQe Pretreatment Unit ( W NA) 1 Fats. Oil & Grease (FOG) ;0 m ,I ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical O:;ygen Dernand (BOD,) i Cl Mechanical Aeration El Wetland Total Suspended Solids (TSS) V < 220 mg/F ❑ Disinfection ❑ Other. Manufacturer: Model: < 1 50 m L Soil Absorption Component NTA) t'retreated Effluent Quality (X NA) iviontliiy Avetaae I Biochemical Oxygen Demand (BOD,) 1 0 In-ground (gravity) ❑ In-ground (pressurized) 3Q mg1? i ❑ At-grade ❑ ~4ound Total, Suspended Solids (TSS) I Fecal Coliform (geometric mean} 30 in-11- l ❑ Drip-fine - E!, Other: S 10 cfirtl ooml Vertical Distance Tank Bottom to Service Pad: /3 ).Iaximum Effluent Particle Size 1!S inch clam---eter i Horizontal Distance Tank(s) to Service Pad: /440 Dispersal unit ivifg./Tv`iodel '+umber: _14), *L ne47 sa u~crc 'Y t.O G/f~R~sGEas _:c;aafions: - Soil Dispersal End Cap (Dispersal Unit EISA) or Apilication rate = Area Rec wired - EISA = ;Trench,Vidtlil - Units or Total Lcn=th of Trench. 3a7 C N,~~yi3Ca s - G t CR;`E1- 1 Ci "Design of Pressure Distribution Networks for Septic Tank-Soil Absorption Systems` Publication 9.6 (SSWIPMP Manual) ❑ "ICC Flow•tech Mound Component Manual" Version 1.2 ❑ "EzFlow ivlound Component Vianual' Version S,'2012007 ❑ SBD - I0854-P (R.1/121) "At-Grade Component Manual Using Pressure Distribution" Version 2.0 `SBD - 10705-P (itir.03/01) `'In Ground Soil Absorption Component Manual" Version 2.0 ❑ SBD - 10691-P (\.03'01) "iMound Component Manual" Version 2.0 ❑ SBD - 10657--P (8.6199) "Drip-line Effluent Disposal Component i ,lanual" ❑ SBD - 10706-P (N.01/01) "Pressure Distribution Component Aflanual'° Version 2.0 ❑ Other - R 3 _ n ,71,,' .r'mA Ct AND MAN AG .•r;EN_ Service Even' ; Service Frequency Pumplinspect tank(s); inspect dispersal cell(s), clean filter At least once every: j' 13 months K i years ❑ ©ther - j Inspect pump & pump controls. alarm, pretreatment unit At least once every: El months c3 ; years NA Flush and pressure test laterals At least once every:---- ❑ months 3 years Y, NA T ASR ? rP AND f3 'sR= T s~?'r: For rteGV construction, prior -to use of tite PONA" ; S check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur ,?en soil conditions are frozen at the infiltrative surface. he property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity a-nd duality of the wastewater stream will affect the performance and Ion,evity of your POWTS. The installation of water-savin, appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water 1 0; lent s. iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surf. J-,errever possible. Note-- this does not include laundry waste. sho•avers, dishwater. etc. ,his system is designed to handle domestic strength wastewater- however the disposal of food based greases and oils, vegetable,-,'ruit eels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the 0--, paper that should be discharged into tltc system_ Other non-hiodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, Palm, r.~C ! !J( Cp START UP AND OPERATION Page S o For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process andlor damage the dispersal cell(s). If high concentrations are detected have the contents of the 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 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 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 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 POk1VTS. antibiotics; baby wipes; cigarette butts; condoms; cotton swabs: degreasers; dental floss; diapers: disinfectants; fat; foundation drain, (sump pump) water; fruit and vegetable peelings: gasoline, pesticides; sanitary napkins; tampons; and water softener brk,;~ ABANDONMENT `/Uhen the POWTS fails and/or is permanently taken out of ser. and safely abandoned in compliance with chapter SPS 383.33, Vsconsin Administrative All piping to tanks and pits shall be disconnected and the abandoned pipe opening, Y The contents of all tanks and pits shall be removed and properly disposed of by a Septage After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space tiiied 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. i he replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need mx a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. r 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. t❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation _ust be performed to locate a suitable replacement area- if no replacement area is available a holding tank may be installed as iast resort to replace the failed POWTS. :mound and at-grade soil absorption systems may be reconstructed in place following removai cf t".e biomat at the infiltrative surface- Reconstructions of such systems must comply with the rules in effect at that time. <<VVARNING>> SEPTIC, PUMP AND OTHER. TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR HNSUFFI`;IENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH ;MA'v RESULT. RESCUE OF PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER ~1 Name le1,tCE ^a- 4 y Name _7-o ,J 1E'L/CE ,dE"z,r£ durY,ti~lc~ Phone i 7J,, 47.2-,S" 224 Phone 7/S G7.?^ Sa'G,r SEPTAGE SERVICING OPERATOR (PUMPER)' ? LOCAL REGULATORY AUTHORITY Name i Name 6taix Phone ry Phone 71.5 .38G - yG SD This document is intended to meet the minimum requirements of ch. SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not guarantee the parforrnancs m the P00'11VTS. Rev.(3?13) iLi y Q is a _ C) V e Y a V ~D <n 7S C~j G 'Y /Q~'i pr Li - X ~N ;tea-3++'" i r a'L. a y is ~n G ( fi J C/u N ry r LLJ M J o c, 3 V 4 c Z ti ~ ~ m Q U 1 L~ n - Q) ui 2 r y VS V J~ ~\d a= v t,_ ~ v y v 0 t~ ^ G G j LL z L Qj rte. ~ ti CL l N 2 C -y-Ti C C ~ Q N S - a G= 4r C r C V U .ova, - rt O C C O _ - r a ti G~ vi c_ c g- c _ O -~J, U G J G G. 2 w O O 72 r p ti o Y m a .4 J l= h V ,0 Q a a u a+ o ~ 3 - w c - n E 4.4 w = i cc cn J T U c c tv a_ C' K Z3 L Un f J G Dave Hauch Proposed House Layout on Lot dhauch@comcast.net Cell 651-269-4250 167.63' I /I / I / I I 1 I I I / I I / N 928 - r /I , , 9 , - - r I , 932 - , ~ err r 934 r \ - r - rr I O / r-- N r 936 I rrr O co / r I 938 r ~ - r r r - / - - ` r \ 940 942, 944 / I 946 rr/ ,r 948 Meadow Ridge of Troy Development Lot #2 150' Meadow Ridge Trail 950 ST. CROIX COUNTY AND ow 11 er"B it yer Mailing Andress /L.. N i'rt'pen,y Addros "'Vern .catirn rt:citarred from Pi nniiV & Zoning I)epartrnent fur ."1Q_W conio n.) ` ity:'Stat IfJ~V._Qf A w/ Parcel Identific,atio~~'v€ tuber ~ ~D-/,31D "DO "Odd LEGAL DESCRIPTION Property Location Sec. T %2_i' L Too of T/?OY , r Subdivision 1Yce5 P _4 ..__!~JG, Dr T OY , Lot warranty Deed -7r Pag,e# Sec -house yes Lol :fines identifiable yes to SYS CATION 1inproper use and mainten:uice of } o"T septic system could result in its prema=-1 failure to handle wastes. Proper maintenance co nsisis 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 treatxnten't stage in the a t4 disposal system. Owner n aintenance responsibilities are specified in §C:~=,r, 8M2(l) and in Chapter i? w St Croix Counry Sanitary Ordinance. The property ow7ier agrees to submit to St. C'roi- Count? Plarnia- & Zoning Deparm-icnt a Lrrtixication form. signed by the owner and by a rrras~i~r pl tirn'~er. jo arnevnian plumber, restricted piuutber or a licensed bumper verifying that (l) the on-site wastewater disposal system is 1,r prober operaung condition a ndior f2} alt°c-r inspectioia an 131.rmping (if nocessar/), the sfl',tic tank is l ,we, the undersigned have read 'In,-, above requirements and agree to t iintairi z1h private sewn' e disposal sx,st7in1 vii }5 th tandards set forth, herein, as, c. by the Uepa isnettt of C.onurerce and tie Department of Na-wral Resources, State of 1Visconsin. i c°rdficiation stating that your sets. system has been maintained must be completed and returned to the St, Croix County Planning o$ti;tg I:ne-liartrrtc;ni within 30 days of the Three year expiration dal:... , 1/we certify that all statements on is form are, true to the best of t iv/ou< knowledge, I/we am-are the mvnerts) of the propenN described above, by virase of a ~ ?rfarliv tit' d crcor'ft?i in, tja I t t' s "t"v f l fa.:_. Number of bedrooms S TG` J' A I l.: k CST , 1':€ I . " ? 4 ` .'t DATA ***Any information that is misrepresented. tmy result in the sanitary perrrat bein#a revoked by the Planning Zonino TiPnas•tment. Include with this application a recorded warranty deed f o ni the Register of heeds Office and a copy of the certified survey map if reference is made in the Nvarrar:.ty deed. (REV. 08105) i ,m host H `mvu zom moavn 836 L o 6.1 r! 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N 0 m r 0 M 'n - 11 m ~co sI oZ z I $ N Te ` L a x m - - ISO a ~ "HEADpK,R~pG f AIC R 3 a $BUILDER: WATERS EDGE CONSTRUCTION PAGE INFO:~m LOT PLAN m ~ iff R n z ~ ~ AUCH RESIDENCE ~ H m m 458 MEADOW RIDGE TRAIL. HUDSON WI