HomeMy WebLinkAbout036-1013-30-000
a1t•ty a Vvt, ^na Depan Hur ding Dhnsio" Di of t%0°11ne e PRIVATE SEWAGE SYSTEM co,.nty
S St. C.fOIX
INSPECTION REPORT 1.11-t_ No
GENERAL INFORMATION (ATTACH I > PF?1MIT) S 597348
tave. V.an IC NO
Persural irt0nneh~n yc,: muv~~de roav c¢use:. far seccrtlari Vct P0vR5;gr:acL:x ' C•A i I'tlmiJ
r -
°erm t Hock's Name C,ly umayc Tnwosrip Paice. Tax No
SAMUEL & KRISTIN AUSEN TOWN OF STANTON 036-1013-30-000
'::ST BM R,r I'Se. Blv1 Eev BV Desaiohnn ~L J I
U Serhor: iv:n: F.ararMlaV No
166 C 5 T 06.31.17.82A
TANK INFORMATION ELEVATION DATA
Y STATION
RS HI ! S ELEVBenchmarkAlt BM HldgSewe`
7•t5 9~ •S
SUH: Inlet
9 `7 9y-5!
Ew
TANK SETBACK INFORMATION St-111 outlet
TANK TO !i WELL BLDG. em tc. 1 IT take ROAD Dt Inlet
Septic Sd /AI'
72- , DI Bottom \ \
Jcucig - HeatleriMan
/d. ZS 9 3'
Aeration
Dist. Pipe 93• &
Flolding
6:,1 System
l7•-~ S
PUMP)SIPHON INFORMATION Final Grade
Manufacture• 7.3
Deciantl St Covcr~ / w
GPM
Model Numbe-
IJH I it - Friction Loss System I Ieaz__ FI
- - - (3- Z (,.as y~.ds
Fora:rnaln Len !I Did 'n.:4 mYJe~l
SOIL ABSORPTION SYSTEM
BED!TRENCH V.inl- / Le III No O`Treochca PITDIMFNSIONS Na ;YPCS I•sidr Dia
DIMENSIONS Z Gquin vcuth
SETBACK ';YS-LM 10 PA BIDG VJFLL LAKE/STREAM LEACHING ivtanc'a ~ti.-er ^
INFORMATION
~yoe O' Sya0.^- CHAMBER OR r•-I a~-~
Ge1`~IOQ >Sts 51 93 UNIT umYr C., 16
DISTRIBUTION SYSTEM L4-
ZZ
-'7/-'FD
He.:;ti nr,ian f~lc stir, IN s 401, S1 ¢ x 4ole SuaCiny Veil Jq Alf kf
Q t,( 1
Lcr,th_ V _J= _ ~en9tn ~ ~a_~ „u:,c1,1 A S
SOIL COVER x Pressure Systems Only xx Mound Or Al-Grade Systems Only
Depto :I:cr ❑701 Orvr
n. Ucnth S xo S~_~•uch:Sotlr.,q xx N1ulrhed
ftey: trcnC- ::a ac' B=m7rench Edger, ` ?opso'.I
Ye'. Nc \~Ye~ Nc
COMMENTS: (include code ciscrepences. persons present. etc : Inspection at InspecbJn #2.
Location: 1457 COUNTY LINE AVE
a
94 ,y.,
' i Alt BM Description =
2.; Bldg sewer length - d/ 7 /e~C. ~.Q,.J~.rre~s ~s/L
amount of cover = D t0 I/ /n~ n f
7 '4 Z o Qe h no, ~e CI /fix
Plan revision Required? Yes No S I y Il U .y..,>
Use other sloe for additional information. lJ / _ 44~( ~ X•
Date lose. .lot`s Sian ."I
fert No
-RECEIVED
"Lill
:MAY 182017 - - - -
S _ Safety - )d Buildings Division 5
` - PS $T CROIX COUNTY 201 W. Was on Ave., P O. Box 7162 ♦al ii c. I': nn t \I ndu: llo II •d i.'. i~ Col
. M W 707-7162
WUNrrY DEVELOPMENT n
J
SanltarN Pertnrt Appltcatio). 1a ff•:n e t nhunf - -
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l I fank Info f _ ( G
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054_> 511. Nfulamulhlhh'\lalrmrnl 1. thr mJu♦tgnell x..unw rcrla,n ihilil. furl. 11vVun of the I'/1\\-ISO, on the altathed plats. -
\ t II LIt p hnni\r r n,t Ic \ VI R\ %,I..b I Bu: u4v I nor V,.n,lrr
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uunlc I)tpartment 1 w 0m, - - - - -
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I t\ (bnditurm of ]ppnluaUNcawm For Diwpproual J/ \ ~ - I,
SVSTEMOVS'NER. 3 lnleu ~D Mme" a2 SNba~ksl -
1. Septic lank e°iucnt tiler and
dispersal cal mu,t Ylce i, mamra n . 7) t(Qn~~'. P{ C~ ~U 7U~ f l Lt /re V
as pet man ag r)7t plan an pry vie' r p' 1 Itr. - /
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CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Owner's Name
Ll'F_ -Sin T31 - jK l w
~
Tcv.nship. S tc- vl,OVl
T L/tlr`~+c
Subcwision Name.
ti'-f+
I, at Nt:mber.
Pa•cel ID Number
Page 1 index and title
rage 2 _ Plot Plan
face 3 System Sizing & Cross-Sechcn _
Pa ,e 4 Fil;er Specs
Page b Maintenance lnforma:Ion
Page 6 Manageemen! Plan
Page 7 St. Croix Cty Sept c TanK Maintenance Form
Page 8 Warranty Deed
Page 9 CSM or Rat
Attachments. Soil I es: & Ilouse Plans
Destgner/Plumber 0!~t LicenseNumber 0-3 -5-
Date - PhoneNumbe!
Signature
Des gow pursuant io the I .mono Sol Absorption Component Manual for Pow^.i vesion 2 0 S3D-10!05-P (fr 01v01)
page 1
4
v-0-
q 1) X n~ X06
>3 711f~~ ~
X 43-1 i~`l,iL)
X13- _ lO~~o~~ ~
Z98 73a'
X~ _ 3
Soil Absorption System Cross Section
ft
4' Su ec_ a Final Grade
PVC /-ro, y0~
Chamber
System Elevation
Soil Absorption System Plan View
~Sr
ft
_.111(.Q111~i11.1.®lilll ~~~I~IIIIiii~lllf~(ffliiilll#lil
( Leaching f rencn 1
Vent Or Observaton Rpe % Clambers J _ r
li ~ Iln~r i-
-~l(~~1~(J~IIIll~IIIDIIll(11~11f
4 Dia
1leade-
Leaching Chamber Specifications
Manufacturer And ModelC 7 i ~T~ j4Zp~ 77L/
EISA Rating sq ft per chamber Soil Application Rate ( gpolsq ft
60c) gpd Design Flow _ O ( Soil Application Rate ~~99U t 5 I
e tR EISA Chambers
1 of chambers each
l ~:ca cF Gad J
4/3
Page -_ot_ Qn~ Culp
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PlUc ^:.i a+d Chmrnber Spec : . I M-
POWTS OWNER'S MANUAL & MANAGEMENT PLAN
FILE INFORMATION SYSTEM SPECIFICATIONS
O~,. Her
<A'M _ ~ Septi_Tank Capacity _5-C-) gal 0 NA
Pe.-mit a •l Septic Tank Manufacturer 0 NA
DESIGN PARAMETERS Effluent Filter Manufacturer C NA
Nurnbet of Bedrooms 7 , C NA Effluent Filter Model
O NA
Number of Public Facil' y Jails A! NA Pump Tank Capacity gal r NA
Lstimated flow iaveragel L16 O al/day Pump Tank Manufacturer AV NA
Design flow (peakl, (Estimated x 1.5) (00 U gal%d'ay Pump Manufacturer i NA
Soil Application Rate p. 7 ai+day'fY Purip Model AtNA
Standard Influent,'Effluent Quality Monthly average' Dretreatmen: Unit NA
Fats, Oil & Creasy (FOG) 530 mg r'. C Sandiuravel sitter ❑ Peat Filter
Biochemical Oxygen Demand IBM,) -20 mgrL ;t NA C Mechanical Aeration C Wetland
Total Suspended Solids (TSS) 5 i 50 mg/L C Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Celllsl ❑ NA
Biochemical Oxygen Dernand IBOD'I 't'dC mg/L l ln-Ground (gravity) C In-Ground (pressurized)
eta) Suspended Solids (TSSI =:30 mgiL NA ❑ At Grade C Mound
Fecal Coidorm ;geometric mean) 110` cfu!100ml C Drip-Une C Other:
Maximum Effluent Particle Size a in dia. ❑ NA ❑ NA
Omer: O NA O;tor. C NA
'Values typical fur domestic wastewater and su:nic tans, C NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tankis; At least once ovary: G monthls' (Maximum 3 years) ❑ NA
3 yZ yearls,
Pump out contents of tankis) When combined sludge and scurn equals one-mird r1, of tank volume C NA
Inspect dispersal cell(s) At least once every: 13 monthls) 3 year(s! (Maximum 3 years) C NP.
Clean effluent filter _ At least once every: 13 10V ❑moyear[syntn(s) C NA
C monthls!
Inspect pump, sump cpnuols & alarm At feast once every: C yearlsi A9 NA
Fluah laterals and ressure tuat At least once evet C month(s! NA
P i y; ❑ year(s)
Other At (cast once every: .1 monthls) 7 NA
yearls) _
Othun
NA
MAINTENANCE INSTRUCTIONS
inspections of ranks and dispersal cells shall he made by art individual carrving one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector, POWTS Maintainer, Septage Servicing Operator. Tank
inspections must include F. visua. inspection of the tanktsl to identify anv :Hissing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge anc scum anc to check for any back up or ponding of effluent on the ground surface.
The dispersal cell(s) shali be visually inspected to check the effluent leves in the observation pipes and to check for any pending
of affluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and rauuires the
immediate notification of the local regulatory authority.
'J'!nen the combines accumulation of sludge and scum in any tank equals one-third fi'i or more of the tank volume, the entire
?meats of the tank shall ce removed oy a Septage Servicing Operator and disposed of in accordance with chapter NR 113.
.h;coasin Administrative Code.
YI otner services, including but not limited to the servicing of effluent fitters, mechanical of pressurized components, pretreatment
its, and any servicing at intervals of <_12 months, snail he performed by a certified POthTS Maimainer.
_ervmv report shall he provider. to the Inca'. regulators eutnoriry v; it his " days of rrmpl e'inr. of any servi^e rve:nt
Z of
START UP AND OPERAI ION
=c- ne'.y ronstruction, prior to usu of the PDI. S Chun, troatmenf tBnKIs1 for the presence of painting ptuducts Or other chemicals
Oka! may impede the treatment process andior damage the dispersal COIL'S). If high concentrations are detected have the contents
nt the tank(sr removed by a septage servicing operator prior to use.
stem start up shall not occur when suil conditions a:e frozen at the infiltrative surface.
luring power outages pump tanks may fill above normal higawater levels, Whar power is restored the excess wastewater v:1 be
discharged tp rte dispersal collie) in one large dose, overloading the cellfs) and may result in the backup or surface discharge of
e8iuent. To avoid this situation have the contents of the pump tank removed by a Septago 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
cs: ore normal levels within the pump tank.
Jo not drive or park vehicias over tanks and dispersal cells. De not drive or park over, or otherwise disturo or compact, the area
w ithin 15 feet down slope of any mound or at-grade soil absorption area.
Rr;ductiun or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
P,')WTS: antibiotics; baby wines; cigarette butts; condoms; cotton swabs; aeareasers; dental floss; diapers disinfectants; faz;
foundation drain (sump pump) water; fruit and vrgetablo peelings; gasoline: grease; herbicides; meat scraps; madicazions: oil;
❑inting products; pesticides; sanitary napkins: tampons; and water srimmer hrile.
ABANDONMENT
,%Iv I. the POWTS `.ails and/or is permanently taken ou: of service the foliowing steps shall be taken to insure the. the system is
pr. p=,ry and safety abandoned in compliance with chapter Cmam 83.33, Wisconsin Administrative Code:
• Ad piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• I he contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pis shall be excavated and removed or then covers removed and the void space filled with
soil, g-evel or another urea suW material.
CONTINGENCY PLAN
It thG POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
ol.,::;:count system:
L .4 suitable replacement area has been evaluated and may be utifized for me location of a replacement soil absorptmn
system, the roplaceinem area should be protected tram disturbance and compaction and should not be infringed upnr,
required setbacks from existing and proposed structure. lot lines and wells. Failure to protect the replacement a•ea wi~I
result in the neud for z new soil and site. evaluation to est.iblish a sonabie replacement area. ReWacement systems rtwr~
comply who the rules in effect at that time.
4 suitable reptapement area is not available due to setback aod;or soil limitations. Barring advances in POVv`
technology a hording tank may be installed as a last resort to replace the failed POWTS.
-,e
('~r -~•alua i -r r c ~r i. _ a ro ding •arr
OrJ
y ba -irtc*aried-wro-1 .,•e ,ai e4 Di-118 Ti'EI1r2- C_-'a
&J
Hound and at -grade sail ansnrptine systems may be reconstru:::ed in place following removal of the biomat at cnc
infiltrative surface. Reconstructions of seen systems must comply with the rules in effect at that tirne.
WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
-LATER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER _
Name r(~. Name
?hone 7~:5 ' 7~G ~ / yf/ Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name ' Name OU 0j r/
-Ir it . f -I V. _ ~r
r. -
ST. CROLX COI NTY
SF7'-T(: TA\_ MAP\iT \PNC_ AGZ=1MENT
A. ND
O'nkWF,RSHTP CERTIFICATION FORM
a i ng Address 7IS> 1 (~T
u
P-~+pcrn, Address C~~~r 1.n7 ~ 1r0~:' a~ ~
(Veri&catoa required trom Planning & u iae Departmcv: for new O&M=ion.)
Cm tCk rc,ri'C- LU Yarcel Identification'. tiller
r - -
LEGAL DESCRIPTION'
Pronerry Location j/k=l Sec. , T N R-12- . Town o
Su'1l;vision Plat: Lot 4
Certified Sun e} Map 4 _ VAL::ric Page y
Warranty Deed (b.-fore ^U:)';iVol tine Page
Spec housely-yes D no '.ot lines idea-.i5ablel~z yes 2 no
SFSTEN'f MAINTENANCE AND OWNER CERTIFICATION
It= one: ,,se and maintcnance of „our septi, s+s:em could rvaull in its preina-tire failure to handle wastes. Proper
iL.,xiaenznce consists of pumpmp out tae septic tank even three years or sooner, if aeadcd. by a licensed pumper. What +ou put int;,
the S.VieIL- can a:Tect the ttu1C.ior of the septic tang as a eatment s•,agc in the waste etsposal system. Owner Inaintenancc
responsibilities are specified u; FSPS.R?.52f !'I ans in Chaplet 12 - St. Crd-x Co.mrv Sanitary Circinance.
The propery owner agrees to submit to St. Croix County Piamning & Zovir:c Depa~-ivent a certification form, signed by the
c.+rcr and by a master plumber, iourneyma:i plumber, :ezuic:ed plumber or a licensed pumncr verifying tlhat (i) the on-site
.,rite+r<aer +iisposal system is in ?roper o:+e: atmg condition , or after inspector. and punpin; (i; neccssan the septic rani; is
`ian I:3 lull of sludge.
Uwe, the under.iencd have read the above rectiiretnems and asee `o maintair. Cne private sewage disposal system with the
sC_:,ca: ds set forth. herein, as set by the D-pa=n'. of saiery And Professional Services and the Dcpartment of Natural ResiurzCs,
S;atc of '+\'seoasin. Cemficanon stating :hat yut.L7 septic system has :yea maintained must be completes and returned t;. the St. Croix
C'ounry I'lannirg & Zoning Du?w-twem u~itaic SO days of the three year expiration date.
P.,.e ccCifv that a] statements on tns fora; are true to the best: of mv%our knowlodg- . 1'"C an are tWC owrcrls) :f-he
propem' described abvvc, by vi~n/e oI a war. rm7 deed : ecan9ed is n~ ~:>ter o: Dccc, (ifficc.
Number of drooms
.:IGNATURE OF APPI.1CAN-T'(S) DATLL
"'Any ir=olmatiou :hat is m:src^t-cscnt.;; :ray result in the sanitary p=:'' be:nK revoked by the Aiming & Z:+n:na Deparn,ent.
la.l.ide wi:a this app:icador. L ded a tc: im y iced iiev.: i- !tc_i.. a' ci . Cds and V. co_ y III,- cur,::,. sus c_.,
7efc7tncc is made in tug wawa°~ aee~.
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RECEIVED - 3T-a`',7 -
'~el''I'CYS{~afoO~~ossr:nal Ser.•::es _•rv Kt PORT image
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r reve prrn a I Wormatror, te• r:ed cy... Date
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ST. CROI-X CPUNTY Planning A t and tnlornmhon
Resource 9lanugement
Community Development Department
5/30/2017
Samuel and Kristin Ausen
32 1701' Street
Star Prairie, WI 54026
RE: Conditional Approval: Land Use Permit, File# LUP-2017-019
Project Location: 6.31.17.82A, Town of Stanton PID 036-1013-30-000
Project Address: 1457 Polk/Saint Croix Road
Dear Samuel and Kristin Ausen,
Community Development staff have reviewed the Land Use Permit application for the construction
of a new Single Family Dwelling and to fill and grade greater than 10,000 square feet for the
construction of a driveway and Private Onsite Wastewater Treatment System (POWTS) within the
Shoreland Overlay District, Chapter 17.30. The request has been conditionally approved based
on the application submission and the following findings.
• The proposed project meets all applicable setbacks and the proposed house will not
exceed the 35-foot height maximum.
• The project is greater than 300-feet away from a navigable water body; therefore, the
Impervious Surface calculation is not required.
• Vegetation will not be disturbed within 35-feet inland from the navigable water body.
• Erosion and Sediment Control plans have been submitted that meet Wisconsin
Department of Natural Resources Technical standards.
• The property received the Sanitary Permit #597348 and coverage is valid for two years.
• The applicant understands land disturbance over one acre may require additional permit
coverage.
Based on these findings, approval of the Land Use Permit is subject to the following conditions:
1. Sediment and erosion control (hay bale barriers) shall be staked down prior to any land
disturbance or construction activities as proposed in the plan. Temporary stock piled soils
shall be placed upslope of sediment and erosion control measures.
2. St. Croix County reserves the right to require additional sediment and erosion control
measures to be installed if found necessary due to site-specific concerns.
3. Phosphorus fertilizer shall not be used to establish and/or maintain vegetation unless a
soil test confirms phosphorus is needed.
Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, Wl54016 Fax 715.386.4686
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Resource Management
e;
Community Development Department
4. A temporary cover crop such as oats, winter wheat or rye shall be applied on all disturbed
areas after September 15 but before the ground freezes. Permanent vegetation shall be
established once final grade is reached spring of 2018 after the ground thaws - June 1st.
S. Sediment and erosion control shall not be removed before the project site reaches a point
of at least 70% perennial vegetative cover.
6. It is the applicant's responsibility to secure any other required local, state or federal
permit(s) and approval(s) prior to land disturbance activity.
7. Failure to comply with the terms or conditions above may result in the revocation of this
permit by the Zoning Administrator according to Chapter 17.30(13).
This approval is subject to the conditions listed above; it does not allow for any additional
construction, structures, grading, paving, filling or clearing of vegetation beyond the limits of this
request. Your information will remain on file at the St. Croix County Community Development
Department suite. It is your responsibility to ensure compliance with any other local, state, or
federal permitting or regulations, including contacting the Town of Stanton and the Wisconsin
Department of Natural Resources to inquire if additional permissions are required.
This permit is valid for one year, with the possibility of up to two (2) six-month extensions if the
applicant submits the appropriate permit extension fee and documentation to the Zoning
Administrator. A copy of the Land Use Permit placard should be submitted to the local Building
Inspector for the town upon application for the building permit. The orange placard must be
posted on the job-site and visible from public view.
Please feel free to contact me with any questions or concerns. I am typically available Monday-
Friday from 8:00 a.m. - 5:00 p.m. if you would like to discuss this permit approval letter.
Respectfully,
Jn,/
Sarah Droher
Land Use Technician II
cc: File
ec: ausenfar~n-is~= f o iliN net.nP.
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enclosure: Site plan
Phone 715.386.4680 Government Center, 1101 Carmichael Rood, Hudson, WI 54016 Fox 715.386.4686
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