HomeMy WebLinkAbout020-1057-60-300 (2)
.)nsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
:ty and Building Division Sanitary Permit No INSPECTION REPORT 597373
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:
CLINT HETCHLER TOWN OF HUDSON 020-1057-60-300
CST BM Elev: Insp. BM Ell BM Description: Section/Town/Range/Map No:
j v 5kj 22.29.19.216D
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic , Benchmark -7, ZS Z /a0
/45 Alt. BM
a , e_ 7 !e
Aeration Bldg. Sewer
Holding St/Ht Inlet
mes 1
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO i P/LL WELL BLDG. ent0; it Intake ROAD Dt Inlet
Septic VI+ 1, 0 4LP Za ~ Dt Bottom
Dosing Header/Man. c~ t/ D
. Z
Aeration Dist. Pipe
S,~t JOQ-Z
Holding Bot. System . C C
PUMPlSIPHON INFORMATION Final Grade /6
Manufacturer Demand St Cover
GPM J T
Model Number -
TDH Lift Friction Loss Syste TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION YSTEM
BEDITRENCH Width Length No. Of Trenches~ PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 76b Z 1 f e,,Ac
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION Type Of System CHAMBER OR G
~Z~ UNIT Model Number
O WA~Y~.Q rc..
DISTRIBUTION SYSTEM 40 -7 f'7 *e,~
Header/Manrfold Distribution x Hole Size x Hole Spacing Vent to Air I
Pipe(s) iii Length :5, Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only k-f Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed Trench Center' V Bed Trench Edges Topsoil ~\v~C [ No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: a Inspection #2:
Location: 864 GLINTS TRL 4-*.-
1 Alt BM Description = ( Ca J.t~. 1 j s Lo 5 v ,
2.) Bldg sewer length = L1 CJ~
amount of cover = E~~ '6 C I (9 GO Jam'
Plan revision Required? ❑ Yes o
Use other side for additional information. ' 77
-
Date 4insepctor's Si re Cert. No.
SBD-6710 (R.3197)
744V 01
~.v ~County
Safety and Buildings Division
D y 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
S P iso WI 1701J162
557373
0~4' 1N7 Illtaly Permit State Transaction u Aber
In accordancewith SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Protect Address (if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. 4 G[ i , Q~
1. Application Information - Please Print All I r tion V
Property Owner's Name Parcel #
~
<71
Property Owner's ~Mailing Address Property Location 9,2
r 40
1s rr f is zk Govt. Lot P d
City, State~~ Zip Code Phone Number 1A 1Y,671/4, Section
/f✓ S (.2~~-~ 5 'YO l r~ (,circle one)
T J `r N; R / Eor W
11. Type of Building (check all that apply) Lot #
or 2 Family Dwelling- Number of Bedrooms Subdivision Name
Block #
❑
Public/Commercial - Describe Use
❑ City of
CSM Number ❑ Village of
❑ State Owned -Describe Use
2 1 U.) 7 #-7 !'u r(d :5 [I Town of
III. Type of Permit: (Check only one b on line A. Complete Tine B if applicable)
A.
❑ New System replacement System ❑ Treatment/Holding Tank Replacement Only ❑ ther Modification to Existing System (explain)
List Previous Permit Number and Date Issued
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New
Before Expiration Owner U ? - ~ OZ
IV. Type of POWTS System/ omonent/Device: Check all that apply)
Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain)- ❑ Pretreatment Device (explain) /f Ar2!
V. Dispersal/Treat ent Area Information:
Design Flow (gpd) Design Soil Application Rate(gp st) Dispersal Aria Required (sf) Dispersal Area Proposed f) System Elevation
V1. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units ' o
«3
New Tanks Existing Tanks
0
a U v v C~ a
Septic or Holding Tank -
Dosing Chamber
VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Sjgnatpre MP/MPRS Number Business Phone Number
Plumber's Address (Street, City, State, Zip Code)
Vill. County/ eartment Use Onl
Approved ❑ D Permit Fee Date ssued Issuing nt Signature
_T ! 4 l7
❑ wn en R for Denial
IX. Condi t Rea neso; Disapproval
i761i wvtbi cell must ~alllrt W.Lvw ! rokinj e
v0,p*r,M4r;,a6emen! plan ptonded by plumbe)%
2. Aetl>fielr~crsRtsirerberresrrruu4:butairtrirFd
sit per sppknbla code /,:rdynancw.
Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x I I inches in size
SBD-6398 (R. 11/I I)
~ f
cal (r ~ ~ j
~ i
y
r-- , t
fV N Y
O
(4/7 el
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name:
Owner's Name:
Owner's Address: C (<i / f /Z4,
Legal Description:
Township. ~}^~/Jf
County:
~t
Subdivision Name: U
Lot Number:
Parcel ID Number: ~J .20 U> 6/ e/ 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
f Attachments: Soil Test & House Plans
Designer/Plumber: / /,-,~License Number: Z ~_21
Date: - / 7 Phone Number
Signature
Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01).
Page 1
Jt
s f
~ r
~j vf~•t-~ U i f,
v P
eCve.l f
jug • .17
TpC~tfrt
SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Pageof
Project Name: r Arle e C._
No. of Cells Per Cell
3 ft Cell Width Total No of
661 ft Cell Length • _ a sq ft EISA Per Cell
j ft Cell Spacing C,'d sq ft Total EISA
Manufacturer Model Laying Length EISA Rating
Infiltrator EZ1203H-5ft 5.0' 25.0
EZ1203H-10ft 10.0' 50.0
Gravelless Leaching Unit Manufacturer: ~7 '4"/
Gravelless Leaching Unit Model:
Typical Cross Section
Finished Grade
Observation Pipe with
approved cap or vent
.a°
Soil Backfill
f
in `
Geotextile Fabric
R ■
.
ft Infiltrative Surface
12 in
~t ? ft Limiting Factor
in
7 Slotted and Anchored Vent/
Observation Pipe with Cap
° ° . E ! ! ! f ■ ! ■ i E ! . . ■ i ! ! ■ . ! E ■ ! . ! i . . . . E . ! . ! ! f . E . . . . E . ! f ° . i ■ . . . . . . . . E ■
Plumber/Designer Signature:
License -(Y Date: 6> "'°674- l -7
k S ,.r 1
.r
Installation and Maintenance Instructions
Installation
Step 1 Dry fit the filter case onto the outlet pipe going to the drain field. Ensure it is centered directly under the
access opening. (if outlet pipe is already in a fixed position, additional pipe may need to be added)
Step 2 If utilizing the additional single side support and the two bottom supports: While the case
is still dry fit to the outlet pipe, measure and cut 1"schedule 40 pvc pipe to the length needed to extend from the
hubs that are pre-molded into the case to the side wall and the inside floor of tank. solvent weld pipe into the
hubs that are pre-molded onto the case.
Step 3 Solvent weld the case to the outlet pipe. Insert the filter cartridge into the case pressing down on the
cartridge until it locks into place at the bottom of case.
Step 4 if utilizing a vertical read switch: Insert switch into the hole pre-molded into the top of the filter, Press
straight down until it locks into place
Maintenance
1) Remove the access lid of the tank. Note: To ensure undesirable solids do not exit the tank and into the
drain field, the tank should be pumped out until the level of effluent is below the outlet level of the tank.
2) To remove the filter cartridge from the filter case, pull up firmly on the handle of the cartridge dislodging
it from the case. (if utilizing a vertical read switch, removal of switch is optional)
3) Using an ordinary garden hose, rinse the filter cartridge ensuring all visible septage material is removed.
4) Place the filter cartridge back into the-filter case pressing down on the cartridge until it locks into place.
5) Place the access lid back onto the tank ensuring it is secure.
Lifetime filter has a lifetime limited warranty:
Lifetime filter LLC warrants the filter will be free of manufacturing and workmanship defects during normal use for the period of
time the original purchaser owns the product. Lifetime filter will provide a replacement filter in the event that the original filter was
not damaged during the installation or maintenance process. Damage to this product caused by accident, misuse or abuse will not
be covered under this warranty. Improper care or malfunctions resulting from product not being installed, operated or maintained
properly will void this warranty. Lifetime filter assumes no responsibility for labor charges, removal charges, installation or other
incidental or consequential costs.
Contact: mikePlifetimefilterllc.com Phone: 502-7242231
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC TANK(S)
This is to certify that I have inspected the existing septic and/or dose tank
presently serving the following residence:
(Street address) located
at: 5C6 1/4, f'~' '/4, Section 22 Town Range l Y W,
Town of '~-~~r~• St. Croix County Wisconsin.
Upon inspection, I certify that I have found the tank(s), to the best of my
knowledge, will conform to the requirements of Counn. 84.25, and it (they)
appear(s) to be urictiorling properij%.
Most recent date of inspection or service
Did flow back occur from absorption system? Yes , No
(if no, skip next line.)
Approximate volume or length of time: gallons minutes
Tank Capacity:
Construction: Prefab Concrete _ Steel Other
Manufacturer (if known): Lv ~c 1-~
Age of Tank (if known):
Permit number (if known)v ya
(Licensed Plumber Signature) (Print Name)
(Title) (License Number) MP/MPRS
(Date)
Form to be completed by licensed plumber (Dept of Commerce Chapter 5
and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin
Administrative Code)
Rev. 9/2008
Private Onsite Wastovrater Treatment System Management Plan
Septic Tank And Gravity In-Ground Sots Absorption Component
Puntward to Comm 83.54 Wis. Adm. Code each Private Onsft wastwmw Treatment
System (POWTS) shall include information and procedures for maintaMtMM the sysbm Within
the parameters of Comm 83 and 84, and the condilione of approval by the department. agent.
or gavemmenlel unit. The approved plans and pennils for system are on so at the county
zoning or health depatrttnent.
This mamagemsnt plan compiles with Comm 83.54, Wis. Adm. Code, and the In43round
SON Absorption Component Manual for Private Onsite Ww water treatment Systems SBD-
IOW7-P (RAW).
Table 1: Systm Spe ffl a dons
Permit Nunbw - Zo Z
Number of Bedrooms
Flow - Peek
Estimated Ftow - A Aft
Septic T"- Capecity (gal)
Soil Absorption Co nt Size (W) Liu"
T of Waabswater DonWndc
Table 2: Soo . Component - L mks of Ra labs Ckwation
Tank Sots Abom*m
Des Flow - Peak (2Sn
1/g
Ma)amum Influent Particle Size (in) U
MaxJ mim 220
Maximum TSS 150
Table 3: Maintenanoo Schedule
Septic Tank Irapect wtdlor service once every 3 era
Outlet Filter- Inspect once a yew and dean at least once evwy 3
Soil Absorption Inspect once 3 yeses
Ssotlc Tank
The septic tank shall be nv*te W by an fidivlduat certliled to service septic Weft
under s. 281.48, State. The contents of the septic tank shall be disposed of in accordance wltlm
NR 113. Wis. Adm. Code (Seervk*q Septic or Hong Tanks. Pumping Chambers. Gres"
Interceptors, Seepage Beds. Seepage Pits. Seepage Trenches, Privies, or Portable
Reettroorns).
The operating condition of >he outlet fitter shell be assessed at least
once every 3 years by inspection. outlet cleated as ure
proper operation. The filter cartridge rat be notnonred provisions are made to
to solids to the tank that may slough off the filter when removed from its enclosure. If the
Management Plan for a Septic Tank and Soll Absorption Component
filter Is equipped with an alarm, the filter shall be serviced If the alarm Is activated cordnucusly.
Intern titbent finer alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall hen Its contents removed when fine volume of scum and sludge in Nte tw*
exceeds 113 the liquid volume of the tank. If the contents of the tank are not removed at the
time of an assessment, maintenance personnel shall advise the owner of when the next service
needs to be perfomred to mointabt leas than maximum scum and sludge aoaxnulation in the
tank.
Armhole nears. aoosse risers and criers should be Inspected for water tightness and
sou ndrmss. Aeoess openings used for service and assessment shall be sealed watertight upon
the Completion of service. Any opening deemed unsound, defective. or subject to tenure must
be replaced. Exposed access openings greater than 8-i x*m in dfame w anent be securod by
an affective looking device to preverit aoddentai or unauthorized entry IrAD the tank
ft am should wifer a sapffe or fdbw beabnaif or hOlOis Am* flat
any mason wNiout beMp in !lull CQf AOe WM OSMA sbrxbrds for
anlarhV a OWNned spacer. The abnosprtisre wNh/n f1w sgpfk or otbar
bea6lMv of hori►cftig hek @ray confidn IlsOW gases, and rescus of a
person ftm Me h3twfor of die tw* may be dNWOW or hRMN slMla
Tank abandonmera shall be in ecaooM mw with Comm 83.33, Wis. Adm. Code when the
tank is no korrger used as a POWM oampotertt.
The soil absorption component serving this structure is designed to accept doneetlc
wastewater from a resider*&I fadilly. The limits of operation of this component are shown in
Table Z
The kmgevity of a soil absorption component depends greatly on prOW and timely
maintenance, and system use within or below the limits of reliable operation. Good water
c ation practices by all occupants and the imt ellation of water conserving plumbing
Axfures are key lectors in extending tine used We of this component
The sotl absorption componenfe operation must be assessed by Inspection at MOM
once every three years. The Ini specdon shall include recording the ksvels of PWOV, If any, In
the observation pipes. and a visual Inspection fix any evidence of su dboe seepage or discharge
from the componef On steeply sloping sites, areas of erosion should be IderOW and
reported to the owner for repair. The surfaoe discharge of domestic wastewater or 6ewage
from the system Is prohibAed and considered a human heAW hazard.
Traffic around or over the soil absorption component should be avoided Particularly
during winfer months. The compaction or removal of snow coyer over the component may lead
to hydraulic faikma by freezing. This type of fallum Is usually temporary, but is dff=At Or
impossible to repair until weather eondbons Improve. M general. soli Corn over this
component wig reduce diffusion of oxygen info the soli and dispersal cent, which may lead to
more Intense, avid earfier, organic dogging of the sntl.
2
GONTINOENCY PLAN s code canon,!
It dw POWTS faits And cannot be repaired the btlowqut measunts hive betr+. Cr IMM be taken, 1* ps'~e
nplaca AU Sot=
A suitable replacement area his been hraWat ed and may be staked ,W the badon ot& tsplao -11 t sod absorpdo
system. The replacement area liquid be protected Isom dumea m and eompuGou and fba"TeA be Mttries 61
repaired seebacks from existing and proposed ArvcWrv, tot duet and welts. PaWR to Food dw moacentvettt area
result in site need for a new soft and site evahmOon tea establish a sukabb repbcomm area. Rabeanent systerru r
comply vdth the rules In effect at i at dine.
O A suitable replacement area Is ,tot avatfabie doe to se*adc and/or s" &*Kbes. EWi ji&a is In POWTS w
a hold4v Unk nisy be Irotaftd au a bsc resort to srpbm do lead POWM
O The site his not been evaluated so Identl& a sukabis npiacans ik was. Upon Were of da POWTS a sod and site
evaluation must be performed to locate a sultable replacement am& it no repbcsit etat area, b avaU* a hold ft t
be Itatalled as a last raon to replace the tailed POWTS.
O Mated and at-rade soq absorption systems my be mcowizu ud in plaa ksllou+i k* rovwval of the bivmac at the
InMtradve surface. Rscoentruaiont of such "seems rtwsteoasph vim the nda to efktc at tat clime.
< < WARNING > >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSOVIC16'.
OXYGSW. 00 HOT ENTER A SEPTIC, PUMP OR OTWU TREATMINT TANK UNDER ANY CIRCUMSTA!
DEATH MAY RESULT, RESCUE Of A PERSON FROM TU9 INTSRIOR Of A TANK MAY 51 DIPPICULT O
le p^F*ttRt i.
ADDITIONAL COMMIINT!
~~.r ~~rr. - - r~wr~rrrir.r nr•w
POWTS INSTAUER roWTS MAINTAINER
Namf Name
"ON AE- ~l - 5~ Phooe
ltPTAGE URYICING OPERATOR PUMPER L VtATORY AUTHORITY
Name S r