HomeMy WebLinkAbout004-1027-80-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No
(ATTACH TO PERMIT) 597406
GENERAL INFORMATION 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:
Mary J. Hecker TOWN OF CADY 004-1027-80-000
CST BM Elev: Insp. BM BM Description: Section/Town/Range/Map No:
/ e.6T 12.28.15.186
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER S CAPACITY STATION BS HI FS ELEV.
Septic Z 7 Benchmark
Dosing Ca~ G Alt. v
-P. 10
G s3,
Aeration a (a 525 Bldg. Sewer q
95 -CAI
Holding St/Ht Inlet ~7, ,ice /J
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WEL L D Vent Air Intake ROAD Dt Inlet
Septic `7 166 Ta /1 _ Dt Bottom
Dosing 96 Header/Man.
7 i
Aeration Dist. Pipe
A `
Holding Bot. System p7 U
~
PUMP/SIPHON INFORMATION Dem Final Grade Q C1 Manufacturer Z_a If Demand St Coveil, 401 '73 J 7
Model Number Ag t Z4. 4 6 N tl b
TDH Lif4 i Friction Loss System He TDHx d5t Y
Len tg h, Dia.Z Dist. to Well
Forcemain
I I ?t? i r
SOIL ABSORPTION YSTEM
BED/TRENCH Width Length No. each s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer.
INFORMATION CHAMBER OR
Typ t em 7/46y//~ UNIT Model Number:
DISTRIBUTION SYSTEM ~/CJ
Vent it Intake
Header/Manifold I Distribution x Hole Size x Hole Spacing
~J
~{P
Length~__ Dia_ Length_ • ~ Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only A.94-1
Depth Over De th Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil L No Yes No
• V i /
Inspection #2:
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: s
/L t
6
P~
Paz. Location: 3230 45TH AVER, te%ta 1.) Alt BM Description I w l~
2.) Bldg sewer length = S C C. ~ 66 +
- amount of cover =
7 ~Z d~
Plan revision Required? ❑ Yes X No~i
Use other side for additional information. 41nsepctor's SBD-6710 (R.3/97) Date Sig ture Cert. No.
p Z° ~ ~ fi ~ N
t4 071:1
- a 71
1 it
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t JNV • V~R, B~ Washington ~~en ..County
$ P P.O. Box 7162 Sanitary Permi er f~lic filled in by Co,)
S
g~, CR~17t q,0 L~ M+ Madison, Wl 53707-7162
DLP
,oM
Sanitary Permit Application State Ttatt- ction Number
1111 accordance with SPS 35321(2), Wis. Adm- Code, submission of this lbrm to the appropriate governmental unit v ~
required prior to obtaining a sanitary permit. Nate: Application fotmss 12rr state-owned POW FS arc submitted to project Address (ii dollb(ent ant
ailing address)
tha Department or Satt ty and profess ianal Scrvice.. Personal infomtatiat vau provide may he used for secondary
I puTOses m accordMce With thi frivacv La~~ s 15.04(!)(m), Slats.
1. ~ ~ ~ ~ _y
APplieation Information Please Print All"- Informa n `r
Property Owtrer's Name
Parcel 3
Property Owners Mailing Address
-trupx rty Location P a 1
a. I..
,
- - a Y -W _ qc cert. Lot
City, State l l Zip Code Phone Number
(n/ 6 So I s~ f , 'i',, Section
SYa,77 (circle one:
11. Type of Buldin" (check all that apply) - T ----N; R 1.5
2 L.at
of or 2 Family Dvvelim., Number of Bedrooms - - ? _ Subdivision Name
Blocktr o
- _.,.5
14 t6
I ❑Public/Commercial-DescribeUsz
❑ Siyte Owned-Describe Use GS 4 Tvur~tber 8-.}Tl{ege of
I
A0 /
r Town of ~A,O Y
7V lorlowo &2&
ill. Type of Permit: (Ch one r c A. Complelr line B ifapplicable)
rr1
❑ New System Replacement Syste,n ❑ rcamtarttil lvldirsg Tank Replacement Oil), ❑ Other Modification to Fxistirtg System (explain)
B. Perntlt 1ienewal ❑ Permit Revision ❑ Change oi Pkanber ❑ Permit Trzutsfer to New List Previous Perin t Number and Date Issuai
i Qzlbrz Expiration Owner
IV. Tree of POWTS System/C omponent/Device: (Check all that Al
❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade g 4lound > 24 in, of suitable soil ~~oumd < 24m, of suitable soil
t
Holding Tank ❑ Other Dispersal Component (explain)_
wti Device (explain),
V. DispersalfFreatmc Area Information:
Design Plow (gpd) sign Soil Application te(gpdst) Dispersal Arty Required t) Dispersal Area Propost .st) System Elevation
I ONt"act.z„ ~
pGl, 3 a ✓ eP R i'
\11. Tanl: Info - apacily in Torah o of lvlsnutactur r
CisRons <isl(ans Um Units
/f o
Ne e T:1nka 1:ci31 in81?enls A/ tot /1~ ,m u V o
i 0 ti v .n cd tG
septic'), bfakkm-t4Rk ~ - -
bpca AC d0 f /(f E Ea ~ewJGgErE_ v
nosing Chamber _ _ `
I GOD - GGO l rr „ ---I v .
I'll. Responsibility Statement- I, the undersihned, assume responsibility- for installation of tire POWTS shown on the attached plans.
Plumber's Name (Print) Plwnher' iynamre s m Number Qusinc ss Phone Number
OS_ 93 .3 V
/l AO Y 17.v,~M ✓y`` v~/~1
P!wnbcrs Address (Street, City, Statc,'Zip Code)
E 75!aZ Sr Orr A w~ A~ Iweo 4.r ~TSF '
Vlll. Count '/De a---1 list Onh'
Perntit Fce Date 1, ued Issuing Agent Signature
j roved ed -
-I
❑ 'en Reason for DenaT~_
'1 l S l'1
I\. Conditions of Approval/Reasons for Disapproved en
SYSTEM OWHER:
1. Septic tank, ;affluent filter and in U r.1 oul~ l e (e- va IG1
dispersal ceil must Lie serviced / mainta r I 'f
as per managemc;nt plan prodded by
- -2--tit setbael~ regl~+r~:m2nisml~st be rang tU~l (CIS ,
art rich to tom ~li;P~1?i rte ~ffdw3xte , and sit wart to the County only on paper not lees an s vz x l l inches in size
as per appllca:)te co~:
ptoW 1`pgWred"
J
KID-6398 ~R. M, 14'~
~WiAr
U, V1 S-D b- POW13 lb 66 3 6 Co ~
DIVISION OF INDUSTRY SERVICES
` 10541 N RANCH RD
19\ HAYWARD WI 54843-6462
j f Contact Through Relay
P ; http://dsps.wi.gov/programs/industry-services
www.wisconsin.gov
Scott Walker, Governor
Laura Gutierrez, Secretary
June 09, 2017
CUST ID No. 220355 ATTN. POWTS Inspector
ZONING OFFICE
BRADY DAHMS ST CROIX COUNTY SPIA
E742 ST HWY 12W 1101 CAR-MICHAEL RD
KNAPP WI 54749 HUDSON WI 54016-7708
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 06/09/2019 Identification Numbers
Transaction ID No. 2950745
SITE: Site ID No. 838478
Mary Hecker Please refer to both identification numbers,
3230 45TH Ave above, in all correspondence with the agen NI DV_.
4
Town of Cady Appvz'
St Croix County r Of
SETA, NWIA, S12, T28N, R15W
FOR: 0~ OF
Description: Mound, 3 bedroom residence I~10
Object Type: POWTS Component Manual Regulated Object ID No.: 1708332~~
Maintenance required; Replacement system; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor fro
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 x.145.06,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
Key Item(s)
• 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. In addition, the
owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the
mound component manual are complied with. A copy of this information must be given to the owner upon
completion of the project.
Reminder
• The orientation of the mound system must be such that the longest dimension is oriented along the surface
contour per SPS 383.44(6)(a)2.
• Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual.
• Surface water drainage shall be diverted away from the system area per Mound Component Manual.
• Materials shall conform to the requirements of SPS 384.
• The existing POWTS must be properly abandoned per s. SPS 383.33 Wis. Adm. Code.
BRADY DAHMS Page 2 6/9/2017
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 $ 250.00
Fee Received $ 250.00
Balance Due $ 0.00
Patricia L Shandorf WiSMART code: 7633
POWTS Plan Reviewer, Division of Industry Services
(715) 634-7810, Fax: (715) 634-5150 , M - F 8:00 a.m. - 4:45 p.m.
pat.shandorf@wisconsin.gov
cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm
BRADY DAHMS Page 2 6/9/2017
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 $ 250.00
Fee Received $ 250.00
Balance Due $ 0.00
Patricia L Shandorf WiSMART code: 7633
POWTS Plan Reviewer, Division of Industry Services
(715) 634-7810, Fax: (715) 634-5150 , M - F 8:00 a.m. - 4:45 p.m.
pat. shandorf@wisconsin.gov
cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm
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a New sump and residential construcdon
For complete product
SPECIFICATIONS: l information vissit
1-1,'2" NP-1 discharce `
3/10 HP (713, 55, 57.59), i 2 HP !U8; ~ w ,zoeller. co
Available in autoEZtatic m nonautomatic l
1%'2" 1,13 rnmt spherical solids capnGiv;
Thermoplastic or cast iron base
a Thermoplastic or cast iron impe;ler `
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7? ii)3 f7iCfR73i!Uf7, see tuCI:eZ14cF }i(? Rrt'S L PUMP PLERFO "`AIANCE LrtJC' VE
FIW2778, FM2779
MODEL 53155157(59198
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(LDAll rights reserved. ZOELLER PUaNIP CO, t 502-778-2734 { 300-928-7867 1 vV'.vvvzoelfer.com
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Desi,orl flo o: (D F estilTlatLd - i.5 ~ ~s Oaf alt Punil1 .,',itlUctirL£ --204rZ464
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-~~iniziu [':'Fi~ent particle Sire l!3 inch <iiaitleter_i -ott£ai 'Distance 'rank(s) to Service t'ad` „ro
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1 T3plic,ation rare reti iZ_quiired :1S'A - „nch Widl i} s r )cal Length o('Cl , it I
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M SBD - i OS-54-P (R. L`13) "At-Grade Component A,Iatwal Using Pressure Distribution- Version 10
SB D - ? 070;-l' (v.0 IT 1) " In `a round foil Absorption C:zniponeat vianual`' t'ersion 10
iOS` D - "'0691-P (`L_OPO ) `•ilsiozznd Coznpone-nt ivlazlual'' Version 3.0
SBLi - l 06-57-P I R.61,99) --Drip-line Effluent Disposal Component lkfaiiual"
I$(`,SBD - I f)706-P (N.0PO I) "Pressure-ibu,ic- Cc nponcn? Manual- Version ?.J
;t'sler
et -vice E'„ -q e :CS-, f
un7p impzct tank(s), inspect dlspe ziai deli{5~clean T'tteC At lt,aSt 4tiCe evttl•'N ~;g 13 iiietlt115 2l' 3 veais i CZt1Fer -
Inspect put to a. pump controls alarm, pumt - ~ it least once every: ~ i i months ~ i years F N\
Mush all, DtesstlFe test hitem-Is ~ -at Il.uSi Once tverv: 7 +lloi the Years [7, N "A
J C gT :asr : For Construction. prior t:i use coftho POWTS c .teck t:•eaurien: tamk(s for the presence Or
painting products or Other chemicals that may impede the trcaatment process alld/Or dam4ge the dispersal cel€(s). If high eon-cc rations
are detected have the contents o •the tank(s) removed by a septa e ser :din, operator p; itir to rise. System start up shall Ef not occur
vvtlea staid conditions we froze, n the iriffltraVve sur fam
I lie property" owner is responsible kv the operation and manitertance of the POWTS and submission of required reports. The quantity
and quality of tilc Nvastewatcr stream. rxill affect £tze pQrfibrwanc-e and tongevit of your PO\Nf ('S. The installation of water-savina
appliances and fimures along \vith prompt repair of ieaks reduces the ti -astevy-ater volume. Also cite brine or waste irom water
at avers, iron removal units. other Clear rater trea£znent de, ices and foundation drains should be discharged to the round surface
whellf- er possible- Note_ this does not includo laundry waste, staoyxers, dishwater, etc.
This 4j "ell-i is iiesigned m handle donlesti tlet'i-th washy ice.:, l"mvewr the disposal of rood based greases and oils- vegeiabi--Ifruii
heels and seeds; ?;t nes. and food solid such as those Produced by a garbage ciisf.eaal slzou)c4 be mini .cited]. lViet tissue is the --l-fly
gaper that shmiid he discharged into tite yster".:?thcr nom-biodegradable items such as baby w1pes. zarlpons. sanitary napkins
c'ondomis, clgarelte butts. dental floss, and c(,Aw-a swabs should not tinter ttte system. Chemicals such as petroleum, products, paint,
Pa c of J
STAR-7 UP At°iC tj 3 ,'-1Tit'!I~' age _2 . O'
For nevv construction, prior to use of the linen\qS check tre.ari1 ent art (s! c rte presence rji painting products or other chernicals "hat
iuay impede the treatment process andior damage the 6sperbai cei+l s). r- high concentaUOilS are detected have the contents of th
tank(s) removed by a septege servicing operator prior to use
System start UP shall not occur vlrhen soli conditions are fro=eih at the ; !fi€trat!Ve sun re"
During power outages pump tanks may aiii above normal high` Ater ieve s. V'tlhe poIver is restore `he excess wastewater will be
discharged i^, the dispersal cell(s) in one large dose, overloading the ceii(st and may re t!!" in rile baci:U:7 or surface discharge Ji efTi ter f.
To avoid this situation have tole contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the
effluent pump or contact a Piumber or PMAfTS iviaintainer to assist ir. manually; operating the pump controls to restore normal levels
'within the purrip'ark.
Do riot: drive or Qark vehicles eve, antis and dispersal Celjs. Do not drive or parr( over, OF otherwise disturb or campact he area within
5 feet '.1'^.!":', slope of any C? oC'nd o, at-grade soi ai?sorption area.
Reduction or elii-nination of the foljowil lg from `hi %'_'astevvater slyeat , may improve the performance and {prolong the life of the POtf`Ji S,
r`U !oticS, baba `t ipes; cigarette butts, condoms. cotton swabs- degreases i:aj floss; diapers- C lst'lEc'; iaRiS; fat; foundation Chair
,sump pURlD water- fruit and L'eGet2i'idE peelings; gaSQjir?B; grease, hem.
meat SCr2J5, medications oil, painJnq products
pesticides; sanitary napkins; tampons; and +v,,ate, softener brine.
ABA NDONMIENT
When the P01,r11TS faiis and!or is permanently taken out of service €ne follm,ving steps shelf' be taken to insure that the system is properly
and safely abandoned in cons>^itance wth chapter SPS 363.33, "Ahsconsin Administrative Code
All piping to tank and Nits shall be Fsconnec' d and the abandoned ;pipe openings sealed.
C T' he contents of all tanks and pits shali i.e removed and properly disposed of by a Septaae Servicing operator.
aA' ter pumping, all tanks and pits shall be excavated and removed or inch covers corn;oved and the void space filled with soil,
:ravel or another ineit solid material.
CGNTiZUE€E^tr
If tile- Pt' WTS fails and cannot be repaired the `ollotving measures have been, or roust be taken, to provide a code compliant
replacement systern-
C1 A suitable replacement area has beer evaluated and may be utilized for the location of a replacement soil absorption system.
The replacement area should be protected froinl cisi'urbance and compaction and should no be infringed upon by required
setbacks -rorn existing and proposed structure, ii t lines and wells, Failure to protect the replacement area will result in the need
for a new soli and site, evaluation to establish a suiiaSore rep!aceament area. Repiacerrant sySi""erns must comply with the ruies in
enact 2t tth2t time.
A Suitable replace rit area is not avaiable due ` o bac ,,,nd or soil hfi?F a!icn Sc'i( r.g advances in POVVTS technology a
ice! holding tame may be installed as a last resort to replace Erne failed POVITS,
W E lire site has not been evaluated to i`fent!i}s a 5Uitabie replacement area. Upon failure of the # OVVTS as soil ant site evaluation
must be performed to locate a su;.table replacement area. 1f' no replacement aree €s available a holding tank may be Installed as
a !ast resort to replace the failed P01.AffS_
J lUound and at-'.agrade soil absorption systems may be reconstructed in place follovgng removal of the bionlat at isle infiltrative
surface. `reconstructions cf such systems inust comply with the rule:: in effect that time.
<l4VAfR1 1lMG>>
SEPTeG, PUMP AND OTHER TREATMENT TANKS WiAY COiv-Ali+i LETHAL GASSES A.11,01O R INSUFFICIENT OiiYGEr,I. DO wOT
®NITER A SEPTIC, PUMP OR OTHER TREATMENT T.r NK U114DER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
P=RS'ON FROM THE INTERIOR OF A TANK MAY B DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWI S INSTALLER P0147S i'MAJ1t11 s taiiiE'- - - - -
name /dL AQ y Name
Phone ( Phone
SEPTAGE SERVICING OPERATOR (PUMPER', - ~ LOCAL REGULATORY AUTHORITY
idanne ! Na'a e
i Phone Phones j/ _38~ y 8
i
l his document is intended to meet the minimum reol lirements of ch. ePS 3£3221,2)(b){t)(d)&fi) and 383.540), (2) & (3), YLISCOnsin Administrative Cade.
Use or this document does not guarantee the performance of trie POWTS. Rev.(3113)
:I @NSTALLATION
I TRUCTIONS
PLA /-625 FILTER
th o j)Ct r }
i 5 t
I F tr t .
i
,
`9th'
Stec 1: Steer- 2: Step 3:
(A) Locate the outlet r tie sei.Aic iank_ (A) Z~I inslailation, place th J "t i i.iLc ?~ie T,lier Ilr~ 'Sll'~ on iile
(`J) Remove tank, core; and PUMP tarlk filter housing on to the outfe? pipe- outlet nip°.
it necessary- _ ag] , Make sure chat the housing ;B) insert the filter cartridge in the
is positioned so the filter can be iiousir7a, making sure the filter
W x removed frorT) the tank for cartridge is propedy aligned and
mainteriance and skit+l com eteiv insC:f'1fi:J in Lhe housing.
( S i I
j~ 71
r 1 r --s L t x
~6~ ~..•-~_-.mot ,fi. z ' a-^ xni~i~r
Stec 1: Step 2: Ste 3:
Locate the cut!ef of the septic tank, tA) Remove tank cover and pump i, A) insert the filter cartridge back
IT necessary. into the the housing lt,akincu sure
(B) Pull the filter ou. of the housing. the filter is properly alighed
C` Hose off the filter cave! the septic, tank. and completely inserted.
+ f q~ (B) Replace septic tank cover
SF_ R SBER L0V. E Make sure all soiias fall back into the
WHEN, CLEANING FILTER ~ septic tank.
Pelylok, lair 3 f, . r ~r -
203-264.3,514 -i- ~-1% C. 0645-2 1~,~1. - rte: @?r r,,, .~56(: r ax v1W4+L ljNylet_ca.]rr