HomeMy WebLinkAbout030-2028-70-000 (3)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
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 7 TOWN OF SAINT JOSEPH 030-2028-70-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
22.30.20.440F3
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
Dosing Header/Man.
Aeration Dist. Pipe
Holding Bot. System
Final Grade
PUMP/SIPHON INFORMATION
Manufacturer Demand St Cover
GPM
Model Number
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System: UNIT Model Number:
DISTRIBUTION SYSTEM
Header/Manifold Distribution Ix Hole Size rpacing Vent to Air Intake
Pipe(s)
Length Dia Length Dia 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
Bed/Trench Center Bed/Trench Edges Topsoil ❑ Yes ❑ No E Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 1406 HILLTOP RIDGE
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
Plan revision Required? ❑ Yes ❑ No
Use other side for additional information. LLI_ L_
Date Insepctor's Signature Cert. No.
SBD-6710 (R.3/97)
y~/y 45,gr,~.._ c~ o, 7-
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In-Ground Dosed-Gravity Plan PAGE 1 OF 5
Index & Cover Sheet
Component Manuel Design Relbrenr es:
Version 2.0, SBD-10705-P (N.01/01, R. 10/42)
Pg 9 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
Attachrnents: Enclosures:
Pump Curve POWTS Application for Review
Soil Evaluation Report & Site Map
r
St ~ i 1} /v ~lr rProject Name I Description
S1-A)EX
Owner Name(s): j,Phone• _
Owner Address: 'fz~ Vcrr 4`t. ~~t~L,a LS Phone: Project Address: lqbL- fAii C zl ~v ~-ron
Govt. Lot:
1/4 of 1/4, Section , T N-R E ❑vr W
Township: St. County cR01X
Project Parcel 113
Designer Information
Designer Name: X21 Phone: 7i: t;_- - i 7;5"
Designer Address: 2$`f9 7 tV ti r~r~rt ~ (if: iQ)A Zip: ~ y 8"30
E-mail: i ferJ esiqj-1(c-, t)td Oe r °CiNI Thi% -,;Pace rem
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M4 1i
License Number: I - e G 7 C;oi
Remarks:
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Date:
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Eljen GSF System WI Design Program
Date: % Falt Name: ~
l ~ L.G I `t `JlrL77 (.U '~-/%,~'uC aC
Site Address- /"k Oj LCJ0 P A ,&E
~7 -f /-(ZIiU-71`~'
Designer: 14.1-f
'
System Sizing (Total Number of EI)en GSF Modules Required), Design Notes and Comments
1.1 Site Characteristics:
Total Number of Bedrooms 5
DDF per Bedroom (Daily Design Flow per Bedroom) 150 gpd Effluent #1 A gal/ft,
pplication Rate
DDF (Daily Design Flow) 750 gpd Equivalent Effluent q2 Application gal/ft2
Application Rate 1 gaijft2
Required Basal Area (DDF a Application Rate) 750.0 ft 2 v/' ~J~" Tr
Unit Used (Usually B43) B43
Unit Install Width / 6 It
Square Footage per Unit p ^ 24 ft2/unit
1.2 Module Quantity Analysis:
Minimum Number of Ellen GSF Modules Required
k 32 units
Amount of Eljen GSF Modules Used
32 units
1.3 Trench Design:
Number of Trench Rows 2
Trench Width 6 ft
Trench Length 65 ft
Units per Row 16
Total Square Footprint 780 ft`
r -
3ft
6
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65
AL~
- MW
HN 12" [
CLEAN FILL
NATIVE FILL
12" SPECIFI SANG
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rARTArk~r DIVISION OF INDUSTRY SERVICES
PO BOX 7162
MADISON WI 53707-7162
3 D S Contact Through Relay
http://dsps.wi.gov/programs/iruiustry-services
www.wisconsin.gov
Rocs~o~ A'' Scott Walker, Governor
Dave Ross, Secretary
Identification Numbers
September 06, 2016 Transaction ID No. 2673851
Site ID No.
Please refer to troth identification numbers,
above, in all correspondence with the agency.
OUST 1D No. 1319743
JIM KING
ELJEN CORPORATION
125 MCKEE ST
EAST HARTFORD CT 06108
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 08/31/2021
Re: Description: POWTS COMPONENT MANUAL
Manufacturer: ELJEN CORPORATION
Product Name: (trans id 2673851) ELJEN GSF8 IN-GROUND COMPONENT MANUAL
Model Number(s): VER. AUGUST 2016; GSF® MODULES A42 AND B43
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/phptsb-ppalopp/prodcode_res ult.php/POW TSM/POWTS_COM COMPONENT-MANUAL
Approval of this design manual does not constitute approval of individual POWTS designs based on
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.jones ar A.gov
The DSPS is committed to service excellence. Visit our survey at:
www.surveymonkey.com/s/dspsiscustomersatisfaction
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IH DESIGN
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of Z
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner ! _
IBS 5T/y Septic Tank Capacity /,~7 gal ❑ NA
Permit #
Septic Tank Manufacturer (ti i ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer LI J /V l El NA
Number of Bedrooms ❑ NA Effluent Filter Model L_(',: q ❑ NA
Number of Public Facility Units ❑ NA Pump Tank Capacity g ) gal D NA
Estimated flow (average) 5 Cc gal/day Pump Tank Manufacturer ~I ❑ NA
Design flow (peak), (Estimated x 1.5)
I 1
Pump Manufacturer
7 gal/day DNA
Soil Application Rate al/day/ft2 Pump Model `sZ ❑ NA
Standard influent/Effluent Quality Monthly average' Pretreatment Unit DNA
Fats, Oil & Grease (FOG) 530 mg/L ❑ SandlGravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODS) 5220 mg/L )Q NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Guality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BODS) 530 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L R1 NA ❑ At-Grade ❑ Mound
Fecal Coiiform (geometric mean) _<10` cfu/100ml ❑ Drip-Line Other: ~jJ~~! Jar)
Maximum Effluent Particle Size YB in dia. D NA Other: ❑ NA
Other: ❑ NA Other:
❑ NA
Values typical for domestic wastewater and septic tank effluent. Other. ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) { At least once every: 3 ❑ month(s) Year(s) (Maximum 3 years) 13 NA
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: -0 D months{ year(s) (Maximum 3 yews) 0 NA
Clean effluent filter l At least once every: 1 ❑ month(s) p NA
( year(s)
Inspect pump, pump controls & alarm At least once every: D month(s) ❑ NA
f I 13 year(s)
Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA
Other: { 'C year(s)
At least once every; C. month(s)
❑ Year(s) ❑ NA
Other:
❑ 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 (Y3) or more of the tank volume, the entire
contents of the tank shall 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 fitters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 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.
A
s%A,ZK
START UP AND OPERATION Page of 121'
For new construction, prior to use of the POWTS check treatment tankis) for the presence of painting products or other chemicals
that may impede the treatment process and/or damage the dispersal ceft). 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 cells) 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
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 by
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 POWTS
A technology a holding tank may be installed as a last resort to replace the failed POWTS.
T
aluati
be ' e ai e 11RD44Ij5 r7~ FD2- "j6-k/ c NST?ZCTG?1jU> 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 AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER 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 -E► fi t/ _
Phone 5 Name 5 ( Ede (~t-~k1L~ LtA E Phone EZ/ 27-763- 11-f-7
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name
(It Lb~' CHT ~ ( tA&R 1/✓(., EgEt,
. r- LX (_0 V Phone ( - 7U -3 _ '3f) 7 -
This document was drafted in compliance with chapter Comm 83.22(2){b)(3)Id)&(f) and 83.54(1), (2) & (31, Wisconsin Administrative Code.
7
ST. CROIX COUNTY
SEPTIC TANS'. MALNTENANCE AGREEMENT
AND
OWNTER.SHIP CERTIFICATION FORM
O~+QerlP.uyer ~JU, t>T1~1+ 't= S ► tE~`e
Ml_i~ no address _ LA1 z /l~rapt r
Property Address _ f H u L- 41 LLTDP P 1 DC'C--
Nerification required from Planning Zoning Departmnn: for new construction.'
Cit;~iSraZe (~i:~t-T{~?-,) Parcel Identihoation Number
LEGAL DE-SCRfFTIO.N
G v4 . Lc
Property Location t/ , 't, Sec. 02 > T 30 N R i W, Town of f;'t". JD~5z-
Subdivrision Plat: - s Lot 4 1-1
Certified Sun ey ?✓Lap m Volume Page #
NVarranty Deed 4 (before 20r)-Volume ~ Page
Spec house a yes no Lot lines ideminable i~/yes ❑ no
SYSTEM MA.I:'i'TENr~uNCE AND OWNER CERTER CATION
Improper use aa3 maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists &f pumping out the septic tank every three years or sooner, if needed, by a been: d pumper. )A'= you pur into
111e SySWM can &M:ct tffic function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §SPS. 3 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner cgrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
ov,ver and by a master plumber, }owmeyman plumber; restricted plumber or a licensed pumper verif ing that (l) the m-site
wastewawr disposal system is in proper operating condition andior (2) aftu inspection and pumping (itnecessarv the septic tank is
less than 1;3 ful! ofslud_ge.
i'we, the unaersipned have read the above rejui:ements and ag;ree to mainuin the private sewage disposal system with the
standards yet forth, hc.: ein, r : set by the Deparunent of Safety And Pro fm. sional Services and the Dupw =cnt of Natural Resources,
State of Wisconsin. Csr tificarion statin; that your septic system has been maintained must be completed and rearmed to the St. C`ro:x
Cotmry Planning & Zoning Department within 30 days of the three year crpiration date.
1,'we cerrif;, that all statements on,tminis form are true to the best of myrour knowledge. Uwe amla e the owner(s) of the
p, op°rty described above, by virw e of a warranty deed recorded m Reg;rs= of Deeds Office.
Number of bedrooms
r._,
SIGN. L.TRE Or APPLICA.I TT(S) DATE
"'Amy information tl~,at is misrepresented may result in the sanitary permit being revokee by the Planning g Zoning lic-paramem.
include with this application a r';CordGd warranty deed f om the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed,
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