HomeMy WebLinkAbout040-1069-20-100 (3)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No
(ATTACH TO PERMIT) 592238
GENERAL INFORMATION State Plan ID No: w'
Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)] N
Permit Holder's Name: T City Village Township Parcel Tax No:
Greg & Rachel Tschumper TOWN OF TROY 040-1069-20-100
CST BM Elev:
I 1 0, ~Lb Insp. BM Elev: BM Description. Section/Town/Range/Map No:
17.28.19.264A-10
TANK IN ORMATION ELEVATION DATA
TYPE Cpaiii, fvtMVIS1 CAPACITY STATION BS HI FS ELEV.
Septic 1 IN U ^ Benchmark 1~I 10 /00,
Alt. BM V "I
aeSing 1V r) Irv' /
'Opo ean3la oil CI-- 0 4
~iutC
ra ion J to k- Bldg. Sewer
lHoldiD g ~•t'Inlet C~1S $•21 9777
TANK SETBACK INFO AT[ N t t Outlet 4' °17.7&
TANK TO P/L L 13LDG. Vent t n Ike ROAD 44t Ii let
~y
►Ae{ can3 f-r by 3 • `f .S
Septic Dt Bottom
Dosing 4 Header %.151
Aer 'on
Dist. Pipe ~y~ 14~ L4 s Bot. System •CJ
T~ I-
~ ~3q1
Final Grade ql•2/
PUMP/SIPHO TION ( : 9.1 Lo : boa D. /g
Manufa r
Demand ~!T~ Q d,
GPM PM T I~rfGL )Sjjl! •~JZ o~.-I
odel Number 7 93 • $
TDH Lift Friction Loss ystem Head T Ft Valge 00 1-4
Forcemain Lengt Dia. Dist. to Well Vu /ve 0 (J7 , l& '7,
SOIL ABSORPTION SYSTEM IQ 15 /S t
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Di a. Liquid Dept
DIMENSIONS
31 1
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Ty e Of System: I Dd► UNIT Model ber: l
p 4
a
' U i/
DISTRIBUTION SYSTEM A-01 I;m r
Heade o d 7 Distribution x Hole Size Ix Hole Spacing Vent to Air Intake
Pipe(s) ~lI
Length 12 • Dia Length Dia Spacing / IV
SOIL COVER C x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over n Depth Over xx Depth of xx Seeded/Sodde
Bed/Trench C n Bed/Trench Edges / it Topsoil Yes No Yes L] No
JJJJ
COMMENTS: Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 441 MEADOW RIDGE TRIL SDU+-rfl CAA 6-~ _L UA
1.) Alt BM Description = Q n-P " 4 t4er C_*% g11/-yh ag ~1'~ 1 l ~x 1 *
2.) Bldg sewer length = 1 r S s~ "'l~ OVA
- amount of cover ~t,OLC` r
Plan revision Required? [ Yes ~o
Use other side for additional informatn. I~-11 _lu~LwlJ•1 il' -
Date Insepc or's Signature Cert. No.
SBD-6710 (R.3/97)
- o 17 - 4025
Count)
REC t " 1 Safety and Buildings Division St. Croix
s _ 2Ui W. Washington Ave.; P.O. Box 7162 Sanitary Permit Number (to be tilled in b)' Co.)
`t PS Madison, WI 53707-7162
p,
State Transaction Number
Sjitarv Permit Application
In accordance with SPS 383 2101. Wis. Adm. Cote, submission of this form to the appma%"6 Na
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Pmiect Address (if different than mailing address)
1
the Department of Safety and Professional Services. Personal information you provide may be used for secondary,
to oses in accordance with the Privacv Law. s. 15.(14(1 i(n), Slats. w,>
Same
1. Application Information - e Print All Information 11
Property Owner's Name ' Parcel #
Greg & Rachel Tschum er 040-1069-20-100
Property Owners Mailing Address Propert) Location
441 Meadow Ride Trail Govt. Lot
City, State Zip Code Phone Number NE / SW !/a, Section 17
(circle one)
Hudson, Wl 54016 715) 381-2832 1, 28 N, R 19 w
11. Type of Building (check all that apply) Lot #
ms R Subdivision Name
P ' or 2 Family Dwelling - Number of Bedroo 1
Block # CSM Vol. 3, Pte. 625
El Public/Commercial - Describe Use Na
❑ City of
L1 State Owned - Describe Use CSM Number ❑ Village of _
:l G' r Na ~ (ow•n of Troy
III. Type of Permit: (Check only o box on line A. Complete line B if applicable)
A. L1 New "placement System ❑ Treatment/Holding Tank Rcplactxttent Only El Other Modification to Existing System (explain)
System "e
B- ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit 'transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner
180281 issued 10(02;92
IV. Type of POWTS System/Component/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 U Other Dispersal Component (c ) ❑ Pretreatment Device (explain) _
V. Dis rsal/Treat lent Area Inform atio 45 filtrator Quick 4 Standard Plus c mbers & 3 air end caps. PoIN'Lok PL-525 effluent filter
Design Flow (gpd) Design Soil Application Dispersal Area Required (st) Dispersal Arca e (sf) 1"S79M-EN57ion
450.0 Gpd 0.5 Gpd,'Sq. Ft. 900.00 sq. ft. 9 sq. ft. 87.50'
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units ,p o 2
,cO U J -y y J
New Tanks Existing Tanks
s v s ~ ;n i:- :7 a
Septic or Holding Tank 1,000 1,000 1 Weeks Concrete X
Dosing Chamber filter canister Wieser Concrete X
VII. Responsibility tement- 1, the u ersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Signature J f MP/MPRS Number Business Phone Number
James K. Thompson MPRS 30021 (715) 248-7 767
Plumber's Address (Street. City, State, Zip Code)
340 Paulson Lake Lane, Osceola, W1 54020
VII ount /De artment Use Only
/7~~
Cot sued Issui gent Sign e
Approved 1~D'ts ~r Permit Fee D
Ci 4)vw + rven Reason for Denial $ 40 3 f
IX. ConditAlF easons for Disapproval 3) ' f~t~ J
e E m ,1e twt Q 1
uispr rn cell must ail be sL,micas ~
r intG 5 l/ r
as per,, ar.3yement plan P! Co iiderl by plumbei*
2. =AN mbmlt`,k'reci irp±riencs mu t tit i..,7cnt, ir.E.1 f t T~ r 5
as per PKiicnbin coda / rdinanom P
` Attach to complete plans for the system and submit to the County only on paper not less than 8 IR x I 1 inches in size
SBD-6398 (R. I 11)
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Conventional POW'I-S Index & Title Sheet
Project Name: 'I'schumper 3 bedroom Rep] Conventional Dispersal Cell
Owners Name: Greg, Rachel Tschumper
Owner's address: 441 Meadowv Ridge Trail, Hudson. WI 54016
Site address: Same
Proiect Location:
Subdivision: lot 01. CSM Vol. 3. P<7. 625
Leal Description: NEi,4 SW/4, Sec, 17, "1'.28N„ R. 19W., Tn. of Troy. St. Croix Co.. '1.
Parcel 11) 040-1069-20-100
Page I Index and Title Sheet
Page 2 Site Plan
Pare 3 Dispersal Cell Sizing Calculations
Paoe 4 Dispersal Cell Cross Section
Page 5 Infiltrator "Q-4" Chamber Specifications
Page 6 PolvLok PL-525 Effluent Filter Cross Section
Pa,-, e 7 System Management Plan
Pare 8 Septic Tank Maintenance Agreement
Page 9 Certification for Utilization of Existing Septic "hank
page 10 Sertified Survey Map
page I I Warranty Deed
Mater Plumber Restricted Service: James K. Thompson. DSPS Credential X130021
Signature: Date:
Page I Of 1 1
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'#'schtBnmer 3 Bedroom Dispersal ('ell sitiztL Calctilatlotis
E~ C{TC?tlialt 1(i11 <Q1101t5 SCltll~il~C (~Ot Cl ~('l3 E"<iCCi~l1- 4;( li) Gpd t1' swlt lIoNA.
Intiltr itiv e cat>aeit~ of liallt c soil 0, 5' r?x?
:~??so~ptiott az~a zegl6rcc3 9000() s(, II,
to?xloll ttrel as ploposed' 915,60 ~;ti It (45 ch,imbcx5 Imn encl_c;ti7s~ ~
W,111:11or Omck .1 20.00 HSA leer clumber. ?iifl?n-:11"'r Quick 4" encl IF
't C? q_ C11 o.tlt) _ 44 22 chamtm,, rccluirc(I
\unihcr of' trctl,:fws I ~n nloi _t_` I)Ur m2n~, it t-I(~ ch:imb rs totali
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Utfll ~1 (~~Ifl.If }1 i :127t1i "po"Hlt': ? t ~i(~ `2 i>+ 1141..
Soil Absorption System Cross Section
'IL~ ft
~ • c`~ ft
4" Schedule 40 Final Gracie
PVC Vent Pipe
With Vent Cap ft
Leaching
Chamber ft
System Elevation
C(j ft
ft ft
Soil Absorption System Plan View
ft
~ ft
ft Leaching Trench 1
Chambers
4" Dia.
Trench 2 Header
Vent Or Observation Pipe
Trench 3_]
Leaching Chamber Specifications
Manufacturer And Model _ : ~ f_~ E _ ._f :r,,3G=-~✓ ~1fiv~
EISA Rating sq ft per chamber Soil Application Rate gpd/sq ft
i I
god Design Flow Soil Application Rate EISA Chambers
3 rows of chambers each.
Page of
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i1 Of filtpr over H", „10, tank \I,lkt, Surf' Kill "Mr,
s27lltf5 Icil! h,l, k Islet, Se pm tank.
(ti>C'itit~e!iltc~itt2i'r 'bmkilloWe WrAnginakuq,'
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WAi ngko"d t. 1 1 `.ci:'
Conventional Septic System Management Plan
Pursuant to SPS 383.54. Wis. Adm. Code
General
The conventional septic system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall be maintained
in accordance with component manual SBD-10705-P (N.0I'O I All local and/or state rules pertaining to system
maintenance and maintenance reporting shall be complied with. Questions on the operation or maintenance of the system
should be directed to the installinl-I plumber. Jim Thompson at (715) 248-7767 or the St. Croix County Zoning Department at
(715) 386-4680.
Septic Tank
Septic tank servicing mechanics comply with SPS 383.54(1)(e). Septic tank to be located within 150' of service pad. with
bottom of tank to be < 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be
assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in
the tank exceed 1 /3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR
113, Wis. Adm. Code. by an individual certified to set-vice septic tanks under s. 281.48. Stats. If the contents of the tank are
not removed at the time of a biannual assessment. maintenance personnel shall advise the owner of when service will be
needed to maintain less than 1'3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to
ensure proper operation. The Filter cartridge should not be removed unless provisions are made to retain solids in the tank
that may slou.zh off the filter whetl removed from its enclosure. If the filter is equipped with an alarm, the filter shall be
serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water
tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of
service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater
than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank.
No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank
abandonment shall be in accordance with Conun83.33, Wis. Adm. Code when the tank is no longer used as a POWTS
component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If
such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings
Division.
Soil Absorption Cell
Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should
be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for
vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface
within and above the system and will promote frost penetration during cold weather months. Cold weather installations
(October-March) dictate that the system be heavily mulched for frost protection.
Influent quality into the system may not exceed 220ml(,1, 1301)5, 150 N1G'L TSS, and 30 mg/L FOG. Influent flow may not
exceed maximum design flow specified in the permit for the installation.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Pondin- levels shall be reported to the
owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring.
Effluent flow shall be alternated between dispersal cells on a two-year schedule by use of diversion valve. Effluent to
be diverted from new cell to old drainfield at 4 year anniversary ofnew system installation. Old drainfield to be utilized for a
2 year period. Effluent dispersal to be alternated between systems on a two year rotating basis thereafter.
Continp_ency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition. Fxcessive ponding within the dispersal cell will be eliminated by installing a new soil
absorption cell to bring the system into proper- operating condition.
P=,. 7 of I 1
SLI'TI( TANK NIAl', I L V\, ,C E ;\(jRL FAILNT
.N
O NL.R`J HP ( ER FWATUN FORM
Ci"ne-r'Buvet Greg Rachel TsChC. mr)er
NLliling,,Addross 441 ~fl d0~rv Ridge Trail
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I'lopert~ Locatimi . `sec r w' It Q lo" n of
SAN &on I=iat hNa Lot # 01
Certiiied survey Map # a ~~c;lttl~i~ 3 825
%I arranf Deed 0 083357 (hokre 20 7)Volume 1558 11"we ~ 100
N[)(}NNNERCERTIF ffi1':VI10N
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.~,..,.1, "el 1.ofih, Iiclcill the Depaltmenl of Stifcl", And Pnde~,ni nr.tl Se1~ICcs and the Dcp<utment ol' Naturd kcnources.
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i, I'I ]t Iili;' /"Id l il ItSit t\ iihil ~Q lix,, 5 UI the On ,,C A wa! wXpil ttion dalC-
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clc,c-rlhc`cl atxo;C~u-tea tl a v,rrani•c clCed reCi>rdcd in 1'wI~oster o1~I3ec:4-I: Olttee.
-°-t 3
i3190 C (d bed [`001
/ 2 07 17
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ltlloi-nf non out h mmvp7Cmute I niax r"'tsi m the q ilt2li`. Ivinvl Wing rC oked 10 lit I'Iffiling &.0my Dyartl?1cm.
r biviC "IT this app(ie mum a rec mied ttwinanq decd Van the l:cyann o Dmk t We mW a copt~ Q w cer&hd >ur`v, mate if
w!,erwnce f, made in tIle 1nil-rant decd.
';l
FO I."TIIAl.AAW OF EXISTING SEPTICTANK(S)
AS iS 1 =tilt ti1a.1 I IMC 111`.I)eOUL11h )itl ~C'()ilt <lnctr;}I_ {dt).`ka 1i111K
j)icsontly serving the following residence:
;`n et address} 44 i eauo vv Ridge Trail, Hudson. VVI51 {{-)u<itetl
at: PJE sw f . ``;ecti«rr own 8 fZarrge 19- -IVN 1'o~Gin of T"O St. Croix County Wisconsin.
Clion insl)ectiorr. I cen (y' that I I143ve I-ound the tank(s), to the best of illy
knowledge. will conform to the requirements of SPS. 38415. mul it (dw )
Ippeav(s) to be finictionin`, properly.
Mtkt rum (lCltt; o in )e~I Ion or sere ice ~`'71u try; x)17
DA! iicm howk O+4ut) from Mm't>tiC311 n4'stan? Yen 0
i iilo. skit) nc:m line. i
late %oinnie oI. le)lt,rth of nill «'a ~,~allorrs Na Ininntes
Ank Capacil . 1.OC70 gallon-.
Qmsu nc6on: Prefal) C"oncrete x Steel Other
Manufacturer (if known y Ne<ks Concrete {
Age Wink Of knownh 2 Years nsiasle~ 1~IOb;a2
I'mmit number (ifknONVII) 11§81
James K. ,
_ Cam' ~i t
ed Hull-4)er ~i~7n`4ltnre'~ (Print \nme)
WARS z,.„)~ r.
l it 1c.ense \t inkier) MP MPRS
t' i )site i
1 orm to be conWleted by ]lensed 1-1mber (Dept of Salety and Professional
`services Chapter 305 and s. 145.06. \Visconshi tatntes) or licensed disposer
K R I K Wiscc)nsh Administrant e Code
ACA. is} I ?
74 ) -5
Page 1 of 3
X Wisconsi d Professional Services - - ^
Division c iK
gp NB7FXP8KB4MHR
SEP 14 2016
In accordance with SPS 385, Wis. Adm. Code County
Attach com I St. Croix
p ~r6W~t les han 8 1/2 x 11 inches in size. Plan must include,
but not limy'~I'~is DipifflOPMEWrence point (BM), direction and percent slope, Parcel I.D.
scale or is, north arrow, and location and distance to nearest road. 040-1069-20-100 Ref#2446
Please print all information. Revie by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). ~L L7 1
Property Owner Property Location ❑
Greg & Rachel Tschumper Govt. Lot NE % SW % S 17 T 28 R 19 E (or W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
441 Meadow Ridge Tr. 01 na CSM Vol. 3, P g. 625
City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road
Hudson WI 54016 715) 381-2832 Troy East Cove Rd.
❑ New Construction Use: ❑ Residential/ Number of bedrooms 3 Code derived design flow rate 450 GPD
® Replacement ent ❑ Public or commercial - Describe:
Parent material Glacial Outwash Flood Plan elevation if applicable na ft.
General comments and recommendations: Site suitable for In-ground POWTS with 0.5 gpd/sq/ft. design loading rate. Recommeded system infiltrative surface
elevaton = 88.50'& 87.50'.
1❑ Boring # ❑ Boring
® Pit Ground surface elev. 93.40 ft. Depth to limiting factor >88" in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2
In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh.
*Eff#1 *Eff#2
1 0-9 10yr3/2 none sil 2fgr mvfr gs 2fm1c 0.6 0.8
2 9-16 7.5yr4/4 none sicl 1 fsbk mfr gs 3fmc 0.2 0.3
3 16-23 10yr4/4 none sil 2fsbk dsh gs 2fmc 0.6 0.8
4 23-29 7.5yr4/6 none gr Ifs Osg dl cw 2vf,fm 0.5 1.0
5 29-48 10yr4/6 none gr s Osg dl cw 0.7 1.6
6 48-72 10yr5/4 none gr s 0sg dl aw 0.7 1.6
7 72-88 10yr7/2 none fs Osg dl 0.5 1.0
2❑ Boring # ❑ Boring
® Pit Ground surface elev. 91.62 ft. Depth to limiting factor >91" in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2
In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh.
*Eff#1 *Eff#2
1 0-19 10yr3/2 none sil 2fgr mvfr cs 3fmc 0.6 0.8
2 19-34 7.5yr4/4 none sicl 1 msbk mvfr gs 2fl me 0.2 0.3
3 34-69 7.5yr4/6 none Ifs Osg dl gw 1 vf,fm 0.5 1.0
4 69-91 10yr5/4 none fs Osg dl 0.5 1.0
h
* Effluent #1 = BOD, > 30s 220 m L and TSS > 0 150 m /L flue W2=BO , > 30 220 m /L and TSS > 30:5 150 !Qg/Lj
CST Name (Please Print) Signa re CST Number
James K. Thompson Or- 30021
Address Date Evaluation Conducted Telephone Number
340 Paulson Lake Lane, Osceola, WI 54020-5413 Au ust 8, 2016 (715) 248-7767
SBD-8330 (R04115)
~Boring # F-1 Boring
® Pit Ground surface elev. 91.08 ft. Depth to limiting factor 84" in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2
In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-11 1Oyr3/2 none sil 2fgr mvfr cs 3fmc 0.6 0.8
2 11-20 1Oyr3/4 none sil 2fsbk mvfr gw 2fmc 0.6 0.8
3 20-25 7.5yr4/4 none sicl 1 msbk mfr cw l fm 0.2 0.3
4 25-44 7.5yr4/6 none gr Is Osg dl gs 1 vf,f 0.7 1.6
5 4484 1 Ory4/6 none gr s Osg dl gs - 0.7 1.6
6 84-90 1 Ory712 c2p 7.5yr5/8 fs Osg dl 0.5 1.0
kill,
1
4❑ Boring # E:1 Boring
® Pit Ground surface 2fev. 91.29 ft. -6ept to limiting factor >89" in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2
In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-10 1Oyr3/2 none sil 2fgr mvfr cs 3fmc 0.6 0.8
2 10-21 1Oyr4/4 none sil 2fsbk mvfr cs 3fmc 0.6 0.8
3 21-30 7.5yr4/4 none sicl 1 fsbk mfr aw 2fm1 c 0.2 0.3
4 30-55 7.5yr4/6 none Ifs Osg dl cw 1 fm 0.5 1.0
5 55-73 1 Oyr4/6 none gr s Osg dl ci 0.7 1.6
6 73-89 1Oyr7/2 none fs Osg dl r 0.5 1.0
t i
,d
iBoring # El Boring 31'~
❑
❑ Pit Ground surface elev. ft. D th to limiting factor in.
Soil Application Rate
Horizon Depth 1 Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ftz
In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
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