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HomeMy WebLinkAbout032-2169-11-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No (ATTACH TO PERMIT) 600219 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 age Township Parcel Tax No: Joseph & Melissa Bell TOWN OF SOMERSET 032-2169-11-000 CST BM Elev: Insp. BM Elev: BM scription. Section/Town/Range/Map No: r 18.30.19.1437 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER 1 CAPACITY STATION BS HI FS ELEV., Septic Benchmark 3 il/ G D Alt. BM 7 ra ion Bldg. Sewer 62 -~7 olding t Inlet t Outlet TANK SETBACK INFORMATION 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 I Final Grade 2 PUMP/SIPHON INFORMATION 1, Manufacturer errand St Cover r / GPM •!4 ~i Model Number TDH Lift Friction Loss System Head TDH Ft n O Forcemain Length Dia. Dist. to Well f SOIL ABSORPTION SYSTEM 171 BED/TRENCH Width ] Leng h' To. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 1 D / -/ice SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR fY1//G j' Type Of System: ;g 1 UNIT Model-Number: DISTRIBUTION SYSTEM Header/Manifold Distribution ix Hole Size x Hole Spacing 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 `s Topsoil Yes No Yes L~.No COMMENT : (Include code discrepencies, persons present, etc.) Inspection #1: WV/7017 Inspection #2: 1 i Location: 323 153RD AVE 0}~ -pl„~n LI~AO 1.) Alt BM Description Cover i t (VG/~ 7 , I`L k l~ 2.) Bldg sewer length = I 1~S~u/lahvn, V - amount of cover b p/7/ 7 hd l PS 4 properly l t'nL s on oil I cove I Plan revision Required? ❑ Yes ❑ No Use other side for additional information. _ SBD-6710 (R.3/97) Date Insepctors Signature Wp~ I Cert. No. A Al, L- 4-6 v 2 ~ T L r 7V - 73 v ~ k I ~ t cc//~~ f V1 L \ E I ~ ~ I 'I E ( 7 i I ' V CN Zqr { E'T CA. N LA, r, p T, ' i; Tr ! C SAiv -do 7 - 337 SW* WW BuMW DIA411M Y, 99 Ve'' Ct 201 W. VVM8hkVWn Ave., P.O Box 7162 S=kwyPwm*XmGber(lobe ,t~ed byCo-) 6~w MOCIS rt, W1 53707-7162 1 Ug2WO Ita- t _ _ State T l+h~bar an ac m ce t x was. Ada 1 W C M V 17 M R8 E32W nw uwt N is rnqu mWd g a samft yr permit ]`lose. App' gftd w Prtdeat Add Of tbae moms ate ft Depumniew of Sday told Profesaioaat servies. Pasty............,.. ae usoa oar secandwy , 1 m Ste& z RIUM j2 naooordes{ae with the Law S. 15.04 .A lies IMforseataoa - Mm Print AN lztriormat ion 3 1310-L& Pr0urty0eraars 1 Amreu • 3 t~, i q. r r0 136' f mot. Lx city. Soft zip Cade PlKme NadOa 5C-- S4, Saaisa II. Type of (cbs& an apply) Lot / 2 Family Dwelling- Number of B Subdivision Name edropms rrr/// Block tl PublirlCwmaneaaiel - D= %v vas t/ 5V i City rW) St lo<\S I ® of 0 &M OvoW - Destm-be Use CSM Number Q Viliagc Of 3 VIST1216VMN CELLS W ~ J`j fi lq-~ (84) -2 2 COI &T""f S~ Nib r LT IIL oaiy am box as &a A. Ceaapiale h B # a bkj Neer S ❑ Repieaemgai ❑ Tr~tiies Tmdc Repiao t oaly D Od= Mos Cio to EdOdOg SYWM (eapk a• 80a6oPa=it Rmuwal ar 0 Permit Revision 0 C bmp of Piw dw ~ Transfer to Naw Lin PMvima Peemit Number and Doe howd y In~i'Ifi'r 7~' om naret/~evico: cbeck sit that a I d . Nloa-Preasut zad la-Ground Pre~ b-Citound D At-Grog ❑ Mouad ? 24 is of miuble soil [7 Mound < 24 ia. of suit bk sail of ft Tack C}s>>ar Dispersal O=pom w (cglaia) ❑ Prcorabnettt D ice (cow) ~l ea c L~'1 V. &kRSMn__reatp&t Area hifornation: L 4~ t DeApFlov Demp ~ Soil D' Art a Req (st) Dispe~.al Od) Synew mavotion -7 sls-'(f ) 7 7, e, - # of Va. Tank bb t masts UW% Nar Ttria 7attim ~t'/•T-C '4 Y Septic or HoWbe 1> DoiKGlamLar, ~ ,r VM onsib SbdOMemt• $ the and ed, non=e ras ndbtlrty f lotion of the &'O1VT5 attached plans pho2ws Nmnr {Print) 's S. cotilve RS bet $usiaaaa Priaae Nmaba Flurnbw $ Address f Street, Oty Siaa, Zip Cork) PG. s t~S ki;~,, r S J VIII. Cams errt Ilse O Famdtlac Dale S y85. to 0171 M 1 Room Ow Adt h'VAS In t IV 26 - o5Z Are , n .-geCf 1. Septic tank effluent filter and Ca I i A dispersal cell must be s„rvicr;d I maintained -f" 1'lIS pPrMt4 ~ ~QOS On .COn•hZ/ f"O/ / as per management plan provided bi plumber. 2. All setback requirements must be maintained r a licable code/ordinances. AtMai M piles ter tN teataet aei sabadt to tM tsaew stdy as IrNar tart Nss hose 8 iR n 11 eta ie alp I SBD-6398 (IL 11111) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: - 66_5%}A U Owner's Name: S f~ N\ C_ Owner's Address L AKG K\tZ M Legal Description: Township: County: Subdivision Name: dCj v~t Lot Number: Parcel ID Number: Z 16q c) 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 Warrant Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans 7 Designer/Plumber: License Number: AAPiZ~ l~ `1 tzy Date: lo I-t/-- Phone Number q 1 J~`jC1 Signature / s Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01101). Page 1 { N W z -41 /l a OA c~ 22 7j l~ r lop' ft d° Sdoduk 40 Final Graxle PVC Vent Poe ft Ff~Nt vent Gas p teaching Chamber ! ft system Ekrmuw I `l j. -~L_ ft r~ ft ®1 A Bay ft S ~ Leaching > French i 7vwt or 1 CtOM 4° ice. Trench 2 Header hi A e1= Man rer And Modaij Q +\M x y mss g 1_ C sq ft par c mber $oil Application Rate . gpoleq ft 9 Flaw + , / n i _ ~ (1) EIISA Chambem j 2 roves of I S chambers each. ✓ caQS S tP ti ~ Page of lu ' I - 1 installation and iviairILtIIci M _t ;«LI Ucliu, is 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 fitter 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 fiher 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: mike(a)lifetimefilterlic.com Phone: 502-7242231 WLP1250-MR 1201" TANK SPECIFICATIONS 0 DIMENSIONS: WALL: 2 1/2" BOTTOM: SEPTIC 3" 0 COVER: 5" z MANHOLE: 24" I.D. PRECAST CONCRETE RISER w HEIGHT: 52 112" O.D. ~yQ LENGTH: 120 1/4" O.D. WIDTH: 84° O.D. m`LN BELOW INLET: 41" 0. D. LIQUID LEVEL: 36" °o 1 WEIGHT: 8,810 LBS. INLET AND OUTLET: N \ , \ FILTER 4" CAST-A-SEAL BOOT OR EQUAL m a OR GASKET, CAST-A-SEAL BOOT OR EQUAL J 3 3 BAFFLE INLET AND OUTLET BAFFLE AND FILTER: o a WISCONSIN, SEE DETAIL X10 (OTHER STATES SEE CHART) Lai o LIQUID CAPACITY: 34.81 GAL/IN W TOP VIEW HOLDING TANK: G~.1 x Ln OUTLET HOLE PLUGGED ACTUAL CAPACITY: 1,253 GALLONS C o co LOADING DESIGN: 8' 0" UNSATURATED SOIL v w N MN TANKS: WILL HAVE ONE VENT OVER OUTLET W o AND WILL HAVE TWO VENTS IN COVER OVER INLET co W_ TANK CAN BE USED AS: 3 I - - - - SEPTIC/ HOLDING/ PUMP OR SIPHON 4" INLET 4" OUTLET J co ~N Q O N O Z (V 2}" o a CUSTOMIZED TANKS: m Z TANKS CAN BE CUSTOMIZED CONTACT WIESER CONCRETE N U IL F - j w w N of SIDE VIEW SHEET NO. 0 TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS of 0 - IOWTS 0 'S MANUAL A (D MANAGXbMff PLAN SYST614t cnTtor~ NA Fait # TU& mansamm L z NA Ghi ~'A1tAY CR9 Efl'laeat Fiber iRii L 1 L NA 100 ❑ 14A hM T Fear NA Nw~sber ms DNA Nm dwl of Canzaamw 1awft NA NA Bidusaad flow ( Uda Taa120 T~~ rtA flow (peakl asdamad x 1.5° da Pump M1 9oi! 1 unit firlA Zia ElBnemt QualBjr 1(NAQ) s Y Ate" ❑ Sandl kwd E+&w p Pent FWer Fats. Oil & Ot a m p (P'CX)) 5 30 nUIL p Meolnenicsl Aax VAM Q W4fimd $oa ~ SOOB& ( S 220 ml#L C3 Didnflwdm C3 Admaot8ate+er. Wwd§L. S 250 =WL Disp I CONS) plill a rdlueat Quality ❑ Mary AVU20 mm W (~vity) a Bkmbmdcd ool OXYVm ~ Sonde s) S 30 mg/L. C3 At > 'f (TSS) 06111111 Fein Colifam • mean) S 30 mg/L 4mmam _ go rfu1104m l ❑ Mamm~id~at ' it- c K ti plu5 tmbeC Effiermt Peatlc:la Sian US iaclt dianoetet Modal ~ *®V Flow Verification ud Calcubtiom- Sail Apglication Fkao ' 7 A= (O& w rim ba&mom b md) z in5lultv umber of '~l. ID ltaae~ min, i 8 a1I matea~aia mauat eoaply wide Wt l4rrtr. a~ Vd= typical for dameatlc (aomyo I m Waft and septic Oink afllaemL X84 and ba immWed pR * **vd oes typicd for ggmremd rjg~. and g2pvsi k* m p aWismcimb Atocade Sant Absoqftn Sys Sift Design & Coamwdm Mmur (CONVO a et a1.19" ❑ -Wbaamin Mound SaQ Abimpbom, Syseam: Sif& Des* & CauMmadan Maum r C~mcvm"4 I.C:. and B.L Ww- PubUtsdan 15.22 C) "Dasip o}' Neatwoft fnr Septic Tmk-Soil A'bmpd m 5yaeem6" P"cmbuw 9.6 ❑ MWp of Conv Soil on Timbes and Beet". R.J. Otis - A, Publicetiaas S•77 amd "POOP Mumma Omata ',[VWmBt and Dbpoul EPA 6WI-9"12 October 1980 Q SBD -10570-P (ILfi") "At-Cks& U*g Pmmm I3istn'ba iW (SBD tOW7-[e (-6199} na Coxmd AWoqWm CComponent Mmmr ❑ 3813 -10705-P (H.Ot/dl) "Iu Gmmd"Absocprm Companal Mmmr Vemeiam 2.0 13 SBD - IOM4 (N.6199) Meci addin8 Sand Hines' Sydsm C,ampaaemt Mam or C3 SOD - lo656-P (N.&") "Split Bed Reaiacubft Saud PHW System Cfompoamt IMP' . C3 SBD • 10572-' (8.8199) "Mound Comet Moor Vextdan2.0 ❑ SU -10691-P (14.01111) "Mound Canapo~t ❑ SBD -1059 {.11.4 97 -Sh& Pass Sod FHW CaMOOM Mm ml" ® SBD . IO&V--P (jL6 s)' C3 SBD -10573-P (P. 6199) "Itawwre Dimbution Verdan s^.11 L7 SBD -10706-P (NAIADI) ❑ Ddp4im EfflOaot Mm and fan Mnalttr 60 Omios'W"WwaW Tm"m" MAINMA NCS AND MANAGEMENT MAUffZNANCZ I~~ltMTORING so-vin 801*0 P=W ae immrae3 s- oa him of tam s At Ifest on A I Qm codmb of a When god 3 ta. 9 L- a ` At last am s At km am nwn*s 13 at acm~L dE alretm At least esnem 1.1 p s 1+iA Q in Flmh Taub =d g"m tad At amaze , 61 vamirto NA At 1rt..e a wva~er t'1 moaft Q Vac(s) JL,L 13, 2017 1.31) PM St Ci Co God Center No. 4490 P. 11 START UP AND OPEIiATfOlif` ' j ' Pse•c„ of For new construction. prior to use of the pOWT8 chock treatment tonklal for the orssenoe of painting products of o*W ohirnioa that may impede the trestowt pMOM and/or damsels the dispersal celNai, If high eanosntrations ere detected have the content of the tankisl removed by a aeptege servkning operator prior to use. Sefaterrf ataWt up snail not oeetrr wnerr acli conditions are frozen at the infiltrative suffaae, curing power outages pump tanks may fill above normal highw6tar levels. When power is resters, the 4tteeap wastewa discharged to the df6pensai ii In 01% large doss, overloading the ooiilsi and may raWt in, the backup or awfeoeWdisohterar"WIN c b atfhieitt. To erokf• this el<uatlon here *wcoments of the pump tank !moved by a Sapefga INerVWq op wow price to Moto* power to the eNlufNtt pump or tiontsot a Ptumbar or POWTS McWelner to resist in manU* opera ft the pump Controls t restore neMa1 levels within this pump tank, 00 not dttvs or park vehicles over.tanks and dlspereai•calls. Do not drive or park over, or-otherwlss, uisturb a aampspt, the are within 16 test down 61008 of any mound or. at-grade soil absorption ores, Ftsducftn Or elimination of the following from the wastewater strearn may improve the pertormanoe and prolong the life of th, POWTS- antiblotlCs,' baby V11i_.0198rstte butts,' condoms; cotton swabs; dooresssrs; dental floss; diapers; disinfectants; fat foundation drain lsump pump( water; fruit and vegetable peaiktge; gasoline; grease; herbicidai rni scraps;- medications; oil painting products; pestlcldas; sanitary napkins; tampons; and water softener brin - tRANiaONMENT whoa the POWTS faNi and/or Is permanently taken out of service the following steps shall be taken to Insure that the system i,, properly and aefaiv abandoned in compliance with chapter Comm 83.33. Wisconsin Administrative Codet • All plping to tank, find pits chap be disconnected and the abandoned pipe openings esslis • The contents of alltanks and pits shell be removed and properly disposed of by a Bei $ervibing Operator. After pumpini -all tanks and pits shall be excavated "removed or their coven removed and the Vold apace feted with soil, gravel or ona er inert solid material. "ONTIN©ENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant repfacement systems A suitable replscermen't'.brea has been evaluated and may be tltlllzsd for the location of a replacement sop absorption system. The replacement area should be protected from disturbance and compaotiorl and should not ba Mfli'li-Am by required setbacks from existing and proposed structure, lot lines and walls. Failure to protect the rbplooonwt►t area will result in the need for a new solf and site evaluation to establish a suitable replacement was. Replacernont systems must comply with the rules In effect at that time. ® A suitable replacement area • la not available due to setback and/or soil limitatione. Buying advances M POWYS I chnology a holding tank may 4Installed as a at resort to replace the failed POWTS.- aK a nqt•~ssrt • svskfittod to,10ontify a e stable n lai ,sings. Upon furs of t~la S e an is e at be\perfonned~ to fora}e a 9ultabl Ie ed an p 'lea r8 jq aN~. it nooplyrten lairs is a k o~ta p ever the faNyd'PO ; `SCI Mound aft, at-grade lf absorption systems may be reconstructed In space following removal of the bicmat at the infiltrative surface, Reconstructions of such systems must comply with the rules In offset at that Ume. <WARVING> > SEPTIC, PUIN AND OTifER TREATMENT TANU MAY CONTAIN LETHAL OASSlES ANDtOR NUUFFiClipiiT OXYGEN, DO NOT ENTER A SOnV, PUMP OR GTiiIR TWTMENT TANK uneft ANY CiRCUMtTAii ft!lATN MAY RULILT. RNSCUE OF A PERSON FROM 11~IE INTUIOR Of A TANK MAY ~ wF'iCuu OR Efltpt?SBIBa, (30ITION AI, OMM e' aWTB iNS'T ,t@'; . -•r„ POWTS MAINTADI N Name Phone (5, 401 Phone i'T+40E V/CENQ QPLrRAt' ) LOCAL R TORY Name a.• ti Evame pftane -it document was drsfteKfirt sonpNenaew1 afw, of Comm 83,2212NblitlfoAtfi and 83,5410,121 his), VYia06ndAAdadnisvatWs Leda, ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address (Verification required from Planning & Zoning Department for new construction.) City/State Sw G:'~ ~ Parcel Identification Number Z B - - ("~i 4~~ G LEGAL DESCRIPTION Property Location 1/4 1/4 Sec. T J6 N R/16 W, Town of 52r'J, r Subdivision Plat:u N~ X 't c Lot # Certified Survey Map # .L , Volume Page / Warranty Deed # j ' > (before 2007)Volume Page # Spec house ❑yelAo Lot lines identifiable es❑no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that aft statements on thi form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a wa anty deed recorded in Register of Deeds Office. Numcl?ro bedroo 13117 NATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) I i mF Ap~ g E 3~ r I E - s ~ s " ~ ~sm, z s o I ~l iz o X12 i o to ~ t {o z I ~ Id 3r I m r p n m } e R' I Ic _ ~ ~i4 I I- I -n ED: - 3 N z8 le x'"° v- I 9 a 9 T~ - 4\~ I I g~~ is to ~I ~ I I I t = I~ 1- _ .i e - - I I. 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