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HomeMy WebLinkAbout036-1093-90-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) State Plan I D No: 600304 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 Royal Credit Union TOWN OF STANTON 036-1093-90-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: ja,,~, o S,roQ,' 36.31.17.5658 TANK INFORMATION ELEVATION DANA TYPE MANUFACTURER s CAPACITY STATION BS HI FS ELEV. A Be ch rk e Z l~ alce~ M~v _ U 44 Dosing Alt. BM Aeration Bldg. Sewer Holding SUHt Inlet el 71 St/Ht Outlet TANK SETBACK INFORMATION TANK TO /L WELL BLDG. Cent t Air Intake ROAD Dt Inlet bC ~ Dt Bottom Septic ! jr_ 51 to to Dosing _ Header/Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St over ` GPM Mr C►8 J ~ ~ d Z, G Model er TDH Li Friction Loss System H 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 SYS M TO P/L BLDG ELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System - UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution Ix Hole Size ix Hole Spacing IVen o Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only oJ~~ Depth Over TBed/Trench Over xx Depth of Seeded/Sodded Mulched Bed/Trenh Center Edges Topsoil - Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1945 HWY 64 Q y~ 0ce, f A-- ~ /t1 O n 1.) Alt BM Description = d~ p ~G a'i~Ga y► Y~~ 2.) Bldg sewer length = - amount of cover = Q Plan revision Required? n Yes J{~ No Use other side for additional information. 7 ~Z Z , - ll SBD-6710 (R.3/97) Date Insepc 's Stature Cert. No. cJ County 4L ety and Buildings Division t 01 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) 2 a r f. Madison, W1 53707-7162 UN SID J, Stale In accordance with SPS 383.21(2), V,ris, , submission of this form to the appropriate governmental unit t Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) required prior to obtaining w a Privacy Law, the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance ce with th the e Privacy s. 15.04{1 m), Stats. I Application Information - Please Print A11 Information Property Owner's Name Parcel # Property Owner's M ling Address Property Location !1) 31 7 5 (ps 2-00 1 0 ~ T ~CC. CQ--. Govt Lot ) City State Zip Code Phone Number ;.~,tJ Y. Section ~ , I lc on T N; R E W II. Type of Building (check all that apply Lot 1 or 2 Family Dwelling -Number of Bedro Subdivision Name Block # ❑ Public/Commercial - Describe Use ❑ City of CSM Number ❑ Village of ❑ State Owned -Describe Use .4.,~ 1044- L Town of III. Type of Permit: (Check only one box on ne A. Complete line B if applicable) J p'' ( Wew System 726eplcernent System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System (expi O l'1 List Previous Permit Number and Date Issued B. El Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS Svstem/Com onent/Device: Check all that apply)..-_ El Non- sunzed In-Ground El Pressurized In-Ground El At-Grade ~ Mound > 24 in. of suitable soil 11 Mound < 24 in. of suitable soil olding Tank ❑ er Dispersal Component (explain) ❑ Pretreatment Device (explain) at t Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) I Dispersal Area Proposed (sf) System Elevation Total auufactur VI. Tank Info Capacity in # of M :r Gallons Gallons Units s 2 rj ( Al New Tanks Existing Tanks ^ ° o a. o U V5 ~ E,'5 C7 EnC or Holding Tank i hamber VII. Responsibility Statement- 1, the undersigned, assume risibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's " - MP/NTRS Number Business Phone Number Plumber's Address (Street, City, State, Z' e) VIII. ountv/De artin at Use Only Issuing entSignat Permit Fee Date su417 Approved El i ~ .1 Z er en Reason b ,D enial DL Conditi ns of ApprovaVReasons for Disappror b(1 ~ 4 Joe, Ia aD d. 2.) Z3 - z J% c ei~~ (:;aaz4~ ( J djtA- Attaco late plx~ r the and so if to the Cowry Ip on paper ` less than S 12111 inches in size 53 3~ f-Ea(~t ~ i~ a: 7 Z5 je . 5 SBD-6398 (R. 11/11) System PLOT PLAN PROJECT Roval Credit Union ADDRESS 200 Riverfront Terrace Eau Claire Wi 54703 NE 1/4 NW 1/4S 25 /T 31 N/R 17 W TOWN Stanton COUNTY ST. CROIX SYSTEM ELEVATION TBD DATE 12/15/17 BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK XXX MOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 3000 LOAD RATE ABSORPTION AREA # of chambers BENCHMARK V.R.P. Top of well ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark 165' Highway 64 Driveway 60' T M. * >25' 8' 4-4° e 5 30' 60' >25% Slope Septic tank and drywell are >25% Slope Existing 3 to be collapsed and burned Bedrooom House No area for testing, site is only IF IF suitable for a holding tank Property Line Area of flood plain, as determined by house to the east when that system was installed Willow River Property Line Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 12/17/17 Owner: Royal Credit Union Location: NE1/4 NW1/4 S25 T31 N,R17W 1945 Hwy 64 Stanton System type: Holding Tank Manuals Used: Holding Tank Component Manual Version 1.0 Page# 1. Cover Page 2. Holding Tank Plot Plan 3. Holding Tank Cross Section 4. Maintance and C' ntingency Plan 5. Holding Tank an ring sheet Signature / r' 226900 License num6 System PLOT PLAN PROJECT Roval Credit Union ADDRESS 200 Riverfront Terrace Eau Claire Wi 54703 NE 1/4 NW 1/4s 25 /T 31 N/R 17 W TOWN Stanton COUNTY ST. CROIX SYSTEM ELEVATION TBD DATE 12/15/17 BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK X00< r MOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 3000 LOAD RATE ABSORPTION AREA # of chambers BENCHMARK V.R.P. Top of well ASSUME ELEVATION loo' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark 165' Highway 64 Driveway 60' ? T M. * >25' 1 L_ 8' 5' We 40' 3 0' T ~A 60' 10 41 >25% Slope Septic tank and drywell are >25% Slope Existing 3 to be collapsed and burried Bedrooom House No area for testing, site is only suitable for a holding tank Property Line Area of flood plain, as determined by house to the east when that system was installed Willow River Willow Property Line Single Holding Tank Cross Section and Plan View Plan View > a } > > } a > > s r : s > > s > > a > a > > > a a s s > > : a Y > > > > > > a s s > > > > > a > > : Y Y s > > > s y i 2{{{ S< c i i{ S< S{{ i t t L t< C i i i i{{{{{< f c{ i S;; S i; i i;< L S{ i i i>{ a y > S } < < t Typical t y< 24" I.D. s!s Inlet Manhole Vent Pipe Y L Opening <s t { ci yi y y S>S s } 44 s < ~i t>t tyt S i S > } < > i y ! S Y Y S S}> a Y Y Y>! S!>}}! Y Y> S Y Y!!> S S S S S S Y> Y Y Y>>! S!> a 3} Y S S Y>> S!<! i t t;{{{ i S t<<< t i{ L i t t t<<< C L L L{{ t t< i i t< L L t{ i t<<<<<<<< i<<< i{ t{ Cross-Section 0 4 in. Dia. ` - - - - Finished Grade - - _ _ _ _ _ Vent with Min. 4" Cap 12" Above Above Grade With -3 Ft Cover t-- Grade Locking Manhole Cover Device Sealed Watertight : Y a> s a a s> s s Y s a>! a s Y r Y r s a>>! s s a Y> a a a a> a Y s y i aS S S<< S S S S i;< i; S t G< S t i S S i L S S S[ i<< S S S S i S S y S YiY ~ Yt i fi Tether Tank Manufacturer: y < 1, Weight > Tank Capacity: Gallons < < : a Y ,<y-t1 t t Tank Maximum Depth of Bury: Ft YiY Alarm Switch Depth of Soil Cover Over Tank Ft. Y;y C)n Y< Yty yi Tank Outside Dim.: Width Z.N Ft, Length Ft, Height Ft ; i Y Y y }t} Alarm Switch Type: ❑ Mercury echanical t ; > Y ! ! > Y > > > > > s Y > > > > > > a > s > > > a : > > Y > > ! a > s s ! > > > r s > ! ! > > > > ! > ! > Y > Y s L i i i{{ i{{; c; L L; L i i S S{ S t{ S t i S<{{ t< t S{{{<; L{ C t{ L L; c i L{{ t C t L{ GENERAL INSTALLATION: The tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Manhole covers below grade are sealed watertight. Piping at the inlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. Electrical is as per the National Electrical Code and applicable Wisconsin standards.. Electrical is as per the National Electrical Code and applicable Wisconsin standards. 03/05 lgj Page _ of ii&b %r -TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed, and is to be installed and maintained according to Corgm 83, Wis. Admin. Code, the Holding Tank Component Manual (SBO-10571-P 6111!'1998), and the County Sanitary Ordinance. 1. This POWTS is designed to accomm6date an estimated domestic wastewater flow of y. V 9Pd_ 2_ The owner of this POWTS is responsible for system operation and maintenance, including all proviwom in the attached Holding Tank Servicing Contract and Maintenance Agreements. 3. Each time the wastewater in the second tank reaches a level of 12° below the inlet invert (at which lime the alarm will activate), the pumper fisted in the Current Servicing Contract must be called to empty the tank's contents and dispose of them in accordance with NR 113, Wis_ Adm. Code. 4. At each service event, the service proyider should visually inspect the condition of the tank, fters' and manhole cover(s) and verify that the alarm system functions and manhole locking devices are present Discrepancies are reported to the owner in a timely manner for corrective action. All Corrective actions shall comply with the county sanitary ordinance and Comm 83 and 84 Wls: Adm. Code. 5. All service events or inspections of this POWTS shall be reported to the county within 1 o business days. 6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes from this holding tank to the ground surface, inciuding intentional discharges and discharges caused by ' r neglect, constitutes a faMw POWTS and may result in issuance of correction orders or a citation by the county or state. 7_ No one should enter a holding tank for any. reason without being in full compliance with OSHA standards for entering a confined space. atmasph ce within these tanks may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. _ 8. In the event that this POWTS fails and cannot be repaired, a code compliant replacement holding tank may be installed in the same location (a new sanitary permit is required for such a replacement). Connection to municipal services would also be considered at this time if they are deemed available to the property. 9. If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned in accordance with Comm 83.33 Wis. Adm. Code. 14. If there is a problem with, or question about this installation,°,the following persons should be corn tacted: a Installer ~!1 - 13 i 17-LI Phone: / 7.r d- b. Service Provider Phone: 7iJ C. County Zoning or Health Dept sf Phone: 11. Project: Tmnsa~ction;Number Sepfic Tank Dimensions & Weights Septic Tank Size Dimensions Weight (lbs) Anchor Weight (lbs) Soil Cover (in) 5000 gal 204"L x 96"W x 93"H ~N41,400 T30,850 24 3000 gal 165"L x 92"W x 76"H 20,300 23,320 23 2600 gal 147"Lx 90"W x 73"H 18,100 20,625 24 2000 gat 162"L x 78"W x 64"H 16,100 15,675 19 1600 gal 145"L x 78" W x 61 "H 14,000 11,270 16 1200 gat 111 "L x 78"W x 61 "H _ 11,4009,532 17 1000 gaL Low Profile 120"L x 67"W x 5TH 9,500 8,705 17 1000 gal Heavy Duty 96"L x 78"W x 61 "H 9,200 8,945 18 i 800 gal 96"L x 67"W x 5TH 8,000 6,560 16 600 gal 78"L x 56V x 60"H 6,600 3,810 14 1600/1400 gal 174"L x 90"W x 73"H 23,000 22,410 22 1250/750 gal 162"L x 78" W x 64"H 16,400 _ 15,725 19 1000/600 gal 145"L x 78"W x 61"H 14,700 12,705 17 i Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed Dat Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Z~ ~7 Property Owner / Property Location -Z0 / Govt. Lot 1/4/1/0/4 S4, 3 I N R E (or W Property Owner's Maili Address =11,OCI # Subd. Name or CSM# Z Z-i Jo Z L) A-4 rs S- City State . Zip Code Phone Number ❑ city ❑ village Town Nearest Road ❑ New Construction Use: residential / Number of bedrooms 3 Code derived design flow rate -~1 GPD Replacement Public or commercial - Describe: Parent material Flood Plain elevation if applicable Nib ft. ents and General Comm datioris: 9 v e) Q-).9 / - 0 i 44~~1711System Type ( ,4-/ V System Elevation a Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 V Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30 < 150 ` Effluent #2 = BOD, < 30 mg/- and TSS < 30 mg/L CST Name (Please Print) Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 715-246-4516 Property Owner _ Parcel ID # Page of 1-1 ❑ Boring Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # ❑ Boring ❑ pit Ground surface elev. _ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring a Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODS > 30 < 220 nxf/L and TSS >30 < 150 mgft- ' Effluent #2 = BODS < 30 mg/l- and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (RAM) ArcGIS Web Map J r Y,04 P -13 P Mw \1 f I7j , 01 1!111 ss W! a t a 7 " >x s~ °It kl^ 4 a- ~ kc t 7; 3 3,.. r,., v, 5 8 ( 7s ^E ! a xn i% ri' •fe 4. a + a ~4 € ,g A _ r 'lip ^iC ky j4 » u { 'PS qv a P Y- a u all Ne m~.'A`~s3 ~iR u AL~ s 4 , 12 ! 18 / 2017 12 50 28 PM 1:1,128 Subdivision/CSM Boundaries _ DOT Bridges 0.2% Annual Chance Flood Hazard 0 0.01 0.02 0.04 mi Tax Parcels - Record Flood Levels - Cross Sections 0 0.01 0.02 0.04 km Lot and Units Floodplain Analysis Lines Floodway Outlot Other - Base Flood Elevations t Unit Flood Insurance Study IntermediateComours Park - Letter of Map Revision - all other values, Lot - Case By Case Analysis - INDEX Limited Common Element - Bridge INDEX DEPRESSION General Common Element Floodplain Analysis Points INTERMEDIATE 11 1!" / / / ( /S Pnvate Right-of-Way Other INTERMEDIATE DEPRESSION ~•/~,.}~'t€ jiV~ ' ! J / Subdivision/CSM Flood Insurance Study IndexContours J , t I V J G 111 L_. / Public ROW Letter of Map Revision <all other values, WI Dept of Natural Resources /`~•t St, CDD Dams - Case By Case Analysis - INDEX SL Croix County Community Development, Vsconsin 1V Dams with FERC License Bridge INDEX DEPRESSION C J1A/9' Dams 1% Annual Chance Flood Hazard WebAppBuilderforAmGIS CS, Eari I Source: USDA Natural Resources Conservation Service I Wisconsin DNR I WI Dept of Natural Resources I St. Croix County Community Development Department I St. Croix County Community Development, Wisconsin I f SEPTIC or HOLDING TANK SERVICING CONTRACT Contract Date 2 This contract is made between the Tank Owner )Name(s) and Pumper's Name exf 1 7,~_ yny,~ We knowledge the installation of (a) septic/holding tank(s) on the following property: (Provide legal description): 111-41, , J C1 444) -T' I/ U04 1. The owner agrees to file a copy of this contract with the local governmental unit (St. Croix County Planning & Zoning Department) to document maintenance by a certified septage servicing operator as required in SPS 383.52(1)(c)2. Wis. Adm. Code and the approved Component Manual. 2. The owner agrees to have the septic/holding tank(s) serviced by the undersigned pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the septic/holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the septic/holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the septic/holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local governmental unit (St. Croix County) a report for the servicing of the septic/holding tank(s) on a monthly basis. The pumper further agrees to include the following in the monthly report: a. The name and address of the person responsible for servicing the septic/holding tank; b. The name of the owner of the septic/holding tank; c. The location of the property on which the septic/holding tank is installed; d. The sanitary permit number issued for the septic/holding tank (if known); e. The dates on which the septic/holding tank was serviced; f. The volume in gallons of the contents pumped from the septic/holding tank for each servicing; g. The disposal sites to which the contents from the septic/holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the local governmental unit named above within ten (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) Owner's Signature(s) Subscribed and sworn to me on this date: Nov` ~36X 3~Zc« Today's Date /ftk ,A ` 41 ,,(Print) Pumper's Signature Notary Pu c Signature Pum-pye~r's Name Pumper's Registration Number BOt~V,y'''•, Commission Expiration A FZ PUBS\C, RECEIVED ! i J4 8 L DEC 19 `Zi Tx : 44 t 8v -.CRo%-, Q©UNTY 1058824 OM UNITY DEVEL6PMEW BETH PARS' :iC7kcs€ rtf REGISTER OF DEED' t-lol my Tank Agtecmiont ST. CROIX CO., ire RECEIVED FOR RECORD r ' o / 20, 417 12:5 7 EXEMPT REC FEE: 3030 .Yom- PAGE5:72- i i y s .eC.itl til t tnlA t 3 i~ . EI (I lii< ~ ~ e 'r I k~~ i , 1~~.,s t t rt,.,(r ht r~i•~1cr t S ; Ut 3i t.~ .Ce <r„ . t7; (Ea hn ~a ue. and NO., Addy f 1 r r~ t ltI `"s6 t' 1t i C, a ,I 7 `•I KQ% t stmt I ir;,a,,tt,i,r 1 ies , C j rt I Cry} P ~ , , i, t. W.1 , -I q, . O fc, r pp~' - -t ~(ro.n See. 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