HomeMy WebLinkAbout040-1327-25-000
Wisconsin Department of Commerce County:
PRIVATE SEWAGE SYSTEM St. Croix
Safety and Building Division
Sanitary Permit No:
INSPECTION REPORT
1
TO PERMIT 6003 5
GENERAL INFORMATION (ATTACH ) 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:
DCCI Investments TOWN OF TROY_ 1 040-1327-25-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
17.28.19.2223
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAR ITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer
(Holding t/Ht Inlet C)c
0,
St/Ht Outlet rr
TANK SETBACK INFORMATION ` t .
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 Coder
GPM
Model Nunioer
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 Type Of System: CHAMBER T OR Model Number:
DISTRIBUTION SYSTEM
[Herader/Manifold Distribution x Hole Size ix Hole Spacing Vent to Air Intake
1P (s)
th Dia Length Dia Spacing
SOIL COVER f 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 ~ Yes' No ~
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 363 MEADOW VALLEY TRL u t a
1.) Alt BM Description (AAA G v>9 llli~~ 0-1d
2.) Bldg sewer length = p
- amount of cover 01, e
Plan revision Required? ] Yes No
Use other side for additional information. "
Date Insepctor's Signature Cert. No.
SBD-6710 (R.3/97)
l^
r~l L! D Safety and Buildings Division ~un`
t 9 1 K 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be ed in by Co.)
p Madison, Wl 53707-7162
JAN 16 2018 ,'k 4 WO /5
5
State Transaction Number
i:on,rr,tr}i XYQZ29TD4CXWP
In accordance"a~tdi3S 3383.21(2), Wis. Aden Code, I unit
is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04(1) m), Stats. rr c _ r
1. Application Information - Please Print All Information
Property Owner's Name Parcel
IV, _7-73_171"n 3?
Property Owners Mailing Address Property Location
Govt l.ot
City, state Zip Code Phone Number Section L"2
- % circle o
T!_.. , , N; RE W
II. Type of Building (check all that apply) _
Family Dwelling-Number of Bedrooms I j Subdivision Name
oc .f: /fro r;
6,k ed PtA_
❑ Public/Commercial - Describe Use ❑ City of d
❑ State ved - Describe Use CSM Number ❑ Village of
7- Oi 274-Z7 of
III. Type of Permit: (Chet only one x on line A. Complete line B if applicable)
A. ew System El Replacement S
ystcm ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B• ❑ Permit Renewal 11 Permit Revision Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued
❑ I Y~
Before Expiration Owner
` Q
IV. of POOPTS System/Component/Device: Check all that apply)
?Zype Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil S
❑ H idutg Tank ❑ Otber Dispersal Component ( plain) ❑ Pretreatment Device (explain) !f
V. Dis rsaareat ent Area Information
Desi Flow (gpd) Design Soil Applicati e(gpdsf) Dispersal Area Required (sf) Dispersal Area Propose (sf) System Elevart
VL Tank Info Capacity in Total # of ManufacturF
v ~
Gallons Gallons Units B 57
New Tanks Existing Tank t _ m c`na
Septic or Holding Tank
Dosing Chamber
l
VII. Responsibility Statem t- 1, the undersigned me responsibility for installation of the POWTS shown on the attached plans.
P bar's Name (Print) Pl /ells Signature MP/MPRS Number Business Phone Number
61
Plumber's Address (Street, City, State, Zip Cod')
VUL_CountyMepartment Use Only
proved isapp Permit QFee Da is~sjued l Issuing ent Sign
Reason for Denial /
DLCondit~ns,p ~p ~g~ ~trl~}siaPProval
7. .D ~~ar~ ,Ee e
r. uls+et :i cell must all be s u _s ! r + nt~ ; ~)l c~c,~, ~vu .ti
As per inaragemen' pl n , u noel W plumbe:.
2. All ge!trx k reC,L:it-! en s mu t tit. i art it'.E,i
n per 4Tkn:bim c r)elo /
Attach to complete plans for the system and submit to the County only on paper not less than 8 in z 11 inches in sift /
x
SBD-6398 (R_ 11/11)
System PLOT PLAN
PROJECT DCCI Investments ADDRESS P.O. Box 445 New Richmond Wi 54017
SE 1/4 NW 1/4S 17 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX
SYSTEM ELEVATION 93.0/92.5 4.5' below grade DATE 1/15/18 BEDROOM 5
CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000/630 LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1091 # of chambers 54
BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE O WELL *H.R.P. same as benchmark
Scale = 1/4" = 10'
108' _
2-3' X 110' Cells with >3' Spacing
96' 8% Slope
ents
133'
f
98'
B.M.*
20'
15' B-2
90'
B-1 To be >5'
30'
30'
Pro 5
Bedroom
House
All piping shall be ASTM SDR 30/34, within
Meadow Valley Trail 10' of tank, piping shall be ASTM F891
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 1/15/18
Owner:DCCI Investments
Location: SE1/4 NW1/4 S17 T28N,R19W 363 Meadow Valley Trail Hudson
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Leaching Chamber oss Section
4-6. Maintanance and tingency Plan
7. Filter Cross Secti
Signature-'
License numb r22'6900
System PLOT PLAN
PROJECT DCCI Investments ADDRESS P.O. Box 445 New Richmond Wi 54017
SE 1/4 NW 1/4S 17 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX
SYSTEM ELEVATION 93.0/92.5 4.5' below grade DATE 1/15/18 BEDROOM 5
CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK
1000/630 LIFT TANK SIZE DOSE TANK SIZE
MOUND SEPTIC TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1 091 # of chambers 54
BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE O WELL *H.R.P. same as benchmark
Scale = 1/4" = 10'
108'
2-3' X 110' Cells with >3' Spacing
96' 8% Slope
133' ents B-3
98'
B.M.* 30'
20'
15' B-2
90'
B-1 To be >5'
30'
30'
Pro 5
Bedroom
House
All piping shall be ASTM SDR 30/34, within
Meadow Valley Trail 10' of tank, piping shall be ASTM F891
Cross Section of Infiltrator Quick 4 Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 ft2 of Area per Chamber
5.6ft^2 pair of end plates To be >1' above grade
Finish grade elevation
Typical Installation ~ 99.5°
,Iven,
Grade rent 4" 3'
X30/34 :Se tic Tank
5' 5' Lon36 Gr
Grade at System Elevation
ade at System Elevation
I
Spacing 5'
2-3' X 110' Cells
Same on other end Observation tube/Vent
At end of cell
A
B
27 chambers per cell
System elevations:
A 93.0'
B-92.5'
POWTS OWNER'S MANUAL $ MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner
Septic Tank Capacity
Permit# al ❑NA
Septic Tank Manufacturer NA
DESIGN PARAMETERS Effluent Filter Manufacturer - /G ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units 3211NA Pump Tank Capacity al NA
Estimated flow (average) ' al/day Pump Tank Manufacturer NA
1 Design flaw (peak), (Estimated x 1.5) gal/day Pump Manufacturer NA
Soil Application Rate avda /ft' Pump Model NA
i Standard Influent/Effluent Quality Monthly average" Pretreatment Unit NA
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD5) 420 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) :5150 mg/L ❑ Disinfection ❑ Other.
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BODs) 530 mg/L .ir\i-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/LNA ❑ At-Grade ❑ Mound
Fecal Coliform (geometric mean) 5104 cfu/100ml ❑ Drip-Line ❑ Other.
MMaximum Effluent Particle Size l8 in dia. p NA Other. ❑ NA
(Other. A Other: ❑ NA
"Values typical for domestic wastewater and septic tank effluent Other ❑ NA
IAINTENANCE SCHEDULE
'f Service Event Service Frequency
Ilnspect condition of tank(s) At least once eve ❑ month(s)
ry' ears (Maximum 3 years) ❑ NA
(.Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA
(Inspect dispersal cell(s) At least once every: El month(s) (Maximum 3 years) ❑ NA
joeyear(s)
(:.lean effluent filter At least once every: month(s) ❑ NA
ear(s)
Inspect pump, pump controls & alarm At least once every: I-] ❑ month( yeaar(s) ) NA
l9ush laterals and pressure test At least once every: ❑ month(s) NA
❑ year(s)
ether. ❑ month(s)
At least once every: ❑ year(s) NA
tither: 11 NA
MAINTENANCE INSTRUCTIONS J
!Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Mauer
!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
icmmbined 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 (f6) or more of the tank volume, the entire contents of
I:he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin
Administrative Code.
INI other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units,
And any servicing at intervals of <12 months, shall be performed by a certified POWTS Maintainer.
.la service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
page of
START UP AND OPERATION nt tank(s) for the presence of painting products or other chemicals tl*t
For new construction, prior to use of the POWTS check treatment
concentretions are detected have the contents of thO
may impede the treatment process and/or damage the dispersal cell(s). If high
tank(s) removed by a septsge servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface. ter will by
bIa
During power outages pump tanks may fill above normal highwater levels. When power is restored or the excsurfaceess discharge wastewater
discharged to the dispersal tea(s) in one large dose, overloading the cell(s) and may result in the backup per to the
To avoid this skustion have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring a
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. the area within
Do not drive or park vehicles over flanks and dispersal cells. Do not drive or park over, or otherwise disturb or eon pact,
15 feet down slope of any mound or at-grade soil absorption area. the life of the POWf
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong
-condoms-, cotton swabs; degreasers; dental floss diapers; disinfectants; fat foundation drain
antibiotics; baby wipes; cigarette butts
fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting produc#s;
(sump pump) water,
pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT shall f taken to insure that time oyster is properly
When the POWTS fails and/or is permanently taken out of service the following steps
and safely 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 properly disposed of by a Septage Servicing OperaW.
• 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 code conmplirst
If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a
replacement system:
suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelm.
f The replant area should be protected from disturbance and compaction and should not be infringed upon by requirled
setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the r*ed
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rule:l in
effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWfS technology a
holding tank may W installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a sal and site evaluation
must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed) as
a last resort to replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiitraiive
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 TANW UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O~ A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name Name
Phone ~J• s ;d, Phone r?j~ ' ~,J~l
r'.~- -rte
SEPTAGE SERVICING OPERATOR LIMPER LOCAL REGULATORY AUTHORITY
Name Name > r~ ; k_ {>Zr4 Z
,s ~ y` • , j' - , _
f,
/J Phone
Phone
This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(1) and 38IWI), (2) & (3), Wisconsin Administrative Code.
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Department of #1887
It SAIL AY,~
SP ALUATION REPORT,
Safety and
Jn 1C07 ice WifK r'omm 85, Wis. Adm. Code I Page 1 of 3
$ Professional cA^
--,,Schmitt Soil Testing, Inc.
5VBJOESECE980
Attach complete site plan on F gas in size. Plan must ISE11/4, . Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest
roadZL - 006
IsO
- L?~7
M. 6,
Please print all information.
By Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location
DCCI Land Planners Govt. Lot N 1/4, 17, T28N, R1 9W
Property Owner's Mailing Address Lot # Block # I Subd. Name CSM#
1505 Hwy 65 P.O. Box 445 25 i Meadow Iley Of Troy 1 St Addn
City State Zip Code Phone Number City Village Town Nearest Road
New Richmond WI 54017 Troy Meadow Valley Trail
New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
Replacement Public or commercial - Describe:
Parent material Outwash plain (Pillot Series) - Flood plain elevation, if applicable NA ft.
General comments Area is suitable for a conventional system with a 0.7 gpd/sgft rate. Install system on the contour between 3 feet and 5 feet below
and recommendations: grade. Slope of area is 8%.
1 Boring # F -1 Boring
Pit Ground surface elev. _ 97.62--- ft. Depth to limiting factor 98+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure . Consisten Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. j "Eff#1 "Eff#2
1 0-8 10yr3/2 none I 2fsbk mfr as 2vf 0.6 0.8
2 8-19 10yr4/4 none sl 2fsbk mfr gw lvf 0.6 1.0
3 19-26 10yr5/6 none Is 2msbk mfr gw lvf 0.6 0.8
4 26-62 10yr5/4 none grcos Osg ml gw 0.7 1.6
5 62-98 10yr6/4 none s Osg ml 0.7 1.6
A2 07
1 ~
Boring'
❑ Boring # ! -
Pit Ground surface elev. J48 ft. Depth to limiting factor 9 + in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistent Bff~! ots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'E ff#2
1 0-11 10yr3/2 none I 2csbk mfr as lvf 0.6 0.8
2 11-22 10yr4/4 none sil 2fsbk mfr gw 1vf 0.6 0.8
3 22-32 10yr4/6 none Is lcsbk mvfr gw 0.7 1.6
4 32-97 10yr6/4 none grs Osg ml 0.7 1.6
I' I
lip i
Effluent #1 = BODS> 30 < 220 mg/L and T >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature: CST Number
Thomas J. Schmitt 227429
Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number
1595 72nd St. New Richmond, WI 54017 6/22/2017 715-760-1978
SBD-8330 (R.07/00)
Propeity Owner DCCI Land Planners Parcel ID # Page 2 -of 3
Boring
F3 Boring # Pit Ground surface elev. 95.56 ft. Depth to limiting factor
98+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description ' Texture Structure Consistence Boundary Roots _ GP_D_/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2
1 0-13 10yr3/2 none I lmpl mfr as 1vf 0.6 0.8
2 13-23 10yr4/4 none sl 2fsbk mfr gw lvf 0.6 1.0
3 23-98 10yr6/4 none s Osg ml 0.7 1.6
-
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_/ft2 _
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#t *Eff#2
-
i
Boring
Boring # Pit Ground surface elev. ft. Depth to limiting factor _ in. Soil Application Rate
Horizon 1 Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2
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' Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L
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SBD-8330 (R.07/00) Schmitt Soil Testing, Inc.
Paae 3 of 3
Conducted bv: - Conducted fo-
Schmitt & Sons Excavating. Inc.. Name: DCC1 LanManners
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Thomas J. Schmitt, CST 227429 Address: 1505 Hwv 65
586 Valley View Trail City, State, Zip: New Richmond, W1 54017
Somerset,Wl 54025
Phone: 715-7 0-1978 PID: Pending
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Signatur Lot No. 25
Date Legal Description: SE1/4 NW1/4 S17 T28N R19W -
■ Backhoe Pit Township, County: Tvy~ 'Township, St. Croix County
ABench Mark 1 El. 100.00' Top of 2" PVC Pipe.
A Bench Mark 2 El. 95.99' top of 2" PVC Pipe MNAOow (/AL I- e o TRo /
Slope= 8%
Scale 1"= 60'
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