HomeMy WebLinkAbout030-1083-90-100
St. Croix
ansi e?pa rncnt ~r cmmec? PRIVATE SEWAGE SYSTEM
Safe-y Hrr7 It, 1f ng Di, 5 it Sanitary Pe_rmi: NV
INSPECTION REPORT 606911
GENERAL INFORMATION {AI TACH TO PERNITI Sale Plan ID No
Pclscra nfo--toe- you p•srldc moy i LS.?tl'c tt:cc^JA'y ourocses Lav, s.*504 ;It:-:*
Permit HC de's Name City Village Towrsrip Parcel T,R NO
Jeff Waldroff TOWN OF SAINT JOSEPH 030-1083-90-100
:ST 610 L ev Insp I Flea. BNl Oese'iptioa Seel onrl ve, nAtir•goada:, No.
ftl l GS 29.30.19.307A-10
TANK INFORMATION ELEVATION DATA
TYPE h1ANUFACTURLR 3 CAPACITY STATION 6S HI FS ELEV
Sopnc Rercnmark
7~ g.b5 /d8•b
pa Alt. BM Ir 7, 11
k^
Aeration Slog Sevier
I lolding St1Ht Inlet 1 /a/ 0 3
TANK SETBACK INFORMATION S'fHt Outlet 7 ,96 Ill 7 5
IANKTO °fL WELL BLDG. + ] it h,take ROAD DI I',lel
rn-l~ I
Septic 7 ~I /V{~ , 1/A I s~ r_ Dt Bottom t
57S r_9 Headeriwtan /-66 V5
Aeration Dist. Pipe I JPr
Holding B^t. System
F.ral Grade y 65
PUMPISIPHON INFORMATION
t Deni no St CarerI rd ~7,-- t-69
GPM
W r~~ -7 mo 1 ' .7
Head TDHF: ejCj,35 "1
gth Uia Dist:c'o7ull rf'{ g9, 2S
SOIL ABSORPTION SYSTEM
BEDJRENCH oMc1F I L•m,U' No Of Trenches PIT DIMENSIONS Nn OI P115 e;:Je Dia. L qu J Ceph
DIMENSIONS ^3
''arr~cturgr1l
SETBACK SYSTEM TO P4, SLUG :YELL IAKCJSTKEAF.1 IROR
INFORMATION CHAhIBE T•F- O, Svst?-, I i--
l C `4 UNIT IvlcJe N_m •er.
G o t1G+vl"1 r n 7 tl
DISTRIBUTION SYSTEM IH~ /I - 33
Ct slrnir,en xhr.=SieC xHC+o Spacing Ve. to tar ln-ake
Head-r~Idani'c 1
IT,
5~ s ` 'r e(sI _ ~I Cti 5
la-g.h_ Ca _ Lc'J'I' D6` SFar:ir!__-
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
h'r(n Over w. l: L4l- a( Yx Sxtin?d!Sodcee xx!AUIC!'od
Oe:d`i Over - ~V~C
H?drTrenc` ?r;c• ~ BeaTr;:nc` Ftlces ~ Tnpe I - _ ! Nc No
COMMENTS: ilrel.rde cede c screpencies. persons present. etc: Inspect crInspector #2
Location: 484 PERCH LAK RD O-^1
' 11. Goy I1 '~/C bexc~
1. i A't Btol Dcscnchon
2 ~ Bldg si 'ergtn
- ar = Z I 7 „ ^ J
arror.nt cf cove's ` L 61~ G.y/C'J/CJ~ ~oJ'lP~/syr~rr,
Pan •emsior Regwrl Yes ~NO r r ~D 1 I (IT"-
Jse ether sloe fcr additional rformaton - Inseocloi s gnalur \ 1 Cert. No.
Date
SHC-u'151N 3&r'
Safety and Buildings Division t _ Yr~ X
p D 201 W. Washington Ave P
. .O. Box 7162 sanitap 1'rnnu \umber(to be filled in by Cal
I
~ SP - 5 Madison, WI 53707-7162
/
f -
t < state fmnsenio ~mnb -
Sanitaty Permit Application
Inc orJ n¢c. itn SIS1\i21(>1 \4>, Adn: l .i nl. nut tts c:nt td ,
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f 1. Appltemion Information Please Prmt All In i uu
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11. "Type of BmldutK (check all that apply) V 1.nIA I
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~ It T sta rtJC om nnentlDes rce (Check all that aptl
\t l u`• u I 11•: t': L-rc_ 2.! Ill of xalable xvl ❑ ]4o a A-2: o tn.. l) c soi -
~ _ i (,.r : tNSm lh:ctc (vest :iQ _
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1. Tank luf. - lltl~C: ` " t lol J o \lnnn!kcwrrr
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VII Responsibility Statement- 1, the understxned, a>wma resttunsihd{ty for knaallntion of the PON IS shorn on the attached pl utv - _I
I L. r V: t rl .irt) \ ~iwn':I S~-u'fi': \IfJ\!PRS \utnbu ! I1,+n .ms l'i~on. \u,iu..: 'l hunh„r's AJJw>(Shut. Cdy S1nte, Zip Co`e)
Vill bunts•!Oe numlxOoh I Pi nllil re, U•tv-
an -r Isdm
t gent Smndt d
:Iaeazml lL: U,r•:ti 171ll /0 4 /0 _
1\. Condit w eawn far){sanpro.•a1 L /
oiypr::., cell riot all be r 1 •ttt. r
As per mrayemen! plan rn L ,,❑e : Ls ,1U Me
2. AN mfhw* nKt iw-.ene; must ou r..axit,,i i i
as per lipFdCMtt co& / urfluxell.
- - ---"Allodt w 1.01111 a mans fur IM Ililantand tohno t to da Counts.Ns on ooaor not less than s I.2 s 11 inttus look. -
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CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name:
Owners Name:
Owner's Address:
CLk L/
Legal Description: 3 c ; N -/C /C/
Township: 7r, Tl=~` L1 1-- -
County
Subdivision Name:
Lot Number:
Parcel ID Number. U SC' -/U 3 ~o -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 SL Croix Cty Septic Tank Maintenance Form
Page 8 Warranty Deed
Page 9 CSM or Plat
Attachments: Soil Test & House Plans
n
Designer/Plumber. <"O(,4s, Number
Date: 7- ~U Phone Number
Signature j - -
i
Designee PurauaM to the in and soil Absorption eompo ,,nl Manual for POWTs Verson 2-0 S130-1 07D5 P (N.01101).
Page 1
L,iu.U..Q-c~r
13 -
A 13
(Y 15 -
I
Soil Absorption System Cross Section
I ft
4° Schedule 40 _ ; 't;l Grade
PVC Vent Pipe
With Vent Cap
System Eleva^_cn
Leaching Trench
ft Ch2 nbers
I I I,ti• j
Il F1 cl!a_.,_. 111
_ 4' Dia.
Trench Header
Vent Or Ocser.2-Cn Pipe
min
Trenc'Leaching Chamber Specifications
Manufacturer And Model ~X,
EISA Rating sq ft per chamber Soil Application Rate + ? gpolsq ft
y5 gpd Design Flow< ? Soil Application Rate ;L' EISA= 3 Chambers
I
3. rows of chambers each. '
Page of
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' ( LJif:tC r. r.IS is ~'/lfi i.:hafTlbe,- `^idc and t_r'd Vill
-48'-
I~ FFCCTIVF I INC IH (({{fit
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'I rim 1
4r r
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I 1Ir r i- r
8" INVf RT 8" INVE5.3'INVERT
LAI
- 18.2"- -33'--...-~..~
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NI~N-IMa R"R4C~ \
IxC>xwvN !
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Fil l n~xL,Y
Arl I~rly
Quick4 Plus Standard Chamber Specifications
Sire (W x L x H) 34" x 53" x 12" (86 cm x 13b cm x 31 cm) Invert Height 0.6', 5.3", 8.0", 12.7"
Effective Length 48" (122 cm) (1.5 cm, 8.4 cm, 18.5 cm, 22.6 cm)
RrFILTRATOR SYSTEMS. INC. STANDARD LIMITED WARRANTY
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of 2
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner -t.
r- Septic Tank Capacity )
C.% gel ❑ NA
Permit-J- EEl
Septic tank Manufacturer I] NA
DESIGN PARAMETERS Effluent Fiter Manufacturer D NA
Number of Bedrooms _ D NA Effluent Filter Modal l D NA
Number of Public Facility Units _ NA Pump Tank Capacity gal NA
Estimated flow (average) _ Qn gal/day Pump Tank Manufacturer V NA
Design flow (peak), (Estimated x 1.5) Pump Manufacturer NA
9aUday .4p Soil Application Rate al/day/ftr Pump Model 1% NA
Standard influent/Effluent Quality Monthly average' Pretreatment Unit 4Z NA
Fats, Oil & Grease (FOG) 530 rug/L D Sand/Gravel Filter D Peat Fiber
Biochemical Oxygen Demand (BODs) i 5220 mg/L NA ❑ Mechanical Aeration D Wetland
Total Suspended Solids (TSS) 5150 mg/L D Disinfection D Other.
Pretreated Effluent Quality Monthly average Dispersal Callls) U NA
Biochemical Oxygen Demand (B0Dr1 530 mg/L 6d In Ground (gravity) D In-Ground (pressurized)
Total Suspended Solids (TSS) :530 mg/L lI NA D At-Grade D Mound
-...-Fecal Coliform (geometric mean) 5104 cfWIOOmI D Drip-Lime D Other:
Maximum Effluent Particle Size a in dia. D NA Other: D NA
Other: Other
❑ NA ❑ NA I
`values typical for domestic wastewater and septic tank effluent. Other. D NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At leas once every' D monthlsl
yearlsl IMaudunum 3 Years) DNA
Pump out contents of tankis) When combined sludge and scum equals one-third of tank volume D NA
Inspect dispersal call(s) At least once every:
? D m rl9l l (Maximum 3 year:) D NA
_ _1_
-C Year151
Clean effluent fiber At least once ev ! 4W month(s)
ery: /3 D year(s) D NA
Inspect pump, pump controls & alarm At least once every: D month(s) _
NA
D year(s)
Flush laterals and pressure test At least once every: 'D month(s) NA
D yearls)
litho. D month(s)
At least once every: D year(s) -E(NA
Other
❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal calls shall be made by art 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.
l he dispersal call(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pending
of effluent on the ground surface. The pending of affluent on the ground surface may indicate a fairing 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 Wli or more of the tank volume, the antra
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 fibers, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Ma'artainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
START UP AND OPERATION
7i
tha noev construction, prior to use of the POY✓'i S check treatment tankisi for the presence of Painting PayV at
that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have Ifrf' r content
of the tanorp r'h ed h a Products or arbor chemical
by septage servicing operator prior to use.
System start up shall not occur when soil conditions ern frozen at
.
During pov,'er outages pump tanks may fill move normal yhv,•ater the levels. surface..
hi. LNhan
discharged t0 tite dispersal calllsl in one large dose, overloading rite cellist and
effluent' to avoid this situation have rho convents of The Power ul restored The excess wastewater will b7
power to tho effluent pump or contact a Plumber or POWTS Maintainer to assist yin manuin the ally oackup or surface discharge of
restore normal levels m' h' pump tank removed by a Septago Servicing Operator prior to restoring
nt m the p;;rnn tank. Y elan' The um
De not drive or park vehicles over tanks p um controls to
:within i 5 feet down slope of an and dispersal cells. DO not drive or park over, or other
wi
any mound ar at-grade SOH absorption are.
Reduction or elimination of the follow:rg a se disturb or compact, the area
from Vie wastewater stream
POl'yTS: antibiotics; baby wipes; cigarette burrs: condo^7s; cotton may improve the performance and prolong
the life of the
pfoundation drain products: trump puatp, t;ato4 fruit and vegetable pe co s; dental floss; diapers; disinfectants; fat;
pesticides; sanitary napkins; tampon 9
aslin ase;
herhicides; meat scraps; medications; nil:
ABANDONMENT s; and winos so gasftoner brine.
prope Iho PO fails and/or i l permanently tly with r. taken
properly and safely abandoned in haomm
prope "1rerofCo service the following stops shall be taken to insure that the system is
All pipin 83.33, Wisconsin Adminisiratieo Lode:
• g =.c ;Inks and pits shad be disrdn :ectad and the abandoned pipe openings sealed.
• The contents of all tanks and Pits s!ial! be :emoved and properly disposed of by a Septayo .
•
excavated Servicing Operator
soil, After gravel or pumping, anoall ther tanks inert and solid pits shall material. .
and removed or their covers removed and the void space filled e:itf7
CONTINGENCY PLAN
!i lac ?OLt:' i"5 Tails and rannot be repaired the following measures have isean, Or must be taken, to provide a code com
pliant
[J A suitable replacement area has bean avaiuatad and may be utilized for the location of a r
system. "lhe replacement area should he protected from disturbance and cam
absorption
reyem setbacks from arin o not be infringed sot! upon by
result in the need for a new so! and si oposed strnucturo, lot foes and wells. Falu'^o to and should ld not pl ails
°rtnrP Y with the rtdns !n effect at char ad t to establish a xdi wie replacement area. Replacement t systemsmust
area must
❑ N suitable ro 1. yst
p t•cealent area is not available duo to sarbaok and/or soil ations . Barrio
technolotly a holding tank may be installed as a lass resort to replace the failed limitPO!ation
r/ JZn liw_sif~y~fe, 9 advances in PON'TS
"ecr
- ua'
al
ruzy be inctnl!e,j • r
rat e a o mg tank
i Iviound and a:-grade soil absor ~D;41a rT:p 7:1) ~fV5772UCTL0
'r.`i!tnd al gdrfarr e soil b orptio n syste s
ms m ss; ov ere constructed in
place following removal of the binmat at the
WARNING: cr,;npiyr.•i;h the cures in effect at that time.
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,
rODITIONAL COMMENTS
JWTS INSTALLER -
P
_ __u! OWTS MAINTAINE
R
Namc
7j_S-
Phone
PTAGE SERVICING OPERATOR (PUMPER)
Name LOCAL REGULATORY AUTHORITY
'hnrc -Name r _ Phone -7/
-
C: a[ drahnri rn r.0 1*an^n x'gty ..huit, H'
tmn: 83.22" -)1!1 irdifrilh and 83.54!7 r.:2, S 131, wts sin Administrative Cade.
ST. ('ROLZ COUNTY
SEPTIC TANli?` A NTEN.VNCL AGREE-NIL,NT
OVWERSHIP CER'IIFICATiON FORM
C)-„-ter,'312vet
Mzt.ing : '1~ .iires / X111 ` 111 /ail C-' Lie%~ Z
nr.; P R' Address~ Perc-k. L~ t,e - c+~- -
(Verificatioc required mom Natmurc & Zoning Dcpartmeat for nc•u car:>tuc:ion'
Cir,~+'State r'/ u-c=~l~-e"'~ 1J--t-~ Pazcal ldenti:5c•.ation I~umher C~ -~C' ~ /Z) ~ l~%_
LEGAL DESCRIPTION
Proper[}' Loca_ian SF' ~ . 5%_ .Sec. 1 ~~GN R l \t', I'ot~tT of _ Te~'z_
Subd`: lion Pia': Lot a -
Certified Survey Map Volnute Pagz 1
'Warranty Deed # . ' (before 200`iVolurne Page
I
Spec house:- yes o Lot hues i:iencftabfe yes L no
SI'STEM A'LAYNTENAVCT AND ONVNER CERTIFICATION
Imaroaer ese and maiuterarce o` your septic system could result m its premature faihcc t: handie wastes. Proper
mainwilance consist of pumping out the septic tank every 'hree yea's or soancr, if needed. bV e li Ln3l:d ptltnper. N\la: you put into
the stirstcrm can a- th,e f Ljclion oithe septic tank as a :reanncnt stz,e io the waste disposal system. Owner maintenance
responsii?ilities are specified in §SPS.'g3.52(i) and in Chapter :2 - S:. Croix County' Sanitary Ordinance.
The propeY.y ot3ncr agrees to subrnit to St. Croix County Narmitg Zoning Deparunent a certification fo^r., si- cd'-. trc
ou-i:r utd `.,y a master niu?nber. journe m= pa.unber, restric`.e4 plum he-r o. a licensed ptunpcr verifying that (:l the on-site
%+rutc.cz:c- :'.isposal system is in propu operating condition and'ur (<I after insacction ati l pumping i if necessan'), the septic tx-, : 's
;css tau J3 full of sludge.
I -"c, the undersiincd have read the above ragtjrements and agree to maintain the pr-.\-ate sewage disposal system with the
sizndar& s : '_o>'h.:aerciz. US set bN. the Department o Safety And Professiana: Services and the Department Of Natural Resources;
Statc of Cer?:(:canon stating that your septic system has been maintained mutt be completed and returned is the St. Croix
County Planting & Zoning Depa-L-nen: within 3G days of tae titre, year ezi,i-abon date.
we certify that LIl statements on t:tis farx are true tO tht• best of my'oar knowledge. 1`we aru are the owTen s) of the
In'opery dcsc:ibed above, by virtue Of R waran:y~ deed :'ecnrded in Register of Deed:'. e.
Mmbe f bedrooms
.;]G-\A'1'LTLL OF.,V?L1C'_ANT(S DA
"'Any information :hat is n:is:'ep-esente:: may result in the sanitary permit being revalted by the ?tanning & Zo:irg Dena anent.
Include with *us application a recorded w'arra9•y :feed from'ltt Register Of 7cces Off-ice and a co^y of'-.9e cs:S d survey map if
rcfereace is made in the wa-ra,ty
(REV. 04?12)
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Please print all information. Rev'""ed 111 Date
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