HomeMy WebLinkAbout040-1151-40-000 (2)
m'S"ueoa`e^'°'CO°'we^e PRIVATE SEWAGE SYSTEM St. Croix
Sa'eIy and Hdtlcmg L'vism~
INSPECTION REPORT Sanitary Pe(ma No SAN-2018-387
GENERAL INFORMATION (ATTACH TO PERP:IIT) Sia:e Pla- ID No
Pe,sonal irformat Dn yod Pr>':ide may De uscJ V sccur7a'y Du'pcsCs -°n:•acy Lax. s'i f:4 I I Im)]
Per- it HoIDeYS Name City Village Tor.-sND Parce. Tax No.
James & Linda Walsh TOWN OF TROY 040-1151-40-000
D_SCllpl.pfll .SC'CI OI`.'rGxn Rdi 3EltVlap NJ
CST BrAl P.': -T77777
23.28.20.583A
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS III FS ELEV
Septic Benchmal
Dosirg 2 I vd A.I. BM-
Aerat on Bldg Sewer _
SLHI In et
SVHI Outlet
TANK SETBACK INFORMATION 10C "11,, 1
TANK I O PL 1%ELL .8 OG. rent to A'r lrtake ROAD Dt Inlet _
w _
Septic f 1 f D: Borom - -
+ -76 lao ~1 0 - - - -
Dosing Header*Aan.
Aeration - - - - Dist. P,pe r/
i
Holdn'a Bot System -
PUMP/SIPHON INFORMATION Finai Grade
rvtanufac:arer Del land S: Cover 3•Y6
3 }
cmra
Model Numbe_
C*Ol
TDH W`< Fr ction Loss Syslem Hear, TDH rt
F mcernarn Longth Dia.
SOIL ABSORPTION SYSTEM
BED,-TRENCH 'N-V) Le^gth Nn O' Irc,uli PIT DIMENSIONS No. CI Pits 1-side C a. I ipuin Depah
DIMENSIONS
SETBACK SYSTEM T D' TELL LAK_ .STREAM LEACHING Varwactunn
INFORMATION Tyre O` S; stem CHAMBER OR
UNIT Mucel N,,-ob~~
DISTRIBUTION SYSTEM A W 1A &U, Jill. 1-5
HeaderManifcld Clsl'Il - -j. HDIe Siva x Hple Sveorg vent to Al' intake
LenyIll _-_T.I, tA.al~ SDacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
depth i'ver CepP'Qaer-- _ C'ePt°xx Seececr5od7~~y utalsCnc7
3uG RVn; .lyr \ eed.'Trernh Edges- 'Dp sc l- - _ i-
. - Y-c. Vn Yes ~ _ No
COMMENTS: {Include cede olsciepencids, persons present etc j Inspection #1'. Inspection #2.
Location: 1W GLENMONNTpR{aD.~ .(c 1~_S 16,u, l(_pt 6,-t-
1 ] AI BM Description = ~`7 t l vq ~L~.~~~,
2.)B.og sewer length = Ito amount of cover
Ran revision Re9unedv _ j Yes 1 No r1'XI f,9J } -I ~l'l, lY~
Use other side for additional ,rformation. "-4-__ v ~7
587;r C ; 3 . ~'1 Dal! Irsepc:cr's Siyratcre Cert. No.
St}►~ -ao1~ - 39 7
iQOtlnly,Sanltary PermITZ plicatton - ST. CROIX COUNTY WISCONSIN
In..ir~'oid wlrh paper 12 r rix Cunt uif r, rdirav,-e PLANNING& ZONING DEPARTMENT
C#to h r royal in t u line you p1 T. ir .y br, u F 1 cr ;e tJ r, pwposes SI CHUIX C^,tIN TF C O •ERNI ENT C--NT;--Ii
lU IRiro].y Lai. S. 7 04111 nli: 1121 (,arm hae'l t oac
Hex r 11 w~tlr ;to
t'15', vyo-4580 Fax Ii 1513tl6-16?,Fi
' 'vYtNac ~r'CUrWe:r pl[,r_ f .111tr ayslnm on pspz- 1-01 Css;han i3-t:7 x 11 Inches In site.
ucnjm-.,eMe vr--f it F- ;;heck it revis cn to prov,; I% applicabcn
5 N-Zat
1. Application Information - Please Print all Informa - n Location:
Plop~rly Ov.-rer Nam-' amQ.ZN~
6., 4, See z3
Z N, L R Lio6W
Pr Ay Owners Mail ./ny Address ~ fol Number Slack N, r_ ( V A/ LA
C.ty State lip Coda PhocO Numcr SO:dims.On Name or CSfvt N1:mber
II T e of Building: (check one) a L a4~ I C7ity U village To'nn o' 5 -1
t ar ^ Family L1ve111 .4 - No. ;I !tD;IrEan:;: -
U Pub.ic.Cmnrnerckl deSrnue cse1: j6.:~ rJ
1-1 stale armed - 1 ad
II. Type of Permit: (Ghcck only one box uo line A. Cheek bux a>n I.ne R 1 a.^,pl.oable; J
Parcel Tax NUmber.si a3 .28.ao.S 3f~
A) 1U Repar 'connection ❑Numpitan n7 '_nH,.,u,=nation L/
Sandakwl o g b - l^ C -Dorf
Perm t Number Dale Is=.u d
B)
O Slact :ianitciry Perm t ,vas pnr,ioa~Py csued
IV. T pe aROwT-Systc"n°(f,heck all that apply)
plan-pressu:iz:o :e-dnn.c:: " Muond ` 2.4 m. scilable sod n N10"I'd 21 in- sdnahle s0a
i ❑ MaJn^. F.. L.
❑ Uoum acted wo;l nd ❑ Peat Filler ❑ Dnp Lne
❑ P,essun[ed In-9r^„md ❑ Holding lank n Single Pass ❑ Olhof
I I Al grade Fl ACrlbrc Ir_;atmrnl Una ❑
Reun:ulat:rxl
V. Dispersol~Treatment Area Inlormation:
I_ Desgo Flow lgpd) 7 I'rual Area 7 Ui5pdmil Area 4. 5011 Application Rate S. Purarlalion Rale if. Syslam Elevation Final Gradc
Rrqui•ad ROp:Isa7 IiJah'dayr'sq.ll..' jtot=c.; mchi Pevahen
VI. Tank Information C pa::r; In C9:. ens total p of lrlinu`ackacr Prefab Site Con- Steel Fiber Plastic
N cv: Fxstrnu Ga:k^'s IUnk:: Concrete sllucted glass
Iankz Tarlks
❑
_ ❑ LL -1
I n n 7 ❑
II. Responsibility Statement
1• the undelsignod. assu respongibilty for r airro;;urn nrt ^n rjnd 1 tea" 1, s!A!At Dr 'If nc r plumb ing tor the POWI S shr,.vn on the attacheo Cans. A
I:rense i6 n0l Wuvircd f r --Fralin widat er it ShV lahun or non-pl1.m RnO .an laM1 Cn system.
bcis Name,;nrinli PIU Sinnanrre :no ::Temps; "Pq1PPSNo Rusnes5 Phon Num
~:mbor's Z Addrr•sg ~ Ft, ty. SInIF in Core;
D1 (1 ov,
III. County Use Only 71
Oi appfev'-d `ovw1Nmy Peril Fe° 0,w uvee 1-C 4~Lnl Sr nalur iNn
Approved Cin'n^.r er :Mac R 7 Z J - 66 l y
.rrr•inaliar i liN'll
I%. Conditions of Approval, Reasons for Disapproval:
I~ Cd b: ~UP -Zola-0(e)3 p~(rlMrd
Z~ bl~ 5ewu - S a~~ /60 G~e4.n o~~ 5 /r>2d/ ]
1
_ ~ s f r t " ~j ;.~~1SL
1. ~ICV. ~3.0• ise
Tom ~
.K i r ~ L10~
J
6!
.r
I C
f y
,.2 rCncnes 3 l X3.75
I
i n
Cow r
N n I
~¢rfy .`~c~/rests
5~,,_ .rte EjcV. `x'3.0
~,'roo.t.
3M rl fie
I
. 7~o~i b>,rtl d
d~. !~YV~~~ti't nn
~ I
f ^n~ 4 'lcl, i?=<1
n
I1
1 I rl, ~i 'rfCr.cAc.5 3'd 93.73'
i
az 3; ~
i i
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _of-
FILE INFORMATION
Owner SYSTEM SPECIFICATIONS
Permit Septic Tank Capacity ~al C NA
Septic Tank Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Fitter Manufacturer NA
Number of Bedrooms - _ _ - 3 ❑ NA Effluent Fitter Model I NA,
Number of Public Facility Units -G NA Pump Tank Capacity
- - d NA
Estimated flow (average) al - - Pump Tank - -
J L7 alida p Manufacturer NA
Design flow (peak), (Estimated x 1_5) _ /J 1_2 aaudav Pump Manufacturer
A
Soil Application Rate -
TNA
Uda IfY' Pump Model Standard InfluenUEffluent Quality Monthly average' Pretreatment Unit
Fats, Oil & Grease (FOG; 530 m ii.
9 ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand ,BODs) 420 mg/L ❑ NA O Mechanical Aeration C Welland
_ Total Suspended Solids (TSS) 5150 al 9/ C Disinfection ❑ Other
Pretreated Effluent Quality Monthly average Dispersal dell(s)
CN~
Biochemical Oxygen Demand (BODs) 530 mglL in-Ground (gravity) ❑ In-Ground
(pressurized)
Total Suspended Solids (TSS) <30 mg/t- NP. C At-Grade ❑ Mound
_ Feral Coliform (geometric mean) 510° c uN00m -I Drip Line ❑ Other.
(Maximum Effluent Particle Size Yd in dia. C NA other - _ -
Other 7- NA
- A Olhe,
❑ NA
"Values typical for domestic wastewater and septic tactic effluent Other: - -
❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Ilnspeci condition of tank(s) At least once eve, ❑ month(s)
y' ~~ijyear(s) (Maximum 3 years) ❑ VA
!Pump out contents of tank(s) _ i When combinod sludge and scum equals one-third (Yd) of tank volume U NA
Gnspect dispersal ceN(s) At least once every: O months} (Maximum 3 years) C NA
;lean effluent filter ear(s)- -
. At least once every : ❑ i(s)
year(s) ❑ NA
nspect pump, pump controls & alarm Aleast once every: ❑ month(s) -
❑ year(s) IN A
=lush laterals ang pressure test I At least once every: O month(s) _ A
C year(s)
,5t-h,5t-her.
A: least once. every J month(s) -1 ye r(s) N
A.
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal ce,is shall be mace by an individual carrying one of the following licenses or certifications: Master
Plumber; Master Plumber Restricted Sewer; POWTS inspector, POW7S Maintainer, Septage Servicing Operator. Tank inspections mast
include a visual inspection of' he tank(s) to identity any missing or broker hardware, Identify, any cracks or leaks, measure the volume of
~*mbfned sludge and scum and to check for ary back uo or ponding of effluent on the ground surface. The dispersal cell(s) shall be
visually inspected to check the effluent levels in the otuervatun pipes and to check for any pending of effluent on the ground surface.
i'he ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local
I-egufatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third (Y,) or more of the tank volume, the entire contents of
the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin
Administrative Code.
Pit other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units,
and any servicing at intervals of 512 months, shal' be performed by a certified POWTS Maintainer.
R service report shall be provided to the local regu:atory authority •ailhin 10 oays of completion of any service event.
page _of START UP AND OPERATION Products or other chemicals d*t
For new construction, prior to use of
may impede the treatment process the and/or POWTS damage thdlecle dispersal cell(s). s) If for h r9 ~ h copresence Of Painting ncentrations are detected have the contents of the
tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infittrative surface. ter w
During power outages pump tanks may 511 above normal highwater levels. Whan power is restored or the surface excess discharge wastewater will be
11 be of efflueni discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup power to the
restoring
To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to
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 tanks and dispersal cells. Do not drive or park over, or otherwise disturb or comDaa'
15 feet down slope of any mound or at-grade soil abi area. d prolurr life of ft POW ffi: the Reduction or elimination of the following from the wastewater stream may
improve the Perfo andid prolong ants, nts; fat; foundation drain
anthotks: baby wipes; cigarette butts: condoms; cotton swabs: degreasers; dental floss; diapers:
(sump pump) water, fruit and vegetable peelings: gasoline: grease: herbicides; meat scraps; medications: oll; palimting products;
Pesticides; sanitary napkins: tampons; and water softener brine
ABANDONMENT
shall be taken to insure that the system is property
When the POWTS fails ari is permanently taken out of service the following steps
and safety abandoned in compliance with chapter Comm x3.33. 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 property disposed of by a Septage Servicing Operator.
• 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 compliant
If the POWTS tags and cannot be repaired the following measures have been. or must be taken, to provide a
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement sod absorption system.
The replacement area should be protected from disturbance and compaction and Should not be infringed upon by rec uiiled
setbacks from existing and proposed structure, lot lines and welts. Failure to protect the replacement area will result in the need
ant area. Replacement systems must comply with the ruler in
for a new sod and site evaluation to establish a suitable replacem
effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technolugir e
holding tank may be installed as a last resort to replace the failed POWTS.
-slte has of been evaluated to identify a Suitable replacement area. Upon failure of the POWTS a soil 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'am 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 mfittrallve
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 TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name Name
Phone [Phone (r,
SEPTAGE SERVICING OPERATOR P MPER LOCAL REGULATORY AUTHORITY
Name Name J~. i.Q
i X
Phone - _ J Phone j
Thu dOwnerd was drafted in compliance with chapter sps 3a3.22(2)(bX%d>&(f) and 383.54(1). (2) a (3), VYlsconsn Adminietrative Code.
Ck0[X COUNTY ?,ONING OFFI'C6
FOR UTILI ('FR'O"N F1CATSON STA'PEML;Ni.t.
Nt OF AN EXl'S'l'ING SEPTIC TANK
=3 Yc,
"c'r4V.i11q r.hE, j l.ty that I 1,,, e inspected the s
ePtir' tank presen±..i v
Section Z residence - ---Z--
ri _'.OCatr~cl , .
t}t,-, tank - Upon inspection Tow),
nd battles to l cert.iPy that
runction, n I have found
y properly e in 90od condition, and it appears
rune serviced:
d Ll.ow bac occur prom absorptiorl -
Ye;
ldt: (Zp system?
, p next: li)
+i~1~Ynx irnatt voa kale or lea no sk i ne
pt-tt of time:
tr,i.nuz,-.,
C,ns'truct.ion:
Prefab Concrete X` ,
";nufacturrr; _
(1p known) Steel Other
: - -
/ Dank (re known: /~?a
~jjt p)
- _ J~
(Name)
5 ) .lease print
- 1 nse z 6 jo
(t,zce
dumber)
r`'rtn tc be ~mpleted by 2
Statutes) loensed Cede or' Li. eased Disposer
Plumber
) (NR 113 C,•145.OF;, W..sc:ors,n
Wisconsin Admini.strative
(aPP:lyin9 for. sanitary permit.) Cert.ifi-cation:
ar..cepL.i.ng ;-he above statement re
c;er-t;ify that the tank to t
rm ga.rding existing scl.~tic r.a;tk
o b
requirements of T best of MY k:
i nconsifctcl..L tot,o the openinq
LHR t33, Wis, lo vl~dpe i
/ vc:r outlet- battl Adm. Code (except-. for
Name
iynatyrr
Mn/JMPRSz7-
~Y" V
S1- CROIY COUNT I
SI PIIC ',A-NK NlAiN'I'J_?NANCI! .t(?ILtiL-N4LiN I
AN"D
OWNFFLS111p CFRTIFICATJi iN FORM
Owner/Buyer j w tiJ
MailingAddressS?7_
PropcrtvAdch'ess
wet ification required from pianniar 7.unmg Dup-ar t,rlent tiu new : onst:ucuon) -
City"Statc_ l'ac'e; Iucnli[ication Nm fiber 6 'Ilb -~L6 - 606
LEGAL DESCRIPTION - -
r3
Property Localior,
76 N1L ZO W'.1'ownol TTJt
Subdivision Lot #
Certified Survey 1\Iap # - - - Vt luute r-
- - - -
~ JJ d - ~
Warraute Deed Volume Page t
-
sp,c- hoosc yea no q iur: idectdhtblu vcs no
SYSTENI NLUNTENANCE AND (INNER CLRTJJ;WATI()N
Improper use auC u>dinteuance nl your scl c stem cunld r cut! W hk; pencunrr Hahne- to hatdh wastes. Proper
mai.ntenauce consists of purnping ,in the septic. cant c,,, three years o_ soamr. iI needed, by a II ccnsecl puugrer. Whal You pat ru!,
the, mitem can affect ire limctio_t of the septic rrtrk as a keaimcrn s,ngc in the :vasre disposal systetIL Owner maintenance
tusponsibilities ate specified in Wnrttm. 8S i.'i2( I ) and in C7haptet 12 - St Croix Citumv Sanitary Ordinance.
'fbe property oyvneh agrccS lo submit to St. i'unx Count? plann:r;il & Zoo, an• De artmcut a oct Iilicadot: tout
owner and by ~ - ~ , P 6 sighed by (he
a master phunhcr,,µmmcynhan pum ns. resU)rd plosd t rr t hcete:ed ptmrpc to nty'u:g that (I) the, on-sae
wastewater di pusal system is in pcup`r opera: ng• conditlo n dnr (21 ,ti r 11,pu.:ion and pump a; (it necessary), the septic tank is
less than U? full of sludge.
Pwe, the undershened h::ac Iead iln:::anrv tecu I,(-,) t~ and g .cc Iu mair taut d:c privarc >ewaKn disposal :,ystcIn with the
srnnowds sell forth, hchcir_, as set by (tic D,par: r nh of l'ir hmcte.c :me the IApanrr c:nt of Natural Acsotuccy Statc of Wisconsuh.
Certification stating that your septic system has, I cc t it ahnamcd must he complehsl and u-cnuned to the S!. Croix Comity Planning r'r
Annul; Dcpattutent within 34) davs of -,tic Il.rco Near uxpiranon date.
L'wc certify that all S Acmenls oil rI s fain an- Lill' to the bcse of uryrout kmhWledyte Ilwc anu'atr the owttat(s) of the
pntpcml described above. by vutue Of a w• anty cited rocorducf ut Regtstet of D(.v, Is Office.
Number of bedrooms .1 _
l
AW(jg-I~J ~ R-L c F' APPI-J<'A NT(s) llATF
***Any intounation that is nrisrephrscuted may resit: in t!!e sanuat? pe.Inut being n+voked by the, Piatually & Zoning Depauulcin
Include with this appacation a tecnrded waranty deed hoin the. Registu of Deeds Rice and a copy orthe ratified survey map if
reference is made m the war:aniv herd.
(REV. 08105)
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wisconAnDepartment of Commerce
PRIVATE SEWAGE SYSTEM ounty:
satery and BuBdings Division INSPECTION REPORT ST. CROIX
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary~~r~1~g3
Personal information you provice play be used for secondary purposes (Privacy L , s.15.Dil(1)(m)).
Permit Holder's Name: Gt VillagC Town o : State Plan ID No
BECKER, BRENDA TROY
CST BM k ev.: Insp BM E ev.r 8M Description Parcel T
l0( I , t r Urh=1151-40-000
TANK INFORMATION ELEVATION DATA A9800407
MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic V J I e S W' l 0 0 0 Bench ZQ pr/ 3 p/
Dosing
Aeration Bldg. Sewer /00.7 y
Holding - Inlet q OAF 00.2
TANK SETBACK INF TION SOW Outlet y, ~ aJl
TANK TO P/L WELL BLDG. AiVrtntake ROAD Dit Inlet
eptic _ a 2,4' 30r NA Dt Bottom
Dosing NA Header I Man.
Aeration - NA Dist Pipe 9'• 8 9.i67 ~`/S"9,F
Holding Bot. System II t l I,-z3
PUMP / SIPHON INFORMATION Final Grade G .qo 97
Manufacturer and r 2•¢O 10/. S
Sa.
Model Number _ GPMI
TDH Lift _ to em TDH Ft!
Forcemain Dia Dist Towen
SOIL ABSORPTION SYSTEM
ED/ NCH Width , ; ength Mo. 01 Trenches IT No Of Pits Inside Dia. Liquid Depth
_
QIMI< 3 473.7 51 2_ IMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHIN M -
INFORMATION Type , - CHAMB Moe Number:
cyst - 11 12 5 OR UNIT
DISTRIBUTION SYSTEM F
Meaderr~f niyld X Distribution Plpettjrte a, xHolc ae xHole spacing Vent To Air Intake
I ength ~7.5 Did j I Length 03-/J yg. Spacing X.~ elik 120
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of~ xx Seeded I Sodded v Mulched
Bed! Trench Center Bed:Tren<h Edges I Topsoil ❑ ycs n No Q Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) $olr.3obA ~~qSA✓/+'
f1
LOCATION: TROY 23.28.20.583A,GL3 150 GLENMONT ROAD c3t~
IRG ~f Yom W W heaelev-
~nal- gl2'~~B
Plan revision required? (]Yes C~(`No
Use other side for additional information
SBD 6710 (R."7) Date Ins actor's Signature Ce o