HomeMy WebLinkAbout020-1112-90-000
V.4s>ons, n DePUnrne•tl of Comme,w PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and 136ildmg Division
INSPECTION REPORT $erIlay PCln@Nu
607002
GENERAL INFORMATION (ATTACI I TO PERMIT) Slate Plan ID Na
Personal mtn.,matirr you provide may Pe used v scccc'^dary purposes IPnva-y Law S 5 C4 ;1::,)
Pound Rude- s Nara City V Rage Tnwnsrip Paice Luc No.
Paul Congdon TOWN OF HUDSON 020-1112-90-000
CST Rh1 Flev 1 Insp UM t lev Utl Descu Pliur. SechontTon•MRangwMap No.
/00 ~e nc re 1e- L.e yS r 12.29.20.458E
TANK INFORMATION ELEVATION DATA
TYPF MANUFACTURER S CAPACITY SI A I ION HS lit FS ELEV
Septic W 2SQ(` T,., Al - s r /Dop Qenchmalk I SS Y6(-54 166
L rek IZZ Alt. BM ~1~. t e 3,(01 r7gip
Aeration Bldg Sewer /
Holding St/Ht Inlet
ti,4 9z•13
TANK SETBACK INFORMATION St/Ht Outlet
TANKTO P/L WELL. BI DG III Arlr ra`e ROAD Of Inlet \
Septic z! Dt Bottom
~+9 o I r-
Dosing HeaderrMan.
Aeration Dist. Pipe
Holding Bol. System !
PUMP/SIPHON INFORMATION Final Grade
~i 04
Nianufeaurer Demand S! Cover
5.0 ol ~I ~l . q`
Model Nu :r
I DI I Lift Fnelion I oxs System TDH Fl
Forcanar, Length Dla D fl
ro voeu
SOIL ABSORPTION SYSTEM
BEDITRENCII 01 dth Lenolo Nu O' aches PIT DIMENSIONS No Of POP. Inside Da Liquid Depth
DIMENSIONS i > >
SETBACK SYSTEM TO HI DC WFLL LAKESTREAM LEACHING ftanulnrlurer
INFORMATION CHAMBER OR
Pipe Of System
5 1 S7 /06, UNIT Model Number
DISTRIBUTION SYSTEM V lill
Header.Manifold Dixtritulan x Bute Size X Hole Spacing VCNO Air Intake
14,.;51 rL~I
I ergth Ilia ICng1h Ua Spaunc
SOIL COVER x Pressure Systems Only xx Mound Or At- rade Systems Only
Depth Oscr De Plh Over xx Oepfh nl xx Scccoui SuJ:k>a xx MulMen
BadTrerc,. Ceri RedlTrener Fares TVpSu,
XI ;-f No
gs s Nu
COMMENTS: (include code disc ncies, persons present etc) Inspection At Inspection #2 (//J
Location: 1034 HWY 35 J.:4 ,..rYov..~-~j'
1 1 Alt HM Description
2.) Bldg sewer Length - Z ! C~OL•~HS
amount of cover -
Plan revision Required? Yes No
Use other side for additional informatt q7
SBDE71C !R 3,17) Date In se pr.Io0i.qnalL.re Cerl. No.
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S Sdfe(v ow! Buildi-gs Dvision /r
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r} 9S 1-i ~1F 2 Madison. W4 53707-7162
07602
Sanitary Permit Application VV Gt 11 1 >a, "amhrl
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SEPTIC TANK 1 EPLAC'ENIENT AND EFFLCENT FILTER
INATALLATION FOR A TN%O BEDROOM RESIDENCE
Owner's Name Paul & Irene Congdon
348 Ilighyicw Rd
Hudson WI 54016
Properti address 1034 Ihyp 35
Located in the NF. of the SNN' Y of Section 12,,r 29 N, R 20 W.
TOWN OF HLDSON
ST CROIX COI, NTY
Parcel # (120-1112-90-000
Prcyions Permit File not on record... Assuming code Compliant
For Home built 1963 (Real Estate listing)
INDEX
Page I Index & Title
Page 2 Plot Plan
Page 3 Septic tank specifications
Page 4-5 Owner's Manual & Management Plan
Page 6 Septic Tank Maintenance agreement
Attachments Warranty decd
Test of soil %eperation under dr%well
Prepared B~ Michael Rodcwald
285 County Road SS
River Falls N11. 54022
715-821-6229
_NIPRS 931384/
Design Pursuant to:
IN-GROUND SOIL ABSORPTION COMPONENT MANUAL FOR POWTS
(VERSION 2.0) SBD-10705 P (N.01/01; R. 10/12)
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pagc y Fit 41
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner PIf LC L Septic !ank Caparitl' _ gat LJ NA
Fe,nh E l 17c Seu'ir, a-tk Man;rfactu:w
6u; ~ 5 iL C NA
DESIGN PARAMETERS "cf°luan: Filler Manufacturer NA
!Jumper of Bedrooms 2 _ C NA Effluent Filter Mode! _ L Z J NA
Nw.rinf of °ubh Faciii y Units ❑ NA Pump Tank Capacity gal f3'NA
Estimated flow iaveragel gapday Pump Tank Manufacturer _ C NA
Design !low ipeaO, (Estimated x 1.5i 5 0v_ _ gaUday ?amp Manufacturer 7 NA
Scil Application Rate _ galiday/ft' Furno Model C NA
ancard InflucnltEf iuun< Quality Monthly average- Pretreatment Unit C NA
'rats, Oil & Grease iFOGI 530 mgiL = Sandi3ravel --i te- ❑ Feat Filter
Biochemical Oxyg`r Demand 130D,1 '220 mgiL. C NA bleahanical Aeration ❑ Wetland
Tota' Suspended Solids ;Ti SS, 15 C- my/L C Disinfection F3 Other:
Pretreated Effluent Ouality Mont.niy averag Cispersal CelNsi 'I NA
Biochemical Oxygon Dernand (BODE! 530 mgiL Wn-Ground ?gravity! WAE In-Grounc ipressu:izadl
Total Suspended Solids (TSS; -30 mgiL 7 NA ❑ At-Grade 2 ❑ Mound
Feral CoWnr.n !geometric :Wean; 5'.0' cfur'100rni C Drip -Line L3 Other:
Iviaximum Effluent Particle Size in dla. ❑ NA 01ner ❑ !J.4
C NA Other G NA
"Value: typical for dunitc;t v: aswv:awe and septic e°mem. Other, 7 N4
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tanKlsl At !cast ones ovary: ranth,sl
(Maximum 3 years) Ll N4
'ump out contents o'tani;(si ':':'hen combined swdyu and scum equals une-third fi,i of tank volume G NA
inspect dispersal calks At ieast once every: y J monthlsi yearisl (Maximum 3 years) ❑ NA
Clean effluent filter ! At least unca eve-,- ~u?N C months; 7 NA
Qyearist 4 C/,,i, .1>
Inspect onihsi b(j' iO j j"r drt CW tC
pump. Pump controls S alarm At least once eve'r': G yams! O NA
Flush laterals and pressure test At least once- ev[ry.: ~ monthisf
❑ NA
❑ Vearls!
tither: :7 mon;d~si
1 A. cast once Query: ] yearls` C NA
11 NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cel~s shall !:e mane oy an individual carrying one of the following licenses or certifications:
Master Plumber; Master Piu:nbe! ResPicted Sewe-: POW IS Inspector, i'OVy IS Ivlaintamer, Sep-,age Servicinc Operator. Tank
inspections must include a vista, insoectior. of we lanklsj u: identify any missing or !woken `;ardvtars, identify any cracks or Icaks.
measure the volume of comoined siudge and scum and to check for any bacx up or pondine of effluent on the ground surface.
Th dispersa! cellist shall be visually inspected is check the effmcn: levels in the observation pipes and to check for any pending
of eCluent on the ground surface. -ne pending of effinunt 111E g-ourc surface may indicate a failing condition and requires the
immediate nom cation of the local regmatory autriorr%.
,'hen -he combined a:curn;:lation of si,!dge and scum in any tack equals one third or mole of the tank volume, the antra
conter:s of the tali: shall De removed by a Septage Servicing Operator anc disposed of in accordance m•i:h chaptur NR 113,
''lJisoonsin .4dminisL-ative -one.
Ali other services, including bur not limited to the servicing of effluent filte-s: mechanica or pressurized components. preveaim=.rt
units, and any servicing a intervals of <_12 months, sra:l be pe-formed by a certified POW-S Maintainer.
servi-,e repor sha:l be provided is the loea. rvqulato-v authority •vetthin IC rays of completion of any service event.
Pate 5 .1,
START UP AND OPERATION
For new construction. prior to use of the POVv-S cnem: ttealmem tankbil fa the presence of painting products or othe: chemicals
that may impede the treatment process andior damage tine dispersal celbal. If high concentrations are detected have the contents
o` the tank(si removed by F. soDtage servicing operator prior to usc.
System start up shall not occur when sail conditions are frczen at the infiltrative Surface.
During power outages pump tanks may fill above normal hignv:aier levels. Vs'hen power is restored the excess wastewater will ae
discharge= to the disperse celltsl ir. one large dose. overicading the colllsi and may : esult in the backup or surface discharge of
effluent. To avoic this situation have the contorts Of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluont Du:np or contact a Piumher or POWTS Maintainer to assist in manually operating the pump controls tc
restore normal levels within the pump tank.
De not drive or park vehicles over tanks and dispersal cells. Do no-, drive or park ever, or otherwise disturb or compact, the are:
•,m•ithin 15 feet down slope of any mound or at-grade soil absorption area.
Heductron or elimination of the following from the wastewater stream may improve the oorformance and prolong the lire of toe
P')14''-H: antibiotics: baby wipes: cigarette butts; conclOrns; coton swabs; d-'greasers: dental Ness; diapers; disinfectants: fat;
fu,mdaiion drain sump pumP~ water f pit and vegetable peelings: yasoiine: grease; herbicides; meat scraps; medications; pint
painting products: pesticides: sanitary napkins; tampons: and water softener airing.
ABANDONMENT
d:`i)en the POYvTS 'ails andior is pennanoctly taken out of service the `,allowing steps stall be. taker. m insure that the syste.r is
prop- dy and saioly abandonec in comphan::e with chanter Comm 63.33 *tsconsin Administrative Cone:
• Ali oiping to tanks and pits shall be disconnected anc the abandoned pipe openings sealed.
• 'he contents of all tanks and nnS shall be remove= and properly ddspocad of by a Septage Servlcin.c Operator.
• 4fter pumping, all tanks and nits shal' be excavated and removed or their covers rernovoc and the void space filled with
soil, gravel it another inert soiid material.
CONTINGENCY PLAN
:f the PDWTS fails and cannot be repaired the following measures have been, or must be taker., is provide a coot compliant
replacement system:
71 A suitable replacement area has been evaluated and may tie utilized for the location of a replacement soil absorption
system. The replacement area should be protactec from disturcance and compaction and should not be infringed upon by
•equvec sczbacl:s from existing and proposed structure, to.. lines and wells. Failure to protect the replacement arre will
result in the need for P. new soil and site rvalua:ioc to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacenont area '.s not avai;abie duo to setba::k andior soil lirn:iatiori Barring advances in PCIATS
tochno.ogy a//holding tank may be installed as a last resort to replace the failed POV97S.
~i qle r+C f'L e. arnr.a ArteA #0; vS, JCo,.~ C vita Igo sf 7a.1 gym.. t
d/1.' /;C is vr..j ,f 1yS/: ..e ~-.v~.+.ZC• d ir..l~ lilt ne~,~~.h r.,~ i. F.- Ct~
'Z 7C ~c'fr.rrPSrU
❑ Mbjnd antl a:-grade soil absorption systems may be reconstructed in mane tonowlrg removal of I:•ie biomat at the
wflt-ative surface. Reconstructions o~ such systems must comply with me n:ies it effect at that time.
t < WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDiOR 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 D Namc X4
L q2 S- C
Phone 2~
SEPTAGE SERVICING OPERATOR fPUMPERi LOCAL REGULATORY /AUTHORITY
Name l S ' f Name `~T• C- _ I - ~CYJ ♦J~ 201,,~ ; F.l
'.ii Ja,rrr"Ilt a. .f J:cc. it onu.i.:rr_e will, chanter m. one X5.54+1!, ;21 & ;31. L -.,tuns:r Aoministanve Code.
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START UP AND OPERATION
F:,; nuw• cons:ructior. prior tc~ use of the "-A% --heck treatr,ex tail:;s~ inr :iw pie~once of par iinp pr:,der,.;: r. otner ener is
tr,x may inoude the treatment p,ocess and,x dar:age tix; dispersa' cellls;. If high surluowratiors are ne:ectad have the contents
trip tankis,, reinovcc CV a --an-,age se-vxinn inis al or prior io L•sL.
Syslom start up shali not occur when soil --ond:ticnr are t~c:7+in a: the in!ihrat:ve surface.
.jun11g powe• outages pumc tanks :nay fill above norma hiphwatw levels. V:'nen Dovre: is restore- the excess wastewater wilt be
d!scnarged 17. tim dispersal -elks! it one lArpe dcsc, ovoroading the pelhs; anc may resin. in the t;ackup oI sirface discharge of
e.=fluent. 7c avoid this sir.cation rave the contents of the min:: task removed by a Septage Serv;ainc Ope-atD- prior to restoring
boww to the effluent pump or carract z Plurribcr or ?Dl•V-S- Maintainer t:: assist in manually operating t•re Dump =ontrois to
restore normal levels within the Dump :arli-
Do not drive or park Vahigirs ova- tanks and dispersal cells. Dc not cinve or pare aver, o: other !Se distort or compact, the area
wltnin 1E. feet nova: slope of ary mound or at-grade soil acs D-Dnon area.
Redur:hor or climir.atior of vie fullowing worn, the waste•mate, struarr may improve the performance and p-piong the life of the
POL'vTE: antipiotigs baby wipes. cicarntta butts; condoms: co-tor swats; degreasers; dental floss: --rapers: disinfectants; fat;
touncation dratn tsump pmm)o -.sate;; turf and vegetan.c sanitnps: gasoline: n-eas-; herbicides; meat sc•aps; mddi-ations: oil:
5aintinr p~oox.,ts; pesticides; sariitary napkins: tampons an". vaater softener br:na.
ABANDONMENT
Vdnen the POVti-S fails andmi is permanently taken out o` swvics the foLowing steps shat: be :ai:ec 1c insure :hat the tryst=s is
nrope:riv and safely a0and0ned ir. ccmpiiance. with ::hapter Comm 83.33. Nrisconsin Administrative Code:
• All piping tc tanks and pits -.rail tie :isci),mucted anc tr•e ananduried pipe openings scaled.
The contents o- at. tanks and nits shat oe remove- and p-oOarh• disposed o'. by a Septaoe Se~vicing ODerator.
._..._.e"_ t. a .r>ld. c~--~ iaied ..~Kb
Rile. vuu,:af,4. tan;:,r aAd'y a a•mu
SDI[, gr3Vel or an0the' Inert Spad :nata:,al`
CONTINGENCY PLAN
If the PDVVTS fails and cannot be repaired the fp:Iowing measure, have beer, or must be taken, tc provide a cope compliant
repla--email system:
❑ A suitapie replacernunt area nas been evalra:ud and rc.ay be utilised for tie iocaticn o` a replacement soil absorption
system. The replacement wea should be protected Now d:s:urbance anc comOactior anc shnuic 1107 be infrinped upon. by
-equirec setbacks fron, °Xlsthg and propesud structure, ix lines anc wells. Fanive tc protect me rep;acumew area wil
-esuh i; Lbe nee- is a now and sit.. wvawanoe to Dstaplist a :un=able rep:agemaw area. FaD.a:aman! systems must
compiv with the r-,ies in e`iuct a: t,at time.
❑ A suitable replacement a'ea is not ivai;aole dae u, sctbac,: and:x sni'. lim;taapns. Barring advances it PO1A'7S
technology a hoicing tans: may be ins;a:.ed us -last resin is replace the fade.^: oDVV7
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wt C-4~,Zcc
Z OL De4 1~1;.eJ
17 Moun- and at-p:adc soi absorpton systems may be raronstructed in place i3nowing remova: if the biomat a; the
111E.vatfvc surtaca. FDCOnsruc:IDnt. of s C:,l systea_ mw: ccmpn• with :he ru,er. in effect at that time.
< ¢ WARNING;
SEPTIC: PUMP AND 0 rHER TR=ATNIENT TANKS MAY CONTAIN :ETHAL GASSES ANDrOR INSUFFICIENT OXYGEN. DO NOT
ENTER. A SEPTIC. PUMP OR OTHER TREATIOENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BF UlE-)--UI-7 OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POV1?S INSTALLER POWTS MAINTAINER
Name / Yr c c k ec. :n-
'none '7/_j - q2 3 'C 2-c-u
SEPTAGE SERVICING OPERATOR fPUMPERI LOCAL REGULATORY AUTHORITY
name ; t /y 5 ~rc am
ED
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ST. CROIX COUN'T'Y
SEPTIC TANK M:11N1 GN:INCI: a(iHl.I.Nll-.N'I-
AND
OWNIfRSI11P CF.R"fIF1C'ATION FORM
Owner/Buvcr ,
Mailing Address t C/t•/(•
Property Address
1 Verification required from planning & Zoning Department for new construction.)
C'itsdStn[c ParcelldcntificationNumbcr C°-
LEGA1. DESCRIPTION
Property Location,!') ba . Sec. . T_N Town of ---/J ,
Subdivision Plat: Lot If
Certified Survey Map # Volume Page #
Warranty Decd # ~u - (before 2007)Volume _ Page k
spCC house❑yeslalo Lot lines identifiable ZIes❑no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintcnancc of your septic system could result in its premature failure to handle wastes. Proper
mramten:uuc consist, of pumping out the Septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
die ;csteni can affect the function of the septic lank as it treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §SPS. +81,5211) and in Chapter 12 - St- Croix County Sanitary Ordinance.
The property owner agrees to submit to SL 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 verilying that I I I the on-site
ksastewater disposal system is in proper operating condition and or (2) after inspection and pumping 1 if necessary), the septic lank is
le, 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.
Slate of Wisconsin. Certification stating that your septic system has been maintained most he completed and returned to the St. Croix
ounty planning & Zoning Department within 30 days of the three year expiration (lale.
f'wc certify that all statements on fln tivm are true to the hest of myr'our knowledge. I we amwe the ownerls) ol'Ihc
properly described above, by virtue of a warr my decd recorded in Register of Decds Officc.
Number otftedrooms -
SI(i 'ATIIRI: FA PP], I CA N I )S) I),•1rl'E -
Any information that is misrepresented may resuk in the sanitary permit being revoked by the Planning & Zoning Department.
Maude 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 warrant' deed.
t REV. 04r'121 /I
I'
Wsconsin Department of Safety and Professional Services
• Diwvon.of Industry Services - I
SOIL EVALUATION REPORT Page I of 2
in accordance with SPS 383, WFS. Adm. Code
County ST. CROIX
Attach comppµ~~~~ee ~SitA~l3n~0Aper not less than 8112 x 11 inches in size. Plan must
include. but rR iimited to: vertical and horizontal reference point (BM), direction and Parcel I_D. 020 - 1112 _ 90 _ 000
percent slope, scale or dimensions, north arrow. and location and distance to nearest road.
_ please-priat all information. Revie by Date
Personal information you pronde may he used for secondary purposes(Povacy Law. s. 1504(111m)) I A48
Property Owner Property Location e 11 El
PAUL J. & IRENE M. CONGDON Govt. Lot NV 114 SE 1/4 12 T 29 N R 20 E (or) Property Owner's Mailing Address Lot # Block # Subd. Name
or CSM#
349 Highvicw Road
City State Zip Code Phone Number ity [:]Village • Town Nearest Road
Hudson, WI 5,1016 ( ) S.T.11.35
New Construction LlseQ Residential! Number of bedrooms _ Code derived design flow rate _ _ _ _ GPD
❑ Replacement Public or commeraal Describe. _
Parent material _ candy Flood Plain elevation if applicable
General comments r )mow aJF.LL,
and recommendations Hoeing required by County to verify soils at existing system.
PROPERTY ADDRESS: 1034S.1.11.35
F] Boring # El Boring
Pit Ground surface elev._ y5-t) 8. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP0tf _
in. Munsell Ou. Sz, Cont. Color Gr. Sz. Sh, 'EfWl 'Eff#2
110-115 ltvf~~/5 _ e. ,r ~I - 6r7 /.tv
AM-
fl -
v
F-1 Boring # O Boring -
Pit Ground surface elev. ft Depth to mating factor in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlfr
in. Munsell Ou. Sz. Cont. Color Gr Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BOD• > 30 < 220 mglL and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mgr. and TSS < 30 ffWL
CST Name (Please Print) Sig CST Number
b1ARY.10HUPPER'1 Hollister'sSoilTestin+&Desi n f ' 224832
Address - Date Evatu i Conducted Telephone Number
28497 King Arthur's Court. Danbury, WI 54830 12 - 21. 2018 715-426-17 75
1051 _5T, H. 35- lam.
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