HomeMy WebLinkAbout004-1012-40-000 (2)
PRIVATE SEWAGE SYSTEM St. Croix
Yalu nd R.u :iu,9 C r
INSPECTION REPORT P,,,l N,
GENERAL INFORMATION A- ACI • To P7RIA[Ti S5" -Zol -6
;;a:c Plan m ~r:
-nal inl r,alC "g FpvuBl,9 1-u=rato"cCOnaa:y:>un 1,nr::n
pr-n'.' Ilomr, PGmr ~,r~ NYiila;>r -o.'ncrnp I'd'ce la, Nc
Dustin Klanderman TOWN OF CADY 004-1012-40-000
RN Elr-v n~D SM Eicv EIM L pl,c, becbom iox~;=,anac~l.tap tar
O~r S -I L I In 06.2815.82
TANK INFORMATION ELEVATION DATA
_YPL Ivl4N_i AG fUR.F. ?:APri;l7) SIA IDN 3S tt F_
I
NBDLC liCIlCnCiar Y,
IZ50 15 `lr1•S 1£~f 3
7'o5rn9 7~✓CU All BIll
Cart::.
neratlon 3uiy SoW;:; qz;"- .
IluldntG 51!H'. inlzt
4UH; OuIW..t
TANK SETBACK INFORMATION
TANK TC: :'VLLL BLOB i 'Jem l Ail imaxe BOAC UI Inlcl
03 t,,J o i->,1_ e J
7 7 ,5 J DI 6o1101T
SS
Daslnn I I~aaeNL1dn
t.etainx Dist. PIPE
'ini;lmo Got Svslcm.
PUMPfSIPHON INFORMATION Final (;:ane
,
hVa9JfaG1aler p 1kfma'xi S1 Covet
_ _ ~e~.L c1}S i Pt:
AIUCiU NJ 1nJCi ' P
B! I Lill 4 ncbo'I ass !iyslcni if AA T'?H -t
-utCC,Gam Lcnyll' :>ta ou.1 e_ _
SOIL ABSORPTION SYSTEM
BED;IRENCH v: vtt• .engN Nc ,t PIT DIMENSIONS Rn- i.iu mspr _ia _ and L::-p.,.
DIMENSIONS
S1,1BACK SYSTEM I U - . 9111:; v,&i I AKFi ,-.I P, Atli L EA'_n1NG 1.1a-,Ra aur'
INFORMATION _ CHAMRFR OR
'iec C"or=tem
lIN1T Llece tJU',ti•"
DISTRIBUTION SYSTEM
-.1 +rrrraa G,-tr[aiL~r s.1a5 Ctzc i,=.: ,sang-ni qi vi,r-
p- g
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
-,,.r,n -•r. I -,_-:m,-,.• ~Lntr
:d o -rite T-, .:ul
COMMENTS: jlnGadc c:xie disrrepumaes, neaaae ores=n'. N.c inspection bl Icsp;•:aio i GJ
Location: ,-Yt• 601 H A-F
Ga J e~-
i AH BNt Des: npBnn = /
7 1 Bldg sevmr length - CJ
G-
;tan revision Required, "es < ( 10 IC~ ~71JJ4--~
Use olnor sldc to: ladilional 1:110r nalral'..
gas rsc:•-, Sio-s
SP.C-r,'tn iF d.v?:
S-Nv- poi `I -0S'V
_,rpl County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN
In accord will, Cha ue.r 1„ St. Croix County Sanitary Gdinance PLANNING 5 ZONING DEPARTMENT
Personal informaion you prmice may he LiSed for - . nda purposes ST. CROIX COUNTY GOVERNMENT CENTER
IPnvacy Law S. 15.04( 1 1101 WI chael Road
Hudson, , W 54016-7710
71 5138 6-4 680 Fax {715)386-4686
Attach complete plans for the syslem on paper rot less -1r2 x 11 inches in size.
County Sanitary Permit G ❑ Cbeck d revision v1 orevrous apDlica
'544 -2nl°1-o$'4
1. Application Information • Please Print all Information Location:
Property/ honer Name r V NJ 1+4 1;4, Sec
L 410 T N. R I~ c icih
Property Owner's Madmi Address Lot Number Block Number
N
City, State Zip Coup. Phone Nurser Subdivision Name or CSM Number
~'U 1) l,(- l G
II Typo of Building: (check one) / k LEi;y ❑ Village own of
$a I or 2 ramify Dwelling - No. of 8ecrooms: W
I7 PubbclCommerciel idescribe use):
❑ State-owned ZN SS oad
II. Type of Permit: (Check only ono box on line A- Check box on lino D d applicable;
Parcel Tax Numbar(s) ,
A) 1.❑ Hepair '{Q Reconnection Nonplumbing ❑Rejuvenation
Sanitation
B) Permit Number/' G Date Issu r
❑ State Sanitary Permit was previously issued 'T p Z~ g ZD i Z1Z
IV. Type of POWT System:- (Check all that apply)
Non -pressurized In ground r7 Mound a 24 In. suitable soil ❑ Mounn s 74 m. sutable soil Ll Mound A+(1
❑ R5nrTFTtUf- - - ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line
❑ Pressun<ed In-grouno ❑ Holding Tank ❑ Single Pass ❑ Otherl I- ,I
F1 At -grade ❑ Aerobic Treatment Unit ❑ Recirculating k I'"~ o v~
V. Dispersal7reatment Area Information: x` i+
I Design Fla+v igpdj 2. Dispersal Area 3. Dispersal Area 4. Soil Application Hale 5. Percolation Rate 6. System levalrun 4F in I Grad
Required Proposed Gals day sq ft.i Win. Zhi Ele~yvv-.ati!tion(
CQ C~ ~l'J Sr
VI. Tank Information Capaicty in Callous Total lot Manufacturer Prefab Site Con Steel Fiber Plastic
New l-xrs6ng Gallons lanrts /I Concrete strutted glass
Tanks Tanks za, b(4~-
x I I tit ❑ ❑ ❑ ❑
~r k YX- r ❑ ❑ ❑ ❑
VII. Responsibility Statement
1. the undersigned, assume responsibility for repairheconnencl,on rejuvenationinstallation of non plumbing for Ise POWTS shown on the attached plans. A
license is not required for terralifl repair or:he installabon non plumbr a• lion syslem.
Plumbers Name (pant) Plurnher i ore no ;fa, MP+MPrq No Business
Ppone7Number
Plumoers Address (Slreel, Cny, Slate. Ain Go el _
Ill. County Use Only
- DI Sanitary Permit Fee D to III APprovod -0 nor Inii erse 256 - p0 2 nation X. Conditions of Approval rReasons for Disa roval:
Pdt 66 A"e-A o,\, t-f o v~ ✓1Nw
Rev' 8 05
VAD (f-
I
i
V I ,
I ~ /'I I
I i ~ I
I i I
i I
CG~J o I i9N 12 0
oil-
AJ 4'
,S 1_Nr~PA__ o
- ! Ar- - ~fN_rS - -f -
~ I
I_. - -
I
Pip
; _ i I i I J I i I
,
Private Onsite Wastewater Treatment System
fide and Index Page
Project Name: \ ( A - ~ sj
Ok%ner's Name: ~S ~ i K, \4~ C/v n
Owner's Address: S _ 60 AJC
Legal Description: NW NF
Jlunicipality: Town. ❑ Village. ❑ City of C~ G7_
County: S~ .CItr,-
Subdivision Name: -
Lot Number: Block Number:
Parcel I.D. Number: CX,LA - JoIZ -LJ (:3 - DOG
Page I Title and Index Page
page _ -k -DA 11 1 _
Page ' rvln ^ yfi -
Page a
Page 5 r!YsA1N~
Page G z-~
Page 7 DLCC
Page 8 -
Page 9 /
Name of Designer: Telephone Number./S 156 712
License Number: 27Y~ Date:
Designed Pursuant 'Fo The Following POWTS Component Manuals And Comm 81-85
Page I of -
i
R H
oMA A o _ _
. - -
d
1 - -
- - - +N - - - - ' - -
i -
-IS !ej
LLC
200 Bremer Avenue. Suite D
PO Box 10
Colfax UJI 54730
Mav 1.2019
TO: Duslin Klanderm3n
FROM: Kent Hoke MP#224199ilIVAC 689549
RL: 2755 60u' Ave, Wilson, ",'154027
The septic system was inspected on April 300', 2019 at the above listed property. On the date
of my inspection the septic system was functional and in working order.
If you have any questions, please feel free to give me a call at 715-556-7621
Sincerely,
Kent Hoke MP#224199
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner lL f'
lei \0 LOU1CJC.V MO-I'1- Tank Manufacturer N ❑ NA
Permit # %Septic ❑ Dose ❑ Holding Vol gal
_ _ i2Cu
DESIGN PARAMETERS Tank Manufacturer 0 NA
Number of Bedrooms E ❑ NA ❑ Septic ❑ Dose ❑ Holding vol. gal
Number of Public Facility Units ❑ NA Effluent Filter Manufacturer ❑ NA
Fstimated (average) Flow - LAW gallday Effluent Filter Model
Design (peak) flow = (Estimated 1-5) (kc) allda Pump Manufacturer L10l,l~CS ❑ NA
In Situ Soil Application Rate C
gal/dayift2 Pump Model _ 1~
Standard InfluentlEftluent Quality Monthly average- Pretreatment Unit ❑ NA
Fats, Oil & Grease (FOG) --30 mgll ❑ Sand/Gravel Filler ❑ Peat Filter
Biochemical Oxygen Demand (BOD,) -220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) --:150 mgiL ❑ Disinfection ❑ Other.
Pretreated Effluent Ouaiity Monthly average Manufacturer
Biochemical Oxygen Demand (BOD.,) s3O mg+L Dispersal Cell(s) n NA
Total Suspended Solids (TSS) -'30 mg!l ❑ NA X In-Ground (gravity) ❑ In-Ground (pressurized)
Fecal Cokform (geometric mean) _104 cful100ml ❑ At-Grade LJ Mound
Maximum Effluent Particle Size In dia ❑ NA ❑ Drip-Line ❑ Other.
Other. n NA Other ❑ NA
'Values typical for domestic waslewaloi and sephc lank effluenl. Other ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
~U month(s) (Maximum 3 years) l7 NA
Inspect condition of tanks At least once every. year(s) _
PUMP out contents of tank(s) IS. When combined sludge and scum equals one-third (k.) of tank volume ❑ NA
❑ When the high water alarm is activated
Inspect dispersal cell(s) At least once every : . J ❑ month(s) (Maximum 3 years) ❑ NA
® year(s)
Clean effluent filter At least once every. j _ Z. ❑ month(s) ❑ NA
fi?year(s)
Inspect pump. pump controls & alarm At least once every: ❑ month(s) ❑ NA
_ ❑ year(s) _
Flush laterals and pressure test Al least once every . ❑ month(s) ❑ NA
❑ year(s)
Other. F1 month(s)
At least once every . n year(s) ❑ NA
Other
❑ NA
MAINTENANCE INSTRUCTIONS
Inspecticns of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications Master
Plumber. Master Plumber Restricted Sewer: POWTS Inspector. POWTS Maintainer Septage Servicing Operator (pumper). Tank
inspections must include a visual inspection of the tank(s) to identity any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and a check for any back up or pending 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 pending of effluent
on the ground surface. The pending 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 treatment tank equals one-third 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
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized Components. pretreatment units,
that require servicing at intervals of 12 months or less require documentation recorded on the deed regarding maintenance requirements.
A service report shall be provided to the local regulatory authority within 30 days of completion of any service event.
GMW(12!02)
Page. _ of
START UP AND OPERATION
For new construction, prior to use of the POINTS check treatment tank(s) for the presence of painting products, solvents or other
chemicals that may impede the treatment process and/or damage the soil dispersal cell(s)- If high concentrations 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 infiltrative surface.
During extended power outages pump tanks may fill above normal high water levels When power is restored the excess wastewater will
be discharged to the dispersal cell(s) in one large dose and may overload them resulting in the backup or surface discharge of effluent.
To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the
effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels
within the pump lank.
Do not drive or park vehicles over tanks and dispersal cells- Do not drive or park over, or otherwise disturb or compact . the area within
15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS.
antibiotics: baby wipes: cigarette butts: condoms, cotton swabs, degreasers. dental floss: diapers, disinfectants, tat; foundation drain
(sump pump) discharge: fruit and vegetable peelings, gasoline, grease, herbicides: meat scraps, medications; oil: painting products
pesticides; sanitary napkins: tampons. and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly
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 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
If the POINTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system.
O A suitable replacement area has been evaluated and may be utilized for the location of a replacement sod absorption
systern. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
Required setbacks from existing and proposed structure. lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology
a holding tank may be installed as a last resort to replace the failed POINTS.
❑ The site has not been evaluated to identify a suitable replacement area Upon failure of the POINTS a sod 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
n Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative 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
POINTS INSTALLER POINTS MAINTAINER
Name 4 N
. -F'/CtLLl_)tl.~}_-L Name H1 /J
l6(/}1/1/IL L.C_C
Phone Phone d/S - -C
SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY
Name Name
Phone Phone 15 , (o _ cE (o$ -
This document was drafted by the Chippewa County Zoning Department in compliance with chapter Comm 83.22(2)(b)(1)(d)&Q) and 83.54(1), (2) & (3).
Wisconsin Administrative Code.
ST. CROIX COUNTY
SEPTIC TANK MA[NTENANCE AGREEMENT'
AND
OWNERSHIP CERTIFICATION FORM
Dustin Klanderman
Owner/Buyer
Mailing Address 2755 60th Ave
Property Address 2755 60th Ave
(Veri fication required IPom Planning & Zoning Department for new construction.) -
City/State Wilson, WI 004-1012-40-000
Parcel Identification Number
LEGAL DFSCRIPTION `
Property Location NW y, NE ,
, ra . see. 6 , T28 N R 15 w. Tovvn of Cady
Subdivision Plat:_ _ Lot : _
Certified Survey Map Volume page
Warranty Deed # (before 2007)Volume Page d
Spec house❑yesEIw Lot lines identifiable Bycs0 no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists ofpumping out the septic tank every three years or sooner. if needed, by a licensed pumper. What you put into
the system can afi'ect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §SPS. 383.52(f) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. 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 verifying that (1) the on-site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 0 full of sludge.
Gwe, the undersigned have read the above requirements and agar: to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department ol'Safcty And Professional Services and to Department of Natural Resources,
State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix
County Planting & Zoning Department within 30 days of the three year expiration date.
Uwe certif)' that all statements this form are true to the best of my/our knowledge. Fwe am/we the owner(s) of the
property described above, by virtue of warranty deed recorded in Register of Reds Office.
Number of bedroo 4 >>'-L? URE `Y
DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include 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 warranty deed.
(REV. 04/12)
' 8JN'4(llSAM NVIN)FRINVIN
- i
7 A' y
'II
'y
3 a{
ll u~
T a:
y
Y
t III n
ly
11 1. .l
y
' 3.1N7C1IS821 NV1\21801\~ l?1
~ _ \1 \IIS, I,1 144
~a
~ ~ Q I
.1
,f 'I 1: I
1 (1
u,
t I
III,I'
7
1 ME
• II I
I ~ I
i1.il- •~'I it
I 1 ~I
i 1
{
i. IL
Wisconsin Deparbnpm of Commenw PRIVATE SEWAGE SYSTEM County S1. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Perml NO:
408275 0
GENERAL INFORMATION (ATTACH TO PERMIT) Sato Plan ID No
Personal information ynu provide may be used la seoundary purposes IPrn acy Law. s. t 5.04 (t)(ml).
Penner Polders Name Cily Village Township Parcel Tax No.
H(listead, Duane Cad Township 004-1012.40-000
CST BM Elev I Insp B" Efev: BM Descdolion.
fv• 3 46 • 3Z e cr'fs f,A.*- 2
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing AIL BM
u~2 F. 0.40. 1z C.etrsr
Aeration Bldg. Sewer r
1.1'7(-Zr 1..2.0 8Y-qwf
Holdirg SVH1 Inlet )2.951 'R4-3f.i
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Ve,dfo A,Inlakn ROAD Dt Inlet p f
Septic 5b h Z S 1 1 Dt Bottom 3 9O /3 • r 3.6 p
Dosing fr t, ,r Header/Man. zo I
3.63'
Aeration Dist Pi CQ
Qe 93.3*I
Holding Bot. System f:A r
q2.3?
PUMP/SIPHON INFORMATION Final Grade
3 `f I
Manufacturer mancr 41 Cover q
•
GPM1 Y. 3P 74
MWeI Numbor -r 1,V I ce.1
e~ &N • ?111AA 3.4fSr 3 ~4• a
o' H Litt r Fnchon Loss System Hood ,k1Ft -
7 Forcomein L I' DIM, Ir Cis! to We'l a /
z _ a. °16 e. 9
SOIL A RPTION SYSTEM j Er o
E CH Vidth Lonq, , No Of Tnenciws PIT DIMENSIONS No. Of File Inside Da. -xiuid Depth
DIM 3r 12S S r 2
it@
SETBACK SYSTEM TO P.11- BLDG WELL [AKIFISTREAM LEACHING cheer
INFORMATION CHAMBER Type fx Sysli,m > Z DO
r UNIT Modell Number z "
.Ise ~ III IL
DISTRIBUTION SYSTEM
Headw/Mandold N Diskibu6on • Bole sits • 11u1e SpauntI ent W Air Intake
Pi I) YI r
ldhglh - Dla_ _ Lm a Spaon
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Ow Depth Over xx Depth of xx SeedoNSoddod xx Mulched
(iedRmnch Center tsed/Trmen [dons Topsoil
IN1 Yes lisNo I■I Yes ■ No MEN , KiL A- T (e0 (IncJy9e cptfN Ql i en ' sr r ns present, etc.) Inspecuon p1: I 1 D Z Inspection
p2:
Location: 2755 60th {Avee! Wilson, W! 54027 (NW 114 NE 114 6 T28N R15W) IN Lot Parcel No: 06.28.15.82- -
1.) Alt BM Description = TT ' --5( "t
r Q ~f /f♦NJ, /
2.) Bldg sewer length= } ! z•qy _r~,,,.wt_
• amount of wvm = t H2 0PPIb+t! f
Plan revision Required? ■ Yes ><No C Lc,~ ~ -fTt Imo-/ ~ ll,
Use other side for additional information. I~1 11 - Z' 'Tr- 1~•'~ A
SBO.6710 JR &W) Date Insepdors Signalum - - Cat. No.