HomeMy WebLinkAbout036-1049-20-050
daxcu~rr ~°pann•_rt rf("on-iren-e PRIVATE SEWAGE SYSTEM r•"O°"t'' St. Croix
Sa'c I'1 a"d Buih:irC C.✓ISdC'i
INSPECTION REPORT S.arn.arit Permit N.1
GENERAL INFORMATION (ATTACH T,^. I'F !tt„11 1) State Plan ID Nu 615465
~wsenaI in'otmat on -in. me de -Jy M used lot se_nnnaN r_fp es IPr va.y _aw, s 15 . 54 1.; r::„
Perm I H°Ider'S Name GCy Vi age faxush p Parce. Tae No
Kevin & Cynthia Blader TOWN OF STANTON 036-1049-20-050
CV °JV EL^: pIiL91 c. :crnnr-
JCCt on I lar,~e; (eIJO N:GD 20.31.17.307A-50
TANK INFORMATION ELEVATION DATA
-vPE tvANl1FAC I URFR CAPA:A IY STATION BS HI FS ELEV.
Se:;UC Benchmark
Dosing Al! W.1
Ae'at on Bldg. Server
Holding SUHt lalot
SVI-t Outlet
TANK SETBACK INFORMATION
TANK TO PiL VVCLI BI U , Ve-t'.c a.lr I take ROAD Dt Inlet
Sep: c Ot BWon-
Dos n- Header.-Van
Aeration Drs: Pice
rice rq Bct. System
Final Grade
PUMPISIPHON INFORMATION
Manufacurer DeTard St Cover
GPM
Mt de Nurrcer
TON L'ft Fitton Loss Syston- Head I D11 I
o'cemar Lendth Dia C.sl roNleI
SOIL ABSORPTION SYSTEM
BFCe1RENCH vvd:h Ie-g'h No 0'1fe-.%fw, PIT DIMENSIONS No Olpls n;rce Dia laud Cepth
DIMENSIONS
SETBACK SYSTEM TO PtL BLDG WELL LAKE+STREAM LFACRwG Mjnufacfs'ur.
INFORMATION CHAMBER OR
l ype Or ,storm UNIT N10de N.nrher
DISTRIBUTION SYSTEM
t-e,:Uckkla-rn d oua!r.i s' I c e Size x 11°to $DaG ng 'derv to A.- ma.e
P pets:
Lcrullr__ jrJ Lcngt'•. J" SPa.: n9_ _
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
CaltnrOver I_JCpPiOwa raCePV'of ra So_JcJlSOd;en xx?tul--Pc
Bcd7-urdr Center Bed+-trench=d9eS '"r;c Yes ENO Ye=. _ No
COMMENTS: rlnclude cede d screpencies, persons present etc l Irseecdon #f Inspecion #2
Location: No Address Ava table
I ; Alt BNt Description
2.; Bldg server eratn -
. amount of cover -
Pan revision Regxredo Yes No
Use other side fo- addii cro iifui e,aticri
:°r
SBD-e Yla lR S'4?y L2 h: '.ns~prlurs Sipr'alu*c No
7 Satetv and Buildings Division T- -
201 W. Wash6gito^ Ava, P.O ficx '1u7 Satuva} Tc tna Nomba (m be by Co.)
P` ! Madis[xt. '•M 53707-7162
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nna.•rry tJw-1c`s Mall¢~t A;IaVSS F`cmcrv ~aca:ion 1 ''7. 2 07 '50
~o •~i
L/ "-t Lot A
.ty, la[r 7.ir "•ve bore Ntm ba Ty
rH. Type of Building check all that apply)
~S4:rdwnroa Name
/rye-~amly Crxalioe, umher r: 3cd.:am _
i LI i'uuilc:Comma. nl:-Lkszbr t,x _ -
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It T.'pe of I'UN'IS S)sxemiCbm onenL'Ucvice: (Check all that applyl - - -
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F 1 Dkfersd Treat ent firer In@rcmanon ~I J
r (1 S riot r~: T) D-<t~n ti<11 :~yli,aun2 e( dsf Du Krul tea PuWlu: 1 -
/ I tl Lsspusai 4.ea Prekx xd s Pl~ a,n
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K-w TuSs .ar=r Tanks S Z
TO Y
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A fI R&ePort tbilrh S12teme t 1, the aedersigoed, . esponvbilin I'or tostallatiou of the POW'[ S shown nrr attach ul plain
khlaba'S \ame 'fto 1 f-1 - - 'r?1'_ : C/,mnrr- AC ff'RS Number Flusims Ph 1.4 her
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lu:uter'S ASSt ss;Strc2' n SL ei
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I tx~,"ppmv. ~~-+haprx : Q~ S Trott lrc ~ hole a~cC Sswn3 nu lieyr3tme
I\. CwtditlSNdtlp~ibYaiBCkawn> for DASapprosal `
I. Septic tW* atlka n:Aff 1`11.1 3)
(r~w ~ -
Gltpan• v cell trust all be - _ - t J
as per mar,agemen' plan 'ac-', Y y1u.nDe.. Af -
2, ANr~,k recur-'°.en.s must t,c ,c.-..rt, it r: -
_ a per eppilorbl3 w6: I s4:•.n r,?.?.
A¢rlh Ic armPfge Vann for rbe sfsrcm and mmm~ m for r.-ounn only "Pop,..: lene Wae J i^- x 11 incbea is sae
SH;1-<r?fix •R i 1: l I1
System PLOT PI.
PI(o.IKC'1 Kevin 3:ader nt)muss 1554 200th .Ave New, RI climond Wi 54017
SW 1 ; 4 SE 1 , 4 s 20 r 3 , N AR tc -Iowiv Stanton cot N'rv ST. CROIX
S1's'IF:N1 1a.L1'AT1ON 92.?'96.0 95.8iSoS.P: Selo 8'26.19 3
DnTE BEDROOM CONVENTIONAL >^/X AT-GRADE CONNENHONAL 1.111 HOLDING TANK
MOUND SEPTIC "LINK SV1: 1000 ga:io•ts IJPT 'YANK SIZE. UOSE'TANK SIZE.
11OLr)ING TANK SIM, LOAD RA11 .2 ABSORPTION : IMN 225;) ft of E'Z-Homs45
BENCHMARK 1'.ltx. Toc ol',r2° stool pipes ASSUME LI,E1'AJI0N 100' Filter Lifetime Filter
❑ 1t010:1101.1 WELL H.It.I'. same aS oe'1ciY»a'4;
1 '0 1'rnpe:lc I,inc
UrthCr LCAITW shaC Lve donC to IUWer
system elevation and find more suitahlC
sails 96' B AI.'
nts
4 9s ?(1'
Ii 1
60'
10'
I; 3
5"r Slope
300'
L.~A
40 ;ir
L'_, f ti1 Pr?o
Re'Fool1
House
X 110' Cells and 2-S' X 1 15* cells
00th. Ace
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 8/26/19
Owner:Kevin Blader
Location: SW1/4 SE1/4 S20 T31 N,R17W Lot 2 200th Ave Stanton
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3.Chamber Cross Section
4-6. Mainlance and Contigency Plan
7. Filter Cross Section
Signature-
License number 422
Svstenl PLOT PLAN
I-ROJI•:c'1' Kevin Blader ADDRESS 1554 200th Ave New Richrrond Wi 54017
SW 1/4 SE 1/4s 20 n' 31 N/R 17 W TOWN Stanton COUN'1Y ST. CROIX
SNWIENT ELEVVVION 92.2,•'96.0,••95.W95.6 2' below DATE W26/19 BEDROOM 3
CON VEN1 IONA I. XXX Al•GR:AI)P. CONVENT IONA1. LIFT HOLDING 'T'ANK
MOUND SEPTIC TANK SIZE' 1000 Gallons IAPI• TANK SIZE I)OS1: TANK SIZE
HOLDING TANK sl/.P LOAD KAIT: .2 ABSORI"HON AREA 2250 y of E%-1;I0ws45
BENCIINIARK V.RX. Top of 1r2" steel pipes ASSUNIF ELI(VATION 100' hiller Lifetime Filter
❑ ROREIIOLEE O I I . R. P, same as benchmark
1320' Property Line
Further testing shall be done to lower
svstenl elevation and find more suitable
soils 96' l
526
Vents
9b' 10,
B-1
60'
10'
30' 0'
B-3
5`ib Slope
300'
40'
Pro 3
B-2 30' S,1 0'
Bedroom
I louse
2-3' X 110' Cells and 2-3' X 115' cells
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN page--of`
FILE INFORMATION
Owner SYSTEM SPECIFICATIONS
P
- J f .ti l~ j ti Z ✓
Pe n Septic 7anK Capacity
# - - _ _
nit at qNA
septic Tank Manufacturer O NA
DESIGN PARAMETERS Effluent Fitter Manufacturer X44--
Number of Bedrooms - - li U NA
- _ _ 'i C NA =fluent Filter Model
C NA
Number of Public Facility Units - -
iNA Pump Tank Capacity
NA
Estimated flow (average) - - - -
yaUda Pump Tank Manufacturer
NA
i Design low (peak), (Estimated x 1.5) t Pure- - -
NA
_ _~j ~J - galida p Manufacturer
Sal Application Rate
aUda~ Pump Model NA
Standard InfluenVEfluent Quality Monthly average' Pretreatment Unit
Fats, Oil & Grease (FOG) 30 m /l. NA
~ 9 U Sand/Gravel =filter C Peat Filter
Biochemical Oxygen Demand (BQC ) :220 mgfL C NA O Mechanical Aeration 0 Wetland
Total Suspended Solids (TSS; <150 m f
~t3f O Disinfection _ C Other
Pretreated Effluent Quality Monthly average Dupe.sal Cell(s)
Biochemical Oxygen Demand (BOD' ❑ NA
s30 rnglL Ground (gravity) ❑ In-Ground
Tots Suspended Solids (-SS) •_30 m /L NA (Pressurized)
9 ~ ❑ At-Grade ❑ Mound
_ Fecal Colifonn (geometric mean) 510° cfuH0om1 0 Drip-Line G Other:
Maximum Elkren_Particle Size C NA Other -
~;in die.
arts : - - - - - - C NA
- -
NA -other
❑NA
Values typical for domestic wastewater and septic tank oftluen_ Other - -
NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
!Inspect condition of tank(s) At least once every: ~1 q month(s)
_-.=-year(s) (Maximum 3 years) U NA
?amp out contents of tank(s)
_ - When combined sludge and scum equals one-!hind (Y) of tank volume q NA
Inspect dispersal cell(s) - - At least once every - O .untfi(s) - - -
_year(s) (Maximum 3 years) C NA
'lean effluent filler -
At least once every / month(s) L3 NA
earls,
nspect pump, pump contro.s-& alann- I At least once every: ❑ month(s)
-l-tt year(s) JN
'lush laterals and pressure test At least once every: C month(s)
'then - - - - ❑ year(s) Ai least once every: U month(s) Ixher----- - - - C Year(s) MAINT ENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual canting one of the following licenses or certifications: Maat.f
Plumber; Master Plumber Restricted Sewer; POWTS Inspector. POWrS Maintai.~er. Septage Servicing Uperator. Tank inspections most
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 uo or poncing of P.Macni on the ground surface. The dispersal cell(s) shaA to
visually inspected to check the effluent levels in the observattw. pipes and to chk!cK for any pending of effluent on the ground surtace.
fhe pording of effluent on the ground surface may indicate a failing condition, and requires the immediate notification of the local
-egulatory authonty.
>^lhen the combined accumulation of sludge and scum to any tank equals one-third (h) or more of the tank volume, the entire contents of
he tank shali be removed by a Septage Servicing Operator ano disposed of in accordance with chapter NR 113, Wisccns:r
Administrative Code
All other services, incuding but not limited to the serv¢mg of effluent filters, mechanical or pressurized components, pretreatment Lrits.
ind any servicing at intervals of ,:12 months, shale be W.,formed o, a certified POVlrS Maintainer.
a service repo-t shall be provided to the local iegulatoryry authpiity nethm 1C days of carrpletion of any service event.
Page i of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or Other chemicals #*it
may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents Of the
tank(s) reproved by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluerd.
To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to tfre
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.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compactt 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 parfomnance and prolong the life of the POWT$:
antibiotics; batty wipes; cigarette butt; condoms; cotton swabs; degreasers; dental tress; diapers; disinfectants; fat; founrdation drain
(sump pump) water, fruit and vegetable peelings; gasoline; greme; 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 propelly
and safety 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 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
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
rep/ eM system:
suitable replacement area has been evaluated and may be utilized for the location of a replacement sea absorption system.
The replacement area should be protected from disturbance and compaction and should not be infringed upon by requlited
setbacks from existing and proposed structure, lot lines and wells. Failure to prated the replacement area will result in the rt led
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 replacemaM area is not available due to setback and/or soil limitations. Bening advances in POWTS technology a
holding tank may be installed as a last resort to replace the failed POW S.
❑ The Site has not been evaluated to Aerrofy a suitable replacement area. Upon failure of the POWTS a sell 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 infiltrative
surface. Reconstructions of such systems must comply with the rules in effect at dud 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 j A~ a=te'
Phone , - - Phone
SEPTAGE SERVICING OPERATO PUMPER LOCAL REGULATORY UTHORITY
Name Name
Phone r'lr- r7 E• Phone
Thu document was drafted in CMV4ance with chapter SPS 31i3.22(2)(b)(1)(d)&(1) and 393 Wi (2) & (3), Vinscorno Administrative Code.
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
I OWNERSHIP CERTIF ICATIUN FORM
Owner/Buyer r i e J; n
Mailing Address J > o-z) ,ti
Property Address _ 11
7 Z_ U f{ V
(Verification required from Plar g & Zoning Department new construction.)
City/State ^
- Parcel Ident;ficationVut7ber_0.Jfj
LEGAL DESCRIP'T'ION /
Property Location S~ eJ% , %'F %a , Sex. T, I V R ! W Town of. r-„Q
Subdivision
Lot # •-L- .
Certified Survey Map # - v c lume Page #
Warranty Deed # _ Vo lume Page #
Spec house yes Lucy Lot tines identifiablecs no -
SYSTEM MAMUNANCE AND OWNER CERTIFICATION`
Improper use and maintenance of your septic system could result to its premature failure to handle wastes. Proper
.oa+ntrnAn^e consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal sysorm Owner maintenance
responsibilities are specified in §Comm- 83.52(1) and in Cbapter 12 - St Croix County Sanitary Ordinance.
The Property owner agrees to submit to St Croix County Planning & 7kiu rig Department a certification fbnn, signed by the
owner and by a master plumber, journeyman plumber, restricted plumb= 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 1/3 full of sludge.
1/wc, 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 Commerce and the Departmvat of Natural 12caotrnes, State of Wisconsin.
Certification stating that your septic system has been maintained must be. completul and returned to the. St. Croix County Planning &
Zoning Department within 30 days of the tbree year expiration date.
Uwe certify that all statements on form are true to the. best of my'our knowledge. I/we am/are the owner(s) of the
prolway described above, by virtue of a w Canty deed recorded in Register of Deals Office.
NZMTURE V
OF APPLICAN`T'(S) DATE
***Any information that is misrepresented may result in the sanitary permit being wvoked by the Planning & Zoning Department
Include with this application a recorded wartanry deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08105)
SOIL BORINGS
CERTIFIED SURVEY MAP
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