HomeMy WebLinkAbout026-1130-40-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPEt'IM'tEPORT Sanitary Permit No:
453179 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Miller, Sam I Richmond Township 026- 1130 -40 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
10 S 25.30.18.900
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 000 Benchmark
Dosing tF.OS_D Alt. BM c Z
Aeration �/ �� D Bld er
g -i 1 �7
Holding St/Ht Inlet - SCq I
(( g. 3 s
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L L BLDG. tVentAir Intake ROAD Dt Inlet
Septic , �- / Dt Bottom I Z Q 4f
Dosing r Heade an. i(g '7 s
Aeration i5ist. Pipe y�
Holding Bot. System
PUMP /SIPHON INFORMATION/ �p r� G'hll�/h Final Grade /
Z. 3
Manufacturer Demand St Cover / / I�IS2 (/ 3
GPM b
Model Number n g r e"'j, t, - / 3
TDH Lift Friction Lo Syste ea TDH Ft `�
Forcemain' Len th j D ry I Dist. to We I
SOIL ABSORPTION SYSTEM
BED/TRENCH Width / Length No. Of Trenches PIT DIMENSI o. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ! D p ,J
SETBACK SYSTEM TO / L ' w<4 B D ELL LAKE /STREAM L ACHING Manufacturer:
INFORMATION / CHA OR'
T ype System- Qf c� > r IT Model Number:
/ V f DISTRIBUTION SYSTEM (�
He ader /Manifold Distribution ` � y x Hole Size I x Hole Spacing to Air Inta e
y Pipe(s Q L `
Length 2r Dia 2 1 Lengffi i
�o Di- _ L . 5 Spacing 2 J I Z� 3 6
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched i
Bed/Trench Center Bed/ Trench Edges Topsoil + Yes No _, Yes No
L. _
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 / /) Inspection #2: ' 2 � / G
Location: 1413 136th Ave Unknown (SW 1/4 NW 1/4 25 T30N R18W) Red Pine Corner Lot 40 Parcel No: 25. 0.18. 00
�rr. -sf gt Gtt
lam- -- f 1 l-�f
1.) Alt BM Description Q u
� (/L(�.XX /i �F
2.) Bldg sewer length = /
- amount of cover
3.) Contour =
�— r
--
av l6 -
Plan revision Required? i_I Yes 4 o
Use other side for additional information.
SBD -6710 (R.3/97) Date Insepctor's Sig ature Cert. No.
Safety and, Buildings Division County
N *isconsin 201 W. Wast iogtoifAJc., P.O. Box 7162 Madis Wl 53707 Sanitary Permit Ntnn (to be filled in by Co.)
Department of Commerce u tJ
Sanitary Permit Application s tate Plan LD. Number
In accord with Comm 83.21, Wis. Adm. Code, onal it'fq}�ttio>�. ptPt Z�
may be used for secondary purposes Priv c Law, §15:1k3(I n4 Project Address (if different than mailing address)
1. Application Informatio - PI A 1 fe a Ion `' 'J `� ' , I !
- �Pi cE [`T 3� tA
Property Owner's Name 1 J J Parcel # Lot # BIock #
M t Ir fir_ ' V6
Property Owner's Mailing Ad s , - Property Location — Q Q 6
yW
City, State Zip Code Phone Number w % i =' /�, Section Z ��
H u & .S O h Lo I � o1 7,-�3V6-Z (cirt le�nG�
11. Type of Building (check all that apply) ®�� T_30 N; Rl_;io
le 1 or 2 Family Dwelling - Number of Bedrooms J ��� '"It ��" "-- Subdivision Name CSM Number
❑PublidCommercial- DeseribelJse
kc- p Pc N E C-O AA14 -
❑ State Owned - Describe Use t d ❑City_❑vdlagexTo,mship of_ : D JO
111. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. XNew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
B • ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. Type of POWTS System: (Check all that apply) `
❑ Non - Pressurized In- Ground K Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter U
Constr sited Wetland ❑ Pressuriz g eat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Dri Line Gravel -less Pi ❑ Other ex lain) t�
V. Dis ersal/Treatment Area Information: It A-
Design Flow (gpd) Design Soil Applicatiou W f) Dis J persal Area R ed (sf) Dis 1 Area Proposed (sf) System Elevation
A0 /l o, / I I'?
Vl. Tank Info Capacity in Total Ntnuber Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units , / _ `D Conc Constructed Glass
New Existing vV
Tanks Tanks /
Septic or Holding Tank
Aerobic Tmmmctu Unit /` VWY W J
Dosing Chamber
VLL Responsibility Statement- L the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number
Plumber's Address (Street, City, State, Zip Code)
Io aNr'F / bl66- RCC. UaS r l.J ! o
VI1L oun /De artment Use Onl
Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date}�s a Issuin Agen Sign e ( s)
Surcharge Fee) (l0 �jle Q l
❑ Owns Given Reason for Denial
1X. Condi ,r Val
SYSTEM OWNER: q
1 Septic tank, effluent filter and �U �' �S — L . 0 3
stall serviced /maintained`
as per management provi e y p um er �idLQh�
2. All setback re uirenonla st be maintained /
4 nW , � ^
as per applicable cadiftr finances. 0AJ o,
Attach complete plans (to the County only) for the system on paper not less than 81/2 x r r Inches in size
SBD -6398 (R. 01/03)
• Locu Ead�orap. � �2 Aue • \
N S ca le ; / _ /
64 0 P /a A.ne
337 9
1
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/a a /�,z "x 88.544 C.J/ %g "
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Safety and Buildings
' 4003 N KINNEY COULEE RD
LACROSSE WI 54601 -1831
TDD #: (608) 264 -8777
►sconsin www
www.commerc .wis c ons
.wisonsin.gov
Department of Commerce
Jim Doyle, Governor
Cory L. Nettles, Secretary
October 08, 2003
CUST ID No.225036 ATTN: POWTS Inspector
MICHAEL P MC DONELL ZONING OFFICE
MILLER CONSTRUCTION ST CROIX COUNTY SPIA
1070 HUNTER RIDGE RD 1101 CARMICHAEL RD
HUDSON WI 54016 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 10/08/2005 Identification Numbers
Transaction ID No. 925648
SITE: Site ID No. 665940
Sam Miller Please refer to both identification numbers,
1413 136th Avenue above, in all correspondence with the agency.
Town of Richmond
St Croix County
SW 1/4, NW 1/4, S25, T30N, RI 8W
Subdivision: Red Pines - lot 40
FOR:
Description: Proposed Three Bedroom Mound System
Object Type: POWT System Regulated Object ID No.: 923385
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
The following conditions shall be met during construction or installation and prior to occupancy or use:
• This system is to be constructed and located in accordance with the enclosed approved plans, the "Mound
Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 101) and the
"SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) ".
• Limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction,
(� excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited.
• A state approved effluent filter is required. Maintenance information must be given to the owner of the tank
explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided
per Comm 84 product approval conditions.
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
• Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on -site during
construction and open to inspection by authorized representatives of the Department, which may include local
inspectors.
P0, €# 7
ZCIIf Z�IF�I�r�
,�.
MICHAEL P MC DONELL Page 2 10/8/03
Owner Responsibilities:
• Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and
maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.
Comm 83.54(1).
• Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as
required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption
system or any of its component parts malfunctions so as to create a health hazard, the property owner must
follow the contingency plan as described in the approved plans.
• The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable
to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the
component(s) utilized in the POWTS.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions
should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this
review shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the
installation, operation or maintenance of the POWTS.
Sincerely,
Fee Required $ 175.00
Fee Received $ 175.00
Balance Due $ 0.00
Gerard M. Swim
POWTS Plan Reviewer - Integrated Services
(608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm WiSMART code: 7,633 1
jswim@comnierce.state.wi.us
cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544
I
i
Mound System Management Plan
Pursuant to Comm 83.54, Wis. Adm. Code
General
This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component
manuals [SBD- 10691 -P (N.01 /01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and
maintenance reporting.
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death.
Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as
POWTS components.
Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings
used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject
to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to
prevent accidental or unauthorized entry into a tank or component.
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank
shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at
least once every 3 years by inspection.
The outlet fitter shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are
made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the fitter is equipped with an alarm, the fitter
shall be serviced if the alarm is activated continuously. Intermittent fitter alarms may indicate surge flows or an impending continuous alarm.
The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If
the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next
service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank.
The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are
used they shall be approved for septic tank use by the Department of Commerce.
Puma Tank
The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper
operation. If an effluent fitter is installed within the tank it shall be inspected and serviced as necessary.
Mound and Pressure Distribution System
No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall
be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative
maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow
compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched
as protection from freezing.
Influent quality into the mound system may not exceed 220 mg/L BOD 150 mg/L TSS, and 30 mg /L FOG for septic tank effluent or
30 mg/L BOD 30 mg/L TSS, 10 mg /L FOG, and 10 cfu /100 mL for highly treated effluent. Influent flow may not exceed maximum design flow
specified in the permit for this installation.
The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed
of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the
system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the
dispersal cell.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels
above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring.
Contingency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system
in proper operating condition.
If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately
repaired or replaced with a component of the same or equal performance.
If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in
its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related
piping, and replacing said components as deemed necessary to bring the system into proper operating condition.
Sea Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider.
Project: Sam Miller 3 bedroom residential mound system Page 6 of 9
SEPTIC TANK MAINT NANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer 5 /Yt / L / -
Mailing Address /3.0,k- b
Property Address 13 3 (P
(Verification required from Planning Department for new construction)
City/State NEW k 1 - MOM D ��' Parcel Identification Number G 2 - 6 / /$o - -- -
LEGAL DESCRIPTION
9� o
Property Location S l) i/s, N O %, Sec. a 15�. T 30 N-R/ Town of 216P Ma NJ)
Subdivision R e �. Cott I�l '� . Lot # `t
Certified Survey Map # y a a 3 , Volume g , . Page # __;�
Warranty Deed # �7 3 I S :5�' . Volume a 3 3 a . Page # q (0 s
Spec house) yes ❑ no Lot lines identifiable R yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
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 system.
The property owner agrees to submit to St. Croix 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 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 Commerce and the 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 Zoning Office within 30
da the three year expiration date.
6 �- / Mo
TURF F APP ICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
oy /�i�jo
A OF PLICANT DATE
r
« « « « «« Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * « « « ««
�« Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of Z
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner 5,44 m rn G Lg7 Septic Tank Cap acity n NA
/Odd gai
Permit p - fj Septic Tank Manufacturer S — ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer 2.s4 a / O NA
Number of Bedrooms 3 ❑ NA Effluent Filter Model ' 0q _ADD O NA
Number of Public Facility Units �NA Pump Tank Capacity g al O NA
Estimated flow (average) g al/day Pump Tank Manufacturer (x)F / S E2 C NA
Design flow (peak), (Estimated x 1.5) Y SO g al/day Pump Manufacturer Z 45 ((@ v— O NA
Soil Application Rate 4 90 gal/day/ft' Pump Model 12 ❑ r;
Standard Influent /Effluent Quality Monthly average Pretreatment Unit O '`1A �
Fats, Oil & Grease (FOG) 530 mg /L X81 Sand /Gravel Filter O Peat Filter
Biochemical Oxygen Demand (BOD,) 5220 mg /L O NA O Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ (:
Biochemical Oxygen Demand (BOD,) 530 mg /L ❑ In- Ground (gravity) O In- Ground (pressurizeei
Total Suspended Solids (TSS) 530 mg /L NA ❑ At -Grade ,Mou
Fecal Coliform (geometric mean) 510' cfu /100 I ❑ Drip -Line ❑ Other:
L um Effluent Particle Size Y in dia, O NA Other. ❑ N
D NA Other: ❑ NA
*values typical for domestic wastewater and septic tank effluent. Other ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
O month(s)
Inspect condition of tank(s) At least once every: /, / y ear(s) (Maximum 3 years) ❑ N�
i
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume
O month(s)
Inspect dispersal cell(s) At least once every: 3 Jn year(g)
(Maximum 3 years( ❑ ^:A i
Clean effluent filter At least once every: 1 f45 ❑ month(s) G rJA
Inspect pump pump controls do alarm At least once every: ❑ month(s) NA l
O year(s) i
O month(s) ❑ r;�
Flush laterals and pressure test At least once every: ❑ I
year(s) _
Other: ❑ month(s) At least once every: O year(s)
C] N
Other:
❑ NA
MAINTENANCE INSTRUCTIONS
Inspections 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. Tare.
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
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponc;r
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
i mmediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (Y,) or more of the tank volume, the ent r_
contents of the tank shall be removed by a Septage Servicing Operator and dispoged of in accordance with chapter NR t 13
Wisconsin Administrative Code, .. ,.: :..
All other services, including but not limited to the 'servicing of effluent filters, mechanical or pressurized components, pretreatrmen:
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of .any service event.
Page Z of
START UP AND OPERATION M
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the 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 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
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 tank.
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; fat;
foundation drain (sump pump) water; fruit ar'id 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 POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. 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 POWTS.
T alua ' a o ing `
0 any
b e of a 1 I15 TT' fb AJ61 Co61 57WUC--A 0r"
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
POWTS INSTALLER POWTS MAINTAINER
Name �c g!!L L Name
Phone (� t— (,S F Z 7 Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name S C (
Phone Phone '7 D
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
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