HomeMy WebLinkAbout026-1167-04-000 I
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitar Permit No:
506119 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'.
Glen Johnson Construction I Richmond, Town of 026- 1167 -04 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No
27.30.18.1306
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
;� 4
Septic 4r.Ak, s Benchmark 7 • 1 66 . 3
A IB �.. oJ�- L . Z /b • 7
Aeration Bldg. Sewer
..._.__._ 7. 6%
9 9 .9 L
Holding St/Ht Inlet
-�� 8. a3 9q ,5
TANK SETBACK INFORMATION SUHt Outlet 8 • Z , 3
TANK TO /V �1 P/ WELL BLDG. [Vent to Air Intake ROAD Dt Inlet
cC� \ \
Septic , C„ ( d a Dt Bottom \
Dosing � v Header /Man. 5�j g -bS
Aeration Dist. Pipe 'a• s 1V
C r
Holding Bot. System �'.qs Qf • �S Ck
Final Grade
PUMP /SIPHON INFORMATION TV-7 6
Manufacturer Demand St Cover MRS l2
GPM r�;1L.+. Z•Z
Model Number,,—
TDH L' t Friction Loss System Head TDH Ft
Forcemain ength Dia. ist. to Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width / Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 1 y Z 11l_e `,� � 1_-__- _,_ \
SETBACK SYSTEM TO JPIL JBLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR ✓V— 4-'r
Type Of System: L6 I
5'4 ' I � . / � 1 UNIT Model Number: �1 J r , DISTRIBUTION SYSTEM Z`t + Z9 _ Sv iak� r
Header /Manifold / ( Distribution x HOle Size x Hole Spacing Vent to I e
, / Pipe(s) \ \ 3t cA" �
Length /d Dia `T Length Dia Spacing C
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded j xx Mulched
Bed /Trench Cente � , Bed /Trench Edges \ Topsoil w(� - Yes No � Yes A
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: / /
Location: 1396 129th Street New Richmond, t WI _54017 (NEE 1/4 NE 1/4 27 T30N R18W) Lundy's Preserve Lot 4 Parcel No: 27.30.18.1306
1.) Alt BM Description = F-144-- ' ' `a�`•"�� `' 6 v ( 11�•G� ; i., S d vim-•
2.) Bldg sewer length = 2-'
1
- amount of cover
Plan revision Required? Yes XN o
Use other side for additional information. tt lU
Date 4 FInsepctcoTr ignatur Cert. No.
SBD -6710 (R.3/97)
commerce.wi.gov Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162
i s eo n s i n Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce 5 '
Sanitary Permit Application State Transaction Number
/
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental ✓ 4
unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if differ than mailing address)
submitted to the Department of Commerce. Personal information you provide may be used for secondary y j / � Q Z `�•
u ses in accordance with the Privacy Law, s. 15.04(1 )(m ), Stats.
I. Application Information —Please PrLW All Information
Property Owner's NameE �` �` P rce
b ' / , cb�l 07
Property Owner's Mailing Address P opert y n \
(,3 y Of`. I .SST. CROIX COUNTY C' 1 3 06 )
G vt. Lot ✓✓
City, Statq Zip Cod ^ P one Number
. � � � Y., Section .27
/4 CO'S o r� S .y p/ (� ,..(circle one)
11. Type of Building (check all that apply) ak C.d Lot # T N; R 1Y E
El or 2 Family Dwelling - Number ofBedroom a (601) E I Subdi ision Name
S Block ,� ddb "ems G fr .l L
❑ Public /Commercial - Describe Use d cb .�_ ,
APR 0 2 200 El ci of
❑ State Owned - Describe Use CSM umber Vtll ge of
!l Ld 0 4J
AM
ST. C�OIX COON Tow of r/1 i'c-
" ij
Iii. Type of Permit: (Check only one box on line A. Complete line B if apbWaMel
A. 9 New System y El Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System (explain)
1;•
El Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration Owner
IV. Type of POWTS System /Component/Device: Chec all that apply)
XNo Pressurized In- Groun ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) retreaument Device (explain)
V. Dispersal/Treat ent Area Information: YS
Design Flow (gpd) Design Soil Application Rate(t Dispersal Area P! 4osed (st) System Elevation
V[. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units o v
New Tanks Existuig Tanks W c ti
W Z,. ci. U `n H vi W c7 a,
i
Septic or Holding Tank
Dosing Chamber /t /d j
d( ! I
VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POW SOAwn on the attached plans.
Plumber's Name (Print) Plumber's Signature M MPRS Number Business Phone Number
Plumber's Address (Street, City, State, Zip Code) /
VIII. County/ e artment Use Onl
Permit Fee Date ssue Issuing ent Signatur
Approved ❑ 'approve $ �j(n /'
❑ rven Reason for De ' " t: ✓ v T 3 D -7
IX. Conditions of Ap r v easons for Disapproval
SYS�t� 3� g�;� cwelo a-o P���,�o. atJ04_A_ t..�
1. Septic tank, effluent fitter and
dispersal cell must all be services / maintained /�
as per management plan provided by pl tunbsr. fJ `
2. AN Se Wk requirements Al ents must be maintained Ji> AJ a!- j t ,jJXu�••- t .� . c. , A l
Pu ac t to complete plans fur the system and submit to the County only on paper not less than 8 la x I 1 inches in size
5) � ( �J u.
SBD -6398 (R. 01/07) Valid thru 01/09 I AAD— Ct"C,O '
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t RECEIVED
r o JUN 0 1 2004
Lundy's Preserve Comments: ST. CROIX COUNTY
ZONING OFFICE
The soils in this subdivision are quite variable and differ across the 80 acres. Some consist
of a clean outwash sand, other consist of glacial tills. In certain areas, the medium sands
have a very deep red color unlike I have seen in all of St. Croix county. The color does not
indicate high ground water because the color is so consistent. If you go through the red
sands then the sands turn off white/yellow but not those of a sand stone. In talking with Pam
Quinn from zoning, she commented that there could be a different chemical reaction with a
sands. I believe this is the case for the sands have a consistent size, and no mottles were
found above or below the sands. Sometimes bands were present, but were very slight,
and were mentioned to have the systems sized a little bigger in order to accommodate for
any inconsistencies in the soil. Also it is worth mentioning that the intersections of lots 6,7,8,
and 9 have a extremely poor soil present not suitable for a mound system. The surveyor
and I discussed this condition, and the resulting tests were spaced as far away from this area
as possible. All the soils tests were done to the best of my ability and I hold no liability for
anomalies and other oddities that can be found on this site.
Shaun Bird
CSTM #226900
5/28/04
F RECEIVEr -,
Wisconsin Department of Commerce SOIL EVALUATION REPORT "
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code ST. CROIX COUNT
County f
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information.
Review by D� Ls-n 7 t
Personal information you provide may be used for secondary purposes (Privacy Law. s. 15.14 (1) (m)).
Property Ow Property Location
l; a �� 1 /4 �/4 S T N R E (o
Govt. Lot W
ailing Address Lot # Block # u .Name or CSM#
Property Owner's
�' - S- - S §
City State Zip Code Phone Number , 0 city 0 Vi Ilage wn Nearest Rgali1�
f i J 7
New Construction Use. Residential / Number of bedrooms Code derived design flow rate — GPD
❑ Replacement U: Public or commercial - D� scribe:
� ' -- --
Parent material f 2 C� �l Flood Plain elevation if applicable � d� — ft•
General cornments j , `� �1
and recommendations:
I 7 102� 'L IF
a Boring # ❑ ring / / ,
pit Ground surface elev. 3 ft. Depth to limiting factor ! l� in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. /� 'Eff#1 `Eff#2
A.Vr 114 i11¢
Ao
It J
.t qD
rig ring
a Pit Bori # Ground surface elevl ft. Depth to limiting factor in. Soil lication Rate
P
Horizon Depth Dominant Color
Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell
Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
6 _ � V 0 c ,
C-I � r
•Z /
.-SVa41a I) tJZA .
f
,t
r qD
r
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < ' Effluent #2 = BOD _< 30 mg/L and TSS < 30 mg/L
Name Please Print) Signature CST Number
CST Na ( 226900
Bird Plumbing, Inc. Shaun Bird
Date Evaluation Conducted Telephone
Number
Address
-4
I 4017 _ 715 -246 16
1008 192nd Ave, Ne
w Richmond W 5
-�
Property Owner Parcel ID # Page of
a Boring # Boring
pi Ground surface elev. _ // I• Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description I Texture Structure Consistence Boundary Roots tE GPD/ffEf#2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
I - ►'i- 3 7 1 �1 GS / b
12_ i1 I 5 — c 1 1 ,.3
F-1 Boring #
❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Boring Boring
F-1 # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit - Sod ArKiliciition Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
-EE]
= <
' Effluent #1 = BOD > 30 <_ 220 mglL and TSS >30 1150 mg/_ Effluen t #2 BOD s _ 30 mglL and TSS < _ 30 mg1L
Department of Commerce is an a
The De P equal opportunity service provider and employer. If you need assistance to access services or
q PP tY
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608 -264 -8777.
SSO.8330 OLISM)
�i
•. 4 7
Soil Test Plot Plan
4roject Name Environmental Holding L.L.P. Shau it
Address 706 19th St. S.
Hudson Wi 54016 C #226900
Lot 4 Subdivision Lundy's Preserve Date /24/04
N 1/2 N E 1/4S 2 7 T 30 N/R 18 W Township Richmond
Fj Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post
System Elevation 98.6/97.8/97.2 *HRPSame as Benchmark
Alternate Benchmark _Top of Survey Iron C 96.0'
B.M. 140th Ave
Alt. B.M. 150'
20'
B -1
50'
10% Slope
20'
B -3
50'
233' 20'
Property 100' B -2
Line
103'
Please note:Soil test
was done to satisfy
county zoning
requirement. Soil Scale is 1 „ = 40 ,
test may not be unless otherwise
suitable for owners
desired building noted
location.
i
I _
03/18/2007 07;30 7153862979 GLEN JOHNSON PAGE 01
LUNDYS I
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I
SEPTIC TANK &PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
4 CI VENT PIPE +► 12" MIN. ABOVE GRADE & WEATHERPROOF
>_ 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED
FRESH AIR INTAKE WITH CONDUIT MANHOLE PADLOCK OVER
FINISHED GRADE WARNING LABEL
4" CI RISER A
1 � ..._4" MIN.
IT 18" IN. 6" MAX. : �
'NLET
I 1
GAS-
WATER TIGHT SEALS , �
JA I AL T � `� vAPPROVED
E JOINTS WITH
PPRaVED ; ALM APPROVED PIPE
IPE 3' ON 3 ONTO
NTO SOLID ► ' � SOLID SOIL
OIL RISER EXIT PUMP OFF ELEV. FT. OFF PERMITTED ONLY
IF TANK MANUFACTURER
'' HAS APPROVAL
3" APPROVED, BEDDING UNDER TANK
CONCRETE
PAD
SPECIFICATIONS '
SEPTIC / DOSE
TANK MANUFACTURER: /, ,'e eY NUMBER DOSES PER DAY:
TANK SIZES SEPTIC 10,dd' GAL. DOSE VOLUME INCLUDING
DOSE S'6 GAL. FLOWBACK: /ir GAL.
ALARM MANUFACTURER: p elQ.y �y, CAPACITIES: A = - c" 7 6 4 t / INCHES = AL •
MODEL NUMBER v 2 INCHES = 3j2 GAL.
SWITCH TYPE: B - -
PUMP MANUFACTURER: ^ 61 u11 '�L C = S INCHES = GAL.
MODEL NUMBER: �, d 4/ D = (�' INCHES = _ GAL .
SWITCH TYPE: l�v - ,e, -
REQUIRED DISCHARGE RATE GPM ✓ PUMP E ALARM WIRING AS PER ILHR •16.23 WAC
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . -3W FEET
+ FEET FORCEM �.Gd AIN X FT /100 FT. FRICTION FACTOR . L 6Z FEET
_/ ,5 FEET
TOTAL DYNAMIC HEAD =
INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH� DIAMETER
LIQUID b` A d "
SIGNED: LICENSE NUMBER: a , 7 7974d DATE: 3
1/88
MOULDS PUMPS Submersible
Effluent Pump
3871 EP05
APPLICATIONS • Fully submerged in high ■ EPOS Impeller: Thermoplas- ■ Bearings: Upper and lower
grade turbine oil for tic enclosed design for heavy duty ball bearing
Specifically designed for the lubrication and efficient improved performance. construction.
following :
g use heat transfer. ■Casing and Base: Rugged
• Effluent systems thermoplastic design provides AGENCY LISTING
• Homes Available for automatic and superior strength and corrosion
• Farms manual operation. Auto- resistance 4 c nadim SWW&rds AWdolon
• Heavy duty sump matic models include
• Water transfer Mechanical Float Switch ■Motor Housing: Cast iron (CSA listed model numbers end
• Dewatering assembled and preset at the for efficient heat transfer, In "F" or "C ".)
facto ry. strength, Ind durability.
SPECIFICATIONS ■ Motor Cover Thermoplastic Goulds Pumild is oo 9NI R"bw ed.
FEATURES cover with integral handle and
• Solids handling capability: float switch attachment points.
'/+' maximum. ■ EPO4 Impeller. Thermoplas- 0 Power Cable: Severe duty
• Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant.
• Total heads: up to 31 feet. pump out vanes for mechanical
• Discharge size: 1'h" NPT. seal protection.
• Mechanical seal: carbon -
rota ry/ceramic- statlonary,
BUNA -N elastomers.
• Temperature:
1041(40"C) continuous
METERS FEET
140°F (60°C) intermittent ; _.._.., . ._ ..... .._ .. _ . _ . ,.......... __ ... __ ....,.
• Fasteners: 300 series 10
.. ..A. _... _. ...
stainless steel. I I
30 _... _. —1► 2.s rr s GPM r _.. _.....,
• Capable of running '
_, _ ...... , .. .... '....
dry without damage to a �
components. 25 1._....
Motor l
x
, ......._
• EPO4 Single phase: 0.4 HP, 6 20 r
115 or 230 V. 60 Hz, 1550
RPM, built in overload with
automatic reset. 4
• EP05 Sin
i
le phase: 0.5 HP, c ,.
EPOS
Single � ,
115 V, 60 Hz, 1550 RPM, '' 3
built in overload with t
_ EPO4 .
automatic reset. 2 ' —•
• Power cord: 10 foot
standard length, 16/3 t _ .i._... _
S1TOW with three ron
grounding plug. Opt 20 ° ° o to o 30 so GPM
foot length, 168 S1TW with 4o
three prang grounding plug o z a 5 s to t z m�fi
(standard on EP05).
CAPACITY
Goulds Pumps
0 2000 Goulds Pumps ITT industries
Effective a
FetNU ry, 2000
B
3871
I
ST CROIX COUNTY
SEPTIC 'TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
'OwnerBuyer _ C ,aui)f e,-' -Mw /-/.a
Mailing Address �r1 �9rLi ��� �i Al/
Prop Address
(Verification required from Planning Department for new construction)
City /State Parcel Identification Number
E. AL DESCRIPTION
Property Location ` 1 7
/., Sec. � , T -��' N- R.��W, Town
Subdivision _ ��- •roLYGS' f'ye_r ep, U � , Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # , Volume , Page #
Spec house O yes Z no Lot lines identifiable0yes O 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 bv a
urn crverif in that 1 the
R P Y on-site wastewaterdis osal m
s in () system
i master plumber, journeyman plumber, restricted plumber or a licensed P Y t
n ro er
P p operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Uwe, 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 ilia ur sc U system s been matnt;unal must be completed and returned to the St. Croix County Zoning Office within 30
days of ree car xptrat n date.
SIGNATURE 0 PLICANT /a 7
DATE
OWNER CERTIFICATION
4 I (we) ce tha II statements on this form are tntc to the best of my (our) knowledge.. 1 (we) am (are) the owners) of
pro desc ibe ab e, by virtue of a warranty deed recorded in Register of Deeds Office.
E O PPLICANT
DATE
Any information that is mis•rcprescntcd may result in the sanitary permit being revoked by (lie Zoning Department. "• "'
•• Include wlth this application: a stamped warranty deed from the Register of Deeds office
a'copy of (lie certified survey map if reference is made in the warranty deed
8 1 5610 5
State Bar of Wisconsin Form I - 2003 KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
Document Number Document Name
ST. CROIX CO., WI
THIS DEED, made between Environmental Holdings Company, RECEIVED FOR RECORD
LLC 01/04/2006 08:00AN
( "Grantor;' whether one or more),
and Glen Johnson Construction WARRANTY DEED
EXEMPT #
( "Grantee," whether one or more). REC FEE: 11.00
TRANS FEE: 516.60
COPY FEE:
Grantor, for a valuable consideration, conveys to Grantee the following CC FEE:
described real estate, together with the rents, profits, fixtures and other PAGES: 1
appurtenant interests, in St. Croix County, State of
Wisconsin ( "Property") (if more space is needed, please attach addendum):
Lots 1, 2, 3, and 4 of Lundy's Preserve, Town of
Richmond
Recording Area
Name and Return Address
Title One Premier Group, Inc.
706 19th Street South
Hudson, WI 54016
* * * *PID# 026 - 1167 -01 -000, 026 - 1167 -02 -000,
026 - 1167 -03 -000, 026 - 1167 -04 -000 * * **
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except:
Roadways, Easements, or Restrictions of Record
Dated December 28 2005
(SEAL) SEAL
* Bill Sherman * Jeff Warren
Environmental Holdings Company, LLC Environmental Holdings Company, LLC
(SEAL) (SEAL)
* *
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
y ) ss.
authenticated on 4L St. Croix COUNTY)
PU BL4C ' Personally came before me on December 28, 2005
Nk 01k the above -named Bill Sherman and
* '9 Jeff Warren
TITLE: MEMBER STATE BAR OF WI 9W to me known to be the person(s) who executed the
(If not f oing instrument an ackn ]edged the same.
authorized by Wis. Stat. § 706.06)
THIS INSTRUMENT DRAFTED BY: CK
War
Michael H. Forecki , Attorney Notary Public, State of Wisconsin
Eau Claire, Wisconsin My Commission (is permanent) (expires: 09/27/2009
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1 -2003
"Type name below signatures.
Attorney Michael H Forecki 3452 Oakwood Hills Pkwy Ste 1, Eau Claire WI 54701 -7928 Phone (715) 835 -3029 Fax. (715) 835 -4112 EHC- GlenJohnso
Title One Premier Group Produced with ZipFormTM by RE FormsNet, LLC 18026 Fifteen Mile Road, Clinton Township, Michigan 48035 www.zipfonn.com
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page __ of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner .
Septic Tank Capacity QDQ al ❑ NA
Permit #
- Septic Tank Manufacturer ��e C3 NA
DESIGN PARAMETERS Effluent Filter Manufacturer (� O NA
Number of Bedrooms ❑ NA `Effluent Filter Model 0 41,d& 1 ❑ NA
Number of Public Facility Units ❑ NA Pump Tank Capacity O al ❑ NA
Estimated flow (average) Lf S-Q al /da Pump Tank Manufacturer g �Q y ❑ NA
Design flow (peak), (Estimated x 1.5) �"� al /da Pump Manufacturer a,*4 ❑ NA
Soil Application Rate al /da /W Pump Model ❑ NA
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA
Fats, Oil & Grease (FOG) 530 mg /I ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (SOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids ITSS) 5150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(a) 0 NA
Biochemical Oxygen Demand (600 530 mg /L ❑ ln- Ground !gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) S30 mg /L ❑ NA ❑ At -Grade ❑ Mound
Fecal Coliform (geometric mean) 510' cfu /100ml ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Ya in dia. 13 NA Othenr ❑ NA
Other: ❑ NA
❑ NA Ot"hec
'Values typical for domestic wastewater and septic tank effluent. Ot 0 NA
MAINTENANCE SCHEDULE
Service Event rW" ' Service Frequency
Inspect condition of tanks) At least once every: k� !non (s) (Maxlrrmm 3 y ears) ❑ NA
earls)
Pump out contents of tank(s) When combined sludge and scum aquals one -third (Y of tank volume'` ❑ NA
Inspect dispersal cell(s) At least once every: months) (Maximum 3 years) ❑ NA
ear(s)
Clean effluent filter At least once every: t , monthts) C3 NA
_ `. �year(s)
Inspect pump, pump controls & alarm At least once every: `.— [3 mo ye ar(s)
[3 NA
_ ❑ earls)
Flush laterals and pressure test At least once every: 0 mo
ye ar(s) ❑ NA
❑ earls)
.Other. O month(&) ❑ NA
At least once every: p ear(s)
Other:
❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individualtcarrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer, Septage Servicing Operator. Tank
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 an sludge and scum and to check for ;back u ending of effluent on the ground surface.
, y_ P or P
The dispersal call(s) shall be visually Inspected to check the effluent'leveis'in the observation pipes and to check for any ponding
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. r „
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.
All 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, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within'l0 days of completion of any service event., .
START UP AND OPERATION
For new construction, prior to us of the POWTS check treatment tankle) for the presence of P ainting Agee
that may impede the treatment process and /or dannps.the diepAteal i?elf(s). if high concentrations are dete have the contents
Of the tank y s) removed b a se P tag e servicin g P prior.tQ u operator P g Products or other chemicals
se,
System start up shall not occur when soil conditions are frozan at the Infiltrative surface.
During power outages pump tanks may fill above normal highwster levels. When power is wastewater will be
discharged to the dispersal coil($) in one large a nd dose, oyerlgedln the calk restored the excess
s) may result In the backup or surface $ter d isch ar ge
effluent. To avoid this situation have the contents of
Power to the effluent pump or contact a Plumber, or �'OWTS Mwl p tltagi ep e SOM894 Servicing Operator prior to restorring
restore normal levels within the pump tank.
Y operating the pump controls to
Do not drive or park vehicles over tanks and dispersal cells, Do not drive or park over, or otherwise disturb or compact, th e area
within 15 feet down slope of any mound or at- grade'aall absorption area.
P
Reduction or elimination of the following from the w>setcwater etreprR me
POWTS: antibiotics; baby wipes; cigarette butts Y Improve the performance and prolong the life of the
foundation drain (sum p `' ;" '
� I
m °' cotton $1Af6be; degreasers; dental flora; diapers; disinfectants; fat;
p Pum water; napkins; and tarn a delpliripe; ( rease; herbicides; meat scraps; medications; oil;
npt g
painting products; pesticides; sanitary napkins; tarttpap$; and WatAr i0tttiArl ingj grease,
ABANDONMENT
When the POWTS fails and /or is permanently taken 'out of servioe the following steps shall be taken to insure
Property and safely abandoned in compliance with ci�i►ptar.Comm $3,33, Wisconsin Administrative Code; that the system is
• All piping to tanks and pits shall be disconnected And the abandoned pipe openings sealed.
•. The contents of all tanks and pits shah be l r f e'rrtiscvod and properly disposed of by a Septage Servicing Operator.
a After pumping, all tanks and pits shall be'eniiavated 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:
E3 A suitable replacement area has been ea oted end may by u p
tilized for the location of a replacement soil absortion
system. The replacement area should be protected trorrl cbsturbanoe and compaction and should not be infringed upon by
required setbacks from existing and propoeed`structurO, lot Ilnet end wells. Failure to protect the replacement area will
result in the need for a new soil and site evskjeNon to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.. ry;
0 A. suitable replacement area is not availa due to eltbpck and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed_4.a lest resort tp replace the failed POINTS.
tv� � 1Q
The site snot on evaluated to id Egl tly, a $ultabla replacem area. Upon failure of the POINTS a 8oil and site
evaluation be perfo
may rmed to locate ulteble replacem area. If no replacement area is available a holding tank
b ' tails s a last resort to replace1h feilad POWT.S.
D Mound and at -grade soil absorption systam$ May be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such "Systorns must comply with the rules in effect at that time,
< < WARNING > s
SEPTIC, PUMP AND OTHER TREATMENT TANKS JAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TAi K UNCEig ANY CI "CUMS TANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIPFICULT QR IMPQ$$I�LE.
ADDITIONAL COMMENTS
POINTS INSTALLER P $ MA INTAINER
Name
Phone ter" 3`9 "`� I a / Phone
SEPTAGE SERVICING OPERATOR (PUMPER)
.,� - LOCAL REGULATORY AUTHORITY
Name
---- ----- NOR"
Phone
PhOIs
rh s document was dratted in compliance with chapter Comm $3. ?31x)(b111 Nd)rklfi and 83.54(1), (2) 0), Wiscorwin Administrative Code.
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