HomeMy WebLinkAbout026-1167-26-000 Wiscoosin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety =and Building Division
INSPECTION REPORT Sanitar Permit No:
506117 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 Richmond, Town of 026- 1167 -26 -000
CST BM Elev: Insp. BM EI BM Descri n: Section/Town /Range /Map No:
- 7 •; S 27.30.18.1328
TANK INFORMATION LEVATION DA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic �� Benchmark p� � 7 � 5
--
Dosing � Alt. BM 2 D
Aeration , Bldg. Sewer 3o 3 — 6 y �
Z
Holding Ht Inlet i V OW
ll EE 9. it �
TANK SETBACK INFORMATION I�rTLL4Q- 33 Ht Outlet ! ys �✓
TANK TO WELL BLDG. Vent to Air Intake ROAD Dt Inlet 2 71 ,p r
Septic Dt Bottom
Dosing V ead /Man. �
v>`Lvv► T ► /o' 7
Aeration Dist. Pip �( o ��� Gf c a
T , I v. JAW
Holding Bot. Sy em
//. ?5 3 y
1 Fi Gra de
PUMP /SIPHON INFORMATION
Manufacturer Dema St Cover Crn
Model N"'114
TDH Lift Friction Loss Sy TD Ft s
Forcemain Length Dist. to Well
SOIL ABSORPTION SYSTEM Z &444-4,t �,t 4 2 / /S7 , �o
BEDITRENCH Width Lengtt No. Of Trench PIT DIMEN ONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS �'� /
,�) SETBACK SYSTEM TO P/L BLD W L e1 C LAKE /STREAM ACHING Motu+ ur r:,
INFORMATION AMBER V
Typ Of System / ,• NIT Model Number:
7 70 ;;
T IBUTION SYSTEM
Head /Manifold Distribution 1 x �1ole Size x Hole Spacing Vent t Air Intake D
1 n Pipe(s) / � 1 Length�� Dia Length Dia Spacin /
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over j xx Depth of j xx Seeded /Sodded xx Mulched
Bed /Trench Center / Bed /Trench Edges Topsoil Yes ,y' No Yes No
COMMENTS: (in code discrepencies, persons present, etc.) Inspection #1:/ 0/ Inspection #2:
Location: 1263 138th Avenue NT ww Richmond, WI 54017 (NE — 1/4 ' N A^ E 1/4 27 T30N R18W) Lundy's Pre ervko��t 226__ Parcel No: 27.30.18.1328
1.) Alt BM Description =/ Z �� C XaA, fil�( �— syf�vrn 44V A
2.) Bldg sewer length = 15 h — 2 _ j raw C+ " /1 /�j], �4�� 61 (� aZ �/ � • 5
amount of cover =, 1I y V[ Q� VA15 y /D `, 7
Plan revision Required? Yes IV 0 30 �7 lord
Use other side for additional information.
Date In is Signature ton
SBD -6710 (R.3/97) �• y l � p
(1101
commerce.wi.gov Safety and Bu' dings ivisl t County
201 W. Washingt ve.,
i — 7162 � Sanitary Permit Number (to be filled in by Co.)
Department of Commerce _„�.►� ,r H-7
Sanitary Permit Application State TransactioTNber
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental
unit is required prior to obtaining a sanitary permit. Note: Application forms Proj ct Address (if different than mailing address)
submitted to the Department of Commerce. Personal information you provide
p urposes in accordance with the Privacy Law, s. 15.04(1 )(m ), Stats. !�
1. Application Information - Please Print All Information Ft
Properly p er's Na n a Parc #
. 6 0 . 0 a Z(o - i I t o - 7 z to - ao
Property Owner's Mailing Address ST. CR Prop y Location
�9 .�/ s (.13
Govt. Lot
City, State Zip Code Phone Number T
Section
ircle one
T �Lj N; R � E o
11. Type of Building (check all that apply) ok
❑ I or 2 Family Dwelling - Numher of bedrooms �► Subdivision Name
Sr.,tit�. Bloc � ls.,v� .s c' ✓' (/ -e.. �-'
❑ Public/Commercial - Describe Use
9 - F
f-5 f
aCoct.'e' V, CSM Number of
El State Owned - Describe Use e�
own of a/, j GLt 1�rD -U
III. Type of Permit: (Check only o e box on litre A. Complete line B if applicable)
A. New System y ❑Replacement System, ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System (explain)
B. ❑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 S stem /Cons onent/Deviee: Check all that appl _
Non Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. ofsuitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dispersal/Treat ent Area Information: <t ``c j 4 1
Design Fl (pd) Design Soil Application Rate(gpdsf) Area Re wired (st) Dispersal Area Pro sed (sf) System Elev�ion
� � � °� � /� ow l /mss` � � �{•S ,Be��u� �• a .v
VI. T ank Into Capacity in Total # of Manufacturer
Gallons Gallons Units
New Tanks Existing Tanks v '�•°- c
Septic or Holding Tank
Dosing Chamber
Vll. Responsibility Statement- I, the undersigned, assume responsibility for installation of the PON1 rS shown on the attached plans.
Plumber's Name (Print) Plumber's Signature /MPRS Number Business Phone Number
- l
Plumber's Address (Street, City, State, Zip Code)
—
Vll I. County/ e artment Use Onl
Approved XO rove Permit Fee Date Issue Issuing nt Signatu e
w ner rven Denial
$ L v�
IX. Condi��E�teasons for Disapproval
1. Septic tank, effluent filter and
dispersal cell must all be ser0ces / maim 4) e �s G- p e_ e++�e 1 --r /
as per management plan provided by plumber.
J—r' ° Z u((���- n ex-5 c w.
2. AN seftM* requirements must be maintained a.� i �—t� o n JCS k/ t'� l 6t. �.
codeJort�nat>t�s.
Attach to complete plans rot the system and submit to the County only on paper not less than 8 112 x I 1 inches in size n
Ply lea VC_ 6
SBD -6398 (R. 01/07) Valid thnt 01/09 �� 1
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,03118/2007 07:30 7153862979 GLE JOHNSON PAGE 05
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RECEIVED
O JUN 01 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
r
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code t
County
Attach complete site plan on paper not less than 8 1/2 x -
incude, but not limited to: vertical and horizontal referen poi (RIa Parcel 1.0.
percent slope, scale or dimensions, north Ifor w, lion and distance to nearest road
Please print
by
, z /
Personal information you provide may be used dary p es (P nv cy Li;w, s. () (m)). Revie f Date
Property Owner 5 �. �RUIX LPMp fh";Locat n
1 1/4 14 S T N R E (o W
Property Owners Mailing Address lot # Block # 90til. Name or CSM#
City State Zip Code Phone Number 13 city ❑village wn Nearest R
o :c�
New Construction Use. Residential / Number of bedrooms Code derived design flow rate j GPD
❑ Replacement Public or commercial - D scribe: _ - -- -- —
Parent material f n Flood P in elevation if applicable
General cortvnerrts ! J - 3 , O
and recommendations: � - e �/(/
C1 ring
17 1 Q - 7
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 GPD/ff°
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2
A/
J ✓ �� 1 � � � / /' I W
"
a A l' # Pit Ground surface elev.? ft. Depth to limiting factor in. Soil Application Rate
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
- Z' ldjrsj�t Li 15
3• �
Effluent #1 = BOO > 30 < 220 mg1L and TSS >30 < 150 ' Effluent #2 = BOD _< 30 mg& and TSS < 30 mglL
CST Number
CST Name Please Print) 226900
Bird Plumbing, Inc. Shaun Bird Telephone Number
Date Evaluatio n Conducted
~ 715- 246 -4516
1008 192nd Ave, New Richmond, WI 5417 ---�
Property Owner Parcel ID # Page of
Boring � 1/
5 Pit � # Ground surface elev. `-" Depth to limiting factor SoilApplk2tion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Co nsistence Boundary Roots •E GPDHFEff#2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
i p -1 i I 0 3/z s , A0
'3
'� Lr
❑ Ong # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in. SoilAl4icafion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ffF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
Ong # ❑ Boring
C1 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Appl Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDKf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2
Effluent #1 = BOD > 30 < 220 mglL and TSS >30 1150 mglL ' Effluent #2 = BOD 1 30 mg& and TSS 130 mglL
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 264 -8777.
seaasw tR.sroo►
Soil Test Plot Pla
t Project Name Environmental Holding L.L.P. Sh rd
Address 706 19th St. S.
Hudson Wi 54016 OTM #226900
Lot 26 Subdivision Lundy's Preserve Date 5/24/04
N 1/2 NE 1/4S 27 T 30 N/R 18 W Township Richmond
Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of St el Fence Post
System Elevation 93.4/93.0/92.6 *HRpSame as Be
Alternate Benchinar Top of Survey Iron C 9 . '
AL
Please note:Soil test
435' was done to satisfy
Property Line county zoning
requirement. Soil 329' Property
test may not be Line
suitable for owners
desired building
location.
B -2 97'
95'
°' Scale is 1" = 40'
unless otherwise
noted
-3
0 '
B -1 50'
60'
8% Slope
* B.M2 5 '
162' Property Line
SEPTIC TANK 6 PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
4" CI VENT PIPE 12" MIN. ABOVE GRADE 6 WEATHERPROOF
2:25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED
FRESH AIR INTAKE WITH CONDUIT MANHHOLLLOCOVER
FINISHED GRADE WARNING LABEL
7- 4" CI RISER 1 t . 4" MIN.
18" IN. 6" MAX.
'
'NLET PUMP OFF ELEV. FT. OFF
GAS -
WATER TIGHT SEALS
�' TIGHT � � �AppROVED
A SEAL JOINTS WITH
PPRO<VED —}•-- ; ALM APPROVED PIPE a
IPE 3' B ' ON 3 ONTO
INTO SOLID f ' SOLID SOIL
OIL � � *ft RISER EXIT
D PERMITTED ONLY j
IF TANK
MANUFACTURER
' HAS APPROVAL
3" APPROVED. BEDDING UNDER TANK
CONCRETE PAD
SPECIFICATIONS
SEPTIC / DOSE
TANK MANUFACTURER: / ,'eSe� NUMBER I�pS£S PER DAY: •:
TANK SIZES SEPTIC 10�G�' -_ GAL. DOSE VOLUME INCLUDING
DOSE !� Sd _ GAL. FLOWBACK: GAL.
ALARM MANUFACTURER: l �U��av_ s: CAPACITIES: A = INCHES = • ,3�1'y GAL.'
MODEL NUMBER: n t- y 2 INCHES = -�+� GAL.
SWITCH TYPE: � c- B = -
PUMP MANUFACTURER: Goc!,`s� C = S INCHES = GAL.
MODEL NUMBER: "` a e ,( D = INCHES = _ yf GAL.
SWITCH TYPE: c
REQUIRED DISCHARGE RATE Zd GPM PUMP 6 ALARM WIRING AS PER ILHR •16.23 WAC
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRZ•BUTION PIPE FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . 41 w FEET
+ FEET FORCEMAIN X , FT /100 FT. FRICTION FACTOR / - FEET
TOTAL DYNAMIC HEAD = 13,5> FEET
INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH; DIAMETER
LIQUID DEF -TM d
SIGNED: LICENSE NUMBER: .2,279Qd DATE:
1/88
[qGOULDS PUMPS Submersible
Effluent Pump
EPO4
3 8 71 EP05
APPLICATIONS • Fully submerged in high ■ EPOS Impelitr: Thermoplas- ■ Bearings: Upper and lower
Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing
y g lubrication and efficient improved performance. construction.
following uses: heat transfer. ■ Casing and Base: Rugged
•Effluent systems thermoplastic design provides AGENCY LISTING
• Homes Available for automatic and th and corrosion • Farms manual operation. Auto- superior streng Canadian standards As2oda w
• Heavy duty sump matic models include resistance.
• Water transfer Mechanical Float Switch ■ Motor Housi
ng: Cast iron (CSA listed model numbers end
M " M
• Dewaterin g assemb ! and prese t at the
for efficient heat transfer in F or C ".)
facto ry. . strength, $nd durability.
SPECIFICATIONS ■ Motor Cover. Thermoplastic Goulds Pumps h ISO 9001 Re9
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 NPT. seal protection.
• Mechanical seal: carbon -
rota rykeramic- stationary,
BUNA -N elastomers.
• Temperature:
104°F (4000 continuous METERS FEET .. .. . .....
_ ..
.. - - - ...... . ........ ... . ...
140°F 60 intermittent~
• Fasteners: 300 series
stainless steel. ........ . .. . . . . . ....... 5 GPf A
• Capable of running 30
dry without damage to a
�25T
components. 25 ,_....__ F
Motor.
-
• EPO4 Single phase: 0.4 HP, i
115 or 230 V. 60 Hz, 1550
s , _
RPM, built in overload with .rt_
automatic reset o 4-
15 _ .._. l `
• EP05 Single phase: 0.5 HP, o EPOS
115 V. 60 Hz, 1550 RPM. a_._ ._ _ ,._ . --- --- .__ -._
built in overload with ! ' EPOa . _
automatic reset.
• z
Power cord: 10 foot S
standard length, 16/3 t
SJTOW with three prong _
g rounding plug. Optional 20 0 00 to _. Zo . so so oPnn
foot length, 16/3 S1TW with `
three prong grounding plug
(standard on EP05). o z a 6 a to 1 2 m)/h
CAPACITY
Goulds Pumps
® 2000 Goulds Pumps ITT Industries
Effective February. 2000 t>
83871
ST CROIX COUNTY
SEPTIC "TANK MAINTENANCE AGREEMENT
. AND
OWNERSHIP CERTIFICATION FORM
OwnerBuyer � �r �� / d- Cy e,zl /Z64
Mailing Address �/)� / l�li �.�'•m .i Lc�P
Property Address / . i rr
(Verification required from Planning Department for new construction)
City /State Parcel Identification Number
LE GAL DESCRIPTION
Property Location ;AF �/,, �i'A, Sec. "? T 7 0! N -R /9 Town of N,.e
I
Subdivision _ -t &,V , Lot # .�4
Certified Survey Map # , Volume , Page #
Warranty Deed # , Volume , Page #
Spec house O yes X no Lot lines identifiable 0 yes 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
Y
s stem.
P
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and b� a
master plumber, journeyman plumber, restricted plumheror a licensed pumper verifying that (1) the on-site wastewaterdisposal sysce.m
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
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 (lie Department of Natural Resources, State of Wisconsin. Certlficanon
stating ilia ur sc ti system s been nioiit "ned must be completed and returned to the St. Croix County Zoning Office within 30
days of ree car xpirat n date,
SIGNATURE OF PLICANT DATE
OWNER CERTIFICATION
4 1 (w4descibc cc tha 11 statements on this form are tnic to the best of my (our) knowledge,. I (we) am (are) the owners) of
pro ab c, by viriuc of a warranty deed recorded in Register of Deeds Office.
LICANT DATE
A ny 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
I
I
U 2 7 5 9 P 5 1 5 -7 s4S $4F3 6
State Bar of Wisconsin Form I - 2003 KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO.. WI
Document Number Document'Nsme
THIS DEED, made between Environmental Holding Company, RECEIVED FOR RECORD
LLC 03/07/2005 09:20AN
( "Grantor," whether one or more), WARRANTY DEED
and Glen Johnson Construction EXEMPT #
( "Grantee," whether one or more). REC FEE: 11.00
TRANS FEE: Agq.go
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 14 and 26, Lundy's Preserve, Town of Richmond
Recording Area
Name and Return Address
Title One Premier Group
706 19th Street South
Hudson, Wisconsin 54016
partof 026 - 1078 -10 -000
partof 026 - 1078 -30 -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, and Restrictions of Record.
Dated
(SEAL) A (SEAL)
* Jeff Wa en * Bill Sherman
Environmental Holding Company, LLC Environmental Holding Company, LLC
(SEAL) (SEAL)
* *
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
) ss.
authenticated on St. Croix COUNTY 1
Personally came before me on 14-it-rch __ .4, 2005
the above -named Jeff Warren and
* Bill Sherman
TITLE: MEMBER STATE BAR OF WISCONS R A. FF to me known to be the person(s) who executed the
(If not, F� pCG foregoing instrument and acknowledged the same.
authorized by Wis. Stat. § 706.06) ? S'
NOTARY cZ
THIS INSTRUMENT DRAFTED BY * , * _
ennif A. Fe son
Michael H. Forecki Attorney PUBLIC ? of Public, State of Wisconsin
Eau Claire Wisconsin 9 �y y Commission (is permanent) (expires: 03/23/2008 )
(Signatures may au ®/h ' nowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. A MQD ONS 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 I. Eau Claire Wr 54701 -7928 Phone: (715) 835 -3029 Fax: (715) 835.4112 T4363433.ZFX
Title One Premier Group Produced with ZipForm"' by RE FormsNet, LLC 18025 Fifteen Mile Road, Clinton Township, Michigan 48035, (800) 383 -9805 www.zipfcrm.com
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION �wri �.. ' �- to
SYSTEM SPECIFICATIONS
Owner
Septic Tank Capacity l ee 46 al ❑ NA
Permit N
Septic Tank Manufactur l�r�d•.Z ❑ NA
M SIGN PA RAMETERS Effluent Filter Manufacturer 6 ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units ❑ NA Pump Tank Capacity sl ❑ NA
Estimated flow (average) �f j"Q al /da Pump Tank Manufacturer s �, y ❑ NA
Design flow (peak), (Estimated x 1.5) � � g allday Pump Manufacturer a'dA ew ❑ NA
Soil Application Rate g al/day/ft' Pump Model ❑ NA
Standard Influent/Effluent Quality Monthly average" Pretreatment Unit ❑ NA
Fats, Oil & Grease (FOG) 530 mg& ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA O'Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg /L IO Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) O NA
Biochemical Oxygen Demand (BOD.) 530 mg /L ,O -In- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) .530 mg /L ❑ NA O At -Grade ❑ Mound
Fecal Coliform (geometric mean) 51W cfu /100ml ❑.Drip - Line ❑ Other:
Maximum Effluent Particle Size Y in dia. ❑ NA Other' 13 NA
Other: 0 NA Other � ❑ NA
'Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: earm(s)
10 onth(s) (Maximum 3 years) E3 NA
Pump out contents of tanks) When combined sludge and scum equals one -third (Y of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: month(&) (Maximum 3 years) ❑ NA
3 ears)
Clean effluent filter At least on every: " ` ` monthis) ❑ NA
_ �. / '
Inspect pump, pump controls & alarm At least once every: `' ` r 13 13 m e ar(s)) 13 NA
{s)
J i
'0 month(s) O NA
Flush laterals and pressure test At least once every: ^- O earls)
tither: At least once every: ' +,�_ ❑ e ar j(s) ❑ NA
Other:
❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made b an individual carryin one of the following licenses or certifications:
P p Y d
Master Plumber, Master Plumber Restricted Sewer; POWTS Inspector; 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 sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cells) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may Indicate a failing condition and requires the
immediate notification of the local regulatory authority. u
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 S12 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.
START UP AND OPERATION
' For new construction Page
that may • prior to use of the POWTS check treatment tartk(s) for the presence of painting
Y impede the treatment process and /or dame
of t . ..go the dispersal cell(o!. If high concentrations are detects
he tankls) removed b se tae servicin o perat or . products or other che co nten ts
y a P A A prior idle. d have the contents
System start up shall not occur when soil conditions are frozen at the Infiltrative surface.
During power outages pump tanks may fill above normal hlghwster levels When power is
discharged to the dispersal ceN restored the excess wastewate (sl in one large dose, OVerlgadlnp the coil( s
effluent. To avoid this situation have the contents of or will b
the pU S' o lti re and may result In the the moved by a Septage Servicing Qperatorfa a discharge of
Power to the affluent pump or contact a Plumber o r F'OWTS Melnt
restore normal levels within the pump tank, assist Other to in manually operating to restoring
o '
III as ! Prior
p g the pump controls to
Do not drive or park vehicles over tanks and dispersed cell$, pq not drive or park over, or otherwise disturb r
within 15 feet down slope of any mound or at- grade`atiil abanrtipn oral!. o compact, the area
Reduction or elimination of the fallowing from thllMl!{KeVV6 ;lr slf60rrl may fr►tprove the performance and rolar
POWTS: antibiotics; baby wipes; cigarette butte;1.goridiyma; 0000111 swabs; degreasers; dental floss, p g the life of the
foundation drain !sump pump) water; fruit and vegetable peallri "is; diapers; disinfectants; fat;
painting products; pesticides; sanitary napkins; to oni and 11�lnil grease; herbicides; meet scraps; medications; oil;
ABANDONMENT W #tor sditinor brine.
When the POWTS fails and /or is permanently taken"'out of servioli the f o l lowin g s teps Properly and safe! aban A shall be ta ken to Y doped in compliance with
"chapter Comm 83.3,3, Wisconsin Administrative Code; insure that the system is
e Kr
All piping to tanks and r t*
P i ts shall
P be disCOnHeoted and the abandoned pipe openings sealed.
e: The contents of all tanks and pits shall be` removed and properly disposed of by a Septaga Servicing Operator.
g A eta.
e After
Pumping, all tanks and its shall P a 1 be excavated and removed of their covers removed and the void space filled w th
soil, gravel or another inert solid material, - - •
CONTINGENCY PLAN
If the s yste m: ' pw fails and cannot be repaired the follin
replace t meat s 9 measures have been, or must be taken, to provide a code compliant
❑ 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 sho 1
and ro u d not be infringed upon b
9 proposed stru cture , P Y
required setbacks from existing
result In the need for a new soil and site evaluation to e�stab tth a a d able eras Prot
the replacement area will
comply wi -h the rules in effect a Replacement systems t that time. Y s must
A suitable replacement area is not av
shills due t
t q e4tback and /or soli limitations.
echnola . Barring a
{7y a holding tank may be instalied,a A dvances in POWTS lest ►est7rt to r9p(ace the failed POWTS.
The o ite as not an evaluated to idalntll�y a auitablp replace area. Upon failure of the POWTS a soil and site
evaluation be performed to locate a o '
b ' tatle s 144)s rool&QOM*nt area. It no replacement area is available a holding tank
may s a lat resort to replace the failed POWTS.
Cl Mound and at -grade soil absorption systems may, be rsgonstructsd in piece following removal of the biomat at the
'infiltrative surface. Reconstructions of such syst9Ms must 9.omply with the rules in effect at that time.
< <WARNING> > ,
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONT LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNbEp ANY CIRCUMSTANCES.
DEATH
THE INTERIOR OF A TANK MAY MAY RESULT. RESCUE OF p
PERSON FROM
BE DIRF
iCtJLT OR 1MPOBSIf3lL.
ADDITIONA _ L COMMENTS
POWTS INSTALLER h VV t3 MAIN T AINER
Name
Phone Phone
SEPTAGE SERVICING OPERATOR (PUMPER!
Name LO AL REGULATORY AUTHORITY
N ame sd- . G 6- Ze
Phone Phony 7 {S -
rh.
.s doc m
u
en
t was drafted in compliance with c
P (` solar Com 83.221210111 11414if and �,
� 9 64(t), i21 & {31, Wisconsin A
Cmmistratwe Coda.