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HomeMy WebLinkAbout026-1175-17-000 ' County: .Wistonsin Department of Commerce PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 499288 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 Homes of Hudson, LLC I Richmond, Town of 026- 1175 -17 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: Ac gI 1 30.30.18.1417 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic // � ' 6v\ Benchmark / Z 5c C • 1G� ) /d�J Dosing Alt. BM / • �� 6 ^/%1L 760 T.,kv,� C c-J � 7 M5 45 Bldg. Sewer � Holding St/Ht Inlet I6. C21 CiT , 31 St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ,7 50 OV k 5 , �� % Dt Bottom Dosing ; _— Header /Man. 750 IJ 1'6 Aeration Dist. Pipe System Bot. S Holding Y PUMP /SIPHON INFORMATION Final Grade y 1 Z_ ,6 }' 7 ZiLl�u •b - \z,.S ��•— ' Manufacture Demand St Cover /C3 Z5 Manufacturer _ ov` G, '�� Model Number is 3 TDH Lift,-„ . H1 Friction Los System Head TDHH � �t Forcemain Length / Dia. Dist. to Well ZZ z / ✓1-- SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenc PIT DIMENSIONS No. Of Pits Inside Dia. i Liquid Depth DIMENSIONS em Z, ti e .ti �� \ �-_ i SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer.,.V INFORMATION CHAMBER OR J— W . Type Of System: Z� -36 � A / /\ _ UNIT Model Number: pe/ DISTRIBUTION SYSTEM N;! z3 t Z, = 'Y Header /Manifold �� Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) \1 h Lengt 4' Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of ed � xx Seeded /Sodded xx Mulc Bed Trench Center 3• Bed /Trench Edges ` Topsoil Yes , }, No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / ! Location: 904 131st Ave New Richmond, WI 54017 (SW 1/4 SW 1/4 30 T30N R1 8W) Willow River East Lot 1/7 ] Parcel No: 30.30.18.1417 1.) Alt BM Description = � 2.) Bldg sewer length - amount of cover ��.L Plan revision Required? Yes No 15 �� 7 Use other side for additional information. Date Insepct ' Signatur Cert. No. SBD -6710 (R.3/97) I Safety and Buil ' Di County - N W. Washington Ave., 0. Bo f CrE�) x Madis �O��,1� on, WI 53707 - 2 anitary Permit Number (to be filled in by Co.) De artment of Commerce (608)266 - 3151 Sanitary Permit Applica tioiRECEIVEI)l S to PlanI.D.Numbee In accord with Comm 83.21, Wis. Adm. Code, personal info ation you provide /�// may be used for secondary purposes Privacy Law, sl .04(1 m P ject Address (if different than mailing address) x F�B 1 3 200? oy r I. Application Information - Ple rmtAllInformation aw yf �! COUNTY Property Owner's Name P reel N o Block # Property Owner's Mailing Address Property Location P 1 3to # '' /., Section 3D City, State Zip Code Phone Number / u (vdSO� S ®ICp Trr•s3� -b7l� T N, R,�(cEcleWe) l l H. Type of Building (check all that apply) / 1 or 2 Family Dwelling - Number of Bedrooms P �L�Ds�I �(mC Subdivision Name CSM Number (how R tPee, m5'f' ❑ Public/Commercial - Describe Use f El Owned - Describe Use 'f 56 �Ue t f s (�i ( 7 - 40 s'$ ❑City_ ❑Village J(JTownship of eG tie III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New 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 Om S 0 Co ^VaA't �oHe. l IV. T e of POWTS System: Check all that a l t- '� 1 ST C� ! s i k Z 2 3 G f.4 6..r s N - Pressurized In- Groun El Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil. . El At-Grade El Single Pass Sand Filter El Constructed Weiland ski z�cFi t�f6etfd✓ ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating SandF Recirculating Synthetic Media Filter Weaching Chamber Q Drip Line ❑ Gravel -less Pipe ❑ Other (explain) l v V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdso Dispersal Area Required (so Dispersal Area Proposed (s System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units 6.' A{.(w # Concrete Constructed Glass New Existing Tanks Tanks y Septic or Holding Tank v ZS Cy v }.1�� S �C/� /I- Aerobic Treatment Unit !� Dosing Chamber VII. Responsibility Statement- I, 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 Mi kL- M ` b o AGJ -2- .S-© 3 !p 7/S -740 - Z1 z-s Plumber's Address (Street, City, State, Zip Code) /070 . f{vNT R - R/b 6 E XJOS,0 (0 1 sy VIH._County /De artment Use Onl pproved ❑Disapproved Sanitary Permit Fee (' eludes Groundwater D Issu Issuing ent Signatu S Surcharge Fee) /f �1\ pC� �f / 2 Lb ❑ er n Reason for Den IX. Conditions of Approval/Reasons for Disapproval 4 51T nC't.�J SYSTEM OWNER: J. Sepgc tank, effluent fitter and � Lc) : a C, dispersal cell must all be services / maintained as per management plan provided by plumber. 2. AN satDsck requirements must be maintained as per q*1c" code I ordill 0411. �`- Attach complete plans (to the County only) forte system on palAr not less than 81/2 x I I 01thes in size SBD -6398 (R. 01/03) a � J �Ok J M e S Y � r J a 4 i fl COPY J l -}'- r UA a 3 N 11 N V d 1 3 M Q � M -- c6 4r W (fly' o M N N a� 9c r M Wisconsin Department of commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code CounH Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must � � include, but not limited to: vertical and I referencw point (BM), direction and Parcel I.O. percent slope, scale or dimensions, a to nearest mad. Please pr all In fonmafion. by ate Personal inforrrrabon you Pride may be for secondary Purposes (Privacy a. 15.04 (1) (m)). Property Owner . r Property Location 3u1 30 _ Govt. Lot fu two 1/4 tjj 114 S3 1 T b N R E ( W Property Owner's Mai" Address Lot # I Block # Subd. Name CSM# Y Zip Code Phone Number ❑ city ❑ Villa T Nearest Road SX21 A ( ) i New conshuc Lion Use: Residential I Number of bedrooms Code derived design flow rate `T'.>'D GPO ❑ Replacement ❑ Pubic or commercial - Describe: Parent — nrWwial Oa-tZ J 4a,A..� Flood Plain elevation if applicable N 3 ft. aid General comments rr,tions: s� y s,�. 1�� 1103- 7)0Z' S (b I ukttk EO nn T ?w 9 # apit Ground surface elev. Q ' " R Depth to limiting factor d V In. Sod Auication Rate • #1 Morimn Depth Dominant Color Redox Description Texture Sfruchrre C xlsistence Boundary Roots G in. Munsed Qu. Sz. Cont. Color Gr. Sz. Sh. •121191 TOM � - � o-� � rn � ✓� � 1, � �- e # Pit Gro nd swiace elev. Depth to limi" factor- 'im sod Rate Horfmn Depth Dominant Color Redoc Description Texture shctwe Consistence Boundary Roots GPDff In. Munsell am. Sz. Cont. color Gr. Sz. Sh. •Eff#1 •Eff#2 l0 3 L 2 i'h r (►'1 C S L2 1 L r �- 2 )Duvl — CL i< L • Eftlent #1 = BOD > 3D 2211 mg& and TSS >30 IF : • Effluent #2 = SOD 1 30 mg& and TSS 1 30 mglL CST CST (Please ) �2 Number �,'� r✓ r T Nurmber Address Date Evaluation Conducted 6 I Property Owner Parcel ID # Page of ❑ Boring Boring # � Pit Ground surface elev. � ' � ft. 3 Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/f! In. Munsefl Ou. Sz. Cont. Color Gr. Sz Sh. 'Eff#1 'Eff#2 0-1 3 /z t_ Zme r 3 10 rye S os� I -� r) oI j7 4 Z .} ❑ sorkv # ❑ Borkv ❑ Pit Ground surface efev. ft. Depth to Grtrlfing factor in. soa Rate . Horizon Depth Dortinant Color Redox Description Texture SMxdre Consistence Boundary Rocts GPD/fF IM Munsoll Ou. Sz. Cont Color Gr. Sz Sh. 'Eft#1 `Eff#2 F-1 # ❑ BorM9 ❑ Pit Ground surface elev. ft. Depth tD NROV factor in. Sal Rye Horizon Depth DorninardColor Redox Description. Texture Struchre Consrdence Sotmdery Roots GPDVfF In. Mansell Ou. Sz Cont. Color Gr. Sz. Sh. 'E1f#1 'Eff#2 • Effluent #1 = SOD, > 30 S 220 ffV& and TSS >30 S 150 nV& ' Effluent #2 = BOD < 30 n & and TSS 5 30 mgfL 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. ssoasw(RAM) 17 -3 Soil Test Plot Plan Project Name David Railsback Shaun Address 845 133rd Ave New Richmond Wi 54017 CSIY#226900 Lot 17 Subdivision Date 19(12/02 SW/NW 1 /4SW /N W 1 /4S 30/31 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 Survey Iron System Elevation 103.7/102.0 *HRpSame as Benchmark Alt. BM Top of Steel Fence Post @ 104.0' Please Note: Tested area may not suitable for desired building area. Check system location before excavating. Soil test was done to satis 304' Property Zoning Requirement. Line 408' Property Line 107' 106' B -3 45' 30' 3% Slope 40' B -2 80' 4 B.M. 2 Y Pro ert ine OWNERS COUNTY PLAT l' AVIOSARIA1 LSRACK J110 —NILE. WILLOW RIVER EAST v° LOCATED IN PART OF THE SW1 /4 OF THE SW1 /4 OF SECTION 30 AND IN PART OF THE NW OF THE NW1 /4 OF Y +[ SURVEYOR SECTION 31, ALL IN T30N, R7 8W, TOWN OF RICHMOND, ST. CROIX COUNTY, WISCONSIN. EOWIN C. fIJ,NUTA - C NORINLANO SURVEYING, INC. 6 . N +S OSfi "AW El' PO RO %tn urn RO6ERTS. WI 6A02J 2 rLANUM aryl ;fun m G Rv G 0'5 N89"4 1442.0 - zT11''yy�� IT . �. °..er `9N �0� �, 1 3 Dl�l. /Nl CF EA EMFN7 7708 r9 gea. OE 1Rt 8o"o svl ra sW1N Or s[crr0rv:u z�1 rq r 10� \ s1 u irr s.;nsp 6 LOTS 260 ACRES ' 'wx I IJ�J gsq. M1. LOT 1 81 888] sgEB LOT 6 E� A CRES OPAINAGE EASEMENT OETNL LOT 7 9 g 2.09 ACRES T .�0' 111IC:? yy` Lf [v. enau 96.861 vu.n z � tow \. A L�O 22 A CRES ruL,rcmu y < M1i ee,e63 sg. n < d LOT 2 42 ACRES Y _ r. "I 10SA23 '. x . Pry $°q,r 1A y In n ss2nw 1 ' LOT 4Ay i pE 82 1 ACRES z inc e1% b J "e>ssa/ ,z [NSaR LOT 21 203 ACRES. \ ., 86262 R. "" - G) g NO po LOT3 �• ... o ri 81,771 sg -ft. o R x ax a' BB ACRES LOT9 - RA ACRES \• p BB T3B Sqn Zi L A T 20 � 1 CRES a .�rrn °v" N dl° LOT AC f_ r ...S eg. X. 2 aE LOT 10 y ,z4 2.63 ACRES 5 OT 8 '1: � ' '� 8 .. �� 1f0,J98 sq.R ACCL 98ER T 6 .... 2.11 ACRESW 1+Or[ LOT 18 y, ca,AxT uI 9 S no us 1Q W � I . 7 LOT 11 a 13.OTH_ u AVENUE �' 1• LOT 13 1 507 7 7 t 68.226 cqf n 1, 9J,081 QE ' ? 1 g to LOT 12 \ �w Q' LEGENO LOT 11, \�, 2.l4 ACRES 7S CRES {/ 10 ea gn �' vi 'mow - fio_vo v LOT 14 rMLE 210ACRE5 �, P0C ' _r� P � - -' • , .'e al w.vve rolAxr P.r�419 WO �� u� - c � 3 1"' � '• _ oRw_.,'a.rau.lw OI« 3 q�. TEMPORARY CULOE -SAC OETAIL ° ' R InrEAR LM�'n nr Z I E°ErrLOT15 rvSr x,R a a � ° Ivuu rut 221 AGRES ;� I •3°"g n a LOCATION SKETCH 6 °t 2 ' Rzrvo srgE�. vc "cRWa ,In. ro .gr o. r R9R r,vP wr e >i o I >• yyn �. 30 3 Lorz2 .ar. r„RUOw LOT iL w x77'77 r,a1C \ R LOT 6 '- rs. +t..rrvnrvn5 i nNi nre i , N gL51RVti 31 .�I Q, 31 ac - .a1mE [ mr '- vaA ur m 9V Via\ \ �2 • NflNU n�vA,l >snrrt iM nrxA r. LOTS LOTS u+IrriuO P lu.[sµ i va�iu E �(Aa ',.[� I _ —_ - -__ � w[RU+OS.NwruMLOT SIZ[ACCESSroeN1uL.6t�Cl�nsrOrE \ SEC 30 8 al , T30N,, 818W ' mf p°t'R" nzw "ouvr¢NOA=nonunre.wm Y: F° uro+uu[Nr., 6Errtcorm SCALE IN FEET 1` = 100' 108 0 , 99 zoo SHEET 1 OF 2 SHEETS Willow River East New Richmond, Wisconsin rRA4'ACt tI151�4N_�7V Lot 1 b Lot 5 1.$8 Acres 4 2.60 Acres Lot 7 2 '�; 81,887 s ft. 9 Acres " 113,1,35 13,P5-sq. ft. Lot 6 2,0 1 dt 22 ' • , q \ = 2.10 Acres 90 861 sq. ft. 2.04 Acres \i 1 �y ��` 91,345 sq. ft. ' I 8,963 sq. ft. °•., ,, Sold Sold I J Lot 2 + + , 2.42 Acres 92 5/ 2 q ;105,473 sq. ft. �` � C tile) x ' Sold 2 ... F10e�ACY,wfi• ... ............. .. Lot s 'Y -,c,ar _• :-,.: ` 1.62Acres Lot 70,435 � �• � �•- - -z —K�:. sq. 2.03 Acres ., ,; 11'889282 Model. ,a ri 'Sold .L ot 3 - i 1.88 Acres Z ....._....... 81 771 sq. ft. c' �(/ - Lot.:::• 1 Lot i f ` 2.04 Acres J 1.81 A ces Modell" ` �` . 88,738 sq. ft. k 78,649 sq. ft. 1 � ' l •�� �;' j Lot 19 '� �• f. f �� 1.94 Acres• �� ",' Lot 8 2.11 Acreg 84 , 295 . . s4 ' . ft. s ry — �` r r Lot 10 91,776.4q. ft. i Lot 18 _ �' y 1.88 Acres S'Old 2.53.Wes ,.Sold ? !82,078 sq. ft. l b rte' - + `�+ 1 i�T, 95 sq. ft. r Model ' ' +Sold Y i r t 'Lot 13 1 ' ;_"4 »88 Lot 11 �.. , Lot M -. ` - + E 2.14 :Acres: Acres r �/ 1.57 Acres t.�t 93,0$1 sq. ffi, ��'• 8�:75Sq. ft. j t f �, r , - -- 5 68,224 sq•, of 1'6... l 3 �� 2.34 Acres - Lot 12"��+ - 401,844 sq. ft 1.79 Acre. .p F PCJt1hVv C.i d 7 78 14 r P ft. ` ,u� El. I • Lot 14 % d / C 2.10 Acres 91,434 sq f�• ' f, " f i �, GpO� Lot 15 MILLEf� 1 s 2.21 Acre r H 96,3.43 s r A X .'� Miller Homes of Hudson, LLC r PO Box 10 Hudson, WI 54016 -0010 Phone /Fax: 715.531.0714 www.millerhomesofhudson.com ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mi l LiEk Ho M F 5 L L Mailing Address 4 Tao X f D {-f �, p s © " L 1 S"f ,0 ( 16 Property Address C ?a 'y 3 t AVE NjC R (C.HMOMP W (Verification required from Planning & Zoning Department for new construction.) City /State Ah5w C C kru � Parcel Identification Number 7 S - / 7 LEGAL DESCRIPTION Property Location SU-) '/4 , U) '/4 , Sec. '34 , T 8 o N R / S W Town of Subdivision W «•Law k (VEk2 rkss' / 7 ,Lot # Certified Survey Map # q 15 15 , Volume /� , Page # Warranty Deed # - 7 8 Z © `f O , Volume 27 l , Page # Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists 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 alreatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 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 Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms T 0 7 S N URE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) 8�b3� 34 2 6 6 5 P 2 2 1 KATHLEEN H. WALSH State Bar of Wisconsin Form 2 -2003 REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO., WI Document Number Document Name RECEIVED FOR RECORD 08/12/2005 09:55AM WARRANTY DEED THIS DEED, made between David H. Railsback a/k/a David H. Railsback 11 and EXEMPT ii Aria J. Railsback, husband and wife REC FEE: 11.00 TRANS FEE: 1287.00 ( "Grantor," whether one or more), CC and Milla rHomes of Hudson, LLC PAGES: 1 ( "Grantee," whether one or more). Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following Name and Return Address described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is needed, please attach addendum): Lots 1, 9, 13, 11 18 and 20, Plat of Willow River East in the Town of Richmond, St. Croix County, Wisconsin. &E Part of: 026- 1088 -95 -000 & 026- 1091 -70 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated Li (SEAL) k (SEAL) ' *David H. Railsback, 11 , (SEAL) X " Q. ,Oa Ad (SEAL) * *Aria J. Railsback AUTHENTICATION ACKNOWLEDGMENT Signature(s) David H. Railsback, 'It and AHa J. Railsback husband and wife STATE OF ) authenticated on ) ss. COUNTY ) *Kristina O land Personally came before me on TITLE: MEMBER STATE BAR OF WISCONSIN the above -named (If not, to me known to be the person(s) who executed the foregoing authorized by W is. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: * Attorney Kristina Ogland Notary Public, State of Hudson, W1 54016 My Commission (is permanent) (expires: ) (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 0 2003 STATE BAR OF WISCONSIN FORM NO. 2 -2003 ' Type name below signatures. INFO -PROT Legal Forms 800- 855.2021 www.infoprotonns corn POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I 0 1 Z FILE INFORMATION SYSTEM SPECIFICATIONS Owner L Septic Tank Capacity / 250 ga l ❑ NA Permit k Septic Tank Manufacturer W4_ Se'r- ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer P,0' f0 4* ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al ❑ NA Estimated flow (average) S[e)b g al/day Pump Tank Manufacturer ❑ N A Design flow (peak), (Estimated x 1.5) 6100 g al/day Pump Manufacturer ❑ r, Soil Application Rate .. - 7 - gal/day/ft' Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD S30 mg /L XIn- Ground (gravity) ❑ In- Ground (pressurized, Total Suspended Solids (TSS) S30 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) S10' cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia, ❑ NA Other C NA Other ❑ 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: ❑ month(s) (Maximum 3 years) ❑ NA O,y ear(s) Pump out contents of tankls) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 yearsl ❑ NA ❑ year(s) Clean effluent filter At least once every: j — Z ❑ month )(s) E) NA inspect um 13 month(s) ❑ NA p pump, pump controls &alarm At least once every: ❑ year(s) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifica *.ions. Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tary inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or IeaKS, 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 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. 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 dispo$ed of in accordance with chapter NR 11 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 10 days of completion of any service event. �. TARTi UP AND OPERATION Page 2 Q 7/ 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 celi(s). If high concentrations are detected have the contents cf 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 celf(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 and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings seated. • 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 fast resort to replace the failed POWTS. T alua b e ai a '��ZDf -lt8 J7�21 �0�2 N/�b✓ C�NS`7�Rc1G?1 n � ank ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the nfiltrative 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 =7f c 06 KECL Name d Zs . Pone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name S Name ( d Phone Phone - 7 /SS— 3e(o- (o (7 This document was drafted in compliance with Chapter Comm 83 . 22 (2)(b)11)(d) &(f) and 83,54(1), (2) & (3), Wisconsin Administrative Code. ;6cl,' 1 l ow_ 2 J a t e 1,4 57 -- G0 /- COMBINATION SEPTIC/DOSE CHAMBER TANK & PUMP SPECIFICATIONS PER COMM 84.25 CODE CHANGES 2/1/2004 Access Opening, not top of cover, Access Opening, not top of cover, must e►dend to a point no greater must eidend at least than 6" Below Finished Grade 4" Above Finished�Gf ade Cover with V Ajj GOOF Yid `'��t�i �I qd " Locking Device Tv O ,,.J B PP'► -a`'� CAP Zn (typical) Finished Grade IZ /►'I iN�rn Um Min. 23" 30 FT. 42 /A Access Opening 0 � 1IJ5ULAT-;_:� Min. 23" Access Opening PI � Z " 'rne E�riA�N Outet Effluent Filter �( /')P% S( E ► Union i PPP --oVEA { 21106 - 3 PT, Inlet Baffle O/u7� SOS /D SOi C_ ► ► � I ► Pump 3 " Sa,n d 0 1 ra W - , �y u nape l' cu � �, oc h-ler 2 " /awe r fa h ed es J Two ComparTment Septic/Pump Tank ' /� gle°/ � en o��de SPECIFICATIONS J TANK MFR: �,(, DOSES PER DAY: Y TANK SIZE: SEPTIC (ZSQ' GAL. DOSE VOLUME: / S o GAL. DOSE 7-!�;_ o GAL. (INCLUDES FLOWBACK & <20% OF DWF) ALARM MFR: 2,c h CAPACITIES: A = INCHES= GAL. MODEL # Switch type: B = _Z, / 2 = GAL. PUMP MFR: _a,-,, I (@ C = `"l INCHES = S GAL. MODEL #: L Nt SWITCH TYPE: Lz , D = Z INCHES = _ GAL. REQUIRED DISCHARGE RATE GPM PUMP & ALARM WIRING PER COMM 83 . 43 ( 8 )(e) VERTICAL DIFFERENCE BETWEEN PUMP OFF & DISTRIBUTION PIPE (LIFT) _ FT. MINIMUM NETWORK SUPPLY PRESSURE (DISTAL & NETWORK PRESSURE) _ + /V ` {�_ FT. FT. OF FORCEMAIN x l.qe FT. /100 FT. FRICTION FACTOR ...... _ + \eA_ FT. TOTAL DYNAMIC HEAD (TDH) _ FT. INTERNAL TANK DIMENSIONS: LENGTH i S " , WIDT ; LIQUID DEPTH MP /MPRS SIGNATURE: %� I ! t �� , ICENSE NUMBER: W P S e 1 Filters 0 PL -525 EFFLUENT FILTER ( ) Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters.The PL -525 is rated for over 10,000 GPD Alarm �� -_ (gallons per day) making it one of accessibility 11 Accepts PVC the largest commercial filters in its extension hanUle class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the new Polylok PL -525 has an automatic shut off ball installed 525 linear feet with every filter. When the filter is of 1 /16" removed for cleaning, the ball will filtration slots Rated for over float up and temporarily shut off 10,000 GPD the system so the effluent won't leave the tank. No other filter on the market can make that claim! Accepts 4 & 6 "_ SCHD. 40 Pipe PL -525 Maintenance: The PL -525 Effluent Filter should operate efficiently for several years under normal conditions before 1 requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or at least every three years. If the installed filter contains an optional# ; alarm, the owner will be notified FF by an alarm when the filter needs F- servicing. Servicing should be Gas deflector done by a certified septic tank I Automatic shut pumper or installer. '`�r___�" ball when filter is removed 1. Locate the outlet of the U.S. Patent No4 6,015,488 septic tank. 5,871,640 2. Remove tank cover and pump tank if necessary. PL -525 Installation: 1. Locate the outlet of the 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and Com- 2. Remove the tank cover anc: 4. Pull PL -525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the tank. Make sure all solids fall 4" or 6" outlet pipe. If the filter is not centered under the back into septic tank. access opening use a Polylok 6. Insert the filter cartridge back Extend & Lok or piece of pipe into the housing making sure to center filter. the filter is properly aligned and 4. Insert the PL -525 filter into completely inserted. its housing. 7. Replace septic tank cover. 5. Replace the septic tank cove;. ,.achnical Specifications PL- -525 EFFLUENT FILTER (COMMERCIAL) —617 SALL CHECK — EXCEPTS 6' SHO 40 FOR INLET EXIENTION 14.35 1 � OUTLET BUSHING EXCEPTS - -� i 1.��. P SCH 40 d 6' SCH 40 6.10 uA — f 1068 -.._ .._ 3 33 i I ' I � I � PL-525 FILTER HOUSING x34 -t PART N0. - 30142 -525 i MATERIAL: HOUSING - POLYPROPYLENE i 1 OUTLET BUSHING • PVC ! 6.5 BALL -HDPE - SOCKET E XCEPTS FLOAT SNITCH 10.21 -- EXCEPTS I• SCH w ( )' 98 hl � FOR HANDLE EXIENTION i -� 1 _ 10.81 WOF1A6 LOTS � i 6.21 --- SOCKETEXCEPTS 6.04 _ BALL PUSH ROD - OPENING _ I I l 7.09 OPENING 20.71 � O i 19.02 2214 POLYLOK PL -525 FILTER CARTRIDGE PARTNO - 30141-525 MATERIAL - POLYPROPYLENE I - Polylok PL -525 Support Stand Should you feel it necessary to add additional support to the PL -525 filter, use a six -inch Schedule 40 or SDR 35 pipe to extend from the base of the filter to the bottom of the tank. The extention pipe needs to be anchored to the filter housing with one or two #10 X 112" SS screws. Anchor 1 -2 Stainless steel screws throug housing nd into pipe. 9 Use #10 X 112" � 6" Schedule 40 Pipe Pipe rests on bottom of tank i ��Ele H D 04 ES 1 4 VE Qf/i Ck4 STANDARD CHAMBER 0uick4 Standard Chamber -- ------- - - 48 ° — - - - -- _ (EFFECTIVE LENGTH) 8 .. �� - - -- - - -- 34" - - - -- — -� SIDE VIEW SECTION VIEW I i MultlPort End Cap i : Il i r A - - 34" - - - - - -- - - - SIDE VFEW TOP VIEW - -- -- FRONT VIEW r I j Quick4 Standard Chamber. Nomina ;- pee fiat ons n - MultiPort End Cap Nominal Specifications Size W x L x'H Size (W x L x H) 34" x 16" x 12" J . Effective Length t t ; x' +"' 48 s t ,Invert Height 8 or 1.25" Invert Height 4 i 1 INFILTRAT-OR_SYSTEMS INC. STANDARD LIMITED WARRANTY f Ci 1 chi t n C. "IFIC, wi. and clhe., accessory man(faclurrd by Ofillrllo, 1 11 - 1 when,191alldif ]n(1 �P a'. .an P Ih I fllralo' nsl ,xl ons s warranted 10 Ih . p qIn tl { r (HrldP ) aga n51 d Intl 'P e ve _ T th+ dst. Thal the Sept c ne m1 i5 issued to, the setilic sy I c0 to J the firi,ts. prov,l , I owe P 1 a( h ap )I( t.IP law the w arranty oe pd will begin upon the d;III, hill ri, of IN snnl C sysid,n (( n nncP.. t S L V of mo I g a1 IS Cricbrale Headq . uad 01d Sayb ri k ( r,, t In fill 151 'v t al.la e I I ni 1 0 , l t detp —nrad by nfllralp In I.o cnv. ,.,, ,v '.I.. jr, I rrr, Wx-11V ' • 1 ( n .. if � -)nval and /pr slall;tl On of IhP Uni ts r 1 1•;.;p , if MIDI( $ IN S11BRARAGRAPH (a) ARE EXCI.USNE 71 -If RF ARE NO 07 HI_F WARHAN7IE : WITH H[SRF. C T S YSTEM S '- - Mi 'VIA'" FCI W'AR1 a i,N -IES OF MF..RCHANIABIL1TV OR FITNESS FOR A RAWICOLAR 'Ui OtiE IN o r + v t �,f e chamber syae s menufacturad by ar o �n tI, I 1 ll I) Tin, 1 tM W �I It s 1, nd ec dar age RI olor ahafl not be able lo — r Environmental Onsite Wastewater Solutions d Hate a s e:e tinad costs n Diner losses or expenses incInpd by Ih • Holder or an\ rwd padV S(Ax: 6ca0y y ! o orf If ac to ll e Un Is due to ordinary ea "I'd tad II lion. ac : d(. t al n r, )nql ,(t pl Ph l a c ) Otte .ondlons Mich dre not le Hided b J e tall O fat e I n' lan It- 6 Business Park Road • P.O. Box 768' loth in Ih 1131 n In t cl pis' the plalri Of Mproper male IO tt e y t I� l Ih 11 I Id . of m l n g) p rim, tg ex,celwater isag, t ,I dc(y,n( pn n Old Saybrook, CT 06475 - , d by Infptalc Warranty shall be Vold d the Holder frills In cor mW w 1h ao r,r P N:, .el loan n th e L .mac 860- 577 -7000 • FAX 860 - 577 -700'1 In51trid, be ( 't 1 111Y Osc nr da "age Io the Holder the lln v t. rn) n II , g I -Ja o O a 800- 221 -4436 1' 01, Uct ah f ly c1a -,I- o an) I'n rd na'1y For this Lim IM Warra )ly I) annlv..hr. I. t, n te' sl fund n .1 ) dd t � - rsa ired by Itat. I I-f,fl q f05'. all ,,her 111011<:ab1e laws and 1,1fillrW)r t nniallw,r n I. a Ir:tlr�n_a r 1as ha. aul'"o'II, In Change or Px P)d this Lirf Warl N a I s . S'a nnHrC _ 1 1 - , ly oHere(I by Inl Ilrel or A Imileo lumber of att..: n: Ilavr; I,II t wdrr )rtly rrxlnlrP mall I')I�Itralor s Corporate Headquaners In Old Saybrp0 ". ;o) 1pcl r; 1. nr r r ;, (ch purchal:e. to nblaln I - v: R)', Ind _c. o,rld r: arnf road that warranly prtor to (be purphase of I p,,f,; L 04 1, 9 1 :C. / 8f .017,5401,116.5401.4595 5. 7 1(,163 84a 3. 2 U0 5 54 Other patents pending. :� n Soc,Vvicle a n ro rt !e,ed Irademark5 of Infiltrator Systems Inc. Inhllrelo n regtterei trademark n France. InfdVator Fysterns In - m Mexico Cnnlour , n r I necrci ea vavea . Gc tou Sw ve Connection, MicroLeaching. PolyAdl. Snapl_ock C;hamberSpacn(. PosiLOCk, OulckGut. 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