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HomeMy WebLinkAbout042-1077-90-400Wisconsin Department of Commerce Safety and Building Division GENERAL INFORMATION Personal information you provide may be used for PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) [Privacy Law. s. 15.04 (1)(m)l. David and Rosanna Daleiden I TOWN OF WARREN TANK INFORMATION 0 Im,, -r-- R r-L // A TYPE MA N 1 FAC TV RER CAPACITY Septic wc1� to�hb !� Dosing Aeration Holding �r S%rti>lC� �f�0 ,,,ELEVATION DATA TANK SETBACK INFORMATION FVtr- �,/j1,/)AY ..57_f- TANK TO P/L, BLDG. Vent to Air ntake ^ ROAD Septic U t IlWELL 3 ` Co71 Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand Zver GPM ModelHNumber � � Zfo • t/ TDH Friction Loss Systa3 He d TDH Ft Forcemain Leth ` Di�7 ,� Dist. to well g 0 SOIL ABSORPTION SVRTFM STATION BS HI I FS ELEV. Benchmark t 15 %60 Alt. BM Bldg. Sewer 3.g r8 . Z SVHt Inlet St/Ht Outlet Dt Inlet Ot Bottom 8.5y R3.5� Header/Man. Dist. Pipe Bot. System t Final Grade St Cover T� ver .12 1bZ.3 `f7. `/Z BED/TRENCH DIMENSIONS�- Width t0 Length �F No. Of3senohes G 2t PIT DIMENSIONS l No. Of Pits Inside Dia. Liquid Dep SETBACK INFORMATION SYSTEM TO P/L E JBLDG IWELL LAKE/STREAM LEACHING CHAMBER OR UNIT Manufaciureerr� `i ('! -- Type f System {' v✓rip %Ivo� / r (08 /�/k -f- 3Go Model Number: vwrnrvVr Wil Qy0i min HeatlerlManifold Length 3 Z Distribution , • ` ! 3 x Hole�Si s1 6 x Hole Spacing V to Air Intake `° - Dia Length Dia 2 Spacing apt. i SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only O r e n nter [ -Depth 5' H Over Bed?rench �� Etlges-� /'7 / L xx Depth of Topsoil '] r xx Seeded/Sodded )( Yes No rer ulched *Yes ;o COMMENTS: (Include code discrepancies, perso s present, etc.) Location: 1172 70TH AVE "r � s 1.) Alt BM Description = r t/_ " cOv{ r 2.) Bldg sewer length = fo5 Ill -amount of cover=7yZ[ovtir ON al, W vAt1 Plan revision Required? C, Yes © No Use other side for additional information. SBD-6710 (R.3/97) Date Inspection #1: y/9 /-2C) Inspection #2: L4/q/2,�) flow MOUN6FIK)IIL- �iSpc6�� IIZ 3 Insepet s Sg ature Cert. No. a.JP i✓t a Nt aic r r�ixC. � i'H LA %t zrx��y�0 LA ci7: cs ec- CB«cr efe- fido� � Sty /Ci P% e /re ex7 %'j/14crS- gyp^ W� g Norio-5. �• S efc 11...=#cF� C Xc e� ("�o-o-S he Yc i w lt.=/., cfir f'L•G P•y� v.�.6 /dt/+ o 3_ j]< (?or:a� fYar7 rer/ ycs7` 6 _ S c c.rNPdpc r�'y(.iP/dri Fr �zcct�icr 4 54ty - - Y14 corntn -- afety and Buildings Division County �7 CVO / S L' $ �Ei 19' 201 Washington Ave., P.O. Box 7162 019 adison, WI 53707� 62� a SanitaryPe it Number (to be filled in by Co.) Department f Comrrrerce S t Uti lication �tnIn State Transaction Number P W 7 /2 0>u�t��` accordance with s. Comm. e, su mission of this form to nate govemm Project Address differgnt than mailing a 2 unit is required prior to obtaining a sanitary permit. Note: Application forms for state S are submitted to the Department of Commerce. Personal information you provide may be used for sec purposes in accordance with the PrivacyLaw, s. 15. 1 m , Stan. J ( t L Application Information lease int All HoT e Ate-°/ Motion Property Owner's Name u� NW�i Parcel # o -/077 ,9o"f o O Property Mailing Address Property Location •1g 9, ' p (�3R — 71 4 )Owner's ci.. pij 4OO Govt. Lot — s� %S '/., Section City, State Zip Code Phone Number�o. � �cIe on T_ N; R �-� 11. Type g (check all that apply) j Lot II. of Building L�-"",,tt�� # Subdivision Name p1 or 2 Family Dwelling- Number of Bedrooms Block # ❑ City of ❑ Public/Commercial - Describe Usevisa— it �- CSM ❑ State Owned - Describe Use / A ❑D Village of _ JJfTown wa-. ,p Cr7 Number 161 GD GcoM- ; I �S%� of a .Y y e t : ecit only one box on line A. Complete line B if applicable) A""SystemRe lacement S tem p ys ❑ TreaunenlMolding Tank Replacement Only ❑ GdMf Modifialion [a Existing Sysum (explain) B.Permit Revision ❑ Change of Plumber ❑PermitTransfertoNewList Previous Permit Number and Date IsstMd Owner / IV. Type of POWTS S stem/Com oneatIDevice: Check all that a ❑ Non-Pessunzed In -Ground ❑ Pressurized In -Ground ❑ At-G Mound 24 in. of suitable soil Mound <24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) cc (explain) V. Dispersalffireaftient Area Information: Jr Design Flow (gpd) Design Soil Application Rat gpdsf) Dispersal Area Required (at) Dispersal Area Proposed (s System Elevation 0 60o c7-4 9 6•lp /crop l�.30 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units 6�fy�Yf�'e7N K C c a -E a X New Tanks Existing Tanks Septic or Holding Tank e a 0 C7 /s GC/i e r Dosing CFsmber VIL Responsibility Statement- 1, the undersigned, assume i esponsiblllty for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Sign re MPIMPRo ""—ber Business Phone Number CA.,- /t/�6s1c. /3--A73tiS336 Plumber's Address (Street, City, State, Zip Code) s-sus 7705=7L 4 41,T + 0 V 1. Court /Dc artment Use Only Id'Approved ❑ gistped emit Fee $ �•,, Date Issued `�'� Issuing Agent Signed ❑ caReason for Denial l.(; IX. Conditic, s upfj�� oval/Reasons for Disapproval ✓�•f. SYSTEM 8WNE 'j. n ( t S iA /y�•,/� 1 ) 1. Septic tank, effluent filter and a� f^ Zt4-eC'� w f'l%1/ "f , dispersal cell must be serviced / maintained by as per management plan prollMl6d plumber. 'f 2026— Q 0-4 ieyl%I W 'I See 1,U 2. All setback requirement$ MUSt be maintained - V0 dS per op;)i.C..D43 for the system and submit to the County qp(v oa paper not lest Ihage In x ij�acyesirn 0 SBD-6398 (R. 02/09) Valid thru 02/11 December 18, 2019 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2021-12-18 Plan Review: PWTS-121902566-C CRARLES L WEBSTER N5815 770th St Ellsworth WI 54011 SITE: Dave Daleiden 70th Ave Town of Warren Saint Croix County Total Amount: $250.00 Description: 600 GPD (4 Bedrooms — New Construction) Maintenance Required DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY VN 54304-5211 Contact Through Relay http://dsps.vA.gov/programsrindustry-services www.vAsconsin.gov Tony Evers - Governor Dawn Crim -Secretary CONDITIONALLY APPROVED DEPT OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES Pressure Distribution Component Manual — Ver. 2.0, SBD-10706-p(N.01/01, R 10/12) Geomat Mound Component Manual — Edition 1 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • With new construction; it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall be properly disposed of on -site or off site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. All loose organic material to be removed from POWTS Dispersal Area • Divert surface water from all POWTS Areas. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1 /4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Well setbacks to meet chs. NR 81 l & 812 • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • Pump Floats to beset and verified per approved plan. Any changes may result in pump resizing to meet TDH and GPM Specifications. Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. if no other site is available, trees in the basal area of the mound must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval SPS 383.54(1). • 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. 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state state 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 and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Thanks, ,6 7/,oa�u �eeef POWTS Plan Reviewer— Wastewater Specialist Department of Safety & Professional Services I Division of Industry Services email: tim.vanderleest@wisconsin.gov Cell: 608-516-6134 Pg -4- of D Private On -Site Wastewater Treatment System (POWTS) Index and Title Sheet Owner: da-V e IJa,le C -7 N :I Project Name and System Type: lrct Ve 02 /e "d e �'! - 4P(4,n �Cdrhd f /"I a 14It O� Location: Ay c — y o w., c A k, i C, rir t y cf q 5'51 �h t, Sr&ye�:r s �F�t s.I8Tz9blgly - Qt4 csM�9-6-�75 Legal Description %wn >d ��� Cro • X C ty Township/Cmnry CONDITIONALLY T J APPROVED Contents: Page 1: -1 h C c k &� I o[// i 7/c S4 cc� DEPT OF SAFETY AND j? PROFESSIONAL SERVICES Page 2: C) )0 Di'JISION OF INDUSTRY SERVICES Page 3: Ma I,t ti Page4: d"rPr',sd/Ce//bc�dr'/S Page 5: Td 4 %( Cro s1 Sc cf•'o H Page 6: Pu np Curvc tln c�S��e,'�r c'on$ Page 7: O tir.1 Mahtt. / 4/-/LldndsC A,t„-f P/e� 6, p 9--r- Page8: 0�„e.s e {yews /I e .05 Page 9: f r C/O /Ift —, -5-0,-/ / ecj �4-Pd y e-5 Plumber/Designer: C14 5Y/ 2 web �p� Signed: c� Credential Number: /�%/� oZ -20 6' 73 Date: I '�2, Ialldl?IS C'.L�e�i3 .j �,: /s2!si� iJ-d \�dtay� J_sr '4 MoiEJ. wdte& <wyc v e/s/161 A N t 4F- 7oikAm '¢, • c �%J .per/,l•<� Pc Gd G• fray r.G.vtf/ 6 _ S.r c.rN �dfC cf't�SY/.ifr F_Y YrGGIf/kY PAYE Mound PUWViil , Obserisfion Pipe K. .lphj:j• �:j:: �J2 f!},$a:j1f.1:1rJ: >1MiJH'i. tiJ.le't.j.:+F.n'•.r�n;:r:' j_::r.• _ • l�l'A.ti..•1�1 YY _ y'w wi:3... � '�\�l •i i�: .14.4.}�4.4 � Y �:•r> `iJ:.11�ti• 2 � ':f:'.2.• r•>•f. .r>.-.fl�t•`y;f. rJ.f�!.-it.r f.J:J. .2.2,`Y. :i. `13 L -F L Nlound`Cornponent rtte ons ' Aft Bffft in E J in F , 4 '/bZ in G L oe 6 ft 3 7c (ft) Dispersal Cell Area q_ 0 � (gpd/ft) Linear Loading Rate H 1 0-0 ft 1 1 t 44 _ ft J it K �ft L 7`6r ft W o (fe) Basal Ares Available So ./,;,�', /t,-� -ram r a•� e = a. 4 q Mound Cross Seallor"I Vi;;; (aeoMat Dispersal Area Observation Pipe 12" ASTM C 33 sand as GeoMat required for Geo Mat Distribution Cell component GeoMat+12" ASTM C-33 sand Finish Grade Cover Material 9 9 Oc Lateral Invert Elevation �f = ' O Dispersal Cell 1 Slope z 4 Elevation ConmWE=evatlon= � -0 a , 4 � ``:"'• .` Tilled Area In situ soil in situ soil sna Mg �v I Topsoil Cap i Subsoil Cap 3 ASTM C 33 sand (F) 4 ASTM C 33 sand (0) 5 Tilled layer C Geo mat Forcernain �Jwr, rJ;� Fete r ar, S. T. S Ao west , a JO; I ffa 04 k-wp e.K ?w? %.�Zi� aaS• 01c so: / 4'o'f" a FPlax r,''a*Z See details on pag�ror number size andspaeinp of iaferals 6E'o M4T Mo a VP /F-o R PA V.E OA1 lc-,z-DEAl iv ,o iaiorHice torated;ai2 Z- Cc Al AIC-C J"iD /y/ All. winces point doom . L AE ,fE'4Z- YaaT..- Number of Laterals Orifice Diameter / �;,,, l' Lateral Diameter 1.114 in Orifice Spacing (X) ,'welt, Lateral Length (P) — ft Orifices per Lateral Lateral End (Z) as Orifice Density _9 Ifriorlfios Lateral Spacing (S) ft Manifold Length _ 2s Lateral Flow Rate .- ' gpm Manifnid Diameter join �s System Flow Rate : ¢ gpm ® Distribution Pipe With Pressure Lateral Lai Orifice Shield �p Tumup Enclosure — — — _ — Pressure Lateral GeoMat is covered with approved geotextile fabric as per the their product approval. L 6 Distribution Cell Plan View Layout - Typical E� 6 " " Call Wtdth • A (ft) Cell Length - 6 (ft) End Connec.ron Lateral Layout Diagram .SriSILi33.mA.�I two ' ceon�n ro.w=nett Y.dduow3.+Si1lC23.".eyt�•, •y . jte.u,a� � t•-ors ) ... t eat, c.�- r %k..r/ •` -• ?�� ® f l Topsoil Cap 2 Subsoil Cap 3 ASTM C 33 sand (F) J ASTM C 33 sand (0) '�N01 T nw i Tilled Layer •.., - _ 6 Geo Mat . 'll I �Xi�MC•33�idvGm�: . aye/Y..i, al /o/dh it PAVZ, />hJ- 6IpEN CA 44 relpA f{ ?,p.�,.ed rT wd e%� (c aocrpf��/e e.yer a..74 wad r•J.Aid<</ r� bu..yyy�,Jcovei e�/%dcGce( a)s dr /cn t :s 6"4i 6t to t.,'jc Y rt— .: I 6 cc ver r s�d� �>�a) l tl � a M:n:wwn *s /i cJi ee V e< &f�ae i 1 Ile •e/Al,yrn A o� 1 jpC P-9 en 7'.. W 6ea/a(il+/r µ,,de. ra4K /O Apprel4Vr tCap Qj Ewa Za a �S%V7 r./ FrFfao E/ , cc?93 Noce: Pump and Alarm Are On Separate Circuits Number of Doses: Jt nZ.Per Day Gallons Per Day/ o -Doses: IS =/ Gallons /io x .163'Volume of Backflow:....... +Gallons -ank Manufacturer: Total Dose Volume: ........ /3 -3 Gallons an Size-Septic/Pump: );zoo e;w G Gallons Alarm Manufacturer: SJb- /7bvr, u3 +ocel Number: 57 r-- Capacities: A 2-.),inches or c5 Gallons Switch Type:_ �an•cd _ + B 2 -inches or f Gallons rump Manufacturer: �o e //ems + C�SZinches or y`-Gallons Model Number: o e Ilea YR + inches or_L3_y_Gal l ons P:'r.irium Discharge ate: 6- Total ..... = 3 E inches or p o Gallcns Vertical Difference Between Pump Off and Distributyton Pipe:�Feet ; inir,•cm Required Supply Pressure: ..... Z-s.0 A'??c/.........3.;5'Feet ' -et of Force Main x LE riction Factor/100 Feet: + �•HFeet inch Diameter Force Main Total Dynamic head: ... = 4_Feet :nte-nal Tank Dimensions: Length/6 9-; Width q 6; ii/rt D';0t4= `r D o.tc C4 Jn iet ✓r fo n, = e�-,� C' L.9 ,a/ IL —fa",, d 1,9/a4 4 0Um> F00111VrERIM }E wru aUwc hnlsowasesawr6 arwaanroariso IEIS CmnsO Iallaa6N 1 McTen 5 1.Si 10 3Il5 15 4.57 20 6.10 GALS 72 61 AS 25 LTM 2n 211 170 m VM 2S �d vC 04:? /e, Q(e`t 4'�A' '�JANCF CURVE !✓C�n dN �Z — o�b _ �I. CONSULT FACTORY FOR SPECIAL APPLICATIONS �V; 16- Electrical anemators, for duplex systems, are available and • Variable level float switches are available for Controlling single supplied with an alarm. and three phase systems. Mechanical alternators, for duplex system, are available with • Double piggyback varable level Boat switches are available or without alarm switches. for variable level long cycle controls. Standard aN modals - Weight 39 Iles. - % H.P "sellies clemW ltle0aon Nadel Volga^ 1100e Ass Its 1 Auld 0.6 1art {7 — NO 115 1 3a6 D98 230 1 hob 6.7 t a t i 7 Ego 730 1 Non 6.7 2or2ie 3Qa{0 SELECTION GUIDE 1. Wift l Sdtl operated 2 pole madwhFJl switch. nc azNrnY control reouimd 2 SJq%IoWbeck wadable Oval noat witch a dohdNe ovoybeak variable level. Gail era Rarer b F110677. 3. Wdtlnol aaNlwbr 104072 a 100075. a. Sea 1`160712, fdr ranad model d Ebcliial Allern6lor, Epak. 5. Contrail wbdh I O-WS inlaid r a 0WVM agvelpr. specily duplex (3) a (a) oat ryeWn. a. Far (a) hob JPse. jahclon Dos. for wale"hl rnanh2on a weed WOPW or ckou Is . 1040002. 7. Two (2) Iwls Ja'aQ for waYrspM cdnr action a aplo CAUTION F. wetrbhrYanlh0enrtlelh>iar.R61CF`}ed U IasOMfhnl d meoak. prtledbe hwas aw wtriea sepAo M done o7 a ewlrteo vrisetr1ae69eaSaAFir3s7/:EYtlfulAYerwr.il��lYtlhGtatArrlerr. ril6Ni;511 Nanud eYddrir AN electrical sad u" codn ssould be folbww in O.9 m, mo,t sleep gam, FY016Y6ed Sign FMaShpasi PWVC4WAoWftm Syaftis, FWM reeeel Natlnsl Electric Code(NEC)and the OcchhpalbwI ssltry sod llaaltk Act IOPA) RESERVE POWERED DESIGN For unusual conditlons a reserve safety factor is engineered into the design of every Zoeller pump. eAa rm F.O. sox tor? lain Kr am6Nr7 IMerscanrs d. . JiO L 11.7Q Social Ma NGed IadaGA Kr 41V W W �1- , Amer Saivr L27Y PlfMP !O. �7,Fml•r� Falsa¢I7uwr POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page—zef—w FILE INFORMATION Owner OQ r Permit # DESIGN PARAMETERS Number of Bedrooms 4- ❑ NA Number of Commercial Units DNA Estimated flow (average) U O aVda Design flow (peak), (Estimated x 1.5) COO gal/day Soil Application Rate a Q- ayda tw InfluenUEffluent Quality Monthly average' Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODJ 5220 mg1L Total Suspended Solids (TSS) 5150 Pretreated Effluent Quality XNA Monthly average" Biochemical Oxygen Demand (BOD,) S30 mg/L Total Suspended Solids (fSS) 530 mg/L Fecal Coliforrn (geometric mean) s10' cfu/100ml Maximum Effluent Particle Sae Ye"diameter SYSTEM SPECIFICATIONS Septic Tank Capacity Z �2 al ❑ NA Septic Tank Manufacturer Gu; 5 ar O NA Effluent Filter Manufacture P/ / c 5,4*ir 4 O NA Effluent Filter Model S s O 00 NA Pump Tank Capacity al O NA Pump Tank Manufacturer wi eS 'G7- O NA Pump Manufacturer ZLo e/ ez- O NA Pump Model O NA Pretreatment Unit XNA ❑ Sand/Qravel Filter ❑ Peat Fitter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other. Manufacturer Dispersal Cell(s) ❑ In -ground (gravity) ❑ In -ground (pressurized) ❑ At -grade jf�Mound G e e ^ di ❑ Dnp4ne ❑ Other. MAINTENANCE SCHEDULE he's fo bC Vakm ty *al for danestic (non-oortrnmc W) wastewater aW septic tank WfWenl. VWuss typical for pratreafed wastewater. Service Event Service Frequency Inspect condition of tank(s) At least once every j ❑ months years) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (Ys) of tank volume Inspect dispersal oell(s) At toast once every 3 ❑ months >Syear(s) (Maximum 3 yrs.) Clean effluent filter �rt At bast once every 3 ❑ months Xyears) m Inspect pump, pump controls & alarm At least once every ❑ months ❑ years) ❑ Flush laterals and pressure test At least once every ❑ months ❑ years) ❑ NA Other At least once every ❑ months ❑ years) ❑ NA olner At least once every O months ❑ year(s) ❑ NA r v 47 e,{'en d." •��o-r ...r¢�c�il /r+�be I e c rsj+!1X e<reo� 7645&' He, MAINTENANCE INSTRUCTIONS ,orccL{CN �oPyryase•�c pc eat_ Lo.o x ,, i�fyi� fQ/1. Inspections of tanks and dispersal cells shay Remade by an individual carrytr gone of the fofwwatg licenses or certffiuitions: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer, Septage Servicing Operator. Tank inspections must Incude 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 ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the Immediate ratification 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 disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatfinent components, and any other maintenance or monitoring at intervals of 12 months or less 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, prior to use of the POWTS cheek 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 a 01, ens/K/4hu.c� �/!'.i2 �(✓'PAx.epage of� t the infiltrative surface. '0 /)/ " I 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 eliminatiorr 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 property and safety abandoned in compliance with ch. Comm 83.33, Wisoonsin'Adminfstrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant 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. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. Mound and at -grade soil absorption systems may be reconstructed In place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at 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 Name E/cc,f/'+oC Phone 7/s - 2 >EPTAGE SERVICING OPERATOR PUMPER Name %7Ga k kc //.S fwy/IC . Phone 71-C — 4 -;4S — /O� Tj_ POWTS MAINTAINER Name CA9=7A0 C' Phone 71S= 7,3— LOCAL REGULATORY AUTHORITY Agency St C-k.,X CT ��• Phone -his doarnent was dmW by the stalls of the Green I.oW Marquette and Waushara County Zoning and Sanitation agencies. This document meats :he rnk*num nequNertWNs of dL Comm 5322(2)(bX1xd)&(0 and 93.54(1), (2) d (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. GMW (2101) Rdve- /✓d /e dp+1 CERTIFIED SURVEY MAP LOCATED IN GOVERNMENT LOT 5 OF SECTION 28,T29N,RI8W, TOIVN OF WARREN, ST. CROLX COUNTY, WISCONSIN. 9 RE NOTE: THESE LOTS CONTAIN AREAS THAT ARE SUBJECT TO THE SHORELAND OVERLAY DISTRICT. ADDITIONAL RESTRICTIONS APPLY. CONTACT THE COMMUNITY DEVELOPMENT OFFICE FOR MORE INFORMATION. in Mf4N0a`�4'9 f4'3 �j8 m � i N w LOT 4 624.713 SQ. FT. (14.34 AC.) INLL. R/W TO WATER'S o EDGE I I 1 I NB9'S6'S0'EI _ _ ��514_88' y S'/e CORNER, SECTION 18 (P STEEL SURVEY MARK NAIL FOUND) JG LAND SDUJITONS 1"1 ?- SOUTH LINE OF 6OV'TLOT5 S89"56'50'W 407.81___. 396.77_ LINE in Y 3 LOT 5 c 547,159 SQ. FT. b (12.56 AC.) w INC- A/W TO WATER'S EDGE s H i Pa6,6 9 *� /C? scaE M FEET 1 200• 1' - 200• g t w w }�n2, LEGEND 0 SECTION CORNER (AS NOTED) • 1.3" OUT5IDE DIAMETER IRON PIPE FOUND ■ 0.75'TRONREBAR FOUND O 1.38 X 24' IRON PIPE WEIGHING 1.68 LBS / LINEAR FOOT SET - FENCE (R) PREVIOUSLYRECORDED ._. INFORMATION 107.81' - - NB9'56'50TE \ ; SE CORNER, SECTION IS J\ I (I- STEEL ARK NAIL FOUND) 1428 134TH AVENUE 1144 70TH AVENUE JOB NO. 100-549 SHEET NEW RICHMOND. IN 54017 ROBERTS. V3 54023 DATE: 08/13/18 1 OF 2 L v rii �r r t y` 4 II I. I �f J p L7 ..Y N J L W* 07- 4- 4' 33 k; 34 0 200 400 600ft' CISCIAIMER: Pis map Is mt guaranteed to be amurate, mood, airent, or complete and coodusions dmm ere Iha responsibillly of the „ ueer. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREJ2v= AND 07f NERSfiIP CERTIFICATION FORM -�wnevBuVer Da k-e Pia, Ie .' Ole- / -Z 2/ Nara Ka, or+ 4 Mailing Address Pro�=—Ly Address 1.1 for new Ciy'�•atP:7�GtCG�s�rr� aL/T S`}oParcel Identification Number o'P;?, -/c)77-70--f0V LEGAL DESCRIPTION Pn?rryLocation 5W 1/._ SE %.,Sea �c9,T� �NR/�'W,Townof WQrve�f Subdivision Certified Survey Map # q ` 6S 7 % G 6� Volume . Paee Warranty Deed # (before 2007)Volume Page Spa house 0 yes,�Vno Lot lines iderttfiableiS,yes ❑ no CYSTEM M.A.IIVTENANCE ATV-D OWNER CERTIFICATION Lot r Improper use and maintenance of your septic system could result in its premature failiue to handle wastes Praoer maintenance consists of pumping out the septic tank every tbree years or sooner, if needed, by a licensed pumper what you put into tine -*'stem can affect the fimction of the septic tank as a nwonem surge in the waste disposal system. Owner maintunance responsfoiiities are specified in §SPS. 38352(1) and in Chapter 12 - St Croix County Sanitary Ordinance. The propery owner agrees to submit to St Croix County planning & Zoning Department a certification form, signed by the owner and by a ma.= pbranber, journeyman plumber, restricted plumber or a licensed pumper vM*mg that (1) the on -site wastewater disposal system is in proper opetaimg condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 13 fill of sludge. 11we, the undersigned have read the above requirements and agree to mam7ain the private sewage disposal system with the standard ser forth, herein, as set by the Department of Safety And Professional Services and the Department ofNatural Resomws, Sate of Wisconsin. Certification sating that your septic system has been maintained must be completed and reamed to the St Croix Corm a Planning &Zoning Department within 30 days of the three year expiration date. Dwe cartify that all statements m: this are ttue to the best of my/our knowledge. Uwe am/am the owner(s) of the propr.-ty des.:ibed above, by virtue of a w Jay deed rsorded in Register of Deeds Office. Number of b oms T— SIGNATURE OF APPLIC_4NT(S) DATE '"Any info.mation that is mis epresettted may resuh in the sanitary permit being revoked by the Planning & Zomg Deparoneoi ... -firbrde with this apphcanon a recorded wasmty deed from the itegister of Deeds Office and a copy of the certified sti vey map if efereex is made in the warms ry deed (REV. 0422) CERTIFIED SURVEY MAP LOCATED IN GOVERNMENT LOT 5 OF SECTION 28. T29N, RISW. TOWN OF WARREN, ST. CROIX COUNTY, WISCONSIN. 1 1 I I W I 1 � 1 I I I 1 1 1 I NOTE: THESE LOTS CONTAIN AREAS THAT ARE SUBJECT TO THE 5HORELAND OVERLAY DISTRICT ADDITIONAL RESTRICTIONS APPLY. CONTACT THE COMMUNITY ' DEVELOPMENT OFFICE FOR MORE INFORMATION. I EAST b�AIP3 �CS� l llW 5 i f <4V 96 77; 3 'Pave Ro 88 LOT 4 624,713 SQ. FT. (14.34 AC.) INQ.. R/W TO WATER'S EDGE • L.1 _5u •2 GOV'TLOT5 � g 589'56'50•W ! _ 407.81___. - - - - - SY4 CORNER, SECTION 10 _umpu (1" STEEL NAIL FOUND) %Q G% LAND $URVEYORi S SOLUTIONS JOSEPH ORANBER NEW RICHMOND, M _ 579.91'02. MEANpE'q L n_ ul N 3 LOT 5 '^ 547,159 SQ. FT. (12.56 ACJ INO.. R/W TO WATER'S EDGE _ 1144 70TH A ROBERTS. WI PAbc- UDf� SCALE M FEET O�IW�200' I' - 2W td2: 1 � 2qW, "' LEGEND 0 SECTION CORNER (AS NOTED) • 1.3- OUTSIDE DIAMETEI IRON PIPE FOUND ■ 0.75 IRON REBAR FOUND O 1.38 X 24" IRON PIPE WEIGHING 1.68 LBS. / LINEAR FOOT SET x - FENCE (R) PREVIOUSLY RECORDED �._ INFORMATION �_N89.56'SO'E 1 SE CORNER, SECTION 18 j (I• STEEL SURVEY MARK I NAIL FOUND) JOB NO. 100-549 SHEET DATE: OB/13/IB 1 OF 2 readD �! s (etyand SO[ EVALUATION REPORT ► V,,10�%n aoce ante with Comm 85, Wis. Adm. Code �S Proles 'onal Sit s6 CST-ad)8 - ao N #1947 Page 1 of 4 Schmitt Sol Testing, Inc. ,— gtoodt) Uie '� 'bhIn sin size. Plan must Attach complete site plan6ert include, but not limited tohe* M) ire anpercent slope, scale or dimolt arrow, and location dis e t as ad. Please print all information. V Personal information you provide may be used for secondary purpose , s. 1) (m)). County Coun St, Crobc Parcel I.D. Part of: 042-1077-W4D25 Rev ate �0 Properly Owner Solimar, Keith & Karen Property Location Govt. Lot SW1/4, S , S28, T29N, R18W Property Owners Mailing Address 1144 70th Ave. Lot # Block # 4 Subd. Name or CSM# CSM City Stile Zip Code Phone Number Roberts I WI 1 54023 612-802-4400 ❑ City ❑ Village if Town Nearest Road Warren 1 70Th Ave New Construction Use: © Residential / Number of bedrooms 4 Code derived design Sow rate 600 GPD Replacement ❑ Public or commercial - Describe: Parent material Outwash (Burkhardt-Sattre Series) Flood plain elevation, ifapplicable zDp/1"'_`_`Y_ . General comments Area is suitable for a mound system. System elevation is 98.8Z based off the contour line established at 97.W Slope of area is and recommendation: 4%. Depth to limiting factor is25'. Boring # ❑ Boring © Ph Ground surface elev. 98.05 R. Depth to limiting factor 30 In. Sol Application Rat* Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Boundary Roots GPDW -sw •EIM2 1 0-14 10yr3/3 none Sit 2fgr mvfr as 2f,2vf 0.6 0.8 2 14-23 10yr4/3 none Sit 2fsbk mfr gw 2vf 0.6 0.8 3 23-30 10yr4/4 none Sit 2msbk mfr gw lvf 0.6 0.8 4 30-37 30yr4/4 n�2 6 Sid 3msbk mfr gw lvf 0.4 0.6 5 37-65 1%"/6 m�2 Sit lmsbk mfr gw lvf 0.4 0.6 6 65 84 10yr5/6 c2i lllyr6/6 s Osg ml — -- 0.7 1.6 # ❑ poring ®pit Ground surface elev. 98.05 R. Depth to limiting factor 34 in. Sol Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consisten Boundary Roots GPD/k' *El#t 'EW2 1 0-11 10yr3/3 none sl 2fgr mvfr as 2f,2vf 0.6 1.0 2 11-22 10yr4/4 none sd 2msbk I111fr gw 2vf 0.4 0.6 3 22-34 10vr4/6 none 51 2msbk mfr gw lvf 0.6 1.0 4 34-64 10yr5/6 � 2 8 IvfS Osg ml CS 0.4 0.6 5 64-84 10yr6/4 none s Osg ml — 0.7 1.6 Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 <30 mg1L and TSS < 30 mg/L CST Name (Please Print) Signa`ture:._L. CST Number Thomas J. Schmitt (, ,11� 227429 Address Schmitt Soil Testing, Inc. Dat* Evaloalion Conducted Telephone Number 1595 72nd St. New Richmond, WI 54017 8/16/2018 715-760-1978 SBD43M (RO/Ao) Property Owner Solimar, Keith & Karen Boring Beenn a Parcel ID 0 Part of: 042-1077-90-025 Page 2 of 4 tJJ - ra Groune surface elev. WOOD R. u Pin to limmi g factor Z5Z in. ISO Application Rate Horizon Depth Dominant Color in. Munsell Redox Description Gu. Sz. Cont. Color Texture Structure I Gr. Sz. Sh. Consistence Boundary Roots GPJD4t2 •EMt 0-11 10yr3/3 none sll 2fgr mvfr as 2f,2vf 0.62 11-25 10yr4/4 none Sd 3msbk mff gw 2f,2vf 0.4 3 25.48 10yr4/6 c2d 10yr6/6 2 Sid 2msbk mfr1 9W 2vf 0.4 4 48-59 10yr5/4 m2i 10y/r26/6 grcos Osg ml as �__ 0.7 1.6 5 59-61 10yr5/3 m2i QWV10yZ/8 sit Om mfr as -- 0.0 0.2 6 61-72 10yr5/6 c2vr6/1 6 10r6/1 S OS9 ml N --- 0.7 1.6 Boring Boring # pit Ground surface elev. In ft. Depth to limitingfactor . Soll Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMte in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. •East •ERs2 I i I _ 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 GPD/ft' in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. 'Ea#t •Ef#2 1 I I Effluentill = 13005> 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent 02 = 80D5 130 mgA- and TSS <30 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 formal please contact the department at 608-266.3151 or TTY 608.264-8777. SBn.E330(R 07,00) S&m SadTeOrg,Inc- Conducted by: Schmitt & Sons Excavating,_ Inc.. . Thomas J. Schmitt, CST 227429 586 Vatley View Trail Somerset,W154025 Phone:715- 1978 Sure oeb lE / ■ Baclthoe Pit ♦ Bench Mark 1 El. 100.00'Top of 2" PVC Pipe 0 Bench Fill El. 991,76 Top of 2" PVC Pipe Slope= 4% Scale 1"= 50' e 13 ofj4 Conducie"b For: 7r - i — — + Name:, Address: 144 70th Ave. City. State, Zip: " -Roberts, W134023 PID: Part of-042,11077-90-025 Lot No.: 4 CSM Pending AppraVall Legal Description: SWi/4 SE1/4528 T29N RISW Township, County: Warren, St. Croix County CO"70u 2 L 9 Z '?0 } } zo�+2 LN� /L EnlvTH /ozD NOTE: or full ow of Lot See Pa9e 4 of 4 F W j 3 30 — � �I �4Yh't COr/70UA L/N6r ` ._ L1S1�2 <� - i 1 , - 70-7(-/, Al PA6o f/D-ry 9 CERTIFIED SURVEY MAP LOCATED IN GOVERNMENT LOT 5 OF SECTION 28, T29N, RI BW, TOWN OF WARREN, ST. CROIX COUNTY, W ISCONSIN. NOTE: THESE LOTS CONTAIN AREAS THAT ARE SUBJECT SCALE N FEET TO THE 5 I0RELAND OVERLAY DLSTRICT. ADDITIONAL p�j"pp�2pp• RESTRICTIONS APPLY. CONTACT THE COMMUNITY I 1' - 200' DEVELOPMENT OFFICE FOR MORE INFORMATION EAST TIMM LAKE � / \ 1V I gff \ �it A O's Ein /i 'yfgHp ' fCfV�?EAG6 I 3t�i 3Zola m qf� N 5 4 MEANDER IgDe 5 1 3%n_ � � 29, 1 o ®, I in ®: 1 in in ass LOT 547,259 SQ. FT. g; LOT 4 a2.56 Ac.) in 624,713 SQ. FT. INCL. A/W TO WATER'S Xi ®; 1 (14.34 ACJ ESE m m w g; I rNCL. R/W TO WATER'S r 7i ED6E Y I e0 La'END SECTION CORNER (AS NOTED) jL • 13'OUTSIDE DIAMETER g, I n IRON PIPE f011ND g• F • 0.75' IRON REBAR FOUND I O 1.38 X 24' IRON PIPE ip WEI6PQN61.68 LBS. / SOUTH LINE OF W 3 LINEAR FOOT SET I 60V'T LOTS -+'-' FENCE (R) PREVIOUSLY RECORDED 8 S89.56'50'W g 815.17' 8 15, INFORMATION N89'56'5WEI " 407.82' "' 407.36' n 514_881_ _ 1-_ -...-..- -____ — -�- 1330D1.-.-. ---___5_________ E. 5S'4 CORNER, SECTION IB .-..-. 2661.02'---- SE CORNER. SECTION IB @.id.f.Y (I' STEEL SURVEY MARK ..... I (1• STEg SURVEY MARK I"I NALL FOUND) 7 A • EWE —J I NAIL FOUND) IAND ww Gip nveroPREn�o Fau s 90LVrtONS JOSEPH GRANBERG KEITH h KAREN SOUMAR DRAFTED BY J11G 1428 134TH AVENUE 1144 70TH AVENUE JOB NO. 100-549 SHEET NEW RICHMOND, RI 54017 ROBERTS, W1 54023 DATE: 08/13/18 1 OF 2