HomeMy WebLinkAbout004-1001-90-100Wisconsin Department of Commerce
Safety and Building Division
GENERAL INFORMATION
Personal information you provide may be used for
TAMARA GIBSON
BM Elev IBM
d_121 Fie I:IY0]:aSI_iII%ZI
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
(ATTACH TO PERMIT)
purposes [Privacy Law, s.15.m/ (1)(m)]
TYPE
MANUFACTURER
CAPACITY
Septic
IV f-4
U l ��r T S. C.
r?, 5 O
Dosing
Coat ho o uT 3,0 Q
-15 D
Aeration
TANK SETBACK INFORMATION
TANKTO
P/L
200
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
�,
5 1
til,
Dosing
.> ?-CND.-
f t�!
Y ,
G 1
_
Aeration
Holding
PUMP/SIPHON INFORMATION Ffr C luwt�,/ -33
Manufacturer
/
Demand
GPM
Model Number
J ,
NSystem
'�
TDH
Frict6.
(5
�Sia
Hea(f e5
(Well
TDH8.IIFt
Forcemain
Lenpty
Dia..Z 0r
Dist. to
�C
SOIL ABSORPTION SYSTEM /„ T,,_ /S
7
TOWN OF CADY
TION DATA
STATION
B 5
IHI
FS
1ELEV. 00
Benchmark
v
IO;•
lOO
Alt. B 1
,l�J
loZ,oS
e . Le t"v �
iv• {e
11. 75
SUHt Inlet
((
SUHt Outlet
Dl Inlet
Dt Bottom
/Z .7
93 605
Header/Man.
�.O
( �
Dist. Pipe
7cA
F0Z
Sot. System
7. -7
C b. GIS
/ o
Final Grade
St o Cuvti�
4t•3
Ia7-oG
BED/TRENCH
DIMENSIONS
Width M .
Len nc e�
PIT DIMENSIONS
No. Of Pits
Inside Dia.
Liquid th
(Y/S
CJ/
SETBACK
SYSTEM TO
P/L
BLDG
WELL
LAKE/ TRVCHBEROR
ING
Manufa ur
INFORMATION
T
Ty��/'L1Yel
�'v
�O
`
Mo Numbe
DISTRIBUTION SYSTEM 72 '
Header/Manifold 1•
y 1
DisVibution / �� 4
Plpe(a /1
z Hole Size v
x Hole Spacing
Vent to Air Intake
V6,
Length Dia Z
11
Length Din % Spacing
(p
3`
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only ver M r
99.3
Depth Over
Depth Over
1�
xx Depth of
sl
Kx Seeded/Sodded
m Mulched
Bed/Trench Center .'jjj�
1 8
Bed/trench Edges 1 Z
Topsoil
> �
A Yes [9 No
A Yes K+ No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 7- 6— Zb Inspection #2:
Location: 325553RD AVE "Gks li-Cl"011;II 0(d IT* `
I.) All BM Description -Pi 1 k ('OH•t r-
2.) Bldg sewer length = (03 1.1x II[XA-jVI V5 r�
-amount of cover= 7u211 l&$T 20�hE1,� FI�1�'i�1'>� �S Yn/`R✓�t
Plan revision Required? � Yes 4. No % � O L -
Use other side for additional information. ( 1(� !!!f -f�--
SBD-6710 (R.3/97) Date InsepcOrs ignat a Cart No.
F#'Ka
•I JD E71nIr3oat -08y
f f t all t -E x a.
S
1.
2.
y
APR 1 2020
Industry Services Division
ounry
1400 E Washington Ave
P.O. Box7182I
Sanitary Pcrmit Number (to be filled in by Cc)
� =
5t. Croix County
Madison, Will 537073707-7182
���
'"'�•.,,,
Community Developm
nt
Sanitary Permit Application
state Transaction Number
In accordance with SPS 383.21(2), Wis. Aden. Code, submission orthis form to the appropriate go,emmental and
PKTS- Dy D D f -T "
u required prior to obtaining u smeary permit Note: Application forms Ibr state•owrad POW7S arc submitted to
the Department of Safety and Professional S,rvies. Personal information you provide may be used for secondary
Project Address (ifdiffercnt than mailing address)
Purposesin accordanx with the Pncacyraw a. I5.04(1 Xmh Sub
I. Application Information - Pkue Print All Information
Property Ow n•e Name
Yarccl4
'?Arw G b
004 -9001.-9G-100
Property Owner's Mailing Address
'3255
Property Location C. 1sC
5-32 D Ill
Go,, Lot
,AJ 5- ye Section 01-
ON. State
lip Cade
phone Number
t 111
T-2.6 N. R _IS-E V
11
ype of9thilding (check all that -Fr.:
La a
tj
I or 2 Family Dwelling -Number of Bed
�-
Subdivisignjlpme
�-
❑PubliUCommeraial - Describe U
of IL/I -
Block a
__
❑ City of
❑Stare Ownfe-d-- Describe l)se
❑ Village of
CSM Number
1 X 75e --
13 pow
2rrc of
Ill. Type of Permit (Check only on line A. Complete line B if spplkabl
A'
❑ New System
Replacement System
❑Trentment/Holding Tank Replacement Only
❑(xhe Modification to Existing System ( plain)
B•
❑ Permit Renewal
❑ Permit Revision
❑Chang, of Plumb,+ ❑Permit Transfer to New
List previous Permit Number and Date Issued
Refuse Expiration
Owner
IV. Tvitie
of POWTS S ystemircom nent/Device: Check el lip l -'
[]No Israesrixd ❑Pressurized ImGround mile Mound>24in.ofsuits soil\❑Mound<2J in auiuble foil
ffIn��1G��rooand
❑Holding lank LJVmer Dispersal Component(exptein)_�---.—_ atment Devra(cxpleln)
Y. Disperseli7restment Area Information:
Design Flow (gpd) pi Sod Application Rate(g s0
Dispersal Ara Requi (sp
Dispersal .Area Pro(sf) System
Etesation
D.
oa
a
VI. Tank Into
Capacity in
Tolel
of
Manufacturer
Gallons
Gallons
Units
✓)^r1r
b
y is
U
•gp
pp
1y�j
New Tana,
Esifayt Tank,
I L l l l }s
!'I
�i
a
V
9-
'3
6U
r7
s.Q
L
Sepic or HOBingTW
Z
A-
Doing Clwnbrr
`7
!
IA sl
VII. Responsibility Statement' I, the oaden d. sue aNMlih or lesrallatba of the PONTS shown ae the attacked plains.
Pitunber's Name (Print)
PI rc
MP/MPRS Number
Business Phorle Number
Lewis Bjork
253876
715-231-7375
Plumber's Address (Street, City. Siatc, Zip Code)
E7818 County E, Menomonie W154751
Court /De
artment Use Onli
�7Vill.
Approved
❑ Disapproved
Permit Fee !
S�J
Da Issued
(fiz9
1 cw Agem tiignewe
❑Owner Given Reason for Denial
�"�
ZO?Q
17�,�(;���{� * : p�.�• ri;,P"y/�,.ar w„,,
TEM OWNtER of ApprovaVRemone, for Di approval j
..Ag ��aa",
epticctaankk,,eEffluentfilterand S� 74-,•C544-10- cwt S� Y1e't^`)/_
ispersal cell must b�erviced / Maintained 'i)� 5e� `uLc x tt55'N10a�^ �0`
0 tl tYsa �� r
j
s per management plan provided by plumber. .�-1�
Il setback requirementst'f iota 6-neck 46 i46 eta
,I; cap
s per ppllca le code/orditi"C@V.atatwa plane for the epsma and submit to the County may on MW ewe iw than a IA, I I Inches in else
}� Q /-0, t �? S-Q � t ��.o : Rhin Z.
sBNAaA.o-teH'k� �3cx L l�[tav1 n�OeM. n� ! C'ks °XdC
Wkt% Les � �f
cal
51
(IBe-)
(01 c2A(\3 1SW 70QkV1F—rAnJ tiT rvn
CHECK BOX AS APPLICABLE, C+CC�K_6O%AS APPUCABLE. CS` 3-of3
0
[SOIL EVALUATION Scale: (SYSTEM PAGE 2 OF4,
4o sD eD -T" DE -
SITE MAP PLOT PLAN "`
PROJECT NAME tDI DESIGNFLOW: 60 ) OPD
�ArKi-4+8y Gr N - Attach design flow calculations for commercial plans.
PROAECTAODRESS: Ja SS 53," A.00 Pipe Material I ASTM Sttaandard(Table, 364.30.38384.305)
�\ r Senilary Se r:�---t`_
aM"bol: am V.e A]i�1 iM 'WFT a I r
-� 11' Fords Main:
BM Dnacnlnbn: �}At Inl �lt... P�_
Slope Gradlent %) Ind"W noon M IMPORTANT:
of Tented Area: ( Wed Symod (II appilcaole): O drama an mw Show ground elevation Conlours at suitable Inter ale.
on Ihr approprU One.
G�UA c �53q 76 .#,xnz'
AAfI/'
1.6
4,1 a2 co
0 of Qr -
I
�t'I
_±.UPS'^_\tl-
4tpic
W
Ar
VA
r�ic)t'
L 7 ,?
�zs fAll
LIL L'
- �cIrnOPY
DIVISION OF INDUSTRY SERVICES
2331 SAN LUIS PL
GREEN SAY 54304-5211
Contact Through Relay
http://dsps.wi.gov/programsAndustry4gervices
www.vAs nsin.gov
Tony Evers - Governor
Dawn Crim - Secretary
April 9, 2020
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 2022-04-09
Plan Review: PWTS-042000474-C
LEWIS C BJORK
E7818 County Rd E
Menomonie WI 54751
SITE: Tamera Gibson
3255 53rd Ave Knapp WI
Town of Cady
Saint Croix County
Total Amount: $250.00
Pressure Distribution Component Manual — Ver. 2.0,
SBD-10706-p (N.01/01, R 10112)
Mound Component Manual — Ver. 2.0, SBD-10691-P
(N.01/01, R 10/12)
Description: 600 GPD /4 Bedrooms —New Construction)
Maintenance Required
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 a.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)(o)
• Well setbacks to meet chs. NR 811 & 812
• Tank Installation to follow all manufacture's recommendations.
• Verify property line(s) prior to installation.
• Pump Floats to be set 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
constructionlmstallation/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 stats 101. 12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any
others who are responsible for the installation, operation or maintenance of the POWTS.
Thanks,
POWTS Plan Reviewer— Wastewater Specialist
Department of Safety & Professional Services I Division of Industry Services
email: hm.vanderleest,¢wisconsin.aov
Cell: 608-516-6134
PAGE 1 OF 6
Mound Plan
Index & Cover Sheet
Component Manual Design References:
Version 2.0, SBD-10691-P (N.01/01, R. 10/12) & Version 2.0, SBD-10706-P (N.01101, R. 10/12)
Pg 1 of 6
Pg2of6
Pg3of6
Pg4of6
Pg5of6
Pg6of6
index & Cover Page
Plot Plan
Mound Cross -Section & Plan View
Distribution Network Specifications
Pump Tank Specifications
Management Plan
Attachments: Enclosures:
Pump Curve POWTS Application for Review
Tank (s) information Soil Evaluation Report & Site Map
Effluent filter information Appliction for sanitary permit
Materials to load list si. COLO,*, _rAni V A9 pt "n -A-
Project Name / Description
-M
Owner Name(s):
Phone:
Owner Address: _1 S2 5 3mA AJe V�NApQv Y Zip:
Project Address:
Govt. Lot: _5A114 of SE_ 114, Section Cd T _ N-R ice.. E ❑ or W
Township: OA county: `st- C X
Project Parcel ID #: QC�4j - 1 0C) �L Q 2 U G
Designer Information
Designer Name: Lewis Bjork Phone: 715 -231 -7375
Designer Address: E7818 County E Menomonie WI
E-mail: lewisbjork@yahoo.com
License Number: DSPS 253976 WDNR 82247
Remarks:
Zip: 54751
Signature: I Date:
Onglnal signature required m each Jbm6ted copy.
SLol r-2p�N1 ISW
SOIL
CHECK BOX" APPLICABLE.
EVALUATION
Scab: "-4V
ECK eo% AS APPUCABLE. CT a i`I -S
PAGE 2 OF4
[ SYSTEM
SITE NIAP
D
PLOT PLAN
PROJECT NAME:
1O'
DESIGN FIOw. GPD
.ram'
1 �yyL
r^'�6w
i�P1 G*
Attach design flow calculations for ammercial plane.
PROJECT ADORESS: 'S"?SS 53.- &jr
Pipe Material /ASTM SIandard(Tables 384.30.383&4.3a5)
BM armed:
{{ /
BM EIn. �ALI W FT
N- -
SeMuSewer:�_/ �tJn40 YJuL
ry
t'
Force Maln:
BM Dg,wdplbn:
I�{AL `� M�1 CL.. fCsk_
/
Slope Gradlern(%i
a TesAed Area:
/ WeII mod Na 7Ce^le):
Sy ( pa O
Indkaw roneM
owlell am
IMPORTANT:
Show gfeuoJ elevation COnbura Msultatle i lwvals.
_(G�
on 14 awopole ke.
/
O.T # 2534 76
A�
ti
4n I
f �e� k� tiff
911
sEr Rev- k-xity F_ Wit- Na} sbww -7106
-4iP�
u
V)
a
OS' TO 2S WASHED AGGREGATE
(coin- Ur beneath dintr6utlon pipe - mit2A•
Dyer dimaAaon pipe and covered van
appoved wlntwdc %W)
Ej AST►f C-33 SAND FILL
SINGLE -CELL
MOUND DISPERSAL AREA
D=It
E= ft
System Elevation = it
q3.5
1-/ lateral Invert Elevation = 1 / It
nit 0.5 it -
�
T g F CROSS SECTION VIEW
p (No Scale)
Surface Cordour% Elevation = ft si , �oax6 i,4T
frh 1-0 ft
(Snow force mein manifold- and Wsh valve locations on plan view-) 7 = 1 4;7 t `3 t 8 Z g/3 X PLAN VIEW
L = I.r,( I A-) A-Ii."7 . R + Ile (No Scale)
r.72
lc
W=
Eb
PVC Lateral j If It
iNvt�
r----_-`�(tYP��------------------ ----- " -•'
i
L— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — ---------_-
B=-7S-ft
I=�2r1 ft K ' ft
�3— ihpr�l
I Ioyg
ProhDit d'usNbance and vehicular h- N
within 15 feet of downslope toe.
Rss�t Pays �
:F ::�-I4f,ig+.5%39.&
?V - 0(1�,
DISTRIBUTION NE N ORK SPECIFICATIONS
Scal
FWSH VALVE DETAIL
(No Scale)
OnTce in Valve Box S = R
Cents of Threaded Cap (insulation optioned) /
for Mead Testing
Wpk
(Optimal)
airs for
j armless wl as / pr�S
/ \ Lateral Ler o (P) = •_ tt
N�wueorlY �' s ti _�
(dtK�tk1 a) OR b) betoal
a),�d-alwp bo0om dlaleral FlushVaNe
b) Il abrq lop ar mew Asscatay
,M &epytn hole
RYpicat -see dmw
adorn
LATERAL INVERT ELEVATION = 19
wpm)
(Ibex pipes
opts
'0 Sdd 40 /
PVC MWft
'0 Sc d 40
PVC Force Main
(slope 1D pow tart
r for )
Fist OdWe
(typical)
/ Lwtrals to be level S _
Sdtd 40 PVC Lateral 0 =' ` in
wpm) Z s
Nk Tjw of OrOces per Lateral =
slows equa/y spaced
along botbn of lalerei
ttyplcel) orfioe(�Spacft (X)= , in
f)r�ce D;amt»er = 3_JS2._ in
OBSERVATION PIPE DETAIL
(No scale)
Saew-Typeor Glade
Sip cap Qoose) " (mWdted 6 seeded)
4-0 PVC Pipe v Topsoil cover
Tap orf�ipe ID blaaWa (min.tfoot)
at o above l d*W Bade
(4)17
x6'Slots
Andnaltq Device
Odbce DischaW Rate = 166 gpm
Number of Laterals = 2
Lateral Obdnarge Rate = 166 gpm
TOTAL DISCHARGE RATE = 3-S GPM
(Mk* Fiat Odke
END MANIFOLD
CONNECTION
Check
applicable box. ► e Old U
Fiat OAoe (deer Pipe ptlattal) D
4YPIc+l) an �
CENTER MANIFOLD -n
�'�ofd CONNECTION W
(soar pee )
G'f t
SEPTIC / PUMP TANK SPECIFICATIONS
(No Scale)
IMPORTANT: N Va"1 c;eP
Anchor tank(s) as necessary
pursuant to SPS 383.43(8)(g)
FlMehed f71ede
CAPACITIES @ 2� gaNn
PAGE
Depth (in)
Volume (gal)
A
9
OU. 3 Z
2.0
qy�
��B++
[l.i]
S
I (
4D
o
(�,,
s.
4
A
*Pump Tank Liquid Level =i In Pump
50F6
ElacWnl mural omnply vMh
SPS 316 and NEC 300
WeeRntrip,mt einat0 manhole rlaer se necessary.
Junction ao>t
APPnwW Looking Manhole
wilh Warning LSWI Allydted
Mpnq
—Conduit
Es4dlenad Flood EN�atlon
,,�AlNphl seat 25
Own Oleeornea
Force Main Diameter = Z. In
Force Main Length = -30�ft 3• A°MM"d Badd"s �
Cho zI �
Force Main Vold Volume =�g� gal p.nA
[C] Total Dose Volume TDV = I I . ZO gal/dose
(SX total lateral void volume < TDV < 0.2X design flow)
+ (force main drelnbedc volume)
MIN. PUMP DISCHARGE RATE =�-�;3gpm
Joints With
1 or Mln.
Wool
Approved
PUMP -OFF
ELEVATION = 9 I •� ft
INSIDE BOTTOM �
ELEVATION = � ft
Vertical
Head =�=ft
+ Min. Supply Head = 2'S ft
/ + FM Friction Loss =��ft
4 +Fitting Loss" —7s ft
_
"(min. suppy head x 0.3) amem�
= TOTAL DYNAMIC HEAD = I 1 •2 ft
PUMP
TAN
SEPTIC TA:
NK(S)
-K:
Volume =�gal
Total Volume =17eq� gal
Manufacturer.
Manufacturer(s): LjI��l
Pump Manufacturer.
Zoeller
0
-
_Install approved effluent filter at the septic tank outlet
Immediately upstream of the Dump tank inlet.
Pump Model; N152
(See nleMed Pump arve.)
Filter Manufacturer. Orenoo -
ContrPalisades ols/Alarm Manufacturer. SJERombus
Cantrols/Alarm Model:
AB
Filter Model: FT-0822-146
Float switches containing mercury
are prohibited.
Mound Management Plan
IMPORTANT:
rJ
PAGE 6OF6
The owner of this mound system shall be responsible for its perpetual operation and maintenance pursuant to
requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2). Wisc. Admin. Code, this system shall be
considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore,
all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS
383.52 (3), Wisc. Admin. Code.
Maximum Dispersal Area Operating Limits:
Design Flow = t.nM gpd; BODE 5 220 mgL"; TSS 5 150 mgL"'; FOG 5 30 mgL''
Inspection Checklist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors (i.e. odors, user complaints, etc.)
c mechanical malfunction (i.e., pumps, valves, switches, floats, etc.)
c material fatigue (i.e., leaks, breaks, corrosion, etc.)
o solids volume In anaerobic treatment tank(s) and any distribution appurtenance(s) (i,e., distribution / drop boxes)
o neglect or Improper use (i.e., exceeding design capacities, prohibited activities, etc.)
o extend of ponding in distribution cell prior to dosing
o dosing irregularities (i.e., pump re -cycling, float switch settings, etc.)
o electrical components (i,e., wiring. connections, switches, controls, timers, alarms, etc.)
o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification)
o surface discharge of effluent or sewage back-up into structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
o Septic and doom tanklal shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis.
Stets. when the volume of solids In the tank(*) exceeds one-third (113) the liquid volume of the tank(s) or
as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin, Code.
o Effluent U t djl) shall be Inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12
months.
o Distribution laterite shall be flushed once every 3 years or when necessary.
System maintenance reports shall be submitted to the proper local government unit in accordance with
SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to:
Name of individual or company: Lewis Bjork Family Septic Service Phone: 715-231-7375
80
Local government unit: S r.tOI� C�1 �1I� r��� Phone: �'S 38� — (�
Local government unit address: C A �"^ c�HWI T1 0' r'J ZIP:
Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin.
Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383. Wisc, Admin. Code.
No product for chemical or physical restoration of the POWTS may be used unless approved by the department in
accordance with SPS 384, Wisc. Admin. Code,
Continnengy Plan
In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to
a plan submitted to the appropriate agency for review and approval. A failed mound dispersal component may be
re -constructed within the originally approved area after removal of all failed components.
System Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code.
I.)U Series Lttluent Pumps Loeller Pump Company https://www.wellerpumps.com/en-na/productsisum"Muent-pumpsref..
FLOW PER MINUTE
I of 5 3'6.2018, 8:36 AM
Maintenance Instructions °®
4" Biotube® Effluent Filter
How to Clean Your Effluent Filter
To ensure your effluent filter is functioning properly, it should be inspected every year. Under normal conditions, your
effluent filter will function for several years before cleaning is necessary. The filter should be cleaned when it becomes
clogged enough to restrict normal flows out of the septic tank At a minimum, the filter should be cleaned whenever the tank
is pumped.
Most people prefer to have a septic tank service provider take care of filter maintenance and cleaning. You can find a
septic tank service provider in the Yellow Pages, under 'Septic Tanks & Systems' Or you can contact your county health
department for a list.
If you wish to inspect and/or clean your effluent filter yourself, be sure to dress properly. Wear full-length pants and shirt,
shoes, gloves, and goggles or glasses. Then follow these instructions:
I. Remove the access lid to your septic tank by unscrew-
ing the stainless steel lid bolts with hex head wrench
provided. If your lid is above ground, it will be easy to
find. If it is buried below ground, find the marker that
indicates its location.
2. Remove the filter cartridge by grasping the tee handle
and lifting it out of its housing (see photo 1).
3. Spray the cartridge tubes with a hose to remove any
material sticking to them (see photo 2A Ensure the three
orifices in the optional flow modulation plate inside the
filter are clear of any debris. Make sure the rinse water
runs back into the tank, but do not allow solids material
to fall into the open filter housing.
4. Firmly place the cartridge back into the housing.
5. Some effluent filters come with an alarm that activates
when the filter needs cleaning. If you have an alarm,
check to make sure it is working by lifting the float
with a stick An audible ham should sound. The alarm
panel is normally mounted on the side of the house or
in the garage.
NoW If your effluent filter doesn't have an alarm system
and you would like one, call your local septic system
installer.
6. Record the date that you inspected and/or cleaned
your filter on the form that follows. if you checked the
alarm or made any other observations about the tank
or system, include that information under "Notes."
T. Attach access lid by placing it onthe riser, matching
the openings in the lid with the bolt catches. Insert lid
bolts into catches and tighten with hex head wrench
provided.
Photo 1. Remove the filter cartridge by lifting it out of its
housing.
Photo 2 Spray the cartridge tubes with a hose.
M 4 74TI
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Insoection/Maintenance Form
Date installed. Model tank _
Model of filter_ .__ _ _ Single/double compartment
Date Cleaned?
inspected yes no Notes:
Size:
rtant Names and Numbers
System service provider:
System installer:
Septic tank pumper:
Electrician:
Designer:
NIN"R-FT-1
Rea U. 7,91
Pep 4 al 4
Phone:
Phone:
Phone:
Phone:
Phone:
164'
CAST -A -SEAL
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FILTER OR
II BAFFLE
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SIDEVIES
ARE MANUFACTURED TO MEET OP EXCEED ASTM C-1227 REQUIREMENTS
WLP120QY/800-MR
TANK SPECIFICATIONS
DIMENSIONS:
WALL 3'
BOTTOM: 3"
COVER: 6"
MANHOLE: 24" I.D. PRECAST CONCRETE RISER
HEIGHT: 53" O.D.
LENGTH: 154' O.D.
WIDTH: 96" O.D.
4" CAS7-A-SEAL BELOW INLET:41" O.D.
LIQUID LEVEL 36"
*EIGHT: BOTTOM 12.OD0 LBS.
COVER 8.170 LBS.
INLET AND OUTLET:
4" CAST -A -SEAL BOOT OR EQUAL
GASKET. CAST -A -SEAL BOOT OR EQUAL
INLET AND OUTLET BAFFLE AND FILTER:
WSCONSIN. SEE DETAIL #10
(OTHER STATES SEE CHART)
LIQUID CAPACITY: 33.46 GAL/IN (SEPTIC)
22.24 GALAN (PUMP)
LOADING DESIGN: 8' 0" UNSATURATED SOIL
TANK CAN BE USED AS:
SEPTIC/SEPTIC. SEPTIC/PUMP
OR SEPTIC/SIPHON
4" /ENT COVER: MIX DESIGN /B (NO FIBER)
TANK: MIX DESIGN #9 (SMALL FIBER)
OUTLE I
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CUSTOMIZED TANKS:
FOR CUSTOM TANKS CONTACT WESER CONCRETE
FOR APPROVAL
APPROVED BY:
APPROVAL DATE:
PRODUCTS NEEDED BY:
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
OwnerB
Mailing j
Property
City/State Parcel Identification Number O 0 `f — 10 0 ► — 9C) — Io 0
LEGAL DESCRIPTION
Property Location G '/, , Scc. __L, T Z& R) W, Town of CARD i
Subdivision
Wt If
Certified Survey Map # Volume Page #
Warranty Deed # 1 � � (G � (before 2007)Volume Page #
Spec house 13yes0no
Lot lines identifiable[3yos❑no
Lot #
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities arc specified in §SPS. 383.52(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, jotarteyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site
wastewater disposal system is in proper operating condition andrbr (2) after inspection and pumping (if necessary), the septic tank is
less than 1 i3 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 Safety And Professional Services 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 onVare the owner(s) of the
property described above, by virtue of a warraq deed recorded in Register of Deeds Office.
Number of bedrooms ✓//
SIGNAT OF APPLICANT(S) DATE
13
***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. 04/12)
SE. 01 alS�j i SW
CHECK BOX AS APPOCASLS. C ECK BOX AS APPLICABLE. �Sf -3 r I
SOIL EVALUATION Scale; V=40' j SYSTEM PAGE 2 OFI,,
SITE MAP 1 80 LOT PLAN Dr-" t-
PROJECT NAME: fD, OESIGN FLOW: GPD
'T Ii b J Attach design flow calculations for commercial plans.
PROJECT ADDRESS: 3 a S S 53 �' , F' Pipe Material! ASTM 3landard (Tables 384,30-3 S 384.305)
,l r N Sanitary Sewer../ D,)
am Symbd: BM Elevation: uR14 W 1� FT 1• ,. .�
BM Dascnpl M � AA � ✓J piz, 'In., ao4(, Forge Male:
Slope % / d.[;snona ty IMPORTANT:
p i ) Well SymtXfi (II appGpeda} 0 dit ap ro rke a Show ground elevation contours at eatable Intervals.
Of Tested Area: on tla approprib Bic.
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SOIL EVALUATION REPORT Page! of 3
a1 accomanov wnn �m w. rvw. none �
Attach complats sib plan on paper not "a than 6 1R x 11 inches In size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scab or dimensions, north arrow, and location and distance to nearest road.
Please print all Information.
ParaonM iNNmNbn ya pantie may Da wedfor secondary purpose Wftecy Lew, a. 15.04 l tl (m))
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County C `
Parcel I l-(j 1 — % C.
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Property Location
Govt. Lot 1l45� 1/4 S a T N R I (a)
Prope Owner's Mailing Address
a 5S �a.� A0E-
Lot N
Block N
SuDd. Name or CSMN
city Llrj State ip a one-- u r
A Wi 5`I7"I (
sty vissga • Town Nearest Road
CAP`< S3�
New Conehuabn UwE] Resbenhal I Number of bedrooms Code derived design sow rate y OPC
0 Replacement Public or commercial - DoscrLe:
Parent material 1 OV6 DL [.� -4 Flood Plain elevation N applicable
General comment I �1--� )
and recommendations. I Ali MO 9�S.k M p �1 '
Y o�hec�y>�:es ORIGIN i
Soo lion Rate
® Boring M Pit Ground surface elev. 1 / it Depth to limiting factor 1�jftundlly
Horizon
Depth
n.
Dominant Color
Muneell
Redox Description
Qu. Sz Cont. Color
Texture
Structure
Gr Sz Sh,
Consistence
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Horizon
patch
in.
Dominant Cofer
Munsell
Redox Description
Qu. Si. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Cona,abnce
Bouncery,
Rods
GPD/IF
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• Effluent Nt . BOD, > 30: 220 mg,L and TSS -30 � 150 n1k ItMljilrjWe . tdvu <.w mgu ano i oa � .w rrv�
CST Name (Pies" Print - CST Number
Lewis Biork 253976
Address Date Evaluation Conducted Telephone NUmDer
E7818 County E Menomonie W 154751 2jo I"t 715-231.7375
Property Owner G t Y Parcel ID a l.r —j W j— _ ol.40 %
sorrg r 18
11 Pomp it Ground surface ebv. �' S R. Depth to limhinp factor in
Pape _of 3
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Ou. Sz. Conl Color
Texture
Structure
Or. Sz. Sh.
Consistence
Boundary
Rods
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D Boring M R Boring
Bo Ground surface elev. R. Depth !o lknMlrp factor in
Sow ADDiloatbn Rate
Effluent 01 - BOD, > 30 < 220 mili and TSS >30 S 150 mprl - Effluent e2 - BOO, < 30 mp/u and T86 130 mph
The Department of Commerce is an equal opportunity service proeider and employer. If you need assistance to access services or
need material in an ahemate format, please contact the department at 608-266-3151 or TTY 608-264.8777.
SBD,3"1.,lainM
SE 01. ':2 Q,(\; l S W
CHECK BOX AS APPLICABLE.
SOIL EVALUATION
scale: =ao
CkaCKONAS APPUCASLE. 'C .3
SYSTEM PAGE 2 OFFSITE
MAP °
40 60
D�",..
B0LOT PLAN
PROJECT NAME:
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DESIGN FLOW. 1Sp7GPO
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Attach design flow Calculations for commercial plans.
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PROJECT ADDRESS. 3 S S 53 r r F
Pipe Material 1 ASTM Standard (Tables 384,30-3 & 384.30-5)
SM Symbol:
1 r
BM Elepalbn. Qh"S IN 1� FT
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Sanbary Sewer: i j�VL
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Force Mein:
BM Deacrrpe .
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Slo eGraelent(%)
of Taelee Ave:
Well Symbol (It BpplirBbC): O
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. the aPwopata
IMPORTANT:
Show ground elevation Contours at Suitable intervals.
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